HomeMy WebLinkAbout2817 ELLESMERE AVE - Building Permits�, ` ` � CITY OF COSTA MESA �
� BIIILD/NG D/V/S/ON
F �� • 77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: P08-00214
PERMIT TYPE PLUM
APN: 13933509
;��-_�k.-.,�.,,_�i
JOB ADDRESS: 2817�EL'L'ESMERE:!>V �CM ;"
Vicinity: BATHROOM ,
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
1010312008
YH
�� r'
,�'.
SCOPE OF WORK: BATHROOM REMODE� - REPLACE SHOW ER/TUB COMBO, TOILET, DUAL SINK - PLUMB. & TILE WORK
ONLY - NO EI.ECT.
OWNER: PHILIP C& KRISTINE SCHROEDER
PHONE:
APPLICANT: PHILIP C &�KRISTINE SCHROEDER
PH4NE: 714 292-9253 .
CONTRACTOR: . �
Address:
City/State: ZipCotle:
A�('HITECT:
EN INEER:
Address: 28'17 ELLESMERE AVE.
City/State/Zip: COSTA MESA, CA .
Address: 2817 ELLESMERE AVE.
City/State/zZip: COSTA MESA, CA
License No.
PHONE:
CELL:
License No. � PHONE: � �
License No. pHONE: �
, �
PLUMBING PERMIT FEE SUMMAk ( � �.<-;�. . ;�j
✓ v
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$52.90
$52.90
� .. � f-;.
�
NOTICE: The work authorized by this permit shall comply vrith all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92) '
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this pertnit.
C�f,�/ INSPECTIONIYPE Q/iTE IN L LOOE� INSPEClIONTYPE Q1g INTI71RL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical ' /�
12QB Pool Spa Final 208 Final Plumbing iC�J� %)7/�jl�/�
/
20p Final Re-Roof 270 Final Electncal
201 Final Block/Retaining Wall 272 Final Fire Prevention
202 Fina1 Factory Fire Place 220 Final Planning Appmval
203 FinalSign 222 Final Site
204 Final Dertrolition 250 Final Building�Occupancy
.. `
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm untler panalty of perjury one o( lhe (ollowing decla2tions: _
❑ I have and will mainlain a certificate of consent to self-Insuie for vrorkers'
compensation, as provideC for by section 3700 of the Labor Code, for ihe
performance of Ihe work (or which this permit is issued.
❑ I have antl will maintain v.orkers' compensation insurance, as required by
section 3700 of Ihe Labor Code, fa the pertormance of the vmrk ta which this
pertnit is issued. My workers' compensation Insurance carrier antl policy
number are:
Cartier:
(Tlus setYbn neM not be ¢vnpkte0/the pertn4 a vd2Mat me �unWM cbAarslS100/ orkss )
Policy Number:
❑ I certi(y lhat in ihe peAortnance of the vrork for which this permit is
issuetl, I shall not employ any person in any manner so as to become subject
b the workers' compenselion laws ot Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall foRhwith comply with these provisions.
Applipm's Siq�aWre Daie
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECYION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby aKrtn that I am licensed under pmvisions o! Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Professions Code, antl
my license is in full torce and eHect.
Lic. # Class #
CAnlranors SiQ�aWre
CONSTRUCTION LENDING AGENCY:
❑ I hereDy affum that Ihere is a constmctbn�lending agency fa the
peAwmance of the v.vrk Fo! wliich Ihis pertnit is issued. (Set. 3097, Civil Code).
Lender's Name: ' � '
lender's Adtlress: �
SignalorC ' �•� ' Dale
� „
OW NER-BUILDER DECLARATIONS:
I hereby affirm that under'penalty of perjury thal I am EXEMPT FROM THE
CONTRACTORS, LICENSE L.4W for the following reason (Sec. 7031.5,
Business and Professions Code: Any cily or counly which requires a permit to
wnstruct?alter; improve, tlemolish, or repair any slrucNre, prior lo its
issuance. also require's the applicant for such permit to file a signed statement
ihat he or she is'IicensCd pursuanl lo Ihe provisions of lhe Contractors
License Law (Chapter 9(Gommencing wi[h Section 7000) of Division 3 of Ihe
Business antl Pro(essions Cotle) or that he or she is exempt there(rom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicaN lor a permit subj0cis the applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as owner ol the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and lhe slructure is nol intended or
oflered lor sale (Sec. 7044. Business and Protessions Code: The Contractors
License Law does not apply lo an owner of property who builds or improves
theieon, antl who does suCh wnrk himself or herself or through his or her ovm
employees, provided that such improvements are not intended or oKered tor
sale. If, however, the buil0ing or improvement is sold within one year of
completion, lhe ovmerbuiltler will have the burden of proving that he or she
did nol build or improve fol purpose of sale.).
�.j�W,{ � I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
/CICENSED CON7RAC70RS to construct the project (Sec. 7044, Business and
Pmfessions Code: The wntractors License Law Oces not apply lo an owner of
property wfio builds or improves thereon, and who contracts for such project with
a cmtracta(s) license pursuant tothe Contractors License Laws.).
❑ I am exempt under sE�.
Business antl Professions Cotle for this reason:
� . � . ... � .'.G►�.tl�� , . • �
�' �... �
Oxmer ID veri�etl Dy drivc. . ncensc. �Yes ❑�vo�, � �
Driver';License�No. � �Expires: '�h-a -'1
Veri(cation of Ownership by pype of document, i.e. - propyt�tax bill oc,dee0):
�.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certRy that no excavation frve (5) a mwe feet in deplh into which a
person is required to descend, will be matle in connectan with wnrk authorized
by this permit, and lhat no building s[ructuie, scaffdtling, falsework, or tlemolition
or tlismantling thereo(, will be more than lhirty-su (36) �eet �igh. (Chap. 3.2. Grp '
2. Art 2, Sec. 347. Ttle 8, Califomia AdministraWe Code�.
❑ As ovmei-builder, I vnll not employ anyone to tlo work which would
require a permit from the Division ot Intlustrial Satety, as noled above. unless
such person has a permit to do such work from the division.
Applicanl's SignaWre Date
Division o! Industrial Safety Pertnit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicam or present or future building occupant need to fle and
certify a Business Plan for emergency response to release or threalened
release of a hazardous material? � Yes ❑ No
(Section 25505 0( the Califomia Health and Sa(ery Code requires, with some
exceptions, Ihat 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 quamily of hazartlous materials equal m or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at slandard temperaWre antl pressure).
2. Does or will the applicant or present or fuWre building occupant neetl to fle
a registralion (orm for acu[ely hazardous materials? ❑ Yes ❑ No
(Section 25533 of ihe Califomia Health and Safety Cotle, with some
exceptions, repuires regis[ralion with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of awtely
hazardous malenals equal lo or greater than a weigM of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet o( wmpressed gas at stantlard
temperalure and pressure).
3. Does or will the applicant or present or fWure building cecupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous mate�als�7 ❑ Yes ❑ No
(Section 25534 0/ the California Health antl Safery Cotle provides [hat the
Costa Mesa Fire Department may require the preparetion, certification and
filing with the Fire Department o( an RMPP by businesses which are required
to regisler aculely hazardous materials with Ihe Fire Department.
4. If an RMPP is presen[ly require0, has Section 25534 of Ihe California
Health and Safety Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or presen[ or (uture building occupanl require for
the work which is Ihe subjec[ o( this application a permit for such conshuction
or modification (rom ihe South Coas[ Air Qualiry Management Dislrict or fmm
any other air pollution con[rol dislnct or agency? ❑ Ves � No
(Sectbn 658502 of the Califomia Govemment Code �equires that the requested
information be lumished on applicalions (or iwn-resitlential builtling permits).
6. Will any paM1 of the facility to be consWcted under Ihis permit be within
1000 feet trom the outer boundaries of a school? ❑ Ves ❑ No
Q( yes", Ihe faciliry must meet the requirement of Sections 25534 antl 42303
o( lhe Cali(omia Health and SaFery Code).
Z If a pertnit (rom the South Coast Air Qualiy Management Dislrict or other
air polWtion wntml dislrict or agency is required (or the work which is the
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certificafe of wmpfiance frbm ihe appropriate air pollution
control oKcer). �
CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the
information given above is correcl. I agree.to comply with all state laws and
city ortlinances regarding Hazardous Materials antl Emissions �� �_
SignaWre Date �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally of perjury ihat I have read this application and-state that
Ihe information given is covecL I agree to comply with all state laws and city
ordinances relating to builtling construction, and authorize representatives of
the City of Costa Mesa to enter upon ihe above-describetl property !or
inspection purposes. I agree not to occupy or allow occupancy of any builtling
ayyth�"ori.zIe�d by Ihis p r il until nal Inspeclion. �
�by�y/�.�1� � � � b�
J Signaw e I legal Owneqs) D te �
Andlo� AUUorize0 Applicant
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENTSERVICES DEPARTMENT
BUtLDtNG DiVtSION
COURTESY NOTICE OF PERMIT EXPIRATION
DATe: April 12, 2011
PERMIT NUMBER (S): PD�• DO2./�I'
ADDRESS OF PERMIT .ZaI % �E//ES/1'1�,eE A�E
FOR: �ATN400n'� RErnodG�
Our records indicate the above listed permit(s) were obtained for property
improvements or alterations at the above address. Per the 2010 Uniform Building
Code, Section 105.5 Expiration, permits are valid for 180 days from the date of such
permit, or the date of the last inspection for the project.
Our records do not show an inspection for these permits within the last 180 days nor
have they had an approved final inspection. If you have a signed inspection card
showing thaf an inspection was made within 180 days, or that the final inspection was
approved, please contact this office so we may correct our records.
If you do not have an a roved final ins ection, your permits will expire on the date
of: APRIL 22, 2011 . Additional fees will be required to finalize
expired permits.
Requestinq an inspection - If you need to request an inspection, please call our
Inspection Request Line at (714)754-5626.
Repuestinq an extension - If you wish to request an extension, requests must be
made in writing addressed to Bill Nunes, Chief of Inspection at the above address,
detailing circumstances and listing an estimated date of completion.
If you have any questions, please contact the Building Division at (714)754-5273,
between 8:00 a.m. and 4:30 p.m., Monday through Friday and a staff member will assist
you. The accuracy of records affecting your property is our goal and we appreciate your
working with us to resolve this matter.
Sincerely,
City of Costa Mesa Building and Safety Division
cc:
k/R
Building Division (714) 754-5273 • Code En(orcement Q14) 754-5623 • Planning Division (714) 754-5245
FAX (7'14) 754-4856 • TDD (714) 75a-5244 � wvrv�.ci.costa-mesa.ca.us
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor.
Address:
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 7000a
Service over 1000a
Motors lo thp
Motors l0 10hp
Motors l0 50hp
Mo[ors l0 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
2817 ELLESMERE AV
13933509
ERICHSON, FRANK
CHECK, STEVEN G
CHECK, STEVEN GLENN TR
COSTq MESA, CA
575 ANTON BLVD STE 570
THE WLB CORPORATION
17780 FITCH AVENUE
IRVlNE, CA
ELECTRICAL PERMIT
Phone:
Zip:
Phone:
Zip: 92626-7685
Phone: 949-250-8959
Zip: 92614
License: 524543
ISSUED BY:
Status: ISSUED
Applied: OS/22/2002
Issued: OS/2Z2002
�
�• • � I1 �
i
♦'
SCOPE OF PERMIT
ADD 105 SF MASTER BEDROOM OF S.F.R. TO THE SIDE OF THE PROPERTY; 2 SETS OF WINDOWS
REPLACED AT WEST SIDE; ELEC WORK IN EXISTING MASTER BEDROOM. (ADD EXTERIOR JET TUB:
SEE 602-00544 ). REF.: 602-00504
523.50
$0.00
$0.00
$0.00
$0.00
30.00
50.00
$5.50
$4.40
50.00
50.00
�0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
30.00
Quantity
FEE SUMMARY
Temp Dist System / Li9hting
Busway /100 ft
Slanding Section
Misc ElecVical Equipment
Trans(ormers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lighls)
Chnstmas Tree Stand
Fireworks Stand
Other ElecMcal Fee
Investigatlon Fee
Plan Check Fee
Reinspection Fee
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES $33.40
COMMENTS / SPECIAL CONDITIONS
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Catifomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) . ,
EXPIRATION: This permit shail 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 Inspeetlone and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit.
FOR INSPECTIONS CALL: (7yq) 7545626
2aae-ae 16��)
WORKERS' COMPENSATION DECLARATION:
I hereby aXirtn under penalry ot perjury one of the lollowing declarations: �
❑ I have entl will maintaln e certilicata of consent to sell-Insure lor workers' compensation, as provided for by section 3700 of the Labor Code, lor the peAormence of Ihe
work tor which this permit is issuetl. .
❑ I have end will maintain workers' compensaGon insurence, as required by section 3700 of the LeOor Code, for the peAortnance of Ihe work for whlch this pertnit is Issued.
1dy workers' compensation Insurence carrier an0 palicy num6er ere:
��� Policy Number
section neetl nof be comp/etad ll the permi! Is ve/ued e( one huntlred tlollars (S I00) or less.)
.11�l:certity t�at in t�e peAortnance ol t�e work lor which Ihis pertnit is issued, I shall not employ any person in eny manner so as to Oecome subject m the workers'
0 compensetion la=_s ot C' o , e� epr at II I s�oultl become sub�ecl to Ihe workers' compensation provLsions of Section 3700 of the Lebor Cotle, I s�all lonhwith
comply with thes / `r' ^
,Alpplicetrt�Slg�Wre:_ �D`1e_�—� ✓ �L '� �
WARNING: FAILURE TO SECURE WORKERS' COMPENSAiION COVERAGE IS UNLAWFUL AND SMPLL SUBJECT AN EMPLOYER TO CRIMINAL PENALilES AND GVIL FlNES UP TOONE HUN�RED
TFiOUSAND DOILARE (5100,000). IN ADDfTION TO THE 00.ST OF CQNPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR COOE, IMEFEST, AND ATTORNEI"$ FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am IiceDse�ip�d��rpyiai�ns of Chapler 9(commancing with Sectlon 7000) of Division 3 of.ihe�Busin and Pmte� io e, tl my license is in full
Iorce.arM:eltad:Lic: M��� C.� X S �Class a�r2 �� �N/ �
Conl� ion��� pate:—�'�7��CJZ�
CONSTRUCTION LENDING AGENCY: �
❑ I hereby ettirtn t�a� there is a construction lending agency tor t�a peRormance ol ihe work br w�ich this permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirm t�et untler penalry of per�ury that I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business an0 Professions
Cotle: Any ciry or counry w�ic� requires e permit to consiruct, elter, imOrove, demolish, or repair eny simcture, prior to its issuance, elso requires the applicam tor.such permit
b tile a slgned statement Ihel he a she Is Ilcensetl pursuent to tha provlsions of the Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 oi the
Business end Professlons Code) or Ihet he ar sha is exempt therefrom end Ihe besis for ihe allaged ezemption. Any violation of Sectlon 7031.5 by any applicant for e pertnit
subjects Ihe appliwnt to e civil penelry of not more ihan five hundred dallers ($500).):
❑ I, es owner of the property, or my employees wilh wages as Ihelr sole compansatlon, WILL DO TME WOHK, an0 the siructura is not intentletl or oHered tor sele (Sec.
7044, Business an0 Professions Code: The Conirectors License Lew does not applY to an owner of properry who 6uilds or improves thereon, and who does such work
�imself or hersetl or through his or her own employees, provided Ihet such impmvemenis ara not intended or oHered for sale. If, however, the building or improvement is
sold within;one year of completion, the owner-builder will heve �he burden of proving ihat he or she did not build or improve for purpose ol sale.).
�� 11 c�i i �,
❑ I, as owner�of ihe property, am EXCLUSIVELV CONTRALTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Proteuions
Code: The contrectore Clcense Lew does not apply to an owner ol property who bullQs or improves theraon, antl who contrads for such project with a contractor(s)
�` se pursuant to� Cuntractors License Laws.).
❑ I am�exempt untler secrZ� n�I Business and Prolessions Cotle tor this reason:
M
SignaWre: - - Date: __
Owner ID veritied by dnvefs Iicense. ❑ Ves ❑ No DrivefS License No. Expires:
Verification ot Ownership by (rype ot tlocumem, i.e. - property tax 6ill or tlaed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certily that no eacavation five (5) or mora leet in depih into which a person is required to descend, will be made in connection wiN work authonze0 by Ihis
pertnit, end that no building struclure, sceMolding, lalsework, or tlemolition or tlismantling thereol, will be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ti�le 8, Califomia Atlministrative Cotle).
❑ As owner-Duilder, I will noI employ anyone to tlo work whic� would require a permit irom the Division of Industnal Sefery, as notetl abova, unless such person hes e
pertnit ta do such wark trom Ihe division.
Signature: Date:
Division of InduStnal Safery Partnil Number:
CER7IFlCATE OF COMPLIANCE AND AIfTFfORQA710N OF ENTRV: I certity under penalry ot perjury that I have read ihis aDPlication and state ihat the intortnation given is
wrtect. I agree to comply with ell state laws end ciry ordinances relaling to builtling construction, end authorize representatives ot the Ciry af Costa Mesa to enter upon Ihe
abova-described properry tor inspection purposes. I egree not to occupy or allow occuDancy ot any building authonzed by ihis permit until finel inspeCtion.
