HomeMy WebLinkAbout865 LOMA CIR - Building PermitsPPOJECT AOOPE55: 8 6 S LOMA C I UN17:
aensxame: DERINGER, KENNETH H
aooeess: DERINGER, PATRICIA J
865 LOMA CIR
COSTA MESA CA 92626
(714)545-0�59
AHCH/ENGINEEN: RAMOS DESIGN CRITERIA "E�.xo.: NONE
aooxess: Z6035 MOULTON PKWY u"'T 55
LAGUNA HILLS CA 92653
'E"""'EE: DERINGER ( 714 ) 545-0659
aooRess: g65 LOMA CI
CM CA 92626
LICENSEO LONTBBCTOP OECIAFFT10N: I here�y allirm �ha� I am Iicen5e0 unaer omvisions ol C�aO�er 9(commencing xit� Seciion
i0001 0� Oir.sion J ol :�e Busn¢55 zntl Pro�esvons CoOe. antl mv license is in lull lorce and elkct.
CITY LIC.: STATE UC.: ' ClASS: .
ve� S�pnamre:
� IHREXS' COMPENSATION OECUflAT10N: I nere0y afhrm Ihai I �ave a cendicaie ol cansenl to sel4insure or a ceNfca;e af'7loM1ers'
�omoensauan Insurance. or a c=mhea caoy inereot ISecuon 3800. Lae. C).
1 POIICY N� E%P O0.TE
LOMPFNY:
❑ Genifie0 coOY 'is here9y furmsnea. ❑ Cenilie0 co�Y 'is filea witb t�e ciry BuilOing Oivisioa
9ate'. �9olicant�.
E1fEMPTIONFROMWOflKEAS'CONPENSATIONOELIAXATION: Qhissec.mnneeOnolGecamole�eadthepe�mitislorone�mMrenIS1001or!essl.
I ceNly;nat n;�2 Oertormanct ot!�e arork for �an¢n Nis permil is issue0. � s�all no� employ any Oerson in any manner so as ;o'�ttome
su'�let� 10 ;�^ `%�oAers' fam�ensatron Laws ol Calilomia.
Oate'. Signature'.
NOTICE: it, al�er makiny �ms aec!araiion, you s�oWe become sublect to I�e Workers' Compen5alion D�ovisions o� ;�e LaOor
Coae. vou musl �otl�wi�t como�y �.vil� such provisions or Ihis permil s�all be de¢med revoked
CONSTFUCTION LENOING AGENCY: I her¢Oy aifirm Ihat Ihere-is a consimctian lentlmg agenry lor Ibe pertormance of Ihe xork br
wmcn Inis �ermn is IssueO ISec;ian 3097. Giv. CI.
LENOEP:
A008E55:
IOWNEN BWlOEfl OECLARATION: I� ereEy atlr.m ;�at I am enem0� ��om Ine ConuaclorY Slate License Law lar I�e folloxin9 reEson
�Secuon i0315 Business ana Prafe55mnal Code: Any ciry nl coun�y �,vhicn reQuires a Oe�mrt ro conslm[t. al�er. imOmve. Cemolis�. ar
repau any slmcNre. Onor fo i;s i;suance, alsa reomres itle applicanl for suc� permil to file a signed Slalemeni t�a� �¢I5�7e is liwnse�
pursuam m ine omvisior,s ol ihe'Comranors' Sta�e L¢ense Law (Cnap�er 9lcommencing wnh Section 700010l Division 3 of ;oe Besiness
�jna Ptole5A0n5 COOeI or I�a� P¢/511¢IS ¢x¢mpl fh¢f¢�tOm 3n0 the Oa5i5 br tll¢ 311eqe4 ex¢mp1l0n. Any violali0n 01 5¢Ciion 7031 � Oy
ny aOPI¢anl �or a permi� su�lecis tne dpplicant Io a civil Oenalfy of noi more Ihan bve �unOred �ollars (5500�.
L as o�.vner oI P,e �:c�eny or my employees wnh wages as ineu saie comoensanon. wiil eo Ne won. ana tne
��' simawe is noi imenEec o: oP,erea tor sale �Seciion i0a4. Busine5s and Pmlessional Code. ihe Canvatlors' S�ate License Law
aoes a0� aooi�� lo an o�xner ol a owPerty w�o �vilds or imOroves Ihereon. ano w�o Caes sucn work himsel�/Aerself or t�roug�
nrs o� ner own emoio�ees. proviaea tna� such imorovemena are no1 inlendeu or offerea fo/ sale. If, howE�er ICe 9uilcing or
imo�ovement �s Sda'.aRun Gne ��eat al com0letian. the a�nner �.vdl nave the Ourae� ol p�oviug he4M OiU nol �wla ar imo�ove
br t.^.e puroose al sx�xi.
�q I. as a'n�er ol Ine omoemy. am exclusively comraciinq •Hn� licensed conlractors to constmc� tAe pro�ect (Seclian i Wa. Business
�.d and Fro�essions Co�e- iGe Coniratlors' State �icense Law Ooes nol apD�Y �o an Owne� ol D�oOefly wAo �WI05 or imOmves fAereon
dnd �.vno conVatts A� sucn 9mle��s '.viin a caniractorls) hcense pursuanl fo Ine Con�racloR' State License law�.l am aware
Ihal or0o1 ot lneir 91oi.¢r's Compensanon insurance shoul0 be p�ov�tle0 to me.
� I am evemoi wder Section�. B. 8 P. C.
mr ;n�. �eason:
�
,. �.s /9,
I oo nereoy c^nty In;� I am a'.�are oi anu unoerstana Ine reauiremen�s ol Calilornia Healin ana afely Coae nions 2550.i 25533. ana
Z553d and Inal I ai any fulure BuAC�ng occu0anl •.vill/vvill nol (ct¢le one� neea to comoty wii� sai� slale [o0e5 an0 I�e rzQuiremenis br a
permil lar conslmc0on or moeihcalian irom Ille Au Ouahly hlanaqemen� OiSiritl. flesid¢ntial con5imtlian applical�ons are exempi tmm
�11p5C plpI�40115. n
dl _ T�4 ��ZiT_ �J_���
/
I:�ere0y ceiliP�!�at I nave reaa :n�s aooi¢atian and Slate Ihal Ihe a�ovein�ormatio� is co«ecL I agree lo com0ly wit� all ciry anU county
�rdinanas aM slalela'xsr?Ial:nqiu +,m�cinq cD�slru<tion ana �ere�y aut�onee reptesentalrves oti�is nryfo emer uD�n/ihe above�menti0ne�
pmOertY :� o� imn Ou�oasei ' . ^ . _ / . _ / .. .
A /
� ;�' . '^"',."�'-e�.+"�S�'�� _Aove�' GolaenroE—A�
. . ... .. _ ...............-v_�_-'_,._'...�.
>:c�r...�.. �. . � . " ....�_,_.
CITY OF C'OSTA MESA — BUiLDING PERMIT
PERMIT NO: B 051140 FLAN CHECK NO: N
PERM NO: B 05119�
GOVT: N SBPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; RESHT. REROOF WlCOlAP � 5(J FT: 5,000 •'
CLAIM VALUE: 5,000,00 CALC—VALUE: 5,000.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTOR(S1 RE�IIIRED IN HOME.
***�r**�r*�r*�r**�e**�**�r�+r***�r�r*�* *�r****�t***�r*�r*�r�r+r�t�r***�*�e�r*�*�r**+r�r*�t****��r*�er�r�r�r
2 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 BUZLDZNG ---------
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; 14133209 2NE: REF NO;
PLANNING N(7TES>
�
If iF k 4 iF iE it 1f M 1F M iF M if i! If iE 3f if if k 1F iF iE if if ik if 1F �E iE IF f! �F iE if iF iE iE IE if if M 1k �f N M iF if M if if IE i! k if 1f 1E M iE 1F iE )f k ik )E jk iF IF iF k iE if �E if if 3F k if
D E V E L O P M E N T S E R V I G E S R E Q U I R E M E N T S
ZONZNG APPROVED BY DATE:
HUILDING APPROVED BY : /� DATE:
APPLICATION ISSUED BY: �/L ° DATE; O��aS�I
aflEifjtiiiFiEiElpiFifMaFifiFlFiFklfMififiFi�"Ri� IfitififkiFifififiE ilit
IFIFif�FiFiFiFiEiFiFIfiFIPiFiEifiFIEMiFifiE3E1f3FifiEk�fiFiflFififiFifiiiEiEitif KifilMiFif3f3fiF3flEif%iFifKififjfiFiElEififiEii%ifiF�k3f3FifiEiFit
LEGALIZATION:N F E E S U M.M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 50
PLAN SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72,50 0.00 0.00 72.50 72.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 72.50 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
72.00 .50
M iF if iF 3E iF iE if iF if iF 1f iF if If 3f if iE �f ik IF if if iE iE M if if 1F 1F �k aF iF i! af IF if 1E IF M iF if if iF M IF M iE M iF iF iE fl�iFiF 1k IF 1f if if k if �f if iF if ik If �f 1E 1f K iE 1F if IF iE 3f �f
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 T P T I O N UNIT COST
SFR 5000 REROOF BY VALUE RESIDENIAL NOZONE 1.00
END OF FEES
TOTAL COST
5,000.00
�;[._:; _ -- -.o; � ;T :_ .
'•.'_ --,_�, _ �:... ._ ..
PflOJECT AOUFESS: .3 �� �OMA !' I ueir:
OWNEP'SNAME: L�LRi�1GGR� K:.��Nh.l!J !I
aooeess. pHRINt�eR, PATRi.CiA J
355 i3OMA CZR
''OSTA hIESArCA 4;'S2fi
(71d)54=-�6�9
AXCHIENGMEEfl: �A4��i 7L$�(jpJ ('�Tlr,�:�, nec.no.:yONE
aooRess: �5035 MOi7LTON PKWY uxir: ;5
i.AGi1NA HIi,LS CA 92h53
PEflMITTEE: (�j�UFSON COMPANir.S, INC. ( 714 ) 683-2120
ADOPE55: "j336 DURAHART
R;V�RSIDE CA 9"l50'7
LICENSEO CONTBACTOfl OEClANA7�ON: I nere�y alfirm that I am licensea untler pmvisions ot CnaO�er 9(comm¢ncing xnn $e[non
i0001 al �insion 3 a� me Buvness ana Prolessons Code. ana my I¢ense is m Iull�orce ana ellea,
cirr uc.: 0 5 �� S 3 suTe uc.: 5 a 5?, cus : �
Sign re: _
,OFKEPS' COMPENSRTION DEC flATION: I �ereo tldv2 d C¢�IfiLdIP 0� COnS¢�� t0 5216i050R 0! d LPRIM1CdIP 01'NOlkffY
CamDenselion Insurance. or a ttrtihea copy t�ereol (Sedion 3800, La�. CI.
POLICY NO.: EXP. DATE:
� COMPANY: �
❑ Cendiea copY �s hereUy furnis�ed. ❑ Cenilied cooy is fileU witll I�e cily Builtling Oivisan. -�
Oa�e: Aoolicant
ESEMPTION fpOM WOflREfl3'C09PENSATION OECIAPATIOH: IThissecaon neearot�ecomoleleailt�e Dermnisforon= nunnreu15t00�orleul.
1 Wrtih� Na� in I�e peAormance o� IAe �vOh tor v��ic�;�i5 Oermil i� t em010y dny person�mannef � as ;o tome
su��eu ta tne :VOBeri ComoensaUan lavrs a� Calep�n � �
�a�e'. �_I 3 �" � �_ Sig a��..� __ ' "
N071LE: If. afier makmg �h6'Jeclarauon. you snoold Uecome subleci lo f�e lNorkers' Com0en5aiion provismn5 ot IM1e I.abor
CODe. yau mUsl �onhwp� COmoly wil� SUCn pmvisions ar I�is p¢rmp sAall be de?med revake0. -
CONSTPUCTION LENOING PGENLY: I �ere�y ailirm I�at t�ere is a con5lmciion lendmg agenry tor ��e oedarmance ot ;�e �xark ior
vmitlt IniS Oermii i5 i55uea I$¢cvon 3W7. Liv. CI.
LENOEP:
AODflESS'.
OWNEN BWLOEF DECLAFATION: I AereOv a�brm t�a� I am gxempt imm l�e COniraqors' Sta�e License Law for Ihe follawing rexson
iSecuon i031.5 Business an� Pro�essiondl Code: Any city of counly wpic� reauires a permilto con5lruCt. alfer.improve, Cemo65h.ar
reoair any s�mdure. Onor A ils issuance. aiso reduires fne aoo�¢anl lor Such oe�mit fo hle a 5igne0 stalement ihat he/sne is licensea
purseanl Io ine pmvisans of Ihe Cwlracmrs' Slaie Lic¢n5¢ Law �Chaocer 91CommenCing wnh Setuon 7000� ot �ivismn 3 of tee dUSine55
�na Pmi?ssions CaCel or ;na� nelsne is exem0� �herelmm an0 ine basis for Ine allegetl exemolion. Any violation ol Senion 70J15 �y
;v aoolicani lor a aermn sua�ec;s :ne aoolicam ro a civil penanp al no� more �Oan five hunaree �ollars ISSW�.
