HomeMy WebLinkAbout357 16TH PL - Building Permits.I PHOJECTAOUflESS: 3S% 16TH PL
OWNEH'SNAME:ENGELHARD FREDERZCK H
aooeess:357 E 16T�I PL
COSTA MESA,CA 92627
�� I
�"'� I
AFCHIENGINEEN:
NOONESS:
flFG.NO.:
UNIT:
UNIT:
PENMITTEE:UNDER THE: SCJN CONST, (%74)974-2034
aooeess: zz�g ROHINHOOD PL
ORANGE CA 92667
IICENSEO LONTflALTOfl OFLU1flATI0N: I PeraGy allirm t�ai I am GcenseG unEer pmvisions ot ChaD�er 9(commenting wil� Setlion
7000� ol Oivvon 3 o�l�e BuSiness an� Pmlessions Co�e. anE is in lull brce and etteci.
cnr uc.: 5 6 87'1 sTnTe uc.d 8 2' S1 �— �
Oate: — Signature: _
WOflNEflS' COMPENSATION �ECIABBTION: I �ere�y allirm Iha� I �ave a cetlificate ol consenl to self-insure or a cetlilica�e ol Worke�s'
Comoensation Insurance. or a certilied coDY �hereol (Seclion 3000, lab. CI.
POUCY NO.: E%P. �RTE:
COMPANY:
� Certifie0 copY is hereGy Iumishe0. ❑ Cenilie0 copy is IileO with ihe ciiy BuilGinp Oivision.
Dale: Applicanl
EXEMPTIONFflOMWOBNENS'LOMPENSATIONUECLANATION: (This 'ncaUna��etamplel¢Uil�hepermilistoraneAundr (SIOO�orless�.
I cerlity Ihal in I�e pedormante 01 Ihe wOrk lOr whith ihi5 is is 81M any per5on in any an 5o a5 �o become
subjecl Io Ihe Workers' Compensa�ion Laws o� Cali�or .
Daie: � ` � � ` � � Signature:
NOTICE: If. ali¢r making Ihls tletlaration. you ShoUltl become SUblett b �he WOBers' Compensalion pmvisio he La�Or
CoJe. you mus� Iotlhvnih comply wi�h such pmvisions or t�is �ermit shall be 4¢emeA revokeC.
CONSTPOLTION LENOING �GENCY: 1 nerebY atliim (hai Ihere is a ConSlmtiion 1¢n0ing aAency �Or��e Oe�ormante of I�e work tor
wnicn mis permn is issued (Seciion 3097. Civ. C1.
LENOEP:
ADOPE55:
OWNEB 901LDEfl DECLFflATION: I here6y a��irm Ihal I am enemp� �mm Ihe ConVaclors' S�aie License Law �or Ihe �allowing reason
(Setlion 7031.5 Bu5ine55 antl Pmle55ional Code: Any ti�y ol wun�y whith repuires a permi� l0 tOnSirUt�. atler, impmve, Oem0lish, or
reoai� any stmnure. o�iar m its issuance. also requires Ine ap0licant far sucA permit ta file a signed staiemem ttut ne/sne is licensee
pursuant io t�e D�ovisions ol �ne Canlractors' S�a�e License Law (Chapter 9 �commencinp vnt� Seclion 7000) of �ivision 3 of ��e Business
and Prolessions Coae) or ��al he/she is exemP� Ihere�mm and IM1e �asis for I�e alleged ehempiion. Pny violaiion o� Seclion 7IX7L5 �y
any applicant for a permit suDjecis �he aDPlicam to a civil penaliy ol no� more �han five �unAreO Aallars (5500�.
I, as awner ol I�e OroDerty or rtry employees wilh wages as Iheir Sole comDensdtion, vnll ao Ille work, antl t�e
❑ strucmre is not imenaea or onerea lor sale 15ection 70aa. Business and Pmiessional Coae: TAe Comracmrs' State License law
Ooes not zpply lo an owner ol a pmpetly who �uiltls or impmves Iherean, antl w�o does such work �imsell/Aerseli or �Amugh
his or her own employe¢5. pmvitletl �hat su[h impmvemenis are no� intendetl ar ollere0 �or sale. II, however �he builtling o�
improvement is solG wi��in one year of complelion, Ihe owner will have Ihe bur0en of Droving he/she Oi0 noI builA or impmve
for ihe purpose ol sale�.
I, as owner of Ihe D�oDeny. am excWsivety conlraclinA wiih licensetl conlraciors Io cons�mc� �Ae Pmject (Seclion 7044, Business
❑ and Pmiesvons Coae' i�e Comranofs' S�ale License Law Goes not apply to an ovmer ol pmperty who builtls or impmves �herean
antl wh0 conVatlS br suc� pmle��s +��h a conlrac�oqs�licenu pursuanl �o t�e Conlrac�ars' S�a�e litense Law�.l am aware
Ihal O�ool ol �heir Worker'S Compen5a�ion insurance 5houlU be provi0¢0 to me.
� I am exempt unUer Sec�ion: 8. 8 P. C.
�or Ihis reason:
oaie: ownec
I ao hereby cenify I�aI I am aware ol an0 unaers�ana Ihe repuiremems o� Calilomia Healih and Sa�ery Code Semions 25505, 25533, antl
25534 and ihat I or any tulure Auiltling occuDani wilVwill not �ciRle one) neetl lo compty with sai0 stale w0es antl t�e requiremenis for a
permi� lor conSlmciion or modilicalion imm the Air Oualiiy ManaAemeni Di9licl. FeSiEen�ial conSWclion apDlicalions are eK¢mpi �mm
Ihese D�ovi5ian5,
Date: ApPliwnl:
IhereDy ceritlyl�al Ihave �eaUi�is applicalioP antl sla�e Ihatt�e above inlarmatian i5 correcl.lagree lo comply vrii� allciiy ana eounry
ortlinances and staielawsrelalingta �uilQing conSlNcti p�ph rizereprC ntalives of�his ci� t teru0ont ve�mentioned
pioperiy lorin5pet�ion purpOseS.
�a�e: � �Q^ �� Signawre �
oiiver's License or Social Secmity .:
i W i�<6 wnne—Buileing�. Green—Coae E��o¢ement; Canery—nppiicam: aink—Fevanue: Gdtlenroa—nssessor
CITY OF COSTA MESA — BOILDTNG PERMIT PEkM NO; B 0612U5
PEHMIT NO: B 061205 PLAN CHECK NO; 00691-93 S GOVT: N SUPP; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION : 75 LIN FT OF 6' HIGH RCMU WALL SQ FT: 75
CLAIM VALUE: CALC—VALUE: 1,500,00 GROUP OCC: R-3 /
COMMENTS• SMOKE DETECTORS RE(�IIIRED PER THE 1991 EDITION OF THE UBC,
*��e�r�*��r*�r*�**�r�*x***�***�** �r�t�***+r�t�r�r�r****�r**ux�r��**x��r��rx�**x+r�*�tx*�*�c•*x�+t�*
Z O N I N GS ERTEB�AUCjKRSE M E N T S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY RUILDING ---------
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 RE • PROV; PARCEL: 92519102 ZNE; R2 REF NO;
PLANNING N 1'ES> CONSTRUCT 75' LONG, 6' HIGH CONCRETE BLOCK WALL, NO PARTY
> WALL AGREEMENT,
�r*�t*+r*�t************�r�r*��***x��t**�r�r��r�*�**�r�r����rx �e**#***x**�r*�r��r�*�r*�*******�*�t*
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 APPROVEA HY C,}� DATE; 3 I2
BUILDING APPROVED BY �_� DATE; �-
APPLICATION ISSUED BY: DATE; !)/
iFiEiEiE�ItiEiEifiE3hlElE#iEiEiffEltiEitiEi(� it .. r� ei n� x iEiE1E3EiFiFiEiEihiEiriCA�F�iEjE
iEifiEiFiF�FitiEiElElEifkitiEiEitititifif3ElEiEifik3EiEjtlfif3E!lifiEiF3tilikik%-�kiFlt3fiE iFiEf(�itiEikiF3EikiE�flFiflEikiEifiEiE3Elfifif�l(��E�fiF3EifiEiE3E
LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SEGNENT;Y
BLDG PMT PLUMAING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 35,00 ,50
PLAN z2,�5 SMIP/NON—RES
ISSUE F'EE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 35,50 0.00 22,75 58,25 58,25 .00
REVENUE DIVISION TOTALS--> COLLECTED; 58.25 OVER/SFiORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
35,00 .50 2?..75
if iE it ihlE if if iE if iE iE 1E iF if if 3E iE if 1f iE k if iE if M� k 1(� if !F!f iE iE jf iF !f iE i! iE 1E iE iF if 1k ih k�47E iflf iE 1f it i! iF if iP M�lt * it 1! ik 3E if 31-3E iE 1F iE iF if i! i4 iE iE if iE !E 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 I P T Z O N UNIT COST TOTAL COST
ISFR 75 RES—CONCRETE BLOCK WALL / FT. 7.0.00 1,500.00
END OF FEES
rw
CONSTRUCTION ANDPLANNING �
APPROVAIS Permit #
-1-
1, Temporary Electr�cal Servic��o`r Pole
i
2. Soi� Pipe�Undrgrnd. �!
•(_
3. Electrical Condu;t Utilrty-Un;lr9rnd.
4. Electrical Conduit�Undrgrnc'�i,
5. Steel Reinforcemenc
6. Electrical UFER Gmd.
7. Footings .
8. Foundation ',7t
9. Water Pipe-Undrgrnd. �
/0. Structura� Fioor 5ystem ,
it. Property Sewer Line & Hou�,seConnection
`• _
72. Setiver Cap
� 13. Roof Drains �
1
' tA. Rough Plum6ing '
C�
75. Rough Elearical,Conduit �
76. Rough Electric Wiring L �
i 17. Rottgh W�nng Sign �
�
18. Rough Electrical-T Bar Ceiling
79. Rough Heating & Air Conditloning
20. Rough FactorY Fireplace
21. Dutts,in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T•Bar Ceiling ($trutturall & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Bro�vn Coat
32. Electrical Power Meter�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factorv Fireplace
38. Final Plumbing
39. Water Service-Finai
40. Gas Service-Final
47. Solar pomestic�Final
42. Backflow Preventer
43. Backflow irrigation
44. landscape Irrigation System
45. Sound Attenuation
46. Handicap Regul�tions
� 47. FINAL STRUC7URE & BUIL�ING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to $outhern California Gas
51. CERTIFICATE nF OCCl1PANCY
Date
Date
r
POOL .PA
Inspector AppROVAIS Permit #
•� 52. Pool & Equipment Location
�� 53. Steel Reinforcement
-t,�� -
"� 54. Forms
1• 55. Electrica� Bonding
'� 56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
�"� 58. Electrical Conduit-Undrgrnd.
J
59. Gas Pipe, [] Undrgmd., Test
�� 60. Backwash Lines, P�Trap, C] Undrgrnd.
61. APPROVAL TO DECK
� � 62. Backwash & Receptor-Final
1�
63. Heacer & VenbFinal
-�
r 64. Piumbing SYstem - Final
� I 65. Electrical-Final
� � 66. So�ar SYstem-Final
�
67. Fencing & Access AnP�oval
68. APPROVED FOR PLASTERING
69. POOUSPASYSTEMSFINAL
fIREDEPT.REQUIREMENT
APPROVALS Permit �
70. Underground Hydro
71. Product Piping C Gas C Oil
72. Under�round Flush
73. Undergrnd. Storage Tank f) Gas ❑ Oil
74. Ovenc�ad Hydro
75. Dry Chemical
76. Dry Standpipe
• 77. FIXED SYSTEM FINAL
. 78. FIRE PREV. FINAL
, � HEALTH DEPT. REQUIflEMENT
79. FINAL INSPECTIDN
. 80. FOOD CERTIFICA7E ISSUED
.. Notes:
8
A
Date � Inspector
7
�
:
.,, , �.
PHOJECIAOOHESS: �
OWNEP'S NIIME: 3 J 7 1 6T�
noosEss: FREDERICK
JR, _
i
UNIT:
� l.VJ1M PIGJA
CA 92627 �
�PCH/ENGINEEN: � 71 4� 7z 2—B 9 Z Z NE6.N0.:
aooaess: SCOTT DAVID BROWNELL CO�NjT839
950 W COAST HWY
PEflminEE: NEWPORT BEACA CA 9266
nooeEss: DEBBIE ENGELHARD ( 14 ) 722-8922
�j W3p5(7��
/
t6a4a6 W�ile—Bmltling; Green—Cotle Eniorcement:
Catle S ions�
�. codes and ihe requiremenis for a
tion apDlications are eKempt fmm
to comply with all city and coun�y
to enter ydon the abgye�mentionetl
Pink—Revenue: Goldenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PEFtM�NO: H 05770
PERMIT NO; B 057707 PLAN CHECK NO; 01532-92 L GOVT; N SUPP; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR PURPOSE; ADD
JOB DESCRIPTION : 1ST S 2ND�FLR ADDITIONS TO EXISTING SFD SQ FT; 1,648
CLAIM VALUE; 45,000,00 CALC—VALUE: 111,172,80 GROIIP OCC: R-3 /M-1
COMMENTS: 2NDFL/ADD MAST BD RM BATH DEN LAUND DECR
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�` Z O N I N G R E Q U I R E M E N T S
� S E T H A C K S
i
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: 17 FT 3 IN REAR; 15 FT IN FRNT: FT IN REAR; FT IN
LEFT; 37 FT IN RGHT; 5 FT IN LEFT; FT IN RGHT: FT IN
PLANNINGRNiS'I'ES> REMODEL/ADDIT—EX RESCE2b'4STBK12NDZFLit,R290 SFEREAR�YD COVER
-> OK•.80_SF PROP, SIDEWALK PROP• PROJ INIT B/F NEW PRING STDS.
w�*�r�r��t**�*�r****�e�r�e**�r�t�r**�r+t***r�r***x���t�r***�r�t�r*����*****+t*�t*�r��r�r�r�e�t�t�r*�r*�*��*�
D E V E.'L O rP 'M E N" T- S E R V I C E S R E Q U I R E M E N T S
,., 7y •
ZONING APPROVED,BY -, ' �� `. SCL DATE; (o(11��'L.
