HomeMy WebLinkAbout1305 STONEFIELD ST - Building Permits 4<0 " 9 CITY OF COSTA MESA
BUILDING DIVISION
• Hie ; � , DEVELOPMENT SERVICES DEPARTMENT PERM T NUMBER
F1 riras
. "NI PERMIT
V R► �+A
P03-00120
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1305 STONEFIELD ST Status: ISSUED
Suite No Applied: 02/27/2003
Issued: 02/27/2003
Vicinity:
Parcel Nunmber: 14102405 ISSUED BY: tvgy
Applicant: NOCK, TIM •
Address: 11612 KNOTT/ST'
,
Phone: (714)895-1246
GARDEN GROVE,.CA Zip: 92841
Owner: GOETTSCH-BARIA, KAREN SUE • '
•
Address 1305 STONEFIELD ST
Phone: 714-641-1956
COSTA MESA,CA Zip: 92626
•
Contractor: NOCK PLUMBING -
Address: 11612 KNOTT ST "
Phone: (714)895-1246
•
GARDEN GROVE,CA Zip: 92841
License: 707775
•
•
Arch / Eng:" _ 4 .
Address:
Phone:
Zip:
License:-
SCOPE OF•PERMIT
WATER HEATER CHANGE OUT.
•
FEE SUMMARY,
AMT . QTY AMT QTY AMT QTY
ISSUE FEE $23.50 - - Laundry Tub/Washer $0.00 0 • - Sunip'Pump $0.00 0
Backflow irrigation $0.00 0' Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0- Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 , Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
•
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 (--) (
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. - -
11/
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 in'suurrancre�rrier an Ilcy n�r jer are:�/ / ^�/y�� �p�
Carder: rr�5vV C.--Or j!" � (n t 6, s'`' Policy Number 78OLJQ/'l 2 V(
(This section need not be completed it the permit is valued alone hundred�doilers($100)or less.) , .
❑ 1 certify that in the performance of the work for which his 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 ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisiol's. �'
Applicant Signature: Date: 3 – S • V "3
WARNING:FAILURE TO SECURE WOR IS' I ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN IT T E OF PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Cha• -r 9(commencing with Section 7000)of Division 3 of the Busines3 a Pro ssions Code,and my license is in full
force and effect.Lic.# a Class#
C-
Contractors Signature: Date: 3 . 0 3
IIImaa!I/
ir
CONSTRUCTION LENDING Ar NCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally 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 drivers license. 0 Yes 0 No Drivers 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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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? ❑Yes ❑No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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 AUTHOR •N 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 a • city •rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for ins.action pu •• :s.I ag -a not to occupy or allow occupancy of any building authorized by this permit until final inspection.
1 : •n /j!• Ow,:Os) ,, Date ^
/ e u 'z'' '••licant Date eV�–C
CODE/ INSPECTION TYPE DATE INTIALS CODE. INSPECTION TYPE • PAIL MAO
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing / -Al -o3 6N
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
PROJECT ADDRESS: 1 305 STONEFIELD ST
ADDRESS: UNIT: CITY OF COSTA MESA — BUILDING PERMIT ' PERM NO: B 05527?
