HomeMy WebLinkAbout952 DAHLIA AVE - Building Permits,� " ,
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' �� �� ' � ` � CITY OF COSTA MESA , � ' ; .
� . : ' " BI/ILDIN�i DIYISION , .
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 •� Fax (714) 754-4856 • v.v✓w.ci.wsta-mesa.ca.us �
�. � �� �- � . - , FOR INSPECTIONS CALL: (714) 754•5626 � - �
4w.�.,�m'� . .. . � . . � . ' . ' . �% .
,� ': ' _ ' `, PERMIT NUMBER:rBC07-00111
PERMIT TYPE: B COMBO
Sub Type: POOLSPA
�os nooResS: 952 DAHLIA AV
Vicinity: REAR SFD �;�
Const Type: � , ' _ �`
' �� � x{��
SCOPE OF WORK: 12'� X 6,GUNITE
ABOVE GRADE. WORK WCCU�DES R
ADDITION OF A DRAIN, GAS OUTLE
.. .. . . P, i�' - a;:�
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OWNER: MINARDI,ANGELO`J _a�"
PHONE: 949-3003082 �' '�
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APPLICANT: BRADY BRENT ..-a .� :`=�
PHONE: : - 951 877-6602 aaf ' q�,_
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CONTRACTOR: BRADYS;POOLjGU,
Address � " 40046'�OAK�GROVE`A'
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City/State: . MURRIETA?CA .'�;;y��"
� . .. ' 't�`i5 ;:ch�r:d '�fi'1.-i
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ARCHITECT: �'pS'�, . �:=.. �";'
ENGINEER:.. . TODDL•CACHER��"
. . - . � . .. . ; �:':... �.�:'+'.: . .
' STATUS: ISSUED
� DATE ISSUED: 07I1912007
�„''"r�` '� ': =#r � ISSUED BY. BJK
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„�> �=y � F ra ,
'a� �_ �� 3 �- �� r
M' i� - r � , �, � -'; �, �,� # � Suite/Untt:_ � . . �
� ,,;;� � .s; i r� t �' �r � �'� �.
o' � 7-;'� �.-x ,�,�""..v.•,'' n,. '�;e,�,��r Primary�Occ u �.. , a
SQ FT��+ �; -Y 60 Valuation �$25 000 00
51 '�.�t£ �r '^:%,�,C¢ il` e;i;l T l`k. 4 . .
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�PA,TO%BE ADDED NEXT TO THE EXISTING POOL,�SPA TO'BE NO GREATER THAN 6"
PL,4STER OF THE EXISTING POOL, "� �,;' ��
S;(:1-4).�ELEC AND PLUMBING. � � ��,�� �z� :� •: - ' -
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a�" .:...,.�.,4 .. . '�,^. � �.- _ '� " '"!' fi`. �, ,' ,f _ t �� ,
Building Fees: . . . �`c:�. ;�
Eledrical Fees: +'���
Mechanical�Fees: .. , � • � ,�,
Plumbing Fees: ' . . � '�
SMIP Residential: ' . � .
SMIP Commercial: . .
TOTAL FEES:
^Refer to fee receipts for all (ees paid for project .
Address:
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License No.
License No.
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4-630-6174 � � �
NO710E: The work authorized by this�permit shalbcomply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) � . � � � - . � . �
EXPIRATION: �PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � �
INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWPin the expiration of lhis permit.
CODEt. INSPEC710NTYPE , p� IN� � DE/ -INSPECPONTYPE � �DATE � INP71AL5 ' �
1676 ,. fixed System Final Fire Prevention � � 206 Final Mechanical � �
1268 . Pool Spa �Final ,�.', � . � - „ 208 Final Plumbing �
200� �Flnal Re-Roo/ � "' � � � ' � ' 210 Final Electncal �
201 ., Final Block/Retaining Wall �. � r . 212 Final Fire Prevention - �
202 Final Factory Fire Place � � � 220 Flnal Planning Approval
203 Final Sign - � � 222 Final Site ����'-"^^(/' ' ��
204 '. Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION: Ovmer ID venfietl by drivi ,ise. ❑ Yes �❑ No
I hereby affrm under penalty of perjury one o( the f��,,..nng declarelions: '�� Dnver's License No. Expires:
❑ I have and will maintain a certifcate of consen[ to sel(-Insure for workers: ..Verification �of �Ownership by (rype of documen[, i.e. - propeRy tax bill or deetl):
compensa[ion, as provided for by section 3700 of ihe Labor Code, for Ihe �� ,
peAormance of lhe wnrk for which this permi� is issued. � •� �
❑ I have and will maimain workers' compensation insurance„as required.by
seclbn 3700 of the Labor Code, for the pedormance of the v.ork !or which this�
permit is issued. My vrorkers' compensation Insurance carrier and policy
numberare: � �� � �
Carrier:
(This seG.on nee0 rrol0e camyeletl AMepermd is reluetl af one �untlmtl cbllars (Ef00) wlessJ
Policy Number:
certify lha[ in the pertormance of the work for which lhis permit is
ssued, I shall not employ any person in any manner so as to become subject
lo ihe vrorkers' compensation laws of California, and agree ihat if I should
become subject to the vrorkers' compensation provisions of Section 3700 ot
the Labor Code, I�I erthwith comply with ihese provisionsq.
..s-� �— �! �
AOPn�?^fs S9nawre ' � Date �
v-
WARNING: FAILURE TO SECUR KERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) of Division 3 of the 8usiness and Protessions Code, and
my license is in full force and eftect.
L'ic'#�' fs class�#� � �3
7--/�-v�
Conl2clor'S - aWre'r! Dale�`
�....---
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
peAortnance o( Ihe vmrk fa which this pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Oale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm lhat under penalry of perjury [hal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or county which requires a permit to
constmct, alter, impmve, demolish, or repair any strucWre, prior to its
issuance, also requires the applicant for such permit to fle a siqned statement
tha� he or she is licensetl pursuant to the pmvisions of the Conhactors
License Law �Chapter 9(commencing with 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 7031.5 by any
applicant for a permit subjects the applicam to a civil penalry of not more than
fve hundred dollars ($500�.):
❑ I, as owner of the property, or my employees with vrages as Iheir sole
compensation, WILL DO THE WORK, and Ihe slrucWre is not in[ended or
oHered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such work himself or herself or [hrough his or her ovm
employees, provided thaCsuch improvements are nbt intended or offered for�
sale. If, however, the building or improvement is sold within one year of
completion, [he owner-builder will have the burtlen.of�proving thal he or she, �
did not build or impiove for purpose ot sale.). �
❑.I, as,owner,of,the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to wnslruct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces nof apply to �an ovmer of
property who builtls or improves thereon, and who con[racis (or�such project with .
a contracta(s) license pursuant to the Contractors License Lavrs.).
❑ I am exempt�untler sec. �
Business and Professions Code for this reason:
^ � - Signawre . � � � Date '
�305]-a6�3/O]) . ,
' DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATIONi � �
❑ I hereby certAy tha[ no excavation fine (5) or more feet in dep[h��into wfiich a
person is required to descentl, will be made in connection with vrork authorized
by this pertnit, antl that no building strucWre, scaffdding, falsev.nrk, a demolition
or tlismantling Ihereof, will be more than thirty-su (36) feet high. (Chap. 3.2, Gry
2, Art 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builtler, I will nol employ anyone to do work which would
require a permit from the Division of Industnal Safe[y, as noted above, unless
such person has a permit to do such work from lhe division.
Appliwnt's SignaWre Dale
Division of Intlusirial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or future building occupant need to �le antl
certify a Business Plan for emergency response to release or threalened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, thal a Business Plan be filed with the Costa Mesa Fire
Department by every business which has a[ any one lime tlunng a reportetl
year a quantity 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 temperature ana pressure).
2. Does or will the applicant or present or (uture building occupant need to file
a registration fortn for awlely hazardous materials? � Yes ❑ No
(Section 25533 of [he Cali(ornia Health and Safety Code, with some
exceptions, requires registration with lhe Costa Mesa Fire Department by
each business which at any one time has on hand a quanlity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaNre and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutety
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of Ihe Califomia Health and Safery Code provides that [he
Costa Mesa Fire Department may require the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
lo register acutely hazardous materials with the Fire Department.
4. If an RMPP is presenlly required, has Sec[ion 25534 of the Califomia
Health antl Sa(ety Cotle been /ully complied with? ❑ Yes ❑ No
5. Does or will the appliwnt or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modifCation from [he SoWh CoaS[ Air Quality Management District or from
any other air polNtion control tlistrict or agency? ❑ Yes ❑ No
(Sectbn 658502 0( the Califomia Govemmen[ Code requires [hat the requested
infortnalion be fumishetl on applications fv non-residential builtling pertnits).
6. Will any part of the facility to be consVucted under this permit be within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf yes", the lacility must meet the requirement of Sections 25534 antl 42303
of the Califomia Health and Safety Code).
7. I( a permi[ from the South Coast Air Quality Managemen[ Dis[nct or other .
air pollulion control district or agency is required for [he vrork which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No,
'8. Qf 'yes", attach certificate of compliance from the appropriate air polWtion
control officer). •, �. - . - . �
CERTIFICATE�OF COMP.LIANCE;I.certify�ihat untler penalty�of perjury the
information given above is correct. I agree to comply wifh all s[ate laws and
city ordinances regarding'Hazardous Materials and Emissions: -• '
. Signalure . Dale �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of �perjury that I have read ihis application and state that
the information given is correcl I agree to comply with all state laws and city
.ordinances relating to building construction, and authorize representatives of
the Ciry of Costa Mesa to enter upon lhe above-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until fnal inspection.
Signat ega Ov+neqs) Da�ery y� �
�..<� � �/'—L/�
(Mtl/ocAUNonze0�A0P1' , . Date—+�
ti
'1 �
'-� CITY OF COSTA MESA ` � � " ," . '
�.. _ .
� .
BIIILDING DIVISION - . ,
F � 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� � � ' ' •
��o� . - . . . . . � � . , . _ ,. � ... „ . . .
. - � PERMIT NUMBER: P07-00430
PERMIT TYPE FLUM STATUS: ISSUED.
, � ;�#DATE ISSUED: . 06I2612007 , , ,
. . �'r r.r- ' „�'�-"" � ISSUED BY: SOK .
. .. . ; � ' � ;a' '- � � ! t�' � a _:, � r. . . . , .
t"r �! t`-..+v "` a„ri�, ' � �.+ t` : Y+ '',�R„� �. .. . � '
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JOB ADDRESS: 952 DAHLIA AV CM� � � rv-�; §�y„ Suite`%Unit ���;�x=�
�.
Vicin�ty: .. ' , j,tre�,'" � .','n..�d;.:s-'��:� �b�'i E''k ' 15 . . . .
,Y M . i
� � t°.P �''` �:`�..s�`3��� s v^..��+,::.� �'
SCOPE OF WORK: INSTALL'NEW A/C •RELOCATE FAU TO ATTIC AND.INSTALL TANKCESS WATER HEATER. PLUMBING
a m� r N Y
IN6LUDES 1 WATER HEATER ,�'6� ,� � - r �:,, . . � . •
y F v
� _1`'�� t��k`� - ty . � �.�y� �V,� " ' . ..
. -_, .,� v�; ��f r ys'- d ++" � � , ., % ��r �
_7f � ♦ i <!'� �. i.-r. fi �'' n��- i 3 *.. {e jt r i � . ' . : .
OWNER: MINARDI,ANGELOJ+- v�� q „} ,. + � 4�w���-:_�.'"'Address � ,.�I952DAHLIA�:AVES � � ,,
PHONE: 949300-3082F �{:`. � �x ` .�i. ��'-` CitylStatelZip _'��COSTA MESA CA�, tti-ut> '! � . .
APPLICANT: IBANEZ, ADOLFO �"' ,� � Add�ess 3101 ENTER?ISE STREET '.d . . . • .
PHONE: 800 503 2666 t� � a-'tl t Gty/State/zZip BREA� CA ��; �� � � 3�
r +. d.
CONTRACTOR ECONh
�. r.,. '�� x - r � .-f � i? aa �S �! � ��� � �
. 0 AIR `4,4. W ' ' ' - � 3 License No '445220 ' ' � ' �_ -
Address: � 3101 ENTERPISE STREET" -� � � � ' i '; � i.� � "'y�' �';' - � �
PHONE: 800-503 2666 {�w� K��h � �' i � h �'` -• r "` _ � '� ' � -
City/State� BREA CA k ��, �y4 F',ZipCode 92821 a- ,.,,,�,:,�, m^�` CE�L r , � �� '" �
, . . .. F ;t f� � � kr� . .
, � "' ��r � } 5� ' _ - ' + { �"�y, � ir :� f ri r ,j I�S'J' . . . -
, . . . . �X i '�, ��ti > � y�.. . �'� ��. � k ,( i� � � ;`�I:yt. � . .
PLUMBING PERMIT FEE SUMMARY' i� ,i ����r"' �,, ��y'; TM r��K
,
' . _ . ��s �� � .:+.���f��pz;`- � !�?--�' � �„�,� �C "� �� ,�, ,�,'� r . _
PLAN CHECK FEE:� � -,� $OOOti �,: F � '•�,,; ++'x„�'�1�t � '� «„i ra �� .�i�'" �
xu, r�� ,,, a ti �; y
PERMIT FEE: $35.80 u1.� � " _ ' a�, ��y�, y« y„ � *, ,'.,
.. . � . � . . `"+ `� k k r � `� J�l+M a'a i .�• ¢v . i 4 F' ..n F{Af' . , .
P1`,�e�.
TOTAL EEES: .. $35.80 � " �,. � �r. b r'�' �� p ,l �� � }+ �� � +-'°r ��"� • :
� Kr ..:+*�. .
.. - ' � ' . . " .a'u °"'" ev n�++ � �q_ . . . . .,.
