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2804 SHANTAR DR - Building Permits
M M CITY OF COSTA MESA LOslp M S,p D + BUILDING DIVISIONt FJu� �F g77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • FOR INSPECTIONS CALL: (714)754-5626 "°^^^^fi PERMIT NUMBER: P11-00150 1 4 PERMIT TYPE PLUM STATUS: ISSUED APN: 13940309 DATE ISSUED: 07/27/2011 ISSUED BY: KJB JOB ADDRESS: 2804 SHANTAR DR CM Suite/Unit: Vicinity: SCOPE OF WORK: COPPER RE-PIPE AND WATER HEATER CHANGE OUT. OWNER: ADDISON,JEFFREY D Address: 2804 SHANTAR DR PHONE: City/State/Zip: COSTA MESA,CA ' APPLICANT: PACIFIC COAST COPPER REPIPE Address: 1556 S ANAHEIM BL PHONE: 714-758-7725 City/State/zZip: ANAHEIM,CA CONTRACTOR: PACIFIC COAST COPPER REPIPE License No. 738350 Address: 1556 S ANAHEIM BL PHONE: 714-758-7725 City/State: ANAHEIM,CA ZipCode: 92805 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $45.60 • TOTAL FEES: $45.60 . • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No. 92-28, §1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTION TYPE DATE INTITIALS CODER INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing X g--►1-103 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval '203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • WORKERS'COMPENSATION DECLARATIO Owner ID verified by driv�ense. El Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the erf rmance of the work for which this permit is'issued. I have and will maintain workers'compensation insurance, as required by sec' n 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy CII hereby certify that no excavation five(5)or more feet in depth into which a number are: a Berson is required to descend,will be made in connection with work authorized /_ -/ by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: r� �'1 U or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp (Tho sewn need not be competed if the permit is valued al one hun- dred dollars(SI 00)or less) 2.Art 2Sec 341,Title 8,California Administrative Code). Policy Number: 3r?- C ..,5(0OO 9 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws • California, and agree that if I should become subject to •e work' + comp,cation provisions of Section 3700 of Applicant's Signature Date the Labor Code, h- I f•- • Th co 'th these provisions. L7 j/ Division of Industrial Safety Permit Number: AODlican's Signature / Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ['Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# 7.M)3-5-0 :lass# e -3‘ (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by Z��/ each business which at any one time has on hand a quantity of acutely C for ignaIry 7 Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY, temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes IDNo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control sale. If, however, the building or improvement is sold within one year of officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build.or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and _ Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that CI I am exempt under sec. the information given is correct. I agree to comply with all slate laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not t. . •.. or allow occupancy of any building authorized by this p-. • it until al inspect+i. • Sig ure• L• Owner( ' Dale Signature Dale � i77—// 3e5746(3/07) . Andlor Authorized Applicant Date Prescriptive Certificate of Cornpliarr_ Residential CF-].R-ALT Residential A Iterations (Page 1 of 5) , Proiecl N' y: Climate Zone n) 1 hof Stories General lnlurmatiuu / Site Address:, q 544,,+or i1 1 Enlorc9ient Agtacy: I Late:. 7 --2`7_ t. I t-ir, Building Type 0 Single Family 0 Multi Family I Circle the Front Orientation:N,E,S, W,or degrees Conditioned Floor Area (CPA): Project Type: D Alterations 0 Envelope D Fenestration 0 hoof. 0 HVAC Replacement or Change Out 0 Duct Replacement.0 Water Heater NOTE: Tb is front is not to be used for Net')),Constructed Buildings or Additions ii sulatimi Values For Opaque S'urfimes(fw•Furring use the Mass and Furring Strips Construction table beton+) - . -.. - . . .AssembiyAlteration . . - . D Opening of framed cdi'ity alone-'Altera!ions that involve the opening of the franred'cavip'•ofa wall,:ceiling,ok floor must install the mandatmnr minirmon 07811100 017 value per sc150 for the altered assembly. Fill in Columns A—C and enter mandator insulation'v`alye in Column H. oTteplaeemenf of entire assembly,Replacement ofan entire wall,ceiling, or.floor assembly1eguires•the installation of Component . _ • "Pricknge,-D In'il/ation value§'lir Table]51-C. 1':1/in Columns A—1.- - 'r`''•' - -"-7.. -.- : C) tq lie Stir Itce DeExlls Rot,the to ergo portioned of Mass Walls see Furring Strips Construction Table Below:"- - .'•'. - Proposed s-4 . . ' Standard ' t ValuesFrmn JA4 Table"'•- . .. s .. • _ t Framing Thickness,' ' - 1 - Framed •Continuous•• JA4:`,-:I"•Proposed - - Tag/ Assembly Name Material - Spacing, 'U- t `-]A4-Table - 'Cavity Insulation Assembly t Assembly -' It - MI" or Typel • and Size2t .: • 4-or Other'- - factor" .•'t Numbel't B-value° )12-Value"' '-Cell:Valueb- t t U-factory - • r .. .. . . _ . I. _....._ _i'.-.- . . Note:Foraia'red assemblies,accounting for Continuous Insulation If-value,see Page JA4-3 and Equation 471. For calculatingfttrn'ed walls use the Mass and Furring Construction sable below. 1.For Tag/ID indicate the identification name that matches the building plans. -• - 2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...lndicate the Frame type and Size:For Wood, Metal, Metal Buildings,Mass, enter 2x4, 2x6,or etc... see JA4 for otter possible frame type assemblies. . .3. Enter the thickness for mass in inches or Spacing between framing members enter; Id"or 24"OC;or Other for all other assembly description such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc.... - - • 4.Based or the Climate Zone;enter the Standard U favor from Table 151-B, C or D for each different assembly Name or type. 5.Enter the Table number that closely resembles the proposed assembly, 6 Enter the.11-value that is being installed in one wall cavil'c'between tnef'enting; otherwise, enter "0" 7. Enter the Continuous insulation R-value for the proposed assembly; otherwise, enter "0". 