HomeMy WebLinkAbout2805 SHANTAR DR - Building Permits IN CITY OF COSTA MESA a
4 9 BUILDING DIVISION
) �i„.,• 4 : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT J E02-00413
(714)754-52730 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2805 SHANTAR DR Status: ISSUED
Suite No Applied: 05/20/2002
Vicinity: REAR OF PROPERTY Issued: 05/20/2002
Parcel Nunmber: 13940235
Applicant: STATTI, PETER ISSUED BY:
Address: 2805 SHANTAR DR
. Phone: 714-556-8290
' ..l. , ::', : ,\,. ,
COSTA MESA,CA Zip: 92626 -
Owner " ADAMS, MICHELLE LEE & HANSEN, MARK VICTOR
Address 2805 SHANTAR DR
Phone: 714-241-7330
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0 - .
• SCOPE OF PERMIT .
ADD SUB PANEL FROM 100 TO 200A. REAR OF S.F.R.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts ,$0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 - up to 100 kva/kw $0.00 0
Switches $0.00 _ 0 - over 100 kva/kw - $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 / 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a , $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over f 00hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $30.50 1 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
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 •
2446-46(6/00)
DECLARATIONS ( l • ; )
WORKERS'COMPENSATION DECLARATION: t
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 performance of the work for which this permit is issued.
My workers compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)is
1 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'
compensatio alifomia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of a Labor Code,I shall forthwith
comply with ese pr si ��v✓
Ice 'Signature: J 5�.�-() (�(��
WARNING:FAILURE TO S RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CRIMINAL PENALTI S 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.a Class k
Contractors Signature: Date:
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: _ _ Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
1 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 properly,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.).
� 2'}'
] - I'ame t and r sec. Business and Professions Code for this reason:
ature:;' 5 -- — =" .5—Zf�^ 0 2
�.`.Zz—_..,
x 1Fes:�l 'rj—q—0 G
Verification of Ownership by(type of docdment,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 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 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 end 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 Califomia 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 en RMPP Is presently required,has Section 25534 of the Califomia 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 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? ❑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 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.
ature si Owner(s) to
IAt1i orautladzed'Applicant" - Bete-'%-
CODER INSPECTION TYPE DATE %MALE CODES INSPECTION TYPE PATE JNTIRALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical _
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical --Sr
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
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS
•
Street Address: . V ' `
J�j0��•�t►Y 7j /+c4..�' AP Number:
1. I (we), I l C1gkjt l."t I . Wl�yf , declare that I am the Owner of Title of the above referenced real property, and that I (we)hereby authorize: ,( p q l
Name: �Y 2-Cr
l I Telephone Number 7 it)
- CS-6 0 � ( (/
Street Address: X o s 5 titan ""r n '7
City: Q054-CA v" c State: CA _ Zip: q2-‘0Le
to obtain permits in my behalf,as owner/builder,for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of 20 ,at , California.
f rjtNeme: t 1 1 1 al YM, ' "r1 U
agf]atlue:
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf
0779-46(rev 11/00)
,�ycV.Lki, .
CITY OF COSTA MESA
F i, BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT P98-00495
J. nit
44
PERMIT PERMIT NUMBER
P
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2805 SHANTAR DR Status: ISSUED
Suite No Applied: 06/22/1998
Issued: 06/22/1998
Vicinity:
Parcel Nunmber: 13940235
Applicant ANDERSON, CLAUDE E TR
Address: 2805 SHANTAR DR -" -__
COSTA MESA,CA _ �'� ?"�
s% � -Zip: - 92626 r �,_ .:\�.
.i alt--- 1 I I I � 7-'��.���
• --r< i : 1 I �V i ���
Owner ANDERSON;CLAUDE E TR --i 'k--I `-' LI v_-//, / \`
Address 2805'SHANTAR'DR\ -- _;-;,�,? - � \\/ \
frA t\COSTA MESA,C���� Zip: 92626 � �\\ �� \�\
%�� c �N\ .
