HomeMy WebLinkAbout3499 QUEENS CT - Building Permitsr
� CITY OF COSTA MESA ' � .. � %" .
. � TpMFq ' �' BlIILD/NG D/VIS/ON .� �
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �
�.�o„��. i FOR INSPECTIONS CALL: (714) 754-5626 .
PERMIT NUMBER: M09-00084
PERMIT TYPE MECH
APN: 41204264
JOB ADDRESS: 3499
VlClflliy:
SQ. FT: 0
SCOPE OF WORK:
OWNER: NAGLE,
PHONE:
APPLICANT: NAGLE,
PHONE: 714-979
CONTRACTOR:
Address: Unit:
City/Slate: '
MECHANICAL P
MECH ITEM FEE:
PLAN CHECK FEE:
INVESTIGATION FEE:
REINSPECTION FEE:
TOTAL FEES:
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STATUS:
DATE ISSUED:
� ISSUED BY•
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ENS CT CM ' }; ° Surte/Untt �
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� Address: 3499 �UEENS;�
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'� - ?ry "Address. i? 3499 QUEENS'1
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License No
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ISSUED
09/28I2009
KJB .
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��; �-�00$��
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'NOTICE: The work authorized by this�permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable wdes„and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration�of.this permil ;-'
LOOEi. INSPEC110NTYPE ORTE INT71RL5 COOEtl INSPEC110NTVPE �j.� O,ATE���� ��IN 71ALS1`
1616 Fixed SyStem Final Fire Prevention 206 Final Mechaniral �'�. .'�" "J_
1
1266 Pool Spa Final � 208 Final Plumbing '
'200 Final Re-Roof 270 Final Electrical �
:201 Final Block/Retaining Wall � � 212 Final Fire Prevention �
�202 � Final Fac�ory Fire Place 220 Final Planning Approval
-203 FinalSign , � t 222 ,FinalSite; . ��:J4��d%��t;?f}����
204 Final Demolition �� 250� Final Building/Occupancy
WORKERS' COMPEKSATION DECLARATION: � ..
I hereby aHirm under penalty of perjury one of the (ollowing declarations: •
❑ I have and will maintain a certifcate of consent to sel4lnsure for workers'
compensation, as provided for by seaion 3700 of the Labor Cotle, for the
peAormance of [he vrork for which this permit is issued.
❑ I have and will maintain workers' compensation insu2nce, arrequired by
section 3700 of Ihe Labor Code, tor the peAormance of the work for which Ihis
pertnit is issued. My workers' compensation Insurance carrier antl policy
number are: �
Carriec
(IDis sedrvr need nd be mmdele� AMe permQ u valuee af one huntl�ed ddlars (3100J w less �
�Polic Number:
I certify [hat in ihe performance of. the vrork for which this permit is
�i�netl. I shall not employ any person in any manner so asto become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 ot
. the Labor Co , I shall forthwith comply with these prov ions. �
1' 2 c�
pplica alur¢� �, ea-
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENAITIES AND CIVII FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm Ihat I am licensed under provisions of Chapter 9(commencing
wi[h Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force antl eRecl.
Lia # Class #
Gontraclor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn thal there is a cons�rucfron lending agency for the
perfortnance of the Hork ta which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Address:
Dale
OWNER•BUILDER DECLARATIONS:
I hereby affrm that under penalty ot perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Code: Any city or counry which requires a permit to
construcl, alter, improve, demolish, or repair any slrucNre. prior to its
issuance. also requires the applicant for such permit to file a signed slatement
that he or she is licensetl pursuant ro the provisions of the Contractors
License Law (Chap[er 9(commencing with Section 7000) of Division 3 0( Ihe
Business and Professions Code) or that he or she is exempt therefmm and
the basis for [he allegetl exemption. Any violation of Seclion 7031.5 by any
applicant for a permit subjecls the applicant to a civil penalry of not more than
five hundred dollars ($500).�:
❑ I, as ovmer of the pmperty, or my employees with wages as iheir sole
compensation, WILL DO 7HE WORK, and Ihe structure is not intended or
ofleretl !or sate (Sec. 7044, Business and Professions Code: The Con[ractors
License Law does not apply to an owner of property who builds or improves
thereon, antl who does such work himself or herself or [hrough his or her own
employees, provided that such improvements are not intended or offered tor
sale. If, however, the building or improvement is sold within one year of
complelioq [he owner-builder will have the burden o( proving thal he or she
did not build or improve for purpose of sale.). ��
as owner of [he property, am EXCLUSIVELY CONTRACTING WITH
IC NSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Codei�The cont2clors License Law does not apply to an ovmer of
propeity who builds or impmves Ihereon, and who cont2cts for such project with
a contrecta(s) license pursuan[ to the Contractors License Laws.). ,
❑ I am exempt under sec.
Business antl Professions Cotle for this reason:
! � � � �-- a
e —oerc
3051A6 �3/0])
�� Owner ID verified by driver s iicense. ❑ Yes ❑ No
;� Oriver's License No. (Expires: �
Verification of Ownership by (rype of document, i.e. - property tax 6ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � �
❑ I hereby certify �hat no excavation five (5) or more feet in depth into which a
person is required [o descend, will be made in connection with work authonzetl
by this pertni�, and Ihat no building s[ructure, scatfolding, falsework, or demolilion
or dismantling thereof, will be more than thirty-six (36) feel high (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia AdministraMe Code).
❑ As owner-builder, I will not employ anyone �o do work which would
require a permit from the Division of Industrial Safety, as no[ed above, unless
such person has a permit to do such work from the division.
ApP���nl's Signatore
Division of Industrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to ile and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Ves ❑ No
(Sec[ion 25505 0( lhe Cali(omia Health and Safety Code requires, with some
exceptions, ihat a Business Plan be filed with [he Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity o( hazardous materials equal to or grea[er than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic fee[ of compressed gas
at standard tempera[ure and pressure).
2. Does or will the applicant or presen[ or future building occupant need to file
a registration form for acutely hazartlous materials? ❑ Yes � No
(Section 25533 of Ihe California Health and Sa(ety Code, wilh some
exceptions, requires reqistretion with Ihe Costa Mesa Fire Departmen[ by
each business which at any one time has on hantl a quantity of acutely
hazartlous materials equal to or greater than a weight oi 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaNre and pressure).
