HomeMy WebLinkAbout3469 PLUMERIA PL - Building Permits�
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Job Address:
Suite:
Vicinity:
CITY OF COSTA MESA
BUILD/NG D►V/S/ON
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
3469 P�UMERIA PL
HOUSE 8 ATTACHED GARAGE
Parcel Nunmber. 41217322
Applicant: NUTfER, ANNE NELLA
Address: NUTTER, ANNE N
COSTA MESA, CA
3469 PLUMERIA PL
owner: NUTTER, ANNE NELLA
Address NUTTER,�ANNE N � ,
, �'COSTA MESA; CA'
� . 3469 PLUMERIA PL
i�� �
Contractor: �, � � ' ; - -
Addre55: . . �
Zip:
Arch :
Address:
Phone:
BUILDING PERMIT
Zo�ing: R1 R1
Phone: (714)662-1410
Zip: 92626
Phone: � � ' �
Zip: 92626
Phone:
License:
Eng:
- Address:. .
NUMBER
I B99-01159
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Slatus: ISSUED
Applied: 07/27/1999
Issued: 07/27/1999
Phone:
, �. 21p �� - . � . License: Zlp: License:
� ' SCOPE OF PERMIT �
, �� REROOF HOUSE & ATTACHED GARAGE (34 SQ). TEAR OFF EXISTING WOOD SHINGLE ROOF & REPLACE SHEATHING '
� WITH 1/2" CDX PLYWOOD. INSTALL t-LAYER OF 30# FELT UNDERLAYMENT & REROOF WITH 30 YR. COMPOSITION �
' SHINGLES.
� � � � FEE"SUMMARY ' � '
` Plan Check: ' $0.00 Calc Valuation: Se,000.00
Permit: $11225 Claim Valuation: Ss,000:oo
�\ SMIP Res: $0.60 � �
SMIP Com: $0.00
Other. $0.00 .
Inspection: $0.00
Total: $112.85
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Exislina: o
NOTES:
PLANNINGB ZONING
Rear 0- 0 Left 0- 0 Right
Rear 0-0 Left 0-0 Right
Required: 0 Proposed: 0
na�;
��
`pD
. �1\�O
NOTIGE: The work authorized by this permit shall comply with all applicable handicap access requirements undar California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for e period of 1H0 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ai'
requlrad Inepectione and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit�
FOR INSPECTIONS CALL: (714) 7545626
;
WORKERS'COMPENSAnONDECLARATION:
I hereby ettirm untler penalty of perJury one of the following tlaclerations: �
❑ I have end will maintaln e certificete of consent to selFlnsure for workers' compensatlon, es provided br by s0ctlon 3700 of ihe Labor Code, for the pertortnance oi the
work for whlch lhis p8rmit Is Issued.
❑ I have end will main�ain wwkers' compensalion insurance, as required by section 3700 ot Ue Labor Cotla, tor ll�e peAo�mance ot ihe work tor which ihis partnit is issuetl.
My workers' crompensetion Insurance carrier and policy number are:
Cerrier. Policy Number:
(Th/s secf/on r�eed nat be cromp/eted I/ fhe permit75 veluetl et one hundretl dollars ($/00J or less.)
❑ I certliy that in the pertortnance of the work for which Ihis permit is issued, I shall not employ any person In eny manner so as to Oecome subject to the workers'
compen4ation laws ol Califomie, and egree t�ai if I shoultl become subject to ihe workers' compensation provislons of Section 3700 of the Lebor Code, I shall fotlhwi�h
compty w�th Ihese p�ovisions.
Applicenl Signetura: Date:
WARNING: FAILUFE TO SECURE WORKEFS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES 4P TOONE HUN�REO
i/qUSPND DOl1�E (5100,000), IN ADDITION TO THE WST OF COMPENSATION, OAMAGES 0.5 PROVIDED FOR W SECTION 3]O60F THE LABOR COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS OECLARA710N:
I hereby aHirm ihat I am licensetl under provisions of Chapter 9(Commencinq wlth Section 7000) of Division 3 of Ihe Business and Professions Code, and my license 15 in full
force antl eHeG�. Lic. # Cless tt
ContrectoYs Sl9nature: Date:
CONS7RUCTION LENDING AGENCY:
❑ I �ere�y ettirm ihat there Is e construction lending agency lor iha pertormence of the work for which this permit is Issuetl. (Sec. 3097, CIVII Cotle).
Lentlefs NemB: Lendels Address:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aNirm Ihet under penelty of perjury ihet I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the iollowing reason (Sec. 7031.5, Business and Profassions
Code'. Any city ar counry which rec}uires a pertnit to wnstruct, alter, Improve, dertwlish, or repair eny structure, prior to Its issuance, also requi�es ihe applicant tor such permit
to file a sl ed statement the� he or she is licensetl pursuant to Ihe provislons af Ihe Contrectars Ucense Lew (C�epter 9(commencing with SecUon 7000) ot Divlsion 3 of the
Busin end P�ofeuions Cotle) or ihat he or she is exempt theretrom and ihe basis for ihe alleged exemption. Any vlolation of Section 7031.5 by eny eppliwnt lor e permit
su cis ihe apPlicant to e civll penelry o� not more than five �undred tlollars (5500) J:
I, es owner oi ihe property, or my employees with weges es iheir sola compensation, WILL DO 7HE WORK, and Ihe structure is not intendetl or oHered tor sale (Sec.
704d, Business antl Professions Code: The Contractors License Lew does not epply to an ownar oi property who builtls or improves thereon, end who does such work
himself or herself or throuph his or her own employees, providetl ihat such improvemenis ere not intended or oHeretl for sale. It, however, the bulltling or improvement Is
sold within one year of complation, ihe owner�builder will heva the 6urden of proving t�et he or she ditl not build or improve for purpose of sale.).
❑ I, es owner of the property, em E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to consiruct tha project (Sac. 7044, Business and Professions
Code: The contrectors License Law tloes not apPly to an owner of property who builds or impmves thereon, end who contracis for suc� project with a contrector(s)
license pu�suant to ihe CoMrectors Licanse Laws.).
❑ I emQ� empi under sec. ---/��� Business and Professions Cotla tor this reason:
SignaWre:(� �� . �1 • 1 V �-(_,lY f.C7 Date: _ � �
Ownar ID venfied by dnvers license. ❑ Yes ❑ No Driver's License No. � Eapires: ��— � C
Veritication of Ownership by (rype of document, i.e. - properry tex bill or deetl):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICA710N:
❑ 1 hereby Certily that no ezcavation tive (5) or more teet in depth into which a person Is requiretl to descend, wAI be made In conneciton w%h work authodzad by tMs
permit, antl that no huiltling stmcture, scaHolding, falsework, or demolition or dismantling thereof, will be mora than t�irty-siz (36) feet high. (Chep. 32, Gry 2, Art 2. Sec.
341, Tltle 8. Califarnie Atlminisireiive Code).
❑ As owner-6uiltler, I wlll not employ anyone �o do work whlch woula require a permit from Ihe Division of Intlusirial Safety, es noted above, unless such person has a
permit to do such work tram the division.
Signawre: Dete:
Division ot Intlusirial Safaty Pertnit Number:
CEfiTIFICA7E OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I ceniy untler penalry of perjury Ihat I have reatl ihis application and state thet Iha infortnation givan is
correcL I egree to comply wlth all state laws and city ordinences relating to building consWction, antl authorize representatives ot tha Ciry of Coste Mesa to enter upon the
ebo,�@-described property for Inspe�cti�on purposes. I agrea not to occupy or allow occupancy of any building authorizetl by this permit until final Inspection.
J��l�e � l\ � %— oZ- r%— � 9
SignaWre Oi Legal Owner(s) Date
And/Or Authorized Applicant Date
COpE�, INSVEC110NTYPE
1616 Fixad 5ysiem Finel Fire Prevention
1266 Pool Spa Final
200 Finel Fe-Roof
201 Fine181ak/Retaining Wall
�Finaf Factory Flre Plece
Finel S�gn
Finel �emolition
PAiE
�
INTITIALS COOE� INSPECiIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Finel Elecirical
212 Final Fire Preventlon
220 Final PlanM�g Approval
222 Final Site
250 Final Building/Occupency
PAg � 1t1�4S
Avolicant to fill in all soaees exceot Ihose witnin heavv bortler lines antl si9n all approo/�ate Oeclarations.
CI7YOFCOSTA,MESA _CONSTRUCTIONPERMIT
� Project'Address + � ��9' PZlIlI�iTd*
�_.<tL_ _- - _.�
• Applicant's Mailing Address -S2lfle -
Owner's Name Mi rhaal NIIYYPY � Phone h�72-�-41�
Address S�1P
Arch/Eng. License No.
Address
Convactor's Name �.S HPatiTi& Fr,�/(' � phone 8�0
Address (mailing) 27324 C�nino Cauistrano db157
City License No. �2,�LIDd Nlgu�],� CA• 02��5$
LICENSEO CONTRACTOR DECLARATION
1 M1ereby affirm that I am licensetl untler provisions of Charter 9(commencin9
with section 7000) of DiviSion 3 ot the Business antl Prote55ions Cotle, antl
my license is in full or�dntl eitect. • 393H18
License CI 5 icense No.
Dale ���, 5'9 �
'ORKERS'COMVENSATION DECLAR ION
hereby affirm that I have a rertificate of mnsent to self-Insure or a certiticate �
of Workers' Compensation Insurance, or a rertlfietl copy thereo( (5ection
3800, Lab. C.) '
aor�r No. F3nli7 comoany Fairmnnt
�Ceriifietl mpy is hereby furnisned. `
Ce�tif"{��/�Qj�$� tiletl with the city B tling Di sio .
Date�� J �`� APPlicant �
EXEMPTION FqOM WORKERS' COMPENS ION DECLARATION
(This se<tion neetl not be completetl if the peri it is for one huntlretl ($100) or
less).
I cer0fy tnat in the performance of the work for which this perm�t is issuetl, 1
snall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws o( CalifOrnia.
Date Signature
NOTICE: If, afte� making thi5 tleclaration, you shoultl-become subject to the
Workers' Compenwtion provisions of the Labor Cotle, you must forthwith
comply with such provlsions o� this permit Shall b¢ tl¢¢metl �evoketl.
