HomeMy WebLinkAbout481 19TH ST - Building Permitsn?FB�° 487 E 19TH'ST
""1E1F101Oi'^' NELSON, SCOTT
"��"�� P O BOX 1125
rIEWPORT BEACH,CA
, � �� ���p� 714? 650-9338
92659
uxr:
uicxirccron��n: THOMAS HURGER �� 15902
urcxonu+c:s,�ss: 17752 MITCHEL 851-0200 uxr: A
IRVINE CA 92714
c«+mncrarsxu� BARRETT DEVELOPMENT CORP ( 714 ) 494-8272
carm�trars�uwa 1110 M COAST HWY
eooxEsz LAGUNA BEACH " CA ucw, 598441
x
92651 uxr: A
IJCENSEU COMflACTOP4 OECL1N�710N: I M�eby dlim �dx qro�y d perjury Nn I em Ikemed under proviaans d Cheqm 9
(mmmeridM nil� Saclian )Oou) d Dir'nun � d Ne Budroo W Pnla�ioru CoM. end mY Gwms u In fuA tacs uM �flact.
CT' IJC. NO.� LIC. C1A49: H uc. No.: 5 /9 8 74 4 1 E P:
�i. One� � S Cawetla: � id _ 1'��
/ c
OWNEfl BUILO R UE RATON: I Mnby eNvm ur�dr paWy d pr'�vy tlut I un uemq hom iM Com�acon limnse lew /p Ns
lolbw'vq roe»n (Setlion ]W t.5 &niro end Rdm�au COG: My Uy a oounly wfiidi naWm � pmnY lo am�huG. Mv. imparo.
, `�mdvh. a repai vry ne�cme, pin ro m iae�o. ebo nqiiia llr epp6rant In weh pwmu to As s ppnsd tWemml dW M a che
IimeeW pumunt Io tM pwi�inu d IM CaLLrWm Licaua Lew (Chepr B(wmmrqnp xu� Ssqun ]000) W DMeion � d iM
�sinesa end Prdavione Code� w iNt he a eM u axemq iharehdn uk IM bmu la tla NapeE usmqion. My voletion d Seaion
)03t.5 M�Y aOWKaM ta � Mm+4 � IM ep�iceM to e dv0 MroM M nu mon �Asn fx� hunde�d do0an �S,AO�.
°°:
� I,moMnerd�MpopMyamyemplv�w�wthwqp�nUriwlammpenrtbn,xitldotMwk,endiM�wctunwnaimeiWea
mro
or dfered la eela (�� 10u. BuaMas ard Prdueona Cods: Ths CoMratlon l}rrue Lew Eon nd epplytoen ownerd popeny
who WiM a inpwea iMroon, eM Wo Eou �uch wak limwll a MnN a piraph he a hor oxn amplqasi, qwidatl ihet auch
ImpanmenN ve nd WaMod a d1anE lor uM. tl. Mwwer. tM W Wuq a tnpwanan� b wtl Mlhm aw Yav d oomP�ion. iM
owner-0uiMer will �eva Ihe WMen d po+iip M or eM did M Wild a improva lor iM W�s d mis�.
� I, e� owner W �he popaM. � utliniMy caMradip xilh IiamW cont�ec�on �o eonmua �M pWxt (Sedion ]OIa. Businms eM
VMmtian� Code: Ths COMMm Licmw lew Eoe� nd eiWY b en ow�el d POGeM who WIN� p Mpw'u IM�san uW Mq
convecu lar wtl� prqWs w4h'e wmrer�a`r��) lcemad quewm io �M ConVadm Lb�n�� lew).
� 1 un vempt urdar Senion: I B. 8 P.G.. lar Nu ree�on:
Daie: . Ovnw: _. _ . . _
�
I Eo IwWY ��N WI I em �wen d md wdr�uM tM �Vw�waa tl GWari� Hrtlh uk SeMY CoM SW bm 45505. ?55]�. ud
P55�. xW UW I v e�ry M1aun EUIW'up oaapenl wlll / wil �M (ac4 aw) Med to canpy M� uid neis mdw eM �he �pulromana b
epermnlwmnslriMionamodifimionhomtMAi�iuT .�i enp�nwmOmM.RwkaqWmM�udianeppb�iamenasmqtmmihaea
w�•
Dma: MG�e�+:
WOflNER'S COMPENSATION DECLAfl�TION: I Mnby dfem uids psiMy d pwjry on� d IM lo0owiiq dW»ibm:
� 1 hew uk rA meimen � c�n!'rsa d mwN lo u0uwn M nakr�' oompnmbn. o praidM fa bry 8qian 9]W W iM LeEor
Cods.la iM pMomwic� d iM wk la W+kh tlw pamtl's buM.
I hm W rAI m�iHen whr�' mmG�dion Lwruo. n n0� bY BWbn 9100 d IM l�bor Cod�. br IM D�m� d iM
A wark Iv wAlrl� iM D�e u WuM. MY raken' cam0�dfon Inaruic� ortir uH O�Y m�mla w:
c.m« STATF. FtlNll EXPIRES
��� ��u�+�� -Q 10/O1/96
.il, .w;m nwe na e. mm�w.d r w o� b h. m. nunew aow R�oo/ n roJ
❑ I qnh Ntl In iAs DMmnuic� W iM wak br v.hkh Ihb V�tl b huM. I dN nd �mV�W M' Vr� in �nY menmr w n lo
bmm wbjW m iM walmn' mnp�vtlbn 4xs M Cddan�, uk epn� tIW tl I Nouk Davwiw wbjq w IM worluri
wmpanwb pwl 'om al6wbn J�00 d tM leba Cah. I�Mi���
od.: O �.m: _ �
W�mMp: F�Y�n ro.cw..vrk.n• conp.rwden eevw�p. b urrwnq uw�rrn ae/�cr.n rnyiqw ro wbNnlpm�roa.ne
dM nn. �q ro em nurdne rnou..M ea�rn ltla4oaoA ti��n ro m. m.� or ronp.ru.tan d.�w u provnw ror �n
9�ctlon ])0! o/ M� IMor CeW. InfwuG Nd �ttum�y'� /w.
CONSTAUCTION LENDINO AOENCY: I MMy tlfiim wkw pwlry d pw�ury IM tMn e� mM�uabn MMinp ep�nc/ b Ns
perlamena d IM v.ak br whidi 1�'s pwmi h'spp0 (9Won ]Op'!, Civ. Cl.
LENDER'B NUAB:
LEN�EH'8 �OONE99:
1 caniN �M I he�a nW Nb WG�icefion ck tlW iMt ths �Evn bdarmYbn b canW. I pn� Io oomWY wXh M ay W comR/adlnerim�
uM.w.le�w nW �q io Euadvq cauvuuo� uia Mr�GY ��Mwiz. npqWnlvu athu �Yy m w« upon ihe em.��m�m'vre piopeny
lairopspion purp�sse.
RICK HARRETT
�� � m� Oela: _�
SiO�undOwind/�penV� rada
(5t5t.ta.WP1 � WAAs-BWk'ep 6 Sday: arsen-Fls: Cuary-Appfum: Rnk-Ps.�nw:Oddonm6�Nwew
CITY OF COSTA MESA — HUILDING PERt4IT
PERMIT NO: H 074427
PLAN CHECK NO: 02717-95 L
�
� _
PERM NO: D 07:442';
GOVT; N SUPP� N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE:.ADD
JOB DESCRIPTION : ADD 423SF MASTER BEDROOM 5 INTERIOR WORFC SQ FT: 923
CLAIM C�ALUE: 40,000.00 CALC—C'ALUE: 39,000.00 GROUP OCC: R-3 /
COMMENTS: ADD MASTER SEDROOM &HATH, DEMOLITION TO CONST. MASTER BATHEi00M
****�******��x*�**�*�*�**+�**�*�**x�*�**x*�******��+�+�****��t*�r*�r****�x�*�**+�****;�*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: 43 FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: 8 FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: -PROV; - - PARCEL: 11734129 ZNE: R1 REF NO:
PLANNING NOTESS ADD�'cA MASTfit� HEDROOM SUZTE TO THE REAR OF AN EXZSTING
�> SINGLE�F.AMILY.RESIDENCE.
iE *-Y.� fF af �1E jE iE i4 iE 3E iE if �YY'iF.3E �E if 3E aF aE if.jf iE �E 1F 3f # 3E �E if iE iE iE iF iE iF 3F if i!� 3E iE 3F � iE 1F k iE if jf'.r jF iE �E if 14 iE if iE if iE dE �E iF 1f iP jF iE iE iF dE 1E �E jE iE3E if �E 1E
D E V E�L O P, M E��N JT' ; S E R V I C �E` S R E Q U I R E M E N T S ,,/
ZONING APPROVED BY �� �0�, DATE: _`bl� �"u
BUILDING APPROVBD HY f` �� DATE:
� , (` ��
APPLICATION ISSUED 'BY:' - -i � 1����� DATE: I� 3 C��
if�lEiFi!-if}.#iEifihiEi(-ififiE�%iFiFi�ihiFif . � iF7F�W� � �E�x��*�t*�r.-ft�rt �F"�"£�iFiF*�t
LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
/ 'r
BLDG PMT PLUMBING ELECTR'�ZC M�CHANIC FIRE SMIP/RES GRADING
PERMIT 343.00 • . 3.90
PLAN 222.95 •.: !•� SMIP/NON—RES
ISSUE FEE y,
BUZLDZNG—DIV—> PERMIT ZSSUE PLAN;.CHECK TOTAL PAID � DUE
TOTALS----> 346.90 0.00 2,22.9.5 569.85 569.85 � .00
REVENUE DIVISION TOTALS--> COLLECTED: 346.90 OC'ER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC.�' FIRE SMZP/TOT GRADING PLAN—CHECK
343.00 '� %i 3.90
1f 1f fF iE iF �E iE iE k iF IE iE iE fF IE iE iE iF iE jE iF iE iE iE i6 i6 iE iE 1E 1E iE iE iE �E iE 1E iPIE 1E if !E iilE iE iE 1E 3E iE 3E 1E �E ik 1E ik if iE if f! jE IE iE 1F 1! iF 1E iF iE 1E i! 1E fE fE IE 3E iE iE 1F-IElE
I N D I V I D U A L �F E�E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
�
SFR 39000 ALTER BY �'ALUE RESIDENTIAI, NOZONE 1.00 39,000,00
END �'OF 'FEES
. �l.
V
�1 QOt93s'44-;;,191?45 T�CaT �$n,q�
DATc� 10/�=19� TfiiE• i;:u�
��• CONSTRUCTION AND PLANNING
APPROVAIS Permit #
1. Temporary Electrical Service or Pote .
2. Soil Pipe-Undrgmd. �
3. Electrical Conduit Utility-Undrgr"rxi.
4. Electrical Conduit-Undrgrnd. � /`
(1r
5. Steel Reintorcement
6. Electriwl UFER Grnd.
7. Footings
8. Foundation s/ �
���-
9. Water Pipe�Undrgrnd.
70. Struaural Floor SYstem
11. Property Sewer L�ne & House Connection
12. Sewer CaP -1
+
73. Roof Drains �
74. Rough Plumbing •-
15. flough Electrical-Conduit
16. Rough E�ectric W��ing
77. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
19. Rough Heat(ng & A�r Conditioning
20. Rou9h Factory Firepiace
21. Ducts, in Struaure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. fioof Framing
25. Roof Sheathing `�
26. T�Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing /:
28. Lathing & Siding !�
29. Insulation �
30. Drywall Nailing C�
37. Plaster Brown Coat I-
32. Electrical Power Metei-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Finai Gas Pipe-Test
36. Hood or Canopy
37. Final Factory FirePlace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigati0n
44. Landscape irriqation System
45. Sound Attenuation
46. Handicap Regulations
47, fINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern Cali(ornia Gas Ct
51. CERTIFICATE OF OCCUPANCY
Oate
F3'
,
y
r POOt PA
Inspecior APPROVALS Permit #
52. Pooi & Equipment Loca[ion �
53. Steel Reinforcement
54: Forms
lp 4/6L 55. Electrical Bonding
56. Rough Piumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Elettrical Conduit-Undrgrnd.
�� 59. Gas Pipe, O Undrqrnd., Test
60. Backwash Lines, P�Trap, [] klndrgrnd.
67. APPROVAL TO DECK .
62. Backwash & Receptor-Finaf i
63. Heater & Ven[-Final '
64. Plumbing System � Final y
65. Electricai•Final
66. Solar SYstem-Final
67. Fencinc� & Access Approval
68. APPROVED FOR PLASTERING
69. POOUSPASYSTEMSFINAL
F�RE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storaye Tank O Gas Q Oil
� /i 74. Overhead Hydro
i�L�
75. Dry Chemicai
�a� 76. Dry Standpipe
�w� 77. FIXED SYSTEM FINAL
�j�[�y' 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
�� 79. fINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
to I 96 Ga y
2-G ��-9.' r,�-
Date � Inspector
Date � � � •
e
a
°'""""` 4 81 E_ 19 T S T
"� NELSON, SCO T
� ADDXE55: P � B �}� 1 1'Z �'J
� NEWPORT HEACH,CA
` wr�. wuuxo woxess
714) 650-9338
92659
urar:
�xcxrtecrox�ar��n: THOMAS BURGER 14ND' 15902
ANCN.OflENfi.'SADDHE55: 1�]�]SZ MITCHEL 851-0200 �NT� A
IRVINE CA 92714
CONfH}CTqiSWWE gp�RETT DEVELOPMENT CORP ( 714 ) 494-8272
CtlRPACTORSM�I101G 1110 N COAST HWY
�op�% LAGUNA HEACH CA ��= 598441
92651 uNr: A
LICENSED CONTflRCTOFS OECLAflATION: I hereby efl'vm unLm penetly d pa�ury Nel I em Icemetl uMm poviaions d Cheqx B
(oommemrq xilh Setlim )UW) d Oivaion 3 d the Busrbas erd Pmlesebns COJa. enE my lioarce u in Iu0 Mtt end eHed.
. cmuc.wo.: uc.cuss: B uc.xo.: 598941 EXP:
.. ome: coovea«:
OWNEN BUILDEN DECUIHRTION: I heeaby alfirtn uMa penely d perjury ihet 1 em axemq hom Ihe ComrWas Limn+s lew la tln
IOlbxin0 �eewn (Sedion ]0�1.5 Buaneae end Prdmeiam Cade: Any ciry « oouny whiM rpuiiea e peimN to conatrucl. Ms, impove,
+emWoh. a reqi eny sbuvMure, pmr to ire sauence, abo rapuires 1M eppliant Im vuch pemiY lo fib a eq�wd eWemen Ntl M a ahe
IicemeE Wisuam ia tM prni4ona d iM ConlreGore Licenae Lew �Cheqm 9(commendlq wilh Sedion 1000) d Oimion 3 M �b
�ainess aM Probseone Code� a thel he a aM ia examq �hael�wn eM the beaie Iw Me dbped exempion. My vblPoion d Satlion
1031.5 by �Y ��^� Iw a permit wbjeds Ihe epplicent to e �rrvil penely d �wl mae then INe huMreC ddlen �5500�.
� I.nowmrdlM1epoGenYamYmmdM�+wAhwapesavlheiadammOMsalian.xiAEotlnMwk.eM�MeUucWrewmliMe�Med
. woMeradlaceb(Seclion)OG6,BueinesseMProfeesiamCoda:ThaComretlanLim�nolawdoeenotapplyloanowr�xofpiope�y
who Wids a inpewu �heieai. ad xtn doas suM wark Ivmsetl or hanel a Nraph he a her own emplym�. pwided Ihm wW
impmvameMs me ra1 inleMeE a dlered Iw eele. X, Iawever, IM Wldirp a inpovemenl is vok xilhin aie yau d campblian, Hq
owewrbuildar xill heva Iha buNen d qovinB � o� sha'did rrot build w impima la tM q�ose d+eb).
