HomeMy WebLinkAbout3102 DONNYBROOK LN - Building Permits�
�
CITY OF COSTA MESA
�,O�pMF,p BIIILDING DIVISION
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax p14) 754-0856 • www.ci.wsta-mesa.ca.us
°�oR�� fi FOR INSPECTIONS CALL (714) 754-5626
PERMIT NUMBER: BC10-00369
PERMIT TYPE: B COMBO STATUS: ISSUED ��
Sub Type: RES_ALT DATE ISSUED: OS113/2010
ISSUED BY: KJB
.106 ADDrtess: 3102 DONNYBROOK LN CM Suite/Unit:
APN: 14104302 Zoning:R1, ,
Vicinity: Primary Occ:
ConstType: V-B SQ.FT: 1265 Valuation: $140,000.00 �
SCOPE OF WORK: COMPLETE RENOVATION OF RESIDENCE TO INCLUDE: NEW DRYWALL, KITCHEN REMODEL;'NEW FAU,
NEW WINDOWS AND DOORS, ELECTRICAL TO INCLUDE: NEW 200 AMP SERVICE, 25 LIGHTS, 30 OUTLETS, 1.7 SWITCHES.
PLUMBING TO INCLUDE: NEW COPpER PIPING, REPLACE MAIN WATER LINE FROM METER TO RESIDENCE, 1 TUB, 1
SHOWER, 1
DISHWASHER, 1 LAUNDRY TUB/WASHER, 1 KITCHEN SINK, 2 TOILETS, 2 WASH BASINS AND 2 GAS OUTLETS. MECHANICAL
TO INCLUDE: NEW FAU AND RELOCATE FAU TO ATTIC, 2 VENT FANS / SINGLE DUCT, 1 APPLIANCE VENT. POUR NEW
GARAGE FLOOR. MINOR NON-STRUCTURAL CHANGES TO DOORS AND W INDOW OPENINGS. POP FRONT DOOR OUT 3
FT TO EXTEND ENTRY HALL. ALL NEW LIGHTING AND W INDOWS SHALL COMPLY W ITH TITLE 24. REF: C10-1151
OWNER: SIERRATRUST
Phone: 714-417-9143
APPLICANT: HOLLER, GLENN
Phone: 714-389-1045
Address: 18 ALBA E '
Cily/State/Zip: IRVINE, CA
Address: 18 ALBA E
City/State/zZip: IRVINE, CA
cONTRAC70R: NIAGRA WEST CONSTRUCTION License Na. 575352
Phone: 714•389-1045 Address: 18 ALBA EUnit:
CeIL City/State: IRVWE, 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
$1,217.75
$127.65
$63.65
$142.45
$14.00
$0.00
$6.00
$1,577.50
"ReTer to fee recei ts for all fees ald for ro'ect
HOURS FOR CONSTRUCTION ACTIVITY: EFFECT
Monday thru Friday • 7:00 am thru 7:00 pm. Salurdays-9:00 am thru 8:00 pm. P
New Years Day, Memorial Dav. Indeoendence Dav. Labor
UniL
Unit: :
ZipCode 92620
PHONE:
PHONE:
0- PER CMMC Sec. 13-279
ours - Sundays and the following Federal holidays:
ivina Dav and Christmas Dav
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, 12-21-92J
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under this permil 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 inspections and fnal approval will result in the expiration of this permit
CO�EO. INSPECTION7YPE DATE IN7ITIALS GODE/ INSPEGTIONTYPE / �AIE {{,,�^ IN�^TITIRlS��/
7616 Fixed System Final Fire Prevention 206 Final Mechanical 1—� 7�� � �YNwW��
1266 PoolSpa Final 208 Final Plumbing X� ���� •{{{�����n� I�,, ,
200 Final Re-Roof 2W Final Electrical X' —� —� � �
201
202
203
Final Block/Retaining Wall
Final Factory Fire Place
FinalSign
204 Final Demolition
212 Final Fire Prevention
220 FinalPlanningApproval
222 Final Site
250 Final Building/Occupancy
� ��
a
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of Ihe following dedarations:
❑ I have antl will main[ain a certificate of consent to sel4lnsure for workers'
compensation, as provided /or by section 3700 of the Labor Code, for the
pedormance of [he work for which this permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the pertortnance o( the work for which [his
permit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Cartier �/�J/VN�1 /J
(Thk secfion neetl�rof be competetl the permrt ¢ va eo al e nunGretl dollars (5f0'J) w less )
Policy Num er:
ertify thal in the performance of ihe vrork (or which this permi[ is
u I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laws of California, and agree that if 1 should
become subject to Ihe workers' compensation provisions of Section 3700 of
the Labor Code1, shall forthwith comply wi[h [hese provision .
.�/,/ // lr��/r. �l
" Si alure �.'�� ate�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT 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 CONTRACTORS DEC�,4RATION:
I hereby affrm that I am licensetl under pmvisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in ✓ullJfo� and efl
-�Lic'#—�v�+... / �' assn3
' c nvac pi �S1gna� re"
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that Ihere is a consirucl'an lending agency for the
performance of [he work fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o( perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit to
wnstruct, alter, improve, demolish, or repair any StmcWre, prior to its
issuance, also requires the applicant for such permit to fle a signetl statement
that he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is ezempt therefrom and
the basis (or Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecis the applicant [o a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and [he slruclure is not intentled or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvemenis are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo cons[mct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply ro an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor�s) license pursuant to the Contrectas License Lavrs.).
❑ I am exempt under sec.
Business and Pmfessions Code for this reason:
Signalure Da�e
305]-4fi (3I01)
Ovmer ID verifed by drive� s license. ❑ Ves ❑ No
Driver's License No. Elpires:
Verification oi Ownership by (type of documen[, i.e. - property tax bill or tleed�:
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cert'rfy thal no excavation fve (5) or more feet in dep[h into which a
person is required to descend, will be made in connection with work authorized
by this pertni[, and Ihat no building s[ructure, scaf(olding, falsevrork, ar demolition
or dismantling [hereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Gry
2, Art 2, Sea 341, Title 8, Califomia Administ2tive Code).
❑ As ovmer-builder, I vnll not employ anyone to do work which vrould
require a permit from Ihe Division o� Industrial Safety, as noted above, unless
such person has a permit [o do such work from lhe division.
Appliwnfs Signature �ate
Division of Industrial Safety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to fle antl
certi(y a Business Plan (or emerqency response to release or [hreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
ezceptions, that a Business Plan be filed with Ihe Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal lo or greater Ihan a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas
at standard temperaWre and pressure).
2. Does or will the applicant or present or future building occupant need to file
a regishation form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registretion wi[h the Costa Mesa Fire Departmenl by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
lemperature and pressure�.
3. Does or will ihe applicant or presenl or Nture builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Calitomia Health and Safety Code provides that the
Cos[a Mesa Fire Department may require the preparation, certification and
tiling with the Fire Department of an RMPP by businesses which are required
lo regis[er acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 of Ihe Cali(ornia
Health and Safe[y Code been Fully complied with? ❑ Yes ❑ No
5. Does or vnll the applicant or present or tuture building occupant require for
Ihe wo�k which is Ihe subject of Nis applicalion a permit for such constmclion
or modifcation fmm lhe South Coast Air Quality Management Dislrict or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
intortnation be fumished on applications fa non-resitlential building permits).
6. Will any part o/ Ihe facility lo be construded under Ihis permit be within
1000 feet fmm the outer boundanes of a school? ❑ Yes ❑ No
(If'yes", the faciliry must meet ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from the South Coast Air Quality Management Disinct or other
air pollution control tlisMct or agency is required for lhe vrork which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of comptiance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AN� AUTHORIZATION OF ENTRY: I
certity under penalry of perjury that I have read this application and state that
the information given is correcL I agree to comply with ali state laws and city
ordinances relating to building construction, and authorize representalives of
the City of Costa Mesa to enter upon Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized 6y this permit until final inspection.
S� ol Legal Own s) Date `
/ \
� � `�
is�FADC/a[Aulh rizetl�Appl�caix
V1�
e 1
CITY OF COSTA MESA
, O� MF y BYILDING DIVISION
i�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�"'°""°� PERMIT NUMBER: 610-00240
PERMIT TYPE B_ROOF2
APN: 14104302
JOB ADDRESS: 3102 DONNYBROOK LN CM
vicinity:
Squares: 1265
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
0 8/1 312 01 0
KJB
$7,000.00
SCOPE OF WORK: T�qR OFF EXISTING ROOF. COVER WITH 30 YEAR COMP SHINGLES. INCLUDES ATTACHED GARAGE. ROOF
PITCH IS 5:12. RE-ROOF WILL BE SUBCONTRACTED TO A ROOFING CONTRACTOR.
OWNER: SIERRATRUST
PHONE: 714d17-9143
APPLICANT: HOLLER, GLENN
PHONE: 714-389-1045
CONTRACTOR: NIAGRA WEST CONSTRUCTION
Address: 'IB ALBA EUnit:
City/State/Zip: IRVINE, Cq 92620
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $139.25
Reinspection Fee: $0.00
Bldg Std Admin Fund , 51.00
Address: 1 B ALBA E
City/State/Zip� IRVINE, CA
Address: 18 ALBA E
City/State/Zip: IRVINE, CA
PHONE:
License No.
