HomeMy WebLinkAbout2754 MALLARD DR - Building Permits 011-1S41-5;\ CITY OF COSTA MESA
BUILDING DIVISION
:J Pi DEVELOPMENT SERVICES DEPARTMENT PERM T NUMBER
t PERMIT
Pira
805-02323
(714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.c$`3ILDING PERMIT 77 FAI IVE, ESA,CA 92626
Job Address: 2754 MALLARD DR Status: ISSUED
Suite: Applied: 12/192005
Vicinity: FRONT ENTRY Issued: 12/19/2005
Primary Occ: R Type of Construction: V-N
Parcel Number: 13953143 Zoning: R1
Applicant: MARTIN, GLENN
Address: 2425W COMMONWELTH DR
Phone: 714-578-0090 ISSUED BY:
FULLERTON,CA • Zip: 92633
Owner: ROTONDO, PETER ATR
Address 2754 MALLARD
Phone:
COSTA MESA,CA - Zip: 92626
Contractor RENAISSANCE.DOORS AND WIN
Address: 2425W COMMONWELTH DR
Phone: 714-578-0090
FULLERTON,CA
Zip: 92633 License: 490375
Arch : Eng:
Address: - Address:
Phone: Phone:
Zip: License: License:
•
•
SCOPE OF PERMIT
REPLACE ENTRY DOORS AND TRANSOM WINDOW ABOVE ENTRY OF S.F.D.
. FEE SUMMARY
Plan Check: $81.41 Calc Valuation: $5,500.00
Permit: $125.25 Claim Valuation: $5,500.00
SMIP Res: $0.55
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $207.21 •
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0.0 Right 0-0
ACCESSORY Front OL 0 - Rear 0-0 Left 0-0 Right 0-0 _
PARKING Existing: 0 Required: 0 Proposed: 0
•
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 It 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
244e46(mm)
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.
I have and will maintain workers'compensation insurance,as required by section 3700 01 the Labor Code,for the performance of the work for which this permit is issued.
Myworkers'compensation Insurance carrier and policy number are:
,GeIL"rrier:<<4}{ .l Z'�`ry 2� Policy,NJu�'b:L (p l W-2.Ov\O '1-\ .
_Th/s section need not be completed if the permit is valued at one hundred dollars($100)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 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. /
came: ' —Q `���� �Da1a 1 �—` \ °\O '<
WAR INCIFFAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER 40 CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby.affirm,that.I.am licensed under provisjons of Chapter 9(commencing with Section 7000)of Divlsion��3F��,ph _.
e'e s and Professions Code,and my license is in full
_ q.0 3.7 0 L]�G
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�C'OnOagors Signature: r r.DMR }3— \qAO
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).
Lender's 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 ler 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 properly 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.).
0 I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑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 6,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
materiel? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight 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 builtling occupant need to file a registration form for acutely hazardous materialss? ❑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 wit the applicant or present or future building occupant require for the work which Is the subject of this application a ermit 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 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 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 0\Legal Owners) \0\ \G�
tci//Or Authodzed.Applicant—ix - Date"
CODE P INSPECTION TYPE PAIL . INTmAIS CODE! INSPECTION TYPE _—_ 'WE PA4g
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 Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place ' 220 Final Planning Approval •
203 Final Sign 222 Final Site ,[�
204- Final Demolition -' ' - -250 Final Building/Occupancy ' IZf7-0)— r45
r?v \O 8/10/05
JOB INFORMATION:
HEADER DESIGN
2754 Mallard Dr .
Costa Mesa, Ca.
Job Number: 05C330
File Name : 05C330 .wrk
ENGINEERING FIRM:
FOERSTEL DESIGN & ENGINEERING
1046 CALLE RECODO, SUITE J
SAN CLEMENTE, CA 92673
Phone : (949) 492-5981
Fax: (949) 498-3020
APPROVED BY:
Edmund C. Foerstel
License State : CA
License Number: S .E. 957
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This residence engineered using the
"EngrEd Wood Frame Residential" software package .
The person using this program is responsible for verifying the
accuracy of all computations and results . EngrEd assumes no legal
or financial responsibility for the safety or integrity of any
structure or member designed using the EngrEd Wood Frame Residential
Software Package.
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r" "E : 8/10/05
ENGINEER: JOB:
NAME Edmund C. Foerstel NAME HEADER DESIGN
ADDR 1046 CALLE RECODO, SUITE J ADDR 2754 Mallard Dr.
CITY SAN CLEMENTE CITY Costa Mesa
ST. CA ST. Ca.
ZIP 92673 ZIP
LIC # S.E. 957 JOB # 05C330
CODE VALUES
CODE VALUES FOR DOUGLAS FIR LARCH
Bending Stress for No. 1, 5"+ = 1350 . 0
Shear Stress for 2" to 4" = 95 . 0
Shear Stress for 5"+ = 85 . 0
Glu-Lam Bending Stress = 2400 . 0
Glu-Lam Horizontal Shear = 155 . 0
Roof Live Load = 16 . 0
Roofing Dead Load = 9 . 5
Sheating Dead Load = 1 . 5
Rafter Dead Load = 2 . 5
Misc . Dead Load to Rafter = 0 . 0
Total Dead Load to Rafter = 13 . 5
Ceiling Dead Load = 5 . 0
Other Dead Load = 0 . 0
Total Roof Dead Load = 18 . 5
Floor Live Load = 40 . 0
Floor Dead Load = 4 . 0
Floor Joist Dead Load = 3 . 0
Ceiling Dead Load = 5 . 0
Other Dead Load = 0 . 0
Total Floor Dead Load = 12 . 0
Deck Live Load = 40 . 0
Stucco Wall Dead Load = 16 . 0
Veneer Wall Dead Load = 56 . 0
Wood Frame Interior Dead Load = 10 . 0
All Soil Bearing Cont . Footing = 1000 . 0
All Bearing for Isolated Pads = 1000 . 0
All Passive Bearing = 100 . 0
Other Soil Bearing Values = 0 . 0
Concrete Strength = 2000 . 0
Reinforcing Steel Stress = 20000 . 0
Reinforcing Steel : ASTM A 615 GD 40 . 0
CODE: = 2001 CBC
LUMBER: = DF Larch
Glu-Lam Combination Number: = 24F V8
- 2 -
'E : 8/10/05
ENGINEER: JOB:
NAME Edmund C. Foerstel NAME HEADER DESIGN
ADDR 1046 CALLE RECODO, SUITE J ADDR 2754 Mallard Dr.
CITY SAN CLEMENTE CITY Costa Mesa
ST. CA ST. Ca.
ZIP 92673 ZIP
LIC # S .E. 957 JOB # 05C330
ROOF FRAMING
Roof Wall Header #1 :
LL = 16 . 0 DL = 18 . 5 TL = 34 . 5
Tributary = 14 . 0 Span = 9 . 0
E = 1700000 . 0 P = 0 . 0
height = 1 . 0 wall value = 16 . 0
w = 34 . 5 * 14 . 0 w = 483 . 00
delta max = ( 9 . 0 * 12) / 180 delta max = 0 . 60
ROOF = (34 . 5 * 14 . 0) = 483 . 0
WALL = 16 . 0 * 1 . 0 = 16 . 0
W = 483 . 0 + 16 . 0 = 499 . 0
(5 . 0 * 499 . 0 * 9 . 0 (A4) * 1728 . 0)
I = - 72 . 22
(384 . 0 * 0 . 60 * 1700000 . 0)
VL = (499 . 0 * 9 . 0) / 2 VL = 2245 . 50
VR = (499 . 0 * 9 . 0) / 2 VR = 2245 . 50
M = (499 . 0 * 9 . 0 * 9 . 0) /8 . 0 M = 5052 . 38
f (b) = (5052 . 4 * 12) / (49 . 9 * 1 .25) f (b) = 971 . 81
Area = (1 . 5 * 499. 0 * ( 9 . 0/2 - 0 . 8) ) /95 . 0;
Area = 28 . 9
Roof Wall Hdr #1 :
4 x 10 - #1
Span = 9 ' -0"
- 3 -
'E : 8/10/05
ENGINEER: JOB:
. NAME Edmund C. Foerstel NAME HEADER DESIGN
ADDR 1046 CALLE RECODO, SUITE J ADDR 2754 Mallard Dr.
