HomeMy WebLinkAbout2871 ELLESMERE AVE - Building Permitsw
�
CITY OF COSTA MESA ""'" ' � - ' "--
�,��pMFq I . .• BlIILDING DIVISION . . . ;.;
Ft�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax 014) 754-4856 • www.ci.wsta-mesa.ca.us ._ .. _I
� FOR INSPECTIONS CALL: (774) 754-5626
�^�" PERMIT NUMBER: B11-00160
PERMIT TYPE B_ROOF2
APN: 13933502
JOB ADDRESS
Vicinily:
Squares: 0
STATUS:
DATEISSUED:
ISSUED BY:
----�—�--n
�2871.EL-L-ESMERE°AV-CM ' Suite/Unit:
Valuation:
ISSUED
05I2312011
CAC
$9,500.00
SCOPE OF WORK: TEAR OFF COMP OFF OF DETACHED GARAGE AND HOUSE INSTALL 1 LAYER 30LB FELT AND 30 YR COMP
SHINGLES . .. . _ _ .
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted unlil access to dwelling unit(s) is provided (or
verificalion of the installation of smoke and carbon monoxide alarms by the Ciry Inspector. See Attachment w/Inspection�Card
OWNER: LARIMER, HARRY C TR
PHONE:
APPLICANT: LINDA DIAZ
PHONE: 949•642-7222
CONTRACTOR: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVEUnit:
City/State2ip: COSTA MESA, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Address: 2871 ELLESMERE AVE
City/State/Zip: COSTA MESA, CA
Address: 1653 SUPERIOR AVE
City/State/Zip: COSTA MESA, CA
License No.
License No.
PHONE:
Unit
,: ....;a
, � "'.. L� : a.
� Unit: :
License No. 349686
949-642-7222 ,
CELL:
. �17'G7T�1
PHONE:
Reroof Plan Check: $0.00 .� ' � '
Reroof Permit Fee: $181.25
Reinspection Fee: $0.00 ' "` `�°' �'
Bldg Std Admin Fund $1.00
�.�� ,
TOTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 � i..;;�' '. ''�'
Monday thru Friday - 7:00 am ihru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holi
New Years Day, Memorial Day, Independence Day, Labor Day, Thanks9ivinq Dav and Christmas Dav
r;; f
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'NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. '
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes, and all
required inspections and final approval must be obtained. Pailure to obtain inspections and final approval will resWt in the expiralion of this permit.
COOE i. INSPELTION TYPE
1616 Fiaed System Finai Fire Prevention
t266 Pool Spa final
200 Fina� Re-Roof
201 Final Block/Retaining Wall
202 Final Fattory Fire Place
',203 Final Sign
�204 Final Dertrolition
DRTE IN7111AL5 LOOEC INSPECTIONTYPE
206 Final Mechanical
( 208 Final Plumbing
�(� / - I 7— / / y �✓l _ � 210 Final Electriwl
2/2 Final Fire Prevention
220 Final Planning Appmval
� 222 Final Site
250 FinalBuiiding/Oaupancy
DATE ' INTITIALS
' _ __" .._.__.._..i
. �., � _...� �...9;J. �-.
WORKERS' COMPENSq710N DECLARATION�
I hereby aKrm untler penalty of perjury one of Ihe following declaretions:
❑ I have and will mai��ain a certificate of consent to self-Insure (or workers'
compensation, as provitled for by section 3700 oi the Labor Code, (or ihe
per(ormance of Ihe work (or which this permit is issuetl. .
I have and will mainlain workers' compensation insurance, as required by
tion 3700 of the Labor Code, f« the peAortnance of the work tor whicn this
' issuetl. My workers' compensation Insurance carner and policy
numbera :�� �N� C� -
rwtbe rr�1enredai�pp/��� rt^nrt7s-�va2Wee�inmenunamdoonars(3io0Jaiess�
�Policy Number: � �C„�� ./� l/' /�C � � �'
❑ I certify that in the peAormance of [he work for which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to lhe workers' compensation laws of Califomia, antl agree that if I shoultl
become subjec to he workers' compensation provisions of Section 3700 of
the Labor C de I shall fort wi h comply with these provisions.
' 23 � �
; iiwnfs Si na� e Da e
WARNINO� QSECU WORKERS' COMP ERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF TNE LABOR CODE, INTEREST, AND
A'(TORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y aKrm that I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my li nse is in full (orce and effect. �
�c � �t�l l�� i� ���
� t
� V clar's Si alur '
CONSTRUCTION LEN�ING AGENCY:
❑ I hereby affrtn that there is a constructbn lending agency for the
per(ormance of the wurk (p wfiich this pertnit is issued. (Sec. 3097, Civii Code).
Lender's Name:
Lender's Address:
Date
OWNER•BUILDER DECLARATIONS:
I hereby aHirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7037.5,
Business antl Pro(essions Code: Any city or county which requires a pertnit to
construct, alter, improVe, tlemolish, or repair any slrUCNre, prior lo it5
issuance, also requires the applicant for such pertnit lo fle a signed statemenl
that he or she is licensetl pursuant to the provisions of the Contracrors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of Ihe
Business and Professions Code) or lhat he or she is exempt therefrom antl
the basis for the alleged exemplion. Any violation of Section 7031.5 by any
applicant for a permi� sUbjects Ihe applicant to a civil penalty of not more than
five hundred dollars (5500).):
❑ I, as owner o� the property, or my employees with wages as their sola
compensation, WILL DO THE WORK, and the sWcture is not intended or
oReretl for sale (Sec. 7U44, Business and Professions Code: The CoNractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or lhrough his or her ovm
employees, provided that such improvements are not intendetl or ottered for
sale. If, however, the building or improvement is sold within one year of
completion, lhe owner-builder will have lhe burden of proving that he or she
did not build or improve for purpose ot sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construcl Ihe project (Sec. 7044, Business and
Protessions Code: The contractors License Law dces not appty ro an ovmer of
property who builds or improves thereon, and who contracts (or such project with
a con(ractor(s� license pursuant to the Contractors ��cense tavrs.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
SigndWre Dale
305]-O6 3IOJ)
Owner ID veri(ied by dri�se. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype of documenl, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certify that no excavalion frve (5) or more teet in depth into vAiich a
person is required to descentl, will be made in conneclion vrith work aulhorizetl
by �his pertnit, and tha� no builtling struclure, scaf(dAing, (alsework, a demolition
or dismanHing thereof, will be more lhan thirty-sia (36� (eet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Cali(ornia Adminislrative Code).
❑ As ownerbuilder, I will not employ anyone to do vrork which vroultl
require a permit from the Division of Industrial Salery, as note0 above, unless
such person has a permit to do such work from the division.
Appliwm's Slgnawre
Division of Intlustrial Safety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or (uture building occupant need to file antl
certify a Business Plan (or emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallOns, or 200 cubic (eet of compressetl gas
at standar0 temperature antl pressure).
2. Does or will the applicant or present or fuNre building occupant need to file
a registration form for acutey hazardous materials7 ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration wi�h Ihe Costa Mesa Fire Depanment by
each business which at any one time has on hantl a quantity of acutety
hazardous materials equal lo or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet o( compressed gas at standartl
lemperaWre and pressure).
3. Does or will �he applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Cali(ornia Health and Safety Code provitles that the
Costa Mesa Fire Depanment may require the preparation, certification antl
fling with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently requireQ has Section 25534 of the Cali(omia
Heal[h and Safety Code been fully complietl with? ❑ Ves ❑ No
5. Does or will the applicant or present or (uture builtlin9 occupant require lor
the work which is the subject of lhis application a permit for such construction
or modifcation (rom lhe South Coast Air Quality Management Dislncl or (rom
any olher air pollution control districl or agency7 ❑ Yes ❑ No
(Sectbn 65850.2 0( the Califomia Govemment Code requires that the requestetl
information be Wmished on applications for nornresidential building permits).
