HomeMy WebLinkAbout2759 SAN CARLOS LN - Building Permits/� �
CITY OF COSTA MESA
BY/LDING DIVIS/ON
i � )7 FAIR pRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-0856 • www.ci.wsta-mesa.ca.us
�.4��� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBE P07-00557 : � =
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PERMIT TYPE PLUM STATUS: FINALED ;" :� r�
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APN: 14155702 DATE ISSUED: 10I29/2007 '<<_T. �,?'� .'�,
� � ISSUED BY: CAC'��` �, °� ��"'�'- �`r�' � �
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JOB ADDRESS: 2759 SAN CARLOS LN CM Suite/Umt�T�$y;_ �-s •� "
Vicinity: ,. , .. _ . . ... . ,',s�'� ;fr�,-=� '� -'.`�o� ro.:�.t � -�r
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' . ' � r e '�Mi.'S "'w'�'<P°.'2&� i Ni�':' - -'.+? �F . :�'
SCOPE OF WORK: REMOVE AND REPLACE WATER HEATER AT
. . ..:,e*'7�.
OWNER:
PHONE:
APPLICANT:
PHONE:
LEWIS, MARK ERIC TR
MEGAN MILEV .
714-891-2177
CONTRACTOR: AABCO WATER F
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;j�2917 CLUBHOU$E RD
i; COSTA��MESA,'�CA
`� � PO�BOX:1212:.*':
�IOS AlAb1ITOS,CA
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.ieense�No.' 708922
r'pzliu PI10NE: 714-891-2177
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FEE SUMMARY (
$0.00 � �
$35.80
$85.30
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NOTICE: The work authonzed by this pertnit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
E%PIRATION: PERMIT EXpIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work aulhorized under this permit to be consideied legal, such work must comply with all applicable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
Final Re-Roof "-
Final Block/Retaining Wal1
Final Factory Fire_Place
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WORKERS' COMPENSAnON DECLARA710N
I hereby aKrm under penally of perjury one of tl ,wing declaralions:
❑ I have and will mainlain a certifcate of wnsenl to self-Insure (or vqrkers'
wmpensation, as providetl for Dy section 3700 0l the Labor Code, for the
peAormance of the work �or which l�is permit is issuetl.
❑ I have antl will main�ain workers' compensalion insurance, as required by
sectbn 3700 of the Labor Code, for ihe peRwmance ot the work for which this
permi� is issuetl. My workers' compensalion Insurance carrier and policy
number are:
Cavier:
(Tlut sedw neM �rol oe c�dete0Alne peimt rs valved al me nunJred tlollars (5 �W) a� less.)
Policy Number:
❑ I certify Nat in Ih¢ pertortnance ot the work for which this permit is
issued, I shall no[ employ any person in any manner so as lo become subjecl
lo the workers' compen9alion laws of Califomia, and agree Ihat if I should
become subject to the workers' compensalion provisions of Section 3700 of
the Labor Code, I shall fort�wilh wmply with these provisions.
AppLwnl's S�gnalure
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND S�LL 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, IMEREST, AND
ATTORNEY'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby affirm Ihat I am licensetl untler provisions of Chapter 9(commencing
with Section 7000) o! Diaision 3 0( the Business an0 Pro(e55ions Code, and
my license is in lull torce and effecl.
Lic. # _ . _ Class #
Comranor's S�gnawre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affvm that there is a constructbn lending agency fw the
peAwmance of Ihe work Ip which ihis pertnit "s asued (Sec. 3097, Civil Code).
Lendei s Name:
Lender'S Address�
pale
OWNER•BUILDER DECWRATIONS:
I hereby affirm that under penalty of perjury Ihal I am E7(EMPT FROM THE
CONTRACTORS LICENSE LAW for the fnllov+ing reason (Sec. 7031.5,
Business and Profession5 Cotle: Any cily or county which requires a permit to
consWct, alter, improv6, tlemolish, or repair any strucWre, prior-to its
issuance, also requires the applicant for such permit to file a 5igned stalemen�
Ihat he or she is licensed pursuaM to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business antl Professions CoOe) or thac he or she is ezempl Ihe�ef�Om 2ntl
the ba5i5 (Or Ihe alleged ezemption. Any violalion of Section 7037.5 by any
appliwm for a permit subjecls the applicant lo a civil penally of not more than
fve hundred dollars (5500).)�
❑ I, as ovmer o( Ihe property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, antl the structure is nol intentled or
offered for sale (Sec. 7044. Business and Professions Code: The Contractors
license Law Uces not apply lo an owner of property who builds or improves
thereon, and who does such v+ork himself or hersel( or through his or her own
employees, provided Ihat such improvements are not intended or oflered for
sale. If, however, the bUilding or improvement is sold within one year of
completion, the ovmer-builder will have the burtlen of proving lhat he or she
did not buila or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
UCENSED CONTRACTORS to construct the project (Sec. 7044. Business and
Professions Code: The contractas License law dces nol apply to an owner ot
pmperty who builds w impro�es thereon, antl who coniracts for such projeCt wi�h
a cml2ctor(s) license pur8uant to the Cont2ctas License Laws.l.
❑ I am exempt under sec. �
Business and Professions Code for this reason:
� C�
Owner ID venfietl by An� nse. ❑ Ves ❑ No
Driver's License No. _ Expires:
Verifiwtion of Ownership by (type of document, i.e. • propetly lax bill or Ceetl):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
❑ I hereby ceAify thal no excavation frve (5) or mwe feet � depth into v.fiich a
persrn is required to descend, will be made in connectbn with v.ork aul�orized
by this permit, and that no building slrucNre, scaHdding, falsev.ork, or demolition
or tlismantling thereof, v.ill be more than lhirty-six (36) feet high. (Chap. 3.2, Grp
2. M 2. Sec. 341. TM1fe 8. CalAomia Administ2live Code).
❑ As owner-builder, I vnll not employ anyone lo do vrork which would
require a Oermit from the Division of Industrial Sa(ely, as noted above, unless
such person has a permit to tlo such wOrk lrom Ihe division.
Aod����'z Sgnalure
Division ol Industrial Salety Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to file and
certify a Business Plan for emergency response to release or Ihreatened
release o( a hazartlous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Safery Cotle requires, with some
exceplions, that a Business Plan De fled with the Costa Mesa Fire
Departmenl Ey every business which has at any one lime dunng a reported
year a quantity o! �azardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed qas
at standard temperaNre and pressure).
2. Does or will the applicant or present or fulure building occupant need lo file
a regislration (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of [he Cali(omia Health antl Safety Code, with some
exceptions, requires registration wilh lhe Costa Mesa Fire Departmenl by
each 6usines5 which at any one time has on hand a quantiry of acutely
hazartlous matenals equal lo or greater ihan a v.eighl of 500 pounds. or a
volume o( 55 gallons, or 200 cubic leel of compressed gas at slanCartl
tempereture arW pressure�.
