HomeMy WebLinkAbout266 SIERKS ST - Building Permits - - _ - • - Applicant to fill in all spaces except those within-heavy border lines and sign all appropriate declarations. 4O 1 4 1 2/1 3/84 8.00 1k-
•--. CITY OF COSTA MESA CONSTRUCTION PERMIT - , PERM- ',NO..• �, - TRACT NO. I LOT NO. , UNIT NO. •. - • _ 1 l .
Pro •
ject Address -�. , S i PJ•I� - • -• • •
-
- rw TYPE OF CONSTRUCTION_ LJ NEW• LJ•
ADD LJ ALTERATION U REPAIR - - - - O
Applicant's Mailing Addre • :i Lq u' • U'i s - ,
Owner's Name / r t+-1-• &.t Phone ❑, CONVERSION -❑ DEMOLISH LI OTHER- • _ A p # . .: _ Zone, '
�A/sLt�`� 4�,�,"�'� • • DESCRIPTION.OF-WORK/USE OF BLOC: - I
'\ Address J ^^ - • -' ! _ - - .. , ` . S Main Building: - ' ' Accessory.Building: - Z
,VMr/� •
Arch/Eng.- License No.l - I TVPE,OF PERMIT ' -❑ GRADING.LJ FOUNDATION ❑ STRUCTURA• L T Front • 'O
V' Address l l �A _ pp ' ❑ TENANT• ❑ ELECTRICAL LJ(.PLUM GING ❑ MECHANICAL B Rear - ' ' _ • - N
. 1 Contractor's Nam¢ m[at •PL enss�i n+s' Phone/s•��' L�OCr ' ❑ 'OTHER ' - A - •
•
- I
R5.-. ,I A 2 PROJECT DESCRIPTION' Cl.SFT. ' 'OCCUPANCY C Right _ _ U ;_ N
�. Address(mailing)D ��-s""-'fJk �UM lt4 4.`271y . K- , - - • G
'mss •� CONSTRUCTION TYPE ' VALUATION S Left
City License No. ,/�'1 J� l ZONE - GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided „ • E
LICENSED CONTRACTOR DECLARATION ' a
'.hereby affirm that I am licensed under provisions of Charter.9(commencing ' Remarks:' • ' , Planning Notes:
with section 7000) of Division 3 of the Business and Professions Code, and -
my license is in f II f rce and effect - - I , - T
License Class—!�} � ` ��—L'�pryse No. q K
Date J:2 -`f Signature • /y�ci-�/4' �O cit
�, PLUMBING FEES '
WORKERS'COMPENSATION DECLARATION Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or aa certificate ELECTRICAL I FEES
•of Workers' Compensation Insurance;or a certif' d'copy thereof (Section - - - •Backflow Preventer --Service Sink "- _ -•
3800, Lab. C.)�CS.a`y Ic ' Automatic Washer Transformer ❑ 15,50 KW' -
y No. Company I�CXf�/ • Backf low Irrigation Sewer Ca 0 56+KW
Cl P Construction Pole Sub.
edified copy is hereby with
the city • __ ,
• Cerci clopy s filed with the B ' i Divisio - Bathtubs -Sewer Connection Cooking Unit -'� Meter Dup to 100 amps
ate -�r Applicant - • , -t_ I 1
EXEMPTION.FROM WORKERS'-COMPENSATION DECLARATION Clarifiers , Solar Collectors - Dishwasher Meter Dover 100 amps.