CITY SAN CLEMENTE CITY Costa Mesa
ST. CA ST. Ca.
ZIP 92673 ZIP
LIC # S .E . 957 JOB # 05C330
FOUNDATIONS
ASSUME COMPACT CLAYEY SAND @ 1000 P. S . F.
ASSUME STANDARD
FOOTINGS FOR ONE,
TWO, AND THREE
STORY FOOTINGS
PER CODE, EXCEPT
AS SHOWN OR
NOTED.
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l Renaissance
V 1` Doors Fr Windows ^)
130 N.Gilbert Street CUSTOMER NAME: I�pTp \,/�
�� -. Fullerton,CA 92633 n a ,,A � v0 ./'�
ADDRESS: 2?S4 MAU A120 Ok•
PHONE:
(714) 5.70-0090 DESIGNER: _ ' •,i _
CONTRACTOR'S LICENSE ZIP CODE:
11490375
PLOT PLAN FOR ALL UNITS BEING .PERMITTED
DIRECTIONS: )
1. FILL OUT THE STREET NAME •
2. SHOW SIZE OF UNIT 6 LOCATION OF ROOMS IN THE HOUSE
3. SHADE IN THE AREA OP NEW UNIT
4. IDENTIFY THE DISTANCE BETWEEN HOUSE AND PROPERTY LINE
IN ALL DIRECTIONS: FRONT, BACK, SIDE. .
5. LABEL DISTANCE BETWEEN BAY 6 BOW AND THE PROPERTY LINE
6. SHOW HOW PAR BAY 6 BOW PROJECT OUT
7. DRAW A ROUGH OUTLINE OF THE HOUSE
PL iI I DING SAFETY
DIV 1510 OF COSTA MESA
I z�_" PR VEE 6_5
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1 ._A;-`ING DIVISION A
St 'r;JECT TO BLDG. DEPT. par/54 NAi4W9RQ Oz
STREET NAME
Ni 'TE: ADDITIONS, DELETIONS, •
DRAWING NOT TO SCALE
OR CORRECTIONS SHALL BE
APPROVED BY THE PLANNING DIV.V.
BDATE:/ I �5 •
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SAPS S ( �' /3�' Cl��—Lr . Entry Door Form
y� • p y� p Showroom Locations I'�_
41 , Q'`� �7�/L�p 10725 Ellis Ave.,Suite 11,Fountain Valley,CA 92708•(714)968-8866•Fax(714)968-4090
_ - /OURS d(�, R'7NDOWS0 23812-A Via Fabricante,Mission Viejo,CA 92691-(949)380-9550•Fax(949)380-0106
® Classic Craftsmanship for Tnrly Beautiful Hames 1022 N.Tustin Avenue,Anaheim,CA 92807•(714)632-8226•Fax(714)632-5198
S.C.L.#490375 Corporate Office: 130 N.Gilbert St., Fullerton,CA 92833•(714)578-0090•Fax(714)578-0208
r r Unit# 757GIOSSary`"iT! " ..+i>...•Weather Exposure...:v., .• 1
Customer Name' �'�a. ,- Z - a Co` IIII '
Heavy Rain A Heavy Sun
Address' -
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ID No Rain U Light Sun
City: �� MESA State CA Zip l a/0 of/ �F=Fixed -;,;,1..t..,t.„•r;_t En"Ineering.k'..n'1p. :;�":.,I
Home# ( 714 757-414z9 dell#(714) 0•95�1 mRough� em ztaw
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E-Mail Map Q. •-+"�_' Gated 0 / "' OR Quarter Round Unit Size ) x
\' �/� '��_ f�� �J, 5 HW=Hardware Wall Thickness 5 /N
Salesperson t � -IIZ Previous Customer Mr> SO# INT=Interior Int.Mould.L-Pnt. 1 x
Ext.Mould L-Pnt. x
Exterior Swing RS to RS x
(Wall Thickness: j� 1 ••••----"--j
NA I"P•,,: ,..
Interior Swing ,J/ v.a Floor Lovell Location..',':.
I I I I I I I I 1 I #3.AL'ock:Functibnr/+Type -' -L 1st Floor � I
12'— /O c lick x Single Cylinder _ 3 d Flo2nd or
,/ , r — Double Cylinder
titAIT 4— _ Key to Customers Key U K;x,.•Permibinformationt' `.J
111— OUERtifLg — QtKey of New Keys )(Renaissance Permit
'"Door HW-r(PO# _ Customer-Permit- `�
• - Baldwin Images._CfS No Permit
101— iy/�I�O ��_ = Baldwin Estates
LA Structural Calculations Required_
_IC`•i•••� s% Standardrinstallatleli 1.•-I
iwit
IA
„ .,,.Interioi-Dooh.Handle;6wE
® = Prck-Upd Customer 11� Lever Knob Strang
ight Replacement
F� 4Dooknocki1W Finishi'd _ pick-Up by Customer
,LJ/CtI�9.Polished oBri —
Delivered by RDW
K SS If' Mull w/#
wA 1'.,tS611d Brass;Butt Hinges j•.” — Install is New Construction
7,
MOLL PBB Hinges —
7 — Ball Bearing ,.
. -,_"rat-"Construction Options.-*
.J .1
/ _ NRP(Center Hinge) �v/
^� — ^New Header:Size x
6 1 w �r— Hirige Finish)PO# _ Remove Wall x
O O VNtTI _ Polished Brass Cut Down Wall "
�� �, (a _ etlme Polish`edr Prasg Line-Up Bars w/#
5
34. �.C/ J,,t x cobra— "" Build-Up/Fill-In Wall x
.. #' NII C:: rCSidelite:HW Colby'..;:.'.
4' — t9�i 3O/ ,�O't•L^ , x While — Removeocate ll
!J Q�n..r,.ss _ Bronze Add/Relocate Posts
Q • No Baeocs._ Pol.Brass(In-Swing Only) _ Remove Posts
3' — �ptASS Ito sac, :Sidelite HW Optibns>.-t Y Vent Pipe Re-Route g .�f7t,I Y
�rO U� y i .t'rt —/i�� _X Std Csmt Handle
V� �.4Vs�ttp wr _ Folding Handle '•••7-4•2 I !White. .I I Ivory'
WingKnob
2' — * 01* — _ Decora Recepticles/Switches
S — Round Knob _ #of Int.Wall Recepticles
t CI.44t 4 _ Extensions
®� ® ® �SrOL _ Ives — FFI — #of Ext Wall Recepticles
1' ,� l ``InF.Mbuld:.1 PO# — #of Standard Can Lights
H12(2 1/2") — #of Low Voltage Lights
1 I I I I I CP I I X Colonial(3 1/2") _ #of Switches
1' 2' 3' 4' 5' 6' 7' 8' 9' 10' — Special #of Ext.J-Box for Lights
rFY� P y� / _ Baseboard# '' All Fixtures Supplied by Customer
V Ltti_t J� C iV Z-CI rya ortice;uselonN,q, "s`-"` — Pre-Wire Alarm
k0oor.Type [PO# Glass Optionsl PO# %'dnti.Unit Colori.-o-2*- — Loose or PreBuilt r "$,.- ''Drywall/Plaster Repair`.. . ' ,I
AAW _ Single Glazed A Paint RDW# I Jamb Ext x
Artglass _ Insulated(Dual Pane) Paint MTS See Elevation X Drywall Sq Feet
_ RDW(See Drawing) . Triple Glazed Black _ Stain MTS .Ext:H18(3/I x 3# Plaster_ Repair(w/Drywall)
H18(3/4 x 3 1/4) _ Paint Color
Y ,• Triple Glazed Brass Stain: RDW#1 1 1l2 x 3 1/4
$ Door Size",Ax x Clear — ( ) +: =•.. Exterior WaltRepair' �' -I
FUS x _..", - - .
