HomeMy WebLinkAbout2823 TABAGO PL - Building Permits - CITY OF COSTA MESA • "
11 114s,Q BUILDING DIVISION
Fk' �•.� 77 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
PERMIT NUMBER: P10-00027
PERMIT TYPE PLUM STATUS: ISSUED
APN: 13933303 DATE ISSUED: 02/0912010
ISSUED BY: RMD
JOB ADDRESS: 2823 TABAGO PL CM Suite/Unit:
Vicinity: •
SCOPE OF WORK: PLUMBING PERMIT FOR A WATER HEATER CHANGE OUT. COMPLIANCE FORMS ATTACHED TO JOB
CARD AND CITY PERMIT.
•
OWNER: TEIXEIRA, JERRY LEE Address: 2823 TABAGO PL
PHONE: - "City/State/Zip: COSTA MESA, CA
APPLICANT: DRAGON,VENT/ Address: 1235 GRAND AVENUE :
PHONE: 866-692-5273 •
City/State/zZip: SPRING VALLEY,CA
CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC License No. 811114
Address: 1235 GRAND AVENUE " PHONE: 800-B98-0008
•
City/State: SPRING VALLEY,CA ZipCode: 91977 - CELL: 866-692-5273
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
•
•
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
TOTAL FEES: $35.80
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.
CODEY. INSPECTION TYPE DATE IN1111ALS CODEC INSPECTION TYPE DATE INIIITRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 1�
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
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive.a license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property lax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: ,-
,>--/"r4
person is required to descend,will be made in connection with work authorized
���, 4 A T` FN by this permit,and that no building structure,scaffolding,falsework,a demolition
1 ..,�,.,�section need not be completed if the Penn is valued at one hundred dollars(3)00)os less) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
/G+9�0�3 2,Art 2,Sec. 341,Ttle 8,California Administrative Code).
Polci y mber rl O
0 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 of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of APpl;tent's Signature Date
the Labor Code/,I shall forthwith comply with these provisions.
v0,01990,01/0,01990,01/ Qa��/
/�N0,01990,01/ 0 Division of Industrial Safety Permit Number:
X'SresdWre:,.r...' kt>,"' HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: •
WARNING: FAIL RE 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? 0 Yes 0 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
in full force and effect. /� a registration form for acutely hazardous materials? 0 Yes 0 No
hrC.'l /7// CI- ss '.- f6 (Section 25533 of the California Health and Safety Code, with some
ENT/ C/ � Qom(/Q���� exceptions, requires registration with the Costa Mesa Fire Department by
!!// each business which at any one time has on hand a quantity of acutely
Oo'ntr oignawre (__pard.— 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)? 0 Yes 0 No
(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 Dale
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 property, 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
employees, provided that such improvements are not intended or offered for 8. (If"yes", attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control 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
O 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 Signalure 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
❑ I am exempt under sec. the information given is correct. I agree to comply with all state 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 to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature or Legal Owner(s) Dale
Signature Date J 777/ ,,-j9�'N go[/Q///0
3057-46(3/07)
.'q._ MSed.App4cant (•Tn�tn
rl� �'
{ Prescriptive Certificate of Compliance: Residential CF'IR-ALT
Residential Alterations' (Page 1 of 5)
Project Name: 0�� Climate Zone k /I of Stories
v T,IS4 Co �G > g e e 6 /
General Information
Site Address: gi, _i 3 TnAa.° pt, Enforcement Agency: bate: co c Oosi1/4 a
Building Type M'Single Family 0 Multi Family Circle the Front Orientation:N,E,S,W,or degrees
Project Type: I'Alterations 0 Envelope O Fenestrate n 0 Roof 0 HVAC
Conditioned Floor Area(CFA): Replacement or Change Out 0 Duct Replacement Water Heater
NOTE: This farm is not to he user/far Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
ID Opening of framed cavity alone—Alterations that involve the opening of the framed cavity of a wall,ceiling, or floor must install the
mandatory minimum insulation value per§150 for the altered assembly.Fill in Columns A—C and enter mandatory insulation value in Column H.
❑Replacement of entire assembly—Replacement of an entire wall, ceiling,or floor assembly requires the installation of Component
Package-D insulation values in Table 15)-C. Fill in Columns A—J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
_ A 'B C I D . E F .1
Proposed bee Not Standard Values From JA4 Table
Framing Thickness, Framed ' Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
ID' i or Type' and Size' or Other factor4 _Numbers R-value R-Value' Cell Values U-factor9
•
Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page 144-3 and Equation 4-1. For calculating furred walls use the Mass and
• ,'Furring Construction table below.
I.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...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass, enter 2x4, 2x6,or etc...see JA4 for other possible frame type assemblies,
3. Enter the thickness for mass in inches or Spacing between framing members enter: 16'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 on the Climate Zone;enter the Standard U-factor 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 R-value that is being installed in the wall cavity or between the framing;otherwise, enter "0".
7. Enter the Continuous Insulation P-value for the proposed assembly;otherwise, enter "0".
S.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J
9.The Proposed Assembly U-factor, Column.1, must be equal to or less than the Standard U-factor in Coruna E to comply.
Furring Strips Construction Table for Mass Walls Only
A I B I C D I E F I G 11 I I I .1 K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5,4.3.6,4.3.7 Joint Appendix'fable 4.3.13
N G
>,
U
is -
V
-j az
j ' o oP t- oaP .4°•
•v 1 o
FinalAssembly z" t o . v
Mass Name or JA4 Table - ✓ .eu = E mo .E n vo i m Assemb
l
ype'Thickness' Numhes ? :5° = w '41 it < -° -/actor
' Comment
4 I f I I I i
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
'Prescriptive Certificate of Compliance: Residential CF-PR-A'LT
(Page 4 of
Residential Alterations5)
Yrgjec!Name: p 2 Climate Zone k S q of Stories
l • oot93 �45,9so A 9.26 /
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split,
Type and Capacity''2'3 (AFUE or I-ISPP) Type and Location4 R-Value Type Space,Package or Hydronic)
I.Indicate Heating Type(Central Furnace, Wall Furnace,Heal pump,Boiler,Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity
< 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(6)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-112-ALT Form foe additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor, Radiators, etc.)
