HomeMy WebLinkAbout2299 FOUNTAIN WAY - Building Permits� �
, l CITY OF COSTA MESA • �
o�p"'F, BUILDING DIVISION
F�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.wsta-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
'�Ar,o.mca'F
PERMIT NUMBER: B10-00151
PERMIT TYPE B_ROOF2
APN: 93074057
JOB ADDRESS:
Vicinity: BLDG A
Squares: 2000
STATUS:
DATE ISSUED:
ISSUED BY:
2299 E FOUNTAIN WY CM Suite/Unit:
Valuation:
ISSUED
OS/2812010
KJB
$5,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF. RE-ROOF WITH BUILT UP ROOFING. INSTALL ALL NEW FLASHING. APPROX 2000
SQ FT.
OWNER: SCHROEDER WILSON ASSOCIATES Address: %GRIMMWAY MANAGEMENT CO Unit: SANTA
ANA, CA
PHONE: City/StatelZip: 1526 BROOKHOLLOW DR # 82
APPLICANT: GOODGAME, JACK
PHONE: 714-840-1626
CONTRACTOR: SIERRA ROOFING CO
Address: 5132 AUDREYUnit:
City/Slate/Zip: HUNINGTON BEACH, CA 92649
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$o.00
$111.25
$0.00
$1.00
Address: 5132 AUDREY Unit: :
Ciry/State/Zip: HUNINGTON BEACH, CA
License No.
License No.
PHONE:
License No. 511172
714-840-1626
CELL:
PHONE:
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Montlay thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thm 6:00 pm. Prohibitied all hours - Sundays and lhe following Federal
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
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 authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final appraval must be obtained. Failure to obtain inspections and final approval will resull in the expiration of this permit.
C OE / INSPEGTONTVPE eR F, IN7111R15 CODEi INSPEL710NTYPE DRTE Ni nnus
1676 Fixed System Final Fire Prevention 206 Final MeUanical
1286 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 6-q "/o br 1�'���z„� 210 Final Electncal
201 Final Block/Relaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 FinalBuilding/Occupancy
�
WORKERS' CqMPEN3ATION DECLARATION:
I hereby aKrm untler penalty of perjury one of the lollowing declarations:
❑ I have and will maintain a certi(cate o/ consent to selFlnsure for workers'
compensation, as pmvided (or by section 3700 of the Labor Code, !or the
peAormance ot the work (or whic� this permit is issuetl.
C��have and will maintain workers' compensation insu2nce, as reQuired by
6ecta� 3700 of the Labor Code, lor the peAortnance of the work for which this
�pertnit is issued. My wnrkers' wmpensation Insurance carrier and policy
number are:` n �'; r.
C�a-�mase..r�: • > �/T / /. � �t� ��
,,,1s sepun neetl rw16e mndefe0 dlne pe�m4 is valueE af are nunOretl �Ilars (StOpJ a less.)
�Y N�m��: oo,� 3G / 3-�oo S
❑ I certify that in the pertormance of the work for which this pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree thal if I should
become su6ject to [he vrorke s' compensalion pmvisions o( Section 3700 of
t Labor Co e, I � I foh � h comply vnth ihese pmvisions.
S �a�-/O
- . Wni's, Si00 lure l -^no ��.
%
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
my license is in full fo^rJce�aJnd eflect. /� �/ �`
�'�_",.�IG:.#� /� / l/ Cla TS #'yrl� � i /
7 Z $��Q
��Cc`ntranor's�si� ure '�Data--"
CONSTRUCTION IENDING AGENCY:
❑ 1 hereby aKrm Ihat there is a constructbn lending agency for the
peAormance of the wurk fa which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre
Dale
OWNER•BUILDER DECLARATIONS:
I hereby aKrm that under penalry of peryury that I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW lor �he following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit ro
construct, alter, improve, demolish, or repair any stmcWre, Drior to its
issuance, also requires the applicant lor such pertnil lo file a 5igned stalement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Seaion 7000) ot Division 3 of the
Business antl Professions Code) or thal he or she is exempt therefrom and
the basis (or the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecis the applicant to a civil penally of not more than
five hundretl dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcture is not intentled or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply to an owner of property who builds or improves
thereon, and who does such work himself or hersel( or through his or her ovm
employees, provided that such improvements are not intended or oBered for
sale. If, however, the builtling or improvement is soltl wit�in one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS ro consWct the projec[ (Sec. 7044, Business antl
Pmfessions Code: The wnt2ctors License law dces not apply to an ovmer of
property who builds or improves Ihereon, and who coN2cts for such pmject wilh
a contracta�s) license pursuant tothe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre Daie
305]a6 (3/0])
�
Owner ID verifed by driver's license. ❑ Yes ❑� o y
Oriver's License No. Expires:
Veri(cation of Ovmership by (rype of tlocument, i.e. - pmperly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY 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 matle in connectbn with work authorized
by this permit, antl that no building strucWre, scaffdding, falsev.ork, a demolition
or dismanUing Ihereof, vnll be more Ihan Ihirty-six (36) teet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administ2Me Cotle).
❑ As ovmervbuilder, I will not employ anyone to do work which would
require a pertnil from the Division of Industrial Safety, as no[etl above, unless
such person has a permit to do such work fmm Ihe division.
Appli�nfs Signature
Division of IndusMal Safery Permit Numher. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or fuNre building occupant need to file and
certity a Business Plan for emergency response to release or threatenetl
release o! a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of ihe Califomia Health and Safety Code requires, with some
exceptions, that a Business Plan be 61ed wilh the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantity of hazardous materials equal to or greater ihan a weight o!
500 pounds, or a volume ot 55 gallons, or 200 cubic (eet of compressed gas
at standard temperaWre antl pressure).