6. Will any part of the facility to 6e constructetl under this permit be vnthin
1000 (eel from the outer boundaries o( a school7 ❑ Yes ❑ No
Qf "yes", the facility must meet Ihe requirement of Sections 25534 and 42303
of Ihe Calilomia Health and Safely Code�.
7, If a permit fmm the South Coast Air �ualiry Management DisMct or other
air pollution control district or agency is required for the v.ork which is the
su6ject of this application, have all of the tlisclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance trom the appmpriate air pollution
coMrol oKcer).
CER7IFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
information given above is wrrecL I aqree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state lavrs and city
ordinances relating �o building consWction, and authorize representatives of
the City of Costa Mesa to enter upon the above-tlescribed propeAy for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until inal inspection.
Signaw ^ er(s - Dale
Antllo A nzeE p i nl e I
,
%�
�r
Rcsidentiul.A[te; ations
Residential
♦ �
L
Zone N
�aQe 1 of
N uf Stories
9➢
� Oouaue SurfaCe D0tai15 rur the furred portioned of Mass N'alls sec Furrin� Strips Construction Table beloh�. �
Tag! I Assembly Name
ID� orTvoe�
Material Spacing, U= JA4 Table Cavity
and Size'' or Other� factor' Number° R-value°
ng for Cauinuous Insufalion R-vnlue, see Page JA4-3 and Egualiai 4J. For
use
�. ror ingau ma�cae me iaempica«on name rna masnes me ouuamg pmns.
3. /rtdicaie lhe Assem6/r Name or rype: Roof�Ceifing, Wal/s, Floors, Slabs, Craw/ Spare, Daors and e�c...lndicate �he Frame rype ond Size: For
N'ood, Meml, Meta/ Bui(dings. Mass, en�er ?x4, ?x6, ar e�c... see JA4 for mher possible fr•amc rype assembliu.
3. Enfer tbe thickne.ss.jor mau in inches ar Spacing between framing members emer; / G"w� 24 "OC; or Orherjor a/1 oiher nssemblp descriptian
such as Conerete Sandwich Panel, Spondrel Panel, Logs, Sn�aro Bale Panel and etc... .
4. Based on �he C/ima�e Zone; ettter 1He Stattdard U facror fi�onr Table 1 Sl-Il, C or D%r eucly d�erem asremblp Name or type.
5. Emer �he Ta61e num6er �ha� closely resem6les the proposed assemblv.
G. L•n�er Ilie R-value �hot is being insm!!ed fn �Re wa!l covftn or Lerween ihe finming; olhenvise, en�er "0 ".
7. EnMr Ihe Continuous ]nsu(afiai R-nalue jor (he propased assemblj�; o�herwise, enrer "0".
d'. Enrer the row ar:d cnlunm o(�he U fac�or va(ue Losed mr Co(umn FTable Num6er and enter �he Assem6lp U-joclor in Column J
). The 1'ropnsed Ae•semLln U-(atior, Column J, nms! be equa/ in m' less ihan �he Stonrfnrd U-(uc1a� in CoAmin E tn comnh�.
Fun•in � Strips Construction TaUle for Mass Walls Onl �
A IS C D E F C H I .l K L M
Proposed I'roperties otMUsonr�• m�d Concreic Added lnterior or Gxterior Insulfltion
N�ulls I�rum Reference in Rurring Sp��ce 1'rum Referenec
Juin� A i�eudix'1'vblr 4.3.5. 4.3.6. 4.3.7 dnini A rewlia 'I'nblc 43.13
v = W -� _ �• u .
v, u p J 4 L '
Asscmblp � � � � �' � � U'� '° Final
<' '� _ c�n a� � L a u..�
Masa Namc ot JAG Table �_ ;, � F E R B 't A Q� � � ASSemb�y
'Phicknesi T c' Num6ef� �" = ui ° e LL 3 ' C 4 ry m C U-fae[or�'� Comment
I
I I
/Cegi.s�ru�fon NumLe�r Regisn�oiion Daie/fimc: HERS Provider:
10pb' Reside�ttiul Complianre Form.s �lugus� 2009
Certificate
Residential
ROOFING PR011UCTS (COOL ROOFS) §I51(pt1
When ti+e area ojrxterior roojs��rjace ro be replaced exceeds uenre
lessl Uic ne�v roofing aren musl xieel Nac roofing producl "Coo! Ro�
Climate
of fhe ezisting roof aren, nr more tbun
or
CF-IR-ALT
• {fta�e 3 of 5)
1 # oT Stories
�vhichever is
Check uppiicaGle alternarive or crceptio�� beloH� if U�e rooJaheration is esempi jrom !he roofing produc� "Cool Xoof'requiremems. No�e: /Jany
one oJlhe al�erna�ives or ercep�ion below is checked, !he Aged Solm' ReJlecmnce and Therma/ Emit�ance requiremexis jw' raofing products rn
§118(iJ are no� applicable. Da noi fill rable be(ow.
❑ Cool Roofs Not Requirod in Climate Zones I• 12, 14, nnd I 6 with u Low Sloped. Less or 2:12 pitch.
�Cool Roofs Not Required in Climate Zones I thmugh ) and 16 with a Steep-Sloped Roofs (pitch greater [han 2:12) and product unit weight less
than 516/Ctz.
Alternatives to §152(b)IHi and §152(b)Hii, Steep-slope roo( (pi�ch > 1:12)
❑ Insulaiion witli a thertnal resistance of at Ieast O.8S hrRZ °FBm or ai least a 3/4 inch airvspace is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(�10; or
.❑ In climate zones 10, 12 nnd 13, with I ft''.of Gee ventilation areu of attic ventilntion for every I50 ftZ of attic floor area, and
where at least 30 percent o(the free ventilmion area is within 2 feet vertical distance oC[he roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requiremenis of §151(Q2; or
❑ Building has no ducts in the attic; or
❑ ln climate zones 10, I l, (3 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hiii, Low-slope roof (pitd� <_ 1:12) �
❑ Building has no ducts in the attic.
❑ RooSng area covered by building integrated; photovoltaic panels end solar theRnal panels are exempt from the below Cool Roof criteria.
❑ RooT conc�ructinns that have thermal mass over [he roof inemhrane wi[h at leasl 25 Ib/ft is exemol from [he below Cool Roof criteria.
np
ProductlD
}om the Roo1
Roof Slope
2:12 > 2:1:
❑ ❑
cannot be used, use [he Pertormance
�Prod—ucts "Cool Roof' Re uirement
I Product Weieht Pmduct
���
���
���
���
Approach ro showw complianc�
Aged 5olar Thertnal
Reflectance3'4 Emittana
�4
❑4
❑4
OQ
❑d
7Y�e CRRC Produc� ID Number tan Le o6�nined from ihe Cool Roof Raiing Council'a Rated ProduG Uirecmry a! wwiv cootroofs.orr/produtla/seorth nhn
Indimrc !he rype of prod�rci is Leing uaed for d�c roof rop. i.e. single-pl�� raof, aspha6 roof, melal roof, e�c.
/f Ilre Aged ReJlecmnce is nm availuLle in.dic Coal RoafRming Counci/ls Hared Producr Direcmr7� tlien uxe the Initial ReJlec�ance valuc fi'om �he same
direc/nq� nnd use ihe equa�ion (O.I+OJ(();,,;�;,,1– 01J io o6�nin n calcu(ared aged vaG¢. Where p is the Iniiial Solar Reflectm¢e.
Check Lox if A�c Aged HeJleelmrce is n calcu(aied vn(ue naing �he equaiion above.
Ca(ndaic rGe Sft/ va/ue Gr using �he SRl- Workrheel a� hnn �U�nvu� enerer.ca.eav/litlel4/ m�d emerlhe res�dring vnlue in Ilic SRI Colurnn above and oaach ucopy
ihe SR/- Worksheei m!he CF-1 H.
