HomeMy WebLinkAbout3466 SAN MARINO CIR - Building Permits� y��'
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CITY OF COSTA MESA
BUILD/NG DIYIS/ON
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job Address: $466 SAN MARINO CI
Suite:
Vicinity:
Parcel Nunmber: 41205102
Applicant: LARRY WILLIAMS
Address:
i ,
Owner: METZGER, TFiEODORE '
Address .��� � � � �- - �
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j /� ; / '
;�.;//� � !�'-- - .
Contractor: ACL-COAST ROOFWG
;'Address: 02107 WACCACE AV
�. ;j,,i/
� �,
. ,' " .' COSTA MESA CA
. Zip: ; 92627 �
BUILDING PERMIT
Zoning: R1 R1
Phone' 714-044-1116
Zip.
Phone: `. '� �^ � . ,
Zip:
Phone:
License: 598440
r i Y
PERMIT NUMBER
'/B99-01276
r
77 FAIR DflIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 0811117999
Issued: 08/11/1999
ISSUED BY: �' V \
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: Arch : . � ' - ' , , E�9� ,
Address: - r ,� ` � _ � � Address:
. ' - � , ��''Phone: ' � - � � Phone:
y �' �
_ � Zip: � • � ��� License: ' �License:
a
j � SCOPE OF PERMIT
� � T/OFF SHEATH AND REROOF 2500SF RES�DENCE W/COMP SHINGLES. SMOKE DETECTORS REQ PER 97UBC.
� ' FEE SUMMARY -
Plan Check: $0.00 _ _ Calc Valuation:
; Permit: � $125.25 - _ _: Claim Valuation:
SMIP Res: $0.55
SMIP Com: $0.00
Other: $0.00
lnspection: $0.00
; �- TotaL•' $125.80
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY � -Front 0- 0
PARKING Existin : -0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Right 0-0
Right 0. 0
$5,500.00
$5,500.00
�
NOTICE: The work authorizad by ihls permii shail comply wiih alI applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-27-92)
i
EXPIRATION: This permit shall automatically expire and become void i( work is not commenced within 180 days, or if work is suspended or abandoned
for e period of 1 BO days. ,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work mus� comply with all applicable codes, and all
requlred Inapectiona end tinal Approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirtn untler penalry ol perjury one oi the �ollowing tleclarations:
❑ I have entl wlll malntain a certllicate of consent to self-Insure for workers' compensation, es providad for by sectlon 3700 of Ihe Labor Cotle, tor ihe pertormance of ihe
work far which ihis permit is issuatl.
❑ I �ave antl will meintain workers'cpmpensati insurence, az required by section 3700 of the Lebor Code, tor ihe peAortnance of tha work tor which this permit is is5ued.
My workers' cam n5a n Ins��,,�','//�ce carrie� nd policy numbar are: / -7-''7-7 [�
Carrier. ���� -"fl l � / Policy Number. J ��� ! / / � / /
(fhis section need nat 6e comp/etetll! he permit is ve/ued ef one hundretl dol/are ($ 00J or less.) f
❑ I certify ihat in the pe rmance oi the wo�k for ich this permit is issued, I shall not employ eny person in eny manner so as lo become subject to the workers'
compensatlon laws of ifornle, and egre§ I �ould becoma subject to the workers' compensetion provisions ot Section 3700 of Ihe Labor Cotle, I shall torthwith
comply with �hese D ov' ns. /
.�il Appliwnt Signature: Date:
WARNWGFAILURETOSECUREWORK 5'COMPENSATIONCOVERAGEISUNLAWFULANDSHALLSU6IECTANEMPLOYEflTOCRIMINALPENALTIESANDGVILFWESUPTOONEHUNDflED
THOUSAND Oq1ARE (5100,000). IN AD01 TO THE G�T OF COMPENSATIIXJ, DAMAGES PS PROVI�ED FOq IN SECiION 3)O60F THE LABOR CODE, IMEREST, AND ATTOPNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm �hat I em licensed
lorce and eHect. Lic. A�
� Contractors Signeture� �
�
CONSTRUCTION LENDING
9(commencing with Secti 7000) af Division 3 oi the I
Class N
/ Date: _
Cotle, and my license is in full
❑ I hereby aHirm Ihel there is a constmction lending egancy for ihe pedormence of the work for which this parmit is Issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
SiqnaNre:
Date:
OWNER•BUILDER DECLARA710NS:
I hereby aHirtn ihat untler penalry ol perjury �ha� I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires a permit to constmct, alter, improve, demolish, or repair any siructure, prior to Its Issuance, also requires the applicant for such permit
to file e signad stetement Ihet he or she is Ilcensed pursuant to iha provisions of lhe Contractors License Lew (Chapter 9(commencing wlih Section 7000) ot Dlvision 3 ot the
Business antl Prolessions Coda) or thet �e or s�e �s exempt iherefrom and ihe basis for ihe allegeA e:emption. Any vlolation of Sectlon 7037.5 by any epplicant for a pertnit
sub�ects the epplicent to e ciNl penelry ot not mor9 than fNe �undrad dollars (5500).):
❑ I, as owner ol Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, end Ihe structure is not intended or oflared tor sale (Sec.
7044, Business antl Protessions Code: Tha Contractors License Law does noi apply to an avner oi property who builds or improves thereon, and who does such work
himself or herself or through his or her own amployees, provided ihat such improvemenis ere not intended or oHered for sale. If, however, the building or improvement is
soltl wit�in one year ot completlon, the owner�6uiltler will �ave Ihe burden oi proving Ihat he or she did not Duild or improve for purpose of sale.).
❑ I, as owna� ot iha properly, em EXCLUSfVELY CONTRACTING WITH LICENSED CONTAACTORS to construct the projac[ (Sec. 7044, Business and Protessions
Code: The conirectors License Law tloes not ep01y to en owner oi property who builds or improves iheraon, antl who coniracts tor such project with a contractor(s)
licensa pursuent to the Comrectors License �ewsJ.
❑ I am e:empt untler sac. Business antl Profassions Code lor this reason:
Signamre: Date:
Owner ID veritietl by tlrivefs license. ❑ Ves ❑ No Driver's License No. Expires:
Varificetion of Ownership by (type of tlocument, i.9. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CBRTIFICATION:
❑ I hereDy certlfy thet no excevation live (5) Or more teet in tlepth in�o which a person is required to descend, wiil be made In connection with work authonzetl 6y �his
permit, and ihe� no building simcture, scaMoltling, felsework, or tlemolition or dismantiing thereol, will be more then thirty-si: (36) leet high. (Chap. 32, Grp 2, An 2, Sec.
341, Titla B, Celifornia Adminisiretive Cotle).
❑ As owner-6ullder, I will not employ enyone to tlo work which wouitl require e permit hom the Division of Indusirlal Sefety, as noted above, unless such person has a
permit to do such wark trom the tlivision.
Signawre: Date:
Division oi Industdal Sefery Pertnit Number:
CER77FICATE OF COMPLIANCE AND AUiHORVAnON OF ENTRY: I certity under penalty ot perjury that I have raed Ihis application and state iha� Ihe information given is
correct. I agree to comply with all state lews and ciry ortlinances relating to builtling consiruction, entl eui�orize representatives oF the City of Costa Mesa to anter upon the
above-tlescn6ed propeny lor inspactian purposes. I agree not to acupy or ellow occupancy of eny bulldinq authodzed by this permit until Ilnel inspection.
COOE �. INSPECTIONttVE
1616 Fixetl System Finel Fire Preventlon
1266
200
201
202
203
Pool Spa Final
Finel Re-Roof
Finel BIxWReleininq Wall
Final Fectory Fira Place
Flnel Sign
204 Finel Demolition
2aa6�48
P� Ili�Li
9-�� L� C�'r'!
cooer iNsvecnoNrrve
206 Final Mechanicel
20B Final Plumbing
210 Final Electricel
212 Finel Fire Preventlon
220 Finel Planning Approval
222 FIneI5lle
250 Finel Builtling�Occupency
o�*� � Il�9L5
PpQIEtf�ROUOESs�, 3 Q(� ( SAN MARINO C I
�` OWNEP'fi�.AME '�'ED & ROSINE METZGER
nuoxess: 3466 SAN MARINO CI
�.• COSTA MESA
`,.. CA 92626
(714)432-1232
RRCHIENGINFEfl:
pDONES3:
flEG:NO.:
UNIT:
UNIT:
PEpMiTTEE: pROVIDENT BUILDERS ( 714 ) 545-7872
ROOPESS: 1(O9 KING ST 6187
SANTA ANA CA 92706
LICENSFD fANTMt70B UECIAMTION: I hereW amrm Itut I am Iiceme0 uMer provisions of Clu ter 9(commendnp wlt� Section
7UW) o� OiviSion 3 0l I�e Business anU P�otesslons Latle, an0 my - ense is in lull foru en0 ette .
cinuc.:050381 sTereuc.:39070 cuss: g
Oare: y� i 2�q ['i— Sipnama: �'
WOPNEBS' C�MPENSRTION OECUfUT10N: I herehy aifirm ihat ve a cenificate oi consen sel4insure or a certificate oi Workers'
Campensalion Insurance, or a certified copY lhereaf (Section , LaU. C�.
PoLILY NO.: EXP. ORTE: '
COMPRNY:
❑ Cetlilietl wpy is hereby fumisheC. ❑ Certille0 copY u �iled with the ciry Builtlin0 Didsbn.
Oaie; ApplicanC •
[xervnoH murn waeK�ns' mrnr[Ns�nox o[puuTrox: (ms secum neee nm ee m�ea ii me p� t�s ia me nwwrm IStaol m iessl.
I cenity tnat in ine perlormance al Ihe wod for wnich iNs p ' is' e0, I stwll not e���999PPPI a � on in any manner so as ta eecome
suUlect lo Ihe Workers' ComDensaiion �aws ot Califomia. /I�
Date: �Z—�� SiOnature:� `
NO710E: II, alt¢r makinA �his tleclaration, you shoultl 6eco ublect to the Workers' Co sation Dravisions of Ihe Lahor
CoCe, you must torthwith comply with sucA O�a�isions or is OermitsAall he OeemeA ke0. .�
�. CONSTBULTION LENOING �GENCY: I hereby allirm that tAere is a cansWction IenCinp apency for tAe Dertormanu al lhe work far
i wAich ��is permit i5 i5sue0 (Sec1ion 3097^Eiv. C�. �•
�
IENDEH:
ROUflE33:
OWNEP BWLDEB DECUX4710N: I AereOy affirm that I am exempt Irom tAe Contractors' State License Law for the I011owinA �eason
(Section 70.11.5 Business an0 Pmiessional CoOe: My dry al counry wNc� repuires a�permit ro consWd, alter, impmve, Oemol¢h, or
repair any structum, pnar ro its issuance, also requires [he appliwnt tor SucA permit to lile a signe0 statemem that he/she is Iicense0
pursuant to I�e pmvisions oi t�e Contractors' Stale License Law (ChaD�er 9(commancinA wilA Seclion 7000) of Division 3 ot i�e Business
and Pmlessians CoOe) or that hUSAe is e�empt Iherefrom and the basis for t�e alleAetl ewempGon. Any violation ai Section 7031.5 by
any appliwnt lor a permit subl��s tAe aD0liwnt to a civil penalry ol not more Nan five �unUretl tlollars (5500�.
I, az owner of t�a properry or my employees wit� wa0e5 as Ihelr sale com0ensation, wiil da ��e wark, antl t�e
❑ iwcture is not intenGeG or ottered for sala (SecUon 1044. Business anE Pmtessional Cotle: The Cantractors' State Licenu law
Oces not aDDN �o an ovmer of a properry wM �uiltls w impmves Nereon, an0 wM Ooes such work kmsell/hersetl or throug�
�is or �er own emDlayeu, proviGeO ttut sucA impmvemen(s are �rot intenEeE or ottere0 lar sale. If, tpwever tAe DulAinO ar
impwvement is mld within ane year of wmpletion, the owner xill haue iAa 6uNen oi D�a��n0 he/s�e tli0 not EuiIG or imD�ove
lor Ine purp05C ot 5dle�.
