HomeMy WebLinkAbout2053 SWAN DR - Building Permits CITY OF COSTA MESA
•
O a"'Fsp BUILDING DIVISION ' • s
ail f77-FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.cosla-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: M10-00059
PERMIT TYPE MECH STATUS: ISSUED
APN: 13953307 DATE ISSUED: 06/25/2010
ISSUED BY: KJB
JOB ADDRESS: 2053 SWAN DR CIX Suite/Unit:
Vicinity:
SQ. FT: 0
•
SCOPE OF WORK: CHANGE OUT FURNACE.5 TON UNIT
OWNER: DOSSINGER,DONALD A TR Address: 2053 SWAN DR Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: ESTRADA,RICARDO Address: 2712 LA CADENA DR Unit:
PHONE: 310-838.6666 City/State/zZip: RIVERSIDE,CA
CONTRACTOR: VENVEST BALLARD License No. 878533
Address: 2712 LA CADENA DRUnit: PHONE: 310-838-6666
City/State: RIVERSIDE,CA ZipCode: 92507 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
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: 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 expiration of this permit.
CODE/ INSPECTION TYPE DATE ROT CODED INSPECTION TYPE p DRT I TmRA
1816 Fixed System Final Fire Prevention 206 Final Mechanical 0 /L-r 0 /On
1266 Pool Spa Final 208 Final Plumbing
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑ No
I hereby affirm ander penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I ave and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.ke.e.-property tax bill or deed):
comp- cation, as provided for by section 3700 of the Labor Code, for the
,• mance of the work for which this permit Is issued.
`,4have and will maintain workers'compensation insurance,as required by
3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My work s' 'compe ation Insurance carrier and policy ❑ I hereby certify that no excavation free(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
trigPts / //�„,r by this permit,and that no building structure,scaffolding,falsework,or demolition
(This septan need not be completed iThee permit is valued atone hundred dollars($100)or less.) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
f j 40mber.
1✓ S Q So a 3 31 yo J 2,Ari 2,Sec.341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become,subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Ica r Code sha ••• ' . ply with these provisions.
a" 05—:-/C) Division of Industrial Safety Permit Number:
antatilln °- 0111111=0" HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
S
3 3 ,;. • t/ "° (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
contra _ el I 36 i 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? IDYes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ 1, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If. however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044.Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signa e of I er :le
signature Dale .b/
3057.46(3/07)
Simplified Prescriptive Certificate of Compliance: 2008 Residential f/VAC Alterations CF-112-ALT-HVAC
r--
Climate Zones 1 and 3-7 •
t •
Site Address:fcR b5...2j Enforcement Agenc meJ _ _�� •�S/a0#_ ` 1
i\-I C' '_ {M 111 e5 la V J
ConditionedDuct insulatio
Equipment Type' List Minimum Efficiency? Floor Area I rnquireme I I�p I Thermostat
fkaged
Unit J !�Over 40f f duc,sace ❑AFUE ❑COPe/i; ❑Setbacl:Served by system addelnoor Coil ❑SEER ❑HSPF (If oat already present.must be
o Condensing Unit 0 EER 0 Resistance 7� sf pnepndmo to pace nstalledJ
0 Other R 6 (CZ 1,3-5)
•
/. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-I R-ALT-HVACfor each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. it
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations.
. • The_design features identified on this Certificate of Compliance are consistent with the information documented on other.applicable _ . . . _ __ . ... .
