HomeMy WebLinkAbout994 TRENTON WAY - Building PermitsPERMIT TYPE
� CITY OF COSTA MESA �
� � � sv����N�•onr►s�oN
77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER. M07-00506
MECH
STATUS: ISSUED
DATE ISSUED: 10/15/2007
ISSUED BY: RMD
JOB ADDRESS: 994 TRENTON 1NY CM � Suite/Unit:
Vicinity: BATHROOM _ � ., . ����i ����N
SQ. FT: 0 � � �: , ..,,�: ,. . ,-. � . , . ,
SCOPE OF WORK: INSTALLATION OF 1�BATHROOM VENT FAN. �.. ��� �
' PER
OWNER: OW, DAVID J Address: �-
PHONE: 714-612-0335
APPLICANT: OW, DAVID J . ,
PHONE: 7'14-612d335 '
CONTRACTOR: OWNER-BUILDER
Address: Unit � ' '
City/State:
PHONE:
ZipCode:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $30.75
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: . . $0.00
REINSPECTION FEE: - $0.00 �
TOTAL FEES: $30.75 -
� � � � 994 TRENTON WA��iRES� � �
. - City/State2ip: COSTA MESA, CA
- Address: " 994 TRENTON WAY Unit: ' �
City/State/zZip: COSTA MESA, CA
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License No. 000000
CELL:
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § t, 12-21-92) �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and Tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.�
C9DE/. INSVECTIONTYVE ORiE IN1111RL5 40oE� INSiECTIONTYPE O��/ R� INli11A��
1816 Fiaed System Final Fira Prevention 206 Final MechaniCal �/R. �-j� u�
1266 Pool Spa Final 208 Final Plumbinq
200 Final Re-Roof 210 Final Electriwl
201 Final Blwk/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolilion ' 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:� •
I hereby aKrtn under penalty o( perjury one of the following declaretions: `'
❑ I have and will maintain a certifcate o( consent to selbinsure (or workerS
compensation, as providetl for by seclion 3700 of the Labor Code, for Ihe
peAortnance of Ihe work tor which this pertnit is issued. -
❑ I have antl will mainuin workers' compensation insurance. as required by
seclbn 3700 of the Labor Code, (or the peRortnance of tha work for which Ihis
pertnit is issued. My vrorkers' compansation Insurance carner antl policy
number are:
Carrier.
(This SCUim neediwl Ee mrtrdetaC I tnepemN is vahretl ef ine hunMatl dotlars (5100) wku I
Policy Number:
�� I certi(y that in the peAormance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
�o Ihe workers' mpens tion laws of Califomia, and agree that if I shoultl
become sub' o t rkers' compensation provisions of Section 3700 of
the Labor C h'th wmply with ihese provisio s.
0 /io7
.� —Applicen�'sSlgnaWre � ate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS �ECLARATION:
1 hereby affrm that I am licensetl under provisions of Chapter 9(commencing
wi[h Sec[ion 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eHect.
Lia # Class #
Comreaor's Signawre
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm Iha[ there is a consWction lending agency for the
peAormance of the woB for v,fiich this pertnit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE U1W (or the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a pertnit to
consiruct, alter, improve, demolish, or repair any s�ructure, pnor to its
issuance, also requires the applicant for such pertnit lo fle a signed statemenl
that he or she is licensetl pursuant to the provisions ol the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a pertnit subjec[s the applicant to a civil penalry of not more than
five hundretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
oftered for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
lhereon, antl who dces such vrork himsell or hersell or through his or her own
employees, provided that such improvements are not intended or oRered !or
sale. If, however, the building or improvement is sold wit�in one year of
completion, the owner-builder will have Ihe burden of pmving Nat he or she
did not build or improve for purpose of sale.�. ' '
� 1, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
�-�NSED CONTRACTORS to wnstnict the project (Sec. 7044, Business and
Professbns Code: The contraclars License Law tices not apply to an ovmer of
property who builds or improves thereon, and who contracts for such prqect with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
d /J�v 7
l, SignaWre . � _ Date .
305]-Ofi(3/0]) �
Owner ID venfied by driv��/e. es ❑ No .. •
Drivers License No. �. � Expires: ��2
Verifibation of Ownership by (lype of document, i.e. - propeAy [ax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certify that no ezcavation frve (5) or more feet in depth into wfiich a
person is requiretl to descentl, will be made in connection with worlc authorizetl
by this permit, and that no building structure, sc�(dding, false�wrk, a demolition
or dismantling thereof, will be more than ihirty-su (36) feel high. (Chap. 32, Grp
2, M 2, Sec. 347, Title 8, Califomia Atlminist2tive Code).
❑ As owner-builtler, I will not employ anyone to do vrork which would
require a permit from the Division of Industnal Safe[y, as noted above, unless
such person has a pertnit to do such vrork from the division.
Apvlifanl's SignaWre
Division of Industrial Sa(ety Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will lhe applicant or present or future building occupant need to file and
certify a Business Plan tor emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, that a Business Plan be filetl with the Cosla Mesa Fire
Deparimen� by every business which has at any one time dunng a reported
year a qvantiry of hazardous materials equal to or grealer than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressetl gas
al standard temperature antl pressure).
2. Does or will the applicant or present or fulure building occupanl need to file
a regisiration fortn for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 ot the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Depanmem by
eac� business which at any one time has on hand a quan[ity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard
tempera[ure and pressure).
3. Does or will Ihe applicant or present or (uNre builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials�7 ❑ Yes ❑ No
(Section 25534 of the California Heallh and Safety Cotle provitles that Ihe
Costa Mesa Fire Department may require the preparetion, certifcation antl
filing with the Fire Depariment of an RMPP by businesses which are requiretl
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of Ihe Califomia
Health and Safery Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require tor
me work which is the subject ol this appliwtion a permit for suc� wnsWction
or modifcation from ihe South Coast Air Qualiry Management District or from
any other air polWtion conhol district or agency? ❑ Yes ❑ No
(Sectbn 65850.2 of lhe Califomia Govemment Code requires tlia[ the requestetl
infortnation be tumished on applications ta noo-resiAential building pertnits).
6. Will any part of Ihe (aciliry to be constructed under this permit be within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf yes', the /acilily must meet Ihe requirement ot Sections 25534 and 42303
o( the Cali(omia Health and Safety Code).
7. If a permit from ihe South Coast Air Quality M1lanagemenl DisMct or other
air pollution control district or agency is required for the wnrk which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8, pf yes", attach certificate of compliance fmm the appmpriate air pollulion
control oKcer�.
