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HomeMy WebLinkAbout3071 YELLOWSTONE DR - Building Permits F - CITY OF COSTA MESA BUILDING DIVISION . •i 11 $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 !f . PERMIT • MOA 00463 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3071 YELLOWSTONE DR Status: ISSUED Suite No Applied: 09/01/2004 Issued: 09/01/2004 Vicinity: 1..� Parcel Number: 14107312 ISSUED BY: Applicant: STEVEN SCHNIERER Address: 2057 MANDARIN DR " Phone: 714-719-1689 COSTA MESA,CA Zip: 92626 Owner: WILLIAMS, RICHARD S Address: 3071 YELLOWSTONE DR iPhone: COSTA MESA,CA Zip: 92626-3027 • Contractor: EMPIRE PLUMBING Address: 12922 HARBOR BL SUITE 687 Phone: 714-530-7320 ' GARDEN GROVE,CA Zip: 92840 License:794154 SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT _ FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 _ Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 • Factory Fireplace $9.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 - ' 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 ' 30 To 50 hp/-1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750-BTU , $0.00 0 Appliance $0.00 0 Boilers , Fire Dampers . $0.00 0 Up to 3 hp . $0.00 0 Smoke Dampers. $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp , $0.00 0 Air Handlers> .10000cfm $0.00 0 Over 50 hp . $0.00 0 • Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $37.20 i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of Consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. 0I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. .21My workers'compens tion Insuura1nce arrier and policy number are: rv� Q OtMOn-, l�Q'�G1/��n LSI Q. yono1/4,1 Policy;Number:QiK.Q.4aJZ7—Z6L T ILa a ctlon need not be completed if the permit/s valued at one hundred dollars($f00)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California.and a re that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with then ovi RSfgnature: q I L 1O1081'WriING-FAILURE SECURE W KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPIDYER-{�yDp�'TG CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm tgiatt I am licensed u der provisions of Chapter 9(commencing with Section 7000)of Division _•,,Its Business and Pfglessions Code,and my license Is in full se and effecL�Lid.8, - GI05e fl - C20 Contractors Srn0turer •&' - C1'1 IcA CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a clvil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.It,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's license No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division, Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end 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 of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (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 hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this,application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L1 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with at state laws and city ordinances relating to building construction.and authorize representatives of 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. al Owners) Q , Date `a •r( uthor -d Applicant, / Date CODE 0 INSPECTION TYPE PATE MAU ;ODE I INSPECTIONTYPE PAIL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocldRetaining 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 -1111• ADDRESS OF MGM 3071 YELLOWSTONE DR UMT: CITY OF COSTA MESA — BUILDING PERMIT aMIERSNAMEIFIINOAN:RICKEY, ROGER J FLOOD : X 47 PERM NO: B 082000 y ADDRESS: 3071 YELLOWSTONE DR A COST04MMESA,CA 92626 PERMIT NO: B 082000 PLAN CHECK NO: N GOVT: N SUPP : N 557- 6 APDL.MILDNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENGINEER: sec.No: JOB DESCRIPTION : T/OFF RE—ROOF W/ COMP SHINGLE SQ FT: 5, 925 ARCH.OR ENG.'S ADDRESS: UMT: CLAIM VALUE: 5, 925 . 00 CALC—VALUE: 5, 925 . 00 GROUP OCC: R-3 / CCNTRACTarsNA1tSPECIALTY ROOFING CONTRAC ( 714 ) 725-0500 CONTRACTORS MIRING 6152 SIERRA PALOS COMMENTS: "RESIDENTIAL RE—ROOF ADDREss:IRVINE CA uCNo.: 449292 ********i****+ *SE*** -***********HESE*+F**********+r*SE«*AF*******SF******SrxSF***+Ex*+E**** 92612 DMT: ZONING R E Q U I R E M E N T S LICENSED CONTRACTORS DECLARATION:I hereby alum under penalty of perjury that I ant licensed under provisiaro of Chapter 9 SETBACKS (commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force end effect. CITY LIC.NO.: uc.cuss:C-39 uc.No.: 4492 2 EXP: MAIN BUILDING ACCESS _BUILDING S Dam: /�/�47 C FRNT: FT IN REAR: FT IN FRNT: FT IN EAR: FT IN /� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under fury the I am exempt from the Contractors license Lew for the wiew:h,o'repel a,,,„„m1s Bror le ty ayorwmtywtold,nemofilea notocansbuctfa r.improm PARKING REQ: PROV: PARCEL: 14107312 ZNE: REF NO: ndah,a repsi eno structure:Prior le b aeuenca.eao requires the applicant la suchpemm to The a signed eWerrsnthel he er end PLANNING NOTES> k e sed pursuant to the odvmars d thesheiseContractors License Law(Chapter 9(commencing with Soden 7030)vi Division 3 d the s1 ass and Professions Cade]or thet he or she a°seine therefrom end the bees for the alleged exemption.My violation d Section > 7031.5 by any applicant for a permit subjects the applicant to a dw penally of not more mance hundred dooa°(SSDDU. *************tE************it**************************************************** ❑ I.es owner of the progeny or my employees with wages a their sole compensation,will do the work,end the structure is nor intended 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 or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of properly who buids or improves thereon,and eta does such work himsei or herself or through hie or her own employees,provided that such improvements are not intended or offered for sale.If. the building orone improvement is sold within year d compelan.Os ZONING APPROVED' BY DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose d sale). _ ❑ I.asownerdmepr°perty.amexmaody`omnd"gwithgassedcoenetont corsmi'°the proje°Media"7044.Business and BUILDING APPROVED BY : DATE: .-a Profession Cab:The Contractors License Law does not apply to an owner d property who builds or improves thereon end who contracts ler such projects with a oauredorfa)licensed pursuant to the Contractors License Law). i7 ❑ Ianswine under B."