HomeMy WebLinkAbout1589 SAN BERNARDINO PL - Building Permits 01/G CITY OF COSTA MESA
, @ BUILDING DIVISION
F ,I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.
). 11P41i FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER. B07-00934
PERMIT TYPE B_ROOF2 STATUS: ISSUED
DATE ISSUED: 09/18/2007
• ;r :: ISSUED BY: RMD
JOB ADDRESS: 1589 SAN BERNARDINO PL CM Suite/Uni
Vicinity: HOUSE AND GARAGE ROOF
Squares: 2000 Valuation $4,000.00
SCOPE OF WORK: TEAR OFF'(E)ROOF ivitERIALS, INSTALL 1 LAYER OF 30#FELT ON A"412 PITCHED'ROOF AND REROOF
WITH 40 YEAR ELK COMP SHINGLES(ICBG#IESR-1475)ON A DUPLEX WITH ATTACHED GARAGE,"APPROX 20
SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED.
OWNER: BARRY SAYWITZ PROPERTIES 1 LP :Address:,t. 1589 SAN BERNARDINO PL. r - Unit:
PHONE: 949-930-7500 ,-City/State/Zip: COSTA MESA,CA
APPLICANT: LA RUE, CHERYL t • Address: 113 SOUTH MINNIE.ST Unit :
PHONE: 714-731-3425 - - City/State/Zip: SANTA ANA,CA - -
CONTRACTOR: WEATHERLINE'ROOFING INC_ " - • • License No. -729560
Address: 113 S MINNIE.STUnit: - PHONE: • 714-731-3425
City/State/Zip: SANTA ANA,CA :92701 . _ CELL:
ARCHITECT: License No. - ' =' PHONE
ENGINEER: License No. . .
FEE SUMMARY • 11 3
Reroof Plan Check: $0 001
-
•
Reroof Permit Fee: $97 25
Reinspection Fee: $000 •
w >7 ';? .,
TOTAL FEES $97.25
1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final q 208 Final Plumbing
200 Final Re-Roof ?_2,V 17 7 / 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
• ,
WOR ERS'COMPENSATION DECLARATI . " • " Owner ID verified by -nse. ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: -:Drivers License No. Expifes:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
,�,�l I have and will maintain workers'compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ hereby certify that no excavation flue(5)or more feet in depth into which a
number are: 1 person is required to descend,will be made in connection with work authorized
Farrier. 1-(,l p Fit ntby this permit,and that no building structure,scaffolding,falsework,or demolition
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not becompleted if the perna is valued at one hundred dollars(3100)orless.)
2,Art 2,Sec.341.Title B,Califomia Administrative Code).
Policy,Number: p? 8 5- a L./q3
` _i ❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code,I shall fort with ply with these provisiggqns. 1 Applicant's Signature Date
CPU)
r q 11 110---1 Division of Industrial Safety Permit Number:
dl AJ1r6�VIitYalnn s ignalure _///�Cte HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
Lic:#---- •n f to- Class#" i - 1' (Section 25533 of the California Health and Safety Code, with some
t 1 ) exceptions, requires registration with the Costa Mesa Fire Department by
_ J��./1� . each business which at any one time has on hand a quantity of acutely
CL on rector's Signature moat hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons. or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
- Signature Date 4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the )
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professlons:Code:The Contractors subject of this application. have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own'
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within.one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty Of perjury the
did not build or improve for purpose of sale.).- information given above is correct. I agree.to comply with all'state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions:
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and ,
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
O I am exempt under sec. • the information given is-correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa.Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection. '
n Signature of I er ) Dat
Signature Date Cie
, rt_ 61/1g107
D,
357.4 (3107) \ ,Anwo 0 thou¢tl Applicant
cm
tiS R ESR-1475
■ ■EPORTTM Reissued December 1, 2006
This report is subject to re-examination in two years.
ICC Evaluation Service, Inc. Business/Regional Office•5360 Workman Mal Road,Whittier,California 90601 •(562)699-0543
Regional Office•900 Montclair Road,Suite A,Birmingham,Alabama 35213 •(205)599-9800
www.icc-es.org Regional Office•4051 West FlossmoorRoad,Country Club Hills,Illinois 60478•(708)799-2305
DIVISION:07—THERMAL AND MOISTURE PROTECTION side or the underside.See Table 2 of this report for adhesive
Section:07310—Shingles location.
The SBS High Profile Hip and Ridge shingles consist of a
REPORT HOLDER: fiberglass mat coated with SBS rubber-modified asphalt
material and with embedded granules over the mat on the
ELK PREMIUM BUILDING PRODUCTS,INC. weather-exposed side of the sheet and sand surfacing on the
14911 QUORUM DRIVE,SUITE 600 unexposed side. See Table 1 of this report for product
DALLAS,TEXAS 75254 manufacturing locations and the respective recognized
(972)851-0400 products.
www.elkcorp.com
3.2 Prestique I Shingles:
EVALUATION SUBJECT: Prestique I shingles are 131/4 inches(336 mm)wide by 393/,
inches(1000 mm)long,with an exposure of 55/,inches(143
ELK PRESTIQUE, CAPSTONE, DOMAIN ASHFORD AND mm).The mineral surfacing is on the weather side,with fine
SBS HIGH PROFILE HIP AND RIDGE SHINGLE ROOFING mineral granules on the back side. Prestique I shingles are
SYSTEMS also labeled as Prestique Cool Color.
1.0 EVALUATION SCOPE 3.3 Prestique Shingles:
Prestique shingles are 131/4 inches (336 mm)wide by 383/,
Compliance with the following codes: inches(984 mm)long, with an exposure of 55/,inches (143
• 2003 International Building Code®(IBC) mm).The mineral surfacing is on the weather side,with fine
mineral granules on the back side. Prestique shingles are
• 2003 International Residential Code®(IRC) also labeled as Raised Profile and as Prestique Xtra, which
• 1997 Uniform Building Coders" (UBC) has a polypropylene film on the back side.
• 1999 Standard Building Code°(SBC) 3.4 Prestique Plus Shingles:
Properties evaluated: Prestique Plus shingles are 131/, inches (336 mm)wide by
393/,inches(1000 mm)long,with an exposure of 55/,inches
• Weather resistance (143 mm).The mineral surfacing is on both the weather and
• Fire classification the back sides of the shingle. Prestique Plus shingles are
also labeled as Prestique Gallery shingles.
• Wind resistance
2.0 USES 15 Capstone Shingles:
Capstone shingles are 12'/, inches (308 mm)wide by 391/2
The Elk Prestique, Capstone and Domain Ashford products inches (1003 mm) long, with an exposure of 5 inches (127
described in this report are laminated, asphalt-shingle mm).The mineral surfacing is on the weather side,with fine
roof-covering materials complying with ASTM D 3462 and are mineral granules on the back side.
Class A roof coverings when installed as described in this
report. 3.6 Domain Ashford Shingles:
The Elk SBS High Profile Hip and Ridge shingles described Domain Ashford shingles are 15'/,,inches(395 mm)wide by
in this report are styrene-butadiene-styrene (SBS) rubber- 401/3 inches(1029 mm)long,with an exposure of 47/1,inches
modified asphalt, glass fiber-mat roof-covering materials (113 mm).The mineral surfacing is on the weather side,with
complying with ASTM D 3462, used as a hip, ridge, or rake fine mineral granules on the back side.
capping when applied in a steep-slope application,and have 3.7 Hip and Ridge Shingles:
a Class A classification when installed as described in this
report. 3.7.1 Elk r Ridge: The shingles are supplied in
3.0 DESCRIPTION 131/4-inch-wide-by-3934-inch-long (337 mm by 1000 mm)
strips that are scored for separation into four hip or ridge
3.1 General: shingles, each measuring 131/4 inches (337 mm) wide by
The Elk Prestique, Capstone and Domain Ashford shingles 931/33 inches (250 mm) long, for installation with a 55/a inch
are composed of a single layer of glass felt,impregnated and (143 mm)exposure.
coated with asphalt on both sides and surfaced with mineral 3.7.2 Elk Seal-A-Ridge: The shingles are supplied in
granules on the weather side.The shingles are self-sealing 12-inch-wide-by-36 inch-long(305 by 914 mm)strips that are
by means of dots of adhesive located on either the weather scored for separation into three hip and ridge shingles,each
REPORTS" are not to be construed as representing aesthetics or any other attributes not specifically addressed nor arc they to be consTrued as an
endorsement of the subject of the report or a recommendation for its use.There is no warranty by ICC Evaluation Service,Inc.,erpress or implied,as to any ANSI
finding or other matter in this report,or as to any product covered by the report. ANSI
amv-.•.ar,s..
copyright er 2006 Page 1 of 6
Page 2 of 6 ESR-1475
measuring 12 inches wide by 12 inches long (305 by 305 UBC in severe climate areas on roof slopes of 4:12(33.33%)
mm), with a 62/3-inch (169 mm)exposure. Seal-A-Ridge hip and over,one layer of 50-pound-per-square-foot(2.4 kg/m3)
and ridge are also labeled as Seal-A-Ridge Xtra. Seal-A- or greater coated roll roofing or coated-glass base must be
Ridge Xtra has a 5-inch(127)mm exposure. applied from the eaves to a line 24 inches(610 mm)inside
3.7.3 SBS High Profile Hip and Ridge: The shingles are the exterior wall line,with all laps cemented together.
supplied in 8-,10-and 12-inch(203,254 and 305 mm)widths 4.1.2 Fastening:
and 16'12-inch(419 mm)lengths for installation with a 73/4-inch
(197 mm)exposure. 4.1.2.1 Standard Fastening: Each shingle must be
fastened to the roof deck with a minimum of four fasteners,
3.8 Starter Shingles: one of which is located 1 inch(25.4 mm)in from each edge,
Starter Strip shingles are factory-made shingles used under and the balance evenly spaced across the width of the
the first course of shingles being used on the roof. shingle, except for roof slopes of 20:12 (167%) and over,
where six fasteners must be used.Fasteners must be placed
3.8.1 Elk Starter Strip: The shingles are supplied in on the fastener line(s). See Figure 1 of this report for typical
13-inch-by-38-inch-long (330 by 965 mm) strips that are fastening details.Each course of shingles must be offset from
scored for separation into two 6'/2-inch-by-38-inch(165 mm the preceding course as shown in the manufacturer's
by 965 mm)strips. The mineral surfacing is on the weather published installation instructions.
side, with fine mineral granules on the back side. The
4.1.2.2 High Wind Fastening: A minimum of six No. 12
self-sealing strip edge is applied facing up and along the roof gage roofing nails,described in Section 3.9, must be placed
eave or rake edge. as shown in Figure 1, when required under the following
3.8.2 Grande Starter: The shingles are supplied in conditions:
13-inch-by-38-inch-long(330 by 965 mm)strips.The mineral 4.1.2.2.1 IBC: When the roof is installed in applications
surfacing is on the weather side,with fine mineral granules on where the basic wind speed(3-second gust)is 110 mph(177
the back side. km/h)or greater.
