HomeMy WebLinkAbout3489 QUEENS CT - Building Permits(7ta) 75a-52�3 • Fax (7ta) �Sa-aess • www.ci.costa-mesa.c BUILDING PERMIT �� FAIH UHIVt, GVSIA MtSA, GA BZti2ti
,lobAddress: 3489 QUEENSCT
Suite:
Vicinity:
Parcel Number: 41204259
Applicant: WILLIAMS, KEVIN L
Address: 3489 QUEENS CT
COSTA MESA, CA
Own@r: WILLIAMS, KEVIN L
Address 3489 QUEENS CT
COSTA MESA, CA
Contractor:
Address:
Zip:
Arch :
Address:
Phone:
�
License:
Zoning: R1 R1
Phane: 714-557-8816
Zip: 92626
Phone:
Zip: 92626
Phone:
License:
StaWs: ISSUED
Applied: O6/17/2003
Issued: 07/31l2003
ISSUED BY: / �
Eng: SPECTRUM ENGINEERING SERVICES
Address: 14200 CULVER DR
IRVINE, CA
Phone: 94g-551-3316
License: 3555
SCOPE OF PERMIT
ADD 697 S.F. TO EXISTING TWO STORY, S.F.D. WORK TO INCIUDE: ADD NEW ENTRY WAY, REMODEL EXISTING LAUN�RY ROOM,
REMODELANDEXTENDEXISTIN6BEDROOMSANDBATHROOMS. rflr07�-BATHROOM PIILL BE ADDED TO TFE
2nd FLUOR.
4 BEDROOM, 3 1/2 BATHROOM S.F.D. WILL REMAIN WITH THE SAME AMOUNT OF BEDROOMS AND BATHROOMS. EXISTING FIXTURES
WILL BE RELOCATED.
MINOR DESIGN REVIEW NOT REQUIRED BECAUSE THE PROPERTY IS A PDR ZONE.
Plan Check: $645.94
Permit: $993.75
SMIP Res: $10.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,649.69
SETBACKS
MAIN STRUC7URE Front 20- 0
Rear 18- 0
FEE SUMMARY
PLANNING & ZONING
Left 5- 0
Calc Valuation:
Claim Valuation:
Right 5- 0
S1oo,o00.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremanis under California statutes and �elated
regulations. (Ortl. No. 92-28, § 7, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPEC710N5: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all
tequlred Inspectlo�s and flnal approval mus� be obtained. Failure lo obtain inspec�ions and final approval will resuN in the ezpiration of this permit.
'i FOR INSPECTIONS CALL: (714) 7545628
za+we �aroo)
WORKERS'COMPENSAnON DECLARAnON: � '
I hereby eXirtn under penalty of perjury one of ihe following declaretions: . ,
❑ I heve and will maintain e certificate of conseN ro self-Insure tor workers' compensetion, es provided tor by section 3700 0l iha Lebor Code, for t�e peAortnance ot the
work for which Ihis permit is issuatl.
❑ I have antl wiil meintain workers' compensetion in5urance, es roquired by section 3700 0l Ihe Labor Cotle, for Ihe pertoRnance of �he work Por which �his permi[ is issuetl.
My workers' compensatlon Insurence carner antl policy number ere:
Carrier: Policy Number:
(fhis sectian need nof be complefed i! fhe permi( is valued ef one hundred dollers ($100) or less.)
�" I certiy that in ihe pertortnance of ihe work for which this pertnit is issuetl, I shell not amploy any person in eny manner so es to bacome sublect to Ihe workers'
compensation laws of alllornia, entl egrae that If I shoultl become subjed to the workers' compensetion provisions of Sectlon 3700 of Ihe Labar Code, I shall forihwlt�
comply with these pr sions.
Applicant Signature: �� (,de`��J(��{(,�/ir�9 Dete: � � 3 1 � � 3
WARNING: FAIWRE TO SECURE WORKERS' COMPENSATIdJ COVEPAQE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDFEO
THOUSAND DOLLARE (5f 00,000�, iN ADDITION TO THE COST OF COMPENSATION, DNMAGES AS PROVIDED FOP IN SECTION 3]Ofi OF THE LABOR CAOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aMirtn that I em licensed untler provisions of C�apter 9(commencing with Section 7000) of Division 3 at the Busineu end Professions Code, entl my license is in full
brce entl effect. Lic. q Class a
Contractars SignaWre: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirtn thai there is a construction lentling agency lor iha peAormance of lhe work tor which this pertnit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn thet untler penelry ot perjury thet 1 em E%EMPT FROM TME CON7RACTORS LICENSE LAW for Ihe tollawing reason (Sec. 7031.5, Buslness end Prafessions
Cotle: My ciry or county which requires e permit ro construct, alter, improve, demolish, or repair any strucWre, pdor to its issuance, also requires the epplicant tor such permit
to file a signed statement that he or sha is Ilcensed pursuant to the pmvisions ol Ihe Cantrectors LJcense Lew (Chepier 9(commendng wiN Saction 7000) ot Division 3 oi Ihe
Business and Professions Code) or that he or she is exempt Iheretrom antl t�e basis for tha allegetl e:emption. Any violatlon oi Section 7031.5 by eny epP���ent for a pertnit
sublects ihe applicant to a civil penalry of not more Ihan five hundred dollars ($500).):
❑ I, es ownar ol ihe property, or my employees wi�h weges es thei� sole compensation, WILL DO 7ME WORK, and the structure is not intendetl or oNeretl tor sale (Sec.
7044, Business end Professions Cotle: The Contradors License Law does not apply to en owne� oi property who builds or improves thereon, and who tloes such work
hlmself ar herself or Ihrough his ar her own employees, provided ihat such improvemenis are not intentletl or oltered tor sale. If, however, the building or improvemem is
,.,/ sold within one year oi completion, ihe owner�Duiltler will heve �he burden of proving ihat he or she did no� build or improve for purpose ot sale.). �
�y I, as owner of lhe pmperty, am EXCLUSIVELV CONTRALTING WITH LICENSED CONTRACTORS lo construct tha pmjett (Sec. 70dd, Business and Professions
Cotle: lTe comrectors Llcense Law tloes not epply to an owner ol property who bullds or improves ihereon, entl who contracts for such pm�ect with a coniractor(s)
license pursuant to the Coniractors License LawsJ.
❑ I em exempt ntler sec.
Signature: ���
Owner ID venfied by dnver's license.
Venlice�ion ot Ownership by (�ype ot
Business antl Professions Code for ihis reeson:
► oate:
Ves ❑ No orivers ucense No. Expires: �
I.e. - properry �a: blll or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certity that no excavation Ilve (5) or more teet in depth into w�ich a person Is required to destenA, will Oe meda in cronneciion with work euthorized by this
pertnit, and Ihat no building sirucWre, scafloltling, falsework, or tlemolition or dismantling Ihereoi, will be more than ihiny�si: (36) feat high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Celifornla Atlminisiretive Code).
❑ As owneo-buiider, I will not employ enyone to do work which woultl require a permit Imm the Division of Intlustnal Sefety, es noted above, unless such person hes e
permit to do such work irom the division.
Signature: Date:
Division of Industrial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUfMORVJITON OF EMRY: I cenity under penelty ot perjury iha� I have read ihis epplicetion and state ihat ihe infortnation given is
correct. I ree to comply with all stete lews end ciry ordinences relating lo bullding cons�ruc�ion, entl euthoriza representetives of ihe Ciry of Costa Mesa m emer upon che
ebove-de ribed property for inspection purposes. I egree nol Io occupy or allow occupency of any building authorized by Ihis permit until final inspection.
� 1����yy�o ?(�Jl lfl"�
Signature Oi Legal Owner(s) Date
And/Or Autharizetl Applicant Dale
GOOE 1, MSPECTIONTYPE ' '
1616 Fixed System Final Fira Preventlon
1266 Pad Spe Final
200 Final Re-Rool
201 Final BIxWRetaining Wall
202
203
204
Final Pactory Fire Place
Final Sign
Final Demolition
fj�jF IMITIpLS
COOE 1 INSPELTION TYPE
206 Final Mechenical �
20B Finel Plumbing
210 Final Electrical
212 Final Fire Preventian
220 Final Planning Approvel
P� UIIII1dL$
222 Final Site � �
250 Final Building/Occupency
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF OEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: Y\) City of Costa Mesa
( ) City o( Newport Beach
( ) County of Orange
N°
4296
DisUict Receipt No.
