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PNr�'' ycr aooxess: 3 6 5 �_�� J�°``�• ��'� � uxiT:
OWNEfl'S NpME: NOT AVAILABLE 6� V�'^%' r-�'�'�'�
AOOpESS: 5��-�',
AHCH/ENGINEEfl:
AUOflE55:
flEG.NU.:
UNIT:
PENMITTEE: �AIR ROOFING, INC. (714)637-0239
aoosess: Z390 AMERICAN WAY
ORANGE CA 92665
LICENSED CONTBpLTOB DECL1Bp710N: I hereDy allirm ihai I am licensed unUer Drovisions ot Chapter 9(commencinA wiih Section
7000� ol Division 3 0� Ihe Business antl Ptolessions Cotle. antl my license is in lull force an0 effec�.
cirr ut.: 0� 5 3 6 sTere uc.: 2 612 21 cuss: C— 3 r ^
Aaie: _� Signawre:
WONNEBS' MPENSA ONOECLABRTION: I�erebyalfirmt�at aveaceniliuteaiwnsemtosetl-insurearacertilicateolWarkers'
Compensa�ion Ipyu���of ��itiea,5qpy Nereai �Seciion , LaG. �).
POLICY NO.: V 1 t3 7 E P. URTE: U 5/ 01 / 9 2
carnrauv: STATE FUND�y
' � CenilieA coD is hereby Wmishetl. L9 Cenihea copy is lilea with tAe city Builain 'ivision.
�� ��
Oate: Fp0licanL
ENEMPTION flOM W fl S' COMPENSFTION OECIABATION: (T 55eciion necd no16e tomDleteO il the permii i51ar one hunOteA (5700� or less).
I cetlify t�at in I�e Dedorman[e oi I�e work �or whic� Ihis pe ii is iSsueU. I shall nol ¢mploy any person in any manner so as to Oecome
su�lecl lo I�e WorkerY ComOensalion Laws o� Calilomia. ,
Oaie: Signature:
NOTICE: II, alier making Ihis Ceclaralion, you s�oultl betome subjeq ta Ihe Workers Compensa�ion provisions of I�e Labor
Cotle. you must fanhwiin comDN w��h sucn o�odsions or inis permit shall Ue deeme0 rewke0.
CONSTPOCTIUN LENUING RGENCY: I �ere�y alfirm Iha� Ihere i5 a tOnSlrutlian lending agenCy lal Ihe peAormante o� �he work �or
w�ich Ihis permil is issued (Seclion 3097, Crv. C�.
LENOEfl:
aooness:
OWNEN BUILDEN DECL4NATION: I here�y allirm Iha� I am exempi �mm Ihe Con�ractors' State License Law �or �he �ollowing reason
(Section 7031.5 Business antl Pmlessional Code: Any cily ol coun�y which r¢quires a permi� �o cons�mct, alief, impmve, tlemolish, or
reDair any slrucWre, Drior to ils issuance, also requires ihe applicani for such permi� �o �ile a signetl s�a�emenl thal he/she is IicenseA
pursuam m tne pmvisions ol ine Camracmrs' S�ale License Law (Cnapter 9lcammencing witA Section 7000) oi Division 3 of Ihe Business
an0 Vrolessions Cotle) or I�at �e/s�e i5 erempi I�erelrom ana I�e 6asis lor ��e allegetl exemption. Any violaiion o� Seciion 7031.5 by
any aODlicantlor a permit 5u01eci5 Ihe a001icanito a civil penaliy al no� more than hve hunAreJ Oollars (E500�.
