HomeMy WebLinkAbout1445 SHAMROCK LN - Building Permits r"' ��i' �•T Y CITY OF COSTA MESA
•
• i ► BUILDING DIVISION
F• �_,, r �. DEVELOPMENT SrRVICES DEPARTMENT PERM! MBER
PERMIT
Wia
J � BO5-01172
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1445 SHAMROCK LN Status: ISSUED
Suite: Applied: 07/13/2005
Vicinity: ROOF Issued: 07/13/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 41814116 Zoning: R1
Applicant: LOYD WATTS ISSUED BY:
Address: 2626 NEWPORT BL
Phone: (949)548-1645
COSTA MESA,CA Zip: 92627,
Owner: RHODES, WILLIAM E TR
Address 1445 SHAMROCK LN
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PETRONELLA ROOFING
Address: 2626 NEWPORT BL
Phone: (949)548-1645
COSTA MESA,CA
Zip: 92627 License: 460707
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT •
TEAR OFF EXISTING ROOF, INSTALL 1/2"CDX PLYWOOD; 1 LAYER#30LB FELT AND 30 YEAR COMP SHINGLES ON ATTACHED HOUSE
AND GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,000.00
Permit: $153.25 Claim Valuation: $8,000.00
SMIP Res: $0.80
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $154.05\•• .
PLANNING &ZONING
SETBACKS
MAINSTRUCTURE.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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92.28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
❑ I have and will maintain a certificate of consent to self-Insure for workers'cbmpensatlun,as provided for by section 3700 of the Labor Code,for the performance of the
for which this permit is issued.
'.::.Lha4e foand will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued.
My workers'corn sation Insuran cern r antl•ooplcy number are: /�
Cartier:-^-. TI>1.4Z ni—l-a Policy Number:' '�-1 C.2,.a- 03
(lhis'secflon need not completed if the permit is valued at one hundred dollars($100)or less) �—
❑ I certify that in the perfo =nce of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cali ia, • ,:ree that If I should become subject to the workers'compensation provisions of Section 37 of the Labor Code,I shall forthwith
comply with these provision S `
Appti nt,Signature:a•-- - Date: 7 jo6
WARNOJG"FAILURE' 6 ZOPCWORK.RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER70-ORIMRtAL PENALT S AND C IL FINES UP TO ONE HUNDRED
THOUSAND COLLA' ($100,000),IN ADDI ION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTR• TO `D LARATION:
I hereby affirm that I am under provisio of Ch 9 ening with Section 7000)of Division 3 of the Busin s an fessions Code,and my license is in full
force and effect„LJc. � (qo CI'ess N� '�
Cont tore ols•Signalu e_ ���'a.�— Date:---. 1 13
•
CONSTRUCTION NDING A NCY:
❑ I hereby affirm t is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivels License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,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 Safely,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit 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 pad 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 all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for i•spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sig• re Tegal Owner(s) Date
tjflan
An. •FAuthod I
d'Appllcent Date ,
CODE I I•, I' RATE ItIIIIlALS CODF( INSPECTIONTYPF. gel$ gi)1�L5
1616 Fixed Syste Mai F e Prevention 4 206 Final Mechanical
1266 Pool Spa Final ''] 1 208 Final Plumbing
200 Final Re-Roof J/FALSE 9' 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
2 L (� 4 "LI " c . A. APPROVED
, a CRY OF COSTA MESA i
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TYPICAL 611 CONCRETE BLOCK FENCE
a •
Cement Coping Optional �3 I '_ 1 j 1 GENERAL- NOTES
_Channel Block With One �Qu4 =�9!
Fencesntal Top i f all • ' ' - I MORTAR: One Part Plastic Cement, and
's. 1 Three Parts Sand
For Fences 5'or Less rg . GROUT: . One Part Cement Three and
• , 2 2 One Half Parts Stand
Vert.Bars 3/8" at 4' -0"0.C. se t o _
� cx _ COPING: One Part Cement, Three
For Fences Higher Than 5' 1pa7 w I I Parts Sand
> — CONCRETE: Well Mixed I: 2i : 3/2
Ven. Ban 3/8"Ø at 32" O.C. w -
cc r
Fill Cells Solid With Grout > Max. of 7%2 Gallons of
Where Steel Occurs sIle > � Water Per Sack of Cement
Reinforcing Steel.Shall §16111 2 I GROUT MAV BE POURED FROM THE TOP
I
{C OF THE FENCE
Conform to Sec.A-15-39 i w 0 -
A.S.T.M. ��II Z ~ CELLSANDAREASOFHORIZONTALREIN-
i urn 1 FORCEMENT SHALL BE CLEAR,CLEAN&
All Steel to Code eeS u. I - - FREE OF ALL MORTAR DEBRIS,ETC.
IS"or
o
r
NATURAL GRADE vr I ` BONDS SHALL BE PROVIDED BY LAYING
III=III=III= • III SIII I 111= BLOCKS IN STRETCHER COURSES SO THAT
o or, • VERTICAL JOINTS ALTERNATE IN EACH
.p -p . v . e . ♦ COURSE.
TWO 3/8" BARSla . r e .� _ e �.. • .
CONTINUOUS TOP I II a. - -
&BOTTOM -..--1 0 F-„WIDTH 0 TO 16' 0.C. MAX. •
• e SEE CHART 0 0 p O
O BELOW o ” DEPTH OF EARTHTCOTH
1 1/3 THE HEIGTH OF FENCE
b BLOW BOTTOM OF FOOTING.
