HomeMy WebLinkAbout3428 SANTA CLARA CIR - Building Permits�
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moeessovew�ara: 3428 SANTA CT.,ARA C.T. uNT:
OWNEXSN�MEIFq10WN: nH.VL�T,N, ,JOSF.PH T FL�OOD: AH-3N
�op� DF..VL�LN, ,7i1L�IF.ANNF.
354 HANOVFR DR
��L����� COSTA MF..SA,CA 97.626
MCNRECT OX FHfdlffA:
uc. ra.:
YNT:
coNrnecTarsx�: COASTRIDGE ROOFING ( 714 ) 557-604$
CONfPACTONSMYIING 7480 EP.LRVIEW RD
monEss COSTA MESA CA uar+o: 541.190
9767.6 uxr:
110EN5ED CONTRACTONS OECIAHATION: I Mreby dlim uMs peiWly d peejury Nel I an lieenaed �Ms pweim+ d Cheqm 9
(wmmandnp vrit� Sec�ion'l000) d Oivieion 3 d IM Buainem end Pmieaeiona Code, eM my licenae u in lull brce end eHect.
cmuc.No.:049912 uc.cuss: C039 uc.No.: 541190 EXP: O1/96
o�<: G — i �o���a: �l �
OWNEN BUILDEP DECLANATION: I hereby elfiim uMx penely d rNrv �� � em esmmq fmm Ihe Contreawa Liceme Lew ia Hre
lolbwirp reeeon (Setlion ]IXi1.5 Busineae end PMasaione COEe: My c!y or munty xfiitli repuiree e peimA lo mnaWM, elter, improva,
demdeh, a repv erry e�r�clure, pv io na'sweMe, elso rep�i�ea iM epplirenl Im wch peimil lo fib e ep�rod sletemenl Nel M a eM
o IicenseE W�uent ia iM provieiom d Ihe Canireaas Lianse law �Chepm 9(�meneiq wilh Setlion )OW) d Drvebn � d ihe
Businesv end GrWesaons Cotle� or thm M a eM is eRempt ihxehom end �ha buia fa IM dleped uamplion. My vuletion d Seqion
1031.5 by any xpp4r,ent Iw e parmil wbpde IM epplirsnl to e tivJ peneM1y d na mwa then IHe huMreE ddlen �5500�).
� I, av owrar o/tha paperry a my empbyeae wIh wepea as thei eda wmpemmion, xill do tM xwk, erd iha evunun e ral imandeL
or Mered br sab (Seclion ]01d, Butineea eM Pmleaeima Cotle: The Coniredors Limrue lew tloae rwl apph/ �o en oxnerd pmpery
W�10 b11�CB d Tp10VB81hBIBp1.91b Y/�10 4009 SIK�I Wq�. �YTM�i Of �I09Br Of �Ifpljh h6IX �IB! OWfI BIIIpO/lGB, pIW�1.jBd �� &IC11
imqwemema are id in�eMad a aHmeE im eale. p, however.IM Wikirp a inprovaneM o eold wilhin me yeer d mmpb�ion, Iha
owmrbuiNer xill M1eve the buMan d provinp M or eM dk � build or impmve Iw Ihe W m�e W eele).
� 1. m axiw d iM pW�Y. em eadmvaty conhedM wilh IieenaeE mnVeMas ro mmhutl Uie MM� (Sedion NI�. Bwie�ms vM
Profamion+ COEe�. TM ConVeqan L'cen» law Eaea ml eppy lo en owmr W popeity Mho buiNs w impwm tlwaon erd x1p
convacis for sudi pml� �h e coniredor(s) Icemed pureuem lo �he Conveqoro Licerea lew).
� I em eumq uMer Seclion: 8. 8 P.G., br No reemn:
Dem: Owner:
1 Eo heieby cenM �� �� aware M end uMenieM the requirsmerua W Celiwnie HeeXh vM Sdery Coda Setliom 25505. ].'w5�3, eM
255�C, enE Ihel I a vry Muro buildirq mupen� will / wJl nM (tircb one) naetl lo comply wR� eeid eble mdm erd iM iaquiremmb far
e G�mn tamnalrucliona modif elianhomlMA'r�iiyl.%iuBemeM qmria. Rmkantiel omstrutlion epN�time en ewemq hom IMae
�lOVISM119.
De�e: AVd��
WOqKEN'S COMPENSATION OECL�RATION: I Mroby etfirm uMar penelly d parjury aw d ihe b0owiip daderazuru:
� I heve aM xil mainte� e cerlifr.ate d mneant lo aeMimun M xaken' comparaetbn. m povideE la by Setlim 3)W d �M Lebar
COEe. la the pe�ormarwe d ihe wak la wlich I�ia pe�mil b i�aued.
� I heve end wil meintein worke%oompenaetion inaurance. ea rpuired by Seeim 3roD d Me lebor Cade. br iM peilormeno d iM
work lor whiM Nb pmnn ia �ued. MY ��n �Va^ee�an inwrerce farriar en0 pdi�.y numbx ua:
c�,:
rawr N�mna,:
(This secfion rreed nw he romproteC I IM peimt is M one hundreE Cdlers /StP01 a lus.)
