HomeMy WebLinkAbout2834 ELLESMERE AVE - Building Permits' CITY OF COSTA MESA
.
BUILDING D/V/S/ON
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • wv✓w.ci.costa-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754•5626
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PERMIT NUMBER: BX08-00257
PERMIT TYPE B MISC STATUS: ISSUED
APN: 13933409 DATE ISSUED: 1 011 3/2 0 0 8
Zoning R1, ISSUED BY: CAC
JOB ADDRESS: 2834 ELLESMERE AV CM Suite/Unit:
Vicinity: ROOF TOP � Primary Occ: . Consl Type :??
SQ. FT: 0 _� Valuation: 578,000.00 �
SCOPE OF WORK: _
INS7ALLATION OF A 6.27KW ROOFSOP MOUNTED PHOTOVOLTAIC SOLAR PANEL SYSTEM (33 STRINGS OF PANELS) FOR A
SFD WITH 1 DISCONNECT, t INVERTERAND 1 JUNCTION BOX.
OWNER: DIETERMANN, META H Address:: 2834 ELLESMERE AVE
City/State: COSTA MESA, CA � � . � � Zip Code: 92626
Phone:
APPLICANT: RIOS, RICK � -
200
CitylState: SAN LUIS OBISPO, CA
Phone: 619-977-5416 �
CONTRACTOR: R E C SOLAR INC
Address: 684 CLARION COURT
Cily/State: SAN LUIS OBISPO, CA
Zip Code: 93401 . - '
ARCHITECT:
Phone
ENGINEER:
Phone
JAMES A ADAMS
Building Plan Check: _
Building Permit: � �
Electrical Permit: '
SMIP Residential
SMIP Commercial
TOTAL FEES
Address: 775 FIERO LANE
Zip Code: 93401
License No. 750184
Phone 805.528.9705
License No.
License No. S1672
FEE SUMMARY
$190.61
. � $29325 , .
$42.80 '
$1.80
$0.00
, S 8.�
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Unit
Unit: UNIT
Unit
Cell:
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NOTICE: The work auNorized by Nis permit shall comply vnlh all applicable hantliwp access requiremenLs under Califomia statules 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 tbe work aulhorized under this permit to be considered legal, such work must comply with all applicabie codes, and all
required inspections and final approval musl be obtained. Failure to obtain inspecQons and final approval will result in the expiration of this permit.
cooa � ixsrccnoNme o� ixmu�s o t iNs�cnoxnvE o�g � ixTm��
1816 Fized System Final Fire Prevention 206 Final Mechanical
1288 Pool Spa Finat 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical '
201 � final Block/Retaining Wall 272 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning ADpmval
203 Final Sign 222 Final Site
204 Final Dertwlition 250 Final Building�Occupancy 16"3�1� i� «
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the follovnng declarations:
❑ I have and will maintain a certifcate o( consent lo self-Insure for wbrkers'
compensation, as providetl for by section 3700 of the Labor Code, for the
pe mance of the vrork for which this permit is issued.
I have antl will maintain workers' compensation insurence, a§ requiretl by
se tion 3700 ot the Labor Code, for the peAormance of the work for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
nu a
Cafnef: �Cc�2�oC; 4 r
(i Ubn ne/eq irot 6e completee tl Mepermrt is valuetl at we huntlied �llars (StCtl) a less J
P icy Numb / 'Q 00 �[Z\, �J S� �i
certify tha[ in the performance ot the work for which this permit is
issuetl, I shall not employ any person in any manner so as to become subject
�o the workers' compensa[ion laws of California, and a9ree that if 1 should
bewme su6jecl to the workers' compensa[ion provisions of Section 3700 ot
the Labor Code, I shall artfiwii comply �t ese provisions.
b-
poli nl's S lure ate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMERES7, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm tha� I am licensed under pmvisions o( Chapter 9(commencing
with Section 7000) of Division 3 of [he Business antl Professions Code, and
my lic � is in (ull force and eHect.
L� # .I s# � ^ ��
�
Comr c r's - aWre te
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn lhat there is a constructbn lending agency for the
peRormance of the work fa wfiich [his pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Oale
OWNER•BUILDER DECLARATIONS:
I hereby affrm that under penalry of perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7037.5,
Business and Professions Cotle: Any city or coun[y which requires a permil to
constmct, alter, improve, demolish, or repair any slmcWre, pnor [o it5
Owner ID venfied by Arive� � ncense. ❑ Yes ❑ No
Oriver's License No. Eapires:
Verifcation of, Ownership by ([ype of document, i.e. - pmparty [az bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
❑ I hereby ceAdy Ihal no ezcavation (rve (5) or more feel in depth into which a
person is required to descend, will he made in connection with work authonzed
by this pertnit, an0 that no building s[ructure, scaffdding, falsewnrk, p tlemolition
or dismantling thereof, vnll be more than Ihirry-six (36) feet high. (Chap. 32, Grp
2, Art 2. Sec. 347, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industnal Safety, as noled above, unless
such person has a permit to tlo such vrork from the tlivision.
Applicanl's Signalure
Division o( Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fulure builtling occupant need to file and
certify a Business Plan for emergency response [o release or threatened
release o( a hazardous ma[enal? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery Code requires, with some
exceptions, that a Business Plan be filed with the Cos[a Mesa Fire
Department by every business which has at any one �ime during a reported
year a quantiry of hazardous materials equal lo or grea[er than a weight ot
500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressetl gas
al standard temperature and pressure).
2. Does or will the applicant or preseni or fuW re building occupant neetl to file
a regislration form for aculely hazardous materials? ❑ Yes ❑ No
(Section 25533 of �he Calitornia Health and Safe[y Code, with some
excep[ions, requires registration with the Cos�a Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater ihan a weigh� of 500 pountls, or a
volume o( 55 gallons, or 200 cubic fee[ of compressed gas a[ standard
tempera[ure and pressure).
3. Does or will the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management antl Preven[ion Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Cali(ornia Health and Safery Code provides that the
Costa Mesa Fire Department may require ihe preparation, certification antl
fling with [he Pire Departmen[ o( an RMPP by businesses which are required
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presenty required, has Section 25534 of the Califomia
Health and Safety Code been /ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or (uture building occupaN require for
the vrork which is me subject o/ Ihis application a permit for such construction
or modifcation fmm �he South Coast Air Qualily Management District or from
any other air pollution contml district or agency? ❑ Yes ❑ No
issuance, also requires the applicant for such permit ro fle a signetl statement (Section 658502 of the Califomia Govemmen[ Code requires lhat the requesled
that he or she is licensed pursuant to the provisions of lhe Confractors information be fumished on applications fa non-residen[ial building permits).
License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of the
Business and Pmfessions Code) or Ihat he or she is exem e�akom� rt-d �I part oithe facility to he consVucted under this permit be within
the basis for the alleged exemption. Any v��,�atio Gioe 703 .ir b5'- yrarry 0 f e[,from the'outer boundanes of a school? ❑ Yes ❑ No
applicant (or a permit subjects e 3pplicaM 3�o a vil enalt of not mwe t� han �'� �1
� yes", lhe facility must meet Ihe requirement of Sections 25534 and 42303
five hundred dollars ($500).): ��'' ��� �� "of the�6aliforiiia Health and Safety Code).
�
❑ I, as ovmer of the property, or^my employees vnth tiages as their sole 7. �� a permit from Ihe Soulh Coast Air Quality Management Dis�nc[ or other
compensation, WILL DO THE',WORK, and the structure is not intended or air polWtion control district or agency is requiretl �or the work which is the
offered for sale (Sec 7044, Business and Protessions Code: The Contracrors subject of Ihis applicatioq have all of the discbsures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
thereon,�antl who does such vrork himself or herself or through his or her ovm � 8(I('yes", attach certificate o( compliance from the zppropnate air polWtion
employees, provided that such improvements are not intended or oRered for .
sale. If, however, the building or improvement is sold within one year of conlrol oKcer�. � � �
completion, lhe owneo-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certi(y-[hat under penalry of perjury the
did not build or improve for puryose of sale.). , , info�mation given above is correct I agree to comply with all sWte laws and
ci� ortlinances re ardin H i rdou M t ri I d E � �
❑' I, as owner'of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and
Professbns Code� The contractas License Law dces no� apply to an owner of
propeRy who builds or improves Ihereon, and who contracis (or such projec� vnth
a contracta(s) license pursuant to the Contractors Ucense Laws.).
❑ I am exempt under sec.
Business and Professions Code tor this reason:
3051�46(3/09)
y g g a a s a e a s an missions. _
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND�AUTHORIZATION OF ENTRYi�I
certify under penalty of perjury tha[ I have read [his application and state Ihat
the information given is cortecl I agree to comply with all state laws antl cily
ordinances relating to building constmction, and authorize representatives of
Ihe City of Costa Mesa to enter upon the above-described property for
inspec[ion purposes. I agree�not lo occupy or allow occupancy of any building
authorized by this permit until f nal inspection. �� �
SignaWreolLegalOvmer�s) pa�e
AntllorA ¢etl ¢anl b oat 1
pt4) 754-5273 • Fax (71a) 754<856 • www.ci.costa-mesa.ca.us 77 FAIF DFIVE, GO51A Mt,A, l:A y[ti[ti
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
2834 ELLESMERE AV
13933409
Applicant: DIETERMANN, MARGARET
Address: 2834 ELLESMERE AVE
COSTA MESA, CA
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA
Contractor.
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 uniLs)
New Res (3+uniLs)
Pool / Spa
Ligh6ng Fixts
Recept OuOets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 7000a
Service over 1000a
Motors to 1 hp
Motors l0 10hp
Motors to 50hp
OWNER-BUILDER
Phone: 714-034-2840
Zip 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 000000
ISSUED BY:
Status:
Applied:
Issued:
ISSUED
07/15/2005
07/15I2005
SCOPE OF PERMIT
CONSTRUCT 366 SF ADDITION, WHICH WILL INCLUDE A 169 SF EXTENSION TO EXISTING LIVING
ROOM AND A 197 SF EXTENSION TO EXISTING BEDROOM. ALSO CONSTRUCT 93 SF COVERED ENTRY
PORCH. INERIOR REMODEL OF EXISTING KITCHEN AND REPLACE ROOF OF EXISTING ENTRY WAY,
CREATE NEW WIC WITHIN EXISTING BEDROOM. REFRAME GARAGE ROOF.
REF: B05-00831
25 LIGHT FIXTURES, 160UTLETS, 13 SWITCHES, 1 SERVICE T0200A
$23.50
$0.00
so.00
$0.00
$0.00
$0.00
$25.65
$17.60
$14.30
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
0
0
0
25
16
73
0
0
1
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up l0 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
� Cirws ( gen or ride)
Circus (mech ride or lights)
Chnstmas Tree Stand
Fireworks Stand
Quantity
$0.00 0
so.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
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
NOTICE: The work authorized by this permit 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 it work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell
requlred Inapectlona and final approval must be obtalned. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
26C6d8 (&00)
WORKERS' COMPENSATION DECLAHA710N: --
I hereby eHirm untler panelty of perjury one of the following declaratlons:
❑ I heve entl will m6intein e certifiwte of cansent to self-Insure far workers' campensetion, as proWded for by sedlan 3700 0l the Lebor Catle, for the pertortnence of Ihe
work for which ihis permit is issued.
❑ I heve erW will mainWin wwkers' compensa6on insurance. az requiretl �y seclion 3700 oi ihe LaEor Cotle, tor Ihe pertartnance of Ihe work for whkh this pertnit i5 iswetl.
My workers' compensatlon Insurence cartler end policy number are:
Certier: Policy Number.
(This secNon need not be comp/eted il (he pertn/f is velued et one huntlred dollers ($100) or Iess.J
�� certify that in the peAortnance ot Ihe work for which this pertnit is luuetl, I shall not employ eny person in any menner so es to becoma sublect lo ihe workers'
compensation laws af Caltlo ia, end egree that II I shoultl become sub�ect to t�e workers' compensation proNsions o1 Sectio 3700 of the Lehor Code, 1 s�all torthwith
comply with thesa,proN(.ip�s �I I �_����
q��:�� M 1l1
SI ,- Nre' /'F�96�� De�le`��
WARMNO: FAILURE TO $ECURE WORKERS' COMPENSATON ODVERAGE IS UMAWFUL AND SMALL SUfl1ECT AN EMPLOYER TO CRIMINAL PEWILTIES AND CML FlNES UP TO ONE HUNDRED
THd15AND DOLLARE (5104W�I. �N ADDITION TO THE OOST OF OOMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SECTION 3)080F TNE LABOR CODE, INfEFEST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eNirm that I em licensetl under provlsions of Chapter 9(commencing with Section 7000) of Division 3 of the Busineu and Professions Cotle, end my Ilcense is in full
larce entl ettect. Lic. # Class a
Contractots SlgnaNre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirm tha� there is a consWction lending egency For ihe pedortnance of the work tor which Ihis pertnit is issued. (Sac. 3097, Civil Code).
