HomeMy WebLinkAbout908 PEACE PL - Building PermitsCITY OF COSTA MESA
��pMFs'q BU/LDING DIVISION
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 • 014) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
° � FOR INSPECTIONS CALL: (7'14) 754-5626
'�°"°"°`� PERMIT NUMBER: M10-00080
PERMIT TYP� MECH STATUS: ISSUED
APN: 41805249 DATE ISSUED: 08111/2010
ISSUED BY: RMD
JOB ADDRESS: �9Q;,�8'PEACE'PL—C—M
Vicinity: REAR YAR� �
SQ. FT: 0
Suite/Unit:
SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT AN EXISTING A/C UNIT LOCATED AT REAR YARD. COMPLIANCE
FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: H�RNANDEZ ROBERTO A
PHONE: 909-519-8970
APPLICANT: HERNANDEZ ROBERTO A
PHONE: 909-519-6970
CONTRACTOR: OWNER-BUILDER
Address: Unit PHONE:
City/State: ZipCode:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
Add2ss: 908 PEACE PL Unit:
City/State/Zip: COSTA MESA, CA
Address: 908 PEACE PL Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CE�L:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § i, 12-21-92)
EXPIRATION: P�RMIT EXPIRES'180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CO�Et. INSPECPONttPE DATE INTIPALS GOOEM INSPECTIONTYPE OAT@ INi111R
1616 Fixed System Final Fire Prevention 206 Final Mechanical ���J�C �.�� �
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Pinal Electrical
201 Final Block/petaining Wall 212 Final Fire PreveNion
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/pccupancy
r.
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalry ot perjury one of the following declarations:
❑ I have and will maintain a certi6cate o( consent ro sel4lnsure for workers'
compensation, as provitletl (or by section 3700 of lhe Labor Code, for lhe
performance of Ihe work (or which this permit is issued.
� I have and will maintain workers' compensa�ion insurance, as requiretl by
section 3700 of Ihe Labor Code, for the perfortnance of the work for which this
pertni� is issuetl. My workers' compensation Insurance carrier and policy
number are:
Cartiec
(Tl�d'seUon neetl rol Ee mmp'efetl4lhe pemr4 is vaW2tl a( me h'mdKV WFars (5100) a les5.)
Policy Number:
il��l certi(y that in Ihe pedormance of [he wnrk (or which this permil is
�issued, I shall not employ any person in any manner so as to become subject
ro the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensa[ion provisions of Section 3700 of
[he L or Code. I shall fo with comply with these provisions.
�Appli nl' 9gnalure ' O. Ie�J
v—
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT 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, INTEREST, AND
ATfORNEY'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby aKrm ihat I am licensed under provisions o( Chapter 9(commencing
with Seclion 7000) o( Division 3 0( the Business and Prolessions Code, and
my license is in full force and eHect.
Lic. # _ _. _ _ Class #
Contractor's Signawre
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(frm that Ihere is a cons[mctbn lending agency fa the
pedortnance of the nork fa wfiich this permit is issued. (Sea 3097. Civil Code).
Lender's Name:
Lender's Address:
Signature
OWNER-BUILDER DECLARATIONS:
I hereby affirm ihat under penalry of perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit lo
consWct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to (le a signed statement
Ihat he or she is licensetl pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Seclion 7000) o! Division 3 of the
Business and Professions Cotle) or Ihat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permil subjecls the applicant to a civil penalty of not more than
five huntlred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the sUucture is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply m an ovmer of property who builds or improves
thereon, and who does such vrork himselt or herself or through his or her ovm
employees, provided that such improvements are not intended or ofleretl for
sale. I(, however, the building or improvement is sold within 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.).
�IIa--I;-as ovmer o( lhe property, am EXCLUSIVELY CONTRACTING WITH
�LICENSED CONTRAC70RS to conslruct the project (Sec. 7044, Business and
Professbns Cotle: The cont2ctors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts for such project with
a cont2cta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code tor this reason:
� !/ ^� v
(� fld illB `••_.3` 'lt ' `....�6�'a^.+ .
]059-461�/0]) `�^'— .
-.
Owner ID verified by dri r s license. Ves ❑ No
Oriver's'Cicense�No. � .Expires:;- Z �1 O
Verification of Ownership by (rype o( document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certiFy thal no excavation frve (5) or more feet in depth in[o wfiich a
person is required to descend, will be made in connec�ion vrith work authonzed
by �his permi�, and that no building sWcture, scaffdding, falsework, a tlemoli�ion
or dismantling thereof. will be more than Ihitly-sa (36) teet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Cali(omia AtlminiSlralive Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Industdal Sa(ety, as noted above, unless
such person has a pertnit to do such work (rom the division.
appliwnt's SignaWre
Division of Industnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or presenl or fuWre builtling occupant need to file and
certify a Business Plan for emergency response to release or threatened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(e[y Cotle requires, with some
exceptions, that a Business Plan be filed wilh the Costa Mesa Pire
Department by every business which has at any one time during a reported
year a quan[i[y of hazardous malenals equal to or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
at standartl temperature and pressure).
2. Does or will the applicaN or present or fuWre builtling occupant neetl to fle
a registration form (or acutety hazartlous matenals7 ❑ Yes ❑ No
(Sec[ion 25533 of the Califomia Heallh and Satery Code, with some
exceptions, requires registration vdth the Costa Mesa Fire DepartmeN by
each business which at any one time has on hantl a quantity of acutely
hazartlous materials equal to or grealer than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature and pressure).
