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Home My WebLink About922 LOMBARD CT - Building Permits(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BIJILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Jobnddress: 922 LOMBARDCT Suite: Vicinity: Parcel Number: 41808251 Applicant: BORG, JOHN A Address: 922 LOMBARD CT COSTA MESA, CA owner: BORG, JOHN A Address � 922 LOMBARD CT COSTA MESA,CA . � Contractor: Address: Zip: ' _ Arch : Address: Phone: Zip: License: Zoning: � Phone: 714-5403944 2ip: 92626 � Phone: Zip: 92626 Phone: License: ' . Eng: v Address: "'' -" - / SCOPE OF PE ENCLOSE EXIST. 96SF 2ND STORY PATIO TO"BE AN EXTENSION TO � - - - Status: ISSUED Applied: 07/16/2001 Issued: 07/16/2001 ISSUED BY: � Phone: � License: ; ' _ EXIST�BEDROOM. , � ;. - , � � - ' FEE SUMMARY - ; Plan Check: " $99.61 ____ _ _ � � _Calc Valuation � � �� , s�,aoo.00� Permit: $153.25 - � � -- � � i��-` � —Claim Valuation. � �� " $�,500.00 SMIP Res: : $0.75 � �� ,,,,. , . ,-� . � . SMIP Com: $0.00 � '_; � i�i, .` � Other � �. $0.00 ' ` - - � , � � ��/'� Inspection: , $Q00 '��- � i /� I�" . � ;�.v-�� ;b_; ��;� i t�'� � w. r i ' TotaL• . '$253 61 � '- ; ,/� ' ii. � 1 � r. � .r l 1 i: i L' / , .' V' ,. i � . ,. � _ , _ . ' . - '" � . � . . / � � A�� -; > � PLP,NNING & ZONING � ��: ��' � % �' . SETBACKS ��'� � ' ' V�°' , - � � � � � �� c �'/ �s�i i � , �;"`.. � c�`: � � � , /%� � . �. MAINSTRUCTURE Front - 0-0 -'\ Rear 0-0`- - �Left -'�0 0'-`„- " Right��0;0,: ; i-' ' ,�, � '� ! / /��'... _ _ -- "� _ ' V�.�/ ' /� •� ACCESSORY Front ��0.,0 � �,��`�Rear� '0-0 _ Lek �0-0�_l`� ��1� Rght ��0�0;". � � � - �1 r � � - - � � � � �' � �� .:�' i/ PARKWG Existinq: ` o�` - Required: �o Proposed: _ �.o ` �; L% �-' . � - . . . ., _�� NOTES: � � . - .� , . ._, -. . ,. .� . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) 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 o! 180 days. INSPECTIONS: In ortler for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and ttnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. POR INSPECTIONS CALL: (714) 754-5626 2aaws �sioo� WORKERS'COMPENSAnON DECLARAnON: � I hereby ettirtn under penalTy of perjury one of the following dedarations: ❑ I have entl will maintain e certificate of consent to self-Insure for workers' crompensation, as pmvided br by section 3700 of the lebor Code, for the peAormence of the work far which Ihis permit is iuued. � ❑ I have and will maintain workere' compensation insurance, as reQuire7 by sectlon,700 of the Labor Code, for Ne partortnance of the work for which Nis peimit is i5sue0. My workers' compensation Insurence wrtier antl policy number are: _ Cerrier: Policy Number.� `(T/h/y�5 section neetl not be complefed il the permit is valued ef one hundred dollers ($f00) or Ieu.J ➢4 I certify ihat in the peAormance of the work for which this pertnit is issueQ I shall not employ any Oerson in any manner so as to become subjecl to the workers' r` compensatlon laws of Califomi end agree Ihet it I should become subject to the workers' compansallon provisions of Saction 3700 of the Lebor Cade, I shall iarthwith comply with these proNs� ' / / Applicant SigneNre: '�-' Date: 7/� b I b I WARNINO: FAIWfiE TO SECURE ORK S' dJMPENSATION COV GE IS U W FUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINPL PENAL� D GVIL FlNES UP TO ONE MUNDRED T/qUSAND DOLURE (f100,00%, I ON TO THE COST OF COMPE IXJ, D GES AS PROVIDED FOR IN SECTIIXJ 3]O60F THE LABOR CODE, IMEFEST, AND ATTORNEYS FEES. IICENSED CONTRACTORS DECLARATION: I hereby attirm Ihal I am IlcenseC