HomeMy WebLinkAbout2868 STROMBOLI RD - Building Permits p51"M6s9 CITY OF COSTA MESA
• BUILDING DIVISION
> • �1 DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
4 n PERMIT
ee E06-00398
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa ��TRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2868 STROMBOLI RD Status: ISSUED
• Suite No Applied: 04/28/2006
Vicinity: . Issued: 04/28/2006
Parcel Nunmber: 13939313
Applicant: RODRIGUEZ, ILDEFONSO
-
Address: 7050 LAMPSON AVE -
Phone: 714-530-7320 ISSUED BY: ' ill
GARDEN GROVE,CA Zip 92841
•
Owner: ADAMS,-JOHN B TR
Address 2868 STROMBOLI RD • _
Phone: 714-437-7334
COSTA MESA,CA . Zip: 92626
Contractor: EMPIREP,LUMBING
Address: - 7050 LAMPSON AV
Phone: 714-530-7320
GARDEN GROVE,CA "Zip: 92841
License:794154
•
' SCOPE OF PERMIT
UPGRADE SERVICE PANEL TO 100AMP FOR SFD(SAME LOCATION).
FEE SUMMARY
Quantity - . , Quantity
ISSUE FEE $23.50 • Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section . $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 - - - --- up to 10 kva/kw $0.00 0
Lighting Fists - $0.00 0 - up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
•
Switches $0.00 0 over 100 kva/kw $0.00 0'
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 "
Res Appl - , $0.00 0 Low Volt Wiring System/Ckt $0.00 0 ,
Service to 200a'- $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 • 0 Misc.Conductor $0.00 - 0
Service over 1000a -$0.00 0 . . Circus(gen or ride)" $0.00 0
Motors to 1 hp •$0.00 0 Circus(mech ride or lights) $0.00 " 0
Motors to 10hp \, $0.00 ' -- 0 • " Christmas Tree Stand- $0.00' 0
Motors to 50hp - $0.00 0 - - Fireworks Stand $0.00 0
Motors to 100hp - - 1// $0.00 - '-0 ' ' - - Other Electrical Fee $0.00
Motors over 1001ip 1 $0.00 ‘•-• 0': c - '
Communication drops • $0.00- - , " 0 , - Investigation Fee - - $0.00
Sub panel to 200a $0.00 0 '- Plan Check Fee - $0.00
Pole Light Pkg $0.00 i 0 Reinspection Fee '--$0.00 -
Sign Circuits $0.00 0 ' - ,
Temp Pwr Pole $0.00 - - 0 - . - TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00. 0 - - , -
COMMENTS/SPECIAL CONDITIONS
•
• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. - .
INSPECTIONS: In order for the work authorized under this permit to-be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 + _ "�
2446-46(6/00)
WORKERS'COMPENSATION DECLARATION: - -
I hereby affirm under penalty of perjury one of the following declarations:-t-' - ,
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
-ork for which this permit is issued.
have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
r—My workers'compensation Insurance carriera d policy number are: ,_- -----
Carder: • 1�G�S)1 4/ ' LiIAtr i;-YLL,, Pr:r-9_ Policy Number: C-0 loon /bg2t7' -
t(Thissection need not be completed if the pert i valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro n
Applicant Signature: c`_Datp: . 4 0 g 9/
WARNING:FAILURE TO SECURE WORKERSS'COMPEON CO RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI PE - ES AND GVIL FINES uP TOONE HUNDRED
TIquSAND DOLLARE($100,000),IN ADDRmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF E LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under pr•visions of Chapter 9(commencing with Section 7000)of Division 3 of.the,Business and Professions Code,and my license is in full
force end effect:Licr#' ' Class# Ci
—Coniragors Slgnat'ure: _ .%J,�,_ — •r"Oete. _
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: 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 he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers 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 feel 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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to Or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
' 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
•(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aLermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes LU No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If ryes",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 COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) -%Deaja.
• AnNOrAuy(orFled Applicant 1`Date�.,
BODE r INSPECTION TYPE DATE " INITIALS •CODE, INSPECTION TYPE ' DAR - IfTTTW.S
1616 Fixed System Final Fire Prevention ' ' • 206 Final Mechanical •
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof - - _ 210 Final Electrical
201 Final BIocWRetaining 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
Crat.tC CITY OF COSTA MESA
F' I, BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT4. grow M48-00304
PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2868 -STROMBOLI RD Status: ISSUED
Suite No Applied: 07/14/1998
Issued: 07/14/1998
•
Vicinity:
Parcel Nunmber: 13939313
Applicant: KITCHELL, KENNETH
Address:
Phone:_''�-=+ ,.-.-..--------
,----,'"[-7..',„'?'--'._;---
/`- _--__ Zip: -..I '`1".