License No.
Unit:
Unit:
License No. 575352
714-389-1045 '
CELL:
PHONE:
PHONE:
TOTAL FEES $14025
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Y�ars Dav. Memorial Dav. IndeDendenCe Dav. Labor Dav. Thanksaivino Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECiIONS: tn order For the work authonzed under this permit to be considered legal, such work must cnmply with all applirable codes, and aN
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit.
CODEN. INSPEC710NTYPE DAiE INPilALS CO�E/ INSPEGiIONTYPE ORTE IN7ITIALS
1616 Fized System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �'1 208 Final Plumbing
200 Final Re-Rwl i:� ���-:a —�� m��GU� 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Piace 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolilion 250 FinalBuilding/Occupancy
4
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following dedaretions:
❑ I have and will maintain a cetlificate of consent to self-Insure for workers'
compensation, as provitled for by section 3700 of the Labor Code, for the
peAormance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the vrork for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This seGion nee0 rpt be mmple(ed Alhe peimR s valve ne hundmd donars (SfoO) w less )
���Po/licy �Number �I� �
certify that in the peAormance of t e vrork for which [his permit is
issued, I shall not employ any person in any manner so as [o become subject
lo the workers' compensation laws o( California, and agree that if I should
become subject to the workers' compensation provisions of Sec[ion 3700 of
the Labor Code, I shall forthwith comply wi[h [hese prov ions.
a��i' nl�s ian�l�5 �rt ate
�ss
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNlAWFUL AND SHALL SUBJECT AN EMPLOVER 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 CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chap[er 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Code, antl
my license is/�in full force and eRecl.
Lic. # L���/ Class #
��ignaWr� � ate
���
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm Iha[ there is a construction lending agency for lhe
peAortnance of the wurk fa which this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o( perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
eusiness and Professions Code: Any city or county which requires a permi[ to
construct, alter, improve, demolish, or repair any structure, prior [o i�s
issuance, also requires the applicant for such pertnit lo (le a signed statemen[
lhat he or she is licensed pursuant to the provisions of the Coniraclors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of [he
Business and Protessions Code) or that he or she is exempt lherefrom and
the basis (or the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecis the applicant ro a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and [he stmcWre is not in[ended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does nol apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided Ihat such improvemenfs are not intended or offered for
sale. If, however, Ihe building or improvement is sold vnthin one year of
completioq the owneo-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner o( lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and
Professions Cotle: The cont2ctors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts tor such project with
a contrector�s) license pursuant to the Contrectas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SlgnaWre Date
905]�46(3I0]
Owner ID veri/ied by driver s license. ❑ Ves ❑ No
Driver's license No. Expires: �
Verifcation o( Ownership by (lype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certi(y that no excavation frve (5) or more fee[ in depth in[o which a
person is requiretl to descentl, will be matle in connection with work authorized
by [his pertnit, and that no building stmcture, scaffolding, falsev.ork, p demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8. Califomia AdminisiraMe Code�.
❑ As ovmer-builder. I will not employ anyone lo do vrork which would
require a permit (rom the Division of Indusirial Safety, as notetl above, unless
such person has a permit to tlo such vrork from the tlivision.
Appliwnl's SignaNre Oale
Division of Industrial Safety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or fuWre building occupant need to fle and
cerlify a Business Plan for emergency response lo release or threa�ened
release of a hazardous material? ❑ Ves ❑ No
(Seclion 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quan[iry of hazardous materials equal to or grea[er ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standartl temperature antl pressure�.
2. Does or will Ihe applicant or present or fuWre building occupant need to fle
a registration form (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Heallh and Saiety Code, wilh some
exceptions, requires regisiretion with the Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantily o( acu[ely
hazardous materials equal to or greater than a vreight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feel of compressetl gas at standard
temperature and pressure).
3. Does or will the applicant or present or (uture building occupant need to
prepare an RMPP (Risk Managemenl and Prevention Program for acutety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Heal[h antl Safety Code provides that the
Cos[a Mesa Fire DepaAment may require the preparation, certification and
fling with ihe Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with lhe Fire Deparlment.
4. If an RMPP is presently required, has Section 25534 of lhe California
Heal[h and Safety Code been fully complied wilh? ❑ Yes ❑ No
5. Does or will the applicanl or present or fuWre building occupant require for
the vrork which is Ihe subject of this application a permil for such construclion
or motlifcation from the South Coasl Air Quality Management Disiric[ or from
any other air pollution conlrol distnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
information be fumishetl on applications for nornresidential builtling pertnits).
6. Will any part o( the facility to be constructed under Ihis permit be within
1000 feet from the ou[er boundanes of a school? ❑ Yes ❑ No
Qf yes", ihe faciliry must meet the requirement of Seclions 25534 and 42303
of the California Health and Safety Cotle).
7. If a permit from the South Coast Air Quality Management DisMcl or other
air pollulion control disMct or agency is required for the work which is the
subject of [his application, have all of Ihe disclosures prescribed by Cali(omia
Health and Satety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach cerlifcate of compliance from the appropriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penally of perjury lhe
information given above is correct I agree to comply with all state laws and
city ordinances regarding Hazartlous Materials and Emissions.
SignaWre �ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of pery'ury that I have read lhis appliwlion and slate that
the information given is correct I agree to comply with all state laws and city
ordinances relating to building conshuction, and authorize representatives of
ihe City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree nol to occupy or allow occupancy o( any building
authorized by this permit unlil fnal inspection.
SlgnaWreotLegalOwner(s� Dale
�tl�lOfll��Qi"S' ,ApW�anl� �ate
!
Residential
Alierations
Climate Zone p
J
] of
� Ooaaue Sut'face Detxlls Ror the (urred oortioned of Mass H'alls see Furrine Strins Construction 7'able beloe�. �
'I'ag/ I Assembly Name
ID� orTvoe�
Naie: For
Material Spacing, U- 7A4
and SizeZ or Other? factor" Nu�,
see
Values From JA4 Table
Framed Continuous JA4 Proposed
Cavity Insulation Assembly Assembty
R-value� R-Value' Cell Values U-facrory
n 4-J. For calculo�in� (wred wo(Is use �he Mass mrd
Fur'ring Consuvction mble befo�r.
l. For Tag/ID indicaie the iden�ificatiori name tha� mntches the building plans.
1. Indicale �he Assembh� Name w' rype.' Roof/Ceiling, Gi'alls, Ffoors, Slabs, Crawl Space. Doors and etc...lndic4�e !he Frame type and Size.' Far
Wood, Meiol, Metal Buildir�gs, Mass, emer 2z4, 2x6, m� etc... see JA4 for other possible jrame rype assem,blies.
3. ErTter �he thiclrness (a� muss irr inches or Syacing 6etween jraming members enter; 16 "or 24 "OC; or O�her jor al! other assembly description
such as Conerete Sandwich Panel, Syandrel Panel, Logs, Sn�aH� Bale Panel and etc....
4. Based o�� the C(inm�e Zone; enter the S�andard U facmr fi'om Tuble I51-B, C or D for each differen� assemb(�� Name m' rype.
5. En1er the TaGle number dia� closely resemGles !he yroyosed asa�emblr.
G. Emer the R-nalue tl�ai is being installed in the wall caviq� or 6e�ween die f�anving; a�her-wise, emer "0 ".
7. Enter die Cantinuous lnsulation R-value ja� the proposed assembl��; olhenvise, enter "0'.
b'. L•n�er !he roN� mrd colunm of die U-fac�or value Gased mr Co(umn FTable Num6er and enter �he Assembl�� U.fuclor m Column J
). The Pra�msed Assemb/i� U fuc�ar. Colwnn J, musf be equA/ �a or less �hau lhe Sta�dard U-fuctar in Colunon E to compl r.
Fun�ing Strips Construction TaUle for Mass Walls Only �
A B C ll E F G H I ,1 K L M
Prapnsed A-operties uf Masonrp and Concrete Added Interior or �zterior Insulntinn
Walls Brum kefcrence in Turring Spnce f'rom Reterencc
Join� A endia 7'ablc 4.3.5. 4.3.G, 4.3.7 Join! A endix 7'ablc 4.3.13
_ `o Y � ° v
U � j Y v � U
v, p � C �
Asscmblp �' j � p�� G ~ � u��v = °�' Final
?^V L'�� v9 C� 'G�U u
Mass Nunle or 1A4 Ta61c - �: "v o � � � o 't ; o� � � ASSe`ilbl
Thickness� Ty e' Numhc�� 5'` � = w 5 a` u`. 3 �. � a'ry uti r U-faCto��O COttlmeni
� I
1legis7rution Number: Regislrutian Ualellimc: HEItS Provider:
2pOb' Residentia! Compliunce Forn�s �lugus� 2009
of Compliance: Residential CF
A[terations (PaQe 3 'of :
ProjecPNamc . � " � Climate Zone # �# of Stories
ROOFING'PRODUCTS (COOL ROOFS) §157(J�12 .
