HomeMy WebLinkAbout1937 LANAI DR - Building Permits • 0
CITY OF COSTA MESA
A 0 , BUILDING;DIVISION
Fy„���. •p0 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov
". I FOR INSPECTIONS CALL:(714)754-5626
4re°"°° ° PERMIT NUMBER: B12-00094
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 13951401 DATE ISSUED: 05/04/2012
ISSUED BY: RMD
JOB ADDRESS: 1937 LANAI DR CM t- t Stiite/Unit:•,.
Vicinity: HOUSE AND GARAGE ROOF` -- - r.• - - T
•
Squares: 23 - - .Valuation: $8,600.00 -
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SCOPE OF WORK: TEAR OFF,EXISTING ROOF MATERIALS, INSTALL A MINIMUM OF(1)LAYER 15#FELT ON A 5:12 PITCHED
ROOF AND REROOF WITH 50 YEAR GAF COMP SHINGLES APPROX 16 SQUARES AND REROOF 7.SQUARED OF FLAT
AREA WITH MODIFIED BITUMEN.THIS INCLUDES AN ATTACHED HOUSE AND GARAGE. REPAIR AND REPLACE
SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMITS....
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card
OWNER: FREDERICKSON,JACK Address: 1937 LANAI DR• _ Unit:
PHONE: • City/State/Zip: COSTA MESA,CA -
APPLICANT: LANGDON,JOE Address: - . Unit: :
PHONE: 714-608-8226 City/State/Zip:,
CONTRACTOR: J N L ROOFING AND REMODELING License No. 648337
Address: 16312 ARLINGTON LNUnit: PHONE: 714-608-8226
City/State/Zip: HUNTINGTON BEACH,CA - 92649 CELL:
714-536-1816
ARCHITECT: License No. . PHONE:
ENGINEER: License No: ... PHONE:
FEE SUMMARY ,
Reroof Plan Check: $0.00 • .
Reroof Permit Fee: $167.25 -
Reinspection Fee: $0.00 •
Bldg Std Admin Fund $1.00
TOTAL FEES $168.25 .
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE R. INSPECTION TYPE DATE INITIALS CODER INSPECTION TYPE DAM IN1111AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof x 5-1r.12 tit 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
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WORKERS'COMPENSATION DECLARATION Owner ID verified by driverse. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: >Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' r Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
O I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,felsework,or demolition
�^rer`� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(rnrsetion ratb m detedeme permit is htd at one hurdred dollars am of less-) 2,Art 2,Sec.341,Title 8,California Administrative Code).
IPolic �/Z�
Number: u//2-97
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not em'loy any person in any manner so as to become subject such person has a permit to do such work from the division.
to the w." ' co .j'nsation laws of California, and agree that if I should
become • bje to ,G�Ta1L workers'compensation provisions of Section 3700 of - Applicants Signature Date
the Labor.ode, s forthwith comply with these provisions.
3//_�'-7 Division of Industrial Safety Permit Number:
� ry ---ure �j,``D''allta (( HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARN! G: FAI RE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UN • AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 9 No
(8100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in ful or e and effect. j, `n� a registration form for acutely hazardous materials? 0 Yes 0 No
L i ,p�® 0 ,•_ �laSSA-4-i` 3 / (Section 25533 of the California Health and Safety Code, with some
.el 5 q Jn exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
� r-- ,-_t?,,".,,, hazardous materials equal to or greater than a weight of 500 pounds, or a
r..�+ volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CON' " CTION LENDING AGENCY: temperature and pressure).
❑ I ereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lenders Name: • hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes-,the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars(8500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If"yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044.Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
properly who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating'to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
natue f Legal Owner(s) Date
Signature Date _ ‘,70L6-7 5-"--41 /Z.--
3057-46(3/07) licant I ale^"—
t .a
Prescriptive Certificate of Compliance: Residential CF-1.12-ALT
'Residential Alterations `. (Pate I of 5)
1ngjec•Namc:, � CltcLune i- I / oL$toriu� _
----' 16I31 LA,
- /(X(f)
a ;
fGeue-ral In iortna Lion . '
Site Address: ) `,/ity I Enlorcemenl Abe c /I I Date: 't( ( 1
Building Type Single FamilllyJ2�Multi Family Circle the Fronk Orienta`tio'n:N,E, S. W,or degrees ``IYf _;t ICV'
Conditioned Floor Area(CFA}_eF7�" J':j� Project Type: ❑Alterations 0 Envelope D Fenestration I-Zoof 0 H VAC
A Replacement or Change Out 0 Duct Replacement 0 Water Heater
NOTE: This,form is not to be used,for Nerv(r Constructed Buildings or Additions •
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Jai i Values For Opaque Surfaces(for Firring use the Mass and Fatring Strips Construction table below) 1.--"'--
Assembly Alteration
D Opening of framed cavity alone-Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the
mandatory minimum instdation value per,¢150 for the altered assembly. Fill in Columns A-C and enter mandatory insulation value in Column H.
