HomeMy WebLinkAbout1912 SUMBA CIR - Building Permits •
a �� - COSTA MESA
CITY OF
r y' .4 BUILDING DIVISION /-.
tit DEVELOPMENT SERVICES DEPARTMENT
PERMIT P MIT NUMBER
P98-00659
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1912 SUMBA CI Status: ISSUED
Suite No Applied: 08/21/1998
Issued: 08/21/1998
Vicinity:
Parcel Nunmber: - 13943135 - - - - --
Applicant: RICHARD HIGGINBOTTOM
Address: " - -
..":' - :Phone:
Zip: /
Owner QUISENBERRY DAN'RJR _ - -
Address//12208 BUENA VISTA_:-: - '--T'-.' i/
Phone: ; i
/,' LEAWOOD,KS-% Zip: 66209 % AK,/ `'
,,
,-*/-;;
2 4,. ,.��: � .
Contractor: '�' MACK/SERVICES "''
Address:•-.-2 MC'IAREN r - -� i v, '
f,. Phone, 71445743070 714-457-8070 :� '
IRVINE CA -Zip . 92714
. - ;i / _ ,, -License:` 404587 - -�1 �,
ArchlEng: ' I- ._E�,� i
N 1° a . •
Address: -i , �
•: •
�, - License - •
i I
�`'"SCOPE OF PERMIT_"'�'
. , ,• _ -r - - _ _ _/ _ - .7i-
ti -,:water heater replacement., - - ., '`f t • /:
/ r
FEE SUMMARY_
• \: , ` ,AMT QTY AMT QTY I ; - AMT QTY
ISSUE FEE:. - $22.00 Laundry Tub/Washer „ $0.00 0 Sump Pump I ;$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 . 'w a $0.00 0 Trap Primer -'!'$0.00 0
Bathtub i,;,'� ';$0.007/,,k 0 Pressure°Regulator 1,r $0.00„ 0 Urinal ;',l'i$0.00 0
Clarifier System' ' •$0.00N v 0*„ _-m Process-Piping(per 10 ft) - -$0.00=, -0 . .'Vacuum Brkr Bkflow(1-0)'-" ' $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 t i - , $0.00 0 - : Wash:Basin / $0.00 0
Dishwasher $0.00 :0 - .Sewer-Cap'for Demo -$0.00.1 ';0 Wash-Basin-Set/V // $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 ' i $0.00 0 • , Water Closet(Toilet) $0.00 0
Drain,Roof $0.00_, i0 , i - 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: ,., -,x$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
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 S 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.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the pedomrence of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: / Policy Number:
(This sect/on need not be completed it the permit/s valued at one hundred dollars($10b)or less.)
❑ I certify that in the performance of the work f r which ihi .1. t is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws o1 Calif a, a t' j me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply g with mese provisl /�/ /��
S
Applicant Si nature: Date:
`/
WARNING:FAILURE TO SECURE WORSE S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOUARE(5100,000),IN ADDITION TO THE CrIST 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 der. . •sion of Chapter 9(commencing with Seri 7000)of Division 3 of the Business and Professions fie,and my license is in fulV
force and effect.Lic. w d Class# L -3 b
• • Contractors Signature: 7i�2 ne-•••.- / Date: g-p /, see)--
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: Lenders 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 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. - a Yes 0 No Driver's License No. Expires:
Verification of Ownership by,(type'of document,i.e.-property tax bill or deed):
A II .,h d x TPi
DIVISION OF INDUSTRIAL SAFETY PERMITCERTIFICATION: •
❑ 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 structurescaffolding,laisework,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 WIII 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 matenals 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? ❑Yes 0 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 far 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 Califomia Health and Safely Code been fully compiled with? 0 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 apermit 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 Califomia Govemment 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? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
•
'a/ SI. atur: i rtra a ner(s) //�pw�
And/Or Authorized Applicant Date
MEL INSPECTION TYPE DATE INIMELS LOOEI INSPECTION TYPF DATE MEALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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
Applicant to fill In all,spaces except those within heavy border lines and appropriate oedaratwns. _.9(195 5/2Q/83, _ -.-•-.W•0!•--ILOF COSTA MESA —tY' _ . • � -" I' -t"--'• • 1 •
I, 1 ' . _ . PERM IT, O._ TRACT NO LOT,•NO. r BLDG.NO i !
