HomeMy WebLinkAbout2920 JACARANDA AVE - Building Permits\
PNOJECTaponEss: ;y�i� J�ACA�A�DA AV
.+�wwer6rame: LALKINS, DAVID '8
�_. �tooRass: y y �0 JACA�ANDA AVL
' C'OSTA NnSA,CA �2626
ABCHIENGINEEH: =56��1�]�3
ADOflE55:
PEG.NO.:
UNIT:
UNIT:
PEqMITTEE: aLE C()NSTF.UCT10N {"7i9)�39i-3i30
aooxess: ��0 FiAMP5TF.t1D ST
�i1��AF�FTM CA 9280i
LICENSED CONTPFCT P CLF AfION: I nereby allirm thal I am Iicense0 untler pwvisions ol Chapter 9(commencing wit� Section
]000� ot Oivision 3 ol �he Business antl Pmiession Code. anA my license is in full lor[e anU efiect.
ciTvuc.:,�9�reuc':�3540/�%���J�,B��� �
Oate: � Signa�ure -L�_ L(jLf
WOHRE85' COMPENSFTION OECLFNATION: I herehy affirm t�at I have a cenificate ol consem �o self-insure or a certilicate oi Workers'
Compensaiion Insurance, or a ceni�ied coPY thereoi (Sec�ion 3800. Lab. C).
POLICV NO.: 9� j(3 3'� �_. [�.' 1 E%P. OPTE: O 1 IO I I y 2
COMPPNY: S i A'PE
� Ceriili¢d py is hereby fumishetl [] Ce �ietl capy is liletl wi}h �he ci/ty/ BuilOing ///�iv���ision. n
oaie � 9 ApPlitanC [�r�/j(���'{�C/`
EMEMP ON FRUM WOPKEBS' COMPENSRTION OECLANATION: (This sectmn need no� be cample�ea if �he permii is lor one huntlred ($11q) ar less�.
I tehity �hat in I�e pedormance oi Ihe work for which �his permi� is issued. I shall no� employ any person in any manner so as to become
suGleci lo Ihe Workeri Compensation Laws of Califomia.
�a1e' SignaWre:
NOTICE: II, after making �his tleclaration, you shoultl become sublect �o the WorkeR' ComDensa�ion pmvisions ot Ihe LaOor
Coee. you must fonnwith compty with sucn provisions or ihis permil shali �e deemed revoke0.
CONSTFUCTION LENOING pGENCY: I here0y aifirm �ha� th¢re i5 a consimc�ion lending agenCy �or I�e pedormanCe of Ihe wOrk for
whith this permi� is issuetl (Sec�ian 3�97, Civ. C�.
LENOEP:
nooeess:
OWNEB BWLOEfl DECLAflRTION: 1 hereby affirm �hat I am exemp� �mm the ContraclorY S�a�e License law for the following reason
(Seclion 7031.5 Business antl Pmlessional Code: Any ciry of coun�y which requires a permit �o cons�mci, alter, improve, demolish, or
repair any slmc�ure, prior lo i�s issuance, also requires the applican� for such permi� lo tile a signetl s�a�emen� Nat he/she is licensed
pursuant �o ihe pmvisions oi �he ConlractoK Siale License Law (Chap�er 9(commencing wi�h Sec�ion 7000� o� �ivision 3 0� �he Business
an0 Pmlessions Cotle� or Ihal �e/she is exemp� �herelmm anA I�e basis �or �he allege0 exemp�ion. Any violation ol Sec�ion 7031.5 by
any applmani for a permi� sublec�s Ihe appllcan� to a clvil penally o� not more than live hunUreO dollars ($500).
I. as owner ol the pmperiy or my employees wi�h wages as �heir sole comDensa�ion, will Oo Ihe work. antl the
❑ stmclure is nol imentletl or olfereA for sale (Seaion 7044, eusiness antl Pmlessional Code: The ConiractorY State License Law
, does noi apply Io an awner oi a pmpeny who builOs or im0�oves Ihereon, antl who tloes such work himseA/herseli or thmugh
his or her own employees. pmvitletl Iha� such impmvemen�s are no� in�enUed or of�ereU br sale. If, however the 6uiltling or
impmvement is sold within one year of completion. ihe owner will have ihe UurOen ol pmving he/she ditl nol build or impmve
for ihe purpose of saie�.
I, as owner o� ihe pmpetly, am exclusively conUac�ing with licensed contrac�ors lo consimc� Ne pmlect (Section 7044, Business
❑ antl Professions Cotle: The Camraclors' S�a�e License Law does noi apply m an owner al pmpeM who huilUs ar im0�oves �hereon
anA who conlracls lor such pmlects with a contracmqs� license Oursuam ro the Coniracmrs' Slaie License Law). I am aware
Ihai pmof ot �heir Worker'S Campensation insurance shoultl �e providetl to me.
� I am exempt�under Sec�ion: H. 8 P. C.