I, as owner al the OrapeM, am exclusNeN conirzctinp vnth licensed wniractors to construct t�e prolect (Section 70C4, Business
❑ an0 Pmfessions CaAe: The Coniractors' SWte License Law Oces not apDly to an owner ol propeny wlio �uAOs or improves thereon
anU who comractsior such O�ojttts with a contractoqs�llcense Dursuant to t�e Coniractors' Siate License Law�.l am aware
t�at D�oot of their WOAer's Compensation insurance shoulE Ge pmviAetl to me.
� I am exempt under Section: � B. 8 P. C.
lor Ihis reason:
Date: Ownec
I Go �erehy certiy ttut I am aware ol an0 unOersWnO the reQuirtmenfs of Califomia Heatrh anG Safery CoGe Sections 25505, T5533. antl
25534 anE tlldt I or any future Om10inA �upant willhn0 not (cirtle one) nee0 to Wmpy wit� SaiO state toaes anO I�e reQuirements lar a
permit lor canstruction or moAifiwtion Imm the Air Oualiry ManaAement Oistnct. NesiOential construction apDliutions are exempl imm
Ihese provitians. .
Oate: POPlicant: _
I hereby cenity that I have reaE tAis aOPlication anU state I�at t
ortlinances anE state laws relatinp to builEinp wnsimction anA he
proDeM �orinspection purposes.
oa,e: � = r � — 9� Siqnaturt: �
oriver's tkenu or Soda� Seanry
1891J8 WHne—BuilEvw: Green—CaEe Enlorcemem: Ce
lo comply with all city antl county
Io bIIP1d00n �h0 aE0v0-menli0fl¢0
Pink—Ravanue; GOIEenroE—Aasesmr
� � CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: BE 046917 PLAN CAECK NO: 03595-90 S
CONSTRUCTION TYPE: 5—N PERMIT TYPE; ELE STR
JOB DESCRIPTION : MODIFY ENTRY & ADD 2 BAY WINDOWS
PERM NO: BE 046917
GOVT:
SQ FT:
N SUPP: N
PURPOSE: ADD
99
CLAIM VALUE: CALC—VALUE: 5,285.40 GROUP OCC: R-3 /
COMMENTS; SMOKE DETECTOA(S) RE(JUIRED IN HOME,
���x*�r�x*x�r*��**�e�e��e**��rx�e�rr�r�x�r�rxxr�e�r�r��r*xx*�r��r*�r�r*x�e*****�r��r�r�r�e**���rx��*x��r*** .
:,2 O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDZNG ----------
FRNT; 39 FT IN REAR: 36 FT IN
LEFT: 5 FT 6 IN RGHT; FT IN
PARKING RE • PROV; PARCEL:
PLANNING N�TES> ADD HAY WINDOWS AND NEW
> BAY WZNDOW OFF.DINING RC
�r���r�r*�r��r�r�*x**x��rx��rx*�r�r�e�e�e�e**�*r*�,���r�t
D E V E L O P M E'N T. S E'�Et V I
. '.
20NING APPROVED BY , SC. r
BUILDING APPROVED BY :...� _
APPLICATION ISSUED
It if ik it iF iF M M it iF 1E k!t M ik if if it ik
if if if 1k 1f 1f if �flklF 1f 1f k ik If M it ik fk
--------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN
41205102 ZNE: R1 AEF NO: �
NTRY TO EXISTING SINGLE FAMILY RES.
M HAS CANTILIVERED WINDOW. -
�r�rx�r**�rr*�e*�r��***x�e**�r*�*�r�r**�e*��t��e��r*
C E S R E Q U I R E M E N.T'S
�I�F'%'I�LI DATE: �O
�� DATE: Y-I Z—�O
DATE: : /2� D
kifkklFMMffMM iE1F
lffffkiliF ifiFMMifikkkkikiFMiEikilifllMMMMiEKMiFiEMlfiFifk
LEGALIZATION:N F E�E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING
PEAMIT. 81,00 2.25 50
T..SOt , SMIP/NON—RES
PLAN 52,65 -
ISSUE FEE 15.00
BUZLDING—DZV—> PERMIT ZSSUE PI:AN—CHECK TOTAL PAID DUE
TOTALS----> 83.75 15.00 ' �52.65 151.40 151.40 '.00
REVENUE DIVISION TOTALS--> COLLECTED: � 151.40 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC . FIRE SMIP/TOT GRADZNG PLAN—CHECIC
81.00 17.25 ' .50 52.65
itiF iF iFiFiF iEiEiEiE MiFiFiFitlf ikit iE±f iE iFiF if aF it iF iFMiFikM if ifrif if Mif M iFitif iFkiE iFiF�f iE if it ikit it ik it3f iFiF aFif ik if 1Fif iFlk �! 3f it iE iF if if iFiE 1Fikif
I N D I V I D U A L."F E E B R E A K D O W N
TYPE QTY D E S C A Z P T I O:N UNIT COST TOTAL COST
SFR 28
ELE 1
ELE 1
DWE—TYPE V—WOOD FRAME�. " —GOOD
DWE—INT. ALT£A TYPE V—WOOD'FR —GOOD
FIXTURES, LIGFiTING 1 ST 20 EA
RECEPT/OUTLET 1 ST 20 EA
RECEPT/SWITCH ' 1 ST 20 EA
•END OF,� F�ES .
y , •�I
r.
69.00 4,899.00
13.80 386.40
,75 .75
01 D0058421-00053424 T G T 151.40
DATE: 04/+2/90 TIME: 11:14
CONS�i'RUCTION AND PLANNING POOI. & SPA �'
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
). .
�1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
%�2�So;l,Pape-Undryrnd.� �,�,'' � 53. Steel Reinforcement �
� 4��ElectricalCon�i"t�l7kiliry�Undrgrnd. 54. Forms .
r, . .. � -, �.
�'4,LEfeLir�cal Con�ii'-l)ndrgrnd: ' , 7 55. Electrical Bonding /'
.i
�".6SStec1 iieinforc¢7nert�.' �q (�,�,�/-� 56. Rough Plumbing & Pressure Test o
� �: .,.
�'56,.��ETecincal UFE&�Gmd. � 57. APPROVAL TO COVER�GUNITE �^
��7;_FootinBs -�= o ,j(�_qp , �/ � 58. Electrical Conduit-Undrgrnd. , a.i .
�;BCFoundation � �- l j� �,f 59. Gas Pipe, � Undrgrnd., Test �r
.-.9'.Water Pipe-Und69rnd. � � 60. Backwash Lines, P-Trap, � Undrgrnd. �
19. Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Lirte�& H se:Connection 62. Backwash & Receptor�Final �
Y. .
12. Sewer Cap o, -;. �, 63. Heater & Vent-Final �.
'1 %'
13. Roof Drains � p� ' 64. Piumbing SYstem - Final �, � �
74. Rough Plumbing V 65. Etectrical-Finai `� '� �
c
15. Rough Electric3l-Conduit 66. Solar SYstem-Final
16. Rough ElectrietiViring 67. Fencing & Access Approval
17. Rough Wiring S�ig� 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19_,Rough Heating & Air Conditioning � FIE3,E D.EPT. H,EQUIREIVIENT
n.� r, nx i n-- a� 7t vJ •9 x�- c �-._:- .�. ` N:,7 .r•!r;
�7 t� i i r 7 .X V a: �F , ^t�C :T7. u�, S' i';n =`7'7
20`,.�Rooyh ��act�y F�ii�place � StT' Sd 'ti S�+ Cx� �,. PPR�VALS�;..�E.,Per.frt #- -- nmC,
21 DlI�iS.IR StfLCtUIL'� ' .... '-+S x S O �-+* * ` ^~^� r .. '-
� ... s� i� S� c. � �l#� .70.Ohderg7�ou�dHq�lro �
22�-Du�s, nt leti F"' � �: r" : # ' ' � � ''
� ��, �x i�� � CJ * G 6 C� e-�1� #•77. Producj.-f?{ping 06ps CJ:OiI
23��GasrPiprRoligh &�est ��M t*1n R Tf �' �Q O� �;7z, Undergro�ntl FI sir�y * � �
� � EX i i-�:+ ..F k � O tT #: � � ti e-iQ� . r• r., -�-.-,
24.�Roof Fr,�ming G* m �; �� N�;,� ..73.-,Undergrnd.Storag�l'�9nk>,OGas ❑Oil
25. RoDf S�athing ;�? r �'o v• k M �.".�, �^.;Y y 74CJ0'ver�ead Hydrq_� �
25.`'T�B3r Ceilin (S{r��°tural) &'Mo"nocoat�' '" m `~' `::"� �' �~ � �` ` `� -^ �c`
0 9 ��,� O-v O } C7� � �S��JY 6her�ical i�..^. � ' 33 .:r1�!
27�-.Frameiod Flashir�g< ^�S YG�T i 76. DryStan �ipe `�'� * � ��'^7F*7
r� `C u n r, t-.0 �'�+r-�
_�28. Lat�inq�Sidin��'y �'¢"' �Q' �� T " �'c -
F. ?�S C�H
�+ O.:;F On �-� i 77•- FIXED SX�SjTE[N FINAL: ,.., �, �F .��
^29. Insulation ^� � S J3 r � ��_' �y � 7g,e'.FIRE PREV. FIN�L �> x ,�. 'a�
[r �r .. a: w S ' ry �r ^+[-.
30. Drywal�Nailing � H �� ;] (��-�. ��,�}�� S ��ALTH.Q�P�: Fi'EQ�UIR�Ij([�,f��,�
i r+ �+. , �: � .� i- � . . ., �: i ...
�31. Plasrer �town Coate : i;+Ta' 3 .� 6'�,,,%+' ' 79. FINAL II�ISEECTIt�N• >^ O� ^
� -
�3�Electric,�1 Po�er��ter;E�nali �` � `�� I '�! �1 � * .n'�FOOD CERTIFI`CATE IS��IED,_.i �;.j, :
1 X,. •.] �. � �� I' M V J Y V �
f33�Firiql Electrja t+j� C7 i ��� , `+' tes: =� ��� :. `�O � t-+ ���,
�-34��Firral Heeti �& Ai��;n1�8itioMn �"�s ' * * a ^n� •s nx � �^ <- :<! o
d .k F-r � ., x IT] g' m m X' - � � x - O . `$%L '� i� �Ga � " -
i 35=jFinal Gas Pipe- estg p; " ix �-+ , � •' � * � �� � ^cn G� * � Oro �
n .-,. .
'^36yHo0tl otCCanoPV�x. �� i c�""� nS: � C1 �7.' * 2-a�'� M C7 m
� s c >. E M n i � m -. [- x ..1, . : = a �4.8' _ ;cn� _ �i �t/�_
�37..FinaJ F@ttory FirePlacex i Fc+ o� x�� :_� I'.�r' �. x S * x"� «
'"'�38WFi2al PF�mbj�g * mN i oC X � 1� I � ~.�' H `�� * � � CJCJ � -
39;,'Wat�r vice��Final� E i M. *� � I+- � y r, '� -;`� *� OOt*r:n[*�
D740J GasService=Final �' TI '2[^c*' 5�+� M TI � ?`�4"� * O�' <N * • • •
x �1FF N' k * • O� * �2
�41�Solar pome�cFir�IS ,.n,� "�..�• x I � p� ^_o T � � �^.
