HomeMy WebLinkAbout2138 IRIS PL - Building Permitsli
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JobAddress: 2138 IRIS PL
Suite:
Vicinity: GARAGE
Primary Occ: U-1 Private Gar/CarporUShed Type of Construction: V-N
Parcel Number: 42615138 Zoning:
Applicane MASSON, READ
Address:
Phone: 714-529-8300 ISSUED BY:
Zip:
Owner: COATSWORTH, KENNETH M
Address 27381RIS PL �
P 4 -3 9 30
COSTA MESA, CA � 9 627�05
Contractor.� OAKWOOD�CONSTRUCTION �
Address: 576 EXPLORER ST" � -
� Phone: 714-529-8300
Arth :
Address:
Zip:
BREA, CA
Zip: 92821 � License: 762828
Phone:
License:
Eng:
Address:
S�aws: ISSUED
Applied: 11/29/2006
Issued: 11/29/2006
Phone:
License:
` SCOPE OF PERMIT
MINOR REPAIR WORK TO GARAGE DUE TO FIRE DAMAGE. INCLUDES FRAMING AROUND GARAGE DOOR, DRYWALL, INSULATION, SIDING.
MtNOR ELEC7RICAL AND PLUMBING REPAIR ALSO. FIRE REPORTATTACHED TO BLDG PERMIT.
FEE SUMMARY
Plan Check: $0.00
Permit: $181.25
SMIP Res: $1.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Calc Valuation: Sio,000.00
Claim Valuation: sio,000.00
Total: $182.25
PLANNING & ZONING
SETBACKS �
MAIN STRUCTURE Front 0- 0 Rear 0- 0 Lefl 0- 0 Righ� 0- 0
ACCESSORY Front 0- 0 Rear 0- 0 � Left 0- 0 Right 0- 0
PARKING ,� Ezistin : 0� �. -Reauired: 0 Pr000sed: 0
NOTICE: The work authoAzed by thfs permit shall comply with all applicable handlcap access requirements under Californla statutes and relatad
regulations. (Ord. No. 92-28, § 1, 12•21•92)
EXPIRA710N: Thls permlt shall autometically expire and become void It work is not commenced wlthin 7B0 days, or if work is suspended or abandoned
for a pgrlod of 1 BO days.
INSPECTIONS: In ordar for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all
requlrqd (napectlons and 1(nel epprovel must be obta(ned. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
caaarn �e�oo�
WORKERS' COMPENSATION DECLARATION:
I hereby eNirm untler penelry oi perjury one ot the following tledarations:
❑ heve end wlll malntain e cenificate of conseni to self-Insure for workers' compensatlon, es provided lor by secllon 3700 0l Ihe Lebor Cotle, fOr Ihe pertormence of Ihe
,�ork for whith Ihis 0¢�il i5 issued.
I have entl w
My workers'
�, as required by sectbn 3700 of ��e Lebor Cotle, to� the perfortnence of the work for whiCh Ihis pertnit i5 i55ued.
number ere: jy,,,( ''_ �ry, p Q J7
P ..Y. _ M�'T�� O�LJ�O �� 1 �Z
one huntlretl tlollers ($700J or less.)
❑ 1 cenly I�et in I�a padormenca of the work tor which t�is permit is issued, I shall not employ eny person In eny menner so as to ewme sub�ect to the workers'
wmpensatlon laws ol Celifomia, antl a ee t�at it I �ould become sub�ect to the workers' compensetion provlslons ot Sectlon 3 00 of the L Dor Code, I shall lorthwlth
com� v_with th_� BSB ProWsions. R 1 ^
ApplicenLSigneture: ? ��� D�_ O�y
WARNINO: FAIIUFE TO SECURE V.'OBI(ERS' COMPENSATION COVERAGE IS UMAW FUL AND SHALL SUBIECT AN EMPLOYEP TO CFIMINAL PENAL ES AND CML FlNES UP TO ONE HUNDRED
TlIOUSAND DOl1ARE (5100.000),IN ADOrt10NT0 THE COST OF COMPENSATION, DPMAGES AS PROVIDED FOP IN SECiION 31060F THE IABOR CODE, INTEREST, AND ATTORNEVS FEES.
LICENSED CON7RACTORS DECLARA710N: / _
I here�y aHlrtn thal I
lorce entl eMect. L�
(commendng with Section 7000) at DlWsion �,p4FtpaBuslne;�dn� Protessbns Cotle, erW my license Is in tull
Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirtn Ihat there is a canslruciion lentling eBency for the peAortnance of the work br which Ihis permit Is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lendels AtlCress:
Signulure:
OWNER•BUILDER DECLARATIONS:
Date:
I hereby eHirtn thet under penalry of perjury ihet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for lhe followlnp reason (Sec. 7031,5, Buslness entl Professions
Code: Any ciy or wunry whic� raquires e permit to construct, alter, improve, Aemolish, or repair eny siructure, prior to its issuance, elso requlres the epplicaN for such pertnit
Ia file e signed 5IBt8meni Ihel he or she Is licensed pursuent Io the proWsi0n5 01 the Contrectars License Lew (Chapter 9(commendng wlth Seclion 7000) oi Divlsion 3 of iha
Business entl Pmtessions Cotle) ar t�at he or she is exempt therefrom and the besis tor the elleped e:em0�lon. Any vloletion ol Section 7031.5 by eny applicant for e permit
sub�ects Ihe epplicam to e ciWl penalry c� nat more than live hundred tlollers ($500).):
❑ I, es owner of the property, ar my employees with wages es their sole compensatlon, WILL DO 7HE WORK, end Ihe struc�ure Is not intended or oHeretl lor sale (Sec.
7044, Business and Professlons Code: The Contractors License Law does not apply to en owner of property who bullds or Improves thereon, antl who tloes such work
himsell or herselt or Ihmugh his or her own employees, provitletl that such improvements are not intended or ofleretl to� sale. If, however, the bulltling or improvement is
sold within one year of completion, the owner-builder will have the burtlen oi proving ihat he or she did not builtl or improve for purpose ol sele.).
❑ I, as ownar of the pmperty, am EXCLUSNELY CONTRACTNG WITH LICENSED CONTRACTORS ro construct the pro�ect (SecJ044, Business end Professions
Cade: The contractors License Lew does not apply to an owner of proparty who builds or Improvas Ihereon, end who contrects lor such pro�ect wlih e comracmr(s)
license pursuant to �he Contracbrs License Laws.j.
❑ I am eaempt under sec. Busineu antl Pmfesslons Code tor this reeson:
Slgneiure: Date:
Ownar ID verllied by tlnvefs license. ❑ Yes ❑ No Driver's License No.
Vedfication oi Ownership by (type of tlocument, i.a. - proparty tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
E:pires:
❑ I hereby certity that no excavation live (5) or more feet in depth into which e person is reqWred to descend, wlll be metle in connection wl�h work euthorized by �his
pertnit, end ihat no builtling structure, scaflolding, falsework, or demolition or dismantling Ihereol, wlll be more then thirty-si: (38) leet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tille 8, Celllomla Atlministretive Cotle).
� As owner�bullder, I will not employ enyone to do work which woultl require a permit Irom Ihe Divislon ol Intlustrial Selery, es noted ebove, unless such person �as e
permlt to tlo such work trom t�e tlivision.
SignaWre: Date:
DlWsion ot Industrlal Selery Permil Number:
CERTFICA7E OF GOMPLIANCE AND AUTHORIZA710N OF ENTRV: I certify untler penelry ot pefury Ihet I have read ihis epplication end stete thet ihe inlartnation given is
correct. I egree lo compry wlth ell stete laws entl dry oNinances relating to builtling conswctlon, end euthoAze reprosentatives ol the Ciry ot Casta Mesa to enter upon t�e
ebove-descnbed property for Inspection purposes. I egree not to occupy or ellow occupancy of eny building euthorized by this permit until finel Inspecilon.
CODE I. INSPEC110NTYVE
1616 Fixed System Finel Fire Preventlon
1266 Paol Spe Finel
200 Flnal Re-Rool
201 FInaI B1acWRelelning Well
202 Flnal Fectory Firo Place
203 Finel Sign
204 Final Demoilti0n
QejE �$ �,Qpf� INSPECfI0N7YPE
206 Finel Mechenicel
200 Final Plumbing
210 Finel ElBctricel
212 Finel Fire Prevention
220 Finel Planning Approval
222 Final Slte
250 Finel Bulltling/Occupenq
PAIE It�4S
(714) 754-5273 • Fex (714) 754-4856 • www.cl,costa-mesa�CttsCTRICAL PERMIT » FAlfi DRIVE, COSTA MESA, CA 92626 �
Jab Address:
Suite No
Vicinity;
Parcel Nunmber:
ApplicanL
Address;
2138 IRIS PL
42615138
MASSON,READ
Owner: COATSWORTH, KENNETH M
Address 21381RIS PL �
COSTA MESA, CA
Contractor OAKWOOD CONSTRUCTION
AddresS: 576 EXPLORER ST
BREA, CA
Phone: 714-529-8300
Zip
Phone: 949369-4305
Zip: 92627-1805
Phone: �00 ��.
Zip: 92821
License: 762828
ISSUED BY:
� �sl,��
� �
Status: I SS U E D
Applied: 11/29/2006
Issued: 11/29/2006
SCOPE OF PERMIT
� . MINOR REPAIR WORK TO GARAGE DUE TO FIRE DAMAGE. INCLUDES FRAMING AROUND GARAGE DOOR,
DRYWALL, INSULATION, SIDING.
ELECTRICAL TO INCLUDE: 2 FIXTURES, 10 OUTLETS, 4 SWITCHES.
ISSUE FEE
Temp service test
Res. a/c packa9e
New Res (1-2 units)
New Res (3+units) -
Pool / Spa
Lighting Fi�s
Recept OuUets
Switches
Non Res Appl .
Res Appl
Service to 200a
Service to 1000a
Service over 1000a �
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over 100hp .
Communiwlion drops �
Sub panel to 200a ,
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
523.50
50.00
$0.00
50.00
50.00
50.00
$2.20
511.00
ga.a0
50.00
50.00
$0.00
50.00
$0.00
50.00
$0.00
50.00
50.00
50.00
�-� 50.00"-
50.00
.30.00
$0.00
30.00"
50.00
Quantity
0
0 -
0
2
10
a
0
0
0
0
0 '
0
0
0
0
0, ,
0 .
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 tt
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up �0 10 kvalkw
.................up �0 50 kva/kw
.................up to 100 kvalkw
...� ...............over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring Syslem / Ckt
Misa Conduit
Misa Conductor
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigalion Fee
Plan Check Fee
Reinspection Fee
Quaniity
50.00 0
50.00 0
50.00 0
50.00 0
S0.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
so.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00
$0.00
so.00
50.00
TO7AL CALCULA7ED FEES 541.10
COMMENTS I SPECIAL CONDITIONS
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: Thi& permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 tlays.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepactlons end final epproval must be obtainad. Failure to obtain inspections end final approval will result in tha expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zasra �e�oo�
WORKERS'COMPENSAnON DECLARATION: �
I hereby eNirm untler penelry oF perjury one oi the following declarations:
❑ I heve entl wlll maintain a certificate of consent to self-Insure for workers' compensetion, es provitled for by section 3700 of the Labor Code, for Ihe pertormance ot the
�/work Por which this pertnit is issued. .
1 have and will
My workers' o
insurance, as requiretl by section 3700 of che Lebor Code, for tha peAortnance of Ihe work tor which this permit is issuetl.
7E Dolicy number are:
POl:icyNumbe. �b""d��Li7�]
ielued at one huntlretl dollers ($100) or Iess.J
❑ I cenity that in the pedormance of the work tor which this permit is issuetl, I shall not employ eny person in any manner so as to become subject to Ihe workers'
compensatlon laws of Calitomia, /ntl,6gree t If I should become subJed to the workers' compensation provisions ot Secti n 3700 of th Labor Cotle, I shall torthwith
��� com.�I with t�ese provisions. /A" // ' � � �
�w-`..'. ., � ilA A /7
A�"`p�Ga'ntlSignaWie:_ Q/' �L� (� Date: -� — L.^ �
WAHNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000�, IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDEO F-0R IN SECTION 3]O60F THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm at I�em�licensed un er royision�j°� Chepter 9(commencing with Section 7000) ot Division 3
force antl e ea. Lic`. A_ � 7�i� d_ i
Date:
entl my license is in tull
CONSTRUCTION LENDMG AGENCV:
❑ I hereby aHirtn that there is e construction lending egency for Ihe pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Adtlress:
Sign�Wre:
OWNEii-BUILDER DECLARATIONS:
Date:
I hereby aHirm Ihet under penalry of perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry which requires a permit to consWcL alter, improve, tlemolish, or repair any stmclure, prior to its issuance, elso requires the epplicam tor such pertnit
to file a signad statement that he or she is Ilcensed pursuant to ihe provisions of the Coniractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Pmfessions Code) or thet he or she is exempt therefrom and the besis Por the aliaged ezamption. Any violation o� Section 7031.5 by any applicenl for a permit
subjects the epplicent ro a civil penalry ol not more Ihan tive hundred dollers ($500).):
❑ I, as owner ot ihe properry, or my employees with weges es iheir sole compensation, WILL DO THE WORK, and the simcwre Is not intended or oHered for sale (Sec.
7044, Business and Pmfesslons Code: The Contractors License Law dces not apply to an owner of properry who builds or improves ihereon, end who does such work
himsell or herself or through his or her own employees, provitled ihat such improvements are not inlendetl or ottered for sale. If, however, ihe builtling or improvament is
sold within one year oi completion, tha ownar�6uiltler will have ihe burden ot proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CON7RAC71NG WITH LICENSED CONTRAC70RS to wnstruct Ihe project (Sec. 7044, Business entl ProFessions
Code: ThB con�rattors LicenSe Law does not epply to en owner of property who bullds or Improves thereon, and who contracts tor 5uch proiect wilh B comractor(5)
licen5e pursuant to �he Contrec�Ors License WwS.).
❑ I am exempt untler sec. Business antl Protessions Code for Ihis reason:
Siqnature: Date:
Owner ID venfied by drivefs IlcenSe. ❑ Y85 ❑ No Oriver's License No. Expires:
Verification of Ownarship by (type of daument, i.e. - property tex bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I �ereby cenify thet no excavation tive (5) or more fee� in dep�h into which e parson Is required to tlescend, will be made in wnnection with work authonzed by Ihis
permit, end lhat no building SWdure, scaflolding, talsework, or demolition or tlismantling theraot, will be more than thirty-six (36) feet hiqh. (Chap. 32, Grp 2, Art 2, Sac.
341, Ti�le B, Califomia Administrative Code).
❑ As owner-6uilder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as notetl above, uniess such person has a
permit to do such work irom Ihe division.
Signature: Date:
Division of Indusirial Sefety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTAY: I carti(y under penalty oi perjury thet I have read this application and state that lhe intortnation given is
correct. I egree to comply with all state laws end ciry ordinances relating to building constmction, end authorize representatives oi the Ciry of Coste Mesa to enter upon Ihe
ebove-descnbed property tor inspection purposes. I agree not to occupy or aliow occupancy of eny building authorized by �his permit until final inspection.