� I centy ihet in Iha parlormenr» d iM woA br wM1c� Ihie pa�mX ia beued, I ehell �wl empby erry pereon in vry menner eo d b
n«ome wd� m me waxm.• oomw�� mw. a cditanie. d,e eo�ee Nm e � anwb e«�ame wqed �o in. xoh .•
�om��/��roo worojo�s d saa�, a�oo a ina �eo, cme, i.n�l}�nn.mn �aN �» a�+a�s.
ode: f� � AOW'seM. �/� �
T
WeminO� Fel/un ro axun woAsri rompxu�tlon rovsraps I� �nbwNl, antl �hvll �ub/set an anploysr ro eNMnl perraltlu erW
GHI firsi up ro om Mntlrstl tM1ouuM Jolkn (5f 00.000), M eWltlon b Ms roat o/ rompauetlo2 Eemrys� u prov/tlM b� In
Sxtlon J]06 0l fhs LeborCOW, Inlwut, end�rtomsY�� Iw.
CONSTHUCTION LENDINO AOENCY: I Mmby elfiim under paneMy W perNrv �� ���a ia e mnat�ueion IwMinp eper�cy br Ne
panon�aree a ine won� r« wniA �nu va�� y�e (s«abn aos]. cH. c).
LENDER'S NaME:
LENOEP'S AODNE54:
I canity �het I heve reeE �hia epdK�ian enE atete ihm the ebave iMorme�ion ia wrtep. I epree to mmpN �h ell dly eM muMy oMinenroe
vM eteie kwe relelinp to buikip mnwunion end Mreby euUwrza repreaentaiivee M Ihis d1Y to enier upan the ebwe-mentuned proparry
fwinapepion rposee.
�f G��✓arL—
.�.j ';n/„ ��� �—� oa,<: 6 — /
� � /Sqiuture a{ r/AgenVApplranUConlreqa
IS151Jb.WP)
Whno--Buikip 8 Selery: Grean-Fb: Cenery-AOC���: Pink-Rmnue: Oddanro�Reeama
CTTY OF CnSTA MF..SA — AU f:t,q.T.NG PF,RMiT
�—PF.RM NO; H Q72627
PF.RMIT NO: A 07Z67.7 PT,AN CH6CK NO; N GnVT; N SQPP: N
CONSTRUCTION TYPF.: 5—N PRRMIT 'CYPF.; STR t?fJRPOSR; qTH
,70H AF.SCRZP'PION : T/OFF SHFATH � RF.RQQF W/COP4P SHiNGT,ES SQ FT; 1.,600
CI�A.T.M VALUF..: 1,600.00 CFtI�C—VAJ.�UF,.; 1,600.00 GROOP nCC; R-3 /M-1
COMMF.NTS: SMOKE AF'CECTORS REQUTRED, REROOF 7.100SF Si�OPFD PART QF RF..SZD.F,NCF.
�t*����*�-�-�t�t*it���x-�t��c**x��x�*i��****�**�**�x-�t*****�w**�c �tx����xx��c�*x-+��-�t�t�*+t��x��xat*�c-x x��+���x��*�s*
7,qNZNG RRQTIIR F,MENTS S�p����TECTOF
S F. T H A C K.S'
FRNT; FT MAIINBREARING FT IN FRNT: FTCESSONYREARLDII3�;F-{�j��Qm
,-� �• � �6,t ��
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41205150 ZNE: REF NO:
PLANNING NOTES>
i
IF �If �7E �IE'k !E 1F iE')F 1f 3E iE if'1EiE iE 1E 7k iE 7F 1F �� 1f �f 1! jE if K' 1f i!'7F'k iE'7E iE iF iE 3E'If iF iE if 1E iE %-%df 1E * 1E *�7E 9E�k�7E iE �IE IE 1f'lEdf �f #'K' iE �(-iE 1E �K' ib % k� if i! if lf � IE �%
D F. V R T� O P M F, N T S R R V I C E.4' R F, p f 1 T. R B M E N T S
7,ONTNG APPROVFn BK ,
Rf7Ii�DING APPROVF.n AY ;
DATF. ;
Tll�T E ;
APnI�TCA•rt�N ZssoFn A�: � DA'Tf,; COI (�qS�
ikif#iE1E3E'XiEiElflfiEiEk'!k'lFiE3f3f3E'7Flf'1E1F1EifiilElflEiEiElE-�-klflt'IF-IfiFiE'KltiPiF3E �if1F7EiEiflF%iflfiflE'K'iE1E'IElE#'I('1F%K7E%�7E�E�lEi4iElElE1(�
LF.'.CAL,I7,ATION:N F E F, S IJ M M A R X STRTICTDRAt, SF.GMFNT:V
BI�DG PM'C PLtIMBING ET,ECTR7C MECHAN:LC F:CHR SM.T.P/RES GRAAING
PF.RMIT 37,OQ ,50
SMT.P/Nt�N—RFS
PLAN
ISSUE FEE
BDILDING—D7V—> PERMIT ISSUF.. -gI�AN—CHE.CK TO'fAT� PA.T.1� DOF.
