HomeMy WebLinkAbout208 SUSANNAH PL - Building PermitsWOHESS:
208 SUSANNAH PL D"ITCITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 0%0332
NAME:GENOSKI . CAROLINE A
ADDRESS: 208 SUSANNAH PL PERMIT NO: B 070332 PLAN CHECK NO: N GOVT : N SUPP : N
COSTA MESA-CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
642-5507
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF SHAKES & REROOF W/CEMWOOD 5 . 8PSF SQ FT: 10. 250
ADDRESS: UNIT:
CLAIM VALUE: 10,250 . 00 CALC—VALUE: 10, 250. 00 GROUP OCC : R-3 /
PERMITTEE: LEE; ROOFING ( 714 ) 642-7223
ADDRESS: 1653 SUPERIOR COMMENTS : CEMWOOD SHAKES ICBO# 4312 , SMOKE DETECTORS ARE REQUIRED, 1991 UBC
COSTA MESA CA 92627 RE:E�E �E�EiE�E�E-�E�E> ****�E�ERERk�E�E�EDE**>E*RE>F�E �E�E'a 4*.x>E�E�EREiE>E�EiE�ERE�EiERE�E�E*�EiE>E�ERE9EiERE�E�EiEaEiE*'>E***xiE**x*:E
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
700D1 0l Division 3 of the Business and Protessions Code.and my license is in full force and effect. SETBACK S
CITY LIC.:02875 sTATEuc.34968 . : Op' EXP - 03/95
Signature:_ /ll ?_— MAIN BUILDING ACCESSORY BUILDING
KERS' OMP SATION DECLARATION: I hereby affirm that I ha - .certificate of consent to sell-insure or a certificate of Workers' FRNT: FT
IN REAR : FT IN FRNT: FT IN REAR : FT IN
,mpen5alien In r/A�n�C{D rp Feniu�jd yopy lhereol(Section 3Rlt ab
LEFT: FT IN RGHT : FT IN LEFT : FT IN RGHT: FT IN
POLICY NO.:I.-3U 41--�4 EXP 'ATE: Vk/30/95
COMPANY:STATE FUNDnn PARKING REQ: PROV: PARCEL: 43918126 ZNE: REF NO:
0 Certified copy is hereby refreshed. tJ Certified cop is lily.with EP- y Building Division. PLANNING NOTES>
L Y. V Applicant: l ******'If*******>**'if**************'If**'M*********' *'IE'k*****-JE***if****1E*****'7f'If******' **
PTID ROM MFRS'COMPENSATION DECLARATION: (This sec': need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENT
certify t -t in the perlormance of the work for which this permit' ' sued,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:
Dale: Signature: BUILDING APPROVED BY : DATE: _
NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor - -- —
Code.you must iortM.ith comply with such provisions or this permit shall be deemed revoked. �.�(��w`
r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance o1 the work for APPLICATION ISSUED BY: �piF7t'HX DATE:
7 Cif
which this permit is issued(Section 3097.Civ.C). *'7E'***'!E**-1E'7E***'7E'1E***********'7F****'ff*'3�iE�F iE****'TfI'WWw*T******1E**'* ' ''9. ' Y' **
LENDER: *******-X***********************X*************************************** * * ***
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: thereby 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 126 . 00 1 03
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty at not more than five hundred dollars(S500). ISSUE F E E
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————> 127. 03 0 . 0 0 0 . 00 1 2 7, 0 3 127. 03 , 0 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.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 12 7. 03 OVER/SHORT • 00
for theepurp is sold of
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 SMTP/TOT GRADING PLAN—CHECK
tor the purpose of sale).
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 126 . 00 1 .03
❑ and Prhcontractsfor
ce ConprojectswithState contractor(s)
ontraselaw doessutoo the owner ofrty builds or improvesI thereonr **************************X******X**X****X************X*)E********X*************
and who forsuchTe with a e License Law
awidoesenotpursuantaly to the Contractors'of props ytwh License em aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN
❑ I am exempt under Section: B.&P.C.
lorthis reason: TYPE QTY DESCH IP T ION UNIT COST TOTAL COST
Date: Owner: SFR 10250 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 10, 250 . 00
I do hereby certdy 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.
