HomeMy WebLinkAbout2215 SAYBROOK LN - Building Permits • a
CITY OF COSTA MESA
„ ' ussy BUILDING DIVISION
Ft; ,gE 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: P11-00040
PERMIT TYPE PLUM STATUS: ISSUED
APN: 41901309 DATE ISSUED: 02/14/2011
ISSUED BY: KJB
•
JOB ADDRESS: 2215 SAYBROOK LN CM Suite/Unit:
Vicinity: •
SCOPE OF WORK: INSTALL TANKLESS WATER HEATER IN GARAGE
•
OWNER: JAEGER, NORITA Address: 2215 SAYBROOK LN
PHONE: 'City/State/Zip: COSTA MESA,CA
APPLICANT: MARTIN REAGAN Address: 12 CALICO CT :
PHONE: 949-587-1157 City/State/zZip: TRABUCO CANYON,CA
CONTRACTOR: PRECISION PLUMBING License No. 778399
Address: 12 CALICO CT PHONE: 949-587-1157
City/State: TRABUCO CANYON,CA ZipCode: 92677 - - CELL:
ARCHITECT: License No. PHONE:
ENGINEER: - License No. PHONE:
•
•
PLUMBING PERMIT FEE SUMMARY
•
PLAN CHECK FEE: $0.00
PERMIT FEE:. $35.80
TOTAL FEES: $35.80
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*. INSPECTION TYPE DATE 'MATS CODE* INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final MechanicalA
1266 Pool Spa Final 208 Final Plumbing P .22 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
• •
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Drivers License No. Expires:
❑ 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
perfor once of the work for which this permit is issued. •
I have and will maintain workers'compensation insurance,as required by
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 El I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
• r a by this permit,and that no building structure,scaffdding,falsework,a demolition
ret:,. /—/ -S , h'J or dismantlingthereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(rn'e seeon need tutee mmpetean0e permnisvaW/ee at one ndred sonars(StoO)wless) 2,Art 2Sec.311 Title 8,California Administrative Code).
timber C J
On
/O� Yb t L 5-'r
❑ 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 Applicants Signature Date
the Labor ode. I shall f hwith comply with these pro isl s.
/ [cf.
-.2 I I Division of Industrial Safety Permit Number:
ntdSgnature t ttJ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
Uc,11 783 9 Class#- -36 (Section 25533 of the California Health and Safety Code, with some
L— 1237 /�� exceptions, requires registration with the Costa Mesa Fire Department by
/ �' ( y i M each business which at any one time has on hand a quantity of acutely
Ceantactlnature Date— hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a conslmctvn lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ 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.
Sign ure of LegalegalOwner(s} Date
Signature Date . /v )7'L[. '//
305]-d6(10]) P....._/
QAn4lac AUlGOrized. -nt
1
I Prescriptive Certificate of Coinpli. -: Residential ' r '� CF-1R-ALT I
_Residential Alterations (I age 1 of 5)
p e+ra+++'+?rr•• •- I Climate Zones It of Stories
C;enenul Information
„mss
$irt�y shires:.¢ XI J2,x n� ii )oi I Lnlur'eement Agency: cai. --- Ieq-0-0/ )
�bvittftQl Ae�Siugle FFaamily ❑/%IMuullti Family I Circle the Front Orientation: N,E,S.V',or degrees
Conditioned Floor Area (CFA): Project 7ype: 0 Alterations 0 Envelope O Fenestration ❑'Roof ❑ HVAC
Replacement or Change Out 0 Duel 1'.eplacemenl 0 Water Heater
Nd)TE: TIL.•.torn,is not In be used for Newly Constructed Buildings or Additions I
• Insulation Patties Far Opaque Surfaces (for Fm-ring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑ Opening of framed cavity alone-Alterations that involve the opening of One framed cavity of a wall, ceiling, or floor must install the
mandatav mininnpn insulmiat value per,¢l5(1 for the altered assembly.Fill in Columns A—C and emer mandaore insulation value in Column H.
❑Replacement of entire assembly-Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C'. Fill in Columns A-J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
-A 1 1) .I C I D E - F I C I H I J --
ProposedsMnU" Standard ' Values From JA4 Table
i Framing Thickness; Framed Continuous JA • Proposed
Tag/ Assembly Name Material Spacing, U- ! JA4 Table Cavity insulation Assembly Assembly
101 or Types and Size'- or Others ' factor' : Numbers R-value R-Value7 Cell Values ' U-factory
' .Note:For furred assemblies,accounting for Continuous Insulation I'-value.see Page JA4-3 and Egnaeion 4-1. For calculating fi n-ed walls use the Mass and
Furring Construction table below.
' I.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors, Slabs. Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass, enter 2x4,2x6, or std... see JA4 for other possible frame type assemblies.
3. Enter the thickness.for mass in inches or Spacing between framing members enter; 16"or 24"OC;or Other le?'all other assembly description
such as Concrete Sandwich Pane!, Spandrel Pane!,Logs,Straw Bale Panel and etc....
