HomeMy WebLinkAbout1092 SANTA CRUZ CIR - Building Permits .3i_(! .� CITY OF COSTA MESA
�
• BUILDING DIVISION /
DEVELOPMENT SERVICES DEPARTMENT /
�•a PERMIT PE•�Ir rJ BER
mom m B9:-01731
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• BUILDING PERMIT
Job Address: 1092 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 09/25/1998
Vicinity: Issued: 09/25/1998
Parcel Nunmber: 41206125 Zoning: R1 R1
Applicant: LE, VINNY
Address:
Phone:
Zip: •
Owner: JAGUSIAK, MARY ANN
Address 1092SANTACRUZ CIR
Phone: - -
;COSTA.MESA,CA - Zip: 92626
N
Contractor: WEST ROOFING CO
Address: 09612 SUTHERLAND WAY
YPhone:
• GARDEN GROVE CA Zip: 92844
Licenser 694940
•Arch/Eng : • •
-
• Address:
Zip:
• License:
SCOPE OF PERMIT
T/O EXIST AND INST BTR ROOF.
FEE SUMMARY
Plan Check: $0.00 • Calc Valuation: $3,150.00
Permit: $87.25 Claim Valuation: $3,150.00
'SMIP Res: $0.50 '
SMIP.Com: $0.00
Other:' ,$0.00
Irispection: $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 shall automatically expire and become void it 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
DECLARATIONf
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.
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 Irencrtnler and policy number are: 7/
Cartier. I/Y Policy Number. (�/-CC,.�J !/
(This section need not be completed it 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 law California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
,, c•r,• with then r visions.
a:19Jil;;y{Cy!y:ure: �c � Date:
RE TO SE RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am livens LLaQ@rproVlslo_ns)fahapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and 'c.W YY 77 [[�% �� Class If �L/ j
Co ctor's • a ure: P C / Date: `�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safely 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 apereit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with at 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.
Signet :OI Le A. ner(s) / e eta 12
And/*•.fRj!gr z.:•A•• cant \ — Date
CODE 6 IucPFCTMN TYPF CODE( ISSPFCRON TYPE GATE DDIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final /�/y208 Final Plumbing
1111� n
200 Final Re-Roof ' 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Flre Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
•
ADDRESS 0c BUILDING: tilt: CITY
OWNEAB NAaiEIF IDl01YX: 1092 SANTA CRUZ CI CITY OF COSTA MESA — BUILDING PERMIT
ADDSSROLAND DANIEL FLOOD : AH-38 "PERM NO: E 077094
1092 SANTA CRUZ CIR
COSTA MESA,CA 92626 PERMIT NO: E 077094 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.gAlUNo ADDRESS: CONSTRUCTION TYPE: V-5 PERMIT TYPE: ELE PURPOSE: OTH
ARCHITECT OR ENGINEER: LK,NO.: JOB DESCRIPTION : REPLACE HEATING & INSATLL NEW A/C SQ FT:
ARMOR Dal ADDRESS: WE:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
C0"1PA0T0'SMM MAGNOLIA HEATING & COOLIN ( 909 ) 369-1364
CGJIRACTORS YMIgq 5841 MISSION BL COMMENTS: REF: B-77093
ADDREssRIVERSIDE CA IIca 658758 ********************iE*************x**iE**************************scsc+t********** FEE
92509 UMf: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby aftim ander penury of pqury that I art licensed under provisions of Chapter a SETBACKS
(commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license is in IW lace and effed.
C .NO: LG.CUSS UC N0:
9�61761 C 20 21= 5 EXP; 3/95 MAIN BUILDING ACCESSORY BUILDING
—dJ (, Cgbaeo FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PO ER BUILDER DECLARATION:I hereby aft oder paW exempt uian theCwtwm Liceme Lew fp the
following reason(Section 7031.5 Burnes and ancessbrn Code:Any Cay a county such
p requires a penn4 to construct,eller,improve,
mens. pursuaany nt to
eeuate,eboreeui (codlpermgleith eapned00)oliUwheorshe PARKING REQ: PROV: PARCEL: 41206125 ZNE: REF NO:
licensed to the provisions of the or xe License Law(Chapter 9(commencing wdh Section 7000)d Division 3 of the PLANNING NOTES>
dusiness and Professions Codex or that he she is exempt therefrom and the basis for the alleged exemption.My violation of Sed'nn >
703L5 by any applicant la a permit subjects the applicant m e civil penalty d o mthan an live hundred dollen 155001). '
I.as owner el the groped amp employees with as(bait sole compensation, *******************************************************************************
❑
or offered for sate(Section Tao,Business end Professions Code:The Contractors l e Law does apply structure
nOwner not"ptmopery DEVELOPMENT S E R. V I C E S REQUIREMENTS
who bolds or improves thereon,and who does such work himself or helmet or through he or her own employees,provided that such
omprovements are not intended a offered for sale.t.however.the bolding or inpriament is sold within one year of completion,the -
wner-builder will have the burden of proving heathe did m bad or improve for the purpose of rale). ZONING APPROVED BY DATE:
❑ I.as owner ol the property,am esNnhey contracting with licensed contractors to construct the project(Section 7044.Business end
Profession Code:The Contractors License Law does not apply man owner of property who builds a improves thereon and who BUILDING APPROVED BY : DATE:
contracts for stab projects with a contractor(s)tensed pursuant to the Contractors License Law).