3.9 Fasteners: 4.1.2.2.2 IRC:When the roof is installed in areas where the
Fasteners must comply with ASTM F 1667 and must be basic wind speed is 110 mph(3-second gust)(177 km/h)or
minimum No. 12 gage [0.105 inch (2.7 mm)], greater, as defined in IRC Figure R301.2(4).
3/;inch-diameter-head(9.5 mm),galvanized,stainless steel, 4.1.2.2.3 SBC: When the roof is installed in applications
aluminum or copper roofing nails. For systems recognized where the basic wind speed (fastest mile) is 90 mph (145
under the UBC,minimum No.16 gage,15/,,-inch-crown-width km/h)or greater.
(23.8 mm), corrosion-resistant staples may be used when
approved by the code official.Fasteners must be of sufficient 4.1.2.2.4 UBC: In areas exposed to conditions where the
length to penetrate into the sheathing 3/, inch(19.1 mm), or basic(fastest mile)wind speed exceeds 80 mph(129 km/h),
through the sheathing,whichever is less. on structures a maximum of 40 feet(12 192 mm)in height,in
3.10 Underlayment: Exposure B areas; but where the maximum basic (fastest
mile)wind speed is not greater than 110 mph(177 km/h),on
For jurisdictions adopting the IBC,IRC or SBC,underlayment structures a maximum of 30 feet (9144 mm) in height, in
must comply with ASTM D 226, Type I, or ASTM D 4869, Exposure B areas.See UBC Section 1620.
Type I. For jurisdictions adopting the UBC, underlayment 4.1.2.3 Shingle Sealing:In colder climates or wind regions
must comply with ASTM D 226 Type I or Type II, ASTM D
4869 Type I or Type II, alternatively, underlayment must be where it is questionable whether the dots of adhesive will
recognized in a current ICC-ES evaluation report as activate and seal the shingles, the shingles must be
complying with the ICC-ES Acceptance Criteria for hand-sealed to the satisfaction of the code official.
Nonasphaltic Fiberglass-based Roof Underlayment(AC160) Hand-sealing consists of applying a minimum of three
and recognized for use with Class A asphalt shingles. 1-inch-diameter(25.4 mm)spots of asphalt cement complying
with ASTM D 4586, Type I or Type II, on the unexposed
3.11 Asphalt Cement: surface,equally spaced across each shingle.
Asphalt cement must comply with ASTM D 4586, Type I or 4.1.2.4 Hip and Ridge Shingles: Hip and ridge shingles
Type II. must be placed evenly over hips and ridges, and must be
4.0 INSTALLATION fastened to the roof deck with two fasteners,located on either
side of the shingle,on the nail line.See Figure 1.When used
4.1 New Construction: in areas requiring high-wind fastening in accordance with
Section 4.1.2.2 of this report,SBS High Profile Hip and Ridge
4.1.1 General: When installed on new construction in shingles must be fastened with four fasteners,and threeV,-
accordance with this section,the shingles are a Class A roof inch-diameter spots of asphalt cement complying with ASTM
covering. The shingles must be installed in accordance with D 4586,Type I or II,on the unexposed surface on both sides
Section 1507.2 of the IBC,Section R905.2 of the IRC,Section of the shingle). Staples must not be used to install the SBS
1507.3 of the SBC, or Table 15-B-1 of the UBC, except as High Profile Hip and Ridge shingles.
noted in this report.The roof deck must be code-complying,
minimum 3/;inch-thick (9.5 mm) exterior plywood; 4.1.3 Valley Construction:Acceptable valley construction
7/1,-inch-thick (11.1 mm) oriented strand board (OSB); or for closed-cut,California closed-cut,or woven valleys requires
nominal 1-inch-by-6-inch(25 by 152 mm)lumber installed as that a 36-inch-wide(914 mm),50-pound-per-square-foot(2.4
solid sheathing. Underlayment must be as described in the kg/m2)or greater,coated roll roofing,complying with ASTM D
aforementioned code sections,except that in areas where the 224, be installed vertically in the valley over required
average daily temperature in January is 25°F(-4°C)or less, underlayment. For open valleys and the California open
or where there is a possibility of ice forming along the eaves, valley,corrosion-resistant metal must be centered and placed
an ice barrier membrane in accordance with IBC Section vertically in the valley over the coated roll roofing. The
1507.2.8.2, IRC Section R905.2.7.1 or SBC Section California valley methods are limited to slopes of 4:12 or
1507.3.8.3 must be provided. In jurisdictions enforcing the greater and are further described in Figure 1.
Page 3 of 6 ESR-1475
Metal valley flashing must be as follows: suitable alternatives to what is specified in,those codes listed
• IBC:A minimum of 18 inches(457 mm)wide,complying in Section 1.0 of this report, subject to the following
conditions:
with Table 1507.2.9.2.
• IRC:A minimum of 24 inches(610 mm)wide,complying 5.1 The shingles must be manufactured, identified, and
with Table R905.2.8.2. installed in accordance with the applicable codes, this
report, and the manufacturer's published installation
• SBC:A minimum of 18 inches(457 mm)wide,complying instructions.In the event of a conflict between this report
with Table 1507.3.9.2. and the manufacturer's published installation
• UBC:A minimum of 18 inches(457 mm)wide,complying instructions,this report governs.
with Section 1508.2. 5.2 Fastening must be in accordance with Section 4.1.2 of
Fasteners must not be placed within 6 inches(152 mm)of this report.Staples must not be used to install the SBS
High Profile Hip and Ridge shingles.
the valley centerline.
4.2 Installation—Reroofing: 5.3 The products are manufactured in Shafter, California;
Ennis, Texas; Fresno, California; and Tuscaloosa,
When installed over existing wood shingle or Class A or Class Alabama, under a quality control program with
C asphalt shingle roofs in accordance with this section, the inspections by Underwriters Laboratories Inc.(AA-668).
Prestique and Capstone shingle products are recognized as 6.0 EVIDENCE SUBMITTED
Class A roof coverings.The existing wood or asphalt shingle
roof covering must be inspected in accordance with the 6.1 Data in accordance with ASTM D 3462.
provisions and limitations of Section 1510 of the IBC,Section
R907 of the IRC,Section 1510 of the SBC,or Sections 1515 6.2 Reports of dynamic wind resistance testing in
and 1516 of Appendix Chapter 15 of the UBC,as applicable. accordance with ASTM D 3161, modified to 110 mph
Prior to the reroofing, hip and ridge covering must be (177 km/h).
removed, and a single layer of Type II (Type 30), 6.3 Quality control manuals.
nonperforated felt underlayment must be installed over the
existing wood shingles. Except as noted in this section, the 6.4 Reports of testing in accordance with ASTM E 108
shingles must be installed in accordance with Section 4.1 of (UBC Standard 15-2).
this report.Fasteners must be of sufficient length to penetrate
7.0 IDENTIFICATION
3/, inch (19.1 mm) into the sheathing, or through the
sheathing, whichever is less. Flashing and edging must Each bundle of shingles must bear a label with the name and
comply with Section 4.1.3 of this report and the following: address of the Elk Premium Building Products, Inc.
• IBC:Sections 1510.5 and 1510.6. manufacturing plant; the product name; the Class A roof
classification; the installation instructions; the evaluation
• IRC:Sections R907.5 and R907.6. report number(ESR-1475); and the name of the inspection
• SBC:Sections 1510 and 1510.6. agency(Underwriters Laboratories Inc.).
• UBC:Section 1520 of Appendix Chapter 15. Additionally,in accordance with ASTM D 3462,each bundle
of shingles must be marked with ASTM D 3462, the brand
5.0 CONDITIONS OF USE name, the manufacturer's name, the area of roof surface
The Elk Prestique, Capstone and Domain Ashford Shingle covered and the style,type and color of the product.
Roofing Systems described in this report comply with,or are
Page 4 of 6 ESR-1475
TABLE 1—PRODUCT MANUFACTURING LOCATIONS
PLANT LOCATION/ ENNIS, FRESNO, SHAFTER, TUSCALOOSA,
PRODUCT TEXAS CALIFORNIA CALIFORNIA ALABAMA'
Prestique I Recognized — Recognized Recognized
Prestique Cool Color — — Recognized —
Prestique Recognized — Recognized Recognized
Raised Profile Recognized — Recognized Recognized
Prestique Xtra — — — Recognized
Prestique Plus Recognized — Recognized Recognized
Prestique Gallery Recognized — Recognized Recognized
Capstone — — — Recognized
Z-Ridge Recognized — Recognized —
Domain Ashford — — Recognized —
Seal-A-Ridge — — — Recognized
Seal-A-Ridge Xtra — — — Recognized
Elk Starter Strip — — — Recognized
Grande Starter — — — Recognized
SBS High Profile Hip and Ridge — Recognized — —
Note:
'Products manufactured at the Tuscaloosa,Alabama,facility may also be manufactured with modified asphalt and carry the designation"with FLX."
TABLE 2—STICK-DOWN DOT SIZES AND LOCATIONS'
PLANT DOT SIZES
Prestique,Prestique I and Domain Ashford Capstone
Prestique Plus2
3/8 inch wide by 3'/2 inches long,
Ennis,Texas spaced 1 inch apart and located 7/, — —
inch above the shingle butt
3l8 inch wide by 31l2 inches long, Two strips-3/,inch wide by 3 inches
Shaker,California spaced 1 inch apart and located 7/, long,spaced,and 2151„inches above the locatedch apart and —
inch above the shingle butt shingle butt
Tuscaloosa,Alabama 3/6 inch wide by 23/4 inches long, 34 inch wide by 23/4 inches long,
spaced 13/8 inches apart and located — spaced 13/4 inches apart and located
(Line 1) 61/4 inches above the shingle butt 51/2 inches above the shingle butt
Tuscaloosa,Alabama 3/e inch wide by 31/2 inches long,
(Line 2) spaced 1 inch apart and located 7/4 — —
inch above the shingle butt
For SI: 1 inch=25.4 mm.
Notes:
'Dots of adhesive are located on the underside of the shingles except at the Tuscaloosa,Alabama,facility(Line 1),where they are located on
the weather side.
2Prestique also labeled as Prestique Xtra and Raised Profile. Prestique I also labeled as Prestique Cool Color.Prestique Plus also labeled as
Prestique Gallery.
Page 5 of 6 ESR-1475
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ELK Z.RIDGE .`:'.:: , °i�`
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ip-
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Valley Flashing
Seal-a-Ridge
HIP AND RIDGE SHINGLES
I Fastener
7\-;— r --7.11B"
36'1914.4 mml wltle Mineral cr allg9N %.1214 4 1111P11111110101.11 Chalkllnet Papp
Poltra Soe.C12.m 4o1 ee9hen atuame Ica Cwlgro l.ndiIlnwv l;¢'olc lad(9%)
Med cl'oatm9ma (dwn ) end ascoodlayer 0150 la Rasa kg(
cv.mnan lenlan1'Mel 4wrg mer canl nine a hew.,sawn Coe ad ml roofing. Py 221111111112_ 1 4IIB9W,a1B 1n 1(a aims 0
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or throne .' I M nlmlwr
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Application of A Closed Application of An Open
"California" Valley "California" Valley
For SI: 1 inch=25.4 mm.
