HomeMy WebLinkAbout874 DARRELL ST - Building PermitsPERMIT TYPE:
Sub Type:
CITY OF COSTA MESA
BUILDING DIY/SION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.qov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC13-00131
B COMBO STATUS: ISSUED
RES ALT DATE ISSUED: 03/04/2013
ISSUEDBY: RMD ����L��
.106 ADDREss: 874 DARRELL ST CM �_ Suite/Untt: � d� �l�
APN: 42236225 -';r. � Zoning � , �-��; -
� DATE
Vicinity: GARAGE r �, � � , �,,� _ _ ' , � Prima'ry Occ '�� - �
Const Type: i SQ Fi - 0�. Valuation � "$250.00
„f'i���. _ - <_ � _
. ri ryF�
SCOPE OF WORK:REPLACEMENT;OF. TP. DISCHARGE VALVE AND NEW WATER HEATER"STRAPPING AT AN EXISTING
WATER HEATER LOCATED IN GARAGE.%;.;��'
�;;" /,', ' jj� ' . � .;.,e,�
OWNER: LITTON, DENNIS CHARLES �,+,- Address: 874 DARRELL ST Und °-,, - .
Phone: � ' - f � City/State/Zip: COSTA MESA, CA � = - -
� ' . ' - - r -.� � j ,�k.;� � :J
. ' , .� _;r.- -' - � ' _
APPLICANT: DEEB, KARU -- �' � " �t' ,. ;,Address.' � Unit:. - � : i, -� �
Phone: 714336-6833� ' '1,'„ (+� -' '�"City/State2ip� -, � � � . � i .
���, .,� _�_� �,..�;,-' - . , _
CONTRAC70R: D H I CONSTRUCTION � License No:922155 .�- •• � �
Phone: 714336-6833 " �- , � � �._,Address14252,CUWERDR__,., . Unit:UNIT�A332_� � �
Cell: . �' - :.-City/State:..�IRVINE,�CAZipCode92604 , " ' - � J
ARCHITECT: ' .,� License No ._.--- , - „ a�r,,,, _ �i ��„PNONE.,,; �
ENGINEER: . � ---�License No.� , - f '� - � ;: PHONE:
,. ' , -. _ �/,�' , i � � - .
' . � _ . �, �, �. / �� � .
COMBINATION PERMIT FEE SUMMARY � _: -- � �
Building Plan Check: ' , , ;,�, � $0.00 �' ,
Building Fees: � � - $23.50 _;;_`�,�' �� �, .,
., , , .
Electrical Fees: $0 00.,;;` r- ,
Mechanical Fees: -, � �t�','$0;00 � r rE - �
Plumbing Fees: ��n. ; � � `�$33.30 ' �. ,���,`
SMIP ResidentiaC �-- ,%. :_ $0�50 �,,; � ^ , � �'�� �
SMIP Commercial: ��,�,_,� �� �; . ;$0.00 �� � :� � _ ^ ,
Bldg Std Admin Fund �'���� `-=%$1:00? ,_, ,_ _ �� �=,. �
�-`�
TOTALFEES: _� $58.30-'��, � �� .�.��_;�� .-a�,>' �.:,,:��.
•'Refer to fee recei ts for all fees aitl for ro'ect —� '
HOURS FOR CONSTRUCTION ACTIVIT�Yi �EFFECTNE=3N8/2010 = PER CMMC Sec. 13-279
mo�aay mr� Frmay a:oo am mru r.00 pm. saeurdays-e:oo am tnru s:ao pm. Prohibited all hours - Sundays and the following Federal hotidays:
New Yeare nav_ Momnrial Oav_ Indeoendence Dav. La6or Dav. ThankSaivina DaV and Chflstma5 DaV
NOTICE: The work authorized by this 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 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 inspedions and Flnal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COUE i. INSPECTIONTVPE DATE INTITIRLS COOEt INSPECTIONTYPE DATE INTffIRLS
1616 Fized System Final Fire Prevention 206 Final Mechanical ��
1266 Pool Spa Final 208 Final Plumbing �3 hJy/ Nf�
200 Final RaRoof 210 Final Elecirical T
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site '2 / �.,,,�/,,�
204 Final Demolition 250 Final Building/Occupancy z �/�/ '
��re�tlr �{ BC /3 — '��/3 �
WORKERS' COMPENSATION DECLARATIOI
1 hereby affirm under penalry of perjury one of tht ��ilowing declarations:
❑ I have and will maintain a certi(rate ot consent to self-Insure (or workers'
compensation, as provided for by section 3700 of the Labor Code, (or the
peAormance of the work for which this permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of Ne Labor Code, for Ne peRortnance of Ne vrork for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
�carrier. . S T/i-'TL �U.1�/�
(lhis sectm needml be cw�plefetl il Mepp�emtif u wdWetl el one huiM�etl ddlars (Sf001 wless.)
