HomeMy WebLinkAbout1421 SHAMROCK LN - Building Permits 9 CITY OF COSTA MESA
BUILDING DIVISION
> :�•,,,,.' DEVELOPMENT SERVICES DEPARTMENT PERM UMBER
2 PERMIT
RATIO PO4-00775
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1421 SHAMROCK LN Status: ISSUED
Suite No Applied: 11/15/2004
Issued: 11/15/20 4
Vicinity:
ISSUED BY:
Parcel Nunmber: 41814121
Applicant: MORELLI, SARAH
Address: 3412 GERANIUM ST
Phone: 714-957-1577
COSTA MESA,CA Zip: 92626-1674
Owner: MORELLI, ABIDALLAH
Address 3412 GERANIUM ST
Phone:
COSTA MESA,CA Zip: 92626-1674
Contractor:
Address:
Phone:
Zip:
License:
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
CHANGE OUT WATER HEATER
FEE'SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00..,. 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval Must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(WOO)
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 it the permit is valued at one hundred dollars($100)or less.)
•
-0,1 certify that in the performance of the work for which this permit is issued,I shall not em loy any person in any manner so as to become subject to the workers'
C i__ccompensation laws of California,and agree that If I should Is,come subject to the worker compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with those pro ' ions. _ z�
Applleant'Slgnature: _1 1�/_I �_ / r , ((,,m��ate:_ ! —4 r� —( I
WARNING_FAILURE TO SE WORKERS'CO •TI •VERAGE I UNLAWFUL AND SHALL SU ECT AN EMPCOYERTOCRIMINAL PENALTIES O CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVID FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.fi Class x
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
IFI 0s 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 ex:I.•^n•_ sec. Business and Professions Code for this reason:
fstggna`tur:. ._ I I .•,
OwnerTD verified by drivers license. al 0 No Onver's License No ire5�'�
Verification of Ownership by(type of document,i.e.-property tax bill or dee :
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,talsework,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 ❑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 aggermit for such construction or modification
from the South Coast Air Quality Management DIstnct or from any other air pollution control district or agency? 1Yes L1 No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I a•ree 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
a•• •escrl.:.propertyfor in pectio •� ..les.I agree •• to occupy or allow occupancy of any building authorized by this permit until final inspection.
Or
•
Signature Of Leg!nwner(s)-'�-„ LDate
lam— �� •- _ �..`-1
And/Or Authorized Applicant Date
CODE I INSPECTIONTYPE PATE INIAL@ CODEt INSPECT10NTYPE PATE FMBLS
1616 Fixed System Final Fire Prevention 206 Final Mechanicalr
1268 Pool Spa Final 208 Final Plumbing n `n(•C - of 13 I lr
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
__ y ` Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. _
• CITY OF COSTA MESA •
PERMIT NO. TR•A T NO. . LOT NO. BLDG.NO. - -
'CpNSTDUCTIOrsjPERMIT
���������� SF 4' /A3 . 3 •
.- 6 •
735 3/28/84 190.43 Tl
Project Address - I� i:�l]/1 it i 2.r - 14/PE OF CONSTRUCTION • NEW II ADD II ALTERATION 1. REPAIR • If I
Applicant's Mailing_,Address . . ii . . Z' 1 La: • - ❑ CONVERSION ❑ DEMOL ISH ❑ OTHER A.P.# qJ��,2— 141 -
/t 1 _ a 1 Zone t/ ' '
Owner's Name /�(] - - Al, / Phone - DESCRIPTION OF WORK • (V-P Cmrv(5�'e UU Cr' -(.L /!¢L - dry (' '-( t
.,_`l to _ • a L - - as ,e i#J.. /ea •O S Main Building: ALessory Building: . Z
Address. 3' 6, (d tf7L9 ANLL-%N 7 'f ' t%43 1.11 ,..L1 0
-
a,/ l - ' 1' J TYPE OF PERMITI�{ GRADING . OUNDATIONSTRUCTURAL T Front Ls.tileeC_h-ZeL 2 N
P•4(Fe J rgt'�t f VOI License NO. ❑ TENANT ey ELECTRICAL ❑ PLUMBING�-0 MECHANICAL� ; [� B Rear 1 I/ I
\ Address 40 Leaf i 1/Yvve ❑ OTHER Con/17P1./A-z'-r. C,vi3 S!L A z� x N
•t/, Contractor's Name Phone PROJECT DESCRIPTION SO. F OCCUPANCY R- 3 C Right (�-py(`p��, •
G
/�, Left '3/ R
W CONSTRUCTION TYPE AlN VALUATION$ I'3 nein
Address(mailing) / , / - f E
\d-b/) ZONE GRADING CU. ACRES Pin Ref.'//= + � e4 -S Park.Fees $ u
City License No. ': - . n j 9� v
1 LICENSED CONTRACTO E L RATION Remarks: Y C / 4 — �'�./' Parking Req./Provided (
•
t hereby affirm that I am licens under provisions of Charter 9 (commencing YYYY / / n r
with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: .IX-/--4. _..- E
1 my license-is in full force and effect. - -
r� License Class License No. PLUMBING I FEES Planning Notes: M
I `ate Signature - r� s, E
7RKERS'COMPENSATION DECLARATION Bar Sink Showers _ J`2/Lu-�'tc^'sv - /-et7DYr� O-iv.-ryl-C.4�� N
.nereby affirm that I have a certificate of consent to self-insure or a certificate - S
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer • Service Sink S
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES •
Policy No. Company 'TE n1N1-> - --
-[],Certified copy is hereby tarnished. ' Bathtubs • Sewer Connectioni YAutomatic Washer Transformer 0 15-50 KW
Certified-� y �lletl with the city = n 'D i _ -
Date /bD// Y {/ Applican .t/ Clarifiers Solar Collectors Construction Pole Sub. 050+KW
EXEMPT! N F OM{WORKERS' •M'ENSATION:•ECLAR N Dishwasher
(This section need not be completed if the permit Is •r one hundred ($100)or Solar Piping _ Cooking Unit Meter ❑up to 100 amps
less). Drinking Fountains
I certify that in the performance of the work for which this permit Issued, I 9 Solar Tank Dishwasher Meter Dover 100 amps'
shall not employ an pe son in any Californiaa [ < O e subject to the
Workers' Co n t' ws of ornia _ - Floor Drains Swimming Pool w/Spa Dryers ❑Gas DElectric Sub Panel
Date i nature 4
NOTICE:If,la t r in this-declaratio you should be ome subject to the Floor Sinks Urinal- -- Fan Motors❑0.1 HP 01%-8
Workers' Compensation provisions of the Labor Code, you must forthwith ,
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.Solar ❑9-15 HP❑16-15+
CONSTRUCTION LENDING AGENCY r
I hereby affirm that there is a construction lending agency for the performance Interceptors • y( Water Heater - - — Fixtures - Microwave 20
of the work for which this permit is issued (Section 3097 Civ. C.) '
Lender's Name Kitchen Sink ' Water Service s Device Boxes Pole Light
Lender's Address
/r
OWNER BUILDER DECLARATION 6-f � . _ Lavatories ?LUM&IMG- Hues A -- 4 Outlets ic Range - V r.44,1 • V ,?p
I hereby affirm that I am exempt from the Contractor's License Law for the T}}t