CERTIFICATE OF COMPLIANCE:.I cetlify that under penalry of perjury the
information given above is correcL"I agree to comply with all state laws and
cily ortlinances regarding Hazardous Materials and Emissions. �
CERTIFICATE OF COMPLIANCE AND AUTHORI7ATION OF ENTRY: I
certify under penalty of perjury that I have reatl this aDP�����on and state Nat
the information given is covecL I agree to comply vnth all state lavrs and ciry
ordinances r ting o building construction, and authonze representatives of
the City os sa to enter upon the above-descnbed property for
inspecti . I a ree not to occupy or allow xcupancy of ny huildin9
aulho � � until fnal insDection. /O /���
/ $ignaWreollegalOwner(s) (Date
Antl/or Aul�orizetl Appliranl
07/07/2008 10:09 FAX 949 794 4990 f THE AYCO C0. L.P. �OU1
� �
David Ow
994 Trenton Way
Costa Mesa, CA 92626
July 7, 20Q8
Ed Petros
Chief of Inspection
City Of Costa Mesa
P.O. Box 1200
Costa Mesa, CA 92628-1200
Re: Permit Number M07-00506
Dear Mr. Petros:
I am writing to formally request an extension for my perrnit. The installation of
two bathroom vent fans was completed several months ago and I received a
signed inspection card. I have not located the final sign off and I am requesting
additionai time to find these papers to submit to you.
Should you have any questions, do not hesitate to contact me immediately at
(714)612-4335.
Sincer ,
David Ow
�� � � CITY OF COSTA MESA � �� �
' ' � ' � BUILDING DIYISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 •�wnv.ci.costa-mesa. us
�• FOR INSPECTIONS CALL: (716) 754-5626
4�0 �."�
PERMIT NUMBER. E07-00854
PERMIT TYPE ELEC
STATUS: ISSUED
DATE ISSUED: 10/15/2007
ISSUED BY: RMD
JOB ADDRESS: 994 TRENTON WY CM Suite/Unit:'
Vicinity: THROUGH OUT HOUSE AND GARAGE ��•
SCOPE OF WORK: UPGRADE SERVICE TO 200A, COBPER REWIRE THOUGHT OUT. HOUSE AND GARAGE, 3 NEW UGHT FIXTS, 6
OUTLETS, 4 SWITCHES, 2 PHONE JACKS, 3 CAT 5 JACKS (ATTIC, MBED CLOSET AND FRONT OF HOUSE).
OWNER: OW,DAVIDJ,Address: � -
PHONE: 714-612-0335;� .,
APPLICANT: OW, DAVID�J � -
PHONE: 714-612-0335 � " � �
CONTRACTOR: O W NER-BUI LDER
Address: Unit - . ' PHONE:
City/State: . ZipCode:
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ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $73.80
Reinspection Fee $0.00
TOTAL FEES , $73.80
a
- -994 TRENTON WAY ' Unit
City/State/Zip: COSTA MESA, CA
Address: 994 TRENTON WAY Unit:
City/State/zZip: COSTA MESA, CA �
License No. OOOOOU
CELL:
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and.all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CODEt. INSPECTIOXTYGE ORTE INTRIRLS CODE� INSPECTIONME DATE IN7I11A1S
1676 Fixed System Final Fire Prevention 206 Final Mechanical
12fi6 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electnwl �� �
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign 222 � Final Site
204 Final Demolition ' 250 Final Building/Occupancy
W,oRK�RS' COMPENSATION DECLARATION:�
I fiereby aKrtn under penalty o( perjury one of the (ollowing declaralions:
❑ I have and will mainlain a certifcate of consent to sel(-Insure for wo�kers'
compensation, as provided for by section 3700 of the Labor Code, tor the
peAormance of the work for which Ihis Dermit is issuetl.
❑ I have and will maintain woAcers' compensation insurance, as required by
section 3700 of ihe La6or Code, for the peAortnance of [he vrork for which this
permit is issued. My workers' compensalion Insurance carrier and policy
number are:
Cartier.
/Tha seCun neeCnot Ge mmpeleC aMa pemM is vallotl er wra nuntlmtl M9ars (E100) w kss J
Policy Number:
�I certify that in the peAortnance o( the vrork (or which this permit is
i uetl, I shall no employ any person in any manner so as to become subject
to Ne worke ' mpe iOn laws o( Califomia, and agree lhat i( I 5houltl
� become su � to t rkers' compensation provisions of Section 3700 of
the Labor s rt �th comply with these provision �
/O /3 v 7
� npdipnYs Si9namre `Daie
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensetl under provisions of Chapter 9(commencinq
with Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in full force and eHect.
Lic. # Class #
Contracmr's SiB�aWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereDy affrm that there is a constmctbn lending agency for the
peAortnance of the work for wfiich this pertnit is issue0. (Sec. 3097, Civil Code).
Lender's Name:
Lender'S Address:
SignaWre Dale
OW NER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW lor iha (ollovnng reason (Sec. 703L5,
Business antl Professions Code: Any city or county which requires a permit to
construcl, alter, improve. demolish, or repair any sWCNre, prior to its
issuance, also requires the applicant for such permit to file a signed sta[ement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
BuSiness and Pfofe55i0n5 COde) or Ihal he or 5he i5 exempt lherefrom antl
the basis for the allegetl exemption. Any violation ot Section 703L5 by any
applicant for a permit subjecls the applicant to a civil penalty of not more than
fve hundred dollar5 ($500).):
❑ I, as owner of the property, or my employees with wa9es as their sole
wmpensation, WILL DO THE WORK, and the sWcture is not intended or
oftered for sale (Sec. 7044, Business and Professions CoCe: The Contractors
License Law tloes not apply to an owner of property v+ho builds or improves
thereon, and who does such vrork himself or herself or through his or her ovm
employees, provided lhat such improvements are not intended or oflered for
sale. If, however, lhe building or improvement is sold vnthin one year of
completion, the ovmer-builder will have ihe burtlen of proving that he or she
did not build or improve for purpose ol sale.�.
� I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LI ENSED CONTRACTORS to conslruct Ihe project (Sec. 7044, Business and
Professions Cotle: The conlractors License Law dces not appty ro an amer ot
property vfio builds or improves thereon, anC who contracts for such project with
a contractor(s) license pursuant to the Contractors license Wws:).
❑ I am exempt under sec.
Business an rofessions Code for this reason:
o �' 07
� SignaWre � Da12
005]>6l�]) -
,
Ovmer ID vedfied by dnv�e. es ❑ No � p� �����
Dnver's License No. ( Expires: 1/�a// �—
Verification oLOwnership by (type of document, i.e. - pmperty taz bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
❑ I hereby cert"rfy iha[ no excavation frve (5) or more feet in depth into which a
persOn is required [o descend, vnll be made in connection with work authorized
by this permil, and that no building sWCWre, scaffdding, falsexrork, a demolition
or dismantling thereof. will be more than thirty-six (36) feet high. (Chap. 32, Gry
2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Cotle).
