HomeMy WebLinkAbout3068 FERNHEATH LN - Building Permitss
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PflOJECTRODNE55: 3OGE FERNHEATH LN �
OWNEN'SNAMF: KOENIG RARL W
noosess: 3068 F�RNHEATH'
COSTA MESA,CA 92626
ABCMIENGMEEB: S 4 S— 3 7 2 9 AEC.NO.:
p�ONFSS:
UNIT:
UNIT:
PERmmEE' NEWPORT ROOFING ( 714 ) 645-0104
ADDNESS: S%% RIVERSIDE AV
�1� CA 9 2 f�6 �3
LICENSEo CONTflACT CLAflATION: I nereoy alfirm ihat I am Iicense0 untler o�oJtsions of naD er 9(commencing wiin Section
7000) ol Oiv�sion 3 0l the Business an0 Pmiessians Cotle. anC my li<en5e is in lull lorce an0 ellecl.
CITY LIC.: TpTE C.: CNSS:
029488 524454 39
Date: 8 '� � Signamre� .
WOPNENS' LOMPENSATION OECIAflATION: I hereby a� I ate of consent m sel4insure or a certilicate ot Workers'
Compensatian Insurance. or a cenifietl coDY t�ereol (Section 3800. LaU. C).
roucrwo.: 1016528-93 E%P.ORTE: O�I�OSI94
carnvaNr: STATE
� Cehifie0 caDY is here0y lurnishetl. � Cetlilietl copY is IileO wilh �he cify BuildinA Oivision.
Oale: � / �( � � Appl' I' �
E%EMPIION FPOM WOBNEflS' LOMPENSATION OECU . his 5� nol be comDlel¢0 il the permil i5 �or one hunAreO (5100� or less).
I cerlily Ihat in Ihe Oedormance ol lhe work lor w�ic� Ihis permii is i55ueA. I shall no� employ any person in any manner w as to G¢came
subjec� lo t�e Workers Gomp¢nsation Laws ol Calibmia.
Oate: Signaiurt:
NOTICE: II. al�er maNing Ihis tleclaration, you shoulA hecome su�le�� �o Ihe Workers' Compensaiion pmvisi0ns ol Ihe Lahar
Cade. yau must lonnwiln comply with suth provisions or tNs permit snail Ee Aeemetl revake0.
CONSTflOLT10N LEN�ING �GENCY: 1 �ereUy afiirm I�ai I�¢re is a wn5imclion IenOinp apency for lhe petlormance o� Ihe work �or
w�ich I�is permii is is5ue0 (Se[tion 3097. Civ. C�.
IFNOEfl:
RUOflE55:
OwNEfl BWLOEP DECUflR7lON: I hereoy affirm ihat I am evempi imm tAe Cantractors' Slate License Law for Ihe lollawinp Bason
(Section 7Q37.5 Business ana Professional Cotle: Any city ol county whicn repuires a permit to conslNcl, alter, improve, Eemol6h, or
repaii any sirutiwe, pnor to ils issuance. also reQuires Ihe appliwnt lor such De�mit ta file a 9gn¢E statemenl ltlat 11PJs�e is licens¢tl
pursuanl la Ihe O�ovisions oi IOe Conirac�ars' State License Law (ChaD�er 9(commendnq vnN Section 7000� af Uivision 3 0l t�e Buvneu
anG Pmlessinns Cotle) or Iha� he/she is erempi Iherelwm anE ihe ba5i5 �or Ihe allegee exemption. Any violaiion ol $ec�ion 7031.5 by
any apDlicant Ior a oermil subi¢tts ihe applicanito a civil penally of not more ihan Irve hundreJ Aollars (5500�.
O I. as owner �ol I�e pmperty or my employees wit� waAes as their sole camDe���on, will Ua I�e work, arM Ihe
simcmre is not intenOeE or atlereG lor sale �Section 70a4, Business an0 Pwlessional COAe: The Contraclors' State License Law
tloes noi aDD�Y �o an owner ol a properly who builds or impmve5lhefeon, anU w�o EOes suth work himsell/hefsell or t�rouph
his or her own em0layees, pmvitletl that such impmvements are nat intenaetl ar affereG for ute. Ii, however tAe UuilOing or
impravement is solE vnt�in one year al wmpletion, the axner vnll have t0e UurOen ol proNnp �elshe GiG nat builE ar improve
for ihe purpase ol salel.
