HomeMy WebLinkAbout979 DENVER DR - Building PermitsCITY OF COSTA MESA
O�pMFS,p BYILDING DIVISION
it� ,� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnwv.ci.wsta-mesa.ra.us
r ' �
�. FOR INSPECTIONS CALL: (714) 754-5626
''`*�fi PERMIT NUMBER: BC11-00325
P.ERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 06130/2011
ISSUED BY: KJB
JOB ADDRESS:!�'979^DENVER;URiCM
APN: 41808127 Zoning: , ,
Vicinity:
Const Type: V-B
SQ. FT: 0
Suite/Unit:
Primary Occ:
Valuation: $5,000.00
SCOPE OF WORK: KITCHEN REMODEL, DRY WALL REPAIR, MISC ELEC AND PLUMBING. SERVICE UPGRADE TO 200 AMP.
ELEC TO INCLUDE: 8 LIGHT FIXT, 8 OUTLETS, 2 SW ITCHES, 1 SERVICE TO 200 AMP. PLUMBING TO INCLUDE: 1
QISHWASHER, 1 KITCHEfJ SIlJK
OWNER: SCHEINBACH, DAVID M AND VALERIE P Atldress: 979 DENVER DR
Phone: 714-545-5922 City/State/Zip: COSTA MESA, CA
APPLICANT: GOLDSTAR CONSTRUCTION AND REMODELAddress:
Phone: City/Slate/zZip:
CONTRAC70R: GOLDSTAR CONSTRUCTION AND REMODEL License No. 945378
Phone: 818•916-7907 Address: 124108URBANKUnit:
Cell: City/State: VALLEY VILLAGE, CA
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
License No.
License No.
$0.00
$111.25
$73.80
$0.00
$43.10
$0.50
$0.00
$1.00
$229.65
HOURS FOR CONSTRUCTION ACTIVITY: EFFE(
Montlay thru K��tlay - 7:00 am thru 7:00 pm. Saturdays- B:00 am thru 6:00 pm.
Unit:
Unit:
ZipCode 91607
PHONE:
PHONE:
- PER GMMG Sec. 13•279
�rs - Sundays and the following Federal holidays:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulalions. (Ord. No. 92-28, § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTION3: 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 £nal approval must be oblained. Failure to obtain inspections and final approval will result in the expiretion of this permit.
COOE k. INSPECTIONTYPE
7676 Fixed SyStem Final Fire Prevenfion
1266 Pool Spe Final
200 Finai Re-Roof
201 Final BIOck/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Damolition
DpT IN7171pL5
CODEt INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildinglOaupancy
DATE INTI7IALS
X S-1-u �a9
WORKERS' GOMPENSATION DECLARATION:
I hereby aKrm untler penalty of perjury one of the following tleclarations:
❑ I have and will maintain a certifca�e of consent to sel(-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
peAormance of the vrork for which this permit is issued.
❑ I have antl will maintain vrorkers' compensation insurance, as required hy
section 3700 of the Labor Code, for the peAormance o( the vrork for which ihis
pertnit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(Th¢ sec(bn neetl rat De mmdeletl � e permrt is valued at one � ntlr tlollars (5100) a less.)
P �cy Number: �
I certify that in t e pertormance of [he work for which Ihis permit is
is ed, I shall nol empl ny person in any manner so as to become subject
Io the vrorkers' Compe ion I -of California, antl agree lhal if I Shoultl
become subject to the ' compensation provisions of Section 3700 of
the Labor Code, I shall f "th comply vnth these proviyon .� I
�U b �
AO�Iiwnfs5ig a e ale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRAC70R5 DECLARATION:
I hereby aHirm ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) o! Division 3 0! the Business and Pmfessions Code, and
my license is in fy II force and ^eflec�
Lic. # �� � � 1 � Class k
D �I
Comracmr's S9^awre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby atfrtn that there is a wnsWction lending agency for the
peAormance of the nurk for which this pertnii is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SlgnaWre �ate
OWNER-BUILDER DECLARATIONS:
I hereby affirm that untler penalry of perjury that I am E7(EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 703L5,
Business antl Pro(essions Code: Any city or county which requires a permit to
wnstmct, alter, improve. demolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit ro file a signed stalement
that he or she is licensed pursuant to the provisions ol the Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of Ihe
Business and Professions Cotle) or ihat he or she is exempt iherefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjec�s Ihe applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees vnth vrages as Iheir sole
compensalion, WILL DO THE WORK, antl the structure is not intended or
offeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an owner of property who builds or improves
lhereon, and who does such vrork.himselt or herself or through his or her own
employees, provided that such improvements are not intendetl or offered !or
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving thal he or she
did not build or improve for purpose of sale.).
� I, as ovmer of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conswct the projec� (Sec. 7044, Business antl
Professions Code: The contractas License Law does not appty to an ovmer of
property who builds or improves thereon, and who contracts for such project vnth
a cmtractor�s) license pursuant to the Con[ractors License Laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
Sigiumre
305]-4fi(3I09)
Owner ID verifed by tlrive. _ �icense. ❑ Ves ❑ No
Driver's License No. Expires:
Verifica�ion of Ownership by (rype o( document, i.e. - property tax 6ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cert'rfy �hat no excavation fve (5) or more feet in depth into which a
person is required to descend, vnll be made in connection vrith work authonzetl
by ihis permiC and Ihat no building s�rucWre, scaf(olding, (alsework, a demolition
or tlismantling Ihereof, will be more ihan ihirty-siz (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 347, TiUe 8, California Adminislralive Cotle).
❑ As ovmer-builder, I will not employ anyone [o do work which woultl
require a permit from the Division ot Industrial Safery, as notetl above, unless
such person has a permi� �o tlo such work from the division.
AppliWnl's SigM'fWre
Division of Intlustnal Safety Permi� Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or (ulure builtling occupant need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Ves ❑ No �
(Section 25505 of �he California Health and Safety Code requires, with some
exceptions, that a Business Plan be filetl with the Cosla Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas
at standartl temperature and pressure).
2. Does or will [he applicant or present or future building occupant need to fle
a registralion form /or acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of Ihe California Health and Sa(ety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or grealer Ihan a weight o( 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure�.
3. Does or will �he appliwnt or presenl or luWre building occupant need �o
prepare an RMPP (Risk Management and Prevention Progrem for acutely
hazardous ma�erials)? ❑ Yes ❑ No
(Section 25534 of the Cali(omia Heallh and Sa(ery Cotle provides Ihat the
Costa Mesa Fire Department may require the preparation, certifcation and
fiing with Ihe Fire Depariment of an RMPP by businesses which are required
[o register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of Ihe Califomia
Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or will �he applicant or present or /uwre builtling occupant require for
the work which is Ihe su6jecl of �his application a permit (or such constmction
or motlifcation trom the Soulh Coas� Air �uality Management District or from
any other air pollution control tlislrict or agency? � Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Cotle requires that the requested
infortnalion be (umished on applications for rwn-residential building permits).
6. Will any part of the faciliry ro be constructetl under this pertnit be within
1000 (eet fmm the outer boun0aries of a school? ❑ Yes ❑ No
(I('yes", the (acility must meet ihe requirement of Seclions 25534 antl 42303
of the Califomia Health and Safety Code�.
7. If a permit from the South Coast Air �valiry Management Disirict or other
air pollWion control district or agency is requiretl for the work which is ihe
subject of this application, have all of the tlisclosures prescribed by Calitomia
Health antl Satety Code Seclion 42303 been matle? ❑ Yes ❑ No
8. (If "yes", attach certificate o( compliance from the appropnate air pollulion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury Ihe
information given above is correcL 1 agree to compty with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I ha e read this application and state mat
the infortnation given is corr t I agr to compty with all state lavrs and city
ordinances relating to builtli n ruction, antl authonze representatives ol
the City of Costa Mesa to upon the above-described propeny for
inspection purposes. I agree occupy or allow occupancy of a y building
authorized by this permit un�il sp ct n. � � ��
Siqnawre o� �ega� � Daie
3� ,�
AnalorAulM1orireEApW�canl D �e
,
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
979 DENVER DR
BATHROOM
41808127
SCHEINBACH, VALERIE P
979 DENVER DR
COSTA MESA, CA
ELECTRICAL PERMIT
Status: ISSUED
Applied: 08/30/2002
Issued: 08/30/2002
ISSUED BY: �
Phone: 714-545-5922
Zip: 92626-2927
Owner: SCHEINBACH, DAV�D M AND VALERIE P
Address 979 DENVER DR
COSTA MESA, CA
Con tra c tor: O W N E R- B U I L D E R
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 7000a
Motors to 1hp
Mators to 10hp
Motors to 50hp
Motors to 700hp
Motars over t00hp
Communication drops
Sub panel to 200a
Pole Liqht Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Phone: 714-545-5922
Zip: 92626-2927
Phone:
Zip:
License: 0
SCOPE OF PERMIT
ELECTRICAL TO INCLUDE: 5 LIGHTING FIXTURES, 2 OUTLETS AND 2 SWITCHES LOCATED IN NEW
BATHROOM (PREVIOUSLY A BEDROOM). REF.: E01-00590 (EXPIRED) AND 602-1401.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$D.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 k
Standing Section
Misc Electnral Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 700 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Voll Wiring System / Ckl
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lighls)
Christmas Tree Stantl
Fireworks Stand
Other Eleclrical fee
Invesligation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$99.00
TOTAL CALCULATED FEES $'122.50
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this parmit to be considered legal, such work must comply with all applicable codes„and•all
required Inepaetions end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis � It.
FOR INSPECTIONS CALL: (714) 754-5626 �
zaawa �eroo�
WORKERS'COMPENSAnON DECLARAnON: � � `
I hereby aHirm under penalry of perjury ona ot the following tleclerations:
❑ I have and will malntain e certificate of consent to self-Insure for workers' compensetion, es provitled for by section 3700 of the Lebor Code, tor the peAormence ot the
work for whiCh ihis permit is issuetl.
❑ I �ave antl will meintain workers' compensation insurance, as requirea by sectlon 3700 ot ihe Lebor Cotle, for the pertortnance of the work for which Ihis pertnit is issuetl.
My workers' compensetlon Insurance carrier end policy numher are:
Carrier: Policy Number:
(—Th/is section need nof be compleled i! the permit is valued ef one hundred dollars ($100J ar less.)
[�jJ I certity ihat in the peAormance of ihe work for which this Dermit is issued, I shall not employ any person in any menner so as to become subjact to the workers'
compensallon laws of Califomia, and agree ihet if I should become sub�ect to the workers' compensation provisions of Section 3700 of the Labor Code, I shell torthwit�
complywithihese rovisions. �(�'�J (� y.�� �y-
Applirani.SignaNre: \��s3_! . `l._�``y`� \ Data S � � U �G�
a� —
WARNING: FAILURE TO SECURE WOFKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSANO DOLLARE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIOED WR IN SECTION 3106 OF THE UBOR CODE, IMEFEST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I am licensatl under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Cotle, antl my license is in full
force ond effecL Lic. # Cless a
Contrectors SignaNre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I here6y aNirm thal lhere is a consWdion lending agency for t�e peAortnance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Neme: Lender's Address:
Signawre: Date:
OWNER•BUILDER DECLARA710NS:
I hereby attirtn Ihat under penelry of perjury thet I em E%EMPT FROM THE CONTFiACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Pratessions
Cotle: Any ciry or counry which requires e permit to consimct, elter. improve, demolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such permit
to file a signed stetement ihet he or she Is Ilcensed pursuent to t�e provisions oi Ihe Contrectors License Lew (Chaptar 9(commencing with Section 7000) ot Divislon 3 of the
Business end Professians Cade) or that he or she is exempt therairom end the besis for iha allaged exemption. Any violatian of Section 7031.5 6y eny appliceM tor a pertnit
subjecis the epplicent to a civil penelry of not more ihen five hundred dollars ($500).):
❑ I, as owner ot Ihe properry, or my employees wlth weges es their sole compensation, WILL DO THE WORK, and ihe structure is not intendad or oHeretl for sale (Sec.
7044, Business and Professions Code: The Coniracto�s License Lew does not apply to an owner of properry who builds or improves ihereon, and who tloes such work
himsetl or herselt or through his or her own employees, provided ihat such improvemenis ere not intended or ottered for sale. If, however, the building or improvement Is
Itl within one year of completion, the owner-builder will have the burden of proving Ihat he or she did nol build or improve for puryose of ule.).
�� I, as owner of lhe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business and Professlons
Cotle: The coniractors Llcense Lew does not epply to en owner ot properry who builtls or improves ihereon, antl who contracis for such prqact with e contractor(s)
license pursuant to the Conirectors License Lews.).
❑ I am enempt under sec.
Owner ID verifietl 6y tlriver's license.
Ventication of Ownership by (type of
DIVISION OF INDUSTRIAL SAFETY
and Protessions Code for this reason:
s ❑ No ,Priver;e�License'No:
t: --.---- �
i.e. - properry tax bill or daed):
EF xpires:
❑ I hereby certify thet no excavetion five (5) or more fee� in depih into which a person is required to descend, will be made in connection wilh work authonzed by this
pertni6 antl that no building structure, scetfolding, falsework, or demolilion or dismantling Ihereof, will be more Ihan ihirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Califomia Atlminis�rative Code).
❑ As owner-builder, I will not employ anyone m tlo work which would require e permit irom the Division of Intlustrial Setery, as noted ebove, unless such person hes a
permit to tlo such work irom ihe division.
Signeture: Dete:
Division of Industrial Safery Permi� Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I cenity under penalry of perjury fhet 1 have read this appiication and state that ihe Information given is
correct. 1 agree to comply wilh ell slate laws and city ordinances relating to building consimction, end au�hodza representatives of the City of Costa Mesa to enter upon �he
ebove-descnbed property tor i spect purposes. I egrae not 4jo� occupy or allow occupancy ol any buildinq euthonzed by this permil untijl final inspection.
�.i c�/11-9- � • �.�v \ �/ � }U / U i..