❑ As ovmer-builder, I will not employ anyone lo tlo work which vrould
require a permit from the Division of Industnal Safely, as notetl above, unless
such per5on has a pertnil to do such work trom Ne division.
Applicanl's SgnaWre Da�e
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will lhe applicant or present or future building occupant neetl to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes � No
(Section 25505 of the Califomia Health antl Safery Code requires, with some
exceptions, that a Business Plan be filed with lhe Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity o( hazartlous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at stantlartl temperature and pressure).
2. Does or will the applicant or present or (uNre building occupant need to file
a regisiration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Cotle, with some
exceptions, requires regisVation with the Costa Mesa Fire Department Dy
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperatme and pressure).
3. Does or will ihe applicant or present or fulure building occupant need to
prepare an RMPP (Risk Management and Prevention Prog2m for acutely
hazartlous malerials)? ❑ Yes ❑ No
(Section 25534 of the California Health antl Safery Code provides that the
Costa Mesa Fire Department may require the prepara[ion, certification and
filing with Ihe Fire Depariment of an RMPP by businesses which are required
to register acutely hazardous matenals with the Fire Department.
4. I/ an RMPP is presently requireG, has Section 25534 of the Califomia
Heal[h and Satety Code been fully complied with? ❑ Ves ❑ No
5. Does or vnll the applicant or present or future building occupant repuire for
the work which is the subject of [his application a permit for such conSlmc�iOn
or modifitation from Ihe South Coast Air Qualiry Managemenl Dislrict or trom
any other air pollution control tlisMct or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requires Ihat the requesled
infortnation be fumished on applica[ions for non-resitlential building permits).
6. Will any part of the (aciliry ro be constructea untler this permit be within
1000 feel from the outer boundaries of a school? O Yes ❑ No
(If'yes", the facility musl meet the requiremen[ of Sections 25534 and 42303
of ihe Califomia Health and Safety Coae�.
7. It a pertnit from the South Coast Air �vality Management DisMcl or other
air polWtion contml disMct or agency is required !or the work which is Ihe
subject ot this application, have all of the disclosures prescribetl by California
Heal[h and Safery Code Section 42303 been made7 ❑ Yes ❑ No
6. (If'yes", attach certifcate of compliance from the appropnale air pollution
control oKcer). '
CERTIFICATE OF COMPLIANCE: I ceRify [hat under penalty o( perjury lhe
information given zbove is correcL I agree to winply with all slate laws antl
city ordinances regarding Hazardous Malenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalry of perjury Iha� I have read Ihis application and state that
Ihe informatio iven is correct. I agree lo comply vnth all stale laws and city
ordinance tin t vilding wnstruction, and authorize representatives of
the City os sa to enter upon the above-tlescribed pmperty for
inspec � . I agr no( to occupy or allow occupancy of an building
autho i til final inspection.
o r.�
Slgnature W Legal Owneqs) � Oate
An0/or AulbonzeG ApPLW nt
J Applicant m flll in all s0aces wilhin heavy bortler lines antl sign all approo�iate aeclarations. I Q2� 7�2a/8 � � 9.U) T�-
CITYLF COSTA MESA PEg,MIT NO TRACT NO. LOT NO. BLDG. NO.
.CONSTRUCTION PERMIT W�, ?� B� S_`�'-If� I I� '
Addrea
Address
LI
J NY TVPE OF CONSTRUCTION
Phon �/ '�(NEW ❑ ADD ❑ ALTERATION
� ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
�iCEnSe No. ❑ �THER
DESCRIPTION OF WORK
provitlons af Char[er 9
on 3 of lhe Busine!
10 full fo�Ce_ dDtl
Llcense Class � can;e �6
Date�'33"�� Signature �
WORKERS'COMPENSATION�DECLARATION
I hereby a(tirT thdt I havG d C<rtI/1CdIG 01 COnSGM lo SCILlnsure Of a
tertifirate of Workers' Compen5ation Insurance, or a tertifietl copy
tM1ereof �5ettion 3 1� b. ).
P��Ity No%���"•��Company -rs�l�i✓
artifietl copy I5 hereby furnlsnetl. . _
.ertifietl copy Is tlletl with [he city Builtling Divislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis sectlon neetl no[ De tompletetl If the permlt i5 far one nuntlretl
(Sloo) or leu).
1 certify that in tne performance of [he work fOr whith this permit is
Issuetl, I shall not emPloy any person In any manner so as to become
5ubject to the Workers Compensatlon Laws of Gllfornia. .'
Date Si9nature
NOTICE: If after making thls tleclaration, you shoultl become subjec[
to thE WOrkers' CompGnSdtioO pfOVI5IOn5 of the Ldbof Cotle, you musE
forthwith comply with such provislons or thls permit 5hall be tleemetl
revoketl. . ..
CONSTRVCTION LENDING AGENCV
I hereby affirm that tM1ere Is a conStrUctlon lentling a9ency for the per-
formante of the work for whlch this permit Is Issuetl (Sectlon 309]
Clv. C.).
Lentler'S Name
Lentler'S Adaress
OWNER BUILDE0. OECLARATION '
I herebv atfirm Ihaf I am exemot trom tha ConVac[or's License Law for
t+.ny ary or councy wnirn reqmres a permn io cons[ruci, aner,
improve, tlemollsh or repair any structure, prior to i[5 issuance, also re-
quires the appliCant for such permlt to file a signetl s[atement that he
is IIC¢nsetl pursuant to lh¢ provl51on5 of the Contraclo�'s License' Law
(Chap[er 9(commencing with SecUon ]000) of Divlsion 3 of the
Busin¢ss and RW¢ssions Cotl¢) Or [hdt h¢ IS ¢x¢mpt th¢refroT antl th¢
basis for the allegetl exemption. Any violatlon o( Sectlon 7031.5 by
- appliGant for a permit subjects Ihe appli<ant to a civll penalty
rt more than five huntlretl tlollars (E500).
, as owne� of tne property, o� my employees with wages az th¢ir
soie tompensation, will tlo tho work, antl the itruc[ure Is not Intentled
of Off¢r¢tl fOr zal¢. (SCCfion ]044, BuSinlss dntl P�'ofe55ion5 Cotle: The
Contractor•s License Law tloez not appty to an owner of a property
who builUs or imOroves thereon, antl who tloes sucn work nimself or
[M1rough nis own employees, provltletl that Such imp�ovement5 a�e not
intentletl or oHeretl for sal¢. I1, howev¢q the bulltling or improvemEnt
is sOltl within one year Of COrtlpletion, th! Own¢r will hav¢ th¢ bu/tlen
of provin9 he ditl nol build o� iTp/ove Po� lne pu�poze of sale).
