HomeMy WebLinkAbout460 16TH ST - Building Permits�
(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.�h►�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 460 E 16TH ST
Suite:
Vicinity:
Primary Occ: R3 Dwellingsl Cong Res <10 Type of Constmdion: V-N
Parcel Number: 42515102 Zoning:
App�icant: TERRY LIVINGSTONE
Address:
owner: BORAGNO, TOM AND CATHY
Addregs 460 E 16TH ST
COSTA MESA, CA
Contrector: NEWPORT ROOFING INC
Address: 177 RIVERSIDE AV
Arth :
Address:
Zip:
NEWPORTBEACH,CA
Zip: 92663
Phone:
License:
Phone:
Zip:
Phone: 949-574-'1999
Zip: 926273266
Phone: (949)645-0104
License: 524454
Eng:
Address:
SCOPE OF PERMIT
T/OFF AND R�ROOF 2500SF RESIDENCE W/COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00
Permit: $167.25
SMIP Res: $0.90
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Stalus: ISSUED
Applied: 10R4Y2005
Issued: 10/24/2005
ISSUEDBY: ✓�T
Phone:
License:
Calc Valuation: $s,000.00
Claim Valuation: S9,000.00
Total: $168.15
PLANNING & ZONING
SETBACK$
MAIN STRUCTURE Front 0. 0 Rear 0- 0 Lek 0- 0 Right 0- 0
ACCESSORY Front 0- 0 Rear 0- 0 Left 0- 0 . � Right 0- 0
PARKING Existina: o Reauired: 0 Pr000sed: 0 .
��1�P
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, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
for a period of 180 tlays.
INSPECTIONS: In order for ihe work authonzed under this permit to be consideretl legal, such work must comply with all appficable coHes, and atl
required Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
I FOR INSPECTIONS CALL• (714) 7545626
244&6818�00)
.
WORKERS' COMPENSATION DECLAqATION;
I hereby ettirtn under penelry of perjury one ot thb tollowing tleclarations:
�I have entl will meintain e certificata of consent to self-Insure for workers' compensetlon, as provitletl for by section 3700 of tha Labor Code, tor tha performance of the
work tor whic� thi5 pertnli is IssueC.
❑ I have entl will maintain workers' compensat� ��surance, es required by section 3700 0l Ne La6or Code, for ihe pertortnance ot the work tor which Ihis pertnit is issued.
My workers' mpensatlon Insuren cartier antl policy number ere:
Certier: � Ti i � Poliry Num�er:
(!h/s section need no�pemuf is value0 et one hundred dollers ($700J or less.)
❑ I certify ihat in the peAortnance oF the work br which t�is permit is issued, I shall not employ any person in any manner so es to �ecome subject to the workers'
compenselion lews of Celifomla, end ae Ihat It I should become subjecl Io the workers' compensatlon provisions of Secllon 3700 ot the Labor Cotle, I shell torthwilh
comply with these provisions.
� Applicant Signature: ��%% ��� � Date: �0/2 y��
WARNINO: FAILURE TO SECORE K COMPENSATION COVERAGE IS UNLAWFUL AND MALL SUflIECT AN EMPLOVER TO CR IMI�NAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRE
T}IOUSAND DqlARE (E100,000), IN ADDRION TO7HE �ST OF COMPENSATIIXJ, OAMNGES AS PPOVIDED FOR IN SECTION 3�O60F THE LABOfl CODE, INTEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I I hereby eHirtn ihet I em Ilcensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl P ofessions Code, and my license is in tull/
torce and eMect. LIc. N Class a G'- 3 9
� Contrector's SignaWre: �%� � Data: /CJ/Z bL(,1 �
�
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby ettirm Ihet thera is e construction IBnding egency tor Ihe peAormance of the work for which ihis Dermit is issued. (Sec. 3097, Civil Code). �
Lenders Nema: Lender's Address: �
Signature: Dete:
OWNER-BUILDER DECLARATONS:
I hereby eHlrm �het under penelry of perlury that I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW lor tha following reason (Sec. 7031.5, eusiness antl Professlons
Code: Any ciry or county which requires e permii �o conslrucL elter, improve, aemolish, or repeir any strucWre, pdor to its issuance, also requlres ihe appliwnt for such permit
ro tile a signed statement ihat ha or she Is Iicensatl pursuant to the pmNsions of the Contracmrs Licensa Lew (Chepter 9(commencing with Sactlon 7000) of Division 3 of the
Business end Prafesslans Cada) or Ihet ha or slre is exempt therefrom end tha besis for the elleged exemption. Any violetlon ol Section 7031.5 by eny eppliwnt for a permit
subjects the epplicent lo a civil penelty of not more than tive �untlretl tlollars ($500)J:
❑ I, es owner oi the property, or my employees wilh weges es their sole compensatlon, WILL DO 7HE WORK, and the sWCWre is not intended or oHeretl tor sale (Sec.
7044, Business end Profeulons Cotle: The Can�ractors License Law does not apply �o an owner oi properry who builds or improves thereon, and who does such work
himselt or herselt or through his or �er own employees, pmvided ihai such improvements ere not Imendetl or oNeretl for sale. If, however, t�e building or improvement is
sold wilhin one yeer of completion, Ihe ownerbuiltler will heve the burden ot pmving that he or she did not build or improve tor purpose ot sale.�. �
❑ I, as awner ot t�e property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct l�e pro�act (Sec. 7044, Business antl Prolessions
Code: The conirecrors Llcense Lew tloes not appty to an owner oi pmperty who builds or improves thereon, entl who contrecls lar such project wit� a wn[ractor(s)
license pursuant to the Contracbrs License �ws.).
❑ I am exempt under sec.
Signature:
Busin85s and Professions Code for �his reason:
Ownar ID venlied by drivefs license. ❑ Ves ❑ No Dnvefs License No.
Vedtication ol Ownership by (type ol documen6 i e. - property ta�c bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CEAT�FICATION:
Date:
Expires:
❑ I heraby certify ihat no ezcavetion five (5) of more feet in tlepth into which a person is required to descend, will be metle in connection with work authonzed hy this
permi�, antl that no building siructura, scattolding, falsework, or demolition or tlismantling ihereof, will be more ihan ihlrry-six (3fi) feet high. (Chap. 3.2, Grp 2, An 2, Sec.
341, Tltle B, Calilarnia Atlministrative Cotle).
❑ As ownerbuilder, I will not employ enyone to do work which would require e permit trom the Division of Indusiriel Sefery, as noted ebove, unless such person has e
pertnit to do such work from the division.
Signeture: Dete:
Division of Industnal Satery Partnit Number:
CERTIFICATE OF COMPLIANCE ANU AUTHORI7-A710N OF ENTAY: I certiry under penalty of perjury ihat I heve reatl this epplication antl stete that the information given is
wrrect I egrea to comply wlth ell state laws and �iry ordinances relating to builtling consiruction, and euthonze represamatives ol the Ciry ol Costa Mesa to enter upon ihe
ebove-descnbed property tor inspection purpases� I agree not to occupy or allow occupancy of eny building authonzed by Ihis permit until final inspec�ion.
CODE �. INSVECTIONTYPE
1616 Fixetl System Final Fire Prevention
7268
200
201
202
203
Pool Spa Final
Finel Re-Rool
Final BIocWReteining Wall
Final Padory Flre Place
Flnal Sign
204 Finel DBmolltion
2i� INmIpLS
'�
��/ //�
LODEt INSFECTIONTYPE
206 Finel Mechanical
20B
210
212
220
Finel Plumbing
Final Electdcal
Finel Fire Preventlon
Final Planning Approval
222 Final Si�e
250 FinalBuilding/Occupenry
��
�—
r �
(714) 754-5273 • Fax (714) 754-4856 • www.c�.costa-mesa. BUILDING PERMIT n FAIR ORIVE, COSTA MESA, CA 92626
Job Address: 460 E 16TH ST
Suite:
Vicinity: REAR OF PROPERTY
Primary Occ: R-3 Dwellings/ Cong Res <10 Type o( Construction: V-N
Parcel Number: 42515102 Zoning:
Appiicant: BORAGNO, TOM
Address: 460 E 76TH ST
COSTA MESA, CA
owner: BORAGNO, TOM AND CATHY
Address 460 E 76TH ST
COSTA MESA, CA
Contracror. OW N E R-BU I LDE R
AAtlress:
Zip:
Arch :
Address: � �
� . � . Phone:
�Phoner-.949-514-1999
. Zip: 926273266
�.:.Phone: 949-514-1999
- Zip: 92627-3266
Phone:
License: 000000
Eng:
Address:
ISSUED BY:
Sfatus: ISSUED
Applied: 04/20/2005
Issued: 07/26/2005
Phone:
Zip: License: � License:
SCOPE OF PERMIT
ADD 354 S.F. TO EXISTING S.F.Dt'WORK TO INCLUDE: ADD A NEW BEDROOM AND�BATH TO REAR OF EXISTING S;F.D. ,
�- .. . � . , _ � � . � , ..
CONVERT EXISTING 2 BEDROOM; 2 BATH S.F.D. TO A 3 BEDROOM; 3 BATH�S.F�.D.� �
PtANNING: -- � -
LOTSIZE=6,OOOS�.FT. ... .. - . .. .." . �
RESIDENCE & GARAGE = 1,784 SQ.FT. �
DRNEWAY = 210 SQ.FT. -
LOT COVERAGE = 1,994 SQ.FT. (33%) . -
OPEN SPACE = 4,006 SQ.FT. (67%)
REAR YARD COVERAGE = 220 S�.FT. (15%). , .
Plan Check:
Permit:
SR41P Res:
SMIP Com:
Olher:
Inspection:
5307.16
5472.55
$327
` $0.00
$0.00
�0.00
Total: $782.98 -
C81C V81U8ti0f1: $32,709.60
Claim Valuation: S25,000.00
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, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned
tor a period of 180 tlays.
INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiralion ol this permit.