Plan Check No. �� �C.�
' " - �-���►L���Jta������-
.,, _ �i� � . � , � '1 � � � �
. .. � �.
TracUParcel and Lot Number(s):
Loca6on ot Project:
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
CommerciaUlndustrial Project is: (Check One)
Warehouse
R8D
Movie Theater
Mini-storage
Heavy Industrial
Regional Shops
Light Industrial
_ This project is exempt because
C�% x a�.aa
x S .30
_ Motel
_ Bank
_ Neighborhood Shops
_ RacqueVHeatth
_ Hotel
Medical ORtce
O(6ce Park
To�� I 2g� u�'s
Total
Preschool
Auto Repair
Hospital
Large Office
Otfice Bldg.
Restaurant
Fast Food
This certifies that the above-named Developer/Applicant has paid school faciNty fees in comp6ance wiM Government Code sections
53080 and 65995. The Building Pemtts for this square footage in this proposed development may now be issued by your jurisdiceon.
Checks are to be made payable to NewpoA-Mesa Unified Sc
6y
AWwrhad RepreseMafive
The above representation as to square footage is true. Appticant agrees that i( it is later detemrned that such representations are not
true, then this certificate shall automatically terminate and the appr riate Cily/County shail be nod6ed ii 2Zp3/2:37 F��V4 1282.4b
� ittf�T9: a1-d1 i 7;�s
i liy„�,,
Date: � 1 13 \ 1 �3
,
0
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 3489 QUEENS CT
Suite No
Vicinity:
Parcel Nunmber: 41204259
App�icant: SPERA, TONY ,
Address: 14622 DANBOROUGH RD
TUSTIN, CA .
,
Owner: WILLIAMS, KEVIN L
Address �3489 QUEENS CT �
COSTA MESA, CA
Contrector. TONYS PLUMBING SERVICE
Address: 14622 DANBOROUGH RD
TUSTIN, CA
�
Arch / Eng : � � �
Address:
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Phone: 714-573-0234
Zip: - 92780-6710
Phane:
Zip: 92626
Phone: 714-573-0234
Zip: 92780-6710
License: 644096
Phone:
Zip:
License:
Status: ISSUED
Applied: 08/20/2003
Issued: 08/20/2003
ISSUED BY:
SCOPE OF PERMIT
ADD 697 S.F. TO EXISTING TWO STORY, S.F.D. WORK TO INCIUDE: ADD NEW ENTRY WAY, � •
REMODEL EXISTING tAUNDRY ROOM, REMODEI AND EXTEND EXISTING BEDROOMS AND BATHROOMS. A.
NEW BATHROOM WILL BE ADDED TO THE2ND FLOOR (BATHTUB, SHOWER, WASH BASIN, WATER , �
CLOSET). � � � � �- - .�
'3 BATHTUBS, 1 GAS OUTLET (1-4), 1 LAUNDRY TUB/WASHER,�3 SHOWER, 2 WqSH � '
BASINS, 1 WASH BASIN SET, 3 WATER CLOSETS. 'I WATER HEATERNENT, 1 WATER PIPING � ���
(INST/REP). , �,
REF: B03-01022 - .
AMT
$23.50
$0.00
$0.00
$29.40
50.00
$0.00
50.00
FEE SUMMARY
�TY - AMT QTY
. Laundry Tub / Washer $9.80 1
0 Landscape Irngation $0.00 0
0 P-Trap 50.00 0
3 . Pressure Regulator . $0.00 0
0 �, - Process Piping (per 10 ft) $0.00 0,
0 Receptors $0.00 ' 0
0 Septic Tank - - $0.00 0
SumpPump
Swimming Pool
Trap Pnmer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr Bkflow(5+)
Wash Basin
AMT
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
519.60
QTY
0
0
0
0
0
0
2
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiraments 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 the work authorized untler this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetlons and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration ot this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zmwe �eroo�
��
WOAKERS'COMPENSAnON DECLARAnON: �� �
1 h6rehy aXirtn untler Qenalry ot pe�ury one of the iollowl�g tlecleretia�s:
❑ I have and will meintein e certificale of consent to seN-Insure for workers' compensatlan, es praWtletl for by section 3700 ot Ihe Labor Code, for ihe pertormence of �he
wark lor which lhis permit is i95ued.
� I �ave and will maintain workers' compens6tlon insurflnce, es requlred by sectlon 3700 of �he Lebor Code, for Ihe pertortnance ol the work for whic� [nis peimit is issuetl.
My workers' compensatlon Insurence cerder end poliry number ere:
Caf�er. Policy NumDer.
fTryls sectlon need not be oomp/efed i! the permif /s ve/ued et one huiMred dW/ers ($100) or less.)
[�'I cenify Ihat in ihe peAortnance of the work for which this pertnil Is issued, I shall not employ eny pereon In any manner eo es to become subject to the workers'
j\ compensatlon laws of Celifomle, end egree ihet 11 I shoultl 6ecome suD�ect to the workers' compensatlon provisians of Seqlon 3700 of ihe Lebor CaAe, I ahall loMwlth
comply wilh these ProWsi / O 3
qppncen�ts�neture: � i/N�// IJ,I.(.�/ oate: Z G�-�0
WAWdMO: FAILURE TO SEWRE WORK PENSATION COVEFFOE IS UNUWFUL M1D SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED
THpUSAND OOLLARE (E/00,000), IN ADdTION TO THE COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SEGTION 3/W OF THE UBOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I he�eDy ettirm Ihat � am Iicensed untler provisions of Chapter 9(commencing with Section 7000) of Divislon 3 of the Business anG Professions Code, and my Ilcense is in full
tome end ettect: uc-a_ 69 ��0 9 G, c�ass� C-3 6
c�onva�orasienac�re:,ti '� � oe�� e-�n-o'3
CONSTRUCTION LENDING AGENCY:
❑ I herehy eXirm that there Is e construqion lending egency for the pedormance ol Ihe work lor w�ich Ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lendefs Adtlress:
signeture:
Date:
OWNER-BUILDER DECLARATONS:
I here6y attlrtn Ihe� under penelry of per�ury Ihat I am EICEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowinp reason (Sec. 7031.5, Buslness entl Professlons
Code: My Gry ar counry which reqNres e permit lo consWct, elter, Improve, tlemdish, or repair eny structura, prior to Its issuance, also requires �he applicent br such pertnit
ro Ole e sipned stetement �het he or she is Iicensed pursuant to the proWsions oi Ue Contreccon LJcense Lew (Chapter 9(commencing wlth Sectbn 7000) oi DMslon 3 of the
Buslness antl Professlons Cotle) or that ha or s�e is exempt Iherefrom end the basls ior the ellegeE exemptlon. Any violetlan of Sectlon 7031.5 by eny appllcant for a pertnit
sub�ects the applicent ro e cMl penalry of not more Ihan fve hundred tlollera (E500).):
❑ I, as owner of t�e pmperty, or my employees with weges es Ihelr sole compensatlon, WILL DO THE WORK, end the structure is not intentled or oflered for sale (Sec.
7044, Business antl Proles5ions Code: The Conhactors License Lew does not apply to en owne� of property who builds or improves ihereon, and who tloes such work
hlmself or hereetl or through his or her own employees, providetl thet such improvemenis ere not Inientled or oHeretl tor sale. I(, however, iha bulld��p or Improvement Is
sold within one year ot completion, the ownervbuiltler will heve the burden oi proving thet ha or sha did not build ar imOrove Por purposa of sale.). '
❑ 1, as owner ot the pmperry, em E%CLUSIVELY CONTRACTNG WITM LICENSED CONTRAC70RS b construct Ihe pro�ect (Sec. 704d, Business anE Protessions
Code: The contrectors License Law does not eppty to en owner oi properry who builds ar impmves t�ereon, end who comrects br such pro�ect with e contracmr(s)
Iicense pursuant ro the ConlreMors Licen50 LawsJ. _
❑ I em e:empl untler sec.
SlgnaNre:
Owner ID verifietl by tlrivafs Ilcen9e. Yes ❑ No
eusiness and Pwlessions Code tor thls reeson:
Vedlicetlon of Ownership by (type oi tlocument, i.e. - property ten blll ar tleed):
DIVISION OF INDUSTRIAL SAFETY VERMR CERTFICATION:
Drivels License No.
Date:
Expires:
❑ I hereby certity thet no excavatlon INe (5) o� more feet In depth Into which e person is requiretl to descen4 will be made in connectlon with work euthorizetl by this
pertnit, enC that no building struqure, scettolding, falsework, or demolition or dismantling thereol, will be more ihen thirty-siz (36) feet high. (Chap. 32, Grp 2, Ah 2, Sec.