When the areu oJexterior roof srrrJkce m be replaced ezceeds iuore than 50% oJ[be exisling 'rooja�en, or iuore thun 1,000 f�,'rvhichever is
less, Uie ne�v roofing area nu�sl nieet [he roofiug producr "CoolRoof'requirenients af§I52(b)IHi, 152(b)IHii, or l52(bJ]Hiii..�
Check applicable alternntive or exceptimr below if the roojal�eration is ezempt fi�om the raofing producr "Caal Rooj" requirements. Note: /f any
one af Ute qbernnlives a' ezceptioi� belaw is checked, !he Aged Solur Reflectance and Thermal Emi!lance requiremen�s for roofing products in
§118(i) are nol applicable. Do no� fi(7 lable below.
❑ ool Roofs Not Required in Climate Zones I-12, 14, and 16 with a Low Sloped. Less or 2:72 pitch.
ool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
han 516/fts.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep-slape roof (pitch > 2:12)
❑ Insulation witli a thertnal resistance of at least 0.85 hrft'�°F/Btu or at least a 3/4 inch air-space is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insutated and sealed according to §151(fl10; or _,
.❑ ln climate zones 1Q 12 and 13, with 1 ft''.of free ventilation area of attic ventilation for every I50 fi� 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 radiant banier in Ihe attic meeting the requirements of §151(�2; or .
❑ Building has no ducts in the attic; or
O In climate zones ]0, ] l, 13 and 14, R3 or greater mof deck insulation above ven[ed attic. .
Exception to §152(b)IHiii, Low-slope roof (pitcl� <2:12J � �
❑ BuilQing has no ducts in Ihe attic.
Other Exceptions
.❑ Roofing area covered by building integrated; phomvoltaic panels and solar [hermal panels are exempt from the below Coo] Roof criteria.
❑ Roof cunstructions that have thermal mass over the roof inembrane with at least 25 Ib/ft is exem t from the below Cool Roof criteria.
- Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Perfonnance Approach to show compliance, otherwise,
Check the a licable box below if Exem t from [he Roofin Products "Cool Roof' Re uirement:
� Roof Slope Product Weight Product Aged Solar Thermal
CILRC Product ID Numher� < 2:12 > 2:12 < 516/fr' > Slb/fr' T e� Reflectance''4 Emittance SRIS
❑ ❑ ❑ � ❑^
❑ ❑ ❑ ❑ p^
❑ ❑ ❑ ❑ ❑a
❑ ❑ ❑ ❑ O"
❑ ❑ ❑ ❑ ❑^
1. The CRRC prodvcllD Nunrber cmr be obinined fi�om !ke Cao( RoofRafing Coimci!'r Raled Producl Direclay a! www coolrnofs.arniproducls/sear'ch aho
2. I��drmie lhe ryrye afprod��cl is being nre� jor !He roafrop, i.e. sittgleplJ� roof, aspha(r raaf, meral rooj, e1c.
./j(he Age�! j2e/leclance i.s no! availq�le in.the Cool RoajRaling Camicil'a� Rafed Pr'oducl Direclop� tl�en use !he Ini(ia( AeJ(eclance value fi'om (he same
direclor�� 0»�1 use !he eqimlion (02+0.7(N�������I— 01) io ab�ain n mlcula�ed aged vulue. Where p is !he Lii(ial Salar ReJlec�mire.
4. CHeck Lo.�� i�(lte Aged Refleclance is o calmdaled i�aluc using (he eguation above.
5. Calcidu(e Ihe SR/ volue Lr asing dre SRI- Workshee! a( httn:Uwrvi � enertm.ca.pov/tille24/and emerlhe ma�uliing value in �he SRl Colurnn above and Attach aco/m o%
ihe SRl- IVor'kshee! �n !he CG-12.
To apply Liquid rield Applied Cuatings, the coating mus[ be applied across the e»lire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating:
❑ Alumihum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other
Registrution Number: 2egisb�ation Dale/Ttme: t1EILS Providerc
2008 Residentia! Compliance Fm-ms - August 2009
Cerciticate o1'
Residenti.a/ Alterations
n ce:
°u;ce � of��)
X of StUries
�V O
HGP.$ VLhIF1CAT101� SUMMAR)' The enlorceme+u ugenc�-shovld parsyeciul ��remiai io the HLKS Measures specifieAm this
checkfis� Lefon�. fl comple�ed und sioned CF-4R Form (or oll !he measines speciJied shol! br suLiniaed �o �iic Guilding inspeclor Lefw�e Jino!
UuCI $Cn1iRe & 7�BStine HE/iS veriJicnlion is re9uired_jor Ihia nrensw'c. "
D 1'GS ❑ NO vCS: ln Climaie Zones 2 and J-1 G, if more tlian 40 linear feet of new or replacement duets nre insitdled in unconditioned
� spxce, the ducts are to be senled per y 152(b)1Dii and the newly inswlled ducts nre to 6e insulated pei §I51(1110.
❑�aC�P770�: Lxisting duct systems th�t are extended; which sve cuustrue[ed, innWated ur sealed with nsbesms.
❑ PiS ❑ NG 5'LS: lu Climate "Lones 2 and 5-7G, if tiie existi��g space-conditiouing system (HVAC equipment and ductinoi is repluced, the
� duc�s are to be sealed per � 152(b)1Di. �
❑]'$S ❑ NO 1'ES: ]n Climam Zones ? a�d 9-16, if the existing HVAC eyuipmem is repluced (including the replacemeni of-[he air handler;
� outduor condensing uni� of ei splii system, cooling w� heating coil, or the furnace Leai exchanger) the ducts are tv be
sealed per §152(b)lE.
D EXC�PT]On: Duct systems that are ducumented to hvve been previuusly senled confirmed thruugL H�T25
_ verification in accurdance witL prucedures in the Referenee Residential Appendix Iu13.
' � ❑�XC�I'T70�: Uuct systems with less than 40 lineur teet in unconditiuned spuce.� � .
❑ E7:CLPT10�': Existin� duct srstems constructed, insulated or senled rvit6 asUestns.
Refriperant Charee - Split S,l'Stem HERS veri/ication fs required,for �hi.s meo.nu'e.
❑ YL�'S ❑ NO YES: ln Climare Zones 2 and 6-15, when the existing HVAC equipmeN is replaced (including ihe replacement of the air
handler, outdoor condensine unit of a spli� system A/C or heat pump, cooling or heating coil; or the furnace heat
exrhanoeri a rrfriaerant r.hnroe. measive.ment shell bC VeriflCd o¢f �1i2(h11F.
Central Fan Inte;rated (CFI) Venfllation System and Fan R'att Draw
The ventilation renuirements oT 4150fo1 do not applv tn existine residential homes.
Ducted Split Systems - Air Condifioners and Heat Pumps: Airflo�� HERS verificaiion is r'eguired,forlhis measure.
❑ Y�S ❑ NO 1'E5: ln Climare Zones ] 0 through 15, wlien the existing space-conditioning system (H VAC equipment and ducting) is
replaced. the airflow and ian watt dTaw shall be verified ner �+152(611 Ci to meet the requirements of & I51(f17B.
Author'S Declaration Statement
that this Certificate of
Company:
Address:
��
If Applicable � CEA m�
(CertiGcation 1!):
Phone: 7.. i �...
�-- . v�� ��_ � T1 � �J \.F'o v i i��-✓ v �. I v �"�
Respnnsible Buildine Aesiriner's Leclaratim� Statement � -
� 1 am eligfble under Division : of the Culiforniu Business and Professions Codc to uccept respmisibiliq� fbr the building clesign identified on
this CertiLcate of Compliance. '
• 1 cenify th�i the energy feaiw�es und pertbrmance speci5entions 1or the building design identiGed on this CertiLcane of Compliunce confonn
tu thc requircments of Title 24, Parls 1 nnd G of Ihe Culifornin Cnde of Regulatiuqs.
• The building design tenwres identiLed on this Certificate of Compliance arc consisiem with thc iniornmtiun provided tu ducwnem this
building design on the other applicable compli�ncc lunne, worksheets, culculations, plans and speciLcations submitted to thc enlbrcement
aeencr for nnnroval with this buildinc� nern,ii anulication.
Uaie:
License:
Gnr a.s.ci.s�anee nr yueslinns regarding fhe Energ�• Sumdm�rls, conla�c! !hc Enm'gl� Hotline �u: 1-b'O!1-i i2-i30(!.
Regrxo-arinu NwriGcr: Regisn�anort Laie/Time: HCRS' f'rowder:
2Ubf,' I(ca�ideiviul Complimicr Forms ,•1 ugu.ri 3bbl
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp serviCe tesf
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 1000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
ELECTRICAL PERMIT
3101 DONNYBROOK LN
FAMILY ROOM & POWDER ROOM ADDITION
14104215
FROST, JACQUELINE
3101 DONNYBROOK LN
COSTA MESA, CA
FROST,JACQUELINE
3701 DONNVBROOK lN
COSTA MESA, CA
OWNER-BUILDER
Phone: (714) 432-0177
Zip: 92626
Phone: (714)432-0117
Zip: 92626
Phone:
Zip:
License: 0
ISSUED BY:
Status: ISSUED
Applied: OS/01I2001
Issued: OS/01/2007
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR NEW FAMILY ROOM & POWDER ROOM ADDITION. INSTALL 9 LIGHT
FIXTURES, 10 RECEPTACLE OUTLETS, 4 SWITCHES, & NEW ELECTRICAL SERVICE.