! CQf��TRUCTION PERMIT t ' 1 '• { v u .a /7 h I o I t `.1 4. I t < •• I c _ 3 •• ; t' 1 •c • I l 1 - i
^' • • Pr 7l Of f�'.� r3 , J f I ci f I f ..: i . r 1 i 1 I C I 1 1
•ApplicariYs Mailing Address //31' ,�c ' /1/n/Rs I1g1F.e-4 ' ` %TYPE'OF CONSTRUCTION, - : NEW L i ADD-LI ALTERATION-Lit REPAIR T, � • f r - 1 -, i C j ';, r r ' 'n ,' I.'. '
/t_ Project Address' /_914 'r c//!rrgfrL-1K'. [ . ' } - ❑ CONVERSION _DDEMOL[15H OTHER r ' 1 - '- •� i C, I - -• ' _ i ' ` _ r ' d I .t {w 1 i
Ai
YI C S'Y'.4Q Gs DESCRIPTION OF,WORK • •/i" A t''5 r/ LEA"T n ZONING REGULATIONS' �. +c
Owners Name ��� mC�{�I/Gf'7tT • Phone - r •
:/. `• • I ,•-
/AO Address. ''/7/� 'srl/n/i/' . • r'02.: (I:m .., I - 1 . ` .. /39� Y� r ZONE '�� .: !
a I, - ,- 7 TYPE OF PERMIT- ' ❑ GRADING 'U FOUNDATION El-STRUCTURAL L. A P..*, ! ' _ =. " ;�
Arch/Eng^APieNi9 D-C 'AO/9M c License No.' /0/73 r - �( 7�{ ' I
/, 5-3 �p /� y p p ❑ TENANT tp,ELECTRICAL -rs PLUMBING MECHANICAL 'PING. REF-qp % + '. ` j I '-BUILDING �I 7.r -/env�� (, '
O Address '^ /47 _ •U/CROO/C//VvCST -cG, - ' {.2410 1 - I ':E1 ,OTHER I r'" ' I r • ' 1 y' I ' .. r �CFTRA(�`I(rye ST oAl 7`�1 Y/' .
tl/a C /� �jp %- -/v 1 ' PR LIN -7 '/�., REAR YARD(TO P/L)-•t 'I °' i
1 M(�CCLr</C S/'/! Co. / -. , PROPERTY LINE•dI, /T'r-/C�-n0' •-
Contractor's Name r'/p• ,,,sss��/ /� �Phdone o� 'PROJECT DESCRIPTION' SG:FT OCCUPANCY ' _
• r r�/II )- '.0 ' i •./ diV e� S/b - ?a70� • CONSTRUCTION TYPF -�- VALUATION$ ? ' r LEFT SIDE YARD . ;f/i RIGHTSIDE VAPID: ;>S� t • C r ^
1
N. Address(Mailing/ / ! - • -PKG.SPACE REQ. PROVIDED
Licen•se NO. �I a(� I 1 ZONA ' t GRADING CU.YDS:: • ?ACRES ! 1 "•�
, LICENSED CONTRACTOR DECLARATION -• ; - - i =+-�! — _
FhereD raffllm that 1 t '` Remarks: 1 I 1 STREET WIDTH /C PARK FEE'S I--T4 ,
y am licensed under proNsions of Charter,9(commencing ,
with section 7000) of Division 3r of the Business and Professions Code,and t ' ` - I . ' • • i SPECIAL CONDITIONS: i I -
my,licenseis In fyy�y for a and effeat. , t
-cleanse Class_ t..-2-'..
I . • can= N. Oo2� ' PLUMBING - {• 1 1 f r,
' nate Signature • A4- . /�rir.L •
+.
RKERS'COMPENSATION DEC LA RATIO , _ Bar Sink I • Sewer Cep • t I - ELECTRICAL , _ y
rebyaffirm tha4Lhave a certificate of consent to say-insure of a-certificate -- I -- r _ —....._ _ Automatic Washer-.'....—. -4.. .4_ !Meter Oover_100 rosy_ _ .2.I_ .- • 4
Backflow Preyenter'- Sewer Connection r'
Workers' Compensation Insurance,?or a certified ico DY thereof (Sec on l - - ' F!
