HomeMy WebLinkAbout320 RAMONA PL - Building Permits, . CITY OF COSTA MESA � ,
F BlIILDING DIVISION
Ft� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
J �
FOR INSPECTIONS CALL: (714) 754•5626
��'°"°"°"�� PERMIT NUMBER: 610-00141
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 42532117 . DATE ISSUED: 05/21/2010
ISSUED BY: RMD
JOB ADDRESS: 320 RAMONA PL CM
Vicinity: HOUSE AND GARAGE ROOF
Squares: 2800
Suite/Unit:
Valuation: $9,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 2 LAYERS OF 15# FELT ON A 2:12 PITCEHD ROOF; REROOF
WITH 30 YEAR DIMENSIONAL COMP SHINGLES ON AN ATfACEHD HOUSE AND GARAGE, APPROX 28 SQUARES.
ALSO INSTALL BUILT-UP ROOFING ON FLAT AREA. REPAIR AND REPLACE SHEATHING AS NEEDED.
COMPLIANCE FORMS ATTACHED TO JQB CARD AND CITY PERMIT,
OWNER: STOCKUS, ROBERT L
PHONE: 949-645-9108
APPLICANT: PANDELL, KEVIN
PHONE: 7146527663
CONTRACTOR: DEPINHO ROOFING
Address: 2832 N OLIVE AVEUnit:
Ciry/State2ip: ORANGE, CA 92665
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$o.00
5167.25
$0.00
$1.00
Address: 320 RAMONA PL
City/State2ip: COSTA MESA, CA
Address:
City/Stale2ip:
License No.
License No.
PHONE:
HOURS FOR GONSTRUCTION ACTIVITY; EFFECTIVE 3/11
Monday thru Fritlay - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm.
New Years Dav. Memarial �av. Intleoentlence Dav. Labor Dav. -
License No. 683894
714-632-7663
CELL:
PHONE:
PHONE:
Unit:
Unit: :
irs - Sundays and the following Federal
and Christmas Dav .
NOTICE: The work authorized by Ihis permil shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and fnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
c o I. INSPELiIONTYPE pn� ixnnnis �QOEt INSPECTIONTYPE oa�t iNnnnis
1616 Fined System Final Fire Prevention ' + 206 Final Mechanical
1266 Pool Spa Final �' 208 Final Plumbinq
200 Final Re-Raof _''p /— /0 ,�%w� 210 Final Elecirical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Facrory Fire Place 220 Final Planning Appmval
203 FinalSign 222 FinalSite
204 Final Demolition 250 Final Builtling/Occupancy
WORJ(ER5' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certifcate of consent to sel(-Insure for workers'
compensation, as provided for by seclion 3700 of Ihe Labor Code, for the
peAormance ot the work !or which this pertnit is issued.
❑ I have and will maintain wurkers' compensation insurance, as required by
seclion 3700 of the Labor Code, for ihe per(ortnance ot the work for which this
pertnit is issuetl. My vrorkers' compensation Insurance wrrier and policy
number are���
Ca�rier.
�iliiss needrpl0etwnp�e?tetl7CNLe�peimaCa�vaNeJa�/melrwrtlredOWars(S1001w1ess)
PolicyNumber. ��nC.N�S � l ��l^��
i�
❑ I certify that in the peAormance of the work for which this pertnit is
issued. I shall not employ any person in any manner so as to become subject
to the workeis' compensation laws o! Cali(omia, and agree that if I shoultl
beco e subject t the workers' compensation provisions of Section 3700 of
he L bor Code s all forthwith comply with these provi ions
b
AppliwnfsSiB^aWre „�. ate
�.�,.__.._-. .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVII FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y aKrm that I am licensetl under provisions of Chapter 9(commencing
wilh Section 7000) of Division 3 of Ihe Business antl Professions Code, antl
my license is in full force antl eflect. /�
ic # nClass # l.. ' �
f �_ _
� D
"CbnUacmr's Signawre �--� Date
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affum Ihat there is a construction lending agency for Ihe
peAortnance o( the v.ark fv wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirm thal under penalty of perjury that I am EXEMPT FROM TME
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pmfessions Code: Any cily or counry which requires a permit to
constmct, alter, improve, demolish, or repair any strucWre, pnor to its
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant to the provisions of lhe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt theretrom and
the basis /or the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects �he applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as owner of Ihe propeAy, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentled or
oKered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply lo an owner of property who builds or improves
thereon, an0 who does such vrork himself or herself or through his or her own
employees, provided ihat such improvements are not iMendetl or oHered for
sale. If, however, ihe building or improvement is sold vrithin one yea� of
completion, the owner-builder will have Ihe burden o( proving ihat he or she
tlid not build or improve for purpose of sale.).
❑ I, as ovmer ot the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWct the pmject (Sec. 7094, Business an0
Professions Code: 7he contractors License Law dces not apply to an owner of
pmperty who builds or improves lhereon, and who contracts (w such pmjecl with
a contractor�s) license pursuant to the Contractors License Laws.).
❑ I am ezempt under sec.
Business and Professions Cotle for this reason:
Signalure oate
305]-46(3/01)
Owner ID verifietl by driver's license. ❑ Yes ❑ No , �
Driver's License No. Expires:
Verifcation of Ownership by (type ot document, i.e. - property tax bill or deea):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereDy certify that no excavatbn frve (5) or mae (eet in depth into wfiich a
person is required lo descend, will be made in connectbn wiih work authorizetl
by this permit, antl Ihat no builtling slructure, scaffdding, (alsewnrk, or tlemolition
or tlismantling thereol, will be more than thirty-s�c (36) feet high. (Chap. 32, Gry
2, M 2. Sec. 34i, Tille 8, Calitwnia Administrative Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which woultl
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from �he division.
Applif2n(s Signalure
Division of Industrial Safe[y Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture builtling occupant need to file antl
certify a Business Plan for emergency response [o release or threatened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Depahment by every business which has at any one time during a reported
year a quantiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume o/ 55 gallons, or 200 cubic feet of compressetl gas
at standartl temperaNre and pressure).
2. Does or will ihe applicant or present or fuWre huilding occupant need to file
a registration tortn for acutely hazartlous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Departmenl by
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal lo or greater than a weight of 500 pounds, or a
volume ol 55 gallons, or 200 cubic feet of compressed gas at standard
temperaNre and pressure).
3. Does or will the applicaN or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 0! the Califomia Health and Safety Code provides that the
Costa Mesa Fire Departmenl may require Ihe preparalion, certification and
filing vnth the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with the Fire Department.
4. 1( an RMPP is presently required, has Section 25534 of the California
Health and Safe[y Code been fully complied with7 ❑ Yes ❑ No
5. Does or vnll the applicant or present or tuWre building occupant require tor
Ihe work which is Ihe subject of Ihis application a permit for such construction
or modifcation from the South Coast Air Quality Management District or (rom
any olher ait polWtion tonirol tliSMct or agency? ❑ Yes � No
(Section 658502 0( �he Califomia Govemment Code requires [hat the requested
in(ormation be (umished on applications for noo-residential building pertni[s).
6. Will any part of lhe facility to be conslructe0 under this permit be wilhin
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet Ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safery Cotle).
7. If a permil from the South Coast Air Quality Management District or other
air polNtion control district or agency is required (or Ihe work which is lhe
subject of Ihis application, have all of the disclosures prescnbed by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air pollution
control oifcer).
CERTIFICATE OF COMPLIANCE: I certiy that under penalry of perjury the
information given above is correcL I agree to comply with all slate lavrs and
city ordinances regartling Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cetlify under penalry of perjury lhat I have read this application and state that
the information given is correcL I agree to comply vnth all state laws and city
ordinances relating to building construction, and authorize representatives of
lhe City o( Costa Mesa to enter upon the above-descnbed pmperty (or
inspecti n purpo�e . agree not to occupy or allow occupancy ot any building
aulhori �tl by t is per it until fnal inspec�ion.
S qty olik a eqs� �ate
� s �1 �
`HpNorA�IhonzeaApO�!��� D t_e�
�, Prescripti�
�— -ltestdenYitt�
P eci N:un
'�nhb�
� CerCificaic ut' Cum
AHeratioixs
Gnnerni Informatiun
SitcAddress: !'10,
fc. SiOc
J
idenEial
Agenc)':
llAlc;
CF-IR-AI,T
fPx�e ] �c�i' S�
�! of �turies
Building Type� ingle Family ❑ Multi Family Circic the Froni Orientation: N, L" W, or degrees
Qouditione<I �looi Area (CFA): Projem Type�. ❑ Alterallons ❑ Envelope O Fenesva�ion toof O HVAC
keplucement or ChanQe Out ❑ Duc� keplacemeni ❑ A�ater I-leater
NO�TE: T6ia� (nrm i.e no! lo he used fr�r Nc�uh� Cn�istrucled 1luilding.c or Adtlitirms' .
Ixs�dntinn Vrrle�ev Fnr Opnryue S�u.Jnees (Im� Fm�i'ing u.re Ihe Adas.r cmd Fw�ring SYrfp.c Carza•n�uc�ion mble belo�+�) --
Assembly AI[eratimi .
� Opei» ng of framed cavit)' almie-Aher'aliona' thn7 im�olne dve opening o(Ihe franect caviq+ ofn H�all, ceiling, or _.floor nvais! iw,rlall Ihe
mmidni�r�� ir7ininnnn instdatim� ralaie per ,¢I50 for tl�e nl/ered usa�emblp. Fi➢ in Colaim�as A-C and enier munda�a�p insu/ation vulue 7n Colunu� H.