8.Enter the row and column of dor ['factor value based on Cerlwnn F Table Number and enter the Assenrblt L1-factor in Colman.1 9,The Proposed Assembly U-factor-, Column.1,must be equal to or less Than the Standard U-factor in Column E to comply, Furring Strips Construction Table for Mass Walls Only • - • A I IS I C DIE F I d I H I 1 .1 ]f L J- M Proposed Properties of Masonry.aud Concrete I, Added Interior or'Exterior Insulation Walls From Reference in Furring Space from Refer once Joint Appendix Table 4.3.5.4.3.6.4.3.7 Joint Appendix Table 4.3.13 J vb Ja cFvp . . a. u. �v, ' a, a v `m : Final Asxcnhly --3 � c � Mass halite or ,IA4 table ,y g: - u s E R °o 'k a 4 _' Z is Assembly Thickness' Type? Number' S « < = w a LE L. .- c S :a w C U-lactor'53 Comineni 1 i I i I I I I l I I . It egis'Ir'ot ton Number: Begis r'at hitt Dote/Time: 1IE11S Provider: 2006'Residential Compliance Forms August 2009 Prescriptive Certificate of Complit. .: Residential CF-1R-ALT Residential Alterations (Page 4 of 5) Project u,lect Name: I Climate Zone# ii of Stories • i HVAC SYSTEMS.-HEATING . • Minimum:' Duct or Piping • -Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split, • Type and Caapacityt'u•s (AFUE or HSPF) Type and Location" R-Value Type - Space,Package or Hydronic) J.Indicate Heating Type.(Cenna Furnace,•Wall Furnace,Heat pump,13oiler„Electric Resistance, etc.) , - - __ - 2.Electric resistance healing is allowed only in Component Package C or except where elecu is heating is supplemental(i.e., '(total capacity <21 0'or 7;000 Biu/hr elecn'ic healing is controlled by a time-limiting device not exceeding 30 Minutes). See§J51(b).3 exception; 3.Refer to the HERS Ret ificatiofsection on Page 4 of the CF-IR-ALT Form for additional requirepems and check'applicable boxes ... .. 4. hahcaie;Type or Location(Ducts,Hydro'»coin Float', Radiators,-etc.). ' H.YAC S\.'ST1 MS- COOLING Minimum;. -.. ..-. ... .- . :'^-.-. ' '- .t::-Effcienc,� .- --. • --Duet orPt in - - -� �-- --�� > -- - P b :. _ _Configuration Cooking Equipment' ' . .t(SEER/EER-o e ,7 Distribution :-.Insulation, -Thermostat ' Nentriir,Spfi - Type and Capacity'a.- - • 7It• COP). ".. Type.and Location' - •••- R Value• _ - :• -Type Space;Package or Hydropic) It Indicate Cooling Type(A/C,Heat pump,Evap. Cooling etc) "•• .-_.;1., ,::.:7'•7-7,- 2 .2.Refer Mitre HERS Verification.section on Page 4 of the CR-IR-ALT Form for additional i'egan emdpts and check applicable boozes - ' ''''• ' 3.Indicate Type or Location(Ducts.Hvdronic in Floor Radiators. etc./_• ” " ' " MATER HEATING ' "'List water healers and boilers for both domestic hot wail:(DEW).heaters and hvdronic space heating. Individual dwelling DEW heaters Hilts1 be gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DEW healer to the Iritchen(s)and on all underground hot water pipes is required in all component packages in all climate zones. • -External Tank ' Water Heater Type/Fuel Distribution Type' Number In Tank Energy Factor or . Insulation Type' - (Standard,Recirculating)' System Capacity(gal) Thermal Efficiency R-Value} - • - • .7-7ro / 5./GncJ•ctd VO Li/Pro t.cw Altii / 1 I.Indicate Type(Storage Gas,Beat Pump,Instantaneous, etc.) - . 2.Jlecirculating.rvstenrs serving multiple dwelling units shall meet the recirculation requirements of P5000. The Prescriptive-t-equirenretrls do not allow the installation ofa recirculating water heating.system for.single dwelling units. . 3. The external Hate'heating tank and pipes,shall be insulated to meet the requirements of.bY SOW, SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. There items may require Heinen justification and documeuation and special verification. NEW ROOF ASSEMBLY-Radiant Barrier The radiant barrier requirement of tj151(02 does not apply to roof alterations. Slab Edge(Perimeter)Insulation 0 YES 0 NO YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation 0 YES 0 NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in'fable I I It-A of the standards. Raised Slab Insulation 0 YES 0 NO YES:In Climate Zones 1,2, II 13. 14& 16,R-8 insulation is required; in Climate Zones 12& 15,It-9 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Date/Time: PIERS Provider: ' 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF-I R-ALT Residential Alterations (Page 5 01 5) , , Project Name: - - - Climate Zone# 1 i/of Stories • HERS VERIFICATION SUMMARY The e for'cenrent agency should pay'speciai citlention to the HERS Measures specified in this - • • checklist below.below. A completed and signed CF-4I?Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Scaling & Testing HERS nerilicu/iso-isrequirec/lot thismeasm.c. - . ., . 0 YES 0 NO YES:In Climate Zones 2 and 9-I 6,if more than 40 linear feel of new or replacement ducts are installed in unconditioned , , • - space,the duets are to he.sealed per§I52(b)I ll❑mid the newly installed duets are to be insulated per§151(f)10. . - -- •.❑ EXCEPTION: Existing duct systents:dmt arc extended, which are constructed,insulated or sealed with asbestos. . ❑ YES 0 NO YES:In Climate Zonesii and 9.-16,if the'exisiing space-conditioning system(1-1VAC equipment and ducting)is replaced,the . . ..ducts are to.besealed.per.§152(b)llli.•l - ❑YES 0 NO YES:Id Climate Zones 2 and 9-16;if the existing HVAC equipment is replaced(including the replacement of the air handler, outdoor condensing unit of a split system,cooling orfrcating coil,or the furnace heat exchanger)the ducts to be sealed per..