HomeMy WebLinkAbout867 PROSPECT PL - Building Permits�
�
CITY OF COSTA MESA
t�'�pMFq BYILDING DIVISION
i�� 77 FAIR ORNE. COSTA MESA, CA 92626 •(714) 7545273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
° � FOR INSPECTIONS CALL: (714) 754-5626
�`"'°�°"°fi PERMIT NUMBER: B11-00146
PERMIT TYPE B_F200F2
APN: 41806416
JOB ADDRESS: 8fi7 PROSPECT�PL�r',CM��
� � ».r
Vicinity: ROOF .
Squares: 2700
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation
ISSUED
05/02/2011
RMD
$3,300.00
SCOPE OF WORK: TEAR OFF. EXISTING ROOF MATERIALS, INSTALL 1 LAYER OF 30# FELT�ON A 5:12 PITCHED ROOF AND
REROOF WITH 30 YEAR GAF DIMINSIONAL COMP SHINGLES ON AN ATTACHED HOUSE AND GAR4GE, APPROX 27
SQUARES. REPAIR AND REP�P,CE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND
CITY SET. ' � ' - - .
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation o( smoke and carbon monoxide, alarms by the City Inspector. See Attachment w/Inspection Card
OWNER: PROSPECT PLACE TRUST � Address: 867 PROSPECT�PLACE � Unit:
PHONE: 714-813-6022 � City/State/Zip: COSTA MESA, CA
APPLICANT: FUENTES; ANDREW
PHONE: 714-813-6022
CONTRACTOR: OWNER-BUI LDER
Address: Unit: .
CitylState/Zip: -
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee' $97.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
-- � � Address:
Ciry/State/Zip:
PHONE:
License No. �
License No.
License No. . 000000
CELL:
PHONE:
PHONE:
Unit: :
TOTAL FEES $98.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N8I2010 - 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 following Federal
New Years Dav. Memoriai Dav, Independence Dav. Labor Dav, Thanksqivinq Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work 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 final approval will result in the expiration of Ihis permit.
COOEO. INSPEC110NTYPE ORTE INIITALS GOOEO INSPECTIONTYPE DATE INi111RL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof � � I �— �� mP � 210 Final Electrical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final 8uilding/Occupancy
WORKERS' COMPENSATION DECLARATION• ' Owner (D verifetl by tlri�nse. Yes ❑ No
1 hereby aNirm untler penalty of perjury one o( Ihe lollovring tleclaretions: Drivefs License�No:-" Expi^ si=��— Z 2 —,�
❑ 1 have antl vrill maintain a certificate of consent to self-Insure for workers' =Venfc�f Ownersh p y(type of document, i.e. - property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, tor the
pertormance of Ihe work (or which lhis permit is issued.
❑ I have and vnll maintain workers' compensation insurance, as required by DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
section 3700 ot the Labor Code, for the peAormance of the wnrk for which this
permit is issued. My workers' compensation Insurance carrier antl policy ❑ I hereby certrfy [hat no excavation frve (5) or more (eet in tlepth in�o wfiich a
number are: persOn is required to descend, will be made in connection vnth work authorized
by this pertnit, and that no building sWcture, scaffdding, falsewnrk, or demolilion
Carrier:
(This sedqn ne¢tl /rotOe comdeled �(he p¢rmrt is valuetl af one hvntlrEd C011ars (3100) oi less )
Polic mber:
•=1�certify that in the performance of the vrork for which Ihis pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws o( Califomia, and agree that if I should
become subject to the workers' compensation provisions o( Section 3700 of
the Labor ode, I shall forthw�ith Jcomply with these provisions.
������f"63,�`� Z %� 2 D ! �
AppLcai4'r5 W e . �Da�e�'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm thal I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of lhe Business and Professions Code, and
my license is in full (orce and eflect.
Lic. # qass #
Comroclor's Signawre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that �here is a constructbn lending agency (or the
per(ortnance o! the wuAc for v.fiich [his pertnit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
SignaNre
OW NER-BUILDER DECLARATIONS:
I he�eby aKrm tha� under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Busine55 and Professions Code: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any slmcture, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant ro me provisions of ine Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business and Professions Code) or Ihat he or she is exempl therefrom an0
the basis for the alleged exemplion. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
fve hundred dollars (3500).):
as ovmer of Ihe property, or my employees with vrages as their sole
ompensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law tices not apply to an owner ot property who builds or improves
thereon, and who does such vrork himself or herself or lhrough his or her ovm
employees, providetl that such improvements are not intended or offered for
sale. It, however, the building or improvement is sold within one year of
completion, the ovmer-builder will 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 EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Profess'pns Code: The contractas License Law tices not appty lo an owner of
pmperty who builds or impmves thereon, and who contracts for such pmject with
a contractor(s) license pursuant to the Contrectors License Lav.s.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
� 7_-�c��
/�Sfon� 9 L�a1ay'
]05]�a6�D/0])
or dismanlling thereof, will be more than ihihy-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Cali(omia Atlministrative Cotle).
❑ As owner-builtler, I will not employ anyone lo do work which would
require a permit from the Division oi Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicanl'S SlgnaWre
Division of Indusirial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Cotle requires, vnth some
ezceptions, that a Business Plan be fled with Ihe Costa Mesa Fire
Department by every business which has at any one time tlunng a reported
year a quanlity of hazartlous materials equal [o or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet o( compressed gas
at standard temperature and pressure).
2. Does or will lhe applicant or present or fuWre builtling occupant neetl to file
a registration fortn for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of lhe Califomia Health and Safery Code, with some
exceplions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quanlity of acu[ely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure�.
3. Does or will the applicant or present or future building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazartlous malerials)? ❑ Yes ❑ No
(SectiOn 25534 0( the Califomia HeaIN antl Sa/ery Code provide5 thal the
Costa Mesa Fire Department may require [he preparation, certification and
fling with [he Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Calitomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will lhe applicant or present or future building occupant require for
ihe work which is [he subject of this applica[ion a pertnit tor such wnstruclion
or modification from Ihe South Coast Air Quality Management District or from
any other air pollu[ion con[rol disMc[ or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumished on applications �a non-resitlential builtling pertnits�.
6. Will any part of the facility to be consWcletl untler this permit be wiNin
1000 feet from the outer boundanes of a school? ❑ Yes ❑ No
(If'yes", the facility musl meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a pertnit from ihe South Coast Air Quality Management District or other
air pollution control district or agency is requiretl for the work which is the
subject of this application, have all of the disclosures prescribed by Cali(ornia
Health and Safety Code Section 42303 been made? ❑ Yes � No
8. Qf yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIRCATE OF COMPLIANCE: I cenify Ihat under penalty of perjury the
intortnation given above is cortect. I agree lo comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Siqnalure
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1
certify under penalry of perjury that I have read this application and state that
the information given is cortecL I agree to comply with all state laws and city
ordinances relating to building wnstruction, and authonze represen�atives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow pancy o( any building
authorized b is permi ntil (nal' peclion.
�_ . . - -- � �7_2��/
SlgnaWreo(LegalOvm s� LData' �.y
An�lorAul�onEeO
�
Prescriptivc Certificatc of
Xesidentia/ Alterations
General lnfurms�[ian
ce: Residentiel � .
Building Type �Singlc Family ❑ Muiti Famiiy
Conditioned Fbor Areu (CFA):
i.v no� 1n hc used (nr Ne�vlr ConsVuc(ed
�ntixcemem
llate:
� i �
Circle the From Orientation: h', E, 3(Lt�r degrees
Proleci Type: ❑ Alterations O Envelope O Fenesvation�32oof I
Replaeement or Chanee Out ❑ Duct keplacement �.Water Heater
�ifdinPs nr Addi(ions .
of
In.suln[ion Vrtlucs For Opnqnc Sur(nces (Jor Fmring use the A4as.t m�d Furring S�rips Cortsnmction m61e below)
Assembly AI[eration
❑ Opening of iramed caviq' alone- A6eraiions thni involoe Uie opening of �he fi�amed caviry� o(n wall, ceiling, orJloor mus� insmll �he
mundulari� minim�un insulnlian vulue per,¢J50 for tAe nbered nsremGlr. Fill in Colvmns A-C and enter mandata�7' insulation value in Ca6enui H.
❑ Replucement of entire assembly-Replucemcm oJ�urv entire ��alf, ceiling, ar jloar' assembl�� reyuires the ins�allation qfConvpo�ient
Porkove- D insulntion voluea� iu ToGle 15/-C. Fill in Columns A-J. .
a ue Snri'ace Details Fa� the rurred porr;onea or
A B C U
�
see
Assembly Name Material . Spacing, U- JA4 Table
or Ty e� and Size' or Other3 factor" Numbers
rred nssemblies', atcounlino fa' Coulinuous Insulqlio�r R-value, see Pnge JA4-3 and Eqi
Values From JA4
Framed Continuous
Cavity lnsulat�on
R-value� R-Value'
9-1. Fa'cnlcula�inojmv�ed
I
Assembly
!. horTng/ID indica�e the identification name (ha� nmtches the building plans.
2. Indicaie rhe Assem6li� Name or' rype: Roo(/Cei(ing, Wal/s, Flaors, Slabs, Crawl Space, Doors and eic...lndim�e Ihe Frame type and Size.' For -
N'ood, Meta(, Metal Buildings, Nlass, eia�er 2x4, 1xG, or ete... see JA4 for other yossible, fi�ame rype assemGlies.
3. Enier (He 1Hic/mess for mass in inches a� Spacing Getween jraming mem6ers enter- 1 G'ar 24 "OC,- or Olher for all olher assemblp descriptiai
such as Cnncrete Sandwich Panel, Spm>dre! Panel, Logs, Straw Bale Pane! and e�c..,
4. TJased on Ihe Clima[e Zane; enler the Standard U facmr fi�om Table I.il-B, C w� D for each diJjerenl assemblp Name or rype.
5. En�er the TaGle number t/ro! closel�� resemGlee� thc proposed aasembh+.
(>. En�er llie R-nalue Ihaf is being ins�alled iir Ihe wall cai�itn or Ge�ween d�e f'nr»i�ig,- od�envise, emer "0 ".
7. Enrer the Cnminuous lnsulation 2-nalue for �he proposed assembly; othe�v✓ise, enler "(I ".
6'. 6nier �he row and cnfunm o(thc U fac�w� valnre based on Column F Table Number ond enter !he Assentbll' U fuctor in Column J
). The Po'opnsed AssentL/v U jacmr. Cofznnn J, nms(�e equal m or less �han �he Smnrlard (I-juc�m� in Co(unvr E �o comnh�.
Fun-ing Strips Construction TaUle fm� Mass W alls Only �
A B C ll � F G H ] 7 K L M
Propused I'roperties oTMasnnr�� and Concrele AdJed Interior or �xlerior Insulntion
�1'ulls Frum ReYcrence in Turring 5�>ace 1'rom Reference
doint A i endix Table 43.5. 43.6. 4.3.7 Joint A�endis Table 43.13
.` � y
v -� n � % U
v, µ p h
Asscmbly �� � � o.O F' v � a, �v �. .:� ��u Final
Mass Name or 7A4 Table �_ v v= E F c 't � Q_ v � /15Sen7bly
Thickness� T c' Numher <" ' i G w � � �i 3 u° C 4`ry u�.� C U-t�Ctol�� Cominenl
I
I I I
/iegia'u�uiion NumGer: Regisrin�ion Du�e/Tinre: HERS Provider:
200d Residentiul Convpliur�ce Forn�s . Augu,r� 2009
A![erations
ROOFING PRODUCTS (COOL ROOFS) §157(p11
When die areu ojexterior roojsurjace to be replaced �ceeds u+ore than 50%
less, (he neiv roofing aren mus! rneei (he roafing product "Coal
CF-IR-ALT
roojarea, or wore lhan 1,000 jT, �vhichever is
b)1Hi, ]52(b)]Hii. or I52(b)IHiii.
Check applicaGle alternative or excep(ion beloH� if the rooJ al�eration is ezemp�Ji�om �he rooJing produc� "Cool Roof' requiremeirts. Note: ljany
one oj7he allernatives a� exception below is checked, �he Aged Solar ReJlectonce and Therma! Emivance requiremenrs jor roofrng producrs in
;¢118(r) m�e not applicable. Do not fill mble below. � �
❑ ool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
ol Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pi[ch greater Ihan 2:12) and product unit weight less
than 516/fl'. �
Alternatives to §252(b)1Hi nnd §]52(b)Hii, Steep-slope roof (pilch > 2:12)
❑ lnsulation with a thertnal resistance o(at least 0.85 hr� °F/BN or at least a 3/4 inch airvspace is added to the roof deck �;
over an attic; or
C) Existing ducis in the attic are insulated and sealed according to §151(�10; or
b In climate zones 10, 12 and 13, with 1 ft'': o(free ventilation area of attic ventilation for every l50 ft� of attic floor area, and
where at least 30 percent ofthe free ventilation azea is within 2 teet verticai distznce of the roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requiremen�s of §151(�2; or
❑ Building has no ducts in the attic; or
(� In climate 2ones ]0, I1, l3 and 14, R3 or greater roof deck insulation above vented atlic.
Exception to §152(b)1Hiii, Low-slope roof (pitcli <2:11) �
❑ Building has no duc[s in Ihe attic.
Other Exceptions
Q Roofing area covered by building integrated; phomvoltaic panels and solar thertnzl panels are exempt from the below Cool Roof criteria.
�� C] Roof constructions that have thermal mass over the roof inembrane with at least 25 Ib/ft is exempt from the below Cool Roof criteria.
ce: If no CRRC-I label is
Check the aoPlicable bor
CRAC Product ID Number�
impliance method cannot be used, use the Performance Approach to show compliance, otherwise,
t from the Roofin Products"Cool Roof' Re uirement
Roof Slope Product Weight Product Aged Solar Thetmal �
<_ 2:12 > 2:12 < Slb/fr' >_ 516/ft� T e2 Reflectance�'4 Emittance SRIS
❑ ❑ ❑ ❑ p"
�Q�
�Q�
�Q�
��7��
�-�
�_�
r1-�
C
�. Tlte C/tRC Produc( lD Number can Ge o6lainedfi�oui Uie Cool RoafRaling Counci!'s Ra(ed Producl Director7� al ww�v.coolraoLx.orn/nroducls/sem�ch nhn �
I. liidicale Ihe tyye of produci is Geing use� (or (he roof (op, i.e. single pl�, roof, asphall roof, meml roof, efc.
i. /fUie Aged ReAeclonce is nol availoble in./he Cool RoafRa(ing Council'e' Rated Praduc! Direelory lhen use !he Ini(ial ReJleclance va/ue fi�om !he snnre
direcmp� mid uae Ihe equulion (02+0.7(P��������— O,Z) la ob�ain n calcula�ed aged vuhre. WLere p is ihe Ini�iaf So/ar ReJlecmnee.
