HomeMy WebLinkAbout3273 WASHINGTON AVE - Building Permits"°'a��1' � "s1�3 ivASHINGiGN AL
°w"E4s"""E"'°kx'n: r�Cii, MAitIIN
�""�%% br"CK, SYEF�iil�N1E h
J"/.%S ivASI�ING'1GN AVi;
i;t)SCA MESA,�A �LGlti
AVPL. MAIIINO ADUNES9:
MCNIfECT OP EN�IEFA:
YKIL Ofl ENd'S �WflE55:
CONfNAtTqf4x��.
CONfPIttORS YYIdlO
AOOflE54:
urar:
Y'LVVU: AE"S�%
\7
�'
�
ua rb.:
UM:
IN. ND.:
uxr:
UCENSED COMR�CTOFS OECIANATION: 1 Mreby allim �Ms peealY d per�vy ihtl I em Ikwued wAer prwuiom d Gheqx B
IcwnmwinB wi�� Sanbn )000) W Gwion � tl Ue 8�9��e aq Pmleseian Cade. aM mY liaeme u in MI Mn md aMsa.
CITY IIC. NO.: LIQ CIAS& LIL. NO.: �XY �
Dete: ConUeen:
OWNEN BUILOER DECI�N�TION: I Iweb� elfirtn u� P�Y a peiWy tMl I em e�emq tmn Ihe CoNrtlan Liomea lew ta tM
INbvnq tm.tan (Setlun'l031.5 Busnma end Admipm Coda: MY uY a auuM/ xtith npu'vw e W�4 �o aqaWct. etld. inVwe.
Mmdsh. a eepai mry �wctwe. pnor b ia ewenoe. abu na� IM npp4m�a la ach pe�m! to Na a sy�ed aalenrm tlW M a�M
� W�� to IM pv.�'vims d ihs Ca4eaqM ��e lew �Chapx 8(cammercuq wvh SwCn ]000) tl D'xebn 3 d Ihs
nrcv ud Prdeaian Codel a �hm M a Ne u uN�q tAaehwn eM IM bem fa tlr eAped ummqion. MV vWetion W Srfian
r W I.5 by eny epplirent lar e permu aOpCa �M eppliceM to e tivi penaly d nal maa Ihen Ms huMrad do0aa �SSOpp.
❑ I. ai ovmer W iM AOGaM a mY emGM� wih wPBee m iMi eob mmD��ian. Mi11 Eo IM wark. ud tln sininurs e M inteMeA
«oneree �or ede (s«fw� �oaa. ausinen end arolaa�. cede: Tne camrmon �icem.lar aoee na roW �oen ownwa pop.�y
wM butlCe a inD�a� Ihereon, eM wM10 tlros �uch xvA Nmeell or henel a ihrpqM1 hw a hm own ampb�ese, qorided Ihtl wch
'mqwemeMe ve nd iMeMaC a dlseE Iw eNe. p, however. iM WiNirq n inqwemmt w wtl wnhin arY� d complstion. tM
owrier-0uildar xill heve iM buNm d qaviip M d�a dk rwi build a impwe la IM pupaa W ub�.
� I. n oxnee d �M V�W�Y. em e�d�*IY oonirep^G xM IicenseE canvecias io conefNtl tln pM� (Seaion MM. Bwiir� md
via..vme coan: rn. wivnan. licma. L.. d� �a eaW io en owne, d a. � �v �,o wfw « impme. ��ww� .�e .no
mMrecis /n wM MMeaa wdh e wMredals) IicMxE Wnuem to �he o ado oeroe lewl.
i.m�e q dr5ec+o�:liY�1144 B.dP.G..brNb sa� :' ' hlt Hl�1LLtlt
Dete: G ��:
anay uw i�,..� d�e �e«n�e me �a�«�am a cauo� �en.m s.im coa. s«a�. zsws. sss�a..w
?553�. utl Ne I a enV Mwe bWtliM � vnA / wa �M (acb ane) roW to mmVh wIM1 md pate mdef and iM npWr^m�b br
aG�lamnwctionnmoE6ralbnhumiMAisuei�y erepmrm0.v�ie.RoridalielmrutwunWO��+ena*emV�hanlMu
Dme: AVd�:
WORKEX'S COMPENS�TION OECLRFATION: I MrebY �� urNer perelty d perjury wr d �hs blbwi�q Aetleiatiom:
� I hew entl xi1 meintein e cenificma d conwnl lo sM�-inaun la xaken' cwnpenetlbn, ee povked 1a by 5qion 3)OO a1 the Lebar
Cade. l« tM parlmrerca ot Ne xvek Iw which �M1is pmmil n imuad.
