HomeMy WebLinkAbout2237 JEANETTE PL - Building Permits� ' .
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax Q14) 754-0856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: 610-00104
PERMIT TYPE B_ROOF2
APN: 42607211
JOB ADDRESS: 22 JE'A+IYETTE"PL G�M
Vicinity: DE7ACHED HOUSE AND GARAGE
Squares: 1954
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
04/2612010
RMD
$2,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF. INSTALL A MINIMUM OF 1 LAYER OF 15# FELT ON A 4:12 PITCHED ROOF AND
REROOF WITH 25 YEAR COMP SHINGLES ON A DETACHED HOUSE AND GARAGE, APPROX 1954 SQ. FT. REROOF
OF HOUSE AND GARAGE TO BE DONE CONCURRENTLY. COMPLIANCE FORMS ATTACNED TO JOB CARD AND PERMIT.
OWNER: JAGER, WILLIAM D
PHONE: 949-280-0758
APPLICANT: HATCH, STUART
PHONE: 951-677-9218
CONTRACTOR: COPPER RIDGE DEVELOPMENT
Address: 23871 WASHINGTON AVUnit:
Ciry/State/Zip: MURIETTA, CA 923562
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $6925
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 2237 JEANETTE PL
City/State2ip: COSTA MESA, CA
Address:
City/State2ip: �
LicenSB No.
License No.
PHONE:
License No. 785590
909-721-2868
CELL:
PHONE:
PHONE:
Unih
Unit: :
4L FEES $70.25
NOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 311812010 - PER CMMC Sec. 13-279
Monday thrU Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitietl all hours - Sundays and the following Federal
New Years Day, Memorial Dav, Independence Dav, Labor Day, Thanksgivinq Dav and Christmas Day
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, 12-27-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 inspections and fina! approval must be oblained. Fa'Oure to obtain inspeGions and final approval will result in the expiration of this permit.
L OE t. INSPECTION1ypE DATE IN7ITIRLS LOOEN INSPECTIONTYPE O�TF INTRIAIS
1616 Fixetl Systgm Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final �, p� 20B Final Plumbing
200 FinalRe-R�( J( pi"2'i"1D R�{.� 210 FinalEl¢�trical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Faciqry Fire Piace 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Dem0lition 250 Final Building�Occupanry
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the lollowing declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as pmvitled !or by section 3700 of the Labor Cotle, for the
pedormance of the work (or which this permit is issued.
❑ I have and will maintain v.orkers' compensation insurance, as required by
section 3700 of [he Labor Code, for the peAormance of the work for which this
permil is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier.
(Thk setlm neetl nol De mmpleted d t�a perm4 is valued al me frundetl tlo6irs (510�) w ku )
Policy Number:
� 1'certify that in t�e peAormance o( Ihe work (or which this pertnit is
ed, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to Ihe kers' mpensation provisions o� Section 3700 of
the Labor Code, I shall f hwit m ly wilh lhese prov.i'sio/rrs.'
� ���
�APpry " ture ' � �e�
WARNING: FAILU E TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions ot Chapter 9(commencing
with Section 7000) ot Division 3 of the Business and Prolessions Code, and
my license is in full torce antl effect.
L(c�#--"'}- O CCtass;#._ 8
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CONSTRUC N LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lending agency for the
peAormance of Ihe work fa wfiich this pertnit is issued. (Sec. 3097. Gvil Code�.
Lender's Name:
Lender's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury lhal I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW lor Ihe followinq reason (Sec. 7031.5,
Business and Pmtessions CoCe: Any ciry or counry which requires a permit to
construcl, alter, improve, demolish, or repair any structure, pdor to its
issuance, also requires the applicant for such permit to fle a signed statemenl
that he or she is licensed pursuant to Ihe provisions ol lhe Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code) or thal he or she is exempt therefrom and
the basis tor the allege0 exemption. Any violation of Seclion 7037.5 by any
applicant for a permit subjects the applicant [o a civil penalty of not more than
fve hundred tlollars ($500).):
❑ I, as ovmer of the propeny, or my employees with vrages as their sole
compensation, WILL DO THE WORK, and the structure is not intendetl or
oHered for sale (Sec. 7044. Business antl Professions Cotle: T�e Contractors
License Law does not apply to an ovvner of property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided thal such improvements are not imended or oKered for
sale. If, however, the building or improvement is soltl wilhin one year ot
complelion, the ovmer-builder will have the burden of proving that he or she
ditl not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRAC70RS lo construct the projecl (Sec. 7044. Business and
Protessions Code: The wnl2ctors License Law dces not apply to an owner of
property who builds or improves thereon, and who conlracts for such project with
a conlracta(s) license pursuant to the Contractors License Laws.�.
� I am exempt under sec.
Business and Professions Code (or this reason:
Signature
305]-a6 (3/OJ)
Ovmer ID venfied by tlriver s license. ❑ Yes ❑ No , •
Dnver's License No. Eapires:
Verification of Ownership by (rype of tlxumenC i.e. - pmperty tax 6ill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
� I hereby certify that no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connectbn with v,nrk auttrorized
by this permit, and that no building struc�ure, scaHdding, falsework, a demolitbn
or dismantling thereof, will be more than thirty-s& (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit from the Division of Industrial Safety, as noled above, unless
such person has a permit to do such vrork from the division.
Appliranl's SignaWre Dale
Division of Industnal Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATION:
1. Will Ihe appliwnt or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 ot lhe California Health and Safety Cotle requires, with some
exceptions, tha[ a Business Plan be filed with the Cosla Mesa Fire
Department by every business which has a[ any one time tlunng a reported
year a quantity of hazardous materials equal to or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlartl temperature and pressure�.
2. Does or will the applicaN or present or future building occupant need to file
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, wi�h some
ezceptions, requires registralion with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of aculely
hazardous materials equal to or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or fuwre builtling occupant need to
prepare an RMPP (Risk Managemen[ antl Prevention Program for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cotle provides that the
Cosla Mesa Fire Department may require the preparation, ceni(cation and
filinq with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous matenals with Ihe Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of lhe Calitomia
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fulure building occupanl require (or
the work which is the subject of this application a permit for such construction
or motlification from the South Coast Air Qualiry Management District or from
any other air pollution wntrol distnct or a9ency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires Ihat the requested
infwmatbn be (umished on applications ta rwn-resitlential building pertnits).
6. Will any part of the facility to be constructed under IhiS permil be within
1000 leel from [he outer bountlaries of a school? O Yes ❑ No
(I('yes", the facility must meel lhe requirement of Sections 25534 and 42303
o! the Califomia Health antl Sa(ety Code).
7. I( a permit from the South Coasl Air Quality Management District or other
air polWtion control district or agency is required for lhe wnrk which is the
subject of Ihis application, have all of the disclosures prescribed by Califomia
Health and Sa(e[y Code Seclion 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty o! perjury the
informalion given above is correct. I agree [o comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have reatl this application and stale that
the information given is correct I agree to comply with all state laws and city
ordinances relating to building conswction, antl authonze representatives of
the City of Costa Mesa to enter'upon [he above-descnbed pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhorized 6y this permit until fnal inspe tion.
SignaWreofLegal er(s ale
�0
[Ma«��rzedAoc�_ m--� F"-�•
I'rescriptive Certificafe of G
Residenti�d flf[erntians
Project Namc: � ���
Residential
✓ � �`Pi�" �
Climnfc Zone #
CF-1 R-A LT
(Pa�e 3 0l'S)
� # of Star�es
ROORING PRODUCTS (COOL ROOFS) §IS/(pl2
IVLe�i the nrea nf crlerinr rnof surfnce tn be rep(nced eeceed.e more thun SO% oJthe erisri��g rnnf uren, or more thnn /,OIlO fr', �✓hichever i.r
less, Ihe nero ronfing nren uur.�7 mce( U�e raofing praducl "Cao! Rrinf'req«iremenfs of§I52(b)llli, 752(b)lliii, nr /52(h)IHiii.
Check npp(icnGfe allernntive ar erception 6e[mr if die ronf a6eru�ian is uempr fi�om d�e roofing product "Coo1 RnoJ" requirwnents. Noie: /jan��
a�ie ajdre uf�ernaiives or ezceytinn Gelaw is checked, ihe dged Solur ReJlecmnce and Thermu( Eniivance reyuirements jor rooTng p,�oducrs in
,¢I /8(i) ure nol npp(icuG/e. Dn nol,fiB mble below.
❑ Cool Roofs Not ILequired in Climate Zones I-12, 14, and I( with ai Low Sloped. Less or?:12 pitch. �
I�Cool Roofs Not Itequired in Climate Zones 1 thrnugh ) and I C> wi[h a Steep-Sloped Roofs (pitch greater thnn 2:12) and product unit weight less
Allernntives tu §152(b)1 Hi �nd §I52(b)Hii, Steep-slupc roof (pitel� >?:l2)
❑ Insulation with a[hermal resisiance of at least 0.85 hr(t2�°F/8tu or at least a 3/4 inch air-space is added to the roo(deck
over an attic; or
❑ Existing ducts in qie attic are insulared and seafed uccording to § I51(f}10; or
O In climnte zones 10, 12 and 13, witli I ft' of free ventilation nrea of attic ventilation for every I50 ft of attic floar area, and
where a[ least 30 perceN of the free ventilation area is wilhin 2 feet vertical distance of the mof ridge; or �
❑ Building has at least R-30 cciling insulation; or
❑ Building has radiant banier in Ihe attic meeting the requiremenu of § I51(�2; or
❑ Building has no ducts in the attic; or
❑ In climare zones 10, I I, f 3 and 14, R3 or greater roof deck insulation above vented nttic.
Gxeepfinn to §152(b)IHiii, L��w-slope rooC(pilcl+ <2:12)
❑ Building has no ducis in the attic. -
Other Gxceptions -
❑ Roo6ng area covered by building integrated; photovoltaic panels and solar thermal panels nre exempt from the below Cool Roof criteria.
❑ Rnnfconstructinns thnt have thermal mass nver rhe rnnFmemhrane wiih at least 25 Ih/ft is exemnt from the. helow Cnn! Rnnf criteri�.
pliance me[hod cannot be used, use the Nertbrma�.
rom Ihe Roofin Products "Cool Roof' Re uirerc
RoofSlope Praduct Weight Product
2:I2 >2:12 < SIb/ft� > Slb/ftz TYPe�
❑ ❑ ❑ ❑
���
I� ,I �
���
�v�
�❑
�
�
�
Approach to show complianc<
Aged Solar Thermal
Reflectance�'4 Emittanci
❑Q
OQ
❑4
❑�
o"
The CfiRC Producl ID NunrLer e<m Ge abmined fi'anr Ihe Caol Roof Ra�ing CoimciYs RaiedYraducl Uireclory al invm.caoDnoCs.nre/nrnductsLtem•clt nlro
Indica�e Are ryyre of produci ia� being used fm� the rooJlop, i.e. single-plp roof, aspl�all roof, me�al roof, etc.
/(llre dgedlfeJ(ecmnce i.s nol nvnilnGle inJhe Coo! Roof /inling CmuiciYe� Rarer(Produc/ Dirncmty Ihen use U�e Inilia( Reflecmnce vn/ue firom (He snnm
direclo��� mrd use Uie equnlion (01+p.7((J���irial— 01) lo nGloin n cnlcula(¢d aged volue. Where p ia� Ihe Inilial Solnr /teJ/ec(nnce.
Check bnr i/ Ilre dged Ite/lecmnce ia' n cnlc�dulerl vuLrc na�ing Ihe equnlion nLnve.
Cafndn�c Uie SR! value In� using tlie SR/- Workslreei nl hun'/hv�m � enerm�.ceecnnhille24/ond emer rlic resulring onlue in Ihe SNI CoLunrr ubnve and nuad� aco�n�
U�e SRl- Workshee� in lhe CF-llf.
� apply Licp�id I�ield Applied�Cualings, [he wating must 6e applied across the entire roof surface and meet Ihc dry mil Ihickness or coverage
commended by Ihe coatings manufacturer �nd meet minintum performanec requirements listed in §118(i)4. Select the applieable coating:
Aluminum-Pigmented Asphalt Roof Coating �0 Cement-Based Roof Coa[ing �� O[her
Regisu�utimt NumGer: Regia•b'oliwr Da�e/7'ime:
2008 2esiden�iul Complinnce Fonns �
i1E2S Po�orider:
�lugusi2009
�
CITY OF COSTA MESA
O�pMFS,p BUILDING DIYISION
i4�� 77 FAIR DRIVE. COSTA MESA. CA 92626 • 014) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754-5626
�`oe,a.ma, A�
PERMIT NUMBER: BC10-00169
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 04/26I2010
ISSUED BY: RMD
�06 Ao�Ress: 2237 JEANETTE PL CM
APN: 42607271
Vicinily: INTERIOR OF HOME
Const Type: V-B SQ. FT:
Zaning: , ,
1954
Suite/Unit:
Primary Occ:
Valuation: $9,000.00
SCOPE OF WORK: REPAIR TERMITE AND DRY ROT DAMAGE,REPAIR/REPLACE WASTE AND WATER PIPING,RE-WIRE
HOUSE,NEW HVAC AND DUCT WORK,REPLACE ALL WINDOWS AND DOORS SAME SIZE OPENINGS AND LOCATIONS,
REPLACE INSULATION IN WALLS AND CEILINGS, REPAIR AND PATCH STUCCO, REPLACE ALL DRYWAL�, REPAIR
EXTERIOR SIDING. NO STRUCTURAL
MODIFICATIONS.
ELECTRICAL TO INCLUDE: 10 LIGHT FIXTURES, 71 OUTLETS, 36 SWITCHES, A/C UNIT. MECHANICAL TO INCLUDE: NEW
FAU, NEW DUCT WQRK, 1 A/C UNIT, 3 VENT FANS. PLUMBING TO INCLUDE: 3 BATHTUBS, 1 GAS RE-PIPE, 1 LAUNDRY
TUB/WASHER, 1 SHOWER, 1 KITCHEN SINK, 1 WATER HEATER, 1 WATER RE-PIPE, 4 WASH BASINS, 3
WATER CLOSETS.
OWNER: JAGER, WILLIAM D
Phone: 949-280-0758
Address: 872 WENDTTERRACE
City/State/Zip: LAGUNA BEACH ,
APPLICANT: HATCH, STUART Address:
Phone: 951-677-9218 City/StatelzZip:
cOrl7Rac7oR: COPPER RIDGE DEVELOPMENT License No. 785590
Phone: 909-721-2868 Address: 23811 WASHINGTON AVUnit:
Cell: City/Stale: MURIETTA, CA
ARCHITECT: License No.
ENGINEER: License No.