�or iAis reason:!
oale. Owner
1 Uo nere�y cenify Inai I am aware o� and untlerstantl Ihe requiremen�s o� California,Healt� antl Safery Code $ections 25505, 25533, and
2553a ana Ihal I or any iWure building occupani will/will not (circle ane) neetl Io camply wi�h said s�a�e co0es and ihe requiremen�s lor a
permii tor constmc�ian or moddica�ion Imm the Air Ouahry Managemen� DislricL Residential conslmction aDDlicalions are exempt irom
mese pmvisions
�a�e: PpplicanP. -
I hereby ceriity ihat 1 have rea0l�is applicalion slaie Iha� �he a6ove informalion is correct. I agree m comply wi�h all ciry ana couniy
ordinances antl 9atelawsrelatingto builtling c Imction and here�y authoriterepresentatives olihis ciiyto enteruponlhe above-menlionetl
proper�y br in pection urpases. '�
Wle: � Si9naWre: - �� /
�river's License or Social Securi�y N� ������ �
t64i_06 W�ite-Builtlmq: Green-Cotle�Enbrcemem: Canary-Applicam; Pink-Revenue: GolEenrotl-Assessor
CTTY Uc COuT'A NESA - HUSLDING R�:tN'=":'' PERM NU: G 05.iE3Ut
P�RD"iIT NU: G 051808 PLAN C7F..CK N0:.00527-91 S GOVi: N SuPP: N
CONSTRUCTION TYPE: V-N PERMiT TYPE; iLE ,�1EC FL"u S;R Pi,��POSz: ADD
JOF3 ilESCkIP:IOi� : AL�li TU ;,FD SQ "r'T: 566
CLAIf, VAI�(JE:: 35,000.00 CAI,C-VALUE: 32,159,Op GRC)UP CiCC; R-3 !
COMMENTS: AI�D TO SFD
%�w �lf 1f iE a df �� k• K�K # 1� K)E % Ir 7E �X aF iF #> 1F �3E �� Jf �if �1f 7E k �E �7E iE �� �if �!f �M iP ��If # df iF�3FdF-0E�K� 3k -74 If au y� i. �X.-x-# 3<'� ri i: k#�M �7'r bF �%?c-1f af .f ;f %�N �k �k'K� ai �Y,- i's
'L O N I N G R E Q U I. R E A1 £ N T'.i •
S E T B A C R S
------------ N.A3N BJILDiNG --------- --------- l:CC�t',SORY BFII'LDiNG ---------
FRNT: 22 FT IN �EAR: 23 FT 8 IN FRNT: FT IN RcAr`t; rT TN
LEFT: S'r'T IN RG3T: 5 rT It� �,EFT: FT . iN RGH:: rT It�
PARKIiVG A:Q• PRUV; PAkCc.L• 139284�3 'LN=: R1 Rr.F �i0:
PL , N7NG NC)1'cS> AUU 465,9 SQ FT, ONE S'I'ORYT�3 c:{1STING }OUSE, iNTcR.�pR
> REMnUn;,iNG MISCcL'i.�ANE0U5• VBRIFY �rZONT �EISACIC,
3'r ?e y:-if ti�k i[� ii iE ii� 3i- N� i4 3e i'r )f iF fr i�'� }". f:� #�I(� # X� iF ##� iE IE iE 3c k�t".E �F iF 3t (e �)f # 3(-'�ii(� 1F :�� # iF k dF?.} k iE * k!i ic dk k� iE -lE 3Y ?t� %� 3F i's *?'r?i�i6 � ie �: i4 f'r # Y�
D H V E L O P M E N T S � k�'tr f C E S' R c Q J. ,.I R£ N, E N T S
ZONSNG APPRf�VED BY C-� -�� I)AiE: ��� I
BUILDiNG APFROVtP BY : DAT�;
APPLSCAT.TON ISSUED �Y: � �CC� S� L1AiE; Z�' L�jl
!b if je � M� %�if?f M'� 34 if iF ic' �!' 1f i'r iE 1F N- iI� # iF���'fl� .. ..� .. .. TFieTFk�i'r�C��i: iF 1!. ir iE iE i( i�� ie i4�TF�F��+' R!: i. ?;� �:
3E� 3'r ii ie''F ii� 3k }f ?f i!� %� 1f k� k 36?i- ii� Y� le %fF i'r iF if iE IF # i(� �1F ii� iE )f �f .r.1F V..lF !F ii If #!E if iF* #.K 3h i i'tl�; '.'t ii� 3� }; �: )(. � a.7F �:?F i(. s(..; +,F i.}; u y. jf iF iti a iE ib !E ;c �.
