HomeMy WebLinkAbout1948 SANDERLING CIR - Building Permits i
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CITY OF COSTA MESA
`oy-na"rF,p BUILDING DIVISION
rIa(P' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
7). ? FOR INSPECTIONS CALL: (714)754-5626
''^ ^•"° PERMIT NUMBER: BC11-00274
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 06 0612011
ISSUED BY:
JOB ADDRESS: 19-48.SANDERCING,CI CM] Suite/Unit:
APN: 13948120 Zoning:R1, ,
Vicinity: Primary Occ:
Const Type: V-B SQ. FT: 0 Valuation: $4,000.00
SCOPE OF WORK: REMOVE A BEARING WALL BETWEEN THE KITCHEN AND LIVING ROOM. ELECTRICAL TO INCLUDE: 5
LIGHTS, 5 OUTLETS AND 5 SWITCHES. PLUMBING TO INCLUDE: 1 KITCHEN SINK. MECHANICAL TO INCLUDE: 1 HOOD.
OWNER: PERALTA,PETER AND CARRIE Address: 1795 PITCAIRN Unit:
Phone: City/State/Zip: COSTA MESA,CA
APPLICANT: SILER,JOSHUA Address: Unit: :
Phone: 714-969-1768 City/State/zZip:
CONTRACTOR: PACIFIC COAST BUILDERS License No. 672362
Phone: 714-969-1768 Address: 20701 GOSHAWK LNUnit:
Cell: City/State: HUNTINGTON BEACH,CA ZipCode 92646
ARCHITECT: GARY MAXWELL License No.C13785 PHONE:949-632-6018
ENGINEER: CHRISTINA R SILVA License No.37201 PHONE:714-307-7101
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $63.21
Building Fees: $97.25
Electrical Fees: $44.75
Mechanical Fees: $34.15
Plumbing Fees: $33.30
SMIP Residential: $0.50
SMIP Commercial: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES: $274.16
"Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays:
New Years Day,Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day
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 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.
CODE S. INSPECfQN TYPE DATE INUTIAIS CODEC INSPECTION TYPE DATE INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 9. pip 4/�r)t�
1268 Pool Spa Final 208 Final Plumbing 4. / 9-• /( 1fl�''
200 Final Re-Roof 210 Final Electrical 9. / 9 . /f �P CI1�p e
201 Final Block/Retaining Wall 212 Final Fire Prevention /
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
�/l
204 Final Demolition 250 Final Building/Occupancy X t rV/
1111
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WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive;.license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers'compensation insurance, as required by
s ' n 3700 of the Labor Code, for the perfomlance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: /) _ person is required to descend,will be made in connection with work authorized
W by this permit,and that no building structure,scaffolding.falsework,cr demolition
�@arner� )
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This seam need not be completed dthe pe+mtiss m
valued alonehunredctn($100)aless) 2.An2,Sec.341,Title 8.Califomia Administrative Code).
Pd(fber. �O V O ? `O I 1 02-0 CoC
0 As owner-builder, I will not employ anyone to do work which would
❑ I ce f that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I .h•l not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the •rk'rs' compensation laws of California, and agree that if I should
beco - sus jr t to e workers' -fpensation provisions of Section 3700 of
Applicant's Signature Date
the - I sha .fort err comply with these ovisi s.
t///
/ / i( Division of Industrial Safely Permit Number:
I - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WAR G: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS • LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Se tion 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my lic//lpp�Ie-is in II f• ce effect. a registration form for acutely hazardous materials? 0 Yes 0 No
:111raD x - .c. / (Section 25533 of the California 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
illy =!"••bSgnature Q '^ 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
n NSTRUCTION LENDING AGENCY: temperature and pressure).
TA I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars(5500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon.and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
•
authorized • this permit until final inspection.
•
Owner(s)Signature Date / j)7.t1eoat
/
30576(3/07) - 9., �_/
etomee-q-oliram rte:
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19 42. c. ,,,;def cb-1 N 5 C `'r (760) 757-0556
Cell: (949) 370-7922
Fax: (760) 757-1064
MIDGET
A Professional Inspection Service
365 Mainsail Road, Oceanside, CA 92054
fp'REINFORCED CONCRETE 0 STRUCT STEEL ASSEMBLY ,Q 'OTHER ERXri
REGISTERED INSPECTOR'S ❑PRE-STRESSED CONCRETE LI /HIGH-STRENGTH BOLTING /4/0/0�
REPORT OF:
0 REINFORCED MASONRY
0 RE-BAR WLDING 0 SHOP
jEIELD
y BUILDING^ PERMIT PLAN FILE NUMBER
19WAK/eit/ n (AA nm , so 1--40..17g i ARCECTOWNER R PROJT NAME Jr nLM-J 47S/ACee r�btke4 ,
1SSd4
,-DESC IBE 341 Y 4,1AL tAnA f�DE� d,'ff• WELD-ROD.ETC.) ECAR/ -•'A/�// t,t4 //�
/Se �.s�.� xi' fkt �siei
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Me, ),�C/Ac/roza /JLIticS
CONT`C R DOING REPORTED WORK
INSP'N. LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
DATE INCLUDES INFORMATION ABOUT AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED NUMBER TYPE 8 IDENTIFICATION NUMBER'S OF TEST
SAMPLES TAKEN.STRUCT CONNECTIONS.IO WELDS MADE,H T BOLTSBTORQUED.CHECKED.ETC.
l'/17/,� ��500)e >I ele44/ I,w,ti-&d /fr u2RSize lues b✓,7�„
t /D €414.4611 a' re/91405 he/4;L / -r -Ae 3 f/QLISI-c
(t 1 Ails , akavel Idea:Howl i lel - Adis.
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,UNLESS OTHERWISE NOTED,AND TO THE BEST OF
MY ABILITY. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVE/D PPPLAAtIS, SPECIFICATIO 5, 8 APPLICABLE BUILDING LAWS.
4
SI NATURE OR REGIS RED INSPECTOR
6-/'1C// Dor/S'?‘,
DATE OF REPORT REGISTER NUMBER
r 1 1
CITY OF COSTA MESA
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•
s BUILDING DIVISION
oAA
F i 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.wsta-mesa.ca.us
k. FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: M10-00030
PERMIT TYPE MECH STATUS: ISSUED
APN: 13948120 DATE ISSUED: 03/12/2010
ISSUED BY: KJB
JOB ADDRESS: 1948 SANDERLING CI CM Suite/Unit:
Vicinity:
SQ. FT: 0
SCOPE OF WORK: REPLACE FURNACE SAME LOCATION. 90K BTU
OWNER: ADAMS, DONALD JAMES Address: 1948 SANDERLING CIR Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: CLARK,DAVE Address: 6892 CARNELIAN Unit:
PHONE: 909-944-1340 City/State/zZip: ALTA LOMA,CA
CONTRACTOR: SOCO AIR CONDITIONING License No. '333239
Address: 6892 CARNELIANUnit: PHONE: 909-944-1340
City/State: ALTA LOMA.CA ZipCode: 91701 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: • $0.00
TOTAL FEES: $38.30
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 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.
