HomeMy WebLinkAbout3055 JOHNSON AVE - Building PermitsCITY OF COSTA MESA i •
os` 'F„ `' B!/ILDING D/VISION
>t� . . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�weci.costa-mesa.ca.us
:
° 4 FOR INSPECTIONS CALL: (714) 754-5626
`�°°�«�°"` PERMIT NUMBER: M10-00149
PERMIT TYPE MECH
APN: 14159310
JOB ADDRESS: �3055_JOHNSON-AV'CM `'�
vicinity: -
SQ. FT: 0 a
SCOPE OF WORK: CHANGE OUT FAU. �
OWNER: MC CARTHY, COLIN
PHONE: 714-641-4708
APPLICANT: BEEKER, ANDREW
PHONE: 714-979-2070
CONTRACTOR: KLONDIKE AIR INC
Address: 1308 LOGANUnit: SUITE H
City/State: COSTA MESA, CA ZipCode: 92626
MECHANICAL PERMlT FEE SUMMARY
MECH ITEM FEE: $38.30
PIAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
STATUS: ISSUED
DATE ISSUED: 12107/2010
ISSUED BY: KJB
Suite/Unit:
Address: 3055 JOHNSON AVE Unit:
City/State/Zip: COSTA MESA, CA -
Address: 1308 LOGAN UnitSUITE H
City/State/zZip: COSTA MESA, CA
License No. 754456
PHONE: 714-979-2070
CELL:
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under California statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under Ihis permit to be considered legal, such work must comply with all appiicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in ihe expiration of this permit.
COOEN. INSiEC110NTYpE DATE INTITIALS COOE% INSPECTONTYPE UATE INTilALS ^
1616 Fixed System Final Fire Prevention 206 Final Mechanical X �Z' 23 —�0 V�1Pv�%�
1266 Pool Spa Final 208 Final Plumbing
Z00 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
�
202 Final Factoy Fire Place 220 Final Planning Approval
203 FinalSign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION �ECLqRATION:
I hereby aKrm underQenalty o3perjuy one o( the following declarations: '
❑ I �ave and will maintain a certifCate of consent to self-Insure for workers;
compensation, as providetl for by sec(ion 3700 of the �abor Code, for the
peAormance of the work (or which thig permit is issued.
❑ I have antl will maintain workers' compensation insurance, as required by
section 3700 of Ihe Labor Cotle, tor the pertortnance o( the work for which �his
permit is issued. My workers' compensation Insurance carrier and policy
numberare:
�Cerri�er.—� c, �L �
(Thissecfionnee �roDemmpleteddMep¢rm�isvaluedarone�untlretldoliars(St00)o�less.)
.aicy�mbe~ K Lw c ! 4�5 /-7 "!
❑ I cehily that in the perfamariCe of the vrork for which this permit is
issued, I shall no[ employ any person in any manner so as to become subject
to the w �rs' compensation laws of Califomia, and agree that if I should
becom subj�ct to Ihe workers' om9 n ation provisions o( Section 3700 ot
ihe L or Co �e, I shall fort �th (>ly t these provisions. ^
� Z �1 �-� V
� , _r__�Si9nat re �pye_,?
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 pF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARqTION:
I hereby aRrm that I am licensed unqer provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in (ull (orce and eftect.
a:IC:� ��'i�v �55.#� ���0
�2-�7 -I O
.,�onGaclo[sS�9^aWre e..:. Dale_�
CONSTRUCTION IENDING AGENCY:
❑ I hereby aKrm that there is a cons[ruction lending agency (or Ihe
pedortnance o� the v.ork ta which this permit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
Date
OW NER•BUILDER DECLARATION$;
I hereby affrm [hat under penalty of perjury lhat I am ExEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any �iry or counry which requires a permit to
construct, alter, improve, demolish, or repair any sirucWre, prior ro its
issuance, also requires ihe applicant (or such permit to fle a signetl statement
that he or she is licensed pursuant [o the provisions of the Contracrors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or thal he or she is exemp� Iherefrom and
ihe basis for the alleged exemption. qny violation of Section 7031.5 by any
applican[ (or a permit subjects the applican[ to a civil penalty of not more lhan
five hundred dollars ($500)J:
❑ I, as owner o( the property, or my employees with wages as [heir sole
compensation, WILL DO THE WORK, and the structure is not intendetl or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of pmperty who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided that such imprbvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have lhe burden of proving that he_or she
did not build or improve for purpose Uf sale.). � � �
❑ I, as ovmer of ihe,property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and
Professions Cotle: The contractors License Law dces not apply [o an ovmer of
property who 6uilds or improves thereon, and who contrac[s for such project with
a contractor(s) license pursuant to the CoNractors License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for Ihis reason:
305]-A6(3/0])
Ovmer ID verifetl by tlriv� .eense. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property tax bjll deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certAy Ihat no excavation five (5) or more feet in depth into wfiich a
person is requiretl to descend, will be made in connec�bn wiih work autFronzed
by this pertnit, and that no building structure, scaftdding, falsevrork, a demolition
or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry
2, Fvt 2, Sec. 341, TUe 8, Califomia Adminis[rative Cotle).
❑ As owner-builder, 1 will not employ anyone to do work which vrould
require a permit from ihe Division of Industrial Safery, as noted above, unless
such person has a permit to do such vrork trom the division.
Appllwnfs SignaWre
Division of Industrial Safery Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will [he applicant or present or future building occupant neetl to file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ety Code requires, with some
exceptions, that a Business Plan be filetl wi�h Ihe Costa Mesa Fire
Department by every business which has at any one [ime during a repoAetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 galtons, or 200 cubic fee� of compressed gas
at standard temperaWre and pressure).
