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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�pyLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 778 PAULARINO AV
Suile:
Viciniry: SFD WITH ATTACHED DWELLING W/GARAGE
Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N
Parcel Number: 14151230 Zoning: R1
Applicant: R L ENTERPRISES INC
Address: P O BOX 1103
COSTA MESA, CA
Owner: R I ENTERPRIES
Address P O BOX 7.1g03�� -
COSTA M�SA, CA
Contractor: .O WNER-BU I LDE R
Address: . �
Zip:
Arch :
Address:
Phone:
Zip:
License:
.Phone: 714-681-5344 CELL ISSUED BY:
Zip: 92627 -
Phone:
Zip: 92627
Phone:
License: 000000
Eng:
Address:
Stalus: ISSUED
Applied: 10/24/2005
Issued: 1024/2005
Phone:
License:
SCOPE OF PERMIT
�`�. �.REROOF RESIDENCE WITH q7TACHED GARAGE: T/O EXISTING WOOD SHAKE, APPLY SHTG AND FELT PER MFGR'S SPECS, APPLY "30-YEAR
SHINGLES." , .
2352 SQ FT
� FEE SUMMARY ., ;_ � ` �
Plan Check: $0.00 Calc Valuation: gs,000.00
Permit: $125.25 Claim Valuation: Se,000.00
SMIP Res: $0.60
SMIP Com: $0.00
Other:. $0.00
Inspection: $O.OQ
Total: � $125.85 >-
PLANNING & ZONING
SETBACKS
MAINSTRUCTURE FroM 0-0 �..> Rear 0-0
ACCESSORY Front 0-0 _Rear 0-0
PARKING Ezistina: 0 . Reauired: 0 -
ieft 0-0 � �Right . 0-0
Left 0- 0'�. Right 0- 0
Pr000sed: � 0-
R
R
�
A
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, § 7, 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 ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all
requlred Inapeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2496d8 (8�00)
WORKERS'COMPENSAnON DECLARAnON:
I hereby ettirtn under penalry oi per�ury one of the tollowing declaretions:
❑ I heve entl will meintaln e cetliticate ol cansent to setl-Insure for workers' wmpensation, es provided Por by sedlon 3700 of Ihe Lebor Code, br the peAortnance of the
work for w�ic� lhi5 pertnit is issuetl.
❑ 1 have and will maintaln workere' cwnpensatlon Insurence, as requirea Dy section 3700 of ihe Lebor Cotle, for the perfortnance of tho work for whiU Ihis pertnit is issuetl.
My workers' compensetlon Insurance cerrier entl policy number ere:
Cartier: policy Number:
(This sectiar neetl nof be completed!!!he pemut is veluetl at one hundred dollars ($100) or Ieu.J
'fIJ� I canity ihat in t�e Dertormance ol the work tor which Ihis pertnil is iuued, I shall not employ any person in any manner so as to become subject to the workers'
�V �mpensation laws ol Celitomia, e egree thet II I s�oultl Decome subjacl to the workers' compensation proWsions of Sectlon 3700 ot the Labor Code, I shall forthwith
wmply with these p[ovisions.
p i—Iiani Slpna"ture t`? .�� Data� IO zS,O�
WFRNING: FAILURE TO SECURE WO ERS' COMPENSATION COVEFiAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENPLTIES AND CML FlNES UP TO ONE HUNORED
hKK15AND �OIJ.ARE (5100.0OO�.IN ADDfiION TO THE WST OF GYMIPENSATION, OMIf�GES AS PROVIDED WR IN SECTION 31O60F TiE LABOR CODE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby aRirtn that I am licensed under provisions of Chepter 9(cammencing with SecUon 7000) ot Division 3 of the Business anC Professions CaAe, end my Iicense is in full
force an0 eNect. Lic. a Class N
Conirectols SlgnaNre: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 �ereby aXirm ihat t�ere is a construction lending egency for Ihe pedortnance ot the work tor which this permit is issued. (Sec. 3097, Civil CoOe). '�,
Lenders Nama: Lenders Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby etllrtn thflt under penelry of perjury thet I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor Ihe lallowing reason (Sec. 7031.5, Business end Professlons
Cotle: Any ciry or counry which requires e permit to constmct, alter, improve, tlemolis�, or repair any structure, prior to its issuance, also requires the epplicent for such permit
b tile a signed statement Ihet he or she is Ilcensetl pureuant to Ihe provisions af the Contractors License Law (Cheptar 9(commencing with Sectlon 7000) of Dlvision 3 oi Ihe
Business and Professions Cada) or thel he or she is ezempt t�erefrom end the basis for the allegetl ezemption. Any violetion of Section 7031.5 by eny epplicent for e pertnit
suhjecis the epplicant to a civil penelty of not more then tive huntlred dollere ($500).):
� I, es owner oi the properry, or my employees with weges as thelr sole compensatlon, WILL DO THE WORK, and the strucWre is not intendetl or oHered for sele (Sec.
