HomeMy WebLinkAbout2413 VENIER WAY - Building Permits •
MF q CITY OF COSTA MESA •
o¢ ..t BUILDING DIVISION r
DEVELOPMENT SERVICES DEPARTMENT
, . L
° � , . PERMIT PERbta NUMBER //
"°s' B99-00148
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2413 VENTER WY Status: ISSUED
•
Suite: Applied: 02/01/1999
Vicinity: Issued: 02/01/1999
Parcel Nunmber: • 43914001 Zoning:
Applicant: HANSEN, DUKE.
Address: 00260 E.ALTON AV
Phone: 557-7440
SANTA ANA CA Zip: 92707
Owner: BACK BAY GARDEN H 0 A
Address 2413 VENIER WAY
Phone: 642-5777
COSTA MESA,CA Zip: 92627
Contractor: ROSS & BARROWS INC.
Address: 00260 E.ALTON AV
Phone: 557-7440
SANTA ANA CA
Zip: 92707 License: 327802 •
Arch : Eng:
Address: Address:
Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
REMOVE EXIST. BUR&REROOF WITH SAMSE ONE BUILDING UNITS 2413 THRU 2417. INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $10,396.00
Permit: $174.75 Claim Valuation: $10,396.00
SMIP Res: $1.04
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $175.79 •
PLANNING &ZONING
SETBACKS •
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 •
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
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 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.
W 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:
Canter: SCrc )l/0/a• Policy Number:
(This section need not be completed If the permit/s valued at 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 I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these v pFdyisi0ns.
Applicant Signature: �fi Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE,INTEREST,MD ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed.{,nder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lk.# 2-)2- ) 5i 02_ Class a C — 9
Contractor's Signature: --�/�� Date: Z — /— 5-
CONSTRUCTION
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 civ,l 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 t0 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 B,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 Q 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? ❑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 appernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ 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 0 No
❑ (If"yes",anach 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 t0 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.
Sign ture Of Legal Owner(s) Date
am i��-- z — ( -
And/Or Authorized Applicant Date
012LI. INSPECTION TYPE DATE RIALS COfE1 IBSPF'TION TYPF DATE UI1IDAl5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof � 5.-9f 7 210 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
•ADORESSOFSSICSO: 2413 VENTER. WY DST: CITY OF COSTA MESA - BUILDING PERMIT
°WNERSNUIEIEUIDym:COVINGTON WALTER T PERM NO: B 080287
Am2413 VENIER WAY
COSTA MESA,CA 92627 PERMIT NO: B 080287 PLAN CHECK NO: 04576-96 S GOVT: N SUPP : N
Apx.MAEhl0 ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
ARCNTTECT OAENDDIEER: LIC.NO.: JOB DESCRIPTION : REMODEL GUEST BATHROOM SQ FT: 2 , 000
ARMOR EN0.'S ADDRESS: WIT:
CLAIM VALUE: 2, 000 . 00 CALC-VALUE: 2, 000 . 00 GROUP OCC : R-3 /
CONTRACTORS NAME
CONTRACTORS IMAM COMMENTS : REMODEL BATHROOM
ADDRESS: UC g Ams'`��i!/iL&� D
NO: *********************lEikfEifiFitiEiFlkiFiElEiEfEiE1E1E1E1EiE1E1(•1ElEiElEif#1EN-1E1FiffE** mt VR
WIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim sada penny ci perjury that I em licensed under pMdona of Chapter 9 SETBACKS REQUIRED
.(commencing with Section 7000)d Divi bn 3 d the Business and Prolaadcm Code.and my kerne is n hA forte and Wed.
CITY UC.No.: LIC.CLASS: LC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
Date: Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
'OWNER BUILDER DECLARATION:I hereby affirm under penaky al perjury that I am exempt ton the Connate=License Law her the
dfowng reason Btthins and Professions Coda:Any a county which requires penile to tenant!.suer,improve, PARKING REQ• PROV: PARCEL: 43914332 ZNE: R2 REF NO:
m OScience,demolish,or repair any structure_prior Oa Science,also o requires the applicant for such perm) fib a signed statement that he or she 0
isliommipumnsritour
tMpwmmomeCaaassLiawLe.phopwo(canmsmwdhswialmoosoomiansdole PLANNING N TES> ENLARGE EXISTING BATHROOM- RELOCATE WATER HEATER INTO GARAGE
Business and Professions Code]or that he or she is exempt therefrom and the b®a for the aEegedtemente Anyvblmun of Semon > PLATFORM TO REMAIN IN CORNER & AT SMALLEST SIZE POSSIBLE.
7031.5 by any applicant for a penal subjects the appfcem to a dol penally of net more than free hundred dollars MSSOOD. *******************************************************************************
k❑ I.as owners theprwarty onnemplm*ea with wages as thee sale compensation,wa do the work and De einucboe isnd intended DEVELOPMENT SERVICES R E U I R E M E N T S
or offered tar or msale(Section 7044,Business and Professions Code:The Connectors License Law does not apply toanoaww d properly Q
who butt' proves thereon.and*to does such work himself or penal or thrmmh he or her own employees,provided that such
knpmvernew ars aawmdedafNredbseie.d,howessA"Ssvnpae
knmoMdb"Id"S1 asyemdodWildada ZONING APPROVED BY (j , G IL DATE: Uro—its
owner-builder will have the burden of proving he or the did not hued or improve for the pupate d sale).
p I.n ower of tha popery.em maven*tentrading wth licensed conpaaon m enmaaa and 7
Professions Code:The Contractors License Law does not apply. owner of. .. and who BUILDING APPROVED BY : DATE:
contracts fa such motet wth a coniadarts)%MISS puMuant a•
❑ 1 under 4 B.AP.C.,b•" 0 a. APPLICATION ISSUED BY: DATE: \4^ �—%&
Omer ,{{/E 1 Ow.w. A�. ******************************************** **********iF*********** * *******
LEGALIZATION: N F E E S U M M A R Y STRUCTURAL SEGMENT: Y
I do hereby that I am a d and understand the ramua ceps of CeMane Ream,end Salary Code Sectionsd — 25513.and
35534,and mal or anyan Mus Wading occupant A will/will red(dole one)need a amply with said matt codas and the emptrom these b
ape attprmnbctanpr modification daAiaaNyuan.MmwowM.ReskraNmmnxaprappimoroanaenpthom0we BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Provision.. PERMIT 62 . 25 , 50
Dale: Watt PLAN 40 , 46 SMIP/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby eon under penalty of penury one d ted labwir*declarations; ISSUE FEE
p I have and wit maintain a certificate ol c,onsent to sethinsure for workers'componential.=provided for by Siation 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE 'PLAN-CHECK TOTAL PAID DUE
Cods,lot the performance of the work for which the pence is blued.
