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HomeMy WebLinkAbout2625 WESTMINSTER PL - Building Permits . • . . ., 41 '' CITY OF COSTA MESA 1 y : BUILDING DIVISION ��,- F' `......���,, ' DEVELOPMENT SERVICES DEPARTMENT �• "� PERMIT PERMIT NUMBS Ibaorna B9 186 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 2625 WESTMINSTER PL Status: ISSUED Suite: Applied: 07/06/1998 Vicinity: Issued: 08/28/1998 Parcel Nunmber: 43920107 Zoning: Applicant: UNKNOWN Address: Phone: - Zip: . Owner WHITFORD, RALPH E _ Address 2625 WESTMINSTER PL • < • Phone: 949-642-0818 - , COSTA MESA,CA , . - Zip: 92627 '' . _ - Contractor:- / > - •;;;', _ Address: - - Phone: Zip'' . License:- . Arch/Eng: JULIE CHAMBERLAIN Address: 2647 WESTMINSTER AV - -; \... .? . 'Phone:. 714-631-0611_ ' . , COSTA MESA,CA":! Zip: 92626 - License: C22332 SCOPE OF PERMIT ,600 sq.ft.secondtstory granny unit with a two-car garage DR-98-05:51SF 1ST FL BATHROOM,480SG GARAGE,•600SF.2ND FL GRANNY UNIT,83SF LOFT&116SF EXTERIOR STAIRWAY. - -- - - %.1. -- ' "FEE SUMMARY. Plan Check: i$467.03 - • - - f Calc Valuation: $72,010.92 - Permit: $718.50 ,- / Claim Valuation: $60,000.00 SMIP Res: . . $7.20 - SMIP Corn: • $0.00 _ - Other: ' $0.00 Inspection: $0.00 , Total: $1,192.73 . -. PLANNING'S,ZONING SETBACKS . , MAIN STRUCTURE Front 30-0 Rear 55-0 Left 11-0 Right 5-0 ACCESSORY Front 110-0 Rear 10-0 Left 5-0 Right 31-0 PARKING Existing: 2 Required: 4 Proposed: 4 • 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 //y 1 • .t.F . ,. 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: Carver: Policy Number: (This section need not be completed if the permit is 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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN 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 CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.# Class# Contractors Signature: Date: 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that 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).): s 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 hip self 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 old 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 Lew 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.). ■ exem.t unc /1� Business and Professions Code for this reason: _�_-� _ ra ignature: . �. V —es Date: Bo . ' •flier ID ve led by driv. s license. • es 0 No Drivers License No. • Expires: Verification of Ownership by(type of docu ,nt,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 Califomia 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 ❑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 en 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 eermlt 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 65650.2 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 eermit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally 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 co ly with all state laws and city ordinances relating toa building construction,and authorize representatives of the Cityof Costa Mesa to enter upon the ` _above-de • pro for in •action p ••eses. agree not to occupy or allow occupancy of any building authorized by this permit until final inspectio cq SI• a .ie Ol Legal •.•: (s) Date And/Or Authorized Applicant Date cQDE t ■SPFFTION TYPE DATE g(IQIAUS mu g1SPFr:T1os TYPE PATE ICALS 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 y 204 Final Demolition 250 Final Bullding/Occupancy ] 2446-46 • . .); 99//SZ ' Insulation Certificat Q8 — -I .25— Vfrsj7c/iln—rP P �17y //,�rA Number and Street ity County Subdivision Lot Number Description of Installation ROOF � Material th TT Brand Name C Oe�N/,f16' Thickness( ches) al, Thermal Resistance(R-Value) ,' R ,c7 CEILING Batt or Blanket Type BArir Brand Name (;;;$7,/,(A/6" r7,/,(A/6' Thickness(inches) G fir), Thermal Resistance(R-Value) 47— /7 Loose Fill Type Brand Name Contractor's minimum installed weight/ft2 lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) EXTERIOR WALL Material Brand Name 0At7W//fitc Thickness(inches) gm. Thermal Resistance(R-Value) t73 RAISED FLOOR Material 77 Brand Name • / Thickness(inche ) 6' � Thermal Resistance(R-Valu ) SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material• Brand Name • Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Buildine Energy Efficiency Standards for new residential buildings contained in Tide 24 of the California Administrative Code. �/ er ' wide- 3/-? icense Number o /q� . r`i� Signarure and Tid Date Sub-Contractor(Insulation Installer) License Number Signanue and Tide Date January 1,1995 Compliance Forms 4`ps�M 9 CITY OF COSTA MESA BUILDING DIVISION )• •- ____ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PEIRMIT 1y� B02-01624 -` oaarcr• (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2625 WESTMINSTER PL Status: ISSUED Suite: Applied: 10/04/2002 Vicinity: Issued: 10/04/2002 Parcel Number: 43920107 Zoning: • Applicant: WHITFORD, RALPH E AND WILLIAM A ISSUED BY: Address: 2625 WESTMINSTER PL Phone: 949-646-1911 COSTA MESA,CA Zip: 92627 Owner: WHITFORD, RALPH E AND WILLIAM A Address 2625 WESTMINSTER PL Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch : • Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING SHAKE ROOF,APPLY SHEATHING, FLET AND 30 YEAR COMP SHINGLES.APROX 2200 SQ. FT. DOES NOT INCLUDE AN ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,000.00 Permit: $97.25 Claim Valuation: $4,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0:00 Inspection: $0.00 Total: $97.75 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 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) 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. 1 ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the w r which this permit is issued. My workers'compensatio sur carrier an poll her are: Carder: Policy Number: (This section need not be completed ilThe p rm/f va ued 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 hat if I should become subject to the workers'compensation provisions of Section 700 o the Labor Code,I shall forthwith comply with these provisions. A A (ApplicanbSignature:. "Qat A fl 4I Date: h 1 v" WARNING:FAILURE TO SECURE WORKERS'ODMPE TION COVEPAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOmON TO THE WS]OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE.INTEREST,AND AITORNEY•S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.tl Class It Contractors Signature: Date: 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 d 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 ubje e 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,end 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 'cense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: }�� 'Signature: e2,044 / Date: i - O Owner ID verified by driver's license. 0 Yes 0 No (Drivers'License No. •ERpiies- Ste.$6 Verification of Ownership by(type of cocument,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,Gm 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 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 L-I 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? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope foorpection purposes.I agree not to occupy or allow occupancy of any building authorized by this pe(mi�til,final inspection. Ignature Of Legal Owner(s) L//NSI/ (/Datate And/Or Authorized Applicant Date CODE I, INSPECTION TYPE GALE DALE CODE r INSPECTIONTYPE QAff. MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 10'1l 1 1_- l/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 • '+„ti 'LLr CITY OF COSTA MESA ,°y. . 