4.Based on the Climate Zone;enter the Standard U factor.fronr Table 151-E, Cor D for each different assembly Name or type,
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the It-value that is being installed in the wall cavity or between the framing; otherwise, enter ''0"
7. Enter the Continuous Insulation R-value for the proposed assembly; otherwise, enter "0".
&Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U-factor in Column.1
9.The Proposed Assembh'U-factor, Column.1, most be equal to or less than the Standard Ll-factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onh'
A I B I C I D I E _ F I C I Fl 1 1 I. J 1 ii L M
Proposed Properties of Masonry and Concrete Added interior or Exterior'Insulation
Walls From Ret creamy iu Tarring Space from lReference. I
,loin) Appendix Table'4.3.5..4.3.6.4.3.7 Joint Aapend'is Table 4.3.13
`J 5 • ie 1 . ° - U
Y,; L - c . e-.G rt
Assembly <-. ,-, i, t .2 R l- t b,•' = o� ., Final
Mast Name of .IA4'I able r. t' - i. = E 'E r , Assembly
'hacienese' .1 yprs Number' S 2 '- m -` u= CL. I S m d LI-Taetord'a Comment
j � ! I 1 . I I ! -Ii I
I I
I. I I
i
Aegiaarut it,, Humbert liep.si ranve Dom/Tune: HERS Provuder-
200l;Residential Compliturce•Toren:. August 2009
e . ,
Prescriptive Certificate-of Conpliance: Residential CF-IR-AL-r • 2." '
Residential Alterations Maize 4 of
Project Name: I Climate Zone k t of Stories'
ITVAC SYSTEMS-HEATING -'
Minimum Duct or Piping
Heating Equipment Efficiency Distribution Insulation Thermostat Configuration
Type and Capacityt23 (AFUE or HSPF) Type and Location R-Value° Type (or Package)
Indicate Heating Type(Central Furnace. Heal pump,
Bode;Electric Resistance, etc)
2.New hearing equipment shall be limited to natio• r r gas,or the existing fuel type. Electric resistance heating is allowed
as supplemental heating if the total capaciy<2 KW and electric ' - is controlled by a time-limiting device not exceeding 60 minutes
3.Refer to the HERS Verification section on Page . .f the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts.Hvdronic in Floor.
HVAC SYSTEMS-COOLING
Duct or Piping
Cooling Equipment Minimum Efficiency Distribution • Insulation Thermostat Configuration
• Type and Capacityt2 (SEER/EER or COP) Type and Location R-Value' Type (Split or package)
J. Indicate Cooling Type(A/C.Heat pump,Evap- Cooling, etc) —
2.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts.Hvdronic in Floor.Radiators. etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hvdronic space heating. Individual dwelling DEW heaters mist be—
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is reouired in all component packages in all climate zones.
.St ggli eeteft elFue) fyow+oatrortyp° uml *""'•"J tt CMS- sutati'+
Type'- (Standard,Recirculation)' In System _ Capacity(gal) Thermal Efficiency R-Value'
Alaw}td 6o S S J_ i I 7•Y 6al . 53 Fn
I
1.Indicate Type(Storage Gas,Heat Pump, Instantaneous, etc.)
2. The new water heater type shall be limited to natural gas,liquefied petroleum gas, or the existing fuel type.
3. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of€l50bhl. The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
4. The external water heating tank and nines shall be insulated to meet the requirements of.C1500).
SPECIAL FEATURES The enforcement agent'should pay special attention to the Special Features specified in this checklist below.
These items may require written iustifucation and documentation and special verification.
NEW ROOF ASSEMBLY- Radiant Barrier
The radiant barrier requirement of F 151(f).2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation ❑ YES ID NO
YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation 0 YES 0 NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table II k-A of the standards.
Raised Slab Insulation ❑YES 0 NO
YES, In Climate Zones I.2. 11. 13, 14& 16.R-8 insulation is required:in Climate Zones 12& 15.R-4 is required under component Package U.
Thermal Mass
To obtain Compliance Credit for the installation of thermal oras:..use the Performance Approach,
l
Registration Number: `'111jjj���eoisiration Date/Tune: HERS Provider:
2008 Residential Compliance Forms f May 2009
♦ r�
Prescriptive Cercilicnte of Comulia. - Residential CT-7 Tt-ALT
I li esitien Tial A iterations (.1)112e 5 of 5)
,I I'r'ulcct Hume: Clinime zone it: of Stories
HERS VEI:IFJ CAL ON SUMMARY The enimnemenl agency should pa)speclol onenuor,m lilt HEIS Measures S/fecl)led m this
checldis;Lelme ii con{ulelcd unci signed C'1-411 Forst for on/he measure:.s'peciiied shall he shammed m tirr buil ding nrspectnr before final
msnecnon
11n e] Settliftg' d' Testing HERS1crifi: m is required lat.this measure.
❑ YES ❑ NC; YES:It, Cliillate Zones 2 and 9-I U,it mart:than 40 lineal lee, of new cu replacetnetll duct:.art MSW Iled i, tn,cnndttiuned
space,the duct:are to he sealed pet y152(h)IDii and the newly installed ducts are to be insulated pen 1'151(f)10-
❑ EXCEPTION: Existing duct systems thin are extended, which arc euustructed; insulated or scaled with asbestos.
❑YES ❑NO YES:In Climate Zoete?. and 9-16, ii'the existing space.conditioning system (HVAC:equipment and ducting)is replaced.the
ducts are to be sealed pet §152(6)1 Di.
o YES ❑ NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced including the replacement of the air handle],
outdoor condensing, unit of a split system, cooling of heating coil,or the furnace hen exchanger)the ducts are to be
sealed pet g152(b)]E.
❑ EXCEPT)ON:Duct systems that are documented to have been previously sealed confirmed through HERS
• • •Lerifidatiou in accordance with procedures in-theddeferencc Residential Appendix 1U:3.
• - ❑ EXCEPTION:Duct systems with less than 4U'linear feet in unconditioned space.
❑ EXCEPTION: Existing duct systems constructed.insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for this measure.
❑ YES ❑NO YES:In Climate Zones 2 and 0-15,when the existing HVAC equipment is replaced(including the replacement of the an
handler, outdoor condensing unit of a split system A/C or heat pump;cooling or heating coil or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b11F.
Central Fart Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation renuirements of F]50f6)do not anoly to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required fo;-this measure.
- ❑ YES ❑NO YES.In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced,the airflow and fan wan draw shall be verified ner§,1512(b)1C1 to meet the renuirements oi`§151(f1712.