❑ Ihave and wit manancompensation for
3703 al al
performance TOTALS > 62 . 75 0 . 00 40 . 46 103 . 21 103 . 21 . 00
work to which Sala permit Is issued.My waken'compensation Insurance cancer and policy number are:
Carer: REVENUE DIVISION TOTALS--> COLLECTED : 103 . 21 OVER/SHORT: . 00
poky Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This.«tion need not be completed l the pant a kr ore hundred dollen(stool orlon) 62 . 25 . 50 40 . 46
❑ 1 candy that in the performance al the work for with this pent Is iniad.I shag not employ any person in any manna o n l0
become obled to the wwkari cdnpenemien Mee d Camane, one agree dw e I Monk became sublet to the workers' *******************************************************************************
pompons/6m"miser""d iserSection 3700 al da Labor Code!shall forthwith comply with those motions. INDIVIDUAL F E E BREAKDOWN
Date: Appfita,t:
Warning:Failure to sum wad'ers'couansadon connive b unlearnt(and shall are$$den rwloyer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
dull fines w to one hundred thousand dollars($104000A In addilon to the coat of compensa0on damages es provided for In
Section 37oeofnaLabor Code,Interest,and.mmey »aaySFR 2000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 000 . 00
CONSTRUCTION el the LENDING fAGENCY: I herebyisis elder under 337 . perjury that ted b e ammrpion wiling agency for the E-`I,•`� END OF FEES
psrtormemw a work for which e Matti b issued(Section 3397.CH.C). Y/
LENDER'S NAME
LENDER'S ADDRESS: DATE7 51 ^ , i /
I candy that I have sad this appfatan and mate that the above kd ' is correct.I apse to comply with al city and coolyordiarces (�/ L//MMrIEY/.
and State laws*tang to building comuwwr and hereby auaoae awes of the awer enter upon the above-mrakand property
01 00218454-00218456 TCET 103.21
R C• . INGT DATE: 11/04/95 TIME: 09:29
k, ` Prvrt ...
\` �,�� Dere:
Signature of Owner/Agent/ ream
15151.46.WP) Whim-Building&Safely Green-Ala:Cavy-Appkcam:Pink-Retinue:Goldenrod-Assessor
• CONSTRUCTION AND PLANNING F _ & 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, D 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 71. Product Piping 0 Gas D Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
`�r�3
24. Roof Framing 73. Undergrnd.StorageTank DGas DOr t
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
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING •
49. Electric Release to Edison'
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
• ADDRESSWBLRLDOn 2413 VENIER WY um:: CITY OF COSTA MESA — BUILDING PERMIT
aniERaNAMEIFKNow%:COVINGTON, WALTER T PERM NO: E 080288
"mil: 2413 VENIER WAY
COSTA MESA,CA 92627 PERMIT NO: E 080288 PLAN CHECK NO: N GOVT: N SUPP : N
AWL.MNUNO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT
ARCHITECT OR ENGINEER: UG NO.: JOB DESCRIPTION : REMODEL GUEST BATHROOM SQ FT:
ARCH OR ENG.'S ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
CONBIACTORS NAME
CaIWACTORSMMLRIO COMMENTS : REMODEL BATHROOM ELECTRICAL RE: #B80287
ADDRESS: LIC NO_ 3E3Eib3E3E3E3E363E3E3E3E*********3E3E***43E3EiE****3E*******3E3f3EiEk3E3E3E******3E3E3E****3r****3E3E3E3E3E♦Eir****
um: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby alliin under penaly of perjury that I am licensed under provisions a Chaster 9 SETBACKS
(commencing with Section 7100)of Division 3 el the Business end Professions Code,and my license Is in led force and effect.
CITY UC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Dale: ContractorFRNT : FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT : FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby aflrum under penalty of perjury that I em exempt from the Connectors Ucense Law for the
following reason(Soaion1001.5 Business and Professions Code:Amur«county which nacres a permit to sommxd,altar,improve, PARKING REQ: PROV: PARCEL: 43914332 ZNE: REF NO:
demolish,or repae any structure.prior to is issuance,also requires the applicant for such panne to flee signed statement the he ache
is licensed pursuant to the provisions of the Contractors license law(Chapter 9(cmrnendng with Section 7000)a Division 3 of the PLANNING NOTES>
Business and Professions Code)a the he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
1001.5 by any eppkan for a garners subjects the applicant to a the penally of net more than fere hundred dollars(S5001). 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E*3E 3E 3E 3E 3E 3E****3E 3E iE 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 1E*3E*3E 3E 3E 3E*3E iE 3E iE 3E 3E iE 3E 3E 3E 3E 3E 3E 3E 3E 3E it 3E 3E 3E
go I,eaovneraltMpmemployees their sole compensation.T
r, do the wok and the structure u
tranaintended DEVELOPMENT SERVICES R E U I R E M E N T S
X" «offered for sale(Seonn7044,Business and Protest's Code:The Contractors License Law does na apply to n a property
opery Q
who beide«improves thereon,and who does such work Fi noel or herself or though his or her own employees,provided that such
inprovemrmre rd mended adhered for sale.ti however,the bwdtp«inprovenw es"Id"ANnone"es Of cnplaun.the ZONING APPROVED BY •v DATE:
owner-eider win have the bunion al proving he cc she did not bund or improve for the purpose a see).