&iffruha .. .. APPLICATION ISSUED BY: DATE: '3 /(-if[/J Dee: _ tea- - _ =�. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y y " I do hereby certify that I am aware of end understand the requirem ... and Safely Code Section,25505,25533.and • and m « the tutus building occupant w;nlwil shitmie(daee)tlsee to comply with eeid.td.ma.s and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for construction or modifiWh ionanth Ai shy aagement Distrit.Residential construction epplcaloare e exempt from these PERMIT 112 . 25 provisions. . 59 D ate: Apptaad` PLAN SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declensions: ISSUE FEE ❑ I have end wil mainteth a cenificsae of consent lo selLinsure for wakens'compensation,es proWded for by Section 3700 cl the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code.for the performance of the work for which the permit aissued. TOTALS----> 112 . 84 0 . 00 0 . 00 112 . 84 112 . 84 . 00 h❑ I have and will maalao workers'compensation b urate,e•rewired by Section 3700 of the Labor Code,kw the performance el the work for which this permit is issued.My workers'inn¢arsdion insurance carrier end policy number are: Gaoler: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 112 . 84 OVER/SHORT: . 00 Policy Number: 1155-13 /UVVUi4 /2 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK es section need not be competed I the permit is For one hundred dollars/$f00/or less.) 112 . 25 . 59 ❑ I way that in the pedamance d the work for which this permit is issued,I shall d employ any person in any manner so an to became subject to the workers'eompenedion laws d California. and agree the B anheworkers'l should bs subject to t ******************************************************************************* `ompe sation provisions Section 3700 d the Labor Code,I shall forth provision.' I N D I V I D U A L F E E B R E A K D O W N Dat.: 3/(/ 1 A��d: Warning:Failure to secure worts's'conwensation coverage Is abject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civilfines w to one hundred thousand dollars($ICG000).In addition to the cost of compensation,damages es provided for in Section 37osolm°ISM'Code,interest,and aro eyale«. SFR 5925 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 925 , 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there Is a construction lending agency for the END OF FEES performance d the work for which this perm is issued(Section 3097.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this am:Reatize and state that the above information is correct.I agree to comply with aft city and county ordinances and state laws relating to bedig constnetice end hereby authorize representatives d this city to enter upon the above'mente sed properly for inspection paPc."BETTY GRABI E 83-11-1997/82:57 P1V$112.84 pri RCPT#:81-8883259 ��a Dale: PERMIT:082000 Sgrwu—. •• .rI pup.- : •.dndor (5151'46.WP) White-Building&Safety:Green-Ala;Caney-Applicant;Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING POO' SPA ,APPROVALS Permit# Date Inspector APPROVALS Perinit # 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 Conduitdlpdrgrnd. 55. Electrical Bonding S._Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. "Electrical UFER'C}rnd. 57. APPROVAL TO COVER-GUNITE . t 7-,footings 58. Electrical Concl,uit-Undrgrnd. 8. Foundation .. - _ - 58. 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 r 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 Fir.'eplace ,L r_ , _ IT APPROVALS' - Permit # 21._Ducts, in Structure - - �• - - 70.-UndergroUod Hydro _ ucts, Ventilating' 22. D71. Product-Piping - _ - F... dices 0 Oil 23.tas.Pipe:Rough & Test _ i. - ^ ] r - - 72. Underground Flush -, 24. Roof Frafning .- - ._ ` i _ Iii= 73. Undergrnd.StorerleTank ❑Gas ❑'Oil 25. Roof Sheathing 3-i,L-,17` 4.4/: - 74.--Overhead Hydro _ 26.'T-Bar Ceiling (Structural) &it45nocoat : r r 75_Dry Chemical '- 27. Frame and Flashing _ - _ v 7 . 76. Dry Standpipe - 28. Lathing & Siding' - _ -' .. - ' '- 77. FIXED SYSTE'ti'1 FINAL_ 29. Insulation - 28. FIRE PREY. FINAL - i• 30. Drywall-Nailing - HEALTH DEPT.REQUIREMENT _ 31. Plaster Brown Coat - r - - 79. FINAL INSPECTION 32. Electrica7Power Meter-Final - 8Q. FOOD CERTIFICATE ISSUED _ - 33.--Final Electric - i Nates: - - - 34., Final Heating'& Air Conditioning _ R _ . r-. _ 35., Final Gas Pipa-Test* , ivi - .- ; 36. Hood or Canopy • = - - . , - " = . 37. -Final Factory Fireplace-- - ,_ • . - < - 38. Final Plurithing - ;. r s a .. - 39. Water Service-Final .. ' - - ', 40. Gas Service-Final • • - S 41. Solar Domestic-Final 42. Backflow Preventer - . - - -- - - . -,-• 43. Backflow Irrigation, -44. Landscape Irrigation System- - - 7-ii, - ic - - _ 45. Sound Attenuation: .- ,,. 46. Handicap•Regulations - _ - _ .-. 47. FINAL STRUCTURE & BUILDING 3-2,L1_4/7 , �(/ 41- •' 48._FINAL _PLANNING . • 4 l ^� v •. _ -49. 'Electric Release to Edison • - . 50. Gas Release to Southern California Gas Co • - ' ' - • 51. CERTIFICATE OF OCCUPANCY - - - No Date ,i Applicant to fill in all spaces except Inose within heavy border lines and sign all appropriate declarations. CLTY,CeF COSTA MESA PE ITN�j ' TRACT NO. . LOT NO. BLDG.NO. E57E / :/ - 1 r :__ /!.SUCTION PERMIT - 7 e 404/� �� 31 • I'i Plat Address 4)0J7/ S. .i • �✓ — TYPE OF CONSTRUCTION L) NEW 111ADD Li ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' Applicant's Mailing •ddress i U A.P.qp # /Y -07 3—/Z Zone egi DF,6C IPTJ�cg9N OF 1�y1.O, RK p Owner's Name - �- i- Phone 6S9 +O`/9�p. (2) •l3EDKc�M J.-am T XJ.ci 1� 7� / 4770 toy S Main Building: r - Accessory Building: -_ ZO Address -• 6HEW1 TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL T Front .4- Cp N • Arch/Eng. License o. ❑ TENANT C ELECTRICAL ❑ PLUMBING 0 MECHANICAL B 7 v-_/ /� N R � /t 0.1-1e. A Rear t0 Address fl y !_ / • G vim •- 4 //V A• OTHER a'.f ici2.� C Right tc' O Contractor's NartIP//Tss- 6t"-42 •� /1 n�s� Phone 'Sw`��lM�nli��/' PROJECT DESCRIPTION SO.�,p .2 `f`t OCCUPANC K / ' R Address(mailing) „r030 TiG VA/OCf oedi. C SM CONSTRUCTION TYPE J� VALUATION$ $ Left 35/-'c+'r E City License No. / • 2 49 3, ZONE GRADING CU.YDS. • ACRES Ping. Ref.