FIGURE 1—TYPICAL INSTALLATION DETAILS
Page 6 of 6 ESR-1475
Domain Ashford
STAsaAAo slur[(4ftile lanaue 121111
It•. 5 Fasteners p.1
Fana •rsa. .
Prestique and Capstone Shingle orntta —®
4 Fastener Pattern 8 Fosreos Pattern w/+ son 10-2/0
rc 1- lmaam� I I
r — Ili _ ) —7 r7 y 1 f -a.e SIMS gnaw landau 21p2 el MAS WWpWAAMr1 — TM SNPoGE
WI1 ' lameErpva r'
a-Nails/Lower 3 applied under obs)
SBS High Profile Hip&Ridge Installation
1.NAILING: Nails must be corrosion resistant with heads a , FULL
minimum of 3/8'(9.5 mm)in diameter.All fasteners must
- ndeua.d SHINGLE
penetrate at least 3/1"(19.1 mm)into the wood deck or \�,w,Sealant
completely through plywood sheathing, -\3
2.STARTER SHINGLE INSTALLATION:To create a starter •' our a'---:y
shingle,cut off the 8'(0.20 m)exposed portion of a full hip (ata m)
and ridge shingle leaving the dimensional fold portion,which STARTER
will be approximately 8 114'(0.2 t rn)long.Starting at the /.1S SHINGLE
eaves for hips and opposite the prevailing wind for ridges, 1/ \
install starter shingle. Fasten through the dimensional fold 4 x '�^ -
with nne nail on each side of starter shingle. -- - -
Approx.9 lie a10.21 '\
\,._9 8'r ryas 8 mm).....
3. HIP AND RIDGE INSTALLATION: Beginning with a Exposure
complete hip and ridge shingle,cover starter shingle with
the.8'(0.20 m)exposed portion overlapping the front end of
the starter shingle by 1/4•(6.4 mm)and nail into place. .y h [Nail Pt95a mel
One nail should be applied on each side of hip and ridge _
shingle 9'(0.23 ml back from exposed end and t' (r as nni Ovntunti STARTER SHINGLE
(25.4 mm)in from each side.
To proceed,overlap the first hip and ridge shingle extending
1/4'(6.4 mm)past dimensional fold with complete hip and
ridge shingle,then nail shingle through dimensional fold.
Continue installation in same fashion obtaining a 7 3/4-
(196.8 mm)finished exposure.
7341195.8mmt_ ':'^
4' \'
[rpesurn
. \ V`.
•
•001°\va(samml a
nrot
COLD WEATHER
Wnen applying in cold climate(under 50°F/10°C),
unpack carton on the roof and allow the shingles to
warm before epplicantion.
FIGURE 1—TYPICAL INSTALLATION DETAILS(Continued)
i
CITY OF COSTA MESA •
/ ;9@@ BUILDING DIVISION
>• ; 1 $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4. j IIL� PERMIT
u4ro �{ 604-00309
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caa..us UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite: Applied: 02/05/2004
Vicinity: DUPLEX UNIT A AND B Issued: 03/04/2004
Parcel Number: 42532129 Zoning:
Applicant: ISSUED BY: der
Address:
Phone:
Zip:
Owner: BARRY SAYWITZ PROPERTIES 1 LP
Address 1589 SAN BERNARDINO PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: • License: 000000
•
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONVERT NON-CONFORMING EXISTING 4-UNIT PROPERTY TO RETURN TO LEGALIZED 2-UNIT PROPERTY.WORK TO INCLUDE:REMOVE
DOOR IN"UNT A"BETWEEN ENTRY WAY AND LIVING ROOM TO CREATE PERMANENT OPENING. GAS RANGES W/OVENS&ASSOC
POWER SUPPLYS REMOVED IN
NON-CONFORMING UNITS,AND TWO SINKS;ONE IN UNIT A AND ONE IN UNIT B.ALL PLUMBING TO BE CAPPED OFF FOR REMOVED
SINKS.
ONLY 2 UNITS ARE ALLOWED AT THIS SITE PER PLANNING.SEE LAND USE RESTRICTION DOCUMENT NUMBER 2004000112488.
THIS PERMIT DOES NOT INCLUDE LEGALIZATION OF GARAGE CONVERSION TO BEDROOM AND BATH.PLANS TO BE SUBMITTED LATER
FOR LEGALIZATION.
•
'FEE SUMMARY
Plan Check: $15.28 • .. Calc Valuation: $200.00
Permit: $23.50 -- • .Claim Valuation: $200.00
SMIP Res: $0.50 -
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $39.28
PLANNING &ZONING
•
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: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
.
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain worke m pan tion ins ra equired by section 3700 of the Labor Code,for the performance of the ork for which this permit is issued.
My workers'compens lion In ca ' p umber are: '/1 1y,//��
Carrier: Policy Number: (J
(Th'Nspsection need not be completed if the permit Is valued at one hundred dollars($100)or less.) - +
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree th If I should become subject to the workers'compensation provisions of S�lion 3700 of the Labor Code,I shall forthwith
comply with these pro sti
��j.,,J
Applicant Signature: - Date: y
WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE
� IES JD CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($t ,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si at e t Legal Owner(s) --- Date
And/Or Authorized Applicant Date
CODE 0 INSPECTION TYPE PAIF INTRIALS CODEC INSPECTION TYPE PATE INTRIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -.
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site /
204 Final Demolition • 250 Final Building/Occupancy 4/74105"
6114(1
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS This Permit#
•
Street Address: Sf 1 c�3tS � '4CJ S/.A� 91 . CM WAP Number:
•
1.O e), Gor'-A c.) V-4 , declare that I am the Owner of Title of the above
• referenced real property, and that I (we)hereby authorize: co_ y -'ri//9
•
Name: ���+ Portico • TelephoneC} C
( Number: `
Street Address: %-1 4 o U^r. (sv Y tsQ1/4n^+ IW N(S / `A 01,4 4 0
City: State: Zip:
•
to obtain permits in my behalf,as owner/builder,for / S Cr? S 6 Pica-k- - v:161.4,1
at
at the above referenced property. • e
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct. .
Executed this r!2— _ day of 20 , at N , California.
Print Name: 2 Slitkfritetd
Signature:
Date: e21, 21644
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attomey to secure this permit in any behalf.
0779-46(rev.l1/00)
JUN-16-2005 THU 10:50 AM The Sayuite Company ; FAX Na 9499307555 P. 02 y
• 7r4 75Q->'-'
OF COSTA MESA,BUILDING SAFETY DIVIS, 7iad 81:54.
POST IN CONSPICUOUS PLACE ON THE JOB
NOTICE
Schedule inspection one workday in advance.To schedule inspections,call(714)754-6626.Provide the following information:
1)Permit number,2)Job address,3)Inspection���"" item number,4)Day and date you need the inspection. y
BOON.Address: �i a '11/1. p i 4 A/. emner. S 11.L e!_,... i I .',41
BWIdbg Permit 0 ‘03SC Elenhkal Pent M AL(, _ Contractor. MEI 1
Mechanical Permit t: i Plumbing Penmtt' V DO(SQ Job Descdpdon I , (j� �+ f t
Type: GraiP ' r, -....-5 N� l-/-(�lX
•
`f ° p(Ir ,
Plan Check No. Issue Data',
I
NEW ADD , Ali R WAND ma` (-
PERM 7S EXI 180 DAYS(8 MONTHS)FROM ISSUEJDR LAST INSPECTION
CO•STRUCTION APPROVALS;
Item STRUCTURAL _ Data Ina puma Itema POOL&SPA Dare inspect=
4 Feelings I 94 Pool 8 Equipment Location
6 Slab , 96 Steel Reinforcement i
8 Structural Floor 7 100 Electrical Banding
11 Pre-Inspect Roof I 102 Rough Plumb&Pressure Test
12 Roof Sheathing 104 Approval to Cover-GJJnite
14 T-Bar Ceiling-Structural 106 Elec Conduit-Underground
16 Shear Panel 108 Gas Pine/Underground Test I
18 Frame&Flashing da, Axa2. o-.W 44,„AK 110 Backwash Lines,P-Trap, I
20 Lathing&Siding Underground
l
22 I Insulation r 112 Approval 6o Deck I
24 Drywall Nailing 116 Pool Plumbing System'-.Final
—
26 Plaster Broom Coat _ • 116 Pool Electrical-Final ' _ _
30 Pre-Grdut 122 Fencing/Access/Alarms Approval
33 Disabled Access 124 Approval for Plastering
, , 126 Pool/Spa Systems-Final
II FIRE DEPARTMENT APPROVAL
1610 Overall Hydro/Overhd Rough. )
1612 Dry Chemical
1614 Dry Standpipe
. 1616 Final-Fixed System
ELECTRICAL ,
36 Ufer Ground - � FINAL INSPECTIONS
38 Elec Conduit-Underground (Must be completed prior.to requesting occu nancy.)
_ 44 Rough Elec-Wring Call(714)754-5626 for the following: Dam Inspector
46 Rough Elec.Conduit - 200 Final Re-Roof
48 Elec T-Bar Ceiling _ 201 Final BlockWRetaining Wall
•50 Elea Power Final 203 Final Sign
• 51 Temp Power Final 204 Final OedlDlitlon
206 Final Mechanical
• 208 Final Plumbing I 15-31-o`i aro
_ 210 Final Electrical
PLUMBING&MECHANICAL Call(714)327-7400 for the following: Data IEngineernspector,
52 Soil Pipe-Underground , 212 Final Fire Prevention
54 Water Pipe-Underground Call(714)754-5671 two(2)Working days
55 Underground Gas A
dor to final, j r
62 Rough Plumbing 216 Final Public Svs,Degt.Approval
64 Rough Mechanical Call(714)75453117 for the following: Date
Dato Inspector
L 66 Rough=Factory Fireplace 218 Fine!CMSD Approval
68 Sewer System • Call(7141 754-5245 for the following: Pate Inspector
_ 72 Gas Pipe-Rough Test 220 Final Panning Approval
90 Gas Pipe Test•Final Call(714)754-5626 for the following: Data Inspector
r-
92 Water Service•Final ' 222 FInar Site
250 Final Building/Occupancy q3-d1 04,-m
If NOTES: SEE REVERSE •
JUN-16-2005 THU 1050 AM The Saywitz Company FAX! NO, 0499307555 la. 01 '
I
•
. Ili : ..;• 1
THE SAYWTTZ COMPANY :
4740 VON ARMAN AVENUE,SUITE 100,NEWPORT BEACH,
KCA 92660
PH (949)930-7500 FX (949)9304555 ' i
FACSIMILE TRANSMITTAL COVER SHEET
,
•
�
Date: fP -/G -0 5 ' ,
TO: 249> JAvr:"- (4I D , /&// 2
FAX NUMBER: /e- 72 -- `7 s"4 -, 4s s-& •
1 ;
PHONE NUMBER:
Q I
4/U
RE: fLfiNf/!i 4a-- Aidhe<-
C MENTS:
: LO '
r / eihtc/ et : /5139, i .