... i,,,.�,�`S�ey s�.,�zf. . . '. ' . . .
NOTICE: The work authorized by this permit�shall comply with all applicable handicap accesS requirements under Califomia sWtutes and related
regulations. (Ord. No. 92-28, § 1, 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 wmply with all applicable codes, and all
required inspections and final approval musl be obtained. Failure to obtain inspections and final approval will result in the ezpirelion of this permit. �
OG �Et. INSPEC710NTYPE ' D,i7E� � IN7I71AL5 CODEt INSPECTIONTYPE . - Q�TE � - IN7IlIALS
7616 . Fbcetl System Final Fire Prevention . � . 206 � � Final Mechanical � � ' ' �•�� /� �,�,
1266 Pool Spa Final ,, � 208 Final Plum�ing I O'I,-CYI I��v [LC�i
• 200 'Final Re-Roo( � ' ' � ' ` ' 210 Final Electrical /
207 Final Block/Retaining W all 212 Final Fire Prevention ' ' '"' �'
202 Final Factory Fire Place � ' � ' `� �" 220 Final Planning Approval -
203 Final Sign �-. � 222 Final Site
204 Final Demolition ., . 250 Final Building�0aupency
WORKERS' COMPENSATION DECLARATION: T �
I hereby aKrtn under penalty of perjury one o( the fo... ..ig Oeclaratiohs: •'`
❑ I have and will mainlain a certifcate of consent to self�lnsure for workers' �
compensation, as provided tor 6y sec[ion 3700 of the Labor Code, tor Ihe
perfor nce of �he work tor which.lhis permit is issued. �.. , � ,.
I have and will maintain workers' canpensation insurance, as required by
sectqn 3700 of the Labor Code, for the perfortnance of the�wvrk for which this
pertnit is issued. My vrorkers' compensation Insurance carner and policy
Ca neer are: �Y`� (.'o � )'%' � W�Y��
L�
(This secfon need 'rro`f De mmp�let7ed Alhe rm`R is valuetl al one Phu7ntl'ie�tlColl rs (8f 00) or less.)
Policy Number. �/ S`J 2 c���, Y� �
❑ I certify Ihat in the peAormance of the v,wrk for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Califomia, antl agree thal if I should
become subject to ihe workers' compensalion provisions o( Section 3700 of
the Labor Co e, I shall forthwit mply with these provisions.
G � Z� -�%
Appi nfsSignaWre Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm lhat I am licensed under provisions ot Chaptar 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
my license is in f�ul>l t/o�rce and eHect.
Lia # � �7 l Z �� Class # ��� U —� �r
�u �-o'
Comr �or's Si nawre Date
Owner ID,venfed by dnve, .e. ❑ Yes ❑ No ��`ti.
� � �Driver's License No. Expires:
�' Verificatioo of Ownership by ([ype of tlocument, i.e. - propeRy tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:- �� � '
❑ I hereby certrfy �hal no excavation frve (5) or more (eet in deplh into which a
person is requi2d to descend, vrill be made in connection with work authorized
by this pertnit, and that no building swcture, scaffdding, falsewnrk, or tlemolition
or dismantling thereof, will be more than thirty-six (36) feel high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administ2tive Cotle).
❑ As owner-builder, I will not employ anyone to tlo vrork which vrould
require a permit from the Division of Industrial Sa(e[y, as noted above, unless
such person has a permit lo do such work (rom lhe tlivisi0n.
Applicanl's SignaWre Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future building occupant need to file and
cenify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Coda requires, vrith some
excep[ions, that a Business Plan be fled vrith the Cosla Mesa Fire
Department by every business which has at any one time tlunng a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas
at stantlartl temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
/a��registration form tor acutety hazardous materials? ❑ Yes ❑ No
t9ection 25533 of �he California Health and Safe[y Code, wilh some
excep[ions, requires registration vri[h Ihe Cos[a Mesa Fire Departmen� by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or grealer than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at slantlartl
CONSTRUC710N LENDING AGENCY: temperature antl pressure).
❑ I herehy affirtn that there is a consiructbn lending agency for tha
per(ormance of lhe v.ork fa which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lentler's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5.
Business and Professions Cotle: Any city or counry which requires a permit to
conswcl, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permil to fle a signed statement
tha� he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or lhal he or She is exempl therefrOm antl
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
fve hundred dollars ($500�.):
❑ I, as ovmer o( the property, or my employees with wages as Iheir sole
compensa[ion, WILL DO THE WORK, and the strucWre is nol intended or
oRered for sale (Sec. 7044, Business and Pro(essions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or Ihrough his or her ovm
employees, provided tfiat such improvements are not�intended�or offered for �
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden�of.proving that he or she -
did not build or improve for purpose of sale.). � � ' �
.. . .. . _� -v,, .
❑; I, as�ovmer.of the pmperty,�am EXCLUSIVELY�CONTRAC7ING�WITH,..
LICENSED CONTRACTORS to construct the projecf (Sec. 7044, Business and
Professans Code: The�conlrac[ors License Law does nol apply to an owner of
propeAy who builds or improves thereon, and who contracts for such project with
-a contractor(s) license pursuant to the Contractors License Laws.j. �
❑ I am exempt undei sec. �
Business and Professions Code for this reason:
��y���a�u�e .. .. .
9os�-as (aro�1
3. Does or will the applicant or present or future building occupaM need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Cali(omia Health and Sa(ely Code prOvides [ha[ lhe
Costa Mesa Fire Department may require the preparalion, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with the Fire Department.
4. If an RMPP is presendy require0, has Section 25534 of ihe Califomia
Health and Safery Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is lhe su6ject of this appliwtion a permit (o� suCh CO�Slnlcti0n
or modifcation (rom the South Coast Air Quality Management District or from
any other air polWtion control diSMC[ Or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requestetl
in(ormation be fumished on applications for non-resitlential builtling pertni�s).
6. Will any part of ihe faciliry to be consiructetl under this permit be vrithin
1000 fee[ from the ouler boundaries of a school? _❑ Yes ❑ No
pf'yes", the facility must meet ihe requirement of Sections 25534 and 42303
o! the California Health and Satety Code).
7. If a permit from the South Coast Air Quality Management Disinct or other
air pollution contml district or agency is requiretl for the wnrk which is the
subject of this application, have all of the discbsures prescnbed by California
Health and Satery Cotle Section 42303 been matle? ❑ Ves ❑ No.
8: Qf 'yes", attach certificate of compliance�from Ihe appropnate air polWtion
controloffcer). _ �, . . . . , �. ..
�CERTIFICATE OF COMPLIANCE: I�certify;that under,penalty of-perjury.the
information given above �is coriecL I zgree �to comply with all state laws and
ciry ordinances regartling-Hazarilous Materials antl Emissions � � ��
o�y��d���r . . . . , . ,
CERTIFICATE OF COMPLIANCE AND.AUTHORIZATION'OF ENTRY: I
certi(y under penalty of perjury that I have read ihis application and state that
the information given is correcL I agree to comply with all state laws and ciry
ortlinances relating to building consWction, and authonze,represeniatives of
the Cityof-Costa Mesa to enter upon the above-descnbetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit un[il fnal inspection.
SgnaWreofLegal ier � Dale
�L%- v�
Anabr WhorizetlAOo����� Da�e
� l ,. . , �
�� - �1 � ,
� � CITY OF COSTA MESA
� . �., BlIILDING DIYISION ,
F � 77 FAIR DRNE, COSTA�MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�wv.ci.costa-mesa.ca.us
�, � � FOR INSPECTIONS CALL: (714) 754-5626 �
��,� �
PERMIT NUMBER: BX08-00083
PERMIT TYPE B MISC STATUS: ISSUED
APN: 41218250 DATE ISSUED: 03/27/2008
Zoning: R1, , ISSUED BY: RMD
JOB ADDRESS: 952 DAHLIA AV CM
Vicinity:. ROOFTOP _r,{;
SQ. FL 0 . �,r- r.�...
SCOPE OF WORK: n,;�P�,�� '±',;''1
INSTALLATION OF A ROOFTOP� PASSIVE'SO
Kf r. :�
(J` 4 ' 'y y.
OWNER: MINARDI,ANGEL�O Jfi-± �'f ��
City/State: COSTA MESA�`CA., �'''
� M �
Phone: 949 300 3082 f� �} .s
+''t� r���`'� .;�-�
APPLICANT: BRADY'BRENTf f"`c� � i- y
City/State: MURRIETA CA �,�'t�� - r
x. c�
Phone: 951-677=5502 }�fx � �4 ,.;_:
CONTRACTOR:
Address:
City/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER:
Phane
�W�� �� F � �i . .
�J';��4 �
�h 4 .'-' �v� "i
'�„r � �.�s,� 1.::::.FE
Address:: 952 DAHLIA AVE�4�;
����/ Zip Code��'*92E
{ 4 ; A� ����.
,�-� Address 40046 OAK GROVI
"- ra...w-_--.�',r�t,}� Zip Cod'e' �;;�92
�_�:.�r:�r� i�.
_::�,`,yt�.,t,�'�,�....,?��A
r,_, ,
«�."r. ct;., $� ';. ; �
-,.�',License
,�
,
f� � d �-, .�' -� 9'+ ? t�; � �
. .s���µPhone,� 951s677 550
'3.,^' � �;,,�-C�`,tA� .:_.�t
"'� � " e' � L`irPnsP No . -
Building PIan�Che�c� �'' �� ��+���
Building Permd � � � zt �, ��
r"s ''k� -� �'-,...w
Electrical Permita,� u�,. �.�;t '"" ..��:a
SMIP ResidenUalk,.?.$ i. ,_ �('sr-..
SMIP Commercial ``��-�., �` ,� �� z�
$O.00TOTAL FEES `;--.�`,�.r,_ -�
Const Type :??
PL PIPING. REF#: BC07-00111 '1
, ����-��03ja
Unit:
Unit:
i
� L ir �qr
.°��v �'^�r � .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 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�fnal approval will result in the expiration of this permit. .
COOEf. INSPEG710NflPE DpTE IN7171RL5 COOE/ INSPECl10NTVPE DATE INTI11RL5
1616 Fixed SyStem�Final Fire Prevention . 206 Final Mechaniwl
1266 Pool Spa Final : 208 Final Plumbing
200 Final Re-Roof � 2W Flnal Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention �
202 Final Factory Fire Place ' 220 Final Planning Approval
203 Final Sign 222 Final Site E7
204 Final Demolition -- 250 Final Builtling/Occupancy ��— 9� �(1�l���
;
WORKERS' COMPENSATION DECLARATIpN: �
I hereby aKrtn under penalty ot perjury one of the tollowing tleclarations:
❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers'
compensation, as provided for by section 9700 of the Labor Code, for the
performance of the work for which lhis permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
sectqn 3700 of the Labor Code, tor the peAormance ot the work for which this
permit is issued. My workers' compensacion Insurance carrier and policy
number are: �
Carner: �
C'^(Td' ecfMneetlrrolD compe�eeAmepermrtavalvedatonenuntlre0d,�lers(Eioo)wiessJ
'Poli Number.
` I certify that in ihe performance of the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Cali(pmia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 ot
[he Labor Cotle, I shall forthwith comp/ly� with these provisions.
�i..�.� �`-7 .__i/ �� -i _ 3 7 - G.�'
Apphranfs'SB�aWre -. l Oate
/ _ - �"�.� -�._
WARNING: FAILURE TO SECURE=WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LqBOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm thal I am licensed under provisions of Chapter 9(commencinq
with Section 7000) of Division 3 of the Business and Professions Cotle, and
my license is in full force and effect.
Lia# 7'S7 i3f9G n Class#.i.G:-,S,3
� _� �/ i �.�.,� / ' - Z 7 - O�
�Comraclor's5lgnaWr�/ - Dale_ �__
{`�c�""._' _ - ..
CONSTRUCTION LENOING AGENCY:
❑ I hereby affirtn that there is a constmctbn lending agency for the
perfortnance of the v.ork fa v.fiich this pertnit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OW NER-BUILDER DECLARATIONS:
I hereby affrm tha[ under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
eusiness and Professions Cotle: Any city or County which requires a permit to
construct, alter, improve, demolish, or repair any SIrUCtUre, prior �o its
i55Uance, also requires lhe applicant (or such permit to fle a signed statemen[
thal he or she is licensed pursuant lo th� provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of �he
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any vi0lation of Section 7031.5 by any
applicant for a permit subjects the applicanl to a civil penalty of not more [han
five hundred dollars ($500).):
❑ I, as ovmer of [he property, or my employees wi[h wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentled or
oHered for sale (Sec. 7044, Business and Professions Coda: The Contrectors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, providetl that such impro4emenfs are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose ot sale.).
❑ I, as ovmer of ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and
Professions Code: The coniractors License Lgw dces not apply lo an owner o(
property who builds or improves thereon, and who coN2cts for such project with
a conlractm(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre . ' . Date
305]�A6 (3I0])
� �_
Owner ID venfietl by tlrive `� ❑ Ves ❑ No
Dnver's License No. � Expires:
Venfcation o( Ownership by (type of document, i.e. - property tax bill or deetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy that no excavation frve (5) or more feet in deplh in[o wfiich a
person is required to tlescend, will be made in connection with work authonzetl
by this pertnit, and that no buildinq structu2, scaffdding, falsewnrk, a demoiition
or dismantling thereof, vrill be more than lhirty-six (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Califomia AdminiStraMe Code).
❑ As owner-builder, I will not employ anyone to do vrork which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from Ihe tlivision.
Applicanfs Signature Dale
Division o( Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture building occupant need to file and
certify a Business Plan !or emergency response to release or Ihreatened
release of a hazardous material? ❑ Yes ❑ No -
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, [hat a Business Plan be filed wilh the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous matedals equal to or greater than a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at slantlard temperature and pressure).