I. 3800, Lab. C�.�, o • I ! r I , - Construction Pole ! -f Sub Panel; ' I
Policy No.ld[L•Jlsy9/j�/; Company �L�YA Ow� tIhLS.' ' Backflow Irrigation i 'I Solar_Collectors I X ,
ACertified-copy Is hereby furnished. -I 1 i ! Bathtubs •' ' I Piping - Cooking Unit I Sub Pole , I
Solar Pi in v
i Da Cerv�ifJletl,Sopy is Me' with the.city guitp hg 5,Ioy - • Dishwasher • /Mars OO 1 HP ratl'h$ � � r
/Date 7.. -Y1� ' .APpuwnt LI X42 /�• m//f�I? 2 • Clarifiers _L_. '_. _l 1_, Solar Tank . ._ 3.c/ •
EXEMPTION FROM WORKERS'COMPENSATI DECLARATION I I I Dryers OGas. 0-Electric • 'Inc.Solar 09-15 HP 01615+ I
I Thissection need not be completed If thepermit Is for one hundred($100) , Dishwasher , Swi@taieg.�µw/Spa '. $'
( 0 or 1 •
, less) . I r - - Fan ! i icrowave • 1 1 ' '
' I certify that In Me performance of the work for which this permit is Issued I 1 . . Drinking Fountains I . Urinal i , ; - !
; shorkeot employ any person In any manner so-as to become subject.to tile ' F.A.U. 1 1 P e;,Li i ! I
' Workers'.Compensation Laws of California:' ,, ! • I I. ' Floor Drains i Water Clout j 1 " - 1 ' III I
• Date t ' Signature - ' I _ 7L._�.z. Fixtures ! 1' • 1 I I :;N 1_
' NOTICE:''{,after making this-dedaratien;you should'become subject-to'the--' - Floor Sinks-I-- - -I- "-- #./ - — e. - - -_..
Workers'. Compensation' provisions sof the Labor, Code, you musdforthwith, - Device Boxes ' 1 I. ' -
comply 'with' such .provisions Aor',this-permit shall be ;deemed. revoked.! -� Mater.Service W .1 ! h r i 1 • - !Sign, 1 I 1 ,
; CONSTRUCTION!LENDING AGENCY ^ I 1 , i - •
_ I „ 1
I I hereby affirm that there Ise•construction lending agency,for the.performance- 1 Q I Interceptors - - n I ` ' I C,. ' Outlets ' I Sta mg Sections I 1 l �'�
' of the work for' which this) permit- is issued (Section 3097 Civ C3.- ' '' •� 'Lender's; Nemec"Name•^ I • -r ° ' - - • • -• • i ; ' i "- x Switches I i •i i rash Compactor • I I i I -:
• • Kitchen Sink //
• Lender's' Address; - 1 :z ; •^' , •.' - Cr : , - - 1 - ,L—
' OWNER BUILDER DECLARATION I " I ( I _ c- -1 1 - ; • Garbage Dispo581 j { i 'I
I 'yy' Lavatories,. , 1 -� -- I 4
i I hereby affirm that I am exempt'from thelContia'ctor's,Llcense Law for the P Tra , r Generator 00-5 KW 05- icW • I' ' ! I • I 'I '
- following reason(Section'7031',5 Business and Professional,Code: Any city or .r p, t 1 ❑_ 1: r , I . i j
county which requires a permit to'construct;alter,improve,demolish or repair.' ,, - I ' Transformer 015- 0 I1 i '1
any structure, prior to Its issuance,-also requires the applicant'for such permit ' Roof Drains r — n 1 r I ' I - ' I .
; file a signed statement that he/she is licensed pursuant to theiprovisions of - ., Oso+ KW' 1 i
t y contractor's License Law;(Chapter 9(commencingiwith;Section.7000)of ' , 1' 1 r •• I - ' - C j I ( } IReinspeptien Fee , $75' i
r ♦;ion 3 of the;Business and'Professions Cade) or that'he/she islexempt , - Showers i, el' • l 'i _ - Reinspection'Fee $15 - '
efrom'anti the basis for the alleged exemption Any violation'of Section Meter Dug to 100:amps I Issue Fee I ' — i .$ 3
r.:
�. .
