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Home My WebLink About2929 ELLESMERE AVE - Building Permits��ia� �sa-s2�a • Fax ��ia) �sa-aass CITY OF COSTA MESA BUILpING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Job Address: 2929 ELLESMERE AV Suite: Vicinity: BEDROOM Parcel Number: 13926105 � Applicant: MATiOX, ROBERT MICHAEL Address: 2929 ELLESMERE AVE COSTA MESA, CA Owner: MATTOX, ROBERT MICHAEL Address 2929 ELLESMERE AVE , COSTA MESA, CA Contractor: OWNER-BUILDER Address: Zip: Arch : Address: Phone: Zoning: R1 R1 Phone: (714) 241-0480 Zip: 92626 Phone: (714) 241-0480 Zip: 92626 Phone: License: 0 — Eng: Address: P�IT NUMBER 00-00147 77 FAIR DRIVE. COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 02/02/2000 Issued: 02/02/2000 Phone: Zip: License: License: SCOPE OF PERMIT CHANGEOUT 2 WINDOWS IN EXISTING BEDROOM (SAME SIZE). Plan Check: $0.00 Permit: $23.50 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $24.00 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Fronl 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0-0 Re uired: 0 FEE SUMMARY PLANNING 8 ZONING Lefl 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 ssoo.00 ssoo.00 EX,PII�� F b � d,�sv�- �o ' `�� NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 1 BO days. INSPECTIONS: In order for ihe work authorized under this permit to ba considered legal, such work must comply with all applicable codes, and all required inspeetlona end finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. . FOR INSPECTIONS CALL: (714) 754-5626 � � WORKERS' COMPENSATION DECLARATION: I hareby affirm under penalty ol perjury one ot the lollowing tleclarations: ❑ I have antl wiil maintain e certllicete of consem to seli-Insure tor workers' compansation, es provitled For by section 3700 of the Lebor Cotle, lor the pertormance of ihe work for which Ihis Dermit is issued. ❑ I have end will maintein workers' compensation insurance, as requirea Dy seaion 3700 oi t�e Labor Code, for the pedortnance of Ihe work for which this permit is issued. My workers' compansetion Insurance carner and policy number ere: Carner. Policy Number: (This section neetl nof be cromp/etetl if the Oertnit is valued et one hundretl dollars (57001 ar less.) ❑ I certify that in the peAormance oi the work for which this permit is issue0, I shall not employ any person in any manner so as to become suhject �o Ihe workers' compensation laws ot Catifomia, end agree that ii I should 6ecome sublect ro the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply with these prOvisions. Appliwnt Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL PND SHALI SUBIECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE �5100,000). IN ADDITION TO THE CAST OF CAMPENSATION, OAMAGE$ AS PPOVIOED FOR IN $ECTION 3IO60F THE IABOR WDE, IMERESi, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm thet I em licensed under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Profassions Cotle, antl my license is in full force and ettec�. Lic. # Class N Contrectors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm that ihere is a cons�ruction lentling agency tor ihe pertormence of Ihe work br which Ihis permit is issued. (Sec. 3097, Civil Cotle). j Lenders Name: Lentler's Atltlress: SiqnaWra: Date: OWNER-BUILDER DECLARA710NS: I �ereDy affirm ihat under penalry of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any siructure, prior m its issuance, also requires the applicant for such permit to file a signed statemem tha� ha or she is licensed pursuam to Ihe provisions ot the Conirectors Licensa Law (Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl Professions Cotle) or that he or she is exempt therelrom end Ihe basis tor the alleged exemption. Any violation of Section 7031.5 by any apPlicent for a permit su —fectsd�e applicant to a civil penalty of not more than five hundretl tlollars ($500).): I, es owner of �he propeny, or my employees with wages as their sole compensation, WILL DO TME WORK, and tha