•
Owner: ADAMS;JOHN-B �/�� -1 I �� L� ��
Address: 2868 OMBOLI,RD ` ,. ���
/ :_
/././T,
AMESA � �ip: 92626`~~����,, �rContractorl/ AND/RUS"PLUMBING& HEATING NN N�
Address: 856GLENNEYR&ST % ���
Phone: 494-8096
/rAir
27 License:
CA Zip:'.92651 I \���"�_-'1 ,1\
I/ License Ij249778 .,\
Arch/Eng.. ///t------
‘
-_� t . • ---,.\ \',
/ TAW ill Fees:
( Lam,1f ! l �__ (f' t�„�.`-.zYkfl L--+:'.ate-4h ticr, .„4„,„ 4 1 �� ,
Phone: a_.�-�..-� ���
�(71J/. /-2,-\4,.., License: �� i \�, 'i..1 i t I
t I IlG$
1 SCOPE.OEPERMIT=— I. I
44 I' .1:1hrCHANGE OUT 1fl t!c�J TU F:A.U.L4L iii{LVAILL l ti 'n�.11l ,�'-- • I,• ',�I (`. _'l l'\
l
�h� � I nd FEE SUMMARY , j jT
1 J v't,,,, r 1 Quantit r/R�. t `/ `i,;t �-, , , I
r .
1.{ ,� Ii i•s y - (../..-..,,•-..1. I_ac• i,�` 'ni ) �( -Quantity
'
ISS� �EE\V , ,t,d, $22.00 1 -L-I------------------'_ -- Repairtith Absorbtion Unit t i,, $0.00 0 fin,'
Inst FAUr<100 k,BTU ` ,/ I $13.25 � --'-Re ai c/AIt,Refri eration Unit '' $0.00. -'0 J/
Inst FAU;>100 k BTU \(i $0.00 Ventillation'System jl/i $0`.007 0/”//
Repair/Alt,Cooling/Heat,' I $0.00) 0 Evaporative,Cooler 1/ ..$0.007 0"Y/
Inst/Rep4Recess Wall Htr`\ $0.00 0 Commerciaaflncinerator //! $0:00 0� `�
Refrig Sys`<100 k;BTU $0.00 0 Domestic Incinerator /r�� $0.00 o l
Refrig Sys>100 k BTU $0.00 0 a...4c.ompressors/Absorption Systems /� so.J /`/
Gas Piping\�\ r $0.00 0 n_ , dUp;to 3 hp/100 k BTU I $0/00 0
Factory Fireplace` . -\. $0.00 0 U`•n ; ' 3_To:151hp,/500 k BTU / -1 $0.00",/0
Hood w/Mech\Exhaust . r: \$0 00 a c lei v 15'To 30hp/1,000 k BTU 4>� ` $0;00/ 0
w..r U f .,
VAV Box \.A\ � $0 00 n0 �QL ,,,„tot. 30 To 50;hp/.,1 750 k BTU,, .,-;•\ $0.00 0
Vent Fan/Single Duct /,?j"i $0:00��O.Z,a"`'�" �' oC-'Over 50 hp/;Over 1 750 BTU /,..!--//;;\ /$0:00 0
Appliance \_ (',, i:$000 .. ...'•••-..,•:„.\.....,_Or-�,R: 6SiC/ Al ,,(Boller5 ,,14,Q,_24,...;2' e ' (/ /
Fire Dampers ; /.$0 00 ,�A h CUp to 3 hp,;-„ ,% .--e;;;•.\\,/,';..1, $0.00 0
Smoke Dampers - �' ' $0.00i<0��' -�-- �_C::3 To:15ihp,,: '• cVY , /Kl` $0.00 0
Inst or Relocate Appl Vent -, ==c $000 0 -___15'to 30 hp , v - / l / $0.00 0
Air Handlers< 10000cfm ?.$0.00.i0 30 to.50.hp3 S''' \ v�'� /'i2 $0.00 0
Air Handlers> 10000cfm ��$0_00 o/ �\'/�, '� ,� -Over 5,O�lip„�'t\�� $0.00 0
Floor Furnace '.$0.00:,0 / I t_ , i _. 1-Other Mechanical Fee ,-7> '
Floor or Suspend Heater $0.00. 0 -- ~-'' ,/\\ ( ; Investigation Fee -2%9> $0.00
• - - ,._"-" r 'Plan Check'Fee�' ' $0.00
'_t----4---`-'Reinspection•Fee $0.00
TOTAL CALCULATED FEES $35.25
. COMMENTS/SPECIAL CONDITIONS
•
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
DECLARATIONS n
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 seg-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.
the 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($100)or less.)