O ems.' 3' � . 1
o" o" 2"-+I.' SCALE: 1/2" : I' •
•
•
_FOOTING REQUIREMENTS '
WALL HEIGHT 6 ' 5' _ 4' _ 3' .
WIDTH OF FOOTING 14" • 14" 12" 12"
THICKNESS OF FOOTING 10" 10" 8 " 8 "
DEPTH OF EARTHTOOTH 24" 20" 16" 12"
SPACING OF EARTHTOOTH 12' 14' 16' 16'
• / OWNERS NAME:
City of Costa Mesa, California JOB ADDRESS:
•
. Building Department
7-6- 84
STATE a' CALIFORNIA )
ss.
O)JNTY CF ORANGE )
on 9 �/ �S before me, the undersigned, a Notary Public in
and for the County of Orange, State of California, personally appeared
1r.im.e: dt.. 4% (!.c%c.L'Gc.ci en. 4L. c y ,
known to me to be the person(s) whose name(s) is subscribed to the within
instrument and acknowledged to me that (he/se/a‘zy) executed the same.
WITNESS my hand and official seal. (SEAL)
Oo 52, •CaA„ a -
SignatureO'FICIAL SEAL 1
4 I t POLLY S.CURRAN '
PO//v S.
n y Y NOTARY rc-CAUFORMA 1
tJ ,V 11W ORANGECOUe17
Name (typed or printed) . . ...r+Ny Comm Enpiet lune 17,I98B
STATE CF CALIFORNIA )
ss.
COUNTY CF ORANGE )
On q/ygd , before me, the undersigned, a Notary
Public in and for the County of Orange, State of California, personally
appeared
known to me to be the person(s) whose name(s) is subscribed to the within
instrument and acknowledged to me that (he/se/tt\ey) executed the same.
WITNESS my hand and official seal. `` (SEAL)
)O” `l Sae. ed.i.A to*t1 aPOLOFRLYICS.ILCURRAN SEAL
Signature) �
NOTARY PUBLIC-CAUFORNIA
OIUNGE COUNTY
My Came Expires lune 17,1988
Th// S. O osQ R-A nl
Name (typed or printed)
. PARTY {ALL AGREEMENT
THIS AGREEMENT, made aryl entered into this day of
s , •I ) {Jan., C_.
, by and between � - pi? ) ,
hereinafter referred to as "LAND GINNER", and /J�. uQ4 3 ' A .•u. ,,,,,�
hereinafter referred to as "ADJACENT PROPERLY OWNER".
It is hereby agreed that a party wall will be constructed on the
property line between M5 0 0..�..� lC a.._„_ rry.,^ ,
�(Addr ss of Adjoining Properties)
>45/ 'J/. c - ti t- -
in the City of Ccsta Mesa, County of Orange, State of California, as per map
recorded in Bock , Page of Miscellaneous Maps, in the office of the
County Recorder of said County. The party wall shall be permitted to encroach
/e (h , «�6 n+,hk3:
IN WITNESS %*iEREOF, the parties have entered into this Agreement the
day arca year first above written.
LAND G NER ADJACENT PROPERTY OWNER
4/9
l'/ ifi�(hFa`-,.,i --1.1,.Lint f/i' tr.L er ra /7 14:C:u,4 :IS.,wv+�1--..._
(Signature) (Signature)
117/ lli Qm Cr.--, /"?l)0de S !C:flip-GI n.T DiiarAZ
Name (Typed or Printed) Nacre (Tyyed or Printed)
l'/'/ 5/ a )71 Ira ck jt� c "'V 67 ‘54.a,,,L -ak--
(Address) (Address)
(NOTE: Please see reverse side for notary's statement)
STATE CF CALIFORNIA )
ss. •
OJUNTY CF ORANGE )
On 9 /'/�PS" before me, the undersigned, a Notary Public in
and for the County of Orange, State of California, personally appeared
.y., a-.ZdC 8. .Q .
known to ne to be the person(s) whose name(s) is subscribed to the within
instrument and acknowledged to me that (he/6 /t') executed the same.
WITNESS my hard and official seal. (SEAL)
CCOUlate) y' OFFICIAL SEAL
Signature rkPOLLY S. CURRANORA GE
NOTA COUNTY RNIA
Po//y SCuaa.al) -✓ my Comm Eapiresslune 17,1988
Name (typed or printed)
STATE CF CALIFORNIA )
ss.
COUNTY OF ORANGE )
On 9/97:915.. , before me, the undersigned, a Notary
Public in and for the County of Orange, State of California, personally appeared
Pcs-r,nod Va » est. lOtt -' .vs
known to ne to be the persone
s) whose names)) is subscribed to the within
instrument and acknowledged to me that (he/s e/t ) executed the same.
WITNESS my hand and official seal. (SEAL)
r'
Signature) - ^ ^^ OFFICIAL SEAL
tka FOLLY S. CURRAN
t �
NOT::R.RANG IC OUNTYORNIA I •.
ORANGECOUNIY
s ` ¢I amm Expires lune 17,1988
Po S. COAAA
Name (typed or printed)
• PARTY WALL AGREEMENT
/9
MIS AGREEMENT, made arra entered into this
/K, /� Tday of •
92.791-- 2/ ,a_by and between
hereinafter referred to as 'LAND a*ZER", and JC U' -a (i
hereinafter referred to as "ADJACENT PROPERTY 04NER".