Lentlers Name: Lentlers Atltlress:
Signeture: Date:
OWNER-BUILDEp DECLARATIONS:
I hereby eXirm Ihat undB� penatly of pe�ury Ihat I am E7(EMPT FROM THE CONTRACTOHS LICENSE LAW tor the following reason (Sec. 7031.5, Business enC Professions
Cotle: Any ciry or counry which requires a permit to construct, alter, improve, tlemdish, or repair eny siructure, prior to Its issuance, elso requires t�e applicant for such permit
ta tile e signetl statemer�� ihet he ar she Is Ilcensed pursuent to ihe proNsions oi the Contractars Llcense Lew (Chapter 9(commendng with Section 7000) oi DlNslon 3 of ihe
eusiness end Pmfassions Code) or that he or she is exempt iharelrom entl the basis for tha alleged exemplion. Any vlolation of Secdon 7031.5 Dy eny applicant for e permlt
subJects the applicant to e civll penelry of not more ihan five huntlretl dollers ($500).):
❑ I, es owner of ihe properry, or my employees with wages as t�elr sole compensatlon, WILL DO THE WORK, and the structure Is not intendetl or oNered 1or sale (Sec.
7044, Business end Professions Code: The Conirectors License Lew does not apply to an owner of properry who builtls or Improves Iheraon, and who tloes such work
himself or herself ar thmugh his or her own emplayees, provi0etl thet such impmvements ere not Intended or oHered tor sale. If, however, Ihe 6ulltling or improvement is
��.�- �sold within one yedr of completion, the owner-builder will have the burden ot Droving thet ha or she did not builA or improve lor purpose of sele.�. �
�q as owner ot the pwperry, am E%CWSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Professlons
Cade:lTe coNrec�ors License Law tloes not eppty to en owner of proDerry wha builtls or impmves thereon, entl who contrads tor such prqec� with a cantractor(s)
license pursuant to the Conirectors License LewsJ.
❑ I am.9xempy�nAeA sec. Business entl Professions Code for Ihls reason:
ID verified by dnvals license. ❑ Yes ❑ Na
VeriTicetion o1 Ownership by (type ot tlocument, t.e. - properry tax biil or tleed)�.
DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION:
❑ I hereby certify t�a� no excavation five (5) or more feet In depth Into which a person Is requiretl to descend, wlll he matle In connection with work authonzetl by Ihis
pertnit, end that na bullding structure, scaHoltling, falsework, or demolition or tlismantling thereol, will De more then thirty-six (36) feet high. (C�ep. 32. Grp 2, Art 2, Sec.
341, Title e, Califom�a Atlministrative Code).
❑ As ownao-builtler, � will not employ enyone to do work which would require a pertnit irom �he Dlvision ol Intlustdel Setery, as notetl ebove, unless such peraon hes e
permit to tlo such work irom Ihe diNsion.
Signature: Date:
Division ol Industrial Sefery Permit Numbar:
CERfIFlCATE OF COMVLLINCE AND AUTHORVATON OF ENTRV: I ceniy under penalry of perjury that I have read this eppliwtion antl stele thet Ihe infortnation given Is
conect I egree to compy with all slete laws end Ury ordinances reletlnp ro Duilding construction, entl euthorize representaWes of the Ciry ot Costa Mesa to enter upon t�e
above-descnbetl property �or inspeclion purposes. I agree not to occupy or allow occupancy of any building authorized by Ihis permi� until final inspection.
COOE /. INSPECTIONTYPE
1616 Fixetl System F,inal Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Flnel BIocWReta�ning Wall
202 Flnfll Fedory Fi�e Place
203 FInaI5lpn
204 Finel Demolllla�
PdIE II�dLi
�j}p�a INSPECTIONTYVE
206 Final Mechanical
208 Final Plumbing
210 Final Electdcal
212 Flnal Fire Praventlon
220 Flnel Planninp Approvel
222 Flnel Slte
250 Finel BuildlnyOccupency
I��
/
�S
(714) 754•5273 • F9X (714) 754-4856 • YAVw.CI.COSt9•fn858.Ce.U9 77 FAIF DFNE, GU51 A MtSA, GA yZtiZti
MECHANICAL PERMIT
Job Address: 2834 ELLESMERE AV
Suite No
Vicinity:
Parcel Number: 13933409 �
Applicant: DIETERMANN, MARGARET
Address: 2834 ELLESMERE AVE
COSTA MESA, CA
Owner: DIETERMANN, META H
Address: 2834 ELLESMERE AVE
COSTA MESA, CA
Co ntractor: O W N E R-B U I LD E R
Address:
Phone: 714-434-2840
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 07/15/2005
Issued: 07/15/2005
ISSUED BY:
SCOPE OF PERMIT
CONSTRUCT 366 SF ADDITION, WHICH WILL INCLUDE A 169 SF EXTENSION TO EXISTING
LIVING ROOM AND A 197 SF EXTENSION TO EXISTING BEDROOM. ALSO CONSTRUCT 93 SF
COVERED ENTRY PORCH. INERIOR REMODEL OF EXISTING KITCHEN AND REPLACE ROOF OF
EXISTING ENTRY WAY, CREATE NEW WIC WITHIN EXISTING BEDROOM. REFRAME GARAGE
ROOF.
REF: 805-00831
1 REPAIR/ALT COOLING/HEAT, 1 HOOD W/MECH EXHAUST, 1 VENT FAN/SINGLE DUCT
ISSUE FEE
Inst FAU <100 k BTU
Insl 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
Insl or Relocate Appl Vent
Air Handlers < 10000cfm
$23.50
$0.00
$0.00
$13.70
50.00
$0.00
$0.00
$0.00
$0.00
$10.65
$0.00
$7.25
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
0
0
1
0
0
0
0
0
1
0
1
0
0
0
0
0
FEESUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial I ncinerator
Domestic Incinerator
Comoressors / Absorption Systems
Upto3hp/100kBTU
3 To 15 hp ! 500 k BTU
15 To 30 hp / 1,000 k BTU � �
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3To15hp
15 to 30 hp
30 to 50 hp
Quantiry
$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
NOTICE: The work aulhorized by this pertnit shall comply with all applicable handicap access requlrements under Califomia statutes and related
regulations. (Ord. No. 92•28, § 1, 12•21-92)
EXPIRATION: This pertnit shall eutomatically expire and become voitl if xrork is not commenced withln iB0 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 xrork must comply with all appiicable codes, and all
requlred InepecUone and final epproval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this pertni�
FOR INSPECTIONS CALL: (714) 7545628
zaae�ae (arool
WORKERS' COMPENSATION DECLARA710N:
I hereby aNirm under penelry of perjury one of ihe follawing Oecleretions:
❑ I have and wlll meintein a certiflcate of consent to selbinsure tor workere' compensetion, es proNded for by sectlon 3700 ot the Lebor Cotle, for the pertortnence of Ihe
work 1or w�lch thls permit is issued.
❑ I have enA wlll maintain wwkers' compensetion insurance, es requiretl by sectlon 3700 of the Lebor Cade, for t�e peAortnance ot Ihe work for which Ihlq pertnll Is Issued.
My workars' compensation Insurence cartier arW polcy number ere:
Cerrier. Policy NumEer
(7hls sectiwn nee0 not be canplete0 il the permif is velued ef one hundred dW/ers ($100) or /ess.J
�1 I certity that in Ihe perfortnance of Ihe work ror which Ihis pertnit is issuetl, I shall not employ eny person In eny manner so as to become sub�ect to the workers'
�`� compensation lews ai Callfomla, end egree that it I should become sub�ect lo the workers' compensellon provislons of ectiop 3700 0l lhe Labor Coda, I s�all forthwith
"��'`y� Bs���a���— �� � I s� Zuv S
0 �•
WARNINO: FAILURE TO S CURE WORI(ERS' COAIPENSAPON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYEH TO CRIAUNAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED
TFIOUSFND OOLLRRE (E100,OW). IN AOOfTIqJ TO THE G�T OF COMPENSATION, �AMAGES AS PROVIDED fOR IN SELTION 37080F THE LABOR CODE, ItJrEREST, AND ATfORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm Ihat I em Ilcensed under provlslon8 oi Chepter B(commencing with Section 7000) of Divislon 3 ot Ihe Busineu and Professlons Code, and my Ilcense is in full
farce end eflecL Llc. a Clau a
Contredols Signature: Date:
CONS7RUCTION LENDING AGENCY:
❑ I here6y aHirtn that there Is a constructlon lending agency for the pertormance of Ihe work lor whlch ihls pertnit is Issuetl. (Sec. 3097, Clvll Code).
Lentlets Neme: Lendels Atltlress:
� Signeture: Date:
OWNER-BUILDER DECLARA710N5:
I hereby eHlrtn �het under penalry of perjury �het 1 am EXEMPT FROM THE CONTHACTORS LICENSE LAW tor tha following reason (Sec. 7031.5, Businass entl Protessions
Code: Any city or counry which requires e parmit to consVuct, alter, improve, demolish, or repair eny eUucture, pnor to Its issuance, elso requlres ihe epplicant for such pertnit
b tlla e signed stetement that he or she Is Ilcensea pursuent to the provislons of t�e Contractors License Lew (Chepter 9(wmmencing with Sealan 7000) 01 Dlvision 3 of Ihe
Business end Professions Code) or that he or she is e:empt iheretrom end the basis for ihe elleged exemptlon. Any violation of Sectlon 7031.5 by any epplicent far a pertnit
subjeds tha epplicent to e civil penalry of not more then five hunAretl tlollars ($500).):
❑ I, as owner ot t�e property, or my employee5 with wepes es their sole campensation, WILL DO THE WORK, entl the structure is not IntenCed ar aHeretl for sele (Sec.
7044, Business flnd Professions Code: The Contractars License Law tloes not eppty lo an owner ol property w�o builtls or improves thereon, end who does such work
himself or hereelf or throuqh his or her own Bmployees, providetl ihe� such Improvements ere no� Intended or oMeretl for sale. H, however, the building or improvement is
sold wilhin ane year of comple�ion, the owner-builder will have the burtlen of proving that he or she did not build or improve for Durpose ol sele.). '
�.����s owner o1 the properry, am EXCLUSIVE�� CONTRACTNG WIiH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Buslness end Professions
✓Code: The cantractars License Lew tloes noi eppty to en owner at pmperry w�o bullds or improves thereon, and who contrects tor such pro�ect wl�h a wntrectar(s)
license pursuant ta Ihe Coniractore License Laws.).
❑ I em exempt p�der ac. Business end Prolessians Cotle for Ihis reemn:
� gna� �;�Aa� - �Da�e�f�
Owner ID vedfied by tlnvefs license. ❑ Ves ❑ No 0�.7s LYcens4�No. �E� res: U
Verlficetlan of Ownership by (type of tlocument, i.@. - D�oDorty taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CHAPFICATON:
❑ I hereby certlly ��et no excavetion fNa (5) or more leat In depth into which e peroon is required lo descentl, will be matle In connactlon wit� work authorized by this
pertnit, end thet no building structure, scefloldinp, falsework, or demolition or dismantling Ihereo�, wlll be more than thir�y-six (36) tee� hlgh. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Tltle B, Celifomla Administretiva Cade).
❑ As owner-builder, I will not employ anyone to do work which would reQuire e pertnit from the Division of Industriel Sefery, as noteA ebrne, unless such pereon hes e
pertnit to tlo such work trom tha division.
Signature: Date:
Division oi Industnel Safery Pertnit Number:
CEHTIFlCATE OF COMPLIANCE AND AUTHORIYAnON OF EMAY: I cenify under penalry ot per�ury that I �ave reatl this epplication entl slete that the inlormetlon given is
cortecL I egree to compty with all slete lews end �Iry ordinances relating to builtlinp constmction, end euthodze representetives of the Clry ot Costa Mese to enter upon the
ebove-describetl property tor inspection puryoses. � egree not to acupy or allow occupenry ot eny building euthorized by this pertnit until final inspection.
COUE �. INSPECTION TYPE
1618 Fixed Syslem Final Fire Preventlon
1268 Pool SDe Flnal
200 Final Re-Roof
201 Final BIocWRelaining Wall
202 Flnal Fectory Fire Place
203 Flnal Slpn
200 Finel Demollllon
�E
�} �QQ� IN9PECTONTYPE
208 Finel Mec�enical
208 Final Plumbing
210 Final EleCtriCal
212 Flnel Flre Preventlon
220 Flnal Planninp Apprwel
222 Flnel Site
250 Final Building�Occupancy
.un_:
���
(��4) 754-5273 • Fex (71a) �54-4856 • www.cl.costa-mesa.ca.us 77 hAIH UHNh, GO51 A MtJN, l:A tlZtiZO
Job Address: 2834 ELLESMERE AV
Suite No
Vicinity:
Parcel Nunmber: 13933409
Applicant: DIETERMANN, MARGARET
Address: 2834 ELL�SMERE AVE
COSTA MESA, CA
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA .
Contractor:
Address:
ISSUE FEE
Backflow irrigation
BackFlow Preventei
Bathtub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Dnnking Fountain
Expansion Tank
OWNER-BUILDER
PLUMBING PERMIT
Phone: 714-434-2840
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 000000
ISSUED BY:
Status: ISSUED
Applied: 07/15/2005
Issued: 07/15/2005
SCOPE OF PERMIT
CONSTRUCT 366 SF ADDITION, WHICH WILL INCLUDE A 169 SF EXTENSION TO EXISTING LIVING
ROOM AND A 197 SF EXTENSION TO EXISTING BEDROOM. ALSO CONSTRUCT 93 SF COVERED ENTRY
PORCH. INERIOR REMODEL OF EXISTING KITCHEN AND REPLACE ROOF OF EXISTING ENTRY WAY,
CREATE NEW WIC WITHIN EXISTING BEDROOM. REFRAME GARAGE ROOF.
REF: BOS-00831 � " �
1 BATHTUB, 1 CONNECT (ICE, SODA), 1 DISHWASHER, 1 GAS OUTLET (1-0), 1 KITCHEN SINK,
1 WASH 9ASIN, 2 WASTE 8 VENT, 1 WATER CLOSET, 1 WATER HEATER/VENT, 1 WATER PIPING
(INST/REP) �
AMT
523.50
$0.00
$0.00
$9.80
$0.00
S9.80
50.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
�N
FEE SUMMARY
Laundry Tub / Washer
Landscape Irngation
P-Trap
Pressure Regulator
Process Piping (per 10 ft)
Receptors
SepticTank
Sewer Cap for Demo "
Sewer Connect
Sewer Privale Line
Shower
Sink, bar .,
Sink, commercial -
AMT
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
30.00
50.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
SumpPump
Swimming Pool
Trap Primer
Unnal
Vacuum Brkr BkFlow(1-0)
�Vacuum Brkr BkOow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$19.60
$9.80
$12.30
$9.80
$0.00
QTY
0
0
0
0
0
0
1
0
2
1
1
1
0
NOTICE: The work authorized by ihis pertnit shall comply with all applicable handicap access requirements under Cali(omia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this peimit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlons and tinel approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 �
saaa+e �sioo�
WORKERS'COMPENSATON DECLARAnON:
I hareby eftirm under penalty of perjury ona of ihe �ollowing tlecleretions:
❑ I heve entl wlll maintain e certificete ot consent to setl-Insure for workers' compensatlon, es proNded for by section 3700 of ihe Lebar Code, for the pertartnence of Ihe
work for which this permit Is IssueO.
❑ I have entl wlll meintain workers' compensetlon Insurance, as required by sectlon 3700 of Ne Lebor Cotle. tor the paAortnance of Ihe work tor which this pertnit is issued.
My workers' compenution Insurence carrler end pollcy number ere:
Certier. Policy Number.
(,�T,h[/s section neerl nof be comp/efetl il Ne perm/t is velued af one hunered dWlars (5100) o� Iess.J
�� 1 certify Ihat in Ihe peAortnanca of the work tor which ihis permit is issueG, I shall not employ eny person in any menner so es to 6ecome subjed to ihe workers'
compensation lews of Calitomie, end egree ��a� tl I ahoultl become sub�ect to t�e workers' compensation provislons ol Section 700 0l the Lebor Catle, I ahall tonhwlth
comply wlih these pra ' ion 1
Aco�a.nt,-� Sif gneture � a..n-� �oate.� J IC LJJ�
WARNING: FAIWRE TO SECURE WORKERS' C1kAPENSATION LUVERAGE IS UNIAWFUL AND SFULL SUBIECf AN EMPLOYFASTO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED
THOUSAND OplARE (E1Q0,000), IN ADDITION TO THE W�+T OF COMPENSATIIXJ, DAMAOES AS PHOVIDE� WR IN SEGTON 31O80F THE LABOF CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm Ihel I em Ilcensed under pravlsions oi Chepler B(commencing wlth Section 7000) ol Divislon 3 of Ihe Busineu end Prolessions Cotle, and my Iicense Is In full
lorce enG eftecL LJc. p Gass q
Cantractofs SlgneWre: Date:
CONSTRUCTON LENDING AGENCY:
❑ I hereby eMirtn ihet Ihare is e conslruction lending agency for ihe performance of ihe work far whic� ihis pertnil is issuetl. (Sec. 3097, Civil Code).
Lendels Name: Lentlers Address:
Signeture: Date:
OWNER-BUILDER UECLARATIONS:
I �ereby aNlrtn ihet under penalry of per�ury Ihat I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business entl Professlons
Coda: Any city or county which requires e pertnit to construc�, elter, improve, tlemolish, or repeir eny shucture, prior ta Its Issuence, elso requlres the eppliwnt for such pertnit
to file e signed stetement that he or she Is IlcensBd pursuent to the provisions ol tha Contractors Llcense Lew (Chepter e(commencing wlth Sectlon 7000) of DMSIon 3 oi [he
Business flnG Profe55ions Code) or that �e or she �5 exempt therefrom an0 the be5i5 for Ihe ellapetl exempUon. My Ndation of Sectbn 7031.5 by any epplicent for e pertnil
sub�ects the epplicant to e civil penelry ol nat mara than five hundred dollers (5500).):
❑ I, as owner of �he praperry, or my employee5 w�th wages as their sole compenselion, WILL DO THE WORK, end the structure Is not IntenAed or aHeretl tor sale (Sec.
7064, Business end Protessions Cotle: TTe Contrectors License Law tloes not eppty to an owner of property who builtls or improves thereon, flnd who does such work
himself or herselt or through his w �er own employees, pravided ihat such Improvements ere no� Intended or otteretl for sale. If, however, Ihe building or improvement Is
sold within one year at completion, the own@�-bulltler will have the burtlen of proving ihet he or she tlid not build ar improve tor purpose of sale.). '
I`'as owner of Ihe property, am EXCLUSIV6LY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe projact (Sec. 7044, Business end Professions
t �Code: The comrectors License Lew tloes noi apply to en owner of property who bullds or Improves ihereon, antl who contwas for such proJect with e contrector(s)
license pursuent to the Conirectore lJcense L.ews.). ,
❑ I em exempJ,undqr sec.
Dy tlriver's license. ❑ Ves ❑ No
Business antl Professions Code lar Ihis reason:
Vedficetlon ol Ownership by (rype of document, I.d. - praperty tex bill or tleed):
DIVISION OF INDUSTAIAL SAFETV PERMR CEAnFICATION:
❑ I hereby cerlify Ihat no excavation five (5) or more leet In depth into which e person is requlreC lo descend, will be matle In conneclion with work authorized by ihls
pertnit, and Ihat no building structure, scaHdding, falsework, or demolilion or dismantlinp ihereot, will be more than ihirry-slx (38) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Califomia Adminlstrative Code).
❑ As owner-builder, I will not employ enyone to tlo work w�ich would requlre e pertnit trom t�e Division of Industrial Setery, es notetl ebove, unless such peraon hes e
partnit to do such work from the tlivision.
Signature: Date:
Division of InAustriel Safery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUfHORVATON OF ENfAY: I cehity under penelry of perjury ihat I have reatl thls epplication and stete that the Infortnation given Is
conect I egree to comply with ell slete lews end Gry ordlnences relating to 6uilAing conswction, end authorize representetives of t�e Clry oi CosW Mese �o enter upon t�e
ebove-tlescribed property tor inspectim purposes. I egree not to occupy or ellow ocwpenty ot any Duilding authorized by this pertnit until final inspection.
CODE I. INSPECTIONTYPE
1616 Fiaed System Final Fire Prevention
7268
200
201
202
203
Pool Spa Finel
Finel Re-Roof
Fl�al BIocWRalaining WaU
Final Fectory Fire Place
Finel Sign
204 Final Demolltlon
7dIE
U�L4
COOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Electricel
212 Final Fire Prevention
220 Final Planning Approval
222 FIneI5lte
250 Flnel Bulldinp/Occupancy
�. � .iw. :
l�%i -�
(714) 754-5273 • Fax (71q) 754-4H56 • www.d.costa-mesa.�. +�LDING PERMIT �� FAIR DRIVE, COSTA MESA, GA 92626
Job Address: 2834 ELLESMERE AV
Suite:
Viciniry:
Primary Occ: R3
Parcel Number: 13933409
Applicant: MARGRET DIETERMANN
Address:
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA
Contractor OWNER-BUILDER
Address:
Zip:
Arch : STANLEY ANDRADE
Address: 24501 DEL PRADO
D-1
DANA POINT
Zip: 92629
Type of Construction: VN
Zoning: R1
Phone: 714-434-2840
Zip:
Phone:
Zip: 92626
Phone:
License: 000000
Eng:
Address:
Phone; 949-248-2684
License; C01897�
ISSUED BY:
Status: ISSUED
Applied: OS/26/2005
Issued: 07/13/2005
Phone:
License:
SCOPE OF PERMIT
CONSTRUCT 366 SF ADDITION, WHICH WILL INCLUDE A 169 SF EXTENSION TO EXISTING LIVING ROOM AND A 197 SF EXTENSION TO
EXISTING BEDROOM. ALSO CONSTRUCT 93 SF COVERED ENTRY PORCH. INERIOR REMODEL OF EXISTING KITCHEN AND REPLACE
ROOF OF EXISTING ENTRY WAY,
CREATE NEW WIC WITHIN EXISTING BEDROOM. REFRAME GARAGE ROOF.
SFD TO REMAIN AS 3 BEDROOM, 2 BATHROOM.
PLANNING:
LOT SIZE = 7,500 SQ.FT.
RESIDENCE + GARAGE = 2,691 SQ.FT.
DRIVEWAY = 843 S�.FT.
LOT COVERAGE = 47% (3,534 SQ.FT.) �
OPEN SPACE _ $3% (3,966 SQ.FT.) '
EXISTING REAR YARD COVERAGE = 9% (130 SQ.FT./1,500 SQ.FT.)
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
$532.19
$818.75
$7.50
$0.00
$0.00
$0.00
$1,358.44
FEE SUMMARY
Calc Valuation: $�s,000.00
Claim Valuation: $�5,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXRIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonetl
Por a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeelions end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zans�as �eroo)
WORKERS'COMPENSAnON DECLARAnON:
I hereby eHirm untler penalty oi perjury one of the tollowing declarations: ,. .
❑ I heve end will melnteln a certificate oi consent ta self-Insure for workers' compensetlon, es provided br by sectlon 3700 of tha Le6or Cotle, tor the pertarmence of the
work for which thls permit is issued.
❑ I have entl will maintain workers' compensation Insurance, es required by seclion 3700 of the Lebor Cotle, for the pertortnance of the woAc for which Nis pertnit Is issued.
My workers' compensatlon Insurance certler and policy number ere:
Cartier: Policy Number:
(lhis sectlon need not 6e comp/efed il Ne permi! is valoed at one huntlretl tlollars ($f00) or /ess.J
{� I certify that in Ihe peAormanca of t�e work �or which this pertnit is issued, I shall not employ eny person in any manner so as to hecome subjact to ihe workers'
compensation lews ot Califomia, end egrae that if I should become subJect to the workers' compensation provisions of Sactlon 3700 of ihe Lebor Cotle, I shell torthwith
comply with Ihes^a��o('�ion
Ap Iicent .�n�re':"' YrI:.VI1 Dete: �`�� Zl7'l7�
WARNING: FAILURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AN� GVIL FlNES UP TOONE HUNDRED
T/qUSAND DOLLARE (E100,OOO�.IN ADDfiiIXJ TO THE G�T OF COMPENSATIIXJ, UAMAGES AS PROVIDED FOR IN SECTIIXJ 31O60F THE LABOR CODE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm �hat I em Ilcensed under provisione of Chapter 9(commencing with Sectlon 7000) ot Division 3 of ihe Business antl Professions Cotle, and my license is in tull
force end aHacL Lic. # Cless k
Contractor's Signature: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm thet Ihere is a conslruction Ie�tling agency for Ihe pedormance of the work for which this pertnii is issuetl. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signeture: Date:
OWNER-BUILDER DECLARATONS:
I here6y aHirtn ihat under penelry of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires a permit lo construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe flpplican� for such permit
to file a signed statement that he or she is IlcensBtl pursuant to the provislons of the Contrectors License Lew (Chapter 9(commencing with Seclion 7000) oi Division 3 of ihe
Business and Professions Code) or that he ar she is exempt therefrom and the basis for the alleged exemption. Any violation of Sedlon 7031.5 by any epplicent for e permit
suhjec�s �he applicent to a civil penalty of not more then tive hundred tlollars ($500).):
❑ I, as owner of ihe property, or my employees with wages es thelr sole compensation, WILL DO THE WOflK, antl the stmclure Is not intantled or ofleretl for sale (Sec.
