HomeMy WebLinkAbout837 PINE PL - Building Permits� � �
CITY OF COSTA MESA
�,O�p ~FS,P BUILDING DIVISION
i ; 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us
�, ` � FOR INSPECTIONS CALL: (714) 754-5626
�`°••��°"` PERMIT NUMBER: B11-00205
PERMIT TYPE B_ROOF2
APN: 42245402
JOB ADDRESS: 837 PINE PL CM
Vicinity: HOUSE AND GARAGE
Squares: 3700
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
07/0812011
RMD
$10,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIAIS, INSTALL 1 LAYER OF 30# FELT ON A 5:14 PITCHED ROOF AND
REROOF WITH 30 YEAR COMP SHINGLES AND INSTALL BUR BASE SHEET, 2-PLYS CAP SHEET WITH ASPHALT
BETN/EEN LAYERS ON FLAT ROOF. ATTACHED HOUSE AND GARAGE, APPROX 37. REPAIR AND REPLACE
SHEATHING AS NEEDED. COMPLIANCE FORMS ATfACHED TO JOB CARD AND CITY PERMIT.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verifcation of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment wllnspection Card
OWNER: BEAVER, ROBERT DALE
PHONE: 949-650-8696
APPLICANT: LECLERCQ, DAVID
PHONE: 714-673-2300
CONTRACTOR: ABSOLUT ROOFING INC
Address: 18903 SAN CARLOS STUnit
City/State/Zip: FOUNTAIN VALLEY, CA 9270A
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: 50.00
Reroof Permit Fee: $181.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 837 PINE PL
City/State/Zip: COSTA MESA, CA
Address:
City/State/Zip:
PHONE:
License No.
License No.
License No. 761118
800-655-2231
CELL:
PHONE:
PHONE:
Unit:
Unit
TOTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3I16I2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the tollowing Federal
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav_ Thanksaivina Dav and Christmas nav
NOTICE: The work authorizetl by this permit shall comply with all applicable hantlicap access requirements under California statutes and relaled
regulations. (Ord. No. 92-28. § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor 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 Ihis pertnit.
GOOEt. INSPECTIONTYPE DATE INTIilALS COOE/ INSPECTIONTYPE ORTE INTITIRLS
1616 Pixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ��/�� 208 Final Plumbing
200 FinalRe-Roof ,,�-�p-/1 �C(Y 2t0 FinalElectrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Pactory Fire Place 220 Pinal Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 Fina18uilding/OccuOancy
r
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalry of perjury one o( the tollovring declarations:
❑ I have and will maintain a certifcate of consent to selhlnsure for workers'
compensation, as provided for by section 3700 0( the Labor Cotle, for the
peAormance of ihe work for which this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
seclion 3700 of the Labor Code, for the pedortnance of Ihe work for which Ihis
permit is issuetl. My vrorkers' compensation Insurance carrier and policy
number are: �/�
�.Carrier, rJ�'�� i�^��
- - (IM1issectpnneetliplpemm,.p.!e,(etl�Mep�ei—m,rt\isvaluMafinelruntlrM�llars(51�)wless)
Policy�Number: � � D �� J v
❑ I certify Iha� in Ihe peAormance o( the vrork for which ihis permit is
issued, I shall noI employ any person in any manner so as to become subjecl
to (he wor rs' compensation laws o( Cali(ornia, antl agree that il I shoultl
become ubj ct to the rk s' compensation provisions of Section 3700 of
Ihe Lab Co e, I shal � r�th c��ply with ihese provisions`. j
�y O _{ 1
Aodi 1' .�r nalure Dale
WARNING: FAILU` TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL D SHALL SUBJECT AN EMPLOVER 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
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Nat I am licensetl untler provisions of Chapter 9(commencin9
vrith Section 7000) of Division 3 of the Business antl Professions Code, and
my license is in full (orce and eNect. 2G,
�hic..tt�- �0 1 Gasstt �' � f
�-fr /I
onUact s� n Wre Da�e
CONSTRUCTION L OING AGENCV:
❑ I hereby aKrtn that Ihere is a constructbn lending agency for the
peAortnance of Ihe v.ork ta wfiich this permit is issuetl. (Sec. 30W, Civil Code).
Lentler's Name:
Lender's Address:
SignaWre �ate
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any stmcWre, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to lhe provisions ol the CoNractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business and Professions Code) or tha[ he or she is exempt Ihere(rom and
the basis for the allegetl exempiion. Any violation of Section 7031.5 by any
applicant for a Dermit subjects �he applicant to a civil penal�y of nol more Ihan
five hundred dollars (5500).):
❑ I, as ovmer of the property, or my employees wilh wages as their sole
compensation, WILL DO THE WORK, antl the structure is not intended or
offered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an ovmer ot propeny who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intentled or oflered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder vnll have the burden of proving that he or she
ditl not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCWSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWct �he prqect (Sec. 7044. Business and
Professbns Code: The contractors License Law does not apply to an owner o(
propeAy who builds or improves thereon, and vfio contracts for suc� project v.ith
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Protessions Code for this reason:
SignaWre Date
JOS]-a6 p/(I])
�Ovmer ID'venfied by driver�se. ❑ Yes ❑ No
Driver's License No. Ezpires:
Verifcation of Ownership by pype ol document, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby ceAify that no ezcavation frve (5) or more (eet in depth into which a
person is required to tlescend, will be matle in connection with work authonzetl
by Ihis permii, and that no building strucNre, scafidding, falsework. a demolition
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32. Grp
2. M 2. Sec. 3A1, Ttle 8, Cali(omia Administrative Cotle).
❑ As ownervbuilder, I will no1 employ anyone to do vrork which would
require a permit from the Division of Industrial Safe[y, as notetl above, unless
such person has a permit to tlo such work from the division.
AppliG)nCs SignaWre
Division of IntlusMal Safety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATION:
1. Will the applicant or present or (uWre building occupant need to fle and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 0( the Califomia Health and Safery Cotle requires, with some
exceptions, that a Business Plan be fled with the Cos�a Mesa Fire
Department by every business which has aI any one time during a reported
year a quantity of hazardous malerials equal to or grea�er �han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlard �emperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety CoOe, with some
eaceptions, requires regisiration vrith Ihe Cosla Mesa Fire Department by
each business which at any one �ime has on hand a quantity of acutely
hazardous materials equal to or greater Ihan a weigM ot 500 pounds, or a
volume o! 55 gallons, or 200 cubic feet of wmpressed gas at standard
�emperature and pressure).
3. Does or vnll the applicant or present or fuNre 6uilding occupant nee0 to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Health and Safety Code pmvides that the
Costa Mesa Fire Department may require the preparation, certification and
�ling with the Fire Department ol an RMPP by businesses which are required
[o register awtely hazardous materials with the Fire Departmenl.
4. I( an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
the vrork which is the subject of Ihis application a permit for such consWction
or modifcation fmm Ihe Soulh Coast Air Quality Management District or from
any other air pollution control disirict or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemmenl Code requires that Ihe requesfe0
informatbn be tumished on applicatbns for rwo-resitlential building pertnits).
6. Will any part of the (aciliry to be consWcted under this permit be within
1000 feet from Ihe outer poundane5 of a 5thool? ❑ Yes ❑ NO
(If'yes", the faciliry must meet Ihe requiremenl of Sections 25534 antl 42303
of �he Califomia Health an0 Safety Cotle).
7. If a permit fmm the South CoaSt Air Quality Management DisMct or other
air pollution control district or agency is required for the vrork which is the
subject o! this application, have all o! the disclosures prescribed by Calitomia
Health and Satety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certifcate ol compliance from the appropriate air polWtion
contml o�cer).
.CERTIFICATE OF COMPLIANCE: I certify that under penalry ot perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Ma�erials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to compty with all state laws and city
ordinances relating to building construction, and au�honze represen[atives of
the Ci[y of Costa Mesa to enter upon the above-describetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by ihis permi� until final inspection.
Signawre o ega wner�s) n Da`le�
/ ! — n � � I
An41o�A ionEe0A0Cli Ddte
1 �
+ Prescriptirc Certi6cate of Compliance: Residenfsal
Jiesi�lentiu/ ALYeraYio�r.e
(��-P�;�V'�T �Ji.�v�l2
Zone q � I!t u1' Stm�ies
1
�
a ue Surface lletails Rm the furred
A B C
of Mass N'alls see Furrin�, Strips Construction Table below.
a . . r. r u--- . .
Freming Thickness, Framec
Assembly Name Material Spacing, U- lA4 Table Cavity
or Tvne� and Size� or Other' factor' Number° R-value
accourilirtg for CoMinuoer�' Jttsufolion R-value, ree
JA4 Proposed
Assembly Assembly
:ell Valueb U-factory
use Ihe Mast artd
1. ra� Tng/ID indicoie �he idemi�ca�iwi name �hai matches the buifding plans.
2. Indicaie ihe Assem6lr Name a� rype: Roo(/Ceiling, Walls, Floors, Sla6s, Crawl Spaee, Doors and eic...lndicaie 1he Frame rype and Size: For
N�ood, Metal, Meial Buildings, Mass, eiver 2s4, ?xb, m� e�c... see JA4 for o�her possible frame rype asse�rblies.
3. Enrer die tl�iclrness (or mass in inches or Spacine 6ehveen f'aming members emer; 1 G"ar 24 "OC; ar O�her jor all oiher assem6lp descripiian
��uch as Cnncrete Sm�dwich Pa»el, Spandrel Panel, Logs, Sa�aN� Ba(e Panel and etc.... .
4. Baa�ed on !he Clinio�e Zone; enier the Smnda+'d U fAclor fi�om Table ]SJ-B, C a' D for eacli d�erent assembl�� Nome or rype.
5. Emer the Table number dm� claselp resembles the yraposed assem6lr. �
G. Lnter !he R-i�alue fha! is' Leing installed ni the wall caniry� or Le�ween !he f�nnring,- odreiwise, emer "0 "'.
9. Emer die Cnn�inuaus Insidaiion R-value for �he�n�oposed ussern6l7�; o(henvise, emer "0".
d'. L• mer �he row and colunm af Ihe U-f4c�or vu/ue 6osed on Column F Table Number and en�er ihe Assembl�� U-(uclor in Colunm J
9. The PropnseAAssemGlv U-fac�or'. Cohtmn./, rnu.ri Le equal �o or [ess' lhan �he Slondnrrf U-lactnr in Column E ln cannln. '
Regi.s�rulinn Nwnber: Regisnntiw� Da�elTimc: H6RS Provider:
20Dd' Reside�otiul Canpliunce Fnrms dugus7 2001
1�
of Compliance: Residential
Residentinl A[teratinns
p`CrPa.sQ,T 'J(SY��.'U2_
Climnre Zonc N
CF-IR-AL"T , �
(Pa e3o1'S)
� I # of Stories
`
ROOrINC PRODUCTS (COOL ROO�S) §I51(pl2
Wheu !he nren qf rxferinr rno/'.curfpce to bc replaced ezceeds niore Uaan 50% ofl6e exi.etimg roojaren, or nmre N�an I,000 j!', rvhichever is
Jess', (he neiv ronfii:g aren m�cv mee� �he rnofing pradirc� "Coa! Roof' requireiuems of§I52(bJIHi, 152(b)]Hii, nr 152(b)IHiii. �
Check app(icnble a(�ernntive or rsception GeloH� if �he rooJaheration is ezempi fr�oni �he ronfing produc� "Cool Xooj" requirements. No�e: /jany
one oJdie allenva�ives' or ezceplinn beloH• is checked, /he Aged Salm� Refleclance and Thermal Eminance requiremems jor roofing products in
,¢I18(i) are nnl opplicable. Do no{fi0 mble below.
ool Roofs Not Required in Climate Zones I-12, 14, and 16 with a Low Sioped. Less or 2:12 pitch.
ool Roofs Not Required in Climate Zones I through 9 and 16 wi[h a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
Alternetives �o §152(b)1Hi and §1S2(b)Hii, Steep-slope roof (pitcli > 2:12J
❑ Insulation with a thermal resistance of at Icast 0.85 hr� °F/Bni or ai least a 3/4 inch air-space is added to the roof deck
over an attic; or
❑ Existing ducts in the attic arc insulated and sealed according to §151(�10; or
❑ ln climate zones 10, 12 and 13, wit6 1 fl�.of free ventilation area of attic ventilation for every l50 ftZ of attic floor ureu, and
where at least 30 percent oPthe &ee ventilation erea is within 2 feet venical distance of the roof ridge; or
❑ BuilAing has at least R-30 ceiling insulation; or �
❑ Building has radiant bazrier in the attic meeting [he requiremen�s of §151(�2; or
O Building has no ducts in thc attic; or
❑ ln climate zones I Q I I, t3 and Iq, R-3 or grea�er mof deck insulation above vented attic.
Exception tn §152(b)1Hiii, Low-slupe roof (pitdi <2:12)
❑ Building iias no ducts in the attic.
Other Exceptions
❑ Roofing area covered by building integreted; phorovoltaic panels and solar thertnal panels are exempt from the helow Cool Roof criteria.
❑ Roof constructions that have thermal mnss over [he roo( membrune with at least 25 Ib/ft� is exempt from the below Cool Roof criteria.
Note: If no CRRC- I label is available, this compliance method cannot be used, use [he Perforrttance Approach ro show ca
CRRC Product ID
RoofSlope I Product Weigh� I Product
2:12 > 2:12 < 516/R2 > 516/ft' Tvoe�
Aged Solar Thecmal
Reflectence�'4 Emittance
OQ
�4
❑Q
❑'
o'
otherv✓ise,
SRIS
The C7iRC Produc! ID NwnGer can Ge ���nined fr�om d�e Coal RoofRaling Council's ltated Producl Direc�ory al www.coolrnnls.are/nrnducts/sem�c�hn
ludicarc die type ofproducl is Leing used,fnr d�e rnof rop, i.e. single-pl�� roof, asphall rnoJ, weml roof elc.
/f (He Aged Re/lectance ir nor avnilaGle iu.tlie Cool ltoo/'Ra�ing Cmmcil'a� Raied Produc( Direcrory� tlien use !he Ini(ia! ReJleclm�ce vulue fi�om Uie same
direcmr�� and use Um egua�im� (0.2+U.7(p���i���l— 0.2) !o ob�ain n calcula�ed aged value. Wdere p is Ihe Ini�ia! Solar ReJleclance.
C/�eck bo.�� rJtlie Aged ReQec�mrce is n calculaied value using ihe eguation abave.
Co(culme Jie SRI value Gv using Uie SfU- Wor/whcei ar Inm�//w�vu•.ene�m�.ca.rnv/iidel4/ond enier rhe resu6ing value in Ihe SRI Colurnn o6o�e and ottach ucopp
die SRI- H'orkshee! m Ihe CP-IR.
