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HomeMy WebLinkAbout2326 FORDHAM DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 e JobAddress: 2326 FORDHAM DR Suite No Vicinity: � HALLWAY CLOSET Parcel Number: 14148213 npp�icane COOTER, LYLE , ��, i�; Address: 188TECHNOLOGY-��-- � 1 . SUITE�C.,-. � - IRVINE � , -- /, � ; � , .-.�''��.- Ownei ;BROESAMLE �THOMAS A ,, Address:� �2326FORDHAM.DR� .� � �. . . �. ., , "„i, . � , COSTA�MESA, CA `�7 , �� Contracror. �' KEMNITZ A/C & HEATING ����Address: 168TECHNOLOGY , . . �� �SUITE C : . IRVINEr � - � � " MECHANICAL PERMIT � �� Phone: Q14) 453-8500� �, � - Zip: 92718 - ` . �, Phone: Zip: 92626 Phone: (714)453=8500 .� Zlp: 92718 . � License: 695874 Status: ISSUED Applied: 02/06/2002 Issued: 02I06/2002 ISSUED BY: / � � SCOPE OF PERMIT , �'�� � � � REPLACE FURNACE 60,000 BTU ` - � � .�-.- — --� , , , �� - - '.� _ � "' - FEE SUMMARY ` ` =` � — ' � - . ' Quantity ISSUE FEE $23.50 , , Inst FAU <100 k BTU , „ $14.80� 1� � _ ,_ - InsTFAU>100kBTU,' $0.00.�0 - � ��— Repair / Alt-Cooling/Heat $0.00 � � 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU � 30.00 0 Refrig�Sys>700k�BTU $0.00 0 GasPiping � ��� ` $0.00 0 Factory Fireplace , �' � 50.00 0 . Hood w/Mech Exhaust 50.00 0 � • VAV Box '= �= � - � 50.00 0 � Vent Fan PSingle DucL _ ,�$0.00_; -0 ,�-` � � - Appliance � � ��� � �50.00 _0� , Fire Dampers �� =��. / �. - ��$0.00�, 0 �, � - Smoke Dampers ' - - �' � $0.00"�0=�� � � � Inst or Relocate Appl Vent " ` , �- = $0.00 � �0��_ ;`_ � Air Handlers < 10000cfm , 50.00 � 0 � � - � Air Handlers > 10000cfm " �' . � $0.00. 0 Floor Fumace ` $0.00 0- Floor or Suspend Heater � $0.00 � -0 � - Quantity ' Repair/AItABsorbtionUnit '-,.$0.00� 0� Repair/AICRefrigeratlon-Unit ���. j!$0.00 `�0� Ventillation System = � ,!' ' $0.00 '0 EvaporativeCooler � � �,'$0�00_-0 . � i ;, Commerciallncinerator i,:-: $0.00 _, .0 � � Domestic Incinerator �- �„}' 1$0 06` , 0.�'� �, Compressors�/ Absorption Systems ' � �- ' � Up to 3 h PI 100 k BTU /! j�j�� ,`�g0.00 �;"O3 ', "-"�3To15h /SOOkBTU � 15 To 30 hp / 1,000 k BTU =" � �$0 00 /,0 � 30 To 50'hp /_1,750 k BTU /i/�'� - $0 00 /,�0 � Over50,hp;%�Ovei;1;750�BTU .,�� , ' $0.00�'�0 - Bollers � . . . �, i % , � � -Up to 3 hp =� �' $0.00 0 3To15hp , �, . ���$0.00 0 � 15 to 30 hp . � . . ' � �- $0.00 0 30 to 50 hp - � � - i = � ' �0.00 D Over 50 hp � ' ` , , - � $0.00 0 Other Mechanical�Fee � �- : Investigation Fee � � 50.00 Plan Check Fee = -� 50.00 Reinspection' Fee, -�' ��`� $0.00 - 'i'' % , � -%"�'TOTAL-CALCULATED FEES $38.30 COMMENTS / SPECIAL CONDITIONS NOTICE;, The4work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (OiC. NG. 9P-2B, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 z+ao-ao law� WORKERS'COMPENSAnON DECLARAnON: . — I hereby aHirtn un0er penalry ot perjury one of Ihe following declarations: � ❑ I have and will mainlain a certificate oi consent to seli-Insure for workers' compensation, as provided for by section 3700 of ihe Labor Code, for the performence of the _ work for which this permit is issued. will n insuranca, as requiretl by section 3700 of the Labor Code, forthe pedortnance of Ihe work for which this pertnit is Issued. and policy numbar are: , one orless.) °�cy�Num�er.- .�iC p Z.� I/ � ❑ I certity lhat in the performance ot Ihe work for which ihis permit is issued, I shall not employ any person in any manner so as to become subject to t�e workers' compensation laws of Califomia, entl agree that if I shoultl bacome subject to the workers' compensation provisions oi Sectio 3700 o the Labor Code, I shall torthwith comply,withdheseprovision . .., i' _ �-%� o � "ylicantSigna W ra: � Datei • WARNING: FAILURE TO SECUREWORKERS' COMPENSATION COVEMGE IS UNUWFUL AND SHALL SU&IECT Ml EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HIINORED THOUSFND DOLURE (5100,000�, IN nDDITION TO iME COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECiION 3I060F THE LABOR WDE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTPACTORS DECLARATION: I hereby attirm that I am licens unp�r r vi i o apter 9(commencing with Section 7000) of Division 3 of ihe Business ar� Prof ssions Code, and my license is in full a�u�;s _��1 .