HomeMy WebLinkAbout457 ELMHURST LN - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
,lobAddress: 457 ELMHURSTLN
Suite No
Vicinity:
Parcel Nunmber: 14137226
Applicant: WENNERBERG, DANNY
ISSUED BY:
Address: 457 ELMHURST W . - , ,- - �- � - � - -
. �' � " -- Phone: �714-556-2732� � �;
COSTA MESA, CA � � �_ -'� Zip: � 92626-6112 -_ � _
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Owner: ,WENNERBERG, DANNY - \' ' .
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Address' "457 ELMHURST LN. . , - -. �. ,�., � � - �
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. - �COSTA MESA,�CA-. � Zip: 92626-6112 � ` ' � �
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SCOPE OF PERMIT � � ' ' '
, ��, ' �•' NEW GUNITE SPA ON�RA�SED BOND.BEAM WITH NEW EQUIPMENT FOR SPA AND EXISTING IN-GROUND � ;
., ', POOL. ' ; ' � � � ' ` �
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� , . REF: 604-01628 �. - . .' - - --- — - --- . -' ' . . -- - :r, . ,� . ". , �
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� � . � ' . �-- FEESUMMARY ', _ .-. ;�j � � ,�.`,
= � � Quantity ,,� r � QuantRy �� , � �
�ISSUE FEE � � $23.50 - Temp Dist System / Lighting ��. $0.00 0 ;! � ' ' �' �� � ,
Temp service test ��� '� -. $0.00 Busway�/100 ft= f : $0.00 0'��% �%� ���i , �l �
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Res:.a/c package , '. � . $0 00 Standing Seclion � $0 00 �0 �'�� � � �� �
New Res`(3 un ts) ��� l\ �\ $0 00 0 7�,'" r' �'T'Mlansfortne saupQolP kvalkw SO 00 � J0� ��� ��/ `� �/
Pool / Spa �� � �� $49.50 1 ��'' :.up to,10 kva/kw $0 00�%���0 ��^��
Lighting Fixts��� ' �$0:00 , 0 ,. , " � .... .:up to 50kvalkw.,.� „ _$0,00��� 0 C � � �" /
Recept Outlets, ' $0 00,� � '0"`� - ... ..up to 100 kva/kw� � $0 00�� 0 ' �- '� - �
Switches �� � � � $000V `0 - �,.r� �� .....�.. overd00kva/kw �� i50.00/ ��0 , � � �
NonResAppl `��� ����$0.00 � "'0 '- >> _.Low�VoltageEquipment -��ir$0.00`���0� � �' �
Res Appl �� �� $0:00 - � 0��� � .� � Cow Volt Winng System / Ckt-' $0.00- � "�,0 i, � /
Servlce to 200a � ' � �� �.,$0.00�� 0� - �` ���, � ��Misc�Condu�t"'.�. - "�" �' � �-$0;00�� 0� �� � �
Serviceto1000a � $0.00 .�/�--0 - - � ��Misc.�Conductor= � ����'$0.00-' �0; ;
Service over 1000a �' � -$0.00 � �� � �0 �. � � Circus ( gen or ride) - � � � - $0.00 � .", 0,%
Motors to 1hp $0:00 � -'� � �% -0 �i' �� Circus (mech ride or liglits) ` 50.00 !� %0
Motorstol0hp �$0.00:,� �-0.�-�.-���� � �:ChristmesTree.Stand , :-$O.00i� 0
Motorsto50hp $0.00_`` ���-�0 ' � � =�, �FireworksStanii��'" , -".,�$0�.00 0
Motorsto100hp $0.00�"'� 0=.�� �' ��OmerElectricalFee -�`50.00 �
Motors over 100hp 50.00 0�,� �--�
Communication drops $0.00 0 -._. _ " Ime�sUgalionFee- $0.00
Status: ISSUED
Applied: 09/17/2004
Issued: 09/17/2004
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirement �rider California statutes and ralated
regulations. (Ord. No. 92-28, § 1, 12-21-92) j�.
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work�is suspended or abandoned
for a period of 180 days. � �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (714) 7545628
zaas�ae (aroo) � '
WORKERS'COMPENSATON DECLARAnON: � - � � . • 7
1 hereby effirtn under penelry oi perjury one ol the following tleclarations: '
❑ I have end wlll meintein e certificete of consent to self�lnsure for workers' compensetion, es provitled for by section 3700 of the Labar Cotle, tor the peAortnence oi ihe
work tor wMch thls permit is issued.
❑ I have end will maintaln workers' compensation insurance, as raquiretl by section 3700 of the Lebor Code, tor the pedortnance of the work for which t�is pertnit is issued.
My workers' compensatlon Insuwnce cflrrier and policy num6er are: _
Carrier: Policy Number:
(Thls section need nof be comple(etl i/ Ne permit is valuetl a( one hundred dollars ($100) or Iess.J _ ,
❑ I cenify that in the pertormence of Ne work for which this permit is issued, I shall not employ any person in any manner so as to become suDject b tha workers'
compensetion laws of Celifomie, end egrae that if I should becoma subject to the workers' compensation provisions ot Sectlon 3700 of Ihe Labor Cotle, I shall forthwith
comply with ihese provisions.
Applicanl Signeture: Date:
WARNINO: FAILURE TO SECUflE WOfiKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPIOYER TO CPIhllNAL PENALiIES AND GVIL FlNES UP TO ONE HUNORED
THOUSAND OOLLAFE (5100,0OO�.IN AODRION TO THE COST OF COMPENSATION, DAh1AGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions of Chaptar 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, entl my license Is in full
force and eHect. Llc. a Class k
Contredors Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I here6y attirtn thel ihere is a construction lentling agency for Ihe Dertormance of ihe work for which Ihis pertni� is issued. (Sec. 3097, Civil Code).
Lenders Neme: LentleYs Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
oate:
I hereby ettlrm that under penalry of Oerjury ihat I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for iha following reason (Sec. 7031.5, Busineu end Protessions
Code: Any ciry or counry which requires a permit to consWct, alter, improve, demolish, or repair any siructure, pnor to its issuance, also requires the appliwnt for such parmit
to file e signed statament that he or she is licensed pursuant to Ihe provisions oi the Contrectors License Ww (Chapter 9(commencinq wlih Section 7000) oi DiWsian 3 of the
Business end Professions Cotle) or that �e or she is exempt therefrom and ihe basis for the alleged exemption. Any violation oi Saction 7031.5 by eny applicant for e pertnit
subjects the applicent ro e civil penalry ot not more ihan five hundretl dollars (5500).):
[�Yt; as owner of Ne property, or my employees with wages es iheir sole compensa�lon, WILL DO THE WORK, and the siructure is not intended or oHered tor sale (Sec.
7044, Business and Professions Code: The Contrac�ors License Law tices not apply to an owner of property who builds or improves thereon, antl who does such work
himself or herselt or through his or her own employees, provided that such improvements are not intended or ottered for sale. If, however, Ihe building or improvement is
soltl within one year oi compla�ion, Ihe owner-builder will have the burden of proving that he or she tlid not build or improve for purpose of sale.). •
❑ I, as owner of Ihe properry, am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Protessions
Cotle: The wnireciors License Law tloes not eppty to an owner ot propeny who builtls or improves thereon, end who comracis lor such prolea wilh a comractor(s)
license pur5uant to Ihe Con�ratbr5 Litense LawS.).
❑�em exempt under sec. Business antl Professions Code tor ihis reason:
ID verifieC by �ver's(icense. [j':Yes ❑ No
Veriflwtion ol Ownership by (type of docG en1, I.e. - properry ta< bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMITCERTIFICATION:
❑ I hereby cenify that no excavetion five (5) or more feet in depih in�o which a person is required to descend, will be matle in connection with work au�horized by this
permit, end Ihat no building siructure, scaMolding, talsework, or demolition or dismantling �hereof, will Ge more than thirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TUe B, Celltomla AdminlSlretive Cotle).
❑ As owner-builder, I will not employ enyone to do work which woultl require a permit irom the �ivision ot Indusirial Safery, as notetl abova, unless such person has e
permit to do such work from the tlivision.
Signature: Date:
Division oi Indus�rial Safety Permit Number.
CERTiFlCATE OF COMPLIANCE AND AUiHORVATION OF ENTAV: I certity under penalty of perjury that I have read this application and state Ihat the information given is
correcL I eqree to wmpty with ell state laws and ciry ortlinances relating to builaing wnsiruction, end authonze representatives ot ihe City ot Costa Mesa to enter upon the
ebove-described property for inspection purpases. I agree not to occupy or allow occupancy of any building authonzed hy ihis pe�ry t until final inspection.
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Signat re Of Legal Ow er(s) ate
COUE �. INSPECTIONTYVE
7876 Fixetl System Final Fire Prevention
7266 Pool Spa Final ,
200 Final FB-Roo�
201 Final BIocWRetaining Wall
202
203
204
Final Factory Fire Place
Final Sign
Final Demolition
PAIE
INiRIALS COOE1 INSPECTIONTYGE
206 Final Mechanical
208 Final Plum6ing
210 Final Electrical
� 212 Final Fire Prevention
• 220 Final Planning Approval
222
' ' • 250
Final Site
�Final Building/Occupancy
Data
�.1 �1111.
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MECHANICAL PERMIT
JobAdd�ess: 457 ELMHURSTLN
Suile No
Vicinity:
Parcel Number: 14137226
Applicant: WENNERBERG, DANNY,, �
'.. �- .:
Address: 457 ELMHURST�LN,-; �%� �_
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COSTA MESA, CA � �
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Owner WENNERBERG _DANNY �
Address: - 457 ELMHURST LN , � � '
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, . COSTA MESA, CA
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Contractor. - ,
-Address: _' , '
Phone: 714-556-2732
Zip: .92626-6112 �.
Phone: 714-556-2732
Zip. 92626-6112
� �Phone: , �� �
� . - . � -Zip:;"�' �
" < . ��License: �' -
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Status: ISSUED
Applied: 09/17I2004
Issued: 09/17/2004
ISSUED BY: �
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ExQ�RES . '�;%` ll _ t
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SCOPE OF PERMIT ;� '
� � . " NEW GUNIT� SPA ON RAISED BOND BEAM WITH NEW EQUIPMENT FOR SPA AND EXISTING� ��,,; �� �
� , � IN-GROUND pOOL: _.. _ . _ _ . _ _ . . ._ ,
�l . , , . ;�,_ .y ^, s,ti':. -• . .i� i
�� � �' REF:604-07628 �,�.: .r .-i:- --,�.1:_'�e .�.._.. . .. . ,
� , ' � t � FEE SUMMARY �"` � � ' �`�, � , �
; i�'� t; � �� '
, ," __ . , ,..__ . Quantity ��� %:�� =��`� !>. '�':� r�r � _. Quantity,� i
ISSUE FEE $23 50 - - - ' . Repav / AIf Absorbtiori Uhit ,'-,� $0.00 0' ; � i� '
Inst FAU <100 k BTU � $14.80 ��1 � ` " Repair/'Alt Refrigeration Unit ! $0.00 - 0'
Inst FAU >100 k BTU • � $0.00. 0 � Venlilletion'System „ ��$0.00�� ,0 � �� l
Repai[/ Alt Cooling/Heat �, $0.00 0 Evaporative Cooler � ���, $0.00 � �0 �, ;' /
Inst / Rep. Recess WaII�Hh�', $OAO 0 Commercizl-Incinerator ��;; �;$O.OD�_` � 0��,' !
Refng,Sys.�100 k BTU ��� $0.00 0 ..�.Domestic Incinerator �. .' j� '�$0 00 0�,% -
Refng Sys?700 k BTU ���� `� $0.00 0 � 1�� `Compressors / Absorption Systems o� ' � „ �
Gas Piping; � `' �' � � $0.00 0 ,r �".€�' � ' ' Up to,3 hp / 100 k BTU � :'/r � $0 00 �. 0 /
Factory Fireplace '� �� �$0.00 0 J; �', � �-, 3 To 15 fip°% 500 k BTU "�� " 50.001 �� 0'
Hoodw/MechEzhaust ° ���--�$000�-:,0.- ."15To30hp'/-1;OOO�k�BTU� � ��i� � -'$0.00;,��,0
VAV Box �� � � � � . .;$0 00 0 � ' - �. - .� . �, 30:To 50 hp / 1,750 k BTU ` , $0.00� � 0
Vent Fan / Single�Ducl !/ � , $0'00: � ;0 "� '� - � Over 50.hp / Over 1,750�BTU � !� � $0 00� 0
Appliance �� - ' � i$1065 1 ,i'� _ � '' `Boilers ` '' /i, '� . �..;" �
Fire Dampers � ' .$0 00 '0 V� ,, ' 1'� ' Up=to 3 fip�T - ��" 1 � / � $0.00 , 0
���"' � t ' . 'r �
�
Smoke Dampers ��� �� � • � $0,00„ - 0 �' �,^- ��-� - _�--3 To'15;hp.` % � �- �'J �'� � i,. ' i $0.00 0
Inst or Relocate Appl Vent --� - $0.00 � �0� � �. �� - � - -�' 15 to�30�hp' � � � !.' � � = / $0.00 0
Alr Handlers < 10000cfm �� � '- ` $0.00� i ,0 �-� 3 � � 30 to SO,hp-- � � �� . � � �'/ $0.00 0
���t�` i !� . - - � -" i
AirHandlers> 10000cfm �,�`$0.00 �,0� � � �,_�% �- •� OJe�50hp.-��', �, ; � $0.00 0
Floor Furnace � ,`$o;oo�_ o '-• � � ! � , � � - Other Mechanical�Fee - �` '
FloororSuspendHeater �$0.00�",0_- ��_- ,-��`�`.,i�-InvestigationFee ..-,�,'����� $0.00
" � - Plan Check�Feei., �_ --' $0.00
�` - _ _ � - _ , �.� _� _Reinspection Fee " $0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremeMs u�der California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO da�;,�if work is suspended or abandoned
for a penod of 180 days. .�.,'
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required i�apeetlona and final approval must be obtainetl. Failure to obtain inspections antl final approval�will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 ,.
2446d6 (&'DO)
WORKERS'COMPENSAnON DECLARAnON: – � � �
I hereby atfirm un0er penalry ot parlury one of Ihe following declarations: � ' �
❑ I heve end will maintain a ceNficate ot conseni to self-Insure for workere' compensation, as provided for hy section 3700 of the Lebor Code, for the pertortnence of Ihe
work for whith I�is pertnit is issued.
❑ 1 have antl wlll maintain workers' compensation insurance, as required by section 3700 oi Ihe Labor Code, for the pedortnance of ihe work tor whic� Ihis pertnit is issuetl.
My workers' compensation Insurance carrier antl policy number are:
Carrier: Policy Number:
(This sectlon need not be completed i! fhe permif is velued et ane hunared dollers ($700) ar less.) ,
❑ I certity that in the pertormance of Ihe work for which this pertnit is issuetl, I shall not employ eny person in any manner so es lo bacome subject to Ihe workers'
compensation laws of California, antl egrae thai if I shoultl become subject to the workers' compensation pmvisions of Seciion 3700 of Ihe Lebor Cotle, I shall forthwith
comply with these provisions.
Applicant SigneWre: Date:
WARNINQ: FAILURE TO SECURE WOHKERS' COMPENSATION COVERAGE IS UMAWFUL ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLAflE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DPMAGES AS PROVIDED FOR IN SECiION 3lOfi OF iHE L4BOq CODE, INTEREST, ANO ATTORNEI"5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby effirtn that I em licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Cotle, entl my license is in Full
brce and ettect. Lic. M Class 8
Contrectofs Signature: Date:
CONS7RUCTION LENDING AGENCV:
❑ I hereby aflirm that �here is a constmction lending agency Por the peAormance ot the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Neme: Lentlers Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm Ihat under penalry ol perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Professions
Cotle: Any clry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit
to file a signed statement Ihet he or she Is licensed pursuent to the provisions ot the Contractors License Lew (Chapter 9(cammencinq with SecHon 7000) 01 DiWslon 3 af the
Business antl Professions Code) or ihet he or she is eaempt therefrom antl the basis for the ellegetl ezamption. Any violation of Section 7031.5 by eny applicent for e pertnit
�� ts Ihe appliwnt Io e civil penalry of not more than five hundred dollars ($500)J:
.� I, as owner of Ihe propeny, or my employees with wages as their sole compensatioq WILL DO 7ME WORK, and the sirucwre is not intended or oflered for sale (Sec.
7044, Business antl Professions Code: The Coniractors License Law dces not apply to an owner of properry who builds or improves �hereon, and who does such work
himself or herseli or through �is or her ov.•n employees, provided that such improvements are noi intended or oHered tor sale. If, however, Ihe building or Improvement is
sold wit�in one yeer oi completion, the owner-builtler will have ihe burden ot proving ihal he or she did not build or improve for purpose of sale.). �
❑ I, as owner ot the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7046, Business and Professions
Code: The comradors Licensa Law tloes not appy to an owner of properry who builtls or improves t�ereon, and who contracts for such project wiN e contracfor(s)
license pursuant to the Contrectors License Laws.).
❑ I em exemRt under
_ Business and Professions Code for ihis reason:
�Deta: % / 7 �Lj/
Owner ID verified by dNvers license. /[e3-1'Be ❑ No Drivers�� No. L� Expires: 4� 2 2�0l-
Venfication of Ownership by (type oi dacument, I.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICA710N:
❑ I hereby cenity Ihat no excavetion tive (5) or more fee� in tlepih into which a person is required to descend, will be mada in connection with work euthorized by this
permit, and that no building swcture, scaHoltling, falsework, or demolition or dismantling Ihereof, will be more �han thiny-siz (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Calitomia Atlminl5lrative Code).
❑ As ownerbuilder, I will not employ enyone to do work which woultl require a permit from the Division ot Intlustrial Sefery, es notad ebove, unless such person hes a
permit to do such work from the tlivision.
Signature: Date:
Division of Intlustrial Safary Parmit Number:
CERTIFICATE OF COMPLIANCE AND AUTMORVA710N OF ENfAV: I certify under penal�y ot perjury �hat I have read this application and state thet ihe infortnation given is
wrrea. I agree to wmply with all state laws entl ciry orainances relating to building consiruction, antl authonze representatives of the Ciry ot Costa Mesa to enter upon the
above-descdbed properry for jnspeciion Durpo eS s. I agree not to occupy or allow occupancy of any building authonzed by this parm� unti�� I i�pection.
%Q,^—'% (�/'�G""'� � / C
Slgnafuie� f�Legel'OwneQs � �Dete–�
yODE �. INSVECTIONTYPE . Q�¢, . I�$
isis Fixetl System Final Fire Prevention
1286 Pool Spe Final
200 Final Re-Root
201 Flnal BIaWRetaining We11 •
202 Final Fettory Fire Place '
203 Final Sign
204 FinalOemoliqon " -' �
COpEt INSPECTIONTYPE Qaj�
206 Final Mechanical �Q
20B Final Plumbing
210 Final Elec�rical
212 Final Fire Prevention •
220 Final Planning Approval
222 FinalSite
250 FinalBuiltling/Occupancy
�
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 457 ELMHURST LN
Suite No
Vicinity:
Parcel Nunmber: 14137226
Applicant: WENNERBERG, DANNY' =
Address: 45� ELMHURST LN �� � .
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COSTA MESA, CA�� � - ,
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Ownec � -WENNERBERG, DANNY
Address � � 457 ELMHURST LN �.
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AdBress�: �
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PLUMBING PERMIT
ISSUED BY:
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Status: ISSUED
Ap pl ied: 09/17/2004
I ssued: 09/17/2004
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� Phone:� 714-556-2732 ! �
; Zip: 9262&6112 -.� r. � �
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._.et. ._ l_�: . <:.._��r !`�'.i'..J� S�i
. . . _ _ _ __ _ __ .'_ ..___ __.
Phone: ',
\ , ,
, � , � Zlp � ,. ��k � �
— =z
_-" _ _ � Lioense ' � � � . r � __
... -. , ' '_"' r". " �,,i �_ _.. ._
' � � SCOPE OF PERMIT ! r �/ ��� ,� , J
� •NEW GUNITE SPA�ON RAISED BOND BEAM WITH NEW EQUIPMENT FOR SPA AND EXISTING IN GROUND ,'
� �. � POOL ' __ i / ', � i /
�-�. �-, �i � A C ; . _ a. - a:e � � �i � �> /�., !
� . ` REF �804-01628 � h %% ' i u �.
� �� e i�, i �l
-'� ?\� ,,��i��. ,�. �ii, /
� � . ., .
� ��. ". . �.. � , . .. � FEE SUMMARY- ; - '%' f ' ,i,'�
� V�: �� AMT �'QTY � . : . ,, ' �.. .AMT � �QTY. . ��, ., � / ' �, , � ;'/AMT
ISSUE FEE ���: � $23 50 - Laundry Tub / Washer, � %Y $0.00 0 - Sump Pump ,- � $Q00
BackBow irrigation � � ' � �$0 00',� 0 � � -Landscape Irrigatron ��- ° $0.00` ' 0 .' r ='�Swimming�Poo6 - ��' � $0.00
BackflowPrevente� ��, $0.00"��0_ ;��P-T�ap��.' � " �`�� $000 __0 -<,� � Trap.Primer�� /,�I � $0.00
Bathtub �� �,$0.�00, ; 0 - Pressure�Regulator �_-. �$0'00� 0 -.�Urinal %�� $0.00
Clarifler System ��$0.00 �� 0� ' � Process Piping (per 10 kp _� $0.00� 0 ��, Vacwm Brk� Bkfow(1-4) $0.00
ConnectQce,Soda,etc) '$0:00,� 0�.' •-Receptors $0.00- �0�-'1 � Vacuum-BrkrBkflow(5+� $0.00
Dental Units $0.00 � ��� 0 � Septic�Tank � � �.., `; $0.00, - 0 � Wash Basin � $0.00
Dishwasher $0.00 �� -,� 0,�. � � Sewer Cap fo� Demo , � $0.00 � 0 ,_- ' ; � Wash,Basin Set $0.00
Drain, Floor $0.00 0�`'�-' ; � � Sewer Connect' ;�`.��, ;'-� �$0.00' ' �0 � !; ,� _Wasfe antl Vent System $0.00
Drain, Rainwater $0.00 0 - Sewer Private Line $0.00 -� 0-; ���-' Waler Closet (Toilet) $0.00
Drain,Roof $0.00 0 �Shower.`�"�"�- -.--��._:$0.00"�0- ` WaterHeater/vent $0.��
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or if w
for a period of 180 days.
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply w
requlred inepeetlons and final approval must be oblained. Failure to obtain inspeclions and final approval will result in
FOR INSPECTIONS CALL: (714) 7545626
244Bd8(&00)
QTY
0
0
0
0
0
0
0
0
0
0
0
statutes and related
orabandoned
tle codes, and all
of this permit.
WORKERS'COMPENSAnON DECLANAnON: - ' � ' �
I hereby aHirm under penalry of perjury one ol the tollowing tleclaretions: � � '
❑ I heve and wlll maintain e certifica�e ot conseni to self-Insure tor workers' compensation, as provided tor by section 3700 of tha Lebor Gode, for the pertormence ot the
woAc for whith this Darmii I51uu8d.
❑ I �eve antl will maintain workers' G�Densation insurance, as requiretl by sec�ion 3700 of the Labor Cotle, tor the pedortnance of ihe work tor which thls pertnit Is issuatl.
My workers' compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need no! be comp/eted il Ihe permit is velued et one hundred dallars ($100) or less.) ,.
❑ I certiy that in the pedortnance o� the work for which this pertnit is iuued, I shall no� employ eny pereon in eny manner so as to bewma subject to the workars'
compensatlon laws ot Celifomla, entl agree that il I shoultl become subjec[ to the workere' compensation pmvisions ot Section 3700 oi the Labor Cotle, I s�ell forihwith
comply wii� �hese Drovisions.
Applicam Signature: Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION GI�VERAGE IS UNLNWFU� AND SHALL SUBIECT AN EMPLOYER TO CPIMINAL PENALilES PND GVIL FlNES UP TO IXJE HUN�RED
THOUSAND 90L1ARE �5100,OW), lN ADDITIO�d TO ME OOST OF WMPENSATION, DAN.4GES AS PROVIDED FOR IN SECrION 3f0G OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLAqAT10N:
I hereby aflirm that I em licensed undel provisions of Chapter 9(commencing with Section 7000) of Divisian 3 of ihe Business antl Pmfessions Code, end my license Is In full
lorce and effect. Lic. N Class M
Contractor's SignaWre: Date:
CONSTRUCTION�LENDING AGENCY:
❑ I hereby attirm Ihat Ihere is a wnsuuction lentling agency for the pertortnance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Neme: Lender's Aatlress:
SignaNre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm t�at under penalry of pe�lury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or county which requires a pertnit to consiruct, altar, improve, tlemolish, or repair any stmcture, prior to its issuance, elso requires Ihe epplicant for such pertnit
to file a signetl statement that he or she is licensea pursuani to Ihe provisions ot ihe Contractors License Law (Chapter 9(commenGng wit� Section 7000) ot Divislon 3 of the
Business end Prolessions Cotle) or Ihe� he or she is exempt iherefrom and t�e hasis for the allaged e:emption. Any violation ot Section 7031.5 by any epplicant for e pertnit
subjeCts the epplicani to a ciNl penalry of not more than tive hundred dollars ($500).):
���s owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the siructure is not in�anded or oflered tor sele (Sec.
i 7044, Business and Professions Gode: The Coniractors License Law does not apply lo an owner of property who builtls or improves ihereon, antl who does such work
himself or hersefl or thmugh his o� her own employees, providetl iha� such impmvements are not intended or oftered tor sale. If, however, Ihe building or improvement is
sold within ona year of completion, ihe owner-builder will have the burden ot proving iha� he or she did not build or improve for purpose of sele.). '
❑ I, as owner oi the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Professions
Code: The comrectors License LIDw tloes not appty to an owner oi property who builds or Impmves Ihereon, entl who contraas lor such project with e contrector(s)
license pursuant to ihe Contracto� License Laws.).
� I am e:em I under sec. Business antl Professions Code for this reason:
Sign�ure: � l <-.� - �^Dale �/ � J � �f �
/ rr
O/v/merlD verifiea by rivers licens 'G]'1'es ❑ No Driver's'L"icense�No. Expiies: ��7-,� oG
.Verificatlon of Ov+nership by (type ��Gmen4 �.e. � property taz bill or deetl): �- �
DIVISION OF INDUS7RIAL SAFETY PEHMIT CERTIFICATION:
❑ I hereby certity that no excavation five (5) or more teet in depih into which a person is required to tlescend, will be matle in connection with work authorizetl hy this
permit, and that no building siruclure, scaHoltling, talsework, or demolition or tlismantling Ihereof, will be more than thirry-six (36) taet high. (C�ap. 3.2, Grp 2, Art 2, Sec.
341, T�le 8, Califomia Administre�ive Cotle).
❑ As owner-builder, I will not emplDy anyone to do work which woultl require a pertnit from the Division ol Industnal Satery, as notetl ebove, unless such person hes e
pertnit to tlo such work fmm the dihsion.
Signaiure: Date:
Division ol Indusinal Salery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTAV: I certity untler penalry of perjury ihat I have reatl this epplication and state that Ihe information given is
correct. I egree to comply with all state �aws entl ciry ordinances relating to Duiltling consimction, and authonze representatives of the Ciry of Costa Mesa to enter upon the
ebove-descnbed property for /ins'pe/ction Ourposes. I aqree not to occupy or allow occupancy of any building au�honzed by this pertnit un�il final ins ction.
� W.,�/ Q %% ? 6 y
Signature L.e9al Owner(s) r��t 1
�Y�'3�.i�"'� ��11
��
AnNOr AV�honzed Applicant Date`
COOE I, INSVECTIONTYPE Pdg IN�9L5
7616 Fized System Final Fire Prevention
1268
200
201
202
203
Pool Spa Finel
Final Re-Rooi
Final Block/Retaining Wall
Final Fadory Fire Place
Final Sign
204 Final Demolition • - ' '.
GODE I INSPEGTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 � Final Planning Approval
222 Final Site
250 Final Building/Occupancy
d]\I�I:1111��Fa
e
(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAlfi DFIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 457 ELMHURST LN
Suite:
Vicinity:
Parcel Number: 14137226
Applicant: WENNERBERG, DANNY
Address: 457 ELMHURST LN
Zoning:
, - ''Pliarie:� �714556-2732 ':
ISSUED BY:
Status: ISSUED
Applied: 09/17/2004
Issued: 09/17/2004
COSTA MESA, CA "��� � " Zip: 92626 6112 , ., .��(
� ' " �; � � � �` �.�� �
Owner WENNERBERG DANNY �. � • � r � ��
' ��� ,
Address 457�ELMHURST LN - � � � ' /�� ' ��.� , �
- < :-Phone:, 714-556 2732 ,� � �'�{ ��� /� .
�� COSTA�MESA, CA - =" �Zip: 92626 6112 � . � ; �I� U�- �,, �
� j �»� �.
' - �� . /
Contractoc � � Q
i - '�, , � -'�" �� `_; � �� , �
Address: � - . , � � ���'� / �� ; A
� ��\
. � Phone: � � ;��, �' '
�
.:�� �, . .- �',:��;. � .
;�`.
, �Zip: � � License:�: .. ' . _ �
, . . , . - . �,'.
A�ch : Eng: BERNARD ADAMS . .
� Address: � � � . ' Address: 11022 ACACIA PKN/Y;' � - � �
. � � " � , Pfione: � .. . - .- -.- - . � � • , Phone: -
� " , � � _ � GARDEN.GROVE'�" �� � , , - " , �� �
� .. Zip: � � � _ , �� License: 92640 �'� •,License: 10183 ,,
`
' SCOPE OF PERMIT `
' NEW GUNITE SPA ON RAISED BOND BEAM.WITH.NEW,EQUIPMENT FOR SPA AND EXISTING IN-GROUND POOL. .,�, � � '
, ' . , / ,/, �, _ � . ,` , � .
" ' - - FEE SUMMARY ' . ,
Plan Check: $136.01 . , Calc Valuation , 5�r000.00'
� '�� - � � '" ��_ ClaimValuation ''-. _ S��z,000:oo'
� , ' � Permit' � �� $209.25 - -- . � �, �; .� i i , „ .
SMIP Res: ' $1.20 -- - -- _ -- - � m�:; �. = � �• . � - - � .. �
�. SMIP Corri:� $0.00 � �� �� � /.j '�
Other: ' ' $0.00 � " �%�
:. _ - � �, i
Inspection� $0.00 = _ - , , i, .'
\ � . \ \ 'l �l .� / .
!� I
l � ✓ . tJ" = .-�f ` �`-_ f �/
��y,�Total:�� $346.46 ,,�k � ", . _,,- ' �%%� � /.I��
. �'. , .� , .A' .,: . , �-1 . ,. �- _. i�/% .., /r, i
,
SETBACKS
MAIN STRUCI
ACCESSORY
PARKING
NOTES:
� �� ; �' ' "" -t'� , "PLANNING &�ZONING � �'''��r ""�r/!,' �'-� �
i� , .� _ � , - ., - r ' " �" ,tr=:' ,/j .
. - �
\� , ,
//� �- ' � � � ;,� � �: _ , .
IRE Froot 0 �0 � � Rear 0:0��; �,Left 0=0 ` � �Right 0�0� �� �. ��
� � '� ., . ; ., C, �i _ �- -,�`!�_�� / i,.�J,�;
4 '..�,, - "" �
�\ Pront 0- 0 � Rear '0- 0 � _ - ' �LeR� 0� 0: '." � � Right - 0�0�' i � ��
• ;� • , -' �._� _ - - -� ' ; -� . i �, � ,
_ �
Existin \ �0 � �"Re uired:�-��0 Pr000sed:-� _0, � � ` � L ;
- ,�, � " � ,,
_ -i. , ;�
��:. _ ',`._ , \��, ,- ., -� - " � �"
_ �;
� - ,
'` - _ . -.- ..---
_ -- - - - - �. � i:. " � -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is susF
tor a period oF 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appl
raquired Inepeclions and }inal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiral
FOR INSPECTIONS CALI: (774) 7545626 ,
2aa6-ae (��)
dutes and related
/1r
�9
ied orabandoned
�le codes, antl all
of this permit.
WORKERS'COMPENSATON'�4CLARATION:� . �' : ' � , S ' . +
I hereby ettirm untler Denalty oi perjury one ot the following tleclarations:
❑ I have end wltl maintain a certificate oi conseni to setl-Insure for workers' compensation, as provided for by section 3700 of Ihe Le6or Code, for the peAortnence of ihe
work for whlch this permil IS issued. . . .
❑ I have flnG wlll maintain workers' compensation insurance, as required by settion 3700 of the Labor Code, for Ihe peAortnance of the woAc for which this pertnit Is issued.
My workers' compensation Insurance carrler antl policy number are:
Carrier. Policy Number:
(This sectlon need not be comp/etetl i! fhe permit is velued at one hundred dollars ($100) or /ess.) .
❑ I cenity Ihat in the pertortnance of the work for whic� this permit is Issued, I shall not employ any person in any manner so as to become subjed to the workers'
compensetion laws of Celifomia, and agree Ihat if I shoultl bewme subject to Ihe workars' compensation pmvisions ot Section 3700 of [he Lebor Coae, I shall torthwith
comply with Ihese provisions.
Applicant Signeture: Date:
WARNING FAILURE iOSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT PN EMttOYER TO CRIMINAL PENPLilES AND qVl� FWES UP TO pJE HUNDRED
i110U5AND DOLURE (5100,000�. IN ADDfTION TO THE COST OF COMPENSATION, DAM4GE5 PS PROVIDED FOR IN SECTION 3lOfi OF THE L4BOF CODE, IMEFEST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, end my license Is in full
force entl eHecL Lic. a Class #
Coniractor's SlgneWre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aNirm Ihat there is a consiruction lending agency for the pertormance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). '�,
LenOer's Name: Lentler's Atltlress: �
Signetura: Dete:
OWNER-BUILDER DECLARAT10N5:
I hereby aMlrtn that under penalry of perjury �hat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professlons
Cotle: Any city or county which requires a permit to construct, alter, impmve, demolish, or repair any siructure, prior to its issuance, also requires iha applicaN tor such permit
to lile a signed statement thet ha or she is Iicense0 pursuent to the provisions oi the Contracmrs License Lew (Chapter 9(wmmencing with Section 7000) of Division 3 of the
Business end Pmfessions Code) or thet �e or she is exempt Iherelrom and tha basis for the alle9ed exemption. Any violation oi Section 7031.5 by any epplicent for e permlt
so '' ts Ihe applicent to a civil penalry of not more than five hundred dollers ($500).):
l, as owner ol the property, or my emO�aYees with wages as their sole compensa�ion, WILL DO THE WORK, and the siruc�ure Is not intendetl or otferad tor sale (Sec.
� 44, Business antl Professions Code: The Contractors License Law tices not apply to an owner of property who builds or improves ihereon, end who does such work
him ell or hersefl or thmugh his or her own'employees, provltled that such improvements are not intended or oflered tor sale. tl, however, the building or improvement is
sold within one year of completion, ihe owner-builder will have tha burden of proving thePhe or she did not builtl or improve for purpose of sale.). '
❑ I, es owner ot the pro0erty, am E%CLUSIVELY CONTRACTNG WI7H LICENSED CONTRACTORS m consimci the project (Sec. 7044, eusiness and Professions
Coae: The contractors License law tloes not apply to an owner ot propeny who builtls or impmves Ihereon, antl w�o contracts for such project with a coniractor(s)
�,, license pursuant to t�e Coniraciors License Laws.).
verilied by ddvefs license.
Vertlication ol Ownership 6y (type of
Business antl Professions Code for this raason:
�oate� 9 � 7 0 '
❑No DriveKs�LicenseNo. Expires: 2 Ob
properry tex bill or deetl): ,--� � _
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify thet no excavatlon tive (5) or mora feet in depth into whic� a person is required to descenq will be matle in conneciion wi�h work authonzed by Ihis
permit, antl that no builCing sirucWre, scaMolding, falsework, or demolition or dismantling ihereof, will be more than thirry-six (36) teet high. (Chap. 3.2, Grp 2, A� 2, Sec.
341, Title 8, Calilomia Atlminis�ra�ive Code).
❑ As owner-builder, I will not employ enyone to do work whic� would require a permit irom the Division of Industriel Sefety, as notetl ebove, unless such pereon has e
permii Ia do such work from the division.
Signature: Date:
Division of Industnal Safary Permi� Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTRV: I certiy under penalty ot perjury that I have read this application antl state that the infortnation given is
wrrecL I egree to comply with ell stete laws end ciry ordinances relating to building consimction, and authonze representatives oi t�e Ciry ot Costa Mesa to enter upon Ihe
above-descnbed properry tor inspaction purposes. I egree not to wcupy or allow occupancy of eny building authorized by ihis permit uNil final inspection.
172..--, �n%pti—�l Y! 7 o Cf
[c,Signatar 'OfL'egal•Ovm87( .�.-�'�ate
CODE 1. INSPECTION TYPE
7678
1266
Fiaed System Final Fire Prevenlion
Paal Spa Finel
200 Finel RB-Roof
201 Final Block/Retaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Finel Demolition
PAg 1tID.J�T k£
CQDE 1 INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final�Fire Preventian
220 Final Planning Approval�
222 FinalSite �
250 Final Builtling/Occupancy
Qeg Ii�S
�
TEST SPECIMEN AND COMPRESSIVE STRENGTH DATA SHEET
PROJECT NAME: WBnnefbefg INSPECTION FIRM OR CLIENT: LuiZ InSpeCfi0n5 �
i
PROJECT ADDRE55: 457 ElmhUfst LanO INSPECTOR'S NAME: � RiChafd LuiZ
Costa Mesa, CA. INSPECTOR'S LICENSE NO.:
PERMIT NUMBER: 04-01628 FIELD IOENTIFICATION: NIA
CAST DATA (ATTACH DATA SHEET OF OTHERS WHEN AVAILABLE)
CASTDATE V27/OS DESCRIPTION Concrata �yy( Monar Snomreie MasonryPnsm Oine�
CONTRACTOR Owner BL•i!def � SPECIFIED F'c � PSI 2,000 CEMENT TYPE V
CONC. SUPPLIER NIA CAST BY Art ADMIXTURE N/A
PLqNT NIA NO. OF SAMPLES � SLUMP N/A
MIX DESIGN N0. 4 1/2 - 1 TOTAL YARDS N/A AIR CONTENT N/A
TICKET NUM9ER N/A CAST 1 MIXTIME NIA +VRICONC NlA
TEMP.
LOCATION OF POUR Wall Of The Swimming Spa
No7e5 NR = Not Reponed
� '' LABORATORY COMPRESSIVE STRENGTH DATA PER ASTM C39, C1019, UBC STD. 2'I - 18
pATE SFECIMENS RECVD. 2/1/OS EQl11PMENT USED FOfne DR2C
REPORTDATE 2/24I05 SNOFEQUIPMENT gg�pg
TECHNICIqN 1NITIALS C. N801ique2 - SupeNi50t CALIB. / RECAL. DATE 9-04 I 9-OS
SPECIM•uy pGEAT OATE TIME PERCENT SPECIMENOIMENSION9aN.� AREA LOAD F�C BREAK
IOENTIF�CATIOi . TES� OF + OF OUTOF 7 2 � � Sp.IN. �HS. PSI TVVE'
NUMBER 1:" OAYS TEST TEST PLUMB 5 ! 1 E (N1�
E0074�A 3.246 3.318 3.250 3.312 10.76
28 2124/05 2:07pm 1.1 73,976 6,867 c
_�_ 5.565 5.561 5.562 5.561 i�.�)
ypecnnec mnienaiwis i- - wwui ana mngm oi,eecn mce ai imwieiu��t +m�ovyn o= sVecimen ne�gnl aLm�owlam.
'Break rype designation per ASTM C39 Figure 2: a=Cone, b=Cone and Split, c=Cone and Shear, 4=Shear, e=Columnar
CPMPUANCE WITH SPECIFIED S7RENGTM / COMMENTS: Compllea ,_ _
i _.
AUTHO SIGNATURE
ea v�
10600 Pioneer Boulevard, Suite G• Santa Fe Springs, California 90670 •(562)903•0034 Fax (562)903=3534
�
� ` =�,���,'�f.'.��+, 1' � rljri�l '�r. ';bw,� �Ji,'C .7
.� �/' YN„^ �r�l, i!
, r..�:T;.t,'
1��
y .. .
?rojeci Namc & Address
?: =i� 4�bcr�
! �spcc�.�on Typt(s)
!nspcc�ion Datc(s)
Describ: Inspcctlon Mad
�)
Lir Tcs�.s :titadr
RICHARO LUIZ
5071�OYOlA AVENUE
WESTMINSTER, CA 92683
Report of Special Tnspection
Gunite
—Z1—� � ] Ptriodic � XXX ) Con�inuous
c, including Locations: Ins eciion of the swimming
�4 C� the above dddress on —�i—��
?o�.=_I lnspccilon'�imc Each Day:
�
'_:s�. I�,c^�s Rcquiring Corrcciion, includc uncorrccied i�cros prcviously lisicd
Co^irrc�is.
ti�
?� �.n: b<s� of my knowledgc, the work inspccltd was in accordana wiih the Building Dcparirrc�.
znpro�cc d<sign drawings, spcc' icaiio and applicable workmanship prov{slons of ihc U.3.0
;�.ccpi as ro�cd abOv .
5:3^'� Daic � — �C7 —� S
I.C.B.O. �
?,:n,. �u�, .��am� Richard T. Luiz Registration No. 10756 91-4 9 Concrece
FORr.i S�-2: 7i
0
(714) 754-5273 • Fau (714) 754-4856 • wvnv.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
457 ELMHURST LN
14137226
npplicant: WENNERBERG, DAN & NAFEY
Address: 457 ELMHURST LN
COSTA MESA, CA
Owner: WENNERBERG. DAN & NAFEY
Address 457 ELMHURST LN
Contractor.
Address: \
COSTA MESA, CA
-. ISSUED BY:
Phone: 714-556-2732
Zip: 92626
Phone: 714-556-2732
Zip: 92626
Phone:
Zip:
License:
Status: ISSUED
Applied: O6/04/2001
Issued: 06/04I2001
� i ,SCOPE OF PERMIT, - ` ' -� ,
MISC EIECTRIC WORK IN KITCHENdO�INCLUDE: 5 LIGHT FIXTURES,'1.1-OUTLETS, 4 SWITCHES. ,
''FEE SUMMARY , • •
,,
,Duantity -__ - ,� - ' _ - j,� ,�-` ` - , Quantity %� � � ,
$23.50 1 Temp Dist System / Lighting $0.00 0 �- �-
$0.00 Busway I100 ft� $0.00 0� %� i�
$0.00 � Standing Section-• �� $0.00 0 � ` , �
$0.00 0 Misc Electncal Equipment $0.00 - 0'%� �
$0.00 0 �-� Transformers up to t kva/kw $0.00 1;0� �' ,
. .�,. .. , , '- �
. � � $0.00 0 _-� ,; %..' ..� ..:..:........up to 10 kva/kw $0.00 .���„ p , .
.• . , ,
�,$5.50 5 • :'�' - _ ......_..:..i.::up to,50 kva/kw $0.00�,:' 0 �
�$12.10 11 •. " . - `....:.upto;100kva/kw $O.00�i 0, ',
$4:40, . � -�,;. � 4: � � .�. �. ` ::..over 100 kva/kw ;y�" :$0,00� 0= ,'� -
, " $0.00 �_ � 0� . - - -Low Volt2ge Equipment � � $0 00 , . 0 � %
�' i/ $0.00�,��� 0 c_ �. � , : � � �Low-Volt Winng SyStem / Ck� r$0.00,.� 0 �;
;/ $0�00 ,0`� , - Misc.'Conduit . -����$0.00_�-�%0 �.%i
' C/
ISSUE FEE
Temp service test
Res. a/c package �
New Res (7-2�units)
New Res (3+units)
Pool / Spa �
Lighting Fixts _
Recept Outlets
Switches "
Non Res Appl'
Res Appl ` � , ��
Service to 200a � ��
Service to 7000a �.
Service over 1000a �
Motors to 1 hp �
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
$0.00 : ��-0���;=�_� " ' MisaConductor.=_.%� �-$0.00�', 0/ 'i!
� $0.00 �� : � 0� - ` - ` " . � Cirws ( gen�or �ide)�' � �, � "�$0.00,� .-0 � i
so.00 o. c��o�5 �meon ��de o� i�ent5> �.` so:oo .= o;�
�$0.00���' -,� 0� � � Christmas.TreeStand�� �,�' $0.00:;. �0
- �$0.00 � �- 0 ,� � - � 'Fireworks Stand }'�, �. > • ; $0.00,% 0
$0:00� .��' 0 ' ' �Othei Electrical�Fee- - � i� $0.00
$0.00",.`..�:...0 .. . .. � .,.,�i �.
�
$0.00 � -0 -� .� _ Investigation�Fee��'�:� � $0.00
$0.00 0 � - . � - " - Plan Check Fee. - $0.00
$0.00 0 ' -Reinspeclion Fee $0.00
$0.00 0
$0.00 0 TOTAL CALCULATED FEES $45.50
$0.00 0
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 1 BO days, or i( work is suspended or abandoned
for a period of 7 BO days.
INSPECTIONS: In order for ihe work auihorized under this permi� �o be considered legal, such work must comply with all applicable codes, and all
required Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2446d61N00)
WORKERS'COMPENSATON DECLARAr�N: .
I hereby ettirtn under penelry of perjury one oi Ihe tollowing declarations: �
❑ 1 heva and will meintain a certificate af consent to selt-Insure for workers' compensation, es pwdded for by section 3700 of the Lebor Cotle, for ihe pedormanca of the
work for which �hi5 pertnit 191uu80.
❑ 1 have entl will maintain workers' compe�setioq uis�urance, as requiretl Dy section 3700 of Ne Labor Cotle, tor Ne pertortnance of the work for whicli this pertnit is Lswetl.
My workers' co% p�n�u%'�on nsurance �V�J �poliry number are:
Cerner / i 1//lL� ��� "` , Policyivumber �
�(Th/s cN�r% nof e mp s e i7 the ��t /s ve/ued et one hundred dollars ($700) or less.)
certify thet in the peAortnanca oi Ihe �'o�k tor which this permit is issuetl, I shall not employ any person in any manner so es to 6ecome subject to Ihe workers'
compensetlon laws oi CalNomia, enC 98�ee Ihet ii I should become subject to ihe workers' compensatlon Dmvisions ot Sectlon 3700 oi the Lebor Code, I shell forthwlth
ApPlirantnSg e1Nre:eseqwqsi�a l� /�u� Dare: lL� /T/�i �
�/ �/T�
WARNINO: FAILUiiE TO SECURE W RKERS' COr�PE�ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP�OVER TO CRIMINAL PE TIES D GVIL FlNES UP TOONE HUNDRED
TYIOUSAND DOLURE (5100.000). IN ADDITION TO TME COST OF COMPENSATIIXJ, DAM4GES AS PROVIDED FOR IN SECTIIXJ 3]O6 OF THE L4BOR CODE, IN(EREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I em licensed under prmrisions ot Chapier 9(wmmencing with Saction 7000) oi Dlvlsion 3 of t�e Business and Professions Cotle, antl my license Is in full
force end eflect Lic, a Class q
Contreciofs Signeture: Da�e:
CONSTRUCTION LENDING AGENCY:
❑ I hereby atlirtn that ihere is a construc��on lending egenry tor the performance of Ihe work tor which ihis permit is issued. (Sec. 3097, Civil Cotle).
LentleYs Name: Lentler's Atldress:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby eNirm that under penalry of perjury Ihat I em EXEMPT FROM TME CONTRACTORS LICENSE LAW tor ihe tollowing reeson (Sec. 7031.5, Business antl Professions
Catle: Any ciry or wunry which requires e permit to constmct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant tor such pertnit
to file e signed statement thet he or she Is Il�eosed pursuant to ihe provisions of the CoNrectore License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Code) or Ihat he ar she is exempt therefrom anC Ihe basis for the allegetl exemption. Any viola�ion ot Section 7031.5 by eny appliwnt for e permil
subjects Ihe eppliwnt to e civil penelry oi no� more than five hundred dollars ($500).):
❑ I, es owner of the proparry, or my emp�oyees with wages es Iheir sole compensation, WILL DO THE WORK, and ihe structure is not intentled or oHered tor sale (Sec.
7044, Business and Professions Cotle: The Contractors License Law does no� appty to fln owner of property who builds or improves thereon, and wno does such work
himself or herseN or thmugh his or her m+'n employees, provided that such impmvemenis ere not intentled or oflered for sale. If, however, tha builtling or improvemem is
soltl within one year of wmpletion, the owner-builder will have the burden of proving that he or she did not �uild or improve for purpose of sale.).
❑ I, es owner ol lhe property, em EXCLUSIVELV CONTRACTING WITT1 LICENSED CONTRACTORS to construct the project (Sec. 704d, Business antl Professions
Code: The coniractare License Law tloas not appry to an owner of pmperty who builds or Improves thereon, and who conirac(s tor such pmject wi�h a contrector(s)
license pursuant to Ihe Contractors LiGense Lews.).
❑ I am exem
Signature: �
Owner ID veniied by
sec.
license. ❑ V�s ❑ No
Bu5in8SS antl Prof855i0ns COde tor �his rea5on:
Venfication o1 Ownership by (type of document, i.e. - pmperty tax bill or deetl):
Driver's License No.
S!Y3C��Lr'����
DIVISION OF INDUSTRI/LL SAFETY PERMR CER7IFICATION:
❑ I hereby certity ihat no eacevation tiva (5) or more feet in depih into which e person is required to descenq will be made in connection with work authonzed by this
pertnit, end Ihet no building struclure, scattolding, falsework, or demolition or dismantling Ihereof, will 6e more Ihan ihirry-six (36) feet high. (Chap. 3.2. Grp 2, Art 2, Sec.
347, Title 8, Calilomia Adminlsirative CAde).
❑ As owner�builder, I will not employ enyone to do work which would require a permit irom the Division of Industnel Safety, es noted above, unless such person has e
permit to tlo such work from the Civisi0�.
Signature: Date:
DivLsion of Industnal Safery Permil Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: I certity under penalry ot perjury ihat I have reatl this application and state that the information given is
wrrect I agree to compty with all state Iaw4 and ciry ordinances relating ro builtling construction, and authorize represeniatives of the Ciry of Costa Mesa to enter upon the
above-described property or i ction puryqsgs.}�'egree n o occupy or allow occupancy of any building authorized b this rmit u til final inspection.
�, � � %%a�
Signaty e Of Legal Owner(s) ��'I Date
And/OrAuthorised Applicant ' Date
COOE 1. INSFECTONTYPE 2ff. INTITIALS
1616 Flxad System Final Fire Prevention
1286
200
201
202
203
204
Pool Spe Final
Final Re-Root
Final BIocWRetaining Wall
Flnal Factary Fire Place
Final Sign
Final Demolition
CODE 1 INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuildinyOccupency
QeL INi1TIAL5
�'�
,� PflOJECT AO�NESS: Q S i ELMHURS T LN
OWNEF1'SNAME: �MITH, HAL W JR TR
aoonEss: q57 ELMHURST LP]
COSTA MESA,CA 92626
�
%�
�
"7
546-0037
FflLM/ENGINEEB:
FOUPESS:
flEG.NO.:
UNIT:
UNIT:
PENMITTEE: SENTRY ROOFING CO (714)751-7663
aooaess: 3364 NEVADA
COSTA MESA CA 92626
LICENSEO CONTXACTOB OECUIHATION: I hereby a�firm iha� I am licensetl un0er pmvisions of Chapter 9(commencing wi�h $ec�ian
7000) ol Division 3 o�ihe Business and Pmtessions Cotle, an0 my license is in �ulliarce and et�ect.
cirvuc./: 0/6092 STqTELIC.:G%SHOL(��,,,� c s: C-"' EXP: 1�/99
Daie: _V/��f Si9nature'. _/_l_��/L�
WOflKENS�COMPE RTION OECIANATION: I hereby aHirm Ihat I have a cenilicaie ol consent m 5el4insure or a cenifica�e oi Workers'
Compensation Insurance. or a cenilietl copy ihereol (Semian 3800, Lab. C).
POLICY NO.: E%P. DFTE:
COMPNNV:
� Cetlilietl copy is �ereby fumi5he0. ❑ C¢rti�ied coDY i5 �ileA wilh �he ti�y Building �ivision.
Uate FppliwnL
E%EMPTIONFHOMWOHREBS'COMPENSATION�ECLAHATION: (Thissectionnee0notbecompleteUifihepermitisioronehunare0(510�)orless�.
I certi�y ��ai in Ne pedormant¢ ol Ihe woB �or which Ihis Dermi� is i55ue0. � Shall not pl0y any p On in any mannef 5o as to beCome
subject Io the W rkers Compensalion Laws ol Calilomia. `!j �
Date: o'%3✓q� Signa�ure: B/
NOTI : II aiter maWng Ihis aeclara�ion, you SAOWa �ecome sublec� to �Ae Warkers' Compensaiion pmvisions of �Ae Labor
Cotle, you mus� Iotlhwilh comply wi�� such pwvisions or this permit s�all be deemed revokeA.
CONSTNUCTION LEN�ING RGENCV: I hereDy a�firm Ihat Ihere is a consimction lentling agency for Ihe Dedormance ol Ihe woB �or
whlch this permlt 7s i.suetl (Seclian 3097. Clv. CJ.
LENOEfl:
aooxess:
OWNEfl BWLOEP oEClAHA7lON: I hereby alfirm ihat I am exempt irom the Coniractors' State License Law for the following reason
(Settion 7031.5 6usiness antl Pmiessional Cotle. Any tity o� counry which requires a pe�mil �o coretruc�, al�er, improve, demolish, or
repair any slmcture. Orior to its issuance. also requires ihe applicant tor sucn permil to tile a signetl statement ihat helshe is licensetl
pursuant �a the pmvisions o� Ihe Coniraclors' S�ate License Law (Chapter 9 �commencing with Sec�ion 7000) of Division 3 0l �Ae BuSinesS
and Pmfessions Cotle� or �hat he/she is eKempt ihereimm and the basis for Ihe alleged exemption. Any violation oi Seclion 7031.5 by
any applicant lor a Dermit suble��s ihe applicant to a civil penalty ol not more tAan five hunaretl tlollars (5500).
I. as owner oi me owoenv or my employees with wages as Iheir sole compensa�ion, will do the work, and �he
❑ stmctureis notintendetl orofleretlforsale�Section 7044, Business and ProfessionalCotle'. The Contractors' State License Law
tloes nal apply �o an owner of a Dropehy w�o builtls or impmves thereon, and who Ooes such work himself/herself or t�mugh
his or her awn employees, pmvided t�ai such improvemen�s are no� in�entled ar offereA tor 5ale. Ii, however �he builtling or
impmvement is saltl wi�hin one year oi complelion, �he owner will have ��e burden oi proving he/s�e did no� build or impmve
tar �he purpose al sale�.
I. as owner ol ��e pmperty. am exclusivety coniracling wi�h licensea contrac�ors �o cans�mct the Dmlec� (Section 7044, Business
❑ and Pmfessions Cotle: The Conlracmrs' Slale License Law tloes nm appry lo an owner o� DmpeRy who builOs ar improves ��ereon
an0 who contrac�s br such pmlec�s wi�h a coniractor�s� license pursuant b the Con�rac�ors' S�aie License Law),I am aware
Ihal pm01 Of Iheit Worker'S COmpensa�ian insuranCe Shou10 be D�oviOetl Io m¢.
� I am exemp� untler Section: 8. 8 P. C.
for ��is reason:
Date: Ownec
I tlo hereby cer�ify Ihai I am aware o� ana under5tan01he requiremen�s o� Cahfomia Heal�h ana Safery Code Sec�ions 25505. 25533, antl
25534 ana I�at I or any INure buAtlmg occupani will/will nol (cirde one) need m comply vnih saiG state cotles antl Ihe reQuirements tor a
permit for conLmclion or mo4ilication Imm Ihe Air Oualiry Managemen� �istricL Besitlen�ial constmction applications are exemp� �mm
Inese pmvisions.
�ate: Applicant:
I hereby ceilily Ihal I have read Ihis applicalion antl sla�e Ihat the above inlorma�ion is correcL I agree to comply wi�h all ciry and couniy
ortlinances and sla�elawsrelalingio builtlmg ConsimClion ana herepy aul�orizer¢presen�atives o��his ciiy L nler u0onlhe abOve�men�ionea
V��Pe�iy �Or in5peciion p rpo5¢S. iI/( "„ l
�aie'. �/_% �9� Signa�ure: Cs
i
onver's �icense ar Socia� 5ewri�y
16aba6 White—Bmltling'. Green—Cotle Entorcemen��, Canary—Applican�; Pink—Revenue', GoltlenmE—Assessor
PERRIIT NO: B 067
CONSTRUCTION TYPE:
JOB DESCRIPTION ,
CITY OF COSTA MESA — BOILDING FEP.PIIT
66 PLAN CHECK NO: N
5—N PERMIT TYPE: STR
T/OFF REROOF W!COMP SHINGLES
FERM NO: B 067556
GOVT: N SUFP: N
PURPOSE: ALT
SQ FT: 6,735
CLAIM t,�ALUE: 6,735.00 CALC—VALUE: 6,735.00 GROUP C�CC: R-3 /M-1
COMMENTS: SMOKE L�ETECTORS ARE REQUIRED AS PER 91UBC, REROOF 3162SF RESIDENC.
+�*��c�r�r*r*ir**�-*+��+�***+�**�v�x****�r*+��-*****+�**�r�t*�**�**�+��*�***�-**�+�*�x-�r- �,r�u��.���. ,�,.,�
Z O N I N GS ERTEBQAUCIKRSE M E N�'MOKE �G'1't�R
------------ MAIN BUILDING ---------- --------- ACCESSORY �cIEQtltRED------
FRNT; FT IN REARc FT IN FRNT: FT IN REP.P.; FT IPd
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ; PROV: FAP,CEL: 14137226 ZNE: REF NO:
PLANNING NOTES> ,
>
ac-i�itiE*if�tlE�fic*a3c-ih*1E#�3(�**iEi�u��E�t*�fc*i�**i��E+F�Eatici��E�EiEifi��f*if�cifiEiF*i�*+ti��f**iE�t-iF�E*�c�%x�fE�3E.ic�i�iE*ic��r�*ar.i(�x�
D E V E� L O P M E N T S E P. V I C E S R E Q U Z R E M E N,T S
ZONING AFPROVED BY �
BUILDING APPROVED BY
APPLICATION ISSUED BY
3E if iF iF if if iE iE if iE if iE iF 9E iF iE iE iE if iE iF
�E iE 1f iF %if if i.` iF iE if iE jE iF iF 1F if if iE iF jc
LEGALIZATION:N
9
C
L1ATE :
DATE: '�
�
`,�' �*��D���*���1 3��I�{.��
if iE iE iE iE iE af jF i!!E jf 1E iE ��f iE iE iP if � ac ic *�4 if iF iE �1F if #� if iE iE ip 3E it # iF iF �E iF aE if iFlf iE if ?F �4 aE
F E E S U M M A R Y STRUCTURAL SEGMEPdT:Y
BLDG PMT PLUMHING ELECTRIC MECHANiC FIRE SMIP/RES GRADING
PERMIT 90.00 ,6�
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT IS5UE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 90.67 0.00 0,00 90.67 90.67 .00
REVENUE DIC'ISION TOTALS--> COLLECTED: 90.67 OVEP./SHORT: .UO
BL�90P00 FLUMBING ELECTRIC f1ECHANIC FIRE SMIP/TO� GRADING PLAN—CHECK
1E iE it 1f iE iE iR iE iE it iF 1E it %1E iE if ih if fl� iE iE �1f if � if M �F �)f �(-if -1h if �lf it iF itlF # if-jf �lE iE iE iE if iE iF if iE 1E iF af if ic �)f iE if iE iF aE r�h iE 1E itlf 3E iE 1E ic 1F iF iF ii� aF iE �f- aE
I N D I?� I D U A L F E E B R E A R D O id N
TYPE
SFR
QTY
6735
D E S C R I P T I O N
REROOF BY VALDE RESIDENTIAL NOZONE
ENP OF FEES
�
UNIT COST TOTAL COST
1.00 6,735.00
01 00162133—OQ162134 T 4 T 40.67
DATE: D6/13/94 TI14E: 09:14
/
%
f �
� i '�, � � `..
CONSTRUCTION ANDPLANNING POOI PA
APPROVALS Permit# �ate Inspector p,ppROVALS Permit=.'k Date Inspector
1. Temporary Electrical Service�or Pole �"� 52. Pooi & Equipment Locaiion
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. 54. Forms ';%'
4. Electrical ConduirUndrgrnd, 55. Electrica� 8onding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUN�TE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation ii '� - 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. '� ' � 60. Backwash Lines, P-Trap, L� Undrymd. ��
,i
t0. Struciurel Floor Svstem �!� 61. APPROVALTO DECK !
11. Property Sewer line & House�,,Connection 62. Backwash & Recep.or�finai
�
72. Sewer Cap . 'j 63. Heater & Vent-Final "
13. Roof Dra�ns � 64. Plumbi�g System - Finai '
14. flough Plumbing 65. Electrical�Final
15. Rough Electrical-Conduit 66. Solar SVstem-Pinal
16. Rough Electric Wiring 67. Fencing & Access Approvai
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Bar Ceiling 69. POOL(SPA SYSTEA,IS PINAI
19. Rough Heating & Air Conditioning F4RE DEPT, REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Siructure 70. Underground HYdro
22. Ducts, Ventilating ?7. Product Piping � Gas � Of�
23. Gas Pipe�Rough & Test 72. Underground Ftush
24. Roof Frem�ng 73. Undergmd. Storage Tank O Gas J Oil
25. floof Sheathing G-��-qY �� 74. Overhead HVdre
26. T-Bar Ceilinq (Siructuraq & Monocoat 75. Dry Chemicai i
27. Frame and Flashing 70. Dry Standpipe I
28. lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIftE PREV. FINAL
30. Drywall f^laiiing HEALTH DEPT. REQUIREMENT
31. Piasrer BroKm Coat 79. FINAL ��SPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATc ISSUED �
33. Final EleCtric Notes:
34. Final Heating & Air Conditioning
35. Fina� Gas P�De-Test
36. Hood or Canopy
37. Final Factory Fireplace ��-{ l
38. Final Plumbing ,� `
39. Water Service�Finaf
40. Gas Service�Final
41. Solar �omesticFinal
42. Backflow Preventer � � ��
43. Backflow Irrigation `..� ��,
44. Landscape Irrigation ,e� �
45. Sound Aitenuation m
46. Handicap Regulations' ,
47. FINALSTfiUCTUR '�DING 4-,L��q(.� �(,�j�
48. FINAL PLANNING � -
49. Electric Release to E� n�`' �
50. Gas Release to Sovth �^ Cafitornia Gas Co �
51. CERTIFICATE OF 0 �UPANCY
No. Date �
Aaolicant to fi11 in all spaces excepl those witnin heavy bortler lines antl sign a11 appropriate tleelarations.
CITY OF�COSTA MESA CONSTRUCTION PERMIT ••• . PERMIT NO. TRACT NO. LOT NO. UNIT NO. P#
_. � Pcoject Ad�ress �S'I E�M�luR57 p � � _
Apylicant'sMailingAµ�fdress P�c.3`i� l+.H. IZVi�O
' Owner's Name ' `A'�- �1,.�. �� T Phone
.Address �1 �'��^'��r G.}�. �
. Arch/Eng. —_ License No.
� Add�ess
- Contractor's Name �,�� yG'��[ ZQ- E�/+�Gu LG� pno�e -�11
ACJdf255IT2111f1JI�a/' �O� `�'• '� I��
. City License No. � 1��
• LICENSEO CONTRACTOR DECLARATION
I hereDy atfi�m lhat I am licensetl untle� p�ovi51on5 ot Cha�te� 9(commen<ing
with section 7000) of Oivision 3 of [he Busin¢55 antl PrOfe55ions Cotle, antl
my license is in tull forGe antl effect. ��
License ass..� � '� License No. � �%�
Date��iL�j c��ar .
WORKERS'COMPENSATION DE ATION
' I hereby attirm that I have a certifi ate o/ consent to selt-insure or a certlficate
Workers' Compensa[ion Insuranw, or a certifietl copY thereof (Saction
' D0, Lab. C.) , '
. . rolicy No. Company
eCertifietl copy is hereby furnishetl.
Certifietl copy is (iletl with the city Builtling Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be complete0 if the permit is tor one huntlretl ($300) or
less).
- I cer[ify Na[ in the p¢�formance Ot thE work Por which thi5 p¢rm�t i5 i55uetl, I
Shall no[ e ploy any person in any ma ne� 50 as to become subject to the
Workers'A pt� n Laws of Califomi
' Date __�i�f1 DJ__Si9nature
NOTICE: I after making this tleclaration u houltl become subject to the
Workers' Compensation provisions oi, th Labor Cotle, you must forthwith
comply with such provisions or this permit shall be tleemetl revoketl.
' CONSTRUGTION LENDING AGENCV
I hereby af(irm that there is a construction lentling agency for Ihe performance
� of the work for which thi5 permit i5 i55uetl (SeCtion 309] CIv.�C.)
Lentler's Name
Lentler'S Atltlre55
OWNER BUIIDER DECLAHATION
I hereby affirm that I am exempt irom the Contractor's License Law for the
followinq reason (Settion ]031.5 Business antl Professional Cotle: Any city or
munty which �equire5 a pe�mit to con5[ruct, al[e�, imprOve, tl¢molish o� �epair
any slructure, prior to its issuance, also reqW�es the dpplicant to� such partnit
to file a signetl Statement that h¢/She is licensed pursuant to the provi5ions of
tne Con[rac[or's License law (Chapter 9(commencing with Section ]000) ot
Division 3 of tlte Business antl Professions Cotle) o� that he/she i5 exempt
, -eretrom antl the basis for the allegetl exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil -
.nalty of not more than five huntlretl tlollars ($500).
L� I, as owne� ot the p�operty o� my employees with wages as thel� sole
compensation, will tlo the work, antl lhe structure is not intentletl or o(teretl
for sale (Section �044, Business antl Professional Cotle: The Contractor's
License Law tloes no[ apply to an owner of a property who builtls or improves
thereon, antl who tloes such work nimseli/herself or through his or her own
' employees, provitletl that SucM1 improvements are not intentletl or o(feretl for
sdle. It, noweveq Ihe builtling o� improvemen[ is soltl within one year of com-
pletion, the owner will have the burtlen ot proving he/she tlitl not builtl or im-'
�rove �or the purpose of sale).
I, as own¢r of the property, am exclusiv¢ly mnt�acting with licensetl con-�
tractorsro construct the project (Section 704a, Business ana Protessions Cotle:,
The Contractor's License Law tloes not apply to an owner ot property who
builtls or improves thereon. antl wnu contracts ior such oroiects with a ron-
tractor�s) lmense purtuant to [ne Contraccor's License Law). I am aware�tnat
proof ot their Wo�ke�'s Compensation insurance shoultl be p�ovitletl to me.
❑'I am.exempt untler Section B. & R C. for this reason
Date Owner
I hereby certity tnat I have rea�
information IS COfl2CI. I d9(CC f0
antl state laws relating to builtlir
sentatives of this City t n er
inspection purpases.
Si9nature . �
Drivars' License or SS
] this application antl scate that the above
comply with all tlty antl munty o�tlinance5
g constructlon', antl hereby authorize repre-
upon the above-m¢ntionetl p opGr y for
� Date�
��
E 3 s95 �
TYPE OF CONSTRUCTION NEW ADD ALTERATION
❑ CONVERSION ❑ �EMOLISH ❑ �THER
. DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT, oCCUaANCV—
..CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs �.
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspectian Fee � $15
Boiler - -' .
Duct-UnderGround
Duct - S[ructural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting'
❑a � oo,000 sTu 0 i oo,oao
Reinspection Fee � $15
0865-46, rev. 5/88 WM1ite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service.Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System �R epair/Alteratio n
F ire Dampers
Registers
Issue Fea
R'
FEES
i
$ 3
FEES
$ 3
A. .
S Main Buildi
E
T Front
B Rear
A
C A�ght
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$witCh¢5
Garbage Disposal
Generator �0.5 KW �
2one
Parking Req./Provided
ELECTRICAL _
Transformer ❑ 15�50 KW
❑ SO+KW
� Meter up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors OP7 HP �1Yh-8
InaSolar �9-15 HP �i6-15+
Microwave
Pole Light
Standing Sections
15 KW Trash Compactor
� Reinspection Fee '$15 � I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APProved By �
Building Approved By
Aoolication Issued Bv ..
SUMMARYOFFEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE
PLAN CHECK 25% $ � ENERGY P.C.
ELECTRICAL $ �3.Sd GRADING
PLANCHECK 50°� $ MICROFILM
MECHANICAL . $ TOTAL FEE
PLAN CHECK 25% $
a
N
O
N
I
N
G
R
E
Q
M
T
S.
FEES
f#1 OOQ27p53—L�002705$ "fn_i'j' ",SC�.-
�?ATE� �fi/24/39 TIME: 14:09
. . . M✓ �� .. �;..,. .-. � ?r''�..- .l.�:v_a�.;.-. ' � _ _W.. �yi . ,^ s.+,,: :l^ ....-_ y„"" :,'ls�"cai y_;4" la+. u• ti � _
3,F
cONSTRUCTION AND PLANNING - POOI PA ,
APP�tOVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
'- 1. � mporary Electrical Service or Pole . `•� 52. Pool & Equipment Location - ' �
2. Soil PI'p'e-Ui�drgmd. ',� ?" 53. Steel Reinforcement �
3. Electfical Conduit Utility•Undrgrpd. - 54. Forms �
4: Electrical Conduit-Undigrnd. ; , 55.°Electrical Bonding ��,-,
5.•Steel�Reinforcement � � 56. Rough Plumbing & Pressure Test ��
•i v
6., ElecSrical UFEfl'Gind. �� 57. APP,ROVALTOCOVER-GUNITE �,,�
�:Footings �� � �_ _ �� 58. ElectricalConduit-Undrgrnd. :F
8: Foundaiion ': .r �t 59. Gas Pipe, O Undrgrnd., Test '��
9•' Water P(pe-Und�grnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10� Siructural Floor System 61. APPROVAL TO DECK
11. Property Sewer Lirie & House Connection 62. Backwash & Receptor-Final
12. Sewer Ca ' - '
P :Y. .r� 63. Heater & Vent-Final
13. Rbof Drains n. �; 64. Plumbing System - Final �-
14. Rough Plumbing; 65. Electrical-Final "
75. Rough Electrical-Conduit � -66. Solar System-Final
16. Rough Elec[ric Wiring 67. Fencing & Access Approval -
�. Rough Wiring Sign 68. APPROVED FOR PLASTERING
i18-. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19� Rough Heating & Air Conditioning FIRE DEPT.�REQUIREMENT
n� > .c
�0. Rough Factory Fireplace � , � APPROVALS Permit #
1..
�271. Ducts, in Structure %; � 70. Undergraund Hydro
22. Ducts, Veniitaiing ^ 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test t � 72. Underground Flush �
24. Roof Framing S 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing '�� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe
28: Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
J
31'Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test '
36. Hood or CanopY .
37. Final Factory Fireplace
� 38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ' -. VJ
4ti
43. Backflow Irrigation -;} � ��}
44. .Landscape Irriqation System , �� �
45. Sound Attenuation � �
46. Handicap Regulations � �� �
47. FINAL STRUCTURE & BUILDING , '�1i
48. Special Requirements Completed
49. Electric Release to Edison . � .� �� �
50. Gas Release to Southern �ylifornia Gas Co �'. "4,'
51. CERTIFICATEOFOCCUPANCY •�' '�' ��' �U
..� ti
No. Date . ii-•
CONSTRUCTI�N LADORATL7RIES, ING.
MATEq1AL5 TE5TING - JOB INSPECTION - ENGINEERING RESEARCH
1ob:
Locafion:
Uni!:
Architect:
Engineer:
f.ontractor:
4475 BANDINI BOULEVARD
Phena: ANgal�� 9-3183
l05 ANGELES 23, CALIFORNIA
r�s yecw�
RFPORT O{�1 CONCRE7E CYL?NDER TESTS
Swimming Pool
457 Elmhurst, Costa Mesa
Pool No. 138
Tibor Gymes
Blue Haven Poole
J. T. MELBLEV
OENCHAL M�N.�OE9
Date; August 21� 1962
' August 26, 1962
Sept. ll ]`Q62
Permit No.: i�bU7
File No.:
Application No.:
--�-------._------- _------------_ — -- --
Date of Pour: 8=i$.362 ''9 10
Dute Received: 8-16-62 � 4► lr
Source of Aggregate: Con Rock RECEIVEO
Brand of Cement: Permente n N
Admixture: None SEP 14' i962
Location in $tructure: P�ols c0 City of Costa Mesa '�
Concrete Mix: 1�4•5 Building Dept.
Slump in Inches: s ti
Time in Mixer: �� �
Cylinders Made By: K. A. Lee
Design Strengfh P.S.I.: 2��
Laboratory No.: 563'73
Age of Cylinders, Days: %
Mark on Cyfinders:
Dafe Crushed:
Diameter, Inch�,:
f\rea, Square Inches:
Maximum Load, lbs.:
Crushing Sirength, P.S.I.:
56374
14
//1 N2
8-zl-bz 8-z8-bz
5.85 5.60
26.87 z4.63
k2000 47000
1565 1910
�i�
� /y � �._
T i�
ec: 1-Dept, of Bldg. & Ssfety (Coata Mesa) Resperttuli�� �ubmit3ed,
3-Blue Haven pools
56375
28
#3
9-11-62
5.30
zz.o6
46000
z085
� ����--
Te�tinq ond Inspection FngJneers
•;;, �G4sta Mesa Bnilding Department
117 EAST 20th STREET
,�� COSTA MESA,-CALIFORNIA
I �O]R APPLICANT TO FILL IN
Costa Mesa, California
Ownerr�l 1 aaF
Mail "
Address ��.� p
City .4antg pr
Arohitect or
Engineer
ddress
ontractor HAS�
Address aama
Legal I Lot
Descriptfon No.
(Attach MeSes and
Size of Lot 6�
B
LIC.
Block I Tract
No. of
Addition
Stories
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply
with all City Ordinances and State Laws regulating
building cronstruction.
3ignatureof
Permittee Harbor Const�tcti�m Co.
Valuation
$ 1?�4��.
pM�204 S-HP 2M 6-5
Permit Fee $ .�D •�
Plan Check $ �S
Total (�
Fee $ J
APPLICATIOAT FOR PERMIT
���� BU LD NG �
FOR OFFICE USE ONLY
I Receipt No. Permit N�
.� 9 �,
i
Costa Mesa, California
Date
CORREC�'IONS
L�PPRo�EiLs
�n Location Inspecto
Materials,
>inning
re Stops,
, Bolts
n
, �_ . . �� ' . . .. � .. �_ • - °_ _.. ' ' `
' _ t� ' ' " • M" �" " � _""_ �"' � - ' . . . . �,' � .) . .- � .. ; • ` �t i(-
� ) _ ' " " """ . . �� _� . � . . _ _ _ . .. . ,
u� i " " " _ " ' ' _ ' _ _
C G� " .. .
• J " .. . � ' ' . . .. .
' a . , �•'� . , J ... ' ___'"' "_ _ _ ' . . .
o � a ,_ .. _ _ � .r , ._ . _ .. _
�y` � - .. . L _.. - - - - - — --- — - � - . i �
i- - --------- —a --.,�� :?.. cnsrn ,,¢ . •', c_ ,
. . _. . . . . ,.n�._. �an�-Z.F1'�P�NESR ?S�Ca"�+"•;;'Y'�IJ-.��
� " .. __ _.____. _' . . ' ._' _' _ _" _,� _ '
' . ' . . . ' ' ___.�.. ' "_' _'.' ' ' . _.i" . "" .�.
_ . " '' _ ' ' �' '' '
,_ ,�: .
_ ' . _" " . . . .. " _ ''-,i_ . . _ ' ' _ _ ' _ '_ ' .
( _ �
i. _ .. . . . . - . . _ . _ . _' . " _ " _' _ .
, _ " " ' ' ' — ' . . . . . .. . r.[ : � . . .
I" _ ' . .. . "_ _ "' '. ' .
(. . _ `
Street . - --'I _. - � , , ' . — -- -' � - � ,'� 1 � � � 1
PLOT EI.AN . . _ - -s . - - - - - -- -
Bhow Iocation and tlistanees from �._ � .
, , �: " .
� property line and between buildings �
-- -- ' , -,. ., ' '. _ . ' •
- � - — - . - � - : ' _ . . - • ' . � .
.- ' -, _ ' -" _ � ... .. . �acc-.,'� . . . . � . , -
. ' ''' � -' - ---- —'" , ._ .
. . � . _ �� e � '��- ( r'„f.'f.�� 2 � .. _ ��. V . .. _
. . '� . . .. _ � r .n ' . �
� . �-. . ' T . � . . .:��I r. .
j- . ,.. . ' . '. . . . - � ' . f . ..
� ' _ _ . . _ "
' __ . .� _ ". _.' __ � ' ° •. = i �^. ' . .._� ..- . .
. ,, .
.-(.'.� � -_._' " " '.'. .
_ _ _ _' _. . . . . - . . . . � � '
. 4. -
:,
Ct�STA MESA BUILDING-SAFETY DEPARTMENT
- P. O. BOX 9f7 C08TA M6BA. CALIRORNIA
For Appllcanf fo Fill In Compleiely
� TYPE OR PRINT �
BUILDING "� �V� �G
ADDRESS
COSTA MESA CAWFORNIA
J .. . / / ...z �
■ MAIL
�
�� No. .5 9y�3 ��[ No� - 3� �J
SIZE �� �/ � TC� No. oR eLDo9.
OF LOT • 'A q/�Ja NOW ON LOT
Y�
BLTBACK LINE PFOM
cHHTeM OR BTReET � REAR YARD�
SIOE YARD I LEFT /G /��� I RIGHTV /
DESCRIPTION OF WORK
NE' I �+LTERATION I II ADDITION
REPAIR I IIMOVING 'I IIDEMOLISH
BUILDING/ `� NO. OF � '
81ZE C� �-1 ROOM6 STORIE
EXTERIOR WALL IROOF �'
COVERING COVERING
USE OF BUILDING AND WORK TO B8 PERFORMED
�•
FIRE
��E RECEev�u
JUL 2 4 t9s2
f�NANCE DEPT. '. /
CITY OF COSTA MESA ����
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
RECEIPT NO. P[RMIT NO
���h �
�r I onre necerveo I� � 1 iet/�
L_/n
�/ �ti 7 (X/li'I� /Y. w'
COSTA MESA. CALIFORNIA
ZONING �
NO.OR I U8E OP NEW
PUN9 1 / BUILDIN6
— YARDS
APPROVED
I (ClNTBR LIN! 8T.)
APPROVED
BY . . .
L�
EVES
U �
1 HERCBY AGKNOWLEDGE TXAT � HAVE R6A� TXIB APPLIWTION � TXE AMOUM BHOWN UNDER VqLUATION 19 FOR THC
AND BTATE THAT TXE ABOVE I6 COR � AND AGRE6 TO GOM•, pUFiP06E. OP, E9TABL19XING A vERMIT FEE ONLY.
PLY WIiN ALL Q HDINANC28 A 9TAT8 }AW9%� 6bLATNO � �
BUILDINO CONBTq ION. " •��`I • f1� . VALUATION
ll ` prl
SIGNATURE O � L[� �/ �� � PERMIT FEE $
PERMI'RE - �/ �
` $ ��� PLAN CHECK $ �/ ��
AU7HORlZED AGENT �
TOTAL FEE �'S�
w 27536
�� COSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O. BOX 7100 � COSTA MESA; CALIFORNIA 92828
1
For Applicant fo F711 In Completaly
TYPE OR PRINT
euao�Na
ADDRESS
COSTA MESA, CALIFORNIA
OWNER � . ' � I I \ /_I l.�
na / O `-'
V'�\�-/ • ! 1
/9 • R( � 3c• S�
o � i� � U
q acreweK una rnor
C
(SEP -G-67P;;°d0 121'� �. '' 1$.CO
ci.-a ''_:-_,•;
APPLICATION FOR PERMfT
BUILDING
For Off1ce Use Only
L Z)`�' I �U1N0 j� I OUILO NO W
/��` �II L[pAL /��'
�Tl! � U / fI D[YCIIIlTO � . ' �
iFT � R16HT
S�-
DESCRIP.TION OF WORK
S Z6 INO `2 � ZO
EXTERIOR WALL �QL
COVERIN6
YSH OF 0U ILDING ARO
1 HEREBY ACKNO{yL6D06 TXAT 1 XAV6 R6Ap Tf118 APPL�GTION
AND BTATE THAT TXH AlOV6 IY CORPBGT�ANO AORH6 TO COM.
PLY WITX ALL CITY ORDJN C[0 AND.Ty[P LAW➢ R60YLATINO
BYILOINO CONBTRYGTIO � 1 / 1/
SIGNATURE OP
�`,� � ' �° `<.�
PERMITTEB
AUTHORIZiD AO[NT
•. NO. / `� "� •S �/.=i ` �( L
f8: N06AV60VipHAN6SHALLBeLE88TXAN
'T081OB8ReARP.L � �
IE8
.OWBD ' N. B. C.�REQUIRHMENT7
YARDBMPROVBD YARDSAPPHOVHD
MAIN BUILDIN6 ACGEG90RY BUILDIN6
VAR.'J�
DATB
- - � rp � i • w
/1� FI
�
�
. BO. Ff. ,'�
0
TH8 AYOUNT BMOWH UNDBR VALUAi10N 18 FOR TXB j
�URP098 OP 6YiAGLIBH�NO A PERMIT R88 ONLY. .�l
VALUATION �
PERMIT FEE $ � � ^ p
0
s 3�0 , loj— w
TOTAL FEH $ /!/ �