3. Does or will the applicanl or presenl or lutwe building occupant need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous malenals)? ❑ Yes ❑ No
(Seclion 25534 of t�e Califomia Health antl Safery Cotle provides that Ihe
Costa Mesa Fire Depaement may require lhe preparation, certificalion and
fling with the Fire Departmenl ol an RMPP by bu5inesses which are required
to register acutely hazartlous materials with the Fire Department.
4. II an RMPP is presently required, has Seclion 25534 of the Califomia
Health and Safety Code 6een lully complietl with7 ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work whiGh is the Subjec� o( Ihis applicalion a permil (or such construction
or motlification from t�e South Coast Air puality Management DisMct or fmm
any other air pollWion wntrol Aislrict or agency? ❑ Yes ❑ NO
(Section 65850.2 of the Calitomia Govemment Code requires �hat lhe reques�etl
infwmalion be fumished on applications lar noo-residential builaing pertnits).
6. Will any part of the facility to be constructed under this parmit be within
1000 feet lrom the outer bountlanes of a school? ❑ Yes ❑ No
pf yes", the faciliry musl meet Ihe requirement of Setlions 25534 and 42303
o( Ihe Calilomia Heallh and Salery Code).
7. I( a pertnit from the South Coast Air Qualiry Manaqemenl DisMct or other
air pollution conirol districl or agency is required for the work which is lhe
subjecl ot this application, have all of the disclosures prescribed by Cali(ornia
Health and Safety CoOe Section 42303 been made7 ❑ Yes ❑ No
B. pf yes', attach certificate of compliance fwm the appropriate air pollution
comrol o(ficer).
CERTIFICATE OF COMPLIANCE: I certify [ha[ untler penalty of perjury the
in(ormation given above is correct. I agree to comply vnth all slate laws and
city ortlinances regarding Hazartlous Malerials and Emissions. �
a�5^aWre Oale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihat 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 conslruction, antl authorize representatives of
Ihe Ciry of Costa Mesa to enter upon the aDove-described property for
inspection purposes. I agree not lo occupy or allow occupancy ol any building
authorized by this permil until final inspection.
$�gnalure o( Legal Owner�s)
]OS]-d61J101) Anplor Rulbonze0 A001¢anl Dale
PERMIT TYPE
CITY OF COSTA MESA..
BUILDING D/YISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa a.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER P07-00557
JOB ADDRESS:
Vicinity:
SCOPE OF WORK:
1�111�4
2759 SAN
STATUS: ISSUED
DATE ISSUED: 10/29/2007
_ _- � -- ISSUED BY: CAC
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4RLOS LN CM Suite/Umt, "
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PLACE`,WATER HEATER AT THE SAME LOCATION�,
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OWNER: LEWIS, MARK ERIC-TR� - �- �.Adtlress:� � �2917 CLUBHOUSE RD���'•
PHONE: �;' ("� � - ���City/State/ZiP: '�,COSTAMESA CA
APPLICANT: MEGAN MILEY � ','� - r ". •-��'"Address �� � "� � ��PO-BOX-1212 �' r'��.
PHONE: 714-891-2177 ',i , _ City/State/zZip: � L05AtAMITOS CA �"�,
i: 1
CONTRACTOR: AABCO WATER HEATERS `. ,.., License No.,,, 708922 ,..-
Address: PO BOX 1212 _ �� �. ,, " PHONE: 714 891 2177
City/State: LOS ALAMITOS CA� � ' ZipCode:� 90720 � - � � - - - �-CELL: � , , �
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PLUMBING PERMIT F�E�E,SUMMARY � �� � �� � � �
PLAN CHECK FEE: ,$0:00 , � .. ' ` � � � ' � "
PERMIT FEE: $35.80 � y� � -
TOTAL FEES: $35.80 � �:' � � r`
4�, .� ' . ._.. .. .
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 DAVS 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 flnal approval will result in the expiration of this permit.
LOOE t. INSPEC710NTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final �
200 FinalRe-Roo!
207 Final BIocWRetaining Wall
202 Final Factory Fire Place
ORiE INTITIALS CODEt INSPEC110NTPE
206 final MechaniCal
208
210
212
220
Pinal Plumbing �
Final Electriwl
Final Fire Prevention
Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition ' 250 Final Bui�ding/Occupancy
Dr1TE IN11ML5
WORKERS' COMPENSATION DECLARATION:
I hereby affrm un0er penalty o( perjury one of the following declarations:
❑ I have and vrill maintain a certificate of consent to self-Insure for workers'
compensation, as provided lor by section 3700 0( the Labor Code, for the
perto mance of the work for which this permit is issued. .
I have and will maintain workers' compensation insu2nce, as required by
bn 3700 of the Labor Code, for the performance of the vmrk for which this
pertnit is issued. My v.nrkers' compensation Insurance carrier and policy
are: /'�� � �
Carrie .� �
' secfunneeO�7�/�Gf/re/pe►rm4a-�va�lueyd�atmenuMrtNMOarslE100)wless)
olicy Number: �V 1"1�`7 — [-IAJ�
❑ I certify Ihat in �he peAOrmanCe o( the work for whiCh lhis permit i5
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Califomia, and agree that if I should
become subject [o the workers' compensation provisions of Section 3700 0(
the Labor e, 1 shall f rth ' co ly with these provisions.
nl's Si re Ie
WARNING: FAI E TO SECURE WORKERS' COMPEN TION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby atfirm that I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
ioaa 's in full force a''n'jd� �effect. !
Lic. # Q v`�— . �-l�/,� �
Q I
co t ' si Da�
CONSTRUCTION LENDING AGEN .
❑ I hereby a((trm that there is a construction lending agency for the
peAortnance of the work for which this pertriit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sea 703L5,
Business an0 Professions Code: Any city or county which requires a permit to
wnstruct, alter, improve, demolish, or repair any strucNre, pnor to its
issuance, also requires lhe applicant for such permit to file a signed statement
lhat he or she is licensed pursuant ro the provisions of the Contrecbrs
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 0! Ihe
Business antl Pro(essions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemp[ioa Any violation of Section 703L5 by any
applicant for a permit subjects the applicant ro a civil penalty of not more than
(ve hundreC tlollars ($500).):
❑ I, as owner of lhe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such vrork himself or hersel( or through his or her own
employees, provided ihat such improvements are not intended or offered tor
sale. If. however, the building or improvement is sold within one year of
completion, ihe owneo-builder vnll have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the.property, am EXCLUSIVELY CONTRAC7ING WI7H
LICENSED CONTRAC70RS lo construct lhe project (Sec. 7044. Business and
Professbns Code: The cont2ctors License Law dces not apply to an ovmer of
property who builtls or improves thereon, and who contracts for such project with
a coniractor(s) license pursuant to the Contraclors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID venfied by driver's �. ❑ Yes ❑ No
Dnver s License No. Expires:
Venfication of Ownership by (rype o( document, i.e. - property [ax bill or deed�:
. . . : r.i. 1; ., <
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: :-'• �
❑ I hereby certBy tha[ no excavation frve (5) or more teet in deplh into wfiich a
person is required to descend, will be made in connection vnth work authorizetl
by this pertnit, and that no building structure, scaHdtling, falsev.ork, a demolition
or dismantling thereo(, will be more [han thirty-six (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, Ttle 8, Cali(omia Administrative Code).
