HomeMy WebLinkAbout2860 SERANG PL - Building Permits ' }
..` lb CITY OF COSTA MESA Ill
rt'
r 1, BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
k ' PERMIT
P99-00304
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2860 SERANG PL Status: ISSUED
Suite No Applied: 05/25/1999
Issued: 05/25/1999
Vicinity: pp
Parcel Nunmber: 13932104 ISSUED BY: m
Applicant: GLOVER, LORIE '
Address: -
Phone:
Zip:
Owner: -.'MILLER,�JOSEPH B
Address /2860 SERANG PL
,'ii Phone: -
.i
i COSTA MESA,CA Zip: 92626
w/ `i //,;:-/ , v A'
/ Contractor: . COAST PLUMBING & HEATING
Address: 2737 S.CRODDY . .
SUITE D Phone: 714 241-1414
SANTA ANA CA - - 'Zip: 92704
- r , License: 529127 ,
I - - i
` Arch/Eng: ; •
' . Address:
Phone: - ,
Zip:
License:
SCOPE OF PERMIT . ,
‘ 'WATER HEATER CHANGEOUT. •
FEE SUMMARY
AMT QTYAMT QTY AMT QTY
ISSUE FEE , $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00, 0
Backflow irrigatio . $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 c $0.00 0 Vacuum Brkr Bkflow(5+) $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 $11.00 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: $33.00
COMMENTS/SPECIAL CONDITIONS
dal
dl0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requi emeriti/Lind-or Califo •ia statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92) cfr•
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 day&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
r • J
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.
C 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 workers'o� compensation Insurance carrier and policy number are: NO f ��S
Carder: pit I to -U 1 J Poli Number:
(This sect/6n no hor be completed i/tNe permit/s valued at one hundred dollars($100)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. C
Applicant Signature: Lyy-� �-"� Date: S_da-S /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 Business and Professions Code,and my license is in full
force and effect.Lic.it Class k CJ(P
Contractor's Signature: /t Date: S K--7'
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.E 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 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.).
❑ 1, 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 B,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 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 ❑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 materiels? ❑Yes ❑No
(Section 25533 of the California 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ 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 at 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? 0 Yes 0 No
8 (If yes",attach certificate of complian from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I ce 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 Emissssss333333ions.
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.
egall
Owner(s) Dal 7
And/Or Authorized'Applicant Date
PODEI INSPECTION TYPE '(z'/-PAIL -' 'INTIRAL$ CODE 4 -INSPECTION TYPE PATE INTiTIALS
1616 Fixed System Final Fire Preventions, 206 Final Mechanical t�
1266 Pool Spa Final 208 Final Plumbing 4 a2SI2f ly M
200 Final Re-Roof • 210 ' Final Electrical •
•
•
201 Final BIock/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
2446.46
PROTECT ADDRESS: 2860 SERANG PL UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: M 044936
OWNER'S NAME: FRANCIS MILLER
ADDRESS: SAME PERMIT NO: M 094936PLAN CHECK NO: N GOVT: N SUPP: N . .•
•
CONSTRUCTION TYPE: PERMIT TYPE: MEC ' PURPOSE: OTH
ARCH/ENGINEER: REO.NO.: •
JOB DESCRIPTION : 80000 BTU FAU SQ FT:
ADDRESS: • UNIT: ,
• CLAIM VALUE: CALC-VALUE: GROUP OCC :: - /
PERMITTIE: ALL AMERICAN H & P ( 800) 525-1598 7
D
3022 HESPERIAN WAY • COMMENTS:
- S .A. CA 9270 • **�6*+ *�r**+ekEirfEae******* -+r+r�Larkr*�r+rar*a6�L�r+6�6ar*srsL**Mar***�6****�L**aL*kr**ara6*�E**�Lsr*+r*�6******
LICENSED CONTRACTOR DECLARATION: I hereby affirm t .m licensed under provisions of C pter 9(/com�9lndng with Section ZONING REQUIREMENTS •
CIT0)of Division 3 of the Business STATE 1.1C.:
Professions Code. license' 'n full forceand eff I.• / / S E 'T B A C K S
CITY uc.:0/2 9 9 9 STATE uc.: � f////// ,
Date: ! — / � sgnatur (f / MAIN BUILDING ACCESSORY BUILDING
WORKERS COMPENSATION DECLARATI I hereby affirm that I have a certificate of consent to sef-insure or acerb'ateofWorkers' FRNT: FT IN REAR: FT IN FRNT: • FT. IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3804 Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN -
Iwo'No.:WC5823086 • EXP.DATE: 01 /01 /90 . .