structura is not intended or oHered for sale (Sec. 7044, 8usiness antl Professions Cotle: The Contractors License Ww does not apply to an owner ot properry who builds or improves thereon, entl who tices such work himseli or herself or Ihrough his or her own employees, provitled that such improvemants are not intended or ottered for sale. If, however, Ihe building or improvement is sold wilhin one year of completion, tha owner-builder will have the burden of proving thet he or she did not builtl or improva tor purpose of sale.). ❑ I, as owner of t�e property, E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct ihe pwject (Sec. 7044, Business and Pmfessions Coae: The co rs Lice e Law d es not appry to an owner oi property who builtls or improves ihereon, and who contracts for such project with a comractor(s) license p ant Ne Co ectors L�nse Laws.). Signeture: Business end Professions Code for Ihis reason: by tlriver's (cense. ❑ Ves ❑ No � Driver'S Veritication of Ownership by (type of document, i.e. - propehy tax bill or DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity that no eacavatlon tive (5) or more feet in tlepth into whic� a person is requiretl to tlescentl, will be metle in conneciion wiN work au�horized by lhis permit, end Ihat no Duiltling structure, scattolding, falsework, or tlemolition or tlismantling thereof, will �e more t�an thirty-six (36) leet �Igh. (C�ap. 32, Gry 2, Art 2, Sec. 341, Ti11e e, Califomie Administretive Cotle). ❑ As ownerbuiltler, I will not employ anyone to do work which woultl require a permit from t�e Division of Intlusirial Safety, es notetl above, unless such person has a permit to do such work from Ihe division. Signeture: Date: Division of Industrial Safely Permit Number: 40pE x, INSPECTIONTYPE 1676 1266 Fixetl System Final Fire Prevention Pool Spa Final 200 Final Re-Root 201 Final Blwk/Reteining Wall 202 Finel Fectory Fire Place 203 Finel Sign 204 Finel Demolitian 2dC6d6 QAjg �NTRIAlS CODEY INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy UpTE �NiRIALS I _ _'. a .� ��;� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31� GOSTA MESA. CALIFORNIA fOR APPUCANT TO F/LL /N COMPLETELY TYPE OR PRINT ADDRE'S5 2929 Ellesmere Anenue COSTA MESA, CALIFORNIA . �wNFRKen�rof Development Co..Inc �CITY Newport Beach TNO.�� K. w, x_ol l IS-T NT�E61195 �LEGAL I LOT �%O DESCPIPTION NO. � �SIZE g3g97 irreg INO.OFBLOGS. O OF LOT Now orv Loi FIRE ZONE �E� R�C�i�lt� L!u� a-�-�o FINANCE QEPT. cirv oF cosr� mEs�a APPLICATION FOR PERMIT BUILDING �oR officF usF aNcy I FECEIPT NO. I � �MIT ! �?f IVF�O_BY I OATE^Ei-1VF�OO I ��TE;65t \.% �� []! COSTA MESA. CALIFORNIA �� „� . � ZONING ZONE / I NO. OF� %I USE OF NI � PLANS/� BUILDIN6 APPROVED �// �� DATE aV .I SETBACK LINE FFOM ccNrEa oF sineei REAR YARD ZO= R.SIDE SIDE YARD ILEFT J t IRIGHT � ^ L.SIDE DESCRIP7TION OF WORK _ _ REAR NFW I JIIIGITFRATION I IIGf]n1TION I REPAIR I IIMOVING I SZ'EDING 1C'OO S1 ROOMS ( EXTERIOR WA ROOF W COVERING �UCCO ICOVERING USE OF BUIL OING AND WORK TO BE F Si no'l c_T?�mi l n � � � I HEREBY ACKNOWLEDGE THqT I HAVE READ THIS APPLICATION pNO STATE THAT ABOVE IS ORRECT �1 D qGNEE TO COM- PLY WITH ALL TX R�INANCE N STATE FWS REGULpTING 9UILOING CON P C ION. ^ SIGNATURE F . __ /1 I� 1 � AUTHORIZED AGENT � ��J IGII THE FMOUNT BHOWN UNOER VALUATION IS FOF THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION //�/ PERMIT FEE $ �� $ /(/i / �3 J PLAN CHECK $ � y�` TOTAL FEE S �/'� . : 1��30 � �COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEBA. GLIRORNIA For Applitanf fo Fill In Complelely TYPE OR PRINT � BUILOINA ,. A�DRE6S ��' COSTA MESA. CALIFORNIA ■ artcH�Tecr ■ STATE TEL. BU NO. AD TEL. FIRE ZON6 � No: /t� s— 733 a �sa.� D68CR � ' NO. O/ pLD68. E NOW ON LAT A P � USE OF � EXISTING BLDG. 66TBALK 4N6 PPOM cHrriea ov srn¢ar REAR YARI 81DE YARD I LHFT I RIGHT DESCRIPTION OF WORK Iv �.%S ROOMS STORIHS WALL IROOF - COVERING IILOING AND WORK TO BE PERFORMED FE RECEIVED ��- NOV 171960 . FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. P6PMIT NO. i 3 c er I !