HomeMy WebLinkAbout3101 DONNYBROOK LN - Building PermitsO t MFS,
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
PERMIT TYPE B_ROOF2
APN: 14104215
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: 610-00225
JOB ADDRESS: 3101 DONNYBROOK LN CM
Vicinity: HOUSE AND GARAGE ROOF
Squares: 2800
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation
ISSUED
07/30/2010
RMD
$8,326.00
SCOPE OF WORK: TEAR DFF EXISTING ROOF MATERIALS, INSTALL (1) LAYER OF 301t FELT ON A 4:12 PITCHED ROOF AND
REROOF WITH 30 YEAR COMp SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 28. REPAIR AND
REPLACE SHEATHING AS NEEDED. COMPIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: CHRISTIE LEONARD R
PHONE: 949-939-7144
APPLICANT: DIAZ, LINDA
PHONE: 949-642-7222
CONTRACTOR: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVEUnit:
City/State/Zip: COSTA MESA, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$0.00
$167.25
$0.00
$1.00
Address: 3101 DONNYBROOK LN
City/State/Zip: COSTA MESA, CA
Address: 1653 1/2 SUPERIOR AVE
City/State/Zip: COSTA MESA, CA
L(cense No.
License No.
PHONE:
License No. 349666
949-642-7222
CELL:
PHONE:
PHONE:
Unit:
Unit: :
MOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 em thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays
New Years Dav. Memorial Dav. Independence Dav. Labor Dav, Thanksqivinq Dav and Christmas Dav
NOTICE: The work authorized by this permi� shall comply with all applicable handicap access requirements untler California statutes and related
regulations. (Ord. No. 92-28. § 7, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the expiration oi this permit.
L OE t. INSPECTONTYPE OP IN7RIALS CO�E� INSPEC110NTYPE OpTE IN7171RLS
1616 Fixed System Final Fire Preven6on 208 Final Mechanical
t 266 Pool Spa Final ..�A � 208 Final Plumbing
200 Final Re-Roo1 ���'IV ���+"l�Y� 210 Final Electncal
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Placa 220 Final Plannirg Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Builtling/Occupancy
„ �
��WORKERS' COMPENSATION DECLARATION:
I hereby aHirm untler penalry ol perjury one o( the lollowing declarations:
� I have and will maintain a ceAifcale of consenl lo self-Insure tor workers'
compensation, as provitletl for by section 3700 of the Labor Cotle, for the
peAormance ot the v+ork for which Ihis permi[ is issuetl.
❑ I have antl will maintain v.orkers' compensation insu2nce, as required by
section 3700 of the Labor Code, for the peAwmance of Ihe work for which this
pertnit is issued. M workers' compensation Insurance carrier and policy
numberare: `r�j _ ��
Camer; � � v
K� (TnrSsec(ionneediwlCe�m/m��p�et allh�eycem��/ u)'valueEa'r7on'e7n�unjdred0ollars(StOpJaless)
Policy�Number. lY"�G 'l���U � !/vO ��
❑ I certify ihat in the peAormance of Ihe vrork for which this pertnit is
issued, I shall not employ any person in any manner so as to become subject
b the vrorkers' compensalion laws of Califomia, and agree that i/ I should
become subject lo workers' compensation provisions of Section 3700 of
the Labor Cotle, I a orthwith com ly vnlh these provisions.
\ � �U
Ap�dl nlb'Sfgnd re .�D IB�.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUT AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Pro(essions Code, and
my license is in `fuIll rce and eHect. n,� ({
Lic. # i Gass�#�- W `
_ O �
�Co vanor's �gnaw �e_ -
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a constmctbn lending agency fa the
peAwmance of the HOM (a vfiich this pertnil is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
SignaWre
OW NER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury Iha� I am EXEMPT FROM THE
CONTRAC70R5 LICENSE LAW tor the following reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or counry which requires a permit to
constmct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to Poe a signed statement
thal he or she is licensed pursuanl lo the provisions of the Contraclors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom and
ihe basis for lhe alleged exemp�ion. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicanl to a civil penalty of not more Ihan
fve hundred tlollars ($500).):
❑ I, as owner o! the property, or my employees with vraqes as Iheir sole
wmpensation, WILL DO THE WORK, and the siructure is not intended or
offered tor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
Ihereon, and who does such work himself or herself or Ihrough his or her own
employees, provided that such improvements are not intended or offered tor
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the hurden of pmving thal he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construcl the project (Sec. 7644, Business and
Pro(essbns Code: The contractors License Law dces not apply to an owner of
propetly who builtls or improves thereon, and who contracts for such pmject with
a cont2cta(s) license pursuant to the Contractars License Lavrs.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
Ovmer ID venfied by drivei a license. ❑ Ves' ❑ No
Driver's License No. Expires: � '
Verification of Ownership by (type of tlocument, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlify that no excavation frve (5) a more feet in depth into which a
person is required to descend, will be made in cannection with work authorized
by lhis pertnil, and lhat no building sWcture, scaHdding, falsework, or demolition
or dismantling thereof, will be more lhan thirty-six (36) teel high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2live Code).
❑ As ovmer-builder, I will not employ anyone to do work which would
require a permit from the Division of Indusirial Safety, as noted above. unless
such person has a permit to do such work Irom the division.
Applican(s SiBnaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or fuWre building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery Code requires, with some
eaceptions, that a Business Plan be fled with the Costa Mesa Fire
DepartmeN by every business v+hich has at any one time dunng a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future builtling occupant need to (le
a regisiration form for awtely hazardous materials? ❑ Yes ❑ No
(Section 25533 of t�e Califomia Health antl Safery Code, with some
exceptions, requires registration vrith �he Cosla Mesa Fire Department by
each business which at any one lime has on hantl a quantily of acutely
hazardous materials equal to or greater Ihan a weight of 500 pountls, or a
volume o( 55 gallons, or 200 cubic leet of compressed gas at standard
femperaNre and pressure).
