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Home My WebLink About3028 GARFIELD AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suiie No Vicinity: Parcel Nunmber: Appliwnt Address: Owner. Address Contracror. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recepl Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors l0 1hp Molors lo tOhp Motors lo SOhp Motors to 100hp Mo�ors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Cittuits Temp Pwr Pole Intermed Pole 3028 GARFIELD AV 14113305 ROBLES,PEDRO 3028 GARFIELD AVE COSTA MESA, CA ROBLES, PEDRO AND MARY 3028 GARFIELD AVE COSTA MESA, CA OWNER-BUILDER Phone: 714-504-5378 2ip 92626-2856 Phone: 714-504-5378 Zip: 92626-2856 Phone: Zip: License: 000000 Status: ISSU ED Ayplied: 04/20I2006 Issued: 04I20/2006 ISSUED BY: � SCOPE OF PERMIT LEGALIZ� 455 SQ.Ff. PATIO ENCLOSURE BETWEEN THE GARAGE AND MASTER BEDROOM ALONG THE RIGHT S14E OF THE HOUSE. REF.: BO6-00607 ELECTRICAL TO INCLU�E: 3 LIGHT FIXTURES AND 3 OUTLETS. 523.50 $0.00 $0.00 $0.00 3o.ao $0.00 $330 $3.30 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 �uantity FEE SUMMARY Temp Dist System / Lighting Busway I100 fl Standing Section Misc Electrical Equipment Trans(ormers up t0 1 kvalkw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduil Misc. Condudor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Sland Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 so.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 50.00 0 30.00 0 50.00 0 50.00 0 50.00 50.00 50.00 50.00 TOTAL CALCULATED FEES 530.'10 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply vnth all applicable handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under Ihis permit to be consideretl legal, such work must comply with all applicable codes, and all raqulred inepectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiretion ot this permit. FOR INSPECTIONS CALL: (714) 7545626 WOHKERS' COMPENSA710N DECLARA710N: I hereby eMirtn untler penalry of perjury one ol the following declaretions: ❑ I heve and will maintain a certilicate of consent to self�lnsure tor woBars' campensation, es provitletl lor by section 3700 0l the Lebor Code, tor t�e pedormence of Ihe work tor which this permil is issued. ❑ 1 �ave and will maiMain workors' crnnponsslion insuranca, es required ty sactlon 3700 ot Ue Lebor Codo, tor 1he podormance oi t�e work lor whkh this pertnit Is issued. My workers' wmpensatlon Insurance cerrler antl pollcy number ere: Carner. PO��cy Number. (Thls secfion need not be comp/eted i!!he permlt is veluetl a! one hundred tlollars ($100) or /ess.) ❑ I canity thet in tha peAormance ol Ihe work for wnich this permit is issuetl, 1 shall not employ any person In eny manner so es to becwne subject to Iha workers' wmpenSetlon laws ot Califomie, end agree Ihet tl I should become subJect to the workers' compansetlon provisions of Sectlon 3700 ot the Lebor Code, I shall lorihwll� compty W�lh Ihese provisions. Applicam SlgnaNre: Date: WARNING: FAILUAE TO SECURE WORKEPS' COMPENSATION COVEMGE IS UNLAWFLI� NJD SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTES AND CML FlNES UP TO IXJE HUNDRED TFIOUSAND Op11 RE (4100,000�, IN AODfTION TO THE COST OF COMPENSAiION, DAMNGES A$ PROVIDEO FOR IN SECTIIXJ 7]O60F THE L400fi CODE. �MEREST, AND ATTORNEI"S FEES. LICENSED CON7RAC70R5 DECLAfiAT10N: I hereby attirm that 1 am licensed untler pwvisions of Chapter 9(commencing with Section 7000) of Division 3 oi tha Business and Prolessians Code, and my license is in full larce entl eHeCt Lic. a Class q Comraaofs Signature: Dete: CONSTRUCTI�N LENDING AGENCY: ❑ I hereby aHirtn that Ihere is a construction lending egenty lor the perfortnance of t�e work for w�ich Ihis perm�t Is issueA. (Sec. 3097. Civil Code). Lentlefs Nama: Lentler's Address: , SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that untler penalty oi pe�ury lhec 1 em EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor ihe tollawing reason (SBc. 7031.5, Buslness entl Prolesslons Codo: Any ciy or counry which requires e pertnit m construct, elter, improve. demolis�, or repair eny structuro, pnor to its issuanca, also requires lhe epplicant tor such parmit to tile a signetl stetement lhat he or s�e is licensetl pursuant to Ihe provisions ol Ihe Cantractors Ucense Lew (Chepter 9(commenGng with Sectlon 7000) of Dlvislan 3 0l Ihe Business entl P�ofessions Code) or thet he or she is ezempt therefrom entl lhe besis for Ihe ellegetl exemption. Any violation of Section 7031.5 by any applicant lor a permit sublects 1he apPlicant to a civil penalty ol not mora than fiva hundred tlallars (5500).): ❑ I, as owner of tha pwperry, or my employees wi�h wages as iheir sole wmpensation, WILL DO THE WORK, and Ihe struciure is not intentled or oHered for 5ale (Sec. 7044, Business antl Professions Cotle: 7Ta Contractors License Law does not apply to an owner of property who builtls or improves ihereon, end w�o does such work himseli