1
•
•
SENDER: PCtit/C7 #of PAGES
i (including cover sheet)
1
IF THERE ARE ANY PROBLEMS WITH THE MATERIAL RECEIVED,
PLEASE CONTACT THE SENDER AT:i
PHONE NUMBER(949) 930-7500 OR 1
FAX NUMBER(949) 930-7555 '
i
This message Is intended only for the use of the individual or entity to which It is addressed,and may contain information that is
privileged,confidential and exempt from disclosure under applicable law. if the,reader of this message is not the Intended recipient,
or the employee or agent responsible for delivering the message to the Intended recipient,you are hereby notified that any dissemination,
distribution or copying of this communication is strictly prohibited. if you have'redelved this communication in error,please notify us
immediately by telephone,and return the original message to us at the above address via the UNITED STATES Postal service. Thank
you.
II
I i.
44.
o5ll M s CITY OF COSTA MESA
a.
BUILDING DIVISION
. • r�,'? 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 IMO i PERMIT
%bep°ai0#4 PO4-00471
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
•
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/07/2004
Issued: 07/07/2004
Vicinity:
ISSUED BY:
Parcel Nunmber: 42532129
Applicant: JOE PONCINO
Address: 4740 VON KARMEN AV- '. •
- . . - Phone: 949-254-5819 -.
NEWPORT BEACH;CA Zip: 92660
-
Owner: BARRY SAYWITZ PROPERTIES 1 LP //
Address v' 1589 SAN BERNARDINO PL - ,
• - - Phone: ' '
' ' COSTA MESA,CA Zip: 92627 - '
Contractor: OWNER-BUILDER - -
Address: - - -
Phone: - - ,
- Zip: .
- - License: 000000 - -
Arch / Eng: - - . . f
' Address: -
- Phone: - • "
•
- - - Zip:- _
---- - -- , - _- License: _
,
SCOPE OF PERMIT
LEGALIZE CONVERSION OF EXISTING GARAGE TO MASTER BEDROOM WITH BATH&SITTING AREA ,
((LIVING ROOM ANNEX)-232 SQ.FT.REF.:604-00561 -
PLUMBING TO INCLUDE: 1 BATHTUB,) SHOWER, 1 WASH BASIN,AND 1 WATER CLOSET.
-
' - `
Vii;
FEE SUMMARY '
AMT QTY, AMT QTY ' - / AMT QTY
ISSUE FEE $23.50 .Laundry Tub/Washer $0.00 0 - Sump Pump' - $0.00 0
Backflow irrigation'V' ` $0.00 / 0 - =Landscape"Irrigation _ N $0.00 - 0 - " ,Swimming Pool /' $0.00 0
Backflow Preventer $0.00 0 P-Trap ` - _ $000 -,-.0 - Trap Primer ; ",' $0.00 0
Bathtub N. '$9.80' _'1 Pressure Regulator $0.00 0 . `. Urinal '• i $0.00 0
Clarifier System `$0.00 0 Process Piping(per 10 ft) ,,$0.00 '.0 . VacuumBrkr-Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 - 0 Receptors - ' $0.00 • 0 ' Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1
Dishwasher $0.00 0 Sewer Cap for Demo. 40.00 0 , ._...Wash Basin Set $0.00 0
Drain, Floor $0.00 0 _ Sewer Connect .$0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line - , :$0.00 0 Water Closet(Toilet) $9.80 1 /
Drain, Roof $0.00 0 Shower - $9:80 1 Water Heater/vent $0.00 0
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: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS ( ) - j
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
. work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed i/the permit Is valued at one hundred dollars($100)or less.)
p certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomla,and agree th I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provis' s.
Applicant Signature: Date: �fl
WARNING:FAILURE TO SEC E WORK RS'COMPENSATION COVERAGE IS UNLAWFt1L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si atur Legal Owner(s) Date
7--)�(
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE Mg INf1TIALs CODEr INSPECTIONTYPE PATE INTIIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical • � I
1266 Pool Spa Final 208 Final Plumbing RI311O`�//Y R V
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
BUILDING DIVISION
Y %r; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 L.4‘.!.
-nil
IIPPIra PERMIT
+h do PO4-00156
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 03/04/2004
Issued: 03/04/2004
Vicinity:
Parcel Nunmber: 42532129 ISSUED BY:
Applicant: PONCINO, JOE
Address: 4740 VON(CARMAN AV
Phone: 949-254-5819
NEWPORT BEACH,CA Zip: 92660
Owner: ,BARRY SAYWITZ PROPERTIES 1 LP
Address 1589 SAN BERNARDINO PL
Phone:
. COSTA MESA,CA Zip: 92627
Contractor:
•
Address:
Phone:
Zip:
License:
Arch / Eng : - - •
Address: -
Phone:
• Zip:
- - - - - - License:
SCOPE OF PERMIT •
CAP OFF TWO SINKS.REF: B04-00309.
FEE'SUMMARY,
AMT QTY ' AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer - $0.00 0- - Sump Pump $0.00 0
Backflow irrigation - $0.00 0 - Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 ' . P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0'- - Pressure Regulator $0.00 0 Urinal " " - $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc), .$0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 - Wash Basin $19.60 2
Dishwasher $0.00 0 - Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 _ • Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar - $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned
for a period of 180 days. . .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS f (�
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the wo for which this permit is issued.
My workers'compensation Insurance ca vier and policy number are:
Carder: C Policy Number:
(This se ' n need ndT- m a ed I N permit is valued at one hundred dollars($100)or less.
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califon :,and agree that If ould become subject to the workers'compensation provisions of Se ion 37p0 oLabor Code,I shall forthwith
comply with these proviss
Applicant Signature: - Date:
WARNING:FAILURE TO SECUR' ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A D CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLI.ARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class If
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutelyhazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aEEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si.;aure n al Owner(s) atDate rie
vi
41 oq
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE BETE INII➢BLS COOP I INSPECTION TYPE PATE INT71AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical /
1266 Pool Spa Final 208 Final Plumbing -. g,.3 11°4
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition ,
- 250 Final Building/Occupancy _ _
4`OW Its 9 CITY OF COSTA MESA
• BUILDING DIVISION
F • •.,•,--,•F.' al DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM ER
t 1 PERMIT
o4.: 04°
_ M04-00367
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/07/2004
Issued: 07/07/2004
Vicinity:
Parcel Number: 42532129 ISSUED BY:•___212L.±
Applicant: JOE PONCINO
Address: 4740 VON KARMEN AV
Phone: 949-254-5819
NEWPORT BEACH,CA . ' Zip: 92660 ' . -
Owner . BARRY SAYWITZ-PROPERTIES 1 LP " .
Address: 1589 SAN BERNARDINO PL `N
Phone: N
COSTA MESA;CA Zip: 92627
Contractor OWNER-BUILDER
Address: - . -
'-Phone: -
Zip:
•
- - - License:000000 - 'ice _
SCOPE OF PERMIT '
LEGALIZE CONVERSION OF EXISTING GARAGE TO MASTER BEDROOM WITH BATH 8 SITTING "
AREA(LIVING ROOM-ANNEX)-232 SQ.FT-REF.:.B04-00561 • -. -
-. , - • '
MECHANICAL TO INCLUDE: 1 INST FAU<100K BTU. "
•
- -FEE SUMMARY
' - Quantity - -_. .-- - - _ ' - Quantity i
ISSUE FEE - $23.50 " ' Repair/Alt Absorbtion Unit -$0.00 0
Inst FAU<100 k-BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 :0
Inst FAU>100 k BTU $0.00 0 Ventillation System
Repair:/Alt Cooling/Heat', . $0.00 0 Evaporative'Cooler /-- $0.00 0
Inst/Rep.,Recess Wall Htr-. $0.00 0 _ Commercial Incinerator ; ; $0.00. 0, ' •
Refrig'Sys,<100 k BTU ' ' $0.00 0 • =Domestic Incinerator
Refrig Sys>100 k BTU - $0.00 0 -"`' Compressors/Absorption Systems -', - r
Gas Piping . ' $0.00 0 Up to 3 hp/100 k BTU -,/ $0.00 0
Factory Fireplace , $0.00_._-0 . - ' - 3 To 15 hp/500 k BTU-'r 1 - $0.90 0
Hood w/Mech Exhaust $0.00 0 - 15 To 30 hp/1,000 k BTU'. '° ' . $0.00 . 0
VAV Box „ $0.00V 0 . .30 To 50 hp/1,750 k BTU/;„/ /2 ,$0.00 0
Vent Fan/Single Duct - - $0 00 ,0 , Over 50 hp/Over 1;750 BTU . - ' $0.00 0
Appliance \ -
Fire Dampers
Smoke Dampers .;, $0.00�_ 0 - - _ -3 To.15 hp` ,-/ 'c../ $0.00 0
Inst or Relocate Appl Vent'- $0.00 /0 - _ 15 to 30 hp.• , /- $0.00 0
Air Handlers< 10000cfm - $0.00 0 j . - • .' 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp , $0.00 0
Floor Furnace $0.00 0. Other Mechanical Fee ,
Floor or Suspend Heater $0.00 -_ '0 - Investigation Fee'" $0.00
_ „Plan Check Fee ' $0.00
Reinspection Fee $0.00
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6100)
DECLARATIONS \
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
n l certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agre t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro "ons. -7
Applicant Signature: -7-7 -o
/ -7-o 4
WARNING:FAILURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOL ARE($1W,OW),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.if Class if
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant far a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec.
341,Title 8,Califomla Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air quality Management District or from any other air pollution control district or agency? U Yes D No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air Tpollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatur Of Le wner(5) Date
An Or Authorized Applicant Date
CODE I INSPECTION TYPE DAM INTITIAL$ CODE I INSPECTION TYPE WIZ �ur-
1616 Fixed System Final Fire Prevention 206 Final Mechanical R-31 -O9 r
1268 Pool Spa Final 208 Final Plumbing •
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
fl` r0 CITY OF COSTA MESA
• BUILDING DIVISION ,
F ,I DEVELOPMENT SERVICES DEPARTMENT PERMITNUMBER
4. r PERMIT •
SIZIetherread. BO -00561
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite: Applied: 03/18/2004
Vicinity: PART OF UNIT A Issued: 07/07/2004
Parcel Number: 42532129 Zoning:
fc_ 04.--.7
Applicant: PONCINO, JOE ISSUED BY: /
Address: "
Phone: 949 254-5819
- Zip:
Owner BARRY SAYWITZ PROPERTIES 1 LP '
Address 1589 SAN BERNARDINO PL - .