_A.S.L.Size 1$x (Z _ Grey 1/8"(15 Sq Ft) 3/8 x 2 1/2 QR MDX v
1 3/4" 2 1/4" `-'-Int.Moulding Color.. -,:e — ^Stucco Repair Sq Ft
Special Glass - Paint ROW# I. — Special _ Stucco Perimeter of Unit
I . /Wood Species . . Custom by: — SidingRepair SqFt
Paint Grade q� — Paint MTS =Otf'ice Use Onl p
StQL,�,r'" Cot -4-„ ➢ `-:'>• '• Paint Color
_ Stain MTS
Stain Grade Fir ��f(�'�c'?,L cell- Stain. Loose or PreBuilt j
— Red Oak am (�ACxSfD� — Combolashin # - !r" Curtain and'Shutter Info. :
Genuine Mahogany Glass Fabrication.-1„' — M 9 Remove Mini-Blinds
See Elevation
_ Maple — Low E2 'Eaint ROW it#Colbr._ _ Tnresnoid'&'Floor QR ;. J Remove Shutters
—
Tempered Label(B. ) x Paint RDW# i Remove&Rehang Shutters
I'.. Threshold Information . _ Bevel 1"(3/1 /4"glass) Paint MTS Wood is 1.4g74-L ! OR to Shutters
X Hydrosill(Swing In) — Bevel 1 4 glass) — Slain MTS — x _
✓ Customer to have curtains/blinds
3/4" lished V-Groove .•c'iFloor-QR Color ir —
-
- Wood(InSwing) — Stain: removed before install
"Polished V-Groove 9t
! arrr
— Ext.Swing(Sidelite) — —:.r ,�Noottes:.-, ]. _` `
-.Lauri Glass/Optipns" s _Ext..M6ulor_ ,lding Co
1: '
-Screen Information '--�
.(Fixed Screen _ Clear Lam" ed Paint RDW# 1
Grey rooted
No Screen — Paint MTS
B I 1 Stain MTS
X Grey Mesh ami Label(Bug) Stain: ✓1
Charcoal Mesh —
Field Engineer
Your door or window unit will be manufactured and installed(or delivered)according to the details,drawings,and information provide above.When altering the size
of a door or window opening there may be additional plumbing or electrical lines hidden in the wall and not documented on these plans.There may be an extra
change for this work.On permitted jobs,any structural calculations or additional work required by local governments will be considered an extra.All extras must be
approved by you before the work will be done.When removing existing doors and windows.Renaissance employees will be extremely careful,but cannot be
responsible for any flooring,wallpaper,or countertop damage.Customer will sche//r�7r��ttl�tule honk-up with th • Alba Company. /�r-
Customer Approval: ilt( """ttt i Date: 074///-.I ---
rrInPnnATC !`rlov
• Entry Door Form
• Showroom Locations
ens ancc 10725 Ellis Ave.,Suite 11,Fountain Valley,CA 92708•(714)968-8866•Fax(714)968-4090
00OORS WINDOWS 23812-A Via Fabricannte,Missioin.V eAjo CA 92691•(949)380-69.550•Fax(949)380-0106
Classic Cresmanshipfor Truly Bea#tVul Homes 1022 N.Tustin Avenue,Anaheim,CA 92807•(714)632-822Fax(714)632-5198
s.c.L.a 4eos�s Corporate Office: 130 N.Gilbert St.,Fullerton,CA 92833•(714)578-0090•Fax(714)578-0208
rUnit# 1.41It:hint" ... .t,:: _
, _'.C .1tu
- .,+ �
- .2z.la.;;:aa
, _:LS.
Customer Name' viii~. •� O`
sr Heavy Rain St Heavy Sun
• • = ' .=Damm ❑ Light Rain ❑ Medium Sun
Address' -
//�,..�� _ //•�,� 926,Z6
E=Egress ❑ No Rain ❑ Light Sun
City: `-�J��STA IgibSA State O*I Zip 72 of =Fixed .......�7...i....:. .77Waii:P,(R12.:;iG:.. Wi:ui
Home# (2/4)IT /31^ , Z9 Cell#(714) 3So•95c.1 X=Casement Aprox. R.O. r- x i a
RS=Rough Sawn
Exact R.O. i 0 in » P
•
Mr.Work# (—) Mrs.Work#(—) - ���777 / MTS=Match to Sample DW to DW x
E-Mail Map Q. i+"R_• Gatedra ❑ //_(/� OR=Quarter Round Unit Size x
'/��_ A /(� HW=Hardware Wall Thickness 5 j/,
Salesperson 1, ^l� Previous Customer +m SO# INT=Interior Int.Mould.L-Pnt. / �x
Ext.Mould L-Pnt. x
Exterior Swing _ RS to RS x
Wall Thickness:
Interior Swing �� ✓ _,.. 1LL7i;.:..':�:[�.+.S.:r�';'+ii
-A 1st Floor C��.,••(),
111 _ °" If I 2nd Floor f-•.fV J R�
12 s_ Single Cylinder
Double Cylinder 3rd Floor
.tom pion , _gOLL Key to Customers Key {:' 1.+ x,i3:GSa.ulTr% »',,i u..r`..`:
Ir. r *"" ^ Key# �Renaisgance Permit
111- it A`Ttu L .1 \pp�.• - Qty of New Keys �� _ Customer Permit
Permit
I Vl ��••II JI Baldwin Images __L No aural
Baldwin Estatectural Calculations Required
1. I . .lilt.
.Y' .-J1LL' '.•i L3. IILJ.I.unu L-1JIW"
Knob — Prepared Opening
' ' _..- ,,.;,, ...,.,•! -,,,., — Straight Replacement
" `'"`:' _ Pick-Up by Customer
etime Polished Br ss Delivered by RDW
Mull w/#
1 d L' / �/ C I y Install is New Construction
7, - \' �/1 ($L PBB Hinges
_.._.- Ball Bearing T cb4z;
Il 9 ,..,_._. 1 '`C Jb a :%!]x :._LIILr: ._.i,ei
NRP(Center Hinge)
,�j a New Header:Size x
6 yR ' �O et 0� �P ` 3117' '� J 71u r 1,.i', PO# = Remove Wall x .,
2,/ Polished Brass Cut Down Wall
5' — ;Q' 4 J e O / Lifetime oh ed as — Line-Up Bars w/#
3 / �`/ , g `•� — Bulld-Up K/Fill-in Wall x_
ft
mite
4, — ' u I tie. Bronze - Remove ll
U 1/ L`� Q- Bronze Add/Relocate Posts
Q No Baia] o• Pol.Brass(In Swing Only) Remove Posts
3' —
�/ 4 �R� 14 5 iif.SC,:Csm 4i indle:a Vent Pipe Re-Route
Li c /,tet jt,--• Std Csmt Handle
443 Folding Handle 1. - sl r ;-3 Nrei'.(I:LrJ»1�0Af1]e'u
2' — * �V=�tl jnt. — Wing d nob oob —
Decora Recepticles/Switches
�•C.1444. by — #of Int.Wall Recepticles
—
Extensions
as
®� ® ® �Sfdt. Ives FFI - #of Ext Wall Recepticles
1' — — — #of Standard Can Lights
}°[A '1i PO# #of Low Voltage Lights
f�
H12(21/2")
® j I T j I j 0 j i }- al(3 1/2•) #of Switches
—
1' 2' 3' 4' 5' 6' 8' 9' 10' — Special #of Ext.J-Box for Lights
7' Special
Baseboard# ✓ All FixturesSuppliedby Customer
1 —
L3<e.. .'ti-vi, IV' I` LG 6-,7 .s'v-A;ailr lirai i" — Pie-Wire Alarm
art tl1G1-1:52 PON .IL t.,241.tPO# .;,i'r'e _2LL:...:Yi,.:t. .A:,„;., — Loose or PreBuilt :�I:�), w/�jT,,:i .- tart fii`''2 ''`p
pAW k.)b,l-T — Single Glazed __,6Paint RDW# —
Jamb Ext x, ' " " '
rtgleSs it?=--Y _ Insulated(Dual Pane) Paint MTS See Elevation Drywall Sq Feet
r — PO# _ Plaster Repair(w/Drywall)
— RDW(See Drawing) _K. Triple Glazed Black _ Stain MTS H78(3/4 x 3 1l4) Paint Color
Triple Glazed Brass Stain: —
_,A Door Sizi-x Clear — RDW#1(1 1/2 x 3 1/4)
_A S.L.Size x Gray 118 (15 Sq Ft) FPS xX ,. a ..
