HomeMy WebLinkAbout2864 INROZ DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2864 INROZ DR
Suite:
Vicinity: 1ST AND 2ND FLOOR TO AN EXISTING SFD
Parcel Number: 13944407
Applicant: KERCE, DONALD M
Address: 2864 INROZ DR
COSTA MESA, CA
Owner: KERCE, DONALD M
Address 28641NROZ DR
COSTA MESA, CA
Contractor:
Address:
Zip:
Arch :
Address:
Phone:
Zoning: R1 R1
Phone: 774-979-4543
Zip: 9262&3528
Phone:
Zip: 9262G3528
Phone:
License:
Slatus: ISSUED
Applied: 07/26/2002
Issued: 10/03/2002
ISSUED BY: �
Eng: L P LEAVITT AND ASSOCIATES
Address: 9724 BLANDWOOD ST
Phone: 562-862-7291
DOWNEY,CA
Zip: License: 90240 license: C71792
SCOPE OF PERMIT
CONSTRUCT A 467 SF ADDITION TO AN EXISTING 2-STORY SFD. 245SF TO THE 1ST STORY LIVING AND DINING ROOMS AND 222SF TO
THE 2ND STORY BEDROOMS. NO NEW BEDROOMS/BATHROOMS ONLY EXPANSION OF EXISTING.
40% OPEN SPACE REQ.; 66% PROVIDED. "
REF: ZA-02-56 (HOLD HARMLESS LETTER ON FILE).
Plan Check: $366.24
Permit: $563.45
SMIP Res: $4.12
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $933.81
SETBACKS
MAIN STRUCTURE Fronl 25- 0
ACCESSORY Front 0-0
FEE SUMMARY
Calc Valuation: Sai,2ii.00
Claim Valuation: so.00
PLANNING & ZONING
Rear 37- 0 Left 5- 0 Right
Rear 0- 0 Left 0- 0 Right
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work mus� comply with all applicable codes, and all
requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit.
FOR INSPECTIONS CA6L: (714) 7545626
24464616'W)
WORKERS' COMPENSATION DECLAAATION: � � � �
I hereby eXirm under penelry of Derjury One of ihe following tlaclara�ions: ^'
❑ I heve end will meinteln e certificale of consent to seli-Insure for workers' compensation, es pmvided for by sectlon 3700 ot Ihe Lebor CoOe, for the pertormance of Ihe
work for w�ich this pertnit Is issued.
❑ I have and will maintaln workers' compensallon insurence, es requiretl by section 3700 0l Ihe Lebor Cotle, for Ihe perfortnance of tha work fo� which this permit is Issued.
My workers' Cmp�nsetippinsurance rrier entl policy number ere: �
Carrier. /� V Policy Number:
(Th/s sectlon nee�d n� e`f.romp ef it fP ermit is veluetl af one hundred dolleis ($ I00) or /ess.)
�/I cenity t�et in t�e pertormence at ��e work tor which t is pertnit is Issued, I shell not employ eny person in eny menner so es to become subject b the workere'
�( compensetion laws ol Celltomia, e�d egrea lhet if I uld eEome subject to the workers' compensation provisions ol Sey�llion 377700 0l Ihe Lebor Code, I shall torthwith
comply with thes .e prSZyjsion � 0��� ,1^
AppliwmSignaWre: Data: U %'--
WARNINO: FAILURE TO RE W Blb PEf�I AT1IXJ CC EMGE IS UNLAWFUL AND SHr1L� SUBIECT AN EMPLOVER TO CRINJNAL PE TIES AND GVIL FlNES UP TOONE HUNDRED
TMOUSAND DOLUR , , IN � fiiON TO T1jE COST PENSATION, DAMAGES AS PROVIDED F-0R IN SEC710N 3lOfi OF iME IPBOR C�DE, IMEREST, PND ATTOPNEY'S FEES.
LICENSEO CONTRACTORS DECLARAnON:
I hereby affirtn that I am licensed untler p�ovisions ot Chapter 9(commencing with Section 7000) ot DiNsion 3 0l the Busineu and Professions Code, and my license is in full
force and effect. Lic. q Cless a
GONractofs Slgnature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eNirtn Iha� �here is e cons/Nction lentling agency for ihe peAormance of ��e work for which ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lentler's Neme: Lenders Address:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
1 hereby aMlrtn that untler penalry of perjury ihat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such permit
to file a signetl stelement lhat he or she Is Ilcensetl pursuant to tha provisions ot the Conlractors license lsw (Ghapter 9(commencing with Secllon 7000) ot D{vislon 3 ot lha
Business and Professions Code) or that he or she is exempt therefrom and the basis for the elleged exemption. Any violation oi Sectlon �031.5 by any epplicant for e pertnit
su�jecis �he epplicent to e civil penelty ot not more than five hundratl tlollars ($500).):
❑ I, as owner of Iha property, or my pmployees with weges es thelr sole compensation, WILL DO TME WORK, entl ihe siructura is not intentletl or ottered fo� sale (Sec.
7044, Business and Pmfessions Code: The Contrac�ors License Law does no� aDPly �o an owner of property who builtls or improves ihereon, entl who tloes such work
himself or harsetl or Ihrough his or �er own employees, proNdatl that such impmvements ere not Intended or oHerad tor sale. If. however, the 6uilGing or improvement I5
d within one year ol com0letion, tha owner-builder will have �he burdan of proving t�et he or she did not builtl or improve lor purpose of sale.).
I, as owner at Ihe properry, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Professions
Code: ThB conlreciors License LaW tloes noI ep to an owner ol property who builds or Impraves Ihereon, Bnd who contracts for 5uch projecl with e conireCtor(s)
license pursuant to the Contrector8 ' ense s.).
❑ 1 m exempt under se Business and Prolessions Cotle for �his reason:
Siqnature: Date:
Owner I nti c V ❑ No Ddvers License No./ �� E:pires: � 2i36S
ot Ownership by,ffype oi tlocument, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PHAMR CERTIiICATiON:
❑ I hereDy certify Ihet na excevetion O�e (5) or more teet in depth into w�ich e person is required to tlescentl, will De made In connection with work authonzed by Ihis
permit, and Nat no �uiltling struclure, scattolding, talsework, or tlemolition or dismantling thereof, will he moca than thiM1y-slx (36) teal high. (Chap. 32, Gry 2, Art 2, Sac.
341, Title 8, Celifomia Administrati�e Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from ihe Division of Intlustrial Sefery, es notetl aDova, unleu such person �es a
pertnil ta tlo such work from ihe division.
Siqnaturo: Date:
Division oi Intlustrial Sefery Permit Numbar.
CERTIFlCATE OF COMPLIANCE AND AIJiMORVA pN OF ENTf�L� I certity undar penalry of perjury Ihel I heve read ihis ep0lication and state Ihat ihe inlormation given is
correct.-7�-egrae'fi'cortrytywN state iaws en it" o' an�relating to huiltllnq consiNction, end euthodze representatives of the Ciry ot Costa Mesa to enter upon the
ebove-descnbed pro rty tor ins e' e. egree no� �o occuDY or allow occupancy ol any building euthonzed by this e it u il tinel inspection.
��Qa--
u e eg Owner(s) T Date
MOE �. INSPECTIONTYPE PAI€ LUID9L5
1618 Fl:etl System Final Fire Prevenlion
1268
200
201
202
203
Pool Spe Final
Final Re-Root
Final BIocWRetaining Well
Final Factory Fire Placa
Final Sign
204 Final Demoli�ion
COUE 1 INSPECTION TYPE
206 Final MeUanical
208 Final Plumbing
210 Final Electrical
212 Finel Fire Prevention
220 Final Plenning Approval
222 Final Slte
250 Final Building/OCcupenty
Q� II{iO�LS
e
L'� � C'� ��eda sc�r�'d� Duri�ioc�
OWNER-B[,IILDER
VERIF[CATION
A city or county, which is reyuired 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 retum of, an
owner-builder venfication.
Attention Property Owner.
An 'owner-builder' building permit has been applicd for in your name and bearing your signamre.
Please complete and return this information in the envelope provided at your earliest opportuniry to avoid
unnecessary delay in processing and issuing your building permit. No buildingpertnit will be issued un[il [his
venfication is received.
1. 1 personally plan to provide [he maj abor and materials for construction of the proposed
property improvemen[ Yes No
2. 1(have/have not) signed an application for a building permit for
the proposed work.
3. 1 have contracted with [he following person (firm) to provide the proposed construc[ion:
Name
Address City _
Phone ( ) Contractor's Lic. No.
4. I plan [u provide portions of the work, but I have hired lhe following person [o coordinate,
supervise und provide the major work:
Name
Address
Phone (
City _
Contractor's Lic. No.
5. I will provide some of the work but 1 6ave conVacted (hired) the following persons ro
provide the work indicated:
Name Address Phone Type of Work
I OE2a6 (REV. 9/98�
I hereby affirtn tha[ 1 have received a copy of the infortnation set forth in Secdon 19830 of the State
of Califomia Health and Safety Code'and have completed [he above information to [he best of my personal
knowledge, in compliance with this S[ate law.
Signed:
Name: �-
(Printed or Typed)
C.D.L. # OR S.S. # �� � [,��
Date: � ✓ �
For more information call City of Costa Mesa Building Division at (714) 754-5273.
1M2J8 (REV.BNB)
J
Qwining
,r,Itaborat�es
Isou�v[wxc�ur nqulc.
"One Tesi /a Worth n Tnousand Expart Opiniona"
TESTIN6•lNS��CTlON•ENO(N6ER/NG
ticn•ires l�r O��er J00 Yenrs
April 14, 2003
CLIENT: DON KERCE
2864 INROZ AVENUE
COSTA MESA, CA 92626
PROJECT: SIDENCE — KERCE
(2864_INROZ DRIV�7
COSTA MESA, C
INSPECT[ON PERFORMED:
To Whom It May Concern:
Job No.: 30402007
Permit No.: 01156
� ���� �
� � �� ���
Attached is the report of Inspection perforcned in the field for the above-mentioned project, by the Inspector on
the date of: , c /
John F. Regan Apri104, 2003 �
��-�� � � C� �
Report #041564 «
Respectfully submitted,
TWINING LABORATORIES OF SOUTHERN CALIFORNIA, INC.
