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Pp0'4CiADOflESS: 9,�2 JUr]IPERO DR
"�NFfl'SNFMF. PORTER, CHARLES DEWITT
aooRess: pORTER, J DIANE
942 JUNIPERO DR
COSTA MESA,CA 92626
RPCH/ENGMEEfl: 5 4 6— 8 C 1 3
flEG.NO.:
FODPESS:
UNIT:
UNIT:
PEflMITTEE: CHARLES PORTER (7143546-6013
nooxess: 99z JUNIPERO DR
COSTA P9ESA CA 92626
LICENSEO CONTBNCTOH �ECIAXPTION: I hereDy a�hrm ��a� I am licensetl under pmvisions ol Chapter 9(commencing wi�h Section
]000) ol Division 3 of Ihe Business an� Pmtessions CoOe. antl my license is in full to¢e an0 etfec�.
ciTr uc.: srare uc.: cuss: EXP ;
�ate: Signa�ure:
WOHNEflS' COMPENSRTION OECLNflATION: I her¢by aflirm �hai I have a terlilita�e 0� Consen� fo 5etl�insure or a CehifiCate of Workers'
Compensation Insurance. or a cenilietl covY �hereoi (5ection 3800. Lab. C).
POLICY NO.: E%P. DATE:
COMPPNY:
❑ Ceriified w0Y is hereby �umishe0. ❑ Cetli�iea copy is file0 with �Ae ciry BuildinA Oivision.
Oate: Npplicant
ENEMPiION FFOM WONRENS' COMPENSATION DECLANATION: (Thi55eqion neetl nOt be campleied if t�e permil is �or one hundretl (5100) ar less).
I ce�ily Iha� in Ne pedormance of Ihe work for whicA Ihis permi� is issued. I shall no� em0loy any person in any man� as to become
sublect to �he Workers Compensatmn Laws ol Calilorma _�
`��2���� /������ �
Daie
�i70TICE: IL afler makmg �his tl a ecome suhlecl �o �he WOBers ComDenSaiion provisions ol IAe Labo�
CoOe, yau mus� Iorihwith com with 5uch provisions or Ihis permi� shall be tleemed revoke0.
CONSTPUC710N LEN�ING RGENCV: I hereby affirm that ihere is a constmction lending agency for the pertormance ot �he work for
, which ihis pe�mit is iSsueA (Sec�ion 3097, Civ. C�.
LENDEN:
ADOFESS:
OWNEB BWLOEFl oELLAPPTION: I hereby aliirm ihat I am exempt tmm ihe Coniractors' State License Law tor the following reason
(Section 7031.5 Business antl Pmlessional Cotle'. Any ciry o� county which requires a permil to constmci, al�e�, improve, tlemolish, ar
repau any stmc�ure, prior �o its issuance, also repuires ihe applicanl for suc� permit ro file a signed sta�ement tha� he/she is licensetl
pursuant �o Ihe orovisions af Ne Cantmctors' State License Law (Cnapter 9(commencing with Section 7000) of �ivision 3 of Ihe Business
anU Pmfessions Cotle) or �hat he/s�e is ecempi t�ereirom antl the Dasis fo� ��e allegetl exemption. Any viola�ion o� Seciion 7031.5 �y
any applicanl �or a permit subjects t�e applicant Io a civil penaliy of nol more Ihan �ive hunOreO tlotlars (E500).
I, as owner of the propeny or my employees witn wages as Iheir sole compensation, will tlo ihe work. antl Ihe
❑ stmdure is nol inlen0etl or o��eretl tor sale (Sec�ion 7044, Business and Pmtessional Code: T�e Contracmrs' S�a�e License Law
tloes no� apply Io an owner of a propeny who builOs or impmves thereon, antl who does such work himself/hersel� or throupA
his or �er awn employees. D�ovidetl that 5uch impmvemems are noi in�en0etl or oflered �or sale. Ii, however the Duilding ar
improvement is sold wiihin one year o� compleiioq Ihe owner will have Ihe bur0en ol pmving he/s�e tlitl no� Euild or impmve
lor the pWpose af sale�.
I, as awner oi �he pmperly. am exdusively contracting wi�h licensee conlradors to conSVuct the pmlec� (Sec�ion 7044, 9usiness
❑ antl Pm�essions Code: The Commc�ors' S�ate License Law does no� apply to an owner of DmPerty w�o builOs or impmves Ihereon
antl who coniracis for suc� pmlecls wi�h a canVactar�s�license Oursuant�a the Conlraclors S�ate license Law�. I am aware
iha� pmo� ol t�eir Worker'S Compensa�ion insurance shoul0 6e proviaetl �o me.