HVAC SYSTEMS-COOLING
I
Minimum
- Efficiency ., ..Duct or Piping Configuration. .
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity l'2 COP) Type and Location' ' R-Vnluc Type Space,Package or Hydronic)
I. Indicate Cooling Type(A/C',Heat pump,Evap. Cooling, etc)
2.Refer to the HERS Verification section on Page 4 of the CF-1R-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location(Ducts,Hydronic in Floor,Radiators, etc.)
MATER HEATING
_ 'List water heaters and boilers for both domestic hot water(DHW)heaters and hvdronic space heating. Individual dwelling DEW heaters must be
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation front the DHW heater to the kitchen(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)2 System Capacity(gal) Thermal Efficiency R-Value3
GnS s7AW,DA.P r 9h 2 30
I.Indicate Type(Storage Gas;Real Pump,Instantaneous. etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive.requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tmnk and pipes shill be insulated to meet the requirements of f150(j).
SPECIAL FEATURES The enforcement agency should pap special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation and special verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151(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 Table 118-A of the standards.
Raised Slab Insulation 0 YES ❑NO
YES:In Climate Zones I,2, I I, 13, 14& 16,It-$insulation is required;in Climate Zones 12& 15,R-4 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: HERS Provider:
200E Residential Compliance Forms August 2009
1 .Prescriptive Certificate of Compliance: Residential CI'-1I2-ALT'
Residential Alterations (Page 5 of 5)
Project Name: �p�� in
' ft` Yi �r e I Climate'Looe# 5 II of Stories
•
}HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below d completed and signed CF-412 Form for all the measures specified shall he submitted to the building inspector befare final
inspection.
Duct Sealing &Testing HERS verification is requiredfor this measure.
❑ YES 0 NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
. space,the ducts are to be sealed per§I52(b)1Dii and the newly installed ducts ore to he insulated per§151(1)10.
D EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. .
❑ YES 0 NO 1'ES:In Climate Zones 2 and 9-16, if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)1Di.
❑ YES 0 NO YES:In 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 or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously scaled confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
._ ❑ EXCEPTION:-Duct systems with less than 40 linear feet in unconditioned space. ......
O EXCEPTION: Existing duet systems constructed,insulated or sealed with asbestos.
Refrigerant Charge-Split System HERS verification is required for this measure,
D YES 0 NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§I52(b)IF.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
_The ventilation requirements of§150(0)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat:Pumps: Airflow HERS verification is required for 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(6)1 Ci to meet the requirements of§151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: //r�7/• 5,egmw Signature: -
/EN/
l/L y(/ �r n 7 �.e.��ta�✓
Company:/s ^ EGTA AleC/b9A//G/�Z /NC Date: ai/,YA0
Address: ,.., If Applicable 0 CEA or 0 CEPE
dard 17 4374Sfz//NF /P,D <TE AX (Certification ii):
City/State/Zip: ,A Phone:
/-7ESAI A z2 i e o.So?.-O6' o�E— 9 —s7Z-17 9
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I 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 I and 6 of the California Code of Regulations.
• The building design teatures identified on this Certificate of Compliance are consistent with the in Rmuation provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications 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.
Registration Number: Registration Date/Tinac: HERS Provider:
2008 Residential Compliance Forms August 2009
Mandatory Measures Summary MF-1'R
Residential (Page 1 of 3)
Site Address: Ent) eme t Ag y: Date:
°ot3 TagAGO 2, _ e ec ,�� dot/osi1/40
NOTE: Low-rise residential buildings subject to the Standards nntst comply with all applicable mandatory measures listed,
regardless of the compliance approach used. More stringent energy measures listed on the C'enijicate of Compliance(CFJR,
CF-IR-ADD, or CF-IR-ALT Form)shall supersede the items marked with an asterisk(*) below. This Mandatary Measures
Summary shall be inemporated into the permit documents and the applicable features shall be considered by all parties as minimum
component performance specifications whether they cine shown elsewhere in the documents or idthis summary. Submit all
applicable sections of the MP-IR Form with plans. •
DESCRIPTION •
• Building Envelope Measures:
§1 16(a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
§116(a)4: Fenestration products(except field-fabricated windows)have a label listing the certified U-Factor,certified Solar Heat Gain Coefficient
(SHGC),and infiltration that meets the requirements of§10-111(a).
_ §I17: Exterior doors and windows are weather-stripped;all joints and penetrations are caulked and sealed.
§I 18(a): Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on CF-6R Form. •
§118(i): The thermal emivance and solar reflectance values of the cool roofing material meets the requirements of §l 18(i)when the installation of
a Cool Roof is specified on the CF-IR Form.
*§150(a): Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor.
§150(h): Loose ftll•insulation shall conform with manufacturer's installed design labeled R-Value.
*§150(c): Minimum R-I3 insulation in wood-frame wall or equivalent U-factor.
*§150(d): Minimum R-13 insulation in raised wood-frame floor or equivalent U-factor.
§1500: Air retarding wrap is tested,labeled,and installed according to ASTM E1677-95(2000)when specified on the CF-1R Form.
• §ISO(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16.
§1500): 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)IA: 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 at least six square inches in area and is equipped
with a with a readily accessible,operable,and tight-fitting damper and of a combustion-air control device.
-
§150(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
hui king,arc prohibited.
Space Conditioning, Water Pleating and Plumbing System Measures:
¢110-¢113: HVAC equipment, water heaters,showerheads,faucets and all other regulated appliances are certified by the Energy Commission.
§I I3(c)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 logs connection requirements of§I 13(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 15(1 Btu/hr arc exempt),and pool and spa heaters.
§I 5000: Heating and/or cooling loads are calculated in accordance with ASHRAE,SMACNA or ACCA.
§I 50(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c).
§1500)1A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with
insulation having an installed thermal resistance of It-I2 or greater.
§1500)1B: Unfired storage tanks,such as storage tanks or backup tanks for solar water-heating system,or other indirect hot water tanks have 1t-12
external insulation or R-16 internal insulation where the internal insulation R-value is indicated on the exterior of the tank.
§150(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 hot water pipes are insulated per Standards Table 150-B.
§1500)2: Cooling system piping(suction,chilled water,or brine lines),and piping insulated between heating source and indirect hot water tank
shall be insulated to Table 15(1-B and Equation 15(1-A.