-�i ��l ciass a-- C.:� o� O. C.� L, n gCtoLs:SlB�ature:_ � i l - ate:—"' �� � . 1 CONSTRUCTION LENDING AGENCV: ❑ I hereby aRirm Nat Ihere is a construction lentling agency for the performance ot �he work for which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: SigneNre: _ OWNER-BUILDER DECLARATIONS: Lendefs Address: Date: I hereby ettirm that untler penalry of perjury �hat I am E%EMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness entl Professions Code: Any city or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair eny siructure, prior to its issuance, also requires the applicant for such permit to tile a signetl statement t�at he or she is licensetl pureuant to the provisions of tha Contractors License Law (Chepter 9(commencing with Section 7000) of Division 3 oi the Busineu antl Protessions Code) or that he or she is exempl therefrom end the basis for the ellegetl exemption. Any violation of Section 7031.5 by any applicant for e pertnit subjects tha applicant to a civil penelty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO TME WORK, and ihe structure is not intendetl or oHered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does noi apply Io an owner of property w�o builds or improves thereon, antl w�o does such work himselt or herself or ihrough his or her own employees, providetl that such improvements are not Intended or offered lor sala. If, however, t�e builtling or improvement is sold within one year ot completion, the owner-builder will �ave Ihe burden of proving ihat he or sha did not build or improve for purpose of sale.). ❑ I, as owner ol lhe property, am E%C WSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7004, Business antl Professions Cotle: The contractore Llcense Lew does not apply to an owner of property w�o builtls or improves thereon, and who contracis for such pmject with e coniractor(s) license pursuam to tha Comractors License Laws.). ❑ I am exempt untler sec. Business antl Professions Cotle for this reason: Signature: Date: Owner ID veniietl by arivar's license. ❑ Ves ❑ No Dnvefs LicenSe No. Expires: Vedtication ot Ownership by (type of dxument, i.e. - pmperty ta�c �ill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certily ihat no excavation five (5) or more feet in depih into which a person is required to descend, will be mede in connec�ion wiih work euthonzed by ihis permit, and ihai no building simcWre, scattolding, falsework, or demolition or dismantling ihereof, will be more Ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Atlministretive Code). ❑ As owner-builder, I will not employ anyone �o tlo work which would require a permit from Ihe Division of Industnal Satery, es notetl a6ove, unless such pereon hes e pertnit to do such work from the division. SignaNre: Date: Division of IndusMal Sefery Permit Number: CERTIFlCATE OF COMPLJANCE AND AUTHORVATION OF ENT1iV: I cenify under penalry of perjury ihat I have read this application antl state thet ihe information given is correct. I agree ro comply with all s;ate laws end ciry ortlinances relating to builtling consWction, and authodze represantatives ot the Ciry ot Costa Mesa ta enter upon the ebove-descnbad properry for inspeciion purpases. I a9ree nol to occupy or allow occupancy of eny building authorized by this pertnit until final inspection. CO�E t. INSPECTIONTYVE 1�� Ui�196�a 1616 Fiaed System Final Fire Prevention �� 7266 200 201 202 203 204 Pool Spe Finel Final Re-Rooi Final Block/Retaining Wall Finel Fectory Fire Place Final Sign Finfll Demolilion . COUEI INSGECPONTYPE 206 Finel Mec�anical 208 Finel Plumbing 210 Finel EletMcal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency �.1 JIII. • •„ %.. wonessaFem�w+o: 2 jz6 FORDHAM DR avxEasruxeiv�auvr+: BROESAMLE, TIiOMAS A � �ss BROESAMLE, PATRICIA M 2326 FORDHAM DR COSTA MESA,CA 92626 APPL. Y/JIING ADDMFSS: AXCNRECT OM E1M�NEER. AIICN.OR ENO.'Si1UUNE55: IJC. NO.: UNT: UNT: coNm�crarswua CULLIGAN WATER ( 714 ) 750-2233 CONiPACTOR'SYYl1N0 1911 S MANCHESTER ���ANAHEIM CA unao.: 663091 92802 uxr: LICENSED CONfNACTONS DECLAFATION: I hereby eNkm unEar peneYy d perjury Ihel I amJ'rw�ued uMx pwidons d