❑ Iern esemplunder Section: B.AP.C.,for this reason: APPLICATION ISSUED BY: DATE;
Date: Owner: ************************************** tt * ********************* **
Ido hereby cenmwtIataware or and awlmtamD.rq�«iter+,dctad.leanerwSafely Code Sectiq.z.w5,25533,and
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGM NT: N
25534,and that I a arty Moe building comae.will/wit not(tee one)need to comply with said dam codes and the tequ4ernents for
m
a perrtafautlmdca
cYpnor modke hN
am e Ae r meggre Diaries.Residential construction appimtcre We axing fon Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
pr)more. PERMIT 7 . 50
Dae: Applicant: 5 0% S M I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedaaons: PLAN
❑ I have and will insintain a certificate of consent to setinaire for*Mien'compensations.provided for by Section 3700 of the L,sbor ISSUE FEE 15 . 00
Code.fathe Worland,oIthe wakfor reach this permit eissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and will maintain workers'compensation Mariano&as required try Section 3700 ot the Labor Code,for the performance of the TOTALS----> 7 . 50 15 . 00 0 . 00 22 . 50 22 . 50 . 00
X work for which this permit is issued.My waiters'compensation insurance terrier and policy number we:
Carr"" STAE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 22 . 50 OVER/SHORT: . 00
Policy Number:
4C �301 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need Nr be completed fperm/a wthe perm/ ro ui�J0� 81 22 . 50
o I certify that in the performance of the work kr which this permit is issued.I shall not employ any person in any manna so as to
aro subject to the workers'compensation laws of CaMsno.and agree that i I should became subject to the wo&em' *******************************************************************************
c pensation provisions of Section 3700 of the Labor Code,I ohwith corn wM ose provisions.
ata: L-8--1 (0 Applicant: INDIVIDUAL F E E BREAKDOWN
emltp:F�gun roaecvn woarar'compenwtlan caverns/sw ,and aNll rre/ecf an emplayerfo cdm'nl penalties and TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
civ/I ants tei to sur hundred thousand dot/ra(5104DDGA in do to the Nat of compenaarkR dnepes as provided for In
Section 3706 of the Labor Cod,Intent&and attorney's less.
CONSTRUCTION LENDING AGENCY: 1 hereby farm oder penalty of perjury that them is a construction lending agency ler the ELE 1 MOTOR/POWR APPARATUS
. 1 — 10 .0 HP 7 . 50 7. 50
performance d the work for which this permit is issued(Section 3097.Civ.C). END OFF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read Na application end state that the above information is cared.I agree to comply with at city and county ordinances - _ _ �•
ed stale laws relating to bulling consuudian and hereby auNorie representatives d this Sty to enter upon the above.mentoned property s - A J.
for inspection purposes.
JAMES GAMMILL
Print Name 0 I
�/(Q�1/_✓L.� Date: 1/4 1 cif
as •
(5151-46.WP) WMe-Buldi g&Safety:Green-Fde:CMuy-Appicant:Pink-Revenue:Goldenrod-Assessor
A"
CONSTRUCTION AND PLANNIN-G -,c POO SPA .
4 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 Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE /1111
7. Footings _ 58. Electrical Conduit-Undrgrnd,
- 8..Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,;P:Trap, 0 Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK _
11. Property Sewer Line & House Connection i 62. Backwash & Receptor-Final T _
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 1 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Healing& AirConditioning = 1 FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace ,APPROVALS:- 'Permit#
21. OLcts,in Structure70. Underground Hydro a
T-
22. Ducts, Ventilating • - - ; 71. Product,Piping I3Gas Oil
23. GIs Pipe-Rough& TeSt r - 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank peas Oil
?
25. Roof Sheathing 74:'Overhead Hydro.
26. T-Bar Ceiling (Structural) & Monoeoat 75TDry Chemical - _
27. Frame and Flashing- 1 - 76. Dry Standpipe
S �
28. Lathing - 77,- FIXED SYSTEM FINAL` - .
29. Insulatiod. _ . 78: .FIRE PREY. FINAL -
30. Drywall Nailing Is - • HEALTH DEPT.REQUIREMENT
31. Plaster Brgwn Coat , - . . v 1-79. FINAL INSPECTIOtV, -
32. Electrical Power Meter-Final 80-,FOOD CERTIFICATE ISSUED - _
33. Final Electric - _ t F� Notes: _ r; r
34. Final Heating& Air Conditioning fff{ �7 rn f '
35. Final Gas Pipe-Test ' N • ,
•$6. Hood:or Canopy • " '•
37. Final Factory Fireplace " ,
t
-38. Final Plumbing , : - --
39. Water Service-Final . • -
40. Gas Service-Final
z • • Y
41. Solar Domestic-Final' -
_
42. Backflow Preventer . . .. ii; •
43. Backflow Irrigation 1
44, Landscape Irrigation System _ - r - - '
45. Sound Attenuation '
46, Handicap Regulations - .
i .