§I 500)2: Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A.
§150(03A: Insulation is protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind.
§1500)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
Mandatory Measures Summary M.F-1.R
Residential (Page 2 of 3)
Site Address: Ent meat Agency: Date::
/Jai leBAgo ,, 9ea ikiAk—' Se/ Wio
§1500)4: Solar water-heating systems and/or collectors are certified by the Solar Rating and Certification Corporation.
Ducts and Fans Measures:
§150(m)1:All air-distribution system ducts and plenums installed,arc sealed and insulated to meet the requirements of CMC Sections 601,602,
603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or
enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable
requirements of UL 181,UL 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to
seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall he used
§150(m)!:Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than scaled sheet metal,
duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts.
Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
§I50(m)2D:Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape
is used in combination with mastic and draw bands.
§150(m)7:Exhaust fan systems have hack draft or automatic dampers.
- • . —§150(m)8:Gravity ventilating systems serving conditioned space have either.automatic or readily accessible,manually operated dampers.
§I50(m)9:Insulation shall be protected from damage, including that due to sunlight,moisture,equipment maintenance,and wind.Cellular foam " -
. insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that
can cause degradation of the material.
§I50(m)10:Flexible ducts cannot have porous inner cores.
§150(o): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoor Air Quality in
Low-Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in
Section 4 of that Standard.
Pool and Spa Heating Systems and Equipment Measures:
§114(a): Any pool or spa heating system shall be certified to have:a thermal efficiency that complies with the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater;a permanent weatherproof plate or card with operating instructions;and shall not-use
electric resistance heating or a pilot light.
§114(b)1:Any pool or spa heating equipment shall be installed with at least 36"of pipe between filter and heater,or dedicated suction and return
lines,or built-up connections for future solar heating
§114(b)2:Outdoor pools or spas that have a heat pump or gas heater shall have a cover. •
§114(b)3: Pools shall have directional inlets that adequately mix the pool water,and a time switch that will allow all pumps to be set or
programmed to run only during off-peak electric demand periods.
§I S0(p): Residential pool systems or equipment meet the pump sizing,flow rate,piping,filters,and valve requirements of§150(p).
Residential Lighting Measures:
§150(k)]: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in
Table 150-C and is not a low efficacy luminaire as specified by §150(k)2.
§150(k)3: The wattage of permanently installed luminaires shall be determined as specified by §130(d).
§150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz.
§I50(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high
efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line-voltage socket or line-voltage
lamp holder;OR shall be rated to consume no more than five watts of power as determined by§130(d),and shall not contain a medium
screw-base socket.
§I50(k)6: Lighting integral to exhaust fans, in roams other than kitchens,shall meet the applicable requirements of§150(k).
§150(k)7: All switching devices and controls shall meet the requirements of§150(k)7.
§150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
EXCEPTION:Up to 50 watts for dwelling units less than or equal to 2,500 112 or 100 watts for dwelling units larger than 2,500 ft2 may he exempt
from the 50%high efficacy requirement when:all low efficacy luminaires in the kitchen are controlled by a manual on occupant
sensor,dimmer,energy management system(EMCS),or a multi-scene programmable control system;and all permanently installed
luminaries in garages,laundry rooms,closets greater than 70 square feel,and utility rooms are high efficacy and controlled by a
manual-on occupant sensor.
§I50(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated
cabinet.
§I50(k)10: Permanently installed luminaires in bathrooms,attached and detached garages,laundry rooms,closets and utility rooms shall he high
efficacy.
2008 Residential Compliance Forms August 2009
> 's
t CITY OF COSTA MESA
:4: BUILDING DIVISION � ,
„......4,.; DEVELOPMENT SERVICES DEPARTMENT L-�.Ji"
Z4• riqi
PERMIT PERMIT NUMBER/
"*.a•PtO tr P98-00583
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2823 TABAGO PL Status: ISSUED
Suite No Applied: 07/22/1998
Issued: 07/22/1998
Vicinity:
•
Parcel Nunmber: 13933303
Applicant TASLIMI, ROBERT • .
Address:
• - Phone: 714-350-7134
7 /. Zip: -
i,/, , •
i, mo;/ i,'' ,
Owner:/TEIXEIRA, JERRY -LEE : - '
.
Address 9,TEIXEIRA, LAURIE�A - -Z /
7/.�/-COSTA MESA,CA. • Phone:
/(t '2823 TABAGO/PL- Zip: 92626
/it/ - i/;' , . ,
Contractor: '-,CORNER CONSTRUCTION I>
Address'-1 1035 S:LABREA ,. r --I, , " .
• �;
- ' / - "r . Phone 213=9651999 ,,
,LOS.ANGELES,CA i -.-/'Zip, 90019
` ; "/ /J r License: 301167 • - -
%' •
Arch I Eng �'
` AAddress:
- � r Phone -.,._ ' ,
- ._ Zip:,. _.._ ,, ,. , - ..
- - - License:
;_1 -
•'SCOPE OF PERMIT ',
,. \ ,INST 6 OUTLETS,2 SWITCHS,6-FIXTURES,'RELOCATE SINK C/O,CONNECT GAS FROM EXIST TO
NEW FIREPLACE. REF B98-01009 / /
. \\, '' FEE SUMMARY
`.\ , '1,,.. ,AMT QTY - AMT QTY AMT QTY
ISSUE FEE�. \ .- $22.00. Laundry Tub/Washer . $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00, 0 Landscape Irrigation .-, $0.00 0 • Swimming Pool 1 $0.00 0
Backflow Preventer ": $0.60;X`,,0 ' P-Trap. " ' - ' $0.00 0 Trap Primer - ' $0.00 0
Bathtub .v,�� - $0.00 \V0',z, --r Pressure Regulator- ", ,"$0.00" - 0 . -Urinal $0.00 0
Clarifier System TS; $0.00 '0.�'"; - • „Process Piping"(per 10 ft)7- $0.00 0'_ Vacuum Brkr Bkftow(1=4) $0.00 0
Connect(Ice,Soda,etc) <$0.00 /• 0`:,=�'. . Receptors ' , .-., $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units " . $0.00 /,0, - ' Septic Tank- , "$0.00 .0 Wash Basin $0.00 0
Dishwasher i$0.00' ' 0' ,. , .," " Sewer Cap for Demo $0.00.. 0 " Wash Basin Set / $0.00 0 .