o� herselt or thmugh his or �er own employees, providatl that such impmvemenls are not intended or ottered for sale. If, however, Ihe building or improvement is sold wit�in one year of compleiion, Ne owner-builder will have the burden of provinq that he or she tlid not build or improve for purpose of saleJ. ❑ t, H5 ownet ot the property, em EXCLUSIYELY CONSRACTING WITH LICENSED CONTRACTORS to constroc� the projed (Sec. 70d4. Businass and Professions Code: T1ra contreciors License Lew does not apply to en owner ol propeny who Ouiltls or Improves IhereOn, antl who Coniracts for 5uch project with a contracior(s) license pursuant to ihe Contractors License Laws.). �_I am exemg� r sec. BuSiness antl ProfeSsions Cotle lor ihis reason: �Signeture:� -/ ^ � � Date:. � ZD�— —D ��— .Ownei ID vonlied by drivels Iiconso. ❑ Ves ❑ No �Drivers licensa No. � �pires�. LA —// —/!'j VenllcaUon of Ownership by (rype of daument, I.e. - propeny lez bill or deetl)� _ DIVISION OF INDUSTRIAL SAFETY 7ERMR CERTFICATION: ❑ 1 �ereDy tertily that no excaveNon flve (5) or more feet in depih in�o which e person is requiretl to descenq will be made in wnnection with work eu�horizetl Dy this permi6 end thai no bulltling sirucwre, scattoltling, lelsework, or tlemolition or dismantling lhereol, will be mo�e then thirry-siz (36) Iee1 hig�, (Chep. 32, Gry 2. Art 2, Sec. 341, 71Ue 8, Califomla Atlminis�retive Coda). ❑ As ownef-builder, I wlll not employ anyone to tlo work wM1ich would require a permit from the Division ol Intlustrial Safety, es no�Btl above, unless such parson hes e permit �o tlo such work irom l�o division. Signature: Data: Division ot IndUsirial Satery Permit Number. CERTIFICATE OF COMPIJANCE AND AUTHORIZATON OF EFfTRV: I conily untler penalry ol perlury thot I have read this epplication entl stale l�a� ihe informetion given is correci. I a e to compty wil� ell stat lews end city ordinences relating to builUing consiruction, anA eWhodze representativos ot Ihe Ciry of Costa Mesa to enter upon ihe ebove�d y� propeny lo cY puryasos. I egree not to occupy or allow occupency ol eny Duilaing eu�horized by this permit until linel inspe tion. ��ic.� � D t�tz.o 11 G ' Sgneture Of Legal Owner(s) � Date ' �'._ AnNOr Aul�odzed Applicant Date SOpE t. �t�<�c�T10NTYPE QL1jE �$ °__ 1616 Fixed Sysiem Final Fire PrBveniion 1266 200 Pool 5pa Final Final fla-Roof 201 Finel 6�ock/Retaining Well 202 Final Factory Fire Place 203 FinelSign 204 Final tlemolition COQE I INSPECTION TYPE 206 Final Mec�anical 208 Final Plumbing 210 Flnel Elecincal 212 Final Flre Preventlon 220 Final Planning Approval 222 Final Si�e 250 FinelBuiltling/Occupancy C� II�ELH (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mes��r�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 3028 GARFIELD AV s�ae: Vicinity: SIDE YARD Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 14113305 Zoning: npp�icani: ROBLES, PEDRO Address: 3028 GARFIELD AV COSTA MESA, CA Owner: ROBLES, PEDRO AND MARY Address 3028 GARFIELD AVE COSTA MESA, CA Contractor. O W N E R-BU I LDER Address: Zip: Arch : Address: Phone: License: Phone: 714-504-5358 Zip: 92626 Phone: 714-504-5358 Zip: 92626-2856 Phone: License: 000000 Eng: Address: ISSUED BY: Status: ISSUED APPred: oanonoos Issued: 0420R006 Phone: License: SCOPE OF PERMIT LEGALIZE 455 SQ.FT. PATIO ENCLOSURE BEN/EEN THE GARAGE AND MASTER 6EDROOM ALONG THE RIGHT SIDE OF THE HOUSE. 46% OPEN SAACE REMAINING. FEE SUMMARY Plan Check: $199.71 Permit: $307.25 SMIP Res: $1.82 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $508.78 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Fronl 0-0 PARKING Existina: 0 Rear 0- 0 Rear 0-0 PLANNING & ZONING Lefl 0- 0 Left 0- 0 Reauired: 0 Pr000sed: 0 Calc Valuation: sta,zoo.00 Claim Valuation: SO.Oo Right 12- 0 Right 0- 0 NO710E: The work authorized by this permit shall comply with all applicab�e handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within t BO days, or if work is suspendetl or abandoned for a period oF 1 BO days. INSPECTIONS: In order for the work authorized under Ihis permit to be considered legal, such work must comply with all applicabla codes, end all requlred inspectlone and (inel epproval must be obtained. Failure to obtain inspections antl final approval will result in the axpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS'COMPENSAPONDECLARAPON: r I �ereCy aflirtn under penalry of perjury one of tho following declaretions: • ❑ I have entl WIII maintain a cenificete of consent to sell-Insure lor workers' compensation, es pmvided for �y section 3700 of the Labor Code, for tha pertormance of Ihe work fOr whiCh ihis pormil is issuetl. ❑ I havB eM vAll mein�aln workers' compen5etlon insurance, es requiretl by secibn 3700 of �he Lebor COde, tor Ihe peAortnance of IhB work for whlCh t�ls pertnit is �ssued. My workers' �mpensation Insurance cerder entl polity number are: Carder. Policy Number. (fhls secllon need �of be complefed i! fhe permit is