HomeMy WebLinkAbout468 16TH PL - Building Permitse �
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PERMIT TYPE
Sub Ty'e:
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CITY OF COSTA MESA �
B!/ILDING DIYISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvew.ci.costa-mesa.ca.
FOR INSPECTIONS CALL: (714) 754-5626
MIT NUMBER: BC07-00191
. B COMBO � STATUS: ISSUED
RES RRIP ` DATE ISSUED: 09/20/2007
ISSUED BY: SOK
�oe nooRess: 468 16TH PL CM
APN: 42515203
Vicinity:
Const Type: V-N
Zoning: , ,
SQ.FT: 923
Suite/Unit:
Primary Occ: 7
Valuation: $100,024.48
SCOPE OF WORK: 923 SQ FT ADDITION. 270 SQ FT LAUNDRY/SERVICE ROOM ON THE 1ST FLOOR. 653 SQ FT MASTER
BED/BATH ADDITION ON THE SECOND FLOOR. NEW 294 SQ FT LOGGIA WlFIREPLACE. MINOR WINDOW CHANGES TO
EXISTING DWELLING AND REMODEL OF KITCHEN AREA. INCLUDES ALL PLUMBING, ELECTRICAL AND MECHANICAL WORK.
OWNER: KELLEY, VALERIE
Phone:
APPLICANT: KELLEY, KEVIN
Phone: 949-650-1651
CONTRACTOR:
Phone:
Cell:
ARCHITECT:
ENGINEER:
OWNER-BUILDER
ESI FME INC
Address: 468 16TH PL
City/Stale/Zip: COSTA MESA, CA
Address: 468 E 16TH PL
City/State/z2ip: COSTA MESA, CA
Address: Unit:
Ciry/State: .
License No.
License No.C33307
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $649.58
Building Fees: $999.35
Electrical Fees: , $222.81
Mechanical Fees: $145.35
Plumbing Fees: $225.90 �
SMIP Resideniial: $10.00
SMIP Commercial: $0.00
TOTAL FEES: $2,252.99
^Reter to tee receipLs for all fees paitl for proJecl
License No. 000000
Unit:
Unih :
ZipCode
PHONE:
PHONE:714-835-2800
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
CODE 0. INSPEC710N TYPE
1676 Fixed System Final Fire Prevention
7266 Pool Spa Final
200 Final Re-Roof
201 Final BlotklRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demoiition
�AT INTI71pL5 40oE/ INSPELPONTYPE
208 Final Mechanical Q/�
� 208 Final Plumbing P/�.
210
212
220
Final Eteciriwl
Final Fire Prevention
Final Planning Approval
222 Final Site
250 Final Building/Occupancy P/�
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WORKERS' COMPENSATION DECLARATIO� . ,
I hereby affirm under penaqy ot perjury one ot the lollowing declarations: �. �
❑ I have and will maintain a certifcate o( Consent to Sel/-Insure tor workers'
Compensation, as provided dor 6y section 3700 of the .Labor Cotle, for the
performance o( lhe work for which this permit is issued.
I.have antl will maintain v.orkers' compensation insurance, as required by
'ection 3700 of the Labor Code, for the pedormance of the vrork !or which this
pertnit is issued. My workers' compensation Insurance carner antl policy
humber are:
Carrier
(This seclion need irol0e wmplefetl ilfM1e peimrt is valued af one �untlretl Collars (8100J or less J
Po �cy Number:
:� ertify that in Ihe pertormance of the work lor which this permil is
� tl'I'shall nol employ any person in any manner so as to become subject
to the w rkers' compepsation laws of California, and agree that if I shoul0
becom ubject to t C� workers' compensation provisions ot Se tion 3 00 of
ihe L r Cotle, I II forthwith comply with these provision � �
� . i- 0 ('�
'�S,;Applit�am' SignaW e rj,.__.--� � te 3'
�
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
PROVIDEO FOR IN SECTION 3706 OF THE LABOR CODE, INiERE57, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: �
I hereby aKrm that I am licensed under provisions of Chapter 9(commencirg
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eRect.
Lic. # Class #
ConVatlw's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirtn that there is a construction lending agency for the
peRwmance o! the woiic ta wfiich this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lenders Address:
Da�e
OW NER-BUILDER DECLARATIONS:
I hereby affirm that under Oenalty of perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5.
eusiness and Protessions Code: Any ciry or county which requires a permit t0
construct, alter, improve, tlemolish, or repair any strucWre, prior to ils
issuance, also requires Ihe appliCan� tor such permil to file a signetl slatement
thal he or she is liCensed pursuant to the provisions of the CoNractors
License law (Chapter 9(commencing wi[h Section 7000) of Division 3 of the
Business and Pro(essions Code) or thal he or she is exempt therefrom and
the Dasis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant ro a civil penalty o( not more than
five hundred dollars ($500).):
•", as ovmer of the pmpeAy, or my employees with wages as their sole
ompensation, WILL DO THE WORK, antl lhe struciure is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply to an ovmer of property who builtls or improves
thereon, antl who does such �wrk himselPor he�self or th�ough hiS or her own
employees, provided that such improvements are nol intended or offered for
sale. If, however, the huilding or improvement is sold within one year of
completion, the owner-builder will have the burden of proving ihat he or she
did not build or improve for purpose of sale.).. .
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS lo Conslmct the prqecl (Sec. 7044. Business and
Professbns Code: The conlractas License Law dces not apply to an ovmer of
propedy wYw buiMs or improves thereon, and x?w cont2cts for such prqecl with
a contractw s license pursuant to ihe Contractds License Laws.).
� • ' am exempt untler sec. '
Business and Professions Code for this reason:
Ovmer ID verified by dr •nse. ❑ Yes ❑ No
�rrver5kicense� � ;Ex ires: T��
R:������v��� ' . ,�
P
eri i�wrier"ship by (type of document, i.e. - property ax 6' I o� deetl):
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DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: �
❑ I hereby certAy that no exwvation fine (5) or more feel in depth into vfiich a
person is required to tlescentl, will be made in connection vrith work authorized
by (his permif, and that no building sWcture, scaffdtling, falsework, a demolition
or dismantling thereof, will be more lhan thirty-six (36) (eet high. (Chap. 32, Gry
2. M 2, Sec. 341, Ttle 8, Califomia Administrative Cotle).
❑ As owner-builder, I will not employ anyone ro do work which would
require a permit from the Division of Intlustrial Safely, as noted above, unless
such person has a permil to do such work trom Ihe division.