2. Does or will �he applicant or presenl or future builtling occupant need to file
a regisVation (orm tor acu[ety hazardous ma[erials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Cotle, with some
ezceptions, requires registralion wilh the Cos[a Mesa Fire Departmen[ by
each business which at any one time has on hand a quantiry of acutely
hazardous ma[erials equal [o or greater [han a weigh[ of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at stantlard
temperaWre and pressure).
3. Does oi will the applicant or present or tuture building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cotle provides that the
Cosla Mesa Fire Department may require the preparation, certification and
fling wi[h Ihe Fire Department o! an RMPP by businesses which are requiretl
[o register awtely hazardous ma[enals with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of [he Cali(omia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupanl require fo�
Ihe work whiCh is lhe Subject o( this appliCation a pertnit for such construction
or modification fmm me Soum Coast Air Quality Management District or from
any other air polWtion control district or agency? � Yes ❑ No
(Seclan 658502 of the Cal'rfomia Govemment Code requires ihat �he reques�ed
informa�ion be fUmi5he0 On appliGali0n5 (d non-residen[ial building pertnils).
6. will any part of the faciliry to be constructed under this permit be within
7000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf 'yes", [he facility must meet Ihe requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the Soulh Coast Air Quality Management Dislrict or other
air polWtion control dislrict or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health antl Safety Cotle SeCtiOn 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate o( compliance (rom the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ortnation given above is correcL I agree ro wmply with all stale laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read Ihis application antl state that
the information given is correct. I agree to comply wilh all state laws and ciry
ortlinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
'� B Wreof la Owner6l Da�e-
t/ t
n� u./�7._ 5" 2 7�.>�
Pn41IXAUt�Onx2tl"AOGIi�'anl_ `__� ,�. _ - Dale
—� �
CITY,nF COSTA MESA - - .
� T F ` B!%ILD/NG DIVISION
F .. � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 7545273 � Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
°•q.� FOR INSPECTIONS CALL: (7'14) 7 �
'"'rno�mau`� . ' � .
� - IT NUMBER. BC07-00115
F."°
�
PERMIT TYPE: B_COMBO
Sub Type: RES_RRIP
Joe aooRess: 952 DAHLIA AV
APN: 41218250 _. s.,ti=
i=t�'
Vicinity: MASTER BATHROOM,�;�"�_
s9;� +:i
Const Type: V-N �,�.- �: ,,m
S•f
SCOPE OF WORK: 132SF��`REMODEL
r;��� €:"'*.� .�
OWNER: MINARDI,ANGELO J �"� f.�
Phone: 9493003082�#� 1 ,�+�f„-'
�y{ ��9
APPLICANT: SHEPHERD,:.STEVE ff;�•°
Phone: 949-764-9495 . .+�:.
CONTRACTOR: UWNtK=ki
Phone: x�� '
Cell:
ARCHITECT:
ENGINEER:
Building Fees: �";;�,��. u.�; .
Electrical Fees: -'z .�--. -
MechanicalFees: �� �r`
Plumbing Fees: �;at��
SMIP Residential: ��
SMIP CommerciaC �
TOTAL FEES:
"Refer to fee receipts for all (ees paid for prqec[
+ ���� �
:�. � '`< .
%r� ..:s."�+'}fi'.i'..va..•".rSi.°'`:�;�-:
-�FT:':"' �132
MASTER BATHR�
Address
`y Gty/Siate/Zip
.T !—r�..5�.
STATUS: ISSUED
DATE ISSUED: 09/06/2007
�'�ISSUED BY: SOK
Vl IN AN EXISTING SF
DAHLIAAVEy -
oTA MESA, CA `�
r }
n'T i ',� 4r° c.
«. _ �
: � ? �rW
,�.r
�t d,Address ` Unitn::��n�'�
'"' � "City/State ' �" "'"'" � ��
� ,�
,��ss. m'k ;,
�j.„� 5�1 .Y �t`' -_
,. . g.� i i.��:
�
$15,000.00
IMBING WORK.
,.
� z Unit:
a;
, f;��� Unit: :
/ '�.i4
�': i:�!
�ry�
� .,
�ipCotle
dE.'774-968-1640
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ,
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � '
INSPECTIONS: In order for the work aufhorized 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 this permit.
COOEk. INSPEC➢ONTYPE UAIE ' INTITIALS OUEtl INSPEGTIONTVPE ) DR INTIiIpLS
1616 Fixed System Final Fire Prevention 206 Finai Mechanical (�� 'S% -
1266 Pool Spa Final 208 Final Plumbing �II ly �) �
200 Final Re-Roof - 210 Final Eiecincal ir,y-t17
201 Final Block/Retaining Wall � 212 Final Fire Prevention �
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign � p22 Final Site.
204 Final Demolition � p50 Final Building/Occupancy � "I )!�'i-�% �_
�'�'ORKERS' COMPENSATION DECLARATION. ." +. � ". Ow�ner'ID verifietl by driv�nse. ❑ Yes ❑ No
I hereby affirm un0er penalry of perjury one of the following declarations; ;: .+�Dnver s Licerise No. , Expi/"�resQ.�� 'S O � q
❑ I have and wil� maintain a certifca�e of consent to self-Irisure tor workers' ��"'��--�' -�- � '�
Verification of Ownership by (type of documen[, i.e. - properly tax bill or tleetl�:
cOmpensation, as provitled for by sec[ion 3700 of �the Labor Cotle. for Ihe .„... . , . .
p@Aormance of Ihe work for which ihis permil is issued. - � � �
.��.
❑ I have antl will maintain v.orkers' compensation insurance,�as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � '�
s�ction 3700 of Ihe Labor Code, for ihe pertormance o(, the work for which this `� ` •
p�rtni[ is issued. My � workers' compensation Insurance �carrier and policy,,- ,� � hereby cetlrfy that no excavation frve (5) or more feet in dep[h inro which a
number are: �� : person is iequired to tlescend, will be made in connection with work authonzed
<' ,! by.ihis permil, and that no buildiig structure, sca/tolding, (alsevrork, a-demolition
Cgrrier: ' or dismantling Ihereof, will be more �han Ihitly-six (36) feet high. (Chap. 3.2, Gry
(ihrssMbnneetlnot0emmp�ete0dmepeimrtisvaWe�aronehuntlretltlW�ars(St00)orlessJ z Art2 gyc.341,.TtleB,CalifomiaAtlminislrativeCotle).
Policy Number:
P'� I;certi(y that in the peAorcnance o( the work for which this permil is
`� is'sued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
b�come subject b lhe workers' compensation provisions oF Section 3700 of
[he Labor Cotle, I shall forthwith comgly vnth lhese proCvisio_ns.
G(�ryr� p _ �m`-�1�( � 3cal� � '� �'7
�—AD�lica 1'sSignaWre -- —�Dale =
�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND
A7TORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
wilh Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eKecl �
Lic. # Class #
Contraclor's Siqnalure Oa�e '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn lhal there is a consWcfron lending agency for [he
pedormance of lhe �+ork for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
' SignaWre Date
OW NER-BUILDER DECLARATIONS: �
I hereby aR�rm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 703L5,
eusiness and Professions Code: Any city or county which requires a permit to
construc[, alter, improve, demolish, or repair any sirucNre, prior �o its
igsuance, also requires �he applicant for such permit to file a signed statement
that ne or she is licensed pursuant to the provisions of the Contracrors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or that he or she is exempt Nerefmm antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicaN for a permit subjects the applicant [o a civil penalty of not more than
fve hundred dollars ($500).):
� I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcture is nol intended or
oHered 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; antl who does such vrork himself or tierself or through his or her ovm
employees, provided that such improvements are not intendetl or oKered for
sale. If, however, the building or improvement is sold within one,yearpf
completion, the owner-builder will have the burden�ot proving•that he or_she
qi not build�or improve for purpose of sale.). � - ., :.�.
/ I, as owner o( the pmperty, am EXCLUSIVELY CONTRACTINGWITH
`'I ENSED CONTRACTORS to construct Ihe project�(SeC. 7044, Business and
Pro�essions Code: 7he contractas License Law does not apply !0 an owner 0f
property who builds or improves thereon, and who contracts for such project with
a cont2ctor(s) license pursuant tothe Contractors License Laws.�. �
C] I am exempt untler sec. �
�3usiness antl Professions Code for this reason:
�r�����r-� " � % 2ao
Si9�aWre- - —'"' ' '— Dale
305]-46(3I0�)—� -�--� :..��
❑ As ovmer-builtler, 1 will not employ anyone to do work which woultl
require a pe�mit !rom [he Division of industrial Sa(ety, as noted above, uniess
such person has a permit to do such work from the division.
Applicants Signawre
Division of InduStrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 ot the Califomia Heal[h antl Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business whiCh has at any one time during a reported
year a quantity of hazardous matenals equal to or greater than a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas
at standard temperaWre and pressure).
2. Does or wil! the applicant or present or fWure buildmg occupant need to fite
a regis�ration form for acu[ely hazartlous materials? ❑ Ves ❑ No
(Section 25533 of the California Heallh and Safety Cotle, wi[h some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantily of acutely
hazardous materials equal to or greater lhan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standard
temperaWre and pressure).
3. Does or vnll the applicant or presen[ or future building occupant nee0 lo
prepare an RMPP (Risk Management and Prevention Progrem for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of ihe California Health and Safery Code provides ihat ihe
Costa Mesa Fire Department may require the prepara[ion, certifcation and
filing with the Fire Depanment of an RMPP by businesses which are required
to register acutely hazartlous materials vrith the Fire Departmen[.
4. If an RMPP is presently required, has Section 25534 of Ihe California
Heallh and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will [he applicanl or Oresent or future builtling occupant require for
the vrork which is the subject of this application a permit for such construaion
or modifica[ion from the South Coast Air �uality Management DisMc� or fmm
any other air polWlion con[rol tlisirict or agency? ❑ Yes � No
(Sec�bn 658502 of the Calitomia Govemment Code requires Ihat the requestetl
infortnatbn be fumished on applications for nornresidential building pertnits).
6. Will any part of the facility ro be constructetl under this permit be within
1000 (eet from lhe outer boundaries of a school? ❑ Yes ❑ No
{If "yes", lhe facility must meel the requirement of Sections 25534 antl 42303
of the California Health and Safety Code).
7. If a pertnit from the South Coast Air �uality Management Distric[ or other
air polWtion coMml dislric[ or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", 2ttach certifcate of compliance from the appropriate air,pollution
control oKcer). ' � '
CERTIFICATE OF�COMPLIANCE: I certify�that under'penalry of perjury Ihe
information given above is•cortecL I agree to comply with all.state lavrs and
city ordinances regarding Hazardous Materials and Emissions. � �. ,,
Signature Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalry of perjury tha[ I have reatl this applicalion and state lhat
the information given is correcL I agree to comply with all state laws antl ciry
ortlinances relating to builtling consWction, and au�horize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
auth� e�d �by l�his ppermil til final inspection. �
�"�„'7'�. f � �""+"[��` �`��.. % %.��t�
� � SignatureolLegalOwner(s� - Oa��
Antllor Aul�onied Ap01if2n1 Date
.,
� � � � CITY�OF COSTA MESA ., , � � , � ' �. „ . � � � , " .
". BUILD/NG DIVISION . - ,
F � � 77 FAIR DRIVE, COSTA MESA,.CA 92626 •(714) 754-5273 • Fax (714) 754-4856 �•� wNnv.ci.costa-mesa.w.us � �•.\.
� �. � . . . FOR INSPECTIONS CALL: j714) 754-5826 � � _ ' _ �' �/ s
4a.ro..�.��`� � � . , -. . � . . � . . �
' , , . PERMIT� NUMBER!' E07-00629
. . . , .. . _ .
_ , , ,
PERMIT TYPE ELEC, ' � - STATUS: , ISSUED '
. y�DATE ISSUED: 0612612007.
, E r � r� ,n< ` � : .� a ISSUEDaBY SOK ,
ps" T '� r r.n � " „ � , �� �'.`�r � .
JOBADDRESS: 952DAHLIAAV°CM� , �, �`" ` �r�fiSuite/Unit` ��zs ,
5.� _ ..� � - > -� =,��e
VlClnity: ; � � ry r.-' t-�..'.'fx v? , .,'.��'�, r � s 7 ,,e . ' . . _ .
.. . . . �`.i�y `... _ e sp;a..' .t r� ,4 p �' - -
. -�. ��; . � .
r �
SCOPE OF WORK: INSTALL NEW A/C RELOCATE'FAU TO ATTIC AND INSTALL TANKLESS-WATERMEATER. ELECTRICAL INCLUDES: �
' A/C UNIT, 1 LIGHT FIXTURE 1 SWITCHvAND 2 OUTL'ETS.., � � '�y �,� -M} '✓ j j �� '
ty+i-:` � h ^ir:" ] ":q . . .
. } f{ . yry< ' _ � : .�it . . . .
.. - � . , ti"�i' ��� .L'd �� .. ' . #� . .. y',a��k ';�. ., . „ . , - . . .
!� . . . �+t� -�'iy Yi..�� .. 5:£ i �9 �i'.i . .
p� f �[ � w. . > +j� =?i;' '� 4
OWNER:� ' MINARDI,ANGELO J ��'�. -` -�� �w � ^' Adii�ess 952 DAHLIA AVE Umt �-�:� '- _ _
PHONE: � �949 300 308,2� �' �,� �.`n�` { .�4 � K'' „���..i,R „�„ City/State/Zip �,, COSTA MESA�CA ^� � ` �+ 3 - ' "
+y
lz5 � t :.1� f ', ,y , � ' . . F��Y., v *,. '-�. r _�f.� f� . . - .