D Replacement of entire assembly-Replacement of an entire wall, ceiling. or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A-J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
-A I B C • - D ' E - ' - F G F I I • L j
Proposed see nun Standard ' Values From JA4 Table
' Framing Thickness, ' Framed Continuous JA4 ' Proposed
Tag/ Assembly Name Material Spacing, U- 1, )A4 Table Cavity Insulation Assembly Assembly
ID' or Type' and Size' or Others j factor" Numbers R-valued R-Value' Cell Values U-factory
• _
1
....Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-I. For calculating furred walls use the Mass and
i Furring Construction table below.
I.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood. Metal, Metal Buildings,Mass,enter 2x4,2x6,or etc...see 1A4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24"OC;or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel,Logs,Straw Bale Panel and etc....
4. Based on the Climate Zone;enter the Standard U factor from Table,151-B, C or D for each different er'ent assembly Name or type.
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the B-value that is being installed in the wall cavity or between the framing; otherwise, enter "0".
7. Enter the Continuous Insulation R-value far the proposed assembly; otherwise, enter "0".
S.Enter the row and column of the 11-factor value based on Column F Table Number and enter the Asserrrbly U-factor in Column.'
9.The Proposed Assembly 1l-facto, Column.1, must be equal to or less than the Standard U factor-in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A I Is C I) I E F I Ce _I A I I J 1c L I M
Proposed Properties of Masonry and Concrete i Added Interior or Exterior Insulation
• Walls From Reference in Furring Space from Reference
joint Appendix Table 4.3.5,4.3.6.4.3.7 Joint Appendix Table 4.3.13
p ..
1 -
U T 1 • V
'V - 0 a 4G. J m
v. t. o o F+ V-' c of v m > filial
Assembly <" 5 ' � .o ._ 2.a -
1 Mass Hants or .IA4 Table ,, m ti E E o f a, 4 _ $ Assembly
Thickness Numbs!'Ty e2 Numbs!' < _ ° ui E u u`- G r < i uii c._. U-faetur6a Comment
1 1
1 1
1 1 1 : :
Registration Number: Registration Dae/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
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Prescriptive Certificate of Contplian.,_. Residential CF-IR-ALT '
Residential71 iterations (Page 3 of 5)
I Project-Nome:Mi (AI n i t' Glimnte.Leme41 f/of Stories
ROOFING PRODUCTS (COOL ROOFS).§151()12
When the area of exterior roof.surface to he replaced exceeds more than 50%of the existing roof area,or more than 1,000ft), whichever is
less, the new roofing area must meet the roofing product"Cool Roof"requirements of§152(b)1Hi, 152(h)111ii, or 152(b)1Hiit
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof'requirements. Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Eminence requirements for roofing products in
,,fI 8(l)arc not applicable. Dn nal,fill table below. —.
'11o(oil Roofs Nit Required in Climate Zones I-l2, 14,and I l with a Low Sloped. Less or 2:12 pitch.
not Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less I
ion ilb/ftz. F
-Alternatives to §152(b)IHI and §152(h)11ii,Steep-slope roof(pitch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hrftz-°F/BRu or at.least a 3/4 inch air-space is added to the roof deck
over an attic;or
O Existing ducts in the attic are insulated and sealed according to§151(1)10;or
O In climate zones 10, 12 and 13,with I ft2 of free ventilation area of attic ventilation for every 150 ft'of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
O Building has at least R-30 ceiling insulation;or
O Building has radiant barrier in the attic meeting the requirements of§151(02;or
O Building has no ducts in the attic;or
❑ In climate zones 10,I I, 13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to §152(1'011Eii,Low-slope roof(pitch<2:12)
❑ Building has no ducts in the attic.
Other Exceptions
. . ❑ Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
. ;CI Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ftis exempt from the below Cool Roof criteria.
• - Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofin Products"Cool Roof'Requirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number' < 2:12 >2:12 < 51b/ft2 > 51b/ft2 Tyoez Reflectance3'4 Emittance SRIS
❑ ❑ ❑ 1 ❑ 04 _
❑ I ❑ ❑ ❑ ❑4
❑ ❑ 0 0 . 04 .