ApplicaN s Sgnature
Division o( Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or p�esent or fuWre building occupant need lo file and
ceriify a Business Plan for emergency response to release or threalened
release of a hazardous malerial? ❑ Yes ❑ No
(Seclion 25505 of ihe California Health and Sa(ety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry o! hazardous materials equal to or greater Ihan a vreight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas
at standard temperature arrd pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? � Yes ❑ No
(Section 25533 of Ihe Cali(omia Health and Safety Cotle, wi[h some
exceptions. requires registration vnth the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazartlous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at stantlartl
temperature and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevenlion Program for acutely
hazartlous materials�l ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health antl Safety Code provides that the
Costa Mesa Fire Departmen� may require �he preparation, certification antl
filing with the Fire Department of an RMPP by businesses which are required
lo registe� acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 of the Califomia
Healt� and Safery Code heen fully complied with? ❑ Yes ❑ No
5. Does or vnll Ihe applicant or present or future huiltling occupant require for
Ihe work which is the subjact o( lhis application a permit for such mnstruction
or modification from Ihe South Coast Air Quality Management Distnct or from
any o�her air pollution control tlistrict or agency? ❑ Yes ❑ No
(Sec�ion 658502 of Ihe Califomia Govemment Code requires that the requested
inlortnation be fumished on applications (or rron-residential building pertnits).
6. Will any part of the /acility to be constructed under this permit be wiNin
1000 feet (rom the outer boundaries of a school? ❑ Ves ❑ No
(If'yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Heallh antl Sa(ery Cotle).
7. I( a permit fmm the South Coast Air �ualiry Management DisMct or other
air pollu�ion contml disUict or agency is requiretl tor Ihe work which is Ihe
subjecl ot lhis application, �ave all of the disclosures prescri6ed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifiwte of wmpliance from the appmpriate air pollution
coNrol officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials antl Emissions.
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
the in(ormation given is correcL I agree to comply with all state laws and city
ordinances relating to building conswction, and authorize representatives of
ihe City of Costa a enter upon ibe aDove-describetl prope y!or
inspecti i purpos agre nol to ocCupy or allow occupancy f any ilding
authori� d r th' r� u il fnal inspection.
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,Y, ���;��I,SPgnaWreo(L v er(s) � T� '� 5te_�'� �,
,��~g�_ AnElor Autnonie0 Ap0lican� Dale
. . . . . . .`,:.
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NEWPORT-MESA UNIFIED SCHOOL OISTRICT
CERTiFlCATE OF COMPLlANCE OF OEVELOPMENT FEES
PURSUANT TO AB 1800 AND AB 181
To: (� City of Costa Mesa
( ) City of NewpoA Beach
( ) County of Orange
Applicant: r�
Address: �
�
Telephbne Number. ^V ` � � �, v � I � �I
Tract/Parcel and Lot " ' " '
Location of Project:
Number of Square Feet oi:
Residential Space
�
(��� x 51.84
�° 6785
DisUid Receipt No.
Pian Check No. '� �i �
ro�i � I ��p �l O 3 2
Commercial and /� '� l� �
Industrial Space x S�7p/ J� D
r
� � SEP 202007
CommerciaVlndustrial Project is: (Check One)
_ Warehouse
_ R8D
_ Movie Theater
_ Mini-storage
_ Heavy IndusVial
_ Regional Shops
_ Light Industrial
_ This project is exempt because
CITY OF COSTA MESA
_ Motel .�"
'Bank ,�V�, ,
Neighborhood Shops 4 �
_ RacqueVHeallh
, Hotel
Medieal Of6ee
Office Park
This certifies that Me above-named DevelopedAppBcant has paid school tad6ly fees in comp6ance
53080 and 65995. The Building Pemi� (or this square footage in this proposed develppment may ny
Checks are to be made payable to NewpoA-Mesa Unified School Disfid.
_ Preschool
_ Auto Repair
, Hospital
_ Large Office
_ Otfice Bldg.
, Restaurant
_ Fast Food
nent Code sections
by yourjurisdicBon.
The above representation as to square tootage is We. Appdcant agrees that i( it is later determined that such representations are not
irue, then this certificate shail automatiealy terminate
Date: l � �
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENTSERVICES DEPARTMENT
New State Law:
Swimming Pool Safety Act of 2006 (Assembly Bill 2977)
Effective January 1, 2007
California Health and Safety Code Section 115928 "(d) Whenever a building permit is issued
for the remodel or modification of a single family home with an existing swimming pool,
toddler pool, or spa the permit shall require that the suction outlet of the existing swimming
pool, toddler pool, or spa be upgraded so as to be equipped wi[h an anti-entrapment cover
meeting the current standards of the American Society for Testing and Materials (ASTM) or
the American Society of Mechanical Engineers (ASME)."
Address/Permit Number
Permit Applicant or Contractor's Affidavit (Please check appropriate box):
❑ There is an existing swimming pool, spa, or toddler pool on this property. I will
install an anti-entrapment device that conforms to this law, and I understand that the
installation of this device is required prior to final building inspection approval.
[�There is no swimming pool, spa, or toddler pool on this property.
Building Divisian (714) 754-5273 • Cotle Enforcement p14) 754-5623 • Planning Division p14) 754-5245
FAX (714) 754-4856 • TDD Q14) 754-5244 • wvrvtci.costa-mesa.ca,us
� � CITY �F COSTA MESA "
� '" BU/LDING DIVISION
a
i �p 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�, + FOR INSPECTIONS C-:(774) 754-5626
�``.aro.��o,"�: �., 7��,,
PERMIT NUMBER. E07-00922
PERMIT TYPE ELEC STATUS: ISSUED
DATE ISSUED: 11/20/2007
ISSUED BY: SOK
JOB ADDRESS: 468 16T - L� Suite/Unit: '
Vicinity: ���� � '. � . � - . . . .
SCOPE OF WORK: INSTALL TE RARY POWER POLE FOR S.F.D. � ��
„s:'�' � _ � �
z: `
OWNER: KELLEY, VALERIE � Address: 468 i6TH PL _ Unit: ', �
PHONE: � -� City/State/Zip: � COSTA MESA', CA '
APPLICANT: DWIGHT BROWN � � ��� - Addressc PO BOX 3486 Uniti -
PHONE: 949-650-�674 �- City/Slate/zZip: �.NEWPORT BEACH, CA",�
CONTRACTOR: OWNER-BUILDER � � � . � � License No. 000000 ' .�
Address: Unit:. �� , - ' . PHONEi _ -" "' � �. � � ', - ,
City/State: , ZipCode:. � - .. _ _ „ � � CELL: � ,-
ELECTRICAL PERMIT�FEES � � �
Electrical Plan Check Fee: " $0.00
Electrical Permit Fee: r$57.00
Reinspection Fee $0.00
TOTAL FEES � . �. $57.00, � � � �
'`
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, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES'180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE N. INSPECTION TPE DATE INTITIpLS CODEA INSPECTION TYPE �ATE INTITIALS
1616 Fixed System Final Fire Prevention 206 final Mechanical
1266 Pool Spa final 208 Final Plumbing �`�
200 Final Re-Roof 210 Final Electricai� � �
201 Final BbcWRe�aining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Plannin9 Approva�
203 Final Sign 222 Final Site
204 Final Demolition ' 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATIO�.
I hereby aKrm under penalty ot perjury one of the following declarations:
❑ I have and will maintain a certifcate of consen[ to sel(-Insure for workers'
compensation, as provided (or by section 3700 of ihe Labor Code, for ihe
performance of lhe work for which lhis permit is issued.
