HomeMy WebLinkAbout2538 OXFORD LN - Building PermitslFj G /�Dolicant to fill in all soaces exceot tbose within heavy boraer lines and si9n all aDoropriate ceclarationz.
PE MIT TFACT NO. L T UNIT N0.
c-;YOFCdS7n�ESa CONSTRUCTION PERMIT �� g ? � q�' __ A.P•51� -
Prqeje,tAddreso- 2�3P% �%�2��T�17 _
ApplicanYs Mailing Address 2�7,/��r�fnx���0 C�• �1��� �qr�
Owner'sName �{G'��A�� 7�����'E Phone„[�/__�¢{,;,)q
Address 253�} OX �.fJ G0�1i����r�
Arch/Eng. License No.
Address
Contractor's Nam Phone
Address ?mailing)
City License No.
LI EENSED CONTRACTOR DECLARATION
� 1 heiCty affitm that I am licensetl untler p�ovisions of Char ng
witn sec f Division 3 of the B rofessions Cotle, antl
my li f II f
ense Class lice Se-hle.�
re qgna;�i.n _
IWORKERS'COMPENSATION DECLA0.ATION
�ereby af(irm tnat I have a certificate of consent to selt-insure or a certificate
workers' Compensation Insurance, or a certitietl covY �hereof (Section
.00, Lab. C.)
Policy No. Company
eCertified copy is hereby (urnisbetl.
Certifietl coOY is filed with the city Builtling Division.
pate Applicant
EXEMPTION FROM WORKERS• COMPENSATION DECLARATION
(This section neetl not Ge completetl if the permit is fo� one huntl�etl ($100) or
IC.S`.
1 certify that in the performance ot the work for which this perm�t is issuetl, I
sna11 not empioy any person in any manner s a to b o e subject to the
Workers' Gompensation Laws of Calirom' .
vate Si9nature
NOTI , a r makin9 this tleclaration, shoultl bemme subjeci to the
Workers'�Compen5ation p�ovision5 of th Labo� Cotle, you must forthwith
wmpty witn sucn Orovisions or this permit snall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV -
I hereby affirm that there is a const�uction lentling aqency fo� the Oer/ormdnce
of the work for which this p r it is issuetl (Section 309� Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNERBUILDER DECLARATION
I hereby affirm Lhat I am exempt from the Contractor's License Law tor the
,�,.(�ilowing reason ($ection ]03L5 Business antl Professianal Cotle: Any city or
',�unly which requires a permit to con5truct, alter, imptove, demolish o� re0air
r'���",'iy structure, prior to ics issuance, also requires the applicant for such permit
�'io (i1e a signetl statement that he/she is licensetl pursuant to the provisions ot
Ithe Contractor's License Law (Chapter 9(commencing with Section 7000) of
;g�ivision 3 of the Business antl Professions Cotle) or that he/she is exempt
',...erefrom an0 the basis to� the allegetl exemption. Any violation ot SectiOn
<:`�)31 5 by any applicant for a Permit subjects the apPlicant to a civil
"�-a'epalry of not more than five huntlretl tlollars ($500). ,
�I�. as owner of the property or my employees with wa9es as their sole
tompen5ation, will tlo the work, antl the structure i5 not intentletl o� otferetl
for sale (Section 7066, Business antl Pro(essional Cotle: The Contractor's
License Law doe5 not apply to an owner of a property who builtls or improves
th@reon, antl who tloes Such wo�k him5elf/he�self or tnrou9h hi5 or h¢� own
.employees, provitletl that such improv¢ments are not intentletl or offeretl for
sale. If, however, tbe builtling or improvement is soltl within one year of com-
pletion, the owner will have the burtlen ot provin9 he/she tlid not builtl or im-
� p�ove for the pu�pose of sale).
: 0-I, as owner of the property, am exclusively contracting with IicenSed Con-,
'tractors to const�uct Ihe p�oject (Section 7044, Business antl Profession5 Cotle:
.Th¢ Contractar's License Law does not apply to an owner of property who
..builtls or impwves tnereon. antl who rontracts Tor such oroiects with a ron-
tractor(s1 license pursuan[ m me Contractor•s License Law). 1 am aware that
proof of tM1eir Wo�ker's Gompensation in5urance shoultl be provitletl to me.
❑ I am exempt untler Section B,.& P. C. lor this reason
.. � i�
Date � ��/� Owner
.I hereby certify that I have reatl this pl
'intormation is wrrecL I agree to com ly wi
antl state laws relating to uil in struc�
Sentatives ot this it on the
inspection pu�pos
Signature
Driv¢rs' License or 5
0865-46, rev. 5/88 White - Building; Ca
�z
TVPE OF CONSTRUCTION ivE�
❑ CONVERSION ❑ DEMOLISH
DESCFiIPTION OF WORK/SASE QF B
ADO LJ ALTERATION
TVPE OF PERMIT LJ GRAOING LJ FOUNDATION LJ STRVCTU
❑ TENANT ❑ ELECTRICA ❑/� PLUMBING ❑ MECHANICAL
❑ OTHER .L�/�Q� /(t,�lJ COJey'
PROJECTDESCRIPTION SQ.FT. ,`iS�__ pG-�VBCOCCUPANCY
CONSTRUGTIONTYPE^S.`� �J VALUATION$�
20NE GRADING CU. VDS. ACRES_
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
�rinking Fountains
Floor Drains '
FI o Sinks
uas Service utlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structurel
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. �CBO #
Heating System & Ducting�
❑ 0-100,000 BTU � 10p-0b0
Reinspeaion Fee � $15
AppliCant; Pink - Accounting; Goltl¢nrOtl � A55e55or
Showers
Service Sink
Sewer Cap "
Sewer Connection
Solar Collectors
Solar�Piping . .
Solar Tank -
Swimming Pool�w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
70-1 P%OOOBTU ❑100,000
stem Repair/Alteretion
Fire Dampers
Registers
luue Fae
S Main Buildi
REPAIR
T Front �
XL^-4�Q I� A Re -�
�— C Right
- I K
g Left
� Ping. Ref. #
� Q . , Planning Notes:
I
FEES <lutomatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher ,
$ 3
$ 3
F.A.U.
Device Boxes
QUtI¢t5
c,.,�r��,e� � ' . .
zooe �
Accessory Building:
2 I.� O
22 N
I
• N
! f'
p I R
Parking Req./Provided E
Q
,.,. M
T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50'+KW
Meter �up to 100 amps
Meter �over100amps
Sub Panel
Motors DO-t HP �7 %- 8
Inc.Soiar �9-15 HP �16-15+
Microwave
Pole Light
Range
GarbageDispoul, . , �
Generator �0.5�KW��05-15 KW
Reinspection Fee � $15
+DEVELOPMENT SERVICES REQU
2oning APProvetl BY .
Building Approved 6y /� ��
FEES
Trash Compactor "
� -.
�luue Fee ' ' ' " $
[�I�Y/ ' (- .�,if.���n/
�" � SUMM' �RV OF FEE - ., ry. , .�
BUILDING PERMIT $�__�� W SMIB ��$ �w � U�
PLAN CHECK $ PERMIT ' �
PIUMBING ' $ �•� ISSUANCE $-
PLAN CHECK 25% $ ENERGY P.C. $
' ELECTRICAL $ ,� GRADING $
- PLAN CHECK 50% $� � MICROFILM $ r-� �� ��"
MECHANICAL $; TOTALFEE $ jJ.l ,v/
. PLAN CHECK 25% $'
�h -..e s,,..� - , . �
s'
, . .. .
_.,
� CQNSTRUCTION AND PLANNI �� � � ' �� 'P'4
APPROVALS Permit #� Date Inspector AppROVALS Permit # Date Inspector
1. �Temporary Electrical Service or Pole 52. Pool & Equipment Location
2.•SoilPipe,-Undrgrnd. �, 53. SteelReinforcemenT
i,
i3f� Elect�ical Conduit UtilitY-Undrgrnd. 54. Forms ' �
4� Electr.ical.Conduit;Undrgrnd. 55. Electrical Bonding _,
5J Steel'Reinforcement 56. Rough Plumbing & Pressure Test
6,;EI,�ctrical UFER Grnd. 57. AP.PROVALTO COVER-GUNITE � :�
7; Footings �-�-�Z �'�: ' 58. Electrical Conduit-Undrgrnd. �
8.;FouRdation : 59. Gas Pipe, O Undrgrnd., Test .
9. Water P.ipe-Undrgrnd. � • ' 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Struclu?al Floor System � 61. APPROVAL TO DECK
1 i. Property.�Sewer Line & Hous'e Connection 62. Backwash & Receptor-Final
12. Sevper,Gap � � 63. Heater & Vent-Final
13. Roof•Drains 64. Plumbing System - Final
•'�
14. RougN Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
.16: Rough Electric Wiring �67. Fencing & Access Approval
]7.. Rough Wiring Sign '68. APPROVED FOR PLASTERING
�18. Rough Electrical-T Bar Ceiling �69. POOL/SPA SYSTEMS FINAL
J�9: Rough�Heating & Air Condit�oning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace '� � w APPROVALS Permit #
21c Ducts, in Structure � •70. Underground Hydro
22: Ducts,"��/entilating .I � ' 71. ProductPipingOGas ❑Oil
23��6as Pipe=RougK & Test , 72. Unde�g ound Flush -� �
24'. Roof Framing j: "� '�� 73. Undergrnd. Storage Tank 0 Gas ❑ Oil �
25. Roof Sheathing- f� �, � Z�-'L (,U 74. Overhead Hydro ��
26. T-Bar Ceiling (Structural) &�Mdnocoat 75. Dry Chemical /
27,. Frame�and Flashirig' � � 76. Dry Standpipe �
� •
�28. Latljing�& Siding -�' . 77. FIXED SYSTEM FINAL
29. Insulation �"� 78. FIRE PREV. FINAL
� � � � HEALTH DEPT. REQUIREMENT
30. Drywall;Nailing „� .
3j. Plaster�Brown Coat•. ,' 79. FINAL INSPECTION
32. Electrical Power Meten-Final:� 80. FOOD CERTIFICA7E ISSUED
.
33. Final Electric .� ' Notes ' �� „ �� �
34. Final Heating & Air Conditioning ��j., _,-
/ j.. .1 � p
35. Final Gas Pipe-Test � G� � ' �
'36. Hood or Canopy g Z
.O_ � L
37,. Final�FactoryFireplace r� ��"'q�,- Q� �y_�, _, �,i!/
38. Final Plumbing � �, � . � $' ,?9 Q� - �qy.g�pJ�SU[-{N?ZO+1'�:.�il �
39. Water Service-Final-�,- ;/� , �' � ✓? Z �,q,$�d '�A
�40. GasService-Final • "' '�-G3 _ ��r�0 �,�`�
41. Solar pomestic-Final/� �' _
icG !' �
42. Backflow Preventer : ;n, Q� `^�
/
43. Backflow Irri ation ;� ' q qp ��y� ' q -
9 : , / %U' l ( - kT� ` D�✓''6k�-t �e ' l'E'sS '.t ,l. �rx
44. Landscape Irrigation-System � �� � ' �r �
45. Sound Attenuation �, ' �
46. Handicap Regulations
� �,
47. FINALSTRUCTURE&BUILDING '
48. Special Requirement"s'�Completed
49. Electric Release to Edison �� j�f
,. i -u�..�
�50. Gas Releaseto�Southern CaliforniaGasCo � f��,v' , � � �
- . � m!
51. CERTIFICATE OF OCCUPANCY •''! '"' r'J � i �F/ ' . i
No. Date S j.' f� t� . <f y,
e
NUVEMBER 16, 1989
�EURGE �DPAISTUN
ACTING BUILDING UFFICIAL
CITY UF CUSTA MESA
D�AR MR. EDMISTUN:
PLEASE EXTEND BLIILDING PERMITS �G-3&G97 AND �BPE-38G98 FOR AN
AqDITIUNAL 180 DAYS.
I UJAS UNABLE TO COMPLETE MY PRUJECTS DUE TU FINANCIAL �IF�ICULTIES.
�
GERAR STUKKIE
253� OXFURD
CUSTA �dESA, CALIfURNIA
��y, /nd //- / 7 - �9
����
! � Applicant to fill in all spaces exeept those within heavy EorAer lines and sign all appropriata Eeclarations.
P RMIT NO A O. LOT N UNIT NO.
� CI7YOFCOSTA F,g� CONSlj�U�TIONPERMIT 6` jFi z�.Gq� ���/'� 1� �_ A'P'#
S Y
r�oiect AdQ�ess � 6 � �� o^ _
ApplicanYs Ma/ili��ng rA�d,,d�resrs� � . � _
(�wner's Name�"��J Phone �I
Fl� g.�'� Licenu No.
Address
ConiFacmr's Nam Phone
Address hnailing)
Ciry License No.
LICE D CONTRACTOR DECLARATION
I hereby a at 1 am licensetl untl i» �arter 9(cammencing
WI(h $QC(10l1 %�Q�) o '� the Business dOd PI0f255I0lIS COd2� dfltl
my license is in t e antl effec .