O 0 0 0 ❑4
O 0 0 0 ❑4
1. The CRRC Product ID Number can be obtainedfrorn the Cool Roof Rating Council's Rated Product Directory at www.coolroofr.ore/products/search.phn
2.Indicate the type of product is being used for the roof top,i.e.single-ply roof,asphalt roof metal roof etc.
3. If the Aged Reflectance is not available irr.the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation(0.2+0.7(pr,rtaut-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at http://www.enern.cagov/title24/and enter the resulting value in the SRI Column above and attach acopy of
_ the SRI- Worksheet to the CF-112.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating I❑ Cement-Based Roof Coating I❑ Other
•
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms • August 2009
_Prescriptive Certificate of Compliance: Residential CF-1.R-ALT_
Residential Alterations. (Page 5 of 5)
Project Nome: of Stories
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HERS VERIFICATION SUMMARY The enforcement agency should nay special salon ar the HERS l'4etunr'ea specified in tins
checklist belays- A completed and signed CF-4R Farm for all the measures specified shall be svbnrined to Inc building ias'pecror before final
inspection.
Duct Sealing Testing HERS verification ixrequired Jar lhi.imeasure.
❑ YES ❑NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of'new or replacement ducts art installed in unconditioned
space,the ducts are to be sealed per§152(b)1Dii and the newly installed ducts are to he insulated per§I5 (ft I 0.
❑ EXCEPTION:Existing duct systema that are extended, which are constructed,insulated or scaled with asbestos.
❑ YES ❑ NO YES In Climate Zones 2 and 9-]6, if the existing space-conditioning system(HVAC equipment and ducting) is replaced,the
ducts are to be sealed per §152(6)7 Di.
❑ YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
- outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION:Duel systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3..
❑ EXCEPTION:Duct systems with less than 40-linear lee'in unconditioned space.
❑ EXCEPTION:Existing duct systems cdnstructed,insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for this measure.
❑ YES ❑NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b)1F.
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of§150(0)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
❑ YES 0 NO YES: In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
• replaced.the airflow and fan watt draw shall be verified per§152(b)1 Ci to meet the renuirenrents of§151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: Signature:
Company. I Date:
Address: 1f Applicable❑ CEA or❑ CEPE
• (Certification ft):
City/State/Zip: Phone:
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Pro lessions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify lint the energy feature:;and performance specification::for the building design )(lenti led on this Certifiente of Compliance euntorm
to the requirements of Title 24,fans-I and 6 of the California Code of Regulations.
• The building design features identilied on this Certificate of Coniplumec are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calcul. ,pit and sttcificati mu:submitted to the enforcement
iaca ever lot apinoval with this building permit application.
OWL'
company: / r� iUnli 5--11-1t_
• Address. L 6, nit fib License
t
•
r.'u);'htatel"Gip: / 1 ^ 6 L�zit
II2q 5% /GJ` 4 J
Far its•. ,,,u,„„„ of question::regarding the Energy Standards contact the Energy Flotfine at: 1-800-y772-5300.-
lterirt abrin Humber Regi trarian Dene/Time: REM Provider-
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -
PERMIT NO. TRACT NO. LOT NO. UNIT NO. _
CITY OF COSTA MESA1CONSTRUCTION PERMIT . • I m 1 y, 7� I 7222 '2j.07/a5 •
I F'"Q'1 I`•
• Project Address . �T a �}e4/4/ J Y,
Applicant's Mailing Address • 4214444,0 22t S, N),s',A' TYPE OF CONSTRUCTION' LI NEW Y4 ADD ❑ ALTERATION •"U REPAIR • - • - '' _ •
-
�, -Qy7C ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - Ap # - ' - Zone!