3. Does or will the appliwnt or present or tuNre builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous materials)? ❑ Yes ❑ No .
(Section 25534 of the California Health and Salery Cotle provitles that the
Costa Mesa Fire Department may require the preparation, certification and
filing with lhe Fire Department of an RMPP by businesses which are required
to regis�er acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 0( the Cali(omia
Health and Satety Code been tully complied vrith? ❑ Yes ❑ No
5. Does or will the applicaM or preseM or IuWre buildin9 occupanl require for
the work which is ihe subjec[ of this application a permit for such consiruclion
or modification from the South Coas[ Air Ouality Management Distric[ or from
any ofher air polWtion control districl or agency? ❑ Yes � No
(Sectbn 658502 of Ihe Califomia Govemment Cotle requires thal the requesteC
information be fumishetl on applications for non-resitlential building pertnits).
6. Will any part o( Ihe facility to be constructed under this pertnit be vnthin
1000 (eet from [he outer boundaries of a school? ❑ Yes ❑ No
(If "yes". the facility must meet Ihe requirement of Sections 25534 and 42303
o( the California Health and Salery Code).
7. If a permit from the Soulh Coas[ Air Qualiry Management DisMct or other
air pollWion control distdct or agency is required for the v.ork which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 Deen made? ❑ Yes ❑ No
8. Qf "yes". attach certifcate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I cenify lhal under penalty of perjury the
in(ormation given above is correcL I agree to comply with all state lavrs antl
city ordinances regarding Hazartlous Matenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I
certify under penalry of perjury that I have reatl this application and state that
the information given is correct. I agree to comply with all state laws and city
ortlinances relating to Duiltling construction, and aulhorize representatives o(
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
a h ri ed y this permit til final inspection.
_ � �// /U Y
S�gnaV.ure e a Owner(s) - °�aie - "—'�
AntllorAut�ar¢etlAppbcant Date
Certificat- � Compliance: 2005 Residentlal HVACAIi. ous CF-IR-ALT-HVA,^ �
« a
Iand3-7
Ll Yackagetl Um� /�,
❑ Fumace ❑ AFUE 7 ��
❑3ndoorCoil �SEER�
�ondensing Unit ❑ EER i
Conditioned Duct
Efficienc�� FloorArea re �
p CQp Qver 40
O HSP� Serve � system added��
❑ Resis[ance sf �nyc ndii
lla"R 6 !
Themiostat
❑ SetbacA
(Ij�mtob'eadrpr'eseut, nmstbe
irrs(al(edJ
/. Equipment Typc: Choose the equipment being insialled; if more than one system, use another CF-IR-AI.T-HVAC for each system,
2. Minimum Equipmen[ Efficiencies; 13 SEER, 78% AFC7E, 7.7HSPF for typical residential systems.
Contractor (Documentation Aut6or's /Responsible Designer's Dedaration Sta[ement)
• I certify that this Certificate of Compliance documeniation is accurate and complete.
• 1 am eligible under Aivision 3 of the Califorttia Business and Professions Code to accept responsibility for the design identified on this
Cenificate of Compliance.
• I certii�� that the energy fea[ures and pedormance specif�cations for ihe design identified on this Certificate of Compliance conform to the
req�irements of Tit1e 24, Parts 1 and 6 of the Califomia Code of Regulations.
• The desigs� features identified on chis Certificate of Compliance a�e consistent with We information documented o0 othec zpplicable
� compliance forms, worksheets, calculations, plans and sQecifications submitted to the enforcement ageucy for approval with the permit „
P
200d' Residentia! Convpliance Fo�mis
SignaNre:
///U
Marclr 2010
-. . . �.-�- _... .. . -^-__�._
(ENFORCEMENT AGENGP ,�.,
� . ` CAN.C'c7STONIIZE YPITHLETTERKEAD/SEAL)
200$ Bnilding Energy Efficiency Standards Residenfial HVAC Alterations
Climate Zones 1 and 3 through 7 �z-6 � GAfr�nPSF,�
BUSINESS AND PRQFESSIONS CODE, SECTION 7110 .
Willful or deliberate disregard and violation of the building laws, including the Califomia Suilding Code, and
local permit requirements constitutes a cause for disciplinary action from the Contractors Staie License Board
working in conjunction witli the local building department. This action may consist of fines up m$5,000 per
violation or suspension/revocation of a contractor's license.
VJIiEN IS A P�RMIT REOUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erec[ion, construction,
reconsttvction, installation, relocation, or alteration of any mechanical system, except as pernutted �in Appendix
Chapter 1, Section 112.2 of the 2007 Califomia Mechanical Code. Projects requaing pernvts include, but are not
limited to:
• New HVAC installation
• HVAC Changeou[
• Replacement of fumace, coil, FAU, or condenser �
-• Relocation of an existing HVAC unit .
+ Adding or replacing more than 40fr ducting in unconditioned space
20�8 BUII.DING ENERGP EFFICIENCY 5TANDARDS lTitle 7A. Par[ 61 REOL7IREMENTS INCLUDE:
1. Heating equipment must have a min'vnum 78% AFUE (Exception: Wall & floor furnaces; room heaters),
2. Centtal air conditioners & heat pumps less than 65,000 Btufhr must have a minimum 13 SEER. -
3. Newly installed or replaced ducts must have a minimum insulation value of R-42.
4. A setback type thermostat (24 hr clock with four set points) is required for ail alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
�• All joints and ope�ings in the in the HVAC system must be seaied.
