HomeMy WebLinkAbout365 19TH ST - Building Permitsi
! CITY OF COSTA MESA � � '
� BIIILpING DIVISION
� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(716) 754-5273 • Fax (714) 754-4856 • www.G.costa-mesa.ca.us
�•� � FOR INSPECTIONS CALL: (714) 754•5626 . .
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PERMIT NUMBER: BX08-00327
PERMIT TYPE B_MISC STATUS: ISSUED.
ApN: 11729417 DATE ISSUED: 11/17/2008
Zoning: , ISSUED BY: RMD
•
JOB ADDRESS: 365 E 19TH ST CM --- Suite/Unii:
ViCiniry. " �PrimaryOcc:' �, � � ConstType� :??
Sq. FT: 0 - . ' . ' �Valuation:` � � 5��,000.00 . � �- •
SCOPE OF WORK: ' . . , , . , - _ -
PERMIT TO LEGAL2E THE CONSTRUCTION OF A F.IREPLACE/BBQ CONSTRUCTION W/OUT PERMITS WITH 2 EL OUTLET
GAS OUTLETS. r"� � �Z/' � ""' `%'! ' � � � ' , � '
OWNER: FOGG, CRAIG S� ���� .. .`„ Address: 365 E 19TH ST '• �. Unit �
City/Stale: COSTA MESA, CA � ., � � . 2ip'Code:� . 92627 .. .
Phone: 949 2753160 , . , . , � ,. , ' . i;,,r
� .,.:...� ' �� .. � . , r ., . . " ; .. .
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APpLICANT: FOGG, CRAIG S , � � i J, � � � � �,Address: 365 E 19TH ST � � ' � ��� . Unit: .
City/State: COSTA MESA, CA � 2ip Code; 92627- ., �-
. . • ',
Phane: 949 27531§0 � �,� �" � - '. .. .� -. .. _.... : , : .. .
C�NTRACTOR: OWNER-BUILbER ' �� - - - - � - ���� � LicenseNo..�'�000000.-4��,
Atldress: - � ' � . � ' � - � UniC
City/State: ' _ - - '
Zip Code: � , . ' . � - .� � Phone . , . � � -, rCeil: .
ARCHITECT: , �• , � Cicense No. - " s� ��-� �
Phone � .
ENGINEER: � . : � � � License No: ��- = �� � � �
Phone - .
� . 'FEE��SUMMARY, , , , � r .: t :;'
Building Plan CHeck: "-$0.00?�'' � � �
Building Permit: . _ - , _� $195.25
Electrical Permit: '-�"� . � �' "�$2.00 � � � �' � �
.
SMIP Residential . '-'•$1.10 � . - �� � � � '
SMIP Commercial � $0.00 �t
TOTAL FEES $208.15 . , ��
�
NOTICE: The work auNorized by this permit shall comply with all applicable handicap access requirements under Califomia slatutes and ralated
regulations. (Ord. No. 92-28, § 1. 12-21-92) � � . . .
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . � ,,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wilh all applicable wdes, and all
raquired Inspections antl final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this De�it.
CODEt ixsvecnoHirre
1818 Fixetl System Final Fire Prevention
1288 Pool Spa Final
200 Final Re-RoOf
ZO7 Final Bip�k/Retaining Wall
202 Final Factory Fire Place
Z03 FinalSign
204 Final Dertwlition
PeIF IN11ilAL5
y4p�a ixsrccnoxTrre
ZOB Final Mech�nical
208 Final Plumbing
Z70 Final Electncal
212 Final Fire Prevenlion
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
P�g . INTff4L5
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WORICERS' COMPENSATION DECLARATION.
I hereby aRrm unAer penalry of perjury one M the following deGarations:
t
❑ 1 have antl will maintain a certificale of consent to self-Insure for workers'
wmpensation, as provided for by section 3700 of Ihe Labor Code, �or the
peRormence ol the vrork lor whlch thls permil la lesued.
❑ I have and will malntain wvrkers' compensatlon Insurance, as required by
sectbn 3700 of tha labor Code, for the pedortnance of the work fw which this
permit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carriec
(Thk settiw� neMnd Ee mmplefetl d Na pcvmf a vaqretl a! are �uM�M NWrs (f f00) d less /
Po�licy Number:
�T.."'I certify lhat in the peAortnance of the work for which lhis permit is
issued, I s�all not employ any person in any manner so as to become subject
lo t�e workers' compensation laws of Califomia, and agree that it I shoul0
becomgcsubiect lo the workers' compensation provisions of Section 3700 of
Ihe L7 ;;��Cotle, I 5 forthwilh comply with these provisions.
L/ov 1 ( i O
Ap Ii�anCs Siy re ate'
j_� --
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERP,GE
IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST. AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions ol Chapter 9(commencing
with Section 7000) ot Division 3 of the Business and Professions Code, antl
my license is in full force and eflect.
lic. # Class #
ConVacbr's Sipnalurc " Data _
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn Ihat there is a constructbn lending agency fa lhe
peAortnance of the Nvrk for v.fiich this pertnit is issued. (Sec. 3097, Civil CoOe).
Lender's Name:
Lender's Adtlress:
SB��um Dale
OWNER-BUILDER DECLARATIONS:
I hereby af(irtn that under penalry of perjury lhat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5,
Business and Pro(essions Code: Any ciry or county which requires a permit lo
consWct, alter, improve, tlemolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant ro the provisions of Ihe Contreclors
License Law (Chapter 9(commencing wilh Section 7000) ot Division 3 of Ihe
Business and Professions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant br a permit subjecis the applicant lo a civil penalty of not more than
five huntlred dollars ($500).):
�.--1, as owner of the property, or my employees vrith wages as iheir sole
compensation, WILL DO THE WORK, and the slmclure is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: 7he Contractors
License Law dces not apply to an ovmer of property who builds or improves
thereon, antl who does such work himself or herself or throuqh his or her own
employees, providetl that such improvements are not intended or offered (or
sale. If, hovrever, lhe buil0ing or improvement is sold within one year of
completioq the ovmer-builder will have the burden of proving that he orshe
did not build or improve for purpose of sale.�. ,
❑� I, as owner of ihe �property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to constmct the projecl (Sec. 7044, Business antl
Professions Code: 'fhe contraclps License Law dces not apply to an ovmer of
property who builds or improves thereon, antl vfio conlracts fa such project with
a cmlracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec.
Business and Protessions Code for this reason:
l� �
Slg ��at
905)-a6(�/01)
3
Owner ID verified by d� nse. ❑ Yes ❑ No �
+Orivefs License No. / Expires' � l l3 LZ
Verification of Ownership by (rype ol document, i.e. - pioperty laz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �• '
❑ I hereby ceAAy that no exwvatbn frve (5) or more (eet in deplh into wfiich a
person is required to tlescend, will be made in connection with vqrk authorized
by iNs pertnit, and that no building structure, scaHdding, falsework, v tlemolition
or tlismantling thereol, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Cali(omia Adminislrative Cotle).
❑ As ovmer-builder, I will not employ anyone to do vrork which vrould
require a permit (rom lhe Division of Indusirial Safely, as noted above, unless
such person has a pertnit to do such work from the tlivision.
AOPliu�nl'S Signature Da�e
Division of Industnal Safe�y Pertnit Number:
HAZNRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a ha¢ardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Heal[h antl Safery Code requires, with some
exceptions. Ihat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantity of hazardous materials equal to or greater I�an a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at slantlartl temperature antl pressure).
2. Dces or vrill the applicant or present or future building occupant neetl to file
a regislration form for acutely hazardous matedals? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires regislralion with ihe Costa Mesa Fire Depahment by
each business which at any one time has on hantl a quantity of acutely
.hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200-cubic feet of compressed gas at slantlard_
temperature and pressure).
3. Does or will �he applicant or presenl or fulure builtling occupant need [o
prepare an RMPP (Risk Management antl Prevention Program tor awlely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Healt� and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certification antl
filing with the Fire Department of an RMPP by businesses which are required
b regis[er acutely hazartlous matenals wilh the Fire Department.
4. II an RMPP is presently required, has Section 25534 of lhe Cali(omia
Health antl Safery Code been fully complied vrilh? ❑ Yes ❑ No
5. Dces or will the applicant or present or fulure building occupant require for
the work which is the subject of ihis applica[ion a pertnit for suc� construction
or modificalion from the Sout� Coast Air �uality Management District or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Section 658W2 of the Califomia Govemment Code requires that the requested
infortnation be fumishetl on applicaCrons for rwn-residential builtlirg pertnits).
6. Will any part of lhe facility to be constructed under this pertnit be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
pf yes", the facility must meet the requirement o( Sections 25534 and 42303
of the Califomia Health and Safely Code).
7. If a permi[ from the South Coast Air Quality Management District or other
air polWtion control districl or agenq is required !or the woB which is the
subject o( this application, have all o/ lhe tlisclosures prescnbed by Califomia
Health and Safety Cotle Section 42303 been made? ❑ Yes � No
8. (If yes", attach certificate of compliance from ihe appropnate air polWtion
control oKcer). ' � � �
CER7IFICATE OF COMPhIANCE: I certify4hat under penally-of perjury the
information given above is correct. I agree to,compty vrith all state laws antl
city ordinances regartling Hazardous Materials and Emissions. ,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' I
certify under penalry of perjury that I have read this applica6on and slate. that
the intormation given is correct I agree to comply with all state laws and ciry
ortlinances relating lo building construction, antl authorize represen[alives of
the Cily ot Costa Mesa to enter upon the above-tlescnbed property for
insp ion purposes. I agree not to occupy or allow occupancy of any building
aut ' edby thi rmit until fnal inspection. - �
� l _
_ nawrealL Ownei�s� O�e'__�
And/or Au��orizeE Applican� Dale
cirv oF cosra mesn
B111LDING DIV/SION
77 FAIR DRIVE, COSTA MESA. CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.w.0
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER. E08-00068
PERMIT TYPE ELEC STATUS:
APN: 11729417 DATEISSUED:
ISSUED BY:
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JOB ADDRESS: 365 E 19TH ST CM Suite/Unit:,=.r`..
Vicinity: WATERHEATERATREARSFD .�**.`�`�^����'.�;�
r, —t.y � . ; ,' .
SCOPE OF WORK: INSTALLATION OF A TANKLESS WATER HEATER AT THE REAR bF�A1V EXI
.�y,SV14L.
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OWNER: FOGG, CRAIG S
PHONE:
APPLICANT: FOGG, MELANIE
PHONE: 949-642-6431
Address:
City/State:
nit Fee:
Fee
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NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspeclions and final approval will result in the expiralion of Nis permit.
COOE L�� �,-r"PAIE �— L�ASS S�PF! Itl�4Il4tl.2Y� t't,t�+p„ r� •PA1� �1S ' .
4
�!i8i8 � Fized Sydtem Final Fua PrevenUon .� '- - � � � 209 Flnal MecFiamcaf �� �` � � - '
- .a� . . � a.;
/n 1288 . �PoolSpa Flnep` - p a� � ,,,t � ' - " , � 208 . Final Plumbmg . , ' �/j���/�-� ���,,,�
-� L t. ..1 i=� �. s_5d' V
--200-. �, Final Re-Rool�"� { 4" � T' , 210 Final Electncal �p�,� s� �.
. . �: :! g . ' � r � f p. � = � . . �. k r . -. T .+
*:�241�;�FinalBlocWRelainingWall i44.'�.� :t �u��+..�� 212e�FinelFraPrevenNon_�"-' S�'"n r
• 202 �`� Final Factory Frte Place 1: -,, :: r - � �:' '- �"' - .J 720 �r Fnal PlanninB Approval '+ '� �
,C :w - , j , ,
� 293 .�'�Fin�al Sign �{"^�f ,. l � i-� l r` ( r'Ai a---c '� j 222 � Finel Site � f� .
��. i t
.'204. FinalDemoLhan i f . ....-.G : _ ..� � y$p t�c FinalBuilding/Octupancy � �
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,
WORKERS' COMPENSATION DECLARATION:
I here�y aKrm under penally of perjury one o( Ihe ring declarations:
❑ I have anG will maintain a certifcate o1 consent to self-Insure (or workers'
compensation, as provided for by section J700 ol Ihe Labor Code, lor Ihe
peAormance of tne vrork for which this permit is issued.
❑ I �ave and vrill maintain v.orkers' compensation insu2nce, as required by
section 3700 0( the Labor Code, for Ihe peHortnance ol Ihe v.ork lor which lhis
pertnit is issuetl. My �wrkers' compensation Insurance carrier and policy
number are:
Carrier.
(IDrs seCion neetl ro� Ge compleletl dtne pennrt ra vaWetl al we n�nErvd Oona�s (5�00) w�ess )
Policy Number:
❑ I certify thal in the peAormance of the work lor which this permit is
issueC, I shall nol employ any person in arly manner so as to Eecome subject
to the workers' compensalion laws of California, antl agree ihal if I should
become subjetl to the wwkers' compensation provisions o1 Settion 7700 of
the Labor Code. 1 shall forlhvrith comply with these provisions.
Ppd��nfs Signalure Da�e
WARNING: FAILURE TO SECURE WORKFRS' COMPENSATION COVER4GE
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVII. FINES UP TO ON� HUNDRED THOUSAND DOLLARS
($100,000), IN A�DITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIOED fOR IN SECTION 3706 OF TNE LABOR COOE. INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby alfirtn that I am licensed under prOvisions ot Chapter 9(commencing
wilh Seclion 7000) of Division 3 0( Ihe Business and Protessions Cotle, and
my license is in full force an0 eHect.
Lic. # Class t!
Gomracb�'s S�gnawrc Oa�e
CONSTRUCTION LENOING AGENCY:
❑ I hereby aKrtn Ihat there is a constructbn lending agency for lhe
peAormance ol the �.ork 1« wfiich tttis pertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I �ereby aKrtn that untler penalty of perjury t�at I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5,
Business and Professions Code: Any cily Or counly which requires a permit to
consiruct, alter, improva, tlemolish, or repair any strucNre, prior to ils
issuance, also requires the applicaM for such permit to file a signed statement
that he ar she is licensed pursuant b the provisions of ihe Contractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of the
Business ana Professions Cotle) or Nat he or she is exempt l�erefrom antl
the basis for Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant lor a permit subjects the applicanc ro a civil penalty of not more than
fve �untlre0 tlollars ($500�.�:
❑ I, as ovmer of the pmperty, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the structure is not intentled or
oflered for sale (Sec. 7044, Business and professions Code: The Contrecrors
License Law does not applY to an owner ol property who builds or improves
thereon, and who does such work himsell br hersel( or through his or her ovm
employees. Orovided that such improvements are not intended or oflered for
sale. I(, �owever, lhe building or improvement is sold within one year of
completion, the owner-builder will have I�e burden of pmving that he or she
did not build or improve br purpose o! sale.). .
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the project (Sec. 70a4. Business and
Prolessbns Code: T�e coNractors License Law tices nol apply to an ovmer of
pioperty who builds or improves thereon, and who cont2cts for such project vnth
a cmtracta�s) licen5e pursuant to Ihe Contrgctors License Laws.),
❑ I am exempl under sec.
Business and Professions CoOe !or this redson:
Owner ID verifed by drive nse. ❑ Yes ❑ No " � '
Dnver's license No. Expires:
Verificalion o! Ovmership by (type ot document, i.e. - propeny tax Dill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereDy certAy lhat no excavalbn frve (5) or mwe feet in depth into vfiich a
person is required to descend, vrill be made in connection vnth vrork authorized
by this pertnit, antl thal no builtling sWCWre, scatfdaing, (alsework, a tlemolition
or dismanUing thereof, v.ill be more than thirty-six (J6) feet high. (Chap. J2, Grp
2, Art 2, Sec. 341, Tlle 8, Califomia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit fmm lhe Division of IntlusMal Safety, as'noted above, unless
such person �as a pertnit lo do such work from the division.
Appivam's SgnaNre Oate
Division ot Indus[rial Sately Permit Number.
HAZAROOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ne applicant or p�esent or future building xcupant need to file and
certi(y a Business Plan for emergency response to release or lhrea[enetl
release of a haiardous material? ❑ Yes ❑ No
(Seclion 25505 of the Califomia Health and Safery CoOe requires, with some
exceplions. lhal a Business Plan be filed with the Cosla Mesa Fire
DepaAment Dy every business which has at any one time Curing a reportetl
year a quantiry of hazarAous malenals equal ro or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cuhic feel of compressed gas
at standard lemperelure and pressure).
2. Does or will the apDlicant or present or fuNre builtling occupant need to fle
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0/ the California Heal[h and Safery Code, with some
eaceptions, requires registration vrilh the Costa Mesa Fire DepanmeN by
each business wfiich at any one time has on �and a quantity of acutely
hazarAous mafenals equal fo or grealer than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at sWnCartl
temperawre ana pressure�.
3. Does or will the applicant or present or future huilding occupant need to
prepare an RMPP (Risk Management an0 Prevention Program br aately
hazardous materials�? ❑ Ves ❑ No
(Section 255J4 of Ihe Califomia Health and Safery Cotle provitles that Ne
Cos1a Mesa Fire Department may require the preparation, certificalion and
fling wilh the Fire Department of an RMPP by businesses which are required
to register acurely hazardous materials with Ne Fire Department.
4. If an RMPP is presently required, has Section 25534 0( the California
Health anC Saley Code been fully complied vnth? ❑ Yes ❑ No
5. Does or will t�e applicant or pre5ent or fulure building occupanl require for
the work whic� is lhe subject ot this application a permit for such cons[ruc[ion
or modifcation from Ihe South Coast Air Qualiry Manaqement DisMct or Irom
any other air pollulion control tlistrict or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code repuires that Ne requested
infortnation he (umished on applications (a non-resitlential builtling pertnits).
6. Will any part of the faciliy to be constructed under ihis permit be wimin
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes", the faciliry must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code�.
7. I( a pertnit fmm the Soulh Coast Air Ouality Management Disldct or other
air polWtion control tlistrict or agency is required for lhe work which is lhe
subject of this application, have all of Ihe disclosures prescribed by California
Health antl Safety Code Section 42303 been made? ❑ Ves ❑ No.
8. Qf "yes", attach certifcate of compliance from the appropnate air pollNion
control ofOceq.
CERTIFICATE OF COMP�IANCE: I certify that under penalty of perjury the
informalion given aDove is correct. I agree to comply vnth all state laws and
city ortlinances regarding HazarEous Materials and Emissions.
' S�Snalure Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree lo comply wilh all stafe laws antl city
ordinances relating to building construction, and authorize representatives o(
the Cily of Costa Mesa lo enter upon the above-descrihed property !or
inspection purposes. I agree not to occupy or allow occupanCy o( any building
authonzed by ihis permit until final inspeclion.
Signalure ol Legal Owner�s)
J09.afi (]r0]1 —
AnOlorAulhonzeE
..
• `1. � .
� CITY OF COSTA MESA �
BUILDING DIYISION �
r � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wv✓w.ci.cosla-mesa.ca.
r �
�. FOR INSPECTIONS CALL: (714) 754-5626
�m �'.
PERMIT NUMBER. E08-00068
PERMIT TYPE ELEC STATUS: ISSUED
APN: 11729417 DATE ISSUED: 0212612008
- ISSUED BY: BJK
. ". � -
JOB ADDRESS: 365 E 19TH ST CM ' Suite/Unif: `
Vicinity: WATER HEATER AT REAR'SFD �� -
SCOPE OF WORK: INSTALLATION OF�A TANKLESS WATER HEATER AT THE REAR OF AN EXISTING�SFD. REF: P08-00061 1 RES APPL
•`. ,
f��;,,' , , ,
OWNER: FOGG, CRAIG�S �� '�°�"�� � Address: 365 E 19TH ST'`�Unit: � •
PHONE: ' � . - . . .. City/State/Zip: ; COSTA MESA, CA �
APPLICANT: FOGG, MECANIE "� , �' � Address: 365 E 19TH ST Un(k '.
PHONE: 949-642�643� ', ,, - City/State/zZip: COSTA MESA, CA , .,'.
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit: � � . PHONE: � �� � - — .- - - ;
City/State: ' � ZipCode: � � - � . . �. .CELL: � � . .. � �
,. ,. � . . , ._ � , .�, . . �'�
' ' ��.''�� ' . ._...:,. �. .� .. . . . .. .. .: ' .y.,
ELECTRICAL PERMIT FEES - � ' . � � -�'
Electrical Plan Check Fee: $0.00 -
Electrical Permit Fee: � , $2825 . . -,
Reinspection Fee � $0.00 � '
TOTAL FEES � � $28.25 '
T� ,
.� � _ ' _ � z \` r . " •
� � `,�% L=,"
��
. �� <
�� ���
���
:
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes. and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
LOOEt, INSPECTONTYPE �RT� INTTIALS �$ INSPEC710NTYPE �pT INTI71pL5
1816 Fixed System Final Fira Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Rool 210 Final Electncal
201 Final Blwk/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition - .. . 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION�
1 hereby atfrm under penalty oi peryury one oi the following declarations:
❑ I have and will maintain a certificate of consent to sett-Insure for workers'
compensalion, as provided (or by seclion 3700 of the LaDor Code, for the
peAormance of Ihe work for which this permit is issued.