(This section need not be completed if the permit is for one hundred ($100)or - _ ' -
less). l , Dishwasher • Solar Piping - Dryers ❑Gas SElectric Sub Panel ,
I certify that-in the performance of the work for which this permi •Tissued, I - - • '_
shall not employ any person in any manner so as to b e ect to the Drinking Fountains Solar Tank ' - Fan • Motors DO-1 HP I]1%-8 '
Worker o enpti n Laws of Californy'}7'/f /��r'S/�}n - _ ,
Date -b Signature `rte�I'/L.� Floor Drains Swimming Pool w/Spar F.A.U. - Inc.Solar 09-15 HP 016-15+
•NOTICE: If,after making this declaration, you should become subject to the 1 — - - '
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 -Outletsi Water Closet device Boxes , POI¢ Light
I hereby affirm that there is a construction lending agency for�the performance - - n • _
of the ,work for which, $4oermrt,-is•issued (Section 3097 Civ- .C.) Interceptors - _ 4 'Water Heater • Kenratr- • Outlets Range •
Lender's Name C//DDI/��//// I
Lender's Address _ Kitchen Sink - • Water Service; _ Switches Sign
OWNER BUILDER DECLARATION - _ _ •
I hereby affirm that I am exempt from the Contractor's License Law for the . ' Lavatories• - - - '
following reason (Section 7031.5 Business and Professional Code: Any city or - • - Garbage Disposal 'Standing Sections -
county which requires a permit to construct,alter,improve,demolish or repair - j P-Trap - l Generator DO-5 KW D5-15 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 ' - -- - - - -I � ' -
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 ' . _ . I > - -
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 - $'3 i
LJ I,.as owner of the property'or my employees with wages as their sole 1 Reinspection-Fee I $15 Issue Fee - �,• -
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Secion 7044, Business and Professional Code: The Contractor's MECHANICAL FEES laanals
-
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 - • - Hood or Type I. ❑' ,
sale. lf,•however, the building or improvement is sold within one year of com- ' Canopy Type II D' r_ 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
LIrove for the purpose of sale). l
I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural , Refrigeration System Application Issued By ' - Date_l I '
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 . - - __ D0-100,000 BTU 0100,000 BTU SUMMARY OF FEES -
builds or improves thereon,and who'contracts for such projects with a con- ,
tractor(s) license pursuant to the•Contract oris License Law). am aware that. rl BU ILD I NG.PER MIT • $ SMIP $ '
proof of their purse s Compensation insur nce should be provided to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration
J PLAN CHECK . $ 'PERMIT
0 I am exempt under Section /��//' B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ,s,� ISSUANCE• $ ,,
Date Owner ! • - Heating System& Ducting -• PLAN CHECK 25% $ ' - ENERGY P.C. $ '
•
I hereby certify-that I have read this application arid state that the above 0o-i 00,000 BTU 0100,000 BTU - - 7 ELECTRICAL $ GRADING $ -
information is correct..1 agree to,comply wit. .II city and county ordinances -
and state laws relating'to bolding cons r� ,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM , $ !_
sentatives of, this, cit t. nter. u''-, bone-mentioned property for -
' Inspection purposes. /� �/���/�Jv MECHANICAL $ TOTAL FEE ' $ -_,5706 /
Signature �' U Date D.� I ,
._
Drivers' License o S � Reinspection Fee '$15 Issue Fee $ 3 PLAN CHECK 25%• $
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor -t
•. CONSTRUCTION AND PLA NING- ' • - •POOL&SPA.