CODE t. INSPECTIONTYPE
1676 Fixetl System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Root
207 � Final BIocWRetaining Well
202 Finel Factory Fire Place
203
204
Final Sign
Final Demolition
1�7-Si�L'IIIld7F1
CODE� INSPECTON7YPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
•tv r,iem�-
�� ,
(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
,lobAddress: 2138 IRIS PL
Suite No
vicinity:
Parcel Nunmber: 42615138
Applicant: MASSON, READ
Addrgss:
Owner. COATSWO,RTH, KENNETH M
Address' ,21381RIS PL , . -
� COSTA MESA; CA = ., -
Contracmri OAKWOOD CONSTRUCTION
,Address: � 576 EXPLORER ST
BREA, CA
Phone: 714-529-8300
2ip:
Phone: 949369-4305
Zip: 92627-1805 ��' .•,,
E
Phone: 714-529-8300
, - Zip; 92821
� License: 762828
Status: ISSUED
Applied: 11/29I2006
Issued: 11/29/2006
ISSUED BY:
:- tia7. -,
� -.,,
� '�k �
" SCOPE OF PERMIT
MINOR REPAIR WORK TO GARAGE DUE TO FIRE DAMAGE. INCLUDES FRAMING AROUND GARAGE DOOR,
DR1'WALL, INSULATION, SIDING. PLUMBING TO INCLUDE: 1 LAUNDRY TUBNVASHER, 1 P-TRAP.
AMT
ISSUE FEE 523.50
Backflow irrigation $0.00
Backflow Preventer $0.00
Bathtub . $0.00
Clarifier System 50.00
Connect (Ice,Sotla,etc), 50.00
Dental Units §0.00
Dishwasher � �0.00
Drein, Floor $0.00
Drain, Rainwaler ' � : 50.00
Drein, Roof 50.00
Drinking Fountain $0.00
Expansion Tank ' . 50.00
Gas EaAhquake Valve � 50.00
Gas (1-4 outlets) y0.00
Gas (Over 4 outlets) � $0.00
Gas Repipe 50.00
Gas Service '. � �-50.00
In�erceptors (Gr�ase, OII)A 50.00
Interceptors (Sand Auto )� � SOAO
. FEE SUMMARY
QTY�.._ _ . ' _ _' _ q�,�7
0
0
0
0
0
0
0 '
0
0
0
0
0
0,
�- 0.
0'
0,
' 0
�� 0-
p
LaundryTub/Washer $9.80
Landscape Irrigation 50.00
. P-Trap . $9.80
- � Pressure.Regulator� $0.00
`Process'Piping (per.10 ft) $0.00
Receptors $0.00
Septic Tank S0.00
Sewer Cap for Demo 50.00
Sewer Connect � 50.00
Sewer Privale Line. 50.00
Shower . . � ' - " 50.00
Sink„bar,< " 50.00
Sink; commercial S0.00
_ _'�Sink,Floor 50.00
-1 � � Sink, kitchen , 50.00
, Sink, serv(ce/mop , . $0.00
Spa (private) � . 50.00
�,; Spa (public) 50.00
Qrr
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
� � COMMENTS I SPECIAL CONDITIONS
�; � � � �
� ���
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Sel
Waste and Vent System
Water Closet (Toilep
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
07HER
VIOLATION
PLAN CHECK
REINSPECTION �
AMT
$0.00
30.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
TOTAL CALCULATED FEES: 543.10
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
.�7
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 commencetl within 1 BO days, or ii work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for !he work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapections and final approval must be obtained. Failure to obtain inspections and tinal approval will result in tha expiration of ihis permit.
FOR INSPECTIQNS CALL: (714) 754-5628
zaaa+e (s�ool
WORKERS' COMPENSATION DECLARATION: �
I hereby aHirm untler penalty of perjury one of ihe following tleclarations:
❑ I have end will meimeln e certi�icate of consent to self-Insure for workers' compensation, as provided for by section 3700 ot the Labor Code, for the peAormance of the
�Mork for which IhiS Dertnit is issuetl. �
I have and will maintein wo ers' compensa�joa�i urence, as e uirea by section 3700 of the Labor Cotle, for the pertortnance of the work for which this permit is issuetl.
yworkers'compen Insurar�e arrleran 'policynum rare: ���' �O� ���
(T�,�j ,v�7`
ection neetl not be'comp t d�I (he p��t is valued af one hundred dollars ($100) or less.) �i� Y'�mber,-
❑ I cetlify Ihat in ihe performanc9 oi iha work tor which ihis permit is issued, I shell not employ eny person in eny mannar so as �o become subject to the workers'
compensetlan lews of Calltornle, e C egree��et if I sho}}}111Itl bacome sublect to the workers' compensatlon provislons of Seppptttion 3700 o///ihe Laboi Code, I shall forthwith
� comply with these provislons. /// f/C w//_� � f I �/ ��^,
�/ � d//' I' L I l
Yi� �9��� 5�� _L �ate: � . Y
WARNINGFAILURETOSECUREWOR RS'COMPENSATIONCAVERAGEISUNLAWFULANDSHALLSUBIECTANEMPIOYERTOCRIMI�NALTIESANDCIVILFINESUPTOONEHUNDRED
THOUSAND DOLLARE (E100,000�, IN ADD�T�� TO THE COST OF COMPENSATIIXJ, OAMAGES AS PROVIDED WR IN SECTION 3]O60F THE LABOF CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby aflirtn ihat I am licensetl untler prov' '
fome and eflecl5�6 tl� _. .. �
CONSTRUCTION LENDING AGENCY:
with Section 7000) ot DiviSion
Cotle, and my licensa is in full
❑ I hereby aHirm ihat ihere is e conswction lentling agency for the peRormance ol the work for which this permit is issuad. (Sec. 3097. Civil Code).
Landers Neme: Lenders Adaress:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm that under penalry oi Perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sac. 7031.5, Business end Professlons
Code: Any ciry or counly which requires e permit to constmct, alter, improve, demolish, or repair eny strucWre, pnor to its issuance, also requires ihe ep0licant for such permit
to flle e signetl stetement Ihet he or she Is Ilcensed pursuant to the provisions ot ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Protesslons Cotle) or thal he or she is exempt ihereirom and ihe basis tor the elleged exemptlon. Any violation of Section 7031.5 by eny applicent for e partnit
subjecis ihe applicant to e civil penalty M not more than five hundred dollars ($500).): �
❑ I, es owner of Ihe property, or my employees wlth weges as iheir sole compensetlon, WILL DO 7HE WORK, antl the structure is not intended or oHered for sale (Sec.
7044, Business end Pmfessions Code: The Conirectors License Law does not apply to en owner of property who builds or improves thereon, and who tloes such work
hlmself or herself or ihrough his ar her own employees, provided that such improvemenis ere not Intended or oHeretl for sele. If, however, ihe building or improvement is
soltl within one year ol complel�on, the owner-6uilder will have ihe burden of proving that he or she tlitl not build or improve for purpose ot sale.).
❑ I, as owner of lhe property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to con5truct the project (Sec. 7044, Business end Professions
Code: The contrectors License L.ew tloes not apply to an owner of propehy who builds or Improves Iheraon, entl who coniracts for such prolect with e con�ractor(s)
license pursuant to the ContraC�ore License Laws.).
❑ I am ezempt under sec. Business and Pmfessions Code tor this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Ves ❑ No Orivefs Licen50 No.
Verification of Ownership by (type of tlocument, i.e. - properry isc bilPor deetl):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ I heraby cetlity that no excavation five (5) or more feet in depth into which e person is required to descentl, will be made in connedion with work authonzed by ihis
pertnit, end ihat no building swcture, scalloldinq, talsework, or demolition or dismantling thereof, will be more than thirry-siz (36) teet hiqh. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celifornia Atlministrative Code).
❑ As owner-Duiltler, I will not employ anyone to do work which woWd require e permit from the Division of Indusirial Safery, as noted above, unless such pereon hes e
permit to do such wolk from the division.
Signature: Date:
DivlSion of Industrial Sefery Permit Number:
CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certily under penelry oi perjury Ihet I heve read this applica�ion anG state that Ihe Intormetion given is
correct. I egree to comply with all staie laws en0 city ortlinances relating to building construc�ion, end authonza representatives ot the Ciry of Costa Mesa to enter upon the
ebova-descnbed property for inspec�lon purposes. I agrea not to occupy or allow occupancy of any 6uilding au�horized by this permit until finel inspection.
COUE t, i�srEcnonlvvE
1616 Fixetl System Final Fire Pre�ention
7266 Pool Spe Final
200 Final Re-Root
201 Final Block/Retaining Well
202 Final Fectory Fire Place
203 Finel Sign
204 Finel Demolition
o"� 1t�AL6
2�T' �9��
Date
CQOE{ tNSPECIIONTYPE.
206 Final Mechanical
200 Final Plumbing
210 Pinal Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildingiOccupancy
PAIE II�A1fi
b71.
��ia»sa-sz�s • Fax(714)754-4856 • www.ci.cosia-mesa.g�qLDING PERMIT
j�
Job Addresg: 213$ IRIS PL
Suite: �
Vicinity;
PrimaryOcc: U7
Parcel Number: 42615138
npp�icant: READ MASSON
Address: 576 EXPLORER ST
BREA, CA
Type of Construction: V-N
Zoning:
Ownec COATSWORTH, KENNETH M
AddreBs 21381RIS-PL'����
COSTA MESA, CA ��
Contractor. - �OAKWOOD �CONSTRUCTION
Addres5: 576 EXPLORER ST '
� BREA, CA� .�"
' Zip: 9282Y �, ,
Arch :
Address:
Zip:
Phone:
License:
. i
Phone: 714-529-8300
Zip: 92821
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
� ' Applied: 11/28/2006
Issued: 11/28/2006
ISSUED BY:
ks a�
. x7 ..,� .j : 'h'�a,� `
x: i;,
ro
., r..
Phone: 714-529-8300
License: 762828
Eng:
Address:
SCOPE OF PERMIT
DEMOLITION pERM1T IS�FOR THE REMOVAL DRYWALLS AND INSULATION DUE TO FIRE DAMAGE
� >
Plan Check: $0.00
Permit 323.50
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
c
FEE SUMMARY
Total: $24.00
PLANNING & ZONING
SETBACKS
MAINSTRUC7URE Front` 0-0 � Reac ',0-0
ACCESSORY Fmnt 0-0 �� �� Rear 0-0
PARKING . Existina: 0 -' � �eReauired: 0
V� -�� _`
�� �' . /��/\ _
\ ; �
�' .
P
Left 0- 0
Left 0- 0
Pr000sed: 0
�
Phone:
License:
Calc Valuation: ssoo.00
Claim Valuation: 5aoo.00
Right 0-0
Right 0-0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undar California
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: ThiS permit shall automatically expire and become void if work is not commenced within 180 days, or if work is sus�
for a period of 180 tlays.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appl
required Inapeetiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiral
FOR INSPECTIONS CALL: (714) 754-5626 /
244Bd8 (8�W)
related
abandoned
�le codes, and all
of this permit.
WORKERS'COMPENSATONDECLARAnON:
I hereby ettirtn under penelry of per�ury one oi Ne tollaxing declarations:
❑ I heve and wlll'�meintein e certllicate ot consent to sell-Insure tor workers' compensetlon, es providetl lor 6y section 3700 of the Lebor Cotle, tor the peAarmence oi ine
/ work for which t�ls pertnit is Issued
ki I have and will maintein workers' compensati� insurence, es reQuired by section 3700 of Iha Labor Code, for Ne pertortnance of the work for which this permit is Issuetl.
❑ I Certily Ihat in the {
�e.rortipemetlpn laws
WRiMNQ.'FAIIURE TO SECUPSWORNERS' C(N.IPEI
TKKISAND DOLLARE (E100,000). IN ADDITION TO THE
,r and policy number are:
Po i er: (��.� %78- 2�0 �
is ve/ued et one hundied tlallers ($f 00) or Iess.J
for which t�is pertnit is issued, I shall not employ any person in any manner so as to become suhject to the workars'
that if I sh uld becoma subject to Ihe workers' comp 'sions of Section 3700 oi the Lebor Cotle, I shell forthwith
��-Z��d't
T10N COVEMGE IS UMAWFUL AND SHr1LL SUBJECT M! EMPLOVER TO CRIMINAL PENA�TIES AND dVIL FlNES UP TO ONE HUNDRED
�ST OF COMPENSATION, DAMNGES AS PROVIDED FOR IN SECTION 3IO60F THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTOHS DECLARATION:
I he ' I am Ilcen� tlyn�e�r/�ovisi � of Chapter 9(commencing with Sectlon 7000) ot 'vision 3 of ihe Busines�d Protessions Code, end my license is in full
Bentl �.M �b��
o s i Nre: �� � 6 yr��f� f�_ _ ate: !/^ F--O �
C
CONSTRUCTON LENDING AGENCV:
❑ I �ereDy eHirtn that there is e construction lending agency for the peAormance of the work lor which this permil is issued. (Sec. 3097, Civil Cotle).
Lentlers Name: Lendefs Atldress:
Signature:
Date:
OWNER-BUILDER DECLARA710NS:
I hereby eNlrtn t�et under panelry ot parjury that I am EXEMPT FROM T1E CONTRAC70RS LICENSE LAW For the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or wunry which requires a pertnit lo construct, elter, improve, tlemolish, ar repair eny siructure, pnor to its issuance, also requires the epplicant for such permil
to file a signed statement that he or she is Ilcens�d pursuant to the proWsions of iha Contrectars Llcense Lew (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 oi the
Business end Pmfesslons Cade) or that he or she is exempt Iheretrom end the basis tor the elleged eaemptioa Any violation oi Section 7031.5 by any epplicem for a pertnil
subjecis Ihe epplicant to a cNil penalry c� not mora ihan five hundretl dollers (3500).): ,
❑ I, es ownar of ihe properry, or my employeeS with wages es Iheir sole compensation, WILL DO TME WORK, antl the siructure Is not intendetl or otferetl tor sele (Sec.
7044, Business and Professions Code: The Contractors License Lew does not apply to en owner of property who 6uilds or improves thereon, end who tloes such work
himselt or herselt or ihrough his or her own employees, provitled iha� such improvements ere not intended or oHered for sela. If, however, ihe building or improvement is
soltl within one year ol completion, the owno�-builder will heve the burtlen ot proviag that t�e or she did not buiW or improve tor purpose ot saleJ.
❑ I, es owne� oi tha properly, em EXCLUSIV6LY CONTRACTING WITH LICENSED CONTRACTORS to construct the O�oject (Sec. 704d, Business end Prolessions
Code: The comreaors Llcense Lew does no� epply to an owner ol property who bulltls or Improves thereon, antl w�o contrads for such pra�ect with a camractor(s)
license pursuant to ihe Contractors License �ws.).
❑ I am axempt untler sec.
Signature:
Owner ID verlfietl by drivers license. ❑ Yes ❑ No
Business end Professions Code lor ihis reason:
VedBcatlon ol Ownership by (rype ol daument, i.e. - properry tax bill or tleetl):
DriverS LiCense No.
Dale:
Ezpires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CEF7TIFICA770N:
❑ I hereby cehity ihat no excevetion Me (5) or more feet in depth into which a person Is required ta descentl, will be made In cannection with work euthodzeG by this
permii, and that no builtlinp struc�ure, scaffolding, falsework, or demolition or dismantling thereot, vnll be more than t�irty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Celitomia Adminisiretive Cade).
❑ As awner-builder, I will not employ anyone to do work which would require e pertnit trom the Division of Indusirial Safery, es noted above, unless such person has a
pertnit ro do such work Irom the division.
Signature: Date:
Division oi IndusMel Sefery PBrmi1 Number:
CER7IFlCATE OF COMPLIANCE AND AUTHORIYATON OF EN7AY: I certily untler penalry of perjury that I have read ihis epplication end stata thet ihe information given is
correct. I egree to comply with ell stete laws and ciry oMinences releting to building construction, end authonze represen�atives of Ihe Giry of Coste Mesa to enter upon the
ebove-described property far inspection Ouryoses. I agree not to occupy or allow occupency of eny building authorized by this permit until finel inspectlon.