CODE O. INSPECTION TYPE LAN INTmALS CODE/ INSPECTION TYPE DATE INi111AL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
• t 1
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑ No
r
I hereby affirm under penAy of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
perfo ance of the work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by
ction 3700 of the Labor Code,for the perfonnanc of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' c nsation In u ance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 1 person is required to descend,will be made in connection with work authorized
Carries
—et) by this permit,and that no building structure,scaffolding,falsework,or demolition
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sectionneed not wmpetC nperm('is valued at rte hued (SIM)or 2,Art2 Sec.341,Title 8,California Administrative Code).
Policy Number: (W_ //lrv�J ((��11
❑ As owner-builder, I will not employ anyone to do work which would
0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
7 2_,_. e 2' --- -IZ_/O Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
•
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license In 2full force2and effect. 90 a registration form for acutely hazardous materials? ❑Yes 0 No
Lic.# ✓ "D ?_'3 0) Class# C — V (Section 25533 of the California Health and Safety Code, with some
�1 p -3.— 19 L—/0 exceptions, requires registration with the Costa Mesa Fire Department by
1 —r C each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described properly for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection. •
Signature of Legal Owner(s) ate
v
Signature Date A/ /Z—/`
3057-46(3107) `�r
And/or Authorized Applicant Date
e
Prescriptive Certificate of Compliance: Residential CF.-ill-ALT
Residential Alterations - (Page l of 5)
Project Nam Climate Zone# 4 of Stories
T j% CO / 8)9t9iii c 6 •
M /U— 3�
General Information
Site Address: Enforcement Agency:,-; 1
19y� n?/9/7pEFl c,in/. (ori 1,7[Ca
Building Type�lSingle Family 0 Multi Family , Circle the Front Orientatior1L' -.,S, W,or degrees 3- j1 //7
Carditioned Flom Area(CFA): '2_17/00 Project Type: 0 Alterations 0 Envelope ElFenestration 0 Roofj'HVAC
Replacement or Change Out 0 Duel Replacement 0 Water Heater
NOTE: This farm is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑Opening of framed cavity alone-Alterations that involve the opening of the fronted cavity of a wall, ceiling, or floor must install the
mandator»minimum insulation value per{x'150 for the altered assembly. Fill in Columns A-C and enter mandator),insulation value in Column H.
❑Replacement of entire assembly-Replacement of an entire wall, ceiling,or floor assembly requires the installation ofCornpmtent
Package-D insulation values in Table 15)-C. Fill in Columns A-J.
Opaque Surface Details For.the furred portioned of Mass Walls see Furring Strips Construction'fable below.
A I B C D _.. .. D.. F C I. H. . I. • J
Proposed s"not Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assemble
IDI or Type( and Size2 or Other; facto? Number' R-valuer R-Value7 Cell Values U-factor
Note:For Tunwd assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-). For calculatingfBred walls use the Mass and
?Furring Construction table below.
- I.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors, Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass, enter 2x4,2x6,or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; )6'or 29"0C;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc....
9.Based on the Climate Zone;enter the Standard U factar-fr om Table I51-B, C or D for each different assembly Name or type.
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the 12-value that is being installed in the wall cavity or between the framing;otherwise, enter "0".
7. Enter the Continuous Insulation R-value for One proposed assembly; otherwise, enter "0".
S.Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U-factor in Column J
9.The Proposed Assembly U-factor, Column.1, must be equal to or less dun the Standard EN-actor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A I B c D I E F C I H I I I J K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5.4.3.6.4.3.7 Joint Appendix'table 4.3.13
V t ,..-
, I u CL ,U„
Assembly = $ a o 'm F v o o,'0 1p ` Final
Mass Name or JA4 Table = 'v _Z. c E E a m 4 0 " F Assembly
1 Thickness' T re' Number 6 ;° a = ' I R - q t7
Y u __� �. LE :4:: � r _ w z U-factor• Cannan
• I I I
II
l I I I I
Registration Number: Registration Datelfime: HERS Provider:
2008 Residential Compliance Forms August 2009
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Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Pat;e 4 of 5)
Project Name: l Climate Zone It 1 #ofStories
d J JS cign/9lrt-r:t/tea 7-✓}S'CO 790111nS
H VAC SYSTEMS- H EATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacityt•a s (AFUE or HSPF) Type and Location' 14-Value Type Space,Package or Hydronic)
IBrnn7a5/ %c /;. 94c1en. cicr, Tj-ys%s� nC249-(
t.Indicate Heating Type(Central Furnace. Wall Furnace,Heal pump, Boiler,Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity
<2 KW or 7,000 Btu/hr electric heating is controlled by a titre-limiting device not exceeding 30 minutes). See§I 310)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate 1)'pe or Location(Ducts,Hydronic in Floor. Radiators, etc.)
HVAC SYSTEMS -COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity'•2 COP) Type and Locations R-Value Type Space,Package or Hydronic)
M /
"" / c
I. Indicate Cooling Type(A/C,Heat pump. Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location(Ducts,Hvdronic in Floor.Radiators, etc.) •
•
WATER HEATING
'List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is required in all component packages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating)' System _Capacity(gal) _ Thermal Efficiency R-Value3
I.Indicate Type(Storage Gas,Heat Pump.Instantaneous, etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§I5000. The Prescriptive•requiremervs do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§1500).
•
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation and special verification.
NEW/ROOF ASSEMBLY-Radiant Barrier
The radiant harrier requirement of§151(1)2 does not apply to roof alterations.
Slab Edge(Perimeter) Insulation 0 YES 0 NO
YES:In Climate Zone 16 in Component Packages D,it-7 insulation is required.
Heated Slab Insulation 0 YES 0 NO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table I1 S-A of the standards.
Raised Slab Insulation 0 YES 0 NO
YES:In Climate Zones I,2, 11, 13, 19& 16,I1-8 insulation is required: in Climate Zones 12& 15.11-4 is required under component Package D.
'I'hernul Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
•
Prescriptive Certificate of Compliance: Residential -. CF-:IR-ALT
Residential Alterations (Page 5 of 5)
Project Name: ClimateZit it# #of Stories
HERS VERIFICATION SUMMARY The enforcenrem agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF-4R Farm for all the measures specified shall he submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required fin.this measure.
❑ YES ig.N0 v its:In Climate Zones 2 and 9-I6,if more than 40 linear feet
o.'new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(b)I Dii and the newly installed cinets are to he insulated per§I5 (010.
�y•� ❑ EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or scaled with asbestos.
❑ YES /`r NO PISS:In Climate Zones 2 and 9-16, if the existing space-conditioning system(H VAC equipment and ducting) is replaced,the
ducts are to be sealed per§152(6)1 Di.
❑ YES ITINO YES: In Climate Zones 2 and 9-I6,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through TIERS
verification in accordance with procedures in the Reference Residential Appendix ItA3.
❑ EXCEPTION: Duct systems with less than 40 linear feel in unconditioned space.
O EXCEPTION: Existing duct systems camp-tided.insulated or scaled with asbestos.
Refrigerant Charge-Split System HERS verification is required for this measure.
ID YES "CND YES:In Climate Zones 2 and 5-I5,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b)I F.
Central Fan Integrated (CM)Ventilation System and Fan Watt Draw
The ventilation requirements of§I 50(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat-Pumps: Airflow HERS verification is required for this measure.
- ❑ YES ,NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced,the airflow and fan watt draw shall be verified per§152(6)1 Ci to meet the requirements of§151(fl7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and comsete.
