HomeMy WebLinkAbout348 SYDNEY LN - Building PermitsCITY OF COSTA MESA �
BDILDING DIVISION
77 fAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w.wi ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (774) 754-5626
PERMIT TYpE PLUM
APN: 93519002
PERMIT NUMBER: P08-00235
STATUS: ISSUED
DATE ISSUED: 12I1212008
ISSUED BY: BJK
JOB ADDRESS: 348 SYDNEY LN CM Suite/Unit: .
Vicinity: GARAGE , �_ . - � " � � �
SCOPE OF WORK: REPLACE WATER HEATER LOCATED IN GARAGE.
OWNER: HEWITT, JEFFREY M- � Address:
PHONE: g4g-642-7'I42 . . City/State/Zip:
APPLICANT: RON BEWLEY � � - � . Address: �
PHONE: 714-534d010 ' � . . City/State/zZip:
,,�
CONTRACTOR: R AND R CONSTRUCT.ION
Address: 11832 MAC ST � � � �
Ciy/State: GARDEN GROVE; CA ZipCode: 92626 �
ARCHITECT: License No.
ENGINEER: � - � . � � License No.
348 SYDNEY LN COSTA MESA, CA
11832 MAC ST� : � .
GARDEN GROVE, CA �
License No. 609338 � - -
PHONE: 714-534d010 �
CELL: ,
PHONE:.
PHONE: '
9
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35:80 .
$35.80
,,..,. , ., , ,u..
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenLs under California slatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) � �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTION3: In order for the work aufhonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and Tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODEt. INSYEL110NTYPE DRTE INTIPNLS f�_��Et INSPEC110NTYPE DATE INTM�S
1816 Fixed System Final Fire Prevention 206 Final Mechanical _15C_'�l—��
1288 Pool Spe Final 208 Final Plumbing
200 Final Re-Root 210 Final Eledrical '
201 Final Blpck/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Si9n 222 Final Site
204 Final Demolition 250 Final Building�Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereGy affrm under penally of peryury one of ihe following declaretions:
❑ I have and will maintain a certificate of consent to self-Insure (or workers'
compensation, as provitlBd (or by section 3700 of the Labor Code, for the
peAormance of the work !or which this permit is issued.
❑ I have and vnll mainCain warkers' compensation insurance, as requiretl by
sectbn 3700 0( ihe Labor Code, for the peAortnance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This sedinn neetl not be mmpleled tl fhe permR is valued af one huntlietl dollars (5100J or IessJ
Policy Number:
�„� I certify tha[ in the peAormance of the work for which this permi[ is
iss d, I shall not employ any person in any manner so as to become subject
to t orkers' compensalion laws of Califomia, and agree that if I should
come bject to the workers' compensa[ion provisions of Section 3700 of
the Labor ode, 1 odhvnth comply with these pmvisions
Z �
AppliwnfSSignaWre �pate �
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SFIALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION 70 THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CO�E, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm ihat I am IiCensed under pmvisions of Chap[er 9(commencing
with Section 7000) of Division 3 of ihe Business and Professions Code, antl
my license is/ i'n� full (or and fect.
c. #. V � Class�#. /
�---
�
Conlrac�Or's Sip�at ,Da�e" �
�-
CONSTRUCTION LENDIN GENCY:
❑ I hereby a(frtn lhat there is a construction lending agency for the
pedortnance of the work fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lentler'S Name:
Lender's Address:
SignaWre oa�e
OWNER-BUILDER DECLARATIONS:
I hereby affirm lhat under penalty of perjury that I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for ihe follovnng reason (Sea 7037.5.