Policy.Number: ��%7 Q V L —ZAi��-'�'
❑ I certify that in tha performance o( the work (or which Ihis permit is
issued, I`shall riot�emp�oy.any.person in any manner so as to bewme subject
to the workers^ compe`nsa[ion laws of Califomia, and agree that if I should
become subject lo the orkers' wmpensation provisions of Section 3700 of
the Labor Code, I sh rt � it c rn ty wit� ese provisions.
:-�' /3
�/y gnature �Da a_�-
WAR : 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 ADDRION 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 aKrtn [hat I am licensed under provisions of Chapter 9(wmmencing
with Section 7000) ot Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic..#- ' 2G1 S � CClass#-�^ �
" �� 3 oC�Jl3.
s 1..._Date�
/
CONSTRUCTION LENDING AGENCY:
❑ I hereby affvm that there is a construction lending agency for the
pertormance of Ihe work for which lhis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender s Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS IICENSE LAW for the following reason (Sec. 7037.5,
Business and Pro(e55ions Code: Any city or counry which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signed sta[ement
that he or she is licensed pursuant to Ihe pmvisions of the Contractors License
Law (Chapter 9(wmmencing wilh Section 7000) o( Division 3 of the Business
and Professions Code) or that he or she is exempt lherefrom and lhe basis for
the alleged ezemplion. Any violation of Section 7031.5 by any applicant for a
pertnit subjec[s lhe applicant to a civil penalry of not more �han five hundred
dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
wmpensation, WILL DO 7HE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contrectors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, Ihe 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 tor purpose o( sale.).
❑ I, as owner of the property, am EXCLUSIVELY CON7RAC71NG WITH
LICENSED CONTRAC70RS ro construd the project (Sec. 7044, Business and
Professions Code: The conVactors License l.aw dces not appy to an owner of
properry who builds or improves thereon, and who contracts for such prqect with
a contractor(s) license pursuantto the Contractors License LawsJ.
❑ I am ezempt under sec.
Business and Protessions Code for this reason:
Owner ID venfied by dn icense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (lype of tlocument, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceNfy Nat no excavation fve (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authonzed
by this pertnit, and that no building sWclure, scaffoltling, falsework, or demolition
or dismantling thereof, will be more than Nirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia AdminisVative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from [he Division of Industnal Safety, as noted above, unless
such person has a pertnit to do such work from the division.
Applican['s SigneNre
Division of Industrial Safery Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 0! the Califomia Health and 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
ot hazardous materials equal to or greater than a weight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard
temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of [he Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by each
business which at any one time has on hand a quantity of acutely hazartlous
matenals equal to or greater than a weight of 500 pounds, or a volume of 55
gallons, or 200 cubic feet of compressed gas at standard temperature and
pressure).
3. Does or will Ihe applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides that the
Cosla Mesa Fire Department may require [he preparation, certification and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully wmplied with? ❑ Ves ❑ No
5. Does or will the applicant or present or fuWre huilding occupant require for
the work which is the subject of this appliration a permi[ for such construction
or modifwtion from [he South Coast Air Quality Management Dislncl or from
any other air pollution control district or agency? � Yes ❑ No
(Seclion 658502 of the Calitomia Govemment Code requires that the requested
in(ortnalion be (umished on applications for non-residential building pertnits).