2. Does or will the applicant or present or (uNre 6uilding occupant need to fle
a registration (ortn for acu[ey hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health antl Safery Code, vrith some
ezceptions, requires registra[ion wi[h the Cosla Mesa Fire Depahment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Sa�ery Code provides that the
Costa Mesa Fire Department may require the preparalion, certification antl
filing with the Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials wi[h lhe Fire Department.
4. If an RMPP is presently required, has Seclion 25534 of the California
Health antl Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the apDlicant or present or (uture builtling occupaN require for
lhe work which is the subject of this application a permit for such conshuction
or modifiwtion fmm the South Coast Air Qualiry Management District or from
any other air pollulion control dishict or agency? ❑ Yes ❑ No
(SecCpn 658502 of Ihe Califomia Govemment Code requires Ihat Ihe requested
infwmation be fumished on applicatbns tor non-resitlential building pertnits).
6. Will any part of the faciliry to be cons[ruc[ed under [his permit be within
1000 feet from Ihe outer boundanes o( a school? ❑ Ves ❑ No
pf yes", the facility must meet the requirement of Seclions 25534 and 42303
of the Califomia Health and Safety Code).
7. If a permit from the South Coast Air �uality Pdanagement Distnct or other
air pollution control tlistrict or agency is required for Ihe work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropnate air pollution
contml oRcer).
CERTIFICATE OF COMPLIANCE: I certify [hat under penally o( perjury the
infortnation given above is cortect I agree lo comply with all state laws antl
city ortlinances regartlinq Hazartlous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalry of perjury that I have read this application antl state that
the intormation given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, antl authonze representatives of
the City of Costa Mesa to enter upon the aDove-described pmperty (or
inspection purpose5. I agree not to occupy or allow occupancy o( any buil0ing
authorized by this permit until final inspection.
Sign e ot L a eqs Dapie �t
� �.��0 �� V
AnE/wA I�otlzeEApplica 1 � �`�;Dale_�„-
ntial Alterndians
Nnmc: 0
� ���
�.e: Kesidenti�l
Z.one N
CF-IR-ALT
N of Stories
� Onaaue SuC1�Bce Details iur tl�e furred ourtioned of Mass N'alls sec Furrin� Strips Consvuction Table below. �
7a�;/ I Assembly Name
ID� orTvoe�
Material
and Size�
l. Fw� Tng/!D indicaie ihe ide�ati�ca�iou name
G F G
ondurd
Framec
U- 7A4 Table Caviry
'actor" Numbers R-vzluc
a�ee Pagc Ji14-3 and Eqrmtion 9-!. F
Assembly
?. b�dicate �he Assenvbh� Name or rype: Roo(/Ceiling, Wa!ls, Floors, S(abs, Crawl Space, Doars and etc...lndica�e the Frame rype and Size.� For
N'ood, Metal, Meta! Buildings, Mass, emer 2z4, ?sG, or e�c... see JA4.for o�her possib(e.frome type assemGlies.
3. En�er !he thickness (a� maas irr inches m' Spacine benveen jraming members enier; ]G "m� 24 "OC; ar O�herfor al( other assembf�� descrip�ion
such as Concrete Sandwich Pane/, Spandre/ Panel, Logs, StraH� Bale Pane! and etc.... _
9- Based an die Climate Zone; enter the S�andard U facior fi�om Table ]5J-B, C ar D for each d�erem assembl�� Name m- rype. .
5. Enter the Table number Iha� closelr resem67es dve yroposed oxsembh�.
G. Ln�er Ihe R-nolue diai is being ina�ta((ed in Ihe wall coviq� or belween tfie (•amirtg; odrenvise, enler "0'".
7. En�er the Conlinuaus Insulaiiar R-value%r the proposed qssemb/J�; otherwise, emer "0".
b', L• n�er ihe row ond colunm o/�hr U-faclor valve based on Co(umrr F Table Number ond ettter Ihe Asaem6fy U-(aelor in Cofumn J
I. The Propnsed Aa�e�emGlr U facmr, Column J, musi be eqtml �o or less than the Standard U-foc�or in Colunm E!o complp.
Fun�in � Sirips Construction Table for Mass Wulls Only
A ]t C ll C F C H 1 .1 K L M
Proposed Yruperties uf Masonn• nnd Cuncretc pilded Interior or Exterior Insula[ion
N':dls rrom Referentt in Furring Space frum Reference
.luinl A i eudia Tablc 4.3.5, 4.3.G. 4.3.7 doinl A endix 7'able 4.3.13
_ `G — >. � '
v � o� � a� ; v
✓ ,� � „
ASSL'111hI�' L� � �`.� F' v c` d,`� �eu :°'o Final
Muss Nmnc or JA4 Tablc - v u= E R o �? , o_ � o ASsemb�y
Thickimss' T c' Numhcr ��` ��� � LL 3 � c �=` � r U-factOrL'� Comment
I
I I �
Regi.struiinn Number: Regisiraiion Uaie/Time: HL•2SProvider'
20bb' Rea�identinl Complicuice Fornat �lugusl 2009
of Compliance: Residential CF-IR-ALT
Project Name: � Climute Z.onc # �# of Stories
ROOFING PRODUCTS (COOL ROOFS) §I57(pl1
When (he aren ojrx�erior rnojsurJare !n bc replaced exceeds more lhau 50% ojtHe exis[ing roojarea, or more tl�m� ],000 jr, �vhichever is
IPT!'� llie neiv roofing arcu uurs! nree! 1he roojtng producl "C�rol Roof' requirexrenls oj§I52(bJIHi, 151(bJl Hir, or 152(6f IHiri.
Check applicable a(lernntive or esceptia�� be(ow if (he raof alieralion is ezempt jrom !he roofing produc� "Cool Roof'requirements. Note: IJany
one ojthe a(�ernatives or excep�ian below is checked, �he Aged Solar Reflecmnce and Therma! Emittnnre requiremen�s for roofing produc�s in
,¢ 8(i) are nor app/icahle. Do na fi!/ mble bela��. �
Cool Roo(s N�t Required in Ciimate Zones i-12, I4, and 16 wi[h a Low Sioped. Less or 2:12 pitch.