❑ Repfacement of entire s�ssembly-Replacemem o/�nn enrire wall, cei(ing, or.Jloa� as'semLl�� reyuires the ins�u!luiiar ofComponenl
Pncknee- D insulntion vnlues in Tabfe ]S7-C. Fil! in Colmm�s A- J. _
Surface DeYuils For ti,e t
8 � C
Tag/ Assambly Name
1D� orType�
No�e: Fa
of M.�ss Wnlls sec rurrin� Sttips Constructiun T'able belon�.
. . . .i: - Y � F G � .. -N - 1 ....
ndard Values Froin JA4 Table �
Framed Continuous JA4 Proposed
U- JA4 Table Caviry Insulation Assembly I Assembly
.ctor' Number' R-value� R-Yalue' Cell Valueb U-factory
a�ee Pngc JA4-3 mvd Eg�m(inn 4-1. For'
use
Fin�ring Cousmiclion Iablr: belmr.
L For Tng//D iirdreate t/re identiJica�ion name 111a� nentche.r the building pla+rs.
?. Jndicate 1he Assemblr Nnme or rype: R00%/Ceiling, N�aRs, Floors, Sla6s, CraHd Space, Doors and e�c...lndica�e !he Frame ryye and Size: For
N'aad, Metal, Metal Biiildings, Nluss, enter 2s9, 2zQ or e�c.., see JA4 for other possible fi-amc ppe assemblies.
3. Enlerlhe lhicicness (or moss in inches or Syacing benreen f'urnino members emer; 7G'ar 24"OC; or O�her;jw� alf o�her assembl�� desa�iplian
.rxrch a.r Concrete Smrdwich Panel, Sparrdrel P4nel, Lags, Stran� Bale Pnnel and nte.... .
4. Bnsed mi ihe Climaie Zone; ereier the S�andard U fac�or:firom Ta61e 151-13, C or D for each dif/ereni assem6ly Nmne or t� pe.
5. Enter tlre Tub1e iaumberlha/ closelp rese»nbles 1he propos�ed assemblr.
6. Lri�erlhel7-nalue lhat iv being inslalled in Ihe wall eavitn a� be�ween thefi�nmi�eg; o�her-wise, e�vtm� "0".
7, Lnter dae ConJina�ous bisuloiion R-vahie jor Ihe yropnsed uss'emblp; otherwise, eu�er "p ",
b'. Enier !he rnw and cnlunm of the U-(actor vahic bused ai Colunm F Table Number and emer the Ae•.sembl>> U facmr in Cohmin J
9. Thc /'rapn.sed ilse•embli� LI-fiicta�. Colninoi�.l, inais! be eqttal 10 a' les,s lhan Die Stundnrd U-fncla� in C�b�mu E In compll'.
Furri�ig Strips Consiniction Table for Mnss Vdalls Only
A ls C D r r C H 1 .l IC L M
Propused 1'rupertics uf Masonry and Cuncretc Added lnlerior ur Exteriur L�sul:�tiun
VI'.Jls Rrum Ruiercuce in Turring Sp.�ce f'rum Relerencc
Joinl A� ren[lix Tflldc 4.3.5, 43.G. 4.3.7 Jninl A �cudix 7�ahlc 4.3.13
U ` D c � L L '� V
F�ssembly 10 � �� �° F^ 1-� c a�'u �° __ Final
'G�W �._ ��9 C = G� u
M.isx Nxmc or JA4 Tablc d y � 'a, v ry E 'c o �t � Q� �� Assembly
R ¢ O
Thickness� T e' Numhe�' ��` z � LL= u. �, ',.5 i; �r E'" � C' �J-iaclol'�'� CominCni
� I
� , � �
i �I �
Itegi.t�trniimi Nmnber: liegLx�ru�im� UutelTfine: HEItSProvidm�:
200b' Residentiul Con�p[icmce Form.s dubn,�.t7 2009
i'
e Certificatc ot'
A[1e�vrtious
#
Pa �e 3'0}'
#.of Stories
ROOrING YRODOC7'S (COOL ROOrS) §t57(��2
Wken !he men njer(crinr rnqjs7�rjrme ro Ge rep(uced c�ceeds n�ore thau SOi� njthe cristing rnoJaren, or more Nun 1,000 ff, �nbichever is
less�, IGe nerr ronfing nres uerra7 �eeet Are rnnfr�eg prudrrc! "Cno/ /tonf'rc�rriren+e��ts nf,$J52(b)IHi, l52(b)INir, ar 152(b)lHiii.
Check npylicub/r. nlir.rnntive or ecceptioii be(oH� if �he roojaheratio�r is ezemp� fi�oni �he roofing produc! "Caal Roof" requircmerus. Note: I f an��
nne oflhe ul�erna(ives or ezceptinn GefoH� ix checked, the Aged Solar XeQeclance and T/rerma/ Emi!(ance reyuiremenls fm� roofrng praducls' in
y�l �i) m�e not upylicuGle. Un nnt fill IaGle belnH�. . ___ __ _ _ _
°f�Cool Roofs Nol Required in Climate Zones I-12, 14, and 16 witfi a Low Sloped. Lesa nr 2:12 pitch.
�lt ool Roofs Not Required in Climate Zones I thmugh 9 and ] 6 wi[h a Steep-Sloped Roofs (pitch grenter than 2:12) and product unit weight less
Alternntives tu §352(b)lHi and �152(b)}lii, Steep-slupe ruof (pitcli % 2:12J '
'�� Insulatio�� with a tl�ennal resistance of at Ie:ist O.SS hrft'�OF(Btu or atleast a 3/4 incii air-space is added to [he mof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to § l51(�10; or
, O.Li climate zones 10, 12 and 13, wi�h 1 ft' of free ventilation area of attic ventilation for every lS0 fi� of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet verticnl dismrice of the roof ridge; or '
❑ Building lias at least R-30 ceiling insulntion; or .
❑ Building has tadiant baRier in the attic meeting the requiremenu of §151(�?; or
❑ Building has no ducts in lhe attic; or
❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic. .
�xception to §152(b)1Hiii, Low-slope roof (pitd� <2:72)
❑ Buildi�e has no ducts in the attic,
❑ Roofing area covered by building integra[ed; photovoltaic panels und solar thermal panels are exemp� from [he 6elow Cool Roof criteria.
D Ruof wnstructions lhnt htive thennal mass over the roof inembrane with at least 25 Ib/ft' is exempt from the below Cool Roof criteria.
Note: If no CRRC-I label is available, this compliance method cannot be used, use the Performance Approacli to show compliance, otherw
Check the a licable box below if Exempt from the Roofin Products "Cool RooF' Re uirement:
Roof Slope Product Weight Product Aged Solar Thecmal
�Q���f;i�.n�
■ ■ ��
����
����
����
❑4
QQ
❑4
❑4
SR/5
I D!� I D!� I Io"I I I
1. T/in CItRC Produn /U NumLer cnn Le nbinined (r�om tl�e Coo(ltaof /iuling Cauncil's' Rnled Prroduc/ Uireclnr)� u/ �vwm.cnalrna/.s.arr/prnducrad��enrch r�/m
1. hidicate !he q�ie nf prodxcl ia� Lei�rg rvte�l Inr !hr rnoJlop, i.c. single-pl i' �'��J, uap/ta!! roof, nrelu! rnof, e1c.
1, /(Ihe Aged lie/leclunce is nnl nvniluLle iri,lhe Cnol /tnnf/ialing Cnunci/'s Raled Prndi¢! Dirccmi�� lLen uer Ihe Inifinl (teJleciance vn/uc,�'om /hr. snnte
drrec/a;p nnd ase rlm eqrmlioir (0.7+p.7(/q��i����r' 0.1J ro nbroL� a calculurrd nged whm. Wlrere p rs rhe /nr�inf Sbinr ReJleclm�ce.
4. Check 6or i(U�e dged Relleclance ia' a cnlc�duied valnc �u�ing Ihe e�pmlion aLnve.
5. Calculale /be 37i/ valucGi� rrsing Uio Sl!!- WnrkrHee( «/!r(In:/hvmir.enerev.ca eav/li(fei4/oiid eiNcr dre me�rclling vafrce in U+e SXI Colmim aLni,e mrd n(tnch ��copr
ihe Slil- II'nrkaheer ro lhe CF-I R.
1'o apply Liquid Rieid Appiied Cu:ilings, the coating must be applied ncross ti�c entire mof surface and meet d�e dry mil thickness or coverage
recommended by the coatings manufacturer and meel minimum performancc reyuirements listed in § I I8(i)4. Select the applicuble coating;
Alumiimm-Pigmemed Asphah Roof Coating
Regi.viraiion Nurnber:
200b' Re.sidenliul Compliunce Fnrm.s
Cement-Based Roof Coating
Du�e/Timc:
Other
HGRS!'rnvider:
dugu.cl 200y
J'Fescriptti��e CcrCitimii.e o1� Comuliaiuce: Residential CI�-] 2-Al,
Residemlal Alteratirms � (Yx�'�e � of c
I. �We I IVJme: — � � Ciinia�r-ZuqC.t! � fi ufStories
HEItS VE7�.IT1CAT101�' SUMfl1AliY Tlm enlorcemeu/ ny,ene�� ��lrwdd pnr a;oeciul cmenrion ro dx� HEJIS 6�cusure.i �peciJied in lhie
checklisl beln�r. 4 canpleied nnd signcd CF-4R Form for a1/ lhc rneaa�in�es s/�ecilied shnll Le suGmived io liie building inspecia� 6e(mr Jinol
1)uClSekllin�ecS:.7�t;5tiu�,� HLItSrerijicnliontsrequirec(forlhisnrensmr.