' APPROVALS Permit#.r .Date Inspector APPROVALS Permit Date Inspector
-4
1. Temporary Electrical Service or Pole, 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . . -
3. ElectricalConduit-Utility-Undrg-rncl. ; - 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 • '
58. Electrical Conduit-Undrgrnd.. -
7. Footings .4 .-,: ,r g _".
8. ,Foundation ": .59. Gas Pipe,'D Undrgrnd.,Test Z f
9..Wster Pipe-Undrgrrid: `r. •-, 60: Backwash Lines, P-Trap,'❑ Undrgrnd. ' •
10. Structural Floor System - -, • . ' 61. APPROVAL TO DECK •
11. Property Sewer Line & House Connection /•� 62. •Backwash & Receptor-Final, - . '
• 12. Sewer Cap F-' - 63. Heater &.Vent-Final - , ., '
13. Roof Drains .• v • -64. Plumbing System - Final' _
+/ "
'14. Rough Plumbing ' •65. Electrical-Final ,
' 15. Rough-Electrical-Conduit - 66. Solar System-Final •
16. hough Electric Wiring - 67. Fencing & Access Approval •- '
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-TBar Ceiling 69. POOL/SPA SYSTEMSFINAL - -
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 ❑Gas ❑Oil
23. Gas Pipe-Rough &Test 72.-Underground Flush
24. Roof Framing - 73.E Undergrnd.Storage Tank' Gas ❑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 f 78.. FIRE PREY. 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 1 • . Notes: ‘02,d.1-GEPr6A20. GOD , ,
. 34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test - ' • •
36. Hood or Canopy - _ -
37. Final Factory Fireplace i - . , •- -
38. Final Plumbing 111-34.5-"C C(J _ -
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final - . .
42. Backflow Preventer. ,
43. Backflow.lrrigatiom. ,.. .. . .• - - . .
44. .Landscape Irrigation System ' - '
45. Sound Attenuation
46. Handicap Regulations ' , - -
47. FINAL STRUCTURE,8( BUILDING ' - • ,
48. Special Requirements Completed - . -
49. Electric Release to Edison - - •
-
•
' 50. Gas Release to Southern California Gas Co . '• ;
51. CERTIFICATE OF OCCUPANCY - _
No. - - Date -
PROJECT ADDRESS: 266 SIERKS ST UNIT: - CITY OF COSTA MESA — BUILDING PERMIT ' • `• : • I E t • "
OWNER'S NAME: BALLANTINE, CYNTHIA A
ADDRESS; 266 SIERKS STPERMIT NO; P 050095 PLAN CHECK NO: - - N • t 1 1 . r : 1
COSTA MESA,CA • 92627 •
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
631-9106
ARCH/ENGINEER: - REG.NO.: JOB DESCRIPTION : REPIPE GAS SYSTEM SQ FT: •
ADDRESS: UNIT: •
•
CLAIM VALUE: CALC—VALUE: r GROUP OCC: R-3 /
PERMITTEE: GILS PLUMBING & LEAK ,DET ( 714 )847-1804 •
OODRES&: 8321 ROLF CIR - COMMENTS: REPIPE GAS SYSTEM - - - • - •
HB • CA 92646 **************************tE+E*tk*tE+E******+E*+t+ESE******************tE****+EtEtE****+t****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: 05g1�9^04 STATE LIC.:44087 CLASS: C '
—'Date://' off ( —g o .SignaWr �/� MAIN BUILDING , ACCESSORY BUILDING ---
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR:
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: _ FT '— IN
Compensation Insurance.or a certrlied copy thereof(Section 3800.Lab. CO -
PCOMY PANY: EXP.DATE: •
CPARKING REQ: PROV; • PARCEL: 42621215 ZNE: • REF NO: -
1 ertir: PLANNING NOTES> '
❑ Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division.
>
Date: � •Applicant: ***********************************************************x-x-x.x x***************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPM .ENT $ 'E R V<1- CESR E Q (] I R E M E N T $
2.
I certify that in the performance of the work far which this permit is issued,I shall not emploWny person in any manner so as to become ,
subject to thethWorkers'Compensation Laws of California. / ) / ZONING APPROVED BY ' . DATE:
—4—vie. Date: /L C�� 9 -/pd - Signature: r�"�•�. L`J{GC 'CC//�/(9 'BUILDING APPROVED BY DATE:
NOTICE:II.after making this declaration,'you should Uecome subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. _ ��
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance of the work for APDL LCAT ION ISSUED BY _ DATE• / Z ,
which this permit is issued(Section 3097.Civ. Cl. *********************** * - � _ — =e�' ****************If* ***** iF **
LENDER: ******************************* ***** ****************.*******************
ADDRESS: LEGALIZATION;N F E E S ' - MMARY STRUCTURAL SEGMENT:N-
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECT" IC MECHANIC F IRE 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 2,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% 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 ISSUE FEE 3.00
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• BUILDING—DIV—> 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 S . OO 5 . 00 • Q 0
•' 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. II,however the building or REVENUE DIVISION TOTALS-->.. COLLECTED: 5. 00 OVER/SHORT
`q„ improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SMIP/TOT GRADING PLAN—• 00
for the purpose ofd CHECK
I.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 ************,*,**,*.*****,**.*.*****,**,*****,**********.***************,********.IF****
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware '**'*'*
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C. -
:for this reason: TYPE QTY D E S C R I P T' I O N UNIT COST TOTAL COST
Date ' Owner: PLU 1 GAS RE—PIPE 2 . 00 2 .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 will/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 exempt from
these provisions. .