❑ As owner-builder, 1 vrill nol employ anyone to do work which would
require a permit (rom the Division o( Industrial Satery, as notetl above, unless
such person has a permit to tlo such work fmm the division.
ApPlicanCs SignaWre Oale
Division of Industrial Satery Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applirant or present or fuwre building occupant need to file and
certify a Business Plan tor emergency response to release or threatenetl
release of a hazardous material? ❑ Yes � No
(Section 25505 of the California Health and Sa(ety Cotle requires, with some
exceptions, ihat a Business Plan be filetl with Ihe Costa Mesa Fire
Depanment by every business which has at any one time during a reported
year a quanlity of hazardous ma[erials equal to or greater [han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at stantlard temperature and pressure).
2. Does or will the applicant or present or future building cecupant need to file
a regisiretion form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registralion with the Costa Mesa Fire Department hy
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons. or 200 cubic feel of compressed gas at standartl
temperature and pressure).
3. Does or will Ihe applicant or present or (uture building occupant need [o
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provitles that the
Cosla Mesa Fire Departmen[ may require the preparation, ceAiLcation and
filing with the Fire Department of an RMPP by businesses which are required
to regis[er acutely hazardous materials wi[h the Fire Department.
4. If an RMPP is presen[ly requiretl, has Seclion 25534 of Ihe California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work wt�ich is the subject of this applica[ion a pertnit (or such construction
or modifcation from Ihe South Coast Air �uality Managemenl Di5Mc1 or (rom
any other air polWtion conirol district or agency? ❑ Yes ❑ No
(Section 658502 0/ ihe Califomia Govemmen[ Cotle requires [hal ihe requestetl
information be fumished on applications for non-residential building pertnits).
6. Will any pan of the (aciliry to be conslructed under this permit be wi[hin
1000 feet !rom lhe ou[er boundanes of a school? ❑ Ves ❑ No
Qf'yes". the facility must meet Ihe requirement of Sections 25534 antl 42303
o( the California Heal[h and Safery Code).
7. If a pertnit from the South Coast Air Qualiry Manaqement DisMcl or other
air polN[ion conVol district or agency is required for the v+ork which is the
subject of this applicatioq have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No .
8. Qf'yes", attach certificate of compliance from the appropnate,air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry �of perjury the
intormation given above-is correcL I agree to comply with all statelaws and
city ordinances regarding Hazardous Matenals antl Emissions: .�..
Signalure
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 correct I agree to comply wilh all,state laws and city
ordinances relatinq to building construction, and authorize rep�esentatives of
the City of Costa Mesa to enter upon the above-Uescribed property for
inspection purposes. I agree not to occupy or allow occupancy ot any builtling
au[hOrized by Ihis permit until final inspection. � � '
�ignaWre of Le al .r(s) � (Jatp �
SignaWre � Dale 1 / /v��
JOS]-061��1) ' An lor u��onze0 AP h 1 �
RODPESSOFBNIqNG: 2'�S9 SAN JUAN LN
°""E"s"""E"'ao'�'":SHOORE, JOSEPH D
LODflE54:2759 SAN JUAN LN
COSTA MESA,CA 92626
APVI.YNIINfidDOPESS
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coNm.crarsru� NOCR PLUMBING ( 714 ) 895-1246
CWiRACTOASMYIJNfi116IO SEABOARD CIR
ADD�STANTON CA ��� 511971
90680 ��
LICENSEU COMNACTON4 UECLARRTION: 1 hareby Mtrm under peneAy W pe�ury Ihet I em Icenead urWx prmiebna d Chepla B
(wmmend�p wnh &anion ]OW) ol Division 9 d Na Buainsp eM Prdseeione CaEe, eM my limme ia in tull face and eXep.
�c.no.:05038b uc.cuss:C-36 L°"o 51]r971_ EXP: 02/97
bWNEP BUILDEP DEClAflATION: I henby elRrm under penely d perWry �het I em aRemq Irom �M ConVeCm Liunss lnw lor Ihs
lolbwip raeaon �Seabn l0.'f1.5 Bue'urose wd Prolaeiona Gode: Any ��Y a�+��Y �� nq�ires e permN lo owuVuq, eller. improve,
•.maen. « ren� env a�.x�ue, v� a a.:euenw, eku ra���e• ��a eoo�iw�t mr wcn w� w fils a+N� ue�amuu uvt ne «an.
eemad WA��� �o IM provieion� d �M Conlradw� Lironee Lew I�haNer B(mmmeridrp xith Sspion 1000) d Divebn � of tM
�inesa eiM Profeaebne Cade� a �hel M or ehe ie ssemq �hsslrom enE t�e beaie lor ihs ellped ezemqion. My videtion d Seuion
�313 by eny eppliram ta e permA aubjeds Iha epplicenl lo e dvil pe�Y b nd mare Ihen fne huMred EWlen �5500��.
� I, � omier d Iha propeMy or my empbyeea wdh weyes es Ihei ade rompeneetion, will Eo iM wah, vd IM ei�uclure i nM inbMeU
w ollered br seb (���� ��. Bueinev end Proleasiona Goda:'�M1e Conveqwa Licenea Lew doea not xppym an ownx d propeM
who buida a inprovae Ihereon, ud �Mo tloee euch woik MmeeH «hanell or Ihraph he a her own empbyses, provideE Ihet wch
improvemenia ve iot inteMed «d1areE tor eale. M, Mwever, �hp buiWinp or improvemem ia eok xilhin aw yeer d campblion. iM
ownerbuiHx MII heve IM WMen M prwi�q ha w elw tliE rot Wild a improve Iw iM W�e W eele�.
❑ 1. es ovmx d Ihe propary. em md�ivaN �nveaina �h IicensoC cantreciae �o cana�rua �ha prqeC (Sx�ion'loM. Bueinaea vW
Pro/esaiwro Coda: Tha Coniradon License Lew daea nd apply lo en owmr d peopa�y who builda a impova IMreon eM who
comrens fa euch Orqeda wit� e caNmpoqa) IicenaaE W�uent m tha ConlracYon Licenae law).
� I em axemq uMer Section�. B. 8 P.C., br Mb reewn:
oeia� o�„e,�.