REF:B01-00366
523.50
$0.00
$0.00
$0.00
$0.00
$0.00
$9.90
, $17.00
$4.40
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
�uantiry
0
0
0
g
10
4
0
0
�
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Trensformers up to�1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 700 kva/kw ,,
Low Voltage Equipment -
Low Volt Wiring System / Ckt �
Misc. Conduit
Misc. 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
Quantity
50.00 0
$0.00 �0 . " �
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 � "� /
50.00 0
50.00" `,p �� i �
. $0.00 -- � 0 i. � �
"$0.00 - 0�'
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E79.30
COMMENTS / SPECIAL CONDITIONS
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, 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 the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspectlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.ot this permi�
FOR INSPECTIONS CALL: (714) 7545626
2446-46 (&00)
WORKERS' COMPENSATION DECLAqAT10N: � �
I hereDy attirm under penalty of perjury one of the following decleretions: �
❑ I have antl will maintain a cenificate of consent to self-Insure tor workers' compensation, es provided tor by section 3700 of the Labor Code, for the peAormance of ihe
work for which this permit is issued.
❑ 1 have and will maintain workers' cnmpensation insurance, as require0 by section 3700 of the Labor Code, for ihe pedormance of ihe work tor which [his pertnit is issuetl.
My workers' compensation Insurance carner entl policy number are:
Carrier. Policy Number.
(This section need not be complefed il fhe permit is valuetl at one hundred dollars ($100) or less.)
❑ I certify thet in the pedormenca of tha work for which this pertnit is issuea, I shell not employ eny person in any menner so as to become subject to ihe workers'
compensation laws of Califomia, end agree Ihat it l shoultl become subject to the workers' compensation provisions ot Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signeture: Date:
W ARNWG FAILURE TO SECURE WOFKERS' WMPENSATIIXJ COVERAGE IS UNL4W FUL lWD SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVR FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF CAMPENSATIQY, DAMAGES AS PROVIOED FOR IN SEGTIQV 3]O6 OF THE IABOR CODE, INiEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I em licensed under pmvisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Professions Code, antl my license is in full
torce and ettecl Uc, a Class N
ContractoYs Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aNirm that there is e conslmction lentling agency for the pertormnnce of the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name:
SignaNre: _
OWNER•BUILDER DECLARATIONS:
Lender's Address:
Date:
I hereby aNirm thei under penalry of perjury ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions
Cotle: Any city or counry which requires e permit to constmct, alter, improve, domolish, or repair any stmcNre, prior to its issuance, also requires ihe applicant for such pertnit
to file a signed statement ihat he or sha Is licensed pursuant to the provisions of the Conirectors License Ww (Chapter 9(commencing with Section 7000) of Division 3 ot ihe
Business antl Professions Cotle) or that he or she is e:empt theretrom and t�e basis for the alieged eaemption. Any violation of Section 7037.5 by any applicant lor a pertnit
subj�e ts the applicant to a civil penalry of not more ihan tive hundred dollars ($500).):
[`]� I,:es owner of ihe properry, or my employees with waqes as �heir sola compensation, WILL DO THE WORK, antl the siructure is not intended or oHered for sale (Sec.
^.�7044, Businass and Professions Code: The Contrectore License Law does not apply to an owner of pmpetly who builds or improves ihereon, and who dces such work
himself or hersalf or ihrough his or her own empioyees, provided Ihat such improvemen�s are not intended or oHered for sale. If, however, ihe building or improvement is
sold within one year of completioq the owner�builder will have ihe burden of proving that he or she did not builtl or improve for purpose of sale.).
❑ I, as owner ot Ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo constmct the pmject (SecJOd4, Business antl Professions
Code: The contractors license Law does not apply to en owner of property who builds or improves ihereon, and who comracts tor such prqect with a comractor(s)
license pursuent to the Coniractors License Laws.).
❑ lam
Business antl Professions Code lor ihis reason:
Owner ID venfiad by drivers license. ❑ Yes ❑ No
Verification of Ownership by (type of document, i.e. - propeny tax bill or deed):
T =l-[9/
�—Expires:^"
DIVISION OF INUUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify tha� no e:cava�ion five (5) or more (aet in depih into which a person is required to descend, will be matle in connection with work authonzetl by �his
permit, and thai no building simcture, scattoltling, falsework, or demolition or dismantling Ihereof, will be more than thirty-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
345, Title B, Calitomia Adminisirative Code).
❑ As ownerbuilder, I will not employ anyone to tlo work which would require a permit from the Division of Indusinal Safery, as noted ebove, unless such person has e
permit to do such work fmm the division.
Signature: Date:
Division of Industrial Sefary Permit Number.
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N.OF ENTRV: I cehify untler penalty of perjury Ihat I have read ihis application antl state �hat Ihe information given is
correct I agree ply with all state laws and city ortllnances relating to building consWction, entl authorize represeNatives of ihe Ciry of Costa Mesa to enter upon the
above-tlescri etl r insp�Clion� ses. I aqrae not to occupy or albw occupaacy ol aoy buildi�g autnorizetl hy this permit unt��oal inspection.
G L, S � �
Signature Of Legal�Owner(5) t-Date--�"
�.�"
AnNOr Authonzed Applicant Date
COOE �. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
0
iyipl�l¢ 4QQF� INSFECTIONTYPE
N l
206 Final MeChaniCal
208 Final Plumbing
210 Final Electrical
212 Final Fire Preveniion
220 Final Planning Appro�al
222 Final Site
250 Final Building/Occupancy
o� iNTfTIALS
�
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
Job Address:
Suite No
Vicinity:
MECHANICAL PERMIT
3101 DONNYBROOK LN
FAMILY ROOM & POWDER ROOM ADDITION
Parcel Number: 14104215
Applicant: FROST, JACQUELINE
Address: 3101 DONNYBROOK LN
COSTA MESA, CA
Owner: FROST, JACQUELINE
Address: 3701 DONNYBROOK LN
COSTA MESA, CA
Contractor: . OWN E R-BU I LD ER
Address:
Phone: (774) 432-0117
Zip: 92626
Phone: (714)432-0117
Zip: 92626
Phone:
Zip:
License: 0
ISSUED BY:
Status: ISSUED
Applied: OSI01/2001
Issued: OS/Ot/2001
SCOPE OF PERMIT
MECHANICAL PERMIT FOR NEW FAMILY ROOM & POWDER ROOM ADDITION. INSTALL NEW
FACTORY FIREPLACE AND VENT FAN.
REF:B01-00366
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
RepairlAlt Cooling/Heat �
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace,
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct �
Appliance � .
Fire Dampers , ,�
Smoke Dampers �
Inst or Relocate Appl Vent
Air Handlers < 10000dm
AirHandlers> 10000cfm
Floor Fumace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$10.65
$0.00
so.00 ,
$7.25
�, $0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
Duantity
0
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair I Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercia l I ncine rator
Domestic Incineretor
Comoressors / Absorption Systems
Up to 3 hp I 100 k BTU
3 To 15 hp / 500�k BTU
15 To 30 hp / 1,000 k BTU '
30 To 50 hp / 1,750 k BTU ,
Over 50 hp I Over 1,750 BTU -
Boilers ` ,
Upto3hp . . .
3To15hp
1510 30 hp
3010 50 hp
Over 50 hp
Other Mechaniwl Fee
Investigation 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
.� $O.00i i0
$0.00 j 0
$0.00 0
"� ' /, $0.00 0
! $0.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
50.00
50.00
$0.00
TOTAL CALCULATED FEES $41.40
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1. 12-27-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell
requlred Inspeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. i�
FOR INSPECTIONS CALL: (714) 7545626 r%
WORKERS'COMPENSAnON DEGLARAnON: , ,
I hereby ettirm untler penelty of perjury one ot the toliowing decleretions:
❑ I heve end will mainteln e certificate of consent to self-Insure for workers' compensation, as provided tor by section 3700 of the Lehor Cotle, for the pertormence of Ne
work lor which Ihis permit is issued.
❑ I have antl will mainWin workers' compensatlon insurance, as requiretl 6y sec�ion 3700 of the labor Code, for Ne peAortnance ot the work tor which this pertnit is issued.
My workers' wmpensation Insurenca cartier and policy number ere:
Carrior. Policy Numbec
(Riis secNon neea nof be canp/eied �� the permit is veluetl at one hundred dallars ($f 00) or /ess J
❑ I certity ihat in the peAortnancd of ihe work for which t�is pertnit is issueQ I shall not employ any person in eny manner so es to become subject to the workers'
crompensation laws of Califomia, and agree that it I shoultl become subject to t�e workers' compensation pmWsions ot Sectlon 3700 of the LaDor Cade, I shell forihwith
comply with t�ese provisions.