Business and Professions Code: Any city or county which requires a permil to
construct, alter, improve, tlemolish, or repair any sWcture, pnor to its
issuance, also requires t�e aDPlicant for such permit to fle a signed statement
that he or she is licenssd pursuant to the provisions of the Contracmrs
License Law�(Chapter 9(commencinq wi[h Section 7000) of Division 3 of the
Business and Professions Code)� or that he or she is exempt Iherefrom antl
the basis for the alleged Bxemplion. Any viola[ion o( Section 7031,5 hy any
applicant for a permit subje�ts �he applicant [o a civil penal[y o(�not more ihan
five hundred dollars ($500).): " �, ' " -�
❑ I, as owner of the propeRy, or my employees wi[h wages as their sole
compensation, WILL DO THE WORK, and the siructure is not intended or
offered for sale (Sec. 7044. Business and Pro(essions Code: The Contractors
License Law does not apply lo an ovmer of property who builds or improves
thereon, and who does suGh work himself or herself or through his or her own
employees, provitletl ihal such improvements are not intendetl or oHered for
sale. I(, however, lhe builtling or improvement is sold within one year of
completioq the owner-builder will have lhe burden of pmving tha[ he or she
did nol build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business and
Professbns Code: The conlractors License Law dces not apply ro an amer of
property wfio builOs or impr0�es Ihereon, and who con[racts (w such prqecl with
a contracta(s) license pursuant tothe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SlgnaWre Dale
305]-a6(3/0]) '
Owner ID venfietl by drive� __.:ense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ovmership by (type ot documen[, i.e. - property tax bill oi deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetldy thal no excavation five (5) or more feet in depth into wfiich a
person is required to tlescend, will be made in connection wi�h work authonzetl
by this pertnil, and that no building strucWre, scaffdding, falsevrork, or demolition
or dlsmantling Ihereoi, wiil be more than thlrty-six (38) teet hlgh. (Chap. 32, Gry
2, Art 2, Sec. 341, Ttle 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division o/ Industrial Safery, as noted above, unless
such person has a permit to do such work from ihe division.
Applicanl's SignaWre
Division of Indus[nal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICA710N:
1. Will Ihe applicant or present or future building occupant need to file and
certify a Business Plan (or emergency response ro release or threatened
release oi a hazardous material? ❑ Yes ❑ No
(Section 25505 0( the California Heal�h and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight ot
500 pounds, or a volume o/ 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicaN or present or tuture building occupant neetl to fle
a registretion form (or acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Sa(e[y Code, vnth some
exceplions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous ma[erials equal [o or greater [han a weight of 500 pounds, or a
vo{ume ot 55 gallons, or 200 cubic feet of compressed gas at standarC
temperaNre an0 pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Preven[ion Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides Ihat the
Costa Mesa Fire Department may require the preparation, certi�cation and
fling wi�h Ihe Fire Deparlment of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Pire Department.
4. If an RMPP is presen[ly requiretl, has Section 25534 0( the Califomia
Health antl Safery Code been fully complied with? ❑ Ves ❑ No
5. Does or will lhe appliwnt or present or fumre building occupant require for
the work whic� is the subject of this application a permit for such construction
or modification (rom the South Coas[ Air Quality Managemenl District or (rom
any other air polWtion control tlistrict or agency? � Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires lhat the requestetl
information be fumished on applications fa rron-residential 6uilding permits).
6. Will any parl of the /acili[y [o be constructed under lhis permit be within
1000 feet from Ihe outer boundanes of a school? ❑ Yes ❑ No
Qf'yes", the faciliry must meet [he requirement of Sec[ions 25534 and 42303
of Ihe California Health and Safety Code).
7. If a permit (rom Ihe South Coast Air Quality Managemen[ District or other
air pollution control district or agency is required tor the work which is Ihe
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. pf "yes", attach ceAificate of compliance trom the appropriate air pollution
control officer). � ' -
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct I agree to comply with all state laws antl
city ortlinances regarding Hazardous Materials and Emissions.
Signature Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceni(y under penalry of perjury ihat I have read this application and state that
the in(ormation given is cortecL I agree [o compy with all sta[e laws and city
ortlinances relating to builtling construction, and authorize representatives o(
Ihe Ciry of Costa Mesa to enter upon the above-described propeAy for
inspeclion purposes. I agree not to occupy or allow occupancy o( any building
au)Cuiae�by lhis pertnil until finat inspeclion.
�oe 6
Dal _Y
CITY OF COSTA MESA
.
BlIILDING DIVISION
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us
�, FOR INSPECTIONS CALL: (714) 754-5626
��
PERMIT NUMBER: M08-00139
PERMIT TYPE MECH STATUS: ISSUED
APN: 93519002 DATE ISSUED: 1211212008
ISSUED BY: BJK
JOB ADDRESS: 348 SYDNEY LN CM Suite/Unit:
Vicini[y: HALLWAY CLOSET , - - " �
SQ. FT: D - �. + -- . � -
SCOPE OF WORK: REPLACE'FAU WITH �A�NEW 100K BTU LOCATED W 2ND FLOOR HALLWAY CLOSET.
