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. CITY/O' r�STA MESA � _ _
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wv✓w.costamesaca.qov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE
APN: 13945514
JOB ADDRESS:
Vicinity: CLOSET
SQ. FT: 0
MECH
2861 EUROPA DR CM
PERMIT NUMBER: M12-00009
STATUS: ISSUED
DATE ISSUED: 01/17/2012
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: MECHANCIAL PERMIT TO REPLACE FAU > 100 K BTU LOCATED AT HALLWAY CLOSET. COMPLIANC
FORMS AT7ACHED TO JOB CARD AND CITY PERMIT. � .
OWNER:
PHONE:
APPLICANT:
PHONE:
ELSTEN,JUNE K
GANDARA,ANGEL
714-901-0500
CONTRAC70R: A PLUS HEATING AND AIR CONDITION
Address: 11330 KNOTT STUnit: PHONE: 714-901-0500
City/State: GARDEN GROVE, CA ZipCode: 92841
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $41.70
PLAN CHECK FEE: $0.00
INVESTIGqTION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $41.70
Add2ss: 2861 EUROPA DR Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit: �
City/State/zZip:
License No. 763154
CEL�:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 12-27-92)
EXPIR4TION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all appliwble codes, antl all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CODE / INSPELhONTYPE
1676 Fixed System Final Fire Prevention
1266 Pool Spa Final
2oo Final f�e-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203
204
Final Sign
Final bemolition
DRT IN_�$ C0� INSPEClIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
�
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
X v�A-I'la �
�
WORKERS' COMPENSATION DECLARATION: '
I hereby aRirm under penalty of perjury one of Ihe following declara�ions:
❑ I have and will maintain a certifca[e of consent to seli-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, !or the
peAormance o( Ihe work (or which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of lhe Labor Code, for lhe peAortnance o( the wnrk for which this
pertni� is issued. My workers' compensa�ion Insurance carrier and policy
number a /C�
�Garner��"�I le �� �
(Ths sectbn neetl nd be m>mpl�elee d Me permR is vaWetl a( one hundied ddlars (5100) oilessJ
tPolicy,Number: � � � �O S��
❑ I certify Ihal in the performance of the vrork for which this permi[ is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws ot Califomia, and agree that if I should
beco e subject to the vrorkers' c mpensation provisions ot Section 3700 of
the or Code, sha6 hwith ply with these provisi� s� �
APW�1's',Si�alure � Da��`�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IPfTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Pro(essions Code, and
my licen�e is in full (orce and eflect.
Li`c.-�#" _ _ � '�� G12ss�#."" - � ���
_ � _ . _�� ~� � �
Nrac�or's SignaWre (_. atel
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that ihere is a construction lending agency for the
peAormance of ihe work for wfiich ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender s Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I �ereby affrm that untler penalry o( perjury [hat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5.
Business and Pmfessions Code: Any ciry or county which requires a permit to
conslruct, alter, improve, demolish, or repair any strucNre, prior to its
issuance, also requires Ihe applican� for such permit to fle a signed statement
Iha[ he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Sec�ion 7000) of Division 3 of Ihe
Business antl Professions Code) or that he or she is exemp[ therefrom and
the basis for the alleged exemption. Any violation of Section 703L5 by any
applicant tor a permit subjects ihe applican[ to a civil penalry of not more Ihan
Me hundred dollars (5500).�:
� I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the sVucture is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of propeRy who builds or improves
thereon, and who does such work himself or hersel( or Ihrough his or her own
employees, providetl that such improvements are not intended or oRered !or
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving thaf he or she
did not build or improve for purpose of sale.).
❑ I, as owner o( the property, am EXCLUSIVELY CON7RAC71NG WI7H
LICENSED CONTRAC70RS to constmct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an ovmer of
property who builds or improves thereon, and wfio contracts for such prqect with
a contractor�s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
Signawre
]OS]-46�]IO])
. �� •
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (type o( tlocument, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excavation frve (5) or more feet in depth into which a
person is required to tlescend, will be matle in wnnecCan with vrork authodzed
by ihis pertnit, and Ihat no building struciure, scaffdtling, falsev✓ork, ar demolition
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Cali(omia Atlminisi2tive Code).
❑ As owner-builder, I will not employ anyone to tlo vrork which would
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a permit to do such vrork /rom the division.
APO�����'s SignaWre pale
Division of Induslrial Sa(ery Permi[ Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicaN or presenl or fuNre building occupant need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Sec[ion 25505 of the California Health antl Safe[y Cotle requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlard tempereture and pressure�.
2. Does or will the applicant Or present or fu[ure building occupan[ need to fle
a registration form tor acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the California Heallh and Safety Code, with some
exceptions, requires registration wi[h [he Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal lo or greater [han a weight of 500 pounds, or a
volume o! 55 gallons, or 200 cubic teet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or (uWre building occupant need to
prepare an RMPP (Risk Management antl Preven[ion Program (or acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Cosla Mesa Fire Departmenl may iequire the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous malerials with [he Fire Departmen[.
4. If an RMPP is presently required, has Section 25534 of ihe Califomia
Health antl Safety Code been fully complied wi[h? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is Ihe subject of this application a permi[ for such construction
or modifcation from the South Coast Air duality Management District or from
any other air pollulion control disMcl or agency? � Yes ❑ No
(Sectbn 65850.2 ot �he Califomia Govemment Cotle requires tha[ [he requestetl
infortnation be fumished on applications for non-residential builtling permits).