% �/ �% �e(D �D I I / "�/ / ��ep� Y �� % � COSTA MESA.�CAL)FOgNIA� _ / • 7E Z I G NO.OF U6H 01 NfiW �LANS � BUILDINa � fCHNTeq LINC 9T.) APPROVED 1 XERHBY ACKNOWI-�O8 TXAT 1 HAVB RP.�D i1118 APPLIGTION TM6 AMOUNT BHOWN IINO2P VALUATION 18 FOP THE AHD BTATE TMAT TXE ABOVB 18 CORRER ANO AGRlB TO COM-' pUFP08¢ OP EBTAOLIBM�NO A P¢H41T P!E oNLY. PlY WIiX hLL CIT! ORDIIUNGES AND 6SATE LAWB q66ULATNO BWLDINo CONaTRurno� , n` ^ VALUATION I �^ - 81GNATURE� OF /� PERMITfEF�r AUTHORIZED AGENT $,��.�n. � I � � ADVlicant to till in all spaees exeeD< <hose within �eavY Do�tler lines antl si9� all ap0�opriate Oeclarationi. CIT-`T��-�'^S�TA MESA CONSTRUCTION PERMIT ' PERMIT NO. , TRACT NO. LOT NO. -� UN1T NG. , . Project Ad�31'ess � 19 E L C... G� S� M E 2 C Applicant's Mailing Addr^ess �So V E � . Owner'sName L. �1 b%� � VCNo Phone P79-07�1 Address .`�9Y1. ELLeS^� GRS � e.. �• 9 iL i r _ . Arch/Eng. Licenu No. � Address - � , Contrector's Name Phone Address (mailing) - Ciry License No. LICENSED CONTRACTOR DECLARATION � I�hereby affirm that �I am licensetl untler provisions ot Charte� 9(commencing with secHon 7000) oi Oivision 3 oi the gusi zs ntl Professions cotle, antl my license is in full torce antl effect. � ' Cicense oass � � � �t Li sp No. Date Signa[ure � WORKERS' COMPENSATION DECLARATIO " � hereby atfirm that I have a certificate of consent to self-insure or a certlficate f Workers' Compensation �Insurance, or a certffietl copy thereof (Section ' .800. Lab. C:) �' -' - " Policy No. Company Certitietl capy is hereby fumisM1etl. � Certitietl copy is filetl with the city Builtling Division. Date � • Applicant ' ' ' E%EMPTION FROM WORKERS' COMPENSATION pECLARATION (This section neeC not be wmpletetl if the permil is to� one huntlretl ($300) or Iessl. � , I certify that in tM1e perfo�mance ot the work � Ich this pe�m�t is i55uetl, I shall n�t mploy any person in any man 1 � ttybe me subject to the Worker m nsation Laws of Califor � , Date � ��S Si9nature � � OTICE: If, aftev making this tleclaration, you shoultl become subject to the Workers' Compensa[ion provislons of the �Labor Cotle, you must (orthwith comply wilh suth provisions o� this permit shall be� tleemetl revoketl. CONSTRUCTION LENDING AGENCV ' I nerety aftirm tnat there is a conztruction lentling agency to� the performance of the work tor which this permit is issuetl (Section 309] Civ. C.) Lentler's .Name Lentler's Adtlress OWNER BUILOER �ECLARATION � 1 hereby affi�m that'I am exempt trom the Contracto�'S LicenSe Law (or the following reason (Section ]031.5 Business antl Protessional Cotle: Any city or counTy whicM1 �equires a permit to Construct, alter, imp/ove, tlemolish o� repai� any structure, prior to its issuance, also requires the applicant for such permit to file a signetl statement [hat he/sM1e is licensetl pu�suant to Ihe provisions of . .tne Contractov's License Law (Chapter 9(commencinq witit Section ]000) of Division 3 of the Business antl Professions Code) or,that ne/she is exempt �ihe�eftom antl the basis for Ihe alleqetl exemp[ion. A�Y violation of $ection � ]031.5 by any. applicant for a permit subjects the applicant to a civil alty of not more lhan five buntlretl tlollars (5500). � I, as ownev of the property or, my� employees with wages as their sole co pensation, will tlo the work„antl the structure is not intentletl or otferetl tor sale (Section 7044, Business antl Profe55ional Code: ThG Contractor'S License Law tloes no[ appty [o an owner�of a properfy who builtls or improves thereon, antl who tloes such work'himself/berself.or through his o hcr own employees, provitletl tnat such improvements a�e not intentletl or otfeietl tor , sale. If, howeve�, tne builtlin9 or imD�ovement is Soltl within one year of com- pletion, the owner will M1ave the burtlen of provin9 he/she tlitl not builtl or im- prove fot the pu�pose ot sale). �� , ' . ❑ I, as owner of tne property, am exclusively mntractinq wlth licensetl con- tractors to construct