HomeMy WebLinkAbout1675 LABRADOR DR - Building Permits(714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ffdfLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1675 LABRADOR DR
Suite:
Vicinity:
Parcel Number:
13918139
Zoning:
R1 R1
Applicant:
ARELLANO, ARMANDO
SMIP Com:
$0.00
Address:
2702 W POMONA ST
Inspection:
$0.00
Phone:
(714) 7544107
SANTA ANA, CA
Zip:
92704
Owner:
SHERRELL, ROBERT L
Address
1675 LABRADOR DR
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
RB ROOFING
Address:
2702 W POMONA ST
Phone:
(714) 754-4107
SANTA ANA, CA
Zip:
92704
License:
772680
Arch Eng:
Address: Address:
ISSUED BY:
Status:
ISSUED
Applied:
04/16/2003
Issued:
04/16/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF AND COVER WITH 25 YEAR COMP SHINGLES. REPAIRIREPLACE SHEATHING ONLY AS REQUIRED. INCLUDES
DETACHED GARAGE.
Plan Check:
$0.00
Permit:
$111.25
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $111.75
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0
ACCESSORY Front 0-0 Rear 0-0
PARKING Existing: 0 Required: 0
FEE SUMMARY
Calc Valuation: $4,500.00
Claim Valuation: $4,500.00
PLANNING & ZONING
Left 0-0 Right 0-0
Left 0-0 Right 0-0
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 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
.44&46(8/00)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: f
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code. for the performance of the
work for which this Permit is issued.
will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which Nis permit Is Issued.
My workers' compensation Insurance carver andrpolicy number are:
Cartier. 0l Policy Number: r�
(This section need not be completed i rhe pemuf is valued of one hundred dollars ($100) or lass.) e t5
❑ 1 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 became 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 tDDbeee Labor Code, I shall forthwith
comply with these provi re. ^SP /
Applicant Signature: `-%�D�IA--/-Gif!'-bGL Dete: (T/ ��
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL NES UP T'Fl OONE HUNDRED
THOUSAND DOLLARE ($100.000), W ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, MEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professi ns Code, and my license is in lull
force and effect. Lic. a Class If C_
Contractor's Signal — e Dela:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders 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, eller, Improve, demolish. or repair any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he a she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Olvlsion 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 dvil penalty of not more than two hundred dollars (5500).):
❑ 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 appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - property lax 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 B. Calilomla 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? ❑ Yes ❑ No
(Section 25505 of the California Healm and Safely Code requires, with some excaptlons, 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,
or200 ............ _._.._.._____.......__...._............_.__._................................................. ____................_.._�.�
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 o1 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 o1 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
Cction 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
artment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of INa plication a m t for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........._..................__................................... __..........._._.___..__.__.__.................._._..........._......................_...... .......................................................
..........._..... ........___.._—__
6 Will any pan of the facility to be constructed under this permit be within 1000 feet Iron the outer boundaries of a school? ❑Yes ❑ No
(it '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
......................................................................_—..................._................______....................._.._.................._......_...................._........................................................................ ____..........__................_..._........._._._
B (If yes", attach cartificate 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.
:�4 en
gre Of L gp D e�(�) t o i /' / bat/ o�
And/Or Authorized A II nt �L• D to
CODE 0. INSPECTION TYPE IAN ISL$ CODE( INSPECTION TYPE 26H gam$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
200 Final Re-Roel�l'Lrr'0� LL.1 �-= 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
ADORE53 OF BUILOM: 1 O
OWNERS NwE IF KNOMN: SHE:
SHE:
ANDREW 167
;OSTA MESA,CA
APDL. Ilam ADDRESS:
ARCNITECT OR ENGINEER:
ARGIL OR EMI ADOREM:
riH un un UNT:
ROBERT L
26714-979-4812
U4 N0.
CONfMCTORS NAME
CONIRACTORSMARpN
ADDRESS: U4 NO.:
UNIT:
UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby affirm uMw pe at, of perjury tlNt I em licensee under povt.om d Cheper D
(oomm.cm,, with Semon 7000) of Di m Sol IM Blmmes end Prolwsom COM, eM my licem. 4 o Mbwe oa
M elte.
CITY LIC. NO, UC, CLASS: LIC. NO, LA t'
OWNER BUILDER DECLARATION: I hereby dfum o Firmly of perF, Net I wn examp from the Camrectpw Li.. lee, for est
.tdoweN weaon (Semon 7031.5 Buseuw ane Prdeav«u Cage: Arty my or oology efI'rA Mum a Mml to arweua, attar, improya.
femdt.h, or repair A sFuctms, PNX to ie it., also Mukes Ihe eppliceM to each Mem d to file A surae gelamed Nal M a she
e lioensee purwanl to IM presume of the Comrmors Liwua leo ICheplar a (ap w wv with Bectbn ]DOD) of DNlson 3 of the
B.. arN Prdeuuro Coeel ar that he or Mu b sump thweh«e and Use best. for Era edepae exemption. Arty violation of Boom
MIS by a, eppSmm for a pwmtt Kb is the appfcW to e air peroAy of no, mae then two NAxbvd doBve FS500D.
