HomeMy WebLinkAbout433 OGLE CIR - Building Permits�
�
CITY OF COSTA MESA
`�§YAMps,9 , :� BUILDING DIVISION
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i� � np" 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
� ' g FOR INSPECTIONS CALL: (714) 754•5626
°`"•^�°fi PERMIT NUMBER: BC11-00378
PERMITTYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 08131I2011
ISSUED BY: KJB
JOs ao�REss: 433 OGLE CI CM
APN: 42514313
Vicinity: SECOND FLOOR
Const Type: V-B
Zoning: , ,
SQ. FT: 741
Suite/Unit:
Primary Occ: Dwellings, 1 and 2 Family
Valuation: 565,000.00
SCOPE OF WORK: ADD A NEW 617 SF SECOND STORY W ITH (2) SECOND STORY DECKS (106 SF) AND 17.5 SF ROOF OVER
ENTRY. FAU < 100 K BTU, REPAIR/ALTER DUCT, 1 VENT FAN, 8 LIGHT FIXTS, 17 OUTELTS, 12 SWITCHES, 1 SHOWER, 1
WASH BASIN, 1 WATER CLOSET. �
NEW BEDROOM WITH BATHROOM, DAY ROOM AND 2 DECK AREAS.
MM-09-17
OWNER: KEEFER, THOMAS E TR
Phone:
APPLICANT: FISH, JAN
Phone: g49-248-1741
Atldress: 433 OGLE CIR
Ciry/Slate/Zip: COSTA MESA, CA
Atldress:
City/State/zZip:
CON7ftnC70R: ROBERT FISH GENERAL CONTRACTORS License No. 433759
Phone: 849-248-1741 Address: 31722 AVE AVILLAUnit:
Cell: City/State: SAN JUAN CAPISTRANO, CA
ARCHITECT:
ENGINEER: VERTREES A AND E
COMBIIYATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
'Monday thru priday -7:00 am thru 7:00 pm.
License No.
License No.51908
$486.69
$748.75
$6420
$59.45
$52.90
$6.50
$0.00
$3.00
51,421.49
Unit
Unit :
ZipCode 92675
PHONE:
PHONE:714-255-9645
�CTIVITY: EFFECTIVE 3/18I2010 - PER CMMC Sec. 13-279
9:0o am thru 8:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
oendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, suctr work must comply with all applicable codes, and all
required inspections and finai approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permil.
COOE k. INSPEC110NTYPE �AiE INTITALS CODEN INSPEGiIONTYPE OATE 1V�� INTITIpLS
i816 Fixed System Final Fire Prevenlion 206 Final Mecbanical -,,� �. l_y_ �� •'/
1266 Pool Sp� Final 208 Final Plumbing �- -i4-la- �
200 Final Re.Roof 210 Final Elecirical �,� - 1i+ '/�' �
201 Final8lq�p/Retaining Wall
202 Final Faelory Fire Place
203 Final Siyn
204 Final Demolition
212 Final Fire Prevention
220 Final Planning Approval
222
250
FinalSite
Final Building/Occupancy �G � " � y ' � �'�
�
WORKERS' COMPENSATION DECLARATION:
1 hereby aKrm under penalry of perjury one of �he following tleclarations:
❑ I have and will maintain a certifcate of consent to sel4lnsure fonworkers'
compensa�ion, as provitled for by section 3700 of lhe Labor Code, for the
peAormanCe of lhe vrork (or which thi5 Defmil is issUed.
❑ I have and vnll maintain workers' compensation insurance, as required by
section 3700 of the Labor Cotle, tor the perfortnance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier: � , �✓.o
(Tn6 sMon neetl rrol Ee mmpered atne pemirt a vahietl al me nuntl.etl da9ars (5100) wless )
Policy Number:
❑ I certify that in ihe peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
ro the workers' compensation laws of California, and agree that if 1 should
become subject ro the vrorkers' compensation provisions o( Section 3700 0(
the Labor Code, I shall forthwith comply with Ihese provisions.
`���� � �.�1- �.., �
ApPlic3nfs $ignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
(5100,000), IN ADDITION W THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 of the 8usiness and Pmfessions Code, and
my license is in full (orce and effect.
Lic. # �!.��� ��j ��// class tt p_��/��—
/ i /Le �C �7h/is �J '—b!/" "LCJ!/
°' ��ure Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that ihere is a construcibn lending agency for the
peRormance of the xork fa which Ihis pertnit is issued (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Atltlress:
SignaWre
OWNER-BUILDER DECLARATIONS:
1 hereDy affirm that untler penalty ol perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing rea5on (Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a permit to
construct, alter, improve. tlemolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signed Slatement
that he or she is licensed pursuant to the provisions of the Contractors
l.icense Law (Chapter 9(commencing with Section 7000) of Division 3 0( ihe
Business and Prolessions Code) or that he or she is exemp[ therefmm and
Ihe basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant lo a civil penalry of not more than
five hundre0 dollars (5500).�:
❑ I, as ovmer of the property, or my employees�with wages as their sole
compensation, WILL DO THE WORK, and the stmcNre is not intended or
o((ered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apP�Y ro an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, pmvided lhat such impmvements are not intended or offered tor
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burtlen of proving tha[ he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the pmperty, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business and
Professions Cotle: The contractors License Law does not apply to an ovmer of
pmperty who builtls or impmves thereon, and who cont2cts for such project wilh
a contractor(s) license pursuant ro Ihe Contractors License Laws.).
❑ I am exempt unaer sec.
Business and Pmfessions Code for this reason:
SiqnaWre Dale
305]A6 (3I01)
Owner ID verified by tlrive�nse. 0 Ves ❑ No
Driver's License No. Expires:
Verification of Ownership by (type Lf documedt, i.e. - property taa bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify that no excavation frve (5) or more feet in depth iNo which a
person is required to descend, will be made in connectbn with work authonzed
by this pertnit, and that no building slrucNre, scaffdding, lalsework, p demolition
or dismantling thereof, will be more than thirty-s�c (36) feet high. (Chap. 32, Grp
2. Arl 2, Sec. 341, T�le 8, Cali(omia Administ2tive Code).
❑ As ovmer-builder, I will not employ anyone [o do vrork which would
require a permit fmm the Division of Industrial Safery, as noled above, unless
such person has a permit to do suc� work from the division.
Appl¢anfs Signalure
Division of Industrial Sa(ety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future building occupant need to file antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of �he California Health and Sa(ety Cotle requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Departmenl by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
a! standard temperaWre antl pressure�. ,
2. Does or will the applicant or preseM or fuNre building occupant need to file
a regislration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0! the Califomia Health antl Safery Code, with some
excep�ions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on �antl a quantity o( acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperaWre and pressure).
3. Does or will Ihe applicant or present or fulure builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazartlous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health and Safery Code provitles that the
Costa Mesa Fire Depariment may require the preparation, certifcation and
filing with Ihe Fire Department of an RMPP by businesses which are required
to register acutely hazartlous matenals with the Fire Department.
4. If an RMPP is presently requiretl. has Seclion 25534 of Ihe California
Health and Safety Code been fully complied wiih? ❑ Yes ❑ No
5. Does or will the aDP���ant or present or fuWre building occuDant require for
ihe work vfiich is Ihe subjec[ of lhis application a permit for such construction
or modification (rom the South Coasl Air Qualiry Management Disirict or from
any other air pollution coNrol disMct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires thal the requested
information be fumished on applications lor non-resitlential builtlinq pertnits).
6. Will any part of Ihe (acility to be constructed untler this permit be within
1000 teet from the outer boundanes of a school? ❑ Yes ❑ No
Qf'yes", the faciliry must meet the requirement of Sections 25534 and 42303
o( (he California Heallh an0 Sa(ery Cotle).
7. If a permit from the South Coast Air �uality Management District or other
air pollution contml district or agency is requiretl for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Satety Code Section 42303 been made? ❑ Yes ❑ No
8. pf "yes", attach certi(cate o! compliance (rom the appropnale air pollution
control oKcer).
CER7IFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct. I agree to wmply vnth all stale laws and
ciry ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state thai
the infortnation given is correct. I agree to comply with all slate laws and ciry
ordinances relating [o Duiltling constmction, and authonze representatives of
the City o( Costa Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow xcupancy o� any building
authorized by �his permit until f nal in5pection.
" Jl nnawreoll a neqs) Da�e
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8�/ I- d o378 .vSPECTION SERVI( :S y�3 0�� �- c�
ICC - ACI - CWI
: � 11732 QuaAz Avenue • Foimtem Valley. CA 92708-2530
714-330.2688 cell • 714775-3409 fex • ksjbwhistlet(a�eatthlink.oet
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REPORT
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WHITE.OFF[CECOPY, CANABY-OHSERVIIY3COPY. PINK-]OBSi'[ECOPY
No.
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October26,2011
Robert Fish Associates
P.O. Box 1465
San Juan Capistrano, CA 92693
Atm: Robert Fish
Re: Keefer Residence
Dear Robert,
�ROFE Sl�,y
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EX . 06 30 12 �
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S� CIVI� ��Q'
TF OF CA��Fo�
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1 have reviewed the structural calculations regarding the reduction of the [wo 2Y' shearwalls on each side of the garage door.
The walls may be reduced to 25" in to[al width. The double sided shear wall and hold down system has sufticient capacity at
2S' wide to resis[ the design lateral loads.
Please let me Anow ifyou require some additional documeniation.
Si rely,
J Vertrees, P.E., AIA
rchitec[ and Engineer
Verfrees A & E
Archi}ecfurol & Engineering Services
532 Ewf. Lanbert Rootl • Breo Co, 92821 • V 71 Q255.9645 • F 714.255.9646
PROJECT ._.IL�/�iY,✓�fC . .--•------------- ----- _. ----.....__- PROJECT NO..iZ �.- I
�ATE .- ___ ENGINEER __��___.______.___._ CHECKED BY `J_: �/ � _-___, SHT.____.. OF-._
a
From: "Alexander E.A." <AIexA@vertreesae.com>
Subject: RE: new photos
Date: November 4, 2011 9:09:28 PM PDT
To: <Robert.fish@cox.neb
Cc: "'Joe Vertrees"' <joe@vertreesae.com>
p 4 Attachments, 178 KB _o—
Robert,
Please see attached detail for straps from beam to wall and some LTP4's.
As for the deck and roof corners, strap is not necessary. Sheathing on top and tie plate at bottom are more than
keep the beams securely attached. There is no net load to pull them apart.
Aiexander E. Aguilar, P.E.
T:714-255-9845
C:323-833-2608
F:714-255-96q6
w'ww.vertreesa¢.com
From: Jce Vertrees [mailto:jce@vertreesae.com]
Sent: Thursday, November 03, 2011 9:05 AM
To: Alexander E.A.
Subject: Fw; new photos
Joe Vertrees, F.E., AIA
Vertrees AfrE
o: 7�4.z55-9645
F:7�4.z55.9646
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
PERMIT TYPE:
Sub Type:
��,�fJ�$��S CALL: (714) 754-5626
` �\
��,1 �y_� PERMIT NUMBER:
1f ��` T�;,
B_COMBO �� � STATUS: ISSUED
RES_ALT ` ATE ISSUED: 12107/2009
P`� �11� ISSUED BY: RMD
BC09-00144
�� ���oe aooReSs: 433 OGLE �F��ES Suite/Unit: �V"U 1�
APN: 42514313 Zoning: , , 1Lt.
Vic'rnity: SECOND FLOOR Primary Occ: R-3 � �� l�
ConstType: V-B SQ. FT: 741 Valuatfon�� $65,000.00
SCOPE OF WORK: ADD A NEW 601 SF SECOND STORY WITH (2) SECOND STORY DECKS (106 SF) AND 17.5 SF ROOF OVER
ENTRY. FAU < 100 K BTU, REPAIR/ALTER DUCT, 1 VENT FAN, 8 LIGHT FIXTS, 17 OUTELTS, 12 SWITCHES, 1 SHOWER, 1
WASH BASIN, 1 WATER CLOSET.
NEW BEDROOM WITH BATHROOM, DAY ROOM AND 2 DECK AREAS.
MM-09-17
OWNER: KEEFER, THOMAS E TR
Phone: 949-642-5602
APPLICANT: FISH, JAN
Phone: 949-246-1741
Address: 433 OGLE CIR
City/State2ip: COSTA MESA, CA
Address:
City/State/zZip:
CON7RAC70R: ROBERT FISH GENERAL CONTRACTORS License No. 433759
Phone: 949-248-1741 Address: 31722 AVE AVILLAUnit:
Cell: City/State: SAN JUAN CAPISTRANO, CA
ARCHITECT:
ENGINEER: VERTREES A AND E
License No.
License No.51908
COMBINATION pERMIT FEE SUMMARY
Building Plan Check: $486.69
Building Fees: $748.75
Electrical Fees: $64.20
Mechanical Fees: $59.45
Plumbing Fees: $52.90
SMIP Residential: $6.50
SMIP Commercial: � $0.00
Bldg Std Admin Fund $3.00
TOTAL FEES: $1,421.49
"Refer lo fee raceipts for all fees paitl for project
Unit:
Unit: :
ZipCode 92675
PHONE:
PHONE:714-255-9645
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenls under California statutes antl related
regulations. (Ord. No. g2-28, § 1, 72-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval wiff resWt in the expiration of this permit.
COOE R. INSPECiIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
OpTE� INTITIAL CODEN INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
ORTE IN1111AL5
� . _ � ,
WORKERS' COMPENSATION DECLARATION:
I nereby aKrm under penalty of perjury one ol the following declarations:
❑ I have and will maintain a certificale of consent to selbinsure !or vrorkers'
compensation, as provided for by section 3700 of lhe Labor Code, for the
pedormance of the work (or which this permit is issued.