CONSTRUCTION LENDING AGENCV �
I hereby affirm that there is a construction lentling agency fo� [M1e perfo�mance
of the work for which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
LentleYs AtlGress -
OWNER 9UILOEH �ECLARATION
I here�y affirm that 1 am exempt from the Contractor's License l_aw tor lhe
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
counfy which requires a permit to wnstruct, alter, improve, tlemolish ar reDalr
any structure, prior to its issuance, also requires the applicant for zucn permit
�o file a signetl statement that he/she is licensetl pursuant to tM1e provisions af
�e Contra<tor's License Law (Chapter 9(commencinq with Section ]000) of
ivisian 3 of the Business antl Professions Cotle) or that he/she is ezempt
.nerehom antl the basis tor the alleqetl exempiion. Any vloldtion ot Section
7031.5 by any applican[ for a permit subjects the applicant to a civil
�enalty of not more than five huntlretl tlollars ($500).
I, ds owner of fhe D�oOerty or my employees with wages as thei� sole
compensalion, will tlo the work, antl the structure is no[ intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor'S
License Law tloes not apply to an owner Of a p�ope�ty who builtls or improves
thereon, antl who tloes sucn work'himself/herself or tnrough his or her own
employees, O�ovitletl that such improvements are not intentletl ot of(eretl fo�
sule. It, noweveq tne bulltlin9 ar imp�ovemen[ I5 soltl witM1in one yea� of com-
pl¢tiOn, tM1e owner wlll hdve the burtlen of proving he/slte tlitl not builtl o� im-
prove for the purpose of sale).
- ❑ I, a5 owne� of the property, am excluSlvely contracting witn licen5etl con-
tiaciors to construct the project (Section 7044, Business antl Professions Cotle:
The Con(ractor's license Law tloes not apDly to an owner of property who
builtls o� improves thereon, antl who conVaGfs tor such p�ojects with a-con-
tractor(s) ucense pursuant to the ConVactor's �icense Law). I am aware that
' proof of their Worke�'s Compensation Iniurance'shoultl be provitletl�to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date
' 1 hereby certity fhal
information is co�recl
antl state laws rel tir
sentative5 of thi ci
.inspection purpos .
Siqnature
Drivers' License or 59
CMF 0865-46, rev. 10/B4
_ Owner
have rea
to
at the above
y ortlinances
hotize repre-
property fo�
TYPE OF CONSTRUCTION LI NEW L1 ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p.# _ '
DESCRIPTION OF WORKIUSE OF BLDG.
Tnatal l i)I'IP � SPaYS 3 TOTl C.�N'1CLP114�Y 5 Main Building:
TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUGTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING � MECHANICAL A Rear
❑ OTHER
PROJEC7 DESCRIPTION" 5p. FT. ' ocGUPANCv C Right
K Left
CONSTRUCTIONTVPE VALUATION$ $
ZONE GRaDIivGCU.voS. aCRES' p�ng.Ref.#
Remarks: Planning Notes:
Sink
%eventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P–Trap
Roof Drains
Reinspection Fee ! $15
Duct-UnderGround
Duct - StrucNral
Duct - Ventilating .
Exhaust System � Multiple ❑
Firepi/Fact. Blt. ICBO #
Heating System & Ducting ,
❑0-100,000 BTU 0100,OOOBT
Reinspaction Fee � $15
White - Building; Canary - Applicant; Pink - Accounting; Goltl¢nrotl - qsse55or
Showers
Service Sink
Sewer Cap
�Sewer,Connection '
Solar Collecrors
Solar Pipin9 �
Solar Tank
Swimming Pool w/Spa
Urinal
.Water Closet `
Water Heater �
Water Service
Auto�Wash
LaundrvTrays ,
�
Issue Fee
Hoodor Typel ❑
Canopy TYpe I I ❑
Refrigeration SYstem
�0-t00,0006TU ❑100,000
System Repair/Alteration
Fire Dampers .
Registers
Issue Fee
FEES
$ 3
$�Q
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
0 ut lets
Switches'
Garbage Dispoul
Generator �0-5 KW �5-15
—
Zone
Accessory Building:
2
O
N
I
N
� R
Parking Req./Provided E
�
a..n– � M
a, �y S
ELECTRICAL , �
Transformer ❑'15-50KW
� ❑50+KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panet . .
Motars O0.1 HP O1'/: - 8
Inc.Solar �9-15 HP �16�15+
Microwave �
Pole Cight �
Range
Sign
Standing Sections
Trash Compactor
Fee �$15 � � Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Building Approved By �
Aoolication Issued Bv
FEES
$ 3
' SUMMARV OF FEES -
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT �
PLUMBING �$ BSUANCE $
PLAN CHECK 25% $ ENERGY P.C.' $
ELECTRICAL $ ' GRADING $ �
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ �OGTOTAL FEE $ Z�F.00 �
PLAN CHECK 25% $ —' , �
DATE: 03/12I88 TIME: 11:09
CONSTRUCTION AND.:PLANNING POOL & SPA _ • - ,
- Date Inspector p�ppROVALS Permit# Date Inspector
APPROVAI.S Permit� ��
it
1•. Temporary �;Electrical,Service or Pole � 52. Pool & Equipment Location , � �
2. Soil Pipe-Undrgmd. � 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-Undrgrnd'. , �
8. Foundation � - 59. Gas Pipe, � Undrgrnd., Test, �� � �
±9: �Water Pipe-Undrgrnd: . 60. Backwash Lines, P-Trap, d Undrgrnd. '
10. Structural Floor SYstem ' ; 61. APPROVAL TO DECK � , �
7 7. 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-Einal � �
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring . 67: Fencing & Access Approval �
17. Rough Wiring�Sign • 68. APPROVED FOR PLASTERING
1S: Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS FINAL .
�19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT
, ,
20. Rough Factory Fireplace � APPROVALS Permit # - .
,'11. Ducts, in Structure � 70. Underground Hydro "
"�42. Ducts, Ventilating 71. ProductPipin9 �Gas ❑Oil
23. Gas Pipe-Rough & Test ' 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro � �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL ' �-
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat � 79. FINAL INSPECTION � �"
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � ' �•5.�
33. Final Electric Notes: - � � `
34. Final Heating & Air Conditioning 9'(p'8FJ L E,� � . -`
35. Final Gas Pipe-Test , � , , - �
36. Hood or Canopy � -
37.. Final Faaory Fireplace - ' .
38.� Final�Plumbing ,
39. Water Service-Final � . - �� ' '
40. Gas Service-Fina� '
41. Solar pomestic-Final �
�
42. Backflow Preventer � ` 1., �'
43. Backflow Irrigation � . �
� ��_.:
44. Landscape Irrigation System , ` ��,� : �
i
'45. Sound Attenuation � ' . i ,�;M'.:��'
� w.
46. Handicap Regulations . , .l�, ,
47. FINALSTRUCTURE&BUILDWG . � ''�
1:: . Y �
48. Special RequirementsCompleted . '.�>�,�.
-49. Electric Release to Edison � - � . '
50. Gas Release to Southern Galifornia Gas Co ' . .. -
57. CERTIFICATE OF OCCUPANCY - � . .
No. Date . , ^! . � . . . � " i , ,
, ,` ,
COSTA N�ESA
IIFGTION PE
Aoo���ant to till in all svaces witnin neavy Eortler lines ana sign a11 apD/opriate eeClaratians.
PERMIT NO. __ TRACT NO. LOLNO. BLDG. NO.
�r:�
Arch/Eng: License No.
Address
Contractor ,/L,rs_ ..]Lt.�i_ Phone
I hereby af(irm �that I am licensetl untler �provislons of Charter 9(com-
mentin9 wlth sectlon ]000) ot Dlvlslon 3 of tlte Business antl
Professions Cotle, ntl my Iicenze I5 In full torce antl e�fetl.
LI<ense Class li 5 N 2
Date �^i'iZ c��..���_.. � _ Y9Lc 'J- L✓ `
WORKERS'COMPENSATION DECLARATION
y'.�h¢r¢by atfirro lltat I nave a certiflCdtC Of cOnsent to self-Insure o� a
y���;ptitiflWte of Workers' Compenzation Insurance, or a certifietl copy
� reof (Sectio 3 00, Lab. GJ.
�'r�iiryNo. �`F��Z`F - Company STA% /�4�1�
❑ Certlfied copy Is nereby furnishetl. .
Certlfletl mpy Is flletl with the city Builtling Division.
XEMPTION FROM WORKERS' GOMPENSATION DECLARATION
(This seCtion neetl not b2-completetl I� [he permit iS �or. one huntlrCtl
1E100) or less).
cartify t�at in lhe pertormance of fh0 work_for whiGh this pErmit I5
Issuetl, I shall not emQloy any person In any manne� 50 a5 to become
SubjeG[ [o the WorkBrs Compensation Laws ot Ulifornia.
Dale Si9nature
NOTICE: I( after making this tlecla�ation, you shoultl become Subject
to th¢ Work¢�5' Compen5ation provi510n5 Of the Labor Cotle, y0u mu5l
forthwith comply with such provislon5 or tnis permit shall be tleemetl
revOk¢tl. . . _
CONSTRVCTION LENDING AGENCV
I M1e�eby affirm tnat lhe�e is a con5truttlOn I¢ntling a9ency for the Oer-
tOrman[¢bf th¢ work for which Ihis,pet,ntit is i55u¢tl (58C[iOn 3097
❑ v. C.7. + � ,
Lentle�'S Name
�entler's AGtlrezs
1 hereby affl�m lhat I am exempt from IM1e Conlracto�'S LicenSe Law (or
the foliowing reason (Section 7031.5 Business and Professlans Cotle:
Any city or county which requires a permi[ to construct, alteq
Improve, tlemolish or repair any structure, Prior to Its Issuance, also re-
qul�es the apFlicanl b� such petmit lo tile a Signetl statem¢n[ that hC
'• licensetl pursuant lo the provisions ot the Contrac[or's License Law
iapter 9(commencing with Section 7000) of Dlvision •3 of [ne
:Iness'antl Prde55ion5 CoOe) o� tnat ne IS exEmpt tb¢r¢frOm antl Ih¢
.sis for the dIICg¢tl exemption. Any violatiOn of Settlon 7031.5 by
any appll�nt to� a permit sub)ect5 t�e appllcant to a clvll' penalty
of no[ more Ihan five huntlretl Eollars (E500).