❑ I. as owne� of Ih¢ orooer[v. am exclusivelv mnt�actina�wilh
TVPE OF PERMIT
❑ GRADING O FOVNDATION ❑ STRUCTVRAL
❑ TENANT ❑ ELECTRICAL OPLVMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION _
50. FT. ,
OCGVPANCV CONSTRUCTION TVPE
VALUATION ��ZONE
GRADING CV. VDS. ACRES
PLUM9ING PL�q
BATHTUBS SH
TO�LETS - . RII
LAVATORIES O
KIT. SINKS ' S
SERVICESINKS SU
FLOOR SINK$
DRI KING F NTAI
IN E CEPTORS LA
5 M ING POOL ' TR
WA ERSERVICE
GAS ERVICE OUT
WATE ERS BTU
A.P. �
ZONE
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
IAL CONDITIONS:
ELECTRICAL
TIONS
PLNG. REF. �
PROVIDED
PARK FEE S
PLANCHECK
J 5 TRANSFORMER 0-1 KW_1-30 KW _
LAVS APPLIANCE 10-50 KW_SO+�KW _
IWASHERS MOTORS ' 0-1 HP_1-30 HP'_
ps ;pNC $OLAR) 30-50 HP_ 50 * HP =
JR ORAINS FIXTVRES - OUTLETS 'SWITCHES
' ' GAS TUBE SIGNS ' '
RI 5 POLELIGHTS — .
ON
SEWER CONNE TIOI
SOLAR TANK COL�ECTOR'_
SOLAR PIPING SVS. �
ISSUE FEE � �
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-100,000 BTU _
AND;OUCT,ING
' t 300,000 + BTU _
ana vroiesvons wae: i ne convacwr'S ucense �aw aoes noi appry w�
an owner ot property who builtls or improves thereon, antl whotoo- aREFRIGERATION 0-300,000 BTU_
Iratlz from such ptojectz with a Contractor(s) Ilcesned pu�suani to�� {$VSTEM `� �
[he COOLIdCIOf'S LiC¢n5C LdW). - . Qf�1�00,000�+ BTU _
❑ I am exempt untle� $e<tion B. & P. C. fo� this BOILERS BTV
reason SVSTEM REPAI R, ALTERATION
Date Owner
I hereby certifytbat 1 have reatl this appli<atlon antl state [nat the above EXHAUST SVSTEM MULTIPLE
information is correcL I agree to tomply wit all dty antl county .
otainant¢s antl state IawS relatlng to cOnStruC[I dntl h¢reby authOriz¢
representatives of t� i(r to enler u the above mentionetl
property for ipSpf�tTSn fpo�5es. �] ,
Si9na[ur¢ /[� Oate!-/3—�
Driverz' License or 55 � � i55V E FEE -
CMF 0865-46 White�Builtling; Canary-ApPlicant: Pink-Accounting: Goltlenrotl-Assessor
PANELS MAIN - ' SVB
SERVICE ' AMP
APPLICAT�ON APPROV ED BV - DATE
SUMMARV OF FEES
BUILDING
PERMIT S/ D • SMIP E��
PLANCHECK b� PERMIT
- �ISSUANCE S �
PWMBING E .GRADING S
PLAN CHECK E �
ELECTRICAL S . ' b �
PLANCHECK E MICROFILM$ �
TOTAL FEE E �
MECMANICAL S � '
• LE55 AD-
PLAN CHECK E VANCE'PG $ _
. FINAIFEE $ I� '1�
1 '
CONSTRUCTION AND PLqNNING .' ' . _ POOL & SPA � ,
APPROVALS Pe�mit# Date Inspector pppROVALS . Permit# Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
Soil ipe-Undrgrn � ' 44. Steel Reinforcement
3. Electri�yl Conduit Utility-Undrgrn ' '' 45. Forms
4. Electrica� Conduit-Undrgrn, 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electriral UFER Grn 48. APPROVAL TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation ' 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra �❑ ndr m
10. Structural Floor System 52. APPROVAL TO DECK
11. Property.Sewer Line & House Connection 53. � Backwash & Rece tor-Final -
12. Street Sewer Conneaion 54. Heater & Vent-Final
13. Rough Plumbing '
14. Rough Electric-Conduit �56.� ' Electrical-Final
� 15. Rough Electric-Wiring - ' � - 57. Solar System-Final �
16. Rough Heating & Air Conditioning • encing & Access Approval
- 17. Ducts in Structure - - APPROVED FOR PLASTERING
18.- Ducts; Ventilating � . . _
19. Gas Pipe-Rough & Test � - 60. POOL/SPA SYSTEMS FINAL � �
20. Roof Framing ' • -
21. Roof Sheathin �
22. Frame and�Flashin NOTES: '
23. Insulation '
24. Lathin & Siding � ' ' -
25. Drywall Nailing
26. Plaster grown Coat •�-
27: Electrical Power Meter-Final � � � - '
28. Final �lectric - � � � � �
29. final Heating & Air Conditioning -
30. Final Gas Pipe-Test ,
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final � '
34.. Solar pomestic-Final
� 35. Candsca e S rink�in S stem
� 36. Sound Attenuation
37. Handicap Regulations -
38. FINA� STRUCTURE & BUILDING -
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co. !�
42.. CERTIFICATE OF OCCUPANCY '
No Date
:�
�
TEf�1TEX
Products
February 25, 1977
Dear City of Costa Mesa:
Temtex Products of California, Inc. , guarantees that
the fireplace installed for Mr. & Mrs. Martin at
994 Trenton Way, Costa Mesa, California, is a
0-Clearance fireptace.
RR C : ch
Enclosures
Temtex Products of Calif. , Inc.
, J'�,-.�
'�. =
` ,�'���
R.R. Creer
General Manager
P.O.Box1148
23560 Oleander Avenue
Perris, California 92370
(714) 657-731 1
�i`�r
5��
�
« � .
.,:� :.
I�t'e`r�atiorial� Confe�-ence of �uiAdin�
. . ��.. ,. . ' .
6i��E89i8B�8 B�Bi�89008E�� �&Q�9�9B99�69��180�90
'- r MODEL NOS. TBF28-1, TBF36-1 AND '�BF42-1
FIIiEPLACES ' �
� TEMCO INCORPORATF.D
,- - 4101 CHARLOTTE-AVENUE
-� NASHVII.LE, TENNESSEE 37202
.�� �I.� SubjccC Model Nos. TBF28•1, TBF38-I and TBF42-1 Fire-
places.
��-II: • DescripHori: T1ode1 Nos. TBF28-1, TSF36-1 and TBF42-1
. are solid fuel buming built-in 6replaces designed for ins[nllatlon
. at zero clearnnce to combustibles The fireglaces are essentially of
�[h e S e u are m e � ee sizes, 28, 36 and 42 inches.