•Owner's Name - J• F12E7£�P/CICSOL� ' 'Phone �o..JJ GG - DESCRIPTION OF WORK/USE OF BLDG.ZU-57AL&� a -/U, J -FALL -
Address e 1t4 - s. - -73, Ro.004 r am J q.npbt/G 4 %o✓S 01=1E2 C/�✓O ' S Main Building: Accessory Building:, 1
Arch/Eng. - - License No.' •
' TYPE OF PERMIT ❑ GRADING- ❑'FOUNDATI NN ❑,STRUCTURAL - E Front - ' - - • 0 '
Address • . - ' ' ❑ TENANT CRI ELECTRICAL '❑ PLUMBING .CSI MECHANICAL B Rear 5 i • -• - N
Contractor's Name�/Fd4UTA Uk=Y lt2'AO Phone.9 -y51S�f ❑ OTHER "' - .0 Ri ht ,_ . . N
Address'Imailing) 22-30 S,FH/QL40C) .c4nlli9:4444 .92709 • PROJECT DESCRIPTION SQ. FT. I _ ' OCCUPANCY K• Left l ' . ' r G i
(1 • CON ST RUCTION TYPE ' VALUATION '$ '
`K City•License No_ 'Q/9 /04 • R
__ ._.. _ - . •
._. . „ • ZONE GRADING CU.YDS. s ACRES ' Ping. Ref.# ; • Park ing,Req./Provided' ti E
1210 LICENSED CONTRACTOR DECLARATION 0
' 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 - _ - T
my license'is in full force and effect. _
•
License Class_a_7207 . Licensse o 5_ •- ' �, S
\ Date 2-7- $S Signature / /�--�-� �P PLUMBING' r �;' FEES 1
WORKERS' COMPENSATION DECLARATION 1 Bar Sink Showers"
I hereby affirm that I have a certificate of consent to self-insure or a certificate , I �. _ ELECTRICAL : , FEES
of Workers' Compensation Insurance, or a certified' copy'thereof'(Section gackflow•Preventer- -• - - ' - -- - -
3800; Lab. ) Service Sink -- s-
C. • Automatic Washer 'Trahsformer'❑'15-50KW
Policy No `k4a�D7Ya!/oDP •
Company • •C� O Ti/P i 1 • Backflow Irrigation - Sewer Ca ' •
0 50+ KW
P Construction Pole Sub. -
lfl Certified copy is hereby furnished.
-
,K�CerSified co y_is filed with the city B il•'•g Divisioy Bathtubs . Sewer Connection Cooking Unit 'Meter ❑up to 100 amps
Date .Z. � Applicant -/ -- 0-^ ^^ '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION 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 ❑Electric 'Sub Panel . f '
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 Drinking Fountains Solar Tank , • Fan •
Workers' Compensation Laws of California. ` -
MOtSolar HP ❑1%-,B
. Date Signature I 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 ' - - 9
Lender's Address - 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
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing,Sections I
county which requires a permit to construct„alter,improve,demolish or repair P=Trap _ 'Laundry Trays, • - '
Y Y Generator ❑0-5 KW❑5.15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit 4
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 ' - .. - - •- i
Division 3 of the Business and Professions ption..or that he/she is exempt - , - - '
rom,and the basis for'the alleged exemption. Any violation of Section - - 1
7031.5 by any applicant for a permit subjects the-applicant to a civil _ 1
penalty of not more than five hundred dollars($500). _ i - •I • -
•LJ 1,•as owner of the property or my employees with wages as their sole Reinspection Fee 1 ' $15' Issue Fee $ 3
compensation, will do the work,and the structure isnot intended etl or offered _ _ - 1 Reinspection Fee $15 Issue Fee l $ 3
for sale (Section•7044, Business and Professional Code: The Contractor's — • MECHANICAL FEES 1.
License Law does not apply to an owner of a property who builds or improves l ,
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 r 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). - ' �. `�^1�
0 1, as owner of'the property, am exclusively contracting with licensed con- • Duct-Structural Refrigeration System •. Application Issued By 1 L7'0 Date_ 2” 7 '
tractors to construct the project (Section 7044, Business and Professions Code: • • _- l
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating , JAIu_1p)p0 BTU ❑140 0o0 BTU f ' CO SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- - .- .r AK 4-S7/L/ • , `t
tractor(s) license pursuant to the•Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $ •
proof• oftheir Worker's Compensation insurance should be Exhaust System 0 Multiple 0 System Repair/Alteration
p provided reason me.. - PLAN CHECK t $ PERMIT
❑ I am exempt under Section B. & P.C.for this Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ •ISSUANCE $ i
Date ' ' Owner' Heating System SrentrIny ' Registers PLAN CHECK 25%I $ ENERGY P.C. : $
I hereby certify_that I.have read this application-and state that trio above ; , V.0.100,000 BTU 0n1100,000BTL - - i
information is correct. I agree to comply with all city and.county ordinances may,{,✓/6eIT C'1 090 l `1 OC ELECTRICAL $ • •oe GRADING $
and state laws relating to buil ng stru tion,'and hereby authorize repre- • MICROFILM $ '
sentatives of this•city to e r upo the bo entloned .property for ' PLAN CHECK 50% $ _ ,
inspection p s f�� �-�4/�r� /�/,4 ' MECHANICAL •' $ 1 •00 ' TOTAL FEE ' $ : (c •c
Signature � U/Le^n a pY/LP/t/ Date 2-'7 u l .