� -
BUILDING APPROVED HY ;.- .' _ DATE:
' � C
APPLICATION ISSUED BY+'' l, W�---, DATE; Cn ll
ifaEifiE�EifkiEiE#fM1E�E�EifiFkfE3FffiFif KiEiElFitifiFiliEaf iFif
****�r*�r*��*�**���r�r*��r�e�r�r�e*��r�e*�r*�r*�r�r�r****��r�r***�r��r�e*�r�**+�*�r*�r*�e*���r*�r*****�r�e�r**
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 681,50 � 11.12
PLAN 4q2 98 i SMIP/NON—RES
ISSUE FEE :
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 692,62 0.00 442.98 1135.60 1135.60 ,00
j
REVENUE DIVISZON TOTALS--> COLLECTED: 692.62 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN—CHECK
681.50 � 11.12
k aE �lf k �! if if 1E ik k 1E if k iE if k iE iE iF iF iF ik if ik if M iE fE �F ik ik k k k it!! �Flk iF k iF k!k!F if if 3f if �k M IF M k if kif 1E k 1f 1f k �F ik 1E iE 1F �f iEiFiF il�F !E if �1f if M IE �F
I N D I V I D U A" L, F E E B R E A R D O W N
TYPE QTY D E S C R I P T I�O N UNIT COST TOTAL COST
SFR 1602 DWE—TYPE V—WOOD FRAME —GOOD 69,00 110,538,00
SFR 46 RES—BALCONY, EXTERIOR STAIRWAY 13,80 634,80
-END OF FEES
�
. . �1 �". . . . _
CONSTRUCTION AND PLANNING POC PA,
APPROVALS Permit #-- Date inspector APpflOVA�S Permit # Date Inspector
• 1. Temporary Etectrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 5,3. Steel Reinforcement
r ._ '
„3:��1�6trital'-Cpn�uit_U�lity-Undrgrnd. :" �4. Forms �-
� A? He�NTicelfC6nduit=Nndrgrnd. �'_ [lZ � � '65. Electrical Bonding
�� / s
-,5: 5te'eI"R�tYforcerF}e�l�' V "� 58. Rough Plumbing & Pressure Test -
'� ��� Electricai-UF6ft'Grnd. �fi7. APPROVAL TO COVER�GUNITE
-.�.- -
=7r;Pootinq�� n�`' � r�,,;r �' SB. Electrical Conduit-Undrgrnd. �
S.� FoundaiipJ}. �9. Gas Pipe, � Undrgrnd., Test
9?Water Pipe-�ndrgmd. ,��50. Backwash Lines, P�Trap, � Undrgmd.
70^ Structurei�Floor System �I�192 ��' �' 61. �APPROVAL TO DECK '
l
11+Property Sewe? Linef& House Connection . G2. Sackwash & Receptor�Final
72. Sewer Cap ; �. � 63. Heater & Vant-Finai
13. Roof Drains '� - 64. Piumbing System - Final .
14. Rough Plumbirig., ' 65. Electricai�Final
75. Rough Ekrctrical.,Conduit 66. Solar System•Finai . �•
76. Rough El�ctric wiring 67. Fencing & Access ApProval
17. Rough WjGing Sign 68. APPROVEO FOR PLASTERING "
18. Rough Electrica'�V.T Bar Ceiling 69. POOUSPA SYS7EMS FINAL -
19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT
- _ _ _ w x a n:.
20. Rou�Factor�tFiceplace ; �:•�; a.'= '! C: -• '-r" {,�ppROVALS%-��erqiit� �` >' •r'
�' f i r� :fi " ' a c:. 3. C. - �}•.'_'_..
21 . buctt, in`StruCture � �. .. :. � �. ? � - 'F : . ' . , .
. • 0. UndergrourSd Hydio �
w
22. Ducts; Ventilaring .K : � � _ > �.y.' ��1. Product 2ip`Sn�j CfG�'S ❑Qil
23. 6as Pipe:Rough & Y�st "' ;' ;� ,r• • '• n , ' ' , '
� ,_;� ~ �72. Underground Flu h�, r .
24. RoonFraming � _ � � ��.t � f yy 73. ilndergrnd:�Storage�a �k L� Gas ❑ Oil "
25. RoofxSheaihing a: ; (,� � Or � �' �4, :Qverhead Hydro � �
L`
26. T-BaciCeiling (Strer�turaQ & Monocoat � _ x 'U O :•Yy y 75. ��Y Cy2my�.al� . ''� ' � :s�;�
27. `Erameand Fla5hing � : � ' _`�' � ' 76. �Dry Stand�pjpQ =�5� .� ' � �
�$. Lathing &�Siding ;a .- �a; .: xa;�� _j� Y`y' p j��•H � 77. =FIXED SYS7EM�P�TNAL ` :' '' .
39. Insulation . '"' :�'�`1�j q��1� x' 78.�FIRE PREV. FINAb s. r .
:30. Drywail fdailirtq - � _ �_l ( c(2 fl(�- �` + HEALTH.�EPT `REQUIREMENT
�
Y. �� ��. I w Y � ' c , l
31. Plaster Brpwn.Coa�` , , � .,, ,. , '�,�:� '�1 �g� 4 �9.'FINAL IN�P�CTION � '
. , . k_
32. ElectricaNPower Meter;Final � � �:x vr �.�. ; � �80.:FOOD CERTIF��^TE ISSU �
33. ��ina��.Ele�tric� y'„ : ` �„ ' � � �lotes: (�� - . r�i�
;�. Fina�-Heaiing& Air,Cori�i�tionir,g,s �-' �r.,x � � ' :. �� . .., �
•'� �� 1 r F f 1
35. E,inalGa£PiPe-l'est-` �7 ^r.�z� � t. � , ^.- tr.•: a- -.0
c -x :- r �- i ta .r... `. - '
•• _ - (
�6. Hootl or CBnopy .y„ � ' � a: �: s '„i. " r
`< ' P l'.
'37. KinaPFaetory FireAl�ce ^ ' �'�` `� ' �, ; s��j
, �
s e . � :{ 'S.
38. Finaj,Plumbing �. �7 . �� � " � + � �� � �c i
�
39. Water:SeNice-Fin31'.'' � �',`• =` ' '`'' . � » �'` r `'� `�
'i". ' � + CC N Y • tA +
'40. Gas Service-Fiqal .� ,,, y., - ;,r•, .x �., . ti ^' L �Zc'� ' �
'4.1 . Solar pornestiC-Finak : : • x � �� C ..t - •
i�i -� �. �� � -
42. Backflow,Preventer � �i � � � � '� : - = - � - �>
. �r _ �r. � . �.
43. Backflow Irrigetion ` '��_� � `�? ' -r- '• ' � ''.
r �^ � '
1` ' r .
¢4. Landsca�e Irrigation.SYstem ;��„ u. :� ,r t:�. C J: � i •- 2.: ?. o�
45. Sound Attenuation` � :'''l. J . � f - .` _' .
�� - - Jl '�, .�' _:;� .l. ;� .
46. NandicaP.Reg4lations `" ':a.r� ``� . , c� •�i �_. - a
47. EINAt STRUCTUR-E & BUILOING `?� �.�b �?j G = . - ; '
ti
48. F-INAL PLANNING; � �"�-�. - ,� F ., ;.� A � . �
49. Electric Release to Edison � v� .* }` u; ' ,,'c
� t . �_i.
.�. Gas Re�e3_se to. Soutfiern Califocnia Gas Co '_ � Fr - -. � _. �
',S ._ .,
51. CERTIFICATE OP _ CCUPANCY' , „ ; . . . or:
No. Date
�
FINAL GRA�ING CERTIFICATION
Project Address: 357 L6 /// �L��
Lot Number: ��T/bk/ OF �T✓�6 � �(/$uDO�j %FE/l.,/i7� Ti�- _
Permit Number. �� ="�5 77 � 7 ---
By Civil Engineer: /
I certify to the satisfactory completion of grading in accordance �•ith the approved plans,
specifications, local and,state codes. All drainage devices required by the grading permit,
grading plan and grading ordinance have been installed. Adequate provisions have been made
for drainage of surface water from each building site.
The minir]r � s are:
2% Fall from structures within 5 feet from exterior aalls.
I% Fall for asphalt surfaces and landscaped areas.
0.5% Fall for concrete surfaces to approved disposal areas.
The final monuments as shown on the recorded tract map were set. All final grading eleva-
tions are within ± 1/10 of the designed elevations.
Supervising Civil Engineer K./�/ ��s�l�f�`— Reg. No.�• y6s3
(Si na�ure)
Date 3 /O-9�
RON MIEDEMA
EXP. DATE: 9/30195
No. 4653
STA� and SIGN
tB9�<6
City of Costa Mesa
California 92628-1200 P.O.Box 1200
Insulation Certificate -
Permit Number � � �/
�s� /6 � P� C�, s��_�I�sA
Number and Street . Ciry
—��,c,�o�e. ��'c�Pu2T_1�6.cS4'S Lo � "�S�
�County Subtlivision Lot Number
Description of Installation
ROOF �j,.���
� s i-5�-�.
Material _; Ydti=.+'ri�� �Sr'fi.u4+G�s Brand Name ��-�
Thickness (inches) Thermal Resistance (R-Value)
EXTERIOR WALL y�-� -
Material _?rj�F1Z. (��'+45��S Brand Name _ _/�/�'K:�/ �-L--�
Thickness (inches) ,�/�'� Thermal Resistance (R-Value)—��//
CEILING
� ,Eait�6PBlanket Type t�aF�� _LIiSs Brand Name—��4_N_U�LC.�L'
Thickness (inches) � " Thermal Resistance (R-Value) —�-��
Loose Fill Type Brand Name
Contractor's minimum installed weight/ftz_ Ib. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR
Material
Thickness (inches)
SLAB FLOOR
Material
Thickness (inches)
Width (inches)
FOUNDATION WALL
Material
Thickness (inches)
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Adminstrative Code.
UN�o-� Ttf,� �u� C'� S?iP.tx.i7�.v �$_? `�5 /
General Contractor (Builder) License Numbe
Dcv�.�'� 8.�///_�S�
Signature and Title Date
/(�oitCE [ �:cA
Sub-Contractor (Insulation Installer) LiCense Number
Signature antl 7iUe
190]L6
Date
� CERTIrICATE OF COMPLIANC�
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-NESA UNIFIL�D SCAOOL DISTRICT
Developer/Applicant:
Address:
Telephone Number:
' � f i �Cr�
�- /��
Tract/Parcel and Lot Number(s):
Location of Proje'ct:
�
/1 Q /2�C
ce /� i,
L�'�� %
Number of Square Feet of
Residential Space �� x..$1.50 Total
Number of Square Feet of
Commercial and
Industrial Space
x $0.25 Total
Commercial/Industrial Project is: (Check One)
Mini-storage
Movie Theater
Racquet/Health
Warehoiises
Heavy Industrial
Regional Shops
Light Industrial
Motel
Bank
Neighborhood Shops
R & D
Hotel
Medical Office
Office Park
Preschool
Auto Repair
_ Hospital
_ Large Office
_ Office Bldg.
_ Restaurant
Fast Food
The provisions of Covernment Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995.
Checks are to be made payable to New�ort-Mesa Unified School District.
Business Manager
Newport-Mesa Unified School District
The above representation as to square footage is true. Developer/
Applicant agrees 'that if it is later determined that such representa-
tions are no[ true then this certificate shall automatically terminate
and the appropriate City/County shall be notified. �
Date: (p�' /b'9o� �� %'
eveloper/ pplic�nt
� rxee�crnooness: �357 1�6TH PL u"�T:
• .fiesHix`sxarne: FREDERICK ENGELHARD JR,
�ooeess: 3 5 7 1 6 TH PL
(714)722-8922
AflCNIENGINEEP: SCOTT DAVID BROWNELL pEc.No.: C011839
�onncss: 950 W COAST HWY uxir:
NEWPORT BEACH CA 92663
PEflMIREE: UNDER THE SUN CONST. ( 714 ) 974-2034
aooecss: Z27$ ROBINHOOD PL
ORANGE CA 92667
ULENSEo CaNiMtTOB oECUMTION: I nereEy atlum ttut 1 am 6CEn5eG uMe� prm'i5iM5 oi CtWpter 9(fAmrtren[' 'In Seclion
7000� ol Divison 3 oi t�e 9usineu aM P�olessans CoEe, anE my li "'�-tW. ellect.
cirruc.:0 '87 saeuc.:48245
Oate: �- Si9iwwrt: _ _
WORHEHS' COMPENSATION OECLAflRTION: I trertEy aflirm Ihat I Iwve a cenilirate ot wrtttnt to sel4insure or a ceniliwte of Workers'
CamDensation ly}y�ap�e_q� �cpftiyeq r,pDY �Aerrol (Seciim 3800, LaE. {'j
70LICY NO.: � � y y u � 4� q n E%P. DRTE: U�1 / 0]/ 9 3
cornrnxr: STATE FUND
� Cenified copY is Aere�y IumisheA. ❑ Certilie0 copy is ileU wit Divisron.
n,+P. �`O ^ � �� Appliwni:
EI(EMPTION FNOM WOPKEXS' COMPENSATION DECtAMTION: (ilik se[Uon neN roI Ge mmpkleE il Ne perml a tor me hwqreG �4100) ar less�.