❑Cool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 516/ft�.
AI[ernatives to §152(b)IHi and §152(b)Hii, Steep-slope roof (pi�ch > 1:12)
D Jnsulation wilh a thermal resistance of at least 0.85 hrft' °F/Bhi or ai least a 3/4 inch airvspaee is added to ihe roof deck �
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to § l51(� 10; or , _
. O ln climate zones 10, ] 2 and 13, with I ft''. of free ventilation area of attic ventilation for every I50 ftZ of attic Floor aren, and
where at least 30 percent of the free ventilation area is within 2 feet venical disiance of the ronf ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has Iadiant bartier in the attic meeting the requirements of §] 51(�2; or
❑ Building has no ducts in the attic; or
❑ 1n climate mnes 10, 11, 13 and 14, R3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hiii, Low-slope roof (pireh <2:12)
❑ Building has no duc�s in the attic.
Other Exceptions
.❑ Roofing area covered by building integrated; photovoltafc panels and solar thermal panels are exempt trom [he below Cool Roof criteria.
, � RooT construclions that have thermal mass over the roof inembrane with at least 25 Ib/ft is exem t from the below Cool Roof criteria.
� Note: If no CRItC-1 label is available, this compliance method cannot be used, use [he Pedormance Approach to sho�v compliance, otherwise,
Check the a licable box below if Exem t from the Roofin Products "Cool Roof' Re uirement:
� Roof Slope Product Weight Product Aged Solar Thertnal
CRILC Produci ID Number� < 2:12 > 2:12 < 516/ft' > 516/RZ T e� Re�eclance� ° Emittance SRIS
❑ ❑ ❑ ❑ ❑°
❑ ❑ ❑ ❑ ❑°
❑ ❑ ❑ ❑ pa
❑ ❑ ❑ ❑ O"
❑ Q ❑ ❑ p"
1. The C/iRC Produc� lD NwnLer cmr Le obmined ��orn Ihe Caol RoofRafing Cauncil's Rnied Produc� Uirecror7� ai �vwu�.cnotrooLs.arn/nrnduces/sew�ch nhn
1. Lidicale IHe lype oJpmducl is Geing used.(or U�e rooJlop. i.e. single-p(�� roof, asphali mof, meml roaf, elc.
./j(hc Aged ReQec/ance i.e �roi availnLle in.�he Cool Roa(Ra�ing Com�ciYs Ra/ed Prnducl Direciar�� /hmr n,ce d�e Ini�iol HeJlecmnm v�duc fi'om (he same
direc/nr�� mtd use die cg�m�inn (01+p.7((I�������I— 0.1/ ro obmrn a calcula�ed aged value. Whei'e p is �he lirilra( Snlar RefJec�mtce.
4. Check 6os i/)he AgeJRe(lecronce is n calwdaled vahie �rsing !he eguoliorr above.
5. Calc�da�e !he SRI volue Lr nsing iHe SR/- Workshee� ol hlm'/hv�v�v enerrr.ca.Envhide24/nnd emer Ihc res�J�ing vah�e in ihe SXl Calurmr above and otmc6 acop�� of
�he SRI- N'orkshee� In �he CP-IR.
o appiy Liquid �ielJ Applied Cuvtings, the coating most be applied across the entire roof sur(ace and meet the dry mi! thickness or coverage
recommended by the coatings manuf�ic�urer and meel minimum performance requirements lisled in §118(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cemeni-Based Roof Coating ❑ Other
Regisn•u�ion Number: 2egist�ntion Dae/Time: FIEILS Pravider:
20081iesidentral Can�p(iunce Fams Avgvst 2009
ve Certiticate nf
l AZtern[io�rs'
Projecl Name:
linncc: Resid
H�ItS V�F.IFICAT10Id SUMMAF1' Theen(arcemeni
checldisi Gelon�. A con�pleied nnd si�ned CF-4R Form for n)1
' CF-] It-ALT
(Pa��e � of' S1
I Ko1�5turies
�;r�c.r shmdd yar s.pecia! miemion �o �he HLRS Meomors speciJmA m �his
mea,sw�e.r specilied shnll be suLmitied io li�c Guilding in��peclw� before 1�nn1
Duct Sealine & i�e5tine HL2S verijicniion is require� for Ihis meuswe.
❑]'�S ❑ NO 1'CS: In Climate 2ooes ° anJ 9J 6, if more t6an 4b linear feei of new �r replucemeni ducu: are insisilled in unconditi�ned
space, tlie ducts ure to be senled per y 152(b)IDii and [he nep�ll' ���sWlled ducts are to be insulnled pei � I51(1)10.
❑ EXC�1'T10�: Lxisting duct systems tl�at are extended, which are cuush�ucted, inzul:ued or sculed with asbestus.
❑ YiS ❑ NO 1'ES: ]n Climate Zones 2 and 9-1 G, if [lie existin� space-conditioniug system (HVAC equipment aud ductingi is replaced, the
� ducts am to be sealed per § I S2(b)1 Di. �
D]'ES D NO ]'ES: ]�� Climate 2ones 2 und 9-J 6, if the ezisting HVAC equipmeni is repluced jincludin� Uie replacement o1-the 1ir handler:
' outdoor condei�sing unit of n splii system, cooling or heating coil, or [he fivnace lieai exchanger) the ducts are to be
sealed pei §] 52(b) I E.
❑ EXCEPT70�': Duct s,yscems that nre ducumented fu have been previousli� senled canfrmed tl�rough HERS
. - veriiication in accurdnnce with procedures in the Reference Residential Appendia RA3.
- � ❑ L�XCL,PTIO�: Uuct svstems with less than 4U lineur leet in uncouditimied space. . .
