HomeMy WebLinkAbout2869 DRAKE AVE - Building Permitsr' ' �
�
�
CITY OF COSTA MESA
�.�'�p MFs'q BUILDING D/VISION
iY�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�'"°•°�`°'� PERMIT NUMBER: M10-00157
PERMIT TYPE MECH STATUS: ISSUED
APN: 14154101 DATE ISSUED: 12/13/2010
ISSUED BY: RMD
JOB ADDRESS: 2869 DRAKE AV CM
Vicinity: ATTIC AREA
SQ. FT: 0
Suite/Unit:
SCOPE OF WORK: MECAHNICAL PERMIT TO CHANGE OUT FAU < 100 K BTU LOCATED IN EXISTING ATTIC AREA.
COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: ADAMEK, WIL�IAM J Address:
PHONE: City/Siate/Zip:
APPLICANT: CANO, BLANCA Add25s:
PHONE: 562-867-4123 Cily/State/zZip:
CONTRACTOR: G C HEATWG AND COOLING
Address: 9672 ALONDRA BLUnit: PHONE: 562-867-4123
Ciry/State: BELLFLOWER, CA ZipCode: 90706
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $36.30
PLAN CHECK FEE: $0.00
INYES7IGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
2869 DRAKE AVE Unit:
COSTA MESA, CA
Unit:
License No. 794228
CELL:
NOTICE: The work authorizetl by this permit shall comply wilh all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § Y, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of lhis permit.
GOOEt. INSPELiIONTYPE Or1TE INTITIALS COOEO INSPEC710NTYPE OATE IN➢
7616 Fixed System Final Fire Pre�¢ntion 206 Final Mechanical X -1- I IJ'1��
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Elecirical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
20a Final Demolition 250 Final Builtling/Occupancy
., �
WORKERS' COMPENSATION DECLARq710N:
I hereby affirm under penalty of perjury one o( the following tleclarations:
❑ i have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as provitled for by section 3700 of �he Labor Code, for the
per(ormance of Ihe work for which lhis permit is issued.
� I have and will maintain workers' compensation insurance, as required by
section 3700 0/ the Labor Code, ta the peAormance of the vmrk !or wfiich this
permit is issued. My vrorkers' compensation Insurance carrier antl policy
number are:
qamen �1� u.r c9
(ihis section neetl nof be oompeletl d tlre pennq q�NeO al` onfe nwMrep ba'W�s (5100) a less )
P I�icy.tJ�mber. � V �7 �. ` 3 `1
❑ I certify that in the pedortnance O( the vrork for which this permit is
issued, I shall no! employ any person in any manner so as to become subjecl
to ihe workers' compensation laws o! Califomia, and agree �hat if I should
become subject ro the vrorkers' compensation provisions of Section 3700 ot
the Labor Cod shall lorthwith com ly with these pmvisions.
Q1..�GJ � `2. �� �O
Ap m'e.5ignaWre 0.Te
�-
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 ADOITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF 7HE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aKrm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Qusiness and Pmfessions Code, and
my license is in full force and eflect.
lA�.—#� ���Z'� Gass�j� ���
CAn,�C�r � �� �Z. l� ��
Conladas'SignaWre �ate
�j�'
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a Constmctbn lending agency for the
pedormance of the work (or wfiich this permit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
OWNER•BUILDER DECLARATIONS:
I hereby a(frm that under penalry o( pery'ury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for (he (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit Io
construct, alter, improve, demolish, or repair any swcture, prior to its
issuance, also requires �he applicant for Such permit to fte a signetl slatement
that he or she is licensed pursuant to Ihe provisions of the Contractors
license Law (Chapter 9(commencing with Seciion 7000) of Division 3 of the
Business and Professions Code) or Ihat he or she is ezempt theretrom and
the basis (or the alleged exemption. Any violation ol Section 7031.5 by any
applicant for a permit subjects the applicynt lo a civil penalty of not more than
five hunOred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensalion, WILL DO 7HE WORK, and Ihe structure is not intentled or
oftered for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who dces such work himself or herself or lhrough his or her ovm
employees, provided thal such improvements are not intended or offered for
sale. If, however, the building or imprbvement is sold within one year o�
complelion, the ovmer-builder will have the burden of proving that he or she
did not build or impmve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business antl
Professbns Code: The cont2ctors Licenge Law dces not apply to an owner of
propeny who Duilds or improves Ihereon, and who contracts for such project with
a contracror(s) license pursuant to the Contractors License Laws.).
❑ I am exempl under sec.
Business and Professions Code for this reason:
� , .,,
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
VeriScation of Ownership by (type o( document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAI SAFETV PERMI7 CER7IFICATION:
❑ I he�eby certify that no excavation frve (5) w more teet in depth into wfiich a
person is required to descend, will be made in connection with woAc authorized
by Ihis permil, antl that no building strucWre, scaHdtling, (alsework, a demolition
or dismanlling ihereof, will be more than thirty-six (36) feet high. (Chap. 32. Grp
2, Ari 2, Sec. 341, Ttle B, Califomia Adminis�2tive Code).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit from the Division of Industrial Satety, as noted above, unless
such person bas a permi[ to tlo such work trom the O�v�sion.
Applicanfs SignaWle
Division Of IndusUial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or future builtling occupant need to file and
certify a Business Plan for emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of ihe Califomia Health and Sa(ety Code requires, with some
enceptions, that a Business Plan be filetl with the Costa Mesa Pire
Departmen� by every business which has at any one time dunng a reported
year a quantiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperaNre and pressure�.
2. Does or will ihe applicant or present or tuture building ocpupant neetl to file
a regislration (orm (or acutety hazartlous malerials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Health and Safety Code, with some
exceptions, requires regis[ration with the Costa Mesa Fire Departmeni by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressed gas at standard
temperaNre and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of ihe Califomia Health and Safery Code pmvides Ihat Ihe
Costa Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Depariment of an RMPP by businesses which are requiretl
to register awtely hazardous materials with the Fire DepartmeM.
4. If an RMPP is presently requiretl, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the aOPlicant or present or fuWre builtling occupant require for
lhe work whiCh is �he subject o( this applicalion a permit tor such consWction
or modifcation from the South Coasl Air �uality Management District or from
any other air pollution control tlislrict or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires Nat the requestetl
information be fumished on applications fa nomresidential building permits).
6. Will any part of ihe faciliry ro be consWcted under this pertnit be within
10001eet from the outer boundaries of a school? � Yes ❑ No
pf 'yes", the faciliry must meet the requirement of Sections 25534 and 42303
ol the California Heal(h and Safery Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution coNrol district or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifcate of compliance from the appropnate air pollution
control o�cer).
CERTIFICATE OF COMPLIANCE: I certi(y that under penalry of peryury the
information given above is correcL I agree ro comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICA7E OF COMPLIANCE AND AUTHORIZA710N OF EN7RY: I
certify under penalty of perjury that I have reatl this application and state that
the information given is correcL I agree to comply with all state laws and ciry
ordinances relating to building constmction, and authonze representatives of
ihe Ciry of Costa Mesa to enter upon ihe above-tlescnbed property for
inspection purposes. I agree not to occupy or allow occupancy ot any building
authorized by this permit until Tnal inspection.
g ureofL galOwneq Da�e
S�9naWre Da�e _ ��_�� �J—� 1z i31 �
305]-46�3/0]) A tllorAWho�izetlApplipnl �- �Dat¢�,
FROM :TOGF SEPRS FRJqC
HaUnB Equipment
FAX N0. (9092563367
�iS D-1`tA�f',t
i
Dec. 63 2010 01:26HM P]] -`
Guvlauon I 7Lamo�
1. E�eerrm �e,t��a.a Jv�,+i��g �s ot�ed oRry in Comaa�.,d Poekare arcfeopt wAc�e dec»'Ic hea(inP+f txPDlaxmWd (L4 }J�Wa/ Capruy
51KWor7,0008�uMrdtcMchmtingir<onrroffed6yafime-1i trnpdtutcenotucetdingJOmlrrutet). See§/5!(b)3acryNoa
3. RG/ar ro �ht il6RS VeriJlcation ittflon nn Pdga Q oflhe CF•JR-AL Form fa addiNond *oquiiamenq and checE aJlpfltab� 6oru.
4. /ndimu Nce or Locmbn (Duccr. Hydronfc in Rloor. Rodiorarr, e J _ _.
EPfldrney
(SEEIVEERa
2. Re/n m rhe
I
L'ui wora� hmrrn oxd bo.laa jor 6o1F domwtte ho1 wpto
gnsorpropaneJired. Hotwatnptpelntufatinn)MmrluL
campanmt pad:u¢eJlrt a1f dimun ronu.
