HomeMy WebLinkAbout2953 COUNTRY CLUB DR - Building Permitsf':
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.qov
FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: 812-00047
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PERMIT TYPE B ROOF2 STATUS: ISSUED \
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fiPN: 13923119 DATE ISSUED: 03112/2012
;= ISSUED BY: KJB
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JOB ADDRESS: 2953 COUNTRY CLUB DR CM Suite/Unit: "
Viciniry: �
Squares: 0 Valuation: ' '$9,900.00 " `
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SCOPE OF WORK: TEAR OFF EXISTING ROOF, INSTALL SHEATHING AND COVER WITH CLASS A COMP SHINGLES. INCLUDES AN
AT�TACHED GARAGE, AppROX 3100 SD FT. ROOF PITCH IS 5:12. � .
NOTE:RESIDENTIqL RE-ROOF: Final approval of permit shall not be granted until•access to �dwelling�unit(s) is provided for
'verification of the installation of smoke and carbon monoxide alarms by the Ciry Inspectoc See Attachment w/Inspection Card
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OWNER: GUSTAFSON, DIANE L' - �� Address: 2953 COUNTRY CLUB DR � . .. UniC
PHONE: , � City/State/Zip: COSTA MESA, CA . �
APPLICANT: CROWLEY, KEVIN �
P.HONE: 714-836-1966
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CONTRACTOR: GREATER PACIFIC ROOFING
Address: 1580 E EDINGER AVUnit: � .
�NA, CA 92705 .
n't
� roof Plan Check:
�R�roof Permit Fee:
f�einspection Fee:
Bldg Std Admin Fund
TbTALFEES
$0.00
$181.25
$0.00
$1.00
5182.25
Address: 1580 E EDINGER AV �� - �. �
City/State/Zip: SANTA ANA, CA - - �
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. �, 5,,. License No.� - 621368
SUITE F , „ PHONE: .714-836=\ 66
CELL: ,
License No.. . � .� --� �PHONE:
License No. - � ` � � � PHONE:
Uni[: :SUITE F
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HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3118/2010 - PER CMMC Sec. 13•279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Years Dav. Memorial Dav. Intleoendence Dav. Labor Dav. Thanksaivino Dav and Christmas Dav
.NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
�egulations. (Ord. No. g2-28, § 1, 12-21-92)
�EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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4NSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. FaiWre to obtain inspections and fnal approval will result in the expiration of this permit.
'�C{ODEN �NSPECTON7YPE �ATE INIOIAL O�E INSPEC710NTYPE p� INTI ALS
96�i6 Fixed System Fiqal Fire Prevention 206 Final Mechanical
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�1�266 Poof Spa Final 208 Pinal Plumbing
�$j0 Final Re-Roof ,� 3- I 9- i a-�n- � 210 Final Electrical
261 Final Block/Retaining Wall 212 Final Fire Prevention �
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x�'� Final Factory Fire Place 220 Final Planning Approval
�p3 Final Sign 222 Final Site
Z04 Final Demolition . 250 Pinal BuilOing/Occupancy
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WORKERS' COMPENSATION DECLARATION: �
I hereby aKrm under penalry of perjury one o( the following tleclarations:
❑ I have and will maintain a certificate of consent to self-Insure for vrorkers'
compensation, as provided (or by section 3700 oi the Labor Code, for the
pertormance of the vrork for which this permit is issuetl.
❑ I have and will maintain wqrkers' compensation insurance, as required by
sectbn 3700 of the L2bor Code,'!a the peAormance of the vrork for which this
pertnit is issuetl. My vrorkers' compensation Insurance cartier and policy
number are:/1
Carrier LA�/� �ittS �pi.-IIa.v✓
(inrsseci.onneedrroieemmpefeEdNepeim.lisv vetlal nund�ed0onars(5�o0)aless)
Policy Num6er. Y� �iin/. SiJ/ —C7i-2�
❑ I certify Iha[ in the Derfortnance of [he work for which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to the worker ' wmpensation laws of Califomia, and agree Iha[ if I should
become su ec� the workers' compensation provisions of Section 3700 of
the Labo otl � hall (orthwith comply vnth these provisions.
3 -i2 -/L
APd����'S SignaWr Da�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED fOR IN SECTION 3706 OF THE IABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business antl Professions Code, and
my license is in (ull (orce and eRect.
Lic. # Class # �'�p
/ �z ir -��
nlractor's Sign ure Date
CONSTRUCTION LENDI G AGENCY:
❑ I hereby affrtn that there is a consWctbn lending agency for the
perfortnance o( the work (a which [his pertnit is issued. (Sec. 3097, Civil Code).
Lentler s Name:
Lentler's Atltlress:
OWNER-BUILDER DECLARA710NS:
I hereby affirm that under penalty of perjury that I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW (or Ihe following reason (Sec. 7031.5,
Business and Protessions Code: Any ciry or county which requires a permit to
consiruct, alter, improve, demolish, or repair any 5[rucWre, prior to its
issuance, also requires the applicant for such permit to file a signetl statement
that he or she is licensed pursuant to the provisions of the Contrectors
License Law (Chapler 9(commencing vnth Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7037.5 Dy any
applicant for a permit subjects the applicant to a civil penalry of not more than
five hundred dollars (5500�.�:
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the sirucNre is not intended or
oReretl for sale (Sec: 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who tloes such vrork himself or herself or ihrough his or her own
employees, provided Ihat such improvements are not intended or offered for
sale. If, hovrever, the building or improvemenl is sold within one year of
completion, lhe ovmer-builder will have the burden o( proving that he or she
tlitl not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo construct the projec[ (Sec. 7044, Business and
Pmfessions Cotle: The contractors License Law dces not apply to an ovmer ot
properly who builds or improves Ihereon, and who contracts for such project with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre Date
JOSl�a6(]/0])
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype of document, i.e. - propeAy tax hill or tleed):
DIVISION OF INDUSTRIAL SAF�TY PERMIT CERTIFICATION:
❑ I hereby certify that no excavalion fne (5) or more (eet in depth into wfiich a
person is required to descenQ will be made in conneclion vnlh v.ork authorizetl
by Ihis pertnit, antl that no building sWcture, scaffdding, (alsevrork, or demolition
or dismanHing ihereof, will be more lhan thirty-sia (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Cali(omia Administ2tive Code).