ve/ued a( one hundred dollars ($100) or less.) ❑ I cenily that in �he peAartnance ol t�e work �or which this permit is issueA, I shell not employ eny person in any manner so es ta 6ecome subject to Ihe workars' compensatl0n laws of Calilomie, entl eg�ee thel il I shoultl Cecome sublect to the workers' compensetion provislons of Section 3700 af the l.abor Cotle, I shell torthwit� comply with these provisions. ApPlicanl Signatufe: Dete: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNUW FUL AND SMALL SU9IECT AN EMPLOVER TO GRIMINAL PENnLTIES AND GVIL FlNES UP TO ONE HUN�qED THOUSAND DOLUqE (5100.000), IN ADDRIIXJ TO THE COST OF COMPENSATION, OAMnGES AS PROVIDED FOq IN SEC�ION 31W OF THE UBOR CODE, INTEREST, AND ATTORNEI^5 FEES. LICENSED CONYAACTORS DECLARA710N: I here�y eNirtn tha� I am licensed under provisions of Chapter 9(commencing with Section 7000) ol Division 3 0l the Business and Professions Code, and my license is in full lorce and eMect. Ua P Class a ContrecroYs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby afliR� Ihet Ihere is e consWaion lending egency Por the peAormance oi the work br w�ich Ihis pormll is issued. (Sec. 3097, Civil Catle). Lenders Name: Lentler's Address: Signeture: Date: � OWNER-BUILDEP DECLARATIONS: I hereby aNirm Iha� unOer penalry of par�ury that I em E%EMPT FROM 7ME CONTRAC70RS LICENSE LAW for the lollowing reason (Sec. 7031.5. Business antl Protessions Cotle: Any ciry or counry which requires e permit to construcL alter, improve, demolish, or repair any strucWm, prior to its issuance, also requires ihe epplicant for suc� pertnit to file e signetl sta�ement thet he or she Is licensetl pursuent to Ihe pwWsions oi Ihe Contrectors License Lew (Chapter 9(commencin9 with Secilon 7000) o} Dlvision 3 ot Ihe Business and Pmfessions Cotle) or ihat he or sha is exempt therefrwn antl the basis lor the alleqed exemptlon. Any violetion ot Section 7031.5 by any appliwnt tor e permil subjects the epplicent ro e civil penalryof nat mare than five hundred dollare (5500)J: ❑ I, as owner 0� �he property, ar my employees wilh wages as their sole compansetion, WILL DO THE WORK, entl Ihe simcNre is not intentletl or oHered tor sale (Sec. 7044, 6usiness and Professions Cotle: The Conirectors License Law tloes not apply to an owne� ot propeny who builds or unprovas tharawt, and wtw tloes such work himself or he�setl or ihrough his or her own employees, proNtled ihat suc� improvemenls are not intended or oNered for sale. If, however, tha building or improvement is sold wilhin one year ot completion, the owner-buiider will have the burden of pmving that ha or she did not build or impmve for purpose of saleJ. ❑ I, as owner tl< <he property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the prolect (Sec. 7044, Business end Protessions Catle: The contractors License Lew tloes not apply to an owner ol pmpeny who builtls or Improves thereon, end who con(racts for such projec� wl�h e contractor(s) license pursuani to the Contractors License Laws.). �I.arn exempt�r�ec. ��./ Businoss and Professions Code for ihis roason: Owner ID verified py tlrivafs Ilcenso. es ❑ No rDriver'3 Licensa No. Vedlicatlan ol Ownership by (type ot daum n, i.e. - propeny tax bill or tlaedJ�- � DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certi�y Ihat no axcevetion live (5) or more feet in depih into whic� e person is required to descen4 will be metle in connection wit� work euthonzed by ihis permit, and ihat no building sirucWre, sceHolding, falsework, or demolition or dismamling thereol, will bo more Ihen �hirty-six (36) �eel high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Titla 8, Califomia A4minlstreUve Coda). ❑ As owner-builder, I will not employ anyone to do work which would require e permit from the DiviSion ol Intlustrial Safery, as notetl ebove, unless such person hes e pertnit to Co such work Irom Ihe division. Signature: Date: Division ol Indusirial Safery Permit Number: CERIIFlCA7E OF COMPLIANCE AND AIJTTIONRA110N OF EMRV: I ceniy under penelry of perjury ihet I havo roatl this applica�ion end stele lhet lhe Inlormation given Is Correct. I egree to �mply with all sta e lews entl ciry orCinances relating to building construc�ion, antl eu�horize representa�ives ot �he City ol Coste Mesa to enter upon iha ebove�d�/�properry lor�_n'purposes. I egree not to occupy or ellow occupency of any building authonzetl by l�is permit until linel Inspe�tion, �O� � D�/�Zv " SlgnaNreOftegalOwner(s) Dat � And/Or Authorizad Applicant GODE �. �y$PESeIl4NTYPE �676 Fixed Sys�em Final Fire Preven�lon 1266 Pool Spa Final 200 Finel Re-Root 201 Final Block/Retaining Well 202 Final Feclory Fire Plata 203 Final Sign 204 Finel Dom ition pelF jli�6$ C9D�e INSPECTIONTYGE 206 Final Mechanical 20B Final Plumbing 210 finel Elecirical 212 Flnal Fire Prevention 220 Flnal Planning Approval 222 Final Site 250 Final Builtling/Occupancy PAIE �� °� �'oQta y'� f�'uu'dus� Dusi¢�o�L OWNER-BUILDER VERIFICATION �ddress> 3G �� 7�� .