Wat:rHearerTypclFuei DistribvNanType
2. ReNrculatlng ays�rmr aming mulOplc JweUing uniu shn(I meet
narafJowJhe inrmllnqon oJo rnhculalL�g warw booting.gnhn
J. The akmo! woter heafi,c¢ rm�k �iyu ahall 6e hwlatad t^
SPECTAL PEATURL+$ he enJbremran( ayexyrlwuld pay
77�a• tralu moY nw+� ,.�lnaeh.nf ton mrdAeemnenrc/raz w
NEW ROOF ASSIEA4DLY - Radiaot BafMer
Received on 12/3/2010 3:13:07 n.[-t
DuG tt Piping
Imvtntlon Eac�mwix
raqulrmaav mrd oherk nDD(irnWe 6oa'a.
ro(he Mk��(a) md on ofl rmdngroiud ho�womy'qacs i� reqvired indi
Ft..,...7 TaS;
N�unper(n I TanY -�.gyFaRorm R..,.�..:..�
7Ae PrnrcrlDMr �(virmnmu d�
FeMmv.rpxiird in lhis dre�il2tf del0�o.
: .. ,
FROM : TOCfl SEFlR.S MJRC
a
s
duCRIfL btbw. A
FRX ND. �:9092563367
�
m
�
Dec. 03 2010 01:25FlM P10 !`
rha b�dldvg inrP�aar6rfr.olvef
UuCt$¢A�10¢&Tatlag NI51LSvufcNianRr7YQnfndfahitmeanve . �
❑ YES L�'�0 YP,S:In Climate zooa 2 md 9-16, ifmma n 4o I'v�ar frat o1�v mieplcsmcuc duus us tnnd7ed'm c•eaiC�kc�G
' ypqce,weduc�scrvtvbeoc+led}mrgl )iD11�nEWenawlylatlLlledEucCaaw6eWuhtcdp=�lSI;�70.
!7 R7�CEPT]ON:Facl+lln�eactry�towi tu+uladed,nMchorlronsLutetl,fw6afedor�nlrQxlthrsenfos
❑ YE9 Q Ys9� ]n CltaWn Ianm 2 �nC 9•16� ItWe acl� g sy�oaalao�ma sycm„ �xv�c eqepm� ma hum� fs ry�a�ea, _u
/ . duo4uswhe�ealeGpapl�2(bprn•
OYES 1'SNOYFS:InNmaul�mesxand9-16,iftheex4� NVACequiptneottaraple�N(inoW�agAo�epl�aroento[JwcirSu'..lv,
auedoaandon.�swJrof.,y}itsyi� ,ewK�gor6ntlngeo0.w�lxlumeeebutaxdwger)�Lsdu.,i�erimba
. wsledpecg152(b)IE.
❑ BXCEPTIONiDuUryataw�hutare ecam�nttdtaLxw6PepD1'Mawjy�aledmnfimudUrooptiHi,RS
veri9utienlnaceordan�p�.lthpf nrulolE�l4fermttHnideatlylMpeoqtiRA3.
❑ HJtCEPTtON: Duct q�hmt wi�d lw lue 4D ilnnr het la aweadldouW ryete,
❑ ON:Bzh a Aucts hcu netnete8l Iatedor�eelcAid
Retrlgeraut 7ga-SpGtSYstam X�SvvrjRaf� �eq�trodjmd�rn�carw�.
❑YES 0 YFe:lnCiimaw7ane�2md8-IS.wtim e�clsd�HVACyuipCtrntiseep(s�zd(ropludingU�aspl:cwalo.'t4_t'r
he¢dlv,ouldoorcau2en��guaitofa li[aynunAlCaha�pmnp,aootiagorLwtmgcoU,ortls9n��:
� � eKch�n tt a mc]w e mm�� I vciGed t Ir.
Cenhai Pan Intxgatcd (CFl) Vmdlation Syctem d Rau Watt IIran
a xes �a No Yae:
botamrumUoaAu�Loi
• 7 w.riH �1x� �ho u
N�mc:
Tp..
Gompwy: �
noar.��: 120'"10
m ct��u zo�s �o m,�n i s.
( �-�tt
aptiymm�.ae � is
IZ—OZ`�O
.. - �, u r�� �0 "lU -1-8'I'1-245-1f,li
iwpomi0le uitplog puiga¢r'e U�latetl.oa tatempp ' —
• Iam.ltptMwd.rD�vrsbn7oftlrcGlVomfaHudaas�o ProlruiansCodrw+cr�ptrespo�ubi7lry(ortheSididntb:dg�iSaa53sdon
1hi� CMV1o�U of Compihnw•
• Ics��tytlatlh�m�ryyfnNnsandye[[ormu�ea�peiRee� vMthsbvJdt� dr�iynldentiffeda��hizCettiC�oteefCb.T{.�i+_-eecarlo.r.
ro N. epuYevunts of Thle 2a, pa�t.1 und 6 of �h� �tifo a Cade of Reyalttiom .
• Tb buildinp deAgn frz�ura Went(Fied on thH GrtifiGate o CauDliwee ue musbknt wIR� � intornutimi wnrided to doeis�c,: tyie
bulidtnedalp�onthcatherryplicebleeOmO�nclfonqs, ksbletc,ttkululons.DlmsLnd�pecifleminotsubmiLed:olh�eo_'e_cieat
�c�$ho-dton m.n0��:
?003 Rvidentlol Complimrce
C��r��e�r�
mntact�J�aEna�Rolliarar,l-800.71L330C.
R�B�+� onOotdl.r-.. _ . � H6AS'ProvtCc:
v '
6r$.u(Z"�^
�ig�.� r�..-�LJ:�-��Q �. �h;-� �?/o�z,�w
Received on '12/3/2010 3:13:07 N4
i����-%,-�
�� S
woness av au�m+a L C b 7 L!(A}C G AV
°""�'"'"'E"'P'0M'" AuAMEn, WZLLlAH 3
-„p0"� auAHEiit M_iiklSilivA
� • t865 LxAric AUn
' CuSiA McbA,CA
�vv�. uuww wo�ss:
UNi:
.,
szoze
MCNRECTOPFMiNHP: �,j�L�L tfUlLLEttJ �'�.: l.
41CN.OP FM.'S �OOPES9: 1�J l+.tt 1 F. � C 1 uxr:
r1.C, l.A �JLbb�
ca+m�crarswu� pL'JANC�.L Bi.iILuExS (%14j%7b—lLbb
CONfPAC70R4YNldlO 1 8 0 5 i SKY PARK
��� IkvIivE CA �MO= 054713
7 2% 1 4 Urrt: L
LICENSED COMF�CTOqS OKLAP�TION: I hwaby d�rm �dw paWy d prpry Ntl I mn fcnved ivda prwuvu d Chepls 9
(wmmanvq vm� Seclim ]00�) d Oiwun 9 d IM &�aw arM Pnlmdo�u Cods. uk mY liaw o in IiA bw end Mloa.
cm uc. no.: ------ uc. cuss: uc.
�j Iyoyyy�� � /�47�i EXF: "vii96
l l��i ` �iil
� .._ —
OWNEN BUILUEN UECIdHATION: I AerWy effiem wda peuly d Net 1 em aemp ham IM CaVetlon Liroms Lew la Ihe
IdbMT'd �aBfOl� l$MiCn �0]1.5 Butfpff W AC1B10 COM: 4 WIVY �iud� �OVWti e VMm010 C1RTK1. !!r. inpOM.
Ymd'oh, a repar ury svuGwe. pna b'ts'v+uenre, e6o �eV�+� app� �� Damm lo fJs e eqnaE uetameM Net Iw a eM
�icens.d wiww �o �n. va++�+ a m. comrecaa liuiue lew Icheq« e(omunendm xan swun �oaa) d oi.eb� a a ��r
�a'viaa eM Prdpaiom GOEeI a �hel ln a ahe u eaemN Ihsdmn mW IM befu la Na e�e0b exemqion. Nr/ vide�ion d Setlun
]W 1.5 W enY eOP� Iv a pnmi umje6� iM eppliaa �o e cri px�Wy d nal mas ihen fxa hundrW dWv� �5500�.