• Contraetor:� \�
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Address:-...t< �� ��� �`"J �,
V , Phone: i I i ��r���(= \>,k\
1�l ''� f .) ) : f�( ,.,yLicense I I ^� ,
NI Address:
I Enif g r`icli +� ` ' j '-'cv.._ �.,t IIx.��/��•\.{S\\/` 4 , �(
/11/4\jjNI (Address: 1,t(./1�h.� �r _...- 7 v�,�ki r :, ; •
V�-_t I�l�/'�-V �/ moi' Phone: �� rr/ - , Th. ��
1I !'f' Pli°{ �' tcenseP n( C"3. fi n1: 'T11 `\ •
t
/
L i. ill �„ ) �•\ SCOPE OF PERMIT ;I '+,I
�� I J,V..i', R/R EXIST(NGWATER-HEATER IN THE GARAGE ,/ ) :;\/1
,.' ,._ y FEE"SUMMARY i - fr • -r 11rt'r'
Vkt,VAMT QTY -'AMTLQTY L._ /rr Yi I /" AMTI� QTY
ISSUE FEE �\`\ $22.00 l Laundry Tub/Washer `$0:00-" 0 dump Pump/j// 1-,---.Z.---�$0.00 0
Backflow,irrigation \ \$0.00 0 1 Landscape Irrigation $0.00 0 Swimming,Pool t. , $0.00 0
Backflow Preventer/ $0:00 0 P-Trap - 4 $0.00 0 Trap Primer/ „ ,$0 00 0
Bathtub A1������ $0 00�;� 0 Pressure Regulator )�'5,") ..\40.00 0 Urinal 5j// /40.00 0
Clarifier System h $090'k',. 0 Process Piping(per 10ft):,'G$000, 0 Vacuum;Brkr Bkflow(1-4)74$0.00 0
Connect(Ice,SOda etc) < ti$0.00k\0 Receptors( ' ,4 t i,1 [$0 00.> 0 Vacuum'Brkr Bkflow(5+),'P $0.00 0
Dental Units \�� ` $0.00'0\5 ,. -r'Septic Tank`'' , ;'`/C$0 00?n,0At , Wash"Basin " /1/ $0 00 0
Dishwasher v�.,' $0.00^, '0� Sewer Caprfor Demo 5�q�.$0.00 LA0 `, Wash BasinSet /if, $0.00 0
Drain,Floor $0A0 ' /0 Sewer Conned o, v i llgt$0 00)�frov" ' Waste and'Vent System $0.00 0
Drain,Rainwater A'._, $0.00 //0V '- :,Sewer PrivateLin -V ir_,sL$000=,- 05"- Water Closet(Toilet)/ $0.00 0
Drain, Roof '' ' $0.00 /<0�jw 'Shower› cC.., -t $0"00- >0,.-'' < ( Water-Heater/vent $11.00 1
Drinking Fountain .$0.00 \.0\// '7 r�Sink bar::-..---------- = $0.00-- 0 \\ Water�Piping((Inst or Rep.) $0.00 0
Expansion Tank $0.00 .,`0 . //, LSink,commercial $0.00. 0�-�\ ' Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00.��._0„, f\ Sink;Floor; , ;140,00 L.::4- 0' Water.Service $0.00 0
Gas(1-4 outlets) $0.00 '-'•.-'0;,‘ "Sink,' -1 r=,1 rkitchen ,$0.00,, 0 ,-' Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 s >`z-Sink, service/mop \ ;-x :$0.00'' 0 j.�!';OTHER $0.00
Gas Repipe $0.00 0 -,'Spa7(private), 5 s ,,,,,t,A$0.00 ,;0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public_)-..:----.:--_,t...y, ,$0.0_0 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 •
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 performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is 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.
Applicant Signature: Date:
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 OCLL1RE(S1c0,00o),IN ADDmON 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.tic.# Class#
Contractor's Signature: Date:
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:My 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 S 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.My violation of Section 7031.5 by any applicant for a permit
su facts 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: .��•�e-- F or r-c a-ter,--- Date: 06/0-2/?q
Owner ID verified by driver's license. ❑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 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 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 end filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Are Department.
4 It an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied 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 appemit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 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 California Health and Safety Cale).
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 Cade Section 42303 been made? 0 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 COMPIJANCE'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.s.I agree nottooccupy or allow occupancy of any building authorized by this permit until final Inspection.
Signature 01-Legal Owner(s) D to
rid A,,,,�_-- h_deep FGaat
COLE INSPECTION TYPE Dam IIIIIDB$ GgQEU URPFCnoN TYPE DEE gL:MIAI$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final - '208 Final Plumbing • ' '' 7I i/9
8
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
, CONSTRUCTION AND PLANNING . . . POOL &SPA •
_
APPROVALS Permit# :Date Inspector' APPROVALS Permit#_
Date Inspector
c ,
1:Temporary Electrical Service or Pole , 52. Pool & Equipment Location , '
2. Soil Pipe_Undrgrnd. ' , 53. Steel Reinforcement ,
3. Electrical Conduit Utility-Undrgrnd. 4. • 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 pi
' 7. Footings 58. Electrical Conduit-Undrgrnd.