❑ I.n owner a the property,ern exclusive},co«nang with Teemed contractors to carer MI the4. - ,v r.' rd
Professor Cede:The Contractors License law does not apply to n owner a. ..... . . .. .y . surd who BUILDING APPROVED BY : DATE:
contracts a such projects*eh a contractor(.)licensed pursuant to the `,-• .!�►
❑ Ian ad« B.aP.c.. . �, --..7110APPLICATION ISSUED BY: DATE: i-14 "__
Dee: f E W Owner: i� Et 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3f 3E 3E 3E 3E 1E 3E 3f 3E 3f 3E 3E 3E 3E 3E 3E 3E 3E 3E 3E 3F 3F 3E 3E 3E 3E 3E 3E iE ********4(**********lF�3F 3E 3E
Idohereby certify that Iamaware al and understand the requirements aCaliorniaHeath adLEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT: N
sway Code usn,Pews,and
2SS0s,ad Mal I«erry Iwun building aoccupant will/willrot(ace one)need to cant*with esuit sen codeses • •.. .int requirements la a
apermtfor construction amodrealon hen the Ai rrannagemern Ueda.Residential conercionappfoetbns ere tamp(from then BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 3 , 00
Data: Appraw: 50% SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby alhprosy m wider penalty of psy sir of the following declarations: PLAN
❑ Have end el maintain certificate consent to setu
4nse kr workers'can, a a
=memoir/1.m providedby Section 3100 ur Labor IUILE FEE 22 , 00
Code,lot the performance a the wok for which this perm is Issued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ endIhave winmanainworkers'compensataa
insurance.
Section 3700oftheLaborCode.atheperfomancealthe TOTALS > 3 . 00 22 . 00 0 . 00 25 . 00 25 , 00 00
work for whew the prem is issued.My waiters'compensation iwarce caner and poky number ole:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 25 .00 OVER/SHORT: . 00
Precy Number, BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(Thu*action need not be completed lthe canna is for one hundred Miss($t00J Or l.) 25 . 00
❑ I certify then the performance of the work for which this peaty is used,I sae not employ any perm in arty roan so es to
became"'bled to the wobn'carcenawian ben a CaMande.and agree rat e I .MUM beoone anbjea to the workers' 3E3E3E3E**3E*3E3E**3E3E3E3E3E***3E3E*3E3E***3E3E363E3E3E3EiE3E3E3Eit3E*3E3E***3E*3E3i3E3E3E3E7E*3E3E*iE3E3E3E*3E3E3E3E**3E3E3E*3E3E3E*
compensation provisions of Section 3100 of the Labs Code,I drag forthwith corny with those provisions.
Dale: Applicant INDIVIDUAL F E E BREAKDOWN
Wanting:Failure to scum warers'compensadon coverage is unlawful,and shall subject an enployer TO criminal densities and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($100,000),In addition to Eta cwt of compo sailor damages as provided for In
Section 3706 of the Labor Code,Interest,and attorney's fees.
ELE 2 FIXTURES, LIGHTING 1 ST 20 EA, 1 . 00 2 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under paraly a perjuy that then is e construction lending agency for IM ELE 1 R EC EP T/SWITCH 1 ST 20 EA. 1 . 00 1 , 00
pedormance of the work for(Mich this pane is bated(Section 5097,Civ.C).
LENDER'S NAME: END OF FEES
LENDER'S ADDRESS:
I certify that I have reed Me appfratim and Pale that the abase information is carnal ogres to comply with al my and arrny=Enema ��T T
end state laws rinsing to budding rnmuain and hereby authorize . .: . a this city to enter upon the above-mentioned property res• AiiF/1
for inspection $Lars e. OVING AN
"7
---- I '$t'L � Peri Name tea, Dale: A �/'V 0ATE:01 211/04/95218453 TINE: TOT9:225,00
` Signature a Owner/Sgent/'••SCTII , arm«
(5151'46.WP) Whee-Ruikip a Safely;Green"Fle Carry-Applcant:Rink-Revenue:Goldenrod-Assessor
w
f CONSTRUCTION AND PLANNING F _ & 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 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil '�
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,•,�
27. Frame and Flashing 76. Dry Standpipe t""'
28. Lathing& Siding 77. FIXED SYSTEM FINAL zsit-
29. Insulation 78. FIRE PREY. 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
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
• ADDRESS OF BUILDING: 2413 VENIER WY tRIE CITY OF COSTA MESA - BUILDING PERMIT
aIONERSNAME IFMNOM'NCOVINGTON WALTER T PERM NO: P 080289
ADDREss: 2413 VENTER WAY
COSTA MESA,CA 92627 PERMIT NO: P 080289 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.MMlMO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ALT
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : REMODEL GUEST BATHROOM SQ FT:
ARCH.OR ENG'S ADDRESS; WIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC : R-3 /
COMPACTORS NAME:
CONTRACTDRSMMUNG COMMENTS: REMODEL BATHROOM, PLUMBING RE:#B80287
ADDRESS: UC.NO.: *******************************************************************************
IMT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under Penally of perjury that I ern licensed under Previsions of Chapter 9 SETBACKS
(commencing with Section 7000)of D'maion 3 of the Birdmen and Professions Code,and my license bin full fate and effect.