Drain,Floor '`$0.00 ` .0 1 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater '$0.00 0.: ".'i Sewer Private Line $0.00 ' 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 , 0 ' , '- Shower ' - - ' $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 ,_ - Sink,bar ' $0.00 _ 0 ' Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 '0 - - Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor , .$0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $5.50 1 Sink,kitchen $8.75 . 1 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $36.25
-
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
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'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:
Cartier: Policy Number:
(This section eed not be completed if the permit is valued at one hundred dollars($100)or less.)
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 1 C lifomie, d agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
'ih thes r vi ons.
�plicant Sisk ature: n,/4 4,....c7 1 Date: ��C�/ t�S`
WA-0 ` :FAILURE T S CURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES M40 CIVIL FINES UP TO ONE HUNDRED
THOUSAND COLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SEC11ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license•u der prov ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force a ktapt. .c.# /_ " • Class#
rector's Sign ure: far ).r _ air Date: -}----7 7--fll'
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 drivers 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,Califomia Administrative Code).
❑ As owner-builder,1 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 0 N
(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 Califomia 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 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 0 No
(Section 85850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 at of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 es ❑No
B (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/iproperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
//� Si. - -.e Of Legal Owner(s) to y
f"'A'LA 4 %/�' 2 '�JpZ yVX
Or AuthonzeicantiB •
/// CODE t INSPECTIONTYPF DATE It1ImAL5 ODE II INSPFCTION TYPE DATE Iti=mALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �^9
1266 Pool Spa Final 208 Final Plumbing VII /c6 - / _
s
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
2446-46
4S:14,5t, CITY OF COSTA MESA
F
4yt(, BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT Cir
k �g PERMIT PERMIT NUMBER%
�doowwro E98-00778
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2823 TABAGO PL Status: ISSUED
Suite No Applied: 07/22/1998
Vicinity: Issued: 07/22/1998
•
Parcel Nunmber: 13933303
Applicant: TASLIMI, ROBERT
Address:
--1..A Phone:• -714;350-7134- -
-
� -- Zip: .
,
•-',:,j// 1 C _ , j,
Owner: TEIXEIRA;JERRY LEE` S _
Address /TEIXEIRA,LAURIE A,�� -Ti' - - --\c. -
/ 0/STA
[COSTA MESA,CA ' Phone:
/: 2823 TABAGO PL�, Zip: 92626
/,(, N / /i�'/
Contractor:/„ CORNER;CONSTRUCTION
,Address j/ 1035'SA/AREA /
!//CV •f,
l '''.;;:7 . / Phoney 213-9851999 • ,
-- LOS'ANGELES;CA :: ,Zip: 90019:I:
---License: 301167'-. '
SCOPE OF PERMIT
'1NST 6 OUTLETS;'2 SWITCHS,6 FIXTURES, RELOCATE SINK C/O,CONNECT GAS FROM EXIST TO
/ ' fNEW FIREPLACREF B98-01009,.
/- / E.. ... •,- ,. :.� . - - N
FEE SUMMARY
Quantity'\r `,`_ , ___ __._ r; -IN, / / Quantity
ISSUE FEE ', r. $22.00 -t _±Temp Dist System'/Lighting $0.00 0
Temp service test ' ' ' $0.00 - - -- - Busway./100 ftif ` $0.00 0-
Res:,a/cpackage', r,, $0.00 StandingSection $0.00 0
New Res(1-2 units) \ $0.00 0 Misc Electrical Equipment ' $0.00 0
New Res.(3+units) Y\ \ ' $0.00 0 Transforup,to 1 kva/kw $0.00 0 •
Pool/Spa' \\ 'V\ Ai., $0.00 0 _ mers up to 10 kva/kw $0.00 i- 0
Lighting Fitts • 'A$ 6.00 ' 6 up to 50 kva/kw $0.00, 0
-
Recept Outlets N \,1• ' 6 - up to 100 kva/kw $0.00:, 0
Switches ','�• \$2.00 2 • , ' " over 100 kva/kw $0.00 • 0
Non Res Appii-:-i, •$0.00, 0 'ii , „' ., .Low Voltage Equipment $0.00 0
Res Appl ' . ' , $0.06 r • '0 -' ,• . N -:Low Volt Wiring System/Ckt - $0.00 0
Service to 200a.". A;$0.00.,-:::'\' 0' - 'Mist:Conduit ' $0.00 0
Service to 1000a - $0.00 '' 0. -N ' Misc.Conductor - _ $0.00•, 0
Service over 1000a �/ $0.00 0-.' ' - - v Circus(gen or ride)- :$0.00 ' 0
Motors to 1 hp '‘,:C '-$0.00 ` -' 0---._ Circus(meth ride or lights). $0.00- 0
Motors to 10hp ' ' 1 ,$0.00 / ; 0-. Christmas Tree Stand $0.00 - 0
Motors to 50hp ' $0.00 -//,0 - ' - Fireworks Stand• • $0.00 ': 0
Motors to 100hp ' •.$0:00 ' '//0 ' -Other Electrical Fee -$0.00'
Motors over 100hp $0.00 0" •. '
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 0' ReinspectionTee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $36.00
Intermed Pole $0.00 0
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
n
U ,
DECLARATIONS ,
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'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 if the permit is valued et one hundred dollars($100)or less.)
XT 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 Cplifomia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
with ihes rov/"ios. / G
yr, •. V eg Date: �! C
•• z.-• 1-E T SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ml EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),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 livens:. .,.der pr•vi lots• •.pter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force a • S-, Lic.# S- 0 ' Class*
tracto s ••,:attire: 4r. . 0 -7- Date: c Jam(--i-'—?�
seli
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's 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 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:
In 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? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 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 LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any 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 ❑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 allstate 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.
tur%Of Legal Owner(s) Date
v /,t. i+'a.,: 2 -22-?