I Documentation Author's Declaration Statement '
• I certify that this Certificate of Compliance documentation is accurate and comoiete. -
Jfvame: d fir/ l /'-n /%in Le 4 if et,/ rj��.
dlRilalt�;; ///�
12 S
/ 2If Applicable 0 CEA or ❑ CEPE
C T (Certification
c tF/Z 7`x-4/30 co (ii/-� 92-67 2 g `19 St7//s
hespon siblc Building Designer's Declaration Statement
▪ I am eligible under Division 3 of the California Business:and Professions Code to accept responsibility fol the building design identified on
this Certificate of compliance.
• 1 certify that the energy Ienturet.and pertain-lance Specification:.for the iniiltling clesi gu identified on this:Catificaic of Compliance conlornl
to the requitement::or Title 24, fart:. I and 6 til the Cal ilornia Code ofRegulatiuns.
• The blilldinl'ticsign le'atoreC identified on Ili:.Certilicale of Compliance arc consistem nail) the 11110f nniun provi dcd to clucument this.
building design nil the other applicable compliances forms, worksheet.,calculations, plans and specifications submitted it,the enforcement
unmet fns illnnuvtd with th,:,buiithuc nsrmit anolicauon.
Plante: Stgiiaittl'c:
C onip-n1Y I Date:
N dnrese :)cellae
C ityllitatetyip Payne
Tor ttssistnncc w question;regartiim' the Energy Slmuia;'d.t, sumacs the Ellen] Hodinr in: J-80(I-772-53110.
kegieuat Um Humber /c:T istrauan bale/lune IIERC Flynnnder
'MOO
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CITY OF COSTA MESA
F` l BUILDING DIVISION ���
DEVELOPMENT SERVICES DEPARTMENT
�•,� "t PERMIT PERMIT NUMBER .
"+ro 699-00014
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
22►5
Job Address: 2222 SAYBROOK LN Status: ISSUED
Suite: Applied: 01/04/1999
Vicinity: 2215 TO 2223 SAYBROOK LN(ODD#S). Issued: 01/05/1999
Parcel Nunmber: 41901342 Zoning:
Applicant: PEARSON, VESS
Address: 4872 CANDLEBERRY AV
Phone: 714-761-8173
SEAL BEACH, CA Zip: 90740
Owner: GARDEN PARK VILLAGE
Address HOMEOWNERS'ASSN
P 0 BOX - - Phone: -
%HOME FEDERAL S&L ASSN Zip: 92112
•
Contractor: G M ROOFING
Address: P.O. BOX 3908
Phone: 714-761-8173
SEAL BEACH,CA - ..
Zip: 90740 License:. 472566
Arch : Eng: • .
Address: Address:
Phone: - Phone:
•
Zip: License: License:
•
SCOPE OF PERMIT
INSTALL 25-YR LAMINATED COMP SHINGLES O/EXIST LAYER(SINGLE)3-TAB COMP.ROOF CERT ATTACHED TO •
PERMIT.
GARDEN PARK VILLAGE HOA.
ROOF"L"COVERING 2215 TO 2217 SAYBROOK LN.(ODD#S). •
•
r
FEE SUMMARY
Plan Check: $0.00 -. Calc Valuation: $5,875.00
Permit: $112.25 Claim Valuation: $5,875.00
SMIP Res: $0:59
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $112.84 -
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 • Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 ' Right 0-0
PARKING Existing: 0 Required: 0 . Proposed: 0
NOTES:
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
� . �
DECLARATIONS
WORKERS'COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury One of the following declarations:
❑ I have end 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.)
❑ 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 alifomia,a agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes ro isions.
Applicant Signature: ,.. Date: — S C S
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND 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 provi r'•ns 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: Ste- C C
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: 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 civ,l penalty Of not more than five hundred dollars($500).):
❑ I,as owner o1 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, 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.).
O 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:
❑ 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,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 hes 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? ❑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 ppermit for such cOnstructi0n or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency?
ID ❑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 California Health and Safety Code).
7 If a permit from the South Coast Air(Duality 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.
'� / nature Of Legal Owner(s) Date
r.
V
And/Or Authorized Applicant — Date C
CODE I IMSPFCTIOH TYPE DEE I611/1A13 CODE I INSPECI1nN TYPF PATE MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final p 208 Final Plumbing
200 Final Re-Roof hi-- - '7 n cat- 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 _
2446-46
•
` CITY OF COSTA MESA ,
•
t s BUILDING DIVISION /2;7: -/a.F 1 'aero: ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER
B99-00013
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• BUILDING PERMIT
2214'
Job Address: .2222 SAYBROOK LN Status: ISSUED
Suite: Applied: 01/04/1999
• Vicinity: 2224 TO 2228 SAYBROOK LN(EVEN). Issued: 01/05/1999
Parcel Nunmber: 41901342 Zoning:
Applicant: PEARSON, VESS
Address: 4872 CANDLEBERRY AV
Phone: 714-761-8173
SEAL BEACH,CA Zip: 90740
Owner: GARDEN PARK VILLAGE
Address HOMEOWNERS'ASSN
P O BOX Phone:
%HOME FEDERAL S&L ASSN Zip: 92112
Contractor: G M ROOFING
Address: P.O. BOX 3908.-
I
Phone: 714-761-8173
SEAL BEACH,CA
Zip: 90740 License: 472566
Arch : Eng:
Address: • Address:
Phone: Phone:
Zip: • License: License:
SCOPE OF PERMIT
INSTALL 25-YR LAMINATED COMP SHINGLES 0/EXIST LAYER(SINGLE)3-TAB COMP. ROOF CERT ATTACHED TO
PERMIT.
GARDEN PARK VILLAGE HOA •
ROOF"K"COVERING 2224 TO 2228 SAYBROOK LN(EVEN NUMBERS).