� apply Liquid Rield Applied Cuutings, the coating musl be applied across the entire roof surfnce nnd meet the dry mil thickness or coverage
commended by the coatings manufacturer nnd meei minimum performancc requirements listed in ¢11 B(i�. Select the applicable coating:
Aluminum-Pigmented Asphalt Roof Coating ID Cement-Based Roof Coating ID Other
Registru�ion Number: 2egisira�ion Da�e/Time: HERS Provider:
2008 Residentia! Compliance Forms � Augusl 2009
' ' �.
� I'rescripCive..Certi?�ic.ite uf Cumpli:�nce: Residential CF-7R-ALT
Ifesideiitiril Alterntion,c (Pa�e � 01'�)
,_ Yi�ujec�n�me: ��� I�� � Cfiniatc "Lunep I i: ai�Sturiea
r�
ri1..�
HERS V�1'�IFJ CATJ ON SUMMARI' The en/orcemeni ugencr rhmdd pop sueciul onen�ion ro !he HL•12S Nleasures syecifieA m lhia
checklisi Lelan�. d canpleied und signed CF-4/t Fornr jor all !hr weas�n�er specified s•hol! Lc submiued io �iie building ine�pec�or Leiare Iinol
DIICISenlin�ed:7�L'Stilld HGRSverifica�ionisrcyuired/a'ihiamcarurc.
� YCS ❑ NO YCS: lu Clima�c Zones ^_ xnd )-I G, i1' mort thau 4U linear feet of ncw or rcpl•ucement ductx are insifilled in unconditioned
space, Om ducts m�e «, be seuled per §I52(b)1Dii and the newly inswlled ducts are to be insulateA pe� §I51(1110.
❑ LXCCI'T1U�: Lzisting duct systems thnt ure extended, which sve consh�ucted, insulaied or sealed witli asbes�os.
❑ Pi5 ❑ NU 1'E5: ]n Ciimate Zones 2 and 9-7 G, i1'the existing space-conditiouing system (HVAC equipmem and duciingl is repinced, the
' duc�s are to be sealed per §152(b)1Di. �
❑ YLS ❑ NO YCS: ]n Clima�e 2ones'_' and 9J6, if [he exis�ing HVAC equipmem is mpluced (including the replacemem of the air handler,
- owdoor condensing unii of zi splii system, cooling or heating coil, or tl�e furnace heai exchangerj the ducts are to be
sealed per § 152(b)1 E.
❑�XCGPTIO�: Duct systems thnt are ducumented W Luve been praviously sealed confirmed tivuugh HCl2S
, � verificalion iu uccordonce with procedura� in the Reference Residential Appendis I2A3.
� � ❑ CS:CGPT70�: Uuc� sysiems with less thnn 40 iineur teet in uncouditioned space- � �-.. � �
duci
with
Ref'rioerant Charge - Split S}'stem HERSveriJicaiion is requirecV fa �hi.s measioe.
❑ Y�S ❑ NO YES: ln Climare Zones 2 and S-I5, when the esisting HVAC equfpment is replaced (including th: replacement of the air
handler, outdoor condensing unit of a split system A/C or heai pump, cooling or heating coil: or th� fumace heat
exchargerj e refrigerani charge mwsuremwt shall be veri5ed per �152(b11F.
Central Fan Inteerated (CFI} Ventilation S,l�stem and Fan VJatt Draw
The ventilation requirements of §ISDfoj do not anoN to existine residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verilicaiion is requirnd.Jor this measvre.
❑ Y�S ❑ NO 1'ES: In Climate Zones 101hrough I5, wlien Uie exisiing space-conditioning system (HVAC equipment and ducting) is
reolaced. the airflow and ian watt draw shall 6e veri5ed oer § 152(b)1 Ci to meet the reauirements of & I51(f17B.
oT Comoliance documentetion is accurnte and
Signature:
�
Respunsiblc Ruildine Designer's Dcd:u•aliun Statemeid
e 1 am eligible under Di�•ision 3 olthc Caliiamia Business nncl Professions Codc to accep� respunsibility ('or the buiiding design identiGed on
this Certif�cate of Complianec.
• 1 eenify lhai d�c energy feamres und performanec specificntion:� for the building design identiLed on this CeniSente of Compliunce conform
w �hc requirements oI7'ille 29, Pnns 1 tind G nf'Ihe Culitornia Codr oTRe�ulaiions.
• The building desigu feawms idrntiGed on this Cenificme of'Compliance are consistem wiih thc information provided tu ducumeni thit
building design on th: other applic�ble complianee lonns, wurkshee�s, calculations, plant and specificaiion:�• submiucd �o the ent'ureemeni
veencp fa� ap!>rnval with tliis buildiu�� Permil a plicatia�.
Nnmc: Signature:
Phone:
Fnr uatsi.rltuice nr gue�'tintts regwv(ing tlic Lnerel' StruidturLs, cnn[uc1 !hc Lneroi' Hot(rric ut: 1-b'(1(1-7i?-i300.
I(eg�su�tuiou AhmiGer: /(egisir��ion Laic/I'ime: HEI;S ('rnniner:
2UOF, )fesidential Compliunce Fa�ms Augu��� 3p(IJ
�
(714) 75M1-5273 • Faz (714) 754�4856 • vnvw.ci.costa-mesa.ca.us 77 tAIN UHNt, GUJ" 1 A Mt,A, l:H 82tlZti
�ob Address: 2871 ELLESMERE AV
Suite No
Vicinity:
Parcel Nunmber: 13933502
Applicant: BROWN, BARBARA '
Address: 3801 LENAWEE AV
CULVER CITY. CA
Owner: LARIMER, HARRY C
Address 2871 ELLESMERE AVE
COSTA MESA, CA
PLUMBING PERMIT
Phone: (310) 253-5229
Zip: 90232
Phone:
Zip: 92626
Contractor: GEORGE BRAZIL PLUMBING, HTG.
Address: 3801 LENAWEE AV
Arch / Eng :
Address:
CULVER GTY. CA
Phone: (310)253-5229
Zip: 90232
License: 679898
Phone:
Zip:
License:
SCOPE OF PERMIT
SEWER REPAIR. NO CONNECTION TO MAIN LINE AS PER APPLICANT.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo(
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceplors (Sand Aulo )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
so.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
so.00
$0.00
$0.00
Qn
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
- FEE SUMMARY
AMT
�Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 70 fl) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo 50.00
Sewer Connect 524.65
Sewer Private Line 50.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: 08/28/2001
Issued: 08/26/2001
ISSUED BY: // 1' � '
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilep
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water.Service
Water Sokener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 548.15
aN
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-2/-92)
EXPIRATION: This permfl shall automatically expire and become void it work is not commenced within 780 days, or if work is suspended or abandoned
tor a period of 180 days. .
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapettlone end flnal approval must be obtained. Failure to obtain inspections antl final approval will result in the expiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zms�ae �sroo�
a
WORKERS'COMPENSAnON DECLARAnON:
I hereby eHirtn un0er penelry ol perjury ane ot the following declarations:
❑ I heve entl wlll maintain e certilicate ol consent Io sell-Insure for workers' compenseilon, as provided tor by section 3700 oi the Lebor Code, for Ihe peAormance of the
d' work for which this pertnil Is issuetl.
!CJ\ I heve entl will maintain workers' cOmpensetbn insurance, fls requiretl by section 3700 of ihe LeOor Code, for �he perfortnance of Ihe work fo� which 1�I5 pertnit is issued.
1�Ay workers' mnpensatlon Insuran�e cer �r end policy number ere: //
Cartier. � _ � �� Poliry Number: /�, �7 � � �_Q �
(Thls secNar not be romp/ete I/ fhe perm�t Is velued at one huntlretl tlollars ($100J or less.)