I. as owner ol t�e propeny or my employees wilh wages as t�eir sole compensation, vnll do IOe woM, antl the
❑ slrucWre is not intenEeG or oltereA lor sale (Secimn 704a. Business anE Prolessianal Code: ihe Canlracmrs' Sta�e License Law
Ooes nni app1Y lo an ownei o� a prop¢riy wtro �uilOs or im0�ovu �hereon, antl wha Do¢5 SUth wOrk �imi¢if/�er5ell 0� I�muA�
hi5 Ot het own emD�oyees. O�oviCed �hat sut� impmvemenl5 are no� in�¢n0¢0 Or att¢retl tor sale. I�, �Owev¢r Ih¢ Ouilainq ar
impmvem¢nl fs 5010 wiihin ane year ol compl¢lion. �he owner will have Ihe �mUen ai pmving he/s�e tlid not builE or impmv¢
lor ihe purpose al sale�. . , '
I, as owner oi t�e pmpeny. am exclusively contraciing vn�� licensetl conVac�ors �o wnstmci Ihe pmle�� ISeclion 70dd, Business
❑ ana Prolessions Code: i�e Comracmr5' Staie License Law Ooes not aD01y to an owner of pmperIy w�o GuilEs or improves tAereon
antl who coniracls lor suc� pmlecls with a Coniracror(s) license Oursuan� lo Ihe Canttactors' S�a�e license Law). I am awar2
I�al praol o� I�eir Worker'S Compensalion insurance shoula Ge pmviUeU Io me.
� I am erem0� unUer Setiion: B. 8 P. C.
lor Ihis reason:
Oare: Ownec
I tlo heieoy cenily t�at I am aware ol and untlerslanU Ihe requiremems oi Cahbmia Healih anA Safery Cade Seciions 25505. 25533, and
25539 ane Inat I or any future Uuiltling occupant will/will not (circle onq need to comply wi�� saitl state cotles antl Ihe requiremenis tor a
p¢rmil lo� mnSlmciion or motliliCaiiOn Irom I�e Air Oualily Managemeni OislriCi. Fe5i0eniial ton5tmt�i0n appliCalions afe exemp� Irom
I�ese pmvisions •
Oaie: ApPlican�'.
I here0y cetlily t�al I have reatl��is application antl state��al Ihe a�oveinlorma�ionis correcL lagree to comply wilh allciiy antl counly
ortlinances anU slate laws relaling to Duilding conslmclion antl herehy aut�ar¢e reD�eseniatives ol t'., city to enler uDo� Ihe abOve�mentione0
pmpeny lor'•' .clion PWP es.
Oale: . / Signalure' �
ori�crs menseo�sod secudry/ . �
164n06 Wnite—B'�iaing; Grean—Cotle EnlorcemenL Canary—Applicam; Pink—Revenue; Golaenrod—Assessor
l
CITY OF COSTA ,MESA — BUILDING PERMIT P:'RM NO; B U53441
PERMIT NO; b 053441 PLAA1 CHECK NO; N GOVT; N,SUPP: N
CONSTRUCTION TYPE: V—N PERN,TT TYPE: STR PURPOSE; ALT
JOB DESCRIPT'tON ; T/OeF REROOF W/BUIL'f [JP SQ FT: 2,700
CLAIM VAL'JE; 2,200.OU CALC—VALUE:
2,200,00 GROUP OCC; R-1 /
COMMENTS: BiDG. 1 HAY VIEW TERRACE •
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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 ---------- --------- ACCSSSORY BUILDING ---------
FRNT; FT IN REAR• rT IN FRNT: FT IN REAR: FT IN•
LEFT; FT IN RGHT; FT IN LcFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 00000000 ZNE; REF NO;
PLANNING NC�TES>
>
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D E V$--I, O P M E N T S c R V I C E S R E Q U I R E M E N.'T S
ZONING APPROVfiD BY DA1'E:
HUILDING APF�ROyED BY : DATE; f
APPLZCATION ISSUaD HY� �- � DATE• ��/��
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#F ik 1f iF if N� 3f iF �F 1E 1E 14 k��F fF iF # ie ii� 3Eli* i't iFlE 3'r iE fE i'r ik 1f fE iE k iE iE if iE if iF if 3F!(� if ik ib 3F 3f iF iE iE iF 1f iF aE �k iE 1E iF ii� iF i't if ie �lE �E iF if i'r ir+e iE ii� ?i iE 1F 1P iE it 7(�
LE:GALIZATZ013;N F E E S i7 M M A R Y STRUCTL3RAL SEGMENT:Y
ELDG PMT PLUNHING ELECTRIC MECHANIC FIRE SMIP/RE§-' GRADSNG
PERMIT 54,OU SMIP/NON-�ES
PLAN ��<�
ISSUE FEE i
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID ' DUE
TOTALS----> 54,50 0,00 0,00 59.50 54,50 � ,00
REVENIIE DIVISION TOTALS--> COLLECTED: 59,50 OVER/SHORT: 00
BLD54P00 PLUNBING ELECTRIC NECHANIC FIRE SMIP/TO�T GRADZNG'�•PLP.N—CHECK
N
iE it Iklf 1f ii 3E iE iE 1h iElEif if IE ie af ►1E 1f iE iE 3f i! ii� If -1F iE If fi: iF iE it iE if iE if if i't 1E i6 if !E if' iF ii� iE 7F 3e iE 3: iF # 7E i!� if #F 1E iE �E iE ff 1i�!f 1"t ir IE if if if #f?i?f i(' if iF 1E iE 1f
I N D I V I D U A L F E E 3 R E A K D O W N �•'
.�
TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST
SFR 2200 REROOc HY VALliE RESIDENiIAL NOZONE 1.00 3,200.00
EA?D OF FEES �, „
/ /•2:
f.l 4
�t
Q: COOi4?98-00094999 T'�C1'�" 54.SG
DRTE� Q8!19/41 iIfiE: 1D:22
CONSTRUCTION AND PLANNING � POOL .PA � ,
t APPROVALS Permit # Date Inspector AppROVALS Permit # Date inspector
n
1. Temporary Electrical Service orPole ° j' 52. Pool & Equipment Location �' �
,- . i'i
2. Soil Pipe-Undrgrnd. i', �; / 53. Steel Reinforcement ':/ �
�i ,✓
3. Electrical Conduit Utility-Undrgrnd. � �� 54. Forms �"
4. ElecVical Conduit�Undrgmd� �� - 55. Electrical Bonding i� i
�
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE
7. Footings . 58. Electrical ConduirUndrgrnd.
8. Foundation � y ��� 59. Gas Pipe, O Undrgmd., Test ��'
,9.,Water Pipe-Undrgrnd. �� � '�' 60. Backwash Lines, P-Trap, O Undrgrnd. � =:y
A
10. Structural floor System � . 61. APPROVAL TO DECK ���
1'7. Property Sewer Line & Hous�Connection j� 62. Backwash & Receptor�Final �
!�
'12. Sewer Cap „R '. �K 63. Heater & Vent-Final -r'�
� v , ,
1=3. Roof Drains � � 64. Plumbing System - Final .
1.4. Rough Plumbing � `'� 65. Electrical-Final � �
75. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
t9. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace �. APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Oucts, Ventilating " 77. Product Piping OGas OOiI
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing " 8�� - 7q: Overhead Hydro
26. T�Bar Ceilin9 (Structural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding ; 77. FIXED SYSTEM FINAL '
29. Insulation � ; 78. FIRE PREV. FINAL �
30. Drywall Nailing j � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat • 79. FINAL INSPECTION
32. Electrical Power Meter�Final I `� 80. FOOD CERTIFICATE ISSUED
33. Final Electric ;�j � 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 � .
47. Solar pomestic-Final ' �
42. Backflow Preventer . - .
43. Backflow Irrigation '
44. Landscape Irripation System � � . •
45. Sound Attenuation ' '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ��yl� �'� g�8-�/ 5��� � 1�6�
/
48. FINAL PLANNING - . , �.�� �
49. Electric Release to Edison /: . '
50. Gas Release to Southern California Gas Co , ,
51. CERTIFICATE OF OCCUPANCY
No. Oate