'
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,525.00
Permit: $87.25 Claim Valuation: $3,525.00
SMIP Res: $0.50
SMIP Corn: $0.00 ,
Other: .$0.00 •
Inspection: $0.00
Total: $87.75 • -
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0.0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
EXPIRATION: This permit shalt 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 .
•
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/s 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 alifornia,an agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes r isions. /J
Applicant Signature: �_ Date: S c C
WARNING:FAILURE TO SEC RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL�ENALTIES AND CIVL 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions•f 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.N Class It (I
Contractor's Signature: Date:- l•-.S l Q
-
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 em 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,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 Califomia 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 Califomia Health and Safety Code been fully complied with? ❑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 a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? I�Yes ❑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 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
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.
flgature Of Legal Owner(s) 1- Dat
•nd/Or Authorized Applicant Date
ODES INSPECTIONTYPE PATE R®Al5 Oat INSPECTION TYPE PALE ItiuALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final p 208 Final Plumbing
200 Final Re-Roof g"1-4 210 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
2446-46
Tem' Laboratories �f c& it, ee(fo nu .ne.
e 11
� 3310 Airport Wily 1514-D North Susan Street
II ,L Long Beach,CA 90806 Sante Ane,CA 92703
W 4I) ,111' .II't, Mei:P.O. Box 47.90801 (710)554-2845
(213)426-3355 FAX(714)554-4960
TESTING (714)828-6432 FAX(213)426-8424
Compression Test on Concrete
CUSTOMER: PRECISION ENTERPRISES EXAM NO: 91-1-625079
ATTN TRACY HART
4075 E LA PALMA UNIT X DATE: 05/15/91
SANTA ANA, CA 92807 JOB NO2 00724202
PERMIT NO:
JOB NAME: VARIOUS PROJECTS (PREC. ENTR. ) OSH PD:
See "Sampled From" for OSA AP #:
ADDRESS: Job Name & Address FILE #:
PAGE #: 1
ARCHITECT: CONTRACTOR:
- SOILS ENGINEERING CONSTRUCTION
ENGINEER: SUBCONTRACTOR:
SAMPLE FROM: #2221, # 215 SAYBROOK LANE, STA MESA
MIX: 3940 SPEC. STR. (P 000 SLUMP: - - - CAST: 05/08/91
DATE TESTED 05/15/91 06/05/91 06/05/91 • 28 DAY AV
SPECIMEN NO 1 2 3
AGE (DAYS) 7 28 28 28
TOTAL LOAD (LBS) 116000 171000 171000
LBS PER SQ IN 4100 6050 6050 6050
SPECIMEN SHAPE: Cylinder SIZE: 6 x 12 %AREA/SQ IN: 28 .27
COMPLIANCE: 28-DAY TEST RESULTS COMPLY WITH SPECIFIED STRENGTH.
TEST METHOD: ASTM-C-39
SPECIMENS BY: G. IBANEZ DELIVERED BYt TLSC RECEIVED"ON: 05/09/91 .
DISTRIBUTIONS :
PRECISION ENTERPRISES, 3
•
}
Herbert J. StockingJ, E
Branch Manager
ALL REPORTS REMAIN THE PROPERTY OF TWINING LABORATORIES OF SOUTHERN CALIFORNIA,INC.AUTHORt2A HON FORPUBLIOATIONOFOUR REPORT S.CONCLUSIONS,OR
EXTRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS.THE PUBLIC AND OURSELVES.
ADDRESS OF BUILDING: 2215 SAYBROOK LN WIT: CITY Or COSTA MESA - BUILDING PERMIT 7 —0a01-44S
OWNER'S MINE IF MOM SHINIANI, AKIRA PERM NO: P 0B518`-
ADDRESS: SHIN'iANI, OSAMI
13990 AVENUE, 396 PERMIT NO: P 085185 PLAN CHECK NO: N GOVT: N SWAP: N
CUTLER,CA 93615
AP PL.MMHGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLO PURPOSE: 0TH
ARCHITECT ORENGMEER: UC.NO.: JOB DESCRIPTION : DISHWASHER CHANGE OUTSu is T:
ARCH OR ENG.'S ADDRESS: UHT:
CLAIM VALUE: CALC-VALUE: GROUP OCC : R'-3 /
CONTRACTOR'S NAME NOCK PLUMBING ( 714 ) 895-1246
Ca4maaOWs MMUNG 11612 KNOTT ST COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
ADDRESS: GARDEN GROVE CA707775 fF',E'IEY'****1(R'Ril1F'R1E'h1F*lt'RR'JFlFfF3F'%1****R'Jtit'****�t1F'R3F'RYt1F'IF'RR�Is!'Rft'****if YFil Yl********fF1!'AA'IFA'if R1t*'Rft
92841 u ir: 17 T O N I N G REQUIREMEN "i S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally d perjury that I em licensed under provisions d Chapter 9 S E '1 B A L K S
(commencing with Section 7000)d Division 3 d the Business and Professions Code,end my license is in lug forced.