���-�,�:�;�
ohn M. Verrocchi, Sr.
Distribution List:
DON KERCE
CITY OF COSTA MESA DEPT BLDG & SAFETY
1
1
ALL BLPORTS REMAIN THE PROPERTY Of T WINING UBORATORIE$ OF SOUTNERN CAWFOILYIA, INC. AUTHORIZATION FOA PUBLIGTIOY OF OUR REPORTS, CONC WSIONS, OR EMRACTS
FROM OR 0.EGARDING iHEM IS RESERVED PE\�ING OUR WRITTEH APPROVqL p$ A NUTUAL PROTECT10� TO CLIEYTS, THE PUBLIC, AND OURSELVES.
ron� Tof b Werth � i/�ouulW Hip�M Opinlrnl°
Cwpant� amc�� 3310 Ai�porl Wey. Lonp BeacR CA 90000 . Plme: (582) a2B-3355 • Fu: (�) ��24
Mrq. Ca.My: 5892 ECuqer Ave., Suila 113, P.M.B. 313, Munibipton Baaqi, CA 926C9 • PMne: (ltd) 988�pB,'10 • Fev: �/11) B60.0gQp
Mn olpa� 9235 C�esapaeke UrHe, Suile U. Sen Dlapo, CA 92121 - Pha�e: (058� 91431W • Fex: (BSB) 8)4�3�52
Ib Fpual Oppertunify EmploY�r
1 ' ,�� Twining .
��,�����1 Labor�torie �
CONCRETE/MASONRY
Testing & Inspection Report
TEST/NG
"One Testis Worth a 7housand Expert Opinions"
041564
�SPECTlON � ENG/NEER/NG
Servicesfor Over 700 Years
Corporate Office:
3310 Airport Way
Long Beach, CA. 90806
Ph: (562)426-3355
Fax:(562) 426-6424
www.twininglabs.com
INSPECTOR COOR�GA J JOB NUMBER � DATE � _ O z M T W T W S S
_� i�
JOB NAME ��/ ��S I DENCc BUILDINGQOSH'PD P.ERMIT k/ OSA�APP N DSA�FILE Y
L� C� S
AODRESS � GENEPALCONTFACTOR JUFISDICTION
��`/ �2oZ .1��_ CGZ57'AMESA � 13 cosrar,EsA
ARCHITECT ENG W EER SUBCONTRACTOR (II Any)
TAHES N� ?oMO
RECUIREMENTS: Limit of one job number, one pertnit numher per sheet. Identity all work by type and SPECIFIC location, Non-compliant work must be
specifically identified. Communication (RFI, Sketch, etc.) voiding previous norncompliant items must be listed, rewrd conversations antl communications
with omiect desianers, buildinq and permit qrantinq authoriN oHicials.
HOURS
REGULAR 1.5% 2X TIME W TIME OUT
Lf -�- -�- 8� oo. 12� o0
� Mileage
� Reinforcement �Concrete Placement
� Fireproofing �Quality Control—
DR�[.ccA
�
cPoxy
�aND 7=
S�T 2;
00 T/NG
MIX USED
DESIGN SLUMP
�Additional Page (Page �) CM
� Expenses
� Masonry —
�Administration
'`xYl2 " yo�cs
ri oF �-2 = 5/8 "X
„ TNR�ADcTD RoA�
� �A ) DA 7t / 2/o .� -
AOMIXTURE
Certification of Compliance
I declare under penairy of perjury that all of the above statements are true,
and that oi my own personal knowledge ihe work tluring the periotl coveretl
by fhis report has Oeen periormed antl installed in compliance with ihe
approvetl plans, specifications and ali
applicable cotles.
Inspector Name � � „ 'f- �G�
Inspector's Signature -
Inspector IDs � 6c='� /O/O C,dO /�,Z(o 3.s'%
� Prestress Post Ten— Q Batch Plant —
�'other E�OX Y
TE' ^�%- ' '�� �=-��r
x� � _-�'"
JD /"X /2"f/OLFS,
D" 7'H R
E�ox >
Pc�1 Cc,
OESIGN PSI
REPORT
U.S�,D S/r� PSD.c1
�7 OF TH/�A�
CUBIC YARDS � SPECIMENS
� Contains
NornCompliaM Items
� Does Not Contain
All inspections based on a minimum of 4 hours and over 4 hours - 8 hours minimum.
In adtlition, any inspection extending past noon will be an B hour minimum.
If inspector is calletl to a pmjea antl no work is peAormed, a 2 hour minimum
charge will be applied.
Approved/Authorized by � C
(Project Superintendent)
Submitted byl������'��6�'El�
Twining La6oratories of Sou ern California, Inc.
CI IRI�AIT T!1 TWININ/.
!
September 5, 2002
CITY OF COSTA MESA
P.O. BOX 7200 • 77 FAIR DRIVE • CALIFORNIA 92828-1200
DEVELOPMEN7 SERVICES DEPAR7MENT
Donald and Janet Kerce
2864 Inroz Drive
Costa Mesa, CA 92626
RE: MINOR DESIGN REVIEW ZA-02-56
2864 INROZ DRIVE, COSTA MESA
Dear Mr. And Mrs. Kerce:
The minor design review for the above-referenced project has been completed. The
application has been approved, based on the following project description and
findings, subject to the conditions set forth below:
PROJECT DESCRIPTION
The applicant is proposing to construct a one- and two-story, 462 square-foot
addition on the rear of an existing two-story, 2,1 36 square-foot, single-family
residence. The addition consists of a six foot extension of an existing living room
and den on the first floor, and two bedrooms with two new walk-in closetsl on the
second floor. No other changes are proposed.
The homes surrounding the subject property are two story. There will be no
privacy conCerns relative to second floor windows on adjacent properties due to the
following: (1) the existing two story residence has a 43 foot setback from the rear
property line; (2) the existing second floor bedrooms have windows on the rear of
the residence, which will only extend six feet closer to the rear of the property, (3)
there is existing, dense landscaping (trees) at the rear of the site which increases
the privacy of the adjacent yards.
The intent of the minor design review process is to ensure that scale and massing
of proposed second-story construction is compatible with the neighborhood as well
as the existing design for the residence. The addition has been designed to be
physically and architecturally compatible with the existing residence.
FINDINGS
A. The information presented substantially complies with Costa Mesa Municipal
Code Section 13-291g)12) in that the proposed project will not be detrimental to
the health, safety, and general welfare of the public or other properties or
Builtling Division (714) 75a-5273 • CoCa Enlorcement (774) 7545623 • Plannirg Division (71a) 756-52a5
FAX (774) 754-aB56 • TDD (774) 754-52d4 • www.ci.cos�a-mese.ca.us
ZA-02-56 • � �
September 5, 2002
Page 2
improvements within the immediate vicinity. The recommended conditions of
approval will ensure that the construction will not be materially detrimental to
the health, safety and generaf welfare of the public or otherwise injurious to
property or improvements within the immediate neighborhood. Granting the
minor design review will not allow a use, density or intensity that is not in
accordance with the general plan designation for the property.
B. The proposed project complies with Costa Mesa Municipal Code Section 13-
29(e) because:
. The proposed development and use is compatible and harmonious with
uses on surrounding properties.
• Safety and compatibility of the design of the buildings, landscaping,
and other site features including functional aspects of the site
development such as automobile and pedestrian circulation have been
considered.
. The project is consistent with the General Plan.
. The planning application is for a project-specific case and does not
estabfish a precedent for future development.
C. The project has been reviewed for compliance with the California
Environmental Quality Act (CEQA), the CEQA Guidelines, and the City
environmental procedures, and has been found to be exempt from CEQA.
D. The project is exempt from Chapter XII, Article 3, Transportation System
Management, of Title 13 of the Costa Mesa Municipal Code.
CONDITIONS OF APPROVAL
Ping. 1. Street addresses shall be displayed on the fascia adjacent to the
main entrance or front door in a manner visible from the public
street. Numerals shall be a minimum 4 inches in height with not less
than %z-inch stroke and shall contrast sharply with the background.
2. The conditions of approval for ZA-02-56 shali be blueprinted on the
face of the site plan as part of the pian check submittal package.
3. The applicant shall contact the Planning Division to arrange for a
planning inspection of the site prior to the release of
occupancy/utilities. This inspection is to confirm that the conditions
of approval and code requirements have been satisfied.
4. Existing mature vegetation shali be retained wherever possible.
Should it be necessary to remove existing trees, the applicant shall
submit a written request and justification to the Planning Division. A
report from a California licensed arborist may be required as part of
the justification. Replacement trees shall be of a size consistent
with trees to be removed, and shall be replaced on a 2-to-1 basis.
� . ,
ZA-02-56
September 5, 2002
Page 3
Eng
This condition shall be completed under the direction of the Planning
Division.
5. New and exisiing construction shall be architecturally compatible
with regard to building materials, style, colors, etc.
6. Maintain the public right-of-way in a"wet-down" condition to
prevent excessive dust and remove any spillage from the public
right-of-way by sweeping or sprinkling.
CODE REQUIREMENTS
The following list of federal, state and local laws applicable to the project has been
compiled by staff for the developer's reference. Any reference to "City" pertains to
the City of Costa Mesa.
Ping. 1
2
3
4
5
: ..
Eng.
0
7
:
Ali contractors and subcontractors must have valid business
licenses to do business in the City of Costa Mesa. Final
inspections, final occupancy and utility releases will not be granted
until all such licenses have been obtained.
Approval of the zoning action is valid for one (1) year and will
expire at the end of that period unless building permits are obtained
and business commences or the applicant applies for and is granted
an extension of time.
Development shall comply with all requirements of Section 13-32,
Title 13, of the Costa Mesa Municipal Code relating to development
standards for residential projects.
All new on-site utility services shall be installed underground.
Any mechanical equipment such as air-conditioning equipment and
duct work shall be screened from view in a manner approved by the
Planning Division.