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Sid Admin Fund
TOTAL FEES:
$0.00
$167.25
$139.71
$56.95
$190.10
$0.90
$0.00
$1.00
$557.91
Unit:
Unit: :
ZipCode 923562
PHONE:
PHONE:
Re(er ro fee receipts (or ell fees paitl for proJect
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3I18I2010 - PER CMMC Sec. 13-279
Montlay thru Friday-7:00 am thru 7:00 pm. SaturCays-9:00 am tnru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Yeers Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE Of ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes, and all
required inspections and final approval must be obtained. FaiWre to obtain inspections and fnal approval will result in the expiration of this permit.
COOE t. INSPECTIONTYPE DATE INifilALS WUE1 INSPECiIONTYPE D�TE IN111UL5
1816 Fixed System Final Fire Prevention 206 Final Mechanical � 3 � 0 ��
1266 Pool Spa Final 208 Final Plumbing y r! �� � H/L
200 FinalRe-Rool 210 FinalElecincal �cj� l�'{� �i/
201
202
203
Final8lock/Retaining Wall
Final Faclory Fire Place
Final Sign
204 Final Demolition
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final euildinglOccupancy � /�� �'��h ��
. ` ' •
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalry of perjury one of the following declaretions:
� I have and will maintain a certifcate of consent to self-Insure for vrorkers'
compensation, as providetl for by section 3700 0( [he Labor Code, for the
performance of ihe work for which this permit is issued.
❑ I have and vrill maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for lhe peAormance of the vrork for which this
permil is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier
(IDu sedon neetl not be mmpleted A(he pertnrt is valuetl a( one huntlietl da9ars (5100) orlessJ
Policy Number:
I certi/y tha[ in [he peAormance of the work for which this permit is
iss ed, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of California, and agree that if I should
become subject [o e work ' compensa[ion provisions of Section 3700 0(
the Labor Code, I all fo comply with these provisi ns.
D
pliranl's i nalure lo d
WARNING: ILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLA UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO TNE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy aKrm [hat I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of ihe Business and Pmfessions Code, antl
my license is in full force and eflect.
� c-n� 7 55 D c�ss,n
6 0 0
onfi rsSgnaWre DeG!�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm ihal there is a construction lending agency for [he
perfortnance o( [he work fa which this pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name-
Lender's Address:
SgnaWre
OW NER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
conslruct, alter, impmve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicaN for such permit to fle a signetl statement
that he or she is licensed pursuant to Ihe provisions of the Coniractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or that he or she is exempt �herefrom and
the basis for the alleged exemption. Any violation o( Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more ihan
fve huntlretl dollars ($500).):
❑ I, as owner of the propeAy, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
ofteretl tor sale (Sec. 7044, Business antl Protessions Code: The Contrecrors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such work himself or herself or throu9h his or her own
employees, provided that such improvements are not intended or otfered for
sale. If, however, the building or impmvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or impmve for purpose of sale.).
❑ I, as owner of [he property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conswct Ihe pmject (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builtls or impmves thereon, and who contracts (or such prqect with
a contractw(s) license pursuant to the Cont2ctors License Laws.).
❑ I am ezempt under sec.
Business and Professions Code for this reason:
SignaWre oa�e
]OS]�46(3I0�)
Owner ID venfied by drive�ense. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ovmership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑. 1 hereby cert'rfy that no excavation five (5) or more leet in depth inro wfiich a
person is required to descend, will be made in connection vnth work authonzed
by Ihis pertnit, and Ihat no building structure, scaHdtling, falsewurk, a demolition
or disman�ling Ihereof, will be more than thirty-six (36) (eet high. (Chap. 32, Gry
2, Art 2, Sec. 347, Title 8, Cali(omia Administrative Code).
❑ As ownerbuilder, I will not employ anyone to do work which would
require a permi[ trom ihe Division of Indusirial Satety, as noled above, unless
such person has a permit to ao such work from [he division.
Applicanl's SignaWre �a�e
Division o( IndusUial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to fle and
cehity a Business Plan for emergency response to release or Ihreatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, Ihat a Business Plan be fled vrith the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater Ihan a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas
at stantlard temperature antl pressure).
2. Does or will fhe applicant or present or fumre building occupant neetl to file
a registration form (or acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 ot the Calilomia Health and Safety Cotle, with some
exceptions, requires regisiration with ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity o( aw[ely
hazardous materials equal to or greater than a weighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure�.
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutety
haZardou5 materials)? ❑ Ye5 ❑ No
(Section 25534 of the Calitomia Health and Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, certi(cation and
filing with the Fire Department of an RMPP by businesses which are requiretl
to regi5tef aCu[ely hazardous malefial5 wilh [he Fire Departmenl.
4. I( an RMPP is presently required, has Section 25534 of Ihe California
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of lhis application a permil for such construc[ion
or modi6cation from the SouN Coast Air Quality Management Dislrict or from
any other air polWtion control dislrict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires Ihat Ihe requestetl
infortnation be fumished on applications for noo-resitlential builtling pertnits�.
6. Will any part of [he facility to be constructed under Ihis permit be within
1000 feet (rom the outer boundaries of a school? ❑ Ves ❑ No
(I( "yes", the (acility must meet the requirement of Sections 25534 and 42303
of the Califomia Heal[h and Safety Code).
7. If a permit from the South Coast Air Quality Management DisVic[ or olher
air pollution control disMct or agency is required for Ihe work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
& Qf'yes", attach certifwte of compliance from the appropriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify ihat under penalry of perjury the
in(ormation given above is correcL I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
SignaWre �ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury tha� I have read this application and state that
ihe in/ormation given is correcL I agree to comply with all state laws and city
ortlinances relating to builtling construc�ion, and authorize representa[ives o(
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. 1 agree not to occupy or allow occupancy of any building
authorizetl by this permit until tinal inspection.
SignaWreofLeg vmer Dale
L�dror onied'Av ���nl �_" e� p
I'rescrintivc
f,,� Residentinl.
� .. ]'Pul�cl N.�me:
ce:
2237 Jeanette Place
General lnformartion
s�«namrss: 2237 Jeanette Place
BuiidingTypef�QSingleFamily� ❑MuI�iP�mily
Conditimieel Fioor Area (CPA)�, � .9rj4
��
Clinmte Zunc
EnlorcemenlAgency: - � llate:
Circle tl�e Fwm Orientation: N, E, S, U�, or degiees
or Chanee Out Q' Duci
CF
ti o1' Sturies
1
HVAC
NOTE: 7his Ja•m is nn1 rn bc u.sct! Jnr Nc�nfr Cnnatruc�ed 6nilding.e nr AAdilimzr � � �b
%nsulntinn NnA�es' Fnr Opnryta�.5'm.Jnces (/nr F��n'ing usn Ihc Mas.r and Furring Su�ips Crnisrruc(ion table belony � ' � � �
Assem�lp Altcrntion ��
❑ Opening of framed caviq� xlune-Alleralions Iha/ involve the opening of (hefi�anred cnvi�+n(n wal( ceiling, a�Jinor musi insmN !he
rsmnda/on+miniminn insula�inn rnluc yer §JS(1_l�r the nlrered ossemblr. Fi(! in Columns A-C and en�er mandaior7' insulution vutiie in Colrmvr H.
❑ Replveement of entire assemblp- Replucemeivr q(an enure woll, ceifing, orJlaor assemhl�� requires Ihe ins7alla�ion o%Comyonent
!'acknne- D insulntion va(ucs in 7'uGle 151-C. Fill in Columns A-J. � �
'Iag/ I Assembly Nan
�ID� oi 7' p�e�
�7 WACl.S
-��
�-
�me Fa _Iurred assem6lie.t
tioned oTMess N'nlls see Rurring Strips Constructiou T'abie helow: � �
D � L �I F G :. ,;.....�....... .. _ . .I � I
Standard .� Values Nrom JA4 Table
Phiclmess, Framed ( Continuous JA4
Spncing, U- .]A4 Table Caviry lnsulazion Assembly
orGtlier; factor5 Num ei5 R-valuc° I R-Value� Ccll Value
3
O
I
fn.svlotia� R-value, a'ee Page JA9-3 nnd Emialiwi 4-). Fm� cn loun�furred walla usr Ihe
Assembl��
U-fac[or
L For Tag/ID indicaie the ident�icmion name that mniches Ihe buiiding p(ans. -
2.lirdicaie �he Assembl��Name a• rype: Roof�Ceiting. Walls, Floors, Slabs. Crowl Space, Doors and etc...lndicate the Fr•ame type and Size.� For
Wood, Me�a1, Mem! Buifdings, Mass, en�er 2x4, 2x6, or etc... see JA4 for od�er possible fi�ame ryye assernblies.
3. Enler ll�e thickness;{or muss in ineHes m' Spacino Genveeri f'aming mene6e�s emer; 1 G'or 24 "OC; or O(her for a1l other assembiy dra�criptiai
a�utli as Cnncrele Sandwich Pane(, Spandref Pmie(, Logs, Su'aw Bale Pane( and elc....
4. Based on �he Clima�c Zone; enter fhe Slandard U-/Qctor fi�om Table I51-B, C orD fa� each d�/erenl assembl�� Nnme or q pe.
S. Enter fhe To6le �eumbcr lha� c7oselp resembles !he proposed assemblv. . .
6. L•iller !he R-i�alue dmt is being ins�ulted in �he Hrull cavip� m' Le�wee�i die fi�miving; anetwise, enier "0".
7. Lmer lirc Continuous lnsndniion R-nalve ja� the proposed nssernblp; Mherwisc, emer "0".
d'. Ln�er the row ond calmnn nf �he U-(nctm� vafuc based on Colvmn F Table NmrvLer and enter the As.rembly U facmr in Column ./
J. TiieYrupn.rer7 dsscmbll' U'(�c�m�. Cnlumn./, nrusr Ge equal ro m� less Uian the Sta�utnrt! U fac�w� in Colwnn E lo camplp.
Fun�ine Strips Consiraction Tuble for Mass WFills Unlv
A B C ' L � T G H I J ii ]. M
1'rupnsed Prupertien uf M�isunrp nnA Cuncrcu A�ded Lneriur ur �xterim� lnsulatiun
V�'nllti Troni Reference in Tm�ring Spacc i'rom Referenec
duint A �pendix 71i61e4.9.5. 4.3.G, 4.3.7 .7oin1 A>>endis 1'able 4.3,13 —�
..c : u p L =
V u J �c v ai , [j
v �� U LL W
. i�SxcNbl). �� ;� � �`c ° :- F`o a�'_ � p•� rlllfl�
Mass IJninc or !N4 7nble q � 'v � = E 6 0 �t � ,� • � � � ' Ass�inbl
Tl�ichncss' I T 7Jumhcr < = ui � te 1i 5 I v: c !� w C U-fLct01�� �.OmInL'nl
I
I I I I
� � � �
kegisira�inn Nimii�er: lie��i.cirwinn Ua�e/Time: IIGItS Pravider':
20081ieridenliol Cnmpliunce Fa�ms � .1uge�a•i 2(�OJ
Certiticate ot'
Resirlentin[ Alterations
Proiec[ Namc:
Residential
Clima[e'/.onc # / I # of
p (
2 uf
/ndicnte !he rype of ussentb(y to inchide; Hollnw Unil Ma,sonr�� Wa(/s, So(id Unil Masmvy, S'olid Cmvcrete Walls, �'/c. �(ddi�imio! ne�semblic.s ce�n
.fnund Reference Join� �ppendiz J�74.
Th�:�� ia !hc U-Puctor bused on ihe thickness nJrl�e assemGl�� i�� inches.
7'he R-vnlue n/�fhe insvlu�ion to Ge added mv Ihe Inter•im� nr' exlerim' of (lie aa'.rernbly.
The Calctda(ed R- Unlue rs !he R-vah�e oJ[he f u'red oar! s'ecfror� nf tlte assembl}e � �
-6.The Final'ds.sembl�� is culculnied using Eguution 4-Z or Egun�ion 4-4of J�e Reference Joim dppendiz J44. The equafion is dic inver,se of Calm
��dded to Col�a�vn 1. Colunva K is 1lze inverse fi'om cnhunn J.
/na'ert Ihe cnlcu/u/ed U-faclor vufue on m Ihe Ona�iue Surjace Detuil.x in Cohiintt J ,
FGNLSTRATION PROPOSCD ARI;AS
�RCplaeing W indow alOue — Replucemenl windnws shal] meet !he U-/�nc(or ond SHGC Value reguirements ojComponenl Pnckage D in
a le I51-C, The Totu/ Fenesn�utron and Wes� facing Area ��e�pdremen�s are no� applicaGle.
❑ A'dding SOft2 0�' Icss of WindoW arefl — Newly ins�alled �vindows shull mee� !he U-Factnr attd Sl�GC �ala�e reyuirenterv.r nf Contpnncn� .
Pnchage D in Table I S!-C. �
❑ Adding mor¢ than $OSt2 of�window at'ea — Newl�� installed window,s shal! meet fl�e U-Fuctor and SHGC Va(ue and dae Fenestrutiort
�I ren requiremenls o,f Componenl Pncknge D in Ta6[e /51-C. Complete the �illere<f Fene.sir'atia� �1 /lowed dren Table on Page 2 qf Ihe CF-/R-ALT
Orientation �
Fenestration Type and Frame (North, East, PropsedArea� Maximum Maximum - N�RC or DefaWt
(Window,GlnsnDoororSk light) SoUth, WeSt� (ft2) U-FaCtor�'� SHCiC�'3'� ValUes
Oa�.-LS . O � 0
r � „J
. � , J
i
/. Fenesh�a7ion urea ie� rhe areu af�totnl g/azed product (i.e. glass ph�s fi�ame). Exception: When n doo�� is less than 50% glass, �he fenesh�n�ion
area nm�� 6e !he gluss area plus a"2 inch frmne" uround the glass.
1. Enter i�alue frona Componen! Pnckage D Requi+'emen(s in TaGle /51-C.
3. Actual fenestrplion produc�s inslalled nnd as indicated in CI'-6R-CNV !'orm shall be eyuivalen! to or have a lower U facra� i+nd/or a lower
SHGC value �han �ha� specified on the CF-/R ALT Form.
4. Subnvil n conaple�ed WS-3R Form if a reduced SHGC is caladaled ivid� ex�eria� shading.
5.!/�a �licable m Ihis .stage eriier "NFRC"%ar NFRC CertiTed rvindows or are CEC "De(ault'" values fow�d in TaGle 116-A a' B.
Registra�ion Nurnber: Hegish�n�io�� Date/Time: HERS Prnvider;
2008 Residentia! Conaplimece Farnrs Atrgusr ?00)
Certificate of
Project Name: �z �
3
CF-IR-AL,T
Zune # J I# of Stories
K7 i
ROOFTNG PR011OCTS (COOL ROOFS) §IS](n12
WHen the areu ojezterior roof strrfnce to be rep/nced ecrecds uiare tlra�� 50% of Uie etisting roof area, or �nore (6a�� 1,000 f, ivl�ichever is
less, tlee �ieiv rnnfing nren nmst nieet [he rvinftng produc[ "Crml RooJ" re9nirements nf,¢I51(b) IHi, ]52(b)IHii, ar 152(b)1 Hiii.