FOR INSPECTIONS CALL: (714) 754-5626
/
244fi-48 (fib0)
WORKERS'COMPENSAnON DECLARArON:
I �ereby affirm under penalry of perjury one of the following declarations:
❑ I heve entl wlll maintein a certificete of consent to sell�lnsure for workers' compensation, es providetl for by section 3700 of the Lebor Cotle, for the pertormence of the
work for whlch this permit Is issued.
❑ I have end wlll malntain woAcers' compensation insurence, fls requiretl by sectlon 3700 of the Lebor Code, for ihe peAortnanca oi ihe work tor which Ihis pertnit Is I5sue0.
My workers' compensatlon Insurence carrier entl policy num6er era:
Certier: Policy Number:
(Th/s secNon naed nof be comp/eted i/ Ihe permit is ve/ued ef one hundred dallers ($100) or /ess.)
]a'� I certify Ihet in the pertortnance ol tha work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to the workers'
� compensatlon laws of Celifomla, end egree that if I should become subject b Ihe workers' compensalion proNsions of Secllon 370� �e Lebor Code, I ahelllorthwith
comply with ihese rovisi,p ons. ,,. �� � 6
ApPlicam'Slgneture: �_ ���% ��� /�sYr— �:> 7 GJ'
WAqNING: FAILURE TO SECURE WORKENS' COMPENSNTION WVEMGE IS I1N FUl rW0 SHALL SUBIECf !W EMPLOYER TO CRIMINAL PENPLTIES AND CML FlNES UP TO ONE HUNDRE�
TKKISAN� DOLLAHE (5100,000), IN ADDfTIdJ TO iME COST OF COMPENSAiION, DAM4GES AS PROVIDED FOR IN SEGTIXJ 31O80F THE L4BOF COUE, IMEREST, AND ATTORNENS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihet I em licensad under pravisions of C�epter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Cotle, and my license is in tull
lorce end eMect. LJc. a Class N
CoNrecrors Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eNirtn t�at there is a construction lentling agency tor the pertormance of �he work for which Ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lenders Name: Lender's AdAress:
Signatura: Date:
OWNER-BUILDER DECLARATONS:
I hereby aAirm t�e� untler penalry of perjury ihat I am E%EMPT FROM THE CON7RACTORS LICENSE LAW lor the lollowinq reason (Sec. 7031.5, Business entl Professions
Cotle: Any city or county which reQuires a pertnil to construct, alter, improve, demolish, or repair eny strucWre, pdor to its issuance, elso requires Me epplicant br such permi�
to file e signed stetement that he or she is licensed pursuent to ihe provisions oi the Contractors License Law (Chapter 9(commendng with Sectlon 7000) of DlWslon 3 of tha
Busineu and Professions Code) or Ihet he or she is exempl thereFrom and the basis for the elleged exemption. Any violation oi Sectlon 7031.5 by any epplicant for a permit
�sub'ects the epplicent to a civil penalry ol no� more than tive hundred dollars (5500).):
) I, es owner oi �he properry, or my employees wl�h wages es their sole wmpensation, WILL DO THE WORK, and Ihe swcture Is nol IntentleC or otteretl for sale (Sec.
� 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner oi properry who �ullds or improves thereon, antl w�o tloes such work
himself ar herseH or through his or her own employaes, pmvitled that such improvements ere not intended or ottereA tor sale. N, however, ihe bulitling or Improvement Is
sold within one yeer oi rqmpletion, the owneo-builder will have the burden of pmving that he or she did not build or improve for purpose of sele.�. '
❑ I, es owner oi the properry, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construcl lhe project (Sec. 7044, Business end Protessions
Code: The contracbrs License Lew tloes no� apply to an owner of property who huilds or impmves thereon, and who contrects tor such pmjec� wl�h e contrecior(s)
licensa pursuant to tha Contrectore License Lews.).
❑ I�exemp}�xidar sec. � i� Business and Professions Code for this reason:
'OwneclD�vediled by tlrivers license. y� Yes � � No Ortver's Licensa�No.-..� �%�'
Verification of Ownership 6y (rype ot tlo0�iment, i.e. - pmperty tax biil or deed): �—
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION:
❑ I hereby cenily thet no exwvetlon five (5) or more faet in depih into which a person is required to descentl, will Ce made in connection with work euthonzed by Ihis
permit, entl ihat no building structure, scaHolding, talsework, or tlemolition or dismanNing thereoi, will be more than thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tltle e, Celifomia Adminisiretive Code).
❑ As owner�bullder, I will not employ enyone to do work which would require a pertni� irom Ihe Division of IndusVial Sefery, as nofetl ebove, unless suc� person has e
pertnit to do such work from the tlivision.
Signamre: Date:
Division of Indusinel Safery Permit Number:
CER7IFlCATE OF COMPLIANCE AND AIITHORIZA710N OF ENTRY: I certity under penalry ot perjury that I have read this application end stata Ihet the inlortnation given is
correct. I agree to comply with ell state lews antl ciry ordinances relating to building construction, an0 authonze representatives of the Ciry ot Costa Mesa to enter upon tha
ebove-describe�pr�j fyosqeciion pu es. I agree not to acupy or allow occupancy of eny building authorized by Ihis pertnit�til 'nel��ction.
� �
SfgnaNre Of L Ovineqs)_ � / De a
Antl/Or Authorized Applicant
COOE �. INSPECTIONTYPE Qa¢, IMRI�LS
1616 Firetl System Final Fire Prevention
1266
200
201
202
203
Pool Spe Final
Final Re-Root
Final BIacWRetainin9 Well
Final Factory Fire Place
Final Sign
204 Final Demolitian
CpDE� INSPECTIONTYPE
206 Final Mec�anical
208 Final Plumbing
210 Final Eledncal
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
2 Lt•oS
.nu- _
(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa��TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
460 E 16TH ST
ADDITION
Parcel Nunmber: 42515102
Applicant: BORAGNO, TOM AND CATHY
Address: 460 E 16TH ST
Owner:
Address
Phone: 949-514-1999
COSTA MESA, CA ,,,Zip , � � 92627�3266
. a' _ " _ ' �_,�z_
. _ - _ _. `r ., .
BORAGNO, TOM AND CATHY
460 E 16TH ST � . . -
Phone: 949-514-1999. _��i�=::.- �..
_.Zip ': r=�92627•3266.. -r--�- -
�.
COSTA MESA, CA, � ^
� -
Contrector ' OWNER-BUILDER''
Address:-� �
� Y-
-
-.'>
Phone:
Zip: r_
License: 000000
�
" SCOPE OF PI
-� ELECTRICAL PERMIT TO ADD 354 S.F. TO EXISTWG
" '�BEDROOM�AND�BATH�TO REAR OF EXISTING S.F.D.
Status: ISSUED
Applied:� 08/18/2005
Issued: 08/18/2005
ISSUED BY: �--�
2K TO INCCUDE:-ADD A NEW�,p�'v-.
REF#605 00649� � ��
- _ .� � ����. n, k. �„_ _r
v�� -
_^ ' WORK TO INCLUDE 9 LIGHTING'FIXTS, 9 RECEPT OUTLETS AND 11 SWITCHES .,�� -
� � - . �...E. . � . . .. � � ` 3 . .
ISSUE FEE
Temp service test
Res. a/c package
New Res (t-2 units) .
New Res (3+units),
Pool / Spa
Lighting Fizls.�,-
ReceptOutlets �� "
Switches
Non Res Appl � � ;,
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motore to 10hp
Motors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
a
;� <, :. FEE SUMMARY
' Quantity` - . _ - _: , "" --Quan6ty r,
s: �
;; � $23.50 - - � . �'� � � : Ternp Dis� Systerri / Lighting'' � . $0.00 � � 0` .
- _-$0.00'e" �- "- Busway/100"ft - - $0.00 O;,df _
-' $0.00 Standing Section $0.00 0
- ' $0.00 0 Misc Eleciricaf Equipment $0.00 ' 0. - -
��- $0.00� � 0 Transformers-up to 7 kva/kw $0.00 � � 0� - �
' ���;-�.$0.00 � �, .,. 0 ................up to 10 kva/kw $0.00 0 ,,%:.
" ._ .$9.90 '�.. 9 :. � ..:...... .......up to 50 kva/kw $0 00 `. �: a 0 ` .
$9.90��. 9 � � � .up to 100 kva/kw $0.00^:-.'� 0 .
$12`10', 11 -.-�?s ovec,t00kva/kw $0.00�' 0 � -
$0 00��.�� .:.0 - - � � Low�Voltage Equipment,;;�„_ $0:00 0 ,--- .
$0.00 _ � 0 Z Low Volt Wiring_System / Ckt �' �$0.00 0- ,
. , ' �,$0.00 � � -:; 0 - -°'r MisciCondud �,`� ` '.�� � � $0.00= ' 0
;�$0.00 ��0",;- � MiSa Conductor - $OAO � 0 : --
�'�-== � (9enornde) $0.00 " 0 °
� � $0.00 ; 0 ' ; Clrcue � `-
;_ $O.W �a�- 0 - - �Cirws(mechnde�orhghts) - - $O.OD 0 `
:.,-$0.00 . �0-. - - , -0hristmasTreeStand -$0.00 � �-�0
�-.�$0.00 , 0'�•�� . FireworksStand,�-;N�4- -��" $0.00 � 0
�$0'00. �. 0'�-� ���- � ' OtherElectncalFee •._ .$0.00
$0.00 0 `�'� : �b >d -.
$0.00 ��d 0 �. � ., �Jnveshgation Fee . � F��y' "$Oy00
$0.00 0"--��- PlanCheckFee��� � $0.00
$0.00 0 � �_ �•:Reinspechon Fee�����- $0.00
$0.00 0 �� -- . , , __ . .
$0.00 0 TOTAL CALCULATED FEES E55.40
$0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and re ted
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended r ebandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all icable codes, and all
requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will rasult in the axp retion of this parmH.
FOR INSPECTIONS CALL: (714) 7545626
cwoco �aw�
WORKERS' COMPENSA770N DECLARATION:
I hereby efllrtn undar penalry of perjury one of the following tleclarations:
❑ I heve end will maintein a cenificate of consent to self-Insure for warkers' compensetlon, es provitled for by section 3700 of Ihe Labor Cotle, �or ihe pertortnenca of ihe
woAc for which �his pe��t is issuetl.