following reason (Section 7031.5 Business and Professional Code: Any city or " i -- 5 Switches Sign u
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 Roof • 3 — Garbage Disposal Standing Sections
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she'is exempt - Generator ❑0.5 KW ❑5.15 KW Trash Compactor
•-,therefrom and the basis for the alleged exemption. Any violation of Section I I _ -
7031.5 by any applicant for a permit subjects the applicant to a civil X !J(aNC
.J /A/(�{(Q/6e-
'p natty of not more than five hundred dollars($500). Reinspection Fee $25 Issue Fee $ 3' 3
LJ I, as owner of the property or my employees.with wages as their sole MECHANICAL Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered FEES
for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS: •
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I ❑ by..C.-
�7
thereon, and who tloes such work himself/herself or through his or her own Zoning Approved By K•� I // Date 2-1
employees, ever,provided that such Improvements are not intended or offered for Canopy Type II 0 t/.a, tK.C.I�A//
sale. If, however, the buildingor Improvement is sold within oneyear of com- Duct-Under Ground BApproved By Date
Buildin f u�
pl elle the owner sewill have the burden of proving he/She did not build or forim-
LJrov< the purpose of sale). Duct-Structural Refrigeration System Application Issued By x�'� / Dat. H
I, as owner of the property, am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000 BTU ,
tractors to construct the project(Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who ft . SO
builds or Improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration ▪ BUILDING PERMIT $ • • SMIP $ �' `�
tractor(s) license pursuant to the Co rq License Law). _ • 02
•
0 I am exem t un er SectAn !/ - & P. .'for t•is reason Firepl/F.act.Blt. ICBG# ' It PLUMBING CHECKPLAN $ - PERMIT
U' , I 61 ISSUANCE $
•
Date cane •- - F /� ' Heating System& Ducting _ < PLAN CHECK 25% $ 0 ENERGY P.C. $
I hereby certify t at-I have red ./is applicat.t and std • that the above 00-100,000 BTU 0100,000 BT ■ 0 GRADING $
Information Is correct. I agree to comply with all city and 'ounty ordinances $
• ELECTRICAL
and state laws relating to building construction, and heresy authorize repro- • PLAN CHECK 50% $ - .2Q MICROFILM $
sentatives of this city • ent• p•• the above-mentioned pr pert for �__
Inspection purpose= y 24 / .i.e, MECHANICAL $ '-'f /
Signature
!� Reinspection Fee $25 Issue Fen $ 3 PLAN CHECK 25% $ o V 0,tf'�
CMF 0865-46 rev.12/83 White-Building; Canary-Applicant;Pink -Accounting;Goldenrod-Assessor I `
iFONSTRUCTION AND PLANNING - POt,_ Al SPA - -
APPROVALS.
Permit# Date - .Inspector APPROVALS Permit# - Date' Inspector
R1. Temporary'Electrical Service or Pole ' - • 52: Pool & Equipment Location ' -
' 2: Soil Pipe=Undrgrnd.' - , ,53. Steel Reinforcement -
3: Electrical Conduit Utility-Uridrgrnd. , 54. Forms • . - - -
4. Electrical Conduit-Undrgrnd: -. • 1 55: Electrical Bonding - .
5. Steel Reinforcement , , . 56. Rough Plumbing & Pressure Test �r
6. Electrical UFE .R Grnd. - - 57• . APPROVAL TO COVER-GUNITE -
/l: Footings,_
, -, 58. Electrical.Conduit-Undrgrnd. .
8. Foundation ' 59. Gas Pipe, 0 Uridrgrnd., 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 - . •
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- r Z j,-- .71 (t( C� - 67. Fencing &Access Approval - •
•17. Rough Wiring Sign ' 11 - 68. APPROVED FOR PLASTERING
' 18.; Rough'Electrical-T Bar Ceiling ' 69. POOL/SPASYSTEMS•FINAL ,
19.;Rough Heating & Air Coriditioning FIRE DEPT. REQUIREMENT-
•
20..Rough Factory Fireplace APPROVALS Permit#
21;-9ucts, in Structure ' 70. Underground Hydro
22, 'Ducts, Ventilating . `-,) 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test ; • - 72. Underground Flush.
24. Roof Framing, 73. Undergrnd{St6rage Tank 0 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 - , ' I , . 77. FIXED'SYSTEM FINAL
29. Insulation - f .78. FIRE PREY. FINAL '
30. Drywall Nailing '•/. ' • I HEALTH DEPT. REQUIREMENT ,
"31. Plaster Brown Coat'. - . - - 79. FINAL INSPECTION
32. Electrical Power Mete1Final , 80. FOOD"CERTIFICATE ISSUED
33. Final Electric " Notes: ,
• 34. Final Heating &'Air Conditioning ' t ®'(6 tid S 41 are a&f
35. Final Gas Pipe-Test , . -
36. Hootor Canopy -
37. Final Factory Fireplace
f
38. Final.Plumbing' a , r . ,FlZhj/)7f LFA'
39. Water,Service-Final -
- rr
40. Gas Service-Final ' '
41. Solar Domestic-Final I -- - - - - '
42. Backflow Preventer . ' t ' .-:-. - ..
, -
43. Backflow Irrigation - ' ,
I
44. Landscape Irrigation System . . a
45. Sound Attenuation' , I - ,
46. Hanflicap Regulations - . • ' ',
47. FINAL STRUCTURE & BUILDING,. 9/S./B� p . .
48. Special Requirements Completed , . ••
49- Electric Release to Edison �-
•
50. Gas Release t6 Southern California Gas Co i r ' '� ' ' ''I
51. CERTIFICATE OF OCCUPANCY - - - - - - - - •�
No. • s '- : Date m • ' - ,
y% SUBCONTRACTOR LIST
P� City of Costa Mesa — Planning Division * P.O. Box 1200, Costa Mesa, CA 92626
•
Builder Robert Volpe (Agent) Address 40 Lewis, Irvine Phone 546-3629
Job Site 1421 Shamrock, Costa Mesa Date 3-28-84
Permit # BEP-12323 Valuation $13.000.00
SUSPENSE DATE FOR PARTIAL LIST DUE: 4-24-84
TRADE SUBCONTRACTOR ADDRESS PHONE STANUTEMBER LIC.,
ASPHALT
CABINETS '
CARPETS
CARPENTRY
CEMENT CONT.
CEMENT TRANSIT
CLASSIFIED SPEC.
CLEANUP/HAULING
DOORS (GARAGE)
DRAPERIES
DRY WALL
ELECTRICAL
ELEVATOR
EXCAVATION
FENCING
•
FIRE EXTINGUISHER
FLOORING/DECKING
FORMICA
FOUNDATIONS
GLAZING
HEATING
INSULATION
LANDSCAPING
LATHING
LINOLEUM/ASPHALT
TILE/GUNITE
MASONRY k
PAINTING •
PLASTERING
PLUMBING
POOL /
REFRIGERATION
ROOFING •
SANDBLASTING
SEWER
SHEET METAL
SHOWER DOOR
SOLAR
SPRINKLERS
STEEL REINFORC.
STEEL STRUCT.
•
STUCCO
TRUSSES/GLU-LAMS
TV ANTENNAS
WALL COVERINGS
WEATHER STRIPPING
OTHER SPECIALTY
CMF 0701.30 rev.1)2/82
r
.CITY OF COSTA MESA
DEVELOPMENT SERVICES DEPARTMENT
PLANNING DIVISION
• OWNER BUILDER ' CERTIFICATE OF EXEMPTION
• I am fully aware of the responsibilities as owner builder. The persons named below are my
employees and I agree to withhold.the following required deductions: Federal and State Income
• Taxes, Social Security payments, and Workmen's Compensation Insurance Premiums. My employer's
nwnher is. 565,52E 'Of,
Further. I hold no objection to a copy of this certificate being forwarded to any governmental
agency upon their request for same.