� I.saow�xWlhepopenYamY�dA+e+x'vhrpeanNwdomnV�.witldoNev.ak.andNsslrucNmwnalmlaMed
a ollereE la seb (Senbn )Oaa. Butlron enE PmlmvmeCaEe: The Conrmas lioenae lawdoes nd ewN �oen ownx d pioparty
wlw Wida a mYw� the�eon. end M+o dow urh work Fnnrtl a hend a Mwph he a Mr am r^dolw. Vw'� �tW euM
impv+ememe ve na iiuxdad a dlaed la eeb. tl. howwer. �M buiNi�p a inpwana+ w wtl xtrlun wYw d camplelian. tlw
owner-0uiker will heve �M Mnden d poviiq M ar Ne tlk nd briM a impwa lor tM puryou d Ws�.
� I. ea ovmer N the pWsM. em extlicnNY conlred'nY r.iM liwwd wnbacton ro mMrvp ihs qqetl (Setlion �s. Busirova eM
Pmlesdau Code: The Comrmon licarns lew doea nd nGdY b en owner d propMY Mc bnlds a inpw'x Ilw�son ud who
convecu M auN Y9aae wGh e mNradMe) Ikemed O�uW lo �M Comream llorua lew).
� I em uemq urder.9Mian: B. 8 P.C.. la No reawn:
o�e: ow�..:
i eo n.�anr �.nM ���.wa.e d�d �,�nene mme �ew�.m«m a cwomie He.m, .m sdar coa. seao�. usas, zss�, ena
255N. eM tlw I a eny Mure diMuq omme�a. rri0 / wY nd (tlacb one) roM b oomGN wth utl ue�e ooAu ud tM nW'vemsnb br
e pelmN lamnvuctiona mdi&etion hamiMAr�Tiiy�enyement pipntl. RoridW iel oonqrWbn appioeliom en esamq Irom ihese
qoviaiom.
Dme: MV��:
W ONKER'S COMPENS�TION OKWi�TON: I lreby elfvm �vWr pauly d pr}ry w d qa Idbwhq dedve�bn:
� IMwWvilmm4en�wnLuudmmeNloWuw�bwhen'wmpmWbn.opwidedlaW6edion�]WdNslebor
coa., i« ms wn�e a ub »� i> �+:�m m� v� e w�,.d.
il fl in��d���:n�.�.�.�m�v��:a,�.m�.wswwswa,arooaw.t.no�cod..a,.m,w�«�wdm.
7� .o� �«.m�a� mm v«mu m�.a. wr .,�w.�r o�.�+�:�eM. �..oa wxr �,n« a.:
c�..: STATF. PiiNL E}CPIKES
P�vr�n�. taaann�-a� G1/G1/98
. re.e�,asenaw�daaerw.c«m�am.a.w.�m.ddmvsR�oola�wJ
� 1 cmt�Y tlW m IM GMamenca d iln wdk b MiiM �hu D�e u umu I tlu0 rc� amV�W M' W� in eny mennw �o n lo
bxmn aEpa to �M worlws' miqenWcn Isx+ tl CeNmi�, a tlW � 1 dcuN be�mw sbjaG io �M woelmn'
comp ��ipi'piwiiomd5eeonarzoM�,.l.ec.coa..i onn.in ompl�.en,tly�tp�oVuuv.
oy.� u r �� "(l'�—
.�
Wemlip: F�Yun ro wcun roAwti calpwwtlon cw�rp� l� w .,a.wi.�e�.c�.n.�yror.. ro eN�+w w�.m...�e
�roa n�.. w ro w�. m.w�.e mew.m awd� (siat000x a m m. �o.� or �o�c«�..uon e.�.a. .. n�.aw ro. �o
Slctlon 9106 0/ IM IaDor Cob. INwmL W�ttomry'� Iwa
coNsrnucnoH �awra �oewcr: i n.wv .�, �.w. v��r a wdw �nn w.e o..am�,ao� w�mq rodKr a, m.
p.el«m.M. a m..a+� �« whirA �M e.� ��»a (seea, am�. c:. c�.
LENDEN'S NW1E:
LENDEN'S AODRE55:
I ceNN Ihet I Mw �aed No eDd�s�cn eM eme ihel Ns abv+a Wamelbn e conatl. I ep�w to m^NY wil� aP M' anC cauM' adinences
eM eima kxs nletM ro Wildiq muo-utian en0 herebY eWwca np�a�e�nmiw d �hu rsY m amr u0� �M eEwa�mamioneE P�M
la iropedian puepsas.
� ---- � --------{_.�Ofi Gi'�$Se.+.11
CIZY VF CVSIA MESA - bUILUING PEnMII
"rEkMZT Ni�: b �85515 FlAN CHECK NG; N
PEkM iVG: b u85315
GuVT: N SOPr: N
CONSYRUCiIuN TYPE; PEkMZZ iYFE; 57R YIJttYVSG; AL1
� (n ss c
JGB uESCnIPTION : IiG EiCISTING ti RERuGr •wi Z,�1p, S�„a�Q SSj Y 1: b, 4u0
CiAIM tiAi.IIE: o,4"v"v.0"v CAi.C-VAL'uE: o,�i0"v."vu GhOuP uCC; R-1 i
CGMMENiS: Z/O EXISrING ti REROGF WIrH COMP. SHINGLE, SMi�KE LEZECTGkS REQ.
iF ie'st ii'si # iF ii if iF ii ii ii ie ii ii ie ii iE'si'se w ii ii iF "si'sF ii ii ii iF i? ie ii's? ii ii ie ie w ii ii ie ie "si ii ie'vi ie iE'sF w ii ie iF ii iF i' ie ii ii ie i'r ii ii ie ie iF iF ii ie A ie ii "se'si ii ie it
Z G N I N G k E Q U I k E M E N T 5
5 E T b A C K 5
----- - MAIN bUILLING ---------- --------- ACCE550itY t7UlLL1Nl.v — —
FkN7: FT Ilv AEAFi: FI I13 FkNi: t7 Itv fiEAFt: rY IN
LEFT: FT I13 RGHr: FT IN LEtl; !1 iN AGrii: FT iN
YAnitING !(E�j;__ YRVV; FAtll't.L; 'ILLL%G1L LIVh; tlt.t NV; �
FiAlvivlNG Nvre.n> �,
� .'. .
iiieifsiiewiiwieie"sf+eiFieifwiiwiiiiiiiiiiiewiiiei'ieiiiiieieiFiiiiiiiiiewwirwieif�iiwiiiiiiiiwi'iriei'i'iiwifiiie'seiiiiiiiei�i�wiEiFwi'ieieieie
u E ti E,`.L G F M E N 7 S E k ti I C E S n E Q i.i I R E M E N? s
a� ' _
ZUNING APPkGtiEL eY uAIE; '
niJii.ullvG AYF►tvZt.L nY : uH7c:
. -r
AYPiIiAiluN 155Ut.L tfY: �C7 Lj�lt,: I I Z�1 ' G�7
-1 I /
tiesrie'sFi'iiiiiiieiesPwwwwieiiwiriiiiiiwxa'w�rxwxwww�e�ewwwwwwx srs's'fiwwwwwws'w+txiei'w�vewiFwiF wwse sr�rxi'i'r
LEGAI.IZATIGN:N F E E S U M M A R Y sThUCiUkAL SEGMEiVI:Y
t1LLl'a FMI PiiiMbING fiLfiCTkIC MECriANIC rlk�. SMiPik�.S GRFwING
PEkMIT 129,75 .b4
SMIF/N�N-nE5
PLAN
ISSUE FEE
bUILLI13i�-LIij-� FEhMIT ISSUE PLAN-CHECK TOIAL PAIL LUE
7OTAL5----> 125.39 G.GG G.'vG 125.39 125.39 ."v"v
kEVENUE LIVISIi�N 7G7AL5--> CGLLECTEL; 1i5.35 GVERiSHGkT: ,"vG
bLLG YMT FLUM&ING ELECTkIC MECHANIC FIkE SMIY/7G7 GRALING PLAN-CHECH
1�4.i5 .04
if ii ii if iF ie w�e x iP ie w'se iF ii ie ie w ie ie "se ie ii if ii ii ie ii ii ie ie i'r ie iF ie w ie ii ie ii ii ie w iF'sF w iF if ii'si ie ii w i'r ie ie w ie i'r ii iF ie w'si ie i't'si 1i w# i'r ii ae ie ie ie "s'r ii iF
I N U I V i U U A L F E E H n E A K L O W N
1YYt Sj7ii u n 5 C n i P 7 I O N i7NI7 CUST 'IGI:4L CO�i
SrR o4uu REROGF bY liF�L'JE kESIuEN7IAL 'NUZuNfi 1.G"v o,4v"v."vu
ENu GF FEES
����E �E���'I �F➢
REQUBRED
I1-24-1997/�4:80 Pr�/f125.39
RC�TN:01-�215345
PEkMIT:08 ;915
Whne-B�iN:q 8 Selety: Orea�Fb: Cvwy-Appirxu: Rnk-Revamw:OOMwoaNaeasw
�
Cf2+VSTRUCTION AND PLANNING P� 'PA
APPROVALS Permit # Date Inspector qppROVALS Permit �/k Date Inspector
L�Temoorary Eiectrical Service Qr Pole 52. Pool & Equipment Location
N2. Soil Pipe; Undrgrnd. 53. Steel fieinforcement
.�:": �i�,_.,
. 3.. @,'Ie�trical,Con�uSt,;l�lityUnifrgrnd. 54. Forms
, =4ty Elettrical3�•undtnl-URfrgmd. ' S5. Etectriwt Bonding '
� 5y:$igel Reiii�a^ce�e�,t 1 56. Rough Plumbing & Pressure Tesi
�.s -
��_ ."�IeCtricatd'JFER�'irnd. 57. APPROVA� TO COVEfl�GUNITE
,'�i� �o�tings,.� _ �;x 58. Eloctrical Cond.�Itt�Undrgrnd.