'i. as o�nn?r oi ;�e ,ro�erty or my emoloyees �.viih �xages as �neir sale compensaiion, ^�ill ao ;�e �e�orr, an0 ,he
❑ sVucture is nalintenoea o�olferea lor Sale (Section 70<d. Business ano PratessionalCoee: 7he CoNraciors' Slate licens¢ Law
aoes not ao01y to an o�.vner of a Omoerty vmo builds or impmves I�ereon. ana ai�o tloes Suc� work himseltl�erseil or [�raugh
his ot her own em�loy?es. p�ovi0¢4 II1at such imD�ovemeNs are not inlende� or ofleretl for sale. 11. however tiw, bwldmg ot
improvement rs sold cnihm one year o� comoleiion. f�e owner :�nll have 'he hurtlen of prOving he/s�e ditl nal �uAa or improve
_ �or Ihe ourpose ol sa�eL
I. 350wnQfpli7E OtGOPRy.drtIExCWSivPly COnifd[bOg vn1111iCEfISCd CO�ItdCtOR �0 LOOS�Ntl Ihp p�01¢C1�$CCtI0f1i0CA, BUSifIl55
❑ and Pmtessions Caae: Tne Comraciors Slale LRense Law aoes nol aooly lo an owner ai prooerty'++no �wl�s or imomves inereon
and wno comraas for sucn oro�ects �xnn a<omracmtlsl license oursuant b the Commaors' State License lawl. I am awa2
inal o�oo� ol ;neir':larke(s Comoenyalion insurance snou�a �e OroviCetl to me.
� I am eMempi un0er Secllon: 8. d P_ C.
lo� mis reason:
�a�e� Owner
i ao nerebvi ceniry;nai l am aware ot �no unaprstano ihe reCuiremems of CalAornia MealU ana Satety Code SecLons 25505. 2553J. an0
2557d an0 Ihal la�anyluture EmIC��q occuoant'.mlll•.vill �oticrtcle one� nee0lo com0ly :nih said 5�aie codes and ��erPpmremenls tor a
�ermi� �or consimclion oi r.wciLca��on Imm I�e Au Quality IAanagemeni Oisirict. flesiQenlial consim[tion appl¢ations are e�em0� ��om
�II¢SP pl041510nS.
Oafe'. POph�ant
I here0y cetlity Inal I nave reaU IM aoUl¢alion and slate Inal ;ne a0ove mtormatmn is correcl. I agree lo complY'x��ll all ciry antl
ordinancesan�statelawsrelalinqtoJUA4inqconSVuclwnano�ere0yautnan�ereoresentatrvesoflhisci�yloenteruponllKapqy¢�me
o�openy mr mscecuon ourooses ////// � //�
� //
mi�.3 - I3 ` `I( ��.i�= �i
. , a�.... «. > smr sK,n!�y� _..:.- - _ -
--- -- . ._.�..--.__...... ._�:._ .—,-."--=+r�a
Ci:Y OF COS"in .VicSn - 3U'.LP_NG P�RM�S r�ctM PiG: _ Q�i:t.i,
P=RM�T NO: � 051347 Pi,F:�i Cii�CK Nd: P7 GOVT: N�i:iPP: Ti
CONSTRJCi?ON TYPE: :-N PEkMIT TYP?; cLE PURPOSH: O"i:I
303 DeSCRIPTION :�DD WORR RM, DINING �M 5 PANTRY/STORAGE SQ FT: •
CLAIM VALUE: CALC-VALUE: GROUP Orr__ R-3 /M-1
COMMENZ'S: RH: B50864 PRIMr'UZY Bi,DG. PEr�tMIT.
iE aE if 1f Y� 1f �K IE iF if >� YY iE AG Y ff if V IF iF Y Y 1� iF 1F iF iE +f 1h df iF 1F Y)f �E if iE �f 1E iF 1F if �E iE 1F �F iE aF IF )F } if if IE 1f Y�f in { iF �F iF 3%Y. If iE If iF i1� iF+F� iF if N�f if Y Y
Z O N I N G R c Q U I R E M E N? 5 .
S t 1 B A C K s' '
------------ MAIN BJI�DiNG ---------- --------- ACCESSORY Bt7:LD'1NG ____.._-__
FRNT: FT IN REA�• FT IN FRNT: cT IN R�P,R: �T I1v
i.EFT: FT IN RGHT: FT IN i,EFT: FT IN rZGHT; ri IN
PArZKiNG REQ ; PROC�; PARCai,; 14133209 ZNE: REr' NO:
PiANNING NtSTcS>
� .
sl'iklFii'iFYY.i!iFMiFiFil'k#7F1Fii�FiFili!Y'k3!M'Y?FY!1'a!�!af?k'ki!'iFiF3PYYiF?FjkiFiF)E�MY3f'kMYYifklfa?'K�iFi!?iiP?f+E}YiEaYiEifiEiF'K'A4iEiL
D F. V e. L O P M e, N: S c R V T C E S R c'. Q J 1 R � M c N i S
_ZODiING APPROV�D BY DA?2;
3UIyDI?vG APPRUVED bY ; DA:E;
��pi,icAiioN is�u�� HY: DAT�; � �3�
1Fi1�iEf'M'ik�E+fIf1E7FiFiFirlfY.+EM�f'/.�1fiE . .. . � f . 'R..�T%iF?FY'iE>?ft!'YKifi KY
IE iFie lE +FiF k 14 3E iF �E 3f iE 1! V IF �E ?f if If if �E ik if Y Y � k If 3E iF iF 3f �E 1f } if iF ik N-?f !f iE k k.�c iE if i! if Y jfaE 3fi� +F Y}.Y 1:�i �E k+ Y-YY-u ac i% �E �R ?F ii�K� IF i4
�EGAi.IZAT:ON:N r c' .. 5 u M u R Y s'?R:7CTII�AL S�r_,MENT:!v
BLDG PMT PLuMnTNG �i.ECiRIC ��C3AN=C
S�ti(�"�1 1 3� . �Q
Jn�
�LaN
IS'S ^Ec. 1`,QO
BC7:i.��ING-DiC�-> P:r�MI'•" Is'SiiE PLAN-C3�CI!
:'OTALS----> 32.00 1�_00 0_00
FIr�� SK_P/RcS Gr�,�DINt;
5 i� 1}� � lV f�1�1—.� L Jr
?OTA;. PA=D il'u'c
47,OU 4?,00 _Oq
�cVn'tvUE D�VZS�OIV TO�'Ai.S--> CGi,LECi'cD: 47,00 OV?R/SyOR?: ,00
9i.7G PMT P;,iJMei�NG �i.EC :tIC ucCHAiVIC r'=�� SMIP/TOi G�r�7ING Fi,AN-CiiECK
47.00
YY-�tY��fY�p{EKiLk+f�FY�liflf+E�+F%X�Eil1FY{k1�'�L1f1f+fK1PiG!FiElf�fll'�E1EY-if-aFYiFYa=iEiEiF'1l1GY1FMV.)iFY#1t�C>iaE±FsYiFiEY..Y?f?fY+i-
I N D I V I D G A:. F c � � R E A K D O i�T N
TYPE QTY
LLE ZO
�i� a
D r. S C R I P T: 0 N
Rr'.CnPT/OUT:.HT
�Lc�.��r�swrrcy
sua-P��.L
1 ST '0
1 S� 20
ENU OF F�=S
UNIT COST
EA. .7`
EP.. � =
I1.00
01 9GG�:�=�.'-:•_�L:2`c%
Qt:T�: ci':41�: it�t
70i'r1i. C05�
15,00
6,00
+i.oe /
V
_ _`... _
, .-: <1.. ._......._ .-
PqOJEL7 q00FESS: S 6 S 1+0� C I �NIT:
awxeAsxame: DERINGER, ICENNETH H
aooeess: DERINGER, PA'PRICIA J
865 LOMA CIR
COSTA MESA CA 92626
(714)545-0�59
ANCNIENGINEEP: RAMOS DESIGN CRITERIA xac.xa.: NONE
aoosess: 26035 MOULTON PKWY uniT: 55
LAGUNA HILLS CA 92553
� aenroinee: DERINGEA ( 714 ) 545-0659
AOOHE55: EGS LOMA CI
CM CA 92626
❑�Ex5E0 CONTPACTOB OEIXANRTION: I �ereby atlirm ��a� I am licensed uneer amvlsions ol C�apter 9(rommencing wit� Sec[mn
1p001 at Oivsion 7 d me duuness ana Pmtessions Cooe. ano my Iicense is in tutl force an0 ettect.
CIiY LIL.: STpTE LIL.: CIASS:
Da�e. Signamre:
WONI(EPS' COMPENSRTION OECLAPRTION: I hereoy al�irm mat I have a cendicate o� consem ro sell-insure or a cenihwte ot Workers'
Comoensation Insurance. or a cemt�ea copY ihereol �Secnon 3800. Lab. CI.
O��CY NO.: . EXP. OATE:
COMPRNY:
J Cemhetl caoy is �ereoy Wmrsnea. ❑ Cemfietl ca�Y is IileO �.nin Ne ciry Builaing Division.
oate: Applican[
E%EMP710N FBOM WOfltlEBS' fAMPENSRTION OECIABATION: (This setlion neee na� be completed il Ihe Oerm�I is lor ane huMreU 151(p) a� lessl
1 cirtily Ihat in �ne oetiormance ol :� e �vOrk lor whic� Ihis permit is issueo. I s�all nol em0loy any person in any manner so a5 io b¢come
su01ec1 Io I�? :Yohe¢ Conoensa[ian Laxs af Calilomia.
pare: Signamre:
NOTICE: II, atter maiina !�is :eclaration, you s�oula Oemme SUElecl ro the Workers' Lompensauon pmvisions ol ��e lao0�
Coae. you :nust �ortnxnm cono�y'N��n sucn orovisions or tnis aermit shall oe aeemed revakeo.
LONSTHIlC710N LENDING pGENLY: I �ereoy a�fum t�ai I�ere is a con9�uction lenaing agency for the pedormance ol t�e wOrk lor .
�.vnit� I�iS p¢rmii is 6sued ISeGmn 7�9i. Civ. C). '
LENOEP:
p00NE55:
aWNEB BWLOEB OECLAPATION: I nereoy attum inat � am eMempl Irom [ne Comracmrs' S�ate license Lax tor Ne louowing reason
ISe�tion 7031.5 Busine55 au0 Pm�xssional Co�e: Any Gty ol county wpic� repuires a perm�� lo construc�. alier, improve, cemolish, or
reoau any simcture. pnor ;o As Rsuance. also reqmres Ille a0���cani lar sucll permit lo Itle a signetl statemenl Illat n2lsne is licensed
]msuant lo Ine vrovisians c' �he ConVaclors' Slate llcense Law (ChaO�er 9lcommencing wilh Sectmn 7000) of �ivision 3 of ihe Business
anA Pmfessions Lodel or ;.�;� neis�e is exemol Iher=�mm and t�e Oasis for I�e alleqetl exem��ian. Any violalion ol Seciion 7037.5 by
an}' 3D01¢dni 10� a OC��iI iubleCS i�? 2oolicaN �a a civil penal�y ot not more Ihan five �undretl dollars (55001.
I. as o�xner ol ;ne prcce�y ar my ?m�loyees •xi�h wages as I�eir sole comoensalion. �.vtll Oo tne work, antl t�e
❑ simcmre is noi lnrencea ar otter¢o �or sale �Secuon %0aa. Busmess antl Pmiessional CaCe: The Comranors' Siate license Law
• aoe5 noi a0ply Io zn owner p� a OraOeny w�o buil�5 or im0�ove5 ihereon, and w�o 40es Sut� work �imseltl�er5ell or I�mugh
nis or ner o'nn emoloyees. amviaetl Inal such impwvemenis are nat imendeo or o��erea tor sxle. II. nowever t�e �wleing or
. unpmvemznl'�s saia �niUm one year ol com0letion. I�e owner v+tll bave t�e burtlen of pmving �e/s�e aia nol Ow10 or lmpmve
N tor ine ourpose of sa:ei.
� I, as oxner o� Ine erooery. am ezclusively contracling witn licensed contraclors lo consirutt the Drolet� ISection 70<a, Business
� and Pro�essions COCe: ihe Conlraclors' S�ale License Lav� Qoes not ao0ty m an orvnei ol OroPerty'•vAo OUA05 or improves �nerean
and wno mnfracis Iw suca o�ole��s'xnn a comraaorls� license pursuani Io Ine Comracmrs' State License lawL I am aware
Inat prool al t�ei� :Yorie� i Comoensaiion insurance snoWd Oe pm�itlea to me.
� I am eaem0� under Sxnen'. B. 8 P. C.
lor Inis �eason: �� /� ���
�$fp � �i ��
Dare'. —� [,. �1lSLc.i�
I a0 �¢re0y cerUP� I�al I am aware ol anU understand Ne reQmremenls oi Calitomia Heal1� antl Sahty Code Sections Q5. 25533. an0
25533 andlM1a{ tor any WN2 1u�ICmq p�cuWnt^�iIR�xM1t�wt(citcle onel need ta comply wit� Said state CAtl¢s andl�e reduireme�t5lota
aerm�i �or consimclion or mOpibcation Irom Ihe Art Oualily Managemenl Dis«ict. flesiaeniial consimction apDlicalims are ezemp� �rOm
;neie O�ovisians.
�aie: Appfi[ant: �
I pete�y cetlAy I�al I M1ave read IAR ap0licaiian and 51aie Itla� ihe apove in�ofmaiion is correci. I a9ree lo com0ly wit� all ciry and coun�y
ordinances antl Siale Iarvs relaling lo Dm10ing [Onsimctian an0 M1erepy au��oriie re0�e5enlalrve5 o� Ihis tiry ID enler u0on t�e aDOve-menllone�
oropeny lor inso cuon a(�ojasn. / '
Oale' ` Signalw=- /]' no�/F-�/��j-�--�
Onvers license or Sooai Semmy .: $ �� ,
i64t.�6 Wmie—Bmbing: Green—CoOe Entorcemen��, Canary—Aoolrcant Pink—Pevenue'. Goltlenrotl—Assesser
CITY OF COSTA MESA — BUILDING PERMIT t .
PERMIT NO: B 051994 PLAN CHECK NO; 01607-91 S . .
CUNSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : ADD SKYLIGHT TO NEW ROOM ADDITION SQ FT: S00 '
CLAIM VALUE: 500.00 CALC—VALUE: 500,00 GROUP OCC: R-3 /M-1
COMMENTS: RE: B50869 PRIMARY HLDG. PERMIT.