❑ in....�a���m.:��no�s��o�oowu�o..mAw�awsw�arooa�i.escoa..n.meo�m.�w.am.
wak 1« MiiN Nu W� e 6aueE. My wrcken' c�pa�+dian insurarcs unier vd D�Y num Wr ero:
c�
Pd'ry Number.
nn earon msd �a bs cm�q�ed r ue w�+� b ror a+. n��w�ed edmn R�oo� w rm./
❑ I cenh IIW in Ne peefomiarca d tM work la wHch thu permil b ieweE. I ehetl mi smpby erry paeon in airy mvuw o n lo
bxane wbjetl to tM xorkera' mnpenWion W�n d CelManie. erd pree Net il I kauk Eecm�e wbpe b iM xvlmn'
comD�+a�ion pom'wo d Smion 3'!00 d tAe le� Code. I MM IaUvrilh oomVN tih Oma p�w�wn.
ow.: �ow�:
W�m/np: F�llun ro��cun worken'rorr�owvatlon eM�raW l� un1�wN1, �rW �hsll au�J�ct �n wlplayer ro crhNlul pwWllis �M
c/vll flrws'q ro on� hunOrM tMuurM dolbn (S10A�1� ��Itlon ro M� cwt ol rompwwfbR damepr u qovlWtl br In
S�cXon 9]GB ol Ih� Lebor COM, Infwst, �n0 �tfomlY i fss,.
CONSTqUCT10N LENDINO FGENCY: I haeby etFrM uMer parelry d perjury Ihet IMrs u e mnwrvdion kMinp ape�wy br Ns
veno"o�, a me won ia..n�e, ine o�� m ewed �smo� x��. cw. c).
LENDEP'S NAME
LFNOER'S �DDRE55:
I cantly tl� I heve �eed tlie eppGs�ian aM aeta Ilx� IM ebme udmretc� o canerJ. I eyes lo oompy wuh e� cry end opvtly ad'nmir
eM eteia lewe �almiq ia buJdiq cwmutlion md AeraEy eW�a¢e �epeeenieuvae dtM ciry io amx upon IM ebwa�memiorad papary
ta infpeqbn W�qnes.
MAit i. Fi ti: i�
rinl Neme
Dma: _� �_��
Sy /RpenUApp4enUConlreCor ��
(St51�de WP) W���itl'vq 8 Selery; OmerFb; Car�ary-Appiwn: Rnk-Rewnue: (3aldenrod-Aaseamr
CIiY �F CUs'iA MEciH - EUILliiNG i�1:riMI'i
rtKMI'i NG: P �u�v9G Pi,AN Ciif,Cii IVI/: N
I:VNS1KUl.T1VN �1'YYY.: V—N Y£}tM1T �lYYP.: f'LU
i'ERM hiO; P vis509G
liVVt: !V SUPI': I�
Yl71tVG:i�: UTH
JUb LhJl,2tIY'1'1VN : h/SThIVU GAS iINE i� rii'iC�itiJ S{Z r'i;
ILAlM VALUt.: I.ALC.�-�ALUC.: l�ttVVk' Vl.i.: lt�-�i 1
COMMENIS: X
It Yf f! x'.! X f! 1t ft fi f' 1("R!t x lt 1t'R x'R 1"�R lt f' 3t'R 1t x 1! t 1! lt 1�'F R lt 1t Y! ft 1! 1t X ft �F lt A"h ll' R'R'Rif'IR lt"IY'K'%!)t N lY x%t'ih R A"R'R'h h IY iF it A' 1t 1C A' T' A' it
i U N i N � R t, y� il i it "r_' M E 1v 'i 5
5 E'i b A C ri 5
------------ MAIN bZ111.LINli _______'_" ..'.'_"""'_ fll:Cli5:iU1lY uull,liiidi� -.-..�_._....._
rI2Nf: i�'T iN kL•Ak: F'I lN t'tllVl; 1�"1� lIV tir:llti: i� C IN
LEF7; r"Y iN i<Gii'i: F'I IN L�.r':i : r"i :iiv ii�ii i: r'i iN
PAnriINi; RE�: rkGti: PI�iiC:e:T.: 13�"v�6'v8 �1Vt;: It�:i� Ni�:
YLANhllNli NGii::S>
�
'R'R ft'R ft %t ft j! tt f�'A T"R'Jt lr'R R'%t ft ft'If lt lt �t 1' It lt )t 1t R lti! 1!'%t 1T T"%F i! lt x lt 1r 1tlt'R ft Yt lt 1! 1!'It ft YY'R fi'lY ft 1: lt IT' It'.! lt'/t 1l' 1! T Yt YY'I1' hY1 it iF lt'R'A' x jf
L 6 li t i ir Y M E N I 5 i k V I C r: 5" ii r Q u i R r; M fi N i 5
L11h31N1i AL'YItVVt.11 !1Y lil��lY.:
_"_'__�"�. �_"
NUlLLl la AYY1tVVt.L HY ; ' jj%�'ijy; _ _
AYk�LIi:ATIUN 1SSUEL aY: ' �'- J� #'
uAiL:
'RRftKfrlt'IE'Itf�"%l1�1t1ti!!t'X'lt%!'1llt'R'R1tNftT'w'R1tR9llt9F)tftlt'R�!'R 'R'R1tRat'Jtft'It'R'R%ltlth'hflA:F%tf�'A"/1'i\•'fiA'KA'!th'RK'A'9!f'ftftA'
iEGAiIZAI IUN: N F� L S U M M A« Y S C12Ui: i viiAL :ir:GMEN"i : N
&iL� PM'i rLUMbINi; . ELEi:'fRIC ME�fIANI� b'.iti'r. SMlY%111.5 iyiiAiiYNG
PEkMIT S.SV
25Y SM[Y/NON itP.S
FLAN .