Check npplicable niterna�ive a� exception befow if the roojalteration is exenap� fi'om the roofing praduc� "Caol RooJ" requiremen�s. Note: /f any
one af the allernalive.r or exception be(ow is cf�ecked the ffged Solm� ReJ(ec�ance and Thermal Emil�ance reguirements for rnnfing produc�s in
,f118(i) ure no� npplicu6le. Do not fi(Luble below.
. Q Coot 2oofs Not Reyuimd in Climate Zones 1-12, 14, and I6 wilh a Low Sloped. Less or 2:12 pitch:
ool Roofs Not Required in Clima�e Zo�ies I thmugh 9 and 16 with a Steep-Sloped Roofs (pitch greater tfian 2:12) and product �nit weight less
ian Slh/f12.
�A rnatives to §152(b)1Hi and §152(b)tiii, Steep-slupe roof (pitcli > 2:12)
�❑ Insulation with ss thennal resis�ance of at least 0.85 hrRz�°PBni or at least a 3(4 inch airspace is added to the roof deck
over an attic; or -
❑ Existing ducts in the attic are insula�ed and sealed according to §151(�10; or .
❑ In climate zones !0, 12 nnd I3, with I ft of free venulation area of attic ventilation for every I50 ft of attic floor area, and
where at least 30 percent of the free ventilalion area is within 2 feet ver[ical distance oCthe roof ridge; or ��- .
❑ Building has at least 2-30 ceiling insulatipn; or -
❑ Building has radiant barrier in [he attic meeting the requirements of § 1S I(�2; or
❑ Building has no ducts in the attic; or
❑ In climate zones lQ 1 l, 13 and 14, R-3 or greater roof deck insulation above vented attic.
Cxception to §152(h)1Hiii, Low-slope roof (pitcli <2:12)
❑ Building has no ducts in the attic. � � �
O[her Ezcep[ions �
�❑ Roofing area covered by building in[egrated; photovol[aic panels and solar thermal panels are exempt 4om the below Cool Roof criteria.
� O Roof constmctions that have thermal mass over the roof inembrane with at least 25 Ib/tt� is exem [ from the below Cool Roof criteria.
-� Note: If no CRRC-1 label'is availabte, ihis compliance method cannot be used, use the Performance Approach to show compliance, otherwise,
Check the a licable box below if Exem t&om the Roofin Pmducts "Cool RooP' Re uirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number� < 2:12 > 2:12 a Slb/ft2 >_ Slb/ft� T e� . Reflectance�'4 Emittance Sffi5
S�l � � � � as � � ❑4
❑ ❑ ❑ ❑ �°
❑ ❑ ❑ ❑ p^
❑ ❑ ❑ ❑ "
_ ❑ f7 ❑ ❑ ❑^
l. The CHRC AnductlD NumGer cnn Le obinined fi�mrr Ihe Cool RoofRating Caimcil's Rated Prnddc( Direcmry n( �vww.coolroo(s.mg/prodnctxLseordi ohn
Z. /ndiwle tl�e rype of prodirel is being used for Ute rooJtop, i.e. sing(e-ply roof, asphall roaf, u�eml roof, etc.
. Ijthe Aged Itcflec(unce is rrn! ovarlable rir.Ure Con! RoofRn(iirg Co�urci!'s Roted Po'oduc! D'n'ecloi��lLen ure l/re Inr(ra! ReJlecmi�ce vn(ue fi'om Ure smrre
dii�ecroiy nnd �rse lhe eguuliore (0.2+OJ((lirriiiol — O.TJ lo ahmin n calculared aged value. Where p is (helnilial Solar fteJlecmnm.
4. Check box iJ'Ihe Aged Reflecmnee i.r a cnle�da(ed vohre u,sing lhe equation above.
5. Calculale tl�e S21 vah�e b�� usi��g Ihe SRI- Warkthee( a� hun'/Avm a enertv cn eov/(itle24/and enler 1he resnlling value in (he SR! Column nbove nnd ounclr acopy of
die S!i/- Wnrkshee( (o Ure CF-l2. � .
o apply Liquid Rield Applied Coatings, the coati�g must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings ma�ufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
� Aluminwn-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other �
2egistratiott NmnLer: Rvgfstra[iore Dale/Time: �HERSPrm�ide��'
2008 Residentia! Campliunce Forms Augusl 2009
� Prescri �tivc Certificatc of'
Re.sidei:tin] Alterati��ns
_ PrnjectName:
� Zz 3� �
cr-�u-ALT
(Pake 4 of 5)
Climatc 7.nne #/ q of S�ories
.c� �
H VAC SYSTEMS - HEA'PIfVG
Minimum Duct or Piping Configuration
Heating Equipment Efficicncy Uistribu�ion Insulation Thermastat (Central, Split,
Ty c and Ca acit "'3 AFUE or HSP�) T e and Location` R-Value T e S uce, Packa �e or H dronic)
� e � U G C�AC l W
�
1. lndicn�e Hen�ing Type (Ce��tral Fw•nuce, Wnll Furnace, Hen� pwnp, 6oi(er, Efecn�ic Resismnce, e�c.)
l. Elecrrrc resrs�ance /reating is ullowed onl�� L� Canponenl Pnckage C, bi� ezcept where elecu�ic heuting is supplemeirtu! (i. e., iflota! capacrtv
< 2 KW or 7,000 Blu/hr elec(ric healing is cnnlrolled Gt� ulime-lirni(ing derice nol exreeding 30 nvinule.$). See §!5l (h)J ezcep�ion.
3. Refer to the NERS Verificnfion sec�ion on Pnge 4 oj/he CF-lR-ALT Fnrm for additiono! reqvirements and check upplicnGle boxes.
4. /ndicute Type w� Locmiat (Ducls, Hydrnnic in Ffoor', 2adiutau�, e(c.) �
H VAC SYSTI:MS - COOLING
Minimum
Ef7iciency Duct or Piping Configuration
C��oling Equiprrien[ � � (SGGI2/L'LR or' � ' ' ' Distribution Insulation Thennostat '(Centml, Splii;� �
T e and Ca acit �� COP) T e.md ocation� R-Value T e S ace, Pneka>e or H dronic)
f
1. /ndicote Cooling Type (A/C, Heat pamp, Evop. Cooling, e!c)
2. Rejer �o the HERS Verifica�ion .rection on Puge 4 of the CF-1 R-ALT Form jor addilional requiremenls und check applicuGle Goxcr.
3. Indica�e T e or Gocatimr (Ducts, Hvdronic in Floor, Radiuta�s, etc.)
,WATER HEATING
� /Lis1 wu�er heufers mrd boilers• ja� b�dr danes�ic hal i+�aier fDHWJ heafers nnd hydronic spuce hea�ing. lndividunl dwelling DHW heaters mi�rt
Igas or propane fired, and may no� exceed 50 gaf(ons. Ha1 water pipe insula�ion jrom the OHW heater 10 �he ki�chen(sJ and on a!( underground
ho� water oioes is renuired in al1 rnmponem nacka¢es in all dinm�e zones.
External Tank
Wacer Heater Type/Fuel Distribution Type Number In Ta�k Energy Factor or Insulation
l. Mdicate Type (Smruge Gns, Heat Pump, Ins(nntnneous, e�c.J
1. Recirculaiing sys�ems serving muftiple dwel(ing unils shull mee� �he recirculatian reyuiremenis oJ§!50(nJ. The Prescripfive regui�'emenls do
na np�rn doe iiuvn/Inrion nf a rncircu/aling rvaler heuliirg s)stem. jor sing/e dwelling imi(s. .
Regisn�aion NumGer:
Z008 Residenlia( Coinp(iunce roi•i��s•
Da�e/Ciuie:
HERS Provider:
Augusl 2009
r Certil7cate niCnmpliance:
Al[ernaia��.��
2237 Jeanette Place
Zm�c i!
cr-zsz-Ai
(Yn_�e � ui�
$$RS VEk17'7 CATJ Of� SUMMARi' The enforcemmv agencr shmdd pm� sueciu! nuemion �o nc� NEHS'A9ensure.r specified in Ihi�
chcckfu'r LeMr•. d conryleied and si�neACF-41t Fonn jor ull !hc mea.nire.r eycciiiedrlradl br submined to liie lmilding inspec�or Leforr Jinnl
DuCt Sealine� b': Te51inp _ HL•fu 1@)'I%IG�h0111]' I'L'[jLl!'C(I �O)' IIIA� IIICUSlI�'C. �
❑ �'�5 �NU �'C5: L� Cliinaie'Lwms? ainel 9-I G, iflnmc t6au 9U lineur feoi ofliew� ur replxcemem Auus ove ins�silled ii� uncnndi�ioncel
spnee, the ducie ure w be sealeA per § 152(b)lliii and Ihe newly insi�dled dacta� ore tu be insuluieA per §7 SI (1 il U.
��XCCI'T10�: Lxisting duct syslemx ILnI urc estended; rvhic6 ure cunstrncieQ insuhitetl nr senl�al �vith nSbesWt.
❑ Y�S �NO YES:In Ciimate "Lones � nnJ 9-1G, iflhe er,istiug space-conditiouing system (HVAC equipme�u and duciin�j is replaccd, thc '
ducts ure io be seeled per � I 52(bp Di.
❑]'ES ,j�NO YES:In Climaic Zones 2 and 4-1G, if thc oaisting HVAC equipmem is replaced �(incluuing the replac�mem of Ihe air hendler,
ouidoa� condensing unii oi n splii sysiem, cooling or heuing coil, or [he fumace lieat exdiangerj the ductc nre to be
. � sealedper§1S2(b)lE.
D EXC�PTION: Luct syslems thnt nrc ducumented lu hnve Leeu previuusly senled conf rmed tivuugh HCP.S
' '"" '"'"'"' V€�fTtetiIIn in accurtlunce �vitli'procedures'in the Reference Residential Appendiz P.A3. ,,,. .... ....,...
❑��XCLPTJO�: Duct sys�ems with'less tlmn 4U linem� leet in uncouditiuneJ spxce. , � .. � �
O L'aCLPT10R: Existine ducl svstems cunstructed, insulated m� sealed with vsbestns. �� ��
Reiriverant Charge - Split 51'stem HERS verifico(ion ir reguired,/or �hi.+ measurc.
❑ 1'ISS �NO YES: ln Climate Zones 2 anJ F-15, when Ihe exisiing HVAC equipmem is replaced (including the replacemeni of�tl�e air
� handler, ontdoor condensing unii of o splii system A/C or heat pump, cooling or heating coi!, or th: [umnee heat
exchenee�l a iefri^erant charee mceauremem shsll oe verified pe�' §I52(b1iF. '
Central Fan Integrated (CFI) Ventilation S)'stem and Fan V�'att Draw
The ventilation reauirements of 5150(01 dn not anolv tn exisiinc residentiel homet.
Ducted Spli7 S,ystems - Air Conditioners and Heat Pumps: Airtlow HERS verificaiion is reguired fm� ihis measure.
❑ 1'L�S �NO YFS: ln Climaie Zones 1 U torough 15, wlien the ezisting space-condiuoning system (H VAC equipment and ducting) is
renlaced. the eirflow and fen wan drew shall be verified ner §152(b11Ci to meet the requn�emen[s of &I51(�7B.
Declarafion
• I certitr thal this Certi6cate ot Comnlience documentation is accurxte and
Name: � Signzmre:
w: //,�..,._ ��� '
Company:
� SVv� a
Dam:
Phonc
CEH or O CEPE
�uqsiolc Iluiidine Desi�iier's Leclaratiuu St:itemenl
7 um cligiblc under Lirision 3 otllie C�ilifamia Business nnA Professions Codc �o .iccepl reypousibiliry� for U�c building design identil��ed on
thia CeriiLcam of Cmnpliance. �
1 ecrtify �hai ihe energy Icmwe; uml perl'ormunec speeificntionc i�or ihe buildinb de,sign identiLed ou this Ceriifiente ol' Cuinpliance cnnforn�
in Ihc ru�uiremems o(TiUc 4A, ]'uns 1 and G ol'Ihe Culilbmi�i Cnde of Regulati<mc. '
Tlic building dexign l�ealurec identiGed on ihi��. Certil'�c.uc nfComplisince nrc cunsisten� wiih the iuTnnna�iun provided ti� ducumem thir,
buildiug design on �he oiher tipplic�ible eompliuner ionnc, wurlshce�s, culculationc. plans und speciLe.��iunti submiued ia �he enforecmem
a�cnc�� fur anorovui with Ihis 6uildim� nerniii �innlicutian.
Cump�m>•:
Hddres�:
Fnr assisuuicc or yueslion:: regtu�ding Ific L)ita�gr SuinAruda', carnac� Ihc Energr Hn[Linc n�: 1-8f1l1-772-i ibG.
• . ............. ......rr:�...., /iLR.S 1'rnn�cinr.
J
�ISOQ�: Solurwata-heating systems andlor collectort nre certiCied by the Solar Ra�iug aud Cer�iSca�ion Corporution. —�
Ducts and raas Mcasures: -
§150(m)I: All air-distribution system ducis ancl plenums inslulled, are seaktl and insulaied �o meeYt6e requirements of CMC Sec�ions fiQl, 602,
603, 604, 6D5 mid Stendard 6-5; supply-air and return-air duct� mid pla�ums nre insulated io s minimum installeA level of R-4? oi
enelosed entireiy in condilioned spuce. Openings shaU be sealed with mastic, tnpe or other duci-closure system thoi nmeis the upplicable
rcquirements of UL � 81, UL 181A, or L1L 1SITi or uerosol sealaut thet mee�s the requiremenls uf UL 723. lf maslie or tape is useti lo
seal openings greaier thmr ll4 inch, the combi�ation of mastic aud eitlier mesh m� tape shnll be used
§ I50(m)l: Building cevities, support plat[orms for air handlers, �and plenums defwed or consuvcted with matcrials other than sealeA shce� meiul,
duct bourd or flexible duci shall not bc used for conveying wnditioned nir. Building-cavities and�suppm t pintforms may contain di�cts.
Ducts instnlleA in cavities and supPort platforms shnll not be compressed to cause reductions in the cross-sectional aren of the Aucts.
�li�(m)2D: Joints end seams of ducl systems and their components shall no� be seeled wi[h cloiL baG; rubber adhesive duct tapes uniess sucb �¢pe
is �ise.d in c.nmhinetion with mastic anA dra�v bands.
fizhausi Can systems have back draFl or automatic
§750(m)B�.Grnviq� ventiiatin systems.servin couditioncd space have either autometic or readily ucccssible, manually operated dampeis: -
§I50(m)9: lnsulation shall be proucied froin,damage, including that due to 3unlight, mnisture, equipnient mdintenonce; mid ti�ind: Cellular faain� �-"� �
insulation shall bc protected es above or paintedwith a couting fhal is water retardnnt and providw shielding from solor radiation that
can cause de radation of the ma�erial. - �
§ I50(m)t 0: Flexible ducts cenwt have porous inuer cores.