2. Does or will Ihe applicant or present or future building occupant need to fle
a registra[ion (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure).
3. Does or will [he applican[ or present or future building occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Healih antl Safety Cotle provitles that [he
Costa Mesa Fire Department may require the preparation, certification and
filing with Ihe Fire Deparlmen[ o( an RMPP by businesses which are required
to register acutely hazartlous malerials with the Fire Depariment.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or fuNre builtling occupant require for
the work which is Ihe subject of this application a permi[ for such cons[ruction
or modifcation trom the Sou[h Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemmeni Code requires that the requested
information be fumished on applications la noo-residential builtling pertnits).
6. Will any part of the facility to be cons[ructed under Ihis permit be within
1000 feet from the outer boundaries o( a school? ❑ Yes ❑ No
(If "yes", �he facilily must meet the requirement of Sections 25534 and 42303
of the California Heal[h and Safety Code�.
7. If a permit from the South Coas[ Air �ualiry Managemen[ District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of lhe disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf'yes", attach certificate of compliance from ihe appropriate air pollution
conirol oKcer). �
CERTIFICATE OF COMPLIANCE: I certify that un'der penalty of perjury the
informa6on given above is correct. I agree to comply with all s(ate laws and
city ortlinances regarding Hazardous Materials and Emissions.
SlgnaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application antl state that
the in(ormalion given is correcL I agree to comply with all state laws and ciry
ordinances rela[ing �o building cons[ruction, antl authorize represeniatives of
the City of Costa Mesa to enter upon Ihe above-described pmperty for
inspection purposes. ree not to occupy or aliow occupancy of any building
authorized by this � rmit n,til final i eFio`
�
gnaWreofLeal wner�s) Date
2 � ��
�., ut�onze0 APClirant ' �B�e)e
Simplified Prescriptive Certifir of Comptiance: 2008 Residential HVAC.a a[ions CT-IR-ALT-HVAC
Climatc Z.ones 7 aud 3- 7 .� �
,,
`sheada.csr
❑ Packaged Unit
�Fumace
❑ Indoor Coil
❑ Condensing Uni�
(�i�W S 01J
� AFUEqSgo ❑ GOP
❑SEER ❑HSPF_
❑ EER ❑ Resis[ance
Enforceiueq! AgeqcY:
Conditioned Duct
FVoar Arefl re i
Over 40
Served by system addedy r
2� sf pncy fidii
!D"R G (
iA.(�-b`Of
Date: Peruii/ q:
/7'i—ifi
'� Setback
Q(nm aL�eadl' preteiu. nnrst be
ins�olledJ
/. Gquipment Typc Choose the equipment being installed; if more than one system, use ano[her CF-] R-A1.T-HVAC for each system.
2. Minimum Equipment Efiicieucies: 13 SEER, 78% AFUE, 7.7NSPF fortypical resideNial systems.
Cou[ractor (Documentatiou Author's /Responsible Desiener's Declaration Statement)
• I certify thzt this Cenificate otCompliance documentation is accurate and complere.
• 1 am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibiliry for the design identified on this
Certificafe of Compliance.
• I certih� that the energy features and pedonnance spedficafions for the design identified on this Certificate of Compliance conform m the
requirements o£TitVe 24, Parts 1 and 6 of the Califomia Code of Regulations.
• The design features identified on tttis Cenificate of Compliance are consistent with the infonnation documented on other zpplicable
compliance forms, wo�ksheets, calculations, plans and specifications submitted to thyet�'fqrceme�(tv�ency fo�proval with the permit
Name:
Company:
Addccss:
��ft,�� �c
130� - r+ l�, �w-�
C � ✓l� Q( Z �
Date: /�_7_/ �
Ucense: .� �Y � r J
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Phone: -? � y (7-7G}
200d' Residential Compliance Fornu March 2010
(ENFORCEMENTAGENCP
GAN�OUSTOtilIZE :N�ITH•EETZERFIEAD/SEAL)
2008 Building Energy Efficiency Standards Residential I3VAC Alterations
Climate Zones 1 and 3 through 7 CGZ�-6 = ��sr� M��
svsrrress n�vn rxoressrorvs con�. sccT�on� n�o
Willful or deliberate disregard and violation of [he building laws, including the Califomia Building Code, and
iocal permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunc[ion witli the local building departmenL This ac[ion may consist of fines up ro$5,000 per
violation or suspensionlrevocation of a contractor's license.
VI'FIEN IS A PGRMIT I2�OUIRED? �
A written construction perntit shall be obtained from the enforcement agency prior to the erection, construction,
reconstruction, installation, relocation, or al[era[ion of any mechanical system, except as permitted �in Appendix
Chapter 1, Section 112.2 of the 2007 Califomia Mechanical Code. Projects requiring pemilts include, but are not
limited to:
• New HVAC installation
• HVACChangeout
• Replacement ot fumace, coil, FAU, or condenser
+ Relocation of an existing HVAC unit
�• Adding or replacing more than 40fi ducting in unconditioned space
2008 BUII.DING ENERG]' �FFICIENC)' STANDARDS lTitle 7A, Part 61 REOIJIREMENTS INCLUDE•
L Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor fumaces; room heaters).
2. Central air conditioners R heat pumps less than b5,000 Btu/hr must have a minimum 13 SEER. �
3. Newly insialled or replaced ducis must have a minimum insulation value of R-4 �.
4. A setback type thertnostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
+ All joints and openings in the in the HVAC system must be sealed.