42.�Backflow Preventer� N �CJ��x j � k% * � 7i- � * O �-'
r, � , `-,:. K,-; *� m mon� :K �-. �-�
43. Backflow Irratio�' �cS � � - u�• • • •
F!� ni: ?� H * S �K +K i At y ;'1
�
T44. Landscape 177ipatid"n System"'��T1C� �.lJ� �ti ['`7 O O V* *�^ N N �+ ^�� * N CJONNiJ
-� n r. C m�^ K eC '2 �k � f T �� C-��. M S c�
�45ySound ;Qcte�uatio�' "�-' �`� % E' ' � � � �' �' R' �
� -� •• .• �: m m �� � c tr+ a� �o x
p46.••Handicap Regulatitlns � O� •� � ` � * x �Nn 50 � �*,
D47SFIf�AL STRGCTU�.?E & BUILDING .�'y T�.,y7y�'p r./ . 7 ctio ?� �
,. i C �
i.
�'48'�FIMAL PLANNING ' F°" k N � i��1 � tT7 `� � t� <
r.: i k ' I � I' q: :K fJ N $ %r Q '
i ;7 K * y �F x _ +:v
�49.'�Ele'E�tric,`Flel�se to'Edison i I . �
a.. �, i cu * �� � • n u x n, x�
i505GasCRelease ro Southem California Gas Co * t�' : 1 ' � � -' H �• • o •n ' sc '7 • ^ • • '
n y � c�c X I� ' * i: • c 'JC !�r'J # ili C6✓IiL
--51. CERTIFICATE OFKOCCUPANCY * * � � �"' � • �' "'
No. Date
� '
CITY OF COSTA MESA
CALIFORNIA 92628�1200 P.O.BO%1200
Insulation CertiCcate
3 �� �i i� �� .'i �1 17�Q 2cf�7 � i t2 Ce� ��.� {N�e9�
Numbc and Street Ciry
-- O 6L@.e�G r�
ounry . Subdivitiion - Lot Number
Description of Installation
ROOF r�
Material JVIP�i u.�'� C�`O�Y�.e Brand Name
7tticlrness (inches) � . 'It�ern�al Resistance (R-Value)
EXTERIOR WALL
]vTaterial C_Gp BrandName
Thickness (inches) '7 " 7T�ermal Resistance (R-Value)
CEILING
Bau or Bianket Type Brand Name Q,/VS�/i�/e
Thickness (inches) O` 7hertnal Resistance (R-Vaiue) �•-19
Loose Fill Type Brand Name
Contrxtor's minimum installed weighUft lb Minimum thicla�ess inches
Manufact�er's installed weight per square foot to acheive 7'hermal Resistance (R-Value)
RAISED FLOOR
Material (���
'Ihic}�ess (inches)
Brand Name
'Ihermal Resistance (R-Value)
SLAB FLO�JR _ I �,
Material �09JCY'�7'� BrandName T•�GNs,�� /y! �SC .
`Ihiclrness (inches) `f °� Thermal Resistance (R-Vatue)
Width (inches)
FOLJNDATION WALL _/
Material (�� � Brand Name %�C�'-N tS7� !%'� ( �C
Thickness (inches) / Z '� 'Ihertnal Resistance {R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in confomiance with
the cunen[ Building Energy Efficiency Standazds for new residenpal buildings contained in TiAe 24 of the
Califomia Administrarive Code.
/� 3i07o G
t��„�� N,�,t�
>'� ��'v.
Dam
icR e er
�
Da�e
i
t�oolicant to fill in all aoaees e eef tM1ose wil�in heavY bO�E¢� linei dntl Si4O dll aDOroD�idt[ tleclarolion5
PERMIT NO. � TRAC NO. LOT NO. UNIT. NO. 965.�1 5/02/84
CI7v oF COST,4 nnESA CONSTRUCTION PERMIT �_���� � ����_ Z_ 4.20 '
Project Address -3�!�� si%A� /�A Q/ND.
ApplicanYs Mailing Address /137/-H�vs7ca•�'6.CA. 9zCPo TVPE OF CONSTRUCTION �',�t�iEw /�DD ALTERATiOrv REPAIR
Owner'sName ��ce00.PF/� /14["T7FGir Phone�3�'�23Z �CONVERSiorv ❑�DEMo�ISH ❑oTHER q,p,# � Zone
DESCRIPTION OF WORK/USE OF BLDG. Sd AJ 2eow{
Atldreu 3�{G � S.S+N /•Y/72/�f%G S Main Building: � Accessory 8uilding:
Arch/Eng. liccnSeNo. TYPEOPPERMIT�y GRADING FOUNDATION ❑STRUCTURAL T Front � �p
ArJdresS ❑ TENAN7 LJ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL a Rear � N
Contractor'sNam tFDE�rvST Co Phone 91/-73To �'OTHER _
e�" � 3 C Right N
e PROJECT DESCRIPTION SQ.FT. � oCcuPArvCV K. G
Atldress (mailing) '¢ ` -2C`� Left
�� ^ ^ CONSTRUCTIONTVPE VALUATION$ $
City License No. ��� 7 ZONE GRADING CU. YDS. ACRES R
L�pENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Fieq./Provided E
I he�eby atfirm tha[ 1 am IicenSetl unCer provisions of Charter 9(commencin9 0.emarks: — � SS Planning Notes: ' M
with section ]000) 01 Division 3 of the Business antl Professions COtle, antl
my license is in full force and effect. '\ T
LicenseClays � m g:Z/S3{tL' . S.
Date S/�y 5'9 t .a�/!�v � PLUMBING FEES
WORKERS' COMPENSHTION DECLARATION 88t Sink. Showers ELECTRICAI FEES
� here�y affirm that 1 have a certificate of consent to selbinsure or a certificate
ot Workers' Compensation Insurance, ar a certitietl copy thereol (Section Beckfl0w Preventer Service$ink -
3gp0, �ab. Automatic Washer Transformer � 75-50 KW
Poiicy No.PC 9GG38� Company �E/z��V- Backflowlrri ation SewerCa � ❑ 50+KW
9 P Construction Pole Su6.
� Grtifietl coDY is hereby fu�nishetl. .' � i
�} Gertifie w is filetl wirn tne <ity Builtling Division. � gathtubs Sewer Connection / Cookin9 Unit Meter ❑up to 100 amps
�ate 3y��v APPlicant C�gS �fUOb'Q
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION Cld�ifi¢!S SOIa� COIIgcL0�5 DiShWashel ' M¢i¢� ❑ov2� 1002mp5
(7nis section neetl nat be complete0 if the permit is tor One huntlretl ($300) or . -
less). Dishuvasher Solar Piping Dryers ❑Gas ❑Electric Suh Panel
I�¢rtity tna[ in the pertormance of the work for whlch this perm�[ Is issuetl, I
sqall not employ any person in any manner so as to become subject to tne Drinking Fountains � Solar Tank ' Fan Motors �0-1 HP 01'h- 6 '
Workers' Compensation Laws Of CalitOmia. � '
Oate Signature Floor Drains ' Swimmin Pool w/S a
9 P F.A.U. Inc, Solar 09-15 HP �7fi-15+
NOTICE: If, after making this tleclaration, you shoultl become subject to the
Workel5' Compensation provi5ion5 of Ihe Ldbor Cotle, you must for[hwith FIOOf SinkS Ufinal FixtUf25 MlQowdvE
comply with sucM1 p�ovisions or [ni5 pe�mit Shall be tleemetl revok¢tl.
CONSTRUCTION LENDING AGENCV ' CidS$2NicC �ULI2t5 Watef CIOS¢L D¢viC¢ BOx¢5 POI¢ Li ht
� hereby atfirm that the�e is a construction lentlin9 aqency for tne perfo�manCe 9
o( [he work tor whichg�tY e��� i�ssued (Section 3097 Civ. GJ � Ipterceptors Water Heater � Outl2t5 Range �
LenGer'S Name
�entler's AOtlress ' _� Kitchen Sink Water Service Switches Sign �.
OWNER BUILDER DECLARATIOIV ��
I hereby afil�m that I am exempt from the Contractor's License Law fo� the L2VdtO�i25 Garbage Disposal � Standing Sections
following reason (Section �031.5 Business antl Professional Cotle: Any city or ,
Lounty which requires a permlt to mnstruct, alte�, iTprove, tlemolish or repair P—T�3p �
any structure, ortor to its issuance, also requires the aoP���ant tor such permit Generetor �Q5 KW �5�15 KW Trash Compactor
to tile a signetl 5[atement that he/she is licensetl pu�suant to the p�ovisions of Roof Drains � -
the Confracror's License Law (Chapter 9(mmmencing witn Sectlon J000) of
bivision 3 of the Business antl Profe55ions CotlC) o� that he/she is exempt
therefrom antl the bazis for the alleged exemption. Any violation of Secfion ,
7031.5 by any applicant for a permit.subjects the applicant to a civil
benalty of not more tM1an five huntlretl tlollars ($500). . ' $ 3
❑ I, as owner of Lhe Property or my emPloyees with wages as their sole Reinspec[ion Fee $15 ISSu@ Fee _
<omDensation, will tlo me work, antl the-structure is not intentletl or ofteretl Reinspection Fee $75 luue Fee . $ 3
ior sale (Section �044, Business antl Professional Cotle: The Contractor's - MECHANICAL FEES
Licenu Law tloes not aDPty [o an owner of a property wno builtls or improves �
thereon, antl wno Coes sucn wort himsel//herseif or through nis or ne� own - DEVELOPMENT SERVICES RE�UIREMENTS:
employees, provitletl tM1at such improvement5 a�a not in[entletl or ofieretl tor goiler HOOd O� Typ21 ❑
Shce. If, hOwever, the buil0ing c� ImprOvement i5 soltl wilhin one yed� of com- C,anOpy Typ2 I I ❑ - Z���^9 APProved By Dete
pletion, the owner will nave [he burtlen of provinq ne/she aitl not builtl or im- Duct - Under Ground guilding Approved By Uata
�ove fo� the DurpoSe of sale). , e .r �. /
I, as owner of the properry, am exclusively contracting with Iicensetl con- Duct -Struceural Refrigeration System Appliption Issuetl By �� � Dat � �f
tractorsto constructthe project (Section 7044, Business antl Professions Cotle: �
_The Contracmr's License law does not apply to an owner of oroperty who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU
builtls or improves tnereon, antl who mmracts for such projects witn a con- _ SUMMARV OF FEES
tractor(s) licenze pursuant-to�tne�Contractor'i License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ ' SMIP $
proof of thei� Wotke�'S Cortlpensatlon insurance SM1oultl be provltletl to me. P�.AN CHECK $ PE{1MIT
❑ I am exempt unaer Section e. & P. C. for this reasan Firepl/FacL Bit. ICBO # P�UMBING $ $ ISSUANCE $
Date owner Heating System & Ducting PLAN CHECK 25% $ ��{ � ENERGV P.C. $
I �ereby certity tnat I have read this application and state tnat the above ❑0-100,000BTU 0100,OOOBT ELECTRICAL $ GRADING $
Vnformation is correct. 1 agree to comply wi[h all Gty antl county ortlinances
antl state laws relating to builtling construction, antl hereby aumorize repre- PLAN CH�CK 50% $ � MICROFILM $
6entatives of this Ci5y en�te�� yfp n the dbove-mentionetl O�operty for q
inspection purposes�/ p�,,j'' � MECHANICAL $
Si9nature - /� �"��.t'id� Date S � � TOTAL FEE $ � � d- �
Drivers' !.i SS qf �� � Reinspection Fee $15 laue Fee $ 3 PLAN CHECK 25% $
CMF 0865�46, rev. n/tln White - Bulltli�g; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
COIVSTRUCTION AND PLANNING POOL & SPA
, E- �e29 Date Inspector Date Inspector
Y APPRqVALS Permit # APPROVALS Permit # �
� ,
1. Temporary Electrfcal Service or Pole . , � 52. Pool & Equipment Location •
2: Soil P�pe-Undrgrnd. � �� � � 53. Steel Reinforcement �
3..Electrical Conduit Utility�Undrgrnd. ' 54. Forms �
4. Elect�ical Conduit-Undrgrnd. � 55. Electrical Bonding - ' ; • '
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �
� . '
� 6. Electrical UFER Grnd. �• 57. APPROVALTO COVER-GUNITE , '
7.� Footings ,. �� ' 58. Electrical Conduit-Undrgmd. r�
' 8: Foundation . -� • 59. Gas Pipe, � Undrgrnd.,4Test •
9. Water. pipe�Undrgrnd. � . 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System ' 61. APPROVAL TO DECK .
-- ,.
