HomeMy WebLinkAbout845 DARRELL ST - Building PermitsCITY OF COSTA MESA �
BlIILDING DIVIS/ON
rs , :.
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • wvnv.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC07-00332
PERMIT TYPE: 8 COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 11121/2007
_ - - ISSUED BY:
:.-.:...-. .._
�oB AoofteSs: 845 DARRELL ST CM'_ � � Suite/Unit: �
APN: 42236309 �'� �� - ���., Zoning � � .
Vicinity: NOOK ,.;,f ' �" � PrimaryOcc:�-7?.
ConstType: V-N ��"'1� SQ�_FT ' "'� �74 � �. �-Valuati�on: $36,837.60
� �;.
,. , . ., ..,.. ,
SCOPE OF WORK: 73.SSF N�OOK ADDITION�TO AN EXISTING SINGLE-STORY SFD.'WORK�ALSO��INCLUDES KITCHEN
REMODEL; MECH TO ADD'.INSTALL NEW FAU (<t00K BTU), ADD A/C, KITCHEN HOOD; ELEC:`12 CIGHT FIXTURES, 4
OUTLETS, 4 SWITCHES,,A/C PKG; STUCCO AND RE-ROOF EXISTING S.F.D. REF: BC07;00017 -�
3`: . � � _ .
OWNER: THOMPSON;.ANDREW,-J �� Address:_ 845DARRELST�. � , ,- _, : Unit: �
Phone: .!- City/State/Zip: COSTA-MESA; CA_ �- �+ A�
_:: ;� ( Y � � .
APPLICANT: THOMPSON, SILVIA - ��' -- Address: 845 DARREL ST � . � � _� -�. Unit :
Phone: 949-646-2605 . � . `-�,City/State/zZip: COSTA MESA, CA. , � �
CONTRAC70R � '._ -_ �- � � � - � � � � � License No. . � -
,__ , ,.- .,:
Phone: Y��� t�•�"_ Address Unit �'
Cell: " i� City/Sfate - � �-'ZipCode
U .
. �� �' - ._ � ;
ARCHITECT: '�.� i License No. - - � � PHONE -'
ENGINEER: �� ' ' t'� License No. - - - - � � PHONE:-�
.. �} . . , _ . . .. - .
(`(1MRWTATInN PFRMIT FFF`CI IMMARV..' :'.' ' - � •
Bufldfng Plan Check: • ,� �- -.;: ;$333:42�� � . � � -� �'�--� � _' . � �-. �
Building Fees: - � `''-;$512.95. �, . - -- � .
Electrical Fees: $100.00 . ° �
MechanicalFees: '�:;� - $7630!��, --��-�� - �
Plumbing Fees: " $0 00 + i
SMIP Residential: $0 00� '�
SMIP Commercial: _ ,$7 74 �'� � -
�• ���:.",�
TOTAL FEES: $1,030:44 __ __ , ' P
"Re(er to fee receipts for all fees paitl for project � �
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 authorized under this permit to be wnsidered legal, such work must wmply with all applicable codes, and all
required inspections and findl approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
CODE /. INSPEC710N TVPE
1616 Fived System Final Fire Prpvention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Bbck/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final emolition
OAiE INTITIRLS LOUE/ INSPELPONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final ElectriCal
212 Final Fire Prevention
220 FinalPlanningApproval
222 Final Site
250 Final Building/OcCupancy p/[�,
r�
OATE
���
INTITULS
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WORKERS' CU�APEkS`.4TION DECLARATION: /-'`�!�Tm=�d.�Y tlri e . es ❑
I hereby affrm under penalty of perjury one of the following declarations: Driver's Lice No. � Ex ir .��
❑ I have and vnll maintain a certifcate of consent to self-Insure for workers'� ri icanon o( Ownershi b
compensation, as pmvided for by section 3700 of ihe Labor Cotle, for [he P Y(HPe of document, i.e. - property tax bill or deetl):
pedormance of the vrork for which Ihis permit is issued.
❑ I have and will mainlain wnrkers' compensation insurance. as required by �
sectbn 3700 of lhe Labor Code, fw the peAortnance of the work for which this DNISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION:
permit is issued. My vrorkers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation fve (5) or more feet in depth into wfiich a
number are: person is required to descentl, will be matle in conneclbn with wnrk authorized
by this permit, and that no building sWcture, scaf(dding, falsework, a tlemolition
Cartier: or dismantling thereof, will be more than thirly-su (36) feet high. (Chap. 32, Grp
(Tnissecttannactlnothemmpeletlllhepe�mfsvaluedalmenuMreOd�Bars(E100)arless) Z ArtZ Se� 34� TtIeB.CalifomiaAdminis[rativeCode).
Policy Number:
❑ I certify lhat in the peAormance of the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
ihe Labor Code, I shall forthwith comply with these provisions.
Appliwnl's SignaWre �ate
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 DOLIARS
($100,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eflect.
Lic. # Class #
Contractor's SignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a constructbn lending agency for ihe
peAortnance of the v.ork for wT�ich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name: �
Lender's Address:
SignaWre Date
OWNER-BUILDER DECIARATIONS:
I hereby aKrm that untler penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollpwinq..:}CssU�1. (Sec. 7031.5,
Business and Profess�on�,�Qde: � city,o` ounty whichaequires a permit to
consl[�;,_alter, impro'L€,�(]emol or`��i'�paii��_any sViictuie, prior to its
iss!�"�Y,c,�`$Iso requiresirei pliw� for sutfi pet(nit toS'de a signed statement
tha�+ne`or she is Iicense�purs�Pt to+the provisions of Ihe Con[ractors
Lic€�Se,YL�w (Chapter 9(wmmencing vrith Section 7000) of Division 3 of the
Busi�$s antl Professions Cotle) or that he or she is exempt therefrom and
the basis (or the alleged exemption. Any violation of Section 7031.5 by any
applicant for a pertnit subjects the appliwnt to a civil penalry of not more than
five hundred dollars ($500).):
�I, as ovmer of the property, or my employees wilh wages as iheir sole
ompensation, WILL DO THE WORK, antl the structure is not intended or
oftere0 for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes 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 Ihat such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, Ihe ovmer-builtler will have Ihe burden of proving that he or she
did not build or improve for puryose of sale.).
❑ I, as owner of ihe property, am EXCLUSIVELY CONTR4CTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The wnt2ctors License Law tices not apply to an ovmer of
property who builds or improves thereon, and who cont2cts for such project with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
�
SiBna re ' �ale
J05]-46(310])
❑ As owner-builder, I will not employ anyone to do work which would
require a pertnit from the Division of Industrial Safety, as nored a6ove. unless
such person has a permit to do such vrork from the division.
Fppliranfs Signalure
Division of Industnal Safe[y Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to fle antl
certify a Business Plan (or emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of ihe Califomia Health antl Safery Code requires, with some
exceptions, that a Business Plan be fled wilh the Costa Mesa Fire
DepaAment by every business which has at any one time during a reported
year a quantity of hazardous matenals equal to or greater than a weighl of
500 pountls, or a volume of 55 gallons, or 200 cubic feel of compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or (uture building occupant need to file
a registrati0n form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of the California Health and Safey Code, with some
exceplions, requires registration with the Cosla Mesa Fire Department by
each business which at any one time has on hand a quantity of awtely
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
temperature and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides that the
Cos[a Mesa Fire Departmen[ may require the preparation, certification and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous matenals wi[h the Fire Departmenl.
4. If an RMPP is presently required, has Section 25534 of lhe Califomia
Health and Satety Code been tully complied vnth? ❑ Yes ❑ No
5. Does or vnll the applicant or present or future 6uilding occupant require for
[he work whiCh is [he SubjeC[ ot IhiS applitation a permit for such con5lruC[ion
or motlifcalion from Ihe South Coast Air Oualiry Managemen[ DisMct or from
any other air pollution control tlisMct or agency? ❑ Ves ❑ No
(Section 658502 ot the Califomia Govemment Code requires that Ihe requested
infortnation be Wmished on applications for non-residential builtling permits).
6. Will any part of the faciliry [o be constructetl under lhis pertnit be within
1000 feet from the outer boundanes of a school? ❑ Yes ❑ No
Qf'yes", Ihe facility must mee� �he requirement of Sections 25534 and 42303
of the Calitomia Health antl Safety Code).
7. If a pertnit from the South Coast Air Quality Management DisMct or other
air polWtion coNrol district or agency is required for t�e work which is the
subject of this application, have all o( the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf yes", attach certificate of compliance from the appropnate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
in(ormation given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
9gnaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalty of perjury that I have read this application and stale that
the information given is correcL I agree to comply with all state laws antl ciry
ordinances relating to buildinq construction, and authonze representatives of
the City of CosW Mesa to enter upon the above-described property for
inspection purposes. 1 agree not to occupy or allow occupancy of any Duiltling
a rize by this pe � rtttffina inspection. �
Sign re of Legal O �al
Andlor Aulhonzetl Ap0licanl Dale
+ , �
� CITY OF COSTA MESA � . , �
BUILDING DIV/S/ON
F� 77 FAIR DRIVE, COSTA MESA, CA 92626 •�(774) 754-5273 • Fax (�14) 754-4856 • vnvw.ci.wsta-mesa.ca.us
�.,�o*,o�D� FOR INSPECTIONS CALL: (714) 754-5626 .