3at, TIIIe 8, Califamia Adminlsirative Code).
� As owner-builder, I will not employ enyone to tlo work which would require a pertnit tram t�e Division of Industriel Sefery, es noted ebova, unless such person hes a
permil to do such work irom lhe tlivision.
Signature: Dale:
Divi9�a� of Industnal Safery Permil Number:
ICER'�FlCATE OF COMPLIANCE AND AUTHORVATION OF ENTRV: I certify under penelty of perjury ihat I have read this epplicatlon entl state thet the Informatlon given is I
correcl. I agree to comply with ell stete lews end ciry ordlnances releting to huilding consirudlon, en0 euthorize representatives ol the Ciry of Coste Mesa to enter upon �he
ebove-descdbed property for inspectlon purposes. I agree not to occupy or ellow occupency of eny building authorized by ihls permit until tinel inspectlon.
���Slgneture Ot Legel Owner(s)
<=i�. P
-���MNOr Authonzed Applicent
COOEL INSGECTIONTYFE PATF IIQID9Ld
1876 Fixetl System Final Fire Preventlan
1288 Pool Spa Finel
200 Finaf Re-Roat
201 FIne1 81acN/iieteininp Wall
202 Flnel Factory Fire Place
203 Final Sign
ppq Final Demo��iion
cooe� ixsvernoxme
208 Finel Mechanical
20B Final Plumbing
210 Finel Electricel
212 Finel Fire Prevention
220 Finel Planninp Approval
222 Finel Site
250 Finel Builtling/Oaupency
GAiE It�LS
�� �
(714) 754-5273 • Fax (714) 754-4856 • w�+�v.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3489 QUEENSCT
Suite No
Vicinity:
Parcel Number: 41204259
Applicant: SIMKO, SRlAN
Address: 778 NEWTON WY
COSTA MESA, CA
Owner: WILLIAMS, KEVIN L
Address: 3489 QUEENS CT
COSTA.MESA, CA
MECHANICAL PERMIT
Phone: 949 548-5665
Zip: �92627
Phone:
Zip: 92626
Contractor. ALLTEMP HEATING AND AIR CONDITIONING
Address: 778 NEWTON WY
COSTA MESA, CA
Phone: 949 548-5665
Zip: 92627
License:708775
ISSUED BY:
Status: ISSUED
Applied: 11/25/2003
Issued: 11125/2003
SCOPE OF PERMIT
ADD 697 S.F. TO EXISTING TWO STORY, S.F.D. WORK TO INCLUDE: ADD NEW ENTRY WAY,
REMODEL EXISTING LAUNDRY ROOM, REMODEL AND EXTEND EXISTING BEDROOMS AND
BATHROOMS. A NEW BATHROOM WILL BE ADDED TO THE 2ND FLOOR (BATHTUB, SHOWER, WASH
BASIN, WATER CLOSET).
REF: B03-01022. MECHANICAL TO INCLUDE: 2 FAU < 100 K BTU, 2 ALT/REPAIR OF
EXISTING DUCT WORK, 3 VENT FANS.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >700 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. R@cess Wall HU
Re(rig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
AirHandlers> 10000cfm
Floor Fumace
Floor or Suspend Heater
$23.50
$29.60
$0.00
$27.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
32175
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
�Ventillation System
Evaporative Cooler
Commercial I ncinerator
Domestic Incinerator -
Compressors / Absorption Systems
Upto3hp/100k8TU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1, 750 8TU
Boilers
Upto3hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investlgation Fee
Quantity
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$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
$0.00 0
:� ��
NO710E: Thg work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced wifhin 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTION$: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspactiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�i•.:�.��.r.vcm
WORKERS' COMPENSATION DECLARATION:
I �ereby eHirm untler penelry ot perjury one ol tha tollowing declarations:
❑ I heve and will malntain e certificate ot consent to self-Insure lor workers' compensation, as providatl for by saction 3700 of ihe Lebor Code, br the pertortnance oi Ihe
- tor which Ihis pBrtnil is issuetl.
I heve antl will meintaln workers' compensation insurance, es requiretl by section 3700 of the Lebor Code, for the peAortnance of Ihe work for whlch this pertnit is issuetl.
My workers' compensation Insurance carrler entl policy number are:
Carrier. Policy Number:
(Th/s sec(ion need nof be comp/e pe�i( is valued at one hundred dollers ($100) or /essJ
❑ I certify that in t ertortnence he work lor which �'�rmit is issued, I shall not employ any person In any manner o as to become suD�ect to tha workers'
compensa�lon s ol C Iifoy�f, and egree t shoultl become subject to the workers' compensation proWslons of action 3700 t the bor Code, I shall lorthwith
Comply wit� t�e5e pro 'aifs.
Applicent SignaWre: Date:
WARNING: FAILUqE TO S CURE WORKERS' COMPENSATION COVERApE IS UNLAWFUL AND SHALL SUBIECT rW EMPLOYER TO CRIMIN PENAL S AND CIVIL FINES UP TO IXJE MUNDRED
TMOUSAND OOLLARE (5100,000), IN AO�ITIqJ T07HE WST OF COMPENSATION, DAMAGES AS PROVIDED F-0R IN SECTION 3]OB OF THE LABOR COOE, INTEREST, AND ATfORNE1"S FEES.
LICENSED CON�ACTORS DECLARA710N:
I hereby eftirm tnat I am Ilcense0 und§�.provisions hapter 9(commencing with Section 7000) ot Divis�on 3 ot t�e Busines and ol ions Code, and my license Is in tull
larce antl eRect. Llc. q _i� 7.i% �� Class q —
Contractors Signature: T`� a Date:
CONSTRUCTION LENDING AGENCV:
❑ I herehy aNirtn that there is a construction lending aqency br the pedormance of ihe work lor which this pertnil is issued (Sec. 3097, Civil Code).
Lentlefs Name: Lentlels Address:
Signature:
Data:
OWNER-BUILDEA DECLARATIONS:
I hereby aNirm iHat under penalry of perjury Ihe� I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7037.5, Business an0 Professions
Code: Any ciry o� county which requires a permit to constmct, alter, improve, demolish, or repair any siructure, prior to its issuance, also reduires the applicant tor such pertnit
to lile e signetl s�atement Ihat �e or she is Ilcensetl pursuant to the provislans ol the Contrectors License Law (Chapter 9(rqmmencing with Sectian 7000) of DiWslon 3 of the
Business end Professions Cade) or that he ar she is exempt therefrom and the basis for the elleged exemption. Any violation af Sectlon 7031.5 by any epplicent lor e permit
subjects the appfcent to e civil penalry of not more lhen tive �undred dollers ($500).):
❑ I, es owner of Ihe properry, or my employees with wages as thair sole wmpensation, WILL DO THE WOqK, antl the structure is not intendetl or oftered lor sale (Sec.
7044, Business and Professions Code: The Conirectors License Law tloes not apply co en owner of propeny who builtls or impro�es t�ereon, and who tloes such work
himsett or perselt or through his w her own empbyees, provitletl thet such improvemeNs are not inte�etl or oflered for sale. Ii, howevar, ihe buiiding or improvamant is
soltl wi�hin one yeer of completion, ihe owner�builder will have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.). '
❑ I, as owner of the property, am E7(CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct iha project (Sec. 7044, eusiness and Professions
Cotle: Ttie �onirectors License Lew does not epply to an owner of propeny who builds or Improves ihereon, antl who contracis tor such project with a contrector(s)
license pursuant to ihe Comractors License Laws.).
❑ I em e:emp� untler sec. Business and Protessions Code lor this reason:
Signature: Date:
Owner ID verified by tlrivefs license. ❑ Ves ❑ No Dnvers License No. Expires:
Vedfication of OWnership by (typa af tlocumen�, i.e. - properry lex bill or tleed):
DIVISION OF INPUSTRIAL SAFE7Y PERMIT CER7IFICA710N:
❑ I hereby cedity Ihat no exwvation five (5) or mora taet in tlepih imo which a person is required to descenq will be made in connection with work authonzetl by ihis
pertni�, antl ihat no building structure, scattoltling, falsework, or demolition or dismantling ihereot, will be more than thirty-six (36) leet high. (Chap. 3.2, Grp 2, An 2, Sec.
341, Title e, Califomla Administrative Cotle).