Name: ,,7
Company: Date:
D CO /9/17.
Address: �/ • If Applicable 0 CEA or❑CEPE
Address:,
( '1)/zrtee e> (Certification 0):'
City/State/Zi �/ P1 e;
iii-rfi 1.��.� • X09- sd/ S74 y
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the recta itements of Title 24,Pans I and ft of the California Code of Itegcdatitins.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this •
building design on the other applicable compliance fortes,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Nainc: •Signattu•e:
Company: Date:
Address: • License:
City/State/Zip: Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Ratline at.:1-800-772-3300.
Registration Number: Registration DatelJimc: HERS'Provider:
2008 Residential Compliance Forms August 2009
•
Mandatory Measures Summary .MF-1R
Residential (Page 1 of 3)
Site M rats: Enforcement Agency: Date:
lam/95Co /tWnnf g 5' 2. I 3 -/,- - /a
NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed,
regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance(CF-IR,
CF-IR-ADD, or CF-/R-ALT Fon;)shall supersede the items marked with an asterisk(*) below. This Mandator),Measures
Suautnarl'shall be incorporated into the permit documents and the applicable features,shall be considered by all parties as minimum
component performance specifications whether they are shown elsewhere in the documents or in-this summary. Submit all
applicable sections of the MF-IR Form with plans. -
DESCRIPTION
- Building Envelope Measures:
§I 16(a)L Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
§116(a)4: Fenestration products(except field-fabricated windows)have a label listing the certified U-Factor,certified Solar Heat Gain Coefficient
(SI-IGC),and inflltrador that meets the requirements of§10-)11(a).
§I 17: Exterior doors and windows arc weather-stripped;all joints and penetrations are caulked and sealed.
.§I 18(a): Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on CF-Mt Form.
§118(i): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i)when the installation of
a Cool Roof is specified on the CF-I R Form.
*§150(a): Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor.
§150(b): Loose fill-insulation shall conform with manufacturer's installed design labeled R-Value.
*§150(c): Minimum R-13 insulation in wood-frame wall or equivalent U-factor.
*§150(d): Minimum R-13 insulation-in raised wood-frame floor or equivalent U-factor.
§150(f): Air retarding wrap is tested,labeled,and installed according to ASTM E1677 95(2000)when specified on the CF-1R Form.
• §150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16.
§1500): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%;water vapor permeance rate is no
greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration.
Fireplaces,Decorative Gas Appliances and Gas Log Measures:
• §150(e)1A: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)IB: Masonry or factory-built fireplaces have a combustion outside air intake,which is at least six square inches in area and is equipped
with a with a readily accessible,operable,and tight-fitting damper and or a combustion-air control device.
§150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the
building,are prohibited.
Space Conditioning, Water Heating and Plumbing System Measures: . . .
§110-§113: Id VAC equipment,water beaters,showerheads,faucets and all other regulated appliances are certified by the Energy Commission.
§113(c)5: Water heating recirculation loops serving multiple dwelling units and High-Rise residential occupancies meet the air release valve,
backflow prevention,pump isolation valve,and recirculation loop connection requirements of§I 13(c)5.
§115: Continuously burning pilot lights are prohibited for natural gas: fan-type central furnaces, household cooking appliances(appliances with an
electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr arc exempt),and pool and spa heaters.
§150(h): Heating and/or cooling loads are calculated in accordance with ASI-IRAE,SMACNA or ACCA.
§1500): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(e).
§1500)1 A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard arc externally wrapped with
insulation having an installed thermal resistance of P-12 or greater.
*I 500)1 B: Unfired storage tanks.such as storage tanks or backup tanks for solar water-healing system,or other indirect hot water tanks have It-12
external insulation or It-16 internal insulation where the internal insulation R-va Inc is indicated on the exterior of the tank.
§150(j)2: First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire length of recirculating sections
of hot water pipes are insulated per Standards Table 150-B.
§I50(j)2: Cooling system piping(suction,chilled water,or brine lines),an)piping insulated between heating source and indirect hot water tank
shall be insulated to Table I50-B and Equation 150-A.
§150(j)2: Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A.
§150(j)3A: Insulation is protected from damage.including that due to sunlight,moisture,equipment maintenance, and wind.
§I50(j)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
•
M.aridatory Measures Summary MF-YR
Residential (Page 2 of 3)
Site Address: En forcemeat Agency: Date:
§150(j)4: Solar water-heating systems and/or collectors are certified by the Solar Rating and Certification Corporation.
Ducts and Fans Measures:
§I50(m)I:All air-distribution system ducts and plenums installed,arc sealed and insulated to meet the requirements of CMC Sections 601,602,
603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or
enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable
requirements of UL 181,UL 181 A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to
seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used
§I50(m)l:Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,
duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts.
Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
§I50(m)2D:Joints and seams of duct systems and their components shall not be sealed with cloth hack rubber adhesive duct tapes unless such tape
is used in combination with mastic and draw bands.
•
§150(m)7:Exhaust fan systems have hack draft or automatic dampers.
--§150(m)8:Gravity ventilating systems serving conditioned space have either.automatic or readily accessible,manually operated dampers,
§I50(m)9:Insulation shall be protected from damage, including that due to sunlight,moisture,equipment maintenance,and wind.Cellular foam •
insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that
can cause degradation of the material.
§150(m)10:Flexible ducts cannot have porous inner cores.
§150(0): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoor Air Quality in
Low-Rise Residential Buildings, Window operation is not a permissible method of providing the Whole Building Ventilation required in
Section 4 of that Standard.
Pool and Spa Heating Systems and Equipment Measures:
§114(a): Any pool or spa heating system shall be certified to have:a thermal efficiency that complies with the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater;a permanent weatherproof plate or card with operating instructions;and shall nobuse
electric resistance heating or a pilot light.
§114(b)1:Any pool or spa heating equipment shall be installed with at least 36"of pipe between filter and heater,or dedicated suction and return
lines,or built-up connections for future solar heating
§I 14(6)2:Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
§114(6)3: Pools shall have directional inlets that adequately mix the pool water,and a time switch that will allow all pumps to be set or
programmed to run only during off-peak electric demand periods.
§150(p): Residential pool systems or equipment meet the pump sizing,flow rate,piping,filters,and valve requirements of'§150(p).
• Residential Lighting Measures:
.§I50(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in
Table 150-C and is not a low efficacy luminaire as specified by§I 501k)2. . . - .
§I50(k)3: The wattage of permanently installed luminaires shall be determined as specified by§130(d).
§I50(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz.
§I 50(10: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high
efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line-voltage socket or line-voltage
lamp holder;OR shall be rated to consume no more than five watts of power as determined by §130(d),and shall not contain a medium
screw-base socket.
§150(k)6: Lighting integral to exhaust fans,in raoins other than kitchens,shall meet the applicable requirements of§150(k).
§150(k)7: All switching devices and controls shall meet the requirements of§150(k)7.
§I50(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 fl2 or 100 watts for dwelling units larger than 2,500 h'may be exempt
from the 50%high efficacy requirement when:all low efficacy luminaires in the kitchen arc controlled by a manual on occupant
sensor,dimmer,energy management system(EMCS),or a multi-scene programmable control system; and all permanently installed
luminaries in garages,laundry rooms,closets greater than 70 square feet,and utility rooms are high efficacy and controlled by a
manual-on occupant sensor.