TOTAJ,S----> 37.50 0.00 O.OQ 37.50 37,50 ,00
R.F.VENUE. DTVIS.T.ON TOTA7,S--> COLJ,ECTED: 37,50 OVRIt/SHORT: .00
NT�DG PMT PT,OMHING RLFCTR.T.0 MF.CNAN:[C F.T.RF; SMIP/TO'P GRAq7NG PLAN—CHRCK
37.00 ,SO
�1t if iE k i! k i! iE iE �k �lE if if if if ik iFiF K�lE if it ih �1f �1t �If k if if �k k 3E k it if iE k 1f dE )E 3t iF iP if 7E �)F if ih IE if 3f k iF itiE �k 3t if k il�If 1E 3t iE lE iE iE IE iE � jf� iE iE K lE fE !F if iE
I N D I V.T. D U A t� E E E 8 R F. A K D O W N
TYPF, Q'P1t D F. S C R 7 P T.T. O N, qNT.T CO.S'T TO'CAi, COST
SFR 7.600 RFROQF BY VAi�UE R6SiDEN'f.LAL N07,ONF'. ].,00 1,500,00
END OF FEF.S
ai �aia;�,i-ani�:as_ -e�-r- a;.�o
��rG: �a�oz,�s; T?PiE: i<.!s
� POOL & SPA
CON5TRUCTION ANDPLANNING I
APPROVALS Permit � Date Inspector APPROVALS Permit # Date inspector
t. Temporary Eiectrical Service or P91e 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Cond'uit Utility-Undrgmd. 54. Forms '
4. Electrica! ConduibUndrgmd. 55. Electrieai Bonding �
5. Steei Reinforcerr�ent 56. Rough Pfumbing & Pressure Test
6. Electricat UFER Grnd. 57. APPROVAL TO COVER-GUN4TE
7. Footings 58. Electrica� Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, RTrap, � Undrgmd. �
10. Structurai Floor System � 61. APPROVAL TO DECK
i i. Property Sewer Line & House Con,r�ection 62. Backwash & Recepior-Final ,
12 Sewer Cap 63. Heater & Vent�Finai `
13. Roof Drains 64. Plumbing System - Final
14. Fiough Plumbing 65. Electricai�Fina�
15. Rough Etectrical-Conduit 66. Soiar SYstem�Finai '
76. Rough E)ectric Wiring 67. Fencing & Access ApP�oval `
77. Rough 4Viring Sign 68. APPROVED FOR PLASTERING
' 7$. Rough E!ectricabT Bar Geiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning PIRE DEPT. REQUIREMENT
