HomeMy WebLinkAbout3224 IOWA ST - Building PermitstC��S� MF 9
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CITY OF COSTA MESA , �
BUILDING DIVISION ` '
77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B10-00371
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PERMIT TYPE ' B ROOF2
APN: 13910206
JOQ ADDRESS: 3224 IOWA ST CM
vicinity:
Squares: 2400
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
12/06/2010
KJB
b6,000.00
SCOpE OF WORK: TEAR OFF COMP ROOF. COVER PLYWOOD WITH OSB, COVER WITH 30 YEAR COMP SHINGLE. ROOF PITCH IS
4:12. INCLUDES ATTACHED GARAGE. APPROX 2400 SQ FT.
OWNER: WAYLAND, WILLIAM C TR
PHONE:
APPIICANT: HERMAN, RICHARD
PHON E: 951 •288-'1328
CONTRACTOR: HERMAN ROOFING
Address: 4050 1/2 BROTHERTONUnit:
City/State/Zip: CORONA, CA 91719
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $125.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1'00
Address: 3224 IOWA ST
City/Stale/Zip: COSTA MESA, CA
Address:
City/SWte/Zip:
License No.
License No.
PHONE:
License No. 348265
909-371-0514
CELL:
PHONE:
PHONE:
Unit:
Unit .
4L FEES $126.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N 8/2010 - PER CMMC Sec. 13-279
Montlay thru Friday - 7:00 am lhru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Yeafs Dav. Memorial Dav. Indeoendence Dav. Lahor Dav. Thanksaivina Dav anA Chrisfmas �av
NOTICE: The vrork authorized by this permit shall comply with all applicable hantlicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92)
EXPIRATION: PERMI7 EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must wmpry with all applicable codes, and all
required inspections and final approval must be obiained. Failure lo obtain inspections and flnal approval will result in the expiration of this permit.
OC DEI INSYEC110NTYPE QATE INitlUL LODE� INSVEGTONttPE ORTF IN1171AL
7676 Fixed System Final Fire PrevenNon //�� 206 Final M1Rychanical
126fi pppl Spa Final ��/ 208 Final Plumbing
200 Final Re-Roof Z- — � '�� ��j Ky � 210 Final Electncal
201 Final Block/Retaining Wall 2t2 Final Fire Prevention
2b2 Finaf Fac(ory Fi2 Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Builtling/Occupan�y
WORKERS' COMPENSATION DECLARATION�
I hereby aKrtn under penalry of perjury one of the following tleclarations:
❑ I have and vnll maintain a certificate of consent to self-Insure for vrorkers'
compensation, as provitletl tor by section 3700 ot the Labor Code, for the
pedormance of the wnrk for which this pertnit is issued.
❑ I have antl will maintain workers' compensatbn insura�e. as required by
seclion 3700 of the Labor Code, (w the pedortnance o( lhe work (or which Ihis
permit is issued. My workers' compensation Insurance carrier and policy
number are:
�, �//��� ccJv
(This secfion neetl rrot Oe cnmplefe0 df�a permR u rdlue0 al ona IrunMe00ollars (S I00) w less )
umber. 7130U 2 �(�j j�
❑ I certily Ihat in Ihe peAormance of the work !or which this pertnit is
issuetl, I shall not employ any person in any manner so as to become subject
to the v+orkers' wmpensalion laws ot California, and agree that if I should
become subject lo the workers' compensation provisions of Section 3700 of
t abor ode, I,sh I�vrith compty with the5e provisions.
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-�gnaWre e�, , ,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Protessions Code. and
my license is in full force and efled.
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w�`--�9�ei � �'F
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a constmctbn lending agency fa the
perfortnance of the v.ork for wfiich ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atldress:
oa�e
OW NER-BUILDER DECLARA710NS:
I hereby affrm that un0er penally of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW !or the following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit ro
constmct, alter, improve, tlemolish, or repair any sWclure, prior to iIs
issuance, al5o requires lhe applicantlor such permit ro fle a siqned statement
that he or she is licensetl pursuant to [he provisions of Ihe Contractors
LicenSe Law (Chapter 9(commencing with Seclion 7000) ol Division 3 0( the
Business antl Pro(essions Code) or that he or she is ezempt therefrom anG
the basis lor the allegetl exemption. My violation of Section 7031.5 by any
applicanl for a pertnit subjects t�e applicant to a civil penalty of not more than
five �untlretl tlollars (5500�.�:
❑ I, as ovmer ol the property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner ol property who builds or improves
thereon, and who does such vrork himself or herself or Ihrough his or her own
employees, provitled that such improvements are nol intendetl or oHereO for
sale. I!, however, the building or improvement is sold wit�in one year of
completioq the ovmer-builder will have the burden ol proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construcc the projecl (Sec. 7044, Business and
Professions Code: The wntractors License Law dces not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contracta(s) license pursuant lo the Cont2c[ors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre
9051�a6 (10])
Owner ID verified by driv�se. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype o( Document, i.e. - propeny tax Dill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: �
❑ I hereby certify that no ezcavation frve (5) w more teet in tlepth into which a
person is required to descend, will be made in connecl'qn with wDrk authwizetl
by Ihis permii, and ihat no building strucWre, scaNdtling, (alsework, a demolition
or dismantling ihereof, wiil be more than thiAy-sirz (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Califomia Administ2tive Code�.
❑ As owner-builder, I will not employ anyone to do vrork which vrould
require a permit from the Division o( Industrial Safely, as noted above, unless
such person has a pertnit to do such work (rom I�e division.
Appliwnl'S SignaWre
Division o( Industnal Safely Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Witl the applicant or present or fuNre building occupant need to 61e and
cerlily a Business Plan for emergency response to release or threatened
release ol a hazardous material? ❑ Yes ❑ No
(Seclion 25505 of the Calilomia Heallh and Safety Cotle requires, with some
exceptions, that a Business Plan be filed with Ihe Cosla Mesa Fire
Department by every business which has at any one time during a repoReC
year a quantity of hazartlous materials equal to or greater than a weig�t of
500 pounds, or a volume of 55 gallons. or 200 cubic teet ol compressed gas
at stantlartl lemperaWre antl pressure�.
2. Does or will the applicant or present or fuWre builtling occupant need to file
a registration form for acutely hazardous materials? � Yes ❑ No
(Section 25533 of the Califomia Health and Salety Code, with some
exceptions, requires registration with Ihe Costa Mesa Fire Department by
each business vmich at any one time has on hantl a quantiry oi acutely
hazartlous materials equal to or greater than a weighl of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of wmpressed gas a[ standard
temperaWre and pressure�.