❑ I have and will maintain v.orkers' wmpensation insurance, as required by
section 3700 ot the Labor Code, for the pedortnance of Ihe work (or which this
permit is issuetl. My workers' compensalion Insurance wrrier and policy
number are:
Cariier.>. � \ -
(Tnis ' need�rhemnpeteddmepemNavalue0afwrehundreddoears(5�00)aless)
Policy umber: � '7/ 3-• 0 0 0( �0 3/„�
❑ I certiFy thal in the pertormance of ihe work for which this permit is
issued, I shall nol employ any person in any manner so a5 to bewme subject
lo the workers' compensation lavrs of California, antl agree that if I should
bewme subject to the workers' compensation provisions of Section 3700 of
the LabqcCod� I shall forthvrith wmply with these provisions.
��- � /2-n7'09
Appli 1'S Sig_ nalure l � Oal��
�=—`' �'� :
RRNING FAIL RE TO� E WOR RS' COMPENSATION COVER4GE
IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINA�
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFtS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed untler provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 ot the Business and Protessions Code, and
my license is in (ull force and eftect.
!u`c�x'�'"�'7-�' 3375-`-i_ ctass;a � !3 — /
�� ��..
/,� - 7 —r�
nVact rsSiBnalure �Dy�ale
� � � ✓._
CONSTRtlCT10 ENDWGAGENCY:
❑ I hereby af(irm that �here is a consimction lending agency for the
per(ormance of the wurk fa which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atldress:
Oa�e
OWNER•BUILDER DECLARATIONS:
I hereby aKrm that untler penalty o( perjury that 1 am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit to
construct, alter, improve. Oemolish, or repair any structure, pnor to its
issuance, also requires the applicant for such permit to file a signetl statement
that he or she is licensed pursuant ro the provisions of the Contracrors
License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom antl
the hasis for the alleged eaemption. Any violation of Section 7031.5 by any
applicant for a permil subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).�:
❑ I, as owner of ihe property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the structure is not iniended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property v+ho builtls or improves
thereon, and who does such work himself or �ersel( or through his or her ovm
employees, pmvided that such improvements are nol intentled or offered for
sale. If. however, the building or improvement is sold within one year of
completion, the owneabuilder will have the burden of proving that he or she
did not build or improve for purpose of sale.�.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo construct the projea (Sec. 7044, Business and
Professbns Code: 7he contraclas License Law does not apply to an owner of
property who builds or improves thereon, antl wfio cont2cts for such pmject with
a contracta�s) license pureuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code tor this reason:
305]�a6(3/09)
� � ,
Owner ID verifed by driver's license. ❑ Yes ❑ No
Dnver's License No. Expires:
Verifcation o! Ownership by (type of document, i.e. - property �ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetldy Ihat no excavation Me (5) or more fee[ in depih into wfiich a
person is required to descend, will be made in conneUion with v.ork authorized
by this pertnil, and ihat no building simcture, scaffdding, lalsework, a demolition
or dismantling thereo(, will be more than thirty-su (36) feet high. (ChaD� 3.2, Grp
2, Art 2, SeC. 341, Ttle 8, Califomia Atlminist2[ive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division o! IndusUial Sa(ety, as noted above, unless
such person has a pertnit to do such work from the tlivision.
Applimnfs Sgnalure
Division of IntlusMal Safery Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future building occupant need b file antl
certify a Business Plan for emergency response to release or threatened
release oi a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
DepartmeN by every business which has at any one time during a reportetl
year a quantity of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard tempereWre and pressure).
2 �oes or will the applicant or present or future building occupanl need to file
a regisira�ion form for aculely hazardous malerials? ❑ Yes ❑ No
(Section 25533 of ihe Califomia Health and Safety Code, wiN some
eaceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazardous ma[erials equal to or greater Ihan a weight of 500 pountls, or a
volume ot 55 gallons, or 200 cubic teet of compressed gas at standartl
temperaWre and pressure).
3. Does or will Ihe applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program lor acutely
hazartlous materials)? ❑ Yes ❑ No
(Sec�ion 25534 oi (he Califomia Health and Safety Code provides lhal the
Cosla Mesa Fire Department may require [he preparation, certifcalion and
filing wilh the Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with the Fire Departmen[.
4. If an RMPP is presently required, has Section 25534 of [he Cali(omia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
lhe work which is the subject of this application a permit for such consvuclion
or motlifcalion from the South Coasl Air �ualiry Management Dislrict or (rom
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemmenl Cotle requires that the requested
inlormation be fumished on applications ta ran-resiaential building pertnits�.
6. Will any part o! the faciliry to be constmcted under Ihis permil be within
1000 /eet from the outer boundaries of a school7 ❑ Yes ❑ No
Qf "yes", Ihe faciliry must meet the requirement of Sections 25534 antl 42303
ot the Califomia Healih and Safety Cotle�.
7. If a permit from lhe South Coast Air Quality Management Dislrict or other
air pollution coNml district or agency is required (or [he work whith i5 the
subject of this application, have all of the disclosures prescribed by California
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes". attach ceAificate of compliance fmm the appropriate air pollution
wntrol officer).
CERTIFICATE OF COMPLIANCE: I certify that untler penalty of peryury the
infortnation given above is wrrecl I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
Signature Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read Ihis applicalion and state that
the information given is correcL I agree to comply with all state laws antl ciry
ordinances relating to building consWction, and authonze represeniatives of
the Ciry ot Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not ro occupy or allow occupancy of any building
autfiorized 6y this permit until fnal inspection.
�, �
SiqnaWreo(LegalOvmer(s) Dale
—Cte\-ct-s �%� . � /2 - O 7 - G 9.
Ane/or'AWImnZetlA� . Data`
. . ., �. , �"4,��
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 7600 AND AB 187
To: (/) Gity of Costa Mesa
( ) City of NewpoA Beach
( ) County of Orange
. li�O%-Lq`.1.�/'�'�M'�� iiiYl: .
-..,..�.,:w..�.w..d,� ��S'.:,;�,�.}R.�?::.�;{:R�,.; ;�
ooi-oo�o.�„k� : _
�1� 6951
l��b�
DisUict Receipt No.
�i/q/�
lan ChecK1V,��
Applic8nt (i(„�)L�lT � ( \ Y! C `�(.[�( �'v k � � �' �� �.....�rr �
Address: JI �Z(/ ( Uv ���'I�'-' ��✓1 ��� ��1���'L�/t-O- �AT � 2(2`� j
TelephoneNumber. ���-��{g�^ i7L�i
Tract/Parcel and Lot Number(s): yZ5- I�l �' ��
Location of Project:
Number of Square Feet o(:
ResidenHal Space
Commercial and
Industrial Space
Commercia�lndustrial Projed is: (Check One)
_ Warehouse
R8D
Movie Theater
Mini-storage
Heavy Indusirial
Regional Shops
Light Industrial
_ This projed is exempt because
�� � xS7.84
xS.30
_ Motel
_ Bank
_ Neighborhood Shops
_ RacquetMealth
_ Hotel
Medical Olfice
Office Park
Tota� `V�• (J�
7-
Total
Preschool
Auto Repair
Hospital
Large Office
Of6ce Bldg.
Restaurant
Fast Food
rhis ceRifies that the above-named Developer/Appficant has paid school fadtity fees n comp6ance with Government Code sections
53080 and 65995. The Building Permi� for this square footage in this proposed devel pment may now be issued by your jurisdic5on.
Checks are to be made payable to NewpoA-Mesa Unified School Distrid.
ey:
The ahove representaUon as W uare footage is We. A��
true, then this certificate sh automaticaiN terminate and
Date^r
�,. . .
agrees that ii k is later determined that such representations are not
�ropiiate City/Counry shall be notified.
May 18, 2010
CITY OF COSTA MESA
P.O. BOX 1200 � 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENTSERVICES DEPARTMENT
BUILDING DIVISION
EXTENSION NOTIFICATION
Robert Fish
PO Box 1465
San Juan Capistrano, CA 92693
PERMIT NUMBERS: BC09-00144
FOR: Additional Square Footage
PROJECT ADDRESS: 433 Ogle Ci., Costa Mesa, CA
This is to advise you that an extension on the above permit(s) has been approved by Bill
Nunes, Chief of Inspection. The extension is valid for 180 days. The new expiration date
is November 14, 2010. You must call 714-754-5626 for inspection at any time prior to this
date or the permit will expire. Additional fees will be required to reinstate expired permits.
If you have any questions, please contact the Building Division at 714-754-4871, between
8:00 a.m. and 5:00 p.m., and a staff member will assist you. We appreciate your working
with us to resolve this matter.
Sincerely,
�� �
Barbara J. wart
Office Specialist II
Builtling Division p14) 754-5273 • Cotle En�orcemem (714) 754-5623 � Planning Division (714) 754-5245
FAX�714)754-485fi � TDDpia)754-5244 • wvnv.ci.costa�mesa.ca.us
� ;, � � � � • • ' Page I of2
�ll,., �
ZWART,BARBARA
From: NUNES, BILL
Sent: Tuesday, May 18, 2010 12:34 PM
To: 'Robert'
Cc: ZWART, BARBARA
Subject: RE: Keefer Permit Extension
6 Month granted from 05/18/2010
�i�i �✓/rc�z�
City of Costa Mesa
Chief of Inspections
(714)754-5629
(714) 754-4856 Fax
bn u nes@ci. costa-mesa. ca. us
From: Robert [mailto:Robert.fish@cox.net]
Sent: Tuesday, May 18, 2010 10:57 AM
To: NUNES, BILL
Subject: Keefer Permit Extension
f�;r``--� �� ��r��r��t2
� �
& 6enera/ tontrartnr
May 18, 2010
Mr. Bill Nunes
Chief of Inspections
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92628
Ref: Building Permit #BC-09-00144
433 Ogle Circle, Costa Mesa, CA 92627
Dear Mr. Nunes,
0�/21/2010
Page 2 of 2
We are writing today, to request an extension on the above noted building permit. We have
been unable to start the project because the owners have been seeking other financing, and
the process has met with several delays, and consequently, us getting started.
We respecffully request an extension of approximately six (6) months. We anticipate no other
further delays. If you should have questions or need additional information, please feel free to
email or phone us. Thank you.
Sincerely,
Robert Fish
Robert Fish Associates
P. O. Box 1465, San Juan Capistrano, CA 92693 Phone: 949-248-1741
OS/21 /2010
J
o -�
f
NUNES, BILL
From: NUNES, BILL
Sent: Tuesday, May 18, 2010 12:34 PM
To: 'Robert'
Cc: ZWART, BARBARA
Subject: RE: Keefer Permit Extension
6 Month granted from 05/18/2010 ��
��!✓Y'�
City of Costa Mesa
Chief of Inspections
(714)754-5629
(714)754-4856 Fax
bnu nes@ci. costa-mesa.ca. us
From: Robert [mailto:Robert.fish@cox.net]
Sent: Tuesday, May 18, 2010 10:57 AM
To: NUNES, BILL
Subject: Keefer Permit Extension
May 18, 2010
Mr. Bill Nunes
Chief of Inspections
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92628
Ref: Building Permit #BC-09-00144
433 Ogle Circle, Costa Mesa, CA 92627
Dear Mr. Nunes,
Page 1 of 2
We are writing today, to request an extension on the above noted building permit. We
OS/18/2010
1
Page 2 of 2
have been unable to start the project because the owners have been seeking other financing,
and the process has met with several delays, and consequently, us getting started.
We respectFully request an extension of approximately six (6) months. We anticipate no other
further delays. If you should have questions or need additional information, please feel free to
email or phone us. Thank you.
Sincerely,
Robert Fish
Robert Fish Associates
OS/18/2010
P. O. Box 1465, San Juan Capistrano, CA 92693 Phone: 949-248-1741
�
PflOJECT A�OflESS: Q 3 3 pGL E C I
awxee�s xnrne: KEEFER THOMAS E TR
�nooeess: 433 OG{,E CIR
. COSTA MESA,CA 92627
(714)642-5602
AflCH/ENGINEEN: XEG.NO.:
ADOPESS:
UNIT:
UNIT:
PENMITTEE: HLUF. RIBHON BUILnERS ( 714 ) 581-3636
noosess: 23372 MADERO B
,NISSION VIEJO CA 92691
UCENSEO CONTBALTOfl DECIAPATION: I �ere6y allirm I�al I am licensea unaei pmvisions ot ChaO�e� 9lcommenting with Seciion
7000) o� Didsion 3 0l ine Busineu ane Pmiessians COEe. an0 my litense is in lull b¢e anE efled.
cmuc.: 0650q5 srnreuc.:23259 cuss B
Date: �� �I — / L Signawre: _ .'���C� _ —_
WOBKEBS' COMPENSATION OECLAflRTION: I hereUy atlir i I have a reniliwre ol consent to selbmsure or a certiliwte ol warkers'
ComDensation I1fs a0 e �j i�ie py Ihereol�5¢cli n 3800. LaE.
POLICYNO.: +��QL����� EXP.ORTE: S�OS�93
comrnxv: STATE FUND,.+,/
❑ Cendietl copy is nereby lumisnetl. L9 Ceniliea copy i ii A vnih ine ci�y Builtling ivision.
. Daie: � — / � — / � ApplicanL• � �
EXFMPTION FBOM WOflKEBS' LOMPEN511TION OECLAPNTION: ' setlion neeG noi Ue com01ete0 il �he perml is lor one hmqrN (51 W) ar less).
I[etlily that in the petlormance of Ihe work br w�ich t�is Dermrt is i55ue0, I SAall no� employ any Oerson in any manner so as �o became
subien to i�e Workers' Compensation Laws o� CaliPomia.