PERMIT NUMBE BC07-00017
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 06/11/2007
. :ISSUED BY: SOK
�os aooResS: 845 DARRELL ST CM: "' ��� Suite/Untt �,
' ;..,.
APN: 42236309 ' ��� ,--Zoning, ��� '
Vicinity: THROUGHOUT S F D ; `+ '' — Pnmary Occ " ;' -
Const Type: V-N �� ' SQ FT ' 0 Valuation;-, $8,000.00
�Yr.�' , •-; :,,, d- � ' C: `�
SCOPE OF WORK: INTERIOR REMODEL OF S.F.D. WORK INCLUDES: COPPER RE PIPE, REMODEL%REPAIR EXISTING 2'. .
BATHRMS & KITCHEN, PATCH�DRYWALL;THROUGHOUT. NO STRUCTURAL WORK AUTNORIZED N/ITH THIS PERMIT.
10/30/07: SUPPLEMENTAL ACTIVIT,Y'fO.CHANGE-OUT OF 6 WINDOWS & 1 SLIDER (LIKE-FOR LIKE)'MEETING CURRENT
EGRESS REQUIREMENTSF' ; . :`.
. , - - � . -'-r�. .
, E. . _ , . , � . . .:.. . . _ '. � , .
OWNER: THOMPSON;'ANDREW J'� - F ' � r �Atldiess: �845 DARREL ST. - : ��� . °-Unit: �
Phone: � � ^'.�'City/State/Zip: COSTA MESA, CA - r;-, -. �
r„
APPLICANT: ROBERT LEWA ,_Address: .953 UNION AV , , � , �'�
�'
Unit: .
Phone: 714323-5820 .- � � 'Ciry/State/zZip: COSTA-MESA, CA2'�•,� . . �
CONTRAC70R: ROBERT LEWA'CONSTRUCTION License No. 825124 �.
. '. � :. :
Phone: 714•323•5820� -'Address-�953UNIONAVUnit: � � �.�- �
Cell: Y� �CityBtate:-. COSTAMESA, CA" � .- ��a�,ZipCode 92627 '
ARCHITECT: - � �..- License No. - � � � PHONE �:`�
ENGINEER:. . � � License No. -, � � � �PHONE:'�
COMBINTATION PERMIT FEE SUMMARY':' ',
Building Plan Check: $0 00 .:
Building Fees: ' � $153 25
Electrical Fees: - ` � ti' � $53 20 '.
Mechanical Fees: � '-� $61 25 - �
Plumbing Fees: � �:$171.90� '�- ' �
SMIP Residential: � '" ; $O.SQ �, � : '�' �
SMIP Commercial: $0.00 -- - �
TOTAL FEES: $440.40
^Refer to fee receipts tor all fees paitl for proJect .
�
NOTICE: �The work authorized by this permit shall comply wilh 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 authonzed under this permil 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.
COUE /. INSPECTION TYPE DATE INi171AL5 LODE t' INSPEC710N TYPE � DATE INTITIRLS
1676 Fized System Pinal Fire Prevention � 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof � 210 Final Eleclrical
201 Final BIocWRetaining Wall ' 272 Final Fire Prevention
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
220 Final Planning Approval
222 Final Site ��� �
250 Final Building/Owupancy !// V V
� ..
WORKERS' COMPENSATION DECLARATION:
1 hereby affirm untler penally of peryury one of ihe tollowing declarations:
❑ I have and will maintain a certificate of consent to sel�-Insure for workers'
compensation, as provided for by section 3700 of lhe Labor Code, for the
peAormance of the vrork for which Ihis permit is issued.
❑ I have and will mainlain vrorkers' compensation insu2nce, as required 6y
sectbn 3700 of the Labor Code, for the peAormance of the work (or which this
pertnit is issued. My vrorkers' wmpensation Insurance wrzier and policy
number are:
Carrier.
(ih6 secfion need not be canpefeE d Ine perme a valvetl a1 one huntlre0 tlollars (Stoo) w less.)
Policy Number:
I certify that in the peAormance of the work for which this permit is
s , I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree lhat if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forth '�J wi h these provisions.
�� �,L r-. ���6.s���..`�'t 0 3D
Appliwm's Signalure Dale
WARNING: FAILURE TO SECURE /RKERS' COMPENSATION COVER4GE
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 afflrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfessions Code, and
my licens�ei is in full g(orce/a/nd eRec[.
Lic. # o Z S/� �, ^y Class # ��
i�v�� �� L •
' Convactor'sSi aWre Oa1e
CONSTRUCTION LENDING AGENCY:
❑ I hereby af(vm that there is a consWction lending agency for the
peAortnance of the work ta wfiich this permit is issuetl. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS: '� � �•� ':'F'
� -54 -:,
I hereby a(firm that under penalty of:perjury�[hat I am EXEMPT�FROM THE
CONTRACTORS LICENSE LAW`for'fthe follbwing`��reason (Sec. 703L5,
. t_.,•;,
Business and Professions Coda:`Any'ciry.or cqunty which requires a permit to
construct, alter,�'impiove, demolish, or-.repair any structure, prior to its
issuance, also requires,the applicant for such permit to file a signed slatement
that he or she i5^licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is exempt therefrom antl
the basis for the allege0 exemption. Any violation of Section 7031.5 by any
applicanl (or a permit subjects lhe applicanl to a civil penalty of not mOre Ihan
five huntlretl dollars ($500�.):
❑ I, as ovmer of the pmperty, or my employees with wages as iheir sble
compensation, WILL DO THE WORK, and the structure is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herselt or through his or her own
employees, provided that such improvements are not intended or oNered (or
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden of provinq that he or she
d—id /not build or improve for purpose of sale.).
VC I, as ovmer of ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conswct the project (Sec. 7044, Business and
Professbns Code: 7he contractors License Law dces not appty to an owner of
pmpeAy who builds or improves Ihereon, and who wntracts for such project with
a contracta(s) license pursuant to the Contractors License Lavrs.).
� I am exempt under sec.
�� Business and Professions Code for this reason:
{ !a 3D
� Signa ure � Dale
305]-06 (3/0])
, r
Owner ID verifietl by d,ri,
Expires:
Verification of Ownership by (rype of documen[, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no exwvation frve (5) or mwe feet in depth into wfiich a
pereon is requiretl to tlescentl, will be matle in connection with v,ork authorize0
by this pertnit, and that no building sWcture, scaffdding, falsev,ork, a tlemolilion
or dismantling thereof, will be more t�an thirty-six (36) feet high (Chap. 3.2, Gry
2, Art 2, Sec. 341, Ttle 8, Califomia Atlministra�ive Code).
❑ As owner-builder, I will not employ anyone lo do work which would
require a permit from the Division ot Intlustrial Safety, as noted above, unless
such person has a permit to do such work trom the division.
AppliWnfs SignaWre Dale
Division of Industnal Safety Permit Number:
HAZNRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre building occupant neea to file and
certify a Business Plan for emergency response [o release or [hreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
ezceptions, that a Business Plan be fled with [he Costa Mesa Fire
Department by every business v+hich has at any one time during a reported
year a quantity of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
al slandard temperature and pressure).
2. Does or will the applicant or present or fuWre builtling occupanl neetl to file
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Health and Safery Code, with some
exceptions, requires registration wiN Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazardous ma[erials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at slandartl
temperamre and pressure).
3. Does or will �he applican[ or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous ma[erials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health antl Safety Code provitles that Ihe
Costa Mesa Fire DepaAment may require Ihe preparation, certification and
filing with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali(omia
Health and Safety Code been (ully complied with? ❑ Yes � No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this appliwtion a permit for such conslruction
or motlifcation (rom Ihe Sou[h Coasl Air Quality Managemen[ District or (rom
any other air pollution control district or agency? ❑ Yes ❑ No
(Seclion 658502 of the Calitomia Govemmen[ Code requires [hat the requested
intortnation be fumishetl on applications far non-resitlential building pertnits).
6. Will any part of the facili[y to be consWcted under this permit 6e within
7000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf 'yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safety Cotle).
7. It a permit from the South Coast Air Quality Management DisVict or other
air polWtion control district or agency is required for ihe work which is the
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", ariach certificate of compliance from Ihe appropriate air pollulion
control oKcer). �
CERTIFICATE OF COMPLIANCE: I certi(y that�under penalty of perjury the
information given above is correcc I agree to comply with all state laws and
city ortlinances regarding Hazartlous Matenals and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read this application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building wnstruction, antl authonze representatives of
the City ot Cos[a Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any 6uilding
aut rized by thi$�ermi � n� I inspection. �1
gaWreolLegal er(s) �� Dale �
AnCIOI AutOonztO NPC�iGnl
CITY OF COSTA MESA
BI/ILOING D/VISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.wsta-mesa.ca.us
FOR INSPECTIONS CAIL: (714) 754-5626
' C11 ► II� C : 1 1IIly�
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 06/1112007
- --- ISSUED BY: SOK
�
�oe,aooRess: 845 DARRELL ST CM ""� ,, - ` rSurte/Unit:_
� - ._,,
Vicinity: THROUGHOUT S.F.D,- Pnmary:Occr �����-"' ��-'�
Const Type: V-N SQ: FT1 ° r� 0. Valuation 2$5 000 00 ,
«�.�. '
� � �
SCOPE OF WORK: INTERIC
2 BATHROOMS AND KITCHEI
STRUCTURAL WORK AUTHC
��:
OWNERt� THOMPSON,ANC
PHONE:
APPLICANT: ROBERT LEYVA
PHONE: 714323-5820, �.