CODE t. INSYELRIONTYPE �
1616 Fized System Final Fire Pi
1268 Pool Spe Finel
200 Final RB-ROo1
201 Flnel BIacWRetaining Wetl
202
203
Finel Fectory Fire Place
Final Sign
204 Final Damolition
1��
�
y00E 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbinq
210 Final ElecMcal
212 Final Fire Praventlon
220
222
250
Final Planning Approval
Final Site
Final Building/Occupency
Q� INi1fI�L5
�% '
'� �
. . .;.. ;�—,
(714� 754-5273 • FeX (774) 7541856 � WWW.CI.COSSe-R1C58.Cd.USLDING PERMIT n FA1H UHIVt, GU51 A MtSA, l:A tlLtiLti
6U1
JobAddress: 2138 IRIS PL
Suite:
Vicinity: ADDITIONS TO iST & 2ND FLOORS
Parcel Number: 42615138'
Applicant: SCOTT, M�LISSA
Address: 488 ABBIE WY
COSTA MESA, CA
Owner: COATSWORTH,KEN
Address 21381RIS PL
Zoning:
Phone: (949) 631-9911
Zip: 92627
' Phone: 949-369-4305
COSTA MESq, CA Zip: 92627
Contractor: PREMIERE WOODWORKS INC.
Address: 488 ABBIE WpY
COSTA MESq,CA
Zip: 92627
Arch :
Address:
Phone: (949)631-9911
License: 619755
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: OS/04/2000
Issued: 03/13/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
� � ADD 452SF TO iST FLOOR "TO FAMILY AND LIVING ROOM", ADD 70SF CLOSET TO THE 2ND FLOOR, REMODEL
KITCHEN AND MINOR IMPROVEMENTS ON THE 1ST FLOOR" WINDOWS AND NON BEARING WALLS."
Plan Check: $412.20
Permit: $634.15
SMIP Res: $4.87
SMIP Com: $0.00
Other: $0.00
Inspection: $D.00
Total: $1,051.22
SETBACKS
MAIN STRUCTURE �Front 0- 0
ACCESSORY Front 0- 0
PARKING ExiStinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$48,646.00
so.00
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undar Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred 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) 7545626 �
2d4646 (&00) ��
WORKERS'GOMPENSAnONDECLARAnON: `
I hereby aRirm under penalty of perjury one oi ihe followinq declaretions:
❑ I have and wili maintain a certificate of consent to self-Insme for workers' compensation, as provitletl for by section 3700 of Ihe Labor Code, for the performence of the �
ork tor which this pe�mit is issuetl.
I have antl will maintain workers' compensation insurance, as required by section 3700 of the Lehor Code, for the peAortnance of Ihe work for which this pertnit is issuetl.
-�My worker5' com ensatiYon Insurance camer and policy number are: �7 (� ('� �
Cartiel: � T[ L�� Policy Numbe�: -U ��oL a J!�
"(71iis section neetl not be camplered i/ fhe pelmit is velued af one hundred dollars ($100J or less.)
❑ I certity that in iha pedormance o( tha worlflor which this permit is issuetl, I shall not employ any person in eny manner so as ro become subject to ihe workers'
compensetion laws of Califomia, antl agree th d I shoultl becoma su6ject to the workers' compensation pmvisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro/v �i�s. p � I2 /` /
Applicant Signetura:- ( /VLL�C,I �Dat�� � � J � U
WARNINGrFAICVRE TO SECURE WORKERS' COMPEN9ATION CAVERAGE IS UNLAWFUL rW� SHALL SUBJECT RN EMPLOYER TO CRIMIWIL PENALTIES M1D CIVIL FINES UP TO IXJE HUNDRED
TFIOUSAND DOLLAPE �5100,00p), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3IO60F THE tABOR COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I.am licensed underRiQv' of Chapter 9(commencing with Section 7000) of Division 3 ot the eusiness an rofessions Code, antl my license is in tull
torce and ettect!Lic..N� i e 1�_l �� �. � _ _, Class a. �
CONSTRUCTION LENDING AGENCV:
❑ I here6y affirm that there is a consimction lending agency for ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lentler'S Name: Lentler'S Atldre55:
Signature:
Date:
OWNER-BUILDER DECLARATIONS: �
I hereby attirm that under panalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant tor such permit
to file a signed stetemen[ that he or she is licenssd pursuent to ihe provisions oi the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 oi the
Business and ProFessions Code) or ihat he or she is enempt thereirom and ihe besis for the alleged ezemption. Any violation oi Section 7031.5 by any applicant For a pertnit
subjecis ihe applicant to a civil penalry of not more ihan five hundretl dollars ($500)J:
❑ I, as owner of Ne properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl Ne sWcture is not intended or ottered for sale (Sec.
7044, eusiness and Protessions Code: The Contrectors License Law does not apply to an owner of property who builtls or improves thereon, and who does such work
himself or herself or through his or her own empioyees, provitled that such improvements are not intended or oflered for sale. It, however, the buildinq or improvement is
so�d wiMin one year of completion, the ownRr-builtler will have ihe burden of proving thet he or she did not build or improve for purpose of sale.).
❑ I, as owner of the pmperty, am EXCLUSIVELV CONTRACTING WITH IICENSED CONTRACTORS to constmct the pmject (Sec. 7044, Business antl Professions
Cotle: The contractors License Law does no� apply to en owner of pmpeny who builds or improves ihereon, and who contracis for such pmlect with a contractor(s)
licensa pursuant to the Contractors License Laws�.
❑ I am exempt under sec. Business and Protessions Code for ihis reason:
Signawre: Date:
Owner ID verifiad by tlriver's license. ❑ Ves ❑ No Driver's License No.
Verification of Ownership by (type of document, i.e. - propeny taz bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certify ihat no excavation five (5) or more feet in tlepth in�o which a person is requiretl to tlescend, will be mada in connec�ion with work authonzetl by ihis
permit, and �ha� no building sirudure, scaHolding, falsework, or demoli�ion or dismantling ihereot, will be more Ihan �hirry-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Celifornia Atlministretive Code).
❑ As ownerbuildar, I will not employ anyone m do work which would require a permit from t�e Division oi Industriel Sefety, as noted abwe, unless such person has a
permit �o do such work from ihe division.
Signature: Dale:
Division of Industrial Safety Parmit Number:
CERTFICATE OF COMPLIANCE AND AUTHORILITON OF ENTRV: I cenify under penalty of perjury that I have read �his application and state thai the information given is
correct. I agrse to comply with all state laws and ciry ordinances relating to building consimction, and authorize representatives of ihe City of Costa Mesa to emer upon Ihe
above-described pmpeny for inspection purposes. I agree not m occupy or allow wcupancy of any building authorized by this permit until finel inspection.
COOE I. INSPELTION TYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Fina1 81ocWRetaining Wall
202 Final Faciory Fire Place
203 Final Sign
204 Final Demolition .
Q� INTRIALS
COOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning ApDroval
222 Final Site
250 Final Building�Occupancy
�a�%3 _
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAlli DFIVE, GU51 A MtJA, l:A 82GZti
ELECTRICAL PERMIT
JabAddress: 2138 IRIS PL
Suite No
Vicinity:
Parcel Nunmber:
Applicant
Address:
Owner:
FAMILY & LIVING ROOM ADDITIONS
42615138
SCOTT, MELISSA
488 ABBIE WAY
COSTA MESA, CA
COATSWORTH,KEN
Address 21381RIS PL
COSTA MESA, CA
Phone: (949) 631-9911
Zip: 92627
Phone: 949-369-4305
Contractor: PREMIERE WOODWORKS INC.
Address: 488 ABBIE WAY
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors ta 1hp
Motors to 70hp
Motars ta 50hp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
COSTA MESA, CA
Zip: 92627
Phone: (949)631-9911
Zip: 92627
License: 619755
ISSUED BY:
Status: ISSUED
Applied: 03/13/2007
Issued: 03/13/2001
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR ADDITION 8 REMODEL OF EXISTING SINGLE FAMILY RESIDENCE.
INSTALL 6 LIGHT FIXTURES, 12 RECEPTACLE OUTLETS, 8 6 SWITCHES.
REF:B00-01191
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$6.60
$13.20
$6.60
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
Quantity
0
0
0
6
12
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /700 R
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
........._._..up to 10�kva/kw , .
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment �
Low Volt Wiring System / Ckt
Misc. Conduit
Misc Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Chrislmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$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
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 549.90
COMMENTS / SPECIAL CONDITIONS
NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred 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) 7545626 /
2446-46(fi/00)
WORKERS' COMPENSATION DECLARATION:
I hereby aHirtn under penalry of perjury one of the foilowing tleclaretions:
❑ I have entl will malntain a certificate of consent to self-Insure for workers' compensation, as pmvidetl for by section 3700 of the LaDor Code, tor the petlormence of the
work for which this Dermit Is issuetl.
6have and wiil maintain workers' comoensation insurance as requiretl by section 3700 of the Labor Code for the dormance ot the work fo h' h Ih'
antl policy number are: ' � r w ic is permR is issuetl.
Policy N� umber: `�D 1 5�,g �� b
� velued e! one hundred dollars ($100) or less.) "
❑ I cetlity ihat in the pertormance of the work for w�ich ihis permit is issued, I shell not employ any person in any manner so as to become subject to the workers'
compensation laws of alibmia, and agree ihat if I should become subject to ihe workers' compensation provisions of Section 3700 of ihe Labor Code, I shall forthwith
comply with these pr i�ons
r--.,_- _.-..-.`—. _ � 2
AppliwntSignature: L (Date: . �- J �, � ' Q �
WARNING: FAILURE TO SEWRE WORNERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLURE ($100,000), IN A�DITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVI�ED FOq IN SECTION 3]O60F THE LABOR fAOE, IM�EREST, AND ATTORNEV'S FEES.
LICENSED CON7RACTORS DECLARATION:
I hereby aflirm ihatd�am�iicensetl u tle prfl.�isi ns of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full
force antl eNecL Lic..a-�� t..Q �� l�S � .� ,_ rClas� F�
CONSTRUCTION.LENDING AGENCY:
❑ I hereby aHirm that there is a constmction lending agency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lenders Adtlress:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affi�m �hat under penalty of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reason (SecJ031.5, Business antl Professions
Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit
to file a siqne0 statement that he or she is licensetl pursuant to the pmvisions oi ihe Comrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Cotle) or that he or she is e:empt �herelrom end iha basis for the alleqed exemption. Any violation of Section 7031.5 by any applicant for e permit
subjects the applicant to a civil penalty of not more than tiva hundred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO 7ME WORK, and the stmcWre is not intendad or oHered for sale (Sec.
7044, Business and Pmfessions Code: The Contraqors License Law does not apply to en owner of property who builds or improves thereon, and who does such work
himseN or herseli or ihrough his or her own employees, pmvided that such improvements are noi intended or offered for sale. If, however, the building or improvement is
sold within one year of completioq the owner-6uilder will have the burden of proving that he o� she did not build or improve tor purpose of sale.).
❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Profeuions
Code: The contractors License Law does nol apply to en owner of property who builds or improves thereon, and who conlracis for suCh project with a contractor(s)
license pursuant to the CONractors License Laws.).
❑ I am exempt under sec.
Signa�ure:
Owner ID verified by drivels license. ❑ Ves ❑ No
Business and Professions Coda for this reason:
Verification of Ownership by Qype of document, i.e. - property taz bili or tleetl):
DIVISION OF INDUSTRIAL SAFETY PEFMIT CERTIFICATION:
Driver's License No.
Date:
E:pires:
❑ I hereby certify Ihal no excavation five (5) or more feet in depth imo which a person is requiretl to tlescend, will 6e made in connection with work aut�onzetl by this
pertni�, and that no builtling structure, scaHoltling, falsework, or tlemolition or dismantling Ihereof, will be more ihan thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitomia Administrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom ihe Division of Indus�rial Sa�ety, as noted above, unless such person has a
permit to do such work trom Ihe division.
SignaWre: Date:
Division of Indus(nal Sefety Permit Number:
CEfiTIFICA7E OF COMPLIANCE AND AUTHORVJITION OF ENTRV: I certify untler penalty of perjury �hat I have read Ihis epplication and stale Ihat the infortnalion given is
correct. I agree to comply with all s�ate laws and ciry ordinances relating to building wnstrudion, antl amhonze representatives ol the Ciry of Cos�a Mesa to enter upon �he
above-tlescribed property for inspection puryoses. I egree not to occupy or ailow ocapancy ot any building authorized by this permit until final inspection.
Owner(s) � / ? [�ate /
7 �J �
Applicant (Data�--�
COOE X, INSGECTIONTYPE Wg URII1P1¢
1616 Fizetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
E 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildincyOccupency
PdIF. I+LT�ELS
F37 c �IJ�I�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 2138 IRIS PL
Suite No
Vicinity: FAMILY ROOM ADDITION
Parcel Number: 42615138
Applicant: SCOTT, MELISSA
Address: 488 ABBIE WAY
COSTA MESA, CA
Owner: COATSWORTH,KEN
Address: 2138 IRIS PL
COSTA MESA, CA
MECHANICAL PERMIT
Phone: (949) 631-9911
Zip: 92627
Phone: 949369-4305
Zip: 92627
Contractor: PREMIERE WOODWORKS INC.
Address: 488 ABBIE WAY
COSTA MESA, CA
Arch / Eng :
Address:
Phone: (949) 631-9917
Zip: 92627
License: 619755
Phone:
Zip:
License:
9
Status: ISSUED
Applied: 03/13/2007
Issued: 03/13/2007
ISSUED BY: _��
SCOPE OF PERMIT
MECHANICAL PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE.
INSTALL 1 GAS PIPWG & 1 FACTORY FIREPLACE.
REF: B00-01191
ISSUE FEE
Inst FAU <100 k BTU ,
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU ,�
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 70000cfm
Floor Fumace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$6.15
$ 7 0.65
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$o.00
$0.00
Quantity
FEE SUMMARY
Repair/AltAbsorbtion Unit "
Repair / Alt Refrigeretion.Unit
Ventillation System '
Evaporative Cooler .
Commerciallncinerator . �
Domestic Incinerator
Compressors / Absorption Svstems
Upto3hp/100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU �
30 To 50 hp / 7,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3Toi5hp
i5to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
Quantity
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$40.30
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 780 days, or if work is suspended or abandoned
for a period ot 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 Inspections and final approval must be obtained. Failure to obtain inspections and final appr6val will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 /
2446-46 (NW)
WORKEHS'COMPENSAnON DECLARAnON:
I hereby aHirm untler penelty of perjury one of the foliowing declarations:
❑ I ave and will maintein a certificaie of consent to self-Insure Por workers' compensation, es provided tor by section 3700 ot the Labor Code, for the performance oi the
_ work tor which this permit is issued. .
and will maintain workers'
not
� insurance, as required by section 3700 of ihe Labor Code, for the pedormance of the work for which this pertnit is issuetl.
and policy numbe� ere: .,/.�-�-�� / .�C
Policy Numher: ' :i� � � � V �7 Q� �/`� � y� �
; velued ef one hundred dollers ($700) ar less.)
❑ I certify that in the pedormance ot the work tor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compansation laws ot alifomia and egree Ihal if I ould be e subjec� ro ihe workers' compensation provisions ot Section 3700 of the Lebor Code, I shell forthwith
—c,omply with ihese pro s ns. ,`
ApplicaniSignaWrei� � � Date: �� 1� U/
WAiiNING FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFIIL AND SHALI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($10D,000), IN ADDITION TO THE COST OF CAMPENSATION, DAhL1GES AS PROVIDED FOR IN SECTION 3�O60P THE LABOR COOE, INTEREST, AND ATTORNET"S FEES.