❑ I have and will maintain workers' wmpensation insurance, as required by
seclion 3700 of the Labor Cotle, for the peAortnance of the vrork for which this
permit is issued. My workeis' compensation Insurance carrier and policy
number are:
Carrier:
(This secl.on neetl nol be mmpletetl il fhe peimd is valuetl at one huntlrM dollars (8100) oi less.)
Policy Number:
, ��1-certify [ha[ in the pertormance of [he work for which this permi[ is
issued, I shall not employ any person in any manner so as [o become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Cod I s(h�all forthwi�,,.� Tnc �omply wi[h [hese provisions.
..r 7 - . . .., _ ��I �]
"�� �'�3`A: icanCSSi9na�uie"°" 1 �:"�a�e�"
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
($100,000), 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 DECLARA710N:
I hereby aKrm Ihat I am licensed untler provisions of Chap[er 9(commencing
with Section 7000) of Division 3 0( the Business and Professions Code, and
my license is in full (orce and effect.
Lic. # Class #
Conlraclor's SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn lhat lhere is a cons[ruction lending agency for the
performance of the work fa which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for [he following reason (Sec. 703L5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or tha[ he or she is exempt [herefrom antl
the basis for the alleged exemp�ion. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five undred tloilare ($500).):
-I as owner of the pmperty, or my employees with wages as their sole
`�compensation, WILL DO 7HE WORK, and the stmcture is not intended or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not appty to an owner of pmperty who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
tlid not build or improve for purpose of sale.).
OwnR_r ID verifed by driJer's h,,. .a. ❑ Yes ❑ No
Diiv`ers.License
document, i.e. - property tax bdl or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excavation fve (5) or more feet in dep[h into wfiich a
person is requiretl to descentl, wiil be made in connection with vrork authorized
by [his pertnit, and that no building structure, scaffolding, falsevrork, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administra�ive Code).
❑ As owner-builtler, I will not employ anyone [o do vrork which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit b do such work from Ihe division.
Applicanfs Signature Dale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or presen[ or future building occupant neetl [o file and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Sec[ion 25505 of the Califomia Heal[h and Safety Code requires, with some
exceptions, Ihat a Business Plan be fled vrith [he Costa Mesa Fire
Departmen[ by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperaNre and pressure).
2 Does or will the applicant or presen[ or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of [he Califomia Health and Safery Code, with some
excep[ions, requires regis[ration with the Costa Mesa Fire Department by
each business which at any one time has on hantl a quan�ity of acutely
hazardous ma[erials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl
temperature and pressure).
3. Does or will Ihe applicant or present or fuWre building occupant need [o
prepare an RMPP (Risk Management and Preven�ion Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Calitornia Heal[h and Safety Code provides [hat [he
Costa Mesa Fire Department may require the preparatioq certifca[ion and
fling wi[h Ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials wi[h [he Fire Department.
4. If an RMPP is presently required, has Section 25534 of [he Califomia
Health and Safety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is the subject of this application a permil for such constmction
or modification from the Sou[h Coas[ Air Quality Management Disirict or from
any o[her air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested
information be fumishetl on applications for non-resitlential builtling permits).
6. Will any part of the facility [o be cons[mctetl under [his permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(I( "yes", the facility must meet the requirement of Seclions 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from [he Sou[h Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this applica[ion, have all o/ the disdosures prescribed by California
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air polWtion
conhol offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of peryury the
information given above is correcL I agree to comply with all state laws and
❑ I, as owner o( the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct [he project (Sec. 7044, Business and
Professions Code: The contractors License Law does not appty to an owner of s�9�awre oare
property who builds or improves thereon, and who contrac[s tor such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
a contractor(s) license pursuant tothe Con[rac[ors License Laws.).
�, certify under penalty of perjury ihat I have read this application and state that
°�'��°��' the information given is correct I agree to comply with all state laws and city
❑ I am exempCunder sec. ordinances relating to building construction, and authorize representatives of
Business and Pmfessions Cotle for [his reason: the City of Costa Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
�\ authorized by this permit until final inspection.
�� �� _ �- aWreo(LegalOwner(s) Dale
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NOV-20-2007 TUE 10:31 AM
ivzoizoov i�:se Fax 7747544856
QECLARATION QF AUTHORITY
FQR AOENTS OF PROPERIY OWNCR
TO APPLY FOR PERMITS
Svw1 Addnti:
1. 1(we),
�eterenced real DroDBM, atW Mat 1(we) Aueby auNwrim;
N�:
1Y 1
FAX N0,
J
ea9.Pe�nr w
Thls Permi� p . �
AP N� mt�r;
P, 01
�o0,�003
doU:�re that I am the t lw�wr a! 71tle af the o0ow
- �r
� t����\�� ��Lt�t�
`• ��r Mr �1 �,t � � .I �
�.�. - —
m onratn psm�na in my oenerc, na ownerlbuilaer, r�r �P�(\ Ei . C�f li �1�P f__
,s n+a Qeo,� rore.e�d vro�eKv, ,
Z. StwulA �nr p�nen Decome an empleyss e�epad In Ihe improvem�nt of 1h� piopaly, 1!we) shatl unrn�oyWy proNQb Workera
Compinoaqon Insur+�p cowrayr antl caus8 a celUfleate of thet coverape to De tpeC wlth tHe BuilGii ,O DiWsfon of �he Ctty oi Costa
AAes�. af r�qu'u�W by Sl�dr of Gaqfomia Uws,
3. Aa owTlariDullpYr (n feet, I unASPBMnd Md eceept 7Nft my reeponalbilitiea do nvt transfrr b m ry� ather p�rcon, comp6ny w
mr{wraGon.
4. I agrep tp Indemnfy an0 hold (he Ciry o} Coate Mesa pnd lu empby�w or o�cers harmlass /rom ar y c�afm resWdng !n demape w
pa�onBl IPI�M m mN�h er any elhll qaRiea ee e ieault oi work dUllrorlted Cy She pem+ib from Mio C 1ty ef Coat� pMsa,
6. 1 deokro under 1Ne pentlq ot perj�ay M�t thm fongoinp is W o ond eortse4.