+ Only UL 181, UL 1 S lA, or UL 181B approved tapes or mastic shall be used to sea] duct openmgs.
.�• Connections of inetals ducts and the inner core of flez ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every Rft. max for horizontal runs with no more than 2"
of sag between supports and 6 ft, max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installina contractor. The Tnspector will collect
this form and verify that the model numbers are the same as the installed equipment.
..�
_
,i=-= -��a
�_�1 City of Costa �l�lesa BuiCding l�ivision
77 Fair Drive, Costa Mesa, CA 92626
�CJ�C� esa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
-- � �i y�r
Disclosures 8� Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been b itte in your nam isting yourself as the builder of the
property improvements specified at _� �.,[1�!/ l
We are providing you with an Owner-Builder Acknowled ment and Information Verification Form to make you
aware of your responsibiliiies and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�1._I�understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder'-building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
T�)._ 2._,I understand building permits are not required to be signed by property owners unless they are
`responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
��3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I�may�protect myself from potential financial risk by hiring a licensed Contractor and having the permit fled in his
or her name instead of my own.
�4.rl=understand Contrectors are required by law to be licensed and bonded in Californ(a and to list their
license numbers on permits and contracts.
�5: I-understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
YI understand if I am considered an "employer" under state and federal law, I must register with the state
an` ^federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�7._I_understand under California Contractors' State License Law, an Owner-Builder who builds single-family
re idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan t, 2009 OB Packet template 1 of 2
# • '
a.. �
�S:I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
Y'�1-9��I,understand I may obtain more information regarding my obligations as an "employer" from the Intemal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
thafl'am the party legally and financially responsible for proposed construction activity at the following address:
�11-1:agree that, as the party legally and financially responsible for this proposed construction activity, I will
a6ide by all applicable laws and requirements that govern Owner-Builders as well as employers.
�"tr12. I 2gree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, /orm notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify the property owner's signature.
��.�. .W-.
Signature-of pro'perty owner � . �� q _ � Date� / � /
. _
Note: Tha following Authorization Form is requi�ed to be completed by the property owner only when
designating an agent of the p�operty owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
314830 CALBO Jan 1, 2009 OB Packet template 2 Of 2
(714) 754-5273 • Fa�c (714) 754-4856
Job Address: 908 PEACE PL
Suite:
Viciniry:
Parcel Number: 41805249
npp�icant: BURGER, MARK R
Address: 908 PEACE PL
COSTA MESA, CA
Owner: BURGER, MARK R
Address 908 PEACE PL
COSTA MESA, CA
Contractor:
Address:
CITY OF COSTA MESA
svao�N� onr�s►oN
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Zoning: R1 R1
Phone:
Zip: 92626
Phone: 714-754-4004
Zip: 92626
Phone:
PERMIT NUMBER
800-01078
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 07/20/2000
Issued: 07/20/2000
ISSUED BY: �
Zip: License:
Arch : �C)• �� `� ..y �.- a*��.�' Eng: .. ..�..' . -.�.... i, ..
�;'ti,nddr�5s`9`t V • '3�•Sid��--+� �.. �i1 Address: � �
Phone: ' Phone:
Zip: License: License: .
SCOPE OF PERMIT
CONSTRUCT 60 LF, 6' HIGH BLOCK WALL ON THE LEFf SIDE PROPERTY LINE.
BETWEEN 908 PEACE AND 912 PEACE PL.
Plan Check: $29.15
Permit: $44.85
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $74.50
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 40-0
PARKING Existinq: o
NOTES:
r�.� , . ��'. . ^1
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
1.eft 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0. 0
�,� • , :" • % �
si,zoo.00
So.00
I� NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. Na. 92-28, § 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 ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis parmit.
FOR INSPECTIONS CALL: (714) 7545626
v
WORKERS' COMPENSATION DECLARATION:
I hareby aHirm untler penalry oi perjury one of the lollowing declarations:
❑ I have and will maintain e certificete of cnnsent to self-Insure far workers' compensation, as provided for by section 3700 of ihe Labor Code, for Ihe pertormance oi the
work for which this permit I5 i55ued. .
❑ I have end will maintein workers' compensation insurance, as requiretl by secGon 3700 al the Labor Code, for the pertortnance ot tha work tor which this pertnit is issued.
My workers' compensation Insurance carrier and policy number are:
Cerner. Policy Number:
(Thls sectlon need nof be comp/eretl il the permit Is valued et one hundred dollars ($100) or less.)
❑ I certity thei in Ihe peAormence of the work for which this permit is issueQ I shall not employ eny person in eny manner so as to become subject to the workars'
compensetion laws oi Celifornia, entl egrea thet if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith
comply with thesa provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECUPE WORKERS' ODMPENSATION COVEMGE IS UNLAWFlIL AND SHALL SUBJECT Af! EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUN�RED
THOUSAND OOLLARE (5100.000�, IN NUDITION TO THE COST OF COMPENSATIQY, DAhNGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, PND ATTOfiNEPS FEES.