UCENSEDCONTRACTORSDECIARATION:
1 hereby affirm IhaLl.am lice ed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot�lhe.Business Professions Code, and my license is in full
torce antl ettect�.lic..N%�`. �D ��t i 5-S„ i/� � �Class # �
Contractor's 5gnature`T 0 b bt4 ^ c)� �ate: � U 1
CONS7RUCTION LENDING AGENCV:
❑ I hereby attirm Ihat ihere is e consiruction lending agency for the pertormance oi the work for which Ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Address:
Signalure: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aHirtn Mat untler penalty of perjury thet 1 am EXEMPT FFOM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professions
Cotle: Any city or county which repuires a permit to constmct, alter, improve, tlemolish, or repair any stmcture, prior to i�s issuance, aiso requires the applicaN for such permit
to file a signad statement Ihet he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Seaion 7000) of Divlsion 3 of the
Business flnd Professions Code) or that he or she is ezempt therefmm and the basis for the elleged exemption. Any violation of Section 7031.5 6y any applicant for a pertnit
subjects the applicant to a civil penalty of not more than five huntlred tlollars ($500).):
❑ 1, as owner of the property, or my employees with wages as iheir sole cortipensation, WILL DO 7HE WORK, and Ihe structure is not intended or o%ered for sele (Sec.
7044, Business and Professions Code: The Contrecbrs License Law tloes not apply to an owner of property who builds or improves �hereon, and who does such work
himself or herself or through his or her own employeas, pmvided that such improvements are not intendetl or ofterad for sale. If, however, ihe building or improvement is
sold within one year of completioq Ihe owner-builder will have the burden of proving that he or she did not build or improve for purpose ot seie.).
❑ I, as owner of lhe property. am EXCWSIVELY CONTRACTING WITM LICENSED CONTRACTORS to conshuct ihe project (Sec. 7044, Business antl Professions
Code: The contractors License Law tloes not apply to an owner oi propetly who builds or improves ihereon, and who contrads for such project with a contractor(s)
licensa pursuant to the Comractors Licensa Laws.).
❑ I am exempt under sec.
Signa�ure:
Owner ID verified by driver's license. ❑ Yes ❑ No
Busin855 and Protessions Code tor this reason:
Verification ot Ownership by (type of tlocument, i.e. - properry tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
DriveYs License No.
Date:
Expires:
❑ 1 hereby certify ihat no excavetion five (5) or more teet in dep�h into which a person is requiretl to descentl, will be maae in connection with work authonzed by ihis
permit, and ihat no building strucNre, scaHoltling, talsework, or demolition or dismamling ihereof, will be more than thirty-siz (36) feet high. (C�ap. 3.2, Grp 2, Art 2, Sec.
341, Ttle 8, Califomia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industriel Safery, as noted above, unless such person hes a
permit to tlo such work trom the division.
SignaWre: Date:
Division of Industnal Safety Permit Number:
CER7IFICATE OF COMPLIANCE AND AUTTfORIZATION OF ENTRY: I cetlity untler penalty ol perjury that I have read this application and state that the infortnation given is
correct. I egree Io comply with all state laws and city ordinances relating to building consimction, and authorize represematives of Ihe Ci�y of Costa Mesa �o eNer upon Ihe
above-describetl property for inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permii until finel inspection.
CODE � INSPECTIONTYiE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Ra-RooF
201 Final BIocWRetaining Wall
202
203
204
Final Fectory Fire Place
Final Sign
Final Demolilion
UA
IIRRI�LS (CJOEt INSPELTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Elecirical
212
220
222
250
Final Fire Prevention
Final Planning Approval
Final Site
Final Building/Occupancy
!6 Z
FflOJEtT AUOflESS: � 1 3 8 I R I S PL
OWNEP'S NAME: SORENSEN GLEN
nooRess: 2138 IRI� PL
COSTA MESA,CA
pBCHIENGINEEH:
ROUHESS:
UNIi:
92627
flEG.NO.:
UNIT:
PEFMITTEE: GLEN SORENSEN ( 714 ) 646-4104
aoosess: 2138 IRIS PL
COSTA MESA CA 92627
LICENSEO CONTBACTOB OECLABATION: I �er¢by a�lirm t�at I am IicenseE unGer D�ovisions of Chap�er 9(wmmenting wii� Section
70001 0l Orvision 3 of Ine Business antl Proiessions COOe, ane my license is in luil farce anA eilect.
CITY UC.: STRTE LIC.: CIASS:
Oate: Signaiure:
WOflREBS' COMPENSA710N OECUflFTION: I �ereEy aflirm ihal I have a ceniliWte of consent to selbinsure or a cenilicate of Warkers'
CAmpensdlion Insurance. or a ceniliea coDY �hereof (Section 3800. Lab. q.
POIICY NO.: EXP. ORTE:
COMPRNY:
� Cenilie0 copy is here0y lumis�ea. ❑ CertifieE coOY is IileA wi�� t�e city BuilUinB �ivisron.
Date: AD�IicanC
EXEMPiIONFBOMWOBNEflS'COMPENSRTIONOECLAflPTION: (ThiSstttionnee0irolbecompleteEilthepermiti5loronehmkre0�5700)orless�.
I cetlity �hal in �he pedormance ol Ihe work lor which Ihis �ermi� is issued I shall not employ any Derson in any manner 5o as lo become
sublecl lo Ihe Worker5' Compen5aiion LawS 01 Calitornia.
Date: Signature:
NOTItE: If. atlei making Ihis Eeclaration, you shoulC Eecome sublect to Ne Worke2' ComDensalion pmvisions ol t�e Labor
Code, you mus� Iorthvni� compty wiill sut� pmvi5ion5 or IOis permii s�all Oe GeemeU revakeA.
CONSTHUCTION IENUINC RGENCY: I �ereby atfirm I�ai ��ere is a conSlmciion lenaing agency lor Ihe De��ormance ol the woB �or
whicn I�is permil is issue0 (Seciion 3097. Civ. C�.
LEN�Efl:
aoon[ss:
OWNEP BIIILDEfl DECLANATION: I �ereby affirm ihal I am e�emp� irom �he ConVactors' State License Law �or Ihe lollowing reason
(Section 7031.5 Business anA Pm�essional COAe: Any ciiy o� coun�y which repuires a permil ro constmc�, alier, impwve, tlemolish, or
repair any stmcWre, Orior to its issuance, also requires tAe apP�icanl br such permil ta lile a signeC statement that he/she is license�
pursuanl to Ihe pravisions ol Ihe Camratmrs' Sta�e License Law (ChaD�er 9(commencing wilh Seclion 7000) ol Division 3 0� Ihe Business
and Prolessions Code) or I�at he/s�e is e�em0� Iherelmm antl ihe basis lor ihe allepe0 e�emption. Any violalion ol Section 7031.5 by
any aDP�icanl br a permil suojects the apv�icanl lo a civil oenalty oi not more than live nundreJ dollars (5500).
I, as owner ol Ihe pmpetly o� my employees wilh waAes as I�ei� sole compensation, will Oo the work, ana �he
❑ slmclure is not inten0etl or ol�erea �or sale (Section 704a, Business and Pmfessional Code: T�e Contractors' State License Law
tloes nol appty ta an owner ol a pmpeny wno 6uil�s or improves inereon, and w�o tloes such work himsell/Aerself or tAmuAh
�is or her own employees. pmvitletl Ihal such impmvemenis are not imentletl or offere0 lor sale. II, however the buil0ing or
impmvemeni is sold within one year ol completion. �Ae owner will have Ihe burden ol pmvinp �e/she tlia noi build o� impmve
br t�e purpose ol 5al¢�.
I. as owner o� Ihe D�oOetly, am exclusively coniraC�ing wilh licensetl con�raCiors l0 tons�mc� I�e pmleC� (SeC�ion 7044, Business
❑ ana Pm�essions COJe: The Coniractors' Slate Litense Law tloe5 no� appty Io an owner 0� pmperiy who Duilds or imD�Oves ihereon
and wh0 tonlraclsior SUC� D�ole�ts wilh a tonlrat�oq5�litense pursuanll0 Ihe Canlratlors' Siale LicenSe Law),I am aware
�ha� pmol ot I�eir Warker's Compensatian insurance shauld �e pmvitled Io me.
� i am exempt under Sec�ion: B P% O 4 4 B. 6 P. C.
ror tnis reason: BY OWNER
_ G'
�aie: `S � ' (� �'nec �
I tlo here�y cenify Ihat I am aware o� antl untl¢rs�ana Ine requiremenis o� Cali�or a Healih ffiU ¢�y Cotle S¢ction5 255Q5, 255 , antl
2553<an0l�ai I or any IUWre buil0ing occupant vnlllwill not (circle one� n¢eU lo comply with said stale cotles antl ihe repuiremen�s �or a
permit for consVuction or m04ificaiion Imm Ihe Air Oualiry Managemeni DiSificl. Fevdential wn5imction apDlita�ions are exemp� tmm
Ihese pmvisions.
Oate: FpWicam:
I hereby cenAyl�ai Ihavereatl Ihis applicalion antl slale Ihai IAe aDov inlormalionis rrecl.lagree to campiy wilh allcily and county
ardinancesandslatelawsieWling�obuiitlmg[On9ruclqnaMhereGya iiereprese ai esoflksci�y�oenterupontheabove�meniion¢tl
pmpe�y b�inSDeciwn purpases
Daie' S _' (_� SignaWre:
Oriver's Luense or Social Secwily r:
i6d��a6 W�i�e—Bwlei�: Green—Coae Enlarcemem: Canary—Applicanl; Pink—Rovenue: Goldenroa—Assesmr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IB 05187
PERMIT NO; IH 051879 PLAN CHECK NO; N GOVT; N SUPP: Y
CONSTRUCTION TYPE: 5—N PERMIT TYPE: OTH STA PURPOSE: OTH
JOB DESCRIPTION ;"COMPLIANCE" INSPECTION ON PATIO COVER SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC; R-3 /
COMMENTS: CHECK RE�UIREMENTS TO LEGALIZE PATIO COV
�r�t�t*�r�r+r*******�t**�t �*�r*****+t�r+t*r**�**�r*�r*���*�r*�r�r*�r**�*�r�r**���r+t�r**�r�*�r*��r+�*�t+��r*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ HAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42615138 ZNE: REF NO:
PLANNZNG NiSl'ES>
i
*�**�r�t*�r**+t�r�r+t��t�t*�**�t�t�t��t�rx��r*****��t,r�r«��e�e�ex***�r��r*�r,r*�r+�+�*�*��r***�r**�r*+t�e+r�t�r��t�
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 HY : ... /-1 ,.., A DATE•
APPLICATION ISSUED
fE if iE �F jf if iE �k if �f iF iE 1k if ikif if if if
fE if iE ii iE jE iF 1f �F 1f �flt iF i! k iF M if ff
LEGALIZATION:N
BLDG PMT
PERMIT 30.00
DATE:
ififltiFiFiFitlfiFlfiFitiFiFifiFififitifikif iF iflEiFififMiFitlflEikiFitifiFiFiE�F1E�E�E1liEiFiFiFiE�Ekifif�fif
F E E S U M A R Y STRUCTURAL SEGMENT:Y
PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 30.00 0.00 0.00 30.00 30.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 30,00 OVER/SHORT: ,00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30.00
iE IE iE iF if ik df if iFif iF iE iFikik iF aF iF k if if 1F k if iF if 1f ik 1f if M iE if iE if 3F ik IF ib ik 1F iF af if 3F 1E if k �E k if �F �E if iF 1f iE �k �F k�E fE iE aE if 1! iF iE M k iE iElf iE if if iF lE M
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
INS 1 BUILDING RE—INSPECTION FEE 30.00 30.00
END OF FEES
�' :.LE5:.9� ::'" _ "� - ,.
,.,T�: C"_ ./ .. . .. _ .. .
CONSTFiUCTION AND PLANNING PO� , SPA .
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipmen[ Location .
_�.- Spil Pipe-Undrgrnd,� 53. Steel Reinforcement ',
�' :
-��3.�Efectrical Conduii.UJility-Undrgrnd. 54. Forms , �
'•4. Nectrical Conduit=Undrgrnd. 55. Electrical Bonding
.,, '.
���5.`:St�eel Reinforcemen{� 56. Rough Plumbing & Pressure T.es�`
.
-: 6. �Electriwl UFE'R'Grfid. 57. APPROVAL TO COVER�GUNISE -
� - . r�
�.7. Footings �`� 58. Electrical Conduit-Undrgrnd. ^ "
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �,�-
9. Water Pipe�U�drgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floo� System 61. APPROVAL TO DECK
11. Property Sewer Linf& HouseConnection 62. Backwash & Receptor-Final
12. Sewer Cap _•,� 63. Heater & Vent-Final ""
13. RooF Oralns �� 64. Plumbing System - Final '
14. Rough Plumbitig " 65. Electrical-Final '
15. Rough Electriwl�Conduit 66. Solar System-Final
76. Rough Elearic Wiring 67. Fencing & Access Approval ,
17. Rough Wiring Sign 68. APPROVED FOF PLASTERING
1 B. Rough Electrical�T Bar Ceiling 69. POOI(SPA SYSTEMS FINAL �
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - - - - ,r-x� - • -
20.�Aough Factory F.&eplace �'tt�7 e:'] ♦ _ ' �� �i �� �qpPROVAIS �=-Per,mit # * " `
4' > O.' .0 �:f- t Sb' �1;�� .t ' 7'.t. a' ' h: T.;r�{_. y n - �u
21.''Ducis, in,Struauee:. � �'� .••�'�- ,. ' -' � ' � _.. � �� ; �
� • -+_. ��� 7 .r � 2 -!70. Undergraifnd Hydro :
22. Duc�fs, Vent41atirig� � ' t: 5'� _ �� S K�r -� ?��, produc�epfng C3�Gas D,OiI
n , r.
23.[Gas Pipe�Rou9h $"fest � ;;y ; Y C,; � ,-,� ,�, _7y, Underground Flush�i_ �. -
24: Roof Framing �%�r : F(- ^ ! �� C o' ��x. �r �73!�Undergrnd�.Stora�gg.,T�nk�Gas ❑Oil
f:' •�[". f ^> T, w-1 �
25. Roo Sheathin � 2 �' "� '� - = ` �' � --`' ',�
1 9-v� � „�� y �, j x. T 74; Oyerhead �-lydro�
26� T�Bzr Ceiling (Stiuctural) &1vl�nocoat •e �D C ;a; r 75,?.Dry Chemical +� - - '�
27; =Frame and Flashin ' '1` • '�' ' � � "' ` � "'
�9. .•�� �. y . , 76:�DryStandfilyie _M �:'
-���.. -' ` -
.-28.L Lathinq & Siding� � '- . ��*L '�. ': �' �• "r r %%;T FIXED SY$TEIV�,�FINACr� �_ _ �.
�29. Insulation ��; ' S ,' � � � �`. r 76sPIRE PREV. FINAi :�.;> �c
��30. DrywallNailingr�. � �� ; ' �x; � HE,ALTHDEPTFREQUIREMENT
;-'31. Plaster Biowa Coat;, S ; rz, . � :' �i �.79 'FINAL IfYSP_ECTIQN '' ` '� S
�-�32.-Electrical Power PileteP.Final: y� �.c �/ x.� +�SO.rF00D CERTIFI.Ct�TE ISSUED 7
.r
.r33:cFinal Eleciri�, r: ' ;� � ' "'' �No�es: - �F' �' _ '_�
r .ir �r G 'r.
�. .� . � .., :�, ' ,. _ ,�, , _. , -
:1,34; Finai Heati�g:& Air,.Conditionigg; � t. � 4� • � . �; . '�= r . _
�. �.r .
n35:'_Final Gas Pipe-Testt �= ' � ' '' �*' �1 =? ''_�� M -
�� I � a ,.o t^ ,..
., _' .. ; - , . . - . �r • i • �
�,36. Hoad o%Canopy- � ; M•., ��. � ; , � I � � r s ^o + '�� ^
- - l IY : r. rt�
"37 �Final F�ctory FireP7aEe _ ' ` �`� `� � ' � ' + ' ,. R F �' " `'
r � rF t L' K D•
' - U. � .. .. .� - .. _.� , -..