I. as owner ol ine D�ooeny, am exclusivery Canlracling wiih IitenSeA Eontratlor5 i0 conStNti Ihe D�OjeC� (Sec�iOn 7044, BUSine55
❑ antl Pmiessims COAe: 7he Contracmrs' State License Law Eoes not apDly ro an ovmer ol propeny who OuilUs or improves thereon
an0 who Conirac�s lor SutA OmjeCts wih a tOnirat�Or(5) liCense purSuani Io �h¢ fqntrat�or5' Sia�e Lic¢n5e Law). I am awaf¢
Ihai pfool oI ��eir Workei 5 Camp¢nu�ion in5urance S�ould �e pmviGed IO me.
� I am exempt undei Seciion: B. b P. C.
tor mis reason:
oate: Qwner.
I ao nereby cenily Inat I am aware ol antl un0erslantl Ine reQuiremenis ot Calilomia Healih antl Salety Coee Seclions 25505. 25533. antl
2553G antl ��al I or any �uture OuilOing accupant wilUwill nol (circle one) nee0 to comply wilA 5ai0 slaie co0e5 anOlhe i¢Ouir¢ments tor a
permii lOr wnSVutlion or mo0ilitalmn Imm Ihe Air Oualiiy ManaAemenl OiSiritl. ReSiC¢n�ial con5imtlian aD�liCa�ions are evemp� imm
ihese D�ovisions.
Dale: NOPlicanl:
I �¢r¢by ceriity Ihal I haveread Ihis appliCaiion antl Slalelhai Ihe aboveinlormalion is correci.lagree�o tompiy wiih all tily anA Counly
orUinances anA state laws relaling lo builaing conslmclion and hereby auihorim represen�alives oi �Ais cily Io en�er upon Ihe above�mentioned
pmpeny tar inso ���on our ses.
�a�e: _ 5� �.� N�W�o2r JP�fi�s
�rivefs License or Social Securiiy k: � �
i64i�46 Wbne—BmlCmg; Green—Cotlo EnlorcemenC Canery—Applicant: Pink—Rovenue; GoltlenraE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06360
PERMIT NO: B 063600 PLAN CHECR NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMZT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : T/OFFI REROOF W/COMP SHINGLES SQ FT: 2,200
CLAIM VALUE: 2,20b.00 CALC—VALUE: 2,200,00 GROUP OCC: R-3 /M-1
COMMENTS: REROOF 1500SF RESIDENCE S GARAGE W/COMP SHINGLE 4p
�r�t�t�t*�r��r�t*�t�t�r�r�e**�t**x�r�r*�r�r�t�t*��r�r���r�r�r�r�r�t�t*�t�t�r�r��e+t�r�r�r�t�e�r��tJ' �r�r�r��r��t�t**�rx�r
2 O N I N GS ERTEB�AUCIKRSE M E N T S ��r�
------------ MAIN BUILDING ---------- --------- ACCESSORY HU'I��T���FY ��—'
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: U IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL: 19104909 ZNE: REF NO:
PLANNING N01'ES> �. ,
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NZNG APPROVED BY DATE: �%
HUILDING APPROVED BY ; DATE;
APPLICATION ISSUED BY: � DATE: ���
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LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RESi GRADING
PERMIT 54.00 50-
PL� SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID "� DUE
TOTALS----> 54.50 0.00, 0,00 54,50 54,50 ' ,00
REVENUE DIVISION TOTALS--> COLLECTED; 54.50 OVER/SHORT; !� 00
BLD54P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADING'PLAN—CHECK
1'
it it k if k ik 1f 1k 1Fif �t M 1f k �k 1f M if 1flf ikiF if 3f iF it3F �f k it it it iF if iF ik if iF �Fik if �! kik fFif if if k�k ki! k 1t if if �kk if 1t it if iF if iF it iFiF iF it if it N it M ik iE M it
Z N D I V I D U A L F E E B R E A K D O W N �
TYPE QTY D E S C R I P T Z O N UNIT COST �TOTAL COST
SFR 2200 REROOF BY VALUE RESIDENTIAL N020NE 1,00 2,200.00
END OF FEES
01 00145420-00145421 T rJ T 54.50
DATE: GS/23193 TI11E� 15:¢y
�.
: <� .v' 'F
CONSTRUCTION AND PLANNING POO� iPA
APPROVALS PBrmit # Date Inspector APpqOVALS Permit # Date Inspector
1. Temporery Electrical Service�or Pole 52. Pool & Equipment location
2. Soil Pipe�Undrgrnd. i 53. Steel fleinforcement �.
`7;' He,ctri�l ConduU,Uttiity-Uadrgmd!' � 54. Forms
_4.�'Eleeirical Condu t�Undrgrnd. 55. Electrical Bonding
:'S."�teel ftpinforcerfieP� - 56. Rough Piumbing & Pressure Test ��
a�i:, le�trical UFER.Cx!nd. 57. APPROVAL TO COVER�GUNITE ;
e
'7::Footings �� � 58. Electrical ConduirUndrgrnd. 1
i. r + �.