Date: Applicant:
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 building construction and hereby authorize representalrv' of this city to enter upon the above-mentioned
property lar inspection purposes. ....‘4111001,-,'
� /�
ate: Z Signature: .r S' : '�— 01 00173262-00173263 TOT 127.03
errer Mc seer •oriel Security DALE; 12/12/94 TInE: 09:21
1641-46 White—Burtding:Green—Code Enforcement: dry—Applicant;Pink—Revenue;Goldenrod—Assessor
Ilk--CONWRUCTION 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
�- I
7. Footings 58. Electrical CondUndrgrnd.
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 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 tz-B-1? /mg`� e 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ! µ 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 Notes:
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
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations L
47. FINAL STRUCTURE & BUILDING (I !
2�C>'["6(,�/bL
48. FINAL PLANNING (1 7
49. Electric Release to Edison
50- Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant
tofill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTIO< PERMIT•
e. PER/811T(JZ'U/ 11 TRACT NO. LOT NO. UNIT NO.
sae t, )risorina /• PE N T V
Project Address y '`�
Applicant's MailingjAddress OX-321-/a. }jQ/ g,-;1-51-07
/gr TYPE OF CONSTRUCTION U NEW LI ADD U ALTERATION LJ REPAIR
V�.,/ P Phone lQ 7/f�SS� '❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,p.# ( Zone
Owner's Name DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING -L,,FOUNDATIOry E O
� ❑ STRUCTURAL RAL Front
Address ❑ TENANT ❑ ELECTRICAL PLUMBING Li MECHANICAL BA Rear N
3ggen ❑ OTHER
Contractor's Nam- //li /%, - -� r'�,Q�,}�',/e�--(f C Right N
Address(mailing) p -� / .A F/"��/ v PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left
—
G
CONSTRUCTION TYPE VALUATION$ s
City License No. din ZONE GRADING CU.YDS. ACRESR
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
i Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full f• • •n• effect.
License Cl. 'c- se o. .,AL , _ _
- tRECEIVED JUL 2 8 1988 $
Date ' i -:ff Signature Lail - - •/ — � - .r PLUMBING FEES
l WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
\t�V I hereby affirm that I have a certificate of consent to self-Insure or a certificate _
of Workers' Compensation Insurance, or a certified copy thereof (Section ' Backflow Preventer Service Sink ❑ 15-50KW
3800, Lab p _ Automatic Washer Transformer
Policy No. /9//q3�y e' Company _� . �.L•� Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
Certified copy is hereby furnished.
.LCerti ecl5pp sled with the city B ng Ivisi / Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date %"w 'ROM WORKERS'Applant �./� Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
EXEMPTION FROM COMPENSATION DECLARATIONP
(This section need not be completed if the permit is for one hundred($100)or - -
less). r Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued,
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 ❑9-15 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
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance _ Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Heater •' — Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service SwitchesSign - '
•
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW
any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
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
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
enaIty of not more than five hundred dollars($500).
U 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 is 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
thereon, and who does such work himself/herself or through his or her own Boiler Hood Type I 0 DEVELOPMENT SERVICES REQUIREMENTS:
or
employees, provided that such improvements are not intended or offered foryp Zoning Approved By Date -
sale. If, however, the building or Improvement is sold within one year of corn- Canopy Type II ❑
pletIon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
•
Prove for tthe purpose of sale).