Comply with the requirements of the Uniiorm Building Code as to
design and construction.
Construction, grading, materials delivery, equipment operation or
other noise-generating activity shall be limited to between the hours
of 7 a.m. and 8 p.m., Monday through Friday, and between the
hours of 8 a.m. and 7 p.m., on Saturday, Sunday, and Federal
holidays. Exceptions may be made for activities that will not
generate noise audible from off site, such as painting and other
quiet interior work. ' �
At the time of development submit for approval an off-site plan to
and grading plan to the Building Division that shows sewer, water,
existing parkway improvements and the limits of work on the site,
prepared by a civil engineer or architect. Construction access
approval must be obtained prior to building or engineering permits
being issued by the City of Costa Mesa. Pay off-site plan check fee
to the Engineering Division. An approved offsite plan and fee shall
ZA•02-56 ' f �
September 5, 2002
Page 4
be required prior to engineering/utility permits being issued by the
City.
9. A construction access permit and deposit of 5350 for street
sweeping will be required by the Engineering Division prior to the
start of any on- or off-site work.
Fire 10. Provide approved smoke detector(s) to be installed in accordance
with the 1997 Edition of the Uniform Fire Code.
SPECIAL DISTRICT REQUIREMENTS
The requirement of the following special districts are hereby forwarded to the
applicant:
Sani. 1. Developer shall contact the Costa Mesa Sanitary District at (949) 631-
1731 for current district requirements.
School 2. Pay applicable Newport Mesa Unified School District fees to the
Building Division prior to issuance of building permits.
State 3. Comply with the requirements of the California Department of Food
and Agriculture (CDFA) to determine if red imported fire ants (RIFA)
exist on the property prior to any soil movement or excavation. Call
CDFA at (714) 708-1910 for information.
Upon receipt of this letter, your project has been approved, subject to the above-
listed conditions. A copy of the conceptually-approved plans is enclosed. The
decision will become final at 5 p.m. on September 1 2, 2002, unless appealed by an
affected party or by a member of the Planning Commission or City Council.
If you have any questions regarding this letter, please feel free to contact the
project planner, Mel Lee, at (714) 754-5611, between 1 p.m. and 5 p.m., Monday
through Friday.
Sincerely,
� �v `"
PERRY . VALANTINE
Zoning Administrator
Enclosure: Conceptually-approved plans
cc: Engineering
Fire Protection Analyst
Water District
Building Division
:
PLANNING APPLICATION SUMMARY
Location: 2864 Inroz Drive Application: ZA-02-56
Request: 2n° story addition to existing single family residence
SUBJECT PROPERTV: SURROUNDING PROPERTY:
Zone: Rt - North: Surrounding pmperties are zoned residential
General Plan: Low Density Residential Souch: And improved with residential uses.
lot Dimensions: 70 FTx1100 FT East:
lot Area: 7,000 Sf West:
Existing DeveloDment: 2 story single family home
DEVELOPMENT STANDARD COMPARISON
Develooment Standard Reauired/Allowed Pr000sedlProvided
CEQP. 5[atus Exempi. Class 3
Final Action Zoning Administrator
(714) 754•5273 • Fax (774) 754-4856 • wviw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suile No
Viciniry:
Parcel Nunmber:
Applicant:
Address:
Owner:
2864 INROZ DR
13944407
KERCE, DONALD M
2864 INROZ DR
COSTA MESA, CA
KERCE, DONALD M
Address 2864 INROZ DR
COSTA MESA, CA
Contractor: O W N ER-B U I LD ER
Address:
ISSUE FEE
7emp service lesl
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool I Spa
Lighting Fixts
Recept Oullets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
MotorS to 1hp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
ELECTRICAL PERMIT
ISSUED BY:
Phone: 714-979-4543
Zip: 926263528
Phone:
Zip: 926263528
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 04I16I2003
Issued: 04116/2003
SCOPE OF PERMIT
ELEC PERMIT IN CONJUNCTION WITH CONSTRUCTION OF A 467 SF ADDITION TO AN EXISTING
2-STORY SFD. 6 LIGHT FIXTURES (INCLUDING 2 CEILING FANS). 8 OUTLETS, 4 SWITCHES, 1
SERVICE TO 200A.
REF: B02-01156
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$6.60
$8.80
$4.40
50.00
ao.00
$30.50
50.00
50.00
$0.00
$0.00
so.00
$0.00
$0.00
ao.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Buswaylt00ft
Standing Section
Misc Electrical Equipment
Transtormers up to 1 kva/kw
................uP to 10 kvalkw
.................up to 50 kva/kw
.................up l0 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conducior
Circus ( gen or ride)
Circus (mech ride or lights)
Chnstmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigafion Fee
�uantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
so.00
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1. 7247-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wlthin 180 days, or it work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all
required Inspectione and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
24a&a8�6tl0)
WOAKERS'COMPENSAnON DECLAFiAnON:
I hereDy attirtn under penalry ot perjury one of tha tollowing declarations:
❑ I have and will main�ain a cenificate of consent to selt-Insure tor workers' compensation, es provided tor by section 3700 of the Labor Code, for t�e peAortnance ot the
woAc lor which NIs permit I5 Issued.
❑ I have and will maint n workers' compensation insurance, as raquired by sectlon 370� ol the Labor Code, lor ihe peAortnance of ihe work for which ihis pertnit is lswetl.
My workers' compe tlon Insurance carrier anA pdicy number are:
Cartier: Pdity Number:
(This sectlon nee0 nof be �Pleted i/ the permil ls va/ued at one huntlred CW/ers ($100) or Iess.J
{] � I ceMity 1h81 in the pBrfortnence of ihe woAc for whiCh Ihls permit fs issuad, 1 shell not employ any pereon In eny manner so as �0 68fAme suhjecl �o Ihe worker9'
iompensatlon laws ol Galifomia, and egree Ihat il should Eecome subjed m t�e workers' compensatlon pmvislons of Sectlon 3700 oi tha Le6or CoCe, I ahell tort�with
comply with �hese p�ovisions. /� 2
Applicant Signeture� Date: � /C%—� >
WFRNING: FAILURE T NSATION COVERAGE IS UMAWFUL AND SHAl1 SUBJECT AN EMPLOYER TO CRIMINAL PEWILTIES M10 CML FlNES UP TOONE HUNORED
hKKl$4ND DOLLARE (5100,000�.IN ADpTION TQ ' WST OF COMPENSI�TION, DAMAGES AS PqWIDED FOR IN SEGTON 3106OF THE UBOR COOE, �MEREST, AND ATTORNEYS FEES.
LICENSEU CONTRACTORS DECLARATION:
I hereby aXirm Ihat I em li�ensed under provisions of C�eptar 9(cammencing wlih Section 7000) of Dlvision 3 of Ihe Business entl Professions Code, end my license is In tull
fOfCB 8ntl BfleCi. LI0. M CI855 M
Coniractofs SignaWre: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hereDy ettirtn that there is e wnsW ction lending agency tor the peAortnanca of the work br which Ihis Dermit is issued. (Sec. 3097. Civil Code).
Lenders Nema: Lentler's Adtlress:
Signature: Date:
OWNER•BUILDER DECW7ATIONS: -
I hereby aflirm that under penalry of pe�ury that 1 em EXEMPT FROM THE CONTflACTORS LICENSE LAW }or �he lollowing reason (Sec. 7031.5, Buslness anA Profession5
Cotle: Any ciry or wunry Whic� requires e Dermit lo consiruct, elter, improve, demalish, or repair eny strucmre, prior to its iuuenca, also requires the applicant tor such permit
to file e signed statement that he or sha is Ilcensed pursuant to ihe provisions of the Contraaors LJcense Lew (Chapter 9(commendng with Seclion 7000) of Dlvision 3 oi the
Business end Prote55ionS Code) or that he or she is ezempt iherelrwn entl the basis lor the ellegetl e:emption. Any Noletion of Section 7031.5 by any applicant tor a pertnit
subjects the appliwnt m a�� Venalry of not more than frve hunAred dollars (5500).):
❑ I, es owner oi the D�aPertY• or my empioyees with wages as Nelr sole compensatlon, WILL DO 7HE WORK, antl �he sW cture Is not imenaetl or ofleretl tor sala (Sec.
7044, Businass and Pmfessions Code: The Contractors licensa Lew does noi apply to an owner ot Omperty who Duilds or improve5 lhereon, and who does such work
�imself or herselt or �hrough his or her own employees, provitletl Ihat such improvemenis are not in�ended or oHeretl tor sala. Ii, however, the Duilding or improvement is
sole wit�in one year ot wmpletion, the owner-builder will �ave ihe burden of proving Ihat he or she tlid not build or improve lar purpose ol sele.). �
as owner oi the properry, am EXCLUSIVELV CONTRACTING WIiN UCENSED CONTRACTORS to wnstruct the pmject (SecJ044, Business entl Professions
Code: The contraaa�s License Law tloes not appty to an owner al pmperry who builtls or imprwes Ihereon, end who contracts for such project with a conirectar(s)
licen5e Dur5uanl to ihe Con�rattor5 Licer�5e Laws.�
❑ I�_m
Signature:
Ownerl0�
Busineu and Professions Code for this reason:
�/-��w��3
Date:
s ❑ No Drivefs License No.
i.e. - property ta< blll or tleed):
DIVISION OF INDUSTRIA�- SAFETY PERMIT CERTIFICATION:
Expires:
� I hereby cenify that no excava�ion fve (5) or more feet in depth into which e person is required to descend, will be matle In connection with work authorfze0 by Ihis
pertnil, and that no building siruciure, scaHdding, lalsewo�k. or tlemolition or dismantling �hereat, will be more then thiny-six (36) feet �igh. (C�ap. 32, Grp 2, Art 2, Sec.
341, Title B, Celifomia Administrative Coda).
❑ As owner�builder, I w��l not employ anyone to tlo work which would require e Oermit Irom the Divislon of Industrial Satery, es notetl ebove, unless such person hes a
pertnit to do such w0�k hom the division.