It is hereby agreed that a party wall will be constructed on the
property line between �7%Si�J�I�CLtr.ar. an=-e
7 •`_ r) I (Ad��dress,pf Adjoining Properties)
in the City of Costa Mesa, County of Orange, State of California, as per map
recorded in Book , Page of Miscellaneous Maps, in the office of the
County Recorder of said County. The party wall shall be permitted to encroach
4 " . I - c7 .
IN WITNESS WHEREOF, the parties have entered into this Agreement the
day arra year first above written.
LAND OWNER ADJACENT PROPERTY CANER
/-7
,(r 1cc -Ca, / C
(Signature) (Signature) /
I
b - l?l _.✓, l� i a �/7-7 � c. r I N5 1i �-�tr"�,- C�( �) i7U�-,.r
Name (Typed or Printed) Name (Typed or Printed)-
/05 , Si) a h1 roc kJ_ n c /167/ . w,-p-c-L>-ur-
(Address) (Address)
(NOTE: Please see reverse side for notary's statement)
57/9 - 3) 3v
•
PROSECT ADDRESS: 1445 SHAMROCK LN . . CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 045591 .
OWNER'S NAME: BILL RHULES
ADDRESS: SAME PERMIT NO: M 045591 PLAN CHECK NO: N GOVT : N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: NEW
714 /645-1970 •
' ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 1 65, 000 BTU FURNACE - SQ FT:
ADDRESS: ' UNIT: - ,
CLAIM VALUE: CALC—VALUE: .GROUP OCC:
PERMITTEE: MAIO PLUMBING ( 714 ) 56'8-1555
ADDRESS: 1708. E MC FADDEN 117 'COMMENTS: . •
SANTA ANA • CA 92705 ****************Ef*******�E�E***+r*******�E+E*r*****aE+E+E*�P�e�6+E**+re6+r+E�r�E**�E*****�E** *** **
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMENTS
7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect. SETBACKS
cmu'c.: 86380 STATE uc.:00393 7 SSC 36
Date: ,'f rile Signature: MAIN BUILDING ACCESSORY BUILDING'
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-Insure or a certificate of Workers' FRNT: FT IN. REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 0791700-89 EXP.DATE: 01 /01 /91
CMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 41802232 ZNE: • REF NO: •
J Certified copy is hereby furnished. ( Certified copy Is fit with the city PLANNING NOTES>
Q >
Date: I —1 -10 Applicant: l C *******************************************************************************
• IXEMPION FROOM WORKERS'COMPENSATION DECLARATION: (This not be completed it the permit is for one hundred(S100)or less). DEVELOPMENT S E R V ICES , REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become • •
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: '
Date: Signature: - -
NOTICE:If,after 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 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:
DATE: � y/ 9
3097,issued(Section C). ************************************ **•3e***********************Wt* *�* *****
LENDER: *******************************************************************************
ADDRESS:• – LEGALI,ZATION:N F E E SUMMARY STRUCTURAL SEGMENT :N
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,alter,improve,demolish,or PERMIT 9 . 00
repair any structure,prior to its Issuance,also requires the applicant for such permit to file 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 PLAN 2 51 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 •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred-dollars($500). - ISSUE FEE 15 . 00
I, as owner of the properly or my employees with wages as their sole compensation, wig 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————> - 9 . 00 15 .00 0 .00 2 4 .0 0 24 . 00 .00
does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 . 00 OVER/SHORT: . 00
forthepurpose
uuperposeooildyle)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TUT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business t • 24 .00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. IND I. V •I D U A L FEE B R E A K D O W N
❑ I am exempt under Section: 8.8 P.C.
torthisreason: ' -TYPE QTY D E S C R I P T I O N ' UNIT COST TOTAL COST
•
Date: owner; MEC 1 INSTALL FORC/AIR FURN <= 100 K BTU/H . 9 . 00 9 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,andEND OF FEES
25534 and that 1 or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a . - _
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from •
these provisions. i ' l
Date: Applicant: - - •
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby ayyylllho' representatives of this city to enter upon the above-mentioned -
gr inspection rigor.
`•'� Signature: e o �,J` \
Date: 01 000 1096-00051096 TOOT 24.00
Date:
Drivers License or Social Security A: • DATE: 01/04/90 TI%E: 12:05
l
1641-46 White—Building:Green—Code Enlargement Cenarv—Aoplicant;Pink—Revenue:Goldenrod—Assessor -
r CONSTRUCTION AND PLANNING - PC Si SPA
APPROVALS Permit+ - Date - Inspector APPROVALS Permit + Date Inspector
1. .Temporary Electrical Service'or Pole,;j -. 52. Pool & Equipment Location •
•
2.c.Soil Pipe-Undrgrnd., ^ • 53. Steel Reinforcement '
3..S.Electrical Conduit-Utility-Undrgrnd) - 54. Forms ' •,.
"t'4. Electrical Conduit Undrgrnd. en 55. Electrical Bonding
' 5. Steel Reinforce_mem"-I �"x 56. Rough Plumbing & Pressure Test 0
T$. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE o
1--
i 7. Footings ,w - 58. Electrical Conduit-Undrgrnd. t-
8. Foundation _ - _ 59. Gas Pipe, 0 Undrgrnd., Test
- 9. Water Pipe-Undrgind. - ` j 60. Backwash Lines; P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK 1
11. Property Sewer Linkk& House Conrectiori i " 62. Backwash & Receptor-Final
12. Sewer Cap , o C. 63. Heater & Vent-Final
n .