20. Rough Factory Fireb�ace ,. APPROVALS Permit #
21. O�cts, in Structure � - 70. Underground Hydro
22. Ducts, Ventilating ' 71. Prod�ct Pipinc� �Gas ❑OiI
23. Gas Pipe-Rough & Test • 72. Underground Flush
2R. Roof Framing � , 73. Undergrnd. Storaga Tank t] Gas ❑ Oil
25. Roof Sheathing . '� �p s q �Ga/� 74. Overhead Hydro
26. T-Bar Celing {Structura0 &�Monocoat _ 75. Dry Chemicai �
27. Frame and Flashing .� - 76. Dry Standpipe
28. Lathing & Siding � � � � 77, FIXED SYSTEM`FINAL -
29. Insulation " .. �• 78. FIRE PREV. FINAL
36. Drywall Nailing HEALTH DEPT. REQUIREI4IENT
31. Plaster Brown Coat �• � r � 79. FINAL INSPECTION �
32. Electrical Power Meter�Final ' 80, f00D CERTIFICATE ISSUED �
� � 9f�� ifiCV K! o.e/^•-- eL
33. Final Elec[ric , � Notes: Z �Q �.
34. Findi HeaYin9 & Air Conditi0ning �� 2� �� �
lusY � a� �
35. Final Gas Pipe-Te"st � ' � -
3fi. Hood or Canopy - re �-�- ��_ �" �_ �
� 37. Final Factory Pireplace - �
38. Final Plumbing . _
39. Water Service-Final ' � � �
40. Gas Service-Final . � �
41. Solar pomestic-Final � �
42. Backftow Preventer �
43. Backflow Irrygation, ' � � � �
1 �
44. La�dscape Irrigation System " ' ' . �
45. Sound Attenuation' , . ,
46. Handicap Regulations - � �
47. FINAL STRUCTURE & BUILDING �_el L�c/ -
iD 6�
48. FINAL PLANNING ' �
49�.' Electric Release m Edison '
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY
No. Date
3 yZ � . APPlicant to fill in all spatts except tnose within �eavy �ortler lines antl sign all appropriate tleclarations. . 7AB3- CI I 3I UJ +700CI I L�
CITY OF ST CONSTRUC I �� �PE�R�M T �- PERMIT NO.� , TRACT NO. LOT NO. UNIT NO. _ • �
Project Address � �g/�lC[ �I�/i'�_/C�G,._'l L�— _• �Y � � � . - . � �
ApplicanYs Mailing Address �E� C���7 •- TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
�.�y. � OQr ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p.# ZOn¢
Owner's Name -���ryA�L' Phon DESCRIPTION OF WORK/USE OF BLDG. �
Address 5 ' S Main Building: Accessory Building:
Arch/Eng. LicenseNo.� TVPEOFPERMIT GRnoirvG ❑ FOVrvoATlOnI E _ , Z
❑ STRUCT,URAL T Front � p
Add�¢55 - � ' ❑ TENANT ❑ EIECTRICAL � PLUMBING ❑ MECHANICAL B R¢dt N
❑ OTHER �
Convactor's Name �'Z Phone � � � C Ri9ht - � N
Address Imailing � PROJECT DESCRIPTION 54. FT. OCCUvarvcV K Left � • G
���� p� CONSTRUCTIONTVPE VALUATION$ $
CityLicenseNo. J ZONE GRADINGCU.YDS. ACRES ' R
LICENSED CONTRACTOR DECLHRATION Pln9. Ret. # Parking Req./P�ovided E
I hereby affirm [hat 1 am licensetl untler provisions ot Charter 9(commencin9 Remarks: / Planning Notes: . ry�
with section 7000) oi Division 3 of the Business antl Professions Cotle, antl
my license is in fu�or� rtl�eitect. ' � T
Licen e�j ss �•-� •� Icens 10 � S'
,Date �'T'� �� Si9 t '� � ' PLUMBING FEES � --
WORKERS COMPENSATIONDEGLARATION BafSink ShOw2f5 � �
I hereby affirm that I have a certificate of consent to seu-insure or a certificate . ELECTRICAL � FEES
of Workers'�Compensation Insuranc¢, or a certifietl, copy-the�eof (Section Backflow Preventer SE�vice Sink ' - ' - -
3800, 1_aD.f �) 'J p Automatic Washer Transformer '0 15-50 KW �
PolicyNo.v`��`��Iv Company_a«e� Backflowlrrigation ' SewerCa ❑50+KW
/-� P Construction PoleSub.
q�c�t ifietl copy is hereby (umisnetl. � -� -
E9�C t' 'ea c ' tl wim me city Bui ' " . � � Bathtubs Sewer Connection Cooking Unit ' Meter ❑up to 100 amps
Oate APPlicant
.EXEMPTI N�RKERS' COMPENSATION DECLARATION Clarifiers SOId� COIIBCLO�S Dishwasher MEI¢� ❑Ov¢� 1003mp5
(This section neetl not be campletetl if the permit is for one huntlretl (E100) or - ' " '
less). Dishwasher ' SolarPiping Dryers ❑Gas �Electric SubPanel
1 certify tM1at in the perfo�mance o/ Ihe work for which this permi� is issuetl, I � '
snall not employ any person in any manner so as to become subject ta the Drinking Fountains Solar Tank Fan Motors �0-1 HP �1 h- 8
Workers' Compensation Laws ot Cali(orni
�ate � Signature � � Floor Drains Swimming Pool w/Spa F.A.U. �
NOTICE: If, afte� making thiz tlecla�atlon, you Shoultl becOme subject to the Inc. SOIa� 09-15 HP �16-15+
Workers' Comp¢nsatiou provisions of.the Labor Cotle, you must forthwitb � FIpOr5ink5 � � Urinal ' ' FixtW25 -" � - --
comply with such p�ovi5ions or this pe�mit shall be tleemetl revoketl. MiC�OWav2' .
CONSTRUCTION LENDING AGENCV ' G255E�vic¢ Out12t5� Wdt¢fCIOSEt D¢vIC260%¢5
I hereby a(firm that there i5 a mnstructlon lentling agenry tor the performance � P012 Liyht �
of the work for which this �ermi �s issuetl (Section 3097 Civ. C.) InterC¢ptOrs Wdter Heater OUtl¢ts Rdng¢
Lentler's Name
Al
�entler's Aetlress � Kitchen Sink - ' Water Service � Switches � � �
OWNER BUILDER DECLARAT ON � Sig�
I he�e�y aftirm that I am exempt from the Cont�actor'S License l_aw tor [h¢ L2vatO�i¢5 ' , � -
following reason (Section ]031.5 9usiness antl Professional Catle: Any city or Garbage Dispoul Standin9 Sections
county which requires a permit to wn5truct, alter, improve, tlemoli5h or re0air P-Tt2p .
�any structure, prior to its issuance, also requiresthe applicant tor zuch permit � - Generator �0-5 KW 05-15 KW Trash Compactor
to file a signetl statement that he/sM1e is licensetl pu�suant to the provisions of ROOi, D�ainS
the ContractoYs Litense law (Chapter 9(mmmencing with Section ]000) of � .