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -
49. Electric Release to Edison -- -- 1
50, Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
ir ADDRESS aMONO: 1092 SANTA CRUZ CI °Ni` CITY OF COSTA MESA — BUILDING PERMIT
owxEhs NAME"P3IOM4ROLAND DANIEL FLOOD: AH-38 ./PERM NO: M 077093
ADDREss:1092 SANTA CRUZ CIR
COSTA MESA,CA 92626 PERMIT NO: M 077093 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: V-5 PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : REPLACE HEATING 6 INSATLL NEW A/C SQ FT:
ARCH.OR END'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
CONTRACTOWS1AaMAGNOLIA HEATING 6 COOLIN ( 909 ) 369-1364
CONTRACTORSMMUND 5841 MISSION BL COMMENTS: X
AD°REss:RIVERSIDE CA LUC.N0: 658758 *****************NE*sE***+rsE*SESEsrsENEsrsE**x****+E*+ERERESE*sE*****sESESE****** sE***sENESE*SN+ERE**soxsE
92509 DMT: Z ON ING REQUIREMENTS
LIC EDC NTRACTORS DECLARATION:I hereby affirm under penally of perjury that I ant keened under provisions of Chapter P SETBACKS
( endng with Section 7000)of DMsion 3 d the Business end Professions Coda,and my license Sinful force end effect.
LIC.NO LIC.CUSS: LIC.NO.:
61761 C 20 6587 8 EX . 3/95 MAIN BUILDING ACCESSORY BUILDING
4i iG FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dee: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
WN BUILDER DECLARATION:I hereby affirm under penaly rjury that I am exempt from IM Contractors License Law for the
I reason(Section 7031.5 Busieae end Professions Code:Any city«county wbOi requbss a permit to construct,alter,improve, PARKING REQ:
PROV: PARCEL: 41206125 INE: REF NO:
emofah,or repair army structure,prior to its bsuenro,also requirea the applksnt for such permit to fib a signed statement that he or she
r licensed pursuant to the provisions d the Contractors License Law[Chapter 9(commencing with Section 7000)d Di+iion 3 d the PLANNING NOTES>
Business and Professions Code[or that he or she S exempt therefrom and the basis 1«the alleged exemption.Any violation of Section >
7035.5Many applicant for a permit subjects the applicant toe civil penalty of not more then lite hundred dollars 155031). *******************************************************************************
❑ I,as owner of the property or my employees wlh wages as their sole compensation,will do the work.and the structure is not intended
or offered for sale(Sectkn7044,Business and Professions Code:The Contractors License Law dons notappyto an owner ofpropeny DEVELOPMENT SERVICES REQUIREMENTS
who bolds or improves thereon.and who does such work Nmsef or henN or through his or her own employees,presided that such
improvements are not intended or offered f«sale.n.however.the building or knprmement a sold within one year of completion,the ZONING APPROVED By
DATE:
owner builder will have the burdend proving he or she did not Oakes or improve for the paee of Se/.
❑ I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and
Professions Code:The Contractors License Law does not appy to en owner of property who builds or improves thereon end who BUILDING APPROVED BY : DATE:
contracts for suds projects with a contractor(s)[tensed pursuant to the Contractors License Law),
❑ Iamexempt under Section: B.AP.C.,f«this reason: APPLICATION ISSUED BY: DATE: 6
Dela: Owner: **********************7F**************** * ** *7F7 **a*************** *
I do hereby milky that I am aware of end understand the requirements of Calif orris Meath b Meaand Safety Code Sections 25505,25533.and LEGALIZATION:N F E E S MMARY STRUCTURAL SEG ENT: N
milky
25534,and that I or any future building«wpenl will/wil not(circle one)need to comply wlh said stale codes end the requirements for
a permit for modification hoes the As Ouakty Management District.ResidentialMWnMkn apptmtns areexempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 18 . 00 •
Dale: Applicant: 2 5* S M I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury ane of the following declarations: PLAN
❑ I have and wit maintaincertificate d consent to see-insure for workers'compensation,se provided for by Section 3700 d the Labor ISSUE FEE 15 . 00
Code,fortheped«mancedthewnforwhihthispemmeissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
xoI haseard inside works&compensation insurance,as required by Section 3700 o the Labor Code,lot the performance o the TOTALS----> 18 .00 15. 00 0 . 00 33 . 00 33 .00 . 00
x work for which this permit Is issued.My wakes'compensation insurance remx and policy number are:
Carder: CTAP cnPn EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 33 . 00 OVER/SHORT: . 00
Policy Number: 0469600005238 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not he completed 4 the penna is for one hundred dollars(Stool or less. 33 .00
❑ I centy that in the performance of the work for with this permit is Sued,I shell not employ any person in any manner so as to
subject to the xorkms'compensation laws of California.and agree that if l should become ab' G the workers' *******************************************************************************
• convoke provisions el Section 3700 d the Labor Code,I shall forthwith
comp*w those provisions.