❑ As owner-builder, I will not employ anyone ro do work which woultl
require a permit from the Division of IndusMal Safety, as noted above, unless
such person has a permit to do such work from the division.
Apvlicanl§ SlgnaWre
Division of Industrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to file antl
certify a Business Plan foi emergency response to release or threatened
release of a hazardous ma[enal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safery Cotle requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal [o or greater Ihan a vreight of
500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or fuWre building occupant neetl ro fle
a registration fortn for acutely hazardous matenals? ❑ Ves ❑ No
(Section 25533 of the Calitomia Health antl Safery Cotle, with some
exceptions, requires registration with the Costa Mesa Fire Depanment by
each business which a[ any one time has on hantl a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard
tempereWre antl pressure).
3. Does or will Ihe applicant or present or fuWre building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Cali(omia Health and Safety Code provides thal lhe
Costa Mesa Fire Department may require the preparatioq certification and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre buildinq occupant require for
the work which is Ihe subject ot this application a permit for such constmction
or motlification from the South Coasl Air Quality Management District or from
any other air polWtion con[rol distnct or agenCy? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that t�e requested
infortnation be fumished on applications for rroo-residential building pertnits).
6. Will any part of [he facility to be consWc[ed under ihis permit be within
1000 (eet (rom the ou[er boundanes of a school? ❑ Yes ❑ No
Q('yes", ihe facility must meet Ihe requirement of Sections 25534 and 42303
of Ihe Calitornia Health and Safety Code).
7. If a permit from the South Coasl Air Quality Management Dislrict or other
air pollution control distdct or agency is required (or the vrork which is the
subject of this appliwtion, have all of the disclosures prescribetl by California
Healih antl Safety Code Section 42303 been matle? ❑ Ves ❑ No
8. Q�'yes", attach cenificate of compliance from Ihe appropriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read Ihis application and state that
the information given is correct I agree to comply with all slate laws antl city
ordinances relating to builtlinq construclion, and authodze representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhorized by this permit until fnal inspeclion.
n [� ol Legal Ovmeqs� D te
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An01or qulM1otrze4 ApPli 1 Da�e
PrescriPfive Certifica[e ui'
l:e.videi:tlul AlteraCio�t.r
Cial
70�%
CF-7R-ALT
(Yase] oi'S1
r Prnject N:mie Climatc Zunc # /-� U of Slories
. �rJ.S'/lG�1'%it � /J
� a ue Surface Details Tm the tun ed portic
A IS C
7'ro used "�o"
Framing Thi
Tag/ Assembly Name Material S{
ID� or Type� and Sizez or
Nole: For(w-red
of Mass N'alls see ru
U-
Ca�tinuou� Insula(ion P-value. xee
Constructiun 7'able below.
Values From ]A4 Table
Framed Continuous JA4
JA9 TAble Cavity ]nsulation Assem
use rhe Mas.s mid
:�:
� 1. For TngUD indica�e the idemifcation name ihai mntches �he building plans.
?. /ndicate /he Assembh� Name or ryPe: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc...Indica�e �he Frame ryye and Size: For
N'ood, Mem(, Me�a! Buildings, Nlass, enter 2z4, 2z6, m� etc... see JAS for oiher possible fi"ame rype assemb/ies.
3 Eirter the thickness: for nrass in iirches or Spaciirg ben+�eeir f�aneing members eieter, 1 G"or 24 "OC; or 01her jor al! olher assenrblp description
a'uch as Cnncrete Sandwich Panel, Spandrel Panel, Logs, Su'aH� Bnle Panel and elc....
9. Bused on die Cliniaie Zone; enter tl�e Standard U fac�o�.f'ani Tuble I51-B, C a� D jor euch differeiv assembl�� Name or q��e.
5. Enter U�e Table num6er dmt closeG� re.remble.x the yrroposed assem6(r. � -
6, Ln�er lhe 17-value dva� is 6eireg irvstulled in �he wu/I cavim or beiween the fi�nn+ing; o�hermise, enter "0 ".
7, Lnter 1l�e Contirtuous Instdn�ion R-value for lhe proposed ussemblp; ntherH+ise, eirter "0 ".
6. En�er dre r'ow aud colainm qf ihe U-fnetm� i�altie bas'ed on Colunu� F Table Ntmiber ar�d e�ver the Assenablp U-fucior u� Colunm J
). The Propn.��ed da�semblp Cl-(uclor, Cnlunxn J, nnis/ be equa! io a� le.r.s thun dm Stnndnrd U juclm� in Column E to r.nmph�.