Cheqx 9 (wmmentl�q xilh SMian )000) d Dnision � d I�a Businep enE PMeesi oda. eM i yircerw'u'in 1 f1W.!e a�M eXecl. cmuc.tio.:005950 uc.cuss: C 55 /}� 6 91 ; 08 /97 d — % comrmJ—�� � N BUILOEF DECLAflAT10N: I hereby atfi'm uMer pen perN�Y �het I em ax Iro he Contretlan License Law la Ihe � resron ($epion 1031.5 Busneu eM Prdaeaiona : Airy cIy a couny e pa�mil lo canalriwt. ellm. imparo. �moleh, w repa'r eny aivciure. pnor to iis aeuance, ebo reyuirea Iha epd�� la il to fila a eyred sleiemam thet he a sha ., i���a w�� �o m, ao„��, a ma ca,o-aao� ���a. i.. �cnaw� e( ��e w�m sea�, �000l w owe�oo a ot ma Butinasa vM Prdesaiw COEeI a tlw he a Me's ezemq Iheraimm end tM tlr elbped miemqion. My vbW ion d Seaion )dJ1.5 by eny epplicent lor e permn eubpds Ihe applcaM to e avJ panelly d iwl mora Ihan live huiMreE AOAen �5500�). � 1. ee owiwr o/ IM properlY or my empbyees w%h wepae m ihe'r eda mmpevalian. v.ill Ao tM wak. eM IM al�u�Yure'o �wl inbndetl or MereC M aeb (Secuon )044. Busma eM PMaeaionaCade: The Comradwa Licenae Lewdoea rim eppyta en owner ol prope'ly wha buida or inproves Iherean, ud who Eoes suW wak Nmsetl a MneY a Nraqh ho a hm own empb�me, provided thm auch impmvememe ere nM inleMed a dlereE lor eale. tl, however, t�e buiNirp a impovemem ia edd wiihin me yeer of cwnpletun. the owrer-0uiltlar xill heve tM WrEm d po+irq M w ahe dk � Wik a im0� far IM purpoee ol eele). ❑ �. m mmm a �ne aowM. � a.aueiveM omveaiw wnn �icenwd camrec+we io wnnna me v�iaa cseeun roaa. eu.irian eiw Vroleaeiare Code: TM Comretlon l.icenae lnw doan m� apyy to en owrcr d qopeny who buitla rc impovae Iheraon eM wfio comrecla la euM prqeqa wiih e wmreUor(e) IkensaE punuent to �M Conlradore Liceme law�. - � I em axemp uMer Sectian: B. 8 P.C., br the reeaon: Date: Ormer: i m n�nr ��v �nm i� ew�a a�a ��d.�i.�e ina rea���am� a cda�r �.m� �,d sm�r cod. saa�,a asws, zssa3. d,e ?5534. aM thei I a enY �ure WilEinp attupent will / wil mt (acb ma) roeE b comply wIh aeid qele mdee eM iM mpuimmenb lar oma: nwi�'ax� WONKEF'S COMPEHSATION DECLAN�TION: I hereW elfirm uMer penelty d pe'jury ar d Ne Idbvrirp detlarelom: ❑ 1 heve aM wil meimein e cenAice�e d mnsenl to eallimure lar warken' comparuelion, n yovided ta b/ Seqion J100 d tM lebor code. �« �ne wnmrence a �ne.wx e« wnicn mis wm,il la iae�ee. . _ f] i nev. d,e wi� me�men wo�ten� mmre�.m�, �m�.eno.. e. naun.a M s«�:n s�oo d me �.na, cede. m, me w�m.�,ca d me 1C wwk la xfii A ihia peimM e roueE. My wakera' campanaation insuraice umar eM pdiry number ere: c��: ZURICH EXPIRES Po�ry N�m�= w�'i — 0 8/ 31 / 9 7 (liria settian need nw be complekJ d fM1e permA u Iw one hundred ddlera /$IDJj w hv.) /) � I mnM ihe� in ihe peAormerce d �M woM 1« which t�ia pertnn o uaued. I a I in empbyq��y � in em� manmr eo sv to cwne wbjae io �M xwken• campenemim la�x d 'r , ne e e in B I ey�Ald e wbjea to iM worken' . e mpenaalbn D�aqeu o/ Setlion �)00 0/ �M Lebor . I ghell 1 �hw' m wN rw r ore. Poe: U " Applc � W Inp: F�ll�n ro s�cvn woikxi eomperuetlon mvx l� un/ewlul, �ndLu ef �n wnplqw ro erlMiul pm�Mu uM NI flrri �q ro aro hundred fhouunJ JWMn (Sf00 A In M11tlon ro M� � n�vmxtbn, tlemspe� u pvhAstl br In Sxtlan ])P6 eI Ms Lebor Cotls, Intersat, entl attornsy'a /eew CONSTqUCl10N LENDINO AGENCY: I hereby etA�m uMer parely d perjury tl� IMre n e conelruclion bMi�p epency br tM parlormenca o/ iha v.ork 1« whirA ihe W�mY u'neuad (Setlion 309]. Civ. CI. LENDEF'S NAME: ' LENUER'3 RODRESS: I cen�ty Ihet I heve ned Ihis epplicetbn eM e�ma ihm Ne ebova inlamelbn iv cortaa. I�ree to comply wilh ell dly aM ooumy adlnenroe eM nme levn relqnp lo buildinp wnavunion eM hereW eu�hor¢e reyesanla�ivee N Ihis irly b emer upon tM ebove�memioned pmpeny ��� ���J�I AGU E �� o�e: ,�—`� 9� (5151�48.WP) WhileL�ildiq 83elely: araen-Fle: Canery-Appirani: Pink-Revenue: polEeneo�Avseawr CI1'Y OF COSTA MESA — BUILDING PERMIT PERM NO: P 081405 IPERMIT NO: P 081405 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU PURPOSE: REP JOB DESCRIPTION : INSTALL WATER SOFTNER SQ FT; CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHEA WORK AUTHORIZED BY THIS PERMIT if iF iE iF if 1E 1f 1ElE'lE 1E 1E 1E IE �E iE �E ik 1E iE iE 9E iE 