� apply Liquid Pield Applied Cuatings, the coating must be applied across the entire roof surFace and meet the dry mil thickness or coverage
commended by lhe coatings manufacturer and meet minimum performance requirements listed in § I I8(i�}. Select the applicable coating:
Aluminum-Pigmented Asphali Roof Coating
Regisiruiian Number:
2008 Residen�iul Campliunce Fqrms '
Cement-Based Roof Coating
2egisira�ion Da�e/I'ime:
O[her
HERS Provider:
Augus�2009
� , :
)'rescriptive. CerL�iiicate of Cumptiance:
Residentirzl Allerntio�a.v
CF-I 32-ALT
(Pa�'e � u1 5)
Pruject 1V;�mc � �/� I Clima[c'LuncY. � I$ pi tturies
UN2.�C UJ 13YkV t_.rD'Z
H�P�S V�RI]P1CAT701� SUMB7ARY The e�?JorcemeN ngcnqr should ym• syecfa! �mamfon �u �hc HfiRS hleasurc.r speciJied m dvie
checiclisi Lelmr. d cnmpletcd nnAsioned CF-4R Fm'm (or n// 1hc men.sures specified shn!( Gc suLmivcd io tlr�� Guilding ina;nec�a� LeJwz- finnl
UuCt SeAlinp d T05fllle HL2Suerilicniion is reqzrired.fw� lhia mensw�e �
❑ Y�S ❑ NO l'CS�. ln Climaie Zones ° and 9-1 G, if more thau 40 linear feei of nevr nr replucemem ducts m�e fnsialled in uncondiiioned
spnce, the ducts are to bc se�iled per {�152(6)IDii and [he newly ins�ulled dums nre tn be insulei�ed pei §151(1170.
❑�XC�I'T10�: Lzisting duct systems tlm1 are estended; w6ich are cuustructed, insWated ur seuled with sisbestos.
❑ Y�S ❑ NO 1'L+S: ]n Climate'Lones 2 and 9-1G, if tlie existing space-conditiouing s��stem (HVqC equipmem and duciingi is replaced, the
- ducts are to be sealed per §152(bpDi. �
❑ 1ES ❑ NO 1'ES: ln Climate Zones 2 and 9J 6, if the existing HVAC equipment is repluced (including the replacement of the nir handler;
- outdoor condensing unii of ti splii sys�em, cooling or he�ting coil, or [he furnace heai exchanger) die ducts are to 6e
seoled per §l52(b)lE.
❑ r.XC�PTION: Duct systems tl�nt are dacumented ta huve Ueen previousl�� se�Ied conS�rmed througli HERS
. - verilication iu accordancc with procedures in the Reference Residential Appendix �.A3.
- '' ❑�XC�PTION: Duct systems with less than 4U linear feet in unconditiuned spuce. . - .
❑�XC�PTIO�: �xistin� duci svstems constructed, insulated or sealed with asUestos.
RefrlgeYant Ch8re2 - SJlllt S1'StOID HE2S verijication is reguired,forlhia� measw'c.
❑ YL7S � NO YLS: ln Climate Zones 2 and 6-15, wl�en the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensina unit of a splii system A/C or heat pump, cooling or heacin� coil; or the fumace heat
Central Fan Integrated (CFI) Ventiiation S,ystem and Fan �'att DraH�
The ventilation reauirements of 8150(0l do not aoolv tn existinc residential homes.
Ducted Split Systems - Air Condifioners and Heat Yumps: Airtlov�� HERS veriYicoiion is reguirec( forlhia measum.
❑ Y�5 ❑ N 0 YES: ln Climate Zones 10 through 15, wlien [he existing spaee-conditionine system (H VAC equipment and ducting) is
replaced. the airflow and ian watt drax� shall be verified per § 152(b} 1 Ci to meet [he renuireinents of § I51(f17B.
"� Locumentation Auti�or
• I cerfifi� that fhis Cer
Name.
`�r��e
Company:
��
Address:
l $�t�
�
and
0
,�
� ?-6•I�
icable O CEA or � CEPE
��i�o�, r�r
-2231
Responsible I3uilding Designer's Leclaratim; �Statement .
�_ o' 7 am eligible under Division 3 of the C�litorni�i Business and lh'ofessions Codc lu accepl respunsibility for ihe building design identiGed on
this CeriiLcate of Compliance.
• 1 cerlify thai the energy (eauu�es and performance specification:�• fnr the building desigu identified on this Certiflcaue of Complinnce coniorm
to thc requirements o1'Titic 29, Pnr�s 1 sind G of the Culiiorni�i Code of ILegulaiions.
• Thc buildVng desigu fea�ures identibcd on thic Cenif�cate o1'Complieince �re cunsis�em with lhe infonnation provided tu ducumeni this
buildin� design on lhe other appLcnble compliuncc J-ounc, wurl;shee�s, calculations, plens and specificaliona submi�ied lu t6c eirf��rcemen�
aeenc�- for npproval wi[h this buildinr permii a�plicaiion,
Naine� Sipnuture: ,
Crnnp:rny:
Hddress:
Giv!.S'tatc/Zip:
Date:
License.
Tnr a.r.si.sttuice or que,vtinrte regurtling ihe Enr.rbl' St�uidru�tdt} cnntac! the Energ�-Notli��e at: J-8UU-7i2-i300.
Icegravrounn h'urnLer: Ifegixu�mia! Luie/Timr: HCRS' I'rnricier:
2001,' Rca�idemial Compliance Forms Aaocesi 2p09
' rmon�ssoFem�axc: 8 3 7 P I N E P L uNr:
OWNEq'SNAMEIFppWN: BEAVER, ROBERT DALE
�oonEss: BEAVER, MARIKO C �
837 PINE PL
:OSTA MESA,CA 92627650-8888
APPL. NAll1N0 ADUPE55: i
��cxnecTox�+ax�x: ROBERT LINNAUS uc.r+o.: C18713
ARCN.OHFNG.'SADONE55: 91O S EL CAMINO REAL uxr: B
SAN CLEMENTE CA 92072
cor�m�c.arsNu�E: SCANDINAVIAN pACIFIC HLDR ( 719 ) 631-2858
ca+mncroxswauxo 461 N NEWPORT BL
�oo�ss: NEWPORT BEACAg2663 �A °`'"°'' 62985�5
uNr:
LICENSED CONfNRCTOflS UECLAPATION: i hereby eHim u�� p¢�¢„y m Ve'u thet I am licensed unEer pansiom N Chepter 9
(mmmemnp wiih Seclion ]000)olDrvieion 3 dthe Busine» eqa Protesaions C , d nylicenseisin fulliorce eM eilecl.
cmuc.xo.: 065227 uc. inss: B uc.xo.:� ' S5 EXP: 06/96
p'�e: Comredor. u
/
� IEN BUI D N DE flRTION: I hereby ffifirtn under penepy d perlury Ihel I am eicempt Irom �M Coniredae Lice�rea Lew lar the
xing resmn (Saqion ]031.5 Busness e'M Prolessiona Cada: Any cny a munry which reQuirea a paimn io mnnrucl, eller, improva.
_..molish, or repai eny slmcWre, qior �o nn'saueue, eleo repuirea the epplirenl im auch peimit to fb e signed sletemeM ihel he or ehe
is licenaed pureuenl m Ihe qorisions d Ihe Convenore Licanse �w (Cheptar 9(mmma�nB �h SeGon ]OW) of Divaion 3 N iha
Busineea end Prdessuns Code� ar ihe� M or she is exemq iher¢�rom eiM Ihe besia iw iha ellepaE exemplion. RnY �ble�on N Seeion
]�3t.5 by eny epplicani lor e parmit subjecis Ine apdw� �o e r,Ml penelry oi nW more ihen live hundred ddlen [$500�).
❑ I. es owner a tne o�aPeny or my emVb'/� �n we9as � ine'v ade mmpenae�ion, will do tne xrork, eM ihe awtlure e nM inlenaeE
«oflered br mle (Seclion')OaC, Buaiross enC Proimsioro Cotle� The ConVedors lkense law Eoes rw� epph/ io an ownard pmpairy
wno waes o, mc�s m<reoo. �a.no a� a��n wwk h;m�n o, n�er o, m,a,an na «na� o.M emoim�. oro�aaa md s�on
improvementa era � in�eMeE w dlered lor sele. tl, howeyer, ihe buiNing or improvement is aoH wilhin one yeer d mmdafnn, �he
owrier�W iWer will have the buken d proving he or sha ditl not build or improva br iha Wrpose d eele).
� I, as oxirer W the DropeM� em exd�ivety conireclig wilh licensed conlreclon to mnshud ihe prol� (Sec1'vn )Obl. Buair�e eM
Praleaeiona Code�. The Conlredon ���se iaw aoes na appry �o en ovmer a prapeny vmo bu�tle «�mpovas me.eo� �e wno
conVacb tw sudi prol�a ��h e mnVacla�s) Icenaed Wrsuem �o �he Conlredora License lew).
� I em arampt uMer Sec�ion: B. 8 PA., fa �hia reewn:
Dale: Ovmer:
I da hereby ceniry Ihat I em ewere M ene unJermtene the requir¢mama W Celdamie Heel�h arM Setary Code Secliom z55�s, 2s533, eM
25534, end the� I or any /ulure buikinp ocwpem wili / will nM (prcb one) naeE lo camply wilh aeid etete codes and the requiremend for
epermXiorwnsVuctimwmadifiratbnhamlMAir u-OTI.�enegementDislnd.Reaidentielmnst�uclbnappXratioraereezemD�iromNeae
pmWsionn.
oa�e: pooi�em;
WONKEWS CONPENSRTION DECIAXATION: I Mreby affirm uMer penelty d perjury oiro M Ihe /ollovnrp dederatbna:
� 1 heve enE wiP mantein e cMXkele d roneent to aeH�insura y�e%mmpenmtbn, av O�ded fa by Sedion 3]00 d ihe Lebor
Ci040. �IX �h8 �IBfiOf111BfICB O� I�IB MOlII �Of WhICh �NI9 �IB1111M 18199U04.
" I heve e�M xill meinian worke%mmpenmtun inaurence, � �eq�ired by Seqim 3]00 d tha lebor Coda, M iM paRormence d iM
wak br which Ihis permi� ia iaued. My wwka�e companspp� innurence fartier eM poliry number ere:
Cam .
� PolicyrNumbar:
' secfion need na 6e rompleleE a the peimAis lor one hun�� �llers 1007 w bss.)
1 ce�lAy �he� in �ha peRormenca d tha wak for whch ihin pa�� ie i I shall nd empby eny pereon in eny menner ao ea to
bacome aub'eq b the vrorkers canpen lion lewe d Cali! e. pree Ihet H 1 ehould bewme eubjed to iha worlmn'
nse�i Oro�151009 OI CaMIMI 3�W ihe Lebor Corye, I s II lo OTpA' MtIM1 �M109B plOVI910119.
em: nvWK+nc
Warnlnp: Fellun ro ax worka�'rompsnaaUon cowrey� /� ��/ewNl, entl a II wb/Kf an �mployo ro ctlMm/ peru/f/u �nd
e/H/ HMa up ro on� h rotl fMua�M dollan (S/0Q000), �n edd/Hon b fhs eoaf ol compsivatbn, dem�pu u prov/tled lor In
Swtlan 9106 0l tl�s Lebor COM, infereaq and ettomsy's /s�y
CONSTHUCTION LENDING AGENCV: I hereby eifirm under qnelry d parjury the� iMre ie e mnatmdion IeMinB e9ency /or Ne
�IBBIiOR11911� Oi�hB WOf�t�O! W%iIC�11h6 j9l11111 19 B811Bd�$BL11011308].riN.Cii.
LENOEN'S NM1E:
LEN�ER'S ADDAE55:
I ceniy �het I heve read thia epplkalion enE aiate thet the ebova {���etion ia mrted. I epree lo wmDN �h ell dly enE caunry mEinencea
end sle�e lexs relating to building conavueion eik hereby au m¢e reD�asenlelivee W Ihis d�y lo an�e� upon Ihe above-manlioned pmperry
ro.��sa�u�o�o�.w�s. LARS LARSO
(S15tdB.WP)
PnnlNem � � )�
�" Dete:,��
�ignewre d Owrar/AgenVAppli o � or
WhBe-BuilEiig 8 Selery;Green-Fle: Cenery-Applirant; Pink-Ravenue; Goldanrod-Aeaessor
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: M 0736"1'
PERMIT NO: M 073673 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
JOB DESCRIPTION, : 345SF BEDROOM ADDITION (ELEC. PERMIT) SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: A-3 /
COMMENTS: RE: H73258 PRIMARY HUILDING
*it*+eu x *���*at�**+r** �***���*���*�et�*at� *********�****+�at*�efx �*�at*� **��**��* �*ie**x **
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 BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ; PROV: PARCEL: 42295402 ZNE: REF NO:
PLANNING NOTES>
1 ��
If if 1f iElE if 1E 1E 1E'IE 1E 3E iE iE iflE fE dE iE 1E �IE 1E 3E 3E 3E iE 3E iE iF if IE if iF iE 3E �E'lh 1F iElE 1E 1E 1E iE 1Elf 1F 1E if iE iF iF iE if iF 3E 1E iE if 1E 9E if 3f 1E if 1f 1E 1ElF if if� 3E 1E 1f iF ib 1E iE if
D E V E L O P M E N T S E R�V I C E S R E Q U I R E M E N T S
�•ZONING APPROVED BY r DATE:
"BUILDING APPROVED BY : ��1 DATE:
i �,�a
�APPLICATION ISSUED HY: �%�; DATE: �L ��
� lEaE'!f'3ElEiFiEitiEiF3EfE1FiE�E1EfEiE!(�iEifiETF�F7fif3F�F7F3F'iFiFiF3F±F3F7FiF7F3F3F 3F3F iF7FiF3F�FifiF7FiFaF3FiFiElfiFlfif3E1FiE3EiF iE3f
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING £LECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 18.00
25$ SMIP/NON—RES
PLAN �
ISSUE FEE � 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 28.Q0 15.00 ,, 0.00 33.00 33.00 .00
REVENUE DIVISION TOTALS--> COLLECTED; 33.Q0 OVER/SHORT: .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
,,33.00
1E-0E!E -0E iE iE �F 1f 1f 1E iElE 3E 1E iF 1E-0E 3E iE 3E 3E iElf if iE 1E �E 1E 1E 1E fE 3E 1E dE 1ElE iE iE fF iF 3E iE If if if if iE if Ik 1klE 1E 3E 3E if 3f iE if if �F iE 1E iE 3E �]E� 3E 1E 1E if iE iE'If iE 3EiE iF 1E iE jE
I N D I V I D U A L� E 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
MEC
MEC
1 REPAIR/ALT COOLING -UNIT/SYS W/CNTLS
1 REPAIR/ALT HEATING IUNIT/SYS W/CNTLS
`END OF FEES
���I
'v:T�Ui�r�4�(j<''3y��iis%BC��(�,� T�b'!'