6. Will any part of the facility to be constmcted under this permit be within
1000 feet from the outer boundanes o� a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safery Code).
7. I! a permit (rom the South Coast Air �uality Management DisVict or other
air polW[ion contml district or agency is required for the work which is lhe
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf "yes", atlach certificate ot compliance from the appropriate air pollulion
cOntrol offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
intormation given above is wrrect. I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
Signature Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certiry under penalty of perjury that I have read this application and state that
the information given is cortect. I agrea to comply with all state laws and city
ordinances relatlng to building wnstruction, and authorize representatives of
the Cily of Costa Mesa to enter upon [he above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by this permit until final inspection.
SignaWre gal wner(s) Da�e
03 3
SIBnaNre Da[e ��� t r ate' ) '
305]<6 (3/O])
� - ,. . . . ,
� AVGlicant to fill in all spaces exttpt ihase within heavy oorder lines antl.si9n all aOPropriate tleclaratians.
4� CITtirU COSTA MESA CONSTRUCTION PERMIT ' P MIT N � TRA LOT NO. UNIT N6.
�
I
�
:._-._ - �. , � � �° as-� a��'� q
�?roject Adtlress � ( `✓� Fi�L L L
Applicant's f4�ailMing Address /�'/
Owner'sName rs`�J"��� C:�C1�OL�_phoneY�(_�Q(j
\. ��
Address
Arch/Eng. �_License No
Address -�`�•
ConVacmr'sName � ('" 'P"�ho�na7/�
Address (mailing) ,�{{ay.:tf��y'S�0
�� �~_
City License No. _ '
UCENSED CONTRACTOR DECLARATION
I hereby affirm tha[ I am litensetl untler provision5 of Charter 9(commencing
with section 7000) of Division 3 oi the Business antl Professions Cotle, antl
my license is in f II f�rce antl effect.
License Class � LtiEenSe N
Oale � Si9nature
WORKERS' COMVENSATION DECLARATION � �
I hereby affirm tM1at 1 have a certificate of consent to self-insure�or a c ificate
of Workers' Compensation Insurance, or a certifietl copy thereot (5 ction
3800. lab. C�4(c-BSOn�{- lS� °' Y S7�i4� ��
Policy No.
,� Certifietl copy is hereby fumishetl. �'. '
�d�Ce Iti H/ �co yyy���sJ�led with the city B in iv n. �
Date�y_J.{p_.�P�{/`— Applicant ` - + .
EXEMPTION ROF M WORKERS' COMPENS ON DECLARATION
(Thissection neetl not be wmpletetl if the�permit is tor one hundretl ($1 0) or
less). -- .�
I certify that in lhe pe�fo�mance of the w6�k fo� which this.perm�t is�lss e, I
shail no[ employ any person in any manner so as to become subjett to he
Workers' Compensation Laws of Califomia. .
. Date Signature -
�NOTICE: If, af[er making this tlecla�ation,'you shoultl become subject to the
Wo�kers' Compensation orovisions o( the Labo� Cotle, you must forthwith
comply wi[h such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENGV �'
I hereby afflrm [hat there is a constructiomlentlinq agency for.thE pertormanC¢
of tne work for }tys, i iss }$��tyop 3097 Civ. CJ
Lentler's Name `V f��� L'
Lentler'sHtltlress _ U ST �Isli'�T��
OWNER BUIL�ER DECLARATION
I hereby affirm that I am exempf from the Contractor'S License Law for the
(ollowin9 reason (Sec[ion ]031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any structure, prior to its issuance, also requires Me applicant for such permit
to ti�e a signetl statement that he/she Is licensetl pursuant to�tlie proviswns of
the Contractor's License Law (Chapter 9(commencing wifh Section ]000) of'
Division� 3 of the Business antl Profe5von5 Cotle) o� that h¢/she i5 exempt
therefrom antl the basis for the allegetl exemption. Any viola[ion of Section
]031.5 by any applican[ for a permit subjectr the applicant to a civil
�enalty of nof more than tive huntl�etl tlollars ($500).. �.