Phone: -
•
- COSTA MESA,CA . . - Zip: 92627 . .
Contractor: ' OWNER-BUILDER , .
'Address: -
. Phone:
Zip: ' License: 000000 .
Arch : _ Eng: . , - '••
Address: - '� . Address: ,
- Phone: - Phone: -
Zip: ,- License: N License:
SCOPE OF PERMIT _
LEGALIZE CONVERSION OF EXISTING GARAGE TO MASTER BEDROOM WITl1 BATH&SITTING AREA(LIVING ROOM ANNEX)-232 SQ.FT.
FEE SUMMARY
Plan Check: $172.41 - Calc Valuation: $15,799.00
Permit: $265.25 — - ; Claim Valuation: $2,500.00
SMIP Res: $1.58 • . .
'SMIP Com: , • $0.00 .
Other: $0.00
�Inspectiom . $0.00
/
,'Total: $439.24 .
PLANNING &-ZONING
SETBACKS
MAIN STRUCTURE Front 0-0- Rear'.-.0-0 Left' 0-0 //
� „\
2.
ACCESSORY Front' 0-0 Rear 0-0 - - Left- 0=0 _ Right '0=0 -/-i
PARKING Existing: 4" Required: 6 . 'Proposed: ` 6, "
NOTES:
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS ( )
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
'(This sect/on need not be completed If the permit Is valued at one hundred dollars($100)or less.)
(T
Ip I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,andree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr. ons.
.I /!
Applicant Signature: 'LA .„i` Date: 7- 7-0
WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this!pence—lion apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ignaturegal Owner(s) D
^� 7- 7-0
And/Or Authorized Applicant Date
ODE INSPECTION TYPE DAA INRTIALS CODEr INSPECTION TYPE 037E INRTIALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy qiSLOy
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS This Permit#
Street Address:( 7S—g4 E�'Y�C'"a AP Number:
7s
1. I (we), ` Any Sla i'W-f4t , declare that I am the Owner of Title of the above
referenced real property,and that I (we)hereby authorize:
Name: 3i5erA4 Tem.C,1 Telephone Number: lig Si-SW/ 7
Street Address: 4740 \e nGlR-w.a'-'
City: Al ew ?o _f 6d1 State: C Zip: 7,66'6
to obtain permits in my behalf,as owner/builder,for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of 20 , at , California.
•
Print Name: r\./ c�CM�Lu11$
Signature: fr/
Date: -1/ 7l 011
ram—
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
•
0779-46(rev.11/00)
Cs rF CITY OF COSTA MESA
BUILDING DIVISION
o•q � DEVELOPMENT SERVICES DEPARTMENT PERMIT BER
Ff i '
t PERMIT
°o , ,., 4,, E - 0783
+ „
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1589 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/07/2004
Vicinity: Issued: 07/07/2004
Parcel Nunmber: 42532129
Applicant: JOE PONCINO ISSUED BY:
Address: 4740 VON KARMEN AV - 7 . - -
Phone: 949-254-5819 -•
,
NEWPORT BEACH,CA. Zip: 92660
Owner: i BARRY SAYWITZ PROPERTIES 1 LP . .N
Address 1589 SAN BERNARDINO PL - ' ,
Phone: .
" . COSTA MESA,CA Zip: 92627 - ,
,
��
•
Contractor: OWNER-BUILDER -
Address: . '
-Phone: •
Zip:- . .
- - License: 000000
•
' • ._. _ - . . . SCOPE OF PERMIT . - '
LEGALIZE CONVERSION OF EXISTING GARAGE TO,MASTER BEDROOM WITH BATH&SITTING AREA
• (LIVING ROOM ANNEX)-232 SQ.FT.-REF.: B04-00561 - • - • - - - -
, - - ELECTRICAL TO INCLUDE:4 LIGHT FIXTURES,7 OUTLETS,AND 6 SWITCHES. ,
FEE SUMMARY, • '
Quantity Quantity
ISSUE FEE ' $23.50 Temp Dist System/Lighting $0.00 0- , " •
Temp service test - $0.00 Busway/100 ft $0.00 10-
Res)-a/c package .. $0.00 .•-,.r, "Standing Section $0.00 0 - ,'
New Res'(1'-2 units) " $0.00 0 `_', Misc Electrical Equipment $0.00 0
New Res(3+units) -$0.00 0 -`' Transformers up to 1 kva/kw $0.00 , 0 . .
Pool/Spa - $0.00 0 - up to 10.kva/kw --- . $0.00"' 0 , ,
Lighting Fixts $4.40 ' 4' - , ' up to 50 kva/kw '- $0.00- 0
Recept Outlets $7.70 7 up to 100 kva/kw - $0.00 , 0 •
Switches $6.60 - 6 - • over 100 kva/kw $0.00" ' 0' ' -/
Non Res Appl \ -/ $0.00 • -1 0 ;-, - - - .Low Voltage Equipment> $0.00 -v 0 - , ',,
Res Appl V :, .,$0.00 - 0- _- - _ Low Volt Wiring System/Ckt ,' -$0.00' , 0'
Service to 200a - - ` $0.00 ..- 0 - . _ ' - 'Mist.Conduit:-- V-,A'_$0.00- /0'
Service to 1000a $0.00 - 0 - - Misc.-Conductor .- - ' -$0.00 ' i0%
Service over 1000a ' `$0.00 0 -
C . Circus-(gen.or ride)`, `, ' $0.00 x'70
Motors to 1 hp $0.00 0 - Circus(mech ride or lights) 7 $0.00 ' 0
Motors to 10hp $0.00 - 0 • • . Christmas Tree Stand - / $0.00 0
Motors to 50hp $0.00 - - •
_ 0 ' ' Fireworks Stand - - $0.00 0
Motors to 100hp $0.00 0- - Other Electrical Fee _ - $0.00 /
Motors over 100hp $0.00 0 - - " - -
Communication drops $0.00 0 Investigation Fee $0.00
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and an
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
-
•
244646(6/00)
DECLARATIONS 4 j - (Th •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This,issection need not be completed if the permit is valued at one hundred dollars($100)or less.)
2 I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr ions.
Applicant Signature: (N"—v`^-0 Date: '7 -7-oil
WARNING:FAILURE TO5 RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 Class 4
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Drivels License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aAermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si naturepegal Owner(s)beia
ate
And/Or Authorized Applicant Date
800E I INSPECTION TYPE 0I ?MALE CODE# INSPECTION TYPE p_,kg jam_
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical q—q—d'1. •AstAJ'\
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
City of Costa Mesa INSULATION CERTIFICATION ,( TK
_ , Buildi/ng'Safety Division
7 ATI
J ��Rn1An's" NC) `-UJ ' /9Za79 C X7n/Cc
Number and Street City ,yn'� Y7 Countyu
l.E'Pcr /2 57
n F_✓�_ 4 ,. !I 4: n
Subdivision 'P1pimber COSTA
I,BI I'i ni l,if I?�l, r
DESCRIPTION OF INSTALLATION SEP G 1984
�j Putti
ROOF S <avgar tai8aa_64a rt AS?Npe.TN 6'�1iif�lli`t21.l.1 i�►�:''`JI�
Material f "Art" ornr Brand Name
Thickness (inches) Thermal Resistance (R Value)
EXTERIOR WALL
Material iso -.3HgrorV2 /3 L¢. F,2Cfl•S'TCcco Brand Names,'uG-
/r /
Thickness (inches) %/ rh4CK Thermal Resistance (R Value) —I0/
CEILING ,F')
Batt or Blanket Type Sai.,f�T' 7/9 Brand Name 17AJ lr.C' �o AS 4AI6
Thickness (inches) Thermal Resistance (R Value) �- /9
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
FLOOR,SLAB
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Adminis - ..
General Contractor(Builder) License Number
� ,Ea — 0U/ E,2 /9S'
Signature and Title sate
Sub Contractor(Insulation Applicator) License Number
Signature and Title Date
CMF 1106-30
.
Applicant to fill in all spaces except those within heavy-border lines and sign all appropriate declarations.
.1• P.,L,RMIT NO._ TRACT NO. LOT NO. UNIT NO.
CITY OF dress 'N/6199
tESA� CON RU+CATION PERMITf ..E-�LAf /37 1�7 2624 6/21 /64 199.31 Ti.
Project Address / 61 9 N LTcaVEC$Y71 NO P.. '�/` - - , I
Applicant's Ma MailinQAddres5 •slA. �11STE -• TYPE OF CONSTRUCTION Li NEW LJ ADD U ALTERATION, ❑ REPAIR I
Owner's Name t'2Y-- W. DAN'I.4- Phon4A71"2 J9 ❑ CONVERSION ❑ DEMOLISH O OTHER - - A-P•# 4-1- 5--..:3-217 _ I Zone Q�
DESCRIPTION OF WORK/USE OF:BLDG. / C.TD_•y'ncn?
tato?". - . .2-q-
Address �I;.rs - - 1 I _ •r S Main Building: - Accessory Building:
Arch/Eng. ,s0 1& ense No.' •' I - TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ��/ ^ ' -Ir ^ ,� - • Z
,,/ r�,�LG ST RUCTU RAC E Front ad-7 -p
Address ` ' Cfj , • '❑ TENANT LM ELECTRICAL 0 PLUMBING I�KMECHANICAL A Rear - N
- Qr�wa� ' Ill OTHER ,-
Contractor'sName - Phone - ,� •C Right Com/ - ..
. PROJECT DESCRIPTION $ FT. eSO' 26
Address(mailing) - • ..p,T OCCUPANC/,V' K' ; - G
CONSTRUCTION TYPEYh. I ATtS VALUATION $ • / /C" S Left 2L� R,
City License No. I ' - ZONE GRADING CU.YDS. ACRES E_
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided .
1 hereb affirm that I:am licensed under rovisions of Charter9 (commencing ' - - D
Y' P Remarks: ' , Planning Notes: - M
with section 7000) of Division 3.of the Business and Professions Code, and : '
my license is in full force and effect. . - A s+ T '
License Class _ ' License No. i ���_ J • S' I
Date Signature I I PLUMBING - , I I FEES . - '
I. I
k.�+ORKE RS'COMPENSATION DECLARATION Bar Sink Showers , ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-insure or a certificate ' 1 _
of Workers' Compensation Insurance;:or a certified copy theieof (Section-, Backflow Preventef - - - Service Sink �"' - - -" - ""-�
•
3800, Lab. C.) , _ I
_ Automatic Washer' ,Transformer-❑ 15'50 KW"
Policy No, Company ' I Backflow Irrigation Sewer Cap „ _ -' Construction Pole Sub- - ❑ 50+ KW
ACertified copy Is hereby furnished.