7044, 8usiness and Professions Code: The Contractore License Law dces not apply to an owner of properry who builds or improves ihereon, and who does such woAc
himself or hersetl or through his or her own employees, provitlatl that such impmvements are not intended or oHered for sale. If, however, the building or improvement is
�soltl within one year of completion, the ownB�-builder will heve ihe 6urden of proving ihat he ar she did not build or improve for purpose of sale.).
I, ss ovmar ot tha property, am EXCLUSIVE�Y CONTRAC�7NG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Profeuions
Cotle: The comrectors Llcense Lew tloes noi aPPty to an owner of property who builtls or Improves thereon, and who coniracts for such project with e contracmr(s)
license pursuant to ihe Coniractars License L�ws.).
eu5iness end Professions Cotle for thi5 reason:
Owner ID verifiad by driveYs license. ❑ Yes ❑ No
Vedlication ot Ownership by (rype of document, I.e. - properry la�c bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CEAnFICATION:
❑ I hereby cetlify that no excavation five (5) o! more teet in dep�h Into which e person Is required to descentl, will be made in connectlon with work euthorized by this
permi4 and ihat no building structure, sceHolding, talsework, or tlemolition or dismantling ihereof, will ba more ihan Ihirty-six (36) feet hiqh. (ChaD� 3.2, Grp 2, Art 2, Sec.
341, Ttle 8, Celitomla Atlminisiretive Cotle),
❑ As awner-builder, I will not employ anyone to do work which would require a permit from ihe Divislon of Indusirial Safery, as notetl above, unless suc� person has e
permit to tlo such work from ihe tlivision.
Signature: Date:
Division of Induslnel Sefety Permit Num6er:
CERTIFICATE OP COMPLIANCE AND AUh10RIRAnON OF ENfAY: I certify under penelty of perjury thet I heve read [his epplicetion end state that ihe Information givan is
wrrect. I egree to wmply with all state lews end ciry ordinances relating to building consWctlon, end euthotlze representetives of ihe City of Costa Mesa to emer upon the
ebove-tlescribed properry tor inspection purposes� � agrae not to occupy or allow occupency of eny building euthorized by this permit until finel inspection.
Ot Legal
CO�E 1. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
12fi6 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202
203
204
Finel Fectory Fire Place
Finel Sign
Finel �emolllion
t� � 2 � ate
�Dete
CO�Et INSiECTIONTYPE j1�, �$
206 Final Mechenical
208
210
272
220
Final Plumbing
Final Eletirical
Finel Fire Prevention
Flnel Planning Approval
222 Finel Site
250 Flnel Bullding/Occupenq
1.. y
(7/4) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, C:A 92Ei'LEi
BUILDING PERMIT
Job Address: 2834 ELLESMERE AV
Suite:
Viciniry:
Pnmary Occ: R3 Type of Conslruction: VN
Parcel Number: 13933409 Zoning: R1
Applicant: MIGUEL BARRUETA
Address: 24981 DANA POINT HARBOR DRIVE ,
Owner:
Address
Contrector.
Address:
DANA POINT, CA
DIETERMANN, META H
2834 ELLESMERE AVE
COSTA MESA, CA ;
Phone: 949-248-2684 X111
Zip: 92629
Phone:
Zip: 92626 �
Phone:
ISSUED BY:
StaWs: ISSUED
Applied: 05/26/2005
Issued: 07/13/2005
Zip: . � .� License:� . � _ ,
`
Arch : STANLEY ANDRADE Eng: '
Address: 24501DELPRADO � - � Address: �
D-1 � � Phone: 949-248-2684 - . Phone:
DANA POINT . - �
Zip: 92629 �� License: C018971 , � license:
• ' SCOPE OF PERMIT - -'
CONSTRUCT 366 SF ADDITION, WHICH WILL INCLUDE A 169 SF EXTENSION TO EXISTING LIVING ROOM AND A 797 SF EXTENSION TO
EXISTING BEDROOM. ALSO CONSTRUCT 93 SF COVERED ENTRY PORCH. INERIOR REMODEL OF EXISTING KITCHEN AND REPLACE
ROOF OF EXISTING ENTRY WAY, �
CREATE NEW WIC WITHIN EXISTING BEDROOM. REFRAME GARAGE ROOF. �
SFD TO REMAIN AS 3 BEDROOM, 2 BATHROOM.
PLANNING:
LOT SIZE = 7,500 SQ.FL ' � - , .
RESIDENCE + GARAGE = 2,691 SQ.FT. - - - � , �
DRIVEWAY = 843 SQ.Ff. � ' ' � -
LOT COVERAGE = 47% (3,534 SQ.FT.) • , � - ' " �
OPEN SPACE = 53% (3,96fi SQ.FT.) � ' ' . � , � - �
EXISTING REAR YARD COVERAGE = 9% (130 SQ.FT.N,500 SQ.FT.) � .-
� � FEE SUMMARY -
Plan Check: $532.19 � � � � Calc Valuation: . �, g7s,000.00
Permit: � � � $818.75, � , � �� � ClairrrValuation:;' 8�5,000.00
SMIP Res: ��.$7,50�, � '; �
SMIP Com: �-$0.00 �
Other: $0.00-
Inspection: $0.00
Total: $1,358.44
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under
regulations. (Ord. No. 92-28, § 7, 12-21-92)
and related
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is sy�pended or abandoned
for a penod of 180 days.
INSPECTIONS: In order for the work authorized undei this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeclions and final approval must be obtained. Failure to obtain inspectioris�and final approval will resul� in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zaasns�doo)
WORKERS'COMPENSAnON DECLAHAnON:
I hereby eHirtn under penalry oi perjury one oi ihe following tleclarations: ,_
❑ I heve antl will melntaln e cenificale of consent to self-Insure for workere' compensatiah, es provided for by section 3700 of the Lebor Code, for the pertortnence of tha
work for which this permit Is issued.
❑ 1 have anG will maintain workars' compensetlon Insurance, as required by saction 3700 oi the Lehor Code, for ihe pertortnance ot Ihe work Por which t�is permit is issuetl.
My workere' compensation Insurance carrier and policy number ere:
Cartier. Policy Number.
(This section need not be cromp/eted il fhe peimif is veluetl at one hundred dollars ($100) or less.)
❑ 1 certify that in t�e pertormance of tha work tor w�ich ihis pertnit is issuetl, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws oi Celifomia, antl agree ihet ii I shoultl hecome sub�act to the workers' compensetlon provisions oi Section 3700 oi ihe Lebor Cotle, I shall forlhwit�
comply with ihese provisions.
Applicent Signature: Date:
WARNINO: FAILURE TO SECURE WOFKERS' COMPENSATIqJ COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED
TNOUSMID OOLLARE ($100,000J, IN ADDRION TO THE COST OF COAIPENSATION, �AA41GE5 AS PROVIDED FOR IN SECTIIXJ 3]W OF THE LABOR CODE, IPIrEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON: �
I hereby aHirtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my licensa Is in full
force entl eNect Lic. # Class q
ConirecroYs SignaWre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihet there is a construction lentling agency for the peAormance ot Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lentlefs Address:
Signature: Date:
IOWNER-BUILDER DECLARATIONS:
I hereby aHirtn ihat under penelry of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Professions
� Code: Any ciry or county which requires a permit to consfrucL alter, improve, tlemolish, or repair any structure, prior to ils iuuance, also requires the applicam for such permil
ta file a signed statement that he or she is licensetl pursuant to Ihe D��slons af the Cantractors lJcense Law (C�apter 9(commencing with Secllon 7000) of Division 3 of the
Busineu end Professlons Code) or ihat he or she is exempt t�eretrom and ihe basis for the alleged ezemption. Any violetian of Sedion 7031.5 by any applicant for e pertntl
sub�ects Ihe epplicant to a clvil penelry of not more ihen five hundred dollare ($500).):
❑ I, es owner of ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, and the siructura is not inten0etl or oHerad tor sale (Sec.
7044, eusiness antl Professions Code: The Contradors License Law does not apply to an ownar of properry who builds or improves thereon, end who does such work
himself or hersetl or thmugh his or her own employees, provided that such ImprovemeNs ere nat intended or oNered for sale. It, howaver, �he building or improvement is
�soltl wit�in one year of completion, Ihe owner-builder will have ihe burden of proving that he or she did not build or improve tor purpose of sale.).
I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions
Cotle: The contractors License Law tloes not epply �o an owner ot pmpeny who builds or improves thereon, end who comracts for such projed with a comractor(s)
licensa pursuant ta tha Contractors License Laws.).
❑ exem t er s. eusiness end Pmfessions Code for this reason:
atur .
er ID veniietl by tldve/s license. s ❑ No i fs Lic se Na �
Verification ot Ownership by (type of document, i.e. - property taz 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
Expire :
❑ I hareby certify �het no excavetion five (5) or more teet in depth into which a person is requiretl Io tlescentl, will be mede in connection wiih work euthonzed by Ihis
permit, and Ihat no Duiltling sirucWre, scaHolOing, falsework, or demolition or dismantling ihereof, will be more than �hirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Title B, Califomle Adminisirative Code).
❑ As owner-huilder, I will not employ anyone to do work which woultl raquire a parmit trom the Division of Industriel Setety, as noted ebove, unless such person has e
permit to do such work irom Ihe division.
SignaNre: Date:
Division of Intlusirial Satety Pertnit Number:
1 W ill the applicant or present or fuNre bulltling occupant naetl to file entl certify a eusiness Plen for emeigency response to releasa or threatened release of e hezerdous
materiel? ❑ Yes ❑ No
the Celifomi,
s et any ona
at a Business Plan be tiletl with Ihe Coste Mese Fire Depariment by every
equel to or greeter ihan e weigh� of 500 pountls, or a volume of 55 gallons,
(Section 25533 0l Ihe California Health and Sefety Cotle, with some exceptlons, requires registretlon wiih the Costa Mesa Fire Depariment by each business which et eny
one time has on hand e quantiry of acutely hazerdous meterials equal to or greater Ihan e weight of 500 pounds, or a volume of 55 gellons, or 200 cublc feet af
compressea gas at stentlard temperaNre end pressura).
................................................................................................................................................................................................................:.............................................................................................................................................................
Does or will the applicent or present or future building occupant need ro prepare an RMPP (Risk Management and Prevention Program for ecutaly hazardous matedals)7
L of the Califomia Healt� and Safery Coda provides Ihet the Costa Mese Pire Department may require the preparation, cenificetion end tiling with Ihe Fire
en RMPP by businesses which ere required to register ecutely hazartlous metedals with the Fire Depertment.
4 If an RMPP is presently requiretl, has Sectlon 25534 ot the Galltomla Heeltn anU Satery Gotle been fully complletl wrth7 U Ves U No
..................._.............................................._......_..................................................................................................................._....................................._......................................................................................................._...........
5 Daes or will t�e epplicant or present or tuWre builtling occupant reQuire for Ihe work which is Ihe subjecl of ihis e plication a gertnit for such wnstruction or
�rom Ihe South Caast Air Quali�y Management Disiria or from any other air polWtion coniml dlsMct or agencyl � Ves �J No
(Section 658502 of ihe Califomia Govemment Code requires that Ihe requested iniormation ba fumished on applications for non-residenlial building permits).
any part of the feciliry to be construdatl untler Ihis permit be withln 1000 feat irom ihe outer bountlatles of a school7 �J Ves U No
ies", the facili�y must meet the requirement ot Sections 25534 end 42303 of the Califomie Healih and Setety Coda).
................................................................._.................................................................................................................................................................................................................................................................................................
pertnit irom ihe South Coest Air Qualiry Menegement District or other air pollution control tlistnd or egency Is raquired for Ihe work which is the sub�ed of this
iwtion. have ell ol the disUasures prescdEetl by Califomia Health end Sefery CoOe Section 42303 been made9 ❑ Ves ❑ No
(If yes', atlach certificata ot comD�iance trom the aDPropnate air pollution wnirol ofticer).
GERTIFICATE OF COMPLIANGE: I certity that untler penalry oi perjury the intortnation given ebove is corred. I agree to comply with all state laws antl ciry ortlinences
regarding Hazardous Me�enals and Emiuions.
SignaWre: Date:
COOE �.
1616
1268
200
201
202
203
CATE OF COMPLUWCE AND AllTHORIZA710N OF EMAY: I certify under penalry of perjury that I have reatl this epplication end stata thet the informetlon given is
I agree to compy wilh ell state laws end ciry ordinances releting to building conslruction, entl eu�horize representa�ives oi Ihe Ciry ot Coste Mesa to enter upon the
escribed property tor inspection purposes. I egree not to occupy ar ellow occupancy ot any building authonzed by this permit until final inspeclian.