�r�r��r�**�*��x��r***�rrr****�r�t***�**+r�r******+�**�t*�**r�*x**r�**«�****�rr��x**�►**x��***
Z O N Z N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ----------
FRNT: FT IN REAR: FT IN
LBFT: FT IN RGHT: FT IN
--------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN
PARKZNG REQ• PROV: PARCEL; 14133209 ZNE: REF NO:
PLANNING NbTES>
i
�c**��********��***�*�e*+��**�*�*�***�**��e«�r�+r*���e�***�*���*��+�***�**�*�*���*�***�
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:
HUILDING APPROVED BY : DATE: �
APPLICATION ISSUED BY: DATE: ��
iFlFifiEiE-1FififlfiklE3kififMiE3Flfif3fiiiE ±FiFIFiFaflElflfifiE jE*
ifiFiFaf�FiE*ififillEiFiFMiF�f1EiE1Eif3FiEiFiflfjFlFlEfEiFiEiF3FiF3fiF1 EiEiF ± ifliiFM�ik±E3tifk*itlfifaFiFiFifaFiEif3EififiFiEaf3F)E±fikiE#FjfaFlEaFif
LEGALIZATION;N F E E S U M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 15.00 SO
SMIP/NON—RES
ISSUE FEE 9�75
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15.50, 0.00 9.75 25.25 25.25 .00
REVENUE DIVISION TOTAi,S--> COLLECTED: 25.25 OVER/SHORT: .00
BLDG PMT PLUMBING £LECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
15.00 .50 9.75
If aF if 3F �1F if iF if *�F If iF if �f If if 1f �f if iF 1k iE �f * iE if if if iE iE If 3F ik M if 3� if iF iFif 1E if iF ik if iF if �k if if iF k M iE if iE iF iE k iF iE iE iF if IF iF if if iF M 1f �F iE If+FiF �f k ik
I N D I V I D U A L F E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 500 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 500,00
END OF FEES
V
:ii. n:.r..— ' _:��J.;O.''," .'�f_i i _ ...
L�G�C ....»l�. .."C. .0 �t
PNOJEC''T" _A,�O�P�E55: �30 � iJMA �� : UNIT:
0}yqwannME:L:.RiNG:R� F.bNN.'-'.TSI A
nooecss: U��1��rcR, ?a-r�iCI� .�
36� :,OMA CiR
i:GSTA MESA CA 926?.6
(7191�45-Ub59
AflCNIENGINEEX: ��0� �yjiGV CR1�-•�L�IA NEG.NO.: �vO�
aooness: z6035 ,yOULTON PKNY y� 5�
iAGJNA ={ILiS CA 925';3
PEFMIREE: L tn j 1 �GLR �� 1 4% J a J-� O`J �
ADONE55: 8 6 S LG� C y
C,N CA 920[��
LICENSEO CONTNPCTOfl OEClAM710N: I tieie�v alti�m I�al I am lirenseo under pmvisions oi C�a�1et 9 �commencinq �x�ID Section
70001 al Oies�on 3 ol me Business aro Pmfessians CoCe. ana my iicense is in full torce dna etlect.
LITY LIL.: STATE LIC.: CLASS: .
� )aiA: Slgnature',
WoBREPS' ComPENSRiION oECaRaT10N: I neie0y ellirm Nai � nave a cenificate of consent to sel4insure or a cemhcate of'!lorkers'
Comoensaiion Insurance. or a cemheo copy thereol ISection 3800. Lao. CI.
POLICY NO.: EXP. OAiE:
COMPpNY:
❑ CeNlred ropy is Gereoy Wmi5�e0. ❑ Cer,tli¢4 ro0y is :Aea wi�� Ihe ciry Builaing Oivision.
Date: Aoo��cam:
EREMPTIONFflOMWORMERS'COMPENSATIONOELLAHA710N: Qhissecl�onneeanoi�ecomoleteOiltAeoermilistwonebuncre0151q11+�lessl.
I cenity t�al In Ine oer9rmance ol Ne •.vork �or �xnicn tlli5 �ermii fs issuetl. I snall nol employ any person in any manner so as;o'�ecome
suC�C[t 40 It1! N(Oh¢K CARq¢nSatWn lacis 6� CdN10tNa.
�aie: SignaWre:
NOTICE: II. al�er maMing �his ceclaraUon, you s�oWd become suolecl Io fhe Workers' Compensauon pmvismns of I�e LaGor
Ga�¢, yDu muSt IppRwittl tpmpry'sRtl SutR O��viSiaRS 0[ INS 0¢tmM1 Sh011 he d8¢mCd r¢vOke�_ -
CONSiFI1CTI0N LENOING AGENCY: I hereoy afhrm IAat I�ere is a canstmcuon lentling agen<y fori�e pedormance of ��e �sark for
wh¢n Ihis Oermii is'�ssuetl (Sectmn �097. Crv. C�.
LENOEfl:
p00flE55:
OWNEfl BUILOEP OECLAflRTION: : aer^�y al�um ;�a� I am ?aemp� Imm ;he Convactors' Sla�e License Law lor Ne following :?ason
($¢CliOn iN1.5 Bu9ne55 and Pm:e55i0nal Coae: Any [iP� 01 [ounty •xpi�� repuires a Oerrtiil io Con9Ntt. aller. imprOve. aem01i5�. or
reoair any simclure. orior lo its issuance. a�so 24uves t�e aoo�icant lor such oermit ta ble a signed slatement tnat �e/sne is licen5¢4
�ursuam io Ine D�omsians ol tne Comacmrs' Slale Li�ense law ICnapter 9(commencing wiM Section 700010� Drvision 3 at tne 0usiness
ana Pmtessions CoDel or t�a� �e/sne is eaemo� IhereUom arC ;ne Easrs tor t�e allege0 exemption. Any violation o� Secbon 703t.5 Gy
any apD�kani tor a Oermn su�jec;s t�e apoh[anl to a civd penalty of nol more than fiv¢ Itundred dWlars �5500�.
� I, as owner o� Ine prooeny ar my emoloyees witn �.vaqes as Iheir sole compensalion, will tlo Ine waM, ana tne
�I y�ru<Wre is nol mlen0e4 or oRered for sdle (SecUon 70aa. Bu9ness ane Professional Coae: ipe Conlraclors' Slate L¢ense Law
Aaes nol aoDly io an owner oi a vmperty wno hudtls ar improves ��ereon, and wno does suc� work �im581V�erseli or :�rough
Ais Or �er o�.m =m0loyees provided ;�ai Sut� impmvemenls 3re no� m�endetl or otlere0 fOr sal¢. II, �owever t�e �mlaing Or
improvement Is sold wilhin one year o� com0�eiion, Ine owner will have Ihe buroen ol Droving ne/she tlitl not Dudd or imOrove
for Ine Ouroose �I sale�.
i, as awner ol tne omceiry. am exclusnely com�ac��� xa�n iwensed contmaors w coastruc� tne praien (Sectian 70m. Business
� ana Pmfesvons Coae: The Conuac;or5' Staie license Law Co¢5 noi appty lo an own¢r of O�oOerry w�o budds or imOmves t�ereon
gp0 '.v110 WIIIfdCIS �Of SUC� OfO�EC�S 'NI�11 d COI1�fdC�Of�S) �ICPIISE ppRlldlll IO �h2 �OOIfdCIOlS� SIdIP �ICPf152 �dW�. � dRl dNd(P
IOaI 0�001 ol IA¢il ':lOrker i Cump¢n5ali0n in5utdnt¢ StlOul� �P pro'/ide� IO m¢.
� i am e.emD1 wwe+ Stttion-. 8. 8 P. C.
b< <�is reason: ,/ `
oaie: l� J��� � Ow�T�'-s�L%�� /`� '�L='�"
I Qo nereoy cently inat l am a�.vare ot ano unaersUno Ine reauiremenis o1 Ca�mia Healt� ano Safery CoOe Seciion5 25505. 25533. an0
2553d antl tAat I or any luture �mlUing occupant vn�IlwAI no� (crtcle onel neeo ta com0ly wit� sai0 slate cotles ane I�e iepuiremenis �or a
permit Ipr conslmc0on or modJicalion Irom itle Au pudbry Management Otstt¢L Resi�ential con5lNc�ion a0phcalions are exem0� �mm
11125¢ D�OViSi0�5.
Oaie: � Aoolic�m:
I �ere0y c¢tlil/ IAaI I pave rea410i5 aoolication an0 stale I�ai Ihe a0ove informati0n is mrrecL I agree to comply wilh all city anQ cauniy
oramances ana stale 1a�.vs �e�aling Io �udtling ronsfNQion antl �ere�y aul�onze reoresentaiives o� t�is ciry Io enier upOn Ine aEave-meniron¢a
p�Opt�ly 10� inSpCCIiO� p�/�OSfS. �� � 'v/�/� .
/
'ryie: / � � 9 � Signa �ii[.(iv...Ji:...
-_'� -w s.��,.��., ,
r....,..`�'�-s.xr.r...� .. �. �
Canary-nopl¢am: Pink-Revenue: Goi48�m0-Asseswr
Ci'"Y p= =�=�Si�i M:S.� - clG.".i.D�VG P:.R:9iT �'ciM 'vp: a 0�0�6
?c�Mii v;�; c+ 6�085�7 ?iiaN CiicCR ;10: Oo550-90 S G•`.`V:; tv SJFP: ti
CO:VS'i�;jC;ION TYPt: �-N P=ii�!I: TYPc; STR ?iJcZPOSe: r1DD
J03 DE5�rtIPTZON : ADD :vOR'r: RM, DiNING RM 6 PANTRY/S:.ORAGE SQ rT: 602 -
CLAIM VA:,UE: CAi,C-VA:.UE: 41,538,60 GROuP OCC: R-3 /M-Y
COMME,�TS: S�iOKc: DnT�:CTOR(S) R��UiRe.D iN fiUMn. '
E if 3t iF it if iE fE if iE 1E iF N�Y- if if 3f if k�!f if if iF !E 4±E if k!t rt % if �k !f %� 1F !F iE ?F jE iE fE fEiE �E lE if fE IEjE iE If 1F fE if 1f k if ik if fi 1E 1E t'E iE iE If iE fF i�ff 1f if ii iF�lf ik
Z 0 N I N G R c Q i] I R E�1 E N T S _
s e�r a.� c K s .
------------ MAIN 3UIL,DI�IG ---------- --------- ACCESSORY BCiILDING ---------
��NT: FT IN REAR: ?9 ci IN rRNT: cT iaV REAR: cT IN
:,EFT; 5 FT IN RGH:: =T IN LEFT; FT IN RGri:': FT IN
PARKiNG REO• PROV: PARC'c'• i4:33209 ZNE: R1 REc NO:
PL.4NNING NdTr.S> ADD A PANiRY/STGRti�.E ROOM, DIN3VG ROOM t�Vt7 Ni0i2K ROOM i0 AiV .
> EX:S':ING SING;.c^ FA14I:.Y RESIll:NCE-: -
x-+r�r*+�t�x�*+t****rtrtx�ie��ri����r*�r*x��r�rzrt+r<�rx,e±r�x�x���wx�*��r�r�r���*�rrti��*�!�+��rx�xx���c�x��ir*x��t*x��ti�r�
D E V E L O P�1 E N T S E R";. C n S r7 E Q U I R E M E N T S
zoNi�c aP�aov_� aY �� L.�. �- �,�:�; o131�i j
Bi;ILDI�G a��riovEn aY : �a•;�:
A?PLiCr1TIOv ZSSUtD BY� Dp;'E;
if if iF iF tE 1E 1f iE iF iE iE 3f iE 4 1f 3E !E lt lE +E iE .. .. ... � i A�iF�E .�!h k«'F ?E f f k k lh n� .�F )�F�r�3t fe
itikiFifiElFiMiEiE+hiElfiElEiklklElf?EiE7fififiEklFiElE4iFE1fit1kik3k�if ?E!f!F?(-%iE1FY�MIf:EiFiFiEiE:4kiEiE?fattk!k!4!t!i!M1k7E:fr.3E3F?f'E�i�3F:4't
�eGALIZ�;:ION: � . c.. :: N;v A c� Y 5��iJ�='::J�iA:. JLGV�IV�; 1
a:.JG P,�iT Pi,"vMtiI\�. ci.'' TR_C ;^.::C�A�_C :=n� �7�it�/r��::; GitP.Di�G
PER4:iT �62,50 �.9i
JVt?�1�iU�l-t�l.�
PLAti �35,63
:SSur. FEE
3UIi,DING-DIV-% PER:MIT ISSuE ?i,AN-CHcCK ',OiA� r�AiU ��;;�
TOTAiS----> 3o5,4i U.OU Z35.6J 50i,04 50i,04 ,OU
aaVtNJE DiVIS'.ON TG'"Ai.S--> COi��'C'.cD: 365,ai 00'crii�riORT: .00
BLDG ?Mi PL'JM�itiG e:,cLiRiC ��:Crir�tilC r"'iR'c" SMii'/'i0i uRr1i7=��G r��::�V-Cnc�i�
362.5G �.�:
±h M k 1k ff ±E iF�IE if 1E if fk k±E% � N�iE i(� it ifE i! )E ! iE1E 1t rt 1E if ak it it !k if it iF iE 1E iE 1f 3E k iE iE Y k lE 1f ?! R!f 3F.Y ��k iF k�f i! < E�E t rt'4 3f i! ?E �(- lE !f .�E .V� �! lk ?f �
I N D� V I D � A L c E c. H R E A?: D 0>v N
TY?E Q:'Y D c S C R I P: i O V �tiIT COST TOT.�.;, CGST
SiR o02 D4iE:-TY?E V-rIUOII FRAN;c -GOOD 6S .00 41 ,;�8 , 00
c.NU Or' FEE�
V:__vJ , . �, .. _. .