owxOWNER'SNAME: GOETTSCH- BARIA KAREN SUE
'1305 STONEFIEL6 ST PERMIT NO: B 055273 PLAN CHECK NO: 04929-91 S GOVT;' N SUPP: N
COSTA MESA,CA 92626 CONSTRUCTION TYPE: •
PERMIT TYPE: STR PURPOSE: OTH
/ ARCH/ENCINEEfl: • flEG.NO.: JOB DESCRIPTION : INSTALL 3 SKYLIGHTS IN .KITCHEN, BATHRMS SQ FT; 1 , 500
4 ADDRESS: • UNIT: .
PERMITTEE CLAIM VALUE: 1 , 500 . 00 CALC-VALUE: 1 , 500 . 00 GROUP OCC; R-3 / '
• ADDRESS: WESTERN SIERRA • ( 714 ) 529-1019
450 APOLLO D COMMENTS- ICBO$4631 SKYLIGHTS SEPARAT. BY OVER 41:1 •
�'�►*��a�(�k ,+E p
''pp jjjjgg�� • CA 59.621 ********i�**********�F********************Q*********** *******��fl \L.* �E✓ �t-t
LICENSED CONTRACTOVDECEARATION: I hereby affirm that I am licensed under provisions of unapter 9(commencing with Section Z ONING R E U I 'R E M E N T S
7000)of Division 3 of the Business and Professions Code.and my license is intuit force and effect. SETBACKS
cDaTY'7, o joi- . /STATE uc..4 9 2 59 ' LASS: 9' � �1 RED__
b7 MAIN BUILDING ACCESSORY BUI
Date: - Signature:
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of ciesent 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. •
�wCYND.: O1WCP12072D EXP.DATE: 04/01 /92 •
laMPANY: SUP. NATIONAL PARKING REQ' PROV: PARCEL: 14102405 ZNE: R1 REF NO:
O Certified copylsherebyfurnishetl. C itieacopy�lled ieh yBuilding Division. PLANNING NOTES> INSTALL 3 SKYLIGHTS IN ROOF OF EXISTING SINGLE FAMILY •
// 77!! • / s // > RESIDENCE,
Date:(C.6 -7/ ,.' .nt:� ` *************it****�E*******************************************iE**1Fi,E.-***iF***3F****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need 'be completed if,the permit is for one hundred($100)or less). • DEVELOPMENT SERVICES R E •Q U I R E ' M E N•.?-.T S
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY (/V - DATE: (V'l`�-(o (5
Date: Signature: era
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE'; i
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. - , 1 q p •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for /� f !•i�/ll W
which this permit is issued(Section 3097.Civ. C). APPLICATION ISSUED BY; �t'� DATE; - 1 '
LENDER: *********************************** * * ************************** 'f-we** *****"'* *:*
ADDRESS: ****************************************** /*
************************ ******** ***
• LEGALIZATION:N F E E SUMMARY STRUCTURAL *
SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason I ` t ,
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP RES GRADING
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 3 5 , 005 0
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P JON-RES *:.1t'
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 22 . 75
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE ,
I. as owner of the property 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 Lawet
TOTALS----> 35 , 50 0 , 0 0 22 . 75 5 8 , 2 5 58 . 25 ` % .'`;.0 0�
does not apply to an owner of a property who builds or improves tnerenand who does such work himself/herself or through \ ,/7'
his or her own employees, provided that such improvements are not intended or offered for sale.If, however the building or • J )
improvement is sold within one year of completion,the owner will have thehurden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 58 . 25 OVER/SHORT: - . 0 `
mr the purpose of sale). ' ..• BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP-COI GRADING PLAN=CHECK '",�
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 35 . 00 . 5 .'. '2 2.Z7 5 ;)
❑ 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 snob projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware ' I.
that proof of their Worker's Compensation insurance should be provided to me. ******************************************************************************* .
❑ I am exempt under Section: ' B.8 P.C. INDIVIDUAL F E' E BREAKDOWN k r`
for this reason: / 1
TYPE QTY DESCRIPTION - UNIT COST TOTAL COST/
Dale'. . Owner: •1 6'
• I do hereby certify that l am aware of and understand the requirements of CaliforniaHealth and Safety Code Sections 25505,25533,and SFR 1500 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 50-0c'QO
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 END OF FEES ) t
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
i
r
these provisions. -
•
. /
Date: Appli ant: o
I hereby certify that I have read this application. d stale Thal the above information is correct.I agree to comply with all city and county /
o•
ordinances and state laws relating to building cstruction and henry authorize re r esenlalives of city to enter upon the above-mentioned ' •
property for inspection purposes. iII (_s j , t r !•: ••, _
Date/ r Signature' 4.
7i Add// , ri. .. .,,e7 . . "C•1' ,
Driver's License or Social Security / • •
•
1641-46 While—Budding:Green—Code Enforcement:Canary_Applicant:Pink—Revenue,Goldenrod—Assessor -
lc
CONSTRUCTION AND PLANNING 1 ,& SPA
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 '
57.'Steel Reinforcenierit 56. Rough.Plumbing &.Pressure Test
6. Electrical UFER Lind. 57. APPROVAL TO COVER-GUNITE
7E. Footings - ' 58. Electrical Conduit-Undrgrnd. -
•8. 'Foundation _ - • _ - 59. Gas Pipe, ❑ Undrgr,t`d Test
9:;Water Pipe-Undrgrnd, V. - • 60. Backwash Lies;P- rap, 0 Undrgrnd.
10: Structural Floor System 61. APPROVAL TD DE�j . -
r •
11. Property Sewer Line'& House Connection dl-- • 62. Backwas tf& Receptor Einal
12. Sewer Cap "' ! ' -.
63. Heater 8/Vent-Final\':,--
•
13. Roof Drains1
• F 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 Sigri 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' FIRE-DEPT.REQUIREMENT • '
. .1:.