❑ I certify that in the perfo ance he work •r which t it permit Is iss ., I shall not employ any personrysin any manner so as to become subject to the workers'
compensation laws of .ifamla, :g =e t :t I sho : e s i' o the workers'compensatlo visions of Section 3700 of the Labor Code,I shall forthwith
comDl with the:: : .vlsions. \A/-, -�f ^ (��
•.- :nt S.•:tura 1 0.�...r�� \ • ` Date: / — 14 — 7
W :F- TO E RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT 0 CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
r.• :. r DOLLARE($l00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that 1 am limns:. under pr.• i. s of Ch pter 9(' me 'ng w' on 7000)of Division 3 of the Business and Professions Code,and my license is in full
tome end elle 1 J I^ r
Co Igneturcr - I 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 properly who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the properly, 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 drivels 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(38)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:
I Will the applicant or presentor 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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure). ,•
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and 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 vplication apermit 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 ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with 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-describ d property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
3ign: rter +.91.47.1 / =�D:�y/
�,PI,
•r • ihonzed •••li :n D. e
CODE L INSPECTION TYPE MTh =!l5 LOgEI IyspFChna TTPE ^^USEpo
1616 Fixed System Final Fire Prevention 206 Final Mechanical 1-rX 1'cl Q 1 )ITL
1266 ' "Pool Spa Final •
• - - -' 208 - Final'Plumbing - ,. _..
200 Final Re-Root - 210 Anal 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 '
2448-48
ADDRESS OF BUILDING: 2868 STROMBOLI RD DIT: 1 CITY OF COSTA MESA - BUILDING PERMIT
DNNEgS NAME IF MIOWN: ADAMS, JOHN B PERM NO: P 081 399
ADDRESS:ADAMS, MARL ENE J A —
2868 STROMBOLI RD PERMIT NO: P 081399 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA,CA 92626
ANN.IIUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: REP
ARCHITECT OR ENGWEER: Ldc.NO.: JOB DESCRIPTION : INSTALL WATER SOFTNER SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: ' CALC-VALUE: GROUP OCC: R-3 /
CONTRACTOR'S MALE:CULLIGAN WATER ( 714 ) 750-2233
CONTRACTORS MAILING 1911 S MANCHESTER COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
ADOREss:ANAHEIM CA uC.Io.: 663091 **********************************REff♦EREif9t#9EiFiFitiERtxff♦EiffESE♦ ***)kf[-x-#iE*ft3tiERtat+ERE*****yffE**
92802 LIMY: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Arm under penally of perjury that licensed under provisions of Chapter e SETBACKS
(commencing wish Section 7000)of Division 3 of the Business and Professions Code. .my is forte and effect.
CITY LIC.No.:005950 GC.CLASS: C 55 do 6 . 1 `l. / EXB /97 MAIN BUILDING ACCESSORY BUILDING -_
cy Contract. / FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Jr� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWN BUILDER DECLARATION:I hereby affirm under pen that I am ax the Contractors License Law for the
• 'eason(Sedron 7031.5 Business and Professions •. :Any cn'aarnty wit' a para to cnshuct,alter.improve. PARKING REQ: PROV: PARCEL: 13939313 ZNE: REF NO:
moloh,or repel any structure,poor to its issuance,also requires the applicant for suc permit to file a signed statement that he or she
licensed pursuant to the pransons of the Contractors License Law(Chapter 9(commencing with Stadion 7000)of Dnision 3 of the PLANNING NOTES>
,usiness and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemptkn.Any violation of Section >
7031.5 by any applicant for epermit subjects the applicant toe civil penalty not more than flee hundred dollen 1550011. *******************************************************************************
ElI.as owner.cif the properly or my employees with wages as their sole compensation,will do the work.and the rncture is not intended DEVELOPMENT V E L O P M E N T S E R V I C E S R E Q�y U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an Owner of property M
who builds or improves thereon.end who dosuch es mcdi himself or herself or through his or her own employees.provided that such
revemntPSG e lye nlerded Of offered for sae.5,however,the building or improvement o sold within one year of completion. ZONING APPROVED BY DATE:
• owner-builder will have the burden d proving he or she did not build or improve for the purpose of sale).
and
❑ ofshe meclusnely �sh lwwereooptitct oeseoliPrfemrw Code:r he Contractors Licenseaww do»not�to an owner wbuilds or npmvtherand who BUILDING APPROVED BY : DATE:
contracts for such projects with a cotrador(s)licensed pursuant to the Contractors License Law). .® lb
❑ I am exempt under Section: El.&P.C..tamisreason: APPLICATION ISSUED BY: DATE:
. ., . .