0. Cbeck Gar if lhe Aged ReQeciance ia� n calc�da�ed va6�e using Ihe eguatiar abave.
5. Calculale �he SR/ value Li� using !he S2/- Worksheet a� hltn'��w�vu'.enerm� ca eav/litle24/m�d emer (he resul(ing value in �he SR/ Cofu�nn above ond o(mch aco�r
�he SRI- Worksheer m thc CGJR.
To apply Liquid Pield Applied Cuatings, [he coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufac[urer and meet minimum performance requirements listed in §118(i)4. Select [he applicable coating:
Aluminum-Pigmented Asphalt Roof Coating
Cement-Based RooF Coating �L.I Other
Regisiru�ion Number: Registration Date/Time: HE/LS Pravider:
2008 Residential Campliunce Forms � August 2009
�
ni'
.4[terntions
nce: Residential
v�
cr-i
H�I�S V�P�IFJ CATJON SUMMAFI' Thc en(a'cenrerv ngener shmdd pap special <nten�ion in 1hc HEIiS Measures specified in diis
checldist Lelom. fl cample�ed nnd si���cd CF-4X Fm'nr,for all �he mea.rw�e.r specilied shnll br subn:iued ro tire building inspecior beJore linnl
51
vOCI SL'81iRp �: 7�BSYlile HL'RS verificcrlion is reyam�etf.fm� Ihi� n�cnseu�e.
❑ i'�S ❑ NO 1'CS�.Iu Climate Zones 1 and 9-16, if mort than 4U linear feei of new or replucemeni ducts .ire ins�tilled in unconditioned
- space, the ducts a�ro io be seuled per y152(6)IDii and [he newly instulled ducts are to b; insulaieel pei 5151(1:110.
❑ EXC�PTlO�: Lxisting duct srstems thn� are extended, wirich are cunstructed, insWflted ur sealed with asbestus. �
❑ PTSS ❑ NO YLS, ln Climate'Lones 2 a�d )JG, il tl�e existinp spece-conditioning system (HVAC equipmeni and duciingj is repinced; Ihe
� ducts are to be sealed per § 152(b)] Di. �
❑ 1'ES ❑ NO Y�S: In Climate Zones � and 9-16, if the existing H\+AC equipmeni is replueed (including the replacemeni of-the ai� handler:
� ouidoor condensing unii of n split system, cooling or heating coil, or tlre fur�iace 6eai exchaneerj die ducts are to be
sealed pei § 152(b)1 E.
❑�XC�PT]ON: Duct sysiems tliat xre documented to have Ueen previously sealed confirmed thruugli H�P.S
_ - veritication in acem�dance witL proeedures in the Reference Residential Appendix RA3.
� �� ❑�XC�PTION: Duct systems with less than 40 linear feet in unconditiuned space.- � .
❑ L.RC�PTIO�: Existin^ duct srstems constructed, insulated or sealed with asbestos.
Ref'ri;erant Charge - Split SyStem HERS veri/ica�ion is requirec7 ja'thia measmc.
❑ YES ❑ NO YCS: ln Climace Zones 2 and R-15, when the existing HVAC equipmeni is replaced (includin� ti�e replacement of tht air
handler, outdoor condensin� unit of a split system A/C or hea[ pump, cooling m' heating coil; or the furnace heat
exchaneeri a refrieerant charee measurement shall be verified per § 152(b11F.
Centt•al Fan Inteerated (CFI) Ventilation System and Fan V1'att Drax�
The ve�tilation renuirements oTF150(o1 do not avolv tn existine residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflo�� HERS verifica�lon is reguired.for �h�s measure.
❑ Y�S ❑ NO PES: In Climate Zones 10 through I5, when the ezistiug space-conditioning system (HVAC equipmenl and ductino) is
replaced. Ihe airflov.� and ian watt draw shall be veri5ed Der § 1;2(611 Ci to meet the renuireinents of & 151(f17B. ,
Company:
Address: �G �
Statement
of Compliance documentetion is
� �..� � 5'
/
5-2- z° /i
or L7 CEPE
City/State/Zip: � Phone:
�o� Mn,-a- _ l l� � �' z� 2 � fi ��) � �3 -�
Responsible};uilding Desi�ner's DeclaratT iur Statement �
��-1 em eligible under Division � af the Califomiu Business ancl Professions Code to accep� responsi6iliry� for th� 6uilding design
this Cettificate of Compliance.
c�
1 certify thai ihc energy feauu�es und perlormance specifm�tion:ilor the building desiEu identiLed on this Certiilcaue oTComplinncc confonn
to thc requirumenis of Titlu 24, Paris J tind G of [he Culiibrnln Code of Regul¢tlons.
The building design fealures identiGed on this Certifica�e of Compliunce nrc consisiem wilh the iniurmntion provided to doumient thi::
building design on th� olher :ipplic�ble compliuncc lorms, worlshce�s, culeulations, plans und specificuions su'omiticd tu thc enforcemeni
eeencv for �pprovul with lhis buildin� Permi� ,ipplicotion.
N�une
Compan)'-
Signature.
Late:
License:
Phmie:
Tnr «s.ei,stance or yuestinus regartling the L'nero�• Stnndrn'r(.t} contucl qic L'��eror HoCfi��c ar 1-b'O(1-7i2-33b(l.
l(egia'b'arion IJwnber: /fegi.ru�mi�in Laie/Time:
20(lf.' Rcsidentra/ Conaplimecc Forms
HLI;S' !'rnvicier:
/)tlpt65'1 �U�IJ
CITY OF COSTA MESA
' BUILDING DIVISION
+ �
� DEVELOPMENT SERVICES DEPARTMENT
�• PERMIT PE IT NUMBER
��
M98-00336
(774) 754-5273 • Fax (714) 754-4856 77 FAIF DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
867 PROSPECT PL
Parcel Nunmber: 4�806416
Applicant: TRAN, BRIAN
Address:
Owner:
Address:
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MECHANICAL PERMIT
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�,_%7� Zip: 92626 ���:���\�\ :�1�
Status: ISSUED
Applied: 07/30/1998
Issued: 07/30/1998
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ISSUE FEE.� � �+� $22.00
Inst FAU�'<t00�k�BTU '`\`l� $0.00�
Inst FAU'>,100 k BTU� �� \ �1 $0.00
Repair /�AIt� Cooling%Heat\ �U\ $0.00 0
Inst / Rep��Recess.Walf`Htr \�i\ $0.00 0 �
Refng Sys�<100 k,BTU �1 $0.00 0
Re(ng Sys ?100 k BTU , ��� $0.00 0 �s �;t�
GasPiping \� �'' ( ��$0.00 0 ,,,�>,�„
Facto Fire lace\ f \$000 �OY- �%�' �
MARY�?J�'{ r 1--�'
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Repair / Alt Absorbtion Unit
Re'paia/.Alt Refrigeration�Un
Ventillation.System ;
Evaporative Cooler ,
r� Commercial Incinerator
,;,: Domestic Incinerator
'� Compressors / Absomtion S
f�Up�to 3;hp / 1 W k BTU
�� �3 T - 15`h '!'50 k BT �
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Hood w/Mech Exhausl ���� $0 00� 0. t'r3 ��> �! >%(,�15 To 30�hp / �i 000 k BTU; �� !i��,. �:
VAV Box � "�� C/, n $0 00� 0 �� �. � �; � �� � �30 To 50 hp / 1�750 k�BTU - �/ ' - ' �
Vent Fan / Single Duct;��;� � � j�$0 00 �0 �=C�� ", � i t �Over SO�tip I,Over-1,750 BTU ." � `� / : /
Appliance \\ .� `� /$9 50-�1 `-._ . - �' � , �, Boilers -"' t -' ' � �, -�
Fire Dampers \$0.00 � ,0%_.� �� - Up to 3 hp � � / ; �/
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0moke Dampers �� -� , $0 00 / 0 � �� 3 To 15 hq �i ' %,%' ,
Inst or Relocate Appl Vent �� ��$0 00 LO ���, " �� -� r- 75 to 30 h��� -��� %'%
�.. / r�= -� i .-- . P;
Air Handlers < 10000cfm `-�$O.W �, 0 � � 30 to 50 hp�- --^` -" ��
Air Handlere > 10000dm - � � ` --i ��� `
$0.00= %0 �- , Over 50 fip .
Floor Furnace $0.00�' ��0 �- - . , , , , , „ ,ptherMechanical Fee
Floor or Suspend Heater � $0.00 0� � � � .+� Irivestigation Fee
- Plan Check Fee
Reinspection Fee
$0:00� 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E31.50
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepeetions and finel approval must be obtained. Failure to obtain inspedions and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS'COMPENSATON DECLARATION:
I hereby effirm untler penelry ot perjury one ot the following deGaratians:
❑ I heve entl wlll melntaln e certifcate of wnsent to self-Insure for workere' wmpensation, as provided tor by section 3700 of the Lebor CoAe, lor the peAortnence oi the
work 1or whlc� �his permit is issuetl.
❑ I have end wlll melntflin workare' compensatian insurance, as required by section 3700 oi ihe Labor Cade, for ihe peAortnence of Ne work for which this pertnit is issued.
My workera' compensatlon Insurance cartier end policy number are:
Carrier Policy Number:
(Th/s secfion need not be completetl il the pe�m/t ts velued et one hundred dollare ($ f 00) or less.)
❑ I certity thet in the pertortnance of the work for which this pertnit is issued, I shall not employ any person in eny manner so as to become sub�ect to Ihe workers'
compensatlon laws oi Celitomia, and egree Ihat If I s�oultl become subject to the workere' compensetion proNsions af Sectlon 3700 oi ihe Lebor Cotle, I shell torthwith
compty wlth these provisions.
Applicant SlgneWre: Date:
WARNINO: FNLURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL ANO SMALL SUBJEGT AN EMPIOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO IXJE HIINORED
THOUSAND DOILARE (E100,000), IN ADDRION TO THE COST OF COIAPENSATION, DPMAGES AS PPOVIDED FOR IN SECiION 3]OB OF THE LABOR WDE, INTEREST, PNO ATTORNEV'S FEES.
UCENSED CONTRACTORS DECLARATION:
I �ereby eXirm ihe� I em licensed undar provisions of Chepter 9(commencing with Sectlon 7000) oi Division 3 of the Business end Protessions Cotle, entl my Ilcense is in full
torce and eHect. Lic. q Class q
Contractors SlgneNre: Date:
CONSTRUCTION LENDING AGENCY: .
❑ I hereby affirtn that there is a construction lantling agency tor the peAortnance of the work tor which this pertnit is issued. (Sea 3097, CINI Coda).
LenCers Name: Lentler's Atldress:
Signature: Dete: �
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn Ihet undar penalry of perjury Ihet I am EXEMPT FROM TNE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Pratessions
Code: Any city or counry which reQuires a pertnit to construct, elter, improve, demolish, or repair any structure, prior to Its Issuence, elso requires the applicent for such permlt
to file e signed stetement that he or she is licansed pursuent to the provisions ot iha Conirectore License Lew (Chapte� 9(commencing with Sectlon 7000) of Division 3 of ihe
Business and Profeulons Coae) or that he or she is e:empt Ihereirom antl tha Dasis for Ihe allegetl exemption. My vloletion oi Section 7031.5 Dy eny epplicant for a permit
subjects the epDllcarit t�e civil penalry ot not more Nan five �undred dollars ($500).):
❑ I, as owner of the pioperty, or my employees wilh wages es their sole compensation, WILL DO THE WORK, antl �he structure is not intentletl or ottered for sale (Sec.
7044, Business end Prafessions Code: The Contractors License Lew does not appty to an owner at praperry who builtls or improves thereon, end w�o tloes such work
himselt or �erself or th ugh his or her own employees, provitlatl thai such Improvements are not intentletl or aXered for sale. If, however, the Cuilding or Improvement is
soltl wiihin one year af mpletion, t�e owner-builder will have the burden ot proving ihat he or she did not build or improve for purpose ot sele.).
�I, es owner ot ihe pr erry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business entl ProFessions
Gotle: The cont ector icense Ww tloes not epply to an owner ot property who builds or improves ihereon, entl who conirecis for such projea with a contractor(s)
license pursuan to Ih on tors License Lews.). ``
am exempt u r se � L Business and Professions Code for this reesan: _ 1
ure 1� t7
ner ID veritied by d v s li se. ❑ Yes ❑ No Dnvefs LJcense No. �� �—r� Ezpires:
Venflcellon o1 Ownership dy (rype ot tlocument, I.e. - properry te�c 6ill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION:
❑ I hereby ceNfy ihat no excavation tive (5) or more feet in depth into which e person Is required to descend, will be matla in wnnection wlth work authorizetl by t�is
pertnit, entl ihat no hulltling structure, sceXol0ing, felsework, or demolition or dismantling ihereof, will be more then thirty-sia (36) teet high. (Chep. 32, Grp 2, Atl 2, Sec.
341, Title 8, Celifomia Atlministrative Code).
❑ As owner-huiltler, I wlll nat employ enyone to tlo work w�ich would require e pertnit iram the Division of InCustriel Safery, es noted above, unless such person has e
permit to tlo such work from the division.