Dimensiqns' for .the various fire�laces are given in Figure No. L,
� The basic unit.consists oE d base sectioq a center section, a hood
.- section and n stack and chimney sec[ion. The base section consists
of a heartli pan fabricated from No.'22 gauge Type 1 aluminized
� steel and supPorted on a bottom pan of No. 28 gauge aluminized�
-� steeI. � � �
_ A hent shield oE No."2!3 gnuge aluminized steel is installed
between the hearth pan and [he bottom pan. The hearth pan is
- lined with n,2-inch thick layer of 57-pound per cubic foot density
. � Gem HP870�refractory bricks mauufactured 6y the Gem Refrac-
� �tories, Inc The firebricks form the hearin of the fireplaces. The
' center section consists of refractory briCk (same as descri6ed above)
, insvla[ed side and rear w.dls and an inner radiafion shield. The
�� side and reur walls consist of No. 28 gauge galvanized steel ou[er
'� sectlon with�a No. 28 ga�ge aluminized steel intennedia[e secUon
� and a No�26 gauge aluminized steel inner radiatior shield (No. 22
�. gauge For the 28-inch unitj. The firepinces are designed for use
� with a minimum 9-ineh in[ernal diameter [riple walled listed lo�v
.� heat appliance chimney. A minimum 2-inch clearance is re�uired
°; between the outer chimney pipe and combustible ma[erials. The
;
. ,i:
O�fAcials
' Report Nn. 3195
Februan�,1976
� units are provided with a facrory installed steel damper. A metal ,
screen is also provided with each nniG-The factory supplied hearth
extension consists of a minimum 1-inch thick layer of 1£
. per cubic foot density refractory-material covered with a No. 24
gauge Type 1, alumirmm coated steel sheet Dimensions of the .
hearth extension are shown in Tnble No. I of the report The unit
must be installed in necordance with the manuf¢cturer s instalfation
instmctlons and this report. •
Identi6cation: The fireplace units are identified es follows:
1. The fire chamber beazs a metal listing Inbel which is either
riveted or welded to the assembly et a locallon visible aEter
. .. the fireplacc is ins[al[ed. The lishng label mnteins the Under-
�^� writers Laboratories, Ici'. name, the mam�fecturer's name`
address, [hc,Ilip[leL,�yym�jS�i nnd the wo s zero. c earance
�.; built-in fiicolxcc." ,
2. Each s[arter seetion, chimney secHon, fire stop spaceq rain '
cap, housing, and hearth eztension c.vries the Underwriters
Laboratories label identifying the part nuxnber, the modcl �
number of the fireplace und the minimum clearance ro �.
� wmbustible. ' . �',
III. Evidence Submitted: A report of tes[s conducted in accor- ��.
dance with the 1�J71 Editlon of UL Standard Nu. 127, installaHon ��
brochure, and shop drawings have been submi[ted. �il
Recommendation '
IV. Recommendntion: That the Temrn, Inc., Modcl TBF28-1, li
' TBF36-1 and TBF42•1 are fnetoty built ficepinces provided they
� nre fabricated nnd instulled in ¢ccordance wi[h this repor[ end the
manufac[urer's instructions.
This remmmendntion is subject to ennuaf re-examinuHon. ,
TRBIE N0. I—SIZE OF HEAAiN EXTENSION IINCHES) �
MOOEI N0. OEPTN LEN6TN
TBF28-1 16 44
TBF38-1 18 52
TSP42-1 � 18 58
��
FIGURE NO. I
DIMENSIONSAND CLEARANCES
m
9
_. , Page 1 of 7
Ceme�t Coping Optional
Channel Bluck WitA 1-3l8
p Horixontal Top of all
Fences
For Fencrs 5' or Les�
Vert. Bars 3/8" Y at 4' •0" O.C.
For Fences Hiqher Tha� 5'
Vert. Ban 3/8" oat 32" O.C.
Fill Celh Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-15�39
A.S.T.M.
All Steel to be Lapped
24" or tD Code
- I MATURALGRADE
�' 'a �c��: :�.
�/8" YBARS
CONT I N W US TOP
6 60TTOM
ALL STEEI MUST BE TIEO IN
PIACE AT 11ME OF THENCN
INSPECTION.
TYPIC;AL 6" CONCRETE BLOCK FENCE
, �I
- . �
0
S S
� F
�
Y W
a =
I i �
z
rI-
a
i�
--� w o
u �
Z
W Ml
�
, : .' . 1, 1=
T�— _ _— �
� .
•
� F-�--WIDTH t�
I4 � SEE CH4RT �
� BEIOW ,
�L ���..
. 7
r'O, �� "
•
. .
�•
�L
� -
z"
GENERAL- NOTES
MORTAR : p�e Part Plaslic Cemenf, ond
Thret Parfs Sond
GROUT : One Part Cement Thee ond
One Mail Ports S�and
CO�ING One Pmf Cemenf, Three
PO/}$ SOlIQ
CONCRETE: Weil Mixed 1.2-I/2.3-I/Z
Mar. of 7-I/Z Gcilens of
Wofer Per Sock of Cemen±
GqOUT MAV BE POURED FqOM THE TOP
OF TME FENCE IN CELLS WHERE S7EEL
OCCURS.
CELIS AND AREASOF NORI20NTAl RE�N�
IFORCEMENT SHALL BE CLEAR, CLEAN &
FqEE OF ALL MORTAq DEBRIS, ETC.
VpOVIDE CLEAN-0UT ANDlNSPECTION
MOLES AT TNE BOTTOM OF CEILS CON�
TAINING VERTICAI REINFORCEMENT.
BONOS SHALL BE VROVIOED BV LAYING
BLOCKS IN STRETCHER COURSES SO THAT
YERTICAI JOINTS ALTEHNATE IN EACl1
COURSE.
DFPTH �F EARTHTCOTH .
IjJ (HE NEIGTH Of FENCE
BF[.OW 20TTOM OF FOGi1NG.
SCALE: I/2° = I'
FOOTING REQUIRFMENTS CHART
WALL HEIGHT . . . . . . . 6�. . . . . . . . . . . 5�. . . . . . . 4� . . . . 3�
WIOTH 14" ... 14�� . 12". 12�
THICKNESS 10". 10" 8". 8"
DEPTH OF EARTHT�OTH 24'� 20" 16". . 12r
SPQCING l;F EARTH7007H 12' t4� 16�. 16'
City of Costa Mesa California O✓YNEF$ NANE: __ � � �� ���T --_
JI�B 400RF SS C�i�'� ��`�'�r__ _
� Pf RMIT N;iMpEF _ _
Building Department SIGNATURE -'��= `— _ _ _ ._ __ _ _. —
. �---
�� � ��� ��
Gity of Costa Mes° g�ildin9 �ePt.