• Only UL 181, UL 1S1A, orUL 181B approved tapes or mastic shall be used to seal duct openings.
• Connections of inetals ducts and the inner core of flex ducts shall be mechanically fastened. Flex d�cts
must be connected using a metal sleevelcoupling.
• Flex ducts that are suspended must be suppotted every 4ft. mas for hocizontal runs with no more than 2"
of sag between supports and 6 ft. max for venical runs.
6. The Cr-6R-MECH-04 must be completed and signed by the installin� conttacmr. The Inspecror will collect
this form and verify that the model numbers are the same as the installed equipment.
1
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PHOJECTA�ONE55: 3OSS SO:iNSON AL�
owr+i�snnme: GANDY, MICHAEL B
- aooness: GANDY, P9ELODY M
� 3055 JOHNSON AVE
COSTA MESA,CA
590-0198
RPCNIENGINEEN:
AOOHESS:
UNIT:
92626
flEG.NO.:
UNIT:
veemnree: SKYLIGHT SPECIALTIES (714)645-86�i5
aooeess: 316 0 I NC L I NAD O
SAN CLEMENTE CA 92573
UCENSEO CONTHACTOB OECLAflATION: I hereby aifirm �hat I am licensed unaer pmvisions o� Chapter 9(commencinA wi�h Sec�ian
]000) of Oivsion 3 ot tne Business anrl Pmfessions CoOe, an0 my license is in lull �arce and ef�eci.
ciTruc/.:0'2'77-7519 sTaTeuc.:395551 �inss:B E:{P: 11/94
Da�e: _Q�C�—/'� � Signamre:�
WOHNEflS' COMPENSPTION DECIABAiION: I Aereby al m Iha� I have a cetlilicate ot consent to sel4insure ol a cetlilicaie of Workers'
Compensation Insurance� w a certifietl copy inereof (Sec�ion 3800, La� C.
POUCYNO.: U0�871J'y4 exa.oaTE: �9/01/95
comeaxr: STATE FGND
❑ Cehified caOY is hereby lumishea. 0` Certihetl copY wiU (he city Builtling Oivision.
Date'\)=_(���� ApDlicant' �
EAEMPTIONFBOMWOAHEHS'COMPENSA710NOFClAHA710N: (ihissectionneeanat�ecampleteOiflhepermi�isforane�undre0�57W�arless�.
I cenify Iha� m the pedormance of Ne work �or which this permi� is issued, I shall noI emDloy any person in any manne� so as to become
sublecl Io �Ae Workers' Gampensaiion Laws o� Cali�ornia.
Date: Signature�,
NOTICE: It. ai�er making ihis Oeclaration, you should become subjetl lo the Wo�kers' Compensation pmvisions o� �he Labor
� Cotle. you must �orthwilh comply wi�� suc� pmvisions or Ihis permit shall be OeemeO revoketl.
CONSTflUCTION 1EN01NG AGENCY: I her¢Dy afiirm fhai ihere is a tons�mt�ian IenAing agenCy lor Ihe petlormance ol Ihe wOrk �or
which Ihis permil is issuetl �Seciion 3097, Civ. C).
lENOER:
AOOPE55:
�
OWNEB BWLOEB OECLAflPTIDN: I hefe6y atlirm ��al I am exemp� �wm the ContratlOrs' State License Law for me follovnnA reason
�Sedion 703L5 Business ane Pm�essianal Cotle'. Any ciry o� coumy w�ich requires a Oe�mi� m con5imct, al�er, improve. Oemolis�, or
repaii any 51mcWre. prior Io its issuance. also require5 ihe applicant �or SucA permi� �o lile a signetl s�a�ement ��at he/she i5licen5e0
pursuam Io Ihe pmvisions ol t�e Comracmrs' Slaie License Law (Chap�er 9 �commencing with Seclion 7000) of �ivision 3 of �he Business
and Prolessions Cotle) ar thal helshe is exempt thereimm and Ihe basis �or Ihe allege0 exemption. Any violaiion o� Section 703L5 by
any applicant br a permit sublec�s ihe applicani �o a civil penal�y oi no� more Ihan tive huntlretl dollars ($500).
I. as owner o� ihe pmpehy or my employees wiih wages as I�eir sole compensation, wi0 Go Ne wo�k, and t�e
❑ SlmtiUre is noi in�enAed Oro��¢retl �ar 5ale (Seclion 7044, Business anA Pmiessional Cotle: The ConVac�ors' S�a�e License Law
does not appry m an owner of a D�openy who builOs or improves t�ereon, an0 who Ooes such work himselVherself or IhmuAh
his or �er own employees, pmvided �hat such impmvements are no� intentled or oilere0 Por sale. tl, however the building or
impmvemenl is sald within one year of complelion, the owner will have �he hurden of Droving �elshe tlitl no� build or impmve
tor ine purpose of sale�.
I. as owner o� Ihe pmperty, am exclusively conlracting wilh licensed coN�ac�ors b consimct the pmlec� (Seclion 7044, Business
❑ and Pmlessions Cotle: The Conlraciors' Slaie License Law Eoes no� apply �a an owner ol propeM who 6ui105 or improves lhereon
and wno coNracls for such proiects wilh a coniractarls) license pursuani b the Contractors' State License Law�. I am aware
1ha1 pmol ol Iheir Worker's Campensa�ion insurance shaultl be pmvided to me.