GO�E 1, MSPECTIONTYPE
1616 Fixetl System Finel Flre Prevention
1266 Pool Spa Fin01
200 Finel Ra-Raol �
201 Final BIocWReteining Well
202
203
204
Final Factary Fire Place
Finel Sign
Finel Demolition
py�E irrtrtu�s
COUE I INSPECTION iYPE
206 Final Mechanicel
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
dob Address: 2817 EI.LESMERE AV
Suite:
Vicinity: SIDE OF PROPERTY
Parcel Number: 13933509
Applicant: ERICHSON, FRANK
Address:
Owner: CHECI<, STEVEN G
Address CHECK, STEVEN GLENN TR
COSTA MESA, CA
575 ANTON BLVD STE 570
Contracror. THE W�B CORPORATION
Address: 17780 FITCH AVENUE
IRVINE, CA
Zip: 92614
Arch :
Address:
Zoning: R1 R1
Phone: 949-250-8959
Zip:
Phone:
Zip: 92626-7685
Phone: 949-250-8959
License: 524543
Eng:
Address:
Phone:
Status: ISSUED
Applied: 04/16/2002
Issued: 05/22/2002
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
ADD 105 SF MASTER BEDROOM OF S.F.R. TO THE SIDE OF THE PROPERTY; 2 SETS OF WINDOWS REPLACED AT WEST
SIDE; ELEC WORK IN EXISTING MASTER BEDROOM. (ADD EXTERIOR JET TUB: SEE B02-00544 ).
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$126.g1
$ise.zs
$1.10
$0.0p
$0.00
$0.00
$323.26
SETBACKS
MAINSTRUCTURE Front yg-p
ACCESSORY Front 0- 0
PARKING Existina: 0
NOTES:
Rear 16-0
Rear 0- 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
Left 10- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 7- 0
Right 0-0
$10,977.50
so.00
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 780 days, or if work is suspended or abandoned
tor 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 inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714} 7545626 ,
2446d81fV00)
WOHKERS'COMPENSAnON DECLARAnON:
I hereby afrirtn un0er penalry of perjury one of the following tleclaretions:
❑ I have antl will maintain a cenificate of consent to selt-Insure for workers' compensation, as provided for by seclion 3700 oi ihe Labor Code, for the pertortnance of ihe
work for which this pertnit is i55ued. .
❑ I have and will maintain workers' compensation insurance, as required by seclion 3700 ot the La6or Code, tor Ihe pedortnance of ihe work for which this permit is issued.
My orkers' compensation Insurence carrier antl policy number are:
Carti Policy Number:
(Th' section need not be completed il fhe Oermit is veluetl et one hundred dollars ($100) or less.)
JI certity ihat in ihe peAormence the work for which this permit is issuetl, I shall not employ any pereon in any manner so as to become sublect to Ihe workers'
compensation laws o ' omi , a egree that it I should become subject to the workers' compensation provisions of Section 3700 ot ihe Labor Code, I shall forthwith
Comply with the5e r vi ' ns �i � ^�
Ap_ p�lic�nt StBnature:� SDat� —Ll
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEPAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
TFKKISAND DOILARE (E100.000�. IN ADDITION TO THE COST OF WMPENSATIOtJ, �AMAGES AS PROVIOED FOR IN SECTION 3106 OF THE L400R CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I am licensedynd$prov3ie
ContrectoPs.Signetire:
of Chapter 9(commencing with Section 7000) of Division 3 of the Busin end nd my li nse is in tull
�c,� � — `���.��%3 ,yc.��
- ���'-Z -�_
CONSTRUCTION LENDING AGENCY: �
❑ I hereDy aflirm that ihere is a construction lending agency for t�e peAortnanca of the work For which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signawre: Date:
OWNER-BUILDEq DECLARATIONS:
I heraby eNirm that under penelry�of perjury that I am EXEMPT FROM 7HE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl ProFessions
Code: Any ciry or counry which�requires e pertnit to consWd, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant tor such pertnit
to file e signed stetement thet he or she'is Ilcensetl pursuant to the provisions of the Conirecrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or ihat hebr she is exempt therefrom and Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by eny applicant for a permit
sublecis ihe appllcant to a divil penalty of not mor9`hen tive,hundred dol�ars ($500)J:
❑ I, as owner of the properry, or my employess with wages as their sole compensation, WILL DO THE WORK, antl the structure Is not intended or ottered tor sele (Sec.
7044, Business and Professions Cotle: The Contractors License Law tloes not apply m an ownar of properry who builas or improves ihereon, antl who tloes such work
himself or herself or through his or her own employees, provided that such improvemenis are not Intended or oHered for sale. If, however, the building or improvement is
soltl within one year ot completioq the owner-builde� will have ihe burtlen of proving that he or she did not build or improve tor purpose ot sele.).
❑ I, es owner ot ihe properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to con5truct the project (Sec. 7044, 8usiness and Protessions
Gode: Tha contractors Llcense Lew tloes not epply to an owner of property who builtls or improves thereon, end who coniracts tor such proiect with e contrecior(s)
license pursuant to t�e Contractors License Laws.).
❑ I em exampt under sec.
Signature:
Owner ID venfied by tlnvers license. ❑ Yes ❑ No
eusiness and Professions Code for ihis reason:
Verificetion of Ownership by (type of document, i.e. - pmPerry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Dnvefs License No.
Dete:
Expires:
❑ I hereby certity ihat no eacavation five (5) or more feet in tlepth into which a person is required to descend, will be made in connection with work authorized by this
permit, and ihat no building sWcture, scaHolding, falsework, or demolition or dismantling thereof, will he more ihan thiny-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Califomia Administrative Code).
❑ As owner-builtler, 1 will not employ anyone to do work which would require a permit from the Division of Indusinal Sefey, as notetl above, unless such person has a
permit to do such work irom the divisian.
Signature: Data:
Division of Indusirial Safery Permit Number:
ICERTIFICATE OF COMPLIANCE AND AUTMORIZATON OF ENTRY: I cenity under penal�y ot perlury ihat I have read this application and state ihat ihe information given is I
correct. I agree to comply with ell stata lews and city ordinances relating to building cons�ruction, and euthorize representatives of the City of Cosia Mesa to enter upon ihe
above-descnbed properry for inspedion purposes. I agree not to occupy or allow occupency of any building authorized by this permit until final inspection.
Of Legai Owner(s) - �� ,ZZ `� .� Dale
COUE N. INSPECTONTYPE �L
1616 Fixed System Final Pire Prevention
7266 Pool Spa Final
200 Final Ra-Roof
201 Final Blak/Relaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demoli�ion
INTRIALS �QU�j INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAI€ INTffIRL3
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Number:
Applicant
Address:
2817 ELLESMERE AV
73933509
ERICHSON, FRANK
Owner. CHECK, STEVEN G
Address: CHECK, STEVEN GLENN TR
COSTA MESA, CA
575 AN70N BLVD STE 570
Contractor:
Address:
THE WLB CORPORATION
17780 FITCH AVENUE
IRVINE, CA
MECHANICAL PERMIT
Phone:
Zip:
Phone:
Zip: 92626-7685
�Phone: 949-250-8959
Zip: 926'14
License: 524543
ISSUED BY:
Status: ISSUED
Applied: OS/22/2002
Issued: OS/22/2002
SCOPE OF PERMIT
ADD 105 SF MASTER BEDROOM OF S.F.R. TO THE SIDE OF THE PROPERTY; 2 SETS OF
WINDOWS REPLACED AT WEST SIDE; ELEC WORK IN EXISTING MASTER BEDROOM. (ADD
EXTERIOR JET TUB: SEE B02-00544 ). REF.: 802-00504
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 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 < t0000cfm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
50.00
$0.00
$27.40
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
FEESUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercia l I n ci n erator
Domestic Incinerator
Compressors / Absorpiion Systems
Up to 3 hp / 700 k BTU
3Tot5hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp ! 7,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3To15hp
15 to 30 hp
30 l0 50 hp
Over 50 hp
Other Mechanical Fee
Investiga[ion Fee
Plan Check Pee
Reinspection Fee
Quantity
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES $50.90
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremeMs under California statutes and related
regulatio�s. (Ord: No: 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void iF work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-48 (6�W)
WORKERS' COMPENSATION DECLARATION: .
I hereby attirm under penalry of perjury one ol ihe tollowing declarations: �
❑ I have and will maintain e cenificate ot consent to self-Insure tor workers' compensation, es provided br by section 3700 ot the Labor Code, tor the pertormence of the
work tor which ihis pertnit Is issuetl. .
❑ I have antl will maimain workers' compensation insurence, as required by section 3700 of the Labor Code, for the pertormance ot Ihe work for w�ich ihis permit is IssueG.
My workers' compensation Insurance carrier entl policy number are:
Cerner Policy Number:
(Thi ection neetl not be comp/eted i/ the permit is valuetl af one hundred dollars ($100) or less.)
-�I cetlity Iha� in Ihe performance oi iha work for which ihis pelmit is issued, I shall not employ any person in any manner so as to become subject to the workers'
�mpensa� tio�n�la,ws �en e re hat if I should become sub�act to the workers' compensation` provislons of Section 3700 of ihe Labor Code, I shall torthwith
complywiththe pmh ns (�—
Applicanl'Signeture: Datat� .7 ' `-'�
WARNING FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU9IECT AN EMPLOVEP TO CRIMINPL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PFOVIDED FOR IN SECTION 3106 OF THE LABOR CADE, INTEREST, ANO ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am license,�.y_nderp �ro,visiory�of Chapter 9(commancing with Section 7000) of Division 3 of lhe
force�enQeflect-Lic?a ��'d ¢-J` SYS Las:
Gonirectors'SignaNre;? �� i ' �pyg;
CONSTRUCTION I.ENDING AGENCV: �
❑ I hereby aHirtn that there is a consVuction lending agency for the peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lendels Name: Lender's Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
mY license is in full
I hereby ettlrm that under penalty of perjury ihat I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Professlons
Cotle: Any ciry or counry which requires a permit b consWcL alter, impmve, tlemolish, or repair any siructure, pnor to its issuance, also requires the applicant for such permit
to tile a signed stetement ihat ha or she is licensetl pursuant to the provisions oi ihe Conirectors License law (Chapter 9(commencing with Section 7000) of Divislon 3 oi the
Business antl Professions Cotle) or ihet he or she is exempt therefrom and the basis for the alleged e:emption. Any violation oi Section 7W 1.5 by any applicant for a permit
subjects iha ep0licant to a civil penalry of not more than tive hundred dollers ($500).):
❑ I, as owner of the propeny, or my employees with weges es �hei� sole compensation, WILL DO THE WORK, and ihe siructure is not intended or ottered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves ihereon, antl who does such work
himself or herself or through his or her own employaes, provided ihat such impwvemenis are not intended or oHeretl for sale. If, however, the building or improvement is
sold within one yeer ot completion, the owner-builder will heve the 6urden oi proving ihat he or she did not 6uild or improve for puryose oi sele.).
❑ I, as owner ol lhe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS ro construct the prolect (Sec. 7044, Business and Pmfessions
Code: The contrectors License Lew tloes not epply to an owner of pmperty who builds or improves thereon, and who contracis for such projact with a contrector(s)
license pursuant lo ihe Con�raclors License Laws.).
❑ I am exempt under sec.
Signature:
Owner ID ventietl by tlnver's license. ❑ Ves ❑ No
Business and Professions Code tor this reason:
Verification oi Ownership by (type of document, i.a. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATON:
Driver5 LicenSe No.
Date:
Expires:
❑ I he�e6y certify that no excavetion tiva (5) or more ieet in depih into which a person is required to descend, will be made in connection with work euthorized by Ihis
pertnit, and that no building strucWre, scaflolding, talsework, or demolifion or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec.
341, Title 8, Celifornia Adminisirative Code). ,
❑ As ownerbuilder, I will not employ anyone to tlo work which would raquire a permi� fmm the Division of Indusinal Safery, es noted above, unless such person has e
permit to da such work from ihe division.
Signature: Date:
Division of Indusinal Safery Pertnit Number:
CERTiFlCA7E OF COMPl1ANCE AND AUTHORIZATION OF EN7TiY: I ceniy under penalry of perjury ihat I have reatl this application and state that the infortnation given is
correct. I agree to comply with ell stete laws and ciry ordinances relating to builtling construction, and authorize representatives of the Ciry of Costa Mesa to enter upon Ihe
above-describetl property for inspection puryoses. I egree not to acupy or ailow occupancy of any building authorized by this permit until final inspection.
GOUE I, INSPECTIONTYPE PeLG INTRIALS
1616 Flxetl System Final Fire Prevention
1266 Paol Spe Final
200 Finel Re-Roof
201 Finel BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demoiition
COOE� INSVECTIONTYPE
206 Final Mechanical
20B Finel Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Date
PSiE ixrm��s
�-i3-oa f3N
(714) 754-5273 • Faz (774) 754-4856 • www.ci.costa-mesa.ca.us 77 hAIM UMI V t, GVJ I A MtSF, GA `JLbLO
Job Address: 2817 ELLESMERE AV
Suite No
Vicinity:
Parcel Nunmber: 13933509
Applicant:
Address:
Owner:
Address
Contractor:
Address:
Arch / Eng :
Address:
ERICHSON, FRANK
CHECK,STEVEN G
CHECK, STEVEN GLENN TR
COSTA MESA, CA
575 ANTON BLVD STE 570
THE W�B CORPORATION
17780 FITCH AVENUE
IRVME, CA
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip: 92626-7685
Phone: 949-250-8959
Zip: 92614
License: 524543
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING TO INCLUDE: 1 HOSE BIB. REF.: B02-00504
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clanfier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Founlain
Expansion 7ank
Gas Earthquake Valve
Gas (t-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.6Q
SO.OQ
SO.OQ
$0.00
50.00
50.00
$0.00
$O.OQ
50.00
SO.OQ
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
30.00
$0.00
$0.00
QTY
FEESUMMARY
Laundry Tub / Washer
Landscape Irrigation
P-Trap
Pressure Regulator
Process Piping (per 10 ft)
Receptors
Sepiic Tank
Sewer Cap for Demo
Sewer Connect
Sewer Private Line
Shower
Sink, bar
Sink, commercial
Sink, Floor
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
AMT
50.00
50.00
$O.oO
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: OS/22I2002
Issued: OS/22/2002
ISSUED 6Y: <c-7��
SumpPump
Swimming Pool
Trap Pnmer
Urinal
Vacuum Brkr BkOow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
50.00
50.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$9.80
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 533.30
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-g2)
EXPIRA710N: This'permit shall automatically expire and become void it work is not commenced within 780 days, or if work is suspended or abandoned
for 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 Inspeetions end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626 .
zaa6�a6 (flroo)
WORKERS'COMPENSATON DECLARATON: '
I hereby aflirtn untler penelry of perjury one oi the tollowing tleclaratlons:
❑ I have entl wlll melntein e ceniFlcate of consent ro setl-Insure for workere' compensation, es provitled for by section 3700 ot the Lebor Code, for the pertortnance of Ihe
wark lor whlth thi5 pertnil Is Issued. .
❑ I have ana will m'aintain workere' compensation insurence, as required by section 3700 of the Labor Code, tor tha paRortnance of the work for which ihis pertnit Is issueG.
My workers' compen5atlon Insurance carder end policy number are:
Carrie �: Policy Number:
(Trii ecfion need nat be camplefed ll fbe peimit is veluetl at one hundred dollars ($100J or Iess.J
� �I certiy Ihat in Ihe peAortnence of the work for which fhis pertnit is issuea, I shall not employ any person in any menner so es to bacome subject to the workers'
compen5ation lews ol Call nla, gree t�at If I should become sublect b �he workers' compensalion provlslons ol Sectlon 3700 of the Labor Code, I shell torthwlth
comply with Ihese s. ^�
Applicant'�pnatura: � ' i� D� l �� G�—� � —
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBIEC� AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO dJE HUNDRED
T/KKISPND DOLLARE (5100.000), IN ADDITIIXJ T0 THE COST OF CAMPENSATION, DAA/AGES A$ PROVIDED FOR IN SECTIIXJ 3]OB OF THE IABOR CODE, INrEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
ettirtn thet I am Iice etl under provisions o LChapter 9(commencing with Section 7000) of Division 3 ol the Buslne� nd Professions Coda, and license is' full
i enec4Uc'q_ =y�9 "u 3 CCwss u—%J � S� i cia'—G�� /�'«�
or's,signeture: �4� -� Coate: J C' — 2 g•—o �—
CONSTRUCTION LENDING AGENCY: �
❑ I hereby aHirtn ihat ihere is e construction lentlinq agency for ihe pedortnance of the work lor which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender'S Neme: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aAlrm that under penalry of perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for t�e tollowing reeson (Sec. 7031.5, Businass ana Professions
Code: Any ciry or county which requires e permit to consimct, alter, improve, demolish, or repeir any stmcWre, prior to its issuance, also requires the applicanl for such permit
to file e signed statement thet he or she Is Ilcensetl pursuent to ihe provisions of tha Contrectors License Lew (Chepter 8(commencing with Sectlon 7000) ot DlWsion 3 oi the
Business end Professions Code) or Ihat �e or she is exempt iherefrom and t�e 6asis for the ellegetl e:emption. Any violation of Section 7037.5 Dy any applicant for a pertnit
subjects the epplicent to e civil penulry oi nol more than five hundred dollars ($500).):
� I, es ov.ner ol the property, or my employees wlth wages es Iheir sole compensa�lon, WILL DO THE WORK, antl �he siructure is not IntentleC or ottered for sale (Sec.
7044, Busineu and Profeuions Cotle: The Coniractors License Law does not apply to an owner ol properry who builds or improves thereon, and who does such work
himselt or harself ar through his or her own employees, providetl that such improvements era not intended or oHered for sale. If, however, Ihe building or improvement is
sold within one yeer ol completion, the ownerbuiltler will have the burden of proving that he or sho did not build or improve lor purposa ot sale.).
❑ I, as owner of the properry, em E%CLUSIVELY CONTRAC7ING WIT}1 LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions
Cotle: The conirac�ors License Lew tloes noi apply ro an ownar oi property who bullds or Improves Ihereon, antl who contracis tor such projed with a coniractor(s)
license pursuent to the Coniracbrs License Wws.).