•
Employee's Name .Address . Social Security No.
1.1 dl,J f l-i✓rc f- 1- 6 2.2_ 1,14,4411-7-0 n! t. AI •
6-6/ -
•
•
•
Under penalty of perjury, I declare that the above statement is true and correct to the best of my
knowledge and belief.
� KtA%Ta2
Signatu„ / ,;(-4( Date
Date
iq I ri
Address 2/0 / ' Gt/t j a!!/17&<---
i
V
CITY OF COSTA MESA •
DEVELOPMENT SERVICES DEPARTMENT
P. O. Box 1200
Costa Mesa, California 92628-1200 •
Date: March 28, 1984 ESESf 938
To: Robert Nicol Agent: Robert Volpe 2SaC-82 .
40 Lewis 00.000,Eft ,
• 3406 Sheffield Irvine, CA 92714 •
Arlington, Texas •
Re: Subcontractors List
We note that you have recently been issued a City of Costa Mesa Building Permit to do construction
or home improvements at 1421 Shamrork, Costa Mesa
❑ The Building Permit indicates that you are the General Contractor. Our Municipal Code re-
quires that all subcontractors working on your job purchase a City business license. We are
requesting that you complete the enclosed Subcontractors List and return it to the Planning
Division. It is your responsibility to see that all subcontractors purchase a City business
license prior to your request for final inspection. Final inspections will not be given until
all subcontractors are licensed.
® The Building Permit indicates you are the Owner/Builder. If you are acting as the General
Contractor, our Municipal Code requires that all subcontractors working on your job purchase
a City business license. Please complete the enclosed Subcontractors List and return it to the
Planning Division. It is your responsibility to see that all subcontractors purchase a City •
business license prior to your request for final inspection. Final inspections will not be given
until all subcontractors are licensed.
❑ The Building Permit indicates that you are the Owner/Builder. If you are acting as Owner/
Builder, please complete the Certificate of Exemption which is on the reverse side of the
Subcontractors List and return it to the Planning Division. It is your responsibility to see
that all subcontractors purchase a City business license prior to your request for final
inspection. Final inspections will not be given until all subcontractors are licensed.
❑ Not all Subcontractors at the job site have obtained City business licenses, therefore, as of
, the Building Division will no longer respond to your
requests for inspections. This is the only reminder you will receive from this office.
Should you have any questions in this matter, please do not hesitate to call the undersigned at
754-5623. Thank you for your early response.
Sincerely, •
ta _ -
t2.1
0191
Nancy unge, C e Enforcemat
CMF 1115-30 White-Addressee;Canary-2nd Notice Addressee;Pink-File CU 1Ifr ff11(j
"Y OF COSTA M .
O oat CALIFORNIA 02828 P.O. BOX 1200
I
�� FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/
BUILDING SAFETY DIVISION
• CEF3TIFIED MAIL
COMPLIANCE OR OCCUPANCY INSPECTION REPORT
APPLICANT TO FILL OUT
Subject Address /tit Z/ _..E. , r"/1/C/'OA - ' ' L/17/, • Date Rec'd.
Mail Report or Correction Notice to: '
Applicant /7///2//i. 71?/-7-/- 41/7121//--.M.1/ti Telephoner/) 5.5: ,
Y/7
Address L/) 1. /r�J / -1y////� /I /1 ' Zip Code a~/•7"/
Owner's Name (Print) f�K/rnT f/ /2'///4-(9L - •
Owner's Address • /- - • ,A1 Zip Code
Owner's Signature/ / "` '� "-``�6" - _ Date 1/1
-• ft..//7 ,rsl ,c/.N,vr.:. f
Recorded by
initial
Compliance Inspection No. % ` 4 4/ `;CMB No. ,6 7/
Site Location
At your request, inspection was made at the above-referenced address-on /-1/;'0/ c 3
and the Code violations shown on the reverse side were observed. -
You will be required to correct the violations listed within fifteen (15) days after receipt of this letter. Failure
to comply within the allotted time will result in a complaint investigation being initiated for compliance of the
Codes. • •
If.you need assistance, please contact the appropriate Inspectors listed below:
Structural ),./ I . ( /v/.. Cl •
Electrical iP)ci 1) (" 0: n ,/,/ it/ (754- 5;230 )
Plumbing/Mechanical (754-
Very truly yours;
•
CIOV r/ '
Name
( w i F (- T S ✓�r/aiC
Title i 4 / •
-
cc: Inspectors - -
Property Owner 'NOTE: SEE REVERSE SIDE
CMF 1035-46,rev.9/83
White-Bldg.;Canary-Owner;PlnkClerlcal 77 FAIR DRIVE (714) 754-5273 -
Compliance CMB 591 12/20/83
STRUCTURAL
1. The addition (17' x 20' ) at the rear of the residence has been constructed
without the required plans, permits and. in'spections. -
2. The shade arbor (13', x 18' ) attached to the illegal addition has been con-
structed without the required permits, plans and inspections.
3. A door has been installed between the garage and a bedroom. Prohibited
hazard under Section 1104 U.B.C. 79. The door and steps shall be removed
and the fire wall shall be restored.
4. The fireplace has been altered without the required permits and inspections
(double opening).
5. The illegal addition has a side yard restriction of 33". This may require
application for a variance.
PLUMBING AND MECHANICAL
PMTL,t •
1. The waterAhas been relocated to the garage; permits and inspections required.
2. Plumbing lines and gas lines have been installed in the garage for a washer,
dryer and sink. Permits and inspections required.
3. A gas line and wall heater have been installed in the illegal addition. Per-
mits and inspections required.
4. The gas range in the kitchen requires an approved venting device.
ELECTRICAL
1. . Family room added without permit and inspection. Additional receptacles and
switching required. A.minimum of two additional circuits required. Interior
wiring in walls to be visible for inspection. Exterior receptacle to be
protected by a GFI circuit.
2. Interior wiring in garage to be removed. Romex (sheath cable) cannot be
exposed. EMT (conduit) must be used when not contained between wall cover-
ings.
3. Above items to be permitted and inspected.
4. Ceiling junction box in dining room cannot be concealed.
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA % PERMIT NO TRACT NO. LOT NO. BLDG.NO. •
` •CONSTAUCTION PERMIT jE- la 8' 93 9202 4/24/84 10.50 TL
Project Address - . e \ -
L TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR
Applicant's Mailing Address , ❑ CONVERSION ❑ OEMOLI H 0 OTHER A.P.# I Zone /
Owner's Name r,i # 'I-NI GOL phone DESCRIP ION OF ORK 4 #'I a # '
��""// ' S Main Building: Accessory Building: Z
Address v .Siert/cL.'D A/1L/N[76A17 -)e �f0 �L[Y �( C 1q7� •'A' !/��(� E •
O
VO I_ TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front N
AwHlGwrjr License No. 0 TENANT ELECTRICAL 0 PLUMBING 0 MECHANICAL B I
Rear
Address 40 L'ew is Irytl WE ❑ OTHER A - N
7� 1 C Right / R
VO Contractor's Name OW N�PK %V rl�'A(� Phone PROJECT DESCRIPTION S FT. OCCUPANCY 2-3 K R
CON ST RUCTION TYPE '� ,ti VALUATIONS S Left
Address(mailing) 'r
E
ZONE GRADING CU.YDS. ACRES Pln Ref. ' Perk.Fe¢S $
City License No. - 9-
LICENSED CONTRACTOR DECLARATION nJ U
1 Remarks: aep // 3 b2 7 Parking Req./Provided R
I hereby affirm that I am licensed under provisions of Charter 9 (commencing l
' with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: • E
my license Is In full force and effect.