1ElE iE ii 1E 1E 1E �f IE IE iE iE 3E 1E if 1F 1E 1E 1E 1E if if 1f !f if iE 1E 3E 1E 1f 1F 1FlF 1E iE 3ElE If 1E if if 1E fE jE i(- iE iE IE iE 3E 1E If �E 9f iE iE Z O N I N G R E Q U T A E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 43922149 ZNE: REF NO: PLANNING NOTES> i iE 1F ik 1F if ik If 1E 1E iE 1E 1E if if iElE if �E if if 1ElElE iE iE 1E 1FlE iE iF 1E 1f !E if if 1E if ifl6 iE if if iE 1E 1(� jf iF * IE iE 3E 1E IE 3E 1E 1E fE 9E'IF 1E IE �E 3F IE 3E iEl6 if ik if 1E iE If IE �t iE 1E 1E 1E D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: ` —11 iEiEif�rit+�*+tiE�-iE*ieifiF�-iEit*ir*it3F3FTF3F3F�F3FTF3F�F�F7F3FiFiF3F�F�F7F3F 3F�F7FiF3F7F'�FiF3F'iFTF�***i��x-�**i�* *iE \ LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 253 . SMIP/NON—RES PLAN ' ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 8.75 22.00 ,� 0.00 30.75 30.75 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OC'ER/SHORT: .00 BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.75 � 1E 1E fE 1E 1E IE IE fE iE iE iE iE 1F 1E IE!(� �F 1E iElE �E fE iE iklk 1E 1E fF 1E iE 1(� 1f� iE iE if ik fE �IE iE if !E!E iE iF iE iF iE fE if 1E if� �f iE iE 1E 1k iE 1E if iE 3E iE iE IE IE fF iF iE 1E'IE fE IE if iE fE {E!E iE if I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O.N UNIT �65T TOTAL COST IpLU 1 WATER SOFTENER END OF FEES � E.XPI' �� DATE 9� � 8.75 8.75 ���'�'�.` j `1 �,a� JAN�p1997 ;�. �iTlf GF CU5fA MES� CONSTRUC710N AND PLANNING �� - � PQ`' $ SPA APPROVA�S Permit # �Date Inspector � APpROVALS Permit .#. ' Date Inspector � 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2: Soil Pipe�Undrgmd. ..' . 53. Steel Reinforcement ' . � • � :3. Eiectrical Conduit�Utiiity�Undrgrnd. � � 54. Forms � �'. 4.� Electrical Conduit=Ur�drgrnd. ' 55. Electrical Bonding - -; 5r Steel Reinforcement� � ' 56. Rough Plumbing & Pressure Test - _"6: .Electrical U�ER,Grnd. 57. APPROVAI TO COVER-GUNITE - �,,�7:• Footings �''• ' � 58. Electrical Conduii�Undrgrnd. - -E Foundation " = � ` 59. Gas Pipe, i7 U�d�grrtd., Test � c. � 9. Water Pipe-Undrgirid. = � • � - 60. Backwash Lines; P-Trap; O Undrgrnd. ' -l0i Structural Ploor SYstem � 61. APPROVAL TO DECK 11,- Property Sewer Line & House',Connectio� � , 62. Backtivash & Receptor-Pinal 12. Sewer Cap + , �63. Heater & Vent-Final ' � 13. Roof Drains �, � � 64. Plumbing SYstem • Final . 14. Rough Plumbing- - , - ' � 65. Electrical-Pinal . 15. Rou9h Electrical-Conduit - 66. Solar System-Einal . 76. Rough ElectricWiring � _ 67. Fencin9 & Access�ApProval � 17. Rough Wiring Si9n ' � .68. APPROVED FOR:PLASTERING ` 18. Rough ElectricaGT Bar Ceiling , •" �� - '69. POOUSPASYSTEMS PINAI t9. Rough Heating & Air'Conditioning � F1.RE pEPT. REQUIREMENT r, ,. - n 20. ,Rough Fattory Fireplace ��„ � . :� � _, ,�. � _ APPROV�AL5yF Permit # '� ~ 21. Ducts, in-Structare? � •• - _ � _ � •- x ' 70. _Underground Hydro ' - n- < 22. Ducts, Ventiletin `.. � 1"~ �-� t-� .� 9��r . q c��. 71. ProductPipingO�Gas �0�1 23. Gas Pipe+Rough & Test '_ • T Jt � 7q, Underground Piush • - 24. �Roof Framing - _�� ' ` � - � '� ' _,� '. 73, Undergrnd. Storage Tank� � Gas ❑ Oil 25. Roof�Sheathing - _ � . �r. � � 7q, pyerhead Nydro _ � 26. T-Ba� Ceiling (Structural} & Monocoat �'. , i, =� �1 � 75: Ory Chemicai _ � " � � 27. �F.rame and Flashing, =- - � 76. Dry Staridpipe ��� � ' 28. Latfiing & Siding'z' �'' - ' �� " `'.,`: 77; FIXED SYSTEM=F,INAL ^ ,- �i; � 29. insulation �:� � • ' 78�, FIRE-PREV.FINAL �' x ' 30i Drywall Nailing '' � . � , - �--HEALTH DEP.T.`REQUIR�EMENT 31�. Plaster Brown�CoaY�. � . +� 79, FINAL I�NSPECT_�ON ' 32. Electrical Power Meter�Final °� `� 8Q. FOOD CER7IFICATE ISSUED 33. Final Electric� -r _ � . Notes �b'C�% -�' ^(�;. RCC� SS _ Q �/ 34. Final=Heating & Air-ConOitioning= � ' i � � = - - " _ �r � x ^' , y • -�-a t 35. �Final Gas�PiperTest� :, y ,' , _ �'� •. /�a'j � - _. _ . • : . 36. Hood'or CanopY - � - - _ .� . .. . ^� - . � "� - - � i - r r' 37. Final'Factory Fireplace �_� _� i� � ��: - . Y ' 38. Final Plumbing - ' ' - - � - , i r 39. Water Service-Fina� ; - :- �. , ' ' .. - 40. Gas Service-Finai - ' . ' � - - � i r - 41. Sotar pomestio-Fi�a� - _ � .. _ ` , . _ _ 42. Backflow Preventer � � i _' � < - - %�: �' � _n 43. Backflow Irr�gation . --. - - # S � � ' jc�•= �'"'.i ri_'3+ �� 44. landscape irripation System= . - - - �� ' - � �` _1 „ - - .t �45. Sound Atteriqation' a .. . ' `- - .' � -� ' � � _ '. � ^- _- ' ;' _ � � - �: .