11. PropErty Sewer Line & House Connection �� �- 62. Backwash & RecepiorFinal
12. Sewer Cap . � 63. Heater & Vent-Final "
13. Roof Drains 64. Plumbing System - Final .
14. Rough Plumbing 65. Electrical-Final �
19. Rough Electrical-Conduit 66. Solar System-Final � -
16. Rough Electric Wiring ' �� �1 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.,OuCts, in Structure 70. Underground Hydro .
; 22. �Ducf;, Ventilating • � 71. Product Piping O Gas ❑ Oil
�i
..23. Gas Pipe-Rough & Test � � 72. Underground Flush , �
�'24.�Roof Framing � , ' _ 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing � � � 74. Overhead Hydro
26. T-Bar Ceiling (Struciural) & Monocoat � 75. Dry Chemical .
27. Frar�e 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 �.S �� Notes:
34. Final Heating & Air Conditioning � �'
35. Final Gas Pipe-Test ' �
36. Hootl or Canopy �
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestic-Final � .
42. Backflow Prevenier � � ' �
43. Backflow Irrigation . ' ' �
44. Lantlscape Irrigation SYstem '
45. Sound Attenuation
46. Hantlicap Regulations �
47. FINqLSTRUCTURE&BUILDING . ,
48. Special Requirements Completed .
49. Electric Release to Edison � , ' , `�
50. Gas Release to Southem California Gas Co ��
51. CERTIFICATE OF OCCUPANCY ' � ,! � '
No. Date � ' . ,
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�-- =�-�---__ - -_-- .._ _.�..,�-.--- _—
•�
�
1
AOv��cant to ���I In all soaces excepl lhose witnin neavy boraer Iines ana sign a�l aoPropriate tleelarations.
CITY OF COSTA MESA pE IT NO. Tg�c�ry p LOT N BLD . N .
CONSTRUCTION PERMIT �- /2 $�S�j b(�O % � 8354 4/ 10/84
Snw /Yi A.Ri.u_ts.� 93e 72
Pfoj2Ct Addre55 �-�% ,_ TVPE OF CONSTRUCTION EW ADD ALTERATION REPAIR
Applicant's Mailing Addfess ; LZ 7i Zlf{LiSlilL Sl . G� G ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # J —G�J — 2one
Own¢f'SNeme �� L/JOlIENMtTz662 phonE �L3.'t'�2%2 DESCRIPTIONOFWORK��n�r Gpy�,� ��.
Addre55 3y6 � s� 9"e�//O �'rU���� E Main Building: AccesSory Building: ^ ZO
�T 7 TVPE OF PERMIT GRaDIrv- G Ll FOUNDATIDN L!7 STRUCTURAL T Front ry
A�t}1/Eng. ���'�7 Licenu No. ��r% � ❑ TENANT ❑ ELEGTRICAL ❑ P�UMBING ❑ MECHANICAL B Rear '�" �� �
Address ❑ �OTHER . : %� N
Contractor's Nam \ E ���O Phone..i_7��23fd pqOJECT DESCRIPTION 54. FT. oCCUaAN v a'i-/ C Ri9ht t-� �- G
K p
Addresslmailing) �� � f-l'�%R/Jv ��'vE. Z� 6 CONSTRVCTIONTVPE VALUATION$ S LeFt ' E
�-- ����C1 20NE GRADINGCU.VDS. ACRES p�� Ref.# —' Park.Fees$—� . �
City License No. [ �^ Q /� u�j� 9�
I.ICENSED CONTRACTOR DECLARATION Remarks: DN ` P'1�T/JI�AVLE U/�/7vr Pafking R¢q./Provided � ' u
1 h0r<by atfirT Nat 1 arP IicenSetl untle� provi5iOn5 of Ch3rter 9(commencing __ _ R
with sacHon �000) ot Dlvislon 3 of [he Business antl Professions Cotle, antl NO A i� � ��nNE� -. fJ/. Use of Building: . E
Ty IIC¢n5B IS ip (UII (Ou e dOd BHBCf. /�< <v � 7�
License Claf s /�S • � Llger159�O1J.Z�S�I`� ' PLUMBING FEES P�anning Notes: ' �'1
�ate U/l �' cionature —._ N7ii: v_ _ � / ? E
� Bar Sink Showers K '�✓ N
WORKERS' OMPENSRTION DECLARATION
I haraby aiflrm that I have a certlficate of conunt lo salMnsure or a certiflcace gg�kflow Preventer Service Sink T
of Workers' Compensatlon InSurdnGe, Or a certifletl copy thOreOf (Se<tion S
3800, Lae. C) p gackflow Irrigation Sewer.Cap ELECTRICAL FEES
coucv rvo. OG 9L6 3 it L comaa�v %��O 7�� .uNaTy�i1,5 �a
�fi��Iiiea copy is nerenv �urnlsnotl. Bathtu6s Sewer Connection Automatic Washer Transtormer ❑ 15-50 KW
LT Certlietl c py is filetl with tha dty Byllri� DI Isl �
oate Y APpllcant.�(E �,-,! -P/-� Clerifiers SolarCollectors ConsCructionPoleSub. �50+KW
EXEMPTI N FROM WORKERS' COMPENSATION DECLARATION Di5hwa5h¢r SOlaf Pi in
(Th15 S¢Ctlon naBtl not be COTpiBtBtl It the pa�mit is fo� One huntlretl (E100) o� P 9 � - Cooking Unit M¢L2� ❑up IO 1�� drt1p5
less). - —
I cerll(y tnat in tne perfPrmance ot tne work tor whicn tnis verm�t Iz Issuetl I Drinking Fountains Solar Tank r• Dishwasher Meter ❑over 100 amps
shall not employ any person In any manner so as to become su�ject to t�e
Workers' Compensation I-aws of Callfornla. FlOor Orains Swimmin9 Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Data Si9nature �
NOTICE: If,iafte� makln9 this tl¢cla�atlOn, you Shoultl become su��ec[ So th¢ FIOOf $i�k5 U�indl � Fen �
Workers' Compensallon Provislons of the labor CoOe, you must torthwith Motors 00.1 HP 01'h-8
comply with sucn pro+�sions or this permit shall be daemotl revoketl. Ges Service Outlets Water Closet � ' F.A.U. ^ InaSoler �9-15 HP 01fi-15+
CONSTRVCTION LEND�NG AGENCV
I hereby afflrm that tnere is a constructlon IenGin9 a9ency �or tha performance Interceptors Water Heat¢� Fixtures
of the work for which thit�rmitei�suetl (Section 3097 Civ. C.) . Microwave
L.antler`s Name _� A� Kitthen Sink Water Service - Device Boxes Pole Light
Lentler's AtlEress� - Lavatories
OWNER BUILDER UECLARATION . " OuLIEts � Range
I hereby afflrm that I arY�'exempf /rom tna Contractor's Ucense �aw for the p�Tte '
following reason (Sectlon 7031.5 Business antl Pro/es5lonaLCotle: Any clty or P SwitcheY
county which requires a Permit to construct, alter, improve, tlemoli5h or repair �5�9�
any structure, Drlor to IK Issuance, also requires the appllcant for such parmit ROof DrainS ' � -- Gai6ageiDispoSal $tanding Sections
to file a�slgnetl ztatement that he/she is Iicensetl pursuan[ to the provlsions of , _ _
[he Contrattor's License lzw (Chapter 9(commencing with Saclion 7000) of Gene�ator �65 KW �5=15 KW
Divizion 3 ot tha Business and Professions Cotle) or that ne/she Is exempt � � ' T�ash Compacto�
tnere(rom anE [he ba5i5 for the allagatl exemptlon: Any violation ot, Section
7031.5 by-any applicaq� for a permit subjects the apPlican[ to a civil ReinS ction Fee . $ 3'
�enalty ot not more than ��va huntlretl tlollars (E500). P� $25 Issue Fee � '
I, as owner of the property or my employees wltn wagez as thair sole s MECHANICAL ReinsPection Fee � $p5 Issue Fee $ 3
tompensatlon will do the work, antl tne structure I5 not intentletl or offeretl - " FEES
for ule (SecFion 7044, eusinest antl Professional Cotle: The Contractor's , PUBLICSERVICESREQUIR MENTS
LIC8n5p ldw tl095 not app�Y to dn owner of a property who bu11tl5 oI Improves Bpjl¢I HOOd O� TypE I ❑� ' '
theteon, antl wno Goes SUGh wOtk hims¢If/h¢rself o� th�0u9h h15 or har own - 2oning App�ovad 6y '� Ddta —
amploy ees, o/ovldetl that such Improvements aro not intenaetl or oftarea for Dutt - Under Ground �nopy Type I I ❑
sale. 1(, however, the builtlin9 or Improvemant is soltl witnln one year of com- Building Approved By Date
platlon, the owner wlll have the burtlen of proving he/she Cltl not builtl or Im- � .
�rova tor the purpose ot sale). _ , � • Duct - Structural Refrigeration Sys[em Appliwtion'Issuad By '- Dat
LJ I, as owner oi the prPPerty, am azclusively contractin9 with Iicansetl con- � ❑0.100,000 BTU ❑100,000 BTU '
traceors c0 construct the project (Section 7044, eusiness antl Protesslons Cotle: Duct - Ventilating . ',�, SUM�RY OF FEES
Tha Contractor's CicensB ��+ does not apply to an owner oi property who $
bulltls or Improves tnereon, and wno contracts for sucn proiects wlth a con- Exhaust System ❑ Multiple ❑ System Repair/Alteretion ' � BUILDING�PERMIT $ j7 tsQ $MIP �. �
tractor(z) Iicense pursuant to the Contractor4 License Law). PCAN CHECK $ 3i .%Z pERM1T � '
❑ I,am exempt untler Section B. 6 P. C. for this reason Firepl/Fact. Blt. ICBO # ' PLUMBING $ �SSUANCE $
Date � Owner Hea[ing System & Ducting .p�,qN CHECK 25% $ ENERGV P.C. $
I hereby <ercify that I hava reatl this applicaHon antl state that the above ❑6100,000 BTU �t00,0008T - - ELECT,RICAL GRADING $
Informatlon is corrett. I agrea to comply with all tlty antl county ortlinances ' . $
antl itate laws relating t4 builtling m 5truction,'antl hereby aut�ho�riz�atreproel . p�,4N.CHECK 50% $ MICROPILM $
5ontative5 ot this tlty o e ter� �n ihe above-mentbned ?
Inspection purpasesy�
5lgnature ✓�"-� ' Oate_� MECHANICAL $ TOTAL FEE $ J�%
DrlJars' License or 55 � Heinspection Fee $25 Issue Fee $ 3 PLAN�CHECK 25% $' .
CMF 0865-06 rev. 12/83 Mlhite- Builtlln9: �nary -Appllwnt; Plnk - Accountin9: Goltlenrotl -Assessor _
. CONSTRUCTION APJD PLANNING POOL & SPA - . _ - .