6. Will any part o( the faciliry lo be consWcted under this permit be wi[hin
1000 feet from [he ou[er bountlaries of a school? ❑ Yes ❑ No
(If'yes", the faciliry must meet Ihe requirement of Sections 25534 and 42303
of the Calitomia Health and Sa(ety CoOe).
7. If a permit trom the South Coast Air �uality Management District or other
air pollution control dislrict or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from the appropriate air pollution
conirol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaNre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this appliwtion and sWte that
the informalion given is correct. I agree to comply vrith all state laws and city
ordinances relating ro building constmction, and authonze representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
' Siqnawre of L i e s) � te
.�. �/�
AnG] fwi�odzeAAPP���anl l.r � �+,Oele'
Site Address:
2861 EUROPA DR. Costa
� Furnace
Indoor Coil
Condensing Uni[
� Other <= 4p' Di
Mesa, CA 92626
List Minimum
� qFUE 7 %
SEER
EER
� equipmenf being insl
�ncies: 13 SEER, 78 %
r . �
008 Reside�
�
Enforcement
Ci[y of Cos[a
Conditione
Area
HVACAIterations CF-iR-ALT
]an 17, 2012
Thermostat
COP Served by system � Setback
HSPF 3000 sf !f not already p�esenf, mus[ be installed)
Resistance —
-more than one
7JHSPF Ior ryp
RS VERIFICATION SUMMARY Listed below are THREE HVAC alteration Options. The installer decides what work is being donF
I picks one of the appropriate Options. Each Op[ion lists the HERS measures that must be conducted. A copy of the forms shall
left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work lis[ed on this
n was in fact the work completed by the ins[aller. The inspector also verifies that each appropriate Cf-6R and registered CF-4R
ns (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-1R
i CF-6R shall also be on site for final inspection.
1. NVAC Chanqeaut Required Forms:
replaced
forms: MECH-04, MECH-2
forms: MECH-25
. �onaenser �mi mm �or CF-6R forms: MECH-04, MECH-25-HERS
. Indoor Coil and /or CF-4R forms: MECH-25
. Furnace
°or Split Systems: RC, CCA >_ 300 CFM/ton, TMAH
°or Packaged Units: No Testing Required
� 2. New HVAC System Required Forms:
. Cut in or Changeout with �
new du�ts: (all new CF-6R forms: MECH-04, MECH-25-HERS
duLting�Q,�albnew„p CF-4Rforms: MEQH,zS,., •,,,�;an�wa��xaw;n:
�
3. N
Split Systems: KC, CCA 2 300 CFM/tc
Packaged.Units: No Testing Required
. I certify that [his Cer[iFica[e o! Compllance documen[ation is actura[e and complete.
. I am eligible under Di�ision 3 of [he California Business and Professions Code to accept responsi6ility for the design identified on this CertiFlcate o!
Compliance.
. I certify [ha[ Ihe energy features and performance spe�ifications for the design iden[ified an chis Certifica[e o! Compliance conform [o the
requirements o! Title 24, Parts 1 and G af the Califomia Code of Regulations.
. The design fea[ures identified on this Certifica[e of Compliance are consis[ent wiFh the information documen[ed on other applica6le romplianre
forms, warkshee[s, calculations, plans and specifications suhmitted to the enforcement agency for apOroval with the permit appiication.
lan
GROVE / CA / 92841
14)901-0500
Reg: 212-A0002'/71A.p0000000-0000 Regietration �ate/Time: 2012/O1/1'/ 13:3"/:59 HERS Ptovidez: Ca10ERTS, Inc.
2008 ResidenCial COmpliance Forme ,Tuly 2010
r
;
-� � � , . ;
CITY OF COSTA MESA
BYILDING DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Pax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B09-00177
PERMIT TYPE B_ROOF2
APN: 13945514
JOB ADDRESS: 2861 EUROPA DR CM
Vicinity: SFD AND ATTACHED GARAGE
Squares: 2400
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation
ISSUED
08/3'I I2009
BJK
$7,085.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING WOOD SHAKE ON PITCHED ROOF, 7/16" O58
SHTG, 1 LAYER 30# FLAT, APPLY GRAND SEQUOIA COMP SINGLES. 17 SQUARES PITCH 7:12 & 5:12
7 SQUARES FLAT ROOF: APPLY TORCH DOWN ROOF SYSTEM
OWNER: ELSTEN, JUNE K
PHONE:
APPLICANT: GARCIA, FRANK
PHONE: 714-001-6068
CONTRACTOR: COAST ROOFING
Address: 21681 IMPALA LNUnit:
City/State/Zip: HUNTINGTON BEACH, CA
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$O.OD
$153.25
$0.00
$1.00
$154.25
Address: 2861 EUROPA DR
City/State/Zip: COSTA MESA, CA
Address:
City/State/Zip:
License No.
License No.
PHONE:
License No. 450393
714-968-8754
92646 CELL:
PHONE:
PHONE:
Unit:
Unit:
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with ail applicable codes, and all
required inspectiohs and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the expiralion of this permit.
CODEN. MSPECTIONTYPP OqTE INIITIALS CODEN INSPEC710NflPE OATE IN1111AL5
1616 Fizetl System Final Fire Prevention 206 Final Mechanical
i266 PoolSpa Final � 208 Final Plumbing
200 Final Re-Roof � 1/,� 210 Final EieCtrical
7T—
207 Finai Block/R@laining Wall 2t2 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Builtling/Occupancy
WORKERS' COMPENSATION DECLpRATION:
I hereby affrtn under penalty o( perjury one of the following declarations:
❑ I have and will mainlain a certif�yte of consent to sel4lnsure for workers'
compensation, as provided for by gection 3700 of the Labor Code, for the
�ormance of the vrork (or which thls permi� is issued.