� I am e�empt un0er Sec�ion: 9. 8 P. C.
tor Ihis reason:
Oate'. Ownec
I do hereby cenify Iha1 I am aware af and understand the reQuiremems of Califomia Heatlh anA Safery Code Sections 25505, 25533, antl
2553a and ihat I or any IWure UuilOing occupani vnll/will not (circle one) neetl to comply wilh said slale co0es an0 the requirements lor a
permit lor constmclion or motlificalion irom Ihe Air Oualiiy Management �istricL Resitlen�ial conslmciion ap0lication5 are exemp� irom
IAC52 D�Ovi5i0�5.
�ate'. ADPlicani'.
I hereby ceruty �hat I have reatl �his aDo�icaiian and sta�e ihat �he abo � form tion is c ec�. gree lo comply vn�� a0 city and counly
ortlinancesantlslalelawsrelatingtobuilaingcon5imdionand�ere ut iz .presen rves �iscily�oen�eruponthea�ove-men�ioned
�propetly � �ion purposei
Si9naWr'
i�er's ucense or Sociai Sec�niy x: �
t6at�a6 White—Bwltling: Green—CoEe Eniarcemem; Canary—Appli<am: Pink—Revenue: GOltlenro0—Pssessor
CITY OF COSTP. MESA — BUILDING PERP4IT FER24 NO: H Qfi7752
PEP,��1IT NO: B L67752 PLAN CHECIt A70; 02319-94 S GOVT: � SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR FlJRPOSE: CON
JOB DESCRIPTION : INSTALL 2 SKYLIGHTS, ICBO# 2469 SQ FT: 6°5
CLP.IM �'ALUE: 695,00 CP.LC—L'ALUE; 695.00 GRQUF OCC; P.-3 !
COMMENTS; INSTALL 2 SKYLIGHTS W/WELLS HALL BATH E MASTER9EDROOM BATH
iE if�iF i(�if iEi� 1f-1F iE 1f iE if'1fiE # iE iE #-)E iE iE'1F if 1EiF # iEiE if i4'1�')f Yr if if'lE'%'iE if iE iE iE-)F�1F if iE'1F :F'IF'1: if�#if iE # iF )( iR #'�if Y-iE iE'If�iF iF i! # Y�Y if'K�'k iH# ###
Z O N I N G A E Q U I R E M� N T S
S E T B A C K S
------------ b1AIN BUILDING -------- --------- ACCESSORY BU2LDING -------
FRNT: FT IN REAR: FT IN F?iNT; FT IN REAR; FT IN
LEFT: FT IP] RGHT: FT IN LEFT; FT IN RGHT; FT iAl
PARKING AEQ: PROI�; PARCEL: 19159310 ZNE; REF NO;
PLANNING NOTES> ,
1 �
il� iF �)F iM1 K iF �Y �* iF a. iE iE iE jE i4 �IE jf iE'k!f #'+E iE iE iE iE �IF 1F �lE iE 3f i(� tE �3P �f lE �7E 1f�-k #�1F # if if if af if iE ��lE iF ff if if �t # if jF iF� #�%# iF iG iF jF aF;c 1F �k iF iF iF iF # i(� a4 Y-
D E C' E L O P M E N T S E R C' I C r�p� R E Q U I R E M E N T S
ZONING APPROC�EP 5Y ���C
�ATE: �
BIIILDING APPROVEL> BY . C�'►r i� L�•
APPLICATION ISSUED HY:
�lE # iE iE iE if 9t iE iE iF �E iE il� iE iE iF jE i: iF ic 1E �1t3Si�iFSF
�f iE �E it if iE iE ib # if jE iF 1! M#�lE iE if if ?f iE iE 3F Y- iF ff jf 3E Y� 1f iE if if iE
LEGALIZATION;N .. t
BLDG PMT PiI�MF�Q�� ��
PERMIT 19.00 P��
ISSUE FEE 12.35 C''�'� �
5b2
BUILDING—DIV—> PERMZT ISSDE ��i�ri'lv—CAECK _;; .=
TOTALS----> 1°.50 0.00 p�12, 35';1'._.,-,
ti'f'^�
REVENUE DIVISION TOTALS-- COL—- —�"��
BLDG PMT PLUMBING ElECTRZC M
19.00
MECAAN
Y
DATE; ��2%� ��
ii�iF�If#ifififnF?S.:^'# ��'i''.�'�EiF�IE�
1E if #-X.�'1F 1f if iF'1("1F iE 1F:H'iF #?I'iE if iE'N-# ## ###`'
STRUCTURA� SEGMENT:Y
FIRE SMIP/RES GRADING
50
SMIP/NON—P.ES
TOTAL FAIP DUE
31.85 31.85 .00
,.95 O�'ER; SHOP,T: .00
SMIP/TOT CP.r'1DING PLP.A]—CHECF;
.50 12,35
'k'# Y�jf'1f'1F 1f iE iF ik # if if # M: if'�'1E'Y.'if'iE1f if 1E if�L' �iE ic'lf')%iij� il�')M1 If #1F iE i! �F'X'1�-if if 14iF if'IE?f'iE if iE iF if'Ii'iF {F'If�IG 1f'X�')f iE �('# af N'3F�i'if a-�k'�iE iFi4 iF