Dae: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL EGMENT : N
I do hereby certify that I am aware of and understand the requirements of California Neigh and Safely Code Sections 25505,25533,and
25534.end that I a any future building occupant.will/wit not(circle one)need to comply with said stale codes end the requirements for
a permit fomeslmctionor modification y ragement District.Residential applications e aexempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 8 . 75
Dale: Applicant: 2 5% SMI P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby alfimh under penally of perjury one of the Mowing declarations: PLAN
00
❑ Ihave and wilmaintain ce
adificadconsent for workers'compensation,as provided IFEE 22 .
Code,for the perfomanceopermit provBUUILE ILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
x0 I have and wfl maintainworkersworkers'compensation n insurance,as required by Section 3700 the Labor Code,for the performance of the TOTALS 8 . 75 22 .00 0:00 30 . 75 30 . 75 . 00
work for which Ni permit is issued.My workers'compensation insurance ismer and policy number are:
Carder: ZURICH EXPIRES REVENUE DIVISION TOTALS--> COLLECTED:_. 30. 75 OVER/SHORT: . 00
Policy Number WC83 /4140-00 08/31 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC , FIRE SMIP/TOT GRADING PLAN-CHECK
r❑(This section need not be competed it the perm*is for one hundred dollen/5100)or less.) 30 .75 ...-
o
I certify that in the performance of the work for which this permit is issued,!shall.• employ any person in any manner so as to
subject to the wonders'compensation laws o California and WI— ' I should . . mbject 10 the wosken' *******************************************************************************
• pensalion provisions of Section 3700 of the Labor Code h comply ' , ..,. .ms, . INDIVIDUAL F E E B R E A K D O W N
�'- Applicant _
s-.ming:Failure s secure workers'compensation s unlawful,and Ssllra— employer to criminal nosh's'and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
. civil Ones up to one hundred thousand dollars(5104000).in addition to the costo . enation,damages as provided for in
Section 3708o Me Labor Code,Internet,and attorney's lees. PLU 1 WATER SOFTENER 8 . 75 8 . 75
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a mnstrudion lending agency for the END OF FEES
performance of the work for abide this peri is issued(Section 3097,Civ.C). '•
LEAS: � `:•,w
LENDER'SR'S ADDRESS:
I state that have rmdilioain application and ire bale above information is coned.!agree to complywithall illy and munrye ordinances
and stale laws relating to building construction and hereby authorize representatives of this ay to enter upon the abowsinentiard propend O 199
for inspection T s,'AGUI: �1 � ED 4 gar A
�� `�� 4
ill / � Is-- � , X ..
3a �> .144/61: CV\\ aF CUSLA ttES
FA —� yi Date: iIs[
DATE
(5151d6.WP) White-8u•eq A Safety:Green-Rte;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor .
1
CONSTRUCTION AND PLANNING - - POC SPA - /
APPROVALS .Permit# Date Inspector APPROVALS Permit.#• Date Inspector
• 1. Temporary Electrical Service or Pole - • 52. Pool & Equipment Location
2. Soil Pipe.Undrgrnd. - _ 53. Steel Reinforcement '
:3.•Electrical Conduit-Uiility-Und_rgrnd - 54. Forms ' - '
'''',-.4:.-: Electrical Conduit;UOdrgrnd. - 55. Electrical Bonding - -
, 5. Stael Reinforcement. 56. Rough Plumbing & Pressure Test
T6�.ElectricalOFER,Grnd. 1 57. APPROVAL TO COVER-GUNITE_- -
• '7--, Footings " �- - 58. Electrical Conduit=Undrgrnd. ' '
8'.• Foundation -r-- - - 59. Gas Pipe, 0 Undrgrnd., Test t
.. 9.:Water Pipe-Undrgrnd. ::: - - . 60. Backwash Liner:IS:Trap, 0 Undrgrnd. •
10. Structural Floor System • - 61. APPROVAL TO DECK
11. Property Sewer LineHbuse-Connection 62. Backwash &•ReLineator-Final
12. Sewer Cap _ - 63. Heater & Vent-Final
13. Roof Drains _ L 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 Electricl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - • FIRE DEPT,REQUIREMENT
20. Rough Factory Fireplace _ Y,Q w F APPROVALS�t, Permit # 7 -- _
21. Ducts,in.Stru'cture: : •• •• _ - :•;•-:;; C -r r F 70.LUndergrohnd Hydro
22._Ducts Ventilating r r' .. 5 .d' " L ' c re'
.; .� --, a 71. Product Riping GGas 0011
23. Gas Pipe-Rough & Test - _ :'i c ::31 r 72. Underground Flush s
24. Roof-Fraining' - -F F T ,.,r l7i-. 73..-
ndergrnd.Sto-ageTank GGas Otil
25. Roof-Sheathing L* • - 74. Overhead Hydro^
26. T•BaF Ceiling (Structural) & wlo`nocoat - t=.'a 75: Dry Chemical __ '<
27."Frame and Flashings *-4c r* 76. Dry Standpipe C'�-
• 28. Lathing & Siding'_`;' _ - - _ v I " " “:" 77., FIXEDfSYSTEtv1 FNAL., • ;;
T `.