3. Does or will Ihe applicant or present or fuWre 6uilding occupant need to
prepare an RMPP (Risk Management and Prevention Pmgram for acutety
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Cotle provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling vnth the Fire Department of an RMPP by businesses which are required
to regis[er acu�ely hazardous materials wi[h the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future builtling occupant require for
the work which is the subjecl of this application a Oermit for such construction
�or modificalion (rom the South Coasl Air �uality Management District or from
any other air pollution control tlistrict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires ihat the requestetl
in(ortnation be fumishetl on applica�ions (or noo-residential building pertnits),
6. Will any part of the /acility to be constructed under this permit be within
1000 feet from the outer b0undarie5 0( a sChool? ❑ Yes ' ❑ No
Q( "yes", the faciliry must meel lhe requirement o( Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from [he South Coasl Air Quality Management District or other
air polWtion conhol district or agency is required for the work which is the
subject of this application, have all of [he disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf'yes", attach certifcate ot compliance from the appropriate air polWtion
control oKcer). ' '
CERTIFICATE OF COMPCIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all s[ate laws antl�
city ordinances regarding Hazardous Materials and Emissions. , , �,
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I
certify under penalty of perjury Ihat I have reatl this application and sta�e Ihat
the information given is correcL I agree to comply wilh all state laws and city
ordinances relating ro building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property tor
inspec[ion purposes. I agree not to occupy or allow occupa cy of a y building
authorized b}his permit until fnal inspection. ��
�,�.,�R \ a �r�
�gnaR' a O - Hs) ( Dat �7.
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AnC/orAulhonzed ApOLcant
�obAddress: 3499 QUEENSCT .
Suite:
Vicinity: ROOF �
. Primary Occ: R-3 Dwellings/ Cong Res <10
Parcel Number: 41204264
App�icant: SELL, RON
Address: 18032 LEMON
YORBA LINDA , CA
Owner: NAGLE, TIMO-
Address 3499 QUEENS CT,
Contractor.
Address:
ACCESSORY
PARKING
COSTA
Type of Construction: V-N
Zoning: Rl
Phone: (714)528-1758
Zip: 92686
Status: ISSUED
Applied: 08/18/2005
Issued: 08/7 B2005
ISSUED BY: �
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`�M � � -Phone. (714)5281758 �'.;_. ��. �" .
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i:'� 92686 �� ����-�� � � License: 323842
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�s `�� ;���� _,��'«• SCOPE OF PERMIT �
STWG ROOF:-INSTALL`2 LAYERS OF 30# FELT, EAGLELITE, CAPISTRANO
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NO710E: The work authorized by ihis permit shall� comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) � �
. EXPIRA710N: 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 tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetions and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
� FOR INSPECTIONS CALL: (714) 7545626
...,, � �,.,,,,�
��
WORKERS' COMPENSATION DECLARATION: . . -- . . --
'I hereby eflirm under penalry of perjury one of the followinq declarations:�� ' � ' �►
❑ I have entl will meintain e certificete of consent to self-Insure for worliers' compensalion, es provitled tor by section 3700 ot the Lebor Cotle, for the perlortnance of the
�w�ork for which this permit is Issuetl.
,p.�l� have and wlll maintain workers' compensatlo surence, es requiretl by sectlon 3700 of ihe Lebor Code, for the pertormance of the work iw which ihis pertnit Is Issuetl.
My workers' co pansatignlns ca carn d policy number are: �y / ! ^
Certi^r:S �/�'t` Policy.Number.� �V V/ (p �,� �
(ili�s sect�on need nof be completetl i/ Ihe perm s velued af one hundred dollars ($100) or less.)
❑ I certity that in the Oedormance of th rk for which ihis pertnit is issued, I s�all not employ any person in eny manner so as ro bacome subjed to'ha workers' -
compensetlon laws of California, e e ee ihet I I should ecome sub�ect to the workers' compensetion provislons of Sectlon 3700 of e Lebor ode, I shell foRhwith
comply with these D�ovisions. O 0�
Applicent'SigneNre:w.-- � Dete:��. , �
IdARNINO:�FAILUP`� O SECURE WORKERS' G�MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP, AYEFl O CRIMINAL PENALT 5 AND QVIL FINES UP TOONE NUNDRED
THOUSANDDOILARE(5100,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAM4GESASPRWIDEDFORINSECTION3IWOFTHELABOqCp E,INiEREST,ANDATTOFNEY'SFEES.
LICENSED CONTRACTORS DECLARATION: �
I hereDy attirm that I am licansed uptje�rovisiorys of Ch�pter 9(commencing with Section 7000) ot
Cotle, and my license is In full
CONS7RUCTION LENDING AGENCY: �
❑ I hereby affirm that there is a construction lending egency for the performance of lhe work tor which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Signeture: _
OWNER-BUILDER DECLARATIONS:
Lender's Address:
Data:
I hereby affirtn thet under penelty of perjury ihet I am EXEMPT FROM 7HE CON7RAC70R5 LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslness and Professions
� Code: Any ciry or counry which requires e permit to consWct alter, Improve, demolish, or repeir any sirucWre, D�ar to its issuance, also requires the aOP�icant tor such permit
to ille e signed statement that he oi she Is Iicensed pursuant to the provisions of ihe Contractors License Lew (Chepter 9(commencing with Section 7000) of Divislon 3 of ihe
Business end Professions Coda) or ihat he or she is exempt tharelrom end the basis for the alleged exemption. Any violation of Sedion 7031.5 by eny applicant for e permit
subjects Ihe epplicent to a civil penalry of not more then five hundred dollers ($500).):
❑ I, as ownar oi Ihe property, or my employees with wages es iheir sole compensation, WILL DO 7HE WORK, end the structure is not intended or oMerea for sale (Sec.
7044, Business and Professions Code: 7he Contractors License Lew tloes not apply to en owner of property who builtls or impmves thereon, and who does such work
himseN or herself or ihrough his or her own employees, providad that such improvemenis are not intended or ofleretl for sale. If, however, the building or improvement is
sold within one year of completioq the owner-builder wi0 have the burden oi proving that he or she did not build or improve for Durpose of sale.). '
❑ I, as owner oi the propeM, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contrectors Licensa Law does not apply to en owner of proparty who builds or Improves thereon, and who contracts tor such project with e contracbr(s)
license pursuant ta the Coniractors License Laws.).
❑ I am exempt untler sec.
Signature:
Owner ID verified by drivers licanse. ❑ Ves ❑ No
8usiness end Professions Code tor this reason:
Vedfication of Ownership by (type oi tlocumen6 i.e. � property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION:
Dnvers License No.
Date:
Expires:
❑ I hereby certify Ihet no excavation five (5) or more teet in depth into which a person is required to descend, will be matle in connection with work authodzed by this
permit, and thet no building sWdure, scaHoltling, falsework, or demolition or dismantling thereoi, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Celifomla Adminis�retive Cotle).
❑ As owner-builder, I will not employ enyone to do work which would require�a permit from the Division of Industdal Safery, es noted abave, unless such person hes e
pertnit to do such work tram ihe division.
