HomeMy WebLinkAbout1112 VALLEY CIR - Building PermitsPROJECT ADDRESS: 1112 VALLEY CI I UNIT:
OWNER'S NAME: RUPPERT AMY KATHLEEN TR
ADDRESS: 1112 VALLY CIR if
COSTA MESA;CA 492627
548-4930
ARCH/ENGINEER: REG.N0.:
ADDRESS: UNIT:
PERMITTEE: MIKE KILLEENUALITY ROOF (213)429-3398
ADDRESS: 3819 CANEHILF
LONG BEACH CA 90808
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code a license i,in full lone and effect. . .
CITY tic.: 050596 STdTE LIC.:59050 SS C-39
�Uace: �/0-9 1 Signature: _
WORKERS' COMPENSATION DECLARATION: hereby affirm e a certificate o nsenl to self -insure or a certificate of Workers'
Compensation YsOar�r4 0 a1r5ifieaf copy thereof (Sectio 0 . Lab. 64/01/92.
POLICY NO.: 1 V 7 V EXP. DATE:
OMPANY: STATE
Certified copy is hereby furnished. ❑ Certified copy is filed the i Building vision.
Date'. — / 0 _%� Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This s eednet be completedifthe permit is for one hundred(51oO) orless).
I cendy that in the performance of the work for which this permit - sued, shall not employ any person in any manner so as to become
subject to the WorkersCompensation Laws of California.
Date. Signature.
NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forlhwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance ofthework for
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby aOirm that) am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair, any structure. prior to its Issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
I, as owner of the property of my employees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code. The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve
for the purpose of sale)
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Cotle'. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractogs) license pursuant to the Contractors' State License Law). I am aware
that proal of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. A P. C.
for this reason:
Date: Owner
t do hereby candy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533. and
25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Dale. Applicant:
I hereby certify that I have read this application and state that the above
ordinances and state laws relating to building construction and here In
property for inspection purposes.
S%/ O /I
Sale: Signature:
Drivers License o ,Social Security a: -
is correct.) agree to comply with all city and
1641 46 White—Building', Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA -BUILDING PERMIT
PERMIT NO: B 052015 PLAN CHECK NO: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION T/O RERROF W/FELT W/COMP. SQ FT: 3,060;
CLAIM VALUE: 3,060.00 CALC-VALUE:, 3,061 GROUP OCC: R-!3 /
COMMENTS: SMOKE'DETECTOR RE�UIRED IN THE HOME
iE*�6at�6+FaciE+t-**�F�A***�riE*i�***at�F�E�E*TB�F*+rpt**+E•�-*Fat***i6*******
f Z 0 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: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42203111 ZNE: REF NO':
PLANNING Ni
>, r
iE iF if ±E M %ik BE 9E it M if k * 9E iFTe M iE RE kit * ie aE * * iE iF * 9t iE iE Bf jF iE iF 9P IE 9E 1E IE iE iE if iF 7t 3E iF aE RF iE iE i6 aE k 9f 1F iE iF iF iF iE 1F Tf 1F if 7F iE iE iF iF iE ieif if iF RF
D E. V E''L 0 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: r
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: -/J
DATE: V
RF ie 9F iF ltif iRie if lE i(•iF*iF 9E iEk****iF IE 9f iE DATE:
iF 9f 9F
if iF aE 9F iE 1F II•iF Rf RE i(•9E IE is RE**tF if lF iF 1f -9F BFBe at RF iE iE lE ie of iE XF� is IE iE 1E*�E iF iE 3t iE ap*1F It IE 1F±fiF****if Rf IF XE iF eE XE iE is if lE iF iF of 1(•{p RP iE aE iE
LEGALIZATION:N F E E S U M M A R Y- STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
PLAN j; SMIP/NON-RES
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 63.50 0.00 0.00 63.50 63,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: 00
BLD63P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOTO GRADING PLAN -CHECK
iE 3t 3F IF 3F iE iF 9E iF iE iE it Brr RE fE * * BE 9E * BE 3E iF BFiE * RE BP BE k BE ie BE k lE it At RE BE Of iE * 9F IE tt 9k it At * al * * iE iE.if iF iE iE Rt k ie iE iE iF aE iF iP Bf iF iE iF * * i61f * * iE iE
I N D I V I D U A L F E E B R E A'K D O W N
TYPE QTY D E S C R I P T I O N `UNIT COST TOTAL COST
SFR 3060 REROOF BY VALUE REENDEOFAFEESNOZONE ',''1 1.00 3,060.00
X
L .1
O2 0005;035-00087036 -rrJ T 63.50
DATE: 05/10/91 TIME: 09:00
Iti
CONSTRUCTION AND PLANNING r:
POUF. & SPA
t
_
APPROVALS Permit #
Date
Inspector
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pale r.