EweautM 1AIs CeY of 20 _�„ , tr! „_ , Cslilomla.
PMrt NarrK: 9 'C U � 1 ' � • �' � �Q �/ -
/ �' � 7_' �
sipnan,�: � ` _
f ���
�: � .�2 v�o� �
t�YOu THs �ho�qtlon aow rme yrmn eu�amon eo pwtomi the �onc e9 aui gr.
H sobN V�`�� Ibr M�Wed pa�uar of elEaray ED anva tltia Pem�it n arry bel a�.
V»aw p«.�utol
AODPESSOFBUILdNG: � '1.6TH �Iv '
OYMEP'SIUNEIFpqWN:�TRIMPLE, RiCHARD V TP.
�ooxEss:486 E 16TH PL
COSTC�A MESA,CA 92627
MPI. YNIlN01DDFlESk � o � l � �'- �����
RPCNRECT OF �qNEEF:
MCN.OX F.NG.'S ADpRE55:
uc. xo.:
UNT:
UNT:
coNm�crarsruMe:(;EORGE DRAZIL PLMB, HTG, (714)541-9753
cax�n�cToasxuuxa 3022 N HESPERIAN WAY
�+�g SANTA ?�NA CA uc.wo.: 679II98
�27Q( UNT:
LICENSED COtRPACTOflS DECIAHATION: I hereby eRirm under perely d pa'jury ihet 1 em Icmaed under pravaions d Cheper 9
(mmmanci�q wilh Saction 1000) o/ Drvision 3 d ihe Buai�reas eM Pratenaione Goda, arM my limnae u in hll brce end elled.
cmuc.r+o.:060 68 uc.cuss:C 20 ��c"o 679898 EXP: 08/97
� ,y /p
oa1e: `%' /G �r� cam,eao,:�l7�'`-CXG (°�!iz.,.L'�/��/��(/�
OWNEP BUILUEfl DECIANATION: I hanby elfi�m untlar penely d perjury Ihm I em e� Kem� ntredae Licenae Lew la Me
/plbvnnp remm� (Saeion )031.5 Buaroes end Proimsione Gada: Any cdy a cauny which requirea e pe�mn le ooneuun, eller, impove,
'emolah, ar repeir eny sVucture, pvr W Xs beue�e, elao reQuires Ihe eppli�ant br euch permit to file e sipneE aletement Met he a sM
rceosae a��,e�� m me v���a� a me com,ac«s u��.e ie. Icnewa, a(wmma�d�a wnn smk,n �000> a owo�a, a m me
duairrea enE PrWeesione Code� or Ihel M rn ehe is azempt iherefmm aM IM bsvis iw iha elleped uemption. My vide�on d Sedion
]031.5 by eny epplifant for e parmil aubptla Ihe epplcent to fl civil penelry of iwt mom Ihen live huedred dallen �$500�).
� I. as ovmer W Iha propaM a my empbyees vNh wapes m �hei ada wmpanse�ion, will do ihe xork. end IM aVuclure's na inteMeE
Impwamems ere m� m�endee o. one�ea r« sa�e. n, nowarer, �na eulninp « improvemam is sae wnnm a�e yeer d inmyletion, �ne
owrror-0uiNer vnll heve Ihe burden d pmving he or she d'M �wt build or improve Iw iM W�P�e d aele).
� I. es owner ot iM MOPaM. em udusivM' mmred'n9 xiih licenaed convactwa �o mmvud tM Prolea (Seabn )(M6. Businms eM
PMes4ons Gode: The Comredm licenea Lew doec na eppy �o en owrer d qapeM ��ika a impoves t�ereon eM who
convacta Iw suM Orol� �h a mnireda(s) licensed pureuanl lo Ihe ConlraGan Limree law).
❑ i�<.<mw ��ae. s���. s. s v.c., ro� mn �,:
o�a: o..��:
, i eu ne,eW �amN u,m i em awme d e�d ��a.rs�ena ine rea���e�u a cei�om�e Hmnn d,a sare�r code sea�e zssos, zssxa, d,a
usae. �e inm i o. �r nn�.� waie�oa «wo�� ��i i w�i� �a �arcr o�»� naed m cwnpy wih eeid ateta mtles eM iM requiremend fa
epertnnlwmnsiruclbnormodfi�imhanlMAr u3TtyT.—arepementDiatrip.Reeitlentidmretrudionepplrarioreereeumptlromthesa
provisons.
Dele: Applicenl:
WONKEfl'S COMVENSATION DECWHRTION: I Mreby alfiim uMx pereM1y d pe�jury wn d Me blbxirp detlereliora:
� 1 heve eM xip meinlen e cenXcme d oonsent lo aeXinwre b workare wmpeneation, m provided for by &eaan 3)(10 d the lebor
coa41« �ne vanorma,ce d �ne work �« w�:cn mie re�n ie lae�ed.
�I have end xiA meintein vroike�a eanpenselion irourerce, av required by Setlbn 3lOD d ihe lebor Gode, b the peebrmenee d IM
wak fa which Ihia pem�n ie isaued. MY ��r^ �mpeneetion inaurence urrier ard pdic� number ere:
o�a,: rnr,nFN Fz�r,r,F EXFIRES
PolicyNumber. �iwraannA�_�n 07.l01/98
7This seeiwr need rrot Ee compbfed A the perm[ is Iw one hunCreC ddlers (51007 w Ims.)
� I eenry ihet in IM perfaimenee d IM wak 1« whch thia peimu is imued, I ahell ewt empoy enY Oe� �� �Y menner eo sv to
becoma eubjed to �M wakere' cwnpenmlion lewe W Celilamie, end eprea ihe� tl I ehould becoma wbjad �o the woMers
compeneetion pwisiona W Senbn s'!oo d the laWr COEe. I shall fonhwiih mmpM �h i e .p,�r°� iore.
oma: 4-% b� ��_ noa�n: ��'�l�' �i �S' IJV�QYC7
WeminD� F�Nun ro axuro workeri eompewtlon eovnp� l� unl�wNl, arW sMll aub/set m smp/oyx fo MMiul peneMu entl
dv/l fl� up ro ons hundred NouuM Call�n (Sf00,000J, M aWltlon ro fhs cwf o/ ca�vxwf/ory Wmeq� u povltled bi In
9ectlon 3106 0l Me La6orCo0e, Inbre�q antl �ttarney's Iso.
CONSTHUCTION LENDING AGENCY: I hereby elfirtn uMer panelry M perlury ihet ihero ia e mnslrudim bMiiq apency lor tha
parbrtnence W tM woM far which �he paimn is ksued (Sedan �09). Civ. CI.