�2�) A�� C Nf. C%a• Pcrmit#: A city or county, which is required to give notice pursuant to Section 19830, shall attach to such no[ice, and, as a condition precedent to issuing a building pertnit, require the completion and require the rewm of, an owner- builder verification. Attention Property Owner: An b�vner-builder' building perniit has been applied for in your namc and bcaring 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 pemiiL No building permit will be issued until this verification is received. C, l: _ 1 personally plan ro provide the major labor and materials for conswction of the proposed � property improvement. �Yes ❑ No �-2 3 [(have/have not) /4 I./�S - signed an application for a building pemiit for the propo'sed work. I have contracted with the following person (fim�) to provide the proposed constniction: Name Address Phone ( ) Ciry _ 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: 1�'ame Address Phone ( City — Contractor's Lic. No. 5. I will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: \ame �wz.a6 (Rev. t �roa� Address Phone T}'pc of �Vork APPRv�r PLANNING Dl'Jl �� }I�JFCT TO BLDG. i :^; F'.: ADD1 C � �NS , �K COR BY THE Pl .��'t'R�'�� r�� `,�C> � �`�QE P �T OFOGp- �� Q,``S� G�� ; . �l � V^.;:�5 ��i � �� :.'�. � �d`S5 .- . � e�a�:`a „uu "�' �:=;: ^a�C: �s� a�'� � 2 , S 0 tr6�u5 a�,' °..�. �� ' �ac �c°.s� aevY t� .e�a�e�Y� ' 'c� �` � S�aa¢4 d�yS� a � a�S�a��,o�' ��mo � o� �p�`�a�c`Fa REG� IPJ♦ BE G D1v • UJ'��w �� G �� O L� C'P�-2F i � L � �� ,� �S r F 9. P ,�� o�a� � �A`S p\ �a�e a��"�e ��c� � e b rc{�' a��. ��aZ�t��` _Dm`°`,�a�° `'vs.pcA� �"_ i�:_ v" �a�S �a �'eS�,e �0��, °� 6 o\�°��yc§,�3�0\ a��'� �J�'� ��e�.: �r L, A�l � W S Li� /��(G I I �� 9ooR- ` v -� �✓i N �� ' ✓` I j` --..-.- f _ . SS' �� J �..� � � ,�.,'z E A-C'-Y�-F, e WRL�� r c ^�, c�' Rq`�N � � _�,i�„x� p �� . ��ia� �sa-s2�s • Fax (714) 754-4856 • wv+w.ci.costa-mesa��DING PERMIT JobAddress: 3028 GARFIELDAV Suile: Vicinity: Parcel Number: 14113305 Applicant: TR,4N, NGA TUYET Address: 3028 GARFIELD AV COSTA MESA, CA owner. TRAN, NGA T Address 3028 GARFIELD AVE � COSTA MESA, CA . Contractor: O W N E R-B U I L D E R Address: Zip: Arch : Address: � ' Zoning: Phone: 714-751-1367 Zip: 92626 Phone: Zip: 926262856 Phone: License:� 000000 Eng: Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: Ot/07/2003 Issued: 01/07/2003 ISSUED BY: SO 1 � �4�� a�a Phone: ' Phone: Zip: License: License: SCOPE OF PERMIT 36' X 14' PATIO COVER PER CITY STANDARDS A17ACHED TO THE RIGHT SIDE OF TFiE HOUSE, BETWEEN THE GARAGE IN THE FRONT AND ROOM AT THE REAR. 12' RIGHT SIDE SETBACK PROVIDED. - � - Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $108.71 $167.25 $0.81 $0.00 $0.00 $0.00 5276.77 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existino: o Rear 0. 0 Rear 0. 0 Required: 0 FEE SUMMARY PLANNING & ZONING LeR 0. 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $8.724.48 so.00 NOTICE: The work authorized by this permit shail comply vnth all applicable handicap access requirements under Calilomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work Is not commenced wlthin 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable cotles, and all i requlred Inepeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 �asae �aroo� WORKEflS' COMPENSATION DECLARATION: . I hereby effirm untler penfllry of per�ury one oi the tWlowing tledarations: ❑ I heve Bnd will maintain a certificate oi consent ta self-InSure tor workers' compensation, es providatl for by section 3700 0l iha Lebor Code, for ihe pertortnance at the work tor which this pertnit Is issued. ❑ I hflve entl will melntain workers' compensatlon inwre`xe, as requhed 6y secUon 37W ot Ne lehpr Cotlg, tw the peAwmaxe pi (hg w rK tw which Nis pemiit Is lssuatl. My workers' compensatlo nsu e wrti Icy number are: �y � Carrlec � PoliCy NumEer: �J �(Thls �secf/on �eed not be comp/ete011 (he pe 111s valaetl ef one hundred dWlers (S Id0) or less;l V V I cenify thet in the Dertortnance of the work br which Ihis permit is issueq I shall not employ any person in any manner so as to bocome subjec� to the workers' "\ compensatlon laws oi Celifomia, enE epree thet II I shoulC �ecome suD�ect to Ihe workers' compensation provisions ot Section 370 ot the abor Code, I shall lorthwlth comply with thesg.pro�sio� � `, Appllcant SigPeture: l� DOte: V WARNINO: FMW RE TO SECU WORKERS' COMPENSATION CpVEMOE IS UMAWFUL M'� SHALL SUBIECT PN EMPI�YER TO CRIMINPL PENA� ES AN CIY0. FlNES UP TO ONE HUNDRED TIIOUSAND DO�URE (5100,OD0), IN AODfTIIXJ TO THE CQST OF COMPENSATIIXJ, DMMGES AS PROVIOEO FOR IN SECTIIXJ 3]OB OF THE UBOR COOE. INTEREST, AND ATTORNEI^S FEES. IICENSED COMRACTORS DECIARATON: I horeby aHirtn that I em Ilcensetl untler proWsions ol Chepter 9(commencing with Section 7000) ol Divislon 3 of the Business antl Professions Code, end my Ilcense is in tull torce entl eMect. Llc. p Class q Contractors 5�gneWre: Date: CONSTRUCY��N LENDING AGENCY: ❑ I hereby eMirm ihat Ihere is a constructlon lentlinp agency lor ihe peAortnance of ihe work lor which ihis permit is issueG. (Sec. 3097, Civil Cotle). Lentler's Name: Lender's Atltlress: Signature: Dato: OWNEH-BUI4DER DECLARATIONS: 1 herehy aNim+ l�et unde� penalry ot per�ury that 1 am EXEMPT FROM THE CONTRACTORS UCENSE LAW tw the lollowtng reason (Sea T031.5, Business afM Pmtesslons CoCe: Any city or counry which requires e permit to construd, e�ter, improve, tlemolis�, or repair eny structure, prior to Its iuuance, elsa requires the appliwnt tor such permlt to file e signed stetement that he or she is IlcenseG pursuam to l�e D��ans ot the Cantrecrors LJcense Lew (Chapter 9(commendng wilh Sectlon 7000) of DIvlSion 3 of the Business end ProlesslonsAode) or Nat he or she Is e:empt therefran and Ihe besis for Ihe elleBeA exemption. Any NWaHon of Section 7031.5 by any applicant for e pertnil subJects the epPlicem to e cMl penalry of not mora than five hundred doliars (5500).): ❑ I, as owner of t�e property, or my employeas wl�h weges es their sole compensatlon, WILL DO TME WORK, entl the strucwre Is not imentletl or otlere0 for sele (Sec. 7044, Business enC Professions Catle;The ConlreMors License Law does not epply to an owner of property who builds or improves lhereon, and who does such work himselt 0� hersetl or ihrough his or her own �employees, provitletl �het such improvements ere not intendetl o� ottered for sale. It, however, the builtling or improvement is sold witPin one year ol completion, Ihe owner-builtler will have the burtlen af pmving �het he or she did not build or improve tor purpose ot sale.). � ❑ I, as owner ot t�e pmperty am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTNACTORS to construct the projeci (Sec. 7044, Business and Prolessians Cotle: Tde contrectors Licensa Lew tloes not epply to an owner ot properry who builds or impmves t�ereon, end who coMreds lor such pro�ect with a comractor(s) Ilcensa pursuant to the Contractors License Lews.). ❑ I em exemp�ider sec. Signature: �� Owner ID vedfied by (�frvefs Iicense. Verlflcation ol �wnership by (rype oi Business entl Professions Cotle tor Ihis reason: s ❑ No Ddvefs License No. i.e. - property tar bill or tleetl): DIVISION OF INDUSTRIAL SAFETY AERMIT CERTIFICATON: ❑ I hereby cenity that no excavetion fiva (5) or more leet in depth into which e person is requireA to descend, wltl be metle in connection with work authorized by Ihis permit, a�tl �het no building structure, scaHolAinp, lalsework, or demolltion or tlismantling �hereol, will be mo�e then Ihirry-six (38) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TItlO B, Calilomla Atlminlsiretive CoOe). ❑ As owner�builtler, I will not employ enyone to do work which woultl reQuire e permit Irom the Division ol Intluslrinl Sefety, es noted ebove, unleu such person �as e permit to do such work from the tlivision. Signeture: Data: Divislan of Intl�sirial Selery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AIJTTIOR¢ATION OF ENfAY: I certify untler penalry of perjury that I have �ead this epplication and state that the infortnation gNen is correcL I egreB to compty with ell state laws entl ciry ordinances relating to buil0ing constructlon, end authonze �epresematNes ol t�e Ciry ol Costa Mesa to enter upon Ihe ebova-described properry tonr insp�ec�n puyyses. I egree noi to occupy or allow occupenry ot eny builGing eu�horized by ihis iert/�i� nY ti��ction. // f G1 C C;VI--�� l ) S ature Of Legal Ownar(s) �— Date Antl/Or AUlhodzed Applicant GOpE�. INSPECTIONTYPE Q�¢ �$ 1818 Fixetl System Flnal Fire Preventlon 12fi8 Pool SPa Final 200 Finel Re-Root 201 Flnel 91acWRetaining Wall 202 Finel Factory Fire Placa 203 Final 51gn 204 Final Demolitlon CODE� INSPELTIONTYPE 206 Finel Mec�anical 20B Flnel Plumbing 210 Final Electncal 212 Final Flre Preventlon 220 Final Planning Apprwal 222 Final Slte 250 Final Builtling/Occupency PAIE II�AL@ L� t � I � / '�/ 1�., / i ' • I OWNER-BUILDER VERI'FICATION A city or county, which is reyuired to give notice pursuant to Section 19830, shall attach to such notice, and, as a condi[ion precedent [o issuing a building permit, reyuire the completion and require the re[um of, an owner-builder verification. Attention Property Owner: An `awner-builder' building permit has been applied for in your name and bearing your signa[ure. 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 buildine permit will be issued until this venfication is received. I. I personally plan to pro 'd e major labor and materials for construction of [he proposed property improvement. Yes ❑ No 2. 1(have/have noQ signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firtn) to provide the proposed construction: Name Address Phone ( City — Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person ro coordinate, supervise and provide the major work: Name Address Phonc ( City _ Contractor's Lic. No. 5. 