29. Insulation _ ._ •• a 78'. FIRE-PREV. FINAL " > cc ,�
30. Drywall Nailing -"7 v _ `; _ "` HEALTH DEPT:"REOUI9EMENT
31. Plaster Brown.Coatt -. ;r ar - 79. FINAL INSPECTION .i. r...1 _ '
• 32._Electrical"Power MeterF,inal ; . •=
ADDRESS OF BUILDING: ' 2868 STROMBOLI RD DMT: CITY OF COSTA MESA - BUILDING PERMIT
OWNER'S NAME IF MOWN: BERGER, HELMUT F "'PERM NO: B 076328
ADDRESS: 2868 STROMBOLI RD
-
• COSTA MESA,CA 92626 PERMIT NO: B 076328 PLAN CHECK NO: N GOVT: N SUPP : N
AP PL.YAWNS ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ACHrECTORENGNEER: UC.NO.: JOB DESCRIPTION : T/O SHAKE & REROOF W/CLASS "A" SHAKES SQ FT : 6, 000
ARCH.OR ENG'5 ADDRESS: MT:
CLAIM VALUE: 6, 000 . 00 CALC-VALUE: 6, 000 .00 GROUP OCC: R-3 /U'i
CONTRACTORS NAME YOUNG' S ROOFING ( 714 ) 953-5444
CONTRACTORS MAILING 1015 E CHESTNUT COMMENTS : REROOF 2200SF RESIDENCE W/SHAKES
ADDREss: SANTA ANA CA uC.NO.: 568560 ****' *+F+('* '****x-*fEiE*TElE# -BEifif****atiEif*1EiE****+E**K-iEaEiE#Sf3E*****1E***lf3E*#fE*ifiE#3t****+elE****
92701 DMT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY LIC.NO.: 048128 UC.CLASS: C 39 LIG.NO... 568560 EXP: 09/96 --- -- MAIN BUILDING ACCESSORY BUILDING -
`� Date: �7 9 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Contractor FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury t am exempt from the Contractors License Law for IM
following mason(Sedion 7031.5 Business and Professions code:Any cry or county whim requires a permit to context,aver,improve. PARKING REQ: PROV: PARCEL: 13939313 3 9 3 9 31 3 Z N E: REF NO: 4
lemol'ah,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she L/1
-s licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Desion 3 of the PLANNING NOTES> '
or that he or she is exempttherefrom and the basis for the alleged '
Business and Professions Code) exemption.d M y violation of Section .-
7031.5 by any applicant for a permit suble=ts the apdieant to a civil penalty el not more than five hundred dollars 155000. ********************************************************************1Et**********
❑ I,as owner of the property or my employees with wages as their sole compensation,will do the work,and the nnucture is not intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for Bale(Section 7044,Business and Professions Code:The Contractors License Law does not apply than owner of propend
who buids or improves thereon,and who does such work himself or hersee or through his or her own employees,provided that such
improvements are not intended or offered for sale.If,however.the building or inpovement is sold within one yea of completion,the ZONING APPROVED, BY DATE:
ownerbuilder will have the burden of proving he or she did not build or improve for the purpose of sate).
❑ I.as osier of the propend.am exdasireN contracting with licensed contractors to construct the project(Radian 7044,Business and BUILDING APPROVED BY DATE:
Professions Code:The Contractors License Law does nit Mal to an owner of properly who builds or improves thereon and who '
contracts for such projects with a cantrador(s)licensed pursuant to the Contractors License Law).