Signature: Date:
Division of Industnal Safery Permit Number.
CERTIFlCA7E OF COMPUANCE AND AUTHORIZATON OF EMAY: I certity untler penalry ot perjury that I have read this ap0lication entl state that Ihe infortnetion given is
correct. I egree to com I wim an �e��o �� � a� ' an elatfift`o �ulltling wnsWction, end authodze representatives ot Ihe Gity ol Costa Mesa to enter upon the
above- � propeny tor in � n purpos ot to ot any huilding authonzed by this /pe/rtnit until linel inspection.
_ H•'/�Ci -1 dC) 3
ure O e I Owner(s1 � � Dele
COOE �. INSPECTION TYPE
1616 Fized System Final Fire Prevenllon
1266
200
201
202
203
20d
Paol Spa Finel
Final Re-Roof
Finel Block/Retain��9 Well
Final Fectory Fire Place
Finel Sign
Final DemollUon
Q� �$ ��( INSPECTIONTYPE �
206 Finel Mechanical
20B Finel Plumbing
210 Flnel Elecidcal
212 Finel Fire Preventlon
220 Finel Plenning Approval
222 Flnel Site
250 Finel Bullding/Occupency
,1%� � ''R"
(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2864 INROZ DR
Suite No
Vicinity:
Parcel Nunmber: 13944407
Applicant: KERCE, DONALD M
Address: 28641NROZ DR
COSTA MESA, CA
Owner. KERCE, DONALD M
Address 28641NROZ DR
Contractor:
Address:
Arch / Eng :
Address:
ISSUE FEE
BackFlow irrigation
Backflow Preventer
Bathtub
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwaler
COSTA MESA, CA
PLUMBING PERMIT
Phone:
Zip: 92626-3528
Phone:
Zip: 926263528
Phone:
Zip:
License:
Phone:
Zip:
License:
ISSUED
Status: ISSUED
Applied: 04/07/2004
Issued: 04/07I2004
SCOPE OF PERMIT
REF: 802-01156; CONSTRUCT A 467 SF ADDITION TO AN EXISTING 2-STORY SFD. 245SF TO THE
1ST STORY LIVING AND DINING ROOMS AND 222SF TO THE 2ND STORY BEDROOMS. NO NEW
BEDROOMS/BATHROOMS ONLY EXPANSION OF EXISTING.
PLUMB. PERMIT FOR REPLACEMENT OF TOILET 8 SINK IN EXISTING BATHROOM.
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
laundry Tub / Washer ' $0.00
0 Landscape Irrigation $0.00
0 P-Trap $0.00
0� , Pressure Regulator $0.00
0 Process Piping (per 10 ft) $0.00
0 Receptors 50.00
0 Sep[ic Tank . $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Connect $0.00
0 Sewer Private Line $0.00
�TY
0
0
0
0
0
0
0
0
0
0
SumpPump
Swimming Pool ,
Trap Primer '
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$9.80
�TY
0
0
0
0
0
0
1
0
0
t
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced vnthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
24a6d6 (NW)
WORKERS' COMPENSA710N DECLARA710N: '
I hereby aflirm undar penalty of perjury one of the tollowing declarations:
❑ I heve and will maintain e ceniFiwte of consent to selbinsure tor workers' campensation, es provided lor by section 3700 of the Lebor Code, for the paAartnance of ihe
work for which,this permit is Issued.
� I have antl will maintain workers' compensation Insurance, es requiretl by section 3700 of the Lebor CoOe, for the pedortnance of Ihe work for which this permit is issued.
My worke�s' compe?satlon Insurance cerrier end policy number ere:
�,
Carrier: � Policy Number:
(This secfion need nat be campletetl i/ the permit is velued af one hundred tlollers ($100J or less.)
❑ I certify ihat in ihe peAortnance of the work for which this pertnit Is issued, I shall not amploy any person in eny manner so es to �ecome subject to the workers'
compensation laws af Calitornla, and egree thet II I shoultl become sub�ect to the workers' compensetlon provisions of Sectlon 3700 af the Lebor Code, I shall forihwith
comply with these provisions. �
Applicant Signature: Date:
WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DIXLARE (5100,000), IN ADOITIqJ TO THE COST OF COMPENSA710N, OAMAGES AS PROVIDED FOR IN SECTIqJ 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CON7RACTORS DECLARATION:
I hereby ettirm Ihat I em licensetl under provisions of Chapter 9(commencinp wtlh Sedlon 7000) of Divislon 3 of iha Business and Professions Code, entl my license Is in full
force antl eNecL Lic. N Class N
Contrectors Signeture: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn Ihat Ihera is e construction lending agency for �he peAormence ot the work for which Ihis permlt is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lende✓s Adtlress:
SignaNre: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm that under penelry ot perjury Ihet I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW lor the following reason (Sec. 7031.5, Business entl Protessions
Cotle: Any ciry or county which requires e permit to construct, elter, Improve, demolish, or repelr eny structure, pdor ro Its Issuenco, elso requires the epplicent far such permit
to tile a signetl stetemem t�et he or she is Ilcensetl pursuent to �he DroNsions ot ihe Contractors LJcense Lew (Chepter 9(wmmencing wlth Sectlon 7000) of Dlvislon 3 ot Ihe
Busine55 end Prolessi0n5 Code) or Ihet hB Or she is e:empt therelrom end the �asis lor the elleged ecemption. Any violetion of Section 7037.5 by eny appllcant tor e pertnit
subje the applicant to e civil penalry ot not more ihen five hundred dollers ($500).):
I)es owner ot the property, or my employees with wages es thelr sole compensation, WILL DO TME WORK, and the structure Is noI Intanded or oHeretl for sale (Sac.
�7044, Business and Professions Code: The Coniractors License Lew does not apply to an owner of properry who builds or Improves ihereon, end who tloes such work
himself or herself or Ihrough his or her own employees, provitletl ihat such improvements era not Intentletl or oRered lor sale. It, however, ihe builtlinq or improvement is
sold within one year of completion, tha owner-builder will heve the 6urtlon ot proving ihat he ar she ditl not build or ImDrove for purpose of sale.). '
❑ 1, as ownar of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business antl Protesslons
Code: The Contreclors LitenSe law does not epply to en owner ol property who Dullds or Improve5 Ihereon, entl w�a cantrattb tor such pro�ect with a Conlrector(s)
license Oursuanl to ihe Contractors License LawsJ.
Business and Professions Cotle lor this reason:
�Ownef.IB'4 '0•if�v4� �' r� � No Drive'Ys License No.
Verification oi�wnership by (type o doc em nt, i.e. - pmpeny tas 6ill or deed):�
OIVISION OF INDUSTRIAL SAFETV PERMIT CERTFICATION:
❑ I hereby certity that no excavetion five (5) or mare teet in tlepih into which e person is required to descend, will be metle in connection wilh work euthodzed by Ihis
permit, and Ihat no building structure, scaHolGing, falsework, or demolition or dismantling Ihereot, will be more ihan thlrry-six (36) teei �igh. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Calitomla Adminisirative Cotle).
❑ A5 owner-builder, I will not employ anyone to tlo work which would require a permit from Ihe Division ol Industrlel Safery, es noted above, unleu such person hes e
pertnit to do such work trom the divislon.
Signature: Dete:
Division oi Industrial Safery Permit Number.
CERTIFlCAiE OF COMPLIANCE AND AIfT}IORIZgA6N OF ENfi]Y; I cenily under penalry of perjury lhet I have read this epplication end state thei the infortnation given is
correcL I egree to wmply with ell state lews � u o na�H�relating to building construction, entl euthorize representatives oi the Ciry oi Costa.Mesa ro enter upon the
�ro�tlescnbeApropertyforinc�= [ �•� . egree not to occupy or ellow occupency of eny building euthorized by this permit un�il tinel inspection.
� � �-, y �-oy
tu e t8gaF9rq�r(s) �� Date
GODE �, INSPECiIONNVE Q�g �ELS
1616 Fi:ed Sysiem Finel Fire Prevention
7266 Pool Spe Finel
200 Flnel Re-Rooi
201 Flnel Block/Retaining Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Flnel Demoli�ion
tOpE� INSPECTIONTYPE
206 Final Mechanical
20B Finel Plumbing
210 Finel Electrical
212 Finel Fire Prevention
220 Finel Planning Approval
222 Finel Site
250 Finel Bullding/Occupency
Date
�g �
• ��
JY
(7�4) 75a-5273 • Fax pta) 75a-ae56 • www.ci.costa-mesa.ca.us 77 tAIH UHIVt, GVJ IA MtJH, GA tlLOLO
Job Address: 2864 INROZ DR
Suite No
Vicinity:
Parcel Nunmber: 13944407
Applicant: KERCE, DONALD M
Address: 28641NROZ DR
COSTA MESA, CA
Owner: KERCE, DONALD M
Address 28641NROZ DR
COSTA MESA, CA
Contrector: OW N ER-BU I LDER
Address:
Arch / Eng :
Address:
PLUMBING PERMIT
Phone: 714-979-4543
Zip: 92626-3528
Phone:
Zip: 926263528
Phone:
Zip:
License: 000000
Phone:
Zip:
License:
Status: ISSUED
Applied: 01/23/2003
Issued: 01/23/2003
. : ��1.
SCOPE OF PERMIT
PLUMBING TO INCLUDE: 1 SEWER CONNECTION.
2/4/03: PROPERTY OWNER CONFIRMED WITH INSPECTOR THAT ONLY A WASTE/VENT SYSTEM AND WATER PIPING
FEESUMMARY INST REP W R . �k
AMT QTY AMT QTY AMT �TY
ISSUE fEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 . Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifer System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr BkFlow(1-4) $0.00 0
Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bktlow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin 50.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System 50.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet (Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent $0.00 0
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) -
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized undar this permit to be considered legal, such work must comply vdth all applicable codes, and all
required Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446d6 (N00)
WORKERS'COMPENSATON DECU1RAnON: '
I hereby aNirtn under penalry of perjury one of the tollowing declarations: �
❑ I have and will maintain e certificate of consent to self�lnsure for workers' compensation, as provitlea tor by sectlon 3700 ot ihe Labor Code, for the pertormence of iha
work for which Ihis pertnit is issued.