CONTRACTOR: ROBERTLE
Address: 953 UNION A'
Ciry/State: COSTA;;MESF
;!REMODEL'OF S.F.D. WORK INCLUDES: RE-PIPE WITH CC
ANDPATCN�DRYWALLTHROUGHOUT.NO �'y�."
IZED WITH THIS PERMIT. � � ��>f
h '+' i
-. , --�: .� �..���:. ; .,'
EW"J, ,}, �. Address � :��.845DARREL�ST
' CirylState/Zip: "�COSTA`MESA,
� Address: 953 UNION'A
i� :��:'°d Ciry/State/zZip,� �;"COSTA MES)
VR�CONSTRUCTI�ON rv �� " License No. '�'�.
lnit :.:'. . A`r: BHONE._ �, 714323 5820 ��.
CA �'-�` .,ZipCode� 92627 '-�� . , - ��'�� `CELL�.':��
� .,
ARCHITECT: License No. ... ...
ENGINEER: . License No. --
COMBINTATION-PERMIT FEE SUMMARY �';;' � �^ ' ��� �
Building Plan Check: ;��, r, ' r$0 00;,!� �. '�,"�.. �
Building�Fees�. � $11�125
z -tr �
Electrical Fees: $53 20"
Mechanical Fees: �� �$61.25 ��� " �" :
Plumbing�Fees: . ��$17jgp � �'".`'k
�' I �.,
SMIP Residential: � '�$0;00 ti „ " t'i �:-r "
SMIP Commercial: $0.00 y.,E.`-
TOTAL FEES: $397.60 -
"Refer to fee receipts for all fees paid for project
'ER�,•REMODEL/REPAIR EXISTING
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NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and relaled
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 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 final approval will result in the expiration of this permit.
cooe�. iNsvecnoxTrae
1676 Fixed System Final Fire Prevention
1266 Pool Spa Final -
200 Final RB-Roo(
201 Final BIocWRetaining Wall
202 Final Pactory Fire Place
203 Final Sign
204 Final Demolition
o� INTRIRL
CODE/ ixsvecnoNrrve � pnf ixmu�s
206 Final Mechanical
20B Final Plumbing
210
2 i i r e'
c�
220 Final Plannin pproval
222 Final Site
250 Final B � ' g/Oaupancy
WORKERS' COMPENSATION DECLARATION: - .
1 hereby affirm untler penalty of perjury one of the i�_. _..mg declarationsi '
❑ I have antl vnll maintain a certiflcale of wnsent to self-lnsure foFvrorkers'-.
compensalion, as pmvidetl for by section 3700 of the Labor Code, for the
performance o( the work (or which this pertnit is issued. - �
❑ I have and v.ill maintain v.orkers' compensation insurance, as required by,
section 3700 of the Labor Code, for the peAortnance o/ the work fw which this
permit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carrier.
(Th¢ setlan nee0 nol De mmdeletl Jllie pe�mY is valuetl al one hundre0 dodars (St00) wless )
Policy Number:
C�� I i rti(y that in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to lhe workers' compensation lavrs of California, and agree that if I should
become sub� ct to the workers' compensation provisions of Section 3700 of
the Labor d/1 sh oAhwilh comply wi[h [hese provisions.
r� - � O-o 7
�Ab0liwnf Signature . �a�e, ?'�^;•
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 LJ+BOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Iha[ I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in full torce and eHect.
�� z � z c�� ��
tia 6-/i-o�
CConVaclo sSignatdre "� Dzte
�--�_'
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
per(ormance o( the v.ork (a wfiich this permit is issuetl. (Sec. 3097, Civil Code).
Lentler's Nama:
Lender's Atltlress:
OW NER-BUILDER DECLARATIONS:
I hereby affrm that under penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
construc�, alter, improve, demolish, or repair any stmcWre, prior to its
issuance, also requires the applicant for such permil to file a signed statement
that he or she is licensed pursuant to the provisions o( ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( the
Business and Pmfessions Code) or that he or she is exemp[ therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant tor a permit subjects the applicant to a civil penalty of not more than
frve hundred tlollars ($500).):
❑ I, as owner ot the pmperty, or my employees with vrages as meir sole
wmpensation, WILL DO THE WORK, and the structure is not intended or
oRered for sale (Sec. 7044, Business anC Professions Code: 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 through his or her own
employees. provided that such improvements are not intentled or offered for
sale. If, hovrever, the building or improvement is sold within one year of
wmplelioq the ovmer-builder will have [he burden of.proving that he or she
did not build or improve tor purpose of sale.). �
❑ I, as ovmer of �the property, am EXCLUSIVELY CONTRAC7ING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not appty to an owner of
property who builds or improves thereon, and who contracts for such pmject with
a contracta(s) license pursuant to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
SiB�aWre . „ . Dale
�OS]-Ofi1�10))
Ovmer ID verified by driv se. ❑ Ye ❑ No
Driver's License No. /�.%.< �, � � Expires: �� �
Verificalion o( Ownership by (rype of document, i.e. - property [ax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . •
❑ I hereby certdy that no ezcavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection with work authonzed
by this pertnit, and that no building strucWre, scaHdding, falsev.vrk, or demolition
or dismaNling thereof, will be more than thirty-sa (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 311, Ttle 8, Califomia AtlministraMe Cade).
❑ As owner-builder, I will not employ anyone to tlo work which vroultl
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
ApPli W nfs Signalure
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or future building occupant need to fle antl
certify a Business Plan !or emergency response to release or Ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Sec[ion 25505 of lhe Cali(omia Health and Safety Code requires, wi[h some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantity of hazardous malerials 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 antl pressure�.
2. Does or will the applicant or present or fuWre builCing occupant need to file
a registration form for acutely hazardous matenals? ❑ Yes ❑ No
(Seclion 25533 of Ihe Califomia Health and Satety Cotle, with some
exceptions, requires registration with ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quanlity of acutely
hazartlous materials equal to or greater ihan a vreigh[ of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
lemperature antl pressure).
3. Does or will Ihe applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazar0ou5 matenals)7 ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safery Code provides thal Ihe
Costa Mesa Fire Department may require the preparalion, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Calitomia
Heal[h and Safery Code been fully complied with? ❑ Ves � No
5. Does or will the applicant or present or future building occupant require for
the work which is �he subject of this applicalion a permit for suc� construction
or modifcation from Ihe South Coast Air Quality Management Districl or (rom
any other air pollution control OisMct or agency? ❑ Yes ❑ No
(Section 65850.2 of the Califomia Govemment Code requires [hat the requesletl
information be fumished on applications (v noo-residential building pertnits).
fi. Will any part of the facility [o be constructed under this permit be within
1000 teet from the outer bountlanes of a school? ❑ Yes ❑ No
Qf 'j�es", ihe facility must meet the requirement of Sections 25534 and 42303
of the Califomia Heal[h and Sa(ery Code�.
7. If a permit from the South Coast Air Quality Management Distrid or olher
air pollution control district or agency is required tor the work which is Ihe
subject of this appliwtion, have all of the disclosures prescribed by Calitomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certifiwte of compliance from ihe appmpnate air polNtion
controloffcer). _ .
:, CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
� information given above is cortect. I agree to comply �vrith all state laws and
� city ortlinances regarding Fiazardous Matenals antl Emissions. �
SlgnaWre
CERTIFICATE OF. COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalry of perjury that I have read this appliwtion antl state that
the in(ormation given is cortecL I agree to comply with all state laws and city
ordinances relating to building consWction, antl authonze representalives of
the City of Cosla Mesa ro 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 fnal inspection.
� . Si re�l e§aq.neri�— / �D/a!te ' '7
(p %/ ��/
Antl/orAUNonzeEAppican�w'�Y~=' .f" Date: ,;'.:--t
IL�
�f
r�aooeess: g q 5 DARRELL ST
owxe s r+aMe: THOMPSON, ANDREW J
aooeess: TAOMPSON SYLVIA J
845 DARR�L ST
COSTA MESA CA 92627
RflCNIENGMEEP: t714�646—z��J ' ' -
ROOHE55:
UNIT:
flEG.NO.:
UNIT:
PEHMIT�EE_' �LSEN ROOFING CO,-, ZNC. (�13 ) 634-8470
ADOflESS:� 6(jSl NEWTON AV '
LONG BEACH CA 90805
LICENSED CONTBpCTON UECLAIIATION: I �ere0y allirm tha� I am licensed'under provisions o� C�ap�er 9(commencing wi�h Section
7000� a� �iv�sion 3 of Ihe Business and Pmfessions Code, antl my license is in full force and eflect. �
arr uc.: U 3 3 9 0 6 STATE IIC.: � 5 41 9 cuss: �_ g�
Oa�e'._��'�� SignaWre:_
WOFNEflS' COMPENSATION D LABPTION: I hereby aili �hai I have a cenilicale oi consen� �o self-insure or a cenificaie ot WorkeK
Compensation Insurance. or a certilietl capy thereoi (Se ion 3800. Lab C)
roucrNo.: 456122-91 E%P.�ATE: O%I%LI92
. comPaNr: STATE FUND
❑ Ceni�ied copy is hereby fumishetl. � Certilietl co -etl nth ��e mry��Bm/lry'ng DivisiyonJ�/
I'�a�e'. /(%`L�^,�� APPlicant� /�%LN//d ��L�:�-a"' .