# fG Park.Fees $. . O U LICENSED CONTRACTOR DECLARATION Remarks: q0 :,gq 7Q s vr0 , Parking Req./Provided • I I hereby affirm that I am licensed under provisions of'Charter 9 (commencing r�t'- with section 7000) of Division 3 of the Business and Professions Code, and -2 - 3 Use of Building: .ectr - '� Oyi f O Q //c�bi�. R my license is in full force and effect. - `- license Class /11/ - Li se No /9°/ , PLUMBING ' . FEES i Planning Notes: - M Date /A.I'.rt Signature /[./AfL /1IL1 E WORKERS'COMPENSATION DECLARATION Bar Sink Showers N 'hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink S ' Workers' Compensation Insurance, or a,certified copy thereof (Section • - • .00, Lab. C.) - - Backflow Irrigation Sewer Cap - - - • ELECTRICAL ' FEES Policy No. • --. - Company - - ---- 8 Certified copy is hereby furnished.'•� " Bathtubs Sewer Connection Automatic Washer Transformer ' 0 15'S0'KW Certified copy is filed with the city Building Division. 0 50+KW Date Applicant - C• larifiers • Solar Collectors.'• - Construction Pole Sub. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher ' '$Dior Piping ' • (This section need not be completed if the permit is for one hundred ($100)or r - r - Cooking'Unit -- ,Meter Our)to;100 amps - - -- • - less). ..r I cetify that in the performance of the work f r which th permit is�'y.��ed I .. Diinking Fountains Solar Tank -S _ _ Dishwasher Meter Dover 100 amps shall not employ any person in any.manne o a o b me s o the - _ - - Worker Co ens5g� n Laws of California. //y� . Floor Drains Swimming Podl:w/Spa ` Dryers ❑Gas ❑Electric Sub Panel _ • Date iq-'r Y_ Signature /t-�l.Gf- r ~ NOTICE:If,after making this declaration,you should become subject to the Floor Sinks Urinal Fan I _Motors 00-1 HP ❑1'h-B - ' Workers'.'Compensation provisions of-the Labor Code, you must forthwith - comply with Such provisions or this permit shall be deemed revoked. Gas Service, Outlets Water Closet - F.A.U." •"- •-1- ,f t Inc:Solar,❑9-15 HP 016-15+ • CONSTRUCTION LENDING -AGENCY i - - • r' ^> I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater I - Fixtures of the work for,r.+•hl this ermyL�s ;syl�p �.5ecoon 3097 Civ. CJ. - - - Microwave Lender's Name <-!i/F t i �YYJ/f✓LJ�•-- Kitchen Sink Water Service - ' I Pole`Li ht Lender's Address /3/G/5/bI /3/LAR//•N C.47. - - , Device Boxes: - g OWNER BUILDER DECLARATION '- Lavatories . . - Outlets _ _ flange I hereby affirm that I am exempt from the Contractor's License Law for the - - ' following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap _ Switches - r Sign county which requires a permit to construct,alter,improve,demolish or repair - -•-any any structure, prior to Its Issuance, also requires the applicant for such permit Roof Drains • Garbage Disposal r- -‘ Standing Sections to file a signed statement that he/she Is licensed pursuant to the provisions of - . the Contractor's License Law(Chapter 9(commencing with Section 7000)of Generator ❑x5 KW❑5-15 KW - Division 3 of the Business and Professions Code) or that he/she is exempt Trash Compactor , efrom and the basis for the alleged exemption. Any violation of Section I' '. 5 by any applicant for Y permit subjects the applicant to a civil • shy of not more than five hundred dollars ($500). Reinspection Fee $25 Issue Fee $ 3 - L I, as owner of the property or my employees with wages as their sole - • Reinspection Fee': _ - $25. Issue Fee • . $ 3 compensation, will do the work, and the structure is not intended or offered • MECHANICAL - FEES • for sale (Section 7044, Business and Professional Code: The Contractor's - - PUBLIC SERVICES R UI M S' ' License Law does not apply to an owner of a property who builds or improves (Boiler - Hood or Type I 0 // ��/f r2' thereon, and who does such work himself/herself or through his or her own Zoning.APproved By ` Date it—A cs employees, provided that such Improvements are not Intended or offered for Canopy Type II ❑ sale. If, however, the buildingor Improvement is sold within oneyear of com- Duct-Under Ground _ //��/p3 Application'Approved By. Date pletion, the owner will have the burden of proving he/she did not build or im- - p ove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By Date_ LJ I,as owner of the property,am exclusively contracting with licensed con- ❑x100,000 BTU ❑100,000 BTU ` tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating ,_SU MA V OF FEES The.Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING'PERMIT $ SMIP $ 0. Z tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK - $ 7� 97. PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBIN• G $ ISSUANCE $ Date Owner Heating System& Ducting . • ,,PLAN CHECK,'_- ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑x100,000 BTU 0100,000 BTs• GRADING $ Information is correct. I agree to comply Ith all city and county ordinances ELECTRICAL_ $ , - and state laws relating to bu Ing c r ction and hereby authorize repro- r ' • $ - • MICROFILM $ sentatives of t cit to ter he above-mentioned property for PLAN CHECK �[ • Inspection pun s�; y IL h._ 9'3 MECHANICAL $ TOTAL FEE $ /73.3 Signature �l.(�//f Date Drivers' License or SS# Reinspection Fee $25 Issue Fee $ 3 • PLAN CHECK $ CMF 0865.46 rev. 7/g3 while_Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor N i9NSTRUCTION AND PLANNINGPOOL "PA ROVALS Permit# Q31EQ'ri - Date• Inspector APPROVALS Permit#- Date Inspector emporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrndr . 53. Steel Reinforcement • 3. Electrical Conduit!Utility-Undrgrnd. 54. Forms 4. Electrical ConduitliUndrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - I Wileje 58. Electrical Conduit-Undrgrnd. 8. Foundation ,-' . ,! gj 59. Gas Pipe, Undrgrnd.,Test , 9.Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Strudtural 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 - 1t. Rough Electric Wiring /-S-S'{ ftle 1'Y 67. Fencing & Access Approval 17. Rough'Wiring Sign 68. APPROVED FOR PLASTERING • •J8. Rough I lectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .39. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough FactoryFireplace 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 Flaming � 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing ` . )2'-9 43 -a) 74. Overhead Hydro 26. T-8ar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing :i.. 1t^ -21-r? I S1 -84 RC1 fl 76. Dry Standpipe 28. Lathing,& Siding *//I 8¢. . • 1/12/to �p•U 77. FIXED SYSTEM FINAL 29. Insulation 1- -" 2E OF( $ 6 -el 4 78. FIRE PREV. FINAL 30. Drywall Nailing 1-i049 44).. HEALTH DEPT. REQUIREMENT 4' � 31. Plaster Brown Coftj, '174,94,1- I id/04-9 _ p v' 79. FINAL INSPECTION I. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: J 2_ 8, 4.3 N0 6norove d e lcrnS O✓1 34. Final Heating & Air Conditioning pp ((�� 1 )�nb Si+e, i f• 11 y `• 35. Final Gas Pipe-Test -T' a -16 $'j 0 t •fi1/4% n loll Q,figrior_ 36. Hood or Canopy Fr co,,.Hct ,o Pnd)rl , block ;frl, n • 37. Final Factory Fireplace ,,ii l ); ‘09 -f) / d PXiSlinJ Cris ntr, JK rtn erg tql� 38. Final Plumbing rough P !ec / t7PihaV S;Ond. 2P 39. Water Service-Final Soo C01reitien.S c 2, Fj, 10 ,sad 40. Gas Service-Final 412 -Zl-fip Frm..,inr, Q1; peAt+ 41. Solar Domestic-FinalNA fY7Ng17 -P'Is e't- is S 1 Gl Y1 ed �. 1{''\ 42. Backflow Preventer -8y rrrtnmy PxCept bran,c}.w a,//S b¢twpey 43. Backflow Irrigation new a e x isi.,.,C bed rrx,», 0 K :,to ;VW c,II 44. Landscape Irrigation System o+h 4r walis. ,.rttp 45. Sound Attenuation y /nJ .1rt/AD/,)„elPisLAPD (:Xis-ria-s toAGL rs eginOP6L 46. Handicap Regulations ScRA7e..,4 C04T ,4,01%/ED r&E ars.T of 44774,1//(2. K.A. 47. F INAL,STRUCTURE & BUI LDI NG 3 22k/ .4F ;IC/-L4-84-P',4,(7-4.91_ ' pwt( CrY/97" On! A« £''Ji 48. Special Requirements Completed • . 72Arir/ n1,ec,4 7.4720 A€gM A/nT•c&e,ct • C,,1L , 49. Electric;Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date • City of Costa Mesa I( ;ULATION CERTIFICA' -3N . Building Safety Division 3O/ Ye/all/laFn1cl,2e• Gri-11 "kW ORANGE Number and Street City County Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material 96g • Brand Name -:::I Thickness (inches) Thermal Resistance (R Value) EXTERIOR WA L Material 77 Brand Name 17) ,Ice5 Thickness (inches) - Thermal Resistance (R Value) I/ CEILING (�� _n / 'j/�- �, ^/}, Batt or Blanket Type nielir Brand Name Cgt, ni,t 1 -i o ! 1/26w e Thickness (inches) Thermal Resistance (R Value) f9 Loose Fill Type Brand Name Minimum Thickness (inches) Number Number of bags Weight per bag lb. Area Covered (ft2) *&b 0 Thermal Resistance (R Value) FLOOR, ELEVATED Material Brand Name Thickness (inches) Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California A ministrative Code . 41 1144. t(.f a/ 7O / 2 General Contractor(Builder) License Number lie,' „QtA)61,0. (owNie) l -6 - E'g Signature and Title Date Sub Contractor (Insulation Applicator) License Number Signature and Title Date CMF 1106-30 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . CITY OF COSTA MESA • - t PERMIT NO. - TRACT NO. • LOT NO. BLDG. NO. -• - , - - -- • -- - CONSTRUCTION PERMIT : 5067 • 1_ /Q"( 0q 1910• • 1/0Ar:i. I a,C', IL Project Address _ a _ ..a. .l - alt ,�hy.� - - TYPE OF CONSTRUCTION: . H NEW LJ ADD Li-ALTERATIONH REPAIR ' -Applicant's Mailin Address. -4? Ll�JL0r El CONVERSION ❑ DEMOLISH -❑ OTHER, - q•p•# , 'Zone' _ Owner's Name eft 4 2-/��- Phone DESCRIPTION OF WORK �/ ^��C �s _ ,�� �-I. - S Main Building: Accessory Building: 2 Address - /O&) TYPE OF PERMIT LIGRADING ID FOUNDATION El STRUCTURAL E• Front ' N Arch/Eng. - - License No. ❑ TEN• ANT rL_�R ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear . ' N Addr����ss ❑ •OTHER A Contractor rs Nam Phoneyl �i z2 PROJECT DESCRIPTION SQ. FT. _ OCCUPANCY C Right G CONSTRUCTION TYPE 'VALUATION$ $ Left R Address(mailing/ 3�F 4 ger-fig- err • E City License No. �(o2(•�sn ZONE GRADING CU.YDS. ACRES Q .b' .. - Ping. Ref.# Park.Fees $ _ , LICENSED CONTRACTOR DECLARATION ' U Remarks: Parking Req./Provided 1 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing •_ /Q/O R with-section 7000) of Division 3 of the Business and Professions Code, and /7 9// �'ig ] Use of Building: , , ' - E my license is in fAII fQr.,ce and effect. l 'T / License /9 Ip�nse•Ipp:�y? j •- PLUMBING '.I FEES Planning Notes: I• N Date -C Signature QN R// ��1,� 6 Bar Sink Showers • . WORKERS'COMPENSATION DEC ARATIO - T hereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer Service Sink • S • ,f Workers' Compensation Insurance, or a certified-copy thereof-(Section • 3800, Lab. C.) Backflow irrigation Sewer Cap . ELECTRICAL FEES Policy No. Company - - - 8 Certified copy is hereby furnished. , Bathtubs • Sewer Connection , • Automatic Washer ' 'Transformer 0 15-50 KW . • • Certified copy is filed with the city Building Division. 0 50• +KW • Date Applicant • • , Clarifiers • Solar Collectors . _ Construction Pole Sub. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION • Dishwasher Solar Piping, CookingUnit - Meter- Du to 100 amps (This section need not be completed if the permit is for one hundred ($100)or iP P less). DrinkingFountains I certify that in the performance of the work for•which this permit is issued, I , Solar Tank Dishwasher Meter Dover 100 amps shall not employ any person in any manner so as to be�pme s bject t the workers' Co en�tron Laws of Calif orn ir(/_" _ . // ��I /� I —Floor Drains. Swimming Pool w/Spa' Dryers ❑Gas' ❑Electric • Sub Panel Date f - � °t Signature �i^ws-( /(/ / v N NLW • NOTICE: If,'after making this declaration, you should become subject to the • Floor Sinks Urinal Fan I Motors❑0-1 HP_01%-8 Workers" Compensation provisions of the Labor Code,-you must-forthwith- , comply with. such.provisions or this permit shall be•deemed revoked. ' Gas Service ( 'Outlets Water Closet F.A.U. Inc.Solari❑9-15 HP 016-15+ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Fixtures Microwave Of the work 'for which- this permit is issued. (Section. 3097 Civ. C.) _ • • Lentler's Name, 1 Kitchen Sink -Water Service • ., , - ' Device Boxes Pole Light 4.44 Lender's AcIBUILDER s Lavatories • - OWNER BUILDER DECLARATION - , ' - Outlets Range • I hereby affirm that I am exempt from the Contractor's License Law for the P-Tra •p reason (Section 7031.5 Business and Professional Code: Any city or P _ . . Switches • Sign ' county which requires a permit to construct,alter,Improve,demolish or repair ' any structure, prior to its issuance,also requires the applicant for such permit Roof Drains r • •. •• - - Garbage Disposal Standing to file a signed statement that he/she is licensed pursuant to the provisions of - •- ' .he Contractor's License Law(Chapter 9(Commencing with Section 7000)of - Generator ❑O5 KW❑5-15 KW Trash Compactor i retro 3 of the basis and Professions Code) or that he/she.f exempt - P erefrom and the basis for the alleged exemption. Any violation of Section • - .031.5 by any applicant for a permit ss($5 s-the applicant to a civil ' anally of not more than five hundred dollars($500). 