APPCICANT: IBANEZ ADOLFO '� r +"'� Address: � 3107'ENTERBISESTREET Umt:
PHONE: S00 503 2668 5� �.; r'�y ��` „���f City/State/zZip BREA CA t,� +� �,�� }? � �
� . . � t ? ' � �..� �.. _ i � � . '
� CONTRACTOR. ECONO AIR '�` , �_ 6 � ° ; d{` a '; ' Lic�enseENo �'�h445220 .� � I '4f': � .
Address: � , . 3101 ENTERPISE STREETUmt �:m' "" ' ' r �-�� ' PHONE ;,800F503 2666 � � � � ��� � .
City/State: � BREA CA�.�`� °�,�y ;tZipCode 92821fk-n i fF CELL : ., �„ _
i- � �y, a. a.. s r „t L . �. .
Y � -c � ){r fi . .. r t� . � ':.:.:.�� J ; p � r '
, ' i :�� 4,te '� ���.� . � ! $i: .. r f r .: tt � ' •
' - "� r ix r � . ., f F>-� "_ -r�" s F � � : .
_ :. : . - - `iy4 ft, -k� "` r= - �-:s. � �r.. + �'h .
ELECTRICAL PERMIT FEES=� , ,i � � Y � �*F*; �r" 4 -�� '
�
Electrical Plan Check Fee � ' � � � � � �
.�� £ Xf d
� $0.�� N ^keat . i �.� . ..
Elecfrical Permit Fee: �9* .� � � $82 40 t � �Y -5'� fi � x �;� 'i � b y+� ii�f
R@I(1SjJ2CtI0f1 FB0 ' �� ^i . �i� ��0 �� �� .f i�' r� h ��' n ?a - � (. •: ¢� ,:' -
TOTAL FEES . , mra.µ a u, �m:.' '$82 40'� �' �;..i �;a� �x ..� .:.= � i � , �� �' :,'� .
. . . � . .. , 3y''„� 4��< .r.i.��f � "r"s� yt ie'�.si�m�-'',� ,a .•� � � .,r ,.: � . . . . .
. . ' . '! ^'� "� f�i' i � � ss � , . � . .. ..
p d 1� K� �'u r��s
. � y ! ; # � x � ,
.. , -a+..s"fi' i �� fl �' .P . . ,. .
_ . � . � ,i ., ' ��! t � �e �F' � . _ . . . ..
r�
. . .. . � �, . .. . , . . . � �.-i;�� � � * ce.l.�:%'>'' ' _ ' . � .
.. . , .. . .. . . .. , . .... , rr '� .. .. . . . .,
NOTICE: The�work"authorized by this permit shall comply with all applicable handicap �access requirements under Califomia sWtutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ' ' . -. . . - � . • � � , �
EXPIRATION: PERMIT EXPIRES 180 DAYS PROM 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 oblained. Failure to obtain inspectionsand final approval will result in the expiration of this permit.
co� iNsvecnoxrvve o� ixnn�� ' cooer INSPECTIONME ' . . '- q�TE . INTITIRLS
1616 � .Fized System Final Fire Prevenlion - ' � 206 ' Final Mechanical � � ' � �
1266 Pool Spa Final .� . � � � 208 Final Plumbing � n /
7-TTT�j
200 '' Final Re-Roof ' ' ' � 210 Final Electncal- � � a l� li�.Yf—
201 �� Final 81ock/Retaining Wall � - 212 Final Fire Prevention ���_
202 Final Facrory Fire Place � -� �� � 220 Final Planning AOP�oval ��- -
203 Final Sign� � , � 222 Final Site �
� .
204 � Final Demolition . . � ' � � • ,� � " 250 Final Building/Occupancy
�� .
' v.
WORKERS' COMPENSATION DECLARATION: �
I hereby af5rm under penalty of perjury one o( the fa.. ..., ig declarations: �� ��' �� �
❑ I have and will maintain a ceAi(cate o( consent to self-Insure (or,workers'.,
compen ion, as providetl for by section 3700 of Ihe Labor Code, for Ihe
perfor ance of the vrork for.which this,permit is issued. •� �' "���� .,�
'�,,,,,I.have and vrill maintain workers' compensation insurance, as required by,.
sectbn 3700 oLlhe Labor Code, (or the peAortnance of the wdrk for�which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
numberare: @p _/'p r
'.:Carrier . �� � � � "i' /l�`e c�1-�Q
(iNs secf�bn need.rol oe cnmplete0 nme perma s valued 'af in!e nundie0 ddlars (5100) a less )
�"P.oIY icy Nu'mbe�:_ �� /� � L� �% v ( (o � � S 7 r/l7
❑ I certify thal in the pertormance of [he work for which this permil is
issued, I shall not employ any person in any manner so as to become subject
lo the workers' compensation laws of California, and agree thal if I should
become subject to the workers' compensation provisions of Section 3700 of
lhe Labor Code, I shall forthwilh c�mply with these prQv ions. �
p. � �� j � �. D
� A � ofs S�ignawre' -� Da� H/1ZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE �� Will the applicant or present or !u[ure building occupant neetl to file antl
IS UNLAWFUL AND SHALL SU&lEC7 AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS �elease of a hazardous material7 ❑ Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSA710N, DAMAGES AS (Section 25505 of the Calitomia Health and Safety Code requires, with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be (led vrith the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during 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 compressed gas
at standard tempereture antl pressure).
2. Does or will the applicanl or present or future building occupant need to fle
�egistration torm for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Cali(omia Health and Satety Code, with some
7 ezceptions, requires regisUation wi[h the Costa Mesa Fire DepaAment by
each business which at any one time has on hantl a quantity of acu[ely
hazardous malerials equal to or greater than a weight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparetioq certification and
filing with the Fire Departmen[ of an RMPP by businesses which are required
[o register acutely hazardous materials vnM [he Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 0( the Califomia
Health and Safety Code been tully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is ihe subject o( this application a permit for such construction
or motlifiCalion (rom the South COast Air Qualiry Management Dishict or from
any o�her air polWtion conVol tlistrict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code require5 that the reques[2tl
infortiiation be (umished on applications for non-resitlential buildinq pertnits).
6. Will any part of the faciliy ro be constructed untler this pertnit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
pf "yes", the facility must meet the requirement of Sections 25534 antl 42303
of [he Califomia Health and Sa(ery Cotle).
7. If a permit from [he Sou[h Coast Air Quality Management Dis[rict or other
air polWtion control tlistricl or agency is required for the work which is Ihe
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Seclion 42303 been made? ❑ Yes ❑ No
. 8�_pt'yes", attach certifcate of compliance from the appmpriate air pollution
control officer). _, . , .. ,
„�CERTIFICATE�OF COMPLIANCE�I certi(y,thaLunder penalty of perjury�the
� information �given above is correct I' agree to comply�wifh all stale laws arid
��� city ordinances regarding Haza�dous Materials and Emissions: � ` -�
Ownryr.l0 yerified by drive� .e. ❑ Yes ❑ No
Driver's License No. Expires: �
i Verifcatiodof Ownership by (type of tlocument, i.e. - property tax bilPor tleetl): �
� t
�DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:- . ,
❑ I hereby certify Ihat no excavation irve (5) or more (eet in depth into which a
person is required to descend, will be made in conneclion with work authonzed
by ihis permit, and that no building slructure, scaffdding, falsework, or demolition
or dismantling thereof, will he more than thiey-siz (36) feet high. (Chap. 32, Gry
2, M 2, Sec. 341, Title 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which wovld
require a permit from the Division of IndusMal Safery, as noted above, unless
such person has a permit to do such work (rom the division.
Appl¢anfs SgnaWre �a�e
Division of Industrial Safety Permit Number:
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in fu(ll force and eRect.
--+ LiG.,# ��J t � rCla55 #_� G � � _ � �
��`—�- Y f'C• +� K�
1.^: � Co cto_s5ignaWreY__,� . ; Dale�/
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construc[ion lending aqency for the
pedortnance of [he work fa wfiich this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
i
Lender's Adtlress:
- SlgnaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o� perjury tha[ I am EXEMPT FROM THE
CONTRAC70RS IICENSE LAW for lhe following reason (Sec. 7031.5,
Business antl Protessions Code: Any city or county which requires a permil to
conStNCt, alter, impfoVe, dem01i5h, or repair any structure, pnor to its
issuance, also requires the applicant for such permit to fle a signetl statement
that he or she is licensed pursuant to ihe provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
eusiness antl Pmfessions Code) or ihat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
fve hundred dollars ($500).�:
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucNre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: 7he Contractors
License Law does no[ apply to an owner o( property who builds or improves
thereon, and who does such work himself or herself or ihrough his or her ovm
employees, provided that such improvementsare not intended or offered foi �
sale. If, however, the building or improvemenl is sold within one year of
completion, tlie owner-builder will have the burden of proving that he or.she:
did nol build or improve for purpose of sale.). �
. . . . ,, - . . , .. j ,�. ��. � � . , . �.'
❑ I, as.owner,of the_ property, am EXCLUSIVELY�CONTRACTING WITH �
UCENSED CON7RACTORS to constmct Ihe project (Sec. 7044, Business'and
Professbns Code: The cont2ctors License Law dces not apply to an owner of
propeny wno tiuiitls or improves thereon, and who contracts for such project with
a'cantractor(s)�'license pursuant ro the Cont2ctors License Laws.).
i �. . .
❑ I am exempt under sec.
Business and Professions Code for this reason:
� �
.... � .. . ... . .
' SignaWre � , _. _ , Date .
305]J6(310]� � �
. + • Sgnawre . Date- .
CERTIFICATE OF COMPLIANCE AND AUTHORRATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
Ihe infortnation given is correct. I agree to comply vrith all state laws and ciry
ordinances relating to 6uilding constmction, and authonze representatives of
the City of�Costa Mesa to enter upon the above-described�-property for
inspection purposes. I.agree not to occupy or allow occupancy of any building.
authorized by this permit until final inspection.
. SignaWreolLegalOwner(s) Da�te, / �
� '^�.�ri-- � ^ vV `_ �'
F:. Antl/ AUNorizetlAppliWnl � � ' Date -
tE-.�— — �-----�_-.
�•
� ' (.
tq r�-4`--
c��G.� Q,.�R •
APP���V�D
CITY OF CQSTA MESA
PLA\NING DIViSIOh`
SUBJCCI' "I'O BLllG. DGPT. REG.
NOT`E: ADDITIONS, DELETIONS,
OR COIthECTIONS SFiALL I�E
APPIZC3VED B`I 1'HF. YLANNING DIV.
BY: "'"� U:ITE:�"6Cd"�
�
�
�
N
' � CITY OF COSTA MESA . � ; , , � �" " � . : . � � �
� , . . evno►N� ��v�s►oN .. ., ., . . . � . .
F � � 77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856.• wviw.ci.wsta-mesa.w.us
�, ' FOR INSPECTIONS CALL: (714) 754-5626' - � ' '
�.e.uw`F �.:, � . . - . ' . . . , . .. . . . ._. , . . , .
' � PERMIT NUMBER M07-00392
PERMIT TYPE„ MECH � STATUS: ISSUED
� , -- DATE ISSUED: 06I2612007
_ _ . . <,sf�x��'4��. , y �*�s`"ISSUED BY: , SOK
JOB ADDRESS: 952 DAHLIA
Vicinity:
SQ. FT:. ' � p��.: rTy ;'..
. � . i �f y`, �,;.
SCOPE OF WORK: INSTALL;NEW A7(
INCCUDES: t FAU, 1 REPAIR%ALT`COO
� . . .. .. i ��.a:
_ ' � a:
� r
. � � � _
' i ]€� �� ��"4:
OWNER: MINARDI ANGELO J� ;�F.�;
PHONE: 949-3003082 ;; �? ;
APPLICANT: 18ANEZ, ADOLFO S��''".°�=
PHONE: 800 503 2666 �' �
��s` ;
�-, , yy
CONTRACTOR ECONO AIR �"?.; ;�
Address: �� � � 3101 ENTERPISE�.STRE
CitylStatei BREA,�CA 4 � ` "A '
<�.
�� � „;,
.. �. . . . �.,_ y���, P,z i�'}���.
�s x
i �� ',. �
MECHANICAL PERMIT�FEE :
�.r �iz... .
MECH, -I;TEM.FEE: .�� � ' �F �— �
PLAN CHECK FEE: �`�, '"
INVESTIGATION FEE: �_
REINSPECTION FEE: � � -_
TOTAL FEES: � � � $82.55. .
�
�`�'� . . . �'�9^.
TE FAU TO ATTIC AND INSTALL�
-ING, AND 1 COMPRESSOR7ABS
. . :r;. . . . �-
. , .4� . , T'.
�� , City/State/Zipr �'�CO:
� � . Address: 3107
City/State/zZip _ BRE
F} L�Y { s'�`F � 44 ;
a :. . ,. �..,.. ,� r L�cen:
. .i,t^'� . , o�. . . PF
_ E;
� H
i�i�x: .
WATER HEATER. MECH. .
�v ,
iYSTEM:'��,- ' � . .. ,.
;,a�w�t� �.�.,.�.� ' ._ .
y4 t � ' tr . .
�y rt , s�--p . . . . � . .
S
255 i��'�k r'�i� � kw e
00 '���.`r�K n ,r 5..'4� , ,�" �'�� �
e �dir- -€i 'r�" !,y� ,, �,s,� pi
�0 .t*, t+F; wr � 4R .x��' fi^'t��i:� 13 �s %'� F' ]'11
t s� e�
0� �e�,tlC . i � � qG°'� i � , ��IJ�
„.
* i
k '� 7 .� r' i J, �..c `�..� - 5 .r' r� ��x. � .
S
�
�^-o ' Y> _ . .
� : V'Ci k x vi.. u
L4�l�i F r �P �p(
'`� ' fP �x! § � l�i �5 �'�� __ —._�'1�,�1 i� ..
.,r..�,=.. , . .