§150(0): All dwelling units shall mee! tMe requirements of ANSI/ASHRAE Standurd G22-2007 Ventilation and Acceptable lndoor Air Qualiry in
Low-Rise Aesiden{ial Buildings. W indow operation is not u permissible tnetl�od of providing [he Wl�ole Building Ventilation required in
Scc6on 4 of that Standard. - -
Pool and Spa HeatinQ Systems and Equipment Measures:
§I 14(a): Any pool or spa heating sys[em shall 6e certified to have: a thermel efficici
an on-off switch mounted outside of the heater, a permanent weatlierproof
eleceric rcsistanet hcatine or a oilot lieht.
§I 14(b)l: Any pool or spa heating equipment shi
lines, or buih-up connections for futura
§I 14(b)2: Outdoor pools or spes that have a heat
§ I 14(b)3: Pools shall have direc[ional intets thai
programmed to run only during o$-p�
&I SD(p): Residentiel pool sYstems or equipmeni
Reaidentia f'i3�iitl6�;Mea�i3:
§I50(Ic)1 �. High efLcacy luminaires or LED Lig
Table 15U-C nnd is nol n low efLcac�
§150(I<)3: The wattage of'permanently installed
or card wvh aperating
JI be instalied with at leest 36" of pipe between fdurand heater,
soler heating ' �
pump or gas heater shall ha�e a cover.
adequately mix [he pool water, and a time switch thai will allow�
:ak eleciric dernand periods.
meel [he pump sizing, flow rate, piping, filmrs, and vnive require
ll Engine vrith lntegrel Heei Sinlc has an efficacy tlmi is no�lower
luminxire as soeci{ied bv &I50(k)2.
nce Efficiency Regulations;
ructiont; and Shall �wt use
dedicated suction aud return
pumps [o be set or
nts of § i 50(p).
n lhc ef6cacies contAined iu
Balias�s for lluorescem lamps rateel 13 W nus or greater shal I be eleetronic nnd shall 6nve ou output frequeney no Iess than 20 kHz.
Permanently installed nighl lights and nighl lights inlegrel to ;i permnnently installed luminaire or exhausi fan sliall contain only high
efTicacy lamps meeting Ihe minimum etficncies contained iu Tnble 150-C end shall nol contain a line-voltage sockei or line-vol�age
lamp holder; OR shall 6c cated to consume na more thfm five walts of power as determined by § 13G(d), uud shall nol contein .i medium
screw-bnse sackel.
tn ezh�msi fnns, iu rooms otha� Ih.m Icitchens, sh�ill mea the
§ I50(k)7: All swiicl;ing devices m}d contmis s6a11 meei the requiremeNs of � I50(k)7.
§ISO(Ic)ii: A minimum o1' S0 perceni of tlie �o�al r.ued w�qsige of pennunently instulled lig6ting in Ici�chens sh;dl be high efficticy.
EXCEPTION: Up to 50 watts for dwellii�g miits less tlion or equal to 2,SOp fl� or 100 watts tar dwelling units largcr than 2,SUU 0' m�q� 6e esempi
from the 50%high efficacy requirement when: all low etTicacy luminaires iu thc kitchen are controlled by oi mauuul on occupnnt
� Sensor, dimmer, energy managcmcnl system (EMCS), vi� n muhi-scene progrxmmable comrol syslem; and all permunently inslnlled
Imninaries in g�rnges, lauudry rooms, closets greater than 70 squete feel, nnJ utility ruoms are high efficacy uud wntrnlled by n
manual-on occupnm senxor.
§15U(!:)9: Yennanently instullcd lighting thai is internal to cabivas s4.dl use ne� more thnn 20 watts of pnwer per lineui fooi of illwninuted
cubinet.
§1 SO(k)10: Permanently insmlled Iuminaires in bm6rnnms, auached nnd deiached gumges, luundry ruoms, elosus and inility rooms slr.fJ hc hi�,h
2005 liesidenliul CompliunceForm.s
n„�;�,sf zoo�
EXCEPTION 1: Pennanently instulled low eff�cncy luminaims shell be allowed provided tluu they arc co��volled by u mmmu6on
acupam scnsor ceniGcd w comply with the applicable reqnirements of §I 19. �
EXCEPTIUN 2: Permonently installeA low efficecy luminnires in closets less t6an 70 square (ce� are not reqiureA io he conh�olled by n
. �manual-on nccupflni sensuc � �
�ISU(k)I !: Permnncntly insmllcd Iwninaires loca�ed in roomx rn� nrens other thon in kilchens, 6athruoms, gnrnges, lanndq• rooms, closets, unA utiliq•
moms shnll be high efficucy luimnaires. � '�
HXCEPTION L Pefm.inen�ly insmlled Imv effic;my luminnires shnll 6e nllnwcd provided they eu'e controlied by cilher m dininier switch
. � IhAI cmnpliex with Ihe npplicnble reqnirements of § I I), a� bp n inamml-on occupani sensor t6at complies with t17e �
� app��cahierequirementsof ¢119. . �
EXCEPTION 2: Lighting in detacheA siorage builAing less thun I OOU squxre feel lucaled on u resideniinl siie is nol requirod to cm�iply
wi[h ¢150(It111. . .
§ISO(k)12: Luminnires rec;ssed ����o insidated ceilingsshall bc lisied for uro clearance insulmimi contaci QC) by Undvwriters Laborotories m
- nther nationally recognized testing/rating Inbomtory; and have a label lhal cenifies the luminnaire is airtighi wilh air leukage less Iheu �
2.0 CFM ai 75 Yascn�s when tested in accordxnee with ASTM �E2S3; nud�be sealed with n gaske� or caull< between the lumineire housing
und ceilin �.
§I50(k)17: Luminnircs providin6 �utduor lighting, including Iightiug for private pntios in luw-rise residential huildings with four or morc dwelling
""�� �' �� `� 'iiiiits, ent8iiicri; baiconies; ancl porchcs; whii6 ere permanently�mounted���o,n residenuol 6uildiug�or to other 6uildings ou thesame.lot__-,...
. . shall be high e�cacY� . � . . . . . . � . . . � .
EXCEPTION I: Permanently installed outdoor low efLceey lumineires ahell be allowed provided thut they nre contmlled by a manual
onloff switcSi, a motion seusor �iot having an override or hypass switch that disables the motion sensor, nnd one of the �
tollow�ng controls: a photocontrol not having an override or bypess switch that disables the pnotocontrol; OR en . [
astronomical time cloc4: not hnving an overzide m� bypau switcli that disebles the astronomical time clock; OR an � t
eneig)' managemenccontmi syseem (EMCS) not having an override or bypess switch that allows the luminaire to lx . �
always on
EXCEPTION 2: Outdoor Iwninaires used to comply wi8i Exeepiionl ro§I50(k)13 may be controlled by a temporary oyerride switch �
� which bypasses the motion sensing funetion provided thac the motion sensm� is au[omatically reactivated wiffiin six
hours. �'
EXCEPTION 3: Pennanently installed luminai�es in or around swimming pool, water features, or other locacion subject to Anicle 680 oT i
the Califomia Electric Code nced not be hi h efficecv luminaires. E
§I50(k)14: Intemally illuminamd address signs shell comply with Section 148; OR no� contein a screw-base�socicel, and consume no more Ihan five �
watts oT ower as demrmined accordin to 613U(d1. - 1
§150(k)I5: Lighting for parking Ioct avd carports with n totnl of for S or more vehicles pw� site shall comply wi[h the applicable requirements in '
f
Sections 130, I32, 134, and 147. Lighting for parking garages for S or more vehicles shall comply wifli the applicable requirements of
Sections 130, 13I, 134, and ]46
§ I50(k)16: Yermnnently instollad li6hting in the euclosed, non-dwetling spnces of low-rise residemial buildings with four or more dwelling units
shall be high efficacy luminaires. '
EXCEPTION; Permanendy installed low effia�cy luminaiies shall,6e allowed provideel tha� tliey �re controlled by.an occupant scnsor(s) .
' cenifiecl to com il �_vtith.11u:a 'e uirements of 0119.
•> .......__.-_ _.. __ _.
_- --� � .-...._.Y._....--�-r_�__
200b' Reside�vicd Cnmpliunee Fw�nts il ugus� 200J
vnd nooeess: 2237 JEANETTE P,L
� o�sname: CHRISTENSEN" -
aoosess: 2237 JEANETTE PL
C'OSTA MESA,Ci1 92626
646-9263
AflCM/ENGMEEB: BEG.NO.:
i aooeess:
UNIT:
uxiT:
PEflMITTEE: SOX E. CHRISTENSEN ( 714 ) 646-9263
aooaess: 2237 JEANETTE
CM CA 92627
LICENSEO CONTBpLTON OECNNATION: i �ereDy affirm that I am IicenSeU untler D�ovisions of ChaD�er 9(comm¢ncinA w��h Section
7000) o� �ivision J ol ��e Business antl Prolessions Code. and my license is in full lorce and efleci.
CITY IIC.: STRTE LIC.: � ClASS:
Date: Signalure: —
WOBNEPS' COMPENSRTION OECIABRTION: I �erebyattirm ai �ave a certiliwte of consent to seli-insurt or a certiliwte ol Workers'
Compensalion Insurance. or a certdietl covY �nereof (Section , lab. CI.
POLICY NO.: EXP. DRTE:
LOMPPNY:
� CenifieE copy is �ereby fumis�ea. ❑ Certified copy is lilea vnth t�e city Builtlinp Oivision.
uale: pOD�ican�:
E%EMPTIONFflOMWOflNEPS'COMPENSATIONUECIABpTION: (T�i55et�ionneeAnotbetampleletli�thep¢rmi�iiloron¢hunAr¢d�E100�or1¢55).
I cenily inat in Ine pedormance ol ihe work for wnich this Dermit is issuetl, I shall nol employ any erson in any manner so as to become
suhlec IAe Workers' Compensaiion Laws of Calilomia. - S
Dale: �� SignaWre:
NOTI ' I. atler makinp Ihis tleclaration. yau sAoWd beco Ojecl lo the Worker5' Compensatian pmvisions of the Labor
Coae. you musi lo�hvnl� comply wit� such pmvisions or �Ns ¢rmit s�all Ee �eemeA �¢voke0. �,2
CONSTPUC710N LENOING RGENCY: I here�y aifirm t�at ihere is a conslmction lenaing agency lor t�e pedormance oi ihe work for
wAic� Ihis permil is issuetl (Setlion 7097. Civ. C�.
LENOEP:
nooncss:
OWNEP BUILOEfl OECLABATION: I Aereby aifirm Ihat I am exemp� trom �he Conlractors' S�a�e License Law lor I�e �ollowing reasan
�Seclion 7031.5 Business and Pmlessional CoOe: Any cny oi couniy whic� reQuires a permit to constmcl, aller, impmve, Aemolish, or
re0air any simclure. D�ior ta i�s issuance. al5o reQuires �he ap0lican� tor Suth permii lo lile a 5ipne0 s�a�ement ihat he/s�e is lirensed
Dursuan�tolAe Omvisions oilhe Conlrac�ors'$tate License Law�ChaD�e� 9�cammencing vnth $¢ction 7000�01 Division 3 a�ihe Business
anG Pmlesvons Code� Or lhai he/S�e is eKempl Iher¢Irom anG ��e Ga5i5 for IAe alleqe0 ¢Kempiion. Any Wolalion ol SecliOn 7031.5 by
any apD�icant lot a permit suUiecis ine aDolitant to a civil penalry of not moa t�lan live huntlretl Uollars (3500).
I, a5 owner of ine O�oOerty or my employees with xages as tAeir sole comDe����� ��I Oo lne waM, ane the
❑ slmcWreis no�intenUeA oroHereO Iorsate�5ecbon 70a4, Business anE PmiessionalCOAe: The Contraciors' State License Law
aoes nai apply �o an awner ol a pm0eny who builtls or impmves t�¢re0n, anG wM Oces such vroA himself/heruli ar �hrough
Ais or �er own employees, providea IAat such imD�ovemenis are not intenG¢E or o�fereA �or Sale. II, however the �uiltling or
imOmvement is sold within ane year of completion, ��e owner will have I�e burEen ol pmvinA he/she Ai0 not builtl or imprme
lor I�e Ourpose ol sale�.
,u I, a5 own¢r o� t�e pmDetly, am extlusively contracWg with Iicense0 coniraclors to constmct the pmlect (Section 70aa, Business
L�] an0 Pmiessions CoEe: The Comractors' State License Law Uaes noi aODN ro an ovmer ol Ompenp who EutlGs or impmves thereon
ana w�o contracls br su[h pmle��s with a contracmr(s�license pursuanuo ��e ConVac�ors' Slate 4cense Law�. I am aware
I�at pmoi of I�eir Worker'S Campen5aii0n insUrance s�oula 6e O�ovideG Io me.
� I am exemD� under Setlion: B. 8 P. C.
�or eis reason: (1�'
�ale: e-% �— Owner. � �y�� �'��1�
I Uo �ere0y re ty�iai I am aware ol anU understantl �he requiremems ol Calilom allh nd Safety Coae Sec�ions 25505, 25533, antl
25534 ana I�al I or any fulure builaing occupant willlwill no� (circle one) neetl ta com with saiU slale codes antl I�e reQui�emen�s for a
permil lor conslruclion or moAil¢ation �rom Ihe Nir Oualiry Managemenl Oisiric�, Fesidenlial conslmclion aDPlications are eMemD� �mm
Ihese provisians.