'��..,�k�oundati�ri� ,q� �': � 59. Gas Pipe, O Ui,i�rgrnd., Tes[ �
•�=� Wa[er Pid�-Undrtjmd. �ti 60. Backwash LineS-�PGTrap, O Undrgmd.
70. Structural Floor Svstem ,� 61. APPROVAL T(�QECK
, 11, Property Sewer. Line.'& House.�Connection 62. Backwash & Receptor-Fina�
�
,12. Se�er Cap y ,� 63. Heater & Vent�Final
13. Roof Drains �� ' 64, Plumbing System � Final
� r
14. Rough PlumbPn�' � ,!X � 65. Electrical�Final
15. fiou9h Electrica�Coi�uit :. 66. Solar System-F6ngF
.�
76. Rough Electric Wirimj' � ; 67. Fencing & Acc��.pp�oval
17, Rough Wiring Sign v 68. APPROVED FO,WPLASTERING
18. Rough ElectricaFJi Bar Cei�ing 69. POOL/SPA SYS7�MS FINAL
79..Rough Heyting & ljiy_Condition(ng. ,,,� r .� ;� ,� r . , : F#fiE:BEPT:�tEQUIREMENS �y
, J . - , . "" :� : Tl 'J�J'� = 'T7 t
� �
20.'Fiou�G Far,tor� Fi�place ��1= x� � S�� .T s� APPRDVALL9-+�� PeTmit # n '- �x
H � c�� .0 : t '7 '7 b• .S ��7 7'S I'1 'r �r,
27. ,Q �, � ' '
uc( in'�truTctur;� r �� �� 'S � i i- � r:� 70. Undergrourui � dro n
22. :�uctSt VFdtilaCingU F i �: R J ;T •� � F� 71. Produ�t�P�f��Og'�l�a�s (� Oil ,�
23. Gas P.f e;Aouy & st � 'T�� • �Tl 7• '2 �� K � ' i �i � i� .a.
P ,Q� ,]� � .:, r , �p g . , 72. Undergrpupd F�4usitia. � :,, �
24. Roof Fremin J �
9 �� ~ �^ � �> �z �^ K 7� Undergrrld. Std�� ian �❑ Gas ❑ Oil
.. .1 � . �l f f } K H H �: ��
25. BooF..She�thi�9 .� � � � l��17 i 74,�verhead Hydr� ;. k
26.: •Bac:Ceiting (Strutqural) & oflncoat Y O .� 7 b 7� .pry Chekflic4l �- ! � �� � '
n. �l^ 'n
27. Prame and Fla3hirj8 �: ��z - ' ,�' '`. 76. Dr Stan„il�" e.'�'� �� -, -.
� : K r�s�."J T r� .>+f'. Y PlP Z_, R �ll .�
,..' 28. Lathing &�Sitf�n9 ` y - �,- �j �� • ..I ..� .. R 77� FIXED'SY-6TEilA�FINA' � � �.
R i K <' I r} .. �r
29. Insulatio�� z� S S " ,,S � I k 7� FIRE PREV. F,�N�L ,
�� 30. Drywall Nailing � r. •-+ � Y.� � f k ;S iJtfiALTH DEPi. REQUIRtEMENT
� :Y
, 31. Plaster Br�wn,Coa� F� !�_, � + � � t�' 79. FINAL INS�ECTjQN ; � �',�j
�� 32. ElectrirahPower NtsterFipal � t - 8, FOOD CERT-I CATE ISSrJED+
,;� �� k "7 � '� k '� "]ln Y "] �1 �U1�
; 33. Fina lec�ric� ,L t,� ��:y r N��es: ,s n�� �. �.,.4
�� � T. 1) ,. ^ � � ! � r J
. 34. :Sina,f}le3�in9.� Air� �opdrtioning ' ,n, .r '� ' � A �+ �� '� -',t q �.Tl
1 � 1 �
35. Rinal GaiTPipe�Tesi.,'K ��`1 .. x"' � � r�' ti.�'� ='�' �,
•r,
- 36. klooc�or CanoPY � . ��,-� � �r r .i i � � ! �n ''�•j v ,T �i*7
- �
� 37. Final'facEory Fire�l ce - • " �� I Y_ ,, r S'L
- �3
A 38. FinaLPlumbing :' � t; �� � :l 1 � �. r, ..+•� r v
39. Water Service-Finafl i� ' "''' `. ' S
F � � I{
r . t . i" tt -vi • K 1(} �
1 k.ti �.•t�.� 5 , F � �.'
.4p, Gas Service•Final L F -;��._, r y � ��� ..;,� ,. y
-i 41. Solar pomestic-FiRak � �;: t� � �f � �~ L 'r 4"� s
. ��
42. Backflow�Prevente� ;. �L 'u � � K �, � ' � �n .,�:� . s _ .
43. Backflow Irrigatioio 5 . � F 'r ° � - �R ' ' '
r ��� k'� � ��
' 1 ' T Y :1 ' - ^ t �� - I : �J �V -' , ) u .
q�l. .landscap� Irrigatio� System -� y� ,y r y 2 �. £ •,: j: r� -
'' -; �. .. . ,�7 n �*/ t ' T .' '2 • -� J #
�5. ;Slound Attentlatien t,
'9 C 1. I / -� .. •• y F
s•
'46. Handj�cap'Regula[ibns ', � � �� �� - ' � ; , �
4�7. FINA.' STRUCTURE & BUI�LDING G +��j,,,Q � '� ~ •�' k �,�
� s� n 1_L � � �� T. 'i
48. F„INk} PLANNING; , ` � � " � .'� ' ; j _ f y
.�9. EJectric Fislease to Edison ' « � '� 1 t • -' • _ -
ny �
50. �ias W1eleaie to Souttiem Califorpia:Gas Co ' ��� - "�''� � l
� � � ��: �a
51. CERTIFICATE OF OCCUPANCY "
No. Date
\
_ �
•
AOPlicant to flll In all spaces axeeot those witnin heavy eorGer Ilnes ana sign al1 aDorooriate aeclantions.
CITY-0F COSTA M{�/$ C T/�R�/U/(�'TION PERMIT
Projec[Address�„(;� �f.��.��1n'1Ci�,C,
' Applicam's Mailing Addresf �L�..
Owner'sName MA�1E ��7/��� Phone`t�7'�
Address
Arch/Eng. l�c�nu No.
Address
�•� Vi �
Contracto ' N .�/��� � p ' Pho �y I 97 5
Addresslmailing) `�3'`�-Gi.tx�_._ '_", / I I�
City License No. L�'JIJLiv'tYL.
LICENSED CONTRACTOR DECLARATION
I hereby aHirm Ihat I am Ilcensatl untlBr proviilon5 of Charter 9(commCnUng
with section �000) of DivlSi n 3 0l t�e Busine55 antl Pmtessions�
my license is in full iorce an tie{h
License s �I�� Lice}�
Date� Si9naturo✓—�p/ /-/ /�/��c/��
WORKERS' COMPENSATION DECL RA ATIOCf -�
I nereby atlirm that 1 have a<ertlticate of consent to � If-insure or a certificate
o( Wo�kers' Com�ppensation(7 Ins[uran7yc�e, or a c¢rtifie c y thereof (Sec[ion
ol�'�c�Y No.. C.Y..I. S� I�J `Company
W
eCerjtifie�- wPY �ivs 1herebwithrnie c dY u' in9 D'vi '
Ba� `� 1 � V� plitant�
EXEMPTION FROM WORKERS' GOMPENSA 1 N EC ARATION
(This seciion neetl not be COmplet¢tl II the permit I5 for one hundred (5100) or
iess).