NOTICE: 'The work�authonzed by lhis permit shall comply with all applicable handicap�access requirements.under Califomia.statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) ' � � � • • . . • � . . . � ,
EXPIRATION:"PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUEOR DATE OF LAST INSPECTION: �- � ` �
INSPECTIONS: In order for.the work authorized under this permif to be considered legal, such work musl comply with all applirable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspections arid fnal approval will result in the expiration of this permit.
COOEt. INSVEClIONTYPE ��F IN�$ .tOpEt INSPEC710NTYPE . . . . � Ij�/7E . INTI71R15
1616 Fixed System Final Fire Prevenlion - 208 ` Final Mechanical . ' - B� 1�
1266 PoolSpaFinal , . � � � ' ' � 208 FinalPlumbing U—� T-07 �
200 ' Final Re=Roof � � � " � 210 Final Eleclncal - '
201 �. Final BIocIJRetaininq Wall � , , 272 Final Fire Prevention � - ' � ' '
202 Final Factory Fire Place �'� ' '� - 220 Final Planning Approval
203 Finzl Sign ' '' ' " ' 222 Final Site
\ . . _ � . � � . .
�� �204 'Final Demolition _, .. 250 Final Building�0aupancy -
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the fo.. ._�g declarations: ��' '"
❑ I have and will maintain a certificate of consent to self-Msure.fokworkers �;
compensation, as provided for by section 3700 ot Ihe Labor Code, (or the
peAor ce of the work for which this permi[ is issued: �-' -: �� '�. * '
I have and will maintain woMers' compensation insurance, as,required �by,�
section 3700 of the Labor Code, for the peAortnance of [he�work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:r-- �p p�� �
Carrier. '� � � � rl' � � Y'
(Thisseeionneetlnotbem�fmde«d��hepe disvaluetlafone n� tlollars(E100/oiless.)
Policy Number. -� >Q Zj (= ��6
❑ I certify [hat in lhe pertormance of [he work for which ihis pertnit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laws of California, and agree that if I shoultl
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Co , I shall (orthwith ly with [hese provisions.
� 'LG-�%
AO N's5ignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVII FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eftect.
Lic. # � ��L � Class # � ^ ��J
G' i/ G�i '- %/ro '- O i
C raclor'sS"�gnaWre '� Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a cons[ruction lentling agency for lhe
peAortnance o( the �ork fa wfiich ihis pertnit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender5 Atldress:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm that untler penalty o� perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Code: Any city or counry which requires a permit to
construct, alter, improve, demolish, or repair any struc[ure, Drior to its
issuance, also requires ihe applicant for such permit to fle a signed statement
Ihat he or she is licensed pursuant to the provisions of the Contrecrors
License Law (Chapter 9(commencing with Section 7000) o( Oivision 3 of the
Business and Pro(essions Code) or that he or she is exempt lherefrom and
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects ihe applicant to a civil penalty of not more than
five hundred tlollars ($500).):
❑ I, as ovmer of ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the struclure is not intendetl or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not appty to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided tHat such �improJements sre'noPintended or oRered for
sale. If, however, lhe building or improvement is sold vnlhin one year o(
completion, the ovmer-builder will have the burden,ofproving that he,or shQ
did not huild or improve for purpose of sale.).
. , • , ., � .j „ , .
❑ I; as,ovmer of the Property, am EXQLUSNELY CONTRACTWG WITH
LICENSED CONTRAC70RS to consWct the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply�to an owner of
property who builds or improves Ihereon, and who contracis for such project with
a contrac[w(s) license pursuant to the Contractors License Laws.).
� ,
❑ 12m�exemptundersec.
Business antl Professions Code (or this reason:
305]-46(3/0])
Owner,ID venfietl by drivei ;e. ❑ Yes ❑ No
Dnver's License No. Expires:
� Verifcation of Ownership by (type of document, i.e. - property tax bill or deed): �
• DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certAy [hat no excavation frve (5) or mwe feet in tlep[h into which a�
person is required to descend, will be made in connection with vrork authorized
by this pertnit, and tha[ no building structure, scaffdding, falsework, a demolition
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Ttle 8, Cali(omia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Intlustrial Safety, as noted above. unless
such person has a permit to do such vrork from the division.
Applicanfs Signawre
Division of Induslrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle antl
certify a Business Plan tor emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safety Code requires. wi[h some
exceplions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet ot compressed gas
at standartl temperaNre antl pressure).
2. Does or will the applicant or present or future building occupant need to file
^/ egistretion (orm for acutely hazardous materials? ❑ Ves ❑ No
y
ection 25533 of the California Health and Satety Cotle, with some
exceptions, requires registration wi[h the Cosla Mesa Fire Department 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 o� 55 gallons, or 200 cubic feet of compressed gas at standard
temperalure an0 pressure).
3. Does or will the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health and Safery Code provides iha[ the
Costa Mesa Fire Department may require ihe preparation, certifcation and
fling vnlh lhe Fire Department of an RMPP by businesses which are required
to register acutely hazartlous ma[erials wi[h [he Fire Department.
4. I/ an RMPP is presen[ly required, has Section 25534 0( the Califomia
Health antl Safety Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
the vrork which is the subject of this application a permit for such construclion
or�modifcalion from Ihe South Coast Air Qualiry Management District or from
any other air polWtion control district or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requesled
infortnation be fumished on applications for non-residential building permits).
6. Will any part of the faciliry to be constructed under this permit be vnthin
1000 feet from the outer bountlaries of a school7 ❑ Ves ❑ No
(If "yes", the facility must mee[ the requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code�.
7. If a permit from the South Coast Air �ualiry Management DisMct or olher
air polWtion control tlistrict or agency is required for the vmrk which is the
subject of Ihis application, have all of ihe disclosures pre5cribed by California
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No,
.� 8. Qf'yes". attach�certi(cate of��compliance from the appropriate air polWtion
contml offceq. - ,. , , _ . . , , .
: CERTIFICATE-0F COMPLIANCE: I certify: thahuntler�penalty of perjury the
in(ormation given above is correct. I agree to comply with all state laws and
��' city ordinAnces regarding Hazardous Materialsand Emissions.'���� " �-
p, . ..i. e. . .. .��e.:..r' , ..... ,,.-� .t' � ..
. . SignaWre � �ale� -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF. ENTRV: I.
cerli(y untler penalty of perjury [hat I have read Ihis application and state Ihat
the information given is correcL I agree to comply with all state laws'and ciry
ordinances relating to building constmction, and aulhorize representatives of
the City of Costa- Mesa to enter upon the above-described property for
inspection.purposes. I agree not to occupy or allow occupancy of any building
authonzed by Ihis permil until fnal inspection. ,
" � ' �'SignaWr�lOw s) �Dale�� ._ O n
Date . /
' AnE/or A orizeE AOPli�anl Date
wrowE:s��i��«:, g52 LAiILIA.AV
OWNEHSNNIEIFpqWN: NEMELEK; WILLIAM R. '
� RWPESS NEMECEK, S[.NLRA M ,
• +� 952 LAHLIA AVE �
APPL.M/JIINGADUPESS �GSTIi MESA,-CA� �92b2b
AIICNREtTOHENGWFEP: . 1 � ,
MCN.ON FNG'S10DME55: ' _ . • • �
B0N1"i1Ci0f�g""'� STAR COURSE kUOFING CG.
ca,m.cToxs�uuxc 2 q 9 81 HON [�V
"0°"Eu' LAGUNA HILLS� CA
• - 92653
LICENSEU COMXACTOqS DECL�RATION: I hereby Mim uMer pe�ally d peijury
pe'
( ' xnh Seclion 1000) d �ivisun 3 d Ne Busi�» eM Pmleaeiaa
UN7: , .
FLuOU: 'ijH-3II
�uc.xo:: � . .
s
' UNf: • '
(800)954—b014
"�N0 532778
uMr:
� IicenmE uMs ' d Chaqm 9
eme e in tu0 eXetl.
GGiCiO
muc. o.::���9�71 uc.cuss: C-3y uc.No.: 532778
OW BNLDEP �ECL�NATION: I hereby dfi'm uMar �d pmjury un uemq Iram Ihe CoMretlon Licerme Law la Ihe
wnp ieesp� 1�� )�1.5 &aiavs eM Rdassione e: An cauMy whit3� �uirea e perm4 to conabutt. ella.'pnpws.
EemdaM1. a repei anY sVu�lum. pv b ils osueMa. Wo eppl'ram ta euch parmn to Rb e ap�roA etalanent Nel he a eM �
n iK,�„d w�m io ma ao�� a ma c�vm� ��.e �.. Icn:a> e tw�m.�am wun swo� r000) a or.e� a a n.
Busrwa eM Prdesa'vn Cadel w thm he a sha o memq iherehan vM IM bmn iv Ne elbped memplion. My videlion d Sediai
]03i 5 W any eppliraM iw a parmil wbpea the epq'rant to e tivil penelry ol m� mwa then Me hundred ddW �55W��.
❑ I.movmerd�MpropenYamYa^d�'��hwepmav�heiadammpanaeiion.willdothev.wk.eMtMHru�YureeMinleriEad
impovemente are rot imended a dieretl lor cele. n, lawever, iM buiqinp a vnpovamsM s�oN wflMn one yw ot rompbinn, tlw
wnxbuiNer.will heve the buNen d provinp M w nhe did M buib a imqove /w �he purywe W eeb). _ .
❑� �. av o�.nx d �M n�ro. �<Rch�eivdr �vm'vro wun �iow�.ee conv.na. ro ca,mrutl �n. o� (seeun 1aa. a„Im» ene
Profmsiwre Cade: The CaNradon Licanae Lew doea na epply lo an owriar d prapeily who Euike ar impoves Ihereon eM x1w
� conve Ys fa eutli projaqe wnh a mntredohe) licanxd W�ueni lo Ihe GoMredme Limme lew�.' ,
�' I em axemq under Section: � B. 8 PC., la ihie reeron: ' , � ,
Dale�. Owner: ' '
I do hereby ceMity,lhel I em awara d e�M uMenlend Me repuirememe d Cd'domie Heallh uM Sdely Code Swiora ?5505, ?5533, e�M
z553�, end ihet I or eny hnure builainp av.vpent vnll / wil nd (rircb aw) neeE Io compy w1n eeie pme codee uM IM �uiremena M
e peimil lormnsVuetion w mod'ifie�elionhwnlM1eA'v�0ue tTy I.re�aBsmM� Oimntl. Raeidemiel eonetiueton eppYW iaroen uempl imm theee
pwisiom: ; � . _. . .
�
De�e:.. � � ApplicenL • • •
WOHKEF'S COMPFHS�TION DECL�P�TON: I hereby elfimi uMar panelly d pe�jury ms d IM blbwinp Eedvetaro:
❑ in��e:u��i�e�ann�meaoo�mmaan-mwnro.�xa:�w�.m�..,wow.ei«Ms«va,arooamsim«.
.COEe. iw �he peAarmvice d tM Mwk Iw which this permn ia ivued. � .
-Q I heva eM vril meiMen xwkere' aoenpense�im iruurura. a rpuired by Seqbn �NO d tM lebar Coda. M tM peNamercs d tM
-X wwk In xfiiefi ihis O�n m osued. �N wakers wmVametion imureze u�rier enA DdwY number are: ' .
c�, r� T --, , PIRES
� raKrrwmn,� ' � �' 03 1 /98
'lm;s seaion neee m' be �o��ee i rna w�. s ror wre nund�ed edwrs /siaol a . .
�i N mm m me v�ama�we d me wuM ror vmcn mre vam�n ia ieauee na emWw .m w� m v m m o �o
.uqetl �o �ne xaNe�s• canPe�mia, �e.w a celilan,m. �nn a �.nwk necan �na wo�F.n•.
�ioi oruinurud Sedion 3100 d tha lebor Cade. I dWl l wilh wmW xiih . -'
�: F�Nw ro wcun vorkeri ronpe�ustlon • li un ',�ndslWl iW/�ct �n wmplqw ro alMml pxuMn mtl
+ c/vlI flMs'p ro aro h�ntlrM tlpumid tlollvs lSfOq ltbn h IM cwl o/ wmpxu+fbM1 A�mps� p prvvMM br In
S�ctlon 3]P6 0/ tln LWorCOJu, Irrtwt �tl atturmy's Na. ,
CONSTRUCTION LENDING �GENCY: I hereW elfiem �m„ va�.M a oe:N.y mm md. e e oo�u�,a� wwoo .vs�y ro�.ub
perlamaMe a �ne xwk �w wnitl� �ne va^^� � msuee (seaon aos]. cN. cl. ' ' ' ' -
LENDER'S NMIE: .
LFN�EB'S�OOHES4e �
IcenilytAalllavereetlt
eiM stele kxa reletiq io
Iw inspeeion puryoses.
�
ae�nmMeebove bnocmeG.lep�eslocampF/wilhdldryeM�counryordinvime
eMMrobyeNlwrixa eiivsndihuaryioanleruponiMebove�memionedqapery
De�e��
� � CITY OF COSTA MESA — bUILDING PERMIT �
. FERM NO: H, 08454:
PERMIT NG:.B 089542 PLAN CHECK,NO: N. GOVi': N SUPP: N
Cc�NSTkUCTION TYPE: V—N PERMIT TYPE: STR PURPVSE: OTH
JOB DESCRIPTION. : T/OFF RESHEA 6 REROOF,Ni/LZTE�TILE ; SQ FT: S,.1GG
CLA3M tiI.LUE; ' 8,100.00 CALC—VALUE:''.' 8,100:00'-.GROUP GCC: R-3 /U-1,
COMMENTS: ICBO#.4b60, S.SPSF "MALIBU TILE" • � '..