❑ 1, as owner of Ihe property, or my employees with wa9es as [hei�
SOI¢ Compen5ation, will tlo the wo�k, antl the St�uctu�e i5 not intentleE
or offeretl for sale. (Section 7044, Business antl R'otessions Cotle: The
Contractor's License Law Eoes not apply to an owner ot a proper[y
wh0 builtl5 or improv¢5 thereon, antl who OoeS Such work him5e11 or
throu9h his Own Cmployees, providetl Ihat Suth irtlprov¢ments ar¢ nOt
. hllentletl or offeretl /or sale. If, however, llie building or improvernent
Is soltl within one year o( completion, the owner will have Ihe buraen
of proving he tlitl no[ builtl o� improv2 for [he purpose o( sdle�.
' � 1, a5 owner of lhe property, am exUusively con[raGting with
Ilicensetl con[ractors to construct the project (Section 7044, Business
i antl Ptofe55ion5 Cotle: The ConGactor's Llcense Law tloes not appry [o
, an owne� oi property who builtls o� ImprOVEs [her¢on, antl who con-
'trdtts from zuch projecls witlt a Conirac[or(5) licesnetl pu�suant to
I the Coniractor's Ucense Law�.
I � I am ¢xempl untle� $ection B. 8 P. C. br tni5
�Cd50n '
Date Owner
I h¢rCby certifythal I have.read Ihis applica[ion antl state [hat [he above
InPormation is corr¢C4 I agree lo comply with all city antl county
ortlinances antl state laws �elating l0 COnstruction, antl h¢reby authorize
representatives of [his city to enler upon the above men[ion¢tl
p�ope�ty for ' spectlon p }a
Signature � Da[e G-7�� Z
Drivers' Lirense or 55 �
TVPE OF C,_O.,�NS,TRUCTION
❑ NEW �[TADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT,�/' , �
❑ C�RADING I!G' FOUNDATION O�STRU
Si
❑ TENANT ❑ ELECTRICAL OPLUMBING I
❑ OTHER � \ �
PROJECT DESCR�IQN
5�. FT. �r ��-
OCCUPANCV GONSTBAICTION TVPE _
VALUATION� ��7/ ZONE
i+r
GRADING CU. VDS. ACRES _
�r
PLUMBING PLAN CHECK
BATHTUBS SHOWERS
TOILET$ URINAL$
LAVATORIE$ DOUBLELAVS
KIT.SINK$ � DISHWASHER$
SERVICESINKS ' SUMPS �
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS �
WTERCEPTORS CLARIFIERS
SWIMMINGPOOL � PTRAP '
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OUTPVT '
SEWER CONNECTIONS .
SOLAR TANK COLLECTORS '
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATINGSYSTEM 0-100,000BTU_
AND DUCTI NG 100,000 + BTU _
REFRIGERATION 0-100,000 BTV_
SVSTEM 100,000 � BTU_
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
ISSUE FEE
CMF 0865-46 White-Builtlin9; Canary-Applicant: Pink-Acmuntinq; Goltlenrotl-Assessor
L
6987 6/D7/82
ZONING RI
F.P. �
ZONE ^•PL
B DING
SETBACK
ARO L
1 VAR
HT
R R VAR ( O P/L)
PK .SPACE RE�.
STREET WIDTH
ZONING APP{30V B
SVECIALCONDITI N5:
�.�_� _ . ..r i.. �
PROVIDED
PARK FEE S
�
ELECTRICAL ' PLAN CHECK
GENERATOR -0-1 KW_1�30 KW _
TRANSFORMER
APPLIANCE 10�50KW_50+KW_
MOTORS ' 0�1 HP_1-10 HP _
pNC.50LAR) - 30-50 HP 50+HP _
FIXTURES OUTLETS $WITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN SUB
SERVICE ' - AMP
17.00 TL
APPLICATIONAPPROVEDBV ���X DFTE
SUMMARV OF FEES
BUILDING'
PERMIT S /O, � $MIP $_� �y[�
PLAN CHECK S �� S.i PERMIT
� ISSUANCE $
PLVMBING § � '
PLANCHECK b GRADIfJG 5
ELECTRICAL b � s
PLAN CHECK S MICROFILM $
TOTAL FEE E •/� �
MECHANICAL S
PLAN CHECK $ LE55 AD- , ,
VANCEPC $�_
FINALFEE S�
CON$TRUCTION AND PLANNING
APPROVALS Permit # -
1. Temporary Electrical Service or Pole
♦ '
.o.. ,piecuivai �rtn,urn . �•
7. . Footings .. . . . '
8. Foundation.
9. Water Pipe-Undrgrn
10. Structural Floor SYstem
11. �P,roperty Sewer�Line & House.Coni
12. Street Sewer Connection
13. � Raugh plumbing.
14. Rough Electric-Conduit �
15. Rough Electric-Wiiing � � �
16. Rough Heating & Air Conditioning
17. Ducts, in Structure
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test
20. Roof. Framing
21. Roof Sheathing
22. Frame and Flashing
23. Insulation
24. Lathiny & Siding
25. Drywall Nailing
26. Plaster grown Coat
27. ElectriGal Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final��. �
34. Solar pomesticFinal
35.• Landscaoe SPrinkling SYstem �
36. Sound Attenuation
37. Handicap Regulations
38. FINA� STRUCTURE & BUILDIN
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California
42. CERTIFICATE OF OCCUPANCY
No Date
- . � P00 L & SPA �
Date Inspector - " ' � -'
APPROVALS Permit#
43. Pool & Equipment Location �
44. Steel Reinforcement
45. Forms
46. Electrical Bonding
S �� 47. Rough Plumbin & Pressure Test
48. APPROVALTOCOVER-GUNITE � � '
_ 4 49. Electrical Conduit-Undr rn
50. Gas Pipe, ❑ Undr rn, Test
51 . Backwash Lines P-Tra ❑ Undr rn
52. APPROVALTODECK "" � ' '
53. Backwash & Rece tor-Final
54. Heater & Vent-Final
' � � � ` 56. Electrical-Final
57, Solar System-Final
� encing & Access Approval
5 . APPROVED FOR PLASTERI
60. POOL/SPASYSTEMSFINAL
NOTES: -Vt�a� .. _ _ /
.
1 �
Date Inspe�
S
�
R i: _
l '.
Cement Coping Outional
Channel Block With 1-3/8
0 Horizontal Top of all
Fences
T Y PI CAL 6�� CONCRETE BLOCK FENCE
For Fences 5' or Less -----.
Vert. Bais 3/8" 0at 4' -0" O.C..
For Fences Higher Than 5' —
Vert. Bars 3/8" 0at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall �
Conform to Sec.A-15-39 --
A.S.T.M.
All Steel to be Lapped
24" or to �Code
NATURALGRADE
TWO 3/8"' 08AR5
CONTINUOUS TOP
& 60TTOM
ALl STEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
GENERAL- NOTES
MORTAR : p�e Part Plastic Cement, and
Three Paris Sand
GROUT : One Part Cement Three and
One Half Ports S'and
COPING: One Part CemenT, Three
Parts Sand
CONCRETE: Weil Mixed ;:2-I/2:3-I/2
Max. of 7-I/2 Gallons ct
�/Jater Per Sack nf CemenT
GROUT MAY BE POURED FROM THE TOP
OFTHE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF. HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, ETC.
PROVIDE CLEAN�OUT AND INSPECTION
HOLESAT THE BOTTOM OF CELLS CON-
TAINING VER7ICAL REINFORCEMEN7.
BONDSSHALLBE PROVIDED BV LAVING
BLOCKS IN S7RETCHER COURSES SO THAT
VERTICAL JOINTS AL7ERNA7E IN EACH
COURSE.
DEPTH OF EARTHTCOTH
I/3 iNE NEIGTH OF FENCE
BELOW BOTTOM OF FOGTING.
SCALE: I/2"= I'
FOOTING REQUIRFMENTS CHART
WALL HEIGHT . . . . . . . . . . .6�. . . . . . . . . . . . 5�. . . . . . . . . . . 4� . . . . . _ . . . . . 3�
WIOTH . . . . . . . . . . . . . 14'� . . . . . . . . . . .14�� . . . . . . . . . . . 12��. . . . . . . . . . . 12��
THICKNESS . . . . . . . . . . . .10��. . . . . . . . . . . .10�� . . . . . . . . . . . 8��. . . . . . . . . . . 8��
DEPTH OF EARTHTOOTH . . . 24'� . . . . 20' . . . .
16 ......... .. 12'
SPACING OF EARTHTOOTH. . 12' . . . . . . . . . . .14� . . . . . . . . . . . 16'. . . . . . . . . . . 16'
OWNERS NAME: _,�-v��4 N1_CS��— _ — — — _ — _
City of Costa Mesa California ��e ADDRESS _.�Y��=/J1G�ct_t= _��___
� PERMIT NUMBER'._ _
Building Department SIGNATURE _ � ,�_ �_�� _ _ _ _ _ _
�=oaM coz�-zrn_a_eu
t�P�`';u11 �ir
City of Coste M�a Building Dept.
BY_.........._........._...... . _" DATE�/__F f_irOG
THESE PLANS MUSf BE N JOB Al� A4L TIMES
MAKE NO CHqNGES WITHOUT PRIOR APPROVAL
OF DEPT.
THE ISS6Al..:c G9 :flRNTING OF A PERMIT OR APPR�VAL
Cf PLANS ANO Si � ir,,:ATIONS SHALL NOT BE CONSTRUED
TO QE A PEfIPIi F03, O4 AN APPROVAL OF, ANY VIOIAiION
OF ANY Of iNf FFO'J" pyS OF THIS CODE NO PERMIT PRE
SUMING 70 GIVE f,UTHOdITY TO VIOLATE OR GANCE4 THE
PROVISiONS Of THIS CO�E SHALL BE VALID, EXCEPT I�Y SO
FAR AS THE W�RK �R US'_ WHICH IT AUTHORIZES IS LAWFUL.