Signeture: Date:
Division of Indusirial Safery Pertnit Number:
COOE 1. INSPECTION TYFE
1616 Fizetl System Final Fire Prevention
1288 Pool Spe Finel
200 Finel Re-Root
201 Finel BIocWReteining Wall
202
203
204
266646
Flnel Feqary Fire Plece
Finel Sign
Final Demolition
� Ui�lL4
GOOE� INSFECTONTYPE
206 Finel Mechanical
20B Final Plumbing
210 Final ElectAcal
212 Final Fire Prevention
220 Final Planning Approvel
222 FinalSite
250 FinalBuilding/Occupancy
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CITY OF COSTA MESA
BUILDING D/V/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
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PERMIT NUMBER
P98-00597
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 867 PROSPECT PL
Suite No
Vicinity:
Parcel Nunmber: 41806416
Applicant: TRAN, BRIAN
Address:
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PLUMBING PERMIT
Status: ISSUED
Applied: 07/30/1998
Issued: 07/30/1998
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Zip: 92626
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��V '" ;V��\ FEE SUMMARY�-
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1�\ \ �� AMT QTY AMT� QTY
ISSUE FEE� �j\ $22.00 ' Laundry Tub / Washer , $0.00 0
Backfiow irrigation „r' $0:001 0' Landscape Irrigation='- #�y $0.00 0
BackFlow Preventer $0�00:�� 0� P Trap ��t ��, '$0 00 0
Bathtub ���\ ��r$000`��\0 � Pressure-Regulator .1�y'�;$0�00. 0
Clarifier System� � "" $0.00 ��O�i !- Process Pipingf(per 10 R)" $0 00 ,�0 1
Connect(Ice,Soda;etc) $200� �0�� �Receptois;,�;Y' X ,l�i $000 ;�0��� �
DentalUnits . ,� -$0.00 n 0 ��` SepticTank:� .�;, $0.00 � �,0 - �� ' `
Dishwasher - ;� $0:00'%i 0 ��� ��SewerCapforDemo���� �, /$0.00 �_ ;0'--;. �
Drain, Floor �� �$0.00���0', � �� Sewer.Connect � �� i '$0.00-� 0-�' ,
Drain, Rainwater \�$0.00 �,`-,0/ � - � ,-�Sewer Private Line� - - $0.00 ' 0
Drain, Roof �`$0.00�� �' 0,��;��j- � - Shower $OAO . � 0� �'�
Drinking Fountain $0.00�=-�.0 �� ��� i �Sink,�bar.', ;� � _ . � _--t$0.00_.-a 0, �. �
Expansion Tank $0.00 �4 0`��_� . `� �`Sink,-commercial �- � �,' $0.00� .-- 0.- 1
Gas Earthquake Valve $0.00 '�0.`"'��>�,. Sink, Flooi- � ,� - �.: $0.00 � � 0 .:
Gas(b4outlets) $Q00 0 -Sink,�ki[chen„ .,,$0.00 �Or��
Gas (Over 4 outlets) $0.00 0 � Sink„service/mop- � , - � ., $0.00 . 0 -�
Gas Repipe $0.00 0 Spa (private) $0.00 0
Gas Service $0.00 0 Spa (public) $0.00 0
Interceptors (Grease, Oil) $0.00 0
Interceptors (Sand Auto ) $0.00 0
COMMENTS / SPECIAL CONDITIONS
Sump
Wash I
( ' Waste
Water
i�.' Water.
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���� % $0:00
ol � �$5425
• . ��,$0.00
1, ' = � f $0.00
Bkflow(1�),� $0.00
Bkflow(5+)- $0.00
/ � %� $0.00
iet_�J� $0.00
:nt System $0.00
(Toilet) $0.00
/ vent $0.00
(Inst or Rep.) $0.00
• $0.00
� Water Service $0.00
Water SoRener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TO7ALCALCULATEDFEES: $76.25
QTY
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapectlona and final approval must be ob�ained. Failure to obtain inspections and final approval will �esult in the expiration of this permi�.
FOR INSPECTIONS CALL: (7/4) 7545826
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalry of perjury one of Ihe following deGeretions:
❑ I heva end will meintein e certtlicate of consent to selbinsure for workers' compensetion, es provided tor by sedion 3700 ai t�e Lebor Code, for the peAarmence of the
woiic for which this pertnit I5Is5ueE.
❑ I heve end will meintein workero' wmpensation insurence, es requiretl by seclion 3700 of the Lebor Code, for ihe peAortnence of the work tor which this pertnit is issued.
My workers' compensation Insurence wrrler entl policy numDer ere:
Carrier: Policy Numbar:
(Th/s sec6on need nof be completed i/ the permif is valued et one hundred dollars ($100) or /ess.)
❑ I certiry thet in the peAortnance ot ihe work for which ihis permit is iuued, I shall not employ any person in any manner so es to become subled to the workers'
compensetion lews of Califomia, entl egree that N I should become subject ro the workers' compensetlon provlsions of Sectlon 3700 at t�a Le6or Coda, I shell torthwith
compy wlth thesa provisions.
Appllcent Signeture: Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FlNES UP TOONE HUNDRED
TIIIXISAND DOU.ARE (S10U,000), IN ADDRION TO THE COST OF WMPENSATION, DAMAGES AS PROVIDED FOR M SECTIIXJ �W OF TNE LABOR CODE, IMEREST, FND ATTORNEYS FEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby e%rm ihet I em licensed under provisions oi Chepter 9(commencing with Section 7000) of DIvlslon 3 of ihe Business end Professions Code, end my Ilcense Is in tull
force end eHact Lic. # • Cless x
Contractofs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there Is a consiruction lentling egency for the perfortnance oi the work for which this pertnil is issuad. (Sec. 3097, Civil Code).
Lentlefs Name: Lenders Address:
Signature: Date:
OWNER-BV�LDER DECLARATONS:_ .
�vti l� l�4 �la-:
I hereby atfrtn that under penelry;otperjury tfiat I em E%EMPT FROM THE CONTRACTOHS LICENSE LAW for �he following reeson (Sec. 7W 1.5, Business entl Protesslans
Code: My ciry or counry whic� requires a;pertnN to construct, elter, improve, demolish, or repair eny sWcture, priar ta its issuence, elso requires ihe epplicant br such permit
to lile e slgnetl statament Ihat he ar she Is Iicensed pursuent ro the provisions oi the Contrec�ors License Law (Chepter 9(wmmencing with Section 7000) of Didsion 3 of the
Busineu and Pmfessions'Code) or t�at he or she Is exempt therafrom and the basis tor the elleged exemptloa Any violation ot Section 7031.5 by any epplicant for e pertnit
subJects Ne apPlicant to e ciNl penalry of not more than frve hundred dollare ($500).):
i
❑ I, es owner ot the properry, or my employees wit� wages es Iheir sole compensatlon, WIL� DO THE WORK, end Ihe structure is not Intended or oHered for sale (Sec.
7044, Business and Protessions Cotle: The Contractors License Lew does not apply to en owner oi property who builds or improvas thereon, and who tloes such work
himselt or herself or through his or her own employees, provltleA Ihat such improvements are not intended or ottered lor sale. Ii, however, the 6uiltling or Improvement is
sold within one year completlon, ihe awner-builder will have Ihe burden of proving that he ar she tlid not Duiltl or improve tor purpase oi sale.).
❑ I, es owner ot he perry, am EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS to consiruct the projed (Sec. 7044, Business entl Professions
Gode: The co irec r License Law does not epply to en owner of property who DUIICs or improves iherean, and who contrecis for such project wlt� a contrector(s)
license pursu t to h C ector 'cense Laws.).
� I am ezempt r � L� Business and Professions Code for ihis reason:
SI e: � Ta e: r�
veritied by 've s license. ❑ Yes ❑ No Drivefs License No. �— Expires:
Verlticetion of Ownership by (rype ot document, i.e. - property ta�c bill or tleetl):
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICA710N:
❑ I �ereby certify thet no e:cavatlon tive (5) or more teet in depth into which a persan Is requiretl to descend, will be made in connec[ion with work euthorizetl by this
pertnit, enC ihet no Dulltling structure, sceXolding, felsework, or tlemolition or dismantling thareat, will ba more than thirty-sla (38) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Tiile 8, Califomle Atlministrative Code).
❑ As owner-bulltler, I will not employ anyone to do work w�ich woultl require a permit from Ihe Dlvision of Industriel Satery, es notetl above, unless such person hes e
pertnit to do such work from the division.
Signature: Date:
DlWsion oi Industrial Safery Permlt Number:
LOOE I. INSiECTION TYVE
1616 Fixed System Finel Fire Prevention
1288 Pool Spe Final
200 Finel Re-Roof
201 Final BIocWRetalning Well
202 Final Factory Fire Place
203
204
2d4&I6
Final Sign
Final Demolitlon
LAIE It�AlS
LOOE I INSPELTION TYPE �
206 Flnel Mechanicel
20B Finel Plumbing
210 Flnel Elecincal
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Finel Building/Occupancy
�� ��
CITY OF COSTA MESA
BUILpING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
PE IT NUMBER
E98-00809
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DflIVE, COSTA MESA, CA 92626
Job Address: 867 PROSPECT PL
Suite No
Vicinity:
Parcel Nunmber: 41806416
Applicant: TRAN, BRIAN
Address:
Owner:
Address
ELECTRICAL PERMIT
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,'% `��j /'; y�/'�'j � r' .�/ ,,li � � , e � : � ;
� , � J� %� :�' + -� �`� ���� °\k^,i
� �' � tt����
I 11 i � ���NEV
��if:
� t � /-- � �
� � � � r� �
i � � ' i
� ��.,
�i �
, , �_� 111�` �
11SSUE FEE �r,�
Temp `service test�� � � _; �
Res. a/c'paokage ��\ �i
New Re`s (1-2�units) ������
New Re`s�(3lunits) �����-.
Pool / Spa r" �
Lighting,F,izts �" 1�\ ��
SCOPE OF PERMIT �
FB98-01361 - �
ni � , �;)Cr)�,', !. r . -�;
�) r�. � ...,.�� �-.,
SWtus: ISSUED
Applied: 07/30/1998
Issued: 07/30/1998
, i �t .°�a ' _ -FEE�SUMMARY �,, ,, � , � , ' ��: i
\ _- _ � _
`Quantity � �/ � quantity� �.� �
$$O.W ("`���'�`J����'--�=�Buswa�yl/700fttem4Lightmg� $0.00 0'.:' ,,=t+I/
� �-- �: _ _ ._.__ .
$0.00 -- - �- Standing Seition - -"' $0.00 0�, � � . l r,}� r
$0.00 � 0 Misc ElectiicaPEqwpment $0.00 0 ; J
$0.00 ; 0 Transform�ersyp to 1 kva/kw '-. $0.00 �0 1 - � ���'i
$44.25 j 1 ..........`.:.�.::up to:10 kva/kw , $0.00 '�0 � � ��"' -�ti� �
` ' $0.00 i 0 .. up to 50 kva/kw $0.00 � i0 . ' � � . � .'1, ��
Rece t Outlets �� � " ' ` �� i � � � � � t
p v � �� \$ODO , 0 . .. up to 100 kva/kw $0 00� ,; 0 � >> ,
Switches����� / ��$0.00 `� 0 �' � ` ' -r�.,,. . over 100 kva/kw $0 00 �;i 0 �' �
Non Res Appl � �$0.00 , 0 �°r` �ti� ���Low Voltage Equipment $0 00� � 0 � ����
Res Appl \� �� $0 00� 0 y � �, i 1P LowyVolt VJinng System / Ckt ;.$0.00 0�' ��; �
Service to 200a ��� " $0:00�3L w '0 ` '� ���`�� �Misa Condwtf,'-� -� ; i $0.00. . 0 1;�,�
Serviceto 1000a�\ ��J$0.00����0',-., � �� � , Misc?Conductor�� ��/ $0.00� . 0 L,� �
Service over 1000a �� ��$0:00��� 0 ; � � ���.�� � � - � ' � �
� � . �`Ci�ws (.gen or;ride) " , �� % $0 00 � 0 „'
Motors to thp ��� �, �� $0'00.` y �0;-``,. � -� �� f � Circus:(mech`riEebr lights) � r-- ,$0.00 : �' Oi ��
Motors to 10hp �� ����V �$0:00 ; , �� 0 � ' -����-___ r Christmes Tree Stand - $0.00� /,�0 "/
Motors to 50hp '� ��$0:00. / % / 0- � Fireworks Stand � `� = $0.00: %�� 0�
Motors to 100hp � � $0.00 ��J,�i 0� � r Other Electrical Fee _ �� � $0.00 � ;: �
Motorsover100hp ��$0.00� � L0,<" , - ";-'-- . �-,i,`,., ��/%��"
Communicatlon drops $0:00 �'��� ��.. 0 �� .,1 � - ' .Investigetion Fee� � - '� �" " �� $0.00
Sub panel to 200a $0.00��,' '�'0- _ ` � � ,�` Plan Check Fee - - j -�'� � $0.00
Pole Light Pkg $0.00 ' �. 0 - ,. , Reinspection Fee � " ' $0.00
Sign Circuits $0.00 0 � � . . , �� � -
Temp Pwr Pole $0.00 0 � TOTAL CALCULATED FEES b66.25
Intermed Pole $0.00 0
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and finel approval must be obtained. Failure to obtain inspedions and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION OECLARA710N: �
I hereby eHirm under penelty of per�ury one of the following decleretions:
❑ I heve and wlll meintain e certtlicate of wnsenl to selt-Insure tor workers' compensation, es providetl tor by section 3700 of the Le6or Code, for the peAormence oi the
work for which this pertnit is Issuetl.
❑ I have anC will maintain workers' compensatlon insurflnce, fls requiretl by sectlon 3700 of Ne Lebor CoCe, for the peAortnence of the woAc for which this pertnit is issued.
My workers' wmpensation Insurence cartier entl policy number are: �
Carrier: Policy Number.
(This sectlon neetl not be completed l/ tbe pertnitls va/ued et one hundretl dollars ($100) or less.)
❑ I certity �hat in the peAortnance ot the work for which this pertnit is issued, I shall not employ eny pereon in eny manner so as to become subject to Ihe workers'
compensation lews ot Celifamia, and egree that if I shoultl become sub�ed to the workere' compensetlon provisions oi Section 3700 of the Lebor Code, I shell forthwith
comply with these provisions.
Applicant Signature: Date:
WARNINO: FNLURE TO SECURE WORKERS' COMPEfJSFTION COVEMGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPIOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE MUNDRED
TIiOUS/J1D OOLLARE (5100.000). IN AD�ITION TO TME WS7 OF COMPENSATIIXJ, DAANGES AS PROVIDED FOR IN SECiION 37080F THE IABOR CODE, INiEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirtn that I em licensetl under provislons of Chapter 9(commencing with Sedian 7000) oi Divislon 3 ot Ihe Business and Professions Code, end my license is in full
torce enC eflact LJc. a Class a
Contrectars Signeture: Date:
CONSTRUCTION LENDING AGENCV:
❑ I �ereby aifirtn that there is e wnstruction lending agenry for Ihe pertortnance of the work tor which ihis pertnit is issuetl. (Sec. 3097, Civil Coda).
