HomeMy WebLinkAbout2750 MALLARD DR - Building PermitsCITY OF7'OSTA MESA
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i�,,. a. � 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.qov
�. .°� FOR INSPECTIONS CALL: (714) 754-5626
°°��^� PERMIT NUMBER: BC12-00507
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 09/06/2012
ISSUED BY: RMD
Jos nooReSs: 2750 MALLARD DR CM
APN: 13953142
Vicinity: BATHROOM
Const Type:V-B
Zoning:R1, ,
SQ. FT: 0
Suite/Unit:
Primary Occ:
Valuation: $9,999.00
SCOPE OF WORK:INTERIQR NON STRUCTURAL REMODEL OF BATHROOM. WORK TO INCLUDE THE REMOVAL OF AN
EXISTING BATH TUB AND REPLACEMENT WITH A THERAPUTIC WALK IN TUB IN SAME LOCATION, INSTALL 2 DUPLEX
OUTELTS, 1 DEADFRONT GFI, REPLACE WATER CLOSET.
OWNER: HADDAD, GEORGE N TR �
Phone:
APPLICANT: DAVIDSON, PETER
Phone: 714-655-3202
CONTRAC70R: GALKOS CONSTRUCTION
Phone: 714373-8545
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commerciai:
Bldg Std Admin Fund
TOTAL FEES:
Address: 2750 MALLARD DR Unit:
City/State/Zip: COSTA MESA, CA
- Address: Unit::
- City/StatelZip�
License No:492715
Address:15261 CONNECTOR LN Unit
CitylState: HUNTINGTON BEACH, CAZipCode92649
License No.
License No.
$0.00
S 181.25
$31.55
$0.00
� $43.10
$1.00
80.00
$1.00
� $257.90
PHONE:
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3l18/2010 - PER CMMC Sec. 13-279
Montlay thru Fritlay � 7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New YeafS DaV. Memorial Dav_ Indeoendence Dav. La6or Dav. Thanksaivina Dav and Chnstmas L]av
NOTICE: The work authorizetl 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 resWt in the expiration of this permit.
CODER INSPEC110NTYPE QRjF INRIIALS COOE INSPEGitONTYPE ORTE INTIilAlS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 'i� ��
200 Final Re-Roof 210 Finai Electrical __�_�
201 Final BIocWRe�aining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign
204 Final Demolition
222
250
Final Site "�Y"
Final Bwltling/Occupancy 0 __D�
WORI(ERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of ihe following tleclaralions:
❑ I have and will mainlain a certifcate of consent to self-Insure for workers'
compensation, as pmvided for by section 3700 of the Labor Code, for the
pertormance of the Work for which this permit is issued.
I have and will mainlain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the perfamance of the work la whicb this
permit is issued. My workers' compensation Insurance carrier and policy
number are: �/ -� �/—,
Cairiet� %/{ , ( 'Flk� � .1'�S �LC a4�
(IDis sechon need nof be mmplefed��e pe�mrt is valuetl at one huntlretlCollars (8f00) oi kss )
Policy Number: � Da � ��
❑ I certify that in ihe peAormance of [he work for which ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should �
becom u ject lo tly workers' compensation pmvisions of Section 3700 of
the o de, I s{ I(orthwith ompty wiM lhese provisions.
/T�[i 6 .s_.
qpplicam'sSigneWre D te�
�-�_ _ -- '�-�_.
WARNING FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LIGENSED CONTRqCTORS 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 in full Force and effect. �
�-.
Lic. #. Class #
��' /
� .cotsSlgnaWre ��a'e!'7
y�
CONSTRUCTION LENDING AGENGY:
❑ I hereby affirtn that ihere is a consWction lending agency for the
perfortnance of the work for which this permit is issUed. (Sec. 3097, Civil Code).
Lendets Name:
Lenders Address:
6ignaWre Da�e
OW NER-BUIL�ER DECLARATIONS:
I hereby aKrm that untler penalry 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 pertnit to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicaN for such permit to file a signed S�atemen�
that he or she is licensed pursuam to the provisions ot the Contractors
License Law (Chap(er 9(commencing vnth Section 7000) of Division 3 of ihe
Business and Prof�ssions Code) or that he or she is exempt iherefrom and
the basis for the alleged exemption. Any violation ot Section 7031.5 by any
applicant for a permit subjects Ihe applicant to a civil penalty of not more than
fve hundred dollars (g500).):
❑ I, as owner oI the property, or my employees with wages as their sole
compensation, WIIL DO 7HE 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 hersel( or through his or her own
employees, provided that such improvements are not intended or oHered for
sale. If, however, the building or impmvemen[ is sold within one year of
completion, the owner-builder will have lhe burtlen o( proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner oi the property am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS b construct the pmject (Sec. 7044, Business and
Professions Code: 7he wntractors License Law does not appry lo an owner of
pmpeity who builds or improves thereon, antl who contrac[s !or such pmject with
a con[ractor(s) license pursuant to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305�<6 (3IOl)
Owner ID verifed by driver's license. ❑ Yes ❑ No
C+iRier's L'`,ense No. Expires:
Verifcation of Ownership by (type of dowment, i.e. - prOperry lax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ i hereby certify lhat no excavalion five (5) or more feet in depth into which a
person is required to desCend, will be made In wnnection vrith vrork authorized
by this pertnit, and that no building siructure, scaHolding, talsevrork, or demolition
or tlismantling therBof, will be more than thirty-six (3fi) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, TiNe 8, Cali(omia Administrative Code).
❑ As owner-buitder, I will not employ anyone �o do work which would
require a permit from the Division of IndusMal Safery, as noted above, unless
such person has a permit to tlo such work from the division.
ApphwnCs SignaWre Date
Division of Industnal Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or future building occupant need to fie antl
certify a Business Plan for emergency response to release or lhrealened
release o� a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Cotle requires, with some
exceptions, that a Business Plan be filed with the Cos�a Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet o( compressed gas
at standard temperaWre and pressure).
2. Does or will the applican[ or present or fuNre building occupant need to file
a regisiration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires regislration with Ihe Costa Mesa Fire Departmen[ by
each business which at any one time has on hand a quantity o( acutely
hazardous matenals equal to or grea�er Ihan 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 (uture building occupant need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous matenals)? ❑ Yes ❑ No
(Seclion 25534 of lhe Caiitornia Health and Safery Code pmvides ihat the
Costa Mesa Fire Department may require the preDaration, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register awtey hazartlous matenals with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl 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 Ihis application a permit for such construction
or modifcation from the South Coast Air Qualiry Management DisUict or from
any other air pollution contml disirict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
intortnation be fumished on applications for non-resitlential building permits).
6. Will any part o( the faciliry to be construcled under Ihis permit be within
7000 (eet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the faciliry must meet �he requirement o( Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from lhe South Coast Air Qualiry Managemenl DisMci or other
air pollution control distnct or agency is requiretl for the work which is the
subject o( this applica(ion, have all of the disdosures prescribed by Cafi(omia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes', attach certificate of compliance fmm the appropnate air polWtion
wntrol offcer).