� I. es ovmer d iM prapeily. em ead�nnely oonlradip xit� IbemeE wnVacYon to mrebutl tln Sedion ]OM. Bue'vr+md
Prdeneioru Cada�. T�e ConVedon lsenae law Eoea ml epqy to en ownar d qapany itl impwec thereon eM who
wnvecia la wW pqeea wdh e mMretlar(a) liceneed Wnuem lo �M Cant�erla� lio �
❑ ' ' O
I em esemp urMer Seclbn: �.. B. 8 P.G.,,la thu reeaon:
Dme: �a
1 do he�eby cerlily ihe� I em aware d vW uMmewd Ne requirem Cade SWbns 25505. Y5539. end
zssa�. �e mm i«.or nn�� w�b�m �m �n i.�,n ,� ��. �a ' n � mm eod. me m. Aw��u, m.
epeminiormrmwCianamoEificelionhan�MA'v u�6Tyl�epeme isYrid.R ' iudioneppiceliwroerseaamqhanthoes
FIOVIHIOf19.
oe�e: Avdr���
WOPKEH'4 COYPENSRTION �ECURATION: I hareW effim� uMx pauliy d psjivy ons d iM b0owiiq dedvetiun:
� IheveenEwilmeinteineceMice�edooneentloeeMinaumiaxwken'canpenetlion.mpovitledlabySoqion3]OOd�MLabor
COM. la iM pe�famarwe d Iha xak fa wlich Nu peimil b oeueC.
n I hew eM wil mdmen xrorken' campenaton irourenm. � required by Seabn 9)00 d t�e lebor Code. M Ihe perlmmvm d IM
)� wwk lor whiM ihu pemin ie usueE. MY woFais mmperuetion ieuureMa eemv ud pdiey numbar ere:
carn.r. STATF FiTNn EXPIRES
rawvN�mb« 12u��ns-a5 10/O1/96
nis aenion rreed rrot 6e mmG�ed r tMO�k is /w wre nunered donera Riw/ w/w.l
� I ce�ily ihet in Ihe ps�iwmerce d ihe xrork fa wh'rh �hia paimN ia usued, I ehell M amploy a�ry penon in em� mennx ao u lo
bemm wbjea lo IM xakera' cwnpenmtion lewa o� Celilan4. aM ep�ee Ihet B 1 daN bxome wbpa to �M xMw�'
compenealion p�wiaqm d Sedion �AO W Ihe Lelwr Coda, I aMll IOHhxilh campH wil� IMae pmvieione. -
ome: nvdw+m:
Weml�g: F�llun ro asc�n woilnn' eonperwtlan ewerap� l� unlewNl, eM �IWI wbNet an �mployer ro alM�xl pxWllw en0
n.n n�o y, ro mro n�e.w mo�„�,e eww� (S10q0oo1� In xH/tbn ro Ms caf o/ ronqisnuHort � n prvvMM br N
9xtlon 9106 0l M� Lebor Cotls, lnbn�l, antl ettomsy i/su.
CONSiNUCTiON LENDINO ROENCV: 1 MreW dfirm uMx penehy d pxj1ry thm iM�e o e mmt�utlian Witinp apency,lar IM
perlormenm d iM wo�lc br whiM the peiml ie enueE (Seaion 309]. Civ. Cl. �/:
LENOEF'S NAME �
�vioen�s nooxess:
U.
I cMily �hel I hcn mN thu epplicetion erd Sab ihet Me ebv.e infpme�bn o oortep. I pme lo mmpy rriih eA cryeM odvay adironm
enE etete kvn ralelmg to buildvp mmYuaion erA Mreby eNharae reqaeeMmnea d tAia Nly lo enter upon iM ebwa�meMianetl paparry
fa impmun Wrpoaea. j •.
RICK BARRETT
P��� �, ,,>
r�
oma:
siereWra d Ownx//�9.nuAPOLranVCm�req« ,+Y
(5f51�Ie.WP) While-BuiW'vq85elely:GreairFb:Cenery-APP��t:PinkJieronw:0oken�oE-Aaaeva
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 074427 PLAN CHECK NO: 02717-95 L
.PERM NO: B 074427
GO��T: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PORPOSE: ADD
JOB DESCRIPTION : ADD 423SF MASTER BEDROOM 6 INTERIOR WORK SQ FT: 923
CLAIM VALUE: 40,000,00 CALC—VALUE: 39,000.00 GROUP OCC: R-3 /
COMMENTS: ADD �R BEDROOM 6HATH, DEMOLITION TO CONST, MASTER BATHROOM
�****�t*x+t+c+t� �r�*****�**x���t�t�t�t�t+��t�t*�t�t�t*x*�t�r*�r*�+��t*�t*�t**+�+t**�t+�+��*�t***�t****x�*
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
---- -- — IN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT. IN REAR: 43 FT IN FRNT: FT IN REAR: FT SN
LEFT: FT IN RGHT: 8 FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: .--,PROV; .-�- _— PARCEL: 11734124 ZNE: R1 REF NO:
PLANNING NOTES-> ADD;A'MASTER �BEDROOM SUITE TO THE REAR OF AN EXISTING�
,�> SINGLE� FAMILY. RESIDENCE. �
�f iE iElF 1E �E iF iE 1f iF 1f iE iE 1F iE df iF If'If if 1E if 1E iE iE iE��E if iFiF if 1E iE iEif aE * iE iE9E iF iE iE 1E iE'IE iF iE if 1E if 1F itif i! if i! iE iE1E'IE 1f iE ib iE �F if �If.iE''IE 1E if if i!!f fE aE 1E 3E
D E V E' L O.P M E N�T✓� 5 E R V I C E S R E Q U I R E M E N'T S
•� � ,'�- y+' �1 )/ 1"�
ZONING APPROVED BY�'` :2 .� � �� DATE: '
BUILDING APPROVED •HYi3 '° •'"" ^ n �''
7 .�
APPLICATION ISSUED'H
iE 1E iE iF iE �! 1E �E iE iE iE i! iE iE;-IE 1E iE �E 1F iE
LEGALIZATION;N
BLDG PMT
PERMIT 343.00
I �i �i �=Si ju't ul:�:�9
PLUMHING ELECTRIC 4MECFIANIC
� ,
_ DATE: �,
DATE: ^
�3FiE 1F iE i4 iE 3f if 3E jF if��iF�E 1f
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
3,90
SMIP/NON-RES
PLAN 222.95 �;.,�
ISSUE FEE -'
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 346.90 0.00 y�222:9,5 569.85 569.85 .00
9i
REVENUE DIVISION TOTALS--> COLLECTED:� .346.90 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN-CHECK
343.00 �� �' 3.90
n
1F 1E 1ElE 1E iE 1E 1E iE 1E 1E 1E iE 1Elf 1t f! 1h ik iE iE �lE * 1E fE ik iE 1! IE 1E fE iE iE 1E 1E IE IE �E 1E 1E 1E iI�'141k 1F ik 1E iF I! 1E 1F IE 1E ff IE'lE iE iE iPlE IE 1k if fE 1E iE �E fE 1E iE 3E 1k iE iE 1E iE if IE if
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
SFR 39000 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 39,000.00
END�OF FEES
„ / �
i^ '
:: � �_r
�
'ONSTRUCTION AND PLANNING POO� 1PA
.PPROVALS Permit # Date Inspector qppROVALS �� Permit # Date Inspector
�. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
-3: Electrical Cor�l:uit Ufiliry-Undrgrnd. 54. Forms -
` 4: Electrical�,Co�duit•Undrgrnd. lB,.`2-Q� 6C'/�f 55. Electrical-Bonding -
�5: Steel Reinforcement�� - � 56. Rough Plumbing & Pressure Test
6. ElectriwHl�FER-Gril'd. � 57. APPROVALTOCOVER�GUNITE
_7. Footings ._� � �: � __ � 58. Electrical Condtiit-Undrgrnd. -
�8. FoundOtion � _ /�_ 12,� � �yC.,I,F 59. Gas Pipe, � Undrqrnd., Test
L
9. Water Pipe�Undrgrnd. _ ckwash Lines, P=Trap, � Undrgrnd.
,•
70. Structural Floo�$Ystem t. PROVALTO'�ECK
1 t. ProperrY Sewer l,ine & House�Connection 6. Backwash & ReceptorPinal
12. Sewer Cap ��" -. _ t . Heater & Vent�Final
c
73. Roof D�ains _�. - - C` 64. Plumbin9 System - Fina�
14. Rough Plumbin9- _ 65. Electrical�Pinal
� 15. Rough Electricai'.Conduit �;' 66. Solar System-Final
16. Rough Electric 1Niring • 67. fencing & Access=ApProval
� . i
17. Rough Wiring Sign J 68. APPROVED FOR_PLASTERING �B�? �G �
, 18. Rougfi Electricat-T flar Cei4ing 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Conditioning . - FIRE DEPT. REQUIREMENT
T -� � i-'
20. Rough Factory Fifepiace � - : ,- . �j , c�+: `;APPROV�ALS ��.� Permit #
�
21. Outts, in, Structure.; F' � _- '. � _ � � 70. `Undergrountl Kydro �, �
22. DuctS, Ventil2cing-; � .- ' - , - 7}, produetP.iping'E9'Cas OOiI
23. GasPipe•Rougfi&'Test��_ _ _ ' _ - `"'�', 7p. UndergrpundFr4$h;i � � =
24. Roof=�Framing.. ^�X ���� �. r, :.� . r �. <_; 7$;+ Undergrqd.StorageTanlr[7Gas O`Oil
_, f'\
25. RoofSh�,athi�g ,�� : -, l`LL'�=�`, �,�:C�=- 74:`OverheadHydro;` = F
.
26. T: Bar Geiling (Struo ral) & AAonocoat r,,; �F 4 _ 7�St Dry Chemical �� .- _
27. Frame and Flashing - - _ �y,�(�_ Ct S���_ 76: �Dry'StandpiPe,-, j� ^ ' ;-
�ti
'28. Lathing&•Sidingy• � , ���" � 7h FIXED£Y.STEMSFINAL� �
_ - - li=�1 . 6�;.. . _ _. � _
^29. Insulation, `-'' _ • " " 2:;�,6= � (�u� 78. FIRE PREV. FINAL '
G �< , T
" 30. Orywall Nailipg •- ,2;� �,�C(,S ty� .�HEALTH DEP7.REQUIREMENT
l _. ��1: 6
- 31. Plaster Brown_Coat �` ' 4 ��� CoG� 79; FINAL tNSPECTION � � -
I&- - _ l`lG A. -
_, 32. Electrital Pow'er Meter•Final "'�. c -. 80:. FOOD CERTIFICATE 185UED
. 33. Fina�i"Eleciric� ` k � � � � y � .; � • Notes: �, �ir �� � �,-
�34.F,inat,Heating_&Air�Condicioni�y� ��`^� ;, ./������5:'=`�� `"�,,r�1
35. FinaFGas"Pipe'-Test'� '= -��r IL � � r= " • � ` = " �
- r
. 36. Hood_or CanopY � _ : _ ;:; . r' . l?-`C� �� ,-i~ � �,/
- - � �l�fil^
37, FinaF Factory Fireplace - " '' � ^ ��. ��-
- - - : r =.
, 38. Final Plurt�bing " - .. . .. ` ` ���,,���Q �J��
- ' io �2% �`"",_'" �,om�,'��%tl
� 39. Water Ser�vice Final y - - . ' ''. : .�•� -
x S 4- ` -� - ` -
�' 40. Gas Service-Finai '_ . ' , _ �. -_ � �
=� 41. Solar pomesticPinai� ; - �+ � �. c.= - ,. �
42. BackfioW Preventer'. �, S. = Z_ ' . -
43. BackFlowirriyation < � � - + . . , ' , -
�.
. t 4 .
44. Landscape IrtipatiodSystem�'� - _ .; �. - - �"; � _� ' "� ,
45. Sound Attenuation� - � -� � ._ F- � - • -� i� ' - ' -� � �
- �+ r'
4�6. HandicAd�Regulations " '�r; ' � _�` ��� �
47. FINAL STRUCTURE & BUILDING � �� 7��6 6w,�/. ' ' - - , ,
v,
48. FINAL PLANNING, _ _ . � ti - . •;, � �_.
49. Electria Release to Edison ' . � �� � -. "
� _
50. Gas Release to Southem California Gas Co ' - = s ". `.
, ' :v . . C •
51. CERTIFICATE OF OCCUPANCY` = _ ... -
No. Date
,F"`,�,�,°"�.,,,; 4 81 E 19 TH S T �"T`
�,00pEss NELSON SCOTT
e o sok iizs
NEWPORT HEACH,CA 92659
�ooxeu:
'q`"r"`To"��+` MICHAEL R GABRIEL 10N0' C—}59�2
u�cxoxe++a•s�oontss: 3620 HIRCH ST uN:
�ut�gw.�. NEWPORT BEACH CA 92626
������� COSTELLO CONSTRUCTION (714)768-4292
28781 PRUDENTE
A0°"� MSSSION VIEJO CA 1BNp= 367968
92697 u"T
LICENSED CONTRRCTOXS DECLANATION: I Mreby all'rm undar penetly d pa�ury ihet I em Icenaed unEar prowiom of ChaWer H
(��nenanp wnh Seciion ]000) d Dirrenn � d Na &�si�rose vd Pmleaepns Coda, end my I� e in tull lau vM eXerJ.
CRV V C. NO.: UG CLASS: B IJC. NO.: J 1 �{p/ /� ��+{�/py../.��
]y Dme: Corureqar �.�n�i5%/���/1/////�IG3�N
ri
OWNEP B ILUEP OECLANATION: I heraby elfiim vnCer pene�y d perjury Ihet I eaemq Irom iM Contmdon licenae law Iw �he
idlo+'M ��� (�w^ ��1.5 &niiese eM Prolesaione CoCa: Airy eYY a couniY ��+ �Vui'es e peemil lo mmWct. ellx. impova.
Mm�h. «rpei e�ry swnure. qia io ee awvKe, ebo repuiree tha npplimM Im wc� permit to fib a eqroC �lelemeni Rw M«�M
ip.�..d w�.�v io �he wwe�wm d Me"C«aream �.a �w �cn.a., e I��a�a wan s,aoo �oaol a o:�:� a a iro
rn�u end Pedaviora COEeI a ilw he ar aha e uemq Iherelmm eM �M Eavu In tha ^�Wb exemqion. AnY videlion M SWion
I,a».s M�r aod�� �w• oxma euei«++me wpken �o a dw oe�nv d �a mae men ii+e num.ea adiere issm➢.
� I. m owner ol iM popeelYw mY a^�Y� �h wepea n Ihei sde mmpemalion. Mill do Ns xwk. eM IM nrueWm e rwl iMendeE
iv miwewn m, ub ISeeiim �ou.9mrov erd PMmwna Cade: The Caniredon L'ranee LewEoea mt aeolv to en owrierd dooeM
�
owo.��w�u.� �;u n� me w,e.� d w��e n. «.ns eb „n w�e a �ma� e« me wmo.• d de).
� 1. ea ow�wr d �M W W�Y. em uduenW'/ oonlrep''q wfih ficenfed mNreciwa W amnruC IM qqeO l5M'un )DN. Bueine+e eM
Prolaviom cade: Ths ConVeGws Licenae Lew Ew m� evGN b en owror a VW�r v.1a builda «'unG�'r tMreon W xho
conVecb Irc adi popea r.ith e taureaor(e) Icemetl punuau to the Caq'mas L'ran�e Lewl.
� 1 am azemq u�der Saetion: B. 8 P.C.. br thu eed.an:
,X .,,
Dete� � ' �"'^^��
i ao na.aM �.n�N �nm i em ..ae d.�e wea.�d in< rca���,�re a caaomb Heam, ene sman cede s.aion. uws, zss�a. m,e
2553a. vq tM1et 1 v eM Mws Wiltli^0 omryem. xi9 / wil m� (crcb an) nead to comW r.'t� mid tleb mEm uM ihe reW'uandns b
e 0� lacanvuction amoEifiraiiantranthe Maiuiy�ampamam Oia�itl. Midefail oonY�uaon eVG�ian en memp Imm Ns�a
pahvms.