5--,),
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 Drains64. 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 •
•n
25. Roof SheathingC • , (� 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 �.�,�n
35. Final Gas Pipe-Test - (ti.YW
36. Hood or Canopy !/ "
00•--0ND�r Ort! Oleic- /7oth0,t
37. Final Factory Fireplace • CA . •q`•,1din
• 38. Final Plumbing -
39. Water Service-Final -
40. Gas Service-Final ' 1 • • -
41. Solar Domestic-Final - • - -
42. Backflow Preventer - • ' •
-
•43. Backf low Irrigation .. .
• :44. .Landscape Irrigation System -
45. Sound Attenuation -
46. Handicap Regulations ' j •
47. FINAL STRUCTURE & BUILDING . .'�''I39 f�` i ;i
.. 48. Special Requirements Completed -f r/U i •
•
-
' 49. 'Electric Release to Edison - • ` ' -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date _ - -
1
•
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _
.,.; MESA CONgTR UCTION.PERMIT PERMy7 N0 `•/J/ ' TRACT NO. LOT NO. UNIT NO. -
2- oce 1/7)771/1719° ' ce5M- g.4 LQJC a 7 r 7S . • 28 50 .TL
dress �4- 9052 7%09_%8 6 : - •
Applicanll's Mailing Address /7100✓S : "TYPE OF CONSTRUCTION . LJ NEW ❑,ADD H ALTERATION EPAI R I
•r ❑ CONVERSION 111DEMOLISH ElOTHER n q,p,# •- Zone
Owner's Name C.•l • �C'3^C$ON Phone +; DESCRIPTION OF WORK/USE OF BLDG. /AbOO/2 Si,4.14-C Kl'-l�l� . i
• Address SAnn (3 ^ S- Main Building: Accessory Building: • Z
Arch/Eng.' e ' ' License No. Z7Ooo-r• ''TYPE OF PERMIT U GRADING 117 FOUNDATION El STRUCTURAL T Front I 0
svi�ia��.e a 1' - - , , . - ❑ TENANT. ❑ ELECTRICAL El PLUMBING El MECHANICAL B a r N
Address ))..�� > Rear , •
Contractor's Name /s--/ -W.YLL, Phones 37 z9.6 ❑ OTHER. •.- _ - . - - A ' - - N
Address(mailing) /4-27 2-7/ //9/tGNDG•i PROJECT DESCRIPTION SQ. FT. �-K 59 • OCCUPANCY• C Right •
G
CON STRUCTION.TYPE VALUATION$ /1/0,,..., as $ Left • R
City License No. O�L"F Or? co
• ZONE GRADING CU.YDS. ACRES' •
, E
LICENSED CONTRACTOR DECLARATION - • - - Ping.,Ref.# Parking Req,/Provided + I
I hereby affirm that I am licensed"under provisions of Charter 9(Commencing ,Y Remarks: t Planning Notes: ' I M
with section 7000) of Division 3 of the Business and Professions Code, and - - - • T
my license is in full force and effect. I • •
de License Class -S G� L' ense N.�"oj!No...-2-7°01=3"5"7 '' • S
Date 1' Signature ).-9 .- 7 "" PLUMBING •
!' FEES ' . • I '
WORKERS' O MPENSATION DECLARATION . 'GtBar Sink ' Showers • ELECTRICAL I FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate a
I C . Workers' Compen7a '25. Insurance, or a certified copy.thereof (Section - — --
N. 00, Lab. C, CA.'c i Backflow Prev'enter - Service Sink
) 91`5tC-8 /'TJ"' r C'�y✓ 1J'ex+'b'r Automatic Washer,
Transformer-.0 1550 KW
olicy No.C�l^s'7i tifc?_Q Company��L%'/i lU E( 'f Backflow Irrigation Sewer CapI -❑ 50+KW
.iry- Certified copy is,hereby furnished. Construction POIe Sub. _
'LJ •
Certified copy Is filed•with'the city Building Di 'Mon. ": i Bathtubs 'Sewer Connection ' - ' Cooking Unit - Meter ❑up to 100 amps .