`n s License .
Signahre
WORKERS'COMPENSATION DECLARATION
I hereby atfirm Ihat I have a<ertiticate ot mnsent to self-Insu�e Or d CertifiCate
N Workers' Compensation Insurance, or a certitietl copY lhereof (SecUon
fB00, Lab. CJ
Policy No. Company
8 Certifietl copy is nereby fumi5hetl.
Certifietl copy is filetl with the clty Bulitling Division.
Da[e ApPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion neetl not be completetl if the permit is for one huntlretl ($100) or
INS).
I certify thal in the perfo�mance Of the wo�k fo� which this pe�m�t is i55uetl, I
shall not employ any person in any manner s a to bec i ubje<t to the
Workers�_Co pensation Laws ot Cali(ornia
- Date -�—Signature
NOTI E: 1, afte aking this tlecla�ation, y �Ou tl become subject to the
Workers' Compensation provisions of the bor Cotle, you must forthwith
complY with such provision5 or this permit shall be deemetl revoketl.
. CONSTRUCTION LENDING AGENCV
I hereby atfirm that there is a construction lentling aqency for the pertormance
of the work far which th'S permit is i55uetl ($ection 309] Civ. CJ
Lentler's Name � � �w
Le�tler's Atltlres5
OWNER BUILDER D�HATION
1 hereby affirm lhat I am exempt from the Contractor's License Law for the
•�Ilowinq reason (Sec[ion �031.5 Business antl ProfeSsional Cotle: Any city or
�nty which requires a permit to construct, ali¢r, improve, tlemolish or r¢pair
struc[ure, prior to its issuance, also requires the apPlicant tor such permit
iile a signetl statement that he/she is licensetl puRudnt to the p�ovisions of
� tM1e Contractor's License Law (Chapter 9(commencing witM1 Section 7000) of
Division 3 of tne Busine55 antl P�ofe55ions Cod¢) or that he/sh¢ is exempt
-�herefrom antl tM1e basis for the alle9etl exemption. Any violation of Section
;031.5 by any applicant Por a permit subjects tne applicant to a civil
nalty oi not more Inan tive huntlretl tlollars (E500).
I, as owner of the orooerty or my employees witn wages as their sole
co Oensation, will tlo the work, and the structure is not intentled or of(eretl
for sale (Section 7044, Businesz antl vwfessional Cotle: The Contractor's
License law tloes not apply to an owner of a Droperty who builtls or improves
Ihereon, antl who tloes such wo�k him5elf/herself o� th�ough his o� he� own
employees, provitletl that such improvemenis arc not intentletl or oiteretl tor
sale. If, noweve�, the builtlinq o� imp/ovement is soltl within one year of Com-
ple[ion, the owner will have the burtlen of proving he/she tlitl not bulltl or im-
prove tor the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensetl con-
tractors to construct the project (Section ]044, Busines5 antl Professions Code:
The Contractor4 �icense Law does not appty to an owner of property �who
builtls or improves tbereon. antl who contratts tor such oroiects with a r.on-
trat[or(Si Lcense pur5uant to ine ContraCtof's LicEnse Ldw),I am aware [hai
proof of their Wo�ke�'s Compensa[Ion insu�ance shoultl be provitletl to me.
❑ I am exempt untler Section 8. & P. C. for this reason
.., . /..r-T.t�'
Date �
1 hereby certify i
in/ormation is mr
antl state laws rel
Sentatives of this
inspectlon pu�pos
Signature ��
Driver5' License o�
0065-46, rev. 5/88
Owner
the
the
Date,.�
TYPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTH
DESCRIPTION OF WORK/USE OF BLDG. ���"� w0 C4Y'
e ,
TV OF P IT G DING ❑ FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTR1CAL PLUMBING ❑ MECHANICAL
❑�OTHER I-�alo;�' � � Q G
PROJECT DESCRIPTION 5a. FT. oCCUcaNCv •
CONSTRUCTION TVPE vGl_l_1GTIqN $ IO._TTM�
ZONE GRADING GU. VDS. ACRES
Remarks: �- ZSO`� � i� 4�.0 �� . ���-" ^
'_ Ar�i..-�.L..� � ti/f37•11�ti 1 R77 l'� • r�6a'I....l . M i�-i
Sink
Preventer
Irrigation
Dishwasher
Drinkin9 Fountains
Floor Drains
Floor Sinks
GasServic.e Outlets
Interceptors
Kitchen Sink
Lavatories
P-T�ap
Roof Orains
Reinspection Fee
$75
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. iCBO dk
Heating System & Ducting
❑ o-i oo,000 eru � i oo,000
� _ � i Reinspection Fee � $15
White - Bulltlin9; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmre
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
S Main Building:
E Front 2 . I
T
ARear �
C Right (
K /
g Left �
Ping. Ref. #
Planning Notes:
Aummatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Device Boxes
Outlets
�C ����
zone
Accessory Building:
� O
22� N
I
� N
� G
R
Parking Req./Provided E
Q
�! _ G�N �(G e 4r.17''�i T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors�61 HP �1'h-8
Inc.Solar �9-15 HP 016-15+
Microwave
Pale Light
Gar6age Disposal
Generator 00.5 KW �5-15 KW
Reinspection Fee $15
$ 3 DEVELOPMENTSERVICESREQI
Zoning Approved By
FEES 8uilding Approved By�
� Aaolication Issuad Bv
Sign
Standing Section:
Trash Compactor
�
!
Issue Fee �
s�
JTS '�
FEES
�UMM,A1HV OF FEES•; ,�r ��
BUILDING PERMIT $ �1� O9 SMIP�•� $ �.,t;_
� PLAN CHECK // � �BERMIT
� PLUMBING G b , $ ��UANCE $
PCqN CHECK 25% $ ENERGY P.C. $
� .-ELECTRICAL $ � GRADING $
PLAN CHECK 50% $ MICFOFILM $
MECHANICAL $ `�� TOTALFEE $ �
, PLAN CHECK 25% $ / '] , 7�
;,;,:•'_- - _;3 -
p.,'^:. �.,__. : �,'.c- "•.
_ ..
/CONS� TION AND PLANNI • � lOL _ �BA
APPROV S•`"'9ermit# �� Date laspector p�ppROVALS Permit# Date Inspector
y .
1., Tempora,ry Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe Undrgrnd. �, � - 53. Steel Reinforcement
�3�Electrical Conduit Utility-Undrgrnd. � 54. Forms ' !��
''4y�Electr.ical Conduit-Undrgrnd.t� 55. Electrical Bonding ; /.
5. Steel Reinforcement '+ 56. �Rough Plumbing & Pressure Test
/i `_ ! /.
6�r Electiical UFErR'Grnd. � 57. APPROVAL TO COVER-GUNITE -
� �E
<7�� Footings � . 58. Electrical Conduit-Undrgmd. ' ! '
<
�B��Foundation ' � . 59. Gas Pipe, O Undrgrnd., Test .� �
c_ �
9. Water Pipe-Undrgmd. � � ' ,� 60. Backwash Lines, P-Trap, O Undrgrnd. .. •
•.
10. St�uctural Floor System � � ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ; 62. Backwash & Receptor-Final �
1� Sewer Cap - � � • � � 63. Heater & Vent-Final �
IA;3! Roof�Drains � �� 64. Plumbing System - Final �
��
14'. Rough Plumbing 1 65. Electrical-Final
15. Rough��Electrical-Conduit \ 66. Solar SYstem-Final
96� Rough Ele� tric Wiring �• 67. Fencing & Access Approval
17'. Rough Wiring Sign 68. APPROVED FOR PLASTERING -
� �.
118: Rough Electrical-T Bar Ceiling .' 69. POOL/SPA SYSTEMS FINAL
<79�. Rough Heating & Air Cond �ion�ng FIRE DEPT. REQUIREMENT
20: Rough Factory Fireplace '\� � APPROVALS Permit#
21. Ducts, in'Struct`6re ' 70. Underground Hydro
�22� Ducts, V2ntilatiog c� ._ • 71. Product Piping O Gas ❑ Oil
)23r Gas Pipe,=Rou� �'& T,est , �,,, 72.. Underground Flush
�24. Roof Framing�;r:Li� ' 73. ;Undergmd.StorageTank OGas ❑Oil
25. Roof Sheathing {�' �"" ` 74. Overhead Hydro ,
26. T-Bar;Ceiling (Structural) & Monocoat 75. Dry Chemical
- 27..� Frame and Flas�ing �;' 76. Dry Standpipe
•. .
�28� Lathing & Sidirig ,.tY�, j 77. FIXED SYSTEM FiNAL
29. Insulation V�- 78. FIRE PREV. FINAL
30. Drywall Nailing � �,� HEALTH DEPT. REQUIREMENT
31. Plaste,r Brown Coat � �^ 79. FINAL INSPECTION
�
32.�Elect�ical Power Meter-Fina�" a �L 80. FOOD CERTIFICATE ISSUED f �� �
�'
33. Final Electric = � ' ` �� ♦�� Notes: � p �
34. Final Heating & Air Conditionijig (�� i�,! � I �
35. Final Gas Pipe-Test . +^ � � � � -���v � �
36. Hood or Canopy ,� ��n . �j/
37. Final Factory Fireplace �t__
i38. Final Plumbing !'� � ^
39. Water Service-Finab�y- �'�� � � • , ' �`� !
i r' '
�4�0. Gas Service-Final � "' (,^.� 1 ,
.,
L41. Solar pomestic-Final�.�:- 1 �,�f,•` `
42. Backflow Preventer:. � . � .�;� .i .
43. Backflow Irrigation : � �� t .•, � � � � ' •
.�
44. .�andscape Irrigation System ' 'i �• � i '
45. Sound Attenuatiori � } ����
. � .
46. Handicap Regulations ' ' �
47. FINAL STRUCTURE & BUILDING -
48. Special Requirements ComPleted
n
,49. Electric Release to Edison ' ' , ,
-50. Gas Release to Southern Califomia Gas Co ..'� ' �
.
51.CERTIFICATEOF6CCUPANCY , � �", '�'•� • �i' •
No. Date . . - . � !: �
i �
CITY OF COSTA MESA
6UILDING DIVISION
OWNER-BUILDER VERIFICATION
A ciry or county, whic� is require0 to give notice pursuant to Section 19830, shall atlach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder veritication.
Attention Property Owner:
An 'owner-buitder' building permit has been applied for in your name and bearing your signature.
Please complete a�,� 3tum this iniormation in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. 1 personally plan to provide the major labor and materials for construction oi the pro-
posed property improvement.�es ❑ No
2. I(have/'nave noij �(�L^ sigrteu an appiicatiort for a building permit for the
proposed work.
3. 1 have contracted
Name —
Address
Phone (
following person (firm) to provide the proposed construction:
City
Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and proyide�the major work:
Name _
Address
Phone (
City
Contractor's Lic. No..
5. 1 will provide some o1 the work but I have contracted (hired) the tollowing persons to pro-
vide the work indicated:
Addreas
Phone Type oi Work
I hereby aHirm that I have received a copy of the in(ormation set (orth in Section 19830 of the State
of Cali(ornia Health and Salety Code and have compieted the above iniormation to the best oi my per-
sonal knowledge, in c a e' his State law.
Signed: ' Date: ,�. ��"��
Name: �- � � r
(Printe0 or Typetl)
C.D.L N or S.S. N �.
754-5273
�.
NUVEMB�R ib, 19&9
G�URGE EDPAISTUN
ACTING BUILDING UFFICIAL
CITy U� CUSTA MESA
D�AR MR. EDMISTUN:
PLEASE �XTEND BUILDING PERMITS #G-3BG97 AND #BP�-38698 FUR AN
AiJDITIUNAL 180 DAYS.
I(UAS UNABLE TU CUMPLETE MY PRUJECTS DUE TO FINANCIAL DIFfICULTIES.
�
GERAR STUKKIE
2538 UXfURD
CUSTA �dESA, CALIFORNIA
� �/ � / / � / 7 ' �'���
<.7 YQ7A' `� � / //
��/
I�-�-
Aoo���ant ta fill in all soaces ezceo� tnose wlenin neavy Eoraer lines antl sign all aDo/ooriate Geclarations.
cirv�F.cosTnMesa CON CTIONPERMIT
Project'Address �+ �
``licant's Mailin ddress .�/+'f't`ti.