CSignature.Ol.Legal Owner(s)> lS'-Date/
AnNOr Aut�onzed Applicant
CODE t. INSPECTIONTYPE
7616 Fixetl System Final Fire Preven[ion
1268 Pool Spe Finel
200 Final Ra-Roof
201 Final Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
��
��
COOE 1 IN57ECTION TYPE
206 Final Mechanical
208 Finel Plumbing
210 Final ElecMcal
212 Final Flre Prevention
220 Final Planning Approval
222 Finel Site
250 Finel Building/Occupancy
P.EIF It�dL$
(714) 754-5273 • FaX (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR �RIVE, GUSIA MtSA, (:A 92626
ELECTRICAL PERMIT
Job ACdress:
Suite No
Vicinity:
Parcel Nunmber:
ApplicanC
Address:
Owner:
979 DENVER DR
41808127
SCHEINBACH, VALERIE
2640 BRISTOW LN
TUSTIN, CA
SCHEINBACH, DAVID M
Atldress 2640 BRISTOW W
Contractor:
aUdress:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3�imits)
Pool / Spa
Lighting Fixis
Recept OuUets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t 000a
Service over 1000a
MotorS to 1 hp
Motors to 10np
Morors to SOhp
Motors to t00hp
Motors over 100hp
Communicaiion drops
Sub panel to 200a
Pole Light PYg
Sign Circuits
Temp Pwr Pole
Intermed Pole
TUSTIN, CA
Status: ISSUED
Applied: O6128/2001
Issued: O6I282001
ISSUED BY: ��i-.
Phone: 774-573•0200
Zip: 92782
Phone:
Zip: 92782 �
��
DA'�
Phone:
Zip:
License:
' SCOPE OF PERMIT
REF B01-01004. �
5 LIGHTS, 2 OUTLETS AND 2 SWITCHES.
$23.50
50.00
50.00
50.00
50.00
30.00
35.50
$2.20
5220
$0.00
50.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
Quantiry
0
0
0
5
� .,
2
0
0:
0'
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighting
Busway/100ft
Slanding Sedion
Misc Eleclrical Equipment
Transformers up to 1 kva/kw
................up to 10 kvalkw
.................up l0 50 kva/kw
.................up to 100 kvalkw �
..................over 700 kva/kw
Low Voltage Equipment
Low VOIt Wiring System / Ckt
Misc. Conduit �
Misc. Condudor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
�uantity
50.00 0
50.00 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
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E33.40
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 9248, § 7, 12-21-92)
EXPIRATION: This permil shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order tor �he work authorized under �his permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepeetlona and finel epproval must be obiained. Failure to obtain inspections and final approval will result in Ihe ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244&48 (8�00)
WORKERS' COMPENSATION DECLARATION: ' �
I hereby aHirm untler penalty of perjury one of iha tollowing tleclaretions:
❑ I heve entl wlll maintain a certi�icate of wnsent b sell-Insure for workers' compensation, as providad for by sec�ion 3700 of the Labor Code, tor the pertormence of the
work lor which Ihis permit is issued.
❑ I �eve entl will maintain workers� compe�sation Insurance, es required by section 3700 of the Lebor Cotle, for Ihe peAortnance ol the work for which this pertnit is Issued.
My workers' compensation Insurance carrier end pollcy number ere:
Cartier. Policy Number.
(This section need nof be comp/ete0 �� the permit is velued ef one huntlred dWlars ($100) or /ess J
❑ I cartiy Ihet in t�e pertortnanca of the work for which this Oertnil is issued, I s�ell noI employ eny person In any manner so as to become subjed to Ihe workers'
compensation laws ot Calitom�a, antl agree thet il I shoultl become subject to Ihe workers' compensetian provislons of Section 3700 0l the Labor Code, I shall forthwit�
comply wiih these provisions.
Applicent Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEMGE IS UNIAWFUI PND SHALI SUBJECT PN EMVLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOIXJE HUNDRED
THOUSFND DOLLARE (St00,000), IN ADDITION TO TME CqST OF COMPENSATION, DPMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE IABOR fAOE, IMEREST, AND AiTORNE`fS FEES.
LICENSED CONTRACTORS DECLAAATION:
I hereby aHirm thet I em licensed under provisions of Chapter 9(commencing with Saction 7000) of Division 3 oi Ihe Business and Professions Coda, entl my license is in full
�orce entl eXect. Lic. # Class q
Coniractor's Signemre: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hareby aflirtn that there is a consfruction lending agency tor Ihe pertormance ot ihe work tor which Ihis pertnit is issued. (Sec. 3097. Civil Cotla).
Lentlers Name: Lentler's Atltlress:
SlgnaWre: Date:
OWNER-BUtLDER DECIARATIONS:
I hereby eMlrtn thet untler penelry ot perjury thet I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or county which reqwres e permit to constmct, elter, improve, demolish, or repair eny stmcture, prior to its issuance, elso requires the epplicanl lor such permit
to lile a signed stetement Ihat he or she Is Ilcensed Oursuent to the provisions of the Contrectors License Law (Chapter 9(commencing with Sectlon 7000) ol Divlsion 3 ot ihe
Busi ss and Professions Code) or that he or she is e:empt iherelram and the basis for the alleged eaemption. Any violation of Section 7031.5 by eny epplicant for a permit
su ' cis lhe eppllcant to e civil penalry ot not more than fiva huntlred tlollars ($500).):
I, as owner af the properry, ar my employees wlth weges es iheir sole compensation, WILL DO TME WORK, end the structure Is no� Intentlatl or oHeretl for sele (Sec.
7044, Business antl Professions Cotle: The Contractors Llcense Lew does not apply Io an owner of property who builds or improves ihereon, enA who dces such work
ImselYor herselt or t�rough his or her own employees, pmNdad that such impmvements ere not intendetl or oHeretl for sale. If, however, the builtling or improvement is
sold wilhin'aoe year oi wmpletioq Ihe owner-Ouiltler will have the burden of pmving Ihet he or she ditl not build or improve for purposa of sele.).
uNh,vi
❑ I, es owner of the pmperty, am ExCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS m consiruct the project (Sec. 7044, Business entl Professions
Code: The comrectors License Caw tloes not epply to en owner of pmpeny who builtls or impmves lhereon, and who comracts for such projact wlth e comractor(s)
license pursuant to the ContraC�brsLicense LawsJ.
and Pmfeuions Code for this reason:
by driver's
❑ No
Verificatian oi Ownership �y (type of tlocument, i.e. - property taz bill
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTFICATION:
❑ I hereby certify ihet no excavation tive (5) or more feet in depth imo which e person is required to descenq will be made in connec�ion with work euthotlzed by ihis
pertnit, and thei no building siNcture, scaHolding, talsework, or demolition or dismantling Ihereol, will he more Ihan ihirty-six (36) fee� high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Califomia AtlministraMe Cotle).
❑ As owner-builtler, I will not employ anyone to do work which would require a pertnit irom the Oivislon of Intlustnal Safety, es noted above. unless suc� person has a
pertnit to do such work irom the division.
Signeture: Date:
Division of Industriel Safery Pertnil Number:
CERTiFlCATE OF COMPLIANCE AND AUTTIORIZATION OF ENTAV: I certify under Denalry of Derjury that I have read ihis epplication antl state Ihat ihe infortnation given is
correct I egree to comply with all s�a�e law5 and ciry ortllnances relating �o building consiruction, end aulhonza represantatives ol ihe Ciry of Costa Mesa to enter upon Ihe
ebove-descnbed properry tor inspection p oses. I agree not to upy or allow occupency ol any building authorized by ihis per il until tinal �nspection.
� �-�.��—�-.�,�� c� T��/a �
Signatu�e Of Legal Owner(s) L--�Oate
qnNOr Au�hodzed Applicanl
CODE t. INSPECTIONSYPE
1616 Fized Sys�em Final Fire Pre�ention
1268 Pool Spa Final
200 Finel Re-Roof
207 Finel8locWRetaininq Wall
202 Final Feciory Fire Place
203
204
Final Sign
Finel Demolition
Qd7E RN
GOOEI INSPECTIQNTYPE
206 Finel Mechanical
20B Finel Plumhing
210 Finel Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
1
. /_.(!1►
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 979 DENVERDR
Suite:
Vicinity: BATHROOM
Parcel Number: 41808127
Applicant: SCHEINBACH, VALERIE P
Address: 979 DENVER DR
COSTA MESA, CA
Zoning:
Phone: 714-545-5922
Zip: 92626-2927
Owner. SCHEINBACH, DAVID M AND VALERIE P
Address 979 DENVER DR
COSTA MESA, CA
Contracror: O W N E R-B U I LD E R
Address:
Zip:
Arch :
Address:
Phone:
Phone: 714-545-5922
Zip: 92626-2927
Phone:
License: 0
Eng:
Address:
Status: ISSUED
Applied: 08/30/2002
Issued: 08/30/2002
ISSUED BY:
/ �.
Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE EXISTING TUB & REPLACE WITH SHOWER, ALTER EXISTING BEDROOM TO A BATHROOM 8 INSTALL NEW TUB &
SINK. OPEN AN OPENING IN A NON-BEARING WALL TO THE NEW BATHROOM. ENCLOSE AN EXISTING WINDOW AND
INSTALL A 4'X5' WINDOW. REF.: B01-01004 (EXPIRED).
Plan Check: $0.00
Permit: $0.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $94.00
Total: $94.50
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: 0
NOTES:
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
so.00
$o.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, anG all
required Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. i
POR INSPECTIONS CALL: (714) 7545626 �
zaaaas�doo�
WORKERS' COMPENSAnON DECLARATION: '� _
I heroby aNirm untler penalry of perjury one of the following declarations: � ,
❑ I have and will meintaln a cerliticate of consent lo self-Insure for workers' compensetion, es provitletl for by section 3700 of ihe Labor Code, for the pertormance of the
work br which Ihis permit is issuetl.
❑ I have end will meintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the pertortnance of ihe work for which Ihis Dermit I5 issued.
My workers' compensation Insurance carner antl poilcy numbet ere:
Carnor: Policy Number:
(This section need nof be comp/eted il Ihe permit is velued ef one hundred dollars ($100) or less.)
�/I cenity that in Me pertottnance of the work for which ihis permit is issued, I shall not employ eny person in any menner so as to bacoma subject to iha workers'
wmpensatlon laws oi Celifornia, end agrae that it I should Decoma sub)ect to Ihe workers' compensation provislons of Section 3700 ot Ihe Labor Cotle, 1 shall iorthwith
comply with thesey�ovisi(o�ns.� � _ �
Applicant Signatura: �c�7-s��LS—� ' S��\. Dete: �� �� v� �.�_
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNDRED
TFKKISAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAN.AGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, IMERESi, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn thet I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of the Business and Professions Code, and my license Is in (ull
force und ettect Lic. k Cless N
Contrectar's Signeture: Defe:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn that there is a conslruction lending agency for ihe performance of the work for which �his pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lender's Address:
SigneWre: Date:
OWNER-BUILDER DECLARATIONS:
I here6y aHirtn ihat under penalry ol perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or counry which requires e permit to constmct, elter, improve, demoiish, or repair any siructure, prior to ils issuance, also requires the epplicant for such pertnit
to file e signed statement ihet he or she Is licensed Dursuent to Ihe provisions of ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 oi the
Business and Professions CoOe) or that �e or she is exempt Nereirom and tha besis for the ellaged exemption. Any violation of SeIXlon 7031.5 by eny epplicant for a permit
subjecis ihe ep0�i�eM to e civil penalry of not more than five hundretl tlollars ($500)J:
❑ I, es owner ot ihe properry, or my employees wit� weges es their sole compensation, WILL DO THE WOfiK, and ihe strucwre is nol intentletl or ottered tor sale (Sec.
7044, Business and Pmfessions Cotle: The Contractore License Law tloes not apply to en ownar of propeny who builds or improves thereon, and who does such work
himself or herselt or ihrough his or her own employees, provitletl tha� such improvemenis are not intended or oHered for sale. If, howaver, the building or Improvement is
_ /sold within one year of completion, the owner-6uilder will have the burtlen of proving that he or she did not build or improve for purpose of sele.).
Ly� I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTOHS to construct the Droject (Sec. 7044, Business and Professlons
Code: The contractors License Lew does not epply to en owner ot property who builtls or Impmves ihereon, and who contracis for such prolect wiih e coniractor(s)
license pursuant to the Contrectors License Lews.).
❑ I am ex\emp�t (u\nder sec.
SignaWre:l )oX�u�u
antl Protessions Cotla for lhis reason:
Data:
Owner ID veritietl by driver's license. �_Ves ❑ No Drivels License No. �� \ Eapires:
Ventication ot Ownership by (type o1 tlxumant, i.e. - proparry tax biil or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby certify ihat no ezcavetion five (5) or more feet in depth inio which a person is requirad to descend, will ba made in connectlon wlth work authorizad by this
pertnit, and that no building siructure, scalloltling, falsework, or demolition or dismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 0, Callfomia Administrative Code).
❑ As ownervbuilder, I will not employ enyone to do work which would require a permit from ihe �ivision of Industrial Sefery, es notetl above, uNess such person has a
permit to do such work irom the divisian.
SignaWre: Date:
Division of Indusirial Sefety Parmit Number:
CEBTIFlCATE OF COMPLIANCE AND AIfTHORIZA710N OF ENTRY: I cenity under penalry ot perjury that I have read this application end state that the information given is
wrrect. I agree to comply with all state lews and ciry ordinances releting to building construction, and authorize representatives ot ihe City of Costa Mesa to enter upon ihe
ebove-described property feµnspection puryoses. I egree not to occupy or allow occupency ot any building authonzed by Ihis permit unfil finel inspeclion.
1.. � \ � S . �����'�.\. �'/j G /d Z.
� � A� J Signeture Ot Legal Ownar(s) Date
AnNOr Authorized Applicant
COUE 1. INSPECTIONTYPE
7618 Fixetl System Final Fire Prevention
126fi Pool Spe Finel
200 Final Ra-Root
201 Final Block/Retaining Well
202
203
Final Factory Fire Place
Finel Sign
204 Final Demolition
�@ COpE1 INSPECTIONTYPE
206 Final Mec�anical
208 Final Plumbing
210 Finel Electncal
212
220
Finel Fire Prevention
Finel Planning Approval
222 FinelSite
250 Finel Building/Occupancy
Gdg II�JdLi
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(714) 754-5273 • Fax (774) 754-4856 •�wiw.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
.loe �m�ess: 979 DENVER DR
Suite:
Viciniry:
Parcel Number: 41$08127
npp�icanc SCHEINBACH, VALERIE
Acldress: 26a0 BRISTOW LN
TUSTIN, CA
Owner: SCHEINBACH, DAVID M
Adtlress 2640 BRISTOW LN
TUSTIN, CA
Cor.;r;�ctor:
AAdress:
Zip:
Arch
Atlaress
Zoning:
Phone: 714-573-0200
Zip: 92782
Phone:
Zip: 92782
Phone:
license:
Eng:
Address:
Status: ISSUED
Applied: 0628/2001
Issued: O6/28I2001
ISSUED BY: C/�
� ' �
� �
/r ' � i
�
Phone: Phone:
Zip. License: License:
SCOPE OF PERMIT
REMOVE EXIST. TUB AND REPLACE WITH SHOWER, ALTER THE EXIST. BEDROOM TO A BATHROOM " INSTALL NEW TUB
AND SINK" OP[N .4N OPENING IN A NON BEARING WALL TO THE NEW BATHROOM . ENCLOSE EXISTING WINDOW AND
INSTALL A 4X5 WINDOW.
