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Home My WebLink About3492 QUEENS CT - Building Permits(714) 754-5$73 • Fax (714) 754-4856 • www.ci.costa-mesa��MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lobAddress: 3492 QUEENS CT Suite No Vicinity: FRONT YARD Parcel Nunmber: 412042fi9 Appticant: MACIEL, RICHARD Address: PO BOX 1017 GARDEN GROVE, CA owner: GRAYELI,SAM HOMAYOUN, Address 34924UEENSCT COSTA MESA, CA � Phone: 800-840-2637 Zip: 92642 � Phone: 714-966-9936 Zip: 92626 Contractor: A AMES PLUMBING, HEAT, AC Address: 9971 LARSONAVE Phone: 714-530-2440 GARDEN GROVE, CA Zip: 92644 License: 250307 � SCOPE OF PERMIT PLUMBING PERMIT TO REPAIR/REPLACE WATER MAIN FOR A SFD. WORK TO INCLUDE: 1 WATER PIPE INST OR REP ISSUED BY: Status: ISSUED Applied: 04/19/2007 Issued: 04/79/2007 FEE SUMMARY . AMT QTY AMT � AMT � QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 BackFlow irrigation $0.00 0 I.andscape lrrigation 50.00 0 Swimming Pool $0.00 D BackOow Preventer $0.00 0 P-Trap - $0.00 0 Trap Primer 50.00 0 Bathtub $0.00 0 Pressure Regulator - $0.00 0 Urinal $0.00 0 ' Clarifier System $0.00 0 Process Piping (per 10 fl) 50.00 0 Vacuum Brkr Bkilow(1-4) 50.00 0 Connect pCe,Soda,etc) $0.00 0 Receptors 50.00 0 Vacuum Brkr Bkflow(5+) 50.00 0 Dental Units $0.00 0 Septic Tank , 50.00 0 Wash Basin 50.00 0 Dishwasher $0.00 0 Sewer Cap for Demo 50.00 -0 Wash Basin Set 30.00 0 Drain, Floar $0.00 0 Sewer Connect $0.00 0 Waste and Vent Syslem 50.00 0 Drain, Rairywater $0.00 0 Sewer Private Line 50.00 0 Water Closet (Toilet) 50.00 0 ' Drain,Roof $0.00 0 Shower $0.00 0 WaterHeater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 . 0 Water Pipin9 (Inst or Rep.) 59.80 1 Expansion Tank $0.00 0 Sink, commercial $0.00 � 0 Water Re-pipe � 50.00 0 Gas Earthquake Valve $0.00 0, <- Sink, Floor . $0.00 , 0. Waler Service 50.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen 30.00 0 Water Softener $0.00 0 Gas (Over4 outlets) . $0.00 0 Sink, service/mop $0.00 0 OTHER 50.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION 50.00 Gas Service $0.00 0 Spa (public) 50.00 0 PLAN CHECK . 50.00 Interceptors (Grease, Oiq �$0.00 0 , REINSPECTION $0.00 0 Interceptors (Sand Auto ) 50.00 . 0 TOTAL CALCULATED FEES: 533.30 COMMENTS / SPECIAL CONDITIONS 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, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commencetl 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 consitlered legal, such work must comply with all applicable cotles, and all required inepeetione end 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 2a4&d6 (NW) WORKERS'COMPENSAnON DECLARAnON: I hereby eNlrtn under penalry of per�ury one of ihe tollowing decleretions: ❑ I�heve entl will malnteln e cenitiwte oi wnsent to salf-Insure for warkers' compensetlon, es providetl tor by section 3700 of the Lebor Cade, Por the peAormence of the work tor wNc� t�is perml� is Issuetl. �I.have end will meinlain workers' compensatlon insurance, as required by sectlon 3700 of ihe Labor Code, tor Ne peAortnence of the work tor which ihis pertnit Is issued. ' My workere' compensatlon Insurence wrrier flnd poliry number are: �� Policy Number. i5 �e�y ^ Z�n % or less.) ❑ I certity t�et in ihe perform� o op for which this permit is sqed, I shell nol employ any person In any manner so es to become su6ject to the workero' compensetlon lews oi ellloml a tl (e t�et �H I ysh �eco e s dJect to the workers' wmpensation pmvisions of Sectlon 3700 af the Lebor Code, I shell forthwith comply with these pr slon �P�� S�e��re �� / ` Ge� % y- � � -v � �IN�i FAIWRE TO FE WORKERS' CAMPENSATIIXJ COVEMOE IS UNLAWFUL PND SFI�LL SUBIECT AN EMPLOYER TO CRIMINAL PENPLTIES AND GVIL FlNES UP TOONE HUNORED TIIIXISAND DOLURE (5100,000�, IN AUOITION TO iHE COST OF COMPENSAiION, DAM4GE5 AS PiiOVIDED FOR IN SECfION 31O60F THE I.ABOR COOE, IMEREST, AND ATTOFiNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am Ilcensed under provisions ot Chapter 9(commencing with S i 7000) of Division 3 ot ihe Business and Profassions Code, end my license Is in full farce.and�ettecl-Cic.—H'Y 2SO�X)-�"1/) � �I�assii--��(•/J � , . �__.. wr,� Aontrector's�Slgnalure:� i il �"l �ate:f� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm thel Ihera is a conswction lending agency for the peAortnance ol �he work lor which this pertnit is issued (Sec. 3097, Civil Catle). Lender's Neme: Lendefs Address: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn thflt untler penalry ot perjury that I am EXEMPT FROM T1E CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business entl Professlons Code: My ciry ar counry which requires e pertnit to conslrucL alter, improve, demolish, or repair eny strucWre, prior to its issuance, elso requires Ihe eppllwN for such pertnit to file e signed statement thet he or sha Is Ilcensetl pursuant to the provislons ol the Contrectorg License Lew (Chepter 9(commendng with SeUlon 7000) of DlWsion 3 of Ihe Business end Professions Code) or