_"' "_'"-' - �� -�.
a�ME: 86S LOMA CZ
DERINGER, KENNETH H
nooness: DERINGER, PATRICIA J
865 LOMA CIR
,COSTA �ESA CA 92626
(719)545-0�59
UNIT:
'pHCNIENGINEEH: RAMOS DESIGN CRITERIA . pEc.xo.: NO �
nooeess: z6035 MOULTON PKWY �',� 55
LAGUNA HILLS CA 92653
aexminee: DERINGER ( 714 ) 545=0659
AODHESS: 8 6 S L��l�. C I
CM CA 92626
LICENSE� CONTRACTOB OECLl�BATION: I herehy aflirm thai I am Iicen5e0 untler pmvision5 Ot Chapler 9(wmmenting wi�h Setiion
7000) of �iv�sion 3 of �he Business antl Pmiessions Catle, anU my license is in full force and effect.
. CITY UC.: STpTE LIC.: CIA55: ,
1a1F� SignaWre'.
NOHNEflS' COMPENSATION OECLAflATION: I hereby atlirm Ihat I have a cetlilica�e o� consen� ro sel6insure or a certiticale ol Workers'
�. Compensalion Inwrance. or a cerulied copy �hereo� (Sec�ion 3800. Lab. C).
�' POUCY NO.: E%P. OFTE:
COMPANY:
❑ Ceni�ietl copy is hereby Wmis�etl. ❑ Cetlilied coDY is file0 wi�h �he ci�y Building �ivision.
�ate. Applicant:
ESEMPTION FPOM WOBI(EHS'CUMPENSATION OEClA8AT10N: �ihissenion nee0 nolbecomplete0ifihe De�mitislarone hundretl�St00�orless).
I certify Ihat in Ihe pedormance ol Ihe woB lor which ��is pe�mit is issue4 I shall noi employ any person in any manner so as lo become
suble�� �o Ihe Warkers' COmpensation LawS 01 Cali�ornia. .
Oaie'. SignaNre:
NOTICE: IL a�ter making Ihis tleclara�ion, you 5hou10 become subjec� �o �he Wofkers' Compensation provisions of Ihe Labor
Cotle. You mus� torlhwilh comply wiih such provisions or this Dermil shall Ue OeemeA revoketl.
CONSTPUCTION LENOING ACENCY: I �ereby aifirm Ihal �here is a constmclian lentling agency for Ihe pedormance o� the work for
which Ihis oermi� is issue0 �Seciion 3W7. Civ_ C�.
LENOEP:
FODflESS:
OWNEB BUILOEP OECLNflPTION: I �ere�y a�firm Iha� I am ercempt �mm �he ConVac�o�s' State license Law tor t�e �ollawing �eason
(Seclion 7031.5 Business antl Pmlessional CoOe. Any ci�y of counry which repuires a permi� m consimc�, aller, improve, tlemolish, or
repair any slmclure. prior ta its issuance. also reQuires ihe applicant tor such permit to file a signetl statement ihat he/she is Iicense0
_ pursuam to ihe pmvisions ol the Coniracmrs' Siale License Law (Chapler 9(commencing wnh Section 7000) o� Oivision 3 0� ��e Business
'__pnA Pm�essions CoOe) or t�a� he/s�e is ezempt iherefrom antl ihe basis �or Ihe a�leged eKemp�ioa Any viola�ion of Section 7031.5 by
'`'any apD�itanl for a petmii SUbjeCls ��e applitant �o a tivil p¢nal�y ot noi more �han �ive hunared Oallafs (3500).
�p,� I. as owner of the propetly or my employees wilh wages as iheir sole compensaiion, will Ao Ihe work, antl Ihe
u simc�ure is na� m�endetl or oliered for sale (Section 7044, Business and Pm�essional Cade: The Con�rac�ors' State License Law
Ooes no� apply to an owner ol a pmperty who builds or impmves therean, antl who tloes such work himselt/herseli or ihmugh
his or her own employees, providee that such impmvemen�s are not intended or oHered for sale. If, however the �uilding or
impmvemen� is 5010 wi�hin one year o� completioq �he owner will have �he hurden of Dmving he/she tliA no� build or impmve
�lor ihe purpose ol salel. . �
I. as owner o� t�e pmpeny. am exclusively coNraciing with licensetl conVactors lo construci ��e pmjeci (Sec�ion 7044, Business
��' anU Professions Code: The Contractars' Stale License Law tloes not aDDly Io an owner af property who OUAds or impmves Ihereon
antl who conlrac�s br such pro�ec�s with a conlrac�or(5) license pur5uani 10 Ihe Contracto�s' S�a�e License Law). I am aware
�hal pmo� of Iheir Worker'S Compensalion insurance should.be pmvitletl to me. '
� I am exemp� untler Section: � � B. 8 P. C.
for Ihis reasan: ,/ ,'DI,� '�-_�—�
oate: � [�[_/ Ow"�/`�. �`�"u"'�
� I do �er¢by ceriity Iha� I am aware ol an0 un0erstantl �he requiremen�s oi Ca�omia Heallh an� Sa�ery Cotle $ections 25505. 25533, an0
25534 and�.ihat I or any Wlure building occupan� willlwill noi (circle one) neetl �o compty with saia s�ale coEes an0 the requiremenis lor a
permii for conslmc�ian or modtlitation from �he Air �ualiry Managemen� DistricL Residenlial cons�mction applica�ions are e�emp� irom
these pmvisions.
Da�e: _/ qpplicanP.
I herehy cetldy I�ai I have reatl Ihis applica�ion antl state I�ai Ihe above inlormation is correcL I agree to comDly wilh all ciiy anJ county
oremances and staielawsrelalingto builaing canslmc�ion antl �ereby auttwrize re0�esenla�ive5 aflhis ciiyto enter uponthe above-mentioned�
pmpetly lor inspection purposes. ,(�
. Date: _� � 3�� �_ Si9na4w(��� �+ •
onver's Llcense or Sociai Securiiy p:
t6at�d6 While—Builtling, Green—Cotle Eniorcemem', Canarv—Aaol¢am: Pmk—Revenue: GolEenrod—Assessor
, CI'PY OF COSTA MESA - BUILDING PERMIT PERM NO: B 0�086
PERMIT NO: B 05086� PLAN CHECK NO: 06550-90 5 GOVT; N SUPP; N
CONSTRUCTION TYPE: 5-N � PERMIT TYPE: STk • PURPOSE: ADD
JOB DESCRIPTION : ADD WORK RM, DINING RM 6�PANTRY/STORAGE 5Q FT: 602
CLAIM VE:LUE: CALC-VALUE; 41,538,00 GROUP OCC; R-3 /M-1
COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME. -�
�***x*�*�****�***�*****x-**x*�* **�r*�*x�x**�*���***�+��*�+��r*�**�*x**x�*�*�r***�*+r**
Z O N I N GS ER,rEBQAUCIKRSE M E•N T S .
------------ MAIN BUILDING --------'-- ------�-- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR: 39 FT ZN FRNT: FT ZN REAR; FT IN
LEFT; 5 FT IN RGHT: FT IN LEFT; FT IN RGHT: FT ZN
PARKING REQ• PROV: ' PARCEL: 19133209 ZNE: R1 REF NO:
PLANNING N�STES> ADD A PANTRY/STORAGE ROOM, DINING ROOM AND WORK ROOM TO P,N
> EXISTING SINGLE FAMILY RESIDENCE, ' '� '
�*�**;��*****�*x �*��*�r��*�****�r�+�*�r**�r�*��**x x'�r�xx�����**x�r**x�*****��rt**�x��x**�r�e
D E V�E L O P M E'N T S E /kt V I C E S R E Q U I R E. M E N� T S
ZONING APPROVED BY �G�.� �- DA'PE: �O'I�/9%
BUILDING APPROVED BY : '
APPLICATION ISSUED HY•
ififiEiElEiEiEifiEiEiE1FiElfiEikjE9E3EdF�f .
iE iE iE iE iE iE iF if if iF iF 7f iE 1E1E iE �3f iE if iE IE k iE i! iE iE iE iE iE iE iE ik i! iE
LEGALIZATION;N F E E
HLDG PMT PLUMBING EL
PERMIT 362,50 , �
PLAN 235.63.
ISSUE FEE �
DATE;
DATE:
o-�o-�- � ��F1EjE�EiEiEiE*iE3E��F��jEif
iF iE iE )E 3E if fE iE 1F If 3f iE iFlE iE iE iE 1E iE 3f it 3E iE if 1F iE if iE iE 3E jE 3f if 3F �f if iE iE jE iE
U M M A R Y STRUCTURAL SEGMENT:Y
IC MECHANIC FIkE SMI•P/RES GkAIJSNG
2.91
SMIP/NON-RE5
i
BUILDING-DIV-> PERMIT ISSUE Pi,AN-CHECK TOTAL PAID DUE
TOTALS----> 365.41 0,00 235.63 601,04 601.04 ,00
REVENUE DIVISION TO'TALS--> COLLECTED: 365.41 UVEk/SHORT;' 00
BLD62P50 pLUMBING ELECTRIC MECHANIC E'IRE SMIF�TOi GRADZNG PLAN-CHECK
� �
?f 1E If 1E iE iF iE iE�iE fE �f 1k!!� iE jE iE iE-1f if� if if �E iE iE ff 1F iE �lE 3E 1E'�E iE iE iE iE if 1k iE 1E iE �IE iE 3E IE iE 7E i(� IE iF iE iEiE 1f iE %� %�lf if %� 3E !E iE �)f iE if iE -IF iF iE?F iE 7E i(� lf 3E iE iElE iE
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 H S C R I P T I O N � UNIT COST ��' ' TOTAL 'COST
SfiR 602 DWE-TYPE V-WOOD FRAME -GOOD 69.00 ,41,538.00
END OF FEES
5
V'
07 OD07964?-DG�745a,^_ 'ft1T - -
oafc: ni ls.i�� � t�L: ss: �� "
CONSTRUCTION AND PLAf�:��NG
"wAPPROVALS Permit #
� 1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrica.l Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgmd. -
5. Steel Reinforcement
6. Electrical UFER Grnd.
7:'Footings ,' � '
8. Foundation
9: Water Pipe-Undrgrnd.
10. Structural Floor System
11 . Property Sewer Line & House Connection
12. Sewer Cap �
13. Roof Drains �
14. Rough Plumbing
15. fiough Electriwl-Conduit
16. Rough Electric Wiring
77. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rouc�h Heating & Air Conditioning
20. Rough Factory Pireplace ��
21. Ducts, in Str�ucture . . .. . -
22. Ducts, Ventilating
r' � -
23. Gas Fipe-Rough & Test ; "'
24. Roof Framing • � � •
25. Roof Sheathing . .
26. T�Bar Ceifing IStructurail & Monocoat
27. Frame and Flashing; ' �
. w1�00 L & SPA,
Date Inspector APpROVALS � Permit #
52. Pool & Equipment Location
53. Steel Reinforcement �
54..Forms �
55. Electrical Bonding ,.-
56. Rough Plumbing & Pressure Test •
57. APPROVALTOCOVEfl�GUNITE;,
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK 4i.�
. 62. Backwash & Receptor-Final � ,
63. Heater & Vent�Final "
64. Plumbing System - Final f
65. Electrical-Final . � "
66. Solar SYstem-Final '
s
67. Fencing & Access Approval ' .
68. APPROVED FOR PLASTERIN,G ;�
69. POOL/SPASYSTEMS�FINAL ��"'
FIRE DEPT. REQUIREMENT ��
, ., � ,
' ' ' ' • '''APPROVACS � Permit# �
�
• ` �{ '70. Underground Hydro * ��
�� �,� ,71. Produc{ Piping � Gas ❑ Oil
; � ,
�. ��i � ' , : i � � �2• Underground Flush _ ,
`' - "' � 73: Undergrnd. Storage Tank O Gas ❑ Oil
. �-� . -� , . . �
� . � 74., Overhead Hydro...
28. Lathing & Siding� � �. � ��
29. Insulation �. � �� � , 7j`
30. Drywall Nailing + -
31. Plaster Brown,Coat � � , � , �
�32. Electrical Power Meter-Final � �
33. Final Electric • � '
34. Final Heating & Air Conditioni�g � �
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 pomesticFinal �� •
42.�BackflowPreventer; .
43. Backflow Irrigation � '
'44. Landscape Irrigation System, _ _
45,. Sound Attenuation. �-
46.-Handicap,Regulations - '�
47. FINAL STRUCTURE & BUILO�NG
46. FINAL PLANNING-, ' ,
49.� Electric Release to Edison
50._Gas Release to Southern Califofnia,Gas
�d[C
i , i �� �n.� Chamiral -
�
Date Inspector
_ i.
i-
_ �, 76. Dry Standpipe ' � ,
�i •�i ,� • 77.'FIXEDSYSTEM�FINAL'� -
� �p t �t 78..FIRE PREV. FINAL ; ,
t W�'1 I '
I I 1 �� '- � HEALTH DEPT! REQUIREMENT
I „ � �$ , 79. FINAL INSPECTION ,- � ' �'
v
� `� (,�! � �80. FOOD CERTIFICATE ISSUED
� 'i � . .
� Ijj j� i �No�e"s: � .. � �.I • � �
ItL ", /i � '
�;j ;; � � �
,r �
�i�'� . .. ,
t� i
�
�) ,
ti. .
i:I
� f -� . .
,:; .