Signature: Date:
Division oi IndusMal Safery Permit Number:
CERTFlCATE OF COMPLJANCE AND A RIZATON OF EMAY: I certify under penalty of perjury iha� I have read this application antl state Ihet ihe iniormation given is
correct I egree to comply with ell ste laws ntl city o inances relating to building consiruction, and authorize representatives oi the Ciry oi Coste Mesa to enter upon the
ebove-descnbed properry for inspec o s. I egr e cupy or allow occupancy of eny building authorized by this pertnit until tinal inspection.
/ 1
COOE t. INSVECTIONTYPE
1616 Fizetl System Final Fire Prevention
1266
200
Pool Spa Finel
Final Re-Rooi
201 Final BIocWRetaining Well
202 Final Factory Fire Piace ; -
203 Finel Sign
204 Final Demolition . . . .
P,IF
�
CODE• INSPECTION7YPE
206 Finel Mechanical
208 Final Plumbing
210 Finel Eletlrical
212 Final Fire Prevantion
220 Final Planning Approval
222
250
Final Sita
,Finel Building/Occupency ..
PE� It�ELfl
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PXOIECT POONESS: '� j Q 9 J QUEENS CT
awxee s xnme: MOLNAR DANNY A
nooness: 34T 9 Qf�EENS CT
COoTA F1ESA, CA
432-0605
ANCN/ENGINEEH:
AOOHESS:
UNIT:
' 92626
flEG.NO.:
UNIT:
PEwMinEE: pR0—FORMANCE INC. ( 714 ) 779-6868
nooeess: 4572 -E. EIS�NHOWER-CIR �
�=� ANAHEIM CA 92807
LICENSED CONTXALTOfl OECLABATION: I hereby afLrm iha� I am licensetl untler provisions o� ChaDter 9(commencing wiih Section
7000) oi Division 3 oi the Business antl Pmle55ion5 Cotle. antl my license is in fuil brc¢ anE eflecL _
CITY LIC' Q % � 2 STRTE LIC.: 4 8 3 4 1 S ClASS: C' Q %��.� -
.p�_ � � Z Signature' �� ti.YJC1�
WONNEflS' LOMPENSATION DECLPflATION: I hereby affirm that I have a certificate of consent m seli-insure or a certificate ol Workers'
Compensanon�} s raJ �c �j�certifie0 copY �hereof (Section 3800. Lab ' ' �
POLICY.NO.: <� V�� V E%P. UATE: 9� S Z� 9 2
caMraNr: HIGHLANDS ,i1 � • •
� Certitied coDY is hereby lurnishea. L7 Ce�ilietl topy is �iled with �Ile ti�y Building Oivi5i0n.
p��� ! 7 z— APPlican�'. —' � \ � � 'L. �—F OJ .A
E%EMPTION FBOM WOBKEPS' COMiEN5PTI0N DECLABATION: (TAis sec�ion neetl not Ge completeU il �he permn is �ar one hunAreO (5100) ar less�.
I cetlify ��a� in ihe Dedormance ol the work lor w�ich this Dermi� is issuetl, I shall not employ any person in any manner so as to become
subject la the Workers' Compensatmn Laws of Califomia.
Oa�e' �� Signature: � ' '
NOTICE: II, a�ter making this tleclaralion, you shoWd become suble�� �o ihe Workers' Compensation pwvisions o� Ihe Lahor
Code. you musllonhwith comply with such pmvisions or ihis De�mi� shall be AeemeO revoketl.
CONSTflI1LTI0N LENOING RGENCY: 'I hereby�affirm ��at t�ere is a cons�mc�ion lending aqency �or �he periormance o� t�e woB tor
which Ihis Oe�mit is issue0 (Seclion 3WZ Civ. C�.
- ` IENUEP:. . . , . ' �
ROOflESS:� . ' .
OWNEP BUILDEB OECIAHATION: I hereby aftirm �ha� I am exemp� from the Contrac�ors State License Law �ar ��e following reason
�Sec�ion 7031.5 Business an0 Pmfessional Code: Any cily o� couniy which repuires a permit Io cons�mc�. al�er, impmve, tlemoli5h, or
repair any simclure. prior to i�s issuance, also repuires �he applicant tor such permi� �o �ile a signetl siatement [hai Ae/she is licensetl
Dursuam lo Ihe pmvisions oi the Canlraciors' S�aie License Law (ChaD�e� 91�ommencing wilh Seclion 7q10) o� Oivision 3 0� lhe Business
antl Pm�essions CODe) or �hai helshe is exempt Ihereirom antl the �asis �or �he allegetl exemption. Any violation o� Seclion 703L5 by
any aDO�icanl �or a permit suble��s ��e applicant �o a civil penalry o� no� more Ihan live hundreA dollars ($500). .
I. as owner ol the OmDerty or my employees wi�h wages as Ihei� sole cOmpensa�ion, will Oo �he work, ana the
❑ s�mcwre is nol imendeA or olleretl br sale (Section 7044, Business an0 Pmfessional Coae: The Contractors' State License Law
Ooes nol apOty to an awner ot a proDeny who builds or improves therean, an0 who tloes such work himseli/Aerseli or Ihmugh
his or�her awn employees, pmviOeU ihat sucn impmvemenls are not intende0 or oflere0 for sale. If, huwever ihe buil0ing or
improvemeni is 5010 wil�in one year of completion, �he owner will have ��e bu�den of pmving he/she ditl no� 6uild or impmve
lor ine purpose ol salel. ' . ' '
I. as owner of the pmpe�y, xm exclusively contracting with licensetl coniracbrs to consiNct the Omlect (Section 704d, Business �
❑ ana Pmlessions Cotle: The Conlraclors' State License Law tices not apply to an owner af DmDenY who bwlds or impmves ihereon
antl w�o conUacls �ar such pmjec�s viiU a con[racmr(s) license pursuam m Ihe ContracmrY Slate License law). I am aware •
Ihai prool o� Iheir Worker's Compensa�ion insuranre shoWU be DmviUeO to me. '
� � I am enempl uneer Seclion: B. 8 P. C. ' • _ ,, .
mr mis reason: � . • .
�
oate: Owner
Ido hereby cenifytnatlam aware otane un0erstanetne requiremenis ofCalilomia Healin and Sa1ery Code Sections 25505, 25533, antl
2553a antl t�al I ar anY �Wure Ouiltling occupanl willlwill not (circle ane) need lo comply wi�h saiA sia�e co0es antl the requiremenis lor a'
permil lo� conslmclion or mo0dicalion �mm �he Nir �ualiry Managemen� Districi. Fesiaen�ial cons�mction apDlica�ions are exempt �rom'
these pmvisions.