❑ I have entl wlll meinWi� warkers' compensetlan insurance, as required by section 3700 oi the Lebor Cade, for Ne parfortnance of the work far which Ihis pertnl� Is Issued.
My workers' compensatlon Insurence carrier end policy number are:
Certier. Policy Number:
(This secHon neetl not be comp/efed i! the perm/f!s velued at one hundred dollars ($100) or less.)
❑ I certity thet in the peAortnance of the work for which this partnit is issued, I shall not employ eny person in any menner so a5 to become subjec[ to ihB workers'
compensatbn lews of Calttomia, arW egree t�at tl I should become subject to the wwkere' canpensation provisions of Sedton 3700 W the Labor Code, I sheit iorlhwitl�
comply wlth these pro�isions.
Applicent SigneWre: Dete:
WARNINO: FAILURE TO SECUqE WORKERS' COMPENSFTIdJ COVERAGE IS UNLAWFUL AND SHA�L SUBJECr AN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSANO OOLLARE (5700,000)� IN ADDITION TO THE CAST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3/05 OF THE LABOq CODE, INTEREST, AND ATfOFNEV'S FEES.
LICENSED CONTRACTOHS DECUIRATION:
I hereby eHirm �het I em licensetl untler provlsions of Chapter 9(crommencinq with Sectlon 7000) of Division 3 of the Business entl Professions Code, and my Ilcense is In full
force end eflect. Lic. q qass M
Contractofs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm that th�re is a construction lantling egency for ihe performance ot Ihe work for which ihis pertnit is issuad. (Sec. 3097, Civil Code).
LendaYs Neme: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby etFirtn thet under pBnalry of perjury ihat I em E%EMPT FHOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry wh�ch requires e pertnit to constnict, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the eDP���ent tor such permit
to tlle e signed statement that he or she Is Ilcensed pursuant to the provisions of the Cantrectors License Law (Chapter 9(commancing with Section 7000) of Dlvision 3 oi the
Business entl Profession5 Cade) or ihet he or she is exempt thare�rom and Ihe besis for the allegetl e:emption. Any violetlon of Sedlon 7031.5 Dy any epplicanl for e pertnit
subjecis ihe epplicant to a civil panalry of not more then tive huntlretl dollars ($500).):
❑ I, es owner of Ihe properry, or my employees with weges as iheir sole compensatlon, WILL DO TME WORK, and Iha struc�ure is not intended or oHered for sele (Sec.
7044, Businass and Plofessions CoOe: The Coniractors License Law tloes not apply to an owner of property who builds or improves theraon, and who does such work
�Imself or herself or th�ough his or her own employees, provided ihet such improvements ere not intended or otteretl for sale. N, however, the 6uiltling or improvement is
sold within aie year ot �mpletion, the ownerbuilder will have the burden ot proving that he w she did not build or improve for purposa M sale.). •
�, as owner of iha praperty, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, eusiness end Professions
� Cotle: The contredors License Lew does not eppy to en owner oi propeny who bulltls or impmves thereon, end who contracis tor such pmject with e contractor(s)
Iicense pursuent to th9 Coniractors License Lews.).
Business and Professions Code for ihis reason:
Owner ID vedfletl by dnver9liceb5e. ��Yes ❑ No �
Veriflcetlon of Ownerehip by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION:
❑ I hereby certity ihat na excevetion five (5) or more Feet in depih into which e person Is required ta descend, will be mede In connaction with work euthorized by ihis
permit, and Ihat no bui�ding structura, scaflolding, falsework, or tlemolition or dismamling t�ereof, will 6e more �hen Ihirry-sis (36) feet high. (Ghap. 32, Gry 2, Art 2, Sec.
341, Ttle 8, Califomia Administrelive Coda).
❑ As owner-Dulltler, I will not employ enyone to do work which woultl require e permit irom ihe Division ot IndusMel Sefery, es noted ebove, unless such person hes e
permit to do such worN from the division,
Signeture: Dale:
Division ot Industnal Safey Pertnit Number:
CERTIFlCATE Of COMPLIANCE AND AllT}10RVATON OF EMRY: I certify under penalry of parjury ihat I have read this application antl state that the intormetion given is
correct. I agree to comply with all stete lews and dry ordinances relating to builtling construction, and authonze representativesr� pof Ihe Ciry ot Casta Mesa to enter upon the
above-d_ escribed property for inspe ion puryase5. ree not to occupy or allow occupancy ot any building authonzed by this pe it un 1 f�al inspection.
�_'C%��L!/J p✓/� (JJ
GSIgnaNreOftegeP er(sy Date r-.
_ --,.:
AndiOr Authodzed ApPlicant Date
CODE t. INSPECTIONTYPE
1816 Fiaetl System Pinal Fire Prevention
1288 Pool Spe Final
200 Final Re-Roof
201 Final BIxWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 . Final Demolition
Q�f IN Ip QJ(yg1 INSYECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Eleciricel
212 Final Fire Preventlon
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupency
�l�+ �$
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
JobAddress: 460 E 16TH ST
Suite No
Vicinity:
Parcel Number: 42515102
Applicant: BORAGNO, TOM
Address: 460 E 16TH ST -'
COSTA MESA, CA-- " � -'
MECHANICAL PERMIT
Phone: 949-574-1999
Zip: � 92627-3266 , �..
ISSUED BY:
Owner. BORAGNO, TOM AND CATHY
Address: �' 460-E 16TH ST - - � �
. - �� . � - Phone: 949-514-1999 -
- COSTA MESA, CA � Zip: 926273266
Contracroc OWNER-BUILDER
Address: .;� � ..
. . .: . .. Phone: - � '
Zip:
� License: 000000
REF 805-00649 354 SF ADDITION. 1 ALT
Status: ISSUED
Applied: 10/27/2005
Issued: t0127/2005
, FEE SUMMARY
� . � - - ���Quantity_ - duanlity
ISSUE FEE � $23.50 � �- - . Repair /AIt Absorbtion Unit $0.00 0
Inst FAU <100 k BTU ' - $0.00 0. �- , Repair / Alt Re(rigeretion Unit - $0.00 0
Inst��FAU >100 k BTU . . $0.00 �� 0 _ � .. Ventillation System � _ � , $0.00 0
Repair/Alt Cooling/Heat � � $13�70 1 EvaporativeCooler , $0.00 0
InsP! Rep. Recess Wall HU - $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys <700 k BTU $0.00 0 . Domestic Incineralor $0.00 0
Refrig Sys >100 k BTU $0:00 0. Comoressors / Absomtion Svstems
Gas Piping $0:00 ' 0 � .. Up to 3 hp / 100 k BTU - �, $0.00 0
Factory Fireplace ��� .-- �� �� $0.00 0 3 To 15 hp / 500 k BTU � � $0.00 0
Hood wlMech Ezhaust � $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0
VAV Box .� 50.00 0 30 To 50 hp / 1,750 k BTU $0.00 0
Vent Fan / Single Duct .. $0.00 0 Over 50 hp / Over 1,750 BTU � $0.00 0
Appliance „ �$0.00 0 . Boilers
Fire Dampers -" .. �$0.00 0 -�` Up l0 3 hp -- $0.00 0
Smoke Dampers �$0.00 0 - 3 To 15 hp $0.00 0
Ins� or Relocate Appl Vent • $0.00 0 � �� 15 to 30 hp $0.00 0
Air Handlers < t0000cfm $0.00 0 30 to 50 hp . $0.00 0
AirHandlers>.10000cfm $0�.00� 0 � � � -Over50�hp ,:_. �� - $0.00 0
Floor Furnace -� � � $0.00 0 "" - � - � � � � Olher Mechanical Fee " . ` '
Floor or Suspend Heater � �$0.00 � 0 -- Irnestig2tion Fee . $0.00
� ' . ... Plan Check Fee - $0.00
� ' � - - � � ReinspeIXion'Fee 50.00
' . ` � - -' " " TOTAL CALCULATED FEES - 537.20
COMMENTS / SPECIAL CONDITIONS
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirer
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180
for a period of 180 days.
INSPECTIONS: In ordar for the work authorized under this permit to be considerad'lepal,-such�work��
requlred Inapectiona entl Bnal approval must be obtained. FaiWre to obtain Inspections and final�approval
FOR INSPECTIONS CALL: (714) 7545626 �� �
zanere (aroo) f" t,
r''
Califomia statutes and related
or if work Is suspended or abandoned
st comply with all applicable codes, and all
will result in the expiration of this permit.
WORKERS'COMPENSATION DECLARAnON: � �
I hereby ettirm untler penelty of perjury one oi ihe tollowinq declarations: " ' � �
❑ I heve entl will maintein a cenificate of consem b selFlnsure br workere' compensatlon, es provided for �y sectlon 3700 of Ihe Lebor Cotle, for ihe pedortnence of the
wark tor wNCh this pertnit is issued.
❑ I �ave enG will maintain workers' compensetion insurance, as required by section 3700 of Ihe LeGor Code, for Ihe pertoimance ol t�e work for which Nis pertnit is Issued.
My warkers' compensalion Insurence carrier end policy number ere:
Cerrier: Policy Number:
(This secf/on need not be complefed!l fhe permit is velued ef one huntlretl dollars ($100) or less.)
❑ I certity thet in t�e peAortnance ol Ihe work for w�ich this pertnit is issued, I shall not employ eny person in eny menner so es to becoma suD�ed to [he workers'
compensation laws of Calitomia, entl egree thet II I shoultl become sub�ect to the workers' compensation provislons of Section 3700 of the Lebor Cotle, I shell fort�with
wmply with these Orovisions.