L'3GALI'LATION;N F � E 5 U N M A R Y STF?JCT?IRAL SEGM�.NT:Y
BLDG PMT PLUMBING ELaCiRTC MECi-IANiC cIaE SNIP/RES GRI�DING
F�ERNIT 304,Op � 13.00 4F,,00 9,OU 3.2'
25g SOi �58 SNN,IP/NON-��S
PLAN 197.60
-SSUH FEF 3.00 15,U0 15,00
BUILDIP:G-DTG-> PcRMSI' 3SS�� PLAN-CriECK iOTAi PP.ID DUE'
sOT�LS----> 375,22 33,00 19%.6U 605,82 605.8�'. ,QO
R�VENUE DIVISION TOTALS--> COi,LECi�: 408,2:' O��nR/SHORT: ,OQ
BI,DG nM1 PLUMHING EL£CTRIC 14ECrIANIC FIRi SMIPJTGT G�AilT2vG PT,A�v-C�F.CY
304.00 16.00 61.00 24.00 3,2:?
�ti iF k� lf��K�?i� 3! 3F i(� � jF # iF fi- R�1'r A• ii� 3't �# 3i• iF N� ?t ie i: 1 7: is ih 1e TS iE 3't � if 34 3E �JF� 3.i 3i� 7(� 3f ii 3i� Ji ;}±E 3(� 3F,F' lf ih 1E # ii� %i(� ii� k-?(� i&?i� }i �i'e 3E ?E #'� �*}.+p {�'�;(. ?i� lE �?E
I N D Y V I D t1 A L F c E 3� E A F! D 0 W N
TYPE �jTY ll E S C R T P T I O N UNIT COST '_'OTAL CO5':
SFR
ET. E
ELE
EI,E
ai� �
FL 7
466
�
10
6
:t
1
1
�
�
1
1
DWE-TYPE V-WO011 F�AM� -GOOD
�lXTi7R=5, i�IGHTING 1 ST 20 EA.
RECEPT/OUTi�r.T 1 ST 20 ;.A.
:ter_�pTiswiic:� i s� zo tr�.
SERVICE� b:i,t�W 600 V 6 3Ei.OW 2U1 AMP
SU�-PANEi,
REPAIR/AI�T H�ATING uNITI�YS W/CNTLS
LAUNDRY T[TB OR WASHER
wa�rE� sE�vzc��
GAS PZP�NG SYS OF 1 T� 4 OU'fLETS
�ACY.FLQW P�EVENTER
69.
1R.
' 12.
R1
G'v,
32,154.00
4 . S C)
%.5i)
4.50
1A,50
11.UU
9.00
2,Q0
2.00
1..00
��%4� 'f'� c-" 2. �)(} 2._
'I!1E: ia:']a
; CONSTRUCTION AND PLANNING POL- 6 SPA
��APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
�
. 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.
S. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. - ' 60. Backwash Lines, P-Trap, O Undrgrnd. �
70. Structural Floor System ,. • 61. APPROVAL TO DECK �
11. Property Sewer Line & House Connection �
62. Backwash & Receptor-Final .
12. Sewer Cap ! � � �
63. Heater & Vent-Final
13. Roof Drains , � 64. Plumbing System � Final `
14. Rough Plumbing , 65. Electrical-Final '
15. Rough Electrical-Conduit � �� 66. Solar System-Final �;�
16. Rough Electric Wiring � �, 67. Fencing & Access ApP�oval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS� Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Dutts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush
24. Roof Framing 73. Undergrnd. Stora9e Tank O Gas ❑ Oil
25. Roof Sheathing 74. Oveihead Hydro
26. T-Bar Ceiling (Structural) & Monocoa[ 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 76. 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 g2f
34. Final Heating & Air Conditioning a/�r� (�f�
35. Final Gas Pipe-Test S- u`�� (� '
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing u � (�{'�
39. Water Service-Final �
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer � Z�`q� �p
43. Backflow Irrigation
44. �andscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUC7URE & BUILDING U
�
48. FINAL PLANNING � -
49. Electric Release to Edison
50. Gas Release to Southem Califomia Gas Co �
51. CERTIFICATEOFOCCUPANCY
No. Date
PflOJECT AOOPESS:
1WNEP'-7 SaME:
,_ ►aOUBESS:
RflCHIENGINEEN:
AOOPE$$:
PEHMITTEE:
AODHESS:
HEG.NO.:
uNir:
UNIT:
❑CENSEO CONTFACTOP UECLANATION: I hereby atiirm ��dt I am licensetl unAer pmvisions o� Chapter 9(commencing wilh Sec�ion
7000� of Division 3 0l Ihe Business antl Pmlessions CoOe. and my Iicense is in full force and eflecl.
CITY LIC.: STRTE LIC.: CNSS:
�a�e: Signalure:
WOHNEflS' COMPENSATION OECIAflFTION: I hereUy ailirm Iha� I �ave a cerliliCaie ol ConS¢nl �a Sel4insUre ar a cerii�icale oI WOrkers'
Compensalion Insurance. or a cer�ihetl copy Ihereol (Section �gpp, La�. C�.