Fun�in@ Strips Construction Table for Mass W tdls Onl��
A ]t C ll G P G H 7 ,t 1i L M
1'ropused Propertien� of Mnsunry and Concrelc Added lnterior or Extcrim� Insulatinn
�'�hdln !'rum [teference iu Rurring Sp:�cc f'rom I2efereucc �
Juin� A i�eudi>' 7't�blc 4.3.5, 4.3.G. 43A .luinl A� rentlix 7'nble A.3.73
U VF �.j 1 u — U
G: u, � u � � 4� J �-
Hssembly " � �° �° � F- F- c y�•.. i° u.0 � jula�
Ma4s Namcur .IA4Table �..' � u�` E F 9 �� Lvo °.,< . ASSeIn�IY
-.i = � � R R o t;- a—
Thickness' T e' Nwn6cr' S" = i;i =' � �'a ,� r 4��` u�i r, U-(actor�'� Comment
I �
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liegi.t'irulinn Nuntber: liegi.t�u'u�ion Uu�e/Tirne: NERS' Prnvider:
2GOh' Ile.ridei�tial Cnntpliai�ce Forms fiugiesi 2009
Prescri rtive Certificaic of
/tesidential A[terntinus
Ih•ujecl Name:
�, . �tesidentis�t
ROOrING PRODUCTS (COOL ROOrS) §157(p12
C F-1 R-ALT
(Pa �e 3 01' S)
Climaic?amelt #oCStaries
u Uie nren ojrsterinr rnnjsurjnre m bc replaced rxceedr nmre tlmn .SO% oj[Le ccisting roof nren, or u�ore 16un 1,000 jf, �vLichever is
Iltc nciu rnq�nx aren �nn.r! mce( d�c rnn�r+A P�����ict "Cnal Ro�/" requireuients of§152(L)IHt, ]52(b)lilii, or 152(b)Iliiii.
Check applicab/e niternntive or rxcep�ion Ge(o�+� if ihe rnnf a/�eratiwr ia� exempt fi�om the ronfittg producr "Cool Ronj" reguirementa•. Note: /jan��
one oj(he ulterna/ives m' exceptimt be(oH� is checked, /he Aged So(ar 2efleclance and Thennul Lmittance re9uirementa� for rnofing prnduct.r in
§ l8(1) are noi applicab(e. Un not fill �a6le helne�.
Cool koofs Not Itequired in Climate Zones I-12, 14, and I( with a Law Sloped. Less or 2:12 pitch. �
Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a S[eep-Sloped Roofs (pitch greater [hnn ?:12) and product unit weight less
an 516/fY�.
Alterna�tives to §152(b)1Hi and §152(b)Hii, Steep-slape ruof (pitd� > 2:12)
❑ Insulation with a thennnl resistance of at least 0.85 hrftZ�OFBm or at-least a 3/4 inch airvspace is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to § 15l(�10; or
❑ In climzte zones 10, 12 and 13, with I ft� of free ventilation area of attic ventilation for every 150 ft of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet venical distance of the roof ridge; or �
❑ Building has at least R30 cei6ng insulauon; or
❑ Building has radiant barrier in the attic meeting the requiremen�s of § I51(�2; or
� Building has no ducts in [he attic; or
❑]n elimate zones 10, 1 I, I3 and 14, R3 or greater roof deck insulauon above vented attic.
Gxception tn §152(bpHiii, Low-slope ronf (piteli <_2:12)
❑ Buildine has no ducts in the attic.
.� O RooSmg area covered by building integrated; photovoltaic panels and solar thertnal panels are exempt from the below Cool Roof criteria.
; O Roof constructions that have thermal mass over the roof inembrane with at least 25 Ib/fl� is exempt from the below Cool Roof criteria.
� - Note If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to shom compliance, otherwise,
Check the a licable box below if Exem t from the Roofin Products "Cooi Roof' Re uirement:
Roof5lope Product Weight Product Aged Solar Thermal
CRRC Product ID Number� <_ 2:12 > 2:12 < 516/fr' >_ 516/ft' Tyoe� Reflectance''4 Emittance SRIS
��—�t�������1
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0
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n
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y
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C
C
OQ
�4
❑4
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❑4
The CRRC Praducl lU Nurnber' emi Ge obmined fmrn Ihe Cool RoofRa�ing Council's RaredYroduct Directay a� wwro.cuoLnnLs.m�e/nrndtrcfs/.cearcl nl n
IndicaM IBe type oJproAucl Ls Geing useA,for Ihc roof(op, i.e. sipgle-p(y roof, asphall raof, memlroof, elc.
IJIhe Aged Re(lecmnce is na� nvailnGle in tl�e Coal RoofRaiing�Counci!'s Ra�ed Produci Direcrory Ihen use the /nirial Reflecmnce value fi'om rhe snme
direciop� and use ihe eqimlion (01+0.7(n���iiial — 0.2J io abmin u cn(cula�ed aged vah�c. Wltere p is Ihe Initia( Solar ReJleclonce.
Check Gos if d�e Aged Xeflecrpnce is n calculaKd ra7ne usirtg dre egualron almve.
