HomeMy WebLinkAbout3147 SUMATRA PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ffdfLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3147 SUMATRAPL
Suite:
Vicinity: SIDE AND REAR YARD
Parcel Number: 13915231
Applicant:
MARQUEZ, GUILLERMO
Address:
EDWARDO
Issued:
COSTA MESA, CA
SMIP Com:
3147 SUMATRA PL -
Owner:
MARQUEZ, GUILLERMO
Address
3147 SUMATRA PL
COSTA MESA, CA
Contractor:
Address:
Zoning: R1 R1
ISSUED BY:
Phone: 714-979-7398
Zip: 92626
Phone: 714-979-7398.
Zip: 92626 -
Phone:
Zip: Licenser
Arch Eng:
Address: ,` Address:
Status:
ISSUED
Applied:
04/17/2003
Issued:
04/17/2003
Phone: Phone:
Zip: License: ,License:
SCOPE OF PERMIT
INSTALL 6 FT HIGH BLOCK WALL ALONG 74 FT RIGHT SIDE DEPTH AND 52 FT.WIDE REAR PROPERTY LINE.
Plan Check:
$54.11
Permit:
$83.25
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $137.86
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
Rear 0-0
Rear 0-0
Required: , 0
FEE SUMMARY
Calc Valuation: $2,640.00
Claim Valuation: $0.00
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: 0
Right 0-0
Right 0-0
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
244646 (6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby all I" under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of consent to self-Insure for workers' compensation, as pryvided for by section 3700 of the Labor Code. for the performance of the
work for which this permit is issued. f
❑ I have and will maintain workers' compensation in uranca, as required by section 3700 of the Labor Cade, rAor the performance of the coo for which this permit H issued.
M workers tom ensatl/0 In urance canter ori numbertare: O
Carder:y pl V p s Policy Number: 1�J
his section need not be (plate i/ the permi( valued at one hundred dollars ($100) or less.)
artily 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, andOce r� If h61d become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisi ns. 1..� �7
Applicant Signature: Date: r —' !
WARNING: FAILURE TO SECU E WORKER ' PEN6AhONI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DDLIPAE (5100,000), IN ADDm TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affimr 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. q Class x
( Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Lenders Name: Lenders 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 ha 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).):
@� 1, 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 u er sec. Business and Professions Code for this reason:
Signature: ,�,,
Owner ID ve d by drivers lit es ❑ No Driver's License No.�) , Expires: _(Z%
Verification of Ownership by ( e of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 6, 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? ❑ Yes ❑ 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 then 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? ❑Ves ❑ 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑Ves ❑Po
(Section 25534 of the California Health and Safety Cade 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 a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ LJ
Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....................................................................................................................................................................................................................................................................................................................................................................................
6 Will any part of the facility, to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves C.
No
(It 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 Dy Califomia Health and Safety Code Section 42303 been made? ❑ Ves [I No
..
......_............................................................_.,...................._........................................................................................................... .................................. ...................................................................................................... ....................
B (If yes", allach 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 prope y for mspe enpurposes. a o�ot to Occupy or allow occupancy of any building authorized by thispaPtnit until n�nspection.
-Signature O g51 r(4 �z�TiJJ /l)) I Da
And/Or Authorized Applicant Date
CODE r. INSPECTION TYPE PAIS ICJ-TrTRL CODEC INSPECTION TYPE g;,¢, gig
1616 Fixed System Final Fire Prevention 206 Final Mechanical
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 BuildingrOccupancy S ( 3
1
• THS SKETCH IS FOR INFORMATIONAL PURPOSES
ONLY. APFLCANT S RESPONSIBLE FOR PROVIDING
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SUM DO NOT CORRESPOND
WITH THE INFORMATION PROVIDED ON THIS SHM
3 1 � � -Lma6 t Co) 5&
• SOLID WALLS/FENCES BETWEEN 7-6'k 6' BV HEIGHT SHALL
BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE.
- SOUD WAILS/FENCES SHALL NOT EXCEED 7 6' IN HEIGHT
wnuN MY OF THE FRONT PROPERTY LINE NOT CURB LINE).
• VERIFY DISTANCE FROM CURB TO PROPERTY LINE
^ ` , �T AND SHOW ON PLAN. VERIFICATION FROM THE CTTYS
AFPu I`ll `/ L ENGINEERING DIVISION S REQUIRED. CALL (114) 7545343
1` FOR INFORMATION.