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcementtgeage�ncy forapprovalwith the permit
7appli
Name: ca 1 n, SS�'�l ], Signature:
Comport)'( I�M I/-��-r ,' S���,;t�� Date:/ _2 /0
•
Address: \ ' License: S 3 3
2'7 f 2 (y CAI d�t-t.k OP /
City/State/Zip'. *'\' -$w wu Cl/F. 42 Z. j G-) Phone:\3(0) 4 ..3 - b b,t 6
•
2008 Residential Compliance Farms March 2010
Dossinger: Donald & Arlene #2761.6 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. •
CITU O¢ COSTA MESA CONSTRUCTION PERMIT - PERMJ,7 NO.� Si, 7 / TRACT NO. LOT NO. UNIT NO. 6407 3/08/(1 ' 72850 TL
Project Address 2053 Swan Drive �U 7 W r1 D[�
'Applicant's Mailing Address 450-D Apollo Street in Br O$VP�EI OF CONSTRUCTION U NEW LJ ADD U ALTERATION a REPAIR I
Owner's Name Dossinger: Donald Epharlene #2751.(1' CONVERSION ❑ DEMOLISH ❑ THE Roof with Sierra Ti lGP # Zone
2053 Swan Drive Costa Mesa, Ca 92DESCAIPTIONOFWORK/USEOFBLDO.
Address over existing�oof.�.CgON4�61 9.6 SC]S— S Main Building: Accessory Building: Z
Arch/Eng. License No. TYPE OF PERMIT U GRADING FOUNDATION ❑❑ STRUCTURAL T Front
O
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name
Western :Sierra Ropy ne 529-1019 ❑ OTHER A I
C Right N
450-D Apollo Street Brea 92621 PROJECT DESCRIPTION SD. FT. 2700 OCCUPANCY R 3 K G
Address mailing) p - C ON ST RUCTION TYPE VTT VALUATION 5_4.32.0- S Left
CityLicense No. 39991 . • R
ZONE GRADING CU.YDS. ACRES Ping. Ref.# L LT ParkingLReq./Provided QQ E
LICENSED affirm irm that I a liRcen
DECLARATION RECEIVED FEB X988 0
I hereby that I am lIsl• Under provisions of CharfC!9 ncinq Remarks: Planning Notes: M
with section 7000) of DivIsi. 3,of • ''' sines and Prof Ions Code,and T
my licen e is in f II f.r a and -fleet.
Do Lice 5 �• '7 .nflAN. 92599 — et s
op Dam r][�1� ign. �t� -���`' PLUMBING FEES , RECEIVED
"'ORK'RS'CO PENSATION DELLA RATI• Bar Sink Showers ELEDTRICALRECEIVED MAR FdkS�''�BJ
sreby affirm that I have a certificate of cons-• to self-insure or a certificate `_
Workers' Compensation Insurance, or a cern copy thereof (Section Backflow Presenter Service Sink
6800, kers' 1�' ]-1 ("� /1t Automatic Washer Transformer 0 15.50 KW
Policy No. "-"-�-/ l l�� Company v"" Backflow Irrigation Sewer Cap •• Construction Pole Sub. -
0 50+KW
Certifi copy is ereby furnished. r
a i l d with the:citya I. . .i ior�• Bathtubs Sewer Connection Cooking Unit Meter Dui,to 100 amps
ED e �fr-T f Applicant t '
EXEMPT ON FR M WORKERS'COMPENSATION C ARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(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 041 HP 011-8
Workers' Compensation Laws of California. •—
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets 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 Contractors License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or P
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
.he Contractor's License Law(Chapter 9(commencing with Section 7000)of '
l vision 3 of the Business and Professions Code) or that he/she Is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
.031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). $ 3
U I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee 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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
-
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II D 'jt'
elution, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground f Building Approved By Date
prove for the r of the property,ooer. • ' n`
❑ t rs owner tr ct t eroject Se tion 7 44, sinesscontracting with of licensedionode- Duct-Structural Refrigeration Svsletq p D Application Issued By �.(�/ Dat
hetors t construct the project(Section to
Business and Professions Code: 4r4R$t,^//�llee�Jl S
The Contractor's License Law does not apply to ran owner je property who Duct-Ventilating ❑410 •BT TLJ 171W SUMMA Y F.EEES
builds or Improves thereon,and who cont is such projects with a con- fsl nQ O'7` v
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System RRir/Alteration - . BUILDING PERMIT $ SMIP $ ��
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. IC80# Oafs Dampers sig....—. PLUMBING $ ISSUANCE $
Date a Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereb certify hat I have rea• t' s application and state that the above ❑4100,000 BTU 0100,000 BTL 1f ELECTRICAL $ GRADING $
' inform Ion is correct, I agr: . comely with all city and county ordinances 1
and st.to laws relatim t. •uildi g co struction, and hereby authorize repre- I PLAN CHECK 50% $ MICROFILM $
sumac' es of this open the above-mentioned r erly f g ->\
I Siena
Ion p r��y,I q� MECHANICAL $ _ �J-7 (-J
Signa `JI.�/� JL Dat
CMF 086 - •,rev. ' .' lie - :outline: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL'&- PA