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �� t -
53. Steel Reinforcement
_ 3.4Electrical Conduit UtilitY-Undrgrnd. "
54. Forms
'
'. 4. Electrical Conduit-Undrgrnd. _
55. Electrical Bonding
5:^Steet Reinforcemen[
56. Rough Plumbing & Pressure Test
6.,+ Electrical UFER.Grnd,
57. APPROVAL TO COVER-GUNITE
- 7 -.-.Footings
58. Electrical Conduit-Undrgrnd.
' <8� Foundation `
59. Gas Pipe, ❑ Undrgrnd., Test
60. Backwash Lines, P -Trap, 0 Undrgrnd.
9. Water Pipe-Undrgrnd.
to. Sa..,ecu.at Ftoor System c.
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
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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
"
20! Rough Factory Fireplace IV:
J
c > > ,APPROVALS
=O Permit #
21,�:DuCts, in Structu'rz `-. '- T"'
= •?
" `'
70 ,'nderground Hydro
s
c
.
22. Ducts, Ventilating •
t
s:"4-':71.
Product -,Piping El -Gas 0Oil
23. Gas Pipe -Rough &,Test °:
.,y
'.
72• Underground Flush
y _ - ,
24..Roof Framing- •t-
> -
�* .r x[73?
Undergrnd.Storage;Tank'OGas (3 Oil
25. Shathing.'
,
.4.674'-,Overhead*H
-
dro
_Roof
26. T -Bar Ceiling (Structural) &Monocoat
`1C JJ
_ .111 ,
7 � Dry Chemical C7 '
~'
27: Frame and Flasfiing Lon
"
76. Dr r n X
Y Standpipe ,u- -
28. Laihing-& Siding. ._
7: ••
x
77:; FIXED SYSTEM FINAL
29. Insulation
78- FIRE PREY. FINAL
30. Drywal l -Nailing ja
•-�
_ HEALTH,DEPT.. REQUIREMENT
31. Plaster Brown Coat:..79:
FINAL INSPECTION - - -
i
32:•Electrical PowerMeter-Final ' `
p7 I
I s,,80r.
_
FOOD CERTIF.ICATEISSUED
33,.Firia I Electric'Notes:
_ J-•
34, Firi21 Heating &Air Conditioning
u i
i
35:' Final Gas Pipe -Test
i"
' "' SG
., 36. Hood or Canopy -, - <
:, r. I
k
>
37 -,Final Factory Fireplace„
' 38. Final Plumbing ',y
39. Water Service -Final
�'
_
tY R •
,40. Gas Service.Final
,.41. Solar Domestic-Final4
( 0A,
'42?Backflow Preventer t
"
t
43. Backflow Irrigation '1'`:S
'_
`
-
:�� C
_+
44. Landscape Irrigation 5ystemJ:,j,.
PS
145: Sound Attenuation
_ 46- Handicap Regulations
'
•:; ;'
� ,,S -""
47.cFINAL STRUCTURE & BUILDING•
-
n
48.,FINALPLANNING
K'
u
49:• Electric Release to:Edison
`-
50. Gas.Release to Sodthern California Gas Cn
_
51. CERTIFICATE OF OCCUPANCY
:, Y
No Date
Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
_ _ _ - 3403_
I T - _ 522 /e5 �� Se QQ
) .
' • ,
CITY OF COSTA MESA ' CONSTRUCTION PERMIT.
Project Address
I '; i -
Applicant's Mailing Address
1
Owner's Name !' Phone a
Address
PER IT N
I �0
TRACT NO.
'
LOT NO.
r
'UNIT NG., - -
�_
TYPE OF CONSTRUCTION NEW ADD, ALTERATION REPAIR :.
❑ CONVERSION: DEMOLISH ❑ OTHERq:p.
DESCRIPTION' OF WORK/USE OF BLDG. '
# Zone
-
S
Main Building:. Accessory,6 uildmg' f !�
Arch/Eng. .:License No.