❑ I ser exempt under Section: B.S P.C..for this reason: APPLICATION ISSUED BY: S�� 2 t j/gsr��,
***********************************************v€4************D*******1E 1E�*1E li.i****
Dale: OwnerLEGALIZATION:N , FEE "- SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of end understand the requirements of California Health and Safety Code Sections 25505,25533,and
25for
aperm sod thatCrmWiionfr the
he Aauakty Management
lneedtecomply win000000 tecodes and eseme mmenhse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2534.end
dIoraconstruction futureny moeifcol buildming
tpant 11/ori not
tageme rcle o e)nee to
tialply coess id state
to codesan are exempteme these
provisions. PERMIT 81 . 00 . 60
Date: Applicant SM I P/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations:
IUILE FEE
❑ Ihave and will erirmilccertificate aconsent hsiraUrebrssued. oompenaation,esprwidedlorbySedion3700d1heLeber BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,t«the performance el the work tor which this permit i.issued.
TOTALS----> 81 . 60 0 .00 0 . 00 81 . 60 81 . 60 . 00
I have end wig maintail workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
work for which this permit N issued.My workers'compensation insurance carrier end policy number are:
Carrier FR MONT EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 81 . 60 OVER/SHORT: . 00
Policy Number: WP4'1-.52990004 04 /24 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I'the permit is for one hundred dollars 16100/or less.) 81 . 00 . 60
❑ I certify that in the performance of the work for which this permit is issued,I shall nit employ any penin in any manner so as to
become suMect to the workers'compensation laws of o ✓/ California, and agree that if I should me subject to the woken' *******************************************************************************
penaAej on p/pqw / ase lam 3700 of the Laborcoda.I shall r won oemcomplysu n those INDIVIDUAL F E E BREAKDOWN
Date: / / Applicant.
Wanting:Faillllun to secure wo&xa'compensation coverage/.unlawful,an shell subject an amp to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($i04000),In addition to the cost of compensation,damages se provided for In
Section 3706 of the Labor Code,Intelsat,and ettomey's len SFR 6000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 6, 000 . 00
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Ci,.C). •
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and sate that the above information is cored.I agree to comply with all city end county ordinances
and state laws relatiog to building construction and hereby authorize representatives of this city to enter upon the above•memioned propend
for inspection purposes.
KAT IE 'YOUNG / /q
,al. Date: �//'jJ / �. 0 E! 02/0"."r0^<OTIME TOT 81.60
( DATE! Cit/o�.>y75 TIME: li:Si
Sig ,re of Owner/Agan/a•plicant/Contractor
(5151d6.WP) White-Building A Safety;Green-File;Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
CONSTRZICTION AND PLANNING PQ,OL & SPA .
APPROVALS Permit# Date Inspector •APPROVALS Permit# Date Inspector
1: Temporary Electrical Service oriole 52. Pool & Equipment Location"
-2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement %
_-3: Electrical Conduit-Utility-Undrgrnd. , 54. Forms °4 % V
. _4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding. - ' •
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
--6. Electrical OF ER Grrid. 57. APPROVAL TO COVER-GUNITE
7: Footings .58. Electrical Conduit-Undrgrnd. •
8. Foundation - .59. Gas Pipe, O Undrgrnd.,Test
9:,Water Pipe-Undrgrnd. , ''/1 60. Backwash Lines; P-Trap, Qndrgrnd.