and egad
CITY LIC.NO.: Vwfi186/. UC.CLASS: C-36 UC.NO.: 7 X75 EXP: 02/98 MAIN BUILDING - --- ACCESSORY BUILDING ---- -- - -
��c/f6/� 7 f� FRNT: FT IN REAR: F'i IN FRNT: FT IN REAR: FT iN
Dale: ( Contractor V \ C., / LEFT : FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
/ "NER BUILDER DECLARATION:I hereby affirm under penalty d lotion!that I am exempt from the Contractors License Law for the
/ trig reason(Section 7031.5 Bwiess and Professions Code:Any city or county which require.a panne to construct agar,improve. PARKING REQ: PROV PARCEL: 419 O i 3 G 9 NE: REF NO
alaa itsh,or rapek any structure,prior s issuanissuance.suce,also requires the applicants toenl for each permfib a egndlat
n . ernenl mat M a she
sursuan
ensed pt to the provisions d en the Contractors License Law jChapter 9(commencing with Se7000)d Division 3 d the PLANNING NOTES>
Business and Professions Code]or that he or she b exempt therefrom and the basis to,the staged exemption.My violation d Sedan >
7031.5byrune epdicant for a permit subjects the applicant to a civilpenahy of not more than five hundred drams 155oo1). iFltititit'3t*ititifititif#stitit*7titititititititifitititltitifititititit3titititit:fititpRiti<iftiti4itie:h''niflt****ifiFTftltieitltsEvti('%iii.it:eA
❑ I,asowiwr of the propany or my employees with wages as their sole compensation,will do Na work,and the eNuclure Is not intended DEVELOPMENT SER V I C E S-! 'I( E Q U IR E M E N '.1 5
or offered for sale(Section 7041.Business and Professions Code:TheContractors License Law does not appy brine to en brinproperty "
who kande or inprovea thereon,end wia does such work himself or herself or through his or her own employees,provided that suchimprovements are not intended or offered for sale.I,however,the building or improvement is sold within one year of completion.the ZONING APPROVED BY - V A i E:
ownerbutder will have the burden of proving he or she did nor build or improve for the purposed sale). /1
❑ I,as owner of the propend,am exdssively comrade°with licensed contractors to conatrud the project(Soden 7044.Business and BUILDING APPROVED BY : - DATE: — /
Professions Code;The Contractors License Law does ON apply to en owner d properly who builds or improves thereon and who
centrads for with projects with a contrada(s)licensed pursuant to the Contradas License Law). - e
❑ Iamexempt under Section: B.SP.C.,for this reason: APPLICATION ISSUED BY: DAME: ' r
It*************W*****1t*1t,,*se*1t seveniseve ww*w**** hw www w rfw if R it w it:e!****se*ww www e'er itit
Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby certify that I em aware of and understand the requirements d California Health end Safety Code Sections 25505.25533.and
25534,end that t or any future buildingocupan will/will not(circle one)need locompy with said dale cedes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
apermit for onnswctanonm°difi,anmrfrom the Air QualiyMaragement District.Residential construction apl+�tionaae exempt from these PERMIT t5 . %5
Provbana.
Date: Applicant
25% SMI-P/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one or the following dedentons: ISSUE FEE 22 .00
o Ihave and MI:maintain acertificate of consent toself;at«.brworkers'<omp«aaSection BUILDING-DIV-> PERMII ISSUE PLAN-CHECK TOTAL PAID DUE
Code,f«mawd« a
mKedthe wo f«wrohthepaeb
permit TOTALS----> 8. 75 22 . 00 0 .00 30. 75 30. 75 . 00
1 I have end 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 waken'orponsolion insurance-cagiersod Paltry number are: -- - - - .• - - -
Caner: lsv aLEN EE
EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30. l5 OVER/SHOR1 • .00
Policy Number. NIML i793w402 09/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC VIRE SM.IP/'.11YI' GRADING PLAN-CHECK
(This section need nor be completed r the pens ik is for one hundred dollars j$lOOJ Of less) 30 . 75
❑ I marl'that in the pertormarwe d the work for with this permit is issued.I shell not employ any person in any manner so as to
become subject tot workers' peneation laws of Caldemb ... agree workers'should become subject to the wors' tt*lf*ltlt9tw7f'R*wififitif Yr**********************.ii*A.***ltif T'*R'**it*iFil"t.if liie if*w'*Wit'It it Se*Rif'vt if)(ji..iy A.".
compenseton es provns d 3700 d the LaborCode,I shall onhdoseoomph,we Ne provisions. INDIVIDUAL F E E BR E AKD OWN
Date: n
/V/ / Y 7 Applicant
'7 —1/// Warning:Failure to secure workers'corrpensanon coverage/s unlawful,and shall ue/sct an employer to criminal penaMes and
Y Y E QTY D E S l' R 'i P 'i I O N (JN l l C V 5'T 1 lJ 1 AL �;OS I
coveragecivil fines w to one hundred thousand dollars($lO(OoOA In addition to the costcompensation,compensation,darrrepes a provided rot In
/ Sect/onJAMoIMSLabor Code,IntwssAand atromsyljus. PLO 1 DISHWASHER 8 . /5 8 . 75
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d perjury that there b a contlngan lending agency for the END OF FEES
performance d the work for which this permit is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I teeny that I have read this application and dere that the above information is coned.I agree to comply with all thy end county ordinances
and state laws relating to building construction and hereby authorize representatives d this thy to enter upon the above-mentioned property •
for inspection purposes. RON NOCK • 18-16-1997/81:58 RM/{38 75
T RCRT8:81-8113972
Y P t"ova 0// ��, PERMITa085i85
Dale: /
Signature d Owner/ 7tppican rector .
(5151'46 WP) White-Building&Safety:/Green-Rle: nary-Applicant:Pink-Revenue:Goldenrod-Assessor -
CONSTRUCTION AND PLANNING . PC 1: SPA
APPROVALS Permit# - •• Inspector APPROVALS Permit# Date Inspector
\
1. Temporary Electrical Service or Pole- 52: Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
i 3; ,Electrical Conduit-Utility-Undrgrnd. 54. Forms '
• -.4: Ehctrical Condurt'Urnldrgrnd, 55. Electrical Bonding l
5; Steel Reinforcement"
'56. Rough Plumbing & Pressure Test
6: 'Erectrical UF ER Gr_nd. ' 1 - :57. APPROVAL TO COVER-GUNITE -
1.;7.. ,Footings ; -• "� 58. Electrical CondUi;;Undrgrnd. - '
•$. .Foundation •D .59. Gas Pipe, 0 Ursdrgrnd., Test '
