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Home My WebLink About3148 YELLOWSTONE DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 3148 YELLOWSTONE DR Suite: Vicinity: ROOF Parcel Number: 14153115 Zoning: Applicant: SMALL, DORIS Address: %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 111 W 17TH ST � Zip: 92706-2718 Owner: HOME OF THE MINISTERING ANGEL Address %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 111 W 17TH ST Zip: 92706-2718 Convactor: O W N ER-BU ILDER Address: Zip: Arch : Address: Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 07/15/2004 Issued: 07/15/2004 ISSUED BY: � Phone: Phone: Zip: License: License: SCOPE OF PERMIT . TEAR OFF EXISTING ROOF. INSTALL NEW SHEATHING, 30 YEAR COMPOSITION SHINGLES, AND 30# FELT. 1,985 S.F. INCLUDES ATTACHED GARAGE. Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 SETBACKS, MAINSTRUCTURE Front 0-0 ACCESSORY Fronl 0- 0 PARKING Existinq: 0 Rear a o Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0- 0 sa,000.00 sa,000.00 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, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapections end finel epproval must be obtained. Failure to obtain inspactions and final approval will result in the expiration of this permit. FOR INSPECTIONS CALI: (714) 7545626 ?d48d8 (8�W) WORKERS'COMPENSAnON DECLARAnON: I here6y eHirtn under penalty of perjury one oi Ihe following tlecleretions: ❑ I have and wiil maintein e certiticate of consent b selt-Insure br workers' compensation, as provided tor by section 3700 ot the Labor Co9e, ior the ►ertormence of the work tor which lhis permit is i5sued. ❑ I heve and will maintain workers' compensation insurance s requiretl �y section 3700 of the LaDor Cotle, for ihe peRortnanca ot the work for which this pertnit is Issued. My workers' compensation Insurance carner and pol�mber ere: Carrier: (This s� comply ApDlicent Sig WARNINO: FAI TiIOUSAND IX of Ca0C6r"v(a. and WORKERS' LICENSED CONTRACTORS DECLAR I hereby aNirm that I am licensed under (orce entl eHect. Lic. # Gonirector's SigneNre: Policy Number: fo�w h this pertnit is issuetl, I shall not employ eny person in any menner so es to become subject ro the workers' � tna houltl become subject to the workers' compensation provisions of Sacti n 3700 