I
Address •
TYPE OF PERMIT GRADINGµ ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑'MECHANICAL ' '
1 ;❑, BOTHER - '
.PROJECT DESCRIPTION SQ. 'OCCUPANCY' -
CONSTRUCTION TYPE VALUATION$
ZONE GRADING CU.YDS. ;ACRES
Ti,Fiont
:= - l ( i - - j _• i ' i
p
B
Rear ,-i - �,
N
Contractor's Name- G - hopg
Address(mailingl �-}-
- [� )
City License No. a' '
LICENSED CONTRACTOR DECLARATION -
Phereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in f and effect.
License CI - nine l
Date L - Signature
C
Right _
G
K.
S'
-
Left - _ - - _
FT.
R
' i `,
'Flog, Ref: # Parking Req./Prrovided
EOt'
Remarks:I
Planning Notes: l
M
I
1 '
'
_'
_
- - - !
S
PLUMBING -
FEES
i l
WORKERS' COMPENSATION DECLARATION " '
1 hereby affirm that I have a certificate of consenpto self -insure or a certificate
Bar Sink
Showers
I ELECTRICAL i FEES
of Workers' Compensation insurance, or a certified copy thereof (Section
�1 `^'!' -1 ^' -- -
'3800, -Lab: , t
r Backflow Preventer-
- Service Sink --d -i..
_
.. _ ._ _ _ _ - _
Automaiic`Washer Transformer'❑15.50 KW
Backflow Irrigation
Sewer Ca P
Policy No. `'�J^�-IN ��� IY Company �.�, I ��
�rtifietl copy is hereby furnished.
Certi " copy is filed with the city u d' I o
Date APPlicant����/r 1
EXEMPTMPT NRKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for,one hundred ($100 or
less). )
I certify that in the performance of the work for which this permit is Issued, I
shall-notiemploy any person in any manner so as to become subject to the
Workers' Compensation.Laws of California. ,
❑ 50+ KW
Construction Pole Sub.
Bathtubs
Sewer Connection
Cooking Unit _ Meter ❑up to,100 amps, '
Clarifiers
Solar Collectors
Dishwasher r _ _ Meter ❑over 100 amps... _
Dishwasher
Solar Piping i
,Dryers ❑Gas ❑Electric Sub Panel,
Drinking Fountains
Solar Tank
Fan' :Motors ❑0-1 HP ❑1'/x -B
Floor Drains
Swimming Pool w/Spa
F.A.U. I
Inc. Solar ❑9-15 HP ❑16-15+
.,late Signature
NOTICE: If, after making this declaration, you should!become subject to the
, Workers' Compensation provisions of the Labor Code, you must forthwith-
comply with such provisions or this permit Sha11 be deemed revoked.
I
CONSTRUCTION LENDING -AGENCY
I hereby affirm that there is'a construction lerding agency for the performance
Floor Sinks t - _ '-
Urinal -- -
•
- -
Fixtures - - MIcfOW¢Ve
Gas Service - Outlets' -
-
_
Water Closet
es '
Device BoxPole Light
'
l:_ ,
Interceptors
Water Heater' l
Outlets Range
- of the work for which this permit is Issued ,(Section 3097 Civ. C.)
Lentler's Name' -
_I
= Kitchen Sinkt
-Water'Service'
Switchei " Sign I
Lender's'Atltl ress' - - -�
OWNER BUILDER DECLARATION- {1
I hereby,affirm that I am exempt from the Contractor's License La for the
fallowing reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve; demolish or repair
any structure; prior to Its Issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's. License Law (Chapter 9 (commencing with Section 7000) of'. ,
Division 3 of theBusinessand.Professions Code) or that he/She.-W exempt
therefrom and the basis for the alleged exemption.- Any violation of Section
Lavatories, I. -
Auto -Wash.
Garbage Disposal ;Standing Sections l
P -Trap
.
'Laundry Trays
" Generator ❑0.5 KW ❑5-15 KW i
Trash Compactor
Roof.Drains!
- l
-
7031.5 by any applicant for permit. subjects the applicant ,to a civil
malty, of not more than five hundred dollars ($500).
LJ I; as'owner of the property or my employees with wages! as their sole
compensation, will do the work, and the structure is not intended or offered
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a propertylwho builds or improves
thereon,tand iwho does such work himself/herself or through his or her own
employees, provided that Such improvements are not intended or of red for
( sale. If, however, the building or improvement is sold within one year,of com-
pletion, the owner will have the burden of proving he/she did not build or im.
prove for the purpose of sale).