E%EMPTION FNOM WOBREBS' COMPENSATION UECLAflAT10 .(Thi55etti0n�eU i� IAe Pcrmil is lorone hmMre01S1001or lessl.
I certily t�ai in the pedormance of I�e woB lor whic� �his permi� is issued. I shall not employ any Derson in any manner so as �o become
Subleci lo Ihe Workers' Compensalian Laws of Calilomia.
�ate: SignaWre:
NOTICE: It. aiter making Ihis tleclara�ion, you 5hou10 become sublett to the Workers' Compensaiion pmvisions ol �he Labor
Catle, you must Iart�wiih camply wii� such provisions or ihis permit s�all 6e 4¢emea revokeU.
CONSTNUCTION LENOING ACENCY: I hereby attirm Ihai �here is a cons�mction lentling agency lor ihe pedarmance al �he work for
which �his permil is issued (Sec�ion 3097. Civ. q.
lENOEN:
-ROOflFSS: �
OWNEfl BII1LDEfl DECU1flATI0N: I Aere�y alfirm ihal I am exemp� irom Ihe ConVaclor5' Sia�e License Law for �he tollowing reason
(Seclion 703L5 Business antl Pmiessional Code: Any ciry ot coun�y which requires a permit �o constmc�, alter, imOrave, tlemolis�, or �
repair any simqure. prior �o ils issuance, also requires Ihe apPlicant tor such permit to fiie a signe0 stalement thai helshe is licensetl
pursuam lo I�e provisions a� Ihe ConVatlors' Sla�e License Law �ChaO�er 9lcommencing with Sec�ion 7000) ot Division 3 0� the Business
antl Pmiessions Code) or �hat he/she is e�emp� there�mm and Ihe hasis for I�e alleged exemp�ion Any violation oi 5¢c�ion 7031.5 by
any applican� �ar a permit sublecis �he applican� �o a civil penalry oi na� more Ihan live AunUretl tlollars (5500�. �
I. as owner o� �he propetly or my employees wiih wages as �hei� sole compensation, will do �he woM, antl t�e
❑ simcture is not intendetl orptleree for sale (Seciion 70aa, Busmess anA Pmiessional CoOe. The Conlraclors' State License Law
Ooes not apply �o an owner o� a properly who builtls ar impmves �hereon, antl who does such work himsell/herseli or thwuBh
his or her own employees, provitled iha� Such improvemenls are nol m�endetl or oflered lor Sale. If, however �he Uuiltling or
impmvemeni is sold wi�hin one year oi comple�ion, Ihe owner will have Ihe burtlen o� pmving �e/she Uid not buil0 or impmve
lor ��e purpose ol sale). ' ,
❑ I, as owner of �he propeny, am excWsivery cantrac�ing with licensetl conlractors Io constmct I�e pmlec� (Section 7044, Business
an0 Pmfe55ion5 COAe: The ConVacmrs'�Sta�e license Law Ooes no� appty ro an owner o� pmpeny who builds or improves �Aereon
and who conlraclsfor such prolecis wi�h a coniraclor(5)license pursuant�o �he Contraclors' S�ate License Law),I am aware
��at prool ol Iheir Workei s Compensation insurance shoultl be providetl �o me. .
� I am exempi untler Sec�ion: B. 8 P. C. , . '
br Ihis reason: �
Oale. Ownec
I do hereby cenify Ihat I am aware of antl un0erstand t�e requiremenis of Calibrnia Healt� and Salery Coae Seciions 25505, 25533, an0
25534 and Ihal I or any luwre builtling occupanl wilVwill nol (ci¢le ane) need to camply wilh said s�a�e cotles antl the requirements tor a
permit br conslmclion or mo0ilication �mm ihe Air �uality Managemen� �islricL Re5i0en�ial cons�mction applications are exemp� imm
inese pmvisians.
�aie. Applicanl:
I hereby cetlify Ihat I have reatl Ihis applica�ion antl s�a�e bove intorma�ion is correcL I agree �o comply wi�� all ciry an0 counly
oramancesantlsialelawsrelaiingto�mltlingcons�mctio nUhereb ul rizerepresema(esoiihiscirytaemeruponiheabove�mentionea
properry for inspection purpases. —��c^% P"' ""
�aie'. _((_i ^ .e.�=_l� SignaNre'. _ V
ori�ers �icense or Sodai Security u:
t6<i�A6 W�ile—Buildlnq: Green—Co�e Enbrce em: Canary—Applicanl'. Pmk—Revenue: Goltlenwd—Assessor
�
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B U5462" '
PERMIT NO: B 054623 PLAN CHECK NO: N GOVT; N SUPP; N
CONSTRUCTION TYPE: S—N PERMTT TYPE: STR FURPOSE: ALT
JOB DESCRIPTION : RE—ROOF W/FIHERGLASS COMP SHZNGLES � SQ FT; 4,353
CLAZM VALUE: , 4,353.00 CALC—VALUE: ' 4,353.00, GROUP OCC: R-3 /M-1 '
COMMENTS; SMOKE DETECTOR(S) RE�UIRED IN HOME, " ����/����) �..iEi�A� ���p�"
If-leif-lEjfiEiF�EiE3FjEafaEiFif3EiFjEiEififiFifiE�EiE�fiF�EiE ifiElEif�lE±EiEifjE161Ei(�iE?EiE3E�F#ifiFjFiF3fiFifiE VIYtV�L V��1r.���
Z O N I N G R E Q U I R E M E•N T S �•
SET�A�KS REQUIRED
------------ MAIN BUILpING ---------- --------- ACCESSORY BUILllING ---------
FRNT: FT IN REAR: FT IN FRNT: FT ZN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT,; FT IN RGHT: FT IN
PARRING REQ• PROV; PARCEL; 42236309 ZNE: REF NO:
PI,ANNING N(5TE5>
� � . , L,e
iE if lE if # iE * iF iF �% R iE 3F iE if If if ik 3f It iE iE if iF jE 3f �1E 3f� iF If� �1f �1(� if 1EiE it # iE 3k 3E IF iE 1f �)E �K� �lf if� iE iE jE iE 1E * iE iE iE iE if iF iP �f iE iE �k iF-1F af ie If!IE iE i"t if iF if �F if iE *
D E V E�L O P M E N T S E R V I C E S R E Q U I R E M E N'T 5
ZONING APPROVEI) BY DATE: �~";
BliILDING APAROVED BY : DATE:
: y
APPLICATION ISSUED BY: DATE; ���
ifiEiE3Fi6ifiElEiEiEiEiFiE�1F1EiEiFiEiFiF7fifiFiFi i 7FifiFiF 3F iF ciF iF F3F � iFiF'3E7FiFiFiE-7E�fiEiFiE�lFiFiEie r ifiE
±fafiFiflEiEaE�Fififif3FiElEiFiflEiEifif1E3f3f�lEaf3E3f3E3E�1F3EiEiE1f1F9E3fiEifiFiF f'i�iFi4� 3Fifaf*#iE1flEiFiFiEiE�4if��1fiElEiEiE�-lCif�lE�1F3Eififi41F�1P�Fjf
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
..� •
BLDG�PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP./RES., GRADING
PERMIT 72:00 , . SO�i_,
PLAN
ISSi7E FEE
BUILDING—D7V—>
TOTALS----I>
PERMIT ISSUE PLAN—CHECK
%Z.S� �.�� �,��
REVENUE DIVISZON TOTAi,S--> COLLECTED:
BLDG.PMT PLUMHING ELHCTRIC MECHANIC
72,00
SMIP/N011-.Rr.S ii
i,?� r �
. �i, :..c:tr�F'.. ;.�i..
TOTAL `�. PAI�D";'=i,-% � DUE
72 . 50 7:2,';�:01,;�'. �;_ . 00
72. 50 OVER/SHOR �.1✓rs i'�w Y %;' 00
FIRE SMIP/TOT GR��INGrP�LAN�;CHEC_K
. 50 - ,.s�r'':•`i:; �1�C;� ::..
1E iF if iE 3E iE ib �E iE 3E if iF 1E �E If iF iE if IE if iF If iF 1E iE iE if jE if If iE it 1E iF 3f 3F ik lf if it iE iF iP if aE if � 3F if iF �lE aF iF if 1F 16 lf iE �4 if iE af iE j(-
I N D I V F D U A L F E E B R E A K D`O W' N'
i
TYPE QTY D E S C R I P T I O N UNIT,COST
SFR 9353 REROOF BY VALI)E RESIDENTIAL NOZONE 1.UU
(END OF FEES � .
1:
m
EXPIRED .
Incomplete Insne' : �: '.',
�
� i
� i �ate '' Sig _ __--
� J? GJFIIf 35'r—DGi1'!i?7Q
� � �ATE: .,r,'?!,'9i 'C? ,e
. � {�
3F 3F 3f jFiE �E iP #F
'OTA�li COST
9,353,00
�`�
/ �:
,r '
, '
;
, .
a CONSTRUCTION ANDPLANNING � . , POO. -SPA ,
,� Date Inspector Date Inspector.
� APPROVALS Permit # APPROVAIS Permit #
r; .-
1. Temporary Electrical Service oi Pole, •'� 52. Pool & Equipment Location ��
t !
2. Soil Pipe-Undrgrnd. .. �' '� � 53. Steel Reinforcement � ''�
3: Electrical Conduit Utility-Undrgrnd. � ,�,. . � 54. Forms� �
�.