OWNER: HEWITT, JEFFREY M- _ Address:
PHONE: 949-642-7142 - - . . City/State/Zip:
APPLICANT: RON BEWLEY �- - � � Address: �
PHONE: 7�4-534-7010 - � � - � City/State/zZip:
CONTRACTOR: R AND R CONSTRUCTION -
Address: 11832 MAC STUniY., ;- PHONE: 714-534-7010 �
City/State: GARDEN GROVE;,CA ZipCode: 92626 ' .
MECHANICA� PERMIT FEE SUMMARY
MECH ITEM FEE: , , '$41.70
PLAN CHECK FEE: � - . .. $0.00
INVESTIGATION FEE:, - � $0.00 �
REINSPECTION FEE: _ ' ;$0.00 � � -
TOTAL FEES: $41.70
348 SYDNEY LN Unit:COSTA MESA, CA
11832 MAC ST Unit:
GARDEN GROVE, CA
License No. 609338 �
CELL:
NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ,_
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 ezpirafion of this permit.
COOE/, INSPEC➢OXTYPE DRTE INTIMLS COUEf INSPECTONTYPE D"�y� INTI71RL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical � .j�
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical �
201 Final BIocWRetaining Wall 272 Final Fire Prevention
202 Final Factory Rire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolitiqn 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the (ollowing declarations:
❑ I have and will maintain a certifcale of wnsent to self-Insure for workers'
compensation, as provided for by seclion 3700 of the Labor Code, for the
pertormance of the vrork (or which this pertnit is issuetl.
Ga❑ I have and will maintain v.orkers' compensation insurance, as required by
section 3700 of the Labor Cotle, for the performance of the aork tor which this
pertnit is issued. My vrorkers' compensation Insurence cartier and policy
number are:
Carrier
(This secfivn need irot be complefetl Rthe permrt (s valve0 a( one huntlretl Dollars (5100) o� less )
Policy.IJumber:
���certi(y that in the peAormance of the work for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
yecOlfT€�bject to Ihe workers' compensa[ion provisions of Sec[ion 3700 0!
WARNING fAILURE TO SECU E W OMPENSATION�OVERAGE
IS UNLAWFUL AND SHALL BJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(8100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chap[er 9(commencing
Owner ID verified by dnve� _...;ense. ❑ Ves ❑ No
Dnver's License No. Expires:
Verifcation of Ownership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certRy lhat no excavation frve (5) or more fret in tlepth into which a
person is requiretl to tlescend, will be made in connection vrith work authorizetl
by this pertnit, and �hal no building sWCNre, scaHolding, falsewurk, a demolition
or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2. Art 2, Sec. 347, Ttle 8, Cali(omia Adminisl2tive Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division ot Industrial Safety, as noted above, unless
such person has a permit to tlo such work trom the division.
/ ApPhcanl'sSignaWre Dale
Division of Industrial Sa(ety Permi[ Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl to file and
certity a Business Plan for emergency response lo release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safe[y Code requires, with some
exceptions, that a Business Plan be fled 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 [han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas
at slantlard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and p_ Does or will Ihe applicant or present or fuWre building occupant need to file
my license' in f f e r� rX�' a registration form for acutely hazardous malerials? ❑ Yes ❑ No
_c.y# U G ss # S tion 25533 of the California Health and Safety Code, with some
�_ '� exceptions, requires registration with the Costa Mesa Fire DepartmeM by
� each business which at any one time has on hand a quantity of acu[ely
omractor'sSignaWre c�e - hazardous matenals equal to or greater Ihan a weight of 500 pounds, or a
� volume of 55 gallons, or 200 cubic (eet of compressetl gas a[ stantlard
CONSTRUCTION LENDING A Y: temperature and pressure).
❑ I hereby affrm that there is a construction lending agency !or the 3. Does or will the applicant or present or fuNre building occupant need to
peAormance of Ihe v.ork for wfiich lhis permil is issued. (Sec. 3097, Civil Code). prepare an RMPP (Risk Management and Prevenlion Program for acu[ely
Lender's Name: hazardous materials)? ❑ Yes ❑ No
. (Section 25534 of Ihe California Health and Safety Code pmvides that the
Lender's Adtlress: Costa Mesa Fire Department may require the preparation, certi(cation and
. filing with lhe Fire Departmen[ of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
Signature , Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm ihat under penally of perjury [hat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing 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 permi� �o fle a signed statement
that he or she is licensed pursuaN to lhe provisions of ihe Contrac[ors
License Law (Chapter 9(commencing with Seclion 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 ihe applicant to a civil penalty o! not more than
five hundred dollars ($500).):
❑ I, as owner of the pmperty, or my employees with wages as [heir sole
compensation, WILL DO THE WORK, antl the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
thereon, and who tices 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 vrithin one year of
completion, the ovmer-builder will have the burden of proving that he or she
did no[ build or improve for purpose of sale.). �
❑ I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construcl the project (Sec. 7044, Business and
Professbns Code: The cont2ctors License law tices not apply to an owner of
property who builds or improves Ihereon, and who con[racts for such projec[ with
a contractor(s) license pursuant to the Contractors License Laws.).