20. Rough Factory Fireplace ' • - ': . . . APPROVALS-,=Permit #
21. butts,in_Structure .. . '. - . ,. 70. Uridergroupd.Hydio
22. Ducts, Ventilating:-• _i _ C. i 71. Product;Piping DtGas D Oil
23. Gas PipetRough nest =; - , - r _ . ' 72. Underground Flush-.,
24. Aoof-Framing _ • • 73. Undergrnd-:Storage Tank 0 Gas 0 Oil'
25. Roof Sheathing 'r .,: .. ' .. „ 74. DOrerhead Hydro
26. T-Bar Ceiling (Structural) &Monocoat •- • _ ' .•. • , 75.=Dry Chemical -
27.`Frame and Flashing` "• ,... :•` _ 76. Dry Stand.`pipe i
r
ri 28, Lathing& Siding, .: ' J. 'i• -: , t ••.. + 77. ;FIXED SYSTEM-F9NAL t
29. Insulation - ' . - 78.;FIRE PREY. FINAL
•30. Drywall Nailing - - HEALTH DEPT.REQUIREMENT
`
'.31. Plaster Brown Coat ` '' .79. FINAL INSPECTION - - '
.32. Electrical Power Meier-Final . . . 80. FOOD CERTIFICATE ISSUED
�---:,33.-Final Electric. A • .. '• ' ' Notes: ' '
•34. Final.Heating & Air Co'nditioni'ng. t •
35. Final Gas Pipe-Test '- - 44 - -' •.
.36. Hi'
'Hood or Canopy '- - '1. „-• .
, ,
37:Final Factory Fireplace _ -r• ' ' ' • '
38. Final Plumbing 7 -
"'
�9. Water Service-Final =
0
t 40.'Gas Service-Final t • "
it
:41. Solar Domestic-Final •. • , • - . • •i
. . C . . . t -
42. BackflovJ'Preventer-. 1 .
43. Backflow Irrigation', - _ - - _
!� • -
,:44. Landscape Irrigatiop°System. ,y -,x r -
=45. Sound Attenuation- '` ' l' , : 7 - . - 1
•46. Handicap Regulatiopn _
...7: :.` /._b J - -'
47. FINAL STRUCTURE-& B )LDI NG -7 ZJ q. ' r.._ -
48. FINALPLANNING, - • r. , • , i neoP ED .
49. Electric Release to Edison
Inspection
50. Gas Release to Southe?n California Gas Co .. -' - . �` '-
,51. CERTIFICATE OF OCCUPANCY- \_)
•� , i.
_--_
No. -Date v •
i
PROJECT ADDRESS: 1305 STONEFIELD ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 058080
OWNER'S NAME: GOETTSCH—BARIA KAREN SUE - r a
ADDRESS: 1305 STONEFIELD ST e PERMIT NO: E 058080 PLAN CHECK NO: N GOVT; N SUPP; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; . 5—N PERMIT TYPE; ELE PURPOSE: 0TH
ARCM/ENGINEER: ( 714 ) 641-1956 NFG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : CHANGE OUT LIGHT FIXTURE SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE; GROUP OCC; R-3 /M-1
ADDRESS: KAREN BARIA ( 714 ) 641-1956
1305 STONEFIELD AV COMMENTS;
COSTA MESA CA 92626 ******>E******************************** *** #*******if*x*****Tt*?6*********� *+F**
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 full force and effect. SETBACKS
CITY LIC.: STATE LIE.: CLASS:
Date: Signature: MAIN BUILD'ING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l 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
1LICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 14102405 ZNE; REF NO;
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
> I
Date: Applicant: **********************************-IE****************************************TE***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need no reco\Heted if the permit is for one hundred($100)or less). DEVELOPMENT S E• R V I C E S REQUIREMENTS
I certify that in the performance of the work for which this p• -.1 is is reiv. ,.ha not e'ploy any person in any manner so as to become
subject to the Workers'orCompensation Laws of California I ' ZONING APPROVED BY - DATE;
"' Date. ` 1—V' I& Signature: SILO,h,_ J
NOTICE:If.after making this declaration,you should become sub4 to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE
Code.you must forthwith comply with such provisions or this pe shall be deemed revoked. ��Q`�9
' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a co struction lending agency for the performance of the work for APPLICATION ISSUED BY• ` ,x�,� A (�q DATE•• 47}GTTF3FTr r*
which this permit is issued(Section 3097,Civ.C). ************************* ` - ', * * 9�* **' ***/�f+'J.�**ft* 'fir*************** **
LENDER: **************************************** '*** ********1(-****-*************}.*ji'****
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT , 75
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0$ 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 '
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 1500 00 "_
L as owner of the property or my employees with wages as their sole compensation, wit do the work, and the'
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 0 . 75 15 , 00 0 . 00 15, 75 15 . 75 . 00
does not apply to an owner of a properly who builds or improves(hereon,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
tor
the
of 5d
improvement sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUEBLDG PMT PLUMBING ELECTRIC MECHANICFIRESMIP