�ate: Applicani: ��
,
I here�y ceriity I�ai I have rea4 ihi5 apDlicalion antl stale t0a� �he above inlorma�ion is carretL I agree lo comply with all ciry and counry
ordinances and stale laws rela�ing �o �uiltling constmc�ion antl here6y au��orite representatives of ihis ciry to enter upon the above-mentianea
p�mperry far in/spetlmn purpose%s./� �{v� /�
�. nat� e� 7S �Z �( 7 2 Signature: ' \ � � — `"'�
Iorivei's tirense or sociai searity x:
16at�d6 WM1i�e—BuilEing: Green—Gotle ENorcemenl; Canary—Appl¢anL Pink—Revenue; Goltlenrotl—Assessar
, . CITY OF' CO5TA MESA — BUILDING PERMIT., PERM NO; E 058818
PERMIT' NO: E 058818 PLAN:CHECK NO;, . N GOVT`; N SUPP; N
CONSTRUCTION TYPE: V—N : PERMIT TYPE: ELE ., PURPOSE; OTH
JOH DESCRIPTION ;,ELE. FOR i MOTOR APP, 5 H.P. FOR A/C ' SQ FT:
CLAIM'VALUE: 1,500.00 CALC—VALUE;
GROUP OCC:,R-3 /
COMMENTS: SMOKE DETECTOR RE�UIRED � � �
��**���r�x******�t�*�r�r*x-x*��tx +r*�*�r**a�*����t*�*�r���***���x��x�x***��c*�t*�•**x���x�����*�t
Z O N I N G R E Q U I R E M E N T S � �
� S E T H A C K S � � , �' '
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING '-------== '
FRNT; ' FT. IN REAR: FT IN FRNT; FT IN REAR: � FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING—REp PROV:. PARCEL; 42920405 ZNE; REF NO:
PLANNING NO'�ES> ' ,
�� ' - . - . .. . . . . .
iE 1E if iE 1E iF 1E iF.1f 7E if iE 1E iE it iF�EiE 1E fE �E ilif iF 1E iflE iE i! i! 1E iE 1Fif if iE if if 1E iE iE 1k IF iE iE �E 1F iE iE 1F iF iF iE i!!f if iF iE 1E 1F 3ElE 1f iF iF�3E iF �E iF iE if �E # �E iE if iE iE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T.S ,
ZONING APPROVED BY DATE;
BUILDING APFROVED BY • DATE;
APPLICATION ISSUED BY; ` ' DATE�• Z Y 1�
_ IFiF1E�EifiFiE*1E1EiF�ElfiEiF1F�1E�f.1E1EiEiE � • r ?ff';�iFiFitiEikfEiEiEiEififlE iFjE
iFiE1EiE�E�EIE3ElEiEitiFiF�FffiEiflE.itiEifiliFlEiFiEiE�f)E�FiEiFiFiElEit iE�fiFif'�fifikififklEifiEifiEiEif3E�flFlfiliEiEiF3FiE3E1FiflEiEiE iFiEifiEiFiE��
LEGALIZATION:N ; .F.E E: S U M M A R Y STRUCTURAL SEGMENT;N
, . • � •
PERMIT :�BLDG PMT PLUMBING ELEC7RSC� MECHANIC . FIRE SMIP/RES GRADING
_ , � ' �;502 SMIP/NON—RES �
PLAN �'l
ISSUE FEE .%15,00 ' •
BUILDING—DIV—> PfiRMIT ISSUE PzLAN—CHECK TOTAL PAID DUE
TOTALS----> 7,50 1'S.00 0,00 22;50 22,50; ,00
� j,
REVENUE DIVISION TOTALS-->- COLL'ECTED; 22,50 OVER/SHORT: .00�
� BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT `GRADING PLAN—CHECK �
22.50 � � . , ,
, iliFikiEiEifiEif�-lFififiEiEiFikiEiFiElEifiEiE3EitiE�EiF1EiF3fiEiFiEifiik-IEifiEiEiE�E3EiFlEIE3FifiEiE�f3FiElEikiFlF3E3E�EiE�t�EiFiFiEiE�flF3EiE3FjF�EifiFiFiFiFiP
I N D I V I D U R L 'F E E B R E A K D O W N : .
.� m
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
1
ELE 1 MOTOR/POWR APPARATUS 1,1 — 10,0 HP 7,50 7.50
lEND OF, FEES ;�
�'� , `� .
, � EXPIRED . ,
' I ,'arr 18t@ IrSpectwns
I ,q �
. ; �?ate ` - I "1� gig . ' .
, oi rct�:�ts-,�e+22a4w � �cE� :..
. � . �. , . '� •i}H?G: !•�i:`!g2 �4-�'�Y .`'S:�1 . .. -
�
� << CONSTRUCTIONAND,PL9NNING, � - " ^, �t'. P�� 'PA ^ - - . �- ; �� _
� � Date -, �Ins ector � - � ' �- `Date ��Ins ector��„
y^�'.APPROVALS Permit;# ';' n p: APPROVALS Permit# �. ,Pi
r _ - - .
�].�Temporary�Electncal Serviceor Pole' ~ � ��. ��52. Pool & Eqwpment-location' - A�
- :�.•
, •i c_' ... �� .. .��_ _ '_�; � _ . .. i._' � `__ .. ., �. �- .r
� �� �2.� Soii Pipe�Undrgrnd:T ^ �'� ti� H�--��? - - .� , , 53. _Steel�Reinforcement � � � - � � �
• ' 3 hectrical Condwt Utility Undrgrnd�. � -- 54. Forms.: ; � . _ � ' . _ � •�
� n ' '
, 4. El2ctrical Condu�t Uodrgrnd 4� _ � � z . 5 � � - 55. Electntal Boridmga . � �'. �
� ,� � � e . . . �
; 5' ��feel Reinforce�8nt= � " �> i :'; _ ,� � � =? �; -- 56. 'Rough�Plumbing`&�Pressure Test � - ��� rt �
�,�6. Electrical UFERiGrnd`.';-:c , ' "r�' - - 'c', 57. APP.ftOVALTO�'COVE(i�GUNITE - � � w�
€_ -
_ '.' ' - - � ` ' ' - ' - � i��
�-7.,Footings �"�; � - .�'�'� � , 58..ElectiicalConduit•Undrgind�. . _ � �
` r , - ' _ ; : . . � . �
.�8; FoundaLon _ � :� � � • 59. GarPipe; OrUndigrnd., Tesi . � �
�:
.