Dae: APv�K��
WORKEH'S COMPENS�TION OECLAfl�T10N: I Mreby elfiim uMm psneXy d paijury aw N �he blloxi�p ddvatbna:
� IMroenErrilmeimenawniliuledmmntiovatlJnwrebrworke�e'campenvtion,nprwiMdfabySwima]oodtMlebar
coa.. �« �n. o�«merc. a �n. yan �« M:e, Nu v� a is,uee.
p in�.�e�;�mdm��A•�v���,.�..s�c��.ewswb,arooam.i.ano,cee..win,wn«�,.am.
work la whidi th'v permn ie ivued. My warFen' oompemetion ineuranca u�ner enA pofiry number are:
c�e�:
adw N�mn«:
ds �e�m �eee �d ae m*de�� r w o�++u ror m. nv�e�ve edws Riao1 w bs..�
�] i o.nN mm � me o«iam.z. a �ro .m ro..nicn mm w�u o uwe. i,nan noi emviw drv o� b�r meM« .o e� �o
becmis wbjeif�o ihe v.o eri mmpenmian lew+ d Califmtie. vq 0� �' I 4wuk ecdna wEjee �o �M xaM1w�'
cwnpamelia viaqne qqn J'!W d IFe Lobor Cade. I eFdl l0 1 F P �o
Dtla: � AFWic+M:
Werl,lnp: F� un ro ix'un wrtwi co�vruetlon eov�rp� Is �nlawlul, en all u!/�ct �n wlployer ro cHmhulpeiWJu �M
C/Yll �MI �q b aro h,ndntllhouLnd tlWl�n (SiPqP00A In Mdltlon ro!M tost O/ mmwnallbM1 tlamrpu 4 poHtlM blln
SxHon J1G6 al tlro I.eDorCods, /ntw( uM ettomsY�� I�u.
CONgTAUCTION LENDINO �OENCY: I hereby ��m under pereM1y d perMrv �� IMn ia e oonmivabn bndirq epmry br IM
yp�pmeera OI IM1B xpk Ip wfilCh Ihe peeml ie ee�lE (seetan �09�. Crv. G).
LENDEN'S NMIE:
LENOEfl'SIUDHE%:
I caNiry thet I heve reed No appliation uM vma ihet ila ebwa in/ormelion ie wrtea. I pree ta canpy vM� ell vry aM muMy oNine�aa
erd s�e lewe Malnp lo WiNiq cortq�Won end Mreby eNharae repraeenlelivaa M Ihe dtY �o antu upon IM ebova�mentunad propeM
la iroDe�%ia� W�Wse+.
PAT_ COSTE LO_ _.
P � l�
Da�e:
Sq ure ol wM��ApenVAppYt�anVConiretlw
(StStJfi.WP)
Whna-BuJdip ! SelelY: GeeerFb: Ce^W-AOPiea^i; Pink�bveeu»: Gddeneo�b�ew
PERMIT NO: B
CITY OF COSTA MESA — BUILDING PERMIT
078196 PLAN CHECK NO: 02433-96 L
PERM NO: B 078�196
GOVT: N SUPP: N
CONSTAUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION ; 243 SQ PT LATTICE PATIO COVER SQ FT: 243
CLAIM VALUE: 3,000.00 CALC—VALUE: 3,785.94 GROUP OCC; U-2 / 3'�
COMMENTS: LATTICE PATIO COVER PER ENGINEERED PLANS
+tit��t�t�ti�x��r�r**fr��r�r*�x�x�t�*�t*+�*�r+t�rirxx�x��r�r�r�rx�*�f�+r��rx�+r+r�r�r�*+Fx�x��*�*�e+tx��r�r*+t**x�+�*+�****i�*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 BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: 45 FT IN FRNT: FT ZN REAR: FT IN
LEFT; 5 FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 11734124 ZNE: R1 REF NO:
PLANNING N<S'fES> CONSTRUCTION OF A FREESTANDING PATIO COVER AND TRELLI�S.
> J
Ik ik iE 1E IE iF if iE if 1k 1E iE iE 1Eif 1f ik if 1E 1t iF k/E 1E iE ik 1k iE If iE iE iF 1E fE 1E 1F 1F iE IE 1! ik if 1F fE iE fE fE k iE iE fF iE 1E 1E 1f 1f iF iF ik ik 1k 1f 1E 1ElE 1E IE iE iEAE iE fE 1E iE 1E 1! 1E 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: ''— i � 7�
BUILDING APPROVED BY
APPLICATION ISSUED BY
1E fE 1f 1E 1f' 1F 1El6 if 1Eli 1E IE 1Elf 1f 1ElE 1flf 1E
LEGALIZATION:N... F E E S U M M A A Y STRUCTURAL SEGMENT:Y
i /
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 87.25 50
�� SMIP /iJON—RES
PLAN 56.71 ;y•
ISSUE FEE
HUILDING—DIV—>, PERMIT ISSUE PLAN,-CHECK TOTAL PAID DUE
TOTALS----> 87.75 0.00 ,56.71 144.46 144.46 .00
REVENUE DIVISION TOTALS--> COliLECT'�ED: 144.46 OVERISHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC EIRE SMIP/TOT GRADING PLAN—CHECK
87.25 - .50 56.71
1f 1E fE if if fE if k itlE M iF if i! iE If 1f iF if ik if ff fE iF IF iE if it iE iE iF iE IE 1E 1E 1f 1f iE jE ff 1F 1E 1k Ik 1E 1F M!F fk 1E iF iE1f M Ik i! iE if iE fE iE k ik iF 1E iE fE iE ik it iE fE iE if iE if M ik iF
I N D I V I D U A L fF 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
SFEi _.243 . RES—PATIO COVER—POST.6%TRELLIS 15.58 3,785.94
END'OF FEES _
r!
/
• L':' uU57'_ -' 'i �;Le " �',
�NT_: �_. ',�J ; "*�"- . 1 :..�.1
-..
�fRUCTION AND PLANNING POOL ?Q
iOVALS Permit # Date Inspector qppROVALS Permit �/p
1. 'emporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe�Undrgrnd. . 53. Steel Reinforcement
i .
�. Fitectrical6on�iiinFhilitY-Undrgrnd. . 54. Forms '
....
`�S4 y�ctrical ���n�grntl. -� 55. Electrical Bonding �
� .3 G,�-q ��
n'S,�lteel Reir�pttpmr.�S ' 56. Rough Plumbing & Pressure Test
�����ctrical'D���� 57. APPROVAL TO COVER�GUNITE
x� �otin9s �`nc�� � l�- �(,� 58. Electriwl Conduit-Undrgrnd.
.��8. FoundatidFF Fc, � 59. Gas Pipe, O Undrgrnd., Test
�. vi
9. ater Pipe}lndr6�nd. a � 60. Backwash lines, P-Trap, � Undrgrnd.
10. Structural Floor � stem � 61. APPROVAL TO DECK � �
17. F4�perty Sewer.��ine &� House�nnecfion 62. Backwash & Receptor-FinAI �
12• ��''�ef �P ''� � 63. Heater & Vent-Final "
13. Roof Drains �„ 64. Plumbing System � Final
i
74. Rough Plumbit��., Ry 65. Eiectrical-final � '
. ,
15. Rough Electrical�CoriSult b' 66. Solar SYstem�Final .
'v
i 6. Rough EI'y ric Vihl�� 67. Fencing & Access Approval
17. Rough Witing Sigw 68. APPROVED FOR PLASTERING
18. Rouqh Electriral� Bar Ceiling ° 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air ConditioniogH o �, �,FI �PT. �EQUIR�MENF �:
�q.
20. Yu Fa or� ir r i xr' `'.^ * � :- '� ti'. � �. >'
F% g�' � y� �SCce 5�,.; y K F., �%: PPR�VF�,F.b��`F�Pe�it#
21 . (D�Gb',-in SPruaLreC•:K � '.. .. � ' � O � x ,70. dergro� Hy�ro F
22. I�uct�Ve�ila�'Ing yx ' (�: *� �� E,� .71. Produc,..,iping C7� �s L30i1
2��ougbi& Te�z � � c7 � n K G'+� �72. Unde�gro�nd FI�S�`� k `' -
'\ Y 1 H V �' �l1 G.
24. f�oof$rar�i n '�* �`'� r� '= �• d r-�'s
9 �� r... �; * � �...�,� ..73ryUndergrna� Storag¢�nk� Gas ❑ Cjil
25. Roof�he�hing , f � �� v�ic � T cU r 74y�(SverR2ad Hydr� ^
26. 7�par�eiling (StruF�c�ta1) & MertdEoat � - [3i '
cx,p �,*r p n� �5L v�Q�iNta� F^ *.-, cC
27. F,�meand�fla6,hin y � m A� 76. Dry Stanc�,Sipe F^� ��
k;:t � Xr �i: >. n.�
�-48. Lathwg &Sidia'g �"' �"� -'�^ �^ � * � ^"' 77�'� FIXED SYS�E�,Sr,�,INALi r ;� r
G* ox=- O k� 7
� 29. �nsulatiori;. • :» � S u � - : �j �s �$iFIRE PREV. FI � * % `T �
�`30.Drywall(�'jlin� �'x �' ��„ � ��I '� '' �FALTf�DEP��Q�/1REMENT
h?.t � t f., x. : i S
�31. Plaster Brawn�Coat��: S .^• t* �. > �� � �•J9. FINAL I(t[52ECTIHN �� � J n
y�_ � ^� r.
�2. �ctrical w� M���ir�al ' ;;, �' ' j* 0,.�.�'FOOD CERTIFI��TE IS��1yED,., rt�
� i � i � . � i I. .. < "
�33. Fsal�lec4tr,ic � ;r;�: �r � T; ;: ; .�NaTes: ^: =� C vt�
r " �r
��34. �'nal#ieating �AiF�ndltionfn�S i � . V: ^ I ! � _ S �q� S� C�� ��y� S .'7 `
�a' .^ .-, c .-� r t*: � y. i t.. �`- G-"r�/�",�`-��.
i35. F�alrGas pe�eskj:�� J - i:,.y � { � ,�(c t7�+ x t-�,:
� - .
..r
�36. Hood%or 4"anopv G* � � n"" x^ 'x - i:� = mr-
c o�x n i�n_ x � � �R `m �-� �c m �-:c+:
� m � � r. .� c� i � � . � . . _ ..
�I. inal tractory Firepiace f; , �.� Y� 1 i h. fi r+n'
' m t
-B8. Fi�al'fAuratjing `�x M� � v: � ^ I I �� � • -"Q "X' o
39. VO�ater5ervice•Finaln;* £ ' a F� I �'� y. „ ` .., a`' x
' i • m
�TAO. Gas Service-Final * t* �:"!^ .S' • y t�1 i ;k O� a�v *
u i c. i-� R7 � .�: F• -; � .t +�
�41. So'lar pomesti�Final* �' ; , ••� � :� � � �; i,. .�ro o• :: ;,
�
42. 8ackflow Preventer !: � ^.: '^ ' � ^ � ! ��� � %^ ' �*'� "'
. nl fi�r- 1: F-; K :T7 lTiQfu � c� _-
�". �. G .; 5 r 'e: v ...
43. Backflow IrrigS�wn R; � .� fi L � x ��
+�
44;. Landscap€^rriq3cion�Syscem ;; " x �*• 7 �7w . i� ns -� �n * ' -
- � x. E T� .: G C[ :Y S H
r� r+ x- c r�;� � r, r.
45. Sound At�tenuation * .y .. .. � J * , �; n* , v� cr a; � E•t' �
,
4�. a�dicap Regulationsr� *: O +� *^ a'- r"'9 ` *
c r t -;x .^v0 q "
4�Z FFNALSTRUC'TURF�&BUIL[r91NG !' �,q6 �'y/1� , ;' H �. �
48. F33VA�QPLANNING � . i-•�• r c" • -�I �.� d f� N � T •-�. '
4S. Efectnc R�IeasEto E�son � '.��' y� �; �� � � �.R; y '
59itGss Ralease to Southern California 6as Co ! � . � � f � � � � `-+ '� • ^�'%T• ` C' •
-, �< �x • s oc ;.� � a v
5T." CERI'CFICATE OF OCCUPANCY x ' * �� • � ^ "' � "
No. ' +� Date
`, \
Date Inspector I
areu�occ: 4 8 1 E 1 9 TH S T uHr:
YEIFp10W�k NELSON, SCOTT
�no�u p O BOX 11�'E'S`�•
NEWPORT BEACH,CA 92659
714) 650-9338
1411UW /�OOPE55:
1RCXRECTOREiIfidEFF. THOMAS B URG ER uc.xo.: 1 5 9 0 2
WCX.OXENO.'BAUOPE54: 1%%S? MITCHEL 851-0200 uar: A
IRVINE CA 92714
cartn�crarax,� PAT DRAYER PLUMHING ( 714 ) 496-9307
earmuerox+wuwa 26431 VIA SACRAMANTO
�as: CAPISTRANO BEACH CA ucao: 592399
92624 uxr: A
4 ! COMNICTONB DECL�P�TION: I Mnby �fikm uM�r pm�1y W qQury Ihtl I un IIo�nW uM�r paAtbm W Cluqtt Y
( mm iq xN� 8�elbn ]Wq M qN�bn � W t�� Budmp uW PmMdau Cod�. uk mY Ilam� b in lull Ma W dlw.
u No.: uacuea: C-36 ue.No.: 592399 EXP:
d.: canreaor:
OW R BUILDER DECLARATION: I Mnby dArtn uMar psnaty W p�rWry ihtl I un �umq Imn IM Comratlon lbm� law la IM
1 0��n (�bn ]031.5 &nY�u� uk Pro�enbiu Cade: Arry ctlY a muntY �� �Vuim e p�rmM to aauNcl. ellx. Impow.
d'sh, a npei ury cnucwro, pbr m Iu bwwnu, ebo nQuim tM applkem ta ach prtmX to fiM a dpi»d �lebm�m iMt M a�M
'� IIamM punuem lo IM povhbm d tlr Gonlrma� Lia�m� L�w �Cluqr Y(mmm�ndep wilh BMbn 1000) d OHbbn 3 M iM
Budn�w vd Prdpacm Codel a IMt M a Ma b wmq �harehan uM �M hW tu �Iw �MOb aa�mWion. M/ vb4lbn a18Mbn
]0]1.6 W eiry aGv��� la a psrmB wbj�a, tM epplceN to a dW psndry d na1 man ihen M� hu�dM Eollen �SSOOp.
� I.uovmerMtMYW�MamYxndMwW��ntMiwboomWmetbn.xilltlotlrowwk.vb�IwnrucwnemlinleMM
or dlarod M Wa (Senion )ON. Butlrm uM Pmloe'va Gods: The Comroflon Lbnes lewEon nm eCVMloen owriar d piopsity
who Wids a inpova iMrson. eiW rAn dw suM r.orlc NmWI a Mna1 a Nrap� �e a Mr own employw, povlEaE IMt wc�
improvemand ua not intendsd a Warad fa aNe. X. howewr. iM buiNi�p a inpiwamaX u�dd willdn wro Y� d oompluion. Ns
owiwrbuiltlar xill he�c tM bvMn d pannp M or eha did ew1 buiN a impow la tM Wryoes d Ws).
� I. u owror d the P�PeM. em uCiervdf' wntrer�M wtlh IicawE wnl�eclm b mrutM Ne P%� (3apion ]W. &ninms enE
v,aw�m. coee: me comimon �icm.. �a. dw. m rooN m en owiw a o�r •no a,m: «impw« inmem .ne wno
wnVecia la mxA pojeea wiN a aomrmoHe) liceread Wnuw to �M Comrmaro lionua law)�
� 1 em evemq uMu Seclion: B. 8 P.C.. br No eedon: �
Dma: �^Ta��
I tlo haroby cenily thm I em ewere d uM undaeiend Ne ieqWremenb M Cellanu INMh eM Sdary Cade Saabm u505, 25539. enE
2551a, end ihet I a e�ry Mure Wikiiq oowpent xill / wil nd (ack ma) rimd io ednply wYh eak peb caEm aM the mpulmmmn lur
apaemniwcaneteuciionamod'dretionhpn�M�i e�y enepemeniDmriq.ResidenlidmnmrwioneppiratiomennaemptlmmUroea
pIOV19WM.