� APPROVALS � Permit# Date' Inspector AppROVALS Permit# �Date Irispector
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 UFpR G�nd. . 57. APPROVALTO COVER-GUNITE
7. Footings 9 a� pu C 58. Electrical Conduit-Undrgrnd. �
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test . � . .
9. Water Pipe-Undrgmd. � • 60. Backwash Lines, P-Trap, O Undrgmd. �
" 10. Strucwrel FloorSystem� � 61. APPROVALTODECK
11 . Property Sewnr Line &,House Connection � 62. Backwash &' Receptor-Final .' -
12. Sewer Cap � -- � 63. Heater & Vent-Final �
13. Roof Drains + '� � 64. Plum6ing 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 �'i �
18:!Rough Electrical-T Bar Ceiling. 69. POOL/SPA SYSTEMS FINAL � " �
19. Rough Heating & Air Condifioning FIRE DEPT. REQUIREMENT � '
20:� Rough Factory Fireplace . � APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro , �
22. Ducts, Ventileting .. � 71. Product Piping OGas ❑Oil �
23.�Gas Pipe:Rough & Te3t 72. Underground Flush
24. Roof Framing • ' 73. Undergrnd.StorageTank �Gas ��Oil'-
25.. Roof Sheathing . � y._Z 5_�4 ��� 74. Overhead Hydro ' � �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flgshing � ' ' 76. Dry Standpipe ' '-
28.' Lathing & Siqing�' S �� U�r�s 5"_7 �-� ,� � 77. FIXED SYSTEM FINAL � � �
29. InsulationP����"� °rtOrc ' 78. FIREPREV.FINAL
S-1�
30. Drywall Nailin9 ' � � HEAL'fH DEPT. REQUIREMENT
37. Plaster Brown Coat. ' ' �� / �' 79. FINAL INSPECTION
32. Electrical Power Meter-Final.•� 80. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes: �- �- Z 7_b�y �'i � T(J L,y T;� E,�'T� �
34. Final Heating & Air Conditioning �)
, 35. Final Gas Pipe-Test ��3 ��� � F, ;N -N IG � G N
36. Hood�or Canopy � L�C �%�� � rrL � ��� G � � z `�
37. Final Factory Fireplace iG 5-T ��"7 -�-r �0 T� -
38. Final Plumbing � - - A IG �l �
39. Water Service�Final -' T L d L .S �TI (� �
40. Gas Service-Final IVS T A L L � I f! 1 5 - ��
41. Solar pomesticFinal -
� co T'= o
42. Backflow Preventer � . - . .
43. Backflow Irrigation ' {'� ' � � � + �
44. Landscape Irrigation System '
45. Sound Attenuation . �
46. Handicap Regulations +" '
47. FINALSTRUCTURE&BUILDING s�s�d'y �fj � � ,
48. Special Requirements Completed . ' � �
49. Electrie Release to Edison � � � � ' � . '
50. Gas Release to Southem Califdrnia Gas Co ' . � •
51. CERTIFICA7E OF OCCUPANCY - - �
No. Date . , ,
PP0.IECT AODHESS: � 4 O S aAN MAR I NO C Z
owHee•sxarne: TEDMET2GER
�ooness: 3 q 6 6 SAN MAR I NO C I
COSTA MESA
CA 92626
RNCM/ENGINEEN: {' 1 4� a j 2� 1 2 3 2
,IOOflE53:
PEC.NO.:
uxrt:
UNR:
PEPMITfEE: J�U1j�I COAS�� DESI��N (714)939-6758
eaoa¢ss: � }�p L(iG» ST F
C�:STA hfESA / CA 92526
LICENSEU LONTHACTOB oECUMTIaN: 1 hereby alfirm inat I am Iicense0 unAer D�a�isions of Cnapter 9 �commencinp witA Section
7000) al �ivision 9 af t�e 6usiness anG Pml¢ssions CoGe, anC my license is in full torte anE eflec�.
cin uc.: � 5 Q S y 5 sur� uc.: 5 6 5 3 7 4� cuss: g.
i,- .
oaie: � / •- 1G Signature: i. . `: \ �� , . �
WOPNEPS' COMPENS�TION UECIAMTION: I �ere0y affirm t�at I Aave a ceriifiwte af consent ro SelFinsure or a certificate ol Workers'
Camoensation Insurance, or a cenilieA cooy tnereol (Section 3800, LaO. CI.
roucrxa.:WCA 06 37 97 FxP.o��: 07/Ot/?U
caMr�xr: �;;�LPLN EA��Lc
� cen�rea coov �s ne�eey m���snea. � CerlifieG [oDY i5 �ileA wii� �he tity Buildinq OiviSbn.
I � ` "
uate: _j -� j " �G AOVlicant: T-� •�i�' 1L'�.�^'
EXEMFfION FROM WOPSENS' fAMPENSATION OECIAlUTION: (�hi5 ucUw nee0 na� be com01ele0 ii the p¢rmil i5 �or one hunEreG (E100) or less�.
I certily t�ai in t�a, oeAormanr,e ol Ihe worM �or whic� this De�mi� is issue4 I shall not emplay any person in any manner so as to Getome
su�ier,� �o tbe WnrkPrS' Cnmoensafion Laws of Cali/omia.
Oate: SipnaWre:
NOTICE: II, aM1er making tAis Ueclaration, you s�oulE Eecome suGl�� �a �M WoM1ers Compensaiian Dro��sions ol fAe LaUor
CaOe, you must fonhwii� compry with suc� prodsions or Ihis Dermit s�all 6e AeemeA revoke0.
CONSTBUC710N tFNDINC IGENCY: I �e26y aKrm I�al l�ere is a cons[ruction lending aqency �or IAe pertormance ol t�e work lor
wnicn inis Dermil is !uuea (SMeion 3097, Civ. 4�.
lENOEfl:
ROUflE33:
DWNFfl BUIlOEfl OECLAP�TION: I hertby aKirm that I am erempt imm the CAniraclors' State License Law to� t�e tollovnnp roason
(Seciion 7031.5 8usiness antl Pmfessional CoGe: My ciry ot caunry w�ich rzQuires a permit ro con5wci, al�er, im0�'e, Cemolis�. ar
reoair any simctua, pnor to its issuance, also repuires t�e applicmt lor such Dermtl to file a signetl statement ihat �e/she is licensetl
punuan� lo tAe pmvisions ot �he Coniracrors' State License law (C�epter 9(commencinq wu� Section 7000) of �ivision 3 ot t�e Business
anG Pmhsvans Cade) or that �e/she is exempt Iherefmm anE Ihe bazis lor the alleqeA exemption. My violation ol Section 1031.5 by
any aOVlicant for a oermit su6iects t�e aD0licant to a civil p¢nalry of not mare than fve hunAreO dollars (5500�.
I, as owner'af the prooeM o� my employees wit� wapes as tAeir 5ole comDensation, will Eo I�e wod, antl the
❑ slmcWre is not imendeU or oHered lar sale �Sec�ion 7064, 8usineu anG Pmfessional CoOe: The Caniractors' S�a�e License Law
Aoes not aDUly ro an owner oi a O�operry wAo DuilOs or impmves f�ereon, anE w�o does sucA xroM Aimself/henelt or (hrouph
his or ner own emoloyees, O�oviae0 �hat suc� imD�a�ements are not inten0e7 ar ottertE far sale. II, Aowever lhe huilEinp ar
impmvemem is m�d wi��in one year at compleiion. t�e owner will have �he UurOen of pmvinq ANshe EiE no� �uilC Or impmve
lor t�e ouroose ol sale�.
I, as owner of Ihe DroceM. am exdusiveN contractin0 �tn licensea contnctors to cans[ruct tne project ISection 7011. Busineu
❑ and Pmfession5 Catl¢: ihe Contacrors' State License Uw tices nm appry ro an ovmer ot prapeM � OwlOs or improres Ihereon
anG wno mntracts lor such O�ole��s wit� a contractor�s) licenu Dursuant to iM Coniractors' State License Law�. I am awarc
Ihat �mnf oi t�eir WOM1er'S Campensation insuranu S�ouIG Ge providetl lo me.
��. � I am eRemo� unaer Sectian: B. 6 P. C.
for tAis reason:
'� Date: Ownec
I� I Do �ereCy ceniN tAat I am aware of ana un0erstanE tAe reQuiremems at California HealtA and Safery Cotle Seciions 25505, 25533. anE
�', 2553C anet�atl o!'anyluture huilGing occuoan�wiil/wil�noi (circle one) ne¢d to comply wit� said state coAes anOlAe reQuiremenis lor a
.. permit fo� wnS�mclion or mo0ification irom ��e Air Dualiry Manapement Uisintl. Resitlen�ial rons�mc[ion applications are exeinpt trom
, IIICSC DlOVISi0n5.
I Date: Appliwnt
�I I �ereGy ceniry t�ai I �ave aaE t�is aUplirafion anE state tlu� ��e aGave infarmation is cortttt I aqree Io fAmpty wR� all ciry an0 counry
I ardinantts anE Sta[e Wws relatinq m 6uilJing constmctlm an0 �ereEy aultnri¢e repaseMniives ol Vus city to enter upon t�e ahove-mmtioneE
�i D�opeM �o� inspection Ouryoses. � ---� �
i
Oate: r � `.- • �� Signalua: �' 1. U ` �:.•�`-�-
Oeivei s licenu or Saial Secunry M: .:: ��'�
1601J6 Wnne-BuilEing; Graen-C�a Enbrcemem; Canary-ApO��cant; Pink-Revenoe; GoldenroE-Assesaor
CIT'l OF CGSTA �tESA - BUILDING FERMIT P£P,M ZlU; B Q4732?
YEkMIT NO� B 047��7 PLAN CHECK NO: U4000-90 S GO�T: N SUPP: N
CONSTRUCTION TYPEi 5-N PERMZT TYPE: STR PURPOSE� OTH
JUB DESCRIPTION = 40LF OF CMU WALL Q 6'H/60LF RET 2'HFG SQ FT� 100
CLAIM VALUE: CALC-VALVE� 2,600.OQ GROrJp OCC; R-3 /
COMMENTSs SMOi(E DETECTOR(S) REQUIRED IN HOME,
+t�at+��r�*;r+t�k+t*�rt�±�w�r�*#�,t*�*�r+�***,�x+r**rr��**frwir**�e+e�r;e*r+r�r�r*+:*x��e�±���r�*+��r±F+�+��x*
2 O N I N G A E Q U I R E 4! E N T S
S E T B A C K S
----------- M.lIN BUILDING ---------- ---------- ACCESSORY BUILDItJG --------
FRNT: 10 FT IN RE.AR; FT IN FF.NTt FT IN RETiR; FT IN
LEFT: FT IN ftGHTs FT IN L�.FTi FT IN P.GHT: FT IN
?�RKItIG RE�• PROV; PARCEL: 41205102 2NE: R1 REF NUz
PLANNING iJ 'PES> 40 LE 6 F't PRZVACY WALL 10 FT FROM FRONT PROP LI1JE
> AND 60 LF RETAINING WALL ON FRONT PROP LINE
+rr�**+r:r�r±r�r+�*��r:�«+t*k�****�e�r*r+t���r�*����r*�;��e�*�x*r**�r�r**r�e*�*�r±r±�**r*,r�*;«*�,r*+�*,r�*
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
2er�=r�c APFROVED HY -� �'�' �",:�r., ��j"s� DATE; r / S
BUILDING APPROVED BY i_ �'i �� DATE: S-�?� �%G
aPPLZCATION ISSUED BYc . �������--. DATE: ' ' �i' �G
Y?f 4 �1 rt?F ff 3f 3f ik 3! 1f k iE !F M!f jf �F !�! M .. "�'i�F+. �iFJF iF if M ik ik k If 1f 4�Ri�iF�'iF'i�f �t
fiifltYlf9f?tiiMlti4if1t�FlFkifiEiE±klfMlkkMiF1lMiEMiF%�F1f1FiFlffkifiFMlhMlFlkil. ktf�kifiif?f1FlFafifMiF?FiEiFltjfik'Jk1tlF+kiFiF4jfffiFlfif
LEGALIZATIONsN F E E S U M M A R Y STRUCTURAL SEGMENTiY
BLDG PP1T PLUMBING ELECTRIC MECHANIC FIRE SMIPiRES GRADING
PERMIT 54.00 SMIPINON-RES
PLAN 35.10
tSSUE FEE
BUILDING-DIV-> PERMIT ISSOE PLAN-CHECK TO'PAL PAID DUE
TOTALS----> SA.SO 0,00 35.10 J9.60 99.60 .QO
REVENUE DIVISION TOTALS--> - COLLECTED: 83.60 OVER/SHORTi .00
bLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADII�G PLAN-CHECK
54.00 ,SO 35.10
4+r if:{ M 1f k if 4 if iF if if !?k if it +F k i! Vif?k iF 1f+! M iE 1f!k if ?E +r R k if fE fY if V't +f N iF if it lt k-M !k M k< i6 k'R ?k �F ±f M 1f!f ik ?f if ia 3f 1k +tif # it iF if if if'F fE
I Id D I V I D U A L F E E fl R E A K D O H N
TYPE
SFR
SFR
��TY D E S C R I P T I O N UNIT COST
40 RcS-CONCP.ETE bLUCK HALL / FT, 20.00
60 RES-AET WA1,LS <= 3 FT W/SURCHG/ FT, 30.00
END OF FEE5
TOTAL CO�Y
800,00
1,800.00
_:ii[� 'c;l�"^ �1 I � i:�. '�
�:11_. ._ .. , :�•�� ..J*✓. �'�. : ..