'Reinspection Fee' $25, • . Issue Fee _ $ 3 0 I, as owner of theproperty or my employees-with wages as their sole Reinspection Fee $25 Issue Fee ' $ 3 compensation, will do the work,and the-structure is not intended or offered , ,MECHANICAL , - FEES for sale (Section 7044, Business and Professional Code: The Contractor's ; — - - I PUBLIC SERVICES REQUIREMENTS: License Law does not apply to an owner of a property who,builds or improves Boiler Hood or Type I 0 - thereon, and who does such work-himself/herself or through his or her own • Zoning Approved By 4 Date employees, provided that such improvements are not Intended or offered for - Canopy Type 11. ❑ - sale. If, however,the buildingor improvement Is sold within oneyear of com- Duct-Under Ground , Application Approved By Date platten,the owner will have the burden of proving he/she did not build or im- . rove for the purpose of sale). Duct-Structural 1 Refrigeration System , Application Issued By /�J i��7 Date I/U� LJ I, as owner of the property, am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating :SUMMARY OF FEES ' 4 -The Contractor's License.Law does not apply to an owner of property who . ... _ -_ - , , • • builds or improves thereon,'and who contracts for such projects with a con- ' Exhaust System 0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ • tractor(s) license pursuant to-the Contractor's License Law). - PLAN CHECK $ PERMIT ' 0'1 am exempt under Section B.& P.C.for this reason ' Firepl/Fact.BIt. ICBG# • PLUMBING $ ISSUANCE $ - - •Date Owner - Heating System&DuctingPLAN CHECK $ ENERGY P.C. $ • I hereby certify that I have read this application and state that the above i ❑0-100,000 BTU ❑100,000 BTU - GRADING information'is correct;I agree to comply with'all City and county ordinances - - - , - . ELECTRICAL $ /?'O $ and state laws relating to building construction,and hereby authorize repre- sentatives of' ,this city t. enter •pon •he above-mentioned 'property for - ; $ • Inspection per ,ses. ,,Lr..,,�� MECHANICAL $ i Signature -•r, ���_ Date �-,) ' Pr - - I TOTAL FEE $ ISDGi Drivers' License or SS - • Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK ' $ , CMF 0865-46 rev. 7/83 - -White'Building;Canary.Applicant;Pink-Accounting;Goldenrod-Assessor ., - . - . • . . - '7Jf- i CONSTRUCTION AND PLANNING - POC SPA APPROVALS. Permit In i01 Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms .4. Electrical Conduit;Undrgrnd. 55. Electrical Bonding '5. Steel Reinforcement ' - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. • 8. Foundation r 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 P- 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 I' - 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. Rdof 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 i/3/fey `C Notes: 34. Final Heating & Air Conditioning I 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 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 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY•QF COSTAMES4. . - • PE'u T NO.�f� (Q TRACT NO. LOT NO. • BLDG.NO. - - •CONSTRUCTION PERMIT E- %?/D J < i`1 • !5'6? I `/?;/, e l ; T Project Address 0 - L. �� - TYPE OF CONSTRUCTION '❑ NEW ❑ ADD ❑ ALTERATION .❑ REPAIR Applicant's Mallin�%g/�Address' �J at ,,4_JOU - Is . ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone Owner's'Name x'0S6e 7 /17/91C ' M1��IP �• _ DESCRIPTION OF WORK - �,.,7-, / ((( / . S Main Building: Accessory Building: 2 Address, �,JI �x/ )(C -C7(.( f , I - O TYPE OF PERMIT,.,/IJ GRADING ❑ FOUNDATION ❑ STRUCTURAL • E Front N Arch/Eng. License No. ❑ TENANT LI ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear r i I Address - ❑ 'OTHER - • A N ou?TcC—Ie - - WYJ C Right G o trcorsNamr•,'f a•v:J7 ///�/;//c/' Phone �H!//.7� PROJECT DESCRIPTION SQ. FT. OCCUPANCY K • G Address(mailing) ?L'�2-'Po•Re Tn 6.Sri- Ne-SO, CONSTRUCTION TYPE VALUATION$ S Left E City License No. J2�'D ' ZONE - GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ Q LICENSED CONTRACTOR DECLARATION U Remarks: Parking Req./Provided I hereby affirm that I'am licensed under provisions of Charter 9 (commencing - R with section 7000) of Division 3 of the Business and Professions Code,and fsJ — 1 /�x3- 2 2 Use of Building: E my license Is In full force and effect. M License Class//C • ex No.V!/!f VPI PLUMBING FEES Planning Notes: . ' Date/7--'y-QT Signature /'><'r0u.- E WORKERS'COMPENSATION DECLARATION Bar Sink Showers I N hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer- Service Sink - - - S • of Workers' Compensation Insurance, or •a certlfiad copy thereof (Section ' • 3800, Lab. C.) Backflow irrigation Sewer Cap ELECTRICAL FEES • • Policy No. Company .- - BCertified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW Certified copy Is filed with the city Building Division. . - - ❑ 50+KW Date Applicant Clarifiers • Solar Collectors Construction Pole Sub. EXEMPTION FROM WORKERS''COMPENSATION DECLARATION Dishwasher Solar Piping - - ' - (Thissection need not be completed if the permit Is for one hundred ($100) or P 9 Cooking Unit Meter ❑up to 100-amps less). - - I certify that in the performance of the work for which this permit is issued I Drinking Fountains Solar Tank - Dishwasher , Meter Dover 100 amps' shall not employ any person in any manner so as to become subject to the -e Workerq Compensation Laws of Calif orrit$,` mQ.._.i.,T. Floor Drains Swimming Pool vv/Spa Dryers OGas DElectric Sub Panel • Date /2-2/-93 Signature 'tb� r • • NOTICE: lf,'after making this declaration,you should become subject to the Floor Sinks - Urinal _ - Fan - Motors❑0.1 HP ❑.1.