the project (Section �044, Business antl Professions Cotle: The Contractor'S License Law tloes mt apply to an owner of property who builtls or improves [hereon, antl who contracts fot such projects witM1 a wn- tractor(s) license pu�suant�[o Ihe Con[�acto�'i Licenie Law). I am aware that proof of their Worker'S Compensation insurance shoultl be provitletl to me. ❑-I am exempt untler Section��,& G. C. for this reason i n � �i /�< nw� t'jO�Nw __- _ 1 hereby certify tnat I nave reatl this application antl state that the above informatiun is correcL I agree lo comply with all city antl�county ortlinances antl state laws rel ing o bulltlinq construttion, antl hereby authorize rep�e- sentatives of t t upon the above-mentioneG proper[y for inspection pur � 3e Slgnature � �a<e / /� Drivers'�License or 55 � �' � �� J � � � . � . TYPE OFCONSTRUCTION � NEW ADD ALTERATION�, REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' ��-�ESCRIPTION OF WORKNSE OF BLDG. � � TYPEOFPERMIT GRA�ING FOUNDATION OSTftUCTURAL� � � -O TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECNANICAL � � � OTHER PROJECT DESCRIPTION Sa.Fr. ocCucANCv .GONSTFUCTION'TYPE VALUATION $ ZONE GRADINGGU.VDS. �ACRES Sink Preventer Irrigation Drinking Fountains '.. Floor Drains ' Floor Sinks . Gas Service ' Outlets Interceptors� ' Kicchen Sink P-Trap Roof Drains � Reinspection Fee � � $15 8oiler Duct- UnderGround - . Duct - Structural � D'uct-Ventilating � Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # • Heating Sysrem & Ducting ❑ o-i oo,00a eTu O i o0 00o er Reinspection Fee �� $15 Cfv1F'OB65-46,-rev. 10/84 'Wnite - BWIdin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor ServiceSink' _ Sewer Cap � Sewer Connection � Solar Collectors Solar Piping Solar Tank � Swimming Pool w/Spa� Urinal Water Closet Water Hea[er Water Service - Auro-W ash Laundry Trays f Issue Fee Hood or Type I ❑ . Canopy Typell ❑ � Refrigeration System ' ❑0-100,0006TU ❑100,000 System Repair/Alteration Fire Dampers Registers ' luue Fee � FEES - $ 3 A.P. # S Main Buildi E T Front 6 Rear A C Right K Left 5 Ping. Ref. # Planning Notes: i � 6688 I-/3�/85 •. t+e20 iL Zone � -Accessary Building: . 2! _ N . : N. Parking Req./Provided . ' ELECTRICAL Automatic Washer � - - - -Transformer ❑ 15-50 KW � ConstructionPoleSub. . - ❑50+KW Cooking Unit � Meter ❑up to 100 amps ' Dishwasher � Meter ❑over 100 amps Dryers �Gas ❑Electric Sub Panel � Fan � Motors �0-1 HP 01 Y: - 8 F.A,U. InaSolar �9-15 HP �16-75+ Fixtures_ _ , Microwave � Device Boxes Pole Light Outlets � � Range Switches � Sign � Garbage Disposal ; Standing Sections Generamr �0.5 KW �5-15 KW Trash Compactor � n FEES R. E Q M T S � Reinspection Fee ,$15 luue Fee �$ 3 FEES DEVELOPMENTSERVICESRE�UIREMENTS: � ' � - Zoning Approved By Date ' Building Approved By Date � Application luued 8y � Daffi �-�� ' ' SUMMARV OF FEES � ' BUILDING PERMIT $ � ' SMIP� $ PLAN CHECK $ �PERMIT PLUMBWG g �SSUANCE � $ PLAN CHECK 25% $ �ENEqGY P.C. $ - � ELECTRICAL $ �•�SY D GFADING $ PLAN CHECK 50% $ 4� ;MICROFILM $ - ' MECHANICAL $ TOTALFEE $ .LO $ 3 PLAN CHECK 25%' $ ' ' , � CONSTRUCTION AND PLANNING POO� e SPA 1. APPROVALS Permit# Date � Inspector qppROVALS Permit# � Date Inspector � . Temporary Electrical Service or Pole � 52. Pool & Equipment Location �• i . Soil Pi{ie-Undrgrnd. . 53. Steel Reinforcement . '�� Elecfrical Conduit Utility-Undrgmd. 54. Forms ' 4'. Electricel Conduit-Undrgrnd. � 55. Electrical Bonding �;�, . 5. Steel Reinforcement �, 56. Rough Plumbing & Pressure Test � � � � 8�, Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � � , 7i FooFings - - � 58. Electrical Conduit•Undrgmd. � � 8: Found�tion 59. Gas Pipe, ��Undrgrnd., Test � � ,,� 9: Water Pipe-Undrgrnd. . - 60. Backwash �ines, P-Trap; � Undrgrnd. .10: Structural Floor System .. 61. APPROVAL TO DECK �� 1}. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12: Sewer Cap 63. Heater & Vent-Final � 13: Roof Drains 64. Plumbing System - Final , 14: Rough Plumbing 65. Electrical-Final . ' 15. Rough Electrical-Conduit 66. Solar System-Final - - 16. Rough Electric Wiring . ��! (a 67. 