CITY OF COSTA MESA
PLANNING DIVISION
SUB]EC� T,O BLDG. DEFT • REG.
NO E: IDDITIONS, DELETIONS,
O L C CTIONS SHALL BE
APP V D BY THE Pi ARNTI�'
4
�� A t
0 I
DA ' tim i 7' mon a �
BY: I
RESIDENCE
I
3117 Surn6tra
t
W DDEMCE
I
I
5um4m.
. STREET
Ii+,oPosQ� L
�B/oeJc l,Jal(.,
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________________ ,
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
Channel Block With 1.3/80
Horizontal Top of all
Fencn
For Fences 5' or Less
Ven. Bari 3/8" oat 4' 0" O.C.
F F
or ences Hih T$a�5
Vert. Be, 3/1sc- Ckall
® 3a
FIII Cells Soh h�prg.
Where sleelORRQRS� �s $� cam
Reinforcing St I&ha�lo o
Conform to Se Aa15Df 04
A.S.T.M.
A11 Steel to be
24" or to Code a 'o
NATUN-A& &L
TWO
CON
6 BO
IlotalzST E E L MU'.
PLACE AT TIMI
INSPECTION.
TYPICAL 6It CONCRETE BLOCK FENCE
1
s
"n
n ° a
z I
T_QTH 111 16' O C MAR '
ISOCHART♦L 4
�
�1 I ,
A. r
m 3
Z C.
s FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT: One Part Cement Three and
One Half Parts Stand
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well Mixed 1:2-112:3-1/2
Mau of 7-1/2 Galtcns of
Water Per Sack of Cemenl
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN
FORCEMENT SHALL BE CLEAR,CLEAN6
FREE OF ALL MORTAR DEBRIS, ETC.
OC PTH (F CARTHTCOIH
V� TI1f HEIGTH OF FENCE
BrLOW BOTTOM OF FOOTING
SCALE'. 1/211= I'
WIDTH
a
141j
0
12"
-THICKNESS
m
1011
Y W
a
o
Z
a
24"
20"
16"
12"
SPACING OF EARTHTOOTH
o
141 .
161
g�
s
"n
n ° a
z I
T_QTH 111 16' O C MAR '
ISOCHART♦L 4
�
�1 I ,
A. r
m 3
Z C.
s FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT: One Part Cement Three and
One Half Parts Stand
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well Mixed 1:2-112:3-1/2
Mau of 7-1/2 Galtcns of
Water Per Sack of Cemenl
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN
FORCEMENT SHALL BE CLEAR,CLEAN6
FREE OF ALL MORTAR DEBRIS, ETC.
OC PTH (F CARTHTCOIH
V� TI1f HEIGTH OF FENCE
BrLOW BOTTOM OF FOOTING
SCALE'. 1/211= I'
WIDTH
14"
141j
12".
12"
-THICKNESS
1011
1011
e"
8"
DEPTH OF EARTHTOOTH
24"
20"
16"
12"
SPACING OF EARTHTOOTH
121
141 .
161
161
BUILDING DIVISION
I,,
T
s.
VA
�:oDRESSOFBUILN' 3147 SUMATRA PL
EWS NAME IF INOMIN: DOBBS, JEFF A TR I9�
MSDREM: 118 AVE SAN PABLO
SAN CLEMENTE,CA 92672
492-8970
APPL. MARING ADORESM
ARCHITECT OR ENGINEER:
ARCR OR ERG'S AODI M:
UG N0:
UMT:
UNIT:
CONTRACTON'SNAME: CLEAVINGER, MICHAEL R (714)565-4525
CONTRACroRSMMIRIO 2085 PLACENTIA AV
ADDRESS: COSTA MESA CA uCNG: 594924
92627 UNIT: 44
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penefy of Perjury had I an licensed under provisions of Chapta S
(oommenang with Section 700)) of Division 3 of the Buanme am Professions Code, and my license is in full Mae and effect.