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil Pipe�Undrgrnd.
3. Electrical Conduit Utility-Undrgmd.
R. Electrical Conduit�Undrgrnd.
5. Steel Reinforcement
6. Elecvical UFER Grnd.
7. Footings
$. Foundation
9. Water Pipe�Undrgrnd.
10. Structural Floor Sys[em
� 1. Property Sewer �i�e & House Co�nection
12. Sewer Cap
13. Roof Drains
lA. RoughPlumbing
1y. Rough Electrical�Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
78. Rough Electrical�T Bar Ceiling
79. Rough Heatin9 & Air Conditionin9
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilatin9
23. Gas Pipe�Rough & Test
2R. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) &"Monocoat
27. Frame and Flashing
28. Lathing & Siding '
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat '
32. Electrical Power Meter-Final
33. Final Electric
3A. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factory Fiieplace
38. Final Plumbing
39� Nlacer Service-Final
40. Gas Service-Final •
41. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irri9ation
44. Landscape Irrigation SYstem .
45. Sound Attenuation ��
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING �
49. Electric Release to Edison
50. Gas Release to Southern Califomia Gas Cc
51. CERTIFICATE OF OCCUPANCY
Da[e
Date
12
' ��
G �S�
i
�
Inspector
'M.I
Gw
POOL & SPA
APPROVALS Permit# Date Inspector
52. Pool & Equipment Location
53. Steel Reinforcement �
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undr9rnd.
61. APPROVAL TO DECK
62. 8ackwasfi & fteceptor-F�nal �
63. Heater & Vent-Finai � �
64. Plumbing Sysrem • Final ,
65. Elec[rical�Finai �
�
66. Solar Svstem�Final ' -
67. Penciny & Access Approval �
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Pipiny OGa5�O011
72. Underground Flush
73. Undergmd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIHE PREV. F:NAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION �
80. FOOD CERTIFICATE ISSUED
Noces:
- 2S �!v m �- �° J
� , .,:,' . � G'-2� 10 -
.. I '
r
rnaecraooxess: 3466 SAN MARINO CI
owxex�sx►rne: TEllMETZGER
nooeess: 3 q 6 6 S AN MAR I NO C I
COSTA MESA
�• CA 92626
(714)432-1232
RPCHIENCINEEfl:
• RDDRESS:
REO.NO.:
uxi1:
UNIT:
PENMIiTEE: SOUTH COAST DESIGN ( 714 ) 434-6758
aooeess: 1370 LOGAN ST F
COSTA MESA CA 92626
LICENSEO CONTMCTOB OECLAMTION: I �ereby affirm that I am Iicense0 unAer D�ovisions oi Chapter 9(commencinq with Section
7000) oi Oivision 3 ol Ihe Business ana Pmiessions Cotle, and my license is in lull force and effect.
cinuc.:050595 srnreuc.:5663 $ Hn
�ate:.,f—�� r�' pQ-- SiqnaNre:_ �'�Y
-"VINERS' COMPENSRTION �ECUMTION: I Aerehy aflirm Ihat I Aave a certificate of consent to sell-insure ar a cerli/icate al Workers'
�pensation Insurance. or a urtifietl cop ihereof (Sectian 3800. LaD. C).
.icr xo.: WCA 0 6 3 7 g 7 EXP. ORTE: O�I � O S I 9 O
cornrnnr: GOLDEN EAGLE
� Certifietl coDY is here6y tumishetl. ❑ CertifieA rcoov, 'is tit�eE with the ciry BIuilEinp Division.
Date: �-r � f ! d NPPlicant: r'" -�' "�
� E%EMP710N FflOM WORI(EHS' COMPENSITION OECIANITION: RNs uctian nee0 not Ga mmDletcd ii Ne permit is lor one huMrcd (f100� or less�.
''�. I cenity that in the pertormance of t�e work lor whic� ihis Oermit is issueG, I shall not emDloy any person in any manner w as ta Oecoma
suUject ta Ihe Workers' Compenution Laws oi Calitomia.
Dale: SiqnaNre:
NOTICF: If, after maldnA �Ais tleclaration, you shoul0 Oecome suhject to [he Woders' Compensatian Orovisions oi tAe Labor
CoOe, yrou must fort�wilh campty wit� sucA provisions or this Dermit s�all Ee Eeemed revoke0.
CONSTBUCTION 1EN01NG �CENCY: I �ere0y allirm that Ihere is a consimction lentling apency for tAe petlormance ol ��e work lor
which lhis Dermu is iuuea (Seclion 3097, Gv. C�.
IEXOEB:
ADOflE33:
OWNEB BUR➢EP DEIXAHIITION: I hereGy a8irm ihat I am exempt irom the Caniractors' State Licenu Law tar Iha lollovnnp 2uon
�Seciion 7031.5 Business an0 Pmfessional CaUe: My ciry oi counry whic� reQui2s a permil to constmci, atter, improve, UemolisA, or
repair any simcwre, pnor to Bs issuance, also requires t�e aDDliwnt tor sucA Dermit to fle a sipne0 statement ihat Ae/she is IicenuA
pursuam ro[he pmvisions of tAe Contracrors' Stata License Law (ChaD�er 9(commencing wRh Sec[ion 7000) ot Division 3 0l IAe Business
anJ Pmfessians CoOe) or that he/s�e is exempt therefrom anE t�e Ua4s for t�e allepaE exemD�ian. My dolation oi Sectlon 7031.5 by
any appliunt for a Dermit su6jects t�e applicant to a civil penalry oi not more ttun irve �un0a0 Uollars (5500).
I, az ovmer of tAe pmperty or my employees vnih waAes as their mle comDensaUon, will Eo tha vroM, antl t�e
� swcNre is not intenOeU or oifere0 tor sale (Secnon 7044, Business anG Prolessional CaOe: The Con[actors' State License Law
tlaes not a00N �o an owner ot a pmpeM who builds or impmves tAereon, and wAo Ooes such vroM �imself/Aerself or I�muAh
his ar her own emDloyees. proviAeO Nat such impmvements are not inten0e0 or olfere0 for sale. Ii, �owever Ihe builEinO or
imOrovement is soltl within one year of completion, ihe owner vnll have t�e hur0en of provinp he/s�e tli0 nat bui10 or Improve
tor the Duryose oi sale�.
I. as owner ot t�e propeM. am ra�clusiveN wntrzcunp with Iicense0 contactors to construct Ihe D�alecl (Saction 704A, Business
❑ antl Protessions CoOe: ihe ConVacears' State License Law Aoes not appty ta an awner of property who EuilOs or im0�s IAereon
anA wAo comracls far suc� pmjecls wiih a wntracroqs) lic¢nse Dursuant to Ihe Conlraciors' State License Law). I am aware
[Aat D��� of I�eir Work¢r'S ComDensaiian insufanc¢ Sh0ul0 Ee pmviAeO to me.
� I am exempt unAer Sectlon: B. 6 P. C.
tor this rea5on:
Date: Owner:
I do hereby cenity Ihat I am aware ot anA untlersWnd the reQuiremen[s af Califomia Healih an0 Safery CaEe Sections 25505, 25533, antl
25534 anA ihat I or any tuNre GuilOing occupant wilUvriil not (circle one) need lo compy with saiE state co0es antl tAe 2quirtmenis lor a
permil tor constmctwn or mo0ifwtian from the Air Qualiry ManaAement Oistnct. HesiOential constmccion apDlications are exempt irom
these D�ovisi0ns.
Date: Ap0liwnt:
I �ereby certity ihat I have rea0 this aODlication anE state that the a0ave information is coned. I apree ro comDly wii� all ciry anE counry
oNinances anG state laws rela�ing to Duil0in0 constmciion anE �ereby authonze repreuntatives of this ciry Io enter upon t�e aUove-men[ioneE
properry tor inspection purpous. C'�}/�w,�
Date:,,�./� SipnaWre' r �' V `
Dnver's License or Social Secunry x:
1601<6 WNte--Builtling; Green—Code Enbrcemen�; Canery—ApP���^�I P��k—Fevenue: GoltlenroE—Aaseasor
CITY OF CUSTA MESA — BUILDING PERMIT PERM NO: B 047327
PERMIT NO: B 047327 PLAN CHECK NO: 04000-90 S GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: 5TR PURPOSE:'OTH
JOB DESCRIPTION : 40LF OF CMU WALL @ 6'H/60LF RET 2'HFG SQ FT: 100
CLAIM VALUE: CALC—VALUE: 2,600.00 GROUP OCC: R-3 /
COMMENTS: SMORE DETECTOR(S) REQUIRED IN HOME.