Plan Check:
Permit
SMIP Res:
SMIP Com:
O�her.
I n spection:
Total
�72.31
�11125
50.50
50.00
so.00
50.00
$184.06
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0. 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
LeR 0. 0
Lefi 0. 0
Proposed: 0
Calc Valuation: Sa,sso.00
Claim Valuation: Sa,sso.00
Right 0.0
Right 0.0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 7241-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under Ihis permit to be cansidered legal, such work must comply with all applicable codes, and all
required Inspectlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2aaere la'oa�
WORKERS' COMPENSAnON DECLARATION: � �'
I hereby eflirm untler pe�alry of perjury one oi Ihe tWlowing dedaralions: � ,
❑ I have entl wlll ma���ein a certificate of consent ta selt-Insura tor workers' compensation. es provided for by section 3700 of the Lebor Code, lor the peAortnance CI ihe
work lor which Ihi9 Germ�i Is Issued.
❑ I �ave entl wlll mal�tein workers' compensaUon insurance, es reQuiretl by sectlon 3700 of the Lebor Cotle, tor the perfortnence of Ihe work for w�iU� Uug pertni� I5ls5ugE,
My workers' compensation Insurance wrtier antl policy num�er ara:
Certiar. Policy Number:
(This sectlon need not He cpnp�efed'ANe pertNf /s velved et one hwrdred dd/ars ($ f00) or less.)
❑ I certity ihat in Ihe pertormance ol the woAc lor which this pertnit is issued, I shall not employ any person in eny manner so es to Eecome suD�ect to t�e workere'
compensallon laws ol Celifomla, entl epree that If I should become sub�acl to the workers' wmpensation provislons o1 Section 3700 of t�e Lebor CoEB, I shall foMwlth
comply with these p�ovisions.
Appllcant SlOneture: Da�e:
WARNINO: FAILURE TO SECURE WIXiNERS' COMPENSATIpJ WVERAGE IS UNUWFUL AND SIULI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES ANDCIVIL FlNES UP TOIXJE MUNDRED
TFIOUSAND OOLURE (5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3'lO60F THE IABOR CO�E, IMEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACYORS DECLARATION:
I hare0y aNlrm that I em Ilcensetl untler proWsions af Chapter e(commencing wilh Sectlon 7000) af Dlvislon 3 ot the Business end Protessions Code, entl my Ilcense is In full
force entl eflect. Llc. p Class a
' Controctofs Slgneture: Dete:
CONSTRUCTION LENDING AGENCV:
❑ I hereDy eHlrtn Ihal Ihere is a construction lending agenq for the peAortnance at t�e work tor which ihis permit is iuuetl. (Sec. 3W7, Civil Cotle).
Lendefs Neme: LentleYs Adtlress:
Signeture: Date:
OWNER•BUILDER DEGL�ATIONS:
I hereby eflirtn that under penelry ot per�ury Ihet I am EXEMPT FROM TME CON7RACTORS LICENSE LAW for ihe tollowinq reeson (Sec. 7031.5, Business entl Professions
CoGe: Any ciry or counry which requires e pertnit to construct, alter, improve, demolish, or repeir eny structure, pnor lo its issuance, elso requires Ihe epplicant tor such pertnit
to file a slgned stetemen���het he or she is Iicensed pursuam ro Ihe pravislons of �he Contraaore Llcense Law (Chepter 9(cnmmencing with Sectlon 7000) ol Dlvision 3 of Ihe
Businass end Protebsions'(.bde)',or 7fiet he or sha is a:empt the�efrom and tha �asis tor ihe eliegetl exempiion. Any violation oi Saclion 7031.5 �y any epplicant for e pertnil
sublects the epPlican(ta e civil'p`enalry M no� more than frva hundretl Dollars ($500).):
❑ I, es owner ol the D�opeM1y, or my empWyees with wages as thelr sola compensalion, WILL DO THE WORK, end the structure is not Intentletl or ofleretl lor sale (Sac.
7044, Business antl Prolessions Code' The Contractors License Law does no� aDPly to an owner of propeny who builds or improves ihereon, antl who tloes such work
himself or herself tlr Ihrough his or her own employees, provided Ihat such improvements ere not intended or oHered for sale. If, however, Ihe 6uiltling or impro�emant Is
s��-. sold within one ye9r ol completion, the owneo-huilder will have Ihe burtlen of proving that he or she did not builtl or improve for purpose of sale.).
❑ I, as owner ot the property, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business end Professions
Code: The comrac�a�s License Lew does not epply to an owner ol pmpeny who bullds or Improves thereon, end who contracts tor such project with a contractor(s)
license pursuent to �he Comractors License Laws.).
❑ I am exempt under sec. Business and Protessions Code tor this reason:
Owner ID verifled by tlrivels Iicense. GQ�Ves ❑ No �Drlvets:L7censelJo.
Veritication ot OwnarshYp by (lype ot dxumenL i.e. - proparty tax blll or tlaed):
DIVISION OF INDUSTRIA� SAFE7Y VERMR CERTIFICATION:
❑ I hereby cenify t�at �o excavetion tNe (5) or more leet in depth Into which e person Is requlred to descenA, wlll be made in connecilon wlih work authorizetl by Ihis
pertnil, and �hat no builtlinp strudure, scattdding, lelsework, or tlemolitlon or tllsmentlinp thereoi, will be more than t�irry-six (36) feet high. (Chap, 32, Grp 2, Art 2, Sec.
341, Titla B, Celllamle Atlminlstrative Code).
❑ As owner-builtler, I w�ll not employ eriyone ta do work whlch woultl require a pormi� Irom the Divlsion ot Indusirial Safery, as noted ebove, unless such person hes a
permit to tlo such work from the diWsim.
Signature: Date:
Divislon ol Intlustnel Sef6ry Parmit Number:
CERTIFICATE OF COMPU�INCE AND AUTHORPA710N OF ENTAV: I cenity under panelty of perjury that I have reatl ihis application end state ihat t�e information given is
wrrect. I agree to comply with ell stete laws and city ortlinances releting to bullding consimctlon, and euthorize representatives o� iha Gty of Costa Mesa to enler upon the
above�d\ ed pr�o(pe�rty �ar I�;P��4�*pi �s. I egr� ee not t' upy or ell� upancy of eny building authorized by this pe� �il tipeQl In �pectlon.
�a� V �J �'� � L1`>� � / /
SignetuVt.Legal�Owner(s) f—�—Date�
�_
And/Or Authorized Applicant Date
LOUE �, INSPECTIONTYPE
1816 Fixotl Sysfem Fl�el Fire Preventi0n
1286 Pool Spa Final
200 Finel Ro-Root
201 Final BIocWRel9ining Well
202 Finnl FectOry Fife Place
203 Finel Sign
2�4 Final �emoliUon
QdSF It�EL:
CO�E I INSPECTION NPE
208 Final Mechanical
208 Final Plumbing
210 Final Electrical
2/2 Final Fire Prevention
220 Final Planning Approvel
222 FinalSite
250 Final Building/Occupancy
PeIE I[�45
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U� '^i,(�� IjJ.�<� C5�19� �C� ��� %��� P�+� /�}Jo�c (JtQ�,�.
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�' � rov;�,�t F�oarrsCe�-[ ��gl�l:.�,-�� o., pn r,c4�s �-� U��g�.h ��� L�,rti�-,Il�ia��
,� l-,�7� �l S y,�,��� f�t-�<<-r�,� �.. ��«�
Nti llv-r�� �CS�i� � �' Occ�ro�m t
�I3���—�
IJJ V IJj••`�4� �'•" .i3\iIi.JLAL\,U �i���aJ� p
� cc� r�� m F �•�' Y�JF GUSTr','�GSA
li�pRQVED
:'�---�� oate Gl?_n l �
iiis soi o( plaas antl speciiicalions MUST 6e kept cn ihis job af all limes and it is unlawiul
�uke z„y cJ�ango; ��;�,zratbn on ;ame w;ihout yrtrtten permi;sion frar 1ha Div�ion of Buildi�
,9 Safety, City ol Co;t; Mesa. •
as stam�ing ci Ihis pan antl speci6;a!ioc; SH%;i NOT be heid fo psrtni or lu be an apprp� �
::' the v;olation of eny provisions c( any Cily uf Costa ?dssa Crdinance andlor State 14i
��ie�"- p�'��s and psrtnil ,heL' expire b�� I:mi'.=_!ior. 2nd becnrtis null and cci� if 1hz bu� ding ,
:i�( �5 f�?� G�llRicil:7;iv' 3.^.f).^:.ui:l`^!:92i EClfdi: f.'F'i �)�v'; A7�;j ('j' Yfi?ii10 �$U' C�B;'S 0� ISSUdif.�:
C LOS
A� ��
�d�"�� � ��
�iTY oF cosrA M
By BJE� LiDG �'EP7�, REG.
�EVIS�D
DATE: n �
d�
v?r�-'�2i �: S�}�,�Jb++c11
4� � � �n� ��� ,�Q.
, Co.s�`� ��s ✓+� ct� c7 �6 ��
(714) 754•5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
979 DENVER DR
BATHROOM
Parcel Nunmber: 4'1808127
Applicant: SCHEINBACH, VALERIE P
Address: 979 DENVER DR
COSTA MESA, CA
PLUMBING PERMIT
Status: ISSUED
Applied: 08/30I2002
Issued: OB/30/2002
ISSUED BY: �
Phone: 714-5455922
2ip: 92626-2927
Owner: SCHEINBACH, DAVID M AND VALERIE P
Address 979 DENVER DR
COSTA MESA, CA
Contractor: OW N ER-BU I LDER
Address:
Arch / Eng :
Address:
Phone: 714-545-5922
Zip: 92626-2927
Phone:
Zip:
License: 0
Phone:
Zip:
Cicense:
SCOPE OF PERMIT
PLUMBING TO INCLUDE: t BATHTUB, 1 SHOWER AND'I SINK IN NEW BATHROOM (PREVIOUSLY A
BEDROOM). REF.: P07-00391 (EXPIRED) AND B02-01401.
ISSUE FEE
Backflow irngation
Backflow Preventer
Balhtub
Clanfier Sysiem
Connectpce,Soda,etc)
Dental Units
Dishwasher
D2in, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-0 outlets)
Gas (Over 4 oWets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
30.00
50.00
$0.00
$0.00
$0.00
$0.00
orv
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) 50.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Pnvate Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop 50.00
Spa (pnvate) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
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)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
ao.00
$0.00
$0.00
sss.00
TOTAL CALCULATED FEES: E122.50
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and�all
required Inspections and flnal epproval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2608�d6(8N0)
WORKERS' COMPENSA710N DECLARATON: � � � �
I hereby ettirm under penalty oi per�ury one ol the tollowing declaratlons:
❑ I have entl wlll maintein a certificale oi consent to self-Insure for workers' wmpensetion, es provitletl for by section 3700 oi the Lebor Cotle, for the peAormanca of the
work lor which this pertnit is luuetl.
❑ I have antl will maintain workers' compenSaUon insurance, a5 required by seclion 3700 0l Ne Labor Cotle, for the peAortnence ot ihe work for which this pertnit is Issued.
My workere' wmpensation Insurance carner and policy numbar ere:
Certier. Policy Number:
(This section need not be complefed i! fhe pertnlf /s velued ef one hundred do//ers ($100) ar /ess.)
� I cenity Ihat in the pedormance oi the work for which Ihis pertnit Is issued, I shell not employ eny person in any manner so es to become subject to t�e workers'
compensatlon laws of Californla, and egree thet If I should become subjecl to the workers' compensation provisions of Sectlon 3700 of the Lebor Catle, I shell tonhwith
comply with thesa provislons. � ^ �
Applicent Signeture: l�Y's�1-+-+� y:�- � _ .� .��" �-�-' \ Date: �/.��/��
WARNINO: FN W RE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE MUNDRED
TKKISAND OOLLARE (5100,000�, IN qDDR10N TO TME COST OF COMPENS/TION, OAMAGES AS P(iOVIDED WR IN SECfIIXJ 31O60F THE UBOR COOE, INTEREST, AN� ATTOFNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirm that I am licensetl under provisions ot Chepter 9(commencing with Section 7000) ol Division 3 ot Ihe Business entl Professions Code, flnd my license is in full
force and eXect. Lic. q Class p
Gomrectofs SignaWre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirtn that Ihere is a construction lending egency for Ihe performance oi t�e work tor which t�is permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Name: Lenders Address:
Signelure: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aMirtn Ihat under penaly oi per�ury t�et I am EXEMPT FROM THE CONTpACTORS LICENSE LAW for Ihe tollowing reeson (Sec. 7031.5, Business entl Professions
Code: Any clry or counry which requires e permit to construct, elter, improve, damolish, or repelr eny strucWre, pnor to its Issuence, elso requires the applicam for such pertnil
to tile e signed statemem [hat he or she is IlcenseA pursuant to t�e pmvisions of the Contrectors LJcense Lew (Chepter 9(commendng wlth Sectlon 7000) af Division 3 of the
Businou entl Professions Code) or that he or she is axempt therefrom and ihe besis far the elleBeE e:emption. My vialatlon o1 Sectlon 7031.5 by any applicent for e pertnfl
sub�ects the applicant to e cNil penalry of not more Ihan live hundred dollars (5500).):
❑ I, es owner ot the property, or my emplqrees with weges as their sole compensetion, WILL DO THE WORK, and Ihe structure is not Intended or oHerad tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law tices not apply to an owner of properry who builds or improves Ihereon, and who does such work
hlmsell or herself or ihrough hls or her own employees, providetl �hat such Improvements ere not intentled or oflered for sale. II, however, the building or improvement is
ola wit�in one yeer of completion, the owner-builder will heve the burden of Droving that ha or she did not build or improve for purpose oi sale.).
�I, es owner of the property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the prolect (Sec. 7044, BuSiness and Professions
Cotle: The coniractors Llcense Lew tloes not apply to an owner of property who bulltls or Improves ihereon, and who contrecis lor such pro�ect with e contractor(s)
liconse pursuent to the Contractore License Lews.).
❑ I em exempt untler sac. -
Signature:' � �': � � �J
Owner ID ventietl by tlriver5litense. es ❑ No
Business and Protessions Code tor this reason:
Verillcelion ot Ownership by (rype ol documem, I.a. - property tex blll or daetl):
DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION:
Drivets License No.
Date:
Expires:
❑ I hereby cehi�y that no ezcavation live (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this
pertnii, antl Ihat no building siructure, scattolding, telsework, or demolition or dismantling Ihereof, will be more ihan thirty-six (36) feet high. (Chep. 3.2, Grp 2, An 2, Sec.