§152(b)1E. _..-..'. • .... ._. .. ... . . ❑ EXCEPTION:Duct systems th it fire tlocumentell to have been.previously sealed confirmed thr imgh HERS - ' ' • -•. verification in acemdmice with,procedur es in the Rel erence Residential Appendix RA3 l - - - . _ --- - a:EX CEPT]ON U.imt'sy§tears with-Jess than 40 Iineai leet in unconditioned space - -- ' " - . ' 40—EXCEPTIONExisting'du ct systems consn•u eted,.insulated 0rsea led with•asbestos. -_- •. -Refrigerant Charge,?-Split System HERS ver i/icauoP..ls reganedfor diipemdasurc • - • ' ❑YES ci NO YES:In Climate Zones 2 and 5-15,when'the•existing HVAC equipment is•replaced.(including the replacement of the airr '•-. ' .1- .,.c handler;outdoor condensing unit!of t splir system A/CALL heat pump,;cooling or heating coil,or the furnace heat - . .. exchanger)a refrigerant charge measurement shall.be verified per§152(b)1F. . .. _ • ' 'Central Fan Integrated-(CFI)Ventilation System and Fan Watt Draw - • - -• The ventilation requirements of§150(o)do not apply to existing residential homes. -- - - - " ' Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is reguiredfor this measure. . ' ' -' .- . 0 YES 0 NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is - replaced,the airflow and fan watt draw shall be verified per§152(b)ICi to meet the requirements of§151(07B. Documentation Author's Declaration Statement . . . • I certify that this Certificate of Compliance documentation is accurate and complete. b Name: • ''Signature: • fr97 i' <Auny Compan ate: -4 /vC , s ... .. ao � - C7—%1 Address: ' If Applicable 0 CEA or❑CEPE /55-6 S AcI•e,.wr RAtte (Certification#I): City/Stateedip: Phone:. - — . 41�i,e,M (lc-. 9a Ao;r 7/V'- 7i8-77 r Responsible Building Designer's Declaration Statement . • I am eligible under Division 3 of Our Cilifonirn nosiness and Prol'cssioat Code to accept responsibility for the builcling design identified on , this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this building design on the other applicable compliance forms,worksheets,calculations, plans and speci fieatiun5 submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy hotline at: 1-800-772-3300. ifegisuntion Number: ifegisiration Date/Time: HERS Provider: 2008 Residential Compliance Fat ms August 2009 Mandatory Measures Summary MF-IR Residential (Page 1 of 3) Site Address: Enforcement Agency: ; 'Date: NOTE: Low-rise residential buildings subject to the Standard';must oomply with oll applicable mandatory measures listed; regardless of the compliance approach used. Move stringent energy measures listed on the Certificate of Compliance (CF-1R, CF-IR-ADD, or CF-1R-ALT Forin)shall supersede the items marked with an asterisk(") before. This Mandatory Measures • Swnniarr shall be incorporated into the permit documents and the applicable features shall be considered by all parties as nrininno» component performance specifications whether they are shown elsewhere in the documents or in"this summary. Submit all. applicable sections of the MR-IR Form with plans. . _ . DESCRIPTJON : " . . • , . • Building Envelope Measures: .. .. '. .. . . - ' • §I I6(2i)l: Doors and windows between conditioned and unconditioned limit air leakage. _._..-... .. .__ - ;. :§1IG(i)4r Fenestration ploducit{except field febricateil.wrndox s)IiaJe alabel-lisungthe ceniGed.U-Factor:ceniLerl SolarHeat GaurCoefTtcmnlr" (SHGC),`aitd infiltration that meets-the'requrements (a). . ... . ... . . .. .'•_. . ._ . . . . ... - .. - .. .. • — {§1.13-'-.Exterior.doors,andi.Windowsare-weather-stripped;.all_loints and penetrationsare.caulked and sealed. -:- • -' §118(a): 'Mutation'specified.of insialled'meets:Standards for Insulating Material Indicate type andinclude.on CF-6R Form „,.I y§118(i)i:The thermal-en-intense-and solar reflectance-values-of the coolroofinb material meets the reguu einents;of §118(1);when the installation of ': 1 , .; a.Cool Roof:is specified oirthe CF-IR.Form _ "i -" :•§150(ak Minims m R-19 insulationin wood-frena ceiline,or,equivalent,U-factor." §150(b): Loose'fill"insulation shall conform with manufacturer's installed:design labeled R-Value ' 1150(c): Minimum R-l3 insulation in viood-frame wall or equivalent U-factor. , *§150(d); Minimum R-13 insulation-tri raised wood-frame floor or equivalent U-factor. _ . - _ . . - . §150(f): Air retarding wrap is tested,labeled,and installed according to ASTM E1677-95(2000)when specified on the CF-1R Form. . " §150(g): Mandatory Vapor barrier installed in Climate Zones 14 at' 16. " - . • §150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%;water vapor permeance rate is no -' - greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. _ . • . . Fireplaces,Decorative Gas Appliances and Gas Log Measures: _ . . . §150(e)lA: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox. - • -• .. . §150(e)IB: Masonry or factory-built fireplaces have a combustion outside air intake,which is al least six square inches in area and is equipped with a with a readily accessible,operable,and tight-fitting damper and or a combustion-air control device. §I50(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket,when that indoor air is vented to the outside of the building.are prohibited. Sluice Conditioning,Water Heating and Plumbing System Measures: . .. - • §I'I O-§113:-HVAC equipment,water heaters,showerheads,faucets and all-other regulated appliances are certified by the Energy Commission. .