Owneqs)
INSPECTIONIVVE PdIE
Fizetl System'Final Fire Prevention
Pool Spa Finel� b
Final Re-Rooi � `�% `\=%��
Final BIocWReteining Wall
Final Fectory Fire Place
Final Sign
206 Final Demolitlon
f� 4QQf�( INSPECTIONTYPE
206 Final Mechanical
Final Plumbing
�g �
250 Finel Bullding/Occupency
(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job nddress: 2834 ELLESMERE AV
Suit@:
Vicinity:
Primary Oca Type of Construction:
ParcelNumber: 13933409 Zoning: Rt
App�icani: CLIFF SMITH
Address:
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA ".
Convactor COLBERT CONSTRUCTION
Address: 5200 IRVINE BL #391
IRVINE, CA
Zip: 92620
Arch :
Address:
Phone:
Phone: 774-585-0145
Zip:
Phone:
Zip: 92626
Phone: 714-585-4145
License: 395907
Eng:
Address:
Status: ISSUED
Applied: 07/11/2005
Issued: 07/11/2005
ISSUED BY: �
Phone:
2ip: License: License:
SCOPE OF PERMIT
DEMOLISH GARAGE WALLS AND ROOF IN PREPARATION FOR AN ADDITION, RE:BOS-00831
Plan Check: $0.00
Permit: $8325
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS
MAIN STRUC7URE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
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:
Right 0- 0
Right 0- 0
$3,000.00
$3,000.00
NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 tlays.
I INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end ell
required Inspeelioha end flnel epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zanc as (sroo�
WORKERS'COMPENSAnON DECLARAnON:
I hereby eRirtn untler penelry oi per�ury one oi ihe following declaretions:
❑ I heve end wlll mainteln e cenlficate ot consent to seli-Insure for workars' compensetion, es provided for by section 3700 of Ihe Lebar Code, lor the pertortnence of tha
work for which Ihis permit Is Issued.
❑ I have and wlll malntaln workers' compensaUon insurence, es requlretl by section 3700 of Ihe Lebor Cotle, for Ihe peAortnence ol the work lor which thls pertnit is issuetl.
My workers' compensatlon Insurence cerrler and policy number era: /
Cerrier: / Policy Number:
(This section need nof be completed i/ the perm/t /s veluetl et one hundred dollers ($100) or /ess.J
�I cenify that in the peAormance ol the work lor w � h ihls pertnit is Issued, I shall not employ any person In any menner so es to become subject to the warkera'
crompensetion lews ol Celifomle, en0 egree that i shou4 bewme subJect ro t�e workers' compensation provisions of SecNon 3700 0l Ihe Lebor Code, I shell torthwlth
camply with these provisi ns. /� '% //� !�
� Applicant Slgnature: � �/ / Date: ! ^/ � D �
WARNINO: FAILURE TO SECURE W ERS' COMPENSATION COVEMGE IS UNLAW FUL U SHALL SUBIECr AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO IXJE HUNDR,Fp'
THOUSAND �OLJ.AHE (5100,000), IN ADDITION TO THE CQST OF COMPENSATION, DAMACaES AS PROVIDED FOR IN SECTION 370fi OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
—I
LICENSED CONTRACTORS DECLARATION:
I hereby eMirtn ihet I em Ilcensed untler proNs�loqs of Chepter 9 commendng with SeMion 7009) ot DlWsion 3 oi the Business end Pratessions Code, and my Ilcense Is in full
force and eflact. Lic. q���� �J L- /� / / qau A
ConlrecrofsSignemre: �_� �,�� /" Date:
fr
CONSTRUCTION LENDING AGENCY:
❑ I hereby aitirtn thet Ihere is e consWction Iending agency tor the peAormance of ihe work for whiU Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendafs Name: Landefs Address:
Signature:
OWNEH-BUILDER DECLARATIONS:
Dete:
I hereby ettirtn lhet under penelry of perjury t�at I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness and Professions
Code: Any ciry or counry which requires a permit to construct, elter, improve, demolish, or repair eny structure, prior ta its issuance, elso requires ihe applicant for such pertnit
to file e slgnetl statemeN Ihet �e or she Is Ilcensed pursuant ta the provisions ot Ne Contractors License Lew (Chapter 8(commenGng with Section 7000j oi DMslon 3 of Ne
Business entl Professions Cotle) or ihe� �e or she Is exempt Iheretmm and Ihe basis for Ihe alleged ezemption. Any violaUon of Section 7031.5 6y eny applicant Por e pertnit
su�jeds ihe epplicent ta e civll penelry ot not more t�an five �undred dollars ($500).):
❑ I, as owner ol ihe properry, or my employees wlih weges es their sole compensatlon, WILL DO THE WORK, and the structure is not Intentletl or oXered for sale (Sec.
7044, eusiness antl Professions Code: The Contractors License Lew does not apPh �o an owner ot property who Dullds or Impmves thereon, end who does such work
himself or �erself or thmugh his or her own emDloyees, proNded lhat such improvements ere not Intendetl or oNered for sele. It, however, l�e building or improvement is
sold within one year ol completion, the owner�Duilder wlll have ihe burden of proving that he or she did not builtl or improve for purpose oi sele.). '
❑ I, as owner af the properry, em EXLLUSIVELY CONTRACTING WI7H LICENSED CONTiiAC70RS to consiruct Ihe project (Sec. 7004, Business and Professions
Cotle: TTe conirectors License Law does not epply ta en awner oi properry who builds or Impmves t�ereon, end who cromrects tor such pro�ect wlih e contractor(s)
license pur5uent to ihe Con�reClOre liCen9e Lews.).
❑ I em exempt under sec.
Signatura:
Owner ID verified Dy tlriver's licanse. ❑ Ves ❑ No
Business antl Pmfesslons Code for this reason:
Veniicatlon of Ownership by (type of dwument, i.e. - property teu bill or dead):
Driver's License No.
Date:
Ezpires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certity Ihe� no excevetlon five (5) or more feet in depth Into which a person Is requl�ed to tlescenq wlll be meda In connecilon wlth work euthorized by ihis
permit, antl the� no builtling siructure, scaHolding, felsework, or demolition or dismantling Ihereot, will be more then Ihirty-sla (38) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celitomia Adminlstrative Cotle).
❑ As awner-builder, I will not employ enyone to tlo work w�ich woultl require e permit from the Division of Industrlal Safety, es natetl ebove, unless such person hes e
pertnit to do such work irom the division.
Slgnature: Date:
Division o1lnGusirial Safery Permit Number.
CERTiFlCATE OF COMPLIANCE AND AUT}10RQA710N OF EMRY: I certity under penelry of perjury ihat I have read this epplication antl state t�at t�e Information given is
conect. I egree to comply wlth ell state lews end clry ordinences relating to bulltling consiructlon, end euthorize representetives of the Clry of Costa Mese to enter upon the
above-descnbed properry for inspection purpasas. I egree not to ocapy or allow occupancy of eny building eufhorized by this pertnit until final inspection.
COOE �. INSPECfIONT'VE QAff.
1616 FIzeO System Flnal Fire Prevention
1266
200
201
202
203
204
Pool Spe Final
Final Re-Rooi
Flnal Block/Retaining Well
Flnal Fectory Fire Place
Flnal Slgn
Finel Oemolltlon
� �Qyf,j INSPECiqNTYPE
208 Finel Mechenical
20B Final Plumbing
270 Finel Electrical
212 Final Fire Preventlon
220 Finel Plenning Approval
222 Finel Site
250 Finel Building/Occupency
PdIE It�lLS
(714) 754-5273 • FaX (714) 754-4856 • wWw.Cl.Coste-mOSe.Ca.Us 77 FAIF �HIVE, GOSTA MESA, GA 92ti26
JobAddrsss: 2834 ELLESMEREAV
Suite No
Viciniry: BEDROOM
Parcel Num6er: 13933409
Applicant: FLETCHER, JOHN
Address: 2725 SANPIPER
COSTA MESA, CA
Owner: DIETERMANN, META H
Address: 2834 ELLESMERE AVE
COSTA MESA, CA
Contractor: OW N ER-BU ILD ER
Address:
MECHANICAL PERMIT
Phone: 714-556-2082
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License:000000
Status: ISSUED
Applied: 02/03/2004
Issued: 02/03/2004
ISSUED BY:
SCOPE OP PERMIT
CONSTRUCT 182 S.F. ADDITION TO AN EXISTING SINGIE-STORY S.F.D. WORK TO INCLUDE
ADDITION OF A NEW OFFICE. � �
3 BEDROOM, 2 BATH S.F.D. WILL REMAIN THE SAME. '
1 REPAIR/ALT COOLING/HEAT
REF: 603-01920
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 Exhausl
VAV Boz
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 70000cfm
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$13.70
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$O.DO
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial Incinerator
Domestic Incinerator
ComDressors / Absomtion Svstems
Upto3hp/t00kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3Tot5hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigafion Fee
Plan Check Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
NOTICE: The work authorized by Ihis parmit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord'No. 92-20, § 1, 12-21-92)
EXPIRATION: This permit shall automatirally expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPEC710NS: In order for �he work aufhorized under inis permit to be considered legal, sucJi work must comply wifh all applicable codes, and all
requlred Inapeetions and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ol this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaac �a�oo7
WORKERS' COMPENSATION DECLARATION: R )
I hereby eflirm under penalty of per�ury one oi Ihe following declarations:
❑ I have and will mainteln a certlliwte of consent to sell-Insure lor workers' compensation, es provided tor by section 3700 of the Labor Code, for tha peAormence ot the
work tor which Ihis permit is Issued.
❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Lebor Cotle, for �he pedormance of �he work for w�ich Ihis permi[ is issued.
My workars' compensetlon Insurance carner entl policy number are:
Carrier. Policy Number:
(This section neetl nof be completod il the permi� Is velued ef one hundred dollers ($700J or less.)
(� 1 certify that in the paAormance ol Ihe work for which ihis permit Is issued, I s�all not employ any person in eny manner so as �o become subject to Ihe workers'
compensatlon laws ol Califomle, antl egree that If should hecome subJect to ihe workers' compensatlon provisions of Seclion 3700 of the Labor Cotle, I shall fonhwlih
comply with these provisi s. �o
Applicant Signature: � H L � oe,a:, ,Z — 3-- o�l
WARNINO: FAILUflE TO S E WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES ANO dVIL FINES UP TOONE HUNDRE�
THOUSMIDDOLLARE($ OW),INA�DITIONTOTHECOSTOFCAMPENSATION,DMMGESASPROVIDEDFORINSEGTION3]OBOFTHELABORCADE,IMEREST,ANDATTORNEY'SFEES.
IICENSED CON7RAC70R5 DECLARATION:
I hereby aHirm that I am licensed under pmvisions of Chapter 9(commencing wilh Sectlon 7000) of Division 3 of the Business and Professions Cotle, antl my license is in tull
'��. rorce ana enect. Lic. a cless a
�, Contractor's SignaWre: Dete:
CONSTRUCTION LENDING AGENCV:
❑ I hereby affirtn ihat Ihere is e conslruction lending agency for the pertortnance of Ne work for which this permit is issuad. (Sec. 3097, Civil Code).
Lenders Neme: Lender's Atltlress:
Signalure:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aflirtn t�et under penalry of perjury ihat I am EXEMPT FROM THE CONTAACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl ProFesslons
Code: Any ciry or counry which repuires e permit to consiruct, alter, impmve, demolish, or repair eny strucNre, pnor to its issuance, also requires the applicant for such permil
to tile a signed statement that he or she ISlicensed pursuent to Ihe provisions of the Contrectars LJcense Law (Chapier 9(commencing with Section 7000) oi Division 3 of the
Business entl Professions Cotle) or Ihet he or she is exempt therefrom and the basis for ihe ellagad exemptian. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicent to a civil penelry ol not more than live hundred tlollers (5500).):
� I, es ownar ol ihe property, ar my employees with weges es their sole compenutlon, WILL DO THE WORK, and the structure is not intended or oflered for sale (Sec.
70a4, Business and Professions Coda: The Contractors Licensa Law tloes noi appty to en owner ot propeny who builds or improves thereon, antl who does such work
himseN or herself or Ihrough his or her own employees, provitled that suc� improvemenis are not Intended or ottered for sale. If, however, the builtling or improvement Is
sold wit�in one year ol completion, the owner�builtler will have ihe burden of proving that he or she did not huiltl or improve for purpose of sale.). '
i❑ I, a5 owner Of �he property, am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to wn5�rucl the projed (Sec. 7044, Business antl Profeuion5
' Coae: The coniractors License Lew tloes not epply to an owner ot pmpeny who builds or Improves Ihareon, antl who contracts tor such project with a contractor(s)
license pursuant to Ihe Comrectors License Laws.).
❑ I am exempt un er sec.
Signature: C
Owner ID y ed by drivers licensa.