*�t�r*�r�r�rx�t�t�t�tx�t�xx�r�t�tx�t�t*�t�t*�t**�t�r�e��tx**�t**�t�t�t�t�t��t�t*��xx�r�***�*��*x��r*�t�c*�r*�t�***�x
2 O N Z 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: 10 FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REO• PROV: PARCEL: 41205102 2NE; Ri REF NO:
PLANNING NCSTES> 40 LF 6 FT PRIVACY WALL 10 FT FROM FRONT PROP LINE
> AND 60 LF RETAINING WALL ON FRONT PROP LINE
�t�t*�t�r�r*�tx�t*�r�t�t*+t**�t�t�rx�r�rx**�t�r�r**�t*x�r*�r�t**x******x*+t*��t�t**x*��*�x�******�t�t�etr�r****
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N iT' S
ZONING APPROVED HY S eC-' � ��� DATE: rS�^ IS—�
HUILDING APPROVED BY : DATE: S.'—� S 9'G
APPLICATION ISSUED BY; � DATE: -? �S �G
lEititififititiPlk�kikiEifiEiEiEiEiEifiEiEiE . !t ihifitjfiEiE3fiElfjE��i�IFiE�k
iFiEikiEiEiElEiE�flFififatikiE%iElf�f3fiEiFiEiE�I(�jEifiEifiEiEiEiEifikiEitif�EiFitiEiEiflfih. fEiFiEikif�)fiEiFiEiFiFitiEiE�EiflEitlE�FifltitiEiE*iEiE'EiFiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL,�SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES �� GRADING
PERMIT 54.00 .50 �
SMIP/NON:AES
PLAN 35.10 !=
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 75.10 89.60 89.60 .00
REVENUE DIVISION TOTALS--> COLLECTED: 89.60 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRZC MECAANIC FIRE SMIP/TOT GRADZNG PLAN—CHECK
54,00 .50 35,10
k if iF if iE if if 3t �E iE fE it it iE iE if iE iE jE ik it if iE ik iF iE if if iE iE iF if if 1f iE iE'.E it iE iE iE k iE iE iE if iE it M 1E iE iE iE 3E iE iE jE iE iE iE iE iE iE if jE iE 3E aE iF if ik iE ik iE iE if if iE iE
I N D Z V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 40 RES—CONCRETE HLOCK WALL / FT, 20.00 800.00
SFR 60 RES—RET WALLS t= 3 FT W/SURCHG/ FT. 30.00 1,800.00
END OF FEES
\ �
�1 OOOb0919-0006Q9?1 Tt�'4'
04TCe 05liS/0❑ T7MFe 15e91
°,9.6G
GON$fRUC'�ION AND PLANNI, '��� $ SPA n
L(PPROVALS 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-Undrgmd. 54. Forms i-
4. Electrical Conduit-Undrgmd. . 55. Electrical Bonding
5. Steel Reinforcement 56. Rouqh Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, O Undrgrnd. �'
10. Structural Floor System �• 67. APPROVAL TO DECK "
11. Property Sewer Line & House Connection � 62. Backwash & Receptor�Final -�
12. Sewer Cap � ! 63. Heater & Vent-Final �
�
13. Roof Drains 64. Plumbing System - Finaf, `
14. Rough Plumbing 65. Electrical-Final -
15. Rough Electrica6Conduii 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access AnProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
2}, pucts,in,Structure � 70. Underground Hydro
22, pucts, Ventilating 71. Product Piping OGas OOiI
23. Gas Pipe�Rough & Test � 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas Q Oil-
25. Roof Sheathing � 74. Overhead Hydro �
26. T�Bar Ceiling IStructural) & 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, prywall Nailing ,r,'� i,� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat `�' ��� 79. FINAL INSPECTION
32. Electrical Power'MeterFinal -!� `� �" 80. FOOD CERTIFICATE ISSUED
33. Final Electric - ��` y Notes: .
34. Final Heating & Air Conditioning � � , �
35. Final Gas Pipe-Test � � '
36. Hood or Canopy . ; _
37. Final Factory Fireplace � !% -%�, F
"��.
3$. Final Plumbing , ��•� , ' � "
39. Water Service�Final - . �- �
40. Gas Service-Final • �
41. 5olar pomestic-Final
42. 9ackflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System �
45. 5ound Attenuation �
46. Handicap Regulations � �
47. FINAL STRUCTURE & BUILDING 6
48. FINAL PLANNING � � '
49. Electric fielease to Edison � �
50. Gas Release to Souihem Califomia Gas Co jl �/.
51. CERTIFICATE OF OCCUPANCY
No. Date
'
I PN0.IECT pDOflES3: j 4� 6 SAN MAR I NO C I unir: '
OWNEH'SN'ME: TE� METZGER
�, ROGiiiS3: $�.ME
�.� �
° �432-1232
� RflCNIENGIHEi�� B, C, ADAMS qE�.NO.: C S O S H 3
„�,�oass:�11022 ACACIA PHWY uNrt: �
'% G.G. CA 92600
�pEAMITTEE: SUNSET POOL & SPA ( 714 ) 538-4398
RDOPE83: ZEI% E WALNUT AV
. ORANGE CA 92667
IICEASEO CONTMCTOB OECUMTION: I �erzDy alfirm Ihat I am Iicense0 unEer D�ons of CtaD�er 9(comme�in0 wit� Section
7U0� of �ivision 3 of tAe Business an0 Professbns CoOe. anE my Gcensa L5 in tull lo¢e anE ellat.
cm uc.: 0� �5{ �0 �4 4 2 sT�re uc:( 4 7 3 7 3 5 <cuss: C
Oate:, ' (._J � � � \ SiOnature: _�� —
'IIKEB3' COMPENSRTION OEClAN1TI0N: I here0y allirm tAat I have a certllicate ol canunt lo sel4insure or a artificate ol WaM1ers'�
npenution x�a3cD a� $cerc�e� mpy ihereai �Section 3800, Lae.6l5 / 19 / 91
raucv xo.: STATE E%P. ��TE:
fAMPFNY: ,y
❑ Certifie0 coDY a here�y IumkAeO. L'� Cenilie0 copy is ideC wii� Ne dry Bui10' 0 D' '' /
� y"1
Oate: N� O �� Q � ppplicam: Y
IXEMPfION FlIOM VIONIlEflS' COMPEN&TION OECWWTION: (1Ns satian necE noi bo wmpletcd il Vw permit ¢ lor one AuMreO �5100) ar less�.
I cerliy Ihat in Ihe petlormance oi the work for whic� ihis Dermit is isweE, I stull not emDby any person in any manner w as to becoma
su0lect ro tne Workers' Compenutian laws al Calilomia.
Date: SIOnaWre:
NOTICE: tl, arter maMnp ihis Oeclaratian, you SMuW hecama subject ro IM Workers' Compensafion prmdslons ot tAe LaEor
CaOe, you must tartAWitA Campty vnt� wc� proW5ian5 or this permil s�all E¢ EeemeO ravOkeE.
CONSfHUtTiON LEXOING ICENCY: I �ereby atfirm t�at I�ere is a constructian Ientlin0 a0ency lar t�e pertormanca at tlw work for
w�ich t�is permit is issueA (Section 3097. Civ. C).
lENOER:
AOOflE33:
OWNEP BUILOEP OECIANITION: I �ereGy allirm Wt I am exempt Imm the CantaRori State License Law tor tM lollowinp reason
(Section 7031.5 Busineu and Professional CoOe: My ciry ol munry w�ic� repuires a Dermit to canstrud, atter, imprwe, Oertrolish, or
re0air airy sWcwre, pdor ta i6 issuance. also repulres I�e aDDlicant lar such Dermit ta lile a si0ne0 sWtement tlat �Uslie is Ilcensed
pursuant to ihe Drovisions ol t�e Contractors' State License Law (Cnaplar 9(commencinp with Sectian 7000) of Division 3 al t�e Busineu
anG Pmieuions COAe) or that �e/she is exemD� ��emimm an0 t�e �asis lor I�e alleqe0 axemptlon. My violation ol Sectlon 7031.5 hy
any apDlkant for a Dermit sublects Ne applicam ro a cidl penalry of not more than iNa hunEmO Uollars (5500).
I, az ovmer ol IM pmpeM a� �' employees with xapes as t�eir sole comDensatlon, witl tlo Na waA, an0 Ne
❑ sWcture a natinten0e0 orottereElorsale�5ec�on 706d, Buvness an0 PmfeSsionalCoAe: The Contadors' Stata License Law
Eces not appy to an awner ol a OmpeM � �wl0s or im0�'es lAereon, anE wtq does suc� vrod �imsell/herself or ihmu0h
his ar her ovm emDloyees, proviOeE tlut suc� ImDmvemenis am not intentle0 or ollereE lor sale. II, �owever the 6uiWinO or
impmvement ¢ 5014 vnlNn one year ol mmpl¢Iion. IAB Ownlr will Aave t�e EufOen ol pfodnp Ae/Sh! di0 n0i buil0 Or imprOve
for tha Durpose ol sale�.
I, as owner of the pmDerry, am excluslvely conlractln0 ��� Iicensa0 contractars to constmct the Dmle� (Sactlan 70Ed, Business
❑ an0 Pmfessrons Code: Tha Coniractors' SGte License Law does noI apDN �o an owner oi property who EutlCs or impmves Iherean
and who contrac6 lar such prolecit wiih a coniractor(s) Ilcense Dursuant ta ihe Coniractors' Siate licensa law�. I am awa2
tlut prool ol their Worker's Compensation insurance SMNU Ue DroN0e4 to me.
0 I am exempt unOer $ection: B. d P: C.
for this reason: ,
Date: Owner.
I do hereUy certiy that I am aware of an0 un0erstan0 t�e repuirements of Calitomia Heallh and Safety CoOe Sections 25505, 25533, antl
25534 and that I or any IUWre UuilOinp acupant will/wiil not (circle one) nee0 to compty wii� said state cotles anE tAe apNrements for a'
permit lor constructwn or moEification irom ihe Nr Oualiry'Mana`Oement OislncL ResiOential con5tmciion aDD�ications are exem0� ��om
Inese provisions: • �� • . ' �
" " '�-- �s' �_' . .
Uate: Applicant:' • ' �� -
i
I hereby cehity Ihat I Aave read this applicalian anE 5[ata I�2� �Ae a6ave inloimallon is a rrect. I apree ta comply �itA all city anOAcounry
orainancesandstatelawsrelatinptobuiltlinpconsimctlonantlhereCyauthor@areD�esental soflAisc (oenterupnlAeabove�meqtione0
pmDe�Y �or inspectlon puryoses. ( i" �/,
Q � �f,
Date: T3 � --(^7"1"
AppllcenC Pink—Revanue; GolAenroE—Ass¢upr
CITY OF COSTA MESA — HOILDZNG PERMIT PERM NO: BEP 047129 \I'
PERMIT NO: BEP 047129 PLAN CHECK NO: 03804-90 S GOVT: N SUPP: N ,
CONSTRUCTION TYPE: PERMIT TYPE: ELE PLU STR PURPOSE: OTH
JOB DESCRIPTION ; INSTALL POOL & SPA SQ FT: 14,900
CLAIM VALUE: 14,900,00 CALC—VALUE,:, 14,900,00 GROUP OCC:, R-3 /
1
COMMENTS; NO APPROVAL FOR SOLAR SYS.'I'EM
k k iE k iF iE if 1f iElf 1E!! iF iE iE �1! it if if ik it it i! ik if k if i! if �Ik iE iFlf iF�iklf.lf iE ik itlE i! if iE iF if iF if ik 1t ik it 1t ik iF if ik if ik iF �t dk ff 1F iE iE iE fE M!t iE iF * iE iE k i! iE ik
Z O N I N GS"ERTE�QAUCZKRSE M E N T S
------------ MAIN BUILDING ---------- --------- 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: 41205102 ZNE; R1 REF NO;
PLANNING N(S1'ES> FOR THE INSTALLATION OF A POOL AND SPA, ONLY.
>
ik it if df iE iE iE iE if iF it iE if iE iF if it iE iE iE k i! iF ik k iE iF if it ik iF ik k!E i! M ik ik if iE iE if ik iF ik k 1E iflt ik iE iF if if ik 1t if iE i! M!f it ik if it itlE ik iE 7f if iE ik if ik iE iE it iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY C�.,_ �, DATE: --Z —q0
HUILDING APPROVED HY : DATE:
APPLICATION ISSUED BY; V� � DATE: — a— �
ikiEiEitiEifikiEiEikifiEifdEiF�lfififitititiE itiF�kiliFikitif*if iEit
M 1E if iE i! iE i! M iF i! if iE iE iE if iE iE iE iE iF iE iE it it if iF ik 1F it a! iE iE if if iE ik iE iE iE iE if if if ik it IE it �f M k if ik ik iE iE k iE iE ff if iF iE iE fE iE iE if iElE if 1E iE iE iE iE i4 if if iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 162.00 2.00 30.00
PLAN 105.30 ZSY SOt. SMIPZN04—RES
ISSUE FEE 3.00 15.00
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 196.24 18.00 105.30 319.54 319,54 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 319,54 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN—CHECK_
162.00 5.00 45,00 2.24 105.30
df ik iF iF it iE iF it * it it i! i! iE ik iE ik ik if i! if it jE if if if ak �lf ik it iE iE iElt if ik ik ik iE iE iF if it it 4 if 1k iE iE if if 1f if iF if iE 1E ik 1f iE it if iF ft iE if if iE iE �f iF if ik iE if if 1E iE jf
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N�� UNIT COST TOTAL COST
SFC 14900 POOL & SPA 1.00 14,900.00
ELE 1 SWIMMING POOL — IN GROUND — NEW EA. 30.00 30.00
PLU 1 SWIMMING POOL •. 2.00 2.00
END OF FEES
01 QQ059739—Op0.;9�43 T�l�" 319.:�:
DATE= 04/3q/90 TIME: 1?:17
C PlSTRUCTION AG1D PLANNi._., POOL & SPA
APPROVA� ' Permit# � Date Inspector Date Inspector
APPROVALS Permit #
.
