HomeMy WebLinkAbout3079 YELLOWSTONE DR - Building PermitsCITY OF COSTA MESA
o�`" F9 BUILDING DIVISION
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77 FAIR DRIVE. COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • ww.ci.costa-mesa..us
FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: B10-00152
PERMIT TYPE B_R00F2 STATUS: ISSUED
APN: 14107310 DATE ISSUED: 06/01/2010
ISSUED BY: RMD
JOB ADDRESS: 3079 YELLOWSTONE DR CM Suite/Unit:
Vicinity: HOUSE AND GARAGE
Squares: 2400 Valuation: $6,900.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 1 LAYER OF 15# FELT ON A 4:12 PITCHED ROOF AND
REROOF WITH 30 YEAR COMP SHINGLES ON HOUSE AND INSTALL TORCH DOWN ON FLAT GARAGE AREA; APPROX
24 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND
CITY PERMIT.
OWNER: CO, MARY L - Address: 3079 YELLOWSTONE DR Unit:
PHONE: City/State/Zip: COSTA MESA, CA
APPLICANT: HASSEINZADEH, BEHZAD
PHONE: 800-736-4933
Address: 5341 FRANKLIN Cl
City/State/Zip: WESTMINSTER, CA
CONTRACTOR: B AND N CONSTRUCTION COMPANY
Address: 5341 FRANKLIN ClUnit: PHONE:
City/State/Zip: WESTMINSTER, CA 92683
ARCHITECT: - License No.
ENGINEER: License No.
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$139.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. 598800
800-7364933 -
CELL:
PHONE:
PHONE:
Unit:
'OTAL FEES $140.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
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 O. INSPECTION TYPE DATE INTMALS CODED INSPECTION TYPE DATE INTDIALS
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 BIocWRetaining 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:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
'Carrie
(This sd-diallneedn�mpleted dthe putithed is valued alone hundi eallars(8100)or lessJ
P II Number
Owner ID verified by drivels license.
Driver's License No.
❑ Yes ❑ 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, a demolition
or dismantling thereof, vnll 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
❑ 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
the Labor Code, I shall forthwith comply with these provisions. Avpr�wnrs Signature Date
Division of Industrial Safety Permit Number:
App IIC2n sSignature
f� 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:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is �vinf�ull force and effect.
Lic'�#-- Pj #
1_49 �-�(o•a2� l6
Cunti3d.e,signatGre` c— tem
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 civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature
3057<6(W07)
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the 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 an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ 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 and
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 all 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.
/Signature of Legal Ovvnegs)
/// Date /�
1L � — V
�odmAvltlom2ed--,—_.� Nate
Residential
I Project Name -Climate Climate Zone p (� 4 of St ries
General Information
Site Address: Enforcement Agency:
Date:
(
[7"1113,
Proposed "" Nare
Building Type Inisingle Family ❑ Multi Family Circle the Front Orientation: N, E, S, W, of degrees
Project Type: 13 Alterations ❑ Envelope ❑ Fenestration Roof ❑ HVAC
Conditioned Floor Area (CPA): �`Z U'� 5�.
Replacement or Change Out ❑ Duct Replacement ❑ Water Heater
NOTE;rThis jornr isnot it, be used for Newly Constructed Buildings or Additions
lresnl Oar Values For Opaque Surfaces (fmFurring use the h4asv and Furring Soxpr Construction table below) C�
Assembly Alteration
O Opening of framed cavity alone —Alterations that involve the opening of the fi aned caviar ofa wall, ceiling, orllom' must install the
masdaiory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
❑ Replacement of entire assembly—Replacement ofan entire wall, ceiling. or _floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
O ague Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A -T S C D
E
F G I H I- I -- 9
Proposed "" Nare
Standard
Values From JA4 Table
Framing Thickness,
in Furring Space from Reference
Framed
Continuous
JA4
Proposed
Tag/
ID'
Assembly Name
orType I
Material Spacing,
and Size or Other
U-
factor"
JA4 Table
Number'
Cavity
R-value6
Insulation
R -Value'
Assembly
Cell Values
Assembly
U -factor'
Assembly
Z••.,
8
L O ..