LenCers Name: Landers Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eXirtn ihet untler penelry af perjury ihe� I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe follawing reason (Sec. 7031.5, Buslness end Prafessions
Code: Any ciry or counry which requlres e permit m wnsWct, alter, improve, demolish, or reDair any strucNre, prior to Its issuance, elso requires iha applicant for such pertntl
to file e signed statement that he or she is licensed pursuent to the pmvisions of Iha Contrecrors Licensa Law (Chapter 9(commencing with Sectlon 7000) of Dlvislon 3 of Ihe
Business end Profeuions Code) or �hat he or she is exempt therefrom and the basis for the alleged exemption. My violation of Seclion 7031.5 by eny epplicant tor e permit
sublects the applican� to a civil penelry o1 not more Nan five huntlred tlollars ($500).):
❑ I, es owner of Ihe properry, or my employees with wages as Iheir sole compensailon, WILL DO 7HE WORK, enG ihe structure Is not intended or otteretl for sale (Sec.
7044, Businesa entl Professions Code: The Contractors License Law does not apply to an owner ot properry who builds or Improves Iheraon, end who does such work
hlmself or hereelf or through his or her own employees, provided Ihat such Improvements ere not intended or offered for sale. It, however, ihe bulltling or Improvement is
sold within one year of completlon, the owner-builtler will have the burden ot proving that he or she did not build or improve tor purpose of sale.).
❑ I, as owner of ihe operty, em EXCWSIVELY LONTRACTING WRM LICENSED CONTRACTORS to consirud lhe project (Sec. 7044, Business end Professions
Code: The c tre rs License Law does not epply to en owner ot property w�o builtls or improves thereon, entl w�o coNrects for such project with e contrector(s)
license ours nt e.Contr�Ctors License Lews.). '
�vner ID veriTed
Vedflcetlon ot Ow
Business and Protessions Code for this reason:
license. ❑ Yes ❑ No
by (rype o1 document, I.e. - Oroperry tev 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
Dnvefs License No.
i'DafS:l � i�1e i '
v-� Expires:
❑ I hereby certly Ihat no excavetlon five (5) or more teet in depih into which a person Is required to descend, wlll be matle in connection with work euthorized by ihis
pertnit, end Ihet no building structure, scafroltling, falsework, or demolition or dismamling thereof, will be more then thirty-siz (36) feet high. (Chep. 32, Grp 2, Atl 2, Sec.
341, 71tle e, Celltornle Adminlstre�ive Cotle).
❑ As owner-bullder, I will not employ anyone to do work w�ich woultl require e pertnit iram Ihe Division at Industrial Sefery, as notetl above, unleu such person hes e
permit to do such work from the division.
Signature: Date:
Divisian ot Industnel Sefery Pertnit Number:
��i�i���: ��'TTt�11T�i � ���i
1616
1266
200
201
202
203
FixeO System Final Fire Prevention
Pool Spa Final
Finel Re-Root
Finel BIocWRetaining Wall
Finel Fectory Fire Place
Finel Sign
204 Final Demolitlon
zaa5ae
7A7E It�dL4
GO�Et INSPECTIONTYFE
206 Final Mechanicel
208 Final Plumbing
210 Finel Electricel
212 Final Fire Prevention
220 Finel Plenning Approval
222 Finel Site
250 Finel Building/Occupency
QA7E IlI�ALS
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.Bc IIILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 874 PROSPECT PL
Suite:
Vicinity: REAR/SIDE OF RESIDENCE
Parcel Number: 41806413
Zoning: R1 R1
Applicant: JORDAN,TERESA ISSUED BY:
Address: 874 PROSPECT PL - ,. �� " �� � . - ' -
, y:
� � ' Phone: 714-437=1349 HOME '
COSTA MESA, CA �� �' Zip: 92626-2954 ' , �
Owner: JORDAN�MICHAEL A AND TERESA �. � �� �V '���� d`�
Address i874 PROSPECT PL ' � . ' � ��� � � �ry�
�
/ � /� � ��, ' � ' Phone: 714-4371349 � �` � ��. �
' COSTA MESA, CA � - � Zip: 92626-2954 ' �� . '� � `D'
i � �. _. /,i \
Contractor: OWNER-BUILDER � � � ` 9� '� .�
, i-
�;� �,
Address: - �', , A = ;AA i ���
� _ �
� - .��; Phone:.+ � ,�;�
�. � , %�:� , ��� �1�
Zip: . " , ' Llcense:�` 000000 , -. 'l �` ''- ;� `
.'�; % . -' . - _ • , . . ,
� , .0 . . . � , � � � � �
Arch�. ' � 1 -
. ._ , ,. _ - - Eng: . . . �'� , ,
Address: � ' � ` � � _ Address:; �.� '. - - �'�
_ . . ; r i � Phone:
, - , ' � - i= .., Phone: � - - . _ ,
_ � ;, ,.
. - `- i�, :` �. .
�
�,
\ ,
�
Zip. - ... . _ _ . � License: ��� � �License: , - . ` ' `
Stalus: ISSUED
Applied: 09/27/2002
Issued: 12/04/2002
� " ' ; ' f �'. SGOPEAF P_ERMIT...., .".,_. �, � . ,-'
� ADD 96 SF TO EXISTING SFR CREATE NEW BEDROOM AND BATH.`MINOR ALTER�TO EXISTING;SFR AND GARAGE� �- '�
. . _. � ,
� FEE SUMMARY �
� Plan �Check: • '�$208.81 �' ��_ �` _ �. - � . �." :' ?, �, -- -Calc Valuation i� � � � �-S2o,000.001
�. i.� ��
Permd: $321.25 '— - — � , /� _ Claim Valuation i < < <_ S2o;oo0.00'
. . . �,� r ; �,�
� � SMIPRes:�-� $2.00 �� ,_
�SMIP Com: ' $0.00 �! - '
Other: ' . $0.00 ` :.
`, Inspection: '. ��. :$0.00 �� ,- � � �! .
. � � _ � i,-, � �� i. .
, `� -
,
� - ��.i ,
��Total: $532:06 � � � ' �; ��, �
�, � ' ��� . � , i;/ � , �; .
�' . ' +
��, � `. � � PLANNING &�ZONING � % / ; ��i
i / � ,,,
SETBACKS� '-- ;, � _ - . �.%' r� �f ��; /
MAIN STRUCTURE'Front 30�.0 '-Rear ���37-0 �' � Left - &�0 Right , �5-�0 � �� -� i/� �
� . , , ' _ . _ . _ -. . t`� '��/
ACCESSORY Fiont ` 0- 0� " -� Rear 0- 0 Left -0= 0 Right i.0- 0.- �� �!�
�� ,'.� . , .. �i
PARKING Existin :� 4,�. �Re uired: � 4 � Pr000sed: �0 �" �
l.
NOTES: � ,
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes �� related
regulations. (Ord. No. 92-28, § 1, 12-27-92) .
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended����abandoned
for a period of 1 BO days. � �
INSPECTIONS: In order for [he work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446ds (8�00)
WORKERS' COMPENSATION DECLARATON: �_
I hereby eHirtn underpenafl� P� perjury one of ihe following declarations: i,
❑ I have antl wlll maintain e certificate ot wnsent to sel4lnsura tor workers' compensation, as providad for by section 3700 of the Labor Code, for Ihe pedormence of the
work tor which Ihis perrt�lt is issued.
❑ I heve and will meintain Wa�kers' compensation insurance, as required by section 3700 of Ne Labor Cotle, for tha peAortnance of ihe work for w�ich t�is pertnit is issued.
My workers' compensallon Insurance cerrier antl policy num�er ere:
Carner: Policy Number:
(TA/s�sec0on need not be rnmp�etetl i/ fhe permit is veluetl et one huntlretl dollars ($100) or less.)
� I caNiy that in the peRolmence of the work for which ihis pertnit is issueQ I shall not employ eny person in any manner so as to become subject to the workers'
compensalion lews of Celifomia, end egree Ihat if I shoulC become sublect to t�e workers' compensetlon provisions of Sactlon 3700 f the Labor Cotle, I shall forthwlth
comply wilh Ihese pmvis�on�-� � �
�II tnce SiBnature: � � �Date� � �Z� � ��L
W�RNINO: FAILURE TO SECURE WO KEfJ ' COMPENSATIqJ COVERAGE IS UNUWFUL AND SHALL SUBJECT AN EMPCOYEF TO CRIMINAL PENALTIES AND CIVIL FINES lIP TOONE HUNDRED
THOUSANO OOLLARE (5100.000�, IN ADDrtYON TO THE COST OF COMPENSATION, DPMAGES AS PROVIDED WR IN SECTIqJ 3]O60F THE LABOR WDE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I em IicanSed under provlslons of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Coda, and my license is in full
force and eflect. Lic. q pass x
Contracto/s Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirtn ihal ther@ is e construction lending egency br Ihe peAormance ot the work for which Ihis pertni� is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lentler s Address:
Signature:
Date:
I hereby effirtn that under penely oi perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Buslness entl Profeuions
Code: Any city or counry which requires a pertnit to consiruct, alter, impmve, tlemolis�, or repair any strucWre, pnor to its issuance, also requires the applicant for such pertnit
to Nla a signetl statement lhet he or she is IlcenseC pursuant to the provisions oi tha Contrectors Licensa Law (Chapter 9(commencing with Section 7000) oi Dlvlsion 3 01 t�e
Business and Professions Cotle) or ihat he or she is exempt thereirom and ihe basis for the elleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
su ects the epplicanl to a civi� penalty of not more then five hundred dollers ($500).):
r I, as owner of ihe propeM� or my employees with wages es iheir sole wmpenutlon, WILL DO THE WORK, end tha structure Is not intentletl or oNe�ad for sele (Sec.
t�7044, Business end Professions Cotle: The Contractors License Law does not apply to an owner of properry who 6uilds or improves ihereon, end who tloes such wotk
himselt or herself or Ihrough his or her own employees, provided ihat such improvements ere not intentled or oMered tor sele. tl, however, the Duilding or improvement is
sold within one year ot completion, the owner-6uiltler will have the burden ot proving that ha or she ditl not build or improve for purpose ol sale.). �
❑ I, as owner of the propeM, am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Co6e: The cwrtractws Ucertse Law does noi apply to an owner oi property wtw builds or Improves thereon, and wfio contracts tor such proiect with e contractor(s)
license pursuan� to the Cantractors License Laws.).
❑ I am exempt
Ownert�'verified by tlr�vef license.
Vedficatlon ot Ownerehip (type oi
Business antl Professions Cotle for lhis reason:
Ves ❑ No
I.e. - property tax hill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no ex�evation tive (5) or more teet in depth into which a person Is required to tlescentl, will be made in connection wiih work authorized by Ihis
permit, anC that no buildi�9 siructure, scattoltling, talsework, or demolition or tlismantling thereoi, will be more ihan thirry-six (36) teet high. (C�ep. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Caltlomla Adminisirative Code).
❑ As owner-builder, I will no� employ anyone to do work which woultl raquire a permit from ihe Division of Indusirial Satery, as noted above, unless such person hes e
pertnit to do such work ffom the tlivision.
SlgnaWre: Date:
Division of Industrial Safery Pe�i� Number:
CERTFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTFiY: I certify under Denalry of perjury that I have read this application and state ihat the intortnation given is
correct. I egree to comply with all s�ate laws end ciry ordinances ratating to building construction, and authonze representatives of the Ciry of Costa Mesa to enter upon the
ebove-descnbed propeny for inspeai n oses. I aqree not to occupy or ellow wcupency of eny building au�ho�ized by this permi� until fnel ins ction.
i� �til� �b�
SIgY ne�u Oi.Le9 �ner s) oate
r �
AnNOr Auihonzed Applican� Date
COOEI. INSiEC110NTYPE �
1616 Flzetl System Final Fi�e Prevention
7268 Pool Spe Final
200 Final Re-Rooi
201 Final Block/Retaining Wall
202 Final Fectory Fira PIaGe
203
204
Final Sign
Final Demolition
�g ���
COOE� INSPECTIONTYPE
206 Finel Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Preventian
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
P97E II�ALS
RDQUEST FUR OCQJPANCY
�cr No. /05/ 3
rAm No. 3 7
• ..; �.
II]�TE: �l'_ � � � � %
Zhe developer of the above entitled tract desires to sell the above set forth
lot prior to the tune that the tract has been conpleted and its streets
accepted tr� the City of Casta Mesa.
By executing this agree��ent, the undersigned acknaaledges that he/she/they
was/were advised that this tract has not been given final inspection nor has
it been accepted bp the City of Costa Mesa as having conplied with the conditions
of approval which were i.urposed ty the City at the time the Final Tract Map was
approved.
The City assimies no liability for the enforcement of the conditions necessary
for approval other t1�an those oonditions protected b� surety bond.
The undersigned agrees to indemnify and hold the City harmless from any claim
resulting in dam3ge or personal.injuLy to the undersigned 1� reason cf the
aforanentioned unconpleted condi
�1 i�' ��' I�! ��� � ¢ ��a
CITY OF COSTA MESA
PLAt•!MlP:G DEPT.
SU3;:CT TO ELCG. DcPT. RFG.
� �e/s� /� y
oare.......__.__..�
� !Oi OF iUNNING
an9
IZ
BY
authorized representative
�' �
� � o,�--�,.�.� �.� ��
'� (Signature�of Lender)
O.'it�t"s.'-v
,,'�-�„�.�-,
C �'' U I I
SC.40EFt ENGINEERING
612 Balboa Drive
SEAL BEACH, CALIFORNIA 90740
PHONE/FAX {310) 596-2863
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612 Balboa Drive
SEAL BEACH, CALIFORNIA 90740
PHONE/FAX (310) 596•2863
A� ex;
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(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
JobAddress: 874 PROSPECT PL
Suite No
Vicinity:
Parcel Nunmber: 41806413
Status: ISSUED
Applied: 12/04/2002
Issued: 12/04/2002
Applicant: JORDAN,TERESA ISSUED Bv:
Address: 874 PROSPECT PL . � -_ - ' � �
, � �Phone: 714-437-1349 ,�
_. `'�
�
WSTAME3A,"CA-- � � Zip: 92626-2954 � -'��'�
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owner UORDAN, MICHAEC A � - �� � � `! �"�'�
� � ���� � .� '��.�
Address ��874 PROSPECT PL � � � � � ; / -,;�
' . � - . � Phone: �
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,� COSTA MESA, CA Zip: 92626-2954 � � i Y��: \�
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� Contractor: -� OWNER-BUILDER •
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� Address: � � � , • ' Q�`���\��
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' - . - , _ � , - Phone: � _ , ' � . .
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, . �.� � . . License: 000000 � ._ ` �� ,� , ' . .