Applicenl Signeture: Date:
WARNING: FAILURE TO SECURE WORKEFS' COMPENSATION GOVERAGE IS UNL4WFUL ANO $MALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED
i110USAND DOLURE (5100,000�, IN ADD�TION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTON 31W OF THE IABOR CODE, IMEREST, ANO ATiORNE`f5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm thet I em Ilcensed under provisions of Chapler 9(commencing with Sectlon 7000) of Division 3 of the Business and Professions Code, antl my Ilcense is in full
brca entl eNect Lic. M Class a
ContractoYs SlgneNra: Date:
CONS7RUCTION LENDING AGENCY:
❑ I hereby ettirm t�at there is a consiruction lending agency tor the peAormance ol ihe work tor w�ich Ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lentlers Nema:
Signatura: _
OWNEP-BUILDEFl DECLARAl10NS:
Lendefs Atltlress:
Date:
I �ereby eMlrtn ihat under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protesslons
Code: Any city or county which requires e pertnit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, elso requires the applicant tor such permit
to file a slgneA stetemaN thet he or she is Iicensed pursuent to the provisions of the Contracmrs License Lew (Chepter 9(commencing with Seaion 7000) ol Division 3 of Ihe
Business end Prolessions Code) or that he or she is exempt iherefrom entl the basis lor the allegetl exemption. Any violetion ol Section 7031.5 hy any applicant for a permlt
subjects the eppliwnt to e civil penalry ot not more than live hundred dollars ($500).):
�
I, es owner ol Ihe property, or my employees wlth wages as their sole compensetion, WILL DO THE WORK, antl Ihe siructura is not intendad or oHeretl tor sela (Sec.
�7044, Business entl Professions Code: The Contractors License Law does not apply to an owner ot propeny who builds or improves thereon, and who does such work
himsetl or herself or ihrough his or her own employees, provitletl thet such improvemenis are not intended or oHeretl for sale. If, however, Ihe builtling or improvement is
sold within one year of comple�ion, the owner-builder will �ave tha burden oi proving that he or sho did not build or improve for purpose of sale.).
❑ I, es owner oi the property, am E%CWSIVELV CONTRACTING WITM LICENSED CONTRACTORS to constmct the pmject (Sec. 7044, Business ana Pmlessions
Code: Tha conirectors License L.ew tloes not apply to en owner ot propeny w�o builas or improves ihereon, and who contracts tor such project with a coNractoQs)
license pursuant to Ihe Coniradors License Laws.).
8usiness end Professions Code tor this reason:
ID veritied by dnvers license. ❑ Yes ❑ No
Venfication of Ownership by (rype of document, i.e. - properry tan bill or daed):
DIVISION OF INDUSTRIAL SAFET' PERMIT CER7IFICATION:
❑ I hereby cenify Ihat no ezcavadon tive (5) or more Ieei In depih Into which a person is required to descend, will be made in connection with work authorized by Ihis
pertnit, end that no building stNCWre, scaHolding, talsework, or demolition or tlismantling thereof, will be more ihan thirty-six (3fi) feet high. (Chap. 32, Gry 2, An 2, Sec.
34 i, 71t1e 8, Calitornle Adminis�rativa Code).
❑ As owner-builder, I will not employ enyone to do work whic� woultl require a permit from the Division of Indusiriel Satety, es noted above, unless such parson has e
permit to do such work from the division.
Signature: Date:
Division of Intlusirial Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTTIORIZA710N.OF ENTRV: I certify under penalry ot perjury that I have reatl this ep0�ication and state that the intormetion given is
correct. I agree to comply with all sta�e laws end ciry ortlinances relaling to building construction, end authorize representatives of the Ciry of Costa Masa to enter upon Ihe
ebove-describetl prope r inspe �on pu�gree not to acupy or atlow acuPancy of any building authorized by this permit until final inspaction.
s- �-v i
Signatur�9alOwneQs) Date �
And/Or P.u�horizad Applicant Date
GODE i. MSPECTIONTYVE
7616 Fixad System Final Fire Pre�en�lon
1266 Pool S08 Finel
200 Finel Re-Roat
201 Final Block/Retaining wall
202 Final Factory Fire Place
203 Finel Sign
204 Finel Demolilion
Qdjj' AL
COpE1 INSPECT{ONTYPE
206 Final Mechanicel
208 Finel Plumbing
210 Finel Electdcal
212 Flnal Fira Prevention
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupancy
�o.a9_o� �
%
(�ia) �sa-52�3 • Fax (�ia) �sa-aess • wNM1v.CI.COsta-mOSe.Ce.us 77 FAIF DRIVE, GOSTA MtSA, GA 92626
PLUMBING PERMIT
1ob Address: 3101 DONNYBROOK LN
Suite No
Vicinity: FAMILY ROOM & POWDER ROOM ADDITION
Parcel Nunmber: 14704215
Applicant: FROST, JACQUELINE
Address: 3101 DONNYBROOK LN
COSTA MESA, CA
Owner: FROST. JACQUELINE
Address 3101 DONNYBROOK LN
COSTA MESA, CA
Contractor: OWNER-BUILDER
Address:
Arch / Eng :
Address:
ISSUED BY:
Phone: (714)432-0117
Zip: 92626
Phone: (714) 432-0117
Zip: 92626
Phone:
Zip:
license: 0
Phone:
Zip:
License:
Status: ISSUED
Applied: 05/01I2001
Issu¢d: 05/Oi/2001
SCOPE OF PERMIT
PLUMBING PERMIT FOR NEW FAMILY ROOM & POWDER ROOM ADDITION. INSTALL 1 GAS LINE, 1
WASH BASIN, 8 1 WATER CLOSET. - "
REF:B01•00366
ISSUE FEE
Backflow irrigation
Backtlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Draiq Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$6.15
$0.00
$0.00
$0.00
$0.00
$0.00
�
0
0
0
0
0
0
0
0
0
0
0
0
0
1
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 ft) 50.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, wmmercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $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
, � Sump Pump �. � � �
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 Qnst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
l
AMT
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 549.25
QTY
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
NOTICE: The work authorized by ihis permit s(I���c�l$p$p�{Ij�i� ���p� 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
tor a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapettlons end final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration.oi this permit.%
FOR INSPECTIONS CALL: (714) 7545626 �j
244W8 (fiNO)
WORKERS' COMPENSA710N DECLARATION: � �
I heraby eNirm under penalry ot perjury one ol ihe lollawinq declaretians:
❑ I heve and will maintain a certificate of wnsenl to self-Insure for workers' crompensation, es proNdetl for by section 3700 ot t�e Lebor Code, lor the pertortnance of the
work for whicP this pertnit is issued.
❑ I have and wlll maintain workere' wmpensetion insurance, as required by section 3700 of the Labor Code, Por Ihe perfortnance of the work for which this permit is issued.
My workers' compensation Insurance carrier entl policy number are:
Carnor. Policy Number.
(Thls secfion need nol be complefed i/ the Oermit is velued e( one hundred dollers ($100J or /essJ _
❑ I cetlity thet in the pertormance of the work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to ihe workers'
compensatlon laws oi Calitomia, and agree t�at II I shoula become sub�ect to t�e workers' compensation provisions of Section 3700 of the Labor Code, I shall torthwith
comply with these provisions.
Applicent Signawre: Date:
WARNINO: FAILUFE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMP�OVER t0 CRIMIWIL PENALilES NND CIVII FINES UP TOONE HUNDRED
TiOUSAND DOl1ARE (510D,000). IN ApDRION TO THE COST OF COMPENSATIIXJ, DAMNGES AS PHOVIDED FOR IN SECTION 3/p60F THE LPBOR COpE, ItJrEREST, AND ATTOfiNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y eHirm that I am licensed under pravisiaas ol C�epter 9(commencing with SecUon 70�0) ol Oivision 3 at lha Business eatl Prolessions Cotle, and my license is in tufl
force end eHect. Llc. N Class #
Conirector'S Signeture: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirtn lhat �here is a construction lending egency for the performance of the work for which ihis permi� is issued. (Sec. 3097, Civil Code).
Lentler's Neme: Lentler's Atldress:
Signature:
OWNER-BUILDER AECLARA710NS:
Da�e:
I herehy ettirm Ihat Under penalry of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or counry whic� requires a permit to consiruct, alter, improve, tlemolish, or repair any structure, prior to its issuence, also requires the epplicant tor such pertnit
to file e signetl statement that he or she is Iicensad pursuant to Ihe provisions of the Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business end Professions Cotle) or thal he or she is exempt iherefrom and ihe basis for the alleged exemption. Any violation of Section 7031.5 by any apPlicant lor a parmlt
subjects the eppllceN to e civil penalry ol not more ihan live hundred dollars ($500).):
��I�es owner ol Ihe property, or my employees wilh weges as their sole compensalion, WILL DO THE WORK, and the structure Is not intended or oNered for sale (Sec.
--7044, Busines5 and Professions CoOe: Tha Conirectors License Law tloes not apply lo an owner of propeny who builtls or improves thareon, antl w�o does such work
himself or herselt or through his or her own employees, provided that such improvements are not Intendetl or oRered lor sele. If, however, �he building or improvement is
sold within one year ot completioq Ihe owner-buildar will have the burden of proving ihat he or she did no� build or improve for purposo of sala.).
❑ I, es owner of the property. am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions
Code: Tha con��actors License Law does not epply to en owner of property who Dullds or Improves ihereon, and who contrects lor suc� project with a contractor(s)
Ilcen58 pur5uent to Ihe Coniractors llcense laws.).