3. Does or vrill the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program tor acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provitles that the
Costa Mesa Fire Department may require the preparalion, cehifcation and
fling wilh lhe Fire DepaAmenl of an RMPP by businesses which are requiretl
ro register acutely hazartlous matenals vrilh the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Healt� antl Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or vrill the applicant or present or fuNre building occupant require for
the vrork which is the subjecl of this application a permit for such cons[ruc[ion
or modiflcation (rom lhe South Coasl Air Quality Managemenl Dislrict or from
any other air polWtion control disVict or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Cotle requires that the requested
infortnation be fumished on applications for non-resitlential buildin9 permits).
6. Will any part of lhe facilily lo be constructed under this permit be vnlhin
1000 feet lrom the outer boundaries of a school? ❑ Ves ❑ No
Qf "yes”, �he (acility must meet Ihe requirement o( Sections 25534 and 42303
of the Califomia Health and Salery Code).
7. If a permit from the South Coast Air �ualiry Management District or olher
air pollution conhol district or agency is required for the vrork which is the
subject of this application, have all of the tlisclosures prescribetl by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", a��ach certifcate of compliance from the appropriate air pollution
control officer).
CER7IFICATE OF COMPLIANCE: I certiy that under penalty o( perjury the
information given above is conecl I agree to wmply with all state laws and
city ortlinances regartling Hazardous Materials and Emissions.
Signawre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penal�y of perjury that I have read lhis appliwtion and state that
the information given is correct. I a9ree to comply vrith all state laws and city
ordinances relaling to building consWction, antl authorize representatives o(
the City of Costa Mesa ro enter upon me abovetlescribed properry for
inspection purposes. I agree not Io occupy or allow occupancy of any building
authorized by this permit until final inspeclion.
SignaWre LegalOwner( ate
�,
SignaWre Oale
0051�a6(3/O)) ! " utfibnze OW��m�.� e� �e-�.
t�_.� .
� Ooaoue Suffac¢ Detail5 For the furred portioned of Mass N'alls see Forrin� Strips Construction Tabie beion�. �
Tag/ I Assembly Name I Material
]D or Tvoe and Size''
U-
1A4
JA4 Table f Cavity I Insulation
� . L . )
R-value, see Page JA4d and 6guatia� 4-f. For' cafculalinp furred �valfs use
Furring Coosiniction mble belo�e.
1. For Tag/!D iadicale !he iderrtificatimr name tha/ matcher the building planr.
?. bidicaie the Assemblr Name or rype: Roaf/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors ond eta..lndiea�e �he Frame rype and Size.� For
N�ood, Me1al, Metal Buildings, Mass, enrer 2x9, 2s6, or etc... see JA4 fa� other possible frame rype assem6lies.
3. Enier Ihe thickness for' mass in inchet or Spacing 6enveen framing members enter; I6 "or 24 "OC; or O�her ja� alf o�her assembly descriprion
such as Cnncrete Sandwich Panel, Spandrel Panel, bogs, Straw Bale Panel and etc....
4. Based on Uie Clima�e Zone; enter the Srandard U factor fi�om Toble I51-B, C or D fm� e�ch dij{erem assemb(p Name or type.
5. En�er the Table num6er dia� closelp resembles the proposed assembh�.
G. L•n�er IHe R-n41ue (ha( is being inslalled in �he walf caviq� or Getween the finming; od�erwise, enrer "0 ".
7. Enter ihe Continuous Insulaiia� 2-naluejor the propoaed assernblp; a�herwise, emer "0".
b'. Lnrer �he rnw and cnlunm o(the U fac�or valne based on Calumu FTable Number and en�er �he Assem6l�� U fac�or in Column J
). The Propnsed AssemGlr U jacior', Calumn J, musi be equa! m or fess thon �he Smntlard U factw' in Column E m complp.
Fuiring Strips Constn�ction Table for Mass Walls Only �
A B C D C F G H I .I K L M
1'roposed Pruperties uf Masonry and Concrete Added Interim� ur lix[erior Insulntiun
Walls Prum Itekrence in Farring Space (rom Refcrence
Juint A eudiz 9'able 4.3.5. 4.3.G, q3.7 .loint A endis 7'able 4.3.13
_ "� — >. _
V � j y v -
� � G`L � V
�; �° o F U c i>_. m .,.. Final
Asscmbly z' 'j _ o �� v c � �.'� '_ _
Mass Namc or JA4 Table .s ` �v v� E ry o 't . Q o � A Asse�itb�y
Thickuess' T c' Num6er' �'� _ yj = LL i L C Q'� u�i r U-factor�� Comment
� I
I I I 1
kegia•u�ulion N1m�ber: Regisn'ution Duie/I'ime: HL•RS Provider:
200d' Resideirlial Contpliuncc Farrn,s �lugus� 2009
e CertificaYe of Compliance: ResidenYial
Alteratinns
ChrIS
C1lmetcZone
ROOFING PRODUCTS (COOL ROOFS) §151(p12
When Nie areu ojcrterior roojsr�rjace to bc replaced exceeds more Ihan 50% oJUre eris(ing raojarea, or niore Ntun 1,000 j�,
less, �he ne�v roofing aren inust n�eet the roofing prodaci "Con! Roof'requirements oj§]52(bJIHi, 152(b)1 Hii, or I52(b)]Hiii.
or
Check app[icab/e a6ernatrve or exceptiai below if the rooJaUera�ion is esemp� jrom (he roofingproduc� "Cool Xoof" requiremenls. Nole: /Jany
one of the o6erna(ives or exceplion belo�� is checked, (he Aged Solar ReJleclance m�d Therma! Emittance requirements jor roofing products in
-,¢l /8(rJ are no� applicab(e. Do nor fi(l iable below. f�
❑ Cool Roofs Not Requircd iu Climate Zones I-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch,
�oo! Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater Ihan 2:12) and product unit wei�ht less
il@rnatives to §152(b)1Hi and §152(b)Hii, Steep-slope roof (pitcli > 2:I2J
❑ Insulation witli a thermal resistance of a� least 0.85 hrfi��OF/Bhi or at least a 3/4 inch airvspace is added to the mof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(�10; or
❑ In climnte zones 10, 12 and 13, with 1 ft�.of free ventilation area of ariic ventilation for every I50 ftZ of attic Floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radient barrier in [he attic meeting the requirements of §151(�2; or
❑ Building has no ducts in tlie attic; or
❑ In climare zones 10, I t, l3 and 14, R3 or greater roof deck insulation above vented attic.