Division 3 oi the Business antl Professions Cotle) or that he/she is exempt
ther¢from antl th¢ basis fot tM1e allegetl exemption. Any violation of Section _ . '-
�031.5 Gy any applicant for a permit subjec[s the applicant to a civil
ee0dlty of mt more than tive huntlretl tlollar5 ($500)._ ' - . , 3
I] 1, as owner of the property or my employees with wages as their sole Reinspectiom Fee $15 Issue Fee $
comoensation, will tlo the work, antl the structure is mt intendetl or ofieretl — Reinspection Fee $15 luue Fe¢ $ 3
for sale (Seciion �044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES
License Law tloes not apply to an owne� of a property who build5 or improves .
thereon, ana wno tloes sucn work nimself/herself or tnrougn his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, p�ovitletl that 5uch imp�ovements a�2 not intended or offeretl to� BOiler HoOd or Type I ❑ �
sale. If, however, the builtling cr improvement is soltl within one year of com- Canopy Type II ❑ Za�ing Approvetl By Date
pletion, the owner will have the burtlen of provinq he/sne tlitl not builtl or Im- DUct - UOd¢� Ciround Building ApprovEd By DatB
�ove for the pu�pose of sale). - � � p'
Ll I, as owner o( the property, am exclusively contracting with iicensed con- Duct - Structural Refrigeration System Appliwtion Issued By Dat O
tracto�sto construct the project (Section ]044, Business antl Profe55ion5 Cotle: �
The Contractor's license Law tloes not apply to an owner of pronerty who Duct- Ventilating. ❑0-t00,0006TU ❑100,000 BTU SUMMARV OF FEES '
builtls or improves thereon, antl who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ MWtiple ❑ System Repair/Alteration BUILDING PERMIT $ � SMIP $
proof o( tnev Worker's Com sati n rance shoultl be provitletl to me. ' P�AN CHECK $ PERMIT �
❑ I am exempt unaer Sectio B. & P. C. for this reason FirepUFact. BIL ICBO # PWMBING $ a� �SSUANCE $�
Date nw�a. ' ' Heating System & Duc[ing ' ENERGV P.C. $
PLAN CHECK 25% $
I hereby certify that I have reatl this application and state that the above ❑0-100,000 BTU 0100,OOOBT GRADING S
intormation is correct. I a9�ee m complyyu h all city antl county ortlinances ELECTRICAL $
antl state laws relating to builtlin cons rti ion, antl hereGy authorize repre- MICROFILM $'
sentatives o this�ity to en po e above-menfionetl p per P�AN CHECK 50% $ ��T
inspectio u e MECHANICAL $ TOTALPEE $ J �� ��
Signatur Date � Reinspection Fee $15 laue Fee $ 3 PLAN CHECK 25% $
Orivers' License or 55 �
CMF 0065-46, rev. 4/84 White - Building; Canary - Applicanh Pink - Accounting; Goltlenrotl - 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-Untlrgmd. -� '��� 53. Steel Reinforcement �
.
3t. Electr.ical Conduit Utility-Undrgrnd. 54. Forms F �t
.4: Electrical Conduit-Undrgrnd. -� " 55. Electrical Bonding /
5. Steel�Reinforcement�' � � . 56. Rough Plumbing & Pressure Test � '
6.: Electrical UFER Grnd. ' - 57. APPROVAL TO COVER-GUNITE �
7.. Footings , . - : 58. Electrical Conduit-Undrgrnd. '
'�,
S.. Foundation ,• , �,l 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. , �� 60. Backwash Lines, P-Trap, O Undrgrnd. `�
10. Structural Floor System . �'� 61. APPROVAL TO DECK �
11. Property Sewer Line & House Connection .. � 62. Backwash & Receptor-Final
12.%Sewec�Cap ` � � �• - 63. Heater & Vent-Final -
13. Roof Drains " ' , 64. Plumbing System - Final ,
14. Rough Plumbing .,: ' � 65. Electrical-Final .
75. Rough ElectricallConduit 66. Solar System-Final �
t
16. Rough Electric Wiring 67. Fencing & Access Approval
17:�Rough Wiring Sign 68. APPROVED FOR PLASTERING �
I
18� Rough Electrical-T Bar Ceiling• 69. POOUSPA 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 OGas ❑Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush
24. Roof Framing �. � 73.%Undergrnd. Storage Tank 0 Gas C] Oil
' 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing �� 76. Dry Standpipe �
28. Lathing & Siding " 77. fIXED SYSTEM FINAL
29. Insulation . �. 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Pinal Heating & Air Conditioning �
35. Final Gas Pipe-Test '
36. Hood or Canopy . � , ' �
37. Final Factory Fireplace �
38. Final Plumbing � �,s (� (.�/% � - �
39. Water Servicn-Final
40. Gas Service-Final � �
41. Solar pomestic-Final . � �
� '..
42. Backtlow Preventer � , "'�
43. Backflow )rrigation . , _ __ . _
44. ,Landscape Irrigation System .
45. Sound Attenuation � � . ��
46. Handicap Ragulations � .
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed . � .
49. Electrie Release to Edison ' ..
50. Gas Release Yo Southern California Gas Co '
51. CERTIFICATEOFOCCUPANCY
No. Date
�
/ Aop��cant to fill in all sp5ces exceot tnose within heavy Cortler Ilnas anE sign all approvriate aeclaratians.