❑ t as owner tr the property, Se exclusively contracting with stens can.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to r s owner of property who
j builds or -improves thereon, and who contracts for such projects with a -con-
tractor(s), license pursuant to the Contractor's License Law). I am aware that (
proof of their Worker's Compensation insurance should be provided to me.11
l
l ❑ lam exempt under Section B. & P. C. for this reason
m
Reinspection F.ee '.
;$15
r Issue Fee,; r
$ 3'y.'
f Rein Fee
$15 Issue Fee - '$ 3 l
-, MECHANICAL
-
'
FEES.
,
DEVELOPMENT SERVICES REQUIREMENTS:,
'
Zoning. Approved By Date
o
Building Approved By Date
Application Issued By Dat 1 Zi
i
Boiler
Hood or Type 1 ❑
Canopy , Type II' ❑ -
_
s
Duct - Under Ground
-
Duct -Structural -
Refrigeration System ,-
E.10-1 00,000 BTU ❑100,000,BTU
- -
Duct -Ventilating i -
- -- '-'
,
"` i i SUMMARY OF FEES I.
-�7 I'BUI LDING PERMIT $ I SMIP, l$
" PLAN,CHECK $ PERMIT '
+- ISSUANCE $
j"/J"`
= PLUMBING' $��
; PLAN CHECK 25% $ I + ENERGY P.C. �$ 1
ELECTRICAL ;$ GRADING' $
'p'. r
%.p CAN CHECK 50% $ MICROFILM •$ '
' � 1
r MECHANICAL $ TOTAL FEE I$ t- V
j PLAN CHECK 25% $
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBO #
Fire Dampers i
y)
-Date �' owner l
I -hereby certify that.11have read, this' application antl-state that One above -�--
information is correct. I agree to comply with all City.and county ordinances I
and state laws relating to building construction, and hereby authorize repre-
Sentatives of Ithis 'city to enter ;upon the ab ve-mentioned property for
,inspection our s. !
Signature - J Date
Drivers' License or SS 9i
Heating System &Ducting
X0.100,000 BTU -0100,00067
Registers I
-
, !
-
Reinspection Fee $15 Issue Fee $ 3
'MF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND PLANNING -
APPROVALS Permit #
_
Pate
Inspector
- _ POOL & SPA
APPROVALS Permit #
Date
Inspector
.1. 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-Uridrgrnd.
55. Electrical Bonding
• 5. Steel Reinforcement
56, Rough Plumbing & Pressure Test
=6• Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
,-7. Footings -
58. Electrical Conduit-Undrgrnd.
8. Foundation
;
- 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
-
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
-
61. APPROVAL TO DECK
1.1. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sevver-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 '
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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. -Roof Framing
-
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
-
76. Dry Standpipe -
28. Lathing & Siding
77. FIXED SYSTEM FINAL
-
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: �1-2 Lo. --7- r, -o
34. Final Heating & Air Conditioning
r zxjy
vy / 0
35. Final Gas Pipe -Test
03+
36. Hood or Canopy
i 3
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final -
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
`
44. Landscape Irrigation System
-
45. Sound: Attenuation
" 46. Handicap'Redulations
'47. FINAL STRUCTURE&BUILDING
'
48. Special Requirements Completed•
49. Electric Release to Edison -
-
- -'
50. Gas Release to Southern California Gas Co
1
,
1
-51. CERTIFICATE OF OCCUPANCY
N0. Date-
'
PROJECT ADDRESS: 1112 VALLEY CI
OWNER'S NAME: RUPPERTAMY KATHLEEN T 2
ADDRESS: 1112 VALLY CIR
COSTA MESA,CA 9262.7
642-1436
ARCH/ENGINEER:
ADDRESS:
UNIT I CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 59
(30 �(EYT'E
PERMIT NO: M 055948 PLAN CHECK NO: N GOVT; N SUP
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH
REG.NO.:
UNIT:
PERMITTEE: CRYSTAL AIR (714)630-5455
ADDRESS: 11801 MAC STREET
GARDEN GROVE CA 92641,
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and effect.