D�'LS rJ NO )'ES: L� Climate Zones 2 tind J-1 G, if�inore U�a�� 40 linear feei of'ueu• m� replacemeni ducia are i�isizilled in unnondi�itmetl
spxce, tlie ducls urc ln 6t sealed per y152(b)IDii amd.the newly instulled ducts are to be insulated pei §I51(1.110.
❑�aC�)'T10�: Lxistind duct spstem� Lh�i1 :u'r. eXluudetl; whiCh flre cunstrucled, insulnlod ur set�lud with �is6estos.
❑ YES ❑ NO 1'P.S: ]n Climate 2ones 2 and 9-]G, if Ihe existinE spaee-conditionino sl'stem (HVAC equipmenl and ductingj is repluced, the
ducts aie to he sealed per § 152(hpDi.
❑ Y�S �❑ NO YCS: ]n Climate Zanes ^_ and 9-16, if [he existing HVAC equipmem is mpluced (including the replacemem of Ihe tiir handler,
� ouidoor coudensing unii of a splii systeiii, cooling or heating coil, or the fivnace lreai�exchnnger) the dueis are io 6e
� sealed per §]52(b)lE.
❑�XC�PTION�. Uuct sYsiems tLat are ducumented tu h�ive Leen previuuslp senled confirmed thruugh H�ILS
� . veriticotion�in necurdance �vith prucedures in the Reference Residenfial Appendia PA3.
� �� ❑�EXCEI'TJO�: Uuct systems with less than 4U liuear feet in unconditioned spaice. - . �
❑�XCLPTIO�: �xisfin� duci sYs[ems construc[ed, insuln[ed or senled �vith asbestos.
12�irigerxnt Charee - Split SyStC�O HERS veri/ica�ion is required.for �hi.s mea.nirc.
G 1'�S ❑ NO YES: ln Climate Zones 2 and S-1 i, when the eaisung HVAC equipment is replaced (includme the replacemem of the air
haudler, ontdoor condensin� uni� of a split 5ystem A/C or heat pump, coaling o� heating coil; or the iurnace heat
exchaneer} o refrieerant charee measuranem shall be verified pe
Central Fan Inte�rated (CFl) Ventilation System and Fan V�'att brav��
The ventilation ren���rements of 4150(oj do not anoly tn existine residential homes.
Ducted Split Systems - Air Conditioners and Heat Yumps: Airf7oH� HERS i�erilicaiim� is reguirec! Jor rhis measurc. �
❑ Y�5 ❑ NO TL�S: In Clima[e Zones� 10 through ] 5, when tlie existing space-conditioning system (H VAC equipmem and ductingj is
� re�laced. the airflo�� and fan watt draw shall be veriSied �er §1;2(b)1 Ci to meet the remiirements of § I51(f17B.
�.ion Author's lleclaration SiatemenY
thal this Certificate of Comoliance documentution is
Date:
C7�
�
N ar C] CEPE
�t G�Z-=766'�
�onsible 7:�[ling Desi�ner's Declardtion St:itemcnt '— �'-
I um eligiblc under Divisinn 3 oi the California Businessaincl ]'rofessions Cude tu uceept responsibility for the buildiug design identified on
this Cenificate of Compliance.
1 cenii)' thnl thc cncrgy (eaiwec und perlmmancc specific�iLion:; for thc building dcsign idcniiiied nn thls Cenii'meic of Cumpliance conform
tu �hc requircincnu; ol'Tiilc 2q, Parts 1 tmd G of tlie Culil'orni<� Code of'ltegulutiuns.
'llic buildiuµ cle�ign Ic�i�ures IdcntiGcd on thi� Certiiicatc of'CumpliEmcc are cunsistcm wilh the inform�tiun pruvldcd tn dncumem thls
build6�� dexign on Ihe olher applicalilc cumpliancc lunns, wurl;shccL;, CiIILIII.IIIUII:,'� I)IJIL'; JIl(I 5�)CCI�ICilllp119 SIIV]I111L1C� lU thc cnliirccmcN
uuenc�� for �innrnval wlth this 6uildin�� nermil aiuolic�riion.
Ntune:
Company:
Address:
Signature:
I'iiane:
Tor tra•si.suuice ur q��esiirnac regurtling thc Lncro�' Strmdru•rl.r, cn»u�cr �hc Enrao r Hotli��c at: J-X!/U-; i?-3."tUU.
1(egis7i�atron /t'ttnrLer' /(egi.rrrarinn liure/Timce.
2(108 Rea•identiul Cwnplim�ce Forms
HEI;S' Yroricier..
d ugicti�i 3(J(lJ
(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, Gn 9262e
ELECTRICAL PERMIT
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
Applitant
Address:
Owner:
Address
320 RAMONA PL
42532117
SHAYFRETWELL
24192 SALERO LN
MISSION VIEJO, CA
STOCKUS,ROBERTL
320 RAMONA PL
COSTA MESA, CA
Contractor: ONE TIME CONSTRUCTION
Address: 24'192 SALERO LN
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+uniLs)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motars to thp
MISSION VIEJO, CA
Phone: 949-716-0566
Zip: 92691
Phone:
Zip: 92627
Phone: 949-716-0566
Zip: 92691
License: 784966
ISSUED BY:
Status: ISSUED
Applied: 04/15/2003
Issued: 04/15/2003
SCOPE OF PERMIT
DEMOLISH EXIST. GARAGE AND CONST. 484SF ATTACHED GARAGE. CONSTRUCT 25SF SFD ADDITION
TO M. BDRM. AND DRESS AREA. NEW 90SF TRELLIS AND 119SF PORCH. RELOCATE WINDOWS AND
NEW FRENCH DOOR; REMODEL M. BATH AND POWDER ROOM.
REF 802-01479. 16 LIGHTS, 14 OUTLET, AND 9 SWITCHES.
AMENDED 5/05/03 - SCOPE OF WORK TO INCLUDE: SERVICE UPGRADE TO 200 AMP AND RELOCATE
SERVICE, ADD 125 AMP SUBPANEL IN GARAGE.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$17.60
$15.40
$9.90
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
Quantity
0
0
0
16
14
9
0
0
1
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 (t
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..............:...over 100 kva/kw
Low Vollage Equipment
Low Volt Wiring System / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Quantity
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
30.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$1820 1
$0.00 0
50.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire antl become void if work Is not commencetl within 7 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepections and final approval must be obtained. Failure �o ob�ain inspections and final approval will resuH in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
za+ses �doo�
WOqKERS'COMPENSAnON DECLARA710N:
I hereby aHirm under penalty oi perjury ona of tha following tleclarations: '
❑ I have antl will maintain e certilicete of consent to self-Insure for woMers' compensetion, es provitled for by section 3700 of �ha Lebor Code, for the peAortnance ol the
work �or which this pertnit is issued.
❑ 1 havd an0 will malnWin workers' compensation insurance, as required by section 3700 ot the Labor Code, for the perfortnance oi the work tor w�ich ihis permit is issued.
My we�kers' compensation Insurance carrler antl policy number ere:
Carner: Policy Number:
(This section need nof be completed il fhe permif is valued et one huntlred dollers ($ f00) ar less.)
❑ I certly thet in the pedormance of tha work for which this pertnit I5 issueQ I shall not employ eny pereon in any menner so a5 to become subJect lo the workers'
compensalion lews of Celitomia, antl agree Ihel if I shoultl become sub�ect Io the workers' Compensation provislons ol Sacllon 3700 of the Lebor Cotle, I shall forlhwith
�ply wilh these pmWSions.
Applicant SignaWre: Date:
WARNING: FARURE TO SECURE WORKERS' ODMPENSATIIXJ CpVERAGE IS UMAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PEW�LTIES AND GNL FlNES UP TOONE HUNDRED
TFKKISAND PaLARE (E100,000), IN AODITIIXJ TO THE COST OF COMPENSATION, DAA41GE5 AS PROVIDED FOR IN SECiION 31060F TME LABOF CODE, IfJrEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hareby aflirm that I am Iicensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 0l the Business antl Professions Cade, and my licensa Is In full
torca antl anacL Lic. a qass #
GontrecroYS SignaNre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that Ihere is a consiroction tentling agency for the peAormance of iha work lor which ihis permit is issuetl. (Sec. 3097, Civil Code).
Lendefs Neme: Lender's Adtlress:
Signeture: Date:
OWNER-BU��DER DECLARA710NS:
I hereby eHi� thet untler penelry of perjury Ihet I am EXEMPT FROM 7HE CONTHAC70RS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business an0 Professlons
Cotle: Any Gity or counry which requires a permit to construct, elter, improve, demolish, or repair eny strucWre, pnor to its issuance, also requires the applicant tor such permit
to flle e signed statemem Ihet he or she is Iicensed pursuent to the provisions oi ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 of the
Business e�tl Professions Code) or thet he or she Is exempt iherefrom end ihe basis For ihe ellegetl exemption. Any violetlon of Section 7031.5 by eny applicant for a permit
sub�ecis the epplicant to e civll penalty of nat more ihan five huntlred doltars ($500).):
❑ I, as owner ot the pmperty, or my employees with wages es iheir sole compensation, WILL DO 7HE WORK, antl Ihe sirucmre is not intendatl ar offeretl for sela (Sec.