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 Electri aJ-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning "' ' r* ,,FIRE DEPT. REQUIREMENT -
20 aRouugh Factory Fireplace '� -1 " _ * " :APPROVALrS- ; Permit # ` '
ra .
21-Ducts, in StrrictUrei- ��= ^> 170.Underground Hydro x
22. Duois, Ventiiatir:'h 07' "' '- ''` c , `
,g. CJ x c' cS, Ft x I:71. Prod O'Gas Eta'
v - .
23.•Gas-Pipe-Rough & Test - r7S * t; __w.� -72, Underground Flush% -k h
24 woof Framing s s-,'A ' ' * = p_r • 73 Undergrnd.Storage=Tank O Gas 0 oil
25. Roof Sheathing rr ' ' * • C j (uA :> 74:4:Overhead Hydros x
26..'7-Bar Ceiling (Structural) &=$Tdnocoat m r-z 75 Dry Chemical ;� .c-.
27:2Frame and Flashing; - -r x tr - - 76 Dry Standpipe ,r_!
- .�. - y w y. v Y I•^ .n
-28. Lathing& Siding ti " c : O * E " ' r 77V FIXEDSYSTEM;F'INAI -, - y
29. Insulation * - -• * _ i ! L: x 1 Ir . 78�FIRE PREY. FINAL x n
"30. Drywall:Nailing ,_ * I f `. * H_
'HEALTDEPT. REQUIREMENT
n31. Plaster Brown Coat*
s i i+: :"79..,FINAL INSP.ECTION ' <
r.-32:;;�Electrical Power M2l•
te`?-Final " ' y, '80:FOOD CERTIFICATE ISSUED
r, Cr lc E: i• + t -1?..
z33 Finel Electric x _ - 'C * •t * Notes: '- * n
334!--Final Heating•& AirConditioning ,, I�`}//�, Y - •`�� - 'S
e,^. = ' C. - * m 11(../(Zt? i * - f-,fin {:
'SI.:
35.`.Final Gas Pipe-Test; 0 .. r. '74; x n .,1-40 g I, :sr
'-=36. Hood or Canopy s' 3 _, 7. 'v fl I t* - S r o 'r'
r C; ^r-. .'- ' :1' x: - .:o x' 0: .
-37.:Firial Factory Fireplacex i .- 4 ,.1 i 4; x - ` :.j
`38. Final Plumbing cr Y r'•' ' w ^ i :r x . -o-. 0 ' q --••
J. .: : , - '-is (, L-1:-: t T: 1-,
"39. Water Service-Final! , - -
:40. Gas Service-Final * -e•i--- 's x sr] 1 n: * �^c 0;u x'
!A: s J e. t' r
X41. Solar Domestic-Final` ;_; •' > C.I. I (�.' K ,`_.,� '_-' �`
42.rBackflow Preventers c.% +' I 'x :s w C -
.- -1 :r: r: rn F---;'. is .
43. Backflow Ir gation `"S n * „ - > `.J c'.
,=44. Landscape Irrigation Systeni�rf, - * ^ r: G x x c• r t_U - a: _i C.
• e; u'A „ 7 S _" ,n 7:^
'r -S.ti 1: E -' c-• c.x x F. `- 4: y: r-
`45CSound Attenuation - is • ; _.1 ,7* 1: ft' I,. < . ^,0 a
r -
_.46.•Handicap Regulations O r• • .,-. . .r. O.% t' * •
c .. r r ! he .: (: x.
`477-FINAL STRUCTURE & BUILDING ▪ F, = "' 'S _ a
48E'VFINAL PLANNING HE- : a1 A. 7, r C 't - •
X495 Electric Release to Edison 1 ;
Applicant to fill In all spaces except those within hegvY border lines and sign all appropriate declarations. .
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO.
CONSTRUCTION PERMIT A l/a 97' 10 .. 4958 2/08/EA 3G.E3 TI.
Project Address t- TYPE OF CONSTRUCTION U NEW ❑ ADD Li ALTERATION LI REPAIR '
Sa9�6- /9-5 /�&VC • - ❑ CONVERSION ❑ DEMOLISH CI OTHER A.P. I Zone
Applicant's Mailing Address . •
/ DESCRIPTION OF WORK A/r/A)/P&o'7 . - let-et
Owner's Name �� E.440-.611/14 K Zb is Phone��rr'�Fc,4i970 C,�� -, S Main Building: Accessory Building: 2
Address 114/'5-5/1759air /A-9e. Cosmo-sAi E 0
TYPE OF PERMIT GRADING U FOUNDATION U STRUCTURAL T Front N
Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL - AB Rear - N
Address ❑ OTHER
Contractor's Namn 69/4.14/Ere Phone PROJECT DESCRIPTION SQ. FT. -�l,taale 4� OCCUPA V C Right G
Address(mailing) CONSTRUCTION TYPE VALUATION$ / /1 S Left • R
E
City License No. ZONE GRADING CU.YDS. ACRE Ping. Ref.# Park.Fees $ O
U
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided I
I hereby affirm that I am licensed under provisions of Charter 9(commencing R
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.
Ilcense Class License No. PLUMBING FEES Planning Notes: • M
E
(e Signature N
.ORKERS'COMPENSATION DECLARATION Bar Sink Showers
T
I hereby affirm that I s have a Insurance of consent to fel copy or a certificateion Backflow Preventer Service Sink S
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL ' FEES
Policy No. Company '
Certified copy is hereby furnished. Bathtubs Sewer Connection. Automatic Washer Transformer 0 15-50 KW
Certified copy Is filed with the city Building Division.