. ^ � DATE..��-� T M
t __,_......_-�..._..-_'GN J08 AT ALL
BY_.._.. - � . - /,PPROVA�
LHESE P GHANGEST W tH��� PRIOR
MAKE NO
OF DEPT• �- pERM1T OR AP°ROVAL
gE CONSTRUED
THE ISSUAPICE OR GRANTING OF A ����T�ON
OF PIAdS FND SYEGIR�CRTP �� APPROVALNOF. pNPERMIT PRE�
1� BE p PERMR FOR, �pNCEL THE
OF ANY Of LHE PROVISIONS Of TH�S CODE. NO
VIOIATE Oft
VALI�. EXCEPT INFU�L.
SUMING TO GIVE AUTHOR�iY T� 17 AUTHORIZES �S �
PROVISIONE WOftK OR �OD WH �HL BE ry$ AND
FpR fS UPON P�
7NE ISSUANCE OF A PERMiT BASED
THE 6'JILC�I'JG 06FI�IAL
UIRING TF{E ��OR�FRON PPC`lCNTIt + �1
$PECIfICATIONS SHALL NOT PREVEN7
F�fJ1A THEREAFTER REQ
IN SAID PIANS AND SPECIFICATIOM1%
iHIS CODE OR OF ANY 07HEP. O4�I'JPt��..'-
�J�IDING OPERPTIONS BEING CARRIED ON THEREUNDER kH�
IN YIOIRiION �F �_ .�- -
pE TNE C►lY.
�!1
�I
W
W
R
F-
N
NESIDENCE I I I pE51DENLE
STRUCTURAL APPR61/Al. O�1L�i
SEPARATE PERMITS ARE REQUIRID,
FOR ELECTRICAL, PLUMStNG,
HEATING, VENTILP,TING RND
REFRIGERATION WORK
P��att #� 8�
THIS NUMBER PAUST ACCOMPANY
ALL INSPECTION REQUESTS
� Ffl i BU;iLIh�; C:NFRc FERSONS ARE TO
; 9E E;,:'r� 7�ED, b7E SUGGESi THAT THE
' STFSE flF C,'.LIFORNIA DIVISION Of
?:J'�SiRint SPFEfY BE CONSULTED FOR
_ AhJ,ii4;lAl REQUIRE�rMS.
RE91oENCE
STREET � __ -
APPI�.OVED
CITY OF COSTA MESA
PL4NNING DFPT.
.. ��'{Ii61ECf TO BLDG. D87. QEO.
DIQECIO! Ot
XESIOENCE
�i
F
�J
W
Q
�-
�^a�so�aunar,c: gg4 TAENTON WY
avxEaswu'�Fa�m+:MAALOUF, HENRY
R _—` �ooxess:994 TRENTON WAY
COSTA MESA,CA
AYPL. MAIIING ADDNEA4:
/JiCNRECT OX E�MiNFEF:
u�cx. on �o.s �ooxess:
UNT:
FLOOD: X 47
92626
uc. xo.:
uxr:
coNmecrarsN�we:ROBDEL CONSTRUCTION 6 DEV (714)285-3446
CRlfilACTOASMAllINO 3050 S BRISTOL
�ooxess:SANTA ANA CA uc.xo.: 700469
92704 uxt:
LICENSED CONTNACTOHS UECLPPATION: I hareby dlirm undar penelly ol pe�ury Ilw I em Ikenwtl untler proNsiom of Chepbr B
(mmmencinp wilh Sxtion ]000) of Diviaon 3 of IAe Buelnea arM ProtasMona Code, eM my Ikenw la In lull brw end aHsd.
cmue.No.p66924 uc.cuss:H uc.No.:700469 EXP; 02/97
�Dete�. 2 �� Comretlw: i�/ /.�6 f� �a � /�
OW NEN B IIDEX DE� IARATION: I hereby etfirtn under peneXy d perlury Ihm I em eesmq Irom Ihe Comredan Licenes Lew fw ihe
�olbwinp roeaon (&eUion ]031.5 Buav�eaa enE Proteeeione Gods: A�ry <iry a counry whiM requirae e partnN to oomwcl, eller, Improw,
imole�, or ropei eny atmeWn, pnor lo ila uwaeKe, eho repuiree iM epDliun� lor euch permA to file e eprwd elelement ihel he or ehs
. liwnaed W��� �o iM provieiona ol IM Contredora Licenee Lew [ChyNer B(mmmeiarp wit� Sed'pn ]000) M �iveion 9 d Ihe
Buainew enE Prdessiwu Coda� or Oul M a she o ezemq ihxelmm enE iha beaie �w �he dleped exemqian. My vide�bn W Sedan
]031.5 by eny eppliranl lor a permil wbjede iM epd�� �a e civil penelry d mt moro tlan 1've hunErod dollan �55WJ).
� I, es owiwr d�he proparlY ar my amDbYeae xi�h wapea av �he'r eole mmpeneeiion, will do the vmrk, end �he etrucVure e not inlanded
ar oflared lor aeb (Section ]014. Busim» eM PMesabna Code: The CoMreclon Limme Lew Eaee rrol epplyto en ownard propaM
wM buPds w'vnqow �M1erean, and xfw doee auM xvM Mmsell or hanM a throuph hi a her own employeee, povidatl Ilu� euc�
improvemenls ara rol inlmded a dlered br aeb. X, hawever, lhe Witliip a mpiwemen� u edd xilhin aro yeaz d compblon, IM
awner-Wilder xill he�a tM buNm of peovinp M or sha Eid � build or improve fa Ihe W N�e ol eeb).
❑ I. ac ovmar W iM propeM. � exduarvey conireuiq wnh lironaetl conlreclon �o cmnrua �ha P�led (Seqion )Osa. Buei�es aM
Prolessiona Coda: TM1e Lmtrman Lieeenalew doearwt eppy b an ownard qopeny who buiWa wimpwmihereon vM x1w
convacb tw wtli O�M� �h a wNrarfw(s) IcenaeE pursuant to the Comredare Lioensa Lex�.
� I em exemp u�der Seciion: B. 8 P.C., M this �amon:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 077352 PLAN CHECK NO; N
PERM NO: B 077352
GOVT: N SUPP: N
CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : TEAR OFF/RE—SHEATH/RE—ROOF W/20 YR COMP SQ FT: 3,500
CLAIM VALUE: 3,500.00 CALC—VALUE: 3,500.00 GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT�Srno,�C.� .t�eG�U�L.S ���/�FO�
*�**�+t******��**********�c**+�*���**+�+�+�+�******�c**** ***x� ** ** *�t�cxx�*��t�t** *�*
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCE550RY HUILDING ---------
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: 14105250 ZNE: REF NO:
PLANNING NOTES>
i
fE iE iE iE 1ElE fE 1F iE 1f i616 if 1E.1E'!E iE jE �)F iF �)E jE iE 1E �)E �E iE iE �E iF 7E �E iE if if iE 1E 3E iF iF iE 1f iE if iE iE iE 1E 1E �E IE 1E IE fE iE iE 1E fE iE 1E iE 9E 3F 1ElE iE �E �)E fE if iE 1ElE iE iE iE iE 3E iE
D£ 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
ZONZNG APPROVED BY .