I cenity inal in Ihe oetlormance ol Ihe work lor whicn inis permit is issuea. I snall not emDloy any person in any manner so as to �ecome
Su�leti Io I�e Workers' ComOensalion Laws 01 Calilomia. - ,
Oate: 9gnature:
NOTICE: II. aRer makinp �his tleclara�i0n. you 50oultl become subject IO I�E Wo�kers' Compensa�ion pmvisions o� lhe Labor
Code. you musl fort�witA complY w��� suc� O�o�sions or I�is p¢rmil shall Ue AeemeA revoke0. -•
CONSTflUCTION LENDINC AGENCV: I �ereGy a��irm I�ai IAere is a wnStmCiion lentling aAe�ty tof ��P DeNormante o� �he work �or
wAic� Nis permit isissue0 (Seclion 3097. Gv. C�. ,
LENDEN: � '
ROOflESS:
OWNEB BWLOEfl OECUM710N: I hereoy aflirm Ihal I am etempt Irom ine Coniradors' State License Law lor Ine lallowing reason
(Section 7031,5 Business anG Pmlessional CoOe: My ciry of munry wtuc� repuias a permii Io comiruct atter, improve, aemolis0, ar
repaie any Siruttur¢. prior ta ils issuancl. also rtQuires I�E ipW�n1 �Or SUU pBrmii Io fil¢ a 5i0neA S�aiemen� �ha� �pJShe is licens¢E
pursuam m tne provisions oi t�e Camractau' Siate License Law (CIuO�er 9(commencinp vrii� Section 7000) ol Division 3 of t0e Busineu
ana Pmfessions Caael or that ne/sne is erempt Inerelmm an0 ine Easis lor ine alleqe0 ecemD��on. Any Wolation ol Section 7Q31.5 Dy
any apP�icant lor a Dermit SUEjMs tne apptiqnl to a civil ptiulty al not more Itun live nuiMreO Odlars (�1.
I. as o�er of �na propeny or my emWoyee5 witn wapes as tAeir wle camven5ation, vnll ao tAe wOrk, an0 Ihe
❑ slmcWre is not intrnOeG or attereE far sale (Sectron 70a1, Busmess anU Pmfessional CoOe: T�e Canlractor5' State �icensa Law
Uoes rro� aDDN �a an ownn of a propeny wllo dnl0s or improves ihereon, aM who Uoa such work himsell/tcersell or tluouph
Ns o� ne� own employees, proviEea Rul suth imD��'em¢nts are nol inlenAeE ar olfere0 for Sale. II. however ihe huilding or
impwvement is sol0 wil�in one year o� complelion, I�e owner wiA �ave 1�e EurEen ol provinp �PJs�e Ui0 nol builA or improve
lor ine vurpo5e af Satel.
I, as owner o� ��e DmOeny, am e.clusivery conirattinp xil� Iitense0 wniractors lo conslmci t�e proleq Seciian 70aa, Business
❑ anE Professims COGe: The CantrzctoK Slate Lic�nse Law Eces noi appry lo an m�ne� ol Dropetrywtq �Q5 or improves tAertnn
antl wno Wniraps for sucn prqMis witlla toniractwls) IkmSe pursuanl to the COniractofs' Sldte lJtense Law). I am axare
Ihai pro01 0l I�ei! Workei 5 CompCnsalion in5uqn[e S�ouW �e prOviO¢E lo me.
� I am eaempt unGer Section: B. 8 P. C.
lor tltis tea5on:
CZTY OF COS'fA MESA — BUILDING PERMI'1' PERM NO; P 5 ./
PERMIT NO: P 058922 PI�AN CHECK NO: N , ,
CONSTRUCTION TYPE; S—N PERMIT TYPE: PLU PURPOSE; ADD
JOB DESCRIPTION ; 1ST 6 2Nll F'Ltt ADDITIONS TO EXISTING SFD SQ FT; �
CLAIM VALUE; 116,000.00 CALC—VALUE; GROUP OCC: R-3 /M-1
COMMENTS: REF;B57707
*x�+�*�***+��c**** ***��r****�r**�**�**+�***+��t***+�***�+�**x **+t****+�****+r***** ��x ***+��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 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; 42519102 ZNE; REF NO;
PLANNING Nt51'ES>
i
!F!F iflf iE 1ElF iE 1E if if if iE 1E iE 1E if ik iE itlt iflE iF iE it iE iF it 1E iE iE if iF if !E 1F 1E 3f if 1F if iF if if �E if� if iF iE if iF iE iE 1E iF 1F iE 1E fE if !t iFlE iE iF iFlF 1f iE if i! if iE jf if iF 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 HY DATE;
BUILDING APPROVED BY ; DATE;
APPLICATION ISSUED BY; � DATE; �
ififiEiEit�l�iElfiflEkiEiFitifiFiElElEiElEk ��ffElkifiE�FIf1F�1fiF iFiF
i4 if it iE it if iE it if iE if iF 4 ik ik fE iE IE iE tt iE 1k k iF it it iE iE It iE if 1E if if iE iElFiE ik iE ik iE k 3E iE ik iF if iE iFlElf If ik if �f� ik iF if if iE k fE 3f if ik IE 1! iE it 1E iE iF 1F if iF iF 1f if
LEGALIZATION;N F' E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT Q�'�SY
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 47,00 20.00 0.00
REVENUE DIVISZON TOTALS--> COLLECTED; \
BLDG PMT PLUMBING ELECTRIC MECHANIC
67.00
SMIP/NON—RES
TOTAL PAID DUE
67,00 67.00 ,00
67,00 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECK
if if f( it k iF 1E if k dk iF 1FlF it 1f 1k it fk �ElklE it iE i! k!f !f if ff !F!E iF iE If If iElElE if iE ik iFif if if iF if IE 1E k if iF if !F IE 1t if iflElt iE iE ik i! if 1k IF if 1! k IFlE iF i! IE iE iE if 3h
Z 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
Date: �"1ef� P L U
i aa nereby cenity tha� I am aware ol anU undersWnO I�e reyuirement5 al Calilomu Healt� anE Safery CoEe Sections 25505, 25533, an0 p L U
2553< ana ihat I or any tumre Dmleing acupant wilUvnil noi (tircle ane) nee0 �a compy wit� saiE siaie ca0es anU Ihe reQuirertrents tor a p L��
perrtul lor con5imtlion or modilitatian �mm t�e Air Oua41y Manapemeni D'atricl. BaiAmtul cOnSiruclion aDD���wns are ¢x¢mpt Imm pLU
inese D��sions.
PLiI
oaie: npv�icam: P L U
I here�y cenify �hal I nave reatl iA¢ aooliwuon anC state ihat tne a0ove inf : orrtt ompty vnth ail c na c nty P L U
ortlinances antl siate taws reWting ta EuilEinq cros�mciwn an0 �ere0y a ¢e r nt is ciry to en e ove- tionetl
propetly lor' e ect� rPoseS,,,� '�
oate: �� Signature:
'omersucenseoiSodatsecudiyx:
164Le6 WMe—Bmlainp; Green—Coae Enlorcemem: Cenary—Aodiwnt: Pink—Revenue: GoldenraE—Asvussor
1 BATHTOB 7.00
1 DISHWASHER 7,00
1 SHOWER 7.00
1 SINH, KITCHEN 7,00
1 WASH BASIN (SET) , 7,00
1 ,WATER CLOSET (TOILET) 7,00
1 GAS PIPING SYS OF 1 TO 9 OUTLETS 5,00
END OF FEES
7.00
7,0�
7.00
7,00
7,00
7,00
5,00
� CONSTRUCTION AND PLANNING (
POOI & SPA �
� APPROVALS .Permit �r` Date Inspector qppROVALS Permit # Date Inspector
t. Temporary Electrical Service oi Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrqrnd. ` C�J��� _ 53. Steel qeinforcement
/
- 3. E't:c[�ic31 Conduit Utility-Undrgrnd. 54. Forms
6. Elect��caf Conduit�Undrgrnd. 55. Electrical Bonding
� 5. Steel Reintorcement - 56. Rough Plumbing & Pressure Test
6� Electrical UFER G�nd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Wate� P�pe-Undcqrnd. 60. Backwash Lines, P�Trap, � Undrqrnd.
10. Structurel Floor System ' . 61. APPROVAI TO DECK �
11. Property Sewer Line & House Connectlon 62. Backwash & Receptor�Final
72. Sewe� Cap �.,. -�� . 63. Heater & Vent-Final
,
13. Roof Drains • 64. Plumbin9 System - Final
14. Rouqh Plumbing f��b/� __ � 65. Electrical-Finai
!!i
15. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric Wiring � ,� 67. Fencing & Access AnProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS- �Permit #
21. DuCts, in Structure �70. Underground Hydro
22. Ducts, VentiWting • 71. Product�Piping OGas QOiI
23. Gas Pipe-Rough & Test -� 72. Underground Flush. �
24. Roof Framing - ' 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing - . 74. Overhead Hydro
26. T•Ber Ceiling (Strucwraq & Monocoat 75. Dry Chemical
27. Frame and Fiashing 76. Dry Standpipe
28. Lath�ng & Siding � 77. � FIXED SYSTEM FINAL
29. �nsulation I � 78. FIRE PREV. FINAL
30. Drywall Nailing I !, •HEALTH DEPT. REQUIREMENT
31. Plasrer Brown Coat � �- 79. FINAL INSPECTION
32. Electrical Power Meter-Final � � 80. FOOD CERTIFICATE ISSUED
33. Finel Electric ' I � Notes:
34. Final Heating & Air Conditioning ' I
35. Final Gas Pipe-Test � ���4`
�
36. Hood or Canopy � j�, �
37. Final Factory Fireplace � �
\
38. Final P�umbing Y��
39. Water Service•Final � T '
I
40. Gas 5ervice�Final
41. Solar pomestic•Final
I
42. Backflow Preventer � �
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
� 46. Handiwp Regulations . .
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING �
49�. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
i, .
51. CERTIFICATE OF OCCUPANCY
No. Dare
PR0.IECT �OOflESS: • 3 S I 1 bTH pL 11NIT:
OWNEX'SNRME: FREDERICK ENGELHARD JA, �
nooness: 357 16TH PL
COSTA MESA
' CA 92627
(714)722-8922
AflCN1ENGINEEP: SCOTT DAVZD BROWNELL sec.xo.: C011839
nooxess: 950 W COAST HWY uxrt:
NEWPORT BEACH CA 92663
PEflMITTEF: UNDER THE SON CONST, ( 714 ) 974-2034
pODflESS: Z278 ROBINHOOD PL
ORANGE CA 92667
LICENSEO CONTNACTOP OEIXAPRTION: I hBreEy a��irm IIWI I am Iiten5e0 uMer provisio af Cnapter 91�mme 0��n Section
7000� of Division 3 0l t�e Busineu and Pmlessions CoGe. ana m f - rt E et�xt.
cirr uc.: 0 8 7 sT�Te uc.: q g z q 51 c�ass:
� � � Si9nalure:
WOBREBS' COMPENSRTION OEjC�UMTCIOpNy: t�I �ereby allirm iha� I Iwve a cenilicate at wnsent to seli-insure or a cenificate af Workers'
POLICY N0. n I�LaJte— J��V �e� ]�9 j{ereof (Sect%P p iEao. ��1 / O 1/ 9 3
comvnxv: STATE FUND
� Certilietl copy is nere0y IurnisAeA. ❑ Cenifietl coD �s filea wiiA t�e it 9'� .
p` / Q 2� % � ApWiwnL
EXEMPTION FNOM WUPIIEXS'COMPENSNiION OECLAflPTION: (il4sseebon(reeC mtGecampkteGiithepertnlisiw one hun feU�5100�orleu�.
I cetlily Ihal in ��e petlormance ol t�e wOrk IOr w�ic� this permil fs issuetl, I sha�l no� emDloy any person in any manner so as to become
suDleci io i�e Workers' ComDe����on Laws ai Calilomia.
Dale', Sipnalure:
NO71tE: II, after making t�is Geclaratron. you shoul0 Oecame wEl� �o Ihe Warkers' Compensation prmisions o� Ihe Labar
Cotle. y0u must �ort�wil� tom0ly vnlh Sut� O�ovisi0n5 Or lN5 permil shall Ue Oe¢me0 revOked.
CONSTflUtT10N IENUING AGENCY: I �er¢Ey aHirm Ihai lhete is a tonslmc�i0n lending aAenCy for �he petlormante ol �he work �or
w�i�� 1�¢ permit is issue0 (Seqion 3097. Gv. C�.
LENDFfl:
PDDNE55:
OWNEfl BIIIWFfl DECNIU710N: I �ereGy allirm t�al I am eKempl irom ihe COniractors' State License Law lor Ihe lollawinp reason
(Senion 70.1L5 Business an0 Pml�ssional Cude: My ury of wwry wtuc0 repulres a permii to canstrucC �ter, improve, Eertroli511, or
repaii airy Slm[Iur¢. priar lo ils i5tuant¢. 21So tGpuir¢5 IOe aOD��nt lof wCh perrtti� lo �il¢@ 5iqned Sfaiemen� Ihdl �PlShe i5 litensed
pursuam �o t�e O�ovisions of tM Contracmri Siare License Law �Clwpter 9(comme�ng vnt��eCtbn 700D) of DNision 3 of tAe Business
anC Mofesvons COCe) or tna� IWs�e'a aemv� ��erefrom an0 ttu Eazk for Ne aueqM exertlpuon. My Nolation ol Section 7091.5 by
any applicanl lor a D¢rmii suClecls iM apo��W�� lo a civil Denaliy af noi more Itun /rve �unAreE UOAars (5500).