❑ lem
venfied by drivefs licensa. ❑ Yes ❑ No
Business antl Professions Code br this reason:
Verilicatian af Ownefship by (type of dxument, i.e. - pmperry �a: 6ill or
UIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Ex0�r05:
❑ I hereby certity ihat no eacavation five (5) or more feet in depih into which a person Is requirad to tlescend, will be made in connection wi�h work euthorized by this
permit, and tha� no building simcWre, sceHolding, lelsework, oi demolition or dismantling thereol, will be more than Ihirty-six (36) feet high. (C�ep. 32, Grp 2, Art 2, Sec.
345, Title B, California Administrative Codej.
❑ As owner�builder, I will not employ anyone to tlo work which would require a permit irom Ihe Division of Indusirial Salery, as noted ebove. unless such person has e
permit to tlo such work from ihe division.
Signatura: Date:
Division al lndustrial Safery Pertnit Numher.
CERTFlCA7E OF COMPLIANCE AND AUTHORIZA110ROF ENTRV: I certify under penalty ol perjury ihat I have read this applica�ion end state ihat ihe information given is
correct. I egree to comply with all state lews end city ordinances relating to building consiruction, antl authonze representaiives of Ne City of Costa Mesa to enter upon the
above-tlescribed pmparty fo%r i °� ction rpas s. I agree not ro occupy or ellow occupancy of eny builtling authonzed by Ihis pertnit until linal inspection.
�/ ���Gu�— _ S —/= o(
Signature Ot Legal Owner(s)---" `Date—�
AnNOr Au�honzetl Applicant Date
COUE N, INSPECTIONTYPE
1616 Fixed SysteRi Final Fire Prevention
1266 Pool Spa Fi��al
200 Finel Re-Root
201 Final BIocWFetaining wall
202
203
Final Factory Fire Place
Final Sign
204 Final Demoli�ion
QAI�'
�
mrrtin�s
CODE11 INSPECTtONTYPE
206 Final Mechanital
208 Final Plumbing
210 Final Electrical
212 Flnal Fire Prevention
220 Final Planninq Approval
222 Final Site
250 Final Builtling/Occupancy
Qbj� {NTRIA�g
� � e, V •
�1
��
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
BUILDING PERMIT
Job Address: 3'IO7 DONNYBROOK LN
Suite:
Vicinity: FAMI�Y ROOM ADDITION
Parcel Number: 14104215
Appliwnt: FROST, JACQUELINE
Address: 3101 DONNYBROOK LN
COSTA MESA, CA
Owner: FROST, JACQUELINE
Address 3101 DONNYBROOK LN
Conlractor.
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Zoning: R1 R1
Phone: (714)432-0117
Zip: 92626
Phone: (714)432-0117
Zip: 92626
Phone:
License:
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 03/21/2001
Issued: OS/Ot/2007
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 400 S� FT FAMILY ROOM 8 POWDER ROOM ADDITION AiTACHED TO REAR OF EXISTING SINGLE FAMILY �
RESIDENCE. ' �
Plan Check: $320.29
Permit: $492.75
SMIP Res: $3.42
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $816.46
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existina: 2
NOTES:
Rear 15- 6
Rear 0• 0
Reauired: 2
FEE SUMMARY
PLANNING & ZONING
LeR 41• 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 5- 0
Right 0- 0
$34,200.00
so.00
��
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned
for a period of 780 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754-5626 f
/
zaawe Isroo) -
WORKERS' COMPENSATION DECLARATION: •
I hereby eHirm under penalty of Oeriury one of the following declarations:
❑ I heve and will maimain e cenificate of consent to self-Insure lor workers' compensetlon, as provide0 for by section 3700 of the Labor Code, for the pertormence of the
work tor which �his Oermit is issuad.
❑ I heve antl wlll meintain workers' compensation Insurence, es requiretl by section 3700 of Ihe Labor Code, for ihe pertormance of ihe work for which ihis pertnit Is issued.
My workers' wmpensatlon Insurance wrner antl policy number ere:
Cartier: Polity Num6er:
(This section need nat be comp/eted il fhe permit is velued et one hundred doNers (5100J or less.)
❑ I certity that in �he peAormance ol lhe work for which ihis pertnit is issuetl, I shell not amploy any person in eny manner so es lo become subject lo the workers'
compensaiton laws of Callfomia, anC egree Ihal il t should become subject to the workers' compensation provislons ol Section 3700 ot Ihe Labor Coda, I shall forthwith
Comply wiih these pro+�5ion5.
Applitant Signature: Date:
WARNING: FAILURE TO SECUFE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL ANp SHALL SUBJELT rW EMPIOYEP TO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDPEO
TFIOUSAND OOLLHRE (5100,000). IN ADDRION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN $ECT�ON 3]Ofi OF TME UBOR WDE, IMEREST. MIO ATiORNEYS FEES.
LICENSED CONTRACTOflS DECLARATION:
I hereby elfirm ihat I am licansetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of tha Business end Professions CoOe, and my license is in full
force and eHecl Lic. a Class x
Con�recbr's Signeture: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirm Ihet th6�e is a consiruction lending egency lor the peAormance ot the work tor which this permi� is issued. (Sec. 3097, Civil Coda).
Lenders Name: LentleYs AAdress:
Si9neture: Date:
OWNER-BUILDER DECLARATONS:
1 hare6y eNirtn ihet untler penelry ot perjury that I am EXEMPT FROM THE CONTRACTOFiS LICENSE LAW lor the followinq reason (Sec. 7031.5, Business and Profeulons
Code: Any ciry or county wMc� requires a pertnit to construct alter, Improve, demolish, or repair any structure, pdor to its issuance, also requires ihe epplicant tor such pertnit
to tile a signed statemant t�et ha or she is Ilcensed pursuant ta tha proWsions of ihe Contrecbrs License Law (Chepter 9(commencinq with Section 7000) oi Divlsion 3 ot Ihe
Business end Professions Code) or that he or she is exempt therelrom and the Easis for ihe ellegetl ezemption. Any violation of Section 7031.5 by any applicant lor e permit
sub�ects t�e epplicent to a ci�il penelty of not more than five hundred dollars ($500).):
�— \
, es owner ol ihe property, or my employees wl�h weges es lheir sole compensation, WILL DO THE WORK, end the structure is not intended or oHered lor sale (Sec.
L�7044, Business end P�ofessions Cotle: The Coniractors License Lew does not apply to an owner of property who builCs or improves Ihereon, and who does such work
himself or harself or th�ough his or her own employoes, provided that such impmvaments are �ot intanded or otteretl br snle. It, however, lhe huildinq or improvement is
sold within one year of completion, ihe owner-buildor will heve Ihe burden of proving thet he or she did not build or improve for purpose of sale.).
❑ I, es owner ol the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the projact (Sec. 7044, Business antl Prolessians
Code: The wniractors License Lew does not apply to an owner of pmpeny who builtls or improves thereon, end who contracts for such projact with a contracbr(s)
license pursuant b Ihp Coniradors License Lews.). '
❑ lami
by dnver's license. ❑ Ves ❑ No
Business and Professions Cotle for �his reason:
Venfication of Ownership by (�ype of document, i.e. - property tax bill or
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
No."'.
❑ I hereby certify �hat no exwvation tive (5) or more leet in depth into which a person is requiretl to tlescend, wlll be matle in connection with work authonzed by Ihis
permit, antl t�al no building siructure, scaHolding, lalsework, or demolition or dismanNing thereof, will be more lhen thiRy-sla (36) leet high. (Ghap. 32, Grp 2, An 2, Sec.
341, 7tle 8, Califomia Atlminisirative Cotle).
❑ As ownerDulltler, I witl not employ enyone to do work which woultl require a permit from the Division of Indusirial Selery, as noted ebove, unless such person hes e
permit to do such warN fram ihe division.
Signature: Date:
Oivision of Intlustnal Setery Permi� Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N.OF ENTRY: I certity under penalry of perjury that I have reatl �his epplication and state ihat Ihe infotmation given is
correct. I egree lo comply with ell sCjta�te laws entl ci�y or0inences relating to builtling consWction, and authorize representa�ives ot ihe City of Costa Mesa to enter upon fhe
ahove-descnbed pro fot ins .�/ =D �poses. I egree not to occupy or allow occupancy ol any 6uiltling authorized by this Permit until final inspection.
� - GGv.-� , S -/ -O/
StgnaW�e Of Legal Owner(s�� Date�--'
Antl/Or Aut�orized Applicant Date
LOUE I, INSVECTIONTYPE
1616 Fi:ed System Final Fire Prevention
7266 Pool Spa Final
200 Final Re-Rooi
201 Final BIocWRetainin9 �'�'all
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
OATE' IMRIPLS
CODE 1 INSPECiION TYPE
206 Final Mechanicel
208
210
272
220
Final Plumbing
Final Eleciricel
Finel Fire Prevention
Final Planning Approvel
222 FinalSi�e
250 Final Builtling/Oaupancy
PAIE INTRIRLS
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Street Address:
Bidg. Pertnit #
This Permit #
AP Number:
1. I(we), ��6'�c �P Frl1ST , declare that I am the Owner of Title of the above
re(erenced real property, and that 1(we) hereby authorize:
Name: PC U 1 �1 a urr� Telephone Number: ��-I G— Ie 7R —��U�o
Slreet Address:
Ciry: �� QSfl,i ���PSC� State:
to obtain permits in my behalf, as owner/builder, for
at the above referenced property.