Oate'. � Signature:
NOTICE: II, aiter making Ihis Oeclarotion, you shoultl�6ecome Subletl m IAe Workers' Compensation pmvisions of the Labor
CoOe. y0u mUSi �ortliwil� tom0ly wiN SUth praviSionS or thi5 Oermii Shall �e Aeemetl revokeE.
CONSTflULTION LENUING AGENLY: I nerehy ailifm Iha� Ihere is a Conslmttion lendinp aAe�ty �or IAe pedofmanCe o� �he wOrk for
which Ihis Oermit is issued (Sec�ion 3097, Civ. C). �'
IENDEP: '
nooxess:
OWNEB BUILOEB OECIAFATION: I hereDy affirm �hai I am e�empt Imm ihe Comractars' State License Law far I�e lollowinp reasan
. �Sec�ian 703L5 Business ana Pmlessional Cotle: Any city of county which requires a permit b consimm, alter, impmve, tlemolish, or
� repair any s�mcNre, prior to iIs issuance, also reQuires I�e applicani for such p¢rmil to lile a 5igneA sta�emen� �ha� he/she is licensed
pursuam to t�e D�ovisions ol the Coniracmrs' State License Law (Chapter 9 �commencinp with Seclion 7000) ol Uivision 3 of the Business
an0 Prolessions CoOe) or Ihat �e/she is eKempt ��erelmm and Ihe hasis lor ��e alieped exemp�ion. Any violatian ol Section 7Q31.5 Dy
any applicanl �or a permil SUAlecis ��e applicantlo a civil Denal�y ol nol mOre Ihan �ive hUntlr¢a tlollar5 (5500).
I, as owner oi Ihe pmpe�Y a� my employees wiih wa9es as iheir sole compensation, will Oo ihe woB, antl ihe
❑ slmcWre is no� imenAeA or ollereU lor sale (Section 70a4, Business anA Pmlessional CaOe: The Coniractors' State Licenu Law
does nal apPly lo an owner oi a D�aDerty wha Ouilds or impmves Ihereon, and who tloes SucA wo�k �imsell/hersell or Ihmugh
his or her own employees. pmviUeO t�at such impmvemenis are not intentled ar oifereU for sala Ii, Aowever Ihe builaing or
I improvemenl is soltl within one year of campletion, ihe awner will �ave I�e burEen ol pmvinA helshe ditl not huiltl or imD�ove
lor Ine puroose of sale).
I, as owne� ol Ihe pmpetlp, am erclusivel9 conVactinp with licensed conVactors �o consimct �he prolecf (Section 7044, Business
❑ an0 Profeuions Code: The Contra[lor5' Slale Litense Law ADes nol apPly �o an Dwner ot prop¢riy who bwltls or impmveS Ihereon
ana who tOniraps �ar SUth O�oletls wiih a coniratlor�s) litense pursuanl lo Ihe ConVat�ors' Sta�e License Law�. I am awar¢
ihat proof of Iheir Worker's Compensation insurance should be o�oviAeU to me.
� I am e�empl unEer Senion: 8. 8 P. C.
for inis reazon:
Date: Owner.
1 tlo nere�y cenily I�ai I am aware of antl untlerstand t�e reQuiremenis ol Califomia Heallh an0 Sdfery CoEe Sections 25505, 25533, antl
25534 anG IAaI I ar any IWure Uuilaing occuDant wilUwill nol (circle one) neeG ta comD�Y ��� sai0 state coAes an0lhe requiremenis lor a
permi� lor consimction or moJilicalion Imm Ihe Hir Oualiiy Managemenl �isVicl. flesi0enlial consimction applicaiions are exemp� irom
ihese D�ovisions.
Oate: Applicanl:
IhereUy c¢�Idy��al I �ave reaG Ihis ap0�icaiion antl slale�hal ihe aboveiniarmation
ortlmances ana state law5 relatinq lo builGinp conslmclion an0 �erehy authorrze repre5l
pmDeny lar inspeclion purposes.
ua1e: / � �� — ` Z— SignaWre: �
orivers �icense or Sociai Sewriiy
ant: Pink—Revenue: GobemoE—Asuxwr
CITY OF COSTA MESA — BUtLDING PERMIT PERM NU; b 5'Uj4
PERMIT, NO: B 059034 PLAN CHECK NO; 03031-92 L G ; N S 1�Y; N
CONSSI'RUCTION TYPE; 5—N PERMIT TYPE; STR PURPOSE: ADD
:70B DESCRIPTION ; ADD FAMILY TO EXISTING SFD SQ FT: 347
CLAIM VALUE; CALC—VALUE; 25,678,00 GROUP OCC: R-3 /M-1
COMMENTS; SMOKE DETECTOR(S) RE�UIRED IN HOME,
�*�***+��r**���r�**���*+���*r*�x** *�***x�*�r**��xx-**��r****�r+�*�**�r�r�r*�r��**�r*��*****�
Z O N I N G R E Q U I R E M E N T S
sETBAcxs
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDIiJG ---------
FRNT; FT IN REAR; 18 FT 6 IN FRNT; FT IN REAR; FT IN
LEFT: 5 FT IN RGHT; 55 FT IN LEFT; FT IN RGHT: FT Ih
PARKING REQ• PROV• PARCEL; 42514313 ZNE; RI REF NO:
PLANNING NbTES> 347 SQ. F'T, ADDITZON TO AN EXISTING DWELLING TO ADD FAMILY
> ROOM,.400 SF REAR YD COVERAGE OR• 19 SF PROP.
iF ik if if i! if ik iE i! iE 1f iF if fEiFlF iE iFlE �F.3Fif iF it iFif !f if i6 iE iE �f !F ik M�lf 1E iE ik if ik 1f ik i41f 1E iE fk �E �Fit dk k i! 1E iE 1Eik iFlE 1f ik 1E 1F ik lE iElf i(� it iE i! iE iE iF ii� le �E 1f
D E V E_ L 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
ZONZNG APPROVED BY� "_ -" �� DATE; 6 1—
BUILDING APPROVED BY ;� DATE;
iE iF ik iF iE it iE !E iE if iF iP�JF 3E if iElE �F jF
LEGALI'LATION;N
BLDG PMT
PERMIT 258.50
� '`�� j'` *x.�t*D*�*�tar i �1 i�x-�
1Elk if� tl�iE-lE iF iE 1f iE if 1E if iE if i! if !F iE ih iE if !E iE if ik 1E 3f 1FlF iF Ik iE iElE if !f 1E %1F1E lh ih iE 1f !E 1f iE iElE 1E IE IE 1E iE if ih iE
F E E S U M M A R Y STRUCTURAL SEGMENT;Y
PLUMBING ELECTRIC•`' MECHANIC FIRE SMIP/RES GRADING
' � � 2.57
PLAN 168.03 ��:, � ' SN,IP/NON—RES
ISSUE FEE �
BUZLDING—DIV—> PERMTT ISSUE PL'AN—CHECK � T'OTAL PAID DUE
TOTALS----> 261.07 0.00 "168,03 429,10 429,10 ,00
REVENUE D'IVISION 'TOTALS--> COLLECI'Eb: 261',U7 c�VER/SHORT; ,00
BLD58P50 PLUMBING ELECTRIC MECNANTC • FIRE SMIP�TO� GRADING PLAN—CHECK
i •
�E iE i(- iE 1F 1F iE 1E 1F iFlE iE 1(� if iE iF iFlf iE ih iP if IE iE iE if ib if iF If iE iE 7E ik iE 1h iE iF if if,iE iF iE if if ih iF if !E it �(� iE 1E iE 1PlE ik ik �E if �k if iF iE iE if 3F iE 1E 1E iP if iE if if iF iF ik 3k
I N D I V I D U A I� �;• Fi E� E-� B R E A K D O W N
TYPE �, �. QTY D E S C R 2 P T I O• N, ,. UNIT COST TOTAL COST
� � (
SFR � 347 DWE—TYPE V—WOOD�FRPME '�� —GUOD 74,00 25,678,00
fiND OF'FEES
[XPIRED . � '
��1C0lf' I6� lf75i�Ct10fiS _ .
� � $Ig ���=�
� �
1
i
, , �
•�� - i ,-. _ �
CONSTRUCTION AND PLANNING P� -'& SP�' �
I�PPROVA�S Permit # Date Inspector qppROVALS Permit # Date Inspector
i. Temporary Elecrrical Service or Poie 52. Pool & Equipment Location
2, $oil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit UtilityUndrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electricai Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. Z. 57. APPROVAL TO COVER�GUNITE
� ��1/9�-}-
7. Footings ��n/(t'�� 58. Electrical Conduit•Undrgrnd.
L /�
8. Foundation 59. Gas PiPe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. St�uctural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & House Con�ection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing System � Final
14. Rpugh Plumbing 65. Etectrical-Finat
15. Rough Electrical-Conduit 66. So�ar System�Final
16. Rough Electric Wiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR P�ASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYS7EMS FINAL
19. Raugh Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. iiough Facmry Fireplace ". APPRQVALS Permit #
21. DuCts,in Structure 70. Underground Hydro �
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil �,
23. Gas Pipe�Rough &'Test 72. Underground Flush ' �
24. Roof Framing 73. Undergmd. Storage Tank O Gas O Oil �� ��
25. Rpof Sheathing �� � 74, Overhead Hydro '
..
26. T•Bar Ceiling (Structural) & Monocoat �5. Dry Chemical , �
27. Frame and Flashing �- 76. Dry Standpipe �
28. thi Siding . ry �j� 77. FIXED SYSTEM FINAL �
�
2. Insulation 2 t1 �� i 78. fIRE PREV. FINAL �
30. Drvwall Nailing, �� � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �7� 79. FINAL INSPECTION
32. Electrical Power MeterFinal � ( 80. FOOD CERTIFICATE ISSUED
33. Final Electric . � i � Notes: ,��_� �
34. Final Heating & Air Cooditioning f y } AT�y ���, -,�� �` �
( i!/
35. Final Gas Pipe-Test �� �
- f�-�� 3-t
36. Hood or CanopY �
37. Final Factory Fireplace 1 • ��� _-��, �,�p� �,��
38. Final Plumbing • � � � `
,/ / 1 'Z� - �, $ ' 9r'.�-_
39. WBter Service=Final � I ,r jM //� /� S� `
v � t1 (_,,�1c�, �j--GbS- •
40. Gas Service-Final � v
� %-Z 3=1 �''-�
41. Solar pomestic-Final -
42. Backflow Preventer � � !
i
43. Backflow Irrigation .
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. FINAL PLANNING
49. EleMric Release to Edison � .
50. Gas Release to Southem California Gas Co i � {
51. CERTIPICATE OF OCCUPANCY
No. Date
�
�
� ,�
�
�
�
PXOJECT AODNESS: Q 3 3 OGLE C 1
OWNEfl'S NFME: KEEFER TIiOMAS E Tk
� AOOPESS: t� 3 3 OG{.8 C I R
COSTA MESA,CA 9262'7
(714)642-5602
pflCHIENGINEEfl: flEG.NO.:
ROOHE55:
UNIT:
UNIT:
PEPMITTEE: HLUE RIBBON BUILDERS ( 714 ) 581-3636
aooxess: Z3372 MADERO B
MISSION VIEJO CA 92691
LICENSEO CONTflFtTOB OECLABATION: I hereby af�irm lhai I am licensetl unaer pmvisions of C�apier 9 �commencinp wilh $ec�ion
7000) ol Division 3 0l Ihe Business antl Prolessions Cotle. ana my license is in �ull lorce anU ellec�.
cm uc.: 0 0 6 5 0 5 srnre uc: z 3 y 5 c�ass: B� // ,
Oale: �— � � — �� Signalure: /� � �e�f���J
IWONNEPS' COMPENSA710N OELLANA710N: I hereby altir/p�ihat I have a cetlilicate af consent to sel6insure or a certificate oI Worker5'
ICompensation I{'s aqce ifieg�Q pY inereoi (SectMn 3800. Lab .
POUCY NO.: +�•� 4���� J L E%P. ORTE: I I O i I 9 3
comraxr: STATE FUND�+.i
❑ Cer^litie0 WpY is heBby lumished. L9 Cerli�ietl c is filetl wit� ihe city /B�u�Itling DivisiDn.
Oate: / � ` � � � AODlieanC �'� `"'"���
E%EMPIIONFPOMWOflNEflS'LOMPENSATIONOECUflRTION hi55eclionneeEnolGecomple�eAillAepermi�isforone�mkrcd�E100�orless�.
I ceriily (hat in ihe pedormance of the work for which I�is ermit is issue0. I shall not employ any person in any manner so a5 io hecome
sublecl lo Ihe WorkerY Compensa�ion Laws o� Cali�ornia.
Da�e: SignaWre:
NOTILE: II. atler making this Aetlafa�ion, y0u S�oula DeCome Su�le�� �o t�e Workers' Compensation provisions ol tne laeor
COAe. you must lorlhwilh comDly wi�� such provisions or ihis Dermit shall be tleemeA revake0.
COkSiBUCTION LENOING �GENCY: I herehy aflirm inat there is a consimction lenaing agency lor ihe Oedormance af ihe vrork for
which Ihis Dermi� is issueE (Senion 3097. Civ_ C�.