3. Does or will Ihe applicanl or present or fuNre building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of lhe Califomia Health and Safery Coda provides that Ihe
Costa Mesa Fire �epartment may require the preparation, certifiwtion antl
filinq with the Fire Department of an RMPP by businesses which are required
to register awlely hazardous materials with the Fire Department.
4. If an RMPP is presently required, �as Section 25534 of the Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future building occupant require for
Ihe work which is the subject ol lhis application a permit for such wnswction
or motlification from the South Coast Air �uality Management Distnct or from
any other air pollution control dislrict or agency? ❑ Yes ❑ No
(Secl'an 65850.2 of the Calitomia Govemment Code requires Ihat the requested
information be Nmished on applications fa ran-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet Irom lhe outer boundaries of a school7 ❑ Yes ❑ No
(II yes", Ihe facility must meet the requirement of Seclions 25534 antl 42303
of Ihe Calilomia Health an0 Safely Cotle).
7. If a pertnit lrom the South Coasl Air Ouality Managemenl Districl or other
air pollu�ion control tlistriCt or agency i5 requiretl for Ihe work which is the
subject o! this application, have all of the disclosures prescribed by Cali(omia
Health antl Safery Cotle Section 42303 been made? ❑ Ves ❑ No
8. Qf "yes", attach certificale of compliance from the appropnate air polWtion
control offcer). ,
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ortnation given above is wrrecL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre 6ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this a0plication an0 state that
the information given is correct. I agree to comply with all state lavrs and ciry
ordinances relating to building constmction, antl authorize representatives of
the Ciry ot Costa Mesa to enter upon the above-0escribed property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorize0 by this permit until final inspection.
naWreol e IOwner(s) Daie
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fea9-avvronzaeAP �ram �
Prescriptivc� Cer6ficat
Residenlial Alterati�ns
General ]nformation
Family ❑ Multi Family
Conditioned Flooi Areu (CPA):
Residential
N
�nforcemeni Agenc�•: I Date:
Circle the Front Orientation: ]�, L, S, Vd, or de@rees
Type: ❑ Alierations O Enve
ment or Change Ow ❑ Duci
CF-lR-ALT
(Pa e, ] of 5)
1 il of Stories
�
7(
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NOTE: Tl�rs�Jr,rnr r.c �mr rn hc rre�ed Ji�r Nc�vli� Cnnslructed DeiildinKa' m' AAdiliana�
tiis�dntinn Values Fnr Opaqur Sur(nces (Ja� Furring use tl�c Mass and Furring S�rips Consu�uc�ia� mble beloN�)
Assem6ly Alteration '
O Openin; 01' trnmuA cariq� ulone- A6ero�ions �hni involne �6e opening q/�he fi�mned caviry� o(n wa[(, ceiling, a,Jloor musr insm(1 �he
manduion� minimum insulrniou value per §I SQfor �he af�ered ou�emGlp. FJl in Columns A-C and enter niandaion� irtsula�ion value in Coh�mn H.
❑ Replacement of entire assemblp-Reylucemeiv ofan emire wall, ceiling. or floor assembl�� requires the ins�olla�ion ojComponen� .
Parkaee- L insidn�ian va/vrs in TnGle ]5/-G Fi!! in Columns A- J. .
Tag/
ID'
Nole:
+Furri.
SurfaCe Detalls Fm� the furred pm'tioned of Mass Vdalls see Purring St
B C ll E F
Pro osed "hO1 Standord
Framing Thickness,
Assembly Name Meterial Spacing_ U- JAQ Table
or Ty e� and Si2e� or Other' factor" Number$
��red aseemblie.�, accoumingfor-Cavinuaur Insululion R-value, see Poge JA4-3 m�d Eq
Construction Table belne�.
G I H- �..j. - I
Valuas From JA4 Table
Framed Continuous JA4
Cavity lnsulation Assembly
R-value� R-Value' Cell Value
4-1.
use
�
L h or Tng/!D indica�e the idenii�caiion name lha� malches Uie building plans.
?. Indica�e �he Assem6lr Nume or ,rype: Roo(/Ceiling, Walls. Floors, Slabs, Craw1 Space, Doars and elc..lndica�e Ihe Frame rype and Size: For
R�ood, Meta(, Metal Buildings, Mass, enter 2s9, 2s6, w' e�c... see JA4 fm' olher possible frame ryyc asse�r,blies.
3. Enier lhe �hic/rness.for mass In inches or Spacina 6enveer� jraming members en�er; )6 "ar 24 "OC; or Orherjm� all aher assembl�� descrip�ioio
such as Concrete Sandwich Pane(, Spandrel Panel, Logs, Sn'aH� Bale Panel and eic....
4. Based wr the C(imafe Zone; enter the Standard U fac7m' fi'om Table 1.51-D. C or D/or each diJ, jeirm� assembl�+ Name a� q�pe.
5. Enter the Table num6er Ihai closelp ree�em6les die yroposed asxembfi�.
6. Lnter �he /f-nalue �hm is being insm!!ed in tfie mall cavim or Geiween die f'm�iing; odmrwise, enier "0 ".
7. Lrner �hr Cnn�inuous Lisidatia� R-nalve for �he proposed assembl��; o�herwisc, enter "0".
8'. 6nler tl�e rnN� and colwnn of !he U-factor valuc Lased on Colvnm FTu61c Number ond emer !he Assemblp U-fuc�or in Colvnm J
). The Propnsed �Ia�semGh� U-fnclor, Column J, nms� bc equa/ �n or less ihan !he Slandprd U-faclor in Colunm E lo Compl7�.
Fun'in� Strips Constniction Table for Mass N�alls Only
A B C ll LT F G H 1 J K L M
]'ropused Properties of MesonrY and Conerete A�ded Interior ur �zterior ]nsul:ifiun
N'alls Prum Relerence in Purring Space f'rum Referenee
Juinl A i endix Table 43.5, 43.G. q3.7 .luinl A�endia 7'able 4313
� "� ` � -
U � .� Y " ' U
�. � � c g '
Asscmblp �' � � c ° ~ v ° d�'� �• "".v Final
M�4S Nmnc oi JA4 Tablc ° :, o= R rt o 't , o- ` r ASsertlb�y �
ThiCkness� l' c' Numhef � - = yj � � �, ',�'� ¢', C �' t�i� c U-fac[or�'� Commem
i
I
I I
kegi.rrrarion Number: 2egisira(ion Uure/T�me: NERS'Provider:
20f1b' Res[dentiul Compliunce Forms �iugu.sr 2009
Atterations
Project Name:
ROOrING PRODUCTS (COOL ROOFS) §ISl(p12
CF-1 R-ALT
(Pa�e 3 of 5)
ii � � n # oT Storiea
Wl�en Uic nre« oJcrlerior rnojs�rrjace !n bc replaced exceeds iuore 1Lan 50% af [he eriSNng rooJaren, ar mom tdau J,000 jf, ivhichever is
Icss, die nem roofi�tg arert uu�st meel (hr rooJtng prnd�re� "CoolRoof'requireu�ents oj§I52(b)IHi, 752(b)IHii, or 151(bJlHiil.