1 3/4" 2 1l4sti Ud 1 '.tic.Tu IL,1 �, '.. — 3/8 x 2 1/2 QR MDX X Stucco Repair Sq Ft
'xl 1....4,,,i-c,I: l ./SL F,',� Paint ROW# t — Special _ Stucco Perimeter of Unit
w, lal.et1`( z�ii„.' Custom by: SidingRepairFt
Paint Grade -Si�L TLS Cts — Paint MTS -. P Sq
Slain MTS Paint Color
Stain Grade Fir w gL C0 Stain. Loose or PreBuilt
i :
Red Oak • sft(J Combo •.,::_Y (b;:1�&1,ii/:,(,�i},If.1LiZljr"8r,3:i:i
{— Genuine Mahogany ''c.:3f L t<1.iii.:11 1 — — Metal Flashing# _ Remove Mini-Blinds;r� --� See Elavahon
_ Maple _Low E2 '- Y u- •..�, a 1. ..`.' Remove Shutters
_ Tempered Label(B ) 'ir`^ - —
11 Paint RDW# ( ” 1O I Remove&Rehang Shutters
i - v — Bevel I”(3/1. : /4"glass) W dis bi%.q t.
.vd liC1L.u uuuiiLSi, Paint MTS Q9,� x QR to Shutters
Bevel I _ (1/4 glass) ll
X. Hydrosll(Swing In) — — Stain MTS ,.a ✓ Customer to have curtains/blinds
3/4' -dished V-Groove Slain: _, v i CL uis
Wood(InSwmg) — removed before msiall
Ext Swing(Sdekte) Polished V-Groove — 9rairr•
S r '-'r-- i rt�- .:..n
„l yy .-, i .. :`”--Lu1LLL1 ''''''"-Li'Litx i -T-,y- aa1....y:.�'s,.su.d.�) s.-':, -.,.'r•,.-..- :+ ti`l'e._:. :.,:Y.Y .... na+VYtaeidTllwre`0
.c ..S'�:Mlll tlllLll:.:1_'.i.. .,. - :lL`..l' 1_.LL4'.d:�{:g 13�! til.,�
Clear Laed
Fixed Screen — A. Paint RDW# 1
_ No Screen — Grey inated _ Paint MTS
— B d1" Stain MTS /
_( Grey Mesh ami Label(Bug) _ Stain: (J
Charcoal Mesh —
— Held Engineer
Your door or window unit will be manufactured and installed(or delivered)according to the details,drawings,and Information provide above.When altering the size
of a door or window opening there may be additional plumbing or electrical lines hidden In the wall and not documented on these plans.There may be an extra
change for this work.On permitted jobs,any structural calculations or additional work required by local governments will be considered an extra.All extras must be
approved by you before the work will be done.When removing existing doors and windows.Renaissance employees will be extremely careful,but cannot be
responsible for any flooring,wallpaper,or countertop damage.Customer will schöt
le ho k-up with thpir�Ala Company. //1(" -
Customer Approval: `e�4 Date: 07 4 / O
CORPORATE COPY ill t�, (((
- r
J
'�i t �> O;Lc,1 tri Wood Window Form
_ • Showroom Locations
enaissance 10725 Ellis Ave.,Suite 11,Fountain Valley,CA 92708•(714)968-8866•Fax(714)968-4090
0[fripOORS OWINDOWS 23812-A Via Fabricante, Mission Viejo,CA 92691-(949)380-9550•Fax(949)380-0106
Jtsmaashipjor7tuly Beautiful 1022 N.Tustin Avenue,Anaheim,CA92807•(714)632-8226•Fax(714)632-5198
S.G.L.R 4e0375 Corporate Office: 130 N.Gilbert St.,Fullerton,CA 92833•(714)578-0090•Fax(714)578-0208
�LLi- n £T r F n,�QO Unit# - • Glossary. - _ Weather Exposure
Customer Name ��rQ
2:7541-. I�//���� '/��� A=Active Heavy Rain DS. Heavy Sun
Address' r`r�'+ -�g RD �r� D=Dummy O Light Rain 0 Medium Sun
�k_, Q,^ //^�� (��� �� E=Egress O No Rain 0 Light Sun
City: I 126714 "v 4 ,Sttate''(.--11�r _ Zipp_aCk 10 ooff �& Enyineering
Home# (714) �•S7r Cell#( r r r) `-+"`•'• CIS-C:1' / X=Casement Aprox. R.O. x WO
RS=Rough Sawn Exact R.O. x
Mr.Work# (—)- Mrs.Work#(—) DW to DW x
ant / �7 ( /// MTS=Match to Sample
E-Mail Map O.�-+-' •Fw Gated El C%„(_/ ( OR=Quarter Round Unit Size
x
/`' W cis-.
NW.Hardware Wall Thickness
Salesperson Previous Customer L V SO# Int.=Interior Int.Mould.L-Pnt. x
Ext.Mould L-Pnt. x
Exterior Swing RS to RS x
1 Wall Thickness: - Floor LevgI/Location I
Interior Swing x 1st Floor
_24___------ _ 2nd Floor
8' I I I I X ( I I I I I 3rd Floor
7_ / Permit Information -. I
� '\ \ • Renaissance Permit
I — Customer Permit
N 6'' No Permit
TStructural Calculations Required
E 5
It
- -- Standard Installations,R Straight Replacement
_ Prepared Opening
0 R ' _ --.J OD I (/L — Pick-Up by Customer
— Delivered by ROW
✓ 3,_ DW
I �) IL _ mull es/#
Install is New Construction
E . Construction Options .
W 2 New Header:Size x
_ Remove Wall x
1'— _ Cut Down Wall "
— Line-Up Bars w/#
I I I I 1 I I I I I I I I I — Build-Up/Fill-In Wall x
I' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' _ Remove Kneewall
_ Add/Relocate Posts
Wood Species Glass Options I PO# Int.Moulding I PO# . Total Paint Colors _ Remove Posts
A Paint Grade X. Single Glazed 165' — Int.Mould. )(1 _2 _3
Vent Pipe Re-Route
Stain Grade Fir _ Insulated I — H12(2 1/2")
— Red Oak 1')!12 iS X Colonial(3 1/2") -int.Unit Color "Electrical - I !White I 1Ivory I
_--_ Genuine Mahogany _ Clear _ Match Existing
Maple _ Grey 1/8"(15 Sq Ft) J� Paint MIS # _ #of Inat.