CERTIFICATE OF COMPLIANCE: I certify tha� under penalry of perjury Ihe
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I
certiy untler penalty of perjury that I have read this application and state lhat
the information given is correcL I agree to comply with all state laws and ciry
ordinances relating to building consWction, and authorize representatives of
ihe Ciry o/ Cos[a Mesa to enter upon lhe above-descnbetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhorized by �his permit until final inspection.
S naNr opal pwn ) 2ta
Signawre Date ,���� SCj� p�
AnNorAulM1orizetlApplicanl ( Date
.�:a� `
�,..
: :, .
�-�"` ��-.. ,. �;,t.. �t=�=, ww,. �,.:,:�
�� �
0
� ��
Existing Bathtub or Shower Measurements: Customer: %t'R�11�l1\ . l C�1.�
��
Length:�� inches Does tub backup to another bath: ye� Are there open:breakers in elec. panel. y no
�i� �� �� �
Width:on d inches. Distance betwee tr�u�nd vanity o il :�inches Brand of BreakerNO—tiWW�2�
Does vani: decrease the size of the door opening: yes (Li��llllidth:�inches Water heater size/yr:S�al OT y�
Crawl Space Y No Type of Existin Tub hower ��` � , Existing tub walls ile or Fiberglass
Window Over the Bathtub (ff applicable): rime for tub to ru I I min. Time for tub to drain � min
�r
Distance from the floor of the Bathtub to the BOTTOM of the Window: � inc
� a� Fu� � t�-� �a r��- .���'t�� �
Door Measurements: ��� � Sp,-��2�`X�.A
.-. - � �
,�
Width f Front r 8ack Door of House2.k-�� inches TUB
Width of Interior poor: � inches LH o RH White Biscuit
Width of Interior Hall:
Width of Bathroom Daor:
r.
�AfIZS-?6 inches
V
�� inches
a�
W
V�h (Ty.
Reverse plumbing �r No
R&R Vanity Y or No
Pony wall Y or �
Backwall shelf Y or No
R&R Door(s� Y or No #�
r Y
R&R Toilet �r No
Safety Bars �r No # �
Surround Y or�brlNMite
ShowerBreck� Y or No
hich Wall of your Existing Bathtub (or Showe as e fixture?: CI-l�1{T Wall
Back Wall
Left Wall EXISTING � o - ight Wa Customer's initials
TUB
,PpOWNERSNAME: 27SO MALLARD DR
nooRess: HADDAD, GEORGE N
2750 MALLARD DR
COSTA MESA,CA 92626
AflCMIENGINEEfl: S�IS—Z89Z flEG.NO.:
NODPE55:
uxir:
UNIT:
PEHMITTFF:
nooeess:11�610pSEABOARD CIR ��14)895-1246
G��j (��j CA 90 8�
LICENSEO CONTBACTOA�LO(A�IUFf � I hereby a��irm Ihat I am licensed under pmvisions oi��aprer 9(commencing wi�� $eclion
7000� al �rvisiun 7 ol the Business an� Prolessions Code. and my license is in full inme an0 effect.
cirruc.: 050386 srareuc.:511971 cuss: C-36
Oate: Signamre:
WOPRENS' COMPENSA710N oECIABRTION: I here0y atfirm t�ai I have a cerlificate o1 consent m selbinsure or a cenificate of Workers'
Campensalion Insurance, or a ceridietl copy ihereol (Settion 3800. Lab. C�.
eoucrNa.: 116799290 E%P.UATE: O3IOSI9Z
comrnxv: STATE
� Ceriifietl capy is here[0yy furnishetl. � CerlilieA copy is liletl � h the ciry BuilUing Oivision.
�ale:�^ �j � `� APDlicanL ��
E7(EMPTION FflOM WOPHEBS' COMPENSATION OECIAHR7IDN: �This Set�ian n¢ee nol b¢ completed d Ihe per '' lor one hunJretl �8700) Or 1¢55)
I cently Ihat in ine oeriormance of Ihe work lor which ihis permit is issuetl. I shall not employ any pe on' any manner so as to become
sublect qlo IAe WorkersQ' C,ompensation Laws ol Cali�omia. `�
Dale: l � � � L � Signature: �`�'� �
NOTICE: II, al�er making �his Declaralion. you 5hou10 become Su�lec� Io the Workers' Compensa�ion provisions of the Labor
Cade. you musl �orthwii� tomply wilh suth provisi0n5 or Ihis permi� Shall be tleemeE revoke0.
CONSiHIlCTION LENUING AGENCY: I �ere0y aifirm t�at there is a consimtlion IenOing aAency far t�e pedormance of Ihe work for
whic� I�is permn is issued �Seclion 3097, Civ. C�.
LENOEfl:
aooness:
OWNEP BOILDEB OECLAflRTION: I �¢re0y afUrm �ha� I am exemD� �rOm the ConVaClors' Slale License law �or Ihe �ollowinp reason
(Seciion 7031.5 Business antl Pmfessionai Coae' Any ci�y of counly which re0uires a permA to consimct, atler, impmve. Cemolis�. or
repair any stmcture. o��or lo its issuance, also requires Ihe applicant 1or such permit ta file a signea statement tAat he/she is Iicense0
pursuan� io �he pmvisions o� the Contracmrs' State license Law (CM1aDter 9(commencing wilA Section 70W) oi Oivision 3 0l �he Business
ano Pm�essions Code) or tha� helshe is exempt iherelmm and Ihe �ass tor ihe allege0 exem0�ion Fny violation ol Section 7031.5 by
any applicani lor a permi� subjec�s �he applican� to a civil penal�y of not more (han live �unCretl dollars �&5011).
I. as owner of the D�opertY ar rtry employees with waAes as IAeir mle compensation, will do tAe work, antl the
❑ simcmre is not intenaed or offeretl lor sale (Secuon 7044. Business antl Pmiessianal Cotle: T�e Caniracmrs' State License Law
Uoes noi apply to an owner of a pmperty w�o builtls or imDmves thereon, and who does such work �imsell/�erSeA or ihmugh
�is or her own employees, pmvitleU �hat such impmvemenis are not intenCea or offeretl lor sale. tl, howev¢r the �uilding o�
impmvement is soltl vnt�in one year ol camplelion. Ihe owner vrill have ��e buraen oi Dmvinp he/she OiG not Guild or impmve
� for the Durpose o� sale).
I. as owner of �he property, am eaclusivety coniracting with licensetl con�ractors lo canslmcl ��e prole�� (5ec�ion 7044, Business
❑ antl Pmlessions CoEe: The ConVaclors' Sta�e License Law Ooes no� apply �o an owner o� pmDehY who Uui105 or impmve5 i�ereon
and who conirac�s br such Omlecis with a conVacroqs) license pursuanl to lhe fAnVacrors' Slaie License Law�. I 3m aware
t�at pmol ol their Worker's Compensatian insurance 5houlA 6e pwvitletl �o me.