LENDEH'S NANE:
LENDEH'S �OOHE53:
I cerliy thet I heve reaE Nis epplcetim end stele ihat tha ebova iniammion ie coneq. I apreeto compy vmh ell dly eM muMy oNinences
end atele lewa Mminp ta builEip conslruqion eM hereby aNhor¢e reqesentetives Mihis dtyto enler upon iM ebove-mentuned piapeny
Id inspeabn W rpases.
F'I:P.14.�iNDQ h1�REtdO
Pnnl Name �
rs '`��`-- om,: (' �
SigneNre N OvmerlAgenVRpDliranVCOMreda
(5151de WP) Whde-Buildvp 85alely; GreemFAe; Cenery-Appiranl: Pink-Revanue: GdEenra�Acsesmr
CITY OF COSTA MESA - BUILDING PERMIT'
PERMIT NO: P 082400
COPISTRUCTIUN TYPE: �'-N
PLAN CHECK NO:
PERMIT TYPE: PLU
1V
PERM h10: P 082400
GOVT: N SUFF: Pd
SUH UESCRIPTION : GAS REPIPE OF EXISTING SFD SQ FT:
PURPGSE: OTH
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
COMMENTS: GAS REPIPE OF EXISTING SINGLE FAMILY DWELLING
*�*x**�*xx���e*��*#�****�*�**�**�*�*�**��*�x�*u*�****��**x#�;�**�**��#*��*����tr�#
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 5
---------- - MAIN BUILDING ---------- -------- ACCESSORY BUILDING --------=
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: PT IN RGIiT: FT IN
�
PARKING REQ; PROV: PARCEL: �Ylt� ZNE: REF NO:
PLANNING NOTES> y2SlS%O�
1
iEiE�EiEiF'IE�EiE�1E�f3f3kiflf�lElE#iE#iE#iFiEiFif3E�1E1E#iE�Ej:3E�f9(-1F1E�ElE9E�)klF3FiF3FiEjf�jf�t.f�E3E##if3f#lEdE1E3:lE1E�#3E�kjE3f±EiFiE"1E?:itiEiF3E#j: �.
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
��i�
ZONING APPROVEU BY . - DATE;
BUILDING APPROVED BY :
APPLICATION ISSUED BY: � y ��
iEiEiEiE1E*�E*',E�'jEitlEifiElFiEiEjE�1EiE�# - F E i#iFl2 iE .��EiF
LEGALIZATION;N F E t S U M M R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 8,75
?5� �
PLAN ,�_ v
ISSUE FEE 22.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK,
TOTALS----> F1.75 22.00 " 0.00
l
REVENUE DIVISION TOTALS--> COLd?ECTED:
FiLUG PMT PLUMBING ELECTRIC MECHANIC
'�.75
_ DATE:
DATE; y/�O`��
3E��itiE3EiEiEiElf'E3fjfiEiElEf.-�3FdE 3EjE
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON-RES
TGTAL PAID DUE
30.75 30.75 ,00
30,'75 OVER!SHORT; ,00
FIRE SMIP/TOT GRADING PLAN-CHECK
#j(9:jfiflE'.E#Y�iE�AiEiEiFjFiE##1EjEi:�K#iEiE�;EfE?'.�#3EM-iE3F �iFlEiF1'.-l6if3fiEfE3F#if3f#iE-k�jEif�)f3EiFf�fEiEffiE3EiE�iF�F�kiE'.E#iE-%�lEiE#fEiE�3E
I N D I V I D U A II' F E E B R E A K U 0 W N
TYPE QTY D E S C R I P T I O� N, UNIT' COST TOTAL COST
PLO ]. GAS RE-PIPE /' �.75 8,75
END OF FEES
.�
hi
84-18-1997/18:38 flM/f38.75
PEkM I Tp10824F10
- CONSTRUCTION AND PLANNING � POC SPA
APPROVALS Permit # •Date Mspector qPPROVALS Permit # Date Inspettor
L Temporary Electricai Service or Pole 52. Pool & Equipment Location
2. Soii Pipe�Undrgrnd. � '" . - 53. Steel Reinforcement �
3. Electrical Gondu�t Utility�Undrgrnd. - 54. Forms
4. Elactrical Condu�t-Ur.drgrnd. ' . ; 55. Electrical Bonding �
5. Steel Reinfarcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings , 58. Electrical ConduicUndrgrnd.
8. Poundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. "+ ". - 60. Backwash Lines, P�Trap, Q� Wndrgrnd.
10. Structurai Pioor System . 61. APPROVAL TO DECK �
t t. Property Sewer Gine & House Connection � , 62. Backwash & Receptor-Final ; .
72. Sewer Cap 63. Heater & Vent�Final
i3. Roof Drains � 64. Plumbing SYstem - Final �
74. Rough Piumbing • � 65. ElectricabFinal - '-
/5. Rough Electrical�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. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . � APPROVALS Permit #
21. Oucts, in Structure 70. Underground Hydro
22. Ducts, Ventiiating 77. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test ' 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiliog (St�uctural{ & Monocoat 75. Ory Chemical
27. Frame and Fiashing 76. Dry Standpipe
28. Lath'rng & Siding �7. FIXED SYS7EM FINAL
29. Insulation ' 76. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Mecer�Flnai �• 80. FOOD CERTIFICATE ISSUED �
33. Finai Electric Notes: _. �'
; ; �-� % �'a ��s �,� ,�'
34. Pinal Heating & Air Conditioning ' "
35. Final Gas Pipe-Test •
36. Hood or Canopy !
37. Final Factory Firep�ace � �
38. finai Plumbing ' w��9q �
/'� /!
39. Water Service-Final ��_
40. Gas Service-Pinal
�_
47. Solar pomestioFinal �
42. Backflow Preventer
43. Barkflow Irrigation
44. Landscape Irrigation System .
45. Sound Attenuat�on
46. Handicap Regulations � �
47. FINAL STRUC7URE & BUILDING •
48. FINAL PLANNING
49. Electrie Reiease to Edison -
50. Gas Release to Southern California Gas Ca
51. CERTIFICATE OF OCCUPANCY
No Date
`
�
7
�oonessaem�mro: qb8 1bTH F'L
an+exsrwieiviu+o�vn: $HANNAHAN, ERLINE P TR
�nEss qo8 b 16'PH PL
tOSTA MESA,CA 92627
548-5652
�vr�. Wuuxo �ooa[ss:
1XCNIfECTOR BlCd�EFN:
IIFl10.
ur�r:
ARCX. OP FNG.'S /i00PE55: UNi:
camunarswu� ROHERT FISHER GEN. CONTRA ( 714 ) 248-1741
cam�croirs��wc 31722 AVE AVILLA
,�oo�ss: SAN JUAN CAPI926,A750 CA ��,; 4M3759
110EN5ED COHrflRCTOflS DEClAP11TI0N: I Mnby ellim uMr pruly d peejury Net I un ficmaeE wMx pwmme d CMqs 9
(eanme�r'aq wtlh Seelbn ]000) d Oirisun � W Ne Butinea eed Prdpeiwa CoE�. uM mY lieeme n in hA bee W elletl.
cmuc.No.:G36332 uc.cuss: B uc�.No.:143�3759 EXP: 08/86
om.:/��/�i^�7 camana /�7-�i''%` .:�� ,
OWNER BUILOFA DECUR�TON: I hreb� efimi uMs pe�Wy M perjvy �hel I am usmp han iM CaqMm li.wee lew Iv tlr
toAownO �ufan (SeGion R115 Buenmt W Rdmriom Coda: MV uY a odvaY MJN �p�'um e D��d b muV W. tlW. oMwa.