I N D I V I D U A L F E E H R E A FC D O W Pd
TYPE �TY D E 5 C R I P T I O N. JNIT COST TOTAL COS`T
SFR 695 ALTER BY C'ALUE RESIDENTZAL NO2t3NE 1,00 545,U0
cND OF FEES
' O1 OO1d2916-0016?918 TQ T 3i.8`
DATE: D6127/N4 TI17E: 13:23
CUNSTRUCTION AND PLANNWG POOL & SPA
� APPROVALS Permit#"� Oate Inspector APPROVALS Permit?k Date I�spector
♦
1. TemporarY Electrical Service or Pole 52. Poo! & Equipment Location
2, Soil Pipe-Undrgrnd. 53, Steei Fe+nforcement
3. Elec;rical Conduit Utility-Undrgrnd. 54. Forms i
4. Electrical Conduit-Undrgrnd. 55. Electrical Bording �
5. 5cee! Reirforcemenc 56. Rough Plum6ing & Pressure Test i
6. Etectrical UFER Grnd. 57. APPROVAL TO CdVER�GUiv4TE {
7. Footings 58. Electiical Conduit�Undrgrnd. �
-'-�
8. Foundatien 59. Gas Pipe, O Undrgrnd., Test !
9. Water Pipe-Undrgrnd. 60. Backwash Linae, P-Trap, C] Undrgmd. ' �
10. Structural Floor Svstem 61. APPROVAL TO �ECK j
11. Property 5ewer �ine & House Connection 62. Backwasi� & Receptor�Fi�ial �
12. Sewer Cap 63. Heater & Veni-rin2i � �
73. Roof Dreins 64. Piumbiny System - PinaE �
14. Rough Plumbing 65. Electrical�Fina!
15. Rough Etea�ical-Conduit 85. Soiar System-Final
16. Rough Electric Wiring 67. Fencing & Accass ApProvai `
17. Rough Wiring Siyn 68. APPROVED FOR PLASTERING ��
18. Rough Efectrical-T Bar Ceiling 69. POOUSPA SYSTEMS FiNAI
19. Rouyh Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # (
21. Duc.s,in Structure 70. Underground Hydro �
22. Duc*s, Ve�tiiating 71. Product Piping O Gas O Oii 1,
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof �ram�ng 73. Underymd.Stora9el'ank OGas ❑Oil '
25. Roof She�thing �4. Overhead Hydro
26. T-8ar Ce�l�ng (Structuraq & bionocoat 75. Dry Chemical �
27. Frame ancl Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM PINAL �
29. insu�ation 78. FIRE PREV. FINAL
30. Dry+vall Nailing . 3=�` HEALTN D�PT. REQUIREMENT
_ �
37. Plaster Brawn Coat 79. �iNAL INSPECTION - �
32. Electrical Power Meter�Final 80"^F000 CERTIFICATE I,SSUED �
33. Fina� Electric f03;�s: � �j.� �� �Q ��, i
34. Final Heating � Air Conditioning �.;. � � ��� �
��
35. Final Gas PiDe-Test �,;,, , , ' •
��
36. Hood or Canopy „�'� �
�
37. Finat Factory Firepiace � , s
. -- _. i
38. Finai Plumbing � �
39. Water Service-Final " � �
y �' .
40. Gas Sarvice�Final
41. Solar pomestic-Final r..:. � �
i r?' 1
42. Backflow Preventer ,��f" � i
43. Backflow lrrigation �� , ' j
44. Landscape Irrigation Sys:am
45. Sound Attenuation �
46. Handicap Regulations -�
47. FINAL S7AUCTURE & 3UILDING :�Z,S'"' , / L(/�
�/
46. �INAL P4ANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF QCCUPANCY
No. Date
�
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;
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,
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OP BiJlt.DDVG SnFE�rY
r OP 008TA MESA
ApPitOVED ,
�
,e �flesua,s e�tsr ce ke� �+ e�b pe s a e�a.
rualce Wp du�es a atleralion on same wiitaut writtai
pMision ot � and Satery. Ciry d Costa Mesa.
1 pYn mid 60��s SHA�L NOT be held to pemril
I W tlr �n of an prov�vais af arry City of Casta
Yor Slate lar. r�'�� ^<)�
ai dW expre DY �itatiun�id d�'�fulTaid vWC B i
b rmt odnmenced ar�a maintameU active per U8C §303
d issl�ante. �
R
�z Ol�(/-/Ai� lN
(� jHi S�PF�
----- ----- — -------
r� ti���� . _� �� � - ------� ,_
. -------- _.__
PN6IECTROORESS: 3OSS J�HNSON AV
OWNEN'SN�ME: MORTON� ARTHUR F
noosess: 3055 JOHNSON AVL
C�STA MESA,GA
nncxienaixeen: �40—01S8
aooHEs3: n
UNI7:
92626
NEO.NO.:
uxrt:
PEPMITTEE: OOOOO
�ooeess: NCCK PLUMBING 1714)895-1246
11610 SEABOARD GIR
STANTON CA 906H0
LICENSEO GON7MCTOP UEClAN117tON: I here�y aXirm Iha1 I am IicenSeA un0er provisions of C�apter 9(commencin0 w��� Section
70W) ol DNision 3 of tAe Businest and Prolessians Cade, an0 my Gcense Is In Nil taru aiM eHect/G� �
cm uc.:050386 q�T"TE uc.:511971 . c�s ��6 ii. [��
Date:�� p—'L..� Siqnama: ,,,. � � t 4�r��
WOBNEBS' COMPENSATION OECLAMTION: I hereDy atlirm tAat I Aave a urtificate af onsent to self-insure or a cenifiute of Warkers'
Compensation Insurance, ar a certilietl capy th¢reoi (SecGon 3800, La�. C�.
roucrxo.:116799290 �P�o�� 03/O1/92
I coMrexr: STATE
_I C¢rii�ietl copY �5 her¢O�yitumiSheE. � CeNIieO capy is f/ilrp/ vnih ehe tiry uildinq DNision.
oate: � � /D � L / Ap0licant: ��"�!