� I am exempt under Sec�ion: B. 8 P. C.
lor this reason:
Oale: Ownec
I tlo here�y cetlity tM1at I am aware oi an0 understantl Ihe requiremenis ot Califomia Healih antl Sa�ery Caae Sections 25505, 25533, and
25534 an0 thal I ar any fuiure Ouiltling accupant mNvnil not (circle one) neea lo [omply wilh saitl itate codes and �he reQuirements lor a
permit for constmction or mo0ilica�ion Irom I�e An Oualiiy Managemen� DisVicl. Fesitleniial consimc�ion apD�ica�ions are exempi �mm
these pmvisions.
Daie: ADplicanl:
I hereUy cendy t�a� I have reatl Ihis aDPlicalion antl 51aie t�al Ihe a�ove fnbrmation is corr¢ci. I agre¢ to comply vnl� all ci�y anG counry
or�inances an0 Slalelawsrelating�o builaing cons�mclion antl hereby ayyyMMM���qqq��� ¢erepresen�alives ofthis cityJq enieruponlhe above�meniionetl
pmperly for inspeciian pm ases � 1� //
vn� ��`�'y�I � ,ri �
Oate: J_tY�.L� Signamre: i AV� I /nY�
�river's License o� Social Securiiy n:
164La6 WM1ue—BwlOing; Green—Gotl¢ Eniorcemenl; Canary—Applicanl: Pink—Revenue: GOIJenroa—Aneswr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 053'79
PERMIT NO: P 053742 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION ; CHANGE OUT WATER HEATER S(j FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS• SMOKE DETECTOR RE�UIRED IN THE HOME
�r�r***�r*�r***x*�t**+t�t�t***�**** **�t+tr�r�r*****�t+t+t�r�t**��t+t�r�t**x**�***�t+t*�**�t+t�t*+���r*�**+t
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ• PROV; PARCEL; 13953142 ZNE: REF NO:
PLANNING NtST'ES>
i
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D E V E L O P M E N T S E R V I C E S,' R E Q U I R E M E N T S
20NING APPROVED BY � DATE;
HUILDING APPROVED BY ;
APPLICATION ISSUED BY: —
�F 9E if if M iEiF iF 1E iE iE IflE iF iE 9f I:If if 1f if �F
MiEitMikiFlElflfiEifififiEiFifiFifif�lfikiFiFiElFif�FiEifiFjtifiFMikif if
LEGALIZATZON:N � F E E
PERMIT BLDG PMT PLUM�I�NG� ELECTRIC
?SZ .
DATE:
DATE • ��'�
*�e�****�r** ��
ifMiFil�flF�kMiFififikiFMifMif�k�fiEMiFiFiFatit3FlFkiFiFMM1EkMiFiEiF
U M M A R Y STRUCTURAL SEGMENT:N
MECHANIC FIRE SMIP/RES GRADING
SMIP/NON—RES
PLAN ,
ISSUE FEE 3.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 2.00 3.00 0.00 5.00 5.00 .00
REVENUE DIVISION TOTALS--> COL'LECTED; 5,00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
5.00
ik ik M k k iE if k k 1P iF 1F k 1F k iE if ±f if iF k iF iE if if if if 3F if iE iF if if iF k if if iF k if �F iE k if iE iF M if iF iE 1F M if iF if ik if if k if �E 1E if if iE IE iF It iF �F iF if IF iE k if if if IF
I N D I V I D U A'I. F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 2.00 2,00
•END OF FEES
. - .��t��: .':.'`, J4_. �F _' _, "_ ' , �
- �::• '1"ii+:.�'1 ? i.:' ',.i'._
� CONSTRUCTION ANDPLANNING . POO SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole_�� 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � Ty 53. Steel Reinforcement
�E�ectri�al Condu''����T.ity-L�drgrndry�'`� 54. Forms _
� , .r J ' - S J
�Eleetri&alConduii�ndrgrnd. y 55. Electrical8onding
s6.' �I F2inforcemen'tS 56. Rough Plumbing & Pressure Test �_
r
;G,;.F�triCal UFEf�nd. y.; 57. APPROVAL TO COVER�GUNITE `�
i
�7.� fi��atings 5 y a, 58. Electrical ConduiFUndrgrnd.
�
`8:� �oundation ^�' ' 59. Gas Pipe, O Undrgrnd., Test ''
o,
+'9. Water Pipe�Undrgnnd. 60. Backwash Lines, P-Trap, O Undrgrnd. .a.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Prpperty Sewer Lina-& Howse Conn�tion 62. Backwash & Receptor-Final
12. Sewer Cap �' � 63. Heater & Vent-Final
ic « a
13. floof Drains ^' �� -
ro 64. Plumbing System - Final
74. Rough Plum6in�y � 65. Electrical�Final
75. Rough Electric�Conduit 66. Solar SYstem-Final
� 16. Rough Electric101iring 67. Fencing & Access AnP�oval
n
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. flough ElectricaMT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
.� . .. . ^ q�� � t� �D:-� 'F„ :F '. �T
20. `�iough F�to'ry Fir�'place i rx�:j ��y .t ,j � � .� x �{�ppRuyvPrq�i;�(Yerrqit # ��-
i.= c ,r •* r.�z 1 �[r �
21.�3uc�'s',i Str'2tur�.� �c-i-� 7:;[ , �^ y:ta. �7��H o " i*7
r, 1.. � t;t t•• -;S :r 5 i�x a. �0. l�Cder9{A�., �� +
r •.. �._ � - . , v � �... . ,- .
22. Duc�, Vpptilgting.x i !dS .x S k:,x x �g7, productd't�ing �60s O:OiI
23.Q.ias�i'ipeCRou'T &"fest ' '^ �` � '""�� �`-'~ 2, Under r' � "'� Y �+
r. x � .:i �• n7 C' '�L O�'.?� i-� 9 by+iaci FIU�F�.,'' r
24. �to � Framing, rx �'-'r-� �• F x> O t^ x ��3.cUndergrn�Stora9e.7Tank � Gas ❑ 0'+1
25. Rodf'ShgSthing %T�r �' �� �' "� ` � Lti y: ;�74.�Overhead �Hydro;-j• w
26.��Ba�,Ceiling�Str,dcjural) &`�lonqcoat � � �,;,� �� �,�Y: 75:;DryChemical * , r 3
27.:�Frame and Flashih�t� W a � �' � 76f"Dry Stanc�iP,� ��,�� � s ih f"
n. n r. s .R ." y [C � x :K
r�8.`'lat�ng'�i Siding�..�.,�. r, ^�� � x�; �.* Y 77.� FIXED Sr,3TENh�FCAL:K . K
�P9. Insulatiq�y �<�' O � ••�'• > � �*� I N � 7gsFIRE PREV. FIf�F,jL * � ��",'.
