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Home My WebLink About2840 SERANG PL - Building Permits a `PSTN NFS �9 CITY OF COSTA MESA t BUILDING DIVISION / • PERMIT NUMBER z" DEVELOPMENT SERVICES DEPARTMENT PERMIT '`a ' . ::o 4 P00-002/2 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2840 SERANG PL Status: ISSUED Suite No Applied: 05/24/2000 Issued: 05/24/2000 Vicinity: -Q'y/� Parcel Nunmber: 13932109 ISSUED BY: Cl / Applicant: LORIE GLOVER Address: 2737 S CRODDY Phone: (714)524-7304 SANTA ANA,CA Zip: 92704 • Owner ZWICK, KENNETH T Address 2840 SERANG PL Phone: COSTA MESA,CA Zip: 92626 �j � Contractor: COAST ROOTER PLUMING HEATING &AIR CONDITIONING / /; 0 Address: 2737 S CRODDY Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 License: 529127 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink.service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 . TOTAL CALCULATED FEES: $35.80 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. to I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My wo rat'c�o-9m�T pen alien Insurancesucarrier and policy number are: ( Carrier: ` - N t-'l • Policy Number: �I O K"3 o y (This section need not be cramp eted if the permit is valued at one hundred dollars(5100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signa�tur ' Date: 3 -at/x=0 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businessp,nd Professions Code,and my license is in full force and effect.Lic. /I-31 Class ft C.,SCO Contractors Signature: 4—_ _. Date: 1–alA d CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044, Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself,p,herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold rithn once year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner oftthe p}roperty^am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Corttr ctors'License Laws.). ❑ I am exempt under sec. 4444Business and Professions Code for this reason: Signature: . .. Date: • Owner ID verified by driver's license.' 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (11"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _..----- t-from ut.... Air Quality_. bje t. . s.... 7 If a ication fhav tae South iscced Management Califomia Healtheat or dother air pollution controln42303 district been agency is requiredsfor the work which is the subject of this application,have all of the disclosures described by and SafetyCode Section made? 0Ves 0 No B attach cote of --- ropri ..._... .. ....... ...... .. -........._. ........---. ........ ........... 8 (If yes attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. f Legal Owner(s) Dat And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE oat JNTRIALE CODE$ INSPECTION TYPE PATE JNTRIAIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical �Y (� 1266 Pool Spa Final 208 Final Plumbing I. `o7 1.] 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 t` CITY OF COSTA MESA pC BUILDING DIVISION > N,., ,,, ,r 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER F t .®1' 'PERMIT *tbitftwegtso`94. 02-01447 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2840 SERANG PL Status: ISSUED Suite: Applied: 09/09/2002 Vicinity: Issued: 09/09/2002 • Parcel Number: 13932109 Zoning: R1 R1 Applicant: BLANKS, JERRY ISSUED BY: Address: 17501 NORWOOD PARK PL Phone: 714-573-0155 TUSTIN,CA Zip: 92780 Owner: ZWICK, KENNETH T Address 2840 SERANG PL Phone: COSTA MESA,CA Zip: 92626 Contractor: PREMIER ROOFING AND BUILDING CO INC Address: 17501 NORWOOD PARK PL Phone: (714)573-0155 TUSTIN,CA Zip: 92780 License: 634404 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL OSB AND 30 YEAR COMP PER MFG SPECS.INCLUDES ATTATCHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,217.00 Permit: $139.25 Claim Valuation: $6,217.00 SMIP Res: $0.62 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.87 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(ero0) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ve and will haintain orkers' pensation insurance,as required by section 3700 of 4 Labor,Code,for the performance of the work for which this permit is Issued. My work pens Insuran carder antl pplicy number are: '( /2/ OJ Cartier: /V{ rPolicy Number: `f ,� (This section need riot be completed ll t e permit/s valued et one hundred dollars(3100)or less.) ❑ I certify that in the pedo ante of the work for ch this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of coif Ifomla,an.a• -,t if I should become subject to the workers'compensation provisions of n 37 of the Labor Code,I shall forthwith corn*with these Pit i i.. y Applicant Signature: �tr Date: 0..