G�.'j14� L�J�Li�I] �lll�a ��ii�i
9.00
9.00
3;a.OQ
CdNSTRUCTION ASVQ P�AN3ViNG � & SPA .'�, �^� (
APPROVALS Permit# � Date inspector APPAOVALS Permit# ' ( Date ins�ector
t. 7emporary Electricai 5ervice or Pole 52: Pooi & Equipment Locatior
2. Soil Pipe�Undrgmd. -� 53. Steei Reinfarcement �
- 3.,��Iec2ricai.Conduii UtilitY-�ndrgrnd. . 54. Forms �
. �
�4:.��lectrical�Conduit-Undrgmd. ; 55. Eleciricai Bonding �
� 5. 5tee4 Reintoscemenc-» _ 56. Rough P4umbi�g & P�essure Test !
'6. �iectrica! UF�ER Grn'd. � 57. APPROVAL T4 COVEF-GUNITE ,
� _ .. ,i
�7_ Footings��.rc=;y � 58. ElectricalConduit�Undrgtnd. � `
C
"�-8: �oundatiori.. '. 59. Gas Pipe, O Undrgrnd., Test �-
�9.' 4Vater Pipe�Undcgcnd. � 60. Backwash �ines, P�Trap, � Undrgrnd. �
'70. 5tructural Floor-SYs:em '_ - 61. APPRQVAi TO DECK-- __
i t, propertv Sewer Line & Hovse Connecuon S2. Backtvash & RecepiorFina! 1
72; Sewer Cap --� ' _ � 63. Heater & VenbFinal �
13. fioof Drains ;__ � 6A. Ptumbing System - Final �
74. Rough Plumbing ,. � 65. Electrical-Final �
15. Hough Etearicar-Cooduit " 66. Solar SVstem-Final
16. Ftough ElEctricN.�irin9.: '- 6Z Fencing & Access Approvai -� !
77. Hough bMiring Sign � 68: APPROVED FQR PLASTERING -- I
i$. Rough Electrical-T Bar Celling " 69. POOLISPA SYSTEMS PINAL �
19. Rough Heating & Air Conditioning ,�s���9� , FIjiE D�P7..REQUIPyEMENT . I
. �. : ( i e .. , `; ,_, i. T . ' _ _� I
20. Rough Pec:orY F:repiace 'i v APPROVf1LS:iC� Peemit �r-` � �- : i
?l. i�ucis, in-StrJctuse .• ,. _- .^� = �' ''�t' 70.^Underground HYd,ro �� �
K
22. Ducis', Venfflafin9�-�, � - . - - � �, % 7i. Produez�_P.iping�CGas GOiI �
23. Teas Ripa-Rough & Test �__ � = t� 72. Undergroynd F7ush .
24. �oof-Framing' '�'' , ",.-. �; " - ,., `; �� 73�. Undergrnd. Sroraye Tank � Gas C! QB
25. poof Sheathing r* � � ��, `�� 74. Overhead Nvaro _ '
Y �__' � t
26. -T-Bar Ceiling {Struc{'ural) & i�+ioaqcoat * -. , �. 7b. Dry Che��nical = - � .
27. Frame and Flashing:� � -' 76. Dr� Standpipe='� - •
- 2&. !_athing&Siding'�';'� r�'� .. ,"- .. .. 77-, FIXED�SYSTEP.7�PINAL_ _. ' . �
29. Insulation ' _ •� � 4 7$, FIRE PREV. FI(�AL ''
' 30. Drywal! Na(ling � � � ; - ;-NEA�TH DEP,�. REQUIR6NIENT
� � 79. F1NAL iNSPECTION � - ��
� 31. Plaster Brown'Coat ; -. �„ ., � _
� _-- .____-----��
' 32. ��6lecirical�o�`v2r Me:er�P:nal � ;' '` 8Q: FOOD CERTIF-(CATE ISSliE�.'1.,
- � - M .; ' ; � . �" � _,_ .
� 33. FinaE Ele.c�tric� �a ^. . a' d: ' Nbtes: �i,2z �'1�'� j� �
. � _. . _ . _ . . _, _ i , _Y � �7FL _ _.L
� 34. �Finat-Heating;& Air ConBitioning= �, ib*,��,5� � • � ' "- '' -� _ -
�, .- : *. - :. , ,+, n -' �Q; � ` ♦ _.___._ �
35. Finai Gas-PipeETest . ^. � �.: :; �, . � _ ' � ' _ _ :� � ,c-: r
36. Hood or CanoPY ^ -. "�-7 � ; " "�•. , ' _,�' • ~ ,'`���`�
; 1 .• m '_ Xc . Y-r ',:1 . > >, . �
�- 37. Final Paetory Fireplace :: = _ �. ., . �' �-- . � � i
38. Finai-'Piumbing � 4 ^ � - �` ' �' ~ - • " _ -�-~------�-�
R r � y- ' 'c _
39. Water Seniice-Final Y - � , 'j: ? ' ` � ` w' � . �� - c�� �
f
44. Gas Service-Finai . - .. ' - � � " � ��
qt, golar Oomesiic-Fina1 ` � -, -j ^ r � f x - -
i
� 42. �Backfiow-Preve�terr � - � x G' = .- ' -,
_ z �,. _
43. Backflow irri�ation.Y , - -' .� - �. n - � ' �'
�44. Lendscape Ir'rigation System = �'"" y� !''. r C, ^ : r � � ,r, , _ .- I
- x - + '^ i
� , r.. . , r. - .;: . . .
-45. Sound Attenuation; _ . ,. . �. . ,. - -- .; : .
46. Nandiczp•Regulaifons ' - + s� � - � - ' i
� r• '
.97. FINA'L STRU'CTUR'E & BUi'CDING " _� �` " -
. � �� '+
4$. FlNAL PLANNlNG ' x^" + r _
e
49. `E�ect�ie Release io Edison � ' � � , �
.. . �-;:- - �-
50. Cas Retease to Sauthern CafiSomia Gas Co � `y ' - ' � � ''
. .",,' _ - � , -
57. CERTIFICA7E OP OCCUPANCY ' _ �' J� '
No.� - Date
1
\ I
. u�,�uaemiouc: g37 PINE Pli
ox'r+EasriwEiF�+a"": BEAVER, ROBERT DALE
�o�� BEAVER, MARIKO C
837 PINE PL
:OSTA MESA,CA 92627650-8888
�vv�.wuuxc �ooxEss:
UNT:
excxRecTon�+ar+�+: ROBERT LINNAUS ��� C18713
,IpCN.ORENG.'SADUPE55: 91O S EL CAMINO REAL uNT: B
SAN CLEMENTE CA 92072
CONfNAtTd1'SNAME
cam�cToxsxuuwa
�noxEss: uc.xo.:
UNT:
UCENSEU COMRACTOHS OECLAP�TION: 1 MnEy eflkm ivMar penely d perjury thet I em Icaneed uMm pwivms d Cheqm 9
(commeria�q xnh Sac�ion )OW) d D'maun � d Ne 8uvriea anE Pmlaevma CoEe. erq mY limrma b in lull forca uM aHep.
cm uc. No.: uc. cuss: uc. No.: EXP :
ode� com.eaor:
OWNEF BUILDEP DECIdFATION: I MmEy elfirm unEer pe�ly d perjury Ihm I am emmq Imm tM Comrmae limros lewlw tla
'bw'vq �eaaon (Setlion ]091.5 Busnefs arN Rdefeions Code: Arry ctY a wunly wh'rh �uim e peimil �o om5bucl. ellx. impma.
ndvh, a repei arry ntriMure, p'v b na uauarca, e6o repuire� iM epplicent Iw wch pemN to fib a eqmd ele�emenl tIW he a ehe
ticenaed punuent lo tM prmwiom d Ihe Goniraqas Licema Lew IChapler 9l�mmdnp wilh Seaion )000) d Drveion 9 W Ihe
Buaima eM Rdeaaiom Code� a thet he ar eM 6 avemp iherehom end iM beau fa Ne ellpad wempion. My vielction W Seqon
]oa1.5 by ary eppirani lor e permil wbjeae ��e eppiceni io e dvil panelry d rw� m«e t�en iHe �uMred Edlen �Ssoop. i.
� I, es owner d �ha propeny or my empbyeee v.ilh wepea m �M1ai eole campen�etion, xill Eo ihe wak, end tha el�ucturo e na imendeA
a allered fa sele (SecUon ]OId. Buanae eM Vrofeeaiona COEe: TM Contredwa licerue Lew does mt epplyto en owner W piopeM
wlw WdEe w'un0�� �herean. eM v.tw doee auch xwk limaaM «henep a �hraph he a her own emplqeea, pwiEeE IMI auch
imqovameme me mt iniendad a oHered lor vala. tl, howavx, ihe buiNiip a inpwemeM u�dd wilhin aw yaer d'mmpblbn. iM
owrer-0uikm xill haw �he buNm al yv+iiq M w ehe d'd ml Wik or impova lar �M W?ae a�1.
� I. m oxmr d iM O�WsM. em esdwivN/ ooniimiq vmh 4eanaeA eonveebn io we�M tM pM� (Setlion IOM. Bwins� anG
Pmle�ion+ COEe: TM Caniredae licams lew doea na eppy w en owiw d popeM ���+ a impwsa theieon aM who
comreW br wd� pqeae wGh e coMrador(e) licenaad i lo IM Conlratlon Licero Lew�. '
� ���a p�oee�'e'�: P7044 B.BPC..� ro F O R HY OWNER
i
Dete: Owner: -
I do Mreby cerNy Ihtl I em ewva d end unJenMM Uro ipuiremerua d Gel/anu lbMh enE Selery oEa Setliau 25505, 255]3, enE
2SSW. vd the� I a env Mun Euild'mp ommen� vnll / wil na (aeb me) need �o comqy wth veid uete eodp eM ths ieyu'vsmenb lor
o�.: nod�c
WOPKEH'S COMPENSATION DECLAPATION: I Mraby elfi�m under penMy d pwjury aia d Ne Idlowiiq datlaraiiom:
� I heve eM wJ meinten e ceNfbele d wuem to vaMiruure br waAen' wnpemelion, u pwided Iw by Seqian 3)00 d ths lebor
coaa. �o. ine wnonewie. m �h. xak �«.N:�m m� o� a��.e.
❑ � new dd w m.im.n wnwen• cano�c� mwrer�... �w�.e M seeion a�ao d ue �.ea. coa.. m. m. wdwmenca a me
wark tor whiN Nu Po�� u usued. MY warke� camPomffiion imuruice mrier eM G�Y wmbar ue:
c�«
Pdry NumEer
(7his eMion neeG rwf b comd� / Ne prmrt b M aie hunLieJ EWlen �SICtlI a lue.)
� I cenfy Ntl in Ne pa�lormenca d tM xroA M xhch this pmmil is iseuM. I ehell iwl empby enY Oa� in vry mennx eo a� lo
becnme wbjetl to IM xoM1an' canpaneetian lehe d Celilomie. enA prae thu tl I ehouN beconre wbjea to iM xvrken'
cumpense�ion piowuna d Sadion 3)00 ot tM lebor Cods. I Jull IwNwqh mmpry wiTh ihon pwiacm.
Dme: AppfreN:
Wam/np: F�llun ro s�cun woMsn'rompawtlon rovenp� l� unbwNl, �ndWll �ub/cf �n �mp/qw fo c�IMrulO�ltlw �rb
clHl flrMs w ro orH h,.viArM fhouwd JOINn (S10q000A M eddltlon ro M� cwt ol rompmutbR ��pu �s qvHGM br In
S�ctlOn 91f16 0l Ih� La6or COds, IMslu( anE ettomry'� lsu.
CONSTflUCT10N LENOINO R4ENCY: I Mmby eH�m uMer pereR/ d perjury Ihel Ihere u a mnprutlion brdi�p epency la Ne
peAwmeMa d IM xak la whkh thu Wm�i is bweE (Sedion 309). CM. CI.
LENDEP'S NNIE:
LENOEH'S ADOHE55:
I eenM �� I hew maE Nb epplieaWn vd nma ihm tha ebove inlamubn u eortea. I apiea to eanpy wilh all cry aeN wurMy pdinenme
eM gtate lawa relel'vq �o buikvq [anbWon end Mreb/ aNhotce �epeeenlatives diho tily b eMer upan tM ebwe.memunad popMy
lor iropeiYbn W�p�ps
� Pn Nema �` ry/Iln(�-'
Ome: �
en ree« T ��
IS151�a6.WP) W�ile-6uiWiq 8 Sdary:OreeMFle:Cenery-AOG���: Rnk-Revenue:(3aldenmFAsamoe
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 073511 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE
PERM NO: E 073511
GOVT: N SUPP: N
PURPOSE: OTH
JOH DESCRIPTION : 345SF BEDROOM ADDITION (ELEC. PERMIT) SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: RE: H73258 PRIMARY BUILDING
�tx x *�t**�titit**��*iE**x x��it�*x�it*�r*etitit*at*�tititx��r�x�**itiex�x�**�+tx�***iE**�r*feitieieieiE��***fE**fe*irat
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 REAA: FT IN FRNT: FT IN REAR: ET IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42245402 ZNE: REF NO:
PLANNING NOTES>
i -
1k iF 181E 1E 1E IE 1F iF 1F if iE IE 1E 1f 1E 1E 1E iF 1f 1E 1E 1E 1F if 1E 1E 1E 1E 1i 14 iE if 1E iE 1E ik ik ih if 16l61F 1E 141f iE if ik 1f 1E 1flF 1ElF iE 1E if 1E IE 1k 1E 1E 1E iE 1E iE 1f iE 1E 1f IE 1F 1E if ik 141E k
D E V E L O P M E N T S E„R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY .
BUILDING APPROVED BY
APPLICATION ISSUED BY
�t�t+t**+t+�+tx�x�*��*��rrt��**
LEGALIZATION:N
BLDG PMT
PERMIT
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
DATE:
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
43.00
SO2
15.�0
STRUCTURAL SEGMENT:N
EIRE SMIP/RES GRADING
SMIP/NON—RES
PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
43.00 15.00 0.00 58.00 58.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 58.00 OVER/SHORT: ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
58.�0
1k 1F 1E 1E iF iflF 1f 1E 1k iF iE 1k k 1E iE if if iE 1f k if 1E 1E 1E 1E 1F iE 1E 1E 1l1E iE k 1f 1E 1f 1k 1f IE 1E 1F iE 1k 1F iE ik iE fE 1E 1Fk fE k 1E 1E �E iE 1f iE 1E 1E 1E 1f 1k 1E 1E 1E if 1k iE 1E 1E iE iE 1E 1E 1E 1E
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
ELE 7 FIXTURES LIGHTING 1 ST 20 EA.