Check applicoble alternntive or r�ceptio�r befoir if �he rooJal�era�ion is esemp� fi�onr �he roofing praduc� "Coal Roof 1 reguiremenla�. Note: /jan��
��ne oJU�e aliarna�ives or exceptimr below is checked, ihe Aged Solar Reflecmnce a�vd Thermal Emitmnce requiirnien�s jor roofing products in
,y�ll8(iJ mr no/ app/icab/e. Do no� fil/ �oble beloN�.
❑ S)Col Roofs Not Itequired in Climale Zones 1-12, 14, and 16 with a Low Sloped. Less or 2: ] 2 pitch,
�6aol Roofs Not Itequired in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater [han 2:12) and pmduct unit weight less
than Slb/fr'.
•Alternatives to §152(b)IHi and §152(b)Hii, Steep-slope roof (pi�ch > 2:I2)
❑ InsulalioU witlt a thermal resistance of at least 0.85 hr� °F/Bni or at least a 3/4 inch airvspace is added to [he roof deck
over un attic; or
❑ Existing ducts in Ihe attic are insulated and sealed according to §151(�10; or
❑]n climate zones 10, ] 2 and 13, witb 1. ft. oTfree ventilation ama of attic ven[ilation for every I50 ft of apic iloor aren, and
where at least 30 percent ot the free ventilation area is within 2 feet venical distance of the roof ridge; or �
� Building has at least R-30 ceiling insulation; or .
❑ Building has rediant barrier in [he attic meeting Oie requirements oT§151(�2; or
❑ Building has no ducts in the attic; or
�O In climate zones 10, 1 l, 13 and 14, R3 or greater roof deck insulation above vented attic.
Exception [o §I52(b)IHiii, Low-slope roof (pitdi c 2:72)
❑ Building has no ducts in [he attic.
Other Exceptions
O Roofing area covered by building integrated; phomvoltaic panels and solartheanal panels are exempt from the below Cool Roof criteria.
❑ Roof consuuctions that have thermal mass over Ihe roof inembrane with at least 25 Ib/R� is exempt from the below Cool Roof criteria.
Note: If no CRRC-I label is available, this compliance method cannot be used, use the Performance Approach to show comptiance, otherwise,
Check Ihe a licable box below if Exem t from the Roofing Produets "Cool RooP' Requirement:
Roof Slope
Prodact ID Number� <_ 2:12 > 2:
Produc� WeigM Pmduct
< Slb/ftZ > Slb/ft' T e�
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
Aged Solar Thermai
Reflectance3'-0 Emittanc�
�4
❑4
On
❑4
The CRRC Pr'oducllD NumGer cai Ge o6mined fi'om Ihe Caol RoafHaling Co�mcillr RatedYroducl Uirecloiy al w�n�v molroak or�/prnducls/searclr nl
lndicme d�e qye of piroduc� is Geing useA(a' ds ronJ�op, i.e. single-pl�� roaf, asphal� rooJ mmol roof, c�c.
//tlie Aged ReAecimree ia' noi availaLle inlhe Cooi RooJRo�ing Cmx�cil'a� Ro�ed Produc� Direc�ory A�en use ihe lni�iol Xrnecmnce v<due jrom Ore sanre
direcmr�� an(� use rhe eyuaiion (O.d+OJ(/1�ni�id— O.IJ lo ab�ain n calculaled aged vafne. Where p�s Ihe L�ilia( Solar Reflecmnce.
Check bos i/'Ihe dged Relleclw�ce ia' n caltulmed volne using ihe eqimlim� above.
Calc�daie Ihc SRI value Lr using �he SR/- Workrhee� a� Mryr//�v�vu•.enerm�.ca.¢nv/fitle24/m�d emer Ihc reau6ing vah�e in !he SRI Column a6ove and auoch act
�hc SRI� IVarhshee! m !hr CF-Ilt.
i apply Liquid rield Applied Cuatings, the coating must be applied across the entire roof surface and meet tlie dry mil thickness or coverage
commended by the coatings manufacturer and mee� minimum performance requirements lisled in §118(i)4. Selec� [he applicable coating:
Aluminum-Pigmented Asphalt Roo�Coating
Regisfru�im� Number:
2008 Residenlial Compliunce Forms �
CemenbBased Roof Coating
Regisvaiion Date/Time:
Other
HEILS Provider:
Augusr2009
I'rescriDth�r Ceriiiicate o1� CumpllSA� Residential �� CF-]R-ALT
Yrujecl
Clim�[r "Lunc # � K ui�
HEKS V�%IFJ CATJOI� SUMAIARY Thc en/m'cemem ngener rhuufd par syecial auemi�o �n lhr yE�tSlileasurex �yecifie�l in this
checkhs� bc(mr d ca�rple�cd and sipned CF-41( Fa'm Ia� all /he meaxur'er a/�ecilied s•htJl Lr submfned in iiic Guildmg n>spec�or' Gejor<� /inol
DuCI Se.�line � Te5[ine HL'liu NCl'(fCU/IOI� Id'1'L'[�tlU'L'[I,IO�'/III.I I1ICGYW'C.
� YES ❑ NQ l'CS'. lu Climalc Z.oues ° and 9-14, if more thaii 40 hneer (ee1 of ne��� ui repluccmenl ducls :ire ins�silled in uncundiiioned
SPftC[, II1C (IIILLS iIIC lp be senled pei y152(6)1Dii und Ihe newlp inswlled ducts am tn be insul:ued pei §I51(fY1G.
❑ EXCGPTIG�': Lxisting dud systema� [hnl are exlended, �vhich m�e cunstructed, inxulnted ur xculed �vith asbestus.