��� � ..r/]
2. Should any person become an employee engaged in lhe improvement of lhe property, I(we) shall immediately provide Workers
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the Ciry of Costa
Mesa, as required by State ot California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other paRies as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executetl this �� day of ��F a 20 �, at � Ue G ��f.'S Q, , Califomia.
�
Print Name: �(��� � P FY'OG 1
Signature: � � ' �
Date: L — — �
Note: This authorization does not grant authorrzatbn W perfortn the work as owner,
it soley provides for limited power of alfomey to secu2 this permit in any behalf.
0779�46 (rev.11N0)
..�
�
/�
�
PNOJEG�AOOPE55: 3102 DONNYBROOK LN
'OWNEP'SNAME: HERMANSKI CLYDE
AOOflESS: SSS9Z GAR�.AND CIR
WESTMINSTER_CA 92683
APCM/ENGINEEH:
PDDNE55:
xec.xo.:
UNIT:
uxir:
PEflMIREE: �MIRAL ROOFZNG ( 714 ) 447-�996
nooness: 1351 E CHAPMAN 7
LICENSEO LONTflACTOB � CUN nONTONeGy ailirm tna� I am Iicense0 unCer o�o iio9s o��nap�er 9�commencing wnn Secfon
�000� ol Drvision 3 oi t�e 9usiness an0 Pmle55ions CoOe. ana license is in �ull lorte and ellecl.
ciTruc.: 0512�5 sT"'Euc.:36440� cuss: C39
Wte: —/��'_£{�jL� Sipnature:
WORNE85' CO VENSATION OECLABATION: I her¢by a��irm Ihat I haue a t¢tliliCate oi ConSeni Io Selbinsure or a cerii�i[aip 01 WOMers'
Compensation Insurance. or a renilieU coDY �hereoi (Section 3800. Lab. C�.
POULYNO.: 11OS3%Z—JZ E%P.UIITE: lO�OSI99
ca;avaxv: STATE FUNP
❑ CenibeJ copY is hereby fumisheG. [`t} Cenified coDY is fil with the city BuilUing Oivision.
�ate: ���/_��_ Ppplicani: . •
E1fEMPTION FPOM WOPNEflS' fAMPENSAPON OECIAflRTION: (�his sec6on neeU noi he wmple�e0 ii �h¢ permit i5 �Df one hUMreO (510� or less�.
1 ceriity Ihai in I�e petlormance o� Ihe wOrk br whic� ��is Dermit is i55ue0. I s�all not employ any p¢r5on in any manner s0 as to Eecome
suEiecl to t�e Workers' ComDensation Laws al Cabfomia.
Oale: SignaNre:
NO71LE: II. af�er making t�is aeclaration. you s�oultl become sublect to t�e WOAeri Compensation 0«ons af tAe Labor
Catle. y0u must fonhvnt� compty with suc� O�ovisfons or this permit s�all be AeemeO rewkeE.
CONSTNULTION LENDING pGENCY: I nereoy affirm �hat there is a constmction IenAinp apency for �ne pedormance ol t�e work for
wnicn inis oermit is issuetl (Section 3097. Civ. CI.
LENDEfl:
PODPE55:
OWNEfl BUILOEN DECtABRTIDN: I hereby aifirm Iha� I am exempt tmm t�e Conlrattor5' Slaie License Law br Ihe Io110winp reason
(Seclion 70.1f.5 Business and Pmlessional Cotle: Any city ot counry which reQuires a oermit to consimct, alter, imD�o�e• tlemolisn, or
reDair any 9mclure. Drior to its issuance, also requires Ihe applfcant for such permit to lile a sipne0 slatemenl tnat nPJsne is Iicense0
pursuanitol�e O�ovisions olihe Canlracbrs'$taie License Law�Chapter9(cammencing wilh Seclion 7000�aiDivision 3 o�t�e BuSiness
and Prolessions CoOq or that he/s0e is ezemp� t�erelmm antl the basis for t�e alleAea exempiion. Any violation ai Seclion 7031.5 by
any apPlitanl br a p¢rmii 5u01etis I�e aOD�itan� Io a tivil penalry al noi mare I�an tive �UntlreC EOIlarS (5500�.
I. as owner o� Ihe pmpeny or my emyloyees vnth wages as Iheir sole compen5ation, will do Ihe work, antl the
❑ slmcWre is not intendetl or olfered far sale (Seclion 7044, Business and Pmfessional Code: The ConiractorS' State License Law
Odes no� apply �o an awner of a pmpeny who UuilAs or improves lhereon, anU wAo tloes such work �im5ell/hersel� or lhmuAh
hi5 or her own employees, pwvitled �ha� SUCh impmvemen�5 are nol intendeA or o��efe0 fOr Sale. Ii, �owever Ihe huiltling or
impmvemeni is 5010 wilhin one Vear ol comple�iaq Ihe owne� will have ��e buraen ol pmvinA he/she ditl not builtl or imOwve
lar Ihe purpOSP 01 Shc¢�.
I, as owner o� t�e D�ope�y, am exclusively comraciing wi�h licensea comraciors lo cons�mct ��e pmle�� (,Seciion 70dd. Business
❑ antl Pmlessions Cotle: The Conlractors' Slate License Law does not apDly to an awner of pmpeny who EwIEs or im0�wes lhereon
anA w�o wnirac�s for Suc� O�ojecis wiih a conirac�or(5) license pursuani Io Ihe COnl�aclors' S�ale li[¢nse Law). I am aware
I�al Dmol of I�eir Work¢r'S Compen5aiion insurance shoultl b¢ proviDeC Io m0.
i� I am exempt unCcr Sectian: 8. 8 P. C.
�Of I�iS fCd50R
Oa�e: Owner.
I ao nereoy cenify inat I am aware ol ana untlerstana ine requirements ol Califomia Mealih antl Safery COUe Sec�ions 25505. 25533, an0
2559A anE ihal I ar any luWre GuilGinA o�cuDanl will/will not (circle one) need to comDly with sai0 stale coEes anE ihe requirements for a
permit loi con5imcimn or modilication Imm �he Nir Oualiiy Managemen� Disiritl. PesiCenlial conslmc�ion apPlications are exempt Imm
Ihese pmvi5i0n5.
Daie: Appiicam:
I hereby cer�i�ytAat Ihave rea0�hi5 applicalion anU sla�e��at��e ahoveinformation is correct. I aAree�o tomply with allcily anC cowry
ortlinancesanasiaielawsrelaiingtoDuiiaingconstmctionanahere authonzerepresentativesafihiscityioenteruDon�heabove�memioned
prOpe��y �oi insper ion purposes.
Date: �i���] Signalure: � ��—��
Oriver's Luense or Social Securiiy x:
�641�C6 �"/�ne—Builtling�, Green—Codo Enlorcemem; Canary—Applicanl; oink—Ravenue: Golaenrotl—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 06997�
PERMIT NO: B 064979 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: S-N PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRIPTION ; T/O COMPO 6 REAOOF WITH NEW 3 TAB COMPO SQ FT: 2,800
CLAIM VALUE: 2,800.00 CALC-VALUE: 2,800.00 GROUP OCC: R-3 !M-1
COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER 1991 UBC
*it�cx�***r***+r�rr*±��t*�r*�it**�t+rx�*****ia+t*�r+r+t*+r*****x�***�r��**+e*�**�t***�*it+�*�*+�*+��-***it?t
Z O N I N GS ERTEH�AUCIKRSE M E N T S
------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL,.: 14104302 ZNE: REP NO:
PLANNING N(STES> • •
i '
�r**�r*�r�r�r*r#*�tk�r�r�t�r*�r*+r+t*a�ir�tx�-�r�t**r�r+�**�**#.*x+r**?r*�f**�x-+ir***�r******x�*�t*u+t�c-*******
D E V E L O P M E N T S E A V I;C•E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
HUILDING APPROCtiED BY : DATE:
APPLICATION ZSSUED BY: �� � DATE; � �,I `�� ��
**�c-**�r******�r********����iF,`-�e-�3F' :,rn�'T��F��F��F'3c3F�F3c�i3FiF***�r**�=**+��€,. �i���c.�F� �**
iE �E jE iF if if iF * if it i41f ff it±F iE ik jE iF # iF if if if 1E ic iE aE %af if if if if 1t it if if ff K if if iF'iF �14 iE if iE iF � iF iF iF iF �F iF jf if 3F �k 3F iE �)F iF if it if iF ic if iF a: if �E jE if if iE iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 54.00
PLAN
ISSUE FEE
HUILDING-DIV-> PERMIT ISSUE PLAN-CAECK
TOTALS----> 59.50 0,00 0.00
FIRE SMIP/RES GRADING
50
SMIP/NON-RES
TOTAL PAID DUE
54.50 54.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT: 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
54.00 ,50
iE ik 1E iF it �f 1E?E if k iE 1: if iE iE +f # 1E iF iE iPlE if iE if 1k ik j! iF jE iF iE k if i! if i! if ik M it iF if iP iF if iE if iE iF if 1f if K iE if iE iF?F iF jF fc {F � i! iE iF if if iF jE if %af k jf?E 9f M-
I N D Z V Z D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T 2 O N ONIT COST TOTAL COST
SFR 2800 REROOF BY C'ALUE RESIDENT�AL NOZONE
END OF FEES
�
i.ao z,aoo.00
. , SMOKE DETECTOR
`. ° �- REQUIRED _
_'
•� r�� GOY.D?;`-^f11'�Q9vo li"f_rZ' Sy,gp
C�6T�: 11, +��;3 TiME_ls:l_ 8 ---
_.---'� —�—_ _ _ _ '
`�CONSTRUCTION ANDPLANNING , � POOL. A
f APPROVA�S Permit# Date Inspector p�ppROVALS Permit# Oate Inspector
I
i. Temporary Electrical Servicebr.Pole ' 52. Pool & Equipment Location � -
2. Soil Pipe-Undrgrnd. , 53. Steel Reiniorcement
3. Electrical Conduit Utiliry-Undrgrnd. 54. Porms "
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steei Reinforcement 56. Rough Piumbing & Pressure Test
6. Etectcical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrymd. �
8. Foundetion . 59. Gas Pipe, i� Undrgmd., Test
9. 4i'ater Pipe-Undrgrnd. 60. Backvvash �ines, P�Trap, C1 Undrymd. � � I
10. Scruttural Floor SYstem 61. APPROVAL TO DECK �
17. Property Sewer Line & HousaConnection .� 62. Backwash & Receptor�Final .' �
12. Sewer Cap �� . 63. Heater & Vent,Final
73. Roof Dra�ns ' 64. Plumbing Sysem - Pinal �
74. Rough Plumbing . 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 6J. Fencing & Access Approvai �
17. Rough Wiring Sign 68. APPROVED FOR PIASTERING
78. Rough Electrical•T Bar Ceiling 69. POOUSPA SYS7Ehn5 FINAL
19. Rough Nsati�g & Air Conditioning PIRE DEPT, f?EQUIREMENT
t 20_ ftough Factory Pirepiace APPROVALS Permit #
2L Duccs, in Structure 70. Underground Hyd:a
22. Ducts, Ventilating 77. Product Pipi�g � Gas ❑ Oil
23. Gas Pfpe-Rough & Test 72. Under9round r';ush
24. Roof Fram�ng 73. Undergrnd. Sterage Tank O Gas ❑ Oii
25. floo` Sheathing �j !l��� 6r�,�[ 74. Overhead Nydro .