A • •r Authorize. •p•licant Date
COOEL INSPECTION TYPE DATE ICALS CODE! IBSPFCh1 N TYPF DAIS =AALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical y-ii-qgA ..�
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
2446-46
f
•--1I:Ii._Y. _ -
CITY OF COSTA MESA
;r �AG'-�) BUILDING DIVISION
b.' "'"' ' DEVELOPMENT SERVICES DEPARTMENT89t�
PERMIT PERMITMIT NUMBER
xs
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2823 TABAGO PL Status: ISSUED ()
Suite: Applied: 06/11/1998
Vicinity: Issued: 06/19/1998
Parcel Nunmber: 13933303 Zoning: R1 R1
Applicant MEHRTASH, MOHSEN
Address:
Phone:
Zip:
Owner TEIXEIRA, JERRY LE_E ,.
Address TEIXEIRA LAURIE A -
i
COSTA MESA,CA ( \
2823 TABAGO PL ' i Zip: 92626 i \ ' `,
Contractor. i / N \'' _-� _ , / A\ v\
Address. ,%/ � ��,= _,i" \ N / / /
�L71 ,<----;;c Phone: A`>- v / y:_,
/
• 0i A �� Zip: NN\ ,.
," v /,_ License:—' :�,A
Arch`i Eng: 'NORMAN SIMON AIA
Address:x,,1035 SOUTH LA BREA 1-;•
L �.,
•Phone:. 213986=1999
, tA,CA . , • 'Zip:,— 90019 -
''/. .' i ----/ A- _, _License:- ,
SCOPE OF PERMIT
i, ‘,,, '. 336 SQ FT FAMILY ROOM ADDITION,WITH FIREPLACE,TO REAR OF EXISTING SF RESIDENCE.
/ _ - - °.
// c .
FEE SUMMARY
Plan Check: $244.89 Ai, Calc Valuation: $27,384.00
N Permit ' $376.75 ,_ , ,1 -- - '/ / . - Claimed Valuation: $o.00 '
'SMIP Res: $2.74 = // ,
SMIP.Corr1:- -$0.00 / - '
• Other: \$0.00 !T
Inspection: . x;$0.00
\\\ '\ *1,, �
,
`\\Total:. $624.38 /,
\1� ,
`v N,' N, \�� ' \\ PLANNING &ZONING
,� -
�`\�
SETBACKS
/ /
MAIN STRUCTURE Front 0 0 , �"� Rear 14-,6� Left' :21,„0 = ' Right '` 15-6, , j
ACCESSORY Front 0-0 i Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: .2 _ Required: 0 Proposed: -0 - -
NOTES: -
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 cododdsrena all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration tAt1T /
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS -.
WORKERS'COMPENSATION DECLARATION: .,
I hereby affirm under penalty o1 perjury one of the following declarations: `
❑ 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
work for which this permit is issued.
❑ I have and wit 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 inn/Suurranccecarder and policy number are: , �/ G
Cartier. /"T�–V L2p Policy Number: (L l o cSO�)V
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
.8 I certify that in the performance of the ork 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 torn' nd ee thf ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
/ comply with these pr ons /
Applicant Signature: (n _ (
Z/J �j � Date: /WARNING:FAILURE SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 visio s of Cha ter 9(commencing with Section 7000)of Division 3 of the Business and P1otpssions Code,and my license is In full
force and effect.Lic.N / t Co, Class N �S95(--
CONSTRUCTION
\/Contractor's Signature: �A �g�,t0• Date: CP�( 9 —/�
T CONSTRUCTION LENDIINGNTTTG//GAGENCY:
❑ 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 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 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 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? 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 Application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 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 at 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-desccdbed properly f•r inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
- -•tic Of Legal Owner(s) G i/ (7— ate
A d/Or Authorized Applicant l Date
ODES INSPELTON TYPE PATE MMUS CODE/ INSPECTION TYPF DATE . IMImALS
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 �p// ���/
204 Final Demolition 250 Final Building/Occupancy -(Q 4D SS
2448-46
Architects -, ..
'4 NORMAN SIMON AIA AND PARTNERS ✓
1035 S.LiBre. Angeles,'CA0
9019 213.965.1999 fax 213965.9663
Builders
CORNER CONSTRUCTION CO., INC.
la.1301167
June 9, 1998
City of Costa Mesa
Development Services
77 Fair Drive
Costa Mesa, CA 92626
To Whom It May Concern:
I hereby authorize the following persons to act on my behalf in obtaining permits from the
Building Department and to sign permit applications for me. Only these names shall appear,
please delete any others you may have in your records. I am properly licensed as required by the
State of California.
I assume full responsibility under the law for permits taken by persons authorized to act on my
behalf.
I understand notarization shall continue until the Department of Building and Safety of the City
of Costa Mesa is notified in writing that such authorization is canceled by its contractor. This
request supersedes all pervious requests.
Persons authorized to sign permits a e ignatures follow:
111 James W. Bourgau _,_t,.7 ,i ' E. dam
Jose Niebla
Mohsen Mehrtash iliethlir .
By: •
Norman Si n, MA
LICENSE NUMBER: 301 167
O3 3 / Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
• P MIT O. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PERMIT y � 0179 3707/88 _ ' - E906 iI
Project Address fy 3 TJ484•S-O PZAee / ff � tt �
Applicants Maili11ng��Addresss'• ' e m c TYPE OF CONSTRUCTION LJ NEW.0 ADD LI ALTERATION Li REPAIR r _ - ;
Owner's Name _N AU 2. $ T� 7 x E • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- _ q:p•�e • , _ - Zone
�� P - iC—/�G`q DESCRIPTION OF WORK/USE OF BLDG. - g,
Address / rC S Main Buildin AccessoryBuilding:
E Z
Arch/Eng: License No. - TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑ STRUCTURAL - T Front • - O
Address �/ y L - 7s3_.�ey/ ❑ TENANT ID ELECTRICAL ❑ PLUMBING 0 MECHANICAL - B Rear N
m
Contractor's Nae �.Q>(J?P/7PL / � r(eZ•/p'T/Dy ❑ OTHER . • - •
A
C Right N
PROJECT DESCRIPTION 'SQ. FT. • OCCUPANCY
Address,lmailin I ee'_ P fa L /n K • G
g d /Ale T ! Y CONSTRUCTION TYPE VALUATION$ $ Left - R
l City License No. �'S(/� ZONE - GRADING CU.YDS. ACRES
(�, LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Rey./Provided - E I
l 1-hereby affirm that I am licensed under provisions of Charter 9 (cortimencin9 Remarks: - Planning Notes: I - - Q
with section 7000) of Division 3 of the Business and Professions Code,and M i
\ my licenseis in full low aRQ effect. / T/
�h �s T
License 155 r C� Jf (� / Lice No. 'S '!7 $
L Date 5'rj Signature v - , O/Z?,.,.e...••- PLUMBING • FEES -
\. •
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
`V(• " hereby affirm that I have a certificate of consent to self-insure or a certificate •
f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink .
,800, Lab:C.).y / - - - Automatic Washer Transformer 0 15-50 KW-- -Poncy No, e`�I 9/A Company I SC:.--//C Backflow Irrigation Sewer CapConstruction Pole Sub. ❑ 50+KW '
Certified copy is hereby furnished.
Certifie copy,is f' th the city/wilding Ivis n. • Bathtubs Sewer Connection Cooking Unit .Meter ❑up to 100 amps •
ale r Applicant(y CAI tt � "0125.7',.•.)l
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher • Meter Dover 100 amps'
(This section need-not be completed if the permit is for one hundred ($100)or- - r ' '
less). Dishwasher - Solar Piping Dryers OGas DElectric Sub Panel '
I certify that in the performance of the work for which this permit is issued,I -
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan _
Motors 00.1 HP ❑1%-8
Workers' Compensation Laws of California.
Date Signature • Floor Drains 1'<• Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration, you should become subject to the Inc.Solar 0915 HP 016-15+
Workers! Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal '
comply with such provisions or this permit shall be deemed revoked. �O� - Fixtures - •Microwave— - ,
CONSTRUCTION LENDING AGENCY ' • • r Gas Service Out9CyJs Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance LVJ Pole Light •
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors 19! Water Heater Outlets Ran ¢
Lender's Name ✓�— g
Lender's Address Kitchen Sink VAAL Water Service Switches Sign OWNER BUILDER DECLARATION -•_ g r
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - (_10/_ut0-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap L.�L Trays.
any.structure, prior to its Issuance, also requires the applicant for such permit '�3`ChY Y Generator 00.5 KW 0515 KW Trash Compactor •
to file a signed statement that he/she is licensed pursuant to the provisions oft'Drains f' -
the Contractor's License Law(Chapter 9(commencing with Section 7000)of '
Division 3 of the Business and Professions Code)or that he/she is exempt - - •
'herefrom and the basis for,the alleged exemption. Any violation of Section -
/031.5 by any applicant for a permit subjects the applicant to a civil - - -
LIenalty of not more than five hundred dollars($500). -
I, as owner of the property or my employees with wages as their sole Reinspection Fee. I , $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered .— r -' -
•
for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL I Reinspection Fee $15 Issue Fee •
$ 3
FEE$
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 . , ,
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletlon, the owner will'have the burden of proving he/She did not build or im- Duct'-Under Ground ' I •
prove for the purpose of sale). — - Building Approved By l^t, �/ Date v`�
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System i Application Issued By - /V (/N. / Date 3/o /�
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property. who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES '
builds or improves thereon, and_who contracts for such projects with a con- - , ,
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0: System Repair/Alteration BUILDING PERMIT $ SMIP $ __
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK I $
0.1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO'# Fire Dampers •
PLUMBING $ OPERMIT ISSUANCE $ -5,49-0"
Date Owner. ' • Heating System & Ducting • Registers
• PLAN CHECK 25% $ ' ENERGY P.C. , $ • .
I hereby certify that 1 have read this application and state that the above ❑0.100,000.BTU 0100.000 BTL— GRADING $
information is correct.] agree to comply with all city-and county ordinances - ELECTR ICAL $and state state laws relating;to build' • onstruction,and hereby authonz repffr��qqgo-- I I PLAN CHECK 50% $ MICROFILM $• .
sentatives of;this,n y en ton the-above-mentioned pr p t '
inspection put /j/p
Signature (Y , • -e'j/--G+i✓ • Date MECHANICAL $ TOTAL FEE $ <� 0
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or,SS / �— -
CMF 0865-46,rev.10/84 White - Bulllding(Ca}narr yy`-Applicant;plPink -Accounting; Goldenrod -•Assessor - - - — -' - .. '
/CONSTRUCTION AND PLANNING POG. 4 SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
•
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure '70: Underground Hydro
22. Ducts, Ventilating 7E Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV, FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing crife r (EO
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. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Qh
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OF BUILDING:I 2823 TABAGO PL WIT: CITY OF COSTA MESA — BUILDING PERMIT
,DWNEWSYWEIF IQAIWN: TEIXEIRA, JERRY LEE PERM NO: B 073285
ADDRESS' TEIXEIRA, LAURIE A
2823 TABAGO PL PERMIT NO: B 073285 PLAN CHECK NO: N GOVT: N SUPP : N
' OSTA MESA,CA 92626714 ) 557-2912
AP PL.WRUNG ADORERS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OREI1GNEER: UC.NO.: JOB DESCRIPTION : T/OFF SHAKES RESTH & RE—ROOF W-40YR COMP SQ FT: 8, 225
ARCH.OR ENG.'S ADDRESS: LINT;
• CLAIM VALUE: 8 , 225 . 00 CALC—VALUE: 8, 225 . 00 GROUP OCC : R-3 /M-1
cONTRACTOWsNANE: LEE ROOFING ( 714 ) 642-7223
CCNTRACTOWSMNUNG 1653 SUPERIOR COMMENTS : SMOKE DETECTORS ARE REQUIRED AS PER U.B .C . 1991 .