PERMIT NO TRACY NO. LOT NO. UNIT NO.
Ci7Y OF COSTA MES pCONSTR CTION PERMIT a-Z �'�- 2040 2/09/B7 5.00 TL
Project,Address �� (1 � �a .
TVPEOFCONSTRUCTION NEW AOD ALTERATION PAIR
AppliCant'S Mailing ddre5^5 _ '^�,n ❑ CONVERSIpN ❑ DEMOLISH 0 OTHER q,p. �6 Zone
'Owner'sName�/�t��� Phon ' DESCRIPTIONOFWORK/USEOFBLDG.
Addreu �� S Main Building: Accessory Building:
E Z
Arch/Eng. LicenseNo. TYPEOFPERMIT GRaDiNG F NDATION STRUCTURAL T Front p
Addres5 � ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANIGAL 8 Reaf 6 N
ConVaCtor'S Nam _ Phone � �THER A �
PROJEC7 DESCRIPTION Sp. FT. OCCUPANCV C Right N
Address Imailing) K i G
� S CONSTRUCTIONTYPE VALUATION$ S L¢ft R
City LiCenSe No. ' ZONE GRADING CU. VDS. ACRES '
LICENSED CONTRHCTOF DECLARATION Ping. Ref. # � Parking Req./Provided E
I hereby a/�I�m tnat I am Iltenietl untler rOvi510n5 of Cbarte� 9(commencing rtemarts: ' � � Planning Notes: M
with sec[ion 7000) ot Divlsion 3 ot tn �Cs�ucs antl'Professions Cotle, antl T
my license is in full e ntl efjp t � � ., .
Lic¢nsg�l�j - ic ns . o. r^ S
Da[e._��''// 1 tur , 'PIUMBWG FEES . CL �
r( _ WORKERS' C MPE � ATION 8d� Slnk $hOwE�S ' -
OU I hereby ai/irm tnat I nav a rti ic e oi wnzent to self-insure or a certificate ELECTRICAL � FEES
�of Workers' Compensation Insura ce or a certifietl copY lhereof (S�ct' n
j�.� Backflow Preventer Service Sink Automatic Washer Trans(ormer ❑ 75-50 KW
I 3800, Lab. ���Ja�����'i�� �� . .
PolicyNo.'� Company ���� Backflowlrrigation SewerCap. ConstructionPoleSub. �50+KW
tlfietl copy Is hereby tumish¢tl. '
� CerY i d ile it Ity B� in i nQt-'/� Bathtubs � Sewer Connection . . � Cooking Unit . Merer ❑up to 100 amps �
Date P cant �C !
EXEM 1 N F OM WORKERS' COMPENSATION DECLFRATION Cld/ifIE�S' $Ola� COIICCLO�S Dishwasher ' ' Meter DOv2� 100 amps �
(This 5ectiOn neetl noi ba com0�etetl it the permit i5 for One huntlretl (5100) or � "
less). Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel
I certify that in the pmlormance of the work for which.this perm�t is issuetl I . . _
shall not employ any person in any manner so as to becomo subject to t�e . Drinking Fountains Solar Tank Fan
Workers' Compensation Laws'Of Calitornia. - MOtOfs �0-1 HP 01'6i-B .
Date S9nature Floor Drains . Swimming Pool w/Spa � p q U -�
NOTICE: If, after makinq this tleclaratlon, you shoultl become subject to the Inc Solar 09-15 HP �16-15+
Workers' Compen5ation provisions ol the Labor Cotle, you must for[hwith Floo� Sinks Urinal
compty willt sucn provisions or [his perml[ shall be tleemetl �evoketl. Fixtuf25 MiCrowdv¢
CONSTRVCTION LENDING AGENCV Gas$efviCe OutletS WatCrClos2t DevlteBoXes
I hereby aHirm that thoro is a mns[ructlon lentling agency for the pertormance Pole Light �
of the work far wnlcM1 tnis permlt is issued (Section 309� Civ. C.) Interceptors Water Hea[er � Outl¢ts
Lentler's Name Range
Lender'z Aatlress ' Kitchen Sink Water Service Switches Sign
OWNER BUILDER �ECLARATION '
I hereby altitm that I am ¢zempt �rom the COnllacto!'S LicenSe Ldw for the - LdvdtOfi¢5 AUtO�Wash (�idfbd ¢ Di5 OSdI '
Pollowin9 reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or 9 P $tanding Sections
county whi<h reqWres a permit [o construct, alter, improve, Gemolish or re0air P—T�ap Laundr T�a 5
any structure, p�iot to its Issuance, also reqWres [he applicant tor such permit Y Y Generator �0-5 KW �$�1$ KW T�ash COmp2ct0�
t0 file a slgnetl Sta[ement that he/She Is IlcenSCtl pur5udnt to [he provisions of ROOf D�dins � ' � '
the ConVactor'Slicense Law (CnaOter 9(commencing witn Section �000) ot
Divizion 3 of the Bu5ine55 antl P�otes5ion5 COtle) Or that he/she is exempt -
tnerefrom an� the ba5i5 IOr tne allegetl ex¢mption. Any violation of Section
]03L5 by any applicant fo� a p¢rmit subjects the applitant [o a civil '
�enalty of not more than five huntlretl tlollars (E500).