, /
10. Structural Floor System •r 61. APPROVAL:TO DECK ( / T
11. Property Sewer Line,& House Connection 62. Backwash & Receptor-Final''
12. Sewer Cap - 63. Heater & Vent-Final /
13. Roof Drains . 64. Plumbing System - Final
14. Rough Plumbing - 65. Electrical-Final Lr
15. Rough Electrical-Coriduit .. 66. Solar System-Final - r
16. Rough Electric Wiring 67. Fencing & Access Approval ?�
• 17. Rough Wiring Sign 68. APPROVED.FOR`PLASTERING
18. Rough ElectricalcT Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL r• .
•
19. Rough Heating & Air Conditioning • FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace "' ; - - • APPROVALS Permit #
21. Ducts, in Strubture •• r - - 70.,Underground Hydro
22. Ducts, Ventilating r 71. Product.Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test - - - 72. Underground Flosh - -
24. Roof-Framing _ - , • 73: Undergrrid.Storage Tank D Gas ❑Oil
25. Roof Sheathing - Z- f '9 6 64{4--74.. Overhead Hydro „
26. T-Bar Ceiling (Structural) & Monocoat . ' --�" 75;cDrY Chemical
27. Frame and Flashing . .. s ; 76. Dry Standpipe•- •
28. Lathing&Siding _ ' ' " - 77- FIXED SYSTEM FINAL
29. Insulation _ : . •• ' _, i 78; FIRE PREY. FINAL
30. Drywall Nailing , , . - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat i ,• - 79. FINAL INSPECTION : _
32. ElectricalPowar Meier-Final '' ,. `' 80. FOOD CERTIFICATE ISSUED.
33. Final-Electric- . . h J Notes: • • - - ,.n.-
_
34. Final-Heating,& Air Conditioning - 't ' - -'
35. Final Gas Pipe-Test --
36. Hood-or Canopy ..' • 1. •- ,
37. Final Factory Fireplace...- - I
38. Final Plumbing • _
- -
39. Water Service:Final .
40. Gas Service-Final - -
41. Solar Domestic-Final. p•
42. Backflow Preventer _ I -. '
i
43. Backflow Irrigation . 'c _
44. Landscape Irrigation System ;_, .•••••.... _ �;
45. Sound Attenuation •
46: Handicap Regulations -
-"
47. FINAL STRUCTURE& BUILDING Z-1S ?: 6c- ' . _
48. FINAL PLANNING ! ! la v _ -
• •49. Electric Release to Edison r • : -
50. Gas Release to Southern California Gas Co
1 • ` =c -
51. CERTIFICATE OF OCCUPANCY • -.
No. Date
. - IEEE RECEIVED
1160,-,„6�noJAN 3 1962-
COSTA MESA BUILDING-SAFETY DEPARTMENT /FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
S
For Applicant fo Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING Lot 68,Tr. 4311 BUILDING
ADDRESS Z&6i 5 -S///ONI. 1z/ , 'o . ?
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PERMIT O.
OWNER Adams Street Company I I 1 hOrtVIra
MAIL 1653 Minorca Drive R¢CEI/��.D BY 207
RE EIVED_ DATE ISSUED
ADDRESS -- -- - . -/� /�V/ JIM Q 1040
•
CITY ' Costa Mesa TEL BUILDING .
ADDRESS
OR Earl Kaltenbach NoKe5-0533 COSTA MESA. CALIFORNIA
ENGI9'/'/2 Katella Ave.,Ananeim
ADDRESS FIRE ZONE
ZONE TYPE ✓ GROUPtigk
CONTRACTOR Samar Construction Co. ,The. APPROVED
16)3 Minorca Drive BY DATE
ADDRESS " 1 ZONING
•
Costa Mesa ZONE O_I I NO.OF I USE OP NEW� Q /Ppy
CITY n PLANE a BUILDING "M
STATE
NO. 197838 NOL. Ki 9-0395 LEGAL Lot 6 & T�S'3//
LIC.
DESCRIPTION
OF LOT 70 X 100 - I NO. OF BLOCS.0
NOW ON LOT A.P.NO.
USE OF - - YARDSEVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM I p (CENTER LINE ST.) u
CENTER OF STREET 42 REAR YARD 25 FRONT 7a FT. . IN.
SIDE.YARD I LEFT 5 I RIGHT 5 R.SIDE .S' FT. IN.
DESCRIPTION OF WORK .s
L.SIDE FT. IN.
NEW I X I ALTERATION I V ADDITION I REAR 2-s— FT. ______ IN.