ADDRESS: COSTA MESA CA IX.NOii 349686 ***+F********** -N-RE*****SE+t*it** -*x-*+E**IEIt***aE*BEBrN-******rt+EiE*Bt-+Ei ****rt* -** -x-BEBE+t**xx-**RE
92627 LRAM ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby adkm under penally of perjury tat I am licensed under provisions of Chapter 9 SETBACK S
(commencing with Section 7000)of Division 3 of the Business end Professions Cade,end my license Sin full force and effect.
c "0'028751 Lie.CLASS: C-39 UC.NO.: l 11•
1e EXP: 03/96 MAIN BUILDING ACCESSORY BUILDING
ale: 7 con s«:a /!‘_. • FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN
0 ER B DER •ECLARATION:I hereby affirm under penalty of perjury = I am exempt from the Contractors license Law for the
•wine reason(section 7031.5 Buskleas and Profco
Professions Code:Any • unly Whitt require a remit to construct,alter,improve, PARKING REQ: PRO V; PARCEL : 13933303 Z N E: REF NO:
-%smoleh,or repair any structure,prior to its issuance,also requires the 1 .limnt for such permit to fib a signed statement that he or she
4:;Jj licensed pursuant to the prmdsiona of the Contractors License La (Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES> •
Business and Professions Coda]or thel NI 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 live hundred dollars 1$500]). *.**3.*.5*..IE.***.*.********3.3+.1E.3+**3*3.*****{E.)(-.lE.1E****..)EN.******33+*******3+33*****SE*AP*.IE333****
❑ I.as owner of the properly or my employees yrith wages as their sole compensation,will do the won,and the structure is net intended DEVELOPMENT SERV ICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not appy to an owner of Properly
who buida or reproves thereon,end who does such work Nmsea or herself or through his Cf 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 BYDATE:
ownenbuilder will have the burden of proving he or she did not build or improve for thepurpose of sale).
-
❑ ProfesitnsCoodde::TeCCanthe prcperty,� Limvclusively eLaLawsolesnNotlappyyloan�ossw&pors to`�'the mien ysttobuasor poo.'v thereon Business
ano BUILDING APPROVED BY : DATE:
contracts for such projects with a cotractors)licensed pursuant to the Contractors License Law).
❑ tam exempt under Section: B.AP.a.for this reason: APPLICATION ISSUED BY: //O DATE : LSI ly---
. ********************** w.-. . . . ********** *
Date: Owner:
LEGALIZATION:N F E E SUMMARY STRUCTURAL S GMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health end Safety Code Sections 25505.25533,and
25534,and that I or any future building occupant will/will not(circle one)need to comply with said tate codes end the requirements for
a permit for construction or modification iron,the Ai Duality Management District.Residential connection applications are exempt fnom these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 108 . 00 . 82
Date: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally perjury one of the following dederatiws: PLAN
o I have and wilt maintain a certificate of consent 10 sell-insure for workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE
///w11••www Code.fortheperformanceofthewkforwtichthispennibbmd. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Ihve and wilt mental workers'conpetsation insurance.as required by Section 3700 of the Labor Code.for the performance the TOTALS----> 108 . 82 0 . 00 0 . 00 108 . 82 108 . 82 . 00
work for which this permit is rued.My worker'compensation insurance center and policy number are:
Carrier: STATE FLINT) EXPIRES REVENUE DIVISION TOTALS--> COLLECTED • 108 . 82 OVER/SHORT: 00
Policy Number. T �nnaa R-4� 06 /30/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need no be completed y the perms is for one hundred dollars($1001 or less.) 108 . 00 . 82
❑ 1 candy that in the performance of the wok for which this pemnh is issued,I shall not - • any person in any manner so as to
become subject to the workers compensation laws of Calfarn: and p:. `. I . Id become subject to the workers' ***************kik*********************************-**-***************************
mean n provie ns o .Section 3700 of the Labor •• ' . n on 'oae P• r s.
IND IV IDUAL F E E BREAKDOWN
7 51 4 5 Applicant: ..df -ii. ilit
Warding: Hum secure workers'compensation coverage a unlawfu nda Ii autJ.ct en ensployer to cr1nt/nsf penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fins up to hundred thousand dollars($108000),M addled• • the mat of compensation damages as provided for In
Section 3r%ohthe Labor Coda,Interest,and attorneys leas SFR 8225 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 8, 225 . 00
• CONSTRUCTION LENDING AGENCY:I hereby® tans under penally of perjury that there is a ocntruction lending agency for the END OF FEES
Performance of the sonic for which the permit S issued(Sande 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: p
I certify that I have read this application and tee that the above information Scorrect.I agree to comply with all city and county ordinances SMOKE DETECTOR
l
and state laws relating to building construction end hereby authorize representatives d this city to enter upon the above-mentioned properly
for inspection purposes. ('� F
�a BURKE REQUIRED
�tNa, 01 001336332-03186333 TOT 108.82
:air
Date DATE:
DATE: 07/18/45 TIME: 09.14
:„.:07.4r• ,IsirlicandOr.or
(5151-45.W2Z White-Building&Safely:GrewrFle:Canary-Appicanl:Pink-Revenue:0oldenr«4Asseae«
'CONSTRUCTION AND PLANNING , PO�_ & SPA
APPROVALS Permit # - Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit'Undrgrnd.
8. Foundation 59. Gas Pipe, U Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, b llndrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ( 63. Heater & Vent-Final .
13. Roof Drains 64, Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final '
15. Rough Electrical-Conduit f 66. Solar System-Final
16. Rough Electric Wiring I 67. Fencing & Access Approval ` 4
17. Rough Wiring Sign I 68. APPROVED FOR PLASTERING a
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing / 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 7_-20t1l w¢ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28, Lathing& Siding 77, FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. ANAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED , l
33. Final Electric Notes: - {
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38, Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 7..yq-q5 Gett
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
ZOWNER PAYNE, Joe DATE 7-28-71
}JOB ADDRESS 2823 Tabago ce UILDING PERMIT NO. 33456
-4 GENERAL CONTRACTOR Aluma Kool DESCRIPTION of WORK Patio Cover(sc.res,'ed)
AP No.139-333-03 LOT TRACT FIRE ZONE VALUE $ 900.00
INSPECTIONS Signature Date GROUP J TYPE IV ZONE R-1
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR - -
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER U
ROUGH WIRING Heating and Vent. _
TRENCHES fl FORMS U STEEL REINF.