❑�RC�PTIOR: L�xistine duet svs[ems constructed, insulated m'sealed with nsbestus.
Refciperant Charee - Split S,l'Stem HERS verijicalion is requtre[i,fa' �hi.s' measure.
❑ YiS ❑ NO YCS: in Climate Zones 2 and 6-15, when [he existing HVAC equipmen� is replaced (includin� U�e replacement o£ihe air
haudler, outdoor condensing unit of a split system A/C or heat pump, coo]ing or heating coiL or the fumace heat
exchanveri a re.frioPrant cliaree measummem sh211 be vCriSed �e� �152(b11F.
Centi•al Fan Integrated (CFI) Ventilation S,ystem and Fan V1'att Draw
The ventilation requirements of §150(0) do not anply tn existine residentiel homes. ._
Ducted Splif Systems - Air Conditioners and Heai Pumps: Airilow HERS verilicaiion is required.Jar this measurc.
❑ Y�S ❑ NO 1'ES 1n Climate Zones ] D through 15, when tlie eaistiog space-conditionino system (H VAC equipment and ductiug) is
realaced. the airflow and ian watt draw shall be veri5ed aer § 152(b)1 Ci to meet the requirements of & I i I(fl7B.
• I
Name:
City/Sta�e/Zip:
and
--- GJ�Zb J� �
]f Applicable � CEA or O CE
N):
Re5pun5ibleBuildineDesi�uer'sDeclm�atiur Statemr�rt �
� 1 am eligibie under Divisiml i of ihe Culifomiu Business xncl I'rofessions Code to uccepi respunsibiliry� 1'or thc building design identi5ecl on
this CertiLcate of Canpliance.
• 1 certii�� tha� the eneroy (eaiuros and ped�ormance specifications for the building desipu identified on this CeniSeaue of Cumpliance conform
tu thc requireroents of Title 24, P.rts 1.md G of the California Codr of ILeEulalions.
• The building design 1'eawrex IdemiGed on this Cenificme of Compliance �rc cunsistem wilh thc infbrivation provided tn ducumem tbis
building design on th: ather:ipplicable eompliance lunns, worMshcus, culculaiions, plans and speciLca�ions subniiued 4� �he eniorcement
acencr for �onrnval with this buildine nermii �ionlicalion.
Nemc:
:.�mnu�iny:
Hddress:
Citv!StatJZip:
Si�nalure:
Late:
Phone:
Tnr «,s.si,tlnnce rn� questiorve� regurtlin� t/te L•nerg�� Suuv(ru'd.ti, c�utuie! Uic L•nerer Notline at: 1-H00-772-i3110.
I(egis�nninn h'unrLer l(egisuniimi Duie/Timr: HEI;S Frm�iaer:
2DOf; I(csicientiul Complianee Forms �lmgus� 300J
BiJII.DIDIG SAFETY DEPAR.TMENT N� 1408 �
P. O. Bna No. 317
'f.osta n�esa, Califomia
Date -�7F'i�7� 7 , � �l s�
CITY OF COSTA MESA /
CERTIFICATE OF OCCUPANCY
Building Permit �No%ti � Electrical Pennit No Plumbing Permit No
use oe auila;ng y �/ �• :T iv r�T l�i.i i L n, v i/
_ _ _. - , . / ._.. _
Tlie building located
Legal Descdplio�
(See reverse side for Metes a¢d Bounds)
�,h�� been inspected and found to comply with the piovisions of all City of Costa Mesa Ordin-
. s applicable thereto for a Group _.��Occupancy. � �
ISSUED TO:
/' � � � �'�S � City Building Official
Owner of $uilding) By � � � �"��
CC: ❑ Original—Owner p lst copy—Gas Co. ❑ 2¢d copy—Edison Co. ❑ 3rd copy FIle
Form 208 SB P 1M 1-60
PPOJECT AOOFESS: 7 2 Q 9 W FOUNTAI N WY
owxExsName:SCHROEDER CO,
aooxess: z411 E. COAST HWY
CORONA DEL MAR
CA 92625
(714)675-4900
AXCHIENGINEEF:
nooness:
NEG.NO.:
UNIT:
uxir:
PEflMITTEE:(�LL—COAST ROOPING (714)650-2244
PD�NESS: 21O% WALLACE AV
COSTA MESA CA 92627
LICENSEO CONTFACTOB OECIABATION: I hereyy allirm that I am licensed untler provisions o� Chapter 9(commencing wi�� Sectian
7000) ol �imsion 3 oi �he Business antl Pmte5si0n5 Cotle, and my license is in full force and�eflec�.
CITYUC.: �1. 29 s.areuc.59gqqp cussC39 —
oa�e � s�g�am�e: — V.) ,�OQ---
WONNEAS' CUMPE ATION OECIAflATION: I hp�eby afiirm thal l have a c ilicate ol consent �o selbin5ure or a cehifica�e o1 Worker5'
Compensation Insurance, or a cetli�ietl copy Ihereof (Sec�ion 3800. La�. C�.
POLICY NO.: E%P. OPTE:
COMPANY:
� Certified copy is hereby �umishea. ❑ Ce�i4etl copy is tiled wi�� the ciry Building Oivision.
Oate: AOplicanC
'� E%EMPTION fPOM WOH6EN5' COMPENSA710N OECLppqTION: (This seclion need not be comDleied il lhe permit is tor on¢ hunOreO (5100) or less�.
I certify Ihat in Ihe pedormance ol lhe work for which this Oermi� is is$,uetl, I shall no� employ any person in any manner so a5 to �ecome
sublec� to h Wod rs Com0en5aiion Laws of Cab�omia. , f/�/ � ���
I/ I II 1
Oaie'. SignaWre. ��1. 4 N��.,
NOTIC < Ii. ater making Ihis tleclara�ion, yop 5hou10 become su�le ihe Worker5' Compensation pmvisions of Ihe LaOor
Code. you musl forihwit� compty witA such promsions or t�is permi shall be deeme0 revoketl.
