HomeMy WebLinkAbout2864 EL RIO CIR - Building Permitsoi€cTnooness: zg64 EL RIO CI. '
OWNEfl'SNRME: KLIMRIEWICZ, ANNA M
ADOflE55: 28(9 EL RIO CIR .
COSTA MESA,CA 92626
545-8178
AflCN/ENGINEEF: XEG.NO.:
FOOflE55:
UNIT:
UNIT:
PEPMIREE:�N KLIMKIEWICZ (714)545-8178
nooRess: z864 EL RIO CIRCLE
COSTA HESA CA 92626
LICENSEO CONTflACTOP OECIAHATION: I hereby a��irm �hat I am licensetl untler pmvisions o� Chap�er 9(commencing wi�h Section
7000) oi Oivision 3 of Ihe Business antl Pmiessions CoOe. and my license is in lull force and efleci.
CITY LIC.: SiPTE UC.: CLASS:
Oale: Signalure:
WOBKFflS' COMPENSATION OECIAflATION: I herehy atlirm tha� I have a cenificate oi consent m selFmsum or a cenifica�e ol Workers'
ComDensatmn Insurance, or a cetlilied coOY thereoi (Section 3800, lab- C).
PoLICY NO.: E%P. OPTE:
COMPFNY:
.� Cenifie0 copy is hereDy fumished. ❑ Cenified copy is fileA wi(h ihe ciry BuiltlinA Oivision.
Dale: NpD�icanC
EXEMPTION FBOM WOPKEB$' COMPENSATION �ECtAflRTION: (ihis set�ian nee0 noi 6e cOmple�ed if Ihe Oermi� i5 for ane �unOreO ($100) Or 1e55).
I t¢Rity �hai in the petlOrmant¢ of N¢ work br whith Ihis permit is issued. I 5hall nol employ any pefsOn in any manner 5o as �o b¢tome
sublec� lo �he Work¢rs' Compensa�ion Laws o� Califomia.
Date: Signalure:
NOTICE: I�, a�ier making Ihls declara�ion, yau shaultl become 5u61eci lo the Wo�kers' Compensa�ion pmvisions o� the Labor
Cotle. you musl �otlhwil� comply with such pmvisions or �his permit shall 6e Ueemed revoked.
CONSTqULTION LENOING RGENCY: I hereby a��irm tha� ihere is a cons�mction lending agency tor ihe pedormance o� Ihe work �or
whicn �his permi� is issuetl (Section 3097, Civ. C�.
IENOEfl:
aooecss:
OWNEB BUILOEH OECLABATION: I hereby affirm t�at I am exempl lrom Ihe ConVactors' State License Law for the following reason
(Section 703t.5 Business anA Professional Cotle'. Fny ciry oi county which reQuires a permit to consimct, alter, improve. Oemolish, or
repair any s�mcWre. O��or �o ils issuance, al5o repuires Ihe apD�icanl for such permi� �o lile a signe0 statemen� �hai he/sAe is licensed
pursuam lo Ihe pmvisions o� I�e Con�ractors' Slate License Law (Chapler 9(commencing with Section 7000) oi Oivision 3 0/ ��e Business�
an0 Professions Code) or ��at he/s�e is exempt therelmm and �he basis for the allege0 exemp�ion. Any violation ol Section 7031.5 6y
any apP�icanl �or a permit SUElectS t�e applicanl Io a civil penalry ai no� more t�an live huntlred tlollars (5500).
I, as owner of the pmpetly or my employees wi�h wages as th¢ir sole compensation, will tlo Ihe work, antl Ihe
❑ s�mclure is no� intentletl or of�erea br sale (Section 7044, Business antl Pwfessional Cotle: Th¢ Conirac�ors' Slate License Law
Aoes not apDly Io an owner of a pmperty who buil�s or impmves �hefeoq and who Ooes such work �imself/hersetl or Ihroup�
his or her own employees, provi0ed that such impmvemenls are nol in�ende0 or oifere0 lor sale. Ii, however t�e Duilding or
impmvemeni is so10 within one year o� completion. I�e owner wilt have t�e �ur0en oi pmving helshe tli0 not �ui10 or imOrove
lor Ihe purpose of sale�.
I, a5 Owner Oi Ihe pmperry. am ¢�CIu5lvely COnlrat�inp wilh Iiten5e0 tonlraClOrs t0 tonSlrUti Ihe pmle�� (SeC�ion 704d, Business
❑ and Pmlessians Cotle: T�e Coniramors' State License Law does not apDly to an owner of properry who builds or impmves [hereon
antl who comrac�s br such pmjects with a conUac�a�s) license pursuant m Ihe Contrac[ors' S�ale License Law�.l am aware
that pmof o� iheir Worker'S Compensalion in5urance s�aultl Oe pmvidetl Io me.
�{ I am exemp� untler Seclion: BP% � 4 q B. 8 P. C. % � � ...
ro� mis reaso�: ALL WORK BY OWNE� ��//'� ,
Oate: �— ��� �� Owne o' '� �
I ao nere�y ceniry tha� I am aware ol antl un0erstantl Ihe reQuiremenis o� Calitomia Heal�h an0 Sa�ery Code Sections 25505, 25 , n
25534 ane ihat I or any IUWre bwltlmg occupan� willlwill no� (circle one) need to comDly with said stale cotles and the require nts 1 a
. permil lar cons�mciion or mo0ilicaiion iwm I�e Air Ouabry eRagemeni DiSIriCL F¢Si0¢n�ial tou�mtlion ap0lita�ion5 are ex¢ om
j Ihese pmvi5ions. / ��
I aie: " `�� APPlica �1/.0 fi�G2'GGG�� i5
I hereby cetlity thai I have read Ihis apPlica�ion antl slate Iha� Ne a�ove in�orma�ion is correcL I agree to comply wi�� al iL ntl counry
oremancesanAStatelaw5relalingtobuiltlinqcans�mctionantlherebyaNhorizer resemalivesoithiscirytoenteruponihea6ove�mentione0
propetly lorinspection purposes. /� %
. --/ Signature: � �/�� �B-�/��'—
oriver's �icense or Socia� Sewmy
16aLG6 While—Bmltling', Green—Cotle Enlorcement, Canary—Appllcanl: Pink—Revenue; Goltlenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IH 58
PERMIT NO: IB 058614 PLAN CHECK NO: N GOVT: N S P;
CONSTRUCTION TYPE: V—N PERMIT TYPE; OTH STR , PURPOSE: OTH
JOB DESCRIPTION ; LEGALIZE EXP. PERMIT 407SF ROOM ADDSTION SQ FT:
CLAIM VALUE; 11,600,00 CALC—VALUE: GROUP OCC; R-3 /
COMMENTS; EXPIRED PERMIT #49341
�t�r�r�r�t�t*�t�r*�r*�r*x�t�t�t�t�t�t*�t�t�t�t:*�rr��r�t�tx�t�t*x�*xx �e�t�r*��t***�t�t**+t�r*x�*�t�t� �t*�t�t**�r*�t�t*�t****
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FANT; FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING RE • PROV: PARCEL; 14156217 ZNE: REF NO:
PLANNING N TES>
1
�F �k IEiF k!f �flf 1f �f!!iE �kiE �E 1Elf ikitiF IE ik 1E iF!! �E iE iF 1k iElflF �f iE fEik iF if ikit i! ik if ikik3k ik if if M3E if iEik �f �k �k kik i! iF iE ik Ik �E�1k iF it k 1E iE iklf iFik if �f fE aE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N4T'"S
ZONING APPROVED BY / DATE; --
BUILDING APPROVED BY ;� f'1�fJ � DATE; � IY r"lz—
APPLICATION ISSUED BY: I I�I —� DATEe ��S� y�
LEGALIZATION;Y
BLDG PMT
PEAMIT 30.00
PLAN
ISSUE FEE
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
iF IkiFiFlF iF ik if if 1F �t �F if iE �E iE If �F IFlE �k if !F if IE ik
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 30,00 0.00 0.00 30.00 30,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 30.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30,00 .
iE ik k if k iF �F�E 1f �F if iE aE Iflf 1f �k ik iflE 1E �F kif 1tlf it IElF 3E fE if It �t 3f if it iF if it 1F 1F if it iFif iF if iF if �F iFlE iEikft iE iEltlF k it iF iFif ik iE iE ik if �flE iE i! �F�E iE if iE
I N D I V I D U A L F E E B R E A FC D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
INS 1 BUILDZNG RE—INSPECTION FEE 30.00 30,00'
END OF FEES
0
0" �0121E87—OG1,21E�? R"« �- 'G.,UJ
DATE: Ut3ri4192 T?li�: !i:05
�`
i: '
CONSTRUC710N AND PLANNING � PC 9 SPA �- � ,
• APPROVALS Permitt# Date Inspector qpPROVALS Permit# Oate Inspector
.1. Temporary� Electrical Service or Poie � � 52. Pool & Equipment Location
2. Soil Pipe�UndrgFnd� � 53. �Steel Reinforcement .
Y' 3:�Electr`�cal Cond�i(���'tility-Undrgrnd. 54. Forms. ' .
S
.s�d. Electrical Condafc.l�lndrgrnd. � 55. Electrical Bonding .
, �
T e�� _ 56. Rough Plumbing�& P�essure l'�� j
• �. Sjeel geinforc
c,6. �Iparical UFERBc6d. - ` � 57. APPROVAL TO COVER-GUQfI
'-' 7: Footings �; % 58. Etectrical Conduit-Undrgrnd. � «_
���.��oundation i- 59. Gas Pipe, O Undrgrnd., Test C � �
8. Water Pipe-Undrg�nd. . 60. Backwash Lines, P�Trap, O Und�rnd. .
Y6. Structural Floor System � -� 61. APPROVAL TO DECK � 'F �
11. Paoperty Sewer Line�& House Connection - 62. Backwash & ReceptorFinal �
.�
12. S�jver Cap �� 63. Heater & Vent-Final .
13. Roof Drains �c _ � 64. Piumbing System - Final .
14. Rough PlumUi�9 ' 65. Electrical-Final -
15. Rough Electrical�Conduit � 66. Solar System-Final
76. Rough ElectfiENiring 67. Fencing & Access Approval
77. Rough Wiring �gn 68. APPROVED FOR PLASTERING
t8. Rough Elecvic�ll-T Bar Ceiling � 69. QOOUSPA SYSTER95 FfNAt �
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
_ � . .. J � . � . . •J' ri .1 li. � J: .c i'-I
20.TRoGyh Fecto�Y Fiieplace ':C" -."" x J = ��* TAPPROVA�LS �CPer.mit # x s
1' S. S_r 1'ST 7.'C S vYx j �--�+ �
a _ n a: » -: :'� z � � � : 'T' x
27:�ucts, i� Strj�ctu�2r '.. .. :_s x S � .-ix .- ;70. U�dergrouncL Hydro x '
22. Du�s, VEnt[?Btin,g'� + �'S * � r ^ ¢� � '77. Produc(��ing �C}�s �Oil
23.�,�C�,,aS^f'iP�'Ro�gh &'�e5[ ' . { ... ' • �'r` '� `�
m,g .�r, � �y is > �72. Undergiou�d FlusFp;� x r
24-Ro6f Framirrg :<x . - � a� p C Y, � x .73�'Undergmd'. Srorage`T�hk t7 Gas ❑ Ofl
`Ti' vT 5 ! 'Vj__
25. Roo Sk2athing '` S .' x�n :-r, � n�:� Y � 1=p x
� �zx � �� +�x n7... t 74c=0yerheadYiydro^ x
26.�T-Biu Ceiling (St�putural) &tpAenecoat � � .v '.yT_7� � 75�"'Dry Chem,ycal - � �' .. T
� < �. � « ,
27:�Fr ea d FiZshi�� � " 't' K" � .�':`• �s `� S T' `
- � � ,� .� X = � r zx ;. 76,D�ry StandQtge _ _ ,
' ,28�Latd in9� SidingEx i -��^ Y .^ -•i ...« x 77= FIXED $l`SiE��iNAL•�. �V .~
"29. Insulatioh '' �• •� .... � ° '1 i __, � - � � � � ;�
- g : --- R R 78sFIRE PREV. FINAi �� �
;�30. DrywalhNailTng �.x -` R� s�•'. � HEALTH�DEPT^ R�EQI�IREMENT
nl S
;.�37. Plaster �owq CoatY Y � -_ .r K .� { ':: r79',"FINAL I(VSP�CTIZTN ,. '' �
:-32;rElectrica{ PoN'er MeteCFinal, `-� �.:. ,�S :: :. -80 rFOOD CERTIFI'CIiTE ISSUED^
r�
133.`,�ir�'p�l ELg�triC, .` .. . 'r `Y I x = `'No{�es: _` ' r
� x r .E s: i x 3 - -� }7 �: "] .J '-' A
� 34,-�,Fini H tin & Air.Conditioni Y� " � Y �'� � '
'lt 9_ Sa 4 9$ '1 � < a -r, S C1.F`. t �� .:C,^,
e� - :r \ Y� it ue! M
35 TFiriai Gas Pipe-Test� �- =` " � n �^5 ` '' :
,-^<} �: F- .: i-i �;T T'
,�36. Hoot1 o(1-�CanoPY _ r -_ � t �'� � ` ( µ ,^_ .10 � +' ,r;
� : ��
-'37.-Final FactorV Fireplaee,z ' � ` ;�, ' M { �,� ' = :� :x ^ �`�
: � i . ... -
��8. Final Plumbing . ;� � u ti x=: � S •- * z�
_ w
':39. Wat€r Service�Final% � � '+ x' � i � �' ' • � '-'`� �� 'z
- �
>:
;40. Ga3�erv,�'ce-F�nal Y �„ .�z., � 1 „ � � , ; � �1,+ x `"
i
i'41. Solar D6mesticFinal � ^ _, j r a �" - .�
i �.: �o .:;x
-�42:'Backflow Preventer� - .ti ' � " x 't ��, � � �
43. BackfloW Irrigatiorr � - � ' �` * - x �
�- ^ � �c a x • ,-, .
� : z . v
''.,44. Landscape IR�iqation SYstem � = .i r - - .. n �:: _i m;� � i o
S�A5'Sound Attenuation - - '>-' - '- -' �-+ "� �`3
r /. r - r: rn �ni� 1- J • i-.. -
'46.-,Handicap Regulations , .- �r . • : _ ' � ��' •• -
.F 5 G= S
�47..FINAL STRUCTURE & BUf1DING `p�� 9 � ���/ : .ti s ' *�
r r. . d"!�x � C �k ;�
L48:�FINAL PLANNING; ; =r.' :r :� I . � � ' ; :: .�- v . �
.I
:49. Eleetric Release to Edison � •- � i x i� s�i; � �« .
x i <
�50�Gas-Release to Sou[hem California Gas Co '.v �'; �' �'� {` " - �'s, •,� -
51'. CERTIFICATE OF�OCCUPANCY w v. r i'• 7. . . ..
No. Date
:I
PP0.IECT p00flE55: Z 8(j Q EL
OWNEN'SNAME: F(J�IMKI$W
aoosess:' 2864 EL
COSTA ME
545-8178
ANCM/ENGINEEN:
AOONESS:
� ANNP, M UNIT:
CAIR 92626
XEG.NO.:
UNIT:
PEXMITTEE: ANN KLIMKIEWICZ � ( 714 ) 545-8178
aooness: 2864 EL RIO CIRCLE
COSTA MESA CA 92626
LICENSEo CONTHRCTOB oEClABA7lON: I hereby affirm ihat I am licensetl untler pmvisions of Cnapler 9(commencing with Section
7000) ol �ivision J of the Business and Pmlessions Code. an0 my licens¢ is in lull force antl effec�.
GTY LIC.: ' SiFTE UC: ClASS:
�ate: Signature:
WOFNEflS' COMPENSPTION OELLANATION: I hereby afiirm I�at I have a certificale o1 consent ro salbinsure or a cenificate oi Workers'
Campensation Insurance, or a cenihetl coDY tnereof (Seciian 380q La�. C).
�OLICV NO.: EXP. DRTE:
OMPANY:
J Cehifie0 coOY is �ereby furnis�etl. ❑ Ceni�ieU capy is liled wilh �Ae ci�y Builtling Division.