❑ As owner-6uilder, I will not employ anyone to tlo work which woultl require e permit irom ihe Division of Intlustriel Sefety, as noted ebove, unleu such person hes e
pertnit to do such work tmm ihe division.
Signature: Date:
Divislon ot IadusMal Satety Pertnit Num6er.
CERTIFlCATE OF COMPLIANCE AND AI7TTIORIZA710N Of ENTRY: I certity under penalry ol perjury Ihet I heve reed ihis epplication end state Ihat ihe inlortnaHon given is
correct I egree itl comply with ell state lews end ciry ortlinances relating to huiltlinq conslruciion, end au�horize represeNatives ot ihe Gry ot Costa Mesa to entar upon the
flbove-descnbed p�operry for inspection purposes. I egree not to occupy or allow occupancy ot any building authonzed by this permit until finel inspection.
CODE �. �4kSYPE PeIE 1t�L5
7618 Fixetl Sys�em Final Fire Prevention
1288
200
201
202
203
20C
Pool Spa Final
Final Re•Roo�
Final Blo�k�Retaining Well
Final FaG�ory Fire Place
Final Sign
Final Demolition
�' 's
.�
GOpE� INSVECiIONTYPE psg �
208 Final Mec�aniwl "L-0
208
270
212
Final Plumbing
Final Electncal
Flnal Fire Preventlon
220 Finel Planning Approval
222 Final Site
250 Final Builtling/Occupancy
(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
ELECTRICAL PERMIT
Job Atldress:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
3489 QUEENS CT
41204259
MICHELLE HARRIS
1060 TULARE DR
COSTA MESA, CA
WILLIAMS, KEVIN L
Address 3489 QUEENS CT
COSTA MESA, CA
Contracror. T H ELECTRIC
Address: 1060 TUTARE DR
ISSUE FEE
Temp ssrvice test
Res. a/c package
New Res (14 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outtets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1b00a
Service over 1000a
Motors to 7 hp
Motors to 10hp
Motors lo SOhp
Motors l0 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Liqht Pkg
COSTA MESA, CA
Phone: 714.556.1790
Zip: 92626
Phone:
Zip: 92626
Phone: 714.556.1790
Zip: 92626
License: 791459
Status: ISSUED
Applied: 11/13/2003
Issued: 11/13/2003
.�,
� • �� '
SCOPE OF PERMIT
ELECTRICAL TO INCLUDE: 60 LIGHT FIXTURES, 40 OUTLETS, 35 SWITCHES, AND 7 SUB PANEL
TO 200 AMPS. REF.: B03-01022
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$51.20
$36.60
$32.95
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$30.50
$0.00
�uantity
0
0
0
60
40
35
0
0
0
0
0
0
0
0
0
0
0
1
0
FEE SUMMARY
Temp Dist System / Lighfing
Busway/t00ft
Standing Seclion
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to f00 kva/kw
..................over 100 kva/kw
Low Voltage Equipmenl
Low Volt Wiring System I Ckt
Misc. Conduit
Misc. Conductor
Cirws ( gen or ride)
Circus (mech nde or lights)
Chnstmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
So.00 0
$0.00 0
50.00 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
$0.00 0
$0.00
$0.00
$0.00
$0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, t2-27-92)
EXPIRA710N: This permit shall automatically expire antl become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable�codes, and all
requlred Inspectlons and flnel epproval must be ob�ained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828
zaae�as �eroo�
WORKERS' COMPENSATION DECLARA710N:
I hereby effirm under penelty of perjury one of �he following tleclaretions:
❑ I heve entl will maintain e certllicate ot consent to selt-Insure lor workers' compensetion, as providetl tor by seclian 3700 of Iha Labor CaOe, tor lhe peAortnance of Ihe
wark tor which this permit is issued.
❑ I �ave antl wiil ma���ain workers' compensatlon insurance, as requiretl Dy section 3700 of Ihe LeOor Code, for ihe pertortnance of t�e woAc tar wNch ihis permit L9 IssueO.
My workers' compensation Insurence carner and policy numDer ere:
Carner: Policy Number:
(This secf/on need not be comp/etetl il fhe pelmit is valued ef one hundred dollars ($100) or less.)
❑ I cenity that in th� pertortnance ol the work for which this permil is Issued, I shall not employ eny person in any menner so es to become sublect to the workers'
compensation laws of California, end egree t�at Ii I should become subject to the workere' compensatlon provisions oi Secilon 3700 of Ihe Lebor Coda, I shall forthwlth
camplywithlhes!0.� ions. ���
Applicant SigneNre: v/Y+ �L 00 yba .z � Date: I�- I3 - a 003
WARNING: FAILORE TO SEGUR WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO ONE HUNDRED
T1qUSAND DOLLARE (5100,000). IN ADDITION TO THE WST OF COMPENSATIqJ, DAM4GES AS PROVIDED FOR IN SELTION 31060F THE LABOR COOE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm ihat I am licensad under provisions of Chapt 9(commencing with Section 7000) ol Division 3 0l ihe Business entl Prolessions Code, and my license is In full
torce and ettect. Lic. x �- '% 9/�-oT 9 C. -/ n- N� C�ess a G—/ U
Contrectofs Signature: i Ul. Di_ ;___J Date: //-(-3 "J-�03
CONSTRUCTION LENOING AGENCV:
� I hereby attirm thA� ihere is a wnstruction lending agency for the pedormance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lendefs Atltlress:
Signeture:
OWNER-BUILDER OECLARATIONS:
Data:
I hereby aNirm Ihat under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business en0 Professions
Code: Any ciry or county which requires e pertnit to construct, alter, improve, demolish, or repair any structure, pnor 10 its issuence, elso requires the applicant tor Such pertnit
to tlle e signetl stateme�t ihat he or she Is Ilcensetl pursuant to ihe provislons of the Cantrecbrs Llcense Law (Chepter 9(wmmencing wlth Sectlon 7000) of Dlvlsian 3 oi the
Business and Protessio�s Cotle) w that ha or she is exempt therefrom antl lhe bas{s tor iha allaged exemp4on. Any violafion of Seclion 7031.5 6y eny epplicenl Por e pertnll
subjects tha applicant to e civil penelty ol not more than Nve hundred dollers ($500).):
❑ I, as owner of ihe property, or my emplayees with wages es t�elr sole compensation, WILL DO THE WORK, entl the structure Is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Cotla: T1�e Conirectors License Lew does not appty to an owner oi properry who builds or improves Ihereon, and who tloes such work
himself or herself a� lhrough hls or her awn employees, provitled thei such improvements ere not intendad or otteretl for sale. II, hawever, ihe building or improvement is
soltl within one year oi completion, lhe owner-builder will heve tho burden ot proving that he or she tlid not build or improve tor purpose of sale.). �
❑ I, es owner ot Ihe p�operty, am E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to constmct the pmjacl (SecJ044, Business and Professions
Cotle: The contraGiors License Lew does not apply to en owner ot propeny who builAs or Improves thereon, and who contrects lor such project with a comrector(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt untle� sec.
SignaNre:
Owner ID ventiad by dri�er's license. ❑ Yes ❑ No
Business end P�otession5 Code lor Ihis reeson:
Veritkatlon ol Ownership by (lype of documeot, i.e. - property tax 6111 or deed):
DIVISION OF INDUS7p�AL SAFETV PERMI7 CERTIFICATION:
Driver's LiCense No.
Date:
E:pires:
❑ I hereby certify iha� no eacavetion five (5) or more faet in dep�h into which e person is required to tlescentl, will be made in connection with xrork authodzed by t�is
permit, end thal no builtling structure, scaHoltling, falsework, or tlemolition or dismantling Ihereol, will he more Ihen thirry-sia (36) teet high. (Chap. 32, Grp 2, Ah 2, Sec.
341, Title B, Califomie Atlminisiretive Code).
❑ As owner-builder, I will not employ enyone to tlo work which woutd requiie a permit from the Division of Indusirial Safery, es noted ebove, unless such person has e
permit to tlo such work Irom the division.
Signature: Data:
Division ol Indusirial Sa1ary Permit Number.
CER71FlCA7E OF COMPVANCE AND AUTHORI7A710N OF EMRV: I certity under penalry of perjury thet I have reatl this epplication antl state that the iniormatlon given Is
correct. I egrae to wmply with ell state laws and ciry ordinances relating to 6uilding construction, end euthodze representatives ol Ihe Ciry ol Costa Mesa to emer upon t�e
ebove-descnbed property for inspection puryoses. I agree not to occupy or allow wcupancy of any building authorized by ihis permit until tinal inspection.