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 0765��
PERMIT NO: P 076570 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : C/O WATER HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: X
x x �**��*********�*****�+�+�x �**���***�*��� **�**�*�*+�*x � +tx �**+�**�*x�**x ***+e*�x���*�*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14167210 ZNE: REF NO:
PLANNING NOTES> ,
i �
IE 1E 1E 1f if 1E If iE iE IE 1E 1E If 1E if iF iF �E iE 1E IF IE 1E iE 3E fE')E'N-iE 1E If if 1E iF if iE iE 1E IE IE if fF f(� if if jF i(� i(�!(� it iEiE iF if iE iE �E IE iE 3E iE iE if if 1f if iF iE if 1E iE �)E iE'IE IE * if iE 3E
D E V E L O P M E N T S E R V I C E S r.;R E Q U I R E M E N T S
ZONING APPROVED BY • DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
i eo n<reM �anM ine� i em awme a ene u�ersiena me rea���em�m � caiuom�e Heenn ena sm<y caee s.a�. uws, zssas, �d
LEGALIZATION:N F E E S U M M A R Y
25534, end ihet I«eny Mure buiWirq ompeni xill / wYl rwi (arcle one) neeA lo comON w�h aeid awa codea vM iha reyuiremenb br
epe�millormnsVuc�ionamotlificelbnhomiheAi i�6ialTyl.reropamemDimna.PeaidamielmnbruqoneppFceliomueexempiromthew BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE
o'°"�'°"' PERMIT 7.00
o�a: ncp�c 2 5 $
WOHKEH'S COMPENSRTION UECLAPATION: I Mroby aifirtn uMer perel�Y d peijury aw W ihe lollowi�p Eetlareiiona: PI'AN
� I heva end xill meiniem e canJwa d mnaent to saH�inwre lor vro�an' companaetion, ea prwked f« by Sedion J)00 d ihe labor I S S U E F E E 2 0. 0 0
coea,m,me�no���aa�„on�i«..i:�nm5�nd�..�an. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL
fj inew�dM�meim�w«kns'ca�os��o�m�,.�,�,e.�en���edMseaima�aodin.�no.code,rormeceno.me�ceanw TOTALS----> 7.00 20,00 0.00 27.00
}� work la which ihis peimA ia inueE. My warkers mmpenxlion i�surar�ce e�arier eM pdicy numDer ere:
cerriar: STATF EXPIRES
vdryN�mne,: ��r.ir�Y�t 13100 09/30/96
,is senion need not be comaleree / �ns a�d is M wre nurMied ddlers fS�aol a bss.)
❑ I cenM �ha� in ihe pMwmerce d �he work for whkh thie paimit ie iauetl. I Mell na empby ary penan in e�ry manmr eo av lo
bernme eubl� �o iha xoM1ers' compenaeiion 4..s d Celifwni epree ihm il I nhouW become wbpa to the waMen'
/'� canoensetionom�naiwre A Seaion 3)00 d the lelwr Coda. I I 1 wnh mmpyr<tuM1oea �mviaiwn.
�J4aminp: Fellun ro�zuro wortni mmperueHon cmereps /i unuwNl, antl MNI �ub/xf an �mployw to cAMne/ pmaMu anE
civll Mina up ro ons hunlre0 tMuunJ sollan (JIOO,OW/, M eGtl/tlon h M� co�f ol compuwflort tlameyva es pnv/CM br In
Sxtlm J)O6 0/ fhs Lebor Cods, Intere�f, anJ ettomeyi /su.
CONSTRUCTION LENDINO RGENCY: I M1ereby elfiim undar paneMY � perMY �hel �Mra u a mnavud'wn brdi�g eper�ry br IM
�IBf�q1118MB O�1�1B V.VIt.�IX M�IId1��16�IBTILl9 99UBd (�ECII011'Y.M�).CN.Ci�.
LENDEN'S NAME: '
�ENDEH'S ADDHESS:
I canity ihet I heve read Ihis apqicsiim eM se�e �he� the ebave in/orma�ian ia cartap. I egree to c«nply vmh ell cny vM wunry wdinences
enE eiate leMs rela�'vq io Wikvq consvudim e�d hereby eNMr¢e rtpresenletiv» d this aty b enier upon tM ebove�maniioned propaity
lorinspadian purpwes.
RON NOCK
o�e: J�Z.
(515b46 WP) Whde-Buikip 8 afery; Oreeo-Flle: Cenery-ApPF�C
DATE:
DATE: Z � �
**x�*��**�t �t�
STRUCTURAL SEGMENT;N
SMIP/RES GRADING
SMIP/NON—RES
PAID DUE
2%.�� .0�
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2%,��
1f !E If ik iE iE �E * 9E fE 1E iE iE iE fE iE iE iE iE jE iE iE if IE 7E IE iE IE iE iE iE iE �E iE 1E iE fF fE IE 1E 1E �E iE iE 9E jE iE iE IE if if IF 1E iE iE if 1E iE iE 1F if 1E'1E 9E �E iE �E If iE iF IE If 1E fE 1f 1F 1E if iE
I N D I V I D U A L F E E B R E A K D 0 W N
QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 7.00 7.00
END OF FEES
nl �tevC : . _"_�,i3.%', : t�e7 =7.JJ
GF.ik�: 0,:.�, .. Y71"�' !cca
CONSTRUCTION ANDPLANNING% . POOI ?A •'..7
7'
- APPROVA�S Permit # Date Inspector . APPROVAIS Permit # � Date inspector
� 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. . - . " ' 53. Steel Reinforcement -
�-3: Electrica� Conduit Utility-Undr,gr�d�. 54. Forms /, �
� 4.�ElectricalConduiYL3nHrgmd. �� 55. Electrical8onding ' � �
�• 5. St2el Reinforceme�t . 56. Rough Plum6ing & Pressure Test ' I-
, s_
= 6. Electrical UFER Gind. 57. APPROVAL TO COVER�GUN�TE .
-7r Footingz .. . . ' 58. Electrical CAnduit-Undrgmd. . . . �
„- �8. Foundation 59. Gas Pipe, � Undrgrnd., Test � �
� 9�Water Pipe�Undrgrnd. .�� � 60. Backwash Lines, P•Trap, � Untlrgmd. �
L.> ..
10. Svuctural Floor System ,, 61. APPROVAL TO DECK
11. Prope.ty Sewer Line & Hou'se Connection � 62. Backwash & Receptor-Fi�a1 -
r
12. Sewer Cap - 63. Heater & Vent-Final �'
73. Roof Drains _ _ 64. Plumbing SYstem � Final
74. Rough Plumbing.� ' _' ' 65. Electrica6Finai
75. Rough Electrica6Conduit „,• 66. Solar SYsxem-Final. ^�
16. Rough Electric Wiring• _ 67. Fencing & Access �Approvab
17. Rbugh Wiring Sign � • 68. APPROVEp FOR PLASTERING �
18. Rough ElectricaLT Bar Ceiting � 69. POOUSPA SYSTEMS FINAL
19. Rough Hea[ing & Air Cond�tioning'� " _ - FIREDEP.T. R�EQUIREMENT
20. Rough Factory�Firepiace _, ' _ - APPROVA�LS -Pecmit #
��
21. Dutty.in Structure`, �` ' " - = �_ ; ;.`y ^70. Undergiound Hydro �.
22. Ducts, Ventilating .��� � - . � � 71. ProducfP.iping 0 Gas O�OiI
<
23. Gas Pipe-Rough & Test , �� � �= _ � 72, Underground Ftush . .
24. R�oof framing � • � . �73:1Undergmd.StoragaTank��Gas ❑Oil
25. Roof:Sheathing ` � ' " 74: Overhead Hydro - '
M, � ?