I certi(y that in the performance of the work for wnich this perm�t is Issuetl, I
shall not em0loy any persOn in any manne� so as to become subjEct to th¢
Workers' Compensatlon Laws of California.
Date Si9naWre
'NOTICE: If, a/ter making this tleciaration, you shoula become subject to tne
Wo�ker5' ComOensatiOn proWslons ot tht LaDo� Gotle, you must �orthwitb
comply wilh such 0/o��slons o� lhis permil shall be tleemetl revOketl.
CONSTRUCTION LENDING AGENCV
I hereby afflrm that there Is a construttion lentling agenq tor the pertormance
af the work ior whiGn thi5 p¢rmit i5 ISSuetl (Sectlon 3097 Civ. C.)
Lentler's Name
Lentlet's AtlOr¢55
OWNER BUIL�ER GECLARATION
I M1ereby afflrm that I am axamPt irom the ConlraGtor'S License Law tOr the
followin9 reazon (Sectlon ]031.5 Business antl Protessiona� Cotle: Any city or
wunty which reqWraS a pe�mit to ConStruct, al[e�, Improve, tlemolisb or repair
any sVuctu�e, prlOr to Its IsSuanc¢, also �equire5 [he applicant tor Suth pormlt
to fi�e a signetl statemenl that na/zha is Iicansetl pursuant to the provislons ot
ihe Contractor's License L, w(ChaO�er 9(commencing with Sectlon 7000) oi
Division 3 0/ [he Bu5ine5T antl Profe5Lon5 Co�e) o� l0al he/ShC Is oxompt
rnerefrom an0 tne basis 1or lho allagetl oxemptlon. Any violation ol Seclion
i1.5 by any appllcant for a permit subjects the applicanl to a clvil
alty o/ no( more tnan fivo huntlretl tlollars (5500).
. I, as ownor of tha prOpCrty or my omployee5 wi[h waqes as thalr SOIB
COmpenSatiOn, will tlo th8 wolk, dntl Ihe siru<tufe Is nol Intentletl Or Of/Cr04
fo� Sale ($eclion 7044, Buslness antl Pro/esslondl Cotle: Tho Conl�aclo�'s
Litense Law Uoes not apply to an Owner of a property who builtl5 or Improvcs
[he�eon, antl who tloe5 Such work hlmself/M1erself or IM1rough his or hOr own
employeas, proviGed that such Improv¢mnnts ar¢ nOt in[entlCtl O/ oHoretl tor
sale. If, however, lhc builtling or Improvement is soltl withln one year of com-
pletlon, tne owncr wlll hava tho burtlen oi o�oving he/she tlitl not bulltl or im-
prOve for lhc pur0o50 0/ salo).
❑ I, a5 owne� oi tho property, am uxclu5ively conVacting wi[h IlcenSetl con-
[�actors to cons[rucl lha projoct ($ection 7044, Busine55 antl Profe55ion5 COOe:
The Contractor's License Law tloes not appty to an owner o1 prooerty who
builtls or improves thereon, antl who contracts for zuch projectz with a con-
tractor�sl license pursuant�to tna ConVactor'i License L.aw). I am aware that
proof of lheir Worker's Compensatlon Insurance Shoultl be provltletl [o me.
❑ I am exempt untler Sectlon B. d P. C. tor this reason
Data O�
i nereby certlfy that I hav¢
informaUon is correct. I agre�
antl state lawz rely[mg to bu
sentative5 ot f1NT8tY to�
�rivers'
TVPE OF CONSTRUCTION LJ NEW 11SI ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISIi ❑ OTHER q,p..�p
DESCRIPTION OF WORK/USE OF BLDG.
5 Main Building:
E
TVPE OF PERMIT GRA�ING FOUNDATIOy7N� STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Ry MECHANICAL B Rear
❑ OTHER %�
C Righ[
PROJECT DESCRIPTION Sp. FT. OCCUPANCV K
CONSTRVCTIONTVPE VALUATIONS S Left
ZONE GRADING CU. VDS. ACRES ping. Re(. #
Remarks: � Planning Notes:
Sink
Preventer
Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Kitchen Sink
Lavutories
P-Trap
Roof Orains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct-Strucmral �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
�Ip100,000 BTU 0700,000 V
Rainspection Fee � S15
CMF OB65-46, r<v. 30/B4 Whit¢ - Builtling; Canary - ApO���ant; Pink - Accountln9: Goltlenrotl - Asseisor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater
Water Service
Auto�Wash
laue Fee
Hood or Typel ❑
Cnnopy Typc II ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
Automatic Washer
Consuuction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑ElecVic
6109 12/19/85
zooe
Accessory
ELEC7RICAL
Transformer ❑ 15-50 KW
❑50+KW
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbnge Disposal
Generator �0�5 KW �575 KW
Meter Llup to 100 amps
Meter ❑over t00amps
Sub Panel
Motors067 HP�1h-8
Inc. Solar �9-15 HP � i 6-15+
Microwave
Pole Light
Range
Sign
; Standing Sections
Trash Compac[or
$ 3
Reinspaction Fee $15 luue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB Approvad By
8uilding APProwd By /p/���
Appli�tion luued BV �� � � � �
$ 3
I Co:,
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT.
PIUMBING $ ISSUANCE $
PLAN CHECK 25% 5 ENEHGV P.C. $
E�ECTRICAL $ GRADING $
PLAN CHECK 50% $ /� MICROFILM $ ��/� �
MECHANICAL $ {q.�-�Q 70TALFEE $.(_VSL.—
PLAN CHECK 25% $
TL
CO�NSTRUCTION AND PLANNING POOL y��'A
., APPROVALS Permit# '' Date Inspector AppROVALS Pern���# Date Inspector
1. Temporary Elect�ical Service or Pole 52. Pool & Equipment Location
' 2. Soil Pipe-Undrgmd. 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
i
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
11. Property Sewer L�ne & 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 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 Structu�e � 70. Underground Hydro
22. Ducts, Ventilatin� 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuraq & 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 �� jy��' LyQ
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Fin81
Y
40. GasService-Final ��
41. Solar pomestic-Final I _
42. Beckflow Prevent2r � - .
43. Backflow Irrigation �
44. �Landscape irrigation System
45. Sound Attenua[i0�
46. Handicap Regulations
47. FINAL STRUC7URE & BUILDING
48. Special Requirements Completed
49. Electric Release t0 Edison
50. Gas Release to Southern California Gas Ca
51. CERTIFICATE OF OCCUPANCY
No. Date
ApPlican[ to fill in all ipaces except t�ose within heavY Dortler lines antl sign all aOVropriate tlecla�alions.
CITvoFCOSTnMESA ONSTRU TIONPERMIT
Project Address
ApplicanYs Mailingy9 Ld�dre�ss ; �
Owner's Name �n ��// Phone
Atldress ���N � � -P�
Arch/Eng. License No.
Address (7��/���
Convacror's Nam � Phone �J-1.td-l1Llt
Address (mailing) n
City Licen N �1
LICENSED CONTRACTOR DECLARATION
I hereby aifirm thal I am licenzetl untler provislons of Charte� 9(comm¢ncing
with section 7000) oi Dlvislon 3 of the Buziness antl Protesslons Cotle, antl
my Iicense is In full t r e antl eHecL O
Licens as ' e s o
Date Si9nature
WOR RS' C MPENSATION DECLARATION
I hereby affirm that I have a certificate o/ consent to zelf-insure or a certiflcate
-f Worke�s' Compen5ation Insurance, or a certifietl copY there0f (SeCtion
'00, Lab. C.) � ����
�licy No. �..(.Q,�,�� Company �
ertifietl copy is hmeby umishetl. �
Certif' tl c p rs filetl with the city/�};iltli g Ivl 'o �
Date APPlicant �/ �� /�y���i���
EXE 1 N R M WORKERS' COIOIPENSATION DECLARATION
(Tnissection neetl not be com0�eletl if [he permit Is for one nuntlretl (5300) or
less�.
I certity that in th¢ Perlo�mance of Ih¢ work f0� which Inls pe�ml( is issuetl, I
shall no[ emD�oy any pe�son in any manne� so as to become subj¢Ct [o the
WOrkers' Compensalion Laws of Califo�nia.
Date Si9nature
NOTICE: 1/, alter maklnq tM1is tleclara[ion, you shoultl become sublect to the
Workerz' Compensatlon provi51on5 of lhe Labor Cotle, you mus[ tor[hwith
comply wilh Suth provisions or thi5 permit Shall be tleemeG �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby aHirm that there is a construction lentling a9ency for tne per(ormance
ot the work for whiGh this permil is issuetl (SeCtion 3097'Civ. C.)