LENOEP:
aooecss:
OWNEfl BUILOEfl DELUMTION: I �ereby a��irm I�ai I am exempi �mm t�¢ COntraCiors' State License Law for ihe iWlowinp reason
(Senion 7031.5 Buvness and Pmtessional Cotle: Any cily o� caunry w�icA rtpuires a De�mii to cons�mct, alter. impmve, 0¢molis�, ar
repaii any Slmtlure. prior to its issuante. al5o requires ��e appliCani tor Sut� permii to �ile a SigneO S�a�emeni Ihal he/S�e is litensed
pursuant to ihe Dmvisions ol the Coniracmrs' State License Law (Chapter 9(wmmencing vnt� Section 7000) oi Oivision 3 ai the Busineu
and Proles9ons Cade) or Itut h¢/she is e�emp� �herefmm and Ihe ha9s Ior ine allegea eeemD�ion. My violation of Section 7031.5 by
any aD7licant tor a Dermil subjecis ihe ap0�icant Io a dvil Denalty oi not rtrore Illan live hun4re0 OMlars (5500�.
I, as owner ol Ihe O�operlY or my employees wi�h wages as iheir sole compensa�ion, vnll Eo �he work, and the
❑ slmcWre is noi imenaetl or o��eretl �or sale (Section 7044, Busmess ana Pmlessional Cotle: The Caniraclors' State License Law
aoes not aOPty to an owner of a OmDeny who builds or impmves ihereon, antl who does such work himsell/hersell or t�mug�
�is or Aer own employees. pmviAeO ihat such impmvemenis are nal inten0e4 or otlereG for sale. Ii, however ��e �uiltling or
impmvemenl is sWtl vn�hin one year oi comple�ion, I�e own¢r will �ave ihe OurOen of proving �e/5Ae Ob not Uui10 ar improve
br �he purpose ol sale).
I, as owner o� t�e pmperiy. am eKclusivel9 conVatling wiih licensed conlractors �o conslmct Ihe O�alect (,Section 7044, Business
❑ and Pmfessions Cotle: The Coniractors' Slate License Law does not appty to an owner ol properry wAo butlAs ar improues t�ereon
anG who fAnirat6 �Or Suc� pmje[IS vnlA a talVat�or(S�liCenSe pur5uanl�o tl1e ConVadors' Stam License Law),I am aware
NaI proot of I�eir WOrk¢i 5 Compensation in5urante ShWltl Oe proviDeU Io me.
� I am exempt unaer Section: B. 8 P. C.
br Ihis reason:
oate: P�ec
I Oo �ereby certily Ihal I am aware ol antl unEerslan0 i�e requiremen�s ai Calilomia HeaIIA and Salely Cotle Seciions 25505, 25533, and
2559A an0 I�al I oranylulure building occu0an�will/willnot (circle one�nee0to camply vn�h 5ai0 s�a�e co0es anaihe �equiremen�sior a
permil lor consimction or motlilication Imm Ihe Fir Ovahry Managem¢nl0istric�. fl¢5i0entul conSlmciion appliwlians are exem0� �mm
Ihese o�ovisians.
oale: l+pplicanl:
I hereGy cerlily �hat I have rea01hi5 a001iralion antl state ��at ��e above intormaiion is correcl. I aA�ee lo comply with all ciry anG [ouniy
ordinancesantls�aleWwsreW�inglobuildingconstmcibnantl aulhor¢ereprMentafiveSOlfhistilyioenterupantheabove�men�ionetl
pmpeny (l�or inspec� n pwpose�sj.' ��C�
Oate: `— � — / Z— SignaWre:
Onvei's license oi Socul Secmiiy
t6aLa6 W�ne—BuiMmg: Green—Cotle Enbrcemenl: Canary—Applicant: Pmk—Revenua: GOIJenroO—Assessor
CITY OE COSTA MESA — BUILDING PERMIT
PERMIT NO; P 059037 PLAN CHECK NO; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE; PLU
PERM NO; P 5 �
GOVT; N SUPP; N
PURPOSE; ADD
JOB DESCRIPTION ; ADD FAMILY TO EXISTING SFD, RE:#B59034 SQ FT:
CLAIM VALUE; CALC—VALUE; GROOP OCC; R-3 /M-1
COMMENTS; SMOICE DETECTOR(S) RE�UIRED IN HOME.
u�*+t�t�r��r*�r�r*�c�r�r�t*�r�t*x*�r+t�t�r+r�*�t�r �r�r��r�t�t*�r*�r**�t�r*�r#�rx��r*�tx*�r�r�r�t��**�*x��t�r*�r*�*��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; F'C IN FRNT; FT ZN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARICING kE • PROV; PARCEL; 42514313 ZNE; REF NO;
PLANNING N 'I'ES>
1k ii iE iF iklE 14lE 1f 1f k 1E 1F if iE 1t fElF iFlE 7f iE �E iE 1f if itlE 1E iFlE iE 1E!! k!f k!E iE 1E �Flk iklE iE fh f�if M iE iE 1E 1E i(� k ik if ik iE if 1f iE iE if 9t �E �f iElE if i'r 3f 3e iE iE if iE 1E iF
D E V E L O P M E N T S E R V I C E S'� R E Q U I R E M E N T S
ZONZNG APPROVED BY DATE:
BUILDING APPROVED HY :
DATE;
APPLICATION ISSUED BY; � DATE; � �l
ifrtiEiEifihilikiEiE�lFififlEifkiEiti!!ElfiF iEiEiEiEiE1E1E1Eif�iFiFiF r ih#
iE if 1E iE 1E ik iP iE iE-1E it iE iE ih k iE iE iE iE if iF iF iE if k 1k iE 1E if k 1E if if iE iE iF it iF it iE i! ik iF * 1E if if iE k iE 3E if iE � if i(� �k ik if k ik iF iE Ik iE iE iF iE iF iE iP ib fE �E �f iF iE k�F
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
PERMIT BLDG PMT PLUMBIN�G� ELECTRIC MECHANIC FIRE SMIP/RES GRADING
'15Y SMIP/NON—RES
PLAN
ISSUE FEE 20,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 7,00 20,00 0.00
REVENOE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMBING ELECTRIC MECHANIC
2 % . Q �
TOTAL PAID DUE
2%,�� 2%,�0 ,0�
27,00 OVER/SHORT; ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
iE iE iE �k Ik ik �E it iE iE if i4 iE iE ik If iF if iF jf 3E IE�E iF iE iE iP 3t if iE iE jE if k iE 1E ik iF 1E iE iE it if if if if ik 1F3f IE ik IE iE iE I! k 1f k iE iF ik 3E iF if iE iE if if iE �F IF iE ic �E iE iF iF �F ik
I N D I V I D 0 A L F E E B R E A K D O W N
TYPE QTY D E S C R I P 7' Z O N UNIT COST TOTAL COST
P�U 1 FLOOR DRAI�IS '7,00 7.00
�� END OF FEES
EXPIRED
I m lete Inspe�tions
�e�l�/ s�g .c��--
.�
�,l
a'j
�
.- �.
CONSTRUCTION AND PLANNING POOI & SPA
A2PROVALS Permit�P Date Inspector APpROVALS Permit# Date Inspector
1. Tempoiary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Und�grnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. forms
4. Electrica� Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footing5 58. Electrical Conduit-Undrgtnd.
8. Foundar�on 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & House Con�ection 62. Backwash & fteceptor�Final
12. Sewer CaP � 63. Heater & Vent-Final
73. Roof Drains 64. Plumbi�g System - Final
14. Rough Plumbing 65. Electricai-Final
15. Rough Electrical-Condu�t 66. Solar SYstem-Final
76. Rough Electric Wiring 67. Fencing & Access ApUroval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough E�ectrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fi?eplace � APPROVALS �Permit #
21. Ducts, in Structure - 70. Underground Hydro
22. Ducte, Ventilating 71. Product Pipinc� OGas OOiI ���'
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 C¢iling (Svucturaq & Monocoat 75. Dry Chemical -
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulatipn . ' I 78.. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT _
31. Plaster 6rown Coat � � 79. FINAL INSPECTION
i
32. Electricel Power Meter�Final � 80. FOOD CERTIFICATE ISSUED
33. Final Elgctric � ( Notes:
i
34. Final Heating & Air Conditioning �
35. Final Gas Pipe�Test � � '
36. Hood or Canopy I �
37. Final Factory Fireplace �
38. Final Plumbing . /'/� QZ(�i'Q
r
39. Water Service�Final ' ,
40. Gas Service-Fina� '
41. Solar DOmestic-Final
42. Backflow Preventer ; � �
43. Backflow Irrigation
44. LandscaPe Irriqation System . �
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDfIVG
48. FINALPLANNING �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co , i
51. CERTIFICATE OF OCCUPANCY '
No. Date
�
�
i
--�
�
PflOJECT A��flESS: Q 3 3 OGLE C I
OWNEfl'S NAME: KEEFER THOMAS E TR
.. nooeess: q33 OG�,E CIR
COSTA MESA,CA 92627
(714)642-5602
ANCH/FNGINEEH: HEG.NO.:
aoosess:
uniT:
uxrt:
PEXMITTEE: BLUE RTHBON BUILll6R5 ( 714 ) 581-3636
noonEss: 233'12 MADERO B
MISSION VIEJO CA 92691
LICENSED CONTHRCTOfl DECLIBATION: I hereGy allirm I�a� I am Iicense0 un0er pmvisions ol C�apte� 9 �commencing vn�h Section
7q10) ol Division 3 0l I�e Business antl Prolessions Cotle, antl my license is in �ull lorce antl e�fect.
c�rruc.: 06505 srnrEuc.:23259 cuss: ���� (//;f� � j
Oate: _ � Z' Signature: _ 1 `� `�"`—"^�
WONNEBS' COMPENS�TION OELNNA710N: I nereG affir I have a cenifiWte o� consent to sell-insure or a cenilicate ol waMers'
Compensation lysy�aope4q�y,c�Ctilieq,r,ppy ��ereal �Sec�io 00, LaO. fJ
POLICY NO.: 1� a L 7� �� E%P. �PTE: U�1 / O 1/ 9 3
comrnxr: STATE FUNA
❑ Certilietl wpy is here�y Wmishe0. � Certilied copy' E with IAe ciry BuilEinp D-' ion.
Oate: �_ � � — ! Z— Appliwm:
EIIEMPTION FqOM WOXREHS'COMFENSATION OECIABATION: iseclion ne¢a nolGecompleteOi�lAe permili5lorane�uMrN�f100�or1e55�.
, I tetli�y Ihai in I�e p¢rlorman[e ol IA¢ work �or whiC� �hi5 pe it is issue4 I shall nol em0loy any perwn in any manner so as lo Oecome
I suble�� �o Ihe Workers' ComDensalion laws ol Calilamia.
Dale: SiqnaWre:
NOiICE: If, alier making inis aeclaration, you shW10 �ecome su�ject to Ine worker5' Cam0en5ation prOvisions ol tAe LaEor
Caae. you must fonhwitn como�Y `M�n sucn orovisions or Ihis oermil Shall ee aeemeA revakeA.
CONSTBOCTION LENOING RCENCY: I herehy allirm Ihatlhere i5 a conSlmciion len�inp aqency lof Ihe Dehormance of t�e work lor
which �his permil i5 i55ueC (Seclion 3WZ Gv. C�.
tENOEfl:
ROONE55:
OWNEB BUILOEB UECLANpTION: I hereby aflirm I�at I am exem0� ��om the Contraclors' State License Law Im the followinp reason
(Section 7031.5 Business an0 Pmlessional Cotle: My city of county which r¢Quires a Dermit Io construct, alter, impmve, Oemolisn, or
(¢pdi! d0y SINLIUfC. O�IOf t0 I�5 ISSOdOCP, dIW lCQUifCS lhE dppliCdlli 10f WC11 pCfrtll� IO IIIC d SIA�=4 SldlCrtlEl1� �h31 11Y1511E IS IICC052d
Ou�suam to t�e pmvisiws of tlre Contractors' State Licenu law (Clupter 9 gommencinp with Section 7000) ol Divi4on 3 0l t�e Business
ano Pmlesslons Coee) or iha� ne/she is exempt tnerelmm an0 ine Oavs Ior the allegea exemD�ion. Any Wolation ol Sectian 7031.5 by
any aDPlicani lor a permii su�lec�s �he a001icant to a civil penally o� noi more Ihan live hun4reU tlollars �5500).
I, as owner ol the D�operty or my employees wilh wa0es as iheir sole compensation, will do lhe work, an0 t�e
❑ slmcture is not intenOeA o� otieretl lor sale (Seclion 70da, Business antl Pwlessional Catle: T�e ConlrapOrs' State License Law
Goes nol aOVly to an owne� oi a pmperly wtw OuilGs or imOmves thereon, an0 who does suc� work himsellmersell or IAmupA
�is ar �er own empl0ye¢5. pmvided I�ai Sut� improvemenls are noi in(enGeO Or OflereO lOf sale. II, however I�e Guiltling or
impmvement is sold wit�in one year oi completian, ihe Mmer will Aave ��e burJen of O�a�nA hfJs�e Aitl not buil0 or improve
for ine purpose ol salel.
I, as owner oi me pmpeny. am eKclusively comracting wilh licensetl coniractors m consimc� �he Orolect (Section 704a, Business
❑ anA Proleuions fAGe: The Caniraclors' Siate LicenSe Law tlaes nol ap01y to an owner oi pmDerty w�o bWlOs or impmve5lherean
antl w�o fAniratls ior SUCh pmleCls wil� a tonita[IOr�S) IicenSe DursUanl IO Ihe Contrattor5' Slaie LitenSe Law�. 1 2m awdr¢
t�al D��� a� I�eir Worker's ComOensation insurance shoulG he 0«de0 to me.
� i am erempt untler Section: B. 8 P. C.
lor I�is reason:
i Oa�e: Ue�ec
I ao here�y cenily I�al I am aware ot an0 unders1an01�e repuiremenis ot Caiifornia H¢alt� an0 Sa�eiy Code Sections 25505, 25533, anE
25534 anG t�at I or any fulure �uilGing accupant wilUwill not (ci¢le one) neea to com0ly unih said state coGes and ihe reQuiremenis for a
permil lor cons�mtiion or modihcation Imm ��e Air Oualily Management DiSlrici. He5i0ential con5imc�ian applicaiions a�e exempi imm
Inese pmvisions.