(p Apptenc { INDIVIDUAL F E E BREAKDOWN
• rnlna:Feao»ro..cu» »work. •rnmp.n anon coverage I wndshall to ct.n employer penalties sod TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines w to one hundred thousand dollars($504000),In addition to the cost of cempsnestiork damages as provided for In
Sect/on 3fl of the Lao,Code,Interejf,end attom. .I.... MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
CONSTRUCTION LENDING AGENCY: I hereby aftnm under penalty of perjury that there is a construction lending agency for IM MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 . 00
pedormance d the work for which the permit is issued(Section 3097,Cm.C).
LENDER'S NAME: END OF FEES
LENDER'S ADDRESS:
I candy that I have read this application and come that the above information is correct.I agree to campy with all city and county ordinances
and stale laws relating to building construction end hereby authorize representaWes of this city to enter upon the above-mentioned popery _
for inspection purposes. I' '' T
JAMES GAMMILL 3>'I,: '� L E 1.':C'.
Prof Name 4 I
end .< Itaa Dat dr9�
pneN»ds �..'1 ^•y'= .(Contract«
(5t51dBW PI White-Building&Safety:Green-(RIs;Canary-Apphcent:Pink-Revenue:Goldenrod-Assessor
r -
CONSTRUCTION AND PLANNING POO, . SPA r
J 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 Conduit_ 54. Forms .• .
'
• .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r r1
' - 5. Steel Reinforcement:1 56. Rough Plumbing & Pressure Test ,•�!/'
--'S"Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conditi;`Undrgrnd.
87-Foundation - _ 59. Gas Pipe, 0 Undrgrnd., Test '
t
9. Water Pipe-Undrgtnd. -60. Backwash Lines;-PtTrap, 0 Ondrgrnd.
-3,
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line&, House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains -_ 64. Plumbing System - Final -
•
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical_Conduit - , 66. Solar System-Final- ,
t6. Rough Electric Wiring' 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FORT PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air.Conditioning- : - * .; r - FIRE DEPT.REQUIREMENT
20. Rougff Factory Fireplace `°' r F .1 APPROVAtS',_C Petprit#
21. Duct -in Structure ' - • .i 70. Underground Hydro
1
22. Ducts:Ventilating v _ i ' r • '2, r-
71. Produq .Piping 0 Gas 0OiI
23. Gas Pipe-Bough& .Test r- _ + _ 72. Underground Flush .1
24. Roof Framing _ _ , f: " ' 73,aUndergrnp.StoraggTank tGas 0 Oil
25. Roof Sheathing .F - 74. Overhead Hydro -
26. T.-Bar Ceiling (Structural) & Monocoat '• C ` 75'-Dry Chemical _ f
, 27. Frame and Flashing ' , :T.(I-. Dry Standpipe -
`_ •- .
- 28. Lathing 8i-Siding e- - - 77.: FIXED SYSTEM FINAL: -.
S- -, - ,. v , ,,,
29. Insulation _ 78r FIRE PREY. FINAL
_30. Drywall Nailing - ` 'HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat a _ r 79. FINAL INSPECTION - . •