License Class' License No. PLUMBING FEES Planning Notes: M
, mate Signature E
I
DRKERS'COMPENSATION DECLARATION Bar Sink ShOw¢rs N
.nereby affirm that I have a certificate of consent to self-Insure or a certificate - - T
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service SinkS
3800. Lab. C.) _.fes Backflow •Irrigation Sewer Cap r ELECTRICAL FEES
Policy No. Company ryV - _
ertifie copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW
Cert Vje c fit with the city Bu_ 9..Avis •.. /1i'
Dae 'Y Applicant ds—a --' % a— Clarifiers Solar Collectors Construction Pole Sub. 0 50+KW
EXEMPT! N FR M ORKERS'C• •ENSATION •ECL• 1ATIO Dishwasher
(This section need not be completed If the permit is for one hundred ($1Solar Piping or P 9 Cooking Unit ' Meter ❑up to 100 amps
less).
I certify that In the performance of the work for which this permit Is issued I Drinking Fountains Solar Tank Dishwasher Meter Dover 100 amps •
shall not employ any person in any manner so as to become subject to the ,
Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date Signature -
NOTICE:If,,after making this declaration,you should become subject to the Floor Sinks Urinal Fan
Workers' Compensation provisions of the Labor Code, you must forthwith Motors❑0-1 HP ❑1'h-8
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc.Solar 09-15 HP❑16.15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance • Interceptors Water Heater Fixtures
of the work for which this permit Is issued (Section 3097 Clv. C.) Microwave
Lender's Name - Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address • Lavatories
OWNER BUILDER DECLARATION Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap reason (Section 7031.5 Business and Professional Code: Any city or p Switches
county which requires a permit to construct,alter,Improve,demolish or repair Sign
any structure, prior to its Issuance, also requires the applicant for such permit Roof Drains Garbage Disposal Standing Sections
1
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
.Division 3 of the Business and Professions Code) or that he/she is exempt Generator 00-5 KW 05-15 KW Trash Compactor
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). Reinspection Fee I $25 Issue Fee S 3
U I, as owner of the property or my employees with wages as their sole - - Reinspection Fee $25 Issue Fee $ 3
compensation will do the work,and the structure Is not Intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's -- - - - - — - --- - ----- - a - PUBLIC SERVICES REQUIREMENTS:
•
License Law does not apply to an owner of a property who builds or Improves Boiler Hood or Type I 0
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date
employees, provided that such Improvements are not intended or offered for Canopy Type II ❑
sale. If, however, the building or Improvement is sold within one year of com- Duct-Under Ground Building Approved By _ Date Y �!/
pletion,the owner will have the burden of proving he/she did not build or im- ! Q
prrove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By Date !J
U I, as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project(Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
tractor(s) license pursuant to the Co. actor's License Law). - PLAN CHECK $ PERMIT
❑ I am exem•t under Section s' `B #
. •.C.for this reason Firepl/Fact.Blt. ICBG
•W L 1/ - PLUMBING $ ISSUANCE $
Date s0''2LV Ow n2/4_ -r�'j'/�_ Heating System& Ducting ENERGY P.C. $
o ❑0-100,000 BTU ❑100,000 BTU PLAN CHECK 25% $
I hereby cer ify that I have r ad t is applica and da hat the a• ee GRADING -$
information Is correct. I agree to comply with all dy and y county irepres ELECTRICAL $ e
and state laws relating to building construction,and hereby authorize yfor •S'� MICROFILM $
sentatives of this ci • :neer pc: ����ggggeeee above-mentioned property for PLAN CHECK 50% $
Inspection purees- m q/�i/ MECHANICAL $ TOTAL FEE $ /r/ •"•'"
Signature W" /Is/ ata Y Reinspection Fee /
Drivers'Llc se •f Pe $25 Issue Fee $ 3 PLAN CHECK 25% $ / -SD
N
CMF 0865-46 rev.12/83 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING POU a_&SPA
1 Date Inspector Date Inspector
APPROVALS + Permit# APPROVALS Permit#
5-.Temporary Electrical Service or Pole52.. Pool & Equipment Location - •, -
L
2. Soil Pipe-Undrgrnd. - '' 53. Steel Reinforcement - 'e.
- 3. Electrical Conduit Utility-Undrgrnd. . . 54. Forms. -
" 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ,
6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE +, '
;, 7. Footings 58: Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test
. 9. Water Pipe-Undrgrnd. . 60. Backwash Lines,P-Trap, 0 Undrgrnd. • ,
10. Structural"Floor System 61. APPROVAL TO DECK •
• 11. Pioperty Sewer Line & House Connection - 62. Backwash & Receptor-Final .
•
12. Sewer Cap n • 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 S//1 J$"4 £1 C 67. Fencing & Access Approval ,- -
17! Rough Wiring Sign / 68. APPROVED FOR PLASTERING -
18.. Rough Electrical-T Bar Ceiling _ 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
' 20..iRough Factory Fireplace APPROVALS Permit# '
21. Ducts, in.Structurer 70. Underground Hydro
22. Ducts, Ventilating , - 71. Product Piping 0 Gas' 0 Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar•Celling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION
32. Electrical Power Meter-Final �-L 80. FOOD CERTIFICATE ISSUED
33. Final Electric �- Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hoed Or Canopy '
37. Final Factory Fireplace '
38. Final Plumbing ' •
39. Water Service-Final • '
40. Gas Service-Final
41. Solar Domestic-Final • .
42. Backflow Preventer02._.2
43. Backflow Irrigation ' , ' 1
44. Landscape Irrigation System
45. Sound. Attenuation
46. Handicap;Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed '
49. Electric Release to Edison - - - �`
r.Y
50. Gas Release to Southern California Gas Co '
. ,c)
51. CERTIFICATE OF OCCUPANCY - • - r
No, - Date
M a
air
•
,��► '� , CITY OF COSTA MESA:
ar
y %Q4 CALIFORNIA 92626 P.O. BOX 1200
4• III
FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/
e BUILDING SAFETY DIVISION
•
CERTIFIED MAIL
•
COMPLIANCE OR OCCUPANCY INSPECTION REPORT
APPLICANT,TO FILL OUT I
Subject Address 1421 Shamrock Lane Date Reed._12-15-83
Mail Report or Correction Notice to:
Applicant Diana P1 etewpol-Vol pe Telephone(714)551-8191
Address 40 Lewis, Irvine, California Zip Code 92714
Owner's Name (Print) Robert A. Nicol
Owner's Address 3406 Sheffield, Arlington, Texas Zip Code 76013
Owner's Signature Date
single-family residence Recorded by
initial
Compliance Inspection No. 084453 CMB No. 591
Site Location
•
At your request, inspection was made at the above-referenced address on 12/70/83
and the Code violations shown on the reverse side were observed. •
You will be required to correct the violations listed within fifteen (15) days after receipt of this letter. Failure
to comply within the allotted time will result in a complaint investigation being initiated for compliance of the
Codes.
If you need assistance, please contact the appropriate Inspectors listed below:
Structural W. E. Cloud (754.5293
Electrical Bob Cochran (754-5230
Plumbing/Mechanical (754-
Very truly yours,
3 -2 (3"-- pt?"-„r g 123 23
'7a
4-06/44/ 1-
W.