COMPANY: AM, HOME ASSU, PARKING REQ.: PROV: PARCEL: 13932104 ZNE: .REF NO:
•
1 Certified copy is hereby famished. ® rtified co, s 01•• with the (ding Oivisio PLANNING NOES>
>
Date: I _ � S' Appgcant: V _ -. ' *******************************************************************************
EKEMPIION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed d the permit is for one hundred(5100)or less). DEVELOPMENT S E R' Vi I C E S R E Q U I' R E M E N. T S
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. ZONING• APPROVED BY DATE:
Date: Signature: • -- . .
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : . DATE
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. . .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: . .
DATE: 1
which this permit is¢sued(Section 3097,Gilt.C). ************************ slit_ '********** Fit?�F�
UNDER: ' ******************************eE************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
•
DWNERBUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE' SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9 ,00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% SM I P/NON-RES
•
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 70315 by PLAN • ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). - ISSUE FEE • - 15 . 00
I. as owner of the property or my employees with wapaz as their sole compensation, will do the work, and the BUILDING-DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Secton 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> ' 9 . 00 15. 0 0 0 . 00 24 . 00 24 . 00 . 00
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 employees,provided that such Improvements are not intended or offered for sate.If,however the building or '
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 24 . 00 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 24 . 00 ,
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon '
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **********************************************.******.*.******.N.**.**.******..)E*.*.**.**.**
that proof or their Worker's Compensation insurance should be provide0 to me. INDIVIDUAL F E E BREAKDOWN
0 I am exempt under Section: B.8 P.C. • .
for this reason: TYPE QTY DESCRIPTI O N UNIT COST TOTAL COST
Date: Owner MEC 1 INSTALL FORC/AIR FURN <= 100 K BTU/H 9 . 00 9 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and - END OF FEES •
25534 and that I'or any future building occupant Wil/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exam I from ,
these provisions. '
•
Date:• Applicant: • •
I hereby certify that I have read this application and state tha •e,•ove information is correct.I agree to c• ply with all ty and county
ordinances and state laws relating to building con clion a,.here. audio' resentatives of this city to ter u•on th bove-mentioned .. -
property for inspa(�jtl puNfx . r
� •
Date: 'l �� 1 V gnaiu _ • / •
_ r- - - -
Odver's License or social Security it: -
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor •
' CONSTRUCTION AND PLANNING POOL .;PA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole:< - 52. Pool & Equipment Location •
-2.rLSoil Pipe-Undrgrnd. _ 53. Steel Reinforcement
'3.%Electrical Conduif•Utility-Undrgrndr 54. Forms
`.1 4'. Electrical Conduit-Undrgrnd. 55.55. Electrical Bonding •
'71 5. Steel Reinforcement - . 56. Rough Plumbing & Pressure Test
.6. Electrical UFER Grnd. ?
�` 57. APPROVAL TO COVER-GUNITE -
17.. Footings •- 58. Electrical Conduit-Undrgrnd. -
- .