CITY LIC.NO.: LIC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: CO1H1Hcof: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contrition License Law for the
fa/lowing reason Business and Professions Cede:Andy or aunty whirr requires a pert tocantrud,alter.improve. PARKING REQ: PROV: PARCEL: 43914332 ZNE: REF NO:
demolish,or repair any structure.prior to is issuance,also requires the applicant la such Remit to file a signed statement that he Or she
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code]or the he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a tial penally of not more than five hundred dollars P5001). **.*********irk*****************************.K.i**.N..SFSe*****it iE it***14******************.A.*
has owner tithe Property army employees wih wages asihei sole compensation.will do to wort,and the armature is net intended DEVELOPMENT V E L O P M E N T S E R V I C E S R E Q/� U I R E M E N T S
sale offered for s ]Section 7044,Business and Professions Code:The Contractors License Law does not apply loan Owlet of property M
who bolds or inproves thereon.andsuch who does suwork himself or herself or through his or her own employees.provided that such
improvements are not intended or offered for sale.It however.the building or improvement is add within one year of completion, ZONING APPROVED BY DATE:
owner'builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.as owner of the propend.am exdueivey conlradng with licensed contractors to • - ect( 044.Busi .s and
Professions Code:The Contractors License Law does nor apply • owner.e_arav o.builds a improv..I . .• and who BUILDING APPROVED BY : DATE:
contracts ler such projects with a contractor(s)licensed ours : to t- r I r
❑ Iem`es lot under �j B.BP.C., �1 -` _ , APPLICATION ISSUED BY: DATE: I '—A-1 —S'b
Date: E. 4 ' _I 6 Owner: ` r,;• / iF 1E lF iE if iE iE if iE if if iE iE if iE iE lE iE iE lE iE lE iE7f kif iE if iF irk if-iE if lE If-0E iE iE iE iE if-0F 3E iE iE iE if IF1F iE iE ifi41(-iF IE i(-iE iE iF iE irk iE iE iFif fEif iF iE iE iF**iE if
ISS LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N
1 do hereby cis iy that I am aware of and understand the requirements of rcle one)need Health and Safely Code Sedans 25 ,25533,and
8534.apermil�oraonetwctoion r ormodificattio from occupant i Ouakr mem Management Residential conswith said truction ad re exempt f�rom'hesfor
e BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Provisions, PERMIT 8 , 75
Dale: Applicant: 25% SMIP/NON-RES
PLAN
WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE 22 . 00
❑ I have and will!minion a certificate of oonsent to sethinsure for workers'oompentudion,as provkled for by Section 3703 al the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Cede,for the performance of the work for which this permit is issued.
ElIhave and will maintanworkers'compensaationinsurance.asrequired bySection 3700of the Labor Code,for the pedamarwedthe TOTALS > 8 , 75 22 , 00 0 , 00 30 , 75 30 , 75 00
work for whits this permit is issued.My workers'compensation insurance caner and policy number are:
Cada: REVENUE DIVISION TOTALS--> COLLECTED 30 ,75 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(ibis section need nor be completed I the pent is for one hundred dd/as MOO]or lessl 30 , 75
o I certify that in the performance of the work for which the pert is issued,I shall rat employ any penin in any manner so as to
become subject to the WASPS'wmpmsaion leve d California.end Agree the t d Mould become subject to the workac' ****************************************iE fE*i******iE*****************************
compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. INDIVIDUAL F E E BREAKDOWN
Dale: Applicant:
Warning:Falun to secure workers'compensation coven''.Is unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($104000),M addition to the coat of compensation,damages as provided for In
Section 3706 of the Libor Code,Interest,and attorney's less. PLU 1 BATHTUB 8 , 75 8 , 75
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this panni is issued(Section 3097.Civ.C).
LENDER'S NAME: '
LENDER'S ADDRESS:
I unify that I have read this application end stale that the above information is coned.I agree to comply with all city and county ordinances rMMrw,�-XPTR FF T/
andstatelaws relating to building constructionauthorize repreeenletiveadme Myroennr upon the above-mentioned property iRMXPJR sV
tor inspection purposes.
WA NGTO (� IAA)
01 00218451-00218452 TOT 30.75
I pi.
DATE 37 / 7 IAA DATE: 11/04/95 TIME: 09:28
vi Lia Dale:
Signature of Owner endAppttenuCo reap
1515td6.WPI While-Building&Safely;Green-Flee:Canty-Applicant;Pink-Revenue;Gofdenrod-Assessor
CONSTRUCTION AND PLANNING P� _ & 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 tII
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 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test •
72. Underground Flush 4
1.31
24. Roof Framing 73. Undergrnd.Storage Tank Gas 0 Oil 1 _
25. Roof Sheathing •
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - t
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL .
29. Insulation - 78. FIRE PREY. 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
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
Asscdated- .
frao Building Permit No.
CITY OF COSTA MESA
F if-St (If Applicable)
e PERMIT APPLICATION
a,O o 1
Project Address: '2_4 j 3 Y 4 I f — c` Suite/Unit:
I.D. No.: V3 b3 oS Plan Check No.: ❑ Legalization ❑ Gov't ❑ Supplemental
Purpose: (check one) Category: (check one) Permit Type: (check one)
❑ Addition X Minor Construction ,®. Building
❑ Major Construction ❑ Fire
6 Alteration Conversion j Electrical
❑ Demolition ❑ Mechanical
isk Plumbing
❑ Other
Grading Cut/Fill: cu. yds. ❑ Sign
❑ Repair
��) ❑ Grading
Job Description: yr) one L 9 D 3 trz=r "�( -
Occ. Type: Constr. Type: Stories: E2' Valuation: 2 sb-0 ---
Legal Building Owner: ( ..✓4-k-` C«- - i-tp Lp
4-2-ICA �/ f0.fq g� Phone No.: 7/ AcC3( 1 8
Address: 2-4{IS L4 t�C! � ! Unit:
City: Csra c 4- - trIn_ tA- State: 04- Zip: 2Z/„2-'7
Architect/Eng.: Reg. No.: Phone No.:
Address: Unit:
City: State: Zip:
PERMITTEE STATUS
❑ Contractor LI Contractor/No Employees ❑ Exempt
❑ Employer/Owner ❑ Contracting Owner ❑ Unassigned
/ Applicant: Phone No.:.