❑ YES ❑ NU 1'ES-. ln Climme Zm�es 2 xnd 9-IG, iCtlie existing space-c�nditioniug svsiem {HVAC rquipmen� anA ductinai is repinced, the
ducu are to 6c sealed pu � I 52(bp Di. .
❑ 1'ES ❑ NO YES: In Climate Zones ^_ and 9-1G, if the existin� NVAC equipmem is repluced jincluding th� replacemem o1 the ni� handler,
omduor condaisins uni� of n splii sys�em, cooling or heating coil, or the fumace liea� exchanger) tNe ducu are to be
sealed pei §152(b)IE. �
❑ L�aC�PTlO�: Duct sYstems tLnt are ducumented tu hnve Ueen previuuslr sealed confirmeA Uvuu�li HLI2S
� veriLcetion in accurdnnec �vith prueedurer in the Reference Residentiuf Appendia P.A3.
O�XC�PT70�: Duct systema� wi[Yi less thxn 4U linear fee� in unconditioned space. ....
❑ iXCLPTIO�: Cxisting duci svstems conatructed, insulated orsealeJ with usbestos.
Refriperant Charee - Split S,ystem HE2S verificaiion ia reqvired fa'thi.s measurc.
❑ 1'LrS ❑ NO YES: In Climate Zones 2 and 6• I5, when lhe existing H VAC equipmen� is replaced (including the replacement of the air
haodle��, outdoor condensina unii of a split system A/C or lieat pump, cooling or heating coil; or the fumace heat
Central Fan Integrated (CFI) Ventilation S,ystem and Fan V�'att Draw
Tlie ven[ilation ren�+�rements of §I5�(o) do not avply to existine residentiel homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airfloh� HERS,�e,�i/icarion is reqvired jor rhi, measivc.
❑ 1'ES ❑ NO YES: ]n Clima[e Zones 70 t6rough 15, when [he existing space-condi[ioning system (HVAC equipment and ductino) is
reolaced. the airtloW and ian watt draw shall be verified uer F 152(611 G to meet tlie renuirements of & li I(f17B.
:ion Author's
thal this Certi�.
C�J
��
CEH or O CEPE
Responsible 73uildine Desi�nu''s I)eclm'atim; St�tement �
� 1 am eVigibte under Division + of the Culifomiu Susin:ss and Hrofessions Code tn accept responsiUiliry• for tlie buifd4ng design identiiied un
this CeniLcaie of Compliancc.
• ] cenify Ihn� Ihc energy fwmres aud performance apecif�cetion: 1or the buildin� desipi� idemified on this Cenificate of Cmnpliance cunform
tu the requirements ofii0e 2q.7'an:; 1 anA 6 of thc Culifbrnia Cnde of itegulations.
• Tlic building design fenwres idemified on thi:. Cenifiente ofCamplianec nre eonsisteni wilh lbe inlormntiun provided «� ducumeni thi::
building design on Ih: other applicable complianec Ibnn:, workshee�s, eulculations, plans anJ specific[uiom: xubiru�tcd w the enibrcemeni
u�encr 1or apprnval with tbis buildin^ penni� a phcation.
N�imc: Signaturc:
Cumpunl':
HQdress.
Giy!Smu/'.;ip:
Date:
Lmense:
Frn� ac.si.rumcc or quca•�irm:. reg�u'din�.; thc Encror Suuidru'ds, cnnla�c! thc L•nc�•gl� Hottuve ¢�: 7-8U0-i72-i3l111.
I(egu•b'mmu lJmn6er' /(egtnra�inr. Gale/Timc
2001: ]cc:ricieiviul Canp(ianec Fa'ms
F/L/;S ! roviaer:
�iz���ua•I 300%
o�eTpooness: 3229 IOWA ST
OWNEN'SNAME: WAYLAND, WILLTAM C
aooR[ss: � Z z q I�WA
COSTA NESA,CA 92626
AflCMIFNGINEEfl: 5 Q 9— 2 6 6 7
ROOflE55:
XEG,NU.:
u"iT: CITY OF COSTA MESA — BUILDING PEAMIT PERM NO; B 05331E
PERMIT NO: B 053318 PLAN CHECR NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR Pi7RPOSn: ALi
UNIT:
PEHMIREE: GREGG THOMAS ROOFING ( 714 ) 841-2290
AODflESS: '79zS STARK S'fREET 5
HUNTZNGTON BEACH CA 92697
LICENSEO CONTPACTOfl DECLAPATION: I here�y allirm I�al I am Iicen,eG un0er O�oviSions ol CAaO�er 9(commencing wilh Seclion
7000) ol Orvision 9 0l ��e Business and ProlGssions CoDe, anU my license is in lull force an0 elt¢CI.
ciTruc.: 04z�3� srareuc.:504871 cuss: C39
Oate: Signature:
W08KEBS'COMPENS�TIONOEClABA710N: i�¢�¢Oyailirmlhall�aveacenifuateolconsenuo5el4insurearacertilicateoiWorkers'
�moensation Insu�ance. ar a cendied cooY thereol (Seciion 3800, LaC. CI.
oucrxo.: 1105719-90 EXP.ORTE: SIIOL�9I
COMPpNY: STATE rUND
r] cemreo coov �s nereov wmisnea. GY cemeea caov is rieo wim me u�y euiieinq uvision.
Date: Applitdnl:
E%EMPTION FNOM WOBNEXS' COMPENSIITION OECUflRTION: (i�it se[Uon necd no� Ge complete0 if Ihe perml iT for one huiEreO �51W) or 1e55�.
I Certily I�ai in th¢ Oe�armance ol ��e wark lo� whic� Ihis permil is issu¢G, I 50a11 not employ any perwn in any manner w as lo Gecome
su0lec�io t�e Workers' Comoensaiion Laws ol Califomia.
Oate: Signamre:
NOTICE: II. afier maMinp t�is Oeclaration, you snould Uecome su0lect to the Warkers' ComDensation prwisians ol ihe Labor
CoOe. you musl fonhr+it� comO�Y with suc� pmvisions or t�is permit sAall be OeemeG revoked.
CONSTflUCTION LENDING AGENCY: I here4y alfirm inal ihere is a consiNclion lenaing a0ency lor ine pedormance ol Ine work lor
wNCA ihis permn i5 hsue0 �SetliOn 3097. Civ, C).