Oa�e: pDPlicanl:
I hereGy cetldy IAaI I have reae inis application an0 slale ihat Ine above inlarmation is correct. I apree to comply vnt� all city anE counry
ordinancesandstalelawsrelaunp�oUuilDingwns�mclianarM� �B Ihorirerepresentalivesollhiscilyloenleru0on a0ove�mentioneG
pmperry lor inspectian purposes. /
Daie: �— /� — • � Signalure: `� �
oriver's ticense oi Social Seturily
164La6 Wbite—Buildino', Green—Cotle EnlorcemenC Canary—Aoolicanl; Pink—Revenue', GaltlanroC—Assessor
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: M 5y
PERMIT NO; M 059036 PLAN CFIECK NO: N GO T: N'�: N
CONSTRUCTION TYPE; 5—N PERMIT TYPE; MEC PURPOSE: ADD
JOH DE5CRIPTION ; ADD FAMILY TO EXZSTING SFD, RE;#B59034 SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 /M-1
COMMENTS; SMOKE DETECTOR(S) RE�UIRED IN HOME.
�rx��r***��**x�*x�**x��*�*��*x�*** **�r�*x�rx«�***�***��*�r*�*u��r�*xx**�*�****�*�x�**��**
Z O N I N G R E Q U I R E M E N T 5
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 IN RGHT: FT IN
PARKING REQ� PROV; PARCEL; 42514313 ZNE: REF NO;
PLANNING Nf5'I'ES>
� �
' k if ik 1f iE iE iF ik fk 1E ik iF ik iE iE iF �E iE iE iE ik 1f iE iE fF it if iF iE iF �t if �1F ik iE 1E 9(� ik if i! iF �F �k 3E 1E 1E fF 3E 1'e aE iE 1E 1E 3E if iE iE k k if if it �f iF if� �k iE iE IE itlt iF iE iE iF IE iE IE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M n N T S
! .
ZONING APPROVED BY '� DATE;
,BUILDING APPROVED BY ; DATE;
%APPLICATION ISSUED BY: � � DATE• �I �
�lFiEiEifitiEififikfEiEifiEifiElElEiEiEiFlfiF3F3F�F'iF3F�3FiF�Fiiii'�FiF3FiF�F3F;t !t iY7F3FfF�t3f�iFiFi'Fi�FikkikiFiEikifiEkik !Fk
.�k iE iE fk ih i61ElE if !E ik if il� iflf� if IE fE ik iE 1t iE 1E iE fF ik iF iE iP iF iE ff ik if fE �t ik 1k fE if i! 1F 1E �FiE 1k iE !i iF iElf iE # iE�IF ik # i! 1k iE if iE iF 1t if lE if iE 1E iF iF 1E IF if if iE!(-1E �1F
LEGALI2ATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 9252 SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 9.00 15,00 0,00 24,U0 24,00 .OU
REVENUE DIVISION TOTALS--> COLLECTED; 24,00 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
29,00
k 1f iEiE k if k if fFlF it �F 1f !f 1FlElt iE %� if 1t M� �E fk ik if 3F �! if i! if if �E if if iF iE ik k ik 1f 3f !F iE if iE �E if fF �f if iF iE if 1k iF k k if 1E ib ik 1lif if iF itlE iF if iF if !f tE 1t 3F itlf iE
I N D I V I D U A L F E E B R E A H D O W N
TYPE QTY D E S C R I P 7' I O N UNIT COST TOTAL COST
MEC - 1
�
2
REPAZR/ALT HEAT�NG UNIT/SYS W/CNTLS
r� END OF FEES
:j
EXPIRED
I p te Inspections
�� a ��� Sig ----�._
5.
r� �d
9,00
-, -,�- - .t • .
.,
.�- �
. . . ', ..
• ��
✓
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
� i. Temporary Electrical Service or Poie 52. Pool & Equipment Location
2, Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Elsctrical Conduit UtilitY-Undrgrnd. 54. Forms
4. Electrical ConduibUndrgrnd. 55. Electrical Bonding
5. Steet Reinforcement 56. Rough Plumbing & Pressure Test -
6. Electrical UFEF Grnd. 57. APPflOVAL TO COVEfi�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., 7est
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
71. ProPerty Sewer Line & House ConneMion 62. Backwash & Receptor�Finat
12. Sewer Cap i 63. Heater & Vent-Final
73. Roof Drains � 64. Plumbing SYstem • Final
14. flough Plumbing 65. Electrical�Final
15. flough Electrical•Conduit �6. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rou9h Wiring Sign 68. APPROVED FOR PLASTERING
18, Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rouqh Heating & Air Conditioning ` FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. DuCts, in Structure .70. U�derground Hydro
22. Dutts, Ventilating � 71 . Produc[ Piping � Gas O Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �,; .
24. ftoof Framing • 73. llndergrnd. Storage Tank O Gas ❑ Oil � f
25. Roof Sheathing ' 74. Overhead Hydro ' �
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • �
27. Frdme and Fiashing 76. Dry Standpipe .
28. Lathing & Siding . 77. FIXED SYSTEM FINAL -
29. Insulation I � 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT � '
31. Plaster Brown Coat I � � 79. FINAL INSPECTION
32. Electricaf Power MeterFinal � 80. FOOD CERTIFICATE ISSUED
33. Final Eleciric � ' Notes:
34. Final Heating & Air Conditioning ��QZ (��
35. Final Gas Pipe-Test � ' �
36. Hood or Canopy � i
37. Finai FaMory Flreplace ,
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Finat ' �
47. Solar pomestic-Final
i
q2, gytkflow Preventer � ! �
43. BaGkilow Irrigation
44. Landscape Irriqation SYstem .
45. So�nd Attenuation
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
48. FINAL PLANNING �.:�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ( ;
51. CERTIFICATE OF OCCUPANCY
No. Date
�
%
�I
PPOJECT AOOPES—��4 3 3 OGL E C I
owNex s xnme: KEEFER THOMAS E TR
ADONESS: 433 OG�,E CIR
COSTA MESA,CA 9262"1
t714)642-5602
ABCHIENGINEEP:
FDONE55:
flEG.NO.:
uxit:
UNIT:
PEPMITTEE: BLUE RSBBON HUILDERS ( 714 ) 58 �.-3636
aoosess: 7.3372 MADERO B
MISSION VIEJO CA 92691
LICENSEO CONTHACTOB OECtAflATION: I here0y allirm ��at I am licensetl under pmvisions o� C�apter 9(commencing with Seciion
7000� nf �ivisinn 3 ol�he 6usiness antl Pm�essions Cotle. anA license is in tullforce antl e�fecl.
cirv uc.�Q 0 6 5 0 5/��/ srare uc.: 2 3 2 5 9 cu�s� .����
Dale: `� �� ! • � Signalure: ��
WOHREPS' LOMPENSRTION OECIAflATION: I hereby ailir al I �ave a cenilicaie of consenl �o selbinsure or a cenilica�e oI Workers'
Compen5aiian Iqs a e c tifie py �hereof (Seciion 3800. La�
POLICYNO.: +��4���—�� EXP.UATE: 1IOIIyj
COMPANY: STATE FUND,+1
❑ Cenifie0 topy is h¢reby lumish¢0. L� C¢nifietl cOpy' � A wiih �Ae tiry Builaing �ivi5ion.
Date: �—II��� ApDlicanc � `� �^^--�•-
i
E%EMPTION FBOM WOflNEPS' COMPENSRTION OECIAMTION: is sedion neeU no� be complete0 i� the permil is lor one hmWr¢a (S1W) or less�.
I cerlily I�al in Ihe pedormance oi the work lor which Ihis permit is issuetl, I shall not employ any person in any manner so as la become
5u01e�� lo �he WorkerY Compensa6on Laws al Calibmia.
Oale: SignaNre:
NOTICE: II, afler making inis declaration, you shoultl hecome suUie�� �o �he workers' Compensation Drovisions of�the Labor
GoAe. you musl Iorlhvni� COmDIy wiU Suc� pmvisions or �his p¢rmit 5�all be Geemea revakeA. "
CONSTflUtTION LENOING �GENCC I �ereUy afiirm I�at ��ere is a constmc�ion lentling aAenry br Ih¢ Dedormance uf �he wark �or
wnicA Ihis Oermi� is issueG �Sec�ion 3097, Civ. C).
LENOEfl: ��I
nooxEss:
OWNEfl BUILDEP DECLANRTION: I here6y alfirm Ihal l am exemp� imm ihe Conlrac�ors' Slaie License Law for �he followinp reasan
�Seclion 7031.5 BuSiness an0 Pmfusional Code: Any uiy oi county whic� repuires a Dermil �o tonsVuc6 al�er, impmve, demolish, or
repair any Simtlure, pnor to its issuana. also r¢Quires t�e applicant fOr SUch permil (0 lile a 5igneE Slalemenl Itwl hpJs�e a IiterrseC
Dursuanl to the provisions ol ihe Contractors' Stare Licenu law (Ctepter 9lcammencing with Section 70W) of Oivision 3 al tAe Businew
ana Pmlessions Cotle) or ��a� �e/she is exempt �herelrom an0 Ihe �asis for the alleged exempiion. Any Nola�ion o� Secfion 7031.5 by
any aD0licanl for a permit suGlects the aDO���n� to a civil penai�y of no� more �han �ive IlunAreO tlollars (5500).
I. as owner af the pmpeny or my employees with wages as Iheit wle compensdtion, vAll tlo It1e wafk, anE the
❑ simcwre a not intenCed or ofierea for sale (Sec�ion 70a4, Business and Professional Caae: TAe Contracmri State Licenu Law
tloes not apply �o an owner of a pmpeny w�o OuilOs or impmves ihereon, and who tloes such work himself/Aersell or ihmugh
his or �er own employees. O�a�tleE ihdt sucA improvements are not inten0e0 or ofleretl lor Sale. If, however itle Euil4inA or
improvement is sUa wirttin one year at completion, the owner vnll have Ihe bur0en ol Orodnp tre/she Ck nat Euild or imprme
for ihe purpase ot Shce1.
I, as awne� ol ��e pmpeny, am exclusively contracting with licensetl coniracmrs to consimct Ihe D�alect (Sec�ion 7044, Business
❑ and Pmlessions CoGe: IDe Cantraclors' S�a�e Licenu Law Oces no� appty to an ovmer of DropeM �0 6mI0s or improves ��ereon
antl wno coniracls Iot sucn v�%ecis with a Wntractorls) license oursuant to the CAntractor5' State LicertSe Law). I am awdre
ihat prool ol t�eir Worker's Compensation inmrance shoul0 be pwvitle0 to me.
� I am e�empt unGer Senion: B. 8 P. C.
lor I�is reason:
�ate: Ownec
I Oo nereUy cenily �hat I am aware ot antl untlers�ana the reQuirements ol Califomia Heatlh antl Salery Cotle Sections 25505, 25533, antl
2553E anU Inai I or any IUWre Duiltlmg acupan� mlVvnll not (circle one) neetl to comply wilh 5ai0 s�ate cotles antl ��e reQuiremenis �or a
permit lar con5lmciion or motliiication Imm �he Air Oualiry Management DiSVitt. flevG¢niial con9mciion apD����ions are ¢x¢mp� Irom
ihese pmvisions.
Date: ADPlicani:
I hereEy Cerldy I�ai 1 have reatl �his applitalion antl Sla�e Ihat Ue a0ave informaiion i5 torrecL I agree Io tOmp,yly vn1A ail Ciiy an0 COunty
ortlmances ana 51aie laws rela�g �a builtling cons�mction ana her auiharize r� ves o�cily �o enter pon Ihe above�meniioned
pmperty for ins0ection purposes. � �
� k�
Oate: —� � 2 Signamre: Q���
Drivei's License oi Social Security
�64L46 Wh�te—Butl�in0: Green—Cotle En�orcemenl'. Canarv—Apolican�; Pink—qevenue: GOICenroa—Asanssor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 5 V1tt
PERMIT' NO; E 059038 PLAN CHECK NO: N GOVT; N SUPP; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE; ELE PURPOSE: ADD
JOB DESCRIPTION : ADD FAMILY TO EXISTING SFD, RE:#H59034 SQ FT';
CLAIM VALUE; CALC—VALUE; GROUP OCC; R-3 /M-1
COMMENTS; SMOKE DETECTOR(S) RE(�UIkED IN HOME,
�r�r�r�r�r***�r*�*�t*x��r�t�t�rx��r*�r*�t****�e **��x�rx�r*�r��r�r**�*��r**�x���r�r+rx*�r�t���*x�*x**�t+r�r�+�**�t
Z O N I N G R E Q U Z R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; F'I' IN
--------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 42514313 ZNE; REF NO:
PLANNING N(5T'ES>
�
ik iE it iE 1f 1f iF if if if if iE 9h iE iE iF iP iF iE 1F iflE ih ik 3k iElP iE iE iE iE 3E iE iE jE iE i�E iE if 1E ik 3f if iF iE�IE iF iE iP �f �E iE iF iE it iE lF if * ik?E if ff ik iF it iE iF iE if if ik iF iE if iE ik iP 3f
D E V E L O P M E N T S� R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY . ___ __ DATE;
BUILDING APPROVED HY ;
APPLICATION ISSUED BY•
x **x *� �t* �*�r�r*�r*�� ��f��t�t�i�F��F
�E iklkiF if iF ik i! if 3(�if iF ik if �E if it iF iE %� iE i! jf 1f if jF it if if !f if it �Fl�
LEGALIZATION;N F E E
r
DATE;
iF iE if iE 3k if k iFit k iF # iE iE jE 1! i! k iE iE �!�! ik iP if� it iF iF �Elb if !F i't iF if i! jE iE �k iE if i6
S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 11,25
502
PLAN
ISSUE FEE 15,00
SMIP/NON—RES
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 11,25 15.00 0,00 26.25 26,25 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 26.25 OVER/SHORT; ,00
BLDG PMT PLUMBING ELEC'I'RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
26,25
iE iE if 14 !F i! if 1t k iE iElhlF1E �E iElE iE 1E if iE 3E iE 1E �ElElF fE iE k �E 3E if iE iElE iF ik iE 1E if 1E iEiF k fk 36 if 1E iEiE iE 1F it iE i(�!f!F!F �E 1E iE if iklF iE iE iE IF1E iE if IF 1f if i! iP k iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNZT COST TOTAL COST
ELE 2 FIXTUf1E5 LIGHTING 1 ST 20 EA,
ELE 7 RECEPT/OGTLET 1 ST 20 EA.
ELE 6 RECEPT/SWITCH 1 ST ZO EA,
END OF FEES
,75 5.25
,75 4,50
j; _fi - - , .. ._ . .
CONS7RUCTION AND PLANNING f..�l & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electricaf Service o* Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcemen[
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI 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, � Undrgmd.
10. Structural Floor SYstem 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Ve�cFinal
73. Roof Prains 64. Plumbing System - Final
74. RougN Plumbing 65. Electrical�Finai
15. Rough Electrical•Conduit 66. So�ar Sysiem-Final
16. Aougn Eieciric Wiring �Q-.t,6-.� ��- 6�. Fencing & Access ApProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rougn Electrical�T Bar Cciling 69. POOUSPA SYS7EMS FINAL
19. Rough Hea(ing & Air Conditi0ning FIRE DEPT. i;EQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Dutts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas OOiI
23. Gas PiPe•flough & Test � 72, Underground Flush
24. Roof Framing 73. Undergrnd, Storage Tank fl Gas ❑ Oil
25. Roof Sheathing 74, Overhead Hydro
� 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Ftashing 76. Dry Standpipe
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation � � 78. FIRE PREV. FINAL
30. Drywe�l Nailing I I ' HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat � j 79. FINAL INSPECTION
i
32. Electr�cal Power Meter�Final S0. FOOD CERTIFICATE ISSUED
33. Final Electric � �2Z-C�� Notes:
34. Final Heating & Air Conditioning � ! �
35. Final Gas Pipe-Test I �
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 Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regutations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING �
49. Elearic Release to Edison
50. Gas iielease to Southem Califomia Gas Co ; , �
51. CERTIFICATE OF OCCUPANCY
No. Pate
.�OOXESS: Q33 OGLE CI
i s xaMe: KEEFER THOMAS E TR
nooxess: 433 OG�,E CIR
COST;9 MESA,CA 92627
RflLH/ENGINEEB:
�OOPESS:
flEG.NO.:
uxit:
UNIT:
PEPMITTEE: ALL'COAST ROOFING ( 77.4 ) 650-2244
nooaess: 2107 WALLACE AV
COSTA MESA CA 92627
LICENSED LONTMCTOP OECLAflRTION: I �ert0y altirm IAai I am licensetl unCer provision5 0l CAaD�er 9(commencing wiih Seclion
]000) ol Oivision ;1 ot ��e Business and Prolessions CoOe. anA my license is in full lorce antl e��eci.
cirruc.: p�lgpg srnTeuc.:598440 ��`SS° C39 � r
Date: Siqnature:
WOPKEBS'CO! ENSP ONOECLABRiION: Inereeyaflirmtlw�lnaveacenilicate onsentrosel4in5urearacenitiwleoiWorkers'
Compensalion Insurance. or a Cenilied coDY t�ereo� (Settion 7800, LaO. q.
POLICY NO.: E%P. UATE:
COMPRNY:
❑ CetlilieE copy is Aere�y Wmishe0. ❑ CenilieE copY is �ile0 vnlh Ne ciiy BuilUing Division.
Daie: A071icant
E%EMPTIONFflOMWUflREBS'COMPENSRTIONDECUflRTION: �T�iisetlionn¢cdnolbetOmleli,tlil�hep i�islaronehundreA�5100�orless).
' I certily �ha� in Ine pedormance ol Ihe work lor which I�is permil is � SueG. I SAall not e� y an o in any manner so as �o bewme
, 5u6jeclio I�e N pikers' m ensalion Laws of Calilomia.
�
�i �ate: SiAnawm:
NOTICE:II. al�er makinp Inis Ceclaration, you 5�oul� 6ecame suClectto t� orkers' Compensatian D�o�sions of lhe �aGar
Cotle. you mu9 totlhwiih tomDly wil� SUCM1 Dmvisions ar �his Oermi� S�all b deemed revake0.
CONSTNUCTION LEN�ING AGENCV: I hereby ailirm Ihal �here is a COn5lmt�ion IenOing apency lor �he pedormante ol �he work �or
w�ich Ihis permi� is i=suea (Seclion 3097. Gv. C�.
LENDEfl:
poaxess:
OWNEF BIIILDEP UECLABpT10N: I hereby allirm that I am exemp� imm ihe Contracto7 S�ate License Law for ihe lollowing reason
(Sedion 70.31,5 9usine55 an0 Pmie55ional CoEe: Any city oi counly which repuires a permil Io consimc�, alier, impmve, tlemoliSR or
repair any simclure. prio� to its issuance, also repuires Ne applicant lor such Dermit to lite a signeC slatement that �e/s�e is licensetl
pursuamlothe pwvisions olt�e Coniracbrs' $la�e li[¢n5e Law�ChaO�e� 9(commentinq with Section 7000�o10ivision J oli�e Business
an0 Pmlessions CoOe� or Ihat he/s�e i5 e�empt I�erefmm ana I�e Easis for the allege0 eaemption. Fny violalion ol Section 7031.5 by
any applicant br a permi� SUUlecfS Ille apD�icanl �o a civil penally ol no� more Ihan live huntlred tlollars (5500).
I, as owner oi ihe pmperty or my employees wit� wapes as their sole compensa�ion, will do the wark, and the
❑ slmc�ure is no� intenEed or ollerea �or sale (Section 7044, 8usmess and Pmlessional Cotle: The Coniracbrs' State License Law
Ooes not appry �o an owner ol a Oropeny who builds or imD�oves ��ereon, and who Ooes such work �imselfl�ersell or thmugh
his or her own emptoyees, proviOeU ihat such impmvements are not intenaea or ofiereA for sate. II, however t�e builtling ar
impmvement is soltl within one year ol complelion. ine owner vnll have Ihe buraen ol pmvinA �e�she Ui0 not buil0 or improve
tor ine purpose oi sale).
1, as owner ol Ihe property, am excWsively conlracting witn IirenseU coniraclors lo consiNcl tne prolect (Section 7044, Business
❑ anU Pmlessions Cotle�, T�e Contrac�ors' S�ate License Law tices nol apDly to an owner ot propeny wno Euilds or impmves ihereon
anC who comrams lor such prolects with a comractoqs) license pursuant lo ihe Coniractors' State �icense Law�. I am aware
��a� pmol ol �heir Worker'S Compen5a�i0n insurante 5hauld G¢ pmviJea to me.
� I am exempt unaer Sec�ion: B. b P. C.
lor Ihis reason:
Dale: Ownec
I tlo nereoy cenily ina� I am aware al and untlerstan0 ihe requiremenis ol Californu HeaI10 anA Salety CaOe $ections 25505. 25533, and
2553C and t�al I or any future 6uil0ing occupanl wilUwill not (ci¢le one) neeG to tomply vnih Saitl state coAes antl ihe requiremenis far a
permit tor consimction or moJdica�ion imm I�e Air �uality ManaAement DiSVict. flesiaential [ons�mction applica�ion5 ar¢ ¢xempt �mm
Ihese provisions.
Dale- ADDlicanl:
I here0y rerii�y Ihal I �av¢ rea01�i5 applita�ion anG Slaie Ihai IAe aUOve in�oema�i0n is tor(W. I a r¢e comDN �^�� a0 cily an0 counry
orEinances aM State lavrs reWting Io Euilding can9mclion an0 h¢�Iror¢e re0�euma�iy s o� i 1 1 enier upon I�e a0ovemen6ane0
pmpeny lor ins0 ��ion Ourposes.
/1 J /� �
Da�e: V ___).,� SignaWre:
DrHer's Lkense or Social Securily
1646a6 wnne—Building; Grcen—Coae Emorcemem: Canary—ApplKanr, Pink—Revenue: GOltlenro0—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 059538 PLAN CHECR NO: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR
JOB DESCRIPTION ; T/OFF REROOF W/COMP
PERM NO: B 059538
GOVT; N SUPP; N
PURPOSE; ALT
SQ FT: 2,800
CLAIM VALUE: 2,800.00 CALC—VALUE: 2,800,00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR RE�OIRED
**+r*��x.x.x._�x**x�x**�xx�xx*x�*x- x-*�*xx��*x�***�+��x*xw�**#x****�x*�**��*x�*�+��cx;��**u*
Z O N I N G R E Q U I R E M E N T S
sET�Acxs
------------ 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
PARRING RE • PROV; PARCEL: 42514313 ZNE; REF NO;
FLANNING N TES>
7
if iE 3E if iE iE iF ik iE iE fF if if iE iE # iF iE �E iE 1F if if �)f it� # fFiE iF it iF # i! i! k i4 # iE iE iE iE iE i6 iE if iFit� �k iEit 3k ik 3E iF iE # iE i4 iE iFiF iE k 1F 3F iE iE 3f- iE iE iF iE ## it� ## iE ii
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:'�
BUILDZNG APPROVED HY �JJ � � DATE:
APPLICATZON ISSUED BY • /' l' --����� LIATE • ���'���Y
iEifiEiFiEiE'If'kiEiEiEiEiEifiEiFiEiEil'1EiF'IfiE�FiFiFf'FiFiF�FiFitiF3FiFiFiF iF�iF3FiFildFTlirR3FTEirff'1tiF1Ei%iEiEi%ifiEif#iE 'lr '�R t�1%')E
!E iE ff iE if if iE ik if� 1f iF 1f if 1f 3f iF i(� if # iE 1F iE ik 1E 1f M it # iE iE 1E iF 1f 1E fFlf iElf� iE # if 1E itlF 1E!! 3F iE iElFlf if iF iE iE iF fE if iE fE it iE if iF!(-9F'iF'lEif 1E iE iF 3E # iE # if� if ?e
LEGALIZATION;N F E E S U M M A k Y STRUCTURAL SEGMEtJT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRAD'iNG
PERMIT 54.00 ,50
SMIP/NON—RES
PLAN
ZSSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
TOTALS----> 54.50 0,00 0,00 54.50 54,50 .UO
REVENUE DIVISION TOTALS--> COLLECTED; 54,50 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
59,00 ,50
iE iE iE iE iE iE-IE �1E �lE �IE iE iE iE iF �lE # if iE it iE iE if�lE iE iE 1E iE iF itlE iE if� 3E if *if iElF iF �1f IE 1E if iE # iFiFlE if �1FlE iE iE 1f iE �1E # iE iFlF 3f� iE ik iE iE i4 �)E i(�i! �f iF if if �E 3E j(-# 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 k I P T I O N UNIT COST TOTAL COST
SFR 2800 REROOF BY VALUE RESIDENTIAL N020NE 1.00 2,800.00
END OF FEES
`� � I P�..,�&SPA
- I , CONSTRUCTION AND PLANNING
_�
APpROVALS Permii# Date Inspector APpROVAI.S Permit# Datc Inspector
1. Temporary Electrical Service or Poie 52. Pool & Equipment Location �
2, $oil Pipe�Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undr.grnd. 54. Forms '
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVEfl�GUNITE
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., TeSt
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structurel Floor System 67. APPROVAL TO DECK
11. ProPerty Sewer Line & House Connection �-� 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. fioof Drains ' - 64. Plumbing System � Final '
14. Rough Plumbing 65. Electricai-Final
15. Rough Electricai�Conduit , 66. Solar System-Final
16. Rough Efectric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPflOVED FOR PLASTERING
18. Rough Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rougfi Heacing & Ai* Condiiioning FIRE DEPT, REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground HYdro
22. Ducts, Ventilating 71. Product Pfping �Gas �Od
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Root Framing 73. Undergrnd. Storage Tank O Gas O Oil
25. Roof Sheathing 74, Overhead Hydro
26. T�Bar Ceiling (Structurai) & Monocoat 75. Ory Chemical
27. Freme and Flashing 76. Dry Standpipe
28. l.athing & Siding ' i � 77. FIXED SYSTEM FINAL
29. Insulation � I � 78. FIRE PREV. FINAL
30. Drywall Nailin9 I 't - j HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , � (� � 79. PINAL INSPECTION `�
i
32. Electrital Power Meter-Final ��"� 80. FOOD CERTIFICATE ISSUED
33. Final Electric �"• � Notes:
34. Final Heating & Air Conditioning � ��
i
35. Final Gas Pipe-Test � � � \h
36. Hood or Canopy �'
37. Final Factory Fireplace I I i
38. Final Plum6ing � �
i
39. Water Service�Final
�
40. Gas Service-Final 1 �,
41. Sotar pomescioFinal '
42. BaGkflow Preventer � I
43. BaGkflow Irrigation
44. Landtcape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAISTRUCTURE&BUI�DING � � � � -� '
1�
48. FINAL PLANNING �
49. Electric Release to Edison � � �
50. Gat Release to $outhern Califomia Gas Co i �.�' �
51. CERTIFICATEOFOCCUPANCY
No. � Date
� AOP���ant to fill in alt spacez wilhin neavy bortler lines antl sign all appropriate tleclaratior
CITY OF COSTA MESA . PERMIT NO. ' TRACT NO. LOT NO. BLDG. NO.
CONSTRUCTION PERMIT E� a i 6�
rro�ecc naaress U L�' (,: N• TVPE OF COIySTRUCTION
OWner `' Ij Phone� � ❑ NEW Q�ADD ❑ ALTERATION �
Address 7 (� C� ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
Arch/Eng. AMS ' liCenSe No.�/O/�.j .� OTHER -
AddrCss Q/L �T - • DESCRIPTION OF WORK �� �
Contractor � ,� ��M DO�� Phone Lzy3 �O
�I9�- TYPE OF PERMIT
AdtlrMs L �lo L�,�/Q,( 6aa� y-4 O GRADING -❑ FOUNDATION ❑ STRUCTURAL
IICENSED CONTRACTOR DECLARATION ❑�TENANT �ELECTRICAL OPLUMBING ❑MECHAI
I hereby aHirm thul I am 11<ensetl unAer provislons of Charter 9.(cam- , .
mencing with se<Uon ]000�- of Diviston 3 ot the Business antl ❑ OTHER
ROf¢isions COtlG, antl -my IlcenSe IS In full force dfltl e�fe t.
LicenseCiajs_ � 3- L� � iceqse No � � PROJECTDESCRIPTION
Date �/ �i./'1 SI9 at e ....(� i. t�.n� SQ.FT., ,. ' " '. _
WORK 5' C MPENSATION DECLARATION __. ' OCCUPANCY�CONSTRUCTION TYPE
' hereby afFlrm that I have a cartificate of consent to selt-insure or a YALUF�TION^ - 20NE
!ificdte Of �Worke�s' CompenSatlon InSurance,-o� a�certifietl CoPY . .. ...
reof (Section 3800, Lab. CJ. - GRADING CU. YDS. ACRES
ilcY No. ' ' ComPanY ' - ' ' " ' '
❑ Cer[ifietl Copy-I5 her¢by furnlsM1etl. . _ _ _ . . .REMARKS: ' . � _ �
❑ Certifietl topy is flletl wilh tho city Builtling Division. .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' ' ' - -
(This section neetl nat be tompletetl if the permit is for one huntlretl ,
($300) Or 1¢551. , �., � �
I C¢rti/y,tha[ In [he�perfo�manGe o1 [he work for whiGh [his pe�mit I5�
issuetl, I shall nOt empl0y any Person in an manne� So as to become PLUMBING � PLAN CHECK " -
subject to the Work s' Compensation ws f Ca forni ._ -'
Date � � L���� BATHTUBS SHOWERS '
Si9natura
NOTICE: 1/ after making [his tleclaratlon, you s�oule bec e suGject TOILETS URINALS' � .- ��
to tna Workers' Compensatlon provislons ot the Labor COEe, you must LAVATORIES �OUBLE LAVS - '
fOrthwith Comply with zuch provi5iOn5 or Ihis petmit shall be tleemetl �''
�evokCtl. .
CONSTRUCTION LENDING AGENCV � KIT. SINK$ - "' p15HWH5HER5 '
I hGr¢by aftirm tha[ there is a mns[�vctlon lentlinq agency to� the per- SERVICE SINK$ - $VMP$ '-- ' "
to�mance Ot �he work fo� wM1icb 1b15 permit is i55uetl (Section 309]
' Civ. C.)t ' � ' ' �- " - -FCOOR SINKS � FLOOR DRAINS -
Lentler'S Name
LenOer's Atldress ' � DRINKING FOVNTAINS '-
� OWNER BUILDER DECLARATION ' ' ' ' ' ' "INTERCEPTOR$ � CLARIFIERS �
I hereby affirm thal I am exempt irom the Contractor'S License l.aw for
tne foltowing rea5on (Section ]031.5 Bu5ine55�antl �Profe55ions Code: SWIMMING POOL PTRAP - -
Any city or county whi<h requires a permit to mns[ruct, alier,
�, improve,'tlemolisn or repair any 5[ructure, prior to�its issuance,-also re-- yyqTER SERV ICE ' 'ALTERATION ' '
quires the apr Il�nt lor SUGh permit to tilC a signttl 5[atement that he
'�-licensetl pursuant to the provisions ot ihe Conlracror's License Law GAS SERV ICE ' OUTLETS �
�apter 9(commencing with Section 7000) of Division 3 of the
inezranA PrWessions-Cotle) or tltat he i5 exempt Iherefrom antl [he y�qTER HEATER$ BTV OVTPVT '
.rs fqr [be alle9etl axemp[ion. Any violation of Sectlon 7031.5 by
any applicanC Po� a-pe�mit subjects lhe aDP���dnt to a civil pEnalty SEWER CONNECTION$' �" ' -' '
of not more than live huntlr¢tl t1011ars (§500).
❑ I, a5 owner of lhe property; or my amployee5 witit wa9es a5 tnelr SOCAR TANK COLLECTORS '' -
Sol¢ COrtip¢nsdlion,_will tlo lhe wo�k, antl the structure is not intentletl
or ofleretl for sale. (Sectlon 7044, Business antl Aofessions Cotle: The � SOLAR PIPING SYS. � ' �� '
wno bullas or Improves tnereon, antl wno aoes sucn woru mmseu or
through his own employees, provitleE Ihat such improvements are not
intentlotl or offeretl for sale. If, howeveq Ibe builtling or ImprovemenE
Is soltl within one yea� ol completlon, the owner will have tM1e burtlen
of proving he tlitl nol builtl oi improve for �Ihe pu�pose'ol sale).
❑-I, as� owner- ot the�-�property, am exclu5iv¢ty- contracting with.
IicenSetl contractors to consVuct the projeCt ($ectlon 7044, Business
antl� ProfeSsionS�Cotle:�-The Contractor's Ucnnse Law tloei�not ap01y to
an owne� of property who builtls o� Imp�oves lhe�eon, antl who <on-
tiacts f�om sucn projec[s with� a-contraGtor(s)-•IicCsnetl pursuanito
Ihe Contractor's License Law�.
� I' am exemp[ untler Section � - -- B. 6 P. C. for this
oy tertitythal I have roatl t�is applitation antl StatC that the above
iation is correci. I aqree to comply with all city antl county
nces antl stale laws relating to construction, antl he�eby authOrize
�n[atives -of this- dty' to enter upon [he above mentlonetl
�[Y i0! i SP � P�}1'f)OSCS.
ure ���n�� Date ��y�
ISSVEFEE - �i� -
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_
ANDDUCTING" 100,000+BTV_
REFRIGERATION 0-300,000 BTU
SVSTEM � �- 100,000+g7U �
BOILERS BTU
SVSTEM REPAIR,ALTERATION �
EXHAVSTSVSTEM MULTIPLE
ISSUE FEE
CMF 0865-46 White-Builtling: Canary-Applicant; Pink-Accounting; GolUenrotl-Assessor
0
0155 �/04/B2
ZONING REGULATIONS
A.P. 3t
ZONE
SETBA� CK� C�
LIDE VARD
5EF
R�IGHTA
R EA R YA RD (TO
. PKG. SPAC E R EQ
.STREET�WIDTH
' ' 1 SPECIAL CONDITIONSi
PLNG. REF. �
PROV IDE[
PARK.FEE
DAl
ELECTRICAL " PLAN CHEC
GENERATOR 0-1 KW_1-30 KW _
TRANSFORMER
APPI..IANCE 10-SOKW_50+KW_
MOTORS 0-1 HP_140 HP _
�QN0. SOLQR) �p-50 HP_50 +-HP _
FI%TURES OUTLETS SWITCHE
GAS TUBE SIGNS �- - -
POLE LIGHTS - ' - - -
PANELS
SER V ICE
- MAIN
8.�0 TL
�( C(� - "�O Q AMP .�
' ' ' ' i
_ � �—�.
_ "_ ' " _ ' ' ' . . _ ..;
-�'ISSUE FEE' -
APPLICATION P.P7ROVED BV � - DATE —�
'
� SUMMARV OF� FEES�, . � �� � � �� #
'BUILOIIVG - � - - �
PERMIT $ SMIP $ _ i
PLAN CHECK E PERMIT i
. - ._ ' ISSUANCE, E '�
.PLUMBING S , '
%PLAN�CHECK y ' - GRADING $
ELECTRICAC E� � � S �
' �MICROFILM E
PLAN'CHECK"'E ^ -
MECHHNICHL E _ TOTAL FEE 8
PLANCHECK § . LESSAD-
VANCEPC b--'
FINAL FEE E �
CONSTRUCTION AND PLANNING � � POOL & SPA . -�
APPROVALS Permit# �� e Date Inspector p�ppROVALS � Permit# � - Date-- Inspector
1. Temporary Electrical Service or Poie 43. Pool & Equipment Location -' -�
2. Soil ipe-Undrgrn - ' • 44. Steel Reinforcement � -
3. Electrical Conduit Utility-Undrgrn 45. Forms • -
._ 4. Electrical Conduit-Undrgrn , 46. Electrical Bonding � • �
. tee ein orce 47. Rough Plumbin & Pressure Test -
. 6. Electrical UFER Grn _ � 48. APPROVAL TO COVER-GUNITE �
.7. Footings _ � 49. Electrical Conduit-Undr m� '
8. � Foundation-- 50. , Gas Pipe, ❑ Undr rn, Test �
- 9. � -Water Pipe-Undrgm_ 51 . Backwash Lines P-Tre � ❑ ndr rn ' � � '
10. Structural Floor System 52. APPROVAL TO DECK " �' -' ''
11. Property Sewer Line.& House Connection � 53. Backwash & Rece tor-Final �
-12. Street Sewer Connection - � 54. Heater & Vent-Final �
13. Rough Plumbing _ ' -
14. Rough Electric-Conduit ` 56. Electrical-Final '
. 15. Rough Electric-Wiring - 57. Solar System-Final , '
16. � Rough Heating & Air Conditioning • encing & Access Approval �
17. Ducts, imStructure ' APPROVED FOR PLASTERING '-
18. Ducts, Ventilating � - ' - � _ , _ . _ _ ,
19. Gas Pipe-Rough & Test � � � 60. POOUSPA SYSTEMS FINAL` , ,
20: Roof Frami�ng - � � - - -�-- � - �� � '
21. Roof Sheatfiin - - � � . . � � •
22: Frame and Flashing � ' . NOTES: . _ , � . - � �
23. Insulation � � � �
24. lathing & Siding � ' - - - � - -
25. Drywall Nailing - ' �
26. Plaster Brown Coat ' �
27. Electrical Power MeterFinal - � '
28. - Final Electric- � - � �
29. Final Heating-& Air Conditioning
� 30. Final Gas Pipe-Test � ' �- - ' �
31. Final Plumbing -- � - ' �
� 32: Water Service-Final ' �
33.� Gas Service-Final
34. Solar pomestic-Final � � �
r 35. � Landsca e S rinklin S stem ' ' �
36. Sound Atienuation � - - � ' � '
' 37. Handicap Regulations ' ' �
. 38. FINALSTRUCTURE&BUILDING • ' �
� 39. Special Requirements Completed ' • �
' 40. Electric Release to Edison -1y- � �, � -
47. Gas Release to Southem California Gas Co. -
42. CERTIFICATE OF OCCUPANCY
No Date
• �. ' � Ao�licant to 1111 in all soaces witnln heavy boraer lines ana sign all aporopriate aeclaraUonf
CITY Ol�jf'iOSTA M6*3A 'J PERMIT NO. TRACT NO. LOT NO. � BLDG. NO.
; C TRIJ��IO',�I PERMIT ,a � f/ 17%(D. 10
-Project Address L TVPE OF CONSTRUCTION
Own2r QS PhOnB ] � ryEyy ❑ ADD ❑ ALTERATION
Ada�� ,33 Q GE ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
Arch/Eng. � � Mj License No�/p�� �THER
._ . . ... ��. � . . _ � �. DESCRIPTION OF W03ilf
Contractor
(� 1 hlreby afiirT [nat I am IlcenSed untlGr proviSiOns Ot ChdrtGr 9(wm-
mencing .wlth section 7000) of Dlvlsion 3� o/ tha Buslness antl
OQ vrotessions coda, any3 my- u<ense �s �n tuu torce a d at�ct.
\License lass cense jyo � ' S
Date� � � 519 tu n ' ��'.
O WOR RS• MPENSATION DECLARATION (/
\, $'hereby aftirm that I have a certificate o! consent to self-insure or a
:��ifiwte ot Workers' CompenSaUon Inzuranca, or a certltletl copY
' t:.;;leof (Sectlon 3800, lab. C.).
LJ Certifietl copy Is hereby furnisheC.
❑ Certified copy is tiletl witn the city Builtling Divislon.
EXEMPTION FqOM WORKERS' COMPENSATION DECLARATION
(This 5ettion neatl not ba tompletetl if the permit Is for one huntlretl
SE300) or less). � � "
cerHty that In tne Oerformante of the work tor which [his permit is
issuea, I shall not employ any person In any manner so as to become
subject to t�e Workers' Compensatlon I�ws ot Californla.
Date Si9nature
NOTICE: It after making this tleclaration, you shoul0 become subjett
t0 th¢ WOrktrS' Comp¢nsdtlOn prOviSlons Of [be ldbof Cotle, you must
forthwith comply with such provisions or this permit shall be tleemetl
revOk¢tl. . _
CONSTRVCTION LENDING AGENCV
I hereby affirm that there is a construttlon lentling agen<y forthe per-
formance of the work for whlch this permit Is issuetl (Sectlon 3097
Civ. C.). � ' ..