§11-3(e)5: Water heating recirculation loops serving multiple dwelling units and High-Rise residential occupancies meet the air release valve, backflow prevention,pump isolation valve,and recirculation loop connection requirements of§I I3(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: fan-type central furnaces,household cooking appliances(appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exem_rt),and pool and spa heaters. §I 50(h): Henting and/or cooling loads are calculated in accordance with ASI'IRAE,SMACNA or ACCA. §150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c). §1500)1A: Storage gas water heaters rated with on Energy Factor no greater than the federal minimal standard arc oxternally wrapped with insulation having an installed thermal resistance of]t-12 or greater. §1500)1B: Unfired storage tanks,such as storage tanks or backup tanks for solar water-heating system,or other indirect hot water tan Its Iiave It-12 external insulation or I1-16 internal insulation where the internal insulation 11-value is iuclicated on the exterior of the tank. *I50(j)2: First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire length of recirculating sections of lint water pipes arc insulated per Standards Table I50-B. • §150(B2: Cooling system piping(suction,chilled water,or brine lines),and piping insulated between heating source and mitred hot water taupe shall be insulated to'fable 150-B and Equation 150-A. • §1500)2: Pipe insulation for steam hydrunic heating systems or hot water systems> 5 psi,meets the requirements of Standards Table 123-A, §1500)3A: Insulation is protected front damage,including that due to sunlight,moisture,equipment maintenance,and wind. . §1500)3A: lnstlation for chilled water piping and refrigerant suction Boas iliehldes a vapor retardam or is enclosed entirely in eonditiomal space. 2008 Residential Compliance Forms August 2009 CITY OF COSTA MESA :P ,:-Allit-:-`, BUILDING DIVISION ti ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER .F • M99-00051 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2804 SHANTAR DR Status: ISSUED Suite No Applied: 02/17/1999 Issued: 02/17/1999 Vicinity: Parcel Number: 13940309 Applicant GONZALEZ, ADOLFO ' Address: 09911 LARSON AV - '--, -' _ Phone: 714-530-2440 GARDEN.GROVE CA - Zip: 92842 . Owner ANDERSON, MILDRED L TR_ �� ����, Address. /2804 SHANTAR DR • - - ---� :*‘,;:• z-',-. (:�'/ / • _ Phone: _A�"--:•,.--;; ' ../1�������A '' COSTA MESA,CA-' _- Zip: 92626 " , N/ > \N-,,, Contractor A-AMES PLUMBING & HEATING ti' Address /, 69911 LARSON AV % Phone =714-530-2440 - \ \�� ' •;:// Y." A'I \ V / V �M '( GARDEN,GROVE CA " . ' Zip `92842. ' ' . ' \ • . ? r ., --License: ..250307, i ' Arch/Eng: ' /� , , - - •- Address: _ A• Phone: Zip: •� ' ' License: =‘, SCOPE OF PERMIT': ,, ;. _ , REPAIR EXIST.FA. . . - ._r ,\. �.' FEE SUMMARY Quantity ,/ j _ Quantity ISSUE FEE $22.00 Repair./Alt Absorbtion Unit � _ ;$0:00,/ 01, , Inst FAU.<100 k BTU- $13.25 1 Repair/Alt Refrigeration Unit %, ,-'$0.00• 0 Inst FAU>,100 k BTU. $0.00 0 Ventillation System 2'i='.' ',.$0.00 '0" 1 Repair/Alt_Cooling/Heat $0.00 0 Evaporative Cooler Inst/Rep.,Recess Wall Htr $0.00 0 Commercial Incinerator -$0.00, ''0 Refrig Sys<100 k BTU $0.00 0 - '.. ',Domestic Incinerator $0.001'-0 Refrig Sys>100.k BTU - $0.00 0 - Compressors/Absorption Systems Gas Piping v,'$0.00 0.. ,Up k to 3 hp/100 BTU. - $0.00% 0 Factory Fireplace'- . '$0 00 0 3 To 15 hp/500 k BTU. % " . ;$0.00 0 Hood w/Mech Exhaust' / ' -$6.00: 03 /' - .15 To 30 hp/1 000 k.BTU '$0.00 0 VAV Box ; $0.00 0 -..: �, ".3o To 50 hp/1,750 kBTU ' N v /1/$0.00 0 Vent Fan/Single Duct - ; '$0.00 0 - - Over 50 hp/Over 1,750 BTU' ' i $0.00 0 Appliance `$0.00 0 Boilers , Fire Dampers $0.00 0 - Up to 3 hp $0.00 0 Smoke Dampers -"$0.00 ' 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0. , 15 to 30 hp - • - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp ' • $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace . $0.00 0 ' ' .. Other.Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 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 • 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 sell-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.) ❑ I certify that in the performance of the work for hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca Ionia,and agree t at' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these�9vi n //��� ��i,(^ / Applicant Signature: //� '� Y /L�41�/` /.�(// Date: 1' / /- �� WARNING:FAILURE TO CURE WORKERS'COMPENS ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,100),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# Class# Contractor's Signature: 9'.L _24-0414-2,046,/ Date: 2- q- /7' / i 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 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_permit 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 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? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date tBELL INSPECTION TYPE DATE =ALS COPE/ INSPECTION TYPE (DATE ,1111, 1816 Fixed System Final Fire Prevention 206 Final Mechanical a-1 lc—1 1 I Ni 1266 Pool Spa Final 208 Final Plumbing 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 24413.6 Applicant to fill in all spaces except those within heavy border lines and si• gn all appropriate declarations. -CITY OF COSTA MESA: - < . ft I PEWIT NO. TRACT NO. LOT NOF BLDG NO. CONSTRUCTION PERMIT, • f, i I '• I 1 .9D''3: _ ..-4•t• . 1el ~� ) •`1 ' ' i 1 ' - 1 ' .: ; .xk : i 'r .. ;: I. ' 7549 4/20JB3 5.00 ; TL M Applicant's Mallin Address -TYPE OF CONSTRUCTION"; UINEW -U ADD_U ALTERATION .,L'1 REPAIR- ' • -r ( r ( • ( 1 ' ;� I �. , ' 1 Project Address', 2{��14 ' ' SAI-LIII ' -- I• p •I ❑,CONVERSION r❑ DEMOLISH ❑ OTHER • "IC I I. - 1 ((�� Owners Name /I"I'/yI/F':/"'1AJ/`P'/'• t'Ji 'Phone> 'n"9t 4 DESCRIPTION OF WORK '4- :. - . I , , - )� ^b 1* f l .it f '• I j , ! ( ,' r- . 'c, , -i , '`•. 'ZONING'REGULATIONS I . .. 1 •1 Address _ ' -TIYBE OF PERMIT U,'GRADING Ii IS�III•FOUNDATION ❑ 9TRUCTURAL -' •AP.gp1 to , -ZONE'I '' , _I I • r �. N : Arch/Eng • -, • • ' ' License No i , ❑ TENANTS ❑'ELECTRICAL LI�;PLUMBING ❑'MECHANICAL- - - • I " BUILDING ' i ' - ' v 'r c l I , r, .. i _ 1 _. .PLNG.REF i- , `crTaArrr rAi cT 'T. ' 0 Address` �-ry - • �- - ' - • LiOTHER - I,_ i i j' ` ' TO BVILDING - `REAR VARD'ITO P/LI - \ • Contractor's Namie7A :at�/l✓ci1 "P/ .44 A P17 t°-Phoned "34''70 PROJECT DESCRIPTION: SO FT- • - '• OCCUPANCY + PROPERTY LINE . 