❑ I cenly that in the peAormance of the work for which this pertnit is issued, I shall not employ eny person in any menner so es to come sub�ec� to the workers'
compensatlon laws of alllomie, Bnd egree thet it I shoultl ome sub�oct to the workers' compensatlon provislons of SecRti n 00 oi the Lebor Code, I shall fonhwith
com(ly � hese prohsion . / \ ,(�r �` /`,�
GAppllcent Signet/urg: .0 �C.t n.w_/ /it�A ) Dete: U z-U /U �
N��kOfiE TO SECU WORKERS' COMPENSATIIXJ COVEPAGE IS UNLAWFUI PND SHALL SUBJECTlW EMPL TO CRIMINAL P TIES D GVIL FlNES UP TOONE HUNDRED
THDUSPNO OOLLARE (5100,OW),IN AOORION TO TME COST OF C(]MPENSAiION, DAMAGES AS PROYIDED FOR IN SECTION ffiOB OF THE U90R CODE, IIffEFEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARAnON:
(commencinp with Sec�lon 7000) of Division 3
� entl ettect.
contreaors slo
CONSTRUCTION LENDING AGENCV:
Date:
antl P�fes�ion� Code, anA my Ilcense Is in full
❑ I hereby aflirm that there Is a cons�mction lending agency for the peAormence of the work for which this permit Is Issuetl. (Sec. 3097, Civil Code).
Lender's Name: Lender's Adtlress:
Signature:
Date:
OWNER-BUILOER DECLARA710NS:
I hereDy ettirm that under penelry at perjury Ihei I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry which requires e pertnit to cronstruct, elter, improve, tlemolis�, or repair any swcture, pdor to its iuuance, elso requires ihe epplicaN for such pertnil
to fiie e signetl stetement ihat he or sha is Ilcensad pursuant to the proNslons of tha Contractors Lfcense Lew (Chapler 9(commencing wit� SecUon 7000) of Division 3 of ihe
Business and Professions Cotla) or the� he or she is exempt thereirom and tho basis for t�e allegeA eaemption. Any vloletion oi Sectlon 7031.5 Gy any applicant for e perm�]
subjads the applicant to a civil penalry o� �ot more thfln five hundred dollars ($500).):
❑ I, as owner oi Iha properry, or my 0mployees with wages as Iheir sole compensatlon, WILL DO 7HE WORK, antl the siructure is not intended ar aHered for sale (Sec.
7044, Businass and Professions Code: The Contradors License Lew does not apply to en owner of property who builds or improves Ihareon, end who tloes such work
himself or herself or through his or her own employees, Drovlded thet such improvemanis are not intentletl or oflared tor sale. It, however, tha building or improvement Is
sold within one year of completion, Me owner-builtler will have ihe burden of proving ihat he or she tlitl not build o� improve for purpose of sele.).
❑ I, as owner of Ihe pmperry, am EXCLUSIVELV CON7RAC71NG WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, eusiness and Pmfessions
Code: The coniraclors License Lew does not epply to en owner of Dmpeny who builtls or Impmves iheraon, antl who contracts for such pm�ect with a contractor(s)
Ilcensa pursuant to the Conhactor8 Licanse LewsJ.
❑ I em e:empt under seC. Business end PrOfessions Coda lor this rea5on:
SiqnaWre: Data:
Owner ID verifietl by tlriver's license. ❑ Ves ❑ Na Drivers License No.
Vedllcation ot Ownership by (rype ot tlaumam, i.e. - properry taz �ill or Ceetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Expiras:
❑ I hareby certlty that no excevetion five (5) or more teet in tlapth into which e person is required to tlescentl, will be matle in connection with work euthonzetl by this
perm%, flntl Uat no builtlinq siruclV+e, scaflMtling, talsework, or damolition or tlismanlling thereoi, will be more than thirty-six (36) feet high. (Cfiap. 32, Gry 2, Ari 2, Sec.
341, Tltle B, Calitomia Administratl�e Cotle).
❑ As owner-builtler, I will noI employ anyone to tlo work which would requlre e pertnit trom Ihe Dlvlsion ot Industrial Safery, es notetl ebove, unless such person has e
pertnit to do such wark trom the di��sion.
SignaNre: Data:
Divislon of Intlustrial Safery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTAV: I certify under penalry of perjury that I heve read ihis epplication end state Ihat the infortnation given Is
correci. 1 egree to comply with ell stete laws end clry ordinances relating �o building consWction, end authodze represen�atives ot ihe Clry of Coste Mesa to enter upon t�e
ebove-descnbed propeRy for inspection puryoses. I a9ree not to occupy or ellow occupency of any building euthodzed by ihis permit until finel inspectlon.
CODE�, INSPECTIONTYPE PA7E I�L$
1616 Fixed System Final Fire Prevention
1268
200
201
Pool Spa Final
Finel Re-Roof
Final BIocWRetalning Well
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
�ODE� INSYECTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel ElecMcal
272 Finel Fire Prevenibn
220 Flnal Planning Approval
222 Flnal Site
250 Final Building/Occupenq
PdiE Iti�Lfl
•a9-o ��
ApD��cant to till in all soaces excev< lhosa wlthin neavY
Ci�Y OF COSTA MESA CONSTRUCTION PERMIT
'ProjectAddress ���1 /�LL,6'S�/ER.E /41�6•
Applicant's Mailing Address SG�P S• 6ltiCPNO2 5T• OfZAnr�Jc
bwner'sName �%����'7 ��'��'1A.C� Phonelr�"����
�A.ddress ? �7� �LLdSIHG/(E AYl•
Arch/Eng. License No.
Address
Contracror'sNamas/NOTNGRNAc�VR�+• +'�•phone �`�YO��
Address Imailing) r�� S. G ARAN�R JT• URAN6�E.
CityLicenseNo. �p¢G3
LICENSEDCONTRACTOR DECLARATION
1 her¢by ailirm tlta� I am Ilcrosetl untler provisions of Charter 9(commencing
with section ]000) ot Divizion 3 of [ha Busineu anG Vrofessions Cotle, antl
my Iicense�is In lull force antl ettecL •
Licanse Class G�9 Licensa No. O 5� �
Datc �/�-� $I9nalure �'�_'Z_v�,�jf
WORKERS'COMPENSATION DECLARA�ON
� hereby attirm Ihat I �ave a certiflcate oi consent to selt-insure or a certlfl�te
f Wo�kers' ComOe����on InSurdnce, o� a ce�Utietl copy the�eof (Settion
�800, Lab. C.)
PoliCy No.�37Yi�—S'i{ Company STA�f= /�—�/ND
erblietl copy is nereby furNsbeO.
Certitietl copy is til a witn tne city Builtling O"vizion.
Date I/.. � Y- �"� APPlicant `���/— "'�-��i�i^��
E%EMPTION FROM WORKERS' COMPENSATlON DECLARATION
(This section neetl not be completetl H the parmit is (or one huntlretl (5300) or
less).
I certlfy [nat in the periormance of the work for whlch this perm�t is izsuetl, I
snall nol emplOy any person in any mannar So a5 to become SUDject to the
Workers' Compensation Laws of Calitornla. �
Oate Signature
'NOTICE: If, after making lhlt tloclaration, you shoultl become subjecl to the
Wo�ken' Campensation provisions ot lhe LabOr CotlG, y0u must fOrlhwith
comply wilh such pwvisions o� IhiS permit shali be tleemetl revokeC.