(�: a _
26. T;Bar,CB���ng (Structuralj & Monocoat � �� > 75:'Dry Chemicai : .
27, Frame a�d Flashing - - - _ ' '� ` 76. Dry StandpiPe � '
r -
"28. Lathing & Siding .. � _ " _' = � - , � �; 77- FIXED SYSTEM FINAL
29. Insulatlon r :- 78` FIRE PREV. FINAL �.
30. Drywall Nailing •� . _ �. _ i, c�HEALTH DEPT. REQUIREMENT
31. Plaster 8rown��Coat '_ � �"'79' FINAL�INSPECTION '
.32. Etectrical Powei Meter-Final . . � 80. FOOD CEFiTIFICATE ISSUED
-33. Final'EI&ciric . F - ' * r, No{es: -' ' ' �
Y •I
34. Final�eating&,AirConditioning-�= r � `r - � '
35. FIna1 Gas Pipe�Test ' • i �- � � � ' '
,36. Hood�.or CanoPV s �' ' � - �. �j.': ` ', = " , .
�37. Final Fa�ory Fireplace ' � ' * ' � - " �
�' r: . _ .
38. Final Plumbing K _, - �J/( �CI � -'
39. Water Service-Final t:.: x r: � •
t -
�40. Gas Serv�ce-Final • � � � ` , ,
41. Solar pomesticfinal . " � . _ '
42. Backf�ow Preventer , _ - ,t �-
43. Backfiow Irrigation + � � ; -
44. LandscaPelrripationSystem •�' ' ' . , = � �- '
45. Sound Attenuation - � •• � � c- -• - .: �' - � ..
I 46.. Handicap Regulations . ",�� ,� � � - ,
I • 47. FINAL STRUCTURE & BUICDING . �__ -- _ �
48. FINAL PLANNING ° ' ' ' _
�
49. EleMric Release to Edison ,
50. Gas Release to Southern Califoinia Gas Co " " _ ''
51. CERTtPICATE OF OCCUPANCY
No. Date
, AVVlicant to fili in a1l sDaces except those witnin heavY boraer lines ana.sign a11 aoProo��ate aeclantions. _ _ _ �_ ,
� .S�rtJ��72GOS -.�--. '-..--�— - �- - - " - ' -
�L3!= COSTA MESA � CONSTRUCT�ION PERMIT . PERMIT NO. TRACT NO. LOT NO. ' � UNIT N6. ', , � � ' ' . . �.. . !� . _ '� ^. � -
i . " I
y �Pro�ectAddress �o�%S� ,v ;� '" . . . . '., � . , � � � - �� • i - 3]S4 ��/I�/�G_ �.. � c5.a� "i�,
Applicant,s Mailingq ddr 55 . ; � � TVPE OF CONSTRUCTION; NEW PDD ALTERATION REPAIR' '
� ' /J �.''!' �' / _❑ CONVERSION ❑ DEMOLISH ❑ OT R ' ' " � � � � A:p: # � � ' ' ` � � � � ' . 2one�
Owner's Name (/��'�'� �r u.i � � Phone �7 y�D�% � EY�+i G �.}i�LC Ll ' ' ' . .. . '
DE CRIPTI NOFWORK/USEOF,BLDG. ii'
Address ����� r7 ��%��^ �a��L�i - � � ''��' , �, � : . i . �_ i -. � , S Main Bwldmg:, ' ' � 'Accessory Buildmg: � . -
Arch/Eng. ' - � - ' License No. � �. TYPE OF PERMI � GRADWG E . • ' ' _ ' , ' ^' � Z
O.FOUNDATION �.STRVCTURAL T, Front� - �
� �❑ TENANT �O ECTRyQ AL ❑ PLUMBING O'MECHANICAL . � g - � . - - -' N
�Address � � - � � ' - ' � // . Rear � ' � _ � �
- " '/ . ^ ��� ��'`�/ . ;��OTHER . �C ^/YL7S' .. ' . . A ' � �
Contractor'sNamei�u� �•Phonese_.zexaiZ . . � � � - C Right . - � �r. G
� � PROJECT DESCRIPTION Sq. FT. . ���,OCCUPANCV � � ' , ` ' - - , �
AddresslmaiLng) �fss4+��� �/� �� � � �
/ `� /� ; CONSTRUCTIONTVPE 'VALUATION5�1011� �$ Left. , . ? R
� City Licenie No. `3���� J ,. ,
� _ .. � � � ZONE : � GRADING CU. VDS. ,ACRES p�ng. Ref. # . � , ' ' Parking Req./Provided � = E','
LICENSED CONTRACTOR DECLARATION - � Q�
II hereby aftirm that I am�licensetl untler provisions of Charte�.9 (commencing Remarks:� � .�5 / -' Planning Notes: � ' � _ ' . M
with sectlon 7000) of Division 3 of [he Business antl Professions Cotle, antl �Z•"�'�v G/ � e �
my license'is in tull force antl eftect. /'7 � �1� an O �+ i ' � , � . i ` � - - � � T
License Class _�� �� � / , mens�rNo?� J � / �/' '�' � • - , S
Date �Z-If%�7 - 'cl��a�� � ' � ; ; PLUM ING � . ' FEES ' � � ' , I ' ' � � c' �, !