Oate: Applicanf
I hereby cetlily I�a� I have reatlt�is applicalion antl s�a�e�ha� Ihe above inlormalionis oorrecl. Iagreeio compty with allciiy antl counry
ortlinanCeSanA Sialelavis�¢Ialingi0 Uuiltling fAnsimqion antl hereby autlq�izerept¢S¢ntalives olihis ci�yta enlerupOnl�e abOve�menti0n¢0
O�aOeny lo�insoeclion purposes. � ,q i �
. Da�e: " S�9nalure: � i �
Dmer's �k e or Sadai Security x:
t6Ji�a6 W�ite-0uil0ina: Green—Code EnbrcemenC Canarv—Aoolicenl; Pink—Revenue: Goltlenroa—Assessor
CITY OF COSTA MESA — BUILDING PERMIT x ;�� V�bu..�
PERMIT NO; F 055021 PLAN CHECK NO: N i: rv Sutr:
CONSTRGCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE; REP
JOH DESCRIPTION ; BATHROOM REPAIR/ MISC FIXTURES SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 /
COMMENTS: "HUD" PROJECT
di� �lf df iE 9cK iF �lE �X �f iF �X� df� �1F 9F�lf �� iE �7F 9F �k �lf 1E.)f..K �%df iE if �If df �lE �k �K �%3(� iE if �F!( # if -0E �k-0E dF �If iE if 9f iE 3f dElE�� if iP �X� dEif �� df •7E �)E #�IE dE �IEiE �3f �� ik �k i( �7FiE 7E iE iE
7. O N I N GS ERTEBQAUCiKRSE M E N T S
------------ MAIN BUII,DING ---------- --------- ACCESSORY BUTLDING ---------
FRNT: FT IN REAR: FT IN F'RNT; FT IN REAR: FT IN
L�EFT: FT IN RGHT; FT IN LEFT: FT TN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42607211 ZNE: REF NO:
PLANNING NtSTES>
>
jf iE if if fE if jE iE IF iF iE !F 1F 1E 1E if ik i(� lF iF �f iE iF iF if iE if iE iE iFiE 1E iE iE it it iE ih 1E le iF iF it �1E iF iF 1E if iE ibiE iE iP if iF iF iE iEif iF iE �lE if if jF 3F 3EiF iE iE iF iE ii� )f iE �E 3P fE 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 BY DATE;
BUILDZNG APPROVED HY ; � _ DATE; _____
APPLICATION ISSUED�
kikif%�iE1EjF3EiFfEiEiPiEifiEiEif #fiE
iE iF 1F k� it iF iElF if iFlE iF ff 3F # IM1 #
LEGALIZATION:N
iE if iF iF if iF �lE 3f
F E E
HLDG PMT PLUMPING
PERMIT 19,�SY
PLAN
ZSSUE FEE 3,00
BUILDING—DIV—> PERMIT ISSUE
TOTALS----> 19,00 3,00
��—= � � DATE•oJ 09Z
� ?E�kiEiEaEiFi4ifklE � Ifft
3f �k iE iE iE iE aE 3E if if 1E K- iE iF rt ik if� i(�±E iE iE lE 1E iFlE iE i'r If iP 34 ff 1E iE iF iE if 1(� fF
M M A R Y STRIJCTURAL SEGMENT:N
MECHANIC FIRE SMIP/RES GRADING
SMIP/NON—Rfi5
—CHECK TOTAL PAID DUE
0, � � 1 7, Q � 1%, 0 � , � �
REVENUE DIVISION TOTALS--> COLLECTED: 17.00 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECFiANIC FIRE SMIP/TOT GRADING PLAN—CHECK
1%,��
iE iE �lE iE if if iF iE iE i(- 3e �k if �)E iF 3h if ib dE if if 3F iE if lE �Ih iE �fF 1(- if 3(� 3E iF iE fE if IE if if IE if iE if i(� if iF i6 iE iE �f )k IEiE iE iE if iE 3E iE if iF iE i! if iE iP iE iE N� iF If i£ iF iE If %if if �f
I N D I V Z 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 UNZT COST TOTAL COST
PLU
PLU
PLU
PLU
1 BATHTUB
1 SHOWER
2 WASH BASIN
2 WATER CLOSET (TOILET)
1 WATER HEATER AND/OR VENT
END OF FEES
2,00
2,00
2,00
2,U0
2,00
" ,1:�" _�,;_.'i-,
_ 'L; �'.�_ �.
2,00
7..U0
4,00
9.U0
2.00
"� POOI �A ' �
CONSTRUCTION AND PLANNING
. APPROVALS Permit # Date Inspector qppROVALS Permi[ # Date Inspector
�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electriwl Conduit Utility•Undrgrnd. 54. Forms
4. Electrica� 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. Wa[er Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, 0 Undrgrnd. .
10. Structural Floor Sysiem 61. APPROVAL TO DECK .
11. ProOerty Sewer Line & House Conne"ction � • 62. Backwash & Receptor•Final� �� � .
72. Sewer Cap 63. Heater & Vent-Final -
13. Root Drains 64. Plumbing System - Final .
14. Rough Plumbing y(�ii'L L� 65. Electrical-Final
/ /
15. Fough Elec[rical-Conduit 66. Sotar System-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rou9h Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Conditioning FIRE DEPT. FiEQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Dutts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. P�oduct Piping �Gas OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathin9 74. Overhead Hydro .
26. 7�8ar Ceiling (Struc[ural) & Monocoai 75. Dry Chemicat
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:
34. Final Heating & Air Conditioning �
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �/��/�( ��
/ �-�
39. Water Service�final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
� 47. FINAL STRUCTURE & BUILQING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern Calitornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
QMOJECT AOOHESS: 2 z 3% J EANETTE PL
' owx¢r��3xarne: CHRISTENSEN
noonEss: Zz37 JEANETTE PL
C06'TA MESA, CA
646-9263
AflCH/ENGINEEfl:
RUUflE55:
UNIT:
92526
XEG.ND.:
UNIT:
PEflMITTEE: SOY E. CARISTENSEN ( 714 ) 646-9263
FODflESS: Zz3% SEANE'1'TE
CM CA 92627
IILENSEO CONTBACTOP DEClAflATION: I here�y allirm Ihat I am licensee under pmvisions ai ChaD�er 9 Icommencinp wilh Section
7000� ol �rvision 9 of �he Business antl Pmtessions Cotle, antl my license is in lull foae an0 eflect.
CRY LIC : STATE LIC.: CUSS:
Date: Signam�e:
WOPREPS' COMPENSATION OECIAflATION: I Aere�y allirm Iha� I have a certilicate o� mnsent �o self-insure or a ceflilica�e ol Worker5'
Compensation Insurance, or a cemfietl copy �hereol I�ction 3gpp, Lab. C�.
� POlICY NO.: EkP. UATE:
COMPRNY:
� CenifieG copy is hereby Wmis�etl. ❑ Cehi�ied copy is liletl vmh t�e cily Builtlinp Oivision.
Uale: ADDlicanc
E%EMPTIONFBOMWONREPS'COMPENSPTIONOECIAXRTION: (7hi55eclionneednalUecamplete0itihepermi�i5�oronehunOrea�5100�Or1e55�.
I cerlily Iha� in Ihe petlorman[e ol �he work for whic� ��is permi� is issuetl, I shall no� emplo any per5on in any manner so as �o become
suble�� �o Workers' CAmpensa�ion Laws of Califomia. �
�ate', 0 �$ignalure: � 4��A
NOTICE: I�, r making �his tleclara�ion, you shoultl �ec e subl �� �o Ihe Warkers' Compensation pmvisions of Ihe Labar
Catle, yau mu Iorihwith campty wi�� suc� pmvisions Or is permil s�all De Oeemetl r¢voketl.
CONSTPUCTION LENOING RGENCV: I here0y affirm that ihere is a consiruction lentling agency lor ihe p¢dormance of ihe wark for
w�ich Ihis permii is issue0 (Section 3097. Civ. C�.
LENOEN:
aoosess:
OWNEN BUILOEB UECIAPRTION: I hereby aifirm iha� I am ¢xempt imm �he Contractors' Sta[e License Law br t�e lollowinp reason
�Sectwn 7031.5 Business anA Pmtessional Code: Any city ol wunty which requires a permit to constmct, alter, improve. Oertrolish, or
�¢Oair any 5lmclure. prior la it5 �ssuanc¢, also r¢Quires Ihe dpplicant lor 5uc0 Oe�mit to lile a 5igne0 Slatement Ilui �tJsheis Iicen5e0
Dursuant to �he prohsions ol i�e Contracmrs' State License Ldw �C�apter 9 �commencing wth Section 7000) ot Divisian 3 of ihe Business
ana Prolessions Cotle) or Ihal helshe is exempt iherelmm ane ihe basis for Ihe allegee eMemD�ion. Any violation ol Section 7031.5 by
any apDlican� loi a permil SuLle��S t�e applicani to a civil ppnally of no� more Ihan �ive AunOreA dollars ($500).
I, as owner oi iAe pw0eriy or my employees wit� waAes as Iheir sale camDensation, vnll tlo ihe work, antl ��e
❑ slmciure is no� imen0e0 or oflered lor sale (Secuon 7pda, Business an0 Pmfessional Coae: The Canlractars' State License Law
does not aDDly Io an awner of a pwPeny who 6uilds pr impmves thereon, and who tloes such work himself/hersel� or �hrough
Ais or her own em010yee5. pmvide0 ��al 5uc0 imprOvemenls are no� intentle0 or offeretl for 5ale. I�, however Ihe builtling or
impmvemeni is so10 witAin one year o� complelion. �he awner vnll �ave Ille 6ur0en ot pwNng �¢/she Aid no� Uuiltl ar impmve
lor t�e purpose ol 5aie).
,}{ I, as owner oI lAe D�oDeny. am exclusively coNracting witn IicenseA conlractors to consimct Ihe pwjecl (Section 7074, Business
LY antl Pmtessims COUe: The Caniractors' State Licensy �aw Goes not ap01y to an owner oi pmperty wlw OmIGs or imD�oves t�ereon
anE w�o ConVacis lar suc� pmlecis wit� a Contracl0qs) license pursuant to Ihe Contraciors' State Limnu Law). I am aware
ihal proal af ineir Worker's Compensation insurance snoul0 be proviee0 to me.
� I am eKempi untler S¢clion: B. g P. C.
lor �ni reason:
Dale: 2 Ownec � `�- d
I tla nereDy cenily � I am aware o� antl untlersiand Ihe r¢Quiremenls ol Calilo � Heal an0 Safety Cotle Sections 25505, 25533, an0
2553a anC I�ai I or any IWure LuilAing octupant vnlVvnll nol (�ircle One) neea IO camply vn�h said stal¢ todes anA Ihe reQuitemen(5 br a
permil lor conslmclion ar moJilicaiion Imm Ihe Nir Ouality Management DiSVic�. Fesiden�ial con5lmciion apDliaiions a�e exemp� imm
I�ese pmvisions.
Date: Fpp�icant:
I hereUy cerlily t�al I Aave read Ihis apDlicaiion antl state Ihai �p¢ above in�ormation is correct. I agree to comply wilh all ciry antl counry
ortlinancesantlslatelawsrelaling�obuil�ingconslmclionantlqere�yauUorizerepresen�atrve5 �ihiScily�oenle�uponlhea0ove�mentionetl
proDeriy Iorins0ecfon purpases.
y � ��Ii�EAl�F w.
Daie: \ 9 Signa�ure: x �
Driver's licero or sociai Secumy a: �
i6at�a6 Wbite—Builaing; Green—CoEe Eniorcemem: Cxnary—AOOlicanl; Pmk—Revenue; GOIEenrotl—Assasmr
CITY OF COSTA MESA — BUILDING pERMiT t ; t�T�6�Zi1
i
PERMIT NO: E 056020 PLAN CHECK NO: N c;C�Vi': N SuF�
CONSTRUCTION TYPE: V—N PERMIT TYPE; ELE PL7RPOSE: REP
JOB DESCRIPTION ; HATHROOM REPAIR/ GFCI ELECTRICAL SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 /
COMM£N'I'S; "HUD" PRpJECT
iFdf iF �k #�lE-%� �E �%�% iE �if �If 9f i6 �)E �%�if !f •%�lE �% dE if If iFdf iF �IF �lf �lE i4 iE �%�M 3f if� i(1E dE�l(� �F 1i ih 3f �%ibif if iE i'r 1EiE �i( 3E �k 3F jFiE �M �lE if �%�% i( iE �I(� �1E �l( �If �M -%iF #�rt �IE 3f 3F dE
'L O N I N G R E Q U I R E M E N T S
sETs�cxs
------------ MAIN AUILDING ---------- --------- ACCESSORY BUII,DING ---------
FRNT; FT IN REAR: FT ZN FRNT: FT ZN REAR: F7' IN
LEFT'; FT T.N RGHT: FT IN LEFT: FT IN RGFiT: FT IN
PARFCING REQ• PROV; PARCEL: 42607211 ZNE: REF NU:
PLANNING NO'tE5>
�
if iF *�lElF ic ik iE iF �1E if 1E iE jf iE �1F fE 1E iE 3E �1F iF 1E iE R# 3E iE iE �F iF iE 3E iE 1E 3(� 1E iF 3E 7E 3E 1E iE�1F 1f IE 1F If iE if 1E jE iE it aE iE iE 3Flf iE 1E �7F 1E 1E iE jF 1E ii� if iE if 3e iF ie 3F iF iE iF iE
D E V E L O P M E N T S'&�R V I C E S R E Q U I R E M E N T S
'/,ONING APPROVED BY ,
BUILDING APPkOVED BY : '
APPLICATION ISSUED
3fikltr�FiEiE1F1EiEiEiEiEiEiFiEiEiE iEiFifi�
3EitiFiEitiFK�IEiEiEif9EiEjF#3Eat�Eif �EK-Ifl(�iE�1F�N-iFlEififff3ElEiFiE
LEGALIZATION;N F E E
BLDG PMT PLUMBING EL TR
PERMIT i:
5
DATE:
llATE:
DATE: �
�cic 3EfEiiiFiE�E1EiF3fiE : �FiE
iE if iE iE 1E If iF jF iF iF if �f �k 3F if iE 1E iE�1E IFlE if �F if �E �E if iF 1F iE 3f if ii• if lEif �E IF iF ik
U M M A R Y STRUCTURAL SEGMENT;N
MECHANIC FIRE SMIP/RES GRADING
SMIP/NOV—RES
PLAN ' '
ISSiJE FEE � 15;00
BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TUTAL PAID DUE
TOTALS----> 1,50 15,00 0,00 16,50 16.50 ,()0
REVENUE DIVISION TOTALS--> COLLECTED: 16,50 OVER/SHORT; ,00
BLDG PMT PLIIMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN—CHECR
16,J� .
Y iF 1E jE if� if 1f 1f 3f iE if iE iE iE 1E iF iE f! iE it IF iE Y� iE iF if iE if ih IE 3f !E ib iF� 3E jf iF iF iE �lf iE 3f 3E if iE iF iE iE if %� if if if iF iE iE �1F 1E iF ii iE i(�iF 1E IF%iE iF if i(� if� 1E iF iE 3e iFlE�IE
I N D I V I D 0 A'S.. 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
ELE 2 RECEPT/OUTLET � 1 ST 20 $A, .75 1,SD
END OF FEES
A: i .��.L, i - ''
�
� CONSTRUCTION ANO PLANNING POOI °A �
� ' Date Inspector Oate Inspector
APPROVALS Permit # _ APPqOVALS Permit #
"7. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. - - ' � 53. Steel Reinforcement
3. Elect�ical Conduit Utitity-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electriwl Bonding �
5. Steel Reinforcement 56. Ro�gh Piumbing & Pressure Test .
6. Electrical UFER Grnd. 57. APPROVAL TO COVEft�GUNtTE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Fo�andatio� . 59. Gas Pipe, 4 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Struttural Floor System 67. APPROVAI TO DECK ., .