❑ I am e:empt under sec. Business antl Professions Cotle for this reason:
Signature: Date:
Owner ID verifietl Dy tlnvef5liCense. ❑ Yes ❑ No Dnvefs LicenSe No. E:pires:
Vedfication of Ownership by (rype of daument, i.e. � pmperty tac bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
❑ I hereby certify ihat no excavetion �ive (5) or more feet in depth into which a person is required to descend, will be metle in connection with work authonzed by this
permit, and that no building structure, scattolding, falsework, or demolition or dismantling thereoi, will be more then thiny-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Califomia Atlminisirative Code).
❑ As owner-6uiltler, I will not employ enyona to tlo work which would require e permit from the Division of Intlustrlel Setety, es notetl above, unless such person has e
pertnit to do such work irom the division.
Signature: Date:
Division of IndusMal Salery Permit Number.
CERTIFlCATE OF COMPLIANCE ANO Al7THORVA710N OF ENiAV: I certity under penalry of perjury that I heve read ihis epplication and state ihat the infortnetion given is
correct. I egree to comply with ell state lews and city ortlinances releting to butltling consWction, end euthorize representatives of the qty of Costa Mesa to enter upon the
abova-descnbed property for inspection purpwes. I egree not to occupy or allow occupancy of eny building authorized by this permi� until final inspection.
CODE I, INSPECTONME
1616 Fi:ed System Finel Fire Prevention
7266 Pool Spe Finel
200 Finel Re-Rooi
207 FInaI8lock/Reteining Wall
202 Final Fectory Fira Place
203 Final Sign
204 Final Demolition
�jE INiIiIRLS
t00E 1 INSPECTION TYPE
208 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220
222
250
�' �v�
Finel Planning Approval
Final Site
Finel Building/Occupancy
UpTE �
�-�3-oa �v
J
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.BUILDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2817 ELLESMERE AV
Suite:
Vicinity: FAMILY ROOM & KITCHEN
Parce� Number: 13933509 Zoning: R1 R1
Applicant: MARTIN, GLENN
Address: 130 N. GILBERT ST
Phone: (714)578-0090
FULLERTON, CA Zip: 92633
Owner: CHECK, STEVEN G& DONNA L
Address 2877ELLESMEREAVE
Phone:
COSTA MESA, CA Zip: 92626
Contractor: RENAISSANCE DOORS AND WIN
Address: 130 N. GILBERT ST
FULLERTON,CA
Zip: 92633
Arch :
Address:
Phone: (714) 578-0090
License: 490375
Eng:
Adtlress:
ISSUED BY:
Status: ISSUED
Applied: 07/16/2001
Issued: 01/16/2001
Phone: Phone:
Zip: license: License:
SCOPE OF PERMIT
REPLACE 2 EXISTING AL WINDOWS WITH SAME SIZE WOOD WINDOWS IN THE FAMILY ROOM (72" X 44") 8 KITCHEN
(60" X 40") IN A SFR.
Plan Check: $40.46
Permit: $62.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $103.21
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left ' 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Righl 0- 0
Right 0- 0
sz,000.00
s2,000.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1. 12-21-92)
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 inepeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�aaw6 (erool
WORKERS' COMPENSA710N DECLARATION: � .
I hereby aHirm under penalry ot perjury one ot the following declarations:
�� I have end will maintain a certificate ot consent to self�lnsure for workers' compensation, as provided for Dy section 3700 ot the Lebor Code, for the performance of ihe
work tor which ihis pertnit is issue0.
� I have end will maintain workers' compensetion insurance, as required by section 3700 oi the Lebor Code, for the peRormance of the woM for which this pertnit is Issued.
My wyjkers' compensation Insurance carrier and policy number are: �,OA �Q ^�i n�
Carriec \�" QD�4. r(i � f�C Policy Number: y� a �� v
(This section need nof be crompletetl i/ the permif is valued et one huntlretl dollars (S100J or less.)
❑ I certify that in Iha pedormance of Ihe work lor which this permit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers'
compensatlon laws of California, end agrae that If I should becoma subject to Ihe workers' compensation provisions of Saction 3700 oi the Labor Cotle, I shall forihwlth
comply with these rov ions.
ApplicanlSigneture: ��_�� Date: � � I� 41 I 6 1
WARNINO: FAILURE TO SECURE WORKEfiS' COMPENSATIQY CAVERAGE IS UNLAWFIIL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (E100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIDED FOR IN SECTIdJ 3%O6 OF THE UBOR COOE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm Ihat I am licensed under provisions of ChaD�er 9(wmmencing with Section 7000) ol Division 3 oi the Businass antl Professions Code, antl my license Is In full
torce and ettecL Lia a �� ,-. Class M
Contractor's SlgneWre: �� CV�—.,-s� Date: _ M� 1 r_ ,� I
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm that ihere is a constmction lentling agency for ihe pedormance of the work tor which this permit is issued. (Sec. 3097. Civil Code).
Lender's Name: Lentler's Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby affirtn thet untler penalry of perjury that I em E%EMPT FROM THE CON7RACTORS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business anC Protesslons
Code: Any ciry or counry which requires a permit to construc4 atter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the applicant for such pertnit
to file e signed stetement that he or she is licensetl pursuant to Ihe provisions of ihe Contractors License Law (Chapter 9(commancing with Sectlon 7000) of Division 3 of Ihe
Business antl Professions Code) or ihat he or she is exempt t�eretrom and the basis lor the elleged exemption. Any violatian of Sadion 7031.5 by any applicant for a permlt
subjecis ihe epplicant to a civil penalry of not more than tive hundred dollars ($500).):
❑ I, as owner of the property, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and ihe structure is not Intended or oHeretl tor sale (Sec.
7044, Business and Professions Cotle: The Coniraciors License Law does no� apply to an owner oi properry who builds or improves ihereon, and who does such work
himself ar hersetf or through his or �er own employees, provided that suc� improvements ere not intendetl or oHered br sele. If, however, Ihe building or improvement Is
sold within one year of compietion, the owner�builder will have ihe burden of proving �hat he or she did not build oi improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED LONTRACTORS to constmct the project (Sec. 7044, Business and Pmfessions
Cotle: The contractors License Ww does not epply to en ownar oi propetly who builds or improves theraon, and who coniracts tor such prolect with e conireqor(s)
license pursuent to the Contractors License Lews.).
❑ I em exempt untler sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID veritied by dnver's license. ❑ Ves ❑ No Driver's License No. Ezpires:
Venfication at Owners�ip by (type of document, i.e. - properry tex bill or deetl):
DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby cenily that no excavation five (5) or more feet in depih into which a person is required to descend, will be made in wnnection with work authorized by this
permit, end ihat no building sWcture, scaXolding, falsework, or demoli�ion or dismantling thereof, will be more ihan thirty-six (36) tee� high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will nol employ enyone to do work which would require a permit irom ihe Division of Industnal Sefety, es noted above, unless such person hes e
permit to tlo such work from �he tlivision.
Signeture: Date:
Division of Indusirial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTMORIZA710N OF ENfTiY: I certity under penalry ot perjury that I hava read this appliwtion and state that the information given is
wrrect. I egree to comply with all state laws antl city ordinances relating to 6uiltling construction, and euthonze representalives of Ihe Ciry oi Costa Mesa to enter upon Ihe
ebova-descnbed property tor inspection purposes. I egree not to occupy or allow occupancy of eny buildinq authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
��� C�.'� - a t �<<v � o I
AnNOr Authorized Applicant Data
CODE t. INSPECTIONTYPE
1616 FIzeO System Final Fire Prevention
1266 PoolSpe Final
200 Final Re-Root
201 Finel BIocWRetaining Wall
202 Final Factory Fira Place
203 Final Sign
204 Final Demolition
QajF IN RIR
COUE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
��
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.im. .:
I� M
, �
. ✓�Jun-01—Jq OS:OJP lEs I'I%\Y�S
(714) 578-00°0
iier�aissmiCe
Dowt £r Wi�idoius
t;10 N. riibe,� Si,ne�
Fullmlon, C� 92G�J
CON7'ftRCTOR'S LICEHSF
�a9aJ75
OLRECTIOI79:
P [,
�.4 52Fi 137�3 P.0
CUSTOMP.R NANF:__.C��.�'�`. .
RDDRS55: ��$1 _ C IIe3.'�to✓�C _ . ._.._
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PItONF.: ---5-��--��`/ � ----- - -- --
UESICIiHR: �✓��c --_ _-- _ —
� tr cvor: �----------
�LyT PG11I�_[SZR I±LL U,CI�'CtLfiElti9_CER1t�'�'T�U
1. FILL OUT THE 5�rner�r rinrfr
2. SflOtd 5t7.fi OF Ut119' b LOCATIOtI OF ROOt1S IN 1'itE HOUSE
J. 31(A3DG 1N TIIE ARfA 0� NEW UP1IT
4. [DG7'IT1FY 1'llE UISTANCF. E1F.TNEF,N IIdU;C.AND PRUPERTY LINE
[N ;ql.l, DIRECTtOTS: fROt7'f, II71CA, 9IDE.
. LA�IiL llI�9TAMCF, AE'PWEEN BAY 6 ADW AND TIIE PROFERTY LINE
6. 9F[Oh.i HOW F71R 8AY 6 BON PROJECT 011T
7. URAi�^ A �.OUc1I OUT�'NE OF Tl1E HOUBE /��/ ���
UIVLSiUN t�}r U '
Pt• CITYOFC ST4�N�'yH1���Y
-- -- — ---.�E' Pit MESR
-p-�-6------ i
�'
�
m�
cl
G'/. i
� ma�eqtbn on sa�eJwitlwW�t cn Ihis jOh at a4icnes azi0 il is Iu�a�Nul �:.
���haesa. "'�e^PenMssionhnmlAe'Dlv'sbndBu�d'nc
olan�and��atbrsSHALlNOaM� �,Permitwtobeanappmvcl
Y Drovisione �t �,,. �:.. _. _
�!d'fR&Ifb BMVOf $1818 �W.
�ec�me m.il end voitl if the buibmg a
4�3 {d) wC1w� 180 deys ot issuancs.
� g l -t
_ s•ttt��r Nnrae
���
�r
�,
YI.
D�iniairrc�TioT To scn�s �" —_---_..___._—
� ��g er� ' arace
�� OORS {V/NDONS
CL�snc LYq/tmw�uAiyl� �+ly BeauljlW llomes
Corporaie Of�ces and Factory
130 N. Gilhen, Ivller�on 92Cr73
S.C.L. N490375 �� 14� 578��0 • Fax (714) 578-0208
�,__ . . �'��`
;
• Showroom LocaUons �p9�2
10725 Lllis Ave., Sui�c {(, Poimtain Valley. CA 9270R (714) 9(R-RR66 • Pax (714) Y68-4090
238I2-A Via l'abricante, Missiun Vicjo, CA 92691 (949) 380-9550 • �nx (J49) 7R0-010(
1022 N.'1'ustin Avenuc, Anahcim, CA')2807 (714) 632-822fi • Paz (71A) �32-51'IS
385 Lemon Avenue, "G" WalimtwCA 917R'I O(nI) 598-3339 • Fnx ('Xi9) 59S-8R96
Sales
Address �,� �� E���S%'��'�� Gpa.ted Yes N�
City_�` Map Q. SC� /� �G
Home N( � ) S7 �' %� y�p P/r�ev,i�ous Customer
Work N (—) - "_"�.�Yc�_ I
E-mail Address
E�lerior Swing
Wall
Interiar Swing
e'
7'
6'8"
6' � / ��
I /�I
You are 5�
looking
al Ihe
drawing 4'
Irom ihe
INTEqIOfl
al house 3'
1'
�/
Upstairs �---I�—�-
ownslairs 1' 2'
Ins allalion location:
Wood Species
Doors t',�"
Oak
q I
of �
goes with
N (
R.O
APP. R.O
� Screened
A = Active
X = Casement
D = Dummy
�= Fixed
"x
�°X
WEATHER EXPOSURES
Orientation N � E W
Sun (Hrs.) 2 4 �8 l0
Rain None Ligh Heavy
Gutters 'Qi3je No
t_�
Overhang� No
Size
x
x
Renaissance Pennit
Customer's Permit
1 Story or 2 Story
Preparetl Openfng
- Set On Countertop
/ J�.�nr�tY Tilelnto
n DNIS��; YPp�Ov�Dp, cuc-ooWn
Cut-0own and
S I1 A � ..�„� I�� �,4�,Bars
i
4' S'
ber.�P`.°", m,w
mak��yuG'MofCosta"".�. w���,,�,•�aM���
.�dSale�y. a�SP�� �., G'ey ot G �
��;ugoto�aR prov�sic:=° �' �m��.ronaU C�3ii
G� 1119 V101a1W11 - n„� 5.^.�11 u%+"'de �j CN¢?�
,�SeF1�s�nd ���.�+r.ta'tr.d�
Wp '
6' 7' 8' 9' 10' 11' 12' 13' 14' .
— Door Size: x Sidelite Size:
M e & Model q
2Y,• Le:v s Knobs
LiJefirt Finisti
Raised Panel A or B aiocK_a._
Style Glass Deadbol�
Sliding Hinged Fixed Single Cyli
Date P.O. N One Sided
Wihdow Fixed . i5li Garden Key to Cue
Bay Bow Awning Casement Key Alike?
k ol Keys _
Does Eyress Apply? Yes
Height Off Floor
4 x 4 Hinge or Concealed h
Reoi Options
Pilched Aluminum
w/Fla� Aluminum
B t�aqQtvusir'- � x _
Fill-in Opening_ x _
Pick up by Customer
Delivery by Renaissance
16'
FINISHING INFO Electrical Yes �
i Color 2 Color 3 Color H o� Plugs
Pull Handleset tock Custom N of Wires
Ye=. No � ERIOR � t Stain IX of Switches
P.O. N H of ext. Lighis
N o( can Lighis
Double Cylinder INL MOLDING PaiM Stain Exlerior Ligh�s lo be supplied by Cus�omer
Thumb Turn Only Plumbing Yes �
Key Yes No Rerou�e Venl Pipe only
es No EXTERIOR Pai d Stain
Floor Type
Ke R eived? Yes No
Hinges N.R.P. Butt
Sfandard So � Brass Lifetime
Other
Hardware linish
Casemen lidi Hardware
Pitt;hed S� Gle White ras5 8ronzi
Glass top - h Above Below Handle Win knob:
O�her Mould(ng:
Glass Options Low E Interior •��
CI �ar Gre ze Low �� Exterior _
Beveled Laminaled Insulated Base
Other
T
Carpet Repair Yes
EXT. MOLDING Pai�it Stain
Window Treatm ts None
uaq oundto dte
OAK THRESHOLD .R. COLOR emove Shutters Permanently
Remove Mini-blinUs Permanently
Customer lo have window Irealmenis
� removed before installa�ion
ESHOLD NO THRESHOLD Comments
Hydr ill (Interior Swing)
Oak (Inl � r Swing)
Standard(Sh •
Slandard (Extema )'
'Renaissance Patent k5.553.419
empered TG Brass TG Black Buggad Drip Cap Yes p No ❑ Drywall/Plaster Patch. Yes o
Single Gluechip Double Gluechip Date P.O.# Sq. Ft. Color� pFFICE USE ONIY
Special Stucco Patch Yes No
� �--�- eens Ye No S FL Color O.R. Yes No
Stock 1 c'I 1- Sliding q' Combo Yes No
�..../ Metal Frame Alarm Yes N Step ��
Date P.O.q L. Grey es Charcoal Mesh Renaissance to Prewire? Yes No Melal Flash Yes � No.
Your tloo� or window unil will be manulaciwed and installed (oi delivered) according to ihe details, drawings, and inlormalion provided above. When alierinc� Ih�
size ol a dooi or window opening Ihere may be additional plumbing or elecirical lines hidden in ihe wall and not documonied on these plans. Thme may be an exir
charge lor Ihis work. On permitled jobs, any slructural calculalions or additional work required by local yovemments will be consiAe�etl an extra. �II eztras must b�
appwved by you belore ihe work wiil be done. When removing enisting doors and windows, Aenaissance employees will be exUemely careful, bul cannot b�
responsi�le for any flooriny, wallpaper, or counlertop damage. Customer will schedule ho K-up wilh their Alarm Company.
l �� J
Customer Approval 1 el' C�7��/�C A e�/ Da7e
(714) 754-5273 • Fax (�14) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2817 ELLESMERE AV
Suite:
Vicinity: FRONT OF RESIDENCE
ParcelNumber: 13933509 Zoning: R1 R1
a.pp�iwnt: ENRICHSON, FRANK
Address: 2921 CAROB ST.
Phone: (949) 721-1316
NEWPORT BEACH, CA Zip: 92660
owner: CHECK, STEVEN G 8 DONNA L
Address 2817 ELLESMERE AVE
COSTA MESA, CA
Conirecmr. THE WLB CORPORATION
Address: 2921 CAROB ST.
NEWPORT BEACH, CA
Zip: 92660
Arth :
Address:
Phone:
Zip: 92626
Phone: (949)721-1378
License: 524543
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 11/28/2000
Issued: 11/28/2000
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE WOOD SIDING & REPLACE WITH MASONITE SUPERSIDE SIDING (NER 224). ALSO, KITCHEN REMODEL IN AN
EXISTING SFR.
Plan Check: $0.00
Permit: $153.25
SMIP Res: $0.80
SMIP Com: $0.00
Other: $O.OD
Inspection: $0.00
Total: $154.05
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PEE SUMMARY
PLANNING & ZONING
Left 0- 0
LeR 0- 0
Proposetl: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0. 0
$8,000.00
sa,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void It work is not commenced within 1 BO days, or if work is suspentled or abandoned
for 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 Inapeclions and final epprovel must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
/.
zaaeee(6roo1 �
�
WORKERS'COMPENSAnON DECLARAnON: ��
I hareby aftirm untler penelry of perjury one of the followinq declarations:
❑ I hava ena will maintain e certificate ot consent to sell�lnsure for workers' compansation, as provided lor by section 3700 oi tha Labor Cotle, tor the peAormence oi the
work tor which this permit is issued.