WORKERS' COMPENSATION � LAk ION � - ' �
I hereby affirm that I have a certificate ot conse to selt-insure or a tertiticate � Bar Sink � � � � Showers � � � � � � . ELECTRICAL � � � FEES ��
ot Workers' Compensation InsurSnce, or a certitietl copy tneieot (Sectio BackflowPreventer - - ServiceSink' -'` ' �" --� ` —�
38o0,'Lab. ) p 1 -'• // /. Automatic Washer 1' 'Transformer ❑ 15-50 KW- ,
� Pofcy No. �� /�yu/G���%Company ifW wn _p_�/'L� Backflow Irri9ation Sewer Ca - � � ' ' ❑ 50+ KW
Certitietl copy is hereby furnisnetl. ' P Construction Pole Sub. i
Certifietl cp$ y i��[il,e,tl with the city il n9 Divi ' u , � Bathtubs � � Sewer Conneciion Cooking Unit � � �Meter ��up to 100'amps I i �
Date ��-//J�r"� - ApPlicant ' • � ' - •
� EXEMPTION.FROM WORKERS' C ENSA ION D LAR �r V � Clarifiers � SOId� C011¢Ct0�5 - Dishwd5h2� � M¢t¢� ❑ov¢� 100 amps: �
(This section neetl not be completetl 'che permit is far one hun rtl etl ($100) or � - ' ' '. " - ^ ' " - � '- -
less). � ! � � ' � - • ' Dishwasher � ' Solar Pipin9' ' � Dryers �Gas ❑Electric ,Sub Panel � '
I certify �that in tne pe�fo�mance of the work tor which this perm�t is issuetl, I - � ' ' ' ' �
� snap-not employ any pe�son in any manne� so as to become subjeCt to the D�I�king FOUntain5 � $Oldf TBnk � Fan• � �MOt0�5 DO-1 HP �1'/z-8 �
Workers'-Compensation'Laws a/ California. � . ' - • �
. Date � - � Signature ' Floor Drains� . Swimming Pool w/Spa F.A.U. �� �Ina Solar'09-15 HP �16-15�
'NOTICE: If, at[er making this tleclatation, you shoultl bewme subject to the � � �
Workers' Compensalion provisions of the Labor Cotle, you mu5t torthwith. . FIOorSinks + U�indl -' -' Fiztur¢5 "" � � '- �.MiCrowave � ' �
comply witn' such provi5ion5 0� this pe�mit sM1all be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV• • + " • � � `. � � "� ! � ' '- . - � � i �
1 nereb affirm tnat ttiere is a' Gas Service -�Outlets Water.Closet � � . Device Boxes . �Pole',Li ht
y mnstruction lentling agency for the performance 9
o( lhe work for, wh�ch�,Ihis pe�mit i5 issuetl ,(Section 3097 Civ. C.) ' Interce tors ' Water Heatel � '� �� ' � ' ' � -
Lentler's Name � � - P � ' ' Outlets Range
. . � � � . . . . . , . . .
Lentler•s Atltlress � ' ' ' - � ` ' , , _ � Kitchen Sink - �, ' , ' - Water Service �- - Switches Sign � } �
� OWNER BUIL�ER �ECLARATION- � = " �� -- • ' , � -� ' ' ' ��
I hereby aftirm.tha[ I am ezempt trom the Cont�actor's�license Lavu for the � CBvOtO�iBS . ' � - � - . , ,
followin9 reason (Section 7031.5 Business antl Pro(essional Cotle:'Any city or . ?uto-Wash _ Garbage Disposal , ', Standing Sections , �
munty which �equires a pe�mit to con5truct, alt¢r, imp�ove, tlemolish or repair P-T�dp . � " L2und� T�d 5. - ' � ��
Y. V Generetor �0.5 KW �5-15 KW Trash Com actor�.
any st�ucture, p�ior to its�i55uanGe,-also requires the�applicant for Suth permit P
.to �ile a signetl statement that he/sne is licensetl pur5uant to the provisions of ROOi D�ainS � � � � - � �
the ContractorY License law (Chapter 9(commencin9 with Section7000) bf. � .
Division�3'of the Business antl Protessions Cotle) or that he/she is exempt
therefrom,antl the basis for the allegetl exemption: Any vlolation'of Section - '� - _ . " v ' I ' �
]031:5 by any ap0�icant tov a' pe�miL SUGjects the aOP���ant to d civil - ' �
.penalty'of not more than five huntlretl tlollars ($500). ' � ._ . - I � � ! '
❑ I, as owner ot Ihe p�operty�or my�'employees�with wages as thei� sole � �'Reinspection.Fee '$15� - Issue Fee ,� $ 3 '
. compensatlon, wiu Oo tne work, antl tne siructure is not intentled or oHeretl Reinspection Fee $15 �Issue Fee! ' $ 3
for salel (Section p044, Business antl. Pro�essional Cotle+ The Convacior's -, . . , ; , . - � MECHANICAL• � FEES � � - �
License Law dces not apply to an.owne� ot a property,wito builtls or imp�ove5 - ' - ,
ihereon, and who tloes such work himsel�/herselt or throu9h his or her awn . • � , DEVELOPMENT SERVICES REQUIREMENTS:' '
emo�oyees, provitletl that such improvements are not intentletl or otferetl (or Boiler ' � �, Hood or Type I. �'' :
sale. If, however, the builtlin9 or improvement is soltl within one year o� com- ' �. � Canopy ' Type I I ❑ � Zening Approved By Date � �
pletioq tne owner will have.tne burtlen of proving he/she Altl not buiitl or im- Duct - Under, Ground ' � � - �- Building AppiOVed By � � Date �
' prove'fo� the pu�pose ot sale). ' : ' • �
�❑ I, as owner ot the property, am ezclusively contractin9 with Ilcensea con- . Duct - Structural � Refrigeration System � Application IWued By ' Dat �
trattors to construct the project (Section 7044, Busine55 antl Profe55ion5 Cotle: � ��� , �
The Contractor's License Liw does not apply to an owner ot property who ' Duct - Ventilating, • ❑0-100,000 BTU ❑100,000 BTU . • SUMMARV OF FEES � '
' builtls or imp�oves the�eon, antl who contracts for such project5 wrth a-con- - -- ' '' '-- � - '
� Vactor(s1 license pursuant to the Contractor's License Law). I am aware that ,_ , . BUILDING PERMIT $. �,nn. SMIP' . •$ � �
� proot o� their Worker's Compensation insurance shoultl be provitletl to •me. Exhaust System ❑ Multiple ❑ System flepaii/Alteration ��O i
� - PLAN CHECK � $ ' PERMIT
�' � I am exempt untler Section e. & P. G. for this reason Firepl/Fact. BIL ICBO # Fire Dampers' � � . � '' ISSUANCE �� $ �
� ' PLUMBING . $ �
� � Date ' ' ` Owner � � Heating System & Ducting � Registers . � p�qN CHECK 25% � $ � � ENERGV P.C. � $
' I hereby certity ihat 1' nave reaa this application antl state that the above -��0.100,000 BTU 0100,OOOBT - . �- -- . �- r -' - � � � � GRADING :$
� information is correcL I aqree to comply with all city.antl county ortlinances ' ELECTRICAL '$ . . �
ana state laws reiating to builtling construction,�antl hereby authorize reore- i , f � � � � , PLAN CHECK 50% .$ MICROFILM $ �
sentative5 ofithis;city to entersupo th¢ above-mentionetl prope�ty �or � . � `
insvection o � ses. �r7 � � � ' � � i ' MECHANICAL � � $ � � TOTAL FEE � $ ' •SV �
Signature Ozte�Z� ' ' i r
OriJers' Li ze or 55 • � � Reinspec[ion Fee $75 : laua Fee . $ 3 P�AN CHECK 25% �$ �
CMF 0865-46, rev. 30/84 White - guiltling; Canary - Applicant; Pink - Acwunting; Goltlenrotl - Assezsor
.i
' • -• � - POOLtseS°A. - - - - -
I#/CONSTRUC710N.AND PLANNING � ' ! - • . • . �
--� : 4 Date � Inspector� - - • Date � Inspecror
� APPROVALS Permit # - _ - � A7PROVALS Peimit # ,
� 1. Temporary Electrical Service or Pole � • - . - ' ' 52. Pool & Equipment Location � . � � �
` 2. Soil Pipe-Undrgrnd. , � � 53. Steel.ReinFo{cement: , i�,
� 3.:Electrical Conduit Utility-Undrgrnd. ' � ' ' 54: �Forms- , . � �
: 4: Electrical Conduit: Undrgrnd.� . �55. Elect}ical Bonding - � ,
� 5. Steel Reinforcement � . ' . - � - - � � 56. Rough Plumbing & Pressure Test - . � -
i6. 'Electrical UFER Grnd. , � ' `- - , �_ � 57. APPROVAL TO COVER-GUNI�TE . �
;;�7. Footings� � � . , ' 58. Electrical Conduit-Undrgmd.