untler provisions of Chapter 9(commencing with Saction 7000) of Division 3 oi iha Business and Prolessions Cotle, end my license is in full force and etted. Llc. M Class # Conirectofs SlgnaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I here6y eNirm thet there is a consiruction lending agency tor the Oedormance ot the work for which this pertnit is issued. (Sec. 3097. Civil Code). Lentlers Name: Lenders Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aHirm Ihat under penalry ot perjury Ihat I em EXEMP7 FROM TME CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or counry which reQuires e permit to wnswd, alter, improve, demolish, or repair any structure, prior to its issuance, elso raquires Ihe epplicant tor such permit ro file e signed statement that ha or she Is licensetl pursuant to ihe provisions of ihe Contractors License Law (Chapter 9(commencting with Section 7000) ot Divislon 3 oi the Business antl Protessions Coda) or that ha or she is exempt iherefrom and ihe basis for ihe allaged exemption. Any violetion of Section 7037.5 by any epplicant for e permit sublects ihe epplicant to a civil penalry of not more than fiva huntlretl tlollars ($500).): ❑ I, as owner of ihe property, or my employees wlth weges as their sole compensation, WILL DO 7HE WORK, and Ihe strucWre is not intendetl or ottered for sale (Sac. 7044, Business end 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 harsell or through his or her own employees, providad thet such improvemams are not intended or oflered for sale. If, however, the building or improvement is sold within one year of completion, �he owner-builder will have the burden of proving that he or she did not build or improve for purpose oi sale.). � I, as owner of the properry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct ihe project (Sec. 7044, Business and Professions Code: The coniractors License Law does not ap01y to an owner ot property who bullds or impmves Ihereon, antl who coniracts lor such prolect with a coniractor(s) license pursuant to the Coniractors Licensa Laws.). � Business antl Professions Code tor this reason: Date: Owner I venfi by tlrivers licb��. Verification Ownership by (rype ❑ Yes ❑ No Driver's License No. ment, i.e. - property tax bill ar tleed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby certify Ihet no exwvation five (5) or more feet in depth into which a pereon is requireC to descend, will he matle in connection with work authorized by this permit, and ihat no builtling structure, scaHolding, falsework, or demolition or dismantling Nereoi, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Celitomia Atlminisirative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit Irom the Division of Indusirial Setery, as noted above, unless such person has a permii to do such work trom the division. Signature: Date: Division of Indus�rial Safary Permit Number: CER7IFICATE OF COMPLIANCE AND AIfTHORVATION OF EMAY: I certify under penalry of perjury that 1 have read this application antl state Ihat the informetion given is corre t. I agree to comply with all siate laws and ciry ortlinances relating to building constmction, and authorize representatives of t�e Ciry oi Costa Mesa to enter upon ihe above- � cr d pro erry r i spection pu oses. I agree not to occupy or allow xcupancy oi eny building authorized by this permitY mil fina/l inspection. % I��JIC)) SignaWr t LB I Owner(s) D e AnNOr Authonzed Applicant Date COOE I. INSPECTIONTYPE 1616 FIzeC Sysiem Final Fire Prevention 1286 