ELE 13 RECEPT/OGTLET 1 ST 20 EA.
ELE 8 RECEPT/SWITCH 1 ST 20 EA.
ELE 2 MISC CONDUCTOR NOT LISTED REQ PERMIT
END OF FEES
.75
,75
11.00
O2 4�15�:i9—fi0137219 T �1T
CsATE: 07;'!€/?.` ?IrE: 15:i0
5.25
9.75
6.00
22.00
• GONSTRUCTION AND PLANNING >: PO' SPA
�Date Inspector Date � Inspecto*
-� APPROVALS Permit# APPROVAIS Permit#
1. Tetmporary Electrical Service or Pole 52. Pool & Equipment Location -
2. So,ii Pipe-Und{grnd. ' 53. Steet Rei�forcement '
.•�3rElectrical Con9uit Utility•Undrgrnd. �-�`-, 54. Forms
,:�Q1. ��ectrical:l�onduit-Undrgrnd. . � � 55. Electrical Bonding � �
-� b. $Ieel Reinfortement 56. Rough Plumbing & Pressure Test ___
��Fr.- Electriw��ft Grnd. `' 57. APPROVAL TO COVER-GUNITE .__
-�7,`qotings�^;c. 58. ElectricalConduibUndrgrnd.
J�-8. Foundation= - 59. Gas Pipe, O Undrgrnd., Test
'8. WaCer Pipe�l3ndrgrnd. � 60. Backwash Lines, P-Trap, G� Undrgrnd.
T0. 5tructural F1oor System 61. APPROVAL TO DECK
i i. Property SeNier Line & House Connection = . 62. Backwash & Receptor-Final
12. 5ewer Cap � � '� 63. Heater & Vent-finai
13. Roof Drains � -'. � 64. Plumbing System � Final
14. Rough Plumbing t*: , 65. Electrical-Final
.�
15. Rough EleyCtrical-Conduit '� 66. Solar SYstem�Final
16. Rough Efectric Wiring 8$ -�j 67. Fencing & Access Approval
17. flough Wiring Sign 68. APPROVED FOR PLASTEPING ��
18. Rough ElectricaLT Bar Ceiling 69. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditionin,q� F EDE TyREQUIqEMEN,T �, ,;
� n x n- �. c. � •r ra , s � �, .!R . 3 ,
'y I 0.f�1 1 r _< T '� J'- � '^ t y
20. ,�,ougN Factor� Firagiace ��;, x � � S .. � APPq,DVQh�,.- Pe�mit # .. �.;
27. pucir in�Structur�,* . .. ^ � -
,1, � k i " y h �.� �. 70.''�,Jndefg'r�rt'cl F�dro r
22. duc(s; VA�til�in�- r � '�_ :: ,� � _ �* � 77, ProduciPiping �6as OOd
23. Gas Pipe�Rougp & Tast � TS x�T ";;� !- 7Q, UndergroU�d F[iusfi r �
24. Roof-Frai�ing•' � .* � ;;, t 1 � .
, �; c • 73: Undergrnd. Staa� TanhO Gas ❑ Oil
25. Poof Sheazhing ^!* i "�' + '- ^ ^%x 7y; Overhead Hyd�t+'.,.. *
... �r �.
26. 7-Bai Ceiling fStruc2ura�) & Monocoat �, - j �'r 7�: Dry CMe�ical F.,� : y � ..,: -
27. .F.rame and Flashing t - c�^ __' '�- - 76. Dry Starpi'ptPef'� �� •�
r r� u V.r .� r r
' 28. Iathing$�Siding �� � �G�, � � ` �'i ��, �.'.� 7J> FIXEDESL�T[AQ�INAE�� C' r� � ��
29. Insulation ::k � S •• ' �� 7J FIRE PREV. F`N�L `� �' 3' ^�F'_ '�
" '~ -,}iEALTt{�OEP7. REQUI EJdt
30. brywall A�2iling � w�-+ - � 5 �,
� 31. plaster B bwri Coat�r 3 .-;^ k I y'� 79. FINAL R�S�y('ECT-FO�� $,•- _;_ '�
� 32. ElectricaV Power Me',i'�r�finai ; °��' ,;. r 86.�',. F000 CERTIFi'L�ATE ISS�EU., ; �
' < � \ R r � Y' ..
33. Ginal flectric> •�; r� a 8� `� NotBs: ^� ^. � ' '� _ '•�
:- .. � � •,- ;. . ^-� �'
' 3q. �inal-Heating� Air CondRioni�S �' '` , '' � •"' ._: n" x � `i �
n. M' �"c . � J O o` � r1' z .� �.:-, .:
• ' -� 'h �' � ' . . „
35. Final Gas�PiPeTest fi �: .. •-+ f X � � �o c� - r� �:�::ti!:�!''
- ... r rr ' F,;.r
36. Hood or Canopy �.J ' T� 4 �: , i . r�' � C�c � c*'
� r• � �, r �* m .. � r�- ., v�, t=;
37. F�nal.FaceOry Fireptace�r � -,E � � � � � s * =�
.
: 38. Pinal,Plumhing * ri � � �- � I . � . `, ° �T
_ • < ., , , . . , , ,
39. Watei'Service-Final +;_ , ' -n e �q.;M<
v ^i x G -
� 40. Gas ServiZP-Fina� . a" T S ' � ' .� O�� :�tL ` • � !-
_ ' �-. F 'k ,•'. '-' • G <. ! C
J
_
41. Solar porfitsticFinat ' ;n �� l " ,r !r __ - �- x �
42. 6ackflow�Preventer * � � ' � � ' ` ` '7 "
^ �r' Y �� .a ;r r•'. # r+ "
M -
43. 8ackflow Irrig'�tion � >' - c r �f . : � * z _•
44. 4andscaP@ Irripatior�SYstem �,'. � � �^ �`' � - ' -� _ � ' ; _ . .t.-' "`
r �r s .;; G r .
A5. Sound Atsennation;. `-� �. . ' . ` ;,� r`�r, -n � m . : r = x'
., �
A6. Handicap•Regaiatior�s �+ � '`� '�: � `-' '_� '�
<- i' S ' r' [n Y
47. FiNAL STRUCTUR'� & BUILDING ' s "'
�
r t- i. •� ,* _ V'
48. FINAL PLANNING' - "' " "' - ' -' r. '`t +: <
� �. r
4g, �lectric Release to E'dison , :;� i. . �; v � �
i -,
50. Gas Refease co Soutfiem Cafifort1ja Gas Co ' ` -' � ' !- ''� ; � �
*� 5 oc f
51. GER�IFICATE OF OCCUPANCY " " ^ " -` '
N0. �ate
e
�3�7 �►n E P�Gce
CoS�-G YV�-eSa C1�
KO[�j er � d- %i� o� i IC�-J
� 7 3S//
�
.,
(Secve�
S
a� �,� � ,�.� � c., R
��r� �M �j N-�w
I
eiR
r
��1
i �--. i
/i0DflE55 OF BNLptlO: a 3% P I N E P L
owr�"'s"""E"'°q"": gEAVER, ROBERT DALE
. "0D� BEAVER, MARIKO C
• ^� 837 PINE PL
OSTA MESA,CA 92627650-8888
UNT:
,wcxnecrox�++cu+�x:ROBERT LINNAUS �N° C18713
IJiCHOHFNO.'SdODPE55: )1O S EL CAMINO REAL uNr: g
SAN CLEMENTE CA 92072
caam�crarsru�SCANDINAVIAN PACZFIC (714)631-2858
cam�croxs�uiwc 461 N. NEWPORT BL.
,wox�ss:NEWPORT BEACA CA ��= 629855
92663 uxr: A
LICENSED COIRflACTOHS DECLAXATION: 1 hareby ellirm unJer paneXy d perjury ihet I em Iicen�eE under proviaione W Cheqar 9
(mmmancirp wilh Seclion ]OW) ol Diviebn 3 oi ihe Buainen eM PMesaiona Coda, eM my license ia in lull force e�M eHad.
cmuc.No.: c.cuss: B � uc.No.: $1SS EXP:
Dme: "/ Convean: p
OWNEP BUILDEFl DECLINRTION: I hereby alfirtn uMer penely d pujury Ihet I em aaemq ham iM CoMretlas Licaue lew lu Ne
IdbxnB reasan (Setlbn JW 1.5 Bueirav eM Pruleasions Code: Any c�y rc counb xfiich nVuiree a Wrmu te mroouct. eller. imqaro.
'emolbh, w repei eny avuc�ure. prior W ne asue�, Wo repuiroe IM eppl'uam ta wch pennil to fib e aip�d Nalemenl ihet M a ehe
i IiceneeE punuani ia the poviebm d �ha Comrm«a Licenae lew ICheqer 9(�ma�ip xit� Seabn )OW) d Deieion 3 of �he
Bwineu erd Prdessions Cotle� or ihm M ar tlu is e:�emp iMrehom enE �M bmia lar ihe dleped a�emqian. Nry viobton ol SerJion
�os,.s M�r avd��,� �a,. ve�n eubjeaa me �cd�� �o a wa va��v ��a mon me� �aa nu�e,.d adare gsaop.
� I, u ownar af the peopeny or my empbyeas wnh wapea m iha'v wle mmpanae�ion, will do tha woA, eM the atruelure u nM inbMed
a Mmed braela (Seclion ]Wd, Bumness end PrdessbnsCaJe: TM Coniredors lioensa lawtlros �wl epplyto en ownar al propaity
w!w Wlda a inprovee �hereon, eiM xAro doe+audi woM NmuM a h«m� a Nrwph hu a Mr ovm empbyma, qoviEeE �IW wch
imqwemmia are mt imenAeE a Wered 1« sab. X, howaver. IM Euikirp a'vnpwemam b aold wilhin ane ymr al comOblion. �he
ownar-0uiker will heve iM burden d proviig M w aM d'd mi buiN w impo.e la iM WNae d eeb).
� I. es oxnar d �M popary. em udmrety oontretliq xth Ikmsetl conVeNas lo cmwutl ihe pajetl (Sedion 10a�. &niriva eM
PMesn'via Code: TM COMredas L"senm lew Eoea nd epply b an oxner d p�opMy wM Wilda a impwm iMreon W who
mnlrern M sKh propqe wAh e coMreqor(n) Icamed Wnuem to the Camrmore L'vne Lew).
� I em eRempt uMer Saetion: B. 8 P C., la Ihia reswn:
oe�a: ow��:
I do hereby caXiy Ihel I em ewera A eM uMersteM �M mQuimmeme M Cdiwna Haellh ud Sdely Code Saaiom Z5505. 25539, eM
]551a, eM thm I a e�ry Mure WiMi�p ocapent vnll / wll rwl (dicb one) rieaE lo wmply wIh eaid eb�e codea eM iM mpuiromanb la
epermnlaromsVuciionwmodififatbnhan�M/.'r u�vapemeru0imrie.Reaken�ielarm�uaioneppYrmbmenezamqlmmtheaa
Dele: ADdiunL
WONKER'S COMPENSATION DEC Wi�T10N: I hereby etFrtn uMer penNly M perjury aro d dw blbwi�q dede�miona:
� I heve eM xil mamm� e ce�ilictle W mroant to seX�irouro br woM1en' comparoetion. m praitled la by Sepion J�00 d the lebor
Cotle, lw �ha perlormenca o/ �M walc lor wlJch Ihie pennil ie ieeueE.
� I heve enE wip meimen worke�e' mmpenamon ireuranw, m required by Saeim 3]00 d iha Lebor COEe, fa IM peAormence W ihe
WOfI[ IIX NTIIfJI �M1IB (IBlRIII 191YYGE. M`/ WIXIIBR mmpeneetion inaurence cerrier ud poliry number ue:
c�a,:
vaKy N�mw.:
�mi: mnr�eee�oraem,�dweerurew���ro.a�.nunmeaddrers(s�aolwbss.�
I cenA' � in Ure pMame�we d tM wak M wTich Ihu parmu ia iaued. I e I mi empby ury penon in em� men'wr o m lo
become subjetl to IM1e xoMere' companee�ion la�+e d Cdilanie, e���qqq re �t X I ahouM becana m�bjw to tM waken'
compensmion pr 'si ne M Se ion 9]00 d Ihe Lebor Code. I Mell IMM ' c� i�}�y wn� ihwe p�ovieions.
Dele: AVdkeni: I
Wern/np: Fallun swun woqrx�' mmpxwtlon rovenp� l� vn/ewNl, entl Nsll wbpef �n nrploysr to eNMro/ pinaMu mtl
GH/ flrisa up ro aro hunCrM thouuntl OOINra (5100,000), In etlCltlon b tl�s roat o/ rompNuefbrt d+�pu �+plor�AsO bi In
Sxtlon 9106 of Ms LeDo� Cotlr, Infsisit anJ attornsyi lau.
CONSTPUCTION LENDIN(i AOENCY: I hereby elfi�m uMer pareXy d perjury �hm iArs u e mnsiwfion bMi�p eyency lar tln
parlormerra d iM xwk M xfiiM Ihb VarmY b'asuaE (Setlion 3091. CM. Cl.