POLICY NO.: E%P. DATE:
COMPRNY:
� Cetli�ied tOpy is h¢r¢by �urnished. ❑ Certilietl copy is file0 wi�h the city BuilUinA Oivision.
Oate: ADDlicanC
E%EMPTIONFHOMWOHKEflS'LOMPENSATIONOECIAPPTION: (7hi55ec1ionneeanothecomplele0i11hepermili5foronehunUre0�511p)orless�.
I ceNly Iha� In ihe petlormance of Ihe work br whic� t�is permil is issuea. I shall not employ any person in any manner so as to �ecome
su�jec� m �he Workers' Comoensation Laws ot Califomia.
�a�e: SignaWre:
NOTICE: II, after making Ihis tleClaralion, yoU S�oultl beCome 5ubjeC� �0 �Ae Workers' Comp¢n5ali0n pmvi5i0n5 0� Ihe La�Or
Cotle. you musl lo�hwith comDty wi�h such pmvisions p� Ihis permi� shall �¢ JeEmeO �evoketl.
CONSTPIlCTION LENOING AGENCY: I �ere�y affirm Iha� Ihere is a con5lmction lending agency �o� ihe petlormance o� �he work for
which Ihis permii is issued (Setlion 3097. Civ. C�.
LENOEX:
ADOflESS:
OWNEfl BUILOEfl OECIAflRTION: I �¢reby aflirm Ihai I am ex¢mpt �mm �he Coniraciors' Siale LiCense Law tor fhe �oliowing rea5on
(Seclion 7031.5 Business antl Professional Cotle: Any ciiy oi coun�y w�ich repuires a permi� to cons�mm, alter, imD�ove. Oemolish, ar
repair any slmcNre, prior �o iis issuance. also repuires Ihe applicani �or such permit to lile a 5igneU s�a�emen� �ha� he/she is Iicense0
pursuam to ihe pmvisions oi ihe Coniraaors' S�a�e License Law (Chapler 9(commencinp wilh Seclion 7000) ol Division 3 0l ��e Business
and Pmlessians Cotle) or Ihai he/she is exempl l�erelmm antl Ihe hasis �or the alleged exempiion. Nny violation of Seciion 7031.5 by
any appbcani tor a permi� Sublet�s �he apPliCanl Io a tivil penalry o� no� more �han live hunOfeO tlollars (5500�.
I, a5 owner of Ihe pmp¢rty or my employees Wiih wages as Iheir Sole tompensa�ion, will 40 lhe work, antl �Ile
❑ stmcmre is nat intenAed or olfered lor sale (Section 7Wp, Business an� Pmfessional Code'. The Conlractors' S�ate License Law
�oes not applY �o an owner of a D�openy w�o builAs or improves Ihereon, an0 w�o tloes such work himselllAerselt or thmugh
his or her own employees, provitle0 Ihal such improyemenis are notintended or offeretl for sale. If, howeverlhe Uuilding or
' improvemenl is soltl within one year of comple�ion, Ihe owner will have Ihe hur0en oi pmving �e/s�e Jid no� 6uild o� improve
for ihe purpose ol sale). '
I, as owner o� ��e pmperry, am exclusively ConVatiing wiih liCensetl Conirac�ors to Constmtl �he prole�� (Sec�ion 7044, Business
❑ antl Pm�essions Cade: T�e ConVac�ors' Sia�e License Law Ooes no� apply Io an owner of Oropehy who builtls or impmves �hereon
antl who tontracts for SUCh pmjetis with a tonVatio��s) litense purSUani �o Ihe ConlraC�ofs' S�a�e Litense Law). I am aware
Ihal proof ol Ihert Worker's Compensatian insurance shoulU be pwvidetl to me. ,
� I am exempt under Sec�ion: B. g p, C.
tor �his reason'.
�ate. Ownec
I tlo hereby certily Ihal I am aware ol antl untlers�and Ihe req�iremen�s o� Cali�omia Healih and $a�ery Code Seclions 25505, 25533, antl
25534 dfld�hd� I 0� 30y WW�E b011�lflg aCCOp3�iWIIIIWIII p0� (pifClB 0118) fIBBd10 GOrtlply Wl�h 581d 5�2�B COd06 2fltl�h¢ f¢q1lifErtl¢015 IOfd
permit tor consimciion or modifica�ion imm �he Au Oualily Managemen� Dis�ricL Residenlial constme�ion applications are exempt �mm
�hese pmvisions.
Daie' Applicanl'.
I hereby certify �hai I have read Ihis appllcaiion and sta�e �hai ihe above in�ormaiion Is correcL I agree ta comply with all ciry antl counry
ortlmances antl state laws relaling to buil0inq constNCUon antl h¢�eby aNhorize representatives of ihis cily to enter upon ihe above-menlione0
pmpetly far inspec�ian purposes.