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 20E Final Demolition pd�. �¢ �QQ�( INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Preventian 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy URTE � ' INTITIAlS CITY OF COSTA MESA BI/ILDIN6 D/VISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: 922 LOMBARD CT 41808251 BORG, JOHN A 922 LOMBARD CT - - COSTA MESA, CA BORG. JOHN A Address 922 LOMBARD CT Contrector. Address: COSTA MESA, CA Phone: 714-540-3944 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: r NUMBER E01-00634 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: I SS U ED Applied: 07/16/2001 Issuetl: 07/16/2001 '" '' i SCOPE OF PERMIT,�" � '"" ' ENCIOSE EXIST. 96SF 2ND STORY_PATIO TO BE AN EXTENSION TO THE AN�EXIST BEDROOM. REF BOi-01100. � _�� - � - - � -- � - - - - - � � ' - --- .-_- .. . _ , , 2LIGHTS, 2 OUTLETS AND1 SWITCH. � '� i . . , - /_ _ _ , . �.. , .. ' FEE-SUMMARY �'� , — ___., � -� . - - � ,Quantiry 1! ,,�` puantity�f,'�! � �' ��' r' ISSUE FEE , $23.50 � Temp Dist System / Lighting ,$0.00 0��%; �� , `t� - Temp service test � 50.00 ' Busway"%100 ft�"' S0.00 '0 �� ' ' Res. a/c package � $0.00 { .. :=,Standing Section .$0.00 �OJ i � � '��.j New Res (1-2 units), � $0.00 , 0 — i-, �. . .Misc Electrical Equipment $0.00 /��0 ' � � New Res (3+unitsj ;� $0.00 � 0 - �� ` ' " Transforme{s up to 1 kva/kw $0.00%j' 0 � � Pool / Spa � . �`��$0.00 0 : •: .. '�� . ,.:�.:....'......up to 10;kva/kw � $O.00r 0 S " . r / Lighting Fizts - $220� w— 2 �, ;Y ,; � ' :.up to"50 kva/kw-�.;= � ��$0.00� 0 � �� Recept Outlets `$220;� � Y� - ... . up to 100 kva/kw �$0 00 �� 0 �! Switches i $110�� A 7 � � � .�� "over:100kva/kw" �$000�.-i��0 Non Res Appl ` �� '�� $0:00 �,,� � 0' " � ` Low Volta e E ui ment��i� '�' � � '� ResA I `�� ,$0�00� �'`-0��-' � � 9 „ Q P ,- //� 50�00 � �0 �l/� pP � ,,�� _ �,� . • Lo�d-Volt�Wiring:System'hCkt � $0.00, � 0%'�, Service to 200a � $0:00 � �,� 0 " �_ - � �. Misa Conduit == ,-� i =:�$0.00�� -0 � ' Serviceto1000a � �;��$0.00%% i; ��0�-, � . � Misa-Conductor ��$0:00 : j0; � Serviceover7000a ��,�-.�$0.00�''�,'_0��%.-� Circus(.genorride)�� a �$0.00;.'.0 Motors to ihp '.�$0.00_ �` 0 , ,� - . � � � 6ircus (mech ride oi�lights) ,.$0.00�, �� 0 Motors to 70hp $0.00� ;.. 0 ' � , ..Christrtias Tree Stand`� . �� $0.00 0 Motors to 50hp g0A0��-..`-' �=0 _ --,�` Firewo�ks Stantl� — �-•'1; �$0.00 0 Motors to 100hp $0.00 � 0�� - , Other Electrical�Fee �' " -�" $0.00 Motors over 100hp $0.00 0 �� -' __ _ .- - - _- Communication drops $0.00 0 investigation�Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES E29.00 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) . EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, antl au requfred inspectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in �he expiretion o( this permit. FOR INSPECTIONS CALL: (714) 7545626 2446d8 (&00) WORKERS'COMPENSAnON DECLARAnON: — . � I hereby affirm untler penalry of perjury one ol iha tollowing tleclarations: ❑ I have end will maintain e cartificate of tOn58nt to 5elf-Insure for workers' Compensailon, es provided for by seciion 3700 ot tha Labor Code, lor lhe pertortnance of the work tar which this permit is issuetl. ❑ I have antl will malntain workere' compensation insurance, as requiretl by sectlon 3700 of �he Labor Code, for the peAortnance of the work Por which this pertnit is issuea. My workers' compensatlon Insurence wrrler an0 policy number ere: Carner: Policy Number (This section neetl not be completed il fhe permlf !s velued et one hundred dollars ($ f 00) or less.) � I certity ihat in the pertortnance of the work tor whic� this permit Is IssueQ I shall not employ any person in eny manner so as to become subject to ihe workers' compensation lews of Celit rnie, d agree thet il 1 should hecome suhject to t�e workers' compensation provisions of Section 3700 oi the Labor Code, I shall forihwith comply with thesa provision ApDllcanlSiqneWre: � Dete: % J�� C.