CITYIj 042006 STATE LIC.: 493924 cuss: 20
i
9aR: / �Y _q Z Signalere:
WORKERS' COMPENSATION DECLARATION: I hereby a0irm that I have a certificate of consent to self -insure or a certificate of Workers'
Compensation ��!{5yfp C��Y a c e copy Thereof (Section 3800, Lab,
POLICY NO.: *M� 4 41 EXP. DATE: 87/28/92
COMPANY: NATIONAL
❑ Cahill copy is herejby furnished. Cer ified copy is filetl A/`D the cityBuildingDivision.
AMe: I � re`� h
Applicant: � Ll-
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred ($11)0) or less).
I caddy that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the WorkersCompensation Laws of California.
Date'. Signature:
NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Coi you must Wool comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ, C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I, as owner of the properly or. my employees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
El and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ ,I am exempt under Section: B. 8 P. C.
for this reason:
Date: Owner
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant will/will not (circle ane) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date. Applicant:
I hereby certify that I have read this applicalion and state that the above information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction and herebya orae representatives of this city to enter upon the above-mentioned
property for inspectionpurposes. �
—Bete e�`C ct—9 Signature: yt �%//� �rk
Driver's License or Social Security a:
164146 White—Buildlnq', Green—Code Enforcement. Canarv—Apollcanl: Pink—Revenue', Goldenrod—Aeeexsnr
JOB DESCRIPTION : REPLACE FURNACE SQ FT:
CLAIM VALUE; 1,000.00 CALL—VALUE: GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR REgUIRED IN THE HOME
##############################################################################
Z 0 N I N GS E R T E B Q A U C I K R S E M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REO PROV: PARCEL: 42203111 ZNE: REF NO;
PLANNING N TES>
>
D E V E L O P M E N T S E R,,V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE; /
APPLICATION ISSUED BY; DATE:
###############################################################################
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 9200
5* SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 9,00 15.00 0,00 24,00 24.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 24.00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24.00
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY ll E S C R I P T I 0 N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAY FURN <= 100 K BTU 9,00 9,00
END OF FEES
Oi OOlO7157 OC10715? t JD—t 14 'ELI
C�1E: 01/14i'12 TIRE: 08;i:
CONSTRUCTION AND PLANNING
•APPROVALS Permit#'
'
Date
Inspector
- POOL & SPA
APPROVALS Permit #
Date
Inspector
.1. Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. -Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
-
54. Forms
4. Electrical Conduit-Undrgrnd. -
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. -
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8, Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61, APPROVAL TO DECK
-
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. 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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
'70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0011
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
>73. Undergrnd.Storage Tank 0Gas 0Oil
25. Roof Sheathing . _
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. -Frame and Flashing
76. Dry Standpipe ,
28. Lathing & Siding
77. FIXED SYSTEM FINAL -
29. Insulation
78. FIRE PREY. 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
l Zj YL-
-"
35. Final Gas Pipe -Test
-
-
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
.-39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irrigation System
-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
"
48. FINAL PLANNING
49. Electric Release to Edison
50'. Gas Release to Southern California Gas Co
'
51,. CERTIFICATE OF OCCUPANCY
No. Date
j
PROJECT ADDRESS:
OWNER'S NAME:
N711110w4KMI
CR
UNIT:
(714)548-4930
ARCHIENGINEER: MARC DALE REG.NU.: 2 2 13
ADDRESS: 250 NEWPORT CENTER DR UNIT: 200
NEWPORT BEACH CA 92714
PERMITTEE: CALIFORNIA SKYLIGHTS INC, (714)852-8541
ADDRESS: 17831 SKYPARK F
IRVINE CA,92714
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect.
D :024537 STATE uc.:380955
Date:
-5 -6 — � Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cenihcate of co nt to self -insure or a certificate of Workers'
Compensation %%�� ��{TcQ� Uhed copy thereof (Section 3800. Lab.
POLICY NO.: `• 1 J EXP. DATE: `v 1/ 0 1/ 9 2
COMPANY: STATE FUND
��AA
I Declined copy is hereby furnished. L'3 Certified copy is filed witW city Buil g Division.
Date. �6 ^f / Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be complet O the permit is for one hundred ($100) or less).
I Certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the WorkersCompensation Laws of California.
Date. Signature:
NOTICE: It, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C),
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the
Elstructure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 owneuwill have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section'. B. 8 P. C.
for this reason:
Date'. Owner
I do hereby comfy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that l or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant
I hereby certify that I have read this application and state that the
ordinances and state laws relating to building construction and hrZ-_l
property Ior inspection puurrposes.