CONSTHUCTION LENOING AGENCY: I hereby a�(irm I�a� Nere is a constmc�ian lentling agency br ��e pedormance ol ��e work lor
which i�is permn is issuetl (Sec�ion 3097. Civ. C�.
LEN�Efl:
nooAEss:
OWNEH BUILDEB �ECLANATION: I hereby ailirm Ihat I am exemp� �mm Ihe ConVactors' $�a�e License Law tor t�e tollowing reason
�Seciion 7Q37 5 Business and Pm�essional Code', Any ci�y ol counry which requires a permi� �o consimct, alter, impmve. Oemolish, or
repair any stmcture, prior to its issuance. also reQuires Ihe ap0licanl lor suc� permil lo file a signed slaiemenl (hal he/s�e is IicenSeU
pursuam to Ihe pmvisions ol the Contracmrs Stat> License Law �Chapler 9(commencing with Section 7000) oi Oivision 3 of the Business
an0 Pmlessions Cotle) or I�aI he/s�e is exempi Ihereimm and the basis �or Ihe allegetl eremplion. Any viola�ion n� Seciion 703L5 by
any applicant �or a permit sublec�s the applicani lo a civil penalry oi not more than tive hundretl tlollars �$500).
1, as owner ol Ihe pmperty or my o,mployees with wages a5 Ihei� sole compensatian, will tla �he work, ana Ihe
❑ 51mclure is not inientled or ofleretl tor saly ($Q�pon 7044, Business and Pmiessional Catle: The ConVacto�s' $tale License Law
does not apply �o an owner oi a O�opetly who builds or impmves thereon, and who tloes suc� work himseli/herself or ihrough
hi5 Or her own employees, provitletl �hai such impmvemenis are noi intended or oHered lor Sai¢. tl, hOweve! ��e DuilOing or
impmvement is sold within one year o� comple�ian, �he owner will have �he burtlen oi pmving helshe tlitl nai Uuild or improve
for �he purpose ol sale).
I, as awner of �he proper�y. am exclusiv¢li contracting with licensed contracbrs to construct �he pmlect (Section 7044, Business
❑ ane 7mtession5 Code: T�e Canirac�ors' ��ate License Law Ooes not apply �o an owner of pmperry who builtls or improues ��ereon
I and who conlracis lor such pmle��s wi�h a conVactar�s)license pursuan�io Ihe Con�ractoK $�ale License Law�.l am aware
Ihat pmol ai Iheir Worker's Compen5ab4n lnsurance shoula be pmvitled to me
� I am exempt unUer Section'. B. 8 P. C.
�or IhiS ieason-
oaie: owner
I tlo here�y cetlily Ihat I am aware oi and un0er5iand ��e requiremen�s of California Heallh and Sa�ety Cotle Sec�ions 25505. 25533, and
2553G and t�al I or any future builtling occupanl willlwill no� (circle one) neetl Io compty with sai0 slaie cotles and ihe requiremenis tor a
pe�mi� foi canstmction or matlification �mm �he qir �uabry Managemenl �isUict. Fesidential consimc�ion apDlica�ions are exemp� �mm
these pmvisions.
�ale: APGlicanl:
I hereby cerlAy I�ai I haverea0 ihis applica�ion and Slate�hat �he abovein�orma�lanls cortecL I agreeta comDly wi�h allciry and coun�y
orainancesandsiatelavs�elanngtobuilaingconslmtlionanahereb authorizerepreSenla�ivesolNisciry�oen�erupon��eabove-meniionea
pfopetly �011 pCcli n pprpo5C5. //�� I �
oate: 1 G SignaNra: �� `/�� %� '.
/\ ori�er s uwnse or Sociai Securny r:
`.16aPa6 Wlu�e—Builtling�, Green—Code Enlorcemenl; Canary—Appl¢an�; Pink—Revenue: Goltlenmtl—Assessor
CITY OF COSTA MESA = BUILDING PERMIT
PERMIT NO; B 061194 PLf1N CHECK NO; N
PERM NO; B Obll
GOVT': N SUPP;
CONSTRUCTION TYPE; 5—N PERMIT TYPE; 57'R PURPOSE; AT,T
JOB DESCRIPTION ; T/O EXISTING,APPLY iBA5E,2PLY 6 ROCK SQ F'T: 2,800
CLAIM VALUE: 2,£i00.00 CALC—VALUE; 2,800,00 GROUP OCC; R-1 /
COMMENTS: SMOi(E DETECTORS REI�UIRED PER THE 1991 UBC
�r�r*��*�**x*�r*�x�***�r�r+r****�r* *��t*������cx��*�*x��t��*���*�****�x�rx***�x�x-��r�*x*�cx*
Z O N I N G R E Q U I R H M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT ZN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; • FT IN
PARKING REO• PROV; PARCEL; 42215407 ZNE; REF NO;
PLANNING N(STES>
}
if 1E iF iE iE it 1F IE i! 1E iE ik iE 3Fr1(�'if iE IE i(' iF 1E 1E iF 1E iF iE ih #� # iE if �)E!F if fF iE i!� iE iE K� iE 1E if 3f if- iE it �1f-!f #!E 1E ik if fh 3f if iF�1E iF 3(� iE iF iE K� iF if� iE if iF'!E iE if iE �lt 1F �3f 1f if
D E V EjL 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 APPROVE1l HY DATE:
HUILDING APPROV�D BY : DATE;
APPLICATION ISSUE:D BY: DATE•
x�ititx�*iF*�+�+��*itirx�ielt��*��*�� , o ,. EiF'7F' �. . .x�i�***iFif*i�.�. . . �. ..x �it�
3Eif-1EiEiEiEiE�EiF3E3E3EiE1E9f1E*3fiflfiEiEif3EiEiFik3EiEif)FiEjFif3EK�it3EiFiE3EjE3Eif�1EiE iF3E3kifiE3Fi(�iElE3F3f3Fjk3EfF#�%i(�iF�ffFX-3E�76if1E�f%-IEiE�E
LEGALIZATION;'N F E E S U M M A X STRUCTURAL SEGMENT;Y
BLDG PMT PLIJMBSNG ELECTRIC MECHANIC FIRE SMIP/RES GRAUING
PERMIT 54.00 ,50
SMIP/NON—RES
PLAN
ISSUE FEE •
HUILDING—DIV—> PERMIT ISSUE PI,AN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 0,00 54.50 54.50 ,00
REVENUE DIVISION TOTALS--> COLliECTED; 54,50 OVER/6AORT; " 00
BLD54P00 pLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADING PLAIJ-CHECK
I
iE iE iE if iE iE iE iF lE iE-1f 1E iE 1f !f !E iF if� if !E iE if iE 1E iE iE it iE �IE iE 3E 1E if 1f �1(-.3E-1E iE-lE 1E iE 3E iE iE iE if iE # iE if 1E iE if �7F 3F ih 1f if iF a�(-iE iE it if -It 9F-% lE if if iE iF�3F if x� 7E if� i! iE
I N D I V I D U A I:: 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 UNST COST � TUTAL COST
5FR 2800 REROOF BY VALUE RESIDENTIAL iVOZONE 1.00 2;.800,00
END OF FEES ,�
�
/s.