DIVISION — ODS O/OT/S
ourh .purpose
GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15. 75
2 and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the ContraØteLrcenseLaw) lamaware. ****************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: itl TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: � '& �� Owner. ME, / ELE 1 FIXTURES, LIGHTING 1 ST 20 EA, . 75 . 75
I do hereby certify that I am aware of and understand the requirements of California Hea%trod 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'71' said state codes and the requirements for a '
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. '
Date: Applicant:
I hereby certify that I have read this application and stale that the above information i5a t.I agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby author esent of this dry to enter upon the above-mentioned
property—foorr inspection(pepurposes. /
_ Dale: I—V 115 Signature: — , 010011902,—00119027
TTn 7;
Driver's License or Social Security C: E: 07;11:92 T1FE: 10;06
164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING I - & 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 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 . •
11. Property Sewer Line & House Connection 62. •Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final - .- _
13. Roof Drains F 64. Plumbing System - Final - •
14. sough Plumbing 65. Electrical-Final - -
15. Rough Electrical-Conduit 66. Solar System-Final• -
16.Sough 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 0 Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush •
24. Roof Framing 73. .Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - , 74. Overhead Hydro ,
26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical
27. Frame and Flashing 176. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
29. Insulation I 78. FIRE PREV. FINAL
-30. Drywall Nailing 1 1l HEALTH DEPT. REQUIREMENT
.31. Plaster Brown Coat 1 I 1 - 79. FINAL INSPECTION
' 32. Electrical Power Meter-Final I 1 _1. 80. FOOD CERTIFICATE ISSUED
33. Final ElectricS' qZ Y 1(> "1'�;� -
Notes:
34. Final Heating & AVConditioning �.
35. Final Gas Pipe-Test 1 . '
36. Hood or Canopy - .
37. Final Factory Fireplace .
38. Final Plumbing •
39. Water Service-Final
40. Gas Service-Final . .
41. Solar Domestic-Final -
42. Backflow Preventer , i. .
43. Backflow Irrigation
44. Landscape Irrigation System - • •
45. Sound Attenuation .
46. Handicap Regulations - '
-
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING • '
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Op - '
51. CERTIFICATE OF OCCUPANCY -
No. _ Date
•
PROJECT ADDRESS:, '5305 STONEFIELD ST UNIT' CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 055033
IO@1kl$IB..yAMEr GiOETTSCH—BARIA, KAREN SUE 22h - _
AD.DRkSS 05- STONEFIELD ST PERMIT NO: B 055033 PLAN CHECK NO; N GOVT: N SUPP; N
COSTA MESA,CA .92626 •
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR . . PURPOSE: ALT
(714 )641-1956
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REROOF W/"SIERRA TILE" O/SHAKE ICBG#4361 SQ FT: 9, 000
I ADDRESS: UNIT: •
•
QTY 1111° CLAIM VALUE: 9,000. 00 CALL—VALUE: 9,000. 00 GROUP OCC: R-3 /M-1
F PERMITTEE: WESTERN SIERRA . ( 714 )529—Mi
4 ADDRESS: 450 APOLLO D COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
BREA CA 92621 ****************************** ** Fit*�F�F***�F**4*******+F*****� d �R
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under prow ions of Chapter 9(commencing with Section Z ONING R E Q U I R E M E N T S
7000)of Division 3 of the Business and Professions Code.an my license i fullI and effect.
CITY LIC.: A31999n.STATE LIC.:49259g� ss: C 9 S E T B A C K S REQUIRED
— Date. III . 1 Signature: I_ MAIN BUILDING ACCESSORY BUILDING
WORKERS' OM ENSATION DECLARATION: I hereby affirm that l have a ce f1 to 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 c thereof(Section 3800.Lab.C): LEFT: , FT , IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
'OLICY NO.: 01WCP12072D EXP.DATE: 04/01/92 .
COMPANY: SUP. NATIONAL PARKING REQ: PROV: PARCEL: 14102405 ZNE: REF NO:
❑ Certified copy\is hereby furnished. [X Certified copy with he city ildin Divi . PLANNING N TES> •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (this section need not b co pleted if the permit is for hundred(5100)or less). D E V E•L O P M E N T SERVICES R E Q U I R E M E N j,T; S ,
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become .
subject to the Workers'Compensation Laws of California. ZONING APPROVED• BY DATE:
Date: Signature: .