Emmd'eh, a ropei mry eWCNe. p'v b en "sweiw, eho iapimee tM eppYUN la wc� pemN lo fle a tqnsE Msnstl Ihtl M a ehe
� licemed punueN io �he prwe'vu d Ihe Caurenon licaiue lew �Ghaqs B(cammmap xdh Setlion 1000) d Diveian 3 d tM
iainan eM Rdeeaiom Codel a Ihet M a the u uemp Ihnelmm dd IM bem In Na NkYb s�amqion. My violelion al Setlion
nt.5 by e�ry epqkau in e parme w�bjew ihs eyqiw to e wrJ prWiy d na maa ihen f a wneree emen �Ssooll�
❑ I.mowrerdtMqopenYamyempbyeaawihwapaantheieobcompeneelbn.willEothexork.ardlMel�uduneMNteMaE
a oflered br aele (Sactian ]Oaa.Binimu eM Prdevebm COEe: TheContredan Lbmee lnwdoee rwt applyto en wnw d popeily
who WIM « inWw'e� Ihareon. enA Ma doea euM r.orklimsetl a Mne1 a IMo�q� he a Im awn emObMs. D�o+� Ihe� euch
. imprwemema are eia imeMed ar dlaed Ia seb. tl. lwwms. iM buJdinp a inpo.anM n eatl within ane Y� d romplMion. lhe
� ownm-0utlMr vNl hew iM Mvden d qovirq M a ehe d'd nd Wild a impps In tM p�pwa d ubl.
li ❑ I. m owror d tha P�H. em utluriwry wmreq^Y xdh fioenxd conVMon b mmNq IM p9� (Satlun IOM. &emms eM
rw�m. coae: me cwreea. 4cm.. V. ma. �a wWr w.� o.,w a o�w�v �N,o waa. «'vnpw« m«aa, w wro
mnue�b br mrh peqepa xnh e mmreuar�e) IieansE Wnuem lo iM Cam�mm lYwua law).
❑ I em uamq unEm Secvion: B. 8 P.C.. tor Nu iaoaon:
Dme: Ow�a:
I do Mroby cMiy Ihe� I an ewere d erd uMenlend IM repuirememe d CeltomM HaeAh enA Sehty Code Sediwu?5505, 25533, enE
255]C, vM ihm I m eny iNure Wikinp ouvpent will / will nm (arcb aro) need to comply wYh eeid e�ela codas uM iM �pNremeMa br
e permil lamnevuc�ionar madilratbn homlMAir�ny}�epemenl Diel1lp. PaeiEeMial ooneliutlun eppYuliam ero exemq homthete
pranaiona.
Daia� Rpplireeu:
WOflKEN'S COYFENSATION OKL�fl�T10N; 1 hereby df uMx pw�My d per'ryry ar d Ihe IoOovrirp Eetluatiom:
� IMwartlWmeinienecenSraisdaoneantlo�otlinarslaxMerioompenwion.mpwiEeEtaby&atlion9)OUdtMLebar
coa.. �n in. v��. a Ne .w i« wFicn ina wmW u u.wa.
❑ � nm..ne w m.�u,n.An.+• oomo«+mon uwrenoe. m�.amne M sew, a�ao d m. �.n« coe.. �or me o�«meroe a me
wwk lor xfi'vh tho 0�� u u�ueE. MY wulan' eanM��ion iiuueenes urt'w uk D�Y number an:
c.�.:
Pdicy Number:
i.an� �..e �or ee como�ee r ms e«me R n, m,s n��e�sd adien Isioo/ a bs..�
I oenAy Oat in iM pmlamerce d iM work lor Mfiich thie pem�n u iauetl. I JWI m� employ eiry peson in em� menner m n lo
� becare a4� io tle wMae' comDe�Wion lews d Celilamu. uM Wr � I ehouM bacann euEjae to �M xorkan'
mnpenae�ion qwuure d Saaion 9)00 d IM lebor Catls. I NeY lo '�xrh t rp 'ei �
o�.: io -is-9 ;� �� ��
G
wemtro: aaw. m.acun wonnn• wno«u.tlon cavr+a �. wwiw, un.n.n ue�.n.ro�mr ro abNwa�ron.ne
dvu nns. w ro�. nure.sd uwu..na eww. lsiu4oroA m am�aon ro m. co.� oi mnw��, d�+ u wo� ror M
s«uo� �ms o� m. �mo, cee.. �mr..c .�e.m,m.✓. �....
cor+srnucnoN ��dew �aener: i nmaw drum w�am w�+eM a o«iw �na mr. e. mmNaa� r�w mmrv mr m.
panamenoe a �ne wak w wnKl, �he v.�� u'eeuee (smon aos�. cw. cl.
LENOEN'S NWIE:
lENOER'S ADOPESS:
I cMiy ihet I heve rte� No eppfratim eM ame tMt IM ebwe iMamelbn e conw. I prae �o comply wGh N ary and rnvuyad'v�enm
md Ble�! I6wa �Ne(�N b bu1b�10 CqIfUYGiqn md hMGb'/ eNMxQO �lpOlM��tliM M Ihtf �Y M MYBf Y�f11MlbOW-IIMNqtME pOpMy
�«��'°'�W`°�"' RANK FIS �
�� _ ..