Cm LIC. NO.: 0 5 2 0 6 6 LIC. CLASS: C 36 LC.NO.: 594924 EXP: 1 /95'
/.�I CJ {T <]emef�.Lv 16 ��
Date: "i III I `�� ell Contmdw:
WNER BUILDER DECLARATION: I hereby affirm under Perahy of Farad huff am axe t fens the Canrerfas Lcmm. Law for the
dldwkp rowan (Seem 7031.5 Guineas. end Profineiom Code: Arty cky or counly which rWuilee a peeth to construe. Wer, improve,
demolish, or rapes any structure, pMr Io its Issuance, also requires the appliraa for such permh to file a signed statement Ma he or she
is licensed Wrfacnt to the yommuct , of Me Contractors license law (Chaps S (mmmewinp with Section 7000) of Division 3 of the
Business andPrdem" Cod,j s that M s she s exemptthsehom atld IM bass for Me abped memption. Any vers d Swain
7031.5 by any applicant for a permit subjeds the aopficae to a wit Penalty of est more than five hundred dollars (5500)).
❑ 1, as owner either proPery or my employees with wpm mtheh sob compensation, will do the work, and Me structure s not intended
or offered for sab (Section 700,, Su imss and Protaeione Code: The C samic. license Lawdom Map*ioan owns of property
wM Wide or i ,,em m thereon, and wM does such work himself or heraeff or through his w her own employees, ptovido l that each
imprgvamenta ate not intended or offered for sae, 9. however, the WitlinS w knprovemenl s sold within as year d compdion, Me
owmrbuilder will hove the Mran of provip he or are dr est build a timprove fa the puTcee of rob).
❑ 1. as ower of the papally. are exclusively, omlredkp with licensed contactors to construct the project (Section 7oaa. Business and
Professions Code: The Coaredos License Lew leas ml apply to an owner of properly who builds or improve Iherson and who
coolness fa such projects cow a contractor(s) licensed Wrivare to the Contractors License law).
❑ I an tempt under Section: B. A P.C.. for his reaprc
Data: Caner
I do hereby cendy that I are aware of and undariland the requirements of California Neakh and Safety Code Sednrre 25505, 25533, and
25530, and the I or any future W iwip occupant will 1 wR ml (clrob ane) need to comply "h said sae codes end IM requ'uemenb M
e permit fa mmituctan or moddication from the Airy.enepemant Didrio. React ectal conNmcticn applications are temp from these
provision.
Dae: Applicant
WORKER'S COMPENSATION DECLARATION: I hereby affirm under penury of perjury, ons of the following declaration:
❑ 1 have err wB meimen a of the d or wN to aeXinpre M waken' comPenwion, u prwlded la b/' Section 3700 of the Labor
Cade, for the padormeawe of the work lion which this pemit is issued.
'] I have and wR mannan wwken' aanl»nwion inuratoe, m require by Salim 3700 d the Lahr Coda, fatM pedwmence d IM
work for ehich this emit is imuW. My workers' compensation insurance mrMr and pokey number ate:
Carver: STATE EXPIRES
Policy Number: j 01/01/96
(This sedlon need net be complesad f Me Permf is for one humorist ddlan j$IOcj or h ss.)
❑ I nearly (het in the pmfamao of the work M witch lis Perot is issued, I atoll n , employ any Pearce in any manner an m to
become subject to the workers' compenmibn ewe of California, and ague that U I should become abject to the workers'
compenml/'�^/ p ions ei SadM 37W of IM labor Cade, I I forthwllh oompy with t seA provsione / _
Dae: / / / / 9.h Appkana: / l� (/N`�!/'A`/
Waminp: Failure b ses urs woM1en' corrpsustlon coversi /s n, arld,Mfl. serf en aap/oyarts crlMrW PamaRlu and
civil fins W h ons hlndred tMOmra dasri (S1og3poA In • on W Ms cast o romperuetbn, damages as Provld d for In
Sectlon 3103 oI Me Labor Cods, u"oulL end af$1OaOi
CONSTRUCTION LENDING AGENCY: I hereby affim under penury d perjury that there s e oonatrudion leash, parry M the
Pedomance d the work fa which this Want is mored (Seam 3037. CH. C),
LENDER'S NAME:
LENDER'S ADDRESS: '
I comity the I heve read this app cabn end come that the above inlamaion is conea.I Mires to comply with all city and county ordinances
and state sws relating 10 Wilding constrWbn end Maby authorize repreaentalivm of that city to enter upon the abovsmetaiornsd popery,
forInspection sur ,Minae.
Date.9._
(515146,WP) White -Building A Safety: Gmam-File: Canary-Appficem:Pink-Revenue; Goldenrod-Asmasar
611
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 07185'
PERMIT NO:. P 071857 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : WATER HEATER. REP SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK APPROVED
Ir -
Z 0 N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 13915231 ZNE: REF NO:
PLANNING NOTES>
>
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 7,00
25.1
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS ---- > 7.00 20.00 0.00
DATE:
DATE:
DATE: di
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
27.00 27.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27,00 OVER/SHORT: 100
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
`27.00
I N D I V I D U A L F`E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 7.00 7,00
END OF FEES
E epi U1.