� 46.HandicapRegulations � - Y� = = t"-� � , � 47. F�NAL STRUCTURE & BUFCDING . � -� �' -� ._ � . •'� -- LS• - 48. FINAL PLANNING - � � � � � ' ' - �'+�� "' - - ��v. 49. Elec[ric Release to Edison � ;�. , � \. ,. ' �50. _Gas�Release to Southern Catitornia Gas Co � • - ' - �• - - • � � � 51. CERTIFICATE OF OCCUPANCY - � • " r' No. Date J "� � , � _ oG�'7 0V0 P' _ . - ; OG���anl to fill in all s aces extepl those within heavy Do�Ger lines antl si n all a �� � P 9 ppropri," 4clarations. CITY OF'COSTA ' �CONSTRUCTION'PE�RMI� •, , PERMIT NO. � .TRACTn{�. � LOT NOs !UNIT � � � . � ; '. ; � ;0515 q I ��,0/B% , 'I %.00 � TL•� � ' % a-�`6� ��� 7rJ �;.`'� � , , Prqect Address� � --��' �'� � lY! - ' , . . , � � ' ' . ApplicanYs Mailin � ddress � ' . ; . TVPE OF CONSTRUCTION ! NEW� �AOD A ERATION . gePt�lg � ' � �/��-�� I/ . O CONVERSION ❑;DEMOLISH ❑ OTHER ��L �H'¢Q 7'��e/ . F,` (} � � ��7'i� 2 (iY � ` ' _ '_..... _ '_ _" . A.P.4k. _� _ i._�1-�-1. };`_t57-=" u� ._ : , 1 ' Zone �. Owner's Name • , I � Phone a,�CL - �-- -' - - — - - i � - � � ' DESCFjJ�PTION OF. WORK/USE OF BLDG. • . � � . � : Addreu ��: m Q=l �,; f=- c ���. • runson v�v `G✓a.- E Main Building: � � ` � ' ; Accessory Building: ' Z Arch/Eng. � LicenselNo. � ! � TVPEOFPERMIT .OGRADIivG FO NDAT�Orv STRUCTURAL � ' T Pront� 37 � ' ' � � ' � O y� Addre52 ' '. � ^ 4,' • � ❑ TENANT • 0 ELECTRICAL � ❑ PLUMBING ❑ MECHANICAL , . 6 Reaf . ' � � ' � , ' - N � � � ' ' Q OTHER ! . : . . , ; . A . � ,i � � � Contractor's Na�me '� • - � ' Phone � "" . . ' - - ' � �- — '� - - � - Address (maiiing) ' ��t+ ' � � � � PROJECT DESCRIPTION � SB-FF �"�e'L ' OCCUPANCY '1 � K RighY - , . G ��CONSTRUCTIONTVPE ' ' VALUATION�$ � -S Ceft , � f 1 � Ciry�License No.�. "� � � � � . ZpNE � GRAOING CU. vDS.. � � ACf3E5• � � p�ng. Ref. # ' � Parkin Re /Provided R LICENSEDCONTRACTORDECLARATION � � ' ' ' ' ' •.. • � ' � ��� � q, ' i . E I hereby aftitm,that �I am licensetl untlei provision5 ot Charter 9(commencing qemarks: � �� ' Planriin NOt25: � 4 � � ' � � n with'rection �000)pt Oivision 3 oi the Business;antl PrOf¢ssions Cotle, antl � V' ��' - 9 %S� �'�'•4C.: ��J.�.4a1 ! M my license is in fuu force antl efieci'. � ' � ' . , � i ` - � i � � - . = - ^ � . , ' � �' T License Class ' License No. . - S Date Signature � ' � � .PLUMBING � FEES� V � � � ; i � 't. � � 7 � � _ �,-�YORKERS'COMPENSATIONDECLARATION ' � ' BarSink, �+ , � ShOwers ' � � ' ',i�`C,aereby affirm tnat I�have a certiticate oi ronient to zelf-insure or a<ertiticate ��� � . I i � . �'� :EL'ECTRICAC . . ' � FEES . Workers' Compensation Insurance, or a ,c¢rtifi¢tl copY thereot (Section � , . � ' � � � '��SB00, Lab. C.)'� . { . . . • Backflow Preventer � Service Sink � � _ ' AutomatiqWasher' .- Transformer ❑ 15-50 KW ': - . � Policy No: � - 1 Company - � ' Backflowlrrigation' � - SewerCa � � � � ; � �- .� 50+KW ' t e Certitied w � � � , P' ' - - � Construction Pole Sub. � -. � � py�is hereby;turni5hetl. Certifietl cobY is filetl witn the dty Builtlin9 Divislon, Bathtubs ' Sewer Connection . -� Cooking'UniY �. M2terv �up to 100 amps �. , Date' � Applicant � � � . � . _ ' - '- � ' � ' EXEMGTION FROM:WORKERS' COMPENSATION DECLARATION' � Cld�ifi2R � � , . S013f COII¢CtOiS ' ' " Dish�N25h¢� • �_ M2Leq Oover 1�03 � 5 (This',section neetl not be completetl if the permit i5 to� one huntlretl ($100 or � , - ' �' ' '' � less), y,,� -� � ..y , � Dishwasher � ` Solar Piping Dryers OGas ❑Electiic , Su6 Panel ' � '� ' ' ' I certify that in the performance of the work for which this perm�t is issuetl 1 ��� � ' shall not employ any �perzon.in any map r o as to become subject /t� t{�e Drinking Fountains - Solar Tank � Fan ' � � , Motois -1 HP 01'f., 8 ' / Worker� Co�npen�aj� Lawrof eali`or ! �'�,�A nl.1�01�nIXC . � � _ . � ,. " . . '� V Date '-� 1�� d ��"Si9nature -�-----.