32. Electrical Power Meter-Finalr 80. FOOD CERTIFICATE ISSUED
-
' 33. Final:Electric , m - ,I Notes: c,
34. Final:Heating &-Air Conditioning 11174,194, r.
35. Final Gas eipe-Test , _ -r -
-36. Hood or Canopy r. c - -• - -
. 37. Final Factory Fireplace,-. ', ;. ,
- 38. Final:Plumbing
t o _
39. Water Service-Final : r ' r
40. Gas Service-Final -
^ - - ••-
-41. Solar Domestic-Final t - '.-
r
42. Backflow Preventer - - q. -
Q-
43. Backflow Irriggtion - 1 r •-, -
44. Landscape Irrigation System - r. - =
45. Sound Attenuation _ " -- - M �.r
46. Handicap Regulations _
47. FINAL STRUCTURE & BUILDING • .
48. FINAL PLANNING t : .. '
49. Electric Release to Edison - - T _
50. Gas Release to Southern California_Gas Co _--_ _ _ _
51. CERTIFICATE OF OCCUPANCY
No. Date '
PROJECT ADDRESS: 1092 SANTA CRUZ CI UNIT: CITY OF COSTA MESA — BUILDING PERM PERM NO: B 061163
OWNER'S NAME:JAGUSIAK MARY ANN
ADDRESS: 1O92 SANTA CRUZ CIR
COSTA MESA, CA 92626 PERMIT NO: B 061163 PLAN CHECK NO: 00649-93 S GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL ONE PATIO ENCLOSURE ( ICB0*2621P) SQ FT: 140
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: 5, 180 , 00 GROUP OCC: R-3 /
PERMITTEE:L,J. HAUSNER CONSTRUCTION ( 714 ) 520-9550
ADDRESS: 202 FASHION LN 108 COMMENTS: PATIO ENCLOSURE WITH ALUMINUM SCREEN & ACRYLIC WINDOWS
TUSTIN CA 92680 ***+E*+E**+ESE+Eek****************************TESE*TETe**+E Ir+6******Tis*** x*********x*TELE***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS
7000)0l Division 3 of the Business and Professions Code.and my license is to full force and effect. SETBACKS
CITY LIC.:O 210� 69 STATELIC.:326317n DLAS :B
Date: kJ1% Signature:�C.— _ __ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent ell-insure or a certificate of Workers' FRNT: 71 FT IN REAR: 14 FT 6 IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: 45 FT IN RGHT: 24 FT IN LEFT: FT IN RGHT: FT IN
POLICYND.:1094768-93 EXP.DATE: 01 /01 /94
COMPANY:STATE FUND PARKING RE PROV• PARCEL: 41206125 2NE: R1 REF NO:
• i7 Certified copy is hereby furnished. SO Certified copy is d with the city Building Division. PLANNING N REQ;,
140 SQ, FT. PATIO ENCLOSURE ALONG SIDE AND REAR OF EX• SFR,
Date: �a� Applicant: • rn"o "`^/ - — '— ` *******************************************************iE************ #*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the perm) far ane hundred(4100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N T S
I certify that in the performance of Me 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 S---r—r—__ DATE: .02/2.64,13
Date: Signature:
NOTICE:II.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:.
Code.you must forthwith comply with such provisions or tits permit slug be deemed revoked. i /
CONSTRUCTION LENDING AGENCY: I hereby alarm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: f�� / �'..a. DATE: 2-%
which this permit is issued(Section 3097.Civ.CI. **************************** * *... * ;*** it*** *************** 3t** *It-**
LENDER: ********************************************* ********************************
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve.demolish,or PERMIT 81 . 00 52'
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement That he/she is licensed I
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 al the Business SMIP/NON L R ES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation at Section 7031.5 by PLAN 52 . 65
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the 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 TOTALS——--> 81 . 52 0 , 0 0 52 . 65 1 3 4 , 17 134 . 17 , 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
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED• 134 . 17 OVER/SHORT: 00
mrthe purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of tee property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 . 00 . 52 52 , 65
❑ and Professions Code: The Contractors'elate 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'Slate License Law).l am aware ***I***************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F Ek,E BR EAKDOWN
o I am exempt under Section: B.&P.C.
lot this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date, Owner: SFR 140 RES—PATIO COVER—ENCLOSED PATIO 37 . 00 5, 180 . 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 of modification from the Air Duality Management District.Residential construction applications are exempt from
(hese provisions. /
Date: ��d G— Applicant• .rNvA—V1AI_A —
•
I hereby cedily that I have read this application and state that the above information is correct.I agree toSh all city and county
ordinances and state laws relating to building construction and hereby au `e representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Date p��aV�3 Signature: -I ` -
Driver's License or Social Security 1
1641-46 White—Budding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
L.Lnv�T�RUCTION 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 Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrrd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
{ i
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 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. Sewer Cap 63. Heater & Vent-Final J1
13. Roof Drains 64. Plumbing System - Final
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
. I
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 0Gas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
7
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas El 011 -I
25. Roof Sheathing 74. Overhead Hydro ,
26. T.Bar Ceiling (Structural; & N'onocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation I 78. FIRE PREV. FINAL
-1
30. Drywall Nailing L 1 i HEALTH DEPT. REQUIREMENT4.
31. Plaster Brown Coat l' l 79. FINAL INSPECTION
32. Electrical Power Meter-Final i 80. FOOD CERTIFICATE ISSUED
33, Final Electric INotes:
34. Final Heating &Air Condition:rg I I I
35. Final Gas Pipe-Test I i
36. Hood or Canopy 1 I .I
37. Final Factory Fireplace . I
_ _ 138. Final Plumbing I I
39. Water Service-Final I I
40. Gas Service-Final I
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape trrigation System {`
45. Sound Attenuation
46. Handicap Regulations -/ �_ e 7
47. FINAL STRUCTURE & BUILDING ' c(IJ '_ at..
48. FINAL PLANNING I/ •
49, Electric Release to Edison l '
50. Gas Release to Southern California Gas Co i
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 1092 SANTA CRUZ CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM. NO: B 061530
OWNER'S NAME:JAGUSIAK, MARY ANN
ADDRESS:
1092 SANTA CRUZ CIR PERMIT NO: B 061530 PLAN CHECK NO: N N SUPP; N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
�� ARCNIENGINEEfl: REG.NO.: JOB DESCRIPTION : T/O EXIST, & APPLY "EAGLE TILE" 1CBO44660 S:°:::: 5, 650
AODflESS: UNIT:
CLAIM VALUE: 5, 650 . 00 CALC—VALUE; 5, 650 . 00 GROUP OCC; R-3 /M-1
PERMInEE`PERFF.CT COVER ROOFING ( 714 ) 434-1566
ADDRESS: 3303 HARBOR BL D-5 COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC,
COSTA MESA CA 92626 **************************** ********yr****x***********suese lift****X**u*nip*ntsp**#.,ft
LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS ` ,�y,� 'f,.