COOE 1. INSPECTONTYVE
7616 Flxetl System Final Fire Preventlon
1266 Pool Spe Finel
200 Final Re-Roof
201 FIneI BIocWRetaining Well
202 Final Fadory Fi�e Place
203 Final Sign
206 Final Demoliiion
PAIE 1I�965
COOE 1 INSPECTION TYPE
208 Finel Methanical
208 Finel Plumbing
210 Pinel Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Date
//- /3 -a-oo3
Date
PAIE 1t�Lfl
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 3489 QUEENSCT
Suite:
Vicinity:
Parcel Number: 41204259
Zoning: R1 R1
Applicant: ISLAND PACIFIC ROOFING
Address: 18193 MUIRWOOD CT
CA Phone: (714) 557-6516
F.V Zip: 92708
owner: WILLIAMS, KEVIN L
Address 3489 QUEENS CT
COSTA MESA, CA
Contracror. ISLAND PACIFIC ROOFING
Address: 18193 MUIRWOOD CT
CA
F.V
Zip: 92708
Arch :
Address:
Phone:
Zip: 92626
Phone: p74) 557-6576
License: 631472
Eng:
Address:
Status: ISSUED
Applied: 07/73/2000
Issued: 07/13/2000
ISSUED BY: L
Phone: Phone:
Zip: License: License: .
SCOPE OF PERMIT
T/OFF SHAKE APPLY 40 LB ASTM FELT UNDERLAYMENT, INSTALL CEDARLITE TILES, ICBO# 2676 AS PER ICBO "
REPORT IS STILL BEING PRINTED" I WAS GIVEN THE WEIGHT BY ONE OF ICBO STAFF AS 5.6 PSF.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$139.25
$0.70
$0.00
$0.00
$0.00
$139.95
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
s�,000.00
s�,000.00
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)
�. EJ(PIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
(or a period of 180 days.
I INSPECTIONS: In order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inepectlone end flnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754•5626
WORKERS' COMPENSATION DECLARATION:
I hereby attirm under penalry of perjury one oi ihe following tleclarations:
❑ I have antl will maintain a certificate of consent to self-Insura For workers' compensation, es providetl for by section 3700 of t�e Lebor Coda, for ihe pertormance of the
work tor which this permit is issuetl. .
�I �ave end will maintain workere' compensation insuran as required by section 3700 of Ihe Lebor Code, for the perlortnance oi the work for which this permit is issued.
My worker c pgqsatio� ,/�n�,s�u an r'e� a{�d,pplicy u er ar .� �j �G�K/')%)
Carrier. �����ElAV !\� �f'�(�,r � �. -�� � Policy Nur.pya :_ 4� � I V vV
(This secfio� not be comp/efed i! fhe Oerm�velued et ane hundred dollare ($100) or less.)
❑ I certity ihat in ihe performance i the r< which this permit is issued, I shell not employ any person in any manner so es to become suhject to the workers'
compensation laws of Cali orni d�e Ihe ' hould become subject to ihe workers' compensation provisions ot Se tion 700 of t�e Labor Cotle, I shall fonhwith
c� Y �/Gl�,�fitZ� 713 Ot�
cant SignaWre: Date:
W RNING: FAILURE T E WORKERS' COMPENSATION WVERAGE IS UNLAWFUL ANO SHALL SUBJECT AN EM YER TO CRIMINAL PE TIES ANO CIVIL FINES UP TO ONE HUNDRED
E($100,000),INADDITIONTOiHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTI EL480R DE,IMEREST,ANDATTORNEV'SFEES.
�Mirm ihat I am I�ad untler Chapter 9(commencing with Saction 7000) of
and ettect. Lia a_ . �.�rT. .. i .
Da�e:
Cotle, and my license is in full
CONSTRUCTION LEN�ING AGENCV: �---�
❑ I hereby aHirm that there is a constmction lending agency for the pedormance of Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lenders Address:
Signature:
OWNER•BUILDER DECLARATONS:
Date:
I hereby affirtn that under penalry of perjury Ihai l em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe Following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant tor such permit
to file a signetl statement Ihat �e or she is licensed pursuant to the provisions ot �he Coniractors License Law (Chapter 9(commencing with Seciion 7000) of Division 3 of the
Business antl Professions Cotle) or ihat he or s�e is e:empt iheretrom and the basis for ihe allegetl ezemption. Any violation of Section 7031.5 by any applicant for a permit
sublects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, es owner of the property, or my employees with wages as their sole compensetion, WILL DO THE WORK, and the stmcture is not intended or oHered for sala (Sec.
7044, Business and Professions Code: The Comracmrs License Law does not apply to an owner oi propetly who builds or improves thereon, and who tloes such work
himseli or herself or ihrough his or her own employees, providetl ihat such improvemenis a�e not intended or offered for sale. If, however, the building or improvement is
soltl within one year of completion, ihe owner�huilder will have Ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, es owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the prolect (Sec. 7044, Business antl Professions
Code: The contrectors License Lew does not eppiy to an owner of propeey who builds or improves thareon, and who contreds for such project with a contrector(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business antl Professions Code for this reason:
Signeture: Date:
Ownar ID varified by drivers license. ❑ Ves ❑ No Drivers License No. Expires:
Verification of Ownership by (type of tlocument, i.e. - property tax bill or deed): �
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlity ihat no excavation tive (5) or more feet in depth inlo which a person is requiretl to descend, will be matle in connection wiih work authorizetl by this
permit, and ihat no building simcture, scettolding, falsework, or demolition or dismantling Ihereof, will be more than thiny-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title e, Calitornia Atlministretive Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom ihe Division ot Indus�rial Safety, as notetl above, unless such person has a
permit to tla such work from the divisian.
Signature: Date:
Division of Indusinal Safery Permit Number:
CERTFICATE OF COMPLIANCE AND AUTTIORIZATON OF ENTRY: I certity under penalry of perjury ihat I have read this epplication and state that the information given is
correct 1 agree to comply with all state laws and cily ordinances relating to builtling construction, and authonze representatives of the City ot Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow acupancy oi eny building aulhorized by this permit until final inspection.
CODE N. INSPECTION TYPE ( / ��
�y_—
1616 Fizotl System Final Fire PreveNion
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demalition
2446-46
"=� %1300
��7 �
UATE INTITIAL �Q� INSPECTIONTVPE
. 206 Final MeChaniCal
208 Final Plumbing
210 Final Electrital
272 Final Fire Prevemion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
OpTE INTITIALS
�
�
�
�ooxRsaeaianc: 3489 QUEENS CT
ovrt,exsruueivaiavr+:WILLIAMS, KEVIN L TR
woxess:3489 QUEENS CT
COSTA MESA,CA 92626
556-4488
1PPL. Y/J W!G AO�flES4:
1NCNRELT OR El1fiNEEH:
�xcx ox �a.•s �ooxEss:
canm�crars ru�:
cam�croxs �u�wa
AOUPESS
UNi:
FLOOD: AHL38
uc. No.:
UNT:
ue/a:
ur+r:
LICENSED CONTHRGTOXS �ECLAHATION: I M1ereby aflim �Mm peiwly W perjury hw I am IcemW uMer pwieime d Cheqa B
(oommencM wnA SacYon )000) G Oivuion � d the Bus'vieu eM Pmlatims CaEe. end mY ticema u in IW lau enE Nletl.
cmuc.xo.: uc.cuss: uc.No.: EXP:
o�.: co�vm«:
OW NER Bt11LUEN OECUPATION: I hwsby dfirtn uMer penNy d perjury Ihat I un uemq han tM Comrmm Lberoe law la Ihe
Yoxiq eee.von (Seqion )W1.5 &uima enE Rdeaame Cade: AT' W a taun7 wfiid� nVuine s 0�!�X lo eamWp. dta. nWtlw.
nnd"n�, a repei erry sVuctuie, p'v W 4� wauvra, e6o reyuiras IM epplimM la wc� permil to fib e aqmd+utemam thm M w sM
n IiceruW W�e^t io iM prwivw d iM Conireaan licenae lew ICheper 9(�mend'p wG� Sed'an 1000) d Orvebn ] d t!r
Bueinen md Pralea�iom Cadel a Ihel M a ehe u naemp ihereham eM �M bem /a Ne dbped ewamqion. My videtion d Setlbn
]W �.5 tr/ mry applicw tor e permY vApea iM epplicW lo a uW pe�Wry M iM mus �han INa hueAmtl EOAen �SSWp.