LFNOEN:
RDOHE55:
OWNEfl BUIWEB OECUBATION: I �ereGy bifi�m ��al I am exempl Irom I�¢ fAnlraciors State License Law for tne iollovnnp reason
�Seciqn 7031.5 Busin¢u an0 Pmiessional CoG¢: Any G�y OI wunly whit� fepuit¢5 a permil IO cort5lrUct, al�ef. imptOve, �¢molisn. oi
repai� any 9Ncium. O�b� to its i55Wnce. al5p t¢Quires t�e apDlicant for suU permil to Ide a 5iq`reG statemenl itlal ONs�e 6 IitenSeE
Owsuant �a I�e piavisid5 0l Ihe Cwiractors' State Liunse Law (Chap�er 9(cammendnq wit� Sectron 7ppp) ol 0ivision 7 al ihe Business
an0 Pmlessions Code� or ��a� OrlsOe ¢ e�empt Iherelrom an0 �ne basis br t�e allegeE exemption. Any violation al Section 7031.5 Gy
any aoDfiWnt to� a cermt sueieci5 Ine aDP�Gn� Io a civil Oenalty ol not more inan live nuntlre0 aolla2 �5500).
I, as axner ol Ine O�aDeny or my employees wilh wa0es as Ineir Sole tampen5d1i0n, will Oa ine work. antl ihe
I J strucWre is noi inteMeG or oikred for sale (SecUon 70a4: Business an0 Prolessional Co�e: ihe Coniractors' State License Law
Ooes no� aO�N �o an owner ol a pmpetly wha builds or imprOves �hefeon, antl w�o doe5 suctl wntk himsell/�er5ell ol NmuAh
�is or her own em0�a/ees. D�ahded t�at suc� imOmvemenis are not intenaed nr oflered for sale. II, however t�e 6uiltling or
im0�ov¢meni is Sold wrthin one year ol campleiion. I�e owner will �ave Ihe buraen o� pmving Ae/she tliA nol build or impmve
lor ine purpose al 5ale�.
I, a5 owner 0� Ihe pmperiy. am extlu9iv¢Iy conVaClinp wi�� litensed ConVatlOrs �o con5lmci t�e proleci �SeCiion 7044, Business
I❑ antl Prafessions Cotle: The Coniractors' Stale License Law OoeS nol apOty to an ovmer of pmp¢hy wta Luilds or improves lhereon
ana wlw wnVac¢ for such D�ol��s �Ih a conlrac�m�5�licen52 pur5uantio I�e Cantractors' S�ate L'uense Law�. I am aware
I�at 0��� a� ��eir Worker'S CamOen��q� insurance s�nu10 b¢ prontlM ro me.
� I am wempl unGer $¢ciion: B. 8 P. C.
lor Inis reason:
Oa�e: O+mer.
I Uo �ei¢Cy ceNiy Itui I am aware oI aM untlei5lanG I�E repuiremen�i al Cali�orrva HCali� aM Saf¢Iy Cotle S¢tlim5 255115, 25517, anG
2553C ane inal I o� any tulute Ouilemq acupanl vnll/xill nol (circle one) neeA le comDN ��h SaiG slate c00M anU ine reauiremenis lor a
permil lor cansVuciiOn Or mo0dicalion Irom �pe Aii Oualiiy ManaBement Disirict. flesi0eniial wnstmction ap0��calions are eKemO� �rom
Inesc provisi0ns.
OaIC ApPlitanl:
I heieDy ceility�Aal I �ave rea0 I�is aDDlicalion and Slate Ihall�e aboveinloima�ion is correcl. Iagreeio comply vnlh ail cily and couniy
oidinances antl stale laws relai�ng to ouiltlmg consimction and here�y aWnorite reDresenlaiives of INs cily lo enler upan I�e above�menlioned
pro0etly lar insp¢tlion Omposes.
Date' Signatwe:
Orivei's �¢ense a� Sociai 5ecuriiy •:
t6at�a6 WM1ue—Bwldirg; Green—Gotle Enlorcemenl; Canary—Applicant; Pink—Revenue: GdOenrotl—AssBSsor
JOB DESCRIPTION : T/OFF REROOF W/COMP, SQ FT: 3,8U0
CLAIM VALUE: 3,800.00 CALC—VALUE: 3,800.00 GROUP OCC; R-3 /
CUMMENTS: SMOKE DETECTOR RE�U7RED IN THE HOME
1EIF#IFM�1Eif�iF14iF1F#ififii�2F#iiiF1E#�F:(�ifiC�IFie i(�ihlflFifiFiF3eiFifiF3fifiFii�i(�1(�iFlklfi4#ibii�lEkifif�df3fiEiEiP7Fih�6ifi(ihk#k�ii��FlFlfffifiEi'rif�
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT ZN
--------- ACCESSORY BUILDINC; ---------
FRNT: FT Ih REAR: FT ZN
LEFT: eT IN RGAT: FT Ih
PARKING RcQ • PROV; PARCEL: 13910206 ZNE: REF NO:
PLANNING N61'ES>
>
# 3f iF i'r iE if �F i(� if N� i4 iF IE 7(� #�lE iF 3f if� iF if �K• iE iE #-1E-%iF 1F 3F iE �F )f ie IF if 3f i'r iE 3E ie �E?f �lE if iF �lE if if iF iFiF iE iE if �f aF 3f iF ib #�lE if 14 i(� ?E ie if ip IF 3f 3E 1F If �E IF ib ii-iF
D E V E i O P M e, N T S c. R V I C E S R E Q U I R � M: N T S
'LONING APPROVED HY DATE:
BliILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATc: �
iFiFiFifIF3f�1F#if3F*�fiiif�3FibiE3F3Fih1F� �r fr iF#?F3f3f3F3FN�36if7FFFit ti'�F'F.��3f3F
IF iE aE iF iF i4 if IF iF aE iE iE If K iE 1h iF 1E M� iE if iE �1E 1E jE if ?f iE 1E if iF 3f if iF If ik % If i'r aE iF # rt iF li� fE iF �lY iE 1F if �E If iF �1(� ib if #�4 iE+(� 3'r aF 34 aFj(� iE I(• i'r if fi� iF-R IF iE k� 3F iF aE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGNENT:Y
BLDG PMT PLUMBING ELECTRIC M.ECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
S,�1I F / NON — R'c:8
PLAN
ISSliE f'EE
BUiLDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID ' DUE
TOTALS----> 63.50 0.00 0,00 63.50 63.50 • .00
REVENUE DZVISION TOTALS--> COLLECTED- 63,50 OVER/SHORT: � 00
BLD63p00 �LUMBING ELECTRIC MECAANIC eIRE SNIP/TOO GRADII�G PLAN—CHECK
%# IF iFlE 3F iE 1f iE 1f ff ii ik ih 3f # iF � ff ?F 7E iE if iF if 3F i41E # 1F iF 1E 1E IE 3E iE i(� if iF if Ie if if i� 1't �6 iF if if If i't 3E iF if �1F f iE 3f ii 3f If iM1 ie iE iF �F Y.- iF i f 3F if iE iE if� 3F i!� i4 iE iF
I N D I V Z D U A L F E E B R E A K D O W N
TYPE (ZTY D E S C R I p T I O N UNIT COST .T'OTAL COST
SFR 3800 RERUOF HY VALUE �ESIDENIAL NOZONE 1,00 ' 3,800.00
END OF rEES �
/� n
'l1 LUJ9`.1�IJ i.�l!/'f'Y4 � y�y11.'
o�rr: c4ii::;a:. t}�:f� �u:�:.