%:8 Workers' Compensation provisions of the Labor Code, you must forthwith - - ' comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets - • - Water Closet F:A.U. Inc.Solar ❑9-15 HP ❑16-15+ CONSTRUCTION LENDING AGENCY -- - - ' I hereby affirm that there is a construction lending agency for the performance Interceptors _ Water Heater . . Fixtures 'Microwave G of the work for which this permit 'is issued (Section 3097 Civ. C.) q l Lender's Name Kitchen Sink • Water Service - Device Boxes , Pole Light Lender's Address . - - Lavatories - . G OWNER BUILDER DECLARATION . • •9' Outlets •• • Range / $5 .1 hereby affirm that I am exempt from the Contractor's License Law for the p-Tia following reason (Section 7031.5 Business and Professional Code: Any city or p - . y/ Switches ' Sign 825county which requires a permit to construct,alter,improve,demolish or repair - ' any structure, prior to-Itsl issuance, also requires the applicant for such permit Roof Drains' - y Garbage Disposal Standing Sections :to file a signed statement that he/she is licensed'pursuant to the provisions of 'he Contractor's License Law(Chapter 9(commencing with Section 7000) of ' - _ ' - - s. ivision 3-of the Business and Professions Code) or that he/she is exempt - - Generator ❑45 KW ❑5-15 KW 'Trash Compactor I lerefrom 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 i ' enalty of not more than five hundred dollars($500). Reinspection Fee $25 Issue Fee $ 3 • LJ I, as owner of the property or.my employees with wages-as their sole - Reinspection Fee $25 Issue Fee $ 3 compensation, will do the work, and the structure Is not intended or offered . MECHANICAL FEES i - - • - - for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS: • • License Law does not apply to an owner of a property who builds or improves BoilerHood or Type I 0 ' thereon, and.who does such work himself/herself or through his or her own , Zoning Approved By nate employees, provided that such improvements are not intended or offered for Canopy Type II ❑ sale. If, however, the buildingor improvement Is sold within oneyear of com- Duct-Under Ground Application Approved By Date prove-f, the owner will have the burden of proving he/she did not build or.lm- - s�rove;for the purpose of sale). Duct-Structural Refrigeration System Application Issued By . r Dat Z LI I, as owner of the property, am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES ' , The Contractor's License' Law does not apply to an owner-of property who , - , builds or improves thereon,'and who contracts for such projects with a con- ' Exhaust System ❑ Multiple 0 System Repair/Alteration ,� BUI LDING PERMIT ' $ ' SMIP $ - tractor(s) license pursuant to the Contractor's License Law). 7 PLAN CHECK $ PERMIT ❑ 1 am exempt under Section ' B.& P.C.for this reason - Firepl/Fact.Bit. ICBG# - • - Date • Owner Heating PLUMBING $ ISSUANCE $ System& Ducting . ENERGY P.C. ' $ ' • . `q PLAN CHECK $ I hereby certify that I have read this application and state that the above 1 ❑0.100,000 BTU ❑100,000 BTL `. information is correct. I agree to comply with all city and county ordinances , - .- I- ' ELECTRICAL , $ GRADING ' $ and state laws relating to building construction,and hereby authorize repre- MICROFILM $ sentatives of this city to enter upon the above-mentioned property for PLAN CHECK $ I inspection purposes- gr.:,./e) y q Signature /7.z.--l{.�yi. Date /Z-2/-93 • - MECHANICAL $ TOTAL FEE $ A i��/ Drivers' License or SS it I ) Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK ' $ • CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - - -- ' - - - - - CONSTRUCTION-AND PLANNING POO. SPA APPROVALS Permit# tinInq Date Inspector APPROVALS Permit# - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding :5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11". Property Sewer Lirie & 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 1(6: Rough Electric Wiring X1/22 C: 67. Fencing & Access Approval 17. Rough Wiring Sign r 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 O Gas El 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 • 32. Electrical Power Meter-Final ` 80. FOOD CERTIFICATE ISSUED ( 33.'Final Electric ( f3{�s'-/ t C Notes: 34. Final Heating & Air Conditioning ((( /JG /AA 63n-ea/WO for /_/y0 35. Final Gas Pipe-Test f71E/Y9 11 3 /9Ef IV 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Servide-Final - 40. Gas Service-Final • 41. Solar Domestic-Final •_ 42. Backflow Preventer p 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 r 51. CERTIFICATE OF OCCUPANCY _ • No. - 'Date • APPLICATION FOR A BUILDING PF' '91T , r 4-- ...-^ Electrical CO Tract Block Lot BUILDING PERMIT NO. Permit No. C Building Plumbing C Address ©? // L / ✓1/D ��e �n• IIC ro Permit No. JJJ Cross �J Mechanical C Area Street Permit No. co Owner /glee te` `y/»y Type of Project: ❑ New ❑ Alter ❑ Addition Owners/� �4AI/S,[,/J ��' 111 aT ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt. Addre /9-/1//[.Li Sup.Dist./ City Zip PhonSr ,^J GG'' A.P. Insp.Area Architect/ Zone Spl.Pmt.No. Designer License No. Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear City Zip Phone Eave Proj. Left Right F.P. ., Engineer License No. C Parking Spaces Required Provide Covered app. Address m City Zip Phone Struct No.of No.of Height Stories Family LICENSED CONTRACTOR'S DECLARATION Park Fees ❑ Yes Fee mI hereby affirm that I am licensed under provisions of Chapter 9 Required No C.T. Receipt (commencing with Section 7000 of Division 3 of the Business and « Zoning Approved By: Date Professions Codn aryq ply license Is in full force and o 73f License lar CY 44 L}'ce�nssehj u/mbb'er. n > Date _- -t I ontractor Jr/4It f"Q• y� 01V4y Mise. E Address /� i/e ZUSs' its 4s4.ti / Proposed Use it City and Zip . //m / : • - - 'hone 43:-/ of Structure in CONSTRUCTION LENDING AGENCY VI N I hereby affirm that there is a construction lending agency for the .9- performance of the work for which this permit is Issued (Sec. 3097. Class Type Code Civ.C.). Class Const. Year y Lender's Name USE/OCCUPANCY SIZE SQ.FT. c Lender's Address , '71 OWNER-BUILDER DECLARATION • Y I hereby affirm that I am exempt from the Contractor's License Law 1. _ ea for the following reason: 0 I, as owner of the property, or my employees with wages as their 2. sole compensation, will do the work, and the structure is not « intended or offered for sale. ❑ I. as owner of the property, am exclusively contracting with 3' licensed contractors to construct the project. 