11. Property $ewer Line & House Connection � 62. Backwash & Receptor-Final ' �
i
12. Sewer Cap 63. Heater & Vent-Final
73. floof Drains 64. Plumbing System - Final .
14. Rough Plumbing 65. Electrical-Final
75. iiough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Aecess Apqroval �
77. Rough Wiring Si9n 68. APPROVED fOR PLASTERING �
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air C.�nditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
27. Ducts,in Structure 70. Underground Hydro .. �
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas PiPe�Rough & Test . 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Struciural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insuletion ' 78. FIfiE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final ' ' 80. F000 CERTIFICATE ISSUED
33. Final Eleciric �/Y.L�L T Noter. �' Z ___ _
34. Fina� Heating & Air Conditioning 7 �
� �
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Firtal Facmry Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer �
43. BackPlow Irrigation
44. Landscape Irripation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PIANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CER71FICATE OF OCCUPANCY
No. Date
�
r�o�Ecr.;.a�vess: 2237 JEANETTE PL
uwNee�sxnme: CHRISTENSEN
aooaess: 27.37 JEANETTE PL
COSTA MESA,CA 92626
646-9263
APCHIENGINEEN:
BEG.NO.:
uxir:
AOUHESS: UNIT:
PENMITTEE: SOY E. CHRISTENSEN ! 714 ) 646--9263
aooxess: 2237 JEANETT£
CM CA 97_627
LICENSEO CONTflACTOP OECNflFT10N: I hereby atlirm ihyt I am licensea under provisions ai C�ap�er 9(commencing wii� Seciion
7000) ol Division 3 0l Ihe Busine55 anU Pwlessions Cotle, a�tl my license is in full lorce ana ef�ect.
GITY L14: STRTE LIC.: CIASS:
Daie: SignaWre: _
WOFNEflS' LOMPENSRiION OECIABAT10N: I hereby aifirm �ha� I have a ceriificale oi conseni ro sel4insure or a cehifica�e of Workers'
Compensa�ion Insurance. or a cetlified copy Ihereol �Sec�ion 3gpp, Lab. C�.
POLICY NO.: EXP. UATE:
COMPRNY:
�] Cetlifietl copy is hereby lurnishea. ❑ Cehi�ietl copy is file0 with �he ciry BuilUing Oivision.
Oate: ApplicanC
E%EMPTIUN FPOM WOBREPS'COMPENSpTION UECIAHATION: (Thissection need notbe completeaii[he Dermilisloronehundred($1W)orless).
I ceNty Ihai in �he perlormance of t�e work for which this permit is issued. I shall not em�son in anY manne� so as to become
su�lec� �o t e Workers' Compensaiian Laws oi Califamia.
Date. � SignaWre�. ' (,�L1`[,i.y�
NOTICE: It,� f�er making Ihis declaralion, you 5hou10 be� sub ct Io �he Workers' CamDensa�ion provisions of �he Labor
Catle. yau must Iotlhwiih comply wi�h such pmvisions Or th permi� shall be aeemed revoketl.
CONSTHUCTION LENOING pGENLY: I �ereby al�irm Iha��here is a constmction lentling agency for the performance o�IAe wark lor
which Ihis permii is issuee �Section 3097, Civ. C�.
iexoee:
aoonEss:
OWNEB BUILOEB OELIABRTION: I �ere�y aifirm ihat I am ¢xempt irom the Coniractors' State License Law lor the followinA �easan
�(Sec�ion 7031.5 Business anU Pwlessional Code: Any city nl couniy which repuires a permii �o consimct, alier, imD�ove, demolish, or
repair any s�mc�ure. Drior lo ils issuance. also rtquires �he applicant �or such permii �o �ile a signeA s�a�emenl I�al �e/5he is licens¢tl
pur5uani�othe provisions ofihe Conlraclois' S�a�e License Law�C�apler9�commencing wi�� Seciion 701q�o�Division 3 o�lhe Business
antl Pmfessions CoOe� ar t�ai �e/s�e is e�empi Ihere�mm antl �he 6asis lor �he allegea exempiion. Any nolation al Sec�ion 7031.5 �y
any apDlicantlor a permit subie��s Ihe applicanl to a civil pNnalty ol not more than irve hunOretl tlallars 135001.
I. as owner of ihe DmpenY or my emplayees vnih wages as tAeir sole compensaiion, wiil da Ihe work, and ihe
❑ simcmre is not inten0etl ar ofieretl for sale (Sec�ion 7pan, Business antl Pmfessional Code: The Contracmrs' State License law
tloes not apDly lo an awner ol a property who builtls or impmves ��e�eon, antl w�a does suc� wark himsel�/Aerseli o� �hrouAh
�is or her own employees. D�oviOetl �hai suCh impmvements are not intentletl or oifered for sale. II, however ihe �uii0inp or
impmvemem is sola witAin one year of completion. ihe owner will have t�e burtlen oi pmving he/s�e tliU not GuilA or impmve
br the purpose ol sale�. .
?,, I, as owner ol lhe pm0eny, am exclusively conVaciiny wilh licensed comracmrs to cons�mcl lhe prolect (Seclion 7044, Business
L^J an0 Pm�essions Code: The COn�radors' S�a�e LicenSN Law Ooes noi apply �o an awner of DropeM1y who builAs or improves ihereoA
and who conVacls lor suc� pmle��s wiih a conVactpqs)license pursuan�ta the Contractors' State License Law�. I am aware
��a� pmo� ol �heir Worker's Compensaiion insurance shoultl �e providetl m me.
� I am exemp� un0er Section: 8. g P. C.
lor Ihiy.ieasun:
I
�ate'. , �d C G'1— Owner Y.Iil.f.�4.�
I Oo here�y ce 'fy �ha� I am aware ol an0 unders�ana Ihe reqUirements ot Califor 'a lealt antl Sa�ery Code Seclions 25505, 25533, antl
25534 antl Ihat I or any lumre �uilding occu0am will/will no� (circle one) neea �o co � ly wiN saitl state codes and the requiremen�s lor a
permi� lor consimclion or mo0ilicalian �mm the Air Oualily Management Disirict. Fe5i0ential constmction applicaiions are exemp� �mm
I�ese pmvisions.
Dale: ADPlicanl: _
I �ereby cerlifylha� I have read Ihis applicalion antl s�ale Iha� ��¢ aboveinforma�ion is correc�. I agree to comply wilh all city an0 couniy
ordinances antl state laws relaling to builaing consimction and hereby authorrze reD�esentatives of this ciry toenter upon ihe a6ove�mentionetl
pm0 «Y �a� inspeclion purposes. �.Q\�---
Date: � C �a— Si9naWre: 6e ��� AAIX .L� l�
onver's C se m Social Searily n:
t6<t�46 W�i�e—BuilOinq: Green—CaEe EnlorcemenC Canary—Aoohcant: Pink—Revenue: Goltlenrotl—Asvesmr
\ '
CITY OF COSTA MESA — HUILDING PERMIT E��x Nu; � �o i.
PERMIT NO: B 056019 PLAN CHECK NO; N ., i: 5�rr; rv
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTION ; REPAIR ROTTEA STUDS/HATHROOMS SQ FT: 500
CLAIM VALUE; 500,00 CALC—VALUE: 500.00 GROUP OCC; R-3 /
CUMMENTS: "HtJD" PROJECT
��***�x-�����**�x�*�t-k�*�x****�**�t��x-�f**�x*+��x��*i�***�x-*�-�*���c����+r�x�*�r+c�*�c�**�t*-�-��� �-**-x�x-�*�t������**����i�
�,- 7."O N FI N G R E Q U I R E M E N T S
- s E T e a c x s
------- — -- MAIN BUILDING ---------- --------- ACCESSORY HUILDiNG — ------
F'RNT: FT IN REAR:� � FT IN FRNT: FT TN REAR: FT IN
LEFT: FT IN.RGHT: -- FT IN LEFT: FT IN RGHT: FT SN
...
PARKING REQ• � PAOV; PARCEL; 4260721I 'I,NE: REF NO:
PI..ANNING NOTBSI
i
�*�����*�*�*�*�#�*****��,�*���***********u���c���*��*��*��*+��-�******��*,��u****��x��
D E V E L O P M E N T S E R V I C E 5 R E Q U I R E M E N T S
70NING APPROVED BY DATE;
HGILDING APPROVED BY : DATE;
�******�*�********t�B���� I DATE: �3G'
r lE�IElEfFll�iflflFiE?F �i!if�E
**��********x��**��****��*****�t**x�*+�*�**i *x*x***��u+�*�r�r**���t***�t**�t**�***u���r**
LEGALIZATION;N F E E �S M�M A R,Y STRUCTURAL SEGN,ENT:Y
4�
BLDG PMT PLUMBING ELECTRI. MECAAiJZC FIRE SMIP/RES GRADING
PERMIT 15.00 F 50
SMIP/NON—RES
PL21N z,
j.�
HUILDINGEDIV—> PERMIT ISSUE PLA —C$ECK'; �TOTAL PAID DUE
TOTALS----> 15,50 0,00 0.00 ? 15,50 15,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; �, 1,y,50 OVER/SHORT; .00
BLDG PMT PLUMHING ELECTRIC MECHANSC,' FIRE,j SMIP/TOT GRADIA]G PLAN—CHECK
15.00 , i .50
� � N
1(� �k ik if 3E iF 3E 343F if �l6 �1E if iF iE 3f iF if #F iE iE iE # IE if iElf �IE 1E if !E iE iE iF iE iF aE �F if iE 3F %� 3(-iE �7E iE iE �1f 3f%F fk 3E if if if �k K!F 1E iFlE iE 1F iE if iE ?F 1F 3E iF !i 1E !E if 14 ?E �7F iE �1F
I N D S V I D U A L " F'.E E B FtjE A K D O W N
TYPE QTY D E S C R I P T I O N • ! UNIT COST TOTAL COST
J f i ('
SFR 500 ALTER BY VALUE RESIDENTTAL NOZONE 1.OQ 500.00
END OF, FEES j;
/
:f
- "� � '� � �����`' , . - -
• 1 `f • '�. ��7" ,:a.— I_ _ �..'. ' , '.
'r � �
0
� CONSTRUCTION AND PLANNING POOt PA - -1
Date Inspector Date Inspector
%� APpROVALS Permit # . APPROVALS Permit # ,
'• l. Temporary Electricat Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe�Undrgrnd. . 53. Steel Reinforcement •
3. £lectrical Conduit Utility-Undrgrnd. � 54. Forms
4. EI¢ctrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFEfl Gmd. 57. APPROVALTO COVER�GUNITE
7. Footings 58. Electrical Conduit•Undrgmd.
8, Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Wtter Pipe-Undrgrnd. 60. Backwash Lines, P-7rap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
7 t. Prpperty Sewer Line & House Connection -i 62. Backw25h & Receptor�Final � '
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plum6ing System • Final ,�
14. Rough Plumbin9 ' 65. Electrical�Final ' ,
15. Rough Electrica6Conduit 66. Solar SYstem-Final � '
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
77. Rough Wiring Sign � 68. APPROVED FOR PLASTERING '
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditio�ing FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping �Gaz 00�1
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof framing 73. Undergmd. Srorage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structurel) & Monocoat J5. Dry Chemical
27. Frame and Flashing ��,� � 76. Dry Standpipe
28. Lathing & Siding �y� ' 77. FIXED SYSTEM PINAL
9
29. Insulation 5 e 78. FIRE PREV. FINAL
30. Drywall Nailing �Q �.., HEALTH DEPT. REQUIREMENT
31. Plester Brown Coat '! 79. FINAL INSPECTION
32. £tectricaf Power Meter�Final 80. FOOD CERTlFfCATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning '7
�" 6 � ��Y.�."ti�{�_�%' ��2 .
35. FinalGasPipe�7est �� __.JL !l Lt���_!� .. i/,
�v� F�7'• lP 'vPSf�
36. Hood or Canopy /�� � /1/� „�� �,,,� ����
�L�« ��- y�9
37. Final Fattory Fireplace `/��
tr�
38. Final Plumbing
39. WaterService�Final g../� er1� ����_ /`/_� f-� �
iQ .� i 'K T Cs
40. Gas Service•Final �
41. So�ar pomestic-Final ,
42. Backflow Preventer � �
43. Backflow Irrigation
44. Landscape Irriqation System �
45. Sound Attenuation
46. Handicap Regulations
47. PINAL STRUCTURE & BUILDING /� .o � (y�
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51: CERTIFICATEOFOCCUPANCY
No. Date
PflOJECT AUOflESS: 2 Z 3'I SEANE'I' i E PL
OWNEfl'SNAME: `HRZSTLNSEN JACK R
FDUHESS: 2z3� JEANET�'E PL
COSTA N,ESA,CA 92626
RHLH/ENGINEEP: 6 4 6—� Z 6 3
AOUflESS:
HEG.NO.:
UNIT:
UNIT:
PEHMITTEE: KEN LANCASTER ( 714 ) 548-5261
aoonEss: 3�jU2(6�p N. NpEW(`P{7ORT � q9
LICENSEU CONTHRLTtlR�CUBAiNNT I ��rESy�a�Grml�at I am IicenseG unCerCpT6visi6nfb��p el r 9(commencing wi�� Seciion
7000� of Div.sion 3 0l Ine Business antl Pwfessions Coae. and my license is in tull brce an0 ellect.
CITY LIC.: O 3`p( .� STRTE UC.: 6 U S 3 2 4 � B
�ate: �1��— Signalure:. . _/� _ —
WOflKEBS' COMPENSAiION OECUBATION: I �er allirm �hat I have a cetlilicate o� consent lo Sell-insure or a cerliliwie ol Workers'
CamDensation Insurance. or a[erlilietl copY �h¢reoi (Sedion 3800. LaE. C�.
POLICY NO.: E%P. �RTE:
COMPpNY:
Q Certilie0 copY is �ere0y fumis�eG. ❑ CenilieU copy is filetl vni� the city BuilUinA Divisbn.
��: APDlicanl:
EllEMP710NFflOMWORREHS'fAMPEN5ATI0NOEClAflAiION: (ihissetlionneeGnotEecampleleCilUepermitisfaonehuibre45100�orleu).
I tetliiy I�a� in Ihe DeAOrmance ol Ihe work �or w�it� ��is permii is i55ueA. I S�all no� employ any Derson in s lo �eCOm '
su71e[t7��o t.h�e .Wo�rkers' Compensalian Laws ol Calilomia.
Daie: 1/� — � � � � Siq�=� •
NOTICE: It. afier making Ihis Oeclara�ion. yo s�oultl become 5u01ec1 to i�e Workers' ComOensation pwdsions ot t�e Labor
Code. you mUst IOr1lm�ii� mmply wit� 5ut� provisi0ns Or IAiS Oefmi( 5twll Ce Ee¢me0 revaketl.