Dele: AVd��
WOHKER'S COMPDIS�TION DECLAR�TIOM: I Mraby affvm uedr pwlly d psjury ans d Ne Idbwuq dede'uuueu:
� I havs W wi1 meimen e ttMktla d aomm�t Io+eHiiw�e br waken' mmpeme�ion. m pmNeG b by Samon �)00 d �M lebar
coa.. i« ins wa«�e a m..o�x i« �n � v�n e m�e.
{�] . � nm. e�e w mam�, w«wn• m�v�on imureze. n nc��.a M swim a�ao a ub �m« coe.. �ar me o.dama�c. a m.
n wpk la whidi No Pa�mu u iuueE. MY workere' mmpereetion i'reuranca fariia md pdiry number va:
c�.�:
aacvN�mn«:
,Thia eattion need na be eompbfaJ / tM pam�i ia lw one huMreE Ldkrs /SIOJI a bv J
mnAy �hm in �ne pertoemenee d Ihe work br whch Ihis permil ie uvuW, I Mell na emWry any peiwn in eny menner eo u to
ana wbjea �o �M v.oMers' compe�emion lewa d CalAanie. eM epne IMI il I ahouk bacome wbjea lo ihe wMrt
mw��bn wwbn�. d s.aim sloo a me lmor coae. �.nd� �onn.tln ownW wan uwsa c�aims.
ApplFanl:
a.4p: F�Yun ro aecun wolkr.'rompwu�tlon roveraps /a un4wN( urOWII sW/�cf en wmployer ro MMiW p�n�ltlp uW
cl✓ll Ilnu W ro ms h�nGrM tMus�M Jd4n (S10qG]VA ��Itlon ro IM cwt ol ronpsivaWM1 Lamspu u provMW br In
S�ctlm �1P6 of tM Lffiar COW. IMwL ���mry�a /wa.
CONSTNUCTION LENDING ROENCY: I hreby elfrm uMx perielly d perjury Ihet iMrs u a mv�rveion bndiiq epercy br Ne
�Gf�OfT811M O� IhB Nqf. �O! W11Y�11hY G0111111f CtYG� (��iM0113Ui%. �.M. �i�.
LENUEH'4 NAME:
LENOEp'S AOOPE59:
1 co�ily Ihet I heve reetl Ihia epplcmbn end nme t�et Iha ebove informetion ie cortad. I eprae io compy xilh ell cey erd munty oMinencee
enA ewe kx+releling io buildip cmevutlon ud Mraby aNhorrse �apeeenteiivee d �hia Uy lo enter upon ihe eEws�men�ioned propeM
�«�°'0°tlp�°��°� PAT DRAYER
(5151�16WP) Whde-B�ikvq d
Pink-Revenue: GobenmE-Neeoor
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 074939
PERMIT NO: P 0�4939 PLAN CHECK NO: N� GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ADD
JOH DESCRIPTION : ADD 423SF MASTER BEDROOM 6 INTERIOR WORK SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: REF: H-74427 '
�+�����*****�*� **��**�*�**���*****rt*+�����rx��r*�*x�*;�*��***��x�**��r***+�**x *�*�+�*�*�*�
Z O N I N G R E Q U I R E.M E N T S
S E T B A C K S'"
------------ MAIN BUILDING ---------- ------:-- ACCESSORY HUILDING ---------
FRNT: FT IN REAR; FT IN FRNT:�, FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT;"' FT IN RGHT: FT IN
PARKING REQ� PROV: PARCEL: 11734124 ZNE: REF NO:
PLANNING NdTES>
i
iE iE 1E if 1E iE IE IE IE IE iE iE 1E iE 1E if 1E 1F if if IE 1ElE 1f iE 1f iE IE iE iE 1E iE 1E 1E 1E iE iE if iE k if IE 1E IE 1E'IE 1E �E 1E'IE iE iElf iE 1f iE IE if iE iE iE IE IE iE iE 1F IE iF 1E 1E if iE if fE if if 1(� iE aE
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 HY DATE:
HUILDING APPROVED BY : ' DATE:
APPLICATION ISSUED BY: � � DATE: ��F������F�? ��
1E'lE 1E 1E 1E 1E iE iE iElE 1E fE IF iE 1f iElflE 1E fE iE iE�fTfTFiF3F7F3FTFiFiFiFiF3FiFiFiFiF�F�iFifiFiFiF�FiEiF7F 1E iE 1E iE 1E 1E 1f if iE 1F
LEGALIZATION:N F E E S U M M A R Y. STRUCTURAL E ME T:N
P. �V
HLDG PMT PLUMBING ELECTRIC,�?,MECHANIG�., � FIRE SMIP/RES GRADING
PERMIT 28.00 °� 1
25Y ,� -r' �`1 � v�' '� SMIP/NON—RES
PLAN '� �? � :. � . �.
ISSUE FEE 20.00 ' '
BUILDING—DIV—> PERMIT ISSUE PLIAN`CHECK '� TOTAL PAID DUE
TOTALS----> 28.00 20.00 r,,, N 0.00` �48,00 48.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: �' '� 48�100 OVER/SHORT: 00._
BLDG PMT PLUMHING ELECTRIC_MECHANIC ��FIAEy�SMIP/TOT GRADING PLAN—CHECK
48.00 � ��; .�� � .^� ,
� � �: •�n
iEiE3EiEiEiEiklEiFiE1F1E1F1E1EiElE3EiEiElEiFiF1FiE1EiE1EiFiFiflElElEiEiFiFiFiEiEiEiFiE1FiE.fFlFiEif�EiE1E �ifiEiEiEiEiEiEiEiEiE1E1E1EifiEiFiFiFiF1EiE1ElEiEifiF
I N D I V I D U A L' �?. F rH E; � H R �E A� K D O W N
'7 ,/ -
TYPE QTY D E S C R I P T I O^N' �- �� C ti UNIT COST TOTAL COST
PLU 1 LAUNDRY TUH OA WASHER/ ��� ;,n 7.00 7,00
PLU 1 SHOWER � �- 7.00 7.00
PLU 1 SINK, BAR �-' r,r>ti �-� �✓ 7,00 7.00
PLU 1 WATER CLOSET (TOILET)j '� �; 7.00 7.00
END A fiF�} S� �
H �. ��A
� ; � J �r �
�
�
�(� t`J. °�-i Dt 0�J19?�^S-t�;19:�.n< TLlT ::B.OJ
,� �� �� L'!iT.; FQ:L1%v= � i i��C; t,):tl
� �
� RUCTION AND PLANNiNG �
tOVALS Permit # Date Inspector
t. Temporary Electrical Service or Pole
2�. Soil Pipe•Undrgmd.
�4.
ity-Undrgmd.
Steel Reinforcerpent �
'Electrical'UF E R'Grnd.
K� _ "
Footings ' _ ;� ,, '
Foundation � -,k �c;c ..
9.WaterPipe-Und�jmd`.,�-. �
10. Structural Floor System
17. Property Sewer Line & House�Gonnectior
72. Sewer Cap � � <i
13. Roof Drains •
14. Rough Plumb.ing � �--
15. flough Electrica�-Conduit �
76. Rough ElectricVJirint�;
17. Rough Wiring Sign '
18. Rough ElectriraYT Bar Ceiling
79. Rough Heating & Air Conditioning
20.'F�ough Factory Fireplace ' �
` r
27. �uCtS, in $TrUC[Urg � � ��
22. Ducts, Ventilating .`� •�
23. Gas Pipe•Rough & Test r•
24.'Roof Framin9" ' `
25. Roof Sheathing � �
26.'�f'�Bar�Ceiling (Struct6rall & Nbfiqcoat
27. ��ame and Flashing � _. ,
� 28. Lattiing &'Siding - _ „ �
��
> . .. _
' 29. Insulation � s ••
" 30. Drywall Naiting x
' , i 31. Plascer B�owq Coat .,, �r-
� 32. Electrical Power Me't�r-�Final
t
�33. Fina(Electric � �,
- 34. Final Heating & Air Eonditioning:> .
II 1 . .
35. Final Gas.Pipe;Test �' ,�
-' 36. Hood or Canopy .� ' ' '-
"37. Final:factory Ffreplace •� � '
- 38. Final Plumbing Pc2��_ „�„/Q - S
' �l'�=L
I4 ' 39. Water Seryice�Final %� � '
I_� 40. Gas Service-Final - - - _
I 47. Solar pomescicFina( = .
� 42. 6ackflow Preventer ^ � •�
If 43. Backflow trriqation �'
� �,
44. Landscape IrriQation System •='- _ '
I 45. Sound A;tenuation �� - x`, "
46. Handicap Regulations - �.
47. FiNAL STRUCTURE & BUILDING
48. FINALPLANNING � F-�
- 49. Electric Release to Edison '
50. Gas Release to Southem California�Gas C
51. CERTIFICATE OF OCCUPANCY
No Date
' • G
POOL �PA �
APPROVALS . Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAITOCOVER-GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash lines, P�Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent•Finai
64. Piumbing System � Final
65. Electrical-Final
66. Solar System�Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOLlSPASYSTEMSfINAL
r FIRE DEPT. REQUIREMENT
APPROV�LS"F' Permit # �
� _ ' '
�. _ - ` � 70. Under�'ou�d HYdro '�
* rt _,"f' :
- � .- „ - . �� 71. ProdusePipingOGas ❑Oil
. ' *' �- 72. Underground Flusfi �
.,, �.73'. Undergrnd.StorageTank,`,�Gas ❑Oil
'� 74�. Ovefiead HYdro _ ..
. � - � -: . y - _
, . � :-; ;. 75. Dry Chemiwl - -
, � _
_ ��• 76. DryStanFlpipe �=" ' T,
'� �� ' "_, 77�.� FIXEDSYSTENVFMALi..� � j,
� i,
•� 7ff;=FIRE'PREV. FtNA� - ' � E"' �-
�•
'F '��,;� ��H�ALTH,DEPF.�REQUIREMENT
�. � ;' 79. FINAL ITVSPECTtON 'r � � � '
` �� � � � � SQ'� FOOD CERTIP CATE I��SUED '
t .'
�
n
9
Date �Inspector
. •� � � r.
l: : G ni' ,�,.,' /�
y N6te5: ��'L.�'ZS�rr L��/LL:��4�
i . �- �'�� .r �.. �: � _.
~ � �����r=rC _
� ��i�Zs��iti:��s�1�c�
� �k �, � < " �.�, �
' • � : u )rE ��-�c �vEr �"''�=�-�rl
�,
(/ � _ - �(�`7 � � Cdi
�[7 .L . V
Giti/L �-,C�Sr/ � � ,�� � ._� �-. r
k`y � : �
, - Z��_���
1 '- J f
i '
, F F
K ' T
{� :' ..
. �� c: � xr:
+ C o n, . ' -1
• t � � - -� � _ ' G
r r �:., F C� ., Q . r
. . . , r T . _ •-
4 `' ! li+
i •i r.
a :. � ' 7
. , .r,
Y,
c
' r' � �� :
:1 7
'_i .
�' '- "" `
x
* _ =
� � `
t
'I
�
�oonFss a eu�owc: 4 8 1 E 1 9 TH S T
oxxexs�eivaa�vw: NELSON, SCOTT
eoo�ss P O BOX 1125
• • NEWPORT BEACH,CA �`42�59
714) 650-9338
�. wu�c.�a�sx
u�: CITY OF COSTA MESA — BUILDING PERMIT
� PERM NO: P 074968
PERMIT NO: p 074968 PLAtJ CIiECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ADD
urcxntcroneNca+�+: THOMAS BURGER uc.xo< 15902
u�cx.oae++c_�saooxEss: 17752 MITCHEL 851-0200 unr: A
IRVINE CA 92714
coNm�crarsrur/e: BARRETT DEVELOPMENT CORP ( 714 ) 494-8272
ca�m.ctoxs�uiu�u 1110 N COAST HWY
�,00xEss LAGUNA HEACH CA �No.: 598441
92651 �r,,; A
LICdSEU CONTPRCfOPS OECIAHATON: I hwaby allim uMer peroly d ps�ury tlut I am fx:enaed uMer pwidoro d Chaqm 9
(�Merwirq wilh Sectwn ]OW) d Divoian � d iM B�r�ea entl Prdmeions Code. arid mY licenas u in iNl iatt anE ellaa.
cmuc. P. uc.cuss: H uc.No.: 98941 EXP:
Da1e: l. � � Cmlreda: ���/.�
OWN€A BUILOEF OECIAFATON: I In�eW eiFrm undar peiWy d perj.vy ihat I em aRamq Irom �M Cadretlaa tiowa �ew ta Me
IOEowkiY �eaton lSeCiM )W1.5 &nivaa eed Prdpabm Code: �m W w aouniY whidi eeVu'vp e V��E Io mnWef. eAa. imYwe.
+�Weh. a reper enY eWcture. pior lo d� esuenca. eho mpuime �M eppliiaM la wch pamiii io fib e op�E amemem tlW he a eAe
liro� W�ent lo IM pro+i�iam d ihe Conireaae Lieema Lew �Cheqm 9(�maneeq xilh Sadion 10�0) N DNeion � d �he
�einem end Prdaaiona Cada� or Ihei he a eM ia aaemq iherehom eM IM bno fw Ne elbped exemqbn. My vble�ion d Sapon
i0�1.5 W enY Wdifant la e pmmn eubjM51M eppl'rsni lo e dvil penelry d ml more then iva huMred ddlara �4500�7.
� I, ae oxnm d Ihe propeny or my ampbyeee wuh wepea m Ihai wle campenae��ian, will do �hs woM, erd iM ewnuro b r�d intended
a oflered fa eab (��^ ]Ose. Buarom entl Prdaeriorn Coda: The Com repon license lew does rM xppy to en owner d qopeM
Iw W Wa a inpo.w ihmean. uM v.ho doee eudi xak Nmxll or Mnel u Waqh hia a Mr own emVMb+, p�b tha wch
imP�*meM ue na irueMeE n atlxeE lor eeb. tl. howe+m. �M buitliiq a inpovemem o�dd xilhin un Yur d canP�ion. the
owMr-0uitler xip heva tM bu�den d qwi�p M w aha Eid na buJd a impas Iw �M Wrywa d aeb).
� I. u owror d ihe qWeM. em mdusnNY canrmYq xnh IicemeE conirecian to mimrue ihe Molb (5eaion )OM. &amms ard
Prdaaime code: TM Coniradore licmae Isw doea rwi eVMf lo an owrror a P�We�Y Ma buiW «"unV�'m tMaon enA who
conlrazls la wM O�M�� �h e mmreaor(e) IicaneaE punueni lo ihe Canvmore Limnae Lew�.
� I em eum unde Secibn: B. 8 P.C., la thie�eeaon;� � �p/'�.
Dms: / ? 5 Owiw: /ft � (J G.n�/!'
I Ao MAb' �Y Ihet I em ewere tl ud uMeniud Hro rpui�emew d Caliaw VheAh end StlMY Cade Sediom P5505. ?SSU. ud
II55J1. arM Nei I a eny Mun buildi^G omia^�_ wYl / wil �(acb ms) neM to w^WY wi� �eN ua�s mGm end IM ieGuimnenb br
a M� IaametnMiona modifmlianhan�M M�e^eC^'^^^� Oiuria. Rpidanl� mmtNpian eVW'e�'vu en axs�+q Imn tlwa
D��aioru.
Dete: AGd��
WORKEN'S CONPENSATON DECUN�TION: I Mraby eifi�m uMer penelly d perjury aw W iM Idlowiiq dedveton�:
p �n..�..�a.a�m.n.�.ne�saw�.«,iio..n;�rem..�«:e�o��.e+w«�a.aiaMs�,aooam.�
4ode, ia tM peAmvrcs d Ne xak la wlic� Nis pemi4 "v bauetl.
C.] � n....�a w mvnw� woi�w.� cano�•mon I�wy��.,��we. m ma�n.a M s«fn, a�oo d �n. teen cm.. ror m. wao�m.m. w m.