7044, Business antl Prolessions Code: The Contractors License Lew does not apply to an owner of properry who hullds or improves ihereon, end who does such work
himsetl or herself or thmugh his or her own em0loyees, provitled Ihat such improvements are not intentled or ofleretl lor sale. If, howeveq Ihe builtling or improvemem is
sWtl wRhin one year oi wmplation, the owner��uiltler will have Ne burden W proving ihat he or she did not build or improve to� purpose ot sale.). -
❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions
Cotle: The contrecbrs Llcense Lew tloes noI epply to an owner of propeny who builds or Improves t�ereon, and who coniracts for such project wilh a contracror(s)
IicensB Oursuant to the Contractors License Lews.�.
❑ I am exempt under sec. Business and Prolessions Code ta Ihis reason:
SignaWre: Date:
Owner ID vprified by drivels license. ❑ Yes ❑ No Drivefs License No. E:pires:
Vedlication 01 Ownership by (rype ot daument, i.e. - pmperry lax bill or deetl):
DIVISION OF INOUSTRIAL SAFETY PERMIT CERTIFIGATION:
❑ I hereby �ertlty thet no ezcava�ion five (5) or more feet in depth into which a person is �equiretl to descenq will be made in connection wlth wolk authorizetl by Ihis
pertnit, antl that no building sirucWre, scaflolding, lalsework, or demolitlon or tlismantling thereof, will 6e more then ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
3q1, Title 8, Califomia Adminislrative Code).
❑ As owneo-builder, I will not employ anyone ta tlo work which woultl reduire a pertnit irom Ihe Division of Industnel Safery, es noted above, unless such person has e
permil to do such work Irom the division.
Signature: Date:
Division ot IntlusMel Safery Permit Number:
CERTIFlCATE OF COMPlJANCE AND AUTHORIZAiION OF EMAV: I cenity untler penalry ot peryury that I have read this epplication and stata that the informailon given is
correct. I aqlee to comply with all state laws end ciy ordinances relafing to Ouilding mnstrucuon, entl authorize representa0ves o� Ihe Ciry ol Costa Mesa to enter upon t�e
ebove-descnbed property for inspection puryoses. I egree not m occupy or allow acupancy of eny building authorized by this permit until finel inspection.
Slgna�ure Of Legal Owner(s) Date
AnNOr Authodzed Applicam Date
CO�E �, IN�PECTIONTYPE
1676 Fixetl System Final Fire Pre�ention
1266 Poo� Spe Finel
200 Fine� Re-Roof
201 Fina� 81xWRetelning Well
202 Fina� Facmry Fire Place
203 Fina� Sign
204 Final �emolition
UATE �$ �QQ�( INSPECTIONTYPE
206 Final Mec�anital
208 Final Plum�ing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finfll Building/Occupency
��
lt�
(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob nddress: 320 RAMONA PL
Suite:
Viciniry:
Parcel Number: 42532117
Applicant GARCIA, HENRY
Address:
Owner: STOCKUS, ROBERT L
Address 320 RAMONA PL
� COSTA MESA, CA
Convactor: ONE TIME CONSTRUCTION
Address: 24192 SALERO LN
MISSION VIEJO, CA
Zip: 92691
Arch :
Address:
Zoning:
Phone: 943829-8114
Zip:
Phone:
Zip: 92627
Phone: 94&776-0566
License: 784966
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 09/13/2002
Issued: 04/15/2003
Phone:
Zip: License: License:
SCOPE OF PERMIT
DEMOLISH EXIST. GARAGE AND CONST. 484SF ATTACHED GARAGE. CONSTRUCT 25SF SFD ADDITION TO M. BDRM. AND DRESS AREA.
NEW 90SF TRELLIS AND 119SF PORCH. RELOCATE WINDOWS AND NEW FRENCH DOOR; REMODEL M. BATH AND POWDER ROOM.
OPEN SPACE: 40% REQUIRED; 48% PROVIDED.
Plan Check: $353.11
Permit: $543.25
SMIP Res: $4.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $900.36
SETBACKS
MAIN STRUCTURE Front 20- 0
ACCESSORY Front 0- 0
PARKING Ezistinq: a
Rear 29-2
Rear 0- 0
Required: 4
FEE SUMMARY
.
PLANNING & ZONING
Left 5- 5
Left 0- 0
Pr000sed: 4
Calc Valuation:
Claim Valuation:
Right 10- 0
Right 0- 0
$ao,000.00
$ao,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 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 tlays. -
INSPECTIONS: In order for the work authorized under ihis permit to be consideretl legal, such work must comply with all applicable codes, and all
required Inapectlons end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
�me-se (e�oo�
WORKERS'COMPENSAnON DECLARAnON:
I �ereby ettirm under penelty of perjury one of ihp lollowing tleclarations:
❑ I heve and will maintein a certiticate oi conSent to self-Insure for workers' compensation, es providetl for by section 3700 0l ihe Labor CoOe, for the peAormance of the
work tor which ihis permit is issuetl.
I have and will maintain workere' compensation insurence, as requiretl by section 3700 of the Labor Cotla, for ihe pedortnance of ihe work for which this pertnit is issued.
My work�e �o ensatien Insu}r� ce carrie� and policy number are: � QC �
' Carrier: \> ��< < vy`�' • i Policy Number. /� v J
(fhis sectian need not be complefed il the permit is valued et one huntlred llers ($100) or less.)
�� I certily that in Ihe pedortnance ot Ihe
compensatlon laws of Cali , ntl
comply with Ihese prov' on9
Applicant Signature:
WARNINO: FAIWRE TO SECURE WO RS' CC
THOUSANO DOLLARE ($100,000�, IN ADDITION TS
LICENSED CONTRACTORS �ECLARATION:
I hereby attirtn t�at I am
force entl ettect Lic. H_
ContractoYs Signature:
CONSTRUCTION LENDING AGENCY:
;6.1Yn�ermit' ' sued, I sh not employ any person in any manner so as to become subject to the workars'
syeot0"6 me su ' t e workers' compensation provislons of Section 3700 of [he Labor Code, I shall forthwith
`- �--rs v 3
Oate:
COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
' CO/APENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3105 OF THE L4BOR CADE, IMEREST, AND ATfORNEV'S FEES.
of ChaO�er 9(com cing wit Section 7000) of Division 3 of lhe Busine�nd Professions Code, and my license is in full
cless a
Date: ��, �J
❑ I �ereby aHirtn that ihere is a construction 19nding agency for Ihe performance of Ihe work tor which ihis permit is issued. (Sec. 3097, CiNI Code).
Lender's Name: �ender's Adtlress:
SignaNre:
OWNER•BUILDER DECLARATIONS:
Date:
I hereby aHirtn that untler penalry of perjury ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7037.5, Business and Protesslons
Code: Any ciry or county which requires a permit to constmct, alter, improve, tlemolish, or repair any simcture, prior to i�s issuance, also requires the applicant for such permit
to file a signed stetement thet he or she Is IlcensOd pursuanl to lhe provisions of the Contrectors License Law (Chepter 9(commencing with Sectlon 7000) of Divislon 3 oi the
Business entl Professions Gode) or Ihat he or she is ezempt therefrom and tha basis for the ellegad exemption. Any violation of Section 7031.5 by any applicant for a pertnit
subjects the applicant to e civil penalry oi not more �hen tive hundred dollars ($500).):
❑ I, as awner of ihe properry, or my employees wi�h weges es thelr sole compensation, WILL DO 7HE WORK, antl the structure is not intended or aNered for sala (Sec.
7044, Business and Protessions Cotle: The Contrectors License Law does not apply �o an owner of property who builds or improves ihereon, end who tices such work
himself or herself or Ihrough his or her own employees, provided ihat such improvements are not intended or oHered tor sale. Ii, however, Ihe building or improvement is
sold within one year oi completion, the owner-builder will have the burden of pmving that he or she did not build or improve for purpose of sele.). �
❑ I, as owner ol the property, am EXCLUSIVHLY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (SecJ044, 8usiness and Profes5ions
Code: The coniracbrs License Law does n0� epply �o an owner ol property who 6uilds or Improves thereon, and who conireds for such project with e coniractor(s)
license pursuant to ihe Contractors License Laws.).
❑ I am ezempt under sec.
Signature:
Owner ID verified by dnver's license. ❑ Ves ❑ No
Business and Pmfessions Cotle for Ihis reason:
Venfication of Ownership by (type ol document, i.a. - property tas bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CEAnFICATION:
�river's License No.
Date:
Ezpires:
❑ I hereby cehify ihat no excavation five (5) o� more feet in depth into which e person is required to descenq will be metle in connection with work amhonzed by ihis
permit, and that no building stmcNre, scattolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle 8, California AdministraGve Code),
❑ As owner-6uilder, I will not employ anyone to tlo work which would require a permit from t�e Division of Indusirial Safery, as noted ebove, unless such person hes e
permit to tlo such work from the division.
SignaWre: Date:
Division of Industnal Safery Permit Number.