Gr I have and will maintain v.orkers' compensation insurance, as requiretl by
section 3700 of Ihe Labor Cotle. fw the pedortnance o( the v.ork for which this
permit is issue� Myyy worker ' c pensation Insurance carrier and policy
numberare:(\j � �
Carrier: � )
(TNssecfrnneetlroibe ' pletMdthepe�qi��aluedatonehundmC�9ars(5100)aleu)
Policy�Number: �� ��y(J� i��D
❑ I cerii(y that in ihe per(ormance of the work (or which tfiis permit is
issued, I shall e ploy any person in any manner so as to become subject
to the vrork ' co ensation I o( California, and agree that if I should
become s ject to e worke compensation provisions o! Section 3700 0(
the Labo ode, I fort �th comply vdth [hese pmvisio s.
Appiican[sSlgnaWre . Dae
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLqRqTION:
I hereby affirm thal I am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Code, and
my license is i u I torce and ef ct.
Lic.-# Class #_ — 3
Comractor's5ignaWre � �
CONSTRUCTION LENDING AGENCV:
❑ I hereby aKrtn that there is a constructbn lending agency !or the
peAormance of the v.ork fa wfiich this pertnit is issued. (Sec. 3097. Civil Cotle).
Lender's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby affum that under penalty o( pe�jury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or the (ollowing reason (Sec. 703L5.
Busine5s and Pro(essions Cotle: Any ciry or counry which requires a permit ro
consUuct, alter, improve, demolish, or repair any stmcNre, prior to its
issuance, also requires lhe applicant (or such permit to fle a signed stalemenl
that he or she is licensed pursuant to [he provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( �he
Business antl Professions Code) or that he or she is exempt therefmm antl
lhe basis for the alleged exemp[ion. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve huntlred dollars ($500).):
❑ I, as owner o� the property, or my employees with vrages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of pmperty who builds or improves
thereon, and who does such work himself or herself or thmugh his or her ovm
employees, provided ihat such improvements are not intended or oNered for
sale. If, however, the building or improvement is sold wilhin one year of
completioq the ovmer-butlder will have the burtlen of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to congtruct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not appty to an owner of
property who builds or improves [hereon, and who contrac�s fa such project wilh
a contracta(s) license pursuant to th2 Contractors License Laws.).
� I am exempt under sec.
Business and Professions Code for this reason:
Signatme �a�e
]OS]-a6�310]7 .
Owner ID verifietl bytlriv�ense. ❑ Ves ❑ No
Driver's License No. Expires:
Verification o( Ownership by (rype of tlocument, i.e. - properry [ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlify that no excavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be matle in connection with work authorized
by ihis pertnit, antl that no building strucWre, scaffGding, talsev.ork, or tlemolition
or tlismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, M 2, Sea 341, Title 8, Califomia Adminislrative Code�.
� As owner-builder, I will not employ anyone to do work which would
require a pertnit (rom fhe Division of fndostnat Safery, as no(ed above, unless
such person has a permit to tlo such work from the Aivision.
AOW����'s Signalure
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the appliwnt or present or future building occupant need to file antl
certify a Business Plan for emergency response to release or I�reatened
release o! a hazardous matenal? ❑ Yes ❑ No
(Section 25505 ot the Cali(omia Health and Satery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time tlunnq a reported
year a quantiry of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic teet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or fuNre building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Health and Salety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic teet of compressed gas at standard
IemperaWre and pressure).
3. Does or will the applicant or present or IuWre 6uilding occupant need to
prepare an RMPP (Risk Management antl Prevention Pmgrem for acutely
hazardous materials�? ❑ Yes ❑ No
(Seclion 25534 ot lhe Califomia Health and Safety Code pmvides that the
Costa Mesa Fire Department may require the preparetion, certification antl
61ing with the Fire Depariment o! an RMPP by 6usinesses which are requiretl
to register acutely hazardous malerials with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of ihe California
Health and Safety Code been tully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
the vrork which is lhe subject of this application a permit for such construction
or modifcation from �he South Coast Air Qualiry Management District or from
any other air pollution control distnct or agency? ❑ Ves ❑ No
(SecCron 658502 of the Califomia Govemment Code requires that the requested
inlormation be fumishetl on applications (a non-residential building pertnits).
6. Will any part o! ihe faciliy to be constructed untler this permit be within
1000 teet Irom the ouler boundaries of a school? ❑ Ves ❑ No
(If "yes", Ihe facilily must meet the requirement of Seclions 25534 and 42303
of the Calilornia Health and Sa(ery Code).
7. If a permit from the South Coast Air Quality Management Distnct or other
air pollution control district or agency is required for t�e vrork which is the
subject of this applicalion, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qt yes", attach certificate of compliance from ihe appropriate air pollution
coNrol officer�.
CERTIPICATE OF COMPLIANCE: I certify that under penalty of perjury the
infortnation given above is correcL I aqree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read Ihis application and state Ihat
the information given is correcL I agree to comply with all state lavrs and city
ordinances relating to building construction, and authorize representatives of
Ihe City of Cost sa to enter upon the above<lescribed property for
inspection purp es. I ree not to occupy or allow occupancy of any building
aulhorized b is perm� until M inspeclion.
Sig 1 � eqs) / ate
iS �%
An01w Au1MnzN AOPliwm y � Da�e - a
Made by:
COMPLAINT INVESTIGATION
na� �/—zZ-6y
� Address �g � l f� "'� ph. No. 7"� 5 3 ��7S
Complete:
Compleinant Yes '�
Interviewed:
(714) 894-21 T1
0
State License No. 201162 (213�31•6526
�.� •
ao�ao � ,
CONT`R . C�T�.S, INC. °
7612 Katella Ave.
Stanton, California 90680
Janucucy 13, 19&&
C.i.ty os Coa.ta Mesa Biu-'di.ng 8 Sa4ety D�,v,i.a�,on
TU UJHUM IT MAY CUNCERN:
Th.c:a .�;a .to ce�,tcby xha.t .the dhu.i.nage and g�cadi.ng on .the job
a,t 2861 Ewcopa, Cah�a Meaa, hu.e been done �.n accohcl�:nace w.i.th
pLan.e aa agneed an by owneh,s and H�.-Lo Con�irac.tonh, Inc.
Any Su.tune gnadi.ng and/o2 .Candacap�,ng .i,a .the ne.apov�s�.b.i,Li.ty ob
�he homeowne�c6.
���,-�,� `�'� C�
Ul-i.LGi,am .�1eRae
0
��"
Applicanl to fill in all ipaGes eacept ihoze
'-CiTY oP' COSrA m2n._ GO— TI� R�ON PERMIT
Project Address �Q�
Applicant'sMaliingAddress Z��� Cr�ro�
Owner'sName �TAV1P i�e�'Q✓"j'IY1 phone Syo-�i��
Address ZS� � L= �.1Y0/M
Arch/Eng. License No.
Address
Comracmr's Name d • � �hone
Address (mailing)
City License No. �
LICENSED CONTRALTOR OECLARATIOIV
I bereby affi�m [M1at I am licenzetl untle� provislon5 ot Chart¢r 9(commencing
Wllh 52Cl1011 %���) Oi �IVI5100 3 of the Buziness dOd Profe55iOn5 Cotle, antl
my license is In full force antl effect.
Licenze Class License No.
Oat¢ Signature
WORKERS'COMPENSATION DECLARATION
I hereby aifirm tnat I have a certificate of wnsent to selt-insure or a certiticate
�t Worker5' Compensation Insurance, or a certitietl coOY thereof (Section
800, �aD. CJ
/oiicy No. Company
8 Ccrtifietl copy is hereby turnishetl.
Certifi¢tl copy is�filetl with [he tity Builtling Dlvision.
Oate APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLFRATION
(Thissection neetl not be comple[etl it the permit is for one huntlr¢tl ($100) o�
lezs).
I cevti(y that In the pe�formanGe of the work fo� which thi5 perm�t is issuetl, I
snall not employ any' perzon in any manner so as to become subjeci to the
Workers' C m en atlon Laws of Californy" �-'-__ r�,
X oate Signature �T�"� �� '�J
NOTICE: I, at er making this tleclaration you shoultl become subject to the
Workers' Compensa[ion provisions of the Labor Cotle, you must forthwith
comply with such p�ovision5 or this permit Shall b¢ tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I M1ereby afflrm that there is a consbuction lentling agency for the performance
ot the work fOr wM1ich this permit is issuetl (Section 309] Civ. C.)
Lentler's Name
Lentler's AEtlress
OWNER BUILDEN DECLARATION
I hereby affirm that I am exempt trom the ConVacfor's Llcense Law for the
tollowing reason (Seclion 7031.5 Business antl Protesslonal Cotle: Any city or
munty whlcb requires a pe�mit to consfruct, alter, improve, tlemOlish o� �epair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signCd statement thal he/she i5 IicenSotl pu�sudnt to the provisiOns of
the Contractor's License Law (Cnap(er 9(mmmencing wlth Sectlon 7000) of
Division 3 ot the Businesz antl Professions Cotle) or [hat ne/she is ezempt
'4er¢from antl the basi5 fOr [he allegetl exemplion. Any violatiOn of $ection
`31.5 by any ap0���ant for a permit subjects the aDP��<ant to a civil
ialty ot no[ more Ihan tive huntlre0 Aollars (E500).
,yf 1, as Owne� ot the properly o� my employees with wages as their Sole
do`mpensation, will Oo the work, antl the struc[ure is no[ intentletl or otteretl
tor sale (Sectlon 70a4, Business ana Protessional Cotle: The Contracror's
LicenSe Ldw tloes not apply to an owner ot a property who builtls or improves
tnereon, antl who tloes sucn work himseli/herselt or tnrough hls or her own
employeei, provitletl tM1at such improvements are not Interltletl or offe�etl for
sale. If, howeveq tM1e builtling or improvemenl is soltl wlOiin one Year of cam-
pletion, the owner will have the burtlen Of proving he/she tlitl nol builtl o� im-
rova tor the purpose oi sale).
I, as ownCr oi the property, am exUusivety contracting with Ilcenzetl con-
t actorsto construct tbe project (Section �044, Business antl Proiessions Cotle+
The ConVactor's License Law does mt apply to an owner of property who
builtls or Improves tnereon, ana who contracts (or such projects with a con-
traclor(51 ❑cense pursuant Io [he Contracto�'S License Law). I am aware that
proof of thair Wo�keYs Compensalion insurance shoultl be providetl [o me. i,
❑ 1 am exempt under Section B. & P. C. for lhis reazon ,
�( Date Owner - �
I M1ereby erl ty that I have reatl ttti applicatlon antl state hdt the above
infOrma[ion IS correct. I a9ree to comply with all city antl county ortlindnces
antl state laws relaling to builtling construction, antl hereby authorize reore-
sentatives of tnis city to en[er upon the a�ove-mentionetl pro0erty for
inspection Ourpye �-z�_`>-<?�e� % � %
Signature L ��� Oata
K Drivers' Licens or 5„�$ �
rtleL�ltnes anG sign all aDGropriate Geelarations.
/3�7- Z4��� I /�lT CJ I L�NW UNITN6.
TYPE OF CONSTRUCTION NEW °.DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER '
DESCRIPTION OF WORKNSE OF BLDG. �i�n�
TVPEOFPERMIT��,} GRADING�y FOVNDATION STRUCTURAL
❑ TENANT �p.ELECTRICAL tJ�PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq.FT OCCUPaNCV� yR��'1
CONSTRUCTIONTVPE VALUATIONS H/�(,/. '�_
ZONE GRADINGCU.VDS. ACRES-
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
n:..�.,.n��.e. ' _
Jrinking Fountains
Floor Drains
Floor Sinks �
Gas Service �4 Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash �
Reinspection Fae I $15 I I Issue Fee I $ 3 I
MECHANICAL FEES
Boiler
Duct-UnderGround
Duct � Structural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepUFact. Blt. IC80 /
Heating System & cting
❑ 0-100,000�0100,000
peinspection Fea � $15 I
CMF 0865-46, �ev. 10/04 Whit¢ - Builtling; Canary - AppllcanL Pink - Accounting; GOltlenrotl - ASsasso�
Hood or Typel ❑
Canopy Type I I ❑
7�0. ,8G',iS00 BTU ❑ 100,000 BT
iystem Repair/Alteration
Fire Dampers
Registers
luue Fee
$ 3
A.P. # �
S Main Buildi
E
T Front
B Rear
A
C Pight
K Left
S
Ping. Ref. #
Planning Notes:
14=E 7/; _/ _' �' '
' 7 Zone
Accessory Building:
2
" O
N
I
N
G
R
arking / videA E
Q
M
T
S
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors �0-1 HP O 1 h- 8
Inc.Solar �9�15 HP �i6-15+
Microwave
Pole Light
Range
` Garbage Disposal
R- Generator �0.5 KW �5-15 KW
Reinspection Fee $15
DEVELOPMENT SERVICES REQU
Zaning Approved By
Buildine APP�o�ed By
Standing Sections
Trash Compacror
Issue Fee
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $--'' '�Sd SMIP $ C�' SU
PLAN CHECK $ PEfiMIT
PLUMBING S {. C]C� ISSUANCE $
PLAN CHECK 25% 5 O• S O ENERGY P.C. S
ELECTRICAL § �- 00 GRA'DING S
PLAN CHECK 50% S �--5 O MICROFILM- $ /�
MECHANICAL S TOTAL FEE 5 " •' �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING ' POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS 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. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
5. Steel 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 3^ .`+ , 66. Solar System-Final
16. Rough Electric Wiring 3_g� .. 67,. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit # -
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergind.StorageTank OGas ❑Oil � ��
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: . '
34. Final Heating & Air Conditioning . ,
35. Final Gas Pipe-Test 1�
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 - `'"•
1`�
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations �p (� �'�' F L �'''
47. FINALSTRUCTURE&BUILDING �_ �� 7,�o�_Q� �q�y U�Ld e- ;�
� �t
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ��7
No. Date _ _ . � �,
Applicant to fiil'in all spaces excev� thase witnin heavy boraer lines antl si9n all aoorovriate aeclarotioos.
. •�^YOF COSTA M S�j Cn�{NS�j�p.' UCT/-�� O�'�� 7pERMIT PERMIT'NO. TRACI N.� LOT N� UNIT N0.
�Aro�'ect-Address � Z7 � 1 2 lJ� oL� \ q �� �
Applitant'sMailin�Addre� /�5,,q,.,T'�
. Owner's Name � �+� � PhonP�� < <7-Z
Address � �''w� L-
� Arch/Eng. —�, � License No.
Address 1 2� 1
Contracror's Name � V .3hone�,_..—
Addresslmailing) 1�L2- �`li����`�'v ` ST��n�
il ��T
Ciry License No. ���1� I 4 � 1,
LICENSED CONTRAGTOR DECIARATION � .
I hereby affirm tM1at I am licensetl untler provislons of CM1arter 9(commrncin9
wi[h section ]000) o( Dlvision 3 of the Businezz antl Profezsions Cotle, anU
my licenze is in full e ntl effect. !1 d� 1���
Licens�..sI ss-�� � Lic,e,n`��p�� o� �
Oate "�JT9 t/� ��C7� Si9natur�'a.1!`�� ��O-Q
WORKE 5'� COMPENSATION DECLARATION
�reby af(irm that I M1ave a certificate of consent to self-insure or a certificato
Vorkers' Componsatibon InSurance� oj a cQrtiSietl ropy thereoT (Sectlon
0� Lab. C. �, p 07 (/�'K r. �'1/�- �
Policy No. � v`� Company �rn�� �W�
�rtifietl copy is hereby furnishetl.
Cerli ' c s I etl with the city� u�iitlin9 DivisiQp�
Oate ApDlicant w�. 1 Y \�
EXEMPTI N FROM WORKERS' COMPENSATION DECLARATION
(This Seclion neetl not be completetl if tne pe�mit is tor One huntlr¢tl ($300) or
less).
I certify tnat in [he per/ormance oi the wo�k to� which thi5 pe�mi[ is issuetl I
shall not employ any person in any manner so as to become subject to [�e
Workers' Compensatlon L.aws of Califomia.
Da[e Si9nature
NOTICE: If, after making this tleclaratlon, you shoultl become subject to tna
Workers' Compen5ation provisions of tne Labor Cotle, you must fortM1witn
comply with such p�ovisions or thi5 permit shall be tleemetl revoketl.
CONSTRUCTION LENOING AGENCV
1 nereby atfirm tnat tnere is a mnsiructlon Ientling agency tor the performanca
ot the work for wbich this permit is issuetl (Settion 3097�Civ. C.)
Lentler's Name
. Lentler's Atltlress ' " �"''
OWNER BUILpEN UECLARATION
I hereby atfirm that I am exempt irom the Contractor's license Law for the
following reason (Se2tion �031.5 Buslness antl Professional Coae: Any city or
county wnich requires a permit to tonstruct, alter, Improve, demolisn or repalr
any structure, orior to Its issuance, also requires the applicant /or such permit
to file a si9ned statement that he/she is licensea pursuant to tne prO��sions ol
the ConVactor's �icense Law (Cnapter 9(commencing witn SecHon.�000)'of
���dsion 3 of the Business antl Professions Cotle) or tna[ be/she is exempt
3from antl, the basis for the allegetl exemption. Any violation of Sectlon
5 by any applican[ tor a permit subjects [he applicant to a tivll
.alty of not mor¢ than five huntlrOtl tlollars ($500).
❑ I, as owner of thu property or my employees wilh wages as their so�e
cotnpensation, will tlo the work, antl the st�u[tur¢ i5 not Intentl¢tl or oft¢r¢tl
for sale (Section 70G4, Business antl Professional Cotle: The Contrac[or's
License Law tloes not appty to an owner of a property wno builtls or impmvez
iher¢On, antl who tloe5 Suth wo�k himself/herself o� through hi5 or he� own
employee5, Provitletl [hat such improvemen[5 are not intentletl o� offeretl for
sale. I/, howeveq tho builtlin9 or improvement is soltl withln one year o( mm-
pletloq the owner will have the burtlen oi proving he/she tlitl not builtl or im-
�rova 10/ ttte Pu�poSe oi sale).
I, a5 ownet ot [he prOOerty, am ¢xUusivery contraCting wllh Ilcensetl con-
tractors to construct lne pro]ect (Sectlon 7044, Business ana Pro(essions Goae:
Tne Contractor's License Law does nOt appty to an owner of pm0erty who
builtls or improves th¢reon, anB who conVacts fo� such prOj¢cl5 with a con-
bactor(sl iicense pursuam to the Contractor's License L.aw). I am aware that
prool of tM1eir Worker's Compensatlon insurance shoultl be provltled lo me.
❑ I am ezempt untler Se[[ion B. & P. C. for this �eason
Date Owner
I nereby certify (hat I have reatl tnis application antl state that the above
into�malion is correct. I agree to com0ly with dll city antl County o�tlinances
antl state laws reiating to builtling constructlon, antl nereby aut�o9¢e re re�
Sentativ¢s of tlus city to enter upp(�(h¢ abov¢-mentiOnetl p�qperty�fo�
' Signature l/�+u�
Drivers' License or 55
CMF 0865�96, rev. 10/84
f. .
� 3 00 _
TYPE OFCONSTRUCTION NEW ADD ALTERATION ' REPAIR
'0 CONVERSION ❑ DEMOlISH ❑ OTHER A p,A6
''DESCpIPT NO RK/USEOF LDG.
i •� �."1�.,� � �.f 1 s "
S Main Buildi
� L
TYPEOFPERMIT GRADING FOUNDATION STRVCTURAL T Flont
C-��' TENANT �ELECTRICAL PLVMBING ❑ MECHANICAL 6 Rear ��
..Q OTHER A �
PROJECT DESCRIPTION SQ. FT. Z- oCCUPnNcv C Right 1
�CONSTRUCTIONTYPE VALVATIONS S�OOO�V.�- S Left
ZONE• GRADING CU. VDS. ACRES Ping. Ref. #
Remarks: .� Oi Gcrf •1 n 1 C/l Planning Noies:
Bar Sink
Backflow Preventer
Backflow Irrigation
Jrinking Fountains
=1oor Drains
Floor Sinks '
3as S rvice OuUets .
I'nterceptors ��
Kitchen Sink '
Lavatories - _ _^'.
?-Trap . � � �
Root Drains •
Reinspection Fee $15
Boiler ' �
Duct - Under Ground _ �
Duct - Structural�dTlN�J"S
Duct-Ventilating �
Exhaust System � Multiple ❑
Pirepl/FacL BIL IC80 #
Heating System & Ducting
❑0.100,000 BTU 0100,000BT
Reinzpection Fee
White - 8ulltling; Canary - APplicant; Pink - Accouniing; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Hearer �
Water Service
Au[o-Wash
Laundry Trays
� .
Isue Fee $ 3
1ANICAL FEES
Hood or Type I ❑ -
Canopy Type I I �
Retrigeration System
❑aioo,000aru ❑ioo,000aru (
System Repair/Alteration
Fire Dampers
Registers '
Issua Fee � $ 3
Auromatic Washer�
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Eleciric
Fan
F.A.U.
Fixtures+
Device Boxes
$witche5
Garbage Dispoul
Generomr �0.5 KW
4� �� �/. . % .
Zone
_ �
_
� �
I�� • • � _�.�'.' ' ' '
1]L%.I � / •
� I i���� I 1'� I I�tl�
ELECTRIQAL
Tremformer ❑ 15-50 KW
❑ SO+KW
Meter �up to 100 amps
Meter ❑over100amps
Sub Panel
Motars �0.1 HP � 1'h - 6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light .;
Renge .
' " r...:. _ r _
Standing Section
5 KW Trash Compacmr
� Reinspection Fee �$15 � � Issue Fee
DEVELOPMENTSERVICESRE�UIREMENTS: ('
Zoning APProved BY I'G
8uilding Approved By
APpliptiOn IssUBd By
SUMMARV OF FEES
BUILDING PERMIT $ '3��•uJ SMIP
PLAN CHECK $ — PERMIT
PLUMBING $ . V� ISSUANCE
PLAN CHECK 25% $ �• 0 ENERGY P.C.
ELECTRICAL $ L�D.B� GRADING
PLANCHECK 50% $ 3•�D MICROFILM
MECHANICA� s 13. �a TOTAL FEE
PLAN CHECK 25% $ a�- S�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electriwl Bonding
5. Steel Reinforcement . ^/ 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.�� _ �.,+ � 57. APPROVALTO COVER-GUNITE
7. Footings � �� 58. Electrical Conduit�Undrgrnd. .
8. Foundation �i 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final _
13. Roof Drains 64. Plumbing System � Final � _
14. Rough Plum6ing �(•5•KI 4Qa17 65. Electrical-Final �.�
15. Rough Electrical�Conduit 66. Solar System-Final �'i
16. Rough Electric Wiring �� 8� 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-T Bar Ceiling . � 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning ��•l�j�$7 L�i�� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ��,�y,�7 L,�p APPROVALS Permit # . _
21. Ducts, in Structure (,�(� 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil: ',.
�
23. Gas Pipe-Rough & Test 72. Underground Flush � �
24. Roof Framing 73. Undergrnd. Storage Tank'� Gas ❑ Oil
25. floof Sheathing ��I�6 �.p/` 74. Overhead Hydro ��
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r''. •,
27. Frame and Flashing � 76. Dry Standpipe - �
28. Lathing & Siding �� ZS ' � 77. FIXED SYSTEM FINAL
29. Insulation �,� (� G. 78. FIRE PREV. FINAL '� ~�
�,
30. Drywall Nailin9 - �� �yy" j � HEALTH DEPT. REQUIREMENT i�
31. Plaster Brown Coat ��D ��_ � 79. FINAL INSPECTION � �
32. Electrical Power Meter-Final . FOOD CERTIFICATE ISSUED
33. Final Electric � 2 otes: � � s.�^� � �
34. Final Heating & Air Conditioning /•{3•$e LgD .5� �., , a • C
35. Final Gas Pipe-Test ' � (-��� (�✓J�
36. Hood or Canopy
37. Final Factory Fireplace b.[;� (�(j
38. Final Plumbing /.(3� %�
39. Water Service-Final ' �� -
40. Gas Service-Final ' .
. 41. Solar pomestic-Final `` ..
42. Backflow Preventer - - '
43. Backflow Irrigatiqn - ' . �:�:;� j ¢
'
44. Landscape Irrigation'SYstem. • �
45. Sound Attenua`tion'� ' - � �
46. Handicap Reg�lations �: � �
i !
47. FINAL STRUCTURE & BUILDING ���6 / � � �./ . �
48. Special Requirements Completed. / � '
49. Electric Release to Edison '
r
�
50. Gas Release to Southern California Gas Co '
,i
51. CERTIFICATE OF OCCUPANCY �
1
No. Date , _
�uro� � / '
� C— a 4' C�-t l C�
/� X i `/'/ e �j �'�" �t /.P _ _ '� / �'J %`�
�% ��(/�GU ti _. �
--/� / ZZ �
r��`�/ 3� z �Z �
i= � v ,��� � _ ___. -
�21 K. T � /�/� / c /��`f @ /, S �c'r.✓
(// G✓//ti/�i � .!/ — — — —
C�� yGr �y�� — ----- �
�� �i /��f�, — -- — —
� �3 v — —% � ,C �✓
�, s �
��� v�/ W u r/ �i P 1/ �' -- �
%� !� _ _ � � —
(/ J / c a „��i7`„— _ _
c �o�f�,�
(�% c�/ o ve r� � ., —
�3 7� 0 �'c.�
�J%� /0 �'(�✓ a� /D� �v —
/0 , D ��u./
���.a ��RvC� yo%D — � ,o,� �w
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OWNER
JOB ADDRESS
AP No. LOT
] 'GCTIONS
$ou
�.
OCCUPANCY
'ORM BU4 � SM —
TRACT 434t3 FIRE 7.ONE
�Signature� DATE GROUP
DATE
VALUE $ �Z� 59"Z.OV
D�SCRIPTION OF WORK T2S
� TYP� '7,ONE
SUBCONTRACTOR
., si�
COSTA MESA BUILDING-SAFEfY DEPARTMENT
P. O. BOX 917 G03TA M83A, CALIFORNIA
For Applicanf fo Fill In Complefely
�� 3 [ TYPE OR PRINT
BUILDING
ADDRE55
COSTA MESA, C LIFORNIA
OWNEft [J �.Y.d�/ - �
MAIL
AODRESS t liJ1.GK�fi�c•
!7 $— � _ TEL. _ _
FEE RECEIVED
MAR z 2 1963
FINANCE DEPT.
APPLICATION'F'OR'per�TA MESA
BUILDING
For Office Use Only
PECEIPT NO. PHRMfT NO/.'
/�j//V
�Y �AT6R C81VH DATE18811EO
�-'�i �,3-�3 MAR 2 2 t4az
- Tvaw r.wni�3. . r . /
ADDRES$
� ' � A. P. NO.
CITY
NOTE: NO EAVE OVERHANG 3HALL BE LESSTHAN
STATE �r TEL. 80" TO SIDE 8 REAR P. L.
LI0. NO. O NO. —O �
EAVES
S¢E I NO.OPeLOOs. A��OWED (U.B.C.REQUIREMENT)
OF LOT O NOW oN LOT O
YARDSAPPROVE� YAROSAPPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. —� .
(FROM C/L6TREET)
6ETBRCK LINE FROM FR NT FT. FT. '
CENTER oF 6TRebT REAR YARD
SIOE YARD I LEFT I RI6HT ' R. SIDE � Ff. - FP.
DESCRIPTION OF WORK L.81D6 ^ Fr. F-r.
NEw - /� ALTERATION _ ADDITION REAR L�. F7'•
T� DISTANCE BET. �� BET. MAIN @
R. _R MOVIN6 DEMOLISH MAIN BLDGS. ' ACCESS. BLD69.
BUILDING ^ �{ NO.OP p VAR•# ' DATE .
SIZE �(O O�'y' ROOMS d 6TORI S C. U. P. �{' APPROVEO /
EXTERIOR WALL ROOF APPROVED .. �/�
GOVERING COVERING BY �ATE b
USE OF BUIL�I G AND� ORK TO BE PERFORMED '
�� N
a/a � s4: �. s�� m
1 HEREBT ACKNOWLED6E TH�1T 1 H/.VE REAO TH18 APPLIGTION TXE AMOUNT eXOWN IINOER VALUATION 18 POR TXE �
AND STATE TXAT THE OVE 18 CORpECT ANO AOREE TO COM. PURP098 OP .EBTABLI8HIN6 A pEFMIT FEE ONLY. �
PLY WITH /LL CITY RO� ANCEB AN� BTATB WB R60UI.ATINO VALUATION py� — 0
BUILOIN6 CONBTRO ION � H
PERMITTE E OF ` ��,�� ��y� PERMIT FEE $ � ,
$ �� " ' � PLAN CHECK $ , J � o
AUTHORIZEDAGENT . �� ��� ��
TOTALFEE �
1
GENI�.RAL CONTRACTOR
P '_;'=�?o. 1�9-455-14 :
� Ii�;S�"�.<ECTIONS
�i Soil
�f .-.�.y�i �-xar�c��ti - . :� r-w..✓ �/.y/s Y
DATE 4-10-G1F
BUILDING PERMIT NO.
VALUE S �9Fi.00
SUBCONTIN(:TOR
�iovn
- 2i��o
COSTA MESA BUILDINGSAFETY DEPARTMEM'
P.O. BOX 917 COHTA MBBA, GALIPORNIA
For Applicanf ro Fill In Completely
TYPE OR PRINT
BUILDINW�,.� �0�� �
ADDRE59
COSTA MESA, CALIFORNIA�
OWNER \�<C�fl��+Bi��S
MAIL n
ADDRE53 _Z� O � �Or7'�
.� cS� TEL.
� ARCHITECT
"Zsa�S -i_ `_ cL� sa _J
STATE TEL. � p L `
LIC. NO.Zmf�L, � NO. T-\
SIZE I no.oPeu
OF LOT S��'L+ NOW ON U
�
❑SEOF _ .\
DESCRIPTION OF WORK'
EXTERIOR WALL I ROOF
COVERING COVERINO
USEOFBUILDIN6ANDWORKTOBEP FORLMED
t /
\\� -� 4 ` va -�. `
1 HEREBY ACNNOWLEOOE THAi 1 H�Ve RBAD TXIH �PPLIWT�ON
AND BTATE THAT THE ABOV¢ IB CORHECT ANO AOREE TO COM.
PLv WITH ALL CI Oq�INANC68 AND BT�TE L�WB R80ULAi1N0
6UILDIN6CON5 �
SIGNATUREOF �y
PERMITTEF �
AUTHORIZED AGENT
rtt RECEiVED
�p fl 10 1964
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION fOR PERMIT
BUILDING
For ONica Use Only
sr
ZONING �
ZON NO.OA / 11860RNEW
✓ ruHe!/bA���oit4q� �i� �1 ut9_.
,r�--�-6ai�r
�Ba.� L �� _ -z.l.—Cv.�. /� 4,
oescnirrion �'l `1'3
A. P. No. r ay — y fs - i�
NOTE: NO EAVE OVERHAN6 6HALL BE LE69 HAN
90' TO SIDE B FEAR P. L.
EAVES
ALLOWED (U.B.C.REQUIREMENTI
YARDSAPPROVEO YARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDINO
fFROMGL¢TREET) �
REAR d F
D19TANGE BET.
MAIN BLDGS.
VAR. �j
DATE
N
$Q. �. �
THE AMOUNT BXOWN UNOEti VALUATION IB POR TNE E
� PURPOS! Op 69TABLIBXINa R PEpMIT FE8 ONLY. �
VALUATION v�
PERMITFEE S J �
m
S �—\� � � �_ 0
3� "
TOTAL FEE S