Address: Unit:
City: State: Zip:
Driver's License/Social Security No.:
•
CONTRACTOR INFORMATION
City License No.: State License No.: Class:
Workers' Compensation Policy No.: Expiration Date:
Insurance Company:
(See Back for Itemized Electrical, Mechanical, and Plumbing)
(5258-46 WP)
Riau A t 1-3/4, Ft,
ELECTRICAL
Qty. Description Qty. Description
.. Fixtures, Lighting Fireworks Stands
Recept/Outlet Misc Apparatus Not Listed Req Permit
Recept/Switch Pole/Platform Mount Light Fixt
Non-Res Appliance Not Over 1.0 HP Swimming Pool - In Ground - New
Res Appliance Not Over 1.0 HP Temp Dist Sys/Lighting
Services Below 600 V & Below 201 Amp Temp Sery Pwr Pole W/Outlets
Services Below 600 V& 201 - 1000 Amp Temp Work with
Sub-Panel Misc Conductor Not Listed Req Permit
Motor/Powr Apparatus 0.0 - 1.0 HP Misc Conduit Not Listed Req Permit
Motor/Powr Apparatus 1.1 - 10.0 HP Standing Section
Sign/Outline Light Sys On 1 Br Circ
Sign/Addln'I Br Circ Within Same Ea.
New Res Bldg For 1 Or 2 Units/Sq Ft •
New Res Bldg For 3+ Units /Sq Ft
Christmas Tree Lots Ea.
MECHANICAL
Qty. Description Qty. Description
Inst Forc-Air/Grav Furn <= 100 K BTU Each Appl Not In Other Cat Under Fee
Inst Forc-Air/Grav Furn > 100 K BTU Fire Dampers
Relo Forc-Air/Grav Furn <= 100 K BTU Inst/Rel Air Handl Unit 0-10000 CFM
Relo Forc-Air/Grav Furn > 100 K BTU Inst/Rel Floor Furn W/Ducting
Repair/Alt Cooling Unit/Sys W/Cntls Inst/Rel Suspended Heater
Repair/Alt Heating Unit/Sys W/Cntls Repair/Alt Absorb Unit/Sys W/Cntls
Inst/Reloc Recessed Wall Heater Repair/Alt Refrig Unit/Sys W/Cntls
Refrigeration System < = 100 K BTU/H Ventilation Sys Not Under Permit Ea.
Refrigeration System > 100 K BTU/H Inst/Rel Non-Portable Evap Cooler
Gas Piping Sys 1 - 4 Outlets Inst/Rel Boil/Compr 0.0 - 3.0 HP
Gas Piping Sys 5+ Outlets Per Outlet Inst/Relo Comm/Indust Incinerator
Factory Fireplace Inst/Relo Domestic Incinerator
Inst Hood W/Ducts Fed By Mec Exhaust
Vav Box
Ventilation Fan Conn To Single Duct
PLUMBING
Qty. Description Qty. Description
( Bathtub Sewer, Connection To Building
Dishwasher Sinks, Commercial Or Industrial •
Laundry Tub Or Washer Sinks, Floor
Shower Sinks, Service/Mop
Sink, Bar Urinals, Pedestal •
Sink, Kitchen Urinals, Stall-
Swimming Pool Urinals, Wall
Wash Basin Install/Repair Water Piping Equip
Wash Basin (Set) Interceptors For Grease, Oil, Solids
Water Closet (Toilet) Interceptors For Sand, Auto Wash, Etc.
Water Heater And/Or Vent Lawn Sprinkler System On 1 Meter
Water Service Rainwater System - Per Drain
Gas Piping Sys Of Outlets Repair/Alter DrainageNent Piping
Gas Service Vacuum Brkr/Backflow Prot. 1 To 4
Backflow Irrigation Water Re-Pipe
Backflow Preventer
Drinking Fountains
Floor Drains
Gas Re-Pipe
Sewer Cap/Demolition
• Sewer, Building/Trailer
(5258-46.WP)
.__.__......c.-and'slgn all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO.
•
CONSTRUCTION PERMIT E_—,;04/3 9567 12/16/BI 6.00 TU
Project Address •�Ll ` ' `/C.a.'. Ls(L ko a IA{ TYPE OF CONSTRUCTION '
OWnnfir 1. [1�.e4— Phone 64-5-- ;D•• NEW lig ADD ❑ ALTERATION ,
4 O VV 777 YYY
Address -‘0z..-P-1 g 0 REPAIR 0 CONVERSION ❑DEMOLISH ING REGULATIONS
Arch/Eng. _ L Y. I .l."w ` ❑ OTHER A.P.46
Address DESCRIPTION OF WORK
ZONE PLNG. REF.9i9
Contractor a � Phone TYPE OF PERMIT -UIL IN• TTpp BgU�1IL,p ING
Address 0 GRADING 0 FOUNDATION 0 STR CT R• 'L is YARDWA TB K /L ST. PRO PE RTV LINE
LICENSED CONTRACTOR DECLARATION 0 TENANT gELECTRICAL ❑PLUMBING ■M�1 I SIDE VAR•
I hereby affirm that I am licensed under provisions of Charter 9 (corn- RIGHT
mencing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, and my license Is In full force and effect. REAR VA P/
PROJECT DESCRIPTION
License Class License No. SPAC PROVIDED
Date Signature SO. FT. SO6 .ate
WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE T WIDTH PARK FEE$
I hereby affirm that I have a certificate of consent to self-Insure or a NIN APPROVED BY DATE
certificate of Workers' compensation Insurance, or a certified copy VALUATION ZONE
thereof(Section 3800, Lab.C.). GRADING CU.YDS. ACRES r1f CO;DITIONS:
Policy No. Company - __ _- _ - /
0 Certified copy is hereby furnished. REMARKS: '
0 Certified copy is filed with the city Building Division. p //��1 ! ////� prat
EXEMPTION FROM WORKERS' COMPENSATION DECLARATIO IC TAW.71-,`/v ZLO)
(This section need not be completed if the permit Is for one hundre•
($100) or less).
I certify that In the performance of t wo or this per it s
Issued, I sh711 note ploy any per jhr er as to be a PLUMBING PLAN CHECK -- ELECTRICAL PLAN CHECK
subjectDate (, f l�A/brk °mooSignature nzal�i or
W'/ GI d. 1 _ Ue tLLINb 6'RHGL __
7/�� BATHTUBS SHOWERS
NOTICE: If after making this declaration, you should become su.ject TOILETS URINALS GENERATOR 0-1 kW_1-10 KW
'to the W rkers' Compensation provisions of the Labor Code,you ust TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50 +KW
revoked.