Exception to §I52(b)1Hiii, Low-slope roof (pitcli _<1:12J �
❑ Buildin¢, has no ducts in Ihe attic.
Other Exceptions
❑ Roofing area covered by building integrated; photovoltaic panels and solar Ihermal panels are exempt from Ihe below Cool Roof criteria.
❑ RnoF cnnstructinnc that have thermal mass nver [he rnnf inembrane with at leas[ 25 Ib/ft� is exemot from the 6elow Cool Rnof criteria.
no
CRRC
�bel is available, this emnpliance me[hod cannot be used, use the Performance Approach to s
de box below if Hxem t from the Roofin Products "Cool Roof' Re uirement:
Roof Slope Product Weight Product Aged Solar
ID Numbcr < 2:12 > 2:12 < 516/ft' > 516/ft2 T e� ReFlectance�'
❑ ❑ ❑ ❑ ❑^
❑ ❑ ❑ ❑ p^
�0�
f�������1
�-�
�_�
�-�
Thertnal
T6e CRRC Po'aducl /D NumGer cmr Le abminedfi�orn Ihe Cool RoofRaling Cauncil's ftaled Praducl Directay n! w�v�v.coalrooCs.ornPoroducLs/.search.�hn
Indicore tlre �ype ofprodimi ia' Leing use� jor d�e roof rop, i.e. singlepl�� roof, asphall roof, meml roof, elc.
1/Ihe Aged Ae/leclance i.e nol avniluLle in.ilre Codl Bno�Raiing Cauncil's Raied Prnducl Directar�� Ihen use !he Inilia! ReJleciance valuc fr�om !he sunte
diirclor�, mrd use dre eqrmlron (0.2+OJ(P;,di�ol— a.2)1n ohroin n calculated oged vok�e. IN/iere p is 1he Lriiia/ Solar RefJeclwme.
Cl�eck Go.c i((he Aged Relleclmrce is n calmdaied vu6�e using U�e equation aGnve.
Calcula�e 16e Sftl valne In� using tlte S/U- Ww'ksheei nl hup'/hwn �• enerm�.co.eov/litlel4/and emer �he resuliing valuc in dre SR/ CoLumi aLave ond a�mch ac<
die SIU- IVorksheer �o Ilie CF-1 R. �
� apply Liquid Tield Applied Cuatings, the coaling must be applied across the entire roof surface and meet the dry mil thickness or coverage
�ommended by the coalings manufacturer and meet minimum performance requirements listed in §1 I B(i)4. Selecl the aprylicable coating:
Aluminum-Pigmented Asphult Roof Coating
Cement-Based Roof Coating
Other
Regisb�ution Nurnber: 2egistration Daie/1'ime: FIE/tS Po'ovider:
2008 Residential Compliunce Forms
Augus�2009
,f 1'rescriptivr CerCific�te ui� Cumpli.�nce: Residenti�l CF-IR-ALT
Resitleixti�d Alterntion,c (Pa�e ; uf� �)
. Yru��'eei�Nume:=�,ry� �_y . Climntce'Lonrli` � * oPS_ '��es
I-�na�-d � ��3 �._ �v I
H�I:S VP�,3�IFlCATIOI�' SUMMARY The enforcemeni nRenei� shoidd pnr special atre�aim� in llrc HE2S hleasw-e.sspeci/ierl in 7his
checldisi Lelow. A conryle�ad and sio»ed CF II' Fonv /or till Uva n�easm�e.r sqecified sl�cil! Ge suLnaftted ��� ihc Guildirvg inspeclor LeJmz� /inril
lluct Sexling S TCStllld HERSverijicniion is reyuire�/or d�ia mcnsure.
❑ 1'�S ❑ NO 1'GS: In Climate Zones ° and J-1 G, i1' mort than 4U linear feet of new or replucemem ducts .ire insinlled in uncondrtfoned
� space, the ducts ure to be sealed per {U52(b)IDii and the newly instulled ducts are tu be insulaled pei § I51(1)10.
❑ EXC�PTIOn: Lzistind duct s��stems thal are estended; �v6icL xre wustrucced, insulnted ur sealed with asbestos.
❑ �'�S ❑ NO 1'i5: ]n Climate Zones 2 and 9-16, if [he existing space-condiuoni��g system (HVAC equipmenl and ductingj is replaced: the
� duc¢ are to be sealed per §152(6pDi. �
❑ P�5 ❑ NO ]'ES: In Climate Zones 2 and 9J G, if the existing HVAC equipmeN is repluced (including the replacemem of�the an� handler,
� outdoor condensing unii of si split system, cooling or heati��g coil, or the furnace heai exchanger) the ducts are to be
sealed per § ] 52(b)1 E.
❑ E3:C�PT101�: Duct systems tLat are ducumented to have been previuuslp sealed confirmed tivuugli HiI2S
� veritication in accm�dance with prucedures in the Reference Residentinl Appendix RA3.
� �� ❑ EXCEPTIO�: Uuct systems with less than 40 linear feet in unconditiuned space. � .