' 9. Water Pipe�Und�gmd. �� ( � '- ' �+ - 60. Backwash Lines,'P;Trap,��;Undrgrntl. � _ . )�
S
� ?0. Structural Floor System� � � � f-�i. " - - 61. APPROV.ALTO�-DECK�`r , - ` • "^
71. Roperty Sewer l� e & Hous Connection t� � ;� „ _ 62. Backwash & Receptor�Final • �- � � � � • �
12. Sewer CaP u; - -- � ; a � ,�p . � ., ` , 63. ;Heater & Vent-Final . - � . �..,� ,. �;�
S3. Roof Drains - " ' , n � ' 64. _Pluihbing System -.Final';-. '
- - '�
; 14. Rough Piumbing � �� � Y 'j -: . - 65. Elect�ical-Pinal .: - ' �
15. Rough Electrical-Conduit ; � ` `:,� �.- - 66.�Sola�,System Final _ - � i
'1&. Rough Electric Wiring � -- � . �_ 67. �Fencing & Access Appioyal, . � . - .
77. Rough Wirin9 Sign � � = � ' - 68. �APPROVED'�FOR PLASTERING � � '
�.
18. Rough Electrica6T Bac Ceiling� , � 69. 'POOL/SPA SYST[MS FINAL � �
19. Rough Neating�& AirConditioning- �`- -� ' ` ' `" 'FIRE�DEPT. REQUIREMENT ` � - " '
' - - ;r _ �� : z: x - r�
20. Rough f.actory Fi?eplace + x:�'r C'7 C c' <'? "APPROVALS%��=Permit # =' �
s r : y. s�:� � •rx : � ...� �t-� - �• �
21.':DuCts,in,�Structuree< ' - . :�' ` . - ."." z �._ .q � x .-,r
i �•- �-S :< � .x •• _70. U�derground�Hydro r
22. Ducts, V,entilgting� X � ��� � r„ r �:� r`77, productiPiping 0'Gas �+Oil ,
23.-Ga's_Pipg?Rou9h &�Test � �_cy- f,+ t �F O�: x�.72. Underground FI sfi; ��. `i -
24.RoofPrsming >-" 't-+5- �•- s:� : � ���;'y3lzUndergmd'StorageTank,OGas•�Oi1 �
.a .'l< �r "� ..h+: , �.
25. Roof SFieathing : �K �� " " ' .� `' .U"'� � - . � _ .;.
•L a � .7 z ._rc:.: 74:^OverheadHYdra_, x
26: T�Bar Ceiling (Structural) & M�nocoat �� y � i� z a 75JDry Chemical ' "-` '
27'"Frame and Flashingy :�Xs, x_ _ r:� y 76' Dry Standpipe =;� '�' ' '
•--_
� ` 28. �Lathing & Siding� � �% _yS i s : _ �-i `,�. "c r. 77� FIXED SYS� EM;FfNAL� y _� '"
� 29. Insulation �` ` �� � `y �� �� � ?� �`� � ��� .; 78'r: FIRE PREV. FINA�� t + .S �= .
�30. Drywall Nailing .� • y i G ir x -� HEALTH�DEPTCREQUIREMENT �;i
c .�i ,.� n r�
�Y :. ` �
�37. Plaster Brown�Coat; � � <<yr :` � �79: FINAL INSRECTION; r ` " ;r • �
��32>Electricai Power M'eterrFinal� �;.. I-:� G` 4$0. =FOOD CERTIFICATE ISSUED '
, ._33..'Final Electric, '� ,; ; s y '� I �, �,`� ;� �Notes:��a7/YZ 1�(oOMF/itm'E"G�.EP-GQ20- �(;iEO_ ( '
,;34.,-Finai Heating?& Air �Conditioning; � �; i � f� '.\'s x �' ' � ^`; � - „� .
� ,i
35.�Final Gas Pipe-Testy " � " ��"'"'- ��� t � X i`� �' �+ � -�
. , r; � i I � I� -� AC �{/'
36. Hood or_Canopy x - 1 ;r � a S � _ t'u � � -��- "- 'y
rr �
_37:-Final,Factory Fireplece.t � Y �� �,`' � ` {' - `� . .,� (X ,-- i
38. Final Plum6ing � , i ... � x. �� ' 1 '+� z ' -- � = j �= -i.:�
T k
39.� Water Service-Final' � . ' ^ I � I" :. + r " r '. �c `� - ' '
. .- �' ;.; S # »: Y :.� i . .
;40. GasService-Final ,,.� it: r ;> � .S � � 'r��^ ._ra �• � - _ i
��,
� 41. Solar pomesticFinal:a. •T •• �'� � I �K . r, '}'^ - .�,
42fBackflow Preventer: ;y �` ' � � " � _-:i.
r
43. Backfiow irri9ation.� ��^,' `'� :x A �' , � � ��. �:.^ . .
�' :y v u� ... x .
44. LandscapelirigatiopSystemi,rr�. s i r �7 ' <,<.: .: _. ��[, ., „ ..�
'"-45�_Sound Attenuation� � �' "`` • ` ' `' � ' c•" •`'�"�
� � �.. r ,� n .s <t: • .
r46� ,Handicap.Regulations . G ,� ` � � ��„ � �; r� �- : ;j �, *� �
�
; �47���fiNAL STRUCTURE & BUILDING :M � f %�'? { � ="'% ? „ �
i �.- i {/,S�
' 48F:FINTAL PLANNING` �� �� � , � { ���r_r: ���i n � x -=
,. � �.,, ,T .
,,-49�� Etectric Release to Edison i � � � -'� 1 '
k � 11' � �. r .� T
' 50� Gas,ReleasetoSouthernCaliforniaGasCo ��` � (� �.�c = ,=i - • o,:� ��r ^' .✓ .'"
;:
� 51: CERTIFICATE OF:OCCUPANCV , � j -; �; _� �� � ,� x , _ '�
No. . _ Date � � �
�
PflOJECTR00HESS: j[��j9 �UEENS CT
OWNEH'S NAME: MOLNAR DANNY A
nooAess: 3499�QtTEEidS CT
COSTA MESA,CA
432-0605
ABCHIENGINEEP:
aooness:
UNIT:
92626 �
� flEC.NO.: '
UNIT:
PEpmiTTEE: pR0—FORMANCE ZNC. ( 714 ) 779-6868"
� aooeess: 4572 E. EIS�NHOWER CIR
y ANAHEIM CA 92807
IICENSED CONTNACTOB OECIAPATION: I �ereUy aMirm thai I am iicensetl untler D�ovisions ai Chapter 9 �commencing wi�h Sec�ion
� 7000� oi Umision 3 0� �ne Business and Pmfessions Cotle, ane my license is in WII �orce and eitecl. �
cirruc.:0 0702 sTaTeuc.:483411 cuss: C-20 �
aie: 2- Sipna�ure:.�-_— �� ��O D� n
WONNEHS' COMPENSFTION oEClABF710N: I hereby aliirm i�at I nave a cenificate oi consent ta self-insure or a certiticate ol workers'
Compensation lysqra{��� �cetlilietl� copy �hereo� ($ec�ion 3000. La�. ('j 9� 1 z� 9 2 .