9.;Nater Pipe.Undrgrnd.? 60. Backwash Lines',•P.-Trap, 0 Undrgrnd. - -
10. Structural Floor System 61: APPROVAL TO DECK , -
11. Property Sewer Line & House-Connection,- 62. Backwash & R%eptor•Final ,
12. Sewer Cap `' . 63. Heater & Vent-Final -
13. Roof Drains - .. X64: Pluinbir4i System - Final ; , -
14. Rough Plumbingi65. Electrical-Final ; • _ .
15. Rough Electrical-Conduit •' ..--; -66. Solar System-Final
.. 16. Rough Electric-Viri Kg- . , ; ;67.. Fencing & Accyss Approval ) . ; -
17. Rough Wiring Sign - • .68. APPROVED FOR PLASTERING
n--
18. Rough Electrical-T Bar Ceiling 1 69. POOL/SPA SYS1EMS FINAL . _
19. Rough Heating &Air Conditioning - - �-- FIRE DEPT. REQUIREMENT _ - '
• - - 7' , T1. .", .�, - .-. D;-� .T. - M
20.'Rough Facto? F2eplace T' ^13 .R 'D =' ' APPBOVA 1S'D Permit# `'
21.4.Ducts,in-Structu,rMfl f. •• - 4-.-t,
_ :-+ -] 70 r-Undeit§round l t,'dro t-
r
22. Duct?, \r ntirHting: f S ` . Is. ( w 71..JProdi t"ping'D'Gas h Oil
r.
•
23.:Gas:Pipelhough &•Best m r , n IC -c .-, 72. UndergrTund Rd-eh :: -
i.
24.1Root Framing. •'_' - :•,-.: �` •� 'f -.k S 74 Undergrlid,Sidi'?Tan f 0 Gas D Oil
-I
25. Roo Sheathing ,r ' 7 > U r 7A. Overhead Hydip
26. -Bar Ceiling (StrucL.
tural) &Nlonocoat r _ :- - J +; 4, Dry Chemical -7' " --1 - s'
27.*ra a and Flashir ' z
r?! .Ae ._'r, . - 'rs 76. Dry Standpipe: Lt _ -k .t.-
y .
• 28. Lathin & Sidin °- ", "" 27 FIXED;S ST� ��N `L^
9' 9 x, t: to Y - �, -1 _i
7 I - j ,l 1 -' 1 lc ..
29. Insulation ;•.y S ^ ,, ) I I. 72. FIREZPREV. FINAL K .> _ ,t
30. Drywall Nailing +J ` _, I =1111 __ DEP:T.-REQUIREMENT■.
37. Plaster Blown.Coat,•, ,c ; r-r zi • I
32.'Electrical:Po,nrerMeter:-Final. 4. I :+ •��
T ~- i r . ) 1 T 7s: r
: 33.�finat Electric ,. r1 1 Notes: •- .r.,,- t 7
- -
34.-Fina{ Heating-$ Air tConditianiri - r f I: i :. a _
35.'Pinal Gas'Pipe-Test: _ , r f ' t T; -
Hood or Canopy .D a - - L m i I
36. t Z F 'i r.
-. ,. r , .. Tj 7 T.'-
•--• s c r I . In c`. '1 k
. 37. ;Fina;YFactory Fireplace - w , tf ;
• 38. Final-Plumbing u+ 1 { �� x - +
-, 7 �Iil ,.
39. \Nater Service-Fina•1I - J ' /� 1 t ,
" Ill M f Iv :) ;
D. r
z >
,� i.'
t .� 1,1
_46 lIandicap.Regulations r - ,.0 _
_'47:',FINAL STRUCTURE& BUILDING ' IF t '-i -
' 48--FINAL PLANNING' - 1 • IK = *$ _ 'r:
'49.:Electric Release to Edison I - ' i 11;. __ '.I -• a
I t'n T I.'
1
' :50- Gas-Release to Sout{tern California Gas Co F ' i IK - _ •
5V CERTIFICATE OF-OCCUPANCY 1 . . - - -
No Date
v
/
PROJECT ADDRESS: 2215 SAYBROOK LN UNIT: CITY OF COSTA MESA BUILDING PERMIT PERM NO: 7 , 4
OWNER'S NAME: GARDEN PARK • - -
ADDRESS: 205 MAYFAIR LN •
PERMIT NO: B 0•
50844 ' PLAN CHECK NO: 00284-91 A GOVT: N SUPTh N
• ' , COSTA MESA
CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STm PURPOSE: REP
1 -
•
ARCH/ENGINEER: REG.NO.: - JOB DESCRIPTION : PATIO 6 STAIR UNDERPINNING SQ FT: 2, 439,
ADDRESS: UNIT: • -
CLAIM VALUE: 2, 439 . 00 CALC—VALUE: 2, 439 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: SOIL ENGINEERING (619) 560-7645
ADDRESS: 1317 SIMP SON WAY • J COMMENTS: SITE ACCESS PERMIT #10564 . "
ESCONDIDO • CA 92027 *****************************-*********-********a6*:H-x**x*********************** ** .
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section: Z O N I N G R E Q U •I' R E M E N T S r
•
70001 of Division 3 of the Business and Professions Code.and my license is in•lull force and effect. SETBACKS
CITY LIC.: 05099 9 STATE LIC.:268082 cuSSA '
Date: /^3097 Signature:_ 422-7W MAIN BUILDING ACCESSORY BUILDING
•WORKERS'COMPENSATION DECLARATION: Thereby affirm that I eacenificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
�, CompensationlnsyLagcp,pL�rrJtl4etl copy thereof)Section 3800. Lab.f110/01 /91 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: W Vt1llV J J EXP.DATE: ,
COMPANY: C.E, HEATH PARKING REQ: PROV: PARCEL: 41901309 ZNE: R4 REF NO:
• 0 Certified copy is hereby furnished. Certified copy is filed with the city Building^ •� iE
Division. PLANNING NOTES> FOUNDATION STABILIZATION FOR PATIO AND STAIRS OF EX. CONDO.