1 will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name 1062-06 (REV.958) Address Phonc Type of Work A': d �, J a I 2� I C W E d N � � w I 0 ��!�i v7v �N{Li.4T' ��'W�' ��ww�w� ��(f��ii V BUILDING PLAN REQUIREMENTS FOR ATTACHED PATIO COVERS (Note: Detached patio covers require an engineered design.) ❑2 P.L. Feet . �il�n �� Post (tYPJ � ■ ■ ■ � Edge of —� _PROPOSED STRUCTURE� _ Qq palio cover - — -�� '� I Garage ❑3 ❑2 House a �--- - - � - - ❑2 P.L. Owner IfGA TRAN Street Atldress 3�8 GAR��6�jj A�� F$U Cosi A M�SA ci4 9z�SI�.�,� De � INSTRUCTIONS - 3 COPIES MUST BE SUBMITTE�e Using this as an example draw your own plot plan on �❑ Show owner's name, projed addr rf�� '�pa{ nI� 2❑ Show and dimension all �i ,��1�p1J@� �ts and Q Show locations of existing�� ctuf�GM1$ 4❑ Show dimensions of propo ru yp�P�e�b� 01 50 Show setbacks from propert�q'�1��8� o y p (3'-0" min.; veri(y if Planning �Ap1.1�01'� fiase v ❑6 Dimension overhangs ,,,,�,ytvfl 2733-46 Y OF STA MESA PLANNI D[VISION SUBIECT TO DG. DEPT. REG. NOTE: ADDIT[ NS, DELETIONS, OR CORRE ONS SHALL BE PPRO ED E PLANNING DIV. Y• � DATE: � � �(0� _� $ � MES ' � p��o � d� 3�� a� �� hqtoba 5��01aW �..t�e'AIoP�„�eac�N°� _ .,,beo� ��m�� V��d�,^ bea'� � �+'1 /-! 1 aP� �`J �—r. ��. Lattice Cover Lattice � Lattice Solid Floor Cover I L Roof Covering 26 Ga. L Roof Sheathing FRAMING PLAN Header Joist Hanger I T� �_ Post �; � �! ( �� 2% �Slab " 1O Slope A� u. Af?U'. '1Ct Y to D♦rain'' (�`S��5-- - - - --/ �•f .I I�i .1 1:.1 3.� < V 1 • Laf i e .GNOiT_i.1:.•:�o.vef 'TIQQP. :iN LIA►17.'I.Sa(�IT..�NAA(', FY LUMBER: ❑ DF ❑ Redwood ❑ Hemfir FY GRADE: ❑;�t�of,?� ❑ No. 2 ,� � RETEi'2500 psi mm. @ 28'days -" —' c � � Roofing 12^ Sheathir O � Joist Hanger Ledger — Solid Roof Cover � 2% Slope to Drain V \ l.'j — ��p ( 1. Roof covering: � ""A Slope:_�:12 2. Roof sheathing: Maximum spans: lattice: x_ @_" o.c::.. 2x2 - 6'; 2x3 - 8'; 2x4 - 10' solid: CCX plywood or _" lumbe� 1" - 2' - 8"; 2" - 8' - 0" 3. Rafters: �x� @ �" o.c. �Singlehl�qub�e� 4. Header: 7 X2x� ❑Single- Double �� l�, 5. Ledger: _x_�c,(2z'min)._ `� ✓ [ : ' �� , ,, �'t )! _•, i. � . . � r!(, � � 6. Fascia: :L• x�h',(2x6min).�� '��: � ' ' '; - : r; , .nPrn. , �t 7. PosC x� (4x4 min)rRaise' 1. �mi �atioveslab surface 8. Fooling: �x 12"x12" min fo� up to.66 sf:fributary�area; 18"x18" min for 67-150 sf tributary area " deptn (Expansive, Soil Zone ��,, 'vc :, 9. Slab � " thick (ExpansiveSoil Zone _� �' ''� . • � ' � 10. Connections: a. Joist to L'edger . � t;� ,� _ Metal joist fianger � '' b. Joisl to Header '�" '!:.., �"= Solid blocking with framing'anchor c. Doubled joisi or header to'postr.=,(2)�1/2' dia: tFiru bolts w% washers d. Joist to Fasda - Metai freming anchors each side (min. capacity = 0.5" joist span 'joist spacing7 15j ._ e. Header to Post - Column Cap "'� � f. Post to Slab or Footing - Metal Anchor/Post Base g. Roof Sheathing - 8 d@ 6" o.c. Edges and 12" o.c. Field � . 'A DETAIL OPTIONS Check the ones thal appy: LatGce Cover. ❑A ❑B �C OD DE OF Solid Cover: ❑A ❑D OE ❑F Z»� ��, ,ss� uec SPAN TABLES LATTICE PATIO COVER SOLID PATIO COVER 1997 UBC 2]7]-C6 Ta01m ��. .�rl .n/ _ � 4 .Z � � � N � � = 3� �, x� �� :�a �. � � r �� - ��'� � �k � �-- �' --�> �-� I � i i I I ti,� � �� :.: �� r�, v �.1 s w�e � �e- C�Y�n. $- �Y.N� 0� � u L� � • ^°� �- $ �- 36�--�-_. .X. � � q ��+> i �- �%� � � I �i.�,;��.��„ � � �;;��.��;, ��„ ��:,�.� � �� ' � �= - �� '�"\ i\ \ � 36' --�> \ � ` `., \ � �. , / ` `� � � ' " '� 1 ` � !` : \ ` ''� .•\ � � i ''. � � � �. •,•,v- i_`T • �`\ i '. ; � . / \ \ � /�� . . \ � . �� % � •'�\\, .�� .\ `:�OU�� /, �/\ �'_.\.��`\ i• . . •� -�/� `,L,,�/`�j �.� � '�.n\/V / / /t�� / \ �,� %�. . �"�^—�-- �="\'""�. �; � :�;'- . .- , �-•--'- - "' , .-_ -_____._.__---- ------=� � '.-� =��'--,� �==,=�-�'=.-`' -,_� . _. � � .�.._`�� _%< .__ �'`� , =' ---- � � � � Pfl0.1ECTA0DBESS: jOZE GARFIELD AV aWNEfl'S NRME: NGUYEN, DUC NGOC aooREss: NGUYEN, HONG C 5402 W BALLAST AVE SANTA ANA,CA 92704 IAHCHIENGINEEfl: � RDOPE55: flEG.NO.: uxit: I1NIT: PENMITTEE: DUC NGOC NGUYEN ( 714 ) 839-7080 aooaess: 3028 GARFIELD AV C,M, CA 92626 ULENSEO CONTHACTOfl OECLANAiION: I hereUy allirm thal I am licens¢A untler pmvision5 of CtuO�e� 91�ammencinA wilh Seclion 7000� ol OiNson 3 of i�e Business ana Pmlessions Coae, anA my license is in lull loae an0 eltect. LITV UC.: STRTE LIC.: ClASS: Date: Signature: WOPNENS' COMPENSATION OECLAPATION: I here�y ailirm ihat I �ave a cenilicate of consent to seii-insure or a certilicate ol Workers' Compensa�ion Insurance. or a cenilie0 copY �hereol �Sec�ion 3800. La�. C�. POLICY NO,: E%P. �RTE: COMPPNY: � Cendied cOpy is �ereby Iumi5he0. ❑ Cenilietl copY is filed wit� lhe city BuilOing �ivison. Da1e: ��cant: E%EMPTION FPOM WOHNEflS' COMPENSRTION OEQAflFTION: (ihis sec6on nee0 nat be mmpleleA ii Ihe permil B for one hunErM (51 W) or less�. I cerlity ihat in ��e pedormance ol t�e work �or which Uis Oermii is issueq I stwli not employ any person in any manner so as lo became