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-: - , -: � , SCORE OF PERMIT , . - ',..;,--. ` . ,
�, .i � ELECTRICAL TO INOLUDE: 4 LIGHTING�FIXTURES,-5 OUTLETS, AND 3,SWITCHES LOCATED IN_ ,' -
. BEDROOMANDBATH:` -� -- `-- . . .".._� r..:.'-'- .-' . � � � '
� REF.:802-01577,� �" - � ' �
, , . . . . � �' ^-- - , ._. " � � � � - � ' : � .
, .___, _� _FEESUMMARY /j�� - _ . !','% .' � ,
.-1 ' Quantity /� Quantity�,��� '
ISSUE FEE - � $23.50 - Temp Dist System./ Lighting $0.00 0" :' � � . - -
Temp service test $0.00 Busway H00 k �$0.00 0��" � �
Res. a/c package . . $0.00 Standing Section $0.00 �i0�� � _ � ` - %
New Re's (1-2 units) ; $0.00 0 - ��'Misc Eleclrical Equipment $0.00 � ;/,0'� � � - ,
New Res`(3+units)` � �$0.00 0 , .�.��;.�_� �-. Transformere up to 7 kva/kw $0.00� �; �0 �� �; � � �
PooUSpa'_�� . ����$0.00 0 .,..�- .............:.'.upto�Okva/kw $O.00i�. 0 �'`' ,
:-
i
Lighting Fixts � _ �$4.40 � � _. 4, � - .................up to 50 kya/kw,� _.._,.$0.00'.- 0� �, � - ;
Recept Outlets �'� . $5.50 ' � 5 � � � � ` - ... " ,. . up to 100 kva%kw � ` . $Oi00 0 � �
�
Switches �- � ' � �$3.30 � 3 ` � - - � .:....... .. over 100 kva/kw - SO 00%� � 0 /„ `,�
Non Res Appl " � $0.00 � _ Q �, '�, . � � � Low Volhage Equipment - � ° : �SO 00 :� j;0 /: '
Res Appl � � $0.00� ' � 0�' � " � Low Volt Winng System / Ckt' � $0.00 � ,0 ,� ', �
Service to 200a �� �� �. - � - $0.00 � 0 ' , - � Misa Conduit , r. ,$0.00' � 0 �.- /
Service to 1000a � -�, $0.00 � �. 0 � Misc. Conductor ,� $0,00' j 0- � � �
Service over 1000a $0.00 -- 0 _ � Circus ( gen or ride) ' � $0.00,;. � 0�
Motors to thp � , $0.00 � � � 0 � � ,Circus (mech ride or lights) ' $0.00 ! �'0
Motors to tOhp �� �$0.00 . 0 �, � ChrisVnas Tree Stand�J �"50.00�' 0
Motors to SOhp $0.00__ _ 0 . ; �, � Fireworks Stand � � ��� $0:00 0
Motors to t00hp $0.00 � 0� �� Other Elec[rical Fee� - J �$0.00
Motors over t00hp $0.00 � � 0 � _ - - , - ,- �.� � �' . �
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandon d
for a period of 780 days. ,
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspeetiona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this p� it.
FOR INSPECTIONS CALL: (714) 7545626
244646 (&00)
WORKERS' COMPENSATION DECLMATION: � '
I �ereby aflirm under penalry of perjury one of the tollowing tleclaretions: .
❑ I heve and will maintain e certifica�e of consent to self-Insure for workers' compensation, as provided tor by section 3700 oi the Lebor Gode, for the peAormance oi the
work for which �his permit is issuBd.
❑ I have antl will maintain workers' c�pensatlon insurence, as required by section 3700 oi the Lebor Cotle, for ihe peAortnance oi the work for which Nis pertnit is issuetl.
My workers' compensatlon InSurAnce carrier entl policy number are:
Cerne,,,555reee.ttt Policy Number.
(Th�tlon neea not be comp/eted /! fhe permlt is valued al one huntlretl dollars ($100) or less.)
I certity Ihat in the pertortnance o� ihe work tor which this pertnit is issued, I shall noi employ eny person in any menner so as to bec me subject to the workers'
compensetlon laws ol Celifomie, and egree Ihet it I should become sub�ect to the workers' compensalion provisions of Secti n 370 oi the Lebor Code, I shall torthwith
comply with these pravisio s.
Applicant Signeture: Date: ( 2 �.Z�
WARNINQ: FAILURE TO SECURE WO KER MPENSATION COVERAGE IS UNUWR/L AND SMALL SUBJECT AN EMPLOYER TO CiiIMINAL ENAL IES ANO CIVIL FINES UP TO ONE HUNDRE�
TYqU$AND Dd1ARE 15100.000), IN A DITI O SHE COSS OF COMPENSATIOh, DAMAGES AS PRdJIDED FOR IN SECTION 3�O60F THE IABOR CODE,111�EREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn that I am licensetl under p�ovislons of Chapter 9(commencing with Section 7000) of Division 3 oi the Business and Protessions Code, end my license Is in full
force entl eflect. Lic. q Cless A
ContrectoYs Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby eHirm that there is a con9iruction lending agency tor the peAormance of ihe work tor which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lentlefs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby atfirm Ihat unCer penalry ot perjury that 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry whic� require5 a permit to construct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant lor suc� pertnit
to Ille a slgned stetemem that he or sha Is Iicensed pursuam to the pmvisions of the Contrectors License Lew (Cheptar 9(commencing with Section 7000) ot Divislon 3 oi the
Business entl Profeulons Code) or the� he or she is exem0� �herefrom and the besis For the elleged ezemption. Any violation oi Section 7031.5 by eny appliwnt tor e permit
�s �ects ihe epplicani to e civil penelty of not more than five hundred dollers ($500).):
I, es owner ot ihe properry, or my employees with wages as Iheir sole compensetion, WILL DO TME WORK, and ihe structure Is not Intended or oXaretl for sale (Sec.
7044, Business and Professions Gode: The Contrectors License Law does nof apD�Y �a an owner of property who builds or improves Ihe�eon, end who tloes such work
himself or herself or through his or her own employees, provided ihat such improvemenis are not intentled or oMered for sale. If, however, the building or improvement is
sold wi�hin one year of completion. the owner-builtler will have ihe burden ot proNng ihat �e or she ditl not build or improve lor purpose of sale.). �
❑ I, es owner of the properry, am E%CLUSIVELV CON7RAC71NG WI7H LICENSED CONTRACTORS to constmct the proiect (Sec. 7044. Business and Professions
Code: The coniracbrs License L6w does not apply to en owner of property who 6uilds or Improves thereon, end who comracts for such project wiN e contrector(s)
liten5e pur5uant to Ihe Contractofs License Lews.).
❑ I em exempt under
Slgneiure: �
Owner ID venfiad by drl
Vedficatlon of Ownership
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICATION:
❑ I �ereDy certify thet no excavation five (5) or more Feet in depth into which e person Is required to descend, will ba made in wnnection with work authorized by this
pertnit, end Iliat no Duilding structure, scaHoltling, ialsework, or demolition or dsman0ing iheraol, will be more than thirty-six (36) teet �igh. (Chap. 32, Gry 2, Ar12, Sec.
341, Title B, Celitomla Atlministrai��a Code).
❑ As owner-builder, I will not empl0y enyone to do work which would require e permit Irom the Division of Indusirial Setery, es noted above, unless such person has a
pertnit to tlo such work trom ihe division.
SigneNre: Date:
Division of Industnal Salery Pertnit Number.
CEHTIFlCATE OF COMPUANCE AND A�17HOHIZATON OF ENTRV: I certify untler penalry of perjury that I heve read this application and state Ihat the infortnation given is
correct. I egree m comply with all state �aws antl clry ordlnances relating to building construction, and au�honze representatives of iha Ciry of Cosia Mesa to enter upon Ihe
ebove-described property tor inspeFt�Purposes. I agree not to occupy or allow occupancy of any building euthonzad by Ihis pe it uny� tinal inspection.
I X�____ � 2��/ b� �
Signa ure Legal Owner(s) �� Date
And/Or Aulhonzed Applicant Date
CODE 1. INSPECTIONTYPE
t818 Fixatl System Final Fire PreveO�ion
7266 Pool Spe Flnal
200 Finel Re-Rooi
201 Final Block/Releining Wall
202 Final Factory Fire Place
203
20E
Final Sign
Finel Demolition
��TE IMRIFLS
�
COpE1 INSPECTIONTVPE f�jE �,$
206 Final Mechanical
20B Finel Plumbing
210
212
220
Final Elecirical
Final Fire Prevention
Final Planning Approval
222 Final Site
250 FinalBuiltlin<yOccupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 874 PROSPECT PL
Suite No
Vicinity:
Status: ISSUED
Applied: 12/04/2002
Issued: 12/04/2002
Parcel Nunmber: 418064�3 - ISSUED BY: N-�
- � ' - , � ' . . ` - �
Applicant: JORDAN,TERESA; �; ' � ��' -
Address: 874 PROSPECT PL �� . � , � � � � � � � � � ��
� � � - , , .
. ' - ' Phane: 714-437 1349 . / t�� - \ \
COSTA MESA. CA � �. Zip: 92626 2954 �. r.,� � ���A
` _ _ - . �. �_ . � .�/ �?.�
� .:/� ', ` �.�.- . . �� �� � ` � � \ �
Owner���JORDAN MICHAELA ���� � �� ���`
�,,, � � �.�A� ._�i �
Adiiress 874 PROSPECT PL ` � ���0
�
, , /-,;; Phone: � �' � , �2
c y�
\ COSTA MESA, CA Zip':� 92626-2954 ��� -�fl ���„j/� ��
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'Contractor OWNER-BUILDER � �' � ' -� � `' ��` �
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Address: � ' - ` . � _ � _ , _ .
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� �' � � _ � ' License: 000000 � , ,
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� ' SCOPE OF PERMIT ���, �' . :• i �� ' �,
, •, 'P6UMBINT TO INCLUDE: 1 SHOWER, 1 WASH BASIN, 1 WATER�CLOSET, AND 1 WATER PIPING. ���`'�� �-•"�
� � � ,-' � REF.: B02-01577 ,,� � '
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FEE SUMMARY '
�t . _ i� i r
� � "� . AMT �"' QTY� :': - • - � AMT: �QTY -, ='d': '" � . �- AMT QTY
ISSUE FEE ' �� � $23.50 � � � Laundry Tub / Wastier _ � $0.00 0 ' � -Sump Pump. �� y i $0.00 0
Backflow irrigation� , �$0:00 . �0 � Landscape Irrigation . � =' $0.00 0 . -� Sv✓imming Pool � ,-' ! $0.00 0
BackflowPreventer �� '�$0.00�', 0�'- -� P-Trap .� . ' " $0.00 � 0 �% '�Trap'Pdriier � �i / $0.00 0
Bathtub �� �(�� $0.00 ,� 0� �� =Pressure Regulator - $0.00 -0 �- . � � Unnal �� � ` � j'�% $0.00 0
ClarifierSystem � ,�$0.00,, 0 �-� �Process.Piping_(perl0ft) $0.00� �0'� � �.�, Vacuum�Brkr-Bkflow(7-4) $0.00 0
Connect Qce,Soda,etc) �� � $0.00 -- � �0 � � Receptors - $0.00� 0. , �. � Vacuum Brkr BkFlow(5+) $0.00 0
DentalUnits �'$0:00��-, 0�� !,� . SepticTank._ $0.00 '�0 �.- �� Wash�Basini� $9.80 1
Dishwasher $0.00� .,.' 0 SewecCap for Demo ' $0.00 0� � Wash-6asin Set $0.00 0
Drain, Floor $0.00 � 0� Sewer Connect . -� $0.00 0 ' --Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 „ - Sewer Private Line ` � - $0.00 0 . : ���, �����Water Closet (Toilet) $9.80 1
Drain,Roof $0.00 0 � - Shower _ $9.80 -.,,1�� � � WaterHeater/vent g0.00 0
Drinking Fountain $0.00 0 Sink, bar � � �� $0:00 �0 � Water Piping (Inst or Rep.) $9.90 1
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and le I
required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of this permit.;
FOR INSPECTIONS CALL: (714) 7545626
2446-d6(N00)
WORKERS'COMPENSATION DECLARATON: — �
I hereby effirm untler Denfllry oi Derlury one ol Iha following declarations: �
❑ I have and will meintain a certificale of consent to sel4lnsure for workers' compensation, es provided for by section 3700 oi the Lebor Gode, tor the pertormance of the
wark for which this Dermit is issuBtl.
❑ I have entl will maintain workere' rAmpertsatlon Insurance, az required by seclion 3700 oi ihe Labor Coda, for t�e pedortnance ot Ihe work for w�ich ihis permit is issued.
My workers' wmpensatlon Insura�ce carne� end policy number ere:
Carrier. Policy Number:
(�Th/i�.secNon need not be wmplefe0 il the Dermif is velued et one hundretl tlollers ($100) or /essJ
�y I certify that in Ihe pertormance o� the work far which this permit is issued, I shall not employ eny person in eny manner so es to bec me suDject to the workere'
wmpensatlon laws oi Celitomle, end egree that if I shoultl becoma subject to the workers' compensation provislons of SecHon 37 oi the Lebor Cotle, I shall lorthwith
comply with these provisians.
ApplicantSignaiure: De�e: Z �
WARNING: FAILUFE TO SECURE WORKERS' � ATION COVEMGE IS UNIAWFUL AND SHALL SU&IECi AN EMPLOYER TO CFIMINAL PENALT S AND GVIL FINES UP TOONE HUNDRED
THOUSANDDOl1ARE�5100.000),INADD{S1CN'�TO COSTOFCOMPENSATION,DNMGEShSPROVI�EDFORINSECTION��080FTHELABORCADE,IMEREST,ANDATTORNE`fSFEES.
LICENSED CONTRACTORS DECLARAnON:
I hereby aHirtn that I em licensed under pmNsions ot Chepter 9(commencing with Section 7000) of Division 3 oi the Business and Professions Code, antl my license is in tull
brCB and BR9tt. Lla M Class k
Contracrors Signeture: Date: '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn Nat there is a con5(Nction landing agency for the pertormance of Ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Cotle). "
Lendefs Neme: Lendels Address:
Signeture: Date:
OWNER-BUILDER DECLARA710NS:
I hereby effirtn that under penalry of peflury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Prolessions
Code: Any ciry or county which requires e permit to consWct, alter, improve, demolish, or repair any structura, pnor to its issuance, also reqUires ihe applicant for such permit
to file a Signed statement Ihet he or shB is licensetl pursuenl to the Drovislons oi ihe Contractors Litense Lew (Chapter 9(commencing wiih Section 7000) of Divislon 3 ot Ihe
Business and Professions Cotle) or �ha� �e or she is exempt therefrom and iha basis lor Ihe ellegetl exemption. Any violation of Sectlon 7031.5 by flny epplicent for e Dermit
su jects the applicem to a civil penalty of not more ihan tive hundred dollars ($500).):
I, as owner of the property, or my employees with wages as their sola compensation, WILL DO 7ME WORK, and ihe siructure Is not intendetl or oHered tor sele (Sec.