- J
, 4 _
CONSTRUCTION AND PLANNIi.., �� �PA
�
APPROVALS Permit # Date Inspector pppROVALS Permit # Date inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. $oil Pipe-Undrgrnd. 53. S[eel Reinforcement
3. Electrical Conduit UtilityUndrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurel Floor SYstem 61. APPROVALTO DEGK
11. Property Sewer Line & House Connection 62. $ackwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Orains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Finai
75. Rough Electrical-Conduit 66. Solar SYstem�Final
16. Rough Electric Wiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Oucts, Veniilating 71 . Product Piping O Gas ❑ Oil
23. Gas Pipe-Fough & Test 72. Underground Flush
24. �Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T•Bar Ceiling (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77, FIXED SYSTEM FINAL
i
29. Insu�ation ' 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
37. Plaster 8rown Coat � 79, FINAL INSPECTION
32. Electrical Power Meter-Final. 80. F000 CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & F.ir Conditioning
35. Final Gas Pipe-Tesi ,
36. Hood or Canopy
37. Final FactorY FirsPlace
.- 38. Final Plum6ing ,
39. Water Service-Finel
40. Gas Service�Final
41. Solar pomesticFinal '
42. Backflow PreventBr ' � i
43. Batkflow Irrigatio�
44. Landscape Irriyation System
45. Sound Attenuati0n
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING $ �j_°/� �c,�, �- b'7'= ^ �� �� _Q� ��
c��
a8. FINAL PLANNING �w,�
49. Electric Release t0 Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�oowEss oc em�axa: 3 2 2 4 I OWA S T
°n'"E"s"""E"'Q'°'"": WAYLAND, WILLIAM C TR
�ooxEss: 3 2 2 4 I OWA S T
COSTA MESA,CA 92626
�vv�. �uiwc �no�u:
549-2667
AXCNRECi ON F1MiNEEA:
�NCII ON FNO.'S �DDPES4:
uc.ra:
UNT:
UNT:
��T�S� ANAHEIM HTG. 6 COOLING (714)772-9699
CONfPACTORSY4IWG 1418 S. CENTRAL PARK
�ooness: p,p]p�E I M CA �+� �: 5 9 4 8 4 3
92802 ��r:
LICENSED COMHnCTOfl4 OECLAN�TON: I Mraby tllim uMer pe�y d perjury Nm I am I� wAer pwie'vn d Cheqw 9
(mmmmrirq Mil� Sec�bn ]000) d Divisian � d �ne Budmea vM PMesebna vd mY lioema e in lull brca vM eHed.
cmuc.No.:055504 uc.cuss: C_Zp uc.No. 59 843 EXP: 07/96
ome:�/ v/ / �Z� cwroec«:
OW NEX BUILOER DECIARATION: 1 Mreby eHvm uMe� penNy d perjNry Ihet I em uemq Imn �he Gonirepws Limnae lew la tlie
�Wbwrq �eesan (5etlian 1OJ15 &wneaa aM Rolaaiona Cod1: RM CtY w mwtY Mfiidi npuim e O�Y to oduVutl. Ma.'vnpow.
aamaen, o. ,w� �r .�����, w�« m n� ewe�. �no rea���, mo md�� �w.�e o�n io eb e w�a.im�m md na «.ne
b licenaed p�muru to the pwmma d tM Caurean� liomu lew IChepv 9(�menunp xilh Seaion IOW) tl Divcion ] d tb
Bueimae end Prdwbm COEeI a tlut M a ehe u xemq iMralmm enE tM Esw la Na aAepsa eaemqion. Nry violetion d Sedian
)OJt.S by any epp4ran� la e parmil wbpdt �he epd�� �o e avil penelry d �wl more IMn irve huMred ddlen �SSOU��.
� I.a�owmrdiMP�WsnYnmYemdoReswihwWeanllwFedammDemetian.vriAEONSMwk.vdNeet�ucturtuna"vneMeE
«aneree ior,eie �sen� �a.. e�� �a a.a...�a,.c�: rn, comrwa. �ti. �.d�. �a wW m� a.�, d poc�+y
wno ddda «:nwwe+�hefean. w.ro aroe aud+ wak Hmxu «han.+or wwph hu «ner mm emoMa�. o�+� tne� urh
impwanerua ere � imeMeA n WaeA Iv seb. tl. Mwmer. IM buiNieq a inpa'emeM is �old xilhin ane Year d eamP�ion. Ne
owrorbuipu xill Mw IM EuNen d pv.•iiq M a ehe d'd m� buiW a imparo lor iM puryoee d eeb).
� I. at oxiw d IM MOPeM. em utludwlY con�2tl^0 wiN IinmeE cm�reclwe b cmffi W Ne P%sd (Satlion ]ON. &»inst aM
Prole siom Codo: TM Conireeaa Lkenx Lew tloea M epply to en o�xne d peopeny Wp WiNs a impww IM1ereon aM wlw
emleari fa s�K'A prqeCa Wh e mtlretla�t) li:emed wnueM b tM Conl�ae liroma lewl.
❑ I em eRemq uMar Section: B, 8 P.C., Ip Nn reeaon:
Deta: Ownr:
i m n�er �r �m i�, a� a�a uwa.i.�d ine �a���n a c��ome wwn .�a sdavi cea sea�. nws. nn�..ro
255Ja, uM thei 1 a ary Mura Wiki�q omryeni will / wtll na (arcb am) neetl to rnmqy w�h eeitl Gele codm enE �Iw rtpuiromeme la
aDe�m4lamnWciqnamo4R�qnhwnlMA'r�uei�.y uuYemeniDiatntl.RmkavielmiutMioneppiWiorueroeaemqtromNoa
a�.
oe�a: �cd�n:
W OPKEN'S COMPENSATION DECLM�TION: I Iwepy elfirm �Mer peneliy d p«jury oro d ihe bllowi�p Mtleimom:
r] IheveardwilmeiruanecanEicmadcamemioeaXimurslorwaMen'conpenution,mpraviCeC/ubybeaianJlOUdtMlebv
Code.lor tha pa�iamerce of iM v.orM lor which Ihia permil ie iaued.