that he or she is ezampt theretrom antl t�e basls for the elleged eaemptian. Any violation oi Section 7031.5 Dy eny epplicent for a pertnit subjects the epplicant to e civil penelry at not more Ihan live hundred tlollars ($500) J: ❑ I, as owner of Ihe D�operty, or my employaes with wages es Ihelr sole compensation, WILL DO 7HE WORK, and ihe structure is not intentletl or oNereC lor sala (Sec. 7044, Business antl Proteuions Code: The Contractors License Lew does not epply to an owner ot Droperty who builds or improves therem, and who Ooes such work �imselt or herselt or through his or �er own employees, pmNded that such improvements are not inten0ed or oflered tor ule. If, hawever, Ne bulltling or improvemant is sold within one yeer of completion, the owner-builder will have ihe burden ol proving that he or she Citl not build or improve tor purpose ot sele.). ' ❑ I, es owner of the properry, em EXCLUSIVELV CONTRACTNG WITH LICENSED GONTRACTORS to construct the prolect (Sec. 7044, Business and Professions Cotle: The coniractors Llcense lew does not apply ro en owner ot propeny who builds or Improves thereon, antl who contrects for such pro�act wlth e contractor(5) license pursuent ro Ihe Contrecbrs License Laws.). ❑ I am exempt untler sec. Business end Professions Coda tor Ihis reason: Signeture: Dete: Owner ID verifietl Dy tlnvar's license. ❑ Ves ❑ No Driver'S liCense No. Expire5: Venlication ol Ownership by (type ol document, i.e. - property ta: blil or deed): DIVISION OF INDUSTRIAL SAFETV VERMI7 CER7IFICATON: ❑ I hereby certify thet no excavetlon tive (5) or more feet in depih into which e person is required to descend, will be made in connectlon with work euthorized by this pertnit, end that no builtling struc�ure, scaHolding, falsework, or demolition or dismantling lhareol, will be more then thirty-six (36) feet hig�. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title B, Celitomie Atlministrative Code). ❑ As owner-builder, I will no1 emplay anyane to do work which would require a permit from ihe Division oi Indusinel Setery, es noted above, unless such person has e pertnit to do such work trom the division. Signature: Date: Division ot Intlustrial Salety Permit Number. ICERTIFlCATE OF COMPLIANCE AND AUTMORIZATtON OF EMRY: I cenity under penelry of perjury that I have read this epplication and state thet the Iniortnation given is I correct. I agree to comply with ell state laws end ciry ortlinances ralating to bulltling constmctlon, entl authorize representatives of the Clty of Coste Mese to enter upon the ebove-described propeny lor inspection puryoses. I agree not to occupy or ellow occupency^f eny building au�horized by this permil until finel inspectlon. CODE�, INSPECTONTYPE 1616 FIxeG System Final Fire Prevention 1268 Pool Spe Final 200 Flnel Re-Roof 207 Final BIocWRetaining Well 202 Finel Factory Fire Place 203 Finel Sign 204 Final Demolition p� �$ COpE� INSPECf10N7YPE 206 Final Mechanical 20B 210 272 220 222 250 L/-�C� v� �--oaia �. Finel Plumbing Final Electrical Final Fire Preventlon Final Planning Appmval Final Site Final 8uilding/Occupency Pdg 1N��L3 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT dobAddress: 3492 QUEENSCT Suite: Viciniry: Parcel Number: 41204269 � � � Applirank SELL, RON AddresS: 18032 LEMON YORBA LINDA , CA Owner: HODGES, MARILYN M Address 3492 QUEENS CT COSTA MESA, CA Contractor. SELL ROOFING COMPANY Address: 18032 LEMON YORBA LINDA , CA Zip; 92686 Arch : Address: Zoning: R1 R1 Phone: (774) 52&1758 Zip: 92686 Phone: 2ip: 92626 Phone: (714)528-1758 License: 323842 Eng: Address: �SSUED BY: Status: ISSUED Applied: 09/17/2002 Issued: 09/17/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE SHAKE INSTALL OSB COVER WITH EAGLELITE TILE. ICBO 4660 Plan Check: $0.00 Permit: $167.25 SMIP Res: $0.89 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.14 SETBACK$ MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Lek 0. 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0• 0 Right 0- 0 $a,soo.00 $8,900.00 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiraments under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIHATION: This permit shall automatically ezpire and become void if work Is not commenced within 180 days, or il work is suspended or abandoned for a perfod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabl9 codea, and all requlred Inspeetloha and final epproval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this pertnit. FOR INSPECTION$ CALL: (714) 7545626 wo+a 1aw� WORKERS'COMPENSAnON DECLARAnON: _ 1 hereby aflirm under penelty of perjury one of the tollowing tleclarellons: ❑ I have and will maintein a certllicate of cansem to setl-Insure for workers' compensatlon, as provide8 bi by seStlon 3700 of the Lebor Code, br the perlormance ot the work for which this pertnit Is issued. ❑ I �ave an0 will maintaln workers' compensation InSur nca, as requiretl Dy sectlon 3700 of Ne LeDor Cotle, for the pertortnance M Ihe work lor which Ihis permit is issuetl. My workers' compe%�_�s� �tlon I _surencerc�`r1wr entl Icy number are: /J / � Cerrier. �/�C(Q / /� Policy Number. �v �C.