❑ i.�o..,�.�ameworonr«mr.mqwee.wm.eyma.m.:.d.�v��.wiaomaw«w..nein..wnN.m�a��mdea
or Merad for eeb (Setlim ]010. Buvmuvd PMmebna CaEe�. The Cantretlon licenae lewdoea ml epplyto en owrcrd popeily
who buida a inpwes �heiean. W who Aroe �urh work IimeeM n hend «Neaqh he a!w oxn amMor�. V�+�dad ihe� vxh
impwemeNv xe rid irvaMM a dtred la eab. tl. Mwe�a. iM buildieq a inpwenam e add xi1Nn ma Y� d eampM�ian. tlr
�owiwrbuilder �.iA hm tM WNen d V^^^9 he or ahe Ek nd bWtl a impwe la �he PeVae W We).
I. a� owner W �M pWaM. em udutivNY mntred�q xn� lioeneed conVmton ro mnpriW Ihe pN� (Seeion'lOU. Bueinr� W
PrWesvane Cade:1M Comrmae Liceree lew doae nd eppy b en wner M qoperlY � b�nld� a impova �he�aan end who
mno- ta 1« md� aaea• �.M, mmemal.) �iwreea w�.uw �u u emoam.liean.. lervl.
� I em azamq wds SMion: B. 8 P.C.. br Utla eaon:
Dme: �^'^e�
I Eo hmebY �M tlW I em ewme M md udxsteM tlw xm d CeOmda IIeeM vd SdatY CaAs Setliaro 25505.255�J. eM
T559t. enE Mm I a em/ Mun dukinp oawqaru wiY / w11 (drtb one) � lo comyy wiM1 uid ams mdu end tM myu"vemem br
.�mhlaramvuctianamoCificmionhantMAi r ����.IMudemielomqvfionappfutiomenexemqlmntMea
Dme: AVd�:
WOflKEN'S CONPENS►Tdl DKL�N�PON: I herab� etNm uMer perally d psjury ar d Ns /dbwinp detlermioeu:
❑ �nanene.amaimen.mnRm.aeaueni�o.w:ewv.ro,.ake�ioomw�+m�.ew��«Ms.abnmooa�n.tmor
Code. lm iM qelamxce d tha wwk Iv w1irA Nu pamd u uswd.
� IMeeMWme'vaenr.aken'mnVa�ion'vmurum.u�N�bMSWian3)WdNalabarCOJe.br�MW��K*NtM
..o� �«.m� ma o�mn a a.�e. ur.�.�.• o�ae��, �,�� ��a wu.v m,mn«.,.:
c.m«:
Patiry Number
Rhtr eeniun �roeC mt be eandw'ed / Us w�l'a b aro hudlse edWe I%�mi n Mu.)
� 1 mlty �M1m in iM pMoemarca d �M wak br r.h'rJN th'o pamin e . I ehell M amWq erry prmn in eery memwr eo m lo
bxane wbje�f to �M Markera' mnpen+elim lew d epies Na ! I ehaJtl Eeconn abjW lo tM wo�lun'
�w w�+ w�� a seao� �oo d m. �n« cees. i w,.an �ar.an °91°i'"'�3�0'l�
Wim/ip: F�6un ro sxvn work�ri ronps�utlon cor s unlerN( �nESIWI uCNc� m nrplqw ro a1MrW pNultlp �M
c/HI nnss �p ro aw h,nWM tMuuM AMhn fsfGq N sAfllbn ro tln cwr ol wmpw�Wn �W u por1CM ror In
5«tlm 91G6 0l tln IaEorCaAr. lirtav[ ���mys foa.
CONSTFUCTION LENDINO �GENCY: I hxeEy Wum uMer peWy d perj,ry ihel ihae u e mm'udion bndiip egaic/ b tM
paAormeMe d iM xak br whirh Ne D�1 u bawE (Sepion ]08]. Ci. CI.
LENOEP'S NAME
LENOEP'S AOOFE55:
� CBILh/ �� � �1TT IWQ NOl1�CB�1011 Y1d tlBiO ��IY 1�10 B�'bY9 Y1iOf111B�1011 O WI1Bf�. ��1lOIO Ctl11VA' M\Ih BD f9Y G(d MINV IXdPWIGm
end sme laxs mWnV m dddiq muawbn erd hereby euJv¢e nn��etivm d �he dty m ws uD� iM Wma�mwioneE qopery
1arnapetlionpufpOB�ff/EVIN WILLIAMS
(515ti8.WP)
Ume: ( Z3
Whes&dd'n0 8 Sde7. GreemFde: CenmY-�GP�: Fnk-Pe�aiue: OddrvoJ-A+»aar
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 081285 PLAN CHECK NO: N
CONSTROCTION TYPE: V—N PERMIT TYPE; PLU
PERM NO: P 081285
GOVT: N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION : REPLACE WATER HEATER/SEISMICALLY STRAP SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: TPR VALVE OR APPROVED E�UALBY INSPECTOR
it*itk��r**�rxfrfr**�r�r*�r�ratx��tatit�e�t�rit�r�rxitft at*�rx��r��r�r�r�ritit*�r**x�*�it*�r*x��r�r��retitxiex��r����*��r�r���e
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT ZN FRNT: FT IN KEAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 41204259 ZNE; REF NO;
PLANNING N6'I'ES>
�
iE 1i 1E iE 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E 1E iE iE 4 iE 1E 1E IE IE 1E 1E IE 1E �IE 1h M M 1f' 1E iE ik fE IF k 1E 1E iE IE 1E 1E 1ElflE i! 1E iE 1E ik 1E 1E 1f if 1f iE IE IE i! 1! 1E 1f iE if iE i! 1E 1E iE
D E V E L O P M E N T S E R V I C E S R E(J U I R E M E N T S
ING APPROVED HY .
ILDING APPROVED BY :
ZATION:N F E E S U M M A R Y
HLDG PMT PLUMHING ELECTRIC MECHANIC
ERMIT 11.00
25Y
LAN
SSUE FEE 22.00
UILDING-DIV-> PERMIT ISSUE PLAN-CHECK
orai,s----> ii.00 z2.00 o�.00
EVENUE DIVISION TOTALS--> COLLECTED:
HLDG PMT PLUMBING ELECTRIC MECHANIC
33.00
DATE:
_ DATE:
DATE: '
�F'�1Ekif1E7fifi(�iEi6ff ffiE
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON-RES
TOTAL PAID DUE
33.00 33.00 ,00
33.00 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN-CHECK
iE 1f 1F 1f 1E iE iF iE K if if iF if 1f ik 1k K iE iF if iR iR iE iR IE K iF 1f If if 1E if 1F if if IE iE If if K if 1F if 1E iE if IE iE iF 1f if iE 1F iE iF if iE if iE IF K iF if iF 1F iF 1E iE iE IE IE 1E iF iF iE 1E if iF
I N D I V I D U A L F E E H R E A K D O W N
YPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
LU 1 WATER HEATER AND/OR VENT 11.00 11.00
END OF FEES
EXI� �E ,�
@1-23-1997/12:16 7M/f33.B2
RCPTN:81-8288932
PERMIT:081285
CONSTFUCTION AND PLANNWG P� �` SPA �
APPROVALS Permit # Date Inspector qppROVALS Pe�mit # ' Date Inspector
1. YemDora�y Electrical Service or Pole 52. Pool & Equipment Location
2, $oil Pipe•Undrgrnd. 53. Steel Reinforcament
��.�3: -EPectrical Conduit Utitity-Undrgmd. 54. Forms --
^:4'. Electrical Conduit-Undrgrnd. 55. Electricai Bonding - '
:=3:S�e� Reinforcement 56. Rough Plumbing & Pressure Test . '
•-�,-�r
6�.'.�.Iectrical UFER Grnd. 57. APPROVALTO COVER�GUNiTE .
�
=7. �footings 58. Electrical ConduirUndrgmd. �a'
= 8'. Foundation '59. Gas Pipe, L7 Undrgmd., Test ,
J 9. Water Pipe-Undrgrnd. . � 60. Backwash Lines, P�Trap, O Und�grnd,
110. Structural Fioor SYstem 61. APPROVAL TO DECK �
17. �Froperty Sewer Line & House Connectio❑ 62. Backwash & Receptor-Final
72.�_Sewer Cap , ' 63. Heater & Vent�Final �
,-73. Roof Drains � 64. Plumbing System - Final �
'74. Rough Plumbin9 y 65. Electrical-final ,
15. Rough Electrical�Conduit -., 66. Solar SYstem�Finai �
,16. Rough Electric Wiring _ 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .
18. Rough Electrical�7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heatiqg & Air Conditio,r�ip,9 �, J * l ., .� _ � F1QEw[;.EPT_REQUI[3EMEIyT .
20r,Rough Factory Fi�eplace = C> S� .� J j AP�OVA�jtS, �= Permit #� - -
21.-DuGTy, in,�-rStructuGe;: '. " " ;�: �; � .y `� � ,.; 70. �Undergrou�ld Hydro �
22. Ducis, Ventiki[ing+: � " r- ',-�`.3: a; 71, Prodttct-Piping_�Gas OOiI
23.'Gas.Pipe�,Rou�h & Test _ i= 5 • = -' � 7Z. Underqro�nd Flush � -
��.
24 �Roo7 Praming . "u �� - = x� 73. Undergrnd. Storaye Tank O Gas ❑ Oil
25. Roof Sheathing � i � k� h., `''� 74. Overhead Hyc�'o_ `
26.�7-Bat Ceiling (Struc'iural) & IGi�onocoat ,: -• i - r 79. Ory Chemical -- � J �^
27.'FramearltlFlashing� _.�� f'�' ?' ^` J6. DryStaizdpipe,,". ��. .. '�
,-_
28. Latfiin & Sidin "' -.: = r` ' - � ` . .. � � '. ` - � �". -
9_ 9� _. . K i 7Z. FIXED-SYSTfNI EWAL-
29. Insulation -'': � ; .. � �, � ' � 7�:�FIRE PREV. FINAL '., ' ". -
�
30. D�YwaIl�Wailing '; « � � :- • �;.; : „H'.EAITH DERT REQUIREMENT
- 31. Plaster Brown,Co53.: � ��T � t� ru T 79. FINA4-l_NSPECi`ION ` � �' •
r - C�'
: 32,�Electsical Power jyleier�F,inat� y Y�� � l ;,'�`' 8Q. FOOD CERTIF�4�CATE ISSUED � �
. _ _ _ _ _
_ 33:�-Fin31 Eleliri� l' �r� ! ' •, � • * � Notes: r ¢ � -
T' ^ ^ ��r I �,-. S
34.,Final Heati�g.& Atr�Conditioning' _,� ; ; � '� __ S j._,� . ` �
35.'FinaV Gas Pipe-Test= �, � � = �- t S �: ' �. I /(, - -r' '�
'k � T�! "�/�
36._Hood or�CanopYi,� - �--� +�'� `. ' f � c�i -c � - �
� �
37. �Final FaLiory Firepl'aTex . �•i' " X �, j ; � a, ^ � �-
38. Finai Plumbin = � F • �� � ~ `
9 , , � �- {. � ,n cr: .. !z
39. Water Service-Final-� ;, � � r. m � � r � � � � '
40. Gas Service�Final T + -`:• � r T; � � _ : _ -. •
- ._ �.- . � r . �
. 41. Solarpomestic�Final` `� -- � 4 cn �o _- � ^
42. Backflow Preventer.' �, ' ' ` � ;` - �� �
�ri� r. - �s � T!" -
43. Backflow Irngationr r � � : r' 'r �- • � '
�14. _ Landscape i�ri4atio� Systerr� ; � � r ` ' y : � �„ - ,,, - - , .
. _ ; - ` - <. - r -... a .
-45.:'�Ound Attenuation� � �• �-+ c; Ts; � , �- . - t
- � .-� -
46. Handicap Regula2iofis � ' . ` '� - � � - ,
's �4 -
-47.`FINAI. STRUCTURE & BUILDING f -. � � � -� �
48."FINAL PLANNINQ' °'-' , ` , " � ;.`� �
49. "Electric Release to Edison , . � �!: ;r �
•50.-GaS-Release to Southern Califoin7a Gas Ca ' " " ' - . =
51. CERTIPICATE OF OCCUPANCY - '
No Date
�
r�,T aoosess: � 4 g 5 nUEENS CT
OWNEP'SNAME: WILLIA�S REVIN L��ZG3
noosess: 3489 Q�gcNS Ci
COSTA MESA,CA 92626
FflCNIENGINEEB: � 7 1 Q� S S-I ' H H L G pEG.NO.:
aooness:
u"iT: CITY OF COSTA MESA — BUILDING FERMIT PERM NO: H 05327°
FERMZT �O: B 0532'15 PLAN CHECK NO: 02932-91 L GOUT: N SUPP: i�l
COiVSTRUCTION TYPr.; 5—N pERMIT TYPE: STR PURPOSe.: ADD
uxiT:
PEflMITTEE: HEVIN I.. wli�I,TA,�tS ( 7i�i ) 557-8816
nooness: 3489 QUEENS COURT
COSTA MESA CA 92626
LICENSEO CONTPRCTON OECIAflAflON: I hereby aflirm IAat I am licensetl untler pmvisions ol Chapter 9lcommencing wi�� Section
IODfI) ol Drvision 3 0� �he Business an� Prolessions CoOe. an0 mylicense is in lull lorce anC effecl.
CIiY LIC.: SiPTE LIC.: CIASS:
Oate: Signature:
WOflKEflS' COMPENSRTION UEClAPp7lON: I hereby atlirm Ihat I nave a cenilicate of cansent Io 5¢INnsure ar a cenifitale ol worker5'
Compen5aiion Insurance, or a cetliliee copy ihereo� (Section 3800, lab. C�.
PO�ICY NO.: E%P. ORTE:
'� Cenilietl copy is hereUy Iumis�eJ. ❑ Cenifietl coDY is filea wit� ihe ciry BuilJinp �ivision.
Oate: — - Applicant
EXEMPTION FBOM WOBREBS' fAMVENSATION DECUflATI�N: (This seciion need noi be comD�¢Ie0 i� Ihe prrmi� istor ane huntlretl �5100) ar less).
I cenify ihal in ihe pedormance of ihe work for which IhL9 oerrtul is issue0. I shall nol emDloy any person in any manner so as to become
su01e[� to t�e Warkers' Cqmpen5a1i0n L3w5 ot Cali�omia. ,
�at¢: Signalure�
NOTICE: II, a�ier making ��is EB�laralfon, you ShoulC �eCom¢ SUCI¢« �o �he WOBers' Compenution pmvisions ol tAe Labor
Cotle. yau must tort�wit� comp�Y wilh such provisions o( iN5 permil shatl be aeemeC revokeA.
CONSTPUCTION LENOING RGENCY: I �e�eby alhrm�al �here is a cons�mction IenOing agency lor Ihe pedormance o� Ihe wmk for
which Ihis permit is i:suetl �Section 3097.;Crv. C�. ,
IENDEN: ~
aooxess:
JOB DESCkIPT20N : EXTENP KITCHEN (ADD BAY WINDOW) SQ FT: 9U
CLA1M VALUE; CALC—VALUE: 2,760.00 GROUP OCC; R-3 /N,-1
COMMENTS: SMOKE Dr.T�CTOR(S) REQOIRED IN HUME.
� *��**+�*#�x�-�*��:�*���*ix �*�r��r*�*�x***��� ��c#��*�*+��R�**+����**x*�r*�*�:r�u+�� �c*ir***fi x
Z O N I N G R E Q li 3 R E M E N T S
S E T b A C K. S
------------ MAIN BUILDING ---------- -------- At:CESSORY BUILDTNG ---------
FRhiT: 20 rT TN REAR: 23 FT 6 IN FRNT: FT IN RaAR; iT IN
LEFT: 5 FT IN RGHT: 5 FT IN LHFT; iT IN RGHi; FT IN
PARHING REQ• PROV: PARCEL• 41209259 ZNE• PDRL REF NO:
PI,ANNING N6TES> 40 SQ, rT. ADDITI'ON TO EXISTIAIG Rc.S. TO EXPAh7U hZTCHEN
� .. ..