341, Title 8, Califamia AtlministratHe Cotle).
❑ As owner�Duiltler, I will not employ enyone to tlo work which would require a pertnit Irom the Division ot Indusiriel Sefery, es noted ahove, unless such person has e
pertnit to do such wark fmm the division.
SigneNre: Date:
Division of Industnal Safery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AU7HORIZA710N OF ENTAY: I certify untler penalry ot perjury ihat I have reaC ihis epplication and state that the infortnatlon given is
correct I egree to compty with all state laws and ciry ortlinances relating to 6uilding cOnstruction, antl euthotlze representatives of the Ciry of Costa Mese to enter upon the
ebove-,tlescnbed properry tqr,inspection purposes. I agree not to occupy or allow occupanq of eny builtling authonzed by this permit until final inspection.
Li�.it`.3" �i� � 'S—v_�� S �.j Z� /b L.
Signeiure Of Legel Owner(s) Date
And/Or Aut�odzed Appllwnt Date
COOE 1. INSYECTIONTYPE
1616 Fixed System Final Fire Preventlon
1266 Pool Spa Finel
200 Flnal Re-Roof
201 Finel BIocWRetaining Wall
202 Finel Factory Fire Place
203 Final Sign
204 Final Demolition
PAIE INTffIALS
cooe� ixsvetnoxTrve
206 Final MechaniCel
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building�Occupency
PdiE ItIlIDdLfl
(714) 754-5273 • Fe�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
!ob Address: 979 DENVER DR
Sude No
V,cinity:
Parcel Nuninber: 41608127
npp�icant SCHEINBACH, VALERIE
Address: 2640 BRISTOW LN
TUSTIN, CA
Owner. SCHEINBACH, DAVID M
Fddress 2640 BRISTOW LN
TUSTIN, CA
Contrnctor.
AUdress:
?.rcl; , Eng :
P.ddress:
PLUMBING PERMIT
Phone: 714-573-0200
Zip: 92782
Phone:
Zip: 92782
Phone:
Zip:
License:
Phone:
Zip:
License:
SCOPE OF PERMIT
REF B01-01004.
7 BATHUB , 1 SHOWER AND 1 SINK.
ISSUE FEE
Backflow irrigation
Backflow Pre�denter
Bathtub
Clarifier System
Connect Qce Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainw.der
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (7-a ouuets)
Gas (Over a outlets)
Gas Repipe
Gas Sen�ice
Interceptors (Grease, Oip
InterceU�ors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$9.80
50.00
$0.00
50.00
50.00
$0.00
30.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
Qn
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 R) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo 50.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $9.80
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) 50.00
Spa (public) $0.00
Qn
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: O6/28I2001
Issued: 06/28I2001
ISSUED BV: �M
SumpPump
Swimming Fool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: E52.90
�TY
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California 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 ihe work authorized undar this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetlone 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
24a8d8(N00)
WORKERS' COMPENSA710N DECLARAT�ON: � �
I hereby aflirtn under penelry af perjury one of the following declaretions:
❑ I have entl wlll maintain e certificala ol consent to self�lnsure for workers' compensetion, es provitled for by section 3700 of the Lebor Cotle, for lhe pertormence of the
wark tor which Ihis pertnit is Issued.
❑ I have antl will meintain workere' cOmpensatlon insurance, es requiretl by section 3700 of ihe Labor Cotle, for tha pertormance ot the work far which Nis permit is Issued.
My workers' campensation Insu2nce carrier antl policy number are:
Carriar: Policy iJumber:
(This section neeC nof be com0letetl i/ the permit is veluetl et ane hundred tlollers ($100) or less.)
❑ I certiy that in t�e pertortnance ot the work tor which this permit is issued, I shell not employ any person in eny menner so es to become subject to the workers'
compensetion laws oi Califomia, 9�d agree that Ii I s�oulE become subject to t�e workers' compensatlon provisions ol Section 3700 ot Ihe Labor Cotle, I shall fo�hwith
comply with these provisions.
Applicent Signeture: Date:
WARNING: FAILUFE TO $ECURE WO(iKERS' �OIAFENSATION COVERAGE I$ UNLAWFUL AND SW1LL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES ANO CIVIL FlNES UP TOIXJE HUNOFED
THOUSPNO OOl1ARE (5100,000), IN ADDITKN� T� THE WST OF CqMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3JOBOF R1E LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS UECLARAnON:
I hereby aHirm that I em Ilcensetl under provisions ol Chapter 9(commencing with Section 7000) ot Division 3 of the eusiness antl Professions Code, antl my licensa Is in full
forco end eflect. Lic. N Class e
Conlrector's Signature: De�e:
CONSTRUC710N LENDING AGENCY: ��
❑ I hareby eMirtn thet there is a cons�Nctian lending egency lor the portormance ot fhe work for which this permit is issuetl. (Sec. 3097, Civil Cade).
Lendefs Name: Lenders Atldress:
Slgneture: Dete:
OWNER-BUILDER DECLARATONS:
I hereby eHirtn that under penalry of parjury Ihet I am EXEMPT FROM T}iE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires a permit to construct, alter, impmve, demolish, or repair any strucWre, prior to its issuence, elso requires the applicant tor such permit
to lile e slgnetl statement that he or she is licensed pursuant to ihe prodslons of tha Contrectors License Law (Chapter 9(commenGng with Section 7000) ot DlNslon 3 0l the
Business end Professions Cotle) or tha� he or she Is exempt therefrom and tha besis for the alleged e:emption. Any violation oi Section 7031.5 by eny epplicant for a pertnit
sub�ects the epplicant to e civil penelry of not mo�e than five hundred dollers ($500).):
+es owner ot ihe properry, or my employees wlih wages es their sole compensation, WILL DO TME WORK, an0 the siructure Is not intentletl or otteratl tor sale (Sec,
7044, Business end,Protessions Code: The Contractors License Law does not apply to an owner of property who builds or impmves thereon, and who tloes such work
himself or herself or:throughjhis or her own employees, provided �het such improvements are not Imentled or oflered lor sale. If, however, Ihe buildinq or improvement is
sold within one year of completiori„1he ownervbuiltler will heve ihe burden of proving ihat he or she did no� build or improve tor purpose of saleJ.
❑ I, es owner of the property, em EXCLUSIVECYbONTRAC7ING WITH LICENSED CONTRACTORS to consWcl lhe pro�ect (Sec. 7044, Business entl Professions
Code: The comreclors License Law tloes not apply to en owner ot pmpeny who builtls ar impmves therean, end who comracls lor such projact with a contractoqs)
/L license pursuant to ihe Conirac�or5 License Lews.).
sec. Business and Pmfessions Code for this reason:
Owner ID venfietl by tldvers licensa��=�'es ❑ No Dnver'C I.J� sa No. �' ( Expires:
Venllwtion of Ownership by (rype of doGumenL i.e. - praperty tex bill or tleetl): ���
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify thet no excavetion ���e (5) or more faet In dep�h into which e person Is required to descend, wlll be mede in wnnection wit� work authonzeC by this
pertnit, end that no builtling sWctUre, scalfolding, falsework, or demolitlon or tlismantling Ihereof, will be more than thirly�slx (36) teet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Tltle 8, Cellfomia Atlminisirative Cotle).
❑ As ownervbuilder, I will not employ anyone to do work which would require e permit imm the Division of Intlustnel Setety, es noted above, unless such person �as a
pertnit ta do such work from Ihe divisian.
SigneNre: Date:
Divlsion of Intlustnal Salery Permit Number:
CERTFICATE OF COMPLIANCE AND AUTMORVATION OF ENfAY: I cenity under penalry of perjury that I have read this epplication and state that ihe information given is
correc�. I egree to comply with ell s�ate laws end ciry ordinances reta�ing to buil0ing conswction, antl euthonze representatives of Ihe Ciry of Costa Mesa to enter upon Ihe
above-described propetly for i ction purposes. I egree not to occupy or allow occupancy of eny building authorized by this permit until final inspection.
���Qan�� � -S—_��J� 6 /��/ c� I
SignaNre�Oblegal Ow,_ n�(�)' Dare
���
And/Or Authorized Applicent Date_J
QQQf�j, INSPECTIONflPE
1616 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Finel Ra-Roof
201 Flnel BIaWRetaining Wall
202 Fi�al Factory Flre Place
203 Final Sign
204 Finel Damolilion
Q� INTRIALS
COpE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumhing
210 Final Electrical
212 Final Fire Prevention
220
222
250
Final Planning Approval
Final Site
Finel Building/Occupancy
Be7E It�1d15
.
PXO.IECTADONESS: C�'�(j DENVER DR
a'sneasxame: SCHEINHACH, DAVID M
nooness: 979 DENVER DR
COSTA MESA_CA 92626
�sa-z�zz
FPCH/ENGINEEH:
RD�HESS:
PEG.NO.:
UNIT:
UNIT:
eEnMirree: MANCHESTER BUILDERS ( 714 ) 760-7880
nooxess: 19631 SAIL ST
GARDEN GROVE CA 92642
LICENSEU CONTPACTOB OECIANATION: I hereby afhrm �ha� I am licensetl under provision ot Chapier 9(commencing wi�� Section
1000) oi Orv�sion 3 oi Ihe Business ana Pmfessions CoOe. an� my lic e is in �ull forc d e�lec�
ciTvuc.:055052 sT^TEuc.:095459 u�ss:
..g�� S—r/�— i 2 slqnamre: — '�
WOBKEBS' COMPENSFTION OECLAflFTIQN: I hereby a��irm Iha� F ve a certitica�e oi con5eni �o sell-insure or a certifica�e of Workers'
Compensation Insurance, or a certifietl capy Ihereof (Sec�ion 3800, Lab. C).
POLICY NO.: E%P. �RTE:
QOMPpNY:
Certitied coDY �s heBby �umishea. ❑ Certitied copy is filetl wi�h Ihe ciry Builtling Division.
Oale. Applicant
E%EMPfIONFXOMWOflNEPS'COMPENSIITIONDECLABRTION: Qhi55eclionnee0not�ecompleletli� De�mili5�aronehundre0�5100�or1e55).
I certity tha� in the pedormance a� �he work lor w�ich Ihis permit is issue I SAall no� empl ny per�en in any p�anner so as �o become
subject �a t�e Workers' Compensalion Laws o� Califomia � /
I oate: .� —�q— s' z Signature: ��
NOTICE If, atter making �his Oeclaration, you 5hou10 become su�lect �o �he Workers' ComDensalion Orovisions o� Ihe LaOor
COAe. you must �arthwilh comply with 5uch pmvisions or thi5 Dermi� shall �e tleeme0 �evoketl.
CONSTflUCTION LENUING RCENCY: I hereby attirm �hat ��ere is a cons[mc�ion lentling agency �or Ihe periormance oi the work for
which �his permi� is i=sued (Seclion 3097. Civ. C�.
LENOEN:
AO�XESS:
OWNEfl BUILOEB DELLANATION: I hereby a�firm thal I am exempi irom lhe ConVacmrs' S�a�e License law �or the followinA reason
�Sec�ion 7031.5 Business antl Pmiessional Cotle: Any ciry oi county which requires a permi� m consimct, al�er, improve, tlemolish, or
reDair any stmcture. prior �o i�s issuance, also requires ihe applicani lor suc� permi� Io file a signed statement Ihat he/s�e is licensed
pursuant m �he provisians ot ��e Conlrac�ors' State License Law (C�ap�er 9(commencing with Sec�ion 7000) oi Oivision 3 of �he Business
ane Pm�essions Cade) or Ihat he/she is exemp� �hereimm and Ue Oasis br ��e allege0 eremption. Fny violation oi Section 7031.5 by
any applican� �or a Dermit su�lec�s the apDlican� to a civil penal�y oi not more than tive huntlretl tlollars (SSIXI).
I, as owner of ihe pwpeny or my employees with wages as iheir sole compensatian, will do the work, antl [he
❑ S�mcWre is na� inten0e0 or o��eretl �or sale (Section 704A, Busness an0 Professional CoOe'. The Contrac�ors' S�ate License Law
Ooes not apply �o an owner of a pmperly w�o builtls or impmves �he�eon, and who does SucA work himsel�/herself or �hroup�
his or her own emDloyees, provitletl tha� such impwvemems are no� intentletl or oflere0 tor sale. I�, however the huilding or
improvemen� is sold within one year o� cample�ioq Ihe owner will have �he burtlen at pmving he/s�e Oitl no� �uild or impmve
for �he purpose o� sale).
I. as owner ol ihe pmperty, am exclusively caniraclinq wi�h licensetl conUac�ors �o consimct �he pmlect (Sec�ion 7044, Business
���i ❑ antl Pm�essions Cotle: The Cantrac�ors' State License Law does na� apply �o an owner o� pmperty who hmI05 0� impmves thereon
and who conlracis �or suc� pmlecis with a contrac�or(s� license Oursuani �o the Contracbrs' Slaie License Law�. I am aware
ihat pmo� ot �heir Worker'S Campensalion insurance 5hou10 be provitletl to me.
� I am exemp� under Sec�ion: 9. 8 P. G.
br ihis reason:
Oaie: Ownec
I tlo here�y certify ��a� I am aware ol antl untlerslanA Ihe reQuiremen�s oi Califomia Heal�h an0 Satery Code $ections 2550.5, 25533, and
2559E antl ��at I or any �uWre builtling occupan� will/will nol (circle one) need Io comply wi�h said sta�e cades and the requi�emen�s for a
permit br cons�mc�ion or moadication imm ��e Air Ouali�y Management OisVicL Re5i0en�ial cons�mction applica�ians are exempt imm
�heSP pmvisions.