-'--- �--- Floor Drains : Swimmin ol w/Spa F.A U. Inc� olar 09-15 HP �76-75+ NOTICE:Jf,atter,making tnis tlecla�atlon, yo OWtl.berome.subjeoTto.the � _�� _ Workers' Compenmtion provisions-o( Ihe l.abor Cotle, you must forthwitb PIoo�Sinks � Urin • Fixtures ' � <omply with such p�oviSlons on titisl permit Shall be tleemetl revoketl. icrow2v¢� j • CONSTRUCTION LENDING AGENCV � ' � ' �GaSS¢NiCe � �Ou[IEtS at¢�C1052t � � , - I hereby affirm that there is a construction lentlin9 a9ency for the performance . ' ' I Device Boxes ' i Pp�y �ight � p of [he work `(or �whiGh this permit is issuetl (Section 309] Civ. CJ , � � - - ' Intercepmrs � Water Heater � Outlets �\ Lentler's Name , , ; � � Range � : Lentler's Atltlress . � . .-, Kitchen Sink . � _ ' Water Service - - - . . Switches � - - 'Sign" ' � '" " � �' ' - �'\ � OWNER BUILOERIDECLARATION � � I he�eby Sf(irm that I am exempt trom the Contractor's License. Law for tne Lavatotiei ' ' Auto-Wash i Garbage Disposal � ' Standing Sections � ' following'reason (Section 7031.5 Busine55 antl Profe55ional COtle: Any city o� county which requiras�a permit to cons[ruct,�alter, imp�ove, tlemolish or repair P-Trap ' LaundryTraYs • Generator 5 KW �5-75 KW ' any st�ucture, prior [o i[s issuance; also���equires lhe applicant for such pe�mit ' TfdSh CORIpaCtO� to file a signetl statement that he/she is Iicensetl pu�suant to tne provi5ion5 of Roof Drai � ' � � the Contractorts License Law (Cnapter 9(commencing with Section �000) of � � ' - � � Division 3 of� the �Business antl� Professions� Cotle) or that he/she is exempt - - -- �� - � - - -� - fheretrom antl the basis for the allegetl exemp[ion. Any violation of Section � , � . ' ' � ' " 7031'.5._by any applicant for a permi[ subjects the applicant to a civil �- - � � _ pendlty-ot not moie than five huntlretl tlollars ($500). . , � � . � • 3 � � i ' ' � � ' � I; as� ownei of ther property or my employees with wages as their sOle R¢inSpeGtian Fe0 � $15 •� � : ISSue F80 $, � � _ � �' compensation,�will tlo�the work, autl the structure is not intentletl or offeretl Reinspection Fee $15 Issue Fee . � �$ 3 ; tor sale (Se<tion-Z044,�Business antl Professional Cotle: The Contractor's ' MECHANICAL �FEES � License l.aw tloes not "appty to an owner of a properfy who bulltls or improves � � _ � � thereon, antl who aoes such work himselt/herself or tnrou9h his or her own , � � DEVELOPMENT SERVICES R QUIREMENTS: , , �� employee5, provitletl that such improvements a�e not intentled or olferetl tor . Boile� � HOOd O� Typ¢ I ❑ � / � �'O ' sale.df, however, the bulltling or improvement is soltl wi[hin one year of com- . , . Canopy Type II ❑ � ' Zoning Approved By '� L ° Date �7 -J� � pletion, the owner will have the buraenbf proving he/she tlitl not builtl or im- � Duct - Under Ground , � Building Approved By Date �'aV+� �rove fo� the purpo5e of sale). i � - � . '•I; as owner'of the property, am exclusively cantracting with iicensea.can- Duct-S[ructural Refrigeration S m. � - APplitatian Issued By � Dat �- t�actors to construct the project (Section 1046, Business antl Professions Cotle: . � Tne contractor's. License Law tloes'not apply [o an owner, ot-property who � Duct - Ventitating � , . ❑0-100 , BTU ❑100,000 BTU . - � SUMMARV OF'FEES ^ ' � builtls or improves�thereon, antl who contracts for such projects with a�con- ' - '� � ' :'�� iractor(s) I¢ense pursuant to the Contracror's License Law). I am aware mab � i Exhaust System ❑ Multiple ❑ s[em Repair/AI[¢ration � : BUILDING PERMIT $,. '�� 'd� . SMIP �'$ � � �� � oof of thair Worker's Compensatlon insurance shoultl be provitletl to me. '" - " PLAN CHECK �$� C� �5�� .�PERMIT �� � I am exempt untler Section ` e. & P. C. for this reason: �-;� Firepl/Fact 81t.•ICBO # � Fire Dampers . � PLUMBING "�$ � �SSUANCE '.' $ �� _ /' oate - • -7 O ~ � � Heating System & Ducti . ' Registers� • ' . � ENERGY P:C.- $ - � f � - - PLAN CHECK 25% �$ � _ I nereby certify that I have reatl this appli ion antl state that the above. ❑0-100,OOOBTU O,OOOBT '- ' GRADING� $ � information:is correct/I agree'to comply with all city antl counfy ortllnances - ' � ELECTRICAL ' $.. � '. ana state laws relatin9•to tiuildin9 construction, antl hereby authorize repre-` ' � ' � ' ' P,LAN CHECK 50% ' MICROFILM � $ �^ ' ' sentatives ot' q�fl Cit to = nter u on the �abq ve-mentionetl Proper[ fot , ' r � 1 .