Certified copy is filed with the city Building Division. - Bathtuhs Sewer Connection Cooking Unit ' Meter Duo to 100 amps ,
Date Applicant - -
EXEMPTION'F ROM WORKERS'COMPENSATION DECLARATION . . . Clarifiers Solar Collectors ' / Dishwasher .Meter ❑over 100ampst 1
(This section need not be completed if the permit is for one hundred ($100) or -_ "- . "' - ' - '
less): : Dishwasher ` Solar,Pipingl , - - Dryers ❑Gas' DElectric Sub Panel '
I certify that in the performance of the work for which this permit is issued, I - -
shall,not employ any person in any man so'as t,` e subject to the Drinking Fountains Solar Tank 1, - Fan t /
Date y-Comgens�tl n Laws of Cali - - / 1 Motors❑0-1 HP ❑1''A-:6 PO
Date 4 -" 7/ -7(0. Signature =M+• Floor Drains Swimming Pool w/Spa I F.A.U. Inc.Solar ❑g-15 HP ❑16-15+
NOTICE:If,after making this declaration, you should become subject to the - '
Workers' Compensation provisions of the-Labor Code, you must forthwith -' - Floor Sinks ' Urinal - - ' ` - 2 'Fixtures' ' , _- 'Microwave ' ' - ' .Dt
comply with such .provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING.AGENCY - - Gas Service Outlets 'Water Closet Device Boxes I Pole Light
1 hereby affirm that there is a-construction lending agency for the performance - - - • 9 _ . /
of the 'work for which this permit is.issued (Section 3097 Civ. 'C.) - - ,
Lender's Name: ` ) •_Interceptors Water Heater gr Outlets eg Range / oe
Lender's Addres's ND/�-' - Kitchen Sink • Water Service 4 Switches ? eer Sign 0
OWNER BUILDER DECLARATION
-
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . Garbage Disposal 'Standing Sections
following reason (Section 7031.5 Business and'Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P •
-Trap - Generator ❑0-5 KW❑5-15 KW '
any structure, prior to'its issuance, also requires the applicant for such permit - Trash Compactor
• file a-signed statement that he/she is licensed pursuant to the provisions of Roof Drains - •
- - -' I '
le Contractor's License Law(Chapter 9'(commencing with Section 7000) of -
Jivision 3 of the Business and Professions Code) or that he/she is exempt - - "" -
therefrom and the basis for the alleged exemption. Any violation of Section ' - - �
70315 by any applicant for a permit subjects the•_applicant to a civil - - ' -
of not more than fivehundred dollars ($500)., $ 3
penaltyh
I,-as owner of the property or my employees with wages as their sole . Reinspection Fee I $15 Issue Fee -- .
compensation, will do the work,and the structure is not intended or offered _ - • ' • -, Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES •
License Law does not apply to an owner of a property who builds or improves ___ - .- . -. - - _- DEVELOPME NT..SER VICE REOIJIRE NTS: /^ )
thereon; and who does such work himself/herself or through his or her own 11 {I [7���
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑! • r i I OT
sale. If, however, the building or improvement is sold within one year of com- — Canopy Type II ❑ • Zoning Approved By Date CLv z
pletioowner will have the burden of proving he/she did not build or im- Duct- Under Ground • Building Approved By Date_-�,�
mfove forr the purpose of sale). ,
LI I, as'owner of,the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System ' Application Issued By Data
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who -_ _ Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU SUMMARY ARV OF FEES /��
builds or improves thereon,and who contracts for such projects with a con-
tractor(s)
- • y!Dr� SMIP $ Ot
license pursuant to the Contractor's License Law). I am aware that / I 2 AD BUILDING PERMIT $ T7
fExhaust System Multiple 0 System Repair/Alteration PLAN CHECK $ ��eRC PERMIT !!
Drool o their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBING $ + ISSUANCE , $ ,
•
Date r Owner I - Heating System& Ducting ' ' - ENERGY.P.C. $
_ - PLAN CHECK 25% $ e
I hereby certify that-I have read this application and state that the above ❑0-100,000 BTU ❑100,000 BTL; 6th GRADING $
Information is correct. 1 agree to comply with all city and county ordinances . , ELECTRICAL $
and state laws relating to builtlin• construction,and hereby authorize repre- - ter,--; PLAN CHECK 50% $ Zt So MICROFILM $
sentatives of to t• it ••• the above-mentioned property for I 7
inspection pu j Jr, !y„•8 - 1'� MECHANICAL $ I • _-'� TOTAL FEE $ �9�tJ�
Signature / Dat - (, •
�\ Drivers' License or 5S# ` - Reinspection Fee •$15' Issue Fee $ 3 avl PLAN CHECK 25% $ •S�
\\ CMF 0865-46,rev.4/84 White-Building; CanaryPink Goldenrod-Assessor
9: -Applicant; 9;
•
f CONSTRUCTION AND PLANNING - F. -&SPA
Date. Inspector. - Date • Ins ector
'' APPROVALS Permit#' - 'APPROVALS Permit# P
1r Temporary Electrical Service or Pole 52. Pool & Equipment Location : .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . r rt'
•
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms
4. Electrical Conduit-Undrgrnd.. - - 55. Electrical Bonding . • • ,1
5.'•Steel Reinforcement 56. Rough Plumbing & Pressure Test i
1
6. Electrical UFEll Grnd. _ - 57. APPROVAL TO COVER-GUNITE . • - t. I
' .7. Footings -i • . , - 7,/$,a¢ Yhi
L ' 58. Electrical Conduit-Undrgrnd. ' I'
8.(Foundation - 59.- Gas Pipe,.0 Undrgrnd.,Test - - •'
9. Water Pipe-Undrgrnd. ° 60.- Backwash Lines,P-Trap, 0 Undrgrnd: •
10. Structural Floor System sa'l"® 7.1 ..`ham t ,y1• • 61. APPROVAL TO DECK
•
11. Property Sewer Line & House Connection - ' 62. Backwash & Receptor-Final
12. Sewer'Cap 7 . 63.' Heater & Vent-Final .,
13.^Roof brains 64. Plumbing System • Final • '
, . 14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit • - -66."Solar System-Final •- - -
•
16., Rough Electric Wiring • 7/9.761/ '.L° 67.'Fencing & Access Approval
17. Rough Wiring Sign • 68. APPROVED'FOR PLASTERING
18. Rough Electrical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace , APPROVALS Permit#
•
21. Ducts, in Structure •- 70. Underground Hydro •
22. Ducts, Ventilating , - 71. Product Piping 0 Gas .0 Oil .
23: Gas Pipe-Rough &;Test - 72. Underground Flush
24. Roof Framing • . - 73. Undergrnd.StorageTank 0 Gas ❑Oil
25.-Hoof Sheathing i/ . / c% • 74. Overhead Hydro
26. T-Bar`Ceiling (Structural) & Monocoat !/ 1( . . 75. Dry Chemical
- -
27. Frameand Flashing �/ i 76. Dry Standpipe
28. Lathing & SidingOor y IV{ ✓c.- 77. FIXED SYSTEM FINAL ,
29. Insulation Nit( • ie, .78. FIRE PREV. FINAL.
30. Drywall Nailing • 0 6 /�I� /t_. HEALTH DEPT. REQUIREMENT
31. PlastetQsrown Coat ' 9 imi- c�, 79.. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
i.
• Asy
33. Final Electric - c c ,Notes: r¢4444[11,41 6 i cotSte. -ra - vac
cdµ
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test • - - /
36. Hood or Canopy lk ' ^ kfter it.A Sg1 O u0'Veit
37. Final Factory Fireplace • 'N1tET`S AU. -57-40(2 4fzOs -rt4 L 4fi ,e
38. Final Plumbing 1` -Vr/:
39. Water Service-Final . -
40. Gas Service-Final .,
41. Solar Domestic-Final . _ . -, •
42. Backflow Preventer �.•
43. Backflow,Irrigation . . -
44. ,Landscape Irrigation System
45. Sound Attenuation - - -
f
46. Handicap Regulations - , ;
47. FINAL STRUCTURE & BUILDING . 3) 01.6(i. t /ce 4,
48. Special Requirements Completed r t r : ..
49. Electric Release to Edison . '
50. Gas Release to Southern California Gas.Co :
51. CERTIFICATE OF OCCUPANCY ' ! - • . •
No. •• Date • •
.
,+--/7 4 Z8-3 -- 52-a"
N \ a PRN M
/ / � i ! in City of Costa Mesa Building Peet
i , . O � I GATE.'/� '"'�
,49 .e
MUST BE Ct. JOB AT ALL TIMES
THESE PLANS �IpR APPROVAL
EU
/// P/ J M OAKS NO CHANGES WITHOUT
Q OF DEPT. APPROVAL.1 Q' '0 CD THE ISSUING' CR CRANTIN' GE A PERMIT e COVSTRUEO
I _ — — _ Q_ _- L N gt FLAWS RID SIECIFICATIO'., SHAELiK.T ET. VIOLATION D" TG EE A FERVIT TCR, ORF ' I F'R^'I'- - t J FER,NIT PRE.
Q / O CF ANY GF THl- FRCVC:OF: , CE THfT COC- T CANCEL THE
11/4 (� I l/T SU,NING TO EWE AUIHC JTY 17 \"E_A.fS D, IN SO
Ut m FROVI`!GNS CF IRIS CI �LP,ALL BE l'. IU.
N - HIGH ITE VLI I_ IS EXCEPT IN SO
a C7 - of N 0 ¢ 4i- Tr..R rSTT:E NORK OR U ,'� ', 1
` A V \ U Y - THE ISSUANCE• lFl FERVJT EASE) C^^rl,FLANS. IAND
/•' u • �� �M f}'_CI'_ATIORS SHALL I' A 1 EcV IT EA i T"'1 C ERRORS
UL
t u I - to a� w - n '-1 TF.ESEAFTER Py^:,.‘iNG MI. ,. T7_}1 C.- ERRORS
Z �'� ¢ J n QED $FECITICE.TiC':;
U _ — _ 6 — __ ENTING
I �;In \I C"Ew T:CNS E`ING CP9Fal CI THERI.TID'A WHEN
6
�' N. Q
9'� — Cr)
STRU TURAL APPROVAL ONLY co
SCALE %6' /-'o" _
SEPARITE PERMITS ARE REQUIRED APP.FOR ELECTRIC^,i. PLUMBING
VETT' g ill CIPin OF
HEFTING, -.TANG AND
P-ANk\
TEFRIGERATHN WORK �T Ut � siraacn to
--- — rmo'mIP I �j � ---
N �`fl5 d_ l _ DY
Pewit #— ' 07S5 CI O T MESA ��r vtn
THIS NUM MUST ACCOMPANY PLANNING DEPT.