E�'Foundation ',y �' 59. Gas Pipe, � Undrgrnd., Test �_
9. Water Pipe�Undrgr�d. � � 60. Backwash Lines, P�Trap, O Undrqrnd.
10. Structurel Floor Svstem - 61. APPROVAL'i0 DECK
t t. Property Sewer Line�'& Ho4se ConnQction 62. Backwash & ReceptorFinal
rn
�Z. SevLe' CaP �, � 63. Heater & Vent•Final �
13. Roof Drains . � . 64. Plumbing System - Final �
14. Rough Plumbing. `� 65. Electrical�Final .
75. Rough Electricafxonduit 66. Solar System-Fina�
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Si�n 68. APPROVEO FOR P�ASTERING
18. Rough Electrica1�Y Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & A�r Conditioning FIRE DEPT. REQUIREMENT
- - -+-�--:*` ' 7 b' Uv , a� �_, S # r. � i
20. Rou� Fd4toryi FiCPpiace ! '., �� ��i a: �J :i =ri. MPPRQI/AL'5�DJ'ermit # * �' ^'
♦ Ir• ti. L Y H r• � o � �� iHF. "� lT� ii
. �� �y ��.�a . z s� 5,� , n,
21. �D�uc�; in;Str�}ureia i �..�,� � . � rJ � ,�: , - 0. llFder9reu�,d- Yti!.+'o �
22. DucB{ V00til3tin�-+� !'✓:� e ' S?'" �J7, productPfiTnqD.G,n Oilil
� + n� � . s' rJ' .-+a: E E r i �'ll7 A CJ, c.!
23.'das�ipe�fi,oug�&T.�st � fr.,.� �, f�y� �.�z, Undergrou�JiFlu3}3i.,,-, ,; �� ��
24. ifloo��Framing.• ���:. � �,� �-,F r . � h .�.. :.i3.�[lndergrnd"Stora�q�4'ar�rk �Gas ❑OiP
25. Roo� Sh�athing G� r � ' Z�f p'3~ r .�'� , jq, �erhead F�ydro C�"� x
' _,.. �
26.7,-BaFCeiling(Structuraq &Ntonocoat - .,.i �� '7< . 75.cDrqChemical 7 ++H �� x
1 ^n Y
27. 'FTame and Flashi�r: _`, J. ; T ,�;� ; 76. �Dry Standp��e' C� * g K`' C,
�28. Lathing �Siding ros o-: .-)S�sJ'. �. F. ��Y 77.'1FIXED S't�SC'EM�INAL `� . . "
'M '\ 4�I
�29. InsulatidA � ;-:� J ""' ,' `'� � 78.�IRE PREV. FINA�; � � r
;$0. Drywall Ngiling ;�* � _ � :� HEALTH E1EPT.�R�EQUIREMENT
,: , .,� � a
� 1. Plasier 8�wn�Co�S �` _. i r � ; , � x `, Z9.�INAL IN�S�,�CTI�{U � �' '� �
5 r 1 .�.a i t � { -' iT :x �T� l- ,
E32. �Electrical=�'ow�r Meter,•Final i .,,. y�! �80. ,F,OOD CEA �IFI�T,E ISSkJED
33. �in�Elee'tric� r;7 �t i r `�� ��or�' -�i �i[q i y O ni;r�
�. ri � ; - - .,�ti
`�3,4.�f�ina�He�ing�A+I�o ditior�ir�gc. , .. S �,,�, > �• rir
35.:Flin�i-Gai'Pipc�est'x '�' � * i r �-� ^ siS ?'h' S��
i tf•. ' .•H x`�7 �^.J `IH Hy'
.. .v ..� . ..�, '
;�?6. 'Hoo�or �CanoPY n� = i - . �� i � � y 5: ?" C�c R � S?
>37. Final�Facjory FirePl¢ce�__ � 5` '� '� .'Y �# f i 4 �
.. . n � ^ •' .. .. � -, i ,c r . _
38. Final PluqSbin9 �., �� i � � x• S - t,:, C
�.9. WateKService�Final-� � � ¢�� <' � � ' • �
s ✓ 6. k $
`�,0. Gas Service-�qal ;,- _ � . ,� ;_ . �.; ^, }- . , .