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemicai I
27. Frame and Flashing 76. Dry Standp;Fe
28. La.hing & Siding 77. FIXED SYS?Eh1 FINAL _-
29. Insuiation 78. FIRE PREV. FINAL "
30. Drywaii Nailing HEAITH DEPT. REQUIREMENT - yr '
31. Pl;ster Brow�n Coai 79. FINAL INSPECTtON : +
32. Elecirlcal Powzr Meter-Final � 80. FQOD CERSIFICATE ISSUED ,
33. Finai Electric _ - Notes'-/b _ �, (�, t( �j�{J�L �/QG��� . �'
i • '
34. Finai Heating & Air Cond'+tioning . - - ' /�fd� �jJyt�jl�E %�£J--� ��
35_ F[nai Gas Pipe-Test � -. , . ' �
. . �_ � ��-.-1
36. Hood or CanopY _,
37. Finai Fac.ory Fireplace � � �� � � � ~ �
38. Pinal Plumbing . . . . --"- -^ '------
39. VJater Service-Finai
Y
40. Gas Service-Final e
�
41. Solar pomestic-Final
42, Backflow Preventer �
43. Backflow Irrigation rr �'`� i
A4. Landscape irripation System (� � �
45. Sound Attenuation
i
46. Handicap Regulations �'� � f+�` �
-f
47�. FINAL STRUCTURE & BUILDMG �Z �, /t'� " � a 1.,.)
t. .
4$. FtNAL PLANNING �-� ,";
49. Electric Felease to Edison . �
50. Gas Releese to Southem Califomia Gas Co ,_
51. CERTIPICATE OF OCCUPANCY -'
No. Date I
-OwNER COLLEGE MESA COAIPANY DA'rE S pt H, 'i qKR _
)OB ADDRESS 3102 Donnvbro�k Lana BUILDING PERMIT NO. 750 �
GENERAL CONTRACTOR THa Hal p(`mm�a*b. VAL[lE $ i�Ren
AP. No. LOT FK TRACT ��7� FIRE ZONE DESCRIPTION OF WORK G• � ,a, � �• /++
,r�'�uP IRiJ TYPE V ZONE Rl PLAN NO. V V
Ii..,PECTIONS I DATE I SUBCONTRACTOR I DATE ` vNUMBER
Gas Test
,�
:.
:. . . ., , `7�C3�
- �:
� COSTA MESA BUILDING DEPARTMENT
P. O. BOX 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
COSTA MESA. CALIFORNIA
OWNER COLLEGE MESA CO1�fPANY
ADDRE55 P•0. Box 2277, Brookhurst Station
TEL.
riTY Anaheim No KE 3-3161
- - �, -,�s.
"'a� Y'1��V�. �.�.,
[' M1 I 4 ^.� �� �� �T
II��.,i.0 l��i i.
APPLICATIO�N �FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
FECEIPT NO. 1211(q
d lJ� � .
ARCHITECT B�1jOCp QU1gLEy LIC.
oR ENGwEER and �lg , �O. jiE ]191 COSTA MESA. CALIFORNIA
no. ,s 1102 41. 17th St., Santa Ana zoNE
ZONE'
CONTRACTOR The Hale CompaclyT� N�o: 7350 �
ADDRE55 1777 W.Lincoln.Anahei���KE 3-3161 BVPROVED
IEGAL LOT
oescr+ivrio� No. 65 �
Plan 1-BR
A.P. NO.
67 x 101 ��ow°�� �o;� None
SETBACK LINE FROM SO'. 31'
CErviEn OF sine[i REAR VARD
SIDE YARD RIGHT LO � LEFT iO �
DESCRIPTION OF WORK �
NEW x ALTERATION ADDITION
REPh MOVING DEMOLISH
BUILDING — L1V. NO.OF
size 440'- Gar• ROOMS., S STORIES 1
EXTERIOR WALL _. ROOF _
dwelline w/att
STRTE TNiT iHE PBOVE IS CORRECT wNp AGREE TO COMPLY WITM RLL
CITV OROINANCES TND $TiTE LtWS REGULnTING BUILDING CONSTNUC-
'��� CO�EGE MESA COMPANY VAWATION
SIGNATURE OF en.� ar r
PERMITTEF BV./The Hale Companv,� __,__,
AUTH
$
12,890
DATE
CORRECTIONS
PERMIT FEE � 30.00
PLAN CHECN $ 1S.00
TOTAL FEE g 45.00
���
otvN�x SCHAAT., GEORGE
5-28-59
JOB ADDRESS 3102 Donnybrook Lane BUILDING PERMIT NO. 9�1j9
GENERAL CONTRACTOR �er-Builder VALUE S Jr�.�
AP. No. �1%-903-02 LOT TRACT FIRE ZONE DESC[2IPTION OF WORK A1�rGaraee
ir�^�ecTioNs DATE I GROUP J TYPE V ZONE
1 rgrovnd Soil U.G. Water _ _I I pERMITS ISSU
— SUBGONTRACTOR
e
� ' ` 9�:39
'COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31� COSTA MESA, CpLIFORNIA
fOR APPUCANT TO F/LC /N COMPLETELY
TYPE OR PRINT '
BUILDING��p� J�nNKWhRoAK,�
ADDRESS
COSTA MESA. ALIFORNIA
ADDRE55
LEGAL
USE OF
NEW
REPn...
BUILDING
SI7F
/3—
E FPOM
TREET R
ILEFT • IRI(
DESCRIPTION� OF V
WALL
11LDI�
NO.OF
ROOM�
IROOF
COVER
W RK TO I
�V I
NO.
LIC.
NO.
—��-
wo. or e�ocs.
How oN ior
1 HEREBY RCKNOWLEOGE THAT 1 NqVE PEA�
AND STATE THNT THE�fBOVE IS COFNEQ AN
PLY WITX RLL CITY ORDINRNCES A! STATE
91lILO�NG CONSTPII I N.
SIGNATURE OF
PERMITTEE
�
AUTHORIZED AGENT
4'-r�l� f �.�,L�� � ��
, 1'�AY 2 0 �y�
F�i9��"�H��PT.
CI�if10� ICQ�r�rl@a�SA
APPLICATION FOR PERMIT
BUILDING
fOR OFf/CE USE ONLY
I FECEIPT NO. I {+[RqIT�Np.�
�J7LtJJ
IVEOI �BY //I `ORjE RECEIVEO DATE�f134'J�/1jD
'�%V I�/�� .��//(1�
NG
i5
COSTA MESA. CALIFORNIA
ZONW��D/'-G� �x+ i ic!10.
/1 Q ��•
20NE /t / I P 4N5 / I BUELOFNGEW
�/�
ICENTEfl LINE ST.)
— FftONT `
— R.SIDE �
ALLOWED
FT. IN.
FT. IN.
FT. I N.
FT. IN.
THE A UNT SHOWN UNOER VRLU�TION IS FOR THE
PUPP SE OF ESTRBLISXING R�PERMIT FEE ONLY.
VA ATION G 'I • _ s�, J.
PERMIT FEE S ��� � �
g �0 � PLAN CHECK $ �
�
TOTAL FEE $ ,��