�
� EXPIR��
Irxomplete InsP�tia�5
' y $lQ .�"=s"—
paie �- ----'_'
�
�=`3
CONSTRUCTION AND PLANNING P��� PA
APPROVALS Permit # Date Inspector APpROVALS Permit # Date inspector
i. Temporary Elearical Serviceor Poie - . 52. Poo! & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Co�duit UtilitY-Undrgrnd. 54.-Forms � '
4, Electrical Conduit�Undrgmd. 55. Electrical Bonding �
5. Steel Reinforcemenc 56. Rough Plumbing & Pressure Test (
6, Etectricai UFER Grnd. 57. APPROVAL TO COVER�GUNITE �
7. Footings 58. Electrlcal Conduit�Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurai Fioor SyStem " 67. APPROVAL TO DECK
11. Property Sewer �ine & House Co�nection 62. Backwash & Rece�tor-Finai �
- t2. Sewer Cap ' 63. Heater & Ven[�Final
13. Roof Drains 64. Piumbing SYstem - Fi�al
14. Rough Plumbing 65. Electrical-Final
15. Rough Elecvical-Conduit 66. Solar System-Pinal
i
18. Rough Electric 4Viring 67. Fencing & Access Approval (
17. Rough LViring Siyn 68. APPROVED FOR PLASTERING
18. Rough Electrical-T 6ar Ceiling 69. POOIlSnA SYS'IEMS PINAL �
19. Rough Heating & Air Conditioniny FIRE DEPT. REQUfREMENT �
20. Rough Factory FireP�ace APPROVALS Permit # �
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Pipir,g � Gas ❑ Oil
23. Gas Pipe�Rough & lest 72. Underground Flush ,
24. Roof Framinj 73. Undergrnd.StorageTank OGas ❑Oil �
25. Foot Sheathing 3/jl/'! �� 7q, p�erhead Hydro
26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemica:
27. Frame and Flashing 76. Dry Star.dpipe
28. Lathing & Siding , 77. FIXEp SYSTEI41 FINAL �
2S. Insulation I � . 7g, FIRE PREV. FINAL
36. Drywali Naiiing � HEALTH DEPT. REQUIREMENT
, i
37. Pizster Broevn Coat i 79. FINAL INSPECTION
32. Eiectrical ?ower Met=r-Final I �_ '' S0. FOOD CERTIFICATE ISSUED
33. Final Etectric � ,f ,� rS�
� � Notes: q`ry�_ .!/'o� icG.w!'/�"' 3--Z-f'�
__� �
34. Final Heating & Air Conditioning , I
35. Final Gas Pipe�Test � �
_l _ _
36. Hood or Canopy � �'
37. Final Factory Firep�ace � '
38. Pinal Plum6ing ..�T ' � � ` -�--- ...' --- {
39. Water Service-Final I ~
40. Gas Service-Final ' ' � `
i
41. Solar pomestic-�inal '
42. Backflow Freventer ' � ! I
43. Backflow Irrigation �
4A. Landscape irripation SVstem �� �
45. Sound Attenuation a� �-
46. Handicap Regulations . � -�
EX_P_I_R E D �
47. FINAL.STftUCTUf�E&BUILDWG ' � {�pnlpl9tQMSp�t��5 �
48. FINAL PLANNlNG , ' 7/(��$�g �"; J- =._
49. Electric Release io Ediso❑ � i L-�[E-� E- �^��
i
50. Gas Re{ease to Snuthem California Gas Co . �
r
51. CERTtFICATE OF OCCUPANCY �
No. Oate
Aoplicant to fill in all spaces except ehose within heavy_oorder Iines antl siqn all aoD�oDriate aeclarations.
CirY oF COS'rA M�1ESA CONS7RU�C!TION PERMIT
Project Address d a q��i�CIL/'UUN�//1 (!�� ��a/fS,,T�
Applicant's Mailing Ay/ddress � �9 � ��n✓��/S�/?
Owner's Name D N`� / Phone
Address
Arch/Eng. License No.