I. as owner ol Ine propeny or my empIqe6 with wapes as their Sole Gomprnsalion, uNl Eo the work, ane ihe
❑ sirucwie is not intenGeO ar olhre0lor sale (SeC�qn 70�e. Buvness an0 Pmtessional COEe: The Contactors' State Liceme Law
aces not apply to an owner al a D�oceny wtq WilOs or improves tlurean. antl who Goes suc� work himselll�ersell ar thmupA
his or �er own emplP/ees• 0«� ��� suc� imprwemenl5 a2 not inlmUeO ar otlere0 for ule. II, Ipwev¢r t�e GuilJinA or
impmvemenl b SWO vniNn one yeu al complelion. t�e owner will luve Ne Eurtlen of provinq �Us�e Eitl not Cui10 or imprme
toi Ine purvose ol Sale�.
I. as ownei ol Iho D�openy. am eKCWsiveIy contractinp wiih IittnseC wmracmrs to mnsimct tAe O�oiecl (Sectian 70aa, Business
❑ aiM Prolessirvtt Code: TM Conirxtors' State Liceise Law Eces ml appy �o an axner of propeM1y wM CW6s ar improues IAereon
ana whp contracis fo� such prolects wiln a wniractorls) IkenS¢ D�rsudnt to ine fAntractor5' $Iate Laense Law�. I am aware
i�� O�ool ol ��eir WOAei s Campensatpn iinurariCe SMuN Ge prmiOeE lo me.
� I am eeempl unOer $ectqn: B. 8 P. t.
br I�is reason:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 058923
PERMIT NO; M 058923 PLAN CHECK NO; N GOVT; N SUPP; N
CONSTRUCTION TYPE; 5—N PER,NIT TYPE: MEC PURPOSE: ADD
JOB DESCRIPTION : 1ST 6 2ND FLR ADDZTIONS TO EXISTING SFD SQ FT;
CLAIM VALUE: 116,000.00 CALC—VALUE: GROUP OCC: R-3 /M-1
COMMENTS: REF:B57707
* r�r��r*�t*+r�r�e**� **��e*��r**�r�rx ******��+�*�*�r*�r�r*+t****�tx �r�r*�r�r*****� x�t�rx *�r*�r�**+t*** ��t+t
Z O N I N G R E Q U Z R E M E N T S
S E T H A C K 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 RE • PROV: PARCEL; 92519102 ZNE; REF NO;
PLANNING N 1'ES>
> �. •
��1E iE 1E iE it ihlE iF iElf 1E * ik �ElElf ff 1E 1E k iE if k iE iE iE 1E iF k if iE if iE iE iE iE #iF iE1F iE IE if �E ik 3k �EiE %iE if �E dk 3E k iF 3E iE k iE iF 3F iE iF !E iF if iE iE iF 3f iF iF �k �E fE iE iE 1F
. D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
�ZONING APPROVED BY ' DATE;
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY; � DATE: � ��,
i!lFiEiflfiFiklfiE�EiFiEiFikiflflElf�ifikiFik . ��iFiFiEififihlEiElEiFiF iEiE
iE jk if iE if ih ik iF ik if iEiE if M if iF iF iE 1f if 3E iE ik 1E if iF * iE �f if M ik ff fE iE if ik IE iE iF 3E aE iE �E 1E iF ik iE iF ik 3f iE iE �f IF ik �E iF 1E lf iF 1E 1E iE If if iklf if IE 1E iF iE iF if iE if if IE
LEGALI2ATION;N F E E S U,M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRICy MECHANIC FIRE SMIP/RES GRADING
PERMIT _.j' . Z6�St SMIP/NON—RES
PLAN : :
ISSUE FEE � 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
1'OTALS----> 26,50 15,00 0,00 41,50 41,50 ,00
REVENUE DIVISION TOTALS--> COLL£CPED•; 41.50 OVER/SAORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
41,, Sfl
if iF iE ik iP k iE lE iF rt ih iE if iE iF if iE iF iE iE IE iE iF iE iE k if 1E 1E1k 1E fE if if iE1E if {E 1E iF�1F if iFlF �FiE 1E M iE 3f 1E if If k iE 1k if 1f iF iE 1f iE If iE IE 1E 1P ik if iE k 1E iE it iF if if jf if
I N D I V I D U A L'iF��E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N�' UNIT COST TOTAL COST
oate: �e� MEC 1 INST FORC—AIR/GRAV FUitN '<= 100 K BTU 9. 00 9, 00
I Oo nemby cendy ina� I am aware ol and unaerstafM iM reVuiremems o1 Catitomia Healih an0 Salery Coae Sections P5505, 25533, ane I MEC 2 FACTQRY F I REPLAC E ' �} 6, S 0 1 3, � �
2553a ana Ilut I or any lumre 6uilCing acupanl wiNwill no1 (cirGe one) neeU �o comON K+�A sai0 state ca0es antl lhe repuirements lor a M EC 1 V EN T I LAT' Z ON FAN CONN '�'O S I NGL $ DUC T 4. 5 � 9,$ 0
permi� lor cOnslmtlion Or m00ilicali0n Imm I�e Air�ualily Maregemeni U5Irit1. fleSiGential Con5lmtii0n ap0���alion5 are exemp� Imm
mese o��srons. END�'OF FEES
Oate' Applicanl:
I nereDy renity ihai I nave reae t�is appiication an0 state tAat ihe above intorr�yt' n is cor e I agree lo comp nh iry an0 county
o�Eiwnces ana sta�e laws relaiing lo builUing conslructim aM hereGy a � rese� o po above-mentionea
pmpetly lor in5 eclion purpases
Date: C �' � SignaWre:
odver's ucense o� saiai Secwiiy a:
164nC6 W�ilo-6mltling; Grean—CoOe Enlorcemenl: Canary—Applicant; Pmk—Revenue; GOICenroO—Assessor
� ' �
.�
� ,.
� ,/
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.,�\
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit �i Date Inspector pppROVALS Permit # Date Inspector
1. Ter-�porary Electrical Service or Pole 52. Pool & Equipment Locat�on ,
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
- 3. Electrical Conduit UtfPty-Undrgrnd. 54. Forms
4, E�ectrical Cond�it�Undrgrnd. . " 55. Electrical Bonding
' 5. Steel Re�nforcement 56. Rough Plumbing & Pressure Tesi
6. Electrical UPER Gmd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Fo�ndation 59. Gas Pipe, O Undrgrnd., Test
8. Wa[er Pipe•Undrgmd. 60. Backwash Lines, P�Trap,'J Undr9md.
10. Strucmral Floor Sy;tem 61. APPROVAL TO DECK
71. Property Se�ver Une & rlo�se"Connection 62. Backwash & ReceptorFinal
12. Sewer Cap ' I ' 63. Heater & Vent-Final
13. Roof Drains � � � 64. Plumbing System • Final
14. Rough plumbing � 65. Electrical•Final
15. Rough ElectricabConduit � " 66. Solar System-Final �
16. Rough Electric Wiring . �-� 67. Fencing & Access Approval
77. Rough Wiring $ign 68. APPROVED FOR PLASTERING
18. Rough Electrieai-T Bar Ceiling � 69. POOUSPA SVSTEMS FINA�
19. Rough Heating & Air Contlitioning !�'��(� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - � - APPROVALS� Permit #
21. Ducts, in Strutture 70. Undergrowd Hydro
22. Ducts, Ventilating ' �71. Producl Piping OGas ❑Oil
23. Gas Pipe�Fough & Test - 72. Underground Flush :
24. Roof Freming � 73. Undergrnd.StorageTank OGas ❑Oii
25. Roof Sheathing - � 74, Overhead Hydro-
26. T-8ar Ceiling (Structural) & Monocoat 75. Dry Chemical '
�.
27. Frame and Flashing . � 76. Dry StandpiPc �
28. lathing & Siding , 77. FIXED SYSTEM FINAL
29. Insulatipn '. . � 78. FIRE PREV. FINAL
30. Drywall Nai4i�9 ' � HEALTH DEPT. REQUIREMENT
�31. Plaster Brown Coat . � 79. FINAL INSPECTION
32. Electrical Power Meter�Final I � � $0. F000 CERTIFICATE ISSUED
33: Final Electric . � � � Notes: �'
. I � J1=�=9t �_m��� •r_vZo_o_��/1j.c/
34. Final H¢ating & Air Conditioning ��� � /�� /� .�-��"/ �- �p � /
35. Finat-Gas Pipe�Test !���-`� �.'!{`��/ �.•mfiL4i!`/�[Oaf.J/_!t�_L7_2� </.CY_c!+Cs! :v'i
i ,�..L'Y� w./� C✓ <Il�l' � ��___���
36. Hood o� Canopy � v
�i
37. Final Factory Firep�ace �3�3� _�
38. Final Plumbing � �
39. Water Service�final � �
40. Gas Service-Final � �
41. Solar pomestic-Final ' �
I
42. Backflow Preventer � � �
43. Backflow Irrigation
44. LandscaPe Irriqation System � .
45.5ound Attenuation
46.�Mandicap Regulations
4Z fINAL STRUCTURE & BUILDING • ••
48. FINALPLANNING' .
49. Electric Release to Edisan
� .
50. Gas Release to Southem Califomia Gas Co � �'��
51. CERTIFICATEOFOCCUPANCY
No._ Date
Pq0.1ECTR00HES5: � 3S%• 16TH PL •� ux�T: •' �"� CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 058672
awxeesxnme: FRED ENGELHARD �•�-�
aooxess: 357 16TH PL PERMIT NO; E 058672 PLAN CHECK NO; N GOVT; N SUPP;
COSTA MESA
� CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; OTH
AflCN/ENCINEEfl: flEG.NO.: JOB DESCRIPTION ; TEMPORARY POWER FOR CONSTRUCTION SQ FT;
ROOHESS: UNIT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: /
PEflMIiTEE: BUILDERS POWER ( 719 ) 996-2660
aooRess: P.O. BOX 37 *p**�***�r*�**+�B*********��*�B*D**�r*�****��r�r�e***�*�r**�*x��r**�*�r**��*x*���*****�r*
( ORANGE CA 92666
I LICENSEO CONTflRLTOfl OECLAMTION: I �e2Ey alfirm t�at I am li[ense0 unaer pmvisions ai Chapter 9 �[ammencing vn�� Section Z O N I N('i R E Q U I R E M E N T S
7000� ol Oirsion 3 0l i�e Buvneu antl Pmlessians CaUe, anG rtry license is in full torce anU ellect. S E T H�1 C K S
cirruc.:006231 sTaTeuc.:246046 cuss:C10
�� �.�� ------------ MAIN BUILDING ---------- ----- ACCESSORY BUILDING
oaie: —/9_ 9 z Signamre: ---- --�------
wOAKeAS' COmPEN5A710N UECLFxA7�Ox: � hereUy anirm �na� � have a ceni�ica�e o� consem m se�i�insure or a certi�ica�e of workers' FRNT I FT 1 N REAR : FT I N F'RNT ; FT IN REAR : FT 1 N
I comoensa�ion��i�r�ce��ie�r�p�l�ereol�Section3800,Lab.L)z�01/92 LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: EXP. DRTE: 1
COMPRNY:GOLDEN EAGLE PARKING REQ• PROV; PARCEL: 42519302 ZNE; REF NO:
• ❑ Cenifiea coov �s nereby �urnisnetl. �Q Cenifiea copy is fiieo wim ine city Buiioing Oiwsion. PLANNING NZSTES>
>
Da�e'. �/9_9'` ppplicanL �/(�✓ ifiFitfElfiF1E1F1FiFlEiEiEiFiElEikfflFiFiFiFfFifikffififlklEifiklf�ikifltikltiF�FiFikiFlEfFiFlflFafiE3f�1E�EiFikikif�lkiE*itiEiEiEfEiEaEiFiEiFfEif�iElhfEitfFfilE
E%EMYfION FBOM WOPREflS' fAMPENS11TI0N DECUBRTION: Rhis secUan neeU na� be complete0 il t�e permit i5 �a one hmMretl (5100) or lew�. D E V E L O P M$ N T $. E Ti �i I C$$ R E Q Ll I R E M E N T$
I t¢tlily tha� in Ihe p¢darmance Of ihe work tor w�ith Ihis permi� is issUetl. I Shall nol emplay any p¢rson in any manner 5o as to OetOme
Isueien to ine Workers' Compensation Laws a� Caubmia. ZONING APPROVED BY DATE ;
oaie: siq�aw�e: BOILDING APPROVED BY DATE;
NOTICE:II: atler maWng ihis declaration, you stroNG Eecome SuEject to t�e Workers' Compensation provisions ol the Labor %
Code. you musl larthwith comO�Y'�^�h sut� prONSions or IAis permi� shall Ce OeemeE r¢wk¢E.
CONSTBOCTION LENOING RGENCY: I �ere�y al�irm ��a� Ihere is a conslmction lentlinp aAency �or Ihe pehormance o� Ihe work �or APPL I CAT ION I SSUED B Y; DATE ;
wnic�IhisDermi�isissuetl�5ec�ion3097,Civ.C�. ffikifififfFiklfiFff�EklEikiFlFikfFitiflElE F'iF'IFiFiflF{f{E****i4�. �{.{(.