❑ I have and will maintain workers' compensation insurence, as requiretl by section 3700 of the Lebor Code, for the pertormance of ihe work for which this pertnit is issued.
My workars' compe;sation Insurence carner antl policy number ere: • .
Cartier: � Policy Number:
(lhis section neetl not be completea il the permif is valued at one hundred dollers ($100) ar less J
I certity that in the performance of ihe work for which Ihis permit is issued, I shell not employ eny person in eny manner so as to become subject to ihe workers'
� compansetion lews oi Cali ia end agree that i hould become subfect to the workers' compensetion provislons of Saction 3700 of ihe Labor Code, I shell totlhwith
comply wi1hM provi5i �ns. 1
ApplicantSi4neWre: . �� ._ Date: /�L /���3
WARNING FAILU O 5 ORKER MPENSATION COVERAGE IS UNLAWFUL ANO SMALL SUBIECi M! EMMOYER TO CiiIMINAI PENALTIE$ AND CIVIL FlNES UP TOONE HUNDRED
TFIOUSAND 1W,000),INADDITI THECOSTOFCOMPENSATION,DAMAGESASPROVIOEpFORINSECTION3)WOFTHELABOFCODE,IMEREST,ANDATTORNEV'SFEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby aHirm ihat I am licensed under provisions of Chapter 9(commencing wl(h Section 7000) of Division 3 oi ihe Business and Prafessions Code, and my license is in tull
torce and eflect. Lic. F Class»
Contractofs Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirm that ihere is a consiruction lending agency for the pertormance of ihe work for which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lentler's Nama: Lendar's Address:
Signe�ure: Date:
OWNER•BUILDER DECLARA710NS:
I hereby affirm t�a� under penalty of perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for tha tollowing reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or county which requires a permit to constmc6 alter, improve, demolish, or repair any sirucNre, prior to its issuance, also requires the applicent for such permit
to tile a signed stetement ihat he or she is licensed pursuent to the provisions oi the Contractors License Lew (Chapter 9(commencing with Section 7000) of Dlvision 3 of ihe
Business and Prolessions Code) or that he or she is e:empt iherefrom and the besis tor the allegetl ezemption. Any violetion of Section 7031.5 by any applicent for a permit
subjects the applicant to a civil penalry of not more than five hundred tlollars ($500).):
❑ I, as owner of the properry, or my employees with wages es their sole compensation, WILL DO 7HE WORK, and ihe sWcture is not intended or oMeretl for sale (Sac.
7044, Business and Protessions Code: The Contractors License Law does not apply to en owner of property who builds or improves Ihereon, and who does such work
himself or herself or ihmuqh his or her own employees, provided that such improvemenis are not intendatl or oNeretl tor sale. If, however, the building or improvement is
sold within one year oi completion, the owner-builder will heve the burden ot proving that he or she did not build or impmve for purpose of sale.). '
� I, as owner of Ihe propeny, am EXCWSNELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the projeq (Sec. 7044, Business and Professions
Coda: The comredors License tl ot apply to an owner ol property who builtls or Impmves thereon, end who wntracts for such project with a coniractor(s)
license pursuant to the Conir cense Laws.).
0
DIVISION OF INDUSTRIAL SAFETY
_ Business and Professions Code tor this reason:
Date: �^ 2 3— 2�' 3
❑No OriversLicenseNo. E:pires: '���
i.e. - property tax bill or deed):
CERTIFICATION:
❑ I hereby certify Ihat no excavation five (5) or more feet in depih into which a person is required �o descend, will be made in connection with work authonzed by this
pertnit, and that no building siructure, scaflolding, falsework, or demolition or dismantling ihereot, will be more than ihirty-si: (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Title B, Calitornia Adminislretive Code). ,
❑ As owner-builder, I will not employ anyone to tlo work which would require e permit irom Ne Division oi Industriel Sefety, as notetl above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safery Permit Number:
CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF Y: I cenify er penalty ot perlury that I have read this application end state that ihe infortnation given is
co�rec�. I agree t � h'aIr513i6hewaa city or ' nces rela�in uilding constmction, and euthonze represen�a�ives of �he City of Costa Mesa to enter upon �he
abo e� prope for inspection u ose5. e not to or allow occupancy ol eny building authorized by this permil until tinal inspection.
�-17— 10" 3
COOE1, INSPECTONTVPE � PAIE INf1TIAL5
1616 Fixed System Final F' Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demoll�ion" '
COOEA INSPECTIONTVVE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final BuiltlingiOccupancy
DpTE IIiIfIR
-5-a3 �n
.:
- ,�ti :i::
L,it�l °� L,odta ��leQa 'si�%��y Du.i�ioya
OWNER-BUILDER
VERIFICATION
A city or county, which is required to give notice pursuant to Sec[ion 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the re[um of, an
owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applicd for in yuur name and bearing your signamre.
Please complete and re[um this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building pennit. No buildina oermit will be issued until this
verificatian is received.
I. I personally plan lo provi Ihe major labor and ma[erials for conswction of the proposed
pmperty improvement. Yes ❑ No
2. 1(have/have not) ���f signed an application for a building permit for
the proposed work.
3. 1 have cnntracted with the following person (finn) to provide �he proposed conswciion:
Namc
Address
Phone ( )
Ciry
Contractor's Lic. No.
4. I plan to provide portions of thc work, but 1 havc hired [he following person to coordinate,
supervise and provide the major wurk:
Name
Address _
Phone ( )
Ciry —
Contractor's Lic. No.
5. 1 will provide some of the work but I have contracted (hired) the following persons ro
provide the work indicated:
lYame
tD42�48 (REV. 9/yB)
Address
Phonc 7'ypc of Work
�
I hereby affirm that I have received a copy of the informa[ion set forth in Section 19830 of [he State
of Califomia Health and Safety Code and have completed the above infortnation [o [he best of my personal
knowledge, in compliance with this State law.
(YMha or -1 y�lea)
C.D.L. # OR S.S. # / %/��
Date: L ' 23����
For more information call City of Costa Mesa Building Division at (714) 754-5273.
1062d8 (REV. 9/98)
L
'PXO�CTFOOBFSS `864 ZNRUZ Dft I
owNepooess: h��RDSTROM, DANIEL AGNEW
2869 INRc]Z DR
COSTA MESA,CA 92626
RflCH/ENGINEEfl: '�40-79$3 qEGA�.:
nooeess:
Uxli:
uxir:
PEHMITTEE: NORDST�POM DANIEi ( 714 ) SAO-7983
nooxess �864 IhRb7 DR
COSTA MESA CA 92626
LICENSEO CONTHFCTOB OECIABATION: I �ereby affirm ��a� I am licensetl under provisions Oi Chap�er 9(commencing with Section
7000) �1 �iv,siai 3 o)�he Bugness and H�o�esswns Code, antl my license is in �ull torce and eHetl.
CITY LIC.: STpTE 4C.: CIASS:
Date: $ignalure:
WOflNENS' COMPENSFTION DECIANAT10N: I here0y affirm Ihat I have a cenifica�e of consent b self-insure or a cetlilica�e of Workers'
Campensation Insurance. or a certilied copy ihereof (Section 3800. LaO. C).
POUCY NO.: E%P. �ATE:
CUMPANY:
' Ceriilietl copy is hereby �umishe0. ❑ Certi6ea copy is filetl with the ciry BuilOing �ivision.
�ale: ADDlican�'.
E%EMPTION FNOM WOPKEBS' COMPENSPTIbN OECIAflATION: (This section need nat be completetl if ihe permit is for one hunared (5100) or less�.
I cerlity Ihat in �he petlormance of �he work for which Ihis De�mi� i issued. I shall no� employ a� persqQ in any manner so a5 �o become
suble�� �o Ihe W rkers ompensation Laws al California.�� \\\}yy'��n/// � //
Si� � �2— Signa�ure: /��dL �/ �C/L�7SC�
NOiICE: �, aiter making ��is tleclardlion, you shauld 6ecome su�lect m tl+� Workers' Compensa�ion D�ovisions of ��e Labar
Cotle, you mu5i lotlhwith comply wi�h suth provisions or iNs permii sha��be Oeematl revoked.
CONSTHUCTION LENDING AGENCY: I qerehy aifirm �Aat �here is a constmc�ion lending agen�y tor the pedormance oi the waB for
w�ich Ihis permil is issuetl (Sectian 309>, Civ. C).
LENOEN:
pOUflESS:
OWNEP BUILOEB DECLPflATION: I Aereby aflirm Iha� I am e�empl fmm Ihe Comractors' Stale License Law �or ��e following reason
(Sec�ion 7031.5 Business antl Protessionql Cotle: Fny ciry oi counry w�ich requires a Dermit to con5huci, atler, impmve, demolish, or
repair any 5irucWre, prior �o its issuance, also reQuires Ihe applicant for such permi� ta �ile a signetl s�a�ement [ha� hels�e is licensetl
pursuam m �he pmvisions a� Ihe ConUac�Ors' S�a�e License Law (Chapter 9(commencing with Section 700�e1-8'wMon 3 oi �he Business
antl Prole55ions Catle) ar Iha� helshe is hxempt lherefwm antl ihe 6asi5 br ��e allegetl ezemption. Any violation o� Sec[ion 703L5 by
any applican� �or a permil subjec�s ihe applicanl lo a civil penalry of not mare �han �ive hunOr¢4 tlollars ($500�.
I, as owner of Ihe pmpeny nr my employees wi[h wages as iheir sole compensation, will do ihe work, antl ihe
❑ slmcture is noI intentletl or oiferetl for sale (Section 7044, Business antl Pmfessional CoOe: The Coniractors' State License Law
Aoes no� appty Io an ownel of a property who bui105 or impmves thereon, antl who tloes such wofk himself/herseA or �hmugA
his or �er own employees, pmvi0ed t�at such imD�ovemenis are not inten0etl or oflered for sale. If, however ihe building or
'mpmvemenl is sold wilhin ane y¢ar of comple�ian. Ihe owner will have �he buraen af pmving he/she Oitl no� 6uild or impmve
lor Ihe purpose ol sale).