❑ I have and will maintain workers' wmpensation insurance. as required by
sectbn 3700 of the LaDor Cotle, for the peAormance of ihe vrork for which this
pertnit is issued. My workers' compensation Insurance carriar antl policy
number are:
Carner:
(Tha secfion neetl iwl Ge mmdefetl d Ihe pemut 6 value0 af ona hunWeO �Ilars (Ef00) a kssJ
Polity Number:
I certi(y [hat in the peAormance of the wrork for which lhis permit is
sued, I shall not employ any person in any manner so as lo become subjec[
to ihe workers' compensation laws of Califomia, antl agree ihat if I should
bewme subject to the vrorkers' compensation provisions of Seclion 3700 of
the Labor Code, I shall foAh 'th comply with these provisions.
' a�c-�In�OF�
Appliranl's S�8^a�ure Oate �-
WARNING: FAILURE TO SECURE WOR RS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm 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 full force and eflecl.
Lic. # qass #
ConVaclor's Slgnawre �ate
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a consWction lending agency for Ihe
peAormance ot tle �nork for v,hich this pertnit is issuetl. (Sec. 3097, Civil Code).
LenOer's Name:
Lender's Adtlress:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5,
Business and Pmfessions Code: Any ciry or counry which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such pertnit lo file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0! the
Business antl Professions Code) or that he or she is ezempt therefrom antl
the basis tor the alleged exemption. Any violation of Section 7031.5 by any
appliwnt for a permit subjects the applicaM to a civil penalry of not more than
�ve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and [he structure is not intended or
oBered tor sale (Sec. 7044, Business and Professions Code: The Contracbrs
License Law dces not apply to an owner of property v+ho builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, proviCetl that such improvements are not intendad or oRered for
sale. If, however, ihe builtling or improvemen[ is sold within one year ot
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
�I, as ovmer of the property, am EXCLUSIVEIY CONTRACTING WITH
NSED CONTRACTORS to constmct the projec[ (Sec. 7044, Business antl
Professbns Code: The cont2ctors License law dces no[ apply to an owner ot
property who builtls or improves thereoq and who contracts for such project vnth
a contractw(s) license pursuaN to the Con[ractas License Laws.�.
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
� - a �a�lo�
Signalur � ' Dai�-
305]-C6(3/0])
.
�.
Owner ID venfietl Dy driv� Yes ❑ No +
Drivers License No. Expires: R��o?O�I ap� D'Z,
Verification of Ownership by (type o( document, i.e. - property tax bili or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereGy certRy that no exwvalbn frve (5) w more feet in depth into wfiich a
person is required to descend, vrill be made in connection with v.ork authorized
by this permil, antl that no building struc[ure, scaffdaing, falsework, or demolition
or dismantling thereof, will be more than ihirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, TiUe 8, Califomia Administrative Code).
❑ As owner-builtler, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a pertnit [o do such work from lhe division.
Appliwnl's Signa W re
Division of Intlustnal Safety Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or fuWre building occupant need to fle and
certify a Business Plan for emergency response to release or lhreatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety CoOe requires, vnth some
ezceptions, Ihat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quanlity o( hazardous matedals equal ro or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic leet of compressed gas
at standartl tempe2ture and pressure).
2. Does or win the applicant or present or fuWre building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Healih and Safery Code, vrith some
exceplions. requires registration with the Cos[a Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous malenals equal ro or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic teet o( compressed gas at standard
temperature antl pressure).
3. Does or will the applican[ or present or fulure building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health and Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to regis[er awtely hazardous matenals with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali(omia
Health and Safely Code been (ully complied with? ❑ Yes ❑ No
5. Does or will Ihe appliwnt or presen[ or fuNre building occupant require (or
the work which is the subject of this application a permit for such conslruction
or modifcation from the South Coast Air �ualiry Management Disiricl or from
any other air pollution wntrol disMct or agency7 ❑ Yes ❑ No
(Seclion 65850.2 of the CalHomia Govemment Code requires that the requestetl
intortnatbn be fumishetl on applications for rron-residential builtling pertnits).
6. Will any part of the faciliry to be consiructed under this pertnit �e wilhin
7000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
(If'yes", the facility must meet lhe requirement ot Sections 25534 and 42303
of the California Health and Satery Cotle).
7. If a permit lrom the Soulh Coast Air Quality Management Districl or other
air polWlion contml district or agency is required for the work which is ihe
subject of Ihis application, have all of the disclosures prescribed by Califomia
Health antl Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certificate of compliance from the appropriate air pollution
wntrol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury lhe
intormation given above is correct. I agree to comply vrith all state laws and
city ordinances regartling Hazardous Materials and Emissions.
Signalure Dal¢
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalty of perjury that I have read this application and state that
the intormation given is correcl. I agree to comply wi[h all state laws and city
ordinances relating to building consiruction, and authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnit un il final inspeclion.
� a/a��o�
SignaWre o1 Lepal Ovmeqs Dale
AnClor Aut�onzetl ApO�iwnt Date
„__. .., �
� '” ^ � �� I
" CITY OF COSTA MESA . '
, BUILDING DIVISION
t � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
".����� FOR INSPECTIONS CALL: (714) 754-5626 ��
PERMIT NUMBER+'E08-00067
PERMIT TYPE ELEC STATUS: ISSUED
APN: 11729417 DATE ISSUED: 02126/2008
ISSUED BY: BJK
JOB ADDRESS: 365 E 19TH ST, CM� . ' Suite/Unit: '
Vicinity: METER AT LEFT SIDE SFD . ,-- �,
SCOPE OF WORK: CHANGE-OUTELEC SVS AT�AN:EXISTING SFD; SVS WILL BE RELOCATED TO THE LEFT SIDE OF THE RESIDENCE.
1 SVS TO 200A NO OTHER WORK AUTHORIZED�WITH THIS PERMIT. �.
> � ,
:_.; , . .�. ..
OWNER: FOGG, CRAIG�S- � �` .. . . 'Address: 365 E 19TH ST �UniY. - � ,_ �
PHONE: , � . � ' , _ - �City/Stete/Zip: COSTA MESA,�CA �,,' - � ,
� - �, s;� ,. _ _ � -
. ;:. --� � .� '��
APPLICANT: FOGG, MELANIE .'- j . "�� `. �' � '� � Address: � �� �365 E�d9TH ST ` Unit:. �� � ..
PHONE: 949-642-6431 , , .". , City/State/zZip: COSTA MESA, CA
CONTRACTOR: OWNER-BUILDER � —�
Address: Unik PHONE:
Ciry/State: � ZipCode:
ELECTRICAL PERMIT FEES '
Electrical Plan Check Fee: . . , $0.00
Electrical Permit Fee: �'> _$54.00
Reinspection Fee ` $0.00 '
TOTAL FEES '$54.00
License No. 000000
CELL:
":
� `F'r
NOTICE: The work authorized by this permit shall wmply vnth all applicable handicap access requirements under Califomia slatutes and related
iegulations. (Ord. No. 92-28, § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
COpEt, INSPECTIONTYVE DRTE INPTIALS COUE/ INSPELl10NTYPE QpTE INT71AL5
7816 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing �.�.Q—/
//LC.dI
200 Final Re-Roof 210 Pinal Electrical �.�[�'
207 Final BlocklRelaining Wall 212 Final Fire Prevention
202 Final Faclory Fire Place 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolilion ' 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION: �
I hereby affrm under penalty of peryury one of the following declaralions:
❑ I have and will maintain a certifcate of consent lo self-Insure for vrorkers'
compensation, as provided for Dy section 3700 of the Labor Code, tor the
pertormance of Ihe work for which this permil is issued.
❑ I have and will rriaintain workers' compensalion insurance, as required by
section 3700 of lhe Labor Code, fa the peAormance of the �+ork fw which this
permit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carrier.
(Tha sedqn neetl rrol0e mmplele0 Athe prm/ is valued ai one huMretl tlWars (5f00) w less.)
Policy Number:
I certify tha[ in the peAortnance of the work (or which lhis permit is
ss ed, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, antl agree that if I should
bewme subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Cotle, I shall fo wilh comply vrith these provisions.
l
Npqiwm's Si9naNre e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLHRS
($100,000J, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IrfiEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm Ihat I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my licensa is in full force and effect.
Lic. # Class #
ConVanor's Signalure Date
CONSTRUCTION LENDING AGENCV:
❑ I hereby aRrtn ihat [here is a construction lending agency (or the
peAortnance of the v.ork for v.fiich this pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty ot perjury that I am EXEMPT FROM TME
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a pertnit to
consWct, alter, improve, demolish, or repair any structure, prior to ils
issuance, also requires the applicant (or such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
8usiness and Professions Code) or that he or 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 applicaN to a civil penalty of not more than
five hundred tlollars ($500).):
❑ I, as owner of the pmperty, or my employees with vrages as their sole
compensation, WILL DO THE WORK, antl the structure is not intended or
offeretl for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an owner of propeAy who builds or improves
lhereon, and who tloes such work himself or 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-builtler will have [he burtlen of provinq ihat he or she
did not build or improve (or purpose of sale.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LI SED CON7RAC70RS to conshuct the pmject (Sec. 7044, Business and
Professbns Code: The contraclas License Law dces not apply to an owner ot
property wfio builds or improves thereon, and who cont2cts for such prqect with
a contractor�s) license pursuant lothe Cont2c[ws License Laws.).
❑ I am exempt untler sec.
Business and Pro(essions Code for this reason:
�O QCA/1'�,�Q� li
SignaWre Dal
]051�4fi�3101)
•,"_... .
Owner ID verifietl by drive c Yes ❑ No m1�,_
Driver's License No. Expires:��/p2
Verifcation of Ownership by (lype o( document, i.e. - property taz bill or tleetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavatbn frve (5) or more feet m deplh inlo wfiich a
person is required to descend, will be made in connection with vrork authorized
by this pertnil, and that no building swcture, scalfdtling, falsewoAc, a demolition
or dismantling thereof, will he more lhan thirty-siz (36) feet high. (C�ap. 32, Grp
2, Art 2, Sec. 341. Ttle 8, Califomia Administ2tive Code).
❑ As ovmer-builder, I will nol employ anyone to do work which vrould
require a permil fmm the Division of Industrial Safety, as noted above, unless
such person has a permit [o do such work from ihe division.
Applitanl's Si9naWre Dale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or present or fuNre building occupant nee0 to fle and
certily a Business Plan for emergency resDonse to release or threatened
release o( a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of lhe Califomia Health and Safety Code requires, with some
exceptions, Ihat a Business Plan be fletl with the Costa Mesa Fire
Depanment by every business which has at any one time during a reported
year a quantity of hazartlous materials equal to or greater than a weighl of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas
at stantlard tempereture ana pressure�.
2. Does or will ihe applicant or present or future building occupant need to file
a registration form for acutely hazardous materials7 ❑ Ves ❑ No
(Section 25533 ot the Califomia Health and Safety Code, wilh some
eaceptions, requires regis[ration with lhe Costa Mesa Fire Department by
each business which at any one lime has on hand a quantiry of acutely
hazartlous matenals equal to or greater than a weight of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure).
3. Does or will the applicant or present or fulure building occupant need to
prepare an RMPP (Risk Managemenl and Prevention Program lor acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( the California Health and Sa/ery Code provitles that the
Costa Mesa Fire Department may require ihe preparation, certification and
fling with the Fire Department of an RMPP by businesses which are required
to regis[er awtely hazardous materials vrith lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of lhe California
Heallh and Satety Code been tully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or tuture building occupant require lor
the work which is the subject of this application a permit for such constmction
or moCification from the Sout� Coast Air Qualiry Management District or from
any other air pollution control district or agency7 ❑ Yes ❑ No
(Sectbn 658502 of ihe Califomia Govemment Code requires ihat the requesled
information be tumished on applications fa non-residential building pertnits).
6. Will any part of the facility to be constructed under this permil be within
1000 feet from the outer boundaries of a school7 ❑ Yes ❑ No
(If "yes", the facility must meet the requiremenl of Sections 25534 and 42303
ol lhe Cali(omia Health and Safely Code).
7. If a permit fmm the South Coast Air Quality Management Districl or other
air polW[ion conirol distric[ or agency is required (or the work which is �he
subject of this application, have all of the disclosures prescribed by Califomia
Healih and Safery Code Section 42303 been matle? � Ves ❑ No
8. (If yes", attach certificate of wmpliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury [he
intormation given above is correct. I agree to comply with all stale laws and
cily ordinances regarding Hazardous Materials and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalty of perjury that I have read this application and state that
the infortnation given is correcl I agree lo comply wit� all state laws and ciry
ordinances relating to builtling construction, and authonze represenWtives of
the Ciry of Cosla Mesa to enter upon the above-tlescribed property lor
inspection purposes. I agree not to occupy or allow occupancy of any buildin9
authonzed by this permit u il Mal inspection. /_
r. � ��U
�O D/(�M_�—Q
'* SignaWreofLegal eqs Dale
Antllar Aut�onzetl Applifanl Dale
• 1 ,�' � � • �r �n.�♦
CITY OF COSTA MESA
BI/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • ewwv.ci.wsia-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER P08-00061
PERMIT TYPE PLUM
APN: 11729417
STATUS: ISSUED
DATE ISSUED: 02126/2008
" ISSUED BY: BJK
- ., . . � - • . .
JOB ADDRESS: 365 E 19TH ST CM SuiteNnit:
Viciniry: WATER HEATER AT REAR SFD '- - � . -- - - - - � � �
�i . . - . . . . .
SCOPE OF WORK; INSTALCATION OFA TANKLESS WATER HEATER AT THE REAR'OFAN EXISTING SFD.
_-�
,',';i� - � �
OWNER: FOGG, CRAIG�,S '� .� � Address: 365 E 19TH ST -
PHONE: � , , � . CitylState2ip: � COSTA MESA, CA. .
APPLICANT: ' FOGG, MEIANIE- � �. � �- Address: 365 E 19TH ST : -
PHONE: 949-642�431 � � " � � � , � -City/State/zZip: COSTAMESA„CA ,� �
CONTRACTOR: OWNER-BUILDER� .+ � License�No. 000000 � ,' ' �
Address: ; , ,,. _ _PHONE: � � • �•
City/State: � . ' � - ZipCotle: . . - �CELL: � . ' , ..
ARCHITECT: . � License No. _ . PHONE: .
ENGINEER: - LleenseNo. _ ' �� , PHONE:,� i
�1"I � . � _ .. -• .. , � _' _
.. , . . �,��� _ , . . _
PLUMBING PERMIT FEE SUMMARY
` PLAN CHECK FEE: . $0.00
PERMIT FEE: $35.80 �
TOTAL FEESi " $35.80
, �� a� \
�_ ���_� �', _.
� � ;� ���:
� �J
NOTICE: The work authorized by this permit shall comply with all applicable handicap access reqoirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized untler this permit to be considered legal, such work must comply with all applicable codes, and all
required inspaetions and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
c�oe� ixsvecnoxrme onre iNTI71ALS �Qn� �xsrecnoNrrve on� �N7RIAL5
7616 Fixed System Final Fire Prevention 206 ' Final Mechaniwl ��
1286 Pool Spa Final 208 Final Plumbing
200 Final Ra-Roof 210 Final Electrical
201 Final BloCk/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire place 220 Final Planning Approval
203 FinalSign 222 FinalSite
20a Final Demolition ' 250 Final Building/Occupancy
WORKERS' COMPENSATION�DECLARATION: �
I hereby affirm untler penalty of perjury one of the following declarations:
❑ I have and will main[ain a certificate of consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Cotle, for the
peAormance o( the work (or which this permit is issued.
❑ I have antl will maintain workers' compensalion insurance, as required by
secCan 3700 of the Labor Code, for the peAormance o1 the vrork for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(inis se[fun neetl ip( pg ppnble�Melhe pemN ¢ valutd al me nurMmCOdlarslEt00) orkss 1
Policy Number:
�I certify Ihat in the peRortnance of the work for which lhis pertnit is
i sued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Califomia, and agree that if I should
become subject to Ihe vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with [hese provisions.
�Q,sa.Y.,�.a-�� a j� e I c�st
ApO�ifanl's SignaWre Dat�—�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class #
ConV3tlor's Signalure Date
CONSTRUCTION LENDING AGENCV:
❑ I hereby affum that there is a cons[ruction lending agency for the
peAormance of ihe wurk fa wfiich this pertnit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby afflrm lhal under penalty of peryury that I am EXEMPT FROM THE
CONTRACTORS UCENSE LAW for the following reason (Sec. 7031.5,
Business and Protessions Code: Any city or wunty which requires a pertnit to
wnsWct, alter, improve, demolish, or repair any swcWre, prior to its
issuance, also requires t�e applicant for such permit to file a signed statemen[
that he or she is licensed pursuant to the provisions o1 [he Contwctors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation ol Section 7031.5 by any
appliwnt for a pertnit subjecls Ihe applicant lo a civil penalty of not more Ihan
five hundred dollars ($500).):
❑ I, as owner of ihe property, or my employees with vrages as their sole
compensation, WILL DO THE WORK, and the sWcture is no[ in[ended or
oReretl for sale (Sec. 7044, 8usiness and Protessions Code: The Contrectors
License Law dces not apply to an owner ot property who builds or improves
thereon, and who dces such work himself or herselt or through his or her ovm
employees, provided that such improvemen[s are not intenEeO or offeretl for
sale. If, however, the building or improvement is sold within one year of
completion, [he ovmer-builder will have the burden of provinq t�at he or she
did not builtl or improve for purpose of sale.).
I, as ovmer o( the property, am EXCLUSIVELV CONTRACTING WITH
I NSED CONTRACTORS to consiruct lhe project (Sec. 7044, Business and
Professions Code: The contractors License Law does not appry to an ovmer of
properly who builds or improves thereon, and who contracts for such project vnth
a contractor�s) license pursuant to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business antl Protessions Code for this reason:
Sgnalur � �Oal
3051-A6 (3I0])
�
,
Owner ID venfied by drivpe� �1 Yes ❑ No �y�,,,, ),^.,•
Dnver's License No. �/ Expires: 15I (�I(1 /.-1 j]� OZ
'TT
Venfcation of Ownership by (type of document, i.e. - propeAy tax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceAAy ihat no excavation frve (5) or more leet in tlepth into v.hich a
person is required to descend, will be made in connecibn vrith work authorized
by this pertnit, and that no building strucWre, scaffdding, falsexork, or demolition
a dismanlling thereof, will be more than thirty-sDc (36) feet high (Chap. 32, Grp
2, /V} 2, $CG. �i�, rI�C 8, i�.d�liOR112 /±(�ff11f115Il2lNQ (�.OdE�.
❑ As ovmer-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above. unless
such person has a permit to tlo such vrork from the tlivision.
Appb[anl'S SignaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fulure builtling occupant need to (le antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous malerial? ❑ Ves ❑ No
(Section 25505 of the Califomia Health and Safery Code requires. vrith some
exceptions, thal a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantiry of hazardous materials equal to or greater than a weigM of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at slandartl temperaNre and pressure).
2. Does or will the applicant or present or future builtling occupant neetl to fle
a registration form for awtety hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity o( acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at stanaartl
tempe2Nre and pressure).
3. Does or will the applicant or presen[ or future building occupant need to
prepare an RMPP (Risk Managemenl and Preven[ion Program for acutely
hazardous matenals)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health antl Safety Code provides that the
Costa Mesa Fire Department may require the preparation, cetlification antl
filing with lhe Fire DepaAment of an RMPP by businesses which are required
[o register acutely hazardous malerials vrith lhe Fire Departmenl.
4. If an RMPP is presently required, has Section 25534 of the California
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Dces or will the applicant or present or fuWre building occupant require (or
the work which is the subject of Ihis application a permit (or such construction
or modificalion from the South Coasl Air Qualiry Managemen[ Distncl or from
any olher air polNtion control district or agency? ❑ Ves ❑ No
(Seclion 658502 of the Califomia Govemment Code requires thal the requested
information De fumishe0 on applications for non-residential builtling pertnits).
6. Will any part o( Ihe (acility to be consirucled under [his permit be wilhin
1000 (eet from Ihe outer boundaries ot a school? ❑ Yes ❑ No
(If'yes", the facilily must meet the requirement of Sections 25534 and 42303
of the Cali(ornia Health and Sa�ety Code).
7. If a permit from the South Coast Air Quality Management District or other
air polNlion control distric[ or agency is required for lhe work which is Ihe
subject of ihis application, have all of the disclosures prescribed by Califomia
Health and Safely Code Section 42303 been made? ❑ Yes ❑ No
8, pf yes', attach certifiwte of compliance from the appropnate air polWtion
wnirol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of peryury the
in�ormation given above is correcL I agree to compty with all state lavrs and
city ordinances regarding Hazardous Materials and Emissions.
Sgnalure oale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceAify untler penalty of perjury that I have read this application and state that
the information given is covecL I agree to comply with all state laws antl ciry
ordinances relating to building consiruction, antl authonze representatives o(
the Ciry of Costa Mesa ro enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed b this pertn�t u til final inspection.
� �
SignaWre of Legal vmer(s Oal�
AnE/or Aut�onzea Applicanl Date
(714) 754•5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
.lob Address: 365 E 19TH ST
Suite:
Vicinity:
Parcel Number: 11729417
Zoning:
npp�icant WHITNEY ROOFING
Address: PO 15396 , , ' ' " - � �
-- ,� =� � � -_ -Phone: (949) 548-0769
NEWPORT BEACH , CA . Zip: 92659 .
Owner FOGG,'CRAIG�S " � ' �
Address �365 E-19TH ST - . ' � " " , - -
, - � . - Phone: �
-COSTA MESA, CA � � � Zip: 92627
�
Contracror: `WHITNEY;ROOFING
�Address: P015396`"_",-' �
, ' Phone:- (949)548-0769
,NEWPORTBEACH,CA
Zip: .. 92659;- � ' License: 406022 '
Arch :
Address:
2ip:
.� i
-, ' .Phone: -
, � -� License:
Status: ISSUED
Applied: 70/03/2001
Issued: 10/03/2001
ISSUED BY: 1� .
�,
, ; \ .
�
�
, ,�
Eng:
" Address:
i . . '. i,
�� TEAR OFF INSTALL i LAYER 75LB FELT AND 30 YF
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Totai:
$0.00 � � �,
$97.25 -
$0.50
$0.00
$0.00
$0.00
$97.75
SETBACKS � '
MAINSTRUCTURE Front 0-0
ACCESSORY �Front�-0-0 ,
PARKING Exi. stinq:. o
NOTES:
FEESUMMARY
�
" ,. � , �� Phone:
�� �
� - , � 'License:
�
THE SF.D AND DETACHED GARAGE..
Calc Valuation: Ss,�sa.00
Claim Valuation: 5s,�3a.00
PLANNING & ZONING
Rear . 0- 0 LeR 0- 0 Right � 0- 0
� �; Rear _ 0- 0 Left 0= 0 Right .�' 0- 0 �
� Required: � 0 Proposed: 0 . �� � �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 72-21-92)
EXPIRATION: This permlt shall autometically ezpire and become vold if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. ' �
INSPECTIONS: In order for the work eutFrorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections antl final approval must be obtainad. Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaasae (arool
WOR�ERS'COMPENSAnONOECLARATON: '
I hereby affirm untler penelry ot perjury one of ihe following declarations: ' � �
i .�.,
❑ I heve antl will malntain e cenificete of consent to seN-Insure for workere' compensetlon, as provided for by section 3700 of Ihe Lebor Code,%r the peAortnence of ihe
work lor which this pertnit is IssueO.
�I heve arW will maintain workere' compensetlon insu ence, as requiretl Dy sectlon 3700 oi ihe Labor Cade, for �he pertortnarica oi the woAc for which Ihis pertnit Is Issued.
My workers' compensatlon Insurence carrier entl p�licy number are:
Carrier.
(7his sectfar neetl no� be wmp
❑ I certlly Iha ' Ihe pertom
setlon la 1 C
cnm ic
icent Signeture:
ARNIN � SECURE W
T1qUSAND DOLLARE (E100.000). IN
LICENSED CONTRAE'rORS D
Polity Number:
il th imi s ve/u d et ane hundred dol/ars ($f00) or less.) . �
of the ork for Ich ihls pertnit is issued, I shell not employ eny person in any menner so es to b Eome subjed to ihe workers'
i, a gree � tl I should became sub�ect to ihe workers' compensation provlslons of Sectlon 3�0 of e Labar Code, I shell torthwith
5' COMPENSATION CAVEPAGE IS UNLAWFUL D SHQL SU ECT AN EMPLOYER CRIMINAL P ALT S AN� CIVIL FINES UP TOONE HUNORED
ION TO THE COST OF COMPENSATION, DAMAO AS PROVIDED R IN SECTIIXJ OF THE UBO CODE, IMEREST, AND ATTORNEV'S FEES.
iDy ettirm t I em licensed u r prodsl of Che r 9(comme ing with Section 7000) ot DJv'siefi� Business e mfeuions Code, end my
end . Lic. # YdCO� L Class N
e Ys Slgnatur � Date:
iTRUCTION�LENDIN AGENCY:
I hereDy eN' at there is a constructlon lending agency tor the peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
�r' ema: Lentler's Adtlress:
Signature:
Dele:
full
OWNER-BUILDER DECLARATIONS:
I hareby aHlrtn thet under penelry oi per�ury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business end Professlons
Code: Any dry or counry which requires e pertnit m consiruct, alter, improve, tlemolis�, or repair any structure, prior to Its issuance, elso requires the appllcant lor such pertnit
to tile e slgned stetement that he or she Is Ilcensed pursuam ro the provislons ot Ihe Contrectors License Lew (ChaD�er 9(commencing with Sectlon 7000) af Dlvision 3 oi the
Busineu entl Profeulons Gotle) or t�at he or she is exempt cherefrom antl the basls for the elleged anemption. Any Woletian o1 Sectian 7037.5 by any applicant tor e pertr+i
subjects t�e epplicant to a civil penalry oi not more then five huntlred dollars ($S00).):
❑ I, as owner oi Ihe properry, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, entl ihe siruMure Is not iniended or otteretl for sele (Sec.
70d4, Business and Professions Code: The Contractors License Law does not apply to en owner of properry who builtls or Improves thereon, and who does such work
himselt or hersetl or through his or her axn employees, provided Ihat such improvemenis ere not intendetl or oHered tor sale. N, however, ihe building or Improvemenl is
sold within one year of completion, the owner-6uilder will have the burden oi proving ihat he or she did not build or Improve lor purpose of sale.).
� I, es owner of the proparty, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRAGTORS to construct the praject (Sec, 7044, Business antl Pmfessions
Code: The contremors Llcense Lew does not epply to an owner ol property who bullds or Improves thereon, entl w�o wntracts for suc� pro)ect wi[h e contractor(s)
license pursuant to the Contrectois License Laws.).
❑ I am exempt under sec. Business and Professions Cotle for ihis reason:
Signeture: Date:
Owner ID veniietl by Onvefs license. ❑ Yes ❑ No DrlveYs License No. Expiras:
Verilication of Ownership by (rype of tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation live (5) or more feet in depth inio which e person Is required to descend, will be matle in connection with work authorizad by thls
permit, and Ihat no building structure, scettolding, felsework, or tlemoll�ion or tlismantling thereot, will ba more than thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomla AtlminlsVetive Code).
❑ As owner-builder, I will not employ enyone to do work which would require e pertnil fram the Division of Intlusirlal Salery, as notetl ebove, unless such person hes e
pertnit to tlo such work trom the division.
SlgnaWre: Dete:
Division ot Industnal Satery Permit Number:
MAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
1 Will t�e applicant or present or future bulldinp occupant need to tile and cenity e Businass Plan for emergenry response to releese or ihreatened releese ol a hazartlous
meterlel7 ❑ Yes ❑ No
(Section 25505 of ihe Califomia Healih entl Safery Cotle requires, with some ezceptions, that e Busineu Plan Ce fileO with the Caste Mesa Fire Department by every
business which has at any one Iime dunng e reporled year a quantiry oi hezerdous meterials equal to or greater then a weight o1500 pounOs, or a volume ot 55 gallons,
or 200 cubic feet of compressed gas at standard temperaWre antl pressure).
........._ ........................._....................................................................................___............................._..................__.................._........................._._..___..A......................'__'............__............._._...........__........
2 Does or will Ihe epplicam or present or future 6uiltling occupant nead to lile e ragistratlon fortn for acutely hazardous matena154 ❑ Ves ❑ No
(Section 25533 ot the Callfomia Healt� end Safety Code, with soma e:ceptlons, requlres registration with the Cosre Mesa Fire Department by each business whlch et eny
one time hes on hentl a quentiry af ecutely hazerdous materlals equel to or greater ihen a weight of 500 pounds, or e volume of 55 gallons, or 200 cubic taet o1
3 Does or will Ihe applicanl o� presen� or tuture builtling occupant neetl to prepere an RMPP (Risk Manegement antl Prevention Progrem for acutely haie�dous matedals)9
❑ Yes ❑ No
(Section 25534 of ihe Califomle Health end Satety Code pmvides that the Caste Mesa Fire Department may requlra the preparatioq certifiwtion anC filing with the Fire
bepariment of an HMPP by businesses which ere required �o register ecutely hezerdous metedels with the Fire Depertment.
................._......................................................................................................._........................................................._._.................._..._�.............................,..........._........._.............._................._......................................._...........................
4 II en RMPP Is D�esently required, has Section 25534 of ihe Califomia Health end Sefery Cade been fully complied with7 ❑ Yes ❑ No
................................................................................................................................................................................................................................................... .......................................... .........................................................................................
5 Does or will the epplicant or present or tuture bulltling occupent require for the wark w�ich Is the subject at Ihis a plication a partnit for such consiruclion or motlificatlon
Irom Ihe South Coast Air Dualiry Manegement Distdct or from any other air pollutlon comrd tlistdct or egencyt � Ves �7 No
(Section 650502 of the Celitomia Govemmem Coda reduires that the requested informetion be fumishetl on applicatlons for non-residantial bullding permits).
................................................__......................_.__._..__._._...........................__............................_........................�................._..—........................................_.........._...........__._.................._.............._._........._
8 Will eny part of the faciliry to ba constructed under this permit 6e within 1000 teet Irom the ouler boundaries ol e school7 ❑ Ves ❑ No
(II yes", the faciliry must meet the repuirement ot Seclions 25534 end 42303 of the Califomia Health antl Safery CoAe).
............................................................................................................................................................................................................_.........................................................................................................................................................................
7 II e pertnit irom the South Coest Air �ualiry Management Distdct or other elr pollution control disinct or agency is requiretl for the work which is the sub�ect of Ihis
aoolicetion, hava all of the disclosures prescnCeC by Calilomia Healih end Salery Code Section 42303 baen matle? � Ves ❑ No
e (If yes', anach cenifiwte of compliance from the appropriate air pollution conirol oHicer).
CERTIFICATE OF COMPLIANCE: I cenHy that under penalry oi perlury �he Iniorme�ion given ebove is correcl I egree to comply with all stete lews end city ordinances
regartling Harardous Matenals end Emissions.
SlpnaNre: oate:
CERIIFlCATE OF COMPLIANCE AND AUTHO ON V: I ceniry under penalry of perjury ihat I have read this applicelion en0 siate that the intormation given is
correct. I egree to compty with ell stete le ntl clty o nances lating to bullCing constructlon, end authodza representatives ot ihe Ciry of ta Mesa to enter upon Ihe
ebove-descnbed property for inspecti urposes. I ree not to py or ellow occupenq ol eny building authorized by this pertnil until finel i pectiof.i
400E t. INSiECTIONTYPE ���
1616 Fixed System Final Fire Prevention
1268 Pool Spa Final
200 Final RaRoof
201 Final BIocWRetalning Well
202 Final Fectory Fire Place
203
204
Flnal Sign
Finel Demolilion
� p� URII19L9 cooe�
206
�/ 200
�� �� `�'�"'� 210
212
220
Finel Mechanical
Finel Plumbing
Finel Elecirical
Finel Fire Prevention
Finel Planning Approval
222 Final Site
250 FinalBuilding/Occupancy
�
BAIE It{�l5
I
em�axo: 3 6 S E 1 9 TH ST UNT:
iF�vr+: FOGG, CRAIG S
��� FOGG, MELANIE L
� 365 E 19TH ST
COSTA MESA,CA 92627
LWPESi
urcxnecron�+m��n:RONALD LACHER �� 20949
wcu.ox�•s�oonEss: 1332 N. MILLER ST ��+T� 201
ANAHEIM CA 92806
ca+rx�crarswu/e: BLUE HAVEN POOLS AND SPAS ( 714 ) 549-4712
carmucroxs�uuxo 433 E COLUMBINE ST
,�ooness: SANTA ANA CA uc xa: 9 5 3 4 4 5
92707 unr:
110EN5E0 CONTP�CTONS DECL�RRTION: I lwreEy dlim uMx perely d perjury that I un IicaraW under prwieime M Cheqm 9
(commenarq xilh Saclion ]00p) d D'nision 3 al iM Bueinew vM Prolmvona Gada. uM mY licenm is in hll brce arM eNec1.
cmuar� ::p3�5��c.cuss: C 53 uc.No.: �4� • P: OS/91
me �i, ••,� Cmvmor.
NEP BUILDEN OECLARRTION: I hereby dfi�m urcbr penelly d parjury IMI I em eumq Imm IM CoMrepas License lew la the
fdbwiq �eeaon (�� ]W 1.5 Bueirs+ end Pmleedma Cada: Aery eiy a munry xfi� reyuiM e pem�n b eanvuel. eller. imprare.
'�md'ah, or repei eny stn�eture, q'w b ils os�a�ro, aho requirea tM epplirant lor wd� peemn to fib e egred Netement �hel M m aM
ikenead punuenl to ihe pwiaioro d �ha Conlredon Licenae lew [Cheptar 9(canma�rp wilh Section ]OW) d DMeion 3 d the
inew eM PrNmeions CoCe� w ihei he a she ia exempt �herefiam entl IM Esvie la the elbped uampion. My viole�bn d Saqcn
1031.5 Ey eiry ep0liran� I« e parmX wbpda iM epplkant io e rnil penelly ol M mora �hen live hundrod Eollen �SSW��.
� I.svowrcrotlMqopenY«mYemplo�mawlhwappn�Miaobcanpamalian.willdotMwoM.eMthenruclumenaliMeMeE
a oRxeE lur ub (Senion 10u. Buarea erd Pmfaasions Code: The Contretlae Liwrea Lewtlom mt nDV�Y lo en owmrd papery
wM buide a mprovea tMraon. enE wlw Cow e�ch xark IimaeM a Mns� «Nrouph h"v a her own employeae, qwMetl Ihal mch
impaemeriH ere ml inteMed a dlertE ta aeb. X. Mwmm. tM buiNi�q n inpwanem ie eoN xil�in ona Y� d comqetion. �hs
owner-0uiNar will heve iM W Nen d qovin0 � or ehe d'M ml Wik w impv.e lar �M purqwa d+eb).
� I. m owner o/ iha praperry. em eRdueivey contreairp Milh IicenaeE conveclore lo consVud IM pml� (�� )�. Businua vM
PMeceione Code: TM Contredore Licenm Lew doee ml eppy lo en ovmsr d propeMy w1w Euilda or impovx Ihe�wn vd who
mnVacte lar witli prol� �h e mMredaMa) Icemed Oumueni lo �ha Con�reqora Liceme lawl.
� I am uemq uMer Senun: B. 8 P.C„ la No reawn:
o�<: u.,+.,.
i an ne,eey cen�b �nm i em eware d.�a ��dars�ene me �ea���a�v w cmaa„ie Haenn ena sde�v caaa sea�. uws, zssaa, ene
zssaa, a�e me� i a.�v �m�re n��bmv oowo� �n i wai na Idreb o�l oeee io canoM wan.eie e�me coa<. ene me �.a��.��. ro.
e permil larconstru<tion ormodifrationhamt�eAi�epement Oinna. Ruidemiel mnn�bn epplcelionaen memq Imm ihme
provisiana. �
Dme: Aod�
WORKEN'S COYPFNSATION DECL�RATION: I hereby Mf�m uMer penelly d psj�vy arW Ns /dlowinp dedartliom:
❑ I heve eM wil meintein a cenJicete d mnsam m eaX�ineura M waken' compenemion, m proviJetl Iw by Sedion 3100 W the lebor
Cade, lor iha paAwmence ol tM xark tor which I�is pelmit is issued.
_ Cl � ne�s d,e �;� �m� �n�re �oa�.m� mw��. � ba�o-ea W sa� a�ao m m. �e« cm.. ro�ma oe�r«m.� a m.
7S— wak ta which the pe�mit re iaued. My warkers' canpenae�ion ireurencs ferr'�ar aM pdiry number ara:
c�.: S,1'ATE FUND EXPIRES
Pa:,y r+�mw: 3���5 O 1/ O 1/ 9 6
is �on need nd be eompbte.f llhe parmt'v br one hunerea Ldlers (StP01 w Ima.l
�I rlAy ihm in �he perlortnence ol �ha work br xfich ihie paimil ie iaeuad, I ehell � ampby any n in vry manr�er eo ea lo
ma eubjed �o �he workere' compenmtion ia.. m c���e. �e .orea mm a i ahould e wbjep to Iha xvrkeis'
comq^ selion pry� p^s an 3100 Mlhe LeborCade,lahalllonhvrit hoee 'eom.
D�e: lO lo � nodsw:
Wamfny: F�llun ro uc�n wort�n' eonpwuetlan coveny� Is un/awF�l, �ntl �IWI /ec! �n wlplayw roWMrol p.neMp en0
c/vll fl� W ro aro hlndrerl tMuuM tlo/br� (SIOqOWA In edd/tlon ro fM eos! I rompenufbn, danup� �a provltletl br In
gxHon 9�f16 0l Ms LeborCode, Infxu( antl ettomsy'� Isex�
CONSTNUC110N LENDINQ AOENCY: I hmeby elfirm urder pe�y of perjury �het ihen b e canatruaion kMinO e0ericy tor IM
' �IBl�01TBMB O���IG MIXk�IX W�11'111��141 jNf1111 6 691184�$lE1011 '.i091.CiN.Cri.
. LENDER'S NMIE: , . �
LENOEP'S �UDRE54: / � � . ,
- ' f "
I cenM ��� I heve reed thia eppliwion e�M 9eb ihet Ihe eEwe infamelbn ia cmed. I epree lo mmpty xil� ell dry eM coumy adirancs
end slele lewe ielelinB �o WiknB ����ion eid heraby ainlarae repesenteiivea d �his dry ta emer upon �he ebove�mentionad prtpeM
lorinepeaion purpoees. ' , ' . '
ERIC D•{TER �
� ' �/7 -��-�5
� Dme: `r
v Sig um OwiwdApenVApp' V nrada � r
(5151J6 WP)
8 Selery: GreeMFb: Cenery-APGlirant: Pink-Revenue: Odden�aLAsaevn
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 072705
PERMIT NO: B 072705 -PLAN CHECK NO: 02157-95 L GOVT: N SOPP: N
CONSTRUCTION TYPE: � PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : INSTALL GUNITE POOL SQ FT; 16,000
CLAIM VALUE: 16,000.00 CALC—VALUE: 16,000.00 GROUP OCC: R-3 /
COMMENTS: POOL
x�**�r�*x �**x�**x�*x *�**+t+r���r**�r�rx��**�***�r�x�x��rx�� *�******x��*****x�*� x��*�r*�**�**��*+t�r*
Z O N I N G R E Q O I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAA: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 11729917 ZNE: R1 REF NO;
PLANNING NOTES> POOL AND SPA
�
iF'IE iE ik 1E k 1E ik iE iE if iE ik iE 1F 1E iE iE ik 1F iE iF ik if iE 181f iE 1l� IE 1F 1f 1!'Ih iE 1F �Ih 1E iF �1F �E iE if iE �IE iF iF it iE ik iE 1E iE iE iF'1F ik if 1E IE iE 1f i6 ib if� iF iE 1E 3! 1E'JE 1E 1F iE iE iF iE iE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY �� A DATE: S Z C-�)
BUILDING APPROVED HY : G'�-� DATE: O-- C S�7
APPLICATION ISSUED HY: G'l�' DATE:���'�'�)
1('�FiE�7ElEillEiEiEik1E1E1EiElFifiEi(�1f"lE1(�1! iflflEiElEiElEifif �iF1EiI�
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 171.00
PLAN 111.15 SMIP3N06—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 174.36 � 0.00 111:.15 285.51 285.51 .00
REVENUE DIVISION TOTALS--> COLLECTED: 285.51 OVER/SHORT: 00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
171.00 3.36 111.15
i! 1F iE iF 1E 1F 141E iF ik 1F if 1(� 1E 1f iE iE 1k 1E 1f iF 1f 1F iE iE �E iF iE 1F iE ik ik �k ik 1F iE i!'1F 1E iE iE i! iF dE 1F 1F if iE 1E 1l' 1E 1h 1E'1F iE ik 1E ik iF iE 3E it'1F i! 1E if' iF 1E iF iE iE 1! iE'lE iI"1f' iE 1t'!h
I N D I V I D U A L - F E E H R E A K D O W N
TYPE (jTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 16000 POOL ' "� 1,00 16,000.00
END OF FEES
��i il0'�3>�i-00133E�b "Tt�'T :�;.5_
DnT�. -6i1%,�9: TIf?f: i3"13
TRUCTION AN� PLANNING % NQ'�� PA
,�OVALS Pennit # '� Date Inspector pppROVALS Perrr�,it #
1. �emporary Electrical Serviceor Pple 52. Pool & Equipment Location•�
�
2. Soil Pipe•Undrgrnd. � 1 53. Steel Reinforcement ,
:-3. Elettrical�on"d'kit Ut�litY�Und{grnd. 54. Forms
,"'4C;�lectricaLCo`ru?Uii;,U�drgrnd. � . 55. Electrical8onding "
�: 9: �Ste�l Reinfbrcemeno= 56. Rough Plumbing & Pressure Test
�.-,
;;6�:F(G�trica}-r}.1�ER�G�nd. 57. APPROVAL TO COVER�GUNITE
�`�-7.i�Footings�r-� - � 58, ElectricalConduit-Undrgrnd.
8. Foundatiorl;; ;yF, y � 59. Gas Pipe, [�Undryrnd., Test
9. Water Pi e- ndi�r` ' r�
P U g�d. j 60. Backwash Line�;�P,Trap,�Und:grnd.
10. Svuctural Floor:Sy`stem 61. APPROVAL T�bECK
11. Property SeweriLine.& HouseConnection . 62. Backwash & Receptor-Final
12. Sewer Cap _ r� � 63. Heater & Vent-Final �
., . .
13. Roof Orains ; �;., 64. Plumbing SVstem - Final t
14. Rough Plumbing� R' --� 65. Efectrical•Final " �1
15. Rough Electricai=Cofiduit -T, ! 66. Solar SYstem-Fina! �`
16. Rough Electric N�7iring 67. Fencing & Access Approval
17. Rough Wiririg Sign .' 68. APPROVED FO;R';PLASTERING
18. Rough Electricai-T Bar Ceiiing 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Ai� Conditioning _ ` r „ F RE,�JEPT,.iREQU1REMENT ,
20.IRough Factor� Fi�eplace � =c�� ,.��: i: � ' �APPgOVALS�- P rmit # , � Y
21. �Ducfs', ir�Structure_� .. .. _ �i� �. C ^ � ". 70. �Undergrsypd �dro � . .
22..Ducts, V�entil�finq�,'�. � `'� ;. i y i-� F�. `' 7�, produHiPipin9 �as OOiI
23. Gas �Pipe�Rouqh & Test � S +� t' _ C� *;' 72, Undergro`und F�IUsk- 1� F '
24. Roof Praming" �� �' '�` - ; ' :r G ,.;�� ` 7,�_ UndergrndyStorageJank �GasM��0i1
25. RoofSheathing � v i k�� '� �^� r� 7q;.Overhead Hydro �
26. �T-82r Ceiling iStruciuralY & Monocoat . - ti ` `r'�y� 75=-Dry��hemical , � ' .
Date I Inspector I
�,l
27..F,rame and Fleshin � � "' u J � ; � ` '� " • . -.
9 � �� � ` �' >' � 76. Dry Staiai9pipeF�^'
' 28. �athing&�Siding � � ` ±4 ' '�' 77-. FIXEDi�YSTE ��INAL
C" 3.: � G S 'Y " �:'
, ... . ti �
29. Insulation * . •• �' • 78; FIRE PflEV. FIN'AL �^
30. Drywall Nailing _ r; � r � ;' � �HEALTH DEPT.`REQWREMENT
31. Plaster Biown-Coat ri_ , �. � �t .r. 79, FINAL tNSPECT.fON �� �
�.
: 32. �ElectricaiPow`er Merer-Final �` � ` " 86y FOOD CERTIFICATE ISSUED
, 33. �FinatiElectricl � . i� � � �+ n Notes: -.� �• -� C
�� 34. -Fin2l=Hea�ing & Air ConBitioning=� �' �,_ i'' � �k i �� F LL�� , O S�
35.'Fina'� Gat PiPe:Test' _,`� '� � - `� �x � • •��� _ _ ..�u
. 36. Hood or Canopy * - - " ,,, t �.; "r ` r � �J ,�
, � � � .
37. F.inal �Factory Fireplace ;� :_._, ,� { ��� - ~ �- `� �- ' � �
' 38. Final Plumbing ' ^� � -� `
' 39. WaterService:Final � _ ' " �; ;T
40. Gas Service-Final �. �^ 5 a��
. 47. So�ar pomestic-PinaT '� . �
42. Backflow Preventer+� � -' •- '
43. Backflow Irrigation , � �-' - � , �, :
.44. Landscape Irriqation System � - . ' r" �
�. - :,
�45.ISound Attenuation� ,", ' ` '� t�"
� l'. T F 1
46. Handicap�Regulations • - �
47. fINAL STRl7CTURE & BUILDING � _
48. FINAL PLANNING' � . ' � �
49. Elect�ic Release to Etlison '
•50. Gas Release to Southern Califomia Gas Co �� .
No. Date
�- i�� (�°,
�'S� �
'� �e K.
ennxFssocew�owa: 365 E 19TH ST
OMNEASWWEIFIRqWN: FOGG, CRAIG S
eonxEss: FOGG MELANIE L
365 � 19TH ST ��'
COSTA MESA,CA 92627
�x. Y.naa .00xEss:
UNT:
umxnecTonFrm+�n:RONALD LACHER ��� 20949
urc�oxee�a�s�ooaess: 1332 N. MILLER ST uM: 201
ANAHEIM CA 92806
CONiIiACTqfBNAYE HLUE HAVEN POOLS AND SPAS ( 714 ) 549-4712
cwm�crorcs�u�wo 433 E COLUMHINE ST
woxEss: SANTA ANA CA uc.ra.: 453445
92707 urar:
11CFN5EU COHfRACTOHS DECLAfl�T10N: I Mreby ellim uMx penNY d pe�jivy Mm I em fcm»d uMar prwi�iw d Cheqer 9
(commantirp xilh S%lion ]OW) d Oi+iaun 3 d tlro Bueineae end Pmlmabne Code. end mY � u in hA latt vM eflld.
cm uc. �o.: 0 3 5 9 2 uc. cuss: C 5 3 uc. No.: 4� 4 EX / 91
me: � Conbaar.
�O ER BUILDER DECLAP1T10N: 1 haWy d5mi uMx w�W d perjuy �hm t em eremq han IM Caq�aaon liowe lew la ihe
ramon (Setlion 1Vi1S Buairaa end Adweion+ COCs: l�rt�'tly n muNY r.fiirh �pu'vm e WmY lo mMrutl. Ms.'vno��.
,�md'nh, w repei erry evunura, prior b ib'ssuenro, ebo �puim tM applivM la ach psme io fib e vipned �smsN OW M w ahe
.�Ipenfed Wnuen� lo IM povieions M IM COM�edon Licenss Lew �Chaqer B(commerwiq vmh Sedion ]000) d D'veqn 3 d Ihs
�uvinw eM Prdauom COEeI a Ihm M a Mie w usmq therMmn eM tM bnm tor Ne alb0� uamqion. MY vblelion ol Seqian
roai.s M�v eoqimm I«. v� +�+�i�+ �ne wpium �o a d.a v�9 d �a mae m� twa nune�m adws I�11.
� I, m ovmer d �M propeny or my empbyeea xYh wepee m ihe'e ada mmpanaetion, will do tM woA, eM IM eM1udun e�at intenEed
or Mered la eds (Se Yion 101I. Buu�roee eM PMaseione Code: The ConlreGon licenae Law doae nd eppN �oen owner d propany
wlw Wida rc inpmvm therean, end xfro doae euM xwk Nm�all a heneM a �hraph he a Mr own empiv/ae�. peaiAed thel eue�
impwanama ue M imeMd or allaeC Ia eeb. tl. however. �M WiNirp p inpmwnam u sold wilhin aa Y� d mmWe�bn. iM
ownerEuilder xill Aeve iM WNen d qovirp M w ehe dM m� build a improve fa IM puryme d ede).
� 1. a� owrw d tM pWaM, em awtlusively oontretlFO wil� liunwd wnirmlm W wnaruq the pM� (SaGion 1014. Buelewa end
aw..�+ coee: rno wm.ao� ���. i.w eo.. �a wwr w� o� a ww�r .no wua. «�o.�e. ms.o� .�a wno
wnirecu 1« adi w9�� wqh e mv�eeMa) Ibensed Wnuw �o �M CaWm«s licmea lew).
� I em e�emq uMer SMian: B. 8 PA.. la inie eseaon:
Dela: �
i eo nmeM unM wm i em ewam a e�d �.w,e me �.a���,w, d cdao�„ie �.een ene saron code s.aim. uws. zss�..d
255,91. eM Yw I a ury Mure EuJGry oowiWN w+Y / wil nal (ticb aa) � b canply wih mid mla mEm vH IM rpu'vameNa br
eD�elammWdionamodifiuliantromtMAi�i enepen+nD'mrie.RevEwawlmnp�udionePG�'mioroenmemdhamiMes
pwieione.
Dma: �Od�� �
WORKER'S COMPENS�TION DECLANITION: I heraby ellmn uMv pwWy d pejury ons d Ne b0or.inp Eeifuetbm:
� I have enE vAY mdmen e carlifma d mmm�� io veHimuro br xnrkere' campeneelbn, es povided fa by Sedion 3ro0 d IM Labor
Code, la �M peMormencs ol Me wA Iw wlich thie permX u iseueE.
.Cl 1 nm ud xH maimen xoM1en' cwn Wmetion Inwreroe. m rayuiroE by Sedian alao d IM leba Code. br ihe perlamenro d iM
�r work Iw wAiM ihu pa�mu ie ieeued. MY waksA mm metian inaurenca �erriar vd pdicy numbm xe:
c�«: ST'�ATE FUND EXPIRES
Pa�,. N�m,,, — O 1/ 01 / 9 6
�Thia aabn med rat bs cand�ed % fMV�t e br me hunEieJ EWen If1001 w bv.)
❑ i mnh �nm in us veno�mence a ms .ak i« wnicn me o�a u �suae. i duo na mpnr v+r ro n in enr m•M•• n n m
Mrnro abpf !o �!a xake ' mmpe�uetim bws a� CeNmde, eM rye Net� ouk bc rmjw lo iM warbn'
"'"lion 'soro d IEO d �M LeEa CoG. I eM01aM h oompy N a, Vi�
e: � � Md�K��:
�mlip: F�9un ro wcun worten'ro�tlon rovxry� la urNMul. eM Mtll rONef w+�ploy�r ro almiml pwWUp uM
clMl flnu iq ro on� h,nOM Nouwd AWNn (f100,0001. M MUtlon b tlw roif ol ro M1 Wm,p�� �� pvHtlM lo/ In
9�etlon 9]PB o/ M� Lebor COW. /nt»st �� etfom�Y'� I�u.
coNsrnucnoH «rnrw naewcr: i n..er .� ww. wNM d v�wv �nm m� e e�nNa:.� w�d�ou m�r t� u.
peAarmeMa d �he Mwk br v.hidi �h's peimi b ieuad (bed'nn ]ae], CH. C�.
LENDER'9 NiUtE: ' ' � .
LQIDER'S AUDPESS:
I eanity �het I heve �aW �hie epdkd� �� ada thei �he ebove iMormtlion b wma. l ep�ee lo eomply Milh dl dry aeM wumy oMiriuiwe
end etme kwe m4tnp to WiIEnO ��%+�da^ ��'^�aby au�Mriza roproeentelivea ot Ihb ary b anter upon IM ebove�menlianed poparry
�°`�"'°°°"°""0°°°° ERIC D XTER
P i Nemo . . _�
Dme:
Synm al x/ApenVAppiranVCy a
( f
(St51J6.WP)
8 SdMy Orean-Ftle: Canmy-Appfum: Rnk-Rwenue: ()alden'od-+Nawor
CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: E 072706
PERMIT NO: E 072706 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION : INSTALL GUNITE POOL SQ FT:
CLAIM VALUE: CALC—VALLIE: GROUP OCC: R-3 /
COMMENTS: REF: H-72705
**�r�r��*+r*+r��*x�*�r*�***x�*�r*�**�r�r*�r*�r�r***+r*�r*�r*x���r�r�*+r**��+��*�r�r�r���r*�r�r*�rx x�+r�r**�*�r*
Z O N I N G R E(j U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FANT: FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARICING REQ: PROV: PARCEL: 11729417 ZNE: REF NO:
PLANNING NOTES>
i
ik if ii iE i:1E iF iF iF iE iE ik it 1E iE i! 1E if 1! IE M 1f if if iE ik iE Ik iE iF iE iE iE iF iF i! iF if iF ik iE i! 1E iE M iE 3E iE k 1E 1E iE iE ik iP if iE iE 1f ik iF ik iE iE iE 1F iE iF if iE if iF iP if if iF iF iE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONZNG APPROVED HY DATE:
HUILDING APPROVED BY : DATE: /
APPLICATION ISSUED HY: /G/xi-� DATE: �'O—��
if 1F 1E 1F iF k iF iE k k k ik iE iF iE iE k!F iE iF iF iE7Fi�iF'�'iF7F�F�i'F �F'�FiFfF if 1E 1! iE 1! iE k 1E k�i�£iklF
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 30 .,00
50$ SMIP/NON—RES
PLAN "
ISSUE FEE i5:00
BUILDING—DIV—> PERMIT ISSUE PliAN�CHECK TOTAL PAID DUE
TOTALS----> 30.00 15.00 � 0.00 45.00 45.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 45,00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN—CHECK
45.00 — `
ilikklElFifiF7E1Eif1E1kiflFkiElfkkklFiFlEiEkkiklklFkiklEiEiFiEiI�3FiEiEffifikif1f1k1kiE1t1EiE1EillEiFikiEiE1likkkklFifitiflkfEilll'IEklEkitifiFlfiF
I N D I V 2 D U A L' .,F E E H R E A K D O W N
�h �
TYPE QTY D E S C R Z P T I O,N,.- UNIT COST TOTAL COST
ELE 1 SWIMMING POOL — IN.�GROUND — NEW EA. 30.00 30.00
END�OF FEES
.��7
�^ r
�% 0I 00183542-00183542 TCa"p'
DkTE: OEIOd/45 TIIiE: 13:16
45.00
CONSTRUCTION AND PLANNING . POG SPA
!{PPROVALS Permit# ' " Date Inspector APPRDVAIS Permit#� Date Inspector
1. 7emporary Electrical Service or Pdle 52. Pool & Equipment Location % i
2. Soii Pipe-Undrgrnd. = 53. Stee� Reinforcement .
O3:'Er�ctricaCCod6Uit Utility-Undrgrnd. 54. Forms ��
i - .
� `^4��EI,�ctrica�Cq,ndut�Ur,.a}drgmd. ' 55. Electrical8onding ! ,'
��
�.'�5: 5CEP� ReinfntcealenF; 56. Raugh Plumbing & Pressure Test -- '
.�,.. ..
;;�c6i,�,WE�ectricz�t';t1�FER:�ind. 57. APPROVALTOCOVEfl�GUNITE . �
� `'Z:;Footings=.�y __ � 58. ElectricalConduiS�Undrgrnd. �/ZO�� __
- !
' B..Foundatiom• v x' � - 59. Gas Pipe, � Undrgrnd., Test
� ^ -ir
9. Water Pipe.lJndrgi�d.`-' 60. Backwash Lines; P-Trap, � Undrgrnd.
70. Structural Floor-S�stem 61. APPROVAL T.O, DECK � '
11, property Sewef.line & HouseConnection 62. Backwash & Recepior-Final
12. 5ewer Cap �• ' ^ i 63. Heater & Vent�Finat ..
13. Roof Drains M, 64. Plumbing SYstem - Final �- "
)
74. Rough Plumbing� - � � 65. Electrical-Final .- - . /// �
}
15. Rough Efectrical•Co'nduii `:' � � 66. Solar System-Final � ��yG r�
_ /w
76. Rough EI`ectric`Wirii7g ,;. 67. Fencing & AccesrApProval
17. Fiough+Nirirlg Sign � 68, APPROVED F,Qfl'P�ASTERING --
r.
18. Fough Electrical�T Bar Ceiling 69. POOUSPA SYSTEA9S FINAL
79. Rough Heating & Air Conditioning FI.(iE,DEPT REQUIREMENT �
R� � t --z r�� �k u� .�: - i - r;, ..+
20.rf�ough Factory Fir'eplace <;,: �: � �� � � j ; APPROVAL'S, � Permit # .
21..DuCts, iri StrUcturet � •• ^ • `' - '-% '� 70.'-Undergrourid HYdro a
h � 7' h
?Z..�UCCS. UB(1Ti`911I1�- � iJ"r' 'k � �' i. .� '-� r
, � �� n a:,r, �.;; �� F>. 7t. Produ¢t,Pipin�U�Gas L�QiI
23. Gas Pipa-�tough & T,est r: t^ ,� �t r• � 72, Undergrovnd Ffush { F
24.'RoofFra`ming' ��� ` _ x� - ,_,.,y � 73. Undergrnd.StorageTank OGas COiI
25. Roo4Sh�thing a �% v .� C � .�. � 74. Overhead Hydro
26.� �Bai� Celing fStructurall & Monncoat ` - ��' �' � t� 75. Dry Chemical ,_ � " �� -
27.%Frame and Plashing' :- c�,� r_- _ r i 76. Dry Standpipe:�'7 �
' 28. 4athing & Siding'�•` ' _ ' �" � ` = "� ' ".; 7:7., F�XED:SYSTEfv�FINAL �
29. Insulatio`n - •• +� ' • 7$. FIFE PREV. FINAI - `I' ,�,
'� 30. Drywall f�ailing *" ' M �" ".�: � HEAIT,H DEPaT�-REdU1REMENT
i 31. P�aster 8_r.owmCoat: - ,-t-� �e. y � -'r 79. FINAL �NSPECYfON +� �
; 32.���ectrica9;Pow�r Meter�Finai �` � i! �' 80: FOOD CERTIFIGATE '�SSUEe, ,r
. . � , �- z: ` r �
� 33.�inal.ElectriC � ,n � '. � . Notes: '_�� _ � �*'
t. -. _ - . . . � . . -
� 34.i Final'Heating=& Air�Coriditioning'� _ y _ ' , � ��/ f �/(�/���� - '-' �
� , [-� . T 1. .� LZ . R ' . F'� �"` _ ,T 1• O 5���
35. Final Gas Pipe:Test r : - .. �- ,.. i� - , r �� ,
� � 36. Hood� or CanoPY �: -• ' ., "'i _ ` C' . _ _ _ ; - � - .
.. - - "' + m n:
:. 37.'F.inal.FactoryFireplace : :_�. ;� F.� � �'� -i� �'�
' 38. FinAl'Piumbing �` ' � - ' ' �' ` - � ^�
- r. :�
39. SVatcr Service•Final' � ��� ; ��
u � t
. . 40. Gas Service-Final r t•7 !'-" � . ' � '� '
w -� t_. T' . r . a ''G:
� 41. Solar pomestio-Final =• _ ' ;. - � I ; .. �. � -� ; t -
� 42.�Backflow Preventer. l � ; � i^ `- �
.. rr c.
� n � _ _ � -• . "" F- + . :J
43. Backflow Irrigation.; � -- , � y , , � .
�44. 4andscape Irripation System -�'� r. + r� c+ +- r r. cz- �� �.t• r�. � n c•
k� t(� i ' ta
'45..Sound qttenuation; � x' ' '� " F F" �', ' , a �, F,'' � ,
T 1T : C. 1 Y
r• '
%46. Handicap Requlations " � t �� c; � - _ .
i �-, - .
47.=FINAISTRUCTURE&BUIrDING � �° - `� ' �
. � c t .
48.,�F.INALPLANNING �r� ��� 4'- �-"'�F ^ `� ° �'
"r- �u � �
�49. �Elecfric Release to �dison ' r , _ , �, ' '
u�
c59. Gas Release to Southem Catifornia Gas C� . ' '� 5 �-� " -'�. r =� �
♦ s C�
51. CERTIFICA7E OFACCUPANCY � + : "' - ` - -
No. Dace
� I�UDpa=OF�1���� 36S E 19TH ST
'nx�xsruYe�amrtr FOGG, CRAZG S
�.i �op� FOGG, MELANIE 1�r......•
365 E 19TH ST
COSTA MESA,CA 92627
wtt. iuiuNc wowess:
UNT:
,wcNrtccTopF+u+Nap: RONALD LACHER ��= 20949
umionwu•sauoxEss: 1332 N, MILLER ST �� 201
ANAHEIM CA 92806
�crarsxu� HLO$ HAVEN POOLS AND SPAS ( 714 ) 549-4712
cam�croirs�u�o 433 E COLUMBSNE ST
�ooxEss SANTA ANA 9270,� CA ucra: 4 N3445
x
LICENSEO COHfH�CTOP4 DEC�APRTION: I MnW elfrm uMx perely d pe�ury tlw I em ficenseE uMm pwidom M Cheqx B
(mmmerciM xiih Senbn 1a00) d Owebn a d IM Buurwm eM Pnlmewns Cods. end mY 4ceree is in ull brce eM eHaq.
�cmuc.No.:03 542 uacuss: C 53 uc.No.: 5 ^ : OS/91
e: ` Camatlar.
NER BUILOEN OECL�flRTION: I Mmby elfirm uMm perely M parjm/ Ihel I em memq mn IM COMretlon Liume lew ta iM
�aw..:ro � lsae� �oai.s a,�:�e �d r�d.e�+ cme: �m �n «owmr wntd, �n, e v�a io em.wn. �n«. mao...
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�� licenaed punuenl �o tAe povi�qna d tlro COMrtlae licame law IGhaqa 9lwmmenenp wilh SMion ]000) d DMwion J d IFe
luvineea arM Ndenons Code� a ihel M a ehe u exemq iherehan eM tM beais la Ns dbpW uampian. My voW ion d Sapion
]W 1.5 by enY WW�+^� la a pamy vAptla iM applFau to a rnM pmelry d nal mwa tMn liva hundeM ddlen �SS00�.
� I.mowrorW�lwC�We�Yamyempb�euxihwape+nthsobcamV��.wiYEOIMwk.eMtlr�VucWia'sml'vnandeE
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a dn did m� EUJA ar improvs la the puryme W�ds�.
� I. m owmr d IM propsry. em eRduairNy amirean0 �h lioenaed conhacion to cmetrud �M projea (Setlion 10a6. Bueiiross ard
Prdesaone Code: TM Cont�epps licenea Law dma M eppry M en owmr tl qoperry Mw W itle ar Impwm tlw�ean uM who
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� I em azamp untler $eciion: B. 8 P.C.. br Nu reevan:
Dele: Oxirr.
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•permulamroleunionamodifirntiontrpnlMAi3i yu�+upsrcm0iur'vf.Ra�id�Nilmm�ionappiut'vsu�wmqM1anYw
poviwme.
De�e: ApplceN:
WOXKEX'S COYPEN9�TON D��uq�TION: I heraby etfimi uMs penMy d ps'ryry wr d the Idbw'vp detleruona:
❑ IMvardwYmeinten.unJiu�.amreenito.etlinaurobrMakan•comPM�ian.mA��l«MSw'v�3]aoaf�MleEw
coe.. �« �ro vMwnw�c. a Ne .ak �o, w1Ycn �nu v� o n.uee.
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2f � iw xfiitli Nu pomiil ie iaued. My wwFen' oom ion i�eanea eenler eM pdiry numbsr ua:
c�«: S'I�ATE FUND EXPIRES
Policy NVmber: � 1/ 41 / 9 6
, m;s ..mw, �e.d na w condw.e 1 ue v�r u ro. o,. nu,wree ewar. lsiool o. iw.l
...
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m . �' Md'�: ,
am/nC: Fe9un ro s�cun roikr�'romV�tlon rnwN� b w4wnd. uW Ntll rbN� ei uTloyw ro cNmlrolY�^�ICqW
clHl lln� up ro o�w �u�NW Mousend Jdl�n (Sfo({aooA �+�Itlon ro tM ewt ol ronpenwWn Ennpu u poHdM ror In
9�ctlon 9106 0l M� laEor COEs, Inhns4 antl ettomry's /�u.
CONSTRUCTION LENDINO AOENC�: I Mreby elfi�m uMer penely d perNN �M1e� ��re ie e conN�udion bMi�q epeiwy br Ne
nen«m� a n» w� m� wnKh �w w�� 4 s.�.e (s.ao� aos�. c:.. cI.
LENDEN'SNANE � , '
LENUEN'9 �DUWESS:
1 ceniry thm 1 heve reed Nu eppli�yion uk qets ihm iM ebove infmwion ia cmetl. I apieo�o compy Mil� all ary vM munry oNmerces
W stals lewa Nd�q m buWd�q mmtrWim entl hareb/ ewhorce �apexn�eV.aa W Ne iYy ro Ws uV� �M ebo.a�meNinad popany
'°`��'"°°�"�"'0°°°�'EAIC DEXTE " //
` n N \//� `' ^. �\�)/
�Ome: H ��� —� `�
..:---.. ._ � — -`---.�,_.__ _ , ,
(St51-16.WP) WM1�e-BuJd�q 8
PinkJWsnue:(iakwoE-Aaemv
CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: P 072708
PERMZT NO: P 072708 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : POOL HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: REF: H-72705
«��r**x�**�***�r*�r*�+��r�*****�**�r*+��*****�r***����***�***�+r�r*�r*�r*�*�**�r**x�x�*�*****�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 HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE(a: PROV: PARCEL: 11729417 ZNE: REF NO:
PLANNING NOTES>
i Q
1F iE iFlf iE 1F 1E if if 1E iE 1k 1F 1E 1E iE 4 iE 1f 1E IE if if 1! 1F i(� iF 1E 1E iF iE if if if 1E if if if iE 1("k if iE 1E iE 1E 1F iF 1! iE 1! iE 1E iE iE 1E iE iE iF if 1F iE 1E {E 1(' 1E 1E 1(' fi iE 1E if If iE 1E i(� if iE if
D E V E L O P M E N T S E R V I C E S• R E(� U I R E M E N T S
ZONING APPROVED HY DATE:
BUILDING APPROVED BY : DATE: �
APPLICATION ISSUED HY: DATE: r
if 1k it 1F 1k iF fE k iE 1E aF ik iE iF iF ik iF fk fE iF if 4 iE iE iF iF iF ib iE if iF 1E��iFiF'lf
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MEC-HANIC FIRE SMIP/RES GRADING
PERMIT �z5$ .'' SMIP/NON—RES
PLAN
ZSSUE FEE 20.00
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK '. TOTAL PAID DUE
TOTALS----> 7.00 20,00 0.00 27,00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27,00 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC HE(:HANIC EIRE SMIP/TOT GRADING PLAN—CHECK
27,00
iF k IF Ik ik iE 1f 1F iF iE k 1E 1E 1E 1E'Ik i! i! i! ik 1k i! if ik it iE 1E iF iE k k if 1k 1E 1! 1k ik ikif 1! iF if Ik 1k if ik ik iE iE 1E if iE ikiE iE 1F 1E ik if iE 1E 1E 1k 1E 1f iE 1k iF iE Ik 1E 1E i! 1E if k if if 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
PLU 1 SWIMMING POOL � 7,00 7,00
END OF FEES .
�f G0�836;7—p013364; T C.�Y ?7.OL1
4ATE= CS/Q5/�J�• TIME: 13:i8
� �
� � � �'CONSTRUCTION AND PLANNING POO .iPA _ �
��QPPROVALS Permit �F Date Inspector AppqOVALS Pennit # " Date Inspector
t. Temporary Electrical $ervice or Pgle 52. Poo1 & Equipment Locacion�; '
2. Soil Pipe-Undrgrnd. �, 53. Steel Refnforcement -
•_�3i ��lectrica�-L'odc7oit U,c,ility-Und�grnd. 54. Forms ' � "'
-;b�,Electrica�Cd�d%it�Undrgrndl . 55. Electricai Bonding � � �
�:.�i: •Stret ReinfotCerieot; �� 56. Rough Plumbing & Pressu�e Test
'�'6 :E(eMrica��'UfEB'.Grn"d_ 57. APPROVALTOCOVER-GUNITE r' ` ,
'7���Footings,��7 � 58. Electrical Co�duit•Undrgmd. �
- 8. Foundatiori � ���' 59. Gas Pipe, � l�Jndrgrnd., Test �
F _� . `.l ti 4' , Cr
9. NJater Pipe�l3ndrgipd.;� 60. Backwash Linep; P•Trap, L7 Undrgmd.
104 9tructura� FIoo�System �� � 61. APPROVAL TQ DECK �
11. Proparty Sewer Line& HoUse Connection 62. Backwash & Recepror-Fiaal �
12. Sewer Cap ` t v - f 63. Heater & Verrt�Final
13. Roof Drains .;� �� 64. Plumbing System � Final `;� z(,� ���
74. Rough Plumbing� . 65. Electrical-Final -' �
:-Y
15. Rough Electricai=Conduit � 66. Solar SYstem-F�iqa!
76. Rough Electric�Niri�9 .� � 67. Fencing & Rccess-APProval '
17. Rough Wirir�g Sign i 68. APPROVED F�fl'PIASTERING
18. Rough ElecVical•T Bar Ceilinq 69. POOUSPA SYSTEMS FINAI '
19. Rou9h Heating & Air Co�ditioning , FIRE.��PT,�REQUIREMENT .
20.'Rough Factorq Fireplace _ _ - , - � '�'' � APp�R01GALS�� PB mit # � - -
27. BucK, irfSt�Scture + ••' -'' - ' � r � 70. Unde�greupd Hydro ,
22. Dutts, Ventitating;,_. ' '-'' c; '. 71, product,-Pipin� O�$as �JOii
r.
23. Gas Pipe-Rough & Test �, : ?�r �" t' �_ �� 7p, Undergre�nd Ftush ' �
24. �iioof-Framing r', F"'" "r; .� ,r . 73. Undergmd. St rpge Tank O Gas � bi�
25. Roof�Shsathing � � � � ' 74. Overhead Hydro . �
`
26. �T�B� Ceiling (StrucJural) & Monocoat ' , ' • . 75. Dry Chemical F.-. �. �"
27. Frameand FlashingR ;='sx - . � 76. DryStandpipe �, ' �
' 28. LathingE�Siding''��� `�� x �T ' � 77, FIXED�SY•STEMSF(NA�..., � `
p�� 'l �:- d: f �
29. Insulatidtt J � •• * � � � '' ZB. FIREPREV. FINAL ° � �^ �
,
� 30.Drywalildailing � -"T ' t' `"_' �F'.HEALTHDEPT:REQl11REMENT
31. Plas:er BrAwn Coat:. - � ,� �� t ��.'� 79. -PINAL INSPECTION � � �
' 32.'Electrical Pov¢er Me[e'r-Final �. �� i �' 80: POOD CERTIFJCATE �SUED�
:. `. � .
33._Final�Electric� � ,� � � Notes: - - . �� ,!
i ' -
' 34. 'Pinal'He3ting`_& Air'Conditioni� + ' � � , _ � -� ��
'. t* � ^ r
35.'�Final�Gas PipecTest �� -' : : f ��. - y,�, _ - i�
36. _,Hooii•or CanoPY x" 1 -= - � / T� �d� 2 r �
�, 37. F.ina7 factory Pireplace;,, , ._ ; �� , / ^��� �j\���3��
•+ 38. FinafPlumbing �- - ,��5� : � -Lti -'�' _
Ki'
39. lNater Service�Finalx _-. '� �. �. � � � � ' . ��
40. Gas Service�Final - -• • � � '�'.- - �
� 41. Solar pomesticFin�l S �� '- � � . " f
r' � '* l.V� T
42.�Backflow Preventer. • '� . ' `-" �
��. ^.l H
43. Backflow Irri,gation�� � "' ' � rt � � ; .
44. Landscape Irripation System ="' •� • " _ - "_' i �� `v -
� 4 ! ).
� r Y J. L^ F� - � i �- F . . . . ' . ,
`45. :Sound Aitenuation�` , „ - .,. ' , . �.: � . . _ -
�46. Handicap�Regulations . * � '� - � -
�47. �FINAL STRUCTURE & BUIL-DING � y � ' ;
48. �FINAL PLAN'NING� - � � _ ' _ , ' �
49.'Elecdic Release to Edison � ^ - '" -
. � ' *
�50. ;Gas Release to Southem California.Gas Co r J t' ',-t � - •
0
:51. CERTIFICATE OF OCCUPANCY 1 ' r' : : ' r� -
No. Date
mon�ae�m+a 365 E 19TH ST �� CITY OF COSTA MESA – HUILDING PERMIT
MIIERBNAYEIFRlOMk FOGG, CRAIG S PERM NO: M 072707
�., wa�se FOGG MELANIE L_• ---�
365 � 19TH ST • PERMIT NO: M 072707 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627
�vv�.�uuxo�ooeeu: CONSTRUCTION TYPE; PERMIT TYPE: MEC PURPOSE: OTH
uxx�cr«�aoc'�m RONALD LACHER ��- 20949
wcwa+v+o.z,�o�ss: 1332 N. MILLER ST �NT� 201
ANAHEIM CA 92806
cam�crarowu� HLUE HAVEN POOLS AND SPAS ( 714 ) 549-4712
COIfIN\CTORSYNlR10 433 E COLUMBINE ST
�om�ss SANTA ANA CA uc xo. 4 S 3 4 4 5
92707 unr:
LICEN9EU COMP�CTOP4 DECL�W�TION: I AereEy Nim uWx psWY d prj�y Np I am GcwC wdx po�vion+ al Cheqa B
�mmm«xino wnn ssua, �oaol a uvem a a ms a�so.d am�aem. coas..e mr �sue u m nm ao w enaa.
cmuc.N .:03 42 uc s: C 53 uc.r+o.: 4 S CP: OS/91
m.� — � cmv.e«:
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IdM�rq esuon (saaion )W � s Bwias+eM Rvlmew Code: AMW a oouMY r.1Jd� nVuim e Prmd to oonewet. edw.'unorow.
dsmd'eh, a repei ury �Ywiaa: pior b<a euiero. abo �aV� � aGO�d ta ach penN lo fJs � dpnM WtemeM tlW M a�M
p 4meeed WnueN lo �he pmmu d tlr CONraCue l+mue lew �GMqr B(�M��O'�h Satlion )000) d Diveian J tl iM
e�.�.+ �e rramo�n coeel «mm ne «.ne a a.�p ma� �a m. em. ior n,.,o,o.d ss.mqo�. Mr •dmo�, a seao�
1m1.5 W ury eppirent �a e permY qmjey tM eppfwit to e wi pr�eCy al nd mm Uw� fws MVMrad daln� �S5oo0.
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Mro Wide a inpwa� �hrean. aM rAn Eom �udi wak tinW a MnN a rtrapM1lo a Mr mm amDbi�+, p�sd tMl wch
'unpmwmWa ve nd ImeMeE a d1anE la ub. tl, Aowr.w, iM buildi�q a inpv.qneM 4�dd r.'uhin ane yw d wmpW on, the
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ir wwk I« Mhic� Nu D�p b m�eE. MY warbn• camD�bn 4rurenu urt'w W V�Y numbm ve:
� c.�:.: STATE FUND EXPIAES
�r+�a, ��q–a n 01 /01 /96
(i1Ja ncfion rcM nol M cwMYMM I W 0�� b M ar hirtlrM EcWs Iflool n IwJ
❑ I mnN Net in tM DMamerca tl ilr w�k b Wikh tlw v� b hnwE� I WY nd r�w�W M' w� ��Y mwr w s to
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..:u—, � �
W�mlip: F�Nun ro ��cun wM'r�• ro�rwtlon rorw�ap.l� unWM, �nE �htll �ypJM �n �nqlqw ro eMMixl pxi�ltlu �nJ
GMI Mu �q ro orr ��MrW tleuurd dvlbn (S�GqGWA N WWMn b IM cwt ol conpwwfbM1 tl�nrpn u pvrMW br In
S�ctlon �)O6 0l N� l�4or COW. IMwvt �n0 �ttonny�� /w.
. CONSTtiUC710N LENDIMO �OENty: I hreby af6m� uNr pmMY d parlW � 4vs u e mut�udian Widnp apw.y iar tla
perlormvwe d �M wk la xfiich �hu pami b"suwE (�� �. CM. CI.
LENDEIY9 NMIE � �
LENDEN'S �OONESg; f �
�' .
I cMih Ihet I heva nW Na epp6ra4M eM atle tIW tM eEo.•a'vdametion u conW.l qya �o romdV wil� eA e�Y eM ooumy ordineMs�
vM nme levrs MtlM m dWdiq wna�rim vdlw�h' �q�ce np�aantefnas d IM ay b Wx upan IM ebave�meMinwd GAPaM
la ireD�� RnD��, r .
ERI DEXTER /
P Nems ' � /
I '• ,�„ –
, \ – � 'a. Oe�r. � \{/
sro��� d ow�«i�✓n� m�,.. cr .�,.n,�
(5151-,6.WP) ' Wh4e-&uidig85ddyO�w�FIe:Cer�mY-�pG�d:�k-Rv.w+»:Oakwod-�e��or
JOH DESCRIPTION ; POOL HEATER
SQ FT:
CLAIM VALUE: CALC–VALUE: GROUP OCC: R-3 /
COMMENTS: REF: B-72705
iE �k 1t 1f 11'it if 1E 1f 1F �E ft it �f 14if �t 1l1FIF 1f lf If lE it it 1E ft 1f M M 1k #E lf fFfF 1E f!1lif 1E ff 1Ek if 1f iF1t1FiF it k 1F 1f iE 1E �f 1F �E iE iE 1E iE iE 1E 1E if 1E lE iE fE 1E iE 1F if ff 1f fE 1F
Z O N I N GS ERTEH�AUCIKASE 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 REQ• PAOV: PARCEL: 11729417 ZNE: REF NO:
PLANNING NfSTES> '
>
iE1k1lkifkifiFiFiFiFif1likil�kiEiFilklkikiFlkkifiEifiFMkililiEilikiliFitiFiFitrftitititiEiFiFititikiFiFlEiFiFiFiFifiEifitiEiFiFiliFiliEifitiEikiFiEififit
D E V E L O P M E N T S E R V I C E S' R E Q U I R E M E N T S
20NING APPAOVED BY .
BUILDING APPAOVED BY :
APPLICATION ISSUED BY
1fiFiFMifk1E1F1Fif1EiflFiEk1E1F1EMiE1f
LEGALIZATION:N
F E E S U M M A R Y
DATE:
DATE:
� � 1
STAUCTURAL SEGMENT:N
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 925f SMIP/NON–RES
PLAN '
ISSUE FEE '� 15.00
HUILDING–DIV–> PERMIT ISSUE PLAN–CHECK , TOTAL PAID DUE
TOTALS----> 9.50 15.00 7 0.00 ', 24.50 24.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24.50 OVER/SHORT: ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FZRE SMIP/TOT GRADING PLAN–CHECK
24.50
1tiFiFilltikilkikikltiFifkikikklflEiElflkililiFiFikkkklElFiF1liEkiElEikltfllflkikiElfkkkiklfNiFltklElfifikiklFlFlkiFif1k1f1k1f1fkitiElFlEifiklElE
I N D I V I D U A L F E E H 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
a
MEC 1 GAS PIPING SYS 1–.4 OUTLETS, 3.00 3,00
MEC 1 EACH APPL NOT IN OTHER CAT CINDER FEE 6.50 6.50
END :OF FEES
.� •y�
/ 'f
—�
if
Oi 0�13�54?-00?83643 Yi0 Y 24.50
GRTE: OS;Ob/9� TIFiE� 13:17
i
CONSTRUCTION AND PLANNIJVG �� POO� a SPA
RPPROVALS Permit # Date Inspector qppROVALS Permit # Date lnspector
1. Temporary Electrical Service or PoJe 52. Pool & E4uipment Location �
2. Saii Pipe-Undrgmd. `_`. � 53. Steel Reinforcement •
� :•�`IeTtrica�"CbriddfiUtiliry�Un�rgrnd. 54. Forms � �
'4'�EJ�ctric2lC7��iY�u�it�Ugdrgrnd. 55. Electrical Bonding �
r:. �5: Steel Reinfor�mpr[t : 56. Rough Plumbing & Pressure Test i. (
�'�'6 :��ctrica�.�JFEF�fir�ii. 57. APPROVALTOCOVER•GUNITE _
j�'7;'¢Qotingsm�� -' � 58. ElectricalCorn}ui{�Undrgrnd.
� ' 8,. Foundation� �_ �� ?' - 59. Gas Pipe, � -U �dr�rnd., Test y� /��� _
�l
, 5i t�Jater PiPellJndrgrfld. = 60. Backwash Line�P-Trap, O Undrgrnd.
10.�Structural Floo� ystem 61. APPROVALT�#DE,CK
11. Property Sewer Line & House Connection 62. Backwash & Receptor•Final 1
72. Sewer Cap �� � �. -, 63. Heater & Vent-Final C p
13. Roof Dreins '' ' � �E ��G
_ 64. Plumbing System � Fina� � • ��.�q�0idt!'
14. Rou h Plumbin^ . f ��-J/
9 9• 65. Electricat-Final
�
15. Rough Efectricat�Co�iiu(t - 66. Solar Svstem-F,inal ''�
.. �,_
16. Rough E[ectric irirjg ; 67. Fencing & Access-ApProval
77. Rough Wiring Sign � 66. APPROVED F�i'PLASTERING .
18. Rough E�ectrical-T Bar Ceiiing� 69. POOUSPA SYSTEMS FINAL
19. Rough Meating & AiYCond�tioning � _� � �, F(URE�QEPT�REQUIREMENT �
y 9 ` GN { P =� -, �� k v �-� . 1APPROVALS- ' P�rmit # � ;�;' �
20. `Rou h Facto Fi a lace
27. �flucts, in�StrJtture. • •• •• _ S '= •-* " 70.'Underground Hvdro '
T ) !� • L
22. Ducz Vertil�ting;::; �: J *--i � c�� ,. 71. `ProducE;Piping O Gas OOii
23. Gas�Pipe�Rouph & Test � •� T' - �w � 7p. UndergroLnd PtUsh �
24.�RooFFraming'. �'•� � - ..- . iJ r� .�;` � ••• �•, �c,• •
_ `. 73; Undergrnd. Stora�}e Tank.O Gas ❑ Oil
25. Roof•Sheathing � C '�� 74. Overhead Hydro �Y "
26. -T�Bai'Ce�Iing (Struc`urall & Monocoat ;� ` ° - ':� 75_ Dry Chemical �,� :r � " ,.:,•
27.KrameandFlashirjy� . .. t� 76.DryStaclif{iiPeF� *�
t' ' -, "
;' 28. Lathing & Siding''� ; ' , j" ; C r � � , " 77y FIXED;SYSTEM-SFINA� _, ��
M r�
29. Insulati0a r�- •• .�� 78: FIRE PflEV. FIN`AL "=' • �`=
� 30. Drywali tSailing .� ,, � F � �` � HEALTN DEPT.`REQUIREMENT
�� 31. Plaster &own'Coai z= �-?� '� t� 79. FINAL lNSPECT�ION - .�
t: �. . � . '^ -^ ^
�
F 7 32. Electrica� Po�ni¢r Me�trF�,nal '. i�� ; ;,r � 8Q`� FOOD CER7IF,JCATE I,SSUEO `
� rvn ' = � '1 1 :' i 2 �
33.�Fina6Electric_ � .� Nntes: �• ._�+���" _t-.7 9 ��/
; . . �.� . .' � � . ¢Id�-/2_swr�•
� j 34. �Final�HeatingR& Air 6onditioningS : k _ � , ' = ���,_.' '
.�• " � �►-�Y � �� �-d _
�,
^ 35. Final �Gas Pip2•Test r ` `v .. �{ _ ` - _, �.��, e = � -
[ `
' 36. Hood or CanoPY � ' -• •- • % -�:' + y ' ir'•T
C' -- ;si �� s t-; i- rn
. . 37. �F.inaLFactory FirePlace - . �r � � �.' ` :�S -C�rL �
� 38. FinaF?IVmbing i. `C: ._ .1 y-- � .�.: . :.• " �" --
r M .7 I �[' Fa i. :J .T Q
f R . ' IJ.+ , .
' 39. Water'Service�Final �` ' �.,.. �� � �, ' •�• -
� 40. Gas Serv�ce-Final • . :� � , '�r � : a 1 '= � •
' �L T t_. .��T r Y'
' 41. Solar pomestic•Fina( = " �� `-� � `"P! _ t -
'r ^-! � K :
42. Backflow Preventer � :J 5. � 'T' "��� `• �J "
� 3 . s ITi C
1: F.
43. Backflow irrigation � . - - � - s . _ . �
[44. �andscaoe IrriAatiori�SYstem"=%.-� �T: -... -� r''.'- .: -' . . � , -
n- .r -
�45. Sound Attenuation:! ' `•` r ' = F F .'y • . � �"�
-� . f � �� �. F, �� r• W, . �"� �
�46. Handicap•Regutations - ^ + � ` �, r _ Cd ' •
n
47. FINAL STRU�TURE & BUILDING ' '� '' - '
. i� f-• t . -'k • r �
48. �FINAL PLANNING+ .- ' �' --'t ' M -" r
49.'Elect�ic Release to Etlison , ' '
�
-� .i� x
.50. ,Gas Release to Southern California Gas Co x � � ''" _ ='." • = ,
51. CERT.IFICATE OF OCCUPANCY ' ' � � - * � '
NO Date
reaecr aooeess: 3 6 5 E 19 TH S T
OWNEH'SNAME: FOGG, CRAIG $
aooeEss: FOGG, MEiANIE I�
: -365 E 19Tii ST
. " (:OSTA MESA, CA
692�-6431
ARLH/ENCMEEB:
IIDOXESS:
uxit:
9:627
flEG.NO.:
UNIT:
PEflM1TTEE: j�ARVIN L. COOLBAUGH ( 714 ) 646-6056
nooeess: 215 HROADWAY
CM CR 92627
LICENSEU CONTHRLTOP DELUIMTION: I here�y allirm iAa� I am Iicense0 un0er Orovisions ol C�aDier 9(commencinp wit� Saction
7000� oi �ivsion 3 of Ihe Business an0 Pmlessions Cotle. anG my license is -in /luyll torcP antl ellect.
y-fj �rrL�/(c p-sygt�. STRTE LIC.: S�I 1 9 4 �S/f� ��cu,s(�/7(�
p,E'e!/� �� fQ Siqnalur����p.C_,— _ _
VONNENS'COMPENSn7lON ED CIA�ON: IOereUya��irmihallhav¢acelli�iWlealtan5enl selbinsureoracenilicateolworkers'
LomOensatmn Insurance. m a cetlifie0 copy Ihereol (Seclian 3800, LaO. C�.
�POIICY ND.: E%P. O�TE:
COMPANY:
❑ C¢nifie0 copy is hereby fumistleJ. ❑ CetlifieG coOY is IileO with t�e city Builtlinp Division.
Dale: NVV�icanc
E%EMPf10NFHOMWaBMEBS'COMPENSATIONOELtABR710N: (iA6sectionnee0irot�ecom0le ilihece itisiwonehadreGg100�orkssl.
I cedity that in Ihe petiormance ot t�e �wrk for which t�is permit is isiuetl. I 51u0 nal em any n in am/ �50 ds �0 6efAme
su0i�� �o tne Workers' COmpensdlion lax5 al Calilomia�
Oate: — � �Onalure: �
NOTiLE: I. a�ter makmg Ihis Oeclarati0n. you shoultl �etome SUEjtt1 m ttre Workers' COm0en5aiion p visions ol ��e LaGor
COCe. yau mu5i fort�wil� comply vnt� 5ut� provisions Or IluS permil 5tw0 Oe GeemeU rewkeA.
CONSTflUCiION LENDING RGENtY: I hereby atlirm Inal lhere is a Construttqn IeMinp apenty for t�e peAarmarrce al ine work tor
whit� IN5 Oermitis issuetl (Sec�ion 3097. Civ. C�.
LENUEN:
RODflE55:
OWNEB BUILOEfl OECLAf1ATI0N: I �ertby aHum thai I am eaempi imm tlie Contracmrs' Siale License Law lor Ne lollmving reason
(Seciion 7031.5 BuSineSS anE PmfeSvonal COCe: Any tiiy o� COuniy wtnU repuires a permii Io tOn5tmtl, aller, imprwe, tlemaliS�. Or
re0ai� any stmcmre, pnor io its issuance. also repuires ihe apD�icant for suc� Dermit ro lile a signeC stat¢ment that he/s�e ¢ Iicense0
pursuam io t�e omWsions ol t�e Conirac�ors' State License law (CluOter 9lwmmenpnp wih Section 7000) al 0ivision 3 0l ihe Busineu
anJ Prol65ians Co0e) or INI h¢/Slle ¢ evempt thereimm ana Ine Oa5i5 lor tne alleqeC exemo�ion. My vio�ation oi Section 7031.5 Gy
ny appti[dnt loi a permit suCjects ine appliWnt to a civil oen2lty ol not moa than live huner¢E aollars (5500).
� I. as ownet ol I�e O�operty w my employees wil� wages az tneir mle campen521i0n, wi0 Eo Ihe work, anE I�e
I❑ svucmre ¢ nol intenaee ar ollere0 for sate (Section 70a4, Business anA Pmleulonal CoUe: T�e Coniracron' State License Law
Ooes noi apPN to an owner ol a pmpenY wM �uiltls or imprmes iMreon, and who Aaes suc� work Nmseli/�ersell or Ihmup�
�is ar Oer awn empl0yees. O��eC that suc� im0�ovemen6 are not inleMeU or allere0 lor 5ale. If, Mw¢vet iM DuilAinA or
impwvement is SOIC witlnn one year al completion. Ihe awner wiA hdve Ihe Eurden of pmving hUs�e ON not EuIIE ar improve
for ine Ourpose ol salel.
I, as owner ot ihe D�opeM• am exdusiveW conVac�ing vrit� licerted coniac�ars Ia wnsimtt the projeci (Section 7044, Bu5ine5s
❑ aiW Prolessions Coae: ine Contracmrs Sute License Law Gaes mt apply to an avmer of pmpercy wM bwlQs w impmves tnerean
an0 who WnVaCtS IOt Suth prole��s wilA a tonirat�af�s) licen32 pur5uani lo Ne Canlratl0r5' Sia@ L¢eM1te law). I am aware
��w� o��� ot iheir Worker's Compensation insurance shaul0 Oe prOnaed lo me.
� I am e.emD� unaei Sectqn: B. 8 P. C.
for I�is reason:
��
Date: Pxner.
1 ao hereby cendy tlWt I am aware ot ana unaerztana Ine reauiremenis of CaLIomN Heallh ana Shcety CO�e $e[tqns 25505, 25533. anE
2553d aM rtWt I or any IUWre Guildmg attupdnl wilVwill not (circle ane) neeE to CamO�Y ��h 5aitl state totles and Ihe tepuirtmenls lor a
permit for fAnslru[tion or moOiliWtion Imm t�e Air Oualily Manaqement Usiritl. flesiUential consimttion aDDliations are e�em0� ��om
these orwisions.
Uate: ADOlicant:
I nere�y cerlilyiha� I have readihi5 aOVIiCaIiUn anA S�a�¢ Iha� Ihe aboveinl0rmali4ni5 COrret�.laA�eelo COmply wii� aIl tiiy aM couniy
oiGinancesanOstaielawsielatin9�oGuilCuigconvmctionananere0yauthor¢erep�es Ialiv¢. �hi5cilylomleruponUeabove�men�ioneG
pmpeny fo� inspeclion( yourpose�s.J �
oate: _3 �� d—L/ Sienawil��� �_
Driver's Lrtense ar Saial Securily e:
tytt.a6 WN�e—BuilOing; Green—COGe Eniorcement: Canary—ApplicenC Pink—Revenue; GolEenroE—Nssessor
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: E 051388 PLAN CHECK NO: N
CONSTRUCTION TYPE; PERMIT TYPE: ELE
JOB DESCRIPTZON : SERVICE i7PGRP.DE
CI,AIM VALUE: CALC-VALUE:
PERM NO: E 05138
GOVT; N SUPP: N
PURPOSE: OTH
$�J Y1,
GROUP OCC; R-3 /
COMMENTS: SERVICE UPGRADE
if iE �1E �I(1F �M K iF �M if �IF df �N K if iE iE �� iE •7kiE �1E iE 3f !E iE �If 1f iE iE if if •M �f if iE � if if �1F �Y if �M-if �N �7f !E jf �1f -K��1E 1f if +G jf �lE K• �� df iE �iE iE dFif �K �f �7f �lE d( #aE iE iE fE dE iE 1E!(�i�
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 ---------- --------- ACCESSOr�Y HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT ZN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL; 11'129417 ZNE; REF NO;
PLANNING N()'['ES>
i •
��*��**x�*****�****�*�*�*�r*�**�r��**+��:����+�*�x�*+�*u���***x���*��+��***�*+�**��*+�*�**
D E V E L O P M E N T S E_R V I C E S R E Q U T R P M a N T S
ZONING APPROVED BY ' DATe,:
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED HY• � ��'"���'�� � DATE; ���
iF�fiFi!�If#fifklEaFiEdfiFififiFlElbiEiElfif ifiEi43EifiF#9EifiF iElf
iF1FkiF1E1f�E4iEiFlfiEi(�iF1FkiEiFlfiEiFihit�lEif�lElF?EiFiF1E1ElEi(�If�ilE iEifiF*iF3flE7EaEifaEY�F3f1f1FiEiE1@iEifiE►+;.iEleiF�fiEiEaE}iiif�iFiEi3Elfif
LEGALIZATION;N F E E S U M M A R Y STRi7CTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 18��5= �MIP/NON-RES
PLAN
ISSUE FEE 15.00
BUILDiNG-DIV-> PERNIT ISSUE PLAN-CHECK TOTAL PAID DJc
TOTALS----> 18.50 15.00 0,00 33,50 33,50 ,00
RcVENUE DIVISION TOTALS--> COLLECTED: 33.50 OVnR/SHORT: �00
BLDG PMT PLUMHING ELcCTRIC MECHANIC FIRE SMIP/TnT GRADING PLAN-CHECK
33.50
if iE i'r if i: ih if if if M r� tf K� iE rt i'r IF i(� iF �E iE 1E iF if if iE iE i41F �F ik iF if iF iE Y.�iE iF iE iF li 3t� if iE iF aE iE iF 1E iEiF if if ?F if 3E if 3E iF iF iE 3F i4 �fY.� iF iE %3P iF if• iE 3E 3E iF iE 3� if 3f
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I U N UNIT COST TOTAi CUSi
ELE 1 SERVICES BELOW 600 V s HELOW 201 AMP 18,50 18,50
END OF FEES
C�
G1 040S2S5?-0�0423hi Z'tu � ;;,;p
UAiE: 03J18/S1 TF.i4E� I4:0�
�
CONSTRUCTION ANDPLANNiNG POO� SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. S�il Pipe-Undrgrnd. • 53. Steel Reinforcement
3. Electrical Conduit Utility-U�drgrnd. 54. Forms
4. El�ctrical Conduit-Undrgrnd.. 55. Electrical Bonding
5. Steel�Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrital UFER Grnd. 57. APPROVAL TO COVER�GUNITE •
7. Footings ' , 58. Electrical Conduit-Undrqr�d. ,
8. Foundation . 59. Gas Pipe, O Undrgrnd., Test �
i:'
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor SYstem � 61. APPROVAL TO DECK
11. Property Sewer Line & House�Connection 62. Backwash & Receptor�Final
12. Sewer Cap • . . 63. Heater & VenbFinai .
13. Roof Dreins � _ , t 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Finai
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. RE�UIREMENT
20. Rough Factory Fireplace ' ' . ' APPROVALS Permit #
21. DuctS, in Structure � � 70. Underground Hydro
22. Duas, Ventilating ' 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test . , 72, Underground Flush . -
24. Roof Framing • 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing ' T - - 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 , . 76, 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 � 3�%,Z'�� Notes: � '
-34. Final Heating & Air Conditioning. � � � �
35. Final Gas Pipe-Test • �
36. Hood or Canopy - - �
37. Final Factory Fireplace ' . ' •
38. Final Plumbing - �
39. Water Service�Final ' �
40. Gas Service�Final , .. �
41. $olar pomesticFinal
42. Backflow Preventer • "
43. Backflow Irriqation �
44. Landscape Irripation 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
�
�}
PXOJECT ADONE�SS:-- — J 6 S t 1� 1 Fi �iT
OWNEH'SNRME: FOGG, CRAIG S
aooxess: rOGG, Mc.LANIF. L
365 E 1yTH ST
COS'TA MESA, CA
(719)642-6431
AflCNIENGINEEfl:
ROOflE55:
UNIT:
926'l"/
flEG.NO.:
UNIT:
PEflMITTEE: C:RAI�G FOGG ( 714 } 642-6431
RDOPESS: �i ( S E 1 5 TH ST
COSTA MESA CA 926`l7
uCENSEU CONTBACTOB OECLANIITION: I hereby a��irm Ihal I am IicenSeU untl¢r D�ovisions o� C�apl¢r 9(commencing wilh Section
7000� of Divi9on 3 al tne Business an� Pmlessions Cotle. antl my license is in full farce an0 effect.
CITY LIC.: STRTE LIC.: ClASS:
e: Signalure: ' �
JHREPS' COMPENSRi10N oECLABA7I�N: I nereby alfirm Ina� I nave a cenilicare at consent 10 selFinsure or a cenilicate of workers'
�Compen5aiion Insurance, or a cerlihe0 copy ihereol �Seclion 3800, Lab. C).
POLICY NO.: E%P. OFTE:
COMPANY:
� Certi�ied copy is �ereEy fumi5he0. ❑ Certifie0 capy is filetl wiih �he ciry BuilOing Division.
�ale: NOVlicanC
E%EMPTION FBOM WOPKEflS'LOMPENSATION DELLAPFTION: (T�issection neea nolbecompkteEilthe permi�i5toronehundrM�5100)arless�.
I cetlify that in Ihe pedormance of Ihe work tor whic� Ihis permii is issuea. I 5�ali no� ¢mploy arry Person in any manner so a5 io become
sublecl ia lhe WarkerY Compensa�ion Laws of Califomia.
Da�e: SignaWre:
NOTICE:II. a�ier maiting this tleClaralion, yoU S�oU10 become SubleCila Ihe WorkeR' CAmDenSalian D�ovisions o�fh¢ Labor
Cotle. you musl lohhvn�h Comply with 5uth provisions Or IhiS De�mil 5�all b¢ deemed maketl.
CONSTPOCTION LENOING AGENCY: I �er¢by aflirm Ihai ��ere is a ConS[mclion IenOing agency �or t�e pedormance of Ihe woB tor
whic� Ihis permi� is issuetl (Section 3097. Civ. C�. -
LENOEP:
aouness: .
IOWNEP BWLUEP DECLRBRTION: I hereby afiirm ihal I am eKempl Irom the Comractors' State Lic¢nse Law lor tAe follawinp reason
(Section 7031.5 Business an0 Pmlessional Code: Any city ol counly w�ich repuires a permit to conslmcL alter, improve, tlemolish, or
�eoair any slmcture. O�ior lo ils issuance. alm requires tlle applicant for such permit to lile a signe0 stalement ihat he/she is licensetl
pursuam to tAe pmvisions ol ��e Comracmrs' S�ate License Law (CnaD�er 9(commencing vnt� Section 7000) of �ivision 3 of �he Business
•nG Pmlessions Coae) or t�ai he/she is exempt �herelmm anA the 6asis lor ihe allege0 exemplion. Fny violation ol Section 7031,5 by
,ny applicani lor a permii suUjecls Ihe applicanl to a civil penal�y o� noi more Nan five hundretl dollars (5500).
I. as owner ol tne OwOeny or my employees wilh wages as iheir sole campensation, will tlo the work, and Ihe
I❑ s�mcture a not iMenAetl or olfere0 1or sale (Seclion 70a4, Busineu antl Pmfessional Code: The Conlraclors' State License Law
� tloes not apply to an owner oi a D�oOeny wlw �uilas onmpmves ihereon, antl w�o tloes such work himself/hersel/ or t�mugh
his or her own employees. pmviJeO ihal sucn impmvements are no1 intentlee or oflered lor Sale. 11, nowever ihe builtling or
impmvement is sola within one year ol comple�ion, t�e owner will have ��e burCen of pmving he/she Uitl not builA or improve
�or ttte Durpose of sale�.
I, as owneroi Ihe propetly, am e�clusively contracting with licensed mntracrors ro constmct the pmject (Section 7044, Business
O antl Pmlessions Code: The Contraciors' Slaie License Law tloes no� apDly Io an owner of pmperry who buAOs ar impmves Ihereon
and wha coniracls for such Omle��s with a convactor�s�license pur5uan�t0 i�e Coniraciors' State License Law),I am aware
that owol ol �neir Worker's Compensalion insurance should be pmvi0etl to me.
� � am eaemo� unaer Section: B P% O 4 4 8. 8 P. C. `
ror ie�s reason: ALL WORY. BY OWN
Date: _�./�� �� / Ox er:
I Oo hereby cenily that 1 am aware al ana unaersiand ihe requiremenis ol Califomia Healih,. Safety Coae Sec s 25505, 25533, antl
2553d and I�al I or any lulure 6uilding OctuOani wiNwill nol (Cirtle one) nee010 mmply wif� SaiE Staie catles antl Ihe r¢puiremenis br a
permil lor con5im[lion or mo4ilicationJrom Ihe Air uali�y Managem¢ni Disirict. fle5i0emial con5imction apDlications are exempi Iwm
Inese pmvisions.
Date: FO�IicanC
I here�y Cerlily �hal I �ave iea0 Nis appliCalion an0 S�ale I�al ihe �hove inlormalion is COrreCi. I agree Io tomply wiN all ciiy antl cauniy
ortlinancesanOsta�elawsreWlinglobuildingconslmciionanah pyamnarrzerepresentali a��hiscilyloemeruponlheabove�memioneA
pmpeny mr ins ec�ion pwpnses. 6(� -
Da�e: ������ Signalwe: �+
Driver's License or Social Security a:
I6al<6 White—Building; Green—Cotle EnforcemenL Canary—ApplicanL Pink—Revenue: GOICenrOtl—Assessor
CZTY OF CQSTA ,uESA. - 3ULI.�DING PERNiT PcR': NO: B USi`_il:.
PERMLT NO: B O.�i1S1'l PLAN CHEC_K NO: 01096-91 s GOVT: N•SUFP: id,
CONSTRilCTI01� TYPB: 5-N PERMIT TYPc: STR PC7RT?i73c.; AZ,T
SOB DESCRIPTION : 336 SQ FT SOLID ROOr PATIO COVER St,� FT: 336
CI�AIM VALUE; 2,000.00 CALC-VALUE: 9,636.80 GROUP OCC: R-3. /Ph-1
COMMENTS: SP-0OKE DETECTOR(S) RE�UIRED IN HOME,
�r�cx�cxr*�cxa*�+�x+�***�x�x�x*�x**** +��*xv���+r+r�t+n*x�t�r�rx+��r�t�r��**�rr:�c���r�r�*��r+r�!���e�r��x��e��
'./. O N Z N G R E Q U L R E N E N T S
S E T B A C K S
------------ MASN 3UILDING ---------- --------- ACCESSORY HUII�DING;---------
FRNT: 35 cT IN REAR: 60 FT TN FRNT; cT IN RcAR: FT IN
LEFT: 5 FT SN RGHT: 19 rT IN LEFT: FT IN RGHT: FT' IN
PARICING RcQ• FROV: PARCI-.'L: 11729917 ZNE: R1 REF NO:
PLANNiNG NvTES> 336 + S�. FT. PATIO COVER AT'fACH'r'.D T'O AN EXISTINE� SrR,
i �' ' '
iF ff 1(• if ii i!� 3f ie iF iE } i(� ii- M 1E if It if� #E ii k- iE IE fF iE 1E k i4 }:� i! iF iE Ik iF if aF R)f iE ih !E �IF 1E k If !F ?E iE i! i41F iE IF 1E lE )E 1F # fF �1F iF iP if ik?E R iF iE iElE.X� 3i� ic iF ik} �� K� #
D.E V E L O P M E N T S' E R V Z� C E s' R E Q U I R E,til c N T 5' '
7.ONING APPROVED BY : SCG DATE; ��c��
BUILllING APPRO�rED HY :_ __ � DATE; y����
APPLICATION ISSUED BY: DAi'E: y�1 /
Y��iFiFlEif3'r3EjEifiF�%�iflEifiFlFiPifkiF?��#'iF� � . � � � �iGf:if�3el'ti'riciF�lEiEiE#�k'7F�fiFtF3f
fE1FIf1E1FIfiF�fi`.�iE1t1E1E161E!t1tiE%iFiflFiElEik!EiE�R1ENifiFiFi(�itiEiFiFi(�iElf �itikifiFfFkil�if-lElfifiFlElFlfiEiElt3EifR!(�iFieiF3FfFt.�iEjlK�iFit#iFY.�
I�EGALI2ATION;N F E E S U M M A R Y STRUCTIJRAi, SEGyENT:Y
BLDG PMT ,PLUMBING cLECTRIC MECHANIC FIRE SMIP/RES GRADYNG
PERMIT 72,OU ; SMIP/NON-RES
PLAN A6,80
ISSUE FEE
BUILDING-DIV-> PERMIT ISSIJE PLAN-CHECK, 1'OTAL PAID DUE
TOTALS----> 72,50 0,00 46.80 119,30 •119.30 ,00
REVENUE DZVZSION TOTALS--> •COLLECTED: 119.30 OVER/SHORT; 00
BLDG PMT PLUMBING �LECTRIC MECHANIC FIRE SMIP/TOT GRADTNG PLAN-CHECK
72.00 .50 96.80
'.F ib 3f'1F �,(� iE if �F i4 iE 1f N� iE 3E if if 1i..1r iF if IF Y� iE } if i(�W. �Y. i!�'i. # 1f �E 1E iE ic iE iF if iF!E #E if ik±E iF iF iE 1E iE �E if iF iti? 3f 1k 1E �1F iF 4 JF # If IF ib i'r �If if lElE !F iE 3f IE iF If iF
. I N D I V I D i7 A L F E E B R E A K D O W N
TYPE QTY D E S C R I F T I U N UNIT CUST TOTAL COST
SFR 336 RES-PATIO COVER-POST 6 SOLID ROOF
END OF FaES
13,80 4,636,80
�J1 GOOE3E�0-Ou0E320: 'd"a� u i'^,_�
DR7E: a4/OI191 TIIi�: I.`."�:SZ
�
CONSTRUCTION AND PLAI. �G . " ��' 'PA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
� 2. Soil Pipe-Undrgrnd. 53. SteeV Reinforcemen[ � �
,
.. 3. Electrical Conduit Utility�Undrgrnd. 54. Forms � _
4. Etectrical Conduit-Undrgrnd. 55. Electrical Bonding . �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrital UFER Grnd. 57. APPROVAL TO COVER�GUN�TE
7. Footings 58. Electrical Conduit-Undrgrnd. -
8. Foundation 59. Gas Pipe, O U�drgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Struttural Floor System 67. 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 �
75. Rough Electrica�•Conduit 66. Solar System-Finai
16. Rough EleMric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriwl-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 O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof �raming . 73 � Undergrnd. Storage Tank O Gas ❑ Oil •
25. Roof Sheathing ' 74. Overhead Hydro
26. T-Bar Ceilin9 (Struoturall &� Monocoat . - 75. Dry Chemical
27. Frame and Flashing . 76. Dry Standpipe
28. Lathing & Sidin9 77. FIXED SYSTEM FINAL
29. Insulation . � 76. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
, •
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter•Final �� 80. FOOD CEftTIFICATE ISSUED
33:'Final Electric . � Notes:
34. Final Heating & Ai� Conditioning ' �
�
35. Final Gas Pipe-Test " _
36. Hood or Canopy� '
37. Final Faaory Firepiace '
38. Final Plumbing �
39. Water Service�Final �
40. Gas Service-Final ,
41. Solar pomesticFinal �
42. Backflow Preventer � "
43. Backflow Irrigation �
44. Landscape Irriaation Svstem , .
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & OUILDING 1 �/
48. FINAL PLANNING �
49. Electric Release to Edison ,__ '
50. Gas Release to Southern California Gas Co �� %
51. CERTIFICATE OF OCCUPANCY
No Date
ApPlicant to flll In sll svaces witnin heavY bortler lines antl sign ali appropriat�elantions.
Y OF �COSTA MESA P ITy�q� TRACT NO. LOT NO. BCDG. NO: '' - - - -
ONSTRUCTION PE,BMIT �(o �% � I D , , -� �' 2056 �2/ I 6/82 • ' � 5.00 TL'
. Project Address � TVPE OF CONSTRUCTION .. �.. _ .! y , ." , , ' �
Ownef [-a- /l{ Ph � NEW ❑ ADD' ❑ ALTERATIOfJ � � - �
1 .j . •
'Address" � '- - ❑�REPAIR ❑CONVERSION,ODEMOLISH . ,
• Arch/Eng. '� License No. - � OTNER � A.P � _ Z Z�NING REGULATIONS
� Addreis � - � - � - ,DFx S-CRIPTION OF WORK� G "
VNDE 2ovN0 G/ti�E' �' zorve � ' PLNG. REF. �
Contractor � (,J � (f Phone TYPEOFPERMIT� • - � ' a�'Bt�i��irv
SETBFCK L T. OP R I
' AddreSi - - - � - � . ❑ GRADING - ❑ FOUN�ATIO�I ❑ STRUGTURAL SIDE YARO- -
LEFT
L'ICENSED CONTRACTOR DECLARATIOf�I - - - �❑ TENANT O ELECTRICAL �d LVMBING-OMECHANICA 9�pE y _ _
I hereby, aifirm th�t I am licensetl untler provi5ions of Charler 9(com- i• • / . RIGHT ' "
mencing with section 7b00) -of �Dlviilon '3 of'-�ha' BuSiness• antl �� OTHER -� ' � REAR YARD TO P/L) -
Professlonz Cotle, antl my Ilcense is In tull force antl ,eftect. ' - • ( '
-_ - _ .. P.ROJECT DESCRIPTION, - - � ' - - • � pKG:SPA.CE REp. " ov,iDED� � -
Llcensa pass � License No. . -. , '
Data � � Si9nature � ' ' _" ' . ' SQ. FT. ' . . .. , . . � - . .. _ . _. . . _ . . �. _ - .
�WORKERS'COMPENSATION DECLARATION�-� .' ` OCCUPANCY_CONSTRVCTION TYPE ' ;STREET WIDTH ARK F.EES � �,
d hereb affirm thaf I have a certiiicate o( consent to self-insuro or a �ZONING'APPROVE��BV'" ATE �
Y �'yALUATION'� � ZONE � - �'� �' � •
certifiwte of Workers"Compensation Insurante, or a carHfietl copy --� � - - � � � -. -- . ._ . . �
[hereot (Section 3800, lab. CJ. GRADINGCV.•VDS. ACRES �SPECIAL CONDITIONS: . . .
� . 'Y No. ComPanY __ . . .. . . . " _ _'. ,' . __ " ..' .. ' " _ ' _ ... . "' ' "' - i
- ertl(letl <opyis hereby furnishetl. - '" - � - - .. . REMARKS: '- � - ' -� ---_ .. -_ _ _ _ _. _ . . , t
� Certlfletl <opy is tiletl wi[n the city BWltlin9 Divi;lon. _ _ � '
�EXEMPTION FROM WORIFERS' COMPENSATION DECLARATION " - - - ' - "' - "' ' � " ' ,�
(Thiz secllon neetl not be completetl if tha permi[ Is for one hundretl __ - _ ' ., _. _- . t _ ', , .'� ; , , � ,
S5300) or less � ' � - ' - �
certity,that �n lhe performance of the work for'Whith this permit IS
Issuetl, I shall not employ any person in any manqer as to be<ome PLUMBWG, ,, � � PLAN CHECK -� � '- � ECECTRICAL- "` - PLAN CHECK -' '
subjatt toShe W rkers' Compeosa b-La s of Calilor �. .. . - �
� �- BATHTUBS' � SHOWERS - � ' � � "- ` -
�ate $i9nature '
NOTICE: If af er making this tleclaration, you shoultl be ma subjec "TOILETS "� ;; {URINAlS�� �' ' ' -' ;GENERATOR -" 01 KW_ 1=30 KW -
to the Workers' Compensation provislons ot the Labor C e, you must � I 4 •TRANSFORMER . •, _ .. ,
forthwith comply with such provislon5 or this permit sball be tleemetl �VATORIES - DOUBLE CAVS " ' APPLIANCE -10-50 KW�=50 t KW -
ravoketl. __ _' . "_' " _ "'� _ ' ' ' ... " ' ' _.'_ . ' ' -
CONSTRUCTION LENDING AGENCV �KIT. SINKS D�SHWASHERS ' � 'MOTORS' - - '0-1 HP=1'-10 HP" " '
t here0 affirm that there is a mnstruction lentling agency for [he per- . --- -- -�(�NC. SOLAR) -. 30-50 HP_-50 + HP �� � - '--
Y SERVICESINKS. SUMPS- �
fo�mance of the_wo�k t0/ wnlc� lhl5 pGrmi[ is Is{uetl (Section 309]
Civ. CJ. � � FLOOR SINItS FLOOR DRAINS � ;FIXTURES ' OUTCETS'""-"SWITCHES ' '
'L[ntler'S. Ndme •
� � DRINKING FOUIVTAINS � ' � - - - `GAS TUBE SIGNS -'� - - - - -• i
Lentler'S Atltlress � - �
OWNER BUILDER�DECLARATION� `� "- � � INTERCEPTORS CLARIFIERS 1 � iPOCE LIGMTS- ' ' ' --�' - - �
I herebY affirm Iha[ I am exemp[ (rom.[M1e Con(rat[br'S Llcense Law for
` lha following reason (Se2tion �031.5' Business anq Professlons Cotle: SWIMMING POOL- � PTRAP '' � -�'- �'POLES METERED � SUB
Any� city. or,munty which requires a permit to construct, alt¢q •
. improve, tlemolish or repaii�any structure, prior"to It5 issuance, also re-' yyqTER SERV ICE � ALTERATION �� -- �PANELS' "- '- MAIN ' SUB ;� ' '- , -
qWrez [he ap'..IiCant fot such p¢rrtfit to tile a Sign¢q statement Ihat he '
is II<ensed pursuant�to tM1e provisi6nsof the Contrdctor•s License'L'aw' GASSERVICE OUTLETS � SERVICE " ' - - � ' '- ' -AMP' . • �
(Chapter 9(mmmencing with Sectlon 7000) ol Dlvislon 3 of tM1e �� �
Business antl Professions Cotle) or that'ne isexemp( theretrom antl'the - yyqTER�HEATERS � BTU OUTPVT "' " --' "" — " ' -- - � - -
1*,. "�+ for [he allegetl exemption. Any violation of Sectlon ]031.5 by �� � �
�.y _44spplicant'tor a permit sub�ects'[he applmdn[ t0'd dvif Penalty SEWER CONNECTIONS - � � � E i � - ; " ' ' - • � " ' . � -
��it more [han five huntlr¢tl tlollats (5500).
'1, as owner of the property " � ' SOIAR�TANK �� COLLECTOR$' - ' ' "- "' '- -"' - '
pwy��,-will tlo.the wo�k, antl the st�uctur¢ is nOt Intentletl . . .. .. . , _t, . _ _ _ , ^� � _
or o teretl for sale. (Section 7044, Business antl Prbfessions Cotle: Tho SOLAR PIPING SVS. r'�SSUE FEE" "
ConVactor'S�Li<ense.Law tloes not apply to'an oy��¢r of a property 'APPLICATION.qPPROVED BV - - - �DATE
who builtls or improves thereon, antl who tloes sUch work hirt�self o� ISSUE FEE f� 1 � � 2��
through his own-employees,�proviOeC tha[ such Improv¢men[s a�e not. - �
intentletl or otferetl for sale. If, howeveq [he builtling or improvement MECHANICAL PLAN CHECK �� �{
t SUMMARV OF F,EES
is��soltl within one year.Ot wmpl¢tlon, the.Owner_Wj�l hdvG [he.bwtlen ' � � ^' � �� �
BUICDING- '
ot p�Ovinq he tlitl not builtl o� imprOve lo� th@ pu�pose o/ sal¢). ' - ' -"" "' " 1
HEATINGSVSTEM Od00,0008TU �PERMIT . E �^' • .,SMIP. . E.-
❑ I,-'as'owner of'the'proper[y, am exclusively contracting-with 'qNDDUCTING -'- -- - ' ' - - "- '- ' ' -' " �'- - - �
liG¢n5etl COniractors to construct the projecl (Secpion ]044, Business 100,000+BTV � �PLANCHECK E RERMIT - •
antl Professions Cotle: The Contrattor's' License Law tloes not apply lo � ---� -�-- ISSUANCE' S� �� -
Bn owner o( property who builtls or Improves tbereon, antl who con- REPRIGERATION 0-300,000 BTU PLVMBING S ,_ � }
tracts trom suc�'pro)ects'with' a contractor(s) Iicesnetl pursuan[-to � -SYSTEM - ' - ' ' ' - ' ' � - - -- - - . �GRADING, E
the Contractor's Licenze l.aw). 100,000 + BTU � PLAN CHECK ',S _ 'i . � , �
❑ I am exempt unaer Section � B. & P. C. for this BOILERS BTV ELECTRICAL b � � � � . S �
ieason'""-"' ' -- � - - ' �PLANCHECK`S- N1ICROFILM'E' �
Date - ' Own¢r , /1 SVSTEMREPAIR,ALTERATION _ TOTALFEEE�
I hereb .Cerlif .Ihal I.have reatl tni5.appliwtian antl 5tate Ihat t above E%HAUST SVSTEM MULTIPLE • MECHANICAI'. S'-� � .- .
IMormation is correct I agree to comply with all city antl county - , �PLANCHECK E" "- . VANCEPC E_ -
orOlnance5.antl.5tate laws relatin9 toy [ruCtion, dhd h¢rtby aulhOriie • , �' ^ ��. - . ; � ,
repre5enfatives of this City to�eJfte�upon [ha abOve men[I netl - _ ��
p�opeRy. r. nsp t' n pu�p S
� 1 �" jl%� // �� FINAL FEE 5
519nature�`b g � '^ `�Oate _ _ . . - . . _ _ -
Drivers' License or SS qF � ISSUE FEE
CMF 0865-46 White-Builtling; Canary-APplicant; Pink-Accounting; GolAenrotl-Asussor
- �°�
- .1�%_-1. ' . - . , .
CONSTRUCTION AND PLANN� G�''���% ' . , POOL & SPA � , �- `� .
APPROVALS Permit #�� Date Inspector APPROVALS� � Permit # Date Vlnspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
2. Soil .ipe-Un rgrn -� � 44. Steel Reinforcement � � '�
.3. . Electrical Conduit Utiiity-Undrgrn � 45. Forms - �-
4. Electrical Conduit-Undrgm - 46.' Electrical Bonding - -
tee em orce 47. Rough plumbin & Pressure-Test ' '
6.. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE -
7. Fo.otings - , - 49. Electrical Conduit-Undr rn � � �
8. Foundation . ' � 50. -GasPipe,.❑�Undrm;Test • � � ' �
9.. Water Pipe-Undrgrn - � � �" 51. Backwash Lines P-Tra � ❑ ndr rn - � - - '
10. . Structural F,loor System, '' 52. . APPROVAL TO DECK' '� ' --
.. ,1.1, _ property �Sewer Line & House Connection _ " . 53. Backwash & Rece tor-Final ' � � • � � - - �� �
12. Street Sewer Cqnnection. ' ' ' ` � � . 54. Heater & Vent-Final � �
13. .Rough Plumbing ' - � - - -- - - - � �
14. Rough ElectriaConduit -- - - - � - •56. Electrical-Final - �
15. Rough ElectricWiring � � � •� - - - � 57. - Solar System-Final ' � ' ' ' � ' � � •�
16. Rough Heating & Air Conditioning - -� - • encing & Access Approval •
17. Ducts in Structure � ' �'� APPROVED FOR PLASTERING' ��� �
18. Ducts, Ventilating �- ' F � . _ � � • . � •
19. Gas Pipe-Rough &Test ' ' 60. .POOL/SPA'SYSTEMS FINAL � � �
20. Roof Framing . _ . " - - � � ' � ' ' ' • �� �
21, Roof.Sheatfiin � � - � - � � . ._ . � _. �
22. Frame and Flashin NOTES: . ` , � .
23. Insulation " � �- - ' ' '
24: Lathing & Siding - ' - - � � �
25. Drywall Nailing - - ---- - . - "'- -- - - - . � - - - ' - .. ' . .
' 26. Plaster Brown Coat � - � � � " � ' - '
, - 27. Electrical Power Meter-Final ' � ' "
� 26. Final Electric ' � 1 . � ' ' � ' � ' � �
29. Final Heating & Air Conditioning - ' ' ' ' � ' - - � " � ' ' �
30. Final Gas��Pipe-Test � ' ,f i � � � - � ' � � � � ' � ' ' - �
31. Final•Plumbing � - ' ' ' � ' � - ' ' • ' �
32. Water Service-Final - ' � ' � � • ' ��'
33.� Gas Service-Fihal � � � - �' �
34. Solar pomestic=Final � ' � ' ' ' � '
35. landsca e S rinklin S stem � - - '
36. Sound Attenuation ' " � � �
37. Handicap Regulations � • � � - -
� 38. FINALSTRUCTURE&BUILDING � • - � - � �
39. Special Requirements Completed ' ' ' � � " - �
40. Electric Release to Edison ' - �� "
41 . Gas Release to Southern Califomia Gas Co: ' - �- �-
42.- CERTIFICATE OF OCCUPANCY ' � �
' fJo Date -- - - ' . . .' . .
AGO��cant to fill in ali spaces within heavy borEer lines an0 si9n all appropriale tleclarations.
'GTY' OF COSTA MESA '�: , PERMITyq a - TRACT NO. LOT NO. � BLOG. NO. -- �-- I C]�J9� ��[��� '�'7 -' 61J.02 .TL�
CONSTRUCTION PERMIT �j - L SS� ' ' ' I I 0.3 � •'�-" '. � " � - - -
,i-•..),
Project'Address TVPE OF CONSTRUCTION , ��' ' � , �'.:,,. . . I � . ;
� OWner (/,/�(.0 PhonB - �' ' ❑ NEW � ADD ❑ ALTERATION . V - . . . _
�Addrea �' • - _ _ ❑ REPAIR ❑ CONVER51oN ODEnnoLISN _ _ _ . . ZpNING REGULATIONS - -
' Arch/Eng. D (,� LiCense NO. _ ❑ OTHER � A P � � _ Z _ .. _ -
DESCRIPTION OF WORK ��' �
Address� -^ _ -.- ---- "" - ' - '-'- "�- - . _ .. - (ZONE " �PLNG.REF.�-_ -- �
Contractor� � " Ph � � TVPEOFPERMIT - : •� " ' ' -'-" -' '-- :. -TQ �l�i�ING' '
�AddIe55 - - �^- --- � -- OGRADIIVG��-OFOVNDATION- l 'SETBACKC T.S PR YLNE
' � - - �SS0.UCSURAL _ _ . LIOE.VARO _ . � . _ _ _
LICENSED.CONTRACTOR DECL'ARATION �_"V' - � ' EF
O7ENANT�OELECTRICAC ❑PLVMBING.OMECHANICA :S�pEyq
I hereby affirm that I am Ilcensetl untler provislons of Charter 9,(tom- , ,- t i� ' RIGHT "' '''' " �
mencing with sacUon-7000)..of toWision 3 of .tha_Businesi �antl' ❑ OTHER ' � � ' , .
Professions Cotle, 'antl my Iicense 'is In full force antl eifect. ,pROJECT.DESCRIPTION' ' � � � REAR YARD (TO'P/L) -- - - � � - - --- - ��
Licenie C1555 � - � ` " Cicense No.""- -" - ' ' ��--' " ' "' -� " -- "' +'PKG. SPACE REQ. ' � -� -PROVIOED �- - -- � -
IDSte " �'. . 'S19nature `- .. ""' ' � !'_" � .' � SQ: FT_ • �. J�.__ _ . _. _r� . _ .. STREET WIDTH '�--� - " PARK FEE E . ••. .
WORKEFS' COMPENSATION DEC�qRAT.ION OCCUPANCV CONSTRUCTION TVPE
I hereby affirm tnal I have a terti(l�ate of consent to sell-insure or a VqCVAT10N • � ZONE � -' � ZONING HPPROVE� BV � DATE 2 -: 8Z
�certificate-of-WorkersLCompensation. Insuran<e, or.a_certliictl copy . . _ . . . - _ .. . - �.SPECIAL�CONDITIONS: ---- -- - - - -- �
ithereof (Sectlon 3800, Lab. C.). � ,GRADING CU. YDS. ACRES
,wqcY'No' " _" 'ComGanY ' '� _ ' ' ' '"" . - - � .. . .� . "" _ ' ' " � ' �
:ertHietl topy Is�hereby furnished. _ _ , _ REMARKS:y, m••: • � � �
:ertlfietl toPY k filetl witn the citY Builtlin9 DlviSion. " /' ' - ' ' - � -' "' . _.. "'- '" �' -" - � ' ' '
EXEMPTION'FROM WORKERS"COMPENSATION DECLARATION � � �-� �� '.F--- - L - "� .A �
(Thiz sectlon neetl not be completetl if tha permit is for one huntlretl �� v:. �� - ,� ; ~ � •, i••/ �� �,' ,^���,.� � �
SS100) or lessl:' 7 ' ' " ' _ _ _ _ -T " '_ '^r" _"' ' . . .. "_ _ . '
•. certiry that In the�berformance of the work tor whl thiz �rmit is'
issuetl, I shall not-employ any oersoh In'any manners r - ecome' 'PhUMBING - - . PLAN CHECK- - - - +ELECTRICAL- -• ---PLAN�cHECK= = �- - '
subjectj o �ye o k rs•Compensa n 5(falifornl - � ` gATHTU65- -�SHOWERS ^ � ' ` ��
x�Date C 3 �-'SI9naWre ' . _ � _ ' _ "" __ ' __ .. ' """ " " _ �_ � _ .. ' �
�NOTICE: If after making this tlecl5rdtlon, you shoultl become,. bject T,OILETS..,, �, . URINALS• �--- -- -�-� -� �GENERATOR ...0-1 KW -� 1 10 KW �� � ��- �
to the Workers' Compensation provis�ons of the Labor Coae,yo must - ' �TRANSFORMER � � �, `� ��_, - ��
�forthwith comply with such provisioqs or [his permit shall be tleemetl LAVATORIES �DOUBLE.LAVS__ . .. . aAPPLIANCE.-_ 30-50 KW_50,+ KW _ _ _ _}'
revoketl. . - , �
�CONSTRUCTION LENDING AG NCV � --` - "KIT.-SINKS- ------ - DISHWASHERS � _�- �MOiORS._ _. , p-1 HP_1-lO.HP: '� _ _ _ _ ' .
�I hereby aifirm that ther¢ Is a construttlon lentling a9enty to� Ine Oerv SERVICE $INK$ . ..SUMPS�� -- -- - � .._ �._. ,�..iINCy$OLHR) _30_50 HP 50_? Hp. � '�_ � . � '
�tormance o� the work ior which thfz permit is iszuetl (Section 3097 '-��
,. . � ._
'�Civ: C::..."__'__ " `_" _' __...._�_ .._ . ___ ' _ ' . ' _ ..- i . ..."s.. �FIXTURES___' OUTLETS.�_$WISCHES .- ..� r- �
1 "'-'- FLOOR SINKS'----• FLOOR•DRAlIVS`- �
Lentler's Name - � y �
�LenCer'zAtldress '- � � � �� - -' "DRINKINGfOVNTAINS--�i-�-----�- - -- --!GASTUBESIGNS_.. __ _ _ ,�
OWNER-BUILDE0.-DECIARATION - INTERCEPTORS ' [LARIFIERS-�-- ��-� - -•�POLELIGH75.. J._ _..._�'^":.__ -_�_ __J
1 M1ereby atflrm [haI � am exempt frort� th¢ Contracto�'S Li<¢nse Law tor - + �
the-(ollowing-reason��5ection 7031.$ Business and_Pwte551ons..Cotle:. SWIMMINGPOOI_� ---P�TRAP -�------ �_ _ - �ypOLES � - -'METERED� � ��StIB- -- �
Any City or county whicb �equirQs a Oe�mit [o Const�uc[, alter, ' '-' �
improve, tlemolish or-repair-any stru¢pure, prior.to.its.issuan<e, also re- -yyqTEF SERVICE ----AL-TERATION- -- -_ __ _ .tPANELS . _--.MAIN _ _ _SUB �'._._ _ . � �_ _ a
qW/e5 th¢ ap� lican[ fo� Such Oermit to flla a signetl Statement that hC � 1 '
is licensetl-pursuant to�the�provisionsof the�Contractor.'s.License Law.. GASSERVICE' ^ ""OUTLETS---��- -;-��� - �SERVICE. . .... _.__._ ..,'AMP`
..,.� . �..r.., ..n � �
'(Chapter 9 (commencing wl(h Secryon ]000) of Division 3 of [M1a � ' ����� -� - . '
Businesz antl �Prolezsions Cotle) or-tbet he is exempt theretrom antl.(he ...yyqTER HEATERS-,- -- � BTU OUTPUT--- y. - . -- ---- - ._.. �
bazis tor [h¢ allegetl exeTPtlon. Any violation o( Settion 7031.5 by ���- - �
�applirant-tor-a-�permit suDjects.the-applirant_to a.civil .penalty -SEWER CONNECTIONS- - -- -- � - -• � - - - -- -- ---- - - - � ._~ �' �'
�t mora than five huntlretl tlollars (s500). ' , _ , , '
� �
, as'owner oYine property, or'rt�y emPloyees with wages as�[helr - SOLAR-TANK- -- - COLLECTORS- - ,_ _ _ . ,.._. .� ..... __.._ __ ._ . ._ . . . ., _ _ . _ _ _ _
sole �compensa[ion, will tlo the work, �ntl the StrUctu�e is not Intentletl ' ��
dr-offered (br sale."(SetUon 7044,-BUsiness antl'Professions Code: The 'SOL"AR PIPING SVS: " - �{ �' ��- -- --- - - ISSUE.FEE
�Contrac[or_5 Li<ense Law tloes not apply to an owner of a property �, __ . 'qppLICATION APPROV.ED.BY • DHTE
,who bulltl5 Or imDroves ihereon, anU who tloes'such'work himself'or - ISSUE FEE �-'- - - ---
Ihrough nis Own employees, prOvitleq that Suth improvements a�e not
�Inlentletl or ofiered'tor sale. It, nowev¢r, the bulltling'orimvrovement 'MECHANICAL`- - PLAN CHECK '' " -' ' T-' '-'- "" SUMMARV�OF' EES ' '-' -"-� '
Js soltl within one year of completioq, the owner will have [he bu�tlen . �
BUILDING. '7� � �'���� /��� '
pf-Proving he-tlitl-not-builtl or'irqprove"for(he�purpose of-sale). HEATINGSVSTEM 0-100,000BTU � " ;PERMIT E_f1SYf_liQ �,,•�SMIP `�8=Y•�� �
��.I,.as owner..ot the_property,.em ex<lusively_conVac[ing wi[h qND�DUCTING� - . =-- .. .—ZS'�OZ_F_ ' - ,•d_.J
Iicensetl contractors to construct tbe project (Seclion 7044, Business� - 300,000,< BTU � , PLAN CHECK g �PERMIT -' - y
antl-Protessionz.Cotle: The.Contractor'S.License Law tloe5 no[ apPly to _ , _ _ _, _. .___ __ _'__ � � ISSUANCE b '
an owner of property wM10 builtls or Improves thereon, antl who ton- REPRIGERATION 0-100;000 BTU --'PCUMBING�-'- b� - '. � "-' �
�Iracts from.suclt.pro�ects with ,a cpn[ractor(s). Iicesnetl ,pursuant to _SVSTEM . _ . . _ _ _. _ � '_ GRADING'� •E
.tne Contractor's License Lzw�. 100,000�� BTU' • PLAN CHECK S' _, -. . -
" " ' ' .' , - . .
❑ I am'¢xemptvntler5ection - � - -- B. C. for this � . '- � � `� _ _
BOILERS ' ' BTV � � - "' � `ELECTRICAL �E -- - s
- , MICROFILM S �
7ea5om SVSTEM REPAIR, ALTERl1TPON ' �'-' ' PLAN CHECK.. $� � �� TOTAL FEE,$ ��
�Date, Owner ' +. MMECHANICAL S ��i_ . _ -
" ' __ ' . �. _.._ . .
I hereby e[' y thal 1 have reatl this appliwtion antl at t at he above EXHAUST SVSTEM MVLTIPLE � . LESSAD- ' '
Information 5 mrrect. I a9ree�to- mply with-all city a d county . _. . _�PLAN,GHECK �y �� VANCEPC'�S_
ortlinances antl stale laws r¢lat� 9 t c struction, an0 hereby aulnorile � , _ ,
r¢pre5entaHveS' of this -cily -t n r vpon � the above -mG ionetl - � � � � ' ._ . ' • �
,prope�ty r" 5 e lon pur e ' � �� Q
FINAL FEE $ Z .
,. Signature Dat �SSUEFEE � _ _ - . � __ _ _ ( � � -
Dri'veis' License or 55 � � -
CMF 0865-d6 While-Builtling; Gnary-APPlicant; Pink-Accountin9: GOltlenroU-ASsezmr '
CONSTRUCTIONANDPLANNING � � POOL&SPA� .. � ' �V�;'��.� . : .�
( Date � Inspecfor �" ' ' ' ' � - � - � -.�Date� - Inspec;or
APPROVALS Permit#3��-s� �l1PPROVALS, �� • . Permit# � .
.1.. Temporary Electcical Service.or. Pole , _ , . 43. . Pool & Equipment Location - � - ' '- - " ' - --- - �
--- -Soi ipe-Undrgr�n =. - . ... . _ _ 44. $teel Reinforcement - - � - - -•
-- 3. - Electrical-ConduihUtilky-Undrgrn • � � � - . _ _. _.. . _ . _ _.45�. Forms� ' ' ' ' - � -� - - - -
}-�4.--�Electrical.Conduit,-Undrgrrn•------ •- ;',_ __ _-_...._. _.. .q6.-Electrica6Bonding-,` "^-""�� - - -- � - -� �- --�� -
_ .._ tee. einorce_._ti:._..__.s._'.__ .!,_�.. .= 47. RoughPlurribin &PressureTest '- -�- - ----��-' �----- - .�
�-�6- Electrical-UFER.Grn - �- -- -. - _ - �+ . 48. APPROVAL TO COVER-GUNITE' � -- - ' ' � ' "--
. - �. . . . -. . .. . . . , �, � � . . �
�-7:--Footings -�-,:.�--_�-_...: ..t': ----_• _'. '� ,1 .. 49. ElectricalConduit-Undr m ..' . _ r,. ... �• . , . . . ,...- � .
-- 8r-Foundation - - ^---^- -- - - --- -- - �i 50:i:rGas Pipe, � Undr rn, Test �" '' "' ' '' `" "'° ' � • . ,
^- -9�. - WaterPipe-Undrgm- - - -- - -- . --- �.- --�-- � ' 51.._"Backwash_Lines P-Tra �� � ndr }n � " ---- --- -' -- - - - , °' �
10r -Structural Floor System - - - �- �•�,;. _ -. 52. �APPROVALTO�DECK - � � � - -� - �
� it:--Property-Sewer'•L•ine�&Nouse�Connection---- - �- � -- - --- 53.' $aekwash�&Rece tor-Final � - '� '�� ' '.�'�
'- 12. � Street-Sewer Connection- - --- ��- --- ---- - - - - - - -54- Heater & Verit-Final ' - "� '' ' ' � +'
.. 13. �Rough�Plumbing - -- - - -- � ----- - ' - •. � - - - --- � - � •- -- -- - , .y,s� -'
------- - -`-- -�. .
_ 14. _ Rough.Electric-Conduit ' � - ---`�"� � �'56. '-Electrical-Final -- �� ' ' ' � ' � � � - �-'� ���,�� :
15. Rough Electric-Wiring ' -� �� - � �' � ` `-57. �Solar SYstem-Final . -� - �" �-'- � ' ' ' � '
_ _ . -.. . ., u
' 16-- Rough Heating &-Ait Conditioning - � ; -- - � - � -- - � ' encing & Access�Approval„ . . ''� J
� 17.` Ducts;in�Structure-r� � --- -- ' - --- --- - 9•- -APPROVED.FORPLASTERING„ -,ro ; �- ' �
,
.. ,
� 16t Ducts, Ventilating---- - - - -- -- - - - - --•� -- - --- - --- - ---�-- - -�---- --- - . - -
19: Gas Ripe-Rough &Test ' � �•' � ' •+ -- - -- -- - 6�• -FOOUSPA SYSTEMS FINAL, . . '. , ,'„' ,-'� ' .�
� ' .. ,
..20: -Roof Framing,- -- - - '-- - - - --- � -- - .r -- - - ' �.. � . , .., ,� , . � .t�
21. Roof,Sheathin I- '- ' - - " � - ' , , , _. . • •.•< . � ,a�-,
NOTES: ' "�
-22: -Frameand-Fiashin - - -- - --- --- --'� - a7.-,a: - -- .- ' . . . ' ' - . .' . . . .
. . . . ... . . . . �
� 23�. Insulation . . _ - --. __.._._- -`--' _. r _ -' . -- . . __ -.. - - - � - - - -----_'-. _- - - -' , ,. .. , �
� 24. "Lathing_&Siding�-- -- - - -� --- - -- -, i - . . _ . _. . - _ - .� -- --- � -- - ---- -- - - - � � � �;
_ �
. :..' i
� � 25.� Drywall Nailing� - - --- � .: � . -. _. _.. .. , . ----'-- - -- � . . .
.--,.� - -- � - -- - -- .-.-_ - - �-•--� - -- ' � � ,
. , , . _ . .. - . . . . .
26. Plaster Brown Coat- ' � " - � � - � �
.. . - . . : '- ' --.. .� _ . , .. �
27[ Electrical�P,ower Meter-Final -� - - - -- - - � - - -- ' e � � � � � ' �• '• ' ' • • • � �•
' 28: �Final�Electric ----- -- --- - -"- � - - ' - - - - . .'° � . '. . . .. �'
'� 29�. Finaf;Heating & AirConditioning ---- --- - - ,-- ... - i - -- - --- � � _ ' . ... . . . ' .. - �
- - • .. . . . .,,�,- .
30: Final'GasPipe-Test - � - � -- -- --; -- '- - - - -- - - -. ' .. - . . • .>-
-31'.-- FinaPPlumbing --- �- � - - - ; - - - .... . � . ' . . ' ""����*.
�"�"32." WaterService=Final' ' - ' - ' ' --i-- --- - - - --� - - - � -
-33.� Gas Service=Fin31` - -- - � - - � -' - � � ' �- �
34. �Solar pomestic-Fina� � � " ' � �� � ' . � � + � ' - - .� � �
� 35. Landsca e S �inklin S ste'm- �-' ' -'' ' � ' � " � � ' � � � �
36. Sound Attenuation •. •._ - , „ . . . ., . �. . � . . � , . , " �"
37. Handicap Regulations � � ' � � � � - � ' ' ' ' '
38.. FINAL STRUCTURE & BUILDING ' ' .&L ' " ��
39.- Special Requirements Completed ' - - � "' � � ��
40.� Electiic Release to Edison ' �� •
41. Gas Reiease to Southem California Gas Co., ' • ' -'
42. CERTIFICATE OF OCCUPANCY - , � ~ . �
'- 'No ' Date - - • - - -• .- _ -- -
^ - - _ - . . --. - - -_ --
`
. � : .
' '7�4�
COSTA MESA BUILDING DEPARTMENT
P.O.80X 31]
. COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
ADDRE�55 \J L•f ��)/ /� {�/ �
COSTA MES CALIFORNIA
MAIL �
ADDRE55 . �, (! 4 ,
TEL. i
CITV � (✓ � � � NOI—�'��i /
ARCHITECT � LIC.
OR F"��NEER NO.
ApDRc55 �
QTY LIC.
CONTRACTOR � NO.
� TEL.
ADDRE55 NO.
�Ec^� LOT
DESCPIPTION NO. BLOCK TRACT
A.P. NO. � — � 7 — /
$12E � �]! � � � NO.OF BLOGS.
OF LOT fJ NOW ON LOT
USE OF
E%ISTING BLDG.
SETBwCK LiNE FIiOM � �
c[r+ier+ or srneE'r � � REAR YARD
SiDE YARD RIGHT LEFT
DESCRIPTION OF WORK
NEW ALTERATION ADOITION
REPAin MOVING DEMOLISH
BUILDING 6 NO.OF
SIZE � ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW
BUIL�ING !1 � _
STATE TMAT THE ABOVE IS CORFECT iND FGREE TO COMPLV WITM qLL
CITY OROIN�NCES RND ST/�TE L�WS REGULiTING BUILDING CONSTRUG
TION. \
SiGNATURE OF 1 ) � My
PERMITTEE ( /�
/
AUTHORI2ED AGENT
_�ti-�.----�_; ...
cosrn � ��*k�
SEP 26-5�'P�µFs�, 321a fi.OQ;,
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
FECEIPT NO. PERMIT NO
COSTA MESA. CALIFORNIA
FIRE
20NE
��� U DATE
A �ESA
�
DEPT. REc
YALUATION � —
PERMIT FEE $
� �� a '-' PLAN CHECK $ �
S
TOTAL FEE S �°'"