LENOEfl: iFififiEiFifiEifiF�FiEikiEiFiFiFlfilififlEftiFkiFIFIfIt1f�E�f�E1klFIfiElf�flf�fiFikififif If1f�f1FIklEifififiFMlFiflflfiklFlEiFklfifikltlflfllifll3kiki!
aooness: LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
OWNENBUILOEBOECLANpTIUN: Iher¢Cyallirml�atlameKemD���omlheConVaclors'State�icense�aw�orme�ouowin9reason BLDG PMT PLUMBING� ELECTRIC MECHANIC FIRE SMIP/RES GRADING
ISection 7031.5 eusiness ane Pmleuional Caae: Any city o1 coumy which revuires a permit ro cansimcC atler. imprwe, Uemolish, or P ERM I T 1 S 0 0
re0air any simcmre. O��or to its iuuance. also reQuires t�e applicant lor such permit to lile a sipne0 statemem thai helshe is Iicense0 '`j� j SMIP /N�N—FifiS
pursuam to ihe pmvisions al Ihe Con(racmrs' S�a�e License Law (ChaD�e� 9(�ommencing wi�h Seclian 7000) oi �ivision 3 0� �he Business PL�
an0 Pmlessians COde� or tha� he/S�e is exempl I�erelmm anE IM1e basis lor �he allegetl exem0�ion. Any viola�ion ol 5¢tiion 7031.5 by
any aODlicant for a permit sublects the aDP�icant io a civil penalty ol not more than five hundreE dollars (E500�. I SSUE FEE 1 5, � �
i. as ovmer oi tne erapeny or my empiayees with wages as tneir sole compensation, wJl Eo ine work, and the HUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
❑ slmciure is noi intenGea or o��ereG �or sale �Stttion 70aa, Buvness anG Pmiessional COEe: T�e Cantracmri Stare Licenu Law T�� $----> i 5. 0 0 i S. � � �. � � 3 �. 0 � 3 �. � � , Q Q
does not apply to an awner a� a D�oO¢�y wlp Ouilds ar im0�ove5 ihereon, antl wlro Gaes such work �imsell/A¢rsell or thmuBh
his or �er own employees. pmviaeG ilu� such imD�ovements are mt intentle0 w aflereG fo� sale. If, however ihe building or REVENUE D IV IS I�N TOTAI.S--> COLLECTED • 30 , 00 OVER /SHORT • 00
impmvemem is sold wi�hin one year ol compleiion. Ihe owner vnll have �he Ourden of pmving he/she Oitl noi build or impmve
rormeourooseoisaiel. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
I, as owner ol Ihe pmDertY. am eKclusively con�racting wilh licensetl contracmrs Ia conslmci I�e pmlem (Section 7044, Business 3�,��
❑ anU Pmfessions CoOe: T�e Coniractors' Slale License Law tloes not apply to an owner of Ompetly wAo �uilds or impmves thereon
an4whocontracls�or5uchprolecl5withacanlraclor�ylicenSeDurSuantlolheCanlrac�or5'$Iate�icenSeLaw).lamaware ***'M�iE�fiFM�If�EikiF�f1fi61F�E�fff�fiFifiEififlfikiliFfFiFiklfififiFiffflEiFiFifiliFiFfliEiffFiFif1k1E1EiffFlfiF�ffElkiE1ElEIFif�fiF{t****�(.***ff{t
Ihat O�ool ol ��eir Worker's Campensation insurance shoula he pwvitle0 lo me. I N D 1 V I D U P. L F E E B R$ A K D � W l�
� I am exempt untler $etlion: B. 8 P. C.
m�inrsreason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
oaie: ov+ner: ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15,00 I5,00
i ao nereby cenify inat I am aware of anU unaerslantl Ihe reauiremems ol Calilomia Heatlh anU Safety Cotle Seaions 2550.5, 25533, antl END OF FEES
255Ja and tha� I or any tuwre Euileing occupam wilVvnll not (circle ane) neetl to camply wilh uiE nale co0es an0 t�e reQuirements far a
p¢imit lor consimclion o� motlilicaiion �mm I�e Air Oualiry ManagEmenl UStncL RevGen�ul conslructian ap0liution5 are exemp� fmm
IiICSP pf0VIS1005.
Daie: Applicant:
I �ereGy cetlily Iha� I �ave reaA Ihis ap0lication and slaie �ha� ��e above inlorma�ion is correcl. I agrte Io comply vn�� all ti�y and county
oiDinance5and5�atelawsielatinglobuA4inBconslmctionantlherebyauthorizereD�ese talive5allhiscilyloen�eruponlheaDove-menlioned
propetly farinSDec�mn purposes.
Da�e: � ��-JL Signaiure: , - .. .
Driver's license or 5ocial Securiiy r: ..'i :,� .. ' � .
t6<t�<6 W�ite—Bviltllno: Green—Cotlo Enforcemen�; Canarv—Aoolicant; Pink—Rovonue: GolCenroE—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit #_ Date Inspectoi qppROVALS Permit # Date Inspector
1. Temporory Electrical $ervice or Pole _� Q,�.�q ��, Pool & Equipment LocatiOn
O 4
2. Soil Pipe-Undrgrnd. -_ 53. Stee� Reinforceme�t
3. Ele�itrica� Conduit Utility-Undrgrnd, :, 54. Forms
4. �EI@ctrical Conduit�Undrgrnd. - 55. Electrical Bonding
. 5.,S�eel ReinforcemePt ' S6. Rough Plumbing & Pressure Test '-
' 6. EI"ectrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE �
'�'}. Footings �, - 58. Electricai ConduiFUndrgrnd.
8. Foundation �� ` 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor System . 67. APPROVAL TO DECK
71. Property Sewer Line & HoLse Conneccion 62. Backwash & Receptor�Final
12. Sewer Cap - � 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing System � Final
14. flough Plumbing � 65. Electricai�Final
15. Rough Electriral•Conduit 66. Solar System-Pinal
i 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Si9n 68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI.
:.t4,Rwgpkleating & Air Conditioning F1RE DEPT. REQUIREMENT
1 7
� 20."Rough Factory t ireplace � � ' '-. ' �' � = - r * �APPROVA�LS ^=Permit # -
I r � v - :.d `< -.t �: z .�:
21 :�DuCts, irt Svuctute . .. �� � , � � ' �; .- ;70. Undergcound Hytlro �
22. Ducis,Ventilating � �=� •> t'�' ;77, Produc{.PapingOGas OOiI
r .
23. Gas PipQ Rough & Jest :� a +- - �. �-,72. UndergYound PlusFi_ 1 =
24. Roof Framing • �• , - _ '� � + - +73t,Undergmd'. Storag�=Tank fl Gas ❑ 011
25. Roof Sheathing , ' � •�'., Y'74; Overhead �Hydro,_,
26..T�Bar Ceiling (Suuctural) &�Monocoat _ ' ~ t ' 75: Dry Chemical ' -
27; Frame and Flashin •' t�` , ' _
9 ,_� >.- .��.: 76.DryStandpipe ' .
` 28. Lathing�& Siding . -' i z .. � �� 77, FIXED SYSTEM FINAL'
<
29. Insulation , "'� : ; - �K ` 78: FIRE PREV. FINAL ` . . .
30. Drywall•Nailing � • I: HEALTH�DEPT. REQUIREMENT
:31. Plasier Brown Coat ; ,. ' , r79` INAL INSP_�CTION: � ' "
32. �Electrical Po�er Meter-Final � �.ZJ-9� i� �� POOD CERTIFiCATE ISSUED �
33. Firial ElectriF � = g:��� .!% :_ No s: _ _ _ - `
/6
�34.-FinalHeating`&AirCondition�ng, �� � • �i . - '.
35..Final Gas Pipe-Tesr � ` ' ����'` ' ' ' ,-
36. Hood or'Canopy . _ - - � � - I � .. � -
'� f-
37. -Pinal FaCtory Fireplace ' � � ' ` � '� j ' ' � ^
�
38. Finai Plumbing . ,_ � � � j� " -
i
�:39. Water Service-Final _ ' ! �'I_ •, ' �
40. Gas Service-Final � .� � �� ,. � ,
� 41. Solar pomesticFirtal - � _ �
� 42.-�Backflow Preventer, � ' � _ �. � .
43. Backflow Irrigation � � : _
44. Landscape Irripation System - C � . � .. '
•�45.'Sound Attenuation '-� ' = ' ' " - ' �
< < <. r .
46. Handicap Regulations ' ' � ��
47.,FINALSTRUCTURE&BUILDING � I ' . _ '.
i
48.'FINAL PLANNING ' � ` �I'. :
.49. Electric Release to �Edison � �; : � "
'50. Gas Release to Southem Califomia Gas Co ` i �. .' • �� •
51. CEiiTIFICATE OF.00CUPANCY . • -
No. Oate
u
PROJELTPOUflE55� 357 16TH PL uxir: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 0589 9
owueesxarne: FREDEkICK ENGELHARD JR.
nooness:357 16TH PL PERMIT NO: E 058929 PLAN CHECK NO: N GOVT: N SOPP: N
. COSTA MESA
• CA 97.627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE; ADD
(714>722-8922
AFCN/ENGINEEH: SCOTT DAVID HROWNELL "Ec."o.: C011839 JOB DESCRIPTION ; 1ST 6 2ND FLR ADDITIONS TO EXISTING SFD SQ FT:
noosess: 950 W COAST HWY uxiT:
NEWPORT BEACH CA 92663 CLAIM VALUE: 116,000,00 CALC—VALUE; GROUP OCC; R-3 /M-1
PEHMITTEE: UNDER THE SUN CONST, ( 714 ) 974-2034
aooeess: 2278 ROBINHOOD PL COMMENTS: REF:B57707 �
ORANGE CA 97.667 ****�x�**x*�*+r*�**�**x*****�****�r**�r***�r*�r**�*��**x*��*******x**�r�r�**�+�**��t*+�**�r
UCENSEO CONTflFLTOB OECIAPATION: I here�y allirm Ihat I am litensetl untler pmvisions ol C�apter 9(commencin i�� tion Z � N I N G R E Q U 1 R E%'i E N T J
7000) ol Diviswn 3 0� Ihe Busness and Pmiessions CoOe. antl my license is in lull lorce anU ¢ttecL S E T B A C K S
ciTv uc.: 0 6877 STRTE LIC.: Q R Z as�
_ c _ � ------------ N�AIN BUILDING ---------- --------- ACCESSORY BUILD�NG ---------
a'"� a s'9""°` � FRNT; FT \ IN REAR; FT IN FRNT; FT IN REAR: FT IN
WONREB$ C O M P EN S R T I O N O E C N B A T I O N: I here bya � �irm l ha l l haveaCe tli lica(¢o lcon5en � �o5e 1 4in5ure0rate r li �i W t eo � W or k er 5' LEFT; FT �N RGHT: FT IN LEFT; FT IN RGHT: FT IN
Compensation�T e. c%�t�'Iry'e 0 �ppereoi (Seciion 3800, LaE.
POLICY NO.: L��—� �"`� ���" E%P. �ATE: 1 I O I I 9 3
omrnxv:STATE FUND PARKING REQ• `PROV: PARCEL; 42519102 ZNE: REF NO:
� CetlitieU coDY is �ereby fumished. ❑ Cenifie0 wpy is file i�tlin �ivision. PLANNING NZ5TE5>
C% >
�ale: �O/ S2 ppplicanG fEiEIf1EiP1EiE1E1EiE7EiElEiflEfFitiElFlElEjFfFklEfElF�E1EiEfEiEfE�F.jhlFlFiki(�iFiEiEififikif�EiEiFif3FiElEffiFi4iE3fiElEiFiFikiEil�iE�flEfEifiFif�F�F1EiEikifif
E%EMPTION fPOM WQFI(EBS' fAMPENSAPON OECIAMTION: (ThR 5etlion n¢¢tl rrot be compl¢tM it the permil is fa ale hUiWr ao� o� iessl. D E V E L O P M E N T S E��t V I C E S R E Q U I R E M E N T S
I cehi�y �hat in Ihe DeAormance ol the work lor whic� IAis Oermil is issuetl, I shall no� emDloy any person m any manner so as ro become �
sub�ecuomeworkers'Comvensa�ionLawsa�Ca�i�ornia. ZONING APPfiOVED BY - DATE;
oate: Siqnamre: HUILDING APPROC�ED BY ; - DATE;
NOTICE: I�, atler making IhiS Aeclaraiion, yoU SMNG �¢come Subl�� to �he WaM1ers' ComDensation provisbns o1 ihe Labor
Code. you mus� �onhwith comply vn�h suc� pmhsions or INs permil shall Oe OeemeE revoked. � �
CONSTflUCTION LENUING AGFNCV: 1 AereUy ailirm lha� �here is a tortS�mCiiOn lentling aqenty lor the pedormanCe ol �he work �or APPL I CAT I ON I S SUED B Y• � -. DATE •
w�ic�Ihispermitisissue4�5ec1ion3097,Civ.C�. 'K"IEiliEfl"k'K"K"K"M'K"K'N'k!("K'if"x'K"x'%if' ' ' ' ' iF�EiEiElF3hi('ififik iEiF
LENDEfl: �)fiEiFiEiliEiEiF�EiPlF1!lk1E*iEM�iE1k1! �EiftlifltiklElfiEiElt�k1Flk�3ElfiF3fikifilififiFikikifikiEiF�lEifitif�tiE�kifililififiEifififikiFlfiffEifiEififififif
aooxess: LEGALIZATION;N F E� S U M M A R Y STRUCTURAL SEGNENT;N
OWNEBBWl�EBOECUflATION: IherebyallirmlAallamexempi�romlh¢fAntrat�ors'StateLicenseLawforihe�onowingreason BLDG PMT PLIJMBINi�i ELECTRIC MECH�NIC FIRE SMIP/R$$ GRADING
�Seciion 7031.5 Business an0 Pmiessional Cotle: Any city ol wunty w�ich reQuires a Dermil to constmcl. aller, impmve. Demolish, or P ERM I T 9 9, 07
reDai� any Slructure. prior to its issuance, also repuires l�e apDlicanl lor such p¢rmi� �o lile a siqnea s[aiemenl Ihal he/5�e is licensetl rj � g SM I P/ NON—RES
pursuam m tne D�ovisions ol t�e Comracmrs' Siate License law �C�apter 9(commencinp wi�h Section 7000� ol �ivision 3 ot t�e Business p LAN
an0 Pmlession5 Code� or Ihai �e/She is er¢mpt I�erB�mm and Ihe UasiS br �he alleq¢E exempii0n. Any vi0laiion of SettiOn 703L5 by
any ap0litanl lor a Dermil subjecis ��e applirani Io a civil Denaliy ai no� rtwre Ilun �ive hunOretl tlallars (5500�. I SSUE FEE 15 . 0 0
i, as owner oi ine wooeny or my em ioyees wiin wapes as tneir soie comDensalion, will do I�e woln, ana the BUILDING—DIV—> PfiiIMZT �ZSSUE PLAN—CHECK TOTAL PAID DUE
❑ s�mcture is not inrenAea ar ollerea for saie (�ciion 7044. Business anE Prolessianal Code: TAe Coniraclors' State License Law TOTALS----> 4 9. 0 7 1 S, 0 0+� 0. � 0 f7 4. 07 6 4. 07 , 0 �
Uoes nol apply to an owner ol a propetly wlb GuilAs or impmves �hereon, anG who JoeS suctl work himself/hersell or I�rouph
nis or ner own emDloyees, o�ovitleC mat such im0�ovemems are not intentletl or oifered for sale. u, nowever ine builaing or REVENUE D I VI S ION TOTALS--> COLLECTED : 6 4. 07 OVER /SHORT • 00
improvememissolOvAl�inoneyearolcomplelion,l�eowneruri0�avethe0urdeno�provinghe/sheUitlno�builUorimproue HLDG PMT PLUMBING ELECTRIC' MECHANIC FIR$ $MIP/'I'UT GAP.I�ING PL.�I9—CHECK
lor t�¢ purpo52 0� 5ale�.