.�Gl. Solar pomestio-Finat: c � � � � ,:; ;-- - � �
n . � ;o � � :
��A2. Backflow Prevents��: `y `� Y ` ' �,�.. . � ~ '
4 • z j H
� s: # -�..^.J " l7
43. Backflow Irri�ation �� -c .S"_ '
a > .J i
'-9;4. Landscape Irribatio�System` � '� '> - � ' � y '
u:� � -.1 � X L(�J F :7 '-�
i , i � .. � � . _ ' .
ft5..$ound AitenQation> . . . * - - - �? - C' �+ �+ .r: _r, � -
,. � � ,. :r: r r rr -
;+16. +landicad'RegJlatiorTs - `. ' �� �'� '� � � i -� J'� '
_ ; .[ .A JO S �•
4�. F�INAL STRUCTURE & BUI�LDING _��/7 ' � .: �1��;,�� �_ ��-�c.�,�
l� J. -
48. FINJZL PLANNING° , •`, x ,� � ` . �h �� x � .
�q9. filec}r�ic Release to Edison . ry �-- �_ • �: � � � � �'!
n C
T50. �ias �eleafe to Soutt�em CalifPrr}ia Gas Co ' " � ; •` `, ;� . �� ; %�' •
� r
31. CER'FIFICATE OF 9CCUPANCY` _ .�, > �, �, -.� ;.. ' �J ,,,
No. Date
�� � � AODlicant to fill in all soatts except those witnin heavy boraer Ilnes antl sign all aooropriate tleclaroUans.
.. � OF �w 'MESA CO STRUCTION PERMIT PEE �T "� � T�t �C 7% L�N�O. UNltib,
Project Address �8�8�°''�'�`'v!��6�J Tf�-� �� F�
Applicant's Mailing/ �Addre[s/s .�0� � ��'U6a r/�
Owner'sName ^ • /`d '��G Phone
Address 306� F6'f''��"��T
Arch/Eng. License No.
Address �
Convactor's Nam 0'�/t /C � Ty � hone8%�'SS %�
Addresslmailingl `��y �6i.u�6e � '
Ciry License No. 3 405�
LICENSED CONTRACTOR DECLARATION
I hereby ai/irm that I am licensed untler provisions o1 Chartar 9(mmmencing
with section ]000) of Division 3 of the Busine55 antl Prote55ion5 Cotle, antl
my Iicensa is in /ull foLge�nNeffect� � ���/
Licens�yC_lass.�� �� � � }�
Dale_l—O3� Signature '�•�A�� �`(j�
WORKERS' GOMPENSATION DECLARATION
� nereby atfirm that 1 have a certiticate oi consent to sclf-insure or a cerHticate
' Wo�kms' Compnnsa[ion Insurance, ot a certifi¢tl Copy th¢reot ($ection
.00, l.ab'. C.) ' �
Volicy �No. Company ��
BCertifietl <opy i5 hereby fu�nishetl. . � �
Certi/i¢d copy IS filetl with [he city Builtling DlWslon.
Da[e APPlicant
EXEMPTION FROM wORKERS' COMPENSATION DECLARATION
(Tni55ection n¢etl nol be ComD�etetl if tne perml[ is tor one huntlretl (E100) or
less).
1 certi(y lhal in Ihe perfo�mance of t work fo� whlcn this Oe�mi��js isSueQ'I
shall not employ any person in any nner so as to bp{ome utij,{l ect co t"he
Work¢ Co DP� szT Laws of Cal' � 1. �`� '
Date V � Signature �l
NOTICE: Ii, after making this tleclaratlon, you shoultl become sub�ect to the
Wo�kers' Compensation provi5ions Of [he ldbo� Cotle, you must forthwith
comply witb Such provlsions o� this pe�mlt Shall be tleemetl �evoketl.
CONSTRVCTION LENDING�AGENCV
1 bereby af(Irm that [nere Is a consVuction lentling aqency fo� the pertormance
of ttie work for .which this permit is issuetl (Section 309� Civ. CJ
Ltntler'S Name
Lentler's ACtlress
OWNER BUILOEH DECLARATION
I �ereby atfirm tnat I'am exempt (rom the ContractorY Ucense Law for the
fo�lowing reason (Section �031.5 Business antl Professional Cotle: Any city or
county which requires a permit [o construc[, alter, ImOrove, tlemolish or repair
any sVucture, prlor to its issuance, also requires lhe applicant for SucM1 permit
to fiie a si9netl statement that he/she is licensetl pursuant to the provisions oi
the Contractor's License Law (CnaO�ar 9(commencing with Section 7000) of
Division 3 of [he Bu5ine55 and Profe55ion5 CODe) o� that h¢/sne is exempt �
^refrom antl the basis fo� the allegetl exemption. Any viOla[ion ot Section
31.5 by any applicant for a permit 5ubject5 Ihe appllcant to a civll
.�alty of not more than tive nuntlretl tlollars (y500).