�:30. Drywall, ailin �». � :� ' � • Y �. ��- .
� 9 th< M� � j�- 7. �-+ •c,a `.NEALTSi;�EPT�F.LEQWR5MENT
'�31. Plaster H�wn CoSir� � � , � � �, � �? �]9.�i^TNX1L4i�] PECTI `" �
'RF32.;Electric$�Po�kr �e{�Final; �� :: p; � � .': � r�0.i�f00D CERQIFIGATE IS�Sl7�D' � �
33.rEin31� EleCiric� � � � M � 4r" fi°7Voj�sp' y '�,,IG � �,�n^
c ..w � i t � .[f w '{ r�tl�� �"..,,f�'�Fa,:'�V�"IN/ �-MW'��.�
,`'�.�34.:Fin�LHeazing'B�f`tr�C�nd,itioni�� � ; x j A � } ;c� .� S �s
35.Cfina4Ge�Pipe;Testr m `7 'n � � (/: .�Y ? :� ,^ �aS r t* SO
�_. t v �.-• > � ' F�,i
�6. Moo orr�ano � .J � y �` • tO . .•' � ,� �n
� � LL. PY C�. '_;cc �;r..� „� x!1 � � � 2: S C�o t �..
� 37.CFinaYFactory Ficejrlace� �>Lr ti �'� t*7 i .< !� :� =:�
� r_ •� x / I v r N
�38. Final,Plumbing � .x �•v � .... ,.w ' `�lQ�� (i�) � � �� �_ 1 _
� y
;39. Wafigc Service-Final: ' ; cn x I I x i� t�i ��� u;
t r� a a. ni �
�T40. Gas Service-Final � '` � I [� �} j, � �, � ' '�
(r� :� C�7 dCr!tM � :r r� I !T > n i t.
: i. �� i � �
g47. Solar pomesticFinal s �� •• .c �� � '� �� �So �� �n
I 4p: .,.
Eq2:Backflow Preventer� E' J .r a I � r'x � U'. >r + C �
t.. Y. ��� . ,_..�.. . .. ,.; -. .
43. Backflow Irrrgation,. tXSS �� �+� � u:[� Y O ��
Y y 4 ^t
�T ^ r lr.l.4 �t. �i �}' : • CU 'i 'T+ �.� O
�44. Landeca�e I�patior Systerr�A�,�r �, :r.: � O C CK� x'• ro �v :L:J �r o�
�,45.%Sound fCttertuatiorr w��C[- [* * S '-�� �- '.-x �r�' .�- � Cn� cC�a: �<
- + :-, �., �-, c r.� .r
546.`Handica�Q'R�ulatio'hs � C `y !'% ' • ••`a " � • •��' "" '
x x T, tr� j CC 5
�47.�IPjAL STR,I�ICTUBE & BU;I',1dING �� s. ' � �� �� s -: ni S ��� r �
. �� rr �.,
48 �FIIJ�1l PLANNING � �`��r . _,. = v t[ '7 �. J
•7 .e � Fr-� •: [V I I �-.,.Y.T . [�� �i �* -
;49 �Ele�'ric Rele�se to��dison i R i . r� � � � w. ,
.
!�50.,.GasRelease to Sou4*hem Califomi Gas Co '� �� ` . �'L " '- `';
� • t-� � - !-� �� p . oia . ��
L51. CEF�TIFICATE OF�OCCUPANEY y :; ;;: r ��a x , . �
No. Dace
�, =��� ApP���ant to fill in all spacp6 except those wi�hin heavy �or0er lines anA si9n all aOPropriate tleclarations.
�!'� 7'isOF COSTA M�1ESA` CONSTRUCAT�ION PTER�MIT
- ProjectAddres5 eC%.JO �fil�./'f2� LY`
Applicant's Mailing Address �
Owner's Name �Q@I^«- � a a' otinna.s .S �_
Address S�
Arch/Eng. License No.
Address
Contraclor's Nam Phone
Address(m�'�'�;)
Ciry License No.
LICENSED CONTRACTOR DECLARATION
' 1 hereby attirm [nat I am Ilcensetl untle� O�ovi51on5 of ChartM 9(commencin9
with section ]000) of DiviSion 3 0l tha BuSiness antl Prof¢ssions CoOe, anE
my Ilcense is in full force antl afiect. ,
License Clazs l.icense No.
Date Signature
WORKERS' COMPENSATION DECLARATION
' hereby affirm that I nave a certificate ot consent to self-insure or a certiflcate
d Wo�ke�s' Compensation Insurance, Or d certlfietl cOpy thereof (SeGtlon _
3800, Lab. C.).. _.
Policy No. - Company
Certifietl coDY is hereby furnishetl. � �
Certitietl coDY Is filetl with (he city Bulltling Division. �
Da[e APplicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not Ee completetl it t�e permit is tor one �untlretl (E300) Or
less).
I certity lhat in,[he Perfo�mance of [hB wo 10� whlcn tnls pe� �t' SuetlYl
shall not ert�Ploy ny Oe�son in any o to b n Su �ec [o t{�e
Work¢rs' e Laws Ot C �a
Date 99�a e
�NOTIC : f, att r makinq thi a�ation, y0u shOUltl becomn sub- ct t�
Worke�s' Comp¢n5d[ian p�ov�s�ons of lh¢ L2bo� Catle, you mus torthwith
comply with such pwvi5ion5 or this pe�mit Shall b< tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I nereby atfirm ihat there ts a constructlon lentlin9 agency tor tne per(ormance
of the work fOr which th15 permit iz issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's Aatlress ,
OWNER BUILOEfi bECLARATION
I hereby aftirm tnat I am exempt from the Conlra<tor's Llcense Law fo� the
following reason (Section 7031.5 Business antl Professional Cotle: Any tity or
munty whicit requires a Oermil to conSVUCt, alteq improv¢, Oemoli5h or repai�
any structure, prior to its issuance, also requires the applicant (or such permit
to file a signetl slalement that he/She I5 IlcenSetl putsuant to the piovisions Of
the ContracioYs License Law (Cnapter 9(commencing with Section 7000) o(
Oivision 3 of the Business antl Professions Cotle) or that he/she is exempt
nerefrom and Ne basi5 fOr Ihe all¢getl exempliOn. Any violation ot $ection
]031.5 by any applicant tor a permit subjects the appll<ant to a civil
alty ot not more than five huntlretl tlollars (5500).
I, as Owner of tM1e property or my emplOyoes wilh wages as [M1oi� sole
co ensation, will Oo the work, antl the structure is not iNentletl or o(teretl
for sale (Section ]044, Business antl Protessional Cotle: The Contrac[or's
License law tloes nol apply to an owner o( a properry who builtls or improves
thereon, antl who tloes such work himself/herself or throuqh his or her own
employees, provitletl fM1at suth improvoments are not in[entletl o� ofleretl for
sale. If, however, the builtlinq or improvemen[ is soltl within one year ot com-
pie[iOn, tbe owner will have the burtlen Of proving he/She tlltl not builtl o� im-
prove for Ihe purpose of sale).