Date Inspector APPROVALS Pe[!rlit# Date Inspector
APPROVALS •Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement et% a
3. Electrical Conduit Utility-Undrgrnd. 54. Forms )r.`4.
,-J
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding- I t)
kn
5. Steel Reinforcement 56. Rough Plumbing Si Pressitfe TO t
6. Electrical UFER Grnd. 57. APPROVAL TO COVE '•GUISUTE •
is
7. Footings J.. 58. Electrical Conduit-Undgrnd .
8. Foundation 59. Gas Pipe, O Undrgrndu 7estLL!
9. Water Pipe-Uridrgrnd. 60. Backwash Lines, P-Trp'❑ Ugflrgrnd.
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 U 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 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning �.
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 l
EXPIRED
43. Backflow Irrigation Inrnmplete In5Oect1Of1
44. Landscape Irrigation System L
45. Sound Attenuation Date (� 11S18
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 4fE
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMI NO. TRACT NO. LOT NO. UNIl'�_
Project Address 8oc3 Su�-+1 r?.s' • v 161 ►s �Ty� 6556 7/I'I/85 5,00 PL
• TYPE OF CONSTRUCTION 0 NEW LI ADD LJ ALTERATION J REPAIR
Applicant's Mailing Address ��� LI!�^ 0 CONVERSION 0 DEMOLISH ❑ OTHER A,P,# Zone
•
i _
Owner's Name p•_ I /• Phone[ DESCRIPTION OF WORK/USE OFA BLDG.
Address .4_ S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ OUNDATION E 0
lyF ❑ STRUCTURAL Front
.0 TENANT 0 ELECTRICAL - PLUMBING 0 MECHANICAL B Rear - N
Address //��//������q��q�� .rI
Contractor's Name_ r n rej•M�la Phone • /"I El OTHER _ _ _ _- - A I
• ��}�// ■ , PROJECT DESCRIPTION SQ. FT. • ' OCCUPANCY • C Right N
Address lmailingl-p _�ei . A. I i/ SW _ - - K Left G
3 CONSTRUCTION TYPE VALUATION$ $
City'License No. 4_ _ ZONE 'GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Park ing,Req./Provided• E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing G
( 9 Remarks: Planning Notes: -. M
r� with section 7000) of Division 3 of the Business and Professions Code,and '
,,�U my license is in I o <e and effect. , . RECEIVED J U L -1 1 1985. - T
% License ya s• 'cense + 1 S
Date 1/ Signature int_# z,,. SIt • PLUMBING FEES
•
(((zzz •
r WORKS S' COMPENSATION DECLARA ION - Bar Sink Showers ELECTRICALFEES
hereby affirm that I have a certificate of consent to self-Insure or a certificate ••
r-^ if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - - Service Sink - - • Automatic Washer 'Transformer ❑ 15-50 KW '
-Pol c Lab. a i• S ri r� R .�., ," lJ
Policy No. ./y,.•-rlv�d—/�O.Tr•.�,`(l ompany /`^)'(TyY7('-_(1'� Backflow Irrigation Sewer Cap I Construction Pole-Sub. • 0 50+KW
ertified copy is hereby furnished. -
. Cer ' a (fly is filed with the city Birth' • vi 10 Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps I
Date Applicant EXEMP I N FROM WORKERS'CO '•� ATI•N DECLARATION Clarifiers Solar Collectors Dishwasher ' Meter Clover 100_amps _ _ :
(This section need not be completed if the permit is for one hundred ($100) or -
less). Dishwasher - Solar Piping l Dryers ❑Gas ❑Electric Sub Panel I
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❑0.1 HP ❑1'h-8
Workers' Compensation Laws of California. - -
Date - Signature • Floor Drains. Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 01t-15+ •
NOTICE:1f,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith _ Floor Sinks Urinal .. - Fixtures • - - Microwave '