Lentler's Name
Lentler's Aaaress
OWNER BUILOEH bECLAqATION
I hereby affirm [hat I am exempt hom the Contractor's License Law Por Ihe
following reason ($ection ]031.5 Business antl ProfeSsional Cotle: Any ciry or
counly wM1icM1 requires a permit to construct, alter, impwve, tlemolish o� �epair
any sVucture, prlor to Its issuance, also requires the applicant tor such permit
to fi�e a signatl statement tbat ne/she is licensetl pursuant to the provisions o/
tne Contractor's License Law (Chapter 9(commenang with Section'7000) of
' DiviSion 3 of the Buslness antl Profession5 Cotle) o� that h¢/5M1e is exempt
therefrom antl [M1e basis for lhe allegetl ezemp[ion. Any viOlatlon of Sectlon
'1.5 by any applicant ior a permit subjects the ap0licant to a civil
Jty ot not more Ihan (ive nuntlretl tlollan (5500).
. I, a5 Owner of Ihe O�operty or my employees with wages as their sole
'� comp¢nsa[ion, will tlo Ih¢ work, antl the structure i5 not Intentletl Or otferetl
for sale (Section ]044, Bu5ine5z an� Prote55ional Cotle: The ContraGlOr'S
liCenSe l2w tlo¢5 not aOPb �o an owner ot a pwperty who builtls or imp�ove5
thereon, antl who tloe5 zuclt work himself/h¢rself o� through his or �er own
employees, provitle0 tha[ such Improvements are no[ intontlatl or offaretl for
sale. It, howev¢r, tho DUlltlin9 0� improvement is Soltl wlihln on¢ y¢ar of com�
pletion, the owner will have the burtlen of provinq he/she tlitl not bulltl or im-
prOve forthe purposa Otsale). •
❑ I, as owner o( the property, am exclusivery mntracting wilh Ilcensea con-
vactors to construct tne project (Section �o44, Business antl P!O(CSSIOIIS COdC:
Tne ContractoYs License Law tloes not apply to an owner ot properiy who
builtls or impwves Nereon, antl who mntracts for such projects with a con-
tractor(s) ucense pursuant to tne ConVactor's License Law). I am aware tnat
proof of their Worker's Compensation insurance shoultl be provitletl lo me.
❑ I am exempt untler Section B. & P. C. for Ihis rea5on
Date Owner
I bereby cer[ity that I have rea�
infOrmation Is corte<L I agree to
antl state laws relating to builtlir
sentatives ot this cily to enter
inspection pu'p se .
Signature
Drivers' License ar SS # _
r .� ,
TYPE OF CONSTRUCTION NEW ADD ALTERATION EPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p#
DESCRIPTION OF WOflK/USE OF BLDG. $ Main Building:
E
TVPEOF�PERMIT GRADING OUNDATION ❑STf2UCTURAL T Front
❑ TEfVANT ❑ ELECTRICAI. PLUMBING ❑ MECHANIGAL B Rear
❑ OTHER p'
PROJECT DESCRIPTION 5�. FT. ocCUaANCv C Right �
K Left
CONSTRUCTIONTYPE VALUATIONS $
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks:' Planning Notes:
Bar Siok
Backflow Preventer
Backflow Irrigation
Jrinkin9 Fountains
Floor Drains
Floor Sinks
GasService Outlets
I ntercepmrs
Kitchen Sink
Lavatories
P—Trep
Roof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilatin9
Exhaust System ❑ Multiple ❑
FirepVFact. BIC ICBO #
Heating System & Ducting
❑ o-i oo,00a sTu O i oo,00a sr
Reinspection Fee � $75
CMF 0865-46, �ev. 30/B4 Whita - Builtling: Canary - Applitant: Pink - Accounting; Goltlenrotl - AsSesm�
PLUMBING _
$IlOW2(5
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
Issue Fae
Hoad or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electtic
Fan
F.A.U.
Fix[ures
Device Boxes
Outlets
Switches
Garbage Disposai
Generator OO-5 KW OS-�
Fee
5470 9/17/87
Zone
Accessory Building:
Parking Req,/Provided
nrn .
��.i t J )y
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors 00.1 HP � 1'h � 8
Inc.Solar �9�15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compacror
$75 IssUO Fae
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved 8y
Building Approved By —_—/�—
Aooliwtion Issued Bv / %1 I
5000 TL
FEES
$ 3
2
0
N
1
N
G
R
E
Q
M
T
S
SUIOIMARV OF FEES
BUILDING PERMiT S SMIP 5
PLAN CHECK $ � PERMIT , � ,
PLUMBING $ ISSUANCE $
PLAN CHECK 25% 5 ENERGV P.C. $
ELECTRICAL $ GRADWG $
PLAN CHECK 50% $ MICFOFILM $ J'�
MECHANICAL $ TOTAL FEE $ ��`-�
PLAN CHECK 25� $
CONSTRUCTION AND;PLANNING � � POOL & SPA
'lAPPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1l:�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. 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 Pide-Undrgmd. '�� 60. Backwash Lines, P-Trap, � Undrgmd.
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 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 OGas OOiI
23. Gas Pipe-Rough & Tes[ 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathin9 ' i 74. Overhead Hydro
26. T-Bar Ceiling (Strucwral) & 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 ' i
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED .�
33. Final Electric Notes: O•2S•� 4�CJ` G��. G,��
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test � '
36. Hood or Canopy
37. Final Factory Fireplace - : •
38. Final Plumbing (�� ' ' , , �
{U � Zd• �t
39. Water Service-Final ' - � � '
I �
40. Gas Service-Final ' � , .
��41. SolarpomesticFinal • ; � ' _
42. Backflow Preventer � � ', , • ; i
�.43. Backflow Irrigation !
I i
'44. Landscape Irrigation SYstem , y � . ' � �
�45. Sound Attenuation � , ' ; : , �
46. Handicap Regulations . . , � i '
.47. FINALSTRUCTURE&BUILDING ' � � i �
48. Special Requirements Completed . �
49. Elect�ic Release to Edison • '� '
50. Gas Release to Southern California Gas Co '' .� . � �
51. CERTIFICATE OF OCCUPANCY
No. Date � � - �
l � �
� lppllcant to /lll In all soaces witnin neavy boraer lines an0 slgn all aoD�ooriate aeelarations.
� CITY OF COSTA MESP� PEi�J.j NO2 3 2 TRACT NO. LOT NO. BLDG. NO.
CONSTRUCTIOIVPERMIT ��' 41 �4� �
Address
Address
C.Ontractof
TVPE OF CONSTRUCTION
PhOnO ❑ NEW ❑ ADD �ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMI
LiC2nse NO. ❑ OTHER
DESCRIPTION OF WORK
LICENSED CONTRACTOR DECLARATION
I hereby affirm inat I am Ilcenied untlar provisions of Charter 9(com-
mencing with section 7000) ol Dlvlsion 3 of tha Businaiz antl
PlO�¢SSIOf15 COtll, dOtl Ty IICOOSC IS Ifl 1UII tOICO Bntl 0110C[.
Licenie Class Licenia No.
Date Signature
WORKERS' COMPENSATION DEClA0.AT10N
I h¢r¢Dy affirm that I have d ClrtiBcata ot COnsent t0 selNnsum or d
certi(Icate ot Workers' ComOensatlon Insuranco, or a certiflatl copy
th¢re01 (Section 3800, lab. C.).
' '49 No. Company
:ertifiM copy is hereby turnlshed.
,;ertifietl copy Is filetl with the city Builtling Divislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl no[ De completatl If tha parmil I5 tor one huntlr¢tl
(y100) or less).
1 certl(y thdt in the partormance o1 tha work for whlCh thi5 permil is
iszued, I snail not emPioy any person In any manner so as to necome
subject to the Workerz Compensatlon Laws ot Calltornia.
Date Signalura
EXPlRED
Incomplete In:!�;ctions
��� a0C21 �
L��-f�ai� Sig �//
TVPE OF PERMIT �
❑GRAOING ❑ FOUNDATION C�STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLVMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
50. FT. �'Q1Q,
OCCUPANCVY�CONSTRUCTION TVPE �'M�� •
VALUATION �n�%n ZONE R�
GRAOING CU. VDS. ACRES
PLUMBING
NOTICE: It after making this tleclaration, you shoultl become zubject TOILETS
to th0 WOrkerz' COmpensation plavl510n5 Of th¢ LdbOr COCa, you must
forthwlth comply with such provlsions or [hls parmit shall be tleemetl LAVATORIES
revoketl.