Drivers' License or,SS# Reinspection Fee $15 j Issue Fee $ 3 PLAN CHECK 25%' $ ._. . • ) '
'
- ' _ - - t' __ -- �CMF0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
-' CONSTRUCTION AND PLANNING ? • - ' POOL&SPA -
Date Inspector I Date. .Inspector
APPROVALS Permit# - _ . APPROVALS - Permit#
�
, .%T
1emporary'Electrical Service or Pole - - I_ •.• - • • - 52. Pool'& Equipment Location .
r.2.' Soil Pipe-Undrgrnd. 53. Steel Reinforcement
_3_Electrical Conduit Utility'Undrg nd. r 54; Forms y
'-14.:Electr,ical Conduit-Undrgrnd.. � _ - : 55. Electrical Bonding - -
t'S. Steel Reinforcement ,. Q1., - - - 56. Rough:Plumbing & Pressure Test-
. r - -
I :6.',Electrical UFERGrnd. - 57. APPROVAL COVER-GUNITE . • ,
`r7.,.Footings ' �' < - * + 58. Electrical Conduit-Undrgrnd. -
..8. Foundation .- S } 'i 59. Gas;Pipe,:El Undrgrnd.,Test - e
•
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
10. Structural Floor System -61. 'APPROVAL TO DECK
,1:1. Property Sewer Line & House Connection 4 i z 62. Backwash,&Receptor-Final - • • • .
.12. Sewer Cap , ' 63. Heater & Vent-Final ' . •- .�_
• 13. Roof Drains ' 64...Plumbing System - Final - •
14. Roret
• ugh Plumbing - ,- " 65. Electrical-Final -,
-15.,Rough-Electrical-Conduit - r i. - - - - - .. 66. Solar System-Final - -•
.-16. •Rough Electric Wiring - - r - 67. Fencing &-Access A -
'--17. ,Rough Wiring Signs 68. APPROVED FOR PLASTERING
18. Rough.Electricai,T'Bar Ceiling - 69.. POOL/SPA SYSTEMS FINAL
,19.'Rough Heating & Air-Conditioning I - FIRE DEPT.,REQUIREMENT - . E' •
• 20. Rough Factory Fireplace - APPROVALS ' Permit#
' 21. Ducts, in Structure •• 70. Underground Hydro - •• ' F -
:22.-Ducts;-Ventilating 71. Product Piping ❑Gas ❑Oil . '�� ' -
23.-Gas Pipe=Rough&Test 72. Underground Flush
24. Roof Framing ,f - '73, Undergrnd.Storage Tank ❑Gas ❑Oil'-
25.rRoof'Sheathing .- '74, Overhead Hydro , ,
' 26..T-Bar Ceiling (Structural) & Monocoat . - ,' 75. Dry Chem'icai 1_ . •
n ,27.'Frame'an&Flashing ; 76:. Dry Standpipe . - , ,
28. Lathing&Siding -. f X77. FIXED SYSTEM FINAL. '
' , 29. Insulation, C • , 78. FIRE PREY. FINAL i.
30. Drywall'Nailing I • • HEALTH DEPT.REQUIREMENT
31. PlasterBroGvn Coat i• - 79. FINAL INSPECTION
32.-;Electrical Power Meter-Final • ' '• r ; ' 80., FOOD CERTIFICATE.ISSUED '
�� �
33. Final Electric I it - Notes: _ '
` 34. Final Heating & Air-Conditioning y c aj� i", I - .
35. Final Gas Pipe-Test' ,, . . - -
II L.
36. Hood or'Canopy . I
37. Final Factory Fireplace ; , z 1
_ , = l - - - -
38. Final Plumbing 1 . ' ' " - ` -
39. Water'Service-Finals • I . ' '
40. Gas Service-Final : ' t I ' - o ' •. .
41. Solar Domestic-Final , r r • i ' -- - -. - • - _
42. BackflowlPreventer _ _ - _.y _-_ -__ __. . -
43. Backflow,Irrigation - - - • - - • ' '
,
44. ,Landscape Irrigation System I 'I '
45. Sound Attenuation : . , r - -
46. Handicap Regulations r _ i I
47. FINAL STRUCTURE &;BUILDING ' ' : -I ; - r f . ' "
48. Special Requirements Completed 1 ' I r < I,
49. Eyectric Release'to Edison , I - --*--i - - - r- i ,--, - - , i
50. Gas Release to Southern California Gas Co ; I i t `�
51. CERTIFICATE OE'O_CCUPANCY, ' I- _ - -- .' _ __) 1 - -+ • , ;
No. - _ • ' Date'- - r-
. /
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. •
CITY OF COSTA MESA - - PE ITN I •
TRACT NO:" ' - LOT NO. . BLDG. NO. " - - 69:5 I I/1 4/R;? ' 1 '"5eTT. • P.