❑ P.XC�PT10�: Existing duct s��s[ems constructed, insulated m'sealed with asUestus.
Refrigerant Charge - Split S,ystem HERS verijicalion is reqvirecl,for lhis meosm�e.
❑ Y�S ❑ NO YLS: ln Climate Zones 2 and 5-15, wl�en the existing HVAC equipment is replaced (includin� the replacement of the air
handler, outdoor condensing unit of a split sys[em A/C or l�ea[ pump, coo7ing m' I�eating coil; or the furnace heat
exchaneerl a refrieerant charee meesurement shall be verified per �152(611F.
Centra] Fan Integrated (CFI) Ventilation S}�stem and Fan Watt Draw
The ventilation renuirements of $l5D(o) do not aoolv tn existine residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airtlow HERS verifcaiion is required jor this meosum.
❑ Y�S ❑ NO YES: ln Climare Zones 10 through 15, when [he existin� space-condi[ioning system (HVAC equipmeni and ducting) is
replaced. the airflow and ian watt draw shall be verified ner § 152(b) i Ci to meet the renuirements of & I> I(f17B.
Locumentation Autlior's
• I rertif�� that this Cert^ificate of G
Name'. ,LI ��GI � /� U (i
Company: �,�` �� �„ n �/ Uate: O � I
«t� ► i �.e� U . � o .
Adlress: � ` n �l/ fL �n ]f Applicable � C A m� O EPE
p� I T� �w, (Certification t!):
City/State/Zip{� �� `^/� � (,�' G,/� �j �f _� Phonc:n `� tL
L; 1 f' l,C.,, `'i'— -� tU "1 'l -%�l ��� ZZZ
�I2espnnsible I3uildine Desi��ner's Leclaratiur Statement � �
� I um eligible under Dirision i of ihe C�lifornia Business and Professions Code to accepi responsibiliq� fm� the buildine design identifiecl-oii'
this Cenificate of Coinpliance.
• ] cenify Ihai the energy @a�w�es and pertormanec speci5c�tions 1or the building design identiLed on this Cer�iLcaue of Compliance conform
to thc requircments of Tillc 24, Yarls I and G of Ihe Caliibrniti Cnde of Regulations.
• The building design features idemiGed on thi;�, Certii�icaie of Cvmpliunce are consisiem wilh the in(brmation provided to documen� this
building <lesign on th: other tipplicable compliunec lonns, worl:sheets, calculations, plans and speciLca�ion: suboiitied iu the enlorcement
ueencr ior approral wrth tliis buildinr permii �� �plicotion.
Ntime: Signative:
Companq'.
Address:
Ciry; SiatelZip:
Lale:
Lieense:
Phmie:
Tnr u.c.si.rttuice nr qneetinn.� reg�u'din� thc Ene�'el' S�mtd�t�vLc, cnttl«c( [hc L'ne�'eP Hotl'u�c ut: 1-8b0-7i2-i30b.
I(egisva�ian R'umber: Regi.su��iia� Uaie/Tfmc HERS' !'ro�dder:
2D(If; lfcsiclenliul Complim�ce Forms /Ja�garst 300J
(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
3101 DONNYBROOK LN
GARAGE
Parcel Nunmher: 14104215
Applicant
Address:
Owner:
Address
STEVE SCHNIERER
28816 CONEJO VIEW DR
AUGORA HILLS, CA
FROST, JACQULINE
3101 DONNYBROOK LN
COSTA MESA, CA
Contractor: EMPIRE PLUMBING
Address: 12922 HARBOR BL
SUITE 687
ISSUE FEE
Temp serviCe test
Res. a/c paCkage
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to 1hp
Motors to 10hp
Motors to 50hp
Motors ta 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
GARDEN GROVE, CA
Phone: 818-735-7876
Zip: 91301
Phone: (714)432-0117
Zip: 92626-2723
Phone: 714-530-7320
Zip: 92840
License: 794154
SCOPE OF PERMIT
ELECTRICAL TO INCLUDE: 3 OUTLETS LOCATED IN GARAGE.
$23.50
30.00
$0.00
$0.00
$0.00
50.00
$0.00
$3.30
50.00
$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
Quantity
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Trensformers up to 1 kva/kw
................up to 70 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
"Misa Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 07/17/2003
Issued: 07/17/2003
ISSUED BY: ��/
Quantity
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered 7egal, such vrork must comply with all applicable codes, and all
required inspeetlons and itnal approval must be obtained. Failure to ohtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2dd646IN00)
WORKERS' COMPENSATION DECLARATION: �
I hereby aHirm under penaliy of perjury ona of the following tleclarations: ' '
❑ I heve antl will maintain e certificate of consent to salf-Insure tor workers' compensation, as pmvidetl for by secfion 3700 0l ihe Labor Cotle, for the peAormance of the
work tor which ihis permit is issued.
�� I have antl will maintain workers' compensation insurance, as required by section 3700 of tha Labor Cotle, Por the pertortnance oi the work for which Ihis pertnit is issued.
My kers' compen{�ation Ins�uraInce 1wrrier end policy number are: iI
Carrier: -��Qf2.Y�](1V� IV0.Tl(1YlG� PolicyNumber:C71KiZ—DOZ—I'ZU1�
(This section need nof be comp/eted i/ fhe permit is velued ef one hundretl tlollars ($100) or Iess.J
❑ I certity ihet in ihe perfortnance of ihe work for which ihis permit is issued, I shall no! employ any pereon in any manner so as to become subject to ihe workers'
compensation laws of Califomia, a e � e that If I should �ecome sub)ect to the workars' compensation provisions of Section 3700 of the Labor Cotle, I shell iorthwith
comply with lhase vi '
npp�iwm5i9nemre: oete: �1�'�3
WARNINd: FAILURE T SECURE W KERS' COMPENSATIQV COVERAGE IS UNL4WFUL AND SHALL SUBIECT AN EMPLOVEq TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREO
THOUSAND DOLLARE (5100,000), IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 3/06 OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am
force and effect. Lic. M_
Comradors SignaWre:
of Chapter 9(commencing with Section 7000) of Division 3 of fhe Business and Professions Code, antl my license is in full
c�ess « � i o czo C3 c y z
Date: —7�i 7 !)�
' CONSTRUCTION LENDING AGENCY:
I. ❑ I hereby attirm that there is a consiruction lending egency for the pedormance of the work tor which this pertnit is issuetl. (Sac 3097, Civil Code).