-P6H6/ rW. E Cloud N4 n'p.t�KY /Ll.14L To op-P0-/
Name pArto Cade,,
Chief BuildingInspector
P
Title q_S , SY /21-C2n4t7 aff/s /1323
//
'�riYy���t' iAIS c4TY ' �� /J
cc: Inspectors 1°St' C 3-9/ (rig 61(21
Property Owner NOTE: SEE REVERSE SIDE
CMF 1035-46,rev.9/83
1 White-Bldg.;Canary-Owner;Pink-Clerical 77 FAIR DRIVE (714) 754-5273
-/
Compliance CMB 591 12/20/83
STRUCTURAL
1. The addition (17' x 20' ) at the rear of the residence has been constructed
without the required plans, permits and inspections.
2. The shade arbor (13' x 18' ) attached to the illegal addition has been con-
structed without the required permits, plans and inspections.
3. A door has been installed between the garage and a bedroom. Prohibited
hazard under Section 1104 U.B.C. 79. The door and steps shall be removed
and the fire wall shall be restored.
4. The fireplace has been altered without the required permits and inspections
(double opening) .
5. The illegal addition has a side yard restriction of 33" . This may require
application for a variance.
PLUMBING AND MECHANICAL
EIe.TeA.
1. The waterAhas been relocated to the garage; permits and inspections required.
2. Plumbing lines and gas lines have been installed in the garage for a washer,
dryer and sink. Permits and inspections required.
3. A gas line and wall heater have been installed in the illegal addition. Per-
mits and inspections required.
4. The gas range in the kitchen requires an approved venting device.
ELECTRICAL
1. Family room added without permit and inspection. Additional receptacles and
switching required. A.minimum of two additional circuits required. Interior
wiring in walls to be visible for inspection. Exterior receptacle to be
protected by a GFI circuit.
2. Interior wiring in garage to be removed. Romex (sheath cable) cannot be
exposed. EMT (conduit) must be used when not contained between wall cover-
ings.
3. Above items to be permitted and inspected.
4. Ceiling junction box in dining room cannot be concealed.
J Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. t 15212 10/15/86 39.28 TL
--• CITY OF COSTA ($JESA CR NSTR�UC� �TI'ION PERMIT1PERMIT''INO. `'7''7 TRACT.�,lNO. LOT NO. UNIT NO, •
Protect A*JdrA' 19 2J •nAt.t 1o. i A, • R � /' ! 7 !�T' 3 - 7 ,
Applicant's Mailing Address 1 a ZZ WOOs"�W?a-4. LN.
At,.. TYPE OF CONSTRUCTION U NEW U ADD ALTERATION ❑ REPAIR
AAI C eI I 5'7'hf0 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ro i -gam/ 3 _O / I AD/
•
-0vdher's Name Phone f < A.P.AP # 4- �-/ Zone /i
11 DESCRIPTION OF WORK/USE OF BLDG. f r1<4(na e•et-
Address 442_I • SM Hm QO! —rerrelL - „---,, � S Main Building: ”- Accessory Building:
Arch/Eng. License No. TYPE OF-PERMIT C7 GRADING ❑ FOUNDATION IcKTRUCTURAL T Front tee S G' _ it? (t..0_ /L 0
Address t)/� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear S D� �j(� L„Q N
Contractor's Name— & n)/43o A"'s PhoneS?9"SI ❑ OTHER A 'C _ I
r� J • PROJECT DESCRIPTION Q. FT. o C NbY R\/M.( C Right N
Address(mailing/ 1 oQvZ wtcd W+O7 A �"�• ' �- � gg,97C• ONe _ _RVA1111,. K G
.2.5�7�$ CONSTRUCTION TYPE_X/M �S[LUATION$ $ Left -be
41,LyQa y1 (Lill .5 hanevbtOL-
'(s` City License No. ZONE GRADING CU.YDS. ACRES ��,,.A R
\ LICENSED CONTRACTOR DECLARATION Ping. Ref.# (p7 6 fed< (.ULI.(,( Parking Req./Providedal a3 X145 E
0
1C_ 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - - Planning Notes: /BLW fJ+.t/ a 2
`v with section 7000) of Division 3 of the Business and Prof esslons Cotle, and JrS/!.(�( M
my license is in full force and -fleet. 377 / /•���dgect �s[L., C1 T
License Clas ' Lie-if se No. J �,(/ ^U,` Ca._
4.-at)
- r
Date)Q O^ - ; - Signature • - - PLUMBING I FEES �7 NJ GP-- 106 4.- LAC
r.[ WORKERS'COMPENSATION DECLA'ATION • Bar Sink Showers
�!
\U hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL •
FE
` Workers' Compensation Ins ranee or a certified copy thereof (Section
An Backflow Preventer Service Sink
"1 ,( t o Automatic Washer • Transformer
�BoO, Lab. C,,jj rT l �j ,�•����/ / 0 15-50 KW
Policy No. {� Company C.I�uL .1 44 'r 1 '( Backflow Irrigation Sewer Cap Construction Pole Sub. DI 50+KW
ertified copy is hereby furnished-
ertified copyIs fty&ed with the city Bu ng Division.&� Bathtubs Sewer Connection • Cooking Unit Meter ❑up to 100 amps •
Date fen r^1 S Applicant lf!'•ov"-
EXEMPTION FROM WORKERS'COMPENS ION DECLARATION Clarifiers Solar Collectors . Dishwasher ' . Meter Dover 100 amp '
(This section need not be completed if the permit is for one hundred ($100) or - -
less). Dishwasher. . Solar Piping Dryers ❑Gas ❑Electric .Sub Panel
I certify that in the performance of the work for which this permit is issued, I - "'
shall not employ any person in any manner so as to become subject to te Drinking Fountains• Solar Tan - Fan
Motors DO HP ❑1'h-8'
Workers' Compensation Laws of California. _
Date Signature Floor Drains Swi • ng Pool w/Spa F.A.U. Inc.S• :r 09-15 HP X16-15+
NOTICE: If,after making this declaration,•you should become subject to the ^ - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • inal Fixtures
comply with such provisions or this permit Shall be deemed revoked. ''crowave
CONSTRUCTION LENDING AGENCY • Gas Service Outlets „,, Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance - Pole Light
—
of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater
Lender's Name Outlets Range
Lender's Address - Kitchen Sink Water Service - Switches Sign -
OWNER BUILDER DECLARATION •
I hereby affirm that I am exempt from the Contractor's License Law for theLavatoriesAuto-Washfollowing reason (Section 7031.5 Business and Professional Code: Any city orGarbage DisposalStanding Sectionscounty which requires a permit to construct,alter,Improve,demolish or repair i4{_#___' ”
Laundry Trays o055-15KW -any structure, prior to its issuance, also requires the applicant for such permitTrash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions ofoof Dr t
the Contractor's License Law(Chapter 9(commencing with Section 7000)of s.-
- ?ivlsion 3 of the Business and Professions Code) or that he/she is exempt - - - -
^.. lerefrom 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 _
tienalty of not more than five hundred dollars($500). I -
�b
I, as owner of the property or my employees with wages as their sole Reinspection Fee ' 1 $15 Issue Fee • $ 3
compensation, will do the work, and the structure is not intended or offered 1 - •
Reinspection Fee I x$15 Issue Fee $ 3 -
for sale (Secion 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES
License-Law 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 - DEVELOPMENT SERVIC S REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 •
sale. If, however, the building or improvement is sold within one year of com- — • Canopy Type II 0 Zoning Approved By /`- Date/0 -is--- •'
prove for, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By /tis•^ � . ' +�^-j Date/G'%S 86
prov0 the purpose of sale). - r,'yJoj-
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration em • Application Issued By .-4-..sa/' t .J1ate •
tractors to construct the project (Section 7044,Business and Professions Code: 11
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-110,410 BTU 0100,000 BTU - SUMMARY OF FEES
builds or improves thereon,and who contracts fol' such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ 23•0--C20--C2SMIP • �0
proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple 0 ystem Repair/Alteration _ - $
PLAN CHECK • $ /S• "-g PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers IS• SUANCE$ $
Date Owner Heating System& D Ing Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above . ❑0-100,000 100,000BTUGRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- MICROFILM $
sentatives of t,is city to ent-r upon the above-mentioned property for PLAN CHECK 50% $ rjp
inspection pur•a - Date J O es. /6•I51'4. ' MECHANICAL $ TOTAL FEE $ /'O3
Signature .r - -
J
Drivers' License •9SS /
,.....-----
CMF 0865-46,rev. 10/84 White - Building: Canary -Applicant; Pink -Accounting; 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 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
7. Footings 1 ' Q Plf 4ieb cps( 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 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
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL l
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Veritilating
v 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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: (q> Z� /aa „�/� _ (�--�
34. Final Heating & Air Conditioning t j"�LY'✓` "
35. Final Gas Pipe-Test i
36. Hood or Canopy . .
37. Final Factory Fireplace
38. Final Plumbing • • ,�
39: Water Service-Final • .•
40. Gas Service-Final
'
41. Solar Domestic-Final ..
42. Backflow Preventer '
-'43. Backflow Irrigation -
.
.44. Landscape Irrigation System • . -
45. Sound Attenuation
46. Handicap Regulations - .
47. FINAL STRUCTURE & BUILDING /or/b p1.C. '
/ _ ' Pt 1'
.A8. Special Requirements Completed
49. Electric Release to Edison . J
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,,
No. Date
J
4/9- /4'3 - Zf
trr• 7'
PARTY WALL AGREEIIENP 2-43a
THIS AGREEMENT, made and entered into this 4.Seee,t9 %y day of
, la
by and between Z•oG /7 4 . ResrAorS'
hereinafter referred to as "LAND CW ER", and 36„,6„L 4, MPo' Ai •' •
hereinafter referred to as "ADJACENT PROPERTY C NER".
It is hereby agreed that a party wall will be constructed on the
prcperty line between /1/02/ 5#/90/19/RDe/t' 40144c•Cps7.9 .0859- C%/ 91,72e,2‘.
(Address of Adjoining Properties)
..149r CoLGEt6 AUF Gosr-,Q /1F5n, ac. 9a.4:.'e' �.
in the City of Ccsta Mesa, County of Orange, State of California, as per map
recordedin.F3ook _ .'.•_, '.Page of Miscellaneous Maps, in the office -of,the
Courityr,Recorder offt said County. The party wall shall be permitted to encroach
fl ;'Y; // 5 0/I/Ly
IN WITNESS %HEREOF, the parties haw entered into this Agreement the
day and year first above written. •
LAND OWNER ADJACENT PROPERTY OWNER
Sa4J� t i'c0/Jr /
(Signature =1gnature)
/
N (Typed or Printed) • Name (Typed or Printed)
/`X?1 S/Cr,6C /1/) ,..309„5" CoLLe e',4t
(Address) � (Address) eosrn/19cs.. en. 9a6-26
L05m //kith& L&. 9a6, •
ya i1" • 'l'• .(t.,)4
9 r.,
•
,,..,r,Ro„CC_, at
4, s .
(NOTE: Please see reverse side for notary's states-cent)
• STATE GF CALIFDRNIA )
ss.
CCUNTf CF ORANGE )
On Jo -- )4- % tD before me, the undersigned, a Notary Public in
and for the County of Orange, State of California, personally appeared
aa A 54 MThide
known to me to be the person(s) whose name(s) is subscribed to the within
instrument and acknowledged to me that (he/she/they) executed the same.
WI my hand and official seal. (SEAL)
Signatuure
KA;MfY' OFFICIAL SEAL .
enrme ',yr ;(. )42_,n zra ON! �1j.=�.�A�C�NO� PUeLIGCALITPO NIA
Name .(typed or printed) `1.1" ORANGE COUNTY
Ro
MY COMM. EXP. MAY 7, 1990
STATE CF CALIFORNIA )
ss.
GXIJN9Y CF ORANGE ) •
• On a „ / /yg 6 , before me, the undersigned, a Notary
Public in and for the County sa
of Orange,-- State of California, personally appeared
known to me to be the person(s) whose.nane(s) is subscribed to the within
instrument and acknowledged to me that (he/she/they) executed the same.
WITNESS my hand and official seal. (SEAL)
.‘/L5t,
(Signature)
OFFICIAL�•S,,��E��AL .A,�
NOTARY11Vj(UGLI So.
ATi'fE.?/h2 A - iy,a- , S—R 0//` �2 ORANGE C07 1910
Name (typed or printed) NY CO/M•. E%P• MAY 1,
I( t QSL�
APPROVED e td oEsd T% 8 OoC W
• Ci of Costa Mesa Building Dept. i �� ri
' ' Br ATF ro-t�r_I; �6 APPROVAL e� ,
4� i i. THESE PLANS MUST BE ON JOB AT ALL TIMES STRUCTUR �2NG�
• • E NO CHANGES WITHOUT PRIOR APPROVA' JI-
Gti�2 � d f 81,0, o�� RATEP };1HlTSARiREnUED floc �S
CIT! Of COCA *tSA : OF. DEPT. ikon Et.ECTdCA
PLANNING DFLPK• tx. �' •
h�`� VENT{LA {NG AND
SO IN G. DEM Raj. :-• THE ISSUANCE OR GRANTING OF A PERMIT OR APP VAL i }{E 11NG. WORK
SUNECS r OF PLANS AND SPECIFICATIONS SHALL NOT BE CON" RUED _ •y Jt&EFRIGERATION
0�- - /0 -/5--d i� t TO BE A PERMIT FOC, OR AN APPROVAL OF, ANY OLAFION I ((
DATE..._. I =1' ANY OF THE PROVI;iCNS OF THIS CODE. NO P MIT PRE.
intik
p PLANNING 7L KING TO GIVE AUTHORITY TO VIOLATE OR ANGEL THE "x',, .A
I •'f.OVISIONS OF THIS CODE SHALL BE VALID, CEPT IN SO =`e�'aL"si o
` AR AS THE WORK OR USE WHICH IT AUTHORI S IS LAWF,UG j}{{(i id4i?+SdE!} !irtl�T ��r"DI'�PANY
N�?E''. t3t REQ11T
THE ISSUANCE OF A PERMIT BAS U ON PlAN3 AND !' � lw-�
< t.CIFICATIONS SHALL NOT PREVENT T E ILDINC OFFICIAL` t- --
1.
"- 77�
;CM THEREAFTER REQUIRING THE CO;RECTION OF ERRQRS
1: :AID PLANS AND SPECIFICATIONS OR FROM PREVENTING -'� -'�
• P ❑iDINC OPERATIONS BEING CABBIE' ON THEREUNDER W 1 �� ` FOn BUILDINGS Virt�!+t PE""°''S �'�,tA�OF
, .ICLATICN OF THIS CODE OR OF _NY QINF$ a;. , �— 5: GESt 7H � "
,.:E CITY.
" .�+��% •
EMPLOYED.VSE
.�►. ��ar CAIIfOHNIA DI1 r: N OrOflOUQ A I0NAL r
REQUIREMENTS.