BUILDING APPAOVED BY :
APPLICATION ISSUED BY:
LEGALIZATION:N F E`E S U M M A R Y
1 do Mreby cMM ��� awara d aM uMerslaM Ilw repuiremenls d CelJoma HaeEh ud Sdery Cotle Sedioru 25505, ?55�3, enA
zssx.�em�i«�n���w�a��,��ni,.�i��aKb����e�o�p�..�n.de�a�.�em.,�����.�a BLDG PMT PLUMBING ELECTRIC MECHANIC
apeimiltaeonsWetionormodihxlunhomiMAr ue�ry aiapameniDielrip.ReaEeMieloonaewionappYutpmuaezemptimmlheee
w�s PERMIT 87.25
oma: nvd�ce�c
WONKEP'S COMPENS�TION OECLAR�TION: 1 hereby elfirtn uMer penel�y d perj�vy ar d Ne Idbxi�p Eedualiom:
❑ i n�re �,d Y.0 �me:, a cenrccme a m�m m.an:�,re'«..o�� �aemei:�. m r� �« M seeion a�oo a ine ieno.
Code. for tM pv�lmrene:e N Ma xak Iw wlieh this pertnil o issued.
❑ i nm,e a,a xi� meime:i won�eB• mmpenmon ir�ureme. m ma�+�aa M smian a�oo a u,e �an« coee. m. in. wnwm.roe w �n,
work la whiN Nia pa�mn b bsued. MY wvkara' eanpammion inwrenee ranix eed pdiry number me:
c�:
vaKrN�mn«:
(ihis axrion need rwt be camplere! / tM perml is Ia one hundred ddWa R��l w ba 1
}�[] I cenh' �� in iha peAwmarice d Ihe wak fa whc� Ihn pe�mu n issued. I ehell m� empby erry pe�mn w any marmx ro u io
n�o� �dm m me �,�.� �va��� m.. d cdn�e. �d aa� wm n i,n�a e«o� �,ei«a io in. ��•
como��� w�+%�%a seeion s�oo d ma �en« cae. � e�wi �onn.nn canoN /wnn inoee/�/�(
{Oeie: L 2 � APWcant �/G�"✓OI �/!!/ /J I`�%S
a
Waminy: allun ro securs woilron'ro�peiuetlon covsnps l� un1�wN1, ena �Nll uOfect en �mployx ro cNMml penaM�s eM
clvll flMa up ro ars hwtlretl Hwuaend tla/M�� (SfOqWOA In addltlon ro Ms roaf o/ romp�iuef/ort d+mepsi �i proWdeJ br In
Sxtlon 9106 0l fhs Labor Code, Infens4 erW etromsy'a Isu.
CONSTRUCiION LENDING AGENCY: I hereby elfiim uMer penelry d parjury ihet iMre o e mnstruaion bMi�p epency /or tM
penrnmeze a �ne woA �or wnim �ne ro�� a as�ea (seauo aos). crv. c�.
LENUER'S NAME:
LENUEfl'S AODFE55:
I ceniy Ihat I have reeE thb epplcmion eM s�s�e thet the ebova inlomietion is mrtea. I epree ta mmply wnh dl cny and munry ortlinencea
end siete lexs reletmg ro building consiruaim erA hereby eu�larae repremntaiives d �his rny lo enier upon Ihe ebove-mantioned properry
�orms�eio�w�w�sRICHARD ROBLES
Pnnt Nen // y/J
� .Fi- �i/ �..� Dete: � i` /�
Signe�ma of anVAppYfanVConlmqo�
�5151-48 WP) W�no-Buildinp 8 Sefely: Greao-Rle: Cenery-Applicenl; Pink-Fwanue: Ooltlenrod-Rsaeawr
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 87.75 0.00 0.00
REVENOE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
87.25
DATE: "
DATE:
DATE: ���
�3FIEiEiE'1EfEiEiE�ElEiE iElE
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
50
SMIP/NON—R$S
V' �_/
TOTAL PAID DUE
87.75 87.75 .00
87.75 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
.50
�k iE iE 1E IE if iElE 3E 1E iElE IE IE iElE IElE iE 9E 9E �E fE jE iE iE 3E fE iElE iE iE �E IE iE iE iE iE �E iElE iE 1E 1E 9E IE 1E iE iE iE iE iF jk iE iE if af 1F 1E �E 1E iE iE if if 3E fE iE iE 9E fE iE iE iE iE if �E iE 1E
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3500 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,500.00
END OF FEES
e
��.CONSTRUCTION AND PI.ANNING POO� .. SPA , �' ` ,
' �APPftOVALS Permit #� - Date Inspector pppROVALS Permit # Date Inspector
/
�I. Temporary Electricai Service or Poie 52. Pool & Equipment Locacion
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Efectrical Conduit Ufility�Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgmd. " 55. Electrical Bonding
5. $teel Reinforcement - 56. Rough Plumbing & Pressure Test ; �
6. Electr3cai UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footin9s 58. Etectrical Conduit�Undrgrnd. .
8. Foundation 59. Gas Pipe, O Undrgrnd., Tesi
9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P�Trap, O Undrgrnd. .
10. Structural Fioor Svstem ' 61. APPROVAL TO DECK
t t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
72. Sewer Cap � ' 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System � Final
74. Rough Plumbing • 65. Electrica��Final �'
75. Rough Electrical-Conduit . 66. Solar SVstem-Finai
i6. Rough Electric4Viring 67. Fencing & Access Approval
77. Rough Wiring S'9� 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Cei;ing ' 69. POOL(SPA SYSTEMS FINAL
19. Rough Heating & Air Condi;ioning FIRE DEPT.�REQUIREMENT �
i20. Rough Factory Fireplace ' APPROVAIS Permit #
27. Duc[s, in StrUcture - , 70. Underground Hydro
22. Ducts, Ventilating- - 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test . - 72. Unde�ground Flush
24. Roof Praming 73. Undergmd.S[orageTank OGas �Oil
25. Roof_Sheathing � �/��� � 74. Overhead Hydro
f
26. T�Bar Ceiling (Structuralf & Monocoet 75. Dry Chemicat �
27. Frame and Fiashi�g 76. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL �
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brow� Coat . 79. FINAL INSPECTION
32. Electrical Power Meter�Final ' , 80. FOOD CEflTiFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-7esi
36. Hood or CanopY
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Finai .