Rall c /Switches
— _ Grey#31,1/8"(15 SF) Paint MTS — #of Int.Wall Recepticles
Grey 3/16"(30Sq Ft) ice Use Only Stain MIS _ #of Ext Wall Recepticles
z Window Info. — — —aa.PreBuilt _ Stain: #of Standard Can Lights
Grey 1/4'(50 Sq Ft)
A Fixed — Jamb Extx — _ #of Low Voltage Lights
Clear Single Gluechip
Fixed(Direct Set) Baseboard# _ #of Switches
Clear Double Gluechip Int.Moulding Color
— 1 Sash Casement — ee Elevation #of Ext.J-Box for Lights
— 2 Sash Casement x Paint RDW# i ✓ All Fixtures Supplied by Customer
4(.3 reA—^ n tci-�� Ext.Mould. )PO#
4 XX Csmt(No Post) -�' _ Paint MTS — Pre-Wire Alarm
H18(3/4 x 3 1/4)
XOX Csmt 1/4,1/2,1/4 RDW#1 (1 1/2 x 3 1/4) _ Stain MTS Drywall/Plaster Repair
— XOX Csmt 1/3.1/3,1/3 — Stain: '
—Awning — — RS _ — Drywall Sq Feet
— Sliding(XO or OX) — — 3/8 x 2 1/2 OR MDX — Plaster Repair(w/Drywall)
— XOX Sliding 1/4,1/2,1/4 Glass Fabrication — Match Existing .-Exterior Unit Color _ Paint Color
XOX Sliding 713,7/3,7/3 _ Low E2 — X Paint ROW# - Exterior Wall Repair
— Garden _ Custom y Office Use Only
Tempered _ Paint MTS
—_ Bay Tempered Label(Bug) — laD or PreBuilt — Stain MTS — Stucco Repair Sq Ft
AC Bow _ Bevel 1"(3/16 or1/4"glass) — Metal Flashing# Stain: _ Stucco Perimeter of Unit
Egress Code Applies Bevel 1 1/2"(1/4 glass) _ Drip Cap _ Siding Repair Sq Ft
— Ht.off Floor • 3/4"Polished V-Groove See Elevation — Paint Color
— Window HW Color — 3/8"Polished V-Groove GardeNBay/Bow Supports Ext..Moulding Color
— Curtain and Shutter Info.
_ White Lami Glass/Options _ SQ Ledger/Korbels X Paint ROW# I
— Bron — = Angled Ld els _ Paint MTS — Remove Mini-Blinds
Clear Laminated Korb my(4x10 in wall) — Stain MIS Remove Shutters
_ Grey Laminated tilever w/Stucco Stain: _ Remove 8 Rehang Shutters
Casement HW Options Bronze Laminated — + — • _ OR to Shutters
Std Csmt Handle — White Laminated Garden/Bay/Bow Roofs — Customer to have cunains/blinds
Folding Handl — Bevel 1' removed before install
Wing Kn — Lami Label(Bug) — Pitched Alum.Roo
_ Pitched Cedar Ingle Notes:.
Rou nob Wood Frame Screen Info.
__ en
x4 Hinges
_ Pitched w ec.Mat.
sions _ Sliding Screen _ All B Glass Top
— 4 Fixed Screen _ bove Glass Top ,f
I Sliding Wind.HW Options _ No Screen Half and Half Glass Top -
Recessed (Brass) — Grey Mesh — + - �'_4
Tru ull Charcoal Mesh See Special Parts Field Engineer
Your door or window unit will be manufactured and installed(or delivered)according to the details,drawings,and information provide above.When altering the size
of a door or window opening there may be additional plumbing or electrical lines hidden in the wall and not documented on these plans.There may be an extra
change for this work.On permitted jobs,any structural calculations or additional work required by local governments will be considered an extra.All extras must be
approved by you before the work will be done.When removing existing doors and windows.Renaissance employees will be extremely careful,but cannot be
reSponsible for any flooring,wallpaper,or countertop damage.Customer will schedule hook-up with thgjt A m Company.
CORPORATE COPY l CustomerApproval: 1 i. V fl -j.,
11-1/ b Date: d7 ��Al
CITY OF COSTA MESA •
4ft BUILDING DIVISION
4-•.;___ DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
�74a . PERMIT
41tbibsmai
rro � 02-00724
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2754 MALLARD DR Status: ISSUED
Suite: Applied: 05/28/2002
Vicinity: ROOF Issued: 05/28/2002
Parcel Number: 13953143 Zoning: R1 R1
Applicant: SHULMAN, JOE ISSUED BY:
Address: 7821 SEAGLEN DR
Phone: (714)536-5116
• HUNINGTON BEACH,CA • ' Zip: 92648
•
Owner: ROTONDO, PETER/A TR
Address /2754 MALLARD
Phone: -COSTA MESA,CA Zip: 92626
Contractor: SHULMAN ROOFING
Address: 7821 SEAGLEN DR
Phone: (714)536-5116
HUNINGTON BEACH,CA
Zip: 92648 License: 690617
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF SHAKES, INSTALL 7/16 O.S.B.ON FRONTAGE RESIDENCE ONLY. INSTALL 7.2#CAP SHEET ON WHOLE
RESIDENCE AND CEDAR PLUS,CLASS B,AND WOOD SHAKES.2600 S.F.WITH ATTACHED GARAGE.
FEE SUMMARY ,
Plan Check: $0.00 Calc Valuation: $12,566.00
Permit: $223.25 Claim Valuation: $12,566.00
SMIP Res: $1.26
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 • •
Total: $224.51 •
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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(&00)
art ISAT/ONS _ z.
WORKERS'COMPENSATION DECLARATION: - '
I hereby affirm under penalty of perjury one of the following declarations: '
0 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.
:Met—iii—My w 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'w enssa``tion Insurance wrier and policy number are:
LCar(eC Fc t U PolicyNumbe -- I I
(This section need not be completed i/the permit is valued et one hundred dollars($100)or less.)
; 1�I c rtify that in the performanc 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 Calif° la,and agre ih t if I sh Ica d become subject to the workerscompensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisio
S a �—�ZAppllcaSigc
WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000), N ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions f Cha ter 9(commencing with Section 7000)of Division 3 of the Business nd Professions Code,and my license is in full
_force.and.ertte�ctrLic.-/— C- Co I7 cClass'r C -739
tion` fs.Signeture: Dat a.= 6--,..2_ S O 2
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).
Lender's 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: Date:
Owner ID verified by driver's license. D 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 wilt 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 and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight 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 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency'? U Yes 1 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? 0 Yes 0 No
Of"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 Li!rg Ow .r(s) Date
nd/OAuthosdApplioanlyA1/4-__17.ale-----Th
;ODE I INSPECnON TYPE Ddff MALS LODE( INSPECRON TYPE ME I[DIDdLi
1616 Fixed System Final Fire Prevention ./ - 206 Final Mechanical
1266 Pool Spa Final L�_ 208 Final Plumbing -
200 Final Re-Root 210 Final Electrical •
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
iJ
CITY OF COSTA MESA
ry� ) BUILDING DIVISION ERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
° gricatt
• �• PERMIT P99-00541
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2754 MALLARD DR Status: ISSUED
Suite No Applied: 09/16/1999
Issued: 09/16/1999
Vicinity: WHOLE HOUSE
Parcel Nunmber: 13953143 ISSUED BY:
•
Applicant: SHAFER, RUTHIE , - .% .r 7,'"--.S.:<" - ; '
Address: 803 MORGAN ST.,,,' 'r= - • • ' - , - - - -
,
ORANGE,CA,•:,/-: Phone: (714)538-8991 / _
UNIT B - ( - . Zip: 92867 ,
Owner: i ROTONDO;PETER"A':TR
-
Address 2754 MALLARD,','�, s/
i ;i Phone: :�. '��i
COSTA MESA:-CA Zip: 92626 �V �7.
,Contractor: SHAFER PLUMBING
Address: 803 MORGAN ST. - - •
ORANGE, CA r- _� -Phoney (714)538-8991
1 -UNITB. + � �4 - ^1-'Zip: 92867 ''.-.� ,
,,A ' 7 �` Lv - License: 579269- - •
'Arch/Eng:- -
' Address:
- - Phone: -: ';> -.
- .
'Zip:
- - License:
V/-N-i-',i':?,SCOPETOF.PERMIT' ",{ "
' COPPER REPIPE FOR.SINGLE FAMILY_ RESIDENCE. -li/ ,
N . ./ r .