" iEiixifii�iEjtii�itiFiFiFiEi'ti6iFieiiiEifiEiciivFiFi"tiFiEiFititififiEiiifiEiFiEicieiEifiFiEiE�EifiE�FiEifiE'r.�EiEiFiti6iFiFiE�ii�icifri�i'tieieifie:FiFiEi"ri%ieiE
Z O N I N G R E Q U I R E M E N T 5 ,
S E T B A C K S •
---=— NiAIN BUILLING =----`---- ---�----- ACCESSOkY HUILLING --�=--=-=
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: — FT� IN'
I LEFT: FT IN RGAT: FT ' IN LEFT: FT IN kGHT::. •FT �.IN
PARKING REQ: PROV":• PARCEL: 4121825G ZNE: �REF NO: ._�
.PLANNING. NOTESI• .. : , _ . ��� _ - .,
� D E V�E�L O P M E N T S E R V I C E*��***���**�rt��rt�**rt��'�3���x������
aE if ie tie ir iE if ie �e if �e x iF se iF iE iE iF iE if �7F ie ii it ee ie iE �l'e if iF #'rt 3F 3't iE'1f ie ic 3e i't iE if fE �iE .:
5 k E:Q U I R. E'M E N-T,S
ZONING AF+F�ROVELf°BY � ' • " � ' UATE: `L��
� <..—
BUILDING, E1PPR lED BY; ; Di�TEt 1'f� (�
APPLICATQON I�SSCTEL HY: , LATE;`".Mt^'" \/�►
ii�ic�ikii3'ricikieii�l'tifieii��7E'3fi2�1fikitiEieiExvr x z x irr. r�iEifri3EieieiciEiEi(� x. xr £if�e I
LEGALIZATIUN:N �. +� -F E E S U��M M A�k Y '. STRUCTURAL^ S GrviE T:Y
� . . . • . ' . . . . .
` BLDG PMT PLUMBING •ELECTRIC MECHANIC •� F",E SMIF,Git�_ GRAUING
PHkMIT 199.7.5 . • . ' ----� .81
.�- - . '-� . . •- . . SMIP/NON—AES
PLAN , . '
ISStIE ,FEE ' '
BUILUING—UIV—> PERMIT ISSUE' PLAN—CHECk TOTAL •PAIU DUE
TUTALS---=�� - 150.56� 0.0�' 0.00' i5G,5o 150.56 .OG
REVENUE DIVISION TOTALS—'-> CGLLECTEL: 150.56 OVER/SHOFtT: .GO
BLUG PMT FLUMHING;ELECTRIC MECHANIC FIRE SMIP/TGT GRALING PLAN—CHECK
199.75 . , . .81
. i
. � •.
.lt'T �f lf jf lf j! if'K"R R'!E'� 9f it 9E'Jf lE'!f'If'�'Jt �t it � �f'�F'R � jtl�"/�' i�' jf %E ff 1f jE jf'%� if'�'K-'k ff �' lE'If ff ff jf 3l' ft'K"x' If jf 1f'lf �t lf jt Jt �t lE 3t ji' lF'!t'1�"�-R'!t'!F'�'yl.3t ]c'It
I N D I V.I D U A L F E E B R fi A Ii U�O W N
TYPE QTY U E S C,R Z Y T I O N UNIT CQST TOTAL CGST
�FR 8100 REROUF BY VALUE RESILENTIAL NGZONE 1.OG. S,luG,OG
ENL OF FEES
(5151a8.WP) White-Buildinp 8 Salely; Greeo-Fle; Cenary-AppAcanC Pink-Revenue; (3oldenrod-�e�ew � ..
�
0
' " A9-84-1337/12:44 GH/Si5u.56
; � RCGT#:GI-6a117i5
' F�ERMIT:084542
9
�
0
0
_ .- -..___ _ _ - --- - - -
-JOL &.SPA -
y� C CONSTRUCTIQN AND PL',ANNIIv� .� `. ?'� �: (� j. n -' : i -� r „1 . . _ ,,,� � �l . � : ... i r 1� �'
: ,r�' . • . F, - r ' z -. Date I nspecto� ` �� �' ` ' ' � � Date In:peh torY
APPROVALS �Permit # �- " � �� +'' . � �� _ APPROVALS - Permrt 9k -
� � - �. r : . ._ , y .-.» _ , �: : ,
� t. Temporary�Electrical•Service oryPole',j �� _: a . -' ' -` � � �52: Pooi & Eqwpment Locatioi f.� , � ' ' ��
. �. ✓t �� -r i ' � 7
. � 2. Soil PiPe=Undrgrnd. w �. �.+ � ^ " �� � , � � � �53r Steei fteinforeemenY - ' �- �t e � ` .. , a� t, . � � ' �.
,,
. , k � � � `_ ' ' �_
3. Electrical Conduit UtilityrUndrgr'ii8:,r ' � '. - �' ; �54: Forms t� ` ' �s��� � ' ' , ���
" �. � � � _ . � . � _ . �
�4. Electrical Conduit-Undrgmd. � { � 55. Electrical�Bonding' ` � �'y�t � �- - , � J(�, i
5. Steei Reinforcemene :, � �.: .�; if "y� �' ;56: RougFi P.lumbing & Presiure Test` �- � .', I,
6. ElectricalUFER"Gmd. •�� ' � '�';`r;:;. �'5Z'; APPROVAL7000VER=GUNIT.E- _ � � �'j'r. ..,
� 7. Footings . -. - _ y-; ' , - �56:� ElectricafConduit-,Undrgcnd�.. "`. F � ;; �,�I
' 8.: Foundation ' � rt �; , - � � 59 Gas P�pe�, �aUndrgrnd.:Tesf ' f �� , - � f ;.,'
t i -
! 'Y= �` "n � ,• , � ��
9. WaterPipe-Undrgrnd. . ��` ' . ;.���-- ' _;� F; � � 60? Backwash,Lines,�P-,Trap,u'Und'rgrnd:"> �,,• ���
�; 10. Structurai Floor SYstem ° � , � �- - �r ;` ,; > .'. � -,61� APPROVAL TO DECK � � � j � I � �
7 7. Pro erty Sewer �ine & House Connection ��g' `'.� � " '' "
�
P �, ; r ;. ,, S . 1 �62. Backwash & Receqtor-Final �j �� i ! .
12. Sewer Cap . - :. � � . . e . �% y ' r � ' j r * _ . i �.
r-� . � - s z, '63- -Heater ffi Venc-Final �.` µ� �
" 73. Roof Drains � "�; � � ` ' , � • �- � �
�• i 1 0:" � C . r �. i'�•64. Plumbi�g SYstem = FinaC j �+•' .� _
'. 14. Rough Plumbing �_ � f � �4 „ � 7 = � ,e65. Electrical Final ! � �� • ' � � ` � �
: � - �!
((15. �Rou h Electrical-Conduit�:�'�.� f ;..v "- •� F ' ` . '' �i � �e• � �' j�.'�. �
�� 9 , �a;�; ' �,w,�: "4 � 66. Solar.SY'stem-Final �.y !
�� _ _ _
16. Rough Electric Wiring �� �'"��r � 2� �``67r� Fenc�n �& A"ccess A pioval i�+! �� a` !`•, ( " �
'- � 2' .:�� w/ � k 9z P �4 �� ,;�
: �� 17. _Rough Wiring Sign � _ � I i 'S, :' '� ���, F; � �68. APPROVED.POR PLASTER�NG L ' � * r� I .j �
� 18. Rough Electrical-T Bar Ceiling i ���" � t: �z`.i; t � � i69� P00�/SPA SYSTEMS`FINAL � � - � - � �
' ' 19.'�Rough`Heating"& Air`Condi(ioning�`"'`�'""'�`�" � ' `�- "'-'� � FIRE DEPT�REQUIREMENT - �� �� � ��
, , �
20. Rough Pactory Firepiace � � � • '' qPPqOVALS Permit#
, 21. Ducts, in Structure , - � � � 70. Underground Hydro � r
�
22. Dutts, Ventilatin9' ' � � '� 71. Product Riping C Gas ❑ Oil
23. Gas Pipe�Rou9h & Test ' . , � 72, Underground Flush
24. Roof Framing � � � � '� � 73. Undergmd.SmrageTank �Gas ❑Oil �
25. Roof-Sheathing, _. � 81�� �� 74. Overhead Hydro �
26. T�Bar Ceilin9lStructuraq & Monocoat t - � 75. Dry Chemical • �
27. Frame and Plashing, ; , �, 76. Dry Standpipe � .
�28. Lathino & Siding • r � . � • • ' • 77�.' FIXED SYSTEM FINA� �
29. Insulation -�. � � � �� �� : � � � 7g., FIRE PREV, FINAL � � �
"30. Dryv,.�all Nailing � _ ' ' HEALTH DEPT. REQUIREMENT
31. Plaster$rown.Coat ( , � i: 79: FINAL INSPECTION � -
32. ElectricaV Power Meter�Final �- � � � 80. FOOD CERTIFiCATE ISSUED
��
.33. Finai,Electric . - , � ; � ' Notes: � - � , (
34. Final Heating & Air Conditioning -� . ; � -- . , i
35. Final Gas Pipe�Test ' � ' . ' ' -, �; , ' �
,36. Hood.orCanOPY - � ' . ,'�
37. Finai Factory fireplace' . : _ , ' i � , ,
�
38. Final Plumbing ' �� _ �: " -
39. Water Service-Finai " ' _ �
. r �.
40. Gas Service-Pinal . • � . � • '- •
.41. Solar pomest�o-Final' " ; • ;
- 42. Backfiow Preventer , � - - . �
�
-43. Backfiow Irrigation � � � , , �
�
44. Landscape IrrigationiSystem � - � ' �
� .
45; Sound Attenuation � . - - ' .
46. Handicap Regulations ' . _ n , �
n �� i .
47'. FWAL STRUCTURE & BUILDING � h�l�i�}' ���
. �1��jg� �, �
48-�. FINAL�PLANNING , � - � ' '
� ���
49� Electric ReleBse to Edison . � ' : � • , .
50. Gas Release to Southem Califomia Gas Co - . � � . -
51!. CERTIFICATE OF OCCUPANCY ' 3__.:
- �._
No. Date
�PROJECT ROOBESS: 9 S 2 DA:?L � A AV .' ,,
OWNEfl'SNAME:NEMECEIC� i�I1tLlA�Njl�'��.<i�� �
anoaess: NEMECEK SANDRA M
952 DAHLIA AVE
COS�A MESA CA 92626
AflCHIENGINEEfl: ( 7� a � �45-6� 50
RODPE55:
4 UNIT: e
flEG.NO.:
UNIT:
PENMITTEE: �iROGRESSIVC DESIGNED PLNH ( 714 ) 780-3500
nooeess: 6 VANDERBII�T B
IRVINE CA 92718
LICENSEO CONTBACTOH OECIAHATION: I here�y aifirm tha� I am Iicen5e0 un0er pmvisions of Chap�er 9(cammencing with Seciion
. 7000) of Division 3 oi Iha BuSlness and Pmfessians COAe, antl my license is in lull force and efiecl.
' CITY IIC.: STATE LIC.: � ClASS: ,
04,9Sa5 33479� C—'"
Da�e:��2�-43 Sigre�ure:.- .��
. WONK 5' COMPENSATION OECLANATION: I �ere�y ' m �hat I have a ceniliw�e co 1 �� selbinsure or a cenilica�e of Workers'
Compensaiion Insurance, or a cetlilied coDY �hereol (Sec ion 3000. Lab. C). , ' '
�oucvNo.:pWC11582094? ExP.oare: 10/O1./93
comvnxv:VALLEY FOR�6 IN
❑ Cerli�ietl capy is hereby WmiS�eU. � Certitietl caDY Ais filed with the ciry BuilOing /�ivision.
Da�e:�'��"9� FpPiicanf: ///�7�./l7_////�
E%FMPTION FNOM WOBRENS' COMPENSATION UECIAXATIO :(This Seciian nee0 noi b iom 0 il the permil is �or ane hundred ($100) Or Ie55).
I cetlify ihal in ihe petlarmance oi �he work for which this permii is issued. I shall no� employ any person in any manner so as lo betome
Subleci �a tAe Warkers' Compensa�ian Laws oi Calilomia.
�aie: SignaNre:
NOTICE: IL afler making �his aeclaraiion. you shoultl Uecome subject m the Workers' Compensation provisions o� the Labor
Cade, you mus� forihwith comply wiih such pmvisions ar Ihis permil shall 6e deemed revoked. .
CONSTPUCTION LENOING PGENCY: 1 here�y aflirm �hai �here is a constmction lending agency lo� Ihe Oe�ormance o� the work �or
which Ihis ueimii is issuea �Sec�ion 3097. Civ. C�. �
LENDEN:
AUOPESS:
OWNEX BUILUEB OECIANATION: I �ereby afhrm Iha� I am eMempt Imm Ihe Con�mclors' S�a�e License Law for �he following reason
�Section 7031.5 Business antl Pro�essional Code: Any city o� counry w�ic� requires a Oermit �o consiruct, al�er, impmve, tlemolis�, or
' repair any 51rucWre. prior lo ils issuance. alsa requires �he applicanl for such permit �o file a signed Slalemenl Ihal he/she is licensetl
pursuanl Io Ihe pmvisions ol �he GonVacmrs' Slaie Licenre Law (Chapler 9(commencing wiih Section 7000) o� Oivision 3 of Ihe Business
and Pwlessions Coae) or Ihat he/s�e is exemp� �here�mm an0 I�e basis lor ihe ailegetl exemp�ion Any viola�ion of Seclion 7031.5 by
any applican� lor a permit su�lec(5'��e apPlican� to a civil Denally ol no� more Ihan live hundred dollars (5500). _
I. as owner al Ihe pmpehy or my employee5 wilh wages as ��eir sole compen5aiion, will Oo �he work, antl Ihe
❑ stmcWre is noi imenJeO or ouered for sale (Section 70aa. Business an0 Pm�essional Code: The Conimctors' Sla�e License Law
Ooes nol apply to an owner ol a pmpe�y who builtls or impmves ihereon. anA who tloes such work �imself/herself or Ihmugh
his or her own employees. provitled Iha� such improvements are nol intended or oifere0 for saie. I�, however the building or
impmvemen� is sold wi�hin one year a� compleiion, the owner will �ave �he bur0en of pwving he/she tlitl no� �uiltl ar impmve
�or Ihe purpose ai sale).