�, '
�. •
F j
, � . -
i Y �
' �
PHOJECT NOOflESS: E E S LOMA C I •
owxeR•s xame: DERINGER, KENNETH H
- noosess: DERINGER, PATRICIA J
865 LOMA CIR
COSTA MESA CA � 92626
('719)545-0�59
UNIT:
' PPCHIENGINEEP: RAMOS DESIGN CRITERIA xec.xo.: NONE '
nooness: 26035 MOULTON PKWY uxir: 55
LAGUNA HILLS CA 92653
� reRmiTree: DERINGER ( 719 ) 545-0659
aooeess: 8 6 S LOMA C I
CM �'- CA 92626
�
LICENSEO CONTBpC70B oECLANRiION: i nereby affirm �hat I am licensetl under Dmvisions of ChaDter 9(commencing with Sec�ion
7000) o1 Div��sion 3 ot �he Business antl Pmlessians Code. an0 my license is in lull force an0 effeci. '
CITY LIC.: STqTE IIC.: ClASS:
IDaie'. SignaWre:
WOFKEHS' COMPENSFTION OECIAflATION: I nere�y aitirm thai 1 have a cenilicale o� consem m sell�insure or a cenilica�e of Workers'
Compensatmn Insurance, ar a cenilietl copy ��ereo� (Section 3800, Lab. C). '
' '�9LICY NO.: E%P. DRTE: ' i
'OMPANY:
) Cetlilied copY is hereby �umishetl. ❑ Cenified capy is file0 with ihe ciry Building Division. .
Udle' ApplicanC
E%EMPTION FflOM WOANEBS' COMPENSIITION UECIAflPTION: (This sec�ion nee0 nol be completed i� �he Oe�mi1 is �or one huntlretl �$100) or less�.
I certify Ihai in Ihe pedormance of �h¢ work �or w�ich this permil is issued. I shall nat employ any person in any manner so as to become
sublect to Ihe Workers' Compensa�ion LawS oi Calilornia.
�aie: - Signalure: ' '
NOTItE: II, after making Ihis tleclara�ion, you s�ould become suble�� �o Ihe Workers' Compensation provisions of �Ae Labor
Cotle, you musi forthwilh comply wi�h such pmvisions or I�is permii shall �e tleemetl revoke0, '
CONSTBIICTION LENOING pGENCY: I hereby a��irm �hat �here is a constmc�ion lentling agency �or �he pedormance ot �he work lor •
which �his permit is i=_suea (Sectian 3097. Civ. C�. �
LFNOEfl: '
aooaess: �
OWNEfl BUILDEfl DECLAflPTION: I hereby allirm ihal I am exempl irom ��e Conirac�ors' S�a�e License Law for Ihe �ollowing reason
(Seclion 7031.5 Business antl Pmlessional Cotle: Fny ciry ol couniy whic� requires a permit �o cons�mc4 alter, improve, tlemolish, or
repalr any simtlure. prior to its issuance. also repuires Ihe aDPlicant lor such permil lo file a signed statement tAal Aelshe is Iicense0
Oursuani lo �he Dmvisions ol the Coniractors' S�aie License Law (Chapter 9(commencing with Seclion 7000) of Oivision 3 0� the Business
and Pm�essians Code) or I�al helshe is exempi Ihere�mm anA Ihe hasis for I�e allegeA exemption. Any viola�ion ol Sec�ion 7031.5 6y
an a licant for a ermit sub ec�s 1he a lican� �o a civil enali o� not more Ihan live hUntlreA dallars-�$500)
CITY OF COSTA MESA — BUILDING PERMZT ��
PERMIT NO: B 051994 � PLAN CHECR NO: 01607-91 S � , �—
CONSTRUCTION TYPE: 5—N _ PERMIT TYPE: STR PURPOSE:,ALT
JOH DESCRIPTION : ADD SKYLIGHT TO NEW ROOM ADDITION ,SQ FT: � 500
CliAIM VALUE: 500.00 CALC—VALUE: 500.00 GROUP OCC: R-3 /M-1
COMMENTS: RE: H50869 PRIMARY BLDG. PERMIT, ' '
***�t**�********+t***�r�r**�*�t�t�r***at*�+t*3t��*�**�tat��r�**s+�+e*+t��t*�*�******r ******rt�t**�
Z O N I N GS ERTEB�AUCIxRSE M E N T S , �.
� .
------------ MAZN BUILDING ---------- --------- ACCESSORY HGILDZNG ---------
FRNT: FT ZN REAR: FT IN FRNT: FT IN REAR: FT ��IN
LEFT: FT IN RGHT: FT IN LEFT: FT ZN RGHT; FT IN.
PARKING REQ• PROV: PARCEL; 14133209 ZNE: REF NO:
PLANNING Nn1'ES> • - '
i .
***�**��**�r*�*�**�**�*�***�****�*��r��****�*�*����x����*******�*��**���«,�***�r����*
' D E V E L O P M E N T S E R V I C E 5 R E Q U I R E,M E N T S ,
� �
ZONING APPROVED HY DATE: �
BUILDING APPROVED HY : ' DATE:
APPLICATION ISSUED BY• DATE: ,�,��
iF3F�fiFifi6iEifififiEiEjEil�if�lEiEafifif�EiF �. . F�i' �iFMiE1FfF�E1EiEiFiF3E iEiE
kiF3FiFitiFiEiElEiEiEifififiFlflfifiEiF�Fif1E3FiffElEaFiEiEaE�EffiEifiE 1EK • IEiFiFiFiEif�EiEitlfiEiE�fiflEiF�EafifififiE�ElFiEiEMIFiEaFiFlf�faEiFiE�f
LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT iPLUMBING ELECTRIC MECHANIC FIRE SMIP/RES • GRADING
PERMIT • 15.00 ,50
SMIP/NON—RES
PLAN , 9.75 ' •
v Pa P i Pa a v ISSUE FEE f
.BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL . PAID llUE
�, as owner m tee owpeny or my emp�oyees wim wages as meh so�e compensa�ion, will tlo me work, and �he . TOTALS----> 15. 50 �. �� 9. 75 25. 25 . 25. 25 �. 00
❑ simcture is no� in�enCetl or ol�eretl �or sale (Section 70EE, Business ane Pwiessional Code: The ConVacrors' Sta�e License Law , � _
tloes no� apply to an owner of a pmpetly who builtls or impmves thereon, antl who tloes such work himsell/Aersel� ar �hmugh
his or ner own empmvees, pmviaed ma� such impmvemenis are not imenaea or oneree mr sa�e. ��, however the buiiding or REV$NUE D I V I S ION TOTALS—�—> � COLL ECTED • 2 5. 2 S OVER /SHORT • Q Q
improvememissmewiminoneyeara�completion.�heownerwi��havethebumeno�pmvinghe�sheaidnothui�dorimD�ove . �$LDC�i Pr9"r PLUMHING ELECTRIC MECHAI�IC . FIIiE SMIP/TOT GRADING PLAN—CHECK
� . mr ine PurPose oi saiel. � 1 5. 0 0 � , , S � �
I, as owner oi ihe pm0eny. am exclusively coniracting with licensetl contractors to consiNct Ihe D�ole�� (Section 7044, Business 9 7 5
� antl Prolessions Code: The ConVaclors' Sla�e License Law does not apPty to an owner ol pmperty who builOs or impraves therean
and who coniracts for such pmleci5 wiih a conimc�or�s) license pursuan� lo ��e ConVaciors' Sta�e License Law). I am aware
ih9t proof of iheir Workei 5 Compensa�ion insurance should be pmvide0 �o me.
� I am exempt under Section'. , B. 8 P. C. . "'
�Or I�is reason' � �/�//)���
Dale'. ��/ Q"/�%� �,—/ 7 JI�Yi`-'ui/i�
I tlo hereby cendy �hal I am awzre of antl untlerstantl Ihe requ7remenis ot Cali�omia HeaIN antl Sa�ely Code Sectlons 06, 26533, antl
2553A and I�ai I or any WWre builtling occupan� willlwill noi (circle one) neetl �o comply with saia s�a�e codes and �he requiremen�s for a
permit �ar conslmction ar modilica�ion imm I�e Air Oualiry Managemen� �iSVict. fle5i0ential conSVuclion applicaiions are exempt �wm
Ihes¢ provisi0n5. ,
Date: ADPlican�:
I hereby cerlity ihal I �ave reatl Ihis applicalian and Slaie Ihai �he above informa�ion is correcL I ag�ee �o comply wil� all ciiy antl coun�y
ordinances antl stalelawsrela�inplo �uiltling con5imction antl hereby au�horizerepresen�atives o��his cityto enierupon�he ahove-menlione0
pmpeny loi msp ction p}'rposes. �,,�/ �/' (//j ' ��
Da�e:�Q1—�� Signaiurg�l�7�t� /X �1/i%/%�-✓�—!�
onver's Cmense or Social Socuri�y #_ �
I6a1-a6 Ydhne—Building: Green—Gotle Enlorcement Canarv—Ap0licam: Pink—Revenue: GOltlenro0—Assessor
1f iE if 3f �E �E aE iE IE �E iE 1E IE�E IF iE iF iF iE IE If fE iE 3E 3f �f iE �f 1E iF iE iPiE 3t IE IFlF iE 1E iF if !E �E aE 1f 1P �IE�E �F If iF iE if iF 1E iE IF if 3f iE iE IF if iE �E iE if iF iF 1F if aE if if iP iE iF iF 3f
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 2 P T I O N UNIT COST TOTAL COST
SFR 500 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 500,00
END OF FEES
. , �
i
i
Of. UOCv6871—O�J48hR73 '�t�"£' ry,,��,
�ATE: �5/0319i Til?E: In�31
CONSTRUCTION ANDPLANNING�� P� 'SPA �
APPROVALS Permit # Date InspeMor AppROVALS Permit # Date Inspector
�
1. Temporary Eiectrical Service or Pole 52. Pool & Equipment Location
2_Soil Pipe-Undrgrnd. 53. Steel Reinforcement �. .
:3.tElectrical.Conduit Utiliry-Undrgrnd. 54..Forms ` y, �- i
`�.t4:_Electrical ConduiY-Undrgmd. 55. Electrital Bonding ,
.� �
_; 5 rSt2el'Reinfo�cement - 56. Rough Plumbing & Pressure Test r
�
�:t, 6. Electcicel�l'IFER-Grnd. 57. APPROVALTOCOVER�GUNITE r�
� 9:1Footingr� ~ , - 58. Electrical Conduit�Undrgrnd. �•' -
�8a Foundatior 59. Gas Pipe, � Undrgrnd., Test '
�9�.�Water Pipe=Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
�, �-
10..:Structural Floor System - 61. APPROVAL TO DECK
17. Pro,perty Se�er Lin.Fe & House Connection 62. Backwash & Receptor-Final
12. Se"wer Cap y �; 63.�Heater & Vent-Final �
13. Roof Drains* 64. Plumbing System � Final
74. Rough Plumbing � ' � 65. Electrical-Final _
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough'Electric Wiring � 67. Fencing & Access ApProval
17. Rough Wiiing�Sign � 68. APPROVED FOR PLASTERING , �
16. Ro�gh Electri,"cJa,l�T Bar Ceiling � 69.,POOL/SPA SYSTEMS FINAL .
19. Rough Heating & Air Conditioning - - FIRE DEPT. REQUIREMENT
- - - - - :n �- :,: - N
20rRough�Factory Fireplace "�?' '�:'� �� v �T���'� "APPROVALS=.:-Permit# ` '� '�'
�r J S x i'�: '�' '.= �G: r 'C ?`S n:; CC e..^ L�- " � a - 1
� ` -P. 'F"F ?.S :! .� _ ?_v j ti.; _V, ic7 .. _
21:� DdCts, in St�uctZ�e; ,., .. . ,� �•- r R ; 70. �Underground H,ydro
22. Dutts, Nenttlating� . ^�� � S S�k x. �: 77. �producE'Piping O Gas � Oil
� �a �:��., .
23r Gas Pi e; Rou h &�Test ' `� `'T ''} " f �� `n � �'�' �` ""
, P 9 y � i„_; . �a Y g �� x �, 72. Underground Flusfi � x E..
` ... . ... . . :- _ .. r _.
24:,RoofFrami�ng �+t•- i'�-- �i-� �9 .� `�+::73?%Under9rnd.Storage,Tank»OGas ❑Oil -
25. Roof Sheathing ..' ' ',• ` �`� r. -' 'U, ;: ; ' p ._. „' `
a r,, � „„ � .,, � v. „ ' 740. verhead Hydro-;' �
26. T-Bar Ceiling (Stcuctural) &cMonocoat � � 'x = s?� � 75' Dry Chemical '� �s '-� �7 S
�+�� ti .�tY ' S�. .y
27�'Frame and Flasfiing u' '' �� " 76� Dr �Stan�pipe r � ;f S �'' ���
''z...:tY. •. � �• LL'v ;. Y
_28Y Lathing & Siding-r „ ��dti u. �e � � :f 77; FIXED SYSTEM_PINAL' v •V ^
t-�M. . ••� ••i. w
'29. Insulation � `"'w - '' � �� ',', ' �� , �' ' 78� FIRE PREV. FINAL � , ��
,�. s' i /�:. a> x
ti, c;:.:. i. : I.l ri • � ♦
� 30. Drywall�Nailinga•x � 'r J ' • „'n x .HEALTH�,DEP�.iREQUIREMEN7
�31. Plaster•Brown Cpat, �� � � ,. y , -7; ; �.79� FINAL INSPECTIeN ` =� '�'� ;:�
� 32. Electrical PowerMet?r-Fina1 � ? i� �.w , 180 ; FOOD CE�RTIF;ICATE ISSUED
�"
.33=Final Electr,ic 'Y ' '� � �"• L ' ' Notes: ?�� "� , !"
' tr, •.t 'f 'Y ±* � - y. r+ �,r,
f � -� 3: • p, ... �-. y ,:' * � �
� 34` Fin'al Heating &�Air Condition;ng ;� � � f� �. C, � C'tS S i�C
��
35'•Final Gas Pipe�'fPsV � r. �v 1 �•� 't� ` �� � t�S • t�' S�`
..x r: ;.. . � '/•;= Y � � .ra, �7.-i . ��.