t
Date: Applicant: r
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 he y authorize representatives of this city to enter upon the above-mentioned • _ '
property I or inspection purposes.
�'n)
Dale:-4/ — !V Signature: ' .0 - '. dt • C 4 0007514-000 5 t74 �I ( 5.00
Driver's License or Social Security DATE:• 1I/29/90 TIME: '10:46
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor '
'
CONSTRUCTION AND PLANNING • POOL & SPA -
APPROVALS Permit# -' _- Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Ser�ice or Pole 52. Pool& Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
.71•:r` rr- rT .
-3.LElectf Ica I Conduit1,Utility?Undrgrnd. 54. Forms
s4i1.Electrical Conduit;Undrgrnd:'• 4 ) 55. Electrical Bonding -,1
:r
`'1.5,7 Steel`Reinforcement 56. Rough Plumbing & Pressure Test Ii1•
W
Ii7I:.6r�Electrical UFEf2sGrnd. 57. APPROVAL TO COVER-GUNITE u:
c-".e7P•Footings ',F, a_ 58. Electrical Conduit-Undrgrnd. j.
-"-8` Foundation �; --I 1 59. Gas Pipe, 0 Undrgrnd., Test ,.•:� ``
-9. Water Pipe-Und-igrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. I-
10. Structural Flow System l 61. APPROVAL TO DECK
11. Property SewerLine & House Connection I 62. Backwash & Receptor-Final
to C. .I,
12. Sewer Cap y, w. r, 63. Heater & Vent-Final --,
13. Roof Drains ^= ; 64. Plumbing System - Final
14. Rough Plumbing r`" - 65. Electrical-Final /CI
15. Rough Electrical-Conduit t 66. Solar System-Final
16. Rough Electric Wiring _.. 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
�.. . - . . _ U-__UE- 7,. _ _
20 fRo'ugh Factory Fireplace I rrRi •'! -- L : Y'.ic fi APPR_OVALS'DC:Pe i-hit# T'
LC! ;SI t� _. s ' r r.te x 5 ,-I •+• v t: rfr
21..:Dut.t.s, in Structu`ree , .. .. 5 _ . ;70. Underground Hydro
22. Duets, Ventilating ' - _ `r ? t' r71. ProductPripingOGas OiOil
230Gas Pipe Rough &7est isx j V - orei .72. Underground Flush- „ ;:
24"Roof Framing ' -- - : - - ? 7.4;_i it, .i73�Uncle rgrnd.Storage_Tank:^O Gas 0 Oil •
25. Roof Sbeathin '`7 X. ' =t =� •''A '`
g J . •t _ t`7ff . '74-Overhead•HydrO-,- a
26„T-Bar Ceiling (Structural) &:M.on�ocoat : 4 'u3 ii"I �I 75-Dry Chemical 't r- (1
27- Frame and Flashing ' r $.ri ,_,' 76. Dry Standpipe ...--',-.1„.. '`1 t'