1S;iUE F'F.E 11.VO
bUILuiN�-LiV-�> Pti2MI7 IS�UE FLAN=i;H�i:K Y�iAi FAiii �)iJE
TUtALs----> S.S"v 2i."vG G."vG "l"/.5G 2'i.5"v ."v"v
u'
t(EVY,NVG L1V151UfV 1VIALS--> CULLY.I.`l'EU: L7.SV VVtk(%:itlQ7(L: .VV
bLLG YMT FL�M61Nii �iEC'iRii: MECFiANIC i�.i�iii SMiYi'iiii i;RE�i:iiv� r[,AiV� Cifiiri
2%.�V
�
Yt 1E ft'It 1t %t f! f! 1! 9�'R 1t Sf j! i� lt l! �t'R f!'1! ft ft')t l� 1tlt'R 1! %!'I!'R'R 1�'R T f� %F i' 1!'It i�'R'll' Yt T If ft JF RYY f1' i�'/F YF i! f!'It�l' h'R 1t 1t 1! Yt 1�' R�' %t iY'll"k'R Yt Jt lt 1t ft')1'
I N U I V S U U!�. L F E �: b R r A K ti O W N
�l YYt. . ' ' ' ' _ •
[JlY L t S l!t 1 Y�1 1 V N� UNLI l'.1/:�l lUL[�� LVS1
b,
YLU j liAu P.IP.CNi; a1'S l.lt ,(' lll � I.IULI,N.��lj �.7V 7.�V
ENG: iir r'EIsS
9 p
Iu�G YnI1Y �p
f� I �0�98���%�00:19 ,vl�f�%.JO
(C
�P �'� �i1nl U `Cl
��•r,�r:��� �
v
PERptITDiBB 0196
CONSTRUCTION ANOPLANNING POOL PA
�� APPROVALS Permic # Date InspecEor AppROVALS Permit vk Date Inzpeccor
�• 1. Temporary Elecc.icai Service or Pole 52. Pool & Equ�pment Locat�on �
►
2. Soii Pipe-Undrgrnd. 53. Steel Reinforcement ,
� 3: Electricai Conduit Utility-Undrgrnd. 54. Forms �.
4.: Electrical Conduit�Undrgrnd. 55. Electricai Bonding '
. 5. SteEl Reinforcement - 56. Fough Plumbing & Pressure Test
�6� E�IeCirical UFER Gmd. " 57. APPROVAL TO COVEft-GUNITE
7ti Footings 58. Electrical Conduit�Undrgrnd.
6:. Foundation 59. Gas Pipe, O Undrgrnd., Test
9,� Water Pipe-Undrgmd. 60. Backwash Lines, P•Trap, CI Undrqrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK
11. Propertv Sewer Line & House Connection - 62. Backwash & Receptpr�Finai
12. Sewer Cap '.� - 63. Heater & Vent-Final
73. floof Drains 64. Plumbing System � Final
14. Rough Plumbing -• • 65. Electrical�Final
S5. Rou9h Electrical-Conduit '" - 66. Solar SYstem-Final
7.6. Rou9h Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS PINAL
79. Rough Heating & Air Conditioning L� ,_ �, _ FLRE� REPT..AEQUIREMENT
20. Rough Fac[orYFirapJace � . �. _ _, �- �. � APpqOVAL•�" ' Permit # � -
27. Dacts� in Structure' � " " _ � _ � � ° � 70. _�IndergroUn�i H�dro '�
22. 6uaS, Ventilap^9 •� F a•� S � `• .�, 77. Product �ping O Gas C� Oil •
23. �ies Pipe�Rough & Test �? � � �T! ' �L � � -, 7z, Undergrov�d FfUsN '
24. fioofJframing" ' J- '�- , l - 7 �.7� Undergrnd.Sioray�Tank��Gasy00it
25. Foof��6heathing �i �: v �•� !�. �ti _ - 'ti ! �q: Overhead Hydrei „ �
26. T;Bar.�Ceilin9 (Structurall & fNoaodoat � _ ' ' � 75; Dry Cher�icai -. - � � -"
27. �rame and� Flashing •. • � � 'r �• -� � 76. Dry Star�pibe ;, y - �..