❑ Les owes of lM prop."«my wnployeeawlh wales n that wAs mmpwwdvl, wird eo UN w«k. and Uu unamu ls nd bdeneee
a filer. W sob (Section ]Me, BumMuertl Pmlesaom Coee: TM Cawraaws Lx erne Lew doer not appy Io. oe,mrd popery
NIM buida or enMows tlwean. end w eoes such work lensed ot M«M «tlu«Oh M or her owes wr ioyaee..Owes Ihet such
impwemwaa d
we not Wwed a dlwae t« how
eels. a. ever, the pu&1mg a inpmamwi is add eni n one year of compbtion, the
X ..t puiUw om hes the buNen d proving M Or elm fist nct b w mpmve la the pwpoee d sob).
❑ 1, es owner of IW pop.". em extlgildy murediN e,4l lcwed mweaors to mnvrud Ne Majed (Bedm 7041, Bua'vwa end
Prtdauiom Codes The C&wept s I. Lew does nct appy to (eM1n out. d property otls « mpwes thelsoo end wdw
11 m o W such Projects e,il a wwad«(sl lierA P.711
. punw(FR(M1e
❑ I errs axemp w Sax' o � S. d P.C., W Urs assn: (/�/ •
Dsta: O .
eo hereby cw4tw I wn owes. of ane UMwauutl U e reommmerua d Caorme lleetlh arld Selety Code Sections mos.15533. wtl
15D3e. NIM the I ,any Mum Welirp 000 anit d will N ww (cools rte) mad to campy Mh sew was oodutl wthe r uiremw s W
a pamm laconstruot.m mohfiool nIran IM A,�annyenNnlDistrict. Rasidwuief mnuruaion apicidom we sump from lhaea
Wwt.bns.
Date: Applmwa:
WORKER'S COMPENSATION DECLARATION: I sereby affirm under perwtty of Feeley au of It. kl.WhV esctslwom:
❑ 1 have wN W meWan a ceneotls d prwm to sedrrwe W workers' compwwslw. es provided It. by Sact o 37M of the labor
Coo. f« IM p.amence
of ere wank for w1edl UIt. Fames Is mu..
❑ Ihwn aM wme atao wa kan'mnwm ioctIr. e..rw ww1byBWon S]Wdlf,*I, Co .bUrpuformemedlM
wait for wNch We pwmd t. t.susd. My e,aken' mmpwvdion Nwaame wIW wN poky mmbw we:
CerMr
Policy Non ..
esden nwe rwl be conplsrod r rhe parrot t. M1w aro InmJad dodwe Is loaf a pew.)
s I wtN Net M the p.amwve of UNI emit W wftidl this e I b wo sty pewan in em n to
bewnw wbpct t, I worked'c 37M of the News d C� Wq. a �. waptl }Y0b woM1aw•
camweaetbj d sn 3700 d 1M labor COM. I ome, wa `/OI
Dole:
- ✓ Appeem: V
Weminp: Fw.. b sseuw workeri rohpwvatlon roys,aPa la unleMiA and alWl aWlct an arrplayar ro edMml pamMes and
c/vll Oms W ro .s hind ad Wwuesrw dollen ($104BODA h wkidon M the cwt of vamp ss WrA dampee As pnrlCM lo, In
Sa.tl. 3700 of Ne Lebo, Cor., Imweet and.Iromsy's tau.
CONSTRUCTION LENDING AGENCY: I hweby sham urMw pwuby of perjry thel live Is e oomo w n leodno e0emy W IM
pedormeme of the wank la which IM parol I, t..wd (Section SOB7. CM. C).
LENDER'S NAME:
LENDER'S ADDRESS:
Icemy Ihei I Mea reed Nu app5odon wo eweIhettlN odamuioo iemrtw. I Apse N comply dh ao my wo ooudy ted'mwcee
W awslewardstepmbdtleq end les wrth«b0 repreeerNaN'es d Nie my b enter tpan Ula aLQ!'1rWECVMd Froyom
l«enpouipn P«Poae+.BO 2 T S •RRELL
Dme:
(515146 WP) Wlot - ldep A Seoly: G.Fle; Cwwy-Appkaa; Rnk-P.; Goleenme-bsew«
CITY OF COSTA MESA - BUILDING PERMIT
x Ivlr: r vyD�yy
PERMIT NO: P 073377 PLAN CHECK NO: N G Vi: N bUek': IN
CONSTRUCTION TYPE: V -N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION INSTALL LAWN SPRINKLER SYSYEM SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /M-1
COMMENTS: REF CORRECTION NOTICE 7-19-95
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
PARKING REQ: PROV:
PARCEL:
13918139
ZNE:
REF NO:
PLANNING NOTES>
>
eF 1E 3E iE if SE iE BF IE �E ilNE%*iE*dE iE*iE fE**♦E*****fE**�*iE*iE iE dE lE eF df iE iE iE iE �iE iE iE�iE
�F dE iF ii 9FlE fE dE
fE*iE iE*iE �E iE iE*aE it*fE 1E jE 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 APPROVED BY DATE:
BUILDING APPROVED BY
APPLICATION ISSUED BY: 1
1k iE * df iE lE 1E ♦E iE iE * iE iE iE * fE IE 1E iE SE if iE�7i'i '3Fit-
LEGALIZATION:Y F E E S U M M R
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 282500
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS ---- > 28.00 20.00 0.00
DATE: p_
DATE: 7 Z /�
*iEi(-iE if dF*iE iE �E' *ii
Y STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
48.00 48.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 48.00 OVER/SHOAT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
48.00
dE if irk♦E iE ak*iE dE*iE df**1E****if♦E1E**iE �E BE fE iE if iE*iEiE if***BE iE fEiF***BE iE iE if*iE iE 1E*1E df fE 1E*iF �f *iE iE iE iE if iF*1F 1Ek*iE**iF if lE
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 P T I O N UNIT COST TOTAL COST
PLU 1 BACKFLOW PREVENTER 7.00 7,00
PLU 1 LAWN SPRNKLER SYSTEM ON 1 METER 7.00 7.00
END OF FEES
01 00156?;7-0"186747 T13T 48,00
Dr TE: 07!?4/95 TIME: 1u:20
- CONSTRUCTION AND PLF _?YING
APPROVALS Permit # Date
Inspector
' ,POC. . SPA
APPROVAL!Y" Permit i' '
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 LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe•Undrgrnd.