• NOTICE:II.after making This declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: 1
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. y
r
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction fending agency for the performance of the work for APPLICATION. ISSUED BY• - DATE: ..../ ,
�l 4/4Fi
which this permit is issued(Section 3097.Civ.C). ************************ *** ' * *** * ** **** ***************** * **
LENDER: * ********************************
ADDRESS: LEGALIZATION:N F E E S. U M M A R Y STRUCTURALi SEGMENT;Y
•
•
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason . BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or -PERMIT , 108 . 00 90
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed -:it 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 i ' h
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE !, • ', ,
I, as owner of the propeny.ar my employees with wages as (heir 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----> 108 . 90 0. 00 - -)0;00 108 . 90 108 . 90 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through Ti
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• - 108 . 90 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
mune purpose of sale). BLDG PMT PLUMBING ELECTRIC•MECHANIC, I FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ryry"y108 . 00
. 90
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon G �_t "' t • • • •
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).I am aware ******* **If*******************************E***********K************************
th• at proof of their worker's Compensation insurance should be provided to me. >• 's I N D I V I D U A L ' F ,E E t'S B R E A K D O 14 N -
❑ I am exempt under Section: 2. B.8 P.C. •
for this reason: TYPE QTY D E S C R I P T I 'p N : ' '; . UNIT COST TOTAL COST
Date: Owne. SFR 9000 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 9,000 . 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 Ouality Management District.Residential construction applications are exempt from
these provisions. -
-
Date: Applicant:
I hereby certify that I have read this application and stale That the above information is correct.I ayee to comply with all cily and county ,
ordinances and state laws relating to building construction and by authorize repre '. tines oft City to enter upon the above-mentioned . '/
property for inspection purposes. •r (iq Date: I) . 1 signature: r A� ' 1 �A �� >
—
r/ 01C'E7 1 001G1948 CCUt0i9 )„ t . ..: 31
Drivers License or Social Security e: WIE: 11/12191
1641-46 White—Bmlding:Green—Cade Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
_.CONSTRIJCTICifrAND PLANNING P & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Servlee or Pole - 52. Pool & Equipment Location - •
r .....q.3
2. Soil Pipe-Undrgrnd. - n.. V 53. Steel Reinforcement
.z •
L.,trliic,ifictrrqaI ConduJhigt:ility-tJndrgrnc S 54. Forms
77,;4.It 1=etrisal ConciZOi ndrgrnd. pp- 55. Electrical Bonding
n'ty ft. _
i•"'i .`$ el FFeinforcer�>:,`nt ars,,: 56. Rough Plumbing & Pressure Test
. r
jai.4.41 4ctncaI UF EW -. 57. APPROVAL TO COVER-GUNITE "'
m_
tr q..r'Footirl�gs �p '- 58. Electrical Conduit-Undrgrnd.
r� •
c of -
-'_t9'. Foundation C °' 59. Gas Pipe, 0 Undrgrnd.,Test L-'
.9::•Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
-IA. Structural Floor System - 61. APPROVAL TO DECK ,
•
1 t. Pio perry Sewer Lirtg•& Hgnse Conggction - 62. Backwash & Receptor-Final
11,. S G'er Cap a ° • 63. Heater & Vent-Final
13. Roof Drains rc 64. Plumbing System - Final , , I
•
. 14. Rough Plumbirt� " 65. Electrical-Final '
15. Rough Ele l ic`31-Conduit - • 66. Solar System-Final ,
1,6. Rough Electiid-Wiring 67. Fencing & Access Approval •
,F-; Rough Wirfpg SigtR - 68. APPROVED FOR PLASTERING
18. Rough Eleciki�-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.-Roilgh I:-actoc'y rIreplace •tri tL? <'1 wCI D Cr.* -t- TAPPROVALS:DGPermit# . 'Y •r
r c' ;i0 it: x t i 'CFO rc c .r ,,,.. N . -:.- •' Cr 4413;J-•-• "� r. r_ u•
215-Duc�t'S,in-Str_ Lt�e`. I & :‘;'..s: .J. r• --.1 i '* ' _ ''FF S'-'-� rr. n
,t• I .. .• '-s a: S , r--1+. * ,70. lfnderg e , H rlro ,
i- S. _ :-
- � -rr=r;J
22. Ducts, Vntdatirtgt I as i S K* x -•71. Produdin-Wing
s6bs 3Oil
-- r^ .r n+. ^ .e ti ^ :-x r kr
235-GasPi e"Ro h &•test r'` r.
Uo'
i t:S :;. 01 < "" ; .-172. Underg 'iJFlrS0 �
24.xRo Framing may. t -c, - _ : ,' 0 c _ S73'AUndergrrOO.Storaye-Tank�OGas D€ l
25. Robe, Sheathin "' F ^-' / ' O r••f S '-� •'-tFo w
g, 9 n.;p. .v - �/ _ * * 74.2 ,verhead'Hydra` x
26; -Qar Ceiling (Stryotural) eonocoat r to Cl lit 75T-Dry Chemical ` ' 1: -, C X
,i� 5 :• S,•�
�'
27'�frame aCd �lashli?- �.a.tXrx * •T Y mill 74.19ry StanWe 2 ;S to n
`-,28``•1,a ing$t Suing-'.: c. ^fix t ; z •.t * 77'.•r FIXED Sa'STEft'1 INALv-cji tij n-
--29. Insulatij °• 'L*it C s •• T tr I I tK 787.FIRE PR EV. FINR,L ' m
r30. Drywal t;Naittng ---a * if ■ z r MEAL i Iip EMI..R,EQUIR-MENT
S -. - 'E
R31. Plaster B`own Coj"t• S ; -r.tr r I i it. w 1.79 )FINAL IIS&ECTI N C C' J
:-32:,Electrici�}Pov/er;0.aeier-Final; of I _./c * r,80pgFOOD CERRIFIGXTE I..SdED
33` irn^I El tri r+ .r w t-'
1",..,-H•.-1..." t. DN1 es: t sr✓tn~.ail - -_4 'i'ri's(/22/t�.