' - - FEE SUMMARY_
AMT QTY •- - AMT --QTY • AMT QTY
ISSUE FEE $23.50 _ Laundry Tub/Washer.. $0.00 0 Sump Pump $0.00 0
Backflowirrigation '.$0.00 0 ''° . Landscape Irrigation '".'.r $0.00 0 Swimming.Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap,.; ` ':-N$ ,00 0 Trap Primer $0.00 0
Bathtub-.` ' - $0.00 , 0 • Pressure Regulator-;`a" ;' $0.00: 0 Urinal�,.' $0.00 0
Clarifier System _$0.00 ,.,0 ._ _ i Process Piping(per-10 ft);' $0.00- ' ,0 " "Vacuum Brkr Bkflow(1-4) $0.00 0
Connect Ice,Soda,etc $0.00 ;:0- ' )3
( ) - �-�) Receptors- - ` - ;; �$0.00 0� '. , Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units. .- $0.00 N.:0,.C-,-„ 9 Sento Tank'^ /-$0.00 '0 ,,'-,Wash Basin $0.00 0
Dishwasher " $0.00 0`;/ :...: Sewer Cap for Demo '' $0.00 ` 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 ", -0 .'Sewer Connect ./' :$0.00 - -0' Waste and Vent System $0.00 0
Drain,Rainwater , $0.00 ' 0 . - --Sewer-Private Line. -%, . $0.00 0 '-Water Closet(Toilet) $0.00 0
Drain,Roof ' 10.00 0' -, '- . Shower _ - : '$0.00 0 '.`'Water Heater/vent $0.00 0
Drinking Fountain ' ,$0.00 '0- r, , -} Sink, bar $0.00 1''0 WaterPiping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 „,/,
. ''Sink,commercial $0.00- •'0- Water Re-pipe $9.80 1
Gas Earthquake Valve $0.00 . - -0... ' ' Sink, Floor $0.00 0 -Water Service $0.00 0
Gas(1-4 outlets) $0.00 -0 '- Sink, kitchen . ,\\,, , $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 ' '',Sink,service/mop $0.00 , ,0 / / - OTHER $0.00
Gas Repipe $0.00 0 - Spa(private) --, , - �- }$0.00.' 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) - $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $33.30
COMMENTS/SPECIAL CONDITIONS
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
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
Fork 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 work s' mpensation Insprance ca/rd'r an policy number aree''
Carrier: o'. /. � N >' • Policy Number: 6.2 ACOA/Fo7
(This section need not completed it the permit Is valued at one hundred dollars($100)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 Calif mia,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 provi /1 /
Applicant Signature: / KJ• 41-44-4Date: % L/N^ !Q/q
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5700,000),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 that I am licensed under provision- C'
sl of Chapter 9(commencing with Section 7000)of Division 3 of the Business�d Professions Code,and my license is in full
force and effect.Lic.if (9. Jq C oc/r 4' Class a
Contractor's Signature: f-+� l) ' l tC'C-e-, Date: 9_ /4. 'P�
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).
Lender's 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 fore 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 properly, 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: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers 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 and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then 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 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully compiled with? 0 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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).
6 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 0 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 stale 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 Leg Owner(s) e
And/Or Authorized Ap cant Date
JADE I INSPECTION TYPE PAST MALE CODEI INSPECTION TYPE pin jNTm*I$
1616 Fixed System Final Fire Prevention 206 Final Mechanical q, Pym.
1266 Pool Spa Final 208 Final Plumbing �/�/// r /
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention -
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site •
204 Final Demolition 250 Final Building/Occupancy
2446-46
7 /
, Applicant-to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
• CITY OF+COSTA MESAMO TR/U TIO PERMIT - PER N TRACT NO. LOT NO. UNIT NO.
Project Address _a.t1st f 1/a IV UT r U 9/ qc IcE: 7/::C.'
Applicant's Mailing A.ddre s S 44 • I. el 0,j ]- - TYPE OF CONSTRUCTION H NEW H ADD LJ ALTERATION ZIEPAIR 1 -
1 ����, 4 CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name �� Phone DESCRIPTION OF WORK/USE OF BLDG.
Address 4 ,�^ I S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT LJ GRADING y'FOUNDATION ❑ STRUCTURAL E Front O
Address [�/1 /y�� L�/y 1�-/1 ❑LI TENANT ❑ ELECTRICAL Y�if PLUMBING ❑ MECHANICAL OTHER A Rear N
Contractor's Name_ pig `l hp e&'39Q J('� -
r�.117�(l�, l //�� ((���///�'1/�� /"�� V'`/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) S( `v--„ -C� (-J �/ ✓ • / K ' G
'J,n,73 CONSTRUCTION TYPE VALUATION$ _ S Left
City License No. ° ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • Planning Notes: -. M
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in fu and effect. I� 1987 T
Licen • C - ES 1/ is nS/ 0 0 a (, S
.� Date !. - a� Signature igen I .f f ���� PLUMBING FEES RECEIVED JUL
WORKERS'COMPENSATION DECLARATION Bar$in•
k Showers•
hereby affirm that.I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified co y'thereof (Sect on Backflow Preventer Service Sink
-800, Lab. CA”, p Automatic Washer Transformer 0 15-50 KW
policy No- `/q 1p �� Company TV Backflow Irrigation 0 50+KW
g Sewer Cap • Construction Pole Sub.
E�Certifietl copy is hereby fur city.
•
Da CeJtl d�agyys filed with the )yin i n. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
EXEMPTIONS !1 ( Applicant m (r / S'A� L� TION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
EXEMPTION e need not WORKERS'd If the permit ii for one hundred ($100)or
—
lecs). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
certify that in the performanceperson the work for as which this permit is issued, I •
olf ' employompeanyiperson inf any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 01%-8
Workers' Compensation Laws of California.
Date Signature _ _ - - Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration, you should become subject to the _ Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. —. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Cly. C.) interceptors Water Heater
Lender's Name p 91 `� Outlets Range
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit - Trash Compactor
to file a signed statement that he/She is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law(Chapter 9(commencing with Section/000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
terefrom and the basis for the alleged exemption. Any violation of Section
)31.5 by any applicant for a permit subjects the applicant to a civil -
enalty of not more than five hundred dollars($500).
ft I, as owner of.the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered -
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL Reinspection Fee $15 Issue Fee $ 3
FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). �s�
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By I/11 Date 10^S�
tractors to construct the project (Section 7044,Business and Professions Code: �G�
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System-0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ J •, , ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 BTU ELECTRICAL ' $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- • $ MICROFILM '$
sentatives of is city to enter .on the above-mentioned/property for PLAN CHECK 50°.6
inspection p ses / MECHANICAL $ ��
Signature ./ll ...%/.' / oate(fJ"(trot TOTAL FEE $
Drivers' License or SS 9ti/ — Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
t
3. Electrical Conduit Utility-Undrgrnd. 54. Forms %. •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding t-
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TOCOVEi--GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd-;Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap j0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECI!
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing •
76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:yy.5.87 LEfr cave(). L.E.D
34. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing Pea Leto
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backf low 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
1
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
(PITY-OF_COSTA MESA CO STRUCTION P MIT - PE MIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address
2754 PIA�Ret) - a - 394441,4S—
Applicant's
944'SApplicant's M.' '.• Address 1 ,
• TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR
1 / i NAIzT"c,� Liz_ -•
p—
Owner's Neil ����- -� tNe� Phone rJ1-T72-� ❑ CONVERSION El El A.P.qµ+ •
Zone
•Tn� DESCRIPTION OF WORK USE OF BJ.�G.T �'F< LY F
Address �a•;-•�12•: DO-46 5 p-1 Por /•l/p-1..•DC Y-CYX-" S Main Building: Accessory Building:
Arch/Eng. License No. TYPE O PERMIT GRADING U FOUNDATION ❑ STRUCTURAL E Front ' Q
Address .`` r /��� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear N
Contractor's Name Myr:1Ns Vresr�n L.'J-VX Pholne9ie5-51:07D ❑ OTHER C Right N
Address(mailing) 11S4(a MAILTau 24 vert, Uftt.t.Lf PROJECT DESCRIPTION SG. FT. FS'S/) OCCUPANCY vo K Left G
��/�� CONSTRUCTION TYPE VALUATION$ 1Z� S R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. R¢(.# Parking Req./Provided E
Q
I hereby affirm 7 that) I am licensedion under provisions Charterro9 (commencing Remarks: Planning Notes: M
with sectioneis n f I of . avid of 3 of the Business and Professions Code, and
my license is in f I f. and effect. LM/��b S
•
License O. �� License No. J0[�'"1
Date Signature ?AT -• _AL.-- - L • C . PLUMBING FEES
WORKERS' COMPENSATION IDECLARATIO Is ' •st r a ..}}IP�
' hereby affirm that I have a certificate of consent to self-insure or a cert1licate Bar Sink Showers ELECTRICAL FEES
1 Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
��///�••y�yyy..�, r� p Automatic Washer Transformer 0 15.50 KW
dOO, Lab.r 4—' ,--.✓-37 1- 10 0 50+ KW
Policy NO. (JJii�^ Company Backflow Irrigation Sewer Cap - Construction Pole Sub.