� 1 WARNINCi: FAILURE TO SECUFE WO ( S' COMPENSATION COV GE I UNLAWFUL PNO SHALL SUBIECT AN EMPLOYER TO CPIMINPL PENALTIES D GVIL FlNES UP TOIXJE HUNDRED T/IOUSANDDOl1ARE(5100,000),INAD ONTOTHECOSTOFCOMP SATI ,DAMAGESASPROVIDEDFOPINSECTION3'lO60FTHELABORCODE,IMERESi,ANDATTORNEVSFEES. LICENSED CONTRACTORS DECLARATION: I hereby effirm �hat I am licensea untler provisions of Chapter 9(commencing with Saction 7000) of Division 3 of the Business and Protessions Code, end my license is in tull fOftO end BflBCL LIc. M CIa55 k Conireaors Signature: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirtn thet thera is a construciion lending agency for ihe pedormanca of Ihe work br which this permit is issued. (Sec. 3097, Givil Cotle). Lenders Name: Lentler's Atldress: Signewre: Date: OWNER•BUILDER DECLARATIONS: I hereby attirm thet under penalry oi perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires e permit to consWct, alter, Improve, demolish, or repair any strucWre, pnor to its issuance, also requires t�e applicant tor such pertnit to file e signatl statement thet he or ahe Is Ilcensetl pursuant ro ihe provisions of ihe Contractors License Lew (C�apter 9(commencing with Section 7000) of Division 3 ot the Business and Profeuions Cotle) or that he or she is exempt Iherefrom and tha besis for the allegetl exemption. Any violation of Section 7031.5 by any epplicant tor e permil subjems ihe eppllcaN to e clvll penalry of not more ihan five hundred dollars ($500).): ❑ I, es owner oi ihe property, or my employees with wages as Iheir sole wmpansation, WILL DO 7HE WORK, and the structure is not intentletl or oflerad for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law dces not apply to en owner oi properry who builds or improves Ihereon, antl who does such work himselt or herself or thmugh �is or her own employees, pmvided that such impmvemems are not intentled or oflered br sele. tl, however, the 6uilding or improvement is sold within one year ot completion, the owner-builder will have �he burden of proving that he or she did not 6uiltl or improve for purpose of sale.). �I, a5 owner of Iha property, am EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Protessions Cotle: The coniractors Llcense Law tloas not apply to en owner ol propeny who bulltls or Improves thereon, end who contrads tor such projact with a contractor(s) license pursuant to the Contractors License LawsJ. ❑ I am m nd eC SlgnaWre: � " Owner ID rifi by dnvers liten Vedtiwtion o nership by (type of Business and P�ofessions Code for this reason: s ❑ No Driver's Litense No. i.e. - property �ac bill or tleed): DIVISION OF INDUS7RIAL SAFE7Y PERMITCERTIFICATION: Date: Expires: ❑ I hereby certity that no excavation five (5) or more feet in dep�h into which e person Is requiretl to tlescend, will ba made in connection with work euthonzetl by Ihis pertnit, end Ihat no builtlinq siructure, sceHolding, falsework, or demolition or dismantling thereot, will be more than ihirty-sis (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle e, Celitornia Adminisiretive Code). ❑ As owner�Duiltler, I will not employ enyone to do work which would require e permit