'� 7044, Business and Professlons Code: The Contrectors Licensa Law tloes noi apply to an owner of property who builds or improves Ihereon, and who tloes such work
himself or herself or Ihrough his or her own employees, Provided t�at such ImD�a�emenis ere nat intentled or ottered for sele. If, however, Ihe builtling or improvemeN Is
soltl within ona year ot completlon. ihe ownerbuilder will have ihe burden of proving that he or she did not �uiltl or impmve tor purpose oi salaJ. '
❑ I, es ownar of the property, am E%CLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS to construct the projecl (Sec. 7044, Bu9ine5s antl Professions
Code: The conirectors Llcense Lew does not epply to en awner at pmperry w�o builds or improves t�ereon, and who contrects lor such project with a wNrector(s)
licen5e pureuanl to lhe Conireclors LicenSe LBwsJ.
❑ I am ezempt u er se Business end Professions Code for ihis reason:
�Sig�_gn�t�ure;� .�-�• � _ � �ate:_� z / ;
Owner ID venf d by drivers license. ❑ Yes ❑ No Ddve�e, �,', Expires g' � O�
Veritication oi Ownership by (rype of tlocumeni, i.e. - properry taz bill or daad):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N:
❑ I hereby ceNfy Ihat no excavetion five (5) or more leet in depth in�o which e person is required lo descend, will De made in wnnection with work euthonze0 by Ihis
permit, end that no Duiltling structure, scafloltling, lalsework, or demolition or dismantling ihereot, will be more than thirry-six (38) leet high. (Chep. 32, Gry 2, Art 2, Sec.
341, Ttle B, Califomia Atlministretive Cotle).
❑ As owner-builder, I will not employ enyone to tlo work which would require a pertnit from the Division ol Indusirial Salery, as noted ebove, unless such person hes a
pertnit to tlo such work Irom Ihe tlivision.
SignaWre: Data:
Division ot Industnal Salery Pertnit Number:
COOE �. INSVECTIONT'PE
tfi16 Fixed System Final Fire Prevention
1266
200
201
202
203
Pool Spe Final
Final Re-Roaf
Final BIocWReleining Wall
Final Factary Fire Plece
Finel Sign
204 Finel Demolilion
P6IE p�
oe
Y I V
COOE 1 INSPECTION TYPE
206 Final Mechanical
20B Finel PlumDing
210 Final Elecinwl
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSi�e
250 Final Builtling/Occupancy
PAIF. It�LS
m
AOP�icant to fill in all soatts excev� those within heavY DorCer lines antl sign all aoo�avriate aeclaretions. A __.
CiTv oF cOSTA MESAp CONSTRUCTION PERMIT
. Project�Address a 7 tl Po.v.l o�r i n o
Applicant's Maili a n�a S 111e�.a.ru+ �Gnrl N �-it�r�u'��rc l`�
Owner's Name �� � �P �` Phone �7
Addreu �n/tiL
ArchlEng. — License No.
Address
�
Contrecror's Nam '� � Phone � �S
Addreu (mailing) - �'�
City License No. �� �7 � �
LICENSED CONTRq�TOR DECLHRATION '
I hereby allirm that I am licensetl untl¢r provisio05 of Chartet 9(Commencing
with section ]000) ot Division 3 of the Business ana Protessions Cotle, antl
my Iicense is in tul or�pntl eitect.