� � � (This section need not4fe comp/ered il (A�alued ef one hundred dWlers (S I00) or IessJ ❑ I certily that in the peAartnance oi Ihe work for which ihis pertnit Is issueq I shell not employ eny person in any manner so as to become sub�ect to tha workers' compensatlon laws of Celilomla, entl egre et il l should Eec e sub I lo the warkere' compensatlon provisions of Seciion 3700 of the Labar Catle I shall forlhwlth Comply wi�h these provisions. � ^ _ I^ /1� Applicant SignaNre: �L Date: �� ( ' �J WARNING: FAILURE TO SECUHE WORKERS' PENSATION COVEMGE IS U WFUL AND SHAl1 SUBJECT AN EMPIOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED TNOUSPND DOLLAPE (5100.000), IN AD�ITION TO THE COST OF COMPENSATIIXJ, ONAAGES AS PROVIUED F-0R IN SECTION 3108 OF THE IABOR CODE, INfEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLAHA710N: I hereby atfirm that I em licensed force and eHect. Lic. q ContractoYs Signature: _ B(commencing with Sectlon 7000) of Division 3 oi t�e Busineu entl P�t`ui� C,qtle, end my license is in full � C1859 M 7 oate: / 1 � 1 �1 �h�— CONSTRUCTON LENDING AGENCV: ❑ I hereby aMirtn Ihat there is a consWction lending egency lor the pertormance ol lhe work lor which Ihis permit is iuued. (Sec. 3097, Civil Cotle). Lentlefs Name: Lentlels Address: Signeiure: Date: OWNER•BUILDER DECLARATONS: I hereby attirm that untler penalry oi perjury Ihet I am EXEMPT FROM 7ME CON7RACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business anO Protessions Code: Any city or counry which requires e permit to construct, alter, Improva, demolish, or repeir eny siructure, prior ta its issuanca, elso requires t�e applicflnt br such permit to iile e signetl stetement tha� he or she Is Ilcensed pureuent ro the proWsions of the Conirectors License Law (Chepter B(commendng with SecUon 7000) of Division 3 at Ne Business antl Pmfessions Cotle) or thet �e or she is e:empt therelrom end tha besis for the elleged eaemptian. Any violation of Section 7031.5 by any applicent for e pertnit subjects ihe epplicant to e civil penelry of nat mare than live huntlretl dollers ($500)J: ❑ I, es owner of ihe propany, or my employees with we9es as thelr sole compensatlon, WILL DO THE WORK, end iha struc�ure is not Intendad or oHeretl tor sale (Sec. 7044, Business and Professions CaAe: Tha Contrectore License lew does not epply ta an owner of property who builds or improves ihereon, and who tloes such wark himself or hersalt or Ihrough his or her awn emplayees, provitletl iha� such Improvemenls ere not Intentled or otfered for sale. Ii, however, ihe building or improvement is sold within one year oi completion, ihe owner-builder will heve the burtlen oi proving ihat he or she diA not builtl or improve for purpose of sale.). ❑ I, es owner of tha property, am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business antl Prolessions Code: The camractors Llcense Lew does not apply lo en owner ol property who builds or Improves Ihereon, antl who coniracls for such project wlth a contractoqs) licen5e pursuant to ihe Con�rectors License Laws.). ❑ I am e:empt under sec. Business entl Professions Cotle for �hls reason: SlgnaNre: Date: Owner ID veniietl by dnver'S Ilcense. ❑ Ves � No DAver's License No. Expires: Venflcalion of Ownership by (type ol doCumeni, i.6. - prOpetly �ex blll or tleatl): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certify thet no excavetlon flve (5) or more feel In depih into which e person Is requiretl Io tlescenQ will be made In connecilon wlth work euthadzed by lhis permit, antl that no building strucWre, scaHolding, talsework, or demolilion or dismamling thereof, will be more than t�irty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Californle Adminisiretive Code). ❑ As owner-builder, I will not employ enyone to do work which wauld require e permit trom the Divislon ot Industriel Setety, es nated abave, unless such person hes a permlllo tlo such work irom the division. Signature: Date: Division of Intlustrial Sefety Permit Number. CERTFICATE OF COMPIIANCE AND AUTHORIZATON OF ENTRY: I cenity under penalry of perjury Ihat I have read this application and state that the intortnation given is correct. I agree lo wmpty with all state lews end dry ordinences relatlng to Duiltling constructian, antl authonze representatives of Ihe Ciry of Costa Mesa to enter upon Ihe above-descnhed property for inspecfion purposes. I agree noI to occupy or ellow occupancy of eny building authorized by this permil until final inspec�ion. Signet I egal Owner( �� I�te Oi/i � An r Authoriz Applicant � Date COUE �. INSPECTIONTYPE 1816 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Finel Re-Roof Flnel Blxk/Retelning Well Final Fectory Fire Plece Finel Sign Finel Demolition �. 