Ll I, as owner of the property or my empioyees witn wages as tneir sole
com0ensation, will Go the work, antl the SVucture is not intentletl o� offerEtl
for sale (Sectian ]044, Business and Professional Code: The Coniractor's
License Law tloes not appty to amowner of a proper[y who builtlz or improves
theroon, antl who does sucM1 work himsel(/herself or th�ou9h his or her own
employees, prOvitletl that such improvements are not intentletl or otfetetl tor
sale. It, however, the builtlinq or improvement i5 soltl wlthin one yea� of com-
pletion, the owner will nave the burtlen ot provin9 he/she tlitl not builtl or im-
prov¢ for the-purpose of Sale).
❑ I, as owne� of the property, am exclusively cont�acting with IicenSetl Can-
tractors fo con5truct the project (Sec[ion 7044, Business antl Profe55ians Cotle:
The eontractor's License Law tloes not apply to an owner of property who
builtls or improves thereon, antl who conVacts fo�'such projects with a con-
iractor(5) OcenSe pu�suant to tM1e�Contrac[or'i Li[ense Law). 1 am aware tM1at
proof of their Worker's Coinpensation insurance shoultl be provitletl to me.
❑ I am exempt untler Sec[ion B. & P. C. fo� this �eason
Date Owner�_
1�hereby certify tM1at 1 have reatl Ih
informa[ion is correct. I a9ree to con
Siqnature _��1
Drivers' License or 55 =
lication�antl state that the above
ith all city antl county ordinance5
:tion antl hereby authorize repre-
e abOve-meMionetl �prP perty for
oate � l �.+� / �
CMF 0865-46, rev. 10/B4 WM1ite - Builtling: Canary - qpplicant;
TYPEOFCONSTRUCTION NEW AD ERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p # 5�
DESCRIPTION OF WORK/USE OF BLDG. �r'�%��G� .eC�jM
S Main Building:
TVPEOFPERM� GRADING OUNDATIOfy,� RUCTURA� T Front
❑ TENANT ELECTRICAI PLUMBING �L\IVIECHANIGAL // B Rear �
❑ OTHER _ �, \ � %�
PROJECT DESCR�P710N so �FjT' `� ' nrruannirv �� C Right
CONSTRVCTIONTVPE y� �VAIUATION$��9� g Left
ZONE GRADING CU. VDS. ACRES' Ping. Ref. #
Remarks: ' ' �� Planning Notes:
Bar Sink
Backflow Preventer
Backfiow Irrigation'�
Bathtubs
Clarifiers
Dishwasher • '
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service 2 Outlets
Kitchen Sink '
Lavatories
P—Trap '
Roof Orains
Reinspection Fee $15
Boiler
Duct-UnderGround
Duct - SVuccural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. ICBO #3i 7
� Heating System & Ducting .
-700,000 BTU �100,000
IReinspection Fee � I $15
Goltlenrotl - Assessor
^ d'S s
PLUMBING
SFIOWCfi
Service Sink
Sewer Cap= � ;j
Sewer�Connection
SolSr Collectors
Solar Piping
Solar Tank � )
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
• Auto-Wash
laue Fee !
Hoodor Typel� ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU 0100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fae
$ 3
$ 3
4243 6/06/85
S� — � Zo�e.
' Accessory Buildin9: �
' �„ Parkin9 Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15�
,Construction•PoleSub. . ❑ 50
Dishwasher'
Dryers ❑Ga
Fan -
F.A.U.
Fixtures
Device �Boxes
Meter �� to 100 emps
Mecer ❑over 100 amps
lectric Sub Panel
� Motors OO-1 HP O1'/:�- 6
Inc. Solar �9-15 HP 016-15+
Microwave
Pole Light
Garbage Disposa�
Generato'r �0-5 KW �5-15 KW
1
', Standing Sections �
Trash Compacmr -
Fee_.- �. . �$15 � � Issue Fee
:::eGS il.