_ INSPECTION REQUESTS su81ECT To BLoc. DEPT. EEa
BY �JYTLI I DATE�� DArE
CORP
_ — — DIRECTOR OP PUNNINa 6 2/_.-8¢- /S89 SAN BFR�IARDINO
1.—FO F. BU!i0i !u ..;I< c"S:24; ARE TO
BE EMPPLO�'CD _ S .'ST THAT THE CNEcKED-sr
STATE QF C: _ "'.:ar. 0VISION OF COSTA iY7ESR , CRC., _ _-
INDUSTR ALS SULTED FOR
ADDITIONAL REQUIREMENTS. -- sxEsr
—...— ----- PL oT PL An/
— — _ r
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_.PROPERTY_...%/NE
/ _I _"1. - - --- --- //OT Tho? 8 GRAVEL R�Fri G
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2_X_i2_FACI,4 --- -- --
Ci /• r/EL $]. cc FIELD
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if --2-5(;14. -JOIST___..-./6/1. O.C.
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— = - - - — _ — R%9 NU
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" - • 7" Au To COtt:.PC.
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2" SAND SASE &t€ PLAsnC_ NIEMBRAIVc
Ci /•S�vEFD EMSEDD'D /As 7//E swan ""4
f=OONDATIOPJ .PLAN ScA_=_ a n=/ 0n � /
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�// - \\ i /5 89 SAN 13ERNARDINO
HEck J4
� ,. ( F. I CH c« -( COSTA MESA. , CAL
•- I
_ WALL DE I L 3 — #4 reP‘Scrag -
I
SCALZ 3/4.e" c /(Q "r I vouNIIAT1014 PLAN c/ ( --
—_ Lam. =TAILS /
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REmOVE EXjS7.7,VG
5L1Di WG 6LASS. .:tonR __._-
RECR�ATION
•
GARAGE_._ . Room
1' i SEDROOM
----..___0 . PATH . : -
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1 t I-------- - I it I I-t R? moot: �x1sTING / x3
68x89.SLID/NG GLASS 2d X-6ca ALUM.___ --
Q aooz (-IEmpEg ED) SL/AiNG Witt. NSI ItJL7oW AN ADP__EXE1AtiST F_AN r �
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'PATIO -_ I
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V- 4411 w>ra
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*-s----- 7 -4 I -/O -o" / crl=c?tct-3Y c4STA MESAJ en L.
f. FLOo2 PLAN ..cALF: 1 '' " _ '
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i -DATE- in_.
/6--sq ,..1-7414 SE.:12 N FiRD I NO ,
6-21-24.
• CosTA MESA) CAL.
: CliECI) a.y
•
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P--`vAtio!,le -------- - 1-52:31
I '
; • • ____aallilt
CITY OF COSTA MESA 1
DEVELOPMENT SERVICES DEPARTMENT
P. O. Box 1200
Costa Mesa, California 92628-1200 jP IR.
Date: June 21, 1984
To: Robert Davis
•
1589 San Bernardino
\66 . \ '66 c> �c \�\ • c \
Costa Mesa, CA. 92626
Re: Subcontractors List
We note that you have recently been issued a City of Costa Mesa Building Permit to do construction
or home improvements at 1589 San Bernardino
❑ The Building Permit indicates that you are the General Contractor. Our Municipal Code re-
quires that all subcontractors working on your job purchase a City business license. We are
requesting that you complete the enclosed Subcontractors List and return it to the Planning
Division. It is your responsibility to see that all subcontractors purchase a City business
license prior to your request for final inspection. Final inspections will not be given until
all subcontractors are licensed.
❑ The Building Permit indicates you are the Owner/Builder. If you are acting as the General
- .Contractor, our Municipal Code requires that all subcontractors working on your job purchase
a City business license. Please complete the enclosed Subcontractors List and return it to the
Planning Division. It is your responsibility to see that all subcontractors purchase a City
business license prior to your request for final inspection. Final inspections will not be given
until all subcontractors are licensed.
X® 'The Building Permit indicates that you are the Owner/Builder. If you are acting as Owner/
Builder, please complete the Certificate of Exemption which is on the reverse side of the
Subcontractors.List and return it to the Planning Division. It is your responsibility to see
that all subcontractors purchase_a City,;business,license,prior to your request for final
inspection. Final inspections will not be given until all subcontractors are licensed. ,
f
❑ Not all Subcontractors at the job site have obtained City business licenses, therefore, as of
, the Building Division will no longer respond to your
requests for inspections. This is the only reminder you will receive from this office,
Should you have any questions in this matter, please do not hesitate to call the undersigned at
• 754-5623. Thank you for your early response. -
Sincerely,
Nancy unge, C e Enforcem t •
-
CMF 1115-30 White-Addressee;-Canary-2nd Notice-Addressee;Pink-File IYII(Ilft 11l G
CITY OF A MESA
PARK FEES
Fee Payment Receipt .
- 3 6 8
Project Address /c /-� lR/-tY
67 C!`k r tt,Q L A.P. Number22- � —°S' Park Area
Building Permit Number4566-4 •
Owner's Name VIA t C • is rIlica r !�
Mailing Address tog •. (a kid ,54-. ; n. IR
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 702.70 =
3-Bedrooms @ 983.13 =
4-Bedrooms @ 1,260.33 =
5-Bedrooms+ @ 1,476.32 =
Multiple Family **
Bachelor or Studio @ 386.81 -=
1-Bedroom @ 467.38 =
2-Bedroom @ 718.80 =
3-Bedrooms+ l @ 1,135.66 = f/ 317.a
�j �! �1 Total Fee "` /1����
Planning Departmen • Datef 7fi By Cc.�/R er7 3
Applicant's Signature �\
" City Ordinance 72-44 ** City Ordinance 72.45 **" City Resolution 77-89 (1 1
CMF 0174-32 Rev.7/77 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant Ijo�I I1I: o
,OWNER KIRCHNER, M.O. DATE 4-21-78
• JOB ADDRESS 1589 San Bernardino Place BUILDING PERMIT NO. 45656
GENERAL CONTRACTOR C.L. Kirchner DESCRIPTION of WORK Add 1 Unit & 6/Car Gar
AP No. 117-221-08 LOT TRACT FIRE ZONE VALUES 49,000.
CINSPECTIONS ' Stratum natuDab TYPE V GROUP T ZONE R-2
sOIL I--L,' 6�Q� 'fig PEJtMITS ISSUD
��``
GAs SUBCONTRACTOR -Data I Number I Signature
11 CCWATER Plumbing ,1
ROUGH PLUMBING� 5 fz �t�.�ty� �(�.t 7-5-)V '4 7
PROP. SWR. LINE I J HOUSE CON. E I2 -771' �C ce.,l �1e /�_.S-7Q /51561
SPRINKLING SYSTEM �(l VVV
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING /2 4 -
TEMPORARY SERVICE OR POLE �✓ /y
UNDERGROUND El POWER 0 �W ./
ROUGH WIRING y-� •
• ijfL_1y•-1 . Heating gar.
TRENCHES Ig FORMS STEEL HEINF. <:J 'rrh/-7 OtAlit_u - i a 'S-) A5654
FLOOR SYSTEM - J-1 9-/1,r
BOND BEAM f, STEEL REINFORCE n �J 'b
SHEATHING /J(//-Ar• t
FRAME AND FLASHING�j� {�-s M• 9-ry
LATHING - IN X_ OUT XI 4 , 7_.i
PLASTER. BROWN COAT 4-4-'9'
STRUCTURAL. FINAL JJJ.JJ/111r11 - - /� Eler ric,, �O /� /��
HEATING, VENT., REFRIG. AND A.C., FINAL Fe /�lal fa ci/4)(��i'jy_GG.-7 S-7n 49.5../0.---
PLUMBING, FINAL AND GAS TEST n (�. o ICR`I G
ELECTRIC. FINAL
c•-•&. 4,-2.o.11
BUILDING,
41gildk
.
a.
1 9 4/21 /78 184.00 7L
4&C
9L_, 4/21 /79 184.000KTD
COSTA MESA BUILDING-SAFETY DEPARTMENT 9663 0000445656 IA
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPil T N FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Onl
RECI DATE RECEIVED DATE ISSUED
BUILDING/�q . TO! f
ADDRESS `7 A 'V`7 r^-
M .0 1 l2ch' E& A.P. NO. PERMIT NO.
OWNER R/
'MAIL ABUDIDLDRIENSGS/ ��. CzA7om e
ADDRESS
TEL.
CITY NO. TRACT I. LOT BLOCK
CONSTRUCTION NEW I ADD ALTER I REPAIR (MOVING DFMOI ISH
LENDER X
BRANCH �( ,f p
' OWNER 14 C I #tCet fri
ADDRESS � �t ryUE
ARCHITECT TEL. (^ILd�� $ .....r---
OR
OR ENGINEER NO
FIRE
ADDRESS ZONE T PE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
CITY NO. PLANS BUILDING
-
n�5+1 STATE CITY YARDS APPROVED YARDS APPROVED
C LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF BLDGS. (FROM C/L STREET)
O. OF LOT •
NOW ON LOT FRONT FT. FT.
Q USE OF
CO EXISTING BLDG. R.SLOE FT. FT.
to
F Separate permits are required for L.SIDE FT. FT.
• electric,plumbing and heating work.
• f� _ - REAR FT. — FT. •
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q MAIN ACDNS. ACCESS.BLDGS.
A VAR.# DATE
.1 C.U.P.# APPROVED
a
nVI/ APPROVED
)"
J
'U
W
M.
O I hereby acknowledge that I have read this application and state
N
C4 that the above information Is correct and agree to comply with m
0+ all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of o
"W_' the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. CV
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in.full force and effect,or I THE PURPLE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE '
and Professions Code, Division 3,Chapter 9. § n
PLAN CHECK $ n
Signature of0
Permittee $ TAX $ LL
F
U
Authorized Agent TOTAL PAID § /84
• 45. ,6' -
COSTA MESA BUILDING-SAFETY DEPARTMENT -
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 a9 7342 3/13/7E1 95e 41TL
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
RECEI F TE ECEI DATE I9.SSUE
BUILDING I C� ^xs ?T 4ECE
ADDRESS Isle .Wv FS •o ki..t>nt t 1 is L. • PERMIT NO.
OWNER M. 4 . K.; A.P. NO.
MAIL ����77 BUILDING
ADDRESS 1LJ�i• �t Lflrl T? ADDRESS/�8Q/ .� ��P�Vyl, 6ma
� p
TEL
TEL. '/ TRACT }I,• LOT BLOCK
CITY gait .n.k.,crt 3cu ( .ti _ NO4Z ZJ-RZ//
CONSTRUCTION NEW/ ADD ALTER REPAIR MOVING DFMOLISH
LENDER
BRANCH
OWNER
EL-I of:i ifs,
ARCHITECT TEL. ,'
OR ENGINEER NO.