I, as owner o� ihe pmperiy, am erclu5iveiV conVac�ing wiih Iicen5e0 contractors �a consimct the pmject (Seclion 7044, Business
❑ and Pmlessions Cotle: The Contraciors' State License Law tloes nol apDly to an owner of propeny who bmltl5 or improveSlAereon
anA who con�rads br such pmjects wii� a conVac�ar(s�license pur5uantio I�e Conirac�ors' Sta�e License Law),I am aware
Iha� D�oof ol Iheir Worker's Compensalion insurance shoultl be pmvided �o me.
� I am exempt unaer Section: B. 8 P. C. � �
'�OI ��IS f¢250f1'.
�ate: Ownec
I do here�y certily iha� I am aware ai antl un�e�51an0 ihe requiremen�s ol Calilomia HeaIN anU Safety Code Seciians 25505, 25533, antl
25534 ane Inal I or any luture bwlemg occupant willlwill not (circle one) neee to comply witn saitl state co0es antl ihe requiremenis for a
permil lor constmclian or modifica�ian Irom the Air Ouab�y Management �i5irict. Besitleniial canstmciion applica�ions are exempl imm
�he5e prOvl5ian5. -
Daie: ApPlicani:
I hereby ceriity�hatl have reatl �his apphcation and slate tha� Ihe aboveln�orma�ion is eorrett.
ortlmances antl slatelaw5ielaiingia �uilaing consimction antl hereby autharirerepre5entalive5 of
pm0etly lor inspec�ion pur0oses.
�ate'.�'�-,�=�� SignaWre ��
/
Onver's Lirense or Saciai Securiiy q: d
to comply wi�h all ci�y and county
�a enleruponihe above-men�ionetl
t6ai n6 Whne—Bmltling: Green—Coee EnlorcemenC Canary—App�icanl; Pink—Revenue: GolCenrad—Fuessor
:'�,Gi1��ie. �
�,N.',.�t., ....
�.t � CITY 0= COSYA MESA�.� ,BL-SL.r�ING PER,KIT
PE�MIT ?�10: � 06193? PLAN CHECK NO; N
CONSTRuCTION TYPE: 5—N P?R�+,IT TYPE: PL"J
JOB DESCRIPTION : CHA,UGE OUT WATER HEATER
PERM NO; F 061931
GOVT; N SUPP; N
PURPOSE: OTH
SQ FT:
CLAIM VAiUE: CALC—VALUE: GROUP OCC; R-3 /
COMMENTS: CHANGE OUT ONLY
��-*�r�*�* �x****�x�****x*�**�**+����**�t���*�+r�t� **�t*��t�x x�x-*** x�c* x-����c�**�**����c**r�� x•
Z O N I N G R E Q U I R E Ni E N T S
, S E T D A C K S
— MAIN HU:LDING —
FRNT: FT IN REAR:
LEFT; FT ZN RGHT;
PARKSNG REp• PRUV;
PLA��NSNG NZSTES>
Y
iE iE iE ?f jE iE iF iF ie iE 3F iE 3F ie iF iF iE �1F iE iF 3E �rt *�7f if iE t�lf
U E C� E L O P M E N T
i
ZO�vIN6 APPRUL'ED BY
BUILDiNG APPROVED BY :
-------- --------- ACCESSORY BUILDING ---------
FT IN �RNT; FT IN REAR: FT IN
FT IN LEFT; FT IN RGHT: FT IN
PARCEL; 41218250 ZNE; REF NO:
iF if iE iE i! iE iE iE 1E 3E 3E iF ic 3E iE�F'3(Ni� �f iE iE * iE 3E jE iE 1E 3E iE if 1F i( iE iE 1E i! �)f fE iflE 3(� �F-1E�F iE 3F if iF
S E R V I C E S�:s, R E Q U I R E M E N T S
ii� DATE :
r? UP.TE:
� �� �
APPLiCATION ISSUED BY; iC (,dti,'�`—�/' `� ' DATE: 2g
ifiEiEifilifiEiE3EiE3E�3fiFlEiEiFiE3fiFiFiEfe'iFft�eK7��titrt� iFit�ci'eiF�i�r�e�. uft ft xrcutetrx titfefciEiEiEif±fiEif�?EiE�IE :� fctx>.�r�r.x�IEiE
dEif3E?fiE�E3EifiEifiEiF3E3FiEif3FifiE�FiEiEieiEifiEiE3fjfi4�r?fiE3ffR1E?E3E�FjEi�it�3fiEif :i 1EiEiEiEiEiEiEiE3riEviE3fiF�kiEitifiFiEiFfE#14iE?ElEit•iEiEitdE
LEGALIZATZON:N F E E S TJ M M A R Y STRliCTURAL SEGMENT:Iv
BLDG PMT PLUMBING ELErTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7.00
25$ ?,.. SM2P/NON—RES
PLAN �
ISSiJE FEE 20, 00 '�1
BUI��DiNG—DIV—> PERMIT �_ISSUE PLAN—CHECK TOTAL PAID DUE
TOZALS----> 7,00 20,00 P;.. 0.00 27.00 27.00 .00
Ki
REVENUE DZVISI�N TOTALS--> COiHECTED: 27.00 OVER/SHORT: .00
BLUG UMT PLF]MBING ELECTRIC M•�'CHANIC FIRE SMIP/TOT GRAPII3G PL'AN—CHECK
2%,0� �
?f if 3E #E iE iE 3E iE iE if 3E # iE iE 1E # df iE if IE iF k iE iF 3E if ?E 1E �)f 3(� �)e ?E 3f iE 3E��?f �X��IE iE if iE if iE �7f iE iklF k!E iF iE iE 3F i't iE iE X-if 3E iE if iF iE iF if if -1f #�1F 7flE iF # iF f! if -%iE jf
I N U S V I D❑ A L� F E E B R E A K D U W N
r�
TYPE . QTY D E S C R I P T I O� N UNZT COST TOTAL COST
PiU ? WATER HEATER AND/OR VENT 7,00 7,00
�ND OF FEES
^y
/�
%
1�
�
' ES OS 00138135-00138i36 TO T 27.U0
s • DATE: 04/23/93 TII1E: 14:3D
•'Y
�
v .
CQNSTRUCLION AND PC.-ANNWG'�� , �
� APPR05fRLS rPermit # � �tiexe
� �t. Temporary'Electricai 5ervicepr Poie� =7, ', .
Z. Soil Pipe-Undrqrnd. --'. � -' ' �
3.�Elect�ical Conduit UYilicy-Undrgcrd. � �
4.'Electtical Condu;t�Undrgrnd. -
i
5: 5teel Reintorcement . , - � . .
'6, Electrical UFER Gmd: .' , •- �
7. � Footings • - � .
- j 8, Foundation � � ' * ? ._ , "�%'. �
i 1,._-
: ; 9. N'ater Pipe-Undrgrnd. '��• �
^ i 10. Structura� Ploor Systein �
:, %,
t 7. Property Sewer: Line & House Connection ,
�t, ,:
' 12. Sewer Cav ��'' - , j i:-
. ,J :
� 13. Roof pfains � � " f'�
� 14. Rough Piumbing� � ^ ! .
� 75. Rough Elecirica�-Conduit ,
!' 76 Rouyh HectricYViring ` � �
r
j 7 7.. Rough 4Vi: ing Sign ,. -
18. ftoayh ElectricalT Bar Ceiling ' �
79. -Rou9h Heating & Air Conditioding
i �
20."Rough h',actory Fireplace �
2L� Duets, in Structure ' ' �� ��
,�
22.. GuGts, 1{enti�ating , . �
23. GasPipe-Rough & Test � � . �
k'
24.' iioo4 Framing' � � ,
25. Roof SheSthing . �
26. T-Bar Celling (Structural) & Monocoat
, 27. F;ame and Plashing � , �
� 28. laihing & Siding . . " . �
29. ir,�ulation ' �•
3�. Drywatl'i�ailing " , �
� 31. Plaster Braxrt�Coat i . • �
` 32.' Electrical Pov�er Metet�Pinal' - .
33.. EinaP Elec.rip � i .
' 34.'- Final NeSiing & Air Cond�itioning ��
�35..Einal Gas Pipe�Test - .
,36. Hood orCanopy � ' � � ' '
�
37. Final.Pactory Firepiace , � �
' 38. Pin1f Pi�mbing � � 3/
`_
39. 4Varer Service�Fina�. � �
40. Gas Service-Final
- 41. Soi;r pomesticFinal ' '� � �
- 42. Bzckflow Preventer � -
_.43. Backflow irn�jation - - _
44. �andscape li(gation System � � �
45. S�und tittenuation ' I , ; '
� 46. �Handicap� Regulations � �
; ..47.�F WAL STRUCTURE & BUICDhVG '
48. FINAL P! ANNING
;.
A9. Electric Release to Edison '
50: Gas Release to Southem California Gas Co
51. CERTIFICATE OF OCCUPRNCY
No. Date
i
R
. � �
_ -.. -_. .. �.' ,.�Ol & SPA - .. . . .._ .- -- '
inspector - � � � Date � Inspector.
APPROVALS Permit # _ / ,
- - � 52. Pool & Equipment Location ' -,; �
- . 53. Steel Reinfo�cement -
� 54. Forms ` � �" �
� - 55. - Eiectrical Bonding' -
- 56. Rough Pium6ing�& PreSiure�Test .
- 57. APPpOVAL7pCDVER-GUNITE - - -
- , 58. Electricai Conduit-Undrgmd.
59. -Gas Pipe, O Undrgrnd., Test , ��
_ „
� 4 60. Backwash �ines, P-Trap, i� Undrgrnd. _ �'
= 61. APPROVAL'TODECK--?� � �
� 62., Backwash & Receptor-Final-
63. Neater & Vent-Finai . � '•
.�'•
64.� Plumbing System - Pinal - � f
65. Eiectrical-Final . �
' 66. Solar System-Final � -
67.-�Fencing & Access Al�proval � t
68. APPROVED FOR'PLASTERING '
� 69. POOL/SPA SYSTEMS FINAL
� „Fi-RE DEPT. REQUtAEMENT �, ' - `
, ;APPRQVAL'S- :� Permit �''r � _ � �
� i� ?0. Underground,'Hyd�o
' .71. Product.Pipin90Gas ❑Qii
' 72. Under�round Flush
' , ':73: Undergrnd�.SrorageTank C�Gas ❑Oil �
� "' � 74.�Oveihead Hvdro �
.� �.. Dry `:hem(cal .
/ 76. Dry Sta\�dpipe
��� . 77. ,FIXED S�"STEM F(NAL � , . -
� � 76. FIRE PRE17. FINA�
1
�.:!� , ' , NEALTH qEPT, REQUIREMEN7
! " . 79. fINAL INSPECTION '
!
I 80.' f00D CERTIFICATE ISSUED,
;�=-; Notes: (.�.Za�l3- Koo+eE�w��.•e,E�ru+ae-
4--�f . �_ ,
� i!'" � . . . .
�
� � ZsA
_ , L ��_,��,�- ��°ti
--, �
TESTING
July 3, 197��
�
i�inq Laboratori�s �f ��,«t�=��,� �«��f�,=,=«�, �,_�.
Pp. BOX a] , 77i0 AIRPORi WAY . LON6 AEACFi, CALIA 90901 .�2171 °�o�335S . �213� b?6�2386 . ��14� BPB-6934
� 3YAS:.�� OF=10E5:
i5ia-ONn�.FHm:mS�m.� �� Ha�Oer�.c�.eie��l�q
ie �•,'°
Sa..en,aCebF—sanm 4i:.. tv'�¢,d:-aon.e.,P.O.eo..v
�nqvi.zc.s ��!'_a.,`;, .ona�e�.,ceeceo�oilzulme-vee
. �d�. i_�., e '
���; .
Examination: SC]4—j]11
COMPRESSION TESTS ON GU41 TE CYtINDERS
Mr. L. E. Sprague
5041 Doanoke llvenue
Irvine, California 92705 .
veO�ecr Swimming Pool for JACK FACE �p��✓
ADDRESS 952 Dahlia Avenue, Costa Mesa
SAMPLE fROM Gun i[e Swi mmi ng Po01
♦RCMi1KI _
ENGiNEFP
MIX
DATE CAST
DAiE TESTED
CYLINDER NO.
COMPRESSION
TOTAt LOAD, LBS.
POUNDS NER SQ. IN
SIZE:
COMPIIANCE
CYLINDER:
CON�PnCtOR
SU9CONiNAC100.
SPECIFIED
STRENGTH
6-26-74 CYIINDER SIZE
7-3-74 7-3-74
1 3
7-Day 7-Day
78,500 67,000
3,t6o 3,238
5-5/8" x 12" 5-i/3" x 12"-
7-day test complies vfith specifications.
MADF 6V DflrvFiED BY
- - - Dave
oisiAieurioN�
�'CoSt-d Ptesa Bldg. Dept.
L. E. Sprague - 4
2,000 psi
7-3-74
2 "HOLD"
5 4 "HOLD"
6 "HOLD"
7-Day
6g,000
2,905
5-1/2" x 12-1/4"
NECEIVFp ON
7-27-74
�UILDIiVG SRFETY DEP i .
�JUL 61974
, �. . :,,�
,�:,�: W._. . ... - �- -
.. ��,� s ...t s s �i: .. . . or. . „ ��� . � , t ..� .,,.... ... o. ,�� v..e,�c. a. o� o., 4e000rs co..c.�sio..s oo �.