C) 5.rDate: /— % � Applicant: 5.', /� — ** ************iklE*iE***!E***********************lE***iE*3E*iE************* fE
***** ****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This setup eed not be completed it the permit is for one hundred(Slip)or less). DEVELOPMENT SERVICES -R EQUIR EMENCS
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, ZONING APPROVED BY nom- t ___ _ DATE: 0 /3 OE J
Date: Signature' BUILDING APPROVED BY )
NOTICE:y:If,afterstmaking this dpy with declaration.you shouldo become t i s ermit the Workers'mrempensation provisions of the Labor : L/LJ /C -C (,� J�� DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: • DATE
which this permit is issued(Section 3097,Civ.C). 0 - *********************4 .a:s—. - .
LENDER: I ************************************* , ************************06*** ***********
ADDRESS: LEGALIZATION:N ' F E E U M M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING EL TRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 54 .00 . 50
repair arty structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed - • SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 8 : 7 8
and Professions Code)or that he/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 penally of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the 'TOTALS—,
BUILDING—DIV—> •PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 'TOTAL S----> 54 . 50 0 . 0 0 8 . 78 6 3 . 2 8 , 63 , 28 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through '
his or her own employees, provided that such improvements are not intended'or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT• 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 •
50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon (
•and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************************************************************* '
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B :R E A K D 0 W N
❑ I am exempt under Section: B.8 P.C. r
•• for this reason: •
, TYPE ,QTY ' DESCRIPTIO N 1 UNIT COST TOTAL COST
•
Date: Owner: SFR 2439 ' ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 439 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a - ,
•
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. /
Date: I Applicant •
•
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county -
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned • - .
property for inspection purposes. ,
l
Dale:-t.--3(L=-/7 Signature: - •
•
DATE: 01/30/91 fl : 1.:::/1 .,`yA
Driver's License or Social Security I •
1641-46 White—Building,Green—Code Enforcement:Canarv—Applicant:Pink—Revenue:Goldenrod—Assessor ' — . - "
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service Or Pole, • 52. .Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
;•3:-Electrical Conddit,Utility-Undrgrnd. 54. Forms
•
i,4..Electrical Conduit-Undrgrnd.'' • . 55. Electrical Bonding
,5. Steel Reinforcement, - 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. ' 57. APPROVAL TO COVER-GUNITE
7. Footings v 58. Electrical Conduit-Undrgrnd. •
8. Foundation /1/ 59. Gas Pipe, 0 Undrgrnd., Test flat -
9. Water Pipe-Undrgrnd. - - 60. Backwash Lines, P-Trap, 0 Undrgrnd. /
y
•
10. Structural Floor System � , • 7 61. APPROVAL TO DECK i'
11. Property Sewer Line & House Connection 2i 62. Backwash & Receptor-Final /1:
12. Sewer Cap f/ f/ 63. Heater & Vent-Final
13. Roof Drains I /1 64. Plumbing System - Final 41
14. Rough Plumbing 65. Electrical-Final !
15. Rough Electrical-Conduit 66. Solar System-Final I
16. Rough Electric Wiring 67. Fencing & Access Approval 1
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 '• ' m APPROVALS1. ,'Permit#
21.Ducts, in Structure, .. .. + , , 1. 70. Underground:Hydro
22. Ducts, Ventilating' . ' - ' - ` • '31. Product Piping Otas O'Oil
23: Gas Pipe-Rough 8/Test ; , , . • , , . . 72. Underground Flush", - ,
24. Roof Framing ,a . ' 1 " ' -• - ' ' . ' '.73. Undergrnd:Storage•Tahk 0 Gas 0 Oil
25. Roof Sheathing - ' •1 - , ; ' . 74.-Overhead Hydra- mc...
26. T-Bar Ceiling (Structural) & Monocoat " : 75.(Dry Chemical , • ' '=
27. Frame and Flashing -., , _ ` 76. D'ry Standpipe - '
' ,28. Lathing & Sidingr r•s . ti ••
- •• 1 ^i:• ' 77;-
, FIXED SYSTEM'EINALL -
29. Insulation : • .. . I f,- . 78;. FIRE PREV. FINAL _
30. Drywall Nailing - ' . I 1, ' ' ' HEALTH•DEPT.; REQUIREMENT
31. Plaster Brown Coat ; I •i; 79: FINAL INSPECTION ; ' 1 1.4 ') I '
•
•32., Electrical Power Meter-Final, � I I. • 80. FOOD CERTIFICATE ISSUED 111 ,
33. 'Final Electric ;; I- • Notes: . 3' , ,_, • i -
34. Final Heating & Air;Conditioning
I I
•
35.�Final Gas Pipe-Test; . _ I ' - '_ -
1.
36. Hood or CanopyI ! L - `-
37t:•Final Factory Fireplace - -
38. Final Plumbing .
39. Water Service-Final. i 1 -
I I
40. Gas Service-Final • I l - - I
41. Solar Domestic-Final - . -e1 '
42. Backflow PreventerII i - -
I
43. Backflow Irrigation S-•• •
44. Landscape Irrigation System, 'i _ - .. • ' r -'
.1
• 45. Sound Attenuation -
•46., Handicap Regulations - , , • •
47. FINAL STRUCTURE& BUILDING 5:-E2q'.11 Cc4.6, ' .I
48. FINAL PLANNING • 1 . I . -
1 - '
•49. Electric Release to Edison : ' I I I ;
,50. Gas Release to Southern California Gas Co I I I. ` ,
.