z
9
u"
o `a
Final
Mass
Name of
JA4 Table
R _,
„ ! —
E
R o
.c
v o
a
Ass(
Thickness'
Ty r'
m
Number'
e_ e_
Note: Fm' furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mars and
;Fu, p ing Con.sovmimn table belme.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or tope: R00%/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Einer the thickness for mass in inches ar' Spacing between framing members enter; 16"or 24 "OC,; ar Other far all other assemble description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone; enter the Standard U facmr from Table 151-B, C or D for each cliffereni assembly Name or type.
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall covin, or between the farming; otherwise, enter, "0".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0,,
8. Enter the row and column of the Ufacior value based our Column F Table Number and enter the Assembly U- factor in Column J
9. The Proposed Assembly U facmr, Colurmn.l, must be equal to or less than the Standard U factor in Column E to comply.
Fuming Strips Construction Table for Mass Walls Only
A I B I C D j E
F G H 1 .7 1 K
L
M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint A ipenclix Table 4,3.5, 4.3.6. 4,3.7
.loran A rendix Table 4.3.13
.V
Y
Assembly
Z••.,
8
L O ..
z
9
u"
o `a
Final
Mass
Name of
JA4 Table
R _,
„ ! —
E
R o
.c
v o
a
Ass(
Thickness'
Ty r'
m
Number'
e_ e_
e- 5
w r
a I
C
U -factor 3
Comment
J
Regisn'ation Numbe):
2008 Residential Compliance Formas
Registration DaielTlmc:
HERS Provider.'
August, 2009
11
IY
Residential Alterations (Patie 31of 5) 1
ROOFING PRODUCTS (COOL ROOFS) §1516912
When the area of exterior roof surface to he replaced exceeds utar'e than 50% of rhe existing roof area, or Dore than 1,000 fr', whichever is
less, the new roofing area uutst meet fire roofing product "Cool Roof'requirentenis of§152(b)lHi, 152(b)/Hii, or IS2(b)1Hiii.
Check applicable alternative ar exception below iffhe roof ahelntion is exemptfi-om the roofing p-oduct "Cool Roof requirements. Nate: If any
one of [lie alternatives or exception below is checked, the Aged Solar Reflectance and Thermal EmlBance requirements for roofing products in
,§]18(i) are not applicable. Do nm fill table below.
❑ Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
P(5ool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 51b/fie.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
:30 insulation with a thermal resistance ofat least 0.85 hr- RZ.OF/Btu or at least a 3/4 inch air -space is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to § 151(010; or
D In climate zones 10, 12 and 13, with 1 W.of free ventilation area of attic ventilation for every 150 ftz of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(02; or
❑ Building has no ducts in the attic; or
❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hiii, Low -slope roof (pitch <2:12)
❑ Building has no ducts in the attic.
Other Exceptions
a
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels re exempt from the below Cool Roof criteria.
. ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 lh/ftZ is exemptfrom the below Cool Roof criteria.
Note: If no CRRC-I label is available, this compliance method cannot be. used, use the Performance Approach to show compliance, otherwise,
Check the applicable box below if Exem t from the Roofing Products "Cool Roof' Re uirement:
Roof Slope
1
Product Weight
Product
Aged Solar
Thermal
CRRC Product ID Number
<_ 2:12 > 2:12
< 5Ib/ft2 >_ 5lb/ftZ
Type2
Reflectance 3'4
Emittance
SRI5
❑
❑
❑
❑
❑4
❑
❑
❑
❑
❑4
❑
❑
❑
❑
❑4
❑
❑
❑
❑
❑4
1. The CRRC Producl RD Number can be obtainedfr'orn the Cool Roof Rating Council's /tared Product Direcfmy at vmv coolrools ore/products/vem'cl,uhe
2. hrdlcale the type ofprodact a being used u, tura tnoftop. i.c. single -ply roof, asphall roof, metal roof. etc.