'Fencing & Access Approval � - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Elearical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fi�eplace 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 O Gas ❑ Oil � 25. Roof Sheathing 74. Overhead Hydro 26: T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION ' � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' � �� (�L Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test . 36. Hood or Canopy � 37. Final Factory Fireplace � ' " 38. Final Plumbing � � 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � , � � 44. Landscape Irrigation System ' . 45. Sound Attenuation . � � 46. Handicap Regulations . � 47. FINAL STRUCTURE & BUILDING � � 48. Special Requirements Completed - . �. � 49. Electric Release to Edison ' - - '50. Gas Release to Southem California Gas Co ' , � I 51. CERTIFICATE OF OCCUPANCY � • Na � Date � � ' � � AO CI.. 0� COST�MESA . , 'CBIOSTRUCTION PERMIT � to �ill in all spaces ezeeo� �MIT�V;�- �� Applicent's Mailin8 A�d'��'le/sys/ � TVPE OF CONS7RUCTION . LJ 1 PrUjEctAddleu —1K[L''�AG ❑ CONVERSION ❑ DEMOL� Owner's Name ' �/L([�S �UE/SI � �vhone '033 DESCRIPTION�OF WORK _Qi ! (- . i Addreu . TVPEOFPERMIT GRADING Arch/Eng. _ �/ LiCCnse NO. � '❑ TENANT �❑ ELECTRICAL Addfeis' � . II � . ' • ' ❑ �OTHER Contractor's Nem Phane �- PROJECT DESCRIPTION sq. F7.: AddfCR�ImeillOy) -,/ � � CONSTRWCTION TVPE� Iinas antl sign all approoriate Eaclantlons. ADD'LJ ALTERATION LJ REPAIR � FOUNDATION �c.v STFUCTURAL PLUMBING, ❑.MECHANICAL ' � L" ' , � ' . . ' 20N€ GRADINGCU.VDS. icense No. LICENSED CONTRACTOR DECLARATION ^ • ' Remarks: ' � � I �ereDy affirm that I am ��ansetl untler provl5ion5 ot Charter 9(commencing � � with saction 7000) oT Dlvislon 3 ot tne Businass antl Protasslons COUe, antl my Iicanie Is In tun torce ana ettect. � -� • L•Icense Cless License No. Date � Si9�ature � `�ORKERS'COMPENSATION DECLARATION' � veoy afflrm thal I hav0 a.tortiflota o/ mnunt to selt-insure or a certifirate... WOrkGri' COmpanutl0n Insurance, or a CerUfiOtl copY t�ereol (SeCtlOn 0800, Lab. C:) . =� Policy No. � � Company � BCerti/ietl coDY Is herebY furn6�eE. ., ' _ � CertHietl coDY Is filetl .'��h t�a city Bulltling Dlvizion. �ate ADClicant EXEMPTION FROM WORKERS' COMPENSATION DECLA0.ATION (This secllon neeC nat Ce Com0letetl It Iha�permit ii Tor one �untlretl (S100j ar less). ; ' � ' 1 certi/y that In t�e performance of [he work tor whith this permR Is �issuatl I shall not employ any petson In any manner so ;as to become subject to t�te . Workers',Compensallon'LPN's of Callfomia.; � oate � Signature • � � '- NOTICE: If, after making thip tletlaration�, you shoultl become suEject to the ' Workers'� Compensatlon provislons of the Labor Cotla, you must (orthwith, comply ,wlth� such prov�slons.or this„permit'shall be.tleemotl revokatl. ' CONSTRUCTION•LEND�NG AGENCV' ' '� ' � � 1 haraby al/lrm t�at there Is a construction lentling a9en<y tor the performance ot the work for. whi<n lhis De!mlt � is 'IssueA ($ectlon 3087 Civ. C:); LenCer'S. Name • , , , �entler's, AOGre55 " - ' � OWNER:BUILDER DEC4ARATION � � ' � ' " � � � , 1 �erebv af/irm that I am exemot trom the Contractor's.Llcense Law for tha : c'refrom anE the ba515 for tne anagea exempuon. My_vioiauon�oi Secuon ��=31.5 �y'any applican� �or_a:permit subjects tne�aOP��q� to a civil �enalty ot not more lhan five'nuntlre0 tlollars (5500). � - I; as-,owner Of tha p�operty or my employees wit� waga5�as their 5010 � comDonsaUon wlll tlo tne work-, antl the structura is not intenaetl or o(/eretl . for wle (SeC4ion 7044, BusinBss' and Professlonal Cotle: The Conlractor's License Law tloes not app�Y to an owner of a property,who builAk or Improves thereon„antl wha tloas such work nimselt/herself or through hls or her own employ ees, proviaetl tnat sucn'imorovements ara not intentletl or offerea for sale. I/, howevaq tha builtlln9 or improvement is soltl within one'yeallof com- � Dletlon, tha owner will ha�e tha burtlen ot proving he/she tlitl not bul�tl or Im- • �row lo� the purposa O/ Sal¢). � � � � r , i I. d5 OW�tli O} flt6 �IODCI�V. dlfl BXC�USIVB�V contractina with Ilcen'sea eon- ouuas or improve5, tnereon, ana wno convaccs �or sucn pro�ac�s wrtn a con- tractor(5) Ilcansa pursuant to the Contractor•5 License Law) � . � , ❑ i am exampt unaer Sattion B. & 7. C. (or lhlt reason I Date Owner � � � 1 I�hereby cartlty-lhat Lbave reaO�[hisappliwtlon�anG state that ttie above informatlon Is correct. 