�(i.�ner's Name Phone
Address
Arch/En � L � License N
Address �z �
Contracror's Nam aL � 4� Phone �-�-3dC�
Address (mailing /�ry �
CityLicenseNo. `���70
L�CENSED CONTRACTOR DECLARATION
I M1ereby affirm t�at I am Iicensetl untle� provi;ions of Cnartet 9(Commen[in9
with seclion 7000) of Division 3 of tM1e Business antl Professions Cotle, and
my iicensc is in f fl for ntl et�ecL � �.� ?/. /��
titens Clas�� L' �X✓ �F
Date� Signature. A'�'l�✓i-/ - �� -�
WORKERS'COMFENSATION DECLARATION
I hereby aHirm that I bave a certificate o1 consent to self-insure or a certificate
f Workcrs' Componsa[ion Insurance, or a certifietl copy t��W�g o( (Section
.800, Ldb. C�� , /�l� � (�-. � / / l.�,�
PoIicY O. •.S lY Companv /i�-.-� -d /
Certlfletl ��oY Is neea withrthenck in9 D' is � � e� �
Dale ����� APOlicant��'�(�
EXEMPTION FROM WORKERS' COMPE ATION DECLARATION
(Thi55eGtion neetl nOt be campletetl if (he permit is tor one huntl�etl (5100) or
less).
I tertity that in [h! PerfOrmanta of th¢ wOrk (or which [his pe�m�t is isSueU I
snall nol employ any pe�sOn in any manner so as t0 bewme subject to t{ta
Workers' Compensatlon Laws ot California.
Oate Si9nature
NOTICE: If, after making tnis tleclaration, you shoultl become subject to Ne
Workers' Comp¢nsatiOn provisions o( the Labar Cotle, you must torthwlth
comply with suc� provizion5 Or Ibis permit Shall be tleemetl revoketl.
CONSTRUCTION LENOING AGENCV
I hereby aflirm tM1at there is a const�uction Ientlin9 ag¢ncy (or the pertormance
of tho work for which thi5 permit is issuetl (Section 3097 Civ. CJ
Lenaer's Name
Lentle.'s Atltlress
OWNERBUIIDER DECLARATION
I hereby affirm that 1 am ezempt from the Contractor's License �aw for the
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
ir a r if c nstruct alter im rove tlemolish or re air
munty wnlch �equ e5 p¢ m t0 0 , 0 . P
any structure, prlor to Its issuance, also requires the applicant for such permil '
to tile a Sign<tl statement tnat he/she i5 IlGenzetl purzuant to the provi5ion5 Of
the Contractor's License Law (Chap[er 9(commencing with SectiOn 7000) of
DiNsion 3 of tne Business antl Protessions Cotle) or that be/she is ezemp[
nerefrom anG lM1e ba5is for the alleqea exemption. Any violation of Sectlon
031.5 by any applicant for a permit subjects the applicant to a civil
Lenalty of na[ more tM1an five huntlretl tlollars ($500).
LI I, a5 Owne� ol lhe D�operty or my employees wilh wages a5 their solo
compensatlon, will tlo the work, antl the structur¢ is no[ intentletl o� ofteretl
for sale (Sec[ion 7044, Business antl Professional Cotle: The Contractor's
Licenso I.aw tloes nol apply to an owner ot a property who builtls or imoroves
thereon, antl who tloes such work nimseli/herself or throu9h his or her own
employces, provitletl tnat such Improvements are not intentletl or offeretl fo�
sale. 1(, M1owevaq the builtling or improvement is soltl within one year of com-
ple[lon, lha ownar will M1ave Uie burtlen of proving M1e/5M1e tlid no[ build or im-
�rove fo� Ihe purpose ot sale).
1, a5 ownEr OI th¢ property, am exclusively contracting with Ilcensetl-con-
traCtorS t6 conitrucl Ihe project (Set[ion 7044, Business antl Professions COtle:
Tha Conlrattor'S LicenSe Law does not appry to an owner ot property who
builtls or improves tnereon, antl who contracts for such projects with a con-
traclor(51 I¢ense pursuant to the Con[raCtor's Lirense Law). I am aware that
proot o( their Worker'S CompenSaHon insurance shoultl be provitletl to me.,
� I am Cxempt untler $ectiOn B. & P. C. for this �eason
�ate Owner
I hereby certity tnat I have reatl this application anG state that the above
info�mation is cortect. I d9ree to compry wi[h all citY antl county o�tllnances
Signature /1L�L"��
Drivers' License or 55
� 865-46, rev. ] 0/84
L
�TVPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATIOfJ LJ REPAIR
� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIP NOF CRK/lJ5�Er0� B DG.
.h
TVPE OF PERMIT G ADING � FOUNDATION STRVCTVRAL '
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL .
❑ OTHER
PROJECT DESCRIPTION� Sq.FT.
CONSTRUCTION TVPE �
20NE GRADINGCU.YDS.
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
titchen Sink
Lavatories
y—Trap '
Rnof Drains
Reinspection Fee $15
Duct-UntlerGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact BIL ICBO #
Heating System & Ducting
❑6100,000 BTU 0100,0008T
Reinspaction Fee � $15
Whit¢ - Builtlin9; Candry - qpplicant; Pink - ACcounting: GOltlenrOtl - AssetSor
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Hearer
Water Service
Auto-Wash
Laundry Treys „
Issue Fea
Hood or Typel ❑
Canopy Typell ❑
AC
Retrigeration Sys[em
❑o-ioo,000aru ❑ioo,000eru
SVstem Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
A.P. � -
S Main Building:
E
T Front
ARear
C Ri
Ping. Ref. #
Planning Notes:
Automatic Washer
ConsVuccion Pole Sub..
Cooking Unit
Dishwasher
Dryers �Gas OElect�
Fan
F.A.U.
�. . -
-■�� • : •
-■C.
.��■. • ..
L'%III / • ■ � ■
�C��►� �
l�I�' , is '
�
�..
FEES
$ 3
Fee � $75
2511 9/04/86
2one
�Accessory Building:
ELECTRICAL
Transformer-❑ 15-50KW
❑ 50+KW
DEVELOPMENT SERVICES REQUIR
2anin8 APProved By����
Building Approved BY 4(/�J
FEES
Meter Llup to 100 amps
Meter ❑over 100amps -
Su6 Panel
� 1'ii--'B
Inc.Solar �9-75 HP �1G15+
Microwave �
Pole Light
Range
Sign
Standing Sections
Trash Compactor
C
Issue Fee $ 3
2
O
N
I
N
G
R
E
Q
M
T
S
SUM�+nn� RV�O�.F� ,FEES - , �7
BUILDING PERMIT $ � SMIP $
PLAN CHECK :$ PERMIT
PLUMBING $ �� ISSUANCE $
PLAN CHECK 2 �$ • ENERGV P.C. $
ELECTR�I�CN�L�� GRADING $
PLANCf�(SC[� MICROFILM $ �-�Tt�
MECHANICAL $ TOTALFEE $ /J�
PLAN CHECK ?5% $ f/ 9• 3�
� CONSTRUCTION AND PL"ANNING
APPROVALS Permit.#.
�'�1. Temporary Electrical Service or Pole
�, '2. Soil Pipe-Undrgrnd. �~
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
'� 5. Steel Reinforcement .
6. Electrical UFER Grnd. ,
7. Footings ,
8. Foundati4��
�
9. Water Pipe�Undr9rnd. '
10. StGuctural Floor Sysiem .
,.
11. P�rpperty Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frameand Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
� --
POOL & SPA
Date Inspector p�ppROVALS Permit#
52. Pool & Equipment Location �
53. Steel Reinforcement
54. Forms
5�i/Electrical Bonding
56. Rough Plumbing & Pressure Test
5Z?APPROVALTOCOVER-GUNITE �
58. Elecirical Conduit-Undrgrnd. �
59. Gas Pipe, O Undrgrnd., Test � �
60. Backwash Lines,P-Trap, ndrgrnd.
61. APPROVAL TO DECK �
Date � Inspector
62. Backwash & Receptor�Final I (4 ��.
63. Heater & Vent-Final �-
64. Plumbing System - Final �'L,, ��, -
65. Electrical-Final (1
66. Solar System�Final
67. Fencing & Access Approval
. 68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro � �
71. Product Piping O Gas ❑ Oil
72. Undergraund Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro � �
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: �( S � � �L
i •
.
�°
e
�
\ ���� •
��"' "'�. Twininq Laboratories �f s�LL�Etn �a�'�fozRta, �.�.
�� �rv n
-2 �,� .
�
3910 /irpprt Way / Mailing Aatlress P.O. Boa <] / Lonq Beacn, CA 9080� / 12t31 �26-9355 / 12i31 636-2386 / i%�al 828-6a32
TE$TIN6 BFaNCH OiFICE. �Sta-O No.m 5uun 5veei / Santa nna CA 9290J / i] �<I SSa�26a5
October 13, 1986
Examination: SC86-11148
COMPRESSION TESTS ON GUNITE CYLINDERS
Richard L. Hubbard
ll422 Yellowstone e�venue
Yorba Linda, California 92686
aROJECr SWIMMING POOL (STUKKIE)
ADDFESS 25?8 Oxford, Costa Mesa
ARCHITECT CONTRACTOR
Royal Pools
ENGINEER SUBCONTBACTOR
B.C. Adams D.J. Gunite
SAMP�E FROM
MIX
DATE CAST
DATE TESTED
SPECIMEN NO.
COMPRESSION
TOTAL LOAD. LBS.
POUNDS PER S�. IN.
28-DAY AVERAGE. PSI
COMPLIANCE
SAECIMENS
Deep end and transition
4.2-1
9-30-86 SLUMP
10-10-86
1
10—Day
62,000
3,320
3,800
SPECIFIED
STFENGTH
SIZE
10-10-86
2
10—Day
84,000
4,280
2,000 psi
ill: 4-7/8" s 11}"
I12: 5" X 11}"
3,4,5 6 6"HELD IN FIELD"
10—Day test complies with specified strength.
MADE BY
Butler
DISTRIBUTION:
Richard L. Hubbard - 2
('we�s-�![�esa Bldg. DQpt./Sco[t Priegel
DELIVEREO 9V
Hubbard
AECEIVED ON
10-3-86
: � � � ��
Rick Hyden �
=LL PEPOFTS AFE SUBMItiE] FS iHE CONFIDENTUL �90PEPTY OF CLIEYTS. �UihOAIZAiION FOF PUBL1GilON OF OUR REPORiS. CO.vCW510N5.OR E%iPnCT� FROM
OR PEGARpiNG TMEM iS RESERVEO PEMDiNG OUR WqirEN aPPROVA� a5 a MUiV�� °ROiEC�ION i0 CIiEP��S, iHE �UBLiC �mp O��SELVES.
d30-i?
�
\}
!`
:�
ADO���anl to fill in all ipaees except t�oze within neavy boraer Iines antl sign all appropriate tleclarotions.
„OF COSTA MESA CONSTRUCTION PERMIT
Project Address 2�+ � a 0%«0 e-�%
Applicant'sMailinjgA_ddress ' ��µ �`%—tiI/�T.,— A�,'1
Owner'sName V� TUIGL;IEphon�C7se��
IAddress ��� � � �T �%�? � "�� �
Arch/Eng. T�L'1��F+ License No.
Addreu �a�� LA,uRI�
�i Contractor's Nam /� Phone
I Address (mailing) � / , �
�I Ciry License No.
LICENSED CONTRHCTOR DECLARATION '
I hereby alfirm tM1at I am licensetl untler proviiions at Charter 9(commencing
witn seclion 7000) of Oivision of ne Business antl Professions Cotle, antl �
my license Is in tull /orce antl ef ec .
License Class License No.
Oatc � ' Signature
� WORKERS'COMPENSATION pECLARATION
hereby atfirm that I have a certificate ot consent to self-Insure or a certificate
ot Worke�s' Compen55tion Insurance, o� a certiti<tl <Opy lhereof (Section
3800, Lab. C.)
� PoliCy No. Company
�, 8Certifietl copy is M1ereby furnishetl. �
Cer[itietl copy is filetl with the city Builtling OivisiOn.
I Date Applicant
� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thls section neetl no[ be [ompleted if the Oermit i5 lor one huntlretl (E300) o�
less).
I Certi(y that In the performance of the wo�k to� which thi5 perm�t is issuetl, I
shall not employ any person in any ma a¢f so a5 lecome subject [o the
Workers' So e t on taws of Califom ,
Date ' � Signature % y� �
NOTICE: H, aller akin9 tnis tleclaratioq%you snoLltl became subject to the
Wo�ker5' COmpensation provisions of [he I.Do� Cotle, you mus[ forlhwith
comply wlth such provisions or this Oe�mit shall be tleemetl �evoketl.
CONSTRVCTION IENDING AGENCV
I hereby affirm that there is a consVuctlon lentling a9ency for tne pertormance
of the work tor whlcn this permit iz Issuetl (Section 309] Civ. C.)
Lentler's Name
Lentler's Ailtlress
�OWNERBUILDERDECLARATION� �
I hereby afflrm that I am ex¢mp[ frbm fhe Cont�actor'S License Law for the
following reason (Section ]03L5 Business anC Protezsional Cotle: Any city or
county wbich �eQuireS a pe�mit to ConStruct, alter, ITprove, tlemolish ot �e0air
any structu�e, priOr to it5 issuance, also �equir¢S lhe aOP�icant fOr such permit
to tile a signetl slatement that he/she Is lic¢nsetl Ou�suanl [o Ihe D�ovisions ot
tha COnlractOr's Licens¢ Law (Chapter 9(commencin9 wilh $ection ]000) of
Division 3 Oi the Business antl Profe55ion5 COEe) o� lha[ he/she i5 exem0�
Iherefrom antl the basis to� the allegetl exemption. AnY vlolalion of $ection
]031.5 by any applicanl tOr a petmit Subjects the apPlicant to a civil
�enalty oi not more than tive huntlretl tlollars (y500).