Date Applicant Clarifiers ❑ 50+ KW
Solar Collectors Construction Pole Sub.
•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher
(This section need not be completed if the permit Is for one hundred ($100)or Solar Piping Cooking Unit Meter pup to 100 amps .
less). l DrinkingFountains Solar Tank ' Dishwasher Meter
I certify that in the performance of the work for which this permit Is issued, I Dover 100 amps
shall not employ any person in any manner so as to become subject to te
Workers' Compensation Laws of California. Floor Drains' . Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel '
Date Signature , - .•
NOTICE:If,iafter making this declaration, you should become 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 ' '
I hereby affirm that there Is a construction lending agency for the performance Interceptors - Water Heater Fixtures Microwave
of the work for which, this permit%-is issued (Section 3097 Clv. C.)
Lender's Name - Kitchen Sink Water Service Device Boxes Pole Light`, 'i'
Lender's Address Lavatories
OWNER BUIL-DER--DECLARATION Outlets Range, .1 G -
I hereby affirm that I am exempt from the Contractdr•s License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap- • Switches .Sign . C •--" 1
county which requires a permit to construct,alter,Improve;demolish or repair
-ny structure, prior to its issuance, also requires the applicant for such permit Roof Drains. - - .
.• Garbage Disposal ' Standing S6ciions i
file a signed statement that he/she Is licensed pursuant to the provisions of •
.Contractor's License Law(Chapter 9(commencing with Section 7000)of Generator ❑0.5 KW❑5-15 KW Trash Com actor'}'
vision 3 of the Business and Professions Code)-or that he/she is exempt - . P. ,
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 . -Ci '
penalty of not more than five hundred dollars($500). :• Reinspection Fee $25 Issue Fee $ 3 •
LI 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 - j 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 ❑
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 11 0
•
Duct-Under Ground
sale. If, however,the building or improvement I5 sold within one year of com- Building,Approved By Date '
pletlon,the owner will have the burden of proving he/she did not build or Im- p
• ova for the purpose of sale). .. Duct-Structural Refrigeration System Application Issued By � �SO
9 y PP Dat:
as owner of the property,am exclusively contracting with licensed con- ❑0.100, OO BTU ❑100,000 BTU 0 rt� '_
tractors to construct the project (Section 7044,Business and Professions Code: • - Duct-Ventilating �,_ -- .y SUMMARY p/yF�) FEES
The Contractor's License Law does not apply to an owner of property who •
BUILDING PERMIT •$ �Qi (/ V C
•
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple❑ System Fair/Alteration SMIP $ iJ
trxc r(s) license pursuant to the Contractor's License Law). R t C PLAN CHECK $ PERMIT t
isinam exempt under Section - B.6 -.C.for this reason Firepl/Fact.Blt.ICBG# ' EXP ISSUANCE $
.(//G/'xav°L. nal ..et c'�IOf1S PLUMBING' $
Date 44.44E4._ Owner - �..e - - Heating System&Ducting Incofnplet� IllaFl '` ENERGY P.C. $
I hereby certify that i have read this applicat •n and state teat the above 00-100,000 BTU ❑100,000BTLI—' _ _ PLAN CHECK 25% $
information Is correct. I agree to comply with an city and county ordinances • in _ ELECTRICAL '$ GRADING $
and state laws relating to building construction,'and hereby authorize repre- Late •!ig MICROFILM $
inspection pofu this city toI'ujlon e.above-mentioned property for _ PLAN CHECK 50% $
Signature puiposeS� L./Y(/JG-O / - MECHANICAL ,$ �i
Signature l� Date o2�%+2/py TOTAL FEE $ s� S
/ . - ' / / Reinspection Fee .$25 ue Fee $ 3 PL/�{V CHECK 25% $ •
Drivers' License or SS 9P —� -
=CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor , ',
1
CONSTRUCTION AND PLANNING PC &SPA .y -
APPROVALS Permit _ Date Inspector APPROVALS Permit 'r . Date • Inspector
- 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - -
_
2. Soil Pipe-Undrgrnd. '.53. Steel Reinforcement . : ' , .
•
3. Electrical Conduit Utility-Undrgrrid. _ 54. Forms . , - ' '
- 4. Electrical Conduit-Undrgrnd. '55. Electrical,Bonding ' - - - - . ' .
5. Steel Reinforcement • 56. Rough Plumbing& Pressure Test - - ,
6: Electrical OF ER Grnd. ' 57. APPROVAL TO COVER-GUNITE -.-
7. Footings' ..58:- Electrical:Conduit-Undrgrnd. - •
8. Foundation- . 59. Gas Pipe,..0 Undrgrnd.,Test ' - r
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,'❑ 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 - J
14. Rough Plumbing 65. Electrical-Final - • - - '
15. Rough Electrical-Conduit 66. Solar System-Final - - _. - -
16. Rough Electric Wiring . 67. Fencing &Access Approval - _ c - -
17. Rough Wiring Sign : 68. APPROVED EOR PLASTERING -
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ;
19. Rough Heating & Air Conditioning • FIRE DEPT. REQUIREMENT -
20. Rough Factory Fireplace APPROVALS Permit#
_ 21. Ducts, in Structure • 70. Underground Hydro I . .
r 22. Ducts, Ventilating 71. Product Piping 0 Gas .1110i! . I 1 •_•
23. Gas Pipe-Rough&Test 72. Underground Flush, i
24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil '
25. Roof Sheathing 74., Overhead Hydro - _ - I
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' s - _
•27. Frame and Flashing 76. Dry Standpipe ' , - ;^�
28. Lathing & Siding , 77. FIXED SYSTEM FINAL '
Fcl .