ElO•NS•TR•UCTION ANDIPLANNING . `73:_:;:.."; ✓ . ' '3a-, `2, Vic' POC �
t o ', ,_ a 3 n '' >�Date ' -Inspector t `7•- ` n Date Inspector oPPROVALS Permit,# �E1:ZcS APPROVALS +Permit# . - '4_- " 1
n" 1 Temporary Electrical Service'er4Pole _"▪ 'r.,1`J or -;=.:F.',/ i 152`Pool &.E4uipment Location' t t•=-C , 7i
tP i 1 C CC _ , rI C 1 -- T. Tf CaC I • _ JI!
v_ ? 1 ,i, : pe,Und�9rnd._ ; ; >.�; r. c t .v R:p -> i =63 Steel •Reinforcement - ` =4'- ,- `` _ i. , .,7:772... ! •
zo c L v n- _„
3? Electrical Condwt.Utllity Uridrgrnrl ' � ?^O '. 54 1 Forms': o' • .... � - - -: C. -
S 4' Electrical Condu t Undrgrnd >a• , ' '' 6• 'IV_ .yt s c „ f ,55 Electrical Bonding:' - q fe t 2-�at :
5' Steel Reinforcement)f i '3 - "' ' - ' • ^ ` - •
I J = 56.t Rough Plumbing&..- . . re'Test
67 Electncal.UF'ER Grnd; '
< ' - o '- lir; .3_ , 57" APPROVAL°TO COVER 614;t4E " - I 1 =` 1 w
7. Footingst`1 l.i 1 f4 n o sA I.i, t. a ., s" ...7.3-,,71 I - 58 Electrical,CondultfUndror`od.".._ ..•;‘,4 ;..i.-.HE i -a a
8. Foundation r it T - '�"1 - <_ t F. ' 59 Gas Pipe;D Undrgrnd Test 9; - ^r 3 ` Q'^}°-i '
1 7 IX 1 ._I J.. h3'•�/• - r, - J i •_ c .a. - aQ a � / I`� ` ♦ C
• 9.•WateRPipe=Undrgrnd. ; oii -, _ ▪ -" 1 ".60. IiiackwashtLines, PTrap,'D,lJnd[gind.= - '
10. Structural FlooriSysterti ; i.P`z of *'I ^ . -^ • 1.61. APPPROVAL'TO;DECK z -• _ -' l _ -
77. i ,.. :ty Sewer Line'& House Connection _ -l_ Q' 9' •-62. Backwash & Receptor-Fipal._ .n'i. . :(e`1 3 rC :
12. Sewer. p ;_r i at .i I L :�'_ o _, i. ? 63 HeateIgo/e it Final r. ": - 9.-7. -
13. Roof'Drains ',1 5I -t : `�� f g o , , 64 Plumbing System«Final - • , -
a 14. RoughP,lumbing ":11: -1 1 '..°, ` _ 765. ElectricarFinal' `,- 7 (;;7:1:3:-45-2.:• t:„.4'v
F75:'Rou h'ElectncafCondwt- . . f--- '
g , r „ _ >._ r i 1 1 ! - 1 66Solar SYstem-Final r •, I 1 .1 _ r :+
O.
.i 11016-Ru gh.Elecfric Wiring, ! it - I ' z I a t r tt'I-o { ------1",_ i 767 1 Fenci g;&>Accei's rApproval r `� I( ' e
.1.17:.RoughjWiri4'Sign ; ti tr I " 1 II I r - 1= i � 1 $1 68 iAPP-RO.VED FOR:PLASTERINGG :' ' - ' si ' c 9 "' ^
, 18;.Rough Electrical„T Ba,Ceilingj q I{ I : y- 1 i 1 ,1-? i ' i :
1PROJECTADDRESS: 1912 SUMBA CI UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05111.