1 8. Foundation . 5: 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 - I 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
,i r,_ -t ;.!. r-FIRE.DEFIT. REQUIREMENT
20:-Rough Factory Fireplace _r• _ ` ,- •APPROVALS' -Permit # •
21: Duta's,in;Structu[e* " •' _' - _. y: 70. Underg oundHydro
22:- -Ducts, Ventilating A. -' -+, - r-.a +: 1'71. Product Piping O Gas 0 Oil
23. Gas:Pi pe,Rough & Test - � ` t ;72, Underground Flush
24.`Roof Framing : r - - y73r.Undergrnd.Storage:Tank OGas ❑Oil
25.. Roof Sheathing •? • 74: Overhead Hydro• -
26:.,T-Bar Ceiling (Structural) & Monocoat fr_,y. - 757,Dry Chemical
27._Frame and Flashing. • - - 1. • 76. Dry Standpipe -
28. Lathing& Siding :. ti " r. , 77,.FIXED SYSTEM FINAL -.
^29. Insulation - r '" 78 ,FIRE PREV. FINAL -
-30. Drywall-Nailing ,� r. t , HEALTH DEPT. REQUIREMENT
231. Plaster Brown'Coatt Sr - ': -79 . FINAL INSPECTION '-
Z32.;Electrical Power Meter Final i u :- 80. FOOD CERTIFICATE ISSUED -
'-33:Final Electric " _ . c, ` C: !• Notes: ', - -
a34:-Final Heating& Air„Conditioning' ,.n 1i/L/aGi • -' - c.:: •
35:Final Gas Pipe-Test .-. `- i ._
_ 'c .. -
_. - it f-t..,
36._Hood or Canopy t 'i- t• -
.
•
-37.•Final Factory Fireplace-. - - e - '"
`-38. Final Plumbing . r' •, ,- ,
*39. Water Service-Final, r - ::: ,,
i;40. Gas Service-Final -t - ' . " -
`41. Solar Domestic Final- ' • _ t• ,• - "
42. Backflow Preventer'~
I. .-
43. Backflow Irrigation: >i - 4, , ': '. a
-. a'-n • r . - •:
;44._ Landscape Irrigatiom;;
n Syster - 4. .i.4: t - ' '
1.45.:Sound -Attenuation = • • -1 .
- 46.'Handicap Regulations " V • _ ^ `
•
a47 'FINAL STRUCTURE & BUILDING F_ I .. 'c -
48FFINALPLANNING, -- ti
;,49.`.Electric Release to Edison } ,-
50.-Gas Release to Southern California Gas Co '. I' x ' ' ' r '
51. CERTIFICATE OF`OCCUPANCY ' '
No. Date
ECT ADDRESS: 2860 SERANG PL /6 UNIT: CITY OF COSTA MESA - •BUILDING PERMIT PERM NO: B 045096 •
OWNER'S NAME: JOSEPH B . MILLER - - •
ADDRESS: SAME AS ABOVE PERMIT NO: B 045096 PLAN CHECK NO: • N GOVT: N SUPP: N
CONSTRUCTION TYPE: 0 PERMIT TYPE: STR PURPOSE: NEW
•
•
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : REROOF-CAL SHAKE 0/SPACE SHEATHING SQ FT: 8, 000
ADDRESS: • - UNIT:
CLAIM VALUE: CALC-VALUE: 8, 000. 00 GROUP OCC: R-3 /
PERMITTEE: JOSEPH ' B . MILLER ( 714 ) 546-0467 '
ADDRESS: 2860 ' SERANG PL COMMENTS:
COSTA MESA CA 92626 ****************************> ************ *****#*###+r#iE#***********************x
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG R EQU I R EMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E T B ACK S '
CITY UC.: STATE UC.: CLASS: i '
Date: •
Signature: MAIN BUILDING ACCESSORY BUILDING"
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT : FT IN REAR: FT IN
Compensation Insurance,or acertified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN ' LEFT: FT IN RGHT: FT IN' '
POLICY NO.: EXP.DATE: •
COMPANY: PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO:
7 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
•
•
Date 1l^�/� h 1 Applicant: vR..�� ##########*########*#*##***#*#####*#*#*##*##*#*******############iE*****###*####
EXEM ON FROM WORKERS'COMPENSATION DECLARATION: ((0 ' dBo need not be completed if de pemtit is for one hundred(5100)or less). D EV EL OPMEN T S ER V IC ES R EQU IR E M E N T S
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. ZONING. APPROVED BY '
DATE:
Date: Signature: , -
NOTICE:If,after making this declaration,you should become subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY : DATE: I
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. �.6j
CONSTRUCTION LENDING AGENCY: hereby affirm that there Is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y : DATE: 'Li u /
which this permit `dt is issued(Section 3097,Civ.C). ************************************************ ************** 'iF*
LENDER: *******##****#*********#*#*************#**#****#*******************************
ADDRESS: • LEGALIZATION:N . - F E E SUMMARY , STRUCTURAL •SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter;improve,demolish,or PERMIT 9 9 , 0 0 '
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed S 6
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500): ISSUE FEE
I as owner of the property . .. ._ . • will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID ' •DUE
® structure is not intended or offered for sale( tion 7044,Business and Professional Code: The Contractors'State License Law TOTALS---->• 99 . 56 0 . 00 i' ' 0 . 00 99 , 56 99 . 56 . 00
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 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED.: 99 . 56 OVER/SHORT: '` 1 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 99 . 00 f 1 . 56
The S 4.