1 a9ree to tomply with all tity and county ortlinances antl�state laws relating tv builtling construttlon, anU hereby authorlxe repre- � spntative5 Of IIIIS �c�ty( t�i¢nt8r � u thB abov9-menUOnptl p! Blly foI inspettlan purpose C/ C Signaturo � Date S � D i rs' Llcense or�SS � - Appllcanl: Pink - Accountlng; � Backflow Preventer - Backflow Irrigatian Bathtubs Clarifiers ' Dishwasher � � Drinking Fountains � noor vrams � � FloorSinks-, � � ' Gas Service` , Outlets • • Interceptors � ^ � , - - . � - � Showers •� :- .- . . Service Sink Boiler , "� " ' Duct - Under Ground Duct-Struc[ural f - . Du[t-Ventilating ' Exhaust System ❑ Multiple FiiepUFact.Blt.ICBO� ' He&tingSystem & Ducting � �4700,OOO�BTU �700,000 Hood or Typel ❑• � CanoPY Tvoell ❑ � Re9isten _ . �TION$� _ ,ACRE So18f CollectOrs� Soler Piping . Solar Tank ' Swimming Pool w/Spa Urinal � x f ' � Water Closeti ,f- ' -Water Heater . _ •.' I:r - , Reinspectian Fea � � Isue Fee � MECHANICAL Refrigeration System , ❑0.100,OOOBTU ❑100,Oq Syst2m RepairlAlteiation ' � ❑• I , _ �' � ' ' Rejnspec[ion; Fee � � � � Iswe Fee � PLNG LEFT SIDE VARD�� j��(� PKG.SPACE qE�� STREET WIDTN �O� SPECIAL CONOITIONS: Wazher Cooking Unit Dishwasher Dryers ❑Gs Fan, F.A.U. Fizares _!. Device Boxes - -- ;Bkt2b 5/I6/B3, � 1 i3�n �c' REAR VARD (TO P/LI� RIGHTSIDE VARD s� � PROVIDED �-. ' PARK FEE $ �" � I Meter. Uover 100 amps �. . . Sub Panel' ' Sub Pole ..-� ; Motors �0-1 HP ❑1'hE Inc.Solar'09-15HP �16-15+ Mitrowave ' ' Pole Lighf � ' � l • �Range � ' . . ' _' ' Trash � Generator LJO-5 KW LJ5d5KW - • ' Transformer ❑75�50KW + , � . ❑5U+ KW qeinspection Fea ! $15 $15 ' Meter ❑up to 100 amps � �.Issue Fee � �$ 3 $ 3 Zaning Approved By � pate AOPliration Approved By � ate �6 � �%23 : 83 ' Applimtian Issued By Date , � . SUMMARV OF FEES . � ; ' S � ' BUILD�NGPERMIT $` �t3L�OL 1 SMI7 ; $ � ' •PLAN CHECK ' $ PERMIT � • ' � ' PLUMBING • � $ � ' ISSUANCE � , $ � �PLAN CHECK�� $ � . GRADING � 5 ' ELECTRICAL , $, ' � $ ' PLANCHECK� . $: � � MICROFILM ' $ � MECHANICAL $� ' TOTAL:FEEI • $ � $15 PLAN CHECK� ' $� � qD ANCED PC '� $ ' � $ 3 ' . . 1 , • FINAL FEE. • g ' �� t ��CONSTRUCTION,AND:PLANNING' ' - ' � `� `"� r- - , �'- POOL P.A - ' � ' , . . - ::`.Date:.. Inspector'. .-#APPROVALS � Permit-# ' "AP.PROVALS "-Permit# - • - - o _ � r1,�Tempor`ary Electrica`I Serviceor'Pole !�` ' � ��° : ��,�52 Pool &`�Equipment Location F � 2. Soil Pipe-Undrgrnd.� �� + -..` •. ` _ - �� Q � 63°�Steel �Reinforcement I ' - � 3: Electrical Conduit Utilitv-Undrqrnd. � .� - � ` ' � �' 54 � Forms � - � � ' � ' 4. Electrical Conduit-Undrgmd� _ :�' ' :' � � � _- ' ''' . 55c Electrical-Bondin'g�-� . �• � � 5. Steel Reinforcement � • '_ . �', � ' ""- � � �56. Rough Rlumbing^& Pressure�Test ,- 6. ,Electrical UFER Gmd.' , � ' - , _ � �� ' "_ " :•57? APP,ROVAL TO COVER-GUNITE 7. Faotings � ' � � � �>, - 3 �, ' 58'� Electrical"(jp�duit-Uddrarnd. , - 8. Foundation � ' _ - ' ° � " � _ ' �59. Gas Pipe, O Undrgmd ; Test � . 9. Water Pipe-Undrgmd. , - � - - 60. Backwash �Lines; P-Trap, O Undrgmd. 10. Structural Floor SYstem �' � - , � - . ' � 61. APPROVAL TO�DECK , - � 71. Property Sewer Line & �House Connection. • � - � ,62. Backwash �& ReceptorFinal ' " 12. Sewer �Cap � � � � ''63. Heater &- Vent-Final � �� • , 13. RoofArains �, - - i� 64. Plumbing System ;,Final '� 14. �Rough Plumbing • - ' � = ' �65. Electrical-Final • � � ° : 15.' Rough-Electrica�-Conduit'7 T i � ^'-• '' I - � ' - � ' -i -'-� -66.