§150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated
cabinet.
§I50(k)I 0: Permanently installed luminaires in bathrooms,attached and detached garages,laundry mums,closets and utility rooms shall he high
efficacy.
2008 Residential Compliance Forms August 2009
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 4491 3/24/87 176.72 TL
•
CIT-rbP"COSTA MESA)) CONSTRUCTION PERMIT I PERMIT110 p � TRACT NO. LOT s�NO. UNIT NO.
Project Address 19LI6 SAWN D-e•
•7P-,�1-JJJ &V Cl ie•' �s�, I ✓7 - 7O3R tQSo2 L�r� /
Applicant's Mailing Address O 530) C' L-1) �K �AI.Aw4k(,m TYPE OF CONSTRUCTION 1.4 NEW ADD LI ALTERATION U REPAIR : 1 v f
Owner's Name y r-2yo 32,;
--
0CONVERSION III DEMOLISH El OTHER _ A.P.# 139 — ' d1 --c2 0 Zone e /
I. /f1/d74 Chl/3 FF€'/ Phone DESCRIPTION OF WORK/USE OF BLDG. I '�fV V
Address SJ3-M-C S _ Main Building: 1 / ' • - Accessory Building:�Os�p�,�,'t_sn�_
Arch/Eng. l3'�'H///�rh S License No.C.�=1O/S$ TYPE OF PERMIT El GRADING U FOUNDATION ❑ STRUCTURAL T, Front c2/...i f, r(4/"�I _ - IJ- -
0
iiPoiva'I E•'&Alastoet°� ' l�
Address UZZ .FJ CI ' ❑ TENANT ELECTRICAL PLUMBING CI MECHANICAL B' Rear �IL, II r ,�5I N
Contractor's Name�'• r'3OI-� S 7527Q/O W OTHER �et]L-- s°e- - A I
CXGWO - II' V' �q"S Phone C Right. f I N
lf) PROJECT DESCRIPTION SQ. FT. �/�2 OCCUPANCY I� a
Address(mailin 1 '0' BOX 1?7— CO 6/4/111LIM Hulls 99/7 p I '^ G
9 CONSTRUCTION TYPE �yrAN/rte VALUATION $ /o2y OOO S Left± O I t �.. I V' R
City License No. ) O I%% ZONE - GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided • E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: •ry Q''7 ('� Plannin Notes: /1 1. M
II
with section 7000) of Division 3 of the Business and Professions Code, and P/ ' *- /tl`> /�] g Pap' /5 pal to/ C� -.(-1 prnQ-Nd S
2
Datemy license is in ful force d effect. T
License„�lass '" License No. 9162..• 9/ /PLUMBING I FEES
_ - Signature _
WORKERS'COMPENSATION DECLARATION Bar Sink Showers - ' '
n I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
d Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer - Service Sink -
.800, Lab �_GO 3 5.3 CMS}- • Automatic Washer Transformer ❑ 15-50 KW
\ Policy No. Company - ' Backflow Irrigation - - Sewer Ca ❑ 50+ KW
P Construction Pole Sub.
Certified copy is hereby thehed.
t�` Certified copy-is filed with the city BuilW/sl g Di'•.�h�.ton� Bathtubs ' Sewer Connection Cooking Unit Meter ❑Up to 100 amps
Date 3--I'"7-47 Applicant !'� - /G.I�I��
-
Q EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or " - '
less). Dishwasher - Solar Piping • Dryers ❑Gas '❑Electric Sub Panel
I certify that in the'performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - • Fan Motors❑01 HP ❑1%-8
Workers' Compensation Laws of California. -
—
Date Signature ' Floor Drains Swimming Pool w/Spa • LCS,_ F.A.U. Inc Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration, you should become-subject to the - - -=
Workers' Compensation provisions of the Labor Code, you must forthwith . Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. • Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes -
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for `hick this permit is issued (Section 3097 Civ. C.) •
Interceptors Water Heater e Outlets Ran
Lender's Name 9
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair • P-Trap LaundryTreys
• any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0.5 KW 05-15 KW Trash Compactor .
to file a signed statement that he/she is licensed pursuant to the provisions of i I
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of Roof Drains 1 `�
Division 3 of the Business and Professions'Code) or that he/she is exempt • - - - K fNwf / aro`0
erefrom and the basis for the alleged exemption. Any violation of Section S��
131.5 by any applicant for a permit subjects the applicant to a civil •
enalty of not more than five hundred dollars ($500). I - .
0 I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 IFee $ 3
' compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL. � EES
License Law does not apply to an owner of a property who builds or improves _ _ -
thereon, and who does such work himself/herself or through his or her own Hood or Type I� ❑ DEVELOPMENT SERVICES REQUIREMENTS: r
employees, provided that such improvements are not intended or offered for Boiler Lll,. // �/�
sale- If, however, the building or improvement is sold within one year of com- Canopy Type II�) Zoning Approved By �I�aR+"` Date r
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ��vvll Date -�-
prove for the purpose of sale).
0 I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �`! ' Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTI 00,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- (1'
tractor(s) license pursdant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ Syste pair/Alteration BUILDING PERMIT $ 7-2.'519 SMIP $ •3]
proof of their Worker's Compensation insurance should be provided to me. -- PLAN CHECK $ (vO r�3 PERMIT
0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# ire Dampers • PLUMBING $ 6.00 ISSUANCE $
Date 'Owner Heating System &Ducting Registers - • PLAN CHECK 25% $ ,75— ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑ ,000 BTL—
information /2.00 is correct. agree to comply with all city and county ordinances -
and state laws relating to building construction, and hereby authorize repre- _ PLAN CHECK 50% $ tits-0 MICROFILM $
sentatives of this icy o enter upon the above-mentioned property for / �
inspection puma • MECHANICAL $ TOTAL FEE $ {//
Signature Date_/f'—O
Drivers' License or SS# einspection Fee $15 Issue Fee -$ 3. PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION ANDPLANNING . POOL&SPA
APPROVALS Permit# • Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1/i/si 04
2. Soil Pipe-Undrgrnd., 53. Steel Reinforcement ` 6
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE tr.. i
7. Footings58. Electrical Conduit-Undrgrnd. telt
Qom/,8. Foundation t 59. Gas Pipe, D Undrgrnd., Test /v
9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, D Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final Cit Pa(
13. Roof Drains 64. Plumbing System - Final 1
14. Rough Plumbing l 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval ,liel 49X1
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 4
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL007 ""
1 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# . -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing l 74. Overhead Hydro '.. - •
26. T-.Bar Ceiling (Structural) & Monocoat • ' 75. Dry Chemical 'f
27. Frame and Flashing. - . 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL o+''29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat il 79. FINAL INSPECTION ..? •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33.' Final Electric Notes: .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test '
• 36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing
'
39. Water Service-Final • -
40. Gas Service-Final
41. Solar Domestic-Final
•
42. Backflow Preventer' - ,
43. Backflow Irrigation' • . • •
44. Landscape Irrigation System - - -
45. Sound Attenuation. . . ••
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING .
48. Special Requirements Completed
49. Electric Release to Edison
,A
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY _ li
No. , Date
•
•
4465 3/24/67-
45.0 .ii, Tl
• )
COSTA MESA SANITARY DISTRICT PERMIT VALIDATION 1
P. 0. BOX 1200 1(�y I
COSTA MESA,CALIFORNIA 92626 PERMIT NO.
�J Q'`(7
APPLICATION FOR SEWERAGE FACILITIES USE AND CONNECTION PERMIT Date
3- -v 1
Ordinance No.6 Effective 9-29-69
CONNECTION CHARGES Applicant to fill in this area only
Building Address /gilt. C /1e•
NUMBER FIXTURE FEE/FIX. FEE
Bathtub $ 15.00
Tract No. Lot No.
Laundry Tub or Washer 15.00
Shower 15.00 Owner LCI��NOA- C11Al" TEy
•
'Sink,bar 7.50 N Sion c 1
Applicant -..+
Sink, Kitchen 15.00 •
•Wash Basin . - 7.50 Address 5301a' ( SV y LAJ'
Wash Basin(Set) 15.00
A/O/Win/ f L1-5
•
Water Closet(Toilet) 45.00 - Telephone Number /1-27 PVC?
Bidet 15.00 � \J
Dental Units 7.50 PROCESSED BY\L%P1h"1}-ss1/4` rl
Drinking Fountains 7.50
Floor Drains 15.00 INDUSTRIAL USE CHARGES
Interceptors for Grease,Oil,Solids, Etc. 22.50
Cu. Ft. per month per acre in excess of 15,000.
Interceptors for Sand,Auto Wash, Etc. 45.00 Rate is$0.50 per 1,000 cu.ft. per month per acre or any
Laundry Tub or Washer(Salt Service) 22.50 fraction thereof.
Receptors 22.50 (non ad valorem user-double above) $
Shower, Gang- Par Head 7.50
Sinks, Bar-Commercial 15.00 SPECIAL CONDITIONS t
Sinks,Commercial or Industrial 22.50 .
Sinks, Floor 7.50
Sinks. Flushing Rim 45.00
Sinks.Service 22.50 /
Swimming PoolSpa, 45.00 451 TOTAL CHARGES
Urinals,Pedestal 45.00 Connection Charge $ I
Urinals,Stall 15.00 Use Charge 1
Urinals,Wall 15.00 Total Permit Charge $
Urinals,Wall Trough 22.50 Penalties
CO Total Due $
Connection Charge $ 4� •
Penalties: Charges are double if connection is made prior to I
NOTEt A sewer permit is required at the time of obtaining permit,plus$5.00 a day. ($25.00 a day for a i
Sewer Hooks-up. public corporation).
CMF 0708-68 Rev.7-78
J
. • ' - ' Applicant to fill in all spaces except those within-heavy border lines and sign all appropriate declarations. ,
PER NO. TRACT NO. LOT NO. UNIT NO. C IL
CITY OF COSTA MESA CONSTRUCTION PERMIT/] a�s9 094B 3/13/86
Project Address /%7(I SQA /7J ea LV 1
Applicant's Mailing
Address OG CC -s 0�1 7e� TYPE OF CONSTRUCTION U NEW H ADO U ALTERATION IJ REPAIR
Owners Name PhonerJ5 /flA ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# 1 Zone •
``n „vsh ' - DESCRIPTION OF WORK/USE OF BLDG.
Address �'4//�/C/ l-I S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING LY FOUNDATION ❑ STRUCTURAL T Front o
Address ❑ TENANT ❑ ELECTRICAL .CJ PLUMBING ❑ MECHANICAL BA Rear • N
Sr- OTHER
Contractor's Nam• ` /// Phone_ QQC Right N
9 r �.�// PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) //rf� CON ST RUCTION TYPE VALUATION $ $ Left G
City License No. 3��?is R
ZONE GRADING CU.YDS. ACRES Ping. Ref. Parking Req./Provided - E
LICENSED CONTRACTOR DECLARATION O
I hereby affirm that I am licensed under provisions of Charter 9 (commenting Remarks: PlanningNotes: _
with section 7000) of Division 3 Of the Business and Professions Code, and
my license is In fu 90 •• .nd effect. f ECCIVeQ FeK l PIS M
tLicense Clas , a 4 ce-s• • a� RECEIVED S
Date « Signature AIM_A 4,._ A�%7i.` PLUMBING FEES RECEIVED 4 1Q$C
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL 11 FEES
'hereby affirm that I have a certificate of consent to self-Insure or a certificate
•f Workers' Compensation Insurance, or a certified copy thereof Section Backflow Preventer Service Sink
3800, Lab. S)n �1 0_7 n I.., �N q Automatic Washer Transformer 0 15-50 KW
MI Policy No. l/(/ '7�n /710 (� Company �rAJ(-y//r�-j Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
-V entified copy is hereby furnished.
Certi le�dj c/q p Lfy'Ietl with the city u' I I n / ® Bathtubs Sewer Connection Cooking Unit el' Meter ❑up to 100 amps
Date //( Jl `�' Applicant.�.^_� �,
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps - -
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers ❑Gas SElectric Sub Panel
I certify that in the performance of the work for which this permit is issued I - --- -_.
shall not employ any person in any manner so as to become subject to the Drinking Fountains , Solar Tank Fan % Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. - _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+
'NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. —
CONSTRUCTION LENDING AGENCY 'Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance _
of the work for which this permit is issued (Section 3097 Clv. C.) interceptors / Water Heater
QV Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal ;Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or ,
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays '
any structure, prior to its issuance, also requires the applicant for such permit • Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she Ig licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
flivision 3 of the Business and Professions Code) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
331.5 by any applicant for a permit subjects the applicant to a civil •
enalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not intended or offered - Reinspection Fee I $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL I FEES - -
License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement Is sold within ono year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date /�/��
prove for the purpose of sale). Cii) •
IDI, as owner of the property,am exclusively contracting with licensed con- - Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who Contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $
(f Exhaust System 0 Multiple 0 System Repair/Alteration
proof o their Worker's Compensation insurance Should be provided to me. _ PLAN CHECK ' $ /� PERMIT
0.i am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO 4e Fire Dampers — PLUMBING $ st/UISSUANCE $
•
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 04100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- iPLAN CHECK 50% $ MICROFILM $
sentatives of this city to e t-r upon t e above-mentioned property for ••
inspection pur...es. / MECHANICAL $ 500
Signature I�
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POO. ;PA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
` 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings •
58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
,17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing r' 6-S-$b Las
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final ^' . 1
42. Backflow Preventer ti.• c
43. Backflow Irrigation
44. Landscape Irrigation System '
45. Sound Attenuation . ;?
46. Handicap Regulations
't.
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
A, 0, Twining Laboratories of sou :/
E = earl/au-Lin, '.