4, BUILDING DIVISION b., , DEVELOPMENT SERVICES DEPARTMENT ( m - L PERMIT PEFIMIT NUMBER / m°° -• ✓ M98-00414 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2625 WESTMINSTER PL . Status: ISSUED Suite No Applied: 09/14/1998 Issued: 09/14/1998 Vicinity: Parcel Nunmber: 43920107 Applicant WHITFORD, RALPH E Address: 2625 WESTMINSTER PL • Phone: COSTA MESA,CA Zip: 92627 , Owner: WHITFORD, RALPH E Address: 2625 WESTMINSTER PL Phone: - COSTA MESA,CA Zip: 92627 Contractor: - - Address: - Phone:: Zip: - , License: . Archl Eng: ` Address: - - Phone: Zip: License: SCOPE OF PERMIT " I F.A.U., 2 VENTELATION FANS, REF B 98-1186.ADD 600 SF DETACHED UNIT WITH GARAGE. FEE SUMMARY Quantity - ' - Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 -Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 , 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 ' ' 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 ' 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $13.00 2 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance - $0.00 0 ' ' Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.25 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 fora 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 WORKERS'COMPENSATION DECLARATIO.. 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 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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,060),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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: 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.). a<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) tic pursuant to the Contractors License Laws.). ❑ m-a p uu s=c. - Business and Professions Code for this reason: 'Signatur � _�/acre 'fn ate ate • mer ID verified by dri er's license. .s ❑No D(vers License NI\ / xp• 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 ❑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 Califomla 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 O 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 end 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? ❑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-descri Top r11'f inspectigp,puree not to occupy or allow occupancy of any building authori this rtn until final Inspection. • Signature Of gal Qwrier(s) / l/ Date And/Or Authorized Applicant —Date- CODE Date 1616 SPECTION COD CTION TYPE X Fixe System Final Fire Prevention GATE UIT 206E! FinalMechanicalMechancal � �-30-99 Arya 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 244646 CITY OF COSTA MESA t >.f-a , BUILDING DIVISION 1-i _ ' DEVELOPMENT SERVICES DEPARTMENT ��� T. MI •, PERMIT PERfvNUMBER i `*•ate E98-00968 ✓ (714)754-5273 • Fax(714)754-4856 - 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT • Job Address: 2625 WESTMINSTER PL Status: ISSUED Suite No Applied: 09/14/1998 Vicinity: BACH OF EXIST. RESIDENCE. Issued: 09/14/1998 r Parcel Nunmber: 43920107 Applicant: WHITFORD, RALPH E Address: 2625 WESTMINSTER PL Phone: 714-642-0818 - COSTA MESA,CA , • Zip: 92627 Owner: WHITFORD, RALPH E Address 2625 WESTMINSTER PL - . Phone: ` COSTA MESA,CA Zip: 92627 Contractor: - - Address: Phone: ' # .Zip:., License: .. i - SCOPE OF PERMIT ADD 600 SF OF DETACHED UNIT WITH GARAGE,7 OUTLETS ,9 OUTLETS&1 MOTOR. REF B 98-1186. ' FEE SUMMARY - Quantity . -- - " Quantity ' ISSUE FEE $22.00 " " .- - Temp Dist System/Lighting $0.00 0 Temp service test $0.00 ` Busway/100'ft / $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $30.00 600 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 "0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 - 0 - Lighting Fixts $12.00 12 • up to 50 kva/kw $0.00, 0 Recept Outlets ' $9.00 9 •- up to 100 kva/kw $0.00 0 Switches $7.00 7 over 100 kva/kw $0.00 0 Non Res Appl - $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $4.25 • 1 Low Volt Wiring System/Ckt ' $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 ' 0 Service over 1000a $0.00 0 k Circus(gen or ride) $0.00 0 Motors to 1 hp - $0.00 . 0 ' ' .Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0" Fireworks Stand $0.00 0 Motors to 100hp $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 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $84.25 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 e, f w DECLARATIONS `;, WORKERS'COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 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: cci„.Carrier: Policy Number: (This/section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify, t' 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' compens 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 „Th �cornply. Ith.th se provisions. Applicant Ignaturg:y Date: "y,, RNING.EAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,0001,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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: • 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.). xempt un.- .ec. - Business and rofef�ssi s Code for this reason: Signature: /.vOi.isl�c� / Da .�1,e�-� /C/, /•�" g` r D verified by driver license. IVY 0 No Drivers License N.. � - , " it �-z1-9 3 Verification of Ownership by(type of document,i.e.-property tax bill or dee • _ \ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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 tile 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made. 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws-and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ o rrtyy ,with spectio purpos:..Vagrree not to occupy or allow occupancy of any building authorize y this permit.unt inal inspection. `Signature Of eget Owner(s) Date), And/Or Authorized Applicant Date CODE L INSPECTIONTYPE - DATE IMAL5 CODE it IYNSPFF.TInNTYPF DATE HENS ' 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /�,, / 200 Final Re-Roof 210 Final Electrical 3-30-`19 QAC° 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 1/ J ` -, ,4 1r CITY OF COSTA MESA y r 4: C BUILDING DIVISION /// �L �. -9'• ' DEVELOPMENT SERVICES DEPARTMENT . PERMIT PER NUMBER / • P98-00692 ✓ (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2625 WESTMINSTER PL Status: ISSUED Suite No Applied: 09/14/1998 . Issued: 09/14/1998 Vicinity: • Parcel Nunmber: 43920107 Applicant WHITFORD, RALPH E Address: 2625 WESTMINSTER PL Phone: 642-0818 COSTA MESA,CA Zip: 92627 - Owner WHITFORD, RALPH-E - Address 2625 WESTMINSTER PL - - Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch/Eng: Address: Phone: Zip: License: ' SCOPE OF PERMIT 2 bathtub/shower, 1 washer/drye, i kitchen sink,2 wash basins,2 toilets, 1 watyer heater,gas connection,connect to exist.water service, refb98-1186.ADD 600SF DETACHED UNIT WITH GARAGE. 1 GARBAGE DISPOSAL. _ FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $8.75 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 - Process Piping(per 10 ft) . $0.00 0 - Vacuum Brkr Bkflow(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 $17.50 2 Dishwasher $8.75 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $17.50 2 Drain, Roof $0.00 0 Shower $17.50 2 Water Heater/vent $11.00 1 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 $8.75 1 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 $10.00 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: $136.00 COMMENTS I 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 y V I DECLARATIONS G u 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 o1 the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is 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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class It Contractors Signature: Date: 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). Lenders 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.). E 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) licen : •ursuant to the Contractors License Laws.). ❑ I am exam• er c _ Busine s and Professions Code for this reason: Ignature: /.