�����is_ _ I �
� �- a.-c
(S151d6.WP) Whns�Buikvp 8 Selety:OmeMFle; Cenery-AppYrent; Pink-lievenue; (idEenm0.Meaea
CZTY UF COSTA MESA - HUILUING FERMIT
FERM NU; B 'v&522
PERMIT NO; H OB5229 PLAN CHECK NO: N GOVT; N SUrF; N
CONSTRUCTIVN TYPE; V-N PERMTT TYPE: STR PY/I2YU:iE: U'IH
JOB DESCRIF�TION ; T/OFF 6 REROOF W/COMP SHINGLES SQ FT: 5,400
CLAIM VALUE: 5,400,00 CALC-VALUE: 5,400,00 GROUP Gi:C: R-3 /
COMMENTS: REROOF 25005F RESIDENCE W/COMP SHTNGLES
�**�c**�*�rr�e*r�r**r+r�r�r�r***x ***+r�*+�****�***;r�c�r�****+r�c�r*�a**�c**�r;�*+�*;��c�*��*;�;�*;���r;��
Z O N I N G R E Q U Z.R E M E N T S
S E T B A C K S
------------ MfAIN BUILDING ---------- --------- ACCESSORY' HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAA: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV: Pt1RCEL: 42515104 ZNE: REF NO: _
PLANNING NaTES> �'
�
M if iF iF iF if iF�F iF iF iF iF iF ik iF iF iF iF i! iF if iF iF 3t iFif M M if 1E iF iF if iF if if iF jk if M M k iE #if i! iF'sE iF iF iF iF iF if it iF iF ih it if iFiF if iflf if 1ElF if 3F i! aF ik if if if iF iE iF
D E V E L O P M E N T S E R V I C�. S R E Q U I R E M E N�'T S
20NING AFPROVED HY DATE; �
HUILDING APPAOVED HY
APPLICATION ISSUED B
iFiFiFMifiFMihiFiFikiFitifiFif3lMiFiE
LEGALIZATION:N
BLDG PMT
PERMIT 112.25
F E E S U H M A R Y
PLUMBING ELEC'TRIC MECIiANIC
LATE;
STRUCTURAL :SEGMENT:Y
FIRE SMIP/R54 GRAUING
:
P LAN SM I P/ NON--R �:5
HUILDINGEDIV-> PERMZT ZSSUE PLAN-CHECK TOTAL �� PAID LUE
TOTALS----> 112,79 0.00 0.00 112.79 112.79 ,00
REVENUE DIVISIOiJ TOTALS--> COLLECTED: 112.79 OVER/:.;fiORT: ,GO
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/'f.OT GRAllING PLAN-CHECK
112.25 ,54
iF if iF iF iF R iF if iF if iF if 1F iF iF k iF 1F iF Mif iF iF iF iF iF iF iE �F iF M iF±F if if'1F iF iF 3f iF iF iF 3Fii ii iF'7F'7F 1(' iF iF iE if if if iF iF�JFiF ik iE if ieK 3f ii iF 3F'k iE iF'7E iF iF ipaf if'lh if
I N D I V I D U A L F E E B R E A K,D, O W N
TYPE QTY D E 5 C R I P? I O iV UNIT CUS'T 'IU'1'AL CUST
SFR 5400 REROOF BY VALUE RESIDENTIAL NOZUNE ��'1,00 5,40�.OG
END OF FE�S ;
� %�r
'F
F� '. 18-IS-1997/89;55 NM/f112.79
RCDTfl:81-B813871
� ' PERMIT:085229
�ti
CONSTRUCTION AND PLANN{NG POOL `A
APPROVALS Permit # Date Inspector qpPROVALS Permit # Oate Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soii Pipe•U�drgrnd. �9 i 53. Steel Reinforcement
;;3.��Iectrical Conduit-U�ility-Uni�rgmd. � 54. Forms i�
=4�'Electricai Cond�r�U�drgmd. � 55. Electrical Bonding • ' =
�=5.}Steel ReinforGementp � . 56. flough Piumbing & Pressure Test ,.
'��?"'€lectrical UFE� G1'�d. 57. APPROVAL TO COVER-GUNITE
..;��Z.;Foo[ings ;��;� � � 58. Eiectricai Conduit-Undrgrnd.
;8� Foundation '7"=�-� 59. Gas Pipe, � Undrgrnd., Test
,-`�9. Water Pipe�Undigrnd; � 60. Backwash Lines, P�Trap, O Undrgrnd.
: �.v
'10. Structural Flaor Svsiem 61. APPROVAL TO DECK
�] t..Property Sewer-Line & House Connecxion 62. Backwash & Receptor-Finai .
72. Sewer Cap rr " i:� . 63. Heater & Vent�Pinal
73. Aoof Drains �. 64. Piumbing System - Final
14. RoughPlumbin8 ��7 ' ' 65, Electrica6Final �
75. Rough Electriral-Conduit ' 66. Solar System-Final
16. Rough Elettric,�WirifSg �� . 67. Fencing�& Access Approval -
17. Rough Wiring Sign J . � � '68. APPROVED FOR PLASTERING
i8. Rough Electrical,-T Bar Ceili'ng � ' 69. POOL/SPA SYSTEMS FINAL " � '
" 19. Rough Heatin9 & Air Conditioning � FIRE DEPT. REQUIREMENT
- - M.. :� " y ��� � .f - .V
20.��Foii�h F�,cto?Y FiFeplace '�'� y'y ' '� J'�{ „' APP,�OV}��3�'-' P,�imit #� ��
�^ z i ..'S i� �ti iT :1 �!...
21 ..�Juctc, inStrticturq t .•- . �a � r S �' '�+ T. =! 70!-1JnderTjr'au'�d Hydro x
c.� -� .��'- �n�
22. ,Duc�, Ventii�tin]� �: � �'� S � :5 � � �» y •r•< i . iT' ^
� r i � .� .� �y ,] �.., � � 71. ProducY=Pip�ng �CGas �7 Oii
� - �-.x .., � � � �- .
23. �as.Pipe=Raugh &`l�est , i-j S !� t�f �T 6 �%�-+ 72, Undergfound Ftus�r a t-+ �
ti
• �.
24."Roo�Framing !�'4 '' ' ;:� k� ;� z ���:�5 7�, Undergr('id,St��e;tan�OGas ,`;bil
25. Roof,ShtYathin9 j 6 � y' a '� '� n1'i 70.•-Overfiead HYdra '+'
26. ��Bai Ceiling (Struciural) &3Clpndcoat " 'z' �� Ma` Z 1� ry Ch, i al , �7 F ��' �= ^
,. t S F i .>+ rt�Y �:..^' �� -�:7 -k �Tl
� Y ' �z r .v • -, � 2. . i
27...�ra�e a2d F„ashi�.� � x �; r; ::• '� x 76. Dry Stauzipipa-•'z % O
i• 28. Lat�ng�&Siding� r'� i7�.'.:=� ,x K:�' ••� .•.�; j.�. FIXEd�`�,STE��FIN�L,� .1 ��
� � �*� � t . J �_ .. .. � .i� . � r u
29. Insulation "- �r t :S .• k I �v Z�. FIRE PREV. FINAL �^ �:�
30. Drywalirf�ailrr+a u."� �� . 4�� � tr �5 »t�EAL7P1 DEPf!'RECYUI�EMENT
Iz
-' � � .} p _ .7.