comply with such provisions or this permit shall be deemed revoked. - •
CONSTRUCTION LENDING AGENCY •
Gas Service Outlets 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 I Water Heater /'1 in, Outlets Range 1
Lender's Name - '
Lender's Address - - Kitchen Sink Water Service Switches Si• gn
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 leason (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 -
any structure, prior to its issuance, also requires the applicant for such permit Trays Generator ❑0-5 KW❑5-15 KW 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
therefromandthe basis for the alleged exemption. Any violation of Section - -
70313 by any applicant for permit subjects the applicant-to a civil
eenalty of not more than five hundred dollars($500). - •
LJ I, as ownor 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 DEVELOPMENT SER •
VICES REQUIREMENTS:
employees, provided that such.improvements are not intended or offered for Boiler - Hood or Type I 0 •
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 GroundBuilding Approved By Date
•
prove for the purpose of sale). r -7
0 I, as owner of the property, am exclusively contracting with licensed<on- ' Duct-Structural Refrigeration System Application Issued By Date_!
tractors to construct the project (Section 7044,Business and Professions Code: VV
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 CI Multiple 0 ' System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ •
PLAN CHECK $ Cq.r� • PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICRO# Fire Dampers PLUMBING $ t_lt/ ll 'ISSUANCE $ '
HeatingSystemDucting RegistersPLAN CHECK 25% $ ENERGY P.C. • $
Date owner &
I hereby certify.that I have read this application and state that the above 00.100,000 BTU 0100,000 BT - 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 repro- PLAN CHECK 50% $ MICROFILM S
sentatives of this city to enter upon the above-mentioned Prop rty for -
inspection p. •o - f •
7 MECHANICAL $ TOTAL FEE $ b1-011)
II
Signature . A 1' ./ ,4SS a__ Date 10
Drivers' License or 5$ • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
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
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, O 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 c;.; 71. Product Piping ❑Gas 0 Oil
23. Gas Pipe-Rough & Test i I 72. Underground Flush
24. Roof Framing ``. 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing ril 74. Overhead Hydro
..J
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing , 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation78. FIRE PREV. FINAL
30. Drywall Nailing sp�j 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 0'6-'J, C40
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
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
VITIVE4n rr.li ai OUnSU.VLUL'f47, .wu. "^ '• c Y w
JOB ADDRESS 2053 Swan Drive BUILDING PERMIT NO. 25117
GENERAL CONTRACTOR Same DESCRIPTION OF WORK t - c - _ : ..g
AP No. LOT 7 TRACT 54.93 FIRE ZONE VALUE $ 31 p 456.00
INSPECTIONS I Sig. „., ' Date GROUP IgJ TYPE g ZONE R.1
Soil % �t•� I_ PERMITS ISSUED
Gas SUBCONTRACTOR Date I Number I Signature
Water . - - er��Patr mu. inc
Rough Plumbing rgCvearii/f 117Fi%X9M/ 421Flartrfel t_ '
Prop. Swr. Line El-House Con. 1 Prate 7 / flr 1_RIEWMMALI
Sprinkling System /
Miscellaneous
Rough Heating and Air Conditioning retadJ`r.