4. Electrical Conduit-Undrgrndr� �' - 55. Electrical Bonding /
5. St'eel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electcical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
J�.-Footings �. � . 58. ElectricalConduit-Undrgmd. `
8.. Foundation ��� ., �. 59. Gas Pipe, O Undrgrnd., Test �,.� � -
� .
9.. Water Pipe•Undrgrnd. �� � % 60. Backwash Lines, P-Trap, O Undrgrnd. �
>, ,
10. Structural Floor System .� . _ 67. APPROVAL TO DECK ��
17. Property Sewer Line & Hou�e Connection �. , . 62. Backwash & Receptor-Final 1'
12. Sewei Cap � , , 63. Fieater�& Vent-Final
,�
13. Roof Drains � �� � . „ 64. �Plumbing SYstem - Final . �;,'.
i ...
14. Rough Plumbing .. . 65. Electrical-Final
15. Rough Electrical-Conduit ,Y 66. Solar System-Final � .,
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Ceiling 69. POOI/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � - FIRE DEPT. FiEQUIREMENT '
20.�Rough Factory Fireplace � �` . � �pppROVALS'� -Permit # ��
A
21.'DuCt's, in Structuie�. � � � , � - '70. Underground Hydro . �
22. Oucts, Ventilating � �� : _ . % � -71, product•Pi�ping O'Gas �Oil
23:^�Gas Pipe�Rough & Test : ". - 72. Underground Flush, . �
24. •Roof Framing •� �. • _ � 73:-�Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . ' ' " i� ,...'�O_ � � 74;- Overhead Hydro � ,
�
26.�T�Bar Ceiling (Structural) & Monocoat _ •' 75. Dry Chemical ..
27:'Frame and Flashing ' . 76.� Dry Stand`pipe � . ' ' ' -
28. Lathing & Sidinq . -+�^ - • y 77.' FIXED SYSTEM�PdNAL �•
29. Insulation � . ' , , � � ' . ` � 78:: FIRE PREV. FINAL
�30. Drywall Nailing � ����� HEALTH:DEPT. REQUIREMENT
• 37. Plaster Brown Coatn . . � i �'. 79. FINAL INSPECTION ; � � � �
��32. Electrical Power Meter-Final .. j I, .. 80.. POOD CE�RTIFICATE ISSUED •
.33.'Final Electric - " - � ���� - '�Notes: - � �~' % '
i/_�•,
j34. Final Heating:& Air.Conditioning. � i`� i � . �1 -, , • - . �
�: �
35. Final Gas Pipe-Test �' _ ' ' - i
�
36. Hood or Canopy, � • . � ' ��.:, - : .T, o ' �
37:-FinalFactoryFireplace_ ' - " � ��jr�; • : �''' ,
� 38. Final Plumbing . ' • .• _ � ' ;�i-.7 � � . � • ._ - � � -
�z
�39. Water Service�Final• . � ' Y � i 1�;4 : ' - � -. ; ,-^ ''^ n.*�
40. Gas Service-Pinal ; . . � ` , . , � �
>'41. Solar pomesticFinal " � � ' � • _
42.'Backflow Preventer° , � ' � � : . '
43. Backflow Irrigatiorc,,,.; - - ' u ,� �=' '> '+ � -� -
44. Landscape Irripati�System, `,` � _ - �' � ��'` �'=- e �
♦,'p . •� � � , . � - � .
-45. Sound Attenuatio�-. ;.`Y,�„ • •
46. Handicap Regulations ;:� � ' � , � �S
47. FINALSTRUCTU'�.EB�$UILDING 2 �� �'�,�.
48. FINAL PLANNING:, r- - �. , , � ' ,
49. Electric Release to' Edison �; � i.%� �.�6 �e _
50. Gas.Release.to Southern�CalifomiaGasCo � � `��. , , ' � ''` ", . - '
51. CERTIFICATE OF OCCUPANGY • -
No. ' "'Date
CITY OF COSTA
ApPlicant to flll in
SA • � PEg� IT
PERMIT ' /�,�
within haavy borCer lines ane.sign all aporopriate aeclarotions.
� TRACT NO. LOT NO. � BLDG. NO.
rro�ect nadress _ - �' TVPE OF CONSTRUCTION
� Own2r ' ��� p � �� - ' Phone� , J _ ❑ NEW ❑ ADD ❑ ALTERATION lw..
�'AddfEa ' � " " ❑ REPAIR ❑'CONVERSION ❑DEMOLISH ��
�Arch/Eng. i ' " Cicense No: ❑ OrriER - -
, AddreSS � ' - - ' -- -' - - - - -DESCRIPTION OF WORK
, Contractor � r YS Pho^f17 77�0�. ��TVPE OF PERMIT .
f1
� Addre55 lJ � p � �� � �Qpj �(.}// _ , ❑�GRAOING ...0 FOUNDATION ❑ STRUCTURAI
LICENSED' CONTRACTOR DECLARATION'� ❑ TENANT ❑ ELECTRICAL� LUMBING�OMECHAI
I hereby atfirm that I am licansetl untler proWslons ot Charter 9(com- �
mencing with'section 7000)' bf � Diviilon 3 of' 4he Buslness antl ❑ OTHER '
R'ofessioni Cotle, antl my Iicense is in tull torce antl efiett.• � ' ' '•
-v�� , � PROJECT DESCRIPTION�--'- �- - -.-
License Cla 5 � License �'�D��O , ; .
� S�.FT.
Date �I/ L Signature � , - � � � � � '
WORKERS'COMPENSATION DECLARATION ' - OCCUPANCV_CONSTRUCTION TVPE- - -
I hereby affirm that I have a certl/icate of consent to self-insure or�a VALUATION '' ' ZONE
�rtificzte ot Workers' Compensatlon Insurance, o/'a'certifietl'mpy ,
eoi (Settion 3800, Lab. C. . ' �,nI ' ,� GRADING CU. YDS. ACRES
CY No. �D%2 �QD'OTi�yom4aaY -�•E�AIIhIiV. " . " . . _ _ _. �- .
Certlfietl copy Is hereby fumiSheG.- "REMARKS:
ry� y'Certifletl copy iz filatl with the city Builtlin9 Divislon.
EXEMPTION.FROM WORKERS' COMPENSATION DECLARATION �.
`Thii 5¢CUon neetl not be complatetl if the p¢rmihif for on¢ huntlreU
55100� Or Il55). i � ' . " �
cert ry that in the performance ot the work (or wp�ch this permit Is
IssueO, t shall not emPloy any person In any manner so as.to Eecome � PLUMBING, ' PLAN CHECK �
subject to the Workers Compensation Laws of Calitot��a. --�
Date Si9nature � BATHTUBS SHOWERS
NOTIGE: If after making this tleclaration, you shoultl become�subject TOILETS� ' URINALS
to the Workers' Compenza[ion provisions of the l.abOr Cotle, you must
fortnwith comply with such prorislons or Ihis permi� shall be Geemetl LAVATORIES DOUBLE LAVS '
revoketl. -'- � ' ' � � KIT.SINKS DISHWASHERS
CONSTRUCTION.LENDING AGENCV
I hereby a(firm that there is a cons[ructlon lentling a9ency tor the per- SERVICE SINKS �'. SUMPS '
(ormance ot the work.foy.which t permit is issuetl (Section 3097
Civ. C.�. G C� FLOOR SINKS FLOOR DRAINS
Lentler.'s Name. ��
LenCer's Atltlress DRINKING FOUNTAINS � -
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS
I hereby af/irm that I am exempt from.the Confrattor'S License Law for
t�e (ollowing reason (Section 7031.5 Busine55 antl P�ofessions Cotle: SWIMMING POOL PTRAP
Any ci[y.or_ county whlcn requires a permit to construct, alter,
improve, tlemolish or repair any structure, prlor to Its issuance, also re- yyqTER SERV ICE ALTERATION
quires the appli�ant for such permit to,file a.5lgnetl 4�atement that he
Is Iicensetl pursuant to lhe provisions of Ihe Contra<<or'S License Law GAS SERV ICE OUTLETS '
(�ter 9(commencing. with Se<tion 7000) ot O���sion. 3 ot the
ss antl Professions Cotle) or that he is exempt theretrom antl the yyqTER HEATERS BTU OUTPUT
or the.allegetl.exemption. Any violation of Sectlon ]031.5 by �
ppliwnt (or a permrt subjects the appliwnt to a civil penalty SEWER CONNECTIONS
ot.not mOr¢.thd0 fivE huntl�etl.tlolla�s (E500). - .