sublec� Io Ihe Workers' Compensalion Laws o� Calilomia. Date: Signamre: NOTILE: If, atler making t�is Aeclaration you should �ec9me su�iect to t�e Warkers' Campensatian D�odsions at ��e La6or Cotle, you mu5i Iorihm�� comDl ' pmvismns or �ms permi be tlEemed revaked. LONSTHIlCTION LENOING R : I here�y allirm that there is a constmction ' g agency for ihe pedormance al Ne work lor whic� Ihis permit is Iss Section 3097. Civ. C). AREA ADDED OF ROOF ONLY �` OWNEN BWLOEB OECUMiION: I here y�hr I am eKemo� ��o �ctors' Sta�e License law lor tne Iollowine reason (Seciion 7031.5 Business anE Pmfessianal Cotle: Any cily o y w ich requires a permil to con5tmct, alter, improve, tlemolish, or repair any slNciWe. prior lo ils issuance. atso repuires Ihe applicant for such permit to lile a signe0 slatement ihat he/she is licensed Dursuant lo I�e pmvisions oi Ihe ConvacmK S�ale License Law �COapler 9(commencinp vnl� $eclion 7000) oi Uivision 3 0� Ihe Business anG Pmlessions Cotle) or �hat �Us�e is ecempi therelmm and ihe basis for i�e alleged e�emption. My violation ol Section 7031.5 Uy any ap0licant for a permit subie��s ine applicant to a civil penal�y ol not more than live nunOreO Oollars 1350(I). I, as owner of t�e O�opetly or my employees with wages as itleir sole comDeosation, will Eo Ihe work, and ihe ❑ stmclure is nol intended or oifere0lor 5aie (Sec�ion 7044. Business antl Professional CoUe: The ConVaciors' Siate License Law Go¢s nol apD�Y lo an owner ot a D��Verty w�o Euiltls or improves �hereon, an0 who does such vrotk 1limselVherselt or thmug� his or her own employees. DmviUeO t�al such impmvements are noi intenaetl or aflered lor sale. II, however Ihe building or impmvement is 5old vnt�m one year ol tomple�ion, Ihe owner vnil haVe �h¢ bUrden ot proving he/5he Ai0 nai �uild or improve �or �he purpose ol sale�. � I. as awner of ��e D�apetly, am exclusivel9 conVaciing with licensetl contracmrs m cons�mc� ��e pmle�� (Sec�ion 704a, Busineu � anC Pmlessions CaOe: The Contracmrs' State License law Ooes not appty m an mvner ol DmpertV wlw bwltls or improves ihereon ' antl who contracisior such pmlecis with a conVactor�s�litense pursuantio ihe Conlraciors' S�a�e License Law�.l am aware � I�al D�ool ol Iheir Warker'S Compensa�ion insurance shoNd �e pro�ieetl m me. � I am exempt unaer Seciion: 8. 8 P. C. lor I�is reason: p A ,� , � / oate: � — ( � ^ � Ownec li'. i �/ ( q �� ^/ � I do �ereGy ceriity Ihat I �m aware of an0 unCerslantl �he repuiremenls al Calilomia HeallM1 n0 Safe�y Cotle ec�ions 550.5, 25533, antl 2553E and Ihalloranylulure EuilAinA a��UDaniwill/willno��tirCle one) neetl�o fAmD�Y ��h SaiG Sfa12 w0e5 antl Nefeduiremen�s lOfa permil lor can9mclion oi mo0ilica�ion Imm Ihe Air Ouality Managemeni Dis�rict. ResiEenlial consimciion apDlicalions are eeempi Imm I1125C pf0VIS10115. �(7 /� � Daie: ��(.� Applicant: I hei¢Ey cerldyi�all haver¢atl Ihis applipalian antl Slale Ihal Ihe a�ovein�ormalion is CorreCL I aA�ee l0 campty with alltiiy antl counry or0inance5 a`M slate Wx5 relatingla building construclion antl hereby a�hor¢e represenlaiiv Sa�llus CiryiO enieruponiheabove�men�iDned pmDerly lor inspeclion pur0ose5./% Date: � -- � �� —f �' Signalure: Orivefs Li[ense or Soual Security .: 16aFa6 Whne—Builtling; Green—Co�e EnlorcemenC Canary—NpP��anC Pink—Revenue; GdEenroC—Awessor CITY OF COSTA MESA — BliILDING PERMIT PERM NO: B USN183 PERMIT NO; B_ 0581$3 PLAN CHECK NO; 02653-92 S GOVT: N SUPP; N CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: ALT JOH DESCRIPTION : CHANGE 560SF GARAGE ROOF FROM FLAT TO SL SQ FT; 560 CLAIM VALUE: 7,000.00 CALC—VALUE: 8,288.00 GROUP OCC; M-1 / COMMtNTS: REROOF NEW SLOPED ROOF W/COMP SHINGLES ��q� �r �� r**�r�r�r�r*�r�**��t�rx**�*�e�r*�r�r�r**�**�r±r�r�r�r**�t*�t�r**�r�t��r�r�t��r��t�r*�E. ►eM p'�*L* Z O N I N G R E Q U I R E M E N T`S S E T B A C K S ��!'1111�,t,�� drl V 0 I{� ------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING ---------�^^ FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT TN PARItING REQ• PROV; PARCEL; 14113305 ZNE: R1 REF NO: PLANNING Nd�ES�, CHANGE EXZSTZNG FLAT GRAVEL ROOF TO SHINGLE GABLE ROOF, f. > r *�E i! jE iE 1F iE if if ** iFlf iFdfriE iE ih iE iE # it iF #F iE iF IE X� iE 3F iF iF iF iF if iE iF I't 3E �E 3E iEjF 3FlF If �E if- 3F IE+E 3f if iE * if %� 3f �1F 3F if �IF if iE 3E �E fF if-�6iF 3E �� iF 1E 3E iF 1E If iE D E 11� E;L O P M E N T S E R V I C E S R E Q U I R E N E N;T S ZONING APPROVED BY Cy `�_ DATE; �� ti BUILDING AP,PROVED BY : DATE: �a APPLZCATION,r,S$UED BY: DATE• �� t 1E i! 1t i4 k iE if iF iF if k3E �F af�iE iE if IE if iE if 1k iFiFiF'iF'iF7FiF iF?F if'iF'3F'iF �3F7FTF�F �h�FiFiF ''3F 3FTF7F�FiF�7F1F i4 if 1E iE iE ie if if �'r if # if ik aF i! 3F if� 1F fE if iE IE 41f if if aE if i! if ik Y� M if if if iF �F if k if if #f k if iP lf ik * ff iE if �f�iF it #f iF 1k iF if iE R iE af iF ii if IE iF ik if iE IE 1f-� iF iE ik if iF iF if M` IF If iF IF if } if LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLI]MBING ELECTRIC MECHANIC PIRE SMIP/R� GRADING PERMIT 108.00 .83? SMIP/NON�RES PLAN 70. 