1 .1111. . G� � i . COOE� INSPELTONTYiE 208 Final Mechanical 20B Final Plum6ing 210 Final Elec�ncal 212 Finel Fire Prevention 220 Finel Planning Approval 222 Finel Site 250 Finel Builtling/Occupancy PAg ItIDIlEL6 Job Address: Suite No Vicinity: 3492 QUEENS CT Parcel Number: 41204269 Applicant: WHITE, BRIAN Address: 9911 LARSON AV GARDEN GROVE , CA Owner: HODGES, MARILYN M Address: 3492 QUEENS CT COSTA MESA, CA MECHANICAL PERMIT ISSUED BY: Phone: (714) 530.2440 Zip: 92&02 Phone: Zip: 92626 Contraaor. A-AMES PLUMBING & HEATING Address: 9911 LARSON AV Arch I Eng : Address: GARDEN GROVE . CA FAU CHANGEOUT ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >700 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 < t0000cfm AirHandlers> t0000cfrn Floor Furnace Floor or Suspend Heater $23.50 $14.80 so.00 $0.00 so.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 Quantiry i 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Phone: (714) 530-2440 Zip: 92842 License: 250307 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY Repair I Alt Absorbtion Unit Repair I Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial I n cine retor Domestic Incineraror Compressors / Absorption SYstems Up to 3 hp I 100 k BTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CAI.CULATED FEES COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 12/08I2000 Issued: t?J082000 Quantity $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 50.00 0 30.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 so.00 0 50.00 0 so.00 0 $0.00 50.00 50.00 538.30 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: 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 1 BO days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicabl¢ codes, and all requlred Inspections and tinal approvel must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 20484818100) WORKERS' COMPENSATON DECLARATON: �� I hereby attirm under penalry of perjury one of the followinq dedarations: ❑/I 17Ave antl will maintain a certificate of consent to sell-Insure for workers' compensation, as pmvitletl for by sectlon 3700 of the Lebor Code, for the pedortnenca ot the ,�\ /� yhrk for which lhis pertnit is issueA. pemVt � I certity ihat insurance, � rnmplY with these proWsio Applicant Signetu7e: � � WARNINCi:FAILURETOSECUREwORK ENSATIONI TFIIXISAND DdlARE (5100.000�, IN ADDRION TO THE COST OF LICENSED I hereby eHi force antl el CONSTRUCTION LENDING AGENCV: Ihis sectian 3700 1 t r Cotle, for the peAortnance af th wy�k tw NU 5 pepnit Is issuetl. �9 c ��p/ � (/'�� C �v�t� J - PolicyNumber.��d/L�`-� � 7 � � / Na(s(Sf00)orless.J � - • yT— In eny menner so es to becomo sublact to the workers' i provlslons ot Sectlon 370 of Ihe r Cotle, I shall larthwlt� � _i?,%jo� YMtt50B1ECT rW EMPIOVER TO CPIMIN�L PENALilES M!0 CML FlNES UP TOONE HUNDRED PROVIDED WR IN SECTION 3108 OF TNE UBOR CO�E, IMEREST, AND ATTORNEI"S FEES. with Sectlon 7000) ol DlWsion 3 ❑ I hereby eMirtn that there is a consiruttion lending egenry for the peAormance of the work tor whlch Ihis Oermit is iuuetl. (Sec. 3097, Civil Cotle). Lentlefs Name: Lentlers AAtlreu: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirm thet untler penalry oi periury ihet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollawing reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry whic� requires e permii to consWct, elter, improve, tlemolish, or re0eir eny structure, prior to Its issuence, also requires Ihe epplicant for such pertnil m file e signed statemem thel he ar she is Iicensed pursuant m the provisions of Ihe Contractors License Lew (Chepter 9(commencing with Seclion 7000) of DlWslon 3 ot the Business antl Professions Code) or Ihat �e or she is exempt Iherefrom and ihe basis for the elleped exemptlon. Any vidation ol Section 7031.5 by eny applicant for e pertnit subjects the apP��nt to e civil penalry oi not more than tive hundretl Oollars ($500).): ❑ I, as owner ot the property, or my employees with wages es their sole compensation, WILL DO TME WORK, anOlhe siructure is not Intentletl or ofleretl tor sele (Sec. 7044, Business antl Professions Cotle: The Contractors License Lew does not eppty to en owner ol proparty w�o builds or improves �hereon, and who daes such work himself or herselt or through his or her awn employees, provitled that such impravemems ere not intentled or oMeretl tor sale. If, however, Ihe builtllnq or improvement is soltl within one year ot crompletion, ihe ownerbuiltler wiil have Uie burden al proving thet he or she tlid not build or improve tor purpose of ula.). ❑ I, as ownar ot the pmperry, am E%CLUSNELV CONTRACTNG WRFi LICENSED CONTRACTORS to conslruct the project (Sec. 7046, Business antl Professions Cotle: The contrecrors License Law tloes not epDN �o an owner ot pmpeny w�o builtls or improves ihereon, antl who contrects tor such prqect with e canirecror(s) litense pursuant to lhe Contractors License LawsJ. ❑ I em exempt under sec. Business and Professions Cade lor thls reason: Signawre: Date: Owner ID venfied by drivers license. ❑ Ves ❑ No Drivers license No. Expires: Vedlicetion oi Ownership by (type oi tlocument, i.e. - proDerry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATON: ❑ I hereby cenify that no axcavation tive (5) or more feet In depth Into which e person Is requiretl to Aescentl, wlll be made In connecilon wlih work euthorizetl by Ihls permi�, and ihat no building siructura, sceMolding, falsework, or tlemollilon or dismantling thereof, will 6e more t�en thirty-six (36) leet hiph. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Calilomia AOmlNstrative Cade). ❑ As owner-builder, I will not employ enyone to do work w�ich would require a permit Irom 1he Divisian of Industriel Selory, es notetl above, unless such person �es e permii to do such work Irom �he Civision. Signature: Date: Division of Intlusirial Salery Permit NumDer: CERTIFlCATE OF COMPLIANCE AND AIJT}IORIZA r enalry of perjury thel I have reatl ihis epplication end state that t�e infortnation gNen is correct. I egree to compry with ell state laws a ary o dinances rela g building ruction, entl authodze represeNatives ol the Ciry ot Coste Mesa to enter upon the ebove-describetl D�aGerty for insppction purposes. I ag ew.ar.cuoency ny building authorized by Ihis permil until linel inspection. CODE I. �NsveenoNTvve 1618 Fi:etl System FIneIFlre Prevention 1266 Paol Spa Final 200 Final Re-Roof 201 FInaI BIOCWRetalning Wall 202 Finel Fectory Fire Plece 203 Flnel Slgn 204 Finel Domolition PAIE i COOE 1 INSVECTION TYPE 206 Finel Mechenlcal 20B Finel Plumbing 210 Finel Elecidcal 212 FIna1 Flre Preventlan 220 Finel Plenning Approvel 222 Final Site 250 Final Builtling/Occupancy � � J -�l -OI .70 16 7 3 Ao��icant to flll in all spaces exce0< <�ase witnin heavY DorOer Iines an0 s(9n all apOropriate tleela�alioni. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. , LOT NO. UNIT NO. ProjectAddress 3492 Oueens rn 2'2 ' Applicant'SMailingAddreig 2a9� �%ld Martens TVPEOFCONSTRUCTIr(1IN NEW ADD ALTERATION REPAIR � Marilyn Hodqes 832-377 � CONVER>ION LI DEMOLISH ❑ OTHER q,p, �6 Owner's Name Phone OESCRIPTION OF WORK/USE OF BLDG. Address 3492 Queens Ct.. COStd Mesa S MainBuildi E Arch/Eng. Lic¢nse No. TYPE OF PERMIT GRA�ING FOUNDATION STRUCTURAL T Front Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑'MECHANICAL B R¢2r ' e Air Manaaement Phone 63Z-%S9O � �'OTHER A Contractor's Nam PROJECT DESCRIP710N 50. FT. oCCUPANCv C Right Addresslmailing12890 vld Martens K Left ' 29640 CONSTRUCTIONTVPE VALVATION$ ' $ City License No. ZON[ GRADING CU. VDS. ACRES p�ng. Ref. �k I LICENSED CONTRACTOR DECLHRHTION � v�I.nereDy.attirm that I am li�ensetl untler provisions of Charter 9(commencing Remarks: Planning NOtes: with sec�ion 7000) of Division 3 of the BuSiness antl Profeszions Cotle, antl M my Iicensc is in tull torce antl eftect. �w IJcense CI 5-�C�- ��+- LIC2I�5 Date � " Signature PLUMBING FEES � WORKERS' COMPENSATION DECLARATION Bd� $i�k $hOw¢�3 �� 1 nereby aifirm [hat I have d certilicale ot consent lo selNnsure or a certifiwte k ' C ti tlf" tl th f 5 H 4974 7/27/34 Zone Accessory Building: Parking Req./Providetl ELECTRICAL it Wor ers ompensa on Insurance, or a cer ie copy ereo ( ec on BackflowPreventer - SernceSmk - - -• lBoO. �a Automatic Washer - Transformer ❑ 15-50 KW `6Vy� C2-216996—� INA ❑ So+Kw Poiicy rvo. C mpany 8ackflow Irrigation $ewer Cap Construction Pole Sub. �Cer[iiletl coDY IS herlby tumi5hetl. Ce ifl�j tl mD,y7� �iletl with the ciry B tlin9 O alo�. Wn ��, Bathtubs $ewer Connection Cooking Unit � Meter Dup to 100 amps Date�-19-H4 APPII[ant —r��1�-�� '✓'-`-�� EXEMPTION FROM WORKERS' COMPENSATION DECLA0.ATION Cldfifi¢�5 SOId� C0112ct0�5 DIShWd5h2� MEL¢t ❑Ov¢� 100amps (Thi55ection neetl not be mmpletetl if the permit is for one hunqretl (5100) or Icss). Dishwasher Solar Piping Dryers �Gas ❑Electric 1 cerNfy Ihat In the per(orry�anc¢ 0/ lhe wo�k for whiGh Ihis pe�m4 i5 BSueQ I . shall not employ any person in any manner so as to become subject to the Drinking Foun�ain5 $olar Tank Fan � - Wo�ke�s' CompenSatiOn LaWi Of California. Date Signaturo Floor Orains Swimming Pool w/Spa F.A.U. NOTICE: I(, after making this tleclaration, you shoultl became subject to the . Workers' Compensation provislons of the Labar Cotla, you must torthwith FIoo�Sinks Urinel Fixtures comply wit� such prOvis�ons or this pe�mit Shall be tleemetl revoketl. CONSTRVCTION LENOING AGENCV ' GaSServiCe OutletS WatErClout DeviCeBOxes I her¢by allirm Nat lhore is a conztructlon lentlin9 aqency tor tbe porformance of tha work for wnicn �his oermit is issuetl_(SecUon 3097 Civ. CJ Interceptors WaterHeater Outle�s l.en0er's Name Lentler's Aatlress - Kitchen Sink � Waler Service Switches OWNER BUILDE0. DECLqqqTION � 1 hereby aifirm that I am exempt irom Ihe Contractor's License Law for the Lavatories Gerbag2 DiSposal i011owing r¢azOn (SettlOn 7031.5 Busin855 and PwfeSSional Catl¢: Any City or county whicn requires a o¢rmit to construct, alter, improve, tlemoilsh or rwalr P-Trap Generator �0�5 KW �5-15 KW a�y St�Uctu�e, p�lOr IO Il5 iSSUance, d150 /equlr¢5 