I, as Owner o� Ihe prOp¢riy, am ¢rtlusiv¢Iy conVaclinq wilh licensed comraciors lo cons�mct I�e pmject (Seclion 704a, Business 6 4, � 7
❑ ana Pmlessions CoAe: TAe Coniraclors' State Licenu Law Ooes not apDN �a an owner of Dmperty who bwlUs or imOroves tAereon
anawhomniratislOrsUchproj¢cl5wil�atontratlor�5�liten5e0ur5uanllOt�eContrati0r5'Sta�eLiten58Law�.lamaware �"��**"K'*'*'�'**"x"x'if'i('!f'i!'il'*1f'1f'*1l"k'�("x'�!'�l'*�l'#K'K'1f"x"N"K'il'K'#'x'i("1fM'i4%iFi('ifitM'#'�iFihM'ih1Fi('i('IF'1('141('1f14lfiEifiti('1fK'#IhiEiE1F3E
Iha� pmol ol Iheir Worker'S Campensa�ion in5uran[e sAou10 6e D�ovi4eE to me. I N D I V 1 D U A L F E E B�i F: �1 x D � W N
� 1 am exemp� unaer $etlion: 8. E P. C.
mrmisreason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
oaie: �^ef ELE 1402 NEW RES HLDG FOR 1 OR 7. UNITS/ SQ FT .03 49,07
I Oo �ereUy cehily that I am aware ol anE under51an01�e r¢Quirem¢nts oi Calilomia Healih anC Salery CaOe Sec�ions 2550.5, 25533, antl Ei�n OF FEES
2553E anOlhat 1 or any fulure builtlmg occupan� vnlVvnll not (cirUe ane) nee0 to comply wilh 5ai0 s�ate wtles antl �ne repuiremen�s lor a
permit for canslmclion or motlification Irom t�e Air Ouality Management Disirict. FeSiaeniial cons�mction applica�ians are exempt �mm
I�CSC D�Ovi5i0�3. �
Da�e: AOOlicanl:
I �ere�y cerlify Ihat I have rea0 �his applicaiion and 5�aie Ihat ihe aEove inbrmaiion is correci. I agree Io comply wi�h �IYEiry and counry
ordinancesan45�atelavrsrelalingtobuil0ingcon5tmctionan0�erehyau�honrerepre5enta�iveso���iscityloenier �on fea6ove-menlioned
property for inSDec�ion purpases.
� t ' / -� �J / ` /� SignaNre'
oa�e�'s �icense or soc�ai secudiy x:
16aFa6 Wbite—BvilEma: Green—Code Eniorcemenl: Canarv—Aoolicant: Pmk—qevenue; Goltlenrotl—Assessor
��
. ;•�. ' . - ' .
� �
CONS7RUCTION AND PLANNWG . � � POOI & SPA
APPROVALS Permit #i- Date Inspector AppROVALS Permit # Date Inspettor
•
t. Ternporary Electrical Service o� Pote 52. Pool & Eq�ipment Location .' �
f 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utiliry-Undrgrnd. 54. Forms
�
4. Electricat Conduic•Undrgrnd. 55. Etectrical Bonding
5. Steet Reinforcement 56. Rough Plumbing & Pressure Test -
6. Electrical UFER Grnd. 57. APPflOVAL TO COVER�GUNITE
7. Fooungs , 58. Electrical Conduit•Undrgrnd.
8. Foundation . 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•7rap, O Undrgrnd.
10. S[ructurel Floor System j � 67. APPROVAL TO DECK
11. Property Sewer Line & House Connectior 62. Backwash & Receptor�Final '
12. Sewer Cap � " 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final
14. flough Plumbi�g � 65. Electrical-Finai
15. Rough Electrical-Condu�t 66. Solar System-Final
i 6. Rough Electric Wiring � _ 67. Fencing & Access ApProval
77. Rough Wiring Sign � 68. APPROVED FOR PLASTEii1NG
18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. flough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS � Permit #
27. Ducts, in Struaure 70. Underground Hydro
22.DuMs,Ventiiating 77.Produc[PipingOG�s ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. � Roof Framing � 73. Undergrnd. Srorage Tank O Gas ❑ Oil
25. Roof Sheaching ' 74. Overhead �Hydro
26. T-Bar Ceiling (S[ructural) & Monocoat 75. Dry Chemical
27. Freme and Flashing 76. Dry Standpipe
28. �athin9 & Siding � � 77. FIXED SYSTEM FINAL
29. Insulation i � 78. FIRE PREV. FINAL
30. Drywall Nailing j- _ i HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat ' 79. FINAL INSPECTION
32. Electricat Power MeterFinaf , � 80. FOOD CERTIFICATE ISSUED
33. Final E�ectric �� � �� Notes:
F���r �
34, Final Heating & Air Conditioning �'• , .
. j'. ,�
35. Final Gas Pipe-Test �•'•
36. Hood or Canopy � � '
37. Final Factory Fireplace ,
38. Final P��mbing � �
39. Water Service-Final t ; �
40. Gas Service-Final �
41. Solar pomesticFinal , ,
42. Backflow Preventer _ � �
43. Batkfl0w Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. HandiGap Regulations
47. FINAL STRUCTURE & BUILDING
.';
48. FINALPLANNING � . ��� ,
49. Electric Release to Edison
50. Gas Release to Southem California Gas Co I '�.I
51. CERTIFICATE OF OCCUPANCY
No. Date
/
CITV OF COSTA MESA
BUILDING SAFETY DIVISION
POST IN CONSPICUOUS PLACE
ON THE 106
NOTICE .
You must furnish PEflMIT NUMBER and the JOB ADDRESS
FOR EACH RESPECTIVE INSPECTION. CALL 7545627.
APPROVED PLANS SHALL BE ON JOB AT'ALL TIMES.
A. P. NO.
TVPE
BUILDING AD
�
TRACT
NEW
OWNER _�
�
USE
DATE ISSUED
GROU RMIT O
1 // �� �/
HLTER I REPAIR I MOVING � DEMOLISH
SETBACKS
Front Yd. Side Yd. L R Rear
Side Yd. L R Rear
CONSTRUCTION AND PLANNING
APPNOVALS Permit#
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd. '
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Foo[ings
8. Foundation �
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property $ewer Line &`Hquse Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
75. Rough Electrical-Conduit'
16. .Rough Electric Wiring
17. Rough Wiring Sign �
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioninq
I20. Rough Factory Fireplace
21. Ducts, in Structure
". Uuale. VanlilNlinJ
23. Gas Pipe•Rough & Test
.^< 12.�N Pianun0
� ,\� .1`.vl �^.wc].,n;
.\� ..Fr . � •�u �\•v�•��•.vv \ 1\.:�1��.� ,
• J
_. . : �,..�.. �...� . ....�i ::y
28. Lathing & Siding
29. Insulation '
30. Drywall Nailing
31. Plaster Brown Coat ' I
ICMF 0559•46, rov. 12/82
"-\
32. Electrical Power Mete�-Final
33. Final Electric
7( 34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36.-- Hood or Canopy
� 37. Final Factory Fireplace
� 38. Final Plumbing
� 39. Water Service-Final
40. Gas Service�Final
%
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape I«igation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
qg, FINAL PLANNING
POOL & SPA
APPROV9LS Permit#
- 49. Pool & Equipment Location
- 50. Steel Reinforcement
51. Forms
Date �Inspector
52. Electrical Bonding
53. Rough Plumbing & Pressure Test
54. APPROVAL TO COVER-GUNITE
55. Electrical Conduit-Undrgrnd.
56. Gas Pipe, ❑ Undrgrnd., Test
57. Backwash Lines, P-Trap, O Undrgrnd.
58. APPROVAL TO DECK '
59. Backwash & Receptor-Final
60. Heater & Vent-Final
61. Plumbing System - Final
62. Electrical-Final
63. Solar System-Final -
64. Fencing & Access Approval
65. APPROVED FOR PLASTERING
66. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
67. Underground Hydro .
68. Product Pipin9 ❑ Gas ❑ Oil
69. Underground Flush
70. Undergrnd. Storage Tank O Gas ❑ Oil
71. Overhead Hydro
7?. D�y qiantical �
73. Dry StandUipa
%1 FI\I�i1�1�i7-..1!1�I�V4i
� j
i '•r IIM� 1"ii\ `.\�\; �
. �
AvO.�
J
(see reverse for additional notes)
r
,I
%
�
�I
�I
.
o�Ecraooxess: 35'7 16TH PL
owNexsxame:EREDERICK ENGELHARD Jk,
AOOFESS: � S% 1 6��i� PL
COS:'A MESA
' CA'92627
(7]4)722-8922
AflCHIENGINEEF: SCOTT DAVID HROWNELL
AODflE$$: QS(1 W !'l1LCT LIWV
xec.xo.: C 0118 3 9
UNIT:
NEWPOFtT HEACH CA 92663
PENMITTEE:UNDER THE SUN CONST, (714)974-2039
AOONESS: 2'l78 ROHINHOOD PL
ORANGE CA 92667
❑CENSEU CONTPACTOX OECIAHAiION: I �ere0y aili�m Ihat I am licen5ee unCer pmvisions of Chapter 9(commencing wrth Section
]qp� ol Umsmn 3 of Ine Business an0 Pmlessions Code. anA my license is in lull fo¢e antl efleci.
c�rvuc.:pSg877 STRTEpIIC.:48'2 �,
Oaie: � '�� � � )_ Signalure: _
wONNEHS' LOMPENSATION OECLABR7ION: 1 hereoy allirm tnat I nave a cenifiWte ol fAntent to sell�insure or a cen 'cale of workers'
Comoensa�io� insurance. or a renilietl copy inereol I�ciian 380U. lab. CI.
POLILY NO.: E%P. OATE:
LOMPRNY:
❑ CenifieU copy is �ereEy Iumis�eE. ❑ Cenifiea capY is IileG vnt� tAe ciry Builtling Division.
Oate: Ap0licani:
EXEMPIION FflOM WOflNEflS' COMPENSATION OECIAPRTION: QM5 5eciwn ne¢a nni be completeG il Ihe permi is fa we hurMreE (5700� a lew�.
I c¢riily Ihai in ��e Oedormance oi ��e work lor whiCh IhiS Der ' C, I S not employ any perso �n any manner so as �0 6ecome
su��ect ro Ihe Wa�kerjs' Compensation Laws ol Cal' .
Oaie: � /(o ��� Sign t r •-
NOTICE: II, alter making I�is Oeclaralion. you ShoulG Gecome SUDIeci la I�e Workers' Comp¢nution isions ol t�e labor
Cotle. you musi tatl�wilh com0ly with SucA pmvision5 or this Dermit SAall be Ceemed revokeU.
CONSTPOCTION LENOING RGENCY: I here0y allirm t�al ihere i5 a canSlmciion lentling apency lor Ihe pedormance oi Ue work tar
w�icA Ihis permil is i55ue0 �Seclian 3097. Civ. C).