`pr,'34,-Finfi Heating& TCogditickik- �, y /1" iL i. iK ' c;y * S o ---},
35R-Firiai Ga3 Pipe-Testi m i-• is ' ! Fa.M'-' t:/lam ,r . �j/lr - .
1�=
v :` ice 'rPC�.. i� '=c..
36. Hood or' Cano fix. •S x r' to - .. n y
j
'-137 n.'F Trial Fafltory Fir@Mace r Sir ti n
'r l { ',1, is C, ^ 1./;
;a38. Firtaj PI�{lnbin9 a: LC N t a II `• 5' S' 1-, CO a
039. Wats Spiivice'Final t IV a_ •. 0 on t LC r
_ •- s .• a -t:: .Jr •� ; * s
40. Gas Serlyce-¢jnal T a I x a I-o y• * to -
:y. Irl „tin r. $ .t ti. I V`[�. .A. 0cc a,co
.,. -. C�� L .Y .\ .. e zi - _C
z41. Solar Dgrnestic-Final ci n i I It
"Ca.• i-+
r * 4F Y it 1-1Q Cr .4: 'er .•
I"42sBackflo43 Preventers " ti K Z I j � *• �-; COi :5
.J 0,-.•- ..4 • -
43. Backflow Irrigations - u:SS i �: * Xl-0 :r 0 -;
`� 2: 'l X- V - i rl •
4;44. Landscape PtfigatiopS .-yster - tr. -+.- , r 7 _: a. - N • 3 `V CLI C -
£45;5Sound Attenuations :ttT.F tr ' S C-- f-• I-'i; :r ; - ,r r%:<
g46;'liandicaK R&ulatir s 1-, `_, i. ``' x P tai,- �� '"j -
S
47 f lr L STR,wCTURE f;JUkDING `T 1 ' 1j 7 Tuts i
1-4
48�'_plt tL PLA`NN11�G" ' trtr `-// '' 'v' r _.
049,f-,-�Ieeiric�lfielease to�Eiiisor .. i i Uri, r , '" I a '
.� ,� , + xt, r at •r .fl
�5o�GattRelease p Souther-Calcforn Gas Co 'k I
I T4s:. 5 ,• •G • o a O C)
!F.
:"51. CERTIFICATE OB'0CCUP413CY yr CD tic r y
No. ' - r Date v
ADDRESS OF BUILDING: 1305 STONEFIELD ST MT: CITY OF COSTA MESA — BUILDING PERMIT
CIR•fWSNAMEIFIDro* GOETTSCH—BARIA, KAREN SUE FLOOD: X 46 PERM NO: M 075419
ADDRESS: 1305 STONEFIELD ST
COSTA MESA CA 92626 PERMIT NO: M 075419 PLAN CHECK NO: N GOVT: N SUPP : N
( 714 ) 641-1556
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE : 5—N PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : FURNACE CHANGE—OUT SQ FT:
UCH.OR ENG.'S ADDRESS: UHT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /M-1
CONTRACTORS NAME: PRO—FORMANCE INCORPORATED ( 714 ) 779-6868
CONTRACTORS MMUNG 4085 E LA PALMA COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT
ADDRESS: ANAHEIM CA uCNO.: 483411 ***********+r•K-SE***x***+t********* -****RS******** -SE*********+r- -** -*** -CESS*****St**SFiF**
92807 DHT: B ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I ern licensed under provisions of Chapter 9 5 E TB ACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in f I force and effect.