a Date 7 - Applicant Tr✓•' 'r _ - '
EXEMPTION FROM WORKERS'COMPE SATION bECLARATION r " !,,.• Clarifiers .• - Solar Collectors' Dishwasher• ' r Meter Dever 100 amps ' - '
(This section need not be completed If the permit is for one hundred ($100)or -
less). y- I, Dishwasher a Solar Piping - Dryers ❑Gas ❑Electric ' Sub Panel ' ' t
I certify [hat in the performance of the work for which this permit Is issued 1' - - -- - -
shall not employ any person in any manner so as to become subject to the � ',�; Drinking Fountains Solar Tank Fan, I Motors❑0-1 HP ❑18-8
Workers' Compensation Laws of California. - - - -
—
Date ' ' Signature ' Floor Drains ' Swimming Pool w/Spa ' ` • Ina Solar 09-15 HP,❑16 -15}•
NOTICE:If,after making this declaration, you should become-subject to the •-•— ' - - -- - - -
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, Microwaves
CONSTRUCTION LENDING AGENCY Gas Service! Outlets : Water,Closet Device Boxes ' 1
I hereby affirm'that there.is a construction lending agency for the performance • ' Pole Light• �,
•
of the work for cwhich' this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater ' Outlets I 1 i Range ,
• Lender's Name -
• Lender's Address - - - - - -; Kitchen Sink Water Service' Switches ' -' - Sign j - - T '
OWNER BUILDER DECLARATION
I hereby affirm that-I'am exempt from the Contractor's License Law for the , Lavatories Auto-Wash ' Garbage Disposal Standing Sections i
following reason (Section 7031.5 Business and Professional Code: Any city or u
county which requires-a permit to construct,alter,improve,demolish or repair ' P—Trap Laundry Trays Generator'❑0-5 KW ❑5-15 KW Trash Compactor ,
any structure, prior'to Its issuance, also requires the applicant for such permit P
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains . e
the Contractor's License Law(Chapter 9(commencing with Section 7000)of 1 •
Division 3 of,the Business and Professions'Code) or that he/she Is exempt , - - - - - -" - --
'herefrom and the basis for the alleged exemption. Any violation of Section ' • ,
131.5 by any applicant for a !permit subjects the applicant to a civil ' '
nalty of not more than five hundred dollars ($500). , , , , •
' .J I, as owner of the' property or my employees with wages as their sole Reinspection Fee' I $15 Issue Fee . $ 3 ' - ) -
compensation, will do the work,and the structure if 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 - 1
thereon, and who does such work himself/nerself or through his or her own • • DEVELOPMENT SERVICES REQUIREMENTS: - -
• employees, provided that such improvements are not intended or offered for , Boiler - Hood or Type I 0 I
sale,,lf, however, the,building or Improvement is sold within one year of corn- - Canopy Type II ❑ , .Zoning Approved By - Date
:pletlon, 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).
❑ I, as owner of the property, am exclusively contracting with licensed con- • Duct-Structural Refrigeration System Application Issued By Date
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 ❑100,000 BTU ,• • - SUMWV F FEES • • •
builds or Improves thereon, and who contracts for such projects with a con- �+v17py�y '
tractor(s) license pursuant to the Contractor's License Law). I am awareithat _ BUILDING PERMIT S. --O-D0 SMIP . ' $1' ' J O
fExhaust System 0 Multiple 0 System-Repair/Alteration _ _
proof o their,Worker's Compensation insurance should be provided to me. - - _ �' --PERMIT,
PLAN CHECK ,$, -
❑ I'am exempt antler Section B.& P.C.for this reason Firepl/Fact Bit. ICBO# • Fire Dampers• PLUMBING -$ • - ISSUANCE
Date -Owner - Heating System& Ducting' Registers) - PLAN CHECK - 25% $ - ENERGY P.C. $•
; '
I hereby certify that I have read this application and state that the above ' 00.100,000 BTU 0100,00087 - GRADING $ • ^
information Is correct. I agree to comply with all city and county ordinances- _ , -- - ' •" ' i 'ELECTRICAL $'- _ ,
and state laws relating to building construction,and hereby authorize repre- - PLAN CHECK 50%,.5 - MICROFILM: $--
sentatives of this city-to.enter, on the'above-mentioned property for r - - • - ..���bj• Tq
Inspection purpo es] - / • . MECHANICAL $ TOTAL FEE , $ O2O�SU
Signature a_ I/..44'-r - Date 7-7, b� _ •
Drivers' License oif(55 _ - Reinspection Fee ' •" -$15 - Issue Fee $ 3 PLAN CHECK ' 25% $ •
/�
CMF 0865.46,rev. 10/84 white - Building; Canary + /
- Applicant; Pink -Accounting; Goldenrod - Assessor 1 /
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. '
CITY OF COSTA MESA' C NSTRUCTION PERMIT PER IT NO. TRACT NO. LOT NO. UNIT N6, do TL)
!(j) 94 •
7288 7/23/85. . 5• c
Project Address PP' -a /9 i/7:�47� /✓/ r . I 'I'Z��b I' r I. 1• l i I I -I ��� 11 r: 4 I I - - 1
1 Applicant's Maili/n9z Address %'/i..3' 2.1. L(...e0/A/= .:72/2•9•11).• : TYPE OF CONSTRUCTION ' IJ'NEW U ADD U ALTERATION', L•J REPAIR . ' ar
F v G F!/�t/J/ Phon ❑'CONVERSION '❑ DEMOLISH 0.01-OTHER - l -
Owner's Name �� e 49-e2/44' A.P.#. + '- •
i . -Zone -
-•� _ DESCRIPTION OF WORK/USE OF BLDG. - _
Address �/A/yle ' ' " . . - '. r. �`t rr''''��' ' - 5, Main Building: ' -' Accessory Building: - Z
Arch/Eng. " License No. . - - - TYPE OF PERMIT- LJ GRADING Iry��-I FOUNDATION LJ STRUCTURAL T Front - - , - O
•Address - ❑'TENANT, ❑•ELECTRICAL IICI PLUMBING' Ill MECHANICAL - B Rear. - _ - , i N '
•
I
0-3
Contractor's Nam: / ' -1 / fa. / •;hohe97�--+�5/'7r? ❑ OTHER l A N
PROJECT DESCRIPTION SQ.'FT. ' OCCUPANCY ' • .0 Right O
Address Imailingl/. -3.3 41 /.�@=d/ H.f/A-Ae/M - K ' - •-
_ _, l CONSTRUCTION TYPE VALUATION$ S. Lett 1 R
City License No. - .S 1
I •
ZONE GRADING CU.YDS. ACRES E'
�,' LIC ENSED,CO NT RACTOR DECLARATION - - ping. Ref.# Parking Req./Provided
hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: = -_ i - M i
%\ •with section 7000) of Division 3'of the Business and'Professions Code, and - T
fJ +my license is in full fo e and effect.
•License Class Lic'rise •PI-/ 76-c-7 - I sE. 1
Dat +3/J'Fr' Signatur li% R .f/ - ,/rr: • PLUMBING .- I FEES
•
WORKERS'COMPENSATION DECLARATION - - s
hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers - ELECTRICAL FEES
f Workers' Compensation Insurance, 'or a certified copy thereof (Section Backflow Preventer -_ Service Sink - - -r "__
3800, Lab.-C.- p• .
e ' TV-6gackflow Irrigation Sewer Ca ❑ 504 KW ,•
�] ertified copy1 P Construction Pole Sub. ,
� is hereby furnished.
Da Certified copy is filed with the cit ilding i'visio•- i l • Bathtubs $ewer Connection, Cooking Unit Meter ❑up to 100 amps '
Date 5.--427-.Pr Applica �/"i ��.� N / - - '
EXEMPTION FROM WORKERS'COMPENSATION DEC ARATION Clarifiers Solar Collectors Dishwasher Meter ❑Over 100 amps
(This section need not be completed if the permit is for one hundred ($100)or .. . '
less). • r Dishwasher - Solar Piping - r Dryers ❑Gas ❑Electric Sub Panel• l l
I certify that in the performance of the.work for which this'permit is issued, I 1I
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'/:-8
•
Workers' Compensation Laws of California.
Date- Signature Floor Drains ' Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
!NOTICE:If,after making this declaration, you should become subject to the - -
.Workers'.Compensation-provisions of the Labor Code, you must forthwith Floor Sinks ' Urinal Fixtures •• Microwave
comply with such provisions or this permit shall be deemed revoked: — ' - - - '
-
,CONSTRUCTION LENDING AGENCY - Gas Service ,Outlets • - 1
I hereby affirm that there is a construction lending agency for the performance Water Closet Device Boxes Pole Light,
of the work for-which this permit is issued (Section 3097 Civ. C.) -
•
Lentler's Name____. - - - Interceptors Water Heater' (� Outlets Range ,
Lender's Address - _, - - ( ' Kitchen Sink , l' Water Service , ' - Switches Sign '
OWNERBUILDER DECLARATION- - , - ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' „ Auto-Wash Garbage Disposal ;Standing Sections
• following reason (Section 7031.5 Business and Professional Code: Any city or ' - . •
county which.requires a permit to construct,alter,improve,demolish or repair -t P-Trap - Laundry Trays.- , ••- -- Generator ❑0.5 KW OS-15 KW Trash;Compactor ,
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 Roof_Drains , o - -
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 exempt - - • - - 1
herefrom and the basis for the alleged exemption. Any violation of-Section - • - •