•
CONSTRUCTION PERMIT , 1 • S�0.
.'"o - S,
Project Address I' y'a7 __.Q A C, i Ci ✓L�� TYPE OF CONSTRUCTION, '❑ NEW U ADD-U ALTERATION U-REPAIR -
Apphcant'SMailingAddress. - 'r ` ❑ CONVERSION:❑ DEMOLISH ❑ OTHER A P # - i • I Zone j _
Fra�r,: Oks6n - ykQ'093 1 • .DESCR •TIeN •FWOR -
Owner's Name Phone /r�/ i •e S Main BuildingI = AccessoryBuilding: Z
Address - • - E O
• TYPE OF PERMIT- i ��GRADING N •.FOUN•ATI ON STRUCTURAL _ T Front 44 - - N
Aron/Eng. • License No. v ❑ TENANT :❑ ELECTRICAL �.PLUMBING ❑ MECHANICAL ' - • B Rear -
! LI _ A i N
Address - - -
E l Toro . P/u' 6:,� IIKPhone 83,-IR •
09 PROJECT DESCRIPTION SOi FT.' OCCUPANCY C Right G
Conductor's Name •7 } �i �!- ,�.1/J K - _
' Addresslmailinq) ,.PJ 7S a I ole tn. Card Q+ `F ,! 'CON STRUCTI ON TYPE - • VALUATION$ $ Left I • i E
us YV ZONE • GRADING CU.YDS. ACRES Ping. Ref. # , Park.Fees $' Q
City License No. ' - - . •
LICENSED CONTRACTOR DECLARATION 1 ' Remarks: - • Parking Req./Provided U
I herebylaffirm that I:am licensed under provisions of Charter 9 (commencing - - -• R
with section 7000) of Division 3 of the Business and Professions Code,and , , I Use of Building: ' • E
^^ry� my.license.is in full farce and e tett. q - ' I._•-
V License Class ' " License No. /8 , PLUMBING FEES •
Planning Notes: M
(L, Date 1/-/4-83 - signature �l;.L . 2Nat-Cas ' ) _ N t
"V WORKERS'COMPENSATION D LAf/6+I ATION , Bar SinkShowers
, T
I hereby affirm that 1 have a certi icate f consent to self-insure or a certificate - 1 •
-of Workers' Compensation Insurance,t or a•certified copy thereof-(Section- -. ,Backflow Preventer I Service Sink' ; _ S y
• 3800, Lab.may) ,• ST7E rain Backflow Irrigation Sewer Cap - , ''' 1 . ELECTRICAL l FEES
Policy No.`1"OZS7 38.3 Company
-
- Certified copy is hereby furnished. I cc.; LBathtubs 1 Sewer Connection Automatic Washer% Transformer 0 15-50 KW j 7 i
Certified copy is filed with the citl�BuiIding Division. 'b ,t)./F--U-4/ f 0 53+ KW
I
Date 11-11—'0 - Applicant` 1 Q C�;r, i,n a&t q,en.A. Clarifiers • - Solar Collectors , Construction_Pole_Sub. - • ; y
I` ) EXEMPTION FROM-WORKERS'CONiGIP SATION DECLARATION- Dishwasher `I
(This section neetl not be tom pletetl th permit is for one hundred ($100) orSolai Piping Cooking Unit r Meter Clop 20100 amps ,
less) DrinkingFountains - I
1 ny'that in the performance of the work for which this permit is issued,I , , Solar Tank Dishwasher s. 'Meter Dover 100 amps I i
shall'not employ any person in any manner so as to become subject to the ' 1 i - • '
Workers' Compensation Laws of California.l Floor Drains' Swimming Pool w/Spa• Dryers ❑Gas Electric Sub Panel l '
•
Date Signature " ' • s — - '
- NOTICE: lf,'after making this declaration, you should become subject to the ' Floor Sinks - ' l Urinal 1' -Fan- I
r Workers' Compensation provisions of the Labor Code, you must forthwith' - ,. . - _. - Motors❑0-1 HP �1'/a-B_ _
I comply with: such provisions. or this permit.shall be,deemed revoked. . i Gas Service. ' 'Outlets' 'Water Closet - F.A.U. •
❑B-15 HP ❑16-151
CONSTRUCTION LENDING AGENCY. - ' - '' I . -- - - I ;Inc.Solar; I i
I hereby affirm that there is a construction lending agency for the performance Interco tors' Water Heater if ' • '
Interceptors _• I RQ. ' G 4Ar ��� Fixtures '•.Microwave i
of the work for which this permit is•Issued (Section :3097 Civ. C,) . •- P n Q/L
Lender's. Name' ' - - - Kitchen Sink _ Water Service Device Boxes • ; • Pole.Light I. ' 1
Lender's `Address ' - - I - I - _