crrYLIC'Nal gg040702 uc.cuss: C 20 LIC.NO: 483411 XP• /96 MAIN BUILDING ACCESSORY BUILDING
N� Dae:1f— /a Q lr contactor: �/� / �/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
v NNER BUILDER DECLARATION:I hereby affirm under penalty or perjury that I am exempt from the on License Lew for the
.oflows g reason(Section 7031.5 Business end Professions Code.Any city a county which requires a to construct alter,improve. PARKING REQ: PRO V: PARCEL : 14102405 Z N E: REF NO:
demolish.or repair any etructure,prior to its issuance,also requires the applicant for such pennh to fib a signed statement that he or she Q
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> —
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 subjects the applicant to a .'I penalty dna more than fire hundred dollars 135001). *******************************************************************************
❑ I.as owner of the property or my employees with wages a their sole compensation,will do the work,and the stn¢ture is not imended D E V E L O P M E N T S E R V I C E S R E U I R E M E N T S
or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property Q
who builds or improves thereon.and who does such work Nmsef or herself or through his or her own employees,provided that such r'
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 he or she did not build or improve for the purposed sale). ZONING APPROVED BY DATE :
❑ I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to an owner d properly who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a co ntracta(e)licensed pursuant to the Contractors license law). �'� cif—
❑ lamexempt under Section: B.APC..for this reason: APPLICATION ISSUED BY: �J DATE ; k\ - O
Date: Owner: ******************************************* ********************* **
I do hereby certify Thal 1 am aware of end understand the requirements of California Health end Safety Code Sections 25505,25533,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
25534,and that I or any future building occupant will/will not(circle one)need to comply with said mate codes and the requirements for .1
a permit for construction or modification hornthe Ai mty anegement Dimnct.Residential construction applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT n-• 9 . 00
Date: Applicant: 2 5% SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaltyd perjury one of the following dedmatiors: PLANCIA
o Ihave and wit maintaacenarateof onsenttoseB:nsurefor workerscompensation.as providedfobySecion3700othe Labor ISSUE FEE 15 . 00
:t
Code.for theperformanceoftheworkforwNchthispemtiiissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
1 I have and MI maimab workers'compensation insurance,as required by Section 3700 of we labor Code.for the performance of the TOTALSTOTALS—'---> 9 . 00 15 . 0 0 0 . 00 24 . 00 24 . 00 . 00
work for which this amid is issued.My workers'compensation insurance carver and policy number are:
Carder PATTT.A TNc rC) EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 24 . 00 OVER/SHORT: . 00
Polity Number: Drrr50007RR 09 /12 /96 • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nor be completed r the Penna is for one hundred dollars(51001 or lass) 24%. 00
o I certify that in the performance of the work for with this permit is issued,I shall not employ any.... in any ,..ner so as to >'
became subject to the workers'compensation laws o California, and agree that N I should .. .me su•',.- to the workers' **************************************/*****************************************
main provisions of Section 3700 of the Labor Code,I shall fyµhwah comply with t p.P ,.
^1jPe/ .pry /y c J(('o'v / IND I V IDUAL �`F E E BREAKDOWN
Date:co1 / U¢ ! J Applicant ../(.4 L.,. ('
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an:.^^J fo criminal penalties and TYPE QTY DESCRIPTIO N./r UNIT COST TOTAL COST
civil fines to to one hundred thousand dollars(Sfoo,on0A In addition to me cost of comp. fon,damps as provided for In i
Section 3706 of the Leber Cods,Interest,and attorney's fees. MEC 1 INST FORC—AIR/GRAV 'O
FU N <= 100 K BTU 9 . 00 9 . 00
• 'CONSTRUCTION LENDING AGENCY: 1 hereby affirm under penalty of perjury Thal there is a commotion lending agency for the END F FEES
performance of the work or which this permit is issued(Section 3097.Ci..C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read u applicationonand mate that the above ndatmatte l conemf I agree to complywithallcityand countyordinancespro erly i,
and state laws mrpose to building rstate
and hereby authorize in� representmiv re of this citye to enter upon the sty emionnd properly n
for inspection purposes. \J/; -/:,1)
'/y%
erVDARREN SCHWARTZ _
��/P9��1 Name
/-30 ^4Signature
`natureof iter/Aggeenn i 0Date: 01 0019552E-00195526 TOT 24.110
DATE: 11/30/95 TIME: 10:36
(5151 de WP) White-Buildig&Safety:Green-Role;Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
•
.`CONSTRUCTION AND PLANNING L& SPA
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
41 Electrical Conduit-U,ndrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF 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
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing
g 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 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ' 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical •
27. Frame and Flashing
76. Dry Standpipe
28. Lathing& Siding • 77. FIXED SYSTEM FINAL
29. Insulation 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 (,2 C, 95 Notes:
r
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy '
37. Final Factory Fireplace •
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final •
41. Solar Domestic-Final
42. Backflow Preventer t - .
43. Backflow Irrigation
44, Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - -
51. CERTIFICATE OF OCCUPANCY
No. Date
JOB ADDRESS ��ZZvv Ll.. i\:1M L.V• BUILDING PERMIT' NU. u N.1.1``�
GENERAL CONTRACTR itetime Res.Bldg. Corp. VALUE $ 17,075.00 li.-rr- Ct_
AP No. LOT 88 TRACT 4355 FIRE ZONE DESCRIPTION OF WORK Res.Watt.Gar.
INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE R1
Soil L�� cil.P•ir '� PERMITS ISSU. _
Gas vf/ 21^••,� SUBCONTRACTOR DATE NUMBER
Water ta, / r<.,?
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating l-• ,t a_„06_� Ac� -
Rough Plumbingi . - <
Miscellaneous \ - "� /,
Prop.Swr.Line 0 House Con.$St.Swr. ❑ -Z-2./41 Z9_;�. _ '-/_._C. .7-026-49 ..?ur7<.90 - ,,,./
Sprinkling System ����i / -�"—/'
Construction Pole Z " /9.4 //C N� ill / ,L'7 / c7 iJ6i1"
Underground 0 Power ❑ _ /�� /r-_ • / /��y-_
Rough Wiring 47-0_1--) 4/.CC Cd �rLt.'1721(2, ha T.�O4..4C. �-R 7-43 Z7,�D.Y7,4
'Frenches 6� Forms E' Steel Reinf. 0 n /-8-6 3
Floor System tale /-2t/-67
Bond Beam 0 Steel Reinforce 0
Sheathing G'? i/ 3-1.1=-6,
Frame and Flashing fllii/J of Q-1-(,z
Lathing — In 0 Out 0 /1f/, 4-n-'65
Plaster, brown coat G-/O -g
Ref rig. 0 Air Cond. 0 Final
Heating, Final ?-5'-'3
Plumbing Fixtures, Final
?-j- .43
Final Gas Test /5 1
Electric Fixtures, Final
Building, Final -S-_________ %f`�,/ y,
G3
18470 1 FEE RECEIVED
•
COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 88, Tract 4355��`�/[{�an Dc'111982
P. O. BOX 917 COSTA MESA. CALIFORNIA / FINANCE DEPT.
For Applicant to Fill In Completely APPLICATION F&T'EQL9OSTA MESA
TYPE OR PRINT •
BUILDING
ADDRESS 130s St;A,e,fre/L/ 's7`
ADDRESS
COSTA MESA. CALIFORNIA For Office Use Only .
OWNER Harbor Hall of Fame Homes, Inc. I RECEIPT NO. I ,gEI�y n,
ILC '$M%V/
MAIL P.O. Box 2066 RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESS /L��./ 'ER S/. /tom- nFc 1 1 •.009
CITY NO
Santa Ana KI 9-220L ADDRESS
,
ARCHITECT TENDL544 I
OR ENGINEER Jamison -0040 COSTA MESA. CALIFORNIA
ADDRESS 225 IIDII St. , Tustin FIRE
ZONE TYPEGROUP 4-44
CONTRACTOR Lifetime Residential Bldg CorDByPROVED DATE
ADDRESS 2131 So. Artesia - ZONING
ZONE / NO.OF USE OF NEW�''}�' /kV"
CITY Santa Ana ( I PLANS a I BUILDING / 7C g'F'l .
:a a
•
n70. 208676 208616 NCO. KI 9-2204 DESCRIPTION �t ea, 7-, I/3sr
SIZE 60001 NO. OF BLDGS.O
OF LOT I NOW ON LOT A.P.NO.
•
USE OFNone YARDS EVES
EXISTING BLDG. C APPROVED ALLOWED
CCENTER OFCK INE STREETAi 50, REAR YARD23.50, FRONT LINE ST.) IC-O FT. �- IN.
SIDE YARD I LEFT 8, I RIGHT 7.301
R.SIDE 7 • 3 FT. IN.
f
DESCRIPTION OF WORK L.SIDE FT. ----- IN.
NEW I X II ALTERATION I II ADDITION I REAR 2- 3 Ft G/ IN.
REPAIR I II MOVING I II DEMOLISH I BYPROVED . 4 p
DATE /6��/(t
eZELDING 16u8- ROOMS NO. OF 9 STORIES 1 den
EXTERIOR WOR- ster I COVVERING Shake
COVERING I.J.
USE OF BUILDING AND WORK TO BE PERFORMED
Single family, residence
-/5�� V-5/d0a /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE CORRECT AND AGREE TO COM- PURPOSE OF, ESTABLISHING A PERMIT FEE ONI.V.
PLY WITH ALL CITY 0 A S AND STA W GULATI G
BUILDING CONSTRUCT! VALUATION /�'
SIGNATURE OF ' PERMIT FEE $ A7 7 N
PERMITTEE _ yN o
$ /7 ll`7� PLAN CHECK $ c2X-5141"
AUTHORIZED AGENT / (// C
...... . _. _ .-... . .o.. TOTAL FEE S /�.J.i)3� 0