❑ and Professions Code: T e Contractors' tate License Law does not apply to an owner of property who builds or Improves thereon
and whocontractstheir for ker'sCompensawith ansuranctshoince be provided purSuant the Contractors State License Law).lam aware *****#*#**#********#********************.�F****#********#*********#****iE****iE**if{E
that proof of their Worker's Compensation insurance should be to me. INDIVIDUAE F/E E BREAKDOWN l••
o I am exempt under Section: B.8,P.C. 1
for this reason: p M ' 0� 1 TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: /�oZj—II D"nef � �.' '�n' 'o " " "' SFR 8000 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 8, 000 . 00
I do hereby certify that I am aware of and understand the requirements of mia Heal and Safety Code Sections 25505,25533,and
25534 and that I or any future building occupant willwill not(circle one)nee, comply with said state codes and the requirements for a END OF FEES "l'
permit for construction or modification from the Wy Management District.Residential construction applications are exempt from r /'
these-provisions. .
Date: Applicant: v:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county / '
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned . . . ' p
1,,' ,•property for inspection� / purposes. `
Date: /!T.–y — O/ Signature: �!" .
l - /.
Driver's License or Social Security -I.,- ---
•
le4t-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • - •
CONSTRUCTION AND PLANNING POO. .;PA
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
F:.6..-Electrical LIFER Grrid. 57. APPROVAL TO COVER-GUNITE
7, Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation I: 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System I 61. APPROVAL TO DECK ..
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ,
' 12. Sewer Cap 63. Heater & Vent-Final •
-p 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 1
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 - _ x-71. Product Piping O Gas 0 Oil
23. Gas Pipe9Rough & Test ' "72. Underground Flush -
24. Roof Framing _ - . -•73:-: Undergrnd.Storage_Tank 0 Gas 0 Oil
25. Roof Sheathing _ _ a 74. Overhead Hydro_
26.-T-Bar Ceiling (Structural) &-Monocoat - 'y 759.Dry Chemical • -
27. Frame and Flashing ; ` 76. Dry Standpipe '_
-_28. Lathing& Siding ' - c 77r. 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 ' s 80: FOOD CERTIFICATE ISSUED_
-- 33."Final Electric _ - " ' Notes: /,4� s e" _�/
,, ` dC' S�iC K
34. .Final Heating;& Air',:Conditioning ; - , 0,071 de` , /f
35. Final Gas Pipe-Ten •_ scat' -.44,7-Arm ,S. g? .
-36. Hood or Canopy • ',- . - . - -
-.
',L 9
• e.-1A.
(� Zit?