❑ I, as owner ot the proverty, am exclusively mntractin9 wiih licensetl <on-
tractors to construci tne project (Section �044, Business antl Proteszlons Coae:
Tne ConVactor's License Law tloes not apply fo an owner oi property who
builas or improves [hereon, antl who contracts fo� such projects with a con-
trac[or(s1 license pursuant�to�the Can[racior's License Law). 1 am aware that
proof o( lheir Worker'S Compensalion in5urance snoultl bo provitletl to me.
❑ I am exempt untler Seclion B. & P. C�or th6 reason
Date Owner _
I�heretivi certiN that I have reatl tnis
state
LDr�R' Liclrtse or 5:
CMF OB65-46, rev. 10/84
E 22 26/ _ _. .._.
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMIT ,/ GRADING�/ FOUNDATION ❑ STRUCTURAL T Front
❑.TENANT LJ ELECTRICAL LHPLUMBING ❑ MECHANICAL A Reef
❑ �OTHE0. ' ' .
PRWECT DESCqIPT10N 5a. FT, ocCUVArvCY C Right
K Left
CONSTRUCTIONTVPE VALUATION$ $
ZONE GRADING CU.YOS. ACRES Ping. Ref. �k
Remarks: Planning Notes:
Sink
Preventer
Irrigation
Floor Drains
Floor Sinks
Gas Service - Outlets
Interceptors �
Kitchen S��k
Lavatories �
P—Trap
Roof Drains
Reinspaction Fee $15
Boiler
Duct - Under Ground
Duct-Strutturel ,
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt ICBO #
Heating System & Ducting
❑4100,000 BTU 0100,000 BT
Reinspection Fee � $15
Builtling; Canary - qpplicanf; Plnk - Acwun[ing: Goltlenrotl - Assessor
IJ
Showers
Service Sink -
Sewer Cap
Sewer Connection
$olar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal � -- -
Water Closet
Water Heacer
Warer Service
Aum-Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑ 100,000 E
SVstem Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3 :
FEES '
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electr
Fan '
F.A.U.
eoxes
Switches
Garbage Disposal
Generotor �0.5 KW �5-15 KW
6727 I/03/36
2one
Accessory Building:
Transformer ❑ 15�50 KW
❑ SO+KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP �7'h-6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range .
Sign '
; Standing Sections
Trash Compaitor �
nspection Fee I$15 � � Issue Fee
.OPMENTSERVICESREQUIREMENTS: �
Approved By
B APProved By .
tion laued Bv
� n� . I"
FEES
$ 3
� % SUMMARV OF FEES
s—��BUILDING PERMIT $ SMIP $ �
� t':PLANCHECK $ PERMIT
.^ % PWMBING $ ___(� ISSUANCE $
' PLAN CHECK 25% $ � S'�D ENERGV P.C. $
�! //��ELECTRICAL $ I GRADING $
?�i PLANCHECK 50% $ S.cQO MICROFILM $
'��'MECHANICAL $ _ TOTAL FEE $ �0.90
• PLAN CHECK 25% $
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CONSTRUCTION ANDPLANNING POC SPA
:�,.APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole �. 52. Pool & Equipment Location
2. Soil Pipe; Undrgrnd. -� 8(� (�� �., 53. Steel Reinforcement , �
�3.'Electrical Conduit Utility-Undrgrnd. � 54. Forms
4:� Electrical,Conduit-Undrgmd. 55. Electrical Bonding �
5. Steel.Reinforcement 56. Rough Plumbing & Pressure Test �
'6: Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE �
7:�'Footings , 58. Elecirical Conduit-Undrgrnd. � � �
8. ��FouFlciation .59. Gas Pipe, O Undrgrnd., Test
' 9. Water�Pipe-Undrgmd. I:E 60. Backwash Lines, P-Trap, � Undrgmd. -
10. Structurel Floor System 61. APPROVAL TO DECK � .
17. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. SewecCap 63. Heater & Vent-Final �
13. Roof Drains `� '
� 64. Plumbing System - Final .
14. Rougti Plumbing � ��16 QO 65. Electrical-Final •
15.. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring ��r� ' �1�0 67. Fencing & Access Approval .
1�7: Rough Wiring Sign . 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ��•1 . 6g. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20., flough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure � � 70. Underground Hydro
22. Dw:ts, Ventilating _ ,. 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test -� 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank 0 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. Elec:trical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � -� Notes: /� 7 � �� ���.� �.•C�
34. Final Heating & Air Conditioning , ,_ G� _
r
35. Final Gas Pipe-Test � ' � � �
i
36. Hood or Canopy '
37. Final Factory Fireplace
38. Final Plumbing �
39. Water Service-Final , ,
40. Gas Service-Final
41. Solar pomestic-Final . � �
42. Backflow Prevenier -- --- , �
43. Backflow Irrigation - `' � � �
44. �Landscape I«igation 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 � ' �Z � - �
ADVlicant to fill in all spaces exeeo� those-within heavy Dortler lines anG sign all apvropriate tleclarations.
CITY OF COSTA MESA CO
�Proje�Address ^�750 ,
; i
Applicant's Mailin Addg_ ress _
i'o�_.: n
�Owner'sNN-ie ���L-YJrJC ��
Arch/Eng. License No.
Address
Contractor's Nam � ' Phone
Address (m= ����) �
City Licen<r Nn
LICENSED CONTRACTOR DECLARATION
� I hereby affirm that I am licensetl untler provisions ot Charter 9(commencin9
witn, section ]000) ot Divlsion 3 of �[he Busine55 antl Profe55ions Cotle, antl
'my licenze is in full /orce antl effect. �
License Class License No.
� oate Signature
��. WORKERS' COMVENSATION DECLARATION •
� 1 M1ereby afflrm tnat I have a certiticate of consent to self-insure or a certificate
�t Workers' compensation Insurance, or a_certifietl copy thereof (Section
3800, Lab. C.) . .
� Policy No. Company
'. e'Certified copy is hereby fu�niSheG.. '
Certifietl capy is tiletl with the cify Builtliqg Division.
,�Oate APplicant � .
'. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
'I (Tnissection neetl not be completetl if the permit i5lor one huntlretl ($100j or
less). - '
I certify that in the perfo�mance of the woik for which th15 perm�t is issuetl, I
shall not employ any person in any manner so as o beco e s�� tO the
Wo�kers' ordqp 5. '�Laws o( Calitorn"
Oa[e �� Si9nature �
�NOTICE: Ii after making this declarationy-you sM1oultl become subjett to [he
Workers' Compensation provisions.of the Labot Cotle,.you must forthwitM1
mmpiy wi[M1 such provisions or this permit Shall be tleemetl� revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aftirm that there is a construction lentling a9ency for the perPormance
of the work tor which this permit is issuetl ($ection 309] Civ. CJ
Lentler's Name -
L2�dCY'S /�1tldl¢55
OWNER BUILOEI2 �ECLARATION �
I hereby aftirm that 1 am exempt trom the Contractor'S License L.aw tor tne
following reason (Section ]031.5 6usiness antl Professional Coae: Any city or
counfy which requires a permit to construct, alter, improve, tlemoli5h or �epai�
any structu�e, prior to its is5uance, also �equires the applicant for such permit
to file a si9netl statement that he/she is licensetl pu�suant to [he provisions of
the Contracior's License Law (Chapter 9(commencing with Section �000) o(
Division 3 of the Business antl Professions_Cotle) or tha[ ne/she is exempt
1erCfrom antl ihe basis fo� the allegetl exemption. Any violation of $ection
)31.5 by any applicant tor a permit subjec[s the apPlicant [o a civil
¢ndlty of not more than tive huntlred tlollars ($500).
� I, as owner of the prOperty o� my employees with wages astheir sole
tompensation, will tlo the wo�k, antl'the structure is not intentletl o� o(teretl
fbr sale (Section 7044, Business antl Professional Catle: The Con[ractor's
License Law aoes not apply to an owner of a property who builtls or improves
the�eon, an0 who tloes such wo�k himselt/he�self or ihrough-his or her own
employee5, provltletl tbat such improvementz are not intentla0 or offeretl fo�
Sale. 11, however, tlte builtling or impvovement I5 soltl wltnin one year of com-
pletlon, the owner wlll have the burtlen oi proving he/she tlitl not builtl or im-
p�ova fot the pu�pose of sale). '
❑ I, as owner ot the'property,-am exclusivelY contracting with licensetl con-
Vaclors to construc[ Lhe project (Section 7044, Businesz antl Protesslons Cotle:
The Contractor's License Law tloes not appty to an owner ot property who
builds,or improves'thereon, antl who contracts for such,projects wlth a con-
tractor(s) license pur5uant�to the Contrattor'S Llcense Law). I am aware that
proo( of their Worker's Compensation insurance shoultl be provltletl to me.
❑ I am ezempt untle� Section B. & P. C. for this reason
il
�
Si9nat
certify that I nave
)f1.15 COfIQC2. I d9lCI
TYPE OF CONSTRUCTION LJ NE\
❑ CONVERSION ❑ DEMOLISH
DESCRIPTION OF WORK/USE OF B
TVPEOFPERMIT ' GRADING FOVNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL � � PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa. FT. � oCCVPANCv�
' CONSTRUCTIONTVPE V�-I�L VALUATION$�
ZONE GRADINGCV.VDS. ACRES—
ADD LJ ALTERATION IJ REPAIR
.Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
rinking FOuntains
loor Drains •
loor Sinks �
as Service Outlets
Lavatories
P—Trap
Roof Drains. .
'Reinspection Fee
$15
Boiler �
Duct �UnderGround '
Duct = Structural �
Duct-Ventilating '
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System & Ducting
.00.100,000 BTU O 100,000 BT
Reinspection Fee
� Driver4:License or 55 � � �
CMF 0865-46, rev. 10/B4 Whi[e - Builtling; Canary - Applicanq Pink - Accounting; Goltlenrotl - Assessor
$15
Service Sink • -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
SolarTank� ' •
Swimming Pool w/Spa
Urinal �—
Water Cloret •
WaterHeater
Water Service �
A uto-W ash
Laundry Trays
A.P. # / �9' -
S Main Building:
T Front q 7 %�
B Rear
A
C Right�[.�' �jCj�
, g Left � �:�
Ping. Ref. #
Planning Notes: Q�
2933 10/�5/85
� y Zone
Accessory Building:
Parking Req./Provided
FEES
' ' � ELECTRICAI .
� Automatic Washer� Transformer ❑ 75-50 KW
Construction Pole Sub. , � 50.+'KW
Cooking Unit � ' Meter ❑up to 100 amps
Dishwasher � Meter ❑over700amps
Dryers �Gas ❑Electtic - SubPanel �
Fan , Motors�0-iHP�i'h-8
F.A.U. Inc.Solar 09-15 HP �i6-15+
Issue Fee ' $ 3
IANICAL FEES
Hood or Typel � . �
Canopy Type I I ❑
Refrigeration Sys[em
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers .
laue Fee
$ 3
Fixtures—
DEVILQ BO%QS
Outlets
Switches
Garbage Disposal
Generator �0�5 KW �5�15 KW
Reinspection Fee -
Zaning Approvad By �
' Building Approved By
APPIICdtiOn ISSUBd BV_
$75
Pole Light 1�
Range
Sign
; Standing Sections
Trash Compactor
Issue Fee
SUMMARV FFEES
BUILDING PERMIT $ �9-."r� SMIP '
PLAN CHECK $ � � .q � ' PERMIT.
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ � GRADING
PLAN CHECK 50% $ ' MICROFILM'
MECHANICAL $ TOTALFEE
� PLAN CHECK 25% $ � �
ico�: 'TL
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$ 3
CONSTRUCTION AND PLANNWG POOI ',PA
APPROVALS Permit# Date Inspector APPAOVALS Permit# Date Inspector
i. Tern nrary 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.�ElectricalUFERGrnd.� 57. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgmd. �
8. Foundation • 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71; 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 .
77. 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 Faaory Fireplace APPROVALS Permit #
� 21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas � Oil
23. Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framing �� 73. Undergrnd. Storage Tank O Gas ❑ Oil
25.. Roof Sheathing 74. Overhead Hydro �
26. T-E3ar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing �) �! �/L, 76. Dry Standpipe
28. Lathing & Siding / � 77. FIXED SYSTEM FINAL
29. Insulation / c� vL. 78. FIRE PREV. FINAL
30. Drywall Nailing � � L� HEALTH DEPT. REQUIREMENT
� v
31. Plaster Brown Coat �Q 6 G�i 79. FINAL INSPECTION •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 2-(�j'-�� �aGfi � Q� K?�/
34. Final Heating & Aii Conditioning Ej��yT 7 ����
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 pomestic-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 G8s Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Pfl0.1ECTA00flE55: z7SO MALLARD DR
QWNEfl� NPME: HADDAD GEORGE N TR
anoAcss: Z�50 MALLARD DR
COSTA MESA,CA 92626
714) 595-2892
AflCH/ENGINEEN:
aoon¢ss:
uxiT:
FLOOD; AE-96
flEG.NO.:
uxir:
PENMITTEE: LOZS HADDAD �714%SQS—ZB92
aooeess: 2'JSO MALLARD DR
C.M. CA 92626
UCENSEO CONTqRCTON OFCIAPATION: I hereDy afiirm that I am IicenreC unEer pmvisions ol C�apler 9(commencinp wii� Section
7000� ot �rv�smn 3 0l ��e Business an0 Pmtessions Code, ana my license is in full brte antl eHect.
ciTr uc.: sTnre uc.: cuss: EXP :
Da�e: Signamre:
WONHEHS' COMPENSR�ION �ECIAHATION: I �ereby athrm ihat I �ave a cenilica�e ol consent to sell�insure or a cehificate of Workers'
Campensalion Insurance, or a certilie0 copy thereof (Section 3800. LaU, C�.