PIE ISSU4NCE C� l PERMIT BASED UPON PLANS AND
SPECIFICATIONS 5}iP.Lt (v��� PREVENT THE BUILDiNG OFFICIht
f,".�'t 7ttER.�4`T.4 REQUIR•1�G TNE CORRECTIaN OF ERR�RS ,
IN ""D FLANS f.`'D S�cGFICATIONS Op fROM PREVENTING ;
P:"'..` `'7 CF«'T'_ �'� S_�P ; CARRIEO ON THFP•EUNDER WH[N �
IN �.._:,:IC.. .. � ....'_ OR 0 ANY O7HER 0.4�6'±p;;�Cs
C_ '. ' _. ..�.__...
STRUCTURAL APPROVAL QNLY
SEPARATE PERMITS ARE REQUIRED
fOR ELECTRiCAt, P! J?"•'��-;G,
HEATIPdG, VE4�T!LA;ING ';ID
REfft16ERATfO�I !`�ORK
r
i �@79�i$ �_i�--38�
; i 7NIS t!t!i : ;�R '.�.ST`ACCOi,�PANY I
' i ALL li{3FtCil���v ",�Q!1�STS f
til : c_,_i'�Y.S li;'it .t �EP'.$����$ ARE T��;
�� �rk^F_o; �=o, �,��� s�c�Es7 rwtir rHE �
S� i- OF C L�F; NiA C1VIS10N OF
'�: '-'.,' L S fET`f b= CUNSULTED FOR
�I;v;.; ;i, _ =°�QUI(;LP,M1ENTS.
flE51DEMCE I �
NESIDENCE
�Y� i
����� '�' .�J�
A MESA � �,�.
PLANNIlVG DE4T. �;�'�
SUB1ECi TO BIDG. DEPT. �f�. '
OF PUHN�ND
��� � ��
�,/ // i
v_ � � � ` a
/N�Y�`� ��P .
��p �������b'�fl��
,�c
�a�
��� ���� �7
�J�
J
RESIOENCE
��um Pf�sTREET �
RESIDENCE
�
? r�
:
:
�'/ �� � V!
ADV���ant to fill in all spaces exceD< those within heavy DorOet lines anE sign all ap0�opriale tleclarations.
- PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CiTv oF COSTa M'E`SA COhN_ STRUCTIQN PERMIT
�. Project Address .3`1 �Q.Q r� ll 411i11�
ApplicanYsMailingAddress ��,el�i� �(\C]MAo4�_.��__
Owner's Name �f� ` � � Phone
Address 3=�le"1 W.'f'{�4.�➢ Ci...
Arch/Eng: License No.
Address
Convacror's nlame_ • � '' o e � y��3
Addresslmailing) ����� �1n��w�
Ciry License No. � � � � - �
.LICENSED CONTRHCTOR DECLARATION
I hereby a/fi�m that I am license r provisions o t13R2 (commencing
with section ]000) ot Divisio 3 of e Busine ntl Protessi Cotle, antl
my license is in full for e antl fect. �O�
License Clazs - ense ry .
Date - Signati
WORKERS' COMPENSATION DECL RATI N
I hereby affirm that I have a certiticate of mnsen[ to self-insure or a certificate
of Worke�s' Compen5ition-Insurance, ot a certitietl copY thereof (Sec[ion
3800, Lab. CJ (�
PoIiCY No�rxp lec�"�4413 ComPany^��� �R�1lL 'n
8 Certifietl copy is hereby furnishetl.
Dateertifi G� � Y;s f;�ed w�iFltPPI caniiy Builtling��siqa. I��
;� �P� �
EXEMPTIO FRN OM WORKERS' COMPENSHTION DECLARATION
(This section neetl not be com0letetl if the Oe�mit is to� one huntl�etl ($100) or
less). • . ' .
I certify [hat in the Oerfo�mance of the work for which this De�m�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workerz', Compensation Laws of Galitornia.
Da[e Si9nature
NOTICE: I(, aiter makin9 this aeclaration, you shoultl become subject to tne
Worker5' Compensation p�ovisions ot [he-Labor Cotle, you must torthwith
compry with such p�ovision5 or tM1is permit 5M1a11 be tleemetl revoketl.
CONSTRUCTION'LENDING AGENCV�i " '
I hereby afflrm that tM1ere i5 a construction lentling agency'for the pertormance �
of Ihe work -for which this permit is issuetl (Section 3097 Civ. 'C.) '
lentler's Name � �
Lentler's Atltlress
OWNER BUILOER DECLARATION
I M1ereby atfirm that I am exempt irom the Contracto�'s LicenSe.Law fo� the
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
county which requires a pe�mit to construct, alteq improve, tlemolish or repai�
'� any structure, prior to its issuance, also requires the aoPlicant for such permit
to file a signetl statement that he/she iz Iicensetl oursuant to the provisions ot
�the Cont�actor's License Ldw (Chapter 9(commencing wi[h Section ]000),of
, Division 3 of the Business antl Professions Cotle) or [ha[ he/she is exempt '
I therefrom and the ba5is for the allegetl exemption. Any violation of Section
' 7031.5 by any applicant for a permit subjects the applicant to,a civil
�enalty of not more tM1an five huntlretl tlollars_($500). �
I, as owner of the p�operty o�' my employees with wa9es as their Sole
compensation, will tlo the work, antl the-structure is not In[entletl or offeretl
I(ov sale (Section ]044, Busine55 •and Professional Cotle: ThC ConVacto�'S
License Law tloes not apply to un own¢r of a property who builtls or improves
thereon, antl who tloes zuch work himself/nerselt or throu9h his or her own
employees, providetl tM1at such improvemenks are not intentletl or offered Por
sale. If, however, the Cuiltling cr improvement is soltl within one yea� of com-
pletioq [he owne� will have the burtlen of proving he/she tlitl not builtl or im-
�ova for the purpose of sale).
LI I, as owner of the property, am exclusively contractln9 with licensetl mn-
ttactors to construct the projecl (Section ]064, Business antl Profession5 Cotle:
The Contractor4 License Ldw tloes not apply to an owner ot property who
builds or improves thereon, antl who mntracts for such projects with a con-
tractor(sl Ocense pursuant�to the Contractor's License Law). 1 am aware that
proof of their Worke�'S Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section 8. & P. C. (or this reason
Date Owner
I hereby certify that 1 have rea�
Information is mrrecL I a9ree to
antl'state laws relatinq toAuildin
this application antl sta[e that the above
>mply with all city antl county ordinances
eynstruction, antl he�eby autho�iie �ep�e-
IDon the abov¢-menlionetl orooertv to�
TVPE OF CONSTRUCTION LI NEW�ADD LI ALTERATION LJ REPAI R
❑ CONVERSION ❑ DEMOLISH O HER p� p�!
DESCRIPTION OF WORK/USE OF BLDG.
5 Main Buildi
TVPE OF PERMI �J GRADING ❑ FOVNDATION ❑ STRVCTURAL T Front
❑ TENANT �2LECTRICAL ❑ PLUMBING ❑ MECHANICAL . A Rear
❑ OTHER � �
� Right
PROJECT DESCRIPTION SQ. FT. OCCUPANGV K
CONSTRUCTIONTVPE VALUATION$ S Left
ZONE � GRADING CV. VDS. ACFES Ping. Ref. #
Remarks: ' Planning Notes:
Sink
Preventer
Irrigation
iking Fountains
�r Drains
�r Sinks -
Service 0
Kitchen Sink -
Lavamries
P-Trap
Roof'Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct-Ventilating '
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0700,000 BTi
Signature ` v �' Date \v �P
Drivers" Li 55 �\v - '
- Accounting; Goltlenrotl - Assessor
PLUMBING
Showers
- Service Sink
Sewer Cap '
Sewer Connection
Solar Collecmrs
Solar Piping �
Salar Tank
Swimming Pool w/Spa
Urinal •
Water Closet
Water Heater �
Water Service •
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
0
e
Refrigeretion System
❑0-1000006TU ❑100,000B'
System Repair/Altere[ion -
luue Fee
e
FEES
$ 3
$ 3
Automatic Washer
Constructior Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Fixtures, �-
Device Boxes
Outlets �
Switches
Garbage Disposal
Generamr �65 KW C
Fee
980� 10/10/84
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
, Meter ❑up to 100 amps
' Meter ❑overd00amps �
Sub Panel
Motors�0.1 HP �1'/:-8
� IncSolar �9-15 HP �16-15+
Microwave -
Pole Light �
Range
Sign
' Standin9 Sections
5 KW Trash Compactor
$15 � � Issue Fee
DEVELOPMENTSERVICESFEQUIREMENTS:
Zoning Approved By
Building Approved By
Applintion Issued 8y �
SUMMARV OF FEES
BUILDING PEPMIT �. $ � SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25°6 $ ENERGV P.C.
ELECTRICAL . $ � GRAOING
PLANCHECK 50%' $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
$ 1
�.00 TL
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
s.
CONSTRUCTION AND PLANNING � FOuI & SPA _ .
APPROVALS Permit# Oate Inspector qPPROVALS, Permit# ' Date Inspector
7. 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�Undrgrnd.
8. Foundation � - -- � 59. Gas Pipe, O Undrgrnd., Test �
.9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final •
12. Sewer Cap ' 63. Heater & Vent-Final , �
13. Roof Drains � 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-C,onduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign� � 68. APPROVED FOR PLASTERING '
18. Rough Electrical-7 Bar Ceiling � 69. POOUSPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace " . APPROVALS Permit #
i
21. Ducts, in Structure 70. Underground Hydro . '
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72.. Underground Flush
24. Roof Framing , 73. Undergrnd.StorageTankOGas OOiI
25. Roof Sheathing � - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing . 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL -
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electriral Power Meter-Final . FOOD CERTIFICATE ISSUED
33. Final Electric ' z�3� tes:'
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Te5t J
36. Hood or Canopy � � � �
37. Final Factory Fireplace �
38. Final Plumbing ' , • . ' . �
39. Water Service-Final ' •
40. Gas Service-Final �
47. Solar pomestic-Final �
42. Backflow Preventer . . � ,
43. Backflow.lrrigation :..,..:_ . ._. . . �. -
44. ,Landscape Irrigation System • �
45. Sound Atterivatibn '
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
ADDlicant to fill in all spaces exce0t those within heavY Do�tler lines
CITY OF COSTA M/E�SA CO/NJ STRUCTIOIV PERMIT
ProjectAddress ��'7�/�/�� ���e,
Applicant's Mailing ddres h � � ' 'l
Owner'sName � _ Phon��4�'��V
Address �.