i -'
- 60. Backwash Lines, P -Trap, O-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 - Finan -
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final r
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
APPROVALS Permit #
20. Rough Factory Fireplace
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 []Gas ❑ Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: 1,
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38, Final Plumbing
_ J's-
39. Water Service -Final
40. Gas Service -Final
r
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
;
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
ADDRESS OF BUILDING: UNT:
O ERS WE IFKNVMN: SHERRELL, ROBERT L
SHERRELL ADELLA 1,3c
"DD"`SS 1675 LABRADOR DR
:OSTA MESA,CA 92626714-979-4812
APDL. INIUM ADORES&
ARCHITECT OR ENGPil ER: LIC. N0:
ARCN. OR EN(L'S ADORESS: UNIT:
CONTRACTORS NAME;
COMACRORs MAILING
ADORES&
LIC NO:
UNIT:
LICENSED CONTRACTORS DECLARATION: I hoary aflim order perely of perp" Gel I on FcameC under «o..io,. of Chner 9
(o www with Some ]000) d DM bn 3 of the Buaarm oaf Prdmdwv Coda. and my Soares Is n bLAtww ad ertw.
CDS' LIC. NO.: UC. CLASS: LIC. NO, LAA YY
Dale: Carmofor
OWNER BUILDER DECLARATION: I hereby affirm ud« pemly d perjay It I two emmpl Imm the CordWore LiDenes Law for Ne
'dloniq neeon (Sedion 7031.5 Biome ed Prolessions Code: Any city or ooevy Mr',o teauim a panne to oombud, etl«. Bnprove.
emd'tih. or rep" oy oaectura. Prior to as uauence, aro mu'ves the aPplicent for auch pend to fib a sgnd alaamed that M «elha
n lioeneed p..anI to the r isiona of IM Cmtradon Linnets Law IChep90 9 (omorno i, wih Section 70DO) d DNhion 3 d IM
Buairem aid Prdmeiona Code] or thaf M or aM u mempl thereh«n and IM boa; 1« Ne alped exemption. Any videtim of Section
7031.5 by any applired for a pemy mbpda IM app4are to a d.8 poetry d nq mote then INe Nmdd doses (5500D.
❑ 1. as w of the pop" or ryy«npblma weh we9m m Nei sob mnpeeWm. will do the wvk and the elrumne a W irvl dd
«c0«edl«seb(Section 7091. Busuemerd Prof. Cob: TM Convey a L ootae LawdoearotAppyl.aaiiw7er d«opo"
w o Wide or knpr«ve thereof. ad woo does tt ci ark Irtnaetl or hwaol «tM«Oh M «her own empkyw, I,ovidsd tied each
X "vnlxwamade are rvI iaedgl «dl«ad l« aab. S. Mraw, the buidkp « rop rwerema b s e thinaro Ye« d.PMion, do
oenodetler will haw Ue burden d prwbp M or afw did not bdd «know 1« Ne pWoo, d eale).
❑ I, as owmo of IM «operty, an, exahai ly ccdmdkp wdh sosimd mnrealov to mn01m the prq d (Sedion 7044. Dmbtma oaf
Prcfem've Code: TM C« fectore License Law door m an owner d Draper, wflo or irrpavm IM ad emo
comms br euro wM a mnredorlq faamW Punuan o the C red e, li ws w).
❑ I am a B. A P.C.. N' roe
Deb:
I do Mraby curdy t I on aware d W uderewd the require, ma d Callomia Health ed Safety Cafe Sediane 25505. 25533, ed
2553.. and Net I or wy Man Wit" oonpw wi8 y will rid (bob «w) oe W to 0 m* wlh aid seta codm oaf IM r uimnwNa for
a ermit l«mmtnwiion«modibutionh«nIMM3i ,tail �aupemenl DW,;d.Maid«4Nmmructon eppFnioman aaampt fern Nme
«ovhi.na.