Lender's Name: Lentler's Atldress:
�, SignaWre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirm thet untler penalty of peryury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions
Code: Any city or counry which requires a permit to construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires �he applicant for such permit
to fila e signetl statement that he or she is Ilcensetl pursuent to the provisions ol the Coniractors License Lew (Chepter 9(commancing with Section 7000) ot Division 3 of ihe
Business and Protessions Code) or Ihat he or she is e:empt thereirom and the basis tor the alleged ezemption. Any violation of Sedion 7031.5 hy any applicent for a permit
subjecis the applicent to a civil penalry of not more ihan live huntlred doliars ($500).):
❑ I, as owner of the property, or my employeas with wages as iheir sole compensation, WILL DO TME WORK, end the stmcture is not Intendetl or oHeretl far sale (Sec.
7044, Business and Professions Code: The Coniractors License law does not apply Io an owner of property who builds or improves �hereon, and who does such work
himself or herself or Ihwugh his or her own employees, provitletl that such improvements are not intendetl or oflered for sale. If, however, the builtling or improvemant is
sold within one year ot complelion, ihe owner-builtler will heve'the burden of proving that he or she ditl not build or improve for purpose of sale.). �
❑ I, as owner ot the property, am E%CLUSIVELV CONTNACTING WITH LICENSED CONTRACTORS to construct the Oroject (Sec. 7044, 8usiness and Professions
Code: The comradors License Law does not apply to an owner of propeny who builds or impmves ihereon, antl who contrecis tor such pmject wit� a contractoqs)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec.
Signature:
Owner ID verifietl by dnvers license. ❑ Ves ❑ No
Business antl Professions Code for this reason:
Varificetion ot Ownership by (�ype ot tlocumen�, i.e. - property lex bill or dead):
DIVISION OF INDUSTRIAL SAFE7V PERMIT CER7IFICATION:
Dnve(s License No.
Date:
Expires:
❑ I hereby cenity thet no excavation tive (5) or more teei in tlepih into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no 6uilding sWcture, scaflolding, talsework, or tlemolition or tlismaniling �hereof, will be more than thiny-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Califomia Adminis�rative Cotle).
❑ As owner-builder, I will no� employ enyone to tlo work which would require e permit from ihe Division of Industrial SefeN, as noted above, unless such person has e
permi� to tlo such work irom the division.
Siqnature: Date:
Division oi Intlustnal Safety Permit Number
CERTiFICA7E OF COMPLIANCE AND AIITHORIZA710N OF ENfAY; I certity under penalry of perjury Ihat 1 have read ihis epplication end s�ate Ihat Ihe information given is
correct I agrea to comply with ell state lews and city ordinances relating to bullding consiruction, antl authorize representatives oi the Ciry of Coste Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow xcupancy of any building authonzed by ihis permit until final inspection.
Of Legal Owner(s) Date
� 7�17 03
i onzed Applicant Date �
CODE �I. INSPECTIONTYPE �
1616 Fixed System Final Fire Prevenlion
1266 Pool Spe Final
200 Final Re�Roof
201 Final Block/Relaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
P6IE INTRIALS
COQE1 INSPECTIONTYVE �
206 final Mechanical
208 Final Plumbing
270 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Finai Si�e
250 FinalBuilding/Occupancy
p� u
� `4�
�
��
�
�oonc^�Soramidr�o: 3101 DOP]P]YBROOK LN
oxr+eRsr�wEicu�oxm: STANBERRY, KATHRYN W
' �oa� 3101 DONP]YBROOK LI•I
COSTA MESA,CA 92626
(714)556-7165
i1PPL.WIIII�G ADDFE55:
WCHRECT ON HM�NEEP:
nxcx. ox �o.•s wox�ss:
uxT: CITY OF COSTA MESA — BUILDING PERMIT
FLOOD: X 96
PERMIT NO: B 071929 PLAP] CHECK NO: N
uc. ra:
UNT:
�+�M«+s� FORTA, DOYLE C AT7D COMPAN ( 714 ) 556-7165
carn�croxsw,utwo 1075 REDDING AV
ADDXE53: C.OSTA MESA CA uc.r�o.: 954306
92626 uxr:
IJCEN5E0 CONfRRCTOPS DECLAN�TION: I Mreby dfim undar parety d pe�ury tM� I un licensed uMer proyisiom W Cheper 9
(cwnmemn0 ++Mh Seciion )000) d Dimion 9 d tha Buvneae vd Pmlesaiona CoEe d my license ia in full lace enA eMetl.
cm uc. No.: 0 3 5 511 uc. cuss: g uc. No.: 6 E X P: O S/ 9 5
oae: � !7-95 ���a: �
OWNEN BUILOEX OECIAPATION: I MmEy etfiim urMer perWy d ry ihel I em e:�amq Imm IM Coniretlas licenae lew la ihe
lollowm0 �aaso� (�w� �03�.5 Bueinese end PMaeeiona Code: R iry a wunry wfiich raquiree e parmn �o mneM1uct, aller, impove,
Omd'oh, or ropeir eiry almdure, pnor m na esuence, elso reqmree epplireni la wch peimn m file a ai8� etmemenl Net he m aM
IicenseE W��I lo IM panvona d the Conlreuas Licenae w ICheqx e(commmd�q xilh Saeion 1000) W D'veion 3 d �he
,eineea eM Prdeaau Codel u thet he a sha ia esemq t ham eM iM bese lor ihe elb0� exempion. MY volation W Setlion
i031.5 by enY aDd�t for e permil wbpcv tM epd�t to e wil pmelry d M mare Ihen fve huMred tldbn �5500�).