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-) HP 1-10 HP
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+HP
formance of the work for which this permit Is Issued (Section 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES
Lender's Name
Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP t.UNS I KUB I!UN
Any city or county which requires a permit to construct, alter, POLES METERED SUB
. Improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB
quires the applicant for such permit to file a signed statement that he q
is licensed pursuant to the9provisions of the Contractor's License Law GAS SERVICE OUTLETS f.....- � /✓7"4 AMP
(Chapter 9 (commencin with Section 7000 of Division 3 of the
business antl Professions Cotle) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT
basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS
sole Compensation, will do the work,and the structure is not Intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE
Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY DATE '
through his own employees, provided that such improvements are not
Intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
is sold within one year of completion, the owner will have the burden
of proving he did not build or improve for the purpose of sale). BUILDING
HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP $
❑ I,"as owner of the property, am exclusively contracting with AND DUCTING o
licensed contractors to construct the project (Section 7044, Business 100,000+ BTU PLAN CHECK $ L`'� PERMIT
and Professions Code: The Contractor's License Law does not apply to ISSUANCE $
an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $
tracts from such projects with a contractor(s) Ilcesned pursuant to SYSTEM GRADING $
the Contractor's License Law). 100,000 + BTU PLAN CHECK $
❑ I am exempt under Section B.& P.C.for this —BOILERS BTU ELECTRICAL $
$
reason' MICROFILM $
AL-G2 I, I. Gavial . SYSTEM REPAIR,ALTERATION
PLANCHECK $
Date Owner aa �. TOTAL FEE$
I hereby certify that I have read this applicati.n and state that the ave EXHAUST SYSTEM MULTIPLE MECHANICAL $ .
LESS EAD-P
aciis to 1 a. t• • •plyru with all cityrand county -- PLAN CHECK $ VANCE PC $_
rersordinancesntaand st e re • o cons ru• ion,and hereby authorize
representati o t ci . enter pin the above m tio ed `^.
property f r I s ec .l ses. , C' FINAL FEE $
L
-- y �
Signature Oat
Z + /
Drivers' License or SS yt . — ISSUE FEE
.
CM
CMF 0865.46 White-Building;Canary-Applicant; Pink-Accounting:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL&SPA - •
r Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn 44. Steel Reinforcement
3, Electrical Conduit Utility-Undrgrn 45. Forms , `. . ', a .` ' : f�
4, Electrical Conduit-Undrgrn 46. Electrical Bonding
5. Steel Reinforce47. Rough Plumbing & Pressure Test
6. Electrical UFER Grn - : 48. APPROVAL TO COVER-GUNITE
7. Footings --.. 49.•
Electrical Conduit-Undrgrn
8. Foundation - - 50. Gas Pipe, ❑Undrgrn,Test
9. Water Pipe•Undrgrn - 51. Backwash Lines, P-Trap, 0 Undrgrn -
10. Structural Floor System 52. APPROVAL TO DECK
. 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final
12. Street Sewer Connection _ 54. Heater & Vent-Final
Rough Plumbing 55. Plumbing System - Final
1 .4. Rough Electric-Conduit 56. Electrical-Final
15. Rough Electric-Wiring - _ 57. Solar System-Final
16. Rough Heating & Air Conditioning 58. Fencing &Access Approval
59. APPROVED FOR PLASTERING
17. Ducts, in Structure _ _
18. Ducts, Ventilating __ / „ - -
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL - -
20. Roof Framing _
21. Roof Sheathing
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing &Siding
25. Drywall Nailing
•
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. - Final Electric `.
^9. Final Heating & Air Conditioning
•
). Final Gas Pipe-Test
-
31. Final Plumbing •
32. Water Service-Final
33. Gas Service-Final
34. Solar Domestic-Final -
_ 35. Landscape Sprinkling System .
36. Sound Attenuation - -.
37. Handicap Regulations
38, FINALSTRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY -
No Date
__...........r,u-nn'm'all'spaces within heavy border lines and sign all appropriate declarations.
'CITT,••OF COSTA MESA PERMIT NO. TRACT NO. ' LOT NO. BLDG.NO.
CONSTRUCTION PERMIT APs /3 3Z.33 % 383 ' a/10.21 261;036 Tl.
Project Address L.' �'� V 4� `
TYPE OF CONSTRUCTIONNS
Owner CQ A -�b,t•I Phone 0 NEW If�lADD 0 ALTERATION
'Address 24 ( '7J /c+ 41 et r2 wAl 0 REPAIR 0 CONVERSION ODEMOLISH ZONING REGULATIONS
Arch/Eng. License N0. ❑ OTHER A•P• -1- +- i`•f•j. Z
Address - DESCRIPTION OF WORK
n -
, ZONE ‘.. PLNG. REF.gie
Contractor C K Phone C.. r).�[E( TYPE OF PERMIT BUILDING TO Bl/11Lnop I NG
/ Oo SETBACK C/L ST PROPERTY LINE
Address - 0 GRADING FOUNDATION,4 gS57 RU CTU RAL SIO LEFTVARD
LICENSED CONTRACTOR DECLARATION 0 TENANT ELECTRICALLUMBING ❑MECHANICAL SIDE YARD 0
I hereby affirm that I am licensed under provisions of Charter 9 (corn-
mencing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, and my license is In full force and effect. REAR YARD(TO P/L) t/9
License Class License Na. PROJECT DESCRIPTIONIP
SQ. FT. ! �- PKG.SPACE REQ. PROVIDED
Date Signature STREET WIDTH PARK FEE$
WORKERS'COMPENSATION DECLARATION OCCUPANCY n3 CONSTRUCTION•�QTYPE Alf-"IV
I hereby affirm that I have acerci/icate of consent to self-Insure or a VALUATION ^�>V 9 LUNE ZONING APPROVED I814_,.. C `& DATE !fl.jet
certificate of Workers' Compensation Insurance, or a certified copy / _` / 1
thereof(Section 3800, Lab. C.). . GRADING CU. YDS. ACRES SPECIAL CONDITIONS:
Policy No. Company •
❑ Certified copy Is hereby furnished, . REMARKS: /
Certified copy Is filed with the city Building Division. �/ j�Fw H 1./J �Q.wl. 7 5Arc-
o
(This sectio •
EXEMPTIOn need notybeRKERS'completed if Phe permON DECLARATION
hundred lig
«S J c-r bet
��- '
($100) or less). (f rg 2 95 07-vor .