$' . . inspectlon pur�6 fs. /�,� �IP�/p�,,,� �/ �� '�/'���% � � � � � ~ � � MECHANICAL. $ TOTAL FEE $ � �' Siqnature � V `"��'� • ^' \ Date!�X.4L"_L .- , . . � . 'Drivers' License o'r 55 ; ' ' einspeetion Fee $75 � � ' Issue Fee � . � $ 3 PLAN CHECK 25� $ ' � ' . ' ' � — CMF 0865-46, rev. 30%84 Whi[e - Buildin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor � � CONSTRUCTION AND PLANNING POOL & SPA. - �� '� APPROVALS Permit #� Date .Inspector AppROVALS Permit # Date Inspector ` 1. Temporary Electrical Service'or Pole - � 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. " � • . 53. Steel Reinforcement , � 3. Electrical Conduit Utiliiy-Undrgrnd. 54. Forms� � . 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding •t 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test " 6. Electrical UFER Grnd.. � 57. APPROVAL TO COVER-GUNITE � ; 7. Footings � . � , 58. Electrical Conduit-Undrgrnd:. " 8. Foundation � - � 59. Gas Pipe; O Undrgrnd., Test� � ' 9. Water Pipe-Undrgrnd. .� � - . 60. Backwash Lines, P-Trap, � Undrgrnd. � . 10. Structural Floor System •�- � . . 61. APPROVAL TO DECK ��. � � 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final • � 12. Sewer Cap . � �� 63. Heater & Vent-Final • ' ` � 13. Roof Drains . � 64. Plumbing System - Final . � � ' 14. .Rough Plumbirig 65. Electrical-Final � 15. �Rough Electrical-Conduit .. 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � ) 19. Rough Heating & Air Conditioning � . FIRE DEPT. REQUIREMENT ' . 20. Rough Factory Fireplace , APPROVALS Permit # _ , 21. Ducts, in Structure 70. Underground Hydro �� 22: Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72,� Underground Flush � .(+, � 24. Roof Framing . . . �73. Undergrnd. Storege Tank O 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. 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 Irrigation System - 45. Sound Attenuation . 46. Handicap Regutations 3� !� � � � ���` ' 47. FINAL STRUCTURE & BUILDING �- �- �� �� 48. Special Requirements Completed 0,� pC,ip��_-�. v .� 49. Electric Release to Edison �1 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY � � No. � ' ' Date � � - I Cement Coping Optional -� Cha�nelBlock With 7•3/8� Horizontal Top of all Fences For Fences 5' or Leu Vert. Bars 3/8" � at 4' -0" O.C. For Fences Higher Than 5' Vert, Bars 3/8"� at 32" O.C. Fill Cells Solid With Grout W here Steel Occurs Reinforcing Steel Shall Conform to Sec.A-15-39 A.S.T.M. All Steel to be Lapped 24" of to Cod¢ NATURALGRADE TWO 3/8"� BARS � CONTINUOUSTOP & BOTTOM AORIZSTEEL MUST BE TIEO IN PLACE AT TIME OF TRENCH INSPECTION. T Y PI CAL 6�� CONCRETE BLOCK FENCE x � � w x z i� w o U F- 2 7 ' d p N oA I—I D IJ_1 F�-WIDTN p SEE CH� 9 BELOW D' I 'e. ING REQUIREMENTS CHART ; GENERAL- NOTES MORTAR; pne part Plastic Cement, ond Three Parts Sand GROUT; One Port Cement Three and One Hulf' Ports S�and COPING: One Part Cement, Three Parts Sond CONCRETE: WQI I Mited t:2- I/2: 3- I/2 Max. of 7-I/2 Galions of Wafer Per Sack of Cement GROUT MAV BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLSAND AREASOF HORIZONTAL REIN- FORCEMENT SHALL BE CLEAR, CIEAN & FREE OF ALL MOHTAR DEBRIS, E7C. H OF EARTHTCOTH �/3 TME HEIGTH Of FENCE �OW �BOTTOM OF FOGTING. SCALE: I/2��= I' W I D T H . . . . . . . . . . . 14" . 14' . . . i . 12'� . . 12'�. � ...___.._. . : : TNICKNESS . . . . . . 10° . . . . . . . . . . .10° . . . . . . . . . . . 8". . . . . . . `. . _ . 8'� ' DEPTH OF EARTHTOOTH . . . 24" 20" . . 16° . . . . . 12° SPACING OF EARTHT00 12' . . . . . 14' . . . . . . 16'. . . . . . . . . . . 16' OWNERS NAME. � .1.. Q[l.S �� , ���__ _ City of Costa Mesa Californio JOe Ao°RESS �_ a _��.. �yr;� ` � PERMIT NUMBER'_� n_ �( Building Department SIGNATURE \.`�/�( �,[�1p- — _ - _ t�v" x - �.y.:a i.._-�-�.._._,.: �YI`�ED NOK82 1; !�; ;�' i. � ' i , : : �; ',: i.. � aoramtsa City of Cost� MEsa Builaing Dept. BY ��_____ C;�iE.l,l'Q� 1?_$� THESE PLhPdS Fai y..- �x r:h� i�^�n r,,' !.! I TiAS�:�.i T.:,�.KE NO CH�W�ES `.......,;i ;�:',^..R :,. ; �7�`rni Cr D[��i. iHi{ISSUp•.:�=Pf,; -. .- -.- cpv�,�; �,;.