LENOEN:
aooaess:
CITY OF COSTA MESA — BUILDING PERMZT PERM NO; E 061385
PERMIT NO; E 061385 PLAN CHECK NU: N GOVT: N SUPP; Y
CONSTRUCTION TYPE: S—N PERMIT TYPE; ELE PiJRPOSE; ADD
JOB DESCRIPTION : i5T 6 2ND FLR ADDITIONS TO EXISTING SFD SQ FT;
CLAIM VALIIE: CALC—VALUE: GROUP OCC; R-3 /M-1
COMMENTS; REF:B57707 REPLACE SERVICE
1E jE 1E 1F iF iE iE i! iE iE rt N� if !k ff iE ff fE if #;E iF 1F iF if !f 1Elt !E 1E �)t IE ik'.E 1F iE iElE 1f iE if ih iE #!f i! 1F i!� IF iF# iE ih iFlf # iE if iF'k if �IF i4 #�E # tE-?f # fE iE if iE iE fF iF # iE if
2 O N I N G R E Q U I k E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT; FT IN F1EAR; FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; cT IN
PARKING REQ • PROV; PARCEL; 42519102 ZNE; REF NO;
PLANNING NtS1'ES>
>
xx**�**x**�t**�r�*���*�c x�e�r�*x�t�r*�r�t'�F�r#'*��rrt��r��r�**� x� x�r*�r�r*�u��*��r*�****x����r**�*� x*�c
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
20NING APPROVED BY ' � DATE:
BQILDING APPROVED HY ; • DATE;
APPLICATION ISSUED BY: ' DATE• ��1��
itfEitiekiEifiEitiFit�itk3fiti(�it#itf�iti[��"ii'iFfriF7Fif'{fiFlFiFiF'3tiFR'7FiF'iFiF3F iFiE���7F##�iF'4iFit�*�(�itu�x�l4x�ii�it��#'SF' ��� � �1(�iE
if iF iE if IE iF iE iE ff iE i! ik if 3k �IFiF !k ft M� # tE ik # iE i! k if it iE �lF iE ik iE 1f M iF iE !E # iE 3k it IE if if if #!E %# If # If �t iElE # if �Jf iF �k it� 3(� it �E iF iE 3f �)E 3f iE 1f 1f # 14 �E if 3t iF
LEGALIZATION;N F E E� S 0 M M A R Y STkUCTUkAL SEGMENT;N
OWNexBU��oeAoeCu�eni�ON: inere�ya��irm�hat�ame�empi�mmtheComracmri StateLicense�awlormetonowinAreason BLDG PMT PLUMHING ELECTRIC hiECHANIC FIRE $M1P/RE$ GkAD.ING
(Sectian 703L5 Busine55 an0 Pwiessional COEe: Any tiiy oi caun�y w�ich reQuires a permii to cons�ruct, al�er, im0�av¢. Cemoli5h, or p ERM I T 1 8, 5 �
repair any slmcWre, prior lo i�s issuance, also repuires the applicani lor such Dermii to Iiie a signeC slalemeni Ihai �Gshe is licensea r) Q$
pursuani Io �he pmvisions ol l�e Comranars' Slale License Law (Chapter 9(commencing wiin Section 7000) ot �ivision 3 0l �he Business
anG Pmiessi0ns Cotle� or Ihai �¢/S�e is etemp� ��er¢Imm ana ��e Oa5i51or ihe allepe0 e�emptian. Any violalion ol 5¢tli0n 7031.5 Gy PLAN
any aOPlicant for a permii suble��s lhe applicanl to a civil penally ol nol more �han live �unOrea Aollars (5500�. I Sj(]E FEE �i , 5 �
t, as owner oi tne pmDeny or my empioyees witn waAes as meir so�e compensafon, wai ao tne wone, ana ine BUILDING—DIV—> PERMIT I$S(J$ P1.,AN—CHECK
❑ slmqure is nol inlen0e0 or olferetl br sale (Seclion 70a4. Business and Professional COAe'. The ConVac�ors' S�ate License Law TOTAL S----> �. 8, 5 � 4, 5 � Q, n n
aoes not appty to an awner of a D�oDer1Y who builtls or impmves t�ereon, and w�o does such work himsell/tlersell or Ihrough
�is or her own emplayees. D�o�itled Ihal such impmvemems are noi intentletl or ollereE lor sale. II, however �Ae builUing or
impmvemcm is sma wimin one year o� comp�mion, the owner wi�� have �he burden o� vmving he/sne did not 6ui�d or imprwe REVENUE D I V I S I ON TOTAL$--> COLLECTED �
�orteeo�rooseo�saie�. BLDG PMT PLUMBING ELECTRIC MECHANIC
23,00
SMSP/NON—RES
TOTAL PAID DUE
23.00 23,00 ,00
23,00 OVER/SHORT: 00
fi2RE SMIP/TOT GRADZNG PLAN—CHECK
I, as owner ol lhe pmperty. am eKclusrvelp conlrac�ing with hcen5e0 conVactors �o con5�ruci Ihe pmlec� (Sec�ion 7044, Business
❑ antl Pmle55ions Cotl¢: T�e ConVat�OrS' Slale Litenie Law Ooes n0� ap01y �o an Ownef 0� D�opetly wA0 bui105 or imprwes �Ilereon
antl who tomratl5 lor Such prolecis wii� a ConiratlOr�s) liten5e pursuan� IO Ihe ConlraCi0r5' Slaie LitenSe Law�. I am aware %�{p �* kiE it !E iEiE�ll1E if if 1F If1f 1f iE 1EiF !h iE Ik iF 3f itif ifi!' ltif !f'lf1F'1E iF1hi('% M'M'-7('1(' 1FM"14'E!l"1h3E !l"16 N'i("%'1t %'jh 1f'%'iF'%"% 1t'1(-if'7!'i('if"N'7�'ih %'# %#iE
mat pmoi oi iheir workers Compensation insurance shouid �e orovieea io me. I N D I V I D U A L F E fi g F� E A K D O W I�l
� I am exemD� under Seclion: B. 8 P. C.
mrimsreason: TYPE QTY D E S C R I P T I O N UNIT COS'P TOTAL COST
oate: Owner: ELE
I ao hereDy ceNiy Ihat I am aware ol and understantl Ine requiremenis ol Calilomia Healin ana Sately Cqee Sections 25505, 25533, an�
2553a antl Ihal I or any iWure �uilaing occupanl willlwill not (circle one) neea lo comply wi1� saitl sta�e co0es antl �he requiremenis �or a
peimit �ai consimc�ion or motld¢alion Imm Ihe Air Oualiiy Managemenl Di5Vic1. HeSitleniul cons�mclion aODlicaiion5 are exempl Irom
IheSe provisi0ni
Oale: Applicani: _
I �ereby cerlily I�ai I have reaa Ihis appliCaiion and Slale Iha�
o�Einances antl statelaxs relalingio buil0ing croslmction ana n
pfOpCtly IOi i05pCt�i � p0�p05¢5.
Oaie: SignaiU . •
ome�'s �icense o� Saciai Secwiiy >:
is correci. lagr¢eio comply wilh allcity and
�fiaba6 WMe—Builtlmg; Grean—CoOe Enb¢ement; Canary—AppLcun�; Pink—Revenue; Gobenrop—Assessor
1 SERVICES BELOW 600 V s BELOW 201 AMP 18,50
END OF FEES
18,50
CONSTRUCTI.ON AND PLANNING
APPRQVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit UtihtY-Undrgrnd.
4. Electrical Condurt•Undrqmd.
5. Steel Reinforcement
6. Elettrical UFER Grnd.
7. Footings
8. Poundation i
9. Water Pipe-Undrgmd. •
70. Structural Floor Svstem ;
1 t. Prnperty Sewer Line & House Connection
12. Sewer Cap
73. Roof Orains
74. Rough Plumb�ng
15. Rough Electricaf-Condwt '
76. Rough Electric Wiring
V. Rough lNiring Sign
18. Rough Electricai-T Bar Ceiling
19. Rough Hea2ing & Air Cor.diUonmg
20. Rough Factory Fireplace
21. Duct:,in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-8ar Cedm9 (Strutturall & .^�lonocoat
27. Frame and F�ashing
28. L2thing & Siding
29. Insulation
30. Dry�•�ail Naihng
31. Plaster Bro�vn Coat
32. Electncal ?ower h'.ecer�Finai
33. Final Electric
34. Final Heating & A�r Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Finai Factory Fireplace
38. Final Plumbing
39. �Vater Service-FinaY
40. Gas Sernce-Final
41. Solar pomesticFinal
42. Backflow Prevenier
43. Backflow Irr�gation
44. landscape irriqation System
45. Sound Attenuation
46. liandicap Regulations
47. FINAI STRUCTURE & BUILDING
48. FINALPLANNING
49. Electric Releate to Edison
50. Gas Release to Southern Ca�ifornia Gas Co
Date
�
Ddte � Inspector
n
�
POOL PA
APPROVALS Permit � Date Inspector
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test �
57. APPROVAL TO COVER�GUNITE �
58. EIecV�cal Conduit�Undrgind.
59. Gas P�pe, G UnUrgmd., Test
60. Backwash Lines, P-Trap, C7 Undrr�nd. I
-�
67. APPROVAL TO DECK
62. B�cx��csh 1L Receptc��Fi:ial .
63. Hoater & VenbFinal i
---'i
64. Plumbing Syscem � Final
65. Electrical�F�nal �
�
66. Solar Svstam-Pinai
67. Fencing & Access Approval �
68. Af'PROVED FOR PLASTERING �
69. POOI/SPA SYSTEMS FINAL '
FfRE DEPT. REQUIREMGNT �- �
APPROVALS Permit � I
70. Underground Hydro J�
71. Praduc[ Piping C7 Gas ❑ Od �
72. Underground Flush '.
73. Undergrnd. Storcgc Tank Q Gas :] Oil �
74. Overhead Hyoro
75. Dry Chemical �
76. Dry Standp�pe �
77. FIXED SYSTEM FINAL i
78. FIRE PREV. FINAL i
� HEALTH DEPT. RE�UIREMEhT
- - -'
7� FINAL I�SPECTIOfv _� ,
�. FOOD CEftTIFICATE ISSUED {
Aovlicant to fill in all spatts exceot thosa witnin heavY EorCar Ilnas an0 sign all approoriate eeclaratlons.
r ITV C� COSTA MESA CONSTRUCTION PERMIT
Project Address ��7 �- ���� P � AL�
Applicant'sMailingAddress SQMQ.
Owner'sName FN _��k.��ntr� Phone7!�Z��'J9ZZ-
Address _,7.(1 �t -
Arch/Eng. ✓�w�'1B..r License No.
Address -�
Contracror's Nam _ Phot _
Address ( mai I i ngl _
City License No.
LICENSED CONTRACTOR DECLAFATI N
I hereby atfirm [hat 1 am,llcensetl untler provisions of C�art¢r 9(commen<ing
witn sectlon 7000) of Division 3 ot the Business antl Professions Go�e, ana
my Iicense is in full force antl elfect.
License CIa55 License No.
Date 'v5i9nature
WORKERS' COMPENSATION DECLARATION
,. i hereby a(tirm that I have a certilicate of consent to self-insure or a certificate
(��, -` Worke�s' Compensation InSurance, Or a ce�tlfled copy tnereof (SeCtiOn
.i�,"`700. Lab. CJ •
Policy No. COmpany
8 Certifietl copy is here�y turnishetl.
Gertifietl copy is tiletl with the city Builtling Division.
Dafe APplicant
EXEMPTION FROM WORKERS' COMPENSHTION DECLARATION
(This section neetl not•be completetl if [he permlt is fo� ane huntl�ed (E300) or
le5s).
I certify that in Ihe perfo�mance of Ihe wo fot wnlcn thi�pe�m�I is i55 I
shall not e ploy ny pe�son in any ma s as to be ome Subjec {�e
Workers' ,p e � n Lawz of Califo
Da[e Si9nature
NOTICE: Ii, att r makin9 thiz tleclara ' ou sho la �ecome subject to the
Workers' Compen5ation provision5 o the Labor otle, you must Porthwith
comply with such pwvi5ions or tbis pe�mit shall be tlaeme� revoketl.
CONSTHUCTION LENDING AGENCV
1 hereby afflrm that there iz a constructlon Ientling a9ency for the pertormance
ot the work lor which Ihls permit i5 ISSuetl (Section 309J Civ. C.)
Lantler's Name
Lentler's Atltlress
OWNERBUILOEH UECLARATION
I nereby ailirm that I am exempt irom the ConVactorY Ucense Law lor tne
tollowin9 reason (Seciion 7031.5 Buslnass antl Protessional Cotle: Any city or
county which requires a permit lo conslruGl, alter, improve, tlemolish or repai�
any sV ucture, prior to its issuance, also tequlres the appiicant for sucb Oermil
lo file a Signetl slatem¢nt Ibat he/ShC is IICPnSatl pu�suant lo the provi51on5 Of
the Contraclor's License Law (Chapte� 9(Commencing wi[h SecHon 7000) ot
D�vision 3 of tha Business antl Professions Co�e) or thal he/zhe is exompt
'}E��+retrom antl Ihe basis tor the allege0 ex¢mplion. Any viOlaHon ot SecHon
�f _31.5 by any applitanl ior a parmit subject5 the aOPlicanl to a tivil
�'-Y�?'vnalty ot not more Ihan five nuntlretl tlollars (E500).
� IG I, a5 owner of [M1e property '- " " " "'`" ""`
rewpnnel:ew, will tlo the work, antl the ztructure is not Intentle0 or oHeretl
fo! Shce (SC<lion 7044, BU5ine55 and Prot¢SSiOnal Catle: Th0 ConlrattOr'S
LiGense ldw tloes n0l apP�Y t0 an own¢r Ot a property wno �wias o� Impwve5
the�eon, antl w�o tloe5 such work himself/h¢rz¢tl or Ibrough hi5 0� ner own
employees, provitl¢tl tnat such improvem¢nts are nol intlntlatl or olfere0 fo�
Sale. If, howevet, lne builtlin9 0� improvemant IS SOItl within one yea� of com-
pletion, thc owner will have in¢ burtlen oi proving he/zhe tlitl not builtl or im-
prova tor tM1e purpozo ot sale).
❑ I, as owner ot (he Properiy, am exUuzivery contracting witn Ilcense0 con-
Vac[ors to mnstruct the project (Section 7044, Business antl Rofesslons Cotle:
Tbe ConVactor's License Law does no[ appry to an owner ot OroOerty who
builtls or improves thereon, antl who conVacts for such projects witn a<on-
tractor(5) lit¢nze pursuant to tlle Conird<fOr'S Llcen58 Ldw�. 1 am awaro tllat
proOf Of lnei� Worker'S COmp¢nSaHo *IrJsu�ance zhoulp be provitleE y�me,
❑ I am ¢xe/nP� uptle� Section yj B.�S P. C. for thiyrpa50f1
Date � Owner '�
I hereby certif that I have reatl t plicati n antl state tha the above
iniormat on rs orrect. I a9ree to c y with a tlty ana county ortlinances
antl state lawz relati to builtling construction and hereby authorize repre-
senta[ivez ot tbis �y10 en[¢� upOn the �va-mintiOneE pfoper1y 10r
Signature _¢/JC1����
Drivers' Li<ense Er SS � /.