Dere: Applicant:
WORKER'S COMPENSATION DECLARATION: I humb, elfin Led« penalty of perjury orre of the iosow'kq dadaratbns:
❑ Ihew ed A,®sen ac«Mire. d mriwe to mNlroes I«Mei mrMommien, m«mddd 1« by Section 37M d IM Labor
Cods, l« the p«lomioce d the waA Iw wlro O:e pone. u m .
❑ I hex ed wit,ahem workan• o,vproetbn i ao op o m rprvod by &.thee well d oy Lahr Cafe. br 1M pad«m«ce tl the
wM 1« wdiiN 0a penM h Mued. NY warlwn' aorrrponWion #,meree weir and posry «only «e:
Carver.
Pd'cy Number:
section road rot be completed i W perm#', tor oro hurdwd dclbo ISI001 «Ree )
L}J, 1 mnty N, m he Iado er,,s of the wok for Whkh this head. I ahetl no . �Iw aty permit h mo a emr ao a 'to
become sub' d 1. IM odwn'. mmpanu bn hews d Celi«nh oaf r bet I _ become ed to IM wurkeri
cum eIi p oaf i e
mal IM Labor Cods. I m IO wet Nom peer# ��
Data Appfiwa:
Wlr,ft: Esus fo n saM1M' wrrgruo0on covwps b bNul oM,hafl awipp'l to owpinyor to «Iniral po otlm few
clvll nim W fo orre rlardrod dreuouid "J ore ISI000001 N add/tlen m die cord of rompsn Uvm damps of pnylbd for In
Seed. 3706 of M Labor Cob, Interest ard.homer. Imo.
CONSTRUCTION LENDING AGENCY: I heeby aRmm and« poesy d mqr Iho then h e eormrudlon larrbrp y MIM
oedomarwe d IM week 1« wo,o the .A
a e (Section 3097. Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I ceniy thaf I hexa reed this ep0im000 out We the he above wametion I, eed. l apse to o ply wlh all dy ed county«dimaces
mdaw.ia.rewirmloWdd P wrh
,oboo Where aWerepraeentoivas d true city w enter upabove
on tM -mentioned papery
for impoo, 0000 RO E SHE RELL
Prku Nams �'7
/ Do.
Sgreon enVAppkeenR:«arad«
(St51 s6.WP) Whm,,Buidnp A Safoy. Olo,-filtr Ca,—Y-kppime: Pnk4Iewmw: Odde«od-Aiaem
CITY OF COSTA MESA — BUILDING PERMIT
e=mrl IVU : 1.1 - --- V I j I tiI
PERMIT NO: M 073378 PLAN CHECK NO: N vvv L: i, ovcv: iw
CONSTRUCTI0 TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH
JOB DESC PTION INSTALL AIR CONDI SYSTEM SQ FT:
CLAIM ALOE: CALC—VALUE: GROUP OCC: R-3 /M-1
COM NTS: REF CORRECTION NOTICE 7-19-95
iEiE* REpf**if 3F REi(1EpF1E1F1E1F*9FiFNF#'-NEiliENEififNFff9F9ENEiEdER(-N(-lENEpENfpFiF*iF9f#�EiF1FiENF3Ek#ciE�EpE*REiFiEiElfiE**#9E9fk3EiEyE*dF*yF
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 RIGHT: FT IN
PARKING REQ• PROV:
PARCEL: 13918139
ZNE: REF NO:
PLANNING N TES>
K D O W N
TYPE
>
D E S C R I P T I O N
UNIT COST
TOTAL COST
iE 9E iE 1E iE AE*1f iF iF lE iF**RE**iE♦E iF iE iE*iF*iF
iE*kiEiE**iE 9F RE iF di♦E iE RE iE♦F♦E dE iF iE iE iE
RE 1F RFlFlE dE iF 1E 1E 9E iE iE RF if iF ie if AE dF iF*RE iF*its ai iE dE AE*
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 APPROVED BY
9.00
9.00
DATE:
BUILDING APPROVED BY
APPLICATION ISSUED BY:
GAS PIPING SYS 1 -4 OUTLETS
3.00
_ DATE:
DATE: S
—dF dF dF dF*** RF RF it dF***dE*******
F i,'7 iF3F iF***iE RE dF4 it iE
LEGALIZATION:Y
F E
E -SrU M M A R
Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/RES GRADING
PERMIT
42.00
25%
SMIP/NON—RES
PLAN
ISSUE FEE
15.00
BUILDING—DIV—> PERMIT
ISSUE
PLAN—CHECK
TOTAL PAID DUE
TOTALS ---- > 42.00
15.00
0.00
57.00 57,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 57.00
OVER/SHORT:
.00
BLDG PMT
PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING
PLAN—CHECK
57.00
_RfibiFiF+F��+F+FaFiFiFitiFit��iF�aF��FiFaF+tit*�itiF�FiEitaEiritiFiFiE�F�t*it��F�F�Fal�F�F��r*���FkiF*+�+F+t�i(xiFiF�r+F�+r+F�"F*Fit*at
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 P T I O N
UNIT COST
TOTAL COST
MEC
1
INST FORC—AIR/GRAV'FURN <= 100 K BTU
9.00
9.00
MEC
1
REFRIGERATION SYSTEM <= 100 K BTU/H
9.00
9.00
MEC
1
GAS PIPING SYS 1 -4 OUTLETS
3.00
3.00
END OF FEES
010010•,7-:5-001186743 TOT 57.00
DATE: P7ftsr'Y4 TT�E: 1e:20
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
PO. - & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd.