❑ I heve entl will meintain workers' compensation InSurence, es requirea by section 3700 of ihe Labor Cotle, for the peAormance oi Iha work for which this pertnit Is Issuetl.
My workars' compensation Insurance carrier entl pollcy number are:
Cerrier: Policy Number.
�(lhis �fion need nof 6e comp/efed i1 the permif is velued e! one h�ndred dollars ($700) or /ess.)
ertify thet in the peAormance of t�e work for which this permit is issued, I shall not employ eny person in any menner so as to become sublact to t�e workers'
compensation lews ol C' mia tl r hat Ii I shoultl become subject to the workers' compensation provislons of Section 3700 0l the LeDor Co\tle, I shall fotlhwith
Comply wi�h �he w i ns ,�� �y P/
Appliwnt SlgneNre: Oate: �j � d"'� O v
WARNINO: FFILURE TO SECURE WORKERS' CQNPENSATION COVERAGE IS UNL4WPUl AND SHALL SUBIEC� rW EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED
T/IOUSAND DOIURE (5100,000), IN ADDITION TO THE C0.5T OF COMPENSATION, �AMAGES AS PiiOVIDED WR IN SECfION 3]OB OF THE LABOR CODE. IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eifirm �hat I am licensed under provisions ol Chepter 9(commencing wilh Section 7000) ol Dlvislon 3 of ihe Business and Professlons Code, entl my Ilcense is in full
force entl aHecL Lic. N Class N
ComrectorsSignaWre: � Date: .� �
CONSTRUCTION LENDING AGENCV:
❑ I hereby ettirtn thel Ihere is a construction lending agency for Ihe peAormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentlels Neme: Lender's Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATONS:
I hereby aHirm t�et untler penalry ot perjury thet I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Profassions
Cotle: Any city or county which requires e permit to constmct, elter, improve, tlemolish, or repalr any stmcture, prior lo its issuance, also requires ihe epplicent for such pertnit
to file e signed statemant thet he ar she Is Ilcensetl pursuent to the provislons of Ihe Contractore License Law (Chapter 9(commencing with Sectlon 7000) of Dlvlsian 3 of the
Business antl Professions Code) or thet he or she is exempl theretrom antl the basis tor the elleged ezemption. Any violetion of Sectlon 7031.5 by any epplicent for a pertnit
subjects the applicant to a civil penalry of not more t�an flve �undred Gollars ($500).):
❑ I, as owner of Ihe property, or my employees with weqes as iheir sole compensation, WILL DO TME WORK, and Iha structure is not Intentle0 or oflerad tor sale (Sec.
70a4, Business and Professions Code: The Contraciors License Law tloes not apply to an owner of properry who builds or improves ihereon, antl who tloes such work
himselt or herself or thwugh his or her own employees, Pmvitletl that such improvements ere not intentled or offered for sale. If, however, Ne building or improvement is
sold within one year of completion, iha ownar-builder will have the burden of pmving ihat ha or she did not builtl or improve for purpose of sale.).
❑ I, as owner of Ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Professions
Code: The contrectors License Lew tloes not apply to en owner at property who builds or Improves thareon, and who wniracts for such projeci wit� e Conlrector(s)
liCense pursuant to lhe Contractors License Wws.).
❑ I am eaempt untler sec.
Signature:
Owner ID verilletl �y tlrivar's license. ❑ Yes ❑ No
Busineu an0 Professions CoAe for Ihis reason:
Verificetion of Ownarship by (type of document, i.e. � property lex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Drivers License No.
Date:
Expires:
❑ I hereby certity that no ezcavation five (5) or more feet in depi� into which e person is requiretl to tlescend, will De mede in connection wiN work euthodzed by Ihis
permiL and t�at no building siructure, scattolding, felsawork, or demolition or tlisman�ling �hereol, will be more then ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Trtle B, Calitomia Adminisirative Code).
❑ As owner-builtler, I will not employ anyone to do work which wauld require a pertnit irom the Division ol Indusinal Safery, es notetl ebove, unless such person has e
permit to do such work trom ihe division.
Signature: Date:
Division of Industnal Safery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I certity under penalry of perjury t�at I hava reea this epplication and stete that the information given is
correct. I egree to comply with ell state lews and city ordinences relatinq to builtling construction, end authorize representatives ol Ihe Clry ot Casta Mese to enter upon Ihe
above-tlescribed property for inspectim purposes. I agree not to occupy or ellow occupancy of eny building authorized by this pertnit until final insDedion.
� �r al Owner(s) // ^ D?ta_a — /
L Q— V
And/ r Aut�orized AppliCent Dele
COOE 1, INSPECTIONTYPE � QSjF �
1616 Fixetl System Final Fira Pravention
1268
200
201
202
203
204
Pool Spe Final
Final Re-Roof
Finel BIocWRetaining Well
Final Factory Fire Place
Final Sign
Final Demolition
y00E� INSPELTIONTYPE
206 Finel Mechanical
20B Finel PlumDing
210 Final Eledncal
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupancy
PAIE ItIIID�L@
(714) 754-5273 • Fax (71a) 754-4856 • v+v+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
2817 ELLESMERE AV
KITCHEN
13933509
ENRICHSON, FRANK
2921 CAROB ST.
NEWPORT BEACH, CA
Phone: (949) 721-1318
Zip: 92660
CHECK, STEVEN G& DONNA L
2817 ELLESMERE AVE
COSTA MESA, CA
Contractor: THE WLB CORPORATION
Address: 2921 CAROB ST.
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 7000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors ro SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Si9n Circuits
Temp Pwr Pole
Intermed Pole
NEWPORT BEACH, CA
Phone:
Zip: 92626
Phone: (949) 721-1318
Zip: 92660
License: 524543
SCOPE OF PERMIT
KITCHEN REMODEL IN AN EXISTING SFR.
10 LIGHTING FIXTURES, 5 OUTLETS, 5 SWITCHES.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
511.00
$5.50
$5.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
Duantity
0
0
0
10
5
5
0
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
Transformers up to 1 kvalicw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System I Ckt
Misa Contluit
Misc. Contluctor
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Elec[rical Fee
Investigation Fee
Plan Check Fee
Reinspedion Fee
Status: ISSUED
Applied: 11/28I2000
Issued: 11/28/2000
ISSUED BY:
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 545.50
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the vrork authorized under ihis permit to be considered legal, such work mus� comply with all applicable codes, and all
requlred Inepecliona end Ilnel approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 /
i
2446361�) V
WORKERS'COMPENSAnON DECLARAnON: �
I hereby eHirm untlar penalry of perjury one at the following tlecleratlons:
❑ I have and will mainiain a cenificate ol consent to selFlnsure br workers' compensetion, as provided for by seaion 3700 of Iha Labor Code, for the pertormance ot the
work for which this permil is i55uetl.
❑ 1 have antl will maintain workers' compensatlon inwrence, as required by sectlon 3700 0l Ne Lebor Code, tor t�e paRortnance ol the work tor which this pertnit is issuetl.
My warkers' compensatlon Insurence cerner end policy number ere:
Carrier: Policy Number:
(ihis sec need not be comp/eted U(he permit is valuetl et one hund�ed dallers ($100) or /ess.J
I cenify that in the pertormance of the work for which thls pertnit is Issueq I shall not employ any person In eny manner so as to become subjea ro t�e workers'
compensatlon laws oi CeJ�crqia, �d thet If I shoultl bacame sub�ect to �he workers' compensetion provislons ot Section 3700 of the Lebor Code, I shall torthwith
wmplywit�these ev(fo d �j- /QQ�
ApplicantSignature: ���� Date�/� � a ``� `--�
WAPNING: FNLURE TO SECURE WORKERS' COMPENSATION COVERAQE IS UNUWFUL M'D SHALL SU&IECT M' EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUN�RED
T}i0U5AND DOLURE (5100,OW), IN ADDITION TO THE COST OF COMPENSAiION, DAAMGES 0.S PROVIOED FOR IN SECiION 3]O60F hIE UBOfl CO�E, IMEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am Ilcensed under p ovisions ot Chapter 9(commencing with Section 7000) ot Division 3 0l Ihe Business and Professions Code, and my license Is in full
brCB BOd BRBC�. LIC. N�_��%��/ CI855 M
Contrectors SlgnaWre: ;'`��— Date: �/— 2.
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirm ihat there is a construction lending agency for t�e pedormance ol Ihe work lor which ihis permit is issue0. (Sec. 3097, Civil Cotle).
Lender's Name: LendeYs Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn that under penalry of perjury ihat I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for the lallowing reason (Sec. 7037.5, Business entl Professlons
Code: Any ciry or county which raquires a permit to consimct, elter, improve, tlomolish, or repair any sWcture, prior to ics issuance, elso requires the applicant tor such pertnit
to file e signed statemeN that he or she Is Iicensetl pursuant to the provisions of the Contrectors License Law (Chapter 9(commencing with Sedlon 7000) of Division 3 01 t�e
Business entl Protessions Code) or Ihef he or she Is exempt therefrom end Ihe basls tor the allegetl e:emption. Any violation o� Saction 7031.5 by any epplicant for a permit
subjecis ihe ep011cent to e civil penalty of not more than tive hundred dollers ($500).):
❑ I, as owner ol ihe properry, or my employees with wages es Ihelr sole compensatlon, WILL DO TME WORK, and t�e strucWre Is not intendetl or otteretl for sale (Sec.
7044. Business and Professions Code: The Contractors License Lew does nol epply lo en owner ol propeny who builds or improves thereon, and who does such work
himsalt ar hersetl or Ihrough hls or her own employees, provided that such improvements ere not Imentletl or oNered lor sala. tl, however, the building or improvement is
sold within one year oi completion, the owner-builder will heve �he Ourden of proving Ihat he or she did not tuild or improve br purpose of sale.).
❑ I, as awner ot Ihe property, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Professions
Code: The comractors License Lew tloes not apply to en owner ol propeny w�o builtls or Improves thereon, entl who comracts for such pmjeci with a contractor(s)
license pursuant to ihe Coniracbrs License Laws.).
❑ I am eaempt untler sec.
Signeture:
Owner ID venfietl by tlriver's iicense. ❑ Yes ❑ No
Busineu end Professions Cotle for thi5 ree5on:
Verification oi Ownership by (type of documem, i.e. - propeny tax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Driver's License No.
Data:
Expires:
❑ I hereby cenily that no excavation five (5) or more leel in tlepth into which e person is required to aescentl, will be made In connection wilh work authorized by this
permit, end thet no builtling stmciure, scattolding, talsework, or demolition or tlismentling ihereot, will be more ihen thlrly-six (36) taet high. (Chap. 32, Grp 2, Art 2, Sec.
341, 77t1e B, Califomia Administrelive Cotle).
❑ As owner-builder, I will not employ anyone to do wurk which would require e permit from tha Division of Indusiriel Sefery, as noted above, unless such person has e
pertnit to do such work imm the division.
Signature: Date:
Division ot Industriel Safery Permi� Number:
CERTIFlCATE OF COMPIJANCE AND AUfHORIZA710N OF ENTRV: I cenity under penelty of perjury ihat I have read this epplication and state ihat the information given is
cortec�. I agree to comply with ell stete laws end ciry ortlinances relating to building construc�ion, and euthonza representatives of the Ciry oi Cas�a Mesa to enter upon the
above-descnbed proparry lor inspeclion purposes. I egree not to acupy or ellow occupancy ot any building authorizetl by this pertnit until final inspection.
' neNre Of Legel Owner(s) Data
�l 2 g-O'�J
AnNOr Authonzetl Applicant Date
CODE 1. INSPECTIONTVPE
1616 Fixed System Final Fire Prevention
12fi6 Pool Spe Final
200 Finel Re-Roo1
201 Finel BIocWRetelning Wall
202 Final Factory Fire Placo
203 Finel Sign
204 Finel Demolition
PAIE Ii�AlS
COOE� INSPECTIONttPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Finel Fira Prevention
220 Final Planning Approval
222 Final Si�e
250 Final Building/Occupancy
PAIE
. ?FJ /
I��
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2877 ELLESMERE AV
Suite No
Vicinity: KITCHEN
Parcel Number: 13933509
Applicant: ENRICHSON, FRANK
Address: 2921 CAROB ST.
NEWPORT BEACH, CA
MECHANICAL PERMIT
ISSUED BY:
Phone: (949)721-1318
Zip: 92660
owner: CHECK, STEVEN G& DONNA L
Address: 2817 ELLESMERE AVE
COSTA MESA, CA
Contractor: THE WLB CORPORATION
Address: 2921 CAROB ST.
NEWPORT BEACH, CA �
Arch / Eng :
Address:
Phone:
Zip: 92626
Phone: (949) 727-1318
Zip: 92660
License: 524543
Phone:
Zip:
License:
SCOPE OF PERMIT
KITCHEN REMODEL IN AN EXISTING SFR.
1 HOOD W/MECN EXHAUST.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >100 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refng Sys <700 k BTU
Refrig Sys >700 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 < 10000cfm
Air Handlers � t0000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$10.65
$0.00
$0.00
$0.00
$0.00
$0.00
$O.PO
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporetive Cooler
Commercial I ncine retor
Domestic Incinerator
Compressors / Absomtion Svstems
Upto3hpl100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 11128/2000
Issued: 11I282000
Quantity
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E34.15
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis parmit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or If work is suspended or abandoned
for a period of 1 BO days.
1NSPECTIONS: In order for Ihe work authorized under this permit to be considered lagal, such work musl comply with all applicable codes, and atl
required Inapectlons and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446d8 (fl�W)
WORKERS'COMPENSAnON DECLARAnON: �
I hereby effirtn under penalty ol perjury ona of ihe tollOwing declarations:
❑ I heve entl will maimain e cenifiwte oi consent to selbinsure tor workers' compensatlon, es provided tor by section 3700 of the Lebor Cotle, for the pertortnance at the
work for w�ic� this permlt is issued.
❑ I �ave antl wlll maintain workers' compensation Insurence, es required by sectlon 3700 of the Labor Cotle, tor t�e perfortnance of the wo�7c for which this pertnit is IssueO.
My workers' compensatlon Insurence certier entl poliry numUer are:
Carner. Policy Number.
(This 5u ion need nof be cromp/efed i! fhe permit is valuetl e( one huntlred dollers ($100) or less.)
P /
I certiy Ihat in the peAormance of the work tor which this pertnit is issuetl, I shall not employ any person in any manner so as to become subject to the workere'
compensation laws of C oml� e at If I should Cecome sublect to the workers' compensetion provisions ot Section 3700 of Ihe Labor Cotle, I ShaII lorihwith
compywiththes i ��^ �)
Applicant Signature: � Dete: �� Z l{ �Q C�
WARNING: PAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNUWFl1L PND SHALL SlIB1ECi AN EMPLOYER TO CRIMINPL PENALTIES AND GVIL FlNES UP i00NE HUNDRE�
THOUSAND WLLARE (5100,000), IN A�DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTION 3106 OF THE IABOF CODE, IMEREST, AND AiTOPNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm Ihat I em licensed under provisl9ns o hapter 9(commencing with Saction 7000) ot Divlsion 3 of ihe Business and Professions Code, antl my Ilcense is in full
force and eHect. Lic. a / / Cless x
GoNractor's Signature: , Dete: � —
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm Ihat there is e construction lending agency tor the peAormance of Ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
SignaWre: Data:
OWNER-BUILDER DECLARATIONS:
I hereby eflirm thet under penelry ol perjury that I em EXEMPT PROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Busineu entl Professlons
Cotle: Any ciry or counry which repuires a pertnit to construct, alter, improve, demolish, or repair eny structure. pnor Io its iuuance, also requires Ihe epplicant for suc� permit
ta tile a signad statement that he or she is Ilcensed pursuant to the pmvisions oi t�e Contrectors License Law (Chapter 9(commencing with Section 7000) of Divlsion 3 oi Ihe
BuSiness antl Pro18551on5 Code) or that he or she Is exempt I�erelrom Bnd lhe besis for Ihe elleged exemption. Any violation of Section 7031.5 by eny epplicant 1or e permlt
subjects the applicant to e civil penalry of not more then five hundreA tlollars ($500).):
❑ I, es owner of the properry, or my employees with wages as their sole compensation, WILL 00 7ME WORK, and Ihe structure is not intended or offeretl tor sele (Sec.
7044, Business end Pmlessions Code: The Contractors License Lew does not apply to an owner of property who builds or improves �hereon, end who does such work
hlmself or herself or ihrough his or her own employees, provitle0 �het such improvemenis are no� intended or affered for sale. If, however, ihe building or improvement is
soltl wit�in one yoar of completion, the owner-Duiltler wiil hevo the burden of proving that he or she did not build or improve tor purpose of sale.).
❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business antl Professions
Code: The contractors Licensa Lew tloes not epply to en owner ol propeny who Dulltls or Improves ihereon, antl who contracts /or such project with a contwctor(s)
license pursuant to ihe Coniractors License Lews.).
❑ I am e:empt untler sec. Busineu and Professions Coda tor this reason:
Signature: Date:
Owner ID venfied by tlrivefs Ilcense. ❑ Y85 ❑ No Drivers LiCense No.
Vediiwtion of Ownership by (type oi tlocument, i.e. - properry tax bill or tlaetl):
Expir85:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I heraby cenify Ihat no excavation five (5) or mora feet in depih into which e person Is required to descend, will be made In connec�ion with work euthodzad by Ihis
permit, antl ihat no building siruciura, scaMoltling, talsework, or demolitlon or tlismantling �hereot, will be more than ihirry-si: (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tlle 8, Celilomia AdminiSlraiive Code).
❑ As owneo-builder, I will no� employ enyone to da work whic� woultl require e permil from ihe Division of Industrial Salery, as notetl above, unleu such persan hes a
permii �o tlo such work irom Ihe division.
SignaWre: Date:
Division oi Intlusinal Sefery Parmit Number.