� Solar-SYstem-Final � '� , - i �16�'Rough Electric Wiring�, ; � i� � � ��' ; � - �, -, �'� ��:- �"� � �67.'�Fencing &�Access Appioval. � - , .� � ,��" - -�. - 17. �Rough Wiring;Sign;' � " � � ' � i . . ��. , � , �, J' . �68.'� APPROVED FOR PLASTERING � _ 18. �Rough_Electiical;T',Bar. Ceiling _ ;; , � ._ � �� I ., ; ;- I �69.' POOWSP.A SY,STEMS F,INAL � 19. .Rough Heating & Air Conditioning I � � , -PIRE DEPT. REQUIREMENT �, : ' � 20. �Rough,Factory, Fireplace ' � � i i ` � ; . � APPROVALS Permit # 41. Ducts, in Structure � ' I ' , t i 1 70.1 Unde�ground Hydro . , 7�..Ducts, Ventilating ' • � , • •! �' � , � � 71. Product Piping O Gas ❑ Oil � � '�23. Gas Pipe-Rough & Test =' i � i � � i � 72.� Uriderground Flush � . �24. �Roof Framing� � � � � • ��;y i�, � � � ��- � � 73. Undergmd. Sto �age Tank O�Gas ❑ Oil' 25. Roof Sheathing � ' ` � ,' ; +; � ; -25�3 ' 74.' Overhead Hydro . _ - 26. T-6ar Ceilin`g (Structural�� & Monocoat � .. ^ � F � � � �,' ' �Z5.j Dry Chemical - ` ' 27.'Frameand Flashing� � � � �� s; . � �76.�DnyStandpipe , �� - - 28. ,Lathing & Siding � �, _ , � � ' �� -�s 3 ' �' � � 77. FIXED SYSTEM �FINAL .. 29. �lnsulation _ o r. - . ; . . ' . � I Pg, FIRE PREV,. FINAL � � � 30. Drywall Nailing , ' � � � 4 � � �Notes:� � � , � ' -i 31. Plaster Brown Coat � � � � '- -i - -- �- ' - --� f � . . . �32. Electrical Power Meter-Final � �� + � ' - � _ ' , ` � . : 33. Final Electric � �.. .�. .I ,. � � ,-' - .Y- .' � : . . `- 34. Final Heating &'Air Co,nditioning ' � � � ' � � 35. Final Gas Pipe-Tesff „ , �' . - i , ' � - ' - s' �;,1 , � r v� 36. Hood or CanopY_ �. ' I � _ , � _ � - i . � ' � , � 37. Final Factory Fi'replace : , � � � � � � - � � ' � '' l�� 'I. � �, � '� - 38. Final Plumbi�ng � . ' ' � �: � :. t ' �.^ � � - � � � � ' . ..- ' . i I' � I I � � I � ' 39. Water Service-Fi'nal' . ; � ; -. � � � � ` � � � ' � ' � � � i , , 40. Gas Service-Final i � I i � � i , I ' � � � . �� . ,• �• . 41. Solar pomesticFinal - • � � _,i I � � i i - --- ' - � ' - -�- -- � - �) q2. Backflow Preventer - , � �_�� _ � . � • . _. , ,- -,�� ' . � . 43. Backflow Irrigation = ^ � � _ - . -- ?, � ; i V a �- �� i i " 44. landsrape Irrigation System . ' �•1 ;, � � ; � ' � �, ; ' . 45. Sound Attenuation � i • ' � ' j � ' �f _ � , � ' i ' � ' � _. . . ; i '� 46. HandicaplRegulations ; ; m � . � � � ;' i `�' i i ' t � ' � . " � - ' � .i � 47. FINAL STRUCTURE & BUILDING ! � ' � � I ' I � � � � ;� i .i � i 48. Special Requirements Comple'ted� i i' � i � �'� i� � � 49. Electric Releaseto Edison� � � i ' � 1 . �_ ��_' � � ! � � _: _. ' i -r-- --r-- -�--- - r 50. Gas Release to Southem California Gas Cn � I . � ' • � i � � , . � 51. CERTIFICATE OF OCCUPANCY • : t.�_ _: _ . ;_ _ _ ___ � _,-_; . No Date ' ' _ „ ._� _ _._ - -�- ' -: .----1 - - -�- - -� Date Inspector i .' 'c _ "_' i _ _ . ' i ' ' �"_' "" ' _' _'_' "Of1-r 9. . . • I . �: � x-C.�." 3?cT,nJ _. . eL��J � I � � �-�--' - -- - - , -i-- ,� � i 1 I I 1__ �� E � .\ .. _: \ � � i �� -'rr»'L��'�rbJY r�*. ��-'�I`-��"Y,:J 4..'`GN ��r{� � i7 on� R I � _ i��, -- - � r. -_� illi'9� �'v� � � �� -�-�9/� � � I � Yi/ �i^.�') � i r�7�� 1 . �. 1 � � ,� .-�, � �� I� `; 1 rrZ za:.J�.t �16x�- J� �.. ; � I yrx� w•-�=rn i.xe u.a �x� J�'�^!id Si+�6 !�.rd�fµ� K -�e{hl �F,4•! ?� I ' OD�INi9Xi/M 6N� �"'-#� � ( � 4f i '.�.'� r� �aN �."?] �J?13�J�:�l'S'�� /ulC+� r '' � � _�� _ l��__. �-. i�,: , � •� �j� . .._ _.� � \ � . � Af��:�� fl :11 m, f -- -.�-., r=� . � �nT'�'IY �. '. � oClflG, . :''a2L^ 9�ik2f ��j'dJC3: `` � . I 1 � -�-� �,� �-� ,� � �� ;�ax>N �r,z�• •Nw -�, ��.�'�_.v�^'�"yt-�"� '� zr.�aw .rr.� �=r��'�s-r �b -�^7�!vtiv�.�o �'cr� �/h W�La 63'>.rd a '` �� \ �-d c.i olJ,�F3�'�FJ 51.J2��J-�J � j '� � 2a-G �,q1rx`,�' a.r!' �� e •-MNO%�+ ,/�'1!•�rD.^6 '�M'^s'�/.F ��!l �1 ✓/ jY�� ' �� ' ,� ^ , � ,.. . � 1 �T��.. , �„ � � _!�i . L i -T : , }-� ..._..__ __.i�_ !o 1_._. _�_ ..__ _.�._,�\ _ . _ _._._ __.._.� _.._...�� ----- < \ � , / �� i . �:� , j---- -- -- -�---. �� .' _ � / .� ��: � i � � �. , : � � � , �, \ �- � ,� --- ; , �_ � . _ _ + .. __.