-2-- WARNING:FAILURE TO •-E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRI P TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 r', ),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DE LARATION: I hereby affirm that 1 am license. nder provisions of Ch.. r 9(cl$le ttiffl 69ot' )of Division 3 of the Businessed P f ions Code,and my license is in full force and effect.Lie.it i1 / �/ rr, 111 """ Class M Contractors Signature: y Date: 6 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a cMl penalty of not more than five hundred dollars(5500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. _ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I Will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the dMsion. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant Or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3—D0(36.-0;s 0 will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and—Prevention Program for acutely hazardous materiels)? NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _____ ... _._ ___ ._._ ode _ _ _ ...Y 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complietl with? 0 Ves 0 No _...._.__ .._._._ __p __.__.._._ ..__.__ 5 Goes he will the ap sicAOu QualityiManagement amen building occupant any other for the work ontch district the or of this tip—pia-Ion Yeep No for such construction or modification from the South Coast Air Management District or from other air pollution control or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes%attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des'ad property for insp�n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' ��.': • eget Owner(s) n 9 Ole �• Z y/ar And/Or Authorized Applicant Date INSPECTION TYPE PA.11 INTr1ALS cODF( INSPECTION mg PALE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final p 208 Final Plumbing 200 Final Re-Roof /-17-15e.. act4c 210 Final Electrical 201 Final Block/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1 - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION I PERMITNO. TRACT NO. LOT NO. UNIT NO. • • i 21914 '4/01/6'6' - I' I', Project Address yd se4'4.1-7 1I PERMIT x3.. 7/ • / t r U U Applicant's Mailing Address /.5-33•41/, /�/.Li eA,1��/ TYPE OF CONSTRUCTION IJ NEW LJ ADD ALTERATION REPAIR Owner's Name /1 e/J-�////C' /) Phonef"' ' --//I9 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone DESCRIPTION OF WORK/USE OF BLDG. ,l Address ,�AhnF S Main Building: Accessory Building: - • E Z s� Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING e'FOUNDATION LI.STRUCTURAL T Front O MV Address '-� . / J - _ ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Cr), Contractor's Name-716- t9/-/l J)J///r4,6////- WCPhone TX-'.--1 A742 ❑ 'OTHER A • PROJECT DESCRIPTION SQ. FT. - OCCUPANCY C Right N Address(mailing) X3.3 I S L/,l?Jj/J KG �vi v CONSTRUCTION TYPE VALUATION$ S .Left City License No. o ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E 0 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PlanningNotes: s I,. Ql with section 7000) of Division 3 of the Business and Professions Code,Mand • RECEIVED ,` i r�'uQ M my license is in full force aid effect. /7�, / • S License Class Cl 56, License No. / Date _�--241--t tC 5ignaturit/././ -4-4'.-.-.0 1 /"/r'3 C c- PLUMBING , - FEES ' • 'ORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES israereby affirm that I have a certificate of consent to self-insure or a certificate of Workers"Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. c.) 1/r C %� _.r- Automatic Washei_- Transformer 0 15-50 KW I Policy No. �Y-s Company/ /e4VQA7 -/-offis- ' Backf low Irrigation Sewer Ca 0 50'+ KW P • I Construction Pole Sub. • Certif ietl copy is hereby futhe Certt{{fie c�q-- (spied with the city Building Division ,yam+ Bathtubs Sewer Connection i • Cooking Unit ` Meter Duo to 100 amps Date 3- Y-- APplicant'1r/Irt• �C .L7 r+'- 4 -/-o2 - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers .-.- • Solar Collectors Dishwasher - • Meter Dover 100 amps -- • . - - (This section need not be completed if the permit is for one hundred ($100)or - less). Dishwasher • Solar Piping i Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for'which this permit is issued, I - shall not employ any person in any manner so as to become subject to the , Drinking Fountains Solar Tank Fan / Motors 00-1 HP 01%-B • ' Workers' Compensation Laws of California. - ' D ate Signature Floor Drains Swimming Pool w/Spa F.A.U.F 'NOTICE: If,after making this declaration,you should become subject to the _ Inc.Solar 0915 HP ❑16-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or 'this permit shall be deemed revoked. . - Microwave , CONSTRUCTION LENDING AGENCY - Gas Service- Outlets Water Closet • Device Boxes • I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Clv. 