7044, Business and Professions Gotle: The Conirectors License Law dces not apply to an owner of property who builds or improves ihereon, end who tloes such work
himsetl or herselt or Ihrough his or her own employees, pmvidetl that such improvements are not Intentled or oflered for sale. If, however, Ihe builtling or improvement is
soltl within one year ol completion, the ownerDuiltler will have the burden of proving ihat he or she ditl not build or improve for purposa of sale.). �
❑ I, as owner of lhe property, am EXGLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS ro construct the projecl (Sec. 7044, Business and Pmfession5
Catle: Tlie cantrec�ors License Le�+'tloes not flpply to an awner ol property who builds or improves thereon, and who contracts for such project with e contrector(s)
license oursuam to the Comracbfs License Laws.).
❑ I am exempt under sec.
Signeture: �
Owner ID venfiBd by drivefs Ike�
Yes ❑ No
Business antl Professions Cotle tor ihis reason: �
oate: TZ b2.� i
Driver'sLicenseNo. — � E ires: _�Z�
Vedficetlon of Ownership by (rype of tlo�utnent, i.e. - pmperty tac bill or deetl): —�—
DIVISION OF INDUSTRIAL SAFETY PERMIT CEH7IFICATION:
❑ I hereby certity ihet no excavatian five (5) or more teet in depih into which a person is required to descenQ will be mede in connection with wark euthorized by this
permit, and ihat no building sirucNre, scaffoftling, falsework, or demollllon or tlismantling Ihereot, will be more Men iMrty-sia (36) ieat hig�. (Chep. 32, Grp 2, Ar12, Sec.
341, lltle B, Celifomla AGminisiralive Code).
❑ As owner-Dulldar, I will not employ anyone to do work which woultl require a permit from the Division oi Indusinel Selery, es noted e6ove, unless such person hes e
permit to tlo such work from the division.
Signature: Date:
Division of Indusirial Safery Partnit Num6er:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I certity under penalty ot perjury Ihat I have read Ihis application and state that �he intormation given is
correct I agree to wmply wlth ell state laws entl city ordinances relating to Ouilding consWction, and authonze representa�ives of ihe iry of Cwta Mesa to enter upon the
ebove-descnbed property inspeCtion p� es. I agree nat to accupy or ellow occupancy of any buildinq authorized by i2p�mit un � tinal insDection.
/ I ��� D %
$i naNre Of Legal Owner(s) Date
Antl/Or Aut�orizetl Applicant Date
COOE 1. INSPECTIONT'PE
1H76 FIzeO System Final Fire Preve��ion
728fi Pool Spa Final
200 Finel Ra-Rooi
201 Flnel BIocWReWining Wall
202
203
20d
Finel FeMory FirB Place
Final Sign
Finel Demolition
Q� �[lTITIRLS
40DE� INSPECTIONTYVE
206 Final Mechanical
20B Finel Plumhing
210 Final Elecirical
212 Final Fire Prevention
22o Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAIE 1�EL$
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 874 PROSPECTPL
Suite No
Vicinity:
Parcel Number: 41806413
Applicant: JORDAN,TERESA-: �'`
Address: 874 PROSPECT PL� � �
i: � � .
,-'�;. � _ _ .
COSTA,MESA, CA,` �
`;� ��
Ownei: JORDAN, MICHAEL A .
Address' �874 PROSPECT PC � �
, � COSTA�MESA,CA
Contractoc ' OWNER-BUILDER
, � Address: , , -
� � _ � ,.
MECHANICAL PERMIT
StaWs:
Applied:
Issued:
- . _ ISSUED BY:
, � .
i �
' � Phone: 714-437-1349 � ' �' :=`�.
'/
� " Zio: 92626-2954 � � � �': " �
Phone:
ZIp: 92626-2954
;
ISSUED
1 Z04/2002
12/04/2002
�.J I �� ` �A�
_ � i :<�
� / � ��
�„��
,.\�p-������� �:\�,.
��',����./"�V �' -�. ',�`,
9 , ,
. � -Phone: " . - � .
. _�
_ . . - � Zip . . .
� - - - � License:000000 � �� _ �� � , " .
:.� �
� ` SCOPE OF PERMIT �� �� � ' ' �� � . _ • ' �
MECHANICAL TO INCLUDE: 1. VENT FAN/SINGLE DUCT.AND ADD 2�REGISTERS TO EXISTING + .- , `
HVAC. REF.: B02-01577 '� "j� ^' �� •- _ '_ " . "t ��� '> ' ' � '
f '� � ;
- .� _. __ _i.. __.___,_. ..,.�...._. � °�; . . �
� FEE SUMMARY �, �
, %
. • . Quantity - . ' ' Quantiry�` ;
� ���"' -
ISSUE FEE � $23.50' � � � -� � 'Repair %�AIGAtisorbtion Unit � /, �$0.00� 0� ' ,
Inst FAU <100 k 8TU � $0.00�� - 0 , '- -� Repair/;Alt Refrigeration Unit �� ' $0.00 0� ` ^�
InsfFAU>t00k�BTU� $0.00 ��0 � � � Ventillation�System , i,� �$0.00-�0 � '
Repair/Alt Cooling/Heat $0.00 0 EvaporativeCooler �-. $0.00 0, �%
Inst/Rep.RecessWall�Htr $0.00 0 Commeiciabincinerator , � � '% $0.00 '0 �'� '
��'� i
Refrig Sys <100 k`BTU', , $0.00 0 Domestic Incinerator � � �`��' -�$0�.00 ; � 0 �
Refrig Sys >100 k BTU � " $0.00 0 - , Compressors / Absorption Systems � �%; � -� r � :
Gas Piping�. ` $0.00 0 � • ����;; � �` -- ��-Up to 3 hp / 100 k BTU i%:- i ` $0.00 !0 � .'
Factory�Fireplace � $0.00 0 -r'��';'" ' � 3 To 75 hp / 500 k BTU /'%%�� $0.00 ' `0 �
i �.
Hood w/Mech-Exhaust� . �,$0.00 0 .. 15 To 30 lip�(-1,000 k BTU �, .� $0.00�'- .0�
VAV Box �� '� � � - '� $O.00 ,r0 <- � `' � "' 30 To 50 hp 1��,750�k�BTU" ,' ." � �� � , � � $0.00, �0
Vent Fan / Single Duct ` \ $7.25 1 - -, ` , � Over 50 hp / Over�-1,750 BTU :; -' � $0.00� � 0
Appliance '�'`` � ; � � $000� 0 ; � " ' " Boilers - �, � �,-', � i % i
Fire Dampers '���� � � $0 00�,� ;0'; - ' . Up to 3 hp � %ri� � U � � �$0.00 0
SmokeDampers . -V �� �-$0.00 0_-� � �'3To15hp � - �'���`� ����$0.00 0
Inst or Relocate AppPVent ,_ " , $0.00 � 0 - .� � �� � - 15-to 30 hp � - � � '�' � � J/ $0.00 0
Air Handlers < t0000cfm � � - - ��$0.00 - ' 0 - �- 30 to 50�hp � . � ! � $0.00 0
AirHandlers> 10000dm `���� ;� , $0.00�;�0 � Over50_hp: , -� ��� � . ,, � � $0.00 0
Floor Fumace � $0.00 � 0 � - � � Other Mechanical ��Pee ;`i� � ;
Floor or Suspend Heater �:$0.00 0 Investigation Fee� �� $0.00
- , Plan Check Fee - � - $0.00
' . - Reinspection.Fee' , - $0.00
TOTAL CALCULATED FEES $38.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. _ /;
INSPECTIONS: In order for ihe work authorizetl under this permit to be considered legal, such work must comply with all applicable
requlred Inepeetions and final approval must be obtained. Failure to o6tain inspections and final approval will result in ihe expiration of
FOR INSPECTIONS CALL: (714) 7545626
244G48 (&00)
WORKEHS'COMPENSAnON DECLARATON: — �
I hereby affirtn under penalry of perjury one ot ihe following declaretions: �
❑ I heve antl will meintaln a cedifiwte of consent to self-Insure for workers' compensation, es provitletl br by section 3700 of the Lebor Code, br ihe peAormance ot Ihe
work tor which this permit is I&sued.
❑ I have and will meinlain workers' compensation insurence, as required by section 3700 oF the Lebor Cotle, for ihe Dedortnance of the work for which this partnit is issued.
My workers' compensallon Insuranca carrier antl policy number ere: �
Cerrier: Policy Number:
(�Thi/s sectlon need not be cromplered il the permit is velueU et one hundred dollers ($100) ar less.)
� I cenity ihat in the peAormanGe of the work for which Ihis pertnit is issued, I shall not employ any person in any manner so e5 lo become subject to the workers'
wmpensation laws ol Calitorrla, en0 agrea ihet If I should become sub�ect to the workers' compensation provisions of Section 3700 I Iha Labor Cotle, I shell fort�wllh
Comply with thesb provi5ions.
ApplicantSigneWre: ` / Date: � 1–
WAflNIN�: FAILURE TO SECURE WORKERS' P S ERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL P QTI 5 AND CIVIL FlNES UP TOONE HUNDRED
THWSPND DOLLARE (5100,000). IN ADD�TIdJ TO COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR COD , IMEREST, AND ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn Ihat I am licensed untler pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Cotle, and my license Is in tull
forca and eflect. Lic. N Class M
ContrectoYs Signeture: Date:
CONSTRUCTION LENDING AGENCY: �
❑ I hereby affirm that there is a Construction lentling aqency for Ihe pertormance of the work tor which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendels Name: Lender's Address:
Signeture: Date:
OWNER-BUILDEA DECLARATONS:
I hereby affirtn that under penelry of perjury Iha� I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professlons
Code: Any ciry or counry which requires e permit m construct, alter, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicant br such permit
m file a signed statement thet he or she is licensetl pursuant ro ihe provisions ol the Contrectors License Lew (Chapter 9(commencing with Section 7000) ot Dlvision 3 oi the
Business and Prolessions Cotle) of ihat he or she is exempt therefrom and ihe basis for the alleged e:emption. Any violatlon of Sectlon 7031.5 by eny epplicant for e permil
��ects the applicant to,a civil pen9lry of not more than tive hundred dollars ($500).):
Il �� //�
I, es owner of the properry; or my employees with weges as their sole compensation, WILL DO TME WORK, and the structure Is not intendetl or oHered tor sale (Sec.
7044, Busines`s'and Professions Cotle: The Conireciors License Law does not apply to an owner of property who builds or Improves theraon, end who does such work
himself or hereelt ar through`hls or her own employees, pravided that such improvemenis are nm Intended or aHeretl for sale. If, howaver, the builtling or improvement is
sold within one yeer of compl9�ion, ihe owner-builtler will heva the burden ot proving ihat he or she tlid not build or improve for purpose ot sale.). �
❑ I, as owner of the property, arr� E%C WSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (SecJ044, Business and Professions
Code: The coniractors Licensa Lew does not apply to en owner of property who builds or improves ihereon, and who contracts for such project with e contrecbr(s)
license pursuent to the Comractors License Laws.). .
❑ I am exampt under sec. _
Signature:
Owner ID verified by tlnvefs Ilcen
Verificatlon ot Ownership by (rype
DIVISION OF INDUSTRIAL SAFET�' PERMIT CERTIFICATION:
❑ I hereby cetltly ihat no excavat�on flve (5) or more feet In depih into which e person is required to descend, will be made In connection with work authonzed by Ihis
pertnit, and Ihat no building sWCNre, swflolding, falsework, or tlemolition or dismamling thereof, will be mora then thirty-six (38) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, lltle 8, Celitornia Atlminis��ative CoOe�.
❑ As owner�builtler, I will not emp�oy enyone to tlo work which would require a pertnit from Ihe Division of Industriel Sefety, es noted ebove, unless such person �as e
permit to do such work from tne tlivlsion.
Siqnature: Date:
Division af Industrial Safary Parmit Number:
CEHTIFlCATE OF COMPLJANCE AND AUTHORIZATION OF ENiAV: I cenity untler penalry oi perjury that I have reatl this eppiication and stete ihe� �he informetion given Is
correct. I agree to wmply with all state laws entl ciry ortlinances relating to buiiding consiruction, and authonze representatives of ih Ciry ot Coste Mesa to enter upon Ihe
ebove-descnbed property for insp cfi purposes. I agree noi �o occupy or ellow occupancy ot any building authonzed by this p rmit u til final inspection.
r2 �� �� _
Sign tU�e egal Owner(s) Date
And/OlAuthorized Applicant Date
COOE �. INSPECTIONTYYE
1816 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203
204
Finel Sign
Final Demolition
PAiL IHSRIA�S
CO�Et INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plumhing
210 Final ElettnCal
212 Finel Fira Pravention
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
RdIE I�L9
�-� CITY OF COSTA MESA
° BUILpING D/VISION ��
� �
� " DEVELOPMENT SERVICES DEPARTMENT
� � PERMIT PERMIT NUMBER
��
698-01361
.(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 867 PROSPECT PL
Suite:
Vicinity:
PamelNunmber: 41806416
Applicant: TRAN, BRIAN
Address:
Owner: TRAN
Address 867,PR
v�!</j
r�l �7
Amh/Eng:
i i �..
� -R f Address:.' ' +
��±„� i ;�,il �r
�� ��� �' ' J . �
��
� !Yr . i„G
� �:
i � i `_ � f,�' �
i �i �- -i l,4const
I
�, ��=_;
BUILDING PERMIT
Zoning: R1 R1
��,ri�Phone� -� __ - '
' ;t
i,�iy�, _�Z�p �� ' �. .: •.
f/ � � r
%? , � ' ���,� /`���,
�� � � ; ' ' � ��� � �� /��
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�%/ ..- '- _ -- _..- _: _. _; � r\> i
C-!-� . _ ,
Status: ISSUED
Applied: 07/30/1998
Issued: 07/30/1998
0
/ SCOPE OF PERMIT V � ' � '''�'�
, , �� ,
� pool,and §pa -GUNITE POOL &�SPA,/���,�` � ` - .• �`\ � ! ' � � \
�, , , . r,_
. a...,=.: .. ._�a._�\'r :, r �.� ,- � , .