FLOOR SYSTEM^
BOND BEAM J STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN Tl OUT 7
PLASTER, BROWN COAT
STRUCTURAL. FINAL Electric
HEATING. VENT., REFRIG. AND A.G., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
RIIII nlun FiNal ^tel /
i
PAI33456 JUL 78-71m7;.:002671i *•-*t9 ro
COSTA MESA BUILDING-SAFETY DEPARTMENT -
aP.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
J o RECE V BY DATE RECEIVED DATE ISSU D7
.--,-
BUILDINGDR ^ OCG / /T / 1A f0 t' / 7- 7 //
ADDRESS()JS /� �I [ 1� J�I/J00'/�-
OWNER J06 Y /'s pie A.P.NO. /39 �l.—
PER
TiJv'-
/� pp BUILDINGMAIL
�t
ADDRESS ,./ 0 A3 / it, /34 c� L, ADDRESS ,=2 112 1 ,Q/>;,
2
0 0 CITY re S iA N7tS A NO.Sei S-bF3J TRACTTOO O LOT BLOCK
Z Q CONSTRUCTION , / NEW ADD ALTER REPAIR MOVING DEMOLISH
O� LENDER /V Q�r /
am /�(
J D BRANCH
J N OWNER JmF 1:).9 y Ai i.-______.
m-I ADDRESS ///��� / VALUE
Jm ARCHITECT /R.
/inaccltie NELS`/2gy07 $��'-��
Q OR ENGINEER LI •
o N FIRE
/jam
za 3 3 R fig ZONE TYPE �Ge OU�Y/
W¢ ADDRESS �� �. u K LK/J
0 W �// ` APPROVED .tet ']
mZ CONTRACTOR AL UM a !\ 0 6 ` By
S)I / DATE 2 f 7)
JCC ADDRESS 37 io 3 S- ii, <( s-- /
W W ZON NO.OFa. USE OF G- -
Z F CITY L, /� , No`7vnv-iI 01 '/ PLANS BUILD! G 4 6A-u An
W-O STATE CITY YARDS APPROVED . YARDS APPROVED
LB O LIC.NO. (C O O 9 O LIC.NO/ 7/D i MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLOCS. / (FROM C/fL,�S"T�"RE )
OF LOT I NOW ON LOT FRONTc 6.1.442t FT.
USE OF �1 1
EXISTING BLDG. L LDL[ 4 $' )1"t "'67/94 A9€ R._S!DE -rO FJ. FT,
I— SIZE OF 7 NO.OF 11
Z NEW BLDG. 3/,r ROOMS / STORIES / L.SIDE I'-1fa FT. FT. Jr
Q EXTERIOR WALL ROOF /J /J
O COVERING COVERING /`7'L JM REAR /d� FT. .• FT.
J USE OF gUILDING A D WORK TO BeeppER ORME -% DISTANCE BET. BET.MAIN&
a /NSta-LL 4C, UM PA I-yo aJg2 MAIN BLOCS. ACCESS,BUGS,
CL
n
g W/ Y4 R/T �/cc ReaNLS40 r/r // VAR.*
/ APPROVE/Dy
I—
ca / / 2 A 2 tT- / ( APPROVED( r+
DATE / -- cve-W
O
UI hereby acknowledge that I have read this application and state
O that the above information is correct and agree to comply with
er all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of —
N the State of California. co
b
? I hereby certify that I am properly licensed as a contractor under SO, FT. - o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business E
VALUATION �.t m
and Professions Coda,Division 3,Chapter 9. PERMIT FEE $ / LZd N
/// D
Signature of YI0
m
Permittee $ PLAN CHECK $ —� E
`o
�/ ) LL
Authorized Agent /. 'lit \ TOTAL FEE $ 1 • LV-!!
Gdp di
J % � � :� � lb
Lo,t , /� t 1c
It'dCOSTA MESA BUILDING-SAFETY DEPARTMENT [ � 6 1969
P. ®. BAX 917 COSTA MESA. CALIFORNIA •I I4 f10E DEPT.
ar CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADUI
IDREss '
COSTAESA. CALIKORNIA For Office Use Only
Investes Investors Marine Inc. RECEIPT NO. I PERMIT NO.NO.
OWNER A fiC4C$0
MAIL - RE IVSD BY -. _DATE'ISSUED
ADDRESS 1600 W.Coast Highway I DTQ RECEIVED A-tee, I _DMAR 8 1461
CITY Newport Beach No.6655 BUILDING �/J
ADDRESS !llttt"'LLL �/
ARCHITECT Same TEL. 3 COSTA MESA. CALIFO IA . r-
OR ENGINEER NO. Ijrip<
ADDRESS FIRE I�
ZONE TYPE GROUP l',./.119,
CONTRACTOR Mesa Verde Builders, Inc. APPROVED
1653 Minorca Drive BY DATE
ADDRESS ZONING et,
CITY Costa Mesa ZONE /{ NO.OF USE OF NEW Z.9 3 • 'I�
AR PLANS .2-•""r.BUILDINNGGGa.lv1T�1 f_.9`...��,
LIC.NO. 181269 TEL Ki 9-0395 LEBCR"IPT`ION � . 4o u Cb —1-4-V,"1 7 $
OF LOT 98' x 108' NO. OF BLDGS.O
NOW ON LOT A.P.NO. •
USE OF YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
88TBACK LINE FROM 40 1 151 (CENTER LINE ST.) / O�� c`ll/—/•.
CENTER OF STREET / REAR YARD FRONT4/&FT.T L - •IN.
A
SIDE YARD I LEFT I I RIGHT 81 R.SIDE FF-T. IN.
DESCRIPTION OF WORK /'
L.SIDE •6 FT. ,� fJ IN.
NEW I X ALTERATION I ADDITION I REAR /7 FT. a—�i2 IN..
REPAIR I MOVING IIDEMOLISH I APBy �fl4 DATES —8-6/
SIZBUILDINGE W1500 sq.Ft.ROOMS 6 STORIES 1 ii.
EXTERIOR w*Sidin� ROOF Shap' �£ / ����
COVERING 6C S 4ucc I COVERING sing e •
USE OF UIL a ND ORK TO S PERF R ��� ,
ing a ami y rest enc garag: 1!
Model 550-AR
/� Attached garage 462 Sq.Ft.
I HEREBY ACKNOW GE THAT I HAVE READ THS APP•KATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT TILE AS VE IS COR CT AND GREE 0 COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORD ANCES AN STATE LA ULATING
BUILDING CONSTRU 10 / ' /�/� VALUATION
1 666 / J 4779 PERMIT FEE
SIGNATURE OF�A (I �)LiA 1 ) $ 6 01
PERMITTEE 666111 9
I $ PLAN CHECK $ /V 'E'
AUTHORIZED AG t5-9._ c
TOTAL FEE . Is.