Cl.)'Ls
, a ----irt--....
• .
' gin dig,
,,===.7
pORttI ' t�_
3 3095 b o 3 140 StInm'- I•„Air. F
9sa- OP
a MSC all Y
cccec.a 8 ���.
•
y57- l5'f 4 s
640•43h8 mi irs
. £4
" tail/ t
L
V'
'"\---- ShR mRo.ciC LLi' •
-
TYPICAL 6"CONCRETE BLOCK FENCE
Cement Coping Optional " ■,
GENERAL NOTES
Channel Block With One W d I _
Horla onset hp of all 1MORTAR: OnThreee PartPorte Pbs{SondtitCement, and
Fences11
GROUT: • One Port Cement Three
hee and
For Fences 6'w Lea
;i� s I I OHalf Ports hand
Ven.Ban 3/8'4 et e'&lox. a oa = COPING: One Port Cement, Three
For Fences Higher Than Tr' W u rilillil
Von.Ban 3l8'j at 32"O.0 > W CONCRETE: Well Mint I: 2% s 3k
Fill Cella Solid With Grout ill� i z .'——" I /2 Water Per SOC of Gallons Cement
Whets Stall Occurs ,-
Reinforcing
Reinforcing Steel.Shall II ra
s M la_M ! GROUT MAY BE POURED FROM THE TOP
OF THE FENCEConform to Sec.A•15•39 W O
u o-
AS.T.M. ;i W n 111011 II I F„us ANO AREAS OF
OR CE SHALL EC EAR. T EAN e"
All Steel to be Lapped 1. . ' I FREE OF ALL MORTAR DEBRIS.ETC.
Wier to Cork 41 IIIH
NATURAL GRADE vJIq
�� ' I BONDSSHALL BE PROVIDED BV LAYING
= 1 1 � ' [[ VERTICALJOINTSALTERNATEINEACH
• L S COURSE.
TWO>,e" BARS /ntae • • It • • . .
CONTINUOUS TOP °,•.1
B BOTTOM el . O WIDTH •0 TO 16' 0 C. MAX.
' SEE CHART a. Q ti O
• O) b ��W '• f d° • ' ' .DEPTH OF EARTHTCOTH
H
a e ID p• I/3 THE HEIGTH OF FENCE
• • \ • o BELOW BOTTOM OF FOOTING.
—4
b'°: i _ 10•' " z. .. SCALE: 1/2" a II
FOO G REQUIREMENTS _
WALL/HEIGHT _ 5o
• WIDTH OF FOOTING 14 14" 12" 12"
THICKNESS OF FOOTIH
10" 10" 6" 6 "
DEPTH OF EARTHTOOT 24 20" 16" 12"
, SPACING OF EARTHTO( H 12' 14' 16' 16'
• 1 JOB OWNERS ADORESS:• -I'LL- �� �• Lilt —
City of Costa Mesa, California — — —
Building Department
•
II S > �}1'i,kr CITY OF COSTA MESA.
O i an t CALIFORNIA 92626 P.O. BOX 1200
I. i . . (
ti Ira
+; FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/
BUILDING SAFETY DIVISION
CERTIFIED MAIL
COMPLIANCE OR OCCUPANCY INSPECTION REPORT
APPLICANT TO FILL/BOUT I
Subject Address ./", 7/ 'St/A r„ /u/cbk Zit' . Date Rec'd./J 15 f
Mail Report or Correction� Notice-Ai:- /+ l'�/.� n /
Applicant 41/.•)
P�F 115'f4/—Pal/75 • /� Telephone 74) J..S/-74/9i!
Address 4�,) l F/off 5 I /,Ca/n ,//" 4 ' Zip Code 9)7/44
/44
Owner's Name (Print) fA/qf r ///r✓ /// /�d` y / .
Owner's Address �• ft't 9&- SNICIf i6 10 i /7�L LA/hitt' Tfit Zip Code-n°/5
Owner's Signature ti/`/�/ d' /� / Date / "�-S e-3
s",„8-- .1., 47t.•i7 (.01 e2. a.vr..a
/ Recorded by, P. y,�
initial
c,
Compliance Inspection No. "A Z./4 _CMB No. .. 9/
Site Location
At your request, inspection was made at the above-referenced address on /.i/a0/8 3
and the Code violations shown on the reverse side were observed. '
You will be required to correct the violations listed within fifteen (15) days after receipt of this letter. Failure
to comply within the allotted time will result in a complaint investigation being initiated for compliance of the
Codes.
If you need assistance, please contact the appropriate Inspectors listed below:
Structural /•`i - ( (C ., Ci (754- -5-1.2 92 )
Electrical 130 6 e OC h /!N h/ (754- 312.0 )
Plumbing/Mechanical (754- )
Very truly yours,
hit - Cie t✓ Cl-
Name
Choir Au,/rl.drr ?n,sib.r/Tt
Title ' i4 / ,
cc: Inspectors
Property Owner • NOTE: SEE REVERSE SIDE
CMF 1035-46,rev.9/83
White-Bldg.;Canary-Owner;PIn k-Clerlca I 77 FAIR DRIVE (714) 754-5273
16. - . .
Compliance CMB 591 12/20/83
STRUCTURAL
1. The addition (17' x 20' ) at the rear of the residence has been constructed
without the required plans, permits and inspections. -
2. The shade arbor (13' x 18' ) attached to the illegal addition has been con-
structed without the required permits, plans and inspections.
3. A door has been installed between the garage and a bedroom. Prohibited
hazard under Section 1104 U.B.C. 79. The door and steps shall be removed
and the fire wall shall be restored.
4. The fireplace has been altered without the required permits and inspections
(double opening) .
5. The illegal addition has a side yard restriction of 33". This may require
application for a variance.
PLUMBING AND MECHANICAL
(IecTeA
1. The waterAhas been relocated to the garage; permits and inspections required.
2. Plumbing lines and gas lines have been installed in the garage for a washer ,
dryer and sink. Permits and inspections required.
3. A gas line and wall heater have been installed in the illegal addition. Per-
mits and inspections required.
4. The gas range in the kitchen requires an approved venting device.
ELECTRICAL
1. Family room added without permit and inspection. Additional receptacles and
switching required. A.minimum of two additional circuits required. Interior
wiring in walls to be visible for inspection. Exterior receptacle to be
protected by a GUI circuit.
2. Interior wiring in garage to be removed. Romex (sheath cable) cannot be
exposed. EMT (conduit) must be used when not contained between wall cover-
ings.
3. Above items to be permitted and inspected.
4. Ceiling junction box in dining room cannot be concealed.
OWNER College Mesa Company DATE 4-1B-56
—
JOB ADDRESS 1421 Shamrock Lane BUILDING PERMIT NO, 2766
GENERAL CONTRACTOR The Hale Co. VALUE $ 11,280.00
LOT 7 BLOCK TRACT 2432 Single Res. w/att gar
tOUP
I & J TYPE V ZONE Rh FIRE DISTRICT 2795
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench ` .�.C1.�� �-t , �'Z
Foundation Form de to Ga f1- Cys—'-�
Rough Framing z�7i�s..Ft/
Plumbing,Rough to Slab 14-,� -5-4,
Plumbing,Rough Complete V iVi,'.yl.,gyy, 4,[,J->r/p if 'IC 'S.-‘ 7 C �y 9.