LICENSED CONTRACTORS DECLARATION:
I hareby affirm ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ne Business antl Professions Cotle, and my license is in (ull
torce antl eflect. Lic. a Class N
Contractors.Signature: Date:
CONSTRUCTION LENUING AGENCY:
❑ I hereby aMirtn that there is a wnstruction lending agency for �he peAormance ot the work tor which Ihis permil is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name: Lendefs Atldress:
SignaNre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn ihat under penalty of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Protesslons
Cotle: Any ciry or county which requires e pertnit to conswct, alter, improve, demolish, or repair any swcture, prior to its Issuance, also requires the applicant for such permit
to tile e signeA staiement thet he or she is licensed pursueni to Ihe pmvisions ot ihe Conirectors lJcense Law (Chapter 9(cwnmencing with Section 7000) ot Division 3 of �ha
Business antl Protessions Code) or thet he or she is exempt therefrom enU Ihe basis for Iha allegetl exemptlon. Any violation ot Sectlon 7031.5 by any epplicant tor a permit
subJects the applicant to a civil penalry ol not more Ihan live �untlretl tlollare (5500).):
❑ I, es owner ai the propeRy. or my employees with wages as their sole compensation, WILL DO THE WORK, entl t�e stmcture is not intentletl or oHeretl tor sale (Sec.
7044, Business and Professions Cotle: The Contrectors License Law tloes not epply to an owner of proparty who Duilds or improves thereon, end who tices such work
himsetl or herself or ihrough his or her own employees, provided ihat such improvements are not intended o� oHeretl for sale. If, however, the building or improvement is
sold within one year ot completion, Ihe owner-�uilder wlll �ave the burtlen of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, es owner ot ihe property, am EXCLOSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the proiect (Sec. 7044, Business antl ProfeSsions
Gotle: The contractors License Law tloes not apply to en owner of propetly who builds or improves Ihereon, end who contrads for such prolect with a comractor(s)
license pursuant to the Contractors License Lews.).
Business antl Protessions Code for ihis reason:
�Owner'ID veritibd by drivers licanse. �6j�Y� ❑ No Driver's License No. GEzplres: /O •�'/• zQ.'1Z
Venfication of Ownership by (type of tlocument, i.e. - pmperty taz bili or deed)`% ��1�
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I �ereby cenity ihat no excevation five (5) or more teet in depih into which a person is required to descend, will be matle in connection with work authorizetl by this
pertnit, entl ihat no builtling stmcWre, scafloltling, felsework, or demolition or dismentling thereof, will be more then thirry-six (36) teef hlgh. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Califomle Adminisire�ive Code).
❑ A5 owner-builtler, I will not employ anyone to do work which would require a pertnit irom the Division of Indusinal Satety, as notetl above, unless such person has a
permit to do such work imm the tlivision. �
Signelure: Date:
Division of Indusirial Safery Parmll Number:
CER7IFICA7E OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certily under penalty of perjury Ihat I have read this application and state Ihat the information given is
correct. I agrea to comply with ell state laws an0 city ordinances relating lo building construction, antl authonze representatives of Ihe Ciry ot Costa Mesa to enter upon the
��abova-describetl propeny f r ins ection purpo s. agree not to occupy or aliow occupancy of any huilding authorized by ihis permit until tinal inspection.
� r�. _ ,.�.00
�reture�OYC aI'Own � Date ---�t
� � �'—'_--•.v.t
AnNOr Authorized Applicant Dete
COOE �. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetalning Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
2an8-a6
1j[�jE INTRIALS
40DE♦ �NSPELTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elec�rical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Q/j( NTI RIRLS
• TFQS SKEia{ LS FOR INFORMAl70NAL WRPQ56
ONLY. APPLtGM 6 RFSPONSiBLE FOR PROVIDRJG
AN ACCURA'fE REPRFSFNTA'I]ON OF TF�t PROPFR7Y
iN CASE 7HE SHAPE AND SIZE DO NOT CORRFSPOND
N7Ri THE AIFORMA770N PROVIDID ON 7HI5 SF�E['.
I
• SOUD WALIS/FQJQ�S BEIWEII�12'6• k 6' IN FQ�]C}fT SHALL
BE SETBAIX A7 LFASf 10' FROM FROM PROPERTY LINE.
• SOI.m WALIS/FFNQ�S SHALL N07 H7t� 2' 6' PI FIDCHT
Wfh�110 OF IHE FROM PROPER2Y [AIE (NOT CURB I7NE�.
• VFR�Y DSfAN� FROM CURB I'0 PROPER'IY LINE
ANDSHOWONPLAN. VERIF7G110NFROM77�Q7Y5
LNCIIJEERIIJG D[V610N S REQUIR�. GLL (714) 754,534i
POR IIJFORMATION.
ADDITION$,'��ET10NSOT ORRECTIONS SHqI �I i �Ob D/0�75
BE AP ROV�D BY THE PLANt�tf�;r, nn�ic�n�.
��
K Y OF COSTA �
� � xcsx�a ' UBJEOr�oqigc BLDG. D E
� �
I�q � i Y i%tyC;/2� C
1 .'""""""""
\
��_
_ _�e� �-' �/ _{ STREET
REG.
O�te� �� �_
iTb�ks onfhisjobatxlllimeszndi!�,unl
vithoN w�,9hx� penns�io; i ircm U5e UivW: �� ot
f.ii n;0 ;ehe4JtopErml
o? .'cst, I�sea Qn�inan
�i ,n? b r,ame r�u!; 2cd �
t.,�
��� RC9�EMq
'"'""""""...""'_ /
/
r
BLOCK WALL LAYOUT FOfi BUILDING PERMIT
PLANNING DIVISION
� �\.. .