❑ Yes ❑ No
Business antl Pmfessions Code for this reason:
� Expires:
Verification oi Ownership 6y (type of Caumeni, i.e. � property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I here6y canity that no ezcavation five (5) or more feet in depth into whic� a person Is requiretl to descend, will be made in connection with work authorizetl by Ihis
permit, and Ihet no building siracWre, scattoltling, falsework, or demolilion or dismentling thereot, will ba more than thirty-si: (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calibmle Administrative Cotla).
❑ As owner-6uilder, I will nof employ enyona to do work which woultl require e permii from the Division of Industrial Safery, es notetl above, unleu such person has e
permi� �o tlo such work from the tlivision.
SignaNre: Date:
Division of Indusirial Safery Permit Number:
CERTIFlCATE OF COMVLIANCE AND AUTHORIZATION OF ENTAY: I ceniry under penalry of perjury that I have read this application and state that the information given is
corred. I agree lo comply with all state lews end ciry ortlinances releting to builtling construction, antl euthonze represeniatives of Ihe Clly of Cosla Mesa to enter upon the
above-deuribed properry tor inspection purposes. I egree not to occupy or allow occupency of any builtling authonzed by Ihis permit until tinal inspection.
COOE�. INSVECTIONTYGE PAIE Ui�IdLS
1616 Fixed System Finel Fire Preveniion
7266 Pool Spe Finel �
200 Final Re-Rooi
201 Finel Blak/Retelninp Well
202 Final Fectory Fire Place
203 Final Sign
204 Finel Demolition
Oate
^3-oy
Date
COOE• INSPEC770NTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
272 Final Fire Prevention
220 Finel Planning Approval
222 Final Site
250 Final Building/Occupancy
3_rA_oy �
pia) �sa-s2�s • Fau pia) �sa-aess • www.ci.wsta-mesa.c��ILDING PERMIT �� FAIH UHNt, GUS IA MtSA, GA 9'Lti'Lti
Job Address: 2834 ELLESMERE AV
Suite:
Vicinity: OFFICE
Parcel Number: 13933409
Applicant: JOHN FLETCHER
Address:
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA
Contractor: O W N E R-B U I LD E R
Address:
Zip:
Arch :
Address:
Phone:
Zoning: R1 R1
S56 ��
Phone: 714-43 0
Zip:
Phone: 714-434-2840
Zip: 92626
Phone:
License: 000000
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 11/04/2003
Issued: 01/O6/2004
Phone:
Zip: License: License:
SCOPE OP PERMIT
CONSTRUCT 182 S.F. ADDITION TO AN EXISTING SINGLE-STORY S.F.D. WORK TO INCLUDE ADDITION OF A NEW OFFICE.
3 BEDROOM, 2 BATH S.F.D. WILL REMAIN THE SAME.
Plan Check: $254.31
Permit: $39125
SMIP Res: $2.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $648.06
SETBACKS
MAIN STRUCTURE Pront 15- 0
ACCESSORY Front 0- 0
PARKING Existinq: a
Rear 10- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 5- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right G 0
Right 0- 0
s25,000.eo
so.00
INOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
��, regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonetl
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
required inepeetlons and final approval must be obtainetl. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
?44W616/00)
WORKERS' COMPENSATION OECLMATON:
I hereby effirm under penalty of perJury �e oi �he following decleretlons:
❑ I heve end wlll malnteln a cenificate ot consent to selt-Insure br workers' compensetion, as provided Por by sectlon 3700 of the Labor Cotle, for the peAortnence of the
wark tor which this permii is Issu6d.
❑ I have end will meinlain workers' �npensatlon insurence, as required by sectlon 3700 af the Labor Code, for the petlortnenca of Ihe work for whicti this pertnit Is Issuetl.
My workers' compensatlon Insure�e carner end policy numbar ere:
Carrier: Policy Number.
(This section need not be completetl il Ne pertnif is veluetl e( one hundred dollers ($100) or /ess.)
�`� I certity thet in Ihe pedormance ot the work br which this pertnit is issued, I shall not employ any pereon In eny manner so es to become sublect to the workers'
compensetion laws ol Celitornia, and egree that if I should become sub�ect to Ihe workers' compensation pravisions of Section 3700 0l the LeDor Cotle, I shell forthwith
compty with these pro ' io . /
Applicent Signeture: � C ��� Date: . � �� (� � � �
WARNIN(3: FAILURE TO RE WORKERS' ��PENSATION COVEM�E IS UNLAW FUL AND SNALL SUBJECT AN EMPLOYER TO CRIMIN�L PENALTIES NND GML FlNES UP i0 ONE HUNDRED
TFiOUSANO DOLIARE (SIOO,OOO�, IN ADDITION TO THE 00ST OF WMPENSATION, OAMAGES AS PROYlDED iOR IN SECTION 31080F TNE UBOR CODE, IMEREST. AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLAFAnON:
I hereDy eNirm �hat I am licensetl untler D�a��sions of Chaptar 9(commencing with Section 7000) of Divislon 3 ot Ihe Business and Professions Code, and my license is in full
�orce end ettect Lic. q Class M
Contrector's Slgneture: _ . Dete:
CONS7RUC710N LENDING AGENCY:
❑ I hereby aHirtn that t�ere is a wn5�mction lentling egency for ihe performance of Ihe work for whic� this parmit is issuetl. (Sec. 3097, Civil Code).
Lentler's Name: Lentlels Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm t�et untler penelry ol pe�ury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE U1W tor the lollawing reason (Sec. 7031.5, Buslness antl Professions
Code: Any ciry ar counry which requlre5 a pertnit to construct, alter, impmve, demolish, or repair any structure, prior ta its issuance, elso raquires the epDlicant for suc� pertnit
lo (Oe e signed atatement ihet ha or shB is licensed pursuent lo Iha provlslons o� Ihe Contrectors Llcense Law (Chapter 9(commencing with Section 7000) oi Divlslon 3 at I�e
Business entl Professlons Code) or tha� he or sha Is exempt therefrom end the Easis tor the ellagetl exemptlon. Any vloletion of Section 7031.5 by eny applicant for a pertnit
subjects the epplicant to a civll penalry oi nat mare than five hundred dollers (3500).):
� I, es owner ot Ihe propany, or my employees with weges as their sole compensatlon, WILL DO 7ME WORK, entl Ihe siruclure Is not intentletl or oflered far sale (Sac.
7044, Business end Professions Code: The Coniractors License Lew tices not apply to an owner of property who builds or improves thereon, antl who does such work
himself or herself or through his of her own employees, pravidetl that such improvements ere noi Intended ar oMered for sale. If, however, the building or improvemem is
soltl within one yeer of complation, the owner-buildei will heve the burtlen ot proving ihat ha or she did not build or improve for purposa ot sale.). '
❑�I, as owner of the prOperty, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to Constmct tha pro�ect (SecJ044, Busin05s end Prof855ions
Cade: The coNrectors License Law does not epply to en ownar oi propeny who bulltls or Improves Ihereon, entl who contracis for such project with a conirectar(s)
licensa pursuant to tha Contractors License Lews.).
❑ I em ezem er sec. Business end Prafessions Code for this reason:
Signeture: �� � Date: n ' 6� D
Owner ID ietl by tlmets license. �Yes ❑ No Drivefs License No. exPires: 5�2 3, 0 6
Venflcatlan ai Owners�ID by (rype of document, i.e. - properry taa bill or tleetl):
DIVISION OF INDUSTRIAL SAFE7Y PEAMIT CERTFICATION:
❑ I hereby certify that no excavatlon five (5) or more teet In depih into which a person is required to tlescend, will be made in connection wiih work euthodzed by this
pertnit, end ihat no building structu�e, swftolding, telsework, or demolltion or tlismanttlng thereoi, will Ge more then thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, 71I1e 8, Cellfomia AdministratWe Code).
❑ As owner-builder, I will not employ enyone to do work which would require e permit from (he Division of IntlusMel Sefery, as notetl above, unless such person has e
pBrtnil Io tlo SUCh work from ihe di�i5ion.
Signature: Date:
Division oi Intlusinal Safety Permit Number.
CERi1FlCATE OP COMPLIANCE AND A�OfiIZATION OF ENfAY: I certiry under penalty ot perjury t�et I �eve read this applicatlon end state thet the iniormetion givan Is
correct. I aqree to wmply with all state laws end clry ordinances relating to building construction, end euthodze representatives of the Ciry of Coste Mesa to enter upon the
ebove-described properry for inspection purpases. I egree not to occupy or allow occupancy of any building eu�horized by this pertnit un�il final inspection.
Signature Or i uw a�s� / ua[a
C/ �� �� (9' O
And/OrAuthonzed Applicent � Date 9
LOUE �. INSPECfIONTYPE PAIE I�LS
1616 FixeA System Final Fire Preven�ion
1266
200
201
Pool Spe Final
Final Re-Root
Final Block/Retaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolltion
caoe� iNsvecnoxnve
206 Final Mechenicel
208 Final Plumbing
210 Finel Electrical
272 Finel Fire Preventlon
220 Final Planning Approval
222 Finel Site
250 Finfll Building/Occupancy
Q� II�ELS
-6-oN �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 hAIH UHIVt, GUJ I A MtJA, l:A 82tlL6
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
2834 ELLESMERE AV
OFFICE
13933409
FLETCHER,JOHN
Owner: DIETERMANN, META H
Address 2834 ELLESMERE AVE
COSTA MESA, CA
Contractor: OWN ER-BUILDER
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixis
Recept OulleLs
Swilches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to �OOhp
Motors over 700hp
Communication drops
ISSUED BY:
Phone: 714-55G2082
Zip:
Phone:
Zip: 92626
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 01/06/2004
Issued: 01/06/2004
SCOPE OF PERMIT
CONSTRUCT 182 S.F. ADDITION TO AN EXISTING SINGLE-STORY S.F.D. WORK TO INCLUDE
ADDITION OF A NEW OFFICE.
5 LIGHT FIXTURES, 6 OUTLETS, 2 SWITCHES
REF:B03-01920
$23.50
30.00
$0.00
$0.00
$0.00
$0.00
$5.50
$6.60
$2.20
$0.00
So.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Busway/100ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kvalkw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Vollage Equipment
Low Voll Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (meCh ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electriwl Fee
Investlgatlon Fee
50.00
50.00
$0.00
$0.00
50.00
50.00
so.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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 requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2C66-6fi (N00)
WORKERS' COMPENSATION DECLARATION: � �
I herehy aHirm under penalry of perjury ona of the tollowing declarations:
❑ I heve end wlll maintain e certificale oi consent to self-Insure for workers' compensation, es provided for by sectlon 3700 of the Lebor Code, for the Dedormance of the
work for which this permit Is Issued.
❑ I have and wlll maintain workers' compensation insurance, as required by sectlon 3�00 0l the Lebor Code, for the perfortnance of the work for which this pertnil is Issued.
My workers' compensatlon Insurence carrier and poliry number are:
Carder: Policy Number.
(This section neetl nof be comp/eted I/ the permit /s valued et one huntlretl dollers ($100) or IeuJ
�
I certify Ihet in the peRormance of tha work for which ihis pertnit is issued, I shell not employ any person In eny menner sa es to become subject to lhe workers'
compensatlon laws oi Calitornie, and agree Ihat if I s dbecome subject to ihe workers' compensation provislons oi Section 3700 of the Labor Cotla, I shall torthwith
comply wilh the5e pr isi ) / L�
Applicant Signeture: � C� r.✓ Date: __! �' a� � /
WARNINO: FAILURE CURE WORNERS' COMPENSAiION ODVERAGE IS UNLAWFUL AND SHPLL SUBJECT AN EMPLOYER TOCRIMINAI PENALTIES D dNL FlNE$ UP TOONE HUNDRED
TVKKISAND DOLIARE (5100,000), IN ADDRION TO THE C0.5T OF COMPENSqTION, OMMGES AS PROVIDED FOR IN SECfION 3)080F TME IABOq COOE, IMEREST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I here�y eNirm tha� I em licensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 0l Ihe Buslness and Professions Code, end my license is in full
force end eHect. Lic. N Class a
ComrectoYs Slgnature: Date:
CONSTRUC710N LENDING AGENCY:
❑ I hereby aMirm that there is e consWction lending egency for Ihe peAormance of Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lentler's Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I here6y ettirtn thet under penalry ot perjury Ihet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business end Professions
Code: Any city or county which requires e permit to consimc6 alter, improve, demolish, or repeir eny stmcNre, prlor to its Issuance, elso requires the epplicant for such pertnit
to lile e signed stetement thet he ar she Is Ilcensed Dursuant to the pravisions of Ihe Contractore Licensa Lew (Chepter B(commencing with Sectlon 7000) of Divislon 3 of the
Business end Professlons Code) or Ihat he or she is e:empt therefrom end the basis for t�e elleged exemption. Any violetlon of Section 7031.5 Dy eny epplicant for a permit
subjects Ihe eppllcant to e civil penalry oi not more ihen five hundred tlollars ($500).):
� I, as owner ol the properry, or my employees with weges as iheir sole compensetion, WILL DO TME WORK, and ihe structure Is not In�endeG or ofleretl for sale (Sec.