Calculare d�e SRI vulue 6�� using !he 521- Worksheer a! hlfn'//�wv�r enerrr ca env/lille24/artd en�er �he resufting value in fHe SRI Colmnrt abone and auach ucopy
ihe SR/- INm�ksheer tn �he CF-IR.
a apply Liquid Pield Appiied Coatings, the coating must be applied ecross the en[ire roof surface and meet the dry mil thick�tess or coverage
commended by [he coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating;
Aluminum-Pigmented Asphalt Roof Coating �CI Cement-Based Roof Coating ILI Other
Regisu�ution Number: Registration Da1e/fime: FIERS Provider: -
2008 Residentia! Campliance Forms � fiugusl 2009
l'rescr�iPCivr Certiiticatr, oi� CumUliance: Residential CF--
I:esideiatird Alteratinna� (2'���,
f�'uiec! IVi��rre: � Climeite Guncil � i) O1�
F3�7:S V��}21IP�CATI�JN SUMMAIiY The eqforcemeni iigcnei'sl�mdd pnr apecia! nnention to tl�c HCPS ldetunres speci�icd ir this
cneclr(9s� beloir. fJ canyle�ec! emdsfgnetl CF-47( Forna /ar n171Fie maaa�au�ex� speci(ied shall Gc.submiu¢d to iiia b:iildi��g iria�pceiar Lef'ore /iri�l
l�uCt SeRlili�e S 7�eStille� HL'2SveriJicn�ion ia�requiredforihia nfeas'wr.
❑ Y�S ❑ NO YGS: lu Climaie'Lones'' ¢md 9-I G, if more thau 40 lineur ieel of new or repleicemenl clucu w�e insi2illed in uncnndlLioued
space, uie tiuc�s ure to 6e sealed per y�l S2(b)IDii and the newly instnlled duetc ore «i 6e insulaied per ��l S1(i)10.
D EXC�7'T10n': Laisting duct s��stenis tLal are estended, rvl�icl� m�c cunstriicted, insuJa�u;d or senle[1 ivitl� »sbesws.
❑ Y�S ❑ NO 1'ES: ]n Climaie "Lones 2 and 9-] G, if the existing spaee. conditioning system (HVAC equipmeni ai�d ductingj is replaced, the
ducts a�e to 6e sealed per �152(6)IDi.
❑ 1'iS ❑ NO Y�S: ]n ClimateZones �' and 9-IG, if�the existing HVAC equipinent is replucetl (including tli: replacem�ni o1-thc nir handler:
outdoor condensing unii of �i spli� system, cooling or heating coil, or the furnecc Leai e>:changer) the ducts are to be
sealed per �152(b)lE.
❑ EXC�PT10�: Duct sYstems th�t nre dncumented to I�are Ueen previously se:iled cuniirmed thruugh HC7�S
veriticatiou iu accm�dance witli prucedures in the Iieferenee Residential Appendia PA3. �
.. . . � � ' � �� ❑ EXC�7'TION: lluc[ systems with less tl�au 40 line�r teet iu unconditiune� sp+ice. � - � . .
❑�XCLPTIO�: �xistine duct 51'stems constructed, insuluted m� sealed �vith aSLestns.
Rei'rioerant Charpe - Split S)'stem NERS veri/icn�ion is requireci Jor thi.0 measme.
❑ Y�S ❑ NO YLS: ln Clintate Zones 2 and S-I5, wl�en the existing HVAC equipmeni is repiaced (including the replacement of ti�e air
hai�dler, outdoor condensine unit of a spJit system A/C or heat pump, coo7ing or heating coil: or the fumace heat
exchaneeri a refrieerant cl�aree measureme�t shall be veri5ed per t 1;2(b11F. .
Centr•al Fan Inte;rated (CFI) Ventilafion Spstem and Fan �'att DraN�
The ventilation renuirements of &150(0l do not anolv tn existine residential homes.
Ducted Split S,ystems - Air Conditioners and Heat Pumps: Airflow HERS »eri�ication is required for this measure.
❑ Y�S ❑ NO YL�S: ln Climare Zones 7 0 through ] 5, wlien the existiug space-conditioning system (H VAC equipment and ductin�) is
reolaced. the airfloW and fan watt draw shall be veriiied ner §152(b11Ci eo meet the requireinents of S I�1(fl7B.
Author's Declaration Statement
this CertiLcate nf Comnliance documentation is zecur�te and
// , Signature:
lf Hpplicable O CEN or ❑
(CertiGcation H):
c�/a.S��T/J ��7�✓P Cil / iT". I/ 7�:�) �,'Sf� �/'l�h
Responsible liuildine Designur's Leclaratiun Statement
� 1 am eligibir. tmdei' Divisimi ? of�thc Califomiu Business and Protessions Code In uccepl responsibility Jor lhe building design identified mi
this CertiScute of Compliance. �
• 1 certiil' thai the cnergl' fe��4u�es and performancc specification;: ior the building desigu identiiied on ihis Cer�iflc�uc of Compliance coniorm
tu thci�:quircmcuts ofTitic 24,Parts I E�nd G oi�Uic Culilbrnia Codc ofltegulatim�s.
• Thu building design 1'eatures Idcn�iGcd on lhi:�. Certific��c of Gumpllance: arc cunsistent wilh the iniurinalion provided to ducwueul thi;;
6uildm� desi�;n ou the olher npplicable complienec fonn::, worLsheets, culculations, plans und sp�cii�ica�iuns subndLLed w the enforeeinent
e�,enc�� 1br approval with this buildinr lacrmil apnl ication.
tJ�imc
Company:
\
Address:
� CiiylState!"Lip�.
Signature:
Uate:
Piione:
Frn� a.s.ci.suuse �n� queti�tiuns regartling the Lnm�gP Struidtard.t, con�ucr the Lnerbl' Ho(line at: ]-R(111_i72-33011.