{ /'
oate', Applicant
FXEMPTION FflOM WOflNENS' COMVENSRTION DECNPRTION: Rhis seclion neeU no� Oe complete0 il the permi� is �or one hunOreU (5100) or leu�.
I certily I�at in �ne pedormance ol �he work lo� w�ich ��is permit is issuetl. I shall noi employ any person in any manne� 3o as to become
subiect to Ihe WorkeK Compensation Laws of Cahfomia. ('
�
Date: Signamre: � �
NOTICE: If, aller making �his tleclamtion, you shoultl become suble[t lo the Workers' Compensa�ion provisions of Ihe;Labor �^
COUe. you mus� forihwilh compty with such provisions or �his permi� shall 6e deemed revoketl. ,. �- (.� ��
CONSTflUCTION LENUING RGENCY: I hereUy aliirm ihat there is a consimc�ion lenaing aAency for tAe petlarmance o� ihe work �orv
whicn ihis permn is issueU 1Section 3097, Civ. C). ��
LENOEfl: _.
AOUflE55:
OWNEP BUILOEP OELNPFTION: I �ereby aifirm �hat I am exempt imm Ihe Contractors' State License Law lor �Ae �ollowing rea5on
(Seclion 7031.5 Business and Professianal Code: Any city o� county whic� requires a permil Io cons�mci, al[er, impmve, Oemolis�, or
repair any s�mc�ure, prior Io i�s issuance, also requires ��e apPlicant �or such permii �o file a signe0 s�a�emen� that he/s�e is licensed
pursuant to ihe pmvisions ol lhe Comracmrs' State License Law �C�aD�er 9(commencing wi�h Sec�ion 7000) o� Division 3 oi �he Business
ana Prolessions Code) or I�al he/she is exemD� ��e�e�mm antl the 6asis for the allege0 exemplion. Any violalion o� Seciion 7031.5 6y
any apDlicani tor a permil subjec�s �he applican� [o a civil penalty of noi more �han live huntlre0 Oollars (5500�.
I. as owner oi ihe D�operty or my employees wilh wages as their sole com0ensation, will Uo ihe work, antl �he
� simcmre is not intenAed or olfere0 for sale �SecUon 7044, Business and Pmfessional CoOe: TAe Comractors' Slate License Law
tloes nol apply lo an owner oi a pmpe�y who Ouiltls or improve5 ihereon, and wha Ooes such work himseli/he�seli or thmug�
his or Aer own emDloyees. D�oviOed Ihat such improvements are no� in�endeA or o��ered �or sale. tl, however ��e Ouilding or
impmvemeni is sold wi�hin one year ol comple�ion, �he owner will have t�e 6urden ol pmving �e/she Oitl no� bui10 or impwve
for t�e purpose of sale�.
I, as owner of �he pmpeny, am excWsively conVac�ing wiih Iicen5e0 con�raciors to constmct ihe pmlec� (Section 70d4, Business
❑ antl Pmtessions CoEe: The Coniractars' State License Law Ooes not aD01y Io an owner ot pro0e�iy who builas or im0�ov¢SlAefeOn
antl who contracls lor suc� prolects wi�h a conVacbqs) license pursuant Io �he Contrac�ors State License Lawl. I am aware
Ihat prool af their Worker'S Compensa�ion insurance should be pmvitletl Io me.
� � am exempt unUer Sec�ion�. HP%O4 A B. 8 P. C. ' �
rmr mis reasoo: p�L WORK BY OWNE �
' Wte:X'��=� ��- - Owne'
I ao hereby cetlily that I am aware of and un�ersland the reQuiremen�s ol Calibmia Healtn and Safety Cotle Seciions Z5505, 25� tl
25534 and Ihat I or any future huilding occuDant will/will no� (circle ane) need �o comply wi�h 5ai0 state codes antl �he requirem or a
permi� �ar conslmtlion or modifica�ion imm I�e Air Ouali�y �eme 1 DisVicL�stmc�ian a lications are exemPi Imm
��ese Dmvisions. /�
��% '1� AP�hcant. � /7 �AO,LG�G
I hereby cerltlyi�at I have reaa��is application ana SIaIe �hat Ihe aboveinlorma�ion is correcL I agree�o comply with �ntl counry
ordinance5antl5taielawsrela�ingtobuiltlingconstmctionantl� eyyauthorirerepre5en�ative5o�thisciryloenleruDon�heabove-mentionetl
pmper�y �or inspection purposes. 1 /'' A
// / L
oate��y—i� siqnature Q �
oriver's �icense oi sociai secu�ity
i6Gt-a6 Wbite—Builtlinq�, Green—Catle Enlorcement Canary—Aoolicanl: Pink—fievenue'. Goltlenrotl—Asspssnr
CITY OF COSTA MESA — BUILDING,PERMIT PE ,
PERMIT NO; IE 058613 PLAN CHECR'NO: N , ,
v �
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE OTH PURPOSE: OTH
JOB DESCRIPTION : LEGALIZE EXPIRED PERMIT OUTLETS/SWITCHES SQ FT:
CLAIM VALUE: CALC—VALUE; GRODP OCC: R-3 /
COMMENTS: EXPIRED PERMIT #46941
******+�*�**�***********��*****�r�******�****�*+r�r*****�*********x***�**�*�*x�x�**�
""' Z O N I N G R E Q U I R E M E N T S
S E T H A C K S """
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT.: ___FT_ _..IN REAR: FT IN FRNT: FT IN AEAR; FT IN
LEF'P: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN "" �
PARKING REQ• PROV: PARCEL; 14156217 ZNE: REF NO:
PLANNING NiSTES>
� "
iE 1E it iE iE
D E V E L O P M E N T S
iE iE �F 1f 1FlE �f if iE if 3f 1F 1Eif if iF 1E iF iE �f �f ik IE iE iE if ik k it if 1E if �! iflF iE �f iF if �k IEiF
V I C E S R E Q U I R E M E N T S
20NING APPROVED BY h., DATE:
BUILDING APPROVED BY : � �� DATE: � ' � — Zi
APPLICATION ISSUED BY• '�-� DATE; � l�
�E1ElfifillFiklF1E1E1fif1EltiE1ElfiFiEifltiF ftifififlfiEffik3E3f �F�E
jfiE1E�E�F�F�EiE�E�k�f�klElffE'iE'lEiElEiFiFif3fiF�FiflEiFikifiE�lf3fiF�FlfiF�FiE iF�Eifik�EiliF�FlfiE�f3fifMiFiF3FifiE�fikiFiE�FiE�fiE�fiFiEiF1ElfjEiEiF
LEGALIZATION;N F EF� S U M M A R Y STRUCTURAL SEGMENT;N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT . 30$OY SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV->.. PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 30.00 - 0.00 0.00 30.00 30.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 30,00 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
30.00
iE if if if ff ik M iE iF �E �F �E iE �F�E 3E iE �EfE iE �E �F iE iE iE 1EiE �EiF iE 1E 1EiElE �E �E �F �E�E if 1E �E �E 3E iE 3E fF if If iE �E ak�f iF�E�E iF �E 3F �E 1E �F�f iElE �f iE 1E1E �f �f aE if fE K �E iF iF if
_ I N D I V I D U A L F E E B R E A R D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 1 ELECTRICAL RE—INSPECTION FEE 30.00 30,00
END OF FEES
oi oniait(�b—G0121tbb Y::;�?�
UATG+ fF2S/!4/92 liJl�. 17;�C
j -,
<' CONSTRUCTION AND PLANNING � . P Si SPA � � ', �
� . Date Inspector ' Date lnspector
� APPROVA6S Permit # _ � = , APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe�Undrgrnd. , 53. Steel Reinforcemeni
��
'-.3. ,Elzctrical Cond�jf�l'Jiility-Undrgmd. � . 54. Forms ' a�
i 4.�E78ctriul Conduit-Undrgrnd. ` 55. Electrical Bonding -
� -
t'.5. §feel Reinforc�m'e� 56. Rough Plum6ing & Pressure TeiK ,
� - ' . ' -' . . ,
�i�.-Electrical UFER GiPd. - 57. APPFiOVAI TO COVER�GU ,I:%E c.
' T. Fqoting: - - 58. Electrical Conduit-Undrgrnd. '� �%
� _
i���.,foundation . . 59. Gas Pipe, � Undrgmd., Test � �"
`�. Water Pipe-Undrg�nd. 60. Backwash Lines, P-Trap, O Unclrgrnd. .
10. Structural Floor Svstem = 61. APPROVAL TO DECK �
it. P.roperty Sewer Line& House Connection 62. Backwash & ReceptorFinal �� '
12. S€wer Cap � . 63. Heater & Vent•Final
13. Roof Dreins � � 64. Plumbing System�- Finai. '
14. Rough Plumbing �' 65. Electrical�Final
15. ftough Electrical-Conduit � �-/%y� 66. Soiar System-Finai
16. Rough Eleccric Wiring 8�g/9z ��'.K .N� 67. Fencing & Access Approval .
�y.,o•-
17. Rough Wiring,Sign �'R. 68. APPROVED�FOF PLASTERING
18. Rough Electrieai•T Bar Ceiling I�D�'b 69. POOUSPA SYSTEMS FINAL �
19. Rough HeSting & Air Conditioning - FIRE DEPT. REQU�REMENT
- ' - CYl�:P�. .w r,
20.�Rough FBttoryFll-eplace � �:T! :�: < ^ ^'* �' APPROVA'LS'��PeiFhit# * "
r! �Z sx �^.�r i cxx. •z �Cft;..-� 5 <
S . . =S � � _. y ..: . . .� 'r K rl
21:.'Ducts, in�5tcuctuie: ' „,. ��- ' y � ,_,� � :70. . ndergip.¢n Hyslro
22.Ducts,Ventilating� � S Sx<�-�� p�oduci� ing[7�as O�OiI
. n :
23�Gas i E„Fo h&' est �, " � '-�' "' �'� Y
. �'�P, �;9 7 -g x ;r, T .Z . x -72. Undergropnii Flu
i. � .. .. � . . . .
24: Roaf Framing :rt- -- J Y? .�• � �� �� ;- 73� Undergme��. Stor'ag"Tank'� Gas ❑ Qfi
rr. �L �'x x 'T
25. Ro� Siieathing _ �x � :�? � :r :, - � - :... �
� .�. � p � :,vY. y ..74?::Overhead�Hydr6"' �+:
� 26.�T-Bar Ceiiing (5tryetura4l F�7Nanocoac +'� x - � _ = x - -
75= Dry ChemicaV
- - �
27.'•Frameand Flashin • - "' -0 ^':': ' �'�' �F x S Y' �
.> � : Xz * � . T :o* x 76�Dry Stan�uge _,o ,. �;
.r ._ :
' 28." Lathing & Sidin� r. ✓ .�.: x ! S •= +' 77:� FIXED SY�T ER�:FINAL' v �
Y29. insulation -'� 'r' � .. .• � .` `� ` K - � � -- :l
r; c . +� Xa: 78iFIREPREV.FINl�.L ::> r:,- r,�
: � , ,. �
=30. Drywall-Nailing c:� � k = * ,-+ •HEALTl-kDEPT? ftEQk�IREMENT
� ��..
�31. Plaster Brawn Coa� _ �__ :; ; K 79`'.'�FINAL If�S?ECTIgR7, Y�' 7�`�
. x _ -. - � ___ • r.
� 32rElectrical PoWer Metq-Final t t; ,r� t, 80,n,F00D CERTIF�CAPf 13SUED S� .
_33.rFin�l EICCtriC .` ' . ` 1 � . x � NOttes: _ t _ ' �i,.
.. `' Y . _ " �� . -. 1 ^. _ .�
_34,.-Final Heating & AK; Conditiorung I. F z�-v .� :` =' . S�-c7
.�
35:''Final Gas Pipe�Test " _` �' ~ ^ " � �'� ' `�� -ns : �'' �� =
�� . �-. M .- .� * �o - S Y
� x ' .F _ e
�.L
_36 �Hood or_CanoPY . - •_ a tl I f . � s .+ ' s' �O p ;rir
_ „
'37 =Fina� Factory FirePlace • - ' � " �� j � +' ` '' T"'•
,c � t « . ;U
.; �� � .... f� .�:� ' .. � -
�38. Final Piumbing ._ - • r. . I 1 .S .-+ �
:39. Water Service-Final<� � � - >: i � k :' c'. �,a {'�
„ ,: i � �.
, 40. Gas•Service-Pinal r � .s.-rr � r , I �; ; `c �p� ;� `•
s41. Solar Oorr+estic-FircatS •• � =s I ( '� ��=� ^ -z a
n .�:� � � '
J42�Backf�ow Preventet : z' *.� i � s-: x 7� +. G -
43. Backflow Irr_igation �-': = � _ "� '^' `
s ` s �: . � i � `" i^ .
� • •` R .
'_44. Landscape Ictigatiq`n Sysrerrt�,=r '� ;� � , �; - „ t n ,1: :c ` N _
�45.:Sound Attenuation -X-� � ` z '- '-'� .l ' �- " ^`� " �
� - *i !*7 r, .. - �2 v -
` � .. ...T :� :7 i � -c� -.y ..
'_46: .Handicap Regulations __ - .T �, .K , _ ,F � ,o � .x
�47sFINAL STRUCTURE & Blt'ILDING` � + � - _'� .`"4* X c ii, _, �� fi
"48. FINAL PLANNIN�i ' I � � '
- - ` �'-' � /I . � `' o i�: S
:_49.+�Electric Release to.Edison , � , •-� -��._ .� x � :
r •C+
"750.�Gas�.Re�easeto SouZhem CalifoJniaGasCo " (� i '�' * .�', : `.l, - . ��;r �. j ".
T51. CERTIFICATE 0 �OCCUPARCY ", r � ; ;; .r,7 ,,` ., � _
No. Date
_
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2864 EL RIO CI
Sulte No
Vicinity: �
Parcel Nunmber: 14156217
Applicant MOSS, TANIA
Address: 2737 S CRODDY �,�
STE D �-,'; '"
�
SANTA ANA; CA �-, �
Owner:- ' KLIMKIEWICZ, ANNA M
Ad"dress 2864 EL RIO CIR� �
COSTA'MESA,CA
PLUMBING PERMIT
Phone:
Zip:
/
(714) 241-1414�,^
92704 -�
Status: ISSUED
Applied: 02/25/2002
, Issued: 02/25/2002
ISSUED BY: U�9IL-..
Phone:
Zip: �92626
:,� . .�'... �. '.��
� ,
� � � A'S� ��'C
�;D �
��.��
�` ' \,
� �, `�
Contractor: - COAST ROOTER PLUMBING HEATING & AIR CONDITIONING .
Address: 2737 S CRODDY �. . � � � " � � � �
. ��STE D , - � Phone: p14) 241-1414 �� � � � � -
" �- `- ,./ � . - � .
� - SANTA ANA; CA Zlp: 92704 . � �\ � , � �
� � " . License: 529127 � � � � � �
Arch / Eng :
Address:
� �,; �. . . . .
Phone:
Zip:
� License:
REPLACEMENT OF WATER HEA
'_ f -. T:
- - - � - ' . �, ��
FEESUMMARY:. ���,�� � - � .
� � AMT-�:. QTY AMT�':�QTY � AMT
'/.' _
ISSUEFEE' . $2350�:-,0, i-='.- �-laundryTub/Washer ��, $0.00, �,�0 � -_�.-Sump�P.ump i ' ' `$0.00
Backflowirrlgation $0�00 ��,0-�. ; L"andscapelrrigatlon�� : $0.00 �0 � "`"-.SwimmingPool ��,".�$0.00
BackFlow PreJenter %, $0'00 `0- � ,: � , P-Trap � �' ' - " r $0.00 0 irap Priiner - �, � % $0.00
Bathtub ' � $0 00 � 0 ` :� P�essure Re ulator - - $0�.00 ' 0 � � Urinal% �; � � % � $0.00
9
Clarifier System ,$0 00'; ��0 ;�� Process Piping (per 10 ft) $0.00 , 0 .Vacuum 8rkr Bkflow(1- ) $0.00
Connect Qce,Soda.etc)� . � �S0.00 _ 0� . Receptors - - - $0.00 - 0� - � yacuum Brkr Bkflow(5+) $0.00
Dental UNts - � 50.00 � � �0' ' Septic Tank $0.00 " 0 - � - Wash Basin % � $0.00
Dishwasher � $0.00 , �0 � "� � _ -� Sewer Cap for Demo $0.00 - _ "0 ' - �'Wash.Basin�Set $0.00
Drain, Floor $0.00 �� � 0 � Sewer Connect ' $0.00 ��0 � Wasle and Vent System $0.00
Drain,Rainwater $0.00� -0 '� � 'SewerPrivateline, $0.00 "'0 • -;WaterCloset(Toilet) $0.00
Drain, Roof $0.00 �0.� Shower � , . $0.00 0 . . ;i = Water Heater / vent $72.30
Drinking Fountain $0.00 0 � Sink, bar $0.00 0, " "� Water Piping (Inst or Rep.) $0.00
Expansion Tank 50.00 0 Sink, commercial � _$0:00�' 0� Water Re-pipe $0.00
Gas Earthquake Valve $0.00 0 Sink, Floor - $0.00 � 0 Water Service $0.00
Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00
Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00
Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00
Intemeptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: E35.60
' ' COMMENTS I SPECIAL CONDITIONS
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
C
NOTICE: The work aulhorized by this permit shall comply with all applicabla handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wi�hin 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, anA all
required Inepectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (774) 7545626
L96CiU �tYW)
WORKERS' COMPENSATION DECLARATION: ��
I hereby afiirtn under penalry of perjury one of the following tleclarations: � �
❑ I have end will maintain e cetlifiwte of consent to self-Insure tor workers' compensation, as provided for by section 3700 of the Labor Code, for the pertormance of the
wo or which this pertnit is issuetl.
heve and will maintain workers' compensation insurance, as required by section 3700 oi the Labor Code, for the peAortnance of ihe work for which t�is permit is issuetl.
My workers' compe ation Insurance carn1er ^an icy number are: /�.-�
Carcier. �J�� �V PolicyNumber. 1��;3�—1,Y_
(This secf/on need not be comp/eteC i/ fhe permit is valuetl af one hundred dollars (3100) or /eSsJ
❑ I ceniry that in the peAortnance of the wo c for which this permit is issued, I shall not employ any person in any manner so as to hecome subject ro t�e workers'
compensation laws ol Ca�iomia, E'6g e that tl I should Eecome subject to the workers' compensation pmvisions ot Sectiqqqnnn 3700 the LaDor Code, I shall fort�wit�
comply with these pr i ans. �/�_� �Q �
A�p�pticant �Sipnetur�' e-"'-� Date: �
WARNINO: FAILURE TO SECURE RKE0.S' COMPENSATIqJ COVEMGE IS UNL4WFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES ANO CIVIL FlNES UP TOONE HUNORED
THOUSAND DOII.FRE (5100,000). IN ADDITION TO THE WST OF COMPENSAT70N, DMUGES AS PROVIDED FOR IN SECiION 3]O6 OF THE LABOR CADE, IMEREST, AND ATTORNE`f5 FEES.
LICENSED CONTRACTORS DECLARATION:
(commencin with Section 7000 of Division 3 of the eusine�s jn Pro e iQn otle, and m license is in full
9 Classk:� � ,S�7�r�J �1 � Y
Da` te�, � �T e�� � ��
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm ihat there is a constmction lending agency for ihe pertormance of ihe work for w�ich ihis permit is issued. (Sec. 3097, Civil Code).
Lentler'S Name: Lender'S Addre55:
Signature: � Date:
OWNER-BUILDER DECLARATIONS:
I hereby effirm that u(Wer penalty of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires e permit m construct, elter, improve, demolish, or reDeir any structure, prior m its issuance, elso requires the epplicant for such partnit
to file e signetl statement ihet he or she is Ilcensetl pursuant to Ihe provisions ot the Contractors License Law (Chepter 9(commencing with Section 7000) of Division 3 of ihe
Business end Professions Code) or that he or she is exempt therefrom and tha Desis for the alleged exemption. Any violation ot Sectlon 7031.5 by eny applicant for e pertnit
sublecis lhe aOGlicant to a civil penalry ot nbt more than five huntlretl dollars (8500).):
❑ I, as owner of the Oroperty, or my employees with wages as iheir sole compensation, WILL DO THE WOFiK, end the structure is not intended or ofleretl for sale (Sec.
7044, Business end Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himselt or herself or thmugh his or her own employees, provided that such improvemenis are not intentletl or oHered br sale. If, however, ihe huiltling or Improvement is
sold within one yeer ol completion, the owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose oi sale.).
❑ I, as owner of the pmpeny, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sac. 7044, Business and Protessions
Cotle: The comrattors License Lew does not epplY to an owner of property who builOs or improves thereon, and who contracts lor such project wtlh a contraclor(s)
licen5a purSuaM �o �he Contractor5 LitenSe Laws.).
❑ I em exempt under sec. Busineu and Pmlessions Code for this reason:
SignaWre: Date:
Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires:
Venficetion at Ownership by (rype of document, i.e. - praperty tax bill or daetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION:
❑ I hereby certify thet no excavation five (5) or more feat in depih into which a person is required to tlescenq will be made in connection with work authonzed by ihis
permit, antl that no builtling sWcture, scallolding, falsework, or tlemolition or dismantling iheraol, will be more ihan thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title B, Calitomla Administrative Code).
❑ As owner-builder, I will not employ enyone to do work which would require a pertnit trom the Oivision of Industnel Satery, as noted above, unless such person has e
permit to tlo such work from the tlivision.
SignaWre: Date:
Division of Intlusinal Satety Permit Number.
CERTIFlCA7E OF COMPLJANCE AND AIJT}IOFiVATION OF ENTHY: I certi(y under penalry oi perjury that I have read this ap0lication and state that the infortnation given is
correct. I egree to comply with ell state laws and ciry ordinances relating to building consWction, and authonze representatives oi the Ciry of Costa Mese to enter upon the
ebove-descnbed property for inspeciion purposes. I agree not to occupy or allow occupancy ot eny building authonzed by this permit until final inspection.
CODE �. INSPECTIONTYPE
1618 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Rool
201 Final BIocWRetaining Wall
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
�_ i �uilF.1F9
Z
LO�E I INSPECTION TYVE
206 Final Mechaniwl
208 Final Plumhing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250. Final Builtling/Oaupancy
��7.\i .1111. .
v' � �
�
�
i ADDFESS OF BUIIdNG: z$ 6 4 EL R I O+C�
I°W"Eas"�"Ei`u+v"": KLIMKIEWICZ,� AvITtVi: M
� �ooxess: z 9 6 4 EL R I O C I R
COSTA MESA,CA 92626•
AVPL.IWIPlO ADDRE55:
ANCXRECT OP FNtlNFEP: 11C. NO.:
ARCN. OH FNO.'S /�OOXE55:
coxm�cTars wuu:
cam�cToxs �uuxc
moxEss:
ua xo.:
UNT:
UNi:
UNT:
LICENSEU CONfflACTOHS DECUXATION: 1 Mmby allirm unEer penelly W perjury Ihet I em IkanseE uMar D«ebm M Chaplx B
(mmmer�aip wilh Section ]000) oi Diviaon J d tha Buaima enE Prdeseiona Catle, eM my license ie in tull brce enA ellea.
cm uc. No.: uc. cuss: uc. No.: EXP :
Dme: Conl�a:
. OWNER BUILDEH UECLRNATION: I Mmby eifirtn uMer parely d perjury Ihtl I em enmp Irom tM Comreqpe lioenae Lew fa �M
,T`dbw'vp rmeon (�ion 1031.5 Buenms eM Pmfwbm COEe: RnY cYY a caunlY �� �9uires e pertnit to oonNrucM. eltm. imOrovs.
�Yemolbh. or mpai eny e�mdure, prior Io ilf eauerrs, deo requiree Ihe ep0lirent br euch permil �o fila e epmd tlelemem ihel M or eM
is liceneed W�uenl to �M povisione d IM GonVeclon Licenee lew [Cheper B(mmme�np wilh Sedon;l000) d 0'viaion 3 d iM
Busirwae end PrMeeeione Code� or Ihv ha or ehe is a�empl ihxehom enC Ihe beaia la ihe elleped eaemqion. Any voletion IN Sadion
)031.5 by eny eppliranl for e parmn eubjeGe �he epplicenl lo e civil panelry d �wl maa t�en INe hundred ddlan �5500�).
� I, m owner d iM prapeny a my empbyeea wth wegea u Nei ade compenamian, xill do tha xork, eM�IM el�ucturo e rwt inleMeE
or aRareE la eeb (Seelbn )016. Busmu eM Prdessbna Cade: TM Coniretlae Lieenae law dma eql epplyto an ovmmd propa�ly
wlw WiM a mqwes �Mreon, aM who dres such xwk IJmmX m Mrsall a Mraph he a her own empbpae. pwMed thm euch
�mv�Wem«m me na mienaee «onerea i« sda. n. iw..ev«. me w�uma «;nwwemem re saa wnn�� one ymr a oomWm�, �,e
y� �,�a.a�,�a., mn na.� ma w.d� a wo+„re ne «.na dd �a w�b «�mwo.+io, m. wmo,� d�d,�.
u I. ea owner W Ihe propaM. � ezdueively mnlreG'uq wilh IioensaA mnvacion lo canslrua �he prol� (Seaion ]014. Busirieae vM
rrmessio�e com: Tna cooveaon �re�sa te. aoes �a avvN �o a� ovn,m a aorony wno nuia.�«;iino�wm ma,eo� ena.no
convacta lor euch pml�a wiih e mnlredm�s) licanaed pureueni Io he Con dwe Liwnse ). .{j�
❑ I em eee undn ion: B. d P.C. r Nis �^'
o�a �z�°"��
�--�
i ao nareev �an�M u,d i� a.�a d�d �,d.s�a ma � a c om n d,�r a o�o zsws. zss:n. �e
255�6, enE ihel I a e�ry M1�lure WiMiip oewpenl will / wil nd (arcb aw) need Io ply ' eak e ood erd iM reQuiremanle Iw
epartnniweanaieunonormad'ifiraiionhwniheAi uei�iy enepementD:mnd.Reai eaiai wnepp brroveezemptimmihese
w��a.
o�a: nvaicem:
WOPKEH'S COMPENS�TION OECLRN�TION: I Mreby dfirm uMer panetly d pwjury wr d ihe fdbwirq Eederqom:
❑ I liew eM xil meintan a cMilicete d muant lo aettinwro ta workds' cwnpamalian. m pwidetl /a by SeGion 3)00 d IM leba
coa. i« m. o�n�, a ub ..m� i« �n mro �n ���e.
❑ I heve enE xil maMen wuhae' mmpenution insurence, a� repuired by Seqbn 9)OD ot ihe labor Coda, br iM perlormaree d ihe
woM lor which ihia permn ie iauad. My warke% wmpenwion insurarca remer erM poliry number ve:
Camer:
Polcy Number:
(This section need rrot he completeC / �he parm'n is lor one hundred CWlars ($1001 a lev.)
�i] 1 eenAy Net in Na peelomienee d �M wak /a whieh thia pa.rmn ia �ieE. 1 shell iwl empby ary penm in enY menrrer w m io
becwre w4� to the x«Mmo' cwnGametian Iaxa d c eM pree �hm il I ahouk bsmie vuhjed to �M1a xwken'
mmpe tlqn pm„sqm d Setlpn 3)00 d �ha LeEa . I n I ' h c pfy xn 1 peovisima.
Dale: R Icenl:
Wam/ng: ellun ro axuro worten' compenseHon co n/a , entl Il • n smp/ er ro cNm/rol pxwlNu end
elvll llms up ro ons huntlretl fMuaentl tlolkn (5100,000), M edtllUon lo ths ro o erwtlo tlamsq� a� provlOSA br In
SxHon 9]06 0l tlre Labor COGe, /nbnal, en0 efrorney i/ws.
CONSTtiUCTtON LENUING AGENCY: 1 Mreby elfirm uMer peneXy d perN�Y �� �� v e mn�Irvpion bMieq aqawy br tM
�n�� d m..on �« »nm, mm w�� c'swea Isaab� sas�. c:.. cl.
LENOEq'S NAME:
� LENpEP'SADDPESS:
I cenlly ihei I heva reed this epplcetion end seie Ihet Ihe ebove inlorme�ion is cortep. I eproe lo comDN ��h ell dty enE county oNiriarwee
enE s�ele lewa releiing to Euildin8 constmdim eM hereby emhor¢e repraeenlatives W thie diy io enter upon the ebove-mentbried pmperry
lorinspadion purposes.
o�e� � Z %�
� (5151de.WP) WhAe-BuildinB8�q:4�ean-FIe:Cenery-Applcant:Pink-Revenue:GokenraE-Avaeawr
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P U76408
PEi2MIT NO: P 076408 PLAN CHECK NO; N GOVT: N SUPP: N
r
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ADD
JOB DESCRIPTION : ADD SIDING/2 SKYLITES/FIRE DAMAGE REPAIR SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: FIRE DAMAGE REPAIR WITH MODIFICATIONS / REF B-76405
***�**at���iE**��+�*��*at*at*+��****�*�******iF*�xit�ie*�ie*+E*iF****��+�****at�t**�+e****et�***
Z O N I N G R E Q U I R E M E N T S
r b S E T B A C K S
J I�
—'—r-=-------- MAIN BUILDING —
FANT: FT IN REAR;
LEFT: FT IN RGHT:
PARKING REQ: PROV:
PLANNING NOTES>
i
!k iE iE fE IE fE 3E �E iE iE.�E iE dF �E �E 1E 1E 1E 1ElElf 1E iE if iE 1E dE iE
D E V E L O P M E N T
.�
ZONING APPROVED BY
BUILDING �APPROVED BY ;
��
APPLICATION ISSUED BY; G�� DATE: 2"/Z- �
*�*�******,��****��**** ,����**���* � � **
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
1.
BLDG PMT PLUMBING ELECTRd�C MECHANIC FIRE SMIP/RES GRADING
PERMIT 14.00
25x =� � SMIP/NON—RES
PLAN
ISSUE EEE 20,00 V
BUILDING—DIV—> PERMIT ISSUE Pli'AN—CHECK TOTAL PAID DUE
TOTALS----> 14.00 20.00 .,r. �- 0.00 34.00 34.00 ,00
.jl /1
REVENUE DIVISION TOTALS--> COL'LECTED: 34.00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
34 . Q� L^ /
n
if'k 3E iElElElE 1F iF 1E 1E 1E 1E IE 1E iF 1E iF iElE if if iE ik iF iElE 3ElE 3E iE 1E IE 1E 1k iElE ik fE ik ik iE ik iE IE �lElE iE 1ElE 1E iE'lE 1E iE iE fElF IE iE iE fE �IE iF 1! 1(� �E �E iE'1E-IE 1ElE iElE if iF 1f 3E
I N D I V I D U A L1 �F E E H R E A K D O W N
�
TYPE QTY D E S C R I P T I O^N— UNIT COST TOTAL COST
� '.
PLU 1 BATHTUB /1� '� 7.00 7.00
PLU 1 WASH BASZN ,; �r.� 7.00 7,00
�ENDfOF FEES
f � �o
-------- --------- ACCESSORY BUILDING ---------
FT IN FRNT; FT IN REAR: FT IN
FT IN LEFT: FT IN RGHT: FT IN
PARCEL: 14156217 ZNE: REF NO:
lEiffElE3EiE1ElEfEiEfEiE1E1E9f1E1EfFiE9EaEIElEjElklFlFffiE3EiEjE3E1EiE1EfE1EiFiEfE1EiE1E1EfEiElE
S E R V I C E S R E Q U I R E M E N T S
DATE:
DATE:
EX I ED '�
DA� � l:i
cx ca?e�a:s-JG20�415 �r Co= :�,�
CATE� G�JI3i95 7'Zt;E: lC:46
:i
�
CONSTRUCTION AND PLANNING � � �� S SPA _
APPROVACS Permit# '- Date Inspector APPROVALS Permit# _ Date Inspector
1: Temporary Electrical Service or Pole 52. Pool & Equipment Location �� �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' . �.
3. Electrical Conduit Utility•Undrgrnd. � 54. Forms � � . ' �
4. Electrica� ConduibUndrgmd. � 55. Electricaf Bonding � �
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test ' ''
6. Electrical UPER Gmd. • 57'. APPROVAL TO COVER�GUNITE �
7. Footings � 58. Electrical Conduit-Undrgrnd. ��
;
.8. Foundat�on 59. Gas Pipe, O Undrgrnd., Tesi , .
'��. Water Pipe�Undrgrnd. � 60. Backwash Lines, P�Trap, i] Undrgrnd.
10. Structurai Floor System , 61. APPROVAL i'O DECK �- '
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Fina(
12. Sewer CaP . 63. Heater & Vent•Final , ��
13. floof Drains . ' - 64.f Plumbing SYstem � Final - �
74. Rough Plumbing 2Z� �� 65.�Electrical-Final � ' -
15. Rough Electrica6Conduic . 66. Solar Svstem-Final �
16. Rough E�ectric Wiring � . 67. Fencing & Access Approval "
77. flough W��ing Sign . 68. APPROVED FOR PLASTERING �
18. Rough E�ectrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ' FIRE DEPT.'REQUIREMENT
- - T - -
20. 3�=-=..,....� � -.�.,.�ace 'j'0�3 i�34. , - � � . APPROVA'L-S.� Permit # �
�5t
21. Ducts, in Structure � � � 70. Underground-Hydro '
22. Ducts, Ventilating � � ' 71. Product-Piping O Gas ❑.Oil
23. Gas Plpe-Rough & Test ���j �� 72, Underground Flusfi- �
24. Roof Framing • �.73.' Undergmd'. Storage Tank O Gas ❑ OII
25. Roof Sheathing _- - - - ��7q, Overhead HYdro '�-� y
, ;�
26. T-Bar Ce�ling (Strucwrall & Monocoat _ 75..Dry Chemical � , ' -' `�
%i e �
27. Frame and Flashing � , 76. Dry StandpiPe �� �;j ;�
28. Lathing & Siding � " ' 77..- FIXED SYSTEM F�NAL ' 1.�..
29. Insulation . � , 78. -FIRE PREV. FINA�L r ��
x
�. •
30. Drywall Nailing � `_ . . HEALTH DEPT: REQUIREMENT v'� i
31. Plaster B�own Coat- - . . . 79. FINAL INSPECTION �
32. Electrical Power Metet�Final � ' 80.��FOOD CERTIFICATE ISSUED
33. Final Electric � . � � Notes: Z_2�i -�.'�. ,�'Z��� � K' - �-� �
34. Final Heating & Air Conditioning . " "
' '�i 'LC �C(�?'t��
35. Final Gas Pipe•Test - . .
36. Hood or Canopy • "- ' '
�37. Final Fattory Fireplace � .
38. Final Plumbing '
�39. WaterService�Fina1 . ' �
/' `
40. Gas Service-Final - � � �
/ a •
41. Solar pomesticFinal "� . ' -
42. Backflow Preventer. . _� � F
43. Backflow Irrigation - ' -
44. LandscaPe Irrigation System - - � ` � - �
45. Sound Attenuation , . ' ,.
46. Handicap Re9ulations � . .-� ' �
47. FINAL STRUCTURE & BUILDING ='' _
48. FINALPLANNING • .'* � .
49. Electric Release to Edison ' : -
50: Gas Releaae to Southem Califomia Gas Co � ' '
51. CERTIFICATE OF OCCUPANCY
No. Date
�
��. AODqES50i BUILpNG: 2 B 6 4 EL R I O.-C.7
IowxeasNu�eiFaawx: KLIMKIEWICZ, ANt�f' M
' . "°o"Eu: 2864 EL RIO CIR
COSTA MESA,CA 92626
AVPL. WIIJNG IiDDNESS:
AXCNRECTORENtlNEFX: pC.NO.:
YiCN.OX F.NG.'S AOOHE55:
caxrn�crars xu.�:
cwm�croxs wuuxc
AUOPE55:
uc. ra.:
UNT:
UNT:
uNr:
LICENSED COMHACTONS OECLAPATION: I Mreby aA'vm unEer pane�y d pefjury thet 1 em I'rerreed uMaz provirione ol Cheqer 9
(wmmenarp wilh Section 1000) M Division � of ihe Buaimee eM Pmlessiona Code, eM my liceme ia in full forca erd eXeG.
cm uc. No.: uc. cuss: uc. No.: EXP ;
Dele: Gonlmdw:
OWNER BUILDEN DECLIFRTION: I hereby atfi�m under peneYy d perlury ihet I em exemq from iM Comreqpe Liceme lew la ihe
Ibxinp roeaon (�ion )0.t1.5 &n'vwaa eM PMevione COEe: RM cN a�nIY �� �Guiree e pe'mn to odnvun. eM1x. impwe.
emdch. a repai anY strvcture. p'v io ea'sauence. a6a repuirea �M applimnt tn euch pemin io fib a eqmE sletamanl ihei M a aM
o licamed W�+�� la tM prmaeiona d IM Cantraqws Lioenae Lew �CAeqer 9(commena�p wilh Setlon )Op0) d Ovubn � d Ihe
Business eM Prdessions Code� a ihei he or she is anemq th>ehan vM ihe bnvia lar the elbped uemqon. My violetion af Sedion
]0]t.5 W eny epplicen� br a pmmil wbjade ihe apd�� lo e dvil peneM1y d rot mora Ihen Ixe huMred dollare �5500�).
❑ I, m ovmer W �he proqny or my empbyeea wilh weges es IMi eole mmpansalion, will Eo Ihe xnM, end the aUucNro a nd inlandad
a ollered for aeb (Seciion ]00<, Buairesv end Prdeeaiona Cotle: The Convenon Licenea Lawdaee not eppyto en ownerd propeity
w�o builEs or improvea Ihereon, anE who Eoas such wak himeetl or hanaX a ihraph he a her own empbyeee, providetl ihe� suc�
improvemenis ere ml in�eMeE a oXereE lor sale. II. however, tha buiMinp a in0�'emeM ia eoN within me yeer d rompblion. IM
y. .�.,.n��ua, �;o neV, m, w,d� w wWnre na a.,n, e�e �a w�m o� �mn� �o, me wm�a d w<l.
u I. sv ovmar W ihe OroPaM. am exdusivaN mnlrean9 Mi1n licenaed conveclon ro canmW IM WWetl (Sedion ]aa. Buairesa eM
Prolesaions COEe: TM Contredaa L'r.ense law Eoas Iwl epply to en awxier d prape�Y ��itls w imqovm iMraon ud xfio
mmrecw Ia axh prqeas v.nh e mm�auor(s) licenaed pu�auent to Ihe Conve e liume law).
� I am esamq Mm Seci/ B. 8 P C.. br ' r
Dale: � �/,� Ownar - �
r
I do haraby canity thet I em ewera W eM unEarslend the u re W Romie eeM1h Cod Sedione 25505, 2553J, antl
25551, enE Ih� I m eny /Wum buikinp ampent will / will nM cimb one) need m wm wlh 'd Mele es enE iM repuiremeMe br
Dab: �A ��� C-� Apqicent:
WOPKEfl'3 COMPENSATION DECLAN�TION: I hareEy elfirm uMer pareliy d peijury ons d tM IOYowi�p dedermueu:
❑ � nmre e�e m� meimen. ceiarw. d omsam �o.arc,�Nre m..wn�ars comoe�.mion,.. va,�e.d �a M seaion a�oo a ine �mar
COEe, iw tM pe�lamence M iM wak la wlvch thia permn ie ivued.
� I hew vM vriA mantan vroMen' mmpanaeiion inaurarim, m reQuired by Sec�ian 3)00 d Ihe Lebor CoEe, for Iha perbrmence d IM
woM Iw wtiich Ihis pe�mil is ieaueE. My wakers mmpeneetbn inaurence cerrier eM poliq numbar ere:
c�,,:
Pdicy Number:
fTAis aeniwr need rrat 6e compbfeE ] �hs permAis Ia ona hundred ddlers /S�0o1 w Ims.1
�] 1 cenN �� in Ne periwmence d �M work for whch Ihia peimN �e . I ehall M amplvy vry penon in em� meniror n m lo
exa�e .uM� �o ine workere• cano�an lew. d celil�� G� .ny,k n«ane w4.a m ine ww4en�
compense�oypmvisona qYSeaion 3]00 M iM Lebar Code. I �ICife qwiaimy.
• unlewNl,
eddltlon ro
CIIIIIIMI(1Ml/I/I! LIIG
p.. ,. vro�mw roi m
CONSTfiUCT10N LENUINO AOENCY: I heieby affirtn uMer penelry W parpiry thet �M� u e canat�ueion bMinp aperv.y br tM
peAortnerce d IM xvM in whirh t�e permi e eaued (�� �]. Ciu. CI.
LENDEP'SNMIE: �
LEN�EP'S �UORE55:
I eenity ihm I heve reed this epplcelion eM dma thm tha ebove inlormetion ia wered. I epree �o comply wnh ell rny arM muMy ordinenrea
entl slele lewa relding m buildrp conamabn eM hereby anhar¢e represenletives of thia cuy m emer upan �ha ebova-mentonetl pmpeM
brinspadion Ourposes.
LONNIE _LANGIJIS
(5t5t<BWP) WhBe-Build'mpBSelely:
o�<: � ��/i
Pink-Ravenue:GOlEanrod-pseaesor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: M 076407 PLAN CHECK NO: N
PERM NO: M 0'16407
GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: ADD
JOH DESCRIPTION : ADD SIDING/2 SKYLITES/FIRE DAMAGE REPAIR SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: FIRE DAMAGE REPAIR WITH MODIFICATZONS / REF H-76405
***�*****�t******at***�t****+�**�x-***rt********i��-at�-*x-**�**x�**ic-*�-**�-+�ititit**it�*�x-i�ic-*ie**it*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILUING ---------
FRNT: FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14156217 ZNE: REF NO:
�PLANNING NOTES>
i
ViE 1E iE if 1Elf IE 9E fE fElE iE iE iElE 1E iE 1F iE if If 1E 1F 1E iF 1f 1E 3E �f jE jf 1E iE iE fE fE fE fElElE iE 1E if dE ik iE iElE �)f 1E 1F 1F �E if 1Elk 1E �E �f iE �E iE �)E iE 1E iE jE iE ik if 1E iElF 1E 1E jf dE iE iE
� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
��
pZONING APPROVED BY . DATE:
ILDING APPROVED BY :
ICATION ISSUED BY
�***���****�**�**
DATE:
DATE:
LEGALIZATION;N F E E S 0 M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 14.00
� 25� SMIP/NON—RES
PLAN
ISSUE FEE � 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 14.00 15,00 f�� 0.00 29.00 29.00 .00
REVENUE DIC'ISION TOTALS--> COL�;ECTED: 29.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC ME�HANIC FIRE SMIP/TOT GRADING PLAN—CHECK
29.00
iE if if 1E iE iE iE iE if dE 1ElE iE iE 1E 9E IE 3E 3E aF �E 1E iE 1E 1E IE IE iElE fElE 1E 1E 1ElE iE dE 3f iE ik ik iE iE fE iE fE �E 1E iE �E 1E 1E 3E iE iE 1E 1E iE jF iE df !f ik fFlk 1E ik fE iElE 3E'lE iElE 1E iE iE 3f 1E
I N D I V I D U A Lr� F E E B R E A K D O W N
�
TYPE QTY D E S C R I P T I O�N UNIT COST TOTAL COST
�
MEC 1 RELO FORC—AIR/GRAV��{URN > 100 K BTU 11.00 11.00
MEC i GAS PIPING SYS 1—y4 OUTLETS 3.00 3.00
END OF FEES
��� 11E � N �e ^y� (� y
l:�C��.�� VZ JU��Q�Y�i^�'::LQ�11� 1{..'�� 7Cl���i7
�� � DkTE: OS;!.?�?: li�i'"c; ;E:�Fa
�.
CONSTRUCTION AND PLANN WG �� P� "�` SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
i. Temporary Elecuicat SeTvice or Pole 52. Poal & Equipment location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. � 54.� Forms � F
4. E�ectrical Conduit-Undrgmd. 55. Electricai Bonding �
i
5. S[eel Reinforcement 56. Rough Plumbing & Pressure Test � �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � '
7. Footings 58. Electrical Conduit�Undrgrnd. � '
. 8. Foundation 59. Gas Pipe, 17 Undrgrnd., Test � ''
��i9. Wa[er P�Pe-Undrgrnd. �60. Backwash Lines, P�Trap, O Undrgrnd.
:
10. Structural Floor System �� -1' 61: APPROVAL�TO DECK ~, .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap . ,83:: Heater & Vent-Final ,' '
13. Roof Prains � 64.-' Plumbing System - Final -
14. Rough Plumbing - - 65. Electrica6Finai �
15. Rough Electrical-Conduit • � 66. Solar SYstem-Final
16. Rough Electric Wiring � 67. Fencing & Access Approval
77. RougN Wiring Sign � - 68. APPROVED FOR PLASTERING '
18. RougN Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � � Z.�,_ FIRE DEPT. R�QUIREMENT
20. RougN Factory Fireplace � - . ' APPROVALS Permit # - �
21. DuCts, in Structure � � -� 70. Underground Hydro .
22. Ducts,Ventila[ing , " 71, ProductPiping�Gas OOiI
23. Gas PiPe•Rough & Test _ ' - 7p, Underground Plush �,.,, �
i
24. Roof F�ami�g ' _ ` " - 73. Undecgrnd. Storage Tank t7 Gas ❑ Oif .- `:
%�;
25. Roof Sheathing ' • 74,' pverhead HYdro , �
26. T-Bar Ceiling (Structuraq & Monocoat ' 75. �Dry Chemicai � " � � � �'a ,
;*.-i
27. Frame and Flashing � � ' - 76. Dry Standp�pe � r' s
:"i"
' 28. Lathing & Siding . - s �- 77�-. FIXED SYSTEM FINAL �a'� i
29. Insulation . . 78..,FIRE PREV. FINAL � ' � �
30. Drywall Nailing .. - HEALTH'DEPT�. REQUIftEMENT
37. P�aster Brown Coati - � -79. FINAI INSPECTION �
32. Electrical Power MeterFinal � � 80. FOOD CERTIPICATE ISSUED
33. Final E�eciric . � � Notes: t�-� � ��,��2� ,Q
��
34. Final'Heatfng & Air Conditioning - ' _ � . •
35. Final Gas Pipe-Test . - _ - � � .
36. Hood or Canopy �_ �
37. Final Factory Firepiace � � - �
38. Final Plumbing ' . , �
39. Water Service�Final - � _ -
-\`
-40. Gas Service+Final � ' � � ' ✓ � -. . •„
f' `�
41. Solar Pomestic•Final. '- � �', � , - �
42. Backflow Preventer ��. ` ' � '
�.�
43. Backflow �rrigation � � •
44. Landscape Irriqation System �� �, ' � t �
•,.
45. Sound Attenuation � � - � _ - -
46. HandiCap Regulations � � .
47. FINALSTRUCTURE&BUILDING � f't . , �
48. FINA�PLANNING ' � �- `
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �:'
.r
51. CERTIFICATEOFOCCUPANCY ' "
No. Date
ADDFESS OG BNIqNG: z$ 6 4 ' EL R 7 O C I
°w."E"s"""E",'m°w": KLIMKIEWICZ, ANNA M
� '0°"� 2864 EL RIO CIR
� COSTA MESA,CA 92626
�i�FPL.NNIING ADDXE55:
�qCXRECT ONEWiNFFA:
�PCN.OP ENG'S AOUXE55:
uc.ra:
UNT:
UNT:
cor+m�cTars x.�:
carimncroxsxuuNc . ,
�noness: uu xo.:
unr:
LICENSE� CONTflACTOFS �ECLABATION: I hereby ellirm uMer.penetly d pe�ury Uut I am Iceneetl uMer O��s�a ol Cheqer 9
(mmmenaip xiih Seclion ]000) d Drviaion 3 d Ne Buaineas and Pmimaiona Code, vM my licenee ie in full foru eM eMetl.
cm uc. No.: uc. cuss: 'i, uc. No.: EXP :
�
Dme: � � CaMreUw:
'NEN 6UILDEB DEClAP4TI0N: I hemby etfirm under peneXy W parlury ihe� I em esemq Irom ihs GomreUon Limnee lew la Ihe
�winp reevon (Sepion )091.5 Bueineae enE Prola�eiona Cods: Any cily w munly xfiitli nyuiras e parmN �o mneltuN. allm, improv�,
..emolvh, p r�peir eny et�ucture, piw lo ib lewerce, ebo ipuiiu tM epd�� la wch permil �o fib a�ipneE tWemeM OW he p�M
ie licenesd W�+�� �e �M proviebns d Ne ConlreUon License Lew �Chaqm 9(aommmdiq wilh Setlon ]000) W DNqbn 3 d �M
Bueinm enE Profaoiona Code� w �htl M a ehe ia exemq ihaehvm enE iha besis Ia �he ellped examqion. Any voletbn al Sed'on
)031.5 by eny epplicenl lor e permil euEjeCe Iha epplkent to e cWil paneXy of rM maro t�an liva �uMrsd ddlen �f500�).
� I.svmwwrdlMqopeMamyemqoywwihwapeaulMiedsaompenmtion.wiAdoNewrk.vM�hs�VucWnemlintendd
a oNered lor Wa (Seclion 1011, BuuMse eM Vrolsetione Cotle: Ths Coniredon Licwe Lew Eoee nM epplyto en ownx W propsM
who builEe or improvea Iherson, end who doea euch vrork MmeeM a hene� or Mmuph hb or her own empbyw�, O�dsd ihtl euch
im0�emmM ere nd inlaMed a dle�ed ta eels. M, howawr, �M Wikirp a'vnpovamem b eold wllhin pw yw W mmpbtion. tlro
ow�wrbuitlx will heve tM WrEen d pwiip M or aha d'd na WiW w imqovs la �M puryoes d We).
�+] I, m owner o/ iM pmpaM. ��d�eNary mntraninp wilh liceneetl con�reclon Io canuruq �he projad (Satlbn 101A, Buairwe end
Pmleaione Code: TM Conlraawe Lbenw lew daee m1 apply (o,en owrier d pmpaM � buitl� w impava iMroon uM xho
I em eae under Sec�ion: �.. B. 6 P. r Ihis F:
❑ — �q Se
TI7�9T� �� �� �
Dete: •
I do Mroby cerliy ihet I em ewere M enE �Men�end Ihe requirome`� nH at�el'Romia H end Sdery ade Sedione 25505, 25533, enE
25531, end the� I or eny INure buildinp oocupent will / wYl nM (drcY ona) naed to ply wih �eiE e mda eM tha rpulromanp br
eprmitlmm�elulionormaEifimlbnhamlheA,'C �aTyiianepemonlDietnd. dantWcmq appiutiomuauemqlmmiMw
provieone.
OeM: AOWkam:
WOPKEN'3 COMPENSATION DECL1flA710N: I Mreby dfirm uMer penelry ot par�ury ap d �he lolloxiiq dedve�ione:
� I heve and xiY melniein e caMHicete d mneent lo ��M-insuro br wAen' cwnpenWion, m provid�d Iw by &atlbn 9)00 d t�e leEa
Coda, ta IM pa�ormenca d tM xoA lor wNch Ihis pertnX i� iauad.
� I hava aiM wit main�em worksn' mmpeneetion ineurenoe, u rpuired by Sedian 9]00 d tha lebor CaEe, lar tM peilmmence d tM
work for which �his pe�mtl ie inued. My wwken' mmpeneetlon insurence urtler uM policy numMr era:
c.�,b,:
raKrrmme«:
(Thie escTion nsed not bs cwnpleroC d ths pimk ie br ons hundied CWHm /S�oJj a Isu.)
� 1 wniy thet in iM porlwmarcs W IM wak for whch thia ps ' v.y�eueE hell no� empby eny pe�eon in any menner eo n m
Ezome �ubjed lo IM v.wken' campenee�ion levn d i' l9 rs� iha ' I uk becoms �ubjse to tM xaNan'
com�pene[9ibn provieo/pca 01/Sxlion 3100 0l lha lebo� s, I ehdl l0 1� oom0� M e pmWeions.
Dete: 4/ � Z/ 1 5o A icem:
W�m/np: Ftl/un b��cen worka�' oompnwtlon cov b unN tl sMll � f en s oyx to m/nal pm�IHu nrtl
onn n�.. w ro w�. e�e..e rno�,.oe dow.,ls+aaooal, m.aaiw� io ro. �o�a �ron a ., vro��e.e ro� m
Sxtlon �108 0l tln LMor coW, Intx�st, �n0 ettom�yl I�u.
CONSTRUCTION LENDINO A6ENCY: I heroby elfirm uMer penelry d paryury �ptl iMm u e mnatmdion lendirp epency br �hs
peAoimeMe W tha work lor wfiiM ihc permY i� 6aueE (Sed'pn 309], CW. C).
LENDER'S NANE:
LENDEP'S ADDflE44:
I ceMiy Ihet I heva reed thia epplicetim eib Yete �het the ebova inlametpn ia wrted. l epme to compty xilh ell rily enE oounry adir�vices
eMelmelex2ieWnplobu' vpconetrumon MrebyeulMr¢empraronIeliveeollhiatilytoenleruponlMebwe.men�ionadprope�y
rorinepeaion purposea. �� N� (� G U � S
�5t51-de.WP) wnae-ewdnua
Pink-Revenue: Oddenmd-Avxua
�
CITY OF COSTA MESA — BUILDING PERMZT
PERM NO: H 07640'
PERMIT NO: B 076405 PLAN CHECK NO; 00491-96 A GOVT: N SUPP: id
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION : ADD SIDING/2 SKYLITES/FIRE DAMAGE REPAIR SQ FT: 10,000
CLAIM VALUE: 10,000,00 CALC—VALUE: 10,000.00 GROUP OCC: R-3 /
COMMENTS: FIRE DAMAGE REPAIR WITH MODIFICATIONS
**etx�it****x�ie+�****�-***�**�-it�**�-**�*at*atx�at*+e*x�****��-*i�iex-****�a��-****i�***iE�*it******�t*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------- — — MAIN BUILDING --- ----- ------ — ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: ✓` 'PROV;� ",' PARCEL: 14156217 ZNE: R1 REF NO:
PLANNING NOTES> ADD NEW BAY WINDOW TO REAR; SKYLITES• REPAIR FIRE DAMAGE;
>`REFURBISH�,BATHROOM• ADD FRONT TRELLIS; ADD SIDING AT FRONT•
* iE iE iF iklE iE fE 3E IE 1ElE fE �E iE jE iE 1E 1E 1E fElE iE iE iE if ik 1E 3E 1f 1f �E fE 1F iF iElE 1E iE iE 1f iE 1E iE 1Flf iE iE fElE �E iE iE iE 1E iE iE iFlF if 1E i(� iE �E fE IElE 3E 1E iE iF 1E fE �E iE iE iE iE iE
D E V E.L O P M E;N.T 5 E R V I C E S R E Q U I R E M E N T S
ZONING APPROVEA BY ':�C.t� DATE: Z(��9.6
BUILDING APPROVED BSt :'� VCsyQ� DATE: Z`�Z ��e
APPLICATION ISSUED HY: �� `� DATE: Z( Z—
�t�-�t**�ki��***�-*i�**ir*�'itx-ie�iFTF3F�FiF3FT�F3F�FaF�i��F�FiF�r�fiF��F�eF7F"i x- FiF�F�FiF�*�tieit***�at* it*
LEGALIZATION;N f F E E S U M M A R Y STRUCTURAL SEGM T:Y
L�
BLDG PMT PLUMBING ELECTR�IC MECHANIC FIRE SMIP/RES G 11DING
PERMIT 117.00 ,''"' r 1.00
SMIP/NON—RES
PLAN 19.01
ISSOE FEE �`.
BUILDING—DIC�—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 118.00 0,00 19'.07.
RE�'ENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
117.00 �, .�•
TOTAL PAID
137.01 137.01
118.00 OVER/SHORT:
FIRE SMIP/TOT GRADIN
1.00 i
�E iE 1E 1E iF jE iE iE fElE jF 1E 1ElE jE 1E 1E �F iE iE iE iF iE iE if iFlE if 1E IE iE fE �E �E iE 1E 1E 1F 1E 1E 1E iElE 1E 1E iflF iE 3E 1E 1E fE �E ff �ElF �E iE if IE 3F jE fE dE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N� UNI.T COST�
SFR
�
10000 ALTER HY VALUE RESIDEN"I'IAL NOZONE
END.OF FEES
EX IRED
DATE � G] � �" �
.
F �
�
.;;.
DUE
,0�
/
00
PLAN—CHECK
�E iElE 3E jE )f iE 1E iE fE
TOTAL COST
1.0 10,000.00
:GQ�: t'-- ���1r�C419 Ttcg 11c:.C'1
J2i�.;a5 `.lrL: ih'.r
' CONSTRUCTION AND PIANNING F _& SPA ,.
`APPROVALS Permit # Date Inspector pppROVAIS Permit # � Date Inspector
.1. Temporery Electrical Service or Pole 52. Pooi & Equipment Location " �
2. Soil Pipd-Undrqrnd. ' 53. Steei Reinforcemen[ � �
3.. E�ectrical Conduit Utility-Undrgrnd. 54. Forms � '
'�4: Electrica� Conduit-Undrgrnd. 55. Electrical Bonding � . �
. 5. Steel Re�nforcement 2,-1.� q� 56. Rough Plumbing & Pressure Test j i .�`
6. Electric2l UFER Gmd. 57. APPROVAL TO COVER�GUNITE -`
:C
� 7. Footings W� Z�7 Q�p � .,58: ElectricalGonduibUndrgmd." ' � ,
. •8. Foundauon c`_ /_ ���� �_ 7 �jJp � � ' 59. Gas Pipe, 17 Undrgmd., Test - � � �
� `�
9. Water Pipe�Undrgmd. , - 6p. Backwash.Lines, P-Trap,�{� Undrgrnd.
�
70. Structural Floor System 67. APPROVAL TO DECK �• �' , �
i l. Property Sewe� Line & House Connection . '� 62.� Backwash & Receptor�Final
/
12. Sewer CaP '� 63. Heater & Vent-Final �,.'` .
. ,
73. Roof Drains 6A. Piumbing System - Finai �
14. Rough Plumbing ' 65. Electrica6Finat , .
15. Rough Electrical-Conduit � 66. Solar SYstem�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. iiough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrica6T Bar Ceiiing 69. POOUSPA SYSTEMS FINAC "
79. Rough Heating & Air Cond�tioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepface � ' � , APPROVAIS,.�,'Permit # . �
21. Ducts, in Structure � ' 70. Underground Hydro
22.Ducts,Ventilating � � - ". ,77,ProductPipingOGas OOii �
23. Gas Pipe-Rough & Test � � 72. Underground Flush - � '
24. Roof Framing . ` 73. Undergrnd. Storage Tank Ll Gds ❑ Oil
25. floof Sheathing . L` ��( 74. Overhead HYdro,
26. T-Bar Ce�iin9 (Struaural) & tvlonocoat " � 75. Dry.C4emical - • �"'i i :�
27. Frame and Flashing . . �..��6 6. Dry Standpipe '� " . ' _ ' �,' r'�
28. Lathing & Siding �� �- 77. FIXED SYSTEM. FINAL , ,- . f
29. Insulati0n '2 7$_ FIRE PREV. FINA{ �- ��
30. Drywall Nailing Z��; 4'�f �� HEALTH'DEPT. iiEQl11REMENT � �
31. Plaster 9rown Coat � /� ;_;, 79, PINAL INS�ECTION
i
� 32. Electric2l Pow2r Meter-Final �-80..' FOOD CERTIFICATE ISSUED
33. Final Electric � Notes: � � -
34. Final Heating &�Air"Conditioning - " , Q'� �� �
< �in�l� ���
35. Final Gas Pipe-Test . � -`'V�r-Ff'"-�nf-yfJ�� -_
36. Hood or CanoPY ' _ - . . ' .. '
37. Fina� FaaorY Fireplace � • � •
38. Final Plumbing � . �� , � .
i.
39. Water Service�Final �, f/_t. _�
.40. Gas Serv�ce�Finat - • - • I ` � - .
41. Solar pomestic-Fi�al � . ' ` - �
42. Backflow Freventer . , _ � '
43. Backflow Irrigation � � .. " - .
44, landscaPe Irrigation Sysiem � � - ' . , " -' .
45. Sound Attenuation , - .
46. Handiqp Regulations - � . �
. .,.
47. FINAL STRUCTURE & BUILDING �� � '� ' '
48. FINAL PLANNING - � ; �� .'r " �
49. Electric Release to Edison ' r. ? �
50. Gas Release to Southern Calitornia Gas Co �'
51. CERTIF�CATE OF OCCUPANCY '
No Date
w
January 30, 1996
To : City of Costa Mesa
This letter authorizes Lonnie Languis to act on my behalf, and as my
agent, with the City of Costa Mesa concerning the approvai of pians and
issuance of permits from the City with regard to the reconstruction of my
property located at 2864 EI Rio Circle, Costa Mesa, California 92626.
This authorization will cease on March 1, 1996. �. ,
ANN M. KLIMKIEWICZ
STATE OF CALIFORNIA )
COUNTY OF ORANGE )
On January 30, 1996, before me, the undersigned, a Notary Public in and
for said State, personally appeared ANN M. KLIMKIEWICZ
m�er proved to me on the basis of satisfactory evidence to be the person who
executed the within instrument.
WITNESS my hand and official seal.
• . G�AHOA PHAM ' ..
, •'"�.. . •. � COMM. i 102872J �
: � ; z
< : _..�� .
Z:'�� - = NotaryPuDlic—Calitomio ; Signature----- - -�R----
;=-> -n ORANGE COUNTV
' My Cwnm. Expires JUN 5. 1998 !
i
J
�
` noon�"aem�axc: Z864 EL RIO CI
°w"Eas"wEi`�o,a"': KLIMKIEWICZ, ANNA M
, 'i
�pE� 2864 EL RIO CIR
COSTA MESA,CA 92626
,�vv�. Muuxc �ooxess:
u+cxrzecr on �axffn:
4MN.OP FI1G.'S �DORE55:
CWfIflACiql'SNAME:
CpfRIfCi0A5 Y4l1NG
AUDIiESS
uc. xo:
uc. w.:
uNr: CITY OF COSTA MESA — HUILUING PERMIT
PERM NO: E 0'76406
PERMIT NO: E 076406 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE; ADD
uHr: SOH DESCRIPTION : ADD SIDING/2 SKYLITES/FIRE DAMAGE REPAIR SQ FT:
UNf:
UCENSED CONfqpCTONS pECLAHATION: I Mreby afl'vm uMer penaXy of pe�jury thel I em Ikenaed uMer proviaians d Cheqm B
(mmmenciiq wilh Seclion ]000) d Drvisbn 3 oi ihe Busiiwse arid Pmleasions Code, enE my licensa is in lull brte end eHea.
cm uc. No.: uc. cuss: uc. No.: EXP ;
De�e� Con�radn�
�WNEN 9UILUEH DECIAHRTION: I hereby elfirtn untler penetly d pa�NrY �hat I am exemp Imm iM Comredora Liceme l.ew Iw �he
Ilowing reemn (Sedion ]0�1.5 Busi�ass enE Pmfesaiona Coda: Any c1y ar caunry whi h reQuires e pa�mil to consVucl, eller, improva,
.emaleh. w �apa'x anY swc�wa. prur w da'swm�m. eko requves tha ePpli sM la such pam�rt ta fila a agred etetement thet M w aha
is liceireed punuen� �a �ha prareione d �he COM�edae Licenae LeW �Gheplm 9(commana�p wilh Setlon )00p) d Divoion 3 d �M
Businesa eM Prdeaions COEa� or Ihel M or ehe is e�emp ihxelmn� end ihe bnvs iw iM elbpeE avampion. My videtvn of Saqun
�w�.s M�r md��� r« e oe.mn wd� �ne evq�,� �o e d.;i ve^eib a �a m� in� r e nu�dred adien R�D.
❑ I. m owner d iM properlY or my empbyeea v.ih wegas aa �hei a�le mmpameiion. xill Ao IM xoek, eM Na strudun 6� inieMeE
«oll«ed lar mla (Sac�ion ]aa, Busimss eM Prdesaiona Coda: The camraaois Lioem. Lewdoea mt eodY lo en ow�r ol prW�Y
w�o bu1Es a inproves Ihereon, eM v.fio doea auch work Mmsell � hermaX w ihraph hb a her ovm em0loyeee, provked �hm wch
improvemanls ere ml intenEed or oflereE lor sab. II, howeveq �he buiNing or impravemeM is aoN wilhin ona yaer N mmpkfun, the
o.�,-w�u� �;n na.a ina wbe� d wW me ns e, ane e�e �a n�na o� �mc,�.� m, ma wm�a d we).
� I, es ovmer d �M O�M. � extlusivdy conlrecl'uq wnh licenaed con�recbn to conmruu tM pojeu (Seevn ]OId. Bueirima eM
Profe»iana Code: TM Contradon Lcense law Aou mi epply to en oww d prape�ry who WiMa a impovev iheeaon ud Mp
mmreciala au h prqeea w'ilh e aonVador(a)Icenaed W��toIM nVmo e' enfe
❑ I am eae uMe Seciion: B. d P.C., lor a ree
o�, �6��i Z� �,,
�
I tlo heraby cen'ily thel I am ewere d ard uMemenA tM req i Ce11 mi Ne d ery Cad $epbns 25505.2553�, eM
25534. enA Ihel I a e'ry /ulwe Wikiip aaupenl v.ill / wil � arcb Me) �� 10 mply w1 ' slal odee uM iM repuiremanle b
apermnl«mnavuctionwmodifrationhwntMRi uL eT�y ariepemenlDialrid.fiesken�ieloons appicmiomereevemqtmmihese
yovisions.
oam� nvoik�x�.
WONKEH'S CONPFHSATION DECLRPATION: I Mreby elfiem uMe� peoelly d pa�ury wr d the lolloxiiq deduetbna:
� 1 heve aM xi1 meinlen e ce�Rkale a( mveni to eeM�nw�e for Wake�s cwnpenWion, m provitletl fa by SeUion 3100 d iM lebor
Cade, fa IM pertameMe d Iln xak 1« wheh �hn peemn ia ielueE.
� I have eM wil meinlen woiken'rompensPoion ins�rarce, m reyuired by Seqbn 9)0p d the Lebor Code. br tM pe�l«menoe d IM
woM br xfiicM1 tM1is parmn ie ipued. My wakere' mmpensetion imurence ramer vd paliq number ve:
Cem .
PolicyrNumber:
(This senion need rwt 6e rompbfed /!M permt a Iw wre huMreJ dd�s /SIOJI w bu.l
n I cenN �� in iM pMmwca d iha wak la which thia pnmX'n csuaE. I sh 1 ria emplvy enY Ga� � enY maruim eo m lo
K� bacwna eubjea m ma xwke�s' cwnpanmtion lewa d Celilom�e. end �hel il I ahou bacome wbjea to IM r.viken'
compense' o�s m Seaion a�oo W ihe lebor COEe. I ompM ��'� e p oNsbna.
oa�e: nod� .
Wam/ng: Fellms ro axuro worksri mmpwu�tlon cw ewNl, entl alu/ qb)ro n lopr ro Mvl pnuMu ane
c/vll flras'q ro ons hunOrW fhouuM aelkr� (St00,PW1. In etlCl�n ro tlro cost �ron ea a.a o n.o�iesa ro. �n
SxHon 3)O6 0/ tlrs LNor Codr, Inrona4 end attomsy'1 leea.
CONSTHUCTION LENOINO A6ENCY: I hereby elli�m under peneM o/ parryry Ihet Ihere is e wnstiudpn IeMinB a0ancy br IM
�norm�w o� me woM �o� wn�U inn re�n �s �Aa�oa lsoa�o� aoo>, c... cl.
LENDEF'S NM1E:
�ENOER'S 10DPES5:
� cenM �nm � nare reae mis endcetia, a,a aae me� me enwe io�«me�b� b carea. � eorae m comNr wan v� cnr �e mumv o.diw�
end etete lexs releteq b Wildvp wnsV Wion vd MreW eNharixe re{��asenietives oi ihn aty b anier upon iM ebova�mentbned O�M
lainspenion purposea.
LONNIE LANGUIS
� PnntNema Dma� �2` �Y
� Signey e9 e genVApPN��^��d
(S15t-�B.WP) Whno-Buiking 8 Salely: areeo-Fle; Cenery-ApDlirani; Pink-Revenue: GWCenroE-fuxsmr
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: FIRE DAMAGE REPAIR WITH MODIFICATIONS / REF B-76405
iE 1E if 1E iE iE fE iE i(� if iE �E ik iE iE 1E IE IE �E aE 1E iF 1E 1E 1E fE iElf 3ElFlE 9E tE 1E jE �IE iE fE 16 fh iE iE iE 3E 3ElE iE if 3E 1E 3E iE 3E �E 3E ff iE �FlE iElE iE 1E 3E 3E fE �E iF ik 1E 3E iE 1E'lE 1E iE 1E iF �E
Z O N I N G5 ERTEBQAUCIKRSE M E N T S
----------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------
FRNT: FT IN REAR: FT ZN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN EtGHT: FT IN
PARKING REQ: PRQV: PARCEL: 14156217 ZNE: REF NO:
PLANNING NOTES>
i
iE iE iE iE iE �E 1E 3E iE iE iE iE fE jE iE iE iE iE jE 1E iE 1E iE iE iE iE iE iF iF iE if if 3f iF it ik iE iE iF iE �E IE iE 3E iE IE iE iE 1E if iE if if iE iE if iF iE 3E iE rt iE iE iE iE iE it iE iE fE 1E 3E 3E iE iE ik if iE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY . DATE:
HUILDING APPROVED BY :
APPLICATION ISSUED BY: IG
f�**�t********�t�t�t*�t**x�*�tiFiF�F�f'iFiF3FiF7F�FSF�TF3FiF*�iF�F�iF***
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 24.00
50�
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 24.00 15.00 0.00
�' i�� DATE; /�
� DATE: ,G—�Z" /`�
+�iE�**itat***�"�r **
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
39.00 39.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 39.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
39.00
1ElE if iF 1E 1f 1E if !E if dE if iE 3Elf 3E 3E 3E 3k ik fE iE iE fE fE iElE �tlE IE iElF iE iE �E fE iE 3E 3E iE �E'1E �E jE iF iF iF �ElE iE IE 3E 1E iE 1E 1E iE iE iE 1E iElk iE 3E ih iF ik iE iE 1E iE iE IE iE 1E jE iE iE iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
FLE 12 FIXTURES LIGHTING
ELE 10 RECEPT/OGTLET
ELE 10 RECEPT/SWITCH
EX IREI�
DATE/ C( �"
1 ST 20 EA
1 ST 20 EA
1 ST 20 EA
END OF FEES
�
75
75
ni oeacQsif-.c�:2ocyi� -� c:-�
GA?E: n2l13r's� Titi,:: i�:4?
9.00
7.50
7.50
..S�IJ
, \ : •�' �
p` .
�I . . PC & SPA .
'CQNSTRUCTION AIVD PLANNING
1 Date Inspector Date Inspector'
� APPROVALS Permit # APPROVAl.S Permit # �
� �
1. Temporary Electr(cal Service or Pole . 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement' � ' �
3. Electrica� Condui[ Utility�Undrgrnd. - 5d. Forms
4'. Electrica� Conduit�Undrqrnd. 55. Electrical 6onding � - �
5. Steel fleinforcement ' 56. Rough Plumbing & Pressure Test �
6. �Elettrit2l 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 Unes, P�Trap, � Undrgrnd.
10. Structural Floor System 6i. APPROVRLTO DECK
11 . Prope�ty Sewer Line & House Connection . 62. Backwash & Recepior-F,.inal .
12. Sewer Cap - 63. Heater & Vent•Final
13. Roof Drains , 64. Plumbing SYstem � Final • •
14. Rough Plumbing ' ' 65. Electrical-Finai '
15. Rough Elec[rical-Conduit ' - 66. Solar SYstem-Finai - .
16. Rough Electric Wiring �' � " 67. Pencing & Access Approval
17. Rough W�ring $ign 68. APPROVEp FOR PLASTERING '
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heafing & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough �actory Fireplace � . � _ � APPROVALS Permit #
21. Duc[s, in Structure " ' 70. Underground Hydro
22. Ducts, Ventilating 71. Product�Pipin9 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 . �`q'i
�
27. Frame and Flashing' - 76. Dry Standpipe � �
�
28. Lathing & Siding � '� � 77.' FIXED SYSTEM FINAL �
29. Insulation � 78. FIRE PREV. FINAL �
30: Dryevatl Nailing ' � NEALTH DEPT, REQUIREMENT �
37. Plaster Brow� Coat -� 79. FINAL INSPECTION '
32.`Elecvical Power MeterFinal - 80. FOOD CERTIFICATE ISSUED
33;jFinal Electric . ♦ 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 . " '
' r�.`
46. Gas Serv�ce-Final � - . r � '.,� - '
i -
41. Solar pomestic�Fina� ' � � ,
: )�
42. Backfiow Prevenier ' ' "
43. Backflouv Irrigation .
44. LandscaPe Irriqation System : • . " �
45. Sound Atrenua[ion ' , , -. . _' . .
46. Handicap Regulations � "' �. -'
47. PINAL STRUCTURE & BUILDING " � .. .
48. FINALPLANNING � ^ '"
�i .
49. Etectric Release to Edison � -
50. Gas Relsase to Southem California Gas Co �%� - �
51. CERTIFICATEOFOCCUPANCY
No. Date
}� I
r— �
RD�FESS OF BUILpNO: z 8( t� EL R I O C I
avr+ERswwEiFa,a�":KLIMKIEWICZ, ANNA M
�� 2864 EL RIO CIR
COSTA MESA,CA 92626
(714)545-8178
�vv�. Yuuxc aooness:
MCNRECT OH EINYNEEP:
ANCIL OX FNG.'S AOOflE55:
CONfpACTqI'S N�YE:
carn�aoxs �uuxa
�oo�ss:
UNT:
uc ra:
UNT:
ucra.:
uxr:
LICENSED COMPACTONS DECLAXITION: I hereby eflirm uMer peneMy d perjury ihet I em IicensaE uMer pra»iona d Cheqar 8
(mmmeeui�q wiih SeMion ]000) o/ Diviaion � d iM Bueirieas eM Proleesiona Code, erd my lioenae is in lull larce eM eXed.
cm uc. r+o.: uc. cuss: uc. No.: EXP :
Dele:
�WNEF BUILOEN DECIARATON: I hereEy e/firtn uiMer pe�aly d p�NrV �Mt I em mcemq Irom tM Contradas Lioeiva lew lor IM
dbwinB reavon lSetlbn lW 1.5 Busiiaff eM PMeaeione Coda: MY c�Y ar muniY whiN �eVuirea e Vetmil lo omaW�Y. eder. imMow.
tlemdoh. w�epr arcy nvuc��ne, yrior ro ea uwmka, e6o �epui�m tM xpp�rsnt lor wch pem�N to fila e ay�wd aletemo�x that ha «sM
is IicenseE W�uenl lo �ha D��srons d �he ConVedae License LeM �Cheptx 9(commerciiq xilh Setlion ]000) d prvwion 3 d Ihe
Buair�eae eM PrWeauna Coda� or �he� M or ehe is eKemq thaehom end the beee fa Ihe allepeE ezemption. My vbletion d Sedion
)031.5 by ary eppli ant la e pmmA wbjetls iM epplceM to e crvd peneM d na mwa than Iwe huMred dd4n �5500�).
❑ I.roox+brdtMpopMyamyempbyeeawYhwepeaavihei0��pmWion.willdo�Inxak.eMlMat�uctunbndiMendeA
w oflazeE br aele (Section 10as, Bua�rosa eM Proleaaiona Code� The Contreaon Liceme Lew doea mt apply ioen owiwr d popefly
wM W ide w'vnprovm Ihereon, end MM10 does auch v.vM MmeeX or heiseX a ihraugh h6 a har own emDloyeea, provided �htl wch
impmvemanls are id intanded a dlered tor aela. M, howevar, iM buiki'q ar mqwemeM ie eold wilhin ona yev ol completion, the
owrrrbuiMx will heve IM Wrdm d povi'p he or aha Ek M bwk w impow fw �ha W�e d aele).
� I. av owmr d IM popem/. em azduaivey mnVaq�p xilM1 IioenoeE cmVeclore to canmrua iM popa (�� �. �sirova aM
Proleaiare CoEe: The Contradon lsenee Lew doea rwt epqy lo en ownw d qopeny wha buiNa w impwee thereon aM who
conirecb la wM OroI�H ��h a mMreclor(s) IkenseE Dunuen� io �he Con�rxYws Licenae Lew�.
}[] i��.�p��a«s«u�BP7044 e.ar.c..ro. ��«,:FOR O NER Y OWNER
Dete: � ' �Q ' Q�i J Omwr: �.I.[�i(3_ �,fA/d / / �L��Fil
I tlo heraby cenily tlut I em awue d eM uMeiaterM Ihe requiremenla d Cel]omie Naellh eM Sefely COEa Sad'wna 2550�
255J0. erd tlat I n enY Mum WiMiiq ocNpeni xill / wil �(orcb une) need to cwnpy wYh eeid mma codm W tM m�uirameme lor
ome: nvoi�m:
WORKEP'S COMPENS�TION OECLAR�TION: 1 hereEy etfirm uMs pmehY d pxjury one d Ne Idbxi'q Aetlea�una:
❑ IheveenExilmeimemacerlifiutadmneentioeaX-inare/awakerscompenmion.myaridedforbySeeion3)OOdthalebor
COEe, lor IM1a parlormence d the xvA lor which thie pafmn ie ipued.
'] � neve ena �ti� meimen waken� cano«ismm inaumrce. m na�✓�a M seeim aroo d u,e lebor coa. m. �ne ro�mence a �n.
wwk fa whiei� Me pwmn is �ued. My waken' oompenaetion inwrarce fertbr enE pdiey numEv are:
c�a�:
Polcy Number:
(This aedion mM rpt be comdered i tM pmn'e z b are hvrMred dd�ers /Sr00/ w bss.J
� I cenAy rtat in ihe perloimarice M IM wak for which No peiMn ia i»uad. I dull mi ampby vy penon in vry menmr eo n lo
became vubjap to the v.vrkera' canpanselian lewe d Celileme. eM pree Ihel il I ehouk became aubjetl to IM v.orken'
compenution powiona o/ Sec�im �]00 M the lehor Code, I � loMhv.ilh compy di� provieian . ,
�
o�e: / —,�— 9s A,w�
Wem/n0� Fellun ro sxun wortsn'rompsiwtlon roveregs la ul��w'M1�l, entl NW/ W.d�set an smp/oyp ro eriMml aM
clvll Arns up ro ons hund�W Npusmtl tlollm (Sf00,00pA ln aCCltlon ro tlrs rosf ol rompxwtbq Mmepu u v/tl br In
S�cHon 91(I6 0l M� La6orCotls, infxut, �ntl ettomsy'a Nu.
CONSTPUCiION LENOINO RGENCY: I hraby elfirm uMx penplly d perry�Y Ihel Ihere u e oonstivaion bMi�q peM.y fa tM
pen«mence d �ne won �« wnia, me ro�� �. as�aa (seen, ao5r. crv. q.
LEN�ER'S NAME:
LENDEN'S AODFESS:
I eerlity Ihei I heve reed iM1a eppliemion vM a�ata thm the ebove inloemv� �s �ed. I apiae lo oomqy xil� all tly eM oounry adinarioea
end eietaleMs releiinB�o building mnslrutlion end herebyeNhoraereprmen�elivea INthiaarylo anterupon�haebwa�mmtioned qaparry
lo. inape4bn ompous.
Deb:�` �h '- i,�
(5151�d6 WP) Wnilo-BuilEiip 8 Salery; OreeMFle; Canery-ADob�: Pink�ievenue: GOIEenro�baaenar
CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: B 072850
PERMIT NO: B 072850 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : T/O SHAKES,RESHEATH W/1/2"CDX,NEW COMPO SQ FT: 6,000
CLAIM VALUE: 6,000.00 CALC—VALUE: 6,000.00 GROUP OCC: R-3 /M-1
COMMENTS: REPLACE WOOD SHAKES WITH NEW SHEATHING & COMPO ROO i ��-.�ys �-��� �7
***��*****�r*�r+�*� **+�*�rx���r***�r*******+r�r�**�**� **�*�*�*�*�****�� V i�����L"lxJ`�Ufl
Z O N I N GS ERTEBQAUCIKRSE M E N T S
REQUIRED
------------ MAIN BUILDING ---------- --------- ACCESSORY HQILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14156217 ZNE: REF NO:
PLANNING NOTES>
%':
�t iE fE iE iE iE iE'lE 1E iE 1E 1E iE if if 1f if iE iE 1E 1E'lE 1E 1E 1E iE if !E iE iE iE 1(' �E fI� 3E fE iE 1k 1F 1E iE 1E iFlt 1E i! IE'lf' iE 1E dE'lE 1E'1E 1E 1E if 1k 1E 1h dE 1ElE 1E'lE iElE iF 1E iE 3E iE iE iF 1f�'IE 1E iE if
D E V E'L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE: �
BUILDING APPROVED BY :
APPLICATION ISSUED HY: � v
�141E dE iE iE if iE iE iE 1E 1E �E 1f� 1F 1F 1F �E 1F �If 1E if k� �7FiF
LEGALIZATION:N F& E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 81.00
_ DATE: �
DATE: � � /`
��1EiEiE�)E�EitlEiEiEiE 3EiE
STRUCTURAL SEGMENT:Y
FIRE SMIP/R60S GRADING
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 81.60 0.00 0.00 81,60 81.60 .00
REVENUE DIVISZON TOTALS--> COLLECTED: 81,60 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
81.00 .60
1k iF 1f 1E 1f 1E iE iE 1! if 1E 1E 1E iE �E 1F 1E iF 1k i! iF if f! 1E 41(� fElf iE iF iE iE 1E iE 1E iE 1F 1E i4 iE 1E iE 1(� ih fE 1k fF!! 1E 1t iElElElE 1! 1f 1!l41E'1("IE iE'k 1ElE �E 1E'If 1E iF if if 1E ik iE 1t iE 1ElE
I N D I V I D U A L F E E H R E A K D O W N
TYPE
SFR
QTY
6000
D E S C R I P T I O N
REROOF HY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1.00 6,000.00
Q:� �018433�-0013433? T CaT 11,6p ✓
D�YE� Q6t16I95 TiME= t.e:l�
- .
CONSTRUCTION AND PLANNING ^ � ,L & SP�
APPROVALS Vermit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Elect�ical Service or Pole 52. Pooi & Equipment l.ocation .
2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement '
3. Elearical Conduit Utiliry-Undrgrnd. 54. Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
^5.'Steel Reinforcement 56. Rough Plumbing & Pressure Test
'6.'ElectricalUfERGmd. 57. APPROVALTOCOVER�GUNITE '
7. Footings � - 58. Electrical Conduit-,Undrgrnd. '
8.. Foundation � 59. Gas Pipe. O Undrgmd., Test
9. Water Pipe-Undrgrnd. 60. 8ackwash l.ines, P�Trap, L Undrgrnd. i
10. Structural Floor System 67. APPROVAL TO DECK .
11. Property Sewer 4ine & House Connection = 62. Backwash & Receptor�Final .
12..Sewer Cap 63. Ftester & Vent�Final .
13. Roof Drains : 64. Plumbing Syscem - Final
74. Rough Plumbing '• ' 65. Electrical�Final � �
15. Rough Electrical-Conduit. '.. " 66. Solar SYstem�Final , � •
16. Rough Elec[ric W�ring � 67. Pencing & Access ApP�oval '
,
17. Rough Wiring Sign , ._�g$. APPROVED FOR PLASTER,ING :
78. flough E�ectriwl�T Bar Ceiling �69. POO VSPA SYSTEft4S FINAI
79. Rough Heating & Ai� Conditioning _ { , P.I,RE,DEPT_REQUIREMENT
20. Rough Factory Fireplace ;'i; _ ",' � . . APPROV.ALS_ _ P'ermit # � -
21. Ducts, in Structure ,�. '� " _ ' � 70. _Underground Hydro '
22. Ducts, Ventilating ; ' `,.^ - .. � 7�, Product Fipin9 O�Gas OOiI
23. Gas Pipe•Rough & Test � tr�:.: ' � ` � � 7p. Underground F,lush � :
24. Roof Framing' �-'. � � y � - _ _., , 73. Undergrnd.Storage,Tank C'Gas ❑Oil
25. Roof Sheathing 7$� 74.�Overhead Hydro _ '
26. T�Bar Ceiiing (St�ucfural) & Monocoat . � 75. Dry Chemicai .. ' �� � �
27. Frame and Flashing � - �- � '- - 76. Dry Standpipe � ' � _ `
' 28. Lathing&Siding A� .�7F F ' � �* 77; FIXEDSYSTEM-FINA�L,
29. Insuiation � ' ' = � � • ' 76. FIRE PREV. FINAL � -
30. Drywall Nailing - r�.. � •� :;HEALTH DEPT.`REQ�UIREMENT
, . -
; 31. Plaster Brown Coat ' r-- �- - 79. FINAL INSPECTION � �
32.-Electrical Power MeterFinal � ' 80. FOOD CERTIFI.CATE 1`$SUED_
33. Final Electric � � . Notes: - � - ' .��r
��
34. FinalHeating&Aii;Conditioning�" � • ' � � '� y ` - -='
• r � , a� .
35. Final Gas Pipe•Test , . .� . � . - _. _ �-':. �. � . .
36. Hood or Canopy " _ ' _ " + ` � _ `�' � T , - :�
a + .-
, 37. Final Factory Fireplace - .. • �- � _. , .
' 38. Finai Plumbing . � ` � • ' ,_ ' -
39. Water Service-Final � . . . '. � ' y �
40. Gas Service-Final: ' . - - - = � �r ' ,. - •
47. Solar pomesticFina� . '� y � . �, _� � i ,; ,
42. Backflow'Preventer + � • -• >r � a '- -
f ' �
43. Backflow Irrigation � _ "" �� 7 » � � � � -
�44. Landscape IrriQatiomSystem��t � � c� � r . � � .; r - � • -
�� t t - - x y. �- .
'45. Sound A[tenua[�on; I;` � � � �`� - c� _: ` '.
?' C t
46. Handicap Reguiations � � ' � - _•= � • �-
�.
47. FINALSTRUC7URE&;BUILDING ZS 4� �w�� - _
48. FINAL PLANNING', ' � - �• r � `. '
. a ''' ti : -
49. Electric Release to Edison ' � ' _
50. Gas Release to Southem Califomia Gas Co • `- �`: + - •
. ,� .
51. CERTIPICATE OF OCCUPANCY '
No. Da[e
P �
� � I��.r
��
�
/
PBQIECT AOONESS: '2 (j ( Q EL R IO C I
owxensxnme: KLIMKIEWICZ, ANNA` M
nooxcss: Zg64 EL R.T.O CIR
COSTA MF.SA,CA 92626
545-8178
FPCN/ENGINEEN: flEG.NO.:
ROOPESS:
UNIT:
UNIT:
PEBMITTEE: ANN RLIMKSEWICZ ( 714 ) 545-8178
aooeess: 2864 EL RIO CIRCLE
COSTA MESA CA 92626
LICENSED CONTBACTOB OELtl�XIITION: I hereby aifirm Iha� I am Iiten5e0 un0er pmvi5ion5 Of Chapter 9(commenCing wi�� SeCtion
7000� oi Division 3 oi the Business anA Professions Code, an0 my license is in full force ana effect.
CITY LIL.: STRTE LIC.: CN55:
Oaie: Signaiure:
WOBNEBS' COMPENSATION OECIABRTION: I hereDy aftirm t�at I �ave a cenificate ol consent to self-insure or a certificate of Workers'
Compensa��on Insurance. or a cenihea copY ��ereoi (Seclion 3800. LaO. C).
1LICY NO.: E%P. OATE:
'OMPRNV:
❑ Certitied copy is hereby fumi5he0. ❑ Cehifie0 topy is file0 wilh �he tiry BUilOing �ivisian.
Dale'. Applicani'.
EXEMPTION FBOM WOflNEHS' COMPENSRTION �ECLANATION: (This sectian neetl not be campletetl ii the permit is br one hundre0 ($100) or less�.
I cetlity �hat in ihe pedormance of I�e work for w�ich Ihis permil is issuetl, 1,61iall no� employ any person in any manner so as �0 6ecome
su�lect lo Ihe Workers' Compensa�ion Laws o� Calilomia. �
/J/ /7 l�
Da�,Y/' Y' 7/� Signa�ure: iL�U� G?f< �/C�Lti��i
NOTICE: II, afler making this declaration, you shaula Cecome sublect m the Workers' Compensa�ion provisio � ihe Labor
COAe. you musl forthvnln compiy with such pmvisions or this Dermit shall 6e tleeme0 revoketl.
CONSTflUCTION LENOING RGENCY: I hereby aflirm that I�ere is a con5tmc�ion lentling agency lor �he peAnrmance ol ihe work lor
wAich Ihis permit is issuetl (Section 3097. Civ. C�.
LENDEfl:
nooRess:
OWNEP 6UILOEB DECIABATION: I �ere�y a��irm tAat I am exempi �mm �he Contrac�ors' S�a�e License Law lor ��e tollowing reason
(Senion 7031.5 Business antl Pmfessianal CoOe: Any ci�y ol counry whicn requires a permit m consimct, alter, impmve, demolish, or
repair any S�mdUre, prior �o i�5 issuante. also requires �he applican� lor SucM1 permii to lile a 5igne0 S�alemen� �ha� he/S�e is Iiten5e0
pursuant lo Ihe pmvisions o� the Caniracmrs Slaie License Law (Chap�er 9(commencing with Section 7000) of Division 3 0� the Business
an0 Pmlessions Cotle) or inal he/sne is exempt iherefmm ana ine hasis for ihe alleped exemption. Any violation ot Section 7031.5 6y
any applicanl br a permii sublects ��e applicant �a a civil penalry o� not more �han �ive �unAreO dollars (5500�.
I, as owner ol Ihe pmperty or my employees wittr wages as their sole comDensation, will Ao the work, antl tAe
7 stmcNre is nol in�en0ee or oilere0 for sale (Section 7044. Business and Pm�essional Code: The Coniracmrs' S�a�e License Law
tloes not apPly to an owner ol a property who builtls or impmves t�ereon, an0 who does such work himseli/hersel� or �hmugh
his o� her own ¢mployees. DmviOetl ��al such improvemems are noi inienaed ar oflereA �or sale. II, however �Ae buildinA or
impmvemen� is so10 within one year o� completion, Ihe owner will have Ihe Ourden ot pmving he/she Aid no� �uilU or impmve
for ihe purpose ol salel.
I. as owner of �Ae pmDerty, am exclusively contrac�ing wi�h licensetl contractors �o cons�mct [he pmlec� (Section 7044, Business
❑ an0 Pmfessions Coae: The Contractors' Slate License Law does nol aDPly Io an owner of Droperry w�o builtls or improves thereon
an0 w�o comracts for such prole��s wii� a coniracmqs)Iicense Dursuanl ta Ihe Canlractors' Stale License Law�.l am aware
�hai pmo� o� Iheir Worker'S Compensalion insurance shoultl 6e pmvitled to me.
�II � � am exempi under Section: H� 7 Q 4 4 B. 8 P. C. /
Date9�or/misre/ajson: AlL WORK BY OWNER \,,—{�/�,
X " Y�%. Own : �. iLU� ' _' � ' /--Ge--
I tlo hereby cenity �hai 1 am aware ol and unGerstand ��e reQuiremems ai Califomia Heal�h anG Salety Cotle Sec�ions 25505. 25533
25534 antl �Aat I or any luture builtlmg occupant wilVwill not (ctrcle one) neetl to comply wilh saia state codes and ihe requirements for a
permi� for con5�mciion or modilicaiion fmm Ihe Air Ouality Managemen� �i trict. flesiden�ial cans�mction applicaiions are exem0� ��om
Ihese provisians. ���/
�7 � , / � CCG//
oa�a!"_,� 'ln� naorc_ ��- — —
I �ereby cerliry �ha� I Aave reatl Ihis applica�ion and s�a�e �hai �he ahove informa�ion is correcL I agree �o comply wi�h all ciry and cowry
ordinancesanAs�atelawsrelatingtobuildingcanslmctionan0�ereDvaNhorizere esen�a�ivesoflhiscirytoenlerupontheabove-men�ionetl
pmperty im inspec�ion purpases.
�ale��' /,� Signawre'. ✓� �� �` � «/��
�river's License or Socia� Security �
164t n6 While—Butlaino: Green—Cotle EnlorcemenL Canarv—Aoolicant; Pink—Revenue'. GoltlenraC—Assessor
CITY OF COSTA MESA —$UILDING PEkMI'T PERM NO; M 058967
PERMIT NO: M 05896'1. YLAN,CHECK NO; N GOVT; N SUPP; N
CONSTRUCTION TYPz; V—N PERMIT TYPE; MEC PURPOSE: OTH
JOB DESCRIPTION ; LEGALZZE WOOD STOVE SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /
COMMENTS; LEGALIZE WOOD STOVE INSTALLATION
***��r***�*�r�*�****x***�����***x�*�c�*�******�****�*�e**x*�x*****+�******�*�*****�*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT ZN kEAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT I[J RGHT: FT SN
PARKING REp • PROV; PARCEL: 14156217 ZNE: REF NU;
PLANNING Nt7T'ES>
i
!F!F iE IE iE 1F 1E 3k iF if iE iE �lE iE fF IE if iE !E iF if iE if if iE 1E iE if 1E iF iF if if !E i!!F k if 1F Ik if 3F if IF iE fE iElElE !E 1E iE iFjElF )k k fE iE iF iF 1f 1E if if iE iE 1k IE IE �6 iE'.F iE 1E 3f iF iF �E
D E V E L O P M E N T S E R�rV I C E S R E�,1 U I R E M E N T S
�
ZONING APPROVED BY .� DATE;
BUTLDING APPROVED BY ; DATE;
APPLICATION ISSUED BY; � nATE; I`� C1 ti'
iE�fiEiFikiElEdflEiEltiEiEiElEiFiFiEikiFititiF3F'iFiF3F7tiF'�ttFiFiF3F3F7FiFi'F3FiF3F3i 3F�F3FiF7FifiF3FiF�ti"�3fiiiE7EiEk9E1fiElkiFIF� iFif
iE iE jF if iE if if iE iE iE i(� IE iP �E if iF iE 1E IE %if ih k iF iF iF iE iF iE iE i! if !f iE jE iF �1F IE IP IE # 3f iElE ik IE iE if �f iE # if iF iF if 3F if iE iF iF iE �f if iE if jE iE % iF IF iF !F if iF if !f # iF 3F
LEGALIZATION;Y F E E( S�U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 13,�St SMIP/NON—RES
PLAN
ISSUE FEE 15,00
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 13,00 15.00 0,00 28.00 28,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 28,00 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECtC
28.00
iE if iE iE iE iF IF if t! iE i! ff �f iF it �f iE iF iE iFlE iP 1E ik if iE IE iE �Elf 3f iF if i6 iE 1E iE jf iE if iE iE iE iF iE iE-)f it iF iE k iE 1E iE if 3E 3f jf iE * fE iE if iE iF iE it if IE iE iE iE iF 3E 1E 3E�t if iE
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COS'I'
MEC 1 EACH APPL NOT IN OTHER CAT UNDER FEE 6,50 6,50
END OF FEES
t�pTE��OP%OEf9^�IaTZfSE: jf�<� ?j,�'
CONSTRUCTION AND PLANNING - _ � �& SPA
Date. Inspector - Date Inspector�.
APPROVALS Permit # � APPROVALS Permit #
1. Temporary Electrical Service or Poie 52. Pool & Equipment Locaiion
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Ganduit Utility-Undrgrnd. 54. � Forms
4. Electrieal Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbirig & Pressure Test
6. Electrical UFER Gmd. � 57. APPROVAL TO COVER�GUNITE
7. Footings • . 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, � Undrgrnd., Test
9. Wa[er Pipe•Undrgrnd. . � 60. Backwash Lines, P-Trap, � Undrgrnd. �
70. Structural Floor System 61. APPROVAL TO DECK
11, Property Sewer Line & House Connection 62. Backwash & ReceptorFinal
12. Sewer Cap " � 63. Heater & VenrFinal �
13. Roof Drains - ' - 64. Plumbing System - Final
14. Rough Pl�mbing ' . 65. Electrical�Final '
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/$PA SYSTEMS FINAL � �
19. Rough HeSiing & Air Conditioning FIRE DEPT. REQUIREMENT � '
_ �.
20. Rough Fattory F.ireplace ' - " � � ��APPROVALS -•�Perinit # _
21. Ducts, in 5tructure� .. - � � 70. Underground Nydro -
22. Ducts, Ventilating _ -� 71. Product Piping OGas OOiI
23. Gas Pi e'Rou h& Test ' � - � -
P 9 72. Underground Flush
24. ftoof Fram�ng � - ' 73: � Undergmd. Stora.geTank � Gas ❑ O(1
25. Roof Shea[hing � 74. Overhead Hydro
26. T�Bar Ceifing (Structural) & Monocoat _ - - 75. Dry Chemical
27. Frame and Flashing _ 76. Dry Standpipe �
28.,Lathing�&Siding� . . � �� 77. FIXEDSYSTEMFINAL;. _
i
�29. Insulation . �_ � � � 78. FIRE PREV. FINAL
30. Drywall Nailing -� � � �^ � HEALTH DEPT. REQUIREMENT
31. Plaster BroWn Coat. � I 79. FINAL INSPECTION
i -
32. Electrical Power Meter-Final . � I � . 80. F000 CERTIFICATE ISSUED �
33. Final Electric - � . � � Notes: - '
34. Final Heating & Air Conditioning � 'l� � � -
35. Final Gas PiPe-Test I 1 _
36. Hood or Canopy . - I �- �
37. Final Factory Fireplace � � _ „ ' `
38. Final Plumbing �, � � � .
I i�
39. Water Service-Final � �' ' � ' �
40. Gas Service-Final � � j . .
41. Solar pomestirPinal � � � � � ,
42. Backflow Preventer � j ;� -
43. Backflow Irrigation +
44. Landscape Irripation SYstem . _ . ,.. .
45. Sound Attenuation �
46. Handicap Regulations -
47. PINAL S7RUCTURE & BUI��DING � �
48. FINALPLANNING . ' � �
49. Eleccric Release to Edison '" ' � �
50. Gas Retease to Southern California Gas Cn ! � �
51. CERTIFICATEOF.00CUPANCY .
No. Date
."�.... r...K':.�- -. /':��. ....�.�. ...���:.� ..� . ..:�.�- 1. "-�' .. ...... ...... .... '
OwNER FRANK S. K�IMKIEWICZ
JOBAbDRESS 2g64 E1-�io CM
GENERAL COt�TRACTOR Okmer
AP No. 141-562-17 LOT 17
INSPECTIONS -�
SOIL
GA$ ~
WA7ER
NOUGM pLUMBING
PROP. $WR. LINE n HOUSE CON. 'i
SPRINK�ING SVSTEM '
MISCELLANEOU �) IQ-p1� Q�O
ROUGN 11EATING ANO AIR CONDITIONING
TEMPOpARY SERVICE OR POLE
UNOEFGROUNO � POWER �
ROUGH yVIRING �
TRENCMES I J FORMS STEEL REINF.
FLOOR SVSTEM
BOND BEAM [_ STEEL REINFORCE �
SMEATIy�NG
FRAME AND FLASMING
ATHING - IN i OUT
ALASTER,BHOWN COAT
STRUCTURAL,FINA� �
HEATING. VENT., REFRIG. AND A.C., FINA�
PlUMB1NG, FINAL ANq GA$ TEST n
° ELECTRIC, FINAL
BUILOING, FINAL
SPECIA� REOUIREMENTS
UTIIITY NOTIFIED, GAS I-I ELECT, (�
CMF 0486-46 (BU 4) Y
DATE 12-12'79
BUILDING PERMIT N0.
� ttu � � aer DESCRIPTION of WORK
TRACT 20 FIRE ZONE VALUE
Si not�re Dot• TYPE GROU
� i�� i I � Y O V V n I R A^. T V R
.
.
1
...+.w.aeana-..,,�-...,,.�....,.....�......__.,.-:........_,._.,_,_......,.....�-• __•--..�y�
.n.....,.r:,,+tt....s�,.,,„..-v..,+p. . .
. _ _ . ..-�... _' _".
_"_ .! ,j•. •
.v,: •�t-�.
.;: ��' � X/_
�.'`':
� ��'
0
� ,. .. .�
. . �;'E`r3��_ ., � � �
- --- - --�F --- ---o��: -- - �-. .
-' �' ��/n/�
_ __ " . . .��Y �� � ,J;. Yit1M�
'� �rtaovK
� NS `
c �`.1. .,qpVld
� �pi?-•.
. ' . NO � �p,tAUEO
. ... JEPi. .. JOJI\ON " — _' ' _ _ . ". .
E
.. '� , iN[ �5`U�MP � ..CCI�NE
\ ' ' ,1pr>r.vaG ,. .,.p„y�jN
� � . 1 '� �i li .
I . � ,10 elY�� 5 �ND
...C� 1 '.1N -
, ...... �iu �� -F��G�I .
_. ..__.. .L__..__'___—'_.__ ___. �NlMOV � .iPOPS i/
- " ri\VG T / / _ / ,
�� �y, ��t��-' _—� r���EH � S� /� �lh j`1 � _
1 " "— _ _ _ _ _ ...—. ♦ ..nn'::.. ^ -- .;4•3�� _'
�
� `/ , �
p A FiES<
I PV.'�:81:0 C:FT.
twQEc ro coc. ov+. �Ec
%!� �DAT£.�ZJI�-��
ourno� a nu�����o
, r...
� � i—� � L<�h� pc�ci�/>��=�-
� . - �" � �ni�T �or��2`y �,n� o��:�t �i
` ' �+oo�,�� ��c�/�ar��i_ lr�fF�l-c�,.(
i /� �
/ G/ l��o F�r %�%,6// /' o M
,, j � � �
� ; r�� s r��-S �i��l� �;,,,,�,�=w,� z
! I 2�cc�LL .hio C�r CI�J/p I/L�
;�
�.,.---._.-�.......,.t.,.�
^� '�--
_ .._ .. . .., . ,. ,. . . � . . . . . , ...
I.
. ..� I .. ., � . � .
. . _..._ _ I ._. . _... ... _ . . _... _. _..'"_"____._ ___"" _'__'"_' _ "" , -. .__. . .- '__._._
... . _. .
. , . . � . . : _. . .. ... . . y . . . . . . .
. _ .�.. . .. .. . . . . ...
. � . �. , . I ...... �. _..... . . . . . . ..
. . !. .. . - . '
. � _. . ..." ' � : I . ' �./ ,O : � .
. .. . .. . � .... .._; ' � .p. .....
i I
. . �� .... // . .
� .. . . . ._ . _ . . . ._. . . .
. . . . . : . i . ... _ . I _. . _ . . . . _ . . . . .
� i
�
: .. .. . . . . .. . . .. . . . . _.. ....� ...__.,.... .-.. . . . . . ... �
r��.
..{_�..i.... I . ... :: i _. .. :� �..... ._ ..... i.. . . � � �
. _ .:. ' .._.
; -__: . . . . . . .. � ........... .. .. �.: . _ . . � .
....�. . . .. � • � ._�.•_ �... ! � . .
28'3"
24 '
# G x i�G//< �x G� Gi. ui .H•
� � I�NC
'_"st =---.` r =a^
TKE./TEo Z X 4 M!/O 3/LL
�Z'�X/a'�q,BotT
/' i,eO.n E,e. Cok.u, 02 opE,urNG,
✓�'O"O.� /,r/FiELO
�Z ••X /� "
OVL,� L,i/i�c Yi50✓��v A 8as r
� -°— :-'--'�s-- i .. —`-"-.�
..006 ✓/SQU�EN
E�,H 3�OOED /N
�% �� -S,✓ND
G ~ G/HG2
Zo •�
.
,6 . .� , '.r.' '.R�.'. ': C .'J� .'r"-rr'i . .
�;. .9� .' p 3�g "(�x/B �� 3TEEc OawEc3
i
. . ' � SANO Fi�t� @ 24 f 0•C. - D.Q/LL /q ~� ,p q .,
;'p'. P�. , OCfP �/utES i.�ro Ex�sr�,✓c, Co.��
� sEr �ou.e�s �-✓ 'Po2-/zo�K ~
/�o
Exisr. Liviiv�, Roo,y
Pa��
z
�JG
i
-- -- F<,vr�/cr,rt Fus,riac,
T-
—__! _'—
- � ' . 2 NG F/LL RAFrEKS
---r----'. � /6'o.G',
-- � --
� ' Ek/ST/NH WAGL
-- -- �— ... _ . � . �/ 4/�S [EO uO
2
8�0�� EX/57.�
SG/OEK
��8
- 4 X (i RAFTE.25
9�0""O.C.
Z X 6 T# �. S/1EEnay
4 X B X Z�� /�.020
FO.OH /dSdGATiON
OEnv6E,v �g "//N'o
,✓/ Cb OA,e SN/wJGCPS
4a(I�o �/OGE BEAM
(o�� �
� ��/Xl�'' y�
�yD
�7/ C�'EOAQ. Siv/.dG L ES
�8 � PL f'.�/O
�OAM /.dSUG,
X(o T. �G. SHEET/�/�j
r�� �L,�z�79
a
/ `STvCG o ON <./f�Y � f•�PE� � �X 2 � A� ��
SL. wiirOdc�
2 X4 STUPS �lo � O, G
S o u tf �� E vA TiO�y
. . , .. -.-,,,.. .
� �
�� //I � �O �/
A
(v'X2
f/XE1J
.
�i�'2 8 �X (o�
�rS�v ALU-N St.
�,� ,�ass
ODoR
ND�PTN ELEYAT/ON
�
/4 ,• � 1•� „
�
i�i� � 1 T
�
/ � ST4CF 0 , ON �
Z X % Uo /G '
�
; -
,
,
; .. . . .
, . ..� ,
_._. .__ _.___.._:.�_- . _...______:.__ _ _ _. .. ... ._. . _. _ . _ . _ _ .. ---, -.. .. . . . _... ..
,. j
,.:..._.,-.... . . . . ._.� :._ . . _ _ ...
f ;
, . . . . . . . . . .._:� . .
;. :... . . �..
.
.._.. . . . .._._._. .� � � . .._ . ; . . . . . . . . . . . ...�
' _ . ... ... __. . . � . � . . . . . . . . . . . � . . . �
. . . _ . . . . i �. .. . � . . . . . . . .
.. . . . ... . . . , . . - � - .- i - . . , . , . _ . . . . . _ .
� _. ......_ '_ ' . . .. ._.. .... .. ...___ ___.. .... _ �-_ �. .. . " " _ . . _. - __ "" ' . . _.._ ...-. _ .
_ _.' , i..Y"' "
;..... : � . .�`F/�fED. ' i_
; __
_ . __. .�.. ; . . _
__._<_� ..._�..__ ._ _. _
�/XE� - �/XEO _ : fix�v
_.. _. .; .
. 1 ._ _._ . . . . . . ... . . .. .. . .
EAs r��E�A r�o�v ��4 � a 1 i0 r
,
3—�
�.t � r =- .:.. ��9�3�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CALIPOiiN1A '.
Fo� Applieanf fo Fill In Complefely
� TYPE OR PRINT
ADDRe�ss 2864 E1 Rio CiTCle
. . COSTA MESA CALIFORNIA
OWNER Mesa Del �ar Development Go.
ADDRES6 3u� E• CO'd81'i H1�Tfi¢�/wa,y ��
�„,. C�rona del �ar. C31if. NE�'OR 3112i
�ER Ma.Cco Corp. No OR
3800 E. �oast Highwaf
�orona del Mar, Calif.
-,nOonO n.�. . TEL.
OF LOT 7869 S F "°. °' BLOe.
xow oH ��none
use oF idone
EXISTWG BLDG.
eereweK urve vaoM e'6� REAR YAR �� 2��
CENTER OP 9TR6ET J
61DE YARD LEFf �"� I RIGHT S� � �
DESCRIPTION OF WORK -
NEW I MII ALTERATION I II ADDITION I
u
■ USE OF BUILDING AND WORK TO BE PERFORMED
I HEPEBY ACKNOWLEDGE TXAT 1 XAVB RE�D iN18 ARI�GTION
AND BTATB TXAT THE A60V6 I6 COfiREGT ANO I16RGG TO COM-
PLY WIiX ALL CIT' ORDINANCE9 AND BTATH LAW6 plGULATNO
BUILDIHO CON9TRUQION. �
APPROVED
BY
20N6
K-I
LBDAL
rEE RE��I�EC-�
�, 2819
FINANCE O�PT
CtTY 6F C,6�1! �it�€
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
xece�rr no. �'$v��7J
BY DAj! PECEIVED Dj�8 188U8D
� /-i.., i�— / /� �it�`, !. i /
COSTA MESA. CALIFORNIA
ZONING
NO. OP " I U88 OP N6W
PLANB BUIIDIN6
/�OI�• �a^T8 I�¢riY .7%�
!3 — Z�o —67
YAR�S EVE6
APPROVED
(C6M6R LIN6 BTJ
S
6
ro
eYPROVED �
Living area
Garage area
Covered rorch
�
�
IN.
Z �N.
E 71z�/!i
467 SF
(�(� n
0o n
THE AMOUNT BXOWN UND¢R VALUATION I8 POR THH
PUPPO6E OF, 89TAlLIBHIN6 ♦ PeRMIT FeE ONLY.
VALUATION
PERMIT FEE $ � � � U O
p�J ` w
$ 1" �2�/�� pLAN CNEGK $ /�• J O o
52.50 �
70TAL FHE �
4
` WS�A MESA BUILD'f"�`�.�i AFETY DEPARTMENT APPLICA. .� FQ,� �S�'RL.�C�T�UR�.�� PERMIT qq
P.O. BOX 1200 COSTA ESA, CALIfORNIA 92626 B3 TL
EI PERMIT *i0 49341
For Applicant to Fill in Completely — Use [nk Only 1��
ADIDRESS �Z t /—G /�/ �/ �J�'��C A.P.NO. �� I
//�/ BUILDING
T�ENANT R , S' � I�IN "�+(Ji C Z ADDRE55 L y� 4 �`C�"� ) Q C%�j .
UNIT OR �
MAILING ' SPACE NO.
nooaEss '� 1fGC/ (.�' ! G C`�/'� �'
/Y �.y•-f /L7 TR.N � LOT'� B�K.
CITV �C.i�/= / /�J /T NOL J� /� �
NEW ADD ALTER REPAIR MOVING DEMOLISH
CAN5TRUCTION
LENOER r�
BRANCH
OWNER
ADDRESS VALUE �
AFCHITECT TEL. USE $
OR ENGINEEfl N
ADORESS ZONE TVPE GROUP
/' ' ` APP �^
CONTRACTOR �(J /'� � ��� � BY DATE /
ADDRESS
TEL. '
CITV NO.
F STATE CITV APPROVEDSETBACKS
� LIC. NO. �IC. NO. '
{Z7 SIZE NO.OF BLIX'aS. (FROM C/L ST EET
6. OF LOT NOW.ON LOT RONT
a USE OF �J � ��
-� EXISTING BLDG. � T)
�
FSeparate permits are required for �. si E 35 �. -
� electric, plumbing and heating work qEAq F±
F USE OF BVILDING AND WORK TO BE PERFORMED PLAfVNING ACTION
Q �
ci
�
DATE
a,p APPROVED
7 C �� �� APPqOVED L�.L � I �
�.. ♦ \
.d •
a
w
� I hereby acknowledpe that I have reatl this application antl state �
y that the above intormatian is correct and agree io comply with
�+ all laws regulating building conrtruction, antl I shall not amploy /!O"7 �
,�L any person in violation of the workman's compensation laws of T J �
� the State ot California. '
� m
3 I hereby certify ihat I am properly licensetl as a conttacior under SQ. FT. �`+
the State of California eusiness and Profassions Cotla, Division 3, THE AMOUNTSHOWN UNOER VAIUATION IS FOR �N
Chapter 9, end that s ch licenses are in full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt trom the p �' ions ot the S te of Calitornia Business y
VALUATION PERMIT FEE $
antl Professions Co q Di sion� „ r 9. � O�
� m
Signatura of PLAN CHECK $ � QQ i°
0
Permittee ✓� � � OO � TAX S u
Authorized Agent Date Z � ��` � // � �
TOTALPAID § qL). Q� 'r