Lentler's Nama '
Lentler's Atltlress �
OWNER BUILOER DECLA0.ATION � � �� "" '" '�
1 hereby at�irm that I am eaempt lrom tho Contractor's LI<ense Law tor
the following reason (Section 7031.5 Bu5ine55 antl Professions Cotle:
Any city Or COunty which r¢quires a pCrmit to construcq alter,
ImprOv2, tlemollSM1'ol Iepall any StluCture, prior f0It5I55udnCE, also fe-
qW�es tne aOPll�nt fo� suth permit t0 /IIO a SiqnCtl 5[at0ment that he
" Ilcensetl pur5udnt t0 [h¢ prOVISIOnS Of lhe Con[fac[o!'s LlcenSe ldw
'apter 9(tommencing with Sectlon 7000) of Oivislon 3 of the
iness antl Prdessions Cotle) or tnat he is exempt therefrom antl the
.Is for the allegeE exemption. Any vlolatlon of Sectlon 7031.5 by
any appllcant for a permit subjects the applicant to a civll penalty
of not more than five huntlrotl tlollars (y500).
❑ I, as owne� of tM1e property, o� my emplOy¢es with waqes as thel�
501¢ Cortlpen5dtion, will tlo th¢ wOrk, antl lhe stluctule i5 not intentletl
Or offGr¢tl tor Shc¢. (52ctlon 7044, Bu5Ine55 antl Aof¢zSionz Cotle: The
Coniractor's �ic¢nse Law tloes not apply to an owner o/ a property
who bulltls or Improves thereon, antl who tloes such work himself or
through his own employees, provitletl [ha[ 5uth Improvements are not
Intentletl or olferetl for sale. If, howev<q the builtling or improvemen[
is soltl within one year of COmpletion, the owner wlll have tne burtlen
of proving he tlitl not bulltl or improve for the purpose ot sale).
❑ I, as owner ot thG ptOperty, am exclu5ively mnVacting wilh
Ilcensetl conVaclors to construct the projett (Section 7044, Business
antl ProfeSslons Cotle: Tne Contractor'S LlcenS¢ Ldw tloes not apply [o
an owner of p�operty wh0 builtls o� Improves Ihereon, antl who con-
t�act5 f�om Suth projeGts with a conl�acto��s) IlceSnetl pursuant lo
the Contra<tor's License Law).
�� � I am exempl untler Section B. & P. C. tor lnis
reazon '
I Date Owner
' I hereby[erlifythd[ I hav! r¢atl lhi5 ap0lication antl statt that the a�ov¢
Intormation is correc4 I dgr¢¢ to Comply wllh all city antl counry
ordinances antl state laws relating to conslruclion, and hereby auNorize
repre5entativ¢5 Of [his City lo enter upon lhe abOve me tlon¢tl
property far Ins c[i n u ses.
Sl9nature �� oate L%f/
Drivers' License or 55 x
7YPE OF PERMIT
❑ GRADING ❑ FOUNDATION �STRUCTURAL
❑ TENANT �ELECTRICAL �I.PIUMBING ❑MECHA!
❑ OTHER
PHOJECT DESCRIPTION
SQ. FT.
OCCVPANCY� CONSTRUCTIONTVPE
VALUATION' `� �'VALONE
G13ADING CU. VDS. ACRES
PLUMBING
BATHTUB$
TOILETS.
LAVATORIES
KIT. SINKS
SERV ICE SINKS
�FLOOR $INKS
�pRINKING FOVNTA
INTERCEPTORS
SWIMMING POOL
WATER SERVICE
GAS SERV ICE
WATER HEATERS
SEWERCONNE
PLAN CHECK '
SHOWERS
URINAl.S
DOUBI.E LAVS
DISHWASHERS
SUMPS
. FLOOR DRAIN$
CLARIFIERS
PTRAP
ALTERATIOI
OUTPVT
COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-100,000 BTU _
AND DUCTING 100,000 + BTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000+gTV_
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXHAUST SVSTEM MULTIPLE
ISSUE FEE
CMF 0865�46 White-Builtling; Canary-Applitant; Pink-Atcounting; Goldenrotl-Assessor
. _ + �— _ '_" _ — _' _��
,.��. . �. i••'
ING REGULATIONS
A.P. � Hz5 -- tN3 - l� .
ZONE F; —� PLNG. REF. �
S�ETrBA,CKC/lST.rIIIGI/�C P� NE I(7�C
SIDE VARD I� hu
L5EpFT L/
R�IGHTA ZS/i�� _
REHR VARD (TO P/l) ,��Q
PKG.SPACE REQ.�� PROVIDED "�'
STREET WIDTH PARK FEE S�—
SPECIAL CONDITIONS:
ELECTRICAL PCAN CHEGK
TRANSFORMER 4"1 KW_ 1-10 KW _
APPLIANCE 10-50 KW_50 + KW _
MOTORS 0-1 HP_1-30 FIP _
(INC.SOLAR) 30-50HP SO+HP_
FIXTURES OVTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN SUB
SERVICE AMP
ISSUE FEE
DATE
SUMMARV OF FEES •
BUILDING �
PERMIT b /��[�•-�.� SMIP S �•
PLANCHECK E��� PERMIT
PLUMBING § � ,pD ISSUANCE b
GRADING E
PLAN CHECK E �
ELECTRICAL E� S
PLANCHECK f MICROFILM $
MECHFNICAL S � TOTAL FEE S
PLAN CHECK E LE55 AD-
VANCEPC $_
FINALFEE a a�i-a
-,_, , . .
_ ...
CONSTHUCTION AND PLqNNI , POOL & SPA ,•t � • a I ..
APPROVALS Pe�mit # -II�-I� Date Inspector qppROVALS Permit # Date �`,ispecfir
1. Temporary Electrical Service or Poie 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-UnUrgrn 45. Forms --
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test �
6. Electrical UFER Gm 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn /r C'
8. Foundation 50. Gas Pipe, �L1ndr rn, Test /_ _� �
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn �
10. Structurel Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House �onnection 53. Backwash & Rece tor-Final �' 'L` ,
72. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing � -
14. Rough Electric-Conduit �� �56�.,_ Electrical-Final � $' CL°
15. Rough Electric-Wiring 57. �Sola[ System-Final
16. Rough Heating & Air Conditioning • Fencing &_Access Approval sZ
17. Ducts in Structure 9• APPROVED FOR PLASTERING _S
18. Ducts, Ventilating I
19. Gas Pipe-Rough &Test � 60. POOL/SPA SYSTEMS FINAL S�r�2 C�n
20. Roof Framing �
21, Roof Sheathin . .
22. Frame and Flashin NOTES:
23. Insulation
24. l.athin & Siding '
25. Drywall Nailing �
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test '
31. Final Plumbing �
32. Water Service-Final -
33. Gas Service-Final
3 . Solar pomesticFinal
3. Candsca e S rinklin S stem
36. Sound Attenuation �
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
E7
No Date
�� Z�q � .
W2�?�W ��%`�y Twia�i�q L�bor�torie: of cSouE�etix �nGcfo'cnict, Jnc. a
� 3310 Artpori Way / Ma�l�np AtlAress P.O. 80. 4] / Lonp Oaxr.h, CN 90801 / �213) 426�3355 / �213� 636Q38G / �714� 82��6472
TESTING 6RANCH OfF1�E. 15i4-0 Non� Harpe� Suem / Sania nna, C4 91]O] / p14� SJ� �70<5
� �
November 9, ty61 Examination: SC81-7107
COMPRESSION TESTS ON GUNITE CYLIMDEflS
Mr. Errol F, fleesch
12921 Aspenwood Lane
Garden Crove, California 92640
VROJECT
ADDRESS
SAMPLE FROM
ARCXITkCT
EMOINEEI
MIX
DATE CAST
DATE TESTED
MR. & MRS. BONAS RESIDENCE
433 Ogle, Costa Mesa
Gunite pool h apa
u�-i
t0/27/8t
ii/o6/81
CONi[ACTOR
Cary's Custom Pools
sueconn�croR
Vern Anthony Gunite
SPECIFIED
STRENGTH
SLUMP SIZE Cyl. I:
Cyl. I:I:
11/o6/8i
SPECIMEN NO. I .CI
COMPRESSION 10-Day 10-Day
TOTAL LOAD, �es. 89 , 000 9% , 000
POUNDS PER SQ. IN. 4, 110 i1,080
GOMPIIANCE 10-Day tests comply with specifications.
�uoE �r
SPECIMENS Skip
OIfTtIWT10M:
E. F. Heesch - ?_
Vern Anthony Gunite
Costa Mesa Bldg. Dept./Chuck Conner
DEl1VE4EG �Y
Heeseh
���/ 7 � ��g1
2,000 p3i.
5�" x 12��
5�;n x 1?_"
iII & 7V "HBLU iN
FIEI.U"
�iCIIVfD OM
t0/28/8�
Neale Zuidema
•ll 1�CIOwTS �wE il1SY1TT[O �� TN[ CONfIDCMTI�I �qOrCNTY Of CIICNT/. �ViNOPIZITION iON VUOLICATION OI OU1� 1�[/OI�T/. CONCLU\IOXt. OA C[�
♦R�CT/ fI�OY OP R[G�wO1NG TMIM 15 P[5[RV[D PCXOING OUR WPITTCN 11V40VIl �3 � MUTV�I �110T[CTION �O Cll[NT\. TNC �U�LIC IND OUR�[lVC1.
]30•13
�
� ;. ... .- .. .. ... ... . . . .
��� crrv or cosr.� r�rs,�
QdLE xui�ains nr,enr,���t:v�•
� qddress OF
BUILDIN.G SAI'P:TY
�%%R f� ON�I S O�.rt� e r
�� ' ( �.5r1kD_I�Q�Contractor Registered Deputy Ruildinr, inspeccor
Cer[lficate of Compliance
�Yv4�4d 1wNDg A<ldress
Penni[ `Jatc
�!�[�Number 'a�S' ?s�::ed
Daee eC Chis Cer[ilicace
/0-.27-'�/
To the Uirectoc of Iluilding Sa�e[y:
I hereby cercify [hat the followi.ng porti.or.s of work on the buildings
at the ahove address w•hich required continuous i^spec[1u❑ and w�hich I was
employed [o inspect, wc:e i.nspected bv me and co;agly wi[h the provisions
�of the I3uilding Code applicaolc t!iereto.
�1) Concrete 3) kelding 5) Special Cases
2) MasonrY , � 4) Reinforced Cy�siun
� Swimmin�; Pool Size �.l X,�O �m:i[e ✓ iland Pack
Sacks Cc:nent /,S�i Tons of Sand 7v
Approxlmate % o.` water Sn aggzegace f�%
This report covers work completed durir.g week ending` /� �� -��
� G',�eoc-�v �'.eev�
Addre�s
Luborucor �
Y JWIN�N G Telephone 9i/-3P5G
fiocm BU 6 ' �0�/iNG� W', ' .
�
�
.�....�.. _.,.._""""'_' ""'""""' �'
,�
:
�
► •
� , 6'756
COSTA MESA BUILDING DEPARTMENT
a. o. eox 3n
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
A�DRE55 �33 Qg]_e Circle
COSTA MESA. CALIFORNIA
OWNER CTOYRI
i � � Yb�Va.,� �•���
s-�s- s� vu
FINANCE DEPT.
CITY OF COSTA MfSA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
♦ �
IECEWfD BY D4TE BECEIVEO� OATE 1 SU I
_ ._ -r� C �LL 1 �411V � !1 �n
CITV Ne � t UB8CLL Va . TNo: OR 3-6601 A00 E'SS '�✓ !' ['� (���
oR ENCENeER F[ T• O'tH • • 1 � GI.1 COSTA MESA. CALIFORNIA
A�DRE55 2035 N ort Blvd. Costa Mesa C'NEe 3
p 1�i/� ZONE MO.OF TVpE GROUP
CONTRACTOR t,• 1Y� ���� v��$��Tv �'o: g534 � P�/5 2. �� �%% 0
ADDRE55 �20
teenl LOT
DESCRIPTION NO.
A.P. NO.
OF LOT � f,
USE OF
E%ISTING BLDG
SETB<CK IINE FROM
CENTER OF STREET
BZVQ� TNO- OR ��1 BPPROVE4' �jj��� DATE
,,,.,, ro,,.r i.�.�� CORRECTIONS
NO.OF BlOGS.
NOW ON LOT
REAR VARD
DESCRIPTION OF WORK
NEW A(.TERATION I ApDITION
REPAIR I II�MOVING DEMOLISH
9UILDING Ll1 x 34� 5 NO.OF
SIZE Jll ROOMS STORIES
EXTERIOR WA�L.�e�c� I ROOF 0.'1'
COVERING L'TUWtUCCO COVERING Syy�yye
USE OF NEW
BUILDING cuil]�ZE fa.m=l3r �el�in��r
.. 'l /.
�S � S N— �
1 MEREBY RCKNOWLE�GE TMRT I M/VE FEr�O TMI$ APGLICATION PND /
STPTE THAT THE RBOVE IS CORflECT LNO AGREE TO COMPLY WITH Rll 2 O_ � �
CITV OROIN4NCE5 �NO $TOTE L�WS REGVLATING BVILOING CONSTPUC. �
TION. VALUATION
SIGNATURE OF �^t y^ ���.r,�� PERMiT FEE S
PERMITTEE �
/!/ "'�/ 7� PLAN CHECK $
,..// (_�/ { S J /f� .J
AUTHORIZED AGENT � � 1 / " _ TOTAL FEE S
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