Address
Conuactor's NamP �� `�' ho'nJe G�% G$
Addresslmailingl ��q��'�Gy ��� ��2 y�.^'L�
City License No. C%f%� ��f)
LICENSED CONTRACTOR DECLARATION
I hereby affirm tnat I am licensetl untle� P�ovisions of Charter 9(commencin9
wi[� section 7000) ot Oivision 3 0! tne Busine5s antl Professions Cotla, antl
my iicense is in tu11 orc n effect. Zj ��}};;�/ c'
UcenS¢ Ia55 ' ���%��en e No � i� �
Date_��L � Si9nature � /��jlt�Q���a�
WORKERS' COMPENSATION OECLARATION
' hereby aHirm tnat I have a certificate of �onsent to self-insure or a certlficate
/ Workers' Compensation Insurance, or a certifietl copy thereoi (Saction
JB00, lab. C.)
aorcr No. �—�'611'jl comoa�v�'i�ll�Cia.�:+�i� �
8 Certiti¢tl copy is hereby tutniSM1etl. / -
Cert1tie cop�y�7�5 filetl wiM the city 6�Itling D�visl0 ��
Date_�l� ��— `r�/ APPlicant p�.
EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION
(Thi55CctiOn neetl not be completetl it tPe pe�mit is to� one huntlretl (5300) Or
Icss).
I[¢rtify iha[ in the pertormance of tne �+o�k fo� which Ih15 perm�t Is i55uetl, I
shall noI employ any penon In any rhanne� so as to become zubjett to [M1e
Workers' Compensation Laws ot Califorma.
Date Signature
NOTICE: If, after making this tleclaratia�, You shoultl become subject to the
WO/ke�s' COmpCn5ati0n provisions of the Labo� Cotle, you must forthwith
comply with such provisions or thiS permit shall be tleemetl revoketl.
CONSTRUCTION IENDING AGENC�'
I M1e�eby afflrm that lhere is a Constru[tion lentling agency fOr the pe�formance
ot tn0 work 1or, whicM1 Ihis permit is.izsuetl (SectiOn 309] Civ. C.)
l.entlerR Name
Lentler's Atltlress
OWNER BUILDER DECLARIITION-
I here0y af8rm thal I am exempt froM the Gontractor's License Law for tha
tollowing rwson (Section 7031.5 Busiqess antl Professional Cotle: Any d[y or
tounty whlch requlres a permit to construct, alter, improve, tlemolish or repalr
dny StruCture, prior to i[5 issuance, a150 requires the applicant for Su<h permit
[o fila a siqnetl slatement that he/She is licensetl pursuant to th¢ prOvisions 01
the Contractor's Licenze law (Ghapter 9.(�ommencing wiih Section 7000) oi
71vi5ion 3 of the BuSin¢55 antl Pfofes51on5 Cotle) or thdt h¢/She IS e%empt
ierefrom antl [he basis for the alleged exemption. Any violatlon o( Section
031.5 by any applicant tor a perrP�� subjects the ap0���ant to d Civll
�enalty of not more than five huntlretl dollars (5500).
I, d5 owner o( the prOp¢rty o1 mY emPloy¢es with wag¢S a5 [Fleit sole
compensa[ion, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Section ]094, Business antl Professional Cotle: The Con[ractor's
LlcenSe Law tloe5 not appty [o an own8r ot a properry wbo bulltls or imOroves
thereon, antl who aoes such work himzelf/herselt or tnrou9h nis or her own
employees, provl0etl [hat such improvements are not intentletl or Otferetl tor
Shce. It, however, the builtlin9 Gr imp�O�emen[ is Soltl within on¢ Yea� ot com-
pletion, the owner will have the burtlen of provin9 he/she tlitl not builtl or im-
�rove tor the purposa oi sale).
1, a5 Ownet of the prOPerty, am exClusively Contracting with licensetl con-
trac[ors to cons[ruct the Oroject (Sectio� �044, Business antl Professlons Cotle:
Tha Coatra<tor's License law tloes not apply to an owner of vroperty who
builtls or improves thereon, antl who 4ontracts tor such prq¢C[s wlth a con-
tra<tor(s license pursuant�to tne�Cont�acto}'s License Law). I am aware that
prool o� th¢ir Worker's GompensatioN insuran<e shoula be provitletl to ma.
❑ I am ¢xempl untler Section 8. & P. C, for thi5 rea5on
Date owner
I hereby certify [hat I have reatl this appliwtion antl state that the above
inPormation is mrrec[. I aaree [o comolv with all tltV antl coun[v o�tlinanc¢5
�/�l0 70 -__ .._.
TVPE OFCONSTFiUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p#
DESCRIPTION OF WORK/USE OF BLDG. S Main euildi
E
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION 5Q. FT. oCCVPnNCV C Right
CONSTRVCTIONTYPE VALUATIONS S L¢ft
ZONE GRADING CU. VOS. ACRES Ping. Ref. #
aemarks: Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks �
CidS $2lVICB QUilELS
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilatin9
Ezhaust System ❑ Multiple
Firepl/FacL Bit. IC80 #
Heating System & Ducting
❑0.100,000 BTU 0100 000
I519natur � ��+��� �� LGf"t�" Dattlj(�/�� I I I
Drivers' Licanse or 55 � � Reinspection Fee $15
,� CMF 0865-46, rev. 4/84 White - Builtlin9: Canary -APplicant; Pink - Accountin9; Goltlenrotl -Azsessor
Showers
Service Sink
Sewef Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water CIOSEi �
Water Heater �
Water Service �Q o.,/;
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/AI[eration
laue ee
FEES
$ 3
$ 3
Auromatic Washer
Constructior Po1p;S�
Cpoking Unit ,'
❑ishwasher !
Dryers LIGas LIEI
Fan
F,A.U.
Fixtures
Device Boxes
O ut lets
Switches
Garbage Dispoul
Generamr �0.5 KW
Fee
4254 I 2/�I �/B4
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL .
Transformer � 15�50 KW
❑ so+Kw
5-15 KW
$15
Meter LJup to l00 amps
Meter ❑over100amps
Sub Panel
Motors �0-1 HP 01 `f. - 8
Int.Solar �9;15 HP �16�75+
Microwave �
Pole Light
Range
Sign
Standing Sections
Trash Compactor
Issue Fee
c.09 Tl I
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S.