�`
lau:.:
q.^.;
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Optional �
Channel Bbck With 1�3/8�
Horitontal Top of all
Fences
For Fence� 5" or Less
Ven. Bars 3/8"yS at C' �0" O.C.
For Fences Mig�er 7han 5'
Vert. Ban 3/8"Q at 32" O.C. �
Fill Cells Solid With Grou�
W M1ere Steel Occurs
Rcininrting $teel $hall
Conlorm to Sec.A�15-39
A.S.T.M.
All Steel Io be Lapped
24" or to Code
NATUHALGHADE
TWO J/8"4 BARS �
CONTINUOUSTOP I
b 00TTOM y_�
HOQIZSTEEI MUST BE TIED IN
YLACE AT TIME OF THENCH
INSPECTION.
V
c
� un �
D^1
1-�KIOTH
� SEE Cn�
i � BELOW
0
GENERAL- NOTES
MORTAR; pne Part Plustic Cement, and
TAree Parts Sand
Gfi0U7; One Part Cement Three anU
One Half Pa�ts �and
COPING: One Parl Cement, T�ree
Parts Sond
C�NCRETE: Weil M�aed 1:2-I/2:3-I/2
Mati of 7- I/2 Gollans of
Walbr Per Sack of Cemenl
GROUT MAV eE POUHED FROM THE TOP
OF THE FENCE IN CELLS WHEHE STEEL
OCCURS.
CELLS AND AHEAS OF HORIZONTAL REIN
FORCEMENT SHALL BE CLEAR, CLEAN 6
FREE OF ALL MORTAq DEBR15, ETC.
M C1' C4RTHTCOTH
V3 1�1E MEiGTM OF fENCE
B�IOW BOTTOM OF �OGTiNG
�� �o' � �_ SCALE: 1/2�� = I�
FOOTING RE�UIREMENTS CHART
WIDTH . . . I4" . .
THICKNESS 10°.
OEPTH OF EARTHTOOTH 24'�
SPACING OF EARTHTOOTH 12'
14
-� . 10"
. . 20"
- iq'
BUILDING DIVISION
8"
16"
16'
12"
8"
12"
16�
�I
�
ApPlicant to fill in all sDaces except thase within heavY bortler lines antl sign all appropriate tleclarations.
v oF COS7a MEsa CONSTRUCTION PERMIT
ProjectAddress 908 Peace Pl
Applicant's Mailing Address � � 14�
Ownet'sName Ossenmachter, David ano�e 549-7941
ndd�e:s 908 Peace Pl. Cstamesa, CA 92626
' Arch/Eng. License No.
Address � � 14 )
�� Comracror's Name E. S. T. Phone 898—$113
Address (ma�iingl 1 1 600 Moanrch Garden Grove
City License No. �� 1 99
LICENSED CONTRACTOR DECLARATION
I nereby atfirm that I am licensetl untler prOvislons of Charter 9(wmmenGing
witn section ]000) of Division 3 of the Business an0 Professions Cotle, antl
my license is in tull force ane effect.
License (r} ss —
' Oate `�� ignature
WORKERS'COMPENSA �ECLARATION
tereby aifirm that I have a ce - ure or a tertificate
,�Workers' Compensation Insurance, or a cerfitietl copy ihereof (Section
3800, Lab. C.) .
Poncv No. 1042904 co�,aa�y State Fimd
�Certifietl copy iz hereby fumishetl.
Cert� i tl y iletl with the city Builtling Division.
Dafe ��—�—�� - Applican[_$�$_,�,'
EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION
�(Thissection neetl not be mmpletetl if the permit is to� one huntl�etl ($300) or
less). '
' I certity that in the performance of the work fOr which this Oermi[ is issuetl, I
I sitall not employ any pe�son in any manner so as [o become Subject to [he
'I Workers' Campensation Lawz of California.
Date ' Signature
NOTICE: If, atter making this tleclara[ion, you shoultl bewme subject [o the
Workers' Compensation provisions of the Labor Cotle, you must fortltwitb
comply wiln such O�ovisions or thi5 p¢rmit shall be tleemetl revoketl.
CONSTRUCTION IENDING AGENCV � '
1 hereby affirm that there is a construction lentling a9ency for tne pertormance
of tho .work far which this Oermit is issuetl (Sectian 3097 Civ. C.)
L.enOer's Name
Lentler's Atltlress
OWNER BUILDER UECLARIITION �
I hereby affirm that I am exemp[ from the Con[ractoCs License Law for the
following reason (Section ]031.5 Business antl Professlonal Cotle: Any city or
county which requi�es a permit to cons[ruc[, alter, improve, tlemolish or repair
'any struclure, prior to its issuance, also requires (he applicant tor such parmit
to (ile a slgneC Sta[ement tnat he/She is licensetl pursuan[ to the prOvisions ot
- tna Contractor's License Law (Chapier 9(commencing with Sectlon 7000) af
�ivision 3 of the Business antl Professions Cotle) or Nat he/she is exempl
herefrom and [h¢ ba5i5 for tne allegetl ex¢mptlon. Any violaHon of Sectlon
7031.5 by any applicanl for a permit 5ubject5 lM10 ap011can[ lo a civil
� enalty of nol more than tive huntlretl tlollars (y500).