�.. v 172•2r—asA / ••--1 igir . — ••••v �� •^ er ID yenned by• vers license. ,■ Yes 0 No F71 - -- • — - x 9'— pires:� - Q 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,Callfomia 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 ❑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? LI Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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? ❑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-describe operty jor inspectin purposes.I agree not to occupy or allow occupancy of any building authorized by this until final inspection. iti ✓ / Sign: . : Date And/Or Authorized Applicant pODE L INSPFCTKIN TYPF - QATF INITIALS CODF E INSPECTION TYPE DATE EMS 1616 Fixed System Final Fire,Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 3-3n-99 200 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 244648 2648 NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( i City of Costa Mesa District Receipt NO1/4R( OCa ( ) City of Newport Beach ( ) County of Orange P/ / Plan Check No. 0320 Applicant ' )A4//75C9P. Address: cr fo 25 1 AE-syi//AV�.E- ' TL , (:0_57:4 frail), 9:27 2 % p Telephone Number: ! 4" 7 (cv n X//JG Tract/Parcel and Lot Number(s): /f _ 1 Location of Project: 2 ` / //X25 EfrA/ STEP fC[. ( OS%LI / th . ( /1 , • Number of Square Feet of: Residential Space x $1.84 Total Residential/ / Go 0 o (Sr.. pa Citizen Space 641 x $ .30 Total /a Commercial and • • Industrial Space x $ .30 Total Commercial/Industrial Project is: (Check One) Warehouse • Motel Preschool R& D Bank Auto Repair Movie Theater _ Neighborhood Shops Hospital Mini-storage c • _ Racquet/Health Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. By: a " . atAkA ' / Authorized Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not .. true,then this//i� certificate.shall automatically terminate and the appropriate City/County shall be notified. Date: %,GG9. j/ •/9q Applicant!/ /' PROJECT ADDRESS: 2625 WESTMINSTER PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05092` OWNER'S NAME: MC KENZIE ROGER G ADDRESS: 2625 WESTMINSTER PERMIT NO: M 050929 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 75BTU FAU CHANGE—OUT SQ Ft: ADDRESS: UNIT: ' CLAIM VALUE: CALC—VALUE: GROUP OCC: / PERMITTEE: GEORGE BRAZIL ( 714 ) 535-7905 ADDRESS: 3022 N. HESPERIAN WY 101 COMMENTS: NO OTHER WORK PERMITTED SANTA ANA CA 92706 *********************************4E****************************3x****•**lfl(******** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIR EMEN TS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect SETBACKS CITY LIC.: 029919 STATE uc.: 306 ^ss: C— 6 Date: LYS^— I V MAIN BUILDING ACCESSORY BUILDING 1 — 7 ( signawre:_ 6 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN YORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of W rkers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ' ,ompensation Nstuaxa,vr,a1ALtAie%copy thereof(Section 3800,Lab.G.1 /0 1 /9 2 POLICY NO.: W 1.V L 7 0 7 J EXP.DATE: V COMPANY' UNITED PACIFIC,.yyPARKING REQ• PROV: PARCEL: 43920107 ZNE: REF NO: ❑ Certified copy is hereby furnished. (J erofied copyisfiled with the city Building Division. PLANNING NOTES> Date:— ` Ci ) APphcant: Y`-^" C`Z) t' ***TE******************************** ***** ************************************ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less) DEVELOPMENT SERNICES REQUIREMENTS I certify that in the performance of the work far which this permit is issued,I shall not employ any person in any manner so as to become ZONING APPROVED BY subject to the Workers'Compensation Laws of California. • DATE Date: Signature: BUILDING APPROVED BY• : DATE: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: ,, DATE: /44 which this permit is issued(Section 3097, Civ. C). ******'******'**'***'*'**'**'**')P***********W********** ****************** ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: t hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES GRADING (Section 7031,5 Business and Professional Code: Any city Of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9,00 • repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ly applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE • I, as owner of the properly or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 9 . 