51. CERTIFICATE OF,OCCUPANCY , , ; '34 , ;,1,1 ,
No. • Date
. 9 ,
_`DSO BOXESA UOOSL...�ESAFCALIFIDEPARTMENT`^ APPWCEI"h`""'`1�,FORbST'R STRUCTURAL PERMIT
P. 126e 40 i TL
• RECEIVED BY PERMIT 49:::241‘
For Applicant to Fill in Completely —Use Ink Only �TQ
BUILDING . A.P.NO. 4/9 — Ct ?. — 11f aa
ADDRESS
BUILDING C"►IZ�lp r �„C
OWNER OR///�,),(��//��,yh , /y�� / fit �� Q/(///�� ADDRESS 1S ^PW{ a\L�{W_.
TENANT // ' /{ (!;// /✓�/F� yrl//i tc//r-��
v//�/J- UNIT OR
MAILING v SPACE NO. ga.,,
ADDU NCITY(G/ADDRESS�aM�/ 7.//� ��,r aiL,eit TNEJ:�(�L/(/(Lt,( R Ncc, LOT BLK.
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER /Z� Ab
����,
BRANCH /4.7.Sitrsc.�r /ath6 /r// A BJ..
OWNER `�j/ N ,c%�lP,
ADDRESS 7 //{{ V•LGE
ARCHITECT / �I. /_ ) TEL. - US , / i/ lv�., .f' LS • 77
OR ENGINEER' ug / L / A.. �.�• /�/1//�/r�, //j ��/J'�
ADDRESS gg atm,• '/ p/,(,(�(,r, / !/p .- ZONE RIA TYPE 2 GROUP L,(
CONTRACTOR /PO;MU- -//a,,an At f �f y te. BYAPPROV ED DATE
ADDRESS 9 to
///th/// J i tail //// i Al conch.� ,I_ j�
CITYJJJGX11.//4 live-. ` TNO. 44 O//`/ coni). onl7 ?
STATE
APPROVED SETBACKS
_ 4# e.7. 41..51
5 /LCNO. YLICNO. FRQ
(FROM DSTEETrp
W
SIZE • INO.OF BLOGSze
C, OF LOT NOW ON LOT FRONT FT.
yUSE OF
EXISTING BLDG. R SIDE ET.
CA
FSeparate permits are required for L.SIDE FT.
C electric,plumbing and heating work. REAR FT.
•
W USE OF BUILDING AND WORK TO BE PERFORMED PLANNI G ACTION
Q lC rMIC X/ batik [��(„C'.//`- ZE — IQ— SS DATE
APPROVED Lt— 1 — 7q
} �// �) APPROVE. cis._
. a �_w
IX
W
0 I hereby acknowledge that I have read this application and state
N
y that the above information Is correct and agree to comply with n.
ri
G. all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL REQ U
Z any person in violation of the workman's compensation laws of IREMENT;- o'
la the State of California. �. y /
= /�77 SO.FT. t1 5t / (OQI� m
N
3 I hereby certify that I am properly licensed as a contractor under (`I
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR D Q
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
am exempt from the provisions of the State of California Business I vz
and Professions Cod Division 3,Chapter 9. VALUATION vERM1T FEE $ in
I
PLAN CHECK § n �j en
^I
Signature of -11/ , /G?df"J \
Permitteeor
/ /� �� $� �g� TAX $ � � f
Authorized Agent ate /' 2-0 - TOTAL PAID $/.ah. .440 U �t
.COSTA MESA BUILD SAFETY DEPARTMENT ' APPLICA'N F�KSdRt}CTUH1I PERMIT!.89.00 TU
"P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' '
RECEIVED PERMIT
•
For Applicant to Fill in Completely -Use Ink Only (./•t 4079E
BUILDING A.P. NO. 419-012-19,22
ADDRESS 2215 Saybrook Lane
BUILDING
TTWNER ENANTOR McKinnon-Bibb Properties, Inc. ADDRESS 2215 Saybrookk Lane
UNIT OR
MAILING SPACE NO. Plan B
ADDRESS 2737 E. Coast Highway
L� TR N805.6 LOT 9 BLK.
CITY corona .del mar 21675-2311 1
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER Home Federal Savings& Loan %
BRANCH 1702 N. Main St.
OWNER McKinnon-Bibb Properties,Inc
ADDRESS Santa Ana, Ca. VALUE
ARCHITECT - ' TEL. USE Townhouse w/att. garages
OR ENGINEER Geo. R. Wiseman NO. 642-5544
•
ADDRESS 833 Dover Drive. N.B. ZONE R4 T E V GROUP H&J
ConstructionAYPROVED /-I�gL
CONTRACTOR elConstruction BY DATE
. ADDRESS 105 E. 18th Street
T .
CITY Costa Mesa, Ca. NOL 642-4372 Condo Unit
F APPROVED SETBACKS
CITY
LIC NO. 367816 LIC.NO. 7420 aST ET)
� der approved P1=
w SIZE NO.OF BLDGS. (FROM C/L
0. OF LOT NOW ON LOT 0 FRONT FT.
Q USE OF
F4 EXISTING BLDG. 0 R SIDE FT.
V) -i
(-•
Separate permits are required for L.SIDE FT.
C electric,plumbing and heating work: REAR FT. _
Fat
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a
a DATE
: Townhouses with attached garages ZE-79-58 APPROVED 4-9-79
7 APPROVED
>., —aY DATE
..i
IX
w
0 I hereby acknowledge that I have read this application and state' al
a that the above Information is correct and agree to comply with
M. all laws regulating building construction, and I shall not employ zi
Z .any person in violation of the workman's compensation laws of a
the State of California.
3 I hereby certify that I am properly licensed as a contractor under 1377 SO. FT. J 664-60.5 0 to.
the State of California Busi d Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that suc manse are in full force ffect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the ovislo of the State of Ifor is Business VALUATION PERMIT FEE SV
and Professions Co , D' n%Chap r 9. 189.00 '^
en
Signature of ///'�/� PLAN CHECK $ o
Permittee / $ %.�� TAX S _—.or
Authorized Agent Date l ! e0 L/ U
TOTALPAID S 189.00