�38. Final Plumbing -� i ; �t �. �� �
:�39. Wat87 Servic6'Finalt. -' � n r ' � '. . , . w � - o:
?: t� �r r
�40. Gas'Service�Final ; � ,y_ � r r �i � fF �> �.o o � ..
:A1. Solar pomesticFinal � :"� � •• � C � {t �+' `t. % .- t I
Y 1 ' tP . r �T 1.'
`42.-Backflow Preventer; '� „i � l � �. .y� �.:; � = x �
43. Backflow Irrjgation� �''� - f u ? f _.. • � •.
7;(: e . `,
��44. Landscape I�r•igation System,��i�:� i. � �r r �: 1, r�; i��: • ,U c�
45.=Sound Atterivation ��Ci- o" i 4 E- -' ^+ '� `K's -
�' t!� 4 �" �T -� �
_46:;Handicap, Regulations � ,j � � 1 � ; ' � - � - .
47rFINAL STRUCTURE & BUILDING � ��� � �� 3 -
- r t. p ' �-
148._FINALPLANNING � �'�'. � ; � ' � : '
E - � .i. Y '
"' '" '_ _
:49. �Electric Release to�Edison � a I �- '.� + - u; �. ..
. '
-50. Gas•Release Co Southern California Gas Co x I � ..- ` , •
�
.51. CERSIFICATEOF_OCCUPANCY ; i Y ,;, ��r ,� � , _
No Date
PflOJELT FDUflESS: Z 1 3 B I R I S PL
OWNEfl'SNRME: SORENSEN GLEN
RDOHESS: Z 1 3 B I R I� PL
COSTA MESA,CA
646-4104
pqLHIENGINEEP:
AOOflESS:
UNIT:
92627
flEG.NO.:
UNIT:
I F
PENMITTEE: GLEN SORENSON ( 714 ) 646-4104
aooness: 2138 IRIS PL
C.M. CA 92626
LICENSEO CONTflRCTOP OECLABATION: I hereby alfirm tha� I am licensed unUer Dmvisions ol Chapter 9(commencing wi�h Section
70(ql ol OiviSion 3 ot Ihe Business antl Pmlessions CoAe, antl my license is in lull lorce antl efieq.
CRY LIC.: STFTE LIC.: CIASS:
�ale: SignaWre'.
WOflNEHS' COMPENSATION OECUBA710N: I �ere0y affum that I have a cehilicate of consenl to sell-insure or a certilicate ol Workers'
Compensation Insurance, or a cenilie0 coov �hereof 1Section 380�. La6. C).
POLICY NO.: E%P. DPTE:
' COMPANY:
� Cetlilied copy is hereby 7umishetl, ❑ Certilied copy is IileO with the cny BuJOinB avision.
�a�e�, Applicant:
E%EMPTION FflOM WOBRENS' COMPENSATION OECLANNTION: (This seciion need not Ue compleietl il �he Dermit is forone hunAreO (3100) or less�.
I cetlily I�al in �M1e Oedormance ol the work �or w�ich Inis Dermil is issuetl, I shall nol employ any Oerson in any manner so as �o Lecome
su0jeci lo I�e Workers' Campensalion Laws of Calilomia.
Da�e: SignaWre:
NOTICE: II, alter making I�is Aeclaration. yau should �ecome 9ubject to I�e Worke�s' Compen5ation D�ovisions of Ihe Labor
Code. you musl lotl�wi�h comply with suc� pmvi5ions or thls p¢rmit shall Ue 0¢emeC revokeA.
CONSTflOLTION LENUING RGENCV: 1 hereby allirm Iha� there i5 d consimc�ion lending agency br �he p¢Aormante of l�¢ work �or
w�iGl I�is De�mit is �55uG0 (SKiion JQ37. Gv. C�.
LENOEfl:
aooeess:
OwNEB BWLOEB oECUFR7lON: 1 hereby aflirm tAal 1 am exempi imm Ihe Coniracmrs' S�ate License Law Ior ihe lollovnnp reamn
(Section 703L5 Business antl Pmlessional Cotle: Any ciiy of county whic� r¢quires a permil to conslNct, al�er, imprwe, Oemolish, or
repart any slmclure. piior lo ils issuance, also requires ihe applicant lor sucn permit to file a sipnetl statement Ihat he/sne is licensetl
pursuant to t�e provisions oi ��e Coniracmrs' Sla�e license Law (Chap�er 9(commencing with Section 7000) of Oivision 3 0l lhe Business
anG Prolessions Cotle� or t�at �e/s�e is eKempllAerelmm ane I�e Gasis for Ihe alleged exemption. Any violaiion of Section 7031.5 6y
any aDClicanl lor a permit su�iects �ne apvlicant to a civil penalty o1 no� mote ihan five hunOretl Oollars (350111.
I, as owner of ine Droperty or my employees with wages as Iheir sole comDensation, will do Ihe work, antl ihe
�I ❑ SimcWre is nol intended or olleretl for Sale (SeC�ion 7044, Bpsine55 an� Professi0nal Code: The Con�racrors' State Litense Law
tl0e5 nai apply lo an Owner o� a pmpetly who huilds orimOrov¢5 �h¢reon, an0 who tloe5 suCh wolk �imSeltlher5ell o! IhroUAh
nis or her own emDloyees, provided Ihal such impmvemen�s are not intenAed or alleretl for sale. II, however tAe �uiltling or
impmv¢menl i5 5010 wi��in One year o� COmp�¢tion. ��e owqer will have Ihe burden ol proving �e/She tlid noi builtl or imD�ove
for ihe ourpose a� salel.
,y I, as owner ol Ine pmpeny. am exclusively coNracting wilh Ilcensed coniraclors to canslruct the proiecl (Section 7044, Business
C7 antl Pmfessions Cotle: The Comraclors' State License Law Ooes nol aODly to an owner oi Dropetly w�a �uilds or impmv¢s tAereon
antl who mmracis �or suc� pmjecls vn�� a comrac�oqs)lic¢nse pursuanito lhe Coniractors' Slate License Law�. I am aware
ihat o�ool ol ineir Worker's Comoensation insurance shoultl Oe pmvi�etl �o me.
� I am exempt untlor Saclion: B. 8 P, C.
br Ihis reason: �
Daie: � Owner �
I eo hereby cenity m I am a are ol and under5land I�e requiremen�s ot Calilomia Healih anG Sa�eiy Co�e $eciions 2550.5. 25533, an0
2553d antl Ihal I or ny fuiw¢ �uilding occupant willlwill noi �circle one) neetl �a comply wilh saitl slale cades an0 Ihe requirem¢nls �or a
permii �oi cans�mtlion or moEilicaiion Imm Ih¢ Air Ouabry Manageln¢n� �iSIriCI. flesidential cOnSimtlion ap0lita�ion5 ate ¢K¢mpi �mm
ihese pmvisions.
Dale: Npplicanl:
I here�y terltlylhai I �avereaU�his aOV�icalion an Iale�hatihe aUpvein�orma�i0n ' OrreCi. lagree l0 tomply wilh allCiiy an0 COuniy
ordinance5and5�alelawirelalinglo0uildingcon uclionanahereDyduU�¢nzerepr¢ Ine5ol1hi5ciryroenle�upontheaDove�mentmnep�
pmperly br mspeclmn urposes. �
Oaie: � � Signature: �
od�ets �mense or Sociai secudiy x:
t6<L46 WM1ite—BuAtlmgl Green—Cade EnlorcemenL Canary�qppli<anL Pink—Revonue: Goltlenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT �EA� ,
PERMIT NO: B 051948 PLAN CHECK NO: 01562-91 S I �VT�SIIFF�—
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION ; 308SF SOLID ROOF PATIO COVER S() FT; 308
CLAIM VALUE: 3,000.00 CALC—VALUE: 4,250.40 GROUP OCC: R-3 /
COMMENTS: X
*****�*��r�r*���****�t*�x��*�t*****�t+t*****�r*****�*+r+��t�*+���r**x **�r*�r�r�*�r��t******��t**�r
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUZLDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: � FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42615138 ZNE: R1 REF NO:
PLANNING NOTES> RETROFIT EXISTING PATIO COVER, ONLY.
�
iF�E �f �f iF jF iF iE af iF iF iF M iF K iE k if If IF iE �f ik iE iF k iE 3E1E 3F �F �E if IF iE if IE 1f 1E iE if iF!! 1f iF if iE if �f IE 1E ik iF iF iF iE iE �1F iE fF #E iE if� iE �f IF * aF if iF iF 1F iF 1F 3f iE IE if if
D E V E L O.P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY C1 C. DATE: S�v
HUILDING APPROVED BY e DATE:
APPLICATION ISSUED BY: %% DATE: ���
iFiEiElEk3fiEiFifiFlFlfiElElFifkMiFMklFiFiFiFiFiF3FiF�flFiFiF iFiFifTfTfiFif7FiEiFiEiEaEifkififik iF3f
iF 1E �f 1f iF �F IF iF If 1t 1F �1(� iF IF if if if if iF M!F iF if 1F iF iFif ik ik iE iE 1E 3k ik 1E 1f if M ik M M k iF aF ik ik 3f iF iE iE if 1f lE iE �E 1ElEiEiF IF if k 1FjF if iEiF if iF If iF �F iF if k ik iF �F 3f
LEGALIZATION:N F E E 5 U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 ,50
SMIP/NON—RES
PLAN 46,80 -
ISSUE FEE
BUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID . DUE
TOTALS----> 72.50 0.00 46.80 119.30 119.30 .00
REVENUE DIVISION TOTALS--> COLLECTED: 119,30 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
72.00 .50 46.80
iE 3E *�E iF if iE 3f iF if 3F iF iF iE k iF iF iE IF M 1f iE IE if if if aE if if iE If 3f if iE iF i(� IE iP M if iE k aF iF if if iF iE 3f iF iF 3f iE iF iF iF aE IEjE k 3F aFik iF IF iE �E �E iE if IE iF iF if iF k if �E �f
I N D I V I D U A L F E E B R E A K D O W N
�TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 308 RES—PATIO COVER—POST S SOLZD ROOF 13,80 4,250.40
END OF FEES
a: aanaEa3.-co�aabaa i �-+-; �. --
DATE: ±iS/Ob/9i T'ii,t: Ste;2 • •
CONSTRUCUON ANDPLANNING PO� .SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Serviceor Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
.� 3` Electrical Cond,uit Utility•Undrgrnd. 54. Forms �
•" `4. Electric9l Conduit�Undrgmd. 55. Electrical Bonding
.�5 �Steel Reinforcement 56. Rough Plumbing & Pressure Test
' 6.�Electrical UFER�Grnd. 57. APPROVAL TO COVER�GUNITE �
��7 Footings �-q' 6'(,�/ 58. Electrical Conduit-Undrgrnd. •'
!�8. Foundation 59. Gas Pipe, � Undrgrnd., Test ,
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Und�gmd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
72. Sewer Cap 63. Heater & Vent-Final
�
13. Roof D�ains � 64. Plumbing System - Final �
14. Rough Plumbing rt' 65. Electrical�Final
15. Rough Electriral-Conduit 66. Solar SYstem-Final �
16. Rough EleCtric Wiring 67. Fencing & Access ApProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elecirieal�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- ' - - - - �,n � �. .
20�,Rough�F.acfoiy Fireplace � �.* : : =' - =r � �^ .'AppROVALS�,�Pe`rmit # `
r .t. * .��' ` ,: -�. �
21:. Ducts, in Stcucture �'.. ^. .� � ti - �; , r'` 70. Underg`iou d Hyiira �
22. Ducts, Ventilating> � 7? � � S? '; 7}, �produci P.ipin �� as OOII
. r r.. y. r-. 9 .S?
23�Gas,Pip���Rough &;Test ' r� �. .:� � t ;� � ,, 72. Underg ound F�usfi � � .
24; Roof Framing � . - f'� _� '- ^ - �.� � c.73! Undergrn'd.Storage.�ank'�Gas OOiI �
25. Roof Sheathing ` T :�' ' *• :.',7 � L' `;; -' " •" - _ -
d r j . x 74..,;Overhead Hydrm,
26. T-Bar Ceiling (S[ructural) &;Mo�ocoat,r v. � n j �rl *'• 75.T. Dry Chemical � _- -
� r� r
27'. Frame and Flashing :,� j- ;� - 9� ,`', �. R � 76.'�Dry�Stan�pipe •: '- ,� �
.. 28. Lathin`g:& Siding x . �K;.,_ ^ :� � }: �• - 77? FIXED SYSTEM;FINAL_'
„
..29. Insulatibn ' _ .... �=• �• ,; . .. , • . .
. � ;, � 78; FIRE PREV. FI�NAL � -
. �
��30. Drywall:Nai�ing � -. ( � j� r •� HEALTH�DEPT.iREQUIREMENT
31. Plaster,8rown Coat� � " ` � �; fi . 79� FINAL INSPECTION ' ;� '
�r
- 32. Electrical Power Meter�Final f;• , ' f� .� �80:.FOOD CERiIFdCATE ISSUED
.33;�Final Eleciric " � � ' �;" _
� i• t�' '� � ' NOteS: '? � �
r" 34.� Fir�al HBating & Air Conditioning� ; ;,'' �,� � ' � '� � ,y- � ^.�r ,� ; '_
� �. ` �
35''Final Gas Pipe-Test _ �` j � �• ' '�� ,; .. .
- � l� ~ .�� c � .`�Z�
. 36.'Hood or CanoPY � . ' i . - � - - � . �. �1 [ ;m � . �
37-.-Firial Factory Fireplac j � �t" �, t � � ' ^
e
.. s� �. � .. .. . �o << �, �
' 38.-Final PlVmbin9 . ��i � . ' r r i r . '
"�397�Water Service��Final i " 7 � � � . � . •
, 40�. Gas Service,Final ; , . '", .�� . 4 '��, � . "
�:4L�Solar DOmesticFinal� •• �! _ � ? ��+' �
y I .r. :o
42."Backflow Preventei ;� _ ' � � ,x , � .
43. BackfloW Irrigation '�":�' '� ` � �� % � � --
, �r a
' 44. Landscape Ir'rigation System.i� � ` ,,, - _ ' � , _ _ - s
=u �� �. :.'�� � -� -. -.-�. c:. � -
r745:`�Sound Attenuation �'�
� �T c ¢
�46; Handicap Regulati�ns - _ ' •• ' ' ` . � ; ' ` ��,
��47 �FI{VAL S7RUCTURE & BUILDING � � „S� ��` .• � _ .. /� /I. , A✓I
l �6 �iG�
48'CFINAL PLANNING ` ' • '' � � _ � - -
; 49- Electric Release to �Edison i ' • ts -� �c • .+ � -�
, �
, 50. Gas Retease to Sodthem Califomia Gas Co ', ; i �, . .. ' •
� 51. CERTIF�GATEOFOCCUPANCY � _, �j ;;,.;, �;�; , �: ;
No Date
2
NOTE� SHOW AND DIMENSION PROPOSED
PATIO COVER AND YARD AREAS
.
�
City �i Costa €�es�� Buiidinn Depi.