CONSTfluC7lON LENOING AGENCY: I here�y allirm that ihere is a consiNction lentling aqenty lor Ine peAarmance ol tAe work for
which �his permn is issuea �Sec�ion 3097. Civ. C).
LENOEN:
AODflESS:
CITY OF COSTA MESR — BUILDING PERMIT PERM NO; B 0�5464
PERMIT NO: B 055984 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N FERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTZON ; REPAIR D�AGE POST & BEAM FOR PORCH SQ FT: S00
CLAIM VALUE: 500.00 CALC—VALUE: 500.00 GROUP OCC: R-3 /
COMMENTS: REF: B55369
aE �1F �lf �7E iE if -%3i �N iF �X if dF �?' -k iE 9E ��if %� iF if iF �?E if �7E iE�lf �lE iF *�1t �� iF af iE iF 9E iFiE iE iE �lf i: if if -0E �lE IE 1E iF iP iF ii iE iE if iE �E 1E iF �tiE 3f if �lE K-x-if i( iFi(� aF if iE iE ���lF dE
'L O N I N G R E� U I R E M E N T S
ssTBpcxs
------------ MAIN BUILI7ING ---------- --------- ACCESSORY BUILDING ---------
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: 42607211 ZNE: REF NO:
PLANNING N6T�S> .
' � V
**�t**�*�t***x***�***�� ��c w��*+�****x x**x�*�e�*��r?rx��*��r*�*�i***�!*�����+r����� *�±���#+�r*
D E V � 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}fT S
J
ZONING APPROVED BY DATE: �=7
BUILDING APPROVED HY : DATE: r','
APPLICATION ISSUED BY: I ` DATE: I•��13'�
%iEififiEiE3F)fiPaFifN�iFif3Ei'r3EiFaEif3f3f r e FiF"iF"£��iFiFiM1ifih*i'r3t�Fii�1: � r . ifif
3fiEffifi(�iFi(�jFiEjFaF#��7FiF3E?f3fii�lEiFlfifihiflfififif�E3Eifif�ielFif�ifififN�i(�iEib � ififiFiFi4*�Fi'rif3fieiE�lfX�k1(�ififa'eiFiEiFielkifie?fif3FlF�Eie'r�if�
LEGALIZATION:N F E E S U M M R Y STRUCTURAL`,$EGMENT:Y
��
OWNEBBUILOEBDECLABATION: Ihere�yallirm��allamexemplimmtheConttactor5'Stamlicense�awronnefollowinqreamn BI.DG PMT PLUMBING c.LECTRIC MECHANIC FZRE SNiIP/RES'�j� GRADIAIG
�Section 7031.5 Business anG Pmiessional COGe: Any ci�y ol counry w�ich reQuir¢5 a permii �o consimc6 alter, imD�ove, Oemolish, or
repair any 51rucWre, prioi lo i�s issuance. also repuires ihe aDDlitan� lor sucA petmi� �o lile a sipnea 5tatemen� thal �e/SAe i5 iicensetl PERM I T 1 5. � � j � Z
pursuant m the pmvisions ol ine Contracmrs' Slate License Law (ChaD�e� 9(commencing with Sec�ion 7000) oi Division 3 0l ��e Business SM Z P/ NON„FES
anU Pmiessons Code) or Ihat helshe is exempt t�erefmm antl ��e �asis �or I�e alleged e�emplion. Any violation o� Section 7031,5 by p I�AN ��p�
any applican� lor a Oermit subjec�s t�e applicanl lo a civil penalty o� nol more Ihan live hunUreU tlollars (5500�. I SSUF. FEE
�.
i. as awne� ol me omoeny ar my empioyees with wages as ineir saie campensalion, vnll Oo ihe work, and lhe BUIZ,DZNG—DIV—> I�ERMIT ISSUE PLAN—CHECK TOTAL PA1D DUE
❑ simcmre is not imendetl ar anerea lor sale �SeWon 7044, Bu9n¢SS anO Pm�e55ional CoE2: TAe CAnlratlOrs' Siate �icense �aw TOTALS----> 1 5. 50 �. 0 0 U. 0 0 1 S, S 0 1 5. 5 0 , 0 �
tloes not apply to an owner ol a propeny w�o �uilds ar impmves thereon, and who Uaes such work himsell/Aersell or thmugh �
�is or her own employees, pmvi0etl ��al suc� impmvemenis are not intw�e0 ar allered br 5ale. II, �owever ihe bui�eing or
,impmvement is solG within one year ol completion. ihe owner will �ave ihe 6ur0en of pwvinq �e/she did not builtl or impmve REVENUE D I VIS ZON TOTALS--> COLLECTED • � S,$� OVER /SHORT • l�� 00
rormeP��poseoisaiel. HLDG PML PLUMBING Ei,ECTRIC MECHANIC FIRE SMIP/TOT GRADING„�LAN—CHECK
I, as owner ot Ihe propehy. am excWsively coniracling with licensed conVac�ars Io consimcl Ihe pmle�� (,Sec�ion 7044, Business 1�, Q Q , J � .
❑ and Pmlessions Code: The ConVaclor5' S�ate License Law does nol apply b an owner ol pmDe�Y who buACs or impmves lhereon
andw�oconlradslorsuchprole��swilha[onlraclor�5�licen5epur5uan�tot�eConiractor5'S�ateLicenseLaw).lamaware ,�*,�,Yki'riEiEifiFit3EifjE�7ciF�N-3E#�E�iE�:�F3Fif�ifiFiEiFi'r?C-i(�afiFaF>�iE1E3FjfihiFlE�(�iP�f�jFi4#:�aEifiFjt�#iFX1E*�t�if3(�IE�hiE�lE3E�F9Eii�:1'raF%�34iFif�lF�kif9F
I�a� pmo� af I�ert Worker's Compensation insurance should be pmuiAeO Io me.
� I am exempi unUei Section: B. 8 P. C. I N D I V I D U A L F E E $ R E A K D U W N �'�
mnnis�eason: TYPE QTY D H S C R I P T I O N UNIT COST' F'OTAL COS"C
Oaie'. Owner.
i eo nereby ceniiy mat i am aware o� ane unnersia�d me reqWremems of Caummia Heauh ana Sa�ery Cotle Sections 25505, 25533, ano SF'R S � � AL'tER $ Y VALUE RES ID ENT I AL NOZ ONE 1. � � /`:1 5 � �. U �
25534 and l�at I or any luture builtling occupant willlwill nol (cir[le one) neetl la comply wi�h saia 5tate codes antl the requiremen�s for a END �F FEES
p¢rmii for tOnslmclion or m0aditaiian Imm Ihe Fir Oualiry Manag¢m¢ni �iSVitL FeSiJenlial tonslmcti0n appliCaii0n5 are eeempl irom ,y!
I�eSe pmvisions. '}.
%F�
Date', � ApPI¢anL _
I h¢reby certifyiha� I �ave reatl��is applicalion an0 s�ate �hai IM1e a
mainances antl slate laws rela�ing �o bwltling conslmclion antl �ere�y
prope�r�y forins.peclion purposes.
BLe:_ `�LJ�—(— Si9�" . i
Oriver's Liwnse ar Sociai Securi�y .: �, �.�
is correci. I aA�ee lo comply wit� cily antl
t6�La6 Whne—Bwleing: Green—Cotle Enlorcament: Canary—ApPlicanl: Pmk—Revenua; Goltlenro�—Asseswr
�I���Gv � _
CONSTRUCTION AND PLANNING ' P���•�A �
Date Inspector Date insprytor
' APPROVALS Permit # � APPROVALS Permit # �
i. Temporary Electricat Service qr Pole 52. Pool & Equipment Location '-"�i
2. Soil Pipe-U�drgrnd. -• 53. Steel Reinforcement � �
3: Electrical Conduit Utility-Un � rgrnd. 54. Porms .,
4. Electrical Conduit-Undrgrndt�-• � 55. Electrical Bonding � �
5, $teel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings - � ' 58. Electrical Conduit-Undrgrnd.
i
8, Foundation � ' 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe�Undrgrnd. � 60. Backwash Lines, P�Trep, O Undrgrnd.
10. Structural floor Svstem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor�Final
12. Sewer CaP . ' .
63. Heater & VenbFinal .
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing � . � 65. Electriral�Final
15. Rough Elecrical-Conduit � � 66. Solar SYstem-Final
16. Rough EleGtric Wiring ,� ) 67. Fencing & Access ApP�oval
17. Reugh Wiring Sign 68. APPROVEO FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling �� 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. ftough Factory FirEplace APPROVALS Permit #
21. Ducts, in Structure - 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Fram�ng 73. Undergrnd.StorageTank �Gas ❑Oil
25. 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. REQUIRENIENT
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. WaterService�Final � �� _;-�
40. Gas Service-Final - .
41. Solar pomesticFinal '
42. BackflowPreventer. �
43. Backflow I�rigation '
44. Landscape Irripation SYstem • � �
-45. Sound Attenuation � '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING �� `i�/i �. ��/�_ /J ,�� � /'y„y_
..T P'�-.f�'y'�' �-`�Iv
48. FINAL PI.ANNING .
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Cn "�
51. CERTIFICATE OF OCCUPANCY
No. Date
OJECT AOONESS: �) 2 3"1 JEANETTE PL
nRsr+amE: CHRISTnNSEN, JAC3{ R
aooxess: zZ3� JEANETTE PL
COS1'A MESA,CA 92626
646-9263
AflCH/ENGINEEfl: PEG.NO.:
AOOflESS:
uNiT:
UNI7:
PEFMITTEE: xEN LANCASTER ( 714 ) 548-5261
aooeess: 326 N, NEWPORT
NEWPORT BEACH CA 92663
LICENSEU CONTRACTOB OECIAXATION: I �ere�y atfirm �hat I am licensed under provisions of C�apter 9(commencin wi�h Sec�ion
7000� ol �ivision 3 oi Ne Business ane Pro�essians Cotle, antl my license is in lull �orce an0 effect.
ciTvuc.:053(8�03q sr�areuc.:601329 �s: g
—Befr. �c7' 1 — l � Signat _/��l-r
wONRENS' COMPENSATION OECLANATION: f nereby affirm that I have a cenificale oi consent to self-insure or a cenilicate of workers'
ComDensa�ion Insurance. or a cenified copy tnereof (Section 3800. Lab. C�.
POLICY NO.: EXP. OATE:
COMPANY:
7 Ceriilietl copy is hereby fumi5he0. ❑ Ceriilietl copy is file0 wit� Ihe ciry Builaing Oivision.
Oa1e: ApDlicanf
' E%EMPTION FNOM WORKEflS' COMPENSpTION UECLABAiION: Qhis SeCiion n¢ee no� be tompleied i��he permi� i5 for ane hundretl (5100) or less�.
I cerlily thal in the pertormance of ihe work �or w�ic� �his permi� is issuetl, I shall no� employ any person in m@r so as e became
sublec�i �o Ne �Workeri Compensation Laws ol Califomia ��
. �: ll�. L{ — � � Sig t � ����
NOTICE: II, afler making IAis tleclaration. yo oWd become sublecl Io Ihe oW rkers' Compensation provisions ot Ihe Labor
CoOe. you must forthwith campty wil� such pmvisfons ar �his permii 5hall be OeemeO revoketl.
CONSTFUCTIDN LENDING AGENCY: I �ereCy a��i�m t�al �here is a constmc�ion lentling agency for �he Dehormance ol the work for
which Ihis permii is i<sued �Seclion 3097. Civ. C�.
LENOEH:
pU0flES5:
OWNEB BWLOEB �ECIAPATION: I hereby af�irm that I am exemp� iwm ��e Conirac�ors' S�a�e License Law Ior the following reason
�Seclion 7031.5 Business an0 Professional Code: Any city o� counry which requires a permi� m cons�mci, alter, impmve, tlemolish, or
repai� any SlmcWre, pnor ta i�s issuance. also requires the applicant �or such permit Io �ile a 5igneA statemen� �ha� �e/she is licensed
pursuanl Io Ihe pmvisions ol the Comracmrs' S�a�e License Law (Chapler 9(commencing wi�h Section 7000) af Division 3 0� I�e Business
antl Pmlessions Code) or �hai he/she is exempl Iherelmm antl �he basis �or Ihe allegea exemp�ion. Nny violation ol $etlion 7031.5 by
any applican� �ar a permit sublecls I�e apPlicani Io a civil penal�y of no� more Ihan five hundred tlollars ($500).
I, as owner oi Ihe pmpetly or my empioyees wrth wages as Iheir sole compensa�ion, will tla the work, and �he
❑ slmemre is nol imentletl or ofleretl �or sale (Seclion 7044. 9usiness anG Pmfessional Coae: The Coniracmrs' Staie license Law
tlaes not aDPly lo an owner of a pmDetly who builtls or improves IhereOn, antl who tloes such work himsell/�erself or ihrough
his or Aer own employees, proviAetl Iha� such impmvemen�s are not intentled or ofleretl �or sale. II, however Ihe builtling or
impmvemenl is sold wilhin one year ol comple�iaq the owner will have ihe buraen o� pmving he/she Oi0 not builtl or impmve '
lar Ihe purpose ai sale).
I. as owner ol l�e pmperty, am exclusively contracting wiih Iicen5e0 conirac�ors b cons�mc� the pmlec� �Sec�ion 7044, Business
❑ antl Pmfessions Co4e: The Coniractors' Siale Litense Law does not apply �o an owner o� pmpeny who builtls of impmves �hereon
ana who contrads lor such prolecls wi�h a coniractor(s) license pursuani Io Ihe Contractors' S�ale License Law�. I am aware
Ihai pmaf ol �heir Worker'S Compensa�ion insurance s�ould be pmvidea to me.
� I am exemp� untler Section: B. 8 P. C.
Ior i�is reason.
�ate: Owner
I Oo �ereby cenify that I am aware ol antl untlerSlanA the requiremems ol Califomia Health and Sa�ery CoOe Seclions 25505, 25533, and
25534 and Ihat I or any W�ure builtling occupanl will/will not (circle one) neetl lo comply wilh 5ai0 s�a�e cotles antl Ihe requirements �or a
permi� lor consimctian or motlihca�ion Imm Ihe Air Oualiry Managemen� OisVict. Fesi0enlial constmclion applica�ions are exem0� ��om
IheSe prOvisi0n5.
Dale: AppOcanC
I'ere0y cerlity Iha� I have rea0 �his aD�licalion and Sla�e ihat the above information is correcL I agree Io comply wi�h all ciiy and cowry
oNmanceSantlslatelawsrelating�obuil�ingcon5buctionanOherebyauthorae alivesoflhiscilyt ���eabo�-meniioned
pmperly �ar inspeclion Omposes.