. .�5�3ar'� ..._..-- --..._. �......�.
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTMER q.p,.�6
DESCRIPTION F WORK/USE OF BLDG. --RE �!�LQ - .�
��'�'`',�,�� �T�(j`'�'` � ��� � � µ � MninBuildi
TVPEOFPERMIT GRLJ A�ING FOUNDATION STRVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER
PROJECT DESCRIPTION SQ. FT. Z-y1OO C Right
OCCUPANCY
CONSTRUCTIONTVPE VALUATIONS�OOO_ � g LCft
ZONE GRADING CU. VDS. ACHES ping. R2f. #
nemarks: Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
floor Sinks
Gas Service QULIQ[5
Interceptors
Kitchen Sink
Lavatories
P—Trop
Roof Drains
Reinspaction Fea ! S75
Duct - UnAer Ground
Duct � Structural
Duct - Ventilating
Exhaust System ❑ MWtiple
Firepl/Fact. Blt. ICBO ,'iE
Heating System & Ducting
� ai oo,000 aru O i oo,000
Reinspeccion Fee � S75
CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant: Pink - Accountin9; Goltlenrotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto�Wash
Isua Foe
Hoodor Typel �
Canopy Type II ❑
Refrigeration System
❑4700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
5 3
S 3
Automatic Washer
CanstructiOn Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Ditposal
Generator O0.5 KW O5-'
Zone
Accessory Building:
Parking Req.IProvided
ELECTRICAL
Transformer ❑ 15-50 KW
� 50+KW
Meter LJup to 100 amps
Meter �over 100amps
Sub Panel
Motors DO-1 HP �tY, � 8
Ina Solar �9�15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compacmr
I Reinspaction Fee I$15 I I Issue Feo
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
8uilding Approved 8y ��
FEES
5 3
SUMMARV�OF F�ES �
BUILDINGPERMIT $ 5�����SMIP S �
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE 5
PLAN CHECK 25% S ENEFGY P.C. S
ELECTRICAL y GRADING S
PLAN CHECK 50% $ MICROFILM S
MECHANICAL ff TOTALFEE S
PLAN CHECK 25% $
Z
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CONSTRUCTION AND�PLANNING POOL & SPA
APPROVALS PermiY# Date Inspector pppROVALS Permit # Date Inspector
. r:
i: ,Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ' 58. Electrical Conduit-Undrgrnd.
8. foundation � � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ' 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electriral-Final
15. Rough Electriral-Conduit 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � -
20. Rough Factory Fireplace APPROVALS Permit # � ' •
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � '
27. Frame and Flashing 76. Dry Standpipe •
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION '�
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
✓
33. Final Electric Notes: � C�d ��p '�
34. Final Heating & Air Conditioning .�.�,
35. Final Gas Pipe-Test
36. Hood or Canopy (
37. Final Factory'Fireplace - � � � . �
38. Final Plumbing � � �
39. Water Service-Final , .
40. Gas Service-Final ,
41. Solar pomestic-Final
� 42. Backflow Preventer + '
. 43. Backflow Irrigation � " ,
� 44. Landscape Irrigation System • �
; 45: Sound Attenuation
� 46. Handicap Regulations (o �Z 9d � �
47. FINALSTRUCTURE&BUILDING � �.. 3o3e� 5+�8 UgC �
.48. Special Requirements Completed ' .
49. Electric Retease to Edison 1
50. Gas Release to Southern California Gas Co *
51. CERTIFICATE OF OCCUPANCY �
No. Date ��
�! IG1Q
�:11 �: �s•y
`1-611 l%%.A �.owtl.� �.n,
54A`' �l HN4 �
�2�06
I:L':
� �-S,v
���r.�'��s;::�_::;xtr'�+�e�,�xs.. , ,..^ z � r..y=;,; r. ,:;i :y..�S'�a ffi'""1 6 �.r» _ .
� ;•.;�:� ' ,r'S''� 'w�,n.a.ae:xx .� .• . •, • .
_. .. S/� � �' - e �-ro-Fv-�t-�r-t-n--c-o� . .: , ��,
�3 �' '' J Not Compared with Original
$3.00
I C8
�
RECORDED IN OFFICIAL RECORDS
OF ORANGE COUN7Y, CALIFORNIA
-IZ 45 pM JUN 21 1977
1. WYLIE CARLYIE, County Recorder
Addition of recreaCion r.uom and bath, liuilding Permit No.
aL- 357 16th P1uce (S.ti. 58' ot N.IJ. SG' ot lot 5G Newport Heights, oF Map
'�R'ecord Book 114, P. S3 oL Niisc. Records of Ur.ange CounCy excep� S.W. 135.07'
tl�ereoL)
'Che abovc proposed :�ddition s1ia11 l�e used for che purpose uf a recreaCion room,
and s1�a11 �tol' 'oe used Lor any oUiei purposes other than those allowed foc in the
resi.denCial distr.i.ct where this use is l.ocated.
9'hi.s addiiion s1�s11 noe Ue used as a separaCc, residence, without iirst obCaining
permits and complying �aiCli a11 appLicabie development sCaiidards� sucl-i as parking�
seCback� park and recreati.on Lecs� eCc.. �
This agreement shall be binding on a11 heirs, successors and assigns.
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✓,(�:-��,l.��Gi�J l'l l .�G(
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� Oc�ners [Jame
�'t q i j L r�. T_ 1:3 , w� �3. .✓ .� `
:') .�' "�
/
,._C�V� ..1/'lc,'•� �
—"_— ._ c�:.'.
OFFiCI.rtl. .
+a���(� �ORJlifr A: itEYNOLDS
,..�!�a1'�) PIOTAf7'(FU7Ur-CHLiFO[ltJiA
i �5����� CRANGE CUUNTY
.�,,,� y
.,'�v� LlyCominisS�oRE�pucsMar.13.19;�
—'---�_._-�.-.��.��.�vv.� :t.-::. vo
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AddTC55
$iAiE OF Cp.�IFO/RNIA jss.
COUNi�� oF—l.�-=``���`�--� — --- --) , (
�I bclo:r mc, fh.• unJzrs�gnr.d. a\omry Pvbfic m and (nr �
! � � % � �-- ---,
�,., _,��'-L'_K-R---i -- � ' --- ----- ---- ---
, , � '
� � :�:;,C3--
o--G-�_P,... _
snld Sfate, persona�ly appcared. .. � — .
whosc namc_.� —
Anown Io mc �o bc thc person. -- �
within invmment and ackno�vled<led m m� OPFICIAL SF,AL �, �i . .. .
+��"�"�°`� '° 'h` ��"' DOROTHY A. REYNOLDS �' , �
e*ecwed tLe sa�ne. y . !.
�I•,r�..�tQ ------ --"---- � � � NOTARY GUBLIC•CALIFORNIA ��
`N11NE55 �ny hand ���'� o�i''cial seal. � ORANGE COUNTY ��. "'
. ��/n _`/�— MyCommisskmEzpireeMacl3.1978 INr��1'.��"C�i�.l�f . .. .
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' ' s� 238 I 0
" COSTA MESA BUILDING�SAFETY DEPARTMENT
P. O. BOX 91] C08Tp MESA. CALIFORNIA
For Applkanf }o Fill In Completaly
TYPE OR�I�PRINT
BUILDIN6 R �G. /
AO�RESS ♦
COSTA MESA. CALIFORNIA
•
OWNER ..J q
MAIL /i r/I .. 1 :!' GK CT
NO. �
u0�0^ BLOOB. �
EXISTING BLOG.
SETBACK LINE FROM �D �
CENTER OFBTqEE! REAR�
� /!�
SIDE YARO LEFT /� �� I RIGHT
DESCRIPTION OF WORK
� USE OF
I HEREBY ACKNO
ANG STFTE THAT
PLY WITH ALL Q
BUILDINO CONSTI
61GNATURE OF
PERMITTE�
AUTHORIZED A
S. OF
)OMS
ROOF
COTY �b• � �;� � i� �9:
MAR 2y 1965
PHC[IMf NO.
P6RMIT NO.
�� � �
ZONING
_� NO.OI � UB60FNQl�' ,` �
PLANB BUIL�IN �I � ���
irrio� i/ �� G� J b�.QG�-%1 dtii
�o. �/ � ' arJ � — � � r
: NO EAVE OVERHANG 8HALL BE LESS THAN
YARD8APPROVED
MAIN BUILDING
( FROM C/L STREET )
VAR.?C
YARDSAPPROVED
ACCESSORY BUILDIN�
�ATE
v / �Q. FT. fi 2 p~ i o
� HAVE RE.�� THIB APPLICATIO THE �MOUNT 6HOWN UNDeP V�LIIATION 18 FOR THE F
CORRECT AND AOpEE TO CO . PUfiP096 OP EHTABLISHINO • PEPMIi FE6 ONLY. p
3 pND eTATB 8 RH uLATi ypLUATION �, � m
PERMIT FEE �
]
� 0
$la z32 � � e�. �
�/ �
TOTALFEE S S ']'•
- r L33�
• COSTA MESA BUILDING-SAFEfY DEPARTMENT
P. O. BOX 81] CO3TA ME6A. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDIN(i " `
ADDRE59 � �
COSTA MESA. CALIFORNIA
OWNER S•JS �
MAIL . 1. AC. �
ADDRE58 / '
�. _�.. I��...�.� TEL.r.N�
NO.
STATE +�f TEL. / �
LIC. NO. i-C • NO. L
SIZE �- I No.ole�oos.
OF LOT NOw oN T
USE OF
E%ISTING BLDG. ��
SET6ACK LINE FROM � �
carvrea oP ernEer REAR YARD�
� ! (f /
SIOEYARDI LEFf I RIGFiT �i7
DESCRIPTION OF WORK
BUILDING q NO.OP
SIZE �7� ROOM9
IEXTERIORWALLr- I ROOF
1 HEREBY ACRNOWLHDa6 TN�T 1 XAV6 qBAp TXIB �PPLICATION
FND 8TAT8 THAT TH8 ABOVB IB CORRECT AND A011HB TO COM�
PLY WITH ALL <ITY O 89 AND BTATB LAW BOUL/�TiNaI
6UILOINO CONBTPUGTI � j�'J
SIGNATURHOP � "�i/AA/�/X�
PERMITTEF . �s`���
AUTHORIZED AGfiNT i
C6TY �a� �;a�a °��; �;)�S�
MAR 2y 1965 S"
i=iu�,.�r.c«s�
RBCHIPT NO. PHqMIT NO.
? y � p c
AT8P8C81v¢p nreieeuac
'�,L%� GS 5�/G /GJ
� �'. iG .t�, �.e iE'i
ZONING
i[ � NO. O� UBH OF NI
PLAN9 � ll11LDIN0
YARDSAPPROVED
MAIN BUIL�INO
iOM C/L STREET) ,
VAR. JC
�.� ��— � �
�� —�
\NO BHALL BE LE39 THAN
(U.B.C.REQUIREMENT:
YARDSAPPROVED
AGGESSORY BUILDING
I.h\i�
%�o % sc �. � 2-g r � o
TH¢ AMOYNT BMOWN UNDEP VALU�TION �e POR TNH =
PURP088 OP EBTABL�BHINO R PHRMIT F88 ONLY. Q
VALUATION ^_l
�V 2 a'� n
PHRMIT FEE $ J 6/ �
s ��� �, 3Z, � �P' � o
.. .. �
:Q04�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 80X 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADDRESS JS ��� f�� 11J5� F�ESF
OWNER j�oBE�,r 73. ��� ti/TZ ✓
ADDRESS �a 7 I�� �� �051q �"IESA
TEL.
CITV 'bSTA Es,a No. S�-/�-7'
LOENDER�ION ����
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BRANCN
ADDFESS
ARCHITECT ry ry.-I-1�„ f� 1J TEL. '
11R FNAINFFR l. � No. (,i3-
CONTRACTOR �'�,(_C,�,/�(jjy/�/��C
ADDflESS
TE�.
CITY NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE 6 � 35 NOWONLO�Ts a
OF LOT S p �
USEOF .{��5.'D���CS
EXISTING BLDG. ��
Separate permits are required for
electric, plumbing and heating work.
VSE OF BUILDING ANO WORK TO BE PERFORMED
I haraby acknowlatlpa that I hove reatl thl� appllcation entl cteta
that tha ebova Information Is correct antl aprea to comply wit�
ali lews repulatlnB bulltllnB consirucNon, entl I shell not employ
any penon In vlolatlon of tha Workmen'a compenaation laws ot
Me State ot Californie.
1 �eraby certify thot 1 em prapaY�V Ilcensotl ea e eontractor untler
the Stata of Callfornie eusineaa e�d Profewions Cotle, Dlvlsion 3,
Chepter 9, end that such Iicanus ere In tull force end effect, or 1
em enemvt from the provislons of tha Stace ot Californla Buelneas
enA Profeaslonz Cotla, DlviNon 3, Chepter 9.
Sipnature of��/ . �'���
Permlttee '�G--�.�L
Authorizetl ABant
A.P. NO.
BUILDING
ADDRESS
PA3�
�'4Y?3-77�y�.O01107_;` �'**'48.5C
FORSTRUCTURALPERMIT
-Z7 l -
OWNER ��
SlSE T�OdI����l �
FIRE
ZONE TVPI
APPROVE
BV
ZONE NO.OF
�� 2
VARDS APPPOVED
MAIN BUILDING
(FROM �/L�TREET).
VAR. �
VALUE
OF
�
VARDSAPPROVED
&
Q4TE
APPROV/ED
ne�rc//J� �+�� /
THEAMOUNTSHOWNUNDERVA�U
TNE PURPOSE OF ESTABLISHING A PERP
VALUATION PERMIT FEE E
g / - /� PLAN CHECK E
T% TAX §
TOTALPAID �
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m
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