�at¢: Applicanl'
I hereby certify Ihai l have reatl Ihis applicabon and s�a�e Iha� Ihe above information is correc�. I agree to camply vn�� all ciry antl tounry
ortlinancesantls�atelawsrelatingto0uildingconslmctionantlhere6yauthor¢erepresenta�iv thiscirymenteruDontAeabove-mentione0
prop:rty fa� Inspection purpos=s. � '`- �
�pyte: ? l � — 9 � Signa�ure- ,,,�
�river s Gcense or Social Secumy 9:
t60La6 Whi�e—Bmltlinp: Green—Cotle Enforcemen�: Ganarv—Aoolicant: Pink—Revenue: Golpenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H 05669_
PERMIT NO: B 056643 PLAN CHECK NO: 01007-92 S GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION ; CITY STD HLOCK WALL 139 LN FT SQ FT: 139
CLAIM VALUE: 3,350.00 CALC—VALUE: 2,680.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR RE�UIRED IN THE HOME
*�**��r�r�r�r�*����r�r�e*�e*�****** �r�r+r***+r*�e�r*���r*�r�r*�x�*�*�r�r�*�e*�*�**+�*�rx**��r**�r�*�**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING RE(� • PROV: PARCEL: 41808127 ZNE; RI REF NO;
PLANNING Ni51'ES> FOR TWO 67' LONG BLOCR WALLS ALONG SIDE PROPERTY LINES, ONLY
i
�*�r�****�������*���*��«�****�*��*���e,�,e�e�*�******��e�e*�e*�***�*�e*�r**������*�****�**
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
20NING APPROVED BY G� DATE; ,�""%���ZZ
BUILDING APPROVED BY ; DATE: `
APPLICATION ISSUED BY: Yn ' DATE; 3.�I�—c1 L
iF 1E IE �F iE it iE �F if ik if iF ik �lf iE iE if iE i(� if i! ik3fiFiF'iF'if3f'iF'{Fif3f�7FifiF7F iFiFif k if if ik k it ik f4 iE il��FiF�t iF
if�EfflEiF�IfIt3FiFjE3FiEififiEiEifiEitkiFiFiFiEiklFiFiFilklFiFiFiF1E 1EiFlfaEkiFiEaFif�f�f�flEif�f�Fif�kiFiFiFifiEiFiFifiEiEiklfiFiFjF�EiFiE#tjfiElF�F
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADZNG
PERMIT 54.00 50
SMIP/NON—RES
PLAN 35.10
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
TOTALS----> 54,50 0.00 35.10 89.60 89.60 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 89.,60 OVER/SHORT: ,00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
54.00 .50 35.10
if ik 1F 1k iF if ih if if iE i! �E ik it iE �F k k IF k k if iF M if ik 1F ik 1F if iE iE �k iE k iE �E 1E iE �F iE iE �t iF iF k iF if M if k if iE iF k�f IE iF if k iF iF if iFiF iF if �f k iE 1f if iF aF j! iE iF iF 1E
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 134 RES—CONCRETE HLOCK WALL / FT, 20.00 2,680,00
END OF FEES
�/� � 31 u0:iu�� .� :.Cw' �
.� D��IE: 03; 1".'� I . .
CONSTRUCTION AND PLAN1NING ... PO( SPA
� AppROVALS Permit # Date 'Inspector pppROVALS Permit # Date Inspector
i. Temporary Electrical Serv,ise or Pole 52. Pool & Equipment Location
2., Soil Pipe•Undrgmd._ � 53. Steel Reinforcement
3..Electriral Conduif.Utility-Undrgrnd. 54. Forms �
4. �Elsctrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcemenir 56. Rough Plumbing & Pressure Test
�. 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE �
7.;Footings � � ' 58. ElectricalConduit�Undrgrnd.
--B. Foundation � . 59. Gas Pipe, D Undrgrnd., 7est
9. Water Pipe�Undcgrnd. 60. Backwash Lines, RTrap, O Undrgrnd.
�'
10. Structural Fioor System 61. APPROVAL TO DECK
i t. Prpperty Sewer Line;& House Connection 62. Backwash & ReceptorFinai � �
�2. SQ`"e� Cap ., � , 63. Heater & Vent�Final
13. Roof Drains ' � 64. Plombing Svstem � Final �
74. Rough Plumbipg , 65. Electrica6Final �
15. Rough Electricai-Conduit 66. Solar System-Final
i 6. Rough Electric'VJiring 67. Fencing & Access Approval
17. Raugh Wiring Sign 68. APPROVEq FOR PLASTERING
18. Rcugh Electricai�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - - - - �- �r _ .
20. �Raugh Factory Fiieplace '• r '� - ' ' '" �APPRQVAL$ '�-Permit # ' '' `
1 .c i - .: � w - -
21. Ducfs, irr Structure„ `.. .. _. ' � ' � �
70. Underground Hytfro
22. Ducts, Ventilating, ' - �'� k=71. Product�Piping OG�3s ❑Oil
23.,Gas Pipe=Rwt�h & test �;� _ r � � 72. Underground Flush_ � � • - --
24: Roof Framing "• � � ��,� - " '�73.' Undergrnd.Stora,geTankQGas ❑Oil
25. Roof Sheathing . '� �� ,,;' � 74i-Overhead Hvdro„ -
26. T-0ar Ceiling (Slrueturall &.Monocoat � r ��1'' ' 75; Dry C�emical - ' -_
27.�Frame and Flashipg �, i ,,. ' � •: , 76. D�ry Standpibe ~ � �
28. Lathing�& Siding _- .. _ r t ti_: , • • 77.-' FIXED SY$'!'ENi FINAL''
�29. InSulation � - � � � , � `� � ., � 78`FIRE PREV. FINA�L � �•
�30.DrYwall'Nailing'�' � - ��' �+ HEALTH%DEP7.FEQUIREMENT
•�31. Plaster Browc� Coa{_ _ , , ,-79 `FINAL INSP�ECTION a " '
� �32. �Electrical Power,MeteRFinal , �- � � ' �� - �80. .FOOD CERTIF4CATE ISSUED "
_ 33.'Final Electric " ,. s '_ � ' ' No{es: _ ' ` ..
�34. ,Finai Heating;& Aic Conditioning. , � �' • �� .�. ; , , i =
35. fina� Gas Pipe-Test _ �� � `� " _ � �� ` .
_ w , i r ',., . � .
-36. Hood or Canopy,� � � � �� � �*
i �
37:-FinAI Factory FireplaceT ' r _ � ' ``� � � '�
i �z
. � i. . .. . . - . . .. ' -
-38.-Finai Plumbing . C ' ' �
�39."Water Service-Final � , '� • x-° � ��- �
` 1 X ., 9 ' f .. .
A0. Gas Service-Final ' . - ' ,r � 1 �i: �R . '
i -
41:.Solar pomestic-Finel� - � x D ' .
r � 1� ' '
42. Backflow Preventer, ' - � ' i P� , i - � :
43. Backifow Irri9ation ' -• � - = , "
. �
• r � .
44. Landscape loripation System: .� - x: • , - - ' _
45._Sound Attenuation �� '' ' ^ - .-�. . -� . '•
.- .
46.,Nandicap Regu4atiqns ' - ' � � � � � . _ _. �
-• • 'c �c
47. FINAL STRUCTURE & BUI�LDING ' • ' -�
�� .,
48. FINAI.PLANNING ' � � � I ' 4 _.
_ ' ,�. . ,y. ': , :L w
48. �E{ec2ric Release to Ed'+son , � ,' w. �. - �
� �
50. Gas-Release to Southem Cali'fomia Gas Co . � � 7�, - -'" u - �"
51. C6RTIFICATE OF OCCUPANCY - , _ - . + .
No. Date
AP�'F��?�'�D
City of Ces�a f�esa Building Deo;.
f3Y � Dr`,TE 3�79 �(
THfSE rLANS h�IUST gE Or! .1Cr; pT ALL iIAdES !�4AKE
NO CH,GNGES UVI7NJU1 PF�U,+ ::^FROVAL OF CFPT.
'fH[ ISSUfuJCF OR GR•�NT�•.^ -. ..._c`4,�T OR::Paq;-;YAL OF
PLANSAND SFcGi';CC.: �0,� _' .c CONSTP.J�u �O BE A
Pf RA51T PU{;. Gn Ah: nPPhO . �� v:OLATIG� � u? =NY OF
rwr_ rao��+s�ONu oa r.,ts c:: _- � '-, p,.:s,.r���rrs To G+t�e
AU(HONIT`/ l0 VIOi AIF. ����'. �. .' "�+F AF`)VISiCi�S JF THIS
GGCE ;NALI. BE VAIID E�CS� � i-°i 2'.. r�hR k5 l'r;c YVORK OR USE
�
YJHICH ITnUZHORIZE� IS LA'fJ, UL.
THE 13SUF.NCE OF A PEFid+7 Sa5&D C'�pA( PL+`.KS hFJO
SFFCIfICAliOlv$ SHALL tJ0? � nF4=.NT THE bU,i�J'•'P. OfF'C1AL
F!i::!.1'fNEFF Rt?ER 7iF; :.'UIRd:G i'rE i qiiBF �Ti;; td Gf cf iiORS ItJ
SAIi� PI;�P:$ /.+�D Sf'FCk4=ir;;;lOA!c pF FACAi FREVENTING
Bu1:.�iA'b u�EHni�lGh!b (3� •,�R.� CAE%FIFI_%(JM 1�1LF;EUMDE? :MWEN
I;; `J 01 k}!GN Gf TN��i ,^.ULC OFi OS :;IVY •'JiHE(i �JROMa.NCE OF
FHt L'1fY.
THIS
it # 5�(�
UMBER US7 ACCOMppNy
INSPEC ION REQUESTS
SN KE DETECTOR
REQUfRED�'
ti
W
Q
F.
N
y�s
nnioc�
��� ����P�croaNs
979
IIUID�MCE
CALL
754-5626
754-5627
�
RqIDEMt[
�6/'�%i%%f�/l �.liU^C
STREET �
/�� `�/23� �
��� � �� i
�:�TY OF COSiA /y�� rf
PLANMIIYG pfpr. {
'�D1ECT TO lLDG. D r!
: G� �►. � ,
p� ---. DA7 .� lq qZ �
ecroa e� n,�++Hi►q
�'' � �5� / ���/C wk//s
�134 lz�,�,��,��
�s Ch q�,°ca �- 1
REt10[MC[ I I ��
��_ —
A
W
W
w
N
Cement Coping Ootronal �
Channel Block Witl+ 13/8�
Horizontal Top of all
Fences
For Fences 5'or Less
Vert. Bars 3/8"¢ at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8"� at 32" O.C. �
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel S�all
Conform to Sec.A-15-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGRADE
TWO 3/8"d BARS
CONTINUOUSTOP
& BOTTO�'1 '
HORiZ.STEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
TYPICAL
�
,
Yo _
d "p N
o A — —
n
F� W'IDTH
� SEE CH�
� % BELOW
DL
_ � e•-i
6�� CONCRETE BLOCK FENCE
FOOTING REQUIREMENTS CHART
�ENERAL- NOTES
MORTAR; p�e Port Plastic Cement, and
T�ree Parts Sand
GROUT: One Port Cement fRree an0
One Holi Ports S'and
COPING: One Part Cement, Three
Ports Sond
CONCRETE: Wen Mixed f.2-I/2:3-I/2
Max. ot 7- I/2 Gallons of
Water Per Sack of Cement
GROUT MAY 8E POURED F.ROM TNE TOP
OF 7HE FENCE IN CELLS WHEHE STEEL
OCCURS.
CELLSAND AREASOF HOR120NTAL REIN�
fORCEMENT SHALL BE CIEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, E7C.
N 0' E4P.TH7COTH
i/? iHE HEiGTH OF FENCE
BELOW BOTTOM OF FOGT�NG
WIDTH 14" . . . . . . . . . . .14" . . . 12��. .
THICKNESS 10�� . . . . . 10° g",
DEPTH OF EARTHTOOTH 24" 20" .. 16".
SPQCING OF EARTHTOOTH. . 12' 14� ... 16�. .
City of Costa Mesa, California
Building Department
. .. � ._,_.,�=p NOV. A:.
SCALE: I/2��= 1'
,
- GENERAL ACKNOWLEDGMENT
State oi l"1 I I I VI 1 1 I"l
County of � �
OFFICIAL SEAL
i CHERYL A. PEDOPJE
ru • NOTARY PUBLIGCALIFORNIA
'Y`� PfiINCIPFI OFFlCE I�I
ORpNCE COUNTY
Idy Commission Expires �day 23, 1994
On this the.� � day of
SS. �;h e rc
the undersigned Notary �
�� h V � h �
❑ p rsonally k wn to me
proved to me on the basis of satisfactc
to be the person�hose name�_
within instrument, and.acknowledged that
WITNESSmv hand and official seal.
ATTENTION NOTANV: Althouph ihe informatian raquested below is OPTIONAL, i[ diu� pi
THIS CERTIFICATE Title or Type of Document �
MUST BE ATTACHED Number of Pages
TO THE DOCUMENT
DESCRIBED AT RIGHT: Signer(s) Other Than Named Above
19 � efore me,
On ,
subscribed to the
N executed it.
fraudulent �,It�h�ent ol Ihis certificate to
v,1 y. I rP
of Doc ment
,� V�� a� {M � �� P
�im izz
�
�;
i'
�
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this ��� day of
E3 � � � i � � I !► � � �
hereinafter referred to as "LANDOWNER;' and � �N�' V� l�t /l��,t� EN
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
%7 c/ l�E7lM1/E,�
(Address of Adjoining I
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book �T , Page � of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach � Mo�eE� 7Tbf+v � FOo,7
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
ADJACENT PROPERTY OWNER
�c ����o� ,P,�
(Signature) Signature)
tq,�?NG v`9J�v' /�tivv,cr� ��4V/D M, SCNE/NL-�!}�'�_�
Name (Typed or Printed) , � Name (Typed or Printed)
9'S�� l�£nrv�/2 Ar- 9���iv�� rae� a��3��`�-
(Address)r . (Address)
1908-a6
NOTARIZATION REQUIRED
e
STATE OF CALIFCRI7IA
COUNTY OF OFtANCE On this ;J_day oE �('(,(�J ,,,Sn the yea�2
before me, tt�e u�dersigned Nota y Public in and for said
State, personally appeared
Glii�/er� .�,i cN
- oFerciAL ssnL personally known to me or proved to me on the besls of
KimberleyGawlak s�tisfactory evidence to be t e person(s) vt�o executed
m : NOiRPYPUBLIG,CAUFOqNIP �he within instrument•
ORANGE WUNTv �
My Gomm ExPrteS Rup 25. �995
NUT UBL1C
My commission expires: O'Z�—/�
`GENERAL
State ot
County of
u) On this the 3~"day
� } SS.
�)
the undersigned Notary
�i J � �n
of r� CJ 19 before me,
� r� � !4 ��e 0 �1 P_
dly ppeared
�
� e�„
❑ personally known to me
OFFICIAL SEAL �roved to me on the basis of satisfactory ev�d ce
% CHERYL A. P[DONE �o be the person�Q whose name�'} ubscribed to the
!� a NOIARY PU6lIC-CqLIFORNIA within instrument, and acknowledged that executed it.
�, Pfi�rvClPaL OFf�CE IN WITNESS my han and otticial seal
ORANGE COUNtt ��
- My Commiuion Ero�res May 23. 1994 /A�
1l 1 /
A7TENTION NO7ARV: Althou8� �he infarmetion requested below is OPTIONAL, i� cauld event Ir utlulent etterc�,,m�nt al t/�1is ertitica ro an ther document.