,.. < ��.... . . ..�,..,,. ..: ..�.. s . _ .e. �. . .. � ..� .. .�..�,. �. . _ ,._._.. ,..� . _ ,�. ro e..e�.�s ...e P _�e ...o o�w
sc_.e
.a n _
� OWNER FACE� JACK
�JOBADDRE55 952 Dahlia Ave
�Q GENERAL CONTRACTOR B1
`t AP No. 1P-1 2-S� LOT
INSPECTIONS
Pool Location �
Forms
Main Drain
Steel Reinforce
Elec. Bond -
i_Approval-to•Cover
Underground Electric �
Gas Piping Test
Filtering System Lines
Backwash Lines and Recep.
Electrical Final �
Heater and Vent Final
Filter System Final
Backwash and Recep. Final
FPnrinn Final
DATE 6-13-74
BUILDING PERMIT N0.
SUBCONTRACTOR
Plumbing
7
� � . . '•. . f _
,,, _
'3a543.: ,�,�.;3-7����<°00„05;: ;.��:=a�,.oc
COSTA MESA BUILDINGSAFET-Y DEPARTMENT ' '� � � . �
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � � '
- � � APPLICATION FOR BUILDING PERMIT -
. � For Applicant to Fill in Completely
'REC I V D BV D TE FECEIVED DATE ISSU D
� BUILDING � � ���.. ^,/ � .
ADORESS e •
f ' ^ P
' OWNER J ' . ' A.P. NO. — �('��
- MAIL C� � . „ �BUILDING . �-
ADOFESS J ADORESS' S e•
�Z � , . . . ,` .
Wa U TEL � ' TRACT 7 �'LOT BLOCK
CITV CO 'e NO. �
�~ Z - � W ADD ALT R P
� Z Q , CON5TRUCTION , ' '
O N LENDER . . . ' . . .
am
J� BRANCH `t - -
J N OWNER � . .
a W ADDRESS p� '
¢] J � ' � VALUE 0
' J m ARCHITECT�� TEL. S� I $
a OF ENGINEER. � N . /
Uw . . -' � � ✓.
. Q O - � � FIRE . , .,.
W Q ADDRE55 ZONE TV GROUP
'dw � APPROVED�� ` /�
w Z CONTRACTOR �8 ' � � BV , � DATE � ;�!' �
J 0
m Z
� J ¢ AD�FESS '
w W � TEL ZO NO.OF USE OF NEW
ZF CITY '.NO. - P�� BUILDING � DU
� STATE � CITY . ♦ ' �'ARDSAPPROVED,. VAR�SAPPROVE
y� LIC.�NO. a LIC. NO. • � MAIN BUILOING'� ACCESSORV BUIIDING
_ � 512E . . NO.OF BLDGS. (FROM GL STREET) - � -}/— ,
OF LOT NOW ON LOT ! FRONT FT: y� 'I F �/ �
USE OF ' ' � � ' - � '
, EXISTINGBLDG. ' SI FT. CFT. �
f" SIZE OF NO.OF . � -
Z NEWeLDG. ROOMS STORIES L.SIDE FT. �i FT.
� U EXTEflIOF WALL ftOOF ' ' -
COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED - DISTANCE BET. , BEf. MAIN&
a MAIN BLDGS. ACCESS. BLDGS. '
a.
Q VAR.# DATE
O .C.U.P.# � APPROVED
� , . . � . � APPROV D ♦ y� v( _ "
��J
Z
O . , •
VI hereby acknowletlge tha[ I have reatl ffiis application antl state � ' � �
�� that the above information is wrrect antl agree ro comply with � ,
� all laws regulating builtling consttuction; and I shall not employ' . � � ' � O '
F any person in violation of ffie workman's compensation laws of - '
y. the State ot Califomia. ,. ' - ' , m
z �
I hereby certity ihat I am properly licensetl as a conttactor under. SQ. FT. o
the State ot California B�siness antl Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS F,OR
v
Chapter 9, antl Mat such licenzas ara im full torce and etfect, or 1' THE PURP�E OF ESTABLISHING A PERMIT FEE ON�Y: Q .
am e.empt from the provisions of the State of Calitornia Business VALUATION
. antl Professions ncie, Division 3, Chapter 9. , �, - N
PERMIT FEE $ ♦ �
SiB^atura of
. Permittae � � ` $�/, � w � p�,qN�'CHECK $ - . � E -
. . Auihorized Agent . , � U �%T/ `a
�•� LL
� TOTAL FEE� 5 / O% v
CK
fl:
ROUGH PLUmBING
PROP. SWR. IINE � HOUSE
SPRINKLING SVSTEM
ROUGH HEATING AND AIR CONtlIT10NING
_ TEMPORARY SEPVICE OR POLE--- --
UNOERGROUNO � POWER ❑
ROUGH WIRING
REIN:.
FLOOR SYSTEM
BOND BEAM � STEEL REI
SHEATHING
FqqME r1N� FLASNING
LATHING - IN n (
PLASTEF.BROWN COAi
STRUCTURAL, FINAL �
HEATING, VENT., REFRIG. AN
PLUMBING, FINAL AND GAS T
ELECTRIF FINRL
BUILOING, FINA�
W
0
SUBCONTRAGTOR
. . �,
�� , . ' � ' PAI�U .
�A �- � ' - ;ili.3n-7;,�r,:�.C!�267�"� �.�;,;.,,G50
38 i.,4 . - .
� COSTA MESA'BUILDING-SAFETY DEPARTMENT. � -
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 . . � ,. '
�� AP L ATION FOR BUILDING PERMIT
� � �For Applicant to Fill in Completely � R ce ev DATE RECEIVED '
. DATE ISSVED ,
BUILDING C: �' � 0_'1�
ADOFESS /
'. - �r.y� PERf�I C
�' � ' A.P. NO. �x� . �
OWNER � �'
MAIL ` _ BUILDING � ���/� � � C_
Z /' �J
ADDRESS 7 ,�� �+DDFESS U
d U CITV (� " /� ��yy NOL�� TRACT � LOT BLOCK. �
F Z G.1
Z Q CANSTRUCYION - . . r . W AD P
O N LENDER ' ' � �
a m ev., ,
v
J � BFANCH tT� ' - /�
JN . —` . . . - OWNEF F�G ACE -
m J ADDRESS � - � , ^ ��/ VALUE '��7/� '
J m ARCHITECT . TEI. � S �YT�U � /L $ `��
a OR ENGINE Fl N -
V N ' ' .r1'/ _. � FIRE . � . . r
W� ADDRESS � ZONE . TVPE GROUP
�' W APPROVED �% � �
JO CONSRACYOR �,(�/1�i� .�L BV � ��DATE (' D�
mZ' � . . , . . ' .
J � ADDRESS ' ' JyJ�
W W TEL. �� -[' ZO NO.OF USE OF NEW '
Z� � CITV �-%Y)�' .. NO. ��/7j'NG. ' PLANS ' BUIIDING � s�
t.i\,
Q STATE � - �� CITY • � VARDSAPPROVEO VARDSAGPROVED.
N� LIC. NO. �' LIC. NO.� �- MAIN BUILOING ACCESSORV BVILDING �
�� SIZE NO.OFBLOGS.' (FROM�C/LST EET) - �
�OF LOT - NOW ON LOT RONT �� FT. '
USE OF � � , , - ' .
' EXISTING BLDG. � � ' � FT �
H SIZE OF %� � NO. OF � i '- � , .
Z NEWBLDG. w ROOMS -STORIES L.SIDE � T' FT.
V EXTERIOR WALL ROOF ' , � ,
COVERING COVERING REAF . FT. FT.
J USE OF BV�LDING AND WORK TO 8E PERFORMED .' DISTANCE BET. BET. MAIN & �
d . � � MAIN BLDGS. ' ACCESS. BLDGS. .
a
Q ' � VAR �k , DATE .
O . i= C.U.P.# � . APPROVED
. y ' ' . , - ' - . APPROVED � � ' 1' �
z .
O . P'�
U�I hereby acK�owledge that I have reatl� this epplication and,stata , - . -
� tha[ the ab0�e'information is torreci antl agrGe �to cOmply with
� ell �aws ragUletin8 building construction, antl I shall not employ y �- �
r any person in violation of tha workri�an's compensation laws of
y the Siate ot Calitomia. , , , . . ' ; . � � ' m
zI.heretiy cer�ity that I am properly�licensetl es e contractor untlar ' SQ. FT. , - O
' ,the State of California Business entl Piotessions Cotla,�Divisicn 3, THE AMOUNTSNOWN UNDER VALUATION IS FOR
Chapter 9; a�tl.thet such licenses are in full torce antl atfact, or I THE PVRPpSE OF ESTABLISHING A PERMIT FEE ONLV: � �
am exempt from the provisions ot the Stete of'Cal(fornia Businass . Q
VALUATION
.antl Professi0ns Code, ivis' A 3, Chapiar 9. . � , � � N
- - � . , .. ' PERMIT FEE S ] -
�. Signamra o - �� ' � m �
Permltte -$ �"� PL4N CHECK $ � E
,�� . `o
' Authorizetl Apent . � ' � ' . � LL
- TOTAL-FEE $�
i
� v i \. . _ . . - f . ' " , i ._ .
' , h�1G 15-77Pnro0�1.060� �:t��U2.�5$.
'3 5 I 7 crisn
. ,. �
., , , . '... ,
� WSTA-MESA BUILDINGSA�FETY DEPARTMENT � � � ' ' � • � ' ` , .
. - -..LI.OIBI�•O. BOX 1200 COSTA MESA, CALIFORNIA 92626 -.. . . " . , .
, � ��PPLICATION FOR BUILDING PERMIT �
For Applicant to'Fill in Completely -
R EI E BV 'DATE RECEIVED DATE IS U D
- BUILDING ' ' . �� �+ _� _�
ADDflESS 5�.� Dahlia Avenue
. . . ' , . ' � . - PERMIT NO. � ,
. own,ed LarwinSouthern Calif . Inc � "�P� NO� �� r
MAIL � . '- . . + BVILDING � ' �I U � J
ADDRESS.. �
. : ' . , ' ':'", •. ' ".. .'.. . .; TRACT I LOr - ,. � .
ADDRESS 1
a� ciTv.:: Encino� Calif. No`'gg(-ggg 77 � T�� BLOCK
zz
Q CON5TRVCiION ' ADD A R P
am LENDER � • . ": . .. ^ r , ;
J� aaan,cH. 16255-_Ventura Blvd.� ' � � C�NG
J � - • - OWNER
mJ ADDRESS E11C1RO �C311f ? VALUE � �
J m ARCHITECT� _ .TEL US GJ � S ��.
a OR ENGINEER Larw' - � n, .
V N ' - '- - . ' FIRE . - � ..
a -ZONE � TVPE- GROUP
w � aooRess g100 Wi1ShiYe
aw - . , � , -�:'- •. . . . . -
W Z APPR ED � I
JO CONTRACTOR Larwin,Soutliern C�lf. B�' ' DATE
mZ' .' �. ' . . ' . _ . � ;� , ,
J�� ADDRESS 16255 Ventura Blvd. � � � � � � N p.�
TEL. Z�NE NO.OF USE OF NEW
�_ - PLANS BUILDING C�- 6
Z� CITV Encino, Calif.- No.986=889
w � STATE . CITV YARDS APPROVED - "� VARDS APPROVED
N fL LIC. NO. � 19�.311 . LI0. NO. B-1 . MAIN BUILDING � ACCESSORV BUILDING �
� O . - (FROM GL STREET) .
SIZE NO.OFBLDGS. � '
OF,�OT (JS �X LOO� �� NOW ON LOT p' FFiONT FT. � FT. '
. 'USE OF • � ' . . . . . „ �
�EXISTING BLDG.' - I I D- FT. � FT
�° SIZE OF'- - NO.OF � � � �
.,. Z NEWBLDG. 1%S�} • ROOMS' � STOFIES "1 L.SIDE. FT. FT. �
a EXTERIOR WALL ' ROOF�. ';� (� ' '
�% COVERING � StUCCO COVERINGWCZ ..SYl� REAR O' �. ' FT.
J �USE Of BUILDING AND WORK TO BE PERFOFiMED DISiANCE BET. ' BET. MAIN & '
�'' . ' MAIN BLOGS. ' � ACCESS. BLDGS.
a
Q . " . - - " . .VAR.,$. . DATE � �
O ' ' C.U.P:� ' APPROVED
N - Construct single _family. dwellin �Roveo w: z/�6/� '
p � � � . �
.�
F, •� - . . ,, . , , „ .
..0 . I.hereby acknow�etlee ma� I have reaa this'applicetion and.state�- '�i-jOLD �FOR:SPECIAL
.� ffiat the above information is wrrecnantl agree�to�comply with'�
� all laws reguleting tiuilding const�uction; antl'1 shall: not employ'. „ ' �, ,
. F any person in violation of the workmads compensation laws of � ,.
. y the State ot Califomia. - . - ' � ' , . . ' �. . .' ' - � ,
z1 hereby certity that 1 am properly licensetl as a contrector untler SQ. FL �_ i° `� � o
� Me State of Calitornia Business antl�Protessions Code, Divisicn 3, THE MOUNT SHOWN UNDER VALUATION IS FOR
„ Chapter 9; antl that such licenses are in tull torce and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt from [he provisions ot�the State ot Calltornia Business p
VALUATION �
' � antl Protessions Cotle, Division 3, Chapter 9. � • . � - �- � � -� "
' . . . ' - � .�'� PERMIT.FEE $ • ' ' .m
. $I Od2Uf0 O / � /�/ �j'�}-�j .. �
Permitiee /L����- D DOWRS $!/ `� / " .•. �PLAN CHECK � E .
�v
, ^ Auffioiizetl ABent , . . . � . .� � . - /�. u �
� " .� TOTAL FEE' $ ( , „