BY \a--z= __IDAI"E S-�S__'9_
�HE; ['PL„y$ �U$T yE ��� �I�B AT ALL TI6"ES FA
T'�E I;']UANCE OF GF.:NTIIvt
i �_;:•.oA'1G S?E:;IPIC.1TtOUS SI�
- �:. r � ;R. Oi AFl Aopnn�'.11
:'<E ; ROV'S;0�5 OF 7HiS GOGE
A( JFii'.F.i4lL a-��OLAIE OR CF
: ^.rr. «
( l�r194 �e
F:R611i OR APPHOVAi �
T��"...�._':i.c�!03 A
�Y �':OL.A710N OF ANY ?F
9111T �RESU!AI":G TO G: �E
�r.C- PqOVISICNS CF fl IS
•_ ��. .�r. tALIU v^_rT '� '. qC'AH AS 7Nf WORK GR U:E
� WH:�t: i7AU7H^uFIZES IS Lq�lJfL
� T�" ISiUAr'CF ,^,F q PER :Ii [115ED UPQN PLANS N U
5 c�u. ..i ..::5 SH,l�t. IJOT PF :VEN 7HF QU�IDIT.� OFRq.
:/MT "._ .,iEG�RRFCT10NOFc'flRORS N
f.1dD �I_Af�S (�1;C £Y�CI`rICF.T10N5 OR fH01d PREVEN;
EL".L'Ji�fG O?FFi:,?ICNS fiCl:+" CAHqIE � py?yEiEU!u:<_$ q4{q {
�J It7 VIGLqTIp;J CF TNIS CODE UR OF ql V OTHER CAOtiypfvt;E
TIiE �', i Y'.
z�3g ���5 P�
-�-- - -- _ I •--- _ <_!
i
ID�y�n�3
PROVE �
CIT OF COSTA MESA
- - NNING DEPT.
SU61 TO BLDCi. DRT. !EG
STREET
PLOT PLAN
�Y._ C��� DATE_S b I
ou.croe o► nu��No
�e- ex�S n
r`"""" � � �
��
SEE DETAI�S ON REVERSE SIDE
ROOF SHEATHING
ov
�%� RAFTERS
Ar f� O.C.
y �
o �% BEAM
7
N T-STRAP EA. SIDE
FOR POST- BEAM
� .CONNECTION.
� / .
o ) (O
r�
�
m 51 a
�` J
F.: N
N U
X Z
W e,��,,r,�S_T1_�"-�"�p_ J V
p�p� W LL 2
iW0R�2C- O o �
`a
SLOPE TO DRAIN a N PLATE 1
�r ABOVE :
:o�.l': o::: .. . a. _ �1�.` . .� ... . . . . .0
0 .O
W '_
a Z a
�
��.*
N a�
a
j � 6
O �
� V, O
N Z U
O W
x J 2
� o �
U
-� �
26 GA. G.1. FLASHING N i
WOOD FLOOR ��
CONSTRUCTION PIERS 12'� SO:J
SIDE ELEVATION
CONSTRUCTION DETAILS
I
J
Z
f
O
I
_^
w
a
a
�
c�
i
�
20u�.ROOF CONNECTION
DETAILS
CONT,
LEDGER
CONT.
LEDGER
ID BIOCK
�I/2�� DIA. X 5�� LAG SCR
AT 32�� O.C.
DETAIL I
CR 9 CL��TECO�
GRIPS OR JOIST
HANGER
3/g'� DIA. X 5�� LAG SCR.
ar �y" o.c.
DETAIL 2
IOi�.OR LIGHT WEIGHT ROOFS
ONLY CONNECTION DETAILS
X FACIA-MIN.REO.
RAFTER
APPROVED METPL
HANGER
DETAIL 3
DEVEL�OP67QdT
sm�rtc�s n�nazs�ar
BUII,DING SAFEI'Y DIVISION
OWfVER :
ADDRESS� —
CONTRACTOR:
ADDRESS�
RAFTERS
CARPORT, PORCH OR PATIO
NOT'SUPPORTING CEILING
SIZE SPACING SPAN '
2"x4" 12"O.C. 9'-6"
16" 8'-0"
24" 6'-6"
32" 6'-0"
48" 5'-0"
2"x6" 12" 16'-6"
16" 14'-6"
24" 12'-0"
32" 10'-6"
48" ,8'-0"
2"x8" 24" 15'-6"
32" 13'-6"
48" 11'-6"
4"x6" 24" 17'-0"
32" 15'-0"
36" 14: -0'� ' a .�
4"x8" 24" 21'-0".: ,
32" 19 _-0"
36" 18'r0"
48" 16.'-0" �
4"x10" 32" 22'-0"
36" 21'-0" .
48" 20'-0". �.. ,.
72�� .17�'0�� .
PATIO COVER
TYP. PLANS
DATE = .
PHONE �
LIC. N0._
PHONE� '
RAFTERS APPROVED FOR
LIGHT WEIGHT ROOF COVER OF BUILDING PERMIT
LATH, FIBERGLASS, ALUM.
By Date_
SIZE SPACING SPAN
2"x4" 16"O.C. 9'-6"
24�� $ � _p��
32" 6'-6"
48" 5'-6"
2"x6" 16" 16'-6"
24" 14'-6"
32" 12'-0"
48" 10'-0"
2"x8" 24" 19'-0"
32" 15'-6"
48" 13'-6"
HEADERS
LIGHT WEIGHT ROOF ONLY
� SIZE POST SPACING
4x4 6'-0"
4x6 9'-0"
4x8 12'-0"
4x10 15'-0"
CARPORT, PORCH OR PATIO
�SIZE POST SPACING
4x4 S'-0"
4x6 8'-0"
4x8 10'-0"
4x10 12'-6"
�
GENERAL NOTES:
1. These Plans must be
kept on the job a[
all time during
construction.
2. All fFaming to be
Douglas Fir N4 � .
grade minimum.
3.. Rafters may not
attach to facia ex-
cept for l0�roofs
as shown on detail�
zQlbsroofs must use
a continuous ledger
attached as shown
on details Ikl��k2.
4. Light weight roofs
may attach [o facia
for 14' span max.,
spans over 14 mus[
use a continuous
ledger'as shown in
de[ail 1i3.
� � ��U�
I
��
PPOJECTPDOXESS: zS3S I}ZIJ �I.
OWNEP'SNAME:SOREWSEN, GLr,N D Tt"t
nooeess:7138 IRIS PL
COSTA M�SA,CA 97.b27
RflCHIENGINEEfl:
qooeess:
flEG.NO.:
uxir:
PEflMITTEE: GLEN SORE�150N ( 714 ) 646-4104
aooness: Z138 IRIS PL
C,M. CA 92626
LICENSEO CONTBACTOB UECtAFATION: I �ere�y atlirm t�at I am IicenSeU untler provisions oi Chapter 9(commencing wi�A Seclion
7000� ol Oivlsion 3 ol Ihe Business and Prolessans Catle, ana my license is in �ull torce and eHecL
LITV UC.: STATE LIC.: CLA55:
Dale: SignaWre:
WONREBS' COMPENSATION OECIARATION: I here�y a��irm thal I have a cetlifica�e o� consent �o seli�insure or a cerlitica�e o� Warkers'
ComDensalion Insurance. or a cenified copY Ihereoi (Sectian 3800. Lab. q.
POLICY NO.: EXP. ORTE:
LOMPANY:
] Cetlifietl capY is hereby lumished. ❑ Cenifietl coDY is filea wi�� the ciry BuilOinp �ivision.
Oale: ApplicanL
E%EMPTIONFBOMWOflNEBS'COMPENSATIONOECLAPATION: (This e unn n betompl¢�¢ailt�epermi�i5�oronehunAre4�$1W�arless�.
I cerlily Ihai in Ihe pedormance o� the work lor w�¢h Ihis permi�' i ue0 5 I no� employ any Derson in any manner so as to became
sublect lo Ihe orker Compensalion Laws ol Calilomia.
Oa�e: Signaiure:
N E: II, a er ma ing Ihis tleclaratioq you shou beco e su Ieci �o ihe Workers' Campensa�ion pmvisions o� ihe La�ar
Cod . yau mu5i fonhwit� complY with such pmvisions orihis Oermit shall he deemed revokeA.
COhSTHUGTION LENDING AGENCY: I �ereby allum �Aat ��ere is a con5imciion IenOing agency lor ��e Oe�ormance o� ��e work tor
w�ic� Ihis permil is issued �Sec�ion 3097, Civ. C�.
LENOEfl:
aoosEss:
OWNEfl BUILOEN DECLAflATION: I hereby aftirm Ihai I am exempl ham Ihe ConVactors' Slate License Law lor ��e following reason
(Seclion 7031.5 Business anE Professional Cotle: Nny cily af counry which reQuires a permi� �o conSlmci. alter, improve, tlemolish, or
repaii any slmciure, prior �oits issuance, alm requires the applicani lor such permil to file a signed sia�emenl IM1aI he/s�e is licensea
pursuam �o�he provisions olihe ConVactors Slaie License law�Chap�er9�commencing wilA Section 7000)o�Division 3 oi�he Business
anJ Pmfessions Code) or Nal helshe is exempi therelmm and Ihe basis �ar �he allegetl exemp�ion Any viola�ion o� Section 7031.5 by
any applicanl lor a permit sublec�s ihe applicant �o a civil penally of no� more than live hunOreO tlollars ($500�.
I, as owner al ihe O�operly or my employees with wages as t�eir sole compensa�ion, will do the work. anJ �he
;[� slmcmre is not in�en0e0 or of�ered lor sale (Semion 704a, Business antl Pm�essional Code: TAe Contracmrs' S�a�e License Law
does naI apply to an owner o� a property w�o builtls or impmves thereon, and who aoes sucM1 work himsel�/hersel� or ��mugh
his or her own employees, pwvideU �hat such impmvemenis are nol inlendetl ar oflered �or sale. If, however the builtling or
imOmvement is solA wilhin one year o� complelion, the owner will �ave Ihe burden o� pmving �e/she Ai0 no� �uiltl or impmve
for Ihe pur0ose ol sale�.
I. as owner of �he property. am exclusively con�mciing wi�h licensetl coniracIDrs lo cons�mcl ihe prolect (Sec�ian 704a, Business
❑ antl Pmfessions Code: The Comrac�ors' Sta�e License Law Ooes not apply m an owner oi OmDerly wha builtls or impmves thereon
ane who conlracls lo� suc� pmlads wi(� a conVacioqs) license pursuant �o Ihe Contraclors' State License Law). I am aware
Ihai O�oof o� Iheir Worker'S Compensation insurance shoulA be providetl �o me.
�� � I am exempl under Sec�ion: 8. 8 P. C.
for Ihis rea n:
Date'. Owner
I tlo hereby cei fy �hat I a aware ol an� untlerstantl Ne requiremen�s oi lifor ia Neal�h antl Saleiy Code Sec�ions 25505. 25533, antl
2553a antl Ihal 1 or any luture builtling occupani wilVwill not �circle one) eetl to compty wiih uid s�ale codes antl ��e requiremenis lor a
permit lor conslmction or moailicatmn Imm the Air Ouality Management Oistric�. flesideniial cons�mc�ion apDlicalions are e�emp� imm
Ihese provisions.
�ate'. Applicanl:
I hereby certify �hai I have read this aDPlicalion antl slate tha� Ihe above in�o on is correct. 1 agree m compty wiih all ci�y anU county
ordinances anA slalelawsrelalinpto building constmction an0 hareby aulh ' erep sen�atives of�his cilylo enterupanthe abave-mentioneA
pmoerly lor m pection urpases.
Da�e: Signawre;
Driver' icense or Socia� Security u:
1641�06 WM1ile—Builtlmq; Green—Cotle EnforcemenL Canary—ApplicanC Pmk—Revenue: Goltlenmtl—Nssessor
CITY OF COSTA MESA — BUILDIN� FERMiT PERM NO; B p61536
PERMIT NO; B 061536 PLAN rHECK NO; 01018-93 S GO��T; N S1;PP; N
CONSTRUCTZON TYPE; PEkMIT TYPE; STR PURI�OSE; OTFI
�7UB DESCRIPTION ; ZNSTALI� SKYLIGAT IN KITCHEN #NfiR216 SQ FT: 500
CLAIM VALUE; 500,00 CALC—VALUE: 500,00 GROUP OCC: R-3 /
COMMENiS; NO OTHER WORR AUTHORI7,ED BY THIS PERMIT
1E ## fF ih if � IF if 1E iE if 7f !E %ik # lt i61t iF iE it'�E fE% lE IE iE-k iE -M fElE N� ih �k�?f �fE iE# 3E3F # iE N� 1!%3E If itiE�J(� 1E N� # 3E 3F 1k iE 3E �E lE #� 3F 3f �H� # iElE H� iE # i4 DE 3f iE 3i
Z O N I N G R E Q 0 I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REA}2; FT SN FRNT; FT IN REAR: FT IN
I,EFT; FT IN RGIiT; FT IN LEFT; PT IN kGHT; F'T IN
PARRING REQ• PROV; ' PARCEL: 42615138 ZNE; REF NO;
I PLANNING Nt5TE5> -
> /J�,.
**x �+�*x*�r*� ��*�r�x��x-x'�*�*��**�t� *ft�x��r****��x•x �*�*rt�r*�r�*�t�c�#**x x x��ce�*##�*���*��*�*
D E V E L O� P M E N T S E R V I C c S R E Q U I k E M E'�7 =�1'�S
ZONING APPkOVED BY �.; ; DATE:; �/�;%
BUILDING APPROVED HY, : DA'I'E;;' I �';.
' �i
APPLICATION ISSUED�B'Y: � DATE� �2�
lEfEiEfFlfifif�lElEic#ififK�iFif�K�i(�i(-jtlElf3FiriFiFiFiF�hiF3F`,F%iE7FiFiF�;FiFiF3F�F�FiF it�Tt3F7tiF�fi�7t3FX�iflF%%�3f�N��lEif�ifx� �+,rit�• xic-n1F�
%�iEiElflFiflFifliif%iFlFiEX�if3EN�iFiElE1FlE7fiElEiE1F7ElE1EiE�1f7ElfiE?FiE1f1P-1f�Fiflf�%'1F##dFiilfdf�If7tifl4iEiElEi67f9{.'lElE?EiE% iE#iFiE1F)b1Eli�1ElF?ti
LEGALI2A3ION;N F E E S U y N, A R Y STRUCTUk�� SEGMENT;Y
� :.�
BLDG PMT PLUMBING Ei,ECTRIC MECHANIC FIRE SMSP/RES GRADING
PERMIT 15,00 ' ,50
" SMIP/NON—RES
PLAN 9.75
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE. PLAN—CBECK TOTAL PAID DUE
TOTALS----> 15.50 0,00 9.75 25.25 - 25,25 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 25,25 UVER/SHOkT: .00
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN—CHECh:
15,�� ,S� �,%J
i!-%IF M� iF iE iE iE �t IE ii iF±t iE if if ii� �1F �7E 3F iE iE 3F?E iE ff'1F 3F iE iElE jE if iE 1E if �1t-iE iE if j(- iF iE iF iF iE iE iE 3! if iE ik �F iEif ft il� if x-�F if if 141(� ih 3f� iF # 7F iE # 3E R� iElf �(� !f i(� #
I Iv D I V I D U A L F' E E B R E A K D O W N
TYF�E QTY D E S C A I P T I O N UNZT COST TOTAL COST
SFR �00 AL'1'ER BY VALUE kESIDENTIAI� N020NE 1,00
END OF FEES
SOU.QO
7�
GONSTRUCTION AND PLANNING ��� SPA I
Date Inspector Date Inspe�
APPROVALS Permit �''r APPROVALS Permit #
i. Temoorary Electrical 5ervice or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd, � 53. Steel Reinforcement +