J. _ N. 1 - IC 4i: C > te
28. Lathin .& Sidings.* _ -et ri7 r- s > 'x M.
g. g�_ � ^I ^I r 77!7 FIXED SYSTE INAL" t�
-P-29. Insulad&, S .t 78,5 FIRE PREV. FINAL v.... .c 1-1
:-30. Drywall;Nailing S" � ' r1 ^7 : HEALTH DEPT'. REQUIREMENT
31. Plaster Brown Coat: n ..
,�. 4.7' til' i k' ;.79' .' FINAL IPISP,ECTION x Cr r=
'-32t-Electrical Power Meter:_Finali f i-80t FOOD CERTIFICATE ISSUED
__33�Fin'a"I Electric ' ., ' tr rNotes: _
, - 1 1 a t
•:C _ _ '1171 - _ 0 n:
j334r Fi al H'eatirig,& AiF Conditioning; .v"L • _
35:'7Filial Gas Pipe-Test; /i - :- t-'iS Tr- 3 •
• i-• '. ry _ ( l It Li .*; ..t:,
1-36_Hoad or Canopy : .'• 1 rYy .*•
E:l'�
-37S3Fin`al Factory Fireplace^ = ti . i. f ✓ 'I' a'
- .. e ; r. - v .. cJ
_38. Final Plumbing f. Sn} /Z/l'jJq 40 • � r >
:139. Water Service-Final' i ' ,i, , i ' , r- "'1 ra r •.!:,
1,740. Gas Service-Final a f=1 F_„7,. _ I , u '0,;• c:0
>;41. Solar Domestic-Finals bri. - '• i --. - -
r" 7- - l 'r ;L -
43. Backflow IrOgation ::"N S
44. Landscape Irrigation System;:c' r.::: cc! r- o
45 Sound Attenuation :-.t'.. _- -- -
46: Handicap Regulations s
-
47:;FINAL STRUCTURE& BUILDING i - I kr-Y : „i --
I
48 .-I,FINAL PLANNING E..•_ to i l - - :i.r 1 = ,r a
-49:3-Electric Release to;Edison i, . I �•);. - F ;; -- i
£50_Gas,Release to Southern California Gas Co " l : i�' " ' ' az - ' `
51. CERTIFICATE OF,OCCUPANCY y FU
No. Date
20 -Z( - "' - - •
•
•PROJECT ADDRESS: UNIT: '
OWNER'S NAME: 266 SIERKS ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 060798
ADDRESS: BALLANTINE, CYNTHIA A
• 266 SIERKS ST PERMIT NO: M 060798 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: : SQ
JOB DESCRIPTION CHANGE OUT 'FORCED AIR UNIT' FT:
PERMITTEE: CLAIM VALUE: ,, CALC—VALUE; GROUP OCC: R-3 /
ADDRESS: SSS HEATING & A/C ( 714 ) 837-2000 �.
27324 CAMINO CAPISTRANO COMMENTS• CHANGE OUT ONLY NO 'B ' PERMIT INVOLVED,
�A(,�7NjL NI ] ********4****************4*****************************************************
LICENSED CONTRACTOR pRI A AN: i hereby alarmrmthat I am licensed under provisions of Chapter 9(cammenemg with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect.
CITY L14: STATE LIC.: LASS: SETBACKS
0 7758 39381 —20
Date: I—E->—f) Signature: i C_ 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
1 Compensation Insurance.ora certified copy thereof(Section 3800,Lab.C) LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.:CA WC 1012 7 3 3 9 0 3 EXP.DATE: 01 /01 /94
CDMPANr:TRANSCONTI NTA PARKING REQ: PROV: PARCEL: 42621215 ZNE: REF NO:
❑ Cemlted copy is hereby furnished Cert0ied copy is filed with the city Building Division. PLANNING NOTES>
>
---- Date:4 — 14-13 Applicant: - ***********************************************,********************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES . REQUIREMENT S -
I candy 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:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 'V�,[// DATE:
Code.you must forthwith comply with Such provisions or this permit shall be deemed revoked.
C/ iN� •C i�'F if�'Y
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency far the performance of the work for APPLICATION ISSUED BY• DATE:
which this permit is issued(Section 3097,Civ.C). *************************, •
* *** *, ** **** ****************l** /
•
LENDER: ******************************************** RP********************************
ADDRESS: LEGALIZATION:N F E E .'S U M-MrcA R Y STRUCTURAL SEGMENT:N , .