. if the Aged Reflectance is nol available in.the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value fi on, the sante
director, and use the equation (0.2+0.7(pp,trtat— 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. C'alndale the SRI value Lr using tum SRU- Worksheet at her// v� nv mirky cu env/litle24/and enter the resulting value in die SRI Colnro above and atlach atopy of
the SRl- Worksheel in the CF -IR.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §1 I8(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
❑ Other
Registration Number: Registration Date/Timc:
2008 Residential Compliance Forms
HERS Provider:
August 2009
of Complian
Resirtential Alterations (Yate j o1 �)
]h:olect,Name; Climnte-Zoyc# I t4LSi ries
/ylia/z Y Lee Co �
HERS VERIFICATION SUMMARY The enforcemem ngener e'hould pm special anemias to the HERSMeasurea specified m this
checlrlisi belom A completedand signed CF -4R Form for all the Inca unci specified shntl be suhntiued rn rile building inspecrm be./biefinal
insnechon
Ducf Sealing & Testing HEI(Sverfficotion is required fw thm nlerisure.
❑ AILS ❑ NO YEs: hn Climate Zones 2 and 9-16, if more than 40 intent feet of nem, or replacement ducts tut installed in unconditioned
space, the ducts are to be sealed per §152(b)ID5 and the newly installed ducts are to be insulated pet §151(1110.
❑ EXCEPTION: Existing duct systems that are extended; which are constructed, insulated m sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §152(b)1Di.
D YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoo condensing unit of a split system, cooling oheating coil, or the furnace heat exchanger) the ducts are to be
sealed per §I52(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. -
❑ EXCEPTION: Existing duct systems constructed, insulated m sealed with asbestos.
Rei'rigerant Charge - Split System HERS verification is require for this measure.
❑ YES [IN 0 YES: In Climate Zones 2 and 5-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling of treating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §152(b)IF.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150(o) do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required. for this nmasure.
❑ YES ❑ NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced. the airflow and fan watt draw shall be verified per § 152(b)1 Ci to meet the requirements of 6151(f17B.
Documentation Author's Declaration Statement C
I certifi, that this Certificate of Compliance documentation is accurate and complete.
Name: `
Sign re:
�jl h
Com n':
Zb
Date:
Z-z-20
Addr
L I
If Applicable ❑ CEA or ❑ CEPE
Z,/�L//✓
(Certification 8):
City/State/Zip: n
L73 >
PIt e:
736,09
Responsible Building Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design idengified -
thia CC] tifmate of Compliance.
• 1 certify that the energy features and performance specihcation'o for the building design identified on this Certif Cale of Compliance coliform
to the requirements of Title 24, farts I and 6 of the California Cotte of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the intonnation provided to document this
building design on tilt other applicable compliance (urns, worl(shcets, calculations, plans and specifications submiuud to dee enforcenneni
aeenm• fo approval with this building pernlil a plication.
Name:
Signauue:
Company:
Date:
Address: -
License:
Cul/State/Zii,
I Phone:
Far assistance or questions regarding the Energy Standard.%-, contucl fire Eller- Hotline at: J-800-7 72-3300.
d(egisp gtim Number J(egiv, ,ion Dote/Timc: HERS ! rovide,
2(1(16' Resicicnaul Compliance Forms August 2009
=1-335
FEE RECEIVED
COSTA MESA BUILDING -SAFETY DEPARTMENT DEC 2416x?
P.O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
FOR APPLICANT TO FILL IN COMPLETELY APPLICATIONCIFORF EaRMAIT ESA
TYPE OR PRINT BUILDING
BUILDING
ADDRESS O YELLOWSTONE DRIVE
COSTA MESA, CALIrrlFORNIA fOR OFFICE USE ONLY
RECEIPT NO. I PER_ IT NO
OWNER
0-11 RECEWED BY I DATE AECEIVEO .I OAT. I... ED
NEWPORT BEACH. CALIF TNO.O-
CONTRACTOR K
APPROVED
COSTA MESA, CALIFORNIA
ADDRESS 1995 PLACENTIA NEWPORT B. l ZONING
LEGAL LOT 'J 4041 20NE NO. OF USE OF NE
GEBCRIPTION I NO. l� I BLOCK TRACT '� I IFI -ANS Fyl BUILDING
SIZE1 O. OF BLDGS.