CONSTRUCTION LENDING AGENCV
I hereby afflrm that tbero is a cons(ru<tion lentling agancy br the performance
of lhe work for whiCh Ihis permlt is issuetl (SeGtlon 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILOEN UECLARATION
I hereby atllrm that I am oxempt irom Ihe Contractor's License Lnw for the
followin9 rcason (Soction 7031.S�Busines5 antl Profosslonal Cotlo: Any clty or
county which reqWres a oermit to construct, alter, improve, aemolish or repalr
any slructura, p�lor to Its IsSuanCe, also �equlre5 tho appllcanl for Suth potml[
lo ti�e a signotl statemant Ihat ho/sne Is IlconSatl pursuant to Ihe provlsions oi
.the ConVaclor's Ucunse Law (ChaO��r 9(Commoncing with Soctlon 7000) oi
Oivision 3 ot Ihe Busina5s ana Prole551ons Cotle) or that hC/5M1e is exempt
ierebom and the basii tor tne allogc0 oxomptlon. Any violaHon o( Sec[ion
J31.5 by any applicant for a pnrmit subjacts lbe applicant to a civil
}�Odlty ot not morC lhan fivo huntl�etl tlollars (5500).
lJ 1, as owner o1 Iho properly or my om0�oyae5 with wages as [h0ir Solo
Compensatlon, will tlo th¢ work, antl tho itruGture ii nol inlentletl Or olleretl
lo� sala (Soction ]044, Businass dnd PrO/e55lonal Cotle: Tha ConVaCtoYS
�icense ldw tloes not appty lo an ownCr ol a property wM10 builtl5 Or Improves
tneroon, antl wno does sucn work himsell/herself or tnroug� his or her own
employee5, Pfovitletl lh0l such imprOvemen[s aru not intentlotl or olleretl tnr
sdl0. N, hawevGq thu bUlltling or ImprovOment IS Toltl within ona y¢ar ot cOm-
pletion, tne owner will havo the buraen of proving he/she tlltl not builtl or im-
p/Ove lor lhc purpOSa O� salo).
❑ 1, as owner of lhe proPerlY, am excluzively contracting wttn licensetl con-
VattOrs to consVUCt lha Oroject (Seclion 7044, Bu5Me55 antl Protesslon5 Cotle:
Tne Contractor's License Law tloes not apply to an own¢r ot property wno
builtls or improves thereon, antl who mnVacts lor such projecls witn a con-
[ractor(sl Iicen3e purSuant�to t�e�COntrac[or's Licenie Law). 1 am aware tbat
proo( o( lhcir Wo�ker'S Componsalion InSurance shoultl �o provitletl to me.
❑ I am exempt untlur Section 8. & �. G. ior thts reason
Dace Owner
1 hereby certify that I nave reatl this aDG���ation antl state tnat the above
iniormaUon is correct. � agrce to comply wlth all city antl county ortlinances
antl state laws relating to bulltling constructlon, ane hereby autnorize reore-
sentativ¢s oi thiz tlty to enter upon the above-mentloneU properry for
inspectlan pur ses /
Signature �z'7'� � u���bte %/ 1-��
orivers' Licenze or 55 '^
Ilnes anC sign all appropriale tleclarations.
7T NO. UNIT NO.
TVP�E �OF CONSTRUCTION LI NEW LI ADD IJ ALTERATION LI REPAIR
LTCONVERSION ❑ DEMOLISH ❑ OTHER A P �
DESCFIPTIONOFWORK/USEOFBLDG. �
S Main Buildi
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Front
❑ TENANT ❑QELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear
❑ -OTHER /��'/=+r/�% � A
PRWECT DESCRIPTION 5�. F7. �3'f� oCCUPaNCY C Right
CONSTRUCTIONTVPE /2�=20'�F VALUATION$ (f90D•`� g Left
ZONE ' GRADINGCU.VDS. ACRES Ping.Ref.#
Remarks: Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwdsher '
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories �
?—Trap�
Root Drains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duci - Strucmral
Duct � Ventilating
Exhaust System ❑ Multiple ❑
FirepVFacc Blt. ICBO #
Heatin9 System & Ducting
❑ P7 00,000 BTU O t 00,000 8Ti
Reinspection Fee � $15
CMF 0865-46, rev. 30/84 White - Builtling; Canary - Appllwnt; Plnk - Ac<ounting; Goltlenrotl - Assessor
Showers
Service Sink'
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
$wimming Pool w/Spa
Urindl -
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
lauo Fae
Hood or. Typel ❑
Canopy Typo II ❑
Re(rigeration System
Daioo,000aru ❑ioo,000
System Repair/Alteration
Fire Dampen
Registers
la�e Fee
FEES
§ 3
33
Automatic Washei -
Construction Pole Sub.
Cooking Unit .
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A.U. ,
Fix[ures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW 05-'.
Fee
3041 II/28/B4
Zone
Perking Req./Provided
EIECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 ampS
Meter ❑over100amps �
Sub Panel
Mo�ors O41 HP O1 h- 8
Inc.Salar �9�75 HP �16-15+
Microwave
Pole Light • �
Fange
Si9n
'S d' S
5KW
515
tan mg ections
Trash Compactor
Issue Fee
3�aa0 r�
FEES
5 3
Z
O
N
I
N
G
R
E
Q
M
T
S
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approved By Date
BUilding Approvetl 6y • Data
Appliption Issued By Data��
SU MARV OF FEES
BUILDING PERMIT $ �y-� SMIP $ � • �
PLAN CHECK 3 � PERMIT
PIUMBING ' $ �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $ �
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ 2`/
MECHANICAL $ ' TOTAL FEE $ ✓ l • �O
P�AN CHECK 25% $ � ,
: CONS7NUCTION AND PLANNING ' POO. .SPA .
� APPROVALS Permit # Date Inspector AppROVALS Permit # Date Insprcrnr
i. Temporai y Electrical Service or Pofe 52. Pool & Equipment Location �
� 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding��
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
.6. ElectricalUFERGrnd. � � 57.�APPROVALTOCOVER-GUNITE
7. Footings . ' 58. Electrical Conduit-Undrgmd.
8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-'frap, O Undrgrnd.
10. Structural Floor SYstem � 61. APPROVAL TO DECK
11. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final ,
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electricat-Conduit � 66. Solar SYstem-Final
i 6. � Rough Electric Wiring 67. Fencing & Access Approval
17.'Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. )Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVAIS Permit#
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating , 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72: Underground Flush �
2A. RoofFraming 73. Undergrnd.StorageTank�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. Insulat�on ' 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 Nntes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test � �
36. Hood o� Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water 5ervice-Final �
40. Gas Serv�ce-Final
41.Solarpomestic-Final __ .
42. Backflow Preventer �
43. Backflo�' Icrigation '
44. Landscape Irriqation System
45. Sound Attenuation �
46. HandicaP Regulations � ' .
47. FINALSTRUCTURE&BUI�DING S�7 6
48. Speciai Requirements Completed �
49. Electrio Release to Edison • � -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Nn. Date� � �
RO� = COVERING CERTIF' ATION
f � �
Property address Z� 7/ � LL�� c rs.i,�RE //i/C
Owner /�i+�v �ARi��+�
Contractor S��'r��R�on/ �lcrCJF/N(,.. Go •
State Contractor License Number 3 DYG /
Permit No. � � � � I `�
Classification G- -;
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the 1979 Uniform Building Code, as
amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
ma nu factu rer.
Cl I further certify that I am the owner of the property. (Owner-Builder permittee only).
L��I further certify that I am:
��Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to
make this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the
Building Division for acceptance.
Received by Building Division by:
� ���LB
Initial Date
Spaee lor No[ariy� Stafamenf for aut�orizetl of/iter o� a9ent
Snr�T.'i5.�i�-ro'✓ J�ov F� N G �b .
Company or Corporate Name
S—�S� S. Gr+2JN6.C. s' i.
Atltlress
.e.niv�F� _ G� . q��6G
519nature
�3o.3'isy /- - S:� � ; l�6/tr-r.•n/
Printetl or Tyootl Nama
CMF 0990�46 Whi[e - Builtling Dfv.: Canary - Contrattor, Pink - Owner
-a
Date
� .CITI�OP COSTA
.t CONSTH�UCTI�
J�
3
AVPliwnt to Iill in all soaees except tnase wit�in
PERMIT
Applicent's MailingAddress /�JZ �f/cSs7r�usrr.0 K/cs-w.✓srxGr
� Project Address�87/LGceS.Nc,GG � Y
Owner's Name �'° �"'�`'e Phone�s� "8g�?
� Address z�7/E[ca`Sa�rF�L/� r Gsrvr l/%SiJ
' ArchlEng. . Licenm No.