� I, as owne� of the p�ope�ty�O/ my eTployees with wa9e5 as thelr sole
compnnsation, will Oo tho work, antl the structura is not Inlentletl or offeretl
tor sale (Section 7044, Bu5ine55 antl Prolessional Cotle: The Conlraclor'S
LiGense Law tloes nol apply to en owner o/ a property who builtls or Improves
thereon, antl who tloes such work himselt/herselt or tnrou9h his or her own
employees, provitletl tM1a[ sucb improvements aru not IntenCetl or oftereC for
Shc¢. It, howeve�, the builtling Gr improvement Is Soltl wi[�in ono yea� of com-
pletlon, the owner wlll have the burtlen of proving he/she tlla not buila or Im-
��Ove fOr lhe pu�pose of sale).
I, az owner ot the prope�ty, am exclu5ively cont�ac[Ing with Ilcensetl con-
tractors to construct the oroject (Sectlon 7044, Business antl Professlons Cotle:
The Contractor's license Law tloes not appty to an owner ot property who
builtls o� Improves thereon, antl who mntracts for such prOjects with a mn-
tractor(5 Ilcense pursuant�[o the Contractor'S �icense Law�. I am aware that
proof o� their Wotker'S ComPensation insurance shoultl be O�ovitletl to me.
�� 1 am exempt untler $ection B. & P. C. for [his reason
Date
ure
Owner _ _ .
h al1 Utv antl
TVPE OF CONSTRUCTION I�1 NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT lJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 54. FT. oCCUaarvCv—
. CONSTRUCTION TVPE VALUATION S
ZONE GRADINGCV.YDS. ACRES—
Remarks:
$ink
Preventer
Irrigation
Drinking Fountains
Floor Dreins ,
Floor Sinks
Gas Service
Interceptors .
Kitchen Sink
�avatories �
P—Trap
Roof Drains
PLUM8ING FEES
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
' Solar Tank
' Swimming Pool w/Spa �
Urinal
'�ULIC[5 WaterCloset
Water Heater �
Water Service
Reinspection Fee � � $15 � � Issue Fae � g 3
Soiler
Duct- UnderGround
Duct - Structural
Duct � Ventilating
ExhaustSystem ❑ MWtiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-700,000 BTU 0700,000
Reinspection Fee � $15
GMF 0865-46, rev. 4/84 White - Builtling; Canary - A�P�kant; Pink - Accounting; Galeenrotl - Assessor
hiood or Type I �
Canopy Type I I ❑
Refrigeration System
❑0-100,0006TU ❑100,000
System Repair/Alteration
Isue Fee
A.P. qW
S Main Buildi
E
T Front
B Rear '
A
C Right
K
S Left
Ping. Ref. # '
Planning Notes:
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device eoxes
Outlets
Switches
Garbage Disposal
Genereror 00�5 KW �
Zone
Accessory
Parking
ELEC7RICAL ' �
Transformer ❑ 75-50 KW
❑ 50+KW
Meter ❑up to 100.amps
Meter Oover100amps
Sub Panel �:
Motors�0.7 HP�th-8
InaSolar 09�15 HP �16-75+
Microuvave -
Pole Light '
Range
Standing Sections
5 KW Trash Compactor
FEES
� Reinspection Fee $15 luue Fee $]
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB APProvad 8y Date
Building Approved By Date
Application Issued By _�� Dat
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ 2h_00 GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ 26.00
PtAN CHECK 25% $
Z
O
N
1
N
G
R
E
�
M
T
S.
_..�.
aViE: li� '_1/ . .Jti�: _._.
0
, CONSTRUCTIQN AND PLANNING
APPROVALS Permit #
i. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit�Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd. .
7. Footings .
8. Foundation �
.9. Water Pipe-Unqrgmd.
10. Structural Floor SYstem
11. Property Sewer Line & House Connection
12. Sewer Cap �
73. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
1G, Rough Electric Wiring
17. Rough Wiring Sign �
78: Rough Electric8l-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and FlaShing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown �at
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Cano�y - •
37. Final Factory Fireplace
38. Final Plumbiny '''�
;,
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestic-Final .� '
42. Backflow Preventer ti
.-i
43. Backflow Irriggtion . ,. , ,� .
44. .Landscape Irrigation System ,��
45. Sound Attenuation �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
46. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date
_ POG < SPA
Inspector p�ppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical�Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
� FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping 0 Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
. 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
S FOOD CERTIFICATE ISSUED
Date � Inspector
�oonessaFem�owo: 908 PEACE PL
ONMEN9N41EIFqpWN: gURGER, MARK
NOPE55: }(
908 PEACE PL
COSTA MESA,CA
�vr�.xuurw �oon[sa
AIICXffECT OP ENfIIIFEN:
fICN.OP FNO.'S,NDPE55:
�NT: Zcc.
FLOOD; X 47
92626
uc. w.:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 082976 PLAN CHECK NO: N
CONSTRUCTION TYPE: l�—N PERMIT TYPE; STR
JOB DESCRIPTION ; T/OFF SHEATH 6 REROOF W/COMP SHINGLES
UNT:
CLAIM VALUE: 4,800.00 CALC—VALUE: 4,800.00
ca+m�crarsw�: TOP OF THE LINE ROOFING ( 310 ) 375-232e
ewm�crornwuwa 431.9 W 230TH ST
�ooness: TORRANCE CA ucr�o.: 728480
90505 uxr:
LIGENSED COMR�CTOflS DECLAHATION: I InraEy ellim uMs W �wjury tlW I mn limsed uM« poviep Mqm 9
(mmmentinp wilh Seciim JOW) d Diviaun � tl I�e &mrov vM V e CaG. eM my ticenee o in IWI I«ce enE eflad.