41. Solar pomesticFinal �
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation Sy:tem � -
45. Sound Attenuation
46. Handicap Regulations � � _ „ ,
47. FINAL STRUCTURE & BUIIDING ��6�
7 �=s� a,�.,�
48. FINAL PLANNING ' ' .
49. Electrie Release to Edison
50. Gas Release to Southem CaAfornia Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
N�IRTIN, RoberE F
eOUGH PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS �1/y.��j:,
ROOGH MERTING �NO I.IR CONDITIONING'
TEMPORARY SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGN WIRING
TRENCXES FORMS STEEL REINF.
FLOOR SVSTEM
BOND BEAM [] �STEEL REINFORCE �
SNERTMING
FRAME AN� FLASNIN em
�NG — IN r] UT �y J��I
� ,iER, BROWN COAT
STRUCTURAL, FINAL
MEATING, VENT., REFRIG. �ND A.C., FINAL
PLUMBING, FINAL AN� GPS TEST n
ELECTRIC. FINAL
DATE
SUBCONTRACTOR
�tJ I8J
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
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CITV
CONSiFVCTION
LENDER
BRANCH
ADDRESS
ARCHITECT
TEL.
NO. .
TEL.
CONTRACTOR S�IyJ�"-
ADDFESS
TEL,
CITV NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE NO.OF BLOGS.
OF LOT �B �/OO NOW ON LOT
USE OF
EXISTING BLDG. �j�S i 7 FIf/f/I� L
Separate permits are required for
elec[ric, plumbing and hea[ing work.
USE OF BUILDING AN� W�AK TO BE PERFORMED
BUILDING �
ADDRESS
TRACT
VAR
DI5TANCE BET
MAIN BIDf'v^.
VAR. #
C.U.�.vW
I hereby acknowletlpa the[ I heve reatl th(s application entl stete
that the abova informetiP� is corraci and epree to comply wi[h
all laws reguleNnp builtllnB �onrtructlon, antl I shall not amplay
any perwn In vlolation of the workman'a compensatlan lawc ot
Me Stace of Celifornie.
I hereby certify thot I am Properly licenutl as a conbactor untlar
the Siere ot California BUsiness end Professiona Cotla, Division 3, THE MO
Chapter 9, and that such licenses ere in full forca antl effect, or I THE PURP(
am exempt from the O�oV�slons of tha Stete of Californie 8usinass V ALV ATION
and Profeuions CoCe, D/iv/,i$ion , Chapter 9.
Signaturaof�� f� �y7/// �' S �%/�
Permlttee .� (7 )( /
(/ (O 1
A�thorizatl ABent
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^rC 13-7b�ws.00 737� *u**�Z60
FORSTRUCCURALPERMIT
DATE RECEIVED nerr iccimn
NO. OF
USE OK N W
BUILDIN �
VApDS APPROV ED
ACCESSORV BUILDI
BET. MAIN &
OF ESTABLISHING A PERI
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TAX S
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P.O. 60X 7200 GOSTA MESA� CALIFORNIA 92EM
For ApplicaM to FIII In Compbhly
TYPE OR PRINT
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ACORHYII
GOSTA MESA. CALIFORNIA
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ucTNo. 7i4'�99 i
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IVPLICATION FOR PERMIT
pUItDING
fOr Offic� Us� Only
11[c[I'l No. �plff�pAp2
Lt3 1 ��
n" 546561 Br — owri
ZONING
COSta M Nl NO.OF Y�[O�NI
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taow� L l7 T' / ! �d'1
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DESCRIPTION OF WORK
� BUILDINO NO.
'1 X6R6pY ACrtMOWL[DO[ TXAT.1 XAVO 11�AD TNI/ AIILIGTOX
AND 6TAT6 TMAT n�i weov�,is CORR[C4 AND AOp6[ 70 CAY.
PLY WITH wLL CITY ORDINANCO A�1D AAi[ LA1M R[OYLATINY
eu�toiHocoxsrnurnoM... /
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ER MpRTIN, Robert DATE �_Z�_
ESS 994 Trenton Way BUI
o. 141-052250 LOT TR
GAS
PROP. SWR. LINE U HOUSE CON. U
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
UN�ERGROUND U P�
ROUGH WIRING
TRENCHES � FORMS
FLOOR SYSTEM
FRAME AND FLASHING
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F
AN� A.C.. FINAL
o���� „��� ���„� IY1 In.� �
SUBCONTRACTOR
- ' 35005
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
PPLI ATI
ForApplican( fo Fill in Completely RE ei e sv
BUII.DING
A�DRE55 Q W
OWNER A.P. NO. '
BUILDING
MAIL ADDRESS
Z ADDRESS S �
W W TEL. TRACT
d U CITV � NO.
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J'� BRANCH
OWNER
� ADORE55
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d W �
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m Z
J � ADDRESS
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FOR BUILDING PERMIT
w w TEL. Z�NE � NO.OF
z= CITV NO. P�"P'� /
h
w � STATE CITV �'ARDS APPROVED
� CC LIC. NO. LIC. NO. MAIN BUILDING
�� SIZE NO.OF BLDGS. (FROM C/L STPEET)
OF LOT NOW ON LOT FRONT FT.
USE OF
EXI5TING BLDG. S FT.
f' SIZE OF NO.OF
Z NEW BLOG. qOOMS STOflIES L.SIDE FT.
aEMERIOR WALL ROOF
COVERING COVERING REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET.
d MAIN BLDGS.
Q VAR. #
O = Q U.P. ,1�
F APPROVED
N
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VI hereby acknowledBe ihat 1 hava reo0 this applicetion anG stata
= that tha ebove information is correct und aprea co comply with
� oll laws �ae��ali�a b�{�tlin8 connruction, and I shell not employ
r any person in violatlon of Me workman's compansatlon laws of
y [he State of Celibmid.
zI hareby certity Mnt I om Oroperly licenmtl aa e eontroctor untler SQ. FT.
Na State ot Calilorniq Business ontl Protossions Codn, Divisicn 3, HE OUNT SHO�
Chapter 9, and that such licenws ara in full forco antl eHect, ar I THE PURPOSE OF ES
am exempe from tha provisions of theStam ot California Businnss VALVATION '/,�
end Professions COtla, Divislon 3, Cheptvr 9, e�� J
Sip^ature of Q{' 1� �_ /O /_DD
Pe�mittoe ��f��'C/ AiLLvsa $ �/
/
Aaffiorized ABani
6f�►ZJ
VALUE
TE
USE OF NEW
BET. MAIN &
ACCESS. BLDi
OATE
TOTAL
)
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VALVATION IS FOR �
A PERMIT 5EE ONLV: m
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