IAddress
Contractor's Nam � 1"'� Phone l''�'�� 9�
Addresslmailing178/2-1 E59.Oi�Srt.0 l•s�a.✓.ssre.C✓
License No. 28! 7.Sro � $/ '' 9 3
LICENSED CONTRACTOR DECLARATION •
I nereDy affirm.that I am Ilcensetl untler provislons of Charter 9(cominencin9
With uttlon 7000� of Olvlsion 3 of the Business antl ProfeSSions Cotle, antl
my Ilcenze Is In f 1� force antl affacl.
LJcen Clzss � '� ' l.icanse Z6�7�0
'fata� Slgnatur ' � .
/ORKERS'COMPENSATION OECLAR TION
.i hereoy affirm that I have a certif(wte of consant to self-Insure or.a certificate .
of Workers' Compensatlon Inturance.�:or. a certlBetl copy Nereof (S tlon
3800, Lab. C.)�-'' 'I �
PoIICY No..'L'%q�� u�m¢�GomPanY �� �^
I��yI�.Ertltietl copyis neraby furNshetl: �� n
Q Cert�T,ietl cop yAs tiletl with [ha c�ty� 101 Ivlsion. .�// � �
�ate Y-/-E.�. � A071iWn:..��� i�.0 .[/���
E%EMPTION FROM WORKERS' COMPEN TION DECLARATION
�(This seclion nee0 not be completetl It the p rmit I5 for,one'huntlretl (E300) or �
� leszl. -. � . , - .- � . . . .
' I certify that In-the performtnce of the�work ior whith thi5 parm�t ii 155uatl I-
- shall not employ any parmn In any manner so �as lo berome su�ject to [{�e'
Workers• Compensatlon Laws of Cali/omia.
Data Signature
NOTICE: If,�a(ter makinq [his tlaclaration, you ShoulG becoma sub7ect to lhe
Warkers'� Compensatlon provlsions o/ the Labor COCo, you must forthwith
comply �with tuch provislons or this permit shall be tleematl revoketl.
�CONSTRUCTION LENDING AGENCV � �
o� ethaY wotrk �lort LwhiChs a Cmp 'Pe mIt �Is6luiuetl 9($ecH'on �30�7�fC v a C j
LonGer's Name A ��ry� ,
Lentlar's AGGress
OWNER BUILOER OECLANATION
I harebv afilrm that I am ozomot from tho Contractor's Llcenze Law for the
lrutl tlollarsb(E500)�hn appllcanl to a. civll
�
or my employaes with waqos as thelr 5ate
�na tho.serucWre Is mt intentlatl or oftaretl
�yees, provlaea tna[ sucn imorovemen[s are-noc m[onaea or orta.ea �or
It, nowever, Ihe bulltling or ImOrovomenl is soltl wit�in one year'of com-
m, tha awner wlll �ave tha burtlen o/ proving ha/iho Citl nol builtl or im-
for the Durpou o( Sale).
as ownei of Ihe property, am exUusively tontracting wlth'licensetl con-
irs to construct the project Sectlon 7044, Buslneis antl Prafeszlons Cotle:
..ontractor'z �icanse Law �oes not apply to an owner of property who
Iines an0 sl9n all apPraD�lala EOclaritlons.
�-9i�4- I Noa�' I � I
TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ dEM LISH ❑ OTHER
DESCRIVTIONOFWORK�nbFric/Q:.rfi cGo irC�✓«!
TVVE OF PERMIT � ' GRADING�y FOUNOATIO�yN STRUCTURAL
❑ TENANT ELECTRICAL L'J PLVMBING LJ MECHANICAI
❑ OTHER
PRQIECT DESCRIPTION Sq. F7. oCCUPANCv
CONSTRU�O(J TVPE �FA-M'C �� VALUATION S�Zssa�„!�'.�
ZON� � GRAOINGCU.YDS. 'qCRES
Remarks: • , � , . �](� ��iZ � � , '
Si�k � Sewer (:ap � �
cflowPrevente�-� -� - � -Sewe(,Coanection ' -.
kflow Irrigation Solar Collectors '-�: �
itubs ��� � Solar Piping , �
:[:..�. . � Gla� Ten4 . �
Floor Drains
Floor Sinks �
Gas Seivice
Interceptors ;
Kitchen Sink
Roof Drains
� �Service5ink
OuNBts
n
Boiler '
Duct - Untler Ground �/twrr
Duct - Struc[urel
Dutt - Ventilating
bulltls or Improv¢s thereon, antl who contracts lor suth Dr,o�ects with a con- . Exhaust System ❑ Multiple
tra<tor(5) Iicansa pursuant to t�e Contractor's Licenze law).
❑ I am exempt untler Sectlon B. 6 P. C. for this rea5on Firepl/Fatt. Blt. ICBO �
Date Owner' � Heating Sys[em & Ducting
1 he�lDy� ttrti/y�t�at I�have reatl 1h15 applicatlOn antl state that [he abOve ❑6100,000 BTU�O100,000
informatlon is correct. I agree to comply wlt� all tlty antl munty ordinances
antl state laws rela[ing to Culltlinq coni[ruttion, antl heraby authorize reD�e- Haod or T e I
san[atives of this Ity to. a r uVon the bovoKnantlonetl proparly far I' �n0 TYp¢ 11 ❑
inspettlon o5 5. ' /
^ Signa[ure h � - Date Q� �^ �3
� �'�rivers' License o 55
���t: P��k - Accounting; Goltlenrotl -Assessor
�
vnna�� -� _ �.
Water qaset
WaterHeater- ��
Water Service � -
. A S� -% �iYc/<dGL
..-:�.
` ��� 2
. ^�
. � �J�
R E F. qW
LEFTSIDEVARD >�(���
I
PKG.SPACE RE�.
STREET WIDTH O
SPECIAL CONDITIONS:
Auromatic Washer , _
� Construction Pole � �
., -t: �Cooking Unit � '
: � `. Dishwasher . - � �
� � Dryers ❑Gas � �Electric
i , Fen .
F.A.U. ,
j Fixtures -
, Device Boxes'
.._ n..«.... . .
..
Reinspection Fea ',$15
laue Fee _ $ 3
❑0.100,OOOBTU ❑100,OOOBTU
System Repair/Alceracion
� Reirtspection Fee
Isue Fee
DispOsel ,.
�r �0-5 KVJ �5-15 KW
mer ' � 7 5•50 K W
�5U+ KW �
�uo to 100'amosQiil,
APPliiation�ilPVruved BY
Application Issued'By 1
�REAR VARD (TO P/U �(� °
RIGHTS�DE VARD � L�� ��ll
PROVIDED , • •
� � PARK FEE $
Meter LJover 100 emps `
Sub Panel `
Sub Pole ' � , i �
Motms L104 HP LJ1X-8 ��
'Inc.Solar 09-15 HP 01645+� -
Microwave -
Pole Light � �
Renge
Sign
Standing Sections
Trnsh Compactor
S
, Reinspection Fee $75
�� . ' /- S�U�M,M�A...R�V OF FEES
' BUILDING PERMIT $, �9 SMIP � $ � �•%�
00 ' PLAN CHECK ' $' PERMIT . , �
PLUMBING • � $ ��I'm� ISSUANCE $
PLANCHECK $' Q-��� ' GRADING � $ �
� ELECTRICAL � $ IS"b � $ , .
PLAN CHECK � $ �' �O � MICROFILM $
� MECHANICAL $; / a�o TOTALFEE S
$15 PLAN CHECK $ �''S� � qDVANCED PC �$ �.� -� �
$ 3 ' FINAL FEE $ -`-S�_S
�
� d
'�CONSTRUCTION AND_PLANNING
� APPROVALS � Permit # . �
�1�. Temporary Electrical Service or Pole �
,2�.��Soil Pipe-Undrgrnd. ��,{,vi .
� 3. Electrical Conduit Utilitv-Undrgrnd.