LiCeO C I 55 � � Lice e No �` O
' Date �^� �/� ,��
��ORKERS' COMPENSATION DECLARATION
hereby aflirm [hat � have a certitfcate o! consent to self-fnsure or a cer[ificate
of Workers' Compensation Insurance, or a certif'etl copY thereol (Sectlon .
3800, Lab. C�IC� 19IU I
�I¢y No. � �� COmpany
Certifietl copy is hereby turnisnetl. '
Ce� ifie opy iz(/tiletl with [he city Buijl ]innaY�_ ivislon/yf
Date �'��-�/ APPllcanl�(�/lj,/t{.�
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need nOt be completatl it [he p¢rmi[ I5 for One huntlretl (5100) or
less).
I certify that in tne p¢rfo�mance of the wo�k for whi[h Nis pe�mit is i55uetl I
shall not omploy aqy pe�son in any manner So as to become Subjoct to t{�e
Work¢rs' Compensation LawS Ot Califomia.
Datn _99�ature
NOTICE: Ii, aiter making this tleclaration, you shoultl become subject to the
�. Wo�kers' COmOensatiOn p�ovisions Of the Labor Cotle, y0u must forfhwith
' comply with such provi5ion5 or this pErmit shall be tleemed revoketl.
I CONSTRUCTION �ENDING AGENCV
I hereby al/irm that [here is a constructlon'lentlin9 agency for lhe per/ormance
of the work tor �whic�oermit is. issuetl (Section 3097 Cfv. C.)
LenGer's Name — -- --
Lentler'z Atltlress �
OWNER BUILDER OECLARATION�,
1 hereby affl�m that � am ¢xempt trom Ihe Contracio�'s LicenSe Law for the
following reason (5¢�tion 7031.5 Business antl Prp(essional Cotle: Any city or
County whith �equires a Oe�mit [O Const�ut[, alte�, improv¢, Uemoll5h O� repair
any st�uCture, prior to it5 i55udnce, also reqWres Lhe applicanl for zucM1 permit
�o fil¢ a slgnetl 5[atement [hat M1e/sh¢ is licenzetl pursuant to the p�ovi5ions of
�e Contractor's Liqense Law (Chapter 9(commencing wilh Section 7000) of
ivislon 3 of the gu5ine55 antl Profe55ion5 Cotle) or lha[ he/she i5 ezempt
iierefrom antl [ne basis tor the allegetl exemption. Any violatlon of Section
7031.5 by any applicant Por a permil subjects Ihe ap0�lcant [o a civil
�enalty of not more than five huntlretl tlollars ($500).
I, a5 owner of the prop¢rty or my employees with wagas as their sole
compensalion, will Oo the work, antl tne structure is not intantletl or offeretl
tor sale (Section �044, Business antl Professional Cotle: The Con[ra<tor'S
l_icense Law tlo¢5 not apply [o an owner of a prope�ty who bulltls or imp�oveS
thereon, antl who tloes sucn work hlmseli/herseli or throu9n his or her own
employees, provitletl that such improvements are nbi intentletl or oHeretl for
sale. 11, howeveq fhe building cr improvement is soltl wilhin one ylar o� com-
pletion, [he owner will have [he burtlen of proving he/she tlitl not builtl o� im-
�rOvO lor the pu�pose ot sale).
U I, as owner ot trye property, am exclusively contracting wi[h Ilcensetl com
[ractors to mnstruR the project (Section 7044, Business antl Professions Cotle:
Tho ContractOr's �j�ense Law does not dPPIY to an owne� ol 0/operty wh0
builtls or Imp�oves [hereon, antl wbo conVac[5 fo� such project5 witn a con-
traclor(5 Ocense pUrsuant�to the�ConVaG[or'S License Law). I am aware [hat
proot o� their Worker's Compen5ation insurance thoultl be provltletl to me.
❑ I am exempt un�er Section B. & P. C. for thi5 reason
Date _ Owner
1 hereby certify tqat I have reatl thls application and state that the above
Information is correcL I a9ree to <ompty with all tlty antl county ortlinances
antl state IawS relating ta �uiltling con5tru<tion, antl hereby aulhO�lze r¢Ore,
5¢ntative5 of lnis city to ent¢r pOn the abov mantlonetl P�op¢rt to�
inspettion purp e
Signature
Drivars' LlcenSe or 5� �
CMF 0865-46, rev. 4/q4
TYPE OF CONSTRUCTION LJ NEW LJ aDD LJ ALTERATION u REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
.DESCRIPTION OF WORK/USE OFBIDG.