� I, es ovmer d IM properly a my empbyeas wIh wepes ea thei ede campenae�ion, vrill do IM woA. end IM Mruclum e rwt iMenEed
ar oNerad lar eeb (Saciim )014, Bueiness erd Prdeesiana Code: TM1e Conlreclas Licansa lewdom not epplyto en owner ol D�W�M
wM Wids a inpoves iharean, mM xho doea euch �k NmeeX a Mnetl a ihrtwph he a her own amployeea, prwidad thm wch
imqovameMa ere nd inieMad a dieieE fa eeb. C. however. iM Witlirq a'vnpmanem is edd wnhin pnYw d mmpbun. tM
o.�.�-d,ad« win ne� ina curaan a ww��a n. e..na ed �a w�b «�mwwe i« me wm�e a seiel.
� I. a� o�xror d IM prtpaM. � e�dueiveN �ireclm9 �h IiceneaE convenae �o wnavuu the qqea (Swon ]OOG. Busiiwae vM
Prolastione CaEe: Tha Gomreaon L'ranse lew doea nM eppy to en owner d popaity who builde w impavec therean vM xfio
conlrecla fw eu h prqetla wilh e ooMredor(a) licanead Wnuenl lo �ha CoMredon Lironee lewl.
� I em enemp uMm Seclion: B. 8 P.C., br Nb reesan:
Dme: Ownec
I Jo hereb/ cenily �hm I em ewera d eM uMarstenE iM requiremenls d CelAomie Heel�h eM Sdery Cade Seeione 25505, ?5533, vM
255�1, eM Ihel I ar eiry Mure buikiip orapent will / wil rrot (tlrcb me) need to compty wIh eaN pate catlm eM ihe reQuirsmsnb M
e Carmil lamntrvpion a modifimibnhanlM Fi�uTliry . anepeman� Octrirl. Rmidefuml mrmrwun ePG�iorewexemq Imm tMv
prwisiona.
ove: nnv���: �
WOPNER'S COMPENS�TION DECLAq�TON: I Mreby elfiim uMre perW�y W pajury me d Ne Idbxirp Eetlarabm:
❑ � neva.�e m� meimen e cenncme a mnami �o..x:�m,n �«.lon�m,• comw�umon, n wwuea r« M seaon a�ao a m. �en«
Cade. in tha pe�ame�e M IM wwk la wHc� ihia peimit is ivued.
� I �eve eM witl mvn�an xnrke�e' mmpanaeiion inwrerun, ea rpuiretl by Seqim 9100 al llro Lebor CoEe. br Iha pe�iwmenca d the
work lor which Ihia pa�mn ie iaued. My warkere' companselion inaurence rarriar erd policy number era:
c�.: STATE FUND EXPIAES
aa� �+�mc«: 10 / O 1/ 9 5
s section rieed nw be cwnpbteE f tM Ga^^d 'n ro. are huneiMCdlers (31w1 w bss.J
❑ 1 cenAy thet in the pe�lormence d iM wark la xfikh thie pemiil is ieaued, I ehell nd empby eiry pareon in eny menner so d �o
b«mn adetl �o �no .wnfere' canro�amlon bwa a cmilanb. ene ro� tlww tl�oNa n«ome vuNw �o �n. wonfen•
com nn o�ore a s«+ion a)oo a �ne lae« cm.. �.nd� fonnw� mqry� oae rwima,..
oa�.: �,[�_ 9.i aoa�,�: /�c
Wam/np: Fellun ro wcvro wo�ksn'rompsnutlon rovorp� l� unl { entl �lull au6/ect en emp/oysr ro erlMrol puw/tlu entl
clvll flro� up N on� h,ndreJ tlwus�nd do/kn (S10q0001. M• on b tl�� cost ot rompawWM1 tlenYp� W prov/dM b� In
Sxtlon J106 0/ tln LeDor Code, Infxu4 �tl emmsy'a fsu.
CONSTRUCTION IENDINO �GENCY: I hereby elfirtn uiMer nelry d perN�Y �hm �hm b e mna�ueion bMirp epenry 1« tlre
paAwmence W �ha wnrk lor which the perml ie eauad (Seaion 308], Civ. C�.
LENDER'S NMIE:
LENOEH'S AOUNE55:
i�en�n m� i nere,�ed m�s ww���.�e mme inm ina eeo� mio�m�, a�c. i m� m�dr.mn di mr.�e �,�n o,d��.
enC elele lewe relelin0 lo building conArutlion e�d hereb/ aNhwrza mpreaenle(rvea d Ihia dly lo enter upon ihe ebove-menlonetl pmpeM
iIXIf19O%INNI.WfWlB9. _
oa,e: �i'S
Whne-BuiWvq 8 Safery: GreerFFle: Cenery-Appfcanl: Pink-!ie`enue: Cmkenrotl-Avxssa
PERM P70; H 07192.
GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : INSTALL ONE 2'0"X4'0" SKYLIGHT E REROOF SQ FT; 2,500
CLAIM ��ALUE: 2,500.00 CALC—VALUE: 2,500.00 GROUP OCC: R-3 /
COMMENTS: REROOF ENTIRE SFDIGAR. WITH COMPO ROOFING / SKYLIT ICBOk 2969
iE iE�IF if if if1E�lE �4 Y--lf if iE Ififif�lE iE if dk1E #ihif if iE�7E �f�If9f 3f�lf-lE aEiE M ii IF if if if�1FjE �iRif-1R ifiFif iF iF�1FfR-lf i4 if �f if�iF�If iF M% iF if�IF af iR iF af iL�IE AF�If3f iE aF�F
Z O N I N G R E Q U T A E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BTJILDING ---------
FRNT; FT Ir] REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IPI LEFT: FT IN RGHT: FT IN
PARKIP7G REQ: PROV; PARCEL; 19104215,ZT]E: REF NO:_
PLANNING NOTES>
i /
if af if iE if iR if iR if iE jf iE af iE iF i4 iR if if iE iF if if �f if iF if iE iF �f 1f 3f 1f if if iE if i4 jt if if iF i4 iF ik iE jf�Y if aR iF if iF a4'tf i4 iF iF iF if if iE if 14 �F if if iF # if �K iF af iR if iF if i� if
D E V E L O P M E N T S E R V I C E S A E Q U I R E M E N,'.T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY:
***i�+t�i�**�-+r***�r+�*******iF ' 3F�3FiFiFiFiFiF3�iF�TiFs�3FiF3F+"��i'�-�ar-��i�3Fit**+�*D*�+Ec�*�����r���c�
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.OQ 50
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL
TOTALS----> 54.50 0.00 0,00 59.50
REVENUE DIVISION TOTALS--> COLLECTED:
HLDG PMT PLUMBING ELECTRIC MECHANIC
59,00
SMIP/NON—RES
PAID DUE
54,50 .00
54,50 OVER/SHORT; .00
FIP.E SMIP/TOT GRADING PLAN—CHECK
,50
iFi4 �f If if M if 1f if ih if tf iF if 1F if?EiF if i! if #' iF 1fk V+fiE 1F if i!�M � if if if M if if # iF iFjE�f if 1F%if if iF Y V� �F if if iF iF M if if �f i! iF iF ifi! iF if � L if4 ±4 lfifiE i4 iF
I N D I V I D U A L F E E H R E A K D O W N
TYPE t�TY U E S C R I P T I O N UNIT COST TOTAL COST
SFR SQO ALTER bY VALUE RESIDENTIAL N020NE 1,00 SOO.UO
SFR 2000 P.EROOF BY VALIIE RESIDENTIAL NOZONE 1,00 2,000.00
END OF FEES
oi onsv00S9—p028DG=4 Tf_f'r Sy,�Q ,�
DA7E: 04/17/,5 rz��. r�:3p
, CONSTRUCTION AND PIANNING POOI 'PA
APPROVALS Permit # Date Inspector qPPqOVALS Permit # Date Inspector
t. TemporarY Electrical Service or Poie 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • � �
3. Elecirical Conduit UtilitY•Undrgrnd. 54. Forms
.
A. Electrical Conduit�Undrgrnd. � 55. Electrical Bonding :
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i �
6. ElecvicalUFERGrnd. 5J. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgmd.
$. Foundativn 59. Gas Pipe, O Undrgrnd., Test ,
9. Water Pip¢•Undrgrnd. , 60. Backwash Lines, P�Trap, L l.�n[Jrgrnd.
10. Structural Floor System � - 61. APPROVAL TO DECK �
it. Property 5ewer Line & House Con;nection 62. Backwash & Receptor�firial '
12. Sewer Ca0 � 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final., �
ta. Rouyh Pl�mbing 65. Electrical-Final •
75. Rough EI¢ctrical•Conduit 66. Solar System-Final ,
76. Rough EI¢ctric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTEiiING �
18. Rough Eiectrical-T Bar Ceiiing � 69. P00�/SPA SYSTEMS FINAI.
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • . - APPROVALS Permit #
2L Ducts, in Structure 70. Uaderground Nydro
22. Ducts, Ventilating ' 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test - 72. Unde�ground Fiush
24. Roof Frem�ng . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheething 74. Overhead Hyd�o
26. T�Bar Ceffing (Stracturail & Monocoat � 75. Dry Chemical
27. Frame and Flashing - . )6. Dry $tandpipe
28. Lathing & Siding ' � 77. FIXED SYSTEM FINAL
29. Insulation . 76. FIRE PREV. FINAL �
30. Drywali Nailing HEALTN DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Final Eleetric Notes: �
34. Final Heating & Air Conditioning . �
t
35. Finai Gas P�Pe•Test � �
36. Hood or Canopy
37. Final Factory Firepiace ' �
38. Final Plumbing
39. Water Service•Final
40. Gas ServiCe-Final �
41. Solarpomestic-Final'
42. Backtlow Preventer
43. Backflow Irrigation ' � . ' '
44. Landscape Irrigation System � • �
45. Sound Attenuation
46. Handicap Regulations
47. FINAL S?RUCTURE & BUILDING L�. ��ji (,./�[
48. FINAL PLANNING . .
49. Electric Release io Edison � .
50. Gas Retease to Southem CaYifornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
-OWNER �Oj;7�E MFSAi ��T�dnrv DATE Sent,. fii '14�R _�
JOB ADDRESS �� O'I T1nn+Lk..-�.��� T•y� BUILDING PERR3IT NO. %rj01
GGNERAi CONTRACTOR ThP Hal P C�mnan� VALUE $ ] � i 5qq
AP. No. LOT �,� TRACT 9(��� FIRE ZONE DESCRIPTION OF WORK Sinvle dwel] inu w/att.4ar,
GROL[P T,e,i7 TYPE p ZONE Rl PLAN NO.
�ECTIONS I DATE I BUBCONTRACTOR ( DATE PERMITSNUMBEF
F Gas Test
,. � �• - ;.�.,. ��,r`-
_ � ' c�= _� u��.�L� d �':..