L� I, as owner o1 the property or my employees with wages as their sole
compensation, will tlo tne work, antl ihe sVucture is nbt Intentletl or ofteretl
tor sala (Sec[ion 7044, Business antl Protessional Cotle: The ContractoYs
LicenSe Law tloes not apply to an owner o( a properry wno builtls or improves
lhereon, antl who does such wo�k M1imselt/he�selt o� th�ough his o� her own
employoes, provitletl that such improvemen[s are not intentlotl or offeretl for
sdl¢. If, hOweve�, the bulltling or imp�ovement i55oltl wl[hin one y¢ar of com-
^pletlon, tM10 owner will have the burden of proving he/she tlitl mt builtl or im-
�rove for tne purPose of sale).
I, as owner of the property, am exclusively conVactlng with licensetl con-
tractorsto consVuct the project (Section ]04a, Business antl Professions Cotle:
Tho ContractOr's License Law tloes not apply fo an owne� ot property who
builtls or Improve5 lhereon, antl.who contratts lo� such proj¢cts witn a con-
tracto�(51 I¢ense pu�suant [o the Coritracto�'S License Law). I am dware thaY
proof O( tneir Worker'S COmpensation insu�anc¢ ShOultl be provi0etl to me.
❑ I am exempP untler Section B. 6 P. C. for this reason
Date Owner _
I h¢reby certlty [nat I have reatl thi5
information is torrect I aare.e tn mmo
Drivers' Licanse or 55 �
above
g a � s-
TYPE OF CONSTRUCTION NE
❑ CONVERSION ❑ DEMOLISH
DESCRIPTION OF WORK/USE OF
� ADD 1J ALTERATION LJ REPAIR
OTHER
TVPE OF PERMIT�q LJ GRADING LJ FOUNDATION 12S STRUCTURAL
❑ TENANT Xl ELECTRICAL ❑ PLVMBING �MECHANICAL
❑ OTHER
PROJECTDESCHIPTION 5(] FT � oCCuanNCv�
CONSTRUCTIONTVPE_�_ VGI_t_IATIbN$��q3SY
ZONE GRADINGCV.VDS. ACRES_
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtu6s
ClariFiers "
Dishevasher ..
Drinking Fountains �
Flooi Drains
Floor.-5�nks
GasService Outlet
Interceptors �'�
KitcAen Sink "
lavatories � . �
P—Trap �
Roof,Drains - '
Reinspection Fee $15
Duct-UnderGrOund
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ MWti
Firepl/Fact Bit. ICBO #
Heating System & Ducting
❑6100,000 BTU 0100,(
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 Trays
Issue Fea
Hoodor Typel ❑
Canopy Type I I ❑
flefrigeration System
❑0-100,OOOBTU ❑100,000
❑ System Repair/Alteration
Fire Dampers -
Registers
Reinspaction Fee ��� $15 I � luue Fee
GMF OB65-46, rev. 10/84 White - Builtling; anary - Applicant: Pink - Accountinq; Goltlenrotl - Assessor ,
S--
$ 3
A.P. �W
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
/�
�
�
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Drycrs �Gas. OEleci
Fan
F.A.U.
�ixtures
Device 8oxes
Outlets
� 0769 B%05/86 -
F? .: " '
Zone
Accessory Building:
'Parking Req./Provided
ELEC7RICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
Gar6age Disposal
Generator �0.5 KW 05�15 KW
Reinspection Fee
FEES
�DEVELOPMENTSER
2aning Approved By_
Building Approvad By
Aooliwtion Issued Bv_
$ 3
Meter Uup to 100 amps
Merer �over 100 amps
Sub Panel '
Motors OO-1 HP �1 %- 8
IncSolar 09-75 HP �16�15+
Microwave �
Pole.Light �
Sign
Standing Sections
Trash Compaccor
$15 � � Issua
BUILDING PEFMIT $ �Y�• "`'' SMIP � $
PLAN CHECK $ �- %I• 3� pERMIT
PLUMBING � $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. S
ELECTRICAL $ /� gO GRADING S
PLAN CHECK 50% , $ �.n -y MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
241.89 TL�`
FEES
$ 3
�
Z
O
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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 G Sy�[ �6 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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 Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring �t�` �J(j 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. P001�/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 O Gas ❑ Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil �
25. Roof Sheathing G, 74. Overhead Hydro (,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . ;i
27. Frame and Flashing 76. Dry Standpipe � '
28. �athing & Siding �Q }� 77. FIXED SYSTEM FINAL
29. Insulation Z G 78. FIRE PREV. FINAL �
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION '' ,
32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ��� � � � �
34. Final Heating & Air Conditioning
�
35. Final Gas Pipe-Test
7-�-�e L�lx� o
36. Hood or Canopy � K �� �� COvr.
37. Final Factory Fireplace ���� �� �
38. Final Plumbing � g? Q.�
39. Water Service-Final � �
40. Gas Service�Final ' '
� :
41. Solar pomestic-Final • , ��
42. Backflow Preventer ' � .
43. Backflow Irrigation � � - "
44. Landscape Irrigation System ' � �. ' ' ��-
45. Sound Attenuation • • �
46. Handicap Regulations � � (� �
47. FINALSTRUCTURE&BUILDING � �Jf�l , .,� � ' , �,`�,
48. Special Requirements Completed � .� ' S
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY � '
No. Date _
AOPlicant to fill in all spaces except those within neavY eoraer Iines ana sign all appropriate aeclarations.
CITV OF COSTA MESA CONST,�UCTI�ON PERMIT PERM NO;' ��� � TRACT NO. ; LOT NO. , UNIT NO; � �
30�oB �-r�, �6R.�h�EgT oc
Project Address
TVPE OFCONSTRUCTION NEW AOD ALTERATION REPAIR �
Appiicant's Mailing Address � •
K. hIO6u. 6 ❑ CONVERSION ❑ DEMOLISH � OTHER A.P. #
Owner'sName� � Phone -- !�4/hI�Y ROPm 6
Address "jC�B F���`'�'�C�TN ' - ; DF�CRIPTION�WORK��E� FB�DG. _
�� 4L t E+ci S Main Buildi
Arch/Eng. License No. TYPE OF PERMIT ❑ GaaDwc� o❑n FOUNDATI.Oc/N� 1 STRUCTURAL T Front
Address ❑ TENANT ❑ ELECTRICAL .N PLUM9ING .Y31 MECHANICAL B Rear ;
Contractor'sName � � �� � Phone�`� � OTHER %�
`� C Pight
Address Imailingl'�6 � �'v6i�EEQ P- y• 8• PROJECT DESCRIPTION i 5Q.!FT. : pCCUaANCY K
CONSTRVCTIONTVPE VALUATION$ S Left
City License No. ��� ZONE G0.ADING CU.YDS. ACRES P� R f# '
LICENSEO CONTRACTOR DECLARATION ' �
I hereby affirm that I am licensetl untle� provisioni o/ Charter 9(mmmencing
with section ]000) of Division 3 of the Business ana Protessions Cotle, and
my license is in tullh orce antl eftect ��
License Class v� ' � L' N 7��
(� Date �'�%—� 8 �l�f�GitiL'� . i��./
' WORKERS'COMPENSATION DECLARATION
�� 1 hereby atiirm that 1 have a certificate oi consent to selt-insure or a certificate
N Workers' Campensation Insurance, or a certitietl copy thereot (Section
800, Lab�����g� SYgTe /"-t/�✓.h
Policy No. T� , ComOany
8 Certifietl mpy is hereby fumishetl.
Cev�Cl(�etl c p is with the cit tlin ivi '
Oate_3('��-��'�� APPlican[ �� J �-t^
EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION
(This section neetl not be <ompletetl if the permit i5 for one huntlretl ($100) or
Icss):
1 certify that in the performance ot the work for which this perm�t is issuetl, 1
shali not employ any Oetson in any mannet so as to become subject [o the
Worke�5�' Cor�p�ensation Laws oi Calitomia.
Date�'•�— Signature
NOTICE: If, af[er making this tleclaratlon, you shoultl become subject to the
Workers' Comp¢n5ation provisions of the Labor Cotle, y0u must torthwith
comply with such O�ovisions or lhis permit shall be tleemetl revoke0.
CONSTRUCTION LENDING AGENCV �
i nereby atfirm that there is a mnstruction lenaing agency for tne performance
ot the wo�k tor which thls permit is issuetl (Section 309"!.'Civ. C.)
Lentler's Name
Lentler's Atltlress �
OWNER BUILOER OECLARATION
I herpby affirm that 1 am exempt f�om the Contracto�'s LicenSe Law fo� tM1e
following reason (Section 7031.5 Business antl Professional Cotle:'Any city or
wunty whith �equires a pe�mit to const�uct, alter, improve, tlemolish or repait
any sbucture, prior to Its issuance, also requires the applicant for such oermit
to file a signetl statement that ne/she is licensetl pu�suant to [he provi5ion5 ot
the Contractor's License Law (Chapter 9(commencin9 with Section 7000) of
Division 3 of the Business antl Professions Cotle) or that ne/she is exempt
� 'herelrom antl the basis for Ihe alleged exemption. Any violation of Section
]31.5 by any applicant tor a permit suDjects the applicant to a civil
:nalty ot not more than five hundretl doilars (5500).
� I, as owne� of the p�operty o� my employees with wages as thei� 5ole
compensation, will tlo the work, antl the st�ucture is not in[entletl or offeretl
tor sale (Section ]044„ Business ana Profezsional Cotle: The Contractor's
LicenSe Ldw tloes not apply [o an owner ot a property who bulltls or imprOveS
tbereon, antl who tloes SucM1 wnrk hlmself/herzelf o� thwugb his or her own
employees, provitletl that such imp�ovements are not Intentled or otteretl for
sale. If, however, the bulltling or Improvement i55oltl within one yea� ot com-
- Oletion, tM1e owner will have tlte bur0en of provin9 be/she tlltl not builtl or im-
�rove for the purpose of sale).
i, as ownet of [he pro0erty, am exclusively contracting with licensetl Wn-
tractorsto consiructthe project (Sec[ion 7044, Business antl Professions Cotle:
The ContractorR License Law doe5 not apply to an owner of proper[y who
builtls or imoroves thereon, antl who contracts for such orojects with a con-
tractor(z) Ilcense pursuant [o the Contractor's License Law). I am aware Ihat
proof of their, Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt under Section B. & P. C. for this reason
Date Owner _
I nereby certify that I have �eatl this
information is correcY. I agree to comp
antl state la relating to builtling con
sen[ativez o his city to enter u�
inspection ses.
Siqnature
DriveR' License or 55 � —
n antl state that the above
city antl county ortlinances
antl hereby authorize repre-
ve-mentionetl property for
v Datell�l,$�—�
• ! �. �_
Remarks: a`G �486
Bar Sink
Backflow Preventer �
Dishwasher �
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
InterCeptor5
Kitchen Sink C{l,
Lavatories
P—Trap
Roof Drains
Reinspaction Fre
O
PLUMBING •
Servite Sink � .
Sewer Cap � ' "
Sewer Connection �
Solar Collecrors �
Solar Piping '
Solar Tank �
Swimming Pool w/Spa
Urinal
Outlets Water Closet
Water Heater �
7.(�E (,yJ. • Water Service
Auto-Wash
Laundry Trays
$15
Duct- Under Ground
Duct - SVuctural
Duct- Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000
Reinspection Fee � � $15
CMF 0865�46, rev. 10/84 White - Builtlin9; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
❑ai00000eTu ❑ioo,000
SVstem Repair/Alteration
Fire'Dampers
Registers
luue Fee
$ 3
FEES
$ 3
ng. e .
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Oryers ❑Gas :DElec[ric
F.A.U.
Fixtures
Device eoxes
Outlets '
Switches
Garbage Disposal
Generator �0-5 KW
Fee
9164 12/23/86
Zone
Parking Req./Provided
ELECTRICAL � :
Transformer ❑ 15-50 KW
❑ 50+KW
' Meter ❑up to 100 amps,
Meter ❑over 100 amps
Sub Panel .
' 8.D0 �TL
FEES
Motors DO-1 HP �7Yz-8
Ini. Solar �9-15 HP'016-15+'
Microwave
Pole Light
Range
' Sign ' ' . . _ '
Standing Sections
5 KW Trash Compactor
i
$15 luue Fee . $ 3
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Appraved By
Building Approved By �
Aoulication Issuad Bv � ��
SUMMARV OF FEES
BUILDING PERMIT $ 'SMIP � $
PLAN CHECK $ . - PERMIT
PLUMBING g � �SSUANCE $
PLAN CHECK 25% $� ENERGV P.C. $ �
ELECTRICAL� . $ GRAOING $
PLANCHECK 50% $ MICROFlLM $
MECHANICAL $ TOTAL FEE $ � O O �
PI.AN CHECK 25% $
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CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector pppROVALS 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, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .
i i. 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
75. Rough Electriral-Conduit 66. Solar SYstem-Final ' �
76. Rough Electric Wiring 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 Struaure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI
25. Roof Sheathing 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical '
27: Frame and F�ashing 76. Dry Standpipe
28. Lathing & Siding 77. FI�XED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailin9 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 "
36. Hood or Canopy •
37. Final Factory Fireplace �
38. Final Plumbing 2.Z�-� «j - ,
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestic-Final �
'42. Backflow Preventer . �
�43. Backflow Irrigation ' �
44. Landscape Irrigation System '� ' .
45. Sound Attenuation
46. Handicap Regulations , �.
47. FINALSTRUCTURE&BUILDING , , -
48. Special Requirements Completed -
49. Electric Release to Edison � �, '.�
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
-OWNER COLLEGE P�SA COMPANY DATE 9/$/58
JOB ADDRESS � 30 Fernheath Iane BUILDING PERMIT NO. 75�
GENERAL CONTRACTOR e a e Omp3ny VALUE $ �
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OP WORK 1ng e we ing w a . gar.
GROUP TYPE ZONE PLAIv tvn.
I� �ECTIONS ' . I DATE I BUBCONTRACTOR I DATE PERMITSNU�U ED
coat
• �r- ��t� ) �Cl-ne
•, '��V-1
COSTA MESA BUILDING DEPARTMENT
p. O. BOx 31'!
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
COSTA MESA. CALIFORNIA
OWNER COLLEGE MESA CONII'ANY
ADDRESSP.O. BOX 2277, Brookhurst Station
CITV Anaheim TNo: KE 3-3161
nR -ecr u ot, uig ey uc.
oF iHEER and Cl�rk ��� P.E 7191
ADORE55 1102, w. 1%tl� �t. � Santa Ana
CONTRACTORTk12 Hale Company"T'� N�o: 7350
ADDRE551777 W.Lincoln Anahei�o�. KE 3-3161
o[stwiano�v NO. 92 BLOCK TRACT ZE%�1
an -
A.P. NO.
s�zE 71 x 105 "° °` a`°°� None
OF LOT MOw ON �OT
SETBf�CK LINE FROM SO, 3Z'
c[NreA oF s1n[[r REAR VARD
SIDE YARO RIGHT LO� IEFT 9�
DESCRIP710N OF WORK
NE X qLTEFATION ADDITION
REPAIR MOVING DEMOLISH
BUIL�ING � lV• NO.OF
SIZE � ROOMS STORIES
E%TERIOR WALL ROOF
COVERING S O COVERING CO O
USE OF NEW
eu��o�Nc _ Single dwelling w/att. garage
.�� Y� 6 Y � Y./ �• J..�. .
�,�s�ss--,
^.�. .. : .. ..
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
OiTE
SEF
COSTA MESA. CALIFORNIA
FIRE
ZONE
APPROVED
BV
tieREev ncrcrvow�eoee rnA�
STATE TH/.T THE TBOVE IS COFRECt nrvD AGREE TO COMPLY WITX aLL
CITT OFp�NANCE$ 4NO STATE l<WS REGULATING BUILOING CONSTRUC�
"�" COLLEGE MESA COMPANY VALUAil�t3
Is�c�oTURg�6Fgy; The Hale Companv,Gen.�rtne
s 12,599
CORRECTIONS
PERMIT FEE S 30.00
PLAN CHECK 5 LS.00
TOTAL FEE S/.S nn
�err
; . � � s���
��
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31� COSTA MESA, CALIFORNIA
FOR APPL/CANT 70 f/ll /N COMPLETELY
TYPE OR PRINT
BUILDING
A�DRE55 � C
COSTA MESA, CALIFORNIA
OWNEi� ��.,, $, GeEEN�F�rF
ADDRE55 3068 1 efKllt'�^ I�^�^
� . _. rF, xi
lw A'
� LEGiIL I LOT /j .� I
OESCPIhTION NO. �I /'
� OF LOTIOµX IO�X y �•,LX IO I NO.OF BLDGb.
NOW ON LOT E
USE OF
EXISTIryG BLOG.
SETB�CK LINE FROM /
CENTEq OF STREET SD �'u� REAR YARD D
ISIDE VqRD ILEFT O IRIGHT O
DESCRIPTION OF WORK
� I� II ALTERATION I II ADDITION
REPAIR I IIMOVING I IIDEMOLISH
BUILO�NG NO.OF
SIZE ROOMS STORIES
EXTERIOR WAL� IROOF
COVERING COVERING
I HEWEBY ACKNOWLEOGE THAT 1 HAVE RE�O THIS NPPLICATION
/.NO STATE THAT THE ABOVE IS COqRECT /�ND pGHEE TO COM�
pLY \y�TH ALL CIT� INANQE�O STATE L�Wg REGULATI�
BVILDING CONSTRIICTION. �' � Ji;�
SIGNATURE OF i� G iI� h�
�AUTHORIZEO AGENT
�
��i�t �(���i�tU
c,,,�✓ �_. , ��a
FINANCE DEPT.
CI (Y OF C�STA MESA
APPLICATION FOR PERMIT
BUILDING
fOR Off/CE USE ONLY
FECEfPT NO. PERMIi NO.
I /�
.1� BY I DAT[ RE�� �� I Q^T�� ��
y G � R (L
NG
ss v�o 6 �.w..e-..� �«-
C057A MESA. CALIFOR IA
FIRE
ZONING .
ZONE[�/ IpqN6 �'IBIIELOFNG
/�
BYPR9 I/1/��/� .
DATE'
YARDS � EVES
REQUIREO ALLOWED
(CENTEft LINE 8TJ �. 1
n.e
THE /�MOIINT BNOWN fINDEH VALUATION 18 FOR THE
PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
ALUATION
�j' �j PERMIT FEE S � �
$ % �v / PLAN CHECK $
q L��
TOTAL FEE S O� �