CONSTRUCTION LENDING AGENCV KIT. SINKS
I hereby aifirm that there is a.constructlon lentlinq agency tor tna per- SERVICE�5INI
formance of tj�e work forwnlch tnis permit-Ii IsSuetlrl�,5�eclion 3097 �
C1°� C��� A , � ` � rFLOOR $INK:
Lentler's Name� �`� -N/ '
Lenaer's Atltlre55 ti ORINKING FC
..�.�.i�.,e����..vu..v��nonr�...n . 1" __-__...
:y wnicn.raquires•a
r repair any structure
lor sucb pe�mit to fil
to [he provl51on5 of t
re-
he
PI.AN CHECK
SHOWERS
URINALS
DOUBIE LAVS
DI SHW HSHER$
$UMPS �,,
FLOOR DRAINS
\ • �CLARIFIERS
- �P TRAP
'. A�TERATION
- a ucon>c GASSERVICE �� OVTLETS
of �Divislon 3�01 the
np[ Inarolrom antl tho yyq7ER HEATERS BTU OUTPUT
�1 Soction 7031.5 by
,PPlitant to� a�pe�mlt SubjCtls Ihe applicant t0 a Clvll pendlty $EWER CONNECTIONS �
F:$i."°t more than tive hunared tlonars (E500).
''a5 owner of the property, or my empl0yCe5 with wa9os as thMr
Ie��Compen5ation, wlll tlo lhe work, antl Ihe st�uctura is not Inicntletl
or offeretl for sale. (Soctlon 7044, Business antl ProfeSsions Cotle: The
Conl�actor's LicenSe Law tloes not aOP�Y t0 an own¢r Ot a property
who bulltls or improvM Iheraon, antl who tl0¢s SUGh work hlmiolf or
through h15 own emplOyces, Orovltletl that sucb Improvem¢nts drC nol
intentletl or offeretl tor salc. I1, however, lhe bulltling or Improvomant
Is soltl within ono year o/ complation, lho ownar will have the burtlen
ot Proving hc tlitl not builtl or Impwve tor tlt0 Purpo50 01 salC).
� I, as owner of the properry, am exclu5ivery contracting with
licensetl concractors to construct tne pro�ect (Sectlon ]044, Buslness
antl'Professions Cotle: The Contractor'S Llcense ldw tloes not apply [o
an owner ol property who builtls or improves tnereon, antl who com
t!a<[s from sucll ploj¢<l5 with a ContfaCtot(S) IlUsnetl purSuant to
the ContractoTY l.icense.Law). ., , . • '�.
❑ I am exempl unde� $action ' B..¢ P� C. tOr [hi5
reason
Date Owner
I her¢by certity tha[ I have reatl tttis applicdiiOn antl StatG tha[ the abOve
intormation is correcL 1 ag�ee to COmply wltb all City antl county
or0inances antl stale law5 relalin9 lo construction, anU �ereby aulhOrize
�epresen[ative5 0( t�6 tily to enler upOn tne abOve menlion¢0
property� tor in ¢c�pu ose,�'/ � - �
Si9nature �� �� 'R�Y'wn O�}je1T. 8}
Drivers' License or 55,-a
SOLAR TANK COIIECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL P�AN CHECK
HEHTING SVSTEM 0-300,000 BTV _
AND DUCTING 700,000 + BTU _
REFRIGERATION 0-100,000 BTU_
SVSTEM � , ,100;000+�BTU_
BOILERS; BTU
SVSTEM REPAIR, ALTERATION
E%HAUSTSVSTEM MUITIPLE
ISSUE FEE
CMF 0865-46 White-Builtlin9: Unary-Appliwn[; Pink-Accounting; Goltlenrotl-Assessor
A.P. �
ZONE
REAR VARD (TO
PKG. SPACE REQ.
STREET WIDTH
SPECIAL CONDITIONS:
ELECTRICAL
�
7/14/81
�, .
REF. 5�
PRO V I DED
PARK FEE S
PLAN CHECK
GEfVEHATOR 0-1 KW_ 1-30 KW
TRANSFORMER
APPI_IANCE 10-50KW_SO+KW
MOTORS 0-1 HP_1-]0 HP
(INC. SO�AR) 10-50'HP 50 + MP
FIXTURES OUTLE
GAS TUBE SIGNS
POLE IIGMTS
POLES METE
PANELS MAIN
SERVICE
SWITCHES
SU8
AMP
ISSUE FEE
°LICATION A7PROV ED BV DHT
6Bo02 TL
SUMMARV OF FEES /�
BUILDING U� SO
PERMIT E���+��j SMIV E
PLANCHECK S—�f al._ar_p PERMIT
ISSUANCE E
PLUMBING E
PLAN CHECK $�_�� GRADING E
ELECTRICAI S_{_� S
MICROFILM 5
PLAN CHECK 5 ;
MECHANICAL E TOTAL FEE E
LE55 AD�
PLANCHEC�K'(E�,' k,' VANCEPC S_
IIICO11pi��.�. I(It � 1.l�in� FINAL FEE S�•02
,
CONSTRUCTION AND PLANNING � � POOL & SPA � _ " - �*-
APPROVALS Permit # Date Inspector qppROVALS - Permit # Date Inspector
: �.
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil ipe-Undrgrn � �� 44. Steel Reinforcement
3. lectrical Conduit Utiliry-Undrgrn' '' � '� 45. Forms
4. Electrical Conduit-Undrgrn ' � - '�46. Electrical Bonding �
. tee ein orce 47. Rou h Plumbin & Pressure Test
6. ElectricalUFER�Grn 46. APPROVALTOCOVER-GUNITE
7. Footings. . 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51 . Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVAL TO DECK
71. � Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Hea[er & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit �56. Electriral-Final
15. Rou h Electric-Wiring 57. Solar SYstem-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure � APPROVED FOR PLASTERING
16. Oucts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. �FrameandFlashin S%F r✓°'� 7 7- NOTES: '
23. �lnsulation �
24. Lathing & Siding
25. Drywall Nailing /� sr ,ci O ,r
26. Plaster Brown Coat d O twl
27. Electrical Power Meter-Final 7� Rr -e � 82
28. Final Electric s D e,, i•
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing
32: Water Service-Final
33.' �� Gas $ervice-Final �
34. Solar pomestic-Final
35. landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING 21 2c. �- q/�,r p
39. Special Requirements Completed ! 6
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY ,
No Date ,
OWNER
�_ CLEM� DONALD &
JOB ADDRESS 2$(9 Drake A
C�_%;�RAL CONTRACTOR ��
��a'f�o� 141-541-01 LOT
N� SPECTIONS
�L
�
�WFTER
fiOUGN PLUMBING
�RpP, SWR, LINE Q HOUSE CpN. �
�PRINKLiNG SVSTEM
ISCELL�NEOUS
AOUGN ME/•TING �Np 41R CONDITIOHING
TEMPOR>pY SEAVICE OR POLE
UNOERGAOUNO � POWER �
ROUGN WIRING
TRENCMES FOAMS STEEL AE
FLOOR SYSTEM
BONO 9EAM I � STEEL REINFORCE �
SMEnTH�NG
FPRME >ND FLASHING
LRTNING — IN rI OUT n
PI "A, BROWN C04T
ST.._.fUR4L, FIN4�
NEATINQ VENT., REFRIG. <ND �.C., FII
PlUMB�NG. FiN�L AN� WS TEST I—I
ELECTP��. FINnL
DATE
BUIL[
VALUE
SUBCONTRACTOR
:
' a i,�;ti�
. ._:,
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 80X 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS G •
OWNER �, /(f A/G LPiI'
MAIL //� �/� C
ADDRESS /G/4�/G
CITV
Co ST� /�t.v NOL ��%_
CANSTRUCTION '1 W A I
LENDEF �/ON�
BRANCN
�_ OWNER
ADDRESS �
ARCHITECT `� TEL. �� S
OR ENGINEER
FIRE
ADDRESS ZONE
Q��e� '� LC./1GDe�2- ByPflOVED
CONTRACTOR
ADDRESS �/Q��E
TEI. ZON
CfTV r� C NO. 5 �-I %
� STATE . CITV �'�+RDS API
� LIC. NO. LIC. NO. MAIN BUI
W SIZE NO.OF BIDGS IFROM C/L ST
�. OF LOT NOW ON LOT / OM
a VSE OP
� EXISfING BLDG. C
� •
� Separate permits are required for L SIDE �
0 electric, plumbing and heating work. REAR
(.�- USE OF BUILDING AND WOflK TO BE PERFORMED DISTANCE BET.