Arch/Eng. License No.
Address /> �.7 }� ^
ConVactor'sName---�y-� Id<� �//g Ph c[i� //�
Addresslmailing) 1 2' Tn�
City License No. _ E— t��
LICENSEO CONTRACTOft DECLARATION '
1 hereby a(firm that I am licensetl Untle� O�ovisions ot Chartet 9(commencing
wit� section ]000) oi Division 3 of the Business antl Professions Cotle, antl
my Ilcense is in ful 1 ce antl efiect. '
Licens I 3 � Licens No'��
'late � Si9nature
'ORKE 5' C MPENSATION DEGLARATION
� hereby affirm that I have a certifica[e of consent to self-insure or a certificate
oi Workers' Compensation Insurance or a certlfletl copy ihereot (Sec�tlyon
3800� Lab. ���7� %9I�JJ����/'/ c//"�
Polic No.��!���jT�[')— Company � ��n/
ertifie copy is hereby furnishetl. 41
Certitie ['p �letl with the city��iii�VbwisiAn.� .
Date�;�t�.��_. APPlicant � � �fi� y •<<�(�.��
EXE PT ON ROM WORKERS' COMPENSATION DECLARATION
(Tltis section neetl not be completetl if the permit I5 for One huntlretl ($100) or
less).
I certify that in'the performance of the work (or which this perm�t is issuea, 1
shall not employ any per5on in any manner so as to become suCject to the
Workers' Compensation Laws of Califomia. . ' .
Date � Signatur¢ �
NOTICE: If, after making this tleclaration, you shoultl become subject to the -
Workers' ComOensatlon p�ovisions of the Labor Cotle, you must (orthwith
comply with such provisions or 'this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aftirm ihat there is a construction lentling agency tor the pertormance
oi the work for which this permit is issuetl (Section 309� Civ. 0.)
Lentler's Name
Lentler's Atltlress � - -
OWNER BUIL�EH �ECLARATION
I hereby affirm that�� I am exempt from the Contractor's License Law for tne
following reason (Sectiod 7031.5 Business antl Professional Cotle: Any city or
county which �equiies a permit to const�uct, alter, improve, tlemolish or repair
any structure, pnor to its issuance, also requires tne applicaM tor such permit
� file a signetl statement that he/She is-licensetl pursuant [o the p�ovisions ot
�e Cantractor's License Law (Chap[er 9(commencing with Section ]000) of
Jivision -3 of the Business antl'Professions Cotle) or that he/she is exempt
therefrom antl the basis for tM1e allegetl exemption. Any violation of Section
7031.5 by any applicant tor a permit subjects the applicant to a civil
�enalty of nat more than five huntlretl tlollars ($500).
1, a5 �owner' of tM1e property o� my'employees with wages as their sole
' compensation, will do the work, antl the strucnre is not intentletl or offeretl
� for saie (Section �044, Business antl Protessionai Cotle: The Contractor's
, License Law tloes nof apply to an owner of a p�operty who builtls o� imp�oves
thereon, antl who tloes'such work himself/herself or Ihrough his or her own
employces, provitletl [M1a['zuch improvements are noi intentletl or offeretl f0�
sale. If, howeve�, the builtlin9 or improvement is soltl within one year of com-
pietion, the owner will have tne burCen ot proving he/she tlitl not builtl or im-
prOve tor the purpose of sale).
❑ I, as owner of [he property, am exUusively contracting with licensetl con-
tractors.io construct the project (Section ]044, Business antl Protessions Cotle:
Tne Contractor's Litense Law tloes not apply to an owner of property who
builtls or improveS thereon,.antl who contracts fo� such projects with a�con-
tractor(s) iicense pursuant to tne Contracro`r's License Law). I am aware that
proof of their Worker's Compensation insuranoe shoultl be p�ovitletl to me.
❑ 1 am exempt untle� Section 8. & P. C. for thi5 reasan
Date Owner .
certi(y that I have read this application antl state tnat the above
m i5 correct. I agree to comply with all clty antl tounty ortlinances _
laws relating to builtlinq construction, antl M1ereby autitorize re0re-
ot_ this�ity to enfer upon the above-mentionetl property tor
Signature pL�// / 1lA 1' �/
Drivers' License or 55 �
TYPE OF CONSTRUCTION LJ NEW LJ ADD IJ a�
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRaoirvG FOUNDATION, ��
❑ TENANT ❑ ELECTRICAL PLUMBINGi�M
❑ OTHER •� �-s�': a
PROJECT DESCRIPTION 5Q. Fr._�^
CONSTRUCTION TYPE �V�A'LUA
ZONE GRADINGCU.VDS.
Remarks:
Bar Sink ' . .
Backflow Preventer
Backflow Irrigation .
Bathtubs � . �
Clarifiers � �
r Dishwasher
Drinking Fountains
Floor Drains � �
Floor Sinks
Gas Service • �Outlets
Interceptors
Kihhen Sink � .
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler .
Duct-UnderGround
Duct-Struc[ural i
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepVFact. BIL ICBO #
Heating System & Duciing'
❑0-100,000.BTU �100,OOOBT
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 WM1ite Builtlinq; Canary - APplicanf; Pink - Accountin9: Goltlenrod - qssessor
'.. -,_ "r 3"�,cy '
TEk(3'T���.,,,; REPAIR
�
w•
7
��
'GTURAL
ECHf.ANICAL
OCCUPANGY
TION $
ACRES
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
WdLE� C1052L
Water Heacer
Water Service
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑700,000 BT
System Repair/AI[eretion -
Fire Dampers
Reaisters . .
Issue Fee
$ 3
$ 3
A.P..#
S Main Building:
E
T Front
ARear
C Right
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer ,
Construction PoleSub.
Cooking Unit � �
Dishwasher '
Dryers ❑Gas. ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes � -
Outlets
switcnes
Garhage Disposal
Generamr �0-5KW C
2035 2/09/B7 '
Zone .
Accessory Building:
6 i��
Parking Re�./ProviAed
ELECTRICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
Meter'�up to 100�amps � '
�Meter ❑over.100amps
Sub Panel . ' -.
Motors O0.7 HP O1 % -�8'
InaSolar �9-15.HP �16-75+
Microwave - � .
Pole Light • ;
Sign
Standing Sections
5-15 KW Trash Compactor �
� Reinspactian Fee I$15 � I Issue fee
DEVEIOPMENTSERVICESREQUIREMENTS:
Zoning Approved By �7
Building Approved By �'- {/ ('�
5.00 'TL
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMARV OF FEES � -
BUILDING PERMIT $ SMIP � $ - �
PLAN CHECK ' $ - . PERMIT
PLUMBING $ Z. �� ISSUANCE $
PLAN CHECK 25% $. � ENERGV P.C. $
ELECTRICAI � $ � � � GRADING $ �
PLAN CHECK 50% $ � MICROFILM $ �
MECHANICAL $ TOTALFEE �-$ �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# - Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electric2l Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. '� 53. Steel Reinforcement R}
3. Electrical Conduit Utility-Undrgrnd. 54. Forms r�,.
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure-Test :<. !
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUIVITE �-�
7. Footings 56. Electrical Conduit-Undrgrnd., �� � ''
,
8. Foundation 59. Gas Pipe, � Undrgrnd., Test�
t '�
9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, �;Undrgrnd. ��� •� �
10. Structural Floor System 61. APPROVAL TO DECK �;�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
e.�
12. Sewer Cap 63. Heater & Vent-Final ...
13. Roof Drains � 64. Plumbing System - Final �
14. 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 Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT jv��`
20. Rough Factory Fireplace APPROVALS Permit # _ `� �l� '
'i .:
21. Ducts, in Structure 70. Underground Hydro �:R� ��� �`���r.'•�, '
� k�'� K'� • •a
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil ���:.t.y'� �.`���'f' ��i'�
�,� ;.
23. Gas Pipe-Rough & Test 72. Underground Flush �� '
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil�•� �'�'�^
25. Roof Sheathing 74. Overhead Hydro
� 26. T-Bar�Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �^'
36. Hood or Canopy
37. Final Factory Fireplace � , �
38. Final Plumbing �Z�7 L�p � ,
39: Water Service-Final - - - �- •
40. Gas Service-Final / _ � �
41. Solar pomestic-Final ' •
42. Backflow Preventer � � .
� .
43. Backflow Irrigation ' • ` � - ' •
�44. .Landscape Irrigation System ,. ' ' , .,
•45: Sound Attenuation � � � , � , .-
46: Handicap Regulations . � , �
.r
47-, FINALSTRUCTURE&BUILDING� � . � • � � �
. : i ,
48. Special Requirements Completed - ' s �
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co �+ -
51. CERTIFICATE OF OCCUPANCY �
No. Date '
�� pqOJECTAUOflESS: 396(J, PLUMERIA PL
OWNEH'SNAME: NUTTER MICIiAEL
aooeess: NUTTER� ANNE N �
3469 P{�UMERIA PI�
COSTA MESA,CA 92626
APCHIENGINEEfl:
PDOPESS:
NEG.NO.:
UNIT:
�
uNir:
PEI7MITTEE: MCH HEATING & AIR ( 71 4) 639-8781
aooness: g60 N, MAZN ST
ORANGE CA 92C�67
LICENSE� CONTHRCTOfl OELtANATION: I hereby allirm t�al I am IicenS¢E unCer provi5ion5 ot �apter 9([ommencing vn1A Seciion
7000� o� Drv�Sron 3 0� ��e Business and Professions CoEe, anG my license is in full lorca antl eBeq.
cirv uc.: �dd9d� s,nre uc.: 56813i/j�. c�u,s,s: �C— 0 �� ��/� �
Dale: �� Signature: _LiS/�i1�1� � �yV �/�-'�� �/
WOPREflS' COMPENSATION oECLAflATION: 1 nereDy allirm Inat I have a cenifica�e of tonsent to sell-insure or a cenificate of WorkeBl
Compensation Insurance, or a ceriilietl copy thereal �Section 3800. Lab. C�.