cmuc�.No^.: p^ uc.cuss: C 39 .No 72$q$0 EXP:
oe�e: J��-U— ` I coimeeor:
OWNEF BUILDEN DECIAPAiION: 1 heeeby e1Nm u�Mm peWY d pmjr/ �hel I aremq hwn tM w la Vie
lolbwiq reeeon (�� ]W13 Buaim� enE PMmvau Cade: My uy n munry MfiiN nawms a perml to consWct. el�x. improve.
bmdch, w repei eny evuciure: pv b Rs esuure, eho iaqu'nea Ihe epplireN lor wch {wmY l0 9e e aqrieA amement Net M a aM
� licensed Wn�N lo IM ywmme al lha CuYretlon LKeme law �Cheqe� 9(mmmenag wilh $etlqn )000) tl D'vbon 9 d IM
dueineo aM Rdeaeum Code� m Ihel he a ehe u uemq �I�admm anC �he bmb fa tM ellaped ntemqion. My vblelion d Sedion
'/m1 s w e�v avV�N �« e o� *�+ �ne eodS.m �o e dv1 v�r d nn mae �nen rwe wnddred mov. [ssml).
❑ i.mo�,dinewoo�nramr�dw�wn.�,.ma:.de�w��...;omubwon�.�en»w�,a��m�am�aodw
«oflareE br eele (5ection 10C1. Buvmv eM Prdmawna CaEe: TMCOMredon lioense Lew dwa mt eppy lo en owiwr d propary
wno wu, o, mw� in«�. w.ro eoe. sw�..oa� i:�,.en a�.d «w�n ne «n« owo �d��. wo�d.a mm .�n
imparemenb ve rid HteMad a dlved la eab. tl, howv.a, the buiNi�q a'vnpemanem i� eold xilhin ons yav d mmplet'ion, the
axrwr-0�iider wiA haw iM EuNm M pw+�q he a#�a d'A nd WAd a impo.e b IM purpaee d veb�.
� I. m ox�r d tM PW�Y. am mbviwN mNreCYq wM fvoed con�ecwa b mmrW Ne p9� (5ed'vn mU. &vi�a eM
Profeedm+ Cade: TM Ca4reem license Lew doe+ m� epWY �o en owmr d papaly xfw WiNa a impavx thneon uM MM10
conirecp Iw wch pqea� wdh e wnrnqa�el �e� WnwM lo tM Cantreda+ lim�ve ler�.
� I am mmmq uMx SecUon: B. 8 P.C.. br Nb mamn:
Dete: �:
I ao nmaW roniry Out � em.wae d eM wiee�sierd iM n9uiremmd a Gellanie NeeM vk Sdetv Cod. Seaioro a55o5. z553�, uM
255J4. enA ttW 1 a enV tuliue build'vq omT� xill / wil m� (e�cb aw) med io mnW wih aak abte wdea eM tlr reW'vamenb br
ome: ncc«:
WORKEN'S CONPEN9ArI0N DKL�FATION: I Mreby dfimi uMx pxWiy d prjuy me W Ns NAov.i�p Eetlue�iom:
� 1 Mve vd wil mein�en e canilicele d mwnt io eeAimun br xvrken' campame�ian, n provided ta by Setlian 9)00 d the lnbor
Cads. la iM pMmiwics d Ns wAc la Mirh Uua pemW u waued.
�7 in��a.u�v.�.a�+•�o����.m�a�ewsw�a�ooaw.i.nacme.i«meo«ro���am.
work�«wnknmh�rmneiavued.nNw«Fen'S_pmwE� FUND "�odi�'m�mber^re: EXPIRES
cerri«: '1'A�1'
Pd'ry Numbr. ZS'S= 9-7II1 01 / 01 / 9 F
�mr,ae+;o,�,�..enwee�o,�W.r.drwv�++mb•�•w�w.eeouenlsia �rem.l
� I eenAy Net in Ihe pa�loemenea d Ihe work M whieh Ihi� prmil b iau tl. I�tiap m� amploy erry penon in ury m r m ta
become wbjw to Ihe xoM1n+' mmpmmNion �ewe d en ap e MY i I dwM bzwne eubpe m �M tl
�p�eiuq•bn^ �qmu pn 3'!00 d Ihe lebor l dull nhr wN� tMro piwiwns.
Dme: \ ' L���� Md�:
Wem4p: F�Ilun ro�sw woMrwti ronpwuetlon eovrap l� un4wNl. • w�Mcf �n w�plyw ro cNm'n/ pHultlu �M
clvll llriu up lo on� �indrM fMusvtl LN/an fJi00.OWA In �Wltlon ro M� cut el rompwuefbn. Gnup� u provltlM br In
Ssctlon.t/06 0/ IM L�6or Cob. Intru4 uM �ttum�/'� Iwa
CONSTFUCf10N LENdNO 10ENCY: I hneby dfi�m uMr penMy d pxjirv �� �� p e canstiukion IaMiiq epezy br Ne
pertormeMe ol tM nak la xfiitli tM pmmi u ewstl (Setlon 3081. Gv. Cl.