irom ihe Division of Industnal Safety, as noted above, unless such person has a parmit to do such work trom the tlivision. Signature: Date: Divislon oi Industnal Safery Permit Number: CERTIFICATE OF COMPIIANCE AND AUTTIORVA710N OF ENTHY: I certify under penalry ot perjury Ihat I have reatl this application and state Ihat Ihe information qiven is correct. I egree to comply wiih ell state laws and city ordinances relating to Duiltling construc�ion, and authonze representatives of the Ciry of Costa Mesa to enter upon Ihe above-described pro erry for i action purp ses. I egree not to occupy or allow occupancy ot any 6uilding authorized by this pe mit until tinal inspection. �-i�, l.��-u�-�- �7/r (01 � r Signature Ot Legal Owner ) . ate And/Or Authonzed Appliwnt Date CODE �. INSPECiIONTYPE �6�6 Fized System Final Fire Prevention 1266 Pool Spe Final 200 Final Re�Roof 201 FInaI BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition ,\ p� i a COOE� INSVECTIONTYPE 20fi Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupancy �g �I:tl11f.lS'. PFOJECT FDUXESS 9 z 2 LOMBARD CT OWNEfl'SNAME: BORG, JOHN A aooness: 91P LOMBARD CT Ct�STA MESA,CA 92626 UNIT: AflCH/ENGINEEB: flEG.NO.: IIDOflE55: UNIT: PEflMITTEE: HILT—WELL ROOF AND MATERI (714)739-1288 aooaess: 3310 VERDUGO ROAU LUS ANGELES CA 90O55 LICENSED CONTPACTON DECLl�BATION: I here�y a��irm Ihai I am licensetl untler Dmvisi0n5 0� Chaplef 9(CommenCinA wiih Set�ian 70001 ai Orv�sion 3 0l Ihe Busine55 and PmfeSsians Code, anU my liCense is in full forCe an0 efteCi. cirruc.: 039076 STPTELIC.:QJSOVS /r�n�� ^ 3" EXP: O5/95 Oate: �//,//G� Signature: _ F _ ' _ WOfleEflS' COMPENSpTION UECIABATION: I hereby atfirm 1 h icare o1 mnsem �o Self-insure or a certiticaie ot Workers' Compensa�ion Insurance. ar a cerlilie0 coOY Ihereof (Sec�ion 38 . ab. C�. roucvNo.: W937102989 E%P.ORTE: O%I13Ii�I COMPANY: CAL COMP �:..:❑ Cetlifiea capy is hereby �umishetl. � Certilie0 copy is filetl wi�h the ciry Builtling Oivision. ��-L'�ale'. Applicanl: E%EMPTIONFflOMWOflKEBS'COMPENSATIONOECIABRTION: (Thissettionn¢e0notb¢tampl¢tedilthepermi�i5�oronehunOre0�E1W)ofless�. I certily Ihal in @e oedormante ot tne work tor which this permii is iss .LeMe� t empl any person in any manner so as to Uecome sublet� b ��e orker ' Compensalion Laws ol Calilomia. Oate: Signature: O NOTICE: If, afler making �his tleclaration, you shoultl ' o �he orkers' Compensation pmvisions ol Ihe Labar Cotle. you mu5i lorihwilh compry wiih such pmvisions ar Ihis permi� shali be Geemetl revakeA. CONSTflULTION LENOING pGENCY: I �ereby afiirm t�at ihere is a constmction IenOing agenry for Ihe DeAormance ol the work lor which ihis Dermn is issue0 (Section 3097, Civ. C). LENOEH: AODPESS: OWNEfl BUIL�Efl �ECIAflRTION: I hereby afiirm ihai I am exempt irom t�e Coniractors' Sla�e License Law for [he followinp reason �Sepion 703t.5 Business and Pmlessional Cotle: Any city oi county whic� repuires a permit m consimct, alter, im0�ove, Oemolish. or repair any sim[Iure. prior lo its issuance. also requires ��e applican� for such De�mi� �o file a signed slatement �hat �e/she is licensetl pursuant m t�e pmvisions of Ihe Contrac�ors' Sta�e License Law (Chapter 9(comm¢ncing wiih Section 7000) o� Oivision 3 oi Ihe Business antl Pmfessions Code) or ihat he/she is exempt ihereimm and ihe basis for Ihe aliegetl e.emption. Any violation oi Section 703L5 by any applicant lor a Dermit suble��s Ihe aDPlicant to a civil penally of not more t�an five huntlred tlollars (5500). I. as owner ol ihe propeny or my employees with wages