POIICVN0.:F1 6004729 E%P.ORTE: OSILBI9Z
camraxv: CA IND EM
❑ Certifietl copy is here�y lurnis�ea. � Certilietl copy is filetl wi�� �he cily Builaing Divisio/n//� /
�ate' / � ' �� � � ACVIiwnC C��/1 ��1�
E%EMPTION FBOM WOfl8EP5' COMPENSATION OECIABATION: �This Seciion neeG not be cnmple�e0 i� Ihe perml i5 for me huna�e0 (51IXp or less�.
I cerlify �ha� in Ihe pedormance ol ihe wo�k br w�ic� Ihis permii is i55ueA, I shall nol ¢mploy any Dersun in any manner so as lo Oecome
Subletl Ia the WOAers' Comoensalion Laws oi Calilamia.
Oate: Signa�ure:
NOTICE: If, aller making Ihis tleclaralion, you 5hou10 beWme sub�ect to the Workers' Compensa�ion pmvisions ol Ihe Labor
Code. you must fonhwitn comply witn such provisions ar ihis permil shall �e deemetl revokea.
CONSiflUCTION LENDING AGENCY: I hei¢by aliirm Iha� ��ere is a ton5lmtlion lentling agency fOr �he p¢tlormance o� 1�¢ wOrk for
whlch t�is permi� is Issued (Section 309L Civ. C).
LENOEP:
AODPE55:
OWNEP BWLOEB OECUHRTION: I here6y ailirm Iha� I am exemp� �rom �he Coniractors' State License Law lor Ihe lollowing reason
(Sec�ion 7031.5 Business an0 Prolessional CoEe: Any ury oi counry whicM1 repuires a permii Io conslruci. al�er, im0�ove, Oemolish, or
repair any simclure. prio� lo its issuance, also reQuires ihe applican� br such permil to lile a signea statement tM1at tlPJshe 6 licensea
Dursuani m the pmv¢Ions al Ihe tomractors' Slaie License Law (Cnapier 9 �commencinq vnl� Section 7000) o� Division 3 0� l�e Business
'. ana Pmfessions Code� or I�al �e/she is exempt Iherelrom and �he basi5lor Ihe allepea exemplion. Any violation ol Sec�ion 703L5 Oy
' any aDDlicam for a permi� subjects I�e applicant�a a civil penaliy of noi more �Aan live hundretl Oollars �5500).
I. as ownet ol Ne pmperiy or my emplayees wilA wages a5 ��ei( Sde campensation, vn0 tlo ihe work, antl Ihe
❑ SlmtNre is not inlend¢0 or olt¢r¢tl lor sale (Se[tion 70G4, Business anA PrOfe55ianal CoOe: The Canlratiors' Sfa[e Lit¢nse Law
does not apDly to an owner ol a o�oPerlY who butles or impmves Inereon, antl who does such work himself/herseli or InroupA
his or her own employees, provitletl �hal such impmvemenis ar2 nol intenEeO or oflered �or sale. II, howeve� �Ae Uviltling a�
impmvemen� i5 sold wilhin one year of comD�eiioq lhe owner will have ��e GurUen o� pmving he/she �iA nol bui10 or imD�ove
Ior �ne purpo5e 01 5ale�.
I, as awner ot t�e properry. am exclusively caniracting with IicenseU coniractors lo consimct Ihe prolect (Section 7044, Business
❑ and Pmfessions Cotle: T�e Conlractors' S�ale License Law Ooes noi apDly to an owner of pro0erty who bui105 or improues ihereon
and w�o conlracis loi suc� prol��s wilh a conVac�ar�s) license Oursuanl io IM1e Contrac�orS' S�aie License �aw�. l am aware
I�at pmOi of I�eir Worker'S Compensalion insUrance Shauld �e Omvidea Io me.
� I am exemp� untler Section: 6. 8 P. C.
10� I�iS �CdS�R
Dale: Ownec
I no hereby cenity Ihai I am aware ol ana unaerSlanA Ihe requirements of Calilornia Heal�h antl Sa�eiy CoOe Seciions 25505, T5533, an0
2553d anA �lui I or any �Wure buil�ing ouu0ant wilVwill not (circle one) neea Io compty vni� 5ai0 slate co0es anE ihe reQuiremenis �or a
pe�mii lor conslmtlion or mo4iiicalion Imm I�e Air Ouality Managemeni DiSincl. flesiQenlial cons�mction applicaiions are e�empi imm
Ihese pmvisans.
Dale: ApphcanC
I pereby cerlily�pai I have iea0 Ihis applica�ion antl slaleihat��e a0oveinformalion is correci. lagree lo comDly wii� all city antl counly
oidlnances ana s�a�e laws ml�iing lo bulamg con5imclion and hereby aWhonxe representalives al ��is ciry to enter upon ihe abow�monlioned
pmpeiry lor ins�lec�ion 0urpases n ^ I
Oale'. ��'d'� � / Signamre'.! GI/1� Y /�—ti�l�'% �
oriver's �icense or Sociai Securiiy
+bat�as White-8utltlinq. Green—COGe EnlorcemenL Canary—AOPlicanl: Pink—Rev¢nue: GOIQenroO—Assessor
CITY OF COSTA MESA — BUILUING PERMIT
PERMZT NO: M 055297 PLAN CHECK NO: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC
JOH DESCRIPTION ; REPLACE FAU 6 AIR CONDITIONIiVG
CLAIM VALUE: CALC—VALUE:
PERM NO: M 05529
GOVT; N SUPP; N
PURPOSE: OTH
SQ FT;
GROUP OCC: R-3 /
COMMENTS: �
i(' iF 3F ii if if iE if If ih jF if i'P iE if if iE if iE ih �f fF iF ii ih iilf iE iF'1F 3'r iE iF if iE 3f iP if 3E jE 1P iE 1f 3E if 1E iE 1f iF jt iE if if iF iE if' if iF if?f #k 3E iF iF #F iE iF iE K' iF i(' iF �E 3i' if'IE iE iFiF
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCzSSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT ZN REAR: FT IN
LEFT: FT IN RGHT; FT ZN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL: 91217322 ZNE: REF NO:
PLANNING NtSTES>
>
iE iE if IF 3E #'-jf it iE #E iF iF 1E IF iF iE iE iF if if iElF if iE k iE if iF iE iF iF iF iE if iPiF iE iFiE iE if iE iE if iE iF jf 3'r if iE if 3F 3F iF iE iF iF 3F ik iEif ff 3F aE �k if %� if iE +�f if if if if if if iE If 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 DATE;
BUILDING APPROVED HY : DATc;
APPLICATION ISSUED BY; G� DATE� /.'�—�
fEiEiM1f61f3FiEiFif3fif�%�-74iEiF1Eif3fiEiEiFft�F£i�� F'iF�"£R'�3Fif1hiF3fiF1ElfiEiPif 3faE
7F1E�IFiF3EiElfiki6i'rifififiEitlFiEiElEdEiE3EiF�lElFiFiFfFiEiF�IEiE�1f3F3E�K-#kif*�MiF Ei #iFiFiflfl41EiE1fiE�lfiEiFi(�1EifiE3E1F3F3fiE�f9EiFlfiEif3kiEieiFit��Ei6
LEGALZZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
c . �
BLDG PMT PLUMBTNG ELECTRIC. MECHANIC FTRE SMIP/RES GRADING
PERMIT . 18.00
• • 252 SMIP/NON—RES
PLAN �
ISSUE FEE " 15,00
BUILDZNG—DIV—> PERMIT ISSUE P3,AN—CHECK TOTAL PAID DUE
iOTALS----> 18,00 15.00 0.00 33.00 33.00 .00
REVENUE DIVISION TOTALS--> COLZECTED; 33,00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING Pi.AN—CHECK
- �3.:00
±k iF if if iF 3f iE iE iF IF if 1f iF 1f if iE IE 3f if iE it iE iF if IF iE iF 1f It IE if it ik if 1f if�iF if fE ii� If IE if k i'r ik iF 1F 1E iE if } i4 iE iF 1EiFif iE ik iF 1f 1E iF� iF iE ii it 3E #f iE iF iF it IE � 1b iE iE
I N D I V I D U A,L . F.E E B R E A R D O W N
TYPE QTY D E S C R I P T I,.O N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAV:FUAN <= 100 R BTU
MEC 1 REFRIGERATION SYSTEM•: <= S00 R BTU/H
"END OF FEzS
.,.
9,00 9,OU
9,00 9.00
.�..C: ._ . ' 1.... . .
�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspe�tor pppROVAIS 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. Forms .
4.� Electrical Conduit�Undrgrnd. ��� 55. Electrical Bonding
5. Steel'Reinforcement 56. Fiough Plumbing & Pressure Test
,�6. Elec[rical UFER Gmd. . 57. APPflOVAL TO COVER-GUNITE
Z. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undr'grnd. 60. Backwa5h Lines, P�Trap, O Undrgrnd.
10. Structural Floor SYstem � , 61. APPROVAL TO DECK
17. Property Sewer Line-& House Connection - 62. Backwash & Receptor-Final
72. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains _ " 64. Plumbing System - Final
14'�Rough Plumbing - 65. Electrical�Final
75. Rough Electricai�Conduit 66. Solar System-Final
lb'�Fough Electric Wifing 67. Fencing & Access ApProval
17. Rough Wirinq Sign 68. APPROVED FOR PLASTERING
18. fiough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory FiteP�ace � - . • APPROVALS Permit #
21. Ducts, in Structur8 , � . 70. Underground HYd�o
22. DuctS, Ventilating - � 71. Product Piping ��Ges ❑ Oil
23. Gas Pipe-Rou9h & Test ' 72. Underground Flush=
24. Roof Framing � � 73. 'Undergrnd; Storage Tank O Gas ❑ Oil
25. Roof Sheathing ' ' �74. Overhead Fiydro
26. T-Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical ,
27. Freme and Flashing' � .' 76. Dry Standpipe . ' '
28. Lathjng & Siding � . - . • �� 77. FIXED SYSTEM .FINAL
29. Insulation " � ' 78. FIRE PREV. FINAL �
30. Drywall Nailing • �`' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ' � 79. FINAL INSPECTIO.N '
32. Electrical Power MeterFinal j� . 80. FOOD CERTIFICATE ISSUED �
� 33. FinalElectric _ � � Notes:/Z�/l�3( (�(o0/w( L/0»7F�LEFj'�)- 41�'�,Q
34. Final Heating'& F.ir �Conditioning , �� •• 2_ � 4 Z�O OO�6Q 4:d117Q� LiF,PriJO?.fl- L��
35. Final Gas Pipe-Test � i �
� s(4 ?z P�+�,- �x.��� �s r� aoi.o
36. �lood or Canopy . ; `� m.,C_ L�
• , U. �-
37. Final Factory Fireplace � • � - - . � .
38. Final.Plumbing , � � � � • �
39. Water Service•Final � � �� � � '
40. Gas Service-Final � � .
-47. Solar pomesticFinal � . - � �
42. Backflow Preventsr . . -
43. Backflow Irrigatio� - �
44. Landscape Ircipation SYstem , , -^ . . � � � -
45. Sound Attenuation ' `
46. Handicap Regulations - � � - ' ; .
47. FINAL STRUCTURE & BUILDING � �. '
48. FINAL PLANNING,, ' - .�, �
49. Electric Release to Edison . � �
50. Gas Release to Southern California Gas Co �, � �
51. CERTIFICATE OF OCCUPANCY
No. Date
\ _ � ��
. . ,. .. � 4u . q.. • t.