� I am exempi untler Sec�ion: 9. 8 P. C.
�or mis reason: B p 7 � 9 4
PG� � ALL idORK BY OWNER�_�
I tlo hereby certify Ihal I am aware ol antl undersiana the req emems o� Calilomia He�antl Sa�ery Code Sections 255�5, 25533, and
25534 antl �hat I or any �uNre builtling accupanl will/will no� (circle one) neetl �o comply with said state cotles and the reQuiremen�s for a
permit lor cons�mclion ar mo0ihcation tmm ��e Air Qualiiy Managemen� Oistricl. ReSitleniial constmc�ion apPlications are exempt fmm
ihese pmvisions.
�ale', AppliCani:
I hereby certify Ihal I �ave reatl ��is application and s�a�e �ha� ��e above inlorma�ion is correcL I agree �o comply wi�h all city antl counly
ortlinancesantlsla�elawsrelatingto�mltlingconstmctionandherebyaNhorizerepresenlalivesolihi ove-mentioned
pmpe�ry �or Inspeclion purposes. �� —
Driver's License o� Social Securny N: �
16aba6 H'hlte—Bmltlmg�, Green—Cotle Enforcement Canary—Applicant: Plnk—Fevenue; GolOenrotl—Assessor
CITY OF COSTA MESA — HUILDI*7G PEP.MIT PERM P70; B 07000:
PERMIT NO: B 070003 PLAN CAECK NO: N GOVT: Pl SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRII'TION : T/OFF RESHT, REROOF W/COMP. SQ FT: 3,800
CLAIM VALUE: 3,800.00 CALC—VALUE; 3,800.00 GROUP OCC: P,-3 /
COMPIENTS: SMOKE DETECTOR REQUIRED PRIOR TO FINAL
x**+�*�*��**�*�***r�r��**�rx�***�**��.***x �*�+�?�**+�;��t�s��c*****�r��*�;�����c��**��c****��
Z O N I N G R E Q U 2 P. E M E N T S
S E T B A C K 5
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FANT; cT IN REAR; FT IN FRNT; FT IN AEAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGAT: FT IN
PARKING REQ; PROV: PARCEL: 19132224 ZNE: REF NO;,
PLANNING NOTES>
>
+t-+FiE«*i�iE*+E+t�i�*�t�F*?t�+t�tE**.*+t#�x�rit**�7f*#+t�c*�f�E�tit+c*-,f-*ac�***w-�(*+E**s**x�***�x+r+F*u��K�ar��c**+�*�f+�tt+t
D E V E L O P M E N T S E R V I C E S R E Q Il I R E M E N T S
ZONING APeROVED HY DATE: �
�BUILDING APPROVED bY : DATE:
APPLICATION ISSUED BY: ��i _ DATE: ���%�
3EiEifafif�EaFiFiEafiEiElfdFlFiEsiFMif+tY� 1r ' iE f itiE itffF��c +E�f1tiE�EiraiitifM K iF
#iFifififiF�lEifiEiE�ki4rMiF+Fif?fifi4�fE�N-iElEMififiF+f�YifaE#fiEifaf+c?E4V�ffiEitl!' stit�M�iF ifr�l4afac#iEaFiEiF>E{c?EifiPiF+f3f�lEitiEiEiFitil�ihaciEiE
LEGALIZATION:N F E E 5 U M 1 STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHAP]IC FIRE SMIF/AES GRADING
�ERMIT 63.00 ,50
SMIP /AJC�N—RES
�LAr�
ISSUE FEE
BUILDING—PI�'—> PERMIT ISSUE PLAP]—CHECK
TOTALS----> 63,50 Q.00 0.00
REVENUE DIPISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECiiANIC
63.00
TOTAL PAID DUE
63.50 63.50 ,00
63.50 OVER/5HORT: ,00
FIRE SMIP/TOT GRADIPdG PLAN—CHECK
.SU
V�iE ifiE if jE if it af it M i1 ik* itjF iEiF if iE iE iE af if iE 1f iFif if iF �?E ifif if% iE 1E if ifjf�Y 1f +t+f if-tf *�G <+'��f +E 4# M� K if 1f if IE 3FiEit if +t-ifiF 4 if iEih+f 1f iE iF +F Y�
I N I? 2 C� I D U A L F E E B R E A K D O Sa N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 380Q ftEROOF BY L'ALUE RESIDENTIAL NOZQNE 1.00 3,800,OQ
END OF FEES
ni 6gi7Yia3-6U.t722S4 't'+_e'p'
oare= zii21194 iit9E: 11-33
� CONS7RUCTION AN�PLANNING POOL °A
� APPROVALS Permit # Oate Inspector pppROVALS Permit # � Date Inspector
1, Tempora�Y Electrical Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Refnforcement
3. Electrica� Condu(t Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electricai Bonding
5. S[eel Reinforcement 56. Rough Plumbing & Pretsure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrica! Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, l7 Undrgmd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd,