�., .'� U - G 1 � __ __
DriveYs License or Social Securiiy w: �
t64��46 Whne—Bmltlmg; Green—Cotle Eniorcement Canary—Fppliwnt�, Pink—Revenue-, Goltlenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERNIT PEHM NO; B 05536_
PERMIT NO: B U55369 PLAN CHECK NU: N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR FURPOSE: OTH
JOB DESCRIPTION ; T/OFF RESHT, REkUOF W/COMP, SQ FT; 4,000
CLAIM VALUE: 4,000.00 CALC—VALUE: 4,000,00 GROUP OCC; R-3 /
COMMENTS• SMOKE DETECTOR(S) RE�UIRED ZN HOME.
�***u�t�*#***�+r�t*x�************ *�**��**�****�r�**�x**��*�rx*�**�*�*�*�***��*��**�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN
--------- ACCESSORY BUZLDZNG --,------
FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT; FT ZN
PARKING REQ• PROV; PARCEL: 42607211 ZNB; REF NO:
PLANNING N15TES>
.i
iE �lE IE if If iE jf �1F M� �IF af iF 3f �lE_!f # if iElFlF iF it jF 3F 3f 3F ih iF f( iF 1E �E iE iE # 3F 3E iE 1E iE iE i!� �lE 1E iFlF iF iF iE # 1E i4 �If j(� ih 1f i(�iF jF if fFiE �1E �1(� 96 IE �le iEif'!f !E iE # 7'r iE i(� if 3h �If�
D E V E L O P M E N T S E R V I C E S R E� U I R S M E N.`—T 5
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED BY: ' DATE• ������
#3FifiElfiFiFiEiEi'riEiE3fiEffiF1FIF1FjtiFiE�IF � r aEif3hifiEiFlEiFiFif . if�k
�FiEifiEiFiFiFiFlEie3fiflEififlEiEiFitlEiFiEifiEiPikif�kifihjf�Fieit3fiEiF �fi(�if#i63Eik##FiEif�flEkiElEiEif�lbiFaE�lkiF�EiflEifiFiFiE3f3FiF�1F3Elf�IbiE
LEGALIZATION;N F E E S U M M A R Y STRi7CTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MfECHANIC FIRE SMIP/RES-" GRAUING
PERMIT 63,00 ,50;
SMIP/NON�RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID '� DUE
TOTALS----> 63,50 0,00 0,00 63,50 63,50 ,00
REVENUE DIVISSON TOTALS--> COLLECTED: 63.50 OVER/SHORT; ? ,00
HLDG PMT' PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING''PLAN—CHECR
63,00 .50
ih if if iE ff if jF iF IF iEl4 iF iE K�lE 3E iP 1E if aF iE 1E iE iE iF iE iE if if If if iE 1F �F 1E 3k ae if iE i(� if� iF # if !F if aE if iE iP �I6 I� jf iE iE af iE IElf iE if 1f iE iE 3E iF if� ��f iF IF ic 3E iE �Y iE iflE �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 ONIT COST �Y'OTAi, COST
SFR 4000 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 � 9,000.00
END OF FEES
/ Ii
i,'
li.
��li�'J%�:l�'L:1��,dJl'� i'— _'
�Q.�L• f �/ U4Ip ♦ '.�.ILi 11. C..
� r
o�jONSTRUCTION AND PLANNING P�� 'PA , _ �
I Date 'Ins ector Date Ins ctor
APPROVALS Permit # P APPROVALS Permit # P�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �'
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Unr�rgrnd. � � 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. f
�` 8. Foundation _, ' � � 59. Gas Pipe, O Undrgrnd., Test "j
9. Water Pipe�Undrgrnd. ';j � 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System � 'r � 61. APPROVAI TO DECK ���
11. Property Sewer Line & HouseF:onnection i� 62. Backwash & ReceptorFinal ; �
12. Sewer CaP r .;
/ 63. Heater & Vent-Final �';'
13. Roof Drains , ! -� � 64. Plumbing System � Finaf � �
,e
74. Rou h Plumbin � ' �
9 9 . 65. Electrical-Final ,
15. Rough Electrical�Conduit 66. Solar System-Final
�
76. Rough Elettric Wiring ' 67. Fencing & Access Approval
17. Rough Wiring Sign ,� 68. APPROVED FOR PLASTERING
19. Rough Electrirzl-T Bar Ceiling 69. P00�/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.�Rough Factory Flreplace . . � .APPROVALS .�� Permit# �
21. DuCts, in Structure ' - . 70. Undergr.ouncl Hydro .
22. Ducts, Ventilating ' � � 71. Product�Piping OGas ❑Oil
23. Gas Pipe�Rough & Test � . � = 72. Undergr'ound FIusK `- �
24. Roof Framing � ' 73.• Undergrnda Storage Tank O Gas ❑ Oil
25. Roof Sheathing �, ' �/�_��cl^���/,L� 7q,- Overhead Hydro
r �v
26. T�Bar Ceiling (Structurall & Monocoat � � 75. Dry Chemical _ '
27. Frame and Flashing 76. Dry Stan�plpe ' " -.
t
' 28.'-Lathing_& Siding . � �� 77. FIXED SYSTEM FINAL �
'29. Insulation `^ ' ' ' , 78.,�FIRE PREV. FINAL � .
=30. DrywallNailing -- "/ • � � HEALTH�DEPT.REQUIREMENT
.31. Plaster B'rown Coat .-' 79. FINAL INSPECTION '
32. Electrical Power Meter:Final . j� '.SO..�FOOD CERTIPICATE ISSUED
33. Final Electric ' /, ' ' Notes: � '
34. Final Heating & F.ir Conditioning, '-' � '^' , � . . '
'J
35. Final Gas Pipe-Test � • � �..� ' -• �
36. Hood or �Canopy . ` , _ . - � ' '
37. Final Factory Fireplace • ' ' , '
i;
38. Final Plumbing � ' - . F� � ' . .
39. Water Service�Final� , .' . � - :
40. Gas Service-Final - - , " '
���41. Solar pomesticFinal � � � , •
� 42. Backflow Preventer � '
43. Backflow Irrigation =
- t �
44. Landscape Irrigation System . ' - .. , � , i . , _
.�45. Sound Attenuation .
46. Handicap Regulations _ ' ' � i .'; .
�47. FINAL STRUCTURE & BUILDING �/�e� �(,� �� L� _ _jl } �' n �, ,_ �' pN�
( (••�._ v�-Pil Il
48.'FINALPLANNING ' _ . . ,
49. Electric Release to Edison , �,�,, � � . � �
� i.
50. Gas.Release to $outhern CaliTornia Gas Co �
I �
51. CERTIFICATE OF OCCUPANCY
No. Da[e
OWNER
IOB ADDRESS
r uP 1 �
INSPECTIONS
F inn F�xtu�.
h..... Gas Test
FABRE CONSTRIICTION CORP.
2237 Jeanette Place
LOT 13
J
coae
�
DATE
DATE 11-25-57
BUILDING PERMIT NO.
VALUE $ ZZe3011.0�
DESCRIPTION OF WORK Residence
SUBCONTRACTOR
PERMITSISSUED
DATE I NUMBEF
_ y '
✓ •
� . ,;: � 6094
•�COSTA MESA BUILDING DEPARTMENT
P.O.80X 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
2237 JEANETTE PLACE
COSTA MESA. CALIFORNIA
R FABRE CONSTRUCTION CORP
MAIL 3404 Via Lido
ADDRE55
�,T,. Newport Beach TNd�R 3-1240
ARCHITECT LIC.
oR F" NEER Raymond Levanas No. C. 747
,,,,,,RFGG 3432 Via Oporto, N. $.
Lido Constr. "TY N`o: 7520
ADDRE55 3404 Via Lido
LEGAL LOT j
OESCRIPTION Np, y� B
A.P. NO.
' ��t.�'�i..'Y � •-,'✓'
. . ,. , p�" ����
,-.t,�-,��CE DcP�i. .,\�
,� t•nF fOS1A r;iL51
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
COSTA MESA. CALIFORNIA
v
OR 3-1240 BPPROVED OATE
_e.�_ 324Z CORRECTIONS
-ox.9000 sq.ft.�,",o,°o„ �o;�' none
�.si
SET64CN LINE FPOM [
CENTER OF STREET uS� REAR YARO�OOO S(�
SIDE YARO RIGHT 1S� LEFT S�
DESCRIPTION OF WORK
NEW X qLTERATION ADDITION
REPAIR MOVING _ DEMOLISH
BUILDING 140� 9.ft. ROOMS 6 STORIES 1
SIZE
-WO
EXTERIOR WALL StuCCO ROOF Sha Se
COVERING COVERING shin�le
llSE OF NEW .-. .. n : . � .. ,.
I MEREBY dCKNOWLEOGE TMST I M�VE NE�O Tn15 w ilOrv Arvp
STPTE THAT TME ABOVE IS COPflECT ANO tGREE t0 COMPIY WITN �LL
CITY OROIN4NCE5 .�ND $TATE L�W$ REGVLAi1NG BUILDING CONSTRUC-
iiotu. VALUATION
SIGNATURE OF PERMIT FEE 5
PERMITTEE
AUTHO
)� � PLAN CHECK S
5 " � 0� TOTAL FEE 5
n
. . OCT 2 S 1958 �'" �'�
OWNER (;}�}�7.STF'Ai.S'ON� CAPT �TACK DATE 6-10-58 _
10B ADDRESS ��'iv .ia�.,�++e vi.,..e MAR 2 �959 BIIQ.DING PERMIT NO. �A[a
GENERALCONTRACTOR
VALL[E
AP. No. LOT 1 7'BAC'1' 32 2 FIRE ZONE �- „- D IPTION OF WORK
�" `UP Y TYPE ZONE I. � PLAN T
INSPECTIONS ' I� DATE I SUSCONTRACTOR I onTE PERMITSNUM E�F
F inq Fixtu
[.. . Gas Test
coat
�
_r,
686g
,
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31]
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
qooRess � � ,
COSTA IESA. CALIFORNIA
C � � n ion .
OWNER
MAIL �
AODRE55 S
r
CITV
ARCHITECT
OR � 'NEER
�[Gn�- N ILOT )
DESCRIPTIO NO. �
A.P. NO. ' ' `
SIZE
OF LOT 5, �
USE OF
E%ISTiNG BLDG.
SETBTCI( LINE FFOM
CENTER OG SiREET
TE�NO.
LIC.
NO.
C ITY y16
/ NO.
TEL
INDiQF BLOGS.
'�OW ON LOT
REAR VAR T
DESCRIPTION OF WORK
NEW AI.TERATION ADDITION �
— .
REPAIR MOVING DEMOLISH
BUILDING �O� I NO.OF
SIZE J ROOMS STORIES .
EXTERIOR WALLp ROOF � f �
COVERING y� �1�G COVEtR�ING WG�d S IY` Q
USE OF NEW \\ 1 I
��� ��C�e��:�
�_s—s g_'.dc�—
FII�ANCE DEPT. '
CITY 0� �OSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO, /� pE(F�MI/T NO
�F a � % �
� �E\VGO BY �OATE( R�ECE\IVEO D�E ISSU(E�O'
1 V IA J'J'� /-�- O' ✓
BUILDING / ` •,p / v
ADDRE55 J �Q,C.N�
��('} V�—r
Si"" COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONE/l � p�sNS TVPE GNOVP
f/b! T
APPROVED
BY DATE
CORRECTIONS . ..
�.�
1vnu::�vv ��a�
CITY 0�= Cr�;:; 1�1ESA
M111V I' � .
UBJECT TO G'LUG. DEPT. REG.
SG U b.
I MEREBV ACNNOWLE�GE TMAT I H1VE PEt� TMI$ 4PPLICFTION FNO "
$TnTE TNRT THE /BOVE I$ CORPECi AND RGREE TO COMPLV WITH RLL
CITY OROIN4NCE5 /�NO STATE LAWS REGULiTING BUILUING CONSTRIIC-
iiorv. VA W ATION
SIGNATURE OF ` ' PERMIT FEE 5
PERMITTEE
�/ �/ e� , � PLAN CHEGK $
rv
AUTHORIZED AGENT TOTAL FEE 3
-OWNER CF.
JOB ADDRESS
AP. No.
� �uP I
INSPECTIONS
[.__. Gas Tut
JACK
OCT 2 8 1958
Owner Builder
3 'r�cr 321�2 r�Rs zorre
1'YPE V ZONE :
DATE � SUBCONTRACTOR
DATE %—�
BUILDING PERMIT
VALUE $ 2�
7113
PERMITSISSUED
NUMBER
7713
• � '79_13
CGtiSTAf MESA BUILDING DEPARTMENT
P.O. BOX 31]
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
MAIL
ADDRE55 %
cirv Cc
ARCHITECT
OR' 'NEER
s / J�"nuei Tc r�
COSTA MESA. CALIFORNIA
ADDRt55_ _ _ S'R K e
coNrancroR o w1/!2
ADDRE55 f � � �
LEGRL LOT J
OESCRIPTION NO. �J E
A.P. NO. J`� ['% /�
OFLOT60'YO' ]0" /�
USE OF
E%ISTING BLDG. H�/K �
SETB�ICK LIrvE FPOM
CENTER OF STFEET � REAR VAR��
/
IGHT LEFT
.R TI N OF WORK
NEW ALTERATION AODITION
REPAIR MOVING DEMOLISH
SIZEO�� F ROOMS S STORIES
EXTERIOR WALL ROOF
COVERING 4,on0 COVERING s'(//✓(rL
USE OF NEW
eui�oir�c LPKpb�L ! Ave.i.t, f�
T T� P �—
TNo u q-s6��
, LIC.
NO.
CITY LIC.
N o.
TEL.
NO.
TR���
NO.OF BL�GS
NOW ON LOT TWD
�=EE,RECEi��D �
FINANCE DEPT.
APPL��C�ATIONSTFORS PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NC
BUILDING p� -% �
AD�RESS � 4 / '� Y'N /� �
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONE NO.OF TYPE
GLRNS
APPROVED � �
BY O1� �' OATE
CORRECTIONS
CITY OF � � n MLJri
SUBJE�C tT0 LDG. DEPT. REG.
un � �- -�
N T: CF i
—.�--�—
v �J � ���
Y , ✓
�p9/
ri+''� L�Art r .fi��.�r
F T T is 7 r a.� e
I HEftEBY ACHNOWLEOGE THAT I HAVE FEAO THIS APPLICFTION AN�
STATE THAT TNE wBOVE IS COFRECT PND AGREE TO COMPLV W!TH iLL '
CITY OROINANCES AND $TATE LAWS REGULATING 6UILOING CONSTRUC-
norv. VAWATION
SIGNATURE OF PERMIT FEE $ C%
PERMITTEE '
s 't� '(G,c �
PLAN CHECK 5 `
AUTHORIZED AGENT TOTAL FEE $ /s�.+ ��M�
� �