I 1) l .
I '
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 SMI P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or / j,
repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed PERMIT A ty .J r. '''1 i 9 Z 50% SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ,fJ ,/
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 " e41 J '1 i
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE r 1 �- '15 :0,0 ..
I. 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 .G 1 ,, TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'Slate License Law TOTALS----> 9 . 00 15, 00 " ,i) 0 , 0'0 n ;'" '=24 . 00 24 , 00 • 00
does not apply to an owner of a properly who builds or improves thereon.and who does such work himself/herdell or through •,
his or her own employees,provided that such improvements are not intended or ollered for sale. II,however the building or b I
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• •7 r "a4 , 00 OVER/SHORT: 00 {
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC `- 'FIR(c , SMIP/TOT GRADING PLAN—CHECCCn
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business V 2:4 . 00 n :), i'.
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon f C "I, v,
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).I am aware .x,***,*.****.***********,N.***.*.**.****.**.N.***-*.N.**.*.'{�p*.{(..jc.*.*.it.7(.*.*.*.*.*.7y,N..l(.*..N..1(.**{(.{(.{E*.**-****..x..N.** *
that proof of their Worker's Compensation insurance should be provided to me. if a
❑ 1 am exempt under section: B.s P.C. I N D I V I D U A I,: :FL-EXd % B,-R E A K D O W N
tor his reason: TYPE 'QTY D E S C R I P T I Q' Na 4 '11 UNIT COST TOTAL CST
Date: owner: "r "' f--- .2
i I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 INST FORC—AIR/GRAN J FURN,-<= 1'0.0 K'�B TU 9 .00 ,0 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 fora END'S OF FEES, /'1 ,
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from ;r r- nf .
these provisions. C' • T • •sti lfl
c gDate: Applicant: r
I hereby cs and that I std this ingtion and state that the above information isl correct.01 agree to complyter with all city and county ,, '
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the abovementioned ? r c ,
property for inspection purposes, 3 C ,
Date: + —7--, -*i3 Signature:
Driver's License or Social Security
164146 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
, . ,
•
CONSTRUCTION AND PLANNING . POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole •52. Pool & Equipment Location
-
2. Soil Pipe-Undrgrnd. • , 53. Steel Reinforcement
3. Electrical Conduit-Utility-Undrgrnd.- • 54. Forms -
4'. Electrical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6.- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7: Footings - - ' 58. Electrical Conduit-Undrgrnd.
B. Foundation -:r 59. Gas Pipe, 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
1
12. Sewer Cap - - 63. Heater & Vent-Final
-
r13. Roof Drains _ 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
•
15. Rough ElectricalConduit 66. Solar System-Final •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sjgn 68. APPROVED FOR PLASTERING
18. Rough ElectricatT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. _Rough'Heatir?„g & Air Conditioning _ FIRE DEPT. REQUIREMENT
20. 'Rough Falctor? Fireplace ' ''. - ' . -APPROVALS- Permit#
21. Ducts, in-Structure - - ' 70. Underground.Hydro
•
22. Ducts• Ventitating-;- - R 71. Product Piping OGas ❑,Oil •
23. Gas Pipe-Rough & Test i ' - 72. Underground,Flush' -
, r•T' e 3.
•
24. Root Framing 73Andergrnd.Storage Tank 0 Gas 0 Oil'
25. Roof Sheathing •` • - - - - - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat , ; c 1 75.;.Dry Chemical - `
27. Frame and Flashing.. - 76. Dry Standpipe
28. Latfrng',..t Siding 1 = 77. -FIXED %'STEM'F1NAL. •_ ,..
29. Insulation _ ..I 78.' FIRE PREV. FINAL •- _ -
30. Drywall.Nailing _ , 1 �' - HEALTH DEPT,;REQUIRENIENT "
-31. Plaster Brown Coat I - 79. FINAL INSPECTION
I I
,32. .Electrical.Power Meter,Fjnal , - 1 LU -80. FOOD CERTIFICAtE ISSUED `
-33. Final Electric, ---f^ Not s +j+43 NOOT{tHOM►Q.