29. Insulation • 78. FIRE PREY. FINAL I .mi 9 '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT C .^,
31. Plaster Brown Coat 79. FINAL INSPECTION ' '
I C^
32. Electrical Power Meter-Final 8
'7
0. FOOD CERTIFICATE ISSUED ry
• , •
33. Final Electric Notes: L
34. Final Heating & Air Conditioning I i .
35. Final Gas Pipe-Test t ' :
36. Hood or Canopy
1'
37. Final Factory Fireplace - - ;
38. Final Plumbing - .
• ,
39. Water Service-Final I I
1 _
40. Gas Service-Final
41. Solar Domestic-Final . . -- -- - _ , ''!
42. Backflow Preventer - - I '
43. Backflow Irrigation 1'i.- - !P
44. Landscape Irrigation System - i 1 E X P-1 R E D - ,
45. Sound Attenuation
Inco plet Inspections t ' _
7y ;
46. Handicap Regulations Jete ` 1Sig y
47. FINAL STRUCTURE & BUILDING {p� - - -
48. Special Requirements Completed' .i , '
' I ,' ' ' " - ' -
49. Electric Release to Edison - - - -- ` - I - - '- ,
50. Gas Release to Southern California Gas Co - ' , 1 • '
51. CERTIFICATE-OF-OCCUPANCY - - - - - - - .
V
No. Date • - -- - I - - - - . -.. . - _ _.
•
Applicant to fill in-all spaces exwr.. .....m ....y'b ro Cor lines and sign all appropriate declarations.
- 9552 9/04/85 159401 It.
CITY OF COSTA MESA CONSTRUCTION PERMIT P MIT NO. TRACT NO. LOT NO. UNIT NO.
ILI� 1 511mr�ck Lc a £5 c oV9 ' .214 32 ►�
•
Projes•Address ❑ ADD U ALTERATION H REPAIR
•
•
Applicant's Malting 1A1 dress, !/ d—•f* - i'1,-.....- TYPE OF CONSTRUCTION U NEW1A P # Zone f
Owner's Name /� _c.t..e,,-.� L-, Phonee5h —/9)a ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �..,,I I S _ I,y 3 — I6 I R
DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: t $n.-e/ate_ ifiE t f Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front `� jL. O
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear g2 - N
Contractor's Namr /'2.
❑ OTHER / / A _--=� /
Phone PROJECT DESCRIPTION -SS FT. 0 2 OCCU ANCV C Right - s-r._ 01 pL# G
N
Address(mailing) ELECT• RICAL ITYPE VALUATION IP CO S Left S,� - R
City License No: ZONE GRAD(NG CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided
0
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: :Planning Notes: L/iv X / k �e• (LY- z ' // q j5 � .0 M
with section 7000) of Division 3 of the Business and Professions Code, and -
my license is in full force and effect. ^£9 /�• T
License Class License No. — OG•'/`� � npp S
Date Signature PLUMBING FEES ` )' / lf�A_./� ,
'•ORKERS'COMPENSATION DECLARATION Bar Sink Showers l ELECTRICAL FEES
• ereby affirm that I have a certificate of consent to self-insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
0800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
8 Certified copy is hereby furnished. •
-
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(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 becqmq subject to the Drinking Fountains Solar Tank Fan Motors❑01 HP 01,1/2-8
Workers' Cornpensation Laws of Califorgia��1. , d' /1. 1.
`/ Pate t1 I g.;. Signature In A_,,, ` / t.4't_s —Floor Drains Swimming Pool w/Spa F.A.U. Ina Solar ❑9 15 HP 016-15+
J' NOTICE:H,alter rharing this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal Fixtures - -
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY ,
Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name -
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 the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or _ ( Garbage Disposal ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator ❑0.5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance,also'requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains' '
the Contractor's License Law (Chapter 9(commencing with Section 7000)of 7•
ivision 3 of the Business and Professions Code) or that he/she is exempt .
erefrom and the basis for the alleged exemption. Any violation of Section ,
031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). .
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 , Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves __ . -.__ __-. ... _ -_ .-
thereon, and who does such work himself/herself or through his or her own Hood or Type 0 DEVELOPMENT SERVICE REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler . ••
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved ByyrNN��/ Cnap /�Date q/1 --
pietion, the owner will have the burden Of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). [/ �(�
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date 7 OJ
rectors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does'not apply to an owner of property who Duct- Ventilating 00-100,000 BTU 0100,000 BTU SUM RY O FEES
builds or improves thereon,a•nd who contracts for such projects with a con- r.�
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration J BUILDING PERMIT $ n SMTP $ r D'
proof off their Worker's Compensation insurance should be provided to me. PLAN CHECK $ /• �r PERMIT
0 I am exempt under Section [ ' B,.& P.C.P.� t�' for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date rf^V-1r•� Owner _Isi: I/ i`-•� -� Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,000 BTL - - , GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction,and hereby authorize repro- PLAN CHECK. 50% $ MICROFILM $ ! 1 f
sentatives of this cit t enter upon the above-mentioned property for ••
q
inspection purposes �-n(7_ pp (IJII C: tI_ '� MECHANICAL $ TOTAL FEE $ hea
Signature •f�'`a"w- ` SLC, Date / 7
x Drivers' License or SS#
-Accounting; Goldenrod - Assessor ---/
• CONSTRUCTION AND PLANNING POC 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
r
"6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ,0105-_,15„... 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
19. ,Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
' 20. Rough Factory Fireplace APPROVALS Permit# -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 1 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