— � --- -- -- - -_ --_--_- -_ -- . " . . .� �
�86.7� `�v.�l-,=�_ `��^'.�,.j4is�+j�'
287.25 'i�= -�.. : _ _� _ .
� � c� yfi��.:.tA
�)
., �.__.�;,o
i � �
� --Calc Valuation: � ; � g2o,000.00
_l;_ _._
- _ _Claim Valuation:';; i- ,�-= gzo,000 00
� �' ` , � -J �n�l
, n��
. � � -? ' 1
�.i, .
�/r�j�.' r� � ; / i � � 1
� /.//: '� � , ,' ( '
�/ i; �..i �,�, %'
-�� �:�' :�'(//
;;
`� A� n �\\t� � - �, � y ;PIANNWG & ZONING ' _ =� ;% � �� n,
�A�.� �/J'� �A�.�*�.lri qC ..� ��'f% � _�" `"'�! '✓�/,_ .����
SETBACKS . • � � � � � ' � �� � `' ` � � �
V�'� � �/ A �.�-:�,�� �_� �f � i,� l ,- . � A/
\ .. � ������> � �. ' " .' � ��' , ..%/ �/, /
MAINSTRUCTURE.Front 0-0 �•� Rear 0-0'''=` �� Lek"^ 0 0�= � �Right .'0-0 �'-�
�V .-i �/, �... - c_�. , ,.,, ,� � /
ACCESSORY Front�0��0, ���,Rear 0,-0 � Left 0 0-�. �,_.� Right /0,0;�
V-:� . . � � . .
J
PARKING Existina �0�' %�-Re uired: 0- ,:���, .Proposed��- 0 '=i,-
NOTES: � . " . . . _ ..., - . - -
r *�
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable cotles, and all
required Inspections end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARA710N:
I hereby affirtn untler penalry of per�ury one of the following declaretions:
❑ I �eva end will meintein e certificate ai cansent to self-Insure for workers' compensatlon, es pmvided tor Ey section 3J00 ot the Lebor Code, for the pertortnence of the
work for which Ihis parmii i9 i5sued.
❑ I heve ena will meintein workers' compensetion insurence, es requiretl Dy seclion 3700 of the Labor Code, for ihe perfortnance of ihe wark for which this pertnit Is issued.
. My workers' compensation Insurence certler anA policy number are:
CaMer: Policy Numher:
(Thls secUon neetl not be campleted i/ Ne permlfls ve/ued et one huntlretl tlollers ($100) or /ess.)
❑ I certity ihat in lhe pertormance of the work tor which ihis pertnit is issued, I shall not employ any person in any menner so es to become subl� to the workers'
compensetion lews of Gelitomia, end egree t�at it I should become subject to the workers' campensetion provislons of Sectlon 3700 of ihe Lebor Catle, I shall Iorthwith
comply with these pravisions.
Applicent Signeture: � Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNUW FUL AND SHALL SUBJECT M! EMPLOVER TO CRIMINAL PENA�TIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND OOLI.ARE (5/00.000), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOFi IN SECTION 3]O60F THE LABOIi CODE. INTEREST, AND ATTORNEV'S FEES.
UCENSED CONTRACTORS DECLARATION:
I hereby efflrtn iha� I am licensad under provislons oi Chepter 9(commencing with Section 7000) ot DNision 3 ot Ihe Business and Professions Catle, end my license Is in full
torce end eHect. Lic. M Class N
Contrector's Signature: - Date:
CONSTRUC710N LENDING AGENCY:
❑ I hereby eifirtn that there is a consiruction lending agency tor the pedortnance of Ihe work for which this pertnit is Issued. (Sec. 3097, Civil Cotle).
Lentlefs Neme: Lender'S AOtlress:
Slgnature: Date: �
OWNER-BUILDER DECL'ARATIONS:
I hereby aRirm ihet under penelry ot per�ury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollawing reason (Sec. 7031.5, Buslneu end Professlons
Cotle: Any city or counry whic� requires a pertnit to consiruct, alter, Improve, demolis�, or repair any slruMure, prior to its Issuance, also requires ihe applicant for such pertnit
to flle e signed stetement Ihat ha or she is liiensed pursuaN to ihe D�ovisions of the Contredors License Lew (Chepter 9(commencing wit� Section 7000) of Division 3 of Ihe
Business entl Professions Code) or that he or she is exempt iherefrom end the basis for the allaged exemption. Any vlolation of Sedion 7031.5 hy any applicant for a pertnit
sub�ects the applicant to e ciWl penalry of not more ihan five huntlretl Collars ($500).):
❑ I, es owner ot ihe property, or my employees with wages as iheir sole wmpensatlon, WILL DO THE WORK, antl Ihe siructure is not intentletl or ottered for sele (Sac.
7044, Business end Protessions Cotle: The Contractors License Lew does not epply to an owner of properry who builds or improves ihereon, end who does such work
himseN or herself or Ihrou h his or har own employees, provltled thet such Improvements are not intendetl or oHeretl for sale. It, however, the builtling or Improvement Is
soltl withln one year o1 w pletion, the owner-builder will have Ihe burtlen of proving that he or she ditl not bulld or improve tor purpose of sale.).
❑ I, as owner oi the�pro , em E%CLUSIVELY CONTRAC7ING WITH LICENSE� CONTRACTORS to consiruct ihe project (Sec. 7044, Business end Professlons
Cotla: The conireQtors ic se Lew does not epply to an owner of property w�o bullds or Improvas ihereon, and who conireds for such pmject with e contrador(s)
� Ilcense pursuant tc�the on actors Licensa Laws.).
Awnerl6eritied by drivi
Verlficallon of Ownership
Business and Professions Code tor this reason:
iD3i�l
u— � .
❑ Yes ❑ No Drivefs License No. Expires:
ot document, I.e. - property ta�c bill or tleetl):
DIVISION OF INDUSTRIAL SAPETY PERMR CERTIFICATION:
❑ I hereby certify thet no excavation five (5) or more teet in depth Into which a parson Is requiretl to tlescend, will be mada in connaction with work euthonzed by ihis
pertnit, entl ihat no bulitling structure, scettolding, felsework. or tlemolition or dismantling thereaf, wlll be more then thirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, 71t1e B, Celifomla AtlministretNe Cotle).
❑ As owner-bulltler, I wlll not employ anyone to do work which would require e pertnit irom Ihe Division of Intlustrial Sefery, es notetl ebove, unless such person has a
permlt to tlo such work trom tha division.
Signature: Date:
Division of Industnel Sefery Permit Number:
COOE � INSVECTONTYVE
7818 Fizetl System Finel Fire Preveniion
1268 Pool Spa Finel
200 Finel Re-Roof
201 Finel BIocWRelaining Well
202
203
204
2d48 48
Finel Fectory Flre Plece
Finel Sign
Finel Demolitlon
� I��
G9pE2 INSPECTION TYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Eledrlcel
212 Final Fire Preventlon
220 Final Planning Approval
222 FInalSite
250 Final Builtling/Occupency
�F
c,;
§ 5-41
BUILDINGSAND STRUCTURES
CHAPTER III. PLUMSII�IG`
Secs. 5•41-5-52. Reserved.
Editor's note--Formerly, §§ 5-01�-52 provided [or the
adoption and amendment of a plumbing code tor the city. Ord.
No. 87-22, § 2, adopted Nov. 2, 1987, de]eted §§ 5-41, 5-47,
5-48, 5-50-5-52; Ord. No. 82-13, § 2(22), adopted Sept. 7,
1982, deleted § 5-42; Ord. No. 75-3, § 30, adopted Jan. 4, 1975,
repealed § 5-43-5-06, 5-09. ;prior to such deletion or repeal,
§§ 5�11-5-52 were derived from the 1960 Code, § 8300 and
the follawing:
Ord.
No. Date Sec.
358 5- 1-61
66-38 9-19-66
68-48 12- 2-68
71-15 6-21-71 2, 3
75-3 1- 4-75 8, 9
82-13 9- 7-82 2(21).
(23), (242
Secs. 5-53, 5-54. Reserved.
Editor's note�Section 11 ot Ord. No. 92-22, adopted Det.
21, 1992, repealed §§ 5-53 and 5-54. Formerly, § 5-53 peRained
to approval of permits by sanitary districts and derived from §
8300.1 oC the 1960 Code; Ord. Na. 68-5, adopted Feb. 5, 1968;
and § 2(25) of Ord. No. 82-13, adopted Sep. 7, 1982. Formerly
§ 5-54 peRained ta gas meter installation aod derived from §
2 0( Ord. No. 74-47, adopted Sep. 17, 1974.
Secs. 5•55-5-64. Reserved.
CITAPTER N SWIMMING POOLS
ARTICLE 1. GENERALLYt
Sec. 5-65. Regulations applicable.
(a) Except as provided herein, the swimming
pool code of the city shal] be the Uniform Swim-
ming Pool Code, 1994 edition, as set forth in
section 5-1 of this title.
(b) No swimming pool shall be constructed closer
than five (5) feet to any propertiy line; measured
from the waterline of the.pool.
(c) No swimming poo] shall be constructed un-
der any electrical power lines or any electric
power easement.
'Cross refereaces--Plumbing Code adopted as part of the
building code, § 5-1; water pollution regulations, § B-30 et seq.
tEditor's note-Section 2 af Ord. No. 92-30, adopted Jan.
18, 1993, amended Art. 1 ot Ch. IV to read as herein set out.
Formerly, Mt. 1 consisted of §§ 5-65 and 5-66, which pertained
� , to swimming pools generally and derived Gom § 8107 of the
- � 1960 Code and Ord. No. 68-49, adopted Dec 16, 1968.
Supp. No. 73, 1-96
§ 5-65
(d) Section 311 of the Uniform Swimming Pool
Code is hereby amended to read as follows:
Waste water from any filter, scum filter, scum
gutter, overflow, pool emptying line or similar
appazatus or appurtenance shall discharge into
an approved type receptor and subsequently into
a publ'ic sewer. The flood level rim of such recep-
tor shall be at least six (6) inches above the flood
level of the adjacent ground. Each such reeeptor
when permitted to be connected to any part of a
drainage system shall be provided with an ap-
proved three-inch trap.
(e) The following is hereby added to the Uni-
form Swimming Pool Code to read as follows:
5-5.2
(1) Every person in possession of land within
the city, either as owner, purchaser under
contract, lessee, tenant, licenses or other-
wise, upon which is situated a swimming
pool or other body of water designed, con-
structed and used for swimming, dipping
or immersion and having a depth in excess
of eighteen (18) inches, shall maintain in
good condition an enclosure, building, bar-
rier or fence of any material or design,
except as hereinafter provided, not lower
than five (5) feet in height above the sur-
face of the ground measured vertica3ly from
the outside grade and completely surround-
ing such pool or body of water.
(2) No opening between vertical members of a
wood, metal picket, stake or other fence
shall allow passa of a four-inch diameter
sphere between ��rs�. Shrubs, trees or
land cape matenals c�fu%oE be considered
as p of the barrier. C�..�, �?� �f_�
(3) Soj,t'��'.� or walls�s}aal�''rT�g,t,�cof��n
or
the
shall be prohi}jiEed„L'a8de "r1ik�
mean any metlaqclfoiiragtion-rw
tutes access to.an a"rea'siyd-,w, li
vertical; and horizontal'ineirit
providedin such a method so�i
access by climbing, crawling,
jumping from the enclosure or
pool or body of water.
(5) Where the barrier is composed of horizon-
tal and vertical members and the distance
between the tops of the horizontal mem-
bers is forty-five (45) inches or more, spac-
ing between vertical member shall not ex-
ceed four (4) inches.
(6) Dlaximum mesh' size for chainlink fences
shall be a one and one-fourth-inch square
§ 5-65
BUILDINGS AND STRUCTURES
unless the fence is provided with slats
fastened at the top or the bottom which
reduce the openings to no more than one
and three-fourths (1�/�) inches. The wire
shall be not less than nine (9) gauge.
(7) �Vhere the barrier is composed of diagonal
members, such as a lattice fence, the max-
imum opening formed by the diagonal mem-
bers shall be no more than one and three-
fourths (13/a) inches. The lattice shall be
installed to a"V" pattem. The material
shall be a minimum of one-half-inch thick-
ness.
(8) All enclosures and gates for swimming pools
shall extend to within two (2) inches of firm
soil or pavement. All access gates shall be
constructed in compliance with all require-
ments for pool fences as set forth in this
section and shall be equipped to accommo-
date a locking device. All gates or doors
opening through�a swimming pool endo-
sure shall open outwazd away from the
pool and shall be equipped with a self-
closing and self-latching device designed to
keep such door or gate securely closed at all
times when not in actual use. The unlock-
ing or unlatching device shall be located
not less than five (5) feet above, grade or
steps at the gate or door measured verti-
cally outside the enclosed areas. The re-
lease mechanism shall be located on the
pool side of the gate at least three (31
inches below the top of the gate, not less
than forty-eight (48) inches from grade on
side and outside fence and installed inside
shall be no more than forty-five (45) inches
from grade. The gate and barrier shal]
have no o�ening greater than one-half (ys)
inch within twenty-four (24) inches of the
release mechanism.
(9) Double gates installed across vehicular ac-
cess-ways , one (1) gate shall be fixed by
means of a lockable bar penetrating sleeve
by four (4) inches. Such sleeve shall be
imbedded in concrete eight (8) inches deep
and six (6) inches wide minimum. The
locking bar shall be fastened shut or lock-
able in the closed position. The openable
gate shall meet the self-closing and self-
]atching requirements of this ordinance
[section]. Pravided, however the building
o�cial may approve the following alterna-
tives:
a. The unlocking or unlatching device may
be located on the inside of the encla
sure at less than the required five (5)
feet in height when not openable from
the outside of the enclosure.
b. Self-closing and self-latching devices
may be substituted installed at fifty-
four (54) inches above the threshold.
Supp. No. 73, 1-96
§ S-6S �
(10) Where an aboveground pool structure is
used as a barrier or where the barrier is
mounted on top of the pool structure, and
the means of access is a ladder or steps,
then:
a. The ladder or steps shall be capable of
being locked, or removed to prevent
access;or
b. The ladder of steps shall be suspended
by a barrier which meets the require-
ments of subsections (1) through (10),
inclusive. When the ladder or steps are
secured, locked, or removed, any open-
ing created shall not allow the passage
of a four-inch diameter sphere.