7 - • I t - / / f i I % C ' i . . .LEFT SIDE Y•ARD RIGHT SIDE'YARD, Address lmailingl� •.-5 hl ./'A/(2d/� : •) -• ' ON STRUCTION TVPF - VALUATION$ , License No 421-/ ' , L- 7' - lc i • 1 ZON)c I - I GRADING CU,YDS: !ACRES ' i ' PKG.SPACEIREQ. ) I r PROVIDED y i.:_i , LICENSED CONTRACTOR DECLARATION ; , 'I i ' Remarks: - I 1 )• • • 'STREET WIDTH I • -• 'PARK FEE'S • - I herebylaffirm that I am licensed under provisions of Charter'9 (commencing i' ' ' - 1 - with section 7000) of, Division 3:of the Business and Professions Code,and 'SPECIAL I :. I. 'SPECIAL CONDITIONS: ) �- - I l ' my license,is in full force and effect, i , - i ` 1 ,Ucense lass:. I - i !' ..3 '- Licens&�rorLa17r- / j ( 1 1 1 PLUMBING I i j • '' _ Date IJ''?' ?.3 Signature .ita4t'& P_-h • i Bar SinK w I t ( • Sewer CeP' r t " II .� 1 ELECTRICAL 1 ORKERS COMPENSATION DECLARATION ' , (. - } ' ' 1 :1' ! I ereby:affirm that I have a certificate of consent to salt-Insure or a certificate ) • I Automatic Washer Meter Dover 100 amps' I Workers' Compensation"Insurance,'f or-a'-certified'copy,thereof (Section y -"Y-Backflow Prev_enter... _t _ ..- $asiv2r"Cortnectron' .__�- • ,_ _ ._. _ 1._. i.... i 800, Lab. CJ i • -'-' i • 1 Sub Panel" •-N_.� - •I ; Construction Paler' I Q, /nit/�, _ T,tJS - . Backflow Irrigation Solar Collectors I 1 I I • - • Policy No- 4- Y Compahy fl✓P/C - • - -- -- - - i ertified copy Is hereby furnished, I I I '! Bathtubs r s I.r ' I 1 Cooking Unit ,, Sub Pole : I. ( j Spier Piping I Certs led copy Is flied with the city Building Division- • I. ( . I Dishwasher t`,. " 'Motors 00-1 HP ❑1'b-e i Date '-,1•1--P'Y I- Applicant •T+•^G-Ass-/-s 'Ptio :a-,1t14Clarifiers 1 Solar Tank c 1 ` r 1 EXEMPTION,FROM WORKERS'COMPENSATION-DECLARATION"- '• " I Dishwasher I : Swimmin Pool w/Spa j I - - '- Dryers ❑Gas,'DElectric•^ I Inc:SoIart09-15'HP'016=15+" "' Iasis section need not be completed If the permit is for,one hundred ($100)or I - - 8 P I . • • Fan; ° Microwave ' I certify that in the performance of the work for which this paring is Issued, I i I' Drinking Fountains Urinal , r I ; . I { 7' 'r j I t shall:not employ any person in any manner so'as td become subject.to the '. , i 1 '„r F.A.U. f •Pole Light Workers•'Compensation:Laws of California.' I Floor Drains! . Water Closet. ; } - I /%I I . 9 i , 1 Date' " ' I Signature I- .i ' - i 1 Fixtures ' r i i .-NOTICE'If,after,makin- this tlon,.you should.becomemust eEt.to the„•y .^ FIOOr•Slhks I _If., ;! -,Water Heaters -. _ ;'t�- 00 I I )� t i ,Range 1 i i i `Workers'• Compensation:provisions of the Labor Code, you must forthwith k - I comply :with such provisions:'or,this_permit shall be!deemed revoked? i Ges Service i Outlets{ -Water Service ✓ ' ' •4, Device Bores 1 'Sign1 4 l 7 1 i I CONSTRUCTION I LENDING!AGENCY; i - '-1 - -' / - Cl ' ' , I '; I hereby affirm that there Is a;construction lending agency for the•pperformance ) Interceptors l 77 ; - I • r I ! Outlets 1 1 # 1 Standing Sections I ; 1 '• of the work 'for which this permit-,is Issued ,,(Section•-30974 3097 Civ C) - .' Lender's Name ' - - I , :Trash Compactor •, 1 ' j _ l.. - ) j KRcheniSinkl • . 4,, i ..t _ I . 1 •, , „t; • Switches., I i , OWNER:BUILDER DECLARATION 1 :' I i . r ) I Lavatories S i c I 1. _ I i . ' N Garoage Disposal i I herebylaffirm that I am exempt-from the1Contractor's License Law for the. - - c.; r I I' Generator,❑0°5 KW ❑5-15 KW • i .following reason-(Section;7031.:S:Business and'Professional Code: Any city or . , P Trap( I •H I i ,+, 1 .. I } i ;: i / ; i - i i , ' county which requires a Dermit'to construct',alter,Improve}demolish•orrepair - I i , r { } I •• I ' Transformer 015-50 KW any Structure'prior to Its lssnade/she5is requires the applicant•for such permit. i ,� poor Drains: • ) i, i , ! ' 1 I Ito file a signed statemen Lthat he/she is licensed pursuant to thefprovisions of , - _ - "f ' 05U+KW) { .. ! I Contractor's License Law(Chapter 9 commencin with Section 7000 of c ' - I Reinspection Fee i $15'I 1 syy-from "of the Business and.Professions Code),or:that he/she_f Secmpt o j Showers I I -, i ? 1 i• ; Remspeitronl Fee i $15 .,from and the basis for the alleged exemption,-he a pplailon•of,Section l - _ Meter ❑u to 100am i ; ' Y,5 byAany applicant for'.a permit--subjects the.applicant to a civil : '1 ' . ) a • • 1 h- , - t -; : , i ' P p 1 tissue Feat • } '$ g_ i ,z fatty of not more than five hundred dollars($500)- < e•••••• ; 1 '� Service Sink c Issue Fee C I i•$ 3 Zoning Approved By ` i !pate t •LJ I as'owner of-the'property orCmy employees with wages as their Sole _ _ , j ' compensation' will'do the work-,and the structure-is not intended or offered t I• , I: : i MECHANICAL 1 ` I ' r" ) Appjirrtien Approved By _ "Date 1 • 1 ' for sale((Section 7044', Business,and.Professional- Code:..The Contractor's 1 - I I� ' License Law does not apply to:an.owner of a property'who builds or improves Boller I ,i I .i I f Refrigeration System j i 1 i i' ' thereon;zndrwho d such ork:himse nherself or through his or her own _ 1 I I Application Issued By Date / • employees, provided that such Improvements are.not Intended or offered for — ❑0.100 OBTU 1100,000 BTU ! sale, If, however,the building or Improvement is sold within one yearlof com- : , Duct Under Ground 'I - , " - i .40 I _f ; I 'I SUMMARY OF FEES '1 1 , ',lotion,for the p ,pose l have-the burden of proving he/she did not build or Im- ' , - 1 1 , ,; rove the purpose of.sale). i - I y y i 1 Duct-Structural 1 I System RepeirlAlteFation t •BUILDING PERMIT $ i 1 SMTP 1' I $ ;moi LJ I,as owner of the property, am exclusively ctingiwitheicenseC con- I I .1 1 ' .� ) i i tractors to construct he•project (Section 7044,Business and Professions Code: ') f Duct-Ventilating ; ' .j . . 