' = . `-; y. , ; � . . , �r ` '
r36YHood or,CanoPv Y. _ , � r� � � � x' �c. ? ' �y;,•
- �Y-� � +i �Y' 1
- 37:'•Final Factory Fireplace ? � � ` � "' f i ��; + ^ ' �
'+: � Cti
- - y. �� �.r .. r Y lU I e •1 L• �
�38: Final Plumbing ;� ;,� i c- . I � .r �. .� + � p
: 39: Water Service-Final. � � ,� �. � � ' r `� ,.+�'7 ^� �: ::
� r tx i. v w ��
r�40:'GasService`final :,. ',.. ,Q�ri, � ?'.�r � � t. ; i�, i. c:p; �;' '"
s'41��Solar pomestic-Final� C. " �' =� r I +: v -`;� �- q
c' + :�' 7
:l �..1 ' > ' „ ��i .. �
42.�Backflow Preventei � �, 1 � � :� �.;� �,ti, , - "
. _ -.
_ 43. Backflow Ir�igation �T"�� ' �- �' =:V`�'+ _ � `
l� ' 4 1 � � .
- � i � S U.' '? 4 ,r p 0� c . v
: 44. Landscape I�rigation SYstem��;. - , 3: _ r ' 7 �7• y � � • v '� "
>�45:,Sound Attenuation �:x� :+ ' ��� �" �: ";" " :_ _ . ��,`S , " '
s �rs n �
. .' _
.�46; Handicap Regulations ,_� } ' �� . x i = u : � - .. - �
� 4�r.FlIJAL STRUCTURE & BUlLDING � � Q/ y :Y ' _ l. �� `� ?
�iV _ x
46."FINAL PLA'NNING ' ' `r � " ' � � :
� � .. �: � " -:� i h-
_�49�Electric Release to.Edison . � j;+� �i, � � -
_ � �:.. - �- .� -
�,50. Gas.Rel'ease, to $ouihem Califomia Gas Co �� � I %{' � ' - '��' °J `
w + . �-e • t'. � . q. `
: 51. CERTIFICATE OF, OCCUPANCY � . :; _ ;;; ;,;�• r',-;';, .j , :� _.
No. Date
PFOJEC7 RDOflE55: $� S L��i C I � UNIT:
OWNEq'SNqME: j�r,RINGE�i, KENNETH A � � -
p�DqfSS �jERINGLR, PATRICZA J
f36`_+ I,OMA CIR
t�STA ME�R CA 91F25
ANCH/ENGINEEH: (7� a �'95-0�i59 ' . flEc.xo.:
RAMOS DESTGN CRITERIA NONE
aooA¢ss: �6035 MOi7LTON PKWY ' uxir: 55
LAGUNA HII,1,5 CA 9:.'653
PEflMITiEE: QLUFSON COMPANIES, INC. (714)683-9120
aooness: 3336 DURAHART �
RIVERSIDE � CA 9'1507
LICENSED CONTqpCT08 DECLAHATION: I hereby aifirm thai I am Iicense0 unaer O�ovisions oi C�apter 9(commencing with Section
7000� o� �iv�sion 3 0� I�e Business and Prolessions Gotle, antl my license i5 in lull torce and ettect '
CITY LIC.: O S� S H 3 sTnTe uc.: 5 9 S 1. cus : g
Siqn re: _
JFN�' CO �ENZSATION��LANqTION: I here I have a cetldicate oi conient �o sel4insure or a cehiticate of Workers'
�ompensation Insurance, or a ceriifietl copy �hereoi (Section 3800, Lab. C�.
POLICY NO.: E%P. DATE: j
COMPANY: i
❑ Cenitietl copy is hereby furnishea. ❑ Ceni�ietl capy is tiled vnth [he ciry Builtling Division.
Oaie: Fpplicanl' ,
E%EMPTION FpOM WONREXS' COMPENSATION �ECIAflATION: (T�is seclian neea nat Ue comple�e0 i� I�e permil is for one hmMreO �5100) or less�.
I cenify ��at in I�e petlormance oi Ihe work �or which Ihis permil is issueJ, I sAall nol employ any persan in any mann/eJr�G as �/o��ecome
subleci �o ihe Workers' Compensa�ion Laws oi Ca6tor-' q/� '/�'!%`^��
Date: �.—._��'_— Sig 1l✓� _4 Y
NOTICE: IL alier making Ihis declaration, you 5hou10 become 5uble�� �o �he Workers' Compensation prOvi5ion5 0� the Labor
Catle. you must fori�wilh compty with suc� pwvisions or ihis Oermi� shall be tleemed revaked.
CONSTFUC7loN LENDING AGENCY: I nereby aflirm Ihat Ihere is a consimdion lentling agency for ihe pertormance of Ihe work for
whic� Ihis perma is issued (Sedian 30W. Crv. C).
LENOEp:
aooxess:
OWNEF BWLOEB oECL11RR710N: I hereby atlum tnal I am exempt,fmm Ihe Coniractors S�ate License law lor ihe following reason
(Seclion 7031.5 Business and Pmlessional Code'. Any ciiy of coun�y which requires a permi� Io conslmc�, alter, impmve, tlemolish, or �
repair any simcwre. priar m its issuance. also repuires ihe�apDlicam for such permit 10 file a signeU statement ihat he/she is Iicense0
oursuant la Ihe P�ovisions ol Ihe Coniractars' S�a�e License law (Chapter 9(commencingwilh Section 7000) ol0ivision 3 0� Ihe Business
�tl Pmfessions Code) or ihat he/she is exemp� iherelmm and ihe 6asis for Ne allege0 exemption. Any violation oi Sectian 7031.5 by
y apphcant br a permi� subletts �he applican��o a civil penally ot no� more �han five hunOred dollars ($500). ,
\,i. as awner oi �he pmpeny or my employees with wages as I�eir sole compensa�ion, will do Ihe work, an0 �he
❑ slmcWre is noi imentletl or o��ered �or sale (Sec�ion 70aa. Business ana Pro�essional Cotle: T�e Con�ractors' State License Law
tloes not apply to an owner oi a pwperty whn builtls or improves Ihereon, anA who tloes suc� work himself/hersell or �hmuAh
his or her own employees, proviDeO Iha� such Impmvemenls are noi in�en4e0 or oifereG for sale. If, �owever t�e 6uil0ing or
imOm�emen� is sold wilhin one year ol completion, ��e owner will have ihe 6urden of pmving he/s�e ditl no� �uild or impro�e
�or �he purpose ol sale�. . '
I, as owner of ihe pmpetly, am exclusively caniracting with licensee coniractors to consiruct the prolect (Section 70d4, Business
❑ an0 P�ofessions Code: Tne Contracmrs' S�ate License Law tloes not applyto an owner of pmpeny who builOs or imDmves ihereon
and w�o coniracis for such pm�ecis witn a contramor(sl license pursuant m@e Comractors' State License Law),I am aware
ihat O�ool oi their Worker's Compensation insurance shoultl be pmvided m me.
� I am exemp� unAer Sec�ion: 8. 8 P C.
for Inis rcason'. �
Date'. Owner.
I Ao hereby cetlity Ihat I am aware al antl un4ersiantl �he requir¢ments ol Cali�omia Health anU Safety Code Se[lions 25505, 25533. antl
2553a antl �bal I or any IuWre buAeing occupanl will/will not (circle one) neeA to comply witn saitl sta�e co0es and ihe requiremenls for a
permil lor con5imction or moAificalion Imm �he Air Oualiry Managemen� District. Ne5i0ential cons�metion aODlicatian5 are exemp� �mm
��ese pmvi9on5.
Date: Applicam'.
1 here0y teruly Ihat I �ave reatl Ihis applicalion antl Slate Ihal ihe abave inlorma�ion is wrreq. I agree Io comply with all ti�y
ortlinances antl s�alelawsrelaiingto �uilding conslmciion antl hereby authoriie represenlatives o��his ci�y�o enier upon�he ab
pmperty f0� in5pection purpo5e5
�aie:3 ' I 3� � I Signati :_
omer's �aense or Socia� Securiry x: $
16dL46 Whiie—Builtling; Green—Cotle En�orcement: Canary—AOPllcan�: Pink—Revenue'. Goltlenmtl—Assessar
CITY OF COSTA MESA — BUSi,DING PcRMIT i�ERM NO: c 05139,=
PERMIT NO: E' 051397 PLAN CHECK NO: N GOVT: N Si:fPP; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE . PURP�]SE; OTH
JOH DESCRIPTION : ADD WORR RM, DINING RM,6 PANT2Y/STQRAGE SQ FT: •
CLAIM VALUE: CALC—VALUE: ' GROUP UCC: R-3 /M-1
COMMENTS: RE: P�0864 PRSMARY BLDG. PERMIT. �
if 1!� 7( � �f iE if !f� IE 1f if� Y{FY.� Y.- NK )F � IE R Y if iE iF iF 3E iE iF 7f i4jF iE if 1E IE iF�1F if iE 1f M• iE iE 1E 1f j4' iE �1E ib af ii iE aF �f If x,- {F if * iF iE IE 3E iF 7F iF 3F if iE iE-lf 1E iF ie IK if fF �1F if
7, O N Z N G R E Q U�I R E M E N 3 S' ' �
S E T B A C K S
------------ MAIN BiJILDING ---------- ----=---- ACCES�ORY BUIiDZNG ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; yT Z13
LEFT: FT IN RGHT; FT , IN LEPT.; FT IN �GHT: FT IN
PARFCING kEp � PROV: PARCEL; 1413.3209 ZNE: REF �30�:
PLANNING NC)TES>
�
�f #F If jt iE if �e if if iE iE iE if� # i'r iF IF iF #F 3i iF 1i-V.� iE i2 i't ik if * �F 9E #�If iE �lE i! fE IF if-ic {! if IE iE iE if iE � if�!` i(� iE IE i! iE lf lf if �u �F 1E }!� {: {c �li iE iF ic?i lE } iF iF if .v. iE #'� iE ih
D E V E L O P M E N T S t. R V I C E S R E[i J I R� M E N T S'
_ZONING APPROVED BY DATE;
HUILDZNG APPROVED BY : � DATE: . �
APPLICATION ISSI7ED HY; DATE: � �3 �
iEdfiFlEiE1F�1EiFiE3E1EiEiF%MY�ifif%iEfEiF . . . . . �ifiFif�ihiEif�fiE3f� . YiF1E
ifiEiF141EiFiEiFiElEifiEififkiEiFiEifibiFiEiflf-1f1E1ciFiEiEiFiElk3FiEifaEif3fi41EiF1Fff If .ifikiE#iFY�lf�f3fiEiFiEiE�ififitifif�?�i#f#F34ik.if�iflFlfikiElFiE
LEGALIZATION:N , ; F E E S U M M R Y , STRDCTURAL Sc.GMENTcN
BLDG PMT PLJMHING ELECTRIC M�CHANIC FIRE SMIP/RES GRRDING
PERMST• 32.00 �
54Y � . SMIP/NON—RES
PiaN . _ � , .
ISS[IE FEE ' 15,00 '
BUTI,DSNG—nIV—> PF.RMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 3:.',UU 15,00 O,UO 47,00 47,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 47.00 OVER/SiiOR1; .00
BLDG PMT PiUMBING nLECTRIC MECHANIC rIRE SMIPIT01 GRADING FLP.N—CHECK
97.00
0
�f 1k fF � k iE-16 �JE fF iE �E 3F,ib�F if k le iE # iF if Y.- iF iF iF jf� 3F ff !F lf �f 1F 1E 951f §f i£ 1E i63F lE #F 1f # iE 3f �IF if iF i'� 3F �1F iE IF i!� #�IE 3E ih �Ir if i!� 1! k 1f 1t ib ib if li 3f �Y �)f iF.;c iE if � i@
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 DNIT COST TOTAi COSi
ELE 20 RECEPT/OUTLET 1 ST 20 ; EA „ .75 15,00
ELB 8 RECEPTlSWITCH 1 ST 20 EA. �,75 6,00 �
ELE 1 SUH—PAt3EL 11.00 11.00
END OF' F�.ES
0
az 000szss�-coas2ss� re� v �-.�,r�
DA?E: �3/14!41 TIt1E: 16:?3
CONSTRUCTION AND PLA�, .�G � . POOL & SPA
� APPROVALS Permit #-�- Date Inspector pppROVAI� 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-llndrgrnd. 54. Forms �.
4. Electrical Conduit-Undrgrnd.'� 55. Electrical Bonding
� 5i,Steel Reinforcement 56. Rough Plumbing & Pressure Test
• 6. Electrical UFER Grnd. � . 57. APPROVAL TO COVER�GUNITE
,
7. Footings - . 7 58. Electrical Conduit-Undrgrnd. �
- , � . �
8. Foundation � ' ; �. ;� 59. Gas Pipe, O Undrgrnd., Test �,
9. Water Pipe-Undigrnd. �'� t � 60. Backwash Lines, P-Trap, O Undrgmd. ���'�
10. Structural Floor System ' 61. APPROVAL TO DECK /��
11. Property Sewer� Line & House Connection �/ � 62. Backwash & Receptor-Final � ; 1
12. Sewer Cap , �� 63. Heater & Vent-Final !'
13. Roof Drains � � �� 64. Plumbing System - Final '' �1
� '
14. Rough Plumbiny ' • ,� ; 65. Electrical-Final ��
15. RoughElectrical-Conduit �:'_ ''/ 66. SolarSystem-Final '"
,�
16. Rough Electric Wiring ,�� � 67. Fencing & Access ApProval '� �
17. Rough Wiring $ign ��� 68.`APPROVED FOR PLASTERING ���'
18. Rough Electrical�T Bar Ceil ing �� � � 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating�& Air Conditioning � ' FIRE DEPT. REQUIREMENT �
� ,
20.�Rough Factor.y Fireplace ' �:�� � - � ` - 'APPROVALS' •' Permit # � �
, _� . ,.
21.�DuCts,inStr;uctur,e' .. . . ,-� ' � ���70. Underground.Hydro -
22. Ducts, Ventilating � '' " 71, product��Piping O Gas ❑ Oil
23.-Gas Pipe`-Rough & Test . ; ,. , � 72. Undergr'ounci FIusF' � `
24. �Roof Framing ' • � � ��73.' Undergrnd. Storage Tank O Gas ❑ Oil � �
25. Roof Sheathing ' � ' ' . ` �"7q,-0verhead Hydro• � .
26. T-Bar Ceiling (St[uctural) & Monocoat � - - 75. Dry Chemical � - '
27._Frameand Flashing . �,' 76. Dry Standpipe - •'� ' �' ' ` � `
r ,.