—4°Z17
AIl1.°2
3310 Airport way / Mailing Address P.O.Box 47 / Long Beach.CA 90801 / (2131 426-3355 / (213)636-2386 / (714)82&6432
TESTING BRANCH OFFICE: 1514-13 North Susan Street / Santo Ana CA 92703 / 17141 554-2645
April 21, 1987 Examination: SC87-3664
COMPRESSION TESTS ON GUNITE CYLINDERS
Max Sitter
P.O. Box 3454
Fullerton, California 92637
PROJECT SWIMMING POOL & SPA
ADDRESS 1948 Sanderling, Costa Mesa
ARCHITECT CONTRACTOR
Executive Pools Executive Pools
ENGINEER SUBCONTRACTOR
B.C. Adams Scott Gunite
SAMPLE FROM Main drain
SPECIFIED
MIX 4.2-1 STRENGTH 2,000 psi
DATE CAST 4-11-87 SLUMP SIZE
5-1/8" x 12}"
DATE TESTED 4-20-87
SPECIMEN NO. A B & C "HELD IN FIELD"
COMPRESSION 9-Day
TOTAL LOAD, LBS. 66,000
POUNDS PER SO. IN. 3,200
28•DAY AVERAGE, PSI
COMPLIANCE 9-Day test complies with specified strength.
MADE BY DELIVERED BY RECEIVED ON
SPECIMENS Dave Max 4-15-87
DISTRIBUTION:
Max Sitter - 3
Coe4e.:4esa Bldg. Dept. /Scott Priegel
feZ
ck Hyden
-LL R^EROF TS APE SUBMITTED AS THE CO::FIDENT,.L PROPERT,OF CLIENTS AUT CRILnnir. TOR PUBLc r,G::OF OU==En'OR's C .CLOS ON5.OR EyiRACTS FRO:.t
OF RF'.r.RDINC TI.E. IS cESE=,.EDFEND:::G CUP t.PIrTE':=occC?NL A5=:4UTWL-crrEC.0•. 70 c,c __
Gunite ) Post-TE 'oned Concrete ( ) P
REPORT OF INSPECTION Masonry ( ) Fireprouring ( ) �-� f
Concrete ( ) Reinforcing Steel ( )
BSM TO: Qa` inPS�
Address :
OWNER: � }qpy n )
PROJECT: S4ninDrntN1 pm( Report No.
Address: 1CiLIR <Aayc Q(ZLt. Permit No. r97R3•Q
Architect: FvP1 IVC lb 5 Contractor: ?'Ke (L FI\1c pais
Address: Address :
Engineer: r2,„( Aowns Subcontractor: c„,714-
(Gunite)
Address : Masonry or
Concrete)
Inspector: rn , S; Address:
f
On • 9w s Lt. y Fbii a'{ay
Mix llsed: c4 .&- j
Slump, inches:-E=j-
Admixture: C)
Designed Strength, PSI :gC.,00
The following inspection was performed in accordance with the approved drawings:
Cu.Yds. No. of
44124.2___
DATES Placed Cyls. Remarks
`t 11 to , ,3 S1«l, rein- ) oT+)l .44 rat. (IC0
t-s::57))Crr1FaY k E k• preet rhea pr. cI il.,
a n�1 lac T,z ;R 1 PL._czu
Copies of Reports to: ( indicate which Bldg. Dept. & furnish address of any not listed)
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT P MIT NO. TRACT NO. LOT NO. UNIT NO. •
Project-Address 1948 Sanderl inq Cr. , C.M. 92626 - ,Zs� 9 '
•
Apant's Wiling Address 126 Commercial Way TYPE OF CONSTRUCTION LJ NEW k l ADD LI ALTERATION Li REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name Susan 8 Joe Lyons Phone• DESCRIPTION OF WORK/USE OF BLDGemove existing, install
Address1948 Sander I i ng, CMM 92626 • sheath i n e CLASS A fiber e I a a ' •e - i - . II- . S Main Building: Accessory Building: Z
TYPE OF PERMIT IU GRADING IIS FOUNDATION U STRUCTURAL E Front Arch/Eng. License No. T t O
Address .
❑ TENANT ElELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear • N
,
Crank Bros. Roofing 548-5569 ❑ OTHERA I
Contractor's Nama
Phone PROJECT DESCRIPTION 5q. FT. S'500.00 • OCCUPANCY single C Right N
Address(mailing/ 126 Commercial Way, C.M. 92627 K G
005993 CONSTRUCTION TYPE res i dent i a l VALUATION $7212.00 S Left R
City License No. ZONE GRADING CU.YDS. ACRES. E
LICENSED CONTRACTOR DECLARATION - - Ping. Ref.# Parking Req./Provided
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full force and effect.
License gip e — i LicenseNo �r PLUMBING FEES $
Date Ill/ "-Signature -
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
:,.1 hereby affirm that I have a certificate of consent to self-insure or a certificate
f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
:38o0, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. 285/274-88 &tratieyFund Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW •
Certified copy is hereby furnished.
Cer{i le filed with the city ng lvlsio Bathtubs Sewer Connection Cooking Unit. Meter Our)to 100 amps
ate I U/ I //bid Applicant B..t�ky c/v
A1/4k,,
EXEMPTION FROM WORKERS'CONTPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
\\\ (This section need not be completed if the permit is for one hundred ($100) or '
V\\less). Dishwasher Solar Piping Dryers DGas DElectric Sub Panel
allI certify thatm in the performance personinof the work for as whichothis permit s t issued,t --
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank • Fan Motors ❑0-1 HP D114-8
Workers' Compensation Laws of California,
\ Date Signature _-Floor Drains Swimming Pool vv/SpaF.A.U. Inc.Solar ❑g-15 HP ❑16-15+
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
\. comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License-Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW -
any structure, prior to its issuance, also requires the applicant for such permit Trash COmpact0r
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • '
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
'livision 3 of the Business and Professions Code) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
131,5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500).
b I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL i I FEES
License Law does not apply to an owner of a property who builds or improves _
thereon, and who does such work himself/herself or through his or her own Hood or Type 0 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for BoilerZoning Approved By Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under GroundBuilding Approved By Date
prove for the purpose of sale).
D I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Datg;204R77
tractors to construct the project (Section 7044,Business and Professions Code: _
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,060 BTU • SU RV OF FEES
builds or improves thereon, and who contracts for such projects with a con- ` 7�M/p /'i)�,.-� ,/
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 I System Repair/Alteration BUILDING PERMIT $ ' fiSMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
,t.E I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
•
•
. Date - Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
, I hereby certify that I have read this application and state that the above ❑0-100,000 BTU ❑100,000 BTL ELECTRICAL $ GRADING $
•
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre-
sentatives of this c er upon the above-mentioned property for ,t�q7 q
inspection purpos �. MECHANICAL $ TOTAL FEE $ /!/!/r!/
Signature Date •
Drivers' License or SS# 10/ 1 //56 RReinspection Fee $15 Issue Fee $ 3- PLAN CHECK 25% $ .
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor DATE: 10/17/E8 TIME: 06:19 -vV•V V
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro ,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing • -
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE_ OF OCCUPANCY
No. - Date
IP45`02
COSTA MESA BUILDING-SAFETY DEPARTMENT - 'lEC -9-77 cnsa00 51-13* ****10.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• 'P I • ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely- Use Ink Only
can
a V DATE RECEIVED ATEI SUED BUILDING i / '
ADDRESS 1 I Y p _SCIA /ePl s1 c:f r 71.4 _�.1r
OWNER 04tA4.(e( CLL,.Y. e� A.P.NO. a37 '- 2O PERMIT NO.