TVP^EOFPERMIT GRADING FOUNDATION ' STRVCTVRAL
.l� TENANT ❑ ELECT(31CAL ❑ PLUM8ING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. F7. �OCCUPArvcV
, CONSTRVGTIONTVPE ' VALUATIONS
ZONE GRADINGCU.VOS. ACRES
Remarks:
Sink
Preventer
Irri9acion
Drinking Fountains
Floor Drains � '
Floor Sfnks
GasService �Outlets
Incerceptors �
Kitchen Sink
Lavatories
P-Trap
Roo( Drains
Reinspection'Fee' � $15
DUCL- UnderGround
Duct - Structurel '
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑ o-i oo,000 eTu O i oo,aoo
� Date ��
- ReinspectionFee
White - Builtling: Cana�y - Ap0licant: Pink - Accountin9: GoltlenrOtl - A55e55o�
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
WdLCf C1052i
Water Heater Q
Water Service
luue Fee
Hoodor Typel ❑
Canopy Typell ❑
Refrigeration System
Oaioo,000aTu ❑�oo,000
System Repair/Alteration
Issue Fee
$ 3
E 3
A.P. �p
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ret. #
Plannin9 Notez:
Automatic Washer
Construc[ion Po�e.
Cooking Unit
Dishwasher
Fan
F.A.U.
Fixtures
Device Boxes
0 ut lets
Switches
Garbage Disposal
Generator �0�5 KW
9579 10/05/84
2one
Accessory Building:
ELECTRICAL
� Transformer ❑ 15-50 KW
❑ 50+KW
M¢ter LJup to 100 ampz
Meter ❑over100amps
Sub Panel
Molors�61 HP01h-8
Inc.Solar �9-15 FiP �16-15+
Microwave -
Pole Light
Range .
Standing Sections
5 KW Trash Compacmr
I Reinspection Fee I$15 I I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved gy
Building ApprOVOd By _
S.00 TL
FEES
$ 3
Z
O
M
I
N
G
R
E
�
M
T
$.
SUMMARY OF FEES '
BUILDING PERMIT $ �SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ .1. b � ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. S
ELEC7RICAL $ � GRADING $
PLAN CHECK 50% S MICROFILM $ C
MECHANICAL $ TOTAL FEE $ -+^ �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING ' � P� ?` SP'0'
'. APPROVALS Permit # Date - Inspector qppROVALS Permit # Date Inspector
�
t. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
'2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. . � 54. Forms �
4. �Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding .
5. Steel Reinforcement '� . 56. Rough Plumbing & Pressure Test
6..ElectricalUFERGrnd. 57. APPROVALTOCOVER-GUNITE '
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap � ^' 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final �
14. Rough�Plumbing 65. Electrical-Final -
15. Rough Electrical-Conduit 66. Solar SYstem-Final
i6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elearical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing 74. Overhead Hydro
' 26. T-Bar Cei�ing (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
_34. Final Heating & Air Conditioning ,
i
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Fac[ory Fireplace
38. Final Plumbing ���q/� L��
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ,
43. Backflow Irrigation , . . .
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
0{VNER NOR'
JOB ADDRESS
JUL 5 1963
m,_Inc . v�.vE S 13,.5�� • �
�FIRE ZONE DESCRIPTION OF WORF{$IIq,F�1.DH1.X�8'E1
DATE I GROUP T R .T TYPE V ZONE Rl � Gar.
SUBCUNTRACTOR
�• �QOi6
�COSTA MESA BUILDINGSAFEfY DEPARTMENT
P.O. BOX 917 CO3fA M83A. CALIFORNIA
For Applican! fo Fill In Completaly
TYPE OR PRINT (�,BJµ�I,y
BUILDIN6 � '
ADDRESS � - U '
COSTA MESA, CALIFORNIA
OWNER NORTHGATE
MAIL 133Lt1 Golden West �
ADDRESS
c,rv Westminster Cal. rT,o`.897-78
ORENGINEER C• H1�PS N0.73S'2Q
o,,,,AF�R Box 11. Anaheim. Calif.