I, as own¢r o1 [he prop¢rty or my emo�oyees with wages az their sole
compensation, will tlo Ihe work, ana tne structuro Is not Intentlea or offeretl
lor sale (Section 7044, Business antl Professional Cotle: Tne Cmtractor's
Llcense Law tloes not apply to an owner of a property who builtls or improves
thereon, antl wno tloes such work nimself/hersetl or through his ot her own
omployces, Orovitletl [hat such improvemen[s are not intentletl o� offeretl for
sale. If, M1owaver, the bulltling cr improvement i5 Soltl wiNin one year of com-
qIeHon, the Owner will have the burtlen of provin9 ne/s�e dIC nOt builtl or im-
drova tOr the pu�pose of sale).
� I, as owne� of the prOperty, am ezclu5ively con[racting wlth Iic¢nsetl con-
tractors to construct the projec[ (Section �044, Business antl Professions Cotle:
The Cmvactor's License Law tloes no[ appry ro an owner of Oroperty who
Duiltls or Imoroves thereon, antl who contracts for such projects with a con-
tlactor�s) license pursuant to the ContractoYS Licanse Law). I am aware that
proot o( their Worker's Compensation insurance shoultl be provitletl to me.
—.� ❑ I am exempt untler Section—� Q. & P. G. �or Ihis reason
Date
I nereDy certity tnat I
information is correct.
antl state lawz relating
sentativas of this city.
inspection ourooses.
Signature
�/ Drivers' Llcense or
/�
CMF 0865�46, rev. 4/ 4
Owner
] state tha[ the above
antl county ortlinances
�creby authorize repre-
�nti�netl orooertv for
TVPEOFCONSTRUCTION LJNEW�P.OD LJALTERATION LJREPAIR
❑ CONVERSION ❑ DEMOLISH OTH R q,p,# '(�
DES�RIPLO�IOFWORK/USEOFBLDG. ?��% `��
TVPE OF PEHMIT LJ GRADING
❑ TENANT ❑ ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION S�.�J.—
'CONST CTI�NTVP�3��
ZONE_.�— GRP
Remarks: , �' �C`E�
.�', i � —�
Bar Sink I
Backflow Preventer ..-
Drinking Fountains
Floor Drains '
Floor Sinks
Gas Service Outlets
Interceprors
Kitchen $ink �
Lavatories
P—Trap
Roof �rains
Reinspaction Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. IC80 #
Heating Sys[em & Ducting
❑ 0.100,000 BTU � 100,000
� A � I I Reinspection Fae I $15
Wnite - Builtling; Canary - Applicant: Pink - Accounting; Goltlenro� - Assessor
�Q
, S Main Bmldmg:
E ��
� FOUNDATION STRVCTURAL T Front �
PLUMBING ❑ MECHANICAL B Rear C
A
C Right C
OCCUPA CV K
VALUATION $ S Left
y(9 CU. YoS. ACRES Ping. Ref. #
!�� �.J pQ� 6 �S[ Planning Notes: 6
G
Service Sink
Sewer Cap
Sewer Connection �
Solar Collectors
Solar Piping �
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset '
Water Heater
Water Service
laue Fee
Hoodor Typel ❑
Canopy Type I I ❑
❑o�ioo,000sru ❑ioo,000aT
System Repair/Alteration
Isue Fee
FEES
$ 3
FEES
$ 3
4204 7/16/B4
— Z Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Consvuction Pole Sub. O 50+ KW
Cooking Unit Meter �up m 100 amps
Dishwasher Meter �over100amps'
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors Oa1 HP O1 h- 8
F.A,U. Inc.Solar �9-15 HP 016-75+
Fixtures Micwwave
Device Boxes Pole Light
Outlets
Switches
Garbage Disposal
Generotor �0.5 KW �5-15 KW
Sign
Standin9 Sections
Trash Compacmr
Fee �$15 � � luue Fee
DEVELOPMENTSERVICESR
Zoning APPraved BY.�—
8uilding Approved By ,YL
B
Aooliration Issued Bv
141,qp
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
7
$.
SU RV OF FEES ' r�
BUIL�ING PERMIT $ SMIP $ �
PLAN CHECK $ PERMIT
PLUMBING S ISSUANCE S
PLAN CHECK 25% $ ENERGV P.C. $
ELECTFICAL g GRADING 5
PLANCHECK 50% g � �MICROFILM S ���� ��
MECHANICAL $ TOTALFEE $ .1�_
PLAN CHECK ZS% $
� 4
��CONSTRUCTION AND PLANNING
/ APPROVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil PipQ-lJndrgrnd.
3:IElectFical COnduit Utility-Undrgrnd.
4.; Elec[lical Conduit-Undrgmd.
5( Steel-Reinf4rcement
,
6�yElectMaal'UFER Grnd.
7,,,Footings� ��-
9::.Water Pipe-Undrgrnd.
r: �
10�;$truciural Floor System
11 . P�operty, Sewer Line & House Connection
., „ ,
12. Sewer.Cap
13. R�ooHDrains
14. Rough,Plumbing �
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough.�ring Sign
78. Rough;Elearical-T Bar Ceiling
19. Rough•Fleating & Air Conditjoning
20. Rough Factory Fireplace , .
21. Ducts, in Structure �
22: Ducts, Ventilating � -I
a3: Gas Pipe-Rough &,�Test ,
24��Roof Framing !" �
.� �.. �
25.'Roof Sheathing '
26.'T-Bar`Ceiling (Structural) & Monocoat
27.� Frame•and Flashing � �
28. Lathing & Siding��� L�,^j� .
� �
29. Insulation � i
30. Drywall Nailing �
31. Plaster Brown Coat `
32. Electrical Power Nlete�r-Final
,....
33. Final Electric '��
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or CanopY .
37. Final Factory Fireplace ,
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestio-Final �
42. Backflow Preventer
43. Backflow Irrigation . .
44. -Landscape Irrigation System
45. Sound Attenuation �
46. Handicap Regulations .
47. FINAL STRUCTURE & BUI'LDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cn
Date
\
� r
POI.� & SPA ,,,,
Inspector qppROVALS Permit#
. 52. Pool & Equipment Location �
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
- 58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62, Backwash & Receptor-Final ,
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
��,,�� 77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
3/ HEALTH DEPT. REQUIREMENT
� Qv 79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
No. Date I ! � �
Date � Inspecior �
.
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUfLDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require
the return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be
issued until this verification is received.
1. I personally plan to provi e the major labor and materials for construction of the proposed
property improvement. �Yes ❑ No
2. I(have/I�t) signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address
City
Phone ( 1 Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and pr�ide the major work:
Name �� � t�- �,,��,., ,�/���
Address City ix`�-`a-,`-<�-"g�
Phone 17�Y) �`�� Z`�� � Contractor's Lic. No
5 I will provide some of the work but I have contracted (hired) the following persons to provide
� the work indicated:
- Name Address Phone Type of Work
I hereby affirm that I have received a copY of the information set forth in Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowledge, in co pli nce i this State law.
Signed: �/ ��� Date: 7-lG. ' �Y
Name: y �I J• SIZ.IKK/t
(Printed or Typed�
C.D.L. #or s.s. # �
7545273
CMF 3042-46
�
Aoo���ant to fill in all spaees except those within heavy �artler lines an0 sign all appropriate tleclarations.
CA:OF cOSTn MESA CON3TRU(;T�ON PERIyIT
Pro�ect Address 'ZS3� �%�!�{�J� (�l
Applicant'SMailingAddre55 ��F
Owner's Name ����-�-E S"f�lY—�' I` Phonel--� N/1�
Address ��r�
ArchlEng. ���'�% L�= License No.
Address
Contractor's Nam Phone
Address (mailing) �+
City License No.
LICENSED CONTRACTOR DECLHRATION
I nereby aitirm that 1 am licensetl untler provisions of Charter 9(commencing
wi[h se[lion ]000) of DIvlSion 3 of the�us n�ntl PrOte55ions Code, antl
iny license is in tull force ana effect.
LICCIISC CIdSS SC i`10.
Date Signature
WORKERS'COMPENSATION OECLARATION
I hereDy ai/irm that I have a certiticate of consent to sel/-insure or a certiticate .
ot Workers' Compensation InSurance, or a certifietl copy thereof (5¢CtlOn
3800, �ab. C.) .
PoliGy No. • Company
eCertifietl copy is hereby turnishetl.
Certltietl copy i5 fllCtl wi[h the city Builtling Divislon.
Date APPlicant �
,EXEMPTION FROM W00.KER5' COMPENSATION DECLARATION
,(This section neetl not be completetl if [he permit is for one huntlretl (SI00) or
I¢ss�.
I certify tnat in the performance of tne work for whlch this permh is issuetl, 1
shall not emplOy any pe�son in any manner so as c subjec[ to NG
WOrker Comp nsalion LawS ol Califomia.
Date �n-v-"{'�.Y Slgnalure �✓ 1�
NOTICE: If, afte� making this tleclaration, yo shoultl become SubjlCt to [he
Workers' Compensation provislons of (ne Labor Cotla, you must fortitwitn
comply with such provisions or this permit shall be, tleemea revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a(firm [hat there is a construc[ion lentlinq aqency tor the par(ormance
of the work tor which tNs permit is�issuetl (Sectlon 309] Civ. C.)
Lanaer's Name '
Lentler'S Atltlress
OWNER BUILDER DECLARATION --
I hereby atflrm [M1at I am exempt from the ConVactor's License Law br [he
following reason (Sectlon ]031.5 Business antl Professional Cotle: Any city or
county whlch requires a pCrmi[ to construct, alt¢r, Im0/ove, tlemolizh on�epalr
any structure, priOr [o Its issuance, also requires Ihe applicant fOr sucb pe�mit
to lile a signetl sta[emanl tnal he/she is Iicensetl pursuant [o the O�oviSions o1
the Contractor's License Law (Chapter 9(commencin9 wlth Section ]000) o�
Oivlsion 3 ot Ihe Business antl Professions Code) m tha[ he/she i5 exem0�
therelrom antl tne basis tor Ihe alle9etl exemption. Any violatlon of Sectlon
7031.5 by any applicant for a pe�mit subjects Ihe apP�icant to a civil
enalty of not more than five huntlred tlollars (E500).
I, as owner o( th¢ Pvoperty'or my employee5 wi[h wages as their sole
� o nsation, will tlo tbe work, antl tne sVucture Is nol Intantletl or offeretl
for sale (Sec[ion 7044, Business antl Professional Cotle: The Contrattor's
License Law tloe5 nOt apply to nn owner of a O�oOe�ty who builtlz Or imp�oves
thereon, antl who aoes such work nimself/herself or Ihrough his or ner own
employces, proviCeC [bat such improvementz are not intentletl or ofteretl tor
sate. 11, �owever, [he builtling cr improvement is soltl within one year of com-
pletlon, the owner will have tna burtlen ot proving he/she tlitl not builtl or im-
�rova tor the purpose ot 5ale�.
I, az Own¢� Ot the Oroperty, am exclusivety Contractlng with licenzetl con-
lractors to construcl the pro�ect (Section 7044, Business antl Pro(e5sion5 Cotla:
The Contractor's License Law tloez not aoP�Y to an owner ol property who
builtls or Imoroves thereon, antl who contracts for such projectz wlth a con-
t�aclor(sl Ocense pursuanl�to ltle�Contracto�'S License Law�. I am aware (ha[
prool o( Ih21! WOIk2f'S QOITpCI15dI100 1OSUfdf1C¢ shoultl ba provitletl [O fOE.
❑ 1 am exemp[ untler Sectlon B. & P. C. for thi5 reason �
.o l.ILi �..rL
Date � �/" '(-Y"/
1 hereby certify thal I
in(ormatlon is correcL I
antl state laws relating t
Senlativ¢5 of this ci
inspectlon purpase
$ignature
Drivers' Llcense or 5 �
CMF 0865-46, rev. 4/84
iT_ Owner
hav¢ r¢ai
rep�e-
y lor
f'mE�SS S _. - - _.........
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, qy�
DESCRIPTION OF WORK/USE OF BLDG.