� IXEMPf10N iNOM VIONKEIIS' COMPEN&TION OECUNA710N: (tNs secuon neeE not 6e mmDleteO i� Ne permit b for one �uMrW (E100) or kss).
I ceNty t�at in the De�ormance af the xrork far wNc� ih¢ De��� ��ue0, I shall nat empby any persan in any manner so as to become
suble�� �o the Workers' Compensatian Laws ol Calilomia.
Oate'. SiOreture:
NOTICE: It, atter making this declaration, you shaNU hecome suGject b tAe Workeri Compensation Dmvisions al t�e LaDor
COEe, you musl fonAvnN comDN �� suc� D�ovisions or tlus perrtut shall De deeme0 rewketl.
CONSTBUCTION IfNUINO �GENCY: I Aereby attirm [hat there is a canstructlw lentlinp a0ency lor Ne DeAormance ai [he work for
which tAis permit is issue0 (Section 3097, Civ. C�.
LENOEfl:
RDOHESS:
OWNEN BUILOEB OECUMTIUN: I hereEy atlirm ihat I am exempt iram I�e Contractors' State License Law for Ihe followinA reason
(Section 7071.5 Business an0 Prahssional Cotle: My ciry of counry w0ich repuirts a Dermit to construct, atter, improve, demolish, or
reDair any structure, prior to its issuance, also repuircs t�e aDd�� �or such permit Io IJe a 5iqneE statement tlat Aels�e is licensetl
oursuant m Ne pmvisions af tna Contracmrs' Suta Liunse Law (Clupter 9(commencin0 ��h Section 7000) of Oivision 3 0l tne Business
an0 Pmtessions CaEe) or that he/she is erempt Ihereimm anE t�e basis for Ne allepM exemptbn. My Nolation al Section 7031.5 by
any apDlicant lar a permlt SuEjecis the apDliwnt eo a ciWl penalry ol not mom ehan iNe hundretl tlNlars (SSOU).
I, as owner ol Ihe O�oDerty or my emyloyees witA wapes az ttreu sole compensaUon, will Oo t�e work, anC tha
❑ simcture is not intende0 or offem0 tor sale (Section 7044. Bus�ness ana Prolessional Cotle: T�e Cantractors' State License Law
Oces not apDh �o an wmer of a propeM � 6uilQs ar imDrww t�ereon, anE wAo Eoa such woM himutl/�ersetf ar Ihmup�
his or her own employees. pmvitleE tAat SucA imD�ovements are nat inten0etl or ottered for sale. If, however Ihe buil0in0 or
impmvement is sdA mt�in one year ol completion. IM axner will have IM hur0en ol pmNnp AUs�e EIE not huilE ar impmve
for Ihe Durpose ol sale).
I, as owner ol iha prapeM• am excluSiveN rnntractinp witn IicenseO wntnctors to construct tAe D�oied (Section 7040, Business
❑ an0 Pmtessions CaOe: Tha Coneactors' Stata License Law Aces rroI apDN �o an owner ot OroDerrywAo bmlds or impmves thereon
antl wM wntracts lor such D�ol�u'MtA a convactoqs) Acense Dursuant to t�e Coniractors Stata Lic¢nse Law). I am awam
thal pmot ol Iheir Worker's Compenuli0n InSuonce sAou10 Ue proNdeO ta me. -
� I am exempt unOer Sectian: B. 8 P. C.
lor Ihis reason:
Data: Owner.
I do �ere0y ceniry tAat I am aware of and unaerstanA t�e requiamenis oi Calilomia Healih and Salery CoGa Sections 25505, 25533, an0
25530 antl Ihat I or any /uwre EuilCing occupant witUwill not (drGe one) neeE to campry wit� said state co0es antl the reQuiremenis for a
permit lor consiructbn or rtwEification Imm tM N�Manapement Oistrict. HesiOentlal constmction applications are exempt fmm
�Aese OroviSions.