43 0 I am exempt under Sec. • B&PC for this reason 4- u C Date Owner E WORKERS'COMPENSATION DECLARATION Total Valuation aI hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No or a certificate of Workers' Compensation Insurance, or a certified C copy thereof. / ,s' Grading Pmt. Grading e3 Policy No. Comp. 11 Required ❑Yes ❑No Pmt. No. .a 0 Certified copy is hereby fur Rough Grading G ❑ Cert' ted copy is filed wit • .e County, Aj - ' re < Approved by: Date Date L O APplican i.iii' /.arf� 3 CERTIFIC-TE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE z (This section need not be completed if permit is for $100 or less). C I certify that in the performance of the work for which this permit is 3 issued, I shall not employ any person in any manner so as to become 0 subject to the Workers'Compensation Laws of California. PERMIT FEES Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $ Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such Electrical Special provisions or this permit shall be deemed revoked. $ Invest. $ ' I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE Plumbing $ THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELAT G TO BUILDING ONSTRUCTION,AND HEREBY AUTH- Mechanical $ OR ' EPRESENT T OF THIS COUNTY TO ENTER UPON T 0 VE ME�OPE RTV FOR INSPECTION PUR- Ins-ectio -4/I 1 '1 Inspection $ V7413/CSO Pre-Grade $ Permit $ .ig/naturee ffAleephyaannt�o�r Agent Date / Rec.No. Issue .JLNAL%lio1/ //gent's Nam Print Applicant's/Agent's Nam spaces within thi box must be completed to process Plan Issuance All P _ Check By: Approved: CMF 0335-46(BU-28) rev.6/80 TYPICAL 411 CONCRETE BLOCK FENCE TOP VIEW x_3/8 Bar INIIIMIIIIII i r. 1 �', "GENERA L— NOTESIF 4" Blocks 8 BlocksMORTAR: One Part Plastic I/4° 0 Pencil Rod Below Top ■, 1 i �- -allMIL Cement And Three Parts Sand. Course Of All Fences GROUT: One Part Cement And 4" Concrete Block Fence With 8° �i—' • Three And One Half Ports Sand. Pilasters. One 3/8 Vertical Bar I II 1 I COPING: One Part Cement , Continuous From Earthtooth Thru 1111 , ' �.. i__, Three Parts Sand. 8' Pilaster. ; I ; � 1 1 1 1 CONCRETE: Well Mixed 1:2 1/2, 1 1 I 1 1 , 1 1 3/8" Vertical Ties 2 Long -_� 1 1 I • 1 1 31/2 . Maximum Of 7 1/2 4odecks 4'Cleanoat/CMa •ximum.Inspection ■,® ! I ,�I 1i , Of Cement STEEL SHALL Per Sack Bl NG H oked In Footing, And Grouted In Gallons Of Water Hole At Pilasters. I SHALL I i 1 _.-I. I I I IICONFORMTO SEC. A- 15- 39 - -- ..® i 1 A.S.T.M. ALL STEEL TO LAP , , . ��� `! I 1 WHERE SPLICED, 2.-0" MINIMUM. . . . . -� -_- , II is GROUT MAY BE POURED FROM ,X TOP OF FENCE IN CELLS WHERE NATURAL GRADE "� /..'-7: 6 . ;o o..�.:P. o ..,'p_ P7 : �'t :;.. a•: 9 fr : a0. -' VERTICAL STEEL OCCURS. HOLES N i,qr.,:p..t . ,.'L, 1;C',A •-: .o p . 19-'. .,'®.Lood1 I:':"' ' • `•P�o.o1 FOR WIDTH SEE CHART , � ' ;.q;.o `r te :• "" SHALL BE CLEAR , CLEAN , AND m`.;o �e :.r e _• .��boe -�r� ;a��y��: is ..n__al ,�__!:,• I -?�_yl FREE OF ALL MORTAR , DEBRIS, it. r� I', e,:� ECT. WITH INSPECTION HOLES TWO 3/8 BARS CONTINUOUS • °I TO',16��O.C. MAXIMUM n01 lol I . AT BOTTOM. BOND SHALL BE �i. ,LI t V1 • Ibap PROVIDED BY LAYING BLOCKS FENCE MAY VARY IN HEIGHT 1�?. 0. � DEPTH OF EARTHTOOTH 1/3 1144` - IN STRETCHER COURSES SO FROM 3� TO 6 is "al THE HEIGHT OF FENCE Ip{?+L� THAT VERT. JOINTS ALTERNATE Gm'el BELOW BOTTOM OF r:y :.a STEEL MUST BE TIED IN PLACE ie-. FOOTING. L�ra IN EACH COURSE. • AT TIME OF TRENCH INSPECTION 3" CLEARANCE FROM BOTTOM t' ro I SCALE: I/211= I� CHART HEIGHT . . . . 6 . . . . . . . . . . . . . . . . 5'.. . . . . . . . 4' 3' WIDTH . . . . . • . 14" 14" 12" 12" THICKNESS .IO° 10 . . . . . . .. . .. 8" .. . 8" r DEPTH OF EARTHTOOTH . . . . . .24" 20" 16" 12" SPACING OF EARTHTOOTH . .12'. . . . . . . . . . . . . . . . 14' . . . . .16' .. . . 16' /?I boa City Of Costa Mesa , California OWNERS NAME; JOB ADDRESS Building Department PERMIT NUMBER: • SIGNATURE; • Form 0013-2M-4-64 S-BP w 133tf1S - _ _ / .. _ e\ 33 / S.Cl 1- ` \ co y ,pS AA C11A rn ` �30N301S3tl p3DN341S3tl 3DN30153M\ 3014130153UA I`, .......... , � MIT) yj 36 ,9--- 1 GS� i trP�!FI JJ in u 2 1 1� 1, .., OW of Mesa Building Dept tL iOed✓cd t�-Q, ,(//? _._.. THESE ;PLANS GES BE ON JOB AT ALL TIMES I ���� ���0�3aL ONLY (MAKE NO CHANGES WITHOUT PRIOR APPROVAL S�IRJJL a Den. TRE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL SFPAR41fE "'i"I,STS ARE REQUIRED APPROVED OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED FOR ELECTRICAL, PLUMBING, CITY COSTA 0C -sn ID BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION HEA.TING, 'VENTILATING AND PLANNING DEPT. OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE.E REFRIGERATION WORK SUBJECT TO BLDG. DEPT. REG. SWING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO NO _ ,,/�. p.ATE � FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS UWEUI. ----------nn J BY tt � # I DIRECTOR OF PLANNING THE ISSUANCE OF A PERMIT B0.SR PREVENTING PLANS D THIS NUMBER MUST ACCCOMPANY .+ SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS ALL INSPECTION REQUESTS IN SAID PLANS AND SPC.:IFICATIONS _ BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN I IN VIOLATION OF THIS CODE OR OF ANY OTHER ORBLNANGE FOR BUILDINGS ;N'H.I 1 PEP,SONS ARE TO OF THE CITY. ST EMPLOYED, WE S 1;;ESI THAT 111 $NATE OF CALIFQ..N,'A DIVISION CF INDUSTRIAL SAFETY ME CDNSULTEA RIR ADDITIONAL REQUIREMENTS 13533 FEE RECEIVED DEC 291560 COSTA MESA BUILDING-SAFETY DEPARTMENT `F MANCE DEPT. P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO NU /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING 3071 ADDRESS YELLOWSTONE DRIVE COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY I RECEIPT NO. PERMIT NO. OWNER KWK CONSTRUCTION CO. , INC. I-R (,l ,r,c39 MAIL RECEIVED BYDATE RECEIVED �ATES-OED ADDRESS 1555 PLACENTIA AVENUE M fY, I 4.2.z2- ' 64 ` i_A.W F' C 1460 - CITY NEWPORT BEACH CALIF 17160427 BUILDING ADDRESS AR^"'TENT LIC. Cr ,INFER NO. COSTA MESA.CALIFORNIA ADDRESS FIRE ZONE ZONE TYPE GROUP v. ATE CONTRACTOR K.W' KOLL LP:Z.4195 T195 APPROVEDBY DATE J ADDRESS 1555 PLACENTIA NEWPORT EACH ZONING LEGAL I LOT 3 I It0 I 20NB� - / I NO.OF UEE OF NE144--0/1 A DESCRIPTION NO. 1 BLOCK TRACT �J`,/ PLANS I BUILDING /I/. l� APPROVED / 1 1 �' v- � �,/ A.P.NO. BY W l/tVE DATESIZE 60X100 NO.OF BLDGS.0 YARDS ES OF LOT NOW ON LOT REQUIRED 0.0.0. LOWED USE OF (CENTER LINE ST.) o c EXISTING BLDG. FRONT ,`J v FT. IN. BACK LINE FROM `/ CENTER OF STREET 50' REAR YARD 287 R.SIDE . FT. IN. SIDE YARD I LEFT 5' I RIGHT 51 L.SIDE L/ FT. IN. DESCRIPTION OF WORK �$ P. IN. REAR NE I X II ALTERATION I II ADDITION I REPAIR I I II MOVING I II DEMOLISH I Mr DING 1506SF ROOMS I STORIES 1 • EXTERIOR Wssrr IROOF COMPOS FT I ON ' COVERING JFU CCO (COVERING SHINGLES USE OF BUILDING AND WORK TO BE PERFORMED SIN GLE FAMILY RESIDENCE AND ATTACHED GARAGE PLANNO . 