-
53. Steel Reinforcement '
3. Electrical Conduit Utilitv-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, O Undrgrnd., Test
9. Water Pipe•Undrgrnd.
60. Backwash Lines, P -Trap, O 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 r
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts. in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas OOil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
3
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE Si BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
- -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
tI(
nu�ec.,.vs.
ADOREss ac SUILOWG SHERRELL, ROBERT L UNIT:
oxxERs xAMElP lwwlx: SHERRELL, ADELLA
"0"""' 1675 LABRADOR DR
:OSTA MESA,CA 92626714-979-4812
APPL.twuxc AODREss:
ARCNRECT OR FNIRLEER: 11C. NO.:
ARCK OR END'S ADDRESS: LIM.
COIETRACTOITS KAME:
CORMACTORSMARSIG
ADDRESS.
LIG NO.:
UW:
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penaly of perjury that I am Roamed und1,erormeFmAsoons d Chewer 9
(commencttq with Semon 7000) d Ohiscn 3 d the Bteineer and Profusions Cade, and my lxxi ee c in C X Y and affect.
Cm LIC. NO.: LIC. CLASS: LIC. NO.: 1L 1'
Dale: Contract«
OWNER BUILDER DECLARATION: 1 hereby affirm under parody d perjury Ihat I am.ramp horn the Comrsctors Lfmme Lew for the
YbeN reason (Semon 70315 Blrakwss end Probations Code: Any city or county ehi h requires a permit to owubucl, Mar, improve.
xmach. or repair any sMtcwmt. prior to ds awwwroe, a6o requires the applicant for mwlt permit to fib a signed moment that M or and
is Iknnstsd putauaa to the ormnsiom of the Comreaors License Law (Chap« 9 (comme«in9 cath Section 7000) of Dwision 3 of the
eupwaa and Prohnon en Code) or that he or she is .xem t Iherehom and the tweet 1« the uUepae exemption. My violation of Section
7031.5 by arty applicant for a porma wtjeas the applicant to a dvil panady of not more then five hordrad dollva [MI).
❑ I, no ower of the property « my, employees wih wages as than sole wmperodan. will do the wok, end tM structure c not amended!
«dlared ler agile (Section 7044, Busirnew and PMeasbns Code: The C«waaon limrea Law data cwt apply to an comer property
who btdda
we
Thereon.endwho does tush work NmseM WiWiM «Ov«gh het«MrownemoMeea providedthioouch
impv+emeraa ars reel emended or altered f« tab. K. however, the ill or m «knpmonan et add within one Year a completion. IM
}( oemar-0pleer wiR have the hoiden d pmlrtp he or Men did tall bulk «impmn f« the peepers of elle).
❑ n matter of Iha popnty, drat exck®mt, conlractkq widn dimmed contractor, to contrite the projetl (Section 7044, Burma. and
Prolavpu Co"
The Cawood.
Licanwe Law does to an owner d prapeny Iks « letpww thereon and wfio
conlrecb ler wh a ant a aornract.r(e) I.
recant o IM Corn a La
❑ I em eze�gsanY��B. a Per l«jN raa'#/ —
Owmr
aware a ane understand! the reouin
poviwiom.
Neqlh evnd Salary Code ctom 25
a505. ?5533. and
entry with pat
h add cadeets ard IM requiremama for
banal oonpwion eppfmlbroan exempt from Ihme
Data: Applicant:
WORKER'S COMPENSATION DECLARATION: I hereby alfam order penalty of perpvy am of the lodoeirp dederatiom:
❑ 1 huvw and W mabaan a owntif of econnt to eap4nwre M worker' carrpernditn, as palled for by Seaport 37M of the Leber
Coda. lar the Dellormetc. of the wok for wNh Ihia pannd'u usuea.
❑ I have and N mention woken' ownprod'an in rnmos. as rewind by Soot. 37W of Ne Labor Code, tithe pedormenw of the
work dor w tltet permit is uwued. MY w«Fara' camornalcn inwrdwe carrier old policy number me:
Carver:
Policy Number
IGSsection need not b oomp hood I the ppml a ler one hundred ddlaw /Slool or law)
1 cenAy Dal In the ped rrmnce d the work (« which thio et ®cod, I aha5 a pky arty Pateon n ercy marcor w m to
became
-A- to Ih worker' ion etas d Cd- en aprw it gipp become atbpa to th
corttDens p e 1 3700 d the Lebon Code
.1 I opt t call Soa prmbiom.