Date: ApPliwnC
I hereGy certity thai I have r¢aOINS aOPlicaii0n antl Sia�e l�al lh¢ a0ove inlarmaGon 6 torreCi. I apree IO tomply wi�� all ciry an0 Couniy
orAinanas and state lavrs aWtinp ta OulOinq construclion aM Aereby a r¢e represe uVres al t6x dry ro e er upon t� ve-mentianed
proDeM for inspectlon pu r-
i
�ate: � `I8 Siqnature:
oriver's license or saia� Secunry x:
1601-98 W�ite—BuiltlinB: Green—Cotle En�orcement; Canary—AppliwnF, Pink—Revenue; GolCenro�—pssessor
e
" CITY OF GUSTA MESA — BUILDING PERMIT FERM N0= P 052305
PEk?IIT NG: P 05230: PLAN CHFGK N0: � GOVT: N SUPP: N
GQN57'RUCTI�N TYPE: V—N PERMIT IYPE: PLU PURPGSE: 07H
JOB DESCRIP7ION : CHANGE OUT HATER HEATER SG FT:
CLAIM VALUE: LALG—VALUE: GROUP GGC: R-3 /
GOMMENTS: SAiOKE �ETEGTOR RE9UIRE0 IN THE HGME
#a�:t#��a �#�*z�a�aa#aa a��t#�:ts�a*#ats*a�ae�t *�a�a#z��z��aa*�#a##�a�#a�a*a� �## #*#ex���
Z � N I N GS ERTEBQAUCIKRSE M E N T S
— MAIN BUILDING ------- ------- AGGESSORY BUILDIN6 — —
FRNT F7 IN REAR: FT II� FRNT: FT I� REAR: FT J IN
LEFT: F7 IN RGHT: F7 IN LEFT: FT IN AGHT: FT 1N
PARKIN& REQ: PROY: PARGEL: 01415931 ZNE: REF N0:
PLANNING NOTES>
� 1
9�#$######*i �YF'�.%�#$XT##$#3####�C###.'k####II#:a#��i#�0#0#ikt#�3#'#�$$�##$#'4$###$�3�RII�*##t�4�
C E V E L 0 P M E N 7 S E R V I G E S'� R E A U I R E M E N T 5
ZONING APPRi7VED BY _ _ DATE: _
BUILDING APPROVED BY : UATE:
APPLICATION ISSUED BY: �����' DATE: � �y�
ss*a�u##s�a�a�s����+zs#�z#s��sa��"�3 3�x x 3�a�33�s a �z aass#s�*�a�3�� �z�
�k�#��Fat##*at#Y�Yr%��R� i�3i�%�#i�Y�3ii3#�t*#A*3#3�#t#t�k�k�F�k�###�#$�i�R�*#i#3######-R�k3�# ��ki #�#
LEGALIZATI�N:N F E E S U H M A R Y STRUCTURAL SEGMENT:N
BLDG PMT P�UMBING ElEC7RIG MELHANIC FiRE SP4IP/RES GRADING
PERP4IT 2.00
25� S M.I P/ NGN-RE S
PL AN
iSSUE FEE 3.00
BUILDING-DIV-> PERMIT ISSUE PLAN-GHEGK TdTAL PAID DUE
TOTALS----> 2.00 3.00 0.00 5.00 5.00 .00
REVENUE OIVISION TpTALS—> COLLEGTED� 5.00 GVER/SH�RT: .00
BLDG AMT P�UMBIN6 ELEC7RiG MECHANI4 FIRE SMIP/TOT GRAGING.PLAtv-CHECK
s.ou
t#i�##X�#X��k####��###�##3�R#�###0%�3# ## #?#�i##3�ROII3�#�#3��C#*#t##�* �3���##4�#Oi� ###3#�#
I N 0 I V I D U A L F E E B R E A K G � 6' h'
TYPE 97Y D E 5 G R I P T I O N UNIT COST TOTAL CGST
PLU 1 WATER I1EA7ER AND/DR YENT 2.00 2.00
END OF FEES
-�':U"'cL.'�i�)t:�`i.n . _
:�'i��C• t�n�'i�.' . i'<;�? .. .:.
CONSTRUCTION AND PLANNING POO ;PA
APPROVALS Permit # �• -Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or,Pole. �� 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd.� � r.�. 53. Steel Reinforcement
•�3: Electrical Conduit�Utility-Undrgmd � F� 54. Forms `
'4t Electrical Conduit-Undrgrnd� l 55. Electrical Bonding
�5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
�6: Electrical UFER,Gind. �� 57. APPROVAL TO COVER�GUNITE �
'7. Footings . � 58. Electrical Conduit-Undrgrnd. i
�8, Foundation . � 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe�Undrgrnd. , " 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor Svstem �' � 67. APPROVAL TO DECK -
17. Property Sewer Line& Ho4'se Conne�tion l• 62. Backwash & Receptor�Final --�
12. Sewer Cap . - 63. Hea[er & Vent•Final
� �
13. Roof Drains �., �
. 64. Plumbing SYstem � Final
14. Rough Plumbing� ,• �� 65. Electrical-Final -
15. Rough ElectriwYConduit • 66. Solar System-Final . ��
16. Fough 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
79. Rough Heating & Air Conditioning FIR� DEPT. REQUIREMENT
> > > >r� 1' JT ;. n <r#1F� r - .r
� �. i �� �. u .� i rwn � -�.v� � -�i ^ } -�
20. RoughFactoryFireplace � -. T g Syit,APPRO,l/ALS,.a,.Ferrrut# _
21. Ducts,inStructure!^ �••" '�� :� ;� ' yk`y 7p, Urjdergro'L�d�Hyd�o �`
22. Ducts, Ventila2ing��; � '.� x� 3 -�.� _71. Product P,ipin9 � Gas ❑ Oil
23. •Gas�Pipe�Rough & Test I � �- � � ` 7 �?;F r • z, Undergrou_ny'd�lu� ' � r
24.`Roof'Frayin' ., ��•- '• '�� • 'T `}� - . �,. �
� 9 ,a; ..> � ,.. , q ,�3. �Undergmd; Storag� Tank O Gas ❑ Oil
�= 25. Roof�Sheathing ' • '✓ ✓ �' - ? �ri �f 74,� Qverhead Hydro t �'
r
26. T�Ba � Ceil,ing (Structurall & Modocoat f , � � .'��; �1; 75.'rDry Chemical _. � �� ' ' ,
27. Frameand Flashing � .�;, : � �' • � 76. Dry Standpipe � ��•� � �
ti
'28. Lathing & Siding' �'.� �' � �_ � � � "� �'� '�� �y 77, �FIXED SYSYEM¢�IN�L },,,, .� r
29. Insulation +t � : �. •• # � 1 i :id 7g,-':FIREPREV.FIf� �L ''� ` ;
� w <<
�30.DrywallNailing �'� '` � � �T'� �=�� �M'IJFALTHDEPT.''�i�EQU�REMENT
4 K•• I .:} ._ I � Ih �t .� ..+
l .r M v . .