(11) Access doors to indoor swimming pools
shall be self-closing and self-latching in
accordance with requirements of this sec-
tion. �Vhere perimeter fencing is required
in other codes, this section must provide
the equivalent protection �d require-
ments, in addition to other perimeter fenc-
ing established by other codes.
Exceptions. The building o�cial may ap-
prove the following as altematives:
a. A wall of a dwelling may only serve as
part of the barrier when doors with
direct access to the pool are equipped
with an approved alarm which pro-
duces and audible warning when the
door and its screen, if present, are
opened. The alarm shall sound contin-
uously for a minimum of thirty (30)
seconds immediately afier the door is
opened and be capable of being heard
throughout the house during normal
household activities. The alarm shall
automatically be reset under all condi-
tions. The alarm shall be equipped
with a manual means, such as touch
pad or switch to temporarily deacti-
vate the alarm for a single opening.
Such deactivation shall last not more
than fifteen (15) seconds. The deacti-
vation switch shall be located at least
sixty (60) inches above the threshold of
the door.
b. Automatic safety pool covers meeting
the standards of an approved testing
agency.
c. A pool or spa safety system which
satisfies the barrier requirements of
this section.
(12) All swimming pool and spa water shall be
maintained in a clean and sanitary condi-
tion which is free of algae, insects, and
debris. The floor of the pool shall be clearly
visible. .
(13) The provisions of this subsection shall ap-
ply to swimming pools and spas that are .
5-5.3
4 5•65
IIUILDINCS AND STRUCTURES
constructed pursuant to a building permit
issued after �July 21, 1993,] the effective
date of the ordinance (article].
(Ord. No. 92-30, § 2, 1-18-93; Ord. No. 93-12, § 2,
6•21-93; Ord. No. 95-22, § 5, 1-2-96)
Sec. 5-66. Public nuisance declared.
It is found, declared and determined that the
maintenance of a swimming pool without appro-
priate precautionary measures set forth in this
chapter shall constitute a hazard to the safety of
small children in the city and is a public nuisance.
(Ord. No. 92-30, § 2, 1-18-93; Ord. No. 93-12, § 2,
6-21-93)
Sec. 5-67. Withholdin� approval.
Plaster inspection Qr approval to fil] a swim-
ming pool with water shall be withheld by the
development services director, or his or her des-
ignee, until there has been compliance with this
chapter.
(Ord. No. 92-30, § 2, 1-18-93; Ord: No. 93-12, § 2,
6-21-93)
Sec. 5-68 Violations; discontinuing use.
Any swimming pool enclosed by a fence which
Cence does nat meet the requirements of this
chapter shall be drained immediately and shall
not be refilled until such time as the enclosure
fence is brought into compliance with all of the
provisions of this chapter.
(Ord. No. 92-30, § 2, 1-18-93; Ord. No. 93-12, § 2,
6•21-93)
' Secs, 5•69--5-73. Reserved, �
,
.� ,r -
$ 5-94
movement of buildings or structures over und
through the city's streets are necessary for the
health, safety and welfare of the public,
Further, the city council finds and declares that
when a building or structure so moved is to be
relocated or �laced on a fixed site within the
corporate limits of the city that certain problems,
conditions or requirements must be considered
and dealt with and, therefore, regulations are
hereby set forth to deal with same for the public
health, safety and welfare.
(Ord. No. 75-45, § 2, 9-16-75)
Sec. 6-94. Size, weight and load limits.
Except as provided in this chapter, no vehicle or
combination of vehicles, motorized or otherrvise,
shall�travel over, on or upon the streets of the City
of Costa Mesa exceeding the size, weight or load
requirements as set forth in the California Vehi-
cle Code, Division 15, commencing with § 35000,
as amended.
Said California Vehicle Code provisions are
hereby adopted and incorporated herein by refer-
ence and any user af the streets of the City of
Costa Mesa found to be in violation thereof shall
be guilty of a misdemeanor.
(Ord. No. 75-45, § 2, 9-16-75)
.-�
r, � �
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX-1200 COSTA MESA, CALIFORNIA 92626
3�65' 2ZI3J-79
3365 21) 3Y.79� _.
3365 OOo94474 46
1��1�4� KT�d'
,.. _t . _- � -
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely - Use Ink Only
RECEIVEDBV DATE,REGEIVED DATEISSVED
BUILDING ,r�
ADDRESS ,US �Ej '
�� � � PERMIT NO.
OWNER Fole Construction�Co. Inc. A�P•NO�
MAIL � � BUIIDING O
ADDRESS 2101 E. Fourth St. #100 ADDRESS a �
TEL. TRACT ZOS13 LOT 3 BLOCK
ciTv Santa Ana No. 543-947
CANSTRUCTION W AD A R R P
LENDER
X
BRANCH
- OWNER Fole COIIStY'I,lCt.lOIl CO. II1C.
ADDflESS ' VALUE
OR ENGINEEa �les-Iangston TEL S4%-OHE �/ $�� O•
FIflE
ADDflESS 777 S. Md711 St.� �ZOS; Orange ZONE TYPE GROUP
APPROVED
CONTRACTOR QdIIPS�D2V21OLJET BV . DATE
AODRESS � S��-'
TEL. ZONE NO.OF USE OF NEW �
CITY S�� NO.
PLAf�6 � BUILOING 'D /� h
STATE .�� CITY YARDSAPPROVED YAROSAPPROVED'
LIC. NO. IIC. NO. � MAIN BUILDING ACCESSORV BVILDING
SIZE NO.OF BLDGS. O (FROM C/l S7R�E_T) �� m� t�� �(]I
OF LOT � NOW ON LOT RONT � Fq r FT. r
useoF N�p 51 Q
EXISTING BIDG. T FT
�
Separate permits are required for ' � sioe � S FT: o Fr.
electric, plumbing and heating work. �� !
flEAR FT.a FT.
USE OF BUILDING AND WORK TO BE PEFFORMED DISTANCE BET. BET. MAIN &
MAIN BLOGS. ACCESS. BLDGS.
D2V210�IElTt of 41 single-family C URP. � APPROVED
d�tached residence units. �^PPRO ° ,3 — � 6 7
I hereby acknowletlBe thet 1 have reatl this eppllcation antl ztate OR SPE AL REOUIR�'MEN'1J '�
that Ne above information I5 correct antl agree to comply with �
m
all lews regulatln8 builtling constructlon, and I shail not employ �
eny parson in vlolatlon of the workman'a compensation laws of �
the Siete of Californlo. a� .� •
1 hereby certify that I am properly licensetl as a contractor under SQ. FT, -��� a
the Stata'of Callfornia Businass anE Profassions Cotle, Di�isian 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR m
Chapter 9, antl that such licenses ara in full force antl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempc from tha provlsions of the State of Celifornia Bus(ness iO
VALUATION PERMIT FEE E `�
and Profasslons Cotle, Divislon 3, Chap t 9. �n
��� �D • pLAN CHECK S / �� o
Slgnefura Of LL
Permittee S � TAX E � �
� V
Auffiorized Agent � TOTAL PAID E!���
�
�\'
....
F�+
C
W
CL
a
y
y
rTi
F
� 676j :�27/79
. 6�a� 3727/79� _.
.., ayzi nnnrtec�� r�e
219,.00 TU'
-2t9.oacKta
COSTA MESA BUILDING-SAFETY DEPARTMENT ' ' ' "---- -- -= la 'y
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �t�
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only qECEI V ED BV DATE RECENED
BUILDING DATE ISSVED
ADDRESS
' PERMIT NO.
OWNER A.P. NO.
MA� � BUILDING
AODRESS ADDRESS
TEL. TRACT LOT BLOCK
CITV NO.
CONSTRUCf10N W AD A P
LENDEF
BRANCN
OWNER
ADDRESS . VALUE �
ARCHITECT . TEL. S S
OR ENGINEEF
FIRE
ADDRESS ZONE TVPE GROUP
APPROVED
CONTRACTOR BV DATE
ADDHESS
TEL. Z�NE NO.OF USE OF NEW
CITV NO.
PLAILLS BUILDING
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS (FROM C/L STREET)
OF LOT NOW ON LOT R NT FT. FT.
USE OF
EXISTING BLDG ' FT
Separate permits are required for � sioe FT. FT.
electric, plumbing and heating work.
FEAR FT. FT.
USE OF BUILDING AND WOFK TO BE PEFFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACC65. BLDGS.
VAR. qlE DATE
C.U.P.,$ APPROVED
APPROVED
1 hereby eeknowled9e ihet I have raad this applieetton and rtate -
Mat Me eDove Information is eorrect entl aprae to comply with
ell laws requlating bulltling conatruction, antl 1 shall not employ
eny De�son In vlolation of Me workman's compenmtion lawe of
Me State of Californla. ,
I hereby certify that I am properly Iieensetl ae a eonttaetor undar SQ. FT.
Ma SUte of Celifornia Busineu antl Profeniona Cotla, Dlvision 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR
Chapier 9, entl that suc� Ifeensea are in full force antl affact, or 1 THE PVRPOSE OF ESTABLISHING A PERMR FEE ONLY:
em exempt trom Me Drovlsions of tha State oi Calltornia Businass VALUATION PERMIT FEE S
end Profeuions Code, Divislon 3, Chep r 9.
PLAN CHECK E
Sipnatura of�� �
Permlttee $ TAX $
Authorizad Oani �TOTALPAID E �
v�i��rt �
JOB ADDRESS
APNo. ��Q_��n_i� LOT z� TRACT �nS�Z FI
GAS
W PTER
ROUGH GLUMBiNG
PROP. SWA. LINE �� HOUSE CON. �
SPRINKLING SYSTEM
MISCELLRNEOUS
ROIIGH NERTING PNO AIR CONDITIONING
TEMPORARV SERVICE ON POLE
UNOERGROUN� � POWER �
ROUGM WIRING
TRENCHES [ FORMS STEEL REIMF
FLOOR SVSTEM
BONO BEr1M L STEEL REINFORCE �]
SNEATNING
FRAME AN� FLASMING
LATNING - IN (� OUT ❑
PUSiER, BROWN COFT
STRUCTUHAL FINRL
MEqTING, VENT., REFRIG. ANO A.C., FIN�L
PLUMBING. FIN4L ANO GAS TEST ❑
E�ECTRIC. FINAL
BWLOING, FINRL
SPECIAL REOUIREMENTS
SUBCONTRACTOR
PERMIT N0.
:'7
� J
�
-
�
y�+•1788 2/21/80 36.50 TL
I.E ; L . . . . . .
-. COSTA MESA BUILD 6AFETY DEPARTMENT APPL[Ct, ,Q FOR STRUCTURAL PERMIT
P.O. BOX 1200 WSTa MESA, CALIFORNIA 92626
RECEIVEL�V PERMIT N� 49702
For Applicant to Fill in Completely — Use Ink Only ���
.BUILOING'�� �1 �[ �S % ,{.�� A.P.NO. � O •�
ADDRESS u /� 7 /'/
BUILDING
T�ENANT RIv//�� (.. (/ �Q��hi,f - '//A ADDRE55 rOS eG
MAILING � UNIT OR
ADDRE55 .'� g' SPACE NO.
TR.N�OCI� LOT �� BLK.
CITY C�j/ h� N/ii'S A�w NOL J
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER O — ,/
(/
BRANCH
OWNER
ADDRESS - i VALUE q /
ARCHITECT � TEL USE CS{��� Lli� $/.�I (,�`
OR ENGINEER ' N .
A�ORESS � ZONE R� TVPE GROUP � 3
Q APPROVEO _ 2 �
CONTRACTOR �[J`�/ C BV DATE
ADDRESS �,�� �t
TEL.
CITY Q ��� NO. 7,�,SyDC�
STATE CITV %�PPROVEDSETBACKS
LIC. NO. � � LIC. NO.
SIZE NO.OF BLDGS. (FROM C/ RE )
OF LOT NOW ON LOT � RONT
USE OF �
EXISTING BLDG. � S � FT.
�
Separate permits are required for L SIDE i� Fr.
electric, plumbing and heating work: O I
REAR FT.
USE OF BUILDING AND WORK TO BE PERFORMED P�qNNING ACTION
�A,� a � DATE .
�/ U /v APPROVEO
� � APPFOVED r-j �7 + �
l Li /
I hereby acknowletlge that I have reatl this application and state �
that the ebove information is cor�ect and agree to comply w(th
ell laws regulating buildin8 �onstruction, and I shall not employ •
any person in violation of the workman's compensation laws oi ,
the State of Calitornia. � -
I hereby certify that I am properly licensetl es a contracior untler �� SQ. FT. � 2, �� <
the State of Califo�nia Business antl Protessions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALVATION IS FOR c
Chapter 9, antl that such licenses are in full forca antl effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the provisions of the State ot Calitornia Business V ALUATION `
PERMIT FEE $ n
antl Professions Code, Division 3, Chapt� . .�
�t�` � PLANCHECw a 2 _ ^
Signature of . // �
Permi� � �.� �/'— TAX S �'(� :
or �''� �
Authorized Agenc� Date � TOTA� PAI D S 6• SQ
N -
WILLIAMS INSULATION COMPANY
� . OF CALIFOR�NIA
, � ;
1201 E. Hunter Ave., Santa Ana; California 92705
(714) 972 9632 k
� , � THERMAL INSULA7lON CERTIFfCAT10N
r THIS IS TO CERTIFY THAT INSULATION HASBEEN INSTALLED IN CONFORMANCE WITH
� CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24 STATE
; OF CqUFORNIA, IN THE BUILDING LOCA7ED?AT: F
: �, �
s' Tract Name: )•
�' }
1 Lot No.. 37 Trect No. 10513 ; glock No.
; Street
��� �'1� City COS�A L�SA
y G
; _ . ,s �
,;� 'y �
;`, EXTERIOR WALLS: � � ;
; •
R—
Y��Mfg. Owene Cornine Thickness/Type 6"t � Value 19
��� �Ceilings: ' . � �
_ Batts: ur . �_.} R—
� Mfg. (k•nne rorning Thickness/Type'� � 'i" � Value 11
' Blown In: . .(.-_-" � ' R—
� Mfg. - Thickness/Type'j Va(ue
,' Sq. Ft.,Covered —
' Floors:
� Mf9
i
Other '
? . Mfg.
�`_General Contractor
' ` l,
No. of Bags Used _
r
i !
Thickness/Type:_'
Thickness/Type' �
Date
R—
Value
R—
Value
R—
Value