00 15. 00 0 . 00 24 . 00 24 . 00 . 00 '❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State 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 employees.provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 , 00 OVER/SHORT• 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/TOT GRADING PLAN—CHECK for the purpose of salol. 24 . 00 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: TheContractors'State License Law does not apply to an owner of property who builds or improves thereon *,****,******,****************,**************************************************** and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B. &P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date. Owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00 I do hereby certify that I am aware of and understand the requirements of Calfornia Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from • these provisions. Dale'. plicant: ' I hereby certify that I have read this appfica on and state that the above information is correct.I agree to ehnpty with all city and county 31 030E,01172-033C0572 7 cs i .<JL ordinances and stale laws relating to buildin construction and hereby authorize representatives of this city to en pr upon the above-mentioned DATE: 152/06/91 TI{(_: 155.1 property for Inspection purposes. Date: b - 9 I Signature: 9 / Driver's License or Social Security et L./ 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor - CONSTRUCTION AND PLANN+x..0 OOL & 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.' I 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. i 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; - i70. Underground Hydro 22. Ducts, Ventilating - :71- Product Piping 0 Gas O Oil 23.-Gas Pipe-Rough & Test - , . 72. Underground Flush 24. Roof Framing - - : 73. Undergrnd.Storage Tank'O 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 I ! 78. FIRE PREV. FINAL . 30. Drywall Nailing • I HEALTH DEPT. REQUIREMENT 31. Plaster Brown CoatiI - 79: FINAL INSPECTION 32. Electrical Power Meter-Final I I I+ • 80. FOOD CERTIFICATE ISSUED 33. Final Electric - I • Notes:34. Final Heating & Air Conditioning Nj0gq 4 •, i.35.; Final Gas Pipe-Test I i I. ' - ' 36. Hood or Canopy � '37. Final Factory Fireplace - i ; ' 38. Final Plumbing • . • I 39. Water Service-Final � ( - 40. Gas Service-Final ' ' - • 41. Solar Domestic-Final • I I '42. Backflow Preventer I l • , A3. Backflow Irrigation 44, Landscape Irrigation System - • 45. Sound Attenuation . 46. Handicap Regulations - • 47. FINAL STRUCTURE & BUILDING 1 i 48. FINAL PLANNING i 49. Electric Release to Edison I I ' 50. Gas Release to Southern California Gas Co I 1 • + . . 51. CERTIFICATE OF OCCUPANCY , . No. Date WV OWNER McItiENZIE, R. . DATE NIG 1 4 1963 JOB ADDRESS 2625 Westminster Pl. BUILDING PERMIT NO. 20409 GENERAL CONTRACTOR William Olson VALUE $ 4,960.00 To.119-163-7 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Add Ft.RM.Remod L,—,ECTIONS l nature ATE GROUP I TYPE V ZONE R2 Kit. Soil 44 1,.,.,i 7G7 PERMITS ISSUED Gas .7 SUBCONTRACTOR DATE NUMBER Water ant- R= z7/, a Rough Com. Refrig. 0Air Cond. 0 Rough Heating Rough Plumbing ,514C-7�/ G3 �1. - - _, t ,P-...?C-C3 37 a Go — Miscellaneous = Prop. Swr. Line 0 House Con.0 St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power 0 Rough Wiring 2 9rC// ��('k ln,.e - e.o. 9-6.-67 ,70,,r- .- Trenches 0 Forms 0 Steel Reinf. 0 �:1-7=_G—.3 Floor System Q Bond Beam !D Steel Reinforce 0 Sheathing q-R,t^4, Frame and Flashing ^� 9— t_.1 - C.3 • I,'..'+ng — In ut(a/ a - �S /'- 3 --C 3 1 ;r, brown coat L/ C s[ Reirig. 0 Air Con. 0 Final Heating, Final • Plumbing Fixtures, Final Final Gas Test 4--)o-43 Electric Fixtures, Final /0 Building, Final 8• �* C f OCCUPANCY Form RTI9--5M-3-63—S-B P nnl.:." ! 