-
'031.5 by'any-applicant for a permit subjects the applicant to a civil - ,
penalty of not more than five hundred dollars($500). $ 3
LJ I, as 'owner of the property or my employees•with wages as their sole ;Reinspection Fee $15 : Issue Fee
Compensation; will do the work,and the structure is not intended or offered Reinspection Fee ! $15 Issue Fee
1 $ 3
for sale (Section 7044, Business•antl.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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Or Type I ❑
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II •❑ Zoning Approved By Date
Canopy
pletlon, the owner will have the burden of proving he/she did not build or im- Duct,-Under Ground. iBuilding ApprovedtBy • ' Date ' (
prove for the purpose of sale). - ,
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System 'Application Issued By IIP to Dat: 22—
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 I ! 00-100,000 BTU ❑100,000 BTU SUMMARY OFFEES • , '
builds or improves thereon,and who contracts for such projects with a con- •
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
'0 I am exempt under Section - B.&P.'C.for this reason Firepl/Fact.Bit. ICBG 4— ' Fire Dampers i $ ••s1 ,^, ,,11 PSS
ISSUANCE : 4
. - PLUMBING S•CY$1 t. ' P'"'
Date - •I Owner •- Heating System& Ducting Registers •
PLAN CHECK 25% $ • ENERGY P.C. $ I
•I hereby certify that I'have read this application and state that the above - ❑0.100,000 BTU 0100,000 BTL • - ELECTRICAL GRADING $ I I
information is correct. I agree to comply with ali•city and county ordinances - - - - - - $ ( , ,
'and state,laws relating to building construction, and hereby authorize repre- . + 1 I + PLAN CHECK 50% $ ' MICROFILM $ I
sentatives of this city to a ter yyypppon the above-mentioned property for l - I 1
inspection u�Qoses: {[ _ MECHANICAL +
Signature /�•A.Q _G
,
' - I ,- - . . . . . .. .._ - S. -- -
CMF 0865.46,rev:10/84"- White - Building;'Canary -Applicant; Pink -Accounting; Goldenrod - Assessor "" '
CONSTRUCTION AND PLANNING r ' • POOL.&SPA - - _
'Date, : Inspector. APPROVAL ' Date Inspector
APPROVALS .. Permit# - APPROVALS • 'Permit# - • -
••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., Elecvical Bonding -
, 5.'Steel Reinforcement - - - 56. Rough.Plumbing & Pressure Test - .
•
• --.6.,i Electrical UFER Grnd. 57. APPROVAL TO.COVER-GUNITE - -
^•7. Footings - ' - , 58. Electrical Conduit-Undrgrnd. - -
8. Foundation - - - 59.Gas Pipe, O-Undrgrnd., Test _ •• . •
_.9.,.Water Pipe:Undrgrnd. - �• . ' , . 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System - - 61. APPROVAL TO DECK • - "
X11. 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 1
15: Rough Electrical-Conduit - 66. Solar System-Final
16' Rough Electric Wiring . 67. Fencing,& Access Approval - .
` 17: Rough Wiring,Sign . . - 68. APPROVED FOR PLASTERING
18.1 Rough Electrical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL
19' Rough Heating & Air-Conditioning : - FIRE_DEPT: REQUIREMENT - -
i
- . 20. Rough Factory Fireplace i 'APPROVALS Permit# -
•
21: Ducts, in Structure 70. Underground Hydro '
22.' Ducts;Ventilating •
71. Product-Piping 0 Gas 0 Oil • .
23.,Gas Pipe-Rough & Test • 72. Underground Flush _
24: Roof Framing ' _ . • 73. Undergrnd.Storage Tank 0 Gas O 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 ElectricNotes: • -
34. Final Heating& Air Conditioning - -
35. Final Gas Pipe-Test - . . . . -
36. Hood or Canopy - •' : - -'. - _ :`
37. Final Factory Fireplace - • - - _ •
38. Final Plumbing 7friet Gr'7J9- ,
39. Water Service-Final - -,
40. Gas Service-Final I - •
i
41. Solar Domestic-Final - -- - . •' - • .
42. Backflow Preventer r - _-- _ -
43. Backflov3 Irrigation - - . , ' - t
44. ,Landscape Irrigation System - •
:('
45. Sound_Attenuation , 1 • - - 1' _ r
46. Handicap Regulations r , ; -
47. FINAL STRUCTURE & BUI LDI NG '. - - I I • ,
48. Special Requirements Completed . ' - 1 . •
49. Electric Release to:Edison ' ' ''I '-- - -1 - , v
50. Gas Release to Southern California Gas Co • ' I r 1 '
I
'51. CERTIFICATE OF-OCCUPANCY - - . -- • - -- -- - • '
No. ' - Date -- I__!