� 4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement ' •
6. �Electrical UFER Grnd. '
7. Footings , . '
8. Founda[ion
9. Wa[er Pipe-Undrgrnd. ,
10. Structural Floor System ,
11. Property.Sewer Line & HouseConnection
12. Sewer Cap .
73. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit'
16. Rough Electric Wiring , ,
17. Fiough Wiring Sign • �'
78. �Rough Electrical-T Bar Ceiling ',
19. Rough Heating & Air Conditioning '
20. Rough Factory Fireplace '. •
21. Ducts, in Structure ' ;' '
22. Ducts, Ventilating � �
23. Gas Pipe-Rough &-Test � � �
1�
24. Roof Framing -' ! � � ,
25. Roof Sheathing ' � , �
26. T-Bar Ceiling (StructuralL & Monocoat
27: Frame,and Flashing �
26. Lathing & Siding
29. fnsulation PndiryaJ Lefi O
!� Z
30. Drywatl Nailing '
31. Plaster Brown Coat� .
32. Electrical PowerMeter-Final �
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
�
39. Water Service-Final ' . •
40. Gas Service-Final .
41�. Solar pomestic-F.inal
42. Backflow P.reventer
43. Backflow Irrigation ,
44. Landscape Irrigation System
45. Sound Attenuation �,
46. Handicap Regulations t'�
47. FINALSTRUCTURE&BUILDING ,
48. Special Requirements'Completed �
49. Eledric Release to Edison � �
50. Gas Release to Southern California Gas Cn
51. CERTIFICATE OF OCCUPANCY
Date
Date
11-2/-8)
Il-28'-Fl3
� ��
n
e
PO. . & SPA � �
Inspector pppROVALS Permit.�1`-
. 52. Pool & Equipment Location
� 53. Steel Reinforcement
54. Forms � ,
55.. Electrical Bonding �
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical �unduit-Undror�d.
59. Gas Pipe, O Undrgrnd., Test .
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor-Final
� 63. Heater & Vent-Final -
� 64. �Plumbing SYstem - Final �
65. Electrical-Final
� .66.. Solar System-Final � - _
-e� 67. Fencing & Access Approval _
68. APPROVED FOR PLASTERING
� 69. POOUSPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
� APPROVALS Pe�mit#
70. Underground Hydro
71. Product Piping � Gas ❑ Oil
72. Underground Flush
73. �Undergrnd. Storage Tank O Gas ❑ Oil
� 74. Overhead Hydro .
75. Dry Chemical
�,p 76. Dry�Standpipe
� � 77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
Notes:
Date Inspector
� i.
.�... /i_ v .�__-
i
1�_��.. � � _a_. �
i � � .
�+ :�i�� �•.�.
lf� � , - �i� - '
� i I i / � ► .
� •-
�
�
4 ---� � C"� 'i � � 1�'� �Y! t-Gi'�, ^,i t -'�..
. ��� r� � �
I�. �
; �U
� _+t � ` ,� �
� � �; 4 � �_.
J-- : l , ���A'� � 1
I �i �,�L�.�,�; �n. � s
�, �'
���— � �— .
� G�,�'��1� Q� i— I
ia ��°�; �;�� �>; ��t=- r i
,>
�
CoN c. _
. �, v,,
� 1�1
I U I �. � I� N
1 �7 . � '�
� �� � -� '� �.
r � _ - -}— — — �
- - - - --- / Si_ ��
. � �� \. - c
�
�
. ,;\
�i��7����� , bt�;v�-�w�r�-�;. .
i .. :;r-==-'----,
� �
; a
.�i ��, .
�
� _ � .:� ..
-----�-- , ..;
i • ..' .�1ii �
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- � .�
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�!�•���' •�i.��
--t----�� —,----,--- .
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v.
.\
�
- (714J 638-1090
(714J 898-4066
1��ogm.��za �rz�o��io�zat�c�
�{omE c�Emoc%iin9 cS�Ecia�isEs
7812 WestmrnsterAvenue
Wesiminster, Californra 92683
Febnuany 29, 1984
C.i,ty o5 Cae.ta Meha
P.U. Box 1200
Ca�s.tcc ,Ne�,a, CA.
REFEiZ�NCE: hUc. and �dn,5. Nwucy Lcv�,inieh
Y871 E22e�smene S.tneet
Co�s.ta Me.sa, CA.
Pelun.i.t #G9174
(213) 598-5884
"Rean Yand Dncu.naye Away �nom New Addi�i.on (SEE PLUT PLAN)
Th,i.s 2e,tten .ih xo ceh,ii.6 y.tha,t .the�ce .i� a 2 o ga2.2 auxt y bnum .the
new add.i,tian wh,ich wcw bu.i.?� a,t 2871 EC2�5mene S�e2t and .that .the
4��shed �2oon ag .the an.i.d add,i,ti.on .i�s pno.tec�ed by a 6" wide x 6" h,i.gh
concnete cunb.
Sincehe2y, /�
C;�s�., I� �►
� �l �.
DENNIS F. D'M4BRA
PRESIDENT
DFD/ec
cc: Mn, and hV�s. Hanhy Lw�,irrien
2&71 E22e�sme�ee S�icee,t
Coh.ta M�sa, CA.
E�ic.2aaune
License Number 281750
'� :15��3 ���,t.���� G',� ✓��u��.��j�
C�� / t' C C1u i�ss`i
CbSTA MESA BUILDING-SAFETY DEPARTMENT ��FINANCE DEPT.
P. o. aoX s,� C08TA M66A. GALIFORNIA CITY OF COSTA MESA
For Appliconf +o Fill In Complefely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADDREBS ��" � ��� �
COSTA MESA. CALIFORNIA For Offite Use Only
aece�rr no. _aPe�eaiE,.xg,�
1 ARGHIT6CT
I BIZE
Pacesetter Jt. Venture
1653 Minoroa
Costa Mesa No: 9
TEL.
Mesa Verde Builders Inc:
1653 Minorca
I 86TBACR LINe PHOM
Ki 9-0395
INO. O� BLpT9. o
NOW N
I LEFf V I RIGHT 7
DESCRIPTION OF WORK
81ZEu��� Z�TSO S .F�F+ROOMS 7
EXTERIOR WALL St11CCO I ROOF SY�
COVERING qq� COVERING G}
USE OF Bl11LD1 %Cf•Ib WORK TO BE PERFO
Sin le famil residence az
Standard Plan No. 750 ffi
I M¢HEBY ACKNO DGH THAT I HAVE RGD T
ANO BTATB THAT E A Ve 18 COPR AND
PLY WITH ALL C OflO ANCEB A I1TH L
eU�LOING CON9 O . /
BIGNATURE OF� �� , ^
1
FIRE
0Y
COSTA MESA. CALIFORNIA
TYPE / GROUP
ZONING
ZON ' NO.OF U6E OP NCWSr.s
k— I vLAN9 � BUILDIN� ��.
LEOAL � �%. p T/{ ��0� �
OQBfVIPTIf]N -o-� u
ICEMCN YN6 BTJ
�o.,.R G13`
R�R 3 r
A�vPROVED � ��
`
�
7/z
— � //p �
_ 'y�yd
-S�e�ea-garage y7U sq.r�t.