20409 COSTA MESA BUILDING-SAFETY DEPARTMENT FEE tE I V E D \ P.O.BOX 617 COSTA MESA.CALIFORNIA AUG t For Applicant to Fill In Completely �Ntil O1 Ee' PERMIT TYPE OR PRINT ' Il,nn / ///, y .bra CITYFBf }' ,', Sbnty BU I LD I ADDRESS�Q �•J L/Ji�ST M it, .S re"? ! L L . RECEIPT NO. PERMIPNO. COSTA MESA, CALIFORNIA �O O AA��11II AI g )� y �/(�ATE/JI/�8I Dt. DyAT 89UE OWNER Ain-Mfi'S �v4L/1 Is/v�/4. -_'77fs %� L/ ! / .� / U fS .!f MAIL •J/+ BUILDING - ADDRESS 4/1.4 a ADDRESS 1 ,E,� RE TEL. ZONE YPE GROUP .I CITY CU X.444675 A1 NO. ARCHITECT TEL. APPROVEDYY aiji , GATE(p /.., / OR ENGINEER NO. NING At .93 ZON I NO.OF�I USK OF NEW - ••i' t '1 �7 k-L PLANS BUILDING 1, CONTRACTOR U/////AM A. ( 7..SON LEGAL i I �C`�0 ,. ADDRESS GY 39O #DIA Nr7 s DR DESCRIPTION ! "' �- l�/7 / A.P.NO. 1 '�] - /(y g^ 7 I` OT7 CITY /1.),...1.0.,00/7 r .BEA Cts p NOTE: NO EAVE OVERHANG SHALL'BE LESS THAN LIC..NO.ATE //7.3 S 7 no'S7 8 7/13 30"TO SIDE O REAR F+.L.EAVES SIZE ;EX / 7(.'dd��II I NO.OF SLOGS. NOW ON LOT J ALLOWED (U.B.C.REQUIREMENT) OF L YARDS APPROVED YARDS APPROVED USE OF Yr y MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. C (FROM C/L n. J SETBACK LINE FROM - ''JJ .6" y9�/1//L CENTER OF STREET REAR YARDFRONT FT. /� / / R.SIDE CC. FT. SIDE YARDI LEFT I RIGHT 7 1 �, DESCRIPTION OF WORK L.6IDH� Ao.QY.A A? FT• NE' ALTERATION 1"..'" ADDITION v REAR "7/ FT. V FT. DISTANCE BET. BET.MAIN& REH,..R MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS. - BUILDING/i / P NO.OF f VAR.# DATE SIZE 7s'C ROOMS / STORIES / C.U.P APPROVED EXTERIOR WAL 1 ROOF p A'�-.o,L-I• r/.— i`74.-‘ 3 COVERING��y _ G/C• I /C,/OWORK pVERING ea•• 5,, B IIS`.It-.AALA DATEUSE OF OO Ai.dAiteei e/N/117. Add BFB. ,R�vED/VA& . f'G�r �/p � ?/ � 7,- i AIL. •!1 / 4// SQ.Fr.G`-4A1 94 ' _42e1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /� 60 m BUILDING RON9TRUCTI ^A $ yf6� coPERMIT FEE $ Cr" B SIGNATUREDINGCO OF STRUC A OA [l�� O PERMITTEE ( /� _ 4 AUTHORIZED AGENT 27 L- TOTAL FEE $ UW1N1iU nuuatt u. DATE uune y, lyo7 JOB ADDRESS 2625 Westminster Place BUILDING PERMIT NO. 24268 1 GENERAL CONTRACTOR owner-builder DESCRIPTION OF WORK Patio A 1.119-163-7 LOT TRACT FIRE ZONE 3 VALUE $ 496.00 INSPECTIONS Signature Date GROUP J TYPE I ZONE R 1 C Soil PERMITS ISSUED —Gas SUBCONTRACTOR Date I Number I Signature Q.-Water Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power IJ hough Wiring Heating and Vent. Trenches LS/Forms a—Steel Reinf. ❑ -- CNC-, Floor System Bond Beam 0 Steel Reinforce 0 Sheathing j Frame and Flashing < Lathing —In ❑ Out❑ P r, Brown Coat SL-.:lural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final 34 Building, Final al a- C/ S 242 8 CITY OF USIA MESA COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA.CALIFORNIA JUN 9 1965 For Applicant to Fill In Completely AP (CATION FOR PERMIT TYPE OR PRINT L Fr Of? BUILDING S[' I ' ) 11 i /(in ` v ADDRESS 2Gzp u/H$T'YLI I Y'I S �'-( t-� l RECEIPT NO. PERMM,ITJ O COSTA MESA. CALIFORNIA */ L(p f< ' {//�� /� M 1C/ REcnv LDAP(�REGEIVED DAA]E IE/pueD OWNER 1�1:1�r-e_'r \T 1 ' 1 C_I eln-7-1-E, O/ (1 �/ T/Ger MAIL } SUELOINO -r) z (A ADDRESS 2 Uas�e i1 Yn S4'CC IPI(l C't ADDRESS /��l . FIRE CITY CUS� / l[SV- ILL.6ittri SIQ ZONE TYP GR9 UP ARCHITECT TEL APROVED - � 6 - ORENGINEER NQ. ZONING A .55 ZONE �/ I NO.OF 1 USE OP NEW d--A V.� N /� //`/' PLANE !� I EUI LDINB CONTRACTOR �1/3t-a- IW)�yc.J•1 y7 ��-2�`F LEGAL TON T,4 /77V.q/- La 14 7 ADDRESS DESCRIC� A.P.NO. // / r/C0 7 CITY NOTE: NO SAVE OVERHANG SHALL BE LESS THAN STATE TEL. SO'TO SIDE&REAR P.L. LIC.NO. NO. SIZE . 4O;0 I L{G•0 EAVES OF LOT S S•%G i c%9 is I NOW ON LOTNO.OFS ALLOWED (U.B.C.REQUIREMENT) USE OF I YARDS APPROVED YARDS APPROVED EXISTING BLDG. I`I41Y�OIMAIN BUILDING ACCESSORY BUILDING / _...- I FROM / T"�R EET) SETBACK LINE PROM X111- FRONT T: • FT. CENTER OF STREET Yt1 . REAR YARD Z° SIDE YARD I LEFT q I RIGHT -S _ -R.SIDE a" Fr FT. DESCRIPTION OF WORK L.SIDE 37 FT. Fr. NEW _ ALTERATION ADDITION X S FT. DISTANCE BET. BET.MAIN e MAIN SLOGS. ACCESS.SLOGS. RL. .R MOVING DEMOLISH VARBUILDING / NO.OF DATE SIZE 0 lath ROOMS 0 STORIES I - APPROVED EXTERIOR WALL ,'^I1��� ROOF r /` J COVERING AL)k).