'C.) Interceptors / Water Heater - • ',tel o Outlets ' Range 1 Lender's Name - - - - Lender's Address - . Kitchen Sink - " . -• . Water Service - ' — Switches Sign ' OWNER BUILDER DECLARATION I hereby affirm that - am exempt from the Contractor's License-Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or - • 9 P ;Standing Sections -county which requires a permit-to construct,alter,improve,demolish or repair P-Trap - , " LaundryTrays ' , any structure, prior to its issuance, also requires the applicant for such permit - y Generator ❑0;5 KW ❑5-15 KW Trash Compactor ,to file a signed statement that he/she is licensed pursuant to the provisions of Roof-Drains — • the Contractor's License Law (Chapter 9(commencing with Section 7000)'of - Division 3 of the Business and Professions Code) or that he/she is exempta therefrom and the basis for the alleged exemption. Any,violation of Section • . ' - . 7031.5 by' any applicant for a permit subjects the applicant to a civil - — •penalty of not more than five hundred dollars($500). - •- f LL I, as owner of the propertyior my employees with wages as their sole ,Reinspection Fee ' ,I • $15 Issue Fee - $ 3 compensation, will do the work,and the-structure is not intended or offered - Reinspection Fee . I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL • FEES - License Law does not apply to an owner of a property,who builds or improves thereon, and who does such work himself/herself or through his or her own Boiler Hood or, Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not'.intended or offered foryp sale- If, however, the building or improvement is sold within one year of com- ' Canopy ' Type II' 0 Zoning Approved By Date prove the owner will.have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By • Date• prove for the purpose of sale). - Lf/-�r-/�p�— ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat M1 • - tractors to construct the project (Section 7044,Business and Professions code: The Contractor's License Law does-not apply to an owner of property who • Duct-Ventilating - ❑0-100;000 BTU 0100,000 BTU - SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- r _ - _- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. • PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBO'# ' Fire Dampers PLUMBING $.J"a'V� ISSUANCE $ Date • Owner _ Heating System& Ducting Registers �� • PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that have read this application and state that the above • 00.100,000 BTU ❑100 ,000 BTL ELECTRICAL $ GRADING $ • information is correct. I agree to comply with all city and county ordinances - and state laws relating to building construction, and hereby authorize repre- - • PLAN CHECK 50% $ MICROFILM $ , sentatives of ;his city to enter upon the above-mentioned property for inspection tqu posesi X J S-o2,/ /G MECHANICAL $ - TOTAL FEE $ hi DSirivers' ic f.,/ or. (724,4,-„,,,i2 ^ Date Y' Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or SS - p _ ' CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final . • 16. .Rough Electric Wiring 67. "Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing U` 1-11-114 &CO 39. Water Service-Final C'•1 40. Gas Service-Final 41. Solar Domestic-Final 1i 42.'Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System: 45. Sound Attenuation ..�i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date . b-�U ._ //6•.;-- `�Q �n_ � �{/j� Lot 66 ��••�1 1 �l7 /V MAR6 1961 COSTA MESA BUILDING-SAFETY DEPARTMENT U FINANCE DEPT. P. O. BOX 517 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING o-O Y--0 BUILDING ADDRESS i1yr 47 v.r ems* csL . COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. PERMIT NO. OWNER Investors Marine Inc. I -I 2°° MAIL 1600 W..,Oast Highway RECEIjE�D BY DA .,RECEIVEDEVI DD — ATfD ADDRESS ['V" ITj .,-1-(p/ IIIA R 1961 CITY Newport Beach,Cali£. No. 1655 BUILDING �� ADDRESS ARCHITECT Same TEL. �s OR ENGINEER NO. O'D 7'v�rii)COSTA MESA. CALIF NIA ADDRESS FIRE '/ ZONE TYPE Y GROUP CONTRACTOR Mesa Verde Builders, Inc. APPROVED BY DATE • ADDRESS 1653 Mir a T`4-4te ZONING_ t^ CITY Costa Mesa,Cali£. ZONE /Vy1�, )I NO.PLANE BUIOP )_ UI LDINOPGNEW �n i STAT 181269 NO. Ki 9-0395 LEGAL '-C `L G 4 rye DESCRIPTION 1 O`A SIZE 70' x 1201 I NO. OF BLDOS.O OF LOT NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. 40)Il1 APPROVED ALLOWED SETBACK LINE PROM 5W (CENTER LINE ST.) CENTER OF STREET REAR YARD FRONT 6 OFT. /IN. SIDE YARD I LEFT 51-611 I RIGHT 5111 R.SIDE I��'`FT. /6.IN. DESCRIPTION OF WORK J FT. (�J IN. II L.SIDE �/ NEW I X II ALTERATION I II ADDITION I REAR /1�f D FT. IN. APPROV D /j(V(161V(!\ / REPAIR I MOVINGI II DEMOLISH I BY it& DATE3 3--C BUILDING 1600 SCI.Ft.NO. OF 6 1ail SIZE ROOMS STORIES EXTERIOR WALL bltl l.11s ROOF ` g O Qi COVERING stucco I COVERING s ingse t.p-/G 7/ USE OF BUILDING AND WORK TO BE PERFORMED 9 F,/ — Single family residence and garagc CC 77 Model No. 620-B Attached garage 462 Sq. Ft. I HEREBY ACKNOWLIDGE AT I HAVE READ THS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE A0 E IB CO AND ORE TO COM- PLY WITH ALL CITY(ORD( CEO STATE LA J�OULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION �// VALUATION SIGNATURE OR I I: 14� {) CC( PERMIT FEE $ 3 7 N PERMITTEF /I 444 d' 3-a. oe a AUTHORIZED AGENT I $ / PLAN CHECK S / 8e S49 e SS' TOTAL FEE $ e 'ru D 6