,l inw.�d.a�,.�md,.on�a.•�ro����«,�dw..m�.a��oews«��a�oodme�.nacoa.b,m,w�«�weam.
7C woh la which ihie parmil is iesued. My wakore rompenemion inwrencs fartiar vM pdi�y number ere:
c�».: GOL N �iLE EXPIRES
PdkyNumber: n1WC� 'TS. �=P�� 07/O1/96
(�u's sMion nee0 �w( bs conp'etM / W psrmt u br me hundrN ddlers �StWI w .)
� I canry inm in ine pMormaree d ihe woM 1« whkh �hie pa�mit ie iaeueC, 1 eM1ell d empby eny peiron in eny menner eo u to
becanie wEjad to Ihe xorkera' rompaneetian lax+ d Ce4tmue. il I ehouM Eecana wbpu io tM r.vrken'
mmveranion qo'�iom M Swion a�a0 W iM Lehor Cade. I e 1 h n com N' h �M1oae Provuiore.
�
o,�,: � I,L ti ���,,: -
Waminp: Fellun b�xun woikx�' co�xwtlon rovwp� b unbw/u( • II wb/�ct �n xnp/oyx ro ctlMiW p�n�/tlu �nC
dvll nn�, yr ro ons hunerM thouaud tlo/N.. /sI00,000A In M11Hon ro m. ro,t or rompxuerron, Gmryps u pov/aM ror In
SxHon 9]O6 0l Ms Le6orCOM, /nNrup enJettornsy'� Iwa.
CONSTHUGTON LEN011W AGENCY: I heraby �rm uMer Po�elry d perNrv �het �ham ie e cana�rudion bMiip eparwy ia lM
pano�mence a �ne woM �« wniM �ne w�a b m.uee Is«aoo aoe�, cr. c�.
LENOEH'S NAME: .
LENOEq'S RDDFE53: .
Icenitythatlh readthiseOGlkalioneMe�ele��el��eeboveinformnlioniamiree.lepreebcomptywilhellcryeMmumyoNinaiwee
end slele le elmmp io buildmg cmmrvaion eM Mreby emhorvs rov�ovemeiivm d IAc tlty Io antar upon ihe ebove�mmiioned propeM
����9, "� RIMB$ALY MILLER '
(StSt-�B.WP)
om.' `7 �
8 Selely: �reen-FAe: Cenary-RppYranq Pink-Revenue; OakemoE-beeevor
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO: M 075942 PLAN CHECK NO: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: MEC
l��il:� �l �[^L�i;f �� �il:l
CLAIM VALUE:
: CHANGE OUT F.A.0
CALC—VALUE:
PERM NO: M 07594
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
COMMENTS: NO 'H' PERMIT INVOLVED.
x*****x��*�*+r**�e�r******�**�r�+t*x**x�**�r�*��r*��e�rr*x�r***�*********+r***�*��r**�r*�r*�*�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FANT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ: PROV: PARCEL: 13910206 2NE: REF NO:
PLANNING NOTES>
i
iEifil'iE1l'1t1FM1h1I'1I'1hih1l'iI'1hil'i('If1('ifiEli'1E1E1EKiFiEil'ifii'iPiEiPi4i�'Ifih1l'iI'1I'M1Eih1('If if'IEI@1('lfihifiEi4i4ihiE1l'1I'II'iF1f1EiEKif iEiFiflhl('i('Ifih�FiP1f
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:
BUILDING APPROVED BY :
APPLICATION ISSUED 8Y: (/y
*�x*****��****�x�*�**��
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 925x
PLAN
ISSUE FEE 15.00
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK
TOTALS----> 9.00 15.00 0.00
DATE:
DATE:
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
24.00 24.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24.00 OVER/SHORT: 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24.00
If if k iE 1E 1E 1E IE 14 iE iE if iE iE 1E IE 1E 1E iE iE iE iE 1E IF iE iE 1E iE ik i! 1! iE I! 1E 1E 1E k 1E 1E 1E iE 1i if� if 1f iE 1k iF IE 1! 1E 1F IE 1E 1k i(� 1E IE 1E iE 1f iE IE 1E if if 1E M IE IE iE if 1h 1f iF 1! if'k 1E
I N D I V I D U A L F E E H 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
MEC 1 INST FORC—AIR/GRAV FURN <= 100 K HTU 9.00 9.00
END OF FEES
� . ,; -o -
� : _ .. 'i ' 1 . .._
CONSTRUCTION AND PLANNIN� �,(�L & SPA
APPROVALS Permit# Date Inspector .pppROVALS Permit# Date Inspe@tor
t. Temporary Electricai Service or Pole 52. Pool & Equipment Loca[ion _ '
Z. Soil Pipe-Undrgrnd. N 53. Steel fteinforcement �
. �c�, ,"%Efiectrical Condu6 �rifityUndrgmd. 54. Forms "
^��.-�Hectrical CondU�'tl+�rgrnd. 55. Electrical Bonding
�6,-?Ste�j Reintorcer�c,+S� 56. Rough Plumbing & Pressure TBst •
'� 6:, Efectriwl UFEFi�'ifnd. 57. APPROVAL TO COVER-GUNITE ;
�1 O �
T
_.'2',�r,'F�ootings r '- '� 58. Electrical Cond'uiCrtJndrgrnd. �
8. Foundation 1' •-. 59. Gas Pipe, O UnBtgcnd., Test '
� r �-,
%9. Water Pipe-UndfBmd, p 60. Backwash Lines,�J,.� 'rap, � Undrgrnd.
10. Structural Ploor'$yYtem , 61. APPROVALT(�DECK ,
Tt. Property Sewer line�i House�onnection 62. Backwash & Rece�'tor-Fi�al
12. �wer Cap � 63. Heater & Vent-Final :'i(�;, �q, f=.�%
�.