FCertified copy is hereby furnished.
Certifl'etl,[opy Is filed with the city rulldin• •'vision-, Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date7'rd•'6l7 Applicant = -a - G' - •• /6 Id°
EXEMPTION F ROM WORKERS'COMPENSA • ' • L• • ' O. Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred $100)or
-
less). Dishwasher Solar Piping Dryers ❑Gas ❑Elbctric Sub Panel
I certify that in the performance of the work for which this permit is Issued, j •
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California.
' Date Signature Floor Drains _ Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration, you should become Subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked- Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name �
Lender's Address I+11� Kitchen Sink Water Service Switches
Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031,5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays
any structure, prior to its issuance, also requires the applicant for such permit ra y Generator OM KW❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
•erefrom and the basis for the alleged exemption. Any violation of Section
131.5 by any applicant for a permit subjects the applicant to a civil
•nalty of not more than five hundred dollars($500). $ 3
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee 1 $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
sale- If, however, the building or improvement is sold within one year of com- Canopy Type II ❑
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By 71,EDate
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 29.to SMIP $ 0, S
proof of their Worker's Compensation insurance should be provided to me. b
PLAN $ PERMIT
❑ I am exempt under Section B.8 P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBINGN CHECK $ PERMIT
ISSUANCE $
IL
Date Owner Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BTL(--- ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives_gf this city to rater upon the above-mentioned property for
inspection piTrp•. s. MECHANICAL $ 29..313
'�,9• TOTAL FEE $
)C Drivers'Siriversre or• a �/.s.' Date Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
ISIS .1elmornalmma
Y' License SS --
CMF 0865.46,rev. 10/84 White . Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor U1 UUtJUdY6:5-U00U5716b 1-CT 29.50
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement- 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 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
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
•
22. Ducts, Ventilating 71. Product Piping 0 Gas O Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: •
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ��
•
38. Final Plumbing •
-
39. Water Service-Final - ,
a
y
40. Gas Service-Final ••I
.41. Solar Domestic-Final r - s
';42. Backflow Preventer•
.A3. Backflow Irrigation
44. Landscape Irrigation System - .+-• - -
45. Sound Attenuation -
S46. Handicap Regulations - - -
47. FINAL STRUCTURE & BUILDING g/g $ft -
UU •
�
48: Special Requirements Completed •
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co t ) , ,
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER
FENSKE, D. M. DATE
8-2-73
JOB ADDRESS 2754 Mallard Drive BUILDING PERMIT NO. 3.7101
C‘‘,...GENERAL CONTRACTOR owner DESCRIPTION of WORK Sewing Rnnm
�_AP No.139-531-43 LOT 44 TRACT 6P17 FIRE ZONE VALUE $ 2,Rnn_on
I ECTIONS — Signature Date GROUP T TYPE V ZONE
1$y
GAS SUBCONTRACTOR PERMITS ISSUED
Date I Number I Signature
1- WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND fl POWER Ej
ROUGH WIRING Heating and Vent.
TRENCHES 0 FORMS LI STEEL REINF.
FLOOR SYSTEM
BOND BEAM H STEEL REINFORCE rl _
SHEATHING _
FRAME AND FLASHING
LATHING - IN rl OUT 7
PLASTER, BROWN COAT -
$TR"CTURAL, FINAL _ Electric
H IG, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST l7 _
ELECTRIC, FINAL
BUILDING, FINAL
SPECIAL REOIIIREMENTS
37 j 01PAIPAID
AUG -2-73186* ****35.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely PATION FOR BUILDING PERMIT
BUILDING �/ / /115V4,-, RE /8Y r�/TE REC D T—z—E fr
ADDRESS D S / - )(a—//�� PERMIT NO.
OWNER / I Fens Ire A.P.NO.1J9_ SJ/- 30
BUILDING
ADDRES2 �G//e?c/ Or
MAIL Sy7 //////
Z ADDRESS ,SaM .qLti 0.1 TEL.
/
bc74 �
U CITY Co sesa NoS5S Z l/pp /'7, TRACTGj4 / LOT4Y BLOCK
Z < CONSTRUCTION r L /�, �, t t Aj / &M L NEW ADD ALTER REPAIR MOVING f1FMO15H
—cn LENDER JoL a-// �j �{�@ /l
am X
JD BRANCH � ✓ ttA/Q
__I to / OWNER 1) /'f ,cg efi /C
I ADDRESS /0 90 75,7,7„,,,,, Dr A 13 VALUE %�J
ARCHITECT TEL. S SL�r.UI d $ 2reo�
U.-...k.
OR ENGINEER /�� JMCAO NO 539- 914 T
Z < FIRE 1
Z Q /� ZONE 4 /TVPE �{j�GROUP
a-K ADDRESS //r('S� C://!/eI`� S7`- l: LT
TT—
a_til APPROVECONTRACTOR 00,11&r`— e r/r�s7 r BY -- DAT$_2_7 3
CO
J pc ADDRESS
w WZONE NO.OF USE OF NEW
LirTEL.
ZF CITY NO. PLANS BUILDING5c�/Nr "rota_
_
WO STATE CITY YARDS APPROVED YARDS APPROVED
zd O LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STRE I ,e2/
SIZE SIZE NO.OF BURS. ` y'
OF LOT I NOW ON LOT / 3
FRONT J FT.
USE OF
EXISTING BLDG. R.SIDE /�J /FT.�J FT.
I— SIZE OF % / ./NO.OF
ZZ NEW BLDG..�O 9 X Q 6 ROOMS 1 STORIES ! L.SIDE L'� FT.f FT.
EXTERIOR WAL ROOF cc
V COVERING Fljrfor COVERING JA/yt /2 REAR �f. T. * FT.
USE OF BUILDING AND WORK TO BE PERFORMECI DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS. BLDGS. -
VAR.* DATE
O SPf.ta t H 7 TI 00 H-S- C.U.P.# APPROVED
NP ROVED& t P6- SATE e-.2_--71
z
O
U I hereby acknowledge that I have read this application and state $TATE
✓ that the above information is correct and agree to comply with (JJ
CC all laws regulating building construction, and I shall not employ /I /
F any person in violation of the workman's compensation laws of C
Li
H the State of California. / SOFT. TAX
Z I hereby certify that I am properly licensed as a contractor under . O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses ere in full force and effect,Or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
m
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9. m
PERMIT FEE $ an N
Signature of y B
Permittee /V t/ 7 s $ a /-/ PLAN CHECK $ / /
e
Authorized Agent LL
TOTAL FEE $
v nivrn Mhos. VAA.L.40 DUlLUr;Itb. INC. mini 14-19-b7
JOB ADDRESS 2754 Ma11arr1 Drive BUILDING PERMIT NO. 20421
GENERAL CONTRACTOR Mesa Verde Builders DESCRIPTION OF WORK Residence W/Att �Garge
Ar No. LOT 44 TRACT FIRE ZONE VALUE $ ?5,385.00
1 ECTIONS I Signature Date GROUP j & STYPE v ZONE R-1
Sou (i'.- >f=2-6 PERMITS ISSUED
Gas fo_20.c± SUBCONTRACTOR Date Number I Signature
Water .� Plumbing
Rough Plumbing cu-6- � /i -�!FTMIPI 1 .:`��jr
Prop. Swr. Line House Con.14 Art ar/zr'a I� nt17. `IGICE!! I'W Fr,
Sprinkling System _
Miscellaneous /�
Rough Heating and Air Conditioning /,tfr2-7-n
Temporary Service or Pole
Underground 0 Power p
Rough Wiring7 (( Heating ����gggd`d_Veqt.