LENDEWS NAME: '
LENDEF'S ADDPE55:
I ceniN Ihet I hew reeC Ihia epd�� � d�e Ihei tha ebove infmbtun a conen. I eproa to compy vrit� ell tlry vM couMY �inenoae
aed ala�e kxe relatip lo Wik'vq cmvVueim end hereEY e��as �qvafenta�iw tl �he ely beMs upon IM ebwe-menloned poparty
��\y�'`'L�J/�'��_�,�
Dete: �•
(515td6.WP) Wluie-Bubip 8 Selery: Gmee�Fle: CanW-Appf�ant: Rnk-Re+ewe: Goldanmd-A+aeaw
1 ,
PERM NO: B 082976 \
GOVT: N SUPP: N
�' PORPOSE: OT�fi^''�-----
SQ FT: 4,800
GROUP OCC: R-3 /
COMMENTS; REROOF 2900SF RESZDENCE W/COMP, SMOKE DETECTORS REQ PER 94UBC
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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
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN ['RNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE(� • PROV: PARCEL: 41805249 2NE; REF NO:
PLANNING N(STES>
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D E V E'L O P M E N T S E R V I C E S A E¢ U T A E M E N'�T S
,y _
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE;
APPLICATION ISSUED BY: � DATE: S ZU .
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LEGALIZATION.:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 99.75 50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 100.25 0,00 0.00 100.25 100.25 ,00
REVENUE DIC�ISION TOTALS--> COLLECTED; 100,25 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
99,75 .50
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 4800 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 4,800.00
END OF FEES
�5-2�-1937/11:59 A3/51C�.25
GCPTN:bI �t�b553
F'�ki'�IT: @82975
��-_�
CONSTRUCTION AND PLANNING POO SPA
APPROVALS Permit # Date Inspecior qppROVALS Permit # Date Inspector
1. Temporery Etectrical Service or Pole 52. Pool & Equipment Locaiion ' �
2. Soil Pipe•Undrgmd. 53. Steel Reinforcement �
3. Electricai Conduit UtiVity�Undrgrnd. 54. Forms
4. Electricat Conduit-Undrgrnd. • 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plum6ing & Pressure Test
6. Electrical UFER Gmd. 57. APPROVALTO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrg�nd. '
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Und�9md. � • 60. Backwash Lines, P-7rap, � Undrgr�d.
10. Structural Floor System � 61. APPROVAI. TO OECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � 64, Plumbing SYstem - Final �,
14. fiough Plumbing � 65. Electricai-Final �
15. Rough ElectricabConduit � 66. Solar System�Pinai
76. Rough Electric4Viring 67. Fencing & Access Approval
17. Rough 4Virinq Sign '68. APPROVED FOR PLASTEPING
18. Rough Electrical�T Bar Ceiling 69. POOVSPA SYSTEMS FINAI
19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product P�ping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrncl. Storage Tank � Gas ❑ Oil
25. Roof Sheathing �/�r � 74. Overhead Hydro
�j
26. T•Bar Ceiling (52�uctural) & Monocoat � 75. Dry Chemical
27. Frame and Ftashing 76. Dry Standpipe •
28. Lathing & Siding 77, FIXED SYSTEM FINAL
29. Insulation " 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. RE�UIREMENT
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-7est ,
36. Hood or CanopY
37. Final Factory Fireplace
3$. Finat Plumh'ing . �
39. Water Service-Finai
40, Gas Service-F(nai �
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. l.andscape Irripation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE & BUILDING ���y,-� /✓GFY
li"q'
48. FINAL PLANNING
49. Electric Releas¢ to Edison
50. Gas Release to S�uchern California Gas Co
51. CER'fIFICATE OF OCCUPANCY
No � Date
. 25440
COSTA MESA BUILDING-SAFEf`( DEPARTMENT
P.O. BOX 1Z00 COSTA MESA� CALIFORNIA 91626
For AppBcanf fo Flll In Complero/y
TYPE OR PRINT
aooRe'sa 08 Peac Pla
COSTA ME3A, CALIFORNIA
San
■ BTATH
�alif .
29�t�-A Randolph
Costa Mesa, Calif.
�9 No 51�(1-r
�., i nn i ��o: o�
CENSBROPBi11[RY 50� RURYARD 3�.7�
BIDBYARDI L[RT V'3�� I RIOFfT V�
� DESCRIPTION OF WORK
BUILDIN6
SIZE
EXTERIOR
� ROOMH
O
Laster COVHR
wno wortK ro ee
�rera �e /- �
-Y—
1 X6R6BY ACKNOWLlpOR TMAT 1 HAV[ RCAD TNIs �
ANO BTATH TIIAT TH6 AGW6 1/ COpR[GT�/�HD AOp
PLY WITX ALL CITY O0.DIlUNCi� I1ND �TI1Tf LAWY
B W LOINO CONBTRYR�ION./ �J /.
816NATUREOP �/J \ if� /L i
CITY Of Ci��T� �li
�VIAR 23 1966
PPLICA ON FOR PERMR
For �i e�
■�c[irt
ZONING
MO. O� Uti
�uns � em�
L[OAL
YARD� MPROVCD
MAIN BUILDIN6
DIBTANC[ BR.
MAIN BLDOi.
VAR.�
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-E�—'
an��� ee �eas rNwN
fU.B.G.RBQVIRBMENT7
YAROSAPPROVHD
ACCE980RY BU ILDINO
DAT6
APP110V � ��.�
er ) DAT!
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0
TM8 11MOUNT BNOWN YNOHR VALV�TON IB POR TN8 j
■UPPoe6 0► [YTApL16HIN0 A P6RMIT I8H ONLY. A
,,,,LUAT��N � �3 �
PEHMIT FE8 $
' l /, d�'S /' �� w
TOTAL FEE $ 'f/ ,