tlte apP��<dnt �Or SUGh pe�mlt i, to 111e a Slgnatl Statement that he/she is Ilcon5C4 Pursuant [o the provlsions at ROOf D�21n5 DlvisiOn 3 Of the Busin¢55 antl PrOtessioni Code) or that he/Sh0 is eaempt =�h¢relrOm antl lhe ba5is (p� th0 allegetl CxOmpUon. Any violatiOn o1 Settlon 'a'?,D31.5 by any applicant tpr a permlt subjects tne applicant [o a civil �`� � ndlty ot not mOrO lhan fiv¢ huntlrCtl Oo11ar5 (5500). �'L7 I, as owner of [he property or my employees witb wages as tholr sole compensatlon, will tlo ihe work, antl tho ztructura is not Inlentl¢tl or otieretl lor sale (Sec[ion 7044, �usinass antl ProfaSsional Cotlo: Tne Conlractor's Ucense Law tloes not aoo�y to an owner ot a oroperty who builtls or Improves tnereon, antl who aoes s4ch work nlmseH/nersalt or tnrough his or her own employBos, p�ovitletl that Such Improv¢ment5 are not Intentl04 0� oHoreO tor sal¢. If, nowavcr, lne builtling or improvemen[ I5 soltl wlthln OOe yaa� 01 com- pletlon, [ho ownar wlll ba�e lho burtlen of proving hc/s�o tlid not bulld or irn- �rOvt to� the pu�pose ot Shce). I, as awn0r Oi l�e Oroperty, am excluslvaly Contrac[Ing wi[h IlcenSCtl cOn- tractoR lo construct the projecl ($ection 7044, Business antl Protessians Cotle: The Contrac[orY License �w does not apply lo an own¢r of prOperty wh0 builas or improves thereo�, antl who contracts for such vrojects with a con- tractor�i) Ilcense pursuan[�to the Contractor's License Law). I am aware that prool oi tnelr Worke�'s Compensation insurance shoultl be provltleC to me. ❑ I am exempt untler Section B. & P. C. for lnis reazon Date Owner 1 hereby certify tnat I h8ve rea� Informatlon is wrrect. I agree to antl ztate laws relating to builtlir 5¢OLdtiVCS Of IhiT Clty f0 ¢nlCf Inspection vurp s Signature orivers' Ucense or 55 �_ ] itat¢ that the a0ove antl county orElnances iereby authoriz¢ �epre- �nUoneC property for ReinspeMion Foe � $15 Duct� UnderGround Dutt • Strucmral Duct - Ventilating Exhaust System � Multiple Firepl/Fac[, Blt. ICBO # Heating System & Ductin9 ❑ ai oo,000 aru O i oo,000 flainspection Fee � $15 CMF 0865-46. rev. 4/84 White - Builtlin9; Canary - Applirant; Pink - Acmuntlng; Goltlenrotl - Assessor Issue Fee Hood or Type I ❑ CanopV Type II � Refrigeration $ystem �10.700,OOOBTU 700, System Repair/Alteration laue Fee Su6 Panel Momrs �0�1 HP � 1`/, - 8 Inc.Solar 09�15 HP �16-15+ Microwave Pole Light Fiange Sign $tending Sec[ions Tresh Compacmr $ 3 �' ^ Feinspection Fee $15 luue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By . Aooliration Issued Bv �� % . S 3 IOo:iC TL FEES $ 3 SUMMARV OF fEES BUILDING PERMIT 5 SMIP $ � PLAN CHECK $ PERMIT � PLUMBING S ISSUANCE S PLAN CHECK 25% S ENERGY P.C. 5 � ELECTRICAL S GRADING 5 PLAN CHECK .50% $ MICFOFILM $ MECHANICAL 5 _N�,� ��TALFEE $ lO�O PLAN CHECK Z5% $ ' Z O N i N G R E Q M T S. CONSTRUCTION AND PLANNING , POOL .'A APPROVALS Permit# ' �� Date Inspector pppROVALS Permit# Date Inspector 1. Temporary Electricai Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrica! Conduii Uiility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 6. Electrical UFEp Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 6p. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical�Conduit 66. Solar System-Final i 6. Rough Electric Wiring 67�. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.�Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23.� Gas Pipe-Rough & Test 72. Underground FlusFi 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: y/6�j/s L�Fj-(,�o-�l L� . 34. Final Heating & Air Conditioning � C�� .�� V� ��3 ` y/LZ.�,�u Ci[O 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Firlal 41. Solar pomestic-Final 42. Backflow Preventer � �r � 43. Backflow Irrigation _ . � 44. Landscape �rripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � 48. Special Requirements Completed 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co ; �; 51. CERTIFICATE OF OCCUPANCY. No. Date App�icant to fill in all spaees exceD� those within heavy Do�Eer linas anC si9n all appropriale tleclarationi. CiTv oF cOST��ONSTRUC�ION PERMIT . Project Addres5 �' � Applicant's Mail/in��g Ad�d ess � Owner'sf��lF� 1-��dd� ' Q' Phone Address "T-�a` Q�iQ�hS �i.i� ArchlEng. Lice�:e No. Address ConVactor'sNam 'Phone � Address Imailing) �' Ciry License No. � LICENSED CONTR T DECLARATION I hereby afiirm �hat i am licensetl untle� P�ovislons of Char[er 9(commencing with s¢ction ]000) o( Division 3 of the Bu5ine55 antl� Prof 5sion5 Cotle, antl my I7<enze is in I t e antl eftect. Ltcen 'cen o. Date� Signahre WORKERS' COMPENSATION DECL TION � I hereby aftirm lhat I have a certi(Itate ot con5ent to self-insure or a C¢rtificate , �f Workers' Compensation Insurance, o� a certitied mpy thereof Sectlon � 1800. Lab(]C,)_ ...vvv . � , - Policy No.Wke:� ComPan � 1 n,�( Certi lea capY is,hereby (urnisnetl�/. � II � I Y1LCtilNSfedIWVXis tiletl wi[h [he ciyy}J�jjQing q �IS!on:�/'�.. _� � EXEMPTION FROM WORKERS' COMP6t75YiTION DECLARAT,ION (Thissectlon ne¢tl