Date: 'S__ 6 rp
— ` 1 Signature:
Driver's License or Social Security a:
to comply with all city and county
to enter upon the above-mentioned
1641,46 Whhe—Building', Green—Code Enforcement: Canary—Applicant, Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM O:
PERMIT NO: B 051942 PLAN CHECK NO: 01556-91 S GOVT: N SUPP:
CONSTRUCTION TYPE: 5-N PERMIT TYPE: SIR PURPOSE: ALT
JOB DESCRIPTION ; INSTALL ONE (1) SKYLIGHT (ICBO# 2469) SQ FT: 700.
CLAIM VALUE: 700.00 CALC-VALUE: 700.00 GROUP OCC: R-3 /
COMMENTS: NO RAFTERS CUT/ONE CEILING JOIST CUT,
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: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42203111 ZNE: REF NO:
PLANNING NOTES>
TETE****Bt BF BEiEiE9fiP**iOifaEiaiFiE*iEIPIE*TE 3EjEBEIEiEBF*BfiE*1EiE*iEiPiEiP*iF9E*3EiEiEiF9F9tBEatiEiEiriE9EBEiFBPBE�.**BEriP*1898*iF3E9EREiE9E
D E V E L 01-P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY- : DATE:
BUILDING APPROVED BY DATE: Jr-ll
APPLICATION ISSUED By DATE: —6
1N 1F iE 9E*9E 98989E*9818 *1E 9E lE lE lE 9E *9E 9E 9E *9E 9Eit 9f iE9E*9t 1E 1F
1F if iE iE iE iE*iE 1818189E 9E lE lE iF lE 9E 9F lE 9E lE 1E 9F iE9E if 9E*iE9P iE** **1P lE9P lE lE 1E 9P 1F 9E 1f 9E 9f if lF if*9E 1E 9E 9t 189E 9E lE 1F aE9E9c 9f 9F 9f ae *la 9E *9t 9F 1G lE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SMIP/RES GRADING
PERMIT 19.00 50
SMIP/NON-RES
PLAN 12.35
'ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 19,50 0,00 12.35 31,85 31,85 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 31.85 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
19,00 ,50 12,35
iE iE lE iF iE lE kiE ♦Eif 1E 9k 9k 9P 119E 1E 9F 9E 9F 1F lF*9E 9F 9E lF 9E 9E 9F***9E 1E 1P 9F 9E 9F 9P 9F 9F**9E**iF9F#*9E of 9E 9E iG 9F iE9F lE*9E 9F 16 iE 9k 1F *lE if *iE 1F *9P 9E**lE
I N D I V I D U A L F'.E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 700 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 700,00
END OF FEES
i14
0
01 00086605-00033507 TI
De
ATE: 05/06/91 1 1E: O's:26
7 ;,(
CONSTRUCTION AND PLANNING 7Datelmpector
POt SPA
APPROVALS Permit # ,.
APPROVALS Permit#
Date
Inspector
14lemporary Electrical Service Qr Poli.`
-52. Pool &Equipment Location
2:k6 I il-Pipe-Undrgrnd. -L' �;`
53. Steel Reinforcement
..`3._ElectricahCoiiduiitUtility-``Undrgrnd"�
54. Forms
'
-•�;4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5.'Steel Fieinforcemept ._ {
56. Rough Plumbing & Pressure Test
6.*ElectricalUFER:Grnd. x
57. APPROVAL TO COVER-GUNITE
7.-Footings
58. Electrical Conduit-Undrgrnd.
i_ �.x . v
r,
- 8. Foundation -
59. Gas Pipe, 0 Undrgrnd., Test
-
9. Water Pipe _Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.
,
,
10. StructuraRFlo& System t: •�;' •-+
61. APPROVAL TO DECK
11. Property Siwer,Linee & HoWe Connection
62. Backwash & Receptor-Final
-,
~4-
rs
12. Sewer Cap _' • ,L
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
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
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
-
- -
-1. T - r t,
rAPPROVAL'S -%Permit # 2 -5.