.. x �y�
_ 28. Lathing &'Siding � ' y .�'�-1 y 4 - � � Ir 77:. FIXED SY$TEM�iNA! - -� -
29. �nsulation" _ ; �� 7g� fIRE PREV. FIN.4L 5
� 30. Drywall Nailing ;" _, � � , J,� . � �1EALTK,DEP�'. FEQUIREMENT
31. Plaster Brown Coat � � � T, �; i �� ' 79.� FINAL IfqSi'ECTIt7N � � . �
'32. @iectrical.RowerMeter-Fi�ai �� '` ' � '80sF00DCERTIFFCATEI�SUED� �
� � , , -
33. finaf.Electric . = � � �� Notes: =�� � � -_ -
' 34. Final ��Heai�ing & Air Con�litionin9 = _ ' � i' � '' � i- � ' � • �
�. r :O / 7 ' ,.92K. :: ;Jn:�b"'_. �LE�
35. final Gas Pipe•Test i� •� ! .� � �. - _ -� . � +^.
- �
36. Hood'pr Canopy ' � . '_ � " - � ' j! •- �.� ` _ "
ti
37. Final �Factgry Pireplace :. - - - . � - . ' "
.- 38. Final Plumbing ` ' ./ z��� _ ' � ' - -
(_
39. WaterService�Final , - � _ � .
40. Gas Service�Final - ' - ' � : i�� - - '%
l _
47. Solar pomestirPinal;� � - ' � - = j • - -
42. Backflow Preventer • ' ' � � � . ' �
43. Backflow Irrig'ation . :. "� � � -
44. Landscape Irrigation System - � ' � � _ = ._ � � �
- 4 " -
45. Sound Attenuation � ' . ' � ' -� � . _ ' ,n ;�
46. Handicap�Regulations - � ' - - - ' -
_ , _ _ '�
47, FINAL STRUCTUR� & BUI�OING _ . . � -+
48. FINALPLANNING - - � - � - :�;'
49". Electric Release to Edison � - , � .`�'�`�'
' � -',i'+
50. Gas Release to Southem Califomia Gas Co - - "' =' - -_ ��
51. CERTIFICATE OP OCCUPANCY ' � - ' - � . �
No. Date
ppolicant to flll in all svaces ezcept those wflnin heavy poreer tlnas anE sign all aooropriate aeclantions.
CiTv OF COSTA MESA COIVSTRUCTION PERMIT
Project Address N"� �
Applicant's Mailing D�.�.ac< {� ��D+. ��13 C�L�NI�}
Owner's Name ��� �T�� Phone " °i6
�ndd�ess ��,•-13 WASNiNGiDN COS7b U1ES��
Arch/Eng. M1��Rp 1���-oD2��T License No. �,�5���
Address a - T � � � '.,,.., ,�'C�
Contractor's Nam �� a �� �� P one ��f.,t
Address (mailing) P 0 W� ��13 ��"R��� � �t �,.
Ciry License No. _��1� � �7-
LICENSED CONTaACTOR OECLARATION
�h¢reby altirm �nat I am IlcenseE untlar piovisions ot C�arter 9(commencing
'with section �000) of DIvlSion 3 01 tne B siness antl Profe55ion5 Cotle, antl
my Ilcensa Is in i II iQ'yrce antl eftoct. 1 -��_
LiCOn CId55 � 1/ • MCII� V'�\
l7are � 6- �7 ',Si9nature —
WORKERS' COMPENSATION DEC RATION
I hereby at(irm tnat 1 liave.a certiilwte of consent to seli-insure or a certificate
vf Wo�ke�s' CompenSaYon Inswance, or a certifietl copy thereof ($ection
1800. Lao. 2j ��r g`.' s-��,TE �M�j .
Po' No. � �V COmpap
Cer[ifietl coOY Is nereby furnishetl. �
Ce ifietl co is /ilea with the city B i i ' cie .
Date �1' APPlicant
EXEMPTION FR M WORKERS' COM NSATION DECLARATION
(Thissection neetl not be <Omple[etl il [n¢ permit is for one huntlretl (5300) or
less).
1 certlfy tnat in Ihe p¢rfpleildnce Of tI1G wOlk fOr which [his perm�t i5 iSSuetl, I
snall not employ any pe�son.in any marine� so as to become subject to the
Workers' CompensaUon Laws of Callfornia.
Oate ' � Signature
NOTICE: Il, atter making t�ls tletlaration, you shoultl becoma subject to the
Workers' Compenwlion proWsions of the Labor Cotle, you muit brthwith
comply with sucn provisions or inis permlt sha11 be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a1/1rm that tnere Is a constructlon lentling agency for the oerformance
ot the work for whiCh thi5 permil is ISSu¢tl (SeC[ion 309] Civ. C.)