34. :Final Heating& 9fr'Conditionin9 I I ' I z-7-13 NOO t Acro'.-cticresa&- csce
35.,-FinalGasPipe:Test... - - 1 134 . a-q-q3 fore At- a.aaoe6reo pier-tti
-
36. Hood or Canopy : _ r ,. - i 't1-/, COiw>(. el s ra'CM'sot.4-L4
37. Final Factory Fireplace - ! = ) ••6/6Y?'3 ' JNet �.f��i
38. Final Plumbingr.--.. - - . i .k6 2 `
- I - _ _ P'- t� Q��tt2:� Y�3 (SEG.
39. Water Service-Final c • I .11-
f • 30 D - '----------
' 40. Gas Service-Final . r - -- 1 I
'41. Solar Domestic-Final I. .
42. Backflow Preventer- - I I -
' 43. Backflow Irrigation' ' ' .
-44. Landscape Irrigation System _ - - - is -- •-
45. Sound Attenuation _ - I- . L
46. Handicap-Regulations _
47. 'FINALSTRUCTURE & BUILDING I I - 'I -
48. FINAL PLANNING • ', I• - _ -
49. Electric Release to Edison I : I' - L
50.,GasjeIease to Southern California Gas Co • i - I .1 /--
51. CERTIFICATE OF OCCUPANCY -
No. Date
'
J :
6138 : .....-1- tit.:QC:
. -. 0 -.99-.f7 v . —
COSTA MESA BUILDING DEPARTMENT HA NICE DEPT._
P.0. BOX 317 !
COSTA MESA. CALIFORNIA mi OC COS1A MEP .
FOR APPLICANT TO FILL IN , APPLICATION FOR PERMIT
BUILDING 266 Sierks Street BUILDING
ADDRESS
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PE$p11j .
OWNER Santa Ana Ranchos (V-1�0
MAIL -RECEIVED BY DATE RECEIVED DATE ISS EO
ADDRESS 419 E. 17th Street "- 02-7-(7 DEC 1 -3 195
fr
TEL. BUILDI
CITY Costa Mesa NO.Lj 8-1159 ADDRESS
ARCHITECT Carlson &- LIC.
OR ENGINEER itiAdlehrook NO. COSTA MESA. CALIFORNIA
FIRE
ADDRESS Garden Grove . ZONE
ZONE NO.OF TYPE GROUP
Dike and Colegrove,Ndnc7333 . . I K(/ PLANS ✓ c ®�
CONTRACTOR n -(
439 E. 17th St. C.1.1 NO. i 8-11 9 BYPROVED DATE
ADDRESS L 5
LEGAL
DESCRIPTION NO.6 BLOCK TRACT 3270 CORRECTIONS
A.P.NO.SIZEN'75 „.
OF LOT X 80 OF BLOCS.
IOWW FON LOT none
USE OF
EXISTING BLDG. none 1
•
SETBACK LINE FROM
CENTER OF STREET 461 REAR YARD 17'
SIDE YARD RIGHT 60 LEFT 9!
DESCRIPTION OF WORK ,
NEW X ALTERATION II ADDITION
REPAIR MOVING ry DEMOLISH
SIZIE DING 1222 SO. ft. ROOMS 5NO.OF 2 STORIES 1
EXTERIOR WALL . ROOF
COVERING Succo COVERING COUP.
. •USE OF NEW
BUILDING Single Family Residence
Garage Attached
Plan No. 720BR j .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND TATE LAWS REGULATING BUILDING ONSTRUC.
TION. /� / VALUATION
SIGNATURE PERMITTEE OFI� 47L ` - /LW7l PERMIT FEE $ 26.G0
PLAN CHECK S 13.00
$ 10,702.00
AUTHORIZED AGENT DIKE AND COLEGROVE, INC. TOTAL FEE $ 39.00 .1/4f Air