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structurat Refrigeration System Application Issued By Dat
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 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 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 $ PERMIT
0 I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ CaDISSUANCE $
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 0100,000 BTL ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter up n t e above-mentioned property for
inspection purp
Signature Date 7/0 if G MECHANICAL $ TOTAL FEE $ y��
d $
Drivers' License or SS# / /�/
DATE: 07/28/88 TIME: 12:14 ��'�V
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting: 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 en
o.:
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ��'•
•r
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.;Test
1
9. Water Pirndrgrnd; 60. Backwash Lines,P-Trapa0 Undrgrnd.
•
10. Structural Floor SyStein 61. APPROVAL TO DECKL 1
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Firial
12. Sewer Cap 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 Appioval
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 U Gas UOil1f
23. Gas Pipe-Rough & Test 72. Underground Flush a1
�l
24. Roof Framing 73. Undergrnd.Storage Tank DCL ❑Oil
.
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 11r1�
r
27. Frame and Flashing 76. Dry Standpipe Ali
28. Lathing & Siding 77. FIXED SYSTEM FINAL:it,
29. Insulation 78. FIRE PREV. FINAL 11.11
30. Drywall Nailing HEALTH DEPT. REQUIREMENT C
31. Plaster Brown Coat 79. FINAL INSPECTION PI
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .•`:
33. Final Electric Notes: y-a -d'cy LEFT nae. LEO
34. Final Heating & Air Conditioning >^4541
-y�!//7 a / / -p•,J
35. Final Gas Pipe-Test _ e eiseg
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing •
39. Water Service-Final i
•
40. Gas Service-Final
ti
41. Solar Domestic-Final y'
42. Backflow Preventer • 2
-�
43. Backflow Irrigation •
ifs
44. Landscape Irrigation System •
45. Sound Attenuation •
-
46. Handicap Regulations
C.�
47. FINAL STRUCTURE & BUILDING r7�:
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
t \.. .
- -- -- '
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address 208 Susannah Pl. ���`�-'I
92807 TYPE OF CONSTRUCTION LI NEW D ADD LI ALTERATION LI REPAIR
Applicant's Mailing Address 4572E.EisenhowerCr.-Anaheim
Owner's Name non x Carn1 ine Butler Phone 642-5507 ❑ CONVERSION ❑ DEMOLISH rij OTHER BPPT LL'Bf[)):'Nrj' A.P.# • Zone
DESCRIPTION OF WORK/USE OF BLDG. RRPT.ACFR1F.NT PAN
Address ' S Main Building: Accessory Building:
Arch/Eng. License No"? TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION E D
❑ STRUCTURAL Front
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear N
Contractor's Name PRO-FORMANCE, INC. Phone 779-6868 ❑ OTHER
• PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing)4 'e•• . ' —:1- 1' 11 � :0 K G
CONSTRUCTION TYPE VALUATION$ S Left
City License No. 40707 - GRADING CU.YDS. ACRES R
ZONE
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided E
O
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: (� t/C 5 1(�p M
with sectionis 7000) of a effect.f 3 of the Business and Professions Code,and '__ „• /)\ ; M RFCFi MLD DEC - 198§ T
/73
my license is in full force and 4II3411 Pr �„ ) A,,`� S
V License Class O L9cens .�j0. � � � � �
Date 12/4/895ignature 7ALLC� /f •
PLUMBING FEES
N WORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
V I hereby affirm that I have a certificate of consent to self-insure or a certificate .
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW
\ 3800,licLab. C.)
t Policy No. BWC19612 Company Hi lands Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
(�. I��-ILCertified copy is hereby furnished. cad --
V lac Certified copyis filed with the city Building Division. Bathtubs Sewer Connection �J Cooking Unit Meter ❑up to 100 amps
Date 17/N FROM _Applicant PRO—F' RmANCP,TION TNC •
Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION .
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel •
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 Drinking Fountains Solar Tank Fan Motors ❑O-1 HP ❑I%-8
workers' Compensation Laws of California. —
__
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 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 FixturesMicrowave
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light _
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name _
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 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 P—Trap Laundry Trays Generator ❑D-5 KW 05-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
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
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 Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is 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
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type 0 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, 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 Dat
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 00100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for Such projects with a con- _I
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 $ PERMIT x.11
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING $ ISSUANCE $ t#!T�
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 1 LXO-100,000 BTU ❑100,000 BTL 00 ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of is city to ent upon the above-mentioned property for
inspection p r se /���j MECHANICAL $ e� •D"n ,/♦0D
Signature /Ii Date 12/4/89 )'OTAL FEE $ �`�'
Drivers' License or SS 9} Reinspection Fee $15 Issue Fee if IS PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor 01 00049085-00049085 TOT 24.00
near! 19/06/50 TTI'IFe mem
CONSTRUCTION AND PLANNING POOL&SPA
Date Inspector APPROVALS Permit# Date Inspector
APPROVALS' Permit#
7 )
1.,Temporary.Electrical:Sei-vice or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement t
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' ••o
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 F . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Teat
94/Vater 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 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
fir. Ducts, in Structure 70. Underground Hydro
"722. Ducts, Ventilating 71. Product Piping 0 Gas ❑'Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �-
24. Roof Framing 73. Undergrnd.Storage Tank`O 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 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT '"
31. Plaster Brown Coat 79. FINAL INSPECTION
t�. l •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE� ISSUED
ti-E,"-go 7
33. Final Electric Notes: 1t gj 441 IT SFPrrz€2 as entry
34. Final Heating & Air Conditioning -� 303 0 ' op-i.L - LEA)
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
t '
38. Final Plumbing
39. Water Service-Final r
40. Gas Service-Final i.
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
46, Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date X
•
17373 id f E J E.�I� D
COSTA MESA BUILDING-SAFETY DEPARTMENT JUN 1 91962
P. O. BOX 917 COSTA MESA, CALIFORNIA Pin �U FINANCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
7�ff/ / BUILDING
ADDRE65p/U� Si/J4 r/h4�r ,040_ 7g
COSTA
40A ` -
COSTA MESA. CALIFORNIA For Office Use Only
I RECEIPT NO. I r7373
13 /LJ
OWNER ,J
MAIL /J / RECEIV90 BY DA RE VEO OATS ISSUED
ADDRESS ✓33 7 Q q Lam[/ I -y-4
' -�6-6
CITY C NO Q'Dq BUILDING p �//�, l� (/y^'),�
" / � ADDRESS L`Z 0.) �-/4(i( ..,12-ii„(%' I.I%.
ARCHITECT . —TEL.—------- COSTA MESA.' CALIFORNIA
OR ENGINEER NO. / //�IDz.
--
ADDRESS � ZONE TYPE [� GROUPs-_ r
CONTRACTOR /(/✓^'�'�/ C.!// lN' BYPR t6 - ( p E
ADDRESS Cant, ZONING
ZONER I NO.OF I USE OF NEW 52. L.. .S
CITY Cie"
�/ - /� -Z PLANE ci BUILDING `�/
LIC.NO. .�C/L' /.-?n TNO. - DESCRIPTION �-oLEGAL / - 7 7 1'h 17
1 {��7c
SIZENO. OF BUDGE. — _
OF LOT I NOW ON LOT 6 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. _ APPROVED ALLOWED
SETBACK LINE FROM '/ (CENTER LINE ST.I d i
CENTER or STREET ?� REAR YARD FRONT o * FT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE 3 FT. .-- IN.
DESCRIPTION OF WORK L.SIDE FT. IN.
NEW I/\II ALTERATION I II ADDITION I REAR /Z L_ FT. —` /IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED O�n�C DATE 4/f eZ
BUILDING
ZE.DING•,,,,,,-)SA 4' r ROOMS 7 STORIES� / (-4-'4.192
'T /
EXTERIOR WALL( / (ROOF /'///(/
COVERING JJJ��NLL COVERING wb/ '"Y]
USE OF BUILDING AND WORK TO BE PERFORMED
J _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONS17x. VALUATION ,J
SIGNATURE OF dal 1.4j PERMIT FEE $ -7 - R
PERMITTE // //�� rj
a /
S /c '
7//1''— PLAN CHECK $ '1.
E
AUTHORIZED AGENT 6 ` cc
0
TOTAL FEE