Lentler's Name
Lc�tl¢�'S Adtl!¢55
OWNEf3 HU1lDEN UECLARATION
I hereby affirm that I am exempt from Ihe Contractor's Licensa Law tor the
/ollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or
county w�ith reqWras a p¢rmll �o conrt�uct, aller, {mprove, Uemolisb o� rapalr
any structure, prior to its Issuanca, also reqWres the applicant for such permit
f0 tlle a Slgnetl Sldt¢menl tllat h0/ShG IT IICenSCtl pufsuant tOlh¢ PrOvisions of
the ConVactor'S Licensa Law (ChaO�er 9(commenUng wiN Section 7000) ol
Olvision 3 0l lM1e Bu5ine55 antl Prolession5 COtle) Or [hat ne/she is exempl
therefrom antl lite ba5i5 fOr [he allogetl ex¢mplion. Any violation of SeCtlOn
7031.5 by any applicant tor a permit subjects the apDliwnt to a civil
�enally ol nol more tnan five nuntlretl tlollars �5500).
LJ I, as owner ol thn prOparty Or my ampl0ye85 with wagCs as tneir Sole
compenSaUon, will tlo the work, and the sirucluro is not intentletl or offeretl
for 5ale (Sectlon 7044, Business antl Pmlessional Cotle: The Contractor's
License l.aw tlOeS not applY �� an owner O/ a propnrty uMo bulltls or imprOv¢5
tnereon, antl wno aoes tu<h work bimSCll/Itersetl o� Ihrougn h15 or ne� own
employees, provldetl Ihat such imOrOVCmenls are not inlentl¢tl Or olfered for
sale. If, nowoveq tna bulltlln9 or ImD/overtf¢nt b SOItl withln one y¢ar Ot COm-
pletion, tne owner wlll hava thG burtlen OI prOving ho/she tlltl not builC or im�
prove for tho pu�poto Ot salo).
❑ 1, a5 owner ot the property, am excluslvely contracting with Iicensetl wm
Vactor5 to consV uct lhe 0/oject (SeCtion 7044, Business dntl ProfeSsionS Cotlo:
The Contractor's Li<ensc Ldw dOes nOt apply lo an owner of property who
builtls or improves theroon, antl who conVactS fo� such projacti witM1 a mn-
tractor(s1 ucensu pursuant to the ConVa<tor's License Law). 1 am aware that
proof of their Workar'S Compensalion insurance shoultl be p�ovitletl to me.
❑ I am exemo� untler Section B. & P. C. for this reason
Date Owner
I hereby certity Ih 1 have reatl this aoP�icatlon antl state that the a0ove
informatlon is rre . I agree lo comply with all <ity antl county ortlinances
antl state laws I � g t0 builtling Cons[ructlOn, dntl hereby au[ho�ize repre-
sentatives of ty to enter upon above-mentionetl property for
inspactlon pu
Signature oa�e YII��Y%
Drivers' Li<e se or SS �
}3 Z'l i $ 8 � (y � ,t _.
TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
�NVERSION ❑ DEMOLISH � OT=H�S'-SiF� %� I'��Ui A�P� � � �
DESCRIPTION OF WOFjjC/USE OF BLDG.
L�E-T K C S Main Building:
E
TVPE OF PEHMIT GRADING FOUNDATION STRVCTURAL T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rfaf
❑ OTHER A
PROJECT DESCRIPTION 5q. FT.�%� OCCVaa v C Rig
S ett
CONSTRVCTION TVPE VA�UATION 5
20rvE GRADING CU. V�S. ACRES p��g, Ref. #
aemarts: Planning Notes: /
Sink
Preventer
Clarifiers
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceprors
Kitchen Sink
Lavatories
P-Trap
Roof Drai
Reinspection Fee
Struc�ural
S15
Exhaust System LJ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ductin
❑o-ioo,000eru o,000
Fee I S15
CMF 0865�46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goltlenrotl - AsSessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimm' Pool w/Spa
Water Heatel�
Water Service
Auto-Wash
Laundry Trays
Isue Fee
Hood or Type I ❑
Canopy Typ211 ❑
FEES
C
Washer
m PoleSub.
Dishwasher
Dryers ❑Gas
Fan
F,A.U.
Fixtures
Device Boxes
�uIICLS
Switches
Garbage Dispoul
Genereror -5 KW
Fee
4128
- Zone
Accessory Building:
i� �
U�
/�l
ELECTRICAL
Transformer ❑ 75-50 KW
❑ 50+KW
5 KW
§15
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel
Momrs�0. P�1Y.-8
Inc. r �9-15 HP �16-15+
icrowave
Light
Fange
Sign
Standing Section
Trash Compactor
luue Fee
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning ApProved By
Building Approved By ��� -�✓
41o7F TL
FEES
5 3
Z
O
N
1
N
G
R
E
Q
M
T
S
❑0.100,00 U ❑100,0008TU SUMMARV OF FEES
BUILDING PERMIT $ �S • 00 SMIP § O• S G
S m Repair/Alteration � � 6 ZS
PLAN CHECK $ PERMIT
Fir ampers PLUMBING $ �SSUANCE S
Registers ENERGY P.C. $
PLAN CHECK 25% 5
ELECTRICAL $ GRADING 5
- PLAN CHECK 50% $ MICROFI�M S
MECHANICAL S TOTALFEE 5 4J . TS
IsueFee PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date I�spector
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.