OWNER'S NAME: UISENBERRY, DAN I
ADDRESS: UISENBERRY, JANIE . PERMIT NO: B ' 051113 PLAN CHECK. NO: N' GOVT: N SUPP: N
2208 BUENA VISTA
• LEAWOOD,KS 66209 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE ALT
ARCH/ENGINEER: • REG.NO.: JOB DESCRIPTION : -RESHEATH 1 /2 COX', •REROOF W/ASPHALT SHING SQ FT: 8,876
ADDRESS: ' ' UNIT: ,
CLAIM VALUE: . 8, 876 . 00 CALC-VALUE:• 8, 876 . 00 GROUP' OCC: R-3 /M-1
PERMITTEE: GREAT WESTERN ROOFING ( 714 ) 738-584.8 •
ADDRESS: 205 S BERKELY CI COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME. •
FULLERTON CA 92632 ********4*****RE*RE*******SE***HESE ****RETE************************************ir*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I. R E M E N T $
7000)of Division 3 0l the Business and Professions Code,and my license is in lull force and effect.
$ E T B �: C K $
CITY LIC.: 052222 STATE LIC.:3 613 8 C-
•
•
Date, a-2T —�/ / Signatur /6552-21e: MAIN BUILDING ACCESSORY BUILDING --
FT IN DECLARATION: Thereby affirm matlhave acedili to of consent mseu-insure ora certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; • FT IN
Compensation 555 arcg,99[[ crlireg(copy thereof(Section 3800.Lab.0, LEFT: FT IN RGHT: FT IN . LEFT: • FT IN RGHT: FT IN
POLICY NO.: 0 D4tl,794-90 EXP.DATE: 11 /01 /91
±` COMPANY. FUND PARKING REQ: PROV: PARCEL: 13943135 ZNE: REF NO:
->D Certified copy is hereby furnished:p % Certified copy': , e city Building Divisio PLANNING NOTES>
Date; 7..—' '�-i l / Applicant: r/! .s � *********************************************************************if*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need /be completed if the permit is for one hundred($100)or less).. D E V E L O P' M E N T • S ER V ICES R EQUIR E M E N j_T $
r I certify that in the performance of the work Lor which this permit is issued.I shall not employ any person in any manner so as to become t
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY t• DATE: - '
•
Date: Signature: - _ - I - '
NOTICE:U,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.#�( ' 1914-44‘ 71€41‘ 27, DATE• oZ�
which this permit is issued(Section 3097,Civ,C) ********************** * *** *********Bf*•
LENDER: ********************************************* *** ************)**************
ADDRESS: ' •
LEGALIZATION:N F EHE S U M M A •R Y 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 PLUMB ING ' 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 • 10 8 . 00 • . 62
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/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). ISSUE ' FEE , r
l as owner of the property or my employees with wages•as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID •
DUE
E ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> .10 8.6 2 -0. 00 0 . 00 108 .62 108 . 62 • Q 0
sa 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 REVENUE DIVISION TOTALS--> COLLECTED: 108 . 62 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
_for me purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 10 8 . 00 . 62 t
❑ 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).I am aware *******************************************************'***'*' '*'****'*'*** '*'K'******* .
that proof of their Worker's Compensation insurance should be provided to me. ' I N D I V I D U A L' r' F E E B R E A K D O W N
o I am exempt under Section: . B. 8 P.C. r ' r
for this reason'. r TYPE QTY D ,E S C R I P T I O N . UNIT COST TOTAL COST
Date- Owner: SFR 8876 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 8, 876. 00 •
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END2OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a •
- 7
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from r
� 1
(hese provisions. /: • r
Date: Applicant:
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 andstate laws relating to building constructions natives of ' Ity for ter upon the above-mentioned 3 3000 TIO} PIE ICC4 Z +_T I
ro erl for ins ection ur oses. 7� ,yf 0.../2 1t'Li T'jliF: "["u; -
•
Date-2", 12-1•• � 9/ Signature:.v. , _ .