THIS CERTIFICATE TiUe or Type oi Documen � � V v� r� ��� ��%L�
MUST BE ATTACHED Number of Pages Date o Document
TO THE DOCUMENT
DESCRIBED AT RIGH7: Signer(s) Other Than Named Above
CF ]499 (BR9) ]120 171
Y
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this
day of
YE6�A-Qti' , by and between _�h��D M. �rlE�nl�4c'tl
/ -- ''i% ^ ' �>tJ
hereinafter referred to as "LANDOWNER;' and ��S%EdrCf%%crp,�
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between q7�1 7��/�Q �Q � �7.5 ����• !�
(Address ot Adjoining Properties)
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
T�PAG'i.�E2
in Book , Page _
of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach �° � a�?/'f�N � F�?
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER ADJACENT PROPERTY OWNER
(Signatu�� ignature� .
7! A-✓>D rYl S�/lJe/��=P� i/i�G�/G ///O/�'To/7
Name (Typed or Printed) Name (Typed or Printed)
�9 �✓�� �rz 9>� ����� �i�.
(Address) (Address)
�
NOTARIZATION RE�UIRED
190GA6
,
i2-Ju�-s�
S a Cover Sheet
N�me of owners:
pavid M. �nd Valerie F'. Scheinbach
Address of owners: �pStD�Mes� California
92626
Fhone Number of awners: (71A> 557-284a
Spa lacation: 5ee p�g�
'i - Location.
� - Lacation.
£4uxPment lacation: S�e p�ge `'
��s and Electric mt�ter location: See p�9� �
- Lo�atipn.
Si�e af mnx� electric�l service: l��eti Ampere breaF;er.
Electrical Fcating of spa electrical equipment:
Pump Motor 1 HF lle� Volts, 20 Amperes.
gp� l.ight 114 Volts, 15 Amperes.
Neaker BTUs: S�, ��Gf,� B7U
pi.stance �nd size af qas line: See P�9e
�r - G�S Line
Plans.
4 - Electrical
C anents : See p�ge
w.- --. Electric�l Circ�u t pmP
� Schem�tic.,, ,,, „ +
� ���p"�c'St�r�+�Proxim�i�ely 300 6allons.
1
P
City of Costa Mesa Buildir ��t, p {abricated f iberglass set in
n truction �y �je
� � - ��,..� DA7E � 15 lg�? 1
' :HESEP!Ah5h1tlS�SEQNJUS,4TA1.lT±�^�Srr�^I�Five.
� ,• ,1 CHANGES�y�t.�� Fd?F)Rs�iZlrt�,y�;P;?�.:.
� :"IE�i55UANCE U° G^nAP!'WG Cr' A F=3.r.!T ,^,.3 nG'>R��ViI. OF �
°.•NS AND �aPfC�H::HTIOP;i gH�Alt P-1)7 5e f:✓N.c'i�sl;Tr f0 RF n
" F..'M.li FOR, QR At'. APFF.Ov�l ��+', A::Y :n4tnr;�;r.� n.: ,.t�- � .
i; � PFOVi54rNS0°Tk!SCGD"c Dd.'-'r.�Ri±;1p;e5U,�Nri"> �<"-.,°'v
,. �. rHORIIY TO kIGlAT"c i`�� �AhiC?i 1H_ a�C:•n^Ki,=� s; ;H;:
'. �DF. SI1A:! RF V,+.iD, f%C�'I W 40 FG� ?,S �Ni. ••.."-; O;','���i
�� � ICH I7 AUTHt)Rd`.5 15 l.P.IVfU!,
� [HE 15SUANCE l�f A PEft,V,IT P,1,5'c� �1FG=: t�.-�-= .��n�
St�.CIFiCATfONS 5}sAt.l NOT P;ifVE;d'i PHE BU?+n:e:) C<=�<:iNL
. F i�M THEREAFTEP, ^."cQli!.iIN3 iHe fpRRECS:C;¢ C., i'.i.`:t5 I� i
� S,D PLqIJS AND SPcCIFICATIONS Dk PNOI» PAE'vp;:iiF:G
' BJItDING OPEI:A710N5 HfINu Ci+RRIEU ON THEkcUh�UfF Wniu
� R VIOL4ilON OF THIS CODE OR OF ANY OiHER OkDiNANCE Of ,
inE CITY. '
Page 1
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JOB Ai ALL T!ME 1+5�K.°•
�Ci /�PPROVAL O i�i! ' �
�J � ';
PER1h17 OR !•.7FROV Q'• i.
.:�il?I:cCONSiRUEDTO A•�4
'^'�' V'!UL�TIJN OP ANY .l •
)F<RAifiP�f:SUM�NGiOG��'. •�
=! iME PiOV15�pN5 OF 7H : ��
ECIFICA'.1045 Sti411 N.�T PREVENT iME BUILDING
`:S THERcnFTER R'cGI;RING TME �CR4ECTION OF E
ID PIqNS AND $PECI�ICAIIONS Ok iROM PNI
E ILDING OPERATIpNS BtING CARRfED ON THEREUNC
. VIOLAiION OF TMIS CODE OR OF ANY OiHER ORDIP
T = CITY. �
HV !� �E
CITY OF COS`ip /�(±ESA
PL4NNING DEPT.
aru� ro Koo. uevr. eeo.
_ DA*�_ y ".�3` 8 7
a rwauoo
OF
. ._, . . . . ��
;;.:'' Fi4TI�.' . •� �'.
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• '� •�'•
..�� .S.n�1 .ti ...�•� •�
�TRI�
P a�e $
��,
�
ADD�TIONS, DELETIONS, OR CORRECTIONS SHAIL
BE APPROVED BY THE PLANIJING DEPARTMENT
�
�as Line Flans
Ter 319° Plu�c
�3/4° Hippl!
L 3J�'
�Shuto
Valu�
Ne
E
3/4' Elbo�
314' Black �ipe �bh��ed bith ta�el
�ound Leuel
,f
314' Elbob {�onnectin$ piye runs parallel �ith hause
ta�ards the backyardy
�
�/��� W�11V4
„
3/4' PVC
3f4" iransition fitiins
0
to heater
lf�" Flex line
3I4'-1/Z' Be]]
Reducer
%
�314' Black pipe
�I�a�ped t�i�h t�pe)
Page 3
.. .
Circuit Break�r
Panel
1S J�,
El�ctrical ScheHatic
12 Gauge RaNex
(Box ta autside Mall)
et
Condui t �i t�
light raHex,
hau�e �all,
Notur and
Runs along
�p�tio side.
Ilnder�round condui t
tGraund �ire running�
in�ide �nd outl
�I
Z� AI�,
Mator
15 I�Q'.
�. SP�I
Light
Pa�e 4
Aop�icant to fill in all soaces exceot those within neavy Ooreer IinLs ane sig# all approvriate aeelarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT P IT NO. TRACT NO. LOT NO. UNIT NO,
� `% AZ� �=idd-'7_ �%/'z� �
ProjectA'ddress G?9 �U�' DC. ['M, C�. Q% b.
Applic'an['s'Mailing Address �4 ��VER �R. CN. Ci: • �i%fo�
i wner'sName �ID� {/qi 9C�IA16ACH Phone `'���'2����
Address �/�19 7%EUUhR'P2• C%1• G� • Q21�u26
Arch/Eng. License No.
Address
Contractor's Nam Phone
AAdress Imailing) .
City Lir,ense No.
LICENSED CONTRACTOR DECIARATION
I bereby atfirm titat I am licensetl untler provisions of Char[er 9(commencing
with section 7000) of Dlvision 3 of the Business antl Protession5 Cotle, antl
my licenze is in full force ana effect.
License Class License No.
Date Signature
WORKERS' COMPENSATION OEGLARATION
i hereDy affirm tha[ I have a certiticate of consent to salf-insure or a certificate
�f Worker5' Compen5ation Insurance, or a cerUfietl topy thereof (Section
l800, Lab. C)
Policy No. Company
BCertifietl copy is he�eby futnisnetl.
Certifietl copy Is filetl with the city Builtling Dlvision.
Date AOp���ant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it [he permit is for one huntlretl (E100) or
less).
I certify that in Ihe pertOrmance Of th¢ work tOr which this p¢�m�t is izsuetl, I
shall not employ any person in any manner Sp ds o eco su ject to the
Workers' Compensation �aws of Calitomia. � L�
Date Si9nature Rl/L(
NOTICE: If, atter making this tleclaration, you shoultl become subject to the
Wo�ke�s' Compensation p�ovi5ion5 ot the Labor CoOe, you must forthwith
compry with sucb proviiions or tltis Oe�mit sttall be tlaemetl r¢voketl.
CONSTRUCTION LENDING AGENCV
1 ne�eby affirm that [hGre is a conSVuction lentling agency (or the performan[¢
of the work for wbich tN5 permit i5 is5u¢tl (Sectlon 3097 Civ. G.)
Lenaer's Name
Lentler's Atla�ess
OWNER BUILOER OECLNRATION
I hereby aHirm thal 1 am exempt from the Contractor's Licensa Law tor the
following reason (Section 7031.5 Business an� Professional Cotle: Any city or
counry which requires a permit to wnstruc[, alter, improve, tlemolish or repalr
any structura, prlor to ils issuance, also reqWrez tne applicant tor"suth permlt
f0 file a slqnetl statem¢nt Ihat ne/she iS IiGensetl pu�suant to Ih¢ Provlsion5 of
the Contractor's License Law (Chapter 9(commencing with Sectioo-]000) of
Division 3 of the BuSiness antl Prolessions Cotle) or that he/she is exempt
heretrom antl lhe basis tor the allegetl exemplion. Any violation o/ Section
031.5 by any applicant ror a permit su�jects tne applicant to a tivil
�enalty ot not more than five nuntlretl tlollars (g500).
I, a5 owne� of th¢ property Or my employee5 witn wag¢5 as their sole
compensation, will tlo tM1e work, antl the structure Is not fntentletl or offeretl
for sale (Section 7044, Business and Pro/essional Coae: The Contractor's
License 12w tloes not apO�Y lo an owne� of a properry who bulitls or ImprOves
lhereon, antl who Goes such work himself/h¢rzelf m througn his or her own
tlniyloyees, provitletl that Such improvemenl5 are no[ inlen0etl or ottaretl f0/
'�. sale. Il, M1owever, th¢ builtling or improvement I5 Soltl within one year of com-
pletion, the owner will bave the bu�tlen of provin9 M1e/sh¢ tlid nol builtl or im-
� prova f0� tne purpoie of sdle�.
❑ 1, as owner of the prOperty, am ezclusivuty conlracting wi[h Iit¢nSeG con-
Vactors lo construct the projecl ISection 7044, Busin¢ss antl Protessions Cotle:
The ConVaclor'S LicenSe �aw cloes not dpply to an owner of pmperty who
builtls or improves theraon, antl who contracts ior such projecls wltn a con-
traclor(51 bcense pursuant Io th¢ ContraGtor'S License Law). I dm awarC that
prooi o( Iheir Worker's Compensation Insurance shoultl be Provitletl [o me.
❑ I am exempt untlet Section B. & P. G. �o� thi5 r¢a5on
Date owner
I hereby certity tnat I have reaa tnis application antl state that the above
information is correcL I agree to comply wiih all tity antl county ortlinances
antl s[ate laws r¢lating to builtling wnsiruction, antl hereby autharize repre-
sentatives of this city to nte�p�the above-mentionetl oroperty tor
inspection p , se
Si9nature (/LHZ �aia %
Driver5' LicenSe or 55 � � `—
TVVE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION lJ REPAIR
O CONVERSION ❑ DEMOLISH ❑ OTHER A p,�
DESCRIPTION OF WORK/USE OF BLDG.
'� $ MainBuilding
TVPE OF �ERMIT GRADING OUNDATION STRUCTURAL T Front �
❑ TENANT ELECTRICA� � PLUMBING ❑ MECHANICAL g
Rear (
❑ OTHER C Right
PROJECT DESCRIPTION Sc?. F7. oGCUParvcV
CONSTRVCTIONTVPE VALUATION$ a-A7�� g Left
ZONE GRADING CU. VDS. ACRES ping. Ref. #
Remarks: Planning Notes:
. Pi'_a'r d'1P-i>7�
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
�rinking Fountains
=1oor Orains '
;loor Sinks
3as Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof'Drains
fieinspection Fea $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/FacL Rlt. ICBO #
Heating System & Ducting
�0-100,000 BTU � 100,000 8T
Reinspection Fee -� $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping �
Solar Tank
Swimming Pool wlSpa
Urinal
W2L2! CI052L
Water Heater
Water Service
Auto�Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeretion System
❑0.100,OOOBTU ❑700,000
System Repair/Alteration
F ire Dampers
Registers
Isue Fee
FEES
$ 3
$ 3
1 E9� 7/ : _/ . �
�jl — Zone
: Accessory Building: '
2�5'� c O
3, 4 �, N
I
' / N
31 � S rS G
R
Par ing Req./Provided E
�
M
T
5
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elecbic
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0�5 KW �5-75
� Reinspactian Fee � $75
DEVELOPMENT SERVICES R/E�Q�
Zoning Appraved By��"� ..
8uilding APP�oved By �
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over�100amps
Sub Panel
Motorr�0-1 HP � 1%� B
Inc.Solar �9-15 HP �i6-15+
Microwave
Pole Light
Standing Sections
Trash Compactor
laua Fae
FEES
ffi 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP S
PLAN CHECK $ � PERMIT
PLUMBING � $ �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. S
ELECTRICAL $-�__�� GRADING S
PLAN CHECK 50% $ MICROFILM $ -
MECHANICAL $ TOTAL FEE $ 1 1/ ,��
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. "
10. Structural Floor System 67. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash,& Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling I69. POOL/SPA SYST S FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. R UIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure I 70. Underground Hydro
22. Ducts, Ventilating I 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling �Structural) & Monocoat 75. Dry Chemical
27. Frameand Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. fINAL
30. Drywall Nailing HEALTH DEPT. REQl11REMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric p N. Notes:
34. Final'Heating & Air Conditioning Q i ,
v
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38�. Final Plumbing � Z �
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING .
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .�
57. CERTIFICATE OF OCCUPANCY ,'
No. Date � r�
♦
�
AOP��cant to fill in all spaces exce0t those within Iteavy borCer lines antl si9n all appropriate tleclarations.
CI'tY'oF COSTa.MEsa C(O�,�N�,S,�T�RUCT(IyON PERM�T_
ProjectAddress ��Q {'�I.S�_,�,..� k'1�, '�R' �� �
ApplicanYs Maili(n�g,AddrIess � �� �,,'r��j`-V` I
Owner's Name L(.F�1CA � �-� `��j,.�g�,��]�'%�'
Address ���
Arch/Eng. License No.