7000)of Dw¢Ii. 3 of the Bu iness and Professions Code,and my license is in lull force and effect. SETBACKS C��0�� (J'L- M )^'
CITY LIC.: 07 3 TE lCa3 .2516 C S'C-1G9 �7
) Date. _ Signature: ZG173 MAIN BUILDING ACCESSORY BUILLR��C J•�•REQ
WOR i- 1M' NSATIONOECLA TION; I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: T IN
Compensation I urance.a a certified copy thereof(Section 3800.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POucYND.:1263623-92 EXP.DATE: 07/01 /93
COMPANY:STATE FUND PARKING REQ; PROV; PARCEL; 41206125 ZNE: REF NO:
❑ Cenifie copy is hereby furnished. $3 Cemfied copy' with the city Building 0' 'on. PLANNING NOT ES>
>
Date:3 26/9 3 Applicant: A. , i . ( **if*!E*****If**IE**X**i(*X-*It*jF{p**!f****************8f***k**iE***********if lE**•f•.**X**jE lF 1f?E
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIr (This section need rpt.•completed it the pernet is Io one hundred(5110)or less). DEVELOPMENT SERVICES R E Q U I R E M E N X.S
I[artily that in the performance of the work for which this permit is issued,l sh. not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of Calitornia. ZONING APPROVED BY DATE:
Date: Signature:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APP ROVED BY ; DATE:
Code.you must lonhvnth 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 B Y r � % �Jes DATE': /�J/�26/ '
which this permit is issued(Section 3097.Civ.C). ****************X*iE***fetr n..* ar .r, ifxt * it *#A:*********XXX********x 31r,(*3CR *A:**
LENDER: **************************************** *********************0.** s ******X***
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCT�JAA3F1.'SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l any exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/REST GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 81 . 00 57
repair any structure.prior to its issuance,also requires the applicant far such permit to tile a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty 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 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 TOTALS————> 81 . 57 0 . 00 0 . 00 81 . 57 81 . 57 . 00
does not apply to an owner al a properly 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 or sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 81 . 57 OVER/SHORT: 00
torthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner ot the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 . 00 . 57
o and Prolessans Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contractstor such projects with acontractor(s)license pursuant totheContractors'State License Law).l am aware **********?E*********************************************-It*X*************it*XX***
mat prool ot their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
O I am exempt under Section: B.B.P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dam. Owner: SFR 5650 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 5, 650 . 00
I Oo 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 tar construction or modification from theAn u Management District,Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and stare that the ab.ve information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and he . bathe representatives 01 tb�s((��:'y to enter upon the above-mentioned
property for inspection purposes. /����
� `� �Dale: J �s? Signature: �_ G.� •
Driver's License or Social Security
1641-46 White—BmWmg;Green—Code Enforcement:Canary—Applicant;Prnk—Revenue:Goldenrod—Assessor
_
CONSTRUCTION AND PLANNING POOL ' SPA T
APPROVALS Permit 4Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrca: Serr:ce or Pole 52. Pool & Equipment Locator,
2. So•! Pipe-Undrg'nd. - 53. Steel Reinforcement
3. Electrical Conduit Utlity-Undjgrnd. 54. Forms
4. Electrical Conda t-Undrgred 55. Electrical Bonding
5. Stee: Reinforcement /' 56. Rough Plumb:ng & Pressure Test
6. Electrical UFER Grnd 57. APPROVAL TO COVER-GUr:'TE
r
7. Footings 58. Electrical Conduit-Undtgrnd.
8. Foundation 59. Gas Pipe, C Undrgrnd.,Test
i
9. (Yater Pipe-Und'grnd. 60. Backwash Linn. , P-Trap, _I Unurvnd
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fi,i,+I !