10. Structural Floor SYstem 67. APPROVAL TO DECK
11, Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Finat
i
13. Roof DrOins 64. Plumbing System - Final
14. Rough Pfumbin9 65. Etectrica4-Finat
15. Rough Electr�cal�Condu�t 66. Solar Syst>m�Finai
16. Rough E�ectric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOS2 PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTeM1iiS FiNAL
19. Rough Heating & A�r Conditionin9 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Oucts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping C7Gas ❑Oil
23. Gas Pipe-Rough & Tes[ 72. Underground Flush
24. Roof Framing 73. Underymd.StorageTank GGas ❑Oil
25. Roof Sheathing 11_7Q,qY �w� 74, Overhead Hydro
"�- l
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 76. FIRE PREV. FINAL
30. Drywall Naiiing -• HEALTH DEPT. REOUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power MeterFirml 80. FOOD CER7IFICATE ISSUED
33. finai Electric � , Notes:
34. Finai HeSting & Air Conditloning .
35. Final Gas P�Pe•Test
36. Hood or CanopY
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Sola� Domestic•Final
42. Backflow Preventer
43. Backflow Irrigation
44. landscape IrriGation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 3/C�Lj � C��
L7
48. FINAL P�ANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
No. Dace
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide thery� jor labor and materials for construction of the pro-
posed praperty improvement. !�d"Yes ❑ No
2. I(have/have not) /-RA�.i4 _ signed an application for a building permit for the
proposed work. —�-s�����
3. I have contracted with the following person (firm) to provide the proposed construction:
Name _
Address
Phone (
City
Contractor's Lic. No. _
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address
Phone (
City
Contractor's Lic. No..
5. I will provide some ot the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name
Address
Phone
Type of Work
I hereby attirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code a ave com I he above information to the best of my per-
sonal knowledge, in co N'
Si��/ i Date: �� Z� � (
Name: �il*�+'s�f/l/3 fQ/�CT�
- (Printed or Typed)
C.D.I. }/ or S.S. #�
754-5273
10d2d8
.. ���_��
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O• BOX S17 COBTA MEBA. CALIFORNIA
For Applican+ fo Fill In Complefely
TYPE OR PRINT
EXTERIOR
COVERING
U5H OR BI
COSTA MESA. CALIFORNIA
fi. Coast Highway
del Mar
1 n_ �'R � �
NO. OF BLDGB.
8 FROM I� �
RPeai �pt REAR YARD �
ILEFT S/ I RIGHT �/
DESCRlPT10N OF WORK
;1
OHEPEBY�KNOWLB
AND BTA TMAT TN8
PLY WITX ALL CIiY
BUILDINO GONBTqU �
81GNATURB OP
PERMITfE
AUTHOFIZED AGENT
NO. OF
e��� ����n�.���,
�" 4EC ? '�'�
F P ANCE DEPT.
�ot 39 PGA�/ ��r���COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECHIPT NO. ,P��Tt�� �
� �
N6C 8D OY pATE R8 IV D D�TH IBBUE�
� �r�-� �P r,� � i�er;
woo EI6b 942 Junipelo Dtive
COSTA�MESA. CALIFORNIA
;�".E �e� ✓ ,.e,.,,e � � Ca-
APPROYEO
ZONING
ZON6 I NO. OP I 119H OP N8W
R�1 PlAN9 2 BU�LDINO W
L60AL V _L ... A '�J _ .L
YARD6
APPROVED
� (C6NTHR LINC BT.)
EVES
3 3
TXAT 1 HAVB HEAD ill APPLIGTION' Tryg AMOUNT BHOWN UNO¢P VALUATION IB ppR TM¢
>V8 18 COfiRSCT AND OR£6 TO CAM- pYRP09E OR E9TABLI6HING A vBpMIT PEB ONLY.
iANCEB /�ND HTAT6 9 p8011LATINO .. —
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