OF LOT OX I OO rvOW ON LOT O
USE OF
I -A
(CENTER LINE ST.)
/
EXISTING BLDG.
FRONT
T.
NL'
34,f-
�
SETBACK
SETBACK LINE FROM li
t
THE AMOUNT SHOWN UNDER VALUATION
-!,
PLY WITH ALL CITY ORDINANCE AND STAT
CENTER OF STREET 4 21
REAR YARD
R. BIDE
FT.
IN.
1
I
1
I
SIGNATURE OF
11
SIDE YARD LEFT
RIGHT
L. SIDE
FT.
IN.
DESCRIPTION
OF WORK
/��7
$ f �1 4j,2�
/ l
PLAN CHECK $
REPAIR 1 II MOVING 1 II DEMOLISH 1
BUILDINGNO. OF
SIZE 1320SF ROOMS STORIES
EXTERIOR WgLth ROOF ROCK
COVERING JIUCCO COVERING
ATTACHED GARAGE. PLAN No.
I -A
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE I6 CORRECT AN AGREE T OM-
THE AMOUNT SHOWN UNDER VALUATION
FOR THE
IG -
PLY WITH ALL CITY ORDINANCE AND STAT
AW6 R UL INO
PURPOSE OF ESTABLISHING A PERMIT
FEE ONLY.
BUILDING CONSTRUCT N.
VALUATION
SIGNATURE OF
PERMIT FEE S
PERMITTEE
/��7
$ f �1 4j,2�
/ l
PLAN CHECK $
�6
AUTHORIZED AGENT
TOTAL FEE 5
UWNtK nv.. W) . 1 •., r. UAlt
JOB ADDRESS 3079 Yellowstone Dr. BUILDING PERMIT N0. 39262
GENERAL CONTRACTOR Owner Bldr. DESCRIPTION ofWORKLegalize Patio Cover
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CON
TEMPORARY SERVICE OR POL
UNDERGROUND POWER
ROUGH WIRING
TRENCHES 0 FORMS
FLOOR SYSTEM
BOND BEAM STEEL RE
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT
PLASTER, BROWN COAT
ST' TURAL, FINAL
HL .G. VENT., REFRIG. AN
SUBCONTRACTOR
_-.. -3922
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
t, For Applicant to Fitt in Completely
\ BUILDING
[ADDRESS ��jj-X/79
OWNER �✓/i�U�.l�
/�� Lf�GUF�iC'.CJ
DATE RECEI2VE
MAIL
DR
ADESS
USE OF DING AND RK TO BE PERFORMED
[REAR
DISTANCE BET.
CITY
y�
ry ���_��
NOL y/J
CONSTRUCTION
LENDER
n
^
BRANCH
Kt -I �L
ADDRESS
(/
that the above information is correct and agree to comply with
ARCHITECT
OR ENGINEER
TEL.
NO
ADDRESS
!
CONTRACTOR
Ot n , &d
V.
ADDRESS
TAX 41
CITY
TRACT
TEL
NO.
STATE
LIC. NO.
CITY
LIC. NO.
SIZE
OF LOT
ADOWNER
NO. OF BLDGS.
NOW ON LOT
°°=r 00 724>- ****10.50
/PPIIA$ATION FOR BUILDING PERMIT
R I V
Y
DATE RECEI2VE
FT.
USE OF DING AND RK TO BE PERFORMED
[REAR
DISTANCE BET.
BET. MAIN &
MAIN SLOGS.
ACCESS. BLOCS.
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DATE
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Kt -I �L
A.P. NO.