CER7IFICATE OF COMVLIANCE AN� AUTHORVJITION OF ENTAY: I cenity unAer penalry of perjury that I have read this application end slate that the Iniormatlon given Is
wrrect. I egree to comply with all siate laws end dry ordinences relating lo building consiruction, antl authorize representatives of tha Ciry ol Coste Mesa to emer upon t�e
above-described properry tor inspectim purposes. I egree noc to occupy or allow occupancy oi any building authorized by this pertnit until finel inspection.
ure Of Legal Owner(s) D
��- 2 �- d �
Antl/Or Authodzed Applicant Date
COOE I. INSPECTIONTYPE
1816 Fixetl System Final Fire Prevemion
1266 Pool Spa Finel
200 Finel Re-Roo�
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203
204
Final Sign
Final Demolition
�g ��
CO�E I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
270 Final Electrical
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • wv+v+.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
2817 ELLESMERE AV
KITCHEN
Parcel Nunmber: 13933509
Applicant: ENRICHSON, FRANK
Address: 2921 CAROB ST.
NEWPORTBEACH,CA
PLUMBING PERMIT
Phone: (949)721-1318
Zip: 92660
Owner: CHECK, STEVEN G& DONNA L
Address 2817 ELLESMERE AVE
COSTA MESA, CA
Contractor: THE WLB CORPORATION
Address: 2921 CAROB ST.
Arch / Eng :
Address:
NEWPORT BEACH, CA
Phone:
2ip: 92626
Phone: (9491721-1318
Zip: 92660
License: 524543
Phone:
Zip:
License:
SCOPE OF PERMIT
KITCHEN REMODEL IN AN EXISTING SFR.
1 DISHWASHER, 1 KITCHEN SINK.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (14 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
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Q7v
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulalor $0.00
Process Piping (per 10 ft) $0.00
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, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
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
1
0
0
0
Status: ISSUED
Applied: 11/28/2000
Issued: 71/28/2000
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum BrkrBkflow(1�)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Soflener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 543.10
QTY
0
0
0
D
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis 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 undar ihis permit to be considered iegal, such work must comply with all applicable codes, and elt
requlred Inspectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae�aelvoo�
WORKERS'COMPENSAnON DECLARATION: � �
I hereby attirm untler penelry of perjury one ot the following tleclaretlons:
❑ I have antl will malntein a certiticate ol consent to self-Insure lor workers' compensation, as provitled for by section 3700 of the Lebor Cotle, for the peAormance of ihe
work for which Ihis permit is Issuetl.
❑ I have end will maintain workers' compensation insuranca, as required by section 3700 of the Labor Cotle, for tha pedortnenca of the work for whic� this permit Is issued.
My workere' compensatlon Insurance carrier end policy number ere:
Cerrier: Policy Number:
(Triis se ' need wt be campleted il the pertnit is velued et one hundred dollers ($100) or Iess.J
I certify that In the peAormance of ihe work for w�ich thi5 permit is issued, I shell not employ any person in eny manner so es to become subject to ihe workere'
compensetlon laws of Califamla, n ee th t If I shoultl become subject to the workers' compensetlon provislons af Section 3700 of the Lebor Code, I shell lorthwith
complywit�these �� ����
Applicant Signature: �g���� Oate:
WARNING: FAI�URE TO SECURE WORKERS' COMPENSAiION COVEMGE IS UMAWFUL ANO SMALL SUBJECT AN EMPLOYEF TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED
TlIOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAGES 0.S PROVIOED FOR IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm Ihat I em Ilcensetl under Orovisions of Chapter 9(commencing with Section 7000) of �Ivision 3 ot the Business and Protessions Code, antl my license is in lull
force end eHecL Lic. q Class q
ContrectoYs SigneWre: � � Date: �� Z. � �
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirm thet t�ere is e consimction landing egency for the pertormance of ihe work tor which Ihis permit is issued. (Sec. 3097, Civil Code).
Lentler's Nama: Lendefs Address:
Signatura: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn thet untler penalry ot perjury thel I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Protesslons
Code: Any city or counry which requires a permit �o constmct, alter, improve, demolish, or repeir any strucWre, prlor to its Issuance, also requires Ihe epplicant tor such pertnit
to file a signed statement that he or she is Ilcensetl pursuem to Ihe provisions oi the Contraaors License Lew (Ghepter 9(commencing with Section 7000) of DlWsion 3 of [he
Busineu end Professions Code) or that he or sha is e:empt iherelrom end the basis tor the elleged azemption. Any violetion of Saction 7031.5 by any epplicent for a pertnit
sub�ects Ihe epplicant to e civil penalry of not more than five hundred dollers ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL UO THE WORK, antl the structure Is not intenaetl or oilerad for sala (Sec.
7044, Business end Pmfessions Code: The Contrectors License Lew does not apply to en owner ot O�openy who builAs or improves thereon, antl who tloes such work
himsell or �ersell or ihrough his or her own employees, proviAetl ihat such improvements are not intended or oHered for sale. It, however, the builtling or Improvement is
sold wit�in one year of completioq Ihe owner-builder will heve Ihe burden of proving ihat he or s�e tlitl not build or improve for purpose ol sale.).
❑ I, as owner of the pmperty, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to Consimct the project (Sec. 7044, Business entl Profe951on9
Code: TOa contrectors License Law tloes not apply to en owner ol property who builds or Improves t�ereon, end who comracts tor such project with e contractor(s)
license pursuam to ihe Contracrors License Lews.).
❑ I am eaemp� under sec.
SiqneWre:
Owner ID venlietl by tlrivers license. ❑ Ves ❑ No
Business entl Profassions Code for this reason:
Vedficalion ol Ownership by (type o� document, i.e. - propeny tax blll Or deed):
DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION:
Drivers License No.
Date:
Expires:
❑ I hereby cenity ihat no axcavation five (5) or more fee� In depih into which e person is required �o descend, will De matle In connaction with work autharized by this
permit, an0 that no building sirucNre, scattolding, falsework, or tlemolition or dismamling thereot, will be more than thirty-siz (36) feet high. (Chap. 3.2, Gry 2, Atl 2, Sec.
341, Title 8, Calilomla Aaministrative Code).
❑ As owner�builder, I will not employ enyone to do work which woula require a permit irom ihe Division oi Intlustnel Sefery, es noted above, unless such persan hes e
pertnit to da such work irom the division.
SigneNre: Date:
Division of Intlustrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AI7TMORIZATION OF ENTRY: I cenify under penelty of perjury that I have read ihis epplication and slate that tha iniortnatian given is
correct. I egree Io compy with ell slate laws end ciry ortlinances relating ro building construction, end euthonze representatives ot ihe Ciry of Costa Mesa to enter upon Ihe
above-describetl D�operty tor inspection puryases. I egree not to occupy or ellow acupancy ot any builtling authonzed by Ihis pertnit un�il tinal inspection.
i OtLegalOwner(s) / /I �nat��
� 7
And/Or Authorized Applicant Oate
COpE 1, INSPECTIONTYPE Q�IE II�LS
1618 FizeO System Final Fire Prevention
7266 Pool Spa Finel
200 Finel Re-Rool
201 Flnal BIxWRetaining Wall
202
203
Final Factory Fire Place
Finel Sign
204 FinelOemolition
CODE� INSPELTIONTYVE
206 Finel MeCheniCal
208 Final Plumbing
210 Finel Electrical
212 Flnel Fire Prevention
220 Final Planning ApOroval
222 Final Site
250 Final Building/Occupancy
�g �
�
. ' Ceke�e. � �-�€�`€�'����
-�- �_�9�� �, � ,�u� 3i,ss� //�-
COS7A MESA BUILDING•SAFETY DEPARTMENT �� FINANCE DEPT.
P. o. sox sn COBTA MEBA. CALIFORNIA CITY OF COSTA MESA
For Applicanf fo Fill In Complefely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING / BUILDING
ADDRE98 ' F .F.��ME E A✓
COSTA MESA. GALIFORNIA FOI' Office Use Only
_. _ . nace�rr Ho. , P%kM1*/�o.
M].II02'C8
Mesa Verde Builders Inc.
cin, C09t8 M288
BTATE � TEL.
LIC. NO. NO.
OFLOT %SOO SQ.Ft,
US8 OP
EXI6TING BLD
86i6ACK L1N6 FwOY � 7
No. oP BLDOB. O
NOW ON LOT
DESCRIPTION OF WORK
IX II ALTERATIQN I II ADDITION I
I II MOVING I II DEMOLI6H I
�.%SO SC1.Ft.ROOMS 7 STORIES 1
WALL Stil1CCO I ROOF _�
1 HBflHSY ACKNO
AND 9T�T8 TH�T
VLY WITM ALL C�
BUILDIMa CONB
61GNATURE OF
ALITHORIZED
I 1 HAVB pBAD
IB CORRECT Af
er I oATB
BUILDING �l�/�
ADDRH88 /()
COSTA MESA. CALIFORNIA
ZONING
ZONB NO. OF t198 OP N8W �'f
�—� I YLANB Z BUIL�INO.O'� w�q
�.,.
¢ecxirriox �i�" l TiP Ya o A
A. P. NO. ��\
YARD9 EVES
APPROVED ALLOWED
ICBNTCR LlN6 8TJ
FRONT � 3 FT. ��
R. SIDE j � Ff. ^—_
L. SIDE � 3 FT. �--
o�.e %�� �r
�n`. " �'- ' p� -
�d garage y50 Sq.Ft.
lJGT10N TH6 AMOUM BHOWN UNDeN VALUATION IB POP TNe
TO COM� pUN]088 OP HBT�BLIBNING A PBNMIT pE8 ONLY.
NLA INa
( VALUATION
p PERMIT FEE S � e
S� PLAN CHECN $��� S O '
K
3 a�3, va TOTAL FEE � � LL
/
� .�
'� �%'Jr/�
��OSTA MESA BUILDING-SAFETY DEPARTMENT F E R E C E i U E D
r. o. sox sn C08TA M�A. C�.�FORNIA JUL 1 7 1�Y
For Applieanf fo Fill In Complefely APPLICATIO F��Vt�!'ekirOEPT.
TYPE OR PRINT 8�����yGOF COSTA MESA
BUILOING q� � 7 ELLC� LT N C.
ADDRESS ti
COSTA MESA CALIFORNIA For Offite Use Only
RECEIPT NO. PERMIT HO.
, /7 S7 G>
RECE�V OY qE EIVED OATE �BSUEO
�.� q � /q4�7-6� r/ /��—/J6,
BUIL�ING �y / ����yLkiviii �1/ // l/
ADDRESS O
COSTA MESA. CALIFORNIA
TEL.
FIRE
ADDRESS � � �% (tZGV'rT14P�� �IV� ZONIIdG �
CITY C.bST� M e'S!}. � _ I�o. op I use OF NeW
PUNS � 9OILDING
sTATE THL. LEWL 'I- r 4
LIC. NO. NO. DeSCnIPTION I
SIZE wr �. i /i �f �� I NO. OF BLD68. . �
V
6ETBACR LINE FROM �� �
CENTER OF BTReET �� REAR YARD �
I /
SIDE YARD I LHFT � RIGHT IO '
DESCRIPTION OF WORK
3
ROOF
1 HERBBY ACKNOWL6DOE THAT 1 HAVQ ReFD TH�B FPPLICATION
ANO 9TAT8 THAT TNE ABOVE I8 COpREGT M1D A6RE8 TO COM-
PLY WITH ALL�HDINANCEB ANP 6TATE LAW9 REUIILATINO
BUILDING CO.�_TRU ION.
SIGNATURE OF / Q,�� ��� p��� �J
PERMITTE
AUTHORIZED AGENT
A.P.NO. I .1�'� ,5�.� �
YAROS EVES
APPROVED ALLOWF
(CENTER LINC 9TJ ��
r 1 l� -(�'�
�G�
THE AMOUM 9HOWN UNDER VALUATION 18 POR TNe
PUPPOBE OF EBTABLI9HING A PEpMIT FEE ONLY.
VALUATION
` PERMIT FEE $ �/ "�'�
7 � /� )
$ .J / � � � �` PLAN CHECK $ /G' . �] p
/ TOTAL FEE $ . �1'f `-J �
AVC��cant to fill in all soaees except those within neavY eoraer lines antl sign all aporopriate aeclarations.
CITY�JF COSTA Mj�ESA�J CO $JTR UCTION PE(p�yy��/•�� IT G•I%T PERMIT NO. TFjA�T NO.n LOT NO. UNIT N6.
Projecilwldress .d_P�/ �/'�S%�%�l�F ii�� • �
Applicant's Mailin� 'A�ddreyss�� . E 5
Owner's NamAe ��..sTsf Phon i
Address pzA�7� %
Arch/Eng. Licenu No.
Address
Contractor's Name Phone
Addreu Imailing)
City License No.
IICENSED CONTRACTOR DECLARATION
I hereby alfirm ihat 1 am licensed untle� 0/ovi5ions o� Charter 9(commencing
with secHon �000) ot DlviSion 3 of the Busin¢zs antl Professlons Cotle, antl
my license is in full torca antl et(ect.
License Clazs License No.
Date Slgnature
WORNERS' COMPENSATION DECLARATION
I hereby aflirm thal I have a certificate ot consent to self-insure or a certificate
�f Workers' Compensallon InSurant¢, or a Certifie0 copy thereof (Section
800, Lab. C.)
Polity No. Company
8 Certifietl Copy i5 h¢r¢by fUmisnetl. -
Certitietl copy i5 tiletl with [he cl[y Builtlin9 Divlslon.
Date Applicant
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissec[ion neetl not be completetl if the permit is for ane hundretl ($300) or
less).
1 certi/y that in the pertormar�te oi the work for wnlch tnis permk is issuetl, I
Sha11 nol employ any person m any mann f� so 5 to becom ubjec[ to Ihe
Work¢r.�j Co�Dp� s ion Laws of Califo��/ /
Date��J�Z5�9�ature p�-.�G(e�' ���A
NOTICE: If, after making this tleclaration, y6u Shoultl beGome subject to the
Workers' Compensa[ion provisions of the Labor Cotle, you must forthwith
comply with such provisions or this permlt sha11 be tleemetl revoketl.
CONSTRUCTION LEN�ING AGENCV
I hereby affirm that th¢re is a construction Ientlin9 a9ency for the performance
af the work tOr whlch tM115 permit i5 i55uetl ($ectlon 309] Civ. C.)
L.entler'S Name
Lentler's Aetlress
OWNER BUILDER �ECLARATION
I hereby aitirm that'I'am exompt trom the Gontractor's License Law for the
following reason (SectlOn 7031.5 Bu5ine55 antl Profe55ional Cotle: Any city or
Counly whlcb �equiie5 a pe�mit to cOnSt�uCt, alter, ImDrove, tlemolish or repair
any slructure, prior to Il5 i55uance, also requires the applicant for such permit
to tile a si9netl statemen[ that he/sh¢ is Iicensetl pursuant to [he provisions of
the Contractor's Li<ense Law (Chapter 9(cOmmencing with Sectlon 7000) Of
Division 3 of the Business antl �Professionz Cotle) or that he/zhe is ezempt
'9e�etrom antl th¢ basis for lhe allegetl exemp[ion. Any violation of Sec[ion
)31.5 by any ap0�icant fo� a permit subjects the applicant f0 a civil
enalty ot not more than five huntlretl tlollars (5500).
L� I, as owner ot the property or my employees witn wagez as their sole
Compensalion, will tl0 tne wOrk, antl Ihe st�uc[ure i5 not inten�etl or offetetl
to� sale (Se<[ion 7044, Buslness dntl Pwte55ional Cotle: The Cont�actor'S
Litenu Law tloes noi apply to an owner of a property who builCs or improves
tnereon, antl who aoes such work himselt/hersel( or through his or her own
employ¢es, provitletl that such imprOvemen[5 are no[ intentletl o� otteretl for
sale. If, �oweveq Iha Duiltling or improvement is soltl within one year of com-
pletiOn, the owner wlll have the burtlen of proving hC/she tlitl not builtl ot im-
prOve for [he purpose of Sal¢�.
❑ I, as owner of the O�operty, am ex<luzively con[racting with licensetl con-
I Hactorsto consVuct the project ($ection 7044, Bu51ne55antl Professions Cotle:
The Con[rattor's License I�w does not appty to an owner of property who
builtls or improves thereon, antl who contrac[s for such projecis with a con-
t�actor(sl ucense pu�suant to Ihe Conlractor'S LiCense Law). 1 am aware that
proof of their Worker's Compen5ation insurance shoultl be provitletl to me:
❑ I am exempt under Seotion B. & P. C. lor thi5 rea5on
_ Owner � �G
I have reatl Ihis appl
I a9ree to comply wi
to bulltling consVuci
� to enter upory Ihe
inspettion pu�pose
Signature -
orivers' License or
- Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewef Cap,
Sewer Connection
Solar Collectors �
Solar Piping
Solar Tank -
Swimming Pool w/Spa
Urinal
Wa[er Closet
Water Heater
Water $ervice
Auro-Wash
Isue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeraeion System
❑a-ioo,000eru ❑iao,000eTu
System Repair/Alteration
Fire Dampers
Registers
Isue Fae
FEES
I�
���i'i����
—f1DI `�
������.y
��I��������� �
Automatic Washer
� CanstructionPoleSub.