as Iheir sole compensation, will tla ihe work, ana the ❑ simcture is not inrende0 or ofieretl lor sale (Section 7044, Busine5s and Pmiessional Code: The Conimctors' State License law tloes no� appry �o an owner ot a propeny w�o buil0s or impwves thereon, antl who Does such work himself/Aersel� ar �hrough his or �er own employees, provi0e0 ��a� such improvemenis are no� intentled or ot�eretl �or sale. I�, however Ihe �uilAinp or improvemenl is sold wilhin one year o� comple�ion, �he owner wi0 have Ihe Ew�en o1 pmving he/she tlitl noi builA or impmve for the Durpose of sale). ' I. as owner of Ihe pmPerty. am exclusively coniraciing wilh Iicense0 contrac�ors �o conslNct �he prolec� (Sec�ion 7044, Business ❑ antl Prafessions Code: The Conlrac�oK S�a�e License Law d0e5 noi appty lo an owner o� O�aPehy wh0 Uuilas of improves �hereon anA who contrac�s br such prajec�s wi�� a con�rador�s) license pursuant �a �he Con(ractor5' Siale License Law�. I am awa�e Ihai prooi Of �heir WOrk¢r'S Compen5ali0n insurante S�oultl 6e pmvitletl Io m¢. � i am ezempt unaer Section: B. 8 R C. for ihis reason: Oale'. Ownec I Do hereby certify Ihai I am aware of and untler51an0 Ne requiremen�s oi Ca6�omia Healin antl Safery Code Seciions 25505, 25533, antl 2553a ana I�al I or any luWre buAtling occupam willlwill no� (circle one� need lo comD1Y wi�h saiU state co0es and �he requiremems lor a permii br cons�mclion or mo4Jication hom I�e Nir �ualily Management �iSVicL Fesitleniial con5tmciian applica�ions are exem0� ��om Ihese prOvi5i0n5. iate: ApplicanP. _ hereby ceni�y�Aal I have read Ihis appliwiion antl slatet�; or�inances ana 5taie laws rela�ing to builtling conslmtlion antl properiy lor insJp ciion rposes. �a�e: ��/�/� N Signa�ure' � �river's Gcense or Social Securily a: �' � is correct. I agree to com0ly with all ciry anA county matives ol �his ciry �o enter uDon �he above�menlione0 16aL46 Whi�e—Building; Green—Cotle Enlomemenrt Canary—Applicant; Pink—Revenue: Goltlenmtl—Assessor CITY OF COSTA MESA — BUILDING PERMIT FERM NO; B 067978 PERMIT NO: B 067978 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: OTH JOB DESCRIPTIdN ; T/OFF 6 RERt�OF WITH COMP, d BUR IN BACK SQ FT: 1,100 CLAIM C�ALUE: 1,100.00 CALC—VALQE: 1,100.00 GROUP OCC: R-1 /M-1 COMMENTS: SMOICE DETECTORS ARE REQCIIRED IN EVERY BEUROOM & HALLWAY ��*��c��*�c�r �:*-*��c��c*�*�c*k�*��**�******��r�*�c#*x��*��*****a��+�*�**�c�r#*�c�r�*�c•+�}�r�* Z O N I N G R E 2 U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDICdG -------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAEi: FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ; PROV; PARCEL: 41808251 ZNE: REF NO: PLANNING NOTES.> .: > �, fF if !E iE iE 3c'k if # k ic if if ih iE 1! 1f 3E 9F iE 1E # iE iE ik iE 1F # iE 3E iE �1E it # jF 1E iF if fE 1! iE IE if iE 3b if �)E!f iF #�f if �f �If it 1E iE ik �� iE �E if� iE 3E iF iE �E i4 ��iF �F ic 1F 1f it rt iF iE k D E V E.L O P M E N T S E R V I C E S A E Q U I R E M E N'.T S ZONING APPROVED BY DATE: � BUILDING APPROVED HY : DATE: APPLICATION IS`SUED BY: ��. DATE: � � � *itic�ti�***��tt�***iFi�*it***i�i[��F�i��"TT�'� - � *�t**iEitit***�>.�r�*� iFiEiFiEiEiElEiEiE#iFiElElEiElfa(-iE�FiE1E�EiEiEi6j'r3EififfEiFif#9f?cif9EiE#3Eit9fi�iF�f#3fiFiEiEifiFiEififiE�)FlE3Fif7FiFiF#fE9EiFdfiElEiF Flhit�i 1Fif�%1f LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIF/RES GRADING PERMIT 27.00 ,5p SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMIT I55UE PLAN—CHECK TOTALS----> 27.50 0.00 0.00 REVENUE DIVI5ION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC z%,0� TOTAL PAID DUE 27.50 27.50 .00 27.50 OVER/SAOAT: .00 FIRE SMIP/TOT GRAL�IhIG PLAN—CHECK .50 ik * ik ik iE �)h it 1E iE # iE i4 iE iE # if if iE if iE ft # iF iF iP iE iE !F �IF i6 �)f 1F jE �Ih 1E if �1F if� iE 1t iE iE if if- iF fi iE fi� if IE 3E it iE �lf iF iE iF iE ik fE i(� i!