POLICY NO.: � 1�� E%P. ORTE: V
COMPRNY: HIGHLANDS �u � �
��,;"] Cenifie0 copy is here�y tumisAetl. L7 CenifieU capy is filed with ihe cily Builaing Division. • n �-
�� �� � �/ � �/7 Z A � O � l—Lx�l/�
�aie: pplicanl:
E%EMPTION FflOM WOBHEPS'fAMPEN5ATI0N OECIANRTION:�(Thissepion neetl no�becompleiedii�he De�mi�islorone hundre0(511p)orless).
- I cetlity Ihat in Ihe Dehormance oi Ihe woB �ar w�ic� �his permil is i55ue41 shall nol emDloy any person in any manne� so as to Uecome-,
sublecl �o ihe Workers' Compensation Laws oi Cali�ornia. ,
Oa�e'. � SignaWre: '
NOTICE: II, alier making this tleclaration, you should become suble�� �o the Workers' Compensation provisions of Ille La�or
Cotle. you musl tort�vn�� compty with such pmvisions ar �his permit shal� he Ueemetl reuokea.
CONSTPUCTION LENOING RGENCY: I here6y aHirm IAat ��ere is a cons�mc�ion lentling aBency fo� the pertormance al Ihe work fa�
, which Ihis permi� is i55ueU (Seciion 3097. Civ. C�. '
. �LENOEB: ' � ' � ' . �
ROOflESS: ' � � � ' "' ' - '
`, OWNEN BUILOEB OECLAB�TION: I here0y ailirm �hal I am eeempl imm the Comrac�ors' S�a�e License Law for the followinp reason �
(Seciion 7031.5 Business and Prolessional Code: Any ciiy ol counry which �equires a permit �o cons�mc�, aller, impmve, tlemolish, or
repair any slmclure. prior la iis issuance, alsa requires �he aDDlican� for such permil to �ile a signetl siatemen� �ha� �elshe is licensetl
- pursuam m t�e pmvisions ol lhe Cantracmrs' S�ate License Law (Chapter 9(tommencing with Seclion 700U) ol0ivision 3 0� Ihe Busineu
ana Pmfessions Cotle) or I�at helshe is exemp� ��erefmm antl �he basis �or �he alleAed exemp�ion. Any violalian ot Sec�ion 703L5 by
any aDPlicanifor a permil suble��s lhe applicani to a civil penalry o� not more ��an �ive hunared dollars (5500�.
❑� I, as owner at the property ol my emDloyees wit� wages as their sole compensation, will do the work; antl the
s�mcWre is not intenEed or ofieretl br sale (Seclion 7044. Business and Pmiessional Cotle: The Contrac�ors' Sla�e License �5w
does nai apply �o an owner ol a propetly who builds or impmves thereon, an� who Ooes such work himself/herself or tAmup� ,
� ' �is or her own emDloyees. D�oviOetl Ihat such impmvemenis are not in�ended or oifere0 for sale. If, however the buil0ing or
impmvement is solU within one year of completion, ihe owner will have the hurJen of D�o�ing he/s�e tlitl not huild or imDmve
for ine purpose ol saleL ' .
t
r n iru tihe ro ec� Seclion 7044 Business
I, as owner ot the pmpehy, am exclusiv¢Iy conirac�ing vnth Iicense0 contrac�o s �o co s c P I ( •
❑�• and Pmlessions Cotle�. The Contracmrs' State License Law tloes not apply to an owner of property who UuilOs or improves thereon
ana who comracts for such D��ie��s with a coniractor(s) �icense pursuant to ihe Contractors' State License Law). I am aware
I �hal pmol ol ��eir Worker's Compensa�ion insurance should �e provided lo me. . - i
� I am exempi unaer Secilon: B. 8 P. C. �
br �nis reason:
�ate: Owner. � �
I tlo hereby cenily ihal I am aware ot and underslantl ihe requiremenis of Calilomia Health and Safery Code Sectians 25505, 25533, antl �
25570 anA I�at I or any IWure builAing occupanl wilVwill not (circle one) nee0 to comD�Y wit� saiC state coUes antl ihe repuiremenis for a
permii for constmction or moAilicaiion imm t�e Pir �uahry Managemen� OislricL FesiOential consimction apDlicalions are exempt imm
�hese pmvisians. �
Oale: APPhcanl'.�
I here�y cerlAy Ihzl I have reaa Ihis ap0licaiion an0 state tha� Ihe above inlormation is correct I agree �o comply wiih all ciry antl counry
ortlinances an� slalelawsrelatingio builUing conslmclion antl herebV aNhorizerepre5en�aiive5 oflhis ciryto enter upon�he a6ove�men0one4
pmperlY �m in50ec�ion Omposes.
o ��y- `—v`� O � �p �
� Ov /S � Signature:
oriver s License or socia� sewriry w:
16aL46 W�i�e—Builtlinq: Green—Cotle Enlorcemem: Canary—Aoolican�; Pink—Revenue: Goitlenrotl—Nssesnnr
CITY OF COSTA MESA — BUILDING PERMIT PERM N; M �
PERMIT NO: M, 058819 PLAN CHECK NO: N GOVT; N'S P:
,CONSTRUCTION TYPE::V—N PERMIT TYPE; MEC - PURPOSE: OTH �•
JOB DESCRIPTION : 5 TON A/C UNIT �' ` SQ FT: .
CLAIM VALUE; 1,500,00 CALC—VALUE:'� GftOUP.00C; R-3 ,/
COMMENTS; SMOKE DETECTOR RE�UIRED • ' � . .
�rx�r**+r*x�r*�cx�**x�r*�r�***�*** ****���*****�txx*+�*�rx*x�**�*x*��r*****r����e****-�**�c+r**�
7. O N I N G R E Q U I.R E M E N T S • �
S E T B A G K S
------------ MAIN-HUILDING ---------- --------- ACCESSORY BUILDING --------=
Fl2NT: FT IN REAR; FT IN FRNT; FT IN REAR; FT, IN.
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ•' PROV: PARCEL; 42420405 2NE: REF NO; '
PLANNING Ni5TE5> '
. � . - . �... .