,��'�i'�'__n!' . . . ��,�'9E��?7„�:r}� w�i tr'�
�} i� %R4��}���
fi�+ • �„r .h�' . '� yy�r� :C �i.
.-. ' ,� ,
;S ' . .. t-c,. c��• e,�.' �'('L�h.,��
.. ' � . _ . 'y'"j. ���''t" S�� p.�♦. �
_ ' ' 1 : .. . � a,r��i �. rqR'
I
i: "
r+ .
}'
�� � �`/(� �/ PLurrrER�iJ Rullding
r.�} � Address
.x,.'� _ . J��%�✓E N�LSUrt.l (haner
i*
� O�'NE�c' �u��E2 Cantractor
� J���"Y'� Address
Penni[ Date Da[e r.f this Cer[lilcate
��/,3�C�Number /L�/D�'f Issued �
�— i/—,�— � J
r
a
. �.;' �
�":r:.:
�"y�Gy.�.r t�/��i���.a {t���d.r���,,�+'��",;,..1...yy��p s „,i�K
��4;i R ��t� t f ,S -' FtR^.'�� �- .':n
} f � :�r. ` J N
Fr t W ^ �� `" ••i
y i,, a r, �;4� .
�i � . 4 �Y `iI}my' 'y�7'{ � �..y'� " . it �
da�u} � � +j�}} = S � • n +�• • _ � � ��
-6r.F'p��. 'a . � �'S
.i r Sr: � � �4.. w.�j' a... . . ' . . . . . . T ,� '. i h'*�
. _ a
CITY OF COSTA `IESA
DEPART`1F.:lS
OF
BUILDIF'G SAFfiTI'
Reglstered Deputy RulldinK inspeceor
Cer[ifica[e of Compllance
To the Uirec[or of ]3uilding Safecy:
i hereby certlfy [hat the follow�inR porCions of w•ork on ti:e buildir.qs
at the above address which required continuous Snspectten and u•hich I a�as
enployed to inspec[, were inspecced by me and conply w�ith the provisio�s
of the I3uilding Code applicable there[o. .
,
�1) Concrete 3) Welding 5) Sper.:al Cases
Z) Mascnry ,� � � 4) Reinfo3 ced Gypsiun
- � �----SclmninG--Poul-�Slze—fs� �'-3L�-- -GuntCe '��jJ �- -iland Pack- -
Sacks Cement 1��. � �?�r.�.of £and�-._5C �' - " �
Approxir,.ate % o: water Sn aggrega[e �/0�
Thls repor[ covers work comple[ed during week endlnR__ ��—��%y _
RET1AtUCS: G�/��
���
v
� RF.GI
. _ . . _ , � . , Name
i
�
Addrees
Laboratory � / W/�Ji,.�(� Telephone
Fotm SU 6�' / Or�q�,,�' L�O, - . .
L,
L r ✓ _
_ �
'UT ILDISG 1::SVECTOR
zo L % . /��fS�H
i
`K9Fi� ��R.o�le-
9 7/- � �s.�
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- . ' � .. . .... �.�, . � .
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� �.
2� 2� -
�2z�"� F�oZ Twiniaq Laboratories �f ��u�E=,= �a��foznta, �,u.
� 3310 Aupon Way / Mailing Aadress P 0 Bo. 47 / Long Beach, CA 90801 /(213� 426-3355 /(213� 636�2386 /(�14� 828-6432
TESTII�IG PR�DfCti OFPICE 151a�D Nonn �+aroP• Svee� / San�a An� CP 9]�03 i �����1 531-20a5
November 15, 1979
Examination: SC79-6351
COMPRESSION TESTS ON GUNITE CYLINDERS
Mr. Errol F. Heesch
129?_1 Aspenarood Lane
Garden Grove, California 92640
PROJECT Pool for STEVE NELSON
aoDeess 3�69 Plumeria, Costa Mesa
SAMPLE FRO M Gunite Swimming Pool g Spa
ARCNiiECi
FHG�NtEP
Mix
DATE CAST
DATE TiSTED
CYIINDER NO
1
CONiRp:;pR
Owner/Builder
SUBCONiRAOOF
Vern Anthony Gu�ite Co.
SPECIFIED
STRENGTH
CYIINDER 51ZE
11-12-79
2
COMPRESSION 10—D8y 10—D8y
TOTAI LOAD, LBS. fi2�000 65,000
POUNDS F'ER SO. IN. 2�j$5 Z�SnS
Cyls. 4, 5& 6"HOLD IN.FIELD"
CO MPLIANLE 10-Day test complies with specifications.
MPDF B♦
CYLINDERS JR
oisTxieuriow
E. F. Heesch - 2
Vern Anthony gunite Co.
�-6esxa i°tesa Bldg. Dept.
DEl!VE0.ED BY
Heesch
2,000 psi
s-siu�� X i2��
11-12-79
3
10-Day
63,000
2,425
RKEIYF� OH
11-7-79
(/ �KY� �_�/�'. ,
.�r ..,._z,.. r_.� _ -.c.....o i�.n.. �.�.. .n....e.e ._,.�..-v�rros_n.,c�so.,s..o�� �
.._ � _ u _ .,� . .. ��� . :,rsi.,.r. .� . . e n� .. .�.., . . . v . � - . � .
- - - -. . ^ - . -. . ..,e.�. -.,a o.vse_.t�
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. ��rJr�— � DATE � / ���
LOT N0. �'j
ADDRESS ; j -�,�_ �T %�' ��,�y�cc_.�� ��C�.
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-gke=tTC�j%)
(was or��ere-}- :.(,,,�� advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnif� and hold the city harmless fron any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
RECEIVED
ClTY GF COST�1 L�ESA
�L',?:'F!i:G t:��T.
S E P 2 6 1973
AA9
7i8i9il0i1tii2tii2i3p4j5 6
�
BY lA� O,. _ _ �
Purchaser � �
BY`����e� �1%!/
D e er d/or authorized �
representative
BY
Lender
�
�
�
CITY OF COSTA MESA
CALIFORNIA 92626 P.O. BOX 1200
FROM 7HE OFFICE ❑F THE PLANNING DEPARTMENT
s�p��� �a. i���
QcCupant andJor tA�n��
The City of Costa Mesa wishes to advise you that in revising street
addresses, the following addresses have been changed:
Old Address
SEE A17ACMED IIST
New Address
For your convenience we are listing the agencies below that we have
not'ified of the change. In addition to those listed, you are advised to
notify your correspondents of the change in order to avoid any possible
interrupt.ion of mail service.
Your cooperation in this matter is appreciated.
Very truly yours,
W. L. Dunn
Director of Planning
cc: Board of Equalization
County Clerk (4)
Orange County Tax Assessor
Pacific Telephone
Southern California Edison Company
Southern Counties Gas Company
United States Post Office
Bond Department
Building Safety Departmen
Communications
Costa Mesa County Water District
Engineering Department
Fire Department
License Department
Police Department
Public Works Department
Street Department
File
�
115
'i17
118
119
120
GOLDEF;ROD tt� f%LUMERIA
Street 14ame and Address Ghanqes
9b0 Go7d�nrod
982 "
ggts �� .
985 �:
9E8 ��
��� ��
�� ��
�-?
994 ��
996 "
993 "
98Z "
9�9 ��
99 � ��
993 "
995 "
ddrzss
To
s469 °lum2rid
3465 "
3461 ��
3�+57 "
3453 ��
3444 °
3a�i5 ��
3441 "
3439 "
J�r.�iJ ��
3456 "
345� "
3448 ��
3A44 "
3440 "
���1C t
OWNER T,pRW7N So. C
JOB ADDRESS 3�+69 Pln
GENERAL CONTRACTOR sa
AP No. LOT g5
IN' :TIONS
sm.
GAS
W ATER
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON.
SPRINKLING SYSTEM
MISCEL�ANEOUS
ROUGH HEATING ANb AIR CONDITIONING
TEMPORAFY SERVICE OR POLE
UNDERGROUN� � POWER �
ROUGH WIRING
TRENCHES FOqMS STEEL REINF.
FLOOR SVSTEM
BOND BEAM � STEEL REINFORCE [1
SHEATMIN6
FRAME ANO FLASHING .
LATHING — IN OUT
P�ASTER, BROWN CpqT
STR���TURAL, FINA�
HE i, VENT., REFRIG. ANO A.C., FINAL
PWn.a1NG, FINAL qND GAS TEST r��
ELECTPIC, FINAL
9UILOING, FINAL
DATE
19�:7LI11
IRE ZONE VALUE $ 29.tS00.00
SUBCONTRACTOR
.,
� �
' � _PA1.� �
" � 3b�2�"�. ._� 5 �-�.�-. 0^ e_ � � : :.:` i 5".3�:
,t � COSTAMESABUILDING-SAFETV DEPARTMENT �p QC�G�� �
3O1 A P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR LDING PERMIT
For Applicant to Fill in Complete!
RECEIVE BV D TERECEIVED OATE1§SUED
BUILDING �/in r1'Q. O%Qe �—�Q� � ppR 10 1973
ADORESS 2
PEFM T.NO.
pWNER Larwin Southern California />�P� NO. ni.� ,
MA I L BUI LDING
_ ,,,,,,,«� 16255 Ventura BLVd. ADDRESS �
TEL.