LENDEX'S NIIAIE:
LENDEfl'3 ADDRE55:
I cerlity thm I heva read this epplcelion arM pma ihe� the ebove iMamelion is corteU. I eprea lo comply xil
end atele lavre reletinp to iildinp ca^avua n eM �e�eb/ eu1M�¢e raD�eeenle�ives M �hin dly lo en�x upon
�o„�,��o��,��,, ,,� YSS
Pnn�Neme
o.�.:
Spnel nVAppicenVConiredu
h dldryeiM coumY ordinericae
tha ebove�manlianeE properly
(515t<B WP) WM1ne-Buildiip 8 Seleq: Greeo-Fb; Cenery-Appf em: Pink�ievenue: GdEenmo-Assasaor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 073258 PLAN CHECK NO: 02330-95 L
CONSTRUCTION TYPE: PERMIT TYPE: STR
JOB DESCRIPTION : 345SF HEDROOM ADDITION
PERM NO: H 073258
GOVT: N SUPP: N
PURPOSE: ADD
SQ FT: 3,J45
CLAIM VALUE: 30,000,00 CALC—VALUE: 28,530.00 GROUP OCC: R-3 /
COMMENTS: MISC RESIDENTIAL ALTERATIONS
***�r*��t*�+���*at*itatx*�***�**ft*�+�*�***+�***�********�*iE+�+t*a��r*�*****atat**+�+�+�*+��+�+��*+��
Z O N I N G R E Q U I R E M E N T S
S E T B A C R S
------------ MASN AUILDING ---------- --------- ACCESSORY BOILDING ---------
FRNT: FT IN REAR: 14 FT IN FRNT: FT IN REAR: FT IN
LEFT; 11 FT IN RGHT: 5 FT 6 IN LEFT: FT IN RGHT: FT IN
PARKING REQ: 2 PROV: 2 PARCEL: 42245402 ZNE: R1 REF NO:
PLANNING NOTES> ADD BEDROOM��AT REAR OF EX. RESIDENCE, (SINGLE—STORY; 12'6"
> MAX:,HEIGHT)
���+�x���*�x*�tx***�***�t+��t**�****�*�tx*�tu�*�*x*******+c�x*�***�*��**�***�*j���****�*�t
D E V E L O P M E N T �S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY �:�_� ' ___ DATE: C( —
BUILDING APPROVED HY�:�� DATE: �( O S�
APPLICATION ISSUED $Y:�L.�:.��/�� —����CY'��,s�(��—� DATE: / /S� �S�
�1FlfiFiEf6if1E1EiEiEiElEiFiEiEiE*lEiE1E1E*,i'c 3Fif iFiF3F�iFiF ifiF����F�TfiF �E�iEif3FiF iflfTF�iF3FiE1E�)EiF1E#3EiE3fiE iFi414
LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 278.00 2.85
SMIP/NON—RES
PLAN 180.70
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 280.85 0.00 180.70 461.55 461.55 .00
REVENUE DIVISION TOTALS--> COLLECTED: 280.85 OVER/SHORT; .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
278.00 2.85
#�If iE if if fE fE 1E 1E 1E ff 1ElE �! 1F 1f iF 1f �R !E iE iE iElE �lE iE 1f 3E 1E iE 1E 1k 1f iElf if ff IE if fE if i41E 1E iE iE fE 1E �E ff �E IE 7E 1f 3E �(' jE IE IE �IE iE iE iE aE IE �IE 3F �1E iE ih iE iE 1E �ElE I4 iE if jE
I N D I V I D U A 1.� F E E B R E A K D O W N
TYPE QTY D E S C R I P T I 0 N UNIT COST TOTAL COST
SFR 345 DWE—TYPE V—WOOD FRAME —GOOD 74.00 25,530.00
SFR 3000 ALTER HY VALUE RESIDENTIAL NOZONE 1.00 3,000.00
END' OF FEES
"2 �^.iv,st�?—�n?°1193 Te4'�
ur1T�: Oii?,�?: TI'E� :4�i3
zsn.es J
GONSTRUCTION AI1ID PLANNING �� SPA
Date Inspector Date Inspector
i�PPROVALS Permit # APPROVAIS ,_Permic #
1, 7emporary Electrical Service or Pole 52. Pooi & Equipmeni Location
Z, Soii Pipe-Undrgrnd. � 53. Steel Reinforcement .
3. Elecvical Conduit Utiliry•Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding ' ._
5. Steei Reinforcemer.t ' ?i�_� �fv�( 56. Rough Plumbi�g & Pressure Test �
6. Electncal UFEft Grnd. � 57. APPROVAL TO COVER�GUNITE
7. Footi�gs ? 21 �'s �gLLl/ 58. Electrical Conduit-Undrgrnd.
8. Foundation ' /_ �� „ 7iL(-' {'S �w� 59. Gas Pipe, � Undrgrnd., Test
�v �Y �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, CI Undrgrnd.
10. Structural Floor System 61. APPROVAL TO OECK
11 . Properry Sewer Line & Ho�se Cormection 62. 8ackwash & fteceptor=Fina1 �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SVstem - Finai
74. Rough Piumbing 65. Electrical•Final
15. Rough Electrica6Conduit 66. Solar System-Finai �
16. Rough Electric4Viring 67. Fencing & Access Approval �
77, Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricai�T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
79. Rouch Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21, pucts, in Structure 70. Underground Hydro
22, pucts, Ventilating 71, Product Pipin� C�Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd.SmrageTank OGaz ❑Oil
25. Roo4 Sheathing � � 74. Overhead Hydro
26. T-Bar Ceiling (Structuratl & Monocoat 75. Dry Chemical
27. Frame and Flashing ._7_-� �(,v� 76. DrY Standpipe
28. Lathing & Siding S 5�(,vbL 77. FIXED SYSTEM FINAL
29. Insulation 8�_q�' �(y6L 7g, FIRE PREV. FINAL
30. P�Y�vall Nailing ,., � HEALTN DEPT. REQUIREMENT
�� � q$'_1__/�u_6�--
31. Plauer Brown Coat g`8 � 79. FINAL INSPECTION
32. Electrical Power MeterFinal � 80. FOOD CERTIFICATE ISSUED
33. Finai Electric Notes:
34. F�nal Heating & Air Conditioning -Z-.f.�l� �'�
35. Finei Gas Pipe-Test �
36. Hood or Canopy
37. Finai Factory Fireplace
38. F�nal Piumbing
39. Water Service�Fl�ai
40. Gas Service�Final
41. 5olar pomestic-Final
42. Backflow Preventer
43. Backfiow Irrigation
44. landscape Irriqation System
45. 5ound Attenuation
46. Ha�dicap Regulations
47. FtNAISTRUCTURE&BUI�DING O�g �(,� .
48. FINAL PLANNING
4g, Electric tielease to Edison
50. Gas Release to Southem California Gas Co .'
51. GERTIFICATE OF OCCUPANCY
No Date
City of Costa Mesa
California 92628-1200 P.O.Box 1200 .�eC (�i 4� � Q�
r r�
Insulation Certificate �°"U %
Permit Number � • �� � (J
g3� �ir�P j�/qce C'�.�� /�eJ�
Number and Street Ci�y
SG� �.
County Subtlivisian lo� Number
ROOF
Material
Thickness (inch�s)
Description of Installation
Brand Name
Thermal Resistance (R-Value) –
EXTERIOR WALL M1,
Material I�'�'� � 'Brand Name /
Thickness (inch�s) � � � Thermal Resistance (R-Value� � ` �
CEILING p
Batt or Blanket 7ype ��� Brand Name �'��"� /��
Thickness (inches) ��� Thermal Resistance (R-Value) / l��
Loose Fill Type Brand Name
Cohtractor's minimum installed weight/ftz— Ib. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR
Material _
Thickness (inches)
SLAB FLOOR
Material
Thickness (inches)
Width (inches) �
FOUNDATION WALL
Material
Thickness (inches)
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Flesistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
C�Iitor�nMia�/P/,d�minstr�� de. � � ���� ��� �J�
JC �X.IM
Coniractor ( ilder) License Nu er
��� CL� .�C� .S�
ignaWra and TiOe Date
Sub-Coniracbr (Insulation Ins[aller)
Signature antl Title
1901A6
License Number
Data
�
X
'\
AODlicant to till in al1 soaces exceo< enose witnin hcavv Coraer lines ana si9n all appropriate declarations.
GITY OF COSTA ESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOJ f�f0. UNIT NO.
�3� P� �, a(��,�e 2 Z3 3 coso ---
Project Address �
ApplicanYs Mailing Address �ML" � �'Q�%V C� �� �(- ,y��p�
Owner'sName %��� �� Phone—sz�L(
Address $�'�E' %L- �-•�
ArchlEn9. License No.
Address
Contractor's Name ��%N��� Phone
Address (mailing)
Ciry License No.
LICENSED CONTRHCTOR DECLARATION
I M1ereby atfi�m that I am IicenSetl untler provisions of Charte� 9(mmmencin9
with uctian �000) of Division 3 0( the Business antl Protessions Cotle, antl
my license is in full force antl eftect.
License Clazs License No.
Date Signature
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate ot consent to self-insure or a certificate
of Worke�s' Compensation Insu�ance, o� a certitietl tOpy [hereof (Section
3800, Lab. CJ '
Policy No. Company
8 Certi(ietl copy is,hereby fumishetl.
Certifietl wpy is filetl with the city Builtling Division.
�ale Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit i5 for One huntlretl ($100) or
less).
1 certity that in [he, performance of the wo�k tor which this perm�t iz issuetl, I
sM1all not employ any pe�son in any ma ner so as to become SUDject to tne
Workers' pens tion Laws of Californ ,7
oate ' Si9nature �,�D -{u{ ,
NOTICE: Ii .afte making this tleclaratio you sn6ultl become subject to the
Workers' ComOensation provisionz of the Labor Cotle, you muzt forthwith
comply with such 'provisions ov this permit Shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a construction lentlin9 a9ency tor the pertormance
oi Ihe work for which this permit is issuetl (Section 309] Civ. C.)
Lentler'S Name
Lentler's Adtlress � —
OWNER BUILOER �ECLARATION
I hereby affirm that I am exempt trom tM1e Contracto�'s license Law (or tne
tollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or
wunty whicb requires a permit [o construc[, alter, improve, tlemolish or repair
any sVucture, prioLto its issuance, also requires the applicant for such permit
to file a signetl statement that he/she is Ilcensetl pursuant to the provisions of
, the Contractor's Lic¢nse Law (Chapter 9(commencmg with Section 7000) of
•t�Division 3 of the Business antl Professions Cotle) o� that he/She is exempt
"therefrom antl the basi5 tor the allegetl exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
�'�e alty of not more than five huntlretl tlollars ($500).
1, as owner of the property or my emoloyees with wa9es as Iheir sole
compensation, will tlo the work, antl lhe structure is not intentletl or otferetl
for sale (Section 7044, Business antl Professional Cotle: The Contractor4
LicenSe Law tloes not apply [o an owner Of a properry who builtl5 or imp�oves
lhereon, antl who tloes Su[h work himself/herself o� through hi5 ot M1er own
emO�oYees, provitletl Inal mch improvements are not mtentletl or o(feretl tor
sale. It, howeve�, the bulltling or improvement i5 saltl wi[hin one year of mm-
oletion, the owner will have the burtlen of provin9 he/she tlitl not builtl or im-
� prove for the putpoke ot sale).
❑ I, as owner of the property, am exclusivery contracting with licensetl con-
Vactorstd consVuct roe project (Seclion ]044, Business and Pwfessions Cotle:
The Contractor'S License �aw does not appty to an owner of property who
builtls or improves thereon, antl who wnVacts for such projects with a con-
trac[or(s) license pu�suant to the ContractoCs License Law). I am aware that
proot of their Worker's Compensation insurance shoultl be provitletl to me.
❑ I im exempi untler Section _ B. & P. C. for this reason
1� Date
�� I hereby ertify tha
information Is mrrec
antl state laws relakii
sentalives of ihis i
inspettion pu�poses.
/� Signature �
� Drivers' License or 5!
` CMF 0865-46, rev. 10/84
— Owner
I have reatl this ap licatic
. I agree [o comply with all
3 to builtling Construt[ion,
y o en[er upon the abo
I
�c �
I state that the above
antl counry ortlinances
ereby authorize repre-
ntionea orooertv tor
TVPE OFCONSTRUCTION 'N'EW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DE$CAIPTION OF WpjiK/VS� OFBLpG. _ _ _ , _
TYPE OF PERMIT LI GRADING LI FOUNDATION LJ STRUCTV RAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION �Sr,rFT. O oCCUanrvCv
CON'ST,RVCTION TYPE VALUATION $ �
ZONE GRADINGCU.YDS. 11CRE5_
Remarkf:
Sink
Preventer
Irrigation
Drinking fountains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavamries
P—Trap
Roof Drains
Reinspection Fee � $15
Duct- UnderGround
Duct - Strucwral
Duct - Ventilating
ExhaustSystem ❑ MWtiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000
Heinspection Fee � I $15
WM1ite - Builtlin9: Canary - APPlicant; Pink - Accountin9; Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
Auto-Wash
Laundrv Travs
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0�100,000 BTU ❑100,000 BT
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$' 3
$ 3
A.P. # 4•
S Main Bui
E
T Front ~
B Rear
A
C Right
K . , _
Ping. Ref. �ik
Plannin9 Notes:
Automatic Washe
Construction Poh
Cooking Unit
Dishwasher
Dryers ❑Gas �
Fan
F.A.U.
Fixtures
Device Boxes
Outlets �
Switches
Garbage Disposal
Generator �0-5
Electric
KW OS-15
4178 /":/.;
— /L Zone
Accessory Building:
Tfti �=C/
Parking Req./Provided
:� b/k �
) �L .
ELECTRICAL
Transformer ❑ 15-50 KW
'� 50+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0-1 HP �1 %- 8
Inc.Solar 09�15 HP �16�15+
Microwave
. Pole Light
Sign
Standing Sections
Tiash Compactor
FEES
Z
O
N
1
N
G
R
E
Q
M
T
S
I Reinspection Fee �$15 I I Issue Fee I $ 3'
DEVELOPMENTSERVICES/gp{�Qp U�IREMENTS: �/[� `/f �
Zoning Approved By �`�+�" Date �+��`-'
Buildin9 Approved By Date
Application luued By Dat � Z� �
SU�r1�ARV OF FEES
BUILDING PERMIT $ � �A�[O— SMIP g �•S-b
PLAN CHECK $ ���� PERMIT
PLUMBING $' ISSUANCE $ �
PLAN CHECK 25% $ ENERGV P.C. 5
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM S
MECHANICAL '$ TOTALPEE $ �10.90
PLAN CHECK 25% $ - �
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1: Temporary Electiical 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-Undrgrnd.
10. Structural Floor System
17. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. F�ugh 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) & MonocUat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31 . Plaster Brown Coat
32. Electriral Power Meter-Firial
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backfldw Preventer
43. Backflow Irrigation _
44. Landscape Irrigation System
45. Sound Attenuaiion
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date �
Date
POOL & SPA
Inspector qppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
�y 56. Rough Plumbing & Pressure Test
57. APPROVA� TO COVER-GUNITE
G. 58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, 0 Undrgrnd.
61. APPROVALTODECK
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/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
70. Underground Hydro
71. Product Piping O 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
80. FOO CERTIFICATE ISSUED
Notes: �% h o'�/ /rI �'� %�C%_ 4
Date � Inspector
i
✓ ' � , �—K Aoo� �
+ ciTv�F'COSraMESAq CONSTRUCTION PERMIT
Pivjec[Address ��+ / q��//Y� �L. �
Applicant's Mailin Address �LQ , M L�/V'9 df .�i� �'�%DS'
Owner's Name � �d�'U6 �+n . Phone G`f� `�`�7�
Address �3 0 ��
y►ilEng. Licenu No. ,
Addreu �
Contracror'sName.����/ 6E/� e4 hone 99�9�`��
Address (mailing) L�/ L�' ���pL�r �� s' C'� �
� Ciry License No. 3��_/ � �T j� �
C LICENSED CONTRACTOR DECLARATION �.