FIRE
ADDRESS ZONE WPE
GROUP
APCONTRACTOR�:�: �i2t\1t-iIL BV ROVEDDATE 4-9/-9�ADDRESS 4 io L , LRrnC� I3LL1 laJiTE qi '�////
CITY *iC.i17Cx;12'T `�•�l� ryOL(O^f.3g^LI Z ZONE�1 PLANB BUILDIOF NG EW t
Airsam
✓ STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. + Z2.. 4q7 - LIC. NO. MAIN BUILDING ACCESSORY BUILD!
W SIZE �� NO.OF SLOGS. (FROM C/4 STR EET) •
{�/, "'�
D• OF LOT �Cy l t2Q . NOW ON LOT t9Ai., FRONT /0 FT. B FT.
Q USE OF
� EXISTING BLDG.12thi q/cti et Cr!. �- R.SIDE O FT. FT.
vs
F^5• Separate permits are required for L.SIDE t FT. FT.
electric,plumbing and heating work. )J��j
W - REAR LeiPT. FT.
[.• USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q� '- z MAIN BLOCS. ACCESS BLDGS.
VAR.+. t ,y J DATE �}-,
`� A Do o e• ��-Li1T LL J 4 r _C.U.P. jZ_^ / APPROVED-2 -?R
•
/� r _ •
>• C i V C-AP- Yl_�('-� _FLY ROVEyr / / • nATE �I�_
HOLD FOR SPECIAL REOUiREMEA[Lt-
w ii . .
a I hereby acknowledge that I have read this application and state
N
C4 that the above information is correct and agree to comply with
p• all laws regulating building construction, and I shall not employ a
z any person in violation of the workman's compensation laws of / 0 4
W the State of California.izo 9 /L�' �y /r�s
I hereby certify that I am properly licensed as a contractor under ��i+ SQ. FT. ` %�D !J a+s�, N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m za l
Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e 0
am exempt from the provisions of the State of California Business VALUATIONe
and Professions Code, 'aisle' 3,Chapter 9. PERMIT FEE $
Signature o v / � r PLAN CHECK $ rn
92,a o
Permittee x� \\ - A - $����Q TAX $ / h. \
C 3•
Authorized Agent / TOTAL PAID $ 75e„ U
V1OWNER . c. KIRCHNER,' M.C. DATE 4-21-78
\ j08 ADDRESS 1569 San Bernardino Place BUILDING PERMIT NO. 45871
h GENERAL CONTRACTOR C.L. Kirchner DESCRIPTION of WORK Remodel Existing Bleier.
AP No. 117-221-08 LOT TRACT FIRE ZONE VALUE $ 5,000.
\INSPECTIONS Signetura Data TYPE V GROUP T • ZONE R-2
sow /' 174 7-7.7g SUBCONTRACTOR PESMITS ISSUED
GAS
GAS - Date I Number I Signature
.WATER4Kir•Z9/6 7 '7/ ( I' &Plumbing
ROUGH PLUMBING I 070 //./ 71C4. /( � 7-5-1,1A 742,.71
. PROP. SWR. LINE I J HOUSE CON. 0
\ SPRINKLING SYSTEM •
\\'MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING 4' •
TEMPORARY SERVICE OR POLE C. C. ‘9-2,0-73-
UNDERGROUND
9.2,0_.gUNDERGROUND fl POWER ❑ -1
ROUGH WIRING I C.. ,. f1-)y• I$' ,'• H &tine and Vont. 1�
TRENCHES IJ FORMS IJ STEEL REINF. 5 _ /yL(�` (��-n_ /0-q- IU (� •
FLOOR SYSTEM .0 �'`' „- 7 (��) Sig-t3
BOND BEAM fl STEEL REINFORCE n �•j ` •
SHEATHING
FRAME AND FLASHING X ({.i9• 7r
LATHING - IN X OUT 2 ochvf /..(7-7q
PLASTER. BROWN COAT
•
STRUCTURAL, FINAL it
Elect 'e _
HEATING, VENT., REFRIG. AND A.C., FINAL t /� / AJ��(I/� i .ii{.kr [Q-,.,AI/ q y�.2.�'�
PLUMBING, FINAL AND GAS TEST I /tL- 6�OL .,pr 9447-7 -4, 1
ELECTRIC, FINAL /� � trial, �1f/ . 44T-7
9-fs/',{ iL c-,o
BUILDING. FINAL A '�/ irnil
r . .4 : 1
•
� 9662 4/21/78 48.50 TL
Li�/i�li'�e 966.2 4/21778 48.5OCKT0
COSTA MESA BUILDING-SAFETY DEPARTMENT 9662 00004458 71 IA
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICA;ION FOR STRUCTURAL PERMIT
For Applicant toFillin Completely -Use Ink Only
�s6 �rr>Yy (i�t _IiAS�n1N[. R _ REC IV D�V DATE RECEIVED' AYISSUED
— r
BUILDING //A/ C �G
ADDRESS
I �7-22/-og PERMIT NO.
OWNER MTV.. �R_G 4L k1(:T= A.P.NO. ` •
MAILnn- y BUILDING ` + �` �. re
,/ ` iQ
ADDRESS •'j \. 4 .1., ,e,(Ar 1� Kt et ` - ADDRESS '1� c.a...
X TEL. /* TRACT - LOT BLOCK
CITY � �J\( e �,(r-s NO.�L/y i-J
CONSTRUCTION �h_ u� i/ NEW APO ALTER REPAIR MOVING InFMOLISH
LENDER �`
BRANCH p�
OWNER C iZc'f�ll�s12
ADDRESS VAWE .1+xr,v au
ARCHITECT TEL. USE P. $ fI V//
OR ENGINEER NO. ��/j `
ZONE YPE/ GROUP i
ADDRESS //L' �j
APPROVE C/ g- Q_"�I-7Y
CONTRACTOR C L. /VI(Z,C_L'LUr TC BY _ C+ DATE N U
ADDRESS G.'L[DF,h(a n.L 'Lrp.+U ?12--i -TE L. NO.OF USE OF NEW
�),r�
CITVkC�Cy�(Z"1" '. - N0.6.1. ,q2.1 ?'. ZONE /I� PLANS 2 BUILDING�� �'�(ii `i.., (///
we(-I STATE CITY YARDS APPROVED YARDS APPROVED
gLIC. NO. i22.-/-fe' i B ✓ LIC.NO. MAIN BUILD) G ACCESSORY BUILDING
(s7 SIZE /ar � NO.OF SLOGS. 1, (FROM WI_STREE I
0. OF LOT 3L�O t€R. - NOW ON LOT (rim FRONT .4 d FT.
!
USE OF ' // 'PR
,S9EXISTING BLDG. V.1�t_L-I txt t! I R,_SI TFTr FT.
CI)
FSeparate permits are required for i L.SI FT. ' FT.
C electric,plumbing and heating work. REAR FT. FT.
W _
.
[ USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
�Q MAIN BLDGS. ACCESS.BLDGS.
`C VAR.Ns DATE r�/prv4
1.-41
:- ...1�kW)0C-4- N 11.A Cr. C.U.P.q p,/;7, ' /DO_L�/OGS. , ,
.28
j� �BY ROVEa l I J DATE -V("/ _2R
w . .,.. . . ,, -,.... N/li,T1 pm SAPPY. T. PPMTltt,c+rnit.#
0 1 hereby acknowledge that I have read this application and state
n
r.
Cd that the above information is correct and agree to comply with
Q+ all laws regulating building construction, and I shell not employ s:
Z any person in violation of the workman's compensation laws of e
the State of California. .:
I hereby certify that I am properly licensed as a contractor under SO.FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR yO
Chapter 9, end that such licenses are In full force end effect,or) THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: -
am exempt from the rovlslons of the State of California BusinessVALUATION ,/�
and Profen • ns ode, ivisi Chapter 9. PEpx9 $.0y e
% uh
PL � $
Signature
Permittee\ ••>:.. S TAX/ $ 60
f
f meq}
Authorized Agent TOTAL PAID $�,r �J U
west
-OWNER GOOCHEY, WM. J. DATE 5_2_58
JOB ADDRESS 1589 Sart Bernardino Place BUILDING PERMIT NO. 6691
7] No
GENERAL CONTRACTOR Owner Builder VALUE $ - 193.00
�lP. l-00
LOT TRACT FIRE ZONE DESCRIPTION OF WORK
Wood Fence
GROUP J TYPE V ZONE Rh PLAN NO. 669h
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam �^p
Frame-and Flashing 9.l-F/f `�
r7 .0 P
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
-Top Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con, St. Swr.
Sprinkling System
Heating Final
Plumbing Fixtures, Final
Final Gas Test
Construction Pole
Underground Power
Rough Wiring
Fixtures, Final
-.00CUPANCY AA,4 I S"- 7-4 1
Form 210-5M-1-57 669h
'_ •.,--,,,,
COSTA MESA BUILDING DEPARTMENT A I FEE RECEIVED
P O. BOX 317 6694 et S/ih i,!- at - c o
COSTA MESA CALIFORNIA
win
FOR APPLICANT TO FILiL
ni�IlvL DEPT.
C.L. OF STREET'" IlY Q_ aWSTA �r
BUILDING
/�ADDRESS/5C I
___ _ PROP LINE I Owner/UZI / ° '
��- -
(— r -IFFY 6IlrFOR 1 FT
10 FT. FOR 60 FT. STREET ` I Mail Address Q.
i 50 . STREET
I I City Cent Mt-44CA Ph. Noingng
• ' I • Contractor Ctt19tt i Ph. No.
Address 44.41ti
50 -11OF PROP City Lic. No. State Lic. No.
_ I W .9s�" �o./I7—:Vat---4" 3
150 FT Size of Lot X/�$U/
Fw I
A I- Setbacks: C/L Street 7t Rear-<
E ` y / // Left 1�/J
I _--J1 Side Yard - Right d
to f ---- a v O Type of Fence /2)00 re- /4 e E�
I 21 _I tys — 5-7i • e_KR-- S-80 A 5 - 3e/4..18,
LI C ALLEY QR PROP, LINEN ¢I O f s� y Ft:
1="'. _'"'I I hereby acknowledge than' i read this application and state
m '_ cc ffi . - IN I — I that the above is correct and agree to comply with all City Ord-
inances and State/ Laws regulating buildingnconstruction.
1 u �I n~. �� I Signature // -7�J �j fc//!��� _ // _
w w I� I of Permittee (/[� t/rl BGG CC��LLtG��
—
C;) l7 ° 4-. FT Agent
37 s 1 " ° Et) FOR OFFICE USE ONLY
I 40
I sec! l' u• m a 'I 1-,- -c4-:4 -.'7 I FT 1 • : , , - Permit No.
0 > - g- / I �� 7-
1 �
I` 60 FT ST. Received b'y, / Date Received •Date Issued
(O I fes' vl= q'- -SM7 Lie d - Jce
I50 FT. ST. i 1= 1
L _1iPROP. LINE __ — I` _ i —J I VALUATION 6--c
Permit Fee $
II • 773• d� Plan Check $
C.L. OF STREET---„,_ I .
co.-0
TOTAL FEE I, '
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- — ---
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS