HomeMy WebLinkAbout3001 FERNHEATH LN - Building Permits` CITY OF COSTA MESA
��pMFs' BUILDING DIVISION _ .
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F� �. � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p74) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
� ` . FOR INSPECTIONS CALL: (714) 754•5626
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PERMIT NUMBER: 610-00012
PERMIT TYP� B ROOF2 STATUS: ISSUED
APN: 14115807 DATE ISSUED: 01111I2010
ISSUED BY: KJB
JOS ADDRESS:
Vicinity:
Squares: 1900
3001 FERNHEATH LN CM Suite/Unit:
Valuation: $5,000.00
e
SCOPE OF WORK: RE-ROOF OVER 1 LAYER OF COMP SHINGLES. NEW 30 YEAR COMP ROOF TO BE INSTALLED. ROOF PITCH IS
4:12.
OWNER: SMILEYFAMILYTRUST
PHONE:
APPLICANT: LEHMAN, JEFF
PHONE: 949-646357�
CONTRACTOR: J S L ROOFING INC
Address: 2415 MqRGARET DRUnit
City/Slate/Zip: N�WpORT BEACH, CA 92663
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$111.25
$0.00
$1.00
$172.25
Address: 2408 MARGARET DR
City/State/Zip: NEWPORT BEACH, CA
Address: 2415 MARGARE7 DR
City/State/Zip: NEWPORT BEACH, CA
License No.
License No.
PHONE:
License No. 747706
949-6463571
CELL:
PHONE:
PHONE:
Unit:
Unit: :
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under California sWtutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: P@RMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work aulhorized under this permit to be wnsidered legal, such work musl comply with all applicable codes, antl all
required inspections and final approval must be obtained. Failure lo obtain inspections and fnal approval will resWt in the expiration of this permit.
CODE1. INSPECTIONTTpE OAT INPPALS COOE� INSPECilON7YPE OATE INii11AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final /�-y 208 Finai Plumbing
200 Final Re-Root �_:'�5 �L u�.� 210 Final Electriwl
20� Final Block/Retaining Wall / 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Pianning Approval
203 FinalSign 222 FinalSite
204 Final Demol{tion 250 Final Builtling/Occupancy
WORKERS' COMPENSATION DECLARA710N:
I hereby affirm under penalry of perjury one of the (ollowing declarations:
❑ I have anC�vill maintdin a cpnilcate of consenl to self-Insure for workers'
compens �on, as provided lor by section 3700 of the Labor Code, for Ihe
edor nce of the vrork !or which this permit is issued.
I have and will maintain v.orkers' compensation insu2nce, as required by
tbn 3700 of lhe labor Cotle. for Ihe peAormance of the v.ork (w v.fiich this
pertnit is issued. M�com nsation I sn uranCe carrier an0 policy
number are: n
(/ i
�C�amer: . r/��
"— (ilv5sectmneetlnol6emmperMq�nopermtisvaluedelwenunWetltlMars(5100)aless)
�ro,� �.: ' 'J_ u�--- � O / g"��_
❑ I certify that in the peAor ance of ihe work for which this permit is
issued, I shall n t employ any rson in any manner so as to become subject
to the workers compensati laws of Califomia, and agree that if 1 should
become s je to the vro rs' compensation provisions ot Section 3700 of
the Lab C , I shall 'th Compl with these pmvi ions.
1 ( �� ��
– m's. re Ltlat�
WARWING: FAILURE T6 SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UF TO ONE HUNDRED TNOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 37p(� OF THE LABOR CODE, IMEREST, AND
A770RNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 0l the Business and Professions Code, antl
my license is in full fa c�) and e c � �j
CL'ic-#� J 4 O C�ss�#' � /
a_ _ � l a
ac r'sSigoa re Oz��
CONS UCTI N LENDING AGENCY:
❑ I hereby affum that there is a constructbn lentlin9 agency tw the
peAormance of the v.ork tar which this pertnit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lentler's Address:
Date
OW NER-BUILDER DECLARATIONS:
I hereby aKrm lhal untler penally ol perjury ma� I am EREMPT FROM THE
CONTRACTORS LICENSE LqW for Ihe (ollOwing feaSOn (Set. 7031.5,
Business and Professions Code: Any City or county which requires a permit to
constfucl, alter, improve, Oemolish, or repair any structure, prior to its
issuance, also requires the applitant for such permil to (le a signetl statement
that he or she is licensed pursuant to the provisions of 1he Contractors
License Law (Chapter 9(commgncing with Section 7000) o! DiviSion 3 of lhe
Business and Professions Code) or that he or she is exempt therefmm antl
the basis for Ihe alleged exemp(ion. Any violation of Section 7037.5 by any
applicant for a permit subjecls Ihe applicant ro a civil penalty of not more than
five hundretl dollars (5500).):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
offered tor sale (Sec. 7044, 8usiness antl Prolessions Code: The Contraclors
License Law does not apply to an ovmer of property who builds or improves
thereon, antl who does such vrork himsel( or herself or through his or her own
employees, provided that such improvements are not imended or oReretl for
sale. If, however, the building or improvemem is soltl vrithin one year o(
completion, the ovmer-builCer will have the burden ol proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ov+ner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70R5 to Construct Ihe project (Sec. 7044. Business antl
Prolessions Code: The cont2ctors License Law does not apply ro an ovmer of
property who builds or improves thereon, antl who contracts tor such project with
a contracta�s) license pursuaN lo Ihe CoNractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code (or this reason:
SignaWre
]OS)r6 (3N))
Ovmer ID verified by driver s license. ❑ Yes ❑ No
Driver's License No. Ezpires:
Verifca�ion of Ownership Dy (type o( Oocument, i.e. - property lax bill or Oeed):
i �.
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no exwvation frve (5) a mwe leet in tlepth into vfiich a
person is required to tlescen4 will be matle in conneclion with work authorized
by this permit, and lhat no building sWCNre. 5caf(dding, falsework, or demolition
or dismantling Ihereol, will be more lhan thirty-su (36) leet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2tive Cotle�.
❑ As owner-builder, I will not employ anyone to do vrork which would
require a permit from lhe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Appliwnl's Signature
Division of Industrial Safely Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicaM or present or fuNre building occupant need lo file and
certify a Business Plan !or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Neaqh and Sa(ery Cotle requires, with some
exceptions. that a Business Plan be filed with tha Costa Mesa Fire
Depanment by every business which has at any one lime tlunng a reponed
year a quamily of hazardous matenals equal to or greater than a weighl ot
500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupam need lo fle
a registration form !or acutely hazar0ous matenals4 ❑ Yes ❑ No
(Section 25533 0! the Cali(omia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Depanmem by
each business which at any one lime has on hantl a quantily of acutely
hazartlous matenals equal to or greater than a vreight ot 500 pounds, or a
volume o/ 55 gallons, or 200 cubic feel of wmpressed gas at slandard
temperalure and pressure�.
3. Does or will the applicanl or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program tor awtely
hazardous materials)7 ❑ Yes ❑ No
(Seclion 25534 of Ihe California Health and Sa(ety Code provitles Ihat Ihe
Costa Mesa Fire Department may require Ihe preparetion, cenifcation and
filing with tha Fire Depanment of an RMPP by businesses which are require0
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali(omia
Heallh and Safety Code been fully complied wit�? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future builtling occupant require tor
me work which is tha subject ol this application a pertnit (or such construction
or modifCalion from Ihe SOWh Coast Air Qualiry Managemenl Distritt Or from
any olher air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Cali(omia Govemment Cotle requires that the requestetl
infortnation be fumi5hed on applications for rroo-residential builtling permits).
6. Will any part of lhe lacility to be constr�cted under this permit be within
1000 feet (rom the outer boundanes o( a school? ❑ Yes ❑ No
pt'yes", the facility must meet me requirement o( Sections 25534 and 42303
of the Califomia Health antl Safely Code).
7. If a pertnit from the South Coast Air �uality Management District or other
air pollution wntml tlistrict or agency is require0 tor the woB which is the
subject ol this application, have all of the aisclosures prescribed by California
Health and Salety Code Seclion 42303 been matle7 � Yes ❑ No
8. Qf yes", atlach certificate of compliance from the appropriate air polNtion
control officer).
CERTIFICATE OF COMPLIANCE: I cenify lhat under penalty of perjury the
information qiven above is conecl. I agree to comply wilh all state laws antl
city ordinances regarding Hazardous Materials antl Emissions.
CERTIFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I
certify under penalry of perjury thal I have read this application and state that
the informalion qiven is correct I agree ro comply with all state laws and ciry
ordinances relaling to building wnsWction, antl authonze representatives of
the Ciry o! Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I ree not t occupy or allow occupancy o( any building
authorized by �his pe until fi inspeclron.
Si re Legal qs) D te
� a
- Or I OflzCd plifdN - �_ 31e '
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. l Jl v v v�� �
Property Address � � � � �� � ti � �G � ` " �
Owner
Contractor �. S % L' �� �.—�'' L
State Contractor License Number �� ��'�' Classification C 3
I hereby certify that I have installed, or caused to be installed, a minimum Class B roof covering at the above
address in conformance with Chapter 15, of the latest adopted edition of the California Building Code, and the
installation instructions of the manufacturer.
❑ I further cerlify that I am the owner of the property. (Owner-Builder permittee only).
❑ I further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited paRner of the company
�Officer of the corporation
I certify that as an aufhorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
ey:
�I►/0
Yrttial Date
0990-46 MW 6ro8 Wpite - Bmlding Uv.: Canary-Gontrzctw: Pmk � Ovmer
�,s � � - ,(�lF . � � .
Company or Corporate Name ,
ADOflESS: 3001 FERNHEATH LN
rsnnme: SMILEY FAMILY TRUST
nooness: 2908 MARGARET DR
NE4IPORT BEACH,CA 92663
642-2221
FflCN/ENGINEEF:
AODPE55:
PEG.NO.:
UNIT:
UNIT:
PERmiTTEE. �3027EROY�CETLNOOFING ( 714 � 631-1929
ADDflESS: COSTA MESA 92626
LICENSEO CONTHFCTOP OECIAHPTION: I hereDy affirm Ih am licen under mvisions o ChaD�e� 9(� mencinp wi�� Section
7000� ol Oiv� i n of 1 e Business and Protessions COde. an y lic¢ns i in full o¢e an0 e Iecl.
/'', v� :��/�9�7 sTpTEuc.434674 c s: C 39 'XP: 6/95
/ Oate' _' � ' ` �� � Signamre: / . —
KENS' COMPENSATION OECLAHATION: I heteby a��um t ic e ol c nl lo self-insu r a c icate o� Wo�kers'
ompensation iosg�ca �� a�ej� qov� �e2oZlgecbon . Lao. �11 / O 1/ 9 S
raucrwo.:STATE FUND EXP. TE:
Nr: y
Ce �ietl copy /i�s hereby fumishetl. L� CertifeC copy is ti th I�e c Buil�i Divisiort �
Date: I I r' "'�� ApDlicant:
MPTIONFAOMWOXNEflS'COMPENSATIONOECIAflATION: �Th45¢tu e Decomple�etli epermili5foronehun4re0�5100)orless�.
I certi�y Ihai in Ihe Oertormance ol the work for which Ihis permit is issued. I shall not ¢mploy any person in any manner so a5 io Oecome
subleci lo ihe Workers' Compensation Laws o� Califomia.
�aie: Signature:
NOTILE: II, alier making I�is Ueclara�ion, you 5hauld Uecome SUGIeci Io tAe Wotkers' Compensa�ion pmvisions of I�e LaOor
Code. you must lonnwitn comply with sucn pmvisians or ihis permit shall Ue tleemee revokeA.
CONSTBULTION LENoINc RGENCY: I here0y atlirm tnat there is a mnstmction lentling agency lar the pedormance a1 the work for
whicn ihis oermit is issuetl �Section 3097. Civ. CI.
LENOEfl:
nooxess:
OWNEH BWLDEfl OECuflR7lON: I hereby aflirm inat I am exemD� ��om ihe Coniractors' Slate Litense Law for ihe followinp reasan
�Seciion 7031,5 Business and Pmlessional Catle: Any ciiy o� county w�itA rtquires a permi� lo constmct, atler, improve, 4emoiisR or
repair any simcture. orior to its issuance. also reauires ihe apoliwnt lor such permil to lile a sipnetl sta�ement that �2Jshe is licensetl
pursuam m ihe provisions ol the Contracmrs' State License Law (Chapter 9(wmmencinp with Section 7000� oi Uivision 3 0l I�e Business
antl Pmlessions Coee� or inal he/sne is evemp� ��erelmm an0 ine Uasis lor ine atleped exemption. Any violation ol Section 7Q31.5 by
any applicant for a permit suoie��s Ihe applican� to a civil penalty ol not more inan five hunaree aollars (5500).
I, as owner ol t�e DmDeny or my emVloyees wilh wapes as t�eir sole compensation, will Oo t�e woB, and tlle
i❑ stmcmre is not imentled or ollere0lor sale Ise�uon 70aa, Business anA Pmleuional CoCe: T�e Coniractors' Stale License Law
Oaes not apDly to an owner of a OmOetly w�o OuilOs or imOroves i�ereon, and who tloes suc� xrork Aimsetl/hersell or ihmugh
�is or �er own employees. pmvided lhat sut� imD�ovements are not imenJea ar offeretl for Sale. II, however �he builtlinp or
impmvemeni is soltl within one year ol complelion. ihe owner will �ave IOe EurUen ol pwvinp �e/s�e Aid not Uuild oi impmve
lor ine puroose ol sale).
I. as owner ol ihe pmDerty, am erclusively coniratling wit� Iicense0 conlractors to constmct the projecl (Section 7044, Business
❑ antl Pmiessions CoGe: T�e CAnIraClorS' Slale Litense Law Ooes n0i apply lo an Owner 0� pmp¢riy w�0 hm105 0! improve5 i�ereon
and who contratls lor sucA D�ajects wit� a mntracloqs) license pursuant to ihe Contractors' $Iaie License Law�. I am aware
ihat proof ol ineir WOBer's Comoensxlion insuranre slwultl be pmnUea to me.
� I am exemD� untler $ection: B. 8 P. C.
for ihis reason:
Dale: Owner.
I tlo hereby ceniry tna� i am aware af anE understan0 t�e repuiremems of Calilomia Health ana Safety CoOe Sections 25505. 25533. antl
25534 ana ��a� I or any luture �ui�tling accupant vnNwill nm (circle one) need to compty vnt� saiG state codes antl ihe reQuirements lor a
permit lor cons�mcimn or motlilica�ion imm I�e Air Ouabry Managemen� Oi9ricl. Resitlential consimc�ion ap0lica�ions are exemp� �mm
Ihese pmvisions
Daie: AOPlicant:
.
I here�y cerlily��at I have read Ihis application antl Slate�ha e abov¢ i I ma�ion correc� It ree�o comply h all city antl counry
oitlmantesantl5ialelawsrelalinglobuildingtonstmtlionand. GyaulOo� repre5e ative50��N5 iryloen�erupo hea0ove-mentioned
/o�a'�e�iY �or inspect^ion pur �
� Oa1e' � � � � I � � SignaWre:
Oriver'S �icense or Social Se<urity »:
ifial-a6 Wlnte—Bwltling; Green—Catle Enbrcement: Canary—Applicant; Pink—flevenue; GalEenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06997�
PERMIT NO: B 069973 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—�l PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION : T/OFF 2 EXZST LAYERS E AEROOF W/COMP. SQ FT: 4,846
CLAIM VALUE: 4,846.00 CALC—Ve1LUE: 4,846.00 GROUP OCC; R-3 /
COMMENTS: SMOKE DETECTOR REQUZRED PRIOR TO FINAL
if �t it if �F if iE +4 ac i� ih if ac iM1 r if it k�t il� ic+t aF+F iE 1E if if iR ic if if +f af if 1F �F �c if if if +f �lf it if +f af 1f aE ic 3h tF iF ac-} aF iF �4 i4 �)p jF if ic �c iF �4 iE iF r iF i4 +c af jF dM-If+F it �V�
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FP.NT; FT IN REAR: FT IN FRNT: FT IN P.EAP.: cT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKIPlG REQ; PROV: PARCEL: 19115807 ZNE: REF T70:
PLAND]ING NOTES>
i
if #F �1E iF �lf �)f iF iE 1E �If if if iE �t if iF i� a;.+F if if iE # 4141F if �f iE tf iF �1%ft � if � if if iE ic if if iF iE ih if iE 1f-?F if if iF at 1f jF if iE if if iE 1E -k if- iE #?F +f 1t iF � i�- iF iE ic iE+E �t Y, jf-
D E V E L O P M E A7 T S E R V I C E S R E Q U I F. E M E N T S
ZONING APPROVED HY __ DATE;
BUILDING APPROVED bY : DATE;
APPLICATZODI ISSUED BY; L_—_— DATE: Q
��*+tirrit�t�f�lt*�t*arae�+t*+rit+t*+t��i�iF�r�FiF�rlFrrt�t�iF��iF�r*— ��*�e'r*�*+-�*ac**r�r-rrr -� +r -r �+�z"�k
jEikififitriFiFiFaFitffit+tifrififilitxitwitaFitiEifrr�tt-if4if�tEifititikifatacjtsifiFitirlfitiFitaaiciFff+F3Fif�ritriFi�-il�irlcx 1t+tiF:f� -icif+P+tu�
LEGALIZP.TION;N F E E S U M M A R Y STP.UCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTP.IC MECHANZC FIRE 5MIP/RES GRADIDIG
PERMIT 72,OQ ,50
SMIF!NOA7—RES
pLara
ISSUE FEE
HUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72.50 0.00 0,00 72,50 72,50 ,00
REVENUE DIC'ISZON TOTALS--> COLLECTED; 72,50 OVER/SY.ORT; ,00
BLDC FMT PLUMBID]G ELECTRIC MECHANIC FIAE SMIP/TOT GRADING PLAN—CHECK
72,00 ,50
if 1f R af af at if iF iF if if it if iE iF ft if ii rt 4 if iF iE if fE af if jf iF it �f iE if iF �1G if N if iE it 1t aE if if it �f �F iE i4 iF it iF aE+F ac if i4 ii a4 iF iR ac �f ?F if if af 1t if� i4 {f iF jF if �lc 1E aL 4+1-
I N D I V I D U A L F E E B R E A FC D O W N
TYPE
SFR
QTY D E S C R I P T I O N
9846 REROOF BY C�ALUE RESIDENTZAL NOZONE
END OF FEES
EXPIRED
�f1C(N��t^ �CS�tl071�
��'�������
UNIT COST TOTAL COST
1.00 9,846.00
oi Op;71406—OQ171907 Ti_tT ;�,Sp
oare. iii17ipt TIttE: i:iadi
�ONSTFtUCTION AND PLANNtNG .
APPROVALS Permit #
t. Temporary Electrical Service or Pole
2. Soil Pipe�Undrgrnd. " "
3. Electrical Conduit Utility-Undrgrnd.
4. Electrice� Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrlcal UFfiR Grnd. �
7. Footings '
8. Foundat�on
9. Water Pipe-Undrgmd. '
10. Structwal Fioor System � -
7 7. Property Sewer Line & House Connection
12. Sewer Cap '
13. Roof OreS.�s
14. Ro�9h Plumbing
15. Rough Electrical•Conduit , � .
i6. Rough Electric Wiring - �
17. Rough LVirinq Sign
18. Rough E7ectricai�T Bar Ceiling
19. Rouah Heating & Air Conditioning
20. Rouyh FaCtory Firep!ace
21. Duccs, in Scructure
22. Ducts, Ventilating
23. Gas Pips�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T�Bar Ce�iing (StrunuraV) & Monocoat
27. Frame and Flashing
28. �athing & Siding �
29. Insulation
30. Drywali Nailing
37. Plaster grown Coat
32. Eiectric8l Powar Meter�Finaf
33. Final Electric
34, Einal HBating & Air Conditioning
35. Finai Ges Pipe�Test
3fi. Hood or Canopy
37. Final Factory Fireplace
38. Final Pl�mbing
39. Water Service�Final
40. Gas Serv�ce-Final
41. Solar DDmestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. LandscaPe irrigation System
45. Sound Attenuation
46. Handicap Regufations
47. FINAL STRUCTURE & BUILDING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern Galifornia Gas Q
51. CERTIFICATE OF OCCUPANCY
Date
Date
POO SPA
Inspector APPROVALS Permit #
52. Pooi & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electricai Bonding
56. Rough Ptum6ing & Pressure Test
57. APPROVALTOCOVER�GUNiTE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, 0 Undrgmd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPROVALTO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Piumbiny Systcm � Final
65. Electrical�Fina:
66. Solar SYstem-Finai
67. Fencing & Access Approvai
68. APPRQVED FOR PLASTERING
69. POOUSPASYSTEPASFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergmd.StorageTank OGas ❑Oil
/[�� 74. Overhead Flydro
;��.v
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: �l agLjc� �'���aj �[�
.✓o� ///e -!%£c'io�Gs /J`
Date �Inspector
, , .
_ . c' .. ..- - --- . _ . ..
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Final
ION OF WORK i'
SUBCONTRACTOR
� 248 I 9 ' C�T� ;� S� q
' �COSTA MESA BUILDING-SAFETY DEPARTMEt�R I _,\ I
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92E20 - J n(�T 1 � �nr�(.tl"
y ' Costa Mesa Bnilding Department
"ti ' 117 EAST 20th STREET
�'� COSTA MESA, CALIFORNIA
� FOR APPLICANT TO FILL IN
Building
nddresa g�pi Fernheath Lane
Costa Mesa, California
Nearest
Cross St.
Owner n..ii,..... v.,se �...,...�....
cy Garden Grove No.Le.9-2158
ehitect or Lic.
�gineer Davia & Quivlev No. ��1790
Idress 43 ?lalaga Cwe I'laza,Palos Verde
City Lla
ntracmr �A Ha7e Comnanv No. 3422
Idresa 8002 Ceatral Ave.�Garden Grove
Metea and
Setback
Centero
New
3ize 1'L'!U
'�erior Wall
erina .StllCCO
No. of Bldgs
Nowon Lot NOII�
No.of No.of
Familles Rooma
Rear Vard 4f; r
I Demolish I
s SWries 1
.._ Rock
I hereby acknowledge ihat 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 construction.
Slgnature of
Permittee � �.
Authorized Agt �QO,(U 1 �b �(.,1_QJ.—
Vdi(f�tf6 �n �A��' Permit Fee $ o� �"'�
� Plan Check $ �
$ $ a ° To�� 7
� Fee J �
FORM 204 S-HP 2M 8-55
APPLICATION FOR PEKml�
igg� BUILDiNG
9 FOR Ok'FICE USE ONLY
Lpy Date Rec'tl. Date
) EP 1 91955 �l'�?�-.
Costa Mesa, California
No.of Type Gr
Plans
nr�Rov�.s
�n'Location I Inspecto
Materials,
Plaster, Int.
Plaster, Ext
Masonry Relnforoed
Bond Beam
O
9
�
2
D
r
� r�
PLOT PLAN
Show Iocation and distances Trom
property line and between buildings
�
SEP 27 •SSPDnesar jO?� � •:�: 23.��