I, as owner oi Ihe Omperty, am exclusively coniracting with Iicense0 contracmrs to consiruct Ihe prolect (Section 7044, Business
❑ an0 Professions CoAe: The Contracmrs' State License Law tlaes not appty to an owner of propeny wha 6uilds or impmves �hereon
antl who conirac�s �ar such pro�@��s wi�h a conVactm�s)license pursuani b �he Contractors' S�ate License Law). I am aware
thai prool of Iheir Worker's Compensa�ian insurance 5hoN4 be pmvide0 to me.
� I am e�empl untler Sec�ion'. B p.� � 4 4 B. 8 P. C.
m� ims �e�so�: � ALL WORR BY 053N :R
I do hereby cehily ihai I am aware af anq under
2553a antl ��at I or any fuWre building occupanl
permi� �or consimc�ian or mo0ilicaiion Iram �he
Ihese provisions.
Owner: L� �
siand �he requiremems o� Califomia Heal�� antl afery Code Sections 25505, 25533, anA
will/will na� (circle one) neetl ro comply wiih sa 5laie cotles antl �he requiremen�s for a
Air Ouality Managemen� �istrict. He5i4eniial coretmc�ion applications are exemp[ �mm
�ale: AOPbcanL
I �ereby certityihal I have reatl this applica�ion and state�ha���e above informa�ion is wrrecL I agree�o camply with a0 city antl counry
ordinancesantlslatelawsrelaling�a�uildin9consimc�ionantlherebyamhurizerepresenta�iveso�this itym merupon�heahove�memione0
properry for insOecUon purposu.
Dai: �J 9 Z SignaWre'. �
Driver's License or Social Securily a: �� �-�
t64t-46 Whne—Builaing; Green—Co�e Enbr<emenq Canary—Applicanl; Pink—Revenue: GoltlenroC—Assessor
CITY OF COSTA MESA - HUILDING PERt�:IT PERii: NO; B Q5690q
PERMIT NO: B 056909 PLAN CHECK NO: N GOV"P; N SUPP: N
CONSTRUCTION TYPE; V-N PERMIT TYP$; STR FURPOSE: ALT
JOB DESCRZPTION ; T/OFF RESNT REROOF W/COMP. SHINGLES S� FT: 5,000
CLAIM VALGE: 5,000.00 CALC-VAL"JE; S,OOO,OU GROUP OCC: R-3 /
COMMENTS• SMOKE DETECTOR RE�UIRED IN THE AOME
?E�7(-�F�E�E-)E#if�lEiFii%%#xifiE3EiEiEiF#i(��1ElE�E#� ifiE*##leiF#*x�if�Eif#iF?E�?fifiEiE�lk�iFifiE##��fii�iElilEx�*�k�isif�ar.ie�k�lE?(�iEiF�f#�Y?e
Z O N I N G R E(Q U I R E N. c N T S
S E T B A C K S
----------- MAIN HUILDING ---------- --------- ACCcSSORY EUILDSNG ---------
FRNT: F'f IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT: rT IN RGHT; FT IN LErT: FT IN RGFiT; FT Iiv
PARKZNG REQ; PROV: PARCEL: 13944407 7.NE: REF NO:
PLAI+!tvING NGTES>,
,?
��*x*�*�tx�t*�*����r*�k*�#���r*x*�*� r*�e**�t*�t�?�?t���� �#u��*���u x���t ��c� �tr;**a�*a��: �r;t�t�x x*
D E V� L O P M£ N T S E R V I C E S R E Q U I R E M E�tvr!T -S
ZONING APPROVED' BY DATE: �'%:'
HUILDIN� APPROV�D BY ; �^ DATE: ��
AFPLICATION ISSUED BY: ' ' \ " � DAPE• ����r��
�fifiFifii�iflE�lEiEY�#�itiF��(#^A-ieiFififiF�f . . �1Fj1-iEifif�3F�l'rkkiF�?(�3���ifif
if # K�iF iE if iE iE !E i{� IF ih ik if If ?f 3t� iE 3c # ie if iE iE iE #F ia±E iE # iE iF �FiE li iF �7F �lt if �f iE ie �1f ff� k 3i� # ir If ie # ie k-�Ih iEli�lF IF If i't 3i� iE iF it if iF if ij' �X•}4 #� k� 3i� N 1F �'r if� 3F #
LEGALiZATIOi�::N F E E S U N M A R Y STRUCTURAL:SEGMcNT:Y
BLDG P,YT PLUMBZNG ELECTRIC MECHANIC FIRE SMIF/RES GRADIhG
PERN,IT 72.00 ,50
sMZF�ir�o�.r�Es
PLAN
ISSUE FEE 7
B[Ii:,DII�G-DIV-� PBkMI1" ISSUE PLAN-CHECK TOTAL PAID �i UUE
TOTAf�S----> 72.50 0.00 0,00 %2.50 72.50 , ,00
RSVENUE DIVISION TOTALS--� COLLECTEI]; 72,50 UVER/SHORT; �� ,00
BLDG FMT' PLiTMBING ELECTRIC MECHANIC FIRE SMIF/TOT GRADI�'G FiAIS-CHECK
72.00 ,Sp
.r
3(� �/E-1F # iF iF ie 3(� #f If 3E iE 3E if k# 9E �lE iE iF i(�%# if �# 3E iE 3f if ii� # iM1 if �x iE 3�� K �(� �ti iFlF �FlF iE iE 3i # i'r iE #!E!( iF 7i�-#� 1M1 j4 %� 3!� iF df 3t iE iF iF 1P )f if IP,#� �i� jf- �lf 3b #'lf # 7E
i N D T V I D U A L F E E B R E A K D O W N 1-
TYPE QTY D E S C R I P T I O N UNIT COST f TQTAL C05T
SFR 5000 REROOF HY VALUE RESIDENTIAL N020NE i.UO S,UOU,00
END OF FEES �
`,.
� I !
�
�
07. �]�?6�'S`-G�7?C'r�,�_` '� ��'
CBTE� J.s'�..'�l .'., t. , .
� j �
� ;
POO SPA
CONSTRUCTION AND PLANNING I
� ApPROVALS Permit# � Date Inspector APPROVALS Permit# � Date Inspec�tor
7. Temporary Etectrical Service or Pole 52. Pool & Equipment Location . '
z, $pil Pipe-Undrgrnd. , 53. Steel Reinforcement �. �
3. Electricai Conduii Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steei Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Faotings 58. Electrical Conduit-Undrgrnd.
S. Foundation X 59. Gas Pipe, � Undrgrnd., Test
9. WAter Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO OECK
77. ProPerty Sewer Line & HouseConnection . 62. Backwash & ReceptorFinal �
12. Sewer Cap 63. Heater & Vent�Final
13. Roof D�ains 64. Plumbinp System � Final � .�
t4. Rough Plumbing 65. Etectrical-Finat �
75. Rough Electrica6Conduit 66. Solar System-Final �
i6. Rough Electric Wiring 67. Fencing & Ficcess Approval
17. ftough Wirin9 Sign 68. APPROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling . 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22.Ducts,VentilaTing 77. ProductPipingOGas OOiI
23. Gas Pipe-Rough & Tesc 72, Underground Flush
24. Roof Framing 73. Undergmd.StorageTank �Gas ❑Oil
25. Roof Sheathing 3--�0-Lt2 f �,. '7q, Overhead Hydro
(�'
26. T-9ar Ceiling (Structuraq & Monocoat 75. Dry Chemical
27. Frame and Flashin9 �6. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywail Nailing HEALTH DEPT. REQUIREMENT
31. Pl2ster Brown Coat � 79. PINAI INSPECTION
32. Electrical Power Meter-Final �• 80. FOOP CERTIFICATE ISSUED
33. Finai Electric Notes:
34. FiOai Heating & Air Conditioning `j
35. Fina� Gas Pipe-Test � �'
36. Hood or CanopY �- '�
� ,
37. Final Factory Fi�eplace �'
38. FiAal Plumbing '
39. Water Service-Final
40. Gas Service-Final
41. Solar pomesticFinal
42. 8ackflow Preventer
43. Backflow Irrigation
44. Landscape Irripation Sysiem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 3��^ y�� � �-
48. FINALPLANNtNG i�
49. Electric Release to Edison ��
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY .
No. Date
CITY OF COSTA MESA - - - _- � - �
CONSTRUCTION PERMIT �
AVo��cant to till in all soaces except inose within neavy Dortler lines ane sign all aoDrovriate tleclarations.
PER IT NO. - TFACT NO. LOT NO. BLD . . •
� ����- �CS ' • • . ' � .
ProjectAddress 1�'FJ I.LY1Y�Q.2,_(/Y� . TYPE-OFCONSTRUCTION NEW AD� ALTERATION REPAIR
AppliCailt'S Mailing Addre�55/,�� �- % � - � , ❑ CONVER ION ❑ DEMOLIS ❑ OTHER � ' • q p #
Dwner'SName �w��T �<<��y�n�r` Pho PESCR TI N WORK � �
4ddreu ��� LViNB'� ' / , ✓'_ '(�� �PCA � '
TVPEOFPE MIT GRADING FOVNDATION ❑ STRUCTURAL
Frch/Eng. License No. ❑ TENANT ❑ ELECTRICAI �PLUMBING ❑ MECHANICAL
4ddres5 ❑ �OTHER ' "
Contrector's Nam � � -g e� -P/hon�e ��L PROJEC7 DESCRIPTION 5�. FT. oCCUPANCv_
Addre551mailing) � �✓���/.]'� �C� - • CONSTRUCTIONTYPE 'VALUATION$
�/ ZONE GRADINGCU.YDS. ACi3E5—
City LicP� N � '
LICENSED CONTRACTOR DECIARATION
I hereby af(irm Iha[ I am lic¢nsetl untle� provi5ion5 of Chdrt¢r 9(tommentlng
with Section ]000) of Dlvision 3 of the Busine55 antl Profe55iOn5 Cotle, antl
my_license is in tull (orce a tl efte t. y�,/� 4
License Clas ice se No. Y}�
Date�. Si9nature' ,
iRKERS'COMPENSATION DECLARATION '
:reby affirm that 1 have a certificate ot consent to self-insure or a certliicate
� Wotkers' Compensatiom InSurance, or a certifietl cOpy thereot�(SeGtion
3600, Lab. C��• / /
Polfcy No. `( Si��i%�% F� Company �� V�^ I - �
� Ce%rSt�ifietl copy jisG,h�ereby fumishetl. '
C[.��li�y� p^� _,d wApPhcani{Y Bu' 9 vi �/�
Da[e � ��
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION�-- -�
(Tbis section neetl not b¢ completetl if the p¢rmit is for on¢ huntlretl (§700) o� �
Iess). !