PROJECT ADDRESS: 2805 SHANTAR DR 0NIT` CITY OF COSTA MESA - BUILDING PERMIT PERM NO• P051463
OWNEWS NAME! ANDERSON, CLAUDE E TR • - r '•
ADDRESS: 2805 SHANTAR DR PERMIT NO: P 051463 PLAN CHECK NO:' - N • GOVT: N SUPP: N
COSTA MESA,CA 92626 • - •
• CONSTRUCTION TYPE; V-N PERMIT TYPE: PLU ' PURPOSE: OT.H
549-2194
ARCHIEN EREG.ND.: JOB DESCRIPTION : CHANGE OUT, INSTALL WATER. HEATER SQFT;
ADDRESS: UNIT: •
PERMITTEE: CLAIM VALUE: - CALC-VALUE: • GROUP OCC; R-3 /
ADDRTEE: EARLS PLUMBING ( 714 ) 772-3470 :
7533 W. LINCOLN •
COMMENTS: INSTALL WATER HEATER
ANANHEIM CA 92801 **************•********************* ***********+E>Fxx>Ex*14**** ********r: -. . ..>E**>Exx>4
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect, ' SETBACKS T B A C K S
CITY LIC.: 005938 STATELIC.:217657 CLASS: C-36 - '
Date: Signature: MAIN BUILDING ----- ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: t 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 a certified copy thereof(Section 3800,Lab.C), LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT:' FT IN
POLICY NO.: 04840 EXP.DATE: 03/01 /92
COMPANY: BEAVER PARKING RE • PROV: PARCEL; 13940235 ZNE: REF NO':
❑ Certified copy is hereby furnished. i1 Certified top 0.w' icy i ;vision. )� PLANNING NOTES>
•
Ate! � et 1—�1 ADDlican *AC******i!****aF3%** **********N•***X•** **5434******Y:********************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: This section need not be completed if the permit is for one hundred(S100)or less). DEVELOPMENT S E R V I C E S J• REQUIREMENTS
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
;)ATE;
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. Cif CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; A/p) 7//
which this permit is issued(Section 3097,Civ.C). **.*-.x-***36.,v,..x.,x.**..****)F4*4*.• • • • • . !----- ,: .% ,- -` ` • •.*.y.7e.{r.DXE.**f(•* �. • - - - lS4r 3F
LENDER: ******5454*********************54****54*5454*******it *****************1F1(.********M##-
ADDRESS: LEGALIZATION;N F E E SUMMA STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractors'State License Law for the following reasonBLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SM I P/RES GRADING
(Section 7031,5 structure.
tc Business io and its issuance, Code: Any city county which requires m a permit to construct,alter, atimprove,demolish,cor PERMIT 2 0
repairurany sthecprov.polo(to issuance,also requires the wapplicant for such menci to fileta signedtionstatement Di that fhe/shet ie ness f25% SM I P/NON—RES
andsProfsthe provisions of h /sher is exemptState
refrom and(Chapter 9oromalleged with Section i ani Businessofnetithe1
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any 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 3 . 00 .
I. as owner of the properly or my employees with wages as their sole compensation: wit do the work, and the BUILD INGD 1V > PERMIT ISSUE PLAN-CHECK TOTAL' PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 00 3. 00 , 0. 00 5 .00. 5 . 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 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: 5 . 00 OVER/SHORT: , 00 •
for purpose of salel. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-Cgr,C.K
rI,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business' . 5 . 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 acontractor(s)license pursuant to the Contractors'State License Law).I am aware * y******SE.x.*..1F5(-5(.***54**.**y.*.{4**5c x.5F*5c**.***.*1E**ai-****5(.56*'p**54***i(.Y..***************k
* *,.y,**
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
•
o I am exempt under Section: B.8 P.C.
for this reason: • TYPE QTY DESCRIPTIO N UNIT COST . TOTAL COST
•
Dale: owner. PLU 1 WATER HEATER AND/OR VENT 2 . 00 7
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 O 0
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 - ,
permit for construction or modification Irom the Air Duality Management District.Residential construction applications are exempt from •
these provisions.
Date: . `—\ `— `\ Applicanl✓� �� '
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to budding construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes-
Date x'\—\�-:'S� Signawre: ►+....011• 01 00055757-00085757 . TOT 5.0{)
DATE: 04/25/91 TI t[: 13:08
Driver's License or Social Security a: •
V/ '
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor-
CONSTRUCTION AND PLANNING POOL . A
'- Date Inspector Date Inspector
, APPROVALS Permit# - APPROVALS Permit #
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 UF ER 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 t - - ,
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap J 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 O'Gas ❑Oil
23. 'Gas Pipe-Rough & Test _ 72. Underground Flush-- -
24. Roof Framing - - 73. 'Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing -i 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat - _ - : 75. Dry Chemical • - •
27. Frame and Flashing. • „ . - 76. Dry Standpipe
28. Lathing& Siding i - } _ • . 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat . , - . y , .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 - , r -c ••
. 36. Hood or Canopy - j
•
37. Final Factory Fireplace iic
i.