8. Foundation . . � � - , : ' � 59. Gas Pipe; O UndFgrnd., Test . . •
�9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, O Undrgrnd. ' � �
' 10. Structural Floor System � � • � 61. APP,ROVAL TO DEC.K � � - � ' -
'. ,1.1. Property Sewer Line & House Connection , - �. 62. Backwash�& Receptoi-Final ' �
. ,
'� �12. Sewer Cap � � ' - . 63. Heater & Vent-Final � - �
� 13. Roof Drains .' 64. Plumbing System - Final
14. Rough Plumbing �� - 65. Electrical�Final � � -
,'
� 15. Rough Electriral-Conduit � ' : � 66. Solar System-Final' � � - - . � � - �-
�16. ,Rough Electric Wiring . ^ --- - 67. Fencing & Access Approval - � - " " '
i. -
17. �Rough Wiring Sign' � � . 68. APPROVED FOR PLASTERING '
18. Rough�Electrical-T.Bar Ceiling � � 69: POOL/SPA SYSTEMS FINAL � ' �
19.'Rough-HeaYing & Air Conditioning � � FIRE DEPT. REQUIREMENT ,
� 20.�Rough Factory Fireplace • � � APPROVALS Permit# � . �
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating' • � ' 71. Product Piping OGas ❑Oil
' 23.��Gas Pipe-Rough & Test . � ' • 72. llnderground Ftush
�.24. Roof Framin9 • �' _ � 73. Undergrnd. Storage Tank O Gas ❑ Oil .
25. �Roof Sheathing � 74. Overhead Hydro � �
26. T-Bar Ceiling (Structural) & Monocoat � -_ 75. Dry Chemical , .
27. '�Frame and Flashing " J6. Dry Standpipe ,
+ 28. rLathing & Siding � , � 77. FIXED SYSTEM FINAL
29.,Insulation � ' � 78: FIRE PREV. FINAL
30. Drywall Nailing � ' ' � HEAL?H DEPT. REQUIREMENT •
= 31. Plaster Brown Coat .-. . � T 79. FINAL INSPECTION
32. Electriral Power Meter-Final , � . , i 80.�, FOOD CERTIFICATE ISSUED �
33. Final Electric ,Notes: �d I� ��l /}�7 �i/j • {�,j� �
-- 34. Final Heating & AirConditioning .
JY
35. Final Gas Pipe-Test ; ' ' ' . . � � - ' _ _. _
36. Hood or CanOPY . . - : � , . �
� ,. .
37. Final Faciory Fireplace � ' � . . _ � - - .
38. Final Plumbir�g . � �, ' ' . �
39. Water Service-Final ' S • , � ' . � � � ' .
40. Gas Service-Final . � � � � . � . � � �
�
41. Solar pomest�c-Final _ _. __ _ _ . �
42. Backflow Preventer � , � � i • � . � �
43. Backflow Irrigation: � � � � , � ' �
44. .Landscape Irrigation System ' � � i ' � �- � ; � '
45. Sound Attenuation ,� _ ' � `' - . V
46. Handicap Requlations �. � • � . _ ! � � . - � � � - _ '
47.FINALSTRUCT.URE&BUILDING� � � � '
i �
48. Special Requirements Completed. . . { � � . . ' ' � ' *
49t Electric Release to Edison 1 �� . -- }-� i ' - - ` - -� � '- - - � _ � ;
� �
50: Gas Release to Southem Califomia Ges Co i � ' � '� �
51. CERTIFICA7E OF OCCUPANCY . - _ . _ � _ . -. . _ _ . � . '
In�n .. . ' Date� � .. ' - ' �. - . _ . . '
OWNER �j,y
JOB ADDRESS
GENERAL CONTF
AP No. 141-557
INSPECTIONS
SOIL
cas
W AT ER
ROUGH PLUMBING
PROP. SWR. LINE �
SPRINKLING SVSTEM
DATE
San Ca- �s Iane BUILDIN
_� -Builder DESCRIPTION of 1 .0 Aa
LOT 4q TRACT 1�,285 FIRE ZONE VALUE S
� e. . . r�... i-r�r���e� T rv � c \'.
HOUSE CON.
:UPI�I:�:l�_\�C[�1e\IIZ\I
UNOERGROUND LJ POWER U
ROUGH WIRING �
TRENCHES Q�FORMS STEEL REINF.
FLOOR SVSTEM ,� J �,.,y
SHEATHING
FRAME AND FLASHING
l
PLASTER, BROWN COA
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. ANO A
PLUMBING. FINAL NN� GHS TEST
BUILOING, FINAL
FINAL
SUBCONTRACTOR
„
' ,. � � � :
•� �' ” PASP .k ir**1k
JUir! 27-69cM,a002878 34.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �
� APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
� / RECEIj/kD DATE RF,CEIVED pq7E ISSUEp
BUI�OING �� p pl7 0 � � /
ADDRESS G
,�7 PE IT��1
OWNEfl � /P�G A.P. NO. / � �/ �
MAI L . BUILDING
Z ADDRESS S,q¢/��C ADDRESS
a Cil CITV (�p ,.( NOL,fjl6 �J TRACT � LOT BLOCK.
Z Q CONSfRUClION ��— �f'/f `l--p�� P
O N LENDER
a m ,�1._.
J � BRANCH �
J � OWNER
ADDRE55 �
mJ ARCHITECT TEL. �GIY�� OO/Y� VALU$� //7cp7
m ID J
J N OR ENGINEER �
V Q � FIRE
W� ADDRESS ((J�(„/E/L — ZONE' TVPE GROUP
a w APPROVED /
W Z CONTRACTOR BV � DATE ��'(�
J Q
m Z
J � ADDRESS N
w W TEL. ZaN NO.OF USE OF NEW y�.-a..i
� = CIT ,( NO. P�-p`� BUILDING
Z H �
—� STATE CITV �'ARDSAPPROVED VARDSAPPROVED
y(Z �IC. NO. LIC. NO. MAIN BUILOING ACCESSOFV BUILDING
� O (FFOM GL STRTEE'�]
OF LOT �o% IC Q J( f( NOW ON LO / R NT P4i . FT.