Address
Convactor's Name hone - Q
Address (mailingl �
City License No.
LICENSED CONT(3ACTOR DECLARATION
I hereby af}irm that I am licensetl untle� provisions of Cnarte� 9(commencing
with section 7000) of Division 3 of the Busines5 antl Professions Cotle, antl
my license is in tull f rce yy�ettect. � � ZG4�iS(
Licen 'SLI �
oate � I s'9 t �� — � ��' '
WORKERS'COMPENSATION DECLAIlATION
' hereby affirm that I M1ave a certificate ot wnsent to self-insure or a Certificate
it Workers' Compensation Insurante, or a certifietl copy thereot (Section
3800, Lab. �.) /� `!`� � j7 �� �� •
Poli<Y Nol �^�,J�u� ��' ComPanY�X
cQtCertifietl c py is reby furnishetl. � '
���CerY ' c f th the city B iltl q nyyfi i. �'
Date— APPlicant �
EXEMPTION FRO WORKERS' COMP SATION DECLq TION
(This section neetl not be completetl if the permit is for one 19bw red ($100) or
less).
I certify that in the periormance oi tne work for which this permit is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws ot California. '�'
�ate Signature
NOTICE: If, after making ihis tleUaration, you shoultl become subje[t to the
Workers' Compensation provisions of the Labo� Cotle, you must forthwith
romply with such provisionz or this pe�mit shall be tleemed revoketl.
CONSTRUCTION IENDING AGENCV
1 hereby atfirm that there is a construction lentling agency for the performance
of the work for which this permit is issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILDER bECLARATION
1 M1ereby atfirm that I am exempt from the Cont�actar's License Law for the
followin9 reason (Section ]031.5 Business antl Professional Cotle: Any city or
county which requires a pe�mit to con5truct; alteq improve, tlemolish or repair
any structure, prior to its issuance, also requires the applicant tor such permit
to file a signetl statement that he/she is licensetl pursuant to the provisions of
the Contractor's License Lzw (Chapter 9(commencing with Section ]000) ot
']ivision 3 of the Business antl Professions Cotle) or that he/she is ezempt
M1erefrom antl the basis for the allegetl exemption. Any violation of Section
703L5 by any applicant tor a permit subjects the applicant to a civil
�nalty ot not more than five huntlretl dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole
rompensation, will tlo tM1e work, antl the structure is not intentled or offeretl
for sale (Section ]044, Business antl Professional Cotle: The Contractor's
License Law tloes not appty to an owner of a properry who builtls o� improves
thereon, antl who tloes such work himself/ne�self or through his o� M1er own
employees, p�ovitletl that such improvements are not intentletl o� offeretl for
Sale. It, howeve�, the builtling or improvement is soltl within one year ot com-
pletion, the owner will have tne burtlen ot proving he/she tlid not buiitl or im-
p�ove for the purpose of sale).
❑ I, as owner of the property, am eKclusively contractin9 with licensetl [on-
tractorsto construct the project (Sec[ion 7044, Business antl Profe55ions Cotle:
The Contractor's License Law tloes not apply to an owner ot property who
builtl5 0� improves thereon, antl who cont�acts far such projects wdh a con-
I� tractor(5) license pursuant to the Contractor's Lirense Law). I am aware that
proof of their Worke�'S Compensation insurance shoultl be p�ovitletl to me.
❑ I am exempt untler Section B. & P. C. fo� this reason
Date owner
I nereby certify tnat I have reatl tM1is appiication antl state that the above
informaiion is correcL I a� ree to comply with all city antl munty ortlinances
antl state laws relajin9 td builtli�1p construction, antl hereby authorire repre-
sentatives of tnis city � e Sr on the, above-mentionetl p ope�ty for
inspectian pu�poses.
Signature Date
orivers' License or 5
TVPE OFCONSTRUCTION LJ NEW LJ AOD LJ ALTERATION LJ REPAIR
� ❑ CONVERSION ❑ DEMOLISH ❑ OTH� A,p, #
DESCRIPTIONOFWORK/US BLDG. �+�' •' � -
/� - —_ - .�r ��Qs ���' S Main Buildi
�Sa��eLt E
TYPE OF PERMIT � RADI �❑ FOUNOATION 5 UCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI A Rear
❑ OTHER
PROJECT DESCRIPTION 5. FT. OCCUPANCY� �y� C Right
CONSTRUCTIONTVPE VAWATION$ SL.TI.W S L¢ft
ZONE GRADING CU.YDS. ACRES Ping. Ref. #
Remarks: ��.J�/' . / . '� � n)j'�',y� :. .�.Yll✓i/i�/7 PlanningNotes:
Sink
Preventer
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap �
Roof Drains
Reinspectian Fee � $15
Boiler
Ducr Under Ground
Duct - Strucwral
Duct - Ventilating
Exhaust System '� Multiple ❑
FireoVFact Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,OOOBT
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Q�,�e
Hood or '� Type I ❑
Canopy ��Type I I ❑
Re�f igeration System
�]o-ioo,000sTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
Automatic Washer
Construction PoleSi
Cooking Unit
D ishwasher
Dryers ❑Gas ❑E
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KV�
lectric
5-15 KW
Zone
Building:
Parking Req./Provided
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps .
Meter ❑over100amps
Sub Pane�
Motors �0-7 HP �1�% - 8
Inc.Solar �9-15 HP 01fi-15+
Microwave �
'�ole Li9ht
Ran9e
Standing Sections
Tresh�Compactor �
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3 I
�— Reinspection Fee $15 Issue Fee $ 3
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By Date
'Buildin9 Approved By ���Dat�
Application Issued By �w,�p � � � Dat
t SUMMARV F FE S 3
BUILDINGr`PERMIS $ �.6Ci SMIP . `= $ � - '�C%
. PLAN CHECK � $ PERMIT '
PWMeING $ E X P I R E D ISSUANCE $
PLAN CHECK 25% ��f�eY�-�I15pECtC(iYR.1�GV P.C. $
ELECTRICAL $� GRADING $ �
PLAN CHECYDa��° �:� $ ��/—�^y�
MECHANICAI � TOTAL FEE $ 1LJ_iLIL
$ 3 PLAN CHECK 25% $ ,
CCONSTRUCTION AND PLANN WG POOL & SPA �
APPROVALS Permit# Date Inspector qppROVALS Permit#� Date Inspector
1,..Temporary Electrical Service or Pole 52. Pool & Equipment Location
.�.. -
2. Soil Pipe-Undrgmd. 53. Steei Reinforcement -'
. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement� � 56. Rough Plumbing & Pressure Test
i
6� Electrical,UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings'= '� , 58. Electrical Conduit-Undrgrnd.
. �
8. Foundation � ! 59. Gas Pipe, 0 Undrgrnd., Test .
t
9. Water.Pipe=Und'rgrnd ��, �I 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Strucwral Floor Syst`em 67. APPROVAL TO DECK ,
77. Property Sewer„Line�� HouseConnection 62. Backwash & Receptor-Final
� ��.,
12. Sewer Cap 63. Heater & Vent-Final -
73. Roof Drains �- ' 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing &�Access Approval
17. Rough Wiring Sign ' 68. APPROVED FOR PCASTERING
78. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �_ r�
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �� �
• .+ -
20. Rough Factory Fireplace APPROVALS Permit # f �' ��
21. Ducts, in Structure � - �'"
70. Underground Hydro`� _ _
.� ; '
22. Ducts, Ventilating . 77. Product Piping O Ga's ❑ Oil f- :
e
23. Gas Pipe-Rough & Test 72. Underground Flush `' .. •�
24. Roof Framing 73. Undergmd.StorageTanK OGas ❑Oil
25. Roof Sheathing 74. Overhead HYdro ""' .. �• ;
- �e
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical " � . ,
27. Frame and Flashing �' 76. Dry Standpipe � -
� - -' ^
f
2S. Lathing & Siding . 77. FIXED SYSTEM FINAL � ,_� �
';
29. Insulation 78. FIRE PREV. FINAL' � �� �
30. Drywall Nailing HEALTH DEPT: REQUIREMENT � t, �'�`
31. Plaster Brown Coat 79. FINAL INSPECTION', �. F. i. ��
32. Electrical Power Meter-Final 80. FOOD CERTIFICAT�E ISSUED ' '
33. Final Electric Nates: ' .'_� . �� �
34. Final Heating & Air Conditioning z _ '_ � _ �A ' '
•�.
35. Final Gas Pipe-Test t� .X'c"� �.Y'�'.{ i�' D ' "'
36. Hood or Canopy ` �'�� � � ����N �'" "'
37. Final Factory Fireplace Date $I�� •• �
!
38� Final Plumbing e� � . r
. � 39. Water Service-Final � � � � - _. , �
i.
. 40. Gas Service-Final -. ' .
� 41. Solar pomestic-Final � ' .. ���
i.
' 42. Backflow Preventer � ` � . ' , i
-� 43. Backflow Irrigation � � _
�,
i � -.
, 44. Landscape Irrigation System : �
45. Sound Attenuation . � . ..
46. Handicap Regulations • " � � �-�- .
�47. FINALSTRUCTURE&BUILDING ' � , � " �
48. Special Requirements Completed ' . ' � � : :
49. Electrie Release to Edison - �
50. Gas�Release to Southem Califomia Gas Co
. ti
51. CERTIFICATE OF OCCUPANCY
No. Date LL� ' '
.,� ^� - •
i
�.
AVO�i<ant to fill in all ipaces exeeDt tnosa within heavY bortler lines antl sign all appropriate tleclarations.
� n I�T I�I/1 I 11T f�ll1
• OFCOSTA Sa C STRUCTIO� ERMIT
. Project Address
Applicant's Maili Address
Owner's Name � one �s�"�—g
Address ����
Arch/Eng. License No.
Address !
Contractor' N ��' 7 F ��
Address (m 'I' g) � �� �
City License No. _— ��
LICENSED CONTRACTOR DECLARATION
i hereby affirm that I am licensetl untler provisions of Charter 9(commencing
with section �000) of Division 3 of he Bu5ine55 antl Protess ons otle, antl
my license is in lull forte antl qfZeery
LiC¢ns¢ I 5 �•��� i nse No.
Date � Signahre
WORKE ' SATION DEGLARATI IJ� �
I nereby aifirm that I have a certiti<ate of consent to selt-ii ure or a certiticate
�f Workers' Compenza[ion Insurance, or d cer ietl mpy tnereot (Section
3800, Lab�'Gny�.�(j�` f'
Policy No�'�'�-'�•��I] S / Company
❑ Certi ' tl opy i h reby turnishetl.
�'Cert ' � �tM1 the cily Bui ' i
Date � APplicant �
EXEMPTION FR M WORKERS' COMPENSATION DECL ATION
(This section neetl not be completetl if the permit is tor one 1 ntlretl ($100) or
less)
I certify that in the periormance of tne work for which this perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Wo�ke�s' Compen5ation Ldws oi California.
Date Si9natute
NOTICE: It, after making this tleclaratiOn, you shoultl become Subject to the
Workers' Compensation provisions of the Labor Cotle, you must fortnwith
comply with sucn provisions or tnis vermit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aitirm tnat tnere is a construction lentling agency tor the performance
of the work for which this permit is issuetl (Sectian 309] Civ. C.)
Lentler's Name
Lentle�'s Atltl�ess
OWNER BUILDER DECLARATION
I hereby afiirm that I am exempt trom the Contractor's License L.aw tor the
following reason (Section 7031.5 Business antl Professianal Gotle: Any city or
caunty wfiich requires a permit to construc[, alter, improve, tlemolisb or repair
any structure, prior to its issuance, also requires the applicant tor such permit
to file a.signetl Statement that tte/she is licensetl pu�suant to [he p�ovi5ions of
the Contractor4 �icense Law (Chapter 9(commenung with Section ]000) ot
.. �Division 3 of the Business antl Professions Cotle) o� that he/she i5 exempt
ai,=.cherefrom antl tne basis for the allegetl exemption. Any violation ot Section
�'7031.5 by any applicant for a permit subject5 tne ap0licant to a civil
- penalty of not more than five huntlretl tlollars (5500).
❑ I, as owne� ot the p�operty�or my emplOyees with wa9e5 as th¢i� sole
�com0ensation, will tlo tbe work, an0 the structure is not intenEetl or,offeretl
tor sale (Section 7044, Business antl Professional Cotle: The Contractor's
Litense Law tloes not apply to an owner of a property wbo builtl5 0/ improve5
thereon, antl.who tloes such wo�k-himself/hersetl or tbrough nls or ber own
employees, providetl that such imp�ovements are not intentletl or otteretl tor
sale. I(, however, tne bwlaing or imorovement is solC�within one year oT com-
pletion, the owner will have-the burtlen of provin9 he/she tlitl nol builtl or im-
p�ove forfhe pur0o5e ot sale).
i h Ilcenzetl con-
❑ I, as owner of the pro0erty, am exclusively contracting w t
Vactors to construct the Oroject (Section �044, Business antl Professions CoOe:
The ConVactor's License Law tloes not apply to an owner ot property who
builtls or improves theieon. antl who conVacts tor such oroiects wLLh a con-
[tactor(s) lmense pu�suant to me ConVacfo�'S LicenS¢ Law). I dm aware tlta[
proof of Iheit WorkeYs ComDensation Insu�ance zhoultl be 0/Ovitled to m¢.
❑ 1 am exempt untler 5ection 8. & P. C. for this reason
Date Owner
I hereby certity-tnat 1 hav reatl tnis application antl
info�mation is mrtect. I a to comply with all tity x
antl state IawS relating to g con5truction, and h�
sentatives of this city t er n the above-mei
inspection purposes.
Si9nature
Drivers' License or.55 �
� 35�-I3 I I I -
TYPE OF CONSTRUCTION NEW D ALTERATION REPAIR
J ❑ CONVERSION ❑ DEMOLISH ❑ O R _
� ESC I ION O W RK/USE OF L —
� �' .�%1...�,n� � �,� �l'� p
TYPE OF PERMIT GRADING IJ FOUNDA ON STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI
❑ OTHER
PROJECT DESCRIPTION Sc2. FT. oCCUVA
CONSTRUCTIONTYPE VALUATION$ N � .
20NE GRADING CU. VDS. ACRES
Remarks:
\
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duc
t � Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iC80 #
Heating System & Ducting
❑P700,000 BTU 0100,000
Reinspection Fae � $15
0865-4fi, rev. 5/88 White - Builtling: Canary - Applicanf; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Wacer Closet
Water Heater
Water Service
Auto-Wash
or Typel ❑
iy Type I I ❑
Refrigeration System
❑aioo,000eru ❑ioo,000
Sysrem Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. �W
S Main Buildii
E
T Front
B Rear
A
C Ri9ht
g . Left
Ping. Fef. #
Plannin9 Notes:�
FEES Elutomatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
$ 3
$ 3
2o�e
Accessory
Parking Peq./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700 amps
Meter ❑over100amps
F.A.U.