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 PLUMBING PLAN CHECK ELECTRICAL 0� or CHECK
subject to the Workers Compensation Laws of California. LLIrvb Rat v..:,HALaE
Date Signature BATHTUBS SHOWERS (� UWESO.FT. 417.0- FT 2.3
NOTICE: If after making this declaration, you should become subject TOILETS URINALS - GENERATOR 0-1 KW_1-10 KW
to the Workers' Compensation provisions of the Labor Code,you must ;
v/ TRANSFORMER .
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS 3 a APPLIANCE 10-50 KW 50 +KW
revoked.
CONSTRUCTION LENDING AGENCY KIT.SINKS - DISHWASHERS MOTORS 01 HP 1-10 HP
I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS - (INC.SOLAR) - 10-50 HP 50+HP
formance of the work for which this permit is issued (Section 3097
Civ. C.). - . FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES '
Lender's Name -
Lender's Address • DRINKING FOUNTAINS GAS TUBE SIGNS
OWNER BUILDER DECLARATION INTERCEPTORS . CLARIFIERS POLE LIGHTS
I hereby affirm that 1 am exempt from the Contractor's.License Law for •
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LUINSI HUL I IUN -
Any city or county which requires a permit to construct, alter, POLES METERED SUB
Improve, demolish or repair any structure, prior to its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB
quires the applicant for such permit to file-a signed statement that he •
is licensed pursuant;to the provisions of the.Contractor's License Law GAS SERVICE • OUTLETS 'SERVICE AMP
(Chapter 9 (commencing'with Section 70b0) of Division ;3,of the,
Business and Professions Code) or that he is exempt therefrom and the' WATER HEATERS BTU OUTPUT -
basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
of-not more than five hundred dollars ($500).
goe I, as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS • _ -
compensation, will do the work, and the structure Is not intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE
tContractor'shLicense Law does not apply wh to ansuch
owner a propertyifor €3 •-•-• APPLICATION APPROVED BY /�� DATE O�f /O/
who builds or improves thereon, and who does such work himself of ISSUE FEE ' ).';• Ji ( /!!! I J'-)
through his own employees, provided that such Improvements are not
intended or offered for sale. If, however, the building or Improvement MECHANICAL ,
PLAN CHECK ' ' SUMMARY OF FEES k�3
is sold within one year of completion,the owner will have the burden -
of proving he did not build or Improve for the purpose of sale). ,. BUILDING /' CIO
HEATING SYSTEM 0-100,000 BTU �� r PERMIT r (l SMTP $
❑ I, as owner of the property, am exclusively contracting with , •7• $
licensed contractors to construct the project (Section 7044, Business AND DUCTING ( '( PLAN CHECK $ 9S- PERMIT
100,000 + BTU 'r •, r Z y
and Professions Code: The Contractor's License Law does not apply to - ISSUANCE $
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU I • I PLUMBING $
tracts from such projects with a contractor(s) licesned pursuant to SYSTEM • •�) t,• . $ • GRADING $
the Contractor's License Law). 100,000 + BTU PLAN CHECK
❑ I am exempt under Section B.& P.C.for this / $
reason BOILERS BTU r ELECTRICAL $ ! �• 2� MICROFILM $
Date Owner SYSTEM REPAIR,ALTERATION . s PLAN CHECK $ -.
MECHANICAL $ . TOTAL FEE$ /2- 37
I hereby certify that I have read this application nd state that the above EXHAUST SYSTEM MULTIPLE LESS AD- '
information I orre . I • •. - y w th all city and county PLAN CHECK $ VANCE PC $_
ordinances a • s .t- tws elat • to constr cti n,and hereby authorize n�.n�1
representat v •f/ s ity/'o enter u•o the above menti ned eKaol ��
property •f Ind.yy4n .osek� �r1 ^^^777
Signature Date /-/ � FINAL FEE $74�•�
Drivers' License or SS - ISSUE FEE - /
CMF 0865-46 White-Building; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
CONSTRUCTI-ON AND PLANNING • - _-= POOL&SPA '-
APPROVALS Permit# Date Inspector APPROVALS Permit# ' • Date Inspector
4
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location • -
2. Soil Pipe-Undrgrn 44. Steel Reinforcement ,
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn . • 46. Electrical Bonding •
5. -Steel-Reinforce _ - 47. Rough Plumbing& Pressure Test
6. - Electrical UFER Grn - 48. APPROVAL TO COVER-GUNITE -
7. Footings 49. Electrical Conduit-Undrqrn _
8. Foundation . _ 50. Gas Pipe, ElUndrgrn,Test
9. Water Pipe-Undrgrn 51. Backwash Lines,P-Trap. ❑Undrqrn '
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer.Line-& House Connection _ 53. Backwash & Receptor-Final
12. Street Sewer Connection 54. • Heater &Vent-Final
Rough Plumbing j'r i2--/fe' F7 55. Plumbing System - Final
- 14. Rough Electric-Conduit _ -56. Electrical-Final
15. Rough Electric-Wiring 57, Solar System-Final
16. Rough Heating& Air Conditioning 58. Fencing &Access Approval
_ 17. Ducts, in Structure ., 59. APPROVED FOR PLASTERING
18. • Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
�_ 20. Roof Framing
21. Roof Sheathing
22. Frame and FlashingNOTES:
p
23. Insulation if fri - �„Tt:'ne5- 79vz4 ,' . .4.,- �:;r .re A-
_
_ 24. Lathing & Siding y AIM rfj/r.v.-to o 7z'r e✓i r, /4.• ca aFP,• /A-id -P' ..1 �
25. Drywall Nailing 5u..2 NO S �v •'i'- 1�+-�-� �-.' t-2-- t!1i--sivl
_ 26. Plaster Brown Coat r�
_ 27. Electrical Power Meter-Final - 1 Ne .Sc-a( on 62ret&GoctrcQ O F 0.s p-er U S•G.yr
28. Final Electric r- oaui✓.o,.,woh1s c-er LC Ito &.etee r Sk'et /9980 •
'9. Final Heating & Air Conditioning R 41 tx-a9-cj
J. Final Gas Pipe-Test -
31. Final Plumbing
32. Water Service-Final
_ 33. Gas Service-Final J)J
_ 34. Solar Domestic-Final ,/
_ 35. Landscape Sprinkling System 11YliU�
36. Sound Attenuation lift `
37. Handicap Regulations �,�
38. FINAL STRUCTURE& BUILDING
39. Special Requirements Completed f�
-
40. Electric Release to Edison }�1
_ 41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
OWNER DOYLE & SHIELDS Development Co. ,Inc. DATE 6-3-63
JOB ADDRESS 2413 Venier BUILDING PERMIT NO. 19722
GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 19,540.00
Nii
4r`1To. LOT 138 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Res.wJatt.gar.
IN PECTIONS Si nature DATE• GROUP I&J TYPE V ZONE R-2
Soil 7#9_,3 SUBCONTRACTOR PERMITS ISSUED
Gas . bl-le tv DATE NUMBERWater �l2JT _
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating /l1�„11" �3 _W _6,-
2 2 1963.3 _, :�
Rough Plumbing / i [3 �-�- - ;
Miscellaneous
Prop. Swr. Line:❑'House Con.lEeSt. Swr. ❑/14'5 //-416.3 I M 4.c2iz4i %_, /a=.23-6 3 y_ 2_415
Sprinkling System
Construction Pole
Underground 0 Power 0 _ _�7
Rough Wiring 2 � 63� , .f a7Q P.Kc _ • r 7
Trenches Forms --Steel Reinf. .❑ r zL,/ _
Floor System Ge- 11- _ I
Bond Beam 0 Steel Reinforce 0 / _
Sheathing /J a— _�o (�-3 - I •_
Frame and Flashing
7,p�fJ�/3 ,(l f
>M0g— In p� Out j / -7"—.."---.2-1
(,J,/�°J(\ _ 17
Ftr, brown coat "- •
j�
Refrig. 0 Air Con. 0 Final /� LI�{�
Heating, Final / "�' /- 3,-a A '�1
Plumbing Fixtures, Final - 2--6"-G9
V -r
Final Gas Test/r 2-I,=(,t/ r
Electric Fixtures, Final f a=3-Ch
Building, Final /011 .2.-C-04,
OCCUPANCY .. •rLr-n
•w z nI Irnr-aia
rtcTS
Form BU4-5M-3-63—S-B P 140733 :7_7 ^ .
" 9 E92 FEF RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT „a i. a ;1963
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APPLICA 1Fl €16RCIATAnMESA
TYPE OR PRINT BUILDING
BUILDING '] For Office Use Only
ADDRESS On, I -�Yv�'1)
RECEIPT NO. *F(tr 729
COSTA MESA. CALIFORNIA ` J fL/.J
R IVSD Y DERE EIV DATE ISSUED
OWNER Doyle & Shields Dev_Co_ ♦Tnr MAIL S - - 3 JUN m63
B DING �j�2 >
ADDRESS 831 So. Manrhaator Aye
^ REss A
TEL P•` - FIRE
ZONE TYPE V GROU-.,' /
CITY Anaheim NO. 2-8070
ARCHITECT TEL. 871- APBy DATE
OR ENGINEER Hai C. Tan NO. 2810
ZO NO.Op ZONING DP NE
ADDRESS 4100 W. Commonwealth, I� � 0��
Fullerton Puna „/ I BmLDU1 j A`
CONTRACTOR Same �'�"llv/�`� (/V
LEGAL Lot 138, Tract 34 3
ADDRESS Same DESCRIPTION
CITY Same A.P.NO. _
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE LIC.NO.151-250-B-1 NO. R 2-8020 30'TOSIDE RREAR P.L.
EAVES
OIF LOT 33 x 53 .50 I NO.OF CLOGS.
NOW ON LOT -
- ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. --
(FROM C/ STREET)
SETBACK
OP LINESTREET FROM `td\l
20.50' REAR YARD -- FRONT FT. FT.
SIDE YARD I LEFT -- I RIGHT _R.SIDE FT. FT.
DESCRIPTION OF WORK L.SIDE /0 FT. FT.
NEW X ALTERATION _ ADDITION REAR l� FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR _MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
BUILDING NO.OF'� VAR.Si DATE
SIZE 1x53 SQ ROOMS 7 STORIES 7 C.U.P.�1 S
� APPROVE
EXTERIOR WALL,.,_,_ ROOF APPRO + �3
COVERING SLAC WO COVERING COM BY_ 1.
DATE{ ~ r VV
USE OF BUILDING AND WORK TO BE PERFORMED
Residence w/attached garage
Model 42G
• 1833 SQ.FT�'
t70 is ' N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHUNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF E BUSHING A PERMIT PEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /3 d N
DUILDINO CONSTRUCTION. e t (� A PERMIT FEE $
SIGNATURE O& )' u�/_ r RIA104 I. / . I cy0� -a
PERMITTEE `�JC�U/'y l� ly afA {{{...fLLAWWN •1��Nf W -2/ ,S G
/-1 ri . �v $ / PLAN F E4K $ ✓ o
AUTHORIZED AGENT �1`�'J 44 .S� E
i _ TOTAL FEE $ / 7