31. Plaster Brown'Coat+,t : I�� a 1 :t iz ^99. FINAL INSPECTION �>
'�y_ A
S ^�� ' I �N I I:Itso " �^ J
i32.�Electrical Pow'�r Mguer-F�al � Q � � ,�,�� 80._�OOD CERTIFICA7E ISS�I.ED ��
s r r. ++ � � . ,. •
,33. �FinahElectricy _.;t i 2 ++ I I lua Notas: �t -i�i 1� � � .� �
� .. .
�34. iinal'He�iin � Airti onditiohin m �� I 'Ib a ^ ' ��' o �: a 7
9 9' ,+ ! �.lo�,v � i �-a � �
�35.rF,inaTGas=Pipe;Tes4a��� •• 4^-� I I. 'r~� tr� n.�. # -rr
36. Hood� or CanoPY �`� � r y � �� I I�'' In a_ ; � � a.-
� f ^ts. n I: n _� o � I. kF v n -� � a m �-n
� n �_ a--� i�. i i� i x a -
-37.-,Fina,I;Factory FireplaceR �_ •.. o I 1 In 2 at �v
x
^38. FinafPlumbing a,i�� I ..� �j�,�0 1 t-�^�1Ka R -+ M ��
39. Wat � Service-Final ri.- j � G' I I lir L> � ���~ u� A
.i ..
❑40. GasService-Final a'� a�' � < +sri � � la �r� :7v �
4 ��. •- .� n t 1 I<r o » ts a
r47. Solar pomestioFina�. ' � �� � I I It �� � "�O S a� J
42. BackflowPreventert; �i a� � � Mf � + �^- *}- ^
'� ' v t..1•.. �.... 4 rt �"1_'� # H
43. Backflowlrri,�tion� T« h '�Q �r Q�-
9� 7 Y +} x A .V / # �i �
'44. LandscapelrrtpatioirSystem�•'��� -� �" � ' 7�•:'� ° :� �n '� .� �
.. ,.r �., n a .+ aa -� ti* '�:+' 6c 'r
y �� -.. � ? .-i :'r� T i! f !� r. 1�S! A 7 r ... tT.0 A
45. fSound P,�ctenuation�, �,,,, q ,,y .T na r c�r a. �n a
46. �Nandicap•Reg�lations � %'t � � H x � '� 7•� � T
ti �•- a�.n � r� a
T7.`FINaLSTRUCTURE&BUILDING •• x� ����� y i`` v. ? ,_
48..FINALPLANNING7 i�-:- �+^� I I aci r *� s �t �--
d. � r r1 n .v d T
�49. `Elecijic Release to ECison � f l � . et n� s � �r
•n a
u50.•Gas�Release to Southem CaliforAia�Gas Co Q I I tt� � �• •im ;i � .
. - u ., , n c. n �
�51. CER7IFICATE OFOCCUPANCY �+ � fi `� ' -' • ' � �
No. Date
' � / Q�8
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. �OX 917 C06TA MEBA. CALIRORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING ?'QSS Je�nJ� r/�( ,
A�DRE55 n
C05TA MESA CALIFORNIA
Eenedict
7EL.
ZB NO.
TEL.
�� NO.
APPROVED
G`�p. ,R."}'-ry� ��, �j
E.. dA�rr'�,r �i] �LUJ
r�nr i � �ssp
��INr;I�tCE D�PT.
C1T1' OF COStA i,1fSA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
neceivr NO. PPRlrly'�(M�
OY
GOSTA MESA, CALIFORNIA
r ZONING
{� ZONE NO. OF U6E OF NEW t�J i
.8 1 y �/ I PLANB � I BUILDING w/`�
TEL. �� r ti�6.. lE6Al .. .� _.
SIZE I NO, OP BLD68. ' .�--��
OF LOT i HOw oN LOT p, p, NO.
USE OP YARDS EVES
EXISTING BLtlG -- APPROVEO ALLOWED
88TBACK LINB VROM ICENTeR LIHs BT.1 ��
esxTea OF eTpCGT � REAR YARD i� FRONT FT. IN.
SIDE YARD I�-eFr 5� IRIGHT l� R.61DE S FT. IN.
DESCRIPTION OF WORK ,_
L. SIDE ✓� � FT. IN.
NEW IIALiERAT10N I IIADDITION I REAR 1� FT. Z IN.
REPAIR I � MOVING I II �EMOLI6H I BYPROVED�� DATE '1 /y 6Z-
BIJILDING^....I..w NO. OF / �
EXTERIOR'
COVERING
U9E oF BU
l — S
1 H8fi8BY ACKNOWLHOOe TXAT � HAVH R6AO THIB APPLJGTION
ANO HtAT6 T14�T TNP I�90YE I6 CORRECT ANO AOREB Tp CCM.
PLY WITH ALL �T'I ORDINANC6B AND BTAiB L�L�f186ULATING
BIlILO1N0 CONBTR/U��n ON. A �/"
SIGNANRE OP/ / / �. ./ ///% / i i �//
.. %.�h %� — i�lJ� a •
TNH AMOUM BXOWN UNOER VALl1�T10N 18 FOP THB
PURPDBB OP 68TABL16HING � FlEqMIT FEE ONLY.
�s 19,�55.00
'AUTHORIZED AG� ' r-/l� l�. I4
TOTA�. FEE S 7 iY� C/