Driver's License or Social Security x: •
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor • ' '
a
CONSTRUCTION AND PLANNING JO. a SPA
APPROVALS Permit# Date- . Inspector APPROVALS Permit # Date Inspector
f :
1. Temporary Electrical Service dr Pole. _. 52. Pool & Equipment Location
1
2. -Soil Pipe-Undrgrnd. •
•• .e : '4 53. Steel Reinforcement
,3.-.Electrical Conduit-Utility 4Undrgrndat - 54. Forms
--14! cIr •
1Eleice! Conduit-Undrgrnd. 55. Electrical Bonding
• 5,:Stee1-Reinforcement; 56. Rough Plumbing & Pressure Test
n18Js�Elecfrical OF ER Grnd. " 57. APPROVAL TO COVER-GUNITE
71 Footings s? 58. Electrical Conduit-Undrgrnd. c
M8!`Foundation r '- w - r 59. Gas Pipe, O Undrgrnd., Test
t r
9.:-Water Pipe-Undrgrnd. r ' j ' • 60. Backwash Lines, P-Trap, O Undrgrnd. I
10. Structural Floor System ;-•, ' � 61. APPROVAL TO DECK !
11. Property SewerLine& Hotse Connection 62. Backwash & Receptor-Final
12. Sewer Cap ;., y j o
-
; I I- 63. Heater & Vent-Final
13. Roof Drains -c• ^ 4 64. Plumbing System - Final ' '
/'
14. Rough Plumbing / ?s - 65. Electrical-Final •'
15. Rough Electrical-Conduit 1 i/' 66. Solar System-Final
-16. Rough Electric-Wiring n i 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 •
r• -a'- t: v.
202rRough Factogy Fireplace ' 'T• r ¢^_ = L =' 2APPRQVAkS' ='CPerm " �it# - '
U.) 4
: 2:• i Sr_ 'JC, t S - : - y c_, ' .J-,
- .
21._Ducts, in StrIuctuie,r. .. .. - , 3. :70. Underground Hydro
22. Ducts, Ventilating. T.; i. =_ IC.): .i.;' 1.71. ProductPtping O*Gas O;Oil
23:-Gas PipetRough&Test z 5 '; a T.. :. is a _,72. Undergroyind Flust% -' [
24:%:Roof Framing 9;= I .-: •n - C, u_; CM b ?73:rUndergrnd:StorageTank OGas-DOiI
25. Roof Sheathing -' z. co - :r; `, ori. r s ' - C -f
.:_n .y 1- f :> nm r 74. Qverhead Hydro- -
26_T-Bar Ceiling (Structural) &.:ivlonocoat 4 to 6 'r.r. r 757Dry Chemical •'- •- C. t .
27:"Frame aid Flashing" :rag _ • - rna›. t: m ILL:Standpipe i_ toY
_28.'Lathing&.Siding-; :;.1.7_:...z r:‹ 5 •• ,- 77R:FIXED SYSTEM FINAL•' c''
:. 7-.:-:
i; ., -1 .i _,
?, •is• ^ j
29. Insulation `, � g1 - - .. - j 1„{.4 .; 78a;FIRE PREY. FINAL .Y.r ^. G: :>.
0-30. Drywall'Nailing ---, . y I >+;'- HEALTH!DEPT:: REQUIREMENT
',31. Plaster Brown Coat;. ` fr
h , r 0, r. i ; }C: ':. r79"FINALINSRECTION :r. ^ .,
, 32.-Electrical PowerMeter-Final; y. co �/. �• _ -r80trFOOD CERTIFICATE ISSUED
s33: Final Electric . - -r j p x 'Noses: : r, - _ U, 01
['34:,Final Heating& Air.Conditioning ( t'- '!- _ r •'-tY.Q'l .,,5 Q 'c' m
35! Firial Ga-s Pipe-Test' - ' I I - * :' Citl: - _64,..."
36. Hood oi'CanoPy_x !- 1 ,T•... : i .//i+- - G <= o- .t''
;-r•r• z ,r ;•,
:37=Final Factory Fireplace,,, • -t °' "' .n % A - '* r'
X38. Final Plumbing CJ + 'ij i-7/AV: _ w
39. Water Service Final ' " -•
,;,40. Gas Service-Final -. . ,z2-. ; / . r .e It - -
•
sA1. Solar Domestic-Finale, • r-' : ,t( ' NI:Ii:` x
`• 42:=Backflow Preventer, fr- j ! E; > 'n; " ' '�
rr
_43. Backflow Iriigatiorr ,r.S= 's.'= ,c.' •• r ._.