.,i 00079701-!10179701 T 0 T 211.00
DATE: 04/11/79 TIME: 0E:20
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
F , & SPA
APPROVALS Permit #
Date
Inspector
1
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53, Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn8.
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, O Undrgrnd., Test
'
9. Water Pipe-Undrgrnd. I
60. Backwash Lines, P -Trap, ❑ tlftdrgrnd.
10. Structural Floor System 1
'61. APPROVAL TO DECK
'
11. Property Sewer Line & House Conhection
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 i
66. Solar System -Final
'
16. Rough Electric Wiring
674 Fencing & Access Approval
"
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
1
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
224 Ducts, Ventilating
-
71. Product Piping O Gas ❑ Oil
21 Gas Pipe -Rough & Test
-
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing -
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
274 Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
774 FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL '
30. Drywall Nailing
-_ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
I
79. FINAL INSPECTION
-- •_
32. Electrical Power Meter -Final
80, FOOD CERTIFICATE ISSUED
'-
33. Final Electric
Notes: -
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
2;, .'5"2 - �/8
36. Hood or Canopy
-
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service•Final
40. Gas Service -Final
'
41. Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System -•
45. Sound Attenuation ••
-
:. '
46. Handicap Regulations
,
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
35
OWNER
DATE
JOBADDRESS 1W Sumatra Place BUILDING PERMIT NO.
GENERAL CONTRACTOR Owner Bldr, VALUE
LOT 63 BLOCK TRACT 2353 Res, w/det. gar.
10^110 T D_ T TvPP R 7nNF Pi FIRE DISTRICT �IQI Fi
INSPECTIONS
DATE
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench
Foundation Forms and Grade to Garage
Rough Framing _
Plumbing, Rough to Slab _ 21ly GS
(+ .,•5 v
qa a y
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
Heating, Roughi'A.
j� , ! w�., ,�l�.ns'�.
j a 3- 7
,� _27
�7�,/ ✓
! G �j L/-,/ ✓
Heating, Final !•i5
Lo. 9•d
Sewer, House Sewer, St. H-5
6-26-5-7
— %
Septic Tank or Cesspool
Lathing, Inx Out
Plastering
Plumbing, Final, Fixtures Completem(r5
Plumbing, Final Gas Test /s &C-5
/)
Wiring, Final
nerunanev G:9 d
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FORM 210 3M 1055
4916
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 317
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING _ 3Z_ !_
1 ums
CITY
ARCHITECT
OR ENGINEER
ADDRESS l'
COSTA MESA. CALIFORNIA'
EEE RECEIVED
a-4-,,
FIN NCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECE
TEL."" BUILDING
NO. ADDRESS
LIC
NO.' COSTA MESA. CALIFORNIA
and Land,, CITY NICO.
F
Z
SS ED
i. -a uv•
, -_j
TELA "
APPROVED
LEFT 1
ADDRESS nc
l o 1'0-1
NO, Ci—A IQ
BY
DATE
LEG"`
LOT
ADDITION
REPAIR
CORRECTIONS
DESCRIPTION
NO. Z
BLOCK
TRACT•J �Z
A.P. NO.
SIZENO.
OF ILDGS.
OF LOT 6000
I'I OU' DN LOT none
USE OF
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET 50t
REAR YARO--lH
S1DE YARD
RIGHT I
LEFT 1
DESCRIPTION
OF WORK
NEW
USE OF NEW
BUILDING .
Sin1e Family
ALTERATION
ADDITION
REPAIR
MOVING
DEMOLISH
SZIE DING
1316
NO. OF
ROOMS 6
STORIES 1
EXTERIOR WALL
COVERING
ROOF
.VE RING
j
USE OF NEW
BUILDING .
Sin1e Family
D;+lellinP
STATELOY TH AT THE ABOVE IS CORRECT „AND RAGREE TO COMPLY WITR ALL
CITY ORDINANCES AND STATE LAWS REGOLATING BUILDING CONSTRUC-
TION. - VALUATION
SIGNATURE OF PERMIT FEE S 28
PERMITTEE
PLAN CHECK S 1 I • oo
S
AUTHORIZED AGE T
TOTAL FEE s42.00