1 . ++� PLAN CHECK $ 1 PERMIT 'The"Contractor'v License Law' who tfor such of party'con- -. - - - ••�q' 1 ' i /}..r� i ISSUANCE I $ '• • r builds or improves thereon,and who contracts for such projects with a con- , Exhaust System 0 Multiple 0; j .f i j I h' • ";PLUMBING • j $ - j 1 1 1�. tractor(s) license pursuant to the Contractor's License Law): } i t l .i i ) j I 1 GRADING $ ' 0 (jam exempt under Sectio! 4 B.&.P.C.far this reason Firepl/FaM.'Bit, ICBG ) j •t 1 t I „Si PLAN CHECKI I $ _ i j 1 j (( i'—` 1 'ELECTRICAL, $ 1 1 i t $ I r 1 Date, I ) .1 Owner I -i : I I Heating;System& Ducting j j ! ' •) I 1' I • 't fff ' - 1 MICROFILM 1 $• t ' . L hereby_certify.that_Ithave.read„this'application-and,state,that•the above,. ...4. ❑o-100,0001BTU.0100,000BTL .__-.1... . ;_ _ - 1 'PLAN CHECK 'I $ 1 =r information is correct. I agree to comply with all city-and county ordinances 1 ' I • I , �I . - ,, !MECHANICAL $ 1 I TOTA L!FEE, $ andtstate laws relating to building construction,.and hereby authorize repre- : • Hdod or • + ' ' sentatives of i this'city'to enter,upon-the above-mentioned 'property for ' i Types 0}.- 1 I Reinspection Feet -i .P/$15. 'PLAN CHECK; .I - I , LESS I ' . Inspection Durpos01 1 : 77y� i Canopy .Typal 0. ' ` Signature I/1_LF'y/(n � °°' 1 'i , Registeis, 1 I I e1 •I Issue Fee i ,� I 7y$ 3 ! • I , FINAL FEE i $ ice' G`"O CMF'0865-46 rev:12/82`White=Bididing:Canary-APPlicant(Pink=Accounting:Goidenio i-•Assessor LL”' '- -'-- ° 7• -, _- ,e -z __. _ -^ _. - ., �„- _ !,� r/ t""S}:-. a,. 1 - .: 'a, ti• :-r-rxy,...- �.^.N - ;� .r T•:�tc�s.� . 1<�.'d..7 .. t c��,c• ?C'CONSTRUCTION AND PLAN - • ' t P00 PA _ ' ' ' ` i `' •` ' -{ 403 `.Date ,Inspector• (APPROVALS:::r ,-t 'ft' e�.' ,' = 'a Date Inspector, ,APPROVALSr Pefmit -r • 1 ��Permit#_ _ . ' .; i1.fTemporary Electrical Service or_Pole ; . ,n mr A] : 5:,-:••: _- > 1• '52'•_Pool_&&EquiPment.Location '.:: : , ' , _ =-< •-• , 2. Soil Pipe Undrgrnd': ` ' , ; ?< 7., I - . , L. ; a: '53 Steel Reinforcement := :`,:: . i- . f3.lElectrical Conduit Utilitv-Undrgrnd?. `l ft, : ' •• n "0 14,:754:t.Forms" f. i...:,_ '„ NI. t4.;Electrical Conduit-Undrgrna._z., 1 T E L. ° I ,• 3 ,. 255:7Electricalionding e • •• '`' ' ,I 5.ISteel Reinforcement ; l e; c:.:-.74, ! - p, ; i h G _ -. - u - . . i56. Rough`Plrimbing &Pressure Test'- 6.• v„ .. � _ 11 c 1 Electrical 11FER Grnd , Q ?>:1 := a_c .47._.APPROVAL TO•COVER-GUNITE _ 1 -!.'„:3. 7.tFootings I j I I ! IuT ; Li• � ' ` ' l .:u !- ' 58. ;ElectricalConduit-Undrarnl-i_ ': r ' 8.1Foundation l I ! ' l a s 1 I = ' ° ' r ^59.`.Gas Pipe O Undfgrnd.,-Test, , _ , 9.:Water PipqUndrgrnd. I I ° _ -, s • ;; ` 60. Backvvasfi!Lines,P,Trap;,O_Undrgrnd:: - ,g'. • ;j i 10.IStructur'al Floor• 'System ! ' s i 1 1 jn _' , :61.'APPROVAL-TaDECK? f...! ,a I t iI 11.IProperfy Sewer Line &House'Connection; , , _E ' :62.;Backwash & Recap -Final _ - - _ " ] t • 12. Sewer Cap! l j i r E" - � ! ' 5^_ 3 :' 63.:Heater&,Vent-Final ' ?'• _ .1 I '' ' ' 13.!Roof Drairis I I; I - if I j rz- :11.64.tPlumbing,System� Final. .5>- - f e 14.IRough Plumbing 1 I SC": ! .. ' ., =65.•Electrical Final - •• . - l ., ;; 115.:Rough-Electrical-Conduit'-' ; T ter_:. 66.-Solar - -• " -- -' -. ` - - - - I h .. a 1 .�it •1 I 1 - I I System=Final; -16 Rough Electric Wiring a E 1 II to m'_ - ",--4-t.- 67:;Fe`n'cii &A-cei foval;'== -i - -i- -; ' 17-''•Rb gh WirlingSign:'. m 1 " 1 iI "ti 1- 14 1"7,1; •- J �1 !� i 68! %APPROVEDIFOR PLASTERING i . 18.:Plough Ceiling 1 '! I= I a I _ I T 1 - 1 •• 1 _ ' , s • ;fig. POO L%SPA;SYSTEMSFINAL j - '! I , . ' I 19Ro.. Heating & Air�Conditioning I. I : 1 ; 1 I 22it1 i 3 . I I I ,FIRE DEPT REQUIREMENT .. _ . ! `- , ' I , • 20.;Rough:Factory Fireplace I I fi ! ! , 1 _APPROVALS . Permit# n .- • -. - nl n _i m > 1 1 i 11 11 I { I ( i , 1 , 21.jOucts;.in Stricture) f-, I I 1 f1 11 1 1 I • 1 ;70! Underground Hydro 0 44 _ 1 ' , `1 `,22.1"Ducts;VeniilatingI ,T 1 lilt i1 { t 1 ! I I I 171! Product Piping'OGas OOil , i ! r • ' 3 23.IGas Pipe-Rough &Team 1 ! IT I I • iF • , I {� •,72! Underground Flush !1`S i - , i • 1 I E °24., Roof F.ra'rning j c I 1 j i I• i, 1 m I 0., - nd I . 73. Undergr .,Storage.Tank-0 Gas'O Oil ' 25. Roof Sheathing : i ; 1 4 I;:�1i 4'2, I• I 1 i• I.^ •I-' 1 ;I` j 74i Overhea• d Hydro r;:' I • ( : •' •126.'T-Bar Ceiling'(Structuralhl& Monocoat ' ; ! - 1 = ' -" - °i ` •75. Dry Chemical I c , i , 1 {I I i g. , ; I , 41 1' i; 14. 1 `- ' I .1 176 Dry Standpipe: '. 1 ' , I ,27.'•F.rame,and Flashing' , I I A .. 28.;Lathir g &Siding n ' I j I �; {77! FIXED SYSTEM FINAL.' ' i i I 1 n I r 71 I ;1 I! I I . : I 1 t i I-78 FIRE PREY. FINAL I. ; 1 a 29.. Insulation- _30.GDrywN all ailing '• P ' ri 1 1 t i� I I i I ti I I , I r - j ' ! 1 1 - ! 31: Plaster.Brown Coat I i 1 { _ I 1 ¢-•zr 83' vt �As2s YJ/lit. X32 EIectrica! Power Meter-Finai I ;I , II , I I , 1 I 1 I I .i I, -' - " I t l l i 33_'Final Electric ' r i.1Mw l'., 'I I I I 1 - 1 ! ,- . .. '- ' ' 34. Final Heating.&.Air Conditioning1 j I „ -11,-_-,-- .- t T { ' I 1 '1 j . 35. Final GasPipe:Te`sti- ' 'j ;if ii ` 'rc: I ": ;' 1 -ET ; .; { s1 :1 - - Tr - 1, E - _ 36. Hood`orIica4 $:,---t m ; I I i . 1- I = - ' _ I r C _ - ' h -I! Ir�I Ii.11 .-:1 %f1 !, tlrl I `- I • ! � • r C , _ _ 37. Final1•Faictory Fireplace' , =, c. it ;�. " 1-= 1 t I I^ . tr , ;t' 2 ;_ ,i 38. Final Plumbin9l I - I , t.�1 It t ` 9�tV-f31 ! f "I.• ', - 1 ' n - ' ' - 39. WaterService-Final I l . it 1 I . I I . 1 I AI l )'_, I _ Z ' r 40. Gas Service-Final •I it I -- ' I ( i i ! I I ; I6 I u 1. 41. Solar yDomestic5Final I I ; - ,_ „1__1,x, Imo_. _- _I , . _.: ,_ i' ' r 42. Backflow P.r'evelnte'r 1 I 1 t., ; ' I i t _{{ - ~'• i _~ ,- „ 24 I i -i t 43. Backflow Inr .rrigation F l 1 - I l '- ro I ,. I i ! I �, :• I t 1 II „ ! I. • ',, ,_) t 44. Landscape Irrtgation1Svsteml ( .c -- ;. I -; a I I a' -' 1 2 j • i t ",1 ' I ' _- �r ,. I,, - 45. Sound cAttenuationil^'+ i I i l=' I I`- ! ! _Irl ; ' t I . N _ • - - 46. Hand ecap Regulationsi ' R I 1 1� I' !. i�t I- '.i ; I , .' •'.