20 ,. t, ISSOE FEE BUILDING—DIV—> PERMIT ISSOE PLAN—CHECK TOTAL PAID �� DOz TOTALS----> 108.83 0.00 70,20 179.03 179.03 ,00 REVENUE DIVISION TOTALS--> COLL�ECTED; 179,U3 OVER/SHORT: i�� .00 BLDG PMT PLUMBING ELECTRIC .NECHANIC FIRE SMSP/TOT GRADING �RLAN—CHECR 108,00 ,83 �i^ 70,20 it iEif if 3E 1E iF if iE iF IE iE 1Eit iE if ik iE �E iF iF i61E it iF !i iE if 3f iE if if if 3F IE if 9E if iE 3E 3F 3f �F1E if iF iE ih iE 3f iE 1F jE N� if i(� iE if if iFik iE iF if iE 3E iE aE �E if jE �E iE � if ic jF je 34 I N D I V I D U A L F E E B A E A K D O W N J TYPE QTY D E S C R I P T I O N UNIT COST •�OTAI, COST SFR 560 DWE—INT. ALTER TYPE V—WOOD FR —GOOD 14,80 � 8,288,00 END OF FEES � �� =i ^,��. . _a. . _ -.�-- _ . C I CONSTRUCTION AN�"PLANNING POOI PA APPROVALS Permit #' Date i�spector qppROVAIS Permit # Date Inspector t. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. � 53. Steel Reinforcement 3. Electrical Con4uit Utility�Undrgrnd. . 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Eiectri�al 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. 70. Structural Floor System 67. APPROVAL TO DECK 71. Property Sewer Line & House Connection 62. Backwash & RoceptorFinal 12. Sewer Cap 63. Heater & Vent•Final 13. Roof Drainz 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical�Final 15. Rough Electrital-Conduit 66. Solar System-Final • i E. Rough Electric W�ring 67. Fe�cing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling 69. POOLISPA SYSTEMS FINAI 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilatin9 77. Product Pipin9 CJGas ❑Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing ?..l�Z �(L 73. Undergrnd. Siorage Tank O Gas ❑ Oi� v 25. Roof Sheatfiing ?�� L �w� 74. Overhead Hydro 26. T�Bar Ceiling (Structurall & 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. Orywail 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 CanopV 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 Irr�aation System 45. Sound Attenuation - 46. Handicap Regulations 47. FIPIAL STRUCTURE $ BUVLDiNG p_�t�i �,,,,� S�a�� .�� 48. FINAL PLANNING 49. Electric Release to Edison , 50. Gas Release ta Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CiTY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATION A city or counry, 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 provide the major labor and materials for construction of the pro- posed property improvement. O Yes ❑ No 2. I (have/have not) proposed work. 3. I have con�[�r\ac�t�ed� Name �l ��-(_ Address �L2 L Phone ('j�Y) � signed an application for a building permit for the with the following person (tirm) to provide the proposed construction: // U� / City Contractor's Lic. No.. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name _L Address � Phone (`j ly ) City � ��-- Contractor's Lic. No. 5. I will provide some oi the work but I have contracted (hired) the following persons to pro- vide 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 per- sonal knowledge, 'n compl''�1an'c-e with this State law. b Signed: — �Ul "�15t Q`✓ Date: � — �� r `7 L— Name: (Printad or Typed) C.D.L. N or S.S. # �,� 754-5273 DATE BUII.DING PERMIT NO. ON OF WORK pdd Bdrm & Ba.t'. ZONE VALUE $E>,�#E2.00 OUP 7 TYPE v ZONE SUBCONTRACTOR r- = " 28282 �,a-6-6a�„"—S�oo ,z6� ****36.00 COSTA MESA BUILDING-SAFETY DEPARTMEt�R P.O, BOX 1Z00 � GOSTA MESA. CALIFORNIA 92636 LOT 62 TRACT �2 Z __-; � ��s� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. GALIFORNIA fOR APPL/CANT TO f/LL /N C�MPLETECY TYPE O PRINT � -�° BUILDING ry �C AODRESS Q COSTA MES . CALIFORNIA nooaess �555 PLACENTIA KAVENUE TEL. ciTv w oRr B A No. M AR�=HITECT LIC. C 1GINEER NnNc NO. CENTIA HVE AD�LEGAL $IZE / 1 � NO.OF BLOGB.o OF LOT OO X � OO rvow oH �oi USE OF EXISTING BLDG. NONG SETB>CK LINE iROM � . CENTER OF STREET � � REAR YARD� LL SIDE YARD ILEFT � IR�GHT � �� DESCRIPTION OF WORK � NE` ftEPAIR I II MOVING I II DEMOLISH BUILDING '1 NO.OF SIZE �400 SQ.FT. ROOMS 7 STORIE: EXTERIOR WALL ROOF COVERING SmUCCO COVERING ROCK 1/5E OF BUIIDING AND WORK TO BE PEftFORMED SINGLE FAMILY RESIDENCE AND ATTAC GARAGE I HEREBY ACKNOWLEDGE THAT 1 HRVE REAO THIS APPLILATION ANO 6TATE THAT THE ABOVE IS CORqECT PND AGPEE TO COM� PLY WITH ALL CITY OFDINANCEB ANO STATE LAW9 REGVLATING BUIL�INO CONSTRUCTION. SIGNATURE OF _� � /J �O— PERMITTEE L �� AUTHORIZED AGENT FEE RECE11lED � SEP27?969 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING FOR OfF/CE USf ONLY flECE1PT NO. I v PERhIIT NO, d-�'�l�Sl IVEO BY � OAiE ftECEIVEO � �DA2E.185OEI COSTA MESA. CALIFORNIA /a\9J:81/��] ZONING ZONE NO.OF ^J U6E OF NEW R '� � PLAN6 ` BUILDIN� APPROVED (CENTER LINE ST.� L. SIDE � FT. RFAR • � FT L� � TNE AMOUNT BHOWN UNDER VALl1AT10N 18 FOR THE PURPOHE OF E9TABLISHING p PERMIT PEE ONLY. VALUATION � PERMIT FEE $ 7 L/ $ /' ) �� PLAN CHECK $ � 7� � � �j� TOTAL FEE $�p7�J��