I certify that in the pe�fo�mance ot th¢ work for which this permR is i55Uetl, I
shall not employ any person in any manner so-as to become suGject to the �
Workers' Compensa[ion Laws of California.
Date Signature �
NOTICE: If,'af[er making this tlecla�ation, you Shoultl becOme subject [o thE
Workea' Comoensatlon provisions of the Labor Cotle, you must fortnwlth- -
comply �with Suth prov�sions o� this pe�mit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCV .. � �
I hereby aftirm that there Is a construction lentling agency tor the per(ormance �
of the work �tor which this perrpi� iz issuetl .(SecHon 3097 Civ. ,CJ
Lentler's Namn �� ^'
Lender'S Atltlres�" " , �
OWNEH BUILDER DECLARATION -
I hereby affirm ehat I am exempt trom the Contractor's License Caw for the
following reason (Section 703L5 Business antl �Protessional Cotle: Any city or
county which requires a permit'to construct, alter, improve, tlemolish or repair
any strucfure, prior to its issuance, also requires the applicant for zuch permit
.lo tile a siqnetl statement that he/she is IicenSeG pu�suant to [ne p�ovlsions oi
�:,�:s,e Contractor'S License Law (Chapter 9(mmmencing with Section']000) ot
�.�"•,�vision 3 of the Business antl Protessions Cotle) or that he/she is exempt '
.�..eretrom antl the basis for the allegetl exemption. Any violation of Section
7031:5 by any applicant for a, permit. subjects the applicant to a civll
�enalty of not more than five huntlretl tlollars ($500).
I, as owne� of tM1e+ p�operty or my �employee5 with waqes a5 their sole
compensation, will tlo Ihe work, antl the-structure Is mt intentled or offeretl
for sale (Section 7044, Business and' Professional Cotle: The Contractor's
License I�w tloes not apply to an owner of a property. who builtls or improves
thereon, antl who tloes such work himself/herself or ihrough his or her own
employees, prOvitl¢tl that such Improvements are mt In[entletl or ofteretl fo�
sale. It, however, the builtlin9 or improvement is soltl within one year of com- '
pletion, the owner will nave the buraen oi proving he/she tlitl not build or im-
�rove,for the purpose o( sale).
I as owner of tne property, am exclusively contracting with Ilcensetl con-
tractorsto constructfhe project (Section ]044, Business antl Professlons Cotle:
The ContraciorY License Law does not apply to an owne� ot p�operty who .
builtls or improves thereon, antl who contracts tor SUGh projecl5 with a con-
tractor(s) Ilcense pursuant ro the Contractor's License Law).
❑ I am exempt untler Section B. & P. C. (or this reason ,
Date Owner �
I hereby certlfy that I have reatl this application antl st2te that the above
information Is correct. I agree to comply with all dty antl county ortlinances
antl state laws relating to bu'Itlipg nstruction�and�hereby aut�orize re0re-
sentatives ot tM �ty to r bove-mentionetl property tor
inipecti6n purp � /
Si9nAture �/ Datl --
Remarks:
' Bar Sink ' .
Backflow Preventer
. Backflow Irrigation
Rathtuhs
ishwasher'r � ' � �
rinking Fountains '
loor D�rains
loor Sinks � �
as Service Outlets
nercepmrs �
itchen Sink '
avatories .
-Trep
loof Drains .
Reinspec[ion Fea $25
Boiler � '�� , �
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ai ao,000 sru O i oo,000 er
/��
��
CMF, 0865-46 rev. 7/83 � White - Builtling;�Canary - APPIiCanh, Pink - Accounting; Goltlenrotl -Assessor --
Showers -
� Sewef Cap ,
Sewer Connection �
Solar Coilecmrs '
Solar Piping " ' ' `
Solar Tank '
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
� Water Service � .
Issue Fee
Hoodor Typel ❑
Canopy' Typell, ❑ �
Refrigeration System �
❑a�oo,000aTu ❑ioo,000aru
System Repair/Alteration �
Issue Fee
5 Main Building: �
E -
T FroriY � 1 '
A Rear '
C Right
K Left
S
Ping. Ref. # ' -
Parking Req./Provided
Use of Building:
Planning Notes:
0
Automatic Washer �
�
� ConstructianPole5u6.
'Cooking Uriit ' ' �
Dishwasher ` •
Dryers ❑Gas.��Electric
i . „
Fan .
F.A.U.
Fixtures ' '
� _'
Device Boxes
Switches
Garbage Oisposal �
Generator �0.5 KW �5-15 KW
IEOG'12L3�/,B� '
Zone .
Accessory Building: :
Park:Fees $ , . �
Transformer 0 15-50 KW
❑ 50+KW
Meter�up to 700 amps �
Meter ❑over100amps, �
Sub Panel , �
Momrs O0.1 HP O1 %- B �
Inc.Solar �9-15 HP �i6-15+
Microwave
Pole Light
Range �
Sign
Standing Sections �
Trash Compactor . '
$ 3 - Reinspection Fee $25 .�ssue Fee,
FEES
�PUBLICSERVICESREQUIREMENTS: �
Zonin9 APProved By
Appliration Approvad By
$ 3
i
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP � $
PLAN CHECK ; $ PERMIT .
PLUMBING $ �S� ��UANCE ' $ �
PLAN CHECK $ ENERGV P.C.. $ �
ELECTRICAL $ GRADING $
PLAN CHECK $ � ' MICROFILM $ �
MECHANICAL $ TOTAL FEE $ � .� O d
PLAN CHECK $ - �
'�' CONSTRUCTION AND pLA NI�G � *i ;' '
PO . SPA
�APPROVALS Permit# �'�b '�s � Date• Inspector- � AppROVALS Permit# Date`'��Inspector
'• 1. Temporary Electrical Sarvice or Pole - 52. Pool & Equipment Location
, 2. Soil Pipe-Undrgrnd. - �z - �� �� 53. Steel Reinforcement / �,
� �3. ElectricalCondui�t,Utility-Undrgrnd." � , 54. Forms '
4;E`lectr.ical'Conduif-Undrgrnd. ' � � . . � 55. Electrical Bonding - �
'5.'Steef Reinforcement�-� � � ,� � � 56. � Roagh Ptumbing & Pressure Test ,
"6rElectrical UFER�Grnd.� � � , � � � 59. APPROVAL TO COVER-GUNITE
�.-
7. Footings ' . .� � � 58. Electrical Conduit-Undrgrnd. ' �
8. Foundation '� ' � 59. Gas Pipe, O Undrqrnd., Test .
�
9. Water Pipe-Undrgrnd. _ . - . 60._ Backwash Lines, P-7rap, O Undrgrnd. � -
10:�Structural Floor System - 61 . APPROVAL TO DECK
11: Property Sewer Line & House Co�ection � : , 62. Backwash & Receptor-Final ��
12. Sewe�.Cap ' - � ' � 63. Heater & Vent=Final '
�.
13. Roof Drains • . - � 64.� Plumbing System�- Final �
14. Rough Plumbing - ' 65. Elecfrical-Final� �
15. 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-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ; � � ; FIRE DEP7: REQUIREMENT �
20. Rough Factory Fireplace , � � � ' APPROVALS Permit #
21. Ducts,,in Structure ' � � ' ' 70. Underground Hydro
22. Ducts, Ventilating ; 71. Product Piping O Gas ❑ Oil
23. Gas Pipe=Rough & Test ' ' �� , 72. Underground Flush
24. Roof F�aming '" �. � 73. Undergrnd. Storage Tank O Gas ❑ Oil
•
25. Roof Sheathing � 74, Overhead Hydro �
�6. T-Bai Ceiling (Structural) & Monocoat �� I � 75. Dry Chemical
27. Fra'me and Flashing . 76. Dry Standpipe
28.� Lath�ng & Siding . � . ' � 77. FIXED SYSTEM FtNAL
29. Insulation� ' 78. FIRE PREV. FINAL
30. Drywall Nailing , . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , � 79. FINAL INSPECTION
32. Electriral Power Meter,Final � � 80. FOOD CERTIFICATE ISSUED
33: Final Electric � � Notes: �
34. Final Heating & Air Conditioning � . '
35. Final GasPipe;Test � . � � � , � . �
36. Hood or Canopy . . , � �
37. Final Factory Fireplac� �. ' �
38. Final Plumbing f' � �
39. Water Service-Final . , '
40. Gas Service-Final , , � '
41. Solar pomesticFinal � � _ � _ _ , '
42. Backflow Pieventer ' �
43. Backflow Irrigation ' � � '
44. ,Landscape Irrigation System � �
45. Sound Attenuation � � •
46. Handicap Regulations ' � . �
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements.Completed � ' " � .
49. Electric Release to EdiSon - - � -
50. Gas Release to Southern California Gas Co '� ' � , � ' .
51. CERTIFICATE OF OCCUPANCY .' . ,
No. Date
e
� ,
L A B O R'AT O R 1 E 5,I Nc.�
Tefin9 and.�napec[�on �»9ineBra
COMPRESSION TEST REPORT
K �
�Test madefor Walter Dufresne, 2864 Inroz Dr:, Costa Mesa-(Fiesta Pools)
Job Identification 2864 INROZ DR. , COSTA h�ESA �
Location iu Structure SWIIvtidIIJG POOL '
I.aboratory Number
Mark
Date moulded �
Date tested
Age, daye
Weight per cu. ft., lba:
Dimenaions, (inchea)
Area, sq. in.
Compresaive Strength
Total Load Ibs.
Lba. per sq. in.'
nux:
Cement
Sand
No. 4
No. 8
No. 2
w$t�
u
I.ABORATORY DATA
7632
LC1
9-4-64
�
9-11-64
7
6,15x12.1
29.71
108,500
3,652
7633
LC2 .. LC3
9-4-64 9-4-64
10-2-64
26
6.20x12.2
30.19
FIELD DATA
�
6.25x 12.2
30.68 '
�
SEP 2g
;ity of Costa
` Specified Strength @ 28 days 2000
Slump
Admixture
Ready Mix Plant
Cyls. made by L. Clark
Date cyls. delivered LaboiatoTy 9-B-64
Reapectfully submitted, '
RAYMOND;�. BORNE LABORATORIES, Inc.
,;
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/ :i� '
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2636 SOUTH GRAND aVE.NUE • LOS ANGELf1S 7. CALIF0�2NIA • RICHMOND 9-3111
��
��
C I T Y 0 F C 0 S T A M E 8 A
CALIFORNIA P.O. BOX 1200
FROM THE OFFICE OF TAE PLANNING DEPARTMEN'P
Mr. I�Tebster Dufresno October 2, 1964
289► 71aoz IJrive
Casta 2+3esa� California
Dear Pool O�mer:
The Costa Mesa Planning Department has been notiYied of the completion
of your swimming pool.
So that your pool will be a safe one and for the purpoae of advising
you of your responsibility regarding the reguirements o£ the Costa Mesa
Municipal Code, we quote Section 9298•9�
1. No swimming pool shall be constructed closer than five (5)
feet io any property lines, measured from water line of pool.
2. No swiu�ing pool shall be constructed under any electric power
lines or on any electric power easement.
3. No swi�ing pool shall be constructed unless the yard
surrounding such pool is completely enclosed by a fence
eix (6) feet in height and have•a self-closing and
locking type gate or gates.
�ge courtesy letter is directed to you so that you will be aware of
our ordinances and cew mske a complete safety check of your pool area.
Sincerely yours,
ljt.�,Y.�G+'1�"'� ,l. �{..� (fiv,r�
:/
William L. Dunn
Director oP Planning
I:�
�
DATE 3-22�69
BUILDIN(� PCR.n4IT N0. lql 50
VALUE $2(-��2�2�.44
'LONE DESCRIPTION OF WORK reS A+t_g9T
LOUP j�J TYPE \7 ZONE
YERMITS ISSUED
SUBCONTktACTOR DATE NUMBEk.
i,..,, �` - � / —G3 S ��
�/-a-�3 0 � — dw
�/ � -.
' �c3
a�• .� �--- A� R 3 t�SEs - o
.._ ,,, ,.-- __ . �s �„ � ,�.;, _.
;
;
��-.��-- isi�o
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BO%9f7 �COBTAMEBA,CALIFORNIA
For Appllcant fo Fill In Completely
TYPE OR PRINT �
eui�oirvo
ADDRE59 � g 6� .�Y+ r o�- l�r-
COSTA MESA, CALIFORNIA
U O
✓
USE OF �
EXISTING BLDp.
BETBACK LINE RRON � � /
CENTER OF 9TqEHT '� 5 REAR YARD �'I'�
SIDEYARpI_LEFT S� I RIGHT � �
DESCRIPTION OF WORK
N�.., I rll.._�e.r�,,..1 I......_..... �
S ZE�INO � �'Z G� ROOM9 � STORIE'
EXTERIOR WALL ROOP SJx I� P
CT� U
1 HEReBY ACKNOWL8GO8 TH�T 1 H�VH NH�O TXIB APPLICATION
ANO BTATC THAT TH8 • 18 CORRECT AND AOREB TO COM-
PLY WITX ALL CITY OI�l1�NA CHB ANU 9TAT IAWB qEOULATINO
i
BUILOINO CON9TRUC{{ON. � � �
V
SIGNATUR80P /`��_� B ��J. .�sY'
PERMI77EF � -CLC�L(
AUTHOHIZEDA6ENT .
�E� RECEI�ED
�MAfl 2 2 1963
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Olfice Use Only
PBCE�P� NO. PE@MIT NO.
eu
ZONING
ZON� NO.OF UB80RNHW
PLANS �� OYILDINO/)/
LEOAL ' '/I- � /n • I � (A�� `
D88CRIPlIONl� % lY r'
A. P. NO.c�� '
NOTE: NOEAVEOVERHAN68HALLBELE53THAN
90' TO SI�E @ REAR P. L.
EAVES
ALLOWED (U.B.C.REQUIREMENT'.
YARDSMPROVED VARDSAPPROVED
MAIN BUILDIN6 ACCESSORV BUILDIN6
VAR. iC
DATE
p � � �4.'�. 5 a G �' �
THE �MOIINT BHOW! NOEH VALUATION �8 POq TH! F
PUHP08E OF EBTABLI8HIN0 A PEHMIT FEE ONLY. p
VAWATION m
PERMIT FEE $ � �
�
Um
$� i� �
/ �� � 0
GI � _ . I '�
7i: �1•
DATE
DATE
BUILDING PERMIT NO.
VALUE
SUBCONTRACTOR
�Z�]
AUG 1 7 1964
22_�5 .-
�1� '.' " 22835
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] COBTA MHBA. CALIPORNIA
For Appllcanf to Fill In Complefely
TYPE OR PRINT
eu��oiNm,
A�DRE55
COSTA MESA, CALIFORNIA
■ ARCHITECT
' X ,1O ' I NO.OPBLDOB.
NOW ON LOT
■ BETeAcrc LINB FROM
DESCRIPTION OF WORK
BUILDIN6 NO.OF
SIZE ROOMS
EXTERIOR WALL I ROOF
COVERING COVE�.
USE OF BUILDING AND WORK TO BI
I HfiPEBY ACKNOWLEOOB TMAT 1 NAVE HEAD TNI6 /�PPLICATION
ANp 6TRTE THAT THE ABOVE 18 COqRECT ANO AOREE TO COM-
PLV WITH ALL C�TY OqpINPNC88 ANO BT�Te LAW9 ReOUL�TINO
BUILO�NG CONSTRUCT�ON.
SIGNATUREOF� �� � r �
PERMITTE� ��^-��Q��`-t- �
AUTHORIZED AGENT
rtt KECEIVED
fINANCE DEPT4
CITY OF COSiA MESA
APPLICATION FOR PERMR
BUILDING
For Office Use Only
I RlCCIpT NO. I PCHMIT NO
ZONIN6
NO.OP UB60FN1
PUNB �i� BUILDINO
YARDSAPPROVED
MAIN BUILDING
DIbTANCE BET
MAIN BLDG3.
VAR. #
V
SHALL BE LE53 THA
(U. B. C. REQIIIREME�
YARDSAPPROVE�
AGCESSORY BUILDII
BET. MAIN 8�
ACCES6.BLC
DATE
I10LD FO SPECI R
�
�
SC. FT.
TH8 AMOUNT BX N NDEP VA
PUHPO88 OP EB �B 6H�N0 A
VAWATION
PERMIT
g�'�d� o0
�o
19 FOR THE F
FE8 ONLY. 0
t^� � �
� G j
m
� £
I S' �O e
or
Bond
rv• U•
OF WORK
)UP I & J TYPI
SUBCON'PRACTOR
GY V
� ti. —
� 2 e'"'�'
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 � COSTA MESA, CALIFOHNIA 928Y6
l
For Appl7cant fo FIII In Complatoly
TYPE OR PRINT
B°"°�"' ,Z�64- ��2o D Cr,
ADDRE59 �
COSTA MESA. CALIFORNIA
OWNER •V • J • I�UF�'2�5��
ADDR888 O'�067� S�J�O � ��,
cin � STA �r'�S�j- No St6 �
AftGH1TECT OW��� TEL ��
ORENGINERR NO.
� 96TlACK LIXI PIIOM
DESCRIPTION OF WORK
q uss
I��G(10! l✓'TL �I�fjLL %�F /i/A�O l nc� ffc
1 Xlq6BY ACRNOWL6p0[ TMAT 1 HAV[ RHAO TX18 APPL�GTION
AND BTATB TXAT TH6 AGOV6 1� CORRBR AND I�OR6[ TO COM•
PLY WITH ALL CITY OpDIfUNCU ANp BTAT[ LAWP R[OU{ATIMO
BUILDINO CON9TRYR10 i.
SIGNATUREOP �
PERMITTB
AYTHORRiDA7QNT
eaic � �::,:::
IUL 24-67c��,nOQ16 iT� ' 13.5C
APPLICATION POR PERMIT
BUILDIN(i
For Office Use Only
RiC[IRNO. I _ PlPMIT
ZONIN(i
I NO.O� UYtOINt �,
�uw e 4ou o
�'•� -Tira.�t-5/�3y
o..��,�,o�
A. P. NO. �! � /' T
N0T6: NO HAV6 OV[RNAN6 SHALL BE Ll88 THAN
90' TO 81D� e RBAR P. L
ewves
ALLOWBD (U..B.C.REQl1IRHMENTI
YARDIMPROVHD YARCBAPPROVHD
MAIN BUILDIN6 AGGELSORY BUILDIN6
(PROM C/LDTRQ[T)
FRONT 1 C 1� $ EFT.
R.➢ID[ 7 !T. Ff.
L. GIOI 7 RT. � � RT_
vwn.#
nwre
er I OAT6 - J
a
w
�
so. r'r. �
0
TH6 AMOUXT BNOWN YNOHR VALUhT10N IB FOR TH8 j
�YRPOGt OP �BiApLIHHINO A PEqMIT F8E ONLY. �
VALIlAT10N C/ �
pD pERMITFEE /�D� E
s 2� ��� f � SO w.
TOTALFEH $ /�'� O