SIZE � rvo.oPel
OF LOT 67 X 1� NOW on I
USE OF
EXISTING BLDa.
BETBACK LINE FfiOM
CENTER OF BTREhT O� REAR YARO
SIDEYARDI LEFT S� I RI(3HT'1Z�
DESCRIPTION OF WORK
'BUILDIN6 [1 X CO� NO.OP
SIZE 7 J ROOMS
� E%TERIOR WALL I ROOF
�1 HEREBY I
FNO 9TATE
PLY WITX �
BWLOINO C
� AUTHORIZED AGENT
FEE RECEIUED
dUH z a 198� �
?�IGA PERMIT
i ii�f11V
CIT`�opf0 ��Aly
R[C[IR NO. I P
13UN.11:[ i
LEOAL
rrPe �1/
DI
ZONING
No.o useon
runa� eui��ii
�� 'n `/_f T
YARDSAPPROVED
MAIN BUILDIN6
v
VAR. #
��T ���s� 1963
SHALL BE LESB THAN
(U.B.C.REQUIREMENTI
YARpSAPPROVE�
ACCESSORYBUILDINO
I.h\��
4II n / �/•�pl ❑
SQ.F7. "7L78
\D THIB APPLICATION THE AMOUNT BHOWN UNCER VALUATI N 18 FOR TNE
AND AOREE TO COM. PIIRPOSB OF BBTABLIBHIN6 A PERMIT FEE ONLY.
�8 LAWB pfiOULATINO yqLUAT10N (y �J
PERMIT FEE $ '�6 � p(
s'\Jf�J�+ L CHEC
��
r
;
Gas
Final
SUBCONTRACTOR
PYt.
UE $ '
; III
PER611T NO,
S�uim Pool
� • 23950
�'COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 9t] C08Yp ME9A. CALIFORNIA
Fo� Applicant To Fill In Completaly
TYPE OR PRINT
ADORESS 778 PAULARINO
COSTA MESA, CALIFORNIA
,,,�,NFa g L saa�R
� ARCHITECT
5871
TEL
SIZE XIOO I noW ON LOT�
OF LOT
USE OF
EXISTINO BLO6.
BHTBACK LINC FXOM S� S,
CENTER OP BTREET RHAR YARD
HIDH YARD LEFT � RIOHT �
DESCRIPTION OF WORK
BUILDINO
SIZE
EXTERIOR WALL
VATE
CITY OF CU5TA MESA
MAY 3 1965
PLICAT �RSI11
■J
For Office Use Only
� R6C[I'T NO. PENMIT NO
77s
F�ree �
ZOIq^ I NO.OF ^
1 rue+s '�—
ceowt 7 � -f� . i
A. P. N�� I� '� (�1 IsK--- �J 0
NOTE: NO EAVE OVERHANG SHALL BE LE59 TMAN
90' TO SIDE @ REAR P. L.
EAVES
ALLOWED �V.B.C.REOUIREMENTI
YARDSAPPROVEO YARDSAPPROVED
MAIN BUILDING AGCESSORY BUILDIN6
D18TANCE BET
MAIN BLOG9.
VAR. }j
C. U. P.
APPROV6D
BET. MAIN @
ACCE55. BL[
DATE
I HEHEBY ACI(NOWLEDOe THAT I HAVB PE�O TXIB �PPLICAT�ON TN8 �MOUNT BNOWN UNOEq VALII�TION �Oq TXH F
AND eTATE TH�T TXC �BOVE 19 CORRER AND AOqEB TO COM� yALUATION OF 88TABLIHXINO A PEPMIT E¢ ONLY. o
PLY WITH ALL C� D ANCfiB�AND BTAT [OULATINO
BUILO�N6<ONS CTION.' � H
PERMITTE F PERMIT FEE $ � � j
��� ���J�� $ 2300.00 � E� �
AUTHORIZfiD AGENT fLL��(%II.I</+-C.CsI O
. d GC) `