CERTFlCATE OF COMPLIANCE AND At7iHOR17.ATON OF ENTAV: I certity under penalry of peryury that I have read this ap0lication antl state that the infortnation given is
correct. I egrae ro comply with all stete laws end city or nences relating m 6uiltling constmction, entl authorize representatives of Ihe Clly of Costa Mese to enter upon the
ebove-described property for inspection purposes. I ag� not to occupy or allow occupancy of eny building authorized by this permit until finai inspection.
C�'7S�GE19�A161:if1J3
1616 Fixed System Finel Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
OATE INiR1AL5
`-� �s _�3 Date
Date
GOOEI INSYECTIONTYPE �
206 Final MecOenical
208 Finel Plumbing
210 Final Elecirical
272 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Buildin9/Occupancy
A�T INTffULS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
JobAddress: 32O RAMONA PL
Suite No
Viciniry:
Parcel Number: 42532117
npplicant: SHAY FRETWELL
Address: 24792 SALERO LN
MISSION VIEJO, CA
owner: STOCKUS, ROBERT L
Address: 320 RAMONA PL
COSTA MESA, CA
Contractor: ONE TIME CONSTRUCTION
Address: 24192 SALERO LN
MISSION VIEJO, CA
Phone: 949-716-0566
Zip: 92691
Phone:
Zip: 92627
Phone: 94&71G0566
Zip: 92691
License: 784966
Status: ISSUED
Applied: 04/15/2003
Issued: 04/15/2003
ISSUED BY:
SCOPE OF PERMIT
DEMOLISH EXIST. GARAGE AND CONST. 484SF ATfACHED GARAGE. CONSTRUCT 25SF SFD
ADDITION TO M. BDRM. AND DRESS AREA. NEW 90SF TRELLIS AND 119SF PORCH. RELOCATE
WINDOWS AND NEW FRENCH DOOR; REMODEL M. BATH AND POWDER ROOM.
1 FAU.
ISSUE FEE
Insl FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst I Rep. Recess Wall Hv
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Faclory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfrn
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$14.80
$0.00
$0.00
So.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unil
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial I ncinerator
Domestic Incinerator
Compressors / Absomtion Svstems
Upto3hp/100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Olher Mechanical Fee
Investigation Fee
Plan Check Fee
Quantity
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.0o a
$0.00 0
50.00 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
$0.00
NOTICE: The work authorized by this permit shall comply with all applica6le handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatirally expira and becoma void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepeetions and final approval mus� be obtained. Failure to obtain inspeclions and final approval will resul� in the ezpiration of �his permi�.
FOR INSPECTIONS CALL: (714) 75h5626
246fMs (fl�W)
WORKERS'COMPENSAnON OECLARAnON:
I heraby efflrm undar penalty of perlury one oi the following tleclarations:
❑ 1 heve entl will meintaln a certilicate ol consent to sell-Insure for woAcers' compensetion, as pmvidatl tor by section 3700 of the Lebor Cotle, for the pertortnence of the
�work tor which t�is pertnit is issuetl.
I have entl will meintein warkers' compensat Insurence, es raquiretl 6y SecNon 3700 of Uia Lebor Coda, for ihe peAortnanca oi the work for whiU this pertnit Is issuetl.
My wOrlcets' mpen Uon Insur cara antl pd.iry �umber are�. �
`�` �e � %��SS
Carner. � �G✓I i � Policy Number:
(Thls section need nof be comp/efed i! (he permit is veluetl ef one hundred dollers ($700) or less.)
p I certity Ihet in t�e pertormance of e),vork Por ieh4 iS� permit i��� sued, I shall not employ any person In eny menne� so es to become subject to ihe workers'
compen5ation laws of Calitoml Q pr et I} I, ou10 becoAvlsub�ect to the workere' compensation provislons o( Sectlon 3700 0l lhe Labor Cotle, I shell forthwith
comply with these pr iei �� 1
APPIIcentSigneture: � � Date: �1����
WARNING: FAILURE TO $ECUq ORKE ' COMPENSqT10N COVERAGE IS UMAW FUL AND SHPLL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE MUNDRED
THIXISANDDIXLARE�E100,000),INADD ONTOTHECOSTOFCOMPENSATION,DAA4IGESASPROVIDEDWRINSECTION3lO60FTHElABORCADE,IMEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I herehy aflirm Ihat I em
to�ce antl eNecL Lic. A_
CQnirectoYs Signature:
of Chapter 9(commencing with Section 7000) of Divlsion 3 of ihe Busin�js and Professions Code, and my license is in full
Cless tt l5
�„1/ Dete: �1'—�,S v
CONSTRUC710N LENDING AGENCY:
d I here�y eNirm ihat ihere is e construction lending egency for the pedormance of the work for which ihis pertnii is issued. (Sec. 3097, Civil Code).
LentleYs Name: Lender's Adtlress:
SiBneture: Date:
O`NNER-BUILDER DECLARATIONS:
I nereby attirtn that under penalry ot perjury Ihet I em E%EMPT FFiOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Busineu and Professions
Code: Any ciry or cou�ry which reQuires a permit to construct, alter, imprrne, demolish, or repair any siructure, pnor to its issuence, elso requires t�e applicant for such permif
�p file a signed statement Ihet he or she is Ilcensetl pursuent to the proNsions ol the Contrectors License Lew (Chapter 9(commencing wilh Saction 7000) oi Divislon 3 of the
BUsiness and Professions Cotle) or that he or she Is exempt iherefrom and ihe basis lor ihe alleged exemption. Any violation ot Sectian 7037.5 by eny epplicant tor a pertnit
suhjects the applicant to a civil penalry of not more than live hundred dollers ($500).):
d I, as owner of iha property, or my employees with weges es Iheir sole compensation, WILL DO THE WORK, and the siructure Is not intended or oNered for sale (Sec.
7044, 8usiness and Professions Cotle: The Contractors License Law doas not apply to an owner of propehy who 6uilds or improves thereon, and who does such work
himself or herselt or t�mugh his or he� own employees, provided iha� such Improvemems are not Intentled or oHarea for sale. If, howaver, ihe builtling or impmvement is
soltl within one year oi complelion, the owner-builder will have the burtlen of proving that he or she did no� 6uild or improve lor purpose of sale.). '
❑ I, as ow�r ot lhe property, em EXCW SIYELY CONTRACTING WITH IICENSED CONTRACTORS to constna fhe prqect (Sac. 7044, Business antl Professions
GoOe: The contracmrs Llcense Law does not appry m en owner oi pmpeny who bullds or Improves Ihereon, and who contracts tor such project with e coniractor(s)
license pursuant to tha Contractors License Laws.).
❑ I am exempt under sec.
Signawre:
pymer ID ventied by tlrivafs licensa. ❑ Yes ❑ No
Business end Prolessions Code lor this reason:
Verification ot Ownership hy (type ol tlwument, i.a. - pmpeny taa blll or Deetl):
DI�ISION OF INDUS7RIA� SAFETV PERMIT CERTIFICATION:
Orlver's LicenSe No.
Date:
Expires:
❑ 1 hereby certify t�at no excavetion frve (5) or more �ee� in depih into which e person Is required to descend, will be made i� connection with work authorized by this
pertnit, and that no builtling strucWre, swffolding, lalsework, or demolition or dismantling thereof, will be more �han ihirty-six (36) feet high. (C�ap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Califomla Atlministretive Cotle).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division o� Industrial Safety, es noted ebove, unless such pereon hes e
parmit to tlo such work from the tlivision.
Sig�eture: Date:
Division of Industrial Sefery Permit Number:
ICER7IFICA7E OF COMPLIANCE AND AUTMORIZATON OF EN7RY: I ceniy under penalry of perjury t�et I he�e read �his application end state iha� Ihe infortnetion given is I
correct. I agrae to comply with ell state laws end ciry ordlnances relating to building construction, and authorize representalives ot Ihe Ciry ot Costa Mesa to enter Upon the
ebo�e-descnbed properry tor inspection puBpsec.f�qree not to acuDY or ellow occupancy of any building euthorized by this permit until finel inspection.
£Qp�, {NSPECTIONTYPE QAIE 1�9A$
1616 Fixed System Finel Fire Prevention
1266 Paol Spa Finel
200
201
202
203
204
Finel Re-Rooi
Fina181ocWReleining Wall
Final Factory Fire Place
Final Sign
Final Demolition
�--(S �'8
Data
COpE! INSVECTONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Plnel Electrical
212 Final Fire Prevention
220 Finel Plenning Approval
222 Final Site
250 Final Building/Occupancy
� 1 1111 .
.;, ��{
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
320 RAMONA PL
42532117
SHAYFRETWELL
24192 SALERO LN
MISSION VIEJO, CA
Owner: STOCKUS, ROBEf2T L
Address 320 RAMONA PL
COSTA MESA, CA
Contractor. ONE TIME CONSTRUCTION
Address: 24192 SALERO LN
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors to 1hp
Motors to 10hp
Motors to SOhp
Mo[ors to 100hp
Motors over 100hp
MISSION VIEJO, CA
Phone: 949-716-0566
Zip: 92691
Phone:
Zip: 92627
Phone: 949-716-0566
Zip: 92691
License: 784966
ISSUED BY:
Status: ISSUED
Applied: 04/15/2003
Issued: 04/15/2003
SCOPE OF PERMIT
DEMOLISH EXIST. GARAGE AND CONST. 484SF ATTACHED GARAGE. CONSTRUCT 25SF SFD ADDITION
TO M. BDRM. AND DRESS AREA. NEW 90SF TRELLIS AND 119SF PORCH. RELOCATE WINDOWS AND
NEW FRENCH DOOR; REMODEL M. BATH AND POWDER ROOM.