If if iE iF 3E �ElE.iE.3E.�f fk ikit iE IE.iE.�E.iE k iE.�E iE iE,1tlFlk fFlE iFiE iE iEiE K� �E �1F iE'iE �f �f �ElE iF�f iF 1E iE iF �E iE iF �k 3f iE �F iE �k IE i! �E ik iE iE IF jf �E iF iE 1E iF if i(• iE if 1F �f iF iF 3E
D E V E L O P M E N T S E.RdV I C E S R E Q U I R E M E N T S '
ZONING APPROVED BY � �� ' DATE:
BUILDING APPROVED BY.: � DATE:
-APPLICATION ISSUED-BY: � � DATE: L�
_ifiEif�Jf,iEihlfiFiP�1F1Fi4.it.�)k3Eiklk�lf.iFiFifiE IEiklEiEiE1EiElFi(�iE iFif
ifiElkiEltiFiFikiEiEi!lEiE1E1EiE�FiEiEiflE�EiEiE1ElEiFiEiEiElfiEiflflElEkifiElFik ifitlElEiEififiFiFlE1EiliflfffifiliEiElEiEiEiEiEiEIEiEiEiElFkiFlElEiE1F.
LEGALIZATION;N "--` F' E E' S U M' M A R Y� -, S�TRUCTURAL SEGMENT;N
- . BLDG PMT -PLUMBING ELECTRIC MECHANIC ; FIRE SMIP/RES GRADING
PERMIT 9'15i �SMIP/NON—RES
PLAN . ��
ISSUE FEE._ _ o*� 15.00
-BUILDING—DIV—>- PERMIT • ISSUE PliAN—CHECK TOTAL PAID . DUE
TOTALS----> 9.00 15,00 G, 0.00 24,00 , 24,00 .00
, �
kEVENUE•-.DIVISION_TOTALS--> ' COLLECTED; 24,00 OVER/SHORT; 00'
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
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'' I N D I V I D U A�li F E E B R E A K D'O W N ` �
TYPE � QTY� D E S C R I P T,Z O,N UNIT COST TOTAL COST
r G.
MEC 1 ZNST FORC—AIR/GRAV,�FURN <= 100 R BTU 9,00 ,� 9,00
� END OF' FEES
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� _ i . - _ � ..a A- �-_ . _- •POO iPA . .. .... , . _ .,:.. " -� . �I
- CONSTRUCTION AND_PLQNNINGa �.�' ' . •. " - � �- .=. ^ - ' ' ' '.= ': _
" ` 1 , DateT� �Inspeitor , ' � ' - "' ' k ; F Date - ��Inspector,� .
: APPROVALS Permit;# - - � - . p; � AFBROVA'LS Permit # ..
r. � ._ .
�- -1.��Temporary Electr,icai Ser.vice or. Pole � _ . • t� � e ��^ 52.,-Pool �&'Equipment� Location - �
- - - ...i� s�" s " - -
2. SoilPi _ • �, �� -_� : ; - - . - ,."s
pe-Undrgrnd. '� ,,F F oc; • t � �� . � r� 53.=Steel�.Reinforcement _ -, � . '° b '
... r r
,� �3.,Electr�i;Cal Cond`uiCUtil,ity-`Undrg`cntl�,� � . � - _ � 54.�Forrris ` ' . � ' - . �
-��4. =iectrical Conduit�Undrgrnd'- � � , � -`� 55 Elec;rical Bond�ng; �� ;',� , - i- ? `
��•5. Steel Reinforce,inen2 i ` -`-� .�, ' ' . 56. -RougFi Pium6ing'& Pressuie�Test ' . ` �� `�
, .., . .
,q�6.;Electrical UFER.Gmd, � , � � r = "-" . _- 57. APPROVAL_TO�COVER;GUNITE ' � � ' ,
_ �r. _
�Li��7�. Fo'otings � � � " �- � 58. Electrical.Conduit-Undrgrnd. �Ja E
.> c". � ^:.x - ' � . �..
i �;$. Foundation _ � � t' - - - - 59. GasPipe, O �Und�grnd.,.Test ` � ' S? F
9. Water Pipe-Undig�nd.;.e ' ' -� � � _ � � 60.�BacKwash L'ines,�P�Trap;�0-Undrgmd. ` � - ' �' ��
.r
10. Structural Floor System �� �� �: � 67. APPROVAL TO=DECK : � '• �
71. Property Sewer Line�& House Connection �-, 62. "Backwash & Receptor ;Finaf }� � 4
-�• xz� � !� �t s� ' � 1
72. Se�wer Cap � y' ; � `.� " 63. Heater & Vent�Fin,al �'.•, - � .'�� ` n
13. Roof Drains a. �._ , . .� " - , � - - - � . _ �� 1 "^
� � j � � 64. �Plumbing System - Final ;, . , �
74. RoughPlumbing � '`' _ . �€ 65.'Electricai-Final ." _ ' .-� ; �i
15. Rough Electrical-Conduit �, _ . a; 66. Solan System-Final �,_ :� 1 . � ` *�'
-�16. Rough Electrio-Wiring�, � - a 67.�F.encing & A'ccess�ApP�oval . • :
17. RoughWirinqSign _ - � - . � ° 68. APPflOVED'FO,R�PLASTERING - ,
18. Rough E�ectrical�T Bar Ceiling s• • _ - 69. P�OU,SPA,SYSTEMS�FI�NA�
' 19: Rough Heating &-Air Conditioning ' ' �" ' - - ' FIRE DEPT. REQUIREMENT � - � ' '
- - - . - - ' :. u"��a7E� .. �..
20.�.Rough F,actor.y F.Preplace � -, ?; �: ' `� O cx .� �APPROVAIS'.^- �Permit # �
i \ i ! \ �'[� = 'E u l �: # .Z +`. , a - �-1 lT (rt
. ^•. �: . i� 7' . . .> .
�. . . _ r 1 = n `a " � ^ �> K :_ , ��-+
21 �'Dutfs, in�StructuieL , .. . - � +� q -g .; -70. Undergrouna Hydro , � �
22. Du�s,Vcntilating,v i • 4.' �, � q;1 r77, producrPipingOG�s �Oil
23�Gas`,:Pipe?Rough &��est ; j� ;'; � � ,y L,x � �72. Undergrounii FlusFi� '
�::
24:•ftoof Framing F�� : rF' %Y�, �� ' i X'73bUndergmit:Stora,g�Tank��Gas ❑Ol
25. Roof Sheathin �'"` = '� -. � ' •"" " > " " '- - •
9 :-Y. �y .r �.. '• �; '� .}.• Y� 74,,.Overhead Hydro,;:
26�T-Bar Ceiling (Structurall &-Monocoat � �- - 75;Dry.Chemlcal " " - �
27xFrame and Flashin � �'� '� ^ � ' .' '. :��- " � T- --
.� � 9: �., �-R 76.�DryStandyipe ,.,r '
F.28�"Lathingw& Siding �x . -:"Z : �� x'.- � 777 FIXED SYSTEM, FINAL'F '' �
.�; .� �•I
� C '� L�i'� _.... :D ".:A., 1 �F. - L
� 29. Insulation , ,^ , , �_ �� �, r 78" FIRE PFiEV. FINA�L � 7 .. t� �
�30.Drywail.Nailing�_%: � ' � � ��x'+ •�� HEALTHhDEPT:REQUIREMENT �
�31. Plaster Brown Coat ' � �` ' .79:`FINAL IN$PECTION � ' " '
c; < < -ir 1 K [ � - �
=�32:.-Elecirical Power Meter-Final ♦ . � =SOrFOOD CERTIFICATE ISSUED ` r
�
3.33._1Final EleCtrit ` ,_, ' '� .,; �, � '� r'NOtes: J ' ' -
.. � / ,_l i� �. 8-ai- Q�:rto oh�r��,e.- c..F.� c�- c.,�r�
,-34.^Final Heating`,& Ai� Conditioning; �� �n/4_ � L��„ • •< t , . �t' • . _ ' ' . '
`1 �
`35.TFinal Gas Pipe-TesY: ' �. � ( � " ` 1 '�` � .�'s, . ' --
['� .. � , �, a.. �F : 7 :�J --4� � � �
�c r, < G;. • � ( I � N+. . _. - .i .