I, as owner of the O�operty ot my ampl0yeC5 with wages as [heir sole ReinSpBction FBB $15 Issue Fee � $ 3 �
compensation, will tlo the work, antl the zeruchre is not intentled or ofteretl Reinspeetion Fee $15 luue Fee $ 3
tor saie (Section 7044, Business antl Protessional Cotle: The Contractor's MECHANICAL FEES
LicenS¢ l.dw tloes'not appty t0 an own¢r Of a property who builtls ot imOroveS
tnereon, antl who tloes such work himzelf/nerselt or mrough �is or her own DEVELOPMENTSERVICESREQUIREMENTS:
cmpioyees, proviaea tnat such improvements are not intentlad or offeretl for Boiler Hood or Type I ❑
zale. It, however, the builtling or Improvement is zoltl within one year of com- Canopy Type I I ❑ Zoninp Approved By Date
pletion, the owner will have tne burtlen of Proving he/she tlid no[ build or im- Duct - Und2r G�ound guilding Approved By � Date '
prove tot �ne purpose ol sale): \(
❑ I, as owne� of the p�OPerty, am excluSivety conVacting with litensetl con- DUCt-St�uctu�el Refrigeretion $y5t¢rtl AppliWtiOn ISt�Bd By � Dat
tractors to construct tne project (Settlon 7044, Buslness antl Professions Cotle:
The Contractor's License Law does not apply to an owner ot property who � Duct - Ventilating �0�700,000 BTU ❑700,000 BTU - SUMMARV OF FEES
builtls or improves t�e�eon, antl wh0 COntracts fo� Such prOlects with a con- _
tracmrp u<ense pursuant to the Contractor's Llcense Law). I am aware that Exhaust System.❑ Multiple � System Repair/Alteration BUILDING PERMIT $ SMIP $
proo( o� tneir Worker's Compensation insurance shoultl be provltletl ro me. PLAN CHECK $ PERMIT
❑ I am exempt unaer 5ection B. & P. C. for this reason Firepl/Fact. BIt. ICBO # Fire Dampers pLUM81NG $ i�� � ISSUANCE $
oate � owner Heating System & Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereby certiry that I have reatl thls application antl sta[e that the above ❑4100,000 BTU 0100,0008T GRADING S�
intormation is wrrect. I agree to comply with all tlty antl county ortlinances ELECTRICAL $ .
anE state laws relating to builtling const�uc[ion, antl he�eDy autho�ize repre- - MICR�FILM
sentatives of his city m enter upon the above-mentionetl property tor . - PLAN CHECK 50� $ $-T��—
inspectlan p os .
Signature oate MECHANICAL $ �,TOTALFEE �$ ✓
Drivers' �icense or 55 � einspection Fee S75 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46, rev. 10/04 White - Goltlenrotl - 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 � "^�
.T
3. Electrical Conduit Utility-Undrgrnd. 54. Forms °�
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding :
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test :;J �
6. Electrical UFER Grnd. 57. APPROVAL TO C0�'�R-GUNITE `,
7. Fooiings 58. Electrical Conduit-Undrgrnd. : ' �
8. Foundation 59. Gas Pipe, O Undrgrnd�.��tTest � :���
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap?O Undrgrntl;,'
10. Structural FloorSystem 67. APPROVALTO DECK._
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing , 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Freming 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ' 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33, Final Electric Notes: �„e� `�,,�� p� f+Q,j v� („�
34. final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing�
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation • '
44. Landscape Irrigation System . �
45. Sound Attenuation
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed .
49. Electric Release to Edison
50. Gas Release to Southern C8lifornia Gas Co `
51�. CERTIFICATE OF OCCUPANCY �
No. Date •
OWNER HELT7ER ENTFRPRiSFS-COCTA MFSA DATE q_p6-69
JOBADDRESS 1G9A ae...., ri.,.-., rt..,.te BUILDING PERMIT N0. 1090G
ROUGH PLOMBING
PROP. SWR. LINE
ROUGH HEATING ANO AIF CONOITIONING
TEMPORARV SERVICE OR POLE
UNOERGROIIN� � POWEft q
ROUGH WIRING
TRENCHES �' FORMS
FLOOR SVSTEM
BONO BEAM � STE
SHEATHING
FRAME ANO FLASHING
LATHING - IN � (
PLASTER, BROWN COAT
F INAL
BUILOING, FINAL
TRACT
TO
SUBCONTRACTOR
�
�t �Q90�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P o_eoX 1200 COST4 MESA.CALIFORNIA 92626
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CMSA
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC E V DATE RE��D DATE ISSUED
no�o ess 3428 Santa Clara Circle — SEP 2 6 1969
PE RMIT(,iCO]
owNeaHeltzer Enterprises-Costa Mesa A.P.NO. w1Uil� 4
MA�� BUILDING //� �
ADDRESS 740 N. La Brea ADDRESS 7
c�rv L.A. Cal. No�937-2171 TRACT 6638 �or 49 e�ocK `
CONSfRUCTION United Galifornia Bank 'N .Aoo P
LENDER
BRANCH Main Office
ADORESS 6th and Spring OWNER
VALUE
ARCHITECT �`. Gonzale5 TEL. SS2�6H] 5 § ���
OR ENGINEER NO.