REPAIR . I. II MOVING I V DEMOLISH I BVPROVED toi..04 DATE /2I Z7/IF /
/e "CC
BUILDING 1650 NO. OF
ROOMS 7
SIZE STORIES 1
EXTERIOR WALLStUCCO- I ROOF /
COVERING WORN COVERING Shakes /4/h CQ
USE OF BUI PIN AN WO TO BE P€ FORMED /
Single Dfamiml`y residence and //
attached garage 3-d
.-- )1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDI.ANCEB AND STATE LAWS REGULATING
BUILDING coe9TRucTlo VALUATION _�j
SIGNATURE OF AD' iti
S ET C. P!�f PERMIT FEE $ ,7 /
PERMITTEE r/ q
7 �6 = ,rT
� � ��� $ / PLAN CHECK $ /% 1-5 -. miz
AUTHORIZED AGENT ' /
�/1 O
TOTAL FEE $ SSS LL
1
OWNER BERGER, HAL DATE 9-30-66
JOB ADDRESS 2868 stromboli Road BUILDING PERMIT NO. 26212
GENERAL CONTRACTOR Roy Collins DESCRIPTION OF WORK Repair Fire Damage
jAP No. 139_3.3_13 LOT TRACT FIRE ZONE VALUE $600.00
INSPECTIONS I Signature Date GROUP J TYPE V ZONE p-1
SoilI PERMITS ISSUED
(�C Gas SUBCONTRACTOR Date I Number 1 Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line ❑ House Con. 0 _
Sprinkling System
Miscellaneous _ -
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground -0 Power 0 -
Rough Wiring • =rig and Vent. A �_ /
Trenches 0 Forms 0 Steel Reinf. ❑ /L,1,f,�� �y,.J/ ,,n./ r /p-./4F'-G6 471 •
Floor System _ _
Bond Beam 0 Steel Reinforce 0
Sheathing �l (4- _.5-(,6
Frame and Flashing - ,krn /a//$/A 6 _
Lathing — In ❑ Out O / •
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final //-/4 ' (/�„q.�-P, 'et.,,,.., a-/,-636 a6 yL.3V
Plumbing, Final and Gas Test 0
�0
Electric, Final ( fd-.i3-GG
Building, Final . WI I p/r/h4
is
26212 SEP 30-66 00 73803*****5.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING .
Hu1LDINa 7 �/( y� For Office Use Only
ADDRESS s. O Cv 1 �t 6 m230 4 / -
RECEIPT No. n�ww'y+y
COSTA MESA. CALIFORNIA }}Yvff ,GUf„y1t�22
/f ' RECEI D'3O 7 , 308/!0
OWNER {�p/)/.(/ �j -4-6 y� �`
G
ADDRESS C✓e O b l�' s ( IS (.7 to 4 / ADDR INH .
// PIR[
CITY ` :kit 1117 ';*471. ZONE. ;771, OROU/�P /// ,,ARCHITECT TEL BYPROVQDDAT[ % /ssOR ENGINEER �- NO.
ZONING t1� (,✓y
ADDRESS `, 1/V1 / / N
CONTRACTOR'] x-,
O . �,(`.a I h / Yt s. 1 I GAL /NO.N� CD- pUSEOPN / <,, --9
ADDRESS / J O (�/- �� LEGALIPTION 41�Y^`1 6 2 cY `(• -4 3,11
CITY 'Y(..—wfO tF�O A.P.NO. I �-/ — 3F & / 3
NOTE: •
STATE // TEL. ^ may. 80'TO HOIDB fi REAR P.L OVERHANG EAVE SHALL B[LESS THAN
LIC.NO.2. 3/ y-0 $o NO. 6 ZCb_E, 6
SIZEPJMM yy�� EAVES
OF LOT / V / (JCS Now or
nto E. J ALLOWED (U .C.REQUIREMENT)
YARDS APPROVED 4YARDS APPROVED
USE OF ap ��xCS MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. ja Ye (FROM C/L STREET)
SETBACK LINE PROM FRONT FT. R.
CENTER OF STREET REAR YARD
SIDg YARD I LEFT I RIGHT R.SIDE FT. Pr.
DESCRIPTION OF WORK L.HIDE Fr. Fr.
NEW ALTERATION ADDITION REAR PT. FT.
42- DISTANCE BET. BET.MAIN e
REPAI ( x. MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS.
BUILDING NO.OF VAR•# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED //+
EXTERIOR WAI�LLLL ROOF [+� APPROVE��+//y7 �(/ 4i/Z7 {4/ G1 /�
COVERING �JC� I COVE RING d"�/-43 AY Y�IV ' DATE / .9
USE OF BUILDING A WORK TO BE PERFORMED A
IT... 0 We -Ai . 9
c.-iiii A., — ,,,,;
IREV ACKNOWLRDGE'THAT.I NA READ THIS APPLICATOR THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O
A STATE THAT THE ABOVE.IH COR ECT AND AGREE TO CON. PURPOSE OP ESTASUFE
SHING A PERMIT E ONLY.
PLY WITH ALL CITY ORDINANCES AND STAT[LAWS REGULATING VALUATION IY+.
'BUILDING CGN �
STRUCTIO •
cc PERMIT FEE $ H
,SIGNATURE
P[RMITTEF OF E
s 6'1)D PLAN CHECK S /I--�� CO
w
AUTHORIZED AGENT
a All
TOTAL FEE ; �J
-