y36. Hood or CanoPY � ' � +. � � is ^ , I 1..�< ; > '�h . ,.
�37rFinal Factory Fireplacefi ' �� '� " `;1 � ' - �^�' .. -:•
.� � f ix +: � ,r o��;.
�-38. Final Piumbing x ��,_� � . • ' . �i I �� �t.+ • ' - .. J „
-. I . � 90 O .. x. �
�:39. Water Service•Final' ' ' ti. �: i� �>. n.''� r
1
� ,40. Gas Service�Final ;:,;, .,. , � � '� :�. ,', � � .. � �.
zA1. Solar pomesticFinai> �'� •- ' �• � � i+� �'� ��' ^ � '
Y. >' � F Y. �l' : F
��42:'BackflowPreventer. ' ;� < � i I t�' < .0 �". � �
.43. Backflow Ir�i9ation•.� �;.� � ; . � - - 1 - : � . . '
7� .' � .Y 'X, �J
.F -+
�44. Landscape Irtiqation System� r ; , ,:, - �� z m r, ;� .. _. _ .
545!�Sound Atte"n'uation �'-; - • K �� ` / _:`' • ~� � � `' 1 '
�� r - ,i n :n r p T iCy -
'+i'46:`;Handicap Regulations " � � `' � � ��. � j _ ^ ;
u
,,47i.F1 SAL STRUCTURE & BUILDING� * �_ � �f� �; = .. �`� � �
''48!RFINAL PLANNING • r : - � �/' �` : i n t . -
�- r
� 49�=Electric Release to-�Edison � I �„�� +� U rt � � ,� -
x5D�SGas-Release to Southem Calitomia Gas Co ,'r i � J� � �`= �� ' ' - �j%r -� `� `
a,51! CERTIFICATE OF�OCCUPQNCY Y ' „ ! ; ;� � - �?
No. Date
.;w�t;ry. �>c:Y i
OWENS-CORNING —.�--+-.�-- -: !.-�--
Fiber� �s
Blanke�c Insulation
;�
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the N,4HB Research Foundation, lnc. labe!
for assured th�rmal 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:
��/9`��.�c�i'u� �uu� /7 /�12 7�'
� Street Lot Number Tract Number
Exterior Walls
Owens-Corning Fiberglas Blanket Insulation
Ceilings
Owens-Corning Fiberglas Blanket Insulation
� ,f ;, //
/
Thickness R-Value
�„ /1
Thickness R-Value �
Floors
Owens-Corning Fiber las Blanket Insulation
Thickness R-Value
Foundation Walls
Manufacturer Type Thickness R-Value
Generel
License No.
By • Title Date
�s�9�aw�eV I,�
Insulai+ / ntr or — �$��" �r�-� -_ ✓�'� �� �`���tLicense No. �� %�L'��
7 ��l /"
By_ Title l/ , t_ Date � l0" �
�Signawre�
Homeowner Copy (White)
S[ate Copy (YelloW) OWENS-CORNING FIBERGLAS CORP.
Builder Copy (Pink)
Insulation Operating Division
Pub. No. i6-BL-699SA Lit�o m U.S.P.. JWy t W] Fibe�9las Tower, Toledo, Ohio 43659
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COSTA MESA BUILDING-SAFETY DEPARTMENT ��
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING 3499 Queens Court _
ADDRESS
OWNEROR Wimbledon Ti$$Q(.'.
TENANT
MAILING 1470 'Jamboree Rd
ADDRE55
c�rv Newport Beach .No640-6800
BRANCH PdSdC12Rd, ' � �
ADDRESS 61 S. Lake Ave. �'
nacNirecT Corbin/Yamafuji N��i'49-7124
OR ENGINEER
ADDRESS 17992 Mitchell' So.� Irvine
CONTRACTORMCLHlll Dev. �Co.
ADDFESS 1470 Jamboree Rd
a-rv Newport Beach rT,o`.640-6800
LIC.NO. . Z%3H%S ' . LICYNO. 1HH%3
-SIZE I NOAF BLDGS. O
OF LOT - NOW ON LOT
USE OP
EXISTING BLOG. � �
Separate permits are required for
electric, plumbing and heating work:
PRD — New Construction
Sinyle-£amily dwelling
I hereby acknowledBe thet I have reatl this application and state
that the above intormation is corract antl agree to comply with
all laws regulating builtling.construction, antl I shall no<amploy
any �person in vialation of the workman's compensation laws of
the State ot Calitornia. � �
I hereby certify that I am properly licensetl es a coniractor under
the State of California� Business and Professions Cotle, Division 3,
Chapier 9, and that such licenses are in full torce antl effect, or I
am exempt trom the provisions of the St �te of Californie B�siness
entl ProfessionsCotle, Di ision 3, C 4pte ' �
Signature of � �
Permlttae '
or
Authoriied Agent Date - '
. '"':�
6076 I/2�I jBit" ` 306.51 TU �
APPLICATION FOR�STRUCTURAL PERMIT
RECEIVE BY PERMIT NO 47791
%/A
A.P. NO. � _�/'� J
BUILDING
aooaess 3499 Qu
UNIT OR ,
SPACE NO. 1�] .
TR.NO. LOT
10275 1
NEW ADD ALTER
REPAIR
OWNER Wimbledon ASSOC.
PRD VP'"
VSE
APPROVED
APPROVEDSETBACKS
PLANNING ACTION
ZE_— -
� �
:1Q4D FOR SPEC
/l %i�i , .
NGROUP- ��' 3
DATE II2�ITJ 1
DATE
APPROVED �-�7��R
THE AMOUNTSHOWN UNDER VA�UATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VA�UATION - PERMITFEE $
�] / PLAN CHECK $ -
$JV /I ��/ TAX $ . .S
TOTALPAID 5?n/ C'/
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