38. Final Plumbing 57a4( 6;€2, : ‘ •
1 39. Water Service-Final . '- .'� -
40. Gas Service-Final . •
41. Solar Domestic-Final - . - -
42. Backflow Preventer . • .
43. Backflow Irrigation'
44. Landscape Irrigation System - _ -
45. Sound Attenuation s
46. Handicap Regulations '
47. FINAL STRUCTURE& BUILDING "I -'
48. FINAL PLANNING t ,1
49. Electric Release to Edison . ..i.... ;
. li •
50. Gas Release to Southern California Gas Co ' II ,. .
51. CERTIFICATE OF OCCUPANCY -
No. Date _
EEE _ RECEIVED
17935 (OCT 1 iss2
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
CITY OF
COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING"'Jfj (� G,f,� �( .�j ,(p/�� BUILDING
ADDRESS dQ O7 / ll 4 7Ftc1ti-A.
COSTA MESA. CALIFORNIA .r}t For Office Use Only
/J��/✓�G• fEr I.f/✓J - Jr `*-21//-� I RECEIPT NO. I PERMIT NO.
Y.I•.�.•C'L�GR •-i%J/.-� /�'F.� /'{I•G rte.•/ � `c1
MAIL //c3 1 bili�j� A RECEIV BY O TE_� VED y' '
ADDRESS
^� ./ �{/'[ ,✓L//'t-(.�/-t- �J,,((�/, } O /7/ L,6'-,II/�d�MM�•` 2 -3/1A 196
g
CITY COr[TT ���� NL. I%!ty/ DRESS /J{ /Ie Cead,z�/tiLe
ARCHITECT RR / /H� zirke.,S44.4 COSTA MESA. VCALIFORNIA
ADDRESS ���/4(`!'1/(�I �'^j�/ �J��,y') /�i FIRE
ZONE TYPE GROUP
CONTRACTOR /�r/(/0.2.07 /4/(/0./ 41 APPROVED DATE Jilt/
ADDRESS /6 S5 44/./Wtea ZONING
ZONA NO.OF USE OF NEW:. 4./&,
CITY ////� //�,, ^/.A`/� '/(` _/ PLANS a BUILDING W/• t/ `
LIC.TNO. g I110 In NO.j�� 40�/ • / LEGAL
DESCRIPTION /3 9 — yo 1._- 3..c
VE
�/) ^ I no I NO. OF BILGE. (( /�///�F
OF LOT NOW ON LOT A.P.NO. A7-�.r d'3 .� �j�I
USE OF r' ;n�7r YARDS VVI_ EVES �YV!!� //
EXISTING BLDG. !/��/L. APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET ✓ '' REAR YARD J/ FRONT 1/7FT. IN.
y�
SIDE YARD ( LEFT FR/ v% I RIGHT ar R.SIDE FT. ____. IN.
DESCRIPTION OF WORKL.SIDE 6 FT. —_ IN:
NEW I XII ALTERATION I II ADDITION I REAR ' 3/ FT. - ! IN..
REPAIR II MOVING I II DEMOLISH BYPROVED - S/1 DATE ��p/F 7-
BUILDING/6
.
BUILDING J6 5-' NO. OF / • G(jq SY�?j�
SIZE ��C.LPy�Jt./C/J) ROOMS / STORIIEES/�/ !
RO
COVERING EXTERIOR W4fj(JKV I* MEDJ/4
ERING j,G)
Ug5-yl�1^L/D(� OR /YJ �T� ,
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT ESTABLISHINGB UNDER V ERMIT IS F N!
PLY WITH ALL CITY OROINANC S AND STATE LAWS REGU TING PURPOSE OF A PERMIT FEE ONLY.
BUILDING CONS ION- A VALUATION
SIGNATURE O ./ 4f.�/) / i PERMIT FEE $ 6o• BO
H
PERMITTEE•• ic,-5C; �� //) ��i/%�J�7 - / OTf7 �O B
G;I �YP; t`c a ���[-(� $ / / PLAN CHECK $ 3 Q. M
AUTHORIZED A _-� 2 O $ 9n. 6'b te
D
TOTAL FEE 0