� - S Main Buildi
E
TVPEOFPERMIT GRADING FOUNDATION ❑STRVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ �OTHER C Right
PROJECT DESCRIPTION Sa.FT. oGcuPANGv K
CONSTRUCTIONTYPE VALUATIONS g LCft
ZONE � � GRADING CU. VDS. ACRES Ping. Ref. $
Remarks: � r'l l l�.(lQ Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Kitchen SinM
Lavatories
P—Trap
Roof Drains
Reinspectian Fee � $15
Boiler
Duct- UnderGround
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multi le ❑
FirepVFact. BI . ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,OOOBT
peinspec[ion Fee � $15
White - Builtling; Canary - AppllCant; Pink - Accountlng; Goltlenrotl -As5e55or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water $ervice
�
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑P100,000 BTU ❑100,000 BTU
System Repair/Alteration ,
luue Fee
FEES
531��
$ 3
0
'1
Automatic Washer •
Constructior Pale Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
OuLIeLS
Switches
Garbege Dispoul
Generator 065 KVJ 05-75
9517 IO/04/84 ! 40.50
Zone
Accessory Building: �
Z
O
N
I
_ N
G
R
Parking Req./Provided E
Q
M
T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
� ❑50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Momrs �0�1 HP �1Yh � B
Inc.Solar 09�15 HP �16-15+
Microwave '
Pole Light
Range
Sign
' Standing Sections
� Trash Compactor
Fee �$15 � � Issue Fee
FEES
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approvad By Deta
BuildinB APPraved By � �/� Date
Applimtion Issued By �^�`4� Date �Z%
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK ' $ PERMIT
PLUMBING $ II�C�O �SSUANCE $
PLAN CHECK 25% $ Z•�� ENERGV P.C. $
ELECTRICAL $ I� �� GRADING $
PLANCHECK 50% $ S•SO MICROFILM $
MECHANICAL $ � - �� TOTAL FEE $ •S�
PLAN CHECK 25% $ I•�(7
CONSTRUCTION AND PLANNING
�1:PPROVALS Permit#
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical�Conduit Utility-Undrgmd.
4: Electrical Conduit-Undrgrnd.
.5. Steel Reinfarcement �
^6. Electrical UFER Grnd.
7. Footings
`8. Foundation
9. Water Pipe,Undrgrnd. �
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer CaP .
13. Roof Drains
14. Rough Plumbing � � �
15. Rough Electrical-Conduit
i6. Rough Electric Wiring
17. �Rough W'ving Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. .Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Freme and Flashing • ,
28. �athing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final �
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or G3nopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas ServicQ-Final
41. Solar pomestic-Final
42. 8ackflow Preventer
43. Backflow Irrigation . ,. . , _
44. ,Landscape Irrigation System
45. Sound Attenuation ,
46. Handicap Regulations
47. FINAL S7RUCTURE & BUILDIiVG
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
Date
Date
S
POOL a SPA
Inspector AppROVALS Permit# Date Inspector
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE "
58. Electrical Conduit-Undrgrnd. �
59. Gas Pipe, O Undrgrnd., Test
, 60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK '
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval � �
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
,�/J APPROVALS Permit #
70. UndergYound Hydro
71. Product Piping OGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank � Gas O Oil
74. Overhead Hydro
75. Dry Chemical
76. Ory Standpipe
77. FIXED SYSTEM FINAL
� 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
� Notes:� I�I24��Y. Of�. �gJFG7' Ttl SNOce�,F�
F'F7Y\ 7ffs j - [�.�
CITY OF COSTA MESA
BUILDING DIVISION
01NNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require
the return of, an owner�builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportuniiy
to avoid unnecessarY delay in processing and issuing your building permit. No building permit will be
issued until this verification is received.
i. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. � Yes ❑ No
2. I(have/have not��+�� ��L signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
5
Address —
Phone ( 1
I plan to provide portions of the work
supervise and provide the major work:
Name
Address —
Phone ( 1
City
Contractor's Lic. No.
but I have hired the following person to coordinate,
Contractor's Lic.
City
I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
Name
Address
Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowledge, in compliance with this State law.
Signed: Ek"i I . �-% Date: ��- – -
Name: �' �R-�� STN��1 E
(Printed or Typed)
C.D.L. #or S.S. # ��� ��
CMF 3042-46 7545273
,
'�
�_.. � ApPlicant to fill in ail sDaces except those within heavY Dortler Iines antl sign all appropriate tleclarations.
CI7v oF COSTA ME�SA {�CONSTRU,�CT,,�IOAN PERMIT
P�oje�t Address �� —'�/ �%�ry�-�'' �"N
Applicant'sMailingAddreu �MF � /
Owner's Name � ��Y `-�'�KKIv PhonN�����
Address �37 L'- �8�-S�% �L '
Arch/Eng. �`�M�� License No. �
Address
Contrector's Nam ' Phone
Addreulmailin9l � •�
City License No.
IICENSED CONTRACTOR DECLARATION
• I hereby affirm that I am Iicensetl untler provi5ion5 of Chartur 9(commencing
with s¢Ction 7000) of Dlvision 3 of the Bu51ne55 antl Prof¢SSions Cotle, an0
my license is in full (orce ana ettect. '
LJcensa Glass icanse No.
Date Signature
WORKERS'COMPENSATION DECI-ARATION
' hereby affirm that I nave a certlticaCe of consent to sel/-insure or a ccrtlficate
! Workers'. Compensation Insurance, or a certlfletl copy thereof (Se<tlon
.800, Lab. C.) � ' �
Policy No. Company
��Certifietl copY is hereby furnishetl. ,
CerHfietl copy is filetl with Ihe tlty Builtling Divlslon. '
Date Applicant
EXEMPTION FROM WORKERS' COMPENSFTION DECLARATION
�(Thiizection neetl not be com0letetl if the permi[ is for One huntlretl (E300) or
less)'
- I c¢rtiry [ha[ in the performance o( the work for wh�¢rmit is ISSuetl I
snall not emo�oY any person In any manne o e suDject to t�e
Workers' ComoenSatiOn Laws 01 CdlifOrni�Q
compry wLLn �sucn provislons or t��s permi[ snau oe aeemea revoHm.
CONSTRUCTION LENDING AGEN��' �
1 hereby af}Irm that th¢re i5 a conStruCtiOn lentling agenty to� the peifo�mance
oi ihe work' for whi<n this perm�t is issuetl (Section 309] Civ. C.)
lRnaer's'Name - ' �
LenOer's Atltlress . �
OWNERBUI�DER �ECLARATION ' - �
I hereby aftirm that I am exempt trom the Contractor's License L.aw for tne
tollowin9 r¢ason (Sectlon 7031.5 BJsine55 antl Prote55iondl COtle: Any clty or
countv wnich reaulres a oermit to cOnstruct, alter, Improve, tlemolish or repali
anG the basis tor the alle9etl eaemptlon. Any vlolatlon oi St
' any .appliCan[ for a DR�mit subject5 the 'appllcdnt to a
not mor¢ [han five huntlretl dolldrs (E500):
wner of the property or my employeas' wlth wages as thei
ion, will tlo tne work, and [he StruCture IS not Intentl¢tl or o'
iection 7044, Business.aPtl Professlonal Cotle: The Contra
w aoes nnt aooW to an oWner oi a property wno builtls or Im[
employees, provitletl that such ImprO`/ements ar¢ n0[ IncenOeO Or Ott¢rea lo!
sale. If, however, the builtlln9 or imProvamenl iz Soltl within ono year of com-
pletion, t�e owner will have tne burtlen of proving he/she tl10 not bulltl or im- '
prove for the purpose of.sale). ,
❑ I, as owner of the property, am exclu5ively contractlng with Iicensetl con- .
tractors [o construct t�e projec[ (Sedlon 7044, Business antl Profassions Cotle:
The Contrac[or's License Law does not apply to an owner of property who
builtls or improves thereon, ana who �ontracts tor such projects with a con-
�tractor�sf lic¢nse Oursuan[�to the Co�tractor's Li<ense'Law). I am aware [nat
proof of�[h¢ir Worker'S Compensatlon.insurance shoUltl be prOvitletl to me.
❑ I�am exem0� untler Section—�� I�/P. C. tor this reason
�Date /// 1 � "a / � Owner
I nereby certity tbat I have rea�
information is'correct. I agree to
antl stale lawi rela[ing to b Itli
senta[ives ot this cit
inspectlan Ourp<y8j.
_....... ._. �m S� 2C7
TYPE OFCONSTRUCTION NEW D ALTERATION REPAIR —
❑ CONVERSION ❑ DEMOLISH OTHER q p#
DESCRIPTION OF WORK/USE OF BLDG. - S Main Building:
E
TVPE OF PERMIT � GRADING FOUNDATION STRUCTV RA� T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING O MECHANICAL 8 Rear
❑ �OTHER C Right
PROJECTDESCRIPTION SQ.FT. ' OCCVPANCV K
CONSTRUCTION TVPE VALUATION 5 S Left
ZONE GRADINGCU.YDS. ACRES PIng.Ref.�
Remarkz: - ���R PlanningNotes:
Bar Sink
Backflow Preventer �
Backflow Irrigation _ = �
Bathtubs '
Clarifiers ' �
Dishwdsher '�
Drinking Fountains .
Floor Drains . �
Ploor Sinks � -- —
Gas Service ' Outlets
Interceptors .
Kitchen Sink
Lavatories
P—Trap
Roof Drains ' �
Reinspection Fee ' � $15
Boiler: . . '-. �
Duct - Under Ground
Duct - Svuctural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO #
Hea ystem & Ducting
0.100,000 BTU O 100,000 BT
�—p'����5� �� 5� --�"-�`i— I I ReinsPection Fee I $15
b
CMF 0865-46, rev. ]0/84 Whlte - Build��9: Canary - Applicant; Plnk - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors �
Solar Piping
Solar Tank
Swimming Pool w/Spa .
Urinal ' "
WdSEI CIOSEi
Water Heater �
Water Service
Auto-Wash �
Issue Fee
iANICAL
Hoodor Typel ❑
Canopy Type I I ' ❑ �
iefri ' n System '
-100,OOOBTU ❑100,000
System Repair/Alteration
Fire'Dampers '
Registers � ;
Issue Fee
FEES
. Automatic Washer
Construction Pole Sub.
� Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec�
Fan
- F.A.U.
' Fixtures � -
' 2 Device Boxes
_ Outlats
0939 10/25/84
zone
Accessory Building:
Parkin9 Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
0 50+KW
Garbage Dispoul
Generator �0-5 KW �5�15 KW
Meter LJup to 100 amps
Meter �over 100 amps
Sub Panel � ,
Motors�0-1 HP�1h-8
InaSolar �9-15 HP �16-15+
Pole Light
Range
Sign
; Standing Sections
Trash COmpactor
$ 3 I
�- Reinspection Fea $15 luue Fee
FEES
�DEVELOPMENTSEHVICESREQUIREMENTS: �
Zoning Approved By
Building Approved By �
ApplicatiOn IssuBd BY
$ 3
18.50 TL
FEES
$ 3
SUMMARV OF FEES � �
BUILDING PERMIT $ SMIP � �$ '
, PLAN CHECK $ PEIiM1T .
PLUMBING 'g 'r�-C� ISSUANCE $ � ,
PLAN CHECK 25% $ .`.�~� ENERGV P.C. $
ELECTRICAL § GRADING� $
� PLAN CHECK 50% $ MICROFILM $
MECHANICAL , $ '� ( �'��TOTAL FEE $ � ��
PLAN CHECK 25% $ Z•C�C�
O
N
1
N
G
R
E
Q
M
T
S
; CONSTRUCTION AND PLANNING POOL ,. SPA
E�PPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
-1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' �
2. Soil Pipe'Undrgrnd. 53: Steel Reinforcement � %'�
3. Electrical Condui[ Utility-Undrgrnd. - 54. Forms � , . •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -' i
Y
5. Steel Reinfo'rcement - 56. Rough Plumbing & Pressure Test ` �
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE �
� i
7. Footings . . , ' : _ • � 58. Electrical Conduit-Undrgind. � �
�i
8. Foundation i , _ - 59. Gas Pipe, O Undrgrnd., Test �; �
9. Water Pipe-Undrgmd. - ' 60. Backwash Lines, P-Trap, O Undrgmd. .,� ��
10. Structural Floor System ' 61. APPRO.VAL TO DECK ' �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer �Cap � 63. Heater & Vent-Final ' �
13. Roof drains 64. Plumbing System - Final ' .
14. Rough Plumbing /y �r 65. Electrica�-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final �
16.'Rough Electric Wiring ' ' 67. Fencing & Access Approval� � ,
17. Rough Wiring 5ign � 68. APPROVED FOR PLASTERING
�
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. �Rough Heating & Air Conditioning � FIRE DEPT. REnUIREMENT
20. Rough FactorY Pireplace � �(�j �ff � qPpROVALS Permit#
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � � 72. Underground Flush •
24. Rqof Freming ' . � 73. Undergrnd. Storage Tank O Gas ❑ Oil,•
25. Roof Sheathing 74. Overhead Hydro �'
26. T-Bar Ceifing (5tructural) & Monocoat 75. Dry Chemlral
27. Frame and Flashing 76. Dry Standpipe - �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED '
33. Final Electric Notes: '
34. Final Heating & Air Conditioning �� i$'g� �
35. Final Gas Pipe-Test . �� I g
36. Hood or CanopY � � � � ,
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-K�nal
40. Gas Service-Final �
41. Solar pomestic-Final . � �
42. Backflow Preventer � ' � ;
43. Backflow Irrigation � ;
44. Landscape Irriqation System
45. Sound Attenuation � . `
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed '
49. Electric ftelease io Edison ' • '
50. Gas Release to Southern California Gas Co � .
51. CERTIFICATE OF OCCUPANCY �
No. Date
�I
�I
�ouprssoFemwra: �=:+3U G: FUfW LN
OYMERSN.WEIFIPID'MW STLKFSIE, GERARD J
�oo�ss: S';.UKKIE, ALISON
1538 OXFORD LN
COSTA MESA,CA 92627
APP�.II�Il1N0 AOOPE59:
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who Wlas n inpovu ihaean. md wfn Eaw �uN wak lnnwtl a IwW a Mwp� he w 1w mm m�lo�an. P�d Rm aM
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Pmlmaw Code: TM CatlreCm licaw lev dou na ewh b m ownar d RWMY Wa dllds a nwa'a+ihsaon aM Wn
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W OflKER'8 COYPENS�TION OECWIATION: 1 MraEy alfinn uiNa prutly d pa'iuy wr d Ns b0owinp dWumiom:
� IMweMwilmenteneceMke�odmwruto�atluuu�brraken'mmpammion.nprvridedlabyBWim�]OOdtMlaEn
coa. �« �n. v«�amrc. a u..oA �a.Na� mv wm+ e ou.a.
❑ �nm.w.Jme:u.n.oi�w.•mmo�:M�.�.eip�bsCWs.u;mamoameLee«caa..au»o.��.*a�he
work Iu xAitl� Nn V�M 6 ivuW. MY +akan' aomV�+ubn'v�wes�w u�rir uN D�Y �xm�bx ers:
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pecome vuEjw to �M wM1s�' mnp�nWc� Isw� d CWarie, aM epn� tlw Y I Ywutl bxma aAjtl io �M �wlmn'
�w�o�d� ao�"voie a seeon a�ao al ui. len« coa.. � wn �onn.um m� W.en no.. pow�'vu.
DNs: Mo�'��
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s.�ao� �ros o� m. taeo, coa., mm..c .�w.mm.r•. rw..
CONSTIiUCTION LENDINO �OENCY: I AseEy elfi�m unAs penNy d psjvy tlw ihan u e mrMiudian knG�p apaMry tor iM
perl«marre d �M wak br xfiid� the M�i u oiad (5wion �041. Cw. CI.
LENDER'S NRME
LENUEP'9 AODNESS:
I caniy ihet I heve read �hu epplicetian W nme ihel Ne eCovs iNameiian ie coneq. I epree lo oomply wil� ell ory eM couMy wdinenms
end ele�e kwe ieWvp lo Wikvq cmffiWon xtl harabyaWhar¢a npasnitli.v d Ihe cry lo ans upan IM eEae.meNioneA popny
'«intp0tl�0�`D°'°° GERARD STUKKIE
�
�. �J o�'7
� Dme: / �� / /
Sgneture d Qnm/I�pam/�ppirsnttionireda .
(5151de.WP) Whds&nldnp85elely:OreemFb:Cuary-�ppfmn:Pink-Rovamp:OddavoA�-A�smev
CITY OF COSTA MESA - HUILDINC FERt4IT
PERMZT NO: B 0838U1
PLAN CHECK NO: 02894-97 S
CONSTRUCTION TYPE: PERMIT TYPE: STR
JOb UESCRIPTION : 299 CITY STANDARD BLOCK WALL
PERM NO: B Ud3II01
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT: 299
CLAIM VALUE: 5,900.00 CALC-VALUE: 5,980.00 GROOP OCC: R-3 /
COMMENTS; CITY STANDARD BLOCK WALL
***��t*it*�*�ia*it�#***�r*�***x�r*��;��c�*it�c***�c*+rific*itx**x��**�*i�*��**�c�*��***n*+�**ac*�*�
Z O N I N G R E Q U I R E M E N T 5
sErBAcxs
------------ MAIN BUILDING ---------- -------- ACCESSORY BUILDING --------
FRNT: FT SN REAR: FT ZN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT !N
PARS(ING REQ; PROV: PARCEL: 19137327 ZNE: R1 REF NO:
PLANNING NOTES> CONSTRUCT APPROXIMATELY 300 LINEAR FEET OF 6 HIGH BLOEK WALL
> ON LFT AND RT AND REAR PROPERTY LINES.
�F jE'1E 3E 3E iE �E * iE iE dE if �F 3F if� �Jf if iF if # if iE if iE iE if if 1E iE?E if iE iE iE iE if iE iE iE iF ih iF 1F If it iFlF if if if -lf 1@ iE iF jE if # iE if ik iF jE 3c je iE 3E �7E �E if ii )E �E iF if'lf #: �F if iE
U E V£ L O P M E N T S E R V I C I/E S R E Q U I R E M E N'F S
ZONING APPROVED BY �^A'K DATE: �•• «���
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: �-�- DATE: �'��
il'ifif?EifiEiE'1f')fiFifif'1f'1E#if3l"IEjhifiF�h 1f *x�'�iFiFif±F'kiEihiEifiE i i�if
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE p SMIP/RES GRtlLING
PERMIT 112.25 60
SMIP/NON-RES
PLAN 72.96 !'
ISSUE FEE �
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID UUE
TOTALS----> 112.85 0,00 72.96 185.81 ;,185.81 .00
REVENUE DIVISION TOTALS--> COLLECTED: 185,81 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTAIC MECHANZC FIRE SMIP/TOT GRADING PLAN-CHEC}(
112,25 .60 ' 72.96
1f if if i! ]4!'f if ff !!'1f if i!'1f'k i! 1!?!'!f if if jP iF'k if if'!f if if if if'Jf if if il' 3E if if if !t'k if if ii it'k' ff if :4'� if'%�)f'Ik if if ik if iF if ii iF if if �f 1f if i%+f �f -I{'?! if iE'Jf # if if if i'f
I N D I V I D U A L F E E b R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT.COST TOTAL COST
/
SFR 299 RES-CONCRETE BLOCI( WALL / FT. 20.00 5,980.00
END OF FEES ��,
♦'
_ B7-1B-1997/91:84 DH/f185.81
PERMI�TDei98380 1
��
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. Temporary Elecvical Service or Pole
2. $oil Pipe•Undrgrnd.
3. E�ectrical Conduit Utflity-Undr9rnd.
4. Electrical Condui[-Undrgrnd.
5. Steel Reinforcement �
6. Electricat UFER Grnd.
7. Footings ?-
8. Foundation
9. Wate� Pipe-Undrgrnd.
10. St�uctural Floor Svscem
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Foof Drains
14. ROugh Plumbing
15. Rough Electrical�Conduft
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough EVectriwt-T 8ar Ceiting
19. Rough Heating & Air Conditioning
20. Rough Pactory Fireplace
21. Oucts, in Structure
22. Dutts, Ventilating
23. Gas Pipe•Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T�Bar Ceiling (Structural) & Monocoat
27. Frameand Flashing
28. LBthing & Siding
29. Insulacion
30. Drywall Nailin9
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe�7est
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Piumbing
39. WBter Service�Final
40. Gas Service-Final
41. Svlar pomestic-Final
42. Backtiow Preventer
43. Backflow Irrigation
44. LBndscape Irrigation System
45, Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUiL01NG /
�
46. FINALPLANNING
49. Eleccric Release to Edison
50� Ges Release to.5outhern California Gas Q
5J. CERTIFICATE OP OCCUPANCY
Date
Oate
�
zi
�
�
POOL & SPA
Inspector qppROVALS Permit # Date
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
�t4�/ 56. Rough Plumbing & Pressure Test
. 57. APPROVAITOCOVER-GUNITE
�Lt/ 58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. 8ackwasfi Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & ReceptorFinal
63. Heater & VenbFinaf
64. Plumbing System - Final
65. ElectricabFinal
66. Solar System-Final
67. Fencing & Access ApProval
68. APPROVED FOR PLASTERING
69. POOLJSPASYSTEMSFINAL
� FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Under9round Hydro
77. Product Piping OGas ❑Oil
72. Underground Flush
�3. Undergrnd.Sto�a9eTankdGas ❑Oil
74. Overhead Hydro
75. DrY Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. AE�UIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
� G�
c
Inspector
PARTY WALL AGREEMENT
��
THIS AGREEMENT, made and entered into this � day of
��N� , by and between _�7�� �- �77i1��.�/G•'
hereinafter referred to as "LANDOWNER;' and �- ����"1�
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between ��3� dX�f�l �
(Address of Adj
_ 3 %� .L��.��7� �
in the City of Costa Mesa, County of Orange, Staie of California, as per map recorded
in Book �, Page �'�f Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach �-f �""���2y
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER ADJ OPE TY OWNER
� ` -
(Si ur (Signa u
�� .T- .�Tlil.f �/�=' �7f,d�� ��i EK�iA'C/
Name (Typed or Prinied) Name (Typed or Printed)
�fJ �'F�2U � • c3�2���
(Address) (Address)
NOTARIZATION RE�UIRED
1906d6
a
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this �^-"►�"- � X-� day of
�) unl� , by and between ���a � sZ/fCKic�
hereinafter referred to as "LANDOWNER," and ��'�+ �T-���,`�T�. -
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
r.v
Z�� � C�?�C�1Via.d�-,ti .!� ��. F�e_�F �—__� L6v1C
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book /-3 , Page 3°2�of Miscellaneous Maps, in the office of the County Recorder
4f said County. The party wall shall be permitted to encroach AS �f/�=cc-��9R2�_
/(�� /z/NZr� �/F/i✓ /a7 � :
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
(S' aur G•� ���\
-��� ��/7�iC/if�/�
Name (Typed or Printed)
ADJACENT PROPERTY OWNER
(Signature
c.'Yl�%- �C�/G
� e (Typed or Printed)
�25��'��Xl7t/l4 �- �-b �' �c�.A_Wra�-fs-z C� h. �
(Address) (Address)
iu�
NOTARIZATION RE�UIRED
�906-46
o-�
PARTY WALL AGREEMENT
�
THIS AGREEMENT, made and entered into this �� day of
_� Ul�! L , by and between ��-$Y�1�PD �)�J' _2_/_K�/L—
hereinafter referred to as "LANDOWNER;' and �iS�Pif�=r ��i%GGl�6c=t1
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wail will be constructed on the property line
between o?.S3 c`�O x�Ln/
- (Address of Adjoining Properties) .
a���Z l�X f��i l�/
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book —( 3, Page �� of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach QS N�ccs-�uG�v
�
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
���
�. �
(Si ure)
—sJ_<-/C/_`/�• ll��jil�fy/C Ci//�/J'77)�/lE%Z � /%�j�
Name (Typed or Printed) Name (Typed or Printed)
as3 � �x�,��/
(Address)CMl � �Z��
1906 <6
�.�/� ��F�1�✓
(Address) � `A ^A ����G
/�/ �//
NOTARIZATION RE�UIRED
CALIFORNIA
� J� A t > .', sa .!au u, km m . d r�'Ys'i �.J�tA t'%�.
rNr. 9 N i � � � J h i r/ b . N tAb. I+�'d�'' .:.
;r �, :. � ;.���: ALL-PURPOSE �;, ,� ,� ,�� - �r�
alU �'ir.'7F u +- -.l A. a.CQR` ?�t< �:i:�1 � . G t � � �+`•A . :r,l. ' �72� �
ACKNOWLEDGEMENT
STATE OF CALIFORNIA
cou�'TY oF ('iP19NG� 1
On Cl'��•!� beforzme.
D�TF,
TITLE UP OFFICF:R � [.G..'7:\.\F DOF:. \OTARI
per.onallyappeared. �%FRD �T ,S'TiJ/lK/E �iv7> �/�/Z/,STD/�/19C T f�M3URGE/"
p�rson�lly known to me (or proved to me on ihe baxis o( satisfaciory e�•idencz) to be the person(s) w�hose name(>) is/are
subscribed to the within instrunxnt and acknowled�ed to mz thai he/she/they executed the same in his/her/their auihorized
cupaciiylies). and that M• his/hzr/their sienature(sl on the insirumznt the person(;). or �he entiiy upon behalf of u�hich the
person(sl ac�ed. executzd the instrumem.
\VITNESS my hund :{nd official seal.
%dc.� Scr� m�/
��OTARY PUBLIC SIG�ATURE
.l'���6:.Ary�:
��;.;_„�..
::hn
.�'�'�;i!c• ' .
�''�t�:�t'�; �' n
�'L�-:'� �; i
. ���;�
_�,:....
OPTIONAL INFORMATION
TITLE OR TYPE OF DOCU�9ENT
�ATE OF DOCU�IENT
SIGN[R(S) OTHER THAN NA �1ED ABOVE
NUMBER OF PAGES
.:'F`U�:;i;iUi,
{''rk!G =� �pe`',
;,,.,
i'��\\': !e
PARTY WALL AGREEMENT
��
THIS'AGREEMENT, made and entered into this
�f� � �� , by and between �c�'�9�n �S� -fTG/K.t�i�
hereinafter referred to as "LANDOWNER;' and /�p,t✓�%GD f�sLa�s1L•r
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between as3� UX z�i/r�___Ls✓ /��✓D
(Address of Adjaining Prope�ies) '
3Y�o /.�..�c,•r,✓c�� c �o
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
day of
in Book _[,L , Page �"� of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach AS,LII��y
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
ADJACENT PROPERTY OWNER
� (Si�i ure)' �l —
(Signature)
��,��.n ����,�,�iE ��i�`�ti.'1� � �132.5'�'�,�
Name (Typed or Printed) Name (Typed or Printed)
�?.s3�d�r�.�� ���, o '�» �f.�. �f�LL �2�
(Address)C^ `� � 9��/ (Address) �O �T� ��� � n ( n ^ ���
� � lo (i I\ l.h' J
V Tl I C.....
NOTARIZATION REQUIRED
t906 46
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the major labor and materials for construction of ihe pro-
posed property improvement. �Yes ❑ No
i L.' I(have/have not) `/,// f� signed an application for a building permit for the
v proposed work.
3. I have contracted with the following person (firm) to provide the proposed constFuction:
Name
Address City
Phone ( ) Contractor's Lic. No. _
4. I plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
Name —
Address City
Phone ( ) Contractor's Lic. No. _
5. I will provide some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated: SG-7",� 6Sul�p �U�c�< wA ��
Name Address Phone Type of Work
�.����� ��u,� � ra- ���� ,��s�,✓�,
I hereby atfirm that I have received a copy of the information set torth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledge, in c�mpl' n w' , this State law.
L /
Signed:�6, � Date: � /� /�%
Name: �r�7?,9�P.4 � cfT�/rYKic�
� (P�inted or Typed)
C.D.L. # or S.S. li �
754-5273
��w ' �� '���
ClTY OF COSTA MESA
PLANiV1NG DIV.
SUBJECT TO BLDG. DEPT�
BY � DATE�
9 3� 9 y/ '--`.
�
35 �a@�.
5
+b
,ap� ��a�
�D H' —�_.l
�
�
��� �
� �� /
135'
REEID[MCC
R[61DfNCf
STREET �
as� c�-�,-d �-�
��RVEY OF LOT UNE
�I1Y SE REQUIRED
r// / �el�. '���% / j3Gc� CK �/-1 �-L � i2D� � �P.QPO�
� - „� ��1�
�OTE
ADDITIONS, DELETIONS, OR CORRE('�"' '� ""ALL
BE APPROVED BY TIiE PLANNIP:` �V
DIVISION OF BUILDING SA
CiTY OF CO TA MESA
APPR�VED
mis set r p�s and �edfux�ns Mu be ke
i1 is unl� ul ro make any changes or ter�tu
' n i�ng S�
fi_ Utis ptan and SHI
:o b:: � of ihe viol�tan any
';'c m �n a5�teiaw.
; I'� :c PI � �ID6'�k0 by 1(11118T10
C b :L Cf M/Otk IS 1101 � F „�Ild
"' Id wit n� H6 r:Vs ot issu
em
tl�
� f
i �7 S (��
� a� �a n�s a�a
without written
;.ost� Mesa
held to pertnd or
y � ca�t� t��
ne null ano veca
z
t.
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Optional -^
Channel Block With 13/8�
Horizontal Top of all
f ences
For Fences 5' or Less
Vert. Bars 3/8" yS at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C. �
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-15-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
�....,� ___,,.,, _NATURAL GRADE
t ''7 � �/! V'.
. �/ %��:�./�`�t�
y 7W0 3/B'r4 BARS; . ,
CONTINUOUSTOP� "
� & BOTTOM � -.�..�
f -
pHOR7ZSTEEI MUS7 BE,TIED-IN
� , ,.P,LACE hT TIME OF TRENCH ; =�
-�iNSPECTION,�: � "' n�+' �','• ' �:i}
+ ., � :.
S._ .. ��1�'�ia'n .JI
•.!',. r,;r , ".a �; ,. .
n_ .. �,;��, ,., ��,:,•_ ..»u,:.��;
�_
��
c�
Y W
�_
a
> Z
> -
a
i �
w o
U F
z
w n
�
I--F— W' I
p SEE
����� '—�BELC
'. ; U�'i 'Y.�
.'.l,^ .� Gl!'
�..�� ����?
� �' .: r„
..,:��� � •-
� .
-1 `�_ . , .
@
. . _ _ "1.: .J'!'..' i' . � . , +� "
..L a . ' .• � 5ii �y.1 � � . .
FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR; pne Part Plasfic Cement, and
Three Parts Sand
GROUT: One Port Cement Three and
One Half Ports S�and
COPING: One Part Cement, Three
Ports Sand
CONCRETE: W¢11 Mited 1:2-Il2:3-I/2
Max. of 7- I/2 Gallons of
YVater Per Sack of Cement
GROU7 MAV BE POURED FROM THE TOP
OF 7HE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSAND AREASOF HORIZONTAL REIN�
FORCEMENT SHALL 8E CLEAR, CLEAN &
FREE OF AlL MORTAN DEBRIS, ETC.
H GF EARTHTCOTH
i/3 TNE NEIGTH OF FENCE
�BELOW 80TTOM OF FOGTiNG.
SCALE: 1/2�� = I�
WIDTH . . . . . . . . . . . . . 14" . . . 14" . . . .12��_._. 12��
THICKNESS . . . . . . . 10". . . 10" . . . . 6". . . . . . . . . . 8„
DEPTH OF EARTHTOOTH . . . 24" . . . 20" . . . . 16°. . . 12"
SPACING OF EARTHTOOTH. . 12' . . . . . . . . . . .14� . . . . 16�. . . . . 16�
City of Costa Mesa, California
Building Department
. . . . . .. . _. _ �.'E.VfSED NOV. b2
a
ixessaew�ara: 2538 OXFORD LN
rsruxeiv�+am+: STUKKIE, GERARD J
anux�ss: STUKKIE, ALISON
2538 O}CFORD LN
COSTA MESA,CA 92627
.IW lMG ADDflE59:
CT OR FNfl11FFA:
FNO.'S ADORESS:
11C. NO.:
UNT:
1 � �
UNT:
roNm�crareru� NOCK PLUMBING ( 714 ) 895-1246
�croaewuuNo 11610 SEABOARD CIR
�ooneea: STANTON CA uc.ra.: 511971
90680 uNr;
!ED COMFACTOflB CECLAp�TION: I Mnby NYm uMx p�v1y d p��ury tlw I un Itaiued uMn qo-Adona d Cheqx B
,ummmdnp wll� Haclbn ]OW) d Dhiebn J o11M Bueln�p enE Prolm�lom COEa, enE my liwms b In lull bru uM aflatl.
c� No.:050386 uc.cuas: C-36 �IC.NO.: � 1971 EX : 02/ 7�
a: � � �' Gonlroaor:
OWNEP BUILOEP OECLANATION: I henby Wlim uMer panelly d perWry �� I em axamp Irom Iha C ietlon Liwm� Lew lor
blbwinp ree+on (Sedion ]0�1.5 Bwnm� enE Pmtnelon� Cad�: Airy cEy a munty �MIM rpui�m e ps il lo mn�lruct. Mor, Impmn,
damdsh, or repei �ny �Vucwn, pbr w n� iwerce, abo rpulrp ihs epplkent lor wch pamA to fiM � upmd �Wemsm Mn hs a�M
b licanwd W��t m iM paA�ion� d tM CoMretlm Lio�nu Lew Itheqv 91�mamnp vMh SWion ]000) d Orvebn 3 d �b
Bueiiwa end Ralea'vn COEeI a�� M a Yw is eaemq �Aerehpn end �M beao la IM elbped ssomqion. My vioWion d Seeion
)0'Jt.S by any eppliran� I« e permil wbjepa �M epplirem io e dNl peroXy d nd maa Ihen 1've hunEred Edlen �5500�).
❑ I, es ovmor d �he properly or my empbyese x'vh wepee ea �he'r eob mmpenWion, xill da Ihe xoh, erd Uia evunure e �al NieMeC
a dtereE Iw eeb (`��^^ )a�. BuarmenE Prduaions Code: TM Canlretlae liro'ue lew Eom nd epplytoan owrer d papeily
who buiCe a inprwae �Miem. eM xtn doea euN xwk limmM a Mnd a Waqh he a her own ampbyee�. pro.iEeE Ow wch
impwemema are r�oi inieMed a dlmed la eeb. tl. lrowwer. ihe buiNieq a inpmwnw n wd wnhin an Y� d mmpMion. Ne
owmrbuikMr will hew tM burden d provinp M w eM d'd nd WiM a improve la Ihe puepua d eeb).
❑ I. ea ox�r d �he P�WeM. em excluaneM mntreuiq wu� IioenaeE wnvecion m mmtrutl I!w V�IM (Seabn 1011. &ni�aea end
armesvm. coda: rne camrmon U�.m. �e. me. na ewN w en o�,x a wowro wro wue. « imo�� ine�eon .iw .Mo
wnvecu la wM pqaea xiN e mmmtlor�e) Icomad punuw to the CpYrepon Licwa lew).
❑ I em eaemq wdm Sxtian: B. 8 P.C.. la Nu iesaan:
Dma: Onrr.
i m n.�nr �v �n.� i� e.�re.e a.m �.�d.�.w,e me na��m a cwo� �en e�w s�er coee sea�e zssos. ns�. �a
25551. enE UW I a enY Mun buJdW oaapn� wdl / wil mi (artb orw) mad m eamVN w�h eeid nme mda eed �he nCuiiemava br
aD�elamuvuctionamoCifiWionhwn�M�i ue3i�y ebpe^e^iDiqrid.RmideM�mret�upionaGV�ianuee�emqlmmRww
praivons.
Dme: �pp���
WOHKEN'S COMVENS�TON DEC4N�TION: I Axeb� dfvm udx prWiy d psjury pn d tln Idbmmp detlermoen:
❑ i neve e�a wi� meime:�. c�nnKme a oo�m m..n.��wn ro,..o�a: ca�ro�w�... w�� �� M s� aao d m. i.n«
Code. la �tn paelamvcs d Ne woek 1a wlidi ihu pxmn u inued.
� I Ma ud Mil meiMan v.orken' mmpenatlo� inwre�w. n�pu'vsd by Sqim J)00 d tM lebar Code. tor tM perl«mv�oe d the
.�n�«w,��w.v�nAmw.Mv•a�•'S1Q4ATEvaureneawrieewo�v�wmberme: EXPIRES
c�«:
Pdiry Number: Q 1� � i� � 1
!TM1is axYian med rcl De ttmP�+�ed / rM Pa'm1 u hr are hwMrd Ocdera (ii WI a kv 1
� I mrldy Mel m Ue perlormencs d tM work la r.fich Ilw pemiu o mued. I Wo mi empb� uy prmn n vry mem« n m to
acoma wbl� io Ihe wakera mnpenwbn kwe d Celibrme. eM pree Na H I MwM bxane abj to iM1e
c mpenseiian prwi�une W Seeion 3]00 W tha labor Cade. I ehdl lonhwnh p�y wnh thoe rovieio .
Ne: � — AVVfraN:
Inp: F�U�n ro ucun wro�k�ri rnmpnu�tlon ror�raps Is unl�Mu, �ntl Nsll �itl/xf �n �np/ yx to cNMvIOWu �s �M
c/vll nnsa up ro ons n1narotl tla�wm eaY.. (ttWoaoA �•��uon m M. cwr or rompxuetron eamspu u povleM rorin
Sxtlon J106 0l M� LMor Cods, Inhnal, siM ettomsyL bs�.
CONSTFUCTION LENDIN6 11GENCY: I Mraby effirm wMer perely d pmjury IhN Ihae a e cons��udion Wdiiq �erwy 1« Ure
peAormerca d tha xoM M whiN ��e pemii n uaueE (Seaion 309I, CN. C�.
LENUEN'S NAME:
LEN�EP'S �DONE55:
I eMM �hel I f�eve reetl Uc eCdi:etion arM mme ilul �M1e aCove inloemdbn u corten. I e0ree lo wmVN wilh ell alY eM eaumY ordinenwa
arM elete levn rale�inq �o WilEip conArudion eM hereby eNMr¢e �epasen�mnea d ihia oty io emer upan iM ebove�meMioneE prope�ty
m,mac�a�n�.�nRON N��ICK _ i /1
Dete: ' 1 � _ ( T/
(5151-,8 WP� W�ne-Buikiq 8 Sdery: OreemFb; Cen�{-�ppYcen�; Nnk-Rewnw; OoldemaFlox�wr
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P U78078
PERMIT NO; P 078078 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : C/O DISHWASHER
CLAIM VALUE: CALC—VALUE:
SQ FT:
GROUP OCC: R-3 /
COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT
*x�+�x***�r�*x�**xxxx*�r*�r*�*�+�***�rx�xx*x*x�+��****u��ru**�**�**xx*x�*�*�*x�+�****�r***�r�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 BOILDING ---------
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: 14137327 ZNE: REF NO:
PLANNING NdTES; C.
iE 1E �E 1E iE fE iE iElE iE if iE 1E IElE 1E 1E 1f fF 141E iE iE ff if iE iE iE if iE if iE iElElE Ik k 1E �E iE 1E iE if 1E if iE �ff it iF if !F 1E If 1E 1ElElE IE 1ElE iE iF iFlE iE iE if if 1E 1E fE fE iE �E iE IE ik fb
D E V E L 0 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
�i�
ZONING APPROVED BY .