Oale: Signature:
�river's License or Social Securiiy q:
164t 46 White—Bwldmg: Green—Code Eniorcemenf, Canary—Applicam: Pink—Revenue: Goltlenrod—Assessor
PtRNIT i�0: G 0518U$ FLAN CiiECK NO: 00527-y1 S P.'�GE; ?.
N� 1f x� 3F � i(. s:- a; k 1E 3F ;r M1. v..%..% N� i'.0 i£ �k i¢ N� 7f N?F 3E �lh )F ie� iF Y� % if %� % X� Y)f fE tF i4 K� �lE if �Y� 3�:• N ii� 1E �IF i:� If k!f Y� 3f ib R� i'r ��'. k- �li� #� 'r: 3F?'r �{�?(� Y.� 3E+( # 3F %. u x JF 3E
TYPE �iTY D c S C R I P T Z O N UNIT CUST TUTAi, CQS'f
F'LU 1 Sr.W�R, CONNcCTION TO BUiLUING cACH S.QO
END OF rEES
S,OU
'K�i�p'��•`_-^f�i��'. 'Cif`��:i`_'..r a'.f
0± OOOE5�37—fiil�E:,?9< "g � �';' :rr_ :_
DATE. f�4/2;/91 TIC1L-: ;3ep:
,
_� CONSTRUCTION AND PLANNING PO� _s SPA
'.qppROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
_(
��1. TemPorary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
A. Electrical Conduit-Undrgrnd. 55. Electrital 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. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Flnal
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar SYstem-Final .
16. Rou9h Electric Wiring 67. Fencing & Access Approval
17. RoUgh Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Celling 69. POOUSPA SYSTEMS FINAL
19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hyd�o
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. fioof Sheathing 74. Overhead Hydro
26. T�Ba� Ceiling (Structurai) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Sidinq 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. Fina� Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Wat¢r Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. BacKflow Irrigation '
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL S7RUCTURE & BUILDING
48. FINA� PLANNING
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CEFTIFICATEOFOCCUPANCY
No. Date
city of .Costa Mesa
Celifornle 92628-1200 � P.O.Bo� 1200
Insulation Certificete �
Cy- 5—"l g �� •
ierm�tNumear 6�51808 ,,, _
?920 �7ACARANDA
�� rvumDer antl 9vaa�
ORA[VGE_
County
__.. _.....
COSTA MESA, CA.
�tY
Subdivision �— L01 NUR1bB�
Descriptlon of Installation
ROOF MANVILLG
Material .___r_18ERGLA55 Brand Name
Thlckness (i�ches) _—L 'L' .._ .,,.�.._ Thermat qcsistance (R•Value)...; 3�
EXTERIOR WALL
Msteriel —_FIHEriGLnSS .
3 � ..
Thickness (Inches) __...
B�and Name rfnNvli,�.E
Thermal Resistance (R•vaiue) 11
CEIUNQ
Batt or Blanket 7ype _ Brand Name _ _
Thickness (Inches) __.-.. Thormal Resistance (R-Vnl�e) ___
Loose Fill Typ4+ _. Brand Name ..
Contraotor's minimurn installed welgnUri=—_ Ib. Minimum thickness inches
Manutacturgi'6 installed weight per 6quare foot to achieve Thermal ResistanGn (R-Value) .... .
RAISED FLOOR
Mat9rlal __
Thlckness (inches)
&LAB FLOOR
Material _.... _
Thickness (lRCh89)
Widlh (Inohes) �
FOUNDATION WALL
Material __.......__._�
ThieknesS (inches) _._
Brand Name
Thermat Resistanco (�•Value)
Brand Name �_,._
Thermal Resistancc (R•Value)
Brand Name _____
Thermal Resislance (R-Value) . .,. .._.
Declaration
I he�eby certify tAat the abOve +nsulaiion was fnstailed in the building at thc apove loCation in conformance with
tha current Building EnArgy Eniciency Standards ipr new residential builtlingE contained in Title 24 01 the
California Adminstrative Uode.
ACE CONSTRUCTION CO. 283540
_..... __�._ _....._ .. . __.._
GBnvril CONf�CIOt (Bullaer) , Liuniiae Numbe�
T._,_..........._........ . . ........_..-_._.._. .... . . __ _
. 6ipn�luw Mi0 TI11e �atb
WF. LS jNSULATION COPffiANY, 1NC. 3h4692
-----...... ---- -- --
8uD• Vac1o� (Ineulatan Inatelleq � Lic9neB N�mpyr
,.._. __--Y.A!'hT.DENT __, . 06-10-91
� ignewro aM 7it�e ' "'—' Dt�t ..... .. . .