LJGTION 'THE AMOYNT BXOWN UNDER V�LUATION IB POR TXH
TO COM- pUPP08H OP HBTqBL19HIN6 /. P6PMIT PE¢ ONLY.
uut
/ A n � VALUATION I
I NUTHORIZED A�QNT ( U ' $ �.�
CHEGK
i
� �U LL
ry3.k5
-' 36947 PAID
lUL -9-73�N�FOO 992+� ��*�*9.50
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
ForApplicant to Fillin Completely qE IV D 8V DATE RECEIVED DATE ISSUED
BUILDING � � — 3
ADORESS � P � P N � -7
OWNEfi �� � y e b A.P. NO. . �� 2 .O� P R� A/
7 4
BUILDING
Z . l' D
ADORESS � Q� Q e y .4DORESS �j y�� �/ Qy
w W C /-f!. c GL NO. �iYSi 07 TRACT��Ov LOT BLOCK
a- U GTY p
z Q CONSTRUCTION
W DD A P
O N LENDER
a m 0�7„ „Q
J � BRANCH / � L� I
J� OWNER /��SI/`� Gre1,e
m J ADDRESS VALUE
Qd
JQApCHITECT TELC i_ S LK Tr� UPV S D
N OR ENGINEER N L 7U _
V Q , j�� FIRE
w2 ADDRESS �.ZCi O• � UI �• /�� Z�NE V E GFOVP
p, W
w Z APPROVED
J 0
CONTRACTOR (� BV DATE �
m Z
J� AODRESS I h �, y�
W W / 20NE NO.OF USE OF NEW
Z= CITV G / d,w NOL�.Z'—l%� PLAKS BUILDING V•
H
� STATE CITV �'ARDSAPPflOVED VARDSAPPROVED
y 2 IIC. NO. � 3��� LIC. NO. MAIN BUI�OING ACCESSORV BUILDING
�� SIZE � NO.OF BLDGS. (FROM C/L EET)
OF LOT NOW ON LOT RONT FT. FT.
US E O F `�• � �J
EXISTING B�DG. 7 �\ FT. F
� SI2E OF NO. OF '��
Z NEW BLDG ROOMS STORIES L. SIDE FT. FT.
U EMERIOR WALL ROOF
COVERING COVERING REAR FTS�/ FT.
J USE OF BUILDIN N WORK TO BE PERFORMED DISTANCE BET. e MAIN&
a %. � � F�. LJ �' MAIN BLDGS. ACCESS. BLDGS.
a
Q n VAR. # DATE
Q TO �' 1 S � l C.U.P.�'+ ' APPROVED
NAPPROVED � l�
z —� al /
0
VI hereby acknowledge that 1 have reatl this aoPlication and stata . STATE
� that ihe ebove informetion is correct and agree to comply with
� all laws regulating builtlinp construction, antl I shall noi employ [�.��
F any pe�son in violation of the workman's compensation laws ot ' O/
y the State of California. � m
b
zI hereby certity that I am properly licensetl as a contractor untler Q' FT' TAJ( 0
the Scate of California Business antl Protessions Code, Divisicn 3, THE AMOUNTSHOWN UNDER VA�UATION IS POR
Chapter 9, antl Nec such licenses are in full force antl etfect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt trom tFe provisions ot ffie State of California Busineu Q
VALVATION
antl ProtessiOnS Cnue, DivisiOn�, Chepter 9. N
� PEfiMIT FEE $ ! �� ]
SiBnature o � � m
Permittee 5 �3U PLAN CHECK 5 E
`o
�� �) LL
Avthorizetl ABen[ TOTAL FEE S i C!'(!
\
J�
�
�.
INSULATION CERTIFICATION
o7��P �LLE5�1'1 C�2� Cas�- (/f/1,Q$ �- C'�
'— NumDer �n0 SLeel UIY , CountY�
�SuDO�rlNon � l0f NumDb .
DESCRIPTION bF INSTALLATION
ROOF
Maferiel
Tnicknrss Gn�hes)
EXTERIOR�
Mrteri�l � .
Thicknest lintheil c�� fZp
CEILING J��
�tt or lanket TVDt_1 • �1 -
TAic��ess (inches) �� 1
Looae Fill 7ype
M�nimum Thickness linthesl
Area Co��md Ih21
� FLOOR,ELEVATED
Matrrial
� T�icknns (incnu)
FLOOR,SLAB
R;nlbial
Tnio4nes� Gnc'�rsl
\ Widtn fintnesl _ _
FOUNDATION WALL
Martrial
Thi�kneas fmchesl '
Bra�O Name
Thermat Resistance IR Valuel
i
Br+nd Name ��i1%��c.r7�s O•%J1��C A��_
TAermal Resistnnce �R Va1ue1 -��
/�� �1 .
Br�ndNamf //�%d!�-i � �LJ✓�I��
Tnerm�l Aesina�ce (R Vaiuel l 9
Brantl Name
Number ol bags Weight Oer Dag Ib
Thermal Resistance (R Value) �
Brantl 1:ame
Tnrrmal Resistance (R Va�uel
'Brand t�imr
Tneemai Res�s�ance 15 Va�uel
Brantl M1amt
Tner¢�l Retiirance (R Vaiae)
DECLARATION
_ �
�
1
1 �ert0�� ttnily ihat tM1e above' inselatio� was �nsralletl �n the building u ihe a�ove lotatio� im m�loiman[r w�th the !
cunmt « qv�arions utt7..g E�ergy Conservarion S�anda.ds �o� new rcsidential buildi�9s IlocateC in Trtie 74 ot rhe �
Cabforois 40mirisvat�vr Codel. �
,/� � - -T�`'- 2 $/ 7�i i
,
' G new Coninclo 8 iaer L:ce e N�muv I
_' �
_ _// 2 z '
r � �
. �sia ��,5,q�., d��,;,�. — . � �u ; a9��
_ ►
. Sue Comuno. �Inwta��on Apo��u�or) L�ceme Numper
Sq�utore �n0 Tiue
F�gv�r G- 1 E.�mple o� s rnmplwncr crn�liu[t
4-9
r
D'AMBRd, INC.
7872 Westminsrer Blvd.
Westminster, CalrJ. 92683
Lic. # 281750 B
, ' " ' � ' ' � '� � i .. ..�... �..y1. �' � .�... ' .' .. �T'�' . 3�e' .r y.,-.E. . _.
. . . . , .- . e . � .. r � . . . . ..
CI7Y OP COStA MESA ` � � ""' '
' �UILDING DIVISiUN � �
CERTIFICATIUN OF SKYLIGHT INSTALLATION
Permit No. � /� ��
Propa'tY Address `"' �� I �<,� �'S Ii�l Lc%�L�.s_�
o.,,,,�, ��rvc._crn�rv
Contractor �-�—� /�'✓��' � A%L
State Contractor Li��ue Number / 7 � 2- a�% J� Classifirdtion �
� � hgr�e,b� certify that I Aave installed, or nuud to Ae inctalled, an approvetf listed skylight I.C.B4O.
_.Q� �j���z on the roof of aDove subjec[ acldress. That I have re-fabrioted the rotif to the
standards of the indiatry and in aaadance with Chapter 32, 34, 52 Appendix 32, ard SeMion 1704 of the
7979 Unifwm Building Code as amended in Section 5-17 Title 5 Cana Mesa Muniapal Code, and tAe installa-
tion instruaions of ihe manuFacturer. The integrity of tAe area worked on is as good or better than the rest of
the existing roof.
�■
1 further certify that I am the owner of the property, (OwnerBuilder permit[ee on1y1.
I further certify that 1 am:
� Owner of wle proprietorsAip company
❑ Full partner of the company
�❑ Limited partne� of the company
��� Officer of the corporatio�
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certifiption, which shall be binding on all successors or assigns of the company or corporation,
1 shall deliver a oopy of Mis Certification [o the above listed owner, aher submittal of form to the
Building Division for.acceptance.
Received by Building Division
By:
�U � ��1,� - /��3��%3
Initial Date
�?LG�L� ��/I fN�
. X��. �'�",��',
-��=y� � C:�%�
-�-c.� �- --�-�'eti
�i�a-3 �g-3
CMF 1029-46 Wbite-City; Canary-Owner: Plnk-Contra<tor
./� �P�/l4 /a L
� Compa o� Coporete Name
��'�02 CJ�'"�a%j�a/N_S�i��Z- /S'�-✓�
Address
inJ �
_'
� � 2 ���
ignat�re � ate
'c�. r 1� .�ti►1152A- .�—C'
Rinted or typed name
Co.porace Sea�
(if corporation)