Caoking Unit �
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor �0.5 KW �
$ 3
$ 3
\�
✓
n� �
Zone
,ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Me[er ❑over 100.amps
5 KW
' Reinspection Fee I$15 I I
DEVELOPMENT SEHVICES REQUIREME
2oning Approved By
Building Approved By
Sub Panel
Morors�0-1 HP�1N,-8
Inc.Solar 09-15 HP �16�75+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
Issue Fee
FEES
$ 3
F�
Z
O
N
1
N
G
R
E
�
M
T
S
SUMMA V OF FEES
BUILDINGPERMIT $ ----� SMIP $ "�
PLAN CHECK $ PERMIT
PLUMBING , $ . ISSUANCE $
PLAN CHECK 25% $ ' ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ ' MICROFILM $ �'j�, �i�
MECHANICAL $ •TOTALFEE $ _I J:7,
PLAN CHECK Z5% $ ' � �
CONSTRUCTION AND PLANNING : POOL & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
7. Footings 58. Electrical ConduirUndrgrnd. �
8. Foundation • 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .. '
i t. Property Sewer Line & House Connection 62. Backwash & Receptor�Final �
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System - Final ` 1
14. Rough Plumbing 65. Electrical-Final
15. Rough Elecvical�Conduit , 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # ._
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StoregeTank �Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical -
27. Frame and Flashing �q/ 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing "�S �j- HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED --
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy ' ` •
37. Final Factory Fireplace . � , .
38. Final Plumbing ' l�
39. Water Service-Final �
40. Gas Service-Final ' �'
41. Solar pomestic-Final
42. Backflow Preventer , ,
43. Backflow Irrigation , .,. •
�
- 44. Landscape Irriqation System � � ,v
45. Sound Attenuation �� '
46. Handicap Regulations ,,:�. � � . �
47. FINALSTRUCTURE&BUILDING � .
48. Special Requirements Completed .
49. Electric-Release to Edison � '
50. Gas Release to Southem California Gas Co tt� - � ,
' 51. CERTIFICATE OF OCCUPANCY
NO.��' Date �
�
r
a
,D,fiN
3
0
�'� l TCKE N
�t+.v�sia� ,Q�ra
W� YIUU��
City of Cos4a esa Buildinc
s __.� ���� •� �7 \
—,.
T'Sf: PLA�VS 1.1UST EE C�N JOB AT All TIM,ES Mr.� �.:
NO F:A.� iGrS \NI?t'.';Ui PF.iCR APPP,C+'r�,l OF DEF. '
g 2�°I6 �
TNE IS$ `I'JC: C"; :i;l.di�iT.!.`�iti O% t1 ?ckr.117 On PPPROVAL t J.
FlA�=AN..°7FCi.`iC�.iIONS;;in:i.idOteECONS:FUED708F 1 �
PcR7�"fT POG. A!d hPPRL'VAL UP, FJ9'; V1qlAfIpIJ OF AthV ;.� /
THE P.:-•:A•IS!:..'15 ::i�D2. : r; i'cti:;.!7 PrE_`llfn!NG TO G� -
AUi4C°ITY TO tilU.:i�a ., S`il. ��HP r,ZpY;$IONS OF ii '
CGCE SHAIt i>; -•,.tilD. E)'.CP„ ',!,>„ � .
Y/HiCH IT :.i�fnGi•iZ � :$ t^:h��UL.
THE ISSUANCE Of A PEA7J,Ii BASED UPON PL4N5 ANf
�`- � d.,� S /`/�lZ.�.
S7ECIFICATI^NS SHA!L NO7 PREVENT TH: BWLDING OFfIQFI
FPOM THEfiEAFTEn SECUIRINv YHE CORRECTION OF ERRORS IN
SAID PtANS AND SfECIFlCAilONS OR FROM PREVEkTINr= �
BUItDWG OPFRATIONS BEING CARRIED ON THEREUNDER WHEt
IN v�p�.nTICN OF THIS CODE OP .^.F rn�. ^.� �ce non�.��.�rc `^'
THr CItY.
l, VG /t rr► .
�4- v,�., •
�,
��/ 7 .0 L LE s�9t�-�.� /r}1/,� _
�� S�'� o?v �.� A 9��oZ 6
,
' Applicant to fill in all soaces exeept tnose within heavy boraer lines ana sign all appropriate eeclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT 9 PERMIT.NO. TRACT NO. LOT NO. UNIT NO.
2<.2G Q � n � -� : ! / Irv.. !.� � �
Projult Address �g� 7�-� f-�S/VIC�G I�%YG �OS'/!� �»CSA
Applicant's Mailing Address ^ZB� 7�LL.ESmC%� g'VG �p,$'7A�C�'.�/
Owner's Name EU6i-.v� .C/fSKO PhoneS.J %-'SL�S7
Address �Ri� ' M �rE Av,e Casr�iYi' 7 y L
Arch/Eng. Licenu No.
Address
Contractor's Name � �B , Phone
Address (mailing)
City License No.
LICENSEO CONTRACTOR DECLHRATION
I nereby affirm Ihat I am IicenSetl untl¢r provisionz o( Charter 9(comm¢ncinq
with zection 7000) 01 Dlvlsion 3 0( [he BuSiness antl Protesslons Cotle, antl
my license is in full torce antl eHect.
License Class License No.
Date Si9�ature
WOf3KER5' COMPENSATION DECLARATION
1 hereby aitirm Ihat I have a ttrtitiCdta o! consent lo SelGinsure or a certi(icale
' Workers' Compensation Insurance, o� a certifletl copy Ihereot ($ection
I00, lab. C.)
Policy No. Company
eCertiliea mpy is hereby tumizheC.
Cer[ifietl cop is letl with the city�ing. vis��
Date q���—�7 Applicant ��� �
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl mt b¢ compleletl it the permit IS for one huntl�etl ($300) o�
tess).
I certify that in ihe performance of the work for which this permR is issuetl, I
shall not employ any person in any mann¢r so as lo beC me Subject to the
Workef s' Comp nsat'on Laws of Calif rn'
Dat✓ �%—/�—�� S�9nalur��-��' Q �?
NOTICE: If, alter making this tleclaration, You snoultl'�ecome subject to the
Wo�kers' Gompen5ali00 provisions of the Labo� Cotle, you musl forthwith
comply witn such provisions or thi5 permlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I lte�eby attitm that [M1e�e is a con5l�uction Ientlin9 agency for the perfOrmance
of the work for which tnis permi[ is Issuetl (Sactlon 3097 Civ. C.)
Lentler's Name �
Lenaer's Atltlress
OWNER BUILOEH DECLARATION
I hereby affirm that I am exemp[ from the Contractor's License Law Por the
tollowing reason (Seation 7031.5 Business antl Professlonal Cotle: Any tlty or
county whiU requiros a pe�mit to con5[ruc[, al[e�, improve, tlem011sh o� �epair
any Structure, prionlo•Its issuance, also requires the applicant for such permi[
t0 file a siqnetl stalemen[ [hat he/sM1e Is IicenSCtl pu�suant to the prOvisions ot
tbe Contracror'S License Law (Cnapter 9(commencing with Sectlon 7000) ot
Division 3 of ihe Bu5ine55 antl Profe55iOns Cotle) or Ihat he/she is exempt
`e�efrom antl the basis for the alle9etl ezemption. Any violation of Sec[iOn
�31.5 by any applicant for a permll Subjects Ibe applicant t0 a civll
malty of nol more than live nuntlretl tlollars (E500).
❑ I, as owne� of the properry or my employeas with wages as thei� Sole
Compensation, will tlo the work, antl [he sVuctu/e i5 not intentletl o� offeretl
/or sale (Sectlon 7044, Business antl Professional Cotle: The Contractor's
License Law tloez not apply to an owner ot a proper[y who builtls or improves
thereon, antl who tloes such work M1imself/herself or tM1rough hls or her own
employees, provi0etl lhat suth improvemenls are not intendetl O/ offeretl for
sale. If, howeveq tM10 builaing or improvoment Is soltl witM1ln one Year of com-
pletion, the owner wlll have the burtlen of proving he/she tlitl nol builtl o� im-
prove for the purpose of Sale).
❑ I, as owner oi lhe property, am exclu5iv¢ly contraGtlng wi[h Iic¢nsetl con-
tractors [o mnstruct the project (Section 7044, Business antl Protessions Cotle:
Tne Contractor's License Law aoes nol apply to an owner of properly who
builtls or improves thereon, antl who contracts for such projecls wltn a con-
Iractor(sl iicense pursuant to tne Contractor's License �aw). I am aware that
proot of ttleir Wo�ket's Compensation in5uranc¢ ShOultl b0 provitletl to me.
❑' I am exempt untler Section B. & P. C. tor this reason
Date � '�/ �"—X7 Owner
I hereby certity that I have reatl t Is appllcatlon antl StatC thal Ihe above.
information Is correcL 1 agree to comply wRh all Gty and countY ortlinances
antl state laws relatlng ro builtlinq constructlon, antl hereby authorize re0re-
seniatives o( lhis city to enter u n the above-mentionetl Oroperty for
inipeCliOn purpose5. p o
Signature �•�� . w_f 11i0 Data %� —��i�A.%
-' Orivers' License or
TYPE OF CONSTRUCTION LI NEW I.J ADD L�ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �6
DESCRIPTIONOFWORK/USEOFBLDG. �
S Main Building:
E
TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T Ffont
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAI B Rear
❑ OTHER %�
PROJECT DESCRIPTION 5q. Fr, oCCVPA Cv C Right
CONSTRVCTION TVPE VALUATION S��0, i!L! S L¢(t
ZONE GRADING CU.YDS. ACRES Pln¢ R¢f. �
Remarks: Planning Notes: �,
Backflow Preventer
Backflow Irrigation �
Bathtuhs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
GasService OuNets
Intercepmrs
Kitchen Sink
Lavatories -
P-Trap
Foof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground �
�uct - Strucmral �
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Pact. Blt. ICBO #
Heating System & Ducting
❑ ai ao,000 sru O i oo,000
Rainspection Fea � $15
CMF 0865-46, rev. 30/04 - Accountfng: Goltlenrotl - Assessor
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service .
Auto-Wash
Laundry Trays
Issue Fee
Hood or TYPeI ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,0006TU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
FEES
5 3
Auromatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Oryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00�5 KW �
Fea
5i96 9/14/87
Zone
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50 + KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors�0-1 HP�1f-8
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compactor
$15 Issue Fee
DEVELOPMENTSERVICESREQ/l�y(p ENTS:
Zoning Approved By `�-A%� �ate
Building AVP�oved By Q�/ Date
SUMMARV OF FEES
BUILDING PERMIT $ %�II.OD SMIP
PIAN CHECK $ y � PERMIT
PLUMBING $ �SSUANCE
PLAN CHECK 25% $ ENERGY P.C.
EI.ECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
17.OU TL
2
O
N
I
N
G
R
E
Q
M
T
$
FEES
$ 3
$
$
5
5
� j�.o0
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe-Undrgmd. 53. Steel Reinforcement
3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 1 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. \ 57. APPROVAL TO COVER-GUNITE
7. Footings �� , 58. Electrical Conduit-Undrgrnd.
S. Foundation ' • 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd.
70. Structurel Floor System 67. APPROVAL TO DECK '
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
74. Rough Plumbing 65. ElectriCal-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Contlitioning FIRE DEPT. REQUIREMENT
, 20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Veniilating 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heatin9 & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
•42. Backflow Preventer '
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation . � �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �y t �,�%• �
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY .. -'
No. Datp �,
r
:' �
�
�A-2.9-n_
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I
LHVN.D�z;• �zm.
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� ' � , ' ` , � � '
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�
���TE
ADDITIONS, O�L'cTIOi•i�, G'� CORRECTIONS SHALL
6�i�S>/ni6 DaaZ�Soiip,
APPROVED
PLANNING DEPT.
wuecr ro xnc. oerr. �eo
��DA g`��f"- ''�
0�.70� Of lIA1911110
�ivv i�" soLiD Do 3 ,r
— I�70VE EX/STi'N6 ��02 T o L,�rT o�= u+�ti�s�.5 �. 02� %�8 JNK-
. r� !� X 4- /f �AD� iZ /� aC/ 2 SEZF� e�oJir✓ L
Z� �� n 6 u7 Fi �r�W t
— 2,�. PL�gcc ,�xisr.0 4 5�x 8' Bo.r.•r
; . , , �.Y 6 � ,2 Bc,��, a �� APPROUED �
. City of Costa Mesa Building DepS. Y
BY .—_�/ili DATE Q� 1 s�' %
r='(_
� 7HESE PLqNS MUSi BE ON J06 A7 ALl TIh;ES FAa �E ��
NO CHqNGES WITHOUT PRIOR F,?pnOVqL OF UEP7. '
I
� THE�ISSUANCE OR GRqNi; '
- L I V/N� /2.y1 � PLANS AND SPEqF!CAT�OFiS SH/d� �PE,yFf,dI; Oi�t qRp�pppy,�� OF f�.,�
I � THEP OV��SION� pdF/dP,ko�/�E.N heR,�4Tf��BNb�dF1GIu�9GL 1"
,�/TC�yEN I� I AUTHORITY TO VIOLATE OR CANCeI iH: pgqV1570N5 OF iH��, � �ry�
� O I COCE SHq(( BF VAiID, EXCEP7IN 50 FaR AS iHE WpRK OR USE � �� � �
i niS >nG c
��i�� BEAR. � ' � WHICH 1T AUTMOFIZES IS LqWp�� r1�/ q
� i,tJ/J L !� �.
� L LL=..._S /�� c�.� � � Vc _
� iHE �IJ f!�E �
i IF T� 5 �q�R 9ASED UGON ?!qp�c .
� fRpJ�1�iY�S� tAWS �{ NOT�R���.i Tnf ._ .,ND ,. '
J S(� Il� N� �'Jb° 3f5+ �Qu `�tra CZ � nu,.c�Nc os��ci •. . VG� GP -
E �CIf! Qk•CiiON OF EP.2pa� `
� ~ RUIiDIN h N CAlIONS C7 F A� r V y{�✓
� � G UPERq?ICNS BE1N � CSG@IED C?1 iR�M1� � ��vENT'.: � � V � .
IN VIOL?ilpN OF THIS CODE OR MER[UN_fR wr.:,,,
iHEUi'Y. OFqlr'iJinEkp�D�Nq.y:F!•' � p
� � ' - �� .%
- :--�-3_�_ y
-� � : �, Go
8G-D �em .
*
(�j -�6/ /il1S>N'LL SLi[7i.vb 1'�OD/Z
Applicant lo fill in all spaces except those within heavY CorGer lines antl sign all appropriale tleclarations.
CITYo�COS7A MESa ,CONSTRUCTION PERMIT y262�
.�,ro}�ct Address.zBl7 ELLE SmtRE f�, V'�. Ce<i.o m��
Applicant's Mailing Address Z13� ���L�`-SMERE AVE. �-0 vrn in.=SA
Owner'sName �Ul'ic .� L�.LRSKD PhoneSS7-�{ST7
Address ��� � �m aE /i✓r� /'or�i/ni=fA 9�G�L
Arch/Eng. License No.
Address
Contractor's Name- �g• Phone
Address (mailing)
Ciry License No.
LICENSED CONTRACTOR DECLNftAT10N �
I hereby attirm that I am licensetl untler provisions of Charter 9(commencing
with section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in full force antl effect.
License Class License No.
Oate Si9nature
WORKERS'COMPENSATION DECLARATION
1 hereby attirm that I have a certificate of consent to self-insure or a certificate
if Workers' Compensation Insurance, or a certitietl copy tbereot (Section
800, Lab. CJ
Policy No. company �
C¢rliti2tl mpy is hereby fumishetl.
Cerlifi tl copy is fileG with the cit '' visie
ate `�. APplicant � �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if the permit is to� one hundretl ($300) or
less).
I certify that in Ihe perfovmance ot the work fo� which thls pe�m�t i5 issuetl, I
shall not employ any pe�son in any manne� so as to come subject to the
Workers' omP ensati n Laws of Califor
Date �/_/p=_�°�Signature �,��j�' Inw��"�
NOTICE: If, aiter making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions ot tM1e Labor Cotle, you must forthwith
compty with suth provisions or this permlt SM1all be tl¢emetl revoketl.
CONSTRVCTION LENDING A6ENCV
I hereby affirm that the�e is a construction lentling a9ency for the pe�Po�mance
of the work tor which this permit is issuetl (Sectlon 309] Civ. CJ
Lentler's Name
�entler's Atltlress
OWNER BUILDEH �ECLARATION
I hereby affirm lhat I am exempt from the Contractor'S License Law for tM1e
followin9 reason (Section ]031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
, any structur¢, p�io� [o its issuance, also �equires [he applicant to� such pe�mit
i to file a zignetl sta[ement that he/she is Iiten5e0 pur5uan[ [o the provisions ot
Itne Contractor's License Law (Chapter 9(commencing with Sectlon 7000) of
Division 3 of Ihe Bu5ine55 antl Prote55ions Cotle) o� that he/she is eKempt
'herefrom antl the ba5i5 fo� the allegetl exemp[ion. Any viOlation of Section
]31.5 by any applicant tor a pe�mit 5ubject5 the applicant [o a civil
endlty of not more than five huntl�etl tlollan ($500).
l� I, a5 owne� of the property or my employees with wa9es as their sole
compensation, will tlo Ihe work, antl the structure is not intentletl or offeretl
tor sale (Section �044, Business and Prote55ional Cotle: The Contractor's
License law tloes not apply to an owner of a property wno builtls or improves
thereon, antl who tloes such work himself/he�self o� through his or he� own
employees, provitletl that such improvement5 are not intentletl or offeretl fo�
Sale. It, M1owever, LM1e bulltling or improveinent is soltl witM1in one year of com-
pletion, the owner will have the burden of proving he/she tlitl not builtl or im-
Qr9 va for the purpose of sale).
i� I, as owner of the pro0erty, am exclusively contractinq with licensed con-
tractors to conitruct tne prolect (Section �044, Business antl Professions Cotle:
Tne Contractor's License Law tloes mt apply to an owner of property who
builtls o�'improves therean, antl who cont�act5 tor such OrojeGts with a con-
tractor(51 ucen5e pursuant to the Contractor'sLicense Law). I am aware that
orooi o( [heit Worker's Compensation insu�an<e Shoultl be provitletl lo me.