28. Lathing&Siding �� . • � 77:_'FIXEDSYSTEM�FINAL•
�29. Insulation - ' "' �„ � t; � 78: �FIRE PREV. FINAL � ��
-30. Drywall�Nailing : r � ''.`�t; .1 HEALTH�DEPT.REQUIREMENT
_37. Plaster Brown Coat� ' ' ,t:;: �� J9. FINAL INSP_ECTION. : - �
32. Electrical Power�Meter-Final ,� �� �80: �FO00 CERTIFICQTE ISSUED
33.FinalElectric r 3C�1 • 'r"' �Noies: • • '
� 34. Final Heating & Aic Conditioning � . ' "l� � - . , .
35.�Final Gas Pipe�Test- . '' ' 1 - - � - � � � � : � - �
36'Hood or'CanoPY , ., � ' •'%'� � s , � � . � 'j
. �.^' _ I
37. Final Factory Fireplace ' � � '� %;"' ' - .
�' •
38. Final Plumbing 'r � � � . ' .;:�-' � . , � _ �
� 39. Water Service-Final' � ' : •-'� .
40. Gas Service-Final , `..' , : ' '
>41. Solar pomesticFinal - �� : � � - ,
42.�Backflow Preventer ' � - � � . .
i i.
43. Backflow Irrigation -- . .
�� �
44. Landscape Irriqation System , , .i� , , � '. ' , '" �
� 45.'Sound Attenuation � � � � � �.c , .
46. Handicap Regulations ' ' ' ' _
47. FINALSTRUCTURE&BUILDING
;.i .
48. FINALPLANNING r� ,
49.-Electric Release to Edison � " -
/'
50._ Gas Release to Southem California Gas Co �l � . �� ''
51. CERTIFICATE OF OCCUPANCY , . ,
No. Date
�
�cr noosess: g 6 5 LOMA C I uxrt:
Neesxame: DERINGEft; KENNETA H '
aooness: DERINGER, PATRICIA J
865 LOMA CIR
COSTA MESA CA 92626
(714)595—O�iSy
AHCH/ENGINEEN: RAMOS DESIGN CRITERIA NEG.NO.: NONE
AD�NESS: 'lEjO3S MOULTON PKWY UNIT: SS
�LAGUNA HILLS CA 92653
PE"miTTEE: DERINGER ( 719 ) 545-0659
aoosess: 865 'LOMA CI
CM CA 92626
LICENSED CONTBACTOB OECIAflRTION: I here�y affirm t�at I am Iicense0 under pmvisions of CAapier 9(commencing wil� Semion
700�) ot Div�sion 3 0l �he Busmess antl Professians Coae, and my license is in �ull tome and eHect.
CITY.LIC.: . STNTE LIC.: CLASS:
�e: � - Signaiure:
,flREBS'-COMPENSRTION DECUIPATION: I hereby afiirm �hal I �ave a cenificate ot consent �o sel4insure or a cenilicaie o� Wofrcers'
.umpensatian Insurance, or a cer�ified coDY lhereot (Seciion 3800. La�. C�.
POLICY NO.: EXP. OATE:
COMPRNY:
❑ Certdietl copy is hereby �urnished. ❑ Certrtietl copy is �iletl with the ciry Builtling �ivision.
Date: ApplicanL
E%EMPTION FBOM WOBNEflS' COMPENSATION OECLAPATION: �ihis section neetl not be campletea if the permil is lorone hunOreJ (5100�arless�.
I cerlity Iha� in the pedormance ot the work lor whic� Ihis permii is issuetl. I 5hail nol employ any person in any manner so as �o become
su0let� lo �he Workers' Compensaiion Lav�s ol Califomia.
�ale- Slgna�ure:
NOTICE: Ii. afier making �his Oeclaration. you shoultl become subject to the Workers' Compensalion provisions o� ihe Labar
Code. you musl �orthwi�h comply with such provisions or Nis permit shall be deemetl revaked.
CONSTHUCTION LENUMG pGENCY: I hereby alfirm thal Ihere is a cons�mc�ion lentling agency lor Ihe periormance of Ihe work lor
which Ihis Dermit is issuee (Sectmn 3097. Civ. C�. �
LENOEfl:
AUOPESS: - "' "
OWNEP BIIIL�EB OECLAflPTION: I hereby afiirm thai I am exempl imm ��e Conirac�ors' State License Law tor the �ollowinA �easan
�Seciion 7031.5 Bu5ine55 and Pmfessional Code: Nny city o� counry which requires a permi� lo consiruc�, aller, impmve. tlemolish, or
repair any stmclure, prior �o its issuance. also requires Ihe aDDlican� lor su<h permil to lile a signed slaiemen� thal he/she is licensed
pursuanl lo �he pmvisions ol the Conirac�ors' S�a�e License Law (Chapter 9(commencing wiih Sec�ion 7000) ol Division 3 0l �he Business
�tl Pmlessions Code) or I�a� ne/she is e�emp� iherefmm and �he basis for Ihe alleged exemp�ion. Fny vialation o� Section 7U31.5 by
p applicant for a permii sublecis Ihe ap0�icant to a civil penally of not more ihan �ive hundretl tlollars (5500�.
I, zs owner ol the pmpetly ar my employees wi�h wages as �heir sole compensation, will do �he work, antl Ihe
Q s�mctureis nolintentletl orof�eretl�orsale (Section 70G4. Business and Pm�esSionalCode: TAe Contrac�ors' State License Law
� tloes not apply �o an owner o� a pmpetly who builds or impmves t�ereon, and who Ooes such wo�k himseli/herseli or (hrough
his oi her own employees, pwvitled ihaLsuch impmvemen�s are not iniended or oflered lor sale. II, however �he building or
impmvemenl is sold wilhin one year of completion. ihe owner will have �he hurden oi Dmving he/she Oitl noi buila or improve
lor ihe purpose of sale�. . - .
- I, as owner o� Ihe pmpe�y. am exclusively canVacting wi�� licensetl conVactors to cons�mc� ��e projec� (Seclion 7044, Business
� an0 PmleSsions CoOe' The Conlmctoa' S�a�e License Law does no� appty m an awner o� pmDeM who builOs or impmves Uereon
and who contrac�s tor such prolec�s wiih a contrac�or�s) license Oursuan� to the Contractars' Stale License Law�. I am aware
�ha� pmo� o� iheir Worker's Compensation insurance 5hou10 be provitled to me.
� I am exempt untler Sec�ion: ' B. 8 P. C. �
tar I�i reason: -
��-s /9�
I do hereby cenify �hai I am aware o� ana wders�and the requiremems o� Calitomia Heal�h and a�ery CoOe ec�ions 25505, 25533, and
25534 antl Ihat I or any �uWre builDing occupant will/will not (circle one) nee0 �o camply with said Sla�e cotles antl �he repuirements �or a
permit for consimdion or modification from Ihe Air Ouality Management Disirict. Residential conslmciion applications are exempt imm
Ih25¢ pfOV1510115. /�
a� �AfMII'�+fi.�✓� �S ��%/
I lereby cerlilyihai I have reatl ihis applicaiion and s�a�etha��he above intarmation is wrrecL I agree ta compty wi�h all ci�y anU counry
ortlinances antl slaie laws relaiing �o builtling cansimclion antl here�Y aN�orize represen�atrves of ihis ciry to en�er upon �he above-mentione0
prape�iy IOr mspectmn purpases. '
� � . , „n . .., i _ ._ /.. . �
�Driver's Lmense or Somal Securiiy #:,
1641-46 White—Butldmg'. Green—Cotle Enbrcement: Canary-ApplicanL Pink—Revenue: Goldenrotl—Assessor
, ' C_ITY OF COSTA MESA — HUILDING PERMIT PERM NO: H 05114
PERMIT NO: B 051148 PLAN CHECK NO: N GOVT: N SUPP,: N
CONSTRUCTION TYPE: S—N PERMIT TYPE: STR �PURPOSE: ALT
JOB DESCRIPTION : RESHT. REROOF W/COMP , - SQ FT: 5,000
CLAIM VALUE: 5,000.00 CALC—VALUE: , 5,000.00 GROUP OCC: R-3 /M-1 �
COMMENTS; SMOKE DETECTOR(S) RE�UIRED IN HOME. �
�e*�r**�r*+r***��r��r�r+�*�r+�*********�r �����r�r****�r*�r****+�****�r�**�*��***��r�***x*x***��r*
2 O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- 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 REp • PROV: PARCEL: 14133209 ZNE; REF NO:
PLANNING NOTES>
� ..
if �E iE iFif If iE If it �f if 1f if If iE iE 1f iF *!F 1E if iE 1E iF if 1E iE if iE if iE if 1E If if if 1E 1f IE 1E �E fE 1f 1E iE 1E If 1E iE �E IE iE jE iE iE IF iFlf iE iE iE iE if 1f If jF iF %� iE 1E 3E IF iF if 1E IE if 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 � DATE: �'
BUILDING APPROVED BY : � DATE: =
APPLICATION ISSDED BY:
iE iE iE iF iE iE iF if 1flE iF if IF iE I: if if iE iE iF iF *�f'�'iFiF
if fF iF iE iF iE if if if iF IF %it 1t 3f jF iE IF if 1E �E itlE fE )E IE If iFli
LEGALIZATION:N �
BLDG PMT PLUMBING
PERMIT 72.00
�
itiFiFiEiFiFiFiEiEiF iFiFiFiFiEif)FiFiFiFiFiFiFiFiFiFiF3E#iEiFiFifiEiF�FiFiF1f��FiFiFaE
ififlElEiEiEifiEifiEifiE iEiklfifiEik163EiE3Flf*3EIfiEiEiEifjE�fiE3E1EiE1EiE3FiEiEiEifiEaEifiFiF
F.E E.' S U M M A R Y STRUCTUAAL SEGMENT;Y
ELECTRIC MECHANIC FZRE 'SMIP/RES GRADTNG
SMIP/NON—RES
PLAN
ISSUE FEE '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72.50 0,00 0,00 72.50 72.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: �'72.50 OVER/SHORT; .00
BLD,G72PM�T� PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT� ,GRADING PLAN—�HECK
k iE�F IF ft ik af if �E k!P IE if �F If �lf iF i6 iF ik IE if if if iF 3flf ib �F if ik iF If 1E�lE iE 1E if iE iE if iFiE iE if 1E IE 1E iE iE iF If ik 3EiE �E iF iEiF 1E iF iE iE �f �E )E jE iE jE iE �E iE )f 1f IF iE if �E iE
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 5 C R I P T I O N UNZT COST TOTAL COST
SFR 5000 REROOF BY VALUE RESIDENIAL NOZONE 1.00 5,000,00
• END OF FEES
e'�-���r�----.,
0
0
0
0
ox�r,da�.za�-��a�;�lz�� �rr��-�- �z.:>+s.
d."NTF: €�7/?�j:4: �(li��: �.?:�r
', -_ : ' ' �
CONSTRUC710N AND PLAb. ,.i POOL & SPA �� /
Date Inspector Date' Inspector
APPROVALS Permit # �� APPROVALS \�Permii # �- f�,!
1. Temporary Electrical Service or Pole ' . 52. Pool & Equipment Location '� : + �'";
2, Soii Pipe�Undrgrnd, _ . 53. Steel Reinforcement � �!
... �.
� . ..T,- �1' :. �r
-3. EI@ct;ic`ayCor�dilit�l�ility-Undrgrnd. � 54. Forms f: �r
�4.;Electrical�-Conilu+i=Undrgrnd. 55. Electrical Bonding � •j
(n r� il vr .�. i
.�5? Sfee`I:Reinfotcemerit - 56. Rough Plumbing & Pressure Test . f .�
.i•.. -. - v.�... . J
r . :
�r6. Eleetkica�.UFERGind. 57. APPROVALTOCOVER�GUNI7E= � � :�
..., ., �_.�
��7:`Foo�ings���'� F: 58. Electrical Conduit-Undrgrnd. ,. '_! .r
8' �Foundationr � 59. Gas Pipe, ��- Undrgrnd., Test � �;; .
9= Wa[er Pipe�ZJndrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd' � '.:.>
•a. ,i.�-
10.�Structural Floor System 61. APPROVAL TO DECK ' '
11. Property Se �Cr Line�& House Connection 62. Backwash & Receptor�Final � '
72. Sewe� Cap �, �, . 63. Heater & Vent-Final r;,. ;'.i
13. Roof Drains � '� _ 64. Plumbing System - Final ,!�
14. RoughPlumliing. �� 65. Electrical-Finaf �� `� .
15. Rough Electrical-Conduit 66. Solar System-Final . j� f' /�
?
16. Rough Electric�VJiring , 67. Fencing & Access ApProval � ��
17. Rough Wiring Sign _ 68. APPROVED FOR PLASTERING
18. Rough E4ecttic�BT Bar Ceiling . 69. POOLJSPA SYSTEMS FINAL -
' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
- ' u �+'J` F '� t li
20.- Rough Facto .ry Pireplace � b: r �t` = � C � �� -.. :pppROVAL=S�=� �Permit # • �' �
� 'r �a S_a. �.�<<' V:�t x C X LN.�:- � t �T .�:
� � _� � i;�.� `;a '� : :�c� 3. '� I11 lO T .
21., Duc[s, in�Structure,�: ... ,_ s c G Nr- .:. �0. Underg[ound.Hydro x '
22. Ducfs, Ventilating�.K i ':.'S N ^ S KT �' %qi_ Product iping CFGas O'Oil
� !- � � , r a� �: �.. c �.. .