Date: Applkarc
'ornmg: Fig.. fool. wplr. cor per nankin covera,w I unMwlul, and ml i ar! t u er low b cdMmi pts Xa end
c/vll flrss apt ro oat Itutdrad thpueartl dean (SIal000A M addltlan ro Ma cwt cal romperuwbn, demtspe a prov/ded ler In
Sxtlon 3706 0l tlu labor Cab, Inrsrwt pad allnrnaYb leu.
CONSTRUCTION LENDING AGENCY: I hereby affirm order penalty of perjury CW done u e construction le9 plen
rtdncY 1« do
pedorat. d IM work for whip this parmi is owed (Section 3097, Cw. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I entry That I turner read that application ard ala the the above information is oorten. I apse to comply with aR ply end ownly otdinam.e
and watts lrowing to Ixldn m pion end hereby ithoriterepreeanlatrvw d this ray to enter
upon the above-mentioned
propend
forlm Ipnperpew.RO iT SHERRELL _
Ptlnt Nemo
Date:
SIgreallhedOwnedApenVAppkmnVContreaor
(515146.WP) White-Buildiq S Sole, Grew -Fl.: Canary-AppiraM: P4nk4%1.: Gakentad-Mucor
CITY,'%' —,OSTA MESA — BUILDING PERMIT
PERMIT NO: E 073379 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE
SOB DESCRIPTION : ELEC FOR SPA HVAC SYSTEM /EXT OUTLETS
CLAIM VALUE:
rand rvu: n v7 '.li>
bVV 1: IV JV Y: !V
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /M-1
COMMENTS: REF CORRECTION NOTICE 7-19-95
drlE*it+��6�6�r�t�r�E*�Ei6�*******x�e-**at**+t i6�6�E"E�6it*�E�E�6�-*+E*�-�-x-*�E��*�-�-�6+6�*�E***�E+E�6**it*�+t*�-�*�E+E•x->E
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
RIGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING
REQ:
PROV:
PARCEL:
13918139
ZNE:
REF NO:
PLANNING
NOTES>
>
RE 1E!(-dE dF 1E iE RE
iE if 3E jE iE 1E if iE iE iE
iE iE iE 1E iE iE iE 1E iE EE fE dE iE iF iE iE lE 1l -RE 1f iE if ii 1E 3(-1f 1k i� �F IE if
if iF iF lE i(-!(-fE 9f 1(fE iE RE fE jE 1E dk 1E iE if i! fF dE 1E 1F 3F iE if irk jE iE
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 APPROVED BY
BUILDING APPROVED BY :
AP-P-LICATION ISSUED BY: /(!�
RE irk R6 R6 iE iF iE Rd iE iE 1E RE 1E rteE lE iE***iF iE z
LEGALIZATION:Y F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
PERMIT 40.00
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL
TOTALS ---- > 40.00 15.00 0.00 55.00
DATE:
DATE-
DATE:
ATE-DATE:
if iE ih iE lk iE lE df 1F {iF aF iE iF �' 1fiF
STRUCTURAL SEGMENT:N
SMIP/RES GRADING
SMIP/NON—RES
PID UE
55.00 000
REVENUE DIVISION TOTALS--> COLLECTED: 55.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
55.00
3E-iE iE 1E 1E iE if iE dF iF 161E k lE i6lE ib * * *irk * iE i(-iE 1f- iE Rf iE 1E iE 3F iE RF RI iE 1E iE iE * * * * iE IE ih 9E 9E 9d lE if !E iE lE 1E E6 ♦f * iE iE lE lE ii RE * eE iE 1E 9f * 9E iE iE If lE 1F iE !6 9E
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 P T I O N
UNIT COST
TOTAL COST
ELE
2 RECEPT/OUTLET 1 ST 20
EA.
.75
1.50
ELE
1 MOTOR/POWR APPARATUS 1.1 —
10.0 HP
7.50
7.50
ELE
1 MISC APPARATUS NOT LISTED REQ
PERMIT
11.00
11.00
END OF FEES
01 aaiL6i'6-v8I°674s T0T
DATE: Gi/?q 'r` r1rE: 16:19
r
CONSTRUCTION AND PLANNING
APPROVALS Permit # -
Date
Inspector
PG_ - & SPA
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.
1
55. Electrical Bonding r t
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER 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, 0Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK_
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Fal'
12. Sewer Cap
63. Heater & Vent•Final -
13. Roof Drains
1
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas 0 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 00il
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
33. Final Electric
80. FOOD CERTIFICATE ISSUED
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39, Water Service•Final
40. Gas Service -Final
-
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
a
ADDRESS OF BUILDING: 1675 LABRADOR DR UNT:
%EF'LNANE IF IDIOIYN: SHERRELL, ROBERT L
A00XES9` SHERRELL ADELLA
1675 LABRADOR DR
ITA MESA,CA 92626714-979-4812
rP .YMIDID ADDRESS:
OONTRAMMS NA10:
C0NIRACf0IYsmm NIO
&DORM
LIC. N4
UC. W --
UW.