12. Sewer Cap 63. Heater & Vent-Firs,
13. Roof Drains hf 64. Rl umbing System • F-nal
14. Rough Plumbing '�• 65. Electrical-Final �^
15. Rough Eiectricai-Conduit 66. Solar System-Fin..l
16. Rough Electric`:liring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING II
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Ro..gh Factory F'rea:ace APPROVALS Permit 4 _ 1
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 1.1 Gas ❑OSI -
23. Gas Pipe-Rough & Test 72. Underground Fluff .-
24. Roof Framing 73- Undergrnd.Stora, 'ink T G
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and F!ash'ng 76. Dry Standpipe J^
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Piaster Brown Coat •
79. FINAL INSPECTION - -~
32. Electrical Por:er :'meter-Final '' 30. FOOD CE CERTIFICATE ISS.:ED
33. Fins) Electric Notus:
34, Final Heating & Air Condition:no
35. Final Gas Pipe.Test •
36. Hood or Canopy -- -------- -----
37. Final Factory F rep ace
38. Final Plumbing
39. Water Service-Final 1
40. Gas Serv+ce-F,nat
41. Solar Domestic-Finai
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46- Handicap Regulations
47. FINAL STRUCTURE & BUILDING V
48. FINAL PLANNING / -7,
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY
No. Date
-j
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 6638 DATE February 9, 1971
LOT NO. 24
ADDRESS 1092 Santa Cruz Circle, C. M.
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
Paul E. Diehl (war yr were-) Janice I. Diehl advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition. fetid �'`
By
Paul E, Die—
BY
chaser -Janice I. Diehl
BY<=��CL,I,4*; l :<
Developer and/or authorized
representative
BUILDING SAFETY DEPT BY
Lender
FEB 1 0 1971
OWNER EF;TTZER ET ERPRTSES - C. M. DATE 9-26-69
JOB ADDRESS 1092 Santa Cruz Circle BUILDING PERMIT NO. 30879
GENERAL CONTRACTOR same DESCRIPTION of WORK ReRidenee W/Attached. Garage
A ,. - LOT 24 TRACT 6638 FIRE ZONE VALUE $pp,014.00
IN.... ECTIONS Signature Date GROUP I & .1 TYPE ZONE R-1
SOIL enS'41—ne. PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number Signature
WATER f4-4-7444.01-r-rea 4'Ad rifle Plumbinq.
ROUGH PLUMBING M�6 -i -i ' r � �0 s/a /�•�
PROP. SWR. LINE [�'FIOUSE CON. d /V«'(o7'r'70 .mi#. /LG .A p 7� -
SPRINKLING SYSTEM 7
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING MC 4 --rid
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER ❑
ROUGH WIRINGt/� /7 70 Heating'a�n J)),Ve t.
TRENCHES L_ FORMS STEEL REINF. g} Li •-76 //j��2 `L<<� s-/ 7 ��
FLOOR SYSTEM V-ia/ 10 // , 0, . ! nen kl-.. /�
BOND BEAM n STEEL REINFORCE Fi ` / /
SHEATHING f 6il0
FRAME AND FLASHING 6 9/ c
LATHING - IN OUT /, iy tO
P. •STER, BROWN COAT��.(.{� i A 00;TU /�
H EAT I HG RAL, F VENT.,NARtPS4Zi.(AND A.C., FINAL -Mrs C-'G/_� /��rindea a PTE
PLUMBING, FINAL AND GAS TEST f' 9 /1-/- /
ELECTRIC, FINAL //WC•7tg
BUILDING, FINAL / /1.10-7D
/1/171
30879 '0v 12-69PA1000 416+ ***1714.50
[N$G
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEI D D R c v
Fp DATE ISSUED
BUILDING 1092 Santa Cruz Circle y& SEP 2 6 1969
ADDRESS
PERMhT,NEkin
OWNER Heltzer Enterprises-Costa Mesa A.P. NO. ,�—/.,��--.'+lir} / 1
MAIL BUILDING to
Q�'�E72'-"'" f`
ADDRESS 740 No. La Brea Ave. ADDRESS /
0. U CITY L.A. Cal O,EL937-2171 TRACT 6638 LOT 24 BLOCK
Z CONSTRUCTIONEW ,ADD ALTER REPAIR MOVING , DFMOI ISH
z_ a United California@alifornia Bank (//
O in LENDER
a m Main Office
J D BRANCH
JN OWNER t idir /M.'
xt W/ _/
ADDRESS 6th and Spring. L.A. VALUE ; ^'/p�
m ARCHITECT TEL USE A a z $040(1 O
J Q OR ENGINEER Frank Gonzales N .532-6878 �) �'/
Z ¢ 1336 E . Cha man Cal. ZONE TYPE p/ GROUsIy V //
W < ADDRESS Chapman, Orange, (((/V////
d W
W Z APPROVED
J O CONTRACTOR George J. Meltzer & Assocs. BY DATE
mZ
J ADDRESS Same as above
W Lu TEL. ZONE NO.OF USE OF NEW Single ram.
ZH= CITY NO. Rl PLANS 2 BUILDING Res. w/att.Gar.
W201098 STATE 201098 CITY 1707 YARDS APPROVED YARDS APPROVED
to cc LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D O 512E NO.OF BLDGS.
(FROM C/L STREET) /
OF LOT I NOW ON LOT FRONT a aFT. f))✓ FT.
USE OF
EXISTING BLDG. R SIDE FT. FT.
I- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE TFT. FT.
ol EXTERIOR WALL ROOF
f
_ COVERING COVERING REAR ail
FT. FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.) BET.MAIN&
0-
C-
MAIN BLDGS. ACCESS. BLDGS.
'Cr Residence with attached garage VAR.# DATE
C.U.P.# APPROVED /
y Plan No. 402 ___ELY
YPgOVED Ian DATE /a/� /H 9
204/7
O
VI hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
I F any person in violation of the workman's compensation laws of /t
cn the State of California. .� '/ �J /� co
Z -
I hereby certify that I am properly licensetl as a contractor under / SQ.fd FT, l//-X y..7-J (/�� o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business �/� 7�j n
and Professions Code,Divisio 3,Chapt. 9. VALUATION �I PERMIT FEE $ a"- r v d j
cc
Signature of /� e Lt� //s6 B
Perm lttee K • $�� D�� PLAN CHECK $ / E
/-2y v L
Authorized Agent u
TOTAL FEE S
OWNER DTERTy PAUL E. DATE 11-9-77 _-__-
JOB ADDRESS 1092 Santa Cruz Circle BUILDING PERMIT NO. 44986
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Le alize Patio Cover
o. 412-061-25 LOT TRACT FIRE ZONE VALUE E 600.00 7
Ih,,YECTIONS Signature Dote TYPE v GROUP ZONE R-1' I _
SOIL SUBCONTRACTOR PE HITS I
GAS Dote Number Sign ure
WATER
Plumbing
IT
ROUGH PLUMBING I h
•
PROP. SWR. LINE n HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
TEHEATING AND AIR CONDITIONING •
H.
TEMPORARY AIRY SERVICE OR POLE \\\\\
UNDERGROUND ❑ POWER
ROUGH WIRING Heating and Vent.
t TRENCHES I J FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM [-] STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING – IN n OUT n
c' STEP. BROWN COAT
,CTURAL. FINAL Electric
HEATING. VENT.. REFRIG. AND A.C.. FINAL —,
PLUMBING, FINAL AND GAS TEST n
ELECTRIC. FINAL p •
BUILDING, FINAL 0/7/f yr 97 --(
PA ID
44986 ;QV 9'T7CHSAOO 11,9# *p•k'Al 2.50
Y' . -•
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEI DATE RECEIVED DA IS U
BUILDING ," // T
ADDRESS i 0 it J(a�./7Q n(�LAct Li et-c-(- L� 1 PERMIT I7"
OWNER P13q- I C . Ole Al A.P.NO. 1'�� l— Z�
MAILBUILDING �1 /�
ADDRESS /D92_JQ.1)4 LR.'•2 CriCG0 ATEDDRESS �09� �j.� �`R�) I.P�-
CITY C.a}4 An o34 9-2-CY.(, NOL SS7'/SSD TRAC1d6S5 I LOTZL1 BLOCK
CONSTRUCTIONEW I ADD ALTER REPAIR MOVING DEMOI ISH
Al/-
LENDER o/✓ e ..j\
BRANCH
OWNER
ADDRESS VALUE \_
ARCHITECT TEL. USUE S
OR ENGINEER NO i
FIRE
ADDRESS ZONE TV GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS L t 1�p7µ�� INO.OF USE OF NEWrth^n Q
CITY NOTE1 PLANS BUILDING came
F. STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
N] SIZE NO.OF BLDGS. (FROM C�/L�ST•J�EET)
o. OF LOT NOW ON LOT ( FRONT/'4�srC t FT. FT.
in USE OF rl 0‘.3-0-
4}� R SIDF 4XCFT. FT.
EXISTING BLDG. 1�
to
Separate permits are required for L.SIDE 3o FT. FT.
electric,plumbing and heating work. 2
dREAR FT. FT.
siC USE OF BUILDING AND WORK TO BE PER DISTANCE BET. BET.MAIN&
C �/ 1 MAIN BLDGS. ACCESS.BLDGS.
7 1 J/ VAR.# DATE
Q G I I v C.)U kfl , ,a C.U.P.0 APPROVED
} /O /` G�sv _aY ROVE DATE 1/-9-77
.•1
IX
fa
0 I hereby acknowledge that I have read this application and state . n
a! that the above Information Is correct and agree to comply with m
3. all laws regulating building construction, and I shall not employ s
Z any person in violation of the workman's compensation laws of oma
x
Me state of Califprnie. 2G O �L
3 I hereby certify that I am properly licensed as a contractor under (� SQ. FT. )-.3/7(j tie
E4
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
vi
am exempt from the •r'visio ns, the eo rola Business /ZOO
r. n
VALUATION PERMIT FEE $ G
end Professions •.•[ 'vision 3,Chap r 9. a_ m
0 PLAN CHECK $ (I
Signature of C
Permittee _. $ ea, TAX $ s•SoU
Authorized •gent TOTAL PAID $ /2/ 5-0 •