not be completetl it_Ihe Permit Is for one huntlred (E100) or less). I certify that in th¢ Performance Ot the work tor wM1ich this permk i5I55uetl, 1 shall nol emploY any person In any manner 50 a5 to become sub�ect to th¢ Workers' Comp6�salion Laws of Califomia. ' , . Date Si9na[ure 'NOTICE:�N, afttl� making Ihis tleclaration, You sM1oultl become sublect[o lhe Workers' Compensation proNsionS of the Labor.Cotle, you must forthwith [omply with such p�ovisions or this Oermi[ Shall be tleemetl �ovoketl. CONSTRUCTIOr1 LENOING AGENCV I hereby affirm that [here is a const�uctio0 lentlin9 agency for the pe�formance .of the work for whiCh this permit i5 issuetl (Section 3097 Civ. C.) Lentler's Name Lentler'S HtlOress � OWNER BUILDER �ECLARATIOlJ ' ' I hereby aflirm that I am exampl (rOm [he COntractor'S-License Law tor [he following raason (Section 7031.5 Buziness antl Professional CoOe: Any city or mun'y whi<h requirez a permlt to construct, alter, improve; aemolish or repai �..., ..�.� �.... n inr rn irc iczuance_ also reouires the aooliwnt tor suctt Dermit theref�om an0 the basls lo� lhe allegetl exempuon. Hny vioiauom m �ecuon 7031.5 by any.applicanf for a permit subjects the ap0licant to a civil �enalty of nol rt�ore than /ive huntlretl tlo�lars (E500). I, as owner of the propC/ty o� my ¢mplOye¢5 with wages as [heir sole compensatiOn; will Oo �he work, and the st�uc�we I5 not intentled ot otferetl for sale ��SectiO� 7044, BuSin¢ss anC 7rofes5ional Cotle: Th¢ Con[ractor's • Lirenze law tloes not apply to an owner o( a properry who Guiltls or improves tbereon, antl who tloes such work himself/herself or through�his or her own employees, prbvitletl that such improvements aroinOt intentletl or oiforetl for Sal¢. It, hOweve/, the builtling or Improvement is Soltl within one yea� of com- O�etion, tM1e ow�er will havc Iheburtlen of Proviny he/she altl nol builtl or im- '� rOve tor tho pUrpoSe of sale). I, as owner of the property, am ez[lusivery contractlng'with licenietl mn- Vactors to conz�ruct the oroject (Section 7044, Business antl Protessions Cotle: Tne Coniractor's License Law tloes nat apply to an owner of property who builtls'or impro�es thereon, and who co�tracts for such projects witn a con- bactor(511icen5e purivant�[o lhe�Contrac[or's LicenSe Law). 1 ain awdre lhat oroof o( tM1eir Worker'S Compensation insuranco shoultl be p�ovltletl to me. ❑ I am exempt untler Section B. & P. C. for thls reason Oate Owner _ I hereby certify ihat I have reaa tnis information is Co�rect. I agrea to comp antl strtn lawa �elatina to builtlina <on I Drivers' Licens CMF OB65-46, rev. pplication antl state tnat tne above with all•clty antl county orClnances ructlon, and hereby authorize repre-. t�e�above-mentionetl� qrooerty tor TVPE OF CONSTRUCTION LJ rvEw I_ ❑ CONVERSION ❑ DEMOLISH ❑ C P�SGRIPTIQ,f� �F WORK/USE OF BLDG. .. , � . .. . I i1I.'n/�I,l6�i�T�l� TVPE OF PERMIT LJ GRAD�NG LJ FOUNDATION Ll STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ pTHER PROJECT DESCRIPTION Sq.FT. � oCCVcarvCv— CONSTRUCTIONTVPE � VAIVATION$ ZONE GRADING CU. VDS. � ACRES_ Remarks: Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher ' � Drinking Fountains Floor �rains Floor Sinks � . Interceptors Kitchen Sink � � Lawrories P—Trap ` Roof Drains - Reinspection Fee $15 Duct-'UnderGFound' . Dutt - St�uctural . Duct - Ventilating Exhaust�System ❑ Multiple Firepl/Fact. BIt. IC80 # Heating System & Ducting ❑ o-� oo,000 e1u O i oo,000 � Reinspection Fee � $15 Builtlin9; Canary - Ap0licant: Pink - Accountinq; Goltlenrotl - Assessor Service Sink SewerCap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Cloret Water Heater Water Service Auto�Wash . Laundry Trays ' Isue Fee Hood or Type f ❑ Canopy Type II ,❑ A.P. � " S Main Building: E T, Front ^ e Rear ' A C Right gLeft � � Ping. Ref. # Planning Notes: � 5281 5/I�/i?; - . , . _ � � �� Zone � Accessory Building: - - Z " O N � . • ' ' - N . - G R Parking Req./Provided � E L Q � M � s -_ Automatic Washer _ Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Refrigeration System � - ❑aioo,000eru ❑ioo,000s System Repair/Alteration Fire Dampers � Registers Isue Fee 5 3 I - FEES 5 3 Fan F.A.U. Fixtures Device Boxes ELECTRICAL Transformer ❑' 15-50 KW ❑ 50 + K W, Meter ❑up m 100 amps Metei ❑over100amps. Dispoul v �0.5 KW �5�15 KW tion Fea $15 ' Suh Panel � Motors �0.1 HP �1 fi - 8 - Ina Solar 09-15 HP �1645+ � . Microwave . Pole Light Range Standing Sections Trash Comoactor Issue Fee PMENT SERVICES REQUIREMENTS: pproved By Approved�By _TTr'^ FEES $ 3 � • � SUMMARV OF FEES ., BUILDING PERMIT $ SMIP� $ ' . '� ;P,LAN CHECK $ - PERMIT � -n-PLUM8ING .$ �S.l�l� ISSUANCE •$ . " PLAN CHECK 25% $ � ENERGV P.C. $ � ��+ i � �ELECTRICAL $ GRADING .$ �3 j'� � � MIC(70FILM $ PCAN CHECK 50% $ ` �fNECHANICAL $ • TOTALFEE �g SOO �'PLANCHECK Z5% $ ' � � , �CONSTRUCTION AND PLANNING � POOL t� SPA � APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector ,� • 1. Temporary Elect�ical Service or Pole � � 52. Pool & Equipment Location _ - 2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement 3.