REF 802-01479. 16 LIGHTS, 14 OUTLET, SWITCHES.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$17.60
$15.40
$9.90
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
16
14
9
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech nde or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 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
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, § 7, 7241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 tlays, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetione and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-O61N00)
WORKERS' COMPENSATION OECLARAYION:
I hereby affirtn undar penalty ol perjury one o� ihe following declarations:
❑ 11iave�ntl�alnte� certif � of con to selid r for wor m on, es ed Por b tlon 370�e Labor Code, tor ihe pertormance oi the
� I have antl will maintain workers' comp@nsation Insurance, as required by seclion 3700 of Ihe Lebor Cotle, lor ihe pertormance of the work for w�ich this permit is issuetl.
My workers' compansatlonJnsure e Carrler and policy number are: ,, _. _��
Carder. �. / %C �^ .
Policy Number. ��— ��iJ
(Th/s secfion need nof be completed Il fhe pa�7t is velued ef one �
orless.)
❑ I certity Ihet in the perfortnence af the work lo h�IMs' f(iit is Is ed, I shall not employ eny person in eny manner so as to become subject to the workers'
compensation laws ot Ce rnle, e e I I If I sho ecome � �ect to Ihe workers' compensalion provislons ol Sectlon 3700 of the Labor Cotle, I shell forthwith
complywiththese � s. � �� �
Applicant Signature: � Date: � �
WARNING:FAILURETOSECU EWORK COMPENSATIONCOVEPAOEISUNLAWFULANDSHALLSUBIEGTANEMPLOYERTOCRIMINALPENPLTIESANDGVILFlNESUPTOONEHUNDRED
THOUSANDDOLLARE($100,000),INA�D IqJTOTMECOSTOFCOMPENSATIqJ,DANAGESASPROVIDEDFORINSECTION3I080FTHELA80RCODE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATItlN:
I hereby attirm that I am licensad unQ� r pmvisions ot Chapte 9(wmmencing with Section 7000) of DiWsion 3 of Ihe Businefys and Professions Code, and my license Is in full
force end efted. Lic. N 7�' �'�" ( / Cless p l>
ConirectoYs Signeture: � �i ,� � �y Date: ���U 3
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirtn that there is a construction lending egency for the pertormance ol ihe work for which this pertnit is issued. (Sec. 3097, CiNI Cotle).
Lentler's Name: Lentlers AdGress:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn that under penalry of perjury ihat I nm EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or wunry which requires a pB�i� 10 construa, alter, improve, tlemolish, or repair any strucNre, prior to its issuance, also requires tha applicant tor such permit
to tila e signetl stetement t�at he or she Is IlGensetl pursuent to the provisions at the Contrectors License Law (Chapter 9(commendng with SecOon 7000) oi DMsion 3 ot the
Business and Pmlessions Code) or t�at he ar she is eaempt theretrom and Ihe basis br the alleged e:emptian. Any violation oi Section 7031.5 by any applicant tor a pertnit
subjects the applicant to e civil penalry oi nat more than fiva hundred dollers (5500).):
� I, as ownar W the proparty, or my empfoyees with wages as thali sole compensation, WILL DO THE WORK, an0 ihe siruc[ure Is no� Intended or oHered for sale (Sec.
7044, Business and Pmlessions Code: The Coniracbrs License Lew tloes not apply to an owner ot properry who builds or improves thereon, antl w�o dces such work
himsell or hersell or ihrough his or her own employees, provided ihat such improvemenis are not Intentletl or oHeratl lor sale. It, however, the building or imprwement is
sold within one year of completion, the owner�builder will heve �he burden of proving that he or sha did not build or improve tor purpose ot sele.). �
❑ I, as owner of tha properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the pmject (Sec. 7044, Business and Professions
Code: The wmractors License Lew tloes not epply to an owner ol property who builds or improves thereon, and who wmracts far such pmjact with a contrector(s)
license pursuant lo the Contrectors License Lews.).
❑ I am exempt under sac. Business and Professions Code lor ihis reason:
Signature: Date:
Owner ID venfietl by tlrivals license. ❑ Yes ❑ No Driver'S License No.
Verilication oi Ownerehip by (type ot Cocume��. I.e. - property taa bill or tleetl):
DIVISION OF INDUS7RIAL SAFETY PERMR CERTIFICATION:
Expires:
❑ I hereby certify t�at no excevation five (5) or more feet in depth Into which a person is required Io descend, wiil be made in connection with work authorized by this
permit, and that no huiltling SWcture, S�Nolding, telsework, or demolition or tlismantling thereof, will be more ihan thirty-six (36) teet hiqh. (Chap. 32, Gfp 2, Art 2, Sec.
341, Tltle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do wark which wauld require e permit Irom ihe DMsion of Indus�nal Sefety, as noted above, unless such person hes a
pertnit to do such work irom the division.
Signature: Date:
Division ot Industnel Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I caniy under penalry of perjury ihat I have read ihis application and state that ihe information given is
correcl. I agree to comply with ell state laws entl ciry ordlnances releting to building consiruction, antl authodze represeniatives oi the Ciry oi Costa Mesa to enter upon Iha
ebove-descnbed property for inspection purpPses. I egree no�o occuDY a� allow occupancy of any 6uilding authorized by this pertnit until final inspection.
COpE I, INSPECTIONTYVE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201 Final Block/Retalning Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
��G� ��7 Date
j
Date
QdjE f�IIp7�4$ �QQEj INSPEGTIONTYPE �
206 Final Mec�aniwl
200 Finel Plumhing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Sita
Final Building/Occupency
�g
,�m _
(7/4) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 320 RAMONA PL
Sulte No
Vicinity:
Parcel Nunm6er: 42532117
Applicant: ONE TIME CONSTRUCTION
Address: 24192 SALERO LN
MISSION VIEJO, CA
Owner: STOCKUS, ROBERT L
Address 320 RAMONA PL
COSTA MESA, CA
Contractor: ONE TIME CONSTRUCTION
Address: 24192 SALERO LN
Arth / Eng :
Address:
ISSUE FEE
BackFlow irrigation
Backflow Preventer
BathNb
Clarifer System
Connect Qce,Soda,etC)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
MISSION VIEJO, CA
Phone: 949-71G0566
Zip: 92691
Phone:
Zip: 92627
Phone: 949-716-0566
Zip: 92691
License: 784966
Phone:
Zip:
License:
ISSUED BV:
Status: ISSUED
Applied: 04/15/2003
Issued: 04/15/2003
SCOPE OF PERMIT
DEMOLISH EXIST. GARAGE AND CONST. 484SF ATTACHED GARAGE. CONSTRUCT 25SF SFD ADDITION
TO M. BDRM. AND DRESS AREA. NEW 90SF TRELLIS AND 119SF PORCH. RELOCATE WINDOWS AND
NEW FRENCH DOOR; REMODEL M. BATH AND POWDER ROOM. REF 802-01479.
1 BATNTUB, 1 SHOWER, 'I WASH BASIN, 1 WASH BASIN SET, 2 TOILETS AND RELOCATE 1 WATER
HEATER.
AMT
$23.50
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irtigation $0.00
0 P-Trap $0.00
1 Pressure Regulator $0.00
0 Process Piping (per 10 ft) $0.00
0 Receptors $0.00
0 Septic Tank $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Connect $0.00
0 Sewer Private Line $0.00
�n
0
0
0
0
0
0
0
0
0
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
AMT
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$9.80
$0.00
$19.60
QTY
0
0
0
0
0
0
1
1
0
2
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 1241-92)
EXPIRA710N: 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 periotl of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapections 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
zaas-ae (eroq
WORKERS'C�MPENSATON DECIARAnON:
I hereby affirm under penalty of perjury o�e of ihe following declarations:
❑ I heve edd wlll maintain a certifkate of consent to self-Insure lor workers' compensetion, as provided tor by section 3700 of the Lebor Code, for the performance of Ihe
work for which this permit is issued.
�I have end will maintaln workers' compensation Insurance, as required by secllon 3700 of lhe Labor Code, lor ihe pertortnance of tha work for which this pertnit is issued.
My wodcd+s.compensatbn I suran cerder antl pollcy number are: �� I^�
� � /'Y X
Carner. 5 �`�F' /v+U PoliCyNumber: �U`O�J
(This secfion need nol be comp/eted i! the permit is ve/ued af one hundretl tlollars ($100) or less.)