iB07J6
Applicant to fitl in au spaces witnin neavy boraer lines anE sign all appro0��ate tleclaratlonL �,. .!-= �� i i� �
CITV OF COSTA MESA - PeRnn,iy� O. / TRACT NO. LOT NO. BLDG. NO. �
GONST�iUCTION PERMIT i ' /ot�o`f'
Project Address q�G/�q/� -' TVPE OF CONSTRUCTION
Owner y � � �'Q��( � Phone /) ❑,-,, ��.yQ� ❑ qDD ❑ ALTERATION
Address S� � LKREPAIR ❑CONVERSION ❑DEMOLISH
❑ OTHER ZONING REGULATIONS
Arch/Eng. License No. A p�
Addre55 DESCRIPTION OF WORK
ZONE GING. REF. �
COntfa[tof Phone I I NG
TVPE OF PERMIT - ��O��R�v LIrvE
Addres5 ❑ GRADING ❑ FOUNDATIO ❑ STRUCTURAL SIOB VARD L ST.
LICENSEO CONTRACTOR �ECLARATION ❑ TENANT ❑ ELECTRICAL PLUMBING ❑MECHANICA L5EpFE VA
I Oereby atfirm fhat I am Iicens¢tl untler provlslons of ChartEr 9(com- RIGHT
mencing with sectlon ]000) ot Dlvizlon 3 Ot th¢ BuSiness antl ❑ OTHER
Vrofes510n5 COde, antl Ty Iicense Is In tull fo�ce antl effect. REAR YARD (TO P/l_)
PROJECT DESCRIP710N
Litense qass license No. PKG. SPACE REQ. PROV IDED
Date SlgnatUre SQ. FT. .
WORKERS' COMVENSATION DECLARATION OCCVPANCV_CONSTRUCTION TVPE STREET WIDTH PARK FEE E
I nereby atfirm [hat 1 have a certitiwte of consen[ to selt-insure or a VALUATION 20NE ZONING APPROVED BV DATE
cerHfifzte of Worker5' Comp¢nSdtiOn Insurant¢, or a certifietl copy
thereof (Sectlon 3800, Lab. CJ. GRADING CU. VDS. ACRES SPECIAL CONDITIONS:
Policy No. Company - '
❑ CertNietl copy is hGr¢by tumishetl. - REMARKS:
❑ Ce�tlfletl cOpy is filetl with the city Builtling DiviSiOn. �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl no[ �0 completetl if tha Oermit i5 for one huntlretl ,
S§LO�) Of �255).
Carti/y that in tlte Oertormance ot the wo�k (or whith this permit is
issuatl, I shall not employ any perSOn in any manner so as [o become PLUMBING PLAN CHECK .ELECTRICAL PLAN GHECK
Subject to the Worker5' Compensation laws of Calitornia.
Date Si9nature BATHTUBS SHOWERS
NOTICE: If after making this tleclaration, you shoultl become subject TOILETS VRINALS GENERATOR 0-1 KW_ 1-10 KW
to the WOrk¢r5' Comp¢nsation provlsions of the Labar Cotle, you must TRANSFORMER
fOrthwi[h compry wilh such proviSiOns or Ihis permit Shall be tleemetl LAVATORIE$ DOUBLE LAV$ APPLIANCE 30-50 KW_50 + KW
revoketl. - �
CONSTRUCTION LENDING AGENCV K�T. SINKS DISHWASHERS MOTORS 0-1 HP_3-30 HP
I nereby atfirm that [her¢ iz a construttion lentling agency tor the per- SERVICE SINKS SUMPS UNC. $OLAR) ]p.50 HP 50 + HP
(armanCE of [hE work ior whicb thls permit i5 i55uetl (SeGtion 3097
���• �'%' F1.00R $INK$ FLOOR DRAINS FI%TURES OUTLETS SWITCHES
LeOtler's Ndme
Lentler'S Atltlress DRINKING FOUNTAIN$ GAS TUBE $IGN$
OWNER BUILDER DECLARATION � � INTERCEPTORS CLARIFIERS POLEIIGHTS
1 hereby aftirm that I am exempt from tne ContraG[or's License Law for
tne following reason (Section 7031.5 Business antl Professions Cotle: SWIMMING POOI PTRAP
Any city or county which requires a permit fo conslrucq alteq POLES METERED SUB
irtfprove, tlemolish Or repair any st�ucture, prior lo its issuance, al5o re- y�rqTER SERV ICE ALTERATION PANELS MAIN SUB
qWres [he applitant !o� such permi[ to file a signetl statemenl that he
Is II<ensetl pursuant to lhe provisions ot the Contractor'S License Lzw GAS __...._E � UTLETS � SERVICE AMP
(Chapter 9(commencin9 with SecHon �000) of Division 3 of the
Builness antl Adessions Cotle) or that he iz ezempt therefrom antl the yyATER HEATERS BTU OVTPUT '
basis for tne allegetl exemption. Any viola[ion of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
o�f � more than five huntlretl tlollars (5500). �`�
IjCI, as owner of tne Oroperty, or my employees with wages as tneir SOLAR TANK COLLECTORS ,�
So1C COmpensalion, will tlo [he work, antl the st�ucture is nOt intentletl