13. Roof Drains 64. Piumbing System � Final
74. Rough Plumbin�. �; 65. Electrical-Final .
15. flough ElectricalLoruiwt 66. Solar SYstem-Fi��
16. Rough Electricl�irin� ` � 67. Fencing & AccessApProval
77. Rough Wiring Sigtr i 68. APPROVED F�Ft'PLASTERING �
18. Rough Electricaf`i Bar Ceilincj�O 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � PIRE D�EPT.GEQUIREMENT
�
20. Eibu�+.F�sory;Fir�'�ace � � ';,^ '�' n � H �� ��APPF�VQ�-..,i�EPetmit#�_
21. D:ucts„in $truffiure=� : .'.. .% fi S C� �+ �� 70. tinder r�f«�h� Hpiro ,•
22. D�ycts=•Vnr'klil �N9`.# • �� �; �,� S H�' J7. Produ�F�ing d�as d0ii
23. (�s �ne•�buqj & Te`st :,j� i m �'; Cy � 72. Undergrd�7ntl FIusR �' �
- .�.
24. Roof`Fra��ng ^ �'� � � `% 1 C, �„� x, 7�� Undergrn8. Sto�7ank�0 Gas ❑ bil
25. Roof�he�hing .;� � , e�. � C7 7 ii �7qjOverhead Hydra7r x
t :-� d
26. T-BarCeiling (Structural) & fVGappY;pat � ., ; � �=' �? K 7'',��T Ory Chem{cal F,� .;� ;
'-�'+- �, a - v ._ . , i � �
27. ame an � Flashin _
�; �, �w >� x, 7. Dry Stand�ripe F�ro �.
-Q8. Lathing &"Siding � r =� �C� � " T_ ^ ",� 7 � FIXED S'jr�%TE�i4�21NAL. �
� w�.. �.... �n
"29. Insulatioq:, . e , �t 78i; FIRE PREV. FIN,�1L k= ��
��30. Drywall Nailing >,�*, y r 'w � " Hf�',ALTF�-0EP}.ftEQGIREMENT
- 31. Plaster Br6wn�Coat��:�; s i�. �, f� ; � 79: FINAL IN$pECT N = �
, . = ?-
�32. Electrical�PovJe1 MeleraF'�inal �"� . � l80."�FOOD CERTIFIC�F1'1"E I$`�S4J,EDH �
.33. F.inalFlect ic� ,� � �; ' �' � '`; �e =� �z .:
S v r? c, . � No s: -7 r•� .. .-. .. r
`�;34. Final�-leating&AirGvnditioning:_. 'i a � .r r., _ i"it.v. �x =, �c
'l T K � 1 < %�. +Q y'
35. F,inal�GasPi e�i�est „ ' "� � � " ' ,',. �-' .
P ,-• . s .-� j � � �:. � '.J �. G ..
-.36. Hoodbr CanoPY ' � ' T� -, ` C� � �k " Cio ' - i -. . ^�
r..� 'x � � - -
-`37. Fina� FaaorY FirePla��y. � .���„�; `_ � �� ! � „�� ' {_� _ ' -?
�
:.�38. Final,ftumbing � � r- �: � �v ! SK � 5 •v • : 'z -
�. te . � -
� 39. LVater Service•Pinal � ~ - ' ' �* ^ �" `� ':� " _
.E: sQ ;* .... t� _
:�40. Gas Service-Fin�l , ,� �;,�� � r � ; 'v� :�n e W s � .
k �' S`
:A1. Solar pomesticFinal '� • n ' ' ' . <o t
;-] A: 1 �e y� G T, -
�42. Backfiow Preventer ,�'J - * "' � ,s r. ;iF '�
- �+ i F
43. Backflow Irrigation � � ��5 r S '„ � - ;.: � . �
4A. Landscape�lnipation�ystem ��-j � , _ ^ f. s�o T ��.� -
45. �und Attenubtion '' '� �- . x •._ -� ;. f ' .-� r �-G,
� .. 1: -r n. .*.'• C � F .. �
� � � �.; � . . .
48. Handicap�E�egulations, p t i.; - � ��c, ^ �
� ^� k
> � 1 � � � �
47. F.lNFCL STFUC.rUR�& BUILDING y, � � � �_ �,
48. PINAL• PLANNING ~ . �' ' . :v ' ' � .` . -
. �
49. EteMcie Release to Edison r : G: , '
- e . �.
5�. Gas Release to 5outhAm CalitorniaGas Co • ' '� .� t- •
5T. CERT-IFICATE OF O.CCUPANC4-' _-- i, �,r. , .
No. Date
OwNER Vermont Ave. Land Co., Inc. DATE 6�21/60
JOB ADDRFSS 322 IOwa St. BUILDING PERMIT N0. 12399
AP. No.
DATE
�e
OCCUPANCY
Form 210—SM-11-59 5•B P
SUBCONTRACTOR
�0
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applicanf fo Ffll In Comple+ely
TYPE OR PRINT
ADD e�s"s 22 Iorra St.
COSTA MESA. GALIFORP1fA
� MAIL
� SIZE
E, 17th
T��P S.a
T'� SnTI 8[
.`3
TEL.
NO.
TEL.
FEE RECEIVED
� FINANCE�DEPT.
CiTY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
HECEIPT NO. P6HMIT NO.
7 ?:�q4
xecerveo er � owre necerveo I DATE iesuso
FIRE
ZONE
APPROVED
COSTA MESA. CALIFORNIA
th st. ZONING
20 I NO. OP � I U8E OF �
PLAN6 BUILDINO
TEL. LEGAL
No. L' B— o��w�„�oH Lot 135. Tr. `
NO, OP 8tDG6.
LINB PPOM
rF ernser �� REAR YARD �� i
R� ( LEFT S� I RIGHT S�
DESCRIPTION OF WORK
�yy
EXTERIOR WALL
COVERING
US8 OF BUILOING
YARDS
APPROVEO
ICENT6R LINE 9T.)
APPROVED
D /
�
� HEPEBY ACKNOWLEDGE TXAT � NAVE HCAD THIB APPYGTION qH6 AMOUNT BHOWN IINOER VALUATION IB FOP THE
ANO BTATE THAT THE ABOVE IB GORflECT AND A6ME6 TO CAM- pUPP098 OP 89TAB�IBHING � PERMIT FH¢ ONLY.
PLY WITH ALL QTY ORDINANCEB PNO BTATE LAW9 REpULATNO
9u�Lo1No CONBTfiUGT10N. VALUATION
61GNATURE OF � PERMIT FEE $ '3�j.
PERMITTE rf
$ Z6�ZO1• PLAN CHECK $ 10•
AUTHORIZED AGENT ��C2 & C egrove� IRC•
TOTAL FEE
Z
0
4