23. ;Gas�Pi e Rough &'Test ' '' � _ '�'� `f F '� � � -'' ° �-` �'
P n7� a+ � C�:: x-72• Underground FIusF�, � y� p
24..Roof.Framing '��" �:-^- v��-' F= O a' �+ ��+' �73.�Undergrnd'Storag'eT nk �Gas ❑Oil
.9. Y.� •< IY HK :r � . L�S.�j
25. Roof Sli�athing ',1 ; r_ :: x . =� '� �.' ` ' �. ^ • :.. o : . . .. .
w, v i.* Y ti= a-74. ;Qverhead Hydro,-+�'
26 �J-Bar Ceiling (Struciuraq &;Monocoat '^ � a t�t�s k 75 �Dry Chemical " > <7 c;
e'.- �+ �s r ' �r �~ .r.
27.';Frame and Flashing,F ;a?1 � * .,. j� w; ^ 76.�D'ry Standpipe �s ;� � � �
' 28.� Lathingt& Siding.•-r =. _.q�.0 l; i � • �•i �••� ?- 77 e'FIXED $YSTEM�F'INAL' � ^ �`'
�29. Insulation � � � .r•� �� � : ��7 , ( � ' 78.>FIRE PREV. FINAL Y �,. j�
t ,>
�30. Drywall Nailing --�� �� � � Y� y HEALTH,DEPT?REQUIREMENT
' 31. Plaster B own.Co�t;f 5 � ,_,,. :;. � � 4 :; „79.'�'FINAL INSP_ECTION `" �' .�
. iF . .
F32.=Electrical�Pawer Meter.-Final .� � �- n: ; yµ s; i+80.t�FOOD CE�RT CATE ISSUED � � �
_ ,i.
t' ^ M1 �::. ... i C x r ,. ^ C" 7�� .a . �• r
.33.,Final Electric, �., n, i ,¢ i j ����Noter. � q t,_..}
r, r
� � � �. �-, i ._ ,c. , � t i . �.J ..� . . ,--_.
i34. �FinaF Heating:& Air,.Conditioning� ^ r � , -,:, f ,. x � � ;-j;G x ,� :� _
- t � � , �r n, •_ .t' ♦ ir.
35.:Final Gas Pipe`,Test' �x� � � I I= k" � ,: �''
.�,s s:�
.:: U v:� r �r
� �,r � L + u, ? • f �. >
a36. Hood or CanoPv _ � r•� + � ��; ��_`,: >_ a. i; . . • �. ���•
,+ z , r.
f37.�Final'Factory Fir�place,�, ; t � � � - � + :� � �'- '� "�
L (l;
' �. .. W .4 I � �t ` � .�
; 38. FinaLPlumb��g � � :J i �� �� * � s - .a m ,:,
f39. Water Service_Final+ � �� � �'' "� � � %'`� ^ � �
- s � • tc, t:: :: �. c,i . g
�;40. GasService-F"nal ', �,• ,t:�p- S -*,,'�+ � �:. =- 'Cl�. 1�ni - ' ,.
- .� �
?41. Solar pomest,icFinal `, -. � .. -` O�• ' : ¢^' ..
,:i t 1 i ��� + t�, �' .;.;
42.`Backflow Preventer. }� � ; :�: k ,� _ , , `•
43. Backflow Irrigation^� �= � '� �" � ��=� _ �+
v �y, v- • .'�; .
� '' �. „:.U. - '• - w �r.ti ^
,44. Landscape I'rrigation Systemy•,.;; u: r �, ;; �-. . 'r, ;�� �s,,;; _ nj ...
`45.�Sound Attenuation• J��' �'' '� �' '�' " � ^`=• •
z; "n�. �.+� -�
i .. . .^ : 1 . � ..n n. ^: i i ..._
:46.`,Handiwp'Regulatiops ' .,'r,_ r .� _,,. �
� �47�..;FINAL STRUCTURE & BUILDING 1 %S� s �- :.cS �+
� �. . t
�46.,FINHL PLANNINGi � ��.E.. a r_ I �� % �, . '� i= �; } ~ �
i _ � _ r
c49. iflectric Release to Edison � �• ( ' , �� : .i7 _ '
� i� �. ,�
^�50. ;Gas Release to Southern California Gas Co ; � �'%,�- �� .`_' - ` � � -� "
� � 7 r x
51. CERSIFICATE OF,OCCUPANCY' . /� . ; } ;� ,s�c• . �: � o
No. Date
2
I � i'� ��,1^ . .
�.. a j:. .j _ . .
CdSTA MESA BUILDING-SAFETY DEPARTMEN7 �E� y 196D. ,
P. o. aax s,� �o�,,, ��,,. ��Po��„ ya 8 cd -�:. :
Lv f 89, P�A,1-. .. �: : -
For Applicanf fo Fill In COrtIPI@fe�y APPLICATION FOR PERMIT �
TYPE OR PRINT BUILDING
BUI�o1NG
ADORESB
COSTA MESA CALIFORNIA For Office Use .On1�7" �
nece�vr no. �cRrrt no.
OWNER Mesa Del Mar Development Co. �;�r�
MAIL RCCtI CD !Y O�TE REC61VeD DAT[ ieeuCtr
ADDRESS 380QB. Coast Si hva I ,� —%G� I�'^� 9 l� 'Q(�`
cin CorooB del Mar HoAR 34220 AopRess
ARCHITE(.T 7E� CpSTA MESA. GALIFORNIA �
OR ENGINEER C CO OiBCSOII NOLIH �{ZZO
ADORESS C " ZONE TYPE " GROUP ��
CONTRACTOR �CGO'COLpOLSC�OII APPHOVEO
BY DATE
ADORESS 380� F.. coasc xi hwa � � ZONING
ZONQ NO.OF US6 OF NEW
GITY R�l I PLANS 2 I Bt11LDING� Stt
STATE^ �` SJ Q A+- C O_/ TEL LeaAL � L O n y J� .� �. i�.
OF LOT p S. I No, oP pLD6i. �
rvoW ON �oT p, p_ NO. IlOT1E
USE OF YARDS EVES
EXISTING BLDG. pppppyEO ALLO
9ETBACK L�NE FHOM / / � (C6NT8R L�NH 9TJ .
ceNTEx oP srn[ei T� REAR YARD SS, FRONT FT.
SIDE YARO ILEFf ,5�� IRIGHT l' R.SIPE FT.
DESCRIPTION OF WORK ,—
;
's
: .•
EXTERIOR WALL IROOF ^ _ L
COVERING COVERING ��
U9E OF OUIL�ING AND WORK IO BE PERFORMED
i�i..w�.rii,��__.�.u2r/ ..__LQ�,-,a��i. C? - � `f
� HBpCBY CIWOWLEDOB TilAi I HAVH uwo n�is ARLIGTION TM6 AMOUM BHOWN UNDlR VALUATION 19 POR TMC
AN� BT THAT TNE ABOVG I8 CORRHR ANO AOR[8 TO CAN- pUFP08[ OP t8iA9LIBMINO A P[PMIT P6Q ONLY.
PLT WITN ALL GITY OBDINANCEB ANO 8TAT6. WB pypU{J1TN0
awLolNo CONeTiiu N . - _ VALUATION
SIGNATURE OP PERMIT FEE $
PERMITTE y
'� - ! S� C� � S/' LTD PLAN CHECK S � d.�
. AUTHORIZED AGENT !, i .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. GLIRORNIA
For A�plicanf fo Fill in Complefely
TYPE R PRINT �
UILDING /
DORESS '�/_� L�l_ C� /li, �-
COSTPy MESA CALIFORNIA
�� �
USE OF
EXI$TING Bl
SfiTBACK LINH
TEL.
NO.
TEL.
, FIRE
�E,E RECEiVEp
AU� 21 �
�FlNANCE 0 1T
APPLICATIdNYFAjt ���E� .
BUILDING
�
For Office Use Onl y
I R[GEIPT NO. P[RI^.�17T y�J
/ / �O
�Y D�/j�i! REfClIJVED OAT! 168UlO
�) �.<L W � I �.ZG
� � r � ���
COSTA MESA. CALIFORNIA �
i.
� ' � � ZONING �
O� i I PLANS V I BUILD NGEW ��
S � (.),�� LE AL n �
DESCPIPTION I
NO. OP 8LD09./
NOW ON LOT e o wi� I I I_ I��� �— C7 C
� fCENT4P LINO ST.I
/ REAR YARDJ /'f'- FRONT
/� � I RIGMT /� / R. SIDE
ION OF WORK
;
FT.
DINC/! /� 6 NO. OF
i x ROOMS STOF
!RIOR WALL IROOF
3RING COVERING
OF BUILDING AND WORK TO BE PERFORMED
I XEREOY ACKNOWLBDai TMAT i MAVe REhD TH18 MPIJGTION TH8 AMOIIM BHOWN �NDER VALUATION IB POR TM8
AND BT�T! THAT TH ABOVL IB COPRlCT AND AOR68 TO CAM- pYP➢098 OP E9TA9LIBXIN6 A PlRNIT PEB ONLY.
PLY W�TX ALL CI INAHClO .WO 9TATE LAWB RHOUlATN6
BUILDINO CON ON. VALUAT�ON
SIGNATURE OF PERMIT FEE $ I�� AD
PERMITTE /
� $ �� c � PIAN GNECK $ (O • � O
AUTHORIZED AGEN �/ �O � �C {�
mr�� err c � lf /i%/
owxER GRANP, Francis
JOB ADDRESS 865 Loma Circle
GENERAL CONTRACTOR B1Ue H8Yeri Po01S
AP No.1�F1-332-09 LOT TRACT
BCTIONS
F
�
OCCUPANCY
coat
� Signature
�
BUILDING PERMIT NO. 1'76tS4
VALUE $ 2500.00
FIRG 7,ONF DE5CRIPTION OF WORI�V't.SWI.III POOl
DATF. GROUPJ TYPE jij 7.ON� R-1
�\
.�lr�r
i �
�
COSTA MESA BUILDING-SAFEN DEPARTMENT
P. O. BOX S17 ,COBTA MEBA. CALIRORNIA
For A�plicant to Fill In Comple+ely
- TYPE R PRINT �
BUfLO1NG
ADDRE6S
COSTA, ME5A. CALIFORNIA
0 MAII
Y��IRI
�E RECEIVED
AUg 21 ���
FlNANCE p
APPLICATIBNIYFQ� �g��ESA
BUILDING
For Office Use Only
REGEIPT NO. I � pIT Np.�/�
7 �O
!Y O TE RECEIVED DRTE 169UE0
li �i.���� )� �'� ��f/
COSTA MESA. CALIFORNIA
FIRE
-- ZONE TYPE GRO'�
�,e,. APPROVED �
BY DATE
/ ' ZONING
ZO NO. OF / U6E OF NEW
� �� �' I PLAN9 l emiowa
� BETBACK LINe FROM �^ �
tl V ILYIry
SIZE
EXTERIOR WALL
COVERING
USE OF BUILDING AND
S�6J
x�w��ua�rs. �
�
RIGH7 ia
OF WORK
OF
LINE 8TJ
"E—�—
—.3�� —o`
i HEREBY ACKNOWLEDGB TXAT 1 HAVE READ TH18 MPLIWT�ON THE AMOUNT BHOWN IINDER VALUATION 19 FOp THE
ANO BTATE THAT TH ABOVE IB CORRECT AN� A6REE TO COM-
PURPOB¢ OR, EBTABLIBXING A PERM�T FEE ONLY.
PLY WITH ALL C� RDINANCEB ANO BT�TE LAWB REGULATING
am�uao coHe �oH. . VAWATION
I g�GNATURE OF PERMIT FEE S/� � ��
PERMITTE � m
� ` $ � �/j PLAN CHECK $ (d ' � U
AUTHORIZED AGEN ,0��-+ "'O � �n � C
TOTAL FEE � LL
w,
� _1_3r'7�
C()STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 3f7 COBTA MEBA. CALIPORNIA
For Applieanf to Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRE6S R65 i.ema Circle �
COSTA MESA. CALIFORNIA .
OWNER Mesa Del Mar Devalopment Co.
AD RFSF. 3BOQH. COgSi Hiehvav :. �
TEL.
xo, ov e�eas.
� ��F ��C�� t�ia,���
FI�� a�gWs��.
�.o � g9, f'L R�1�T� QF COSTI� MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only j
RECEIPT NO. VCPMIT NO. �
�9 `�'tCt_� J,N
rsecei eo e'r owreq nece�veo o�re iesuEe
� � I /.d��-�D�DEr," O 14{:0
ADDRe�ss 865 Laaoa Circle
� COSTA MESA. CAL{FORN4A
FIRE � /%,�/
�nvr rvar � ran��o �.L l
ZONING
ZONH NO.OF I IlBE OF
"R�1 PLANB 2 BUILDI!
�eee� . l � n .. �-/
U6E OF ypRD6
EXI9TING BLDG. APPROVED
66TBACK LINE FPOM � ��/ (CCNiCR uNe !TJ
CeMex Ov sTxaei REAR� YARO FRONT
I �
SIDE YARD ILEFT IRIGHT R.SIDE
DESCRIPTION OF WORK _.__
BUIL�ING NO. OF /
8R8 ROOMS � STORIE6 (_
EXTERIOR WALL � � ROOF � . / '
� IJ.� � S�
- �i� � !
1�•IY-'1
a H6REBY CKNOWLEDGE THAT 1 HAV6 RSAD 'Ii118 APPLIGTION � n{E AMOLINT BHOWN UNDER VALUATION 16 POR TH!
ANO BT THAT THE ABOVE I6 GORRHGT AND AGPEE TO GOM- pUPP09E OF, E9TABL�HH�NG A PERMIT FEE ONLY.
PLY WITH ALL CItY O INANCEe AND BTAiE W9 pHOVLATNO
BUILDIN6 cowerxu H . VAWATION
HIGNATURE OF � � PERMIT FEE $ �L � (I'Z
PERMITTE ' . y
$'/, o g y. � PLAN CHECK $ I d•�
v -
AUTHORIZED AGENT
TOTAL FEE i OI