1(egis�raiiou Iduniber ICegi.vununn Uaic%!'ime: l-IERS Prn��icler:
�llll); It�-ciriemin] Cmm�liunceTTorma� /���„n�� �l101
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2953 COUNTRY CLUB DR
Suite No
� Vicinity:
Parcel Nunmber: 13923119
Applicant: BRASON, ALESMA
Address:
Owner: GUSTAFSON; DIANE L
Address 2953 COUNTRY CLUB DR
� ' COSTA MESA, CA
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip: 92626
Contractor: GEORGE BRAZIL PLUMBING, HTG.
Address: 3801 LENAWEE AVE
Arch / Eng :
Address:
CULVER CITY. CA
WATER HEATER CHANGE OUT.
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlet5)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Phone: (310)253-5229
Zip: 90232
License: 679898
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer � $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 k) $0.00
Receptors $0.00
SepticTank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Privale Line $0.00
Showet � . $0.00
Sink, bar $0.00
Sink, cominercial - $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0 "
0
0
0
0
0
0
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: O6/25/2002
Issued: O6/25/2002
ISSUED 6Y:
AMT
Sump Pump $0.00
Swimming Pool - $0.00
Trap Primer $0.00
Urinal - $0.00
Vacuum Brkr BkFlow(1-4) $0.00
Vacuum Brkr BkFlow(5+) $0.00
Wash Basin $0.00
Wash Basin Set $0.00
Waste and Vent System 50.00
Water Closet (Toilet) $0.00
WaterHeater/vent $12.30
Water Piping (Inst or Rep.) $0.00
Water Re-pipe $0.00
Water Service � $0.00
Water SoRener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TOTAL CALCULATED FEES: 535.80
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
[�]
NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requirements under California statutes and related �
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned �
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all'
requlred inepeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626 ,
zaa��aelaooj
- - - - - - - - - - - - - - - J
WOHKERS'COMPENSAnON DECLARAnON: '
I hereby effirm under penalry of perjury one o1 the following deGarations: �
❑ I have end will maintain a certi(icate of conseni to self-Insure for workers' compensatlon, as provided for by saction 3700 ot Ihe Labor Code, tor the padormanca of tha
work tor which t�is permit is issued. .
ave and ill aintain orke nsetion insu ce, es required by sec6on 3700 oF Ihe Labor Code, for Ne perto�mance ot ihe work for which this pertn0 is issuetl.
My wo surance rrier entl p cy number are: r ,/ �� S (
Carrier: �� .� Policy Number. '�� I��"' 7U
(lhis section need not be completetl i! the permit is velued et one hundre0 dollars (3100J or less.) -
❑ I certity Ihat in t�e pertortnance oi the work lor which this permit is issued, I shall noi employ any person in any manner so as to become suhject to ihe workers'
compensation laws of Califomia, end agree that if I shoultl bacome subject to ihe workers' compansation provisions ot S9�tion 3700 of tha Labor Cotle, I shall forihwith
comply wit� Ihese provisions. � /� �
Applicant Signeture: %s� Date: �
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION OWERAGE IS UNLAWFUL ANO SHALL SUBIEGT AN EMPLOVER TO CRIMI PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
T/10USAND OOLLFflE (5100.000�, IN ADOfiIIXJ TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTION 3]O60F iHE LABOR CODE, INiEREST, AND FTTOPNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I am licensed under prov' ia
tarce and eftecL Lic. a�
Contractors Signature: � �
with Section 7000) of Division 3 of the Business antl Professions
Clau # �L
— Date: ��2
CONS7RUCTION LENDING AGENCV: �
❑ I hereby attirtn ihat ihere is a construction lending agenty tor Ihe pedormance of the work for which ihis permit is issuad. (Sec. 3097, Civil Cotle).
Lendefs Name: Lenders Address:
SignaWre: Date:
OWNER-BUILDER OECLARATONS:
is in full
I hereby alfirtn that under penalry ot perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Protessions
CoOe: Any dry or counry which requires a permit ro wnsWd, alter, impmve, demolish, or repair any sirucNre, pnor to its issuance, also requires the applicam for suc� permit
to tile e signed sletement thet he or she is licensed pursuent to ihe provisions oi lhe Contrectors License Lew (Chapter 9(wmmencing with Sectlon 7000) oi Division 3 of ihe
Business and Profeuions Coda) or ihat he or sha is exempt therefrom and tha Dasis tor Iha ellegetl ezemption. Any violetion of Section 7031.5 by eny applicant for a parmfl
subjecis Ihe epplicant to e civil penalry of not more than fiva hundred dollars (5500).):
❑ I, as owner of Ihe D�operry, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and t�e structure is not intentletl or offered tor sale (Sec.
7044, Business antl Professions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves Ihereon, antl who does such work
himself ar herself or Ihrough his ar her own employees, proNdetl that such improvemenis are not intended or otterad tor sale. If, however, the builtling or improvement is
sold within one year of completion, the owner-builtler will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the properry, am E%CLUSIVELV CONTRACTING WITM LICENSED COMHACTORS to consiruct the project (Sec. 7044, Business end Professions
Cotle: The contrectors Licensa Ww doas not apply to an owner of property w�o builds or improves thereon, and who comracis for such project with e contrector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec. Business and Professions Coda tor this reason:
SignaWre: Date:
Owner ID veritied by tlrivers license. ❑ Yes ❑ No Dnvefs License No.
Vedtication ot Ownership by (rype ot tlwumem, i.e. - propeny tau bill or deed):
Expire5:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIfICATION:
❑ I hereby certify Ihat no excavation five (5) or more feet in depih into which e person is required to descend, will be made in connection with work authodzetl by this
pertnit, and that no building sUucture, scallolding, talsework, or demolition or tlismantling thereof, will be more Ihan ihirty-six (36) feet high. (Chap. 32. Gry 2, Art 2, Sec.