❑ I am exempt untler Section B. & P. C. lor Ihis reason
Date S'�T�G� � Owner �
I hereby certi(y'that I have teatl this
information is correct. 1 agree to wmp
Signature _�
Drivers' License or 5:
CMF 0865-46, rev. 10/84
�
tate tM1at [he above
tl county ortlinances
:by authorize repre-
ionetl properry for
Date 9'—/G"8J
_ E� D�r3 �!1-c�0 g I
TVPE OFCONSTRUCTION NEW ADD
❑ CONVERSION ❑ DEMOLISH- � OTHER
DESCRIPTION OF WORK/USE OP BLDG. —
�
ALTERATION LJ REPAIR
TVPE OF PERMI� LJ GRAOING LJ FOUNDATION LJ STRVCTURAI
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 54. FT. OCCUaANCv—
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES—
Remarks:RFc..i-ro...��,.�s /�.en...,r �B_�OJ��{
Sink
Preventer
Irrigation
Drinkiog Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Intercep[ors-
Kitchen Sink
Roof
Reinspection Fea � $15
Boiler
Duct- UnderGround
Duct-Struc[ural
Duct - Ventilating
Exhaust System ❑ Multiple �
firepl/FacG Blt. ICBO #
Heating System & Ducting �
❑0-100,000 BTU 0100,OOOBTi
Reinspection Fee � $15
- Accounting; Goltlenrotl - Assessor
Showers
Service Sink '
Sewer Cap
$ewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
AULO-N1d5h
Issue Fee
Hood or Type 1 ❑
CanoUy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
FEES
$ 3
5390 9/16/B7
A.P. � � �Q — '-� Tj - OQ Zone
S Main Buildin9: Accessory Building:
E
T Front
8 Rear
A
C Right
g Left
Ping. Ref. # Parking Req./Provided
Planning Notes:
ELECTRICAL
Auromatic Washer Transformer ❑ 15-50 KW
ConstructionPoleSuh. � 50+KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor �0-5 KW �5-15 KW
Meter Llup ro 100amps
Meter ❑over100amps
Sub Panel
Mators �0-1 HP 01 %- 8
Inc.Sola� �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
Fee �$15 � � Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning APPtoved 8y
Building Approved By �
Application Issued By ' /, �
12090 TL
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING g ISSUANCE $
PLAN CHECK 25k S ���j---///---/��� ENERG�' P.C. $
ELECTRICAL $ l. 1lJV GRADING $
PLAN CHECK 50% $ ��� MICROFILM $
MECHANICAL S TOTAL FEE $ ��
PLAN CHECK 25% $ �
CQNSTRUCTION AND�PLANNING :"� �'�� POOL & SPA
dPPROVALS Permii'# Date . Inspector,, pppROVALS Permit# - Date Inspector
1.;;Temporary Electrical $e�vice or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings �'� 58. Electrical Conduit-�Undrgrnd.
8. Foundation '"" . 59. Gas Pipe, O Undrgrnd., Test
� i
9. Wate, Pipe-Undrgrnd. �' 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final - .
15. Rough Electriral�Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION \ ,.
32. Electrical Power Meter-Final �Z-�-� 80. FOOD CERTIFICATE ISSUED '"'
33. Final Electric f2'�,3� Notes: '
34. Final Heating & Air Conditioning 1��`
35. Final Gas Pipe-Test
36. Hood or Canopy '
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final '
i
40. Gas Service-Final �
41. Solar pomestic-Final � �
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ��
51. CERTIFICATE OF OCCUPANCY
No. � Date ��
rnnticracofEss: 2g1� £LLESMERE'AV
OWNEfl'S NAME: LASKO, EUGENE W
nooaess: LASKO, BARHARA RENEE
2817 ELLESMERE AVE
COSTA MESA,CA 92626
557-9557
AflCH/ENGINEEH: flEG.NO.:
aoonEss:
uNiT:
uxir:
PEflmiTTEE: QUALIFTED ROOFING ( 714 ) 850-9166
aooncss: 351 NEWPORT BLVD 462
NEWPOR'1' HEACH CA 92663
LICENSEO CONTPACTOfl DFLIAflAT10N: I hereby allirm �hat I am Iicen5e0 unEer Omvisions ol C�aD�er 9(commencing with Seclion
7000� ot Uiv:sion 3 ot I�e Business and P�otess�ons Coae. ana my iicense is In iNt torce ane eNeq.
cirruc.: ����qJ srnreuc.:517602 ��5'^C�,9Q
oale: —�_l—f_1� Signalure: �'� ���\�"� "���
WOHKEflS' COMPENSpTION oECIAflRTION: I nereby allirm ihal I nave a cenificate ol consen� lo sell�insure or a cenificate of woBers'
Compensation Insurance, ar a cerUlietl 4opY ��ereol (Seciion 3800. Lab. C�.
POLICY NO.: E%P. �ATE:
LOMPFNY:
❑ Cendiea coOYlis �ere0y Iumishe0. ❑ Cenilie0 co is hleC wi he cily Builtli�Divisio .
Date: ` ' R� LJ—�- ApplicanL L �—
E%EMPTION FflOM WOflNEflS' LOMPENSAT�ON UECLABATION: (This s¢c�ion neea noi be wmple�ed ii Ihe permii i5 fOr one hunAreA (3100) or 1e55�.
I cetli�y ihai in Ihe pedormanre ol lhe wOrk lor wAic� Ihis permi� is is5ue0. I shall noi emDloy any rsoqin any manner so as lo become
sublecl lo I�e Workers' Compensation Laws of Calilomia. /� �)
Y 1
ya�e'. � � � � 4 L) — Si9nalure'. �/�U� `
NOTICE: II, atter making IOis aeclaralion, you s�aultl Oecome suGlec� to t�¢ Warkers' ComDenSaiion pmvisions ol ihe Lahor
Cotle, yrou mu5i torlirvnin compty vAlh such p�m�5ia�rs m iks D��1 stwll �e OeemeO ie+okeA.
WASTFUCTION LENOING RGENCY: I �ere0y atlirm ��al Ihere is a conSimt�i0n 1¢Ming agency Por IAe pCAormance ol IAe xrork lar
w�ith Ihis permil is i55ue0 (Setlion 3097. Civ. C�.
LENOEfl: '
ADOflESS:
OWNEfl BUILOEN OECLABATION: I heleby a�lirm Ihal I am exempl imm I�e Conlrac�oR' S131e License Law for ihe lollowing reason
�5¢c�mn 703L5 Business an0 Professional CoOe: Any ciry oi wunty w�ic� requires a permii IO con5imcl. alier, improve, tlemolish. or
rtpair any SlmcWre. D�ior �o its issuancd. also repuires Ne aOP�iwnt �or such permil lo lile a Signetl s�a�emenl lha� helshe is licensetl
oursuam ta ine D�avivans of i�e Gontractors' Siate �icense Law (CIUD�er 9(cammencin9 vm� Section 7000) ol Division 3 0l t�e 9uvness
an0 Pmfe55ion5 Cotle) ar I�al Ire/she is eeempll�erelrOm an0 the Easis �or IAe allegetl exem0��on. My violalion ot Seclion 7031.5 Uy
any applicanl for a permil su�jects ihe 9PPlicani to a civil penaliy oi not more I�an live hunUreO dotlars (5500�.
I, as owner ol Ihe pmpeny ar my employees with waAes as I�eir sole com0ensa�ion, will Ao Ihe work, antl I�e
❑ stmcmre is not imentletl or ollerte lor sale (Seciion 70aa. Business ana Pmfeuional Code: TAe Conlractors State License Law
does not apON to an owner o� a O�openy w�o builtls or impraves Ihereon. and who aoes such wark himseli/hersel� or Ihmugh
his or �er own em0loyee5, pmvidetl thal SucA impmvemenls are nol inlentletl ar o��ere0 lor Sale. II, however t�e �uilaing or
im0�ovemenl is SoIA wi�hin one Year oi com0leiion. the owner will �ave Ihe burden ol pmving h¢Ishe tlitl no� builtl or impmve
far Ihe purpase ol Salel.
I, as owner ol tAe propeny, am e�nusivery contraciing witA IicenseA comracmrs to constmn ��e pmject (Section 704a, Buvness
❑ antl Pmlessions Cotle: The Cont�ac�ors' State License Law Uoes no� aDPly to an ownei ol D�ace�Y who DmIOs or imprmes ihereon
antl wha comracis lor such prolects with a comracmqs) license pursuam m the Comractors' Staie License Law�. I am aware
�hal pmol oi Iheir Woder'S ComPensation insurance shoul0 be DmviAed to me.
� I am exemp� under Senion: B. 8 P. C.
�0� IIIiS �Cd500'.
�a�e: Owner.
I Oo he�e�y ceriity Itul I am aware o� anG unaerslanG IOe reQuiremenis ol Calilornu Healih an0 Snlety CoGe $ections 25505. 25533, anA
25534 ane Inal I or any lulure Guiltling oGcuOant will/vnll nat �ci¢le one) neea to comply vntA 5ai0 slale cotles and ihe requiremenis for a
permii for conSlmciion or moaitication Irom the Air Ouahry ManaBement Di5Vic1. ReSfaeniial con5tmciion applications are exempl Imm
Ih¢5¢ pf0Vi5i0f15.
Dale: App�i[ani:
I �ere�y cerlily Iha� I �ave reatl t�is appUwlion antl slale I�a� Ihe aGove iniormation is correci. I agree lo comply with all ci�y antl county
ordinancesanaslalelawsrelalingloDuilOingconsimclionandherebya orizerepie5entative5o�t0iscirytoen�erupontheaDove�menlioned
pio0e�1Y fo� mSp¢ctron pmposes.
py�¢; �—�_�_ � SignaWre� � `(�
oriver�s �icense or Socia� Secumy
t6ab<6 Whiie—BuilEing; Green—COOe Enlarcement: Canay—qpplicam; Pink—PevenuC GOIQonroO—Assessar
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; H 065632 PLAN CAECK NO: N
CONSTRUCTION TYPE: V—N
PERMIT TYPE: STR
PERM NO; B 06563
GOVT: N SUPP: N
PURPOSE; ALT
JOB DESCRIPTION ; T/OFF RESHT REROOF W/COMP. SQ FT: 6,000
CLAIM VALUE: 6,000.00 CALC—VALUE: 6,000.00 GROUP OCC; R-3 /
COMMENTS: SMOKE DETECTOR REQUIRED PRIOR TO FINAL
+�****r�r*�rir*i�*ir+r*�t***�f�***�t****+tx*ir�r*�t***�t*�t****r*�riti�x�x�***�t+��r**x��r***x�*+��*�r**�t**+t
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 BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEET; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING RE�• PROV: PARCEL: 13933509 ZNE; REF NO:
PLANNING N TES> �.
i
+rx�r+r+t+r*iri��r**+t�+�it+ri�*x�**�r�t��+r+t+t+�x�r�r+r+tirir**+tit�tir�rx�r�rx��r**+r**+t**x�x�*r**�rx***�*+tx��r**ir�t*+�-x�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N,;T S
ZONING APPROVED BY DATE: r'
�!
BUILDING APPROVED BY :
APPLICATION ISSUED BY;
�r**+tx��rxirx�r*+tx�+rx*�r�r�r*+t�r
iFlEiEkiEltjfllMk1f1t1hitifff!l1fiElEiEiFif1!!Flf1litillEffilklFiF lE1f 1E
LEGALIZATION;N F E E
BLDG PMT PLUMBING ELECTRIC
PERMIT 81.00
PLAN
ISSUE FEE
HUILDING—DIV—> PEAMIT ISSUE PLAN—CHE
TOTALS----> 81.60 0.00 0,
REVENUE DIVISION TOTALS--> COLLECTED;
HLDG PMT PLUMHING ELECTRIC MECHANIC
81,�0
DATE:
VHlt; �/ f —
fEihlElEiffElfifiF � if1E
1k i! 1Elf iF jE if fE if iE M 1f 4!E!f !E iF iE M fE iflE it 1E 1F iE ik M 1E ik iE 1t if if iE iE 1E iE
M M A R Y STRUCTURAL SEGMENT:Y
•1 �
MECHANIC FIRE SMIP/RES GRADING
.60�
SMIP/NON.—RES
%l
CK TOTAL PAID DUE
00 81.60 81.60 _ .00
81,60 OVER/SHORT: . � .00
FIRE SMIP/TOT GRADING�PLAN—CHECK
.60 '
iF if iE M if it M 1E it iE iE if 1F 1E iE it if k it it it ik it M it k it if 1! �! ff i! it it if iE iE iF iE iE it ff if k i: k*�M iF %iE 1F iE it if if 1E 3! iE iE iF it iE if iF iE iE iF ik'1k it it if if 1t iE 1E iF if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 6000 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 6,000,00
END OF FEES
C1 001534�b-00153477 T�] T 81.oD
��TE: Ot/1G/94 7I�£: 14:d�
CORS-� RUCTION ANC1 °LARRING
APPROVALS Permit ;,'
t. Temporary Electncal Serv�ce ur Poie
2, So'I Pipe�Undrgrnd,,
�. F_�_c''�e' Con[{:��t 'J: ',Cy-U���.yr^7'
�d. Ele[tncal COnthrt�Ur.drn� i�.
B. S(g.: Ri�rttfOrCETBM.
'-r^---
6. Electrical UFER GrnA
7. Fpot�ngs -y..
$. Fo�ndaUon �
- =-�-----
9. �"ate� '.pe.Uco7�._+r�:;.
1D. Structur�l Floor SYstem
7 i. Prop�r!y S2v✓er Ur.z & Hc�se G. nnec!ior
72. Se�ver Cap
13 qQcf prd��ns
14 Rough Piumhing `
15. Rovgh GectrlcabCond..�r
16. Rou9h Elec[ric4Viring
77. Ro..9h `7�r�rg $,•?n
Da;u
FOO L � SPA i
Inspfec:or I Date I Impecmr �
a° APPROVAIS- Permit # � I , I
I I ;
51. Pool & Eou:�inent Loca6on -�
53. Steel Reinfarcemrrt �
� I 5:. Fc�ms -- - - -- - --- � --',-. .-__--.
T �
� 56- E�ectical Bu��d�rq ��� '
� � 56. Ra�gh Pi�n-h •-y :y ' _�:alc T_5t _ �___� __ -
- .�
57. APPROVAI Tp COVER�GI' iTE �� I
-i-- ------ - -- --- -� -- -� - r .
I58. E�ect'�cal C�: r ui,. „�. �7 crn- --.__ .-�: iI • .
I59. G�; P�,r.r., = U: s��-� y. Tcs� --� -----I� ---. I
_ L
- - � L�. 3zd:..�s;- -L - -- -_ J --- - - - -T-- - --�
. , ' � _} . �_{
61. APPFOVAL, fU U: C'C I �
------------ -�-L- '--
�2. B�cl<::ash 1;� :.:-c � Fn.i �
�-.- ___' __ - _- ___ ' '�_'-_ '1
63. He2tcr & Vr„�� P`r�,' I �-----
-{--t-----�-- - - , --i-: _ .. _
-i- �'aH. P�u�no�irn Sr�,,,�. - - '--- . � - - . .
, Gb.l �,ect,;ca�.F;r,� � ; .
- i * -
� _66. Sola� SYs::r� F�,n.,� _ ._-_-_ . _ I _ . I
� �67. Fencir.g & Acc;s. �ln���uva' --' -�' �--+- -- - '
�- i ii8. APP(�CVED__O;i P1.,15T�NI�:G - -�-- - - ----
I 19 Rough Flect�icai�T Bzr C:r I,rq I I 6g POOL�SP,� �'S'�" �5 FI�`Al
1�. Ro.. �h ;-IEsi�ng $ Air C_�d Lcn ,;q -t� FIRE UEF'T. fiCCU'RF(:''G.�'- --- - -
20. Ro�gh Facto�;y FirePtac `� ` I �, LtPPROVAt_5 -�J �r�^.c :. .---- I I
.. - - � -- �- - -- -- -- --*---- - - -
.. - --�-------- -- �- '
I� .D�cc, �i� 5trvecture. .. �� �� � I ' - 70. Jndcry�.'�i c l lq�J� �.� • ' I
< . _
�T.� � _.___ � I „_" ___
� 22.D.�c.'.,V.+ntilat�n3 __ _ �'_�-- I , 'I 71. Prcouctro•. �-_, _-_'] -_- �_.r-�-__-_-
-_�_ - � _
73. ��-{hip:�+7o,wn � Test �� T � � �7 Lndrrgrcu� � � --. _ __ �� . _ .
� _ * +- _
24 hoOf -ir+ing • • J3 Lrriaiprn i. - .,,� �" < ^:�_ ..� , �
�__ . __ _ . ___-_ - , - _ �_�- .- _ _ ' -___
i
� Z�. HoOF S�iodthing . - '_ - .-,-I_/ft_O�c,f..ead Nt�. "' ,. __ _ _ � _. _ i .
1 y�
Z6 T�B':rC.�.!,n, iSt•uct..��i� d.;.lo�ocoat ' �' 7�, U��, Chea ' � I
� 27. r�.z;i�;.:rd F::.sni�9 --� --+- --- �I IG.�O••, Stan:•.,. -- --,-------- -� - ----�
-}-} _ 1-_ -�.
� 28 la;*�^= �. S,d ^� . . . - �T. I �� -- ,�I 77. F�:;EC c.;�� - - --iL -� - � ��
�: .:, _ ..---�- �.-- � �--- -- ' --- -- ---1�---' - - - -
I �9. Insuiahon , ' . ;, � �� 78. •FIRt PREV. ti'�:AL �^ _ L _ 1
L�- .,_---;.q------ - -- - --- -- --
�..30 7,y.:a' '�I.,n.ro :.- � � YIEAIT'i-0L-PT. �EOUIRC;:.t1i-�
� -__ _-._l. _ __-_- ___'_. ___--. " _._� __ ^ _ -_-_ _, .
31. �.sst.,. ,�vwn Cqat. ;� � 7�. FI'JAL I'at�y C- I,,�. ..I� i
�_--`-----C?�'.r•'.i':n-I-- --'----------�-_ �.,..1 ...J...._ -- -.S�i '. - ,- --- !