i'r 1E ie ie �"r iE 3F � 3E 3f iF iF iF �k 4E iE 3F k iE'�iE iE 14 iF iE ii ie 3F i4 iF iF iE 1E i'r iF iF �E 36 �F ir 1'r if� iE ii-iE 1f #- #:� iElE �lE 3E ii� iF if lE �E 3f 3b iF if 7F i!� f(� if iE � IF iF if k ji }{� if i^ # ii� i'r 9f
D E V E•L O' P,� E N T S E R V I C E S R E Q C7 I R E M E N T S
ZONIhG APPROVED BY` ";, �� G � DATE • OB(�6� J
DUILDING APPROV�D 3`Y �': • DATB: �
APPLICATIO� ISSUED..By. DAiE•
�IFiEie�lfiE�fiFiF3E�klE)(-iF1E1#N-�1'r%iF1ElEfe . �
... .... . . . -,� � xn�,c-ri�irlere r1r • +rx,c � �#'-iEii�iElFif N�?Eii��'r �fr wit lf�#
if3FiEifiEiEififiEl'tiflfiileiE3c3(�1i�if::ii��f3E'iF�1FM3t#1FafifiEiF%ieiEil��1't' iFifi!-3Fii�IF#c-7i1f�IhiFi6i(�ifieiFiFlE3fk�1flEiE�k3FiFi'rki6iikliiciE3ti!�iF1fN•�1E
LEGALIZAT.iON;N F E E U M M A R Y STRUCTURAL SEGN.ET?T:Y
OWNEBBUILDENOELLANR710N: I�ere�yaffirmt�atlamerempiimmt�eCantracmriSuteLic¢nseLawiort�elollowingreason BLDG PNT' PLUMBIN.('i EJ::.CTRIC MCCI-IANIC FIiiE SI�7IP/RnS ('iRAD?]VG
�Secuon 7031.5 Business and Professional Coae: Any city ol crounty which repuires a permit lo constmct. alter. impmve, aemalisA. or p ERMI T S 4, 0 �
reDair any SlruCiure, pri0r Io iis issuance, als0 reQuireS �he aDDliCani lOr 5utll permii �o �il¢ a signed 5tatemenl t�ai he/She is IicenSeO S � �
pursuan� to Ihe pmvisions ol ihe ConUacbrs' State License Law (Chapter 9(commencinq wi�� Section 7000) o� Oivision 3 al �he Business SM I P/NUN—RES
ano Pmlessions Coae� or thai he/sne is exempt Iherelrom ana the basis 1or �ne allegetl ecemption. Any violation oi Semion 7031.5 by PLAN 3 5. i 0
any apo�icanl tor a vermi� su�iecls ihe aoP�icam �o a civil penal�y ol no� more tnan �iue nwUred tlollars (5500�. j$S(IE FEE
i, as owner ol ine pmpeM ar my ¢myloyee5 witn wages as meir sote campenution, vnn ao tne work, ana ihe BUILDING—DIV—> PrRNyIT ISSUE FLAN—CHECH TOTAL PAID Di7E
❑ simnure is nai imenOeG or o��ereG lor sale (Stttion 704d, Buvness and Professional CoAe' 7�e Com2cmrs' Slaie License Law T'OTAL S--- —> 5 4. 5 0 �, � 0 3 5, 1 Q 8 9. 6 0 $ 9, fi � , � 0
a0e5 no� apply to an owner P� a pmpetly who builds ar improve5 ihefeon. anA wAo OoeS Suth work Oimsel�l�¢rsel� Or lhmuq� • _ - �
his or h¢r own ¢m010yee5, p�Ovitled �ha� 5uth imprOv¢menl5 are nol inlenAea Or O��ered IOr Sale. I�, how¢v¢r Ihe builtling ot �
im0�ovement is solU vnl�m One year ol completion. i�e owner vnll have iAe burEen ol pmving �e/she Oitl not bui10 or impwve R r.0 $NU$ D'1 �1I $ ION TOT�:I,S--> COI�,LEC'1'iD • $ 9. 6(i' OVER /Si-TORT •' 0 0
io�meo��ooseoiuiel. BLDG PMT PLUMbZNU" ^LECTRIC MECHANIC FIRE SM1P/TOT GRADING PLAN—CH:CR
�. as owner o� ine PmPeny, am e�crosiveiy contracting wi�� licensetl conVactors �o Cons�mct Ihe pmlect (Section 70aA, Business 5 9� � � , . 50 . 3 5, 10
m antl Pm�essions Code', IDe Gontrac�ors' Staie License Law does not aOPM lo an ownerof pmperry wha builAs or impmves Ihereon �
andw�aconlratlslarSUchProle��swithaton(raClor�s)lit¢nseOursUantlolheLonfraCiorS'SialeLiCenseLaw�.Iamaware {(�iEii3'tiF3faFifiE�E1Fi(�#F1F{p1f)F{pI61E{pif{(�{t*j(k�if�iblei6Y.�1!'kiF1F7F�1Fi(�lE�(�fei�3fiFiF�kii{f1@ii�y�V..{(.{i..)(..µ3(.�{(.{F{(..k.{p{r.�.*�.**{�.�.*.*.��.�.*.y.
mat oroo� oi meir workers Compensaiian insurance snowd �e om�idea to me. 1 N D I L7 I D T3 Fl L F$ Y. B FZ E A K I) (J W IV
� I am ecem0� unAer Section: B. 8 P. C. �
mnnrs�eamre /� - p/� _�� 7'yPE QTY D c. S C R I P T I Q �, UNIT COST TOTAL C051
Dai . Ov ie' / I/_��,� ���' i' .
5FR 40 DWE;�TYPE V—WOOD rRAN.E —GOOD 69.00 2,760,00
I Oo �ere�y cetlily It� I am aware ol anE understantl the r¢quirement5 af Calitomia Heallh 3nd Safeiy CoOe Seclion525505, 25533, antl ' �jVD �t F: ..r.
255JA and Iha� I or any lutwe buil0ing occupant will/will noi (circle one) neetl b comply wi�n said slale cotles antl Ihe requiremenls lor a �� ,
permit for conslrudion or motlilicali0n Irom �he Air Oualiiy Managemenl Oistricl. Resitlential conslmctian applications are exempt �mm � Y /�. -
Inese pmvisions. j3 � !� � p.,
!{ lJ
r Date: AOPlicanL
� 1 hereuy cenify �nat I nave reaa �his a0ulication ana s�ate �nat ihe aDove intormation is correct. I agree ta compy witA all tity ann counry
� or0inantesanes�atelavrsrela�ing�abudaingcorrs�mctianan0�ereEyaulhorrzereDresen�ativesollNscilyioenterupon�heabove�mentianetl
� Oroperiy lor -nspeclion p oses /� �
, �aie' Signa�m�--e�J����V✓.���1
� I orivei�sLicense�Soaa�Securiryd: .
tfi4b<6 W�ne—Bmltling�, Green�Coae Enbrcement: Canary—AOPlicanl: Pink—Ro�enue; Golaenro0—Assessor
J_ _ ' _'_—_ __ _ —..—. . . _ . .
i`� lplete fnsNections .' /
L�Bt! ���� S�gs .'�:L�� (/
!
i ' 1 iJ��]�:_f.. �� i�.C:l r�.�� ' .. •/
� rA��� ��+1�•��;1 �I`y�: jy��•�'/
�CONSTRUCTION AND PLANNING � P��PA
APPROVALS Permit # Oate Inspector p�ppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utifity�Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 9�6-Cf� �t,v� 56. Rough Plumbing & Pressure Test
- 6. Electriwl UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings y��q{ �lt..� 58. Electrical Conduit�Undrgrnd.
8. Foundation Gfzv(j_C.�l � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Hea[er & Vent-Final
13. Roof Drains 64. Piumbing System - Final
14. Rough Plumbing 65. Electrical-Finai
15. Rough Electrical�Conduit 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepface APPpOVALS Permit #
21. DuCts, in Struaure' 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ��G� �(,��%' 74. Overhead Hydio
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27: frame and Flashing `j.,�� ��jGV�L 76. Dry Standpipe -
28. Lathing & Siding 3�-�j, (Q(i'� 77, FIXED SYSTEM FINAL
29. Insulation �;Z(T..� �(N- 8. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �� �� �
31. Plaster Brown Coat „ 79. FINAL INSPECTION
32. Electrical Power MeterFinal i� 80. FOOD CERTIFICATE ISSUED -, ,
33. Final Electric � Notes: Z.- �
l l7- �( � � ���'
34. Final Heating & F.ir Conditioning ;
�
35. Final Gas Pipe�Test � '
36. Hood or Canopy • �.}
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irrigation System a
45. Sound Attenuation
46. Handican Regulations - ' �-��a
. ��r�_� ' •F.C,t1011S
47. FINAL STRUCTURE & BUILDING - �
46. FINAL PLANNING �te __ -�- -
49. Eiectric Release to Edison
50. Gas Release to Southern California Gas Cn ' �
51. CERTIFICATEOFOCCUPANCY
No. Date