POLICY NO.: E%P. UATE;
COMPANY:
❑ Certilied copy is hereDy Wrnishe0. ❑ Certilietl copy is filetl wi�� ��e ciiy BuilOing Division.
Dale: ApDlitanC
E%EMPTION FBOM WOHNEflS' COMPENSATION OECLl�BRTION: Qhis sec�ion nee0 nol be compleleU il ihe pe�mil is br ane AunAreO (5100) or less�.
I ceriify t�a� in ��e peAorman[e ol �he work br w�ich t�is permil is issuetl. I shall no� emD�^oy ny p¢rson in any manner so as Io become
SY��CCI ��IIC WOfkER' COfllp Shci0fl LdWS 0� CdlifO�llid. ' v �
ate: ��`O' Signature: � C' �S � r��
TICE: II, after makinA ihis Ueclaratian, you should 6ecome SUEject to I�e WOA�ers' Compenu�bn prwisions oi ihe Labor
Caae. you must fonnwiln camply witn suc� D�ovisions or this permit shall Oe aeemeA revoketl.
CONSTflULTION LENOING RGENCY: I hereby allirm that Ihere is a con5imction IenUinq aqency tor Ihe petlormance 0� the wo�k lor
which �his Dermil is issued (Seclion 3097, Civ. C�.
LENOEfl:
aooeess:
OwNEH BIIILOEB DEClAXA710N: I hereby alfirm Ihat I am exemp� imm ihe Comracmrs' Sta�e License Law for ihe tollowinp reason
�Semion 7031.5 Business ana Pmlessional Code: Any ciry o1 county whic� requires a permit m consimct, alter, improve, demolish, or
repaii any slmclwe. Orior to its issuance. alm re0uire5 ihe applicanl tor such permit to lile a signed statemen� thai he/she is licensed
pursuanl lo I�e pmvisions ol Ihe Coniracbrs' State License Law (Chapter 9(commencinp with Seciion 7000) ot �ivision 3 ai ihe Business
antl Pmlessions CaOe� or t�al �e/s�e is ecempl I�erelrom and tlle Uasis br t�e alieped exem0��on. Any violation ol Seclion 703L5 Gy
any applicantlor a permil Su�lecl5 Ihe aDDliCanl t0 a tivil penally ol n0� more Inan five hUnOred tlollars (E500�.
I, as owner ol the propeny or my employees with wages as t�eir sole com0ensation, will do t�e woM, an0 ihe
� stmcmre is not imentlea or ollerea for sale ISection 70aa. Business antl Pmlessional Catle: T�e Contractors' Siate License Law
Coes nol apply lo an owner of a propeny wha builds ar impmves lhereon, and w�o Caes suc� work �imself/heRelf or t�rough
�is or �er own employees, O�oviteG t�at suc� impmvemenis are nolin�enC¢E or oflere0 tor Sale. If, Aoweverihe 6uiltling or
im0�ovemenl is sola wi��in ane year o� mmple�ion. �he owner will have Ihe EurEen oi Dmvinp he/s�e did not builtl or improve
lor Ihe purpose ol sale�.
I. as owner of the pmpeny. am exclusively contrac�ing with litensea comractors to constmci Ihe O�ole�� (����on 7UM, Busineu
❑ ana Pmlesvms CoOe: T�e Contractars State License Law tloes not apDly to an owner ol O�operry who builtls or improves tAereon
antl w�o cOmracts lor such pmlecis wii� a wntracmqs) license Oursuam ta Ihe Contractors' Slaie License Law�. I am awart
I�a� proof o� t�eir Workei s Compensatian insurance shaulU Ce DroviGea ta me.
� I am exempl un0er $ettion: B. 8 P. C. �
lor Inis reason'. (�
Dat� •� �� Y Owner� � l� ��
I tla �ereUy c¢Nly I�a� I am aware ol antl un4er5�an0 ihe repuiremenis af Calilornia Heall� anU $aleiy CoGe Sections 255Q5, 25533, antl
2553d antl I�al I or any iWure Guitaing ocaDanl will/will no� (circie one� neea Io comply vn�h uiU s�ale cotles antl Ihe requirements �or a
permi� lor conslmaion or modilicalion imm the Air Oualiry Managemem Oisirict. Fesitlenlial conslmclion aDPlica�ions are exempt �mm
I�eSe prOviSions.
�ate: Npplicani:
I �ere0y cerlilylha� I havereaa t�is applicalion an� state�hai�he aboveinfarmalionis correcl. I agreelo comply vn�h alltiiy and couniy
or0inancesand5talelaw5relatingtoEuiltlingconSlmctmnandherebyaWhorizer resemativesotthiscilyloemeruDon��ea0ove-men[ioneA
O�oDeriy lor mspeclion purposes. \ �
aie: ' � �( Signamre:��`� � �r `
Drivei's License m Saial Secu�iiy �: '
i6<t-a6 Wbito—BoilOing; Green—CoEe Enlorcemenq Canary—Applicant; Pink—Revenue; GolOeneotl—Assessor
CITY OF COSTA MESA — BUILDING PERNIT PEP.M NO; B 06919�
PERMIT NO; B D69199 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF RESTH E REROOF W/COMP, 2 SKYLIGHTS SQ FT: 5,000
CLAIM VALUE: 5,000.00 CALC—VALUE; 5,000,00 GROUP OCC: R-3 /M-1
COMMENTS; ADD 2 SKYLZGHTS ICBOJt 3933, SMOKE DETECTORTS ARE REQ�U+IR+��ED
*�t**�r�t�r�t+����+�*�r**�r**x�r�r*�*��r*��t��r+r�*****�t�****x��*x��rx��r*�r�r*�*�*�I�F���� I �'1.����1
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUI'LC�2t�Te3����--
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN AGHT; FT IN
PARKING REp • PROV; PARCEL; 13953142 ZNE; REF NO;
FLANNING N6TES>
�'
it i! i4YE !! 1f # it 1f iF ik ik iE ff iF k 1t #!f iE 1f i! iE 1f 1! iE iE ik !! if 1F 1E if !F i(� if iE it iF iE iE iF iElf if iE ih it iE iE if # if iklh iE iE ## fE jE iE iE iE 4±f iF 3E iF fi# il� 1E Y� iE �! iE ff 1E
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
ZONING APPROVEU BY DATE:
BUILDING APPROVED BY ; DATE- '
APPLICATION ISSUED BY; _�� DATE: �p _!U � l�
iEi('iEiFlFifihi!')hififlFfFlEiE1EiE?Eitif'1fil"�`lF�f�F1('lfM�F�F�F')t'1f'X'�1t�?'f' taci*\1.`fkiEil'!I' 1{' fflfiflE 'II'M'ififiElEYiE1E'X-1Ff{ f if.t�k�k#f('