3. Electrical Conduix UtilitY-Undrgmd. 54. Forms � ��
4. Electrical Conduit-Undrymd. 55. Electrical Bonding . j
5. Steei Reinforcement 56. Rough Piumbing & Pressure Test
6. Electrical UFER Grnd 57. APPROVAI TO COVER�GUNITE �
7. Footings 58. Electncal Cond�it�Undrgrntl.
8. Foundation 59. Gas P�pe, � UnUrgrnd., Test
9. Water Pipe-Undrgmd. - 60. Backwash Lines, P-Trap,. � Undrgrnd .
70. Strucmral Floor SYstem � � 67. APPROVAL TO DEGK
11, Property Sewei Linz & House Conrection ' 62. 6ackwash & RcceptorFinal ' I
12. Sewer Cap 63. Heater & Vent-Final ,
73. Roof Drains 64. Piumbing SVstem � Final
74. Rough Plumbing 65. Electrical-Final ,
i5. Rough Electrical-Conduit � 66. Solar SVstem-Final
i 6. Rough Electric Wiring 67. FenCing & Acces, A�P��val �
17. flough Wiring Sign 68. APPftOVED FOR PLASTERING
1H. Rough Electrical-T Bar Ceilang 69. POOUSPA SYS'tEMS FINAL
19. Rough Heating & Air Condit�onin4 PIRE DEPT. RE�UIREMENT '�
20. Rough Factory Pireptace APPROVALS Permit ;� I
21. Ducts,in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping �Gas �:Oil �
23. Gas Pipe�Reugh & Test 72. Underground Fliah -�
i
24. ftoof Praming 73. Undergrnd. Storage Tank C Gas � Od j
25. floc£ Sheathing 74. Overhead Hydro �
26. T�Bar Ce�ling (Struc.urali & Monocoat /,, /J 75. Dry Chemical -�I
27. Prame and Flashing ��f/T5 ir"' 76. Dry StandPiPe I
28. l..athing & Siding � � 77. FIXED SYSTEiN FINA�
29. Insuiation 76. FIRE PREV. FINAL
30. Drywali Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. PINAL INSPECTION i
32. Electrical ?ower Meter�Finai . . 80. FOOD CERTIFICATE ISSUED� �
1
33. Flnal Electric ' Notes: '
34. Final Heating & Air Conditioning � �
35. Fina! Gas Pipe�Test �
36. Hood or Canopy �
37. Finat Factory Pirepiace
38. Final Plumbing �
39. YVater Service-Finai � �
40. Gas Service-Flnal i
41. Solar pomes2ic�Finai i
42. Backfiow Preventer
43. Backfiow Irrigation .
�4. Landscape irripatian SVstem
45. Sound Attenuation _ _ � �__ I
46. Handicap ftegulatior.s � 1
� / I r
47. FINAL STRUCTURE & BUILDING �!�/ �'t � -
G �
48. FINAL PIANNING '
49. Electric Release ta Edison •
50. Gas Release to Southem Catifornia Gas Co
51. CERTIFICAiE OF OCCUPANCY
No. Date
Applicant to 1111 In all spaces except t�ose wit�in heavy ooraer Iines antl sign all apvropriate aeclarotions.
CITY OF COSTA MESA CCONSTRI�CTI PERMIT PEFj(�AIT NO. _ ,,� TRACT NO. LOT NO. UNIT NO.
� Pr- je�ii Jress ��-. � ,� p � �
Applicant'sMailingFjddress �� _
Owner's Name � (,22�.t2A.���^wone
Address � �3_���- /� � ���
Arch/Eng. License No.
Address c/-,y
����'-- —I'•�
Convacto�'< Nam� 1 -� Phone
Addresslm�'�'nnl��s�`�Z �L�
City Licen�P No .30�0�0
LICENSED CONTRACTOR DECLA0.ATION
I hereby affi�m [hat I am licensetl untle� provislons o1 Charter 9(commencing
wi[h sectlon 7000) of Division 3 0( the BuSiness antl Professloni Cotle, antl
my Ilcense is in full orce an effeci. � (�
LlcenSe I 55 _ I 8se ..��L
Date Si9na[ure
WORKERS' COMPENSATION D LARATION
hereby affirm that I �ave a certi iwte of consent to selLinsure or a cerUfiwle
' Workers' Compensation Insurance, or a c¢rtifietl copy t ereof (Se$�j lon
.800, Lab. C.) D�� i// �� i.� //
Policy No. ��� Company n/� r«1L
ifietl copy is hereDy fumishea.
ertif%9tl c y i fi� with the city iltli i r(.? C
Date f(���,j Applicani _
E%EMPTION F0.0M WORKERS' C NSATION DECLARATION
(This section neetl not be compie[¢tl i iG Oermit is tOr on¢ hundreC (E300) or
less).
1 tertity tha[ in the Oertotmance of th¢ wOrk fOr which thls perm�t ISlssuetl, I
shall not Cmploy any p¢r5on in any manne� so as to become subject t0 thB
Workers' Comoensation Laws ot California. '
Date Signa[ure
`NOTICE: Ii, after makin9 this tleclaraUon, you shoula Decomo subject to tne
Wo�kers' CompenSaUon provi5ion5 OI Ihe Labo� Cotle, you must torthwitb
comply with such provisions or tltis permit 5hall be tleemotl ruvoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that [here Is a conslruction lentlin9 ag¢ncy br the perto�mance
01 the work for w�icb th15 permit is Iszued (Sectlon 3097 Civ. C.)
Lentler's Name
Ltnaer's Atltlress
OWNER BUILDER DECIARATIOtJ
I hereEy dtfirm Inat I aT exempt trom th¢ Contractor'S LicOnse I..aw for tht
followin9 reason (Setlion 7031.5 Bu5lness antl ProtC551onal Cotle: Any tlty oi
countv which requires a permlt to construct, alter, imorove, tlemolish or repal
�,^.;;:ero/rom ana tne basis for tne alllgetl exemp[lon. Any wO�duon o� xc�wn
'J31.5 by any applicant tor a pnrmlt subjects the applicant lo a civil
�nalty of not more tban five huntlred tlollars (5500).
1, as owne� of the prOp¢r�y o� my Omployea5 wilh wages as tnoir SOIO
COmpenSatiOn, will tlo Ihe wo�k, dntl [ne slrutturo IS nol inlondatl or olteroC
fo� sdle (5¢Ction 7044, Busin¢zs antl PrOie55ional Cotlo: Th0 Cont�acto�'S
License law tloes not apply to an owner oi a properry wno bulltls or improves
thervon, antl who tl0<5 such wOrk himiGlt/hOrselt o� Ih�ough hls O/ her own
emplOyees, O�ovitletl Ihat such Impruvemonts ara mt Intnntlo0 or oHoretl tor
sale. If, however, the bulltling or ImO�ovement ii Sottl within one year of COm-
oleUon, the owner wI11 nave the burtlan oi proving he/she tlitl mt bulltl or Im-
prov0lor the purposa ot Sale).
❑ I, as owner oi cho o�operry, am exclusivnly contracting wlth I7<ensetl con-
tractors to construct the proje<t (Seclion 7044, Business antl Protasslons Cotlo:
The ConVactor'S License law does not appty to an owner ot property wbo
builtls or improves thereon, antl who wntracts lor such profects with a con-
trattOr(5� 11cen50 puRuant t0 the ConVaclOrY l.it¢n5G ldw). 1 am dwar0 Ihat
proot o Iheir Worker'S Compen5ation Insu�anca shoultl bo prOvldetl to m0.
❑ I am exempt untler Section B. 6 P. C. tor thls reason
Oate Owner
I hereby certify tnat I have reatl this aoo���ation antl stata that the above
informatlon is correct. 1 agree to comply with all tlly antl counry ortlinances
antl'sta[e laws rdlatin lo builtlin9 �onstructlon, and hereby authorize repro-
sen[ative5 of�iii� c� ��n� �� �he above-menlionetl ProPe�y for
_____' __ . .: .
ure
_CMF 0865-46,
TVPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p yY,
DES�iIPTIONO�WC�AKy.1SEOF DG.
- S Ma'n e 'Id�
LJ TENANT IJ'
� ❑ OTHER �
PROJECT DESCRIFT
CONSTRUCTION
20NE
Ramarks:
R
SQ.
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
FloOr Sinks
Gas Service Outlets
i w �
E
1 G FOUNDAT ^ 5T UCTVRAL T Front
u� PLUMBING�y MECNANICA� B Reef
� ��j A
� OCCUPANCV C Right
VALUATION $�•?.�—U' r� g Left
GRADING CU.YDS. ACiiES P�ng. Ref. �W
Planning Notes:
titchen Sink
Lavatories
'—Trap
Roof Drains
Reinspaction Fea 515
Boiler
Duct - Under Ground
Duct - Structurel
Duct - Veniilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ ai ao,00a eru O i oo,aoo
T�' I I Reinspection,Fea I $15
55 �
{4 White - Bulltlinq; Canary - ApO��cant; Pink - ACCountln9V Goltlenrotl - Asse55o�
PLUMBING
Service $ink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9 '
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Warer Service
Auto-Wash
Leundry Trays
Isue Fee
Hood or Typet ❑
Canopy Type I I ❑
Refrigeration System
00.100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
3694 11/q6/BS
Zone
Accessory Building:
Porking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Consttuction'PoleSub. � 50+KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F,A.U.
FixWres
Device Boxes
Outlets
Switches
Garbage Disposal
Generator O65 Kw 05�15 KW
Meter LJup to 100 amps
Meter ❑overi00amps
Sub Panel
Motors �0-1 HP � 1�h - 8
Inc. Solar �9-75 HP �16-15+
Microwave '
Pole Light
Range
Sign
; Standing Sections
Trash Compactor
�40�. i';.
FEES
Z
O
N
1
N
G
R
E
�
M
T
S
S 3 I
� Reinspection Fee $15 Issue Feo $ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By nate
BulldinB APProved By Date
Applimtion laued By nate 1/—% �S
SUM ARV OF FEES '
BUILDING PERMIT $ . DO SMIP $ • S� '
PLAN CHECK $ _ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL § � GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ 'TOTALFEE $��
$ 3 PLAN CHECK Z5% $
CCINSTRUCTION AND PLANNING POO SPA
�APPROVAIS Permit # - Date Inspector p�ppROVALS Permit # Date Inspector
r
1 Temporary Electrical Service or Pole . 52. Pool & Equipment Location
2. Soil Pipe=Undrgrnd. � �� 53. Steel Reinforcement
3. Electrica6Conduit Utility-Undrgrnd. 54. Forms .
4..Electrical Conduii-Undrgrnd. � 55. Electrical Bonding �
, 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �' '
6• Electrical UFER Grrid. �; ' 57. APPROVAL TO COVER-GUNITE ..
7. �Footings t. - .- ' 58. Electrical Conduit�Undrgrnd.
6. �Foundation ;� . �� 59. Gas Pipe, � Undrgrnd., Test r�
9. Water Pipe�Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. ��•��j
�
10. Structural Floor System �. � '' 61. APPROVAL TO DECK �
1 t. Property Sewer Line & House Connection . " 62. Backwash & Receptor-Final
12. Sewer Cap . ; � yj ' �% • � 63. Heater & Vent-Final .
13. Roof Drains � l �, : 64. Plumbing System - Final '
� ` i
14. Rough.Plumbing %�' 1' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiiing Sign 68. APPROVED FOR PLASTERING
18: Rough Electric�al-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough.Factory Fireplace . APPROVALS Permit #
21. Ducts, iu Structure 70. Underground Hydro
22. Ducts, Ventilating � 71 . Product Piping � Gas ❑ Oil
23. Gas Pipe;Rough & Test 72. Underground Flush
.
24. Roof Fraining 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ce�ing (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. F�INAL
30. Drywell �Nailing �+ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat :� 79. FINAL INSPECTION
,
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. �Final Electric � � Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestio-Final
42. Backflow Preventer � "
43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. F�NAL STRUCTURE & BUILDING �{/! / C ,5
48. Specia� Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southem Califomfa Gas Cn
51. CERTIFICATE OF OCCUPANCY
No. Date
AOC�«anl to flll in all iDaces except t�ose within heavy eortler lines antl sign a11 approDriate eeclarations.
CITY OF COSTA MESA
CONSTRUCTION PERMIT
ProlectAddress -1/�X 2/�/��f'/�r�P
ApplicanYs Mailing ddress ��f'� j �� ������ �^�P �
Owner'sName �ONP�/3G✓ Phorie�e��'��0�
Addreu —c��"/✓� P ' �
Arch/Eng. License No. �
AddfQ55
Contractor's Nam � � • Phone77� "��7� �
Address Imailingl �« � �� �"/N/a� t� �/✓A iiP i�_
City License No. �3� � � �
LICENSED CONTRFCT00. DECLARATION '
1 hereby at/irm tnat 1 am lic¢nsetl untler provislons of Cnarter 9(commencing
with section ]000� oi Division 3 of the Busineiz antl Professions COCe, antl
mY Ilcense is in full fo`ce a�nU eftect. �/ �� f�
Licen�� Clas�s �� ., Lice e N �
Da[eL� 519�ahre �
iORKERS'COMPENSATION DECLARATION �
nereby affirm that I nave a certificate ot consent to self-insure or a terUftcate '
of Workers' Compensatlon Insuran<e, or'a cnrtifietl copy tnereof (Section
3800, Lab. C.) '/
Poncy No. �'�"��d Comoany�f'A✓/AC r.f/_S
❑ �ertl(letl copy is �ereby furnlshetl.
�,1'Certifieq copy is Bletl with the city Bu�Itling Diviyion.A�p ' r
oa�e 7_� �A" 'A'.3 � APPlicant � L/"�!.r O�L /'J_ (G�x-,r ..�,
EXEMPTION FROM WORKERS"COMPENSATION�RATION - '
(This section neetl not be completetl if the permit I5 for one huntlr¢tl (E300) or �
less).
I certity�[hat'in the Oe[fo�mdnCa ot the work fo� whlch th15 pe�mit IS i55ueQ I'
shall- not employ any pnrson in any manner so'as to be<ome Subjec[ to Ihe
Wotke�s' ComOenSdtion' Laws of California. . • �
Da[e Si9nature
NOTICE: It, after making this declaratfon, You shoultl become subject to the
Workers' Compensation provislons of the Labor Cotle, you must forthwith ,
comply with s�cn p�ovi5ion5 0� thls � pa�mit zhall be, tleemetl �evoketl.
CONSTRUCTION LENDING"AGENCV �
I hereby aHirm that th¢re is x con5tructlon I¢ntlin9 agancy for the per(ormd�nCC '
of the work (or which thls permil is' ISsueC' (Se<tion 3097 Civ. C.) ,
I.entler's Name
Lentler'i Atltlress� �
OWNER BUILDER OECLARATION . -
I hereby a(firm that I am_exemp[ trom tM1e Cont�actor's LIC¢n5e Caw for the
followin9 reason (Sectlon,7031.5 Buslness antl Professlonal Cotle:-Any city or �
a signed statement that he/ihe. is licensatl _pursuant to'the provisions of !
�om anG the basis for [he alleqetl exemptlon. Any v�olatlon of Section ,
> by any applicant tor. a permlt subjecfs tne' applicant ro a civil .
y of not more than five huntlretl tlollars ($500). . . !
as owner of the. prope[ty o� my empl0yee5 wi[h wag¢5 as Ihei� sole �
:nsation, will do the work, antl the ztructure is not intentletl oi offeretl
le (Section ]044, Business antl Profe55ional Code: The Con[ractor's
4cense Law tloes no[ appry m aniown0� m a propeny wno owws or �mp�oves
thereon, antl wh0 tloes such work him5elt/h¢r5¢I( or.through hi5 or her own
employees, provltletl thal such ImOrovements aro not intantlotl or offoretl for
sale. It, howeveq (he �uiltlln9 or improvemen[ is soltl wlthin one yeai ot com-
plGtiOn, the owner wlll•have tha bu�tlen Of prOving hE/sh¢ tlitl not builtl or im-
��Ove�to� the purpOse of sale�.
I, az owner of lhe property, am exclusively tontracUng wlth licen5etl <on-
tractors to cons[ruct tM1e Oroject (Section 7044, Business antl Protessions Cotle: �
Tha Contracror's License law dOes not aOP�Y to an owner ot property who
builtls or improves the�eon, antl who contracts for such O�OjOctz wlth a con- �
traclor�s)license pursuantto t�e Contractor'S Licans¢ Law).