7044, Business entl Professions Code: The Contractors Licensa Law tloes not apply to an owner of property who builds or improves ihereon, end who does such work
himself or �erself or �hrough his or her own employees, provitled that such Improvemenis ere not Intentled or oflered for sele. If, however, Ihe bullding or Improvement is
�soltl within one year of completion, ihe owner-builder will have the burdan of proving thet he or she did not build or improve tor purpose of sala.). '
I, es owner of ihe DroDerty, am El(CLUSIVELY CONTRAC7ING WI7M LICENSED CONTRACTORS to consirucl Ihe project (Sec. 7044, Business and Protessions
Code: The contractors Licensa Lew does not apply to en owner ot property who builds or improves thereon, entl who contracis for such project wit� e contrector(s)
license pursuent to the Contrectors License Laws.).
❑ lam
Signature:
OwnerlD�
sec.
by drivefs
Business and Professions Cotle tor this reason:
❑ No Drivers License No.
Vedfication of Owners�ip by (type ol document, i.e. - propeny taz 6ill or tlaetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:
� / Expires: +'SZ-2 3^ D /�
❑ I hereby certify that no excavatlon tive (5) or more taet in depth into which a person is required to descend, will be mede in connectlon with work eulhonzeC by this
pertni6 enC ihat no builtling siructure, scaflolding, talsework, or demolition or Cismantling t�ereol, wiil be more then thirry-six (36) feet �ig�. (C�ap. 32, Grp 2, An 2, Sec.
341, 7lle 8, Celifornia Atlminlsirativa Cotle).
❑ As owner�bulitlar, I will not employ anyone to do work which would require a permit irom ihe Division of Industnel Sefary, es natetl e6ove, unless such pereon hes a
permit to do such work irom the divisian.
Signature: Date:
Division at Industnal Safary Pertnit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF EMAY: I cehity untler penalty ot perjury that I have read this epplication end stala thet the Intormetion given Is
correct I eqree to comply with all stete lews end ciry ortlinances relating ro building construction, and euthorize representetives oi the Giry ol Costa Mesa to enter upon the
ebove-descnbed property tor inspeciion purpwes. I egree not to occupy or ellow occupancy ot any building euthorized by this permit until final inspection.
COOE �. INSVECfIONttPE
1616 Fixed System Flnal Fire Prevention
1288 Pool Spa Finel
200 Finel Re-Rool
201 FIneI BIocWReteining Well
202 Final Factory Fira Place
203
204
Final Slpn
Final Demolitlon
Pdg 1�5
Dete
/-� �Y
Dale
COUE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electricel
212 Final Fire Preventlon
220 Final Planning Approvel
222 Final Site
250 Final Builtling/Occupency
Q� �
fii �/ i ��' •%
Qc� c
����0 �
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
—
For Applieanf fo Fill In Complefely
TYPE OR PRINT
ADDRE68 ���i�'�� �- /
��COSTA MESA. GALIFORNIA
owr,ea Pacesetter Jt. Venture
MAIL 1653 Minoraa .
ADDRE65
1
arv CostB Mesa No: 9-039:
ARCHITEGT TEL.
Mesa Verde Builders Inc.
Costa Mesa
���-��-��
� �� n,� JUL 31196i �
�7 � � FINANCE DEPT. /��d'
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Onlx �
0.8CEIPT NO. .P.EHM11�N0.�
-n_
HHC61V� BY I DA��^ 1 g�/I % �T7.I Bu� J
K. esT
FIRE
LHOAL
COSTA MESA. CALIFORNIA
rvPE � cwounbC O
ZONING
NO. OF � I U88 OR � �/p'� g�
PUN9 BUILOIN r�� /
�,.�- /S 7/� t%0 0 �
OF LOT `�w ��• r y•Ki I��• OP BlDG6,o
NOW oN �oi p, p, NO.
USE OF YARDS
EXIBTING BLDG. APPROYED
CEMHRNOF18Tq6ETM �2 REAR YARD 2� ICBMHP LINB 9T.][,/
FRONT / Z
SIDE YARD ILEFT IRIGHT R.SI�E !
DESCRIPTION OF WORK g
L. SIOE
NEW I x II ALTERATION II ADDITION I REAR � U
REPAIR I IIMOVING I IIDEMOLI6H I e1,PROVEO ���
SQ.Ft, NO. OF
onnMA RrAGIFK �
� PJCTERIOR
Standard Plan No. 62C
I X8R8BY ACKNO L 6E TH T 1 NAV
AND BTATE THAT T 6 ABOV IB LONI
PLY WITX ALL TY ORDINA C¢9 AND
BUILDINO CON U T
SIGNATURE O
PERMITfE
AUTHORIZED AG
A
nanc ni�e
— IN
�- IN
IN
—� IN
ATE % I2 / �L
_ l� 7i �
. L/OS� �
K��+suucu gcun�c qiv u.1.r�.
TXH AM011NT BNOWN UN�BR VALUATION IB POR TXE
PUIiP098 OP EBiA8L19HIN0 A PERMIT pEE ONLY.
��' � �,� / PLAN CHECK $ �/ �
TOTAL FEE S � / `�
�,
a
�
PXOJECT AO�flESS: 2 8 3 Q ELL ESMER E AV
awxeasxnme: DIETERMANN, META H
AOONESS: 283Q ELLESMERE AVE
� COSTA MESA,CA 92626
' S90-3943
AFCH/ENGINEEN: flEG.NO.:
PDONESS:
UNIT:
UNIT:
PEPMITTEE: BEEMAN CONS'fRUCTION ( 7? 4) 650-4474
aooxEss: 21661 HROOKHURST ST
HUNTZNGTON BEACH CA 92646
LICENSED CONTBRCTOB OECIANATION: I �ereDy aHirm that I am Iicert5e0 untler Orovidons oi ChaD�er 9(commentinp with $ectian
7000� af Division 3 0� ine Business an0 Prolessians CoOe, anG my license is in lull force an0 eitect.
ciTr uc.: 0 5 8 4 8 8q STRTE LIC.: G 1 4 O /O �S '� cuss: B
Oa�e: � �'�! � Signaiure: � u "i"`G'�—����M]-'-i
WONNEBS' COMPENSPTION OECLAflATION: I �ereDy allirm Ihal I have a certifiwte ol consenl Io self-insure or a cenificaie of Workers'
Compensation Insurance. ar a cenilied copy Inereol (Secuon 3800, Lab. C).
POLICY NO.: EXP. ORTF:
COMPRNV: �
� Ceniliea copy is �ere0y Iumis�e0. ❑ Cenifie0 coDY �s IileO w�i� t0e ciry BuilOing DNision.
Oa�e: S Fppli[anC
EXEMPTIONFBOMWOflNENS'COMPENSATIONOECUPATION: �ThisSectionnee0no�becompleteEillhepermiti5foronehuntlre0�5100�orles5).
I cenify Ihat in ine oedormance of Ine work for wnich tnis permit is issued I snall not employ any person in any manner so as to become
su�le�� �o Ne Wmkers' Comoensalion Laws o� Cali�omia.
Daie: � 6 — � � SipnaNre �'�•��n�"'y �� ��
NOTICE: If. afler making I�is Ueclara�ion. yau shoultl �ecome sublect �o lhe WOMers' Compensatian proNsions ol t�e Labor
CoOe. you musl fon�with comply witA such provisions or Ihis Dermil shall be tleemeA revoketl.
CONSTflUCTION LEN�ING FGENCY: I here�y allirm Iha� ihere is a constmclion IenUing agency �or Ihe pedormance oi 1he work �or
whictl Ihis permit is issuetl (Section 3097. Civ, C�.
LENOEH:
nooness:
OWNEB BOILOEP OECLABATION: I hereby allirm Ihat I am eMempi �mm �he ConVactors' S�ate License Law 1or ihe following reason
ISection 7031.5 Business antl Pmlessional Coae: Fny ciry of couniy w�itA requires a De�mi� lo cons�mct, al�er, impmve, demW¢h, or
repair any s�mCiure, prior IO iis issuance, also reQuires Ihe aDP�iCani lor Such p¢rmi� �o �ile a SiA�ed Slaiemen� �ha� h¢/She is licensed
pursuani �o Ihe pmvisions ol l�e Contractors' S�ale License Law (Chapier 9(commencing wi�� Seclion 7000) o� Division 3 0� ��e Business
and Prolessions Code) or thal he/sne is exem0� iherelmm anA IAe Oasis lor ��e allegeA eeemp�ion. Any viola�ion of Sec�ion 7031.5 Dy
any applicani lor a permil 5u�led5 Ihe ap0licant lo a civil penalty ol not more than live huntlred tlollars (35W�.
O I. as owner of ine pmperty or my employees with wa0es as iheir sole compensation, vrill do tAe xrork, antl �he
siruclure is not in�enEeG ar oilereU lar sale (Setbon 7044, Busineu antl Pm�essional CoOe: T�e Cuntracrors' Slaie Licenre Law
Eoes not aODN �a an owner ot a OroDeny wtp Ouilas or impmves Ihereon, and w�o tloes suc� work Nmsetllherseli or tAmuA�
his ar �er own em0�oyees. proviAea I�al such improvemenis are notintenEea or oflere0 lar Sale. If, Mwever Ihe builUing ar
impmvemenl ¢ solA witnin one year oi completion, the owner will nave ine buraen ol DmWng he/she tlia not �uild or impmve
for t�e purpose ol sale�.
I, as owner ol l�e propeny. am extlusively coniracling with Iicense0 coniractors lo tonsimci ihe pmlect (Section 760d. Business
❑ antl Pm�e55i0n5 Cod¢: The ConVatbrs' Siate License Law Aaes not appty to an owner of O�operry who bmlUs or impmvw ihereon
antl who contracis br suc� pmleds wi�h a coniractoqs�license pursuam m �he Canlractors' Slate License Law�.l am aware
lhat proof ol iheir Work¢r'S Campensaiion insurance 5twulA Ue prontleC ta me.
� I am eaempt wGer Seclion: B. 8 P. C.
for t�is reason:
Oale: Owner.
I tla nereby cenily tnal I am aware ol an0 untlerstane Ihe requirements al Califomia Healih ane Safery COAe Sections 25505. 25533, an0
25534 an� ihal I oi any fuWre CuilGing acuDanl wilVvnll noi (circle one) nee0 lo comDN ��h 5ai0 state coaes anA Ihe r¢Quiremen�s �or a
permil loi conslmction or rtwEiiication Imm I�e Ai� Oualiry Managemenl OiSiricl. flevEential [Onstmc�ion appGcaiions are eKemp� Irom
I�ese pmdsians.
Da�e: Appl¢ant:
I here�y cerlifyihal I �avereaU��is apPlicalion anA 51aie��atihe aboveinlormalion is correcl I agree�o campiy wi�A all cily and counry
ortlmances an0 slale laws relaling Io Dwltlinq constmclion anA hereby aulhorize repre5enlaiive5 0l Ihis city to enter upon lhe above�men�ioned
0�o0eriy lorinspe/cl�ian nurooses. �/J ` �
Oale: �� b ' �� � SiBnature— / /��ZCt^! �./ •-��'�
Oriver's License or Social Seariiy
16<La6 WM1ne—Bmldino: Green—CoOe Enlosemen�', Canarv—Aoolicant: Pink—Revenue: Goltlenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT �xM Nu: n UbjjyL
PERMIT NO: 9 063392 PLAN CHECK NO: N UV"; N SUYY: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; ALT
JOB DESCRZPTION : T/OeF SHEATH REROOF W/LIGHT WEIGHT TILc. SQ FT: 8,000
CLAZM VALUE; 8,000.00 CAiC—VALUE: 8,000.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTOAS RE� PER 91 UBC AEROOF W/TILE ICB0119660
***�*******����***�r�-x�*�***x* ***�r*�**�*��ftn#***#*��#��*x�-���*Y Vd\�*x#**#**�r**
Z O N I N GS ERTEB�AUCIxHSE M E N T S �A [p.i �� �
°W' �:�ca'���-
'- �1bt17� •.