USE OF
E%ISTINGBLDG.S e � �PS FT
F SIZE OF NO. OF y/�
Z NEWBLDG.I.� X S ROOMS STORIES � L.SIDE FT. � FT.
V EXTEFIOR WALL fi00F /� pJ
COVERING 4+�'� OVERING `O .�OC�- REAR FT. FT.
J USE OF BUIID G ANO WORK TO BE P Rf�OF) ED DISTANCE BET. BET. MAIN &
a d o. d� r� e� MAIN BLDGS. ACCESS. BLDGS.
a
o� ro �S . � � P* APPROVED
f' ' APPROVED
N
Z '
O
UI hereby acknowlatlpa that I heve reatl this applicetion antl rtate
� that ihe above informetion is corract antl apree to comply with
� all lews regulatin9 buildlnB �onstrucHon, antl 1 shall not employ �
F eny person in vlolatlon of Ma workman's compenmtlon lews of
y ihe Stete of Californla. /�� �
? I he�eby certify that I am properly Ilcensatl es e coniractot untler SQ. FT. ' p
ihe State of Californla Bueinan end Profauiona Codc, Dlvislon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
CM1apfer 9, antl that such Iicensas ere in /�II forca entl effaet, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONIV: �
am exempt from the ro�isl0ns of the Staie of Callfornie 8ueiness VALUATION
end Profassio a, Div lon 3, Cha ter 9. m
/� � PEFMIT FEE $ �� v `� �
SlBnai re o / � v� /J / �j ��� m
Permlttaa/ f// $�J f(//�7 PL•AN CHECK $ / E
0
Authorizetl Aqant � � � LL
TOTAL FEE E
OWNER
B ADDRESS
PROP. SWR. LINE U HOUSE CON. U
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGN HEATING AN� A10. CONDITIONING
TEMPORARY SERVICE OR POLE
bN�ERGR0UN0 � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL RE
FLOOR SVSTEM
BON� BEAM ❑ STEEL REINFORCE [
SHEATHING
FRAME ANO FLASHING
LATHING — IN � OUT �
PLASTER. BROWN COAT
HEATING, VENT., REFRIG. AND A.
PLUMBING, FINAL ANO GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
SPECIAL REOIIIREMENTS
F INAL
DATE _
L191��]I�[�?
Eia:z.i.l:r�:r_t.�c.l:i
^�.
�� ~� ����� Lot L�9, 7't'act Lt285, �a����ECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT .1'� SEP 6 1969
P. o. aoX g,� COBTA M66A. CALIPOFiN1A FINANCE DEPT.
For Applieant fo Fill In Complefely APPLICATION I� FQ�tt�TA MESA
TYPE OR PRINT � BUILDING
ADDRE88 2759 San .Carlos Ix3i18 -
COSTA MESA. CALIFORNIA FOr Office US@ �I1��/
neceiar no. ��� % �
owNEA Mesa Del �ar Develonment Co.
■ MAIL
�2CC0
TEL.
NO.
TEL.
iACTOR �cco.,Corporation
E�3800 'E. �roast Highwa,y
Corona delr�ar, California
'o. 98808-SB-1 No: oR 3-!
.�.a���ii C F nlna � � NO.OF
� B6TBACK LIN[ PROM
�LEFT J� IRIGNT 9�
DESCRIPTION OF WORK
11LDING AND WORK TO BE PERFORMED
gl_e ra;nily res�dence
ttached �ara�e
9V
DNTE IB9UEO
COSTA MESA, CALIFORNIA
FIRE
ZONING
ZONF,�) _ ( I PIANS ��UILDIN� EW
y� i
�/ b
LE6AL y�/% / � � /� /
, [GCNTCR LINL BT.) 3 �
_ FRONT Fi.
R. SIDE � FT.
_ L. SIDE I F7.
REAR �O FT.
BYP�OVED � /
/l
1
Living area
Garage area
Covered porch, etc.
�
�
S F
S F
5 F
1 XEREGY 4C1(NOWLHDOB TXAT 1 HAVE RlAD TN19-APPIAWTION THE AMOUNT BHOWN UNOER VAWATION �8 FOR TXE
wND BtATE THAT TX8 ABOYE 18 GORPECT AND AGPEE TO CON- pUpp08H OP EeTABLIeHING A P6RMIT FEE ONLY.
PLV W�TN ALL CITY ORDINANGEB AND 9TATC LAWrt R¢6ULAi1N�
Bu1tDINo CON9iRUCT1oN. VALUATION ?
61GNATUR PERMIT FEE $ .J 5 �
PERMIpT�T>E Mesa r [
�"J $ I.7�?ZO�OO PLAN CHECK $ I �Sd
AU7HOR1 � Cz'r'n
TOTAL FEE l 79
�_ 370I 7
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BVIIDI
ADOFE
OWNEfi
MAIL
ADDRE
CITV�
BRANCH
ADDRESS
ARCHITECT
CONTRACTOR
ADORESS
CITV
STATE
LIC. NO.
S12E )
OF LOT70xI
VSE OF
EXI5TING BLOG.
512E OF �„/.
:RIOR WALL
ERING
OF BUIL�I
A n r—!+
TEL.
�l �/ N� 5�✓r�%
TEL.
NO.
�l'ltP�£ � car�/.�P_
TEL.
NO.
CITV
LI0. NO.
/ p� NO.OF0LDG5.
� b X l I NOW ON LOT
�� NO.OF
ROOMS STORIE'.
fi00F
COVERING
D WORK TO BE PERFORMED
PAIO � ***�*
JUL 17-73�KSt002o��• 5.50
APPLICATION FOR BUILDING PERMIT
BUILDING
ADDRES:
FIRE
ZONE
Eo
ZONE �/ NO.OF
P�� a
VARDSAPPROVED
MAIN BUILDING
DI5TANCE BET
MAIN BLDGS.
VAR. #
C.U.P. #
APPROVED D/
USE OF NEW
BUILDING
VARDS Af
BET. MAIN &
ACCESS. BLD
�ATE
0
I hereby acknowledge fha[ I have reetl this application and state � SU �
ffiat the above information is wrreci and agree to comply wiM
all laws regulating building construction, antl I shall not employ �`d% �
any person in violation ot the workman'z compensation laws of �' �
Me State of California. m
b
I hereby certify that I am properly licensetl as a contractor untler SQ. FT. o
tha State ot California Business antl Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chaprer 9, antl that suc� licenses are in full force and etfect, or I TNE PURP06E OF ESTABLISHING A PERMIT FEE ONLv: �
am exempt trom tl:e provisions ot the State ot California Business VALUATION
antl Protessions Cnde, Division 3, Chapter 9. i/ 0 �
���_�/// ' PERMIT FEE $ . �
Si8^ature of � �� ]
m
Permittee /Yl y) �,� $//�j� ,� PLAN CHECK $ E
!/1 / 1
Authorizetl Agent ✓ V �� � u
TOTAL FEE $