�0 I bereby a(firm tha[ I am licensetl untle� provision5 of Cnarter 9(commencing
\wi[n section ]000) of Dlvision 3 of the iness antl Professions Cotle, antl
my Iicense is in full �orce an/�,��ptect. /
_/ License Class 'v �i s o ` �� � ��
� U Dale �O—i/�it 5'g �
\"'ORKERS'COMPENSATION DECLARHTION
� veby allirm that I �ave a certificate oi consent to sel/-insure or a certlficate
workers' Compensation Insurance, or a certitietl mqy thereot (Section
3800, Lab. J.Y� % i .�s �
Policy No. �: Company
�Certifietl <opy/ is hereby furNshetl. .
Certifiptl_mpyis fi e witn the city di M o.
Date OU�� Applicant
EXEMPTION FROM WORKERS' COMPENSA ION D CLARATION
(Thissection neetl not Oe Complotetl If tne permit is Po ane huntlretl (§300) or
less). �
I certl/y tnat in the periormance o1 the work for which Nis perm�t is issuetl, I
s�all noe employ any person In any manner so as to become subject to [Ite �
Work¢rz' Compensation Laws ot California.
Date Signature '
NOTICE: tl, after. making thi5 tleUaratlon, you.snoultl become subject to the
Workers' CompensatiOn provizions of the Labo� Cotle, you muzt forthwiih
comply with Such 'OrOvizions o� Ni5 Dermit Shall De tleeme0�tevoke�.
CONSTRUCTION LENDING AGENCV
1 nereby alfirm that therB is a conSVuction lentlin9 aqency for [he performance
of lhe work for,whicn this permit is Issuetl' (Section 309� Civ. CJ
lentler's Name _�—}�..r
Lentler's Aaaress �LICJ
OWNER BUIL�ER �ECLARATION
1 her¢Cy aifirm that I am exempt lrom the Conlrattor'S License L.aw fOr the
following reazon (Section ]031.5 Business antl Professional Cotle:�Any city or
counly which �equires a permlt lo con5truct, alteq improve, demolis� o� repair
any structure, prioi to-Its Issuance, also requires the applicant for such permit
to file a signetl s[atement lha[ hC/She I5 IicenSCtl pursuant [o the provisions of
�^^ Confrdctor'z LicenS¢ Law (Chapter 9.(<ommencing with Section 7000) of
'�ion 3 of the Busines5 antl P�ofes5ions Cotle) o� lhat �h¢/she is exempt
Arom ana the Da5i5 tor tlte allegetl Gxemption. Any violation ot Sec[iOn
.1.5 by any applican[ for a permi[ subjects [he applicant to a civil
•� enalty of nol more than tive huntlretl tlollars"($500).
I, as owner ot the property or my employees witn wages as their sola
� compensation, will tlo [h¢ wo�k, untl the st�ucture i5 not intentletl or offeretl
for sale (Section ]044, Business antl Professional Cotle: The Contractor'S
, License law tloes:not apply lo an owner of a property who bwltls or improves
Ihereon, antl wno does such work himseli/herzelt or tnrou9h his or her own
employaes, provitletl tbat suUl Improvements are not intentletl or ofteretl for
wle. If, however, the builtllnq or Improvement Is soltl within one year ot com-
.o�etioq the owner will nave tha burtlen of proving he/sne tlitl not build or im-
- p�ove �or thC pu/Oose of zala).
❑ I, as owner of the property, am exclusively contracting witn licensetl con-
� t�actors to conitruct the project (SeGtiOn 7044, Busine55 antl Protessions COtle:
The Contractor's License ISw does not appty to an owner ot prope�ty wno
builtls or improves thereon, antl who contracts for sucn o�oiects with a con-
tractor(5I license pursuant to tbo Contractor's Lic¢nse Law). I am aware that"
. proof of tM1eir Worker'S Compan5ation insuranG2 sltoultl be provitletl to me:
❑ I am ezempt untler SeCNon 8. & P. C. fot this reason ,
Date Owner
I hereby C¢rtity thal I have reai
Signature • fY/6/
Driver5' Litense or 55 �
wim au utv
[he abOve-m
v crt�
tate Ihat ine above
d county ortlinances
=by authorize re0re-
Ionetl p�o0e�ty tor
on�e /b--y �`
heary borCer lines anC sign all appropriata tle<larations.
TVPE OF CONSTRUCTION LI NEW ��ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ �THER � �
DESCRIPTIO OF RK/USE OF BLDG. syV *d aL
/ /
TVPqEOFPERMIT GRADING ❑ UNDATION STRUCTURAL
'LJ TENANT LECTRICAL ❑ PLVA�BING ❑ ME`CHA IC �L
❑ OTHEf3 �P ' J �
PROJECT DESCRIPTION 5 !� OCCUPANcv 3
C O N ST RUCTI ON T V PE V A LUATION $-�
ZONE GRADINGCV.VDS. ACRES
Remark5:
c #,�,�`S5� -86 s
�' Bar Sink ( �
-, Backflow Preventer
,� Backflow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service � Outlets
Kitchen $ink �
�dV0tOf125 . �
R
Reinspec[ion Fee
Showers
Service Sink
Sewer Cap
-Sewer Connecti<
Solar Collectors
Solar Pipin9
Solar Tank
Swim g Pool w/Spa
nal
Water (�.�052L
Water Heater
Water Service
Auto Wash
Laundry Trays
$15 Issue Fee
Boiler
Duct - Under Ground �
Duct - Structural
Duct-Ventilating -
Exhaust SyStem ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducti
❑0-100,OOOBTU OO,OOOBT�
Fee � ��5
` CMF 0865-46, rev. 10/84 White - Bulltlln9! Canary - Applicant; Pink - Accounting; Goltlenrotl - Asseszor
Hoodor Typel ❑
Canopy Type 11 ❑
Refrigeration Sys
❑0-700,0 TU ❑100,000
S em Repair/Alteration
Fire Dampers
Issue Fee
FEES
A.P.# �p(o,
S Main Buildin9:
E
T Front
B Rear /
A
C Right
g Left �
Ping. Ref. # '
Planning Notes: ��
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
,Device Boxes
Outlets 5
Switches 3
Garbage Disposal
�59 II/12/B6
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
' � ❑,50+KW �
Meter ❑up w 700 amps
Meter ❑over 700 amps '
Sub Panel
Motors�0�1 HPO1h-8
Inc.Solar �9-75 HP �76-75+
Microwave
Pol¢ Light
Generaror 00.5 KW 05�15 KW
$� Reinspection Fee
FEE
DEVELOPMENTSER
Zonin9 APProved BY_
Building Approved By
� Aaoliwtion Issued Bv_
$ 3
$15
i
Sign
Standing Sections
TraSh Compattor
� �
luue Fee �
145.31 TL
FEES
$ 3
r /� z
Z
O
N
1
N
G
R
E
Q
M
T
$
�7 SUMMARV OF FEES � '0.3,i.,,
BUILDING PERMIT 'J' �SO _�'�' SMIP , $ ���
PLAN CHECK �+��-�� PERMIT l
PLUMBING g � ISSUANCE $ ,
PLAN CHECK 25% $ �' T� ENERG� P.C. $
ELECTRICAL § �'�TO GRADING 3
PLANCHECK 50% 5 �O MICROFILM $ �
MECHANICAL 5 TOTALFEE $
PLANCHECK 25% $ I�S� �/
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
�1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. -, 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgmd. .
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgmd. 60. Backwash �ines, P�Trap, �� Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � ; 64. Plumbing System - Final
74. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit .- 66. Solar System-Final
16. Rough Electric Wiring �_` 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace �� - APPROVALS Permit#
27. Ducts, in Structure� . � -- � 70. Underground Hydro
22. Ducts, Ventilating , 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test - ' 72. Underground Flush �
�24. Roof Framing , , 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �. 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . '
27. Frame and Flashing ' � 76. Dry Standpipe
28. Lathing & Siding � (f�( �% 77. FIXED SYSTEM FINAL
29. Insulation - 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED (
33. Final Electric Notes: )y j� G ` I '
hIK• f� -L1 (�a.w IY'
34. Final Heating & Air Conditioning � ,S %�' �Cb A• �.� '
. 35. Final Gas Pipe-Test y '
� •-�l.
36. Hood or Canopy '
S !
37: Final Factory Fireplace
i ,
38. Final Plumbing � � ' � � '
� ,
39. Water Service-Final � � '� � ��
40. Gas Service-Final .� ' ,
41.. Solar pomestic-Final . ` . �. _
42. Backflow Preventer � � � , "� '
�43: Backflow Irrigation � ' ,
.44. Landscape Irrigation System �� , ' •', �,
.. �
'45. Sound Attenuation � . � ; .
i, .
,Q6..Handicap Regulations � �� � " ' • �
' !, i
,
47. FINALSTRUCTURE&BUILDING � ' ' �.; " i? ;
48. Special Requirements Completed " '
• �
49.-Electric Release to Edison ' � '
2
50. Gas Release to Southern California Gas Co " • `�
57. CERTIFICATE OF OCCUPANCY � .�• �
No. Date "
i � .
AOP��cant to till in all sDaces except those within heavy bortler lines ana sign a11 approDriate tleclarotions.
CITY OF COSTA MESA �
CONSTRUCTION PERMIT
ProjectAddress ��7 �yG C% ��SY//�'tESh
ApplicanYsMailin9Address�����7 r�'✓��/LG'b/t YBiT___/YU.Yla
Owner's Name � � �� y� Phone �S �7�
Atldress �37 �/�uGrST /�iST/1 J�?�S�
Arch/Eng. � �✓����i//"—l�i� /�/b License No. 3 �S�YS `�
Address �79"/?y � S�'iY ��i'GC ��t � z� G i
Contrector'sName�ejY/H�`d �'���a Phone�`l�s�ri
Address (mailing) �7�� T ��1� rU/G-/ b�—
City LicPnse No. ' �
LICENSED CONTRACTOR �ECLARATION . '
I hereby affirm that 1 am IicenseC untler provisions ot'Charter 9(commencin9
with section �000) ot Division 3 of the Business antl Professions Gotle, antl
my license is in tull torce a tl effect. ' , '
';Ytcen � CI �� ' Llcense Na.z� 7s��!
��-+e�—�T Signature�[�Q � �
�'��RKEftS'COMPENSATION DECLARATIONI
I hereby aftirm that I have a certiiicate of congent to self-insure ot a certiti ate
of Workers' Compensation Insurance, or a�certified'copy theieof (Sec ion
3800, Lab. !/,I � ' �
PolicY No. �� T`r4� ComPany �/'�n/ly���
Certifietl copy is hereby fumisnea.
Cer rtietl copy is filetl with the city Builtling D'vision. .
ate �—Z`Y—�i ' Applicant
EXEMPTION FROM WORKERS' COMPENSATION-�DECLARATION -
(This section neetl not be completetl if the permit is for one huntlretl ($100)
less).
I certify that,in the pertormance ot the work tor which this permk is issue
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Califomia. � � �
Date Si9nature '
NOTICE: If,'after making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions ot the Lgbor Cotle, you must forthwith'
mmply'with such provisions or this perM�t shall .be tleemetl revoketl.
CONSTRUCTION LEN�ING�AGENCV .
I hereby atfirm that there is a construction lentling agency tor the performance
of the work tor which thi5 permit is issuetl (Section 3097 Civ. C.) .
Lentler's Name � � �
� .
Lentler's Atltlress
OWNERBUILDER�DECLARATION ' -
I hereby afficm that I am ezempt from the Contractor's License Law for tne ,
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
rom antl the basis for the allegetl exerqp�ion: Any,violztion of Section
5 by any applicant for a permit subjects the.applicant to a civil
�,y of not more than five huntlretl tlollars �g500). , •
as. owner of the� property •or my emp�oyees with wages as their sole
as
will Oo the work, antl the strVcture is not intentletl or offeretl
tion ]044, Business and� professional Cotle:, The Contractor'S
ioes not apply to an owner of a property who builds or improves
wbo tloes such Work himself/h¢rselt or,throu9h M1is or her own
�ovitletl that such improvementA are not intentletl or otferetl tor �
ver, the builtlin9 or improvement is soltl within one year of com-
wne�� will`have:the bu�tlen of p�oving h¢/She ditl not builtl o�`im- `
purpose of sale). � , - � '
� of the property, am exclu5ive�y coMracting with IicEpSetl con-
sstructthe project (Section 704p, gusiness antl Protessions Cotle:
or's License Law tloes-not appiy to an owner of property who
�roves thereon, antl who contracts for such projects with a con-
nse pur5uant to the Contractol'S Lic¢nse Ldw).
I'am exempt untler Section B. & P. C. for this reason
Date � Owner _
I hereby certity that I have reatl this
information is correct. I agree to compl
antl State laws relating to builtlin9 cons
sentatives of'this city to'enter upon
Signature / //,6`ti'+�
Orivers'�License or 55
CMF 0865-46 rev. 7/83
�
TYPE OF CONSTRUCTION- LJ New��ADD U ALTERATION LJ' REPAIR
❑ CONVERSION ❑ DEMOLISH OTHER
�ESCRIPTION OF WORK ��bT «��ln K'I
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTV RAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCV_
CONSTRUCTION TVPE VALUATION $
ZONE GRADING CU. VOS. ACRES—
Remarks: ,
Bar Sink
Backfiow Prevenier
Backflow Irri�ation
ite that the above _ �
county ortlinances
iy authorize repre-
netl �property f4r
Disliwasher . ' "
Drinking Fountains
Floor Orains
Floor Sinks
GasService ,Outletr
Interceptors� �
Kitchen Sink � '
Roof Drains
Reinspection.Fee '
- Under Ground
- Structural
Showers
Service Sink
Sewer Cap
Sewer Connection
$OIdI COIIECSOfi
SolarTank `
Swimming Pool w/Spa
Urinal �
Water Closet
Water Heater
Water Service �
�
$25 . . Issue Fee �
MECHANICAL •
Hood or. Typel' ❑ � �
Canopy ' Type II ❑ .
1
Exhaust5ystem I� Multiple
Firepl/Fact.Blt.IC60# .
Heating System & Ducting
❑0.100,000 BTU �100,000
m Fee ' I $25'
White-Builtling;Canary�-APPlicant;Pink-Accounting;Goltlenrotl-ASse35or ' �' - �
Refrigeretion System
❑0.100,OOOBTU ❑100,0006
System Repair/Alteration ,
A.P. #
S Main Building:
E
T Front
A Rear
C Ri9ht
g Left
Ping. Ref. #
Parking Req./Provi�
Use af Building:
Planning Notes:
6�67 9/�y/!;::
Zone.�
Accessory Building:
Park.Fees $�
� - ELECTRICAL . FEES
Automatic Washer Transformer ❑ 15-50 KW
ConstructionPoleSub. �50+KW �
CookingUnit ' 'Meter ❑upto100amps '
Dishwasher , Meter ❑over100amps �
Dryers L1Gas• LJElectric '
Fan'
F.A.U.