341, T�tle 8, California Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a pertnit fmm ihe Division of IndusMal Satery, es noted ebove, unless such person hes a
permit to do such wark from the tlivision.
Signature: Date:
Division of Indusirial Safery Pertnit Number:
CEHTIFlCATE OF COMPLUWCE AND AU7T10RVATION OF ENTFiY: I cenify under penalry of perjury �hat I have read ihis application end stale that the infortnation given Is
correct. I agree to comply wilh all state laws end ciry ortlinances relating to builCing consWctioq end authorize representatives of t�e Ciry of Cas�a Mesa to enter upon the
above-descnbed property for inspection puryoses. I agree not to occupy or allow ocapancy of any building authonzed by t�is permit until fnal inspection.
Signature Of Legal Owner(s) - �e
�Q 7 e; % 0
� ntl/Or Authorized Applicant -- � Date
CODE t. INSPECTIONTYPE
1616 Fixed System Final Fira Prevention
1266 Pool Spe Final
200 Final Pe-Rool
201 Final BIocWRetaining Wall
202
203
204
Final Factory Fire Place
Flnal Sign
Final Demolition
p0jf INTITIALS
COOE I INSPECTION TYPE
206 Finel Mechanical
208 Finel Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
�� ��
p �._ C►
�
�ooxEssoceuam�c: 1y53 COUNTRY CLUB DR
°""ERswuEi°'°�a"":GUSTAFSON DIANE L
�^"�u "1953 COUDI�'RY CLUB DR
COSTA MESA,CA 92626
641-5821
wv�. uuiwo �oox�ss:
�qCNRECTOR FNfyNHN:
MCII Ofl Hq.'S ADDPE55:
carim�crarswu¢GEORGE BRAZIL
caNm�croxs�awio 3022 N. HESPERIAN WY
�noness SANTA ANA CA
92706
LICENSED CONTflACTORS DECLAR�TION: I Mreby aflim under pneYy d peijury Ihet
(wmmemirq xi�h Seclbn )000) d Division 3 N tha Buvmm eed Pmleeaiom Code. eM m
cmuc.No.:060568 ��c.cuss:C-zp uc.No.: g .
om<:
OWNEfl BUILDEF UEC flRTION: I haieby elfiim undar parely �'ry t em e[e
fdbxiq remon (Sadion )03t.5 Busiims enE hdwiare Code: A c1 a y wfi' r
nd'oh, or repe'v any evucture: pin b i4v veuenca, eleo reQuim 1 icenl m pa
IronseE punueM to �he vroviaons d Ne Conlreeme Licenee lew �Chepter (
dneve aM Prdesviw COEe� a Ihei he w Me ia exemp therelmm vd tM beaie la the
�mis br �r eodiceni ra e aa�mn w,Epcb �ne evp�cem �o e dvi� yane�y of mi m«e �ner
❑ �.esowrrerm�neomoenv«mremWwe»wnwapeam�ne:edeo�momeetion.wil�
u-�
�1—�
IIC. ND.:
UM:
(714)541-9753
uc.ao.: 679898
uHr: 1 0 1
licenaed uMx parieiom d Chepls 9
mx e in full eMetl.
P• 08/�7
aae Licmee Lew br Me
mn.wa. Mer. Ima�we.
.�m«�»m mm ne «.n.
000� m orveion a a �ro
do Ihs xvA. enA IM el�u�Yu�e b nol in�eiMad
or oflared Iw vele (���� ��. B�arev arM Vmtasaana Code: The Camreppa Lcensa uwaom � eppry�o en ownera poperry
who W�iM m vno�ea iherean. enE who doee auch xwk Mmsan w henell or Mraqh hb a har own empbyeea, pwided ihet mkh
im0�a��a ve m� immded a ollared lor aele. tl. M1owaver. �M buikiip a enpmremeM u add wilhin anY� d comWation. IM
o.m.ra,�aer v�;n ne�a ine w� a v�av�na ne or sne ed � w�ie w �mw�. �a me wm�e d.dal.
� I. ea ox�rer M iM MoOaM. em mdirmrveN wnireaine wuh liwr�sad conhedan ro wnehud tlro qul� (Setlion ]ON. Buni�e erM
Pmteabn Code: TM Conlredwe Licerim lew dom � epply to en ow�wr d qape�ly xfio builde a impv.•ea iMraon entl who
convecb iw eudi propqe wnh e mMrada(s) I'censeE WB�t to tM Comrmoro Licenee Lewl.
� I em eaempt under Seclbn: B. 8 P.C.. ior thu reeaon:
Deta: Ownx:
I Eo Mreby cenM � I am aware d uM uMerslenE tM reQuiremenb d Celianie HeaM vM Sdeiy Cade $eqiom 25505. 25SXi. ud
255JC, vd thet I a e�ry M1nure builEirq oxuynt will / wll rwt �arcb one) naeE lo rnmpy Mh aeid dete codm eM the rtquiremWa br
a pemfi lawuvunianw modifimtionhaniM Ai-G eTry�anepamenl Dia1riW. Rukemiel mnativaun eppira�bro ra xemphom Nwa
wa�.w�..