3-A ' • • I HEREBY ACKNOWLEDGE THAT I HAVE READ THI PPLICATION AND STATE THAT THE ABOVE IS CORRECT AND GREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE REGU LNG PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCT ON. ��/A �f/VALUATION SIGNATURE OF 65� y(a PERMIT FEE $ 3�OQ PERMITTEE /v/ S $ / /` PLAN CHECK $ /z 5-0 AUTHORIZED AGENT TOTAL FEE $T_3./T ,521 OWNER ENDSLEY, A. RALPH DATE 2-28-68 SOB ADDRESS 3071 Yellowstone Drive BUILDING PERMIT NO. 28263 GENERAL CONTRACTOR Owner-Builder DESCRIPTION OF WORK Patio Cover AP No. 141.-071-12 LOT 31 TRACT 1+041 FIRE ZONE VALUE § 300.00 '`ECTIONS Signature Date GROUP J TYPE V ZONE R-1 PERMITS ISSUED Gas SUBCONTRACTOR Date I Number I Signature Water Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wiring Heating and Vent. Trenches K1 Forms 0 Steel Reinf. 0 WV- 3 7-cg Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, Brown Coat Stctural, Final Electric t'1ag, Vent., Refrig. and A.C., Final PYraiibing, Final and Gas Test 0 Electric, Final Building. Final A'1AfG a - /.R 28263 FEB F 28.6> 00 650 jj*****3.00 ' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYFE OR PRINT BUILDING BUILDING" /� For Office Use Only ADDRESS-so 7�/EL.2G II.SrOA<L; d/z,✓E swain'no. �[?XI'3 COSTA MESA. CALIFORNIA `-� 7 •+C S �,J �J r R[�On/p('D�Br� it RIC EI -. 1"--,4.-cg T[ISSUED OWNER p. /FALPAI CND,FL£y �" �" � //� - ,� W� MAIL / ADDRESS 3�/ �?�OK.�lT/l�lJ)�. ADDRESS SD J< }�GLCOWSTO.VE L7RI✓E / ,,00 ZOHe TEL ETr. GROUP j. cm' Co5T19 /14654 [.}c/F. NO.S'4•G-8K / y ARCHITECT TEL APPROVED 7/ 'i ' DATE -'z0(y�Gi,/ -"ENGINEER NO. ] ZONING .-.ORESt ZOxL I ;W.OF a I WBuaoD!INNGEW A-tdh CONTRACTOR01✓reie" LEGAL ,,c .-3/ I\LIc* 1-74)// ADDRESS DESCRIPTION A.P.no. Ali/ - n 73 ` /.2„ CITY STATE TEL SONOT'T: NO SAVE O SIDE 8 REAR P,L.OG SHALL BE LESS THAN LIC.NO. NO. EAVES SIZE I NO.OF BLOCS. ALLOWED I U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. I (FROM Cit REET) SETBACK LIN[FROM FRONT /iFer4 , PT CENTER OP STREET REAR YARD ,/ /IDS YARD I LEFT I RIGHT R.SIDE S FT. FT. DESCRIPTION OF WORK �/ L.wog ti PT. PT. _' ALTERATION ADDITION !� r REAR 11(5::) FT. FT. DISTANCE BET. BET.MAIN a REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.swag. BUILDING NO.OF VAR•# DATE SIZE ROOMS STORIES C.V.P.# / APPROVED p J EXTERIOR WALL I CROOF OVERING APPROVED J / DATE ., -, ,{ - f+9 COVERING AAA��`/ nr USE OF BUILDING AND WORK TO BE PERFORMED 1a ADD PA-77 r' C0YER 7. CXl ST/ivG do ME . SQ.FT. a I HEREBY ACKNOWLEDGE THAT" NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO CON. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULA G VALUATION BUILDING CONSTRUCTION. PERMIT FEE 5 3•d V pl SIGNATURE OF 0 `,p " - E PERMITTEE J�-/) $ UU PLAN CHECK S `� [v' AUTHORIZED AGENT TOTAL PEE 4 OWNER RICKEY, ROGER DATE 7/30/8( JOB ADDRESS 3071Xellga^tone Drive 3067 and 3075 BUILDING PERMIT GENERAL CONTRACTOR Jim Caton Masonry DESCRIPTION of WORK Blockwall AP No.141-073-11,12,13;Lot 31 TRACT 4041 FIRE ZONE VALUE S 2,500.( it *.CTIONS Signature Dote TYPE GROUP sE GAS SUBCONTRACTOR Date WATER Plumbing ROUGH PLUMBING PROP. SWR. LINED HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING o Heating and Vent. Ye- FLOORTRENCHES ❑ FORMS r STEEL REINF. rj C3,S ;- - FLOOR SYST'A ~^. A e.G L Pic BONO BEAM er STEEL REINFORCE J� 'lir.' 4-i SHEATHING FRAME AND FLASHING fd LATHING — IN fl OUT fl I'D PLASTER. BROWN COAT cSTRUCTURAL. FINAL // 7`J Electric HF G. VENT., REFRIG, AND A.C., FINAL i•/� I UIPL, SING. FINAL AND GAS TEST AELECTRIC. FINAL Qt BUILDING. FINAL � y ry_/ /�{ > cPEClgy,}�FOOIREMENTS_ - 1 //� /// • Xerox Copies: 3067 & 3075 Yellowstone Files AP COSTA MESA BUILDING-SAFETY DEPARTMENT APP - , TION Fekb.STRIiintatt1 PERMIT 36,50 TMJ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEI ED?" PERMIT ATO 50438 For Applicant to Fill in Completely— Use Ink Only lr BUILDING .0, ..730 y -07 ADDRESS A.P.NO. J �� /�•C/ BUILDING 2 OWNER OR /J� -�/�_ _ , G ADDRESS a��y/QPi Y o .rad ei TENANT /' 6f,f,( V UNIT OR 6047) 3 75 MAILING SPACE NO. ADDRESS $ i .LTL •C zi.!/ /:1" CITY t'S'M MESA- NO.S1�y J9/ TR.NO.�A,�/ LOT SI BLK. TEL. v7 1�/T!Y NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH ��^^//�� D /� �� OWNER GE1e /\ ic.eey ADDRESS /1 VALUE ,(�' ARCHITECT TEL. USE tae, Ea,673-v - OR ENGINEER NO. 1 ADDRESS ZONE iC/ TYPE GROUP APPROVED CONTRACTORJAeiLM p/ rkzfBY DATE — ADDRESS f.,„2 2 /ecian'aTEL. / vy ()Mai NOS‘ .76 n F STATE �� CITY APPROVED SETBACKS LIC.NO. fen- LIC.NO. SIZE I NO.OF BLOCS. (FROM C/L STREET) G. OF LOT NOW ON LOT FRONT 1 FT. �/ h USE OF R SIDE Jl/iy,O"///t27 o, 6Z// EXISTING BLDG. q �/� ` -±I Separate permits are required for L.SIDE 7 / FT. s-s" C// C electric,plumbing and heating work. REAR FT. F U OF BUILDING AND WO TO BE PERFORMED PLANNING ACTION , ,v w crn. 7c1-4 2 y K 4 4'd oar/aka 111,ed.Gr/•/ 3/=G'A,,pIi c' a.-x)219-i"- j I APPROVED /�/ 44 '/-7 S'H.4i?6rf to' ne, a/fn/ebG 1 APPROVED }/z�,/ l DATE- 7l -W C6 Ito aI hereby acknowledge that I have read this application and state• n K, that the above information is correct and agree to comply with S all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of 2 Sthe State of California. m 3 I hereby certify that I am properly licensed as a contractor under SO. FT. 04 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR co Chapter 9, and that such licenses are in full force and effect,or I THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from t.• provisions of the Sta of I ornia Business VALUATION PERMIT FEE �,a� Y E and Profession , Division 3,Chapt ` ���///JJJco Signature jet / Lei 400 v PLAN' CHECK $ /a o Is Permittee $ TAX $ S_ E Authorized AgentI or J / v TOTAL PAID S 3. 5-0V Date