Fixtures !
Device Boxes
OutIQSS
Switches
Garbage Disposal
Generator 00.5 KW �5-15 KW
$31
—L� Reinspection Fee $
FEES
PUBLIC SERVICES REQUIREMENTS:
Zoning Approved By
Application Approved By ._���
� laue Fee ' ' I $ 3
- BUILDING PERMIT
� PLAN CHECK
• PLUMBING ,
PIAN CHECK ,
EIECTRICAL
P�AN CHECK
, MECHANICAL,
PLAN CHECK
Sub Panel
Motors DO-1 HP 01'/: - 8 '
Inc.Solar Q9=15 HP �i6-15+
Microwave � �
Pole Light �
Range
Sign
Standing Sections
Trash Compactor ,
Fee
$ 3
O
N
I
N
G
R
E
Q
U
I
R
E
M
E
SUMMARV OF FEES �
$ SMIP , $ I
$ PERMIT ,
$ . � ISSUANCE . $
� � ENEPGV.P.C. $ �
$ ' GRADING $ � '
$ � MICROFILM � $ �� p�
$ � '—.=— TOTALFEE $ L — .
$ � � .
�
� ' CONSTRUCTION AND PLAN�yy 1 L . � � '- & SPA � ,-
' APPROVALS� �Permit #, U � Date � Inspector p�ppROVALS Permit # , Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location ' ,
2. Soil Pipe-Undrgrnd. • . '- ' � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. � - 54. F.orms � . .
4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding � . �
5: Steel Reinforcement . 56. Rough Plumbing�& Pressure Test , -
6. Electrical �UFER Gmd. . � 57. -APPROVAL TO COVER�GUNITE
7:. Footings � - � . 5S. Electrical Conduit-Undrgrnd. � ,
8. Foundation , - 59. Gas Pipe, 0' Undrgrnd., Test ,
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' . .
10. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final � �
12. Sewer Cap �� 63. Heater & Vent-Final � '
13. Roof Drains . . � 64. �Plumbing SYstem - Final
14. Rough Plumbing � . 65. Electrical-Final �-
75. Rough Electrica6Conduit 66. $olar System-Final �
16. Rough Electric Wiring ' � 67,. Fencing & Access Approval -
17. Rough Wiring Sign �• - � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � - FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � ' APPROVALS Permit #
21. Ducts,in Structure ' 70. Underground Hydro
22. Ducts, Ventilating ' 77. Product Piping O Gas� ❑ Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush �-
24. Roof Framing . 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing , 74. Overhead Hydro
26. T-Bar Ceiling (Strucwral) & Monocoat � � 75. Dry Chemical -
27. Frame and Flashing ' 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � � ' 78. FIRE PREV. FINAL .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT,
31. Plaster Brown Coat . � � 79. FINAL�INSPECTION
32. Electrical Power Meter-Final ' � 80. FOOD CERTIFICATE ISSUED �
33. Final Electric ' � , Notes: � ,
34. Final Heating & Air Conditioning ���
35. Final Gas Pipe-Test , � � ' '
36. Hood or Canopy � , . - - �
37. Final Factory Fireplace . - � �
3S. Final Plumbing ' � � �
39. Water Service-Final ' �
40. Gas Service-Final � ; ,
41. Solar pomestio-Final � . � -
42. Backflow Preventer '
43. Backflow Irrigation , � ' �
44. �Landscape Irrigation System � ' ' � �
45. Sound Attenuation � � . '
46. Handicap Regulations � - ' '
47. FINAL STRUCTURE & BUILDING ' '
48. Special Requirements Completed ' � , ' . ` �
49. Electric Release to Edison � - �=�� 'f�
50. Gas Release to Southern California Gas Co .� � �
51. CERTIFICATE OF OCCUPANCY _ __ , � . �
No, �
Date '
/ . 1' ' .
UCTION�AND PL'ANNING' � '„ - - . --. - . - _� : ..POC SPA ' , . • .
"�• '� " ' �� ' `Date-. !'Inspector ' - � ' � - � Date Irispector
�y�P ALS , Permit# �BP�����`.`-.� �-APPROVALS Permit# . , _
i. Temporery Electrica'I Service or Pole � 52. 'Pool &_Equipment Location ."' _ �•
. „ -
��� 2. Soil Pipe-Undrgrnd:' t .'' � � : F'�� `.�j. � .53~ Steel Reinforcement . ' ' .
� � 3_ E(ectrical Conduit.Utilitv-Undrgrnd.' ' - � 54.�'Forms;( . - ' .
`: 4: Electrical Condui}-Undrgrnd�. �' < . � c - �55. Electrical Bonding _ �
>
5: Steel Reinforcement ' �� ;� � ` ; ' ` _'z$"�-� ,�� 56: Rough Plumbing & Pressure Test � -
i
� �57': APPROVALTOCOVER-GUNITE
'6. �Electrical UFER Grnd.� ' �„q-` � . ' � %-z1•b%� �•p _, -
7. Footings SQi � � j Z7 H� , - _ ' 58. Electricab�nduit-Undrarnrl. -
8. Founilation , � � .� , _ . � �59. Gas Pipe, O Undrgrnd., Test - . - - • .
p 9. Water Pipe;Undryrnd." ' �� „��� i� 60. Backwash Lines,�P-Trap, O Undrgmd. �� - `'
i
10. Structural Floor Sy,stem = � 7 Zg � 61. APPROVALTO DECK
11. Property Sewer Line &'�House Connection 8f30��3 �� 62. Backwasli &.Receptor-Final � '
� h
12. Sewer Cap , � ; ' � � � , ' � {_ . � �63. Heatec & Vent-Final � . ' �
13. Roof,Drains � ' , � - � 64. Plumbing System'- Final ' � � ' - �
� '. i .
14. ;Rough Plumbing � � � ` � ° � � � g� �'�3 �° � 65. Electrical-Final - • -
i.
• 15.- �Rough Etectrical=Conduit'� '�•' -�r �� �" ' - - � � � " �� � ' � �
� ,� "� ��-f � -- � � �66. Solar'System-Final'
e' �
16. �Rough�Elecfric Wiring. .,^ ; f . �� �i�:�"', �� - `-� ,67. Fencing & Access,Approval � � '
- �'17. ,Rough�Winng'Sign? � ' �� � i� ��',,', �� �• � : � - � , , 68. APPROVED FOR�PLASTERWG - � � �
�� ���16. �Rough-Elect�ic`af•T$ai Ceilingl �i �� � � ' 69.� POOC/SPA SYSTEMSFINAL �
� 19. �RougFi�Heating &'AirConditioning � � _ � ? , � � , FIRE DEPT.'REQUIREMENT' . �
" 20.'Rough;Facto'ry Fireplace � � � ,� � � � � ; APPROVALS� Permit# �_
n � • :. �
� 21. D "ucts; in Strueture,; � -� , ; � � � ; •70. Underground Hydro � .
�:22. :Ducts, Ventilating V���, ;� �� � � � ' �71,, Product Fiping O Gas ❑ Oil
} -' �13. Gas Pipe;Rough &;Test r': j ���� �;T � � � ' �� ' 72, Underground Flush - � � ' ' �
�
'. . . . _.:_ .' . .,, . . .� / �
���14. Roof Framiny,. : � ' � � .I �I;:,r�; �� �/rJ2�-$3 �q , • - 93. Undergrnd.StorageTank pGas OOiI
- 25. �Roof SheatFiin`g � �Q� � ;.:,; : � c� Z_gj= ;��J� -' �74, Overhead Hydro -
�� � 2�..�T-BaP Ceiling fStructural}, & Monocoat' � � � �� � `� ' � �75.� Dry Chemical � � - � '
_�27. y rame'and Flashin � '�•'��.: ; ;q_�z-ir3;� � . . . .
g �: 76. Dry Standpipe
� n 28..,Lzthing�&�Siding� . C � ' ,, � i lo-r�- � p. ���' FIXED SYSTEM FINAL . . �
.y rni. �
- ; 29. �Insulat,idn `, � i q �.b « i� . � 9 2�-g.� 4 78.� FI�RE PREV,. FINAL � �, .
'30. �Drywall Nailing f ...�.' � � � i' `.' '2tr"0�3 ' �Notes:� � . . � . .
1
-�
�' a_31. Plaster erown Coat � �/�-z�ffj _� S •
32. �Electrical�Power Me'ter�Final ! f� �j � � � ' ' � � � � ' ' �
i
33. �Final Electric ' , � � , � f � �
� 34. Final Meating &'Air Go�ndi'tioning , • ^� .j �7 , ' �'^�7
�c r � i I ! V'V � 1 �i `
�
35. Final Gas'Pipe T,est `� �, � ; ��. ; "' � �, � �� 7
g3'
j36. Hood or CanopY - -- � .r � �. . � ' .. . - i ; i - ' - ' /7P • ( �'�:.. � .��
1 I' _� c' i � t : `' ' C nP� ,,�+ ' O � G
37. Final Factory Fireplace'. ' ,-' � �I � '' i �' � � � � -8'3 00- !• S P2- � end �N
� r ` -I i, �J y
38. Final f?lumbing . t� �' :� f�i S�M � O4 -�7 Z- �� � C 110Y �11 ( 2
e �i
39. Water�Service-Final� � ! � q � �; � � ' r �
,. � � � 14`� o t �--0 +� h ►-
40. Gas Service-Finat � � . � ' .
'
, t
�' ' �� i i + i ' i
41. Solar D`omesticFinal � � i � _� ��_ : �+�_Z� Gt
. _ , � .- �
42. Backflo�J Preveriter' ' � � � � r. 1 � � '' ' �
_ i ° +' -I�'t - •- '
,; i '•
43. Backflow�lr"rigation ' ; `,�'• � �' ' ' ' �
, ,.. �' I , i, _
�.� ' j ` `
44. Landscape Iriigation.System 1 ?� i `_ - '� .
.. -1 � �''° - &�u` D a LG Ph
45. Sound�Attenuaiion ; jn „rl � � !� � ' fl�sh� aver �Q 01 �'Y' !1 0>'�"$ �
46. Handicap;Regulations� � ; ,;' I � ' I � �� ; ' i ,✓p'r/% � �j% S � � ' M'
�
47. FINAL STRUCTURE & BUILDING . ;. 2_3,�iy � � ' � � _
48. Special Requirements Completed� � i � j � � , { � ,
49. Electric Release to Edison� , ' � ' � � ' - " � '
i t i k ;_ ;_-i_ � � - - r - -- - -. _ , ��
50. Gas Release to Southem California Gas Co l � ' � ', �- , � i�
51.CERTIFICATEOF.00CUPANCY �� r _._�r_ _. _ , _ _ �
No. Date ' � ! � � � � �
i
. � I
MESA
)N PERMIT
- ��
ADDllun[ lo fill in all spaces axee0� 1�osa
PERMIT�NO. TI
� •- Sd.2 �
�' - nYt Mailing Addreu
'�ddresf � �3�7 I�i E � ebSilJ /'�L�'C.e1
. 's Name MZ f//1 ohone 64S�7S'
Addresii.. $37 �'//Y ' PL i��iST�f /4/-J'!2
Arch/Eng. [�d/ti�'2 � Licenm No.
Address S�� g
Contractor'sNem �f-'�� ��+E/� �u���'� � �hoReg�-S2G/
Addresslmeilingl /7gZ7 l�s;ir✓ i�iLi d.c� �Yiii[/71s /rni�ie
Licenx No. �?- 37 SyS'Z �
LICENSED CONTRACTOR DECLARATION �
�I hareby afBrm that I am Ilcanzed unOer provlilons�ot Charter 9(commencing
with settlon 7000) of Divislon 3 ef ��e Business antl PrOfesslons Cotle,antl
`- my Ilcense Is In ful orce antl effeCt. "
w uunse ciass •� ucenu No 37.i`%SZ
� Dat¢7's A-� Slqneture
� 'ORKERS'COMPENSATION DECLARAT�ON � �
� nere0y afflrm Mat I �ave a cerNf�wta at wnsent to selNnsura or a ceril icate
o/ Workars' Com nsatlon Insurdnca, or a' cartHietl co�4� thereo/ (Se<tlJ� n
.\` aeoo, �e, c. � 5�t'�r�'%��.u�/ �
V PoIICY No. �S�iIB'2�5�- ComPany
�� Certlllatl coPY�ii tlletl wit�rthen ItY D fIn •,�
oate 7'�-��4 APGIICAnt���.��'�iz-,�._.�--�G
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(T�Iisection neatl not be completetl It tha parmi[ is for one huntlratl (5100) or �
less) .. • . •
I certi/y that In the Oertormance�Pt�tne worli for whi<� this perm�t is issued I
shall. not employ any person In Hny manner so as to bacame,su07ect. to the
Workeri' Compensatioa Laws ot Californla, ' . �.
Date SlgnatUre
NOTICE: If, atter making this tlec�aration, you shoultl become sub�act to t�e
Workers' Compensation Orovislons of tha Labor Cotle, you must.fort�witn
<omply wlt�; such provislons or this Oermit s�all ba tleemeC revoketl.
CONSTRUCTION LENDING AGENCV
I nereby afflrm that chare is a construction Ientlin9 agency for the performance
of tne work tor which t�is permit is issuetl (Sactlon 3097 Clv. G.)
LEntler's Name'
Lentler'S Atlareu � �
OWNER BUILDER DECLARATIpN � .
I heraby aHirm t�at I am exempt from tna Contractor'S License Law for tbe
following reason (Sectlon 7031.5 Builneis antl Professlonal Cotle: Anv ci[v or :
�•� tne a signea Ratement thal he
Contractor's IJcense Law (C�+
islon 3 ot t�e Buslnass anE I
refrom anC the basis lor the :
�031.5 by any applicant for a
�enalty of not more than five �un
LJ I,.as Owner o7 thB property
' coMpenSation wlll tlo tho wOrk, .
far wle (Sotfion 7064, Buslness
Llcenze Law Coes not apply [o an
thereon, antl wM10 tloes such�wor
employees, provldetl tha[ Such Im
sale. If, however, the bulltling or
platton, t�e owner will have the t
�ove for the purpose of sale).
_ L LJ I, a5 owner Of the Oroperty, a
V tractorsto construct Ihe oroie<t.f'_
✓ Du11C5 Ot ITpfOv85 LI12l800� dlltl W
` tractor(s) Ilcense pursuant lo the C�
` ❑ Pam axempt untler Sectlon�
C Date Owner .
1 hereby certify that I hava reatl
information Ii correct. I agree to c�
. antl stata laws relating to builtling
sentatives of th6 tlty to enter
Inipectlon 0 r O Si/J /J/,
, Signature � l . �•
Drivers' Llcensa or 55 �
CMF0865-4 rev.12/82 White-Ouiltlin9;
a Cotla) or that ha/she is exempt '
emptlon. Any violatiodoLSection I
subjects the applicant to a ctvil �
irs (5500).
TplOy¢85 with wag¢S a5 lhelf sol¢
truchre is not IntenGetl or offerea
rtessional Cotle:'Tha Contractor'S .
a proper[y who bulltls or Improves '
/harsolt or through hls or hor own
its ara not Intantletl or oHeretl for
ient is soltl wllhin one:year of com-
proving he/she Oid not bulltl or im-
vely con[racting with licansetl con-
i44, Business antl Professlons Cotle:
opry to an owner o( property who
IdCIS f0! SIICII p10�8CL5 WIN d COO-
�•s License Law). �
. B. 6 P. C. for this reason
a�ova
cou
�aavY
all apDrooriate tlaclarations.
TYPE OP O,ONSTRUCTION LJ NEW Q%I ADD U ALTERATION U REPAIR
❑ CONVERSION ❑ DEMOLISH ❑'OTHER
TVPE OF PERMIT LI GI2ADING LI FOUNDATION µ� STRUCTURAL
- ❑ TENANT � ELECTRICAL �PLUMBING ❑ MECHANICAL
❑ ATHER i .
PRQIECT DESCRIVTION SQ.FT. g � '
CONSTRUCTIONTVPE,�^"�b}�- VA
ZON� GRADINGCU.YDS._
Remarks: I�'S %� �A� � n ��i
Preventer
Irrigetion
iking Fountains
rt Orains
x Sinks
$ervice OuNets
Sink
P-Trap
Roof Dreins
Showers �
Service Sink , . �/d!i
Boiler.
Duct -'Under Ground
Duct-Structural . -
Duct - Ventileting
Exhaust Sysrem ❑ MWtiple
Firepl/Fact. Blt. ICBO �h
Heating System & Ducting
❑ o-i oo,000 sru O i oo,000
Hood or Type I ❑
'J�?� �%-� -�? �
�7r Registers
- Appll<anh Pink - Accounting; Goltlenrotl - Assessor
Sewer Cap
Sevuer Connection _ -
JVItl! WIIt1:WI3 .
$OIB( PI 10 J •� . •
�.,P 9
SolarTank � �. �'�
Swimming Pool w/Spa �
UrinaP � � --
Water�qoset
Service
Reinspection Fee
Issue Fee �
A.P.qWI I�i � YC
PLNG.REF.# �
a LEFTSIDEVARD �
PKG.SPACE REQ. �'�'
� STREET WIDTH
SPECIAL CONDITIONS:
�
�.$15
$ 3
❑aioo,000eru ❑ioo,000eru
i
System Repair/Alteration � � .
�
n.
� RainsOection Fea � 515
� laue Fee �$ 3
natic Washer
�.ruttion POIe.
ing Unit •
F.A.U.
Dispoml •
x �0�5 KW 05-15KW
'r'G6b �/1'1/ �.
7465
BUILDING S��_/
y`FTon�v � CT �
REAR VAHD (TO P/U I I /'—(/J N
RIGHTSIDEVAROS� O��
PROVIDED �-
PARK FEE $ �
1
Sub Pole
Motors �0-1 HP ❑i'h-6 ,
�nc.Solar �9-15 HP 016-15+
Microwave
Pole Light � "
Fanga _
Trash Compactorr-
i.♦ .{
0
• ��5U+KW . ' ' Reinspec[ionFee 575�
� Meter❑up.to100amps � IsstieFee �g3
Zaning APProved BY ' Date
ApPlifation APProved BY . �e • Date � .
APPlintion�lssued BY � . . , • ' ''� � ' Date
' � ' � �. SUMMARYOF�FEES' � ��,$' �'
' BUILDINGPEFMIT �$ �SG'� ; SMIP,•� , � $ �_ -
„PLAN CHECK .3n r$ � PERMI2 ' . �
"�PLUMBING . $ ��'p0 ISSUANCE $ �
� � . F",
�u• � GRADING $
� PLAN CHECK �.' $ � .
ELECTRICAL„ ^� $ �L�x� : ' $ .
"PLANCHECK � �$ � � d-�� : MICROFILM $
' MECHANICAL � $ ` SOTAL FEE $ '
• PLAN CHECK . ,, ,$ . .�'.. LESS''�� �' .y'��S%
, . ADVANCEDPC( a -
' �� '/ �' _� �
� FINAL FEE S
� . �a3 � �
'�
INSULATION CE�r�IFi�-Ti t�3Fd -
�� � �,� � l'��r.� ��s-�
N�mper �nO $beet � CIIY County
SuOGivLlon tol NumDer
DESCRIPTION OF INSTALLATION
ROOF �
�/ ' ,�' C O f�ii�fiv/
Matcrid /i � .% 8rand Name � �✓ e�) 5 ( r�
/� ir
Tnic4nras G�cAesl �f J Thermsl R-s�s�ancr IR V��ue) �� � U
EXTERIOR WA:.L
Msterid � "� � BrandName ��"��r�5 CO'P'^�/'v �J
�J � '� � �
TAickness linches) .7'-� �� Thermal petisrence IR Valur�
v�.
CEIUNG
Bnt or 9lanket Type ��p �� Brantl Name 0�"� r� S � �p'��'" �
TNckness Iinc�esl �� �� Tnama� Res�sunce (R Valucl /�. ` 3 O
Loa:e Fill Type —'^
Minimum 7hickness (inches�
Area Coverrd (fi�l
FLOOR,ELEVATED
Mairrial �%�
Tnickntss Iinches) ti �
FLDOR,SLAB /
A:ateriai !J � /� 1
Tnick.x�s (inc�esl �' V �
W�dc� lindiesl _ � �
FOUNDATION WALL
Mateual / � ' "
TAickneas (�nc�esl
B.and Name
Number of baqs '"'" WeigAc v« bag �L
TAermal Reils�ance (R Value) � — � C"� " "
Brantl Aame /'� �
Therrtui Hesistance �R Value)
'Brantl 1�amr / v �
TAerma� Res�na�ce (R Va�ud /v /�
Brand Namt � � I 1 ._
Therm�i Revsta�ce fR Value) �v �
DECLARATION
1 �nrDp tmily ihat the abo�e' insulatloo was installetl �n Nr build�g et 2�e above lou�ion im m�lorma�ce w�th che
twrem re9�l�tiom seuing Enetgy Co�sern�ion Sta�dartls lo� new re��tlemial build��gs (brateE in TUe 24 01 Ine
G�dornia 4dmirin�at(ve Code�_
� A,,,�,�o �;�„ o,z �s 3 7 S yS �
Geneut Contoctor (BulloerJ Liceme Numuer
�(//�� � u-�.�/re �- </ - 8 3
S�qna�ure ano Tiu� Ds�e
/�J /-�-- �J�
` Sue Con�nnm pnsuHtio� Aon��u�or) Lfcrnae rvomoer
_ � � —_ �� —
S�qna�u.e ana T�ue Oa�e
� ii'927 Sun FliH �rp.�-f�--p�
� F�g�.r a-7 Ea�mple o( a[ompf�an[e cert�fic�ct Yorba �tn�a� C�. 7�GVo�
C�J
: YY ./: s H: ?a }�1i
7I-IIS A(�tEEMEMP, made arrl entered intn this
r
�� ``
. \
�
\
S�
G� >r( -/9� 1983, by ard between � K� �-/�{-
c/
hereinafter referred to as "LAND addER", and Ei�'/L '�'�%�,C�/�
hereinafter referred to as "ADJACE[�PP PROPEKPY Q�NER".
C
day of
Zt is hereby agreed that a party wall will be constructed on the
property line betr�reen 83 � aNcQ �37 ��N�
in the City of C�ta Mesa, Coimty of Orange, State of California, as per map
recorr3ed in Book , Page of Miscellaneous Maps, in'the office of the
Coi.mty Recorder of said Coimty. The party wall shall be permitted to encroad�
UN
N�
IN WI7NESS 4diEREOF, the garties ha�,e entered into this Agreement the
day and year first above written.
D (�7IdER
� � .
(Si nature�
LUKE I�-A-
Name (Z�ed or Printed)
�� ��ti� p�gcz. c.,�r
cAaares� Si
ADJACINP PROPERTY QdNER
C�'yIl �I,Y�L�l
( $1CjRdil3C�—�
�L Ci S�/"/ �
N� ('Iyped or Printed)
e� � rl�e !�l Gs�/�/i'�S�'
(Address
(NOTE: Please see reverse side for notaty's statetrent)
STATE CF CALIFDIB�]IA )
) ss.
OCt7N2]' CE ORAN(£ )
On
and fo the Coimty of Orange
ore me,
of Cali
imdetsigned, a Notary Public
a, personally appeared /
lmown me tn be the pe s�n(s) whose name(s) is s�
instrume t arr3 acknaal ged to me that (he/she/they)
wI'1NFSS my hard and f icial seal.
ta the
(SEAL)
STATE CF CALIFI�R�]IA )
) ss.
OGL]N7Y �' ORANC£ )
On , before me, the imdersigned, a Notary
Pyblic in and for the Coimty of Orange, State of California, personally appeared
wn tn me tn be the
trument and acknow
my hand and
h-_�FTL:�[� .-. .
(s) wh�e ame(s) is
to me that ( /she/t
seal.
b ibed tn wlthin
) executed the s .
(SEAL)
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or coun[y, which is requ'rred to give notice pursuant to Section 19830, Shall aitaCh 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 apptied for in your name and bearing your signature.
Please complete and return this informatlon 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 pfan to provide the major labor and materials for construMion of the proposed
property improvement. � Yes ❑ No
2. I(have/have not) signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address
City
Phone I 1 Contraaor's Lic. No.
4. 1 plan to provide portions of the work, but I have hired�the following person to coordinate,
supervise and provide the major work:
Name _
Address _
Phone ( 1 Contractor's Lic.
City
5 I will provide some of the work but 1 have contracted (hired) the following persons to provide
the work indicated:
Name Address ' Phone � Type of Work
I hereby affirm that I have received a copy of the information se[ forth in Section 19830 of the
State of California Health and Safety Code and have eompleted the above information to the best of my
personat knowledge, in compliance with this SUte law.
Signed:
Name:
(Printed or Typed)
C.D.L. #or S.S. #
CMF 3062<6 7545273
Date:
APPROVED
City a Mesa Building ept.
BY DATE'� 2$�jq�7
THESE PLANS MUST 8E ON 10B AT ALL TIMES MAK:
NO CHANGE TNOUT oRIOR APPROVAL OF DEPT.
� - 2� �23
THFj 1$$UA�' � RHNTi� i p q pE I7 OR A7PROVAL OF
�LA� AND SPECi�I; 4;•PM17 S4Atl NOT BE CONSTRUED TO 8E A
PERMI7 FOR, OP Aw =PaNCYAL GF, ANY YIOLA710N OF ANY OF
'?HE PRO��SIOh$ Uf l l!!� CCDe. NO Pf.RMIT PRESUMING TO GIVE
nUTHORIN TJ `/IOLt.l2' OR CANCFL TME 7ROVISIONS OF THIS
� CODE $HAII BF VAtI^, E%CEPT 1v 50 FAR A$ THE `NORK OR USE
WHICN IT AUTMORiZES IS IAWFUt.
iME ISSUANCE OF A PERMIT BASED UPON PtANS AND
� S�ECIFICATIONS SNAIL NOi PREVENT iHE BU�LDING OfFICIAI
FROM TNEREAFTER REOUIRWG THF CURRECTION OF ERRORS IN
SAID PlANS AND SPEC�FICA�ION$ OR FROM PREVENTING
BUIIDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN
IN VIOLATION OF iHli COCE JR OF ANV OTHER ORDMnNCE OF
TNE CITY.
�
REfIDfNCE
�
RCC10[MCf
R[81DEMC[
�3%
,APPROVED
!o ��evn.en.c� �.
Of COSTq MESA
PLAIYNfhfG DEPT.
arueer ro ux. oerr. aao,
� `'--�'—._ o�,F 8-2� �-
MI�.fO� Or KANNIIp1
NO1E
ADDITIONS, DELETIONS, QR CORRECTIONS SHALL
BE APPROVED BY iHE PLANNING �EPARTMENT
NflIDEMC[
s rRee r A 1 N� P[�-C.�` _
F.
W
W
�
�
N
Cement Coping Optional --
Channel Block With 1�3/8Qi
Morizontal Top of all
Fences
For Fences 5' or �ess
Vert. Bars 3/8"� at 4' �0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/6"� at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Reintorcing Steel Shall
Conform to Sec.A-15�39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATUqALGRADE
TWO 3/8"S� BARS
CONTINUOUSTOP
& BOTTOM
HOR12.S7EEL MUST BE T1ED IN
PLACE AT TIME OF 7RENCH
INSPEC710N.
TYPICAL 6" CONCRETE BLOCK FENCE
n
F—� W'IDTN
p SEE CN[
.�'=7 BE��W
DL
NG REQUIREMENTS CHART
GENERAL- NOTES
MORTAR; pne Por1 Plestic Cement, and
Three Parts Sand
GROUT; One Port Cement Three and
One Holf Ports S�and
COPING: One Port Cement, Three
Parts Sand
CONCFETE: Well Mixed 1:2-1/2:3-I/2
Mar. of 7- I/2 Go7lons o1
Wafer Per Sack of Cement
GROUT MAV eE POURED FROM THE TOP
OF THE FENCE IN CELLS WFIERE SiEEL
OCCURS.
CELLS AND AHEAS OF HORIZONTAL REIN-
FORCEMEN7 SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBqIS, ETC.
H GF EARTHTCOTH
V3 !HE HEIGTM OF FENCE
�B�LOW BOT70M OF FOGTING.
SCALE: I/2" = I'
. WIDTH I .14" . 14" . . . i...12��..,. . 12��
THICKNESS . . . . . . 10��. . . . . . . . . . . .10�� . . . . . . . . . . . g". 8..
DEPTH OF EARTHTOOTH . 24" . 20'� .. 16". ... 12�'
SPACING OF EARTHTOOTH. . 12' . 14' . . . . . . . . . . . 16'. . . . . 16'
OWNERS N4ME_ — _ — � _ _ _ _ _ _ _ _ _ _
City of Costa Mesa California JOB AooREss. _ __ _ _ _ __ _ _ _ _ _ _ _ _
� FERMIT NUMpER;_ _
Building Department SIGNATURE _ _ _ _ _ _ _ _ _ _ _ _ _ _
\ ' (2F_vlhF_D Nov. &2 �
ORANGE COUNTY�BUIL�EPARTMENT APPLICATION FOR PERMIT �
' 636 North BraadwaY - ` , � �'�� � � � �
� SANTA ANA, CALIFORNIA .
�
; a� � - PLOT' PLAN' � a
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