„ 47.•FINAL STRUCTUREI& BUILDING,f 1 ' ; . II --• i ' I I t I. j.1 :: 1 I , ii I' I I 4 . 48. Special RequireIments Completed 1i I ' I I-- ; u{ 1 1 ; I . . , ' , `'` 'I` ' e r 49. Electric lReleasetoIEdison I i L I r ...-15--,-i • , I _ I _ I _-4-Th. . 1 . r 1 ' l ! - ' :1 I . : 50. Gas Iteleraselto Southern California Gas Cn 1 i 1 ! I ! 1, I 1 , , , I a;.--.-j !!,: + :� 51. CERTIFICATE OF OCCUPANCY 'I _ _}_J__' �{__I . - -H -_ _ _ -' • 1 i No s ti Date t , I, 1 I I I I I I I till I ADDp_430F BUILDING: 1.,Dw�ry.i�l+�, }T��ANTTpp��{{ ppRR WIT: CITY OF COSTA MESA — BUILDING PERMIT owNE:' ElcaawN:^P:f�IDERSON MILDRED L TR FLOOD : AE-46 / •• PERM NO: P 031741 I, ' ADDNESS:'-2$04- SHANTAR DR - COSTA MESA, CA 92626 PERMIT NO: P 081741 PLAN CHECK NO: N GOVT: N SUPP: N APPL.MMUNGADDREBS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH • ARCHITECT OR ENGINEER: DC.NO.: JOB DESCRIPTION : REPLACED WATER HEATER SQ FT: MICK OR ENG.'S ADDRESS: DNT:' • • CLAIM VALUE: • CALC—VALUE: GROUP OCC: R-3 / CONTRACTORSNANE ' CONTRACTORSIINUNG COMMENTS: X ' ADDRESS: UC.NO.: **********#9EBb39E##dE9E39E33339EBEBE3#39E333333E3333**9E39E3**1E BEdEBE*!b*BE#**BE**339E339E31E**#9E db9E dE WIT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force end effect. CITYUC.NO.: LIC.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contredors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city cr county which requires a permit to construct alter,improve. PARKING REQ: P ROV: PARCEL: 13940309 Z N E: REF NO: demolish.or repel any structure,prior to its issuance,also requires the applicant for such permit to fib a signed statement that he or she PLANNING NOTES> is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting 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 > Kr u, 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars P5001). 'KNN'1EfL'3NlE9('lE1EiE1L'*lEIEMlE9LN'1E1E1L'3E1E**K'*1LK'*'>E')L'***********3lfff33****3#3331E**331E#**#333**tE**3* ❑ 1,as owner ofthe properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended DEVELOPMENT S E R V I C E S'.1 R E Q U I R E M E N T S ( or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does res appy to en Owner of propeM I who builds or improves thereon.end who does such work Nmself 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 ZONING APPROVED BY Y DATE: X owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). . 0 I,as owner of the properly.am exclusively contracting with licensed conlractois to construct the project(Section 7044.Business end BUILDING APPROVED BY : DATE: Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who /� A , contracts for such projects with a contrador(s)licensed pursuant to the Contractors License Law). / •,1 : ,. DATE- B. a 2 i Si �Iamexe ptunder aP.c., stn: 5�// APPLICATION ISSUED BY; 11F_ IBE a � at �i� own. m � / L�� * ** *YEx *** fExxSExtEtEBE BEtEBEBEBE tEBEtEtE tE *******-******************4* tE+E • mm. LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N I o hereby certify that Iain aware of end understand the require its of Celdomie Health end Safety Code Sections 25505,2sewl,and 25534,and that or any hnure building occupant will/will not(circle one)need to comply with said state codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING e permit for construction or modification from the Ab Quality Management Disnid.Residential construction applications are exempt from these PERMIT 11 00 provisions. Date: • Applicant: 25% ,' SMIP/NON—RES PLAN .h WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE 22 . 00 ❑ Ihaveandwilmaintaiacertificateoconsentlosei-insure for workers'compensation,as provided for by Section 370of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code.fortheperfon,anceofheworkforwhichthispermaisieaued. TOTALS----> 11 , 00 22 .00 0 . 00 33 , 00 33 , 00 ,00 ❑ I have elf wit maintain workers'compensation insurance,es required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued.My workers'compensation insurance Tamer and play number are: REVENUE DIVISION TOTALS--> COLLECTED : 33 . 00 OVER/SHORT: .00 Carrier: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Policy Number: 33 , 00 This section need not be completed C the permit is for one hundred dollars(5100/or less.) 1� ❑ 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner ea as to became subject to the workers compensation laws of California, and agree that R I should became Babied to the workers' 7EtE%')L)L1E'N'*iE'K'1EIL'1EiE#*'K'iE1E1L'1E'N'iL'1EfE1EiEdEiE9('*lE**,'WIEi('i(If1E#'K'9E7(l('1EM'dE1('1E'N'1E1E9EiElE1E1E1E'N'9E'K'1E'1E'NfE'N'1EiEaF1E***lF**1L'# compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. INDIVIDUA L F E E BREAKDOWN Date: Applicant: "{ Warning:Failure to secure workers'compensation coverage Is unffwA4 and still subject an employer to criminal penalties and TYPE QTY DESCRIPTI _O. N UNIT COST TOTAL COST clvll fines up to one hundred thousand dollars($104000),In addition to the cost of compxuation,damages as provided for In ' t Section 3706 of the Labor Code,Interest,and attorney's fees. PLU 1 WATER HEATER AND/OR- VENT 11 , 00 11 .00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the 'END OF FEES performance of the work tor which this permit is issued(Section 3097,CN.C). ` LENDER'S NAME: _ "' S ,(J,J�'a({�L� LENDER'S ADDRESS: ' S I 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 ; I and state laws relating to building construction and hereby authorize representatives of this dry to enter upon the above•mentioned popery 1997 for inspection purposes.MILDRED ANDERSON FEB 21 .40111101414 / Pim Na�' / / Md✓" j I Cj . w: Of Tft ilaA 1/Lr[✓/� U ,� Date: t�l Signature of I e/,•ent/App canVContrectcr "n (5151-46.WP) White-Building S Safety;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor • i • CONSTRUCTION AND PLANNING POOL 'A - /APPROVALS Permit# ` - Date Inspector 1 APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole i 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 - 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 E .61. APPROVAL-TO DECK • • • 11. Property Sewer Line & House Connection . if. 