OWNER BUILDER DECLARATION - - • ' ; Lavatories: r - ' Outlets'. „ , " Range I
I hereby,affirm'that I am exempt from the.Contractor's License Law for the -
-
• following reason'(Section 7031.5,Business and Professional Code: Any city or o i P-Trap . . - •- _ Switches-, +'. • . 1 Sign ' '
county which requires a permit to construct,alter,Improve,demolish or repair - -
any structure; prior to its issuance, also requires the applicant for such permit j - : Roof Drains . •• ' • . . . - Garbage'Disposal•r 4 ' Standing4Sections
to file a signed statement that he/she Is licensed pursuant to'the provisions of • - _ .- - - '
.the Contractor's License Law (Chapter 9(commencing.with:Section-7000) of. ' r. M ., . t"..1 _ • Genere[or ❑0.5 KW.❑5-15 KW
'Division 3 of the'Business and Professions Code).or that he/she is exempt - Trash Compactor
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 .Reinspection-Fee II 3 •' /%, 1 • - '
; malty of not more than five hundred dollars($500).; ' 1 $25 Issue Fee ' $ - ,
LJ I„as,owner of the;property.or my employee4'with wages as their sole • I • Reinspection;Feer r _ $25 Issue Fee • ' $ 3
compensation, will.do the work, and the structure is not intended or offered - , - _ 'MECHANICAL FEES
for sale (Section 7044, Business and. Professional. Code:. The Contractor's , PUBLIC SERVICES REQUIREMENTS: '
License Law does not apply to an owner of a property'who builds or improves i Boiler - Hood or Type I 0
PUBLIC,
thereon;and'who does such work•himself/herself or through his or her own _ - Zoning:Approved-By ' ' Date '
employees, provided that such Improvements are not Intended or offered for Canopy Type II ❑ ' '
sale, If, however, the building or Improvement issold within one year of corn-
Ducts-Under Ground -, Application-Approved-By ' Date
pletion,the owner will have the burden of proving he/she did not build or im- - - ,
Kaye the purpose of sale). ! Duct-Structural Refrigeration System Application Issued-By ' • Dat
LJ as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044,Business and Professions Code: . • Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU r $UMMARV OF FEES - - '
The sontractor.'s License Law does not apply to.an owner-of property who i - - - - - - BUILDING PERMIT •
• builds or improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration $ SMTP $
tractors) license pursuant to'the Contractor's License Law). ¢f PLAN,CHECK '' $ PERMIT
❑Tam exempt under Section - B.& P.C.for this reason ' Firepl/Fact.Bit. ICBO,# . ,•i �''• ISSUANCE s $
• I y. PLUMBING $ J. to '
Cate ' ' • Owner, - ' Heating System& Ducting - , .r . 'RLANCHECK' f $ ;
- i ENERGV•P.C. $ i ,
I hereby certify that I have read this application and state that the above ❑o-100,000,BTU ❑103000BTL ir” I GRADING $
' Information is'correct. I agree to comply-with ail city and county ordinances' ' ' - - - . _ - - - - - :et, ELECTRICAL �$
- and.state laws relating to building construction;.aad herelw..a uthorize repro- • PLAN CHECK • $ MICROFILM ' $
sentatives-W-this-c-ity-to'enter n the abovPtniegti4nediproperty for ,
.617{er / i • 'F
inspection poses. , //_/��p^7 'MECHANICAL?, $ '
'� o. [D OJ : • , ( TOTAL FEE $ �08
5lgnat are T1I)'li Date ,
Drivers' L•( x or.SS# • Reinspection Fee $25 Issue Fee $ 3 PLA NCHECK" . • $
CMF 0865-46 `, -7/83 white-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor -. - - - - . - - - - __ - . . I
• • CONSTRUCTION AND PLA ; p" : - - POOL& SPA . .