-,R�;".1CF PLANS CN� . . . . � r., .2D Tfi dF 4 Pcfidllt rC^.�: , ' _.d: � ,. '��l :' iF nP.r OF 1'HFPRO"tit^,.�°• .� � , . • �...� :u4C:GT7i�lYc' PUiNf�e;i�' 1.' '.;i .. �.i:. r�e'c_�, .,[ c;:'-;iil��l•�5 OP INiS CGCr., Sh'v=t� ! E vf._,:. F: L.E7 i;� �:'rra: Ai iHE N'6RK O.4 U5; I WHI:�; iT :�i�;:-J;','.iES 6 :i:\i'PI,L. T42 IS`sJ�JaCE CF A. ^EdfdS! 3P°FO L�GN PtANS AND SFcCIFIC: iICiVS �H4U. hOi rR°�.'F:�f r. � cU tC�hG Utf'iClnl FRO.`A TliEF.E%FTCF• fiFi7vi41r.r. TH: Ci..2R:C!ICn �.iF `cRPO£5 IN SAID Pik;S FVD 5!'EOfI�AT�OriS Ck lkq;t� FREVENiING ?UIL'JING �PEkqTIONS oE1Nu CARR7fD ON iH'.REUNDER WHEN IN V;p�qT;ON OF THIS IOUE OR G.' AN'f CiHEn ORDIhAhCE OF i`IE iliY. ' ' � i3aals 7�N3016iY �,.��.���� �.� _ ��� 9DM701Y3Y STRUCTURAL APPROVAL ONCY SEPARATE PERNITS ARE RE�UIREO FOR ELECTRICAL, PLUMuING, HEATING, VEN71LqTING ANO REFRIGERAiIQN WOR�( 5`�i'���i� ;'� ��� 7HIS NU!:9^.P, h.4U$t ACf.O�"?ANY Al: ItV5PEG7(0?; RE,7UESTS FOn EUltrqfJf,S ti';!E'c PEFSCNS AHE Tp �E Ei•.4F�lUYia, U�E SUpGEtiT 1'Ht;i THE S7�iE OF CPdiFQRld�A JIVIS1pN �^.f R�UUSTHIAL SpFEiY 8E COTltili�qgp fOR ACJ�110NqL flEU01AFME�a i S. 77M7C147tl flNltiM�ld �O 101?3i1G '�8_�_�'31VU S��19 �'J3E '1d30 ''Jdl9 Ol 1}7f9f19 � '1d34 JNINNV'Id �' VS3W V1�0� �� � ��O�d� � CITY OF COSTA MESA BUILDING DIVISION OWNER•BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner�builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provid,e,fhe major labor and materials for construction of the proposed property improvement. $I Yes ❑ No 2. I av have not) signed an application for a building permit for the p'r ed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( � Contractor's Lic. No.- 4. I plan to provide portions of the work, but 1 have hired the following person to coordinate, supervise and provide the major work: Name Address Phone Contractor's Lic. City 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone � Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowled ,' complianca ith this State law. Signed: ����2�-G Date: o`��� _ Name: �A�4 id r�'�S�i YV1 I P (Printed or Typed) C.D.L. #or-S.S. # �� CMF 1OG246 7545273 � � � �� OWNER—rO5t8 MP98 FBtBtES DATE 4-12-56 . JOB ADDRESS 2326 Fordham Drive BUILDING PERMIT NO. 26�3 GENERALCONTRACTOR �VBn–SPZeBel C'O VALUE $ 11fZOO.00 �. !�3 e�ocK rRacr 27$0 Single Res.w/att gar GROUP I&. J TVPE V ZONE �-t FIRE DISTRICT 2665 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR _ _ _ DATE I NUMBER Foundation Forms and Grade to G Rough Framing ,YvI Plumbing, Rough to SIa6 . y� Plumbing, Rough Complete � Temporary Pole Wiring, Rough Heating, Rough Heating, Final �wer, House ( Sewer, St. E �^TankorCesspool 1 ig, In Outx � 'S O ' S e! d- � 3.s 3� NO 1 6 1956. -i3-.fL Gt/aK— Plumbing, Final, Fixtures Complete /�'��}S �/'- f�,5; 7 � Plumbing,Fin,alGasTestl,r /�i/}S ,��/�5'7 i ,�j � Wiring,Final MAY 1 �95T VCB - _ Occupancy ����' S �',S � FOFM 210 9M �0�93 ' - Costa Mesa Bnilding Department I_ r�"" >. . 171 EAST 20th STREET � ' COSTA MESA. CALIFORNIA �, FOR APPLICANT TO FII.L IN � Costa M earest , /i f Cross St ll Owner rl7%�- �� Mail // Address �.1�. K- City F'i ��i� Arohitect o ,y�, Enoineer /%T-'V�� California � �� ���%f,�-% � . � f7,r' _, Contrector'JT-�4'✓���C�L`� i�� No.%7i� Address ���'�1.. CG�. I, y� lj,� • L� �j (Attach Metes and Bounda) :i/ Q :/ SizeofLM O�X/C1 � I Use ot I Existing Bldg. SetbackLinefrom �.^��� Center of Street V DESCRIPTdON 1 New f7�Alteretion Repair I I�MOVing auildin9 3�K �� No.of �e Room! terior Wall�- /� Ri Coverinq %%UC- � Ci No. of Bldgs. Now on Lot No.of No.of F�a'milles Rooms Stories I hereby acknowledge that I have read this Application and state that the above is correct and agree to compiy with all CIty Ordinances and State Laws regulating building construction. Signatureof �/ �������"�� Permittee % AuthoAzed Agt. c�/�('i ��%L���iGj Valuation Pe�mit Fee $ �-�'� $ , // �� Plan Check $ -� Total �f Fee $ �S -� AM 204 S-BP 2M 8-55 PLICATION FOR PERMIT 2��� BUILDIPIG ' FOR OFFICE USE ONLY ; " - _ Receipt No. _ Permit No. i ' �(o'SL � Received by. Date Ree'd. Date Issued /a-�'' ,(G-i� �G 5�-/i��1� Address Costa Mesa, California APPROVAE,S m Location Inspecto Materials, �inning ire Stops, Date