� iE 3i� 1E ik iF ik iE d'r!F 1E iE iE �E �lc i(• �1F �1f I N D I V I D U A L F E E & 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 SFR 1100 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 1,100,Q0 END OF FEES O1 ODifi372'�-00163729 TOT DATE: 07/11/94 TI{1E: 11_07 • �7.50 � CONSTRUCTION AND PLANNING POOL ?A APPROVALS Permit# Date Inspector p�ppROVAIS Permit?k Date I�spector 1. Temporary Electrical Servic�oi Po�e - 52. �Pool & Equipment Location `'�• l_ 2. SoilPipe-Undrgmd. �=:' �,�� 53. Steef Reinfo*cement 3. Electrical Conduit Uti�ity-Undgrnd. 54. Forms � 4. Electrical ConduiFUndrgrnd. 55. Electrical Bonding 5. Sceel Reinfarcemene 56. Raugh Plumbing & Pressure Tzst �' 6. Electriw� UFER Grnd_ 57. APPROVAL TO COVER�GUNITE � , 7. Footings 58. Electrical Conduit-Undrgmd. � � 8. Foundation , �i 59. Gas PiPe, O Undrgmd., Test � ;� 9. Water Hpe-Undrgrnd. ,� � � � � 60. Backwash Lines, P-Trap, C Undrgmd. � i�; 10. S2ructural Floor System ; � �._ -� 61. APPROVAL TO DECK � >� 1 t. Proper2y Sewer Line & House:Connectio� ` 62. Backwash & Receptor�Ptnal ',-�r h 'I t2. Sewer Cap �', �' 63. Heater & Vert-Final ` 73. Roof DrainS 64. Plumbing System � Final 14. Rough Plumbin9 65. Electrical�Final ��l 15. Rough Eleccrfcal-Condua 66. Solar System-Finai 16. Rough Electric Wiring 67. Fencing & Access Approvai �.i ll. Rough Wi�ing Sign 6$. APPROVEO FQR PI.ASTERtNG �' 78. Rough Electrical-T Bar Ce�ling 69. POOL/SPA SYSTEM14S FINAI 13. Rough Heat�ng & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Firepiace APPROVALS: Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ve�t��ating 77. Product Piping aGas ❑Oil 23. Gas Pipe�Rough & Tes: � 72. Underground F;ush 24. Roof Framing 73. Undergrnd.StorayeTank G'Gas GOiI 25. Roof Sheathing �ilS�C/ (Qµ� 74. Overhead Hydro . 1 26. T�Bar Cefling (Structural} & Monocoat 75. Dry Chemical 27. Frame and F�ashing 76. Dry Standpipe 28. Lathing &&�ding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Dry�vali Na�ling HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter�Finai 80. FOOD CERTIFICATE ISSUED 33. Finai Electric Notes: 34. Finai Heating & Air Conditioning i� 35. Final Gas Pipe•Test ^ , 36. Hood or Canopy . . 37. Final Facto�4 F��eplace � 38. Final Plumbin9 39. Water Service�Fina� 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow P�eventer 43. Backflow trrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap fiegulations � � 47. FINAL STfiUCTURE & BUILDING �Q-.l�t� (�i� 48. FINAL PLANNING � - 49. Electric Release to Edison -•.r. �. ... 50. Gas Release to Southern California Gas Co _' „ 5L CERTIFICATE OP OCCUPANCY .,,_. No. Date , '� .. � " TRACT N0. 10445 DATE June 5. 1980 LOT N0, 51 ADDRsss 922 Lombard Court, Costa Mesa, CA 92626 Development Services Department Planning Division City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Attention: Mr. Paul Dudley Dear Mr. Dudley: Please be aware that the undersigned are aware that a certificate of occupancy on the abwe referenced lot and unit is being requested prior to the entire tract and its streets and common areas being completed and accepted by the. City of a Mesa. ,. �' . O�/ /D • , ,, � �f� QFC:X�'Tf�•"- /��I//fGLat_ � � �;'9�.��. ��t . t. � ��12 �;..' 7i8i�+"w,�l,�1��2�3i4is 6 �. _ , c