1336 E. Cha man Ave. Orange,Cal. FIRE � Q�
ADDFESS P ZONE TVPE GROUP O��
CONTRACTOR George J.Heltzer CY ASSOC. BVPROVED DATE
ADDRESS Shcile a5 above
TEL. ZONE NO.OF USE OF NEW ng = �ID
PLAN$ BUILDING
cirr No. Rl 2 Res. w att.G t
STATE 201098 CITV l�o� '�ARDSAPPqOVED YARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILOING ACCESSORV BUILDING
SI2E NO.OF BLOGS. (FFOM GL STREET)
OF LOT NOW ON LOT ROfYT / FT.
USE OF /
EXISTING BLDG. T. FT
SIZE OF NO. OF
NEWBLOG. ROOMS STORIES L.SIDE FT. FT.
EXTEFIOF WALL ROOF ^ /
COVERING COVERING REAF FT. b FT.
USE OF BUILDING AND WORK Y� 0E PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
Residence with attached garage CURP.qW qPPqpveo
Plan No.�94- Q �+�ROVED
I hereby acknowletlge that I have reatl this application entl stete
that tha above intormacion is cor�ec[ antl a8rea to comply with �
all lews reBulating builtling consttuction, antl I shall not employ �(% /
any person in violation o( the wO�kman's compensation laws of
che State ot Celifomia �
�
I hereby certity that I am properly licensetl es a contractor untlar SQ. FT. O
[he State of Californie Business antl P�Ofessions Cotla, Divisicn 3, THE AMOUNTSHOWN UNDER VALVATION IS FOF
Chapter 9, antl Nut such licenses are in full force entl etiect, or I THE PVRPpSE OF ESTABLISH N A PERMIT FEE ONLV: Q
am e.empt from t�e provisions ot the State of Celifornia Business VALVATION /�
and Professions Cotle, D' 'sion 3, Ch ter 9. � �
PERMIT FEE 5 �
� �� �j�p ]
Si9nature ot . � +='�'�2 ✓ _ _ N i 0 / —b m
Permittee 5 PV1 CHECK $ ��'�� E
.,2'�63(0 3� —a � s
Authorizetl Agent TOTAL F E $ LL
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COS7A MESA BUIIDING-SAFETY DEPARTMENT
p,p. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
Fo� App(icant to Fil! in Completely
RECEIVEO BV DATE RECEIVED DATE ISSUED
BVILDING _ _ J
ADDRE55 (t-T
' PERMIT NO.
OWNER A.P. NO.
MA I L BUI LDING
ADORESS ADDRESS
TEL. TRACT LOT BLOCK
CITV NO.
CONSfRURION
LENOEP
BFANCH
OWNEF
ADDRESS VALUE
AiiCHITECT TEL. S
OR ENGI EER
FIRE
AODRESS 20NE TVPE GROUP
APPROVED
CONTFACTOR BV DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PL4K5 BUILD�NG
CITV NO.
STATE CITv YARDSAPPROVED VAPDSAGPROVED
LIC. NO. �IC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE p�p,pF g�,p�, (FROM C/L STREET)
OF LOT NOW ON LOT ONT O FT FT.
USE OF �
EX�STING BLDG. FT
512E OF �10.OF
NEW BLOG. ROOMS STORIES L S / FT FT.
EXTERIOR h'ALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WOHK TO BE PERFORMED DLSTANCE BET. BET. M.41N &
MAIN BLOGS. ACCE55. BLDG^a.
VAR.3W DATE
C.U.�,de GPPROVED
_ �f.'�' APPROVED D
V
I heraby ecknowletlpe thet I heva r�etl thi� epplieetion entl etata
that [ho ebova InformeNon i� corraet and eprsa to comply wlth
ell lews �apuletinp Culldin0 conKruction, antl 1�hell not �mploY
eny pano� �� ��olation of Me workman'� companwtlon lew� of
the Sroro e� Cellfornia.
I hereby ��rNfy that 1 am pro0erly Ilc�nutl ef e eonbector untler SQ, FT.
tha Sie[o of Celifornle Businan antl PrOfanion� Cotl�, DIvl�icn 3, 7HE AMOUNT SNOWN UNDER VAlVAT10N IS FOR
C�aptar Q. 0lIO I:102 �Vth IICMNS en In tull forc� entl �tfxa, or I THE PURPO6E OF ESTABLISHING A PERMR FEE ONLV:
em eeampt from tAs provislon� of the Sten of Cellfornie Bualn�n VALUATION
entl Profe���on� Cotla, Dlvltion 3, Chepnr 9.
PERMR FEE S
Slpnetun oi
Pu�mittua S PWN CHECK
Authm@Pd Apmt ' TOTAL FEE $