MAIN BLDGS.
� VAR. �
'� C.V.P.qW
Q �/
7 / �� /` / /1 � u APPROVE
} O�
..�
a
w
pI �ereby ecknowletlpe that I �eva reatl thls application antl stete
� thnt the abova Informetion Is corraet antl epree io comply with
a nll laws reBulaNnp building eonstruction, and I shall not employ
z any peraon in violatfon of the workman's compansetion laws of
Ttho Smta of Californln.
� �` 5(
3 I harebV �ertify thet 1 em proDerly Iicenmtl as a contractor untler
t�o Stato oi Cellfornie Bueineaf end Pro/aulons Code, Dlvielon 3, THE AMOU
C�apter 9, antl t�at sueh Iitenses are in full tarce enO effect, or I THE PURPOE
em exempt from t�e provlslons of the Stete of Cellfornia Businesa VALUATION
and Protes6iona Cotla, ivtslon 3, Chapter 9.
S( t a of ��
Pe. a $ 3i
uthorize Agent
,�!'' �,� � , .
„adBH3�'" 3% I 3%79 36.50 T��
-y!"'�., - .. ._ . .
APPLICATION FOR STRUCTURAL PER111IT
FECEIVEDBY DATERECEIVED neTc�cc��cn
A.P. NO.
BUILDING
ADDRESS
PERMIT NO.
VALUE
� �
DATE
NO.OF USE OF NE !Q
PLANS BUIIDIN
'ROVED V RDSAPPROVED
BEf. MAIN &
ACCESS. BLD
DATE
�
n
m
i
m
T. �v
SHOWN UNDER VALUATION IS FOR m
)F ESTABLISNING A PERMR FEE ONLV:
e
PERMIT FEE E � P
u�
m
d PLAN CHECK 3 1., o
O LL
TAX E �
�U
TOTA�PAID S tilJ.
�WNER � D - '--
�JOB ADDRE5�5'pA
'Cz�:��RAL CONTRA OR py�v,,._�ida,.
� ��'�o. _ ly _ LOT g TRACT
INSPECTIONS Si na��
SOIL
WS
W sTER
ROUGM PLUMB�NG
PROP. SWR. 41NE Q MOUSE CON. �
SPRINKLING S�STEM
MISCELL4NCOU5
ROUGN MEaTING �N� nIR CONDITiONING
TEMPOAnRY SERViCE OR POLE
UNDERGROUND � I POWER G
ROUGM WIRING
TRENCHES FORMS STEEL NEINF.
FLOOR SYSTE��
BONO BERM rI STEEL PEINFOFCE �I
SHEATNING
FR<ME PNO FLOSMING
LATMING — IN (, I
PI '.R. BRPWN C04T
51. .fUA4L, FINOI
HEATING, VENT., REFRI
PLUMBING. FIN�I �NO
ELECTRiC, FiNaL
awi niur. v�xsi
DATE �_i
BUILDING P
RIPTION of WORK T�,gel i�
ZONE VALUEEIC
PE GROUP
SUBCONTRACTOR
H
�
0.
Q
.�..
h
S
F
O
W
L
:a
Q
7
}
�
C
w
o.
�
Cl,
0.
z
�
3
� (1 i1 '7 i•; ia F'
COSTA MESA BUILDING-SAFETY DEPARTMENT .1e� _. .
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ��rVl'B��c 3/:19%79 b�
AP IC TION FOR'`STRUCTURA�I. PERMIT
For Applicant to Fill in Comple[ely — Use Ink Onl
� REC I DATE RECEIVED DATE SSUED
BUI�DING A u �.. C
ADDRESS p� /Y/CtE•
�1// — S�I/ -� O� PERMIT NO.
OWNER [. A.P. NO.
MAIL ADDRESS �O � �K���
A D Dfi ESS /CF �j
C�Ty �eS �1' NQ�' _ � TRACT �/� LOT U BLOCK
/!
CONSiRUCTION W A A T R P
LENDER ONG
BRANCH � /r. �
OWNER C.iG
ADDRESS / 6 VALUE Nr
ARCHITECT TEL. �, SE I��i�S/ 5�PV
OR ENGINEER
FIRE �%
ADDRESS •��� ZONE VPE' V GROVP
APPROVED !/��
CONTRACTOR �e � � BV DAT
ADDfiESS p[ E CLpsF �P
TEL. Z�N NO.OF USE OF NEW VOoK
CITV (�6 NO. � �—� P�NS Z BUILDINGGy�� <�ace_
STATE CITV �'ARDSAPPROVED YAflOSAPPROVED
LIG NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E G'<��S �C �Jy NO.OFBLOGS. (FROMGLSTFEET)
OF LOT NOW ON LOT FFONT FT. FT.
USE OF /
EXISTING BLDG. e I FT li FT.
Separate permits are required for L. SIDE T. 1� Fr.
electric, pWmbing and heating work.
FEAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCES^u. 8LDG5.
VAfl.� DATE
p F � C.U.P.#'- APPROVED
— G%%/�� APPROVED �IX 3-� y-�9
I heraby ecknowletl8e thet I have reatl thls applicetion antl state
that She above Informatlon Is correci and agree to comply wlth
all laws re0ulatinp butltling construction, antl I shall not employ
any person in vlolation of the workman's compensetion laws of
the Steta ot Californle.
I hereby eertlfy t�at I em properly Iicansatl as a eontrecior untler SQ. FT.
the State of California Bus(nesa ond Professions Cotle, Dlvlsion 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR
Chapter 9, entl chet such Iicansas are In full forea and etfect, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV:
am exemDt from tha provisions of She State ot Calltornia Bucinezs VALUATION PERMIT FEE E
and Professlons Code, Dlvislon 3, Chap2ar 9. '�—
� � rj� �� PIAN GHECK S
SIB^etura Of �/ /� ��
Permlttae �__ e/S C�/1Y1� § / o-'{� TAX E �
_ "_ �
AuthorizaEABent TOTALPAID E �/�
50
n
m
i
m
m
N
�
m
b
N
m
n
f
U
. -- -
� :. , - ��851
COSTA MESA BUILDINGSAFETY DEPARTMENT
P. O. BO7( 917 COHTA MBBh CALIRORNIA
For Applicanf io Fill In Complefely
TYPE OR PRINT
COSTA MESA CALIFORNIA
OWNER Mesa Del Mar Develo ment Co
AOORESS 3800 E. Coast Hi�hway
34
M8CC0 COtp.
cin Corona del Mar, California.
ucTrEio. 98808 SB-1 NEo: OR 3-4220
BIZE I no, of B�ae.
oP �or 6000 SF wew ex �er
FEE RECEIVED
JUL 1 2t96)
FINANCE DEPT.
�+b� Of COSTA MESA
APPLICA FOR PERMIT
BUILDING
For Offiee Use Only
ReLB�PT NO. � �idl,f![O
UJ
aecerven ev I OATB necerv¢o I Jp�.rl iesue
ut 2
COSTA MESA. CALIFORNIA
FIRE
ZONE
APPROVED
ZONING
20N¢ (� J 1 I NO. OF I UBe OP N �
�R ; PUN9 2 BUIlDINO /� �
.1
�o.� —;-2 ' �� C�tf h o T
D88CRIMION
A. P. NO. -_
uHe or YARDS EVE6
E%ISfING BLDG None APPROVED ALLOWE[
98'lBACK llN6 FROM ICCMHR 4N8 BT_I�
¢NiER OP 9iPCeT 4�� - 1�� REAR YARO 33- FRorrr FT.
SIDE YARD I LEFT LO �-1�� I FIGHT 9�'S�� R. SIDE FT.
DESCRIPTION OF WORK •�
_���Ysn�_���
1 H6PHBV �GKNOWLEDOH TXAT 1 XAVB RUD TH18 MPLIWTION
•NU BTATE THAT TN8 ADOVC IB COMEGT ANO AORE6 TO COM-
PLY WITX AlL CITT ORDINANCC9 ANO HTAT6 IaW6 RHOUL.�TINO
BUIL➢INO CONBTRUGTION.
sicHaruReo ,SA DEL MAR DEVELOPMENT C0.
PERMITfE
BY� ._ /�.. _� d�%O
�
Living Area - 1306 SF
Garage Area - 387 SF
Cov. Porch - 28 SF
THE AMOUM BHOWN UND¢R VALUATION IB FOR TH8
PUftP09H OP 88TABL19HIN0 A PHqMIT FEE ONLY.
�LUATION �
PERMIT FEE $��
13,576.0� p�pN CHECK $ / �J � �
, /��d c
TOTAL PEE $ H n