�J COVERINGSGR��liC4(i,yc kilt :rat/ DATE b/ 9/CoC USEA k A I� nl, \AFT NLOKTk CI BE P\S'2S% \4eNG-P / 160 H SO.FT. o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 8 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION ..•-03 a BUILDING CONSTRUCTIO cc SIGNATURE OF PERMIT FEE S .._! n PERMITTER 7nc1MS' ZC f�� AUTHORIZED AGENT 1 ` 9) 6 S to I` TOTAL FEE OWNER Royalty Service Corp. DATE 3-31-54 7-J< JOB ADDRESS 26@6 Westminster Place. BUILDING PERMIT NO. 158 `! GENERAL CONTRACTOR J.D. Dcvers•ike VALUE $ 8,800.00 i. LOT ji- 7 BLOCK TRACT Pii Dwelling & Detached Gar. GROUP I TYPE V ZONE -u FIRE DISTRICT #165 PERMITS ISSUED • INSPECTIONS D •TE SUBCONTRACTOR _,�..''//�f�.� DATE NUMBER Footing Trench 1vv/./ .1© .D- . • Foundation Forms and G` de to Garage _ Rough Framing tec-415 a Plumbing,Rough to Slab leAi°. ii /1L 429�� Plumbing, Rough Complete -72a?a .S/� r / g • 7- r Z -, .s a..z_ - Temporary Pole11 • Gv`%' Wiring, Rough l. 1% �V A'� a M--�C/.P,r Ar an / .7 Heating,Rough ��t/ .5 q, •/ 4/Ln . 5/—a Y-J"4 3(J Heating, Final /L F 6 t -.. sewer ce-a r.cy. aq/7JG'�/S %3e/a' .La L a, D12 7(( 'SJZY4 L I/ Septic Tank or Cesspool / Lathing /' SGC/ • Plastering 7,'Al:SF. WeroiS ; _ Plumbing,Final,Fixtures Complete i' Z' 7 / _ ,y^/�.�_ Plumbing,Final Gas Test ling; I l e U V 0 V VG -7.7-/-3-=-5 � Wiring, Final "7,... J _ /P �' '� 7 Cocupancy — 'L1mni 210 GM IM 12-63 it:losta Mesa Building Department APPLICATION FOR PERMIT ., 111 EAST 20th STREET 165 _ _ _ .. B U I.L.D..I_N_G • COSTA MESA, CALIFORNIA : -, _ FOR OFFICE USE ONLY. i FOR APPLICANT TO FILL IN 6 Receipt No. Permit No. I Building GAB %- c 7g / s;G 1 ' Address eZ0 -, -aa./ �eLett. F ' 6/ o • Received by Date R c'd. Date Issued I Coto Mesa, California MA231 Nearest 0 ^ _ 19541, Cross St r >,e/ .1 t--1l�st O Building s,4 �, �_ y q . Address SnTl !.-'TJX wl®— /f///' Owner a `4Ga —s= r Costa Mesa, California ' Mail � ' Address l' 1. i r eatt Nearest s.( /G Tel. Cross St. City No. Zone /1.44 No.of Type / . I Group ,-1-- Architect or Lia I Plans I J -- Engineer No. Approved • 4 by Date ' Address //�� CORRECTION (� - city Lia ° % . atractor JedAle No. r9 / S Address r '_n f' ' e 1 _ Legal Lot I of .i f�# I A r Description I No. 7 I Block Trac r - ) (Attach Metes and Bounds) No.of Bldgs. "— 1 Size of Lot e p /A/Q I Now on Lot T - 0 Use of ,.�/ , I No.of I No.of :( / 70 Existing Bldg. Families/, Rooms Co• , �� B Setback Line from , 7 Rear Yard It;, ` Z Center of Street . i Side Yard „ • y DESCRIPTION,OF WOR ' r New X I Alteration I _ I Addition �� ReRepair I Moving I I Demolish I t R 0 it ��-JJJI{ p v, Building r//�� y / No.of Q ‘'‘ � 1I Size 14,,, 2G Rooms Stories c� '("7771111+ !erlor Wall I Roof c ,eying Q C- Covering (Tp�,(�'''[�' • use of New : Foundation LocatjgFl>t ' Inspector Date Building Forms,Materials, rj g,"�e — w�, ' Under-Pinning , /��j('j GL�t�C Frame: Fire Stops, Bracing,Bolts r•' • I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply 2 Lath. Ext. • with all City Ordinances and State Laws regulating , ' building construction. _ Signature of / Plaster, int. Permittee , it � 1491,4/0/(420. Plaster,Ext. • Authorized./BSK \ Masonry Reinforced Valuation Pa Permit Fee. $ ' 1 •O d Plan Check $ Bond Beam r $ Sr; / 0 Total e - Fee $ as FINAL ,A,_ ?lAl ft • 1t, 19_21. TYLILEIEct 11051 i iOITAl I9fl.L 3:19mtjsasa iaibiia: sz�u: sizes rr • C O J 5 • J a. a. d L a. Street PLOT PLAN Show location and distances from property line and between buildings. P INSPECTIONsEST TO: Building Building Inspector Date. 4.9 7 , 195:11 Hour Asst. Building Inspector 7 - 26,21plum • binractor ••,. Job: Namel[de €1 ' . Address ge-inie‘ fir-4-:. Permit No / ....? • Type our Rough or Final O.K.'d by Date 0 TRENCH id 1) El FOUNDATION 6 GRADE TO GARAGE lIt'ai-l° O FRAMING J. a 4:r.A. PLUMBING.,/ -4-1°.7 40.-- .. .....% /4-wit 4 SEWER El HEATING14/,44,4. ..........0 WIRING CP.Sator Ai/Ara/ e elatt-in, Or< I:I LATHING PLASTERING PLASTERING -•• BLDG.FINAL e*".-E E ISCELLANEOUS 1 , I ' IlkSigned kForm 213 G-H 10M 0-63 6 '