_i31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATEISSUEDISSUEEDD
33. Final Electric Notes: tir3/��V o ` �`����i�/',�/�yj
34. Final Heating & Air Conditioning 4
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing •
39.-Water Service-Final
40. Gas Service-Final .
41. Solar Domestic-Final
42. Backflow Preventer . •
43. Backflow Irrigation ,
44. Landscape Irrigation System
45. Sound Attenuation
•
46. Handicap Regulations ,../���III���
47. FINAL STRUCTURE & BUILDING Ofr 6l
48. Special Requirements Completed (( �V
49. Electric Release to Edison
50. Gas Release to Southern Califbrnia Gas Co
51...CERTIFICATE OF OCCUPANCY
No. - - Date
OWNER College Mesa Company DATE 14-18-56
JOB ADDRESS 11145 Shamrock Lane BUILDING PERMIT NO. 2771
GENERAL CONTRACTOR The Hale Co VALUE $ 10,2/48.00
LOT 12 BLOCK TRACT 21432 Single kes. w/att gar
•
GROUP I & J TYPE V ZONE Rh FIRE DISTRICT 2800
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
,r �' d DATE NUMBER
Footing Trench .�'7 -s6
Foundation Forms�gdar#de to�Gyalra�g7�ju rq,1
Rough Framing ��"`�- S •�,7� /r" _9-3-
t-g.
1-J ��G 7- `7 Q'
Plumbing,Rough to Sla e � '� �3-S SS. O
Plumbing, Rough Complete �� (i)„as ,.4r110.1.1'/;t� t/-2&-54 4-f C fq
Temporary Pole qtr /{ 7 - (/:J
Wiring, Rough "x'4%3 7flrq as. t 3a..... _ 4-, a s g -a..- —
Heating,Rough `/
Heating,Final _ 1 • 4_ -f( 33 V
-
Sewer, House' •(1. Sewer, St. 5-1,3-Ccr 0)--ffi. F -C-.2-1--re ELf 9l -
Lathing, In X out(��/ CSX /r-i 7-�9 j4
Plastering G It -13 .a
Plumbing,Final,Fixtures Complete TT(../.10 -j5 sZ ' {/y
Plumbing, Final Gas Test )61:4 ,ty.Z'.!,10-)Y, \ �2 pis /J- s/WS ii A�
Wiring,Final {1 ��'2� /f.��✓-V`"...:"f _ i`+�
Occupancy _ H7 /a-n2/j4 - -
FORM 210 3M 10-55
osta Mesa Building Department i.ICATION FOR PERMIT
111 EAST 20th STREET il
COSTA MESA, CALIFORNIA —
ti BUILDING
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. I Permit No.
Building 77/
Address 1445 Shamrock Lane ., v4 h
Costa Mesa, California Received Date RQec'd�7 I Dateslued
Nearest
Cross St. Watson Avenue Building
Address
Owner College Mesa Company Costa Mesa, California
Mail
Address 8002 Central Avenue Nearest
Tel. Cross St. ,
City Garden Grove No.LE 9-2158 Zone I,I No.of I Type V Group//y(
Architect or Lic. `f' Plans �`
Engineer Davis & Quigley No. C-1790 Approved
by Date
Address 43 Malaga Cove Plaza,Palos Verdes CORRECTIONS -
City Lis.
Contractor The Hale Company No. 3422
Address 8002 Central Ave. , Garden Grove
LeLot I
Description l I No. 12 I Block I Tract 2432
Cr lj/At i�r, -1--;-..-
(Attach Metes and Bounds) Fr---. ...\ eil try',
No.of Bldg
Size of Lot 71 x 101 I Now on Lots.
None G'� �1=K
Use ofNo.of No.of ADR 1 o ,,,flim,- A
Existing Bldg. I Families I Rooms V i..uu L)
Setback Line from1 Rear Yard301 Z
Center of Street 50 Side Yard 8' y
DESCRIPTION OF WORK or' I �� uus IA nice
New I x I Alteration I I Addition I •••
Repair I I Moving I I Demolish I
Building No.of
Size 1181 Rooms 5 Stories 1
Exterior Wall I Roof —
Covering Stucco I Covering Shake APPROVALS
Use of New Foundation Location Inspector Date
Building Single family dwelling with Forms,Materials,
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.
ISignature of THE HALE COMPANY
Permittee Plaster,Int
Authorized Agt. Plaster,Ext.
SILVIA LARDNER )4r a Masonry Reinforced
Valuation Permit Fee $
p Plan Check$ 3 Bond Beam
$ ) E Total �,,y -
Fee $ , / FINAL
FORM 204 S-BP 2M 6-55
V
C N
-+ `- (}❑COSTP 9 x ".;-.01.111)
c .'PR 1 2.7.61 UtESt, ngny t.• �
a
Street
PLOT PLAN
Show location and distances from
property line and between buildings.