❑ I, as owner of the property, or my employees with wa9e5 as their SOLAR TANK COIIECTORS['...�, �
5ole'compensatioq�will Do�the work, antl the�5tructtl�e is not intenaetl �
or offered for sale. (Section 7044, Bu5ine55 antl Protessions CoCe: The SOLAR PIPING SVS. �
Contractor's License-Caw tloes-not apply to an owner of a property
who builtls or improves thereon, antl who tloes suc� wo�k himselt or ISSUE FEE -
Mrough his own employees,-provltletl that such imp�ovements are not
intentled or offeretl (or sale. It, howeveq tne builtlin9 or improvement MECHANICAL PLAN CHECK
is soltl within one yearot completion, the owneNwil� have Me burtlen - _
of provin9 he tlitl not Guiltl or improve for the purpose of sale). `HEATING SVSTEM 0-300,000 BTU �
❑ I, as owner of� the property,�am exclusivery coutracting with qryD DUCTING
licensetl contractors to consVuct lhe,projec( (SectlOn_�044, Business 100,000+8TU
and ProfMsionS Cotle: The Contracror's License Law tloes nbt apply to '-
an owner of ,property who builtls or improves thereon, an0 who con- REFRIGERATION 0-100,000 BTU
tracts from such projects with a� contractor(s) Iicesnetl pursuant to' SYSTEM �
t�e.Conbaclor's Llcense Law). ._ 300,000 * BTU
❑ I am exempt untler Section B. 6 P. C. for this gQ� LERS BTU
y' " '_' _' '. -. _ _ _ . . .__. .
reason SYSTEM REPAI R, ALTERATION
�zte -�- ' - Owner" '- ` - '
1 hereby certlty that I have reatl thls application antl state that the above EXHAUST SVST.EM MULTIPLE .
into�mation i5 co�recL 1 ag�ee to comply wilh all city antl county
ortlinances antl�state laws relatina to constructlon. antl hereby authorize� -�• -� - .�
519nature o � v . ' ' _ _ ' '
' ISSUE FEE
Drivers' License or 55 � '
CMF 0865-46 White-Builtling; Gnary-Appllwnt; P��k-Accounting; GOIGenrotl-Assessor
3265 �' 3/ 15/82 ' 5.00 ; TI,
'� t'.,:,� :-. .-� �_
, �'1. `. ' � . �l `
20NING REGULATIONS' '
no x ...
ZONE
1 REAR YARD (TO
PKG. SPACE REQ.
STREET WIDTH
SPECIAL CONDITIONS:
ELECTRICAL
P.LNG. REF. � ' '
TO BUILDYNLINE
PROPERT
y , �
�PROVIOED
' �: PARK FEE $ � °� �
; DATE `
. �
:t ' .
PLAN CHECK'
GENERATOR 0-1KW_1-10.KW_
TRANSFORMER . _ ,
APPLIqNCE 10-SOKW_50+KW,_
MOTORS ' 0-1 HP_1-10 HP
(INC.SOLAR)' �10-50HP SO�+,HP -
FIXTURES OUTLETS SWITCHE
GAS TUBE SIGNS
POLE LIGHTS �'
5
J� .
. i. .
NELS MAIN .. SUB, " _
RVICE. AMP
� APPLICATION APPROVED BV � -. � DATE -
SUMMARV OF FEES �
BUILDIIVG - - - - "' �
PERMIT . E � SMIP�� � E-
. PLAN CHECK E [���� - SVAINCE E -
PLUMBING Ea2-f== ��GRADING E
;PLANCHECK $'' � � . . . . �
ELECTRICAL y ' s .
PLAN CHECK E 'MICROFILM $
tMECHANICAL $ ' TOTAL FEE•E -
� �LESSAD-.- ..-� . _ _ _
'PL'AN CHECK E , VANCE PC. S
� FINAL FEE �E •S�^..O Zi
�
CONSTRUCTION AND PLANNING 1 POOL & SPA � �--• ., �: �.� ;`� . �- .
Date Inspector, . . . , - . �, .. Date .�Inspector�
APPROVALS Permit # � APPROVALS : 'Permif# ,.-
1. Temporary Electrical Service or Pole � - 43. Pool & Equipment Cocation ' - �� � -- - �-
_ _ .
'- Soil ipe-Undrgrn, - , - - - - - . "' ' � 4 . Steel Reinforcement '
� 3. Electrical �onduit Utility-Undrgrn � -" � " -' - ' � '" 45. '.Fo�ms ' � ' �
!' 4. Electrical �onduit-Undrgm - 46. Electrical Bonding � ''--
. tee ein orce - � • 47. Rough Plumbin - & Fressure.Test`'O�` ' � '�
6. Electrical UFER Gm �- � � ' � �'48. APPROVALTO COVER-GUNISE _
7. Footings - � ' �••'• • • ' 49. Electrical Conduit-Undr rn � - � -� � � ' " " � �., � -' �
!- 8. Foundation - �� - � � � -- �- � � ' ' - " "50. Gas Pipe, ❑ Undr m; Tes`t i - - � , '� �:v �
; 9. Water Ripe,Undrgrn - • � 51.�- Backwash Lines P-Tra 0� ndr rn � '� -
- - .. .
10. Structural.FloocSystem ,.. .,, � - 52.'��APPROVALTO DECK- -• --' � - - - -- - •" • ----'�
.. _,.._. . . ..:.. . .. ..
11. Property $ewer Line & House Connection " � � 53. 8ackwash & Rece tor-F.inaL � � � - ,• ,� � •
� �12.- Street Sewer Connection � � � � �� 54. �Heater& Vent-Final � � � � �� � � ' � � �� � � � - �� �'� �
13. Rough Plumbing - . � - - -- � • -- - - -- -� -� - - - ' -
� 14. � Rough ElectrioConduit - :56. Electricaf-Final_ �_.�. � • ��� ��� � ��
� � - - - - ` - - - r. ,..� , ., . ; .. :
..
� � „ ��.: c .. . ,; <.o:,, . - , . ... ., ,- _ ..,':-
' -15. --Rough Electric-Wiring� -� ----- -- - --- • _: _ _. . � 57.. Solar SYstem-Final __� -' __ ,
' 16.- - Rough Heating.& Air Conditioning _ - _ encing & Access Approval � � " • �
'. 17: Ducts, in Structure �� � � � �� '�- ' ; � .•' � APPROVED�FOR PLASTERING � � �
18. Ducts, Ventilating � ',. ' "' `� ' • +� � � � " - - - , , - -� �� � � -
' 79: Gas Pipe.-Rough & Test. _ � � � ' ' i � - � 60. POOL/SPA SYSTEMS FINAL� : � � . R�R� -� .��. ,. .,-rr_
. „
20: Roof Framing� .__ . �. . , - -- � . . . � ' - ' ' r„' , . ..
21! RooflSheathiri , . ... , � ' .. �`' _ _. � '.'.. � . ,n � _ .:r. . ,�..
r NOTES: �� ' � ' . ^= � '•
22. Frame antl�Flashin - '� � " ' - ; � �� ' ' ' " ' '
23. Insulation .,. , �� • •' � , -�+, . . . , . . r . .
24. Lathing & Siding ' '�"" �- { I ' • � � � �
25: Dryw811 Nailing � � •� •��a � � � � � � ` ` � ' � •' •'
26. Plaster Brown Coat � � � ; � ' ' � ' � "' ' ' ' '
27: Electrical Powei Meter-Final - �� � ' ' �- � � ` ` � � " ": " ' ' '
28.. FinaLElectric' � �'�' �' 1 . � - � �• u �" � '- � ' ` � ' � �
�. 29: Final'Heating & Air Conditioning - I � '� � � ' ' '� ' � • � � '
� 30.' Final Gas pipe-Test a � � ' � - � � ��' �' ' � � '� ' � J'"' -. - -
31. Final Plumbing � L - . �� � ..v � ;���.•, _ .
: 32? Water Service-Final ' " ; � � ' � � � � � � �
_33. Gas Service-Final ' ' - � ' � � � � � "''
� 34. Solarpomestic-Final:,,F..�.i, � � � - --,�_-��--- -- - , ,-.-� �. �. . . `..,- � . � ..
35. Landsca 0 S rinklin S stem ' � � - � � •" " "� ^�", •' ".;' �
36. Sound Attenuation � '
,
,
"37 - HandicaP � �, ^ . , � . . . ` . „ � •
Regulations � - - .� .- -- - - - `-,� , � � -' - ,
j 38.' FINAL S7RUCTURE & BUILDING ,. ' . �- � _ ' ` � ' ' ' '° `�
• 39. Special Requirements Completed� �- • � � " � � � � ' � � -•-- � --•- - ' ' ' "
i 40. Electric Release.to Edison - • � - - � �� - �- -� � 'i ` - " � -- - - - - -�� - •-- - - � -- -
� 41. Gas Releaseto Southem California Gas Co.`'' ' � � - - �' � � � '-' � - "-�� - � -- ' "-" �� "-� ' - � - '
42. CERTIFICATEOFOCCUPANCY . . Y- � � -- - -_ �--- �-� -� ° � ". . - ''. � - '
- . . _.
� .No .. . . . Date , � ' - � - - - -- �- - . .._ . . . � . . . . � - �. ,.
V -
- - - � -- - ' ., .. . .. ,. � . .:,�.: �i ..- '- :. .. _ . . •
Applleant to till in all s
' CITY OP COSTA MESA , ��veamir no.
CONSiRUCTION.PERMIT I NF_ L,
Addres �� ' ""
Artfi/Eng. ' ' '"' "
Address � - - '•.
C.OntlaCtOf p,�T i2
Addreu !�C'ja' (.LqVt/[�
.ICENSED CONTRACTOR'DEq
hereby aiflrm that I am IlcenseC
lentln9 with 'Settion 7000) o(
Tot¢SSiOnS Cotle, dntl my Ilcef
Date� Si9nature _
WORKE 5' COMPENSATION DE
.I hereby affirm that 1 have a cert
n
License No. -
S PhoneS)�/x
GT QrcK/n.�
i lON
p�ovisions o/ Charfer 9�(com-
an 3 bT the Business antl
in full force ana eifect.
Litense No. �3 7 osS 9
'rif.�. �
iTlO�
oi ConSent to 581f-Insule of a
surance,�Or,a ceiti(IeE copy
❑cY No.�ou'w'uaovComPanY �."a'�T �� ���
J CBrti(letl copy is hereby fumishetl. - '�
ertltietl <opy is fileE with the city Bulltling Dlvision.