� _, _'__- . _ _ _: _.' _ � . _ � . _ -_ ' ' . _ _ ._ _
�. a3. t ' i-��cb�.c I .r_-._ I '���otcs: ' ' � .
� - -' --'r- r �
�34. � ,i i�'..it�rc+ & ��i� :.o � .- �r; � 1 - � - ; . - - _ - - -
` ,.. ' .-': . t,-'.,_.I� -`i---- - � -- --- .. . - - -- -
f----- - - - ' _ .
� 35. Fral c:�, Pi^s.TC:t ., ----- - � � �_ � : • �-- . . .. _ .
� � .-- ---'- - ' ------- -- -- - I � ---% -'----- ----' - - .- ---- ' - - . .. . _ .
, 3:;. ' ... ,. �� Ca��pv ' , .- . I , .
�_ .� _��_ _. .1_J+ � j . � ? I
� 37. F. al �;,t�o•�' Frep;:�c' . i : �. _ _ _ __ _
�___ ______ __ . _-- __-_ �_.: �_ _"'I'TT. i�-_# �_.� _
3a c ._e!'-TbmG :__.. ._ _'-_ �___� __ . -
s. _ --�y
J". \'�'et�r Serwce•Final� " I j
�-- -�
I G0. Gts :e•„�e,.F-;rzi '_ . . _..-- . , -, - - - - --
i---- - ' - - �-- -- - -- -
-� _) r.�
-�7. S�'�ar UomCst�[�Finai _ ' i� � �
li `.:Z. 9.G:� �' P+Bce^iCt _ _ -'_-_'I _-- -�__-i _-_
�'__ _"��
� 43. Bacic(Iov: Irr�gation'
�----- -- � - - - -- --
�, � 4a -��.ntl,-pc h� �4ation Sv. �-;� T- -
• 45. £ound Attenuatiorn _ � •
46 Hz�-� r �j Re��'ato�s
' 47 •fIN.'�'_ STRUCTUR[ A ".�J1! DING
�----- -----
48 � PI�VAL PLANiVIP!G
.A9. EIcC�ric Release to Edicon-
� 5G Gr,,Rcltase to Sout�em C;:Irfo�ma Gas
-- --r----'. -
_... i .:-'•..�; -__
. __�..- - - , - -
__ . � __
-- �------- - ------- - ---- -- � -- --- -
(-�4 � �y��-:;� � �-_�� �-_- -
.
-1__ y _. �
AVP��cant to fill in all spaces exceo� enose witnln neavy eoraer lines ana zign all aovrovriate aeclarations.
CITY oF COSTA O�E�N� U�ISON PER
v
Proiecc Address �{ �
Applicant'sMaili Address R/�
Owner's Name ��G!t-' � �—��,✓,�„ Pho
Arch/En9. Licenu No.
Address
Contractor's Nam� Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATIOfJ
1 �ereby affirm Ihat I am licensetl untle� provislon5 oi Charte� 9(Commenclnq
wilh seciion �000) of Division 3 ot the Bu5ine55 antl Proteszionz COtle, antl
my license is in full force antl efiect.
License Class � License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certl/icate ol mnsent to self-insure or a certi0cate
ot Workers' Compensation InSuran<e, Or a cer[HIeO cOpy Ihereoi (Section
3800, Lab. C.)
Policy No. Company
8 Certitietl copy is hereby tumisnetl.
Cer[ifietl copy IS filetl wi[h the city Builtling Division. ,
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thiz section neetl not be CompletCO it the pe�mi[ I5 fo� one huntl�etl (E100) or
Iess).
I c¢rtity thal in the pe�formdnGe 01 th¢ wotk fo� w�lcn tnis pe�m�t is ISsuetl, I
shall not employ any p¢rsOn in any manner...SSSo a5 to beco E Sub' Ct to the
Worke'S,;�Co�pensDtl law9o( Cal'kfqypi��L 1 �
Date �5=�-� � �Si nature �a2� Q, ��
NOTICE:Jf, after making this tleclaration, you sM1ouldbecome s bjecl to the .
, Workers' Compensatlon provisions of Ihe Labo� Cotle, you must �orthwi[h
� comply wilh Such prOvisions o� this permit Shall b¢ tle¢metl �evoketl.
II CONSTRUCTION LEP/DING AGENCV
I nereby affirm that there is a construclion lentlin9 agency tor the pertormance
01 the work for wM1ich thi5 permit is issuetl (SecHon 309]�Civ. CJ
Lentler's Name
�entler's Atltlress
OWNER BUILDEH �ECLARATION �
I hereby affirm that I am exempt from tbe Contractor's License Law tor [he
fdllowing reason (Sectlon 7031.5 Bu5lness antl Professlonal Cotle: Any city or
county wttiGh rEquires a permit to cOnstruCt, al[e�, improve, tlemollsh o� repair
any structure, prlor to its issuance, also reqWres Iha appliwnt for Such pCrmit
to file a siqnetl stalement that he/she I5 IicehSetl pu�suan[ to lhe p�Ovisions ot
cne Contractor's Li<ense Law (Chao�er 9(commencing with SectionJ000) ot
DiviSion 3 ot [he Business antl Profezsions Cotle) or that he/she is exempt
[herefrom antl lhe basis tor the allegetl exemption. Any violation of SeCtlon
7031.5 by any applican[ for a permit subjects tbe ap0�icant [o a civil
penalty of not more than five nunmetl tlollars ($500).
� I, a5 owner of the Property or my employees wlth wages as their Sole
compensation, will tlo the wo�k, antl the st�uctura i5 nOt Intentletl Or otf2retl
for sale (Section 7044, Business an0 Protessional Code: The Conlractor's
LicenSe 12w tloe5 nOl appty to an Owne� of a property who builtl5 or improves
thereon, antl who tloes such work himself/herseH or through his or her own
em0loyces, provitletl that zuch improv¢menis are not intentletl o� oHCretl for
sdle. If, howeve�, th¢ bulltlin9 or imprOvement IS Saltl wilhin one year of com-
pletion, the owner will have the burtlen of provin9 ne/she tlia not bulltl or im-
r ve Por the purpose of sale).
I, as owner ot tM1e proper[y, am exclusively contractln9 wkh licensetl con-
ractorsto construct the project ($ection 7044, Business and PrOfessions Cotle:
Tne Contractor's License Law tloes not apply 4o an owner ot oroperty who
builtls or imoroves thereon, antl who contracts for such projects witn a con-
tractor(5) uc¢nse pursuant to th¢ Contracto�'s LiCenSe l_dw�. I am awar¢ that
proof of thei� Wo�ke�'S Compensatlon in5urancC shoultl Oe p�ovitl¢tl lo me.
❑ I am exempt untler Section � B. & P. C. (or this reazon
Date ��-�
1 hereby certi�
Inlormation IS
antl sia[e laws
sentatives oi
inspettion p
Signature
Drivers' Licens
that I have reatl this
recL I agr¢e to Comp
atina to builCina con
- Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showerz
Servite Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet ,
Water Heater
Water Service
Auto-Wash
Issue Fae
Hood or Typel �
Canopy Typell ❑
Refrigeration $ystem
❑0-t00,0006TU ❑100,000
System Repair/Alteration
- Fire Dampers .
Registers
Issue Fee
FEES
$ 3
$ 3
A.P. �k
S Main Building:
E
T Front
B Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers QGas ❑Elea
Fan
F.A,U.
Fixtures .
Device Boxes
Outlets
Cr7F- .:�_� � �
Zone
Accessory Building:
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Garbage Didposa�
Generator 5 KW �5-15 KW
Merer LJup ro 100amUs
Meter ❑Over100amps
Sub Panel
Motors 00.1 FIP �1'/:-8
Inc,.561ar �9-15 HP �16-15+
Pole Light
Range
Sign
Standing Sections
Trash Compactor
� Reinspection Fee �$15 � I Issue Fee
DEVELOPMENTSERVICESRE�UIREMENTS:
2oning Approved By
Building Approved By
Appliwtion Issued By
SUMMARV OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK S PERMIT
PLUMBING 5 r.•o0 ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL S TOTALFEE
PLAN CHECK 25% g
FEES
$ 3
S
S
s
$
� $.oD
Z
O
N
I
N
G
R
E
�
M
T
S
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool &,Equipment Location
2. Soil Pipe-Undrgrnd. �53. Steel Reinforcement
3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
�14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping O Gas ❑ Oil .�
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. OverFead Hyd�o ' � ""
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical
� D. Frame and Flashing 76. Dry Standpipe +'�',
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Note • (`(p ��"� 1�L. �Q. G.��O
34. Final Heating & Air Conditioning �'
35. Final Gas Pipe-Test �{".�?f 7 (,$fi' � �.
36. Hood or Canopy .
37.�Final Factory Fireplace � � '
38'.': Final Plumbing � L{9 . ' ` �, :
nJ.= .
39:`Water Service-Final � � ,_ . _
40. Gas Service-Final �� ';; ,
. -
41. Solar pomestic-Final i' � �
42. Backflow Preventer . f ! � �
e �'�
� 43. Backflow�lrrigation .. � `���'`
•i r
44. Landscape Irrigation System . . � ' i�f
�, .
45. Sound Attenuation i� ° �
.46. Handicap Regulations
y . .
47. FINALSTRUCTURE&BUILDING y ' '
48 �Special Requirements Completed � . �
�
49. �Electric Release to Edison " /
y.: .
50. Gas Release to Southern California Gas Co t'�% . �
51. CERTIFICATE OF Q�CUPANCY '
No. Date
n •
•• AOP�icant to fiil in all spaces exceot those witnin heavY �oreer lines ana sign all aoo�oDriate tleclarations.
E1TVOr'_,COSTAMESA CONSTRUCTIONPERMIT �, �,
5roi'ect nddress �' 3�� 7 CpL�L�SA)E/ZE R✓E
Applicant's�AailingA��d�dre�ss�CL!%�L(,�.5��'�7 �'V�-C�M�
Owrart'slVa e��YY• <--./9 SKO Pho e557—�.537
Address ���� �LL��'AJ6?t /�✓E !'Qf)'A A7f3rA.
Arch/Eng. License No.
Address
Convacmr's Nam� . , Phone
Address (mailing)
Ciry Licensc No.
LICENSED CONTHACTOR DECLARATION '
I hereby aftirm lha[ I am licensetl untlet provi5ions of CM1arta� 9(commencing
wifh section ]OOO��of �ivision 3 of the Business antl Professlons Cotle, antl
my licensa is in (WI (orce antl etiect.
License Class License No.
Date Si9nature
WORKERS' COMPENSATION OECLARATION
I hereby affirm that I have a certitica[e of consent to self-insure or a cMtlficate
of Workers' Compensation Insurance, or a certitiea copy thereot (Section
3800, Lab. C.)
Polity NO. Company
Certitietl copy is hereby turnishetl.
Certitietl copy 75 fil¢tl wi[h [he city Builtling Divlsion.
Date APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This mc[ion neetl not be com0�etetl it the permil is fo� one huntlretl (E300) or
less).
1 cerNty that in llte perto�mance of [he wo�k fo� wnich this pe�m�t i5 i55uetl, I
SM1all not employ any p¢rson in any manne� so as lo b Ome subjecl to the
Workers' Compen tion Laws of Califo
Date �—�7� � � Si9nature �����• �% ��
NOTICE: II, after making LM1is tleclaration, you snou a become subject to the
Workers' Compensation provi5ion5 of the Ldbo� Cotle, you muzt forthwitn
comply wilh such pwvi5iOn5 Or this pe�mit shall be tleematl revoketl.
CONSTRVCTION LENDING AGENCV
1 heteby aftirm lhat there is a const�uction lentlinq agency to� the performdnC¢
of tite work tor whlcn tni5 permit is issue0 (Section 309� Civ. C.)
Lentler's Name .
�entler�s Atltlress
OWNER BUILDEN �ECLARATION
I hereby a/firm that I am exempt from the Contractor's Llcense Law for tne
followin9 rCason (SeGtion 7031.5 Business antl PrOfessional Cotle: Any city Or
county wblcM1 requires a permit [o construtt, alteq improve, Oemolish Or repal�
any structure, prio� to its issuance, al5o requires the applicant for zuch permit
to file a signetl statement that he/she is licensetl pursuant lo lho provisions of
tne Contractor's Lit¢nse Law (Ghapter 9.(commencing with SecliOn ]000) o(
DiviSion 3 oi the Business antl�Profesiions Cotle) or tha[ ne/she i5 ezempt
therebom and lhe basis tor [ne allegetl exemption. Any vlolatiOn ot $ectlon
7031.5 by any applitant tor a permit subjects the appliwnt ro a civil
�nalty ot no[ more Ihan five huntlretl tlollarz (E500).
I, as owner ot the properry or my employees witn wages as their sole
compensatlon, will tlo the work, antl tne sVucture is not IntenOetl or offeretl
for sale (Section 7044, Business antl Profezsional Cotle: The Contractor's
License Law tloes not apPb �o an owner o� a properry who buims or improves
thereon, antl who tloes such work himsell/herselt or through hls or her own
employee5, Provitletl Inal sucn improvements ar¢ not intendetl or oH¢retl tor
sal¢. It, however, the builtlin9 or improvement is soltl within one year of com-
plelion, the owner will have the burden Of provinq he/sh¢ tlitl not bulltl or im-
�pr$ ve tot the pu�pose Oi sale).
pSU, as owner of [he proper[y, am ezclusively contracting wilh licensetl con-
Vactorsto consVuct the project (Section ]044, Business antl Professions Cotle:
The Coniractor's License Law does not apply to an owne� of property who
builtls or imDroves thereon, antl who contracts for such projects wlth a con-
tractor(s1 ucense pursuant to the Contractor's License Law). I am aware that
Proof of their Worker's Compensation insu�ance shoultl be provitletl t0 me.
❑ I am exempl untler Section B. & P. C. fot [his teason
Date
I her¢by certify that I
info�mati0n is conect.
ana slate laws rela[ing
Sentallve5 Of tM1ls City
ins0eation pur s.
Signature
Drivers' License S
CMF 0865-46, rev. ]0/84
Owner
have rea
tate that the above
tl counly ortlinanCes
�by autho�Ize repr¢-
lonetl prop¢rty fo�
oa�z•�—U P7
.".........,. ....._..--� --� �--' .,,.,, �....
.sE z43 z5 oos
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVE0.510N ❑ DEMOLISH ❑ OTHER q.p. #
DESCRIPTION OF WORK/USE OF BLDG. �
S Main Building:
E
TVPEOFPERMIT GRAo1rvG FOVNDArION 57RVC7uRAL T Front
❑ TENHNT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 qear
❑ OTHER �3� T/L/CCL' SKYL/T4`S ' A
C Right
PROJECT DESCRIPTION Sq.Fr. oCCU/PqrvlC,v
CONSTRUCTION TVPE VALUATION5��"y ��J• S �eft
ZONE GRADINGCU.YOS. ACRES PIng.Ref.#
Remarks: Planning Nates:
3ar Sink '
3ackflow Preventer
3ackflow Irrigation
3a[htubs
Clarifiers
Di�shurasher
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Intercepmrs �
KitcFien Sink
Lavatories
P—Trap
Roof�Drain
�
einspection Fea S15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ .MWtiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 sru � i oo,000
Fee � $15
White - Builtling; Canary - Appliwnt: Pink - Accountin9: Goltlenrotl - Assessor
FEES
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
Solar Tank
Swim � 9 Pool�w/Spa
Watei Closet '
Water Heater
Water Service�
Auto-Wash
Issue Fee I $ 3
iANICAL FEE
Hoodor Tvpel ❑ �
Canopy Type 11 ❑ /
Refrigera[ion Systerri
❑o-ioo,00�eru Oioo,000eru
Systlem"Repair/A Iteretio n
r�re Dampers .
Registers
laue Fee � $ 3
IE�S 7/.7/. �
� J3S— �g ' Zone
/ Accessory Building:
Automatic Washer
Construction Pole Sub.
Cookin9 Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Pixtures .
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW C
ELECTRICAL
Trensformer ❑ 15-50 KW
� 50+KW
e
5-15 KW
�y1Jup to 100 amps
Meier over700amps
Sub Panel
Morors �0-1 HP 01 `f, - 8
Inc. Solar 09-15 HP 016�15+
Microwave '
Pole Light
Sign
Standing Sections
Trash Compactor
FEES
Z
O
N
i
N
G
R
E
Q
M
T
S
� Reinspectian Fee �$15 � I Issue Fee I $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
2oning APProved BY M M Date� _��—�
Building Approved By t Date
Appliwtian Issued By Dat�
SUMMARV OF FEES ��
BUILDINGPERMIT $ `L-3 • SO SMIP $.� CJ• ��
PLAN CHECK $ /� A PERMIT
PLUMBING ' , $ ISSUANCE $ ,
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ � Q • 'TD GRADING $�
PLAN CHECK 50% $ MICROFILM S�
MECHANICAL $ TOTAL FEE $ ���
PLAN CHECK .25% $ ,
CONSTRUCTION AND P,LANNING � POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1::Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPfiOVAL TO COVER-GUIJITE
7. Footirigs - 58. Electrical Conduit-Undrgmd.,'
8. Foundation 59. Gas Pipe, O Undrgrnd., Te�st
9. Water�Pipe-Undrgrnd. 60. BackwaSh�Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK �'
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. ElectriCal-Final
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventifating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing , , 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat , 75. Dry Chemical
27. Frame and Flashing ' (� ,� 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION 1
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric J C Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy •
37. Final Factory Fireplace '
38. Final Plumbing �
39. Water Service-Final ,
40. Gas Service-Final �
41. Solar pomestic-Final
42. Backflow Preventer .
43: Backflow Irrigation .
,44. Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations . �
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Cn
51. CERTIFICATE OF OCCUPANCY
No. � Date " �