(/
that the above information is correct and agree to comply with
BUILDING
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ADDRESS
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any person in violation of the workman's compensation laws of
TAX 41
FT,
TRACT
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SHOWN UNDER VALUATION IS FOR
ESTABLISHING A PERMITFEEONLY:am
IN
ADOWNER
PLAN CHECK $
of
Permitte
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0
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TOTAL FEE $
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APPROVED11�4 O
BY DATE
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A P r iN 8c'
ZO NO. OF USE OF NEW
PLANS BUILDING
YARDS APPROVED YA SAPPROVED
MAIN BUILDING ACCESSORY BUILDING
(FROM C/L S,TfIEET) / /
EXTERIOR WALLROOF
COVERING
r
COVERING 447A
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FT.
USE OF DING AND RK TO BE PERFORMED
[REAR
DISTANCE BET.
BET. MAIN &
MAIN SLOGS.
ACCESS. BLOCS.
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DATE
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C.U.P.;k
APPROVED
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STATE
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
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all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
TAX 41
FT,
the State of California.
1 hereby certify that 1 am properly licensed as a contractor underFTHEPURPOSE
m
o
SHOWN UNDER VALUATION IS FOR
ESTABLISHING A PERMITFEEONLY:am
the State of California Business and Professions Code, Division 3.
Chapter 9, and that such licenses are in full force and effect, or IOF
exempt Irathe prov is ie ns of the State of Callfornia `inessIt
and Professions de, Divis on Chapte!PERMIT
FEE $Signature
PLAN CHECK $
of
Permitte
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Authorized Agent
TOTAL FEE $
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ECOSTA MESA'BUILDING—SAFETY DEPARTMENT
P.O. BOX 1200
Costa Mesa, California
PAID
;fAY 15-75—
.,,,00 637
PORM eu-3a
BLDG. PERMIT NO. _A,i /tom
PERMIT NO.
1 1 11 I
1
TRACT NO. RECD. BY
/
'7ATE
CONTRACTOR
LOT NO. DISSUED
BUILDING
Addr
✓H'�,J
Tel. N
Ci o1!l��S
BUILDING //��/
ADDRESS
State License No.�/� S'Class. C.
COSTA MESA. CALIFORNIA
1-F
NEAREST
CROSS ST./�E'.?
City License No.
NUMBER TYPE OF FIXTURE OR ITFS,1 FEE
MAIL I:1
Water Close[ (Toile[)
ADDRESS R��77E
��a �J
Bath Tub
CITY TEL. NO.
showor
I hereby acknowledge that I have read this application
Lavatory (Wash Basin)
and state.that theaboveis correct and agree to comply
Kitchen Sink
with. all ,City Ordinances and State Laws regulating
Laundry Tub or Tray
plumbing.,
I certify that I possess the above valid state of Cali-
service sink
fornia classification or I am the legal owner of the resi-
Floor Sink 1', -
.dential property described above
Floor Drain
Signature Of
Dishwasher -
Permittee
DrinkinE Fountain
Urinal
INSPECTION RECORD
Garbage Disposal -'l"„�
Automatic Washin 'Mach. t- -
Water Softener, I '1 J'
Water Heatci KWeni
Rece for- i '
-
Swim Pool Filter Sy§tem
-
Gas System . .Outlets B Q
Lawn S rinklcrs
Installation or Alteration
Water PipiogAPPROVALS
Back Flow Preventer
Prop. Sewer H.
INSPECTOR DATE
H _
U/G Soil I I
C—ool Se tic Talk
U/G Water I 1
Services—Water ❑ Gas O 1 1
Misccll ancous
Rough Plumbing I I
Sprinkler System I
Gas I I
Property Sewer 1 I
Pool Receptor I I
Filter System
Pool Heater I I
Miscellaneous I
Issuing Permit 00
I
Final Gas I ��•
TOTAL FEE
Plumbing Final I I - -
00
Utility Co. Notified I I
PORM eu-3a
BLDG. PERMIT NO. _A,i /tom