B. Foundation � ' 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O 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
78. 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 77. Product Pipinq O Gas ❑ Oil
23. Gas Pipe�Rough & Test � 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & 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. E�ectrical 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 f
39. Water Service-Final •
40. Gas Service-Final �
r
41. Solar pomestic-Final
42. Backflow Preventer '
43. Backflow Irrigation
44. �Landscape Irrigation System �
.
45. Sound Attenuation �'
46j Handicap Regulations u�y' Q��
47"s FINAL STRUCTURE & BUILDING . � �0,3 / �SU�� 1�
48:_Special Requirements Completeq "�
� '�
49�. Electric Release to Edison _ \
50. Gas Release to Southern California Gas Co • ,
51. CERTIFICATE OF OCCUPANCY •
No. Date � � r �
- . �
� .
.
fi�:±�i^r�/�ifCn: �la� a.i
ZtiIS AC�tEEt+�NT, made and entered 'into this ���3 � day of
. 1�, by arrl behueen � ,,(j�Q ' � �: l .��'i�
hereinafter referred tn as "LAND O4dIER", and �%� ��G�Q �
hereinafter referred to as "AA7ACINf PROPEKIY CWNIIt".
It is hereby agreed that a party �rall will be constructed on the
prcperty line behaeen -� �p9 �- 3 Z.�]3 �%��VT'/i(/�rl�/Cf �/
(Ar3dress of Adjoining Properties) ;
�05�� .GIL��.�9� �'.¢ 9�6a�
in the City of Costa Mesa, Coimty of Orange, State of California, as per map
recorded in Book , Page of Miscellaneous Maps, in the office of the
Coimty Recorder of said Co�mty. Zhe party wall shall be permitted tn encroach
IN WIZNESS �EOF, the parties ha.e entered into this Agreement the
day arr3 year first abwe written.
LAND QdNER
����� �
(Signat�re)
}�o f3rR z �_ ��aa�s
Name ('Iyped or Printed)
���Cr I�/�SN 1NG1oN r-tU
(Address) C�STf} !�'i �S !+� � r
y� �a�
. � . .�;� • � • •� •
� • ' ' �
�.= _!%•�_
, _
� - ♦
.-.. =.
/S-�D ���`��i� �D�zr%
(Address )� a> ���/ �� � � J ., /
�!c_iI/ l'b�'y(o
(NOTE: Please see reverse side for notaiy's statement)
�\ I
T '
r �
_,
i� . •
� ,
� STATE CF CAi.IFOR9IA ) .
� -� ) ss.
�; OQIN'IY CF ORAN(£ )
r � rtarch 16, 1987 before me, the imdersigned, a Notary Public in
and Sor the Co�mty of Orange, State of California, personally appeared
� �ROBERT B. COATS and WILLIAM R. GOLD - - - - • -
.
rovec�to me�o�th� basis of satisfactory evidence -
amc e person(s) wh�e name(s) is subscribed tr� the within
instnurent ard acknaaledged to me that �/they) exeasted the s�ne.
WI7NESS arc] and_ ficial seal. (SEAL)
OFFICIAL SEAL
' c� � e �'�GGY J NICHOLS
p m ' NOTARY PUBLIC - CALIFORNIA
^.".A�GE COUNTY
PeKKv J. Nichols Mv r'sar�, azpires MAY 10, 1988
Name (typed or printed) �-�_ =.�-
STATE CF CALIEUIBJIA )
) ss.
OGUNTit � ORANC� )
[�1
before me, the �mdezsigned, a Notacy
Public in and for the Coim ty of Orange, State of California, personally appeared
)mown to me to be the person(s) whose name(s) is subscribed tn the within
. i
instrument arrl acknowledged to me th8t (he/she/they) executed the sa�cie.
WIZNE55 ny hard and official seal.
( S icy�a tise )
Name (typed or printed)
(SEAL)
�
Avp���ant to iill In a1l s0aces excev� ihose within heavy boraer Iines ana si9n all appropriale tleclarations.
CiTv OF COSTA MES C NSTRUCTION PERMIT
Project Address � �Sh � T�
Applicant's Mailin Address
Owner's Name ��� �'�� Phon��
Addreu
Arch/Eng. License No.
Address
Contracmr'sNam E � Um phone��
Addre551mailing) ��3� ��1 �1/Vl�DLAJ
Ciry License No.