37. Final Factory Fireplace • _ -
.. _ _ ze
38. Final Plumbing i -
•
39. Water Service-Final • _ ✓1: .
•_40. Gas Service-Final ' •• _ I ' - -: -
-41. Solar Domestic-Final - - ._• ' ,- - -
42. Backflow Preventer" .. _ ` x -
43. Backflow Irrigation = r J - .
•
44. Landscape Irrigation System. • -- - ; -- - ;
•
45.. Sound Attenuation - .. • _
46:Handicap Regulations -. / /�. J /'
• 47. FINAL STRUCTURE & BUILDING /,4/( �'sis /J //CI era
•
48._ FINAL PLANNING - Cep
49. Electric-Release to Edison -- -
. 50.Gar Release to Southern California Gas Co ' v _,. , _ •
51. CERTIFICATE OF OCCUPANCY c- -
No. Date
ca,
138179 1- . s/i .=9vrc✓/ % " E�320t�3o1 € r
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
H�Fo/rApplicant to Fill In Completely APPLICATION FOR PERMIT
-!k O C7:,24.TYPE ORPRINT _ O BUILDING
BUILDING [_ n•. I-.1�� `
ADDRESS COSTA MESA. CALIFORNIA For Office Use Only
so . TI RECEIPT NO. PERMIT NO.
OWNER H 2 .C .2 /1 MA la m
MAIL ,I,, RECEIVED BY DATE RECEIVED/ _'DATE'That=
ADDRESS^I(p4'Li AA I MPQ CA Na /� /�Ia/-a0'L / I .41'q•7-6
TCITY C.6 err-A- M r`c,/'C NO•KI 9G '��'7 ADDRESS
�(1 ( J
ARCHITECTL .1 EL COSTA MESA. CALIFORNIA
OR ENGINEER /^I`
ADDRESS FIRE 7 91
1 I 1� ZONE TYPE • A GRO2UP '" ��
CONTRACTOR ME, A ynaR/In�}A=,al -� frit APPROVED C3 ZLDATE %/z - /
ADDRESS I(eC3 MI/UUIal-4 b2' ZONINGy,L-,4,' 4grrcw,
/^ yyy///. ,I _
...E/ NO.OF U88 OP NEW
CITY W ,{.{ I� �%I V t 0c%A /J 2 /} HP O.
IBDILDINO /
STATE I ('/I, �W "1 TEL. Kt -I O 5 �I L' LEGAL I ,Y'✓ // 77P v0 0
LIC.NO. a NO. J DESCRIPTION F?
SIZELOT D c/D K I I DI NO. OF BLae. 0
OF NOW ON LOT A.P.NO. „IA i591't-4
USE OF YARDS EVES
EXISTING BLDG APPROVED ALLOWED
SETBACK LINE FROM L/•�///��) l lit (CENTER LINE ST.) c//
CENTER OP STREET ✓L� REAR YARD ``i FRONT ./ (/ FT. IN.
r lI r 1
SIDE YARD LEFT 47 RIGHT ,/ R.SIDE S FT. IN.
DESCRIPTION OF WORK
L.SIDE 5......FT. IN.
NEW I .?(II ALTERATION I II ADDITION I REAR 30 FT. IN.
REPAIR I U MOVING I II PEMOLISH I BYPROVED0�UL'L' DATE 02'6s -6 /
SBZELDING j D RNO. OF
OOMS l(2 STORIES1 `�'11 I7�
EXTERIOR WALL 4IPini 61 P ROOF 6;HAICC
COVERING ,i iL.CUI COVERING 4.41/Al to L.a'
UQE OF BUILDING AND WORK TO BE PER ORMED ' /,
Q/U O Cof1 l?ACt toe - "
I HEREBY ACKNOWL6 OE THAT I HAVE READ TN APP GTIONjilleilir
HE UNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT TN ABOV IS CO CT 0 RE 0 COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY
/ RDINA CEB AND T LA S ULATINO
BUILDING CONSTR IO . ♦ VALUATION �j �J
SIGNATURE OF L, l 1/ 0• PERMIT FEE $ .J /, 00
PERMITTEF a6�n� / 9 �^ N
$ / J PLAN CHECK $ /a% 'J b
AUTHORIZED AGE TOTAL FEE $ 67�'S O O
n