iE1ElEiEffttilihTFifili!iE3tiE�7FfEifkfllEiliE�kitlfiliEi!iFiflfieiElEiE'IE1f1E#k�lfiEilifiti`#`iE%#1fff.i�iEit#1liFil�iEiEjf1ElFifiF+ikil: ##1F#ffkiEif
LEGALIZATION;N F E E S 0 M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 72,00 ,50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CAECK TOTAL PAID DUE
TOTALS----> 72,50 O.UQ 0,00 72,50 72,50 ,00
r r /
�
--> V
RECENUE DICISION TOTALS COLLECTE➢; 72,50 OCER/SHORT; 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GAADING PLAN—CHECK
72,00 ,50
it iE if if iE if iE it ff iE i! i(� iE iE if it iF iE ii iE jk if it k iE iE it iF 1E it 1t iF i! it 1E iE iE iE 1E 1E �1f iE Y- it 1E if iE 1t it iE if k it iE if iE i! M i(�'k iF it iE 1E 1E # 3c if if-ih iE iE 1F it jh 1! # if #
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I F T I O N
SFR 400 ALTER BY VALUE RESIDENTIAL NOZONE
SFR 4600 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1,00 400,00
1.00 4,600,00
V
DATE01f0%lDi90�.GTFiE: OO,j� i?.50
(= -•
�CONSTRUCTION AND PLANNING P00� SPA
� APPROVALS Permit �k Date lospector APPROVALS Permit # Date inspector
'. 7emporary Electncal Service or Po�e 52. Pool & Equipment Location
2. Soil Pipe-Undr9md. 53. Sreel Reinforcement _
3. Electiical Conduit Utility-Undrgrnd. 54. Forms �
4. E'.ectrical Conduit-Undrgmd. 55. Electrical Bonding ,
5. ,K,eel Reinforcement 56. Rough Plumbing & Pressure Test
6. �iectncai UFER Grnd. 57. APPflOVAL 70 COVER�GUMTE
7. Footings 58. Eiectrical Conduit�Undrgrnd.
8. �oundation 58. Gas Pipe, O Undrgmd., Test .
9. Water Pipe-Undrgmd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. 5tructural Floor Sy:tem 67. APPROVAL TO DECK .
17, property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
73. f:oof Drains 64. Plumbing System - Final
14. Rough P�umbin9 65. Electricai-Final .
75. Rough Electrical-Conduit 66. Solar SYstem�Final i
16. Ruugh Electric Wiring 67. Pencing & Access AnProval .
17. Rough Wiring Sign 68. APPROVED FOR PLAS7ERING �'
78. Rough Electrica6T Bar Ceiling 69. POOUSPq $YSTEMS FINAL
19. Rough Heating & Air Canditionin9 F1RE DEPT. REQUtREME4VT
20. Rough Factory Firepiace APPROVALS Permit #
21. Oucts, in Siructure 70. Under9round HYdro
22. Oucts, Ventil2ting 71. Product Piping � Gas � Oii
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorayeTank OGas ❑Oil
25. Roor Sheathing �p..�3�-�Y�W�! 74. Overhead Hydro
26. 7•Bar Cefling (Structuralf & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. lnsulation 76. FIRE PREV. FINAL
30. Drywalt Naiting HEALTH DEPT. REQUIREMENT
37, plaster Brown Coat 79. FINAL INSPECTION
32. Electncal Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning ,
35. Final Gas Pipe�Test
36. Hood or CanopY
37. F�nal Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gai Service-Final
41 . So�ar pomestic-Final
42. BackfloK• Preventer
43. Backflow Irrigation
44. Landscape Irrigation Sys;em
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STFUCTURE & BUILDING �Lg�.s�w�
48. FINAL PLANNING ' �
49. ElectricReleasetoEdison�,�- ,,,
50. Gas Release to Southern Cafifornia Gas Cn
51. CERTIfICATE OF O�'CUPANCY
No. Date �
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. � Yes ❑ No
2. I(have/have not) �-1-pNF signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address
Phone (
City
Contractor's Lic. No. _
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name _
Address
Phone (
City
Contractor's Lic. No. _
5. I will provide some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledg\e, in compli ce with this State �aw.
Signed: �SU�s � �aa�a Date: ld'" (4 "Q �
Name: -�o f S E-�nF-% PrA �
(Printed or Typed)
C.D.L. tl or S.S. #�� ��� �
754-5273
vrravn.n N1C;.7N VC:[SLL'� f3UlLUL'"Y47� 11V1: Ln++'+ '+ 1�1 V I
JOB ADDRESS 2750 M8118Td Dx'ivC _ BUII.DING PERMIT NO. 2(922
AP No.
1NRPECTIONS
or
Date
DESCRLPTION OF
FIRE ZONE
SUBCONTAACTOR
2�3�2
COSTA MESA BUILDING-SAFEIY.DEPARTMENT
P.O. BOX S77 COBTA MEHA: CALIFORNIp
�
For Applicant �o Fill In Completely
j,Ot 45 TYPE OR aRwTTract 6`Z.
@� MAIL
COSTA MESA. CALIFORNIA
esa er e ui ders
Kaltenbach
ea
,5 y x 9s' I �o; °o
� 6ETB/ CK LINE FROM
EFT ' I 'RI6HT -'
DESCRIPTION OP WORK
X II a�rewariaN I II aeo�t
BUILDIN6 NO.OF "
51ZE ROOMS SfOF
EXTERIOR WA ROOF a E
COVERING �tUCCO I COVERIN6 .SY11Y
US6 OF BUILDIIJG AND WORK TO BE P6RFORMEO
New Residence /� /
nc.
AP�i25-G7cwsi��09Z70.� ,r'��1%��.CO
APPLICATION FOR PERMIT -
BUILDING
For Oifiae Use Only
I RHCEI'T NO. I PI�P
ZONING
Ho. oe uae
run�� euu
YARDSAPPROVED
MAIN BUILDING
( FROM GL ST{j�J'iT)
VAR. $F
SHALL BE LE59 THAN
<U.B.C.REQUIREMENTI
YARDS APPROVED
ACCESSORY BUIlDIN6
� HEREBY ACKNOWLES08 THAT I HAt6E REAU TH�B APPLICATION THE AMOUNT BXOWK UNDER VALUATION IB FOR THE
AND STATE THAT THE ABOVE �9 COkRECT AND AOREE TO COM. PfIRPOSE OF EBTABLISHIN6 q PERMIT FEE ONLT. p
PLY WITH ALL qTY OPO�NANCiH ANp eiAT6 Ll�W6 F80ULATING yqLUAT10N ^� n
BUILOIN6 CON9TFUCTION. PERMIT FEE .� y-
SIGNATUREOF p
PERMITTE
AUTHORREDA6ENT $ 3a, ys� � 0
— _ _-__. «< e //�/7 � LL