CITV Fn�+,'yR(1� Cdl i fnrni a NO. (3RFi-R
CONSTRUC710N ��n Southern California
LENDER
BRANCH 16255 Ventura Blvd/
nooaess Encino, California
APCHITECT ��1❑ S. Calif, rE�.273-4
OR ENGINEER NO
ADDRESS ,��$ 9100 Wilshire Blvd. Bev.H�
CONTFACTOR Larwin Southern California
ADDRESS 16255 Ventura Blvd. �
TEL.
CITV Encino, California No. 986-889
IIC.No. 191311 LICYNO. 8�1.
OFIOT %% X L�.S NOWONLOS O
NO. OF
TEflIOR WALL ROOF
NERING StllCCO COVERING WOOd shing
E OF BUILDING AND WORK TO BE PERFORMED
Construction Single Family Residence
FIRE
ZONE
APPROV
BV
ZONE NO.OF
� / PLANS
YARDS APPROV E
MAIN BUILDINC
(FROM C/L STREE7)
l.. SIDE /.y�/ �
REAR �`/ �
DISfANCE BET.
MAIN BLOfiS,
VAR. 5W
FOR
t horaby acknOwletlge thai I have raBtl this npplication enC ste[e
thet ihe e�ove informe�ion iz corract antl epree to comply wlth
all lows reBulating builtling consttuction, antl I shell not amploy
any person in violallon of the workmen's compensallon laws ot
2he Stete of Celifornie. /
1 horeby certity �hat I em pro0erly licensetl as o convacmr unGer Sn
tho Stota ot Celifornle Businesa antl Professions Cotle, Dlvision 3, THE AMOUP
Chapter 9, entl fhet such Iicenus ora in i�ll torce and etixt, or I THE PURPOSE
nm onompt from Me provisions of xho5tate of Calilornla Buainess VALUATION
antl Profezsions Cotle, Division 3, Chepxer 9.
Signoture y
Permltte�,b � / � D. DOWIIS § �,9 � $��
'Aut�orizetl ABent
—ro_
OF NEW
BET. MAIN &
ACCESS.BLDGS.
OATE
APPROVED
nerc �/O- ��
I��� b
FT, o
! SH N UNDEP VALUATION IS FOR �
OF ABLISHING A PERMIT PEE ONIV: m
¢
PERMIT FEE $ 101 . SO tmv
J
PLANCMECK§ SO.%S E
`o
TOTAL FEE 5
1S2.2S �`
I✓-�ECTIONS
F, Location
Forms
Main Drain
Steel Reinforce
Elec. Bond
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final _
Filter System Final
.wash and Recep. Final
Fencing Final
Approval for Finish _
ace
Builder
TRnCT 7557
Si nature Datc
� C /�.I'
e.� ,�-�- ;
c -
C L° i2•3-7
L'.0 lo-�-
SUBCONTRACTOR
Plumbing ""
ING PERMIT N0. 48936
Prvt. Pool w/ Soa
/
i
• COSTA MESA BUILDING-SAFETV DEPARTMENT
�i89 „ „
APPLICATION FOR �RUC�RA/IRERMIT
••V•VV•••`VV VVV•^•••`V^•V^`••v•••••^+`V`V RECEIVEDBY PERMIT N� 48936
For Applican[ [o Fill in Completely — Use Ink Only
BUILDING �/j/_� D" �_, f�'i Q�%i �� A.P.NO. � �
ADORESS YIO /�Wr/....�..�,L. ltiWG�.
OWNER 61a. UDRE55 �
.�.,,.�:- �7'eue /���sv�J 3 6
VNIT OR
MAILING ��� SPACENO.
A�DRE55
^y / TR.NO. LOT BLK.
CITV vI' \ NOL 9/ —6�% �
NEW AD� ALTE REPAIR MOVING OEMOLISH
CANSTRUCTION ��
LENDER l..
BRANCH NE0. ��-wt /elso.�
ADDRESS vALUE
ARCHITECT 4 n TEL. 3� �.� USE E
Ofi ENGINEER
i
� � ZO E TVPE GROUP
ADDRESS �/ ' /
A TE / � � �'
CONTRACTOF 8�'
ADORESS �{�Q,
TEL.
CITY NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. LIG. NO.
SIZE NO.OF BLDGS. (FROM C/L STREET)
OFLOT �OOD� '+ NOWONLOT I RONT FT.
USE OF
ExISTING BIOG. SI
Separate permits are required for �. sioe F'r.
electric, plumbing and heaung work.
REAR FT.
USE OF BUILOING AND WORK TO BE PERFORMED PLqNNING ACTION
� DATE
;/) APPROVED
APPROVED
I hereby acknowletlge that I have read this applitation and s[ate
that the ebove information is correct antl agrea to comply with
ell laws regulatin8 building construction, and I shall not employ
eny person in violation of ihe workman's compensation laws of
tha State of Celifornia.
I heroby cartify [hat I am properly licensatl as a conttactor untler SQ. FT.
the Scam of California Business antl Professions Cotle, Oivision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl that such licenses are In tull torce antl etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am oxompt from the provisions ot the Stexe ot California 0usiness
entl Protessions Cotle, Di/v—ision 3, hapter 9. VALUATION PERMIT FEE E
$ipneture O} ^// / PL%�N CHECK $ ' . �U
Perm7ttee X.1/[� ��� ��
/� -7 TAX = ,SO
or ��� �W /�
Authorixetl ABo�� Date TOTAL PAID S 3!,' O
�
.
2787 9/II/79 49.47 Tl
COSTA MESA BUILDING-SAFETY DEPARTMENT pPP TION FOR STRUCTURALPERMIT
- P.0.90X1200 COSTAMESA,CALIFORNIA92626
RE ED PERMIT '
For Applicant [o Fill in Completety — Use Ink Only N� 4 8 7 8 �
ADOFESS J/U P� A.P. NO. � �--1�
�W�7 R S�G✓C /�/�(SO�{/ ADDRESS �j � �� �C
UNIT OR
ADDRE 5 S6w�.�, SPACE NO.
q p TR.NO��� LOTQS BLK.
/�J� TEL(�/-�% � Cl
CITV ��� i�[�s.i NO.
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH
OWNER A'L{/
ADDRESS USE ,�y � �LUES
ARCHITECT TEL. �SD�O �
OR ENGINEER e S N �
qA 20NE I TVPE GROUP /
ADDRESS 3 C.,.` . '
APPqOVED �j
CONTRACTOR QC(J,(/eQ� BV DATE /I /
ADDRESS SQ,N.R � -
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. IIC. NO.
SIZE % NO.OFBLDCS. (FROMC/LSTREET) �
OF LOT �S�D �`t� NOW ON LOT / OfYT T.
USE OF
ExI5TING BLDG.
Separate permits are required for L SIDE FT.
electric, plumbing and heating work�. /i —�—
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED P�,qNNING ACTION
/1 DATE
e.!`14eN ( ' � � q � �� P.PPROVED
�
„�Ro� . , _ � g
I hereby acknowleGBa thet I have reatl thia epplication entl steta
thet ihe above Informetion Is correct antl aBree to comply wit�
all Inws reBulatln0 buildinp construction, and I shall not amploy
any paraon In vlolallon of the workman's compansetion law� oi
t�e Stete of Celifornie.
I hereby certlfy that I am properly Iicensetl ¢s a contractor untler S�. FT.
Ma Steta of Celifornla Businezs entl Profeuiona Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Cheptar 9, entl [het such Iicenses are In tull torca antl etfect, or I THE PURPpSE OF ESTABLISNING A PERMIT FEE ONLV:
am axompx from the provlsionsof NaSteta ot California Businass VALUATION PERMIT FEE 5
antl Professione Cotlo, D' ialon 3, Chapter 9.
��// A PLAN CHECK 5
Sipnatare ot -_/��/ �„ // • ��
Pormittoe � g .p/`��` 5�OSSv TAX E �
Auffiorizetl Apent Date ( // �� / TOTAL PAI D 5 �
I
�.
3084 9/ I 4�"� ���0
�� COSTA MESA BUILDING-SAFETV DEPARTMENT APPL TION FOR STRUCTURAL PERMIT
� P.O.'BOX1200 COSTAMESA,CALIFORNIA92626
RE PERMIT
For Applicant to Fill in Com letely — Use Ink Only No
ADIDRESS �J �� �� �� A�P� NO.
OWNER OR �� �' AODRESS J �� ' , .P
TENANT
UNIT OR
MAIIING �'j -. _ SPACE NO.
ADORE55 [�(�(i({.�(�
TR.NO. LOT BLK.
TEI.
CITV NO.
NEW ADO ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION '
LENDER �
BRANCN
OWNER
ADORESS ALUE �
ARCHITECT TEL. USE �� 5
OR ENGINEER N
ADDRESS 20NE TVPE GROUP
APPFOVED 'J
CONTRACTOR BV DATE (
ADDRE55
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. �IC. NO.
SI2E NO.OF BLOGS. (FROM C/L STREET)
OF LOT NOW ON LOT flOM FT.
USE OF
EXISTING BLDG.
Separate permits are required for L. SID Fr.
elec[ric, plumbing and heating work:
REAR FT.
USE OF BUILDING AND WORK TO BE PEFFORMED PLANNING ACTION
���`. / /1 Ia DATE
r// V / �S��il'.r`/ APPROVED
2 APPROVED
I hereby acknowledge thai I have read this application entl rtata �
that the above intormation is corract antl agree io comply with
all lews regulating builtlin8 consttuction, antl I shall not amploy �
any person in violatlon of the workman's compensation Iaws of °
the State of Californla.
m
I hereby cerUfy ihet I am properly Iicensetl as e cantrocior under Sn' FT' �
the State of Californie 8usiness antl Protessions Cotle, Division 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR m
Chapier 9, end [het such licenses are in full force antl eftect, or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from ihe provisions oi the State of Calitornia B�siness VALUATION
antl Protassions Cotl D'vision 3, hapter 9. PERMIT FEE S '�p N
n
PLAN CHECK § �- ^
Signoiure of �
Permittee $ � LL
TAX $
or U
AuthorizetlAgent Date TOTA�PAID S �DO
Tl
TL