LICENSED CONTRACTOR OECLARATION
I hereoy attirm that I am licensetl u�tler provisions ot Charter 9(commencin9
with sectfon ]000) ot Dlvhlon 3 ot the Business antl Prolessions COGe, antl
my licenso is in full fo� an�t ffect. /J
Licnn e �' �n/�� �"�" licR�n�a�w�� �N�oP,,,,�/���5�
Date �' S'9 t �LI � �Al'-'-.1-c"""'
WORKERS'COMPENSATION DEC�RATION
I hereby affirm tbat 1 nave a certilic. te ot consent to selbinsure or a certHicate
ot Wo�ke�s' Compensation Inmran�e, or a certifietl coOY thereot ($ection
3800, Lab. C.�/'��T ��nU�� �� e
Policy No. _t U �� Company �� J
�Certitietl copy is hereby fumished. `
CerUfl op� i i with the citY Builypiqply�Sior�. n�f��
AOPlicanl N/S 6��-��
EXEMVT ROM WOqKERS' COMPENSATION DECLARATION
on neetl not be completetl �f the permit is for On¢ huntlretl (SI00) or
lessj.
I CCIII� � �[ IS �SSOCd I
sha emplOy any p¢�Son in anY manner so as to beco�ne Su t�e
W kers�Cop4pengatjqrh�ldw5 Ot Ca���Or�a�J /, /, AA. _ . � i
Workers' Comoensation o�ovisions m tne Laoor Coae, you must rortnwitn
comply with Suth prOvi5iOn5 Or thi5 permit shall �e Gt¢m¢tl revOketl.
C�NSTRUCTI�N IENDING AG�NCY
1 hereby a/flrm that there Is a constrU�tion lentling agency for the perlormance
ol the work tar which [nis Oefmit is Issuetl (Sectlon 30B] Civ. CJ
Lantler's Name
Lontler's HUtlress
OWNER BUIL�E12 UECLARHTION
I hareby alllrm that I am eKempt lrom the Contractor's Llcenso Law tor tho
lollowin9 reason (Sactlon 7031.5 Business antl Professional Cotle: Any city or
county which reqWres a Oermlt to Gonstru<t, alt¢r, Improv0, tlemolish O/ /opal�
any scructure, prlor to its iszuance, also requires the applicant Por sucn parmll
to ti�e a slgnetl statemont tnat ne/spe is Iicensetl pursuant to the provisions of
ihe Contractor's LI<ense Law (Chap�e� 9.(mmmenting with Sactlon 7000) ot
Dlvision 3 0l tba BI151l1055 antl Profess�ons Cotle) or [hat h0/ihu is exompt
therchom anC the basi5 /or the allege0 exemptlon. Any vlolatlon of Soctlon
]031.5 by any applicant ror a Vermit sub)ec[s tha apP�lcant to a civil
�enalty ol not more tnan live buntlretl tlollarz (E500).
I, as ownor of tba pro0erty o� my employees witb wages as their solo
componsation, will tlo tho work, antl the structura is not intentletl or oiferatl
for sale (Saction 7044, Business an� Prolezsional Cotle: Tho Contractor's
Li[anso Ww Cocs not apply to an o�+'�¢r o� a prope�ty who �ulltl5 or ImprOv¢5
thercon, antl wlto tloes such wOrk himzetl/hersel( or lhrough his nr hor own
employ eas, provitletl that SUCh impfovements are not inlentlotl Or oHoretl �or
sale. II, howeve�, lne bu110ing or Irt�Prov¢ment I5 soltl wlt�in ono yaa� ol com-
plelion, IM1e ownor will have lh¢ bu�den of provin9 he/Sh¢ tlid nOt bulltl or Im-
prova lor lha purposc ot sala).
❑ I, as own¢r ol lhe property, am exclusively conl�acling wlth Ilcentetl GOn-
iractorsto construct tna o�oject(Settion 7044, Business antl Prolessionz Cotle:
The CoNractor's Llcense Law does nol aOP�Y to an owner ot pwpmly who
builtls or improvez tnerean, antl who contmcts lor zuch projects with a con-
tractor(zl license pursuant'to'tn¢ ConVattoi's Llcense Law�. I am aware that
prool o( Itteir Wo�ker'S Compensation Insuranca Shoultl �e provl0etl to ma.
❑ 1 am ezempt un�er Section B. 6 P. C. �o� Ih6 reason
Data
I nereby certily [hat I
Iniormatlon is correct. I
antl sta[e laws relating I
Sentatives oi lhis tlt
InSpection pur .
Signature �-
Drivers' License or 55 �
Owner
[nis application antl state that tne above
omply wltn all city antl co�nty ortlinances
constructlon, anU hereUy autho�ize �epre-
UPon tne abov¢-mantionea vroperty tor
TVPE OF CONSTRUCTION LJ NEW L-� ADD U ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORKIUSE OF B�DG.