Applicant Siqneture: Da1e:
WARNINp: FAILURE TO SECURE WORKERS' CO�dPENSATIdJ CAVEPAGE IS UNUWFUL AND SHALL SUBIECT rW EMPLOVER TO CPIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNORED
THOUSAND OOLIARE �5100,000), IN ADDITION TO TME CO^uT OF CqMPENSATIIXJ, DPMAGES AS PHOVIDED FOq IN SECTION 31O80F THE UBOR CODE, INfEREST, AND ATTOqNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettlrm Ihat I am Ilcensed under provisions ot Chepter 9(commencing with Sectlon 7000) of Division 3 ot the Business entl Professions Code, end my license Is In full
forca antl eNect. Lic. e Class q
Contrector'S Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I �ereby ettirtn Ihat there is a consiruction landing egency for the Dertormance of I�e work tor which this permit is issuetl. (Sec. 3097, Civil Code).
Lenders Neme: Lendefs Atltlress:
Signature: Da�e:
OWNER-BUILDER DECLARATIONS:
I hereby eHlrtn Ihat untler penalry of perjury that I flm E%EMPT FROM THE CON7RAC70RS LICENSE LAW tor ihe lallowing reason (Sec. 7031.5, Buslness entl Professlons
Cotle: Any ciry or county w�ic� requires e permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, elso requires the epplican� lor such pertNt
to file e signetl stetement �het he or she Is Ilcensetl pursuant to the pmWslons of the Comrecrors lJcense Law (Chepter 9(commencing with Sectlon 7000) oi DlNslon 3 of the
Business entl Professlons Gotle) or thet he or she is exempt Iherefrom and Ihe besls lor Ihe allege0 exemption. Any violetion ol Section 7031.5 by any applicant tor a pertnit
subjects Ihe epplicant to a civil penalry oi not morP then flva hunAretl tlollars ($500).):
� I, es owner ol the properry, or my employees wlih weges as their sole compen5etion, WILL DO THE WORK, end the structure is not intendetl or ottered for sale (Sec.
7044, Busineu antl Professions Coda: The Contractors Licensa Law does not eDPly to an owner of properry who builds or improves ihereon, anU who does such work
hlmseN ar herself or through his or her own employees, provided that such improvements are not Imendetl or ottered for sale. II, however, the building or Impmvement is
sold within one year ot completion, the owne�-builder will have�e hurden of proving Ihat he or she did not builtl or impmve for puryose of sale.). '
❑ 1, a5 owner of Ihe propeRy, am EXCLUSIVE�Y,�CONTRAQlSNG WITH LICENSED CONTRACTORS to con5iruct Iha project (SeC. 7046, Business and Prolession5
�Code: The contrectors Lice(�se Lew do§�riot;9pply to a�Owr�ei�ol property w�a bullAs or Improves Ihereon, and who contracts lor such project with a contrecmr(5)
veritietl by arlver's lican5e.
Verification at Ownership by (rype oi
entl Professions Code tor this reason:
tarz bill or deed):
DIVISION OF INDUSTHIAL SAFE7Y PERMR C6R71FICATON:
❑ 1 �ereby cetlity ihat no excavation live (5) or more feet in depih into which e person is reqWretl to descend, will �e matle in wnnection with work euthodzed by ihis
pertnil, end that no building sWcture, swflo�ding, telsewoB, or tlemolition or tlismantling thereot, will be more than ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Califomla Admini5trative CoOe).
� As owner-builder, I will not employ enyane to tlo work which woultl requlre e permit irom the Division of Industriel Sefery, es noted above, unless suc� person has a
permit to do such work trom ihe division.
Signature: Date:
Division at Intlusinal Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOHIYAnON OF ENTRY: 1 cenify untler penelry oi perjury that I have read this epplicetion antl state that Ne informetlon given is
conect I egree Io comply with sll state laws end ��ry a�tlinances relating to building construction, and authonze representaWes ol the Ciry ol Costa Mesa to enter upon the
ebov � scnbed pr rty for inspectio rpq es. I a o occupy or ellow occupancy of eny building authorizeC by this permit unC final inspectio .
��� i�a ����
ignaWr egelOw�er(s Date
AnNOr AuthOrizetl Ap��icanl Date
GOOE1, INSPECTIONTVVE
7616 Fixed System Pinal Fire Preventlon
1266
zoo
201
202
203
204
Pool Spa Final
Finel RB-Root
Final Block/Retaining Wall
Finel Fedory Fire Place
Finel Sign
Final Demolition �
. Q�7f, INTRIALS
LO�E� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elecincal
212 Flnel Fire Preventlon
220 Final Planning Appmval �
222 Final Site
250 Final BuiltlingiOccupency
PAg IIi�IdL@
Iz-rz-nr �_
Job Address: 460 E 16TH ST Slatus: ISSUED
Suite No Applied: 08/11/2005
Issued: 08/11/2005
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner.
Address
Contractor.
Address:
MASTER BATHROOM
42515102
BORAGNO, TOM AND CATHY
460 E 16TH ST
COSTA MESA, CA
Phone: 949-514-1999
. Zip: _ 926273266
BOR,4GN0, TOM AND CATHY
460 E 16TH ST . _ "
. . - . Phane:� 949-514-1999"�:�:
COSTA MESA, CA � Zip: 92627-3266
OWNER-BUILDER
Phone:
Zip:
. License: 000000' �
ISSUED BY: � : /
SCOPE OF PERMIT
PLUMBING PERMIT TO ADD 354 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD A NEW �
. BEDROOM AND BATH TO REAR OF EXISTING S.F.D.
REF #BOS-00649
'� WORK TO INCLUDE: 1 GAS (1-4 OUTLETS), 1� LAUNDRY TUBNJAHSER, 1 SHOWER, 1 WASH BASIN
SET AND 1 WATER CLOSET. -�
� FEE SUMMARY "
.. � .. .� ��.AMT QTY " . � . - -^ . ,.. .AMT : �QTY. . , . .. � AMT�. aTY
ISSUE FEE . $23.50 Laundry Tub / Washer $9.80 1 Sump Pump - $0.00 0
BackFlow irtigation 30.00 0 Landscape Irrigation 30.00 0 Swimming Pool $0.00 0
Backflow Preventer , $0.00 0 P-Trap $0.00� 0 Trap Primer $0.00 0
Bathtub �� . , $0.00 0� Pressure Regulator $0.00 0 Urinal � $0.00 0
Clarifer System � � $0.00 0 Process Piping�(per 10 ft) $0.00 0 Vacuum Brkr Bk(low(t-4) $0.00 0
Connect pce,Soda,etc) 50.00 0 Receptors �$0.00 0 Vacuum Brkr BkOow(5+) $0.00 0
Denfal UniLs -- 50.00 0 Septic Tank : $0.00� �. 0 Wash Basin 50.00 0
Dishwasher $0.00 0 .� � Sewer Cap for Demo . 50.00 �. � 0 , � �' Wash Basin Set 59.80 1
Drein, Floor � $0.00 � 0� , � Sewer Connect � � ' � � $0.00 0 ' � Waste and Vent System $0.00 0
Drain, Rainwater , $0.00 0� - Sewer Pnvate Line �'$0.00 ��0 Water Closet (Toilet) $0.00 0
Drain, Roof $0.00 0 Shower 59.80 ' 1 Water Heater / venl $12.30 1
Drinking Founfain $0.00 0� Sink, bar � $0.00 0 Water Pipinq (Insl or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial '. 50.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0� Sink, Floor � � '- $0.00 0 Water Service $0.00 0
Gas (1-4 outlets) $6.15 � 1 ' Sink, kitchen . -$0.00�- `--�0 � � - Water Softener $0.00 0
Gas (Over 4 outleLs) $0.00 0. Sink, service/mop - .30.00� � 0 OTHER $0.00
Gas Repipe $0.00 0 Spa (private) 50.00 0 VIOLATION $0.00
Gas Service $0.00 0 � - Spa (public) � � 50.00 -0 , PLAN CHECK $0.00
Interceptors (Grease, Oiq $0.00 0 � , . , _ � REINSPECTION 30.00 0
Interceptors (Santl Auto ) $0.00 0 � .- . � . - �
TOTAL CALCULATED FEES: 571.35
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abe
tor a period of 180 days. ��
INSPECTIONS: In order for the work authorized under ihis Dermit to be consitlered legal, such work must comply with all applicablelcodes, and all
required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration� lhis permit.
FOR INSPECTIONS CALL: (714) 7545626
244&68 (8/00)
WORKERS'COMPENSAnON DECLARAnON:
I hereby eHirm untler penelry ot perjury one of Ihe following deGarations:
❑ I heve entl will melntein e certiticate ai cansent to self-Insure ior workers�com¢ensation��.s prodded lar by sedlon 3700 of Ihe Lebor Cotle, br the pertormance of the
work tor which this Oermit Is issued. ��
❑ I heva end will mainteln warkers' compensation Insurance, as required by section 3700 oi Ne ..ebor Code, for I�e peAortnance of t�e work for which this pertnit Is issuetl.
My workers' compen5etlon Insurance carrier antl policy number ere:
Carriar: Policy Number:
(/This 7section need not be canp/etetl i/ the pelmit is ve/ued at one hundred dollars ($100) or less.)
9%I'cetlity that in the Dertortnance of the work tor which this pertnit is issued, I shall not employ any person in eny menner so es to become 5ub�ecY ro Ihe workers'
/compensetlon laws oi Celifomle, entl egree ihet II I should beco e subied to the workers' compensation pmvisions ot Sec' n 37 oi Ihe Lebor Catle, I shall forthwit�
�so_m0lywith eseprovisio . C!� � 1 /� /
Applica'nt 9lgnelure. � Q� Date:, �� GO
�'�, - o .
WARNINa�. FAILURE TO SECURE WOflKERS' COMPENSATION COVERAGE NIAWFUL ANO SMALI SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLAFE (E100.000), IN AODITION TO TME COST OF COMPENSATION, OAMAGES AS PROVIOED FOR IN SEGTON 3]OB OF THE LABOF CODE, INTEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION: '�
I hereby altirm that I am Ilcansetl untler provisions of Chapter 9(commencing with Sectlon 7000) of Divislon 3 of the Business end Professions Code, end my license Is in full �
force entl eflecL Lic. a Class M
Contrectofs Signemre: Oete:
CONSTRUCTION LENDING AGENCV:
❑ I hereDy ettirtn that there is a construction lending egency tor the peAortnance of the work for which this pertnit is Issued. (Sec. 3097, Civil CatleJ.
Lenders Name: Lenders AdAress:
Signature: Dai6:
OWNER•BUILDER DECLARATONS:
I hereby eNirm Ihat under penelry at perjury ihat I em EXEMPT FROM THE CONTHACTOFiS LICENSE LAW far Ihe tollowing reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or county which requires e permit to construd. alter, improve, demdish, or repair any structure, prlor lo its Issuance, elso requires the epplicant for such pertnit
to file e signetl stetement t�et he or she Is Iicensed pursuant ta the provisions of the Contrectors Llcense Lew (Chepter 9(commencing with Sectlon 7000) oi Division 3 ot ihe
Business antl Professions Code) or thet he or she i9 exampt therefrOm end the besis for the ellegetl examptlon. Any Woletlan of Section 7031.5 by eny epplicent for e pertnit
su ' c[s�it�e applicant to e civil penalry at not more then five hundred dollers (5500).):
�'�, as owner oi the praperry, or my employees wlih weges as iheir sole compensatlon, WILL DO 7HE WORK, end the strucNre is not intentletl or ofleretl for sale (Sac.
7044, Business end Professions Cotle: Tiie Contrectors License Law dces noi apply to an owner of properry who builds or improves thereon, end who does such work
himself or herselt or through his or her own employees, provided that such improvemenis are not IntenCetl or oflered lor sele. If, howevar, Ihe building or improvement is
sold within one year oi completion, the owner-Cuilder will heve ihe burden of proving ihat he or she did not build or improve for purpase ot sale.). �
❑ I, as owner ot the property, am EXCLUSIVELV CONTRAGTING WITH LICENSEO CON7RACTORS to construct the projact (Sec. 7044, Business antl Pmfessions
Cotle: The conirectOrS Ucense Lew tloes not epply to an owner ot pmparry who builds or Improves thereon, end who conlrecls tor such prolect wit� a wntracmr(s)
license pureuani ro the Cantractors UCanSe LBwS.).
❑ I epi exempt ynger sec.
6y drivers license. ❑ Ves
_ Busine5s and Profes5ion5 Code for Ihis reason:
— —Date:-�--� `-6 ��
No Ddvers Licens `Na,. —��� � �` Ezpires:;, L,
i �-- —
Veniicellon of Owners�ip by (type ol dwumeni, i.e. - property taz hill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certify thet no ezcavetlon Ilve (5) or mora tee� in depih Into which a person is required to descend, wlll be made In connection with work euthonzed by this
permit, end thet no building structure, sw%olding, falsework, or tlemolition or tlismantling ihereot, wlll be more than thirry-six (38) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle B, Californla Atlministretive Catle).
❑ As owner-builder, I will not employ enyone to do work which would requira a permit from Ihe Division ot Industnal Selary, es notatl ebove, unless such person has e
permit to do such work irom ihe tlivision.
Signature: Date:
Division oi Industnal Satery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I certity under penalry of perjury that I have read this epplication and state that ihe information given is
conect I egree to comply with ell slata laws entl ciry ordinances relating ro builtling consiruction, and authodze representatives of the Ciry oi Coste Mesa to enter upon ihe
ebove-describetl property for inspection purposes. I egree not to occupy or allow occupancy of any building authonzed by this permil until final inspection.
CODE I, INSPECTONTYPE PAff. INiIIlALS
7616 Fl:ed System Flnal Fire Prevention
1266
200
207
202
203
204
Pool SDa Finel
Final Re-Root
FIna181ocWReiaining Wall
Final Fectory Fire Pleca
Final Sign
Final Demolition
COOE I INSPECl10NTYYE
206 Flnal MeUanical
20B Final Plumbing
210 Finel ElecMcal
212 Final Fire Preventian
220 Flnal Planning Approval
222 Final5lte
250 Finel Building/Occupancy
o�re It{�.�L4
� L'Z2.-Q} �
�
�
PXOJECT RDOflESS: DOTY DONAL
OWNEH'SNFME: 46O � 16TH
� aoosEss: COSTA MESA,
642-0370
�qPCH/ENGINEEfl:
RDOHE55:
WESTERN COOLING
PENMITTEE: [ Z B S, EAS T ST
aooeess: ANAHEIM
UNIT:
92627
flEG.NO.:
UNIT:
(714)776-1168
CA 92805
LICENSEO LONTBACTOB OECIAMTION: I �ereGy allirm I�al I a ens uneer prwisi n ol Cnapter 9 �cammencing wiln Seaion
7000) ol Di�y� �Qi�tl��usines5 antl Profe�ie�r)C�1� $0 license s fn f an ect.
CITY UC.: STRTE LIC.: S�
Da�e: �, ��� Signamre� -�"
WOBREPS' COMPENSATION oECIABATION: I herep irm that I navea c- icate ol consent �o selbinsure or a cenilicate o arkers'
Compensa�ion Insurance. oi a cer�ilied wpY ��erep( eclion 3800, Ld
POLICY NO.: � E%P. DRT :
COMPFNY:
.0 Cenilietl caOY is Aere6y Iumishe0. ❑ CenilieA coDY is filetl wit� the ciry Builtling Division.
Jale: Applicanl:
E%EMPTION FBOM WOPNEflS' COMPENSPTION OECUNRTION: (TAissection i
I cetliiy I�ai in the petlormance ol Ihe work for which ihis pe�if is i55ued
5u01e�� �o Ae Workers' Compensa�ion laws ol Cali�omia�
Dale: �� «� SignatuJe:
NOTICE: II, aller making this Geclaratiun, you 3houl emme subjei
fAde. you mUs� �otlhwilA [ompty wilh Sut� �wvi - ns or Ihis pern
LONSTflUCTION LENOING RGENCY: I �ert�y (li ItN� Ihere is a rAi
wnic� Ihis Dermil is issu¢G (Seciion 3097, Civ., . .
LENOEfl:
aooaess:
me nuneretl (51001 or lessl.
mannerso aslo Oecome
A'6rkers' ComDenutbn provisions of ihe LaDor
: AeemeU revakeA.
IenGing a0enty tor ��¢ petlorman[¢ olihe vrork br
OWNEN BUILOEN OECLAMTION: I �ert�y aifirm tlWt 1 am exempl irom t�e Cont2ctor5' State License Law for t�e lollowing reasOn
(Settion 70J7.5 Business an0 Pmle55ional COtle: Any cily ot tounly whith requires a Oe�mii �o wnstm[I, ali¢r, imO�Ov¢, aemol6A, or
repair any sirucWre. prior to its issuance. alsa reQuires Ihe applicant for sucn permit ro lile a signe0 statemenl that he/sne Is Iicense0
pursuant io ihe D�avisions ol the Contractors' Stare License Law �Ctupter 9(wmmencing vnt� SecGon 7000) of Oivision 3 al the Busineu
anU Pmlessions Cotle) or Ina� �e/she is erempl ��ereimm antl t�e Easis �or I�e alleAed e�emption. Any viola�ion oi $eclion 7031.5 Dy
any apDlitani tor a permil 5uhle��5 Ihe apDlitani l0 a civil Denalry oi no� more �han live hunOreO O011ars �5500�.
I, as owner ol IAe Dmpehy or my employees wiih wages as Iheir sole compensation, vnll tlo I�e work, and Ihe
❑ structure is not inlen0etl or offeretl for sale (Secuon 704a, Business an0 Prolessional CoOe: The Contractors' Slate Licensa Law
OoeS n01 apply IO an owner ai a pmp¢rly who builtls Or impmves Ihereon, and w�o tloes SUt� work hims¢Ii/hersel� Or ��rouqh
�is or �er own employees, pmvitleU ��at such impwvemenls are noi intende0 or oiferetl lor sale. If, however t�e buildinp or
imDmvemenl is saltl within one year oi complelion, Ihe owner will �ave �he 6ur0en ol Droving �e/s�e tlitl no� �uiltl or improve
tor t�e Durpose al Sale).
I. as owner ol ��e property, am exclusiv¢Iy comraming wiih licensed con�raclors to constmci the prolec� �Seclion 704a, Business
❑ antl Pmle55ion5 Cotle: The Conlradors' Sta�e License Law Ooes no� apply �o an owner oi Ompeny who builOs or imprOv¢S iher¢on
and w�o Contracis lar sucA pmle��s wit� a con�ractor(s) license pursuani Io IAe ConVactars' Siate License Law�. 1 am aware
Ihai prool ol their Worker'S Compen5aiion insurance s�oultl be pmvitled �o me.
� I am exempt unGer Section: B. 8 P. C.
lor Ihis reason'.
Date: Owner.
I ao here�y cenAy Inat I am aware ol ana unaerslanC Ihe reQuiremenls of Califomia Heallh ana Salely COJe Seclions 25505, 25533, anU
25534 and lhat I or any lulure UuilAing acupanl vnIVwAI not (ci¢le One� neeG Io campry wit� 5ai0 s�a�e codu antl Ilre reQuir¢m¢nI5 �or a
p¢rmil �oi conslmc�ian or maailicaiion Imm Ihe Air Oualiry Managemen� US�nci. Fesidenlial conSlmciion apDlica�ions are eKempi Imm
IIICS¢ pfOVISi005.
Oa�e: AOPlicanl:
I hereby ceN�yilul I have reaG I�is ap0��taiion and SIaiE
ortlmances ana stale laws relaling lo DuilUing consimclion
ptoperly lorinspection purposes
�i�
Dale'. /� �Q'��
�
ro comON ��n all city anC counry
to ema upon ine ahove�mentionetl
i6aba6 White—BwlEina'. G�ecn—Co o Enforcemenl: Canarv—Aoolicant: Pink—Revenue: Goltlenmtl—Assxsmr
CITY OF COSTA MESA — BUILDING PERMIT ���
PERMIT NO; EM 058529 PLAN CHECK NO: N GQVT• N SUPP'�
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE MEC PURPOSE: OTH
JOB DESCRIPTION ; INSTALL OUTSIDE A/C UNIT SQ FT;
CLAIM VALUE; CALC—VALUE; GROUP OCC; R-3 /
COMMENTS; ELECTRICAL WORK INCIDENTAL TO A/C UNIT
�r**�e*�r*�e�r+r***�r*�r�r�r�e*r*��r�r�r*�r*�*�r+r*�r�r*r�e�r��***��r***+r*�e�e*�+r�e****�r�r�r*�e�+e*��e**+��e�*�r
Z 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 BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: PT IN RGHT: FT ZN
PARKING REQ• PROV: PARCEL: 42515102 ZNE: REF NO:
PLANNING NtST'ES>
i
*+t�t**�t+r*�r�r«+t*+r�********�t�r*�t�tx*�t*****�e�**�**�r*�r�r�r��r�*�*��r�t�r�r*,e*��r+�*��+r+r��e�r��+��r+t�r
D E V E L O P M E N T S E R,V�I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
� �
HUILDING APPROVED BY : ' DATE;
APPLICATION ISSUED BY; �. DATE:
ifkifkikiEkiFlEiFkifitikfF�fkiFkiFifk iFifiFlfiflFiFlfifjf if
ifk�tifikiFililiFiFifiFkiFltifiFkififiklfiFkifilifitififif3kkkiFikifkifif3filkiEffifkikifkkilififlfkiE�f�fiFkkifikll3flfkif�fiFitififltaEifikM
LEGALI2ATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
� BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7,50 9,00
502 252 SMIP/NON—RES
PLAN
ISSUE FEE 15.00 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 16.50 30.00 0.00 46.50 96.50 .00
REVENUE DIVISION TOTALS--> COLLECTED; 46,50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
22,50 24.00
iF ik N iE if iF iE iE 3F k M if iF �f M iF iF iF if if k iF 1f iF 1F if if 1t if 3f iF i! *if if j! if iF if M ik iF if if if iF ik if if iF IFiF iF 1F i! it 1f if if if �lf k ik if �E ik af 1E �f 1f it if M if if i! if �f 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 S C R I P T I O N UNIT COST TOTAL COST
ELE 1 MOTOR/POWR APPARATUS 1.1 — 10.0 HP 7.50 7,50
HEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9,00 9.00
END OF FEES
ht �Lll�i� "..�,. ' ' , ,
.. � �: � :.. .< . ._ .�..
CONSTRUCTION AND PLANNWG POOL 'A
:.PPROVALS Permit # Date Inspector qppROVALS Permit # Date inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe�Undrgrnd. _ 53. Steei Reinforcement
�;3: Elec,trical Con`�yit Utility-Undrgmd. 54. Forms
��St: Elecrtical Conduii�Undrgrnti. - 55. Electrica� Bonding
" 5- 9teef Reinforce}tt�nt 56. Rough Plumbing & Pretsure Test `�
c
�;6i.�Electrfcal UFEA Gmd. . 57. APPROVAL TO COVER�GUNITE
`'�:_Footings �"- 58. Elearical ConduiFUndrgrnd. •
� 8. `Foundation =, ' 59. Gas P�pe, O Undrgrnd., Test �
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd.
70. Structural floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House ConneMion 62. Backwash & Receptor�Final
72.'Sewer Cap ' 63. Heater & Vent-Final
7 3. Roof Drains _ 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final
75. Rough Electr.ir.al-Conduit 66. Solar System-Final
16. Rough Electiic Wiring 67. Fencing & Access Approval
77. Rough WiringSign 68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Cefling ' 69. POOLlSPA SYSTEMS FINAL
19. Rough Heacing & Air Conditioning FIRE DEPT. REQUIREMENT
- ' ' _ - �. . . ..
20! Rough Factoryf�ireplace =:': �_ "' • * :y APP_FlOVA�S�'� pc�tmit # t�; '.,:_
� .f < �.< <- r�� ,:: [ > >
21: Ducts;-in SF.uct,rGie � ; �'� � �+ � 70:�1n�ergrDund Hydro �
22 DOcts. Yert*+lating . :.,.;. � ; � '� � 71, produ�j�iPing'L�ias �Cl Oil
23, G"a; Pipe•Rdugh'$j Test , r; �- ' � 7Z, Undergrgund Flush , �
24t Rizof Framing �.. � .- '` _ � y z : 73. Undergr�ld. $torage Tank � Gas ❑ 0'tf
25. Rp f Sheathin�� ' '_ •t ' �*7 �z, i;.. . �-� .
P 9, �; . ��; �"' T4. Overhead Hydro
26: T,Bar Ceiling (Siructuraq �&�Monocoat � nl�� - 75. Dry Chemical � ' - Y'
�
27. Frame and FlaSfiing ;; i ` , �� T;. y. 76. Dry Stah27pipe�i ;'� =� �
�� x
28. Lgthing&Sidir�g, , .:1:' r �' ••a.. 7.7. FIXED-SYSTEiVQFINAL �,;n
29. Insula{ion '. - �� , � ' . 79. FIRE PREV. FIfVAL - -�S
30. Drywall Nailing.y ' � b. � �- HEALTH DERT. REQUIREMENT '
� .
� 31. PlasteF$rown Co'at ; �. _ � � i� ; � 7g, FINAL INSPECT,I6N ',- ` � �.-' '
3�i�. Electrical Po`�`iei-INeterFinel � • i� < i• 80-. FOOD CERTIFICA�'E ISSUED r�
�
33 F.FaI Elect;ic � i ' i u�lQZ- � GIEOt ' Notes: �. e� ,��� ,
i
34. �al �-IeatiAg &'Air'Gondi{ionk�g ' . ��//. � G�� it�� ;� � �. - , _ .. 5 '
3"�.�` Final Gas PiPe-Test '� _ ` i � �` - J . -% . _ " _ ��• ' r ± -
-. � ��
3U. H4od:or CanoP9 � ,- � i _�+. x 5. � -• �- t
, 31'. F'inal Factory Firepl2c�e � ^ • '7 � ,� f � � , '
. .. . o � lU � � y ti, .� ' - -
38. Finai Plumbing' ; � .. .. � � � j� .� •;.1 • � .
� 39. Water Service�Final � �� -� � `� .- -�' � -' , . -
i � r �t r ' J
,. � 40. Gas Service�Final ,� ; � � � . _ , � , � . _,
�
i , .
'. 41. Sofar pomesticFinat ': .. .^s � �. ° •`� . +
.�. I i a r. 7• , ! •
42. Backflow Prevent�r � ' � � � ^ v '
� :� t ti�_. 'r'-
43. Backflow �Yrigation � : � � . - �� L�
, � ..
44. Landscape Irriga�ion System�: - •�� - �> - ;; :�,: . : -
" 45. Sound Ati'enua[ion � � - � � � ' ` ' •- - �==
, z+ - •c
� 4�; Handic�p RegulaT�,'ions ; _ '" �� �; ', � '� `, � � � '
47. F. NAL STRUCTURE & BUILDING � ����� � ' �u ' •
t . _
48. FINAL PLANNIf�G � ; � � {� � ,,. F. �.. �.; " . �
� • 49: EleMric Release to Edison � � � : • �
�
50. Gas Releas¢ ro So�u[hern California Gas Co • ! j �; , i. -. ' �'..
51. CfRTIFICATE dF OCCUPANCY t $ . , -_ ~ 'z . _
No. Date
A�D�lean! to fill In all spaces e:cept thosa wH�in haavy Dortler Iinas anE zign all approoriate tleelarotians. �
GTY OF COSTA MESA � � • ' PE MIT TRACT NO. " LOT NO. ' i BL . . � � �
CONSTRUCTION PERMIT ' • " . (�'�j G% 9 � • ti.... , ,' : � • - . . , 4758 . 2/d�/d3 �iJi, •T
�
Applicent'sMeilingAddress�'`?� �'�� L�A/��.d�d� �u/A�.P.iv� TypEOPCONSTRUCTION� . ' NEW ADD ' ALTERATION 'REPAIR' � � � � , � , �� �
ProjectAddreu ��%^ � �-��� �' � � � ❑ CONVERSION ❑ DEMOLISN ❑ OTHER '� �' • ' � � . . � . . � � � � � .. � � . � -
Owner's Nam'/e �/��f � ' � Phone �'' - 3 � • DESCRIVT�ON OP WORK ; _ . - , : .. , ' , . , ' NI G:RE LATI �
� AddfeSs -T��"�� / ��� =� , 7VPEOFPERMIT � - 'GRADING �� FOUNDATION STRUCTVRAL . A.P.:3P+ � - ' ' ZONE _ : � �
� Afth/Eng.. , , � LIC2nie NO. � � �❑ TENANT ❑; ELECT.RIGAL PLUMBING. O'MECHANICAL . ' ' . P�NG. REF. qW ' � .BUILDING � '. .
� Addrea . ' ' ' � : ':❑��OTHERi. ' . • ' "" � � � TOBUILOING • . � ' ` ' �
'�l , - . .. . • ' . . �. PE Y INE � flEAR VAflD (TO P/U � '
� Controctor's Nem �° � � -/ f� ��' � �^ hone �, �� `f"74 ' PROJECT DESCHIPTION, 5�. FT.' . • OccuvnNcv . , , . _
%�3-� G��( lFl/�A�/� 'Hi����'�ivr CONSTRUCTIONTVPE � VALUP.TION$ -LEFTSIDEVARD RIGHTSIDEVARD
Address Imailing) , , . . - - � . . . -
p,h , �. ZON$ -' GRADINCeCU.V05. ACRF< PKG.SPACE:REQ. - � � i PROVIDEO � ' ,, '
\ —_ � 7�1.1 7 , , , � .
License No.
LICENSED CONTRACTOR DECLARATION Remarks: . �' . . � � _ STREET WIDTH 'PARK FEE S'
. Y �ereby, affirm t�at I am Iicensetl untler provislons ofCbartar 9�(commencin9 � .- _ , , , .,
with settlOn 7000) of DlvlilOn 3 of tha BUSine55 antl Proiei�lOns COtle, Sntl - ' � ' - , . ' ' SPECIAL CONDITIORS: ' �:
my Ilcense Is in full forcSantl effect. � . �� ' - . , . ,
. Ucensa Class � � �-3 r- ' + LI<en�/ No.�� �G'-r 7 : � PLUMBING ' .� ' ' ' � �
�� Date �-�riF°�d3 5i9naturo ✓ 9.r�J.l: i/ /.�iJ L
WORKERS'COMPENSATIONDECLARATION' � �" � ' BBISink ' ' � SewefCOp ' � - ' ' ELECTRICAL , 1 � •
'-$lereby alfirm that 1 have a certiilWte of consent to seH-Insure or a certlfl�'ate ,,, gackflow PrBventer. . . . _ SBYVer Conn¢ttion' AutOmaLc Wazher � ' �Metef ❑over 10�) amps �
�.zWorkers'�Compen5dtlon Insuranca,�or a certifted �coOY therenf�(SetNon , ' � � � � � � � � �,
i 5,�0, LaG. C.) �/ '/ • ' � • % � - ;-7+ � " ' Beckflow Irrigatian � Solar Collectors � � Construction Pole Sub Panel , �
PoIICy No. nY�'�`�� ' ComDany "�'Av F`C L.tJS � ' . - " -� ' Cooking Unit � �Sub Pole � � �
�rUiietl-copy Is nareby Turnishea. i � ' � � ' .. Bathtubs Solar Piping '� , � I . . .
Certl ietl <oDY �s.flletl wlt� the clty�Bu�il9in�g Dlvlslon. }� ' , �„ � Dishwasher 'Motors �0-1 HP ❑1 h$
� oate � '�'�' �"3 APPlicant ^t-N��.. �\ -�+�✓ : Clarifiers � , . Solar Tank � �:, y . � � . . ,.
EXEMPTION.FROM'WORKERS"COMPENSATION'OECCARATION'" � - � , � � i '•- - -� � , � � '" Dryers'�Ges'�EleCtnC^' —' ;InC:SOlaf�09=15'HP'016-15+`
(T�Issectlon neetl not be compbted if the permit Is for'one �unCreA (f100) or �� DiShuYdsh2� . • Swimming POO�,'�5 - � �� 1
� less . 1 � - . � � ' , Orinkin Fountains -' 1 Urinal i ' � Fan 1 , + t, ' � Microwave ' ' � 1
I certify'that In tha per�orman<e ot tne work tor,which this permR is IssuaG I. 9 _ _'v ' , , p
, �shall not amploy any person In nny manner 5o,a5 [O be<Ome 5ubjettto L�le � . � . F.A.U. ' � , � �Pole Light � '
� workers• Compensation Laws oT CalifornlaJ . ' � V Flaar Drains ' Water Clo ' - -
Data � �ignature ' ' • � � � � ' - Ran e �
Fixthres ' � r
' NOTICE: IT, after,making.thiS.tlBclaratlon, you Shoultl beCome.subject_to the �., ... Floaf Sinks y„ i. � Wetcr Hfat¢� „ ,,;. �.G,Q . ' 9 �
. Workers" Compensatlan provisions oT tha Labor Cotla, you. must forthwltM1 � ' ' . �� ��� ' �� . Device Boxes ' � 1 -
comply .with; such provisiont �or' tnis! permit • s�all be �Aeemetl revoketl: ' Gas SerJice� . Outl6t3 Water Service �� '�, � 'Sign- �
' CONSTRUCTION LENDING'A6ENCV . . ` I ` "'�' ' - - ' ' " OutlCts ' '
' I �ereDy attirm that Ihere is a•constructlon Ientling agency for the partormanc;. ,� InterceptOrS : - � ,% r, ' Stending Sections j� j
of tha work for wNch! this Dermit �-I5 ��issuetl`. (Section .3097� Civ. C.) � �
� Lenaer's rvame � � � � Kitctien�Sink � ' -, . . ' , - � � Switches � Trash Compactor ' � '
L.enGer's Atltlress; ` � ^� � ` ` , � � �
�� OWNER�BUILDER DEC�ANATION ' i � ' . ' Lsvatories . . � . , ; � '• Gar6age Dispoul ; .
I hereby attirin th5t I am:ezempt from ttie,Con[ractor's'Llcenze taw for.the � � � _ . �, Genfr0t0� �0-5 KW �5-15KW ' ' � � '
tollowing reason:(Sactlom7031.5 Businasi antl�Professlonal Cotle: Any city or P-Tfap _ � ' j � � �
'.county whlch requiras a Oermit to <onstru<t, alter improve, Gemolish or repair ' .� . - Trensformer 015�50 KW ' ' � ��
any ztructure; pdor to Icrissuance, alw reqWres t�e apPlicant tor 5uch permit " Roof D�ains' -� - � �� � . { � � ' '
to. file a slgnetl statement'that he/she is Ilt¢nsetl pursuant to the'provisionz of- • � " ' ❑5U+ KW � "
'the Contractor'S License Law.(CM1apter 9 (commentlng with Section 7000) of ,i� ` - � �� - ' ; . � .� � •Reinspection Pae . � fi$� .
f��yislon 3-of Ihe �BuSinesz� antl� Professlons Code)"or't�at he/sheris:exempt , ShOW2�5 . C� _ ' Reinspection Fea � �$15 , , �
q y.;;tefrom'anif tbe basis for'the alle9eC exemption. Any�violatlon'ot, Section . '.' ' ; , '' 'Meter ❑up to 100amps .ISsue�Pee. '$ 3
�;4:5 Dy- any applicant ior' a� perml[ 5ubject5 tne appliwnt- to a� tivil � - - �- . � ' ' - _ _ _ _ , _ _ _ , I
ralty oi not more than tive huntlratl tlollars (E500). �.' „ . „. Sernce Smk' �` „ Issue Fae -.. - $ 3' Zoning Approved By Date �
� I; as.owner ot•the�property or:.my amo�oyaes�with�wages az Iheir sole � �MECHANICAL � � ' •
compensation will'tlo t�e work�, an0 the,structure iz not intentletl or offere0 � - ' �. � ' Application ApO�oved By � �ate - '
for wle (Sec�lon ]044, Buslness anA' Profe551onal Cotle: Tha. Contractor'S v' y"y. _� � , -
� License Law tloes not apply to�an'owner bi a property�who bulltls or improves f. Boile�. I�y �: �� "^ t Refrigeretion SVstcm � �. p �iption Issued B ,' IJ' � Date �`�z ��
' thereon,'antl.who tloes� such work fiirtiselt/herseli or through hfs or her own � '�� '• ' ' � � . PP. . Y ' �
� employees. ProvlOetl that suc�,improvements are not Intentletl or offered;for � Duci- Under,Ground ' ❑0.100,OOOBTU ❑t00,0008TU ..
sale. If however, the builtling or improvement is soltl within one year'of com- � . • � � � . � SUMMARV OF FEES '
' platlon„the ownar'wlll hava the buitlen of proving he/she tlitl not bulltl o� IT- �� � � ` ' � ' ,
�roveformepurposaofsale). � ; ; , =' ' _ ! , Duct-Structural SystemRepair/Alteration :j .�i.� 'gUILDINGPERMI7 $ ' ' SMIP f . $ � �
LJ I, is owner ot tha pioperty, am exclusively contractln9 with-licensetl con . � , , -
' tractorsto construct the projeci (Section 7044, Business antl. Professionz Cotla: Duct - VeM�lating �� � � . � �PLAN CHECK� �a$ � ; PERMIT � Ji �� �
-The'Contractor's•Litense"'l'aw does'not apPIY'to'an'owner of Oroperty w�o � . , ' �� � � ISSUANCE � , $ , "�
Duiltls or ImOroves thereon,�antl who contracts Tor such pro)ects with a con- Exhaust System ❑ Multiple �� � � � � �� "�j PLUMBING ., `� �
tractor(s) Iicensa pursuant to the Contractor's license Caw). ' . ' ' 'r� � � 7 � GRADING ��. �$�
'PLAN CHECK, $
❑'I;am exempt un`tler Sectlon � B, & P. C. tor this reason �� Firepl/Fa[t. Blt. ICBO # " �I � � ['; ." � f 1 � ,
-� ] � r . . ', � : - � ' ,ELECTFICAU i : � � � ' � $ � � :
. Date �� - ' �' Owner ' � ' � � Heating'Sysfem & Ducting . � ' � � - ' ' ' : $� ' '� MICROFILM j $ ' ' �
,PLAN CHECK. $
._I hereby .certlfy that I..havB reaG th15'appliGatlon.antl.5tate ttiat the above. __ 04100,OOOBT.U.O.100,0008T .....� .. . , , 1 r ' �' 4�
intarmatlon is <orrect. I agree to comply with all clty antl county ortlinanws ' .-� j • TOTAL�FEE ,$,
antl:�state Iaws relatmg to bulltlin9 construction,�antl hareby authorize repre � Hood or . • .MECHANICAL , $ . , .
' sentatives of� this ,clry to anter. up t�e above-mentio�eA ,property �for , �' Type l ❑-- Reinspection Fael $15 " � �ESS - '� .
� inspectlon pury oses. ' y � � , . � i : Cano , T ' e I I ❑ . � ,PIAN CHECK' $ ; � qDVANCED PC ' $ � �
Signalura /f�,1.4�Y_A.i� !� � �/r'Ai�,lJ Data ����'�3 I . • . . . - '. . . . ' ' \
Drlvers LI �ss � �' �— �� � � . Registers . � . Issue Fee � ' S 3 " � � . � C--p
i FINAL FEE-. �� $ �
, . . _ . � . � . . �. ,- . _
CMF OB65-46 rev: I'2/B2 'Pink -'AcLounting; Goltlenro0 -'Assessor'� '"' �" ' `—'/ ' ' `—' ' ' "" ^ ` ' �^- '�- • - • - � - -- - - � - � . � •�- •
�C'/-/i�Y y'o/ Sn/S'fJe?C'-f/c,</ .. . ..�
-, � CONSTRUGTION AND�PLAN -IN -:. � � ' �-: - ":. � = �OL 'A._ . - - , -: ; :, .
-t%' -�3j`�• ��Date � �Inspector � Q. ' ` ` � - ''Date' . Inspecmi �
r �-APFROVACS� Permit�h ` b • + _ APPROVALS � � PermiL,�*' .
� � . r . � ' s -• I
r �7. �Tempo�ary; Electrical Service or. Pole , ; :'� ` ' ' - �'S2'. • Pool-&.Equipment Loca4ion . � -, �
i t2. � Soil Pipe-Undrgrnd'. � r' � ; Y ' i , ` 53 Steel Reinforcement _ - . -, � ' ' � �
+� i � - � ��� � �� ���. ' • � . _ , _�
_ .3. �Elec{rical Conduit Utilitv-Undrgrnd. ry r ; = � c ��, �;54. ;Forms? � . � _ � - � �'
,`�'� �4. �Electrical Conduit-Undrgrnd.- Y , j r' t ` ' � °55; Elearical.Boriding ' � •j � t
5. �St'eel� Reinforcement � ;, ` ' � ' � � : ; � a ' �� � 56 Rough;Plumbing & Pressure Test' : ' • ,
.i
'r6.�ElectricalUFER�Grnd: ,r ��= � �� .''- _ :_��.�; �57;,APPROVALTOCOVER-GUNITE�• - . ' - '
, i.r:
7.�Footings . i ' , - �' � : c ; �� � � �" -' � � �5,8. Electricai-(`qnduit-Undrarod. ' - � - '
8. �Foundation � � � � � � : � ' � - - , : � : _ � -59. �Gas Pipe; �� Und�grnd., Te'st, " � � ,
� 9.�Water Pipe:Undrgrnd. j `:;� � ; ! : � ,� _" �FiO. �Backwasfi Gines, R-Trap, O�Undrgrnd: • � � _ . �
10.�StructuralFloor�Sy�tem ;`� ' I , ;'_. = ; 67.'APPROVAt;TODECK ':,,,•,-
11. �Property Sewer Line &� House'Connection c , � ' - ° t, ` 62.:Backwash�&' ReceptorFinal ' .� - . - '
72. �Sewer Cap � � � ;: ; � ^ , � � ' ' ' 63. Heater & Vent-Final - ' ". �_ - � - �
� 13.�Roof Drains ; � � ' : m � i - _ � � ��, , '-64.'PlumbingSystem�-Final�'�- - ` � . '
i
Q 14. tRough Plumbingi � I , -` ` � i � � � � ` -- � � �� �65.'Electrical-Final - - � - ' -
- ' 15-. Rough'Electrical-Conduit-I "" '"��' � -- -� ' � � 66i Sola� System-Final - `-- -' - ;- - - � � - -
-r----
�� '* �16. ;Rough,ElectricWiiin9 �. ; * ' ' �-`` �^-'"r � ,-' ._"�c� �'_ � _ � 67�i-.Pencing &�Access APProval -: , ' ; � .
_ `'17.' Rough�Wiring-Sign? '; � � '� I I� � ` ; :� � � ` � -_ i � - � J i ?, ' gg A'PPROVED:FOR PLASTERING " � � i- _
. 18.;,Rodgli,Electrical-T;Bar Ceiling , ,. � � - � I ' �',. ` � :. �69: POOUSPA SYSTEMS FINAL � � � :.
19,'�Rough; Heating & Air,Co;ntlitionirig �� � i � . ' � � � , FIRE DEPT; REQUIREMENT � � � � ,. �
20.'Rough:Factory F,ireplace � � �; � , � ' � , � � APPROVALS Permit# ' � �' �
21."Ducts; injS'tructure �� � , � � �� � � � ; � � 70. Underground Hydro �� � '
�:22.•�Ducts, Ventilating;: , c � li i� � i ; � p' g� �,
( � � i 71: Pioduct Pi m❑ Gas ❑ Oil
� } 23.��Gas Pipe-Rough & TeSte , � bs �; } f � � ' 4 "(72'; Underground F.lush � '
°24hRoof Framing ' i � � � � • . ! - � - i - �- J3. Undergmd.�Storage Tank 0 Gas ��Oil •
�►. i r. i •.¢,,'. :,' i
�: � - �
� 2!i.'RoofSheathing �, , �;:-�, �' ��.�,;� ,.� ,��'_- (� �74:O�verheadHydro � ' ' '
,;-
- - � � >' � I, y, . ;i_ _ i
�6..T-Bar Ceiling (Stiuctural�i�& Monocoat i : 1.._ � ,. . � ; �.75. Dry Chemical , , . . � _ �-
^27.��F.rame'and`-Flashing �� ;� j� � � � � � � ' � ,,:� � i 76 Dry Standpipe . , . -� � " '
�28.< Lathing & $iding ^ � ; � ' �,� � � � ! S � 'i � , 77. FIXED SYSTEM FINAL. � - . � �
_ 29� Insulation�- S ' r� � ;� � � � � � �' i j: 78. FIRE PREV. 51NAL � � �
' �
� �30.pDrywall Nailin9 ' i � ' � ' i �;' I i � :ti ;� r i � , Notes: ' �,� -��� ��Y� � � ��I
.
. � �
. . . . . . . _ - .,. - � - - - �
� , � � � - � -�` -�- -
�31 �,Plaster Brown Coat' �� � �� �' � � 1 � � �
l�32. Electrical Power Meter-Final � II � I 1 ! s`"jl �' I. � ' � ' ..� ' �
,
33eFinalElectric � � � '� '� t , , � ; ' � , � •
_t �.. :j. � .� _ d. i
34. Final!Heating:&,,Air CondiFion`ng ��, � �� I� � � -
35. Final Gas Pi�Pe-Test' 1 ' ; _:; . �` � ' ' � �� � � , � . � ' ' . - " . . - ' `-, - ' .
�
36. Hood�br��CanoPY_. ° f � i o �, � . �: , I � 1 � 1 ' � � � � ` � . . � ' ' y : - " - . -
;� t
37. Final �FaMory F,ireplace 1 � al � � , : , � ' � ' � ' �
!. 1 I I 1�� r
38. Final�Plu�mb�ing�' � � � ,�� ' � % ' ' � � � . . � ' , �
.�
39. Water'Service-Final ; � � 1 � I � I � i � � ' � � � � `' _ ' . � �
i t . �
40. Gas Service-Final � i I j ,: � j � � i I � { j ; - .' , , � �
i
41. Solar�DomesticFirial i i , �� .-, -�, - �-- . � -I-_ - - _ -- - � - . .
1 � , �
�
42. Backflow P.reventer i I � � I � 1 � � � � � � ' � � ! � �
.�. �. ... ._. . � ,i... -�-- -- � �- -+ -�- � -*--.._T_ _ ... -
-.� i e1�� , � S i� :. �. ,.. �. �� .
43. Backf�ow Irrigation � � i :[I : i r ' _ I p � - - oi � ' ' ' '
„ .: ; ; .�_i o „- - � � - � ,
44. Landscape Irrigation�System� i ? - � t = �;�� � i `, r � � � ' - •�
�_
,�- � . . . � � . .
!
45. Sound cAttenuation : � � i s � I �i � � � . I : � � ' � � I � -- i . � � • , � . � ' , . , � ' • ,
46. HandicaP Regulations� H � . . �' �� . � � i f �' ' � � . � - . � . . .
47.-FINALSTRUCTURE,&BUI�LDING� ;, i � ''-� i � • -
48. SPecial Requirements'Completed � � 1 ��' '� � � , � � � ' . � . , • . .
i
49. Electric ��Release to� Edisori � � • � _ , ` _ � .,�_ � � - ' . . ' . � ,
r. � i � --F-�' -+� -�-i- � �-- r-.
50. Gas Release'to Southern Califomia Gas Co ' I , f � I � i . �� � �
i � � i i i i I
51. CERT,IFICATE OF OCCUPANCY ' ' ! � . .l._' _ i_ _ __. _ '. - ' _
� � I - _�-'- _ . i ;
No. '� ' � � Date � � , i , � 1 ' ' i � '
r:y_... i_..,. _ ._._ _�__� _t_ �
,_, � - ' ` _ '\
�, .
� I 8 I 02 t' � �� i S� �, �, a�` �.��
. . . Nov i �ss2
COSTA MESA BUILDING•SAFETY DEPARTMENT i.��i.ti���� j�;_y-',j
P. O. BOX 917 G06TA MBHA. CALIP0�11A
Cli� C� CIISda ;.,�;
For Applicanf fo Fill In Complefely APPLICATION FOR PERMIT
TyPE,µOR PRINT gU1LDING
ADO E'88 ��O Il0 'R
COSTA MESA. CALIFORNIA For O#ite Use Only
R8L8�PT NO. PHPMIT NO.
OWNER Q I" D Q �� �
MAIL n n I� p r RHC81V8D BY DAlB q8C81V8D DATB 198UHG
ADDRE56 /��/� V �'�C/ �/� (IG n �— — / / �� ��
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CITY Ca S/ e r� NO. ADDRES8 / tD � •/!O �
ARCHITBCT^^ �l TEL. �,�. COSTA MESA. CAUFORNIA
Sq�ni -Rl �Eo�
NO. OP BLD09.
20N6
L60AL
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NO. OF � I U86 OP N8W �
PLAN9 BUILDIN6//1 nY�
EXIHTING BLDG APPROVED
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CENTER OP BTtaei /'J REAR YARD^�+� FRONT
SIDE YARO I LEFT H/ I RIGHT Cl /(� " R. SIDE
DESCRIPTION OF WORK
EXTERIOR WAI.���/
GOVERING sJ7 1
USE OF BUILDING AND
II H8N8BY�ACKNOWL
ANO 8TAT8 TH.�T Tt
PLV WITH ALL CITY
BUIlDINO CON8TtU1
'AUTMORIZED AGENT
-
NO. OF
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APPROVEO
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THAT 1 HAVB RBAD THIe MPLIGTION TH2 AMOUM BH�NDBP VI
�VB IB CORRBGT AND AGREB TO COM- pURP08E OP [9TABL18HIN0 A
VANCHB ANO 8TAT8 LA REOULATINO
� VALUATION
� PERMIT 1
5/% �31 PIAN CH
iOTAL F
IB POP TN6
PE! ONLY.
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