MAIL
ADDRESS S A His
BUILDING Imr8 `S" /^r'7' C .'1
//••��� /I •• ,, ! -ADDRESS `p'7C�\^.is /
CITY
lJp$TV I�a)V NO. 5578QW TRACT 55297 LOT 7 BLOCK
CONSTRUCTION NEW A4p BITER REPAIR MOVING. neon'I H
LENDER v/
BRANCH f\ / r �
OWNER NIµfit Li e7 La Pine/ e ._
ADDRESS 11.
C7VALUEORCNITECTNEL. CJ� $ 1��7 ��vOR ENGINEER NO.
FIRE
att
EJ_ GROUP C
APADDRESS nCONTRACTOR OWyL e,r DATE ' Leel•��
ADDRESS
TEL. ZONEgq IPLANS NO.OF 2 USE BUILDING /I7OF NEWvn
je d��
CITY NO.
.-. STATE CITY YARDS APPROVED YARDS APPROVED
Z LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STRET)
ID SIZE NO.OF Q. OF LOT INOW ON LOT FRONT /g�rer.Rf'
A!G FT.
USE OF EXISTING BLDG. R.SID/V 4 FT( FT.
V. y
FSeparate permits are required for L.SIDE# r' FT.
electric,plumbing and heating work. �L r
WREAR 2 FT. FT.
(.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& .
MVAR.9F DATE
AIN BLDGS. ACCESS BLOCS.
. C.U.P.# APPROVED
' • ffPs' 2�= V • /8 9 AROVE�S/ r
_YDATE/2—9
. /
a
ID
Cl. I hereby acknowledge that I have read this application and state n
CE co the above information is correct and agree to comply with w
Clo all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of E
the State of California.
3 I herebycertifythat I am 5/e) SQ. FT. a
properly licensed es a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F E ONLY: - e
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ �r �•� a
and ProfessIons Code,Division 3,Chapter 9. t/ n
01{{9e.
,���///��� /// rt PLAN CHECK $ 'n
Signature ofy� - / 1:,E..44‘,.....,"�/p J .�sr t
Permittee t/ L� �J / $ /rtI-f TAX $(J U
Authorized Agent TOTAL PAID $ (0. 5sl! 1
OWNER CHAFFEE, DONALD DATE 12_9-77
OB ADDRESS 1948 t Sanderlt Circle BC NG PERMIT NO. 45202
ENERAL CONTRACTOR Owner-g DESCRIPTION aI WORK ratio CDYer
No. 139-481-20 LOT 7 TRACT 5289 FIRE ZONE VALUES 1,000,
INSPECTIONS Signature Date TYPE V GROUP ,T ZONE R-1
J OIL PERMITS ISSUED
AS SUBCONTRACTOR Date I Number Sian ature
ATER
Plumbing
DUUG.GH PLUMBING
ROP. SWR. LINE Q HOUSE CON. C
PRINNLING SYSTEM
ISC EL LANE CUS
ROUGH HEATING AND AIR CONDITIONING
-.-
TEMPORARY
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER C
ROUGH WIRINGHeating and Vent.
TRENCHES F-71-77477C ELREINF. /STE --en rn•77
FLOOR SYSTEM / ,4vii
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING I--
LATHING - IN n OUT in ,, .h II • — u {
PLASTER, BROWN COAT If /r ,', I 'Cl II
STRUCTURAL, FINAL fl Eleclric•i _l \. I l n !I E
HEATING, VENT., REFRIG. AND A.C., FINAL `=� IJ U U V \� L... IS. I
PLUMBING. FINAL ANO GAS TEST n -�
BUILDING, FINAL • ' DATE -'2"(1-8° el .,7
^ \IF \
SEP 2 77PA1°00 156* ****72.62
4459 i CMSA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A'PL C• ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
R 1' ED BY DATE RECEIVED D1TE ISSUED
BUILDING /,/8 54 /.v I'.H One t'- Al `A—?
ADDRESS VV t•d
OWNERp Lace'I A.P. NO. I - ' r�dir /�� 444/'1�/J//�/
AMAILDDRESS Sr`M� BUILDING /9 /��, \ ^ �/D�C/, &-
ADDRESS / 5s- is yV �J /V l./�
TEL. TRACT 5 LOT ( BLOCK
CITY NO.
CONSTRUCTION NEW DD ALTER REPAIR MOVING DEMOLISH
LENDER (�,/+
BRANCH OWNER Dr/],s/ n C1V I/J % /1,9 FFEE- di
ADDRESS VALUE
ARCHITECT TEL. USE / Dnr $ 1',o
OR ENGINEER NO. Pc
FIRE
ii �
ADDRESS ZONE /��YPE GROUP
rr�� �1 / APPROVED/jN//- , / s_
CONTRACTOR �,yU1, 'ItEepro.i �SkIJ'cM BY DATE % ` x
ADDRESS tete v1eyn:U ilu&.
Flow
TEL. ZONEcal NO.OF //� USE OF NE
CITY �4�'�e. Now NO.�7-677 Ir. j► BUILDING •
F STATECITY YARDS APPROVED YARDS APPROVED
LIC.NO. 13,)7 l/`0 aD LIC. NOVt f& MAIN BUILDING ACCESSORY BUILDING
I (FROM C/L REE
(4 SIZE NO.OF BLDGS.
L OF LOT I NOW ON LOT FRONT FT.
Q USE OF r 2I
CO EXISTING BLDG. a.SIDE 141f0 FT.IY FT.
rn ( 1.48
S Separate permits are required for L.SIDE ' FT.D FT.
F electric,plumbing and heating work. r do
O - REAR FT. FT. .
EW.i VSE �F gTUI LDI G AN WORK TO RFfEORMED DISTANCE BET. BET.MAIN&
st /pc! ,4 t fteO"4 CAr-A MAIN BLDGS. ACCESS. BLOCS.
GI
VAR.# DATE
'C . .4 `�.n� env,N:N7 '/ Rso La-,rt- C.U.P.�S ////�I .fin[ APPROVED 22-77
J 7�/J
�.. 7O LP Co,t.C( �ScS 5.W r r AP ROVEDb—BY DATE Br 22 /
..l
C4 t
LUa
0. I hereby acknowledge that I have read this application and state n
p: that the above Information is correct and agree to comply with m
O. all laws regulating building construction, and I shall not employ
Z any person in violation of the workmen's compensation laws of
m
47 the State of California.I
�76 FT
SQ. m
I hereby certify that I am properly licensed as a contractor under . cl
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FJEE ONLY: b
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ X V
and Professions Coda,Division 3,Ch er 9. // ,I m
Signature ofg. PLAN CHECK E �c,L1 o
Permltt� $ troy TAX S ` 62'N U.
2
U
Authorized Agent TOTAL PAID S / .2_, 6 2.
OWNER CHAFF , D. DATE 9-2-77
JOB ADDRESS 1948 $anderllnA tie BI ING PERMIT NO. 44597
GENERAL CONTRACTOR J. D. ThLuggson Constr. DESCRIPTION of WORK Add kamilyroom
AP No139-481-20 LOT TRACT FIRE ZONE VALUES 8e 800.00
INSPECTIONS Signature Date TYPE V GROUP I ZONE R-1
solL SUBCONTRACTOR PERMITS ISS�ED
GAS Date I Number Signature
PWATER /' n -t-J Ii. Q Plumbing
rt
ROUGH PLUMBING S gn� J ema.t✓o i7 -17 1.21440
PROP: SWR. LINE[� HOUSE.CON. [ICC".