`COSTA MESA BUILDING DEPARTMENT • �� � S�
P.O.80X 31] tp�
COSTA MESA. CALIFORNIA FiIN��i�� E EPT.
i � � nr. �l1CTp M1AFc
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRE�s"s 3101
Donnybrook Iane B U I LD 1 N G
COSTA MESA. CALICORNIA FOR OFFICE USE ONLY
OWNEF COLLEGE MES
AODRE55 P� O. BOX Z�I.
c�Tv Anahei1m
ARCHITECT Bl11Ot� Q
OR ENGINEER an� (��
ADORE55 yyO2 W. 1/C
CONTRACTOR The H31e
nooRess1777 W.Linc
LEGnL LOT 6 2
�ESCRIPTION NO
A.P. NO.
5'ZE 66 x 101
OF LOT
L15E OF
E%ISTING BLDG.
FECEIPT NO, a[RR�(i�
V�
RE<EIVE� BY nAiE RECEIVE pqiE ISSUE
urst Station .�. — SEP 81!
TNo: KE 3-3161 qooRess
��c. COSTA MESA. CALIFORNIA
NO.
FIRE
ta Ana �oNE
NO. �JSO �ONE pOqNs TYPE GROU K
ai�o: KE 3-3161 BVPROVED pATE �
rAorr 'zG]1 CORRECTIONS
"° °F eLpGS None
��IOW ON LOT
SET6PCN LINE F
c[rvr[R or siRcei �j0� ftEqR YARD 3Z�
SIDE YARD RIGHT p� L[�pT p�
DESCRIPTION OF y�/ORK
NEW X ALTERATION II AOOITION
REPAIR MOVING IDEMOLISH
BUILDING 1zZ2 �L1V. NO OF
SIZE � ROOMS S STORIES 1,
EXTERIOR WALL ROOF
rnvcainir. Ctnrrn COVERING l�.........
STATE TMAT THE ABOVE IS CORFECT FND NGREE TO COMPLY WITM RLL
CITY OR�INPNCGS 4ND STPTF. Lt�NS REGULATING DUILUING CONSTRVC�
T��" C LLEGE MESA COMPANY VAIUHTION
SIGNATUREOF The Hale Com an Gen.yart er
PERMITTEE
� 12,599
AUTHORI E
�
PERMITFEE � ,3Q�QQ
P�AN CHECK S ]„5� QQ
TOTAL FEE $ 45.00
VBMI
owNtK 9fANBERAY, JAMES
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� ECTIONS
SOIL
GAS
� WATER
ROUGH PLUMBING
PROP. SWR. LINE
SPRINKLING SVST
_15 LOT
MOUSE CON.
MISCELLANEOUS - - -
ROUGH HEATING AN� Alfl CONOITIONING
UNDERGROUND U POWER U
ROUGM WIRING
TRENCHES FORMS STEEL REINF.
FLOOR SYSTE
BONO BEAM ❑ STEEL REINFORCE ❑
SHEATHING
FRAME ANO FLASHING
LATHING - IN n OUT n
PLFSTER, BROWN COAT
5- 'TURPL, FINAL
M. AG, VENT., REFRIG. ANO A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL
DATE fi-12-E
BUILDING PERMIT
FIRE ZONE VALUE
GROUP J TYPE
SUBCONTRACTOR
'. � 30623 -
v�c 12-6�00 565 � *** **5.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
onn rncTn nncc,. .
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Complefely
R C I D B DATE RECE/IVED DATE ISSUED
BUILDING y/D / � '�/_tl '-ia-�9
ADDRESS il
' O �,l _ /�/ PERMIT NO.
OWNER �f� � A.P. NO. 1
MAI L BUIL�ING
ADDFESS ADDRESS ��U� �
ry} TEL��/s-�7YO TRACY LOT BLOCK
CITV //l�Qq� NO. �r
CAN5TRUCTION N W ADD A R P
LENDEF �
BRANCH
OWNEF •n
ADDRESS � , �% _ _. , VALUE �/� pv
ARCHITECT TEL. SE L19'!Jf/t/ s �/
OR ENGINEER N .
FIRE �'f� / �
ADDRESS ZONE TVPE L/ GROUP
AP7ROVED
CONTRACTOP BY DATE
ADDRESS �
TEL. ZON NO.OF USE OF NEW
CITV NO. � P�+�v BUILDING
STATE CITV VARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILOING ACCESSORV BVILDING
SIZE � NO.OF B�DGS. / (FROM C/L STREET)
OF LOT 6 U NOW ON LOT RONT F. FT.
USE OF �
EXISTING BLDG. S FT. FT
SI2E OF NO. OF �
NEWBLDG. ROOMS STORIES I.SIDE FT. FT.
EXTERIOF WAIL ROOF
COVERING CpVERING REAR FT. FT.
USE F BUICDING AND WOFK TO BE PERFOIiMED DISTANCE BET. BET. MAIN &
LT.p/ %'-� MAIN BLOGS. ACCF�. BLDC'aS.
VAR. � DATE
C.U.P.# APPFOVED
APPROVED pJ
/
I hereby acknowledBe tha[ I have reatl this application and state
ffiai the above informetion is corYect antl agree to comply wiffi
all laws regulaUng buildin8 constructian, entl 1 shell not employ
any person in violation Of the workman's compensation laws ot
the State ot Celifornia.
I hereby certify that I em properly licensetl as a contrector untler SQ. FT.
the State of California Business antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl that such licenus are in full force antl eftect, or I THE PURPpSE OF ESTABI.ISHING A PERMR FEE ONLV:
am exempt from the provisions ot the Stat¢ of Calitornia Business VALUATION
entl Professions Cotle, Division 3, Chapter 9. PERMIT FEE $�-' �1
Signatura of p-r
Permittee �a� ��O PLqN CHECK $ ��
Authorizetl A nt ♦�
TOTAL FEE $ . �—V