XEMPTION FROM WORKERS' COMPENSATION OECLAltAT10N
This 5¢Ction� neetl not be complatatl if the permit IS for one huntlretl
E300) or lezs). t
certlfy that in the,performance of th¢ work�fOr whlch this permit is
Dortler lines anG.sign all aOV�opriate Oeelarotions.
TRACT NO. LOT NO. � BLOG. NO.
TVPE OF CO RUCTION �,
❑ NEW AOD. ❑ ALTERATION
'� REPAIR '❑ CONVERSION ODEMOL
❑ OTHER
DESCR�PTION OF WORK
"'� ' ' . ... , , � . , .
.',.;'�j�.."1F.�, 8663 1I/84/BI ... ',I5.00 T�:
. � i�� � � . � _ . �. � -;
. ZONING REGULATIONS� ' ' "
TVPE OF PERMIT"
❑ GRADING�i. ❑ FOVNDATION �� STRUCTURAL
❑ TENANT ❑ ELECTRICAL'�PLUMBING� OMECHANICA
❑ OTNER —
PROJECT DESCRIPTION� , -- -
SQ. FT. ' ' . "
OCCUPANCV_CONSTRUCTION TVPE � -
VALVATION 20NE
GRADING CU. vDS. ACRES
REMARKS: - '— - '^" - ^•
' � . ' " "' ' ' - ' _Y__
IssueG, I shall not employ any parson in any manner so as to.become PLUMBING .PLAN CHECK
subject to tne Workers`Compensa[iomLaws oi CaliTornia. - .__
Date Si9nature BATHTUBS SHOWERS
NOTICE: If aiter making this tleclaration, you s�ou10 become'subject TOILETS ��� ;�:. �VRINALS
to the Workers• Compensatlon provisions of the LaCor Coae, you must
forthwith comply wlth tuch provisions or this permit shall be tleemeC LAVATORIES � DOUBLE LAVS
revoke0. ' ' "'" ' ' ' ' �� KIT. SINKS DISHWASHERS
CONSTRUCTION LENDING AGENCV
I nereby aftirm that there Is a constructlon lentling agency for [he per- SERVICE SINKS • SUMPS
.(ormance o( the work for.which this permit is issuetl (Section 3097
'Civ. C.). FLOOR SINKS FLOOR ORAINS
Lentler's Name
Lentler's AtltlrMs � DRINKING FOUNTAINS
OWNER BUILDER DECIARATION � INTERCEPTORS CLARIFIERS
I hereby a((irm.that I am exempt from.4he_Contractor•5 License Law for
Ne (ollowing reason (Sectlon 7031.5 Business antl Professions Cotle: SWIMMING POOL PTRAP
Any' city or -tounty which requires a permit to construct„ alter,
improve, tlemolish or repair any structure, prior to its issuance, also re- yyqTER SERV ICE ALTERATION
quires the applicant for such permit to file a.signetl statement that he •
is licensed pursuant to the provisions ot the Contractor'S License Law GAS SERV ICE OUTLETS
hapter,9 (commencing.with Se<tlon 7000) o� Division 3.ot the
ine5s antl Prolessions Cotle) or tnat he Is exempt thereirom antl the yyqTER HEATERS BTU OUTPUT
s.tor the alle9etl exemption. Any vlolation of Section ]031.5 by
appllwnt tor a permit sub�ects the applicant to a civil penal[y SEWER CONNECTIONS �
of. not more than five huntlretl tlollars ($500).
❑ I, as owner of lhe property, or my employees with wages as their SOLAR TANK CO�LECTORS 7/
sole compen5ation, will tlo'the'work, and [he structure is not intentletl - -
or otfGretl (Or Sal¢. (SeCtion �044, Bu5ine55 antl Professions Cotle: The SOIAR PIPING SVS. �
Contrattor's License Law'tloes not appry to an owner of a property
who bulltls or improves thcreon, and who tloes sUCh work himselt or ISSUE FEE •
Ihrou9h his own employees, provitled that such improvements are not �
intentletl or ofteretl for sale. It, however, the builtlin9 or improvement MECHANICAL P�AN CHECK'_ �-
is'soltl within one'year of completlon, Ihe owner will have tne burtlem �
of proving �e tlitl not build or improve for the purpose of sale). HEATING SYSTEM 0-300,000 BTU
❑ I, as owne� o/ the prope�ty, am ¢xc1u51vely contracting��witli qryDOUCTING
IiGensetl contrdctor5 to.ConSVUct the projec[ (Section 7044, Bu5ine55 100,000+8TU
antl Vrote55ion5 Cotle: The Contractor'S License Law AoeS not appry to �-
an.owner of property who builtls or_improves thereon, antl who con- REFRIGERATION 0-100,000 BTU
Vacts from such projects with a mntrattor(s) licesnetl pursuant to SYSTEM
[he ContractoCz License Law). _. 300,000 +BTV
❑ 1 am exempt unUer Sectlon B. 6 P. C. for this
-. _ _ . _ BOILERS BTV
ieason - '
Date � � Owner '- " ' SVSTEMREPAIR,ALTERATION
I hereby certifytha[ I have reatl this application antl state that [he above EXHAVST SVSTEM . MULTIPLE� -
informatlon Is correct. I a9ree [o comply with all city antl <ounty -
OrClnance5 antl state IawS relating to con5truction, antl�her¢by authorize
representatives of thls ci[y to ent r upon Ihe above en onetl
property for i s on purpo . � - -� �- -
Signature Date � � � _ . . . . � _.,
Drivers' Licens or 55 � ISSl1E FEE .
CMF 0865-46 WM1lte-Builtling; Unary-Applitant; Pink-Accounting; Goleenrotl-Assessor
5
ZONE PLNG.,REF. �-.
� . �
REAR YARD (TO G/L) � - ' ' "i
PKG.SPACE RE�. 'PROVIDED' �
STREET WIDTH PARK FEE $ �
ZONINGAPPROVEDBV ' - DATE�,
SGECIAL CONDITIONS: - ' , J . • �
.. .. _.. . _ .. , -..� • . �.
,ELECTRICAL a�Arv cHECK �
S�R1 � , -
GENERATOR 0-1 KW_I-101CW
:TRANSFORMER .
,APPLIANCE 10-50 KW_50 + KW
MOTORS 0-1 HP_1-30 HP '�
QNC. SOL`AR) ' 30-SO�HP_50 + HP � :
.FIXTURES OUTLETS SWITCHES
'GAS TUBE SIGNS ' �
,POLE LIGHTS ,
POLES METERED SVB �•'
;PANELS MAINc� � .SVB �;
SERVICE ' AMP, _-
�
a
ISSUt hEE � �,p
APPLICATION APPROVED BV � . DATE
' _ _ SUMMARY OF FEES •: , _ � _ � �
BUILDING
PERMIT.. �.. S� - ' SMIP . b�
PLAN CHECK. 5 PERMIT ` " �
ISSUANCE $ - � \
PLUMBING E� �
�PLANCHECK $ � "�GRADING $ �
. 1 . a I
+ELECTRICA� S� ,m �.' �, . � , - � �'
iPLAN CHECK S . MICROFILM E
�MECHANICAL E " TOTAL FEE E ' �
�PLAN CHECK E � " ' - LE55 AD- � .. .
.. VANCEPC $
C O ,
' � ' " - - FINAL FEE �$ �%� �
S�
�� �-- . . . . ' .
CONSTRUCTION AND PLANN G POOL & SPA �� , �, e�.
� Oate '-Inspector . Date '-Inspactoc;�'
� APPROVALS � �`' \' � PermiY#� APPROVALS -, ��y . � Permit# .,
i. Temporary Electrical Service or Pole ' �' �43. Pool & Equipment Location � - - -- = - � �'
. Soii" ipe-Undrgrn - . �_ ' - � � " 44. Stee� fieinforcement '
, ; � . -- --- -- --- - � - - -_ '
3. Electrical Co�duit Utility-Undrgm . . --'-'--"-- '-` - �" -' q5. ,Forms i.. "'' � ' '�
4. ElectricalConduit-Undrgm � ' � 46. ElectricabBonding ' -___ _ ` '_ �
. tee , ein orCe � . 47. Rough.Plumbin & Pressure.Test . �_ _ � `' � '� - ' r
6. Electrical UF R Grn � t! -� -+ �' • q8: APPROVAt'TO COVER-GUNITE_
7. ootings i .� ,., ' � �- =� - - •-� - � 'qg. Electrical Conduit-Undr rn , � � � - '
..,.
,, . .� . ,
. _ ..---- -..__ ... . _. � . : .. �.
8. Foundation � - r-- -'- � -' ' ' - ' "50�. � Gas Pipe, ❑.Undr �n, Test ^ �, � • • � � � ' ' �
9. Water Pipe-Undrgrn - 51.� Backwash Lines P-Tre �Q ndr m' -- -
10. Structural Floor SYstem 52r "APPROVALTO DECK. -- • - -
' 11. Property Sewer Line & House Connection� � • �` - - 53. Backwash & Rece tor-Final . � � � �� �� � �� �� � �
� 12. � Street Sewer �nnection - �. � .�� � �.: -., :. 54. Heater & Vent-Final � � � � � '
! 13. RoughPlumbing �. ._.__.-��.��>_� - . ' ' '- ----•�-- , ., . , .