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 - - s . 69. POOL/SPA SYSTEMS.FINAL 19. Rough Heating& Air Conditioning - FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace ,_ .. - - APPROVALS Permit# 21--Duct's, in Structure- _ 70: Underground Hydro - _ 22.•Ducts, Ventilating °. 71. Product-Piping OGas ❑Oil 23. Gas Pipe:Rough &Test - r . - 72. Underground Flush 24. Roof Framing - _ -• . - 73. Undergrnd.StorageTank 0 Gas 0 Oil 25. Roof Sheathing - - - s - 74. Overhead Hydro 26..T-Bar Ceiling (Structural) &.Monocoat , . 75. Dry Chemical 27. Frame and Flashing' _ - 76. Dry Standpipe- i_. l. - . 28. Lathing & Siding • . 77. FIXED SYSTEM EINAL 29. Insulation 7,8., 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 . s Notes' �' a_ay-4� : iN�.�i.z_c13 BEN 34. FinaI Heating & Air Conditioning -. _ 35."Final Gal Pipe-Test. ', _ - 36. Hood or Canopy ' -- - 37. Final Factory Fireplace - - ._ - f aa7 Final Plumbing 1/•n €3,n/_ - 39. Water Service-Final' - - 40. Gas Service-Final •• - - C - • 41. Solar Domestic-Final' - ' 42. Backflow Preventer'. 1. - '- 'thy.* f `ti iiiiramiri 43. Backflow Irrigation- - -- ' 44. Landscape Irrigation System_ - - -- C ' t, tr.:, 45. Sound Attenuation _ _ 46:Handicap,Regulations 47. FINAL STRUCTURE&BUILDING - - i=--e Cu 48. FINAL PLANNING • -- "c•-,-/..Ns• `L j' 49. Electric Release to Edison 50..Gas Release to Southern California Gas th - - .51. CERTIFICATEOF,OCCUPANCY - No Date t J 16518 FEj RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 2 1962 P. O. BOX 517 COSTA MESA. CALIFORNIA • FINANCE DEPT. For Applicant to Fill In Completely APPLICAGiONOfCPMIASA TYPE OR PRINT BUILDING BUILDING ter q te-BK 4-349 ADDRESS 2 co SNANrn?/Q DK(✓E COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. 767518IFV••J.,7518 OWNER/4/iE6E�E.G� WET YY/�/\ S MAIL // g /�/ RECEIVE BY DATE ECEIV ATE ISSUED ADDRESS /(O J./ / /�Noze'n tee. p p $C '-/, 'G y�P�S1R 2 196; CITY CO&r4 /'IES,, [�41Llr NO.k, jo3l-- BUILDING ADDRESS ARCHITECT �� TEL COSTA MESA. CALIFORNIA OR ENGINEER /[/ILr6/✓B<1nN ND �5o533 - •• ADDRESS 17772 KR-reuL4 AVE,440/11eiM FIRE - Def'^y // /f ZONE TYPE 1/ GROUPLie 7(/ CONTRACTOR /347/1/40,0S L,NO [�. APPROVED _DATE _ U ADDRESS /tS7 MINoze/7 ,).e. ZONING M `y ZONENO.NO.OF USE OF NEW S^f-ZT KE/. CITY /,05 rA / /nn ) (Ail(/ /' A-, I FLANS 2q I BUILDING wi..i?yQ 1. E LIC.STANO. /B / /6 6 NO. K1 /O 37✓5 LEGAL LOQ / / " // 3117 DESCRIPTION SIZE NO. OF BLDGS. OF LOT 7.2 x aloe NOW ON LOT NtN� A.P.NO. USE OF YARDS EVES EXISTING.BLDG. APPROVED ALLOWED SETBACK LINE FROM / �j / (CENTER LINE ST.1„U CENTER OF STREET 4 // REAR YARD 2 G FRONT -/ / FT. IN. SIDE YARD I LEFT I RIGHT 4 R.SIDE v FT. — IN. DESCRIPTION OF WORK _ X L.SIDE J6 FT. IN. NEW I X II ALTERATION I II ADDITION REAR z" FT. IN. REPAIR I II MOVING I DEMOLISH APPROVED Vit/ 1.(9 DATE Z//L/6 a Pia BUILDING // ww NO. OF / fi AT SIZE /Y-3Y' ROOMS (O STORIES / / EXTERIOR WALL WOOD I ROOF 037301:, 11 COVERING 6Taere COVERING 5H/N61Le- /Lf3> USE OF BUILDING AND WORK TO BE PERFORMED / �/ 5/NbtE F,M/Le RES/OENOIF Ll 0 jL/ #Vd Gi 9fl SEt / itlf gc4el/ _P_3 � I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE $ aS PERMI /� 1 I� B _ .!/ // _ s/ - }�/Zj PLAN CHECK $/ . j�J�� LLLcccao Ce 7 / y // re AU O IZED AGENT TOTAL FEE $:--1.�C �7 i) 4 i 38444Pr {A'f ?2-71ac;,:,O@ 937* '''****8.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ' For Applicant to fill in Completely APPLICATION FOR BUILDING PERMIT •�/t(� ,r RELEI)yED BY DAT�RECEIVE Q DATE�jISSUED ADDRESSBULDING I4MM0C3 `r' }'�fz4 0 fl2 l/:JI�!/ (q] �✓f; /Y's�IJY' Ibr f(�d~ OWNER A)0 g- le SO lj A.P. NO.13 `�4b3'0) PV V MAIL . BUILDING peg ADDRESS' 1600e ADDRESS S.N, TAd - /r Z ui TEL. 0_ U .E CITY 081 , e24 NO. O- Ll TRACT4 9 LOTS BLOCK. Z Q CONSTRUCTION IAA Q _ NEW ADD ALTER REPAIR MOVING DEMOI ISH CIN LENDER NuT -� ifin �' �y '`I / J D BRANCH J N Q W ADDRESS m J - OWNER VALUE J 03 ARCHITECT f�j//--//ff TEL. _USE gat?t�I"�IY�V $ (J V-Y Q OR ENGINEER (v OYER NO 50 FIRE wcc ADDRESS ZONE III ' YPEt. GROUP �ssi f JO CONTRACTOR ��-e /0 rG . -fergi BYAPPROVED', M// -. JJJJJ�� OATE7`' 22 II_ CO Z «cYYYYYY VV��Jj11ifJ`` J ir ADDRESS 52 3 � ©, 60A., !1-e _ lL w yM// TEL ZOf NO.OF� USE OF NEyr /A D Z I- CITY (Y,jr-A fit A NO. 327 IN- , PLANS BUILDING r.4:2,v -, ill STATE z�n CITY /� YARDS APPROVED YARDS APPROVED N K LIC. NO. 2 VZ- 7'7 L /J ' LIC. NO./6 [`y MAIN BUILDING ACCESSORY BUILDING SIZE I _ NO.OF BLDGS. (FROM C/L SSHEET) OF LOT NOW ON LOT FRONT �!1 FT. FT. USE OF �J ' EXISTING BLDG. A.SIDE 3 B FT FT. I- SIZE OF NO.OF Q_ Z NEW BLDG. ROOMS STORIES _L.SIDE 1 eJ FT. FT. 'Cr EXTERIOR WALL ROOF 0 COVERING COVERING REAR J , FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN Si d MAIN BLOCS. ACCESS.BLDGS. 1 ES VAR.# DATE Q // / O (2, d g.��' C.U.P.# APPROVED 0 7 NAPPROVED/_ Clip) DATE S--2:2-77)( Z W 1IJJ O _ I— I hereby acknowledge that I have read this application and state e---5.; srArE that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ .� Fany person in violation of the workman's compensation laws of f 0 to the State of California. Z I hereby certify that I am properly licensed as a contractor under SO, FT. TAX O the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATIO OR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R am exempt from the provisions of the State of California Business VALUATION SProfessions Code vision 3. � �.��"'� W PERMIT FEE $ N D iin SignatureAO of ( m Permittee $ PLAN CHECK $ E 0 Authorized Agent LL TOTAL FEE $ gre