or ofteretl for sale. (Sectlon 7044, Business antl Rofessions Cotle: T�e SOLAR PIPING SVS. ISSUE FEE
Cont�actor'S LiCens¢ Ldw tloes not appty lo an owne� ot a property - APPLICATION APPROV ED BV DATE
who builtls or improves thereon, antl who tloes sucn work himself or ISSUE FEE
lhrou9h hi5 Own employees� provitl2tl Lhdt SUCh ITPIovCT¢OSS hc¢ OOt
intentletl Or ottetetl fo� Sale. If, however, Ine builCinq or improvement MECHANICAL PLAN CHECK SUMMARY OF FEE$
is soltl witnin one year of completion, the Owner will have lhe burtlen -
ot proving he tlitl not builtl or improve for IM1e Purpose of sale). BUILDING
HEATING SVSTEM 0-100,000 BTU PERMIT S SMIP E
❑ I, a5 owner of [h¢ ProOerty, am exclusively conVaC[in9 with qNDDVCTING
licensetl tontracton to construct the prolect (Section ]044, Business 300,000 . BTU PLAN CHECK S PERMIT
antl Professions Cotle: The Contractor's License Law tloes not apply to 5. O-D ISSUANCE $
an owner of property who builtls or improves [nereon, antl who mn- REFRIGERATION 0-300,000 BTV PLUMBING S �
bacls (rom suGh projects with a Contractor(5) licesnetl pursuan[ to SYSTEM 100,000+BTU PLANCHECK S GRADING S
the Contractor's �icense Law).
❑ 1 am exempl untler Section B. & G. C. (or this ELECTRICAL S b
BOILERS BTU
reason P�AN CHECK g MICROFILM S
Date Owner SVSTEM REPAIR, ALTERATION TOTA� FEE $
1 �ereby certifytha[ I have reatl this application antl ztate that th¢ dbove EXHAUST SYSTEM MULTIPLE MECHANICAL $ .
Information Is correct. 1 aqree to camply with all <ity antl county
PIAN CHECK $ VANCE PC $ _ -
ortlinanG25 antl State IawS relating [o cOnst�uction, and he�eby autho�ii¢
representatives of this city to enter uyyo��ppp [he above men[ionetl
property for jp,spectlo�r�Ose���
Sl9nature �� � •� Date ���5��/ FINAL FEE E
o.��e�s• u�eo:� o, ss �. ISSUE FEE -
CMF 0865-46 Wnite-Builtling; Canary-App�icanh wnu-qccounung; Goioenrovwssmaw
CONSTRUCTION ANO PLANNING POOL & SPA .
APPROVALS Permit # Date Inspector qppROVALS � Permit # Date InsjSector �
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location � '' � .
2. Soil Pipe-Undrgrn - 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51 . Backwash Lines P-Tra ❑ Undr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing � � -� �
14. Rough Electric-Conduit - 56. Electrical-Final
15. Rough Electric-Wiring � 57. Solar SYstem-Final
16. Rough Heating & Air Conditioning - - • Fencing & Access Approval
17. Ducts in Structure ' 9• APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation .
24. Wthing & Siding
25. Drywall Nailing
26. Plaster Brown Coat �
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test j ¢(
31. Final Plumbing
32. Water Service-Final '
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem �
36. Sound Attenuation
37. Handicap Regula[ions
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY �
No Date . . � - ,
OWNER
JOB AC
JERAL CONTRACTOR pvner-Builde
No.1�9-281F-2� LOT 152 T
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARY SEFVICE OP POLE
UNOERGROUNO � POWER �
ROUGH WIRING
�n�il{�YIGI'i�l.�
REINFORCE
SHEATHING
FRAME ANO FLA�SnNING
LATMING — IN p� OUT �
PLASTER, BROWN COAT
$TRULTURAL,fINFL
HEATING, VENT., REFFIG. FND A.C., FINr1L
PLUMBING, FINAL AN� GAS TEST �
FINAL
BUILDING. FINAI
FIRE
DATE 5.
BUILDING PE
SUBCONTRACTOR
. 30289
• ' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.eOX 1200 COSTA MESA.CALIFORNIA 92626
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+?AY 76-69cNs,10�1022,� �u*�*3`�.50
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RlEI V sv �TE RECEI� on��s�s eo
BUILDING h ��—
ADDRESS ��ICJJ.�f0.h A � Q!)
OWNER Q � t \ �( A.P. NO. I3 'd '�� P��T� Y
MAIL BUILDING � ��/
ADDRESS ADOFESS �/�
TEL. TRACT�p n?v1 LOT� BLOCK
CITV NO.