Temporary Pole d J
Wiring,Rough "fin 7/6'5' Q3 _V, ✓ ��n.<-.
r. .. . 6-2 t- 54 as-
b 7Heating,Rough
Heating,Final nn /�y k���J ,,../ �j7-1.,0�C �3 3
Sewer, House W a/Sewer, St.� ,cf�'n1'3•it° _y P4. .6`_al-in 3J—
WH#Kece 49Qaf -/- 7- (/ -tel
Lathing, In X Out .,may 2 "A7- 5e,
PI=stering } ' ra y -.Is:-zci
L lbing,Final,Fixtures Complete 2e �J /o-/L-q
Plumbing,Final Gas Test}/ £c1 /D //- _ _ y�v
Wiring,Final . /)r/q•S4 _
Occupancy &e=Z /,'/G 6
FORM 210 3M 10-55
-. . Costa Mesa Building Department 2795 APPLICATION FOR PERMIT
• • •.— 111 EAST 20th STREET BUILDING I
COSTA MESA, CALIFORNIA
.FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 1 Receipt No. Permit No.
Building I y/ 6
Address 1421 Shamrock Lane - /47
Costa Mesa,California Recely by I Daie`Rec' I Date Icsp��
Nearest ��/{ '9
Cross St. Watson Avenue Building
Address
Owner College Mesa Company Costa Mesa, California
Mail
Address 8Q02 Central Avenue Nearest
Tel. Cross St.
City Garden Grove No. LE 9-2158 Zone //;/ I No.of I Type / Groupvt
Architect or Lic. F-7 Plans V ..Y
Engineer Davis & Quigley No. C-1790 Approved /
by Date /
Address 43 Malaga Cove Plaza,Palos Verdes CORRECTIONS V
Contractor The Hale CompanyNoy Lic. —
No. 3422
Address 8002 Central Ave. , Garden Grove _
Leal I Lot I I r• A - th 1 ..-.,\
Description No. 7 Block I Tract2432
(Attach Metes and Bounds) 1 )
Size of Lot 70-R-110 N
1i0 I Nowo.ofonBldgLots.
None nun 1 8 1oi R o
Use of I No.of I No.of n� �� 2I
Existing Bldg. Families Rooms F)
Setback Line from I Rear Yard 35' - A
Center of Street 50 Side Yard 7� ,ITV OF r`i 1\`�� i��t�}� Z
DESCRIPTION OF WORK 1! t llll�l
New I X I Alteration I I Addition I
Repair I I Moving I I Demolish I
Building 1310 No.of
6
SizeRooms Stories 1
Exter
Coverior ingwall Roof
Stucco I Covering Shake APPROVALS
Use of New Foundation Location Ins ector Date
Building Single family dwelling P
Forms,Materials,
with attached garage Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath.Int.
with all City Ordinances and State Laws regulating
building construction. Lath.Ext
Signatureof THE HALE COMp�1,.y
Permittee �,Q� Plaster,Int.
Authorized Agt.'42a-is - S. Plaster,Ext.
SILVIA LARDJplanCheck$
ValuationPermit Fee $ Masonry Reinforced
/ Plan- V '$ ) 4Total
Fee $ yy, Bond Beam
FINAL
FORM 204 S-BP 2M 645
•
S w
a
C •" 7 coshrt
•
Street
PLOT PLAN
Show location and distances from
property line and between buildings.
OWNER'( FARRIS, TILDEN J. ,JR. DATE 9/16/63
JOB ADDRESS 1121 Shamrock In. BUILDING PERMIT NO.20579
GENERAL CONTRACTOROwner-Builder VALUE $ 580.00
# AP No. 141-012-22 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Add to Res.
\ INSPECTIONS _ Signature DATE GROUP I TYPE V ZONE Ill
it SUBCONTRACTOR PERMITS ISSUED
Is DATE NUMBER
Water
Rough Corn. Refrig. El Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line 0 House Con..p St. Swr. 0
Sprinkling System
Construction Pole
Underground ❑ Power ,p
Rough Wiring 024,,,.r4-41-/ //- `f- ( 3 &/2 9 fC
Trenches 0 Forms 0 Steel Reinf. 9 n ,�A
Floor System
Bond Beam 9 Steel Reinforce 0
Sheathing
Frame and Flashing 6 41 /A -.,a"-eta
Lathing— In,0 Out O
Plaster, brown coat _
Refrig. 0 Air Con, O Final
„;.;ting, Final
. inbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final I _ T��43
Building, Final '+ a.- AX- 5 , '
OCCUPANCY
Form BU4-6M 30 5-13P
Ong7o
..(„fir
20579 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA.CALIFORNIA CC yy����s//E+ P 1
�7 1963
For Applicant to Fill In Completely BN.ANalnnPIFOR• PERMIT
TYPE OR PRINT CITY OF OUBThIISA
BUILDING L/ h/ ` 1 Me L For Office Use Only
ADDRESS / 70L //�"" N RECEIPT NO. PERMIT NO.
TCOSTA.1MESl1A. CALIFORNIA(� ( v /Fa 'TIC /�u J
OWNER 'tided de d i( meets fJ r • � �!•fl� /J'� �� I- �A�Q.Jr�/�f�J
ADDRESS ' L{a.I MI AMIPncK I LN ADDRESS • / Y,z� +L/w/� ']/4 i
FIRE
M /? TEL. ZONE /i(7' - GROUP L
CITY CoSP /)fesJT NO.L. 2-/i r .r .
APPROV / 7xfre95
ARCHITECT TEL �� BY DATE �OR ENGINEfiR N°. ZONING 2 )
ADDRESS
� /^ 2'r I(/ NO.OF USE OF NEVG
eV
LEGAL �LANS �/ BUII /��
CONTRACTOR tOt#7h fes/
ADDRESS �- DESCRIPTION
A.P.NO. / I l - 6 1 } — D ).--
CITY
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE LIGNO./ AA Z TEL.
'y//!/ryX BO'TO SIDE&REAR P.L.
EAVES
SIZE l'V Pl I 4 - I 'JV NO.or BLOCS. I ALLOWED (U.B.C.REQUIREMENT)
OF LOT /� NOW ON LOT YARDS APPROVED YARDS APPROVED
USE OF //�/��NtP ci n_e�� MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG, tI '� Yy (rte (FROM C/L STREET)
SETBACK LINE FROM ..JJ''�� I
CENTER OP STREET L.1/ REAR YARD 35 FRONT S FT. FT.
SIDE YARD I LEFT 7 I RIGHT / R.SIDE Fr.
DESCRIPTION OF WORK L.SIDEf FT.
NEW ALTERATION •t/ADDITION REAR l FT.
DISTANCE BET. BET.MAIN @
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
VAR.# DATE
BUILDING NO.OP
SIZE ROOMS j�STORIES C.U.P.# APPROVED
EXTERIOR WALK`NG / •friymiesp _)! CROOFOVERING CWAS7,7' /�( APPROVED ( / V'( p E 1 J 0
USV OF BOLDING AND KTOB PERFRME (J lil/ l� / ? ` 11
zf to,v
Fie AMC -iN pkec4i
Hen(- n 6 ,4Yn// �o SQ.Fr.
I HEREBY ACKNOWLE O THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE £
AND STATE THAT THE ABOVE IS CORR;CT AND AGREE TO CO... PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES A• TE LAWS REGU VALUATION
efer BUILDING CONSTRUCTION.
ry
SIGNATURE OF //////JJ OO PERMIT FEE $
PERMITTER
�I' � ,�- O
$.��0 PLAN CHECK $ a
AUTHORIZED AGENT �- 1
1 TOTAL FEE $ vo