•
T44. Landscape laigation System• tic: r A. ,:. _ _f . ;• t,. '- ' : `
'45.-Sound Attenuation ;_ t.• i
`46:Handicap Regulations 1tz
'<7.4r//JAL STRUCTURE& 6UfLDI NG 5.-.'-q1 l,wd ,:'.-,S - ., .._ x
48:1'FINAL PLANNING ;
i> i
I
•
I98 1 6 FEE RECEIVED . .
COSTA MESA BUILDING-SAFETY DEPARTMENT dUN 1 0 1983
' P.O.BOX 917 COSTA MESA,CALIFORNIA
•
' FINANCE DEPT.
For Applicant to Fill In Completely , C'titnipARAF sWERMIT
Tr. 113L1 TYPE OR PRINT Lot c? Ott
BUILDING C) -77(
✓ U �y (/fin / For Office Use Only
ADDRESS I"1 12 '-]..t.�- fill "i `X.11 l.�Q.
RECEIPT NO. PERMIT% I b
COSTA MESA, CALIFORNIA ��uu
RECE DRY 'ATE RECEIVE•, TE SS
IUED
,jyA 1 S 1963
OWNERG`rnVP Perk (Thing t part ran,Int' ir /
`
BUILDING • 1
' MAIL / ADDRESS / / .�'C e� //�, _
ADDRESS 1 f]g3 mi nPrrA T)ri qP.
FIRE11// l
TEL. ZONE TYPE ''{GROUP i-` _
CITY nnCtA MPRa NO•K1 90395 '
. , 'TECT TL. APPROVED
A-
NEERE•G.KaltenbaCh NED.7723361
BY • DATE
ZONING /,/�J(,/a�
Ali ,-�77? Ka tel i n Ave_, Anaheim zo No.OF use of nErn [ �,. -_)_
-'j PLANS Z- I BUILDING 1 L'L
CONTRACTOR MPGA 1ltrAe TIP VPI npnient C • IVI
LEGAL 'T.? V-,3 ( I �, ,f
DESCRIPTION
7-----
ADDRESS i i,53 Mi nnrrsl T)ri VP
CITY Costa Mesa • A.P.NO.
• NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. . - SO"TO SIDE 3 REAR P.L.
LIC.NO. l 81 322 Nog; q-n395
EAVES
SIZE l� NO.OF SLOGS:, ALLOWED- (U.B.C.REQUIREMENT)
OF LOT 1 00 X 100 1 NOW ON LOT
USE OF ' YARDS APPROVED YARDS APPROVED
EXISTING BLDG. -- MAIN BUILDING ACCESSORY BUILDING
(FROM C//l,_HTREET�
SETBACK LINE FROM FRONT l OFT. FT.
CENTER OF STREET 1I 5 I REAR YARD 35 I //J -
FT.
In R.SIDE)(
SIDE YARD LEFT 11 i I RIGHT 1 8 I , FT.
DESCRIPTION OF WORK L.BIDE 9/I FT. FT.
N X ALTERATION ADDITION J REAR .7•� PI'• FT.
_.
DISTANCE BET. BET.MAIN 8
REPAIR MOVING DEMOLISH •
MAIN BLDGS. ACCESS.BLOCS.
ryrypp VAR.# ^ DATE
SZBUIEDING 1721 sq. ROOM86 STORIES 1 C.U.P.# APPROVED
EXTERIOR WALL WOOd ROOF shake (SL APPROVE ).. IA NAA. , •-1"--1
USE ERI BUS CG Q.WO TO
PE R{ED P. BY �, rV�rW Pa DATE �•
USE OF BUILDING AND WORK TO BE PERFORMED
- • - •-• . r1. - • • - - _•
garage.
Plan 1 BR /,,'f3 4SQ.FT.5/fl9/ fid,-x.014, "
b 1�.f/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UN VALUATIO I8 FOR THE I O
AND STATE THAT E ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEB ONLY.
PLY WITH ALL RDINANCEB AND STATE LAWS REGULATING VALUATION'
BUILDING CONS �ON. ///JJJ c - / S 0.Q H
� yAc/ X PERMIT FEE $ (7�, , 3 D
PERM ITTEF OF //Wr-� 9�J�J�� S
.. AUTHORIZED AGENT • �'/ Nati 2
J TOTAL FEE $ 77-