CON5TRUCTION W P
LENDER � h
BRANCH /
OWNE � �('
ADDRE55 � VALUE �j_ �
AqCHITECT TEL. $ § J 06
OR ENGINEEF N
FIRE �
ADORESS ZONE TVP GROUP y
APPROVE {�� � %
CONTRACTOfi p�,;�e�- �.,..��� ae�- BY � 4/ DATE /��`//
ADDRESS
TEL. ZONE n NO.OF % USE OF NEW ti
CITV NO. �C P�-p`� pC. BUILDING �
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE /J NO.OF BLDGS. (F TBEE )
OF LOT �J// I�� NOW ON LOT �� FT.
USE OF
EXISTING BLOG. $ FT
512E OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT FT.
EXTERIOR WALL�/r �' ROOF
COVERING �' COVERING REAR �� FT. FT.
USE F UILD G AN WORK BE P FOFMED DISTANCE BET. BET. MAIN &
/ 'PS MAIN BLDGS. ACC65, BLDGS.
VAR.#` DATE
C.U.7.�{'+ APPROVED
i `
APPROVED � /^ /
e� (o
I hereby acknowl¢tlBe that I have reetl this application antl state
that tha above informetlon is carract antl apree to comply with
all laws �egulating buildinp conavuctlon, antl I shall not amploy
any Derson in violation ot ihe workman's compensation laws at
Me State of Celitornia. <
I hereby certify t�et I em proparly Ilcanaetl az e contrector untlar
O SQ. FT. t
ihe State of California Businesa entl Profeulona Cotle, Divisicn 3, THE AMOUNT SMOWN UNDER VALUATION IS FOR
Chepter 9, entl t�et such licenses ara In full force entl aftect, Or 1 TME PURPOSE OF ESTABLISMING A PERMIT FEE ON�V: �
am ezempt from Me provisionsof Ne Steta of Californla Businass VALUATION �j
entl Professions Cotle, Oivision , Chapter 9. PERMR FEE § Z✓� D O i
Slp^aturo ot '^(" � ' ^ �•� ` D �
Permittee � I\ V� �I $ 3 QD(i PLAN CHECK $ /•`� I
Authorized AgenS / L�7� �
TOTAL FEE $� � V V
� �t���� .,.'. � , ..,. .
�' � AUG 7 1959
•COSTA MESA BUILDINGSAFETY DEPARTMENT - -,�-�-,in� ��rt)j
_ P.O. BOX 317 GOSTA MESA. GALIFORNIA •'��"' `V" ''—� �
fOR APPUCANT TO f/LL /N COMPIfTECY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADORE55 2 2 '
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
I RECEIPT NO. � P£RMIT
OWNER Adams Acres Zil�.'• �-�I
ADDRESS ��� E• 1(th Slir RECEIv�av I D�TERECEIVEo IAUU�Tj1O
C�T�. Costa 1�053 T�o: LI81159 pDDftE55
ARCHITECT Carlson & ��c. COSTA MESA, CALIFORNIA
OR ENGINEER r• NO.
ADDRE55 Garden Grove FIRE /,1�
ZONE TVPE' V �� GROUP . !
GOND�BOR Colegrove, InC� L CTNO. ZU72� APPROVED
ov nerc
�ew� LOT G04G zone . or c or rv
OESCRIPTION NO. ��� BLOCK TRACT / PLANS � BUIIDING
APPROVED / �j
A.P. NO. gY DATE fe
SIZE � X 11L No.OF aLocs ypRDS EVES
OF LOT U I NOw Orv lOT hOIlE REQUIRED ALLOWED
USE OF (CENTER LINE BT.) ��c-�/ �
EXISTING BLOG. FRONT {J V� Ff. IN
SEfBwCK LINE FROM SO� �•! R.SIDE FT. IN
CENTER OF STfiEET REAR YARO
SIDEYARD ILEFT 5� IRiGHT 5� L.SIDE J' FT. IN
DESCRIPTION OF WORK '
REAR FT. W
NEW I Y` II ALTERATION I II ADDITION I
REPAIR I IIMOVING I IIOEMOLISH I
S Z'E DING lg(,5 ROOMS � STORIES �
EXTERIOR WALL I ROOF ROw1
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Sin ,le famil residence rrith
attacheci gara�e.
I NEPEBV ACKNOWLEDGE THAT 1 HAVE REAO THIS APPLIGTION
pNO ST1TE THAT TNE �BOVE IS COPRECT ANO AGFEE TO COM- THE AMOUNT BHOWN UNDER VALUATION IB FOR THE
PLY WITH ALL CITY OftDINANCES AND 6TATE LFWS REGULATING PUHP08E OF ESTABLISMING A PERM�T FEE ONLY.
BUILDING LONSTRU ION. - /O VALUATION �} n
P RMIT'fEE OF� � A f��. ��, !� PERMIT FEE $ Jc,�CO
_� ,�� � ,_y _
$ 13�7�5 PLAN CMECK $16��
AUTHORIZED AGENT Dike & Colegrove� Inc. ' TOTAL FEE 5�•�
v