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring J/ 4'/`hoc Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0 Irfy> 7/6Q- �C .,�ni4. (,([2, (es%x.., .5_/6-(o 4, 4.374
Floor System ` t
Bond Beam 0 Steel Reinforce 0
Sheathingv/i3/CL
Frame and Flashing ,P y/ r/G6
Lathing — In p Out ® an fly/6 c
Plaster, Brown Coat Bf T y-(G 5
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final .9-,,,,5F--;G^2>-Yli Al tIZt1kti S 4-/9-66 g-2,-5S i5
Plumbing, Final and Gas Test 114---- 2�%di 0,,.
Electric, Final a
Building, Final
Tr. 5493
Lot 7 2F 1 77 Ls i OF COSTA MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA,CALIFORNIA
1966
For Applicant to Fill In Completely PPLICATION FOR PERM
FEB 2 IT
TYPE OR PRINTI1.I �9
}N1
BUILDING For '-•i `d
ADDRESS 2053 Swan Drive
RECEIPT NO.
COSTA MESA, CALIFORNIA 25177
REC[}T BY DATE RECEIVEDFan issi Qom'
OWNER Pemba Subdividers, Inc. I/�.�J /--)6-63A.
^ fWY
MAIL BUILDING �f15. T / /, ,_
ADDRESS 2850 Mesa Verde DriveFIRE
• ADDRESS (�� LYI//C11-EK/
T ZONE TYPE GROUP t-Y.y�(
CITY Costa Mesa, Cal if,N�f49-0395
APPROVED
ARCHITECT
Kaltenbach N 47-8046 BY DATE
OR ENGINEER
ZONING
ADDRESS 1823 E. 17th St. Santa An ZONE NO.OF USe OF NEW A n7/41 �'.LJ
CONTRACTOR Pemba Subdividers, Inc, 2-/ IPI-ANE .2.. 12It Tin,
/��11�i
LEGAL 0^t �Jr - I 1((- [,�q j
• ADDRESS 2850 Mesa Verde Drive DESCRIPTION / (() Q (>7 // 01
CITY Costa Mesa, Calif, A.P.NO. --0--
NOTE: NO EAVE
STATE TEL. 90"TO SIDE a REAR PH LNG SHALL BE LESS THAN
LIC.NO. 187318 NO. 549-0395
EAVES
SIZE I NO.OP BLOBS. ,.., ALLOWED (U.B.C.REQUIREMENT)
OF LOT 65 x 125 NOW ON LOT
Residence YARDS APPROVED YARDS APPROVED
USE OF Single Family
EXISTING BLDG. Wath t,t I I • - a.`� MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET/
SETBACK LINE FROMA FRONT
CENTER OF STREET 52 REAR YARD 45,75 52 Fr.
SIDE YARD I LEFT 8 l RIGHT 7 R.SIDE PT. FT.
DESCRIPTION OF WORK L.SIDE(, 'FT. Fr.
•
NEW ALTERATION ADDITION REAR 7�,7c PT.
DISTANCE BET. BET.MAIN a
MAIN SLOGS. ACCESS.SLOGS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF VAR.# DATE
SIZE 2393 ROOMS 13 STORIES 2 C.U.P.# APPROVED
EXTERIORWAITL I ROOF Shingles & APPRO '��� -�
COVERING AtUCCO COVERING snakes BY DATE
USE OF BUILDING AND WORK TO BE PERFORMED
-
• Y8741 (I// atil.
/ . ' T7
!�
I ?75o SO.FT. LS I o 11, yT I
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 FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION q
BUILDING CONSTRUCTION. eel (�L/�r� m
PERMIITTEF OF Qij 9 11�� ////, PERMIT FEE $ /-/
. 31 ) '"i 3 PLAN CHECK $ 4 �5�
P /�13ue
AUTHORIZED AGE
TOTAL FEE $