Fiz[ures
Device Boxes �
�Utl¢t5
Switches '
Garbage Dispoul
Generator �45 KW �5-15 KW
Reinspection Fee
DEVELOPMENTSER
Zonin9 APProved BY _
Building Approved By
Sub Panel
Motois�41 HP�7:5-8
Inc.Solar �9-15 HP �1E75+
Microwave
Pole Light
Range
Si9n
Standing Sections
Trash Compactor .
$15 � � Issue Fee
VICES REQUIREMENTS:
FEES
$ 3
� SUMM V OF FEES
� rBUILDING PERMIT $ �/• OJ SMIP .� $ � .�
•PLANCHECK $ PERMIT
��_' PLUMBI�G "+; $ ISSUANCE � . $
:�PLAN C CK 25% $ �� ' �,c�i1 ENEfiGY P.C. $
ELECTRiCAL $ � �" " t��({},f�DING $ �
PLAN CHECK sox�n�omole e����+' MICR P $ fj
MECHANICAL $ 3 OT $ a�• �
PLAN CHECK _.i,5% $' �g .
N
I
N
G
R
E
Q
M
T
S.
� � 1 00014Q74-00014075 T O T 81.50
oarE: o�iosiss TIt1E: is:sz
�
�CONSTRUC710N AND PLANNING
�` APPROVALS Permit#
� 1. Temporary Electrical Service or Pole-'
i
'�� 2. Soil Pipz-Undrgrnd. ' ' �
'- 3. Elecirical ContlyiYUtility-Undrgrnd.�
4: Electrical Conduit-U,ndrgrnd.
5. Steel.Reinforcement . �
' 6.� Eliectrical UFER Grnd:. '
7�• Footings � • ,
8.� Foundation . � � ' � �
: i �.
9., W2ter Pipe-Undrgrn�l. , j� .
10:� Structural Floor System
11'.: Property Sewer Line & House Connection
12. Sewer Cap i . �
� .
13. Roof Drains "r
I' �
74. Rough Plumbing �
15. Rough Electrical=Conduit
,16. Rough Electric Wiring
17. Rough Wirinc� Sign
I
.18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
'20. Rough F2cto�Y Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe;Rou9h & Test
24. Roof Framing '
25. Roof�Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frameand Flashing
28. Lathing & Siding
29. Insulation
-•c30. Drywall Nailin9 ��,
31. Plaster, Brown Coat ��
i
32. Electrical Power Meter-Final
33. Final'Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
� 49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Date
t2 •
-'T-
i.
i •-
I ..
I . .
POO� � SPA
Inspector AppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bondin9
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgmd.
59. Gas Pipe, Q Undrgrnd., Test
60. Backwash Lines, P-Trap, 0 Undrgrnd.
61. APPROVALTO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOLJSPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping � Gas ❑ Oil
72. Undergro�`Flush
73. Undergrnd. Storage Tank O Gas � Oil
74. Overhead Hydro �'•�
75. Dry Chemical
76. Dry Standpipe :
77. FIXEDSYSTEM�FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL'INSPECTION �
60. OOD CERTIFICATE ISSUED �
7•�.
Date � Inspector
AOP�icant to flll In all soaces except those within heavy bortler Iines an0 sign all appropriate tleelarations.
Y OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. CT NO. LOT N � UNIT NO. P#
t Address 479 nENvr� oiz
pplicant's Mailing Address �79 ��t—Q pR,
Owner's Name �u�7�yD� ����a'L �����Phone SS%�IBW�
Address �� t"-�"�V��'.
Arch/Eng. License No.
Address
Controctor's Nam hone
Address (mailing)
City Licenu No.
LICENSED CONTRACTOR DECLARATION
1 hereby allirm that 1 am licensetl untle� p�ovi5ion5 of Char[¢� 9(Commencing
witn sec[lon 7000) of DIvlSion 3 ot Ihe Businezs antl Profession5 Cotle, an❑
my license is In lull force antl etfect.
License Class License No.
Dale Si9nalure
WORKERS' COMPENSATION DECLARATION
I hereby alfirm tnat I hav0 a certiticate of con5ent to Selt-insure or a certificate
�f Workers' Compnnsation Insurance, or a certltietl copy thereof (Sectlon
3800, Lab. C.)
Policy No. Company
8 Certifietl copy is hereby fumishetl.
Certlfietl copy is tiletl with the city Building Division.
oate Applicant
E%EMPTION FROM WORKERS' COMPENSATION DECLHRATION
(Tnisseclion neetl not De completetl if tne permit is tor one huntlretl ($300) or
lezs).
I certity that in [h¢ p¢rlo�mance ot th¢ work fo� which this pe�m�3 i5 i55uB� I
sball not emplDy any pe�son in any mannq� so as e r� Subje(Q to t�e
Workery;gn ens on 9 w9o� Calito�a/ /_ �{' y_ _/
DatP� Si nature/ AL� �
N0410E: N, afte makin this tleclaratlon, ou shoul ewma sub'ect to the
Workers' Compensation provisions ot the Labor Cotle, you must fort�wilh
complY M'�th suc� proviSiOns or this pe�mil Shall b¢ tleemetl �evok¢tl.
CONSTRUCTION LENDING AGENCV
I hereby alllrm tM1at there is a constructlon lentling aqency for the Oerformance
of th¢ work for which Ihis Dermit is i55uetl (Section 309] Civ. CJ
LenCer's Name
Lentler's Atltlrezz
OWNER BUILDER DECLARATION
1 he�eby aHl�m that I dm exempt trom the ConVacto�'S LlcenS¢ Law tor Ihe
followin9 reason (Section 7033.5 Busln¢55 antl Pro(essional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any 5tructure, prior lo its issuance, also requires the applicant for such permil
to file a signatl statement tbat he/she is licenzee Pursuant to [he provisions of
Ihe ConVa<tor's Litense Law (Chapter 9(commencing with Section 7000) of
Division 3 0l the Business antl Protessions Cotle) or that be/she is exempt
lherefrom an0 tlte ba51s tor the allegetl exemption. Any violation of 5¢<tion
]031.5 by any applicant for a permil subjects the applicant to a civll
alty ot no[ more tnan five huntlretl tlollars (5500).
I' as' owner of tho property or my emploYees with wa9es as their sola
. ompensatlon, will tlo the work, antl the structure Is not Intentletl or-otfnratl
for sale (Section 7044, Business antl Profeszional Cotle: The Contrac[or's
License Law CoeS not appty to an owner of a properry who bullds o� impmves
lbereon, enU who tloes such work IJmself/herself or thrauqh hls or her own
emo�oyees, provitletl tnat such-improvements are not intenCetl or otieretl for
sale. If, nowever, tne bulltling or improvement is soltl within one year ot com-
pletian, lhe owne� wlll' have the burtlen O� proving he/she tli0 not builtl o� I�n-
prOve�.tor[he purpo5e of Sale).
❑ I, as owner of the proper[y, am exclusively contracting with Iicensetl con-'
tractors lo cons(ruct the projett (Se<tion 7044, Busine55 antl Profe55ion5 Cotle:
The ConVactor's License Law tloes not apply to an owner oi pmoerty who
builtls or improves lhereon. antl who conlract5 �or such otoi¢cts with a[�n-
tractor(51 Lcense pursuane to me ConVa<tor•s License Law). I am aware tna[
proof of [heir Worker's Compensallon Insu�ance ShOultl be Orovitletl to Te,
❑ I am exempt untler $ection B. & P. C. for this reason
Date ��7�an� Owner �pA�
I hereby ce�tity that I have reaG tnis
Information is correcL I a9ree lo <omp
antl state laws relating [o bulltling con
sentatives ot 's ciry to e t�
Inspectlon pur o es.
Si9nature w�
Drivers' License or 55 9F �=.�
�ate�• 9' 8a
,g 3 S (P �'L "'�
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR'
❑ CONVERSIpN ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OP BLDG. _
TVPE OF PERMIT LJ GRADING ILC"FOUNDATION L3LSTRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PR0.IECT DESCRIPTION Sa. F7. OCCUaANCV—
CON STRVCTION TYPE VALUATION $ �
ZONE GRADINGCV.VOS. ACRES—
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUets
Interceptors
Kitchen Sink
�—Trap - '
Roof Drains
Reinspection Fee $15
eoiier
Duc[ - Under Ground �
Duct - Structural
Duct - Ventilating
Exhaust SVstem ❑ Multiple ❑
Pirepl/Fact.81L iCBO #
Heating System & Ducting
❑0�100,000 BTU 0100,OOOBT
Reinspection Fee � $15
0865-46,rev. 5/88 White - Bulltlln9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
ShOWers
Service5ink .
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa �
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash '
Laundry Trays
Issue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
$ 3
FEES
$ 3
A. .
S Main Building:
E
T Front
B Rear
A
C Right � r
SLeft
Ping. Ref. #
Planning Notes:
�.
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Oryers ❑Gas ❑Electric
Zone
Accessory Building:
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Fan
F.A.U. -
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator 065 KW �5-15 KW
Meter LJup ro 100 amps
Meter ❑over100amps
Sub Panel
Mators �0.1 HP �1'f,- 8
Inc.Solar 09-75 HP �16-15+
Microwave �
Pole Li9ht
Range
Standing Sections
Trash Comoactor -�
� Reinspection Fee �$15 � � Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS: l
Zoning Approved 6y ��
Building Approved By �
AppllCdtl0I1 IStUBf� BV
SUMMARV OF FEES -
BUILDING PERMIT $ %S. o"� SMIP
PLAN CHECK $ � PERMIT
PLUMBING $ � ISSUANCE
PLAN CHECK 25% $ ' ENEFGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $ -
N
I
N
G
R
E
�
M
T
S.
FEES
$ 3
ca �/U—�
te
[e a�
$. .SZJ
$
$
$
$
$ 25,2�
01 00016656-00026658 To7T
DATE: SU/10/88 TIt1E: 10:24
2J.1?
NSTRUC710N AND PLANNING POOL SPA
PPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. . . 53. Steel Reinforcement � �'��
3. Electrical Conduit Utility-Undrgrnd. • 54. Forms I �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .
5.� Steel Reinfoicement 56. Rough Plumbing & Pressure Test '. �
6. ElectricalUFER�Grnd. 57. APPROVALTOCOVER-GUNITE . i .,
7. Fbotings 58. Electrical Conduit-Undrgrnd. � �
. .
8. Foundation .� 59. Gas Pipe, O Undrgrnd., Test ,, �� �i
9.' Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. ?
i.
10. Structural Floor System '� ! 61. APPROVAL TO DECK
i t. PropertY Sewer Line & House Connection , � 62. Backwash & Receptor�Final -
12. Sewer Cap ' , 63. Heater & VenbFinal '
13..Roof Dralns � 6A. Plumbing System � Flnal '
14. Rough Plumbing '� 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
�16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
•1,'9: Rough Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
. 22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
'�23. Gas Pipe=Rou9h & Test � 72. Underground Flush
�
-24. Roof Framing 73. Undergrnd. Storage Tank O Gas D Oil
25. Roof Sheathing . 74. Overhead Hydro
J
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
27. Frame�and Flashing 76. Dry Standpipe
�28. Lathing &•Siding 77. FIXED SYSTEM FINAL
29. insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing ;� . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat�� ' � 79. FINAL INSPECTION
32. Electrical Power Merer-Final . 80. FOOD CERTIFICATE ISSUED
i
33. Final Electric i , Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or.�anopY
37. Final Factory Fireplace
38. Final Plumbing �,
�39. Water Service-Final
.40. Gas Service-Final . � �,
41. Solar pomestic-Final
42. Backflow Preventer ` �
43. Backflow Irrigation : �''
44. Landscape Irrigation SYstem '
45. Sound Attenuation' �
46. Handicap Regulations �� ?�3,
47. FINAL STRUCTURE & BUILDING _� ��8 �D �
dg. Spec.ial Requirements Completed
�49. Electric Release to Edison , . , . �.
.
-50. Gas Release to Southem California Gas Co � � '•
51. CERTIFICATE OF OCCUPANCY
No. Date
� 234c(1
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BO%�Jf] COBTA MHBA�CALIPORNIA
For Appliconf to Fill In Completely
7YPE OR PRINT
iaess / / / �i�3Ni�GR %%R 1 r.R_
COSTq MESA, CALIFORNIA
� MAIL
TEL.
NO.
TEL
6TATE TfiL.
LIG. NO. � �J � .3 NO.._S J
6IZE / � 3 3o I no
OF LOT .S6 � � HOM
USE OF
E%ISTING BLDO.
88TOACK LIN6 FftOM
CENTER Op BTRH[T S R6AR 1
81OH VARD I L6FT � l� � I RIqHT
DESCRIPTION OF WORK
BUILDIN6
SIZE
EXTERIOR
TO BE
CJ
rt� KtCEIVED
JAN 2 7 1965
FINANCE DEPT.
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
R[CS�pT ry0. PERMIT NO.
r
ZONING
6 ` NO.OP,^'� U6EOP
PLANB / � BYILDII
� //��
L[O�L ?✓- � i �
�.NO. I"� � "I YI i I
fE: NO EAVE OVBRHANG SHALL BE LE89 THAN
' TO SIDE @ REAR P. L.
'ES
.OWED (U.B.C.REOl11REMENT
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDINO AGGESSORY BUILDING
tOM C/L STREET T
�VAR.${
C. O. P.
s�/ i o � C�(/�(l N n
� /�
�� G �l a � / / J C'
1 HEREBY �CKNOWLEq08 THAT 1 H�Ve ReAD TNI6 APPLICATION
AND 8TI1TE THAT TH8 ABOVH IB CORHCCT AND AORHH TO COM.
VLY WITH ALL c�T' OqO1NAHCU AND BiAT[ LAWB RBOULAT�HO
BUILDINO CON9TfllIGiION. ^�
81GNATUREOP/�! � ///
PERMITfEG ��>i!Q� �v.—!7`/
v�
AUTHORIZ6D ABHN7
�
L�
eeT. Mwin a
ACCE55. BL[
DATE
�
,� �i � U sa. Fr. � � U [�
THE AMOUNT BHO N UNCEP VALUAT�ON �8 POR TH8
PURPOSE Or H➢TABL�SHINO A PBRMIT FE8 ONLY.
VALUATION �� `!
PERMITFEE S
s � L%�2y� � $ 39—
TOTALFEE S � / /