UNIT:
LICENSED COMRACTORS DECLARATION: I herby Brim urde petMly, of parpy Ne I en ficansed uider ptowiam of Chapter B
(cammananD wwh Seddon )000) of Dr Sion S of Ne Buekmm erd Ptamiam CAM. W my Drones b b hrl bma rd Mw.
CNY UC. NO.: UC. CLAW: UC. NO.: EXP:
Deb: Catanct..
OWNER BUILDER DECLARATION: I haWy mff n eteer perWy of perjury tle I am exwpI from IM Comreaon License Law for the
oDowkq Imwl (Semon )OD1.5 8asimn rd Pmleniarm Code: Arty cly w oouey whkh mqp a perm, ro mm .0w. -ff..
Mmolbh, a repel tato e e Wov, prior IP da bsuence, abo reauvm the apples9 (oo,, w mM to th a e5rod ebtemw Ow M or aM
b licenmd pumnnt to rM Iode] iom d Ns Cwrww lienee Law l Ile S (comm a al Warn pli )0(0) d Div"sgn D d tM
7ml.5b sold aopl lam Code] ro rhe M w pw b exempt a Gramm rd tM bmb to Ne Ne W mwptian. ps XID. n d Swion
)031.5 by my epddem Iw a perm, eubjeas rM aPpbcar, to a avi prlMy d nal mare then (wa WMred dollen j5500�.
❑ I, m owtwr a IM wapWy or my em". mh we0sa m thei sole compm .wIRM Na Work. end Ne stngture6w WwMw
w.Meted for eeb (Section 70se, Bww em e1M Pmrmanns Code: TM Canlrww lierae Lew dam w appy to an 6-1 of Properly
wW Wide or inprovee thenen. eM who does euoh Work Braes w hettel or Asaph M1e w hr own employees provided IMI each
imprwemema ere e, intended or Alred for eeb. tl, however. tM bddirq or knpmvrnw is cold within orle Yam of oomdeun, the
owrt huildar will hme the Wdm of provim M aM edM w Wild! or improv fortM Wmmo of ems).
y[] I, m owror of IM poe". am uokmwo y comrwiq wan Drannsed 000 wor N CotMla the wolwa (Swan )Die, Wnkmss aM
Pnlesamn Code: TM Contra. Lianas Law does m appy W m Owner of PropedY Who buikb w knpovm Ile— and who
commas M each pro, W wih a cararaaor(s) b:erued punuaN m tM Cwntlwe Limma Law).
❑ I exempt urdr Seaian: B. & P.C.. lo, dat awl' ,^,� I1�1 _ �//�
Dma: 1 '1 Owner: IBX( 00 1 �Li%�/70 XXJ
I M candy I em sate of W uManbM Ne naaremama of Ceiomia Nee,h std SeMY Code Bret— 25505, 25533. end
?SSW. and
tire I or arty Man b kWo, oalxel el WiR I w0 w (acb aro) rd ro -WOY w,h road este rodae aM IM -ldremmb M
e Prink for cumtmabn or m Acmion from IW Ar mlepenrm DiOW. Weidwbl cmmrtxim appicwa an exempt loom tl m
wovioioro.
DW.: Appirmtl:
WORKER'S COMPENSATION DECLARATION: I Mraby, alfam Isdr pwft of p.*, w of do IaDowbq Mperebn:
❑ IMvaaMe oo,ows ofdaleamrod to wauua brwaken•wigamlvr.0 I.ovidad rw Ln Salon S)aoarM Lena
CWa.Iw rM pedormencs d M work la Which dole prmG'u mued.
', ❑ 1 haus and wit mekaein Warkan' wnpen+e'vr'vrMmetrn. m raaluiad fry Swion 0)W d the lana Code. kor IM pedamergs d rM
work Iw whiN Nb panty u musd. My waken' mrnpanwion bleuranca writ etM poky rasnbar re:
cm:r:
Pdry Nlanbr:
(TMs mesion need nor M wnpMed i the Pertn1 u b ane hudrW Alien (5100) w bv.J
}❑ I ttdiy Net in UM perlamtanu d IM work br which of Form b uwrs0, I aMe nd aI erry pram in alto mama n m to
cm,, subjw, to the wf Gwt wMof ton IewW C CeMwda, ed aprco t* B 1 mquld became subpa to IM wvrkors'
cornpenardn prwbiam a Swian 0)W d tM lab« COM. I shoe IwNwdA oompy wah Now prwbcru.
Dam: App(icea:
Wamrnp: Fatlun ro secure rohan'ronprreatlon nyrsPe le rmbrRd, mrd elrll sub/acr m enWoyr ro wlrarW pereltlu arM
0l ft labor D
S/ Rrree W ro Labor C Iltoused dabs (STIXL IXiOf, M adWpbn ro Ma cmc or mmprealbn Lrropu m pnvldad rot In
Settlor ]105 Na OM, ImensC sad a0omays bas
CONSTRUCTION LENDING AGENCY: I MnW d5rm unMr pommy of permy Ihm tyre at a cortunnicn brdirq wanaY for Ne
Pedorot rc of IM work for w thu Form, is bmsd (Swan Sop). Cb. C).