'_ Date Inspector R ' Date Inspector
. APPROVALS Permit# - • ' APPROVALS Permit# -
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 Gd -
rn . . ' . 57. APPROVAL TO COVER-GUNITE ,•
7. Footings58. 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 1 I"62. Backwash & Receptor-Final
.1
12.; Sewer Capr - 63. Heater &.Vent-Final
13. Roof Drains - a • • : 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 -
I
17, Rough Wiring Sign 68. APPROVED FOR PLASTERING -
18: Rough Electiical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough,Heating & Air Conditioning FIRE DEPT. REQUIREMENT'
• .--20W-Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure - 70. Underground Hydro
. 22.-Ducts, Ventilating - 71. Product Piping 0 Gas. 0Oil .
23. Gas Pine-Rough &Test 72.-'Underground Flush
24:7 Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof'Slieathing 74. Overhead Hydro
26. T-Bar Ceiling•IStructural) & 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 - ' /l."b-83 //O comet IL®. .Z,e re,
-
35. Final-Gas Pipe-Test - ; GT ',ch t, ,el �,
36. Hood or,Canopy - `
• Af�s�a Lo'
37. Final Factory Fireplace 7 ` 'U- 4_)� 4c ,d9`sv •
38. Final Plumbing
ll-.70.,43 ogy- // e7 � 1� �W
� � 2 i0
39. Water Service-Final • �`T�'
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 j '• , ' , .
48. Special Requirements Completed : , ,
49. Electric Release to Edison - -
50. Gas Release to'Southern California-Gas Co - , •
51. CERTIFICATE OF.OCCUPANCY. . . . _ • •- •'-• •
•
No. - - •• Date -
•
Lot 9 - Tract 6384
Plant-AR
27018a PAID
MAY 25•57&-a5F001401* *1^,I, 1 Li 7.1,50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1917 T.anAi Drive
COSTA MESA. CALIFORNIA For Office Use Only
I RECEIPT NO. pg•1y On
owNEClub House Road Joint Venture 4,'4 t.(.0
MAIL 2850 Mesa Verde Drive RECEI D lig BOLTS RECEIVED DATEDyISSUED
ADDRESS (\r ./ P-L� r'/i-� 7
CITY Costa Mesa . NoL549-0393 BUDRBIN
G
SS
ARCHIT
OR ENGEI EER E.G.Kaltenbach No547 -804 COSTA MESA.ZONE 'CALLIFORNIA /
ADDRE551823 E. 17th St , Santa Ana TYPE V .GROUP 1q//t
CONTRACTOR Republic Homes Corp. APPROVED
BY DATE
ADDRESS 2850 Mesa Verde Drive ZONING rdy_e-
i
ZONE' NO.OF USE OF NEW �/
CITY Costa Mesa R PLANNS . BUILDINGD 6J63(9/
/,�� (I�,/
ucTNo. 197838 TEL
549-0395 LEGAL
DESCRIPTION (7_,74,-. J/ T`\ • (�J' 3Q -/
gam- 60.46 x 100 ' I NO. OF NOW ON LLOE.
OT
A.P.NO.
USCOP YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM
LINE ST.) /�'
CENTER OF STREET 43 ' REAR YARD30. 5 L FRONT /l'ZS FT. IN.
SIDE YARD I LEFT 5 ' I RIGHT 5' R.SIDE / SFT. IN.
DESCRIPTION OF WORK L.SIDE SFT. IN.
NEW I X II ALTERATION I H ADDITION I REAR ?' -15. SFT. IN.
REPAIR II MOVING II DEMOLISH I APPROVED%/ y,/ n f /-- /
BY (�{/ r7 (�/ DATE 7' ii-(09
SIE BUILDING 249 lsq . f LROOMS 8 STORIES l j ..--..1
EXTERIOR WAL{{..,,�{ OOd& ROOF Wood &
COVERING A UC CO COVERING all i 1 t-Hp
USE OF BUILDING AND WORK/TTO BE PERFORMED
J // 7) a VP/ (n y5-s
1 HEREBYACKNOWLEDGETHAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN DER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL. CITY ORDINANCES AND BTA E LAWS ?SLATING
BUILDING CON p 10 . // VALUATION �jt•_-
SIGNATURE OR % � (. PERMIT FEE $ /
PERMITfEF %y�I .Q.�J///J > L�U� ' ,_/�j n_
FjR Ef -627a $ •�/'o( ✓ / PLAN CHECK $ %/ W
S
AUTHORIZ TOTAL FEE $ i 9 7— oG,