1 PRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONINGRA 11.3;
•
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING egti and Vent.
0TRENCHES `FORMS o PK hm. •a�- n �,.,r9 a 9 i��lG
FLOOR SYSTEM FORMS STEEL REINF.
/1- 7'7
BOND BEAM 7 STEEL' REINFORCE Il
SHEATHING ter
G- �o 7'y9
FRAME AND FLASHING 7
LATHING — IN OUT l•,v.I /- ertAl
PLASTER. BROWN COAT • I •
STRUCTURAL, FINAL ,
/�
HEATING. VENT., REFRIG. AND A.C., FINAL a 12v '4i r �� -i a•-••� •• - •/•
PLUMBING, FINAL ANO GAS TEST 7 1 V
ELECTRIC. FINAL I -
BUILDING. FINAL --I i_ 27
MriaLect—staiteettrom "Pe-re-nev
•
rLC IItt,tIVtU
2I 26 MAR 31 1964
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 317 COSTA MESA,CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMR
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS 1948 Sanderling Circle
RECEIPT NO. I ^
COSTA MESA. CALIFORNIA b
RECTOBY Dw3' R¢c IV¢B DATE ISSUe<����
OWNER Pemba Subdividers, Inc. . / y, APR 1 4
BUILDING
MAIL
ADDRESS2850 Mesa Verde Drive ADDRESS
/
BL/
CITY
Costa Mesa, TE•5490395 ZONE TYPE j�✓ GROUP /
ARCHITECT E.G.Kaltenbach TEL5478046 BYPROVHD DATE r
OR ENGINEER NO.
1833 E. 17th St. , Santa Ana ZONING
ADDRESS ZONE No.OF USE OF NEW�ln�. fain.
Owner / R-1 I PLANS 2 5I1ILDINO_/
CONTRACTOR [R hi W
DEeCR
LEIPr1ON
•
SCR Lot 7, Tract 5289
ADDRESS
CITY A.P.NO. none
187318 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
TEL.
STATE SO'TO SIDE B REAR P.L.
LIC.NO. NO.
SIZEEAVES I NO.OF BLDGEO ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
USE OF��X X I/O q0.22C-Y--05`,.2YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM RjI p 50 t
CENTER OP STREET •�3 REAR YARD FRONT . P-1% FT.
8' 7'
SIDE YARD LEFT I RIGHT - R.SIDE 7 FT. FT.
DESCRIPTION OF WORK L.SIDE
NEW X ALTERATION_ ADDITION REAR SDFT. FT.
DISTANCE SET. BET.MAIN S
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDGS.
BUILDING 2 419 NO.OF 7 2 VAR.# DATE
SIZE f ROOMS STORIES C.U.P.# APPROVED
EXTERIOR W l,{�S�Siding ROOF �Shake.j: APPROV{Q�//� (j-
COVERING RIbWCCO I COV ERIN W++ingie BY V.7�L L/LA."4 DATE - .•� 6 f""
USE OFUI INC D WORK-TOB ER OR ED
Single family wiatfa.cneo garage. cam,
House 1, 956 sq.ft.
Garage 463 sq.ft. Plan 52-B / 74)30.E-rd - i3� o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHNDER VALUATION IS FOR THE E'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDIN CES AND STATE LA REGULATING VALUATION
SUILDI TH ALL ORDI. /ST PERMIT FEE $ n
SIGNATURE OF // �O'
PERMITTED 14/4"" A 7
$ // / 7 LA O EC 30 .� O
AUTHORIZED T n
• TOTAL FEE $ 9o--
_ _ - ;— I 7 FSS rap,�..Ip
•
-- — — — — — Tr — — — -- — - 4
� ..01.----
_
4 Z4 FEET
----- -- _-- ;� NOTE 7 T r/
_ ,� CON.�TRUCTION .SHALL + ��"/� �
�CNF(.PM TO ALL _SO EC .-
�/ ,' / s
iI ON ' PAT/o CZ L'EE. DETAIL' I / / %/j/
/,
t ciATED c,-I- c7 .SUPPLIED
j t it Lav CITY (rum RU -4-0)
- ,/
1I
FROjjpil ,
r� —i I S L- ; IJ 1 ' I ' +� OF COSTA MESA ".
f 1 /F C I �+ I PLANNING DEPT.
I i city of N s I/U" SUBJECT F BLDGCOS DEPT. SA '
Ry �esa BUildi„g Dept. f �jn24
CE
_ ST,r�/ e I II ' MAKE ESE PLJA-NS MUST BE —..1)1 -_-_- 1 _.I? OIR[C10R Of RAI�NINO-I
SFP CF°,! — — I OF DEPT O OFfANGES WITHOU7JOB A7 ALL TIMCcS1 11
I
FOR, 0
q,�ql q�41 .e pQ�,i ---1 PR10R APPROVAL
ifit Fe e4Ifil P'ro�7 \ I TO 9E AOF PLDS `�DISSOINSPECF CATIOGRANTNSC OF AT
PERMIT OR APPROVAL
Pei.4Gb/ellPf !`1,A 04// i OF NNY of r, 'II PROVISIONS N APPROVAL OF SHALL r ANYRE C�pLARUED
TION .—.._--7O,I —._ .__.. -_.—_ __ _'._ _---'A'
06, !/�"T, ,L . td \F I PP''.;; iU GIVE AUTHORITYHIS CODE. NO
4 • F?Al/2A 'l!'L ��— — FA.R:i 17HL I!0 +HIS DHfTO VIOLATE OR CANCEL THE PERMIT RE p C i
llyr/; ✓:^ye / * HI RK OR USE WHICH Ii AU BE VALID, EXCEPT IN SO I `' - D ER LI NC- c I R.
J; //\ 10 i, y ISSU,'�N` THORIZE$ IS LAWFUL
4z -.7
its.. �CT\� �; ALAE , , , JlF .friALL NOT PREVENTTHA PERMITED UPON PLANS AND r UT C1 RC_� ��i V J / •
R REQUIRING THE THE BUILDING OFFICIAL //8 81
BF"rBG/` tCl/C y`,f A6� IN j , I . ,.LA+VS 'No , IFICATIONSORRECiION OF ERRORS
Sj, F,/a�U.., ��. C„ + . UPELW RATIONS BEING PREVENTI r�
/!yC'^F"ocy'�o PUFslpgyr ,..?'xi C, SLATS I ry!+ UFIHIS CARIEOORFROM f i OT PLAN
Op , / c y`,.� c � FODE TTN
l fiefVgIrays. t" ' /0 ) q L ckA JGL E .EF AC K ET ,��/
� ot iii{ !- � _‘ t II
T ste
4X fa (MAX. SEAN I'S' a O. F
s� .
C of k N A:JG All_ PD,.rS L - `1PAP
4.. ' I "-iArIGiI;; x4 316 X
MIN. I X(` ! Et?_"rf� �1��
! I + IIL 0
° L7-S Q
az LIQ f . - ^'T ARIC HC,U --
i_i_
____ Li1 1a" t3ELCW GRADE_ N\IN .
-E27 6 -- --- H
PI;OPOSED PArr° C c vis
1 MR. `Ir MRS . Di-'Weal) C. HAFFEE
1948 SANDER:.N� CD�7A ME.lA
• I
le -67- 77