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
Application Issued By— -- Datefa —�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING § •�U ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. S '
ELECTRICAL 5 GRADING 5
PLAN CHECK 50% S MICROFILM $
MECHANICAL $ 70TAL FEE $ • 4 �
PLAN CHECK 25% $ _
CONSTRUCTION AND PLANNING POOL �PA
APPflOVALS Permit # , Date Inspector � AppROVALS Permit # Date Inspector
i. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit-UncJrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 5S. Electrical Conduit-Undrgrnd. ,
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System ' 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap , 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical�Conduit 66. Solar SYsYem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
t7. 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 7Q. tlnderground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage 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 J'Z�/9�!"� G�
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 Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
' 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
Np. Date
_'� �J ,
'--' . ��.`3�C:u .. . . .., .c�%.�,. .i ,;
COSTA MESA BUILDING-SAFETY DEPARTMENT I L�'— � �t —J"'f
P.O. BOX 31] COSTA MESA. CALIFORNIA
FIi'; ;P;CE GEP�I: v <<
FOR AAPUCANT TO f/LL /N COMP[ETELY AP.PLIC:4TION�.FOR�PERMIT
� TYPE O PRI ' CU � � BUILDING
BUILDING , �'Y' � ��-
ADDRESS �
COSTA MESA, CALIFORNIA FOR OFF/Cf USE ON[Y
I RECEIPT NO. e e� 1�J0
OWNER Paul E. Robertson Inc. ' t�
Mq�l RECEIV�BY DATE REC�EI"VEO DATE ISSUE
A�DRE55 I D.-�i� %�J ��n-
TE�. MIdway euaow�
CITY NO. ADDRE55
ARO"'TECT LIC.
oR 'iNEER W_ Sotdan No.C-1449 COSTA MESA. CALIFORNIA
ADDRESS FIRE
ZONE TYPE GROUP �
'_"-_"_...�_ . .. .. . . . � . STATE . ni n�r. APPROVEO `J ID J S� j �
LEGAL lOT
OESCRIPTION NO. 12 BLOCK
A.P. NO.
size 65 x 135 "� °` a
OF LOT Now on
USE OF
EXISTING BLDG.
SETBNCK LINE FROM
ceHrea ov srweer S.O REAR VAI
SIDEYARD ILEFT ZO.S IRIGHT �
� DESCRIPTION OF WORK
BUIL�ING NO OF
size 32 x 55 Rooms 4
EXTERIOR WAL1 ROOF
COVERING JCUCCO COVERING
USE OF BLIILDING ANO WORK TO BE P
� t _"__� ____`-"_`
2
1 HEFE9Y ACKNOWLEOGE TNAT I XqVE FEAD TMIS APPLICATION
AND STATE THTT THE ABOVE IS CORRECT.FNO AGREE TO COM�
PLY WITN qLL CITY OROINqNCES AND STqTE LAWS REGULATING
BUILDING CONSTRUCTION.
SIGNATURE OF
PERMITTEE
AUTHORIZED AG�
BY
NO.OF VSE OF NEW
PLANS �/ BIIILOING
' . GY ' DATE I I/
ST.)
FT.
�T.
Ihll
THE RMOUNT SHOWN IINOER VALUATION IS FOR THE
PUPPOSE OF ESTABLISNING A PERMIT FEE ONLY,
VALUATION _ /�'—
PERMIT FEE $ F�
l
$�% �! °� q '�
I �J PLAN CHECK $ pJ y
TOTAL FEE S �� �
(
\
. 1����2
C09TA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 GOSTA MESA. CALIFORNIA
F0R APP[/CANT TO f/LL /N COMALfTELY
TYPE OR PRINT ��f� � /�I
ADDREISS �—_Z.' �i C u�{Inn11Px���Y` p
COSTA MESA. CALIFORNIA
.,_ t����F °' =
FINANCE QEPT.
���Y �� ';(li«i �F$H
APPLICATION FOR PERMIT
BUILDING
FOR OfF/CE USE ONLY
I FECEIPT NO. Yi'E@P�ITC
MAIL RECEIVEO 6Y � T REC IVEU p qDATE I
ADDRE55 � � S / �<' �,�
Te�. MIdway BUILDING
CITY NO. AppRESS '
ARC�+iTECT ��c. COSTA MESA, CAUFORNIA
OR �1NEER NO. /�
AODRE55 771 W 19th St.. Coata Mesa ZONE TVPE 4/ _GROUP .
LEGAL LOT 1/L1 1
o[scAierioH NO. 12 BLOCK TRXGt
A.P. NO.
I$IZE . _ _ _ _ I NO.OF BLOG9.
SETBACK LINE FROM ()O REAR YARD
CENTEF OF STREET
SIDE YARD ILEFT IRIGHT
DESCRIPTION OF WORK
NE I X IIALTERATION I II'1DDITION
REPAIR I IIMOVING I IIDEMOLISh
512iE DING 2•2 X�iO ROONS STORIE
EXTERIOR WALL _ IftOOF
1 HEfiEBY ACNNOWLEDGE TMAT I NAVE FE/�D THIS APPLIGATION
AND STATE THAT THE ABOVE IS C RRECT NNO AGREE TO COM�
PLY WITH ALL CITY Oq�INqNCES 5li ST C LAWS REGIILATNG
BVILOING CONSTFUCTION. '
SIGNATURE OF
PERMITTEE
AUTHORIZED AGE T
ZONING
�� /NO. OF USE OF NEW
PLANS �_.BUILOING
ICENTEF LINE ST.)
FRONT
R. SIOE
REAR ri-C� FT.
�
THE AMOUNT 9HOWN UN�EF VALUpT10N IS FOR THE
PIIRPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION _
O� n PERMIT FEE $ /�,.�
`�/ �V`� PLAN CHECK S L��
�
TOTAL FEE $ / S