LENDER'S NAME:
LENDER'S AODRESS:
I certify the Ihem mad Nis ep,Aooton rM see Ther tM above Woroefm b cvrrw. I Free to wnpy with N pry a cony odinmoes
eM store leve mWN to WiWM cwwrwbn a Mosby e * npamnteivae of this oy b enter upon IM ebove-mmhated piopody
for impwion purposes.
�/JI ADELLLA SHERRRELL ` �T /] rr
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Sgmlura�d wr /Aper- VAppFaw owl.
`. 15151-46 W P) Wftn uildiq B Sway: G.rt-Isle; Cm App6owrt: %k -P. .; Ookenmd-Aem)r
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: E 073137
PERMIT NO: E 073137 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: ELE PURPOSE: OTH
708 DESCRIPTION SERVICE UPGRADE TO 200 AMP SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /M-1
COMMENTS: NO BLDG PERMIT REF.
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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
PARKING
REQ:
PROV:
PARCEL:
13918139
ZNE:
REF NO:
PLANNING
NOTES>
50%
SMIP/NON-RES
PLAN
>
ISSUE FEE
15.00
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k k k kk k k kk
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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
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY :
--- DATE:
APPLICATION ISSUED BY:
/ DATE:
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LEGALIZATION:N
F E E S U M M
R Y STRUCTURAL
SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES
GRADING
PERMIT
18.50
50%
SMIP/NON-RES
PLAN
ISSUE FEE
15.00
BUILDING -DIV-> PERMIT
ISSUE PLAN -CHECK
TOTAL PAID
DUE
TOTALS ---- > 18.50
15.00 0.00
33.50 33.50
,00
REVENUE DIVISION TOTALS--> COLLECTED:
33.50 OVER/SHORT:
.00
BLDG PMT PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN -CHECK
33.50
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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 P T I O N UNIT COST TOTAL COST
£LE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18.50 18.50
END OF FEES
e CONSTRUCTION AND PLANNING
I APPROVALS Permit #
Date
Inspector
PL,_ - & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
r
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
i
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
APPROVALS Permit #
20, Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0Gas 0Oil
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
33, Final Electric
7,
80. FOOD CERTIFICATE ISSUED
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41, Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER MESA tTFAPF F.STATF4 DATE 12-9-58
JOB ADDRESS 1675 Labrador Dr, BUILDING PERMIT NO. 82"4D
GENERAL CONTRACTOR L. G. Robinson VALUE$ 15,662.00 j? w/oZf'
AP. No. LOT 132 TRACT 311 FIRE ZONE DESCRIPTION OF WORK 15,662 -GO
PERMITS ISSUED
INSPECTIONS I DATE I SUBCONTRACTOR
coat
1 b.
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 317
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
a�NG
noO1ec 147< T,mITTaAn" T)r_
OF!L "', q/, -,i ' :: li -:1T.
APPLICATION FOR PERMIT
BUILDING
COSTA MESA. CALIFORNIA
FOR OFFICE USE ONLY
RECEIPT NO.
PERMIT NO.
OWNER Mesa Verde Estates
Sa3O
MAIL
RECEIVED BV
GATE RECEIVED
DATE ISSUED
ADDRESS 1701 Gisler St.
��- -5�
i -15d'
TEl
BUILDING
CITY g NO. %i 5-1751
ADDRESS
ARCHITECT LIC. '
OR ENGINEER NO. C-21 Q
COSTA MESA. CALIFORNIA
p
ADDRESS Beach Ge 9-0908
ZONE
CITY LIC.
ZONE
POANS
TYP�
CONTRACTORG. NO. 112
TELA
t�
ADDRESSX701 Gisler NO. Si 5-1751
BPPROVED DATE
LEGALLor
CORRECTIONS
DESCRIPTION
NO.132
BLOCK
TRACT 311.5
A.P. NO.
e04•
SIZE
OF LOT Q
NO.OF BLOCS.
NOW ON LOT none
USE OF
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET 50'Plus REAR YARD ZG 1LLB
SIDE YARD RIGHT51plUD LEFT 5'plus
DESCRIPTION OF WORK
NEW
I ALTERATION
ADDITION
REPAIR
L JVOVING
DEMOLISH
NO OF
BUILDING DING 1578 Sq�rit� 7 1
ROOMS STORIES
EXTERIOR WALL
ROOF
COVERINGAq
_COVERING
USE OF NEW
BUILDING Residence & Attached Garage
1 HEREBY ACKNOWLEDGE THAT I HAVEREAD THIS APPLIC "ION AND
STATE THAT THE ABOVE IS CORREyT/ANO AGREE TO COMP WITH ALL
CITY ORDINANCES ANO ST TE L G REGULATING BUILD G CONSTRUC.
TION ` /
VALUATION
()U —
SIGNATURE OF
PERMIT
PERMIT FEE
PLAN CHECK
S
�^ p
S
S/S/
AUTHORIZED AGENT
TOTAL FEE S
B«r