20' Rough Factory Fireplace I A S
'
G u z
21. Ducts, in Structures
0 -- s
-.70. Underground Hy_tlro
22. Ducts, Ventilating;* ! :�:`:�
^
" '4' '`
'71. Produc_Piping O'Gas 0Oil
23 ;Gas. ;Pi peF;Rough &Test
S _ •
-72. Underjroimtl Flush;.-. e
24.-Roof Framing ^'% .-'L "i~
% D O
r - `' •�
�73x Undergrnd: StorbR.Tank'0 Gas 0 Oil
25. Roof Sheathing •v' ✓.,, •
74^,Overhead Hydro`-` -
r
a
T
D'
Ceiling (Structural) &`-Monocoat
75TDry Chemical '" � �•
273 Frame and Flashin'
Si:�i
iirstt..:[:,
` 'r
76: Dy S{antipipe
n.,9: prx'x
;,28 Lathing,& Siding r -C IV J:
x.
77- FIXED SYSTEM.FINAL v
29. Insulation S
>
78sFIRE PREV. FINAL x
rs
30. Drywall Nailing V-`
�' I
�' -: j* *
•-+ HEALTH'DEPT. REQUIREMENT
Plaster Brown Coat*
PECTI,ONX31.
INS. •- ' r
S
32.; Electrical Power Meter: Final
+ �u
' ;
r80:nFO0D CERTIFICATE ISSUED
I
33:=Final Electric s
z'r I
`t Notes
,�
c�34. Fir1al Heating & Air Conditioning: n
v
.35::;Final
Gas Pipe-Test. �•
`f
x,
iCS t'' ?'- /n (/��
r36. Hood o1;,Canopv" , . _ .z
_ 2 C'::.:
;37:^Final Factory Fiieplace_
8
-3:.Final Plumbing .. Lo i
."39 -Water Service-FinaP r '�
+
r1 Will Y o:
S
!
X40"Gas Service Final ^'
;
i
X
2,,.tr
.. I
rr
,,,,•� s
y
417 Solar Domestic- Final• �'- ••
' =x
�:z
rt= �-
_
42: rBackflow Preventer,
43. Backflow Irrigation" • .x=• `,
' '
^r"c ° _
C.
Landscape Irrigation Systern:,r ,� a:
!: �-� r_
- - i. r
,; N
,;,44.
•,
45.--Sound Attenuation
X46.; Handicap Regulations
'47:�FINAL STRUCTURE &BUILDING!
•_ �
i�7-S
,
48.f'FINAL PLANNING
'
Release to.Edison I
-49.:Electric
'-60..Gas.ReleAse to Southern California Gas Cu
>
i
7
��
J G•i-moi X ,
,- rj
-
_ :,.,
.51. CERTIFICATEOROCCUPANCY
; Bt L 7 •, v
No. Date
IF 1
28112
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 02SM
For Applicant to Fill In Completely
TYPE OR PRINT
IB '///9
COSTA MESA, CALIFOR IA
MAIL
RECEIPTNO.
PH Ij 4 1112
ADDRESS
DA —779
JAN 21y1[j-2 1966
BUILDING
ADDRESS
TEL.
CITY
APPROVED
NO.
ARCHITECTTEL
ZOn}�
/UUV
no. oP
OR ENGINEER
NO.
ADDRESS
LEGAL /3
Ll
I
CONTRACTOR
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
ADDRESS
ALLOWED (U. B. C. REQUIREMENT)
YARDS APPROVED
CITYIMATETIE
i 1
ACCESSORY BUILDING
[PROM C/LSTREET) 1
f
C. NO.
NO.
SIZE n
I
FT.
NO. OF RLDDs. - / I
OF LOT i'i �
x V LP
FT.
Now ON {AT '/V L
USEOP
DISTANCE BET.
BET. MAIN e
EXIST NG BLDG, Jy D /V•t�
ACCESS. BLG.
DS
BHTaACK LINE FRON
CENTER of STREET O
REAR YARD
SIDEYARDI LEFT
I RIGHT
BY V'
DESCRIPTION OF WORK
NEW
cnliinc Ir)JT<
ALTERATION
ADDITI N
60. FT.
REPAIR
PURPOSE OF aBTABLIENINO A PERM\T PHH ONLY.
MOVING
PAM2LLEH
PERMIT FEE 5(p
BUILDING 1J
j1 �/ �7 NO. OF
SIZE 6�
/ J-- / ROOMS
PPORIES
EXTERIOREXTERIOR WA�U�OI
COVERING
COVERING��OCOVERINGG
U$$ OJ BU II�GINS
, N4 WORK T0�E-PERPOR,
I HHR)IBY ACKNPYnXDGK THAT 1 HAYS READ THIS APPLICATION
AND STATE THAT THE ABOVE la CORRECT AND AGREE TO CON.