__._ ... _�_ . , . . @ :t I � J �:� - . :jNC` _ � i ____1 � �., _ .� _.. �„�.�..__-- � --_ -t---=-_. t j�� pu � .�� :-.� � , . _ �� •... ;., �'#�;'', ^!' :v : � `i: � . '„"' ." 1:/._ . DNINM'L 10 Wl]Yi0 ��iro ""'��s77ypia �/ �w� v�a•oan ot uinnt 'ld3a ONINNY'Id V53W V150� d0 W� Q.7_! 1� Qd� `�/Ii.---' VV�%`- G�� ti.7 a'T'1f1�!'C�> ��' �\ �.� ':`��K3"„'l �R^r'�� '� �� "f�� ^.1'�Y?--s-C�.. 1:�.:3 i c'JC� 3^�%C'�L- = �% u�'.'�� r� STRUCTURAL APPROVA� OPtLY SEP.'R�?' PEF�F.�' .' . . ':{3�D F(';':� .. . . . .. F7., . ' , � . ':D 1;� : � . .::;�7!S �Per-a't :: �57Lg— THIS .. :,,•�PAtlY i_ ALL i.:�. :� .,.. .:: �:1iSi5 `; �F:i;;; .. �4esdr:5;@Ei0 I EC C.:�.. ,,.,. .., S.::5i 1H:i iHE ;i:.ii cF � UP�ISION OF d;P,C:� ,t 5tPii.' �E GJft5uLTFD FOR .,�J�1,j;GL'nE4UfdEMENi$, " -r�t— �—' ---- — _ __ __._... --------- --_ _ - —.. �� '�'' ` ��' �R' � - �-- -,_ _ .--- -- -- --� - - -- � j; ; � '- -I - '..._ ' .._ ;; �__-_- _- -- ---- ------- r__"_ / '-•=yY�y,� .� '_' i � � �I��—',,Z:1'T. . 3"c".r..'.'?� � oLl�o� 9 7 �� )]N�T:lor rnu.K n� �+ii�i.� s!vaet : 1V171J10 uriv wr �ruMn M NI l.i 3HL 1)0' •�ne ii. r+our.;.: a3fiNiti IVACCJ:. IVM1Ob. s3YYLL �\��,,J �J".n"�'L-\ � � , . �++`' �' '3z� •h��/' �� (� ` -�- Sw'�B^ �17 � � ' � ! � �X'�A i A v�x � ; i�� --- -- ' � � � � � � � � :li�'s:rf �v) � � � �'� � l '.� � � �jr'�_Tc�j/�n � � � �� if'✓ ;.-r.:O'f'� �I ��•�� +- � � �, ' i" � �t�t �1e�n�a c� � �iK.7sa:.d�`i.i �Y� 1�+� �_ I•yrxryr. w •�-re-t�i l:s�'d ti•a �/e�k: , J��•"!�d y %.+�� 'M9 K,-�t�,1. ,r74-e a, �� ,�t px� rv� et�t� �'�� •�.r;: _ �� r.��r�':a.:��✓-:��. � --`.� � �.� . .,� ',:, � :, , {`'• . ! ly � I I ,'"a rC,;� ( � +„ � . 4' • , �: I li ; � � j� I �'� i,-: - — - -- �Y- — — - � --�- � �"�r�,o,,.`�"'� �... � k ; ; , - - - --- -,' ----t r , . ,��_9" � -----. ....___�..�--- __...__.._...__._.__.._ _ _-- .. ---- �l ___--------- _ --- --__—__.__._..-- `_�_'_ 0 �E�. Z! � 7:' -�i-�_. ' :.: : .��,' '' � ' �� , ; .� ; - - - --__. .... . .--,_ ; —f------- _ . "_____�� J APPROVED ; Clfy of Co�ta M sa Builoirg Dept. tT�� _..,.C�ii..7./.�G.._19�` MCSE IUNS NUSi [( C:� ID9 �� tt TIMES MAKE NO CHANGES N'I7HOUI PRW0. APP0.QVA[ OF �GPI. iHE I15U.P.C( 6N L-:::IG:: GV :. I;�,�.::: C:t �fi'10YPL OF PlAnS /�;U ?:�'uL"b:.:r; :, u rJi F`. fCYSiRUEO 70 6E F f(Atr,I 1P(. C4 :•. !: i t. d: �!. :::� 1't.:AAON OF f�Nf 0� :h( IGUP.7�.�Li :� Ir�, CEiiC. fiU fCRMI! CR(� $UMINC 1U CIYI RI:IHCiilli 1J �'NIFIE C:7 C�ACCL IME {`ROYFI;.tiS Gf 1.II5 CGGE Sr,��l r( 1;,:1�, CCCCP� IN 50 /AR hi ]HE W7Hd UR U3L MnIGN II AU;NCftLES IS UWNL ieC ISSUdkCE Q( A fC"nM�i CISCO U(OY MNS AND SPCC�fICAilOnS 91AL1 h0I 1'NIVL'if iNC FU��018G 0(flClnl I fROM TNEFCAFI[R fl[VUIRIOG 711L IU�F;(I10;1 Oi LiR0i6 IN J•ID CLANi !1'0 SF[GfICAllD.1': G7 BOM FRCIUIII/lC � FUILDiNC OfEHFfItiAS NONG CRNft1C00Y IHCRCCApLi WN[N �N VIOIG(ICVOF IHIS COUE 00 OP AM UfHLt pqD�W1,VCE � ' 1NE CI�T, � � M41N OFFICE �E]! WEST GA'/IOPD ST.. - P.O. BO% GOO'! LONG BE>CN 10. W�IFORNU. qEMLOCN O-l<93 6PRUCE S-lOB� Twinina rxamination No. I'ro,ject $amplc from Architect Contractor �. Laboratories BR�NCN OFFICE 101�.0 NOFTH H�RP[R {T. B�NT� �N�. C�LIiORNIA JFFPCR60N 1-301! JlFIEXlON 1�]0�6 o� cSouEizezn ea�i�o¢n1a, �nc. December j0, 196Q GUNITfi RLPORT OF TEST CYLINDER SC60-1124 0. F. SUNDSMO RESIDENCE 2929 Ellesnere Dr., Costa htesa, Calif. Gunite Swim Pool Coral Pools �'T1X \Vater, gal./sk, cement �17C 6-3/8 x 12 pate cast 12-2-60 I)��c tested 12-9-60 Cvlindcr 1�'0. 1 C0�IPRESSION TLST 7 Days Total load to destruction, ]bs. 72,500 Pounds per square i�uh 2,271 Cylinder madc by Cylinder deli��ered by Cylinder recei��ed on cc: O, F, Sundsmo Coral Pools Costa Mesa Bldg. Dept. ' SA Lab 6-3/8 x 12 12-30-60 1-A 28 Days i26,5o0 3,964 Nozzlemen - Ray Blasic H. Daivson 12-6-60 l1,--�."�-: 4A.t,�� •LL REPOPTS PRE SU�MITTEO PS THE CONFIDENTIAL PROPE�" OF CLIENTS, AUTHORIZqT10N GOR PUBLIUTION OF OUH PEPORTS, GONCLUSIONB. OR L[� TflACT9 FNOM Oq pEGAROING THEM IS qESERVEO P[NOING �. NRITTEN /.PPqOVpI p5 A MIlTU6L PpOTECT1011 TO CLIENTB, TME PUDLIC AND OUHSE�V66.