Trenches, Forms al Steel Reinf. p pti7f tr A Y1
-67 ' 1 p/irl y #rzl1ue-F2..67 . "1/ fiSie
Floor System 4 f-8--67' d Ioo] /
Bond Beam ❑ Steel Reinforce ❑
Sheathing ,/y)r. .Chin,
Frame and Flashing ! [.ix c7
Lathing— In El Out ® gat -7.-/-/-47
Plaster, Brown Coat,1U1 ¶?- -e7 40— 7-n-s,
S `ural, Final Ejgc
h .ng, Vent., Refrig. and A.C., Final �./* ,(Q i a 0 }Y�D9,. 1"A-a a 7 Di In ''"
Plumbing, Final and Gas Test f L�/lc4 7[Y.L�
Electric, Final na �,� y:-.
Building, Final Q q„0'_
•
'_ 26921 PAID
•
APR 25-6700 1249* t..**158.25
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA,CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
Lot 44 TYPE OR PRINTTract 6237 BUILDING
//� ^/ / /j ,F/ ////\�/ For Office Use Onlyr�p/��•ll�
ADDREIS$ y2-75-1 a /aAct .4 , RECEIPT NO. �P[f92
COSTA MESA, CALIFORNIA
Mesa Verde Builders Inc. R ED Y DAT RE�BhYBD DATEIB9ygD
OWNER �aTninsXibilgEhbitgaxs X$EEx X9-47 y/ 6J
MAIL BUILDING
ADDRESS 2850 Mesa Verde Drive ADDRESS /
TEL 549 ZO E TYPE 1 GROUP OKn
r
CITY Costa Mesa NO. 0395
ARCHITECT TEL. bill- BY DATE DATE
OR�q GINEER Kaltenbach NO. 8046
�� ZONING
A ,. ss 1823 E. 17th St. Santa Ana
T� ZOj'!� NO.OF USE OF NEW�q eat-
Mesa
Verde t ,X�j d rs Inc , ,(}'_j PLA NS�f BUILDING
CONTRACTOR 1i1XffiEpS. 7L'gf X . _ ��
DESCRIPTION
V� ^. 69.-2--57
ADDRESS 2850 Mesa Verde Drive DBIICRIPTION //[
CITY Costa Mesa, Calif. A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STLIC..NO. 187318 NATE O' 549-0395 30"TO SIDE REAR P.L.
EAVES
SIZE 6 0 �( [ I NO. ONSLOGS. O ALLOWED (U.B.C.REQUIREMENT)
OF LOT " v NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L SSTRW) /}�I
SETBACK LINE FROM FRONT if,' FT. //{'j//n FT.
CENTER OF STREET REAR YARD l
SIDE YARD I LEFT I RIGHT R.SIDE FT. FT.
DESCRIPTION OF WORK L.SIDE
n60 Ft
Fr.
NE"' X ALTERATION ADDITION REAR Ld FT. FT.
DISTANCE BET. BET.MAIN S
REPAIR _MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
- VAR.# DATE
BUILDING NO.OF
SIZE ROOMS STORIES C.U.P.# p/� /T-L APPROVED
EXTERIOR WAL I ROOF Shake APPROVE 7.114.44...4.4-
DATE
y 1,1. ;//�/
COVERING L7tUC C)o COVERING Shingle eY I/ /��!�'�' DATE 7 .if Imo/
USE OF BUILDING AND WORK TO BE PERFORMED
New Residence P 6. 3
✓/oT ZZ vis'
7 /80.FT
I HEREBY ACKNOWLE GE THAT I e READ THIS APPLICATION /THE AMOUNTS N UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF STABLISHINO A PERMIT FEE ONLY. s
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. H
SIGNATURE OR`/-yI - 0,. '0. ) JJ PERMIT FEE $ / ;5-45 D
PERMITTEE /'WW1/ /✓• AJAM�LNLLG 5 35-313-- 1 ,gym
AUTHORIZED AGENT 1 0
reg.?,
TOTAL FEE 5
wnrvErc � D. M. DAIt 5-15-69
JOB ADDRESS 2754 Mallard Drive BUILDING PERMIT NO. 30287
GENERAL CONTRACTOR Owner-Bui3der DESCRIPTION of WORK Add Ramada Room to Res_
An `Ig. �39_53t_4s LOT 44 TRACT 6237_ FIRE ZONE VALUE $875.06
I, ACTIONS Signature Date GROUP J TYPE V ZONE R-1
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING •
TEMPORARY SERVICE OR POLE •
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES FORMS ❑ STEEL REI -F.�,♦! (�SG f;l,-" .
FLOOR SYSTEM � '
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUTJ❑
PLASTER, BROWN COAT
5T TURAL, FINAL Electric
HI 4G, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL ��,/
BUILDING, FINAL gni E;--,t c-67
PAID I 0287 MAY 75 65criscCC 974 �. _***'9.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
�/ �jJ / RECEI E BY DATE RF,CEIVED DATE ISSUED
BUILDING A 7.3 "l A7// — B/— • �� -� c:-/.5--6,
ADDRESS ��--rI �1 /� �j a p MIT Nat,
OWNER 4r.- At-s- /J / I re K)'A- A.P.NO.45 T-s3/ -tI✓ O
AMAIL DDRESS 5,R,../.7,.. BUILDING'DR ,. 7j • / / az
ADDRESS V oAl fff�i�111YYY///"`
Z
0- UJ 7+ ,r, TEL. 9 c TRACT `/,' 7 LOT c11 BLOCK
0- C...) CITY LOST Were NO.5YJ- 7/` �V
CONSTRUCTION�n� NEW AO ALTER REPAIR MOVING OFMOILSH
a- I- LENDER
a m
,J D BRANCH �/
J N - •• M, ��?G
Ci ' ADDRESS //J� • VALUE QUO
J Q ARCHITECT �-' TEL. OSE/401#41/9" QtsOm $ �.�
OR ENGINEER NO
Z5 '
Q FIRE
wtL ADDRESS ZONE TYPE //.�GROUP
aLD
APPROVED
J Z CONTRACTOR 4Ur'Ne �-' BY DATE
mZ .
J cc ADDRESS ��jj'
W W ZONA NO.OF USE OF NEW /v'rr+</��-#
= CITY NO. e/ PLANS pZ BUILDINGea
Z I /� CSS JSP/h sv�/twc�
W° STATE CITY YARDS APPROVED YARDS APPROV eD
N 2 LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D SIZE iNO.OF BLDGS. IFROM C/L,$(�Tp T p
OF
LOT �rox /G O X Jt'.3 NOW ON LOT / FRONT y}/( TT#{C. h FT.
EXISTING BLDG. Na 1$ G R.SIDE 4 FT FT.
I— SIZE OF .y rj / NO.OF _ !
2 NEW BLDG. / h JL' ROOMS STORIES L.SIDE a FT. FT.
CZ
0 COVERING COVERING
N WALL COOF
D\p4“ REAR e,74 FT./, FT.
-' USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN&
MAIN SLOGS. ACCESS. BLOCS.
VAR.# DATE
p .41./1in9 Ram ani P/ �acj a •C C.U.P.# APPROVED
I— // APPROVED A
O ('fa fl _HV HATE L.•/- JS- 7
Z
0
UI hereby acknowledge that I have read this application and state
✓ that tho above Information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of
f/g the State of California. m
Z 351)I hereby certify that I am properly licensed as a contractor under SO. FT, _ o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State of California Business VALUATION ���
and Professions Code,Division 3,Chapter 9. m
PERMIT FEE $ N
D
Signature of _ CO
Permittee !,/.Lr /9 T...e i _t s77:(� PLAN CHECK $ E
n 96=9Authorizetl Agent u.
TOTAL FEE $