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will the applican[ or presen[ or (uture building occupant require for
lhe work which is ihe subject of this ap0lication a permit for such conslmclion
or modification from the South Coast Air �ualiry Managemen[ Districl or from
any o�her air pollution conUol district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemmenl Code requires Ihai ihe requested
information be (umished on applicalions fa non-resitlential building pertni[s).
6. Will any part of the (acility to be conslructed under this permi� be wi[hin
1000 fee[ from the outer bountlaries of a school? � Yes ❑ No
Q( yes", the facility must meet the requirement of Sec[ions 25534 and 42303
of Ihe California Health and Safery Code).
7. If a permit from the South Coast Air �uality Management Distric[ or other
air polWtion con[rol district or agency is required for Ihe work which is Ihe
subject of this applica[ion, have all ot the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach ceAificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
infortnation given above is correct I agree ro comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
Signawre oa�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certif under enal[ of er'u Ihat I have read this a lication and st t th t
Y P Y P 1 7 PP a e a
�Fi I am exempt under sec. the intormation given is correcL I agree to comply with all state laws and city
T ordinances relaling to building construction, and aWhorize representatives of
Business and Pmfessions Code for this reason: the Ci[y of Costa Mesa [o enter upon the above-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any building
auth ized 6y this permit until fnal ins ion.
Sign re ol L al Owne � /� Dat
Signawre Oa�e �� /
309-46 (3/01) �
An0/orAu��onzedAppli ale. _ 7
CI1�Y OF CDSTA MESA
CAyFORNIA 92626 P.O. BOX 1200
FROM THE OFFICE OF THE PLANNING DEPARTMEM
nate: '9a�ch 3, 1977
� The City of Costa Mesa wishes to advise you that in revising street
� addresses, the following addresses have been changed:
U 0 A DRESS
2032,d�JA4,?0�36 a 2088 Thurin Street
��
U�', 3e�') �'a"�'. s���
� �J`
i � ,
NEW ADDRESS
3�6-348 Sydney lane
(Private st�eet-
Sse atiathad maDj
A.P. N0.
It5-220-43
For your convenience we are listing below the agencies we have notified of
the change. In addition to those listed, you are advised to notify your
correspondents of the change in order to avoid any possible interruption
of mail service.
Your cooperatior. in this matter is appreciated.
Very truly yours,
�� �
Charles W. Rob rts
Director of Planning
cc: State Board of Equalization
Finance/$ond Division
Building Safety Department
Communications Department
Costa Mesa County Water District
County Clerk
Engineering Department
Fire Prevention
Pinance/Revenue Division
Orange County Tax Assessor
Pacific Telephone Company
Police Department
Public Services Department
County Registrar of Voters
Southern California Edison�Company
Southern California Gas Company
Street Department
United States Post Office, Costa Mesa
File
Z�B��� 77 FAIR DRIVE (714) 556-5245
PFOJECT AOOflE55: 3 Q 8 SYDNEY LN
owNexsr+nme: EVERGREEN ASSOCIATES
aooness: CIO JIM LOCKER
326 SYDNEY LN
COSTA MESA CA 92626
(719)646-6�57
pflCH/ENGINEEH:
q00HE55:
Aec.xo.:
UNIT:
� PEBMITTEE: CRANK BROTAERS ( 714 ) 548-5569
� aooeess: 126 COMMERCIAL WAY
COSTA MESA CA 92627
LICENSEO CONTFACIDB OECIAflATION: I hereUy aflirm thai I am Iicense0 under provisians of Chap�er 9(commencing wi�h Section
]000� ol Orvision 3 0l t�e Business and Pmlessions Cotle, and my license is in lull force antl eifect.
c�rvuc.:�5993 srnreuc.:q08677 ��3�
Oa�e: � !l � 3 Signalure: � 9> �
WOHKEflS' COmPENSRTION �EClAflR7lON: I hereby aflirm that I have a cenilicate of consent to sel6insure or a certilicate ot Workers'
Compensalion I�5}�r�e, p[ �r,gr ilie� 4QO,y We[goj�$eclion 3800. Lab.��
POLICY NO.: L tf 7 U 1 U V L L 4 EXP. UATE: S� O S� 9�i
comraxv: STATE FUND
� CeNlietl copy is hereby turnishetl. � Cehilie0 copY is filed w/i�� Ihe �ci�y Builtling Division� /�
�ate'. "�/ � � ` ppplicanl. i,v / / � " `
E%EMPTION Fp M WOBREPS' COMPENSATIDN �ECLAPATION: Qhis section neetl noi 6e compleietl if t�e permit is �or one hundreA ($100) or less�.
I cerlity Ihai in �he OeAormance of Ihe work lar which Ihis permi� is issued, I snall not employ any person in any manner sa as to become
su�le�� �o ihe Workers' Compensation Laws ol Cali�omia.
�ate: Signamre:
NOTILE: II, after making ihis tleclaralion, you ShoWd become SUDject lo ��e Workers' ComOensa�ion provisions of t�e Labor
Cotle. you mu5i torthwn� compty with such pmvisions or this permi� Shail �e 4eeme0 revoked.
' CONSTNUCTION LENOING FGENCY: 1 here�y alfirm Iha� �here i5 a con5imction ientling agency �or ��e petlormance a� �he work tor
i wnicA i�is permi� is i=.sue0 (Sectian 3W7. Civ. q.
LENOEN:
aooxess:
OWNEP BUILOEB OECIAflpTION: I hereby a��irm thal I am exempl �mm �he CoNracbrs' S[ate License Law for �he �allowing reason
(Section 7031.5 Business and Pm�essional Code: Any ciry oi county whic� reQuires a permi� to constmc�, alter, impmve, Oemolish, or
repair any slmc�ure, prior ta i�s issuance. also reQuires �he applicani for such permii to �ile a signe0 statemen� Ihal he/she is licensed
pursuanuo Ihe Omvisions of the Comraaors' Slale License Law (Chap�er 9(commencing wi�h Section 7000) ol Division 3 ot �he Business
anU Prolessions Cotle) or Iha� he/s�e is eremp� �herefrom antl the 6asi5 lor Ihe allegetl exemptian. Any violation ol $ection 7031.5 by
any apDlicani br a permi� subjects �he apDlicanlio a civil penalry ol noi more ��an bve huntlred �olla�s (5500�.
I. as owner oi Ihe pmperty or my employees wilh wages as Iheir sole compensa�ion, will Oo t�e work, antl Ihe
❑ simclureis notintentletl orofleretlforsale�5ection 7044, 6usiness and ProfessionalCoee: The Conlractors' State litense Law
tloes noi apply to an owner ol a pmperly who builtls o� improves ��ereon, and who tloes such work himseli/he�sell or Ihrough
his or �er own employees. provi�ed �ha� suc� impmvemen�s are no� intentled or offeree br sale. II, however �Ae building or
improvement is sola wi�hin one year oi completion. �he owner will have �he burden of pwving helshe did noi Uuild or improve
br Ihe purpose of sale�.
I, as owner af Ihe pmperly. am exclusively contracling with licensed contrac�ors �o cons�mct ihe pmlecl (Section 7044, Business
❑ and Pmfessions Cotle: The Contractors' S�a�e License Law does no� apply lo an owner o� D�oPe�Y w�o builOs or impwves ��ereon
and who conimcts �or such pmlecis with a contrac�oqs) license purSuaN to ��e Contracmrs' Stare License Law�. I am aware
ihal pma� ai their Warker's Compensation insurance shoultl be pmvided lo me.
� I am exempt unoer 5eclion: 8. 8 P. C.
I �0� IIIiS fCd50fl:
Daie: Ownec
I tlo hereby cetlify �ha� I am aware ol antl unaerstantl lhe requiremenis of Cahlomia Health anA Safery CoOe Sec�ions 25505, 25533, and
25534 antl Ihat I or any fulure builtling occupant willlwill no� (cucle one) need Io comply wilh saitl s�a�e catles antl Ihe reQuiremenls for a
permii lor conslmciion or modilication imm Ihe Air Ouali�y Management Disirict. Fesitlen�ial cons�mc�ian applications are exemp� irom
ihese pmvisions.
Oate: Appl¢anC
I hereby cei�ily �hal I have reatl Ihis apP6calion antl 5�aie lhat Ihe a�ave inbrmation is correcL I agree �o comply wilh all ci�y antl counry
ordinances and s1a�e laws relating to �uilaing consimclion an0 herehy aNhorite reDresenlatives of ��is ciry lo enter upon I�e a0ove-men�ioned
pioperty lor inspe�c lion Ompose5.
Oaie: C ^ � � � � Signalurer o �
Oriver's �icense or Socia� securiiy x:
I6a1-46 W�ile—Builtlinq', Green—Cotle EnbrcemenC Canary—ApPllcanl; P'mk—Revenue; Goltlenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H
PERMIT NO: B 063816 PLAN CHECK NO; N GOVT: N SUPP;
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; ALT
JOB DESCRIPTION ; T/O COMPO 6 INSTALL NEW FHGLS COMPO SQ FT: 2,100
CLAIM VALUE; 2,100.00 CALC—VALUE: 2,100.00 GROUP OCC: R-3 /M-1
COMMENTS; SMOKE DETECTORS REpUIRED PER THE 1991 EDITION OF THE UBC* ����'�'
**�r�r+t�t�r�r*�t�r�r�*��t�r�r**��t*�t*�r�r+r#�t*�t�r*�e**��rQ�e�r�e**�x*+r*�rx*�r*+r*�t�rx�I'\� �,�i":
Z O N I N GS ERTEB AUCIKRSE M E N T S
�EQUIREQ
------------ MAIN BUILDING ---------- --------- ACCESSORY BUIL ING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL: 93519002 ZNE; REF NO:
PLANNING N01'ES>
� �. • �.
�FiE iE iF iE ikiF 1f iE if 1E 3F iE iE iE iE iE iE iE if iF �F �F iF iF �E iE iP 1EiEiE dE 1FlE ikiE if iE iE 1E 1E iE iE iF iE iE iE iE �F if iE it 1E1E 1k if 1E �f if if iklk iF iF iE if if iE iE ik 1E 3f iE iE iF iFif iF iF
D E V E.'L O P M E N T S E R V I C E S R E Q U I R E M E N'.T S
20NING APPROVEIS BY DATE: '
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY; �� \I CS��.� DATE; �
itit�titi4iEiEitiE;titititiE_1lititiFiEitiE�(-7F3F TF��1FiF 3FiFiFiFiF 7FiF iF7Fif7F 3FiFiEitititit*iFiEiFit itrit
iEififififiEiElEiEiEiFifkif�fkififiEiEifiFiF�EiEiEiFiFififkikiEiEiEiF3E1EiEif�fiEifiFiFkiEif ifiFiEikiEifififlEifiFiFifiEiEiEiEik1E'afiEiFiE1FiE161fikiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC
PERMIT 54.00
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 59.50 0.00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
54,00
FIRE SMIP/R50 GRADING
SMIP/NON—RES
TOTAL PAID DUE
54.50 54,50 ,00
54.50 OVER/SHORT: ,00
FIRE SMIP/TO�T GRADING PLAN—CHECK
iE i! 1E iFif if 1E �E iE �F�E 1F 1ElE if iE iF 3E iE if iF if iE �E iE iE iF 3k 1f if iE iF iE �F �E �E 1E �1E if 3! iE 1E iEiE iE if iF iF 1E if iE iF�E iE �F iE iE iF 1E iE 3Fif IE iF * jE 1E iE iE iE iE iE 1E 3FiF iF 1E �f if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2100 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,100.00
END OF FEES
O1 00146337—Q0146338 TC+T 54,50
DATE: 09Ju3/9: TIME: 11:06
,.,.�-.
CONSTRUCTi6N ANDPLANNING
� APPROVALS Permit#
� 7. Temparary Electr�cai Service or Pole
i
� 2. Soil Pipe�Undrgrnd.
r- • `
3. Electrical Conduit Utdity�Undrgm(t.
i4. Elec`,.2aI Conduit-Undrgrnd. �
�-: �. Sieei Zclnta�ce,�ient .. -
� 6._E'ectrica! UF�R Gind. �
� .7."E�pt�nys � .
� 8. Foundation •
�9. Watar Pipe�Undrgrnd.
I iC. Sll�ctur&! Fioor System
, it. Arope�ty Sewer �ine & Ho�ssConnection
�--
� 72. Sev�e� Cap � �
13. Hoot Dra�ns �
14. Fough Pium6mg
. '5. Rough Efectrica6Condwt
i6. fla�7h Electric4Viring
1 %. fiouyh tVir�ng Sign
18. Rouyh Electric36T Bar Ceihng
79 Rouyh Heat�ng & Air Conditioning
i. ��
'Jfy�Ro�y1 �ac.�'ry FL'rPPlace ' . �� .°;, .
i
21�. �Ou.is, in Struct�re , •• ��
22. Ducts, Venti+ating ' '
. =. .. . i
23. Gzs Pipe;F�ough & Sest � . .
24"Roof Fr2ming ' - � '.. ..
-- -�--�-n,
25. Roo� Sli�athing �-. .�
26. T�Car Ce;i�nq (Strueturall & h�onocoat
27..Frpme�nd Flesh�ng '~i..
r -*-� .
28. Lazh�ng:& 5i���g_,> � •' - �.. _
��..,,
29. Insulation . . ' �•�
� 30. Dryx�aihNaitmg ^ �
, 31 . P�aster t�3ro�yr� Cont� • i, ,
r-•-------f--
32. E�ectr�cai Pou�er Metei�Flna�
i�
. 33.i Final Eiects;c . , i _
_ •--r, -Y*..�
�34. Finel HeA[in�ffiAirCunditipning �'•
r � � � ,
i 3F,: Pihal G:u Pipe�Te;t " �.
36. Houd ocCar,opy � -
�
37; Final Factory Fucplace. � �
38. Final Plumbing � � '
39. Water Service-FinAt '
40. Gas Serv�ce�Final- , �
,`
41. Solar pomes.�c-Plnal '
42. 6ackflow Preventer � �
43. Backflow Irr:gatior� -
..44. landscaPe t�rigatia`,.ZSYstem �
45. Sound Atteeuatio�i'�� . . '
4G..Hantllca� Regulati��i � •�
47.�FIRAL STRUCTU�i� &•�UILDING'
.���
h8' fll'dALP�ANM(�;li `
�w._4__ -
' A5: EIAGtric Release to' Edi�i3tt
50 Gas�ReleasetoSou4he�dCaliforniaGasC
_ Date
POO. SPA
Date Inspector PP P Date
A ROVALS ermn ,-�
52. Pool & Eyvipment Location
53. Stcel Reinforcement
54. Forms
55. Electricai Bond�ng
56. Rouyh Plumb�ng & Pressure Test
57. APPROVAI.TOCOVER-GUNITE
58. Electrical Corduit�Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O U�drgrrd.
67. APPROVA� TO DECK
62. Baako;ash & ReceptorFinal
63. Heater & VeAI-Final
64. Piumbing System � Final �
65. Eloctrical-Pinal
66. So�ar System�Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTEftING
69. POO�/SPl� SYSTEP�iS F INAL
FIRE DEPT. REQUIREMENT
� i n [
,' f1PPRtiV1�L$. " ,Pemiit ;kT ,�'_,
..+--�
' � ' 70. lindergrdu��d Hydre '
,i
�' � . �.71. Produci.Pih�ng!'7Gp�s QOii
- . i-_'--^-1 .
� . � :72. Underqrountl Flu�,h� . . . •
. -1-
� �- 73. Undergrnn. Stora jc'�Tznk�O Gas ❑(9il
��p�W' . 74. Overhead HydrC
� ' ; 75. Rry Cher*ticai - ,
Y 76. Dry StandpFpe . � ' �
" ' 77,, FIXED $y�TEq�,"r,INAL ,
_�-�. � 78: FIRE PREV. FIN }L • � `
HFALTI�i DEPT. REQUIREMEiVT
��� . 79. �FINAL IhhRECTI�N � I
--'-�- -
SOr FOOD CERTIGI(;Y��TE ISSUED
i
Notes: . , • i , �
i;-....-.-
� _,
I�spector
OWNER
JOB AC
BALALIS & PTGNERI
AP No. 115-220-03 L07
GRS
PROP. SWR. LIHE � I NOUSE
FOUGM
POWER
ROUGN WIRING
TRENCNES FORMS
FLOOR $YSTEM
BONO BEqM I^I STEEL
SHERTH�NG
FRAME ANO FL�SMING
LATHIHC - IN n
VENT
BUILD
DATE
SUBCONTRACTOR
OWNER RAT,QT,� & PIGNERI
JOB ADDRESS 24f3 s.�„ev r.
INSPECTIONS�
soa
G�5
W�TER
ROUGH p�UMBING
PROP. SWR. LINE
HEATING ANO �IR CONDITIONING
R�RY SEFVICE OR POIE
;ROIIN� � POWEN �
WIRING
DATE
:7.'.�
:on-Elec. Ground Sigp
SUBCONTRACTOR
FOPMS I I STEEL NEINF. � � I I II �11'- � .