�t� Terttporerv �lectrical Serviceor Pole�: 52. Pool & Equipment Location 8 QU
2„ �r.a� qpe°t7ndrgrnd: �_ ��, 53. Steel Reinforcement
.J� Electrical Conduit Utility�Undrgrnd�. 54. Forms
' 4. Etectrical'Conduit�Undrgrnd. .� . 55. Electrical Bonding
' 5. SteeLReinforcemeni . 56. Rough Plumbing & Pressure Test -
6� Electrical UFER_Gmd. � 57. APPROVAL TO COVER�GUNITE
7. Footings -�'�� � 58. Electrical Conduit�Undrgrnd. �
�
�$. Foundation '' r ' 59. Gas Pipe, O Undrgrnd., Tes ��
9. Water Pipe�Undrgrnd. � 60. Backwash Lines, P�Trap, O Undrgrnd. '
10� Structural Floor System � 61. APPROVAL TO DECK �yj
11, property Sewer Line & Hbuse Connection � 62. Backwash & Receptor�Final -
12, Sewer Cap - 63. Heacer & Vent�Final -
r
-:, .
13. Roof Drains� -.� � 64. Plumbing System - Final �
iq, Rough Plumbing � - 65. Electrical�Final � ,
15. Rough�Electrical-Conduit 66. SolarSystem-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
79,_ Rough Heating & Air Conditioning ,_ t =� „ � r, FIREaPEPT. REQUIREMENT .�,�.�.
20:�Rou h�Factoi Fireplace �'t �' ' ' ' "- ' � '� ��'�'� ' = T , y
9 Y �; # -� rr n;,APPflQVA�L$:� Permit# y
21:' Ducts, in Stiuctuie'� "" �-'� `� �' ~* x 7 70. Under ound H� ~ ro *
�� i - C:� -� �t�x - 9, YS� a
22. Ducts,.Vent7latingy . ' ' } � �, ''u' ��.�77. Product:Piping OGas OOiI -
23. Gas�Pipe�Rough & Test _;=� � �•� � '' ,_ � s_ � � 7y. Undergro� �d Flush � " } j
24..Roof Framin . r"�. .. _ . ' -' � `_ � � ' - .. -': >� -'��,�
9 c � -• t:'�� 73.y Undergrnd. StoragQ.Tank3O Gas O Oil
25. Roof Sheathing �, ` t: � � y �✓ ' � � � ' 7q70verjiead Hydro_ , "
26. T-Bar Ceiling (Structural) &``Monocoat� i , �"., '�i # . 75 = Dry Chemical �;� q { �� � �
z7, Frame and Flashfpg ;' ^ � _ � > •i 4 + 76. Dry StanSfplpe `� '- � . _ '-
r^ ` � cc• s --. ; �
28. Lathing�& Siiiing., � � �`�'� .�_� ^ '�� , "t ' 77;y FIXED S.Y.STEM%FFNAL .-� �
29. Insulation •�� � '�" �•• ' � � ix r 7� FIRE PREV. FINAL r� '� ��.,i.
30. Drywall.Nai7ing-'r„ ,� i I � � �s�., _'.MEALTH�D.EPT.REQUIREMENT
.31. Plaster�Brown Coai- _: ' r�,'�^ ! :� � ���7g �FINAL INSPECTtON•
.� t� ..-. .n :. '
32�Electrical Power.Meter;Final � M�� � �r y'�80`�FOOD CERTIF�ICATE ISSl1,ED , ,�
33.�Final Electric ��- <� *• � � . � + � �Notes: '?�- * ^1 -:
w ! R 1'
34.;Final Heating & AiF Condicionl'ng �� - � � � " 5 :• C " � `
� uc.: r
_ •.Y � I
35:�,Finel Gas Pipe-Tesm �" .: w H ` � v -
_ -0
36,: Hood or CanoPV x " C, ,;.' � � ^ ' � .� i .�� k � 'z
r,
. ` J\• � -� . ^,
37:�Pinal Factory Fireplacer -.F� ov ,x � - =_
�� + : � -i
38�FinB'I Plumb�ng 4, .h �� ` ^ � f� S � r' i 3 '
H '. .
_ z+ . ..» y. � . � - _ ,
39 ;Water Service-FinaG �_ � . �, .r r: ., _, _ + ::
1` . h r�
40. Ga's:Service=Final = , <r"" `•'• ' '' * . �' .'-'(� '� 1 •
- •p• -q•� < T y • i' �-.
41'. Solar pomesiicFinal� - � u " � ' -n �; % >. .. -
i. �
42. Backflow Preventer ' � ��" ' � "
43. Backflow Irrigation t � , ' "' '
44. Landscipe Irrigation System' _. _ '� - - * .' • ' �
w: <
45: Sound Attenuation � �� .'. � � , , , _ _ • • _ �
� 46.•Handicap Regulations � _. - � .
. 47, FINAL STRUCTURE & BUILDING � • - � �
48: FIN;4L PLANNING � • .
�49.,Electric Release to�Edison � �
50. Gas Release to Southem California Gas Co " - ''
51. CERTIFICATE OF OCCUPANCY
`Nn Date
�
V�nCK .' GW�lY'111VV� wm. ���� �
JOB ADDRE55 3466 San Marino Circle BUILDING
FIRE ZONE VALUE:
SUBCONTRACTOR
ROUGH PLUMBING
MISCELLANEOUS
ROUGH HEATING ANO AIR CONDITIONING
POWER
ROUGH WIftING
TRENCHES FORMS STEEL REINF.
FLOOR SYS EM
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,';e t�-73�v�=00 37n•` _'::::�-21.50
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O.BOX1200 COSTAMESA,CALIFORNIA92626
� APPLICATION FOR BUILDING PERMIT
For Applicant to Fi!l in Completely
FECE E V D TERECE DATEISSUED
. BUILDING � // SQN il !Z ' �_/�'
ADDRE55 . J (}(��
OWNER W . (� _ � / • V A.P. NO.
I�-O5 -by PERMITNO. r
BUILDING � v��� �
MAIL G A �•� AODRESS
ADDRESS J R 7
TEL..��/ TRACT�3 / LOT� BLOCK
CITV ��',is7" " NO.`�/VSZ�{%
COP6TRVCTION
LENDEF �7 L��
BRANCM �
OWNER
AODRESS r AWE �/fsli��
ARCHITECT TEL. S ./�J`'`f"
OR ENGINEEfi
FIRE /�
ADDFESS 20NE TVPE GROVP �•�
APPROVED
CONTRACTOR �Jj�7I/L%�(Z ` � BV DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW ,"� p
CITV NO.' `. P�� � BUILDING �
STATE CITY �'.AROSAPPROVED VARDSAPPROVED
LIC. NO. IIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OFBLDGS. (FROMC/ I
OF LOT NOW ON LOT RONT T. FT.
VSE OF y / �/
EXISTING BLDG. F
SIZE OF +�' � � NO. OF /jlVLv�
NEWBLDG. .7']G ROOMS 5T0(iIES L.SIDE FT.
COVEEFl�INGA`L COVOERING ��2' =�'{i� REAF FTKa~
FT.
VSE OF BVILDING AND WORK TO BE PERFORMED p�7ANCE BET. BET. MA1 &
MAIN BLDCS. AOCE$$ LDCS.
�'J� . VAR.iW DATE
% L `jL /U L'�� C.U.P.aW APPROVED
APPFOVED ` � �/y �
t heraby acknowledpe that I have reatl this application entl smte STATE
that the abova informatiOn is cOrrect antl eB/ee to comply wlSh
all laws regulatlnB builtlinp construction, antl I shell not employ ` CO I
any perwn in violation of Ma workman's compensation lawi of ✓
the Stata of California. /
I hereby cartify that I am proDerly licansetl es e contractor untler SQ. FT. T/V,i-�-
the State of Calitornia Business antl Professlons Cotle, Dlvialc� 3, THE AMOUNT SHOWN UNDER VALUATIO IS FOR
C�aptar 9, antl that such licenses are In (ull forca antl atfact, or I THE PVFPOSE OF EuTABLISHING A PERMIT FEE ONLV:
am exampt from the provisionsof the Steta ot Californla Busineas VALUATION
and Prafessions Code, Divizion 3, ChaOier 9.
l�, PERMIT FEE $ ��
SiB�eture of{' [� � y/'�� � � /� jjj /�
Permittee /�u� �1 ��✓V�J"vG� $//Il/��/ P�p,N CHECK $ � 0�
� �Y
Authorizetl ABent � �
TOTAL FEE $
� �4���
� COSTA MESA BUILDING-SAFETY DEPARTMEIYT
P.O. BOX 12W � COSTA MESA. CALIFORNIA 92626
For Appficant fo Fill In Completely
TYPE OR PRINT
COSTA MESA. CALIFORNIA
R[CI
OWNER Heltzer Enter rises-Costa Mesa "G
eui�c
ADDRHBQ 144 South La Brea Avenue wonRi
FIRB
eirr Los An eles 90036 rTio 36- 0 =oNe
ARCHITECT TE 714\/� �pR�
OREN6INEBR OR ales N0��2.-60%8 BT
1336 E. Chapman Avenue
ADDREBB 1ON�
COMRACTOR
L[o�u.
DtaCwl
ADDRHiO
e�rv T,os Aneeles. California 90036 �P•�
s¢e
OFLOT
USH OF
EXISTIN6 BLDO.
YRT�ACN LIX[ II10M
■rr 8 � -4" � R�orrr
DESCRIP710N OF WORK
X I ��T�'��T�I�N� II �nN
BUILDINO
SIZE
EXTERIOR
Plan 404BR - Lot 2
or
27�-6
5'
I HCREBY ACRNOWL6OO6 TMI1T 1 NAV6 R811D TX�9 APPLICATIOH
I�N� BTAT6 TX/�T TH6 ABOV6 1� COqRCGT I1ND AOR¢e TO COM•
PLV WITX �LL CITY OpDINANCtl 11N0 fTATi I.AWY RtOYL11TIH0
BUILDINO CON9TRUCiION.
61GNATURH OP
PERMITTE
AUTHORIZQD AO[ / .✓i+
� v
JAN —7-69va��00 165- 12R.C�
cnr.ti ^ �,tt,
APPLICATION FOR PERMR
BUILDIN(i
Por Ofiice Use Only
11{C[IIT XO. PeRMIT NO.
ZONING
NO. O� YY{ OI HtW
�LAN� .� sU�LDINO
YAROH MPROVED
MAIN BUILDINO
BNALL B8 LE88 TNAN
YARO8APPFOVfiD
ACGES80RY BUILDIN6
DATB
/1/ � • � I 0.
lN p�
�
� D� o. -y9� � �
0
TX6 IIMOUNT • WN UNOHR VALUATION 19 POp TXB
■UflP008 OP [BTABLI8HIN6 I� P6qMIT P8B ONLY.
VALUATION ��r6 �
PERMIT FE6 J p
�7S�d' y , 7 w
TOTALFEE $ /���'S