PLY WITH ALL CITY ORDINANCES AND aTATa LAWS REGULATING
BUILDING CONSTLTION.
SIGNATURE OP�
AUTHORIZED AGENT
A-16-6&=--00 570+ ****94.50
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPTNO.
PH Ij 4 1112
R[C[IY[T- ,61
DA —779
JAN 21y1[j-2 1966
BUILDING
ADDRESS
FIRE n pL
ZONE TYPE GROUP 1-3/ /
APPROVED
BY DATE
ZONING
ZOn}�
/UUV
no. oP
Ui[ or Naw / L' -a ,
-BullDlno
runt
1
LEGAL /3
Ll
D"CRIMON
A. P. NO. J
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
9O- TO SION a REAR P. L-
EAVES EAVES
ALLOWED (U. B. C. REQUIREMENT)
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
[PROM C/LSTREET) 1
PRONT
Fr.
R. SIDS FT,l
FT.
/i
L. SIDS .45 PIT.
FT.
REAR PT.
Fr.
DISTANCE BET.
BET. MAIN e
MAIN BLD1/
ACCESS. BLG.
DS
VAR. * y —,� 9-& 7
DATE i% /
%— (
C. U. P.
APPROV
APPROV �/�/
I
_/
-O
BY V'
DATE
LlnrT Onn Vncf'nT
cnliinc Ir)JT<
60. FT.
TH8 AMOUNT KNOWN UNDER VALUATION IB POR THE
PURPOSE OF aBTABLIENINO A PERM\T PHH ONLY.
VALUATION
PERMIT FEE 5(p
g
PLAN CHECK S. Sv
TOTAL FEE
OPOSTA
O
w
F -
Q
J
Q
Y
J
C
w
ta
O
cc
CL
z
W
x
F
LU
IL
CL
O
C/)
to
2
H
MESA BUILDING—SAFETY DEPARTMENT
P.O. BOX 1200
Costa Mesa, California
PA_.I J r
117
FORM OU -34
BLDG. PERMIT NO.
PERMIT NO.
1 1 1
1
TRACT NO. RECD. BY
CONTRACTOR
LOT NO. DATE ISSUED
Address�5
BUILDING USE
/
Ci
el. No'
BUILDING
4?
ADDRESS
State License N4„
n
Class. V
COSTA MESA. CAL RNIA
I V
NEAREST
City License No. L�
CROSS ST. ti
OWNER - F 1
NUMBER TYPE OF FIXTURE OR ITEM
FEE
MAIL
Water Closet (Toilet)
ADDRESS
— + ].
Bath Tub
CI { a. L. NO �J
Shower
I hereby aclmowledge`that I have read this application
Lavatory (Wash Basin)
and state,ttiat the above is correct and agree to comply
Kitchen Sink
with. aUj_City Ordinances and State Laws regulating
Laundry Tub or Tray
plumbing.,
Iy-� I certify that I possess the above valid state of Cali-
Service Sink
'
Cforma classification or I am the legal owner of the resi-
Floor Sink
--- `
dential property de 'bed a ve.
Floor Drain
/
Dishwasher
y N."C'VY
'^ ^
Signature of kJL(�//yG�
Permittee
Drinking Fountain
Urinal
INSPECTION RECORD
Carb age Disposal ,'"�"-ai
�l�
•I
Automatic Washing'hlach. t,
^ /� T�
/'m ,� '4.-�'j,...-.i ,4'D tio--A ' J�
Water Snftnner. i(t \.
Water Heater &'Veni
R,,V'r, tar h. ) -
SwimPriol Filter System
Gas System ... Outlets
Lawn Sprinklers
natallation or 'Iteration -
"a`1.P'`"
APPROVALS
Back Floe Prcvcnter
Pf0r, SCWCL
(l.
INSPECTOR DATE
U/G Soil I I
Cess ool Septic Tank
U/G —Water I I
Services—Water ❑ Gas ❑ I I
%liscellaneous
Rough Plumbing I I
Sprinkler System I
Gas
Property Sewer
Pool Receptor
Filter System I I
Pool Heater I I
Miscellaneous
I,v,vuing Permit
00
I I
-
Final Gas I
TOTAL FEE
I 5��
Plumbing Final
Utility Co. Notified I I
FORM OU -34
BLDG. PERMIT NO.