Z
O
N
I
N
_ G
R
E'
Q
- M
T
S
FEES
$ 3
— DEVELOPMENTSEPVIC S EQUIREME TS: %% ��^^
Zoning'Approved By ��•_ K� � Date J�GZ�/��'
Buildirig Appmved Hy �Date �����
_ �
�, Application Issued By Data
��� `�_a% SU� �/p� RV O�F--. FEES
� BUI'LDING PEFMIT $ �� SMIP $ /.3�
< PLA�NCHECK $ 9�•.��L pERM1T
� � ��PLUMBING $ .S� OO ISSUANCE $ .
�� 1•� � HLAN CHECK,'25% $ � D. S�O_ ENERGV P.C. $
` ' ELECTFICAL $ ���._ '�C. GRADING $
' PLAN CHECK 50% $ �f• �K% MICROFILM $'�j
' MECHANICAL $ �'� TOTALFEE '$ G67,��
� ' PLAN CHECK 25% $ r�O , �
A
.... w r u_ .
,..
�= �� ONSTRUCTION AND PLANNING i_ POOL & SPA � _ �
" L Date Inspector Date - Inspector
'�� PPROVALS Permit #� , � , APPROVALS Permit # -
1'.,Temporary Electrical Service or Pole� -' " 52. Pool & Equipment Location i
2. Soil;Pipe-Undrgrnd. �� �' .�- 53. Steel Reinforcement �
3..Electrjcal Conduit'Utility�Undrgrnd. • ' 54. Forms �
4: Electrical Conduit;Undrgrnd. � _ 55. Electrical Bonding � �
.,
5. Steel Reinforcement' , �� 56. �Rough Plumbing & Pressure Test
6. ,Elect��icaI�VFER (nmtl. . � '' . . 57. �RPPROVAL TO COVER-GUNITE . ' "
� i i
7. Footiri s �
g X�„ � '� � 58. �Electrical Conduit-Undrgrnd. _ .
8. Foundation , � ' , � _ i ' _ ; ' 59. Gas.�Pipe, � Undrgr.nd., Test ,
9. Water Pipe-Undrgrnd. � • , 60. �Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor Syst2m � . 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection �� � 62. Backwash & Receptor-Final ,
12. Sewer`,Cap •� � , +
� �; � � 63. Heafer & Vent-Final . .
13. Roof�Qrains � �• � , , 64. Plumbing System - Final
14. Rougli Plumbing ; 65. Electrical-Final
15. Rough Electrical-Conduit ' ' 66. Solar System-Final -
�. �
:i6: Rough Electcic Wiring . � c� 67. Fencing & Access Approval
.17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
. 18:'Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
" 19. Rough Heating & Air Conditioning -7�t� J'S C�O FIRE DEPT. REQUIREMENT
/'� ,
20. Rough Factory Fireplace ' •7 � G�� APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts,Ventilating ;.�� - . 71. ProductPipingOGas ❑Oil ,
� 23: Gas Pipe-Rough &.Test . 72. Underground Flush .
2A. Roof Framing �� 1 ' 73. Undergrnd. Storage Tank O Gas ❑ Oil
i,
25. �Roof Sheathing �� � 74. Overhead Hydro ,
26 xT-Bar�Ceiling (Structural) & Monocoat � 75. Dry Chemical
27: CFrame end Flashing . � � �(� 76. Dry Standpipe .
28. Lathing 8F�Siding 77. FIXED SYSTEM FINAL
29. Insulation �� � C/ 78. FIRE PREV. FINAL
30. Drywall Nailing �• � e HEALTH DEPT. REQUIREMENT
31. Plastei 8rown Coat ' � !� 79. FINAL INSPECTION
32. Electrical Power Meter}Final 80, FOOD CERTIFICATE ISSUED
33. Final Electric • Notes: -7 �5 �-� �CEL/J �h/C p�'�� ,C-
34. Final Heating & Air Conditioning � '�/L V� �'/(j 6.�- is Rbl��1>
35. Final Gas Pipe-Test ��ll� („�,� ^ {�/ � ��S 7--�
� �� v
36. Hood or Canopy, � ' '
J
37. Final'Facto'ry`Fireplace �' yj��r �,,Eq �
�
38. Final Plumbing � `+�
'i
39. Water,Service-Final . ' ,
40. Gas Service-Final " '
i :-
41. Solar.Domestic-Final - .
42. Backflow Preventer � ' � � ��` . •
. _� .