}t w«k�«wnkhmuo«mnisusuee.MvwskeA'S1A�E���•�aww.r��mb.,...: EXPIRES
Cerrim:
Pa� N�mn«: — 10 / 01 / 9 6
.,is a«tim rieee rw� w cmiab�ee r rn. w�e h ro. ms nvneiee ear�en R�rol w bss./
I� I�h thet in IM pMo'merca d �M wak tar whkh ihb pemn h mu�tl. I tlWl M wnqry ury pren in vry manrw p m lo
W�� w4b �o tM when` canP^^�bion kxs d Cel'Eamie. enE nires tlW 'b 1 Nould b�cmis uibl� �o �M xaM1an'
eomw��� wwn�. a s.u�, a�oo d in. i.no. coa.. i.nao eonn.nn oomar •an mo« mow�..
�I
Ome: AVWMe�L
W+mNp: F�llun ro�c�n woiMn' eompMwtlon eorn�p� la vnbwNl, �ne Ihs/l a�b/�ct �n �nrployw ro cNMnl pm�Mu antl
nw n�.. w ro m. nuie�re mow.ne eaw.lsia4aoaA � edeirron ro ar. co.� o� nrr�e.,,..rron e+m.p� ., povw.e ror �n
s.eear sros or m. imo. eoa, i�rr..t •�e.m�m.r'. �.n.
CON9�UCf10N LFNdNO AOENC�: I M�eby elfirm uMer peneXy d parjury t!w ihon b e mrulrutlian WMinp epency for Ne
periarmanw d Ihe v.oA la whirh ihu permi ia oaM (Sseon ]08]. CH. C).
LENOEfl'4 NMIE:
�ENOEP'S AUDPE33:
I conJY Ihat I luw naE Nb appficetion eM tleb thel �he ebove i�omutian o consp. I q��iae to canply xdh dl ary eM ooumy adimrces
and eWe Mwe nWiq b buJd�q Canatruqian eM Mraby auihp¢e �eqWnlaYvae d �hu ary W mlar upon IM ebwe.meM'v�stl pi0peny
1prinppsq�'""D°°°' RICK BARRETT
� � � Pn e
� � ) LQ'l /"/ Deb: I( �
Sq�reWred IPgenURqp�unVContreaof
�-y»5�ye-,WP) Whns-BuUiq 8 Seleiy:OissrFle: Cenvy-AppFent: Fnk-Revenue:OaMenm�Assesan
JOB DESCRIPTION ; ADD 423SP MASTER BEDROOM 6 INTERIOR WORK SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: ADD MASTER BEDROOM 6BATH, RE:#B74427
x�+���*��r��+�**�*��+�**�+�*��***+�***rt�+�*x�*+r****�*�**x *�x x��*+�***+�+�*��**��****��+�+��x �*
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 HOILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ; PROV: PARCEL: 11739124 ZNE: REF NO:
PLANNING NOTES>
i In/
ik%iE iE �IE IElE * if iE IE 1E if IE if ik fE iE iE IE If !k jk 1E fE 1E if iF iE 3E iE iE iE iE iI� 1h iE'lE iE iE �E iE �E 1f 1E 1E iE 1f 1E IE iE 1E if ik 1E iE iE �E iE 1h IE if iE 3E')E IE iE IE IF fE iE 3F 1E 1E iE 1E'IE iF if
D E V E L O P M E N T S E R V I C E 5•;'� R E Q U I R E M E N T S
ZONING APPROVED BY ���'' DATE:
HUILDING APPROVED BY :
APPLICATION IS
1h iE 1E 1f iE If iE iE 1E 1E 1E 1E 1E fF
LEGALIZATION:N
BLDG PMT PLUMHING
F E E S U M M A R Y
ELECTR�I4C MECHANIC
DATE: I
DATE:I�L iL�
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
PERMIT 12.00
r
25� � SMIP/NON—RES
PLAN
ISSUE FEE 20.00 � �✓'
BUILDING—DIV—> PERMIT ISSUE PLAN:=CHECK TOTAL PAID DUE
TOTALS----> 12.00 20.00 �0 0.00 32.00 32,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 32.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MEGHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
32.00 ^ .
1f 1F 1F 1F iE 1E jE 1ElE 1E 7k 7E dE iE iEiE 1F 1E 1F 1FlElElE iE 3E 7ElF iF iE �E 3E IF 1F 1E 1E k 1F iElE iE 1E 1E iF ik k iE 1ElF iF fE i4 if 1F 1F ik iE iElF iF iE iE iF 1F iF iF iF ik iF iF iF iF fh ik iE ik jF iE iE if
I N D I V I D U A li. 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 TOTAI; COST
PLU 1 WATER HEATER AND/OR—,VENT 7.00 7,00
PLU 1 GAS PIPING SYS OF �^ 1 TO 4 OUTLETS 5.00 5.00
END,;F FEES
i' / �l /
� �
t
D1 OGI?��1�-�p19351� T�f'9' 33,6u
QATE: li/�1/�i� 'Ii+.i: :::?0
,
�
.:
t: - .v
CONSTRUCTION AND PLANNING POOL ,PA
APPROVAIS Permit# Date Inspector qppROVALS Permit# Date I-nspector
1. '; emDorary Electrical Service or Pole - 52. Pool & Equipment Location
2, Soil Pipe�Undrgrnd. 53. Steei Reinforcement
�.,3..ElectricakConderit-Utility-Undrgmc�. 54. Forms �-� �
�;.�4;,'Electrica(�o�dui�t=Undrgmd. . 55. Electrical Bonding ,
5, Steel Reinforcem�nt � 56. Rough Plumbing & Pressure Test r
6. �Electricakl3FER_G{rtd. 57. APPROVALTOCOVER-GUNiTE -
� �
�7. �FO_otings_ �;-: �.;,`�� +� � 58. Electrical Conduit�Undrgrnd.
8. Ppundation � � 59. Gas Pipe, O Undrgmd., Test
�•:
9. Water Pipe3lnd'r�irid.'�- . 60. Backwash Unes;ls•Trap, O Undrgrnd.
70, Structural Floor�System 61. APPROVALTC�,pECK
11.;P�operty Sewer`Cine.& House.Connection 62: Backwash & Receptor•Final
12 �Sewer Cap �' � � a . 63. Heater & Vent-Final
13. Roof �reins ^' , 64. Plumbing System - Final
14. Rough Piumbing 65. Electrical-Final
15. Rough Electrical-Conduit ': 66. Solar SYstem�Einal
16. Rough Electric�,ViriAg,., 67. Fencing & Access Approval
17. Rough LNiring Sign 68. APPROVED FOR PLASTERING
78. Rough ElectricaliT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning , _, F,IRE DEP7�REQUIREMENT -.
� �' _ . ;� -
20. ROu§h Factor� Fireqlace _ . ' ` ` APPF}OV�2S �,- Permit # �-
21. Ducts�, inStructurE.' • - � � � '�� 70. �lndergrourid Hydro *
.� ..
22. Duc45, Ventilatin�: � - : .�.' �- l 71, product Piping�L�I'ias � Oil
23. �Gas Pipe-Raugh & Test -. •-. =* �� 72, Underground Plush �,
24.'ROoP Framing" :.� � � ' � .. .. 7�; Under9r'nd. Smrsge Tank O Gas ❑ Oil
25. liooi-Sheathing ':+ - � � , .r .� �� 74; Overhead Hydro ..
26. T•Bar.Ceiling (StrUc(ure1) & Monocoat . - �w 75�, Dry Chemical . � � . _
27. Era�eand Flashing* • ' ' �'i 76. DryStapdPiPe�` • , �
" 28. L'dthmq & Siding r�,� ' �. : ? ; � �� � , 7X: FIXED�S`I�STEM F1NA�L � �
29. �nsulation � � J - - � ' 78,'FIRE-PREV.FINAL , � 'G'�
30. Drv�vall Nailing :� f, i � �� � � ��F`iEALTH DEP�.`REQUIREMENT
31. PlBster Btown Coat �< �� � *'- 79. FINAL INSPECTION '
' 32. Electrical Power Met'�r�Final �� i � ,° 80: FOOD CERTIFICATE ISSUED
'- �, . , _ .
� 33. FinarElectric� •- � i � *� Notes: � ' "
, (/-ZSs �5 C.LSYz _2_�-�C� -
34. •finaF•HeaTing'& Air.�qnditioning ` , w �. • �� � ' �
a ���� ��
35..Fina1 Gas Pipe•Test - - � � . .c - � • - -
.r
36. kjood or Canopy - ._ ' -- ` - ;� T _ �. _
„
37. �F.inal Factory Fireplace .^ • - � � � �+' � ' � � �'
i -
38. Final plumbing ' ' � _ �, �� ��
� ,� - =G �� �
39. Water Se�yice•Final . - - • a � �; � � i� ' r -
i r :
�' 40. Gas Service-Final ' ' " � - " � ! ' : . ' - t ,.,
, 41. Solar pomestio-Pinal - �� � ` �x - . � r -
�.
42. Backflow Preventer ' '� � x 'r ' - ' �
. g r rf -
43. Batkflow Irrigation k , c�s; � D. ' ''
44. Landscape IrriGatiori.System . -- � �� � ' �� �.� t ` --� ' ,�� - � �
G
'45. Sound Attenuation. . . . ' `- ~ . �
i•7 ;� c v' C' J'
.a ' .
46. Handicap�Regulations '' - • - -
47, FiNA'L STRUCTURE & BUIIDING � � � . � -
48. FINAL PLANNING' � � � ' � � '�
. n � `w
'49. Electric Release to Edison � �_�, ;�' . • Y �' ,
50. Gas Release to Souther� Catitornia Ga: Cn a �_�
51. CERTIFICATEOFOCCUPANCY - -
No. Date
�
i �
�vonrss a euiou+o: 4 81 E 19 TH S T
a�mexswu�eiFqawr+: NELSON, SCOTT
�ooxFss: p O BOX 1125 �
• • NEWPORT HEACH,CA 92659
714) 650-9338
�rr�. �uimc �ooness:
UNT:
u�cxrtecronErxax�n: THOMAS BURGER ucxo.: 15902
u�cx.onFrxi•awo�ss: 17752 MITCHEL 851-0200 uNT: A
IRVINE CA 92714
ca+mac,arsru�: BARRETT DEVELOPMENT CORP (714 ) 494-8272
carnx�croasxuiwa 1110 N COAST HWY
�noness: LAGUNA HEACH CA uc.no.: 598441
92651 uNr: A
UCENSE6 COHTRfCTOFS OECLAfldT10H; f Mreby elfim uMx parely d pe'jury Nm 1 em ficereaL uMm ryo�ieiana W Cheplm 9
(wmme�rp rmh SMion 1000) d Ovision 3 d the Bwima vk Pmleavma Cods. ard my lioeme u in IUA lace end eHaa.
cmuc.no.: uc.cuss: B uc.No.: 59�8441/J �L$,��{P
ona: // / �� c«wae«: ! `vr��— O�'�Y//" •
OWNEfl BUI DEN DECIAXATION: I heeeby p�� �r pruly d pvjury thm I em exemq /mm Ihe Comrrfm lieeme lew 1�
�dwvmro �esvon (swun lmts &,.nese ena ard.nune coae: Mv civ a aoumr wn:ii iea��roe e va�mN �o canswn. M.r, imwad
�lemdu�. a rpei eiry sirvnun, pior b ia aweMa. ebo repuieee iAe epplimeu Iw eueh pe�mN lo fib q eprod eteiemem tIW M a ehe
IieeiuW Wmieeu to IM pwoior�a d Ihe Comretlon Lieense lew �Cheqer 9(mmmene�q wilh SeCion ]000) d Oiiuion 3 af �he�
uai�v vd Rdmsvn Codel a IMt he 4 aM u ezemW therMmn uM tM bsin la ihe eDeG� ssamqion. AnY videtnn d Saeun
)W 1.5 Gy em/ npWk m la a parmu eubpCs IM epplium lo e c 1 penMy d mi mae then twe MiMraE Eoper� �SSOpU.
� I,esowrerd�heqope�yormyemploy�v,yhwepeamlheiedemmpenWim,xiYdotMwoM,enE�heeVudume�inianAeE
w Mered lor eeb (Section ]Oa4, Buvne� ¢� prWeaeiom Code: The Conirenon limae lew doea �wt applyto en owr�er d propaM
wha WiEa « inqovea Iherean, e�W Mb Eose vurh wak Nm�eM a Mnetl a iMaph he or Mr own emplv�ae�, povidad thel wc�
impovemmia ve na iMended a olleiBE Im eW. tl. however, IM WiHirp a"vnprwement u edd wilhin aw yaer d canpbiion, Ihe
o.�e,a�,ue« �u na�. ma wmm� d awi�ro ne «.ne ad �a nua «�mwa+< �« me wm�s. a w.l.
� I. ea owner W ihe pmpeM. � eRNuei+aly mnirecliq xil� liceneed canvactwe to conmucl iM piopp (Sedion )01d. Buainms eM
Vroleaeions CaJo: The Contredae L'cenae Lew Eoeerwl eppry io en oxnerofpropeny who Wike a impwmthereon enE wlw
con�rensiw eu h D�M�s � e��1ar(a�l'renaeE Wnuenllolha Caniredora Licenaelaw�.
� 1 em azemp/y�, ei S B. 8 P.C., la tlus �,
Dele: /�/ �� ' � Owrrr: - -�7�2'
� `
1 do lw�eby eanAy Uxt I em eware W eM �vyanwM iM1e ispuiremania d Celloretie NeeM eM Satery Cade Seeidn Y5505. 255?i. eM
P5531. erd tlW I n enY Mwe buJdinO �0em will / wil M(dreb aro) neetl io camNf wiA ee'A mte mEa eM tha nCuimmarro lar
e oerme lame4ucfan amodJre�iontrantl�Ai�viq�amau Oiaritl. M�Naviel wM�uaun eppirmiom en exemq Imm Jwa
I �I
I�
Dde: ApplceM:
WONKER'S COYPENS�TON DECLAfi�TIpN: I Mnby etfirtn undx pautly d pa�ury wn d the IODow'up EedeeNiom:
� �n...enex��meonanecanar�eaowamio..n.m�mro'wo�ken�canro�+u�.a.v�a�aMswia,a�ooam.�.eo.
Gade, la �M parlamence ol Ne xvrk Iw wlich thie pe�mil n inue0.
rl I heve enE wil meinlein vrorken' wmpOn�elion ineurenw. ea requireA bY �� �)� � IM Lebor Gode. M the peNormerce of �he
1C work lor whiM �hi� permn ia iaued. My waMis' mm neelian innurenca rarrier vd pdiry number ere:
c�.: ST�ATE FOND E}CPIRESn
Pd'ry Number: - 1 �� � 1� J�]
hia eenion nasd nw be cwnpleredY the p�R u la one hunCro! Edlers (f100) w IusJ
❑ I cenly ihet in Ihe perlarmence d �he wpk la wAc� Ihie peimA u uaued. I WII m� ampby e�ry penon in anY manmr w m to
ppcome wbpf io IM wvrYwe' mrqenmlion I�xs M C�lilomu.WWWjj/ pree Nal A I elwidd becor�w �uLjw lo IM xoM1av'
�wnpeimtion qw'n'wn d Swion 3]pp d tM labor Code. I Wll�h mmpl� wbh�'�"'
oma: �od�m: ���1t,� [��_ .�
W�minp: F�Nun ro��cun rortsra'ro�utlon eoverp� l� unlnrNl, nW aIWI ub/sef en smyloylr roWMml paultlu en0
cMl flns �q ro om MnGrotl Mouau�dCWhn (StOqP00A �^ �Itbn b M� cwf o/ ronpmutbM1 Cemep� u provMW br In
Sxtlm J1f16 0/ M� IeEor Cob, IMrw4 uW �rtomry'i hu.
CONSTtiUCT10N LENDING AGENCY: I F�eyy �� uMm perWry�d per'Fvy ihm tMre u a mMiutlbn NMiip percy M IM
peripmance d ��e v.wk la whiM t�c pmni b asuad (Sedion 309]. CH. CI.
LENOEN'S NIJI E:
LENOEP'S AODFE55:
I cenih/ ihm I Mve med ihia epplceiion eM qqe iM1m iha abvra inlamuion is mirea. l eprea lo comply wilh ell'rty erb oouMy adinancm
end emle lewe nleiinp lo Wildmp canavuaio� ¢� �aroby eulhorae reqewnteiivee d Ihn dry lo enmr upon I�e ebove-mentioned properry
�°"�'P'p�'vU`0�'"' RICK BARRETT
2 P��u N
_�� //�.n�� Dete: / S'-1
sre��,e a o«mnngen✓noW��ucomrea«
(5t5tJe.WP)
wnaa-e��a:q a s,roM oA«,-r,b: caody-�oo�i: w�k-r��.: cdeo�a-a...�
CITY OF COSTA MESA - HUILDING PERMIT j,PERM NO: M 074967
✓�
PERMIT NO: M 074967 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: ADD
JOB DESCRIPTION : ADD 423SF MASTER BEDROOM 6 INTERIOR WORK SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: ADD MASTER BEDROOM 6HATH RE:tFB74427
*+��*x���x x *x�*�rx��*�****�x�x�x�***�***x���r�*�+r+e�r**x�x���*x�*x�+�*+��x�***x�+�*x��� **+r**��+�� *�r**x�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11734124 ZNE: REF NO;
PLANNING NOTES� ��
3F �f iF iE iE iE 1f IF 1E 1f 1E fE 1E 1E If iE fElE 1E 1E IE 3E if ik IE 1E 1E 1F iF iE 1f iE iF 1f 1E iE i6i��1F iE 1E 1E iF iE fE if fE fE {E 1E if 1E 1E 1Elf iF iElF iE iE IF IElE iE iE iE 1E 1E 1f IE iE iE 1E 1E 1E iE iE iE 1E
D E V E L O P M E N T S E R��i/7 I C E S R E Q U I R E M E N T S
ZONING APPROVED BY : �y
----- -- — ---- DATE :
BUILDING APPIiOVED BY :
APPLICATION ISSUED BY:
****���*i�*i�**�*****f�i��
LEGALIZATION:N
BLDG PMT PLUMBING
PERMIT
DATE;
�{ DATE: I� Gl�
iF7F7F7F7F:F�F7F�3F7F7F?F�F3FiFiF F FiFTF7FTF7€7F+� *iffff�ie* * *� ieir
F E E S U M M A R Y STRUCTURAL SEGMENT:N
ELECTRIC� MECHANIC FIRE SMIP/RES GRADING
.1 13.5�
' it' 252 SMIP/NON—RES
PLAN `- •
ISSUE FEE • - I�/ 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 13.50 15.00 '",' 0'.00 28,50 28.50 .00
REVENUE DIVISION TOTALS--> COLLECTED; 28.50 OC�ER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANLC FIRE SMIP/TOT GRADING PLAN—CHECK
2 8_. 50
i '
iE�fiEiEfEiEiF1F1F1F1E1f1E1kiEiElEiEfEfFlFiEit7klkiliFiFlF1F1liF1E1FfE�1F1f�EiElE1E1E9E1E1E1ElE1E1f1ElElEfflEfEiEfEiElEiEiEfElfiflF161EiFiFlEiEfElEiEfl�EfEiElE
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
MEC 1 INST FORC—AIR/GRAV FURN '<= 100 K BTU 9.00 9.00
MEC 1 VENTILATION FAN CONN TO%SINGLE DUCT 4.50 4.50
END C.�F�j FEES
.' 1'��
�? CQiG'_'1 :9�`?2 Yiili - ��,,
f�rE: 7; �F,,�-, TI, _; :- 3 '-
�i
�
i� GJNSTRUCTION AND PLANNING PQ01 PA
' Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit �k
1, `emporary Electnca� Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Urtdrgrnd. � 53. Steet Reintorcesnent
� 3. :ElectricaL:Conduit Uc�lity•Undrgrnd.� 54. Forms
'�'4. ElettricaFCor�CuiY:U�idrgrnd. 55. Electricel Bonding
c a_�_.-_....
. 5�; Steel Reinforcejne�rt 56. Rough Pium6ing & Pressure Test
-6: +Electricai;l7FER-G��I. 57. APPROVAL TO COVER�GUNITE
.�7. Foatings{,..T .;y�.2 58. Electrical Condwt-Undrgmd.
8. Foundation W 59. Gas Pipe, O Undr�rnd., Test
9. N'ater Pipe�(�ndcgri�d..v 60. Backwash lines,,P�Trap, � Undrgrnd.
10? Structural F1oor-System 61. APPROVAL TQ�DECK
1 y;�, Property Sewer Line�& House Connection 62. Backwash & Receptor-Fina�
12. 5ewer Cap '" � 63. Heater & VenbFinal
73. Root Drains _ 64. Plumbing System - Pinal
14. Rough Plumb n : .,;
9 65. Electrical�Final ,
55. Rough EM1uctsicaV-Conduit �r' 66. Solar System-Final '
�
16. Rough EleMric yUiring,- 67. Fencing & Access Approval
17. Rough Wiring $ign 68. APPROVED FQJZ-PLASTERING
18. Rough Electricai�T Bar Ceiling • 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' FIRE DEPT.�REQUIREMENT
� r,. m- , r-� - _ p• r -
20.'Fiough Factory Firtplaca � �: �! `�; � �' �� , - ` ; APPROVAl5; . PeiFnit # ' ' �
21, �uctr, in Str�ture�• � •• -�` '� - � ',-< ' 70.:Unde�''gioGnd H.ydro
22. Ducis, Ventile�ting_.' -�` ' , `- �_, �, 77, Product;Fiping �Gas OOiI
23. Gas Pipe-Rough & Test ' 72. Underground Flusn
24. Foo1 Framing' � ' " " ' ; " ' „� ' - 7�3 Undergmd. StoFa� Tank O Gas ❑ Oil
25. floof.Sheathin � . ' _ •
9 � '� �'�% 74: Ovechead HYdro
26. 7�Ba�Ceiling (Struc�ural) & M�iBcoat , ''� - • , 75. Dry Chemical - , -';
27. �rame and Flashin9 . � t, : �� " � 76. Dry StandPipe , •� ... �
28. Latliing &'Siding r�� -- x 1- `= ", "F,� 77, FIXED SY�TEM�FINAL �
29. Insulatipu� ,�^ � _ '� + � � 78, FIRE PREV. FIf�AL - � -
' 30. Drywall �Idilin9 �: ,- w' F, � •`�. �HEALTH DEPT. REQVIREMENT
�� 31. Plaster B�qwn Coat. �^�- ,,�� � � r t� 79�. PINAL I'NSPECT'ION ti;
' 32. �lectricai Poo`igr Met$r�F�nal � " �' ' '` �� 80:� F000 CERTIF�CATE I�S�UED � f
_ z. �.' , . . � �+ . - � -
. 33. �inaEEleetric-. ". �; � c �� i Notes: l' '�
. �f-Zg tS=• ��2tz�iO�u
: 34. :Fina�;-Ieat(ng'& A%Conditioning�� " * ^�/ � ' I_^�G � -7�
�- � _ .. , � =�==L� � " �1=6C �� � `�' _��� C`�.
35. �ina1 GasPipE:Test�`, . , -6 G�'� . -';C-L�,��
. '` L:� �.-
36. Hood or �CanoPY -, - ' . " . f" � . :, . .
.�.; ^��, ,: ;i „� .
! 37. FinafPacEory Fireplece' � � " � ' � , '� � � � �,•, ,-
- - . .x - � _, .� . . -. --
- 38. Final Plumbing ' ' i- }:�` ' .
��
° 39. Watei Service-Final , ' -' � : ` . . . , • -
. �
r 40. Gas Service-Pinal � �� _ � y ti. • �*1 ' � ; _. : �F ^ - -
,
� 41. So�ar Oomestic�Fina� r ' . , �
� , _ .
42. Backflow�Preventer at ^ >' � � '* - ` � - '
r r i � r r.� - �.
A3. Backffo�v trrigation �. -' .� ..� '.� i � � -
44. 4andscape IrupatiortSystem �- '�: ' � ''" -' � ' `-' ' # _ . ' --
.r a - �-i �^ r..
45. �und Attenuation_ • '. . ' , - � � _
46. Nandicap Regulations � - - - - - ' '
, ,
47. FINAL STRUCTUR� & BUILDING . _ " '" -
48. FINAL PLANIVVNG � - � - . - ',r : ." "
i-
49. Etectric Release to Eqison �� � . '• ,
50. Gas RQlease to Southem CaliforniaGasCo � � '� - '
. x '
51. CERTIFICATE OF OCCUPANCV ' � ' ' ' "
No. Date
�
I�
.�
�"�i°PB"L0"0i 481 E 19TH ST
xrthxeruWeica�oax: NELSON, SCOTT
monEsa p p gOX. 1125
' � NEWFORT BEACH,CA 92659
714) 650-9338
APVL. WIWq IOORE99:
��� �i CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: E 074514
PERMIT NO: E 074514 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ADD
urcxrtecTonom/¢n: THOMAS BURGER 1CN0i 15902
ApCN.OPENO:SADORE59: 17%SZ MITCHEL 851-0200 �"T� A
IR�'INE CA 92714
cartnACTarsw� BOYER, TOM CO ( 714 ) 642-2431
cwrn�croaswuuxo 1760 MONROVIA AV
�� COSTA MESA CA ��= 566902
92627 urar: A20
110EN5ED COHfNACTON4 04ClAF�TION: I IwaEy dlim wdr pmie�y d pejuy Uut I em IcenwE wka pwitima d Cheqm 9
(commerrnq wuh Snion ]000) d Oiwion J d rtro Bus'vwa eM Pminwru COEe. W mY fiovus u in hA brca vM elled.
cmuc.No.:049070 uc.cuss: C 10 uc.No.: 566902 /� EXP: 10/95
od.: /�i�9� ��� �i'4�i� / ".4s+.c�'1�.n�L
��
OWNER BUILDEN OECIAXATION: I Iweb� eMrm uMr per�Ny d perNrv �� em uemq Imm iM reaon ' lew lor �Aa
Idbw'vq reeson (5etlim ]W 1.5 9ueiraa aM Prolmeom Cada: My rry a muruy whkh ispurss s pumY lo awnwc�. War. impow.
�ema4fh. a reper mry �trucW�e. prot b ef ewerce, a6o �pimaf Ne ep01i[eN fu wcA pemG lo fJe a e'ryp�sd HelemeN Ne� M a tM
i;�,,,,e w�u �o me wowia., a n. wureaan �.�e �n.lcneqv z(om�,o wun s.ao� �000l a o�oaon a a me
.uavwsa ad Prdmbre Codel a IM1m he n sM u a�emq Nerahan antl tM Em In Ne aYepeO vampion. My videtun d Swion
�m�s M�r eoW� �a e romm a,�ba+�ne e�wa �o. aa v�M a na mae mm r. nu�w�ee mods Rsoop.� �
� I.movmmd�heP�W�YMmyemGM�r.ihwepaantMisolammpeeepun.wLdoUrMak.ukNe�UWu�ee�mieMe!
w onered far aeb (Sectian iou. Bmrm eM PNnums CoEe: The CoNradae Lioema lawEom rw� ew�Yto en ownx d DmVeM
who buiEa a inG�+a I�e�son. md nho dom suM xak h"vnadl a henM a Nraph ho w her own mmWvr�^. p?'!bd �Aa e�ch
imwow�„mu..,. m inimana s amrea �or.e�e. n. no.m... m. debnq «:nw�w o.da wnnin o�w rw a camq+iw,. me
ow�ror-0uilder wip hew tM buNen d V�'�^Y he n Ns Etl nd dNd a imP� In iM WT�e d da). . J
❑ �. a. mm« a ine o�w.m..m e.dum.N mmrea:�a .m, c�mw m+uana. w ommw ms ad� ts.avn �ou. aninm. ene
Vrd»vms Code: TM Cavrxfm L'cww Lew doa rca ePN'1 m en owner d o�W�Y Mu GWd� a i+wwea iM1meon eM Mn
caureaa IIX arl� D�Md� wh e mNr+GMf) fica�nM WA� to ths Cau'r�m li�maa ler�. ��1'
� I em uemq imdr SMior�: B. 8 P.C.. br pn �aeaon: �
JOB DESCRIPTION : ADD 423SF MASTER BEDROOM & INTERIOR WORK SQ FT:
CLAIM VALUE: CALC-VALOE: GROUP OCC: R-3 /
COMMENTS: ADD MASTER BEDROOM &BATH, DEMO TO CON5T. MA5TER BATHRM, ttB74427
******x*xx��tx�***�r�***��**x�****��***��*****��t***�*x***�***+�*+���******�******�***
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT ZN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11734124 ZNE: REF NO:
PLANNING NOTES>
i �
jf 3f 3f 1f 3Elf iE �f iE iE iE ff iE fE 3f iE if 3F 3E 3f iE # 1E iE K if iE if iE j't jE 3F jE iEiE if �7f iE iE iE if * iE 3E {E iE jE iE iE iE iE jE 3E jF 3E # fE 3E ib 3E 3f 3f fE 3E 3f� if 3E 3E 9F iE 3" if if !P 3E iE 3E 3E jE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
� ..
ZONING APPROVED BY ' DATE:
BUILDING APPROVED BY : � DATE:
APPLICATION ISSUED BY: � DATE: �O�III"L\
iEiE3kiFiFiEkiEiEiFiEiElEaElEifiFiEifi4iFiE��i�iF�F�FiF7F���iF�iF�ii-iF�iF�F7F3FiFiFiF7F �iFiFTFiF�i�iEiEiFi4iElE3FiEaFif�iF�iF���$��FaEjE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
I do hartW ean'ily tlW I em ewye d W ivAs�lud iM eeQuirtman d Cellomu HeMh eM Sdery Gods Saaidu 25505, 255]�, vM
255�a, eM Ihei I a e�ry Mun huikinp omqem MiA / wil m� (acb one) neetl to canply wih eeid qaU mEx vM ihe reQuimnaMs Im
epamillammwelionormoElfkmionhomlMAr�y v�epa�0iaria.RnkrYielmWewmeppire�iamene�anqlmn�hew BLDG PMT PLUMBING
aa^•b^° P E RM I T
oe�.: �cc��:
W OPKER'S COYPEN9ATON OKL1P�110N: I Mr�Oy Mtrm �vder psudy d pajuy aw d tlr b0ow'up Jedueiwn:
� I M�a vd wi1 mrmen a Mndiuu d awsru to �Nawns b worksi oonpwupbn. m pwidW I> b� Satlion �)00 d iM lebar
coe., e« �ne e«�omwce d me .an� �u.,fira, Ne wm+ e uww.
� 1 hew eM vril meimen wqhen' mmpemNm imurenu. n re4Nrsd Dy Sep'v� 7ro0 d ihe Lebw Cods. M IM pe'Mmenoe d tAs
wak Ia r.fiiN Mu permn n 6�ued. My Maken' canpmeetian ivureMs urtia eM Pofv.Y m+mMr ue:
c.m.�: cTaTr rrtntn EXPIRES
PdcY Number: � F i�+++- o c O 1/ 01 / 9 6
,h;. ,�,ia, n..e �a w ewnwme � w o.m, a ri. d» ewdr.e dm.,. rsiool o.,Ys,a
� I oer1,Y Nd in IM VM�wita W Ne �rdk tar wtiich Nu 0� e muetl. ml wndW M' N enY mww p m lo
bBCCTB wbjA'! lo IM bYp�' Wf�lflWien la'M M CBNIXIYB. GM Ntl E I tl101dd lo �M wp4D1�
oomV�+a�ion pwu m q /S�aaion �100 d �M lnEa Cade. l NeA lanh �� WI, MU � /AX� I
Deta: 7 Appl'raa: V/!
Weminp: Fallun ro ueur+wq�� rompwwtlon tovup� b vnbwlul, �no �NII uOJlet en xqvloyn ro etlMiul p�neMn ens
clvll Mu up ro on� �,nOrN (lauurtl JaINn /SIOq000A ��Idon ro 1�� ro�f ol rompxwtbM1 Wm�p�� u qovltlW br In
S�ctlon �]P6 0l tlr� LMo� Coy�, lirtwmt �� ��^mry'a /w.
CONSTFUCTION LENqNO ApENCY: I haeby Wum uMm pmelY d pr'Fry tAa Nars e a muteWian bidifq pury b Ne
parlamerce d iM wM1 b�.fiid� Ilu V�Y e ewed (Swion �09]. CN. CI.
LENOEfl'4 N�11E:
LENOEH'9 ADDRE55:
I ceniN �� I heve med iA'n � mion ud vms thm the ebove iMormetian b conatl. I ep�ee �o canpy rmh eA dIY ��nry adiranoee
eM etete levn relei'vq lo buiMip �yyuqion eM MraEy eulnarze �epwntmive� tl ihis cty ro en�m �pon tM ebove.membiwd pioperry
Iw impxfion qupo+ee.
IANNA DONALD
� Pivu N �� n
Dme: �� �� 7
Sro�t�ta N �pNuM�G«u�ae« -
(5t5t.<e W P) WM1ns.BuiN'rq 8 SefetY: d�^-�e: Cem�y-Appicant: Fnk-Revenue: (3olden�o�/usaoor
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE
TOTALS----> 51.05 15.00
ELECTRIC MECHANIC
52.05
SOR
15.00
PLAN-CHECK
�,QD
FIRE SMIP/RES GRADING
SMIP/NON-RES
TOTAL PAID DUE
66.05 66.05 .00
REVENUE DIVISION TOTALS--> COLLECTED; 66.05 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
66.05
iE iE iE if if iE 1f k iE iE 1E iE if if iE if iE iE ik iE iE 1E iF iE iE iE 1E 3E iE fE 9f !E jE if k iF iE iF 1E �E IE iE 1E iE 1E fE 1f ik iE iE if 1f i4 iE fE �f 1F ik iE iE 3E iE IE k�E iE iE IE iF 1E iF 3F iE i! �F aF iE iE jE
I N D I �� I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. .75 15.00
ELE 4 FIXTURES, LIGHTING ADDITIONAL EA. ,45 1.80
ELE 9 RECEPT/OUTLET i ST 20 EA. .75 6.75
ELE 12 RECEPT/SWITCH 1 ST 20 EA. ,75 9.00
ELE 1 SERVICES BELOW 600 V 6 BELOW 2U1 AMP 18.50 18.50
END OF FEES
�1 00±4tE15-0�191314 't'[Qy bb,QS
DAiE: 1�/il/45 �FFf:: 17y:3%
CONSTRUCTION ANOPLANNING
qPpROVALS Permif#
1, ',-emporary Electrical Service or Pole
2. $pil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit�Undrgrnd. �
5. St&el Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe�Undrgrnd. ,
10. Struciural Fioor SYstem
11. ProPerty Sewer Line & House Conrtection
12. SeWer Cap
13. Roof Drains '
74. Rough Plumbing .
15. Rough Electrical•Conduit ,
16. Rough Electric Wiring
17, flough Wiring 5ign �
18. Rough Electrical�T 8ar Ceiling
.
�19. Rough Heatfng & Air Condit+oni�g
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts. Ventilating
23. Gas PiPe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T�6ar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coai
32. Electrical Power Meter-Final
33. Pinal Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe•Test
36. Hood or Canopy
37. Finai Faciory Fireplace
38. Final Plumbing
39. lNater Service�Final
40. Gas Service•Final
41. Solar pomeStirFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape IrriQation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAI PLANNING
qg. Electrie Release to Edison
50. Gas Retease to Southem California Gas Cc
51. CERTIFICATE OF OCCUPANCY
Da[e
Date � Inspector
0
�.;
POOL PA
APPROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit�Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P•Trap, O Undrgrnd.
67. APPROVAL TO DECK I
62. Backwash & Receptor�Final
63. Heater & Vent�Final
64. Plumbing System � Final
65. Electrical�Final
66. Solar System-Finai
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOUSPA SYSTEI4IS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
1t. Product Pipinq �Gas ❑Oil
72. Unde�ground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
�6. Ory Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Date Ilnspector
♦DDNE44KBIALOPq: 481 E 19TH ST
°�""Ale"'WEi°�"°w": NELSON, SCOTT
ADDNE89: P � BD}( i l z 5
NEWPORT BEACH,CA
uv�. uuwa �ooxess:
AIiCNIfECT OP FNdHFEP:
uNT:
92659
uc xo.:
uNr:
COHf""tT0"�'"""� NEWPORT ROOFING ( 714 ) 64 5-0109
CORN�CTOReYY1D10 177 RIVERSIDE AV
A0°"E'x NH CA 1CN0= 524454
92663 uM:
LICENSEO CONTfl�CTON4 OECL�R�TION: 1 MMy elfrm uiWr pmely d paryry Net I em lime�tl under pwi�oro d Cheper 9
(mmmenavq rmh Sactian ]000) d Oirivion 3 d tM Bu�ev end Pmtm�iorm COEa, erd my tirema u in IUA brca enE alled.
cmf+�no.:n��48� uc.cuss: C039 uc.No.: qq54 EXP: 06/96
�la J r � .4 � ��.�
� bWqEfl BUILDEfl OECL�fl�TON: I Miaby Mum rom tM Corpretlan Lioen�e lew la IM
ibl�ov.+iY �aum (SWion )03�.5 &une�a and Pedemu�+ Cads: A^y m' a aoWY MUN �oPmw a V�u lo oonsWct etla.'vnqw+.
�md'eh, a roDei eny ewnwe. P� b b'nwaro. ebo nOw�m Na eGP�N la aM V�v �o fJe e mP� qeleme�a Nu M a ahe
icanaed W�� �o �M Pwuioro d tla Cwv�amn liowa law IChaPs 91��q xith Saaion'l000) d Owubn � tl ib
mma eM Rdeaiom CoCe� a �M he n tlr e memq IM1aehan end IM b� la IM eb0� munqion. MY videlbn W Setlbn
"l031.5 by enY aPO�� In e permu eiAjeCa IM eppfrsm to e avi penaEy tl mi mva Ihan fxs Awdred doAv+ �55Wp.
❑ I.noxinrMiMPW�Yum�'mipv�Suxthw+W+nNrsolewmD�+d�:wYEotlrv.ark.eMths�inrlureem�m�aMd
impovemeNs me nd uva�dad a a11aaE la sab. o. lwa�v. ilr hnlCvp a mpw�emM u wq w41w ans Y� d aompletun. ilia
o�.a�u.� w n... ine d,.a.� d c�+ro n. «.n. m oa aua «�o� ea m. ama• a.w�.
❑ i.mo.m.ain.aw.m.��awwr�rom:a.wco.o.eoo„n.�,a.rooamm,dm.aa�tseamra..e�.:�.�e
Pmimaan Cade: The Cavratlon li.w� law dom m� eDMY b en owiw d PWMY Ma dnlm a inpw�+tharaon end Wn
wwacn br arn Y4�+ xah e mnrodula) ficensod V�+� w IM CatlrrJa� Licws LeW.
� 1 em e�emq unCr Sec�ion: B. 8 P.C.. br p's naaon:
Dete: �
� eo n«enr �.nM ma � an er+ere a.m wd..w�e me re�uw.m«w a ceoomi. Hseen.ne serotv coe. see:�n. zsws. usaa. ene
255]�. enA Ntl I a miy Mua G+�ldin0 �P^^� wdl / wil rc� (mcb aw) naed �o oamGN xtA v'd mta oode� md �Ae nV�o�ams b
e Da� lamenwniona�'v�tromNe I�i�^^^Y^^pq Oiqritl. M�kW alamq'utlian MV�iaroanssanq Imm Ihua
aw;,�,..
Dma: �Vo��:
WOPKEP'S COMVEN4ATON OKIAP�TION: I MrWy ellnn wdar prWy W prbvy w d N� IoOormq MdeiYiom:
�. � I�maaM�wlmeiNenedNlicYSMaonwXloutli�valawkas'mmpanWon.uVwiEaEla�VSaUian�)OOMIMIeba
ced.. �« me c«��. d u» .w i«.uen w. v� � m�.d.
i ne...�e wi� me�mv�.one.• oomo�on m.N.a.... �.mA.e M s«yo, a�oo d me �ee« coee. �« me w�am� a m.
wak la w1iiM Nu 0�� u u�usd. M' worFen' mm0a�ion Lwraic� finiar aM V�Y m�mber ue:
�°'"" a^TT�TC FUt+lD EXPIRES
Pd'ryNumDer. }8�6�_^& 9� 07/O1/96
I Iris sMia+nW m� De romdKeC / �M Po�l ia M ms AwMM doBsie Rt00� n Nn.l
❑ i wnh �nm in ur o«ia�,urce a in..�aw w wniu, mi. o� �:�e. i wu m anpw .m o.�.� �.m m�« .o m m
beeane wCjea �o iM wclpn' canpruaion bw� d CaLlan4, uM epma Nm G I MwM becama �ubpa to IM woheri
� i � v� ( z+ �oa�n:
F�llun b ucvn roikwi rompwu� b unNwlul, ur • n�wper.n.myror« ro cmm�.� v«uitlss mn
up ro an� �,ntliM fleua�nL JWNn lSf00,000A M�/tbn ro M� cwf ol rompriufbM1 Mmspu �� pravMW br In
CONSTRUCTION LENDINp GQENCY: I hweby elfrm under panaly d perjury 1lui IMrs u e mnn�bn Wdirp epency la iM
perlormwa d IM v.vrk IIX whiN IM1u peiml q'vwed (Ssqion �OBJ, CM. CJ, ,
LENOEH'S NMIE:
LENUER'9 ADOqE94: '
1 cenity tlui 1 heve reed ihia eppficmian xM pei� Ihet IM ebove inlormdion ie comq. l epiee to comply xiih eA Uy end county oNinencee
end �tae lew� eNeiip io WiM�q conprupion eM IwWy vnhoe¢e �epmaMeMm d �he ary to ama upon tM eEwe.memioneE propaM
iwinapaeion purpoeea.
CESAR ALMEIDA
�7�� i/%2�/�
""� oma:
� �__....._�.a. �a �.—���
I L�
�
� (5151d8.WP)
WAns-BUJdep 8
Rnk-Reverwa; (3ddervo�Masvor
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 075380
PERMIT NO: B 075380 PLAN CHECK NO: N GOVT:.N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF 6 REROOF W/MED. SHAKES SQ FT: 5,100
CLAIM VALUE: 5,100.00 CALC-VALUE: 5,100.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS ARE RE�UIRED IN EVERY HEDROOM 6 HALLWAY
*x�**+ri�rt�tx�t*�x�i�******x-*�x-*�t�-�t*x��r�r* *�r***+�i��x-ft-*�rx�**��t��*�r�-fex�i�**+��tx�+t��ri�**�tt�***i�*x�***�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT' IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: -" PROV: PARCEL: 11734124 ZNE: REF NO:i
PLANNING NOTES> T
i �
iE if if if iF iE if iE 1f iE iE 1f iE iE if iF if if 1E if iE iE iE iE iE iklf iE 1E iE 9ElE iE iE 3E jE 3E iE aE 1E IE iElElf 1E iE iElf iF iE 9E 3E aF IE iE ik iE iF iE iE �E if i!� 1E 1f if iE iE iEiE iE iE 3E iF 1E iE 1ElE 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
j� %,
ZONING APPROVED BY DATE:
� ,
BUILDING APPROC;ED BY : DATE:
APPLICATION ISSUED BY: " DATE: I� Q Q�
*��***�****�**�****�** *�***u�**��4/ Yr` .�# ^
LEGALIZATION:N � F E E S U M M A R Y STRUCTURAL S GMEN :Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 81.00 .51
SMIP/NON-RES
PLAN
ISSUE FEE
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 81.51 0.00 0.00 81.51 81.51 .00
REVENUE DIVISION TOTALS--> COLLECTED: 81,51 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
81.00 .51
1E 3E iE aE 1F iE 1E 3E fE aE 3E jE iE iE 1E iE aE fE aE 1E IE iE 3F aE IE if aE 1E iE k iE iE iE iF iF iE iE iF iElE iE 1E if iE 3E iE *!E �f IF IE iE iE 1E aE 1f if if iE iE iF jE aE 1E iF iF iE aE iE IFlF 1F iF if 1E ik iE IF if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N CTNI� CO,�ST TOTAL COST
SFR 5100 REROOF HY VALUE REENDEOFIFEESNOZONE "P�6�9��� �F��Z'9��¢�
.. REQUIR�B rs
.• .rns�M/
U1 Q019`eF]-001�5?5? Y ��.-: .�! .
4�RTE: SL tr: ,° lIii�e C�:1_y
`
.
POOI PA
� CONSTRUCTION AND PLANNING ; �
� APPROVAIS Permit# � Date Inspector pppROVALS Permit�p � Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2, $pil Pipe-Undrgrnd. - 53. Steel Reinforcement �'
�
3. EleMrical Conduit Utitity�Und�9md. 54. Forms �- �
r
4. ElBctrical Conduit�Undrqrnd. � 55. Electrical Bonding " ,
5. Steel Reinforcement 56. Rough Pium6ing & Pressure Test �
6. Electriwl UFER Grnd. 57. APPROVAL 70 COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. .
8. Foundation � 59. Gas Pipe, � U�drgrnd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Sttuctural Fioor Svstem �', 61. APPROVAL TO OECK ' �
17. ProPerty Sewer line & House Conneclion 62. Backwash & Receptor-Final'
12. Sewer Cap 63. Heater & Vent-Final �
� �
13. Roof Drains � 64. Plumbing System � Final �
14. Rough Plumbing 65. Elect.ical�Final
15. fiough Electrical�Conduit 66. Solar System-Final �
16. Rough Electric Wiring � 67. Fencing & Access Approval �
17, qough Wiring Sign 68. APPROVED FOR P�ASTERING
18. Rough Electripl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
59. Rough Heat�ng & Air Conditioning F1RE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ouccs, Ventilating � - 7}. product Piping OGas OOi1
23. Gas Pipe-Rouqh & Test 72. Undergro�nd Flu:h
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing C�3p1� � 74. Overhead Hyd{o
26. T�Bar Ceiling (Stracwral) & Monocoat 75. Dry Chemical
27. Fr9me and Flashing 76. Ory Sta�dpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. �nsulation 78, FIRE PREV. FINAL
30. Orywall Naifing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FiNAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CEiiTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe•Tes[ �
36. Hood or Canopy
37. Final FaMorY Fireplace
38. Final Plumtring
39. Water Service-Finai
40. Gas Service-Finai
41. Soiar pomeStioFinal
42. BaCktlow Preventer
43. BaCkflow Irrigation �
44. Landscape IrriGation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINAlSTRUCTURE&BUILDING � _7 q/� ��..��':
48. FINAL PLANNING -
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCV
No Date ,
� � - , Aop���ant to /ill In a11 spaces exeeD� ihosa wlthin neavr portler Iines ane sign a11 aoVropriata aeclan4ons.
CIjY OF COSTA ME� / COIj�S�R U TI ON PERMiT PERM O. - TRACT NO. LOT NO. UNIT NU.
, yY, i��f: � 3//53
Project Address
Applitant'S Mailin9 drCss TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
v R '❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P,N,
Owner'sName �—Phone .DES�RIPTIPNQF��VORK/IfSEOFBLDG. U� 'L ��
Address -j� � � - - M ' 8 'Id'
Arch/Eng. License No. '
Address /
Convacmr'sNam � £ GB/ o o J���
Address Ima ����� ��� ��% ,� � ��
Ciry License No. f5 a, 6� ��%
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am Ilcensetl under ovisio t Cna r 9(<ommentlng
wi[h section �000) of Dlvision 3 of t e usin ss ntl P ssions Cotle, antl
my Iicense is in fury (or e a ttect. ;
��e�=� ,_ �.—?° : - � No. 6
Date � Si9nature '
WORKERS'COMPENSATION DECLARATION
nereby affirm [hdt I �ave a certitiwCe'of'consent o self-insure or a ter�lficate
Work¢rs' Compensatian Insu�ance; o( a ce(.I�ietl WpY the�eat ($¢Ction
.d00. Lab. C.) "- _ �
Policy No. 'Company
eCertifietl copy is hereoy lumishetl_� .