❑ I certity Inet in the performance oi the work lor which 1�permit is issuetl, I shall not employ any person in any manner so as to become subject to tha workere'
compensatlon laws ot Ce�jtptnia e r .that if I s Id beco subject to the workers' compensation proWsions oi Section 3700 ot tha Labor CoAa, I shall fotlhwlth
COmply with t�esa pr S'io � - (—
ApPlicent SigneNre: ✓��� Dete: � �✓ v %
WMNINO: FNLUAE TO SECURE WORI 6�C01APEN5 TION COVERAGE IS UNUWFUL AND SINl1 SUBJECi AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRE�
THOUSAND OOLWRE (5100,000), IN AO TION TO THE COST OF COMPENSATION, DAM4GE5 AS PROVIDED FOR IN SECTIIXJ 3]Ofi OF THE UBOR CODE, IIJrEREST, FND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eNirm that I em
force entl eMac�. Lic. M_
Contraaofs Signature:
of Chapter �commencing wlih Sectlon 7000) of Division 3 of the Busine�and Protessions Code, entl my license is in tull
CI85S M�--
Date: 'T–i.i
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby attirm iiiet ihere is a consiruction tending egency tor ihe pedormence ot tha work for which �his pertnit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lendars Adtlress:
Signeture:
Date:
OWNER-BUILDER DECLARATONS:
I hereby a%Irm �hat under penalry of Derjury thet I um E7(EMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry which requires e permit to construct, alter, improve, demolis�, or repair any sirucWre, pnor to its issuance, also requires ihe epplicenl lor such permit
to File e signed statement Ihet he ar she Is Ilcensed pursuent to Ihe Orovislons ol the Contractors License Law (Chepter 8(commencing with Section 7000) af Divislon 3 of the
Business flnd Professions Cotle) or Ihat he or she Is e:empt theretrom end the 6esis tor the alleged exempibn. Any vbl8lion ot Sectbn 7031.5 by any epplicent for a permit
subjecis the eDPlicant to a civil penaly oi not more than five hundred tlollers ($500).):
❑ I, es own�r of Ihe properry, or my employees with weges es Iheir sole compensaiion, WILL DO 7HE WORK, and Iha siruc�ure is no� intendetl or offeretl for sale (Sec.
7044, Bu4lness and Profassions Code: The Contractors License Law tloes not apply to an owner of property who builds or Improves thereon, anG who tloes such work
himselt or herself ar through his or her own employees, pravidetl thei such improvemenis ere not intended or oflered tor sala. It, haxever, ihe building or improvement is
sold within one year of completion, ihe owner-builtler will heve the burden ol proving lhat he or she did not builtl or improve for purpose of sale.). '
❑ I, es own8r ot the property, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct the D�alect (Sec. 7044, 9usiness and Professions
Cotle: Tho contrectors License Lew tloes not apply to en owner of propeny w�o builds or Improves Ihereon, end wha conirects lar such projeci with a conirector(s)
license pUrsuam to iha Comractors License Lews.).
❑ I am exempt under sec.
Signeture:
Business antl Professions Code for this reason:
Owner ID venfiBtl by drivers license. ❑ Ves ❑ No Drivers License No.
Venficetlon of Ownership by (type ol tlocument, i.e. - property tae bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Date:
Expires:
❑ I hereby certily that no exwvation five (5) or more Feet in dep�h into which e person Is required to descend, will be made in connection with work authorized by Ihis
pertnit, entl t�at no building slrucWre, scaHoltling, falsework, or tlemolition or dismantling thereoi, will be more than thirty-siz (36) feet higR (Chep. 32, Grp 2, A� 2, Sec.
341, Title 6, Califomia Atlminisiretive Code).
❑ As ownervbuilder, I will not employ enyone to do work which woultl requlre e permit fmm the Division ol Industnel Sefery, as notetl abwe, unless such person hes a
permit to da such work irom Ihe divi5ian.
Signeture: Date:
Division oi Intlus��al Satary Permit Number.
CEfi71FICATE OF COMPLIANCE AND AUTHORIZATON OF EMRY: I cenity untler penalry of Derjury that I heve read this epplication and state that ihe inlormation given is
corred. 1 egree [o comply with all state laws entl ciry ortlinan s relating to building consiruction, and euthonze representalives ot ihe Ciry of Costa Mesa to enter upon tha
ahove-dascri6ed p�operty tor inspecGoo purposes. I egree n� occuQy or allow occupancy of eny building authorized by this pertnit uNil final inspection.
ll���/C/l��t � � ��5��7
AnNOr Aut O�z ApDlicant Date
GOOE I, U15Pi4TIpNTYPE_� – UATE INTRIALS
1616 Fixetl System Final Fire Prevention
1266
200
201
202
203
204
PwI 5pe Fina1
Final Ra-Roof
FIna181ak�Retaining Well
Final FPctory Fire Place
Finel Sign
Final Demolitian
4ppE� INSGECTIONTYPE
206 Finel Mechenical
208 Flnel Plumbing
210 Finel Eletirical
212 Final Fire Prevention
220 Final Planning Appro�al
222 Final Site
250 Final Building/Occupancy
�� ��
OWNER DIKE 8: COLEGROVE � DATE ].O-ZI.�.-CiLI
JOBADDRE83 320 Ramona Place BUILDINGPERMITNO. (�'��
GENERALCONTRACTOR Owner VALUE$ (j,5nn_7n
LOT 7 BLOCK TRACT 2'jl� ,$ine12 Family Resid�ri�"`_
GROUP I TVPE V ZONE RI1 FIREDISTRICT 626
PERMITSISSUED
INSPECTIONS _ DATE $UBCONTRACTOR I
DATE I NUMHER
Foundation Forms and Grade to
Rough Framing -��
Plumbing, Rough to Slab �
Plumbing, Rough Complete '
Temporary Pole
Wiring, Rough u
Heating, Rough %�'
Heating, Final �1G
Lathin9i/✓� �a,(.u:4c' �%7
Plastering �
Plumbing, Final, Fixtures Comp�
Plumbing, Fi�l Gas Test/J _
Wiring,Final �3GG
Occupancy �
Form YIO GH 1M 12-68
' 7_J
�,30
—3-.3
.-6-�'
�7,,
/b'J�
6 .U1�'-
. (7,osta_Mesa Building Department APPLICATION FOR PERMIT
`*�,� �' 111 EAST 20th STREET 6�6 ��' L D �I�.N G_ ._. _.____'�.
, COSTA MESA, CALIFORNIA -�
FOIt APPY.ICANT TO I+'�LL IN ` �OR OFFICE �TSE ONLX ;
_ 1 f Receipt No. Perrriit No. `
Building ' � �
Addreu 320 Ramona Place I ��� �%3 G�!� !
Received�by Date Rec'd. Date issued �
Costa lilesa, California { Y' ' �
Nearest � � ° � �� �d_�� �
CrossSt. ,.'�Iltifl l�a Avenue Building � r
Address j
Owner Dike & Calegrove '� CostaMesa,California �
Mail �
nddress 419 E. 17th Street r.�ea�est ; �
Tel. e y Cross St. � I ,�
c;ty Costa Mesa rvo. 8-1159 zooe p�; I No.of I Type� i Group �
Architector Lic. �I Plans ' �
Engineer $ll�;tl G1bbS No. Approved 4 � ;
— by � Da1e
nddress441�i, l at St .�._IA1ng Beach � COgLRd�+`CTIONS
,
City Lw. — � — � —
co�t�aoto� Di ke&Co�e�rove No. ! �
nddress 419 E. 17th St. , Costa Metsa � +
Legal Lot I � _ _ I ' .
Description I No. �J I BlockNOREI Tract2'Jl� , �
(Attach Metes and Bounds)- - � - ,
No. of Bldgs. � _ f �
Size of Lot 135x60 I Now on Lot None - --- - -
. : . . . . � ' • 0
Useot I No.of I No.of �, ��;a '� 9
Existing Bldg. — — Families Rooms� ----�� �j—t�C�-�--Z
Setback Line from Rear Yard - - -- -- --- --' --
Center of Street 55' Sitle Yard �j t.�.� y
�,- .: <, r: c� r
DESCRdPTION OF WORK — �,�iy ��- ���5�
New �� I qlteration I I Addition I bN-i--kif �-b
.�f,.�buvr � �-
Repair I I Movi�g I I De�nolish I � y
r. Building No. of "
Size H011Se %TE�ooms 6 Stories 1 —
Exterior Wall Roof AppROVALS
C�=vering S'GL1GG0 I Covering Of11�0 �
Use of New
Building Slrigle X''fln111y RES . Foundation �ocation �nspector oate
— — Farms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
Lath.lnt.
I hereby acknowledge that I have read this Application ,
ond �tate that the abovC is correct and agrec to comply Lath: Ext.
with aIl City Ordinances and State Laws regulating
building construction. Plaster, Int.
�Si9nature of
Permittee Plaster, Ext.
Autharized Aqt.
sonry Reinforced
Valu,ation Permi[ Fee $
Plan Check $ Bond Beam
$ (���� � Total
Fee $ /�aS FINAL
�
�
J
d
e
�
a
8treet
� PLOT PLAN.
:,,�: : � . 1 'r�i�
Show'loeatlo� 'andLdistances f�om -'
property line and between bufldings.
��:I ' ,
., � ! ., x c, ..1
_ `^ _ _
� .:
�t �
Y
L � , _ , . '
, .. �•� JD� , '
.. �_ ' `
OWNER TOM JF]rTELL DATE �-13-7$
JOB ADDRE$$ Z g��a Wla.�r BUILDING PERMIT N0. l�p($q
GENERAL CONTRACT � R H��,.� DESCRIPTION.of WORK pdd.. to Res. _
AP No. 117-221-25 LO7 5 TRACT 231A FIRE ZONE VALUE S l�,.rcxi_m
GAS
WAT
NE) IHOUSE CON.