43. Backflow Irrigation ' ,! ' �� � ' • ;K,.y ;
�
.' , '
44. ,Landscape Irrigation System � �> '
45. Sound Attenuation ,� `� �
t �
46. Handicap Regulations ' � ,
,
47. FINAL STRUCTURE & BUILD��NG �� � � �
48. Special Requirements Completed •
49. Ele�ctric Release to Edison � �'��
/ ..
50. Gas Release to Southern California Gas Co � ��� �
51. CERTIFICATE OF OCCUPANCY _ � .`"'r. � ,, ; � �
No. Date � ' , � � • • � �
1 _ ` .
�� � - Ii1�SlJLATIOIV CER�"IFICA`T'IOM
.P7'� ,l�.A,P.�'.Fti / C'o1r:9 ��% s/� �.v/�6c
Number and Street City Counry
Subdivision
Lot Number
DESCRIPTION OF INSTALLATION
ROOF
lhaterial Brand ldame _ �
7hickness (inches) Thermal Resistance (R Value�
EXTERIOR WALL
M1Aaterial ����'�J� Brand Name %���C/41w7i �c�
Thickness (inches) .3 � Thermal Resistance (R Value) ��
CEILING
Batt or Blanket Type F_riS�i�i.'.t�X's
Thickness (inches) � ��L
Loose Fill Type
Minimum Thickness (inches)
Area Covered (ftZ)
PLOOR,ELEVATED _
Material
Thickness (inchesl
FLOOR,SLAB
Material
Thickness (inches)
Width (inches) �
FOUNDATION WALL .
Material _
Thickness (inches�
»
&and Name CF'�i-QT,�'�7�L-i �J
Thermal Resistance (R Value) � % i' _
Brand Name _
Number of bags Weight per bag
Thermal Resistance (R Value)
Brand Name
�
Thermal Resistance (R Value) _
Brand Name
Thermal Resis[ance (R Value)
Brand Name
Thermal Resistance (R Vatue�
DECLARATION
1 hereby certify Yhat the above irtsulation was insialled in the buitding at ihe above location in �nformance with
the current regulations setting Energy Conservation Standards for new residential buildings (lonted in Title 24
of the uiifornia Adninistra4ive C:,da;. .
�, �AYhI�= hini.�ra2,> ��n S T�.
Ganmel Contrector IBuilder)
SiBnature and Title
//.f�"�'rf/E/� /-��</T S/(/.SL(G/fTr_D/U
Sub ntractor (ln�ula ion Applicetod
Signature an itle
35 /9Yy
Licenae Number
Dete
5���y'1�
Licanse Number
9 �/ -� r
Data
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UJ
W
K
H
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W
U
Z
Q
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COSTA k9ESA BUILDING DEPARTPAEIdT
P. 0. BOX 317
COSTA MESA CALIFORNIA
C•L. OF STREET
' ��PROP. TINE _
� 10 FT. FOR 60 FT. STREET—
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T-«� � ��
PROP IINE "� "
L_1!__—_�.____
C.L. OF STREE
LIN
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T � ,
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SOF'�IF FRON
IOF PROP. F
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F- �' � a � 0 I
�1 . Li e- 'v, � FT I ;
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—' ------�
S T.
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES
I 53'71 �I .
FOR APPLICANT TO FII.L IN
BUILDING ADDRESS ���/���' GIIVLt�i�
Owner�i�� �'�''""�
Mail Addres ��� a%�-� ��
City L°��- ' �'�'�e"L`� Ph. No.
Contractor'y 't��✓�--,- �ry ��'Ph. No � � � � � � ^
Address � g� r 7 ��'
City Lic. No. � �J State Lic. No.�...�.5 ��
— - - - - -��-j- - - - - - -
Size of Lot o X/ D-ti� 1�P No. ����"�' S 7� ���
p a'
Setbacks: C/L Street � / � Rear '
Side Yard - Right o� �� Left o� �/ ) ��
Type of Fence—���%—`� � / ��`J�
�� '
1 : � .5 ._ �ii
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State Laws regulating building construction.