Certitietl mpy {s fil¢tl wlth tne city BJiltlin Divislon.
Date �Apolicant =
E%EMPTION FRQM WORKERS' COMPENS ION CLAR TION
(This section neetl not be completeA if>the pe m t is (o retl (E100) or
less). . •
I cerlity [ha[ in lq¢ Petformante ot tfie wOr t r whl h 5 it ISISSuetl, I
shall no[ emolov anv o¢rson (n anv mann r a as e bie<t fo the
Dale •/-//- 1L� S�9nature '
NOTICE: Ii, after making this Eeclaration, You s�aultl b �m subject to the
Wo�ker5' Compen5atlon proWilons o( the 12p� Cotle you must forthwlth
comply wifh 5uc��yH510ns or thi5 pe�Aitt Shall e tleemetl tOvoketl.
CONSTRUCTION LENOING AGENCV
I hereby afOrm that ihere iz a construction lentlin9 agen y for the pertormance
of tho work for whic� this permit is i5suetl (Section 3097 Clv. C.)
LpntleYs Name
Lontler's Hatlress
OWNER BUIL�Ep UECLARATION
I hareby afflrm that I am ozampt trom [he Contrac[or's Licenso Law for the
followin9 reason [$¢ction 7031.5 Busineis antl Professlonal Cotla: Any clty or
county whiCh �equires a Oermit to co05truct, alltr, Improve, tlemoliih Or �apdir
anv strut[ure, Prior to ils Issuanca, also reqWres lhe applicant tor suc� pormit
to file a Si9netl Statemanl Ihat M19/She Is Ikansetl pursuant to th8 ProviSiOns of
�the ContractoPs �iconm Law (CM1aD�er 9(commencing with SecHon 7000) ot
'�IvlSion 3 0( the Bu5lnoss antl Profe55ions COCa) or Ihat hC/sho is eXempt .
erefrom antl lho basis for the alle9ea exemptlon. Any violation of 5octlon
/31.5 by any applicant fo� a Pe�mit SUbjoct5 Ine aOP���dnt lo d Civll
endlty 01 not mOre lhan ilve huntlretl tlollars (5500�.
� I, as owner ol thn pr000rty or my empbyees with wa9es as Iholr sol¢
comoensation, will tlo the work, antl the structure is not intenCetl or olferetl
for saln (Section 7044, Business antl Professional Cotle: The Contrac[or's
LlcpnSe Law doe4 n0l apply to an owne� 01 a prOpe�ty who bulltli Or Imp�OVCs
thereon, and wh0 Ooes suc� work Nmselt/hcrseH or tnrough his or her own
¢mploy Ces, prOvitletl thdt such improvem¢�ts are nOt int¢ntl¢E or ofto�etl for
salo. If, nowever, {ho bulltling or improvem¢nt Is soltl wit�in ona year of com-
plCtion, the own@r will have tbe buttlen Of provin9 hC/she tlitl nOt builtl Or Im-
�rOve tD/ [he purposc ol Shce�.
I, as owner of tne D�operty, am ezclusively conVacting wlth Iiconsed con-
Uactors td consV Uct the oroject (Section 7044, Businass antl Professlons Cotlo:
7he ConVactor's Llcanso Law does mt appty to an owner ot property who
builtls o/ Improv¢s lhereon, antl who <Ont�acts fOr such projecl5 wlth a con-
tractor(sl �icense pursuant lo Ihe Contractor's Llcense Law). 1 am aware tnac
ptoo/ o( lneir Work¢r'S COmpensation in5urance Shoultl be provitletl t0 me.
❑ I am exem"pc u� er ctlon—J--� B. 6 P. C. tor thi5 reason
It.
Date
1 state Nat the above
antl countv ortllnances
e
SignaWre � \ 1\Y/
Drivers' License or 55 �
TYPEOFPERMIT�i_w/LI GRADING LJ FOUNDATION LJ STRVCTURAL
❑ TENANT LJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PR0.IECT DESCRIPTION Sq. FT. oCCUPANCv_
C O N STRUCTI ON TYPE V ALUATI ON S
GRADINGCU.YDS. ACRES_
Remarks:
8ar Sink
Backflow Preventer �
Backflow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspaction Fee � $15
Duct- Under Ground
Duct - Structural
Dutt - Ventilating
Ezheust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0�100,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, r¢v. 30�84 Whlte - Buildin9: Canary - ApPlicanp Pink - q«ountin9: GoltlenrOtl - q55e550r
Showers
Service Sink
Sewer Cap
Sewer Cannection
Solar Collectors �
Solar Pipin9 �
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type l l ❑
�eration System
OO,OOOBTU ❑7p0,000
System Repair/A11Lri4i� � �
Fire Damp�COmP e
Registers � �
ae _-----
Iswe Fee
$ 3
S 3
S am w i
E
T Front
B Fear
A
C Fight
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Garboge Disposal
Generator �0-S KW
9653 II/17/87
Zone
Parking Req./Provided
ELECTHICAL •
Trans(ormer ❑ 15-50 KW
❑ 50+KW
Meter up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �U7 HP 07:4 - B
Inc.Solar �9�15 HP �1615+
MicroWave
Pole Liahc
Sign
Standing Sections
5 KW Trash Compac[or
� Rainspection Fee I$15 � � Issue Fee
DEVELOPMENT SERVICES REaU1REMENTS:
Zoning Approved By
.Building Approved By �
Application Issued By
SUMMARV OF FEES
BUILDING PERMI7 $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% S ENERGY P.C.
ELECTRICAL g � GRADING
PLAN CHECK 50% $ MICROFILM
yMECHANICAL g
t TOTAL FEE
PLAN CHECK 25% $
$
15,00 TL
FEES
S 3
S
5
s
$ •_ �
Z
O
N
I
N
G
R
E
�
M
T
s
�CONSTRUf,TION AND PLANNING '-' ti� t' -% �-y = POOL & SPA
�APPROVALS Permit # Date. •:ynspector App�jOVALS Permit # Date Inspector
• '
i; 'iemporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Condui[ Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Tett
�r
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 & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
.
16. Rough Electric Wiring /� �. , 67. Fepciqg_& 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. REQUIRER�NT f
20. RoughFactory`Fireplace APPROVALS Permit# �� _ "�
�,
27. Ducts, in Structure 70. Underground Hydro ,J- � �
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush y �
24. Roof Framing 73. Undergrnd. Storege Tank O,Gas ❑ Oil
25. Roof�Sheathing 74. Overhead Hydro �f_ Y
C-• r%
•.26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �� r�
27. Frame and Flashing 76. Dry Standpipe 4 `
Y
28. Lathing & Sidin9 77. FIXED SYSTEM FINAI;,.� , �
29. Insulation 78. FIRE PREV. FINAL �. � j
30. Drywall Nailing HEALTH DEP�.,REQUIREMENT ,�, '� �
31. Plaster Brown Coat 79. FINAL INSPECTION %f,1�i j "✓ ,�
32. Electrical Power Meter-Final 80. FOOD CEFTIFICATE ISSUED `' (�
33. Final Electric S� Notes: ��� Y'� ���pt, �� � I
34. Final Heating & Air Conditioning
$/' �kw{1� 5. � %� Wf' i
35. Final Gas Pipe-Tes[ �
36. Hood or Canopy ' '
i
37. Final Factory Fireplace ���
38. Final Plumbing � ,
39. Water Service-Final �� � _
. • 40. Gas Service-Final - - �
_ , �
�.41. Solar pomesticFinal - � _� �
�
:: 42. Backflow Preventer , �. - f�� " '"
i (� �s
� 43. Backflow Irrigation "� E X P I R E D'.' ' �: ��* . -
44. .Landscape Irrigation System ncompl te Inspections �;�' � '' ,;;., ,
45. Sound- Atienuation te "[ � ' �
$I �i :
46. Handicap Regulations � '�' -' - -
� � , �,•
47..PINALSTRUCTURE&BUILDING ,ij ii i_. , � ' 't'�
i L ��:
48�Special Requirements Completed "
••.... �
49. Electric'Release to Edison .i ' �
�
50. Gas Release to Southern California Gas Co � "'
i
51. CERTIFICATE OF OCCUPANCY
No. Date . '
Appllcant to fill In all spaces extept thase wlthln �eavy Dorticr Iines anE si9n all apD�opriate GeclaraLions.
CITV OF COSTA SA C.O�N`S CTION PERMIT ' PERMIT NO. TRACT NO. - LOT NO. UNIT NO.
Projec't llci'dics} I� �q 1 fl �
Applicant'sMailingqddreu � �
Owner'sNam�_���sd Phone
Addreu I
Arch/Eng. L'rcense No.
Address
COn�ractor's Nam PhOne
Address (mA'�'��� -
City Licenu No.
LICENSED CONTRACTOR DECLARATION
1 herlby aftirm lhat I am IicenSEtl untle� proWSiOns ot Charter 9(ComTancln9
wltn section ]000) of Division 3 of t�e B�siness antl Professions Code, an0
my Iicense is In iull force antl efiecl.
Licenze Class License No.
Date Si9nature
WORKERS'COMPENSATION OECLARATION
I hereby aitirm that 1 have a certificate ot conzent to seHtinzure or a certiilcate
�� Workers' Combensation Insurance, o� d certifled copY tM1ereOf ($ecHon
300, Lab. C.7
olicy No. Company
8 Certifietl copy js hereby tu�ni5hetl.
Certifietl copy Is tiletl with the city Builtling OHision.
Date Appiicant �
EXEMPTION FRqM WORKERS' COMPENSATION DECLARATION
(Thi55ectlon neetl not be complated II the ptrmit is to� one huntlr¢tl (b100) or
Iess).
I cerlity Iha[ in [he pet(ormance Of Ihe wor tOr w Ic this ¢rm�l is lssuetl I
shall not e plP y� any person in any man o < e zubject lo t�t
Worke� ' 1��tion Ldws ot CalifOmi
Dat Y 99�aWre
NO ICE: 1, a ter making this tleclar lon, ou s ou become subject to tne
Wo�ker5' Comp¢nSallon p�ovl5ion5 of tM1e I,yb C tle, you muzt fortttwilh
comply wi�h such provisions or this p4rmlt shall be aeemetl revoketl.
CONSTRUCTION LENDING AGENCV .i -
1 hereby afllrm �hdt lhere is a coniiruCtiOn 18ntling a9ency for tne parformance
01 lho work lor whicb tbis permit Is Bsuetl (Sectlon 3097 Clv. Q)
Lantler's Name
'Lontler's Atltlress
OWNER BUILDEq DECLARATION � �
1 haraby alfirm ihat I am ¢xampl from Ih¢ COntracror'S Llcenso.Caw ior th0
tollowin9 reason ($action 7031.5 Buslne5t antl ProfeSslonal Cotle: AnY clty or
munN whlth reauires a oermit to con5[ruct. alter. ImDrova. tl<moll5h pr mpali
to
�31.5 by any appllcant tar a permit subjecti the applitant to d civll
nal[y ot not mqre than five huntlrotl tlollars (5500�.
..J I, as owner q( the praperry or my ^^- ^^s with wagas as t�uir soia
componsation, wql tlo tne work, anC Na structure Is not intentle0 or o(ierotl
ior sala (Soction 7044, Bu5ine55 antl PrOfessiondl Cotle: The Contrdcto�'S
License Law tloeg �ot ap01y [o an owner a1 a Oroperty who bulltls or ImDrovns
thareon, antl wnp tloes such wo�k nlmsetl/hersetl or tnrou9n his or hor own
¢mployoes, prOvitleO tha[ such ImprovOments arC not intentletl or oHeretl tOr
salo. II, howovar, [he Dulltlin9 or improvament Is soltl within one year o1 com-
O�etlon, tno own4r wlll have tna burtlen of provin9 he/sne tlitl not bulltl or im-
prove for tha puroose of sale). � .
❑ I, as owner of {he property, am excluslvely contra<ting wlth Ilcensetl con-
tractors to conslrUct the project (Sectlon 7044, Business and Professions Cotle:
Tho COMractor's License Law does not apply to an owner ot property who
builtls or Imoroves ehereon, antl wno <ontracts for such Drojects witp a con-
Vactor(s7 ❑cense pursuant to the ConVactor's License Law). 1 am aware lhat
prooi o/ th¢I� Worke�'s Compensation InSurance ShoulE be provltlatl to ma.
❑ I am exemot untler5eotion n.—�--,..-� B. �. P. C. for [his reason
Date
Si9nature NIV�
Drivers' License oi55
Owner
have r¢a
aDove
iances
repr0-
V fOf
P3t242- I I I
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF VERMIT IJ GRADING _ L�J FOVNDATION U STRUCTURAL
❑ TENANT ❑ ELECTRICAL j ti� PLUMBING ❑ MECMANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.�FT. oCCUPANCv_
' CONSTRUCTIONTVPE VALUATIONS
ZONE GRADING CU. VDS. ACRES_
Remarks:
Sink
Preventer
Irriga[ion
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspettion Fee
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Swimming Pool w/Spa
Urinal
Outlets Wacer Closet
Water Heater
Water Service
Auto�Wesh
$15
Duct- UnderGround
Duct � Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Hea[ing System & Ducting
❑6100,000 BTU �100,000
Reinspection Fee � $15
CMF 0865-46, rev. 30/B4 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrotl - qssessor
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigerotion Sys[em ,
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
S 3
$ 3
A.P. qW
S Main Buildi
E
T Front
8 Rear
A
C fiight
K Left
S
Ping. Ref. �h
Planning Notes:
Automatic Washer
Construclion Pole Su6.
Cooking Unit
Dishwasher "
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00.5 KW C
Fee
9955 II/19/B7
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL �
Transformer ❑ 75-50 KW
❑ 50+KW
Meter �up to 100 amps
Meter ❑over 100 amps
Sub Panel
MotOrs �67 HP � 1'/a - 8
Ina Salar �9-15 HP �16-15+
Mioowave
Pole Light
Range
Stantling Sections
5 KW Trash Compactor
$15 luua Fee
DEVELOPMENT SERVICES REOUIREMENTS:
Zoning ApProvad By
Buitdin9 APProved BY
_ r
15000 TL
Z
- O
N
I
N
G
R
E
Q
M
T
$
FEES
$ 3
SUMMARV OF FEES
BUILDING PEFMIT S SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ � � O� ISSUANCE S
PLAN CHECK 25% 5 ENERGY P.C. $
ELECTRICAL $ GRADING 5
PLANCHECK 50% $ � MICROFILM $
MECHANICAL $ TOTAL FEE $ � �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1'. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � .
3. Electrical Conduit U[ility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd-. 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Fioor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final .
14. Rough Plumbing � � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
i6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTER�NG
18. Rough Electrical-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 Struaure 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling �Structural) & Monocoa[ 75. Dry Chemical
27. Frame and Flashing . 76. Dry Standpipe ��
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •
33. Finai Electric Notes: �
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test � " � • � ' .
36. Hood or Canopy '
37. Finai Factory Fireplace � :
38. Final Plumbing �7 � � -.
39: Water Service-Final i
40. Gas Service-Final
41. Solar pomestic-Final - '
42. Backflow Preventer . �"
43. Backflow�Irrigation ' „ . ,
.�44.�Landscape Irrigation SYstem � � _, , _.
� 45: Sound Attenuation ' ' '
46." Handicap Regulations ' �
47. FINAL•STRUCTURE & BUILDING ,` �
,:.
48. Special_Requirements Completed "
�
49. Electric Release to Edison � `F
t
50. Gas Release to Southem California Gas Co ' i
51. CERTIFICATE OF OCCUPANCY
No Date