: 31. Plaster B pWFl;CAd".�i� fi y , p- { f}, 79. FINAL���V$PECT�ON � ;>
J � �'� I t� �7 SOl FOOD CERTIFIC�P,TE 1�$S,.UE � _
� 32.':Electricai%Pov4er rolecei:Final•
33.�in31 E18;t�iG, � X r� � r K T � �r i� NpteS: � r1 4"7 �;� ^JITi
1 � : � . . . -, ., � , .. "-
: 5 34.�'Fin3]: Heating',& RirrConditioniDg: � � �� � 6 ".0 'S ,`i'� r � �=1��
.'i r� t e��J .-� i -� G fi ITl
35.'.xinal'Ga�PipL�Te52t � .. � (� � ���y �K� _.�r
i� I ft � �Y.�= I
36.� Hood or;EanoPY'a t .�-. _ = �= r '1 � fx '� 'i ^ � '. , " r
- - - t c :, i � �. � .� �� r, =�.,-,
, ... . � ' � S T� K '. tY. . �K
37.'finaYFaczory Firep�ace � � ,_ „
J 1 `
� 38. PinahP�umbin9 '�' �f.'� � .. . � 1 _ -� ; .;, r; V
�..� K iJ
- 39. WaterSeiwice-Fina1"� ~ �' ��� t � '��r '''^ :c'
, :r„ r � � ��: . ✓ �
� a � --�--;a}-=-
�� � 40. Gas Service-F[nal � �r, . �' �r ,a � ;K �j�ri` u
� ��
41. Solar pomesNE-Final •- " '`� � ' �� '� �' '" '
r ' � � k G' 7�L
42.'8ackflow Preventer'� J ,; !: '' i , �% D �07'�1' � �-� � `�c� �
1', "�m [ !�
43. Backflow Irri�ationk � .; � = �r_ � .� -.�c � ,� , -+ � ,
.- F _ _ � " .� � "
���
�",44. Landscape Iriipation System: �-;:, �x 'r. i*; �? .� �7• �r J �o -� ^�� � J ti o
� ,.o .,�: -c� �'i,r e -� .
�15.;3ound A�teri�ation� �-' �'-' � �K :E ��- r- ��r �". � � •� 'x ti ��
� � '� • K �T1 IT1 <7 }: ! .i - Z • - J % -
.j
,-06. xiandicap;Regulatio�s :� ;j a � � g �,` .j� ,r j!J j K � '`�
I 1. \ '� k
47�.'f INAL STRt7CTURE & BURDING � �,.,� � - "�"� = t •-
_ - V�
48. ��k'INAL PLANNINGp ���,� i: N � �� . Tl : t =� ._ `::c
= -. c F
rA9. .Eleetric Release to Edison i • i � F � �r 1 =� , �', •
i , � r: ,r • � r. �7
�50. �C'ias _i�elease t� Souttiem Califor�ia Gas Co i� � r. '� .Ji ����,,7 i• j . -•
�-, - -. n
51;. CEf{-JIFICA7E OF OCCUPANCY e . '� -;o . + � �
No. Date
o. . _. _ _
OWNER TARANTINO, JOSEPH J. � DATE 8-10-SS� �
JOBADDRESS lyGB 1(>},]1 P],3Ce BUILDINGPERMITNO. ].SZB
G�`�ERALCONTRACTOR Otmer-builder / VALUE $ ZZ�92�.�0
GROUP
INSPECTIONS
Foundation Forms and Grade
� Rough Framing '
Plumbing, Rough to S ab'� W
Plumbing, Rough Complete��
Temoorarv Pole
Heati
Heating, Final
Sewer, House�l
S : Tank or
Le...ina. Inl�
Plumbing, Final, Fixtures Com
Plumbing, Fin.al Gas Test
Wiring, Final
OccupanCy
u�.»�.., oi n r_u unn i_Fs
V ZONE RJ1
DATE I SUBCONTRACTOR
ngle residence
= DISTRICT #1(�lO
PERMITSISSUED
DATE I NUMBER
c�4 , � , /// ' Ci�2a.,� T �� `S f .� 7 �n —
- ,� ..�,...- �- a - ss _�a
. .. —
. MtJ"� rl/ 6-1 �J 1 "�- .Z ^
� ' .- —� /% r .
i —
5' lL1j� � ' la..
`' � - �9/ - A
JUL � i �G?�% fi/9�•e �� �Za�c
���c�
,rCosta Mesa Bttilding. D�partment
` , 171 EAST'�Qfh STREET__
�� . • COSTA MESA� CALI�RNIA
FOR APPLICANT TO FILL IN
s��m'a � ry
Address ';/ � �...- C.� -
; COSi� M0S&� Cfl�IIfOTT118, •
Nearest
Cross St. /.,T 0 F •
owner fCJ'Er�f� •,T• TR,C� A�1'TI
nddress �"01 �� I�LI� � D l�- Il �.
_ _ ._ Tel. 1' —
.X�
Se/ G(2c..H`-�D
tion � No. �C./ I BI�
Metes and Bounds)
� No. of Bldgs .
Size of Lot ���( ,� (1 � Now on Lot�,
Useof No.of No.of
E*�stin`_a__e_Bldn-�I Familles � I RoOms
Setback Line from r^ � Rear Vard
Center of Street J � Side Vard ��r�
No. of
Exterior
add�tion
Stories
PLICATION FOR PERMIT
40 BUILDiNG '�
FOR OFFICE USE ONLY
Receipt No. Permit No.
%�z�
Received by D�te Rec'd� ��� Sed _
f✓..Si
O S =�
Building
Address
Costa Mesa, California
Nearest
Cross St.
Zone/ `/ No. of Type Group �+
7`" I Plans )/ L
Frame: F
Brecini
I hereby acknowledge triat I have read this Application
and state that the above is correct and agree to comply Lath. Int.
with all City Ordinances�and State Laws regulating
building constru�/ction. Lath. Ex1
Signatureof /�� ���s�w
Permittee /7 ( SLc.� � plaster. I
Valwation
$ /oZ, i�o
�
AM 20h S-SP 2M 6-55
Permit Fee $
Plan Check $
Total
APPROVALS
�n Location I Inspecto
Materlals, �^
�inning �
ro Stops, �
VI
Plaster, Ext
0• � � Masonry Reinioroed
J � n
Bond Beam
_— o O
w
�
N
PR
O
9
�
z
a
r
&how location and distances from
properly Iine and 6etween buildings,
�:: . . . . . . .
u