FLOOR SVSTEM
BONO BEr1M [� 'STEEL PEINFORCE
SNE1Tq�NG
FRRM[ 1q0 FLASNING
LATNING - IN [] OUT n
PlASTER, BPOWN COAT
STpUCTUFRL, FINAL
NE�TING. VENT., REFRIG. ANO A.C., F
PLUMBING. FIN4L RNO WS TEST rI
G4�05
�;�76�1
S
Building Site Addres
Name of Lessee _
Q Contractor
H
e Address
QLegal Owner of Sign
; Addxess
❑
❑
❑
❑
❑
❑
❑
G[ound
Wall
RooC
Projecting
Constrnclion
Convenience
Super Gcaphic
� I ❑ Planned Signing
W C.UP. No. _
LL
All applications must be filled
Signatu[e of Pe[mit[ee
Authoxized Agent
Received by
CITY OF COSTA MESA Tag No.
SIGN PERMIT
Planning & Building Safety Departments Type of Sign �
❑ Electr on-electric
.�ocaC-'9�/Ii�, . ; `�.� y' ::.)
z�i( �//�
,�y� Phone 4�P:�Nn7`/`% �`[✓�/
City
City
Descriptions
❑ Canopy
❑ Attcaction Board
❑ Adve[tising Sta[uary
❑ Othec
❑ T[act Sign (Security & Right of En[ry Agreement)
❑ Speciel Event (Request foim submitted)
❑ Change of Copy (amortization)
Pcogams
❑ Shopping Centei/Integrated dev.
� By Ownei/or ❑ by City
(Dare letter sent
�
Date
Signatuce (Bldg. Stat�� /� // �
Date `/v V
CMF 0068-26 Whlta - BullAing: GYeen - Customef; Canary
JUL 28-77crosA�03179� *�**17.50
OfficeUseOniy . � ��r'�':�:Y:
Property � �
� ,: , .,�.:;N ^r:: ..
Phone Sign DisL �DateiReceived:. �-2-��'77
State License No. Received by: �� �
Cit LicenseNo. � � � "'-�' "������ � �
Y .. Sfxeet fcontage: ':: - . ....:.::. . . .
...; ;.. . ...
� `.i:Fcont: ..,:.. . tt. "�'-'Sueet ?i!� . �...:..,:.:���-. -
— Z�P Right: ft � St�eet: ' " �
Lefi: ft. � Street: �
Phone Reaz: ft Street:
HuIlding set back hom centet line of sfreet `.: ft. �
_ Z�P .:.::.. ... .. : .. . _p; .. .., ; �
Mastec Plan Highwiys ultimate right-bt-way ��-'�ft.
Sign Location
Illumina[ion
❑ Non-illuminuted
❑ DvecUy lighted
❑ Indirec[ly lighted
❑ Vaziance
) ❑ MinorVaziance
a�ing, electrical and final Inspections shall be called. (714) 556-5273
VaWation: � �� QO
Planning fee.
_ $ �(j tlti
— � A_ �uilding fee
(/ Plan Check fee
Total Fee $
Date Approved � d % '% /
_ � C� t�� R "c,-
�-- . Sjgnature(PlanningStaf�
_ HQ.4Q�hof�.RJ6jecY�[anCFFWL'i[i^�'cZC7�lCCfVIC�V 1 �d)
Planning; Pink - Flnance; GolOen�otl - Assessor
Fiont Right LeR -
� Batween pioperty line.& pltimate cight•of-way � -
� � Gtound Signs . ' � '"
� 7 ft. & 15 sq. ft./or ❑ Tabie 2 Planter Area=
- �!y S�� .� ��. ��'
Area of Sign _�i't. �n x .�t �: _ � . �
. . .. , � sq. ft." "� ' .
Gcound Cleazance,� /�. '
Ove[all height �Y �
Letter height �,� �� /ii � .
/
'�".' (tems of Infoanation ��"� '� � �
'� Tbtal sq. f6 oF aIl Signage ��" � ��
� � Amortiza[ion � � �
Subject to AmortizaUon: ycs ❑ - no ❑
Bzpuation Date � � � �
... . �.- . . , .. ..
"�� :.•.s':.. �rOPficeUseOnl ..:• ... .., ..:.
.;... . y .;,..... ;' � -
. .. �; g(Insp.B Px B. ; .
D
a
i 4 ,_-F: ., .
F iri.