UNDERGROUNO �Oj� POWER
ROUGH WIRING
BOND BEAM Q STEEL PE
SHERTHING
FRAME RND FLASHING _
PLASTER. BROWN CORT
SUBCONTRACTOR
F
�
a
d
�
y
.T.
F
0
w
F
a
0
J
a
>
�
.�
a
w
a
O
�.
a
2
S
3
4�68�.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Ffll in Completely — Use Ink Only
eui�oiNc .,.. �r;- . .. m. . _
OWNER
MAIL
ADDRESS
��TY Gr��s
CONSTRUCTION
�
BRANCH
ADDRESS
ARCHITECT
L
TEL.
ADDRESS ���OA
CONTRACTOR �_ i�� v�LQfj��/(,Q
ADDRESS _2/J-rj ' �- — /F' �j ��.
' TEL./
CITV C' �� NO�y�'�I'f"2-L
STATE CITV /'��p�Q
�I0. NO. � f 2� — LIC. Nd'
SIZE ��-�,^�� � NO.OFBLDGS. /
OF LOT ,S NOW ON LOT
USE OF �
EXISTING BLDG. �,(���/J�%�l G/�'
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledpe t�at � have �aatl thl� applicetion ontl rtate
that the ebova Informatlon is correct antl eBrae So compiy with
all laws rapu�eting Eulltlinp conttruetion, entl I e�ell not empioy
any person in vlolailon of Me workmen'e eompensation lewa of
the State af Calltornia.
I hareby cartify ihat I am pfopetly Ilcensetl as a contractor untlar
tha Stata of Cellfornia Buelneas end Profasslona Code, Dlvision 3,
Chapter 9, antl that aueh Iicenfes aro In full torce and effact, or I
em axempt from the provislons af tha Stata ot Celifornia Businesa
antl Pro�aulona Cotle, Dlvisl0� 3, Chepte� 9.
Sipneiura ot
Permittee
Authorizatl Apant �
�lCi 1T�7S�pcn�llO aQs�: *::*115.1Z
TION FOR STRUCTURAL PERMIT
A.P. NO. II7 �/.� I
BVILDING �wD qr
ADDRESS , �,
TRACT L .� I O
OWNER IO
FIflE
ZONE
APPROVED
_� 7 —
iM1T NO.
ZONE NO.OF USE OF NEW Cw�-r•.�
R I ru�rs z eu��oiN� aDD W1R
VARDSAPPROVED VARDSAPPROVED
�2
BET. MAIN &
VAR. 9W
C.U.P.9W
N
n
m
i
0
U(J SQ. FT. �S/OK�4� I� rv
THE AMOUNT SHOWN UNDEF VALUATION IS FOfi m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
VALVATION PERMIT FEE S d
J�
ro
PLANCHECK § �!!QY— "�
$��,��\ 0
(/U (/ TAX $ / � /L U
TOTALPAID E .� %
OWNER �� ��y DATE lp-�_'j�
JOB ADDRESS �2p Raabna Place BUILDING PERMIT N0. !{p(c7p
GENERAL coNT AC70R r._ x_ xnwnrd DESCRIPTION oF WORK Gnraae
�AP No. u�]_�
Q,INSPECTfONS
�p SOIL
\'� GNS
-�` W ATER
�[iOUGH PWMBING
3PROP. SWR. �INE [
JSPRINKLING STSTE
_p MISCELLANEOUS
QROUGH HERT�NG AN
TRACT FIRE ZONE
POWER I I I f?�.G
FORMS �'I STEEL REINF.
BOND BEAM n STE
SHEATHING
FRAME AND FLPSMING
LATHING - IN n 1
PLASTER. BpOWN COAT
SUBCONTRACTOR
- � � 4nb�:�
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BVILDING –J
ADDRESS �J O �/
OWNER J � � (,�J = C�
MAIL ... . �_. ,./ . _ i-/
CITV �
CONSTRUCTION
LENOER %
BRANCH
ADORESS
ADDRESS
R
TE
TE
A.P. NO. /�
BUILDING
ADORE55
TRt1CT
F
PG:u
iCT 13-?5�„�,00 496 � *�**�I?_.50
FOR STRUCTURAL PERMIT
DATE RECEIVED D%ATE ISSUE❑
/ � _
.� � � � l- PERMIT NO.
Mol
LOT
VALUE
ADDRESS zJ ^ J_. �
TEI. ZONE NO.OF USE OF NEW
CITV NO��% y�j
PLANS BUILDING
F STATE CITVQ,Q�G6Q �'ARDSAPPROVED YARDSAPPROVED
� IIC. NO. � — LIC. NO. MAIN BUILDING ACCESSO(iV BUILDING
k7 SIZE / NO.OFBLOGS (FROMC/LSTREET)
0. OFLOT `��, ��, � NOWONLOT RONT FT. /� FT.
a USE OF
� EXISTING BLDG. / S �/=' _� T. � FT. �
h
FSeparate permi[s are required for L SIDE FT. FT.
0 elec[tic, plumbing and heating work. qEAq FT. FT.
W USE OF BUILDING AND WOFK TO BE PERFORMED
F DISTANCE BET. BET. MAIN &
�Q �� � � �— MAIN BLDGS. ACCESS. BLDGS.
� VAR.� DATE
J C.U.P.�W APPROVED
a
� A7PROVED r� �^
}
J
�i
W
0 I hereby eeknoW�etl9e t�at I hevs reatl thie eppllcafion entl stnte
Qf ffiat ffie above I�formetfon b correct and epree to comply with
p+- eil laws repuleNnY builtlin0 �onrtruction, end I ahell not employ �
wany perwn In v�olation of t�e workmen's campenaatian law� of
y. ffie Stata of Celifornla.
3 I �areby certify that I am proparly Iicanwtl as e cont�ector under 54. FT.
the Stnte of Cellfornla Bualnap antl Profaulone Cotle, Dlvislon 3, THE AMOVNT SHOWN UNDER VALUATION
Chepter 9, antl thei �uch Iicen�e� era In full torca entl alfaet, or I THE PURPO6E OF ESTABLSHING A PERMR FEE
em axampt froT the p�ovi�lons of tho Stata of Californle Bu�inau VALUATION PERMIT FEE S
enE Profasalons Cotle, Dlviflon 3, Chaptar 9. � �
PLAN CHECK S
Slpnemra o4 ///���
Permittae $��/� �— TAX S
� l
Authorized Ageht f� � TOTAL PAID S
l
n
m
i
0
m
N
IS FOR m
ONLV: �
n
m
m
•— o
� U
Z .
av
�- Z
Z F
O <n
am
J �
J N
Q W
p] J
J m
Q
UN
Z a
W �
aw
wz
J Q
m Z
J �
W W
�
ZH
W �
N 2
70
30253
COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
�� rato ��;r.�trf� \1
AY —8-G9�;jsk00 579 � 8.00 ,
- APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
j�,l_,'QDq RECEIV DBV D�j. E IV D ISS ED
AD'DRESS •��L FN�'w�{ {�• l.'OSTA WE�� `� �
OWNER OM S W yUJ"�. . A.P.NO. '� '�..� / fl nNO.
MA I L �7 BUILDING
ADDRESS •J� Q►4+u�Nµ QL"• ADDRES53� (�p�yll�X�-
CITV CCST� +�t�s�l ��- No`�6��-��76 TRACT a-3%Q LOT � BLOCK
CAN5TRUGTION �+ �'�' A D A R P
LENDER �D�� L
BRANCH
• OWNEfl�
ADDRESS Q ALUE •^/ �
ARCHITECT TEL S � S • D•
OR ENGINEEF a�N.E N .
FIRE
AODRESS 20NE TVPE GROUP
,I/.�./) APPROVED
CONTRACTOR Q(��/y/Zi� , �V/�,�� BV �• ATE � �
ADDRESS
TEL. �ON NO.OF VSE OF NEW' y6�
CITV ' NO. �' P��� BUILDINC��� ,�Q��
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUIqLDI@NG ACCESSORV BUILDING
SIZE I�+(� NOWONLO� (q�/L�� pj'.� FT.
OF LOT (Q J
USE OF J
EXISTING BLDG. FT. FT
SIZE OF NO.OF
NEW BLDG. ROOMS STORIES l. SI�E S T. FT.
EXTERIOR WALI FOOF
COVERING COVERING REAR O FT. FT.
USE� p/F BUILDING AN ORK O 8E PERFORMED DISTANCE BET. BET. MAIN &
F/`� D MAIN BLDGS. ACCESS. BLOGS.
O n UvC VAR.�1'+ DATE
�- C.U.P.*`+ APPROVED
APPROVE �� � �
I heraby acknowletlge thet I have read this application antl state
that t�e ebove information is correct antl agrae to comply with
all laws rapulecing builtling consvuction, and I shall not amploy
any person in violation of the workman's compensatlon laws ot
the Sxa[e of Calitomia. � r
I hereby certity that I am property licensetl as a conbacro� untler n' F'
the Slate of Calitornia Business and P�otessions Cotle, Oivisicn 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR
Cheptar 9, end [het such licanses are in full forca antl etfect, or I THE PURP�E OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the Stete of California Business
antl Professlons Cotle, Division 3, Chapier 9. VALUATION _��
/� PERMIT FEE 5 1
Signeture ot /���� �/l/ -�
Permittee / 1{ � �i/(/`�f�` $ ��D, PLAN CHECK $
Authorizatl Ageni
TOTAL FEE S