37102
PAID
SIIG —2-7300 188* ****35.00 35.00
COSTA MESA BUILDING-SAFETY DEPARTMENT -
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P 1 ATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RE I ElV f6�lTE.{1ECEIVA DATE ISSUED3
BUILDING ,/
A DO R FS,S�///����f/'SD Y �i 1 / /p�
OWNER 6f( 4,..11C1aCd C.,f / A.P. NO. IWI -QIa-Sf P57T Z__
MAIL , /'/S_ / BUILDING �t,s,
ADORESS/4'7 V..lfr�j-ae..t#r' .. tccea-r�r_- ADDRESS 'l�4s 'S 41-Afm �G L�
Z . 1�j2
o U CITY ems, . 140--tet., NO` TRACT/' PJB LOT 1'1, BLOCK
— 2 / S�5��v
Z < CONSTRUCTION n/EL
/e { NEW ADD ALTER REPAIR MOVING DFMOLISH
OI- LENDER H I1 T Q/ X
CL 03 f
J BRANCH LO,&�y/Y e o4_,. /'/
J N / OWNER W
mJ la ADDRESS VV"" ��// ,y�-t V UE y .01
•en ARCHITECT r ���JJ TEL. USE /tet ! IID H$ 0- s/
J Q OR ENGINEER ll�Wwe F - /,7rr/�PLNO. I
V to FIRE
w C: ADDRESS ) /� / ZONE GROUPaJQCONTRACTOR(PLVAI e1,.._ O/ /,- e v PROVE /j(,//PE
/ DAT
2'7?J
CO Z
J m ADDRESS d bwV"t-^t^' a
w W TEL. ZONE NO.OF a1 USE OF NEW �D1TI
Z= CITY NO. R.
PLANS BUILDING S
_ H
wt STATE CITY YARDS APPROVED as APPROVED
UJ K LIC. NO. LIC.NO. MAIN BUILDING A0C00010BV BUILDING
SIZE NO.OF BLOCS. (FROM C/ T (� —
OF LOi I NOW ON LOT / FRONT CC T. I�IFT. /
USE OF
EXISTING BLDG.Awe,7/.:/(/ 9 // _FL SIDF 5SL T. }{'{��/Q FTs 10
I- SIZE Of
Z NEW BLDG./ ROOMS NO.OF /T STORIES / L.SIDE 1J FT. SFT. —
Q
EXTERIOR WALL I/ ROOF G(/OOC(
U COVERING S Oreo I COVERING / r
S`j /a-�2GS REAR I a FT. p r �� FT.
,
J US OF BUI D NAND WORK TO BE PERFORMED
- USI G DISTANCE BET. BET.MAIN&
El .(L _ MAIN BLDGS. ACCESS. B LOGS. _
Q Mr /�_ _ /J,�/x /^ VAR. DATE
0
�/rC`�M/ y /n,( [G-Y C.U.P.# APPROVED
co at O01 /Q A y r// APPROVED, , `L ,` 6 DATE 7a/73
o - Apr 4, a/ (/ � a �f U
Up A�
I hereby acknowledge that I have read this application and state St
D that the above information is correct and agree to comply withI ` /Vl ,
CC all laws regulating building construction, and I shall not employ V
I-, any person in violation of the workman's compensation laws of t ,
N the State of California. / CO
Z t0
I hereby certify that I am properly licensed as a contractor under SO. FT.( j - r o
the State of California Business and Professions Code, Division 3, E MOUNT 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:
am oxernpt from the provisions of the State of California Business 7 C
VALUATION �`i_
and Professions Cove, Division 3,Chapter 9. ,./ PERMIT FEE $ `5'
Signature of ,r(-r//� 4„�/,( /if ir'Lft„Y..„/ r(yJCv// G"�v / CO m
Permittee //l\/iT” $�' ' V PLAN CHECK $ // E
Authorised Agent v • SD
o
LL
TOTAL FEE $ 3 r
UVINLN RHODES, William E. I./Alt A-2-73 .
JOB ADDRESS 1445 Shamrock Lane BUILDING PERMIT NO. 37102
V GENERAL CONTRACTOR owner-builder DESCRIPTION of WORK Add fam.rm„beam. . & patio
AP No. 141-012-51 LOT 12 TRACT 2432 FIRE ZONE VALUE $ 1.000.00 cover
INSPECTIONS Signature Date GROUP I TYPE V ._ ZONE pl —
1SOIL
SUBCONTRACTOR PERMITS ISSUED
GAS
Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER n
ROUGH WIRING ar1)—b'"73 Heating and Vent.
TRENCHES LI FORMS n STEEL REINF. 0 C 'lc-'x4-73 4-44 -e,,,t.� 133. _ . 1—/f-li 1 DV 622- ./
FLOOR SYSTEM hl."-T; 5 r,
BOND BEAM L J STEEL REINFORCE in /�I.,,”
SHEATHING C 7-c...---73
FRAME AND FLASHING , / e2- C-71^
LATHING - IN [ . OUT ca- iter e-7�
PLASTER, BROWN COAT /o73
STRUCTURAL, FINAL /�A 6 Electric
HEATING, VENT., REFRIG. AND A.C., FINAL ,7"'/a/J7- 73 l6A.7.72.2 roe/. ,y-5-73 3 (2,l,Sg_—
PLUMBING, FINAL AND GAS TEST n ��JJ
ELECTRIC, FINAL 4,/k,k1O.-�'/'7-.23
BUILDING, FINAL fin v /f-.z?- 23