Signature
of Permittee
OFFICE USE ONLY
' /)--� % � i• './
VALUATION � �,
Permit Fee $
Plan Check $ �
TOTAL FEE $ ✓ '
U.SE REVERSE SIDE FOR DETAILS
�
-OWNER PARKRR � M. — ��P 2 4 19�7 , DATE _
6-17-57
JOB �ABDRESS g7li Darrell BUILDING PERMfI' NO. 5j17
L NTRACTOR 2Irtid F0nC0 VALiIE $ 290.00
. o. LOT �9 TRACT FIRE ZONE DESCRIPTION OF WORK F2nCe
GROUP TYPE ZONE PLAN NO. 5j71
INSPECTIONS I DATE I SUBCONTRACTOR I ___ PERMITSISSUED ,f
Beam
coat
Pinal Gas Test
OWNER � BRIS`_'OL
DATE
JOBA�DRESS i'j�1 DarrPll Straat � BUILDINGPERMITNO. #3GZ3
GENEHALCONTRACTOR $ V i-IllIl53}C8P VAWE $ 8,856,��
LOT 7J BLOCK TRACT 2873 Sin�le Res, w/att. ear.
GROUP I&`J TVPE V ZONE R�,j FIRE DISTRICT 3EJ5%
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
_ DATE � NUMBER
Formsand Gradeto
Plum
Plum
P.7
-<—�_� �.va�•1. ..�.
Heating, Final Ji�/� s /.- 1-S� ,
Sewer, House Sewer, St � d��� ��. ���/�n, y /p�� �( 7!i �/' %'"'
SepticTaokoFC�pool � m�O S_� 0/6 !< <..- �;CC'�n ��-4'-.rti �� 9 7—
r--r
Lathinq, �n Out i �� /�j..4.; =, � �
Plumbing,Final,FixturesComplete%1�C5 /1•,�„
Plumbing, Fin,al GasTest/S"'.1' �5 �z,�, �
Wiring, Final �
OCcupancy �) � „���
FORM 210 3M 10�+5
'�o�ta Mesa Bnilding Department APPLICATION FOR PERMIT
,-t- P.O.Box3�, .���� BUILDING '
- :_ COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
Receipt No. Permit No.
�9 � P, �P.�.E ✓ � � �_ :
�
Costa Mesa, ria�OPRI& Receive by �Q D�a/te Rec'd� �ate Issu�
st !, l _ �� -
i� _ V�i`-�� � J
�• �} Tel.
/ �iMl�.�� C� i%�V No..
itector � Lic.
neer �. No.
ess —
,/ c�sr
raetor ,�!/ - dryS�,�%;.{,�}q,
_�_
•ess 1r�.in �"
egal � Lot y, r„ � �
Size of Lot G O� /G�C
l�se of �_
Exisling Bldg.
Center of Street m �O �
AESCRIPTIOP
New I �Alteratio�.
No. of Bldgs
Now on Lot 0
No.of No.oi
Familles Raoms
Rea `Vard AS
. _ __ ' _ -�
Demolish
Nearest
Cross St.
Costa Mesa, California
CORRECTIONS
APPROVALS
Foundation Location Inspector
Forms, MaSerials,
Under-Pinning
Frame: Fire Stops,
Braeina. Bolts
I hereby acknowledge that I have read this Applicatlon
and state that the above is correM and agree to rnmply Lath. Int.
with all City Ordinances and State Laws regulating
building rnnstruction. �ath. Ext.
Signaturaof � ���_��'�j plaster,lnt
Permittee �
Authorized Agt�G�j ��y._��i1 p�aster. Ext
Valuatlon Permit Fee $ � ,� Mason
s �f Q0 Pian Check $ �/ ' Bond I
��6 `. • To�� JJ
Fea $ �/ �J � FINAI
FORM R09 IO�y4 D. P. 8 5.