� Electrical Conduit Utility-Undrgmd. ,54. Forms , - ' 4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding ' 5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. . - � 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. _ , 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwasti Liries, P-Trap, O Undrgrnd. 10. Structural Floor SVstem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � . 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Fina( 14. Rough Plumbing 65. Electrical-Final � '15. Rough Electrical-Conduit • � 66. Solar System-Final 16. Rough Eleciric W�ring � 67. Fencing & Access Approval _ 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro � � 22. Ducts, Ventilating . 71. Product Piping O Gas ❑ Oil � � 23. Gas Pipe-Rough & Test, 72. Underground Flush �� 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro ,g 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ��?� 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � ' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT - 31. Plastei Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED 33. Final Electric " Notes: �-/y��L L.EF7-C�j2� , L, f V . 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' �P � 36. Hood or Canopy ' , 37. Final Faa Fireplace - 38. Final u ing � � 39. ter Service- nal t�` 40. Gas Service-Final �,_� � , 41. Solar pomesticFinal . , . - - � ' 42. Backflow Preventer ' !:_. . . _ � 43. Backflow Irrigation ,.;� � 44. Landscape Irrigation System, . 45. Sound Attenuation C ' � � � ' 46. Handicap Regulations '_'; � � 47. FINALSTRUCTURE & BUILDING ' � ' 48. Special Requirements Completed , � ' '- 49. Electric Release t0 Edison � 50. Gas Release;to Southern California Gas Co ' - � 51. CERTIFICATE OF OCCUPANCY � - - , No. � Date . � _ .. __ _ . . . . ,_ F�+ 7. W o. a � h S E• O � F a C � ..1 � k] a O a �. Z {1) 5 3 COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 RECEIVEO P_ IJf _ - �^^��4 For Applicant to Fill in Completely — Use Ink Only << BUILDING 3492 Queens Coui't A�P•N�•r'Y�/9. �-� S� ADOFESS OWNEROR ADDRE55 3492 TENANT Wimbledon Assoc. Queens COl1Tt MAILING 14']Q Jamboree RCI SPACENO. ],3 ADDRE55 TR NO LOT BLK. c�Tv Newport Beach No 40-6800 �0275 13 COKSTRULTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDEfi X BRANCH Wimbledon F1SS�C. OWNER ADDRESS pgp VHLVE �� ORENGINE RCorbin/Yamafuji TE •49-7124 USE E v AODRE55 17992 Mitchell .SO. � Irvine 20NEPoR-� ,�P -N GFOUP /`- � APPROVED p CONTRACTORMCLd1R D2V. CO. BV DATE � Qp p ADDRE55 147� Jamboree FiCl c,Tv Newport Beach No`640-6800 STATE 2�38�5 CITV 18873 APPROVEDSETBACKS LIC. NO. IIC. NO. SIZE NO.OFBLDGS. (FROML7L�STREET) OF LOT NOW ON LOT O Nf � FT. �'� USE OF � EXISTING BLDG. Separate permits are required for L. SIDE S FT. electric, plumbing and heating work: RE FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE PRD — New Construction - 8-3.5 �ROVEDa-c�%`7 Sin le-famil dwellin "'P °VE �� 8t � . �,:9 FOR SPECIAL [tEQ e 1 hereby acknowledge ihat I �ave reatl this applicetion antl stete that tho ebove information is correct antl epree to comply with all laws ragulating builtlinB �onrtrucNon, antl 1 shell not employ any person in violation of tha workman'a compensation laws of Ne State of Calitornle. / i I hereby certify thet 1 am properly licancatl as a convactor unGar SQ. FT. J tho State ot Californio Businexa antl Proteulons Cotle, Dlvislon 3, THE AMOUNT SH WN UNDER VALUATION IS FOR Chapter 9, end that such licensas are in full forta nnd effect, or I THE VURPpSE OF ESTABLISHING A PERMIT FEE ONLV: am ezempt from the provisions of tha Smto f Colifornin Businosz VALUATION PERMIT FEE / and Protezsions Cotle, Ivi lon 3, liap r 9. a SiBnstura of PLAN CHECK $ Pe�mlttoe � �}/� (/�� / TAX E � o, / �J�% $f%tll � Authorizetl Agent Dale TOTAL PqID 5 .3D 30 TL� P C > V 0 � N ��m Y � n � f �U OWENS-0ORNING Fiberglas Blanket Insulation The contractor named below certifies that the Owens-Corning Fiberglas Blanket Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Blanket Insulation is in- stalled in conformance with current energy conservation regulations, California Administrative Code, Title 25, State of California, in the building located at: 1.��19� iJ�...or.y.� �i.z � J '� /4.��" Stieet Lot Number Tract Number Exterior Walls Owens-Corning Fiberglas Blanket Insulation Ceilings Owens-Corning Fiberqlas Blanket Insulation Floors Owens-Corning Fib�las Blanket Insulation Foundation Walis Manufactur�r General �/ '' �/ Thickness R-Value r -- �s Thickness R-Value Thickness R-Value Type Thickness R-Value License No. By Title ' Date Is�ena�ure) i�/ Insulatio ntr tor r��/��• •--Y -� ��`'��-'LicenseNo. J��'� " By � li�� Title l J. i� Date �//J i�/ �s� �a��rel i Homeowner Copy (White) State Copy (Yellow) . Builder Copy (Pink) PUD. No. I6�BL-599SA Lnno In U.S A.. July 19]J OWENS-CORNING FIBERGLAS CORP. Insulation Operating Division Fiberglas Tower, Toledo, Ohio 43659