De�e: Appliran:
WORKEH'S CONYENS�TION OKL�P�TON: I Mraby eHm� uMx penelry d perjwy aro W IM tdbwi�p Aeduel'vre:
� I heva eM Mil meimen e ceni/rale d mnaenl b veMim�n la waMus' compaiuetian, m pavidaE lar by Se�im 9]00 d the lebor
coea. iw ma oeno�. a ub wo�x io...m�n m�. v�n �. ��e.
. f'I � n.w am wi� meimen wa�cen• mmron�nn iriwmnm. sv nwirad M seaim aroo d �na lelwr coes. ror �ne oe�«men�e a �ns
1� work Iw which Ihn pnmu ie aaued. MY'�'a�' �Pen�ion ineuruice urrix eik pdiry number are:
c�,: GOLDEN EAGLE EXPIRES
Polcy Number: N W C� � 1� �]. � y�]
seaion n.ed nw ee candxee � Ne n�x o ror are nune�ee ew�eis Is�a/ a �wJ
�J I wniy thei in tM pMormeze d IM work la whch iM1i� pem�N u'nwed. I�hNI � am enY A �n eiry enner o
necoma wqea m �ne ..onfeii cwnpeneelbn bwe a celifanle. end de inm d n �� qome wbp o �ne
compeneelbn pm 'abn d Sedion 3]00 ot the lebor Cade. I �hell fort oompy h��6 N 5bne.
Dets: •
Wemlip: Fa1Nn ro xu wort�rs'rompewtlon covsrep� h unl �1u1 entl • ll f en en loyn fo alMiW penaMp aM
NHI fliws'q N om hwtlrM fMua�nJ JNNr� (S1Pq000A In MC/ n IM t ol mpsiuet n� demepu u proNOW br In
9�ctlan 9M6 0/ tlis LMor COJs, Inhluf, �ntl attomsy'� Issx
CONSTNUC110N LENdNO AOENCY: I Irereby e/firm u�Mer penalry ol qrjury the� � e oons�ruaim brM'up epency M Ns
perlortneMe M ihe work la whitl� thc peimF ie asued (Sed'on 309], CN. C�.
LENDEN'S NRME:
LENDEX'S �DDHES3:
I cerlily Ihet I heve read Ihu epplce�ian mM aieta tAet Iha ebove iMwmetion ia conep. I epiea �o compy xiln ell ay eM counry ad'meMee
vM ete�e lexs relmig b buiM'nq conm�wian entl heraby e aqmmivea d ihu ary �o mter upon �M ebove.menlior�etl proparry
laimpetlion purposes. �, � �--
Dme:__S�[�
Cenery-AppGrant:Pink-He�enue:(3oldenmFAawen
CZTY OF COSTA MESA - HUILDING PERMI'f
PERMIT NO: M 080308 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC
JOB UESCRIPTION : CHANGE OOT FURNACE
CLAIM VALUE: CALC-VALUE:
PERM NO; M Ul3030B
GOVT: N 5'UPP: N
PURPOSE: UTH
SQ FT;
GROUP OCC: R-3 /
COMMENI'S: REPI�ACEMENT OF EXISTING
��***��*xx-��**�*�*���rt*��**x����****��**�+�+��*���x**�x�+�*��*��****�**�***�*�+�*��*
Z 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 BUILDZNG ---------- -------- ACCE5SORY BUILllING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 13923119 ZNE: REF NO:
PLANNING NdTES>
1
iE iE 1E �E 1ElE iE iF 1E iE 1ElE iE iE �E 3E 41E 1E if 1E 1E iE iF iE ff ik if iE iE iE 1f ik itlk iF if'iF 1f !f 1E 1E iE fE iE 1F 1E 3ElE iF iE 1E iE iE if if iE 1E iF 9E iE fE iE iE iE iE 3E �)E 1E iE iE iE iF IE iE 3E iF �E �E
D E V E L O P M E N T S E R:V I C E S R E� U I R E M E N T S
ZONING APPROVED BY �,, DATE:
HUILDING APPROVED BY :
APPLICATION ISSUED BY
�E 1E 1E iF 1E iF 1Elf �E �ElE 1E 1E;f 1E iE !f 3E iE iE iE
LEGALIZATION:N
BLDG PMT PLUMBING
PERMIT
PLAN
ISSUE FEE
DATE:
F E E S U M M A R Y STRUCTURAL SEGMENT;N
ELECTgIC„'MECHANIC FIRE SMIP/RES GRADING
... 16.25
_ �� . 25k SMIP/NON—RES
' ���Ce�'. 22.��
BUILDING-UIV-> PERMIT ISSUE PLAN-CH�ECK TOTAL PAID DUE
TOTALS----> 16,25 22,00 0.00 J8.25 38.25 .00
t �
REVENUE DIVISION TOTALS--> COLLECTED: 38.25 OVER/SHORT: .00
BLUG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG PLAN-CHECK
3 8 .'2,5
-t
1E iElE �E 1E if �E 1E fE ff iE iE 3ElE 1E 3E iE k iE 3E �E iF 1E iE 1F 1F 1! if dE iE iE 1E iE �f iE iElE iE dElElE IE ff if iF iE iE iF iF ff� iE iE fE �E 1E fE 1f iE 1E iF iE if jE 1klE 1E iF fF iE iE 1E iE 1E ik iE 3E 1E iE if
I N D I V I D U A L, i�'F� E E B R E A K D 0 W N
TYPE QTY D E S C R I P T 7 O N� . UNIT COST TOTAL COST
MEC 1 INST FORC-AIR/GRAV'FURN�.�> 100 K BTU 16.25 16,25
END OF.. FEES
_'\
�_ �
� J
.�. ,�
�
:�
01 QQ228`91—p�218`91 T C�T 3�.g`
OATE� Ii/O5/95 TI11E: i2:S2
CONSTRUCTION ANDPLANNING POOL°�SPA - '
APPROVALS Permit #- Date Inspector : APPROVALS Pe. .i # Date Inspecror �
1. Temporary Electrical Service or Pole 52. Pooi & Equipment �ocauon �
2. Soil Pipe-Und�gmd. � 53. Steei fteinforcemen[ � ' �
3. Electrical Conduit Utility•Undrgrnil. 54. Forms � � .. �
4. Electrical Conduit-Undrgmd. � � 55. Electrical Bonding � '-
5. Steei 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. 8ackwash lines, P-Trap, � Undrgrnd. ��
70. Structural Floor Svstem ;\ 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection - 62. Backwash & Receptor�Pinal i-. . i
12• Sex'e� CaP " � 63. Heater & Venx�Final � � '
13. Roof Drains . 64. Plumbing System - Final ��
14. flough Plumhing � � 65. Electrical-Final '
75. Rough Electrical-Conduit , 66. Solar SYstem-Flnai
' 16. Rough Electric Wiring � 67. Fencinq & Access Approval � �
17. Rough Wiring Sign 5$, APPROVED FOR� PLASTERING
78. Rough Electrical-T Bar Ceiling � . 69. POOL,'SPASYSTEMS FINA�
79. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Oucts, in Struccure 70. Underground Hydro
22. Ducts, Ventil2ting 77. Product Piping � Gas ❑ 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. Ory Chemicat
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 76, FIRE PflEV. FINAL
30. Drywail Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat _ 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FQOD CERTIFIGATE ISSUED
33. FinatElectric Notes: , � ( CCI_SS �m� � {�^�
\.L� J-U��Y
34. final Heating & Air Conditioning �' a' o�
�1-�I- 1=1NA.Ll Z�� -
35. Final Gas Pipe-Test - �t O` � /� � '
I 4
36. Hood or CanoPY �
37. Pina� Factory Fireplace - .
38. Fina�.Plumbing -
39. Water Service-Finai -
40. Gas Service-Final
47. Solar pomest�o-Final �
42. Backflow Preventer �
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation , � '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electtic Releate to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICA7E OF OCCUPANCY
No. Date
GENERAL CONTRACTOR K W Knl l VALUE $ l fji 1�.3 -i pn
AP. No. LOT THACT �q FIRE ZONE .. DESCRIPTION OF WORK re�
IN��ECTIONS G�7�(g I DATE GROUP �j� TYPE V ZONE
� ground Soil/liJfS U.G. Water /�(/��. PERMITS ISSU.
_ , _ � i � SUBCONTRACTOR I ____ . _....
-//-60
Form 210--SM\ 11-59 S-B P ].'�].(�'�
iot -
�.,�.���
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX H17 COSTA MHBA. CALIFORNIA
For Applicant to Fill In Complefely
TYPE OR PRINT �
AODRe�s"s 2953 Counti Club Drive
COSTA MESA CALIFORNIA
oWr,ER E1ken Develo ment Co. Inc,
MAIL 1555 Placentia Avenue �
ADDRESS�
c,rr Ne ort Beach - No:
ARCMITG(:T . TEL_
si
��E ����A���
.�-�' (n�13-(0�
9�p� D��'.
a�r of co�r� �,
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. /�R�T�j10�
C;
IVED CY OAT6 RECEIVEO �ATE 88UEO
�/ I�� �- �v I G• ��-G �
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ADDRE56i 1555;-Pl�a.centia Avenue ZONING �
Ne ort -Beach =��a I NO.OF I USE OF NEW yy
��TM � R_1 PLAN9 2 BIIILDING W �Alili ST•
u�TNo. 61145 No MI 6=3227 Le��
OH6CRIPT�ON
OF LOT 97 33x73 6 i"r�NO�'o� o��
A. P. NO.
USE OF YARDS EVE6
EXIBTING BLDG. APPROVED ALLOWED
8HTB6LK UN8 FROM � � (CENTER LINH BTJ �
CeM6R OP 9TN6ET 50 ' REAR YARO 2�% FRONT FT. iN.
SIDE VARD I LEFT b� I RIGNT � R. SIDE V FT. IN.
DESCRIPTION OF WORK _
�I - L. SIDE . FT. IN.
NEW I"IIALTERATIONI IIADD1710N I REAR 26 FT. IN.
REPAIR I-IMOVING I IIDEMOLISH I APPROVED �
'7 BY ATE 6-10-60
SIZEDING' i8oQ5F ROOMS 1 STORIES1•
EXTERIOR WA IROOF WOOD SHINGLES -
COVERING t GOVERWG
U6E OF BUILDING AND WORK TO BE PERFORMED
Sin le-Famil Residence and
Rttached Garage p�AN 25B
I NERE9Y ACNN Ge THNT 1 XAV6 READ TH19 MPLIWTION TH6 AMOUM BHOWN UNDER VA�UATION IB FOR TH¢
AND BTATE T T ABOVH ib COIiRECi AN� AGREE TO COM- pURPOBE OF EBTABL�BHING A PERM�T FEE ONLY.
PLY WITH A CI ORCINANCE AND eTATE WB REOULATING
Bu1tDINo Co e oN. VALUATION
SIGNATURE O PERMIT FEE $ C��
PERMI7TH (�� Gj a
� /S �3`� PLAN CHECK $ � /
J F
AUTHORIZED AGENT - �
TOTAL FEE LL