------------ MAIN HUILDING ---------- --------- ACCESSO' U
FRNT: FT IN REAR• FT ZN FRNT: FT IN c a R; F �`�N
LEFT: \ FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARI(ING REO• PROV: PARCEL: 13933909 ZNE: REF NO:
PLANNING N(5T'ES>
i
�*****��x��x�x*x�x��#**�r**+��**<�rxx��r�r*x*�r**x���t�r#*��,r�*�r�*x«+��t*�r�###��r*u��i��*��*���r
D E V E L O P M E N T S E R V I C E S k E Q U I R E M E�1�T S
ZONZNG APPROVEI7 ,BY DATE: '��'
BUiLL+It�'G APPR�VED 8Y : DATE: �
ApPLI4'ATrt�N Iv'''�ti?:� pVt �— DATE• g�P..,.:
if if if 3f ih �lE iE iE iE 1E ii #E iE if/ Ihif fE 7E �E f(� iE il7E 3ElFiE iFiF%lFifiF�FiF 3('iFRiF'iFiFiE7F �iF ?F iF9PR'3F3FlF7FlFiFlf if ik ik iE #!E!E �F 7f;iFT ik 1E
�E �F �f if 9F iF if if +E iF 3f iF 3f��1E 1f 1E 1E 3E 1E �E iE jE �14 3E 3E iE iE �E iE 3E iE iE if iE 3k iF 1E If 3f iE iF ik IF it iE 1E �F 1E # iE if� ff IE �1E if if 3f �E iFlF jElE iE iE iE 1E �3f�lFif 1E fE iE if iF if if * iE
LEGALIZATION:N F E E S U M M A A Y STRUCTU:2AI, 5EGMENT:Y
�
HLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADING
PERMIT 99,00 ,80
SMZP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PERMZT ISSUE PLAN—CHcCK TOTAL PAID DUE
TOTALS----> 99.80 0.00 0.00 99,80 99.80 ,00
REVENUE DIViSION TOTALs'--> COLLECTED: 99.80 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
99.00 ,80
iE iE iE iE if iE �F 1E If iE iE iE if if iE 1E if iF i! iE 1f if iE iE iE if if iE if iE 3(-if iE if �lE fk iE fF ik iE # i! �Jf 1E iE 1(� 1E iF ff if if if� 1E ik #�lE IF 1E 1E iE fE !E #!E i!� # 1E i(� ib iF # iFlE 3h iE # iE if ik
Z N D I V I D li A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N
SFR 8000 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1.00 8,000.00
02 0014446?-00144463 T t1 T 99.30
C�ATE� 08/09/93 TII1E: 1.5:27
/,
� � V
� POOL & SPA
CCJSYRUCTION AND PLANNING
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�U�drgrnd. 53. Sieel Reinfiorcement
3, Electrica� Conduit Utility-Undrgmd. 54. Forms
4. Electricat Conduit-Undrgmd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVEP�GUNITE
7. Footinqs . 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, � 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
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final •
14. Rough Plumbing 65. Electrical-Fina�
15. Rough Elettrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Pencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
1B. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIfiEMENT �
20. Rough Factory Fireplace , APPROVALS Permit #- ,
21. Ducts, in Structure � 70. Underground Hydro ,
22. Ducts, Ventilating � 77. Product Piping �Gas ❑Oil
23. Gas Pipe�Rough & Test . 72. Underground Flush �
24. Roof Frem�ng � � 73. Undergrnd.StorageTank �Gas ❑Oil
_ / �
25. Roof SheaChing ��Gy i%Q - 74. Overhead Hydro
[ (7
26. T-Bar Ceilin9 (Scructurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
�
29. Intulation � 78. F�RE PREV. FINAL
30. Drywal� Na�ling � � HEALTH DEPT. REQUIREMENT
31. Plaster BroWn Coat � . � � 79. FINAL INSPECTION
32. Electrical Power MeterFinal ! � � �80. POOD CERTIFICATE ISSUED
33. Final Electric i � Notes:
34. Final Heating & Air Conditioning � �
I
35.�Final Gas PiPe�Test i � � '
�
36. Hood or Canopy � _
37. Final Factory Fireplace �
38. FinalPlumbing ��-,•
39. Water Service�Final ! �
� �
40. Gas Servics-Final � i
41. Soiar pomesticFinal ,
42. Backflow Preventer I .
43. Backflow �rriqation
44. Landscape Irripation System
45. Sound Atrenuation
46. Handicap Regulations ^
���y .+
47. FINAL STRUCTURE & BUILOING �!/r�
!
48. FINAL PLANNING '
49. Electric Re�ease to Edison ( � e
,�
50. Gas Re4ease to Southern California Ga: Co �'�
51. CEflTIFICATE OF OCCUPANCY
No. Oate
ADPlieant to fill in all spaees encept those within heavy Eortler Ilnes ana sign a11 aDDropriate Eeclarations.
CITY OP COSTA MESA- - � • � � � ---� -- -�- - �^ ^ ^' •,^ ' ^T "'^ ^. ^ - .
CONSTRUCTION PE M T� �,` `_
Project Address � '
Applicant's Mailing ddre_s5r ,^
Owner's Na e P�`S"P 1� ,,i,�) �Vl1��� . Phone O�
Addreu �� � � SJ—r—W"� �
Arch/Eng. License No. :
Atldress
Contractor'sNam 1 hone' ��
Address (mailing) '
City LicPn N . � ' '
LICENSED CONTRACTOR DECIARATION � '
I hereby aftirm that I am licensetl untler provislons of Charter 9(commencing
with seciion �000) ot Division 3 of the Business antl Professlons Cotle, antl
my Iicense�is in tullyl� ce a ftect.
Licens�C���%�y" c'���. � � ��i���eA.��i`
Date�—�'—� ^ '
� WORKEftS' ObMPENSATION DECLARATION � � � '
I nerebyaitirm that I have a certificate of consent [o selLinsure or a certi(icate
Of Wa�ke�s' Compen5ation Insu�ance, o�'a certitl¢tl topy the�eof ($ection -
3800. Lab.� )p � ; � ' '
Policy No.� /�3���� Company ' � �
BCertiiietl copy i her y turnishetl. (�
Certi 'e d Ri wrth the city�tlin�W�Sipiya �. � �
Date � d APplicaM � �.4(t,�4w�-��� �
� EXEMPT ON F OM WORKERS' COMPENSATION DECLARASION -
'�i (This sectwn neetl m[ be completetl if the permtt Is tor one huntlretl (5300) or '
I¢55).
1 certify that in the Performance of the work Tor whlcM1 this permit is,issuetl, I.
shall not employ any person in any manner so as to become subject to the '
Workers' Compensation Laws of Califomia. , �
Date $ignature � ' .
NOTICE: If; after makin9 this tleclaratlon, you shoultl become subject to the
Workers' Compensation provisions oi the Labor Cotle,-you'must (orthwith
comply with such provisions�or, this �permit: shall beitleemetl revoketl.
CONSTRUCTION�LENDING AGENCV ' ' ' �
1 nereby affirm that there is a construction lentlin9 agency for the per(ormance
of the work for which. this permit •is issuetl'{Section-'309� Civ. CJ�.
Lentler's 'Name , , . , ,
L.entler's Atltlress �
OWNER BUIIDER DECLARATION � 'J � �
I hereby. atfirm that I am exempc from the Contractor's License Caw tor�the
following reason (SecUon 7031.S�Business ana Professional Cotle: Any city or
county whicn requires a permit to construct, alter, Improve, tlemolish or repair �
�ny Structure, prior to its issuance, also requi�e5 the applicant for Such pe�Tit
� file a signetl statement that.0e/she is licensetl pursuani to the provisions of
ie Contractor's License Law (Chapter 9(commencing witn Sectlon 7000) of
Jivision' 3 of the Business antl ProTessions Gotle) or that ne/she is exempt
therefrom antl the basis for the alle9etl exemption. Any violation ot Section
�031.5 by' any applicant for a permit subjects the' applicant to a civil
�enalty of not more than five huntlretl tlollars ($500). '
I,.as. owner of the property or'my employeei witti wzges as their 5ole
compensation, will tlo the work, antl the�structure is not intentletl or otteretl
(or sale (Section 7044, Business antl Protessional Cotle: The Contractor's
License l.aw tloes not apply to an'owner ot a property who builtls or improves
thereon, antl�wh0 Eoes sucn'wo�k�himself/herself or ihrou9h his or he� own
employees, provitletl Ihat sucn imOrov¢ments are not in[entletl O/ offe�etl fo�
sale. It, however, the builtling or Improvement is soltl within one year of com-
pletioq the owner will have'the burden of provin9 he/she tlia not buiitl or.im-
�rove:for [he purpose of sale). • .
LJ I, as owner of the property, am exclusively contracting with Iicensetl con- �
t�acto�s to const�uct the project ($ection ]044, Buslness antl Prote55ions Cotle:
The Contractor's-License Law does not apply to an owner of O�operty who �
builds or improves thereon, antl who contracts for such proje<ts with a con-
tractor(s) Iicense Dursuant to the Contractor's License Law). .
❑ 1 am ezempt under Section B. & P. C. for this reason �
Date Owner�
I hereby certify that I have reatl this application antl state that the above
information is correct: I agree to comply with all clty antl county ortlinances'
antl state laws relating to puiltling construction, and hereby author ze repre-
senfatives of thi cify t entfr� upon the above-mentionetl. pr�if�y/�f�t/
"""_ "' '..._.. -.�.'� �h. i ,
S�gnature �-�
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERaTION L� REPAI R
'❑ CONVERSION ❑ DEMOLISH ❑ OTHER p.p.#
DESCRIPTION OF WORK
� S Main Buildi
TVPE OF PEHMIT GRADIrvG ❑ FOUNDATION ❑ STRVCTURAL - - T Front �
'❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf
❑ �OTHER' ' C Right
PROJECT DESCRIPTION 5q. FT.� ocCUPANCV • K
'CONSTRUCTIONTVPE VA�UATION$ S Left
� ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: � Parking Req./Pn
' � , � , I . Use of Building:
Bar Sink
Backflow Preventer
Backflov� Irrigation
Bathtubs
Clarifiers
Dishuvasher'. � "
Floor Drains �
Floor Sinks .
Gas Service ' Outlets
Interceptors
Kitchen Sink - � - .
Lavatories_ . - ' -
P.—Trap : • � �
Roof Drains�
Fee I $25,
Boiler , �
Duct - Under Ground '
Duct-Structural � ,
Duct-Ventilating ' '
Exhaust System ❑ Multiple ��
Firepl/Fact.Blt.IC60# '
Heating System & Ducting
❑ 0-7 00,000 BTU � t 00,000 6Tl
iiaitlSPECIiOn FeB
nrotl -�Assessor� �
/IBING
Showers :
Sewer Cap
Sewer Connec[ion
Solar Collectors
Solar Piping
Solar Tank .
Swimming Pool w/Spa
Urinal
Water Closet � -
Water Heater
Water Service
FEES
IssueFee�' � ' il- $�3
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration �
�
$y5 " Isue Fee
$ 3
construcuon Pole Sub.
Cooking Unif �-
Dryers LJGas_ LJElectric
F.A.U. '
Fixtures
Device Boxes
Outlets
Gar6age Disposal
Generator 00.5 KW
M
3080 I/25/84
Zone
Accessory Building:
�'
Park.Fees $�
ELECTRICAL
� Transformer ❑ 15-50 K'W ,
❑ 50+ KW
' ' - . Meter ❑up to 700 amps
Meter ❑over100amps '
Motors C
Inc. Solar
Pole Light
Range ,
P O1%-8
5 HP �16-15+
Standing Sections
KW Trash Compactor
5.00 il
� Z
O
N
I
N
G
R
E .
' Q .
U
�
R
- E
,` E .
T
1
Reinspection Fee . � - $25 ,Issue Fee; , � $ 3
PUBLICSERVICESREQUIREMENTS: � .
Zoning Approved By Date '
Applicatian Approved By ��J Date ��0�'' �
i
Appliotion Issued�By Data �
� ' SUMMARV OF FEES � • , � ,
BUILDING PERMIT $ �SMIP. $ '
� PLAN CHECK $ � PERMIT �
PLUMBING �^��i .ISSUANCE $
PLAN CHECK , . $ ' ENERGV P.C.. $
ELECTRICAL , $ ' GRADING $ �
PLANCHECK $ MICROFILM � $ �
MECHANICAL • $ TOTAL FEE $ � SS�
PLAN CHECK ' $ �
CONSTRUCTION AND PLANNING ' F �& SPA _-
APPROVALS Permit# � P�o1�7 Date Inspector� AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. . ' 53. Steel Reinfoicement
3:'Electrical Conduit Utility-Undrgmd. ' � 54. Forms , �.
4. Electrical Conduit-Undryrnd. 55. Electrical Bonding '
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test .
6.� Electri�cal UFER Grnd. - . . 57. APPROVAL TO COVER-GUNITE
7; Footings � � � 58. Electrical Conduit-Undrgrnd. '
8. Foundation � � � , 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. � . 60. Backwash Lines, P-Trap, � 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
1.6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign , 68. APPROVED FOR PLASTERING
78. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fiieplace 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. 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 , 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 ' • /�-2(��� ,�.(j
39. Water Service-Final . . �"
40. Gas Service-Final - -
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backflow Irrigation ' �
44. ,Landscape Irrigation Sys[em
45. Sound�Attenuation � � � •
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed ' � ' �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. � Date , �