BUILDING APPROVED BY ;
APPLICATION ISSUED BY: �'/.1J'`
iE iE iE 1E 1E 1E 3E iE if if If if iE 1E iE iE iF iF if 1F iE iElF3f�FiFiFiFTF3FifTF�FiF�3F�F�iF�iF� 'iFFiEiEiEiF
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT
PERMIT
PLUMBING ELECTRIC MECHANIC
8.75
25$
PLAN
ISSUE FEE "12.00 '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 8.75 22.00 -- 0.00
REVENUE DIVISION TOTALS--> COI,LECTED:
BLDG PMT PLUMHING ELECTRIC MECHANIC
30.75
_ DATE:
DATE:
DATE: �� �
3�'�*��***�*�� � �*
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
30.75 30.75 .00
30.75 OVER/SHORT: 00
F`IRE SMIP/TOT GRADING PLAN—CHECK
iE if k 3E IF iF 3ElE iE 3E iElE 3F IF iE iE 1f �F iE if iE 1E 1F if 1E if �E 1E fE 1E 1F �F 1E k�E iE IE 3E iE iE iE 3E k iE 3f iE if iF iE 3E IE 1E IE iE if 1F iF if if 3f iE 3E IElE iE 9E IE jE iE iE iE 1f if iE iE �E 1E iE 1E
I N D I V I D U A li F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O1N UNIT COST TOTAL COST
PLU 1 DISHWASHER � £i.75 8.75
END OF FEES
;1 l?'�:L:' - ,_.i';:'i . -.'
.., i.� . ' ' : - . '
APPROVALS Perm�'
1. Temporary Eiectrical Service or P,ole
2. SOiI Pipe-Undrgmd. '
3. Electrical Conduit Uiitity-Undrgrnd.
4: Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7: Footings
-9'.� Foundation -
9. WBter Pipe-Undrgrnd. � ���,
10. Structural Floor System . '���.
1 t. Property Sewer Line & House Gohnection',
12. Sewer Cap � . � -.
I
73. Faof Dreins
. �
74. Rough Plumbing - � �
15. Rough Electrica6Conduit ��'-�'
76. ROugh Electric Wiring . /
77. Rough Wiring Sign
18. ROugh Electrical�T Bar Ceiling. �
19. ROugh Heating & Air Conditioning
20. Rough Factory Fireplace _ �
21. Ducts, in Structure: -
22. D�cts, Ventilating '
23. Gas Pipe-Rough & Test
24. Roof Framin9 �
25. Raof Sheaihing �.
26. T�9ar�Ceiling (Structural) & Monocoat
27. Frame and Flashing . -
28. Lathing & Siding .� . '', -
29. Insuiation --
30. DrYwall Nailing :
31. P�aster Brown Coat
32. Elzctrical Power Meter-Final
33. Finai Electric
34. Finai Heating & Air Conditioning ..
35. PSnal Gas Pipe-Test �
36. Hood or Canopy
37. Finai Factory Fireptace� -
38. Finai Plumbing �
39. LVater Service�Final . - �
40. Gas Service-Final -�
41. Sotar pomestic-Finaf -�
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System - ,
45. Sound Attenuation "
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING
48. fiNALPIANNiNG
49. Electrie Release to Edison
50. Gas flelease to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date � Inspector
0
POOL b �. A
APPROVAIS Permii # �
52. Pooi & Equipment Location '
53. Steel Reinforcement .
54. Forms .
55. Electrical Bonding �
56. Rough Plumbing & Pressure Te:t
57. APPROVALTOCOVER-GUNITE
56. Electrical Conduit•Undrgrnd.
59. Gas Pipe, C7 Undrgrnd., Test
60. Backwash Lines, R�Trap, O Undrgrnd.
61. APPROVAL TO DECK � "
62. Backwesh & Recepror-Firtdl � �
63. Heater & Vent•Final '
64. Plumbing SYstem • Final • •
65. Electrical�Final '
66. Solar SVstem-Final
67. Fencing & Access ApProval; �
68. APPROVED FOR PLAST�ERI[VG
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVGILS _ Permit #
70. Underground Hydro
71. Product Piping �Ges ❑Oil
72. Underground FWsh
73. Undergrnd. Storag'e Tank O Gas ❑ Oit
74. Overhead Hydro
75. Dry Chemical
76. Dry StanUpipe '
7i. FIXED SYSTEM FINAL
78, FIRE PREV. FINAL
� HEALTH DEPT. REQUIREMENT
79. FINAL WSPECTION
80. F000 CERTIFtCATE ISSUED
NOtes: �-�i� �� l/'i/n�C i /
Dace � Inspector
6
�
OWNER COI;LEGr PARK ' — '1ATE ZZ—u—,rjb
JOBADDRES3 2538 Ozford Lane BUILDING PERMIT NO. ryµ�2
GENERAL CONTRACTOR H3r}�Ot CpnSt. CO• VALUE $ 1],�200 OO
LOT lj BLOCK TRACT 2726 Res. i1�f18t.. g3T'•
GROUP I Bc J TYPE V ZONE RL� FIRE DISTRICT �1107
PERMITSISSUED
INSPECTIONS DATE SUBCONTRACTOR
� DATE I NUMBER
Trench
�ion Forms and Grade to
to Slab " ° "
�o�rGtii az �
Complete S-qG S 3� `9�l�,�r ��•, v�' ..icri, ��7•.', ti(� 7�9/ ✓
Wiring, Rough N
Heating, Rough /'y� �
Heating, Ftnal �
S�wer Ho � Sewer, St )'yj, �
Septic Tank or Cesspool �
Lathing,ln Out
Plastering
Plumbing, Final, Fixtures Compiete/n
Plumbing, Final Gas Test/,j Mh
Wiring, Final "'1 �
Occupancy r �
FONM 310 3M IO�53 ,
✓
uosta mesa nmiaing Lepar�ment � n
. �,
111 EAST 20th STREET d� ��
Je ;'s:r-� COSTA MESA, CALIFORNIA _
� E'OR APPLICANT TO FdY.L IN
or
Costa Mesa, California
HARROR BLVD.
LUA'1'aul�l r vic rrini�ui.
BUILDING '
t OF'FICE USE ONLY
� � yoG2'
Recefved by Date Rec'd. Date Issued
��� f �-- I I -S� /�--//�S�
Building
Address
Costa Mesa, California
Date
Address
Address
No. � 3 � Block I Tract 2
Size oi �ot 90 x'122 I Now on �ot
Useoi Na.of No.of
Existing Bldg. Famillp o m:
Setback Line from � � Rear Yard
Size 1 Rooms Stories
Exterior Wall I Roof
Covering Covering APPR,oV�p,S,'
Use of New
Building RESIDENCE cSc DETACHEO FoundationLocation Inapeetor
Forms, Materials,
G AR AG E Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
I hcreby acknowledge that I have read this Application
and state that the above is correM and agree to mmply Lath. Int.
with all City Ordinances and State Laws regulating .
building construction. Lath. Ext.
Signaiure of
Perm�ttee HARBOR CCNSTRUCTION C0. plaster,�nt.
Authorized Agt. Plaster, Ext.
Valuation Permtt Fee $��� Masonry ReinTorced
Plan Check $ % Bond Beam
$ I I� 2 00 . Total 1, r�
Fee $ 7 d` � FINAL
RM 204 5-HP 2M 6-55
Date
�
�.0
J
d
0
�
a
, i ..
IStreeS
PLOT PLAN
Show locatlon and disFancea lrom
� . property Iine.and between butldings
r
`J -
i
_ ..c.
.a . .
N �
C •
C � .
1� � �
O �
W
O
r_r �
� •
OWNER ST1fKKTF,. �':"'H_ Y" "�ATE 8-20-57 �
JOB ADDRESS 2538 Oxi'd�`�"'3;�'Lan2 � 11ILDING PERMIT NO. SS9S
GENERAL CONTRACTOR He2t BI'OS. VAL[IE $ 171.00 �
AP. No. . LOT li TRAC1272% FIRE ZONE DESCRIPTION OF WOR% GraDe Stake Fence
PLAN
INSPECTIONS I DATE I SUBCONTRACTOR I DATE PERMITSN
coat
5595
0
F
W
W
�
F
N
J
F T.
0
�
COSTA MESA BUiLDING DEPARTMEfdT ✓
P. 0. BOX 317
COSTA MESA CALIFORNIA
C•L. OF STREET
' _r-PROP. LINE
�___ __ T ,._ _
I 10 FT. FOR 60 FT. STREET
�
�
�
�
LLEY OR P
� ���,�(j,�
/ ' /T''' � -
/ �
IW
�a
�O
�d i
r ; �
PROP LINE �`
�------=--y----
C.L. OF STREE
n
LI
N ¢ I
u
� i i �
W
� O � i-'
OV� �V z y
� `; o
c r� x
O�` U
� a � ~
u m 'a
� J
N a
N
m
�
ZI
_J�
aI
O
¢
a�
. i
�
—' ------�
,
0
FT
Cd
FI
CITY
t-
w
w
¢
H
N
�
O
J
ci
�
S T.
EC IIYED
,s-� 19S 1,'
�CE PTl �' � �
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
MqSA
�
I
5622
BUILDING
APPLICANT TO FILL IN
./� 1// �-.� _ ,i..•
Mail Address_� ���"—/%[I /- U.�U h N.
City C��D,Sr.4 /1'1�� Ph. No. —
Contractor � �tT �1/OS – – –Ph. No.�,�'dL%�
Address ./� � �' • e,�it/T�L /+!'+.� i 'l✓�'/��-��
City Lic_No.-f��.� State Lic. No. %� l�/ `
Size of Lot AP No. 2�L� <UT/�
Setbacks: C/L Street �� i” Recu �
Side Yard - Right � LeEt p
Type of Fence ���/!� ���� G/�� �/
1 hereby acknowledge that I have read this-application and state
that the above is correct and agree lo comply with all City Ord-
inances and State Laws regulating building construction.
VALURTION
.
FOR OFFICE USE ONLY
�'oL0 _.i � �AUG 2 0 1957
Permit Fee $ �✓ "
� I Plan Check $
TOTAL FEE $ � �
USE REVERSE SIDE FOR DETAILS
�• i
:
STRUC1UflAl APPROVAL ONLY
SEPARATE PERMITS 0.flE REUUIRED
FOR ELECTRICAt, PLUMBING.
HEATING, VENTILATIN6 AND
REFHIGERATION WORK
p�revti# # --
THIS NUMBER MUST ACCOMPANY
' All INSPECTION RE�UESTS
FOH BUIlOINGS WHENE PERSONS ARE TO BE
EMPLOYED. WE SUGGEST THAT THE STATE OF
CALIFORNIA OIVISION�OF INOUSTRIAI SAFETY
BE�CONSIiITF� FOR ABDITIONAL
flE�UIREMENTS.
APPROVE�
City of Co,�tQ_Mesp eytld�p I
� �7oL EQIIIR �
n�.1 fet�c,eL+nl�
hb Ne�+cerc.
THESE PUNS MUST YE ON JOB A`[ TIKIE3
MAKE NO CHAN6E5 WtTNOUT PRIOR ' lU
OF DEPf.
THE ISSUF,NCE OR GRANTING OF A PERMIi OR ''i
Of PLANS AND SPECIFICRTIONS SHALL NOf BE tJSIRUFR
TO BE A PERMIT FOR, OR AN APPROYAL OF, ANY IOIATION
OF !'AIY OF THE PROVISIONS OF THIS CODE NO 1[ PR�
SUMING TO CIVE AUTHORIiY TO VIOLATE OR Cf1 _
PROVISIONS OF iHIS CODE SHALL BE VALID, fXC U!
FAR AS THE WORK OR USE WHICtI RAUTHORIffS I(ilNIQfG
THE ISSURNCE OF A PERMIT BASFD UPON IyiD �
SPECtFICATIONS SNALL NOT PREVENT THE BUILDIN OFFlCIRI;
fROM 7HEREAfTER REQUIRING THE CORRECTION 0 F�RQR$
IN SnID ('LtiNS !ND SPEqFlCATIONS OR FROM EMING ,
BUILDiKC OF:RAT:ONS BEING CARRIEil ON 7HEREUN Ef� W� '
IN VICG,IIC'. l: 7HIS CODE OR OF ANY OiHFR 0 D1N9NCi;
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APPROVED BY: DRAWN E
— REVISED
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