14.- Rough Elecfrio-Conduit - - - � ..56. _Electr,ical':Pinal _ -� � ` �� '
� 1�5: Rough��Electric-Wiring -. ----- -•---- -- _� - - - - - - ' . 57._ _Solar SYstem-Final,.,,. ,i �...• -= "'-• ^ ^.. '+ , f�..•-: -. ..��. _
._16.-- Rough Heating.& Air.Conditioning encing & Access Approval � � �' �; v� ". �--�
17, Ducts in Structure � . nk, � • � � ' ; � � + : APPROUED�FOR PLASTERING � � � � •� � � .� �•�. �;�io� . - �: � , •._
18: Ducts, Ventilating � " -, ; " i ' - � - ' � ' �� " -' " ��
; 19: Gas Pipe-,Rough & Test. _ . s • . ; ; .60. POO VSPA SYSTEMS FINAL . ' • � � � - ��.
20. Roof�Framing ., ..._. . . , � , . , . - - . - -' .: . u �- . ` , . '° `���,,
� 21: RoofiSheathin-- •���� .__. -. . , . ;., r. � i ; : ' .. ' _� : `_. _' . . , .. .:n� . . .,,.'. . ,,. ��
. 22. Frame and FlasFiiri � .. ' � - • -- ' ' � NOTES: .. . ,�va , . . ' . �., .�. � .��: � • . � u
� 23. Insulation • : .�'� ,.c' � .a�, .r�i.::� � q . .
24. Lathing&Siding - �..��. • .i �r� � r ; . . ,�y;a .�
25�: Drywall Nailing � . _• ' • ,. � . , . ---- - - ' .` _ `.. +' - = �� ..
! 26: Plaster Brown Coat i,�; " ' � •• ' � ' � � ' ' '
27i Electrical Power Meter-Final' . .. I ! • � . � . � -.� L G . - ' , . . . . ` '- . . ,'
' 28: Final'Electric�.'� . , � . • - . _ • . . . .i1. . . . .�� �
� 29. Final�Heating & Air Conditioning ' � � � � � ' �� � ' � ' � ' •� �� � �' " �
30: Final;Gas Pipe-Test � � - � � � � � � - '� � � ' �' -
31: FinallPlumbing ' ' • � r � -
! 32. Water Service-Final � � � • �-�� �. • - � ' - � � � � ' � � •- � .� *� -
33: GaS'Service-Final ' . .. .. „ . `�•• � . � . " " � . � : . � - ' � �
34. Solar pomesticFinal �, � ...� ' ' - " ' � " � >��
i 35. Landsca e S rinklin S stem "'' '�' � � � '� � °- + ' � '�
I 36. Sound AttenUation ' � ' ' "` � � �� � � ' �� ' ` '
�
{ 37'. Handicap Regulations - � � � `��� - - - '' � ' '�. � `�' � �� - �
'� � �
. , �. •. � � . . <. � .. ..,. , ,. .,
. . . .. ., � � . . . ., ,
� 38. FINAL STRUCTURE & BUILDING ,U,,, ' ' ' " ' ' ' ' '"' �
, 39.' Special Requirements Completed � � �� ' � �'' •' ' � � � � ' - � � - - - - � • - ' �
I �40. Electric� Release �to Edison � � • ^�� � - ' - - - - ""� � � - - - � - « - - -- - � - -- � - -- - � � -- - - ;i
; 41. Gas Release to Southem Califomia Gas Co. ' � �� � ' ` - -'" - � � - � ' " '- ' " � " - -' "' ��
-„ ., ' ._, . . . ..
42. CERTIFICA7EOFOCCUPANCY � � � "
- -- - • - --- - - .,�.
- �:r.
� No _. . .. _ Date r ; - �- ._ ._ ..- - - - ----- --- .� . .. . . - ,.., .: -. .__
:
. . . -- - . _. • _ __. _ . . .. . . .' . . . ._ . _ . �,.. �. . • . ' -. jw
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SUNBURST
Solar Energy
DIVISION OF.a-A�C_RO ENERGY CORP.
SPECIFICATION SHEET
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BEA and BEAC Models •
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The modular SUNBURST Glass glazed solar collector.
;PP! IC.�?•.C`•!S
Pool and Spa Heating
Domestic Water Heating
Space Heating and Cooling
Industrial Process Pre-Heating
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ReFUTATION: A major solar manufacturer since 1974, SUNBURST is prominent on the CAL-SEAL Solar
Manufacturers' List. SUNBURST collectors guarantee the contractor total design freedom, fast installa-
tion, and excellent service.
LO'.v COST: Efficient production methods provide top quality, low cost, and maximum heat collected per
dollar investBd.
�O YEAR VJARRA�'TY: Extensive 10-year warranty on the absorber plate and 3-year warranty on the glazed
box fully qualify SUNBURST collectors for the California Solar Tax Credit.
�n
L7ET;:L AdSO9�ER PLi�Tc: High thermal conductivity. Invulnerable to ultraviolet degredation.
CC?PER �.YATE3b'JAYS: perfectly compatible with pool, spa, and domestic water — no different from
copper wate�Ways in natural gas heaters.
� GLAZED BOX: Patented standard box accepts absorber plates and glazings Intercha�geably.
DURABLE GLAZING: Solatex is a strong, tempered, high transmittance solar glass. Very resistant to
breakage and �mpervious to ultraviolet degredation. Solatex brings the beauty and permanence of glass to
your project.
�.. . ' ' ___ _ _
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Permit # P F ! 8!
THIS NU^ABER MUST ACCOMPANY
ALL INSPECTION REQUESTS a I
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( ".. �
� ����O�ED
GITY �f C�SiA I���SA
Mechanical Division
Building Cepariment
Approved ..�77<"_"____ "�.". Date��
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3-WAY VALVEs
3 OPERATIONS
1. Solar and Domestic: Valves �k 1 and 2 horizontal, 3 and. 4 open. '
2. Solar only: Valves �k 1 horizontal, 2 vertical, 3 closed,and 4 open.
3. Domestic only: Valves 4k 1 and 2 vertical and 3 open, and 4 closed.
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OWNER BFtISTOL ESTATES � onre 9-5-56 �
aosno�REss 8(�5 Darrell Street BUILDINGPERMITNO. #3GO%
GENERALCONTRACTOR $. p. Hunsaker VALUE $ 8,856.��
LOT 63 BLOCK TRACT pg�3 Sin�le Res. H�Btt �ar.
GROUP I& J TYPE V ZONE RLL FIREDISTRICT 361�1
INSPECTIONS
Faoting Trench
Foundatian Forms and Grade
Rough Framing �n
Plumbing, Rough.to SIa6 -U';
Plumhing, Rough Complete
7emporary Pole
Wirina. Rouah
Heating, Rough LP/!
Heating, Final �p
ewer, House Sewer,
Septic Tank � Cesspool
Lathing,ln Out�
Plastering
Plumbing, Final, Fixtures Com
Plumbing, Fin,al GasTest/.S^'
Wiring,Final ,
Occupancy �.P r
FOFM 210 3M 10-v3
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St.
t0 -
SUBCONTRACTOR
PERMITS ISSUED
DATE NUMBER
— �
� 9-/�l-,5� .:S/�--G --
� %.��: .1 ln ..��/ d J �'
, 4-/�/�_�/_ /-Y1/
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�Costa Mesa Bnilding Department APPLICATION FOR PERMIT
P.O.Boz3�� .���.y BU LD1NG '
��� COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
��OR APPLICANT TO FILL YN I Receipt No. e/rmit No.
Addre� �� �� ��P (j �
�: �.,� E�,� s� _
Costa Mesa, ri3��01711� Receiv�d by Date Rec'd. Date Issued
' Nearest � . _ _ � I � �"" v ��.51. �
Cross St.
G
Arohitectol' ' / L'IC.
Engineer �' No.
Address
.S• i/ �/ , 7 � Cit;
Contrector !/— T7L.IniSON.C�Ne.
Address � g M L`�
Legal I Lot / �
Description No. C� � I Block � I Tract �v
(Attach Metesand Bounds)
Na, of Bldgs
Size of Lot G O�' �O� Nowon Lot �
ljseof _ No.oi No.of
Existing Bldg. Fa'miliea Rooma
Setback Linefrom � Rear Vard d� '-�
Center of Strcet S�O Side Vard .r�.f_r'
Atltlition
Building ,,G No.of .�
Size �U/ ;� fi�' Rooms 1 Stories
Exterior Wall�^� Roof /�
Covering ,) /li/�Cd Covering �t, P�:
Use ot New •
Buildina �..�- /t .�„_e.L.� �earl.
/ ��4 N '� Y
I hemby acknowledge that I have read thIs Application
and state that the abme is correct and agree to comply
with all C3ty Ordinances and State I.aws regulating
building conshvetion.
Signatureof � � y�� �J^��L
Pe�mittee ia.ca�r .f.a�
AuthoNzed Agt.�-/��_,p�
Valuation Permft Fee $ r�c� —
��- `/ Plan Check $ � "'
$ 6J a ���_� Fee' $ �J �
am zas �o.ss o. v. e s.
Buildin
Address
Costa Mesa, California
Nearest
Cross SS.
Zone J No.of Type ,/
.�i � I Plans I y
Approved
by Da
CORRECTIONS
APPROVALS
iundation Location Inspector
Forms, Materials,
Under-Pinning
�ame: Fire Stops,
Ext
� Reinioroed
Q
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A
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2
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