TVPE OF PERMIT U GRADING LJ FOurvDATION Ll SrRVC7uRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. FT. oCCUaANGv_
CON STRUCTION TVPE VALUATION $
ZONE GRA�ING GU. VDS. ACRES_
Remarks:
3ackflow Preventer
3ackflow Irrigation
3athtubs
�larifiers
7ishwasher
�rinking Fountains
=1oor Drains
=1oor Sinks
3as Service Outleu
Intercepmrs
Kirchen Sink �
Lavatories
P—Trap
Roof Drains �
Reinspaction Fea $15
Dutt - Under Ground'
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blc ICBO #
Heating System & Ducting
❑ 0. 7 00,000 BTU � 100,000 BT
Rainspeetion Fee � $15
CMF 0865�46, rev. 10/84 White - Builtling; Canary - Appliwnt Plnk - Accounting: Goltlenrotl -- Assessor
Showers
Service $ink
Sewer Cap
Sewer Connection
$olar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
AUtO•WeSh
laue Fea
Hoodor Typel ❑
Canopy Type II ❑
Refrigeration System
❑0.100,000 BTU ❑100,000 8T
System Repair/Alteration
F ire Oampers
Registers
laue Fee
FEES
$ 3
$ 3
A.P. qW
S Main Bu
E
T Front
B Rear
A
C Right
K �eft
S
Ping. Ref. #
Planning No'
Auromatic Washer �
Conslruction PoleSub.
Cooking Unit
Dishwasher
Dryers OGas ❑Electric
Fan
F.A,U.
Fix�ures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5�15
14D2 12/II/87
Zone
Accessory Building:
Parking Heq.IProvided
DNOV 3 � t�
nirn nrr _ 4 1t
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over 100 amps
Sub Panel
Momrs 061 HP �7 X- 6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
� Rainspection Fee �$15 � � laue Fxe
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approvad By /��
Appliption laUed By / /��_
5o0U TL
FEES
$ 3
SUMMARV OF FEES
BUILDINGPERMIT $ SMIP $
� PLAN CHECK $ —�T�— PERMIT
PLUMBING $ 7� 6/�/ ISSUANCE S
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICA� $ GRADING $
PLAN CHECK 50% $ MICROFILM $ !�1
• MECHANICAL S TOTALFEE $ �Q�/
PLAN CHECK z5% $ �
2
O
N
I
N
G
R
E
�
M
T
S
i � �
CONSTRUCTION AND PLANNING POOI & SPA
'APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
7. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcemen[
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, � Undrgrnd., Tes[
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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
.1
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
'18. Rough Electriral-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 Struc[ure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72.'Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoa[ 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: �./�(-�] (�E,GiCqEQ, L,�
34. Final Heating & Air Conditioning �2t���8 N(�(, P� •�i�•3 �1. �:. L.�
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 pomestic-Final .,C � �
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 Co �
51. CERTIFICATE OF OCCUPANCY •
No. Date
, �����
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C09TA MEBA. CALIPORNIA
For Applicanf io Fill in Compleiely
TYPE OR PRINT
BUILDINC3 3273 Wasnington A:•enue
ADDRESS
COSTA MESA CALIFORNIA
OWNER �erst Development Co.
MAIL 1533 Baker Street
ADDRESS
�,-
tlosta Mesa TNo'KI 9115
■A. .TEGT vua�.ovia �v. TEL.
Garden Grove, Cali£.
AODRE55 1533 Baker Street
��n Costa Mesa Calif.
iicTNo. 1b7293 i.io: KI• 9-1151
SIZE L� g�/�i1 I No. OP BLDO6_
OF LOT V W NOW ON LOT �lORe
U6E OP None
EXI6TING BLOG
BeTBACK LIN6 FRON �O� ���
t'rneer REAR YARD
ILEFf S� I RIGHT 6�
DESCRIPTION OF WORK
BUILDINCn[60 S.f`t� ROOMS 7 6TORIES 1
s¢e .i.�
EXTBRIOR WA1,L ROOF
COVERIN6 LUCCO COVERINGWOOC� shingle
USE OF BUILDING AND WORK TO BE PERFORMED
Single iamily residence with �
attached ara e. Plan 21BR
1 HHREBY ACKNOWLEDG6 THAT I HAVE RBAO THI6 APPLICATION
AND 9TATE THAT THE ABOV¢ �8 COXRER AND AOp6¢ TO COM-
SIGNATURE OFCI �� Cee ANen�Te uW8 n'tJ�TING
BUILDINO cON9TRll
IAUTNORIZEDAGENT DllfB & Co7.e�grove, IT1C�
FIRE
ZONE
APPRI
BY
ZONe
R _]
�eo.,�
APPROVE�
r�Kt�tivru
SEP 161960
FiNANCE DEPT.
Ctif OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RHCHIPT NO. PePMIT NO.
COSTA MESA. CALIFORNIA
ZONING
NO. OF I US6 OF NEW
Pur+v n auaou+o .
9T. ]
!
THE AMOUM BHOWN UNOBR V�LUATION I9 POrt THE
PUPP098 OF EBTABLI9HIN0 A PEPMIT p88 ONLY.
VALUATION [
IPERMIT FEE $ �Vo•
$ 16)1�1• PLqN CHECK $ lV