❑ I am ezempt untler Section B. S P. C. for [his r¢ason '
Date Owner.
I hereby certity ehat I have reatl this apo�iwtlon antl state that the aCove
iniormation is <orrect. I a9ree to comply with all Uty antl county ortlinances
antl'state laws relating to Duiltlinq cons[ruction, antl hereby authorize repre- '
.o..��n„o� ..r rom �i�� �� ¢nter upo � the above-mentionetl properly for
S�gnature /lY/1LA.!
Drivers' License or 55 #
CMF 0865-46 rev. ]/83
— % y (� ' �
TVPE OFCONSTRUCTION NEW %�DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q;p,.�k
DESCRIPTION OF WORK
S Main Building:
TYPE OF PERMIT GRA�ING FOUN�ATION STRUCTURAL T Ffon[ -
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear -
❑ �OTHER � - A
PR0.IECT DESCRIPTION 5�. FT. � OCCUPANCV C Right �
K Left
CONSTRUCTION TYPE VALUATION $ $
ZONE - GRADING CU.YDS. AGRES P�ng. Ref. #
Remarks: Parking Req./Provided
� , � • Use of Building:
. ' PLUMBING FEES P�anning Notes: .
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers � ' .
DiSRuvastier ' .
Drinking Fountains
Floor Drains ' �.
Floor Sinks �
Gas Service � Outlets
Interceptors -
Kitchen Sink -
Lavatories T� .
P—T.�... ' , �
Roof Drains; :=
-Reinspection Fee
$25.
Boiler ' - ' - �
Duci - Under Ground
Duct-SttucNral ,
Duct � Ventila[ing �
Ezhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 eTu O i oo,000 er
C� F=//^Z` Date�j'���3 •
�, '��� Heinspection Fee
Whi[¢ - Bulltling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl -A55e55or
$25
Showers
ServiceSink '
Sewer Cap
Sewer Connection
$olar Collecrors
$olar Piping�� '
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet'
Water Heater
Water Service
i
Issue Fee '
Hood or Typel� ❑ � �
Canopy Type I I ❑
Refrigeration System
Oaioo,000eru ❑ioo,000
System Repair/Alteration .
laue Fae
�Y�'aE �:_�i�/
Zone
Acceuory Building:
Park'.Fees $ �
ELECTRICAL �
Automatic Washer' Transformer ❑ 15-50 KW
ConstructionPole.Sub. � �SO+KW
Cooking Unit � ' - Meter ��up m 100 amps "' '
Dishwasher � 1i. � Meter ❑over 100 amps
Drvers ❑Gas �Electric , Sub Panel ' . �
Fan
F.A,U,
Fixtures
Device Boxes '
Outlets '
$WISCh25 t
Garbage Dispoul
Generator �65 KW 05-15 KW
1 HP O1'/:--8
19-15 HP � 1�6-1
Microwave
Pole Light ,
Sign � '
Standing Section:
Trash Compactor
O
N
I
N
G
R
E
U
U
I
R
E
M
E
N
T
FEES
�
, � i
$y� Reinspection Fee $25 luue Fee. ' � $ 3
FEES '
PUBLICSERVICESREQUIREMENTS: � .
� Zoning Appraved 8y � � , � nata '
Application Approved By Date
Application Issuad By � � � Datu �
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT Cj�
PLUMBING �.(�$ � ISSUANCE $ �L
PI.AN CHECK $ ENERGV P.C. $ •
ELECTRICAL § GRADING $
PLAN CHECK $ MICROFILM $ �
MECHANICAL $ TOTAL FEE $ � 6"'U
$ 3 PLAN CHECK $
CONSTRUCTION A'ND PLANNING - ' � � � - . ?O� s SPA ,
. APPROVALS �Permit# ' Date � Inspector qppROVALS � Permit# Date Inspector
i. Temporary Electrical Service or Pole .52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
' 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms '
4. Electrical Conduit-Undrgrnd. - . � '55. Electrical�Bonding _,
5. Steel Reinforcement - � � 56. Rough Plumbing & Pressure Test
� 6.• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. -Electrical Conduit-Undrgrnd.
8.� Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwaih Lines, P-Trap, O Undrgrnd�.
10. Siructural Floor Sysiem � � 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62..Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final ��-
13. Roof Dreins 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit - ' 66. Solar System•Final
� 16. Rough Electric Wiring � ' �' 67. Fencing & Access Appraval
17. Rough Wiring Sign ' ;, 68. APPROVED.F�OR PLASTEflING
1 S. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIREDEPT. REQUIREMENT -
20. Rough Factory Fireplace � APPROVALS Permit�
21'. Ducts, in Structure � � 70. Underground Hydro
22. Ducts, Ventilating � � 71. Product Piping � Gas ❑ Oil
�3. Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framin9 � � 73. Undergrnd: Storage Tank � Gas ❑ Oil
e5. Roof Sheathing � ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical
27. Frame and Flashing ' 76. Dry Standpipe -
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing � , HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � � Notes: /�,?�J/d'�/ LEF�G�}+ZD- Li�
34. Final Heating & Air Conditioning' ' . �
35. Final,Gas Pipe-Test � � �. -
36. Hood or Canopy � � � .
37. Final�Facto'rY Fireplace � � �
38. Final Plumbing� � a/ � L,� . �
39. Water Service-Final " �
40. Gas ServicerFinal - � � ' '
41 . Solar pomestic-Final � � . , _
42. Backflow Preventer ;
43. Backflow Irrigation - � � I
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 � - �
i�
51. CERTIFICATE OF OCCUPANCY . � � '
- - ��
No. Date,
OwNER Sorensen. G.D. DATE 6_P7_79
JOB ADDRE55 2138 Iri c P1 . BUILDING PERMIT N0. 48328
GENERAL CONTRACTOR Owner-Builder DESCRIPTIONofWORK Leaalize Patio Cover
AP No. 11R-1 �,3_31 LOT 5 TRACT 3856 FIRE ZONE VALUE S 3.200.00
sm�
WS
W ATER
GROP. SWR. LINEIJ NOUSE
SPRINKLING SVSTEM
MISCELL�NCOUS
ROUGH HE�YIHG PN� >IR CO
UNOERGROI
ROVGM wIR
S
FLOOR SYSiE1A
BONC BEnM ❑ STE
SHEnTMING
FRnME ?NO FLISMING
LRTNING — IN (�
PL�STER, 6P0M'N COnT
STRUCTUR4L.FIN�L
HEATING, VENT., REFAIG. �NO �.C„ FINAL
PLUMBING. F�N�L �ND WS TESi n
EIECTRIC KIN�L
HIIII.OING FIN4
SUBCONTRACTOR
r
3913 6%77/79
COSTA MESA BUILDING-SAFETV DEPARTMENT APPLI TION FOR STRIJCTURAL PERMIT 42.50 TL�
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
REC D V PERMIT N° � 48328
For Applican[ to Fill in Completely — Use Ink Onty
BUILDING o/� �j / A.P. NO. �%V ^/� s— 3J
ADDRESS /� l
BUILOING Z/'38 /�/f �L
OWNER OR /• � ApDRE55
TENANT V
UNIT OR
MAILING � � �� SPACE NO.
ADORE55
T�NO�. G LOT �� BLK.
TEL. �
CITV C� N -
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONo^fRUGT10N
LENDER
BRANCH �
OWNER SO�E�(/SF�✓
ADDRESS VALUE
ARCHITECT TEL. USE f3�DO
ADDflE1SS ER ZONE �/j (/
"-/ TYPE � GROUP �•�
� � �I - � APPROVED / nT �
CONTRACTOR iw��-c.�• BV DATE Ip L
ADDRESS / �T/(/ COl��Ie
TEL.
CITV NO.
STATE CITV APPROVED SETBACKS
LIC. NO. LIC. NO.
SIZE �,p.OF B��g (FROM C/L STHEET)
OF LOT O NOW ON lOT RONT � 7�FT. TO �X /�
VSE OF .3� 'Z'
EXISTING BLDG
Separate permits are required tor L. SIDE `T FT.
electric, plumbing and heating work. f
REAR 30 �FT.
USE OF BUIL�ING AND WOFiK TO BE PERFORMED PLqNNING FCTION
DATE
APPROVED
APPROVED � `_��'—�q
���� �
I hereby aeknowledBe that I hava reatl this applieetion antl stnta
thet tha ebova Information is correct nntl aprea to comply wli�
all laws regulatin8 builtling construcHon, end I chall not amploy
any Oerson in vtolation of Me workmen's compansation laws of
the State of Celifornla.
I hereby canify thet 1 em properly Iicensetl es e controctor under SQ. fT.
the State of California Business entl Proteulons Cotla, Dlvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaptar 9, entl that such licenaes are In full forca anC etfect, ar I THE PURPOSE OF ESTABLISNING A PERMIT FEE ONLV:
am ezempt from Me provislons o( the Stata of Callfornle Businass VALUATION PERMIT FEE E
antl Profasslons Cotla, Division 3, Cheptar 9. . B O
$ignatute ot �% PLAN CHECK S / . Q�
Parmlttea 8 J�� � TAX E D� s(�
Of �� � vv
Authorizetl Agent Dale TOTAL PAID b Z�S
m
�
m
b
Y
m
m
0
LL
f
u
OWNER SORINSON,' ]
JOB ADDRESS 2138 Iris P:
GENERAL CONTRACTOR W.D
AP No. 118-153-3110T
INSPECTIONS _
SOIL
� G�5
W �TER
�ROUGN PLUMBING
PROP. SWR. LINE [] HOUSE COM.
SVRINKLING $VSTEM
MISCELL�NEOUS
ROUGM ME�TING �ND MF CONDITIONING
TEMPOR�RV SERVICE ON POLE
UNDEFGROUND � POwER � '
ROUGH WIRING
TREHCNES �_j FORMS STEEL RE
FLOON SYSTEM
BONO BE�M [] STEEL REINFOACE [
SHE�THING
FR�ME �N� FL�SHING
L�TMING - IN OUT
PL�STER. BAOW 1 CO�T
STRUCTUR�L fIH�L
ME�TING, VENT., REfRIG. �N� �.C., FI
PLUMBING, �INLL �NO W$ TEST n
ELECTRIC, FIN�L
BUILOING. FINnI
DATE 5-7-79
BUILDING PERMIT
E VALUE
SUBCONTRACTOR
?—/6 7y iva n.v.P is/o..�E fo,e .«.v.,�.� .L'.vs
�--
e'
�COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fill in Completely — Use Ink Only
BUILDING �/�L )p/! G
ADDRESS O / �� �
OWNEROR N� �O/��(//{�JO�/
TENANT �•�
MAILING S/1�M/�'
ADDRE55 -
TEL./[t''�
CITV NO. (flT()
LENDER�ION %//A�/'L
(/�� �
BRANCH
ADDRESS
ARCHITECT //n A./ TEI.
CONTRACTOR [.(/ f(�j �J /� L /r /
ADDRESS ( � (C ��A�� ,� ���
C�Tr C-�5�%� //rf/� NOL�476'�7b
F STATE CITV
i LIC. NO. / � LIC. NO.
a
{a� SIZE NO.OF BLDGS.
a OF LOT NOW ON LOT
a VSE OF
,�. EXISTING BLDG.
y
FSeparate permits are required for
q electric, plumbing and hea[ing work.
W USE OF BUILDING AND WORK TO PERF`Q RMED
¢ X/ L/ �R rV /� �
�
a 5'ir/� �1�/iOf-.e�
�'. ��i �/r//T «L�
..1
�
W
�a 11 hereby acknowlatlpe that I heve ranG ihis npplieetion antl rtata
1that ihe ebova Infarmat(on B corract antl eprna to eomply wlih
� all laws reg�lating CuiltlinB construc[ion, antl 1 shall not amploy
Z any person In violeilan of the workmen'a compenaation laws oi
W tha Stata of California.
3 I heraby cartify thet I am properly Iicensatl as a conttector untler
iho State of Californin Buainesa antl Profeulona Code, Divlsion 3,
Chapter 9, antl t�at such Iicensas are in fuil force entl effeet, or 1
em axempt irom the D�ovislons ot [he $tata of CalHorn ' em
end Profassiona Cotle, Divisi n 3, CI tar 9.
/// � /
SIB�nture of�/ /
Permlttae �����
ar
Authorizad Agont Date � —
APPUCATTON F
2EC D BV P
A.P. NO.
BUILDING 1�/JG
ADDRESS �[� ��
UNIT OR
SPACE NO.
iR.NO. LOT
NEW ADD LTI
OWNER /�/� �
USE
�,...� �-� ,
9�SfCRBQ�YIRT9. PERMIT
�Bg5T 0 od ugo 01�' •4 �
_ /c- � .� �
APPROVED SETBACKS
ACTION
APPROVED
REPAIR MOVINC
si�l�(6�/.
VALUE
E
E GROUP
DATE �I
0.4TE
AwROVED
�`
n
'o
SQ. FT. H
7
THE AMOUNT SMOWN UNDER VALUATION IS FOR m
TNE PURPO6E OF ESTABLISHING A PERMIT FE NLV: �
VALU �IO/N� PERMIT FEE S � �
/�V �/� �%� PLAN CHECK 5 / 1"'e o
�
- TAX E �s'Q f
V
TOTALPAID S 20�(��%
TO'
!
� :�_���:�
COSTAt ESA BUILDING-SAFETY DEPARTMENT
P70. BOX S77 COBTA MEBA. CALIRORNIA
For Applican+ fo Fill In Compleiely
TYPE OR PRINT
BUILDING 2138 Iris Place
ADDRESB
.GOSTA MESA.CALIFORNIA
OWNER yrV�nC-� C. . Jordan
r�� ����I°���
� APR � G i��l
C INF,PlCE DEPT.
CITY Of COSTA MESA
APPLICATION-FOR� PERMIT
eua�ir��
For Office U`se Only
RECEIPT NO. PERMIT NO.
BY
cin Ne OT't BeACh Nob�38811 pDDREb6
OR ENGE EER D. 3outhworth Noi185161 COSTA MESA. CALIFORNIA
ADDftE55 CO.gtfl Me3Q ' FIRE
ZONE TYPE � GROUP�
CONTRACTOR �� � -� APPROVED
BY DATE
ADDRESS SA1�Pi ZONING
ZO NO.OP UBE OF NEW '
CITY J I P4We 2 BUILOIN6W S
LIC.TNO. BI—VZ No: oR 88ii �c°°� LOT 'r� S TR• �38:
oeaca�rrioN
OF LO7 �d(p 0 J� / 0/ I No. oF etnos.e
xow o., �o. . P N� none
� BBTBACK LINB FROM
I LEPT �� Q�� I RIGHT O� 8��
DESCRIPTION OF WORK �
I X II a� rcwar�oni I II aoo�r�ora I
1 BUILDING NO. OF
AND Y✓ORK TO BE PERFORMED
2
APPROVED
1 H¢REBY ACKNOWL¢DGC THAT 1 HAVE REAO TH18 APPLlGT10N THE AMOUNT BXOWN UND¢R VALUATION IB FOR TX¢
FNU BTRTE THAT TH2 ABOVE IB COHREGT AN� AORE6 TO COM-
PURP08E OF EBTABLISH�N� A PERMIT FEE ONLY.
vLY WRM ALL CITY ORDINANCES AN� eTAT¢ L/.We R6GULATING
Bu�LDINo CONBTNIl�T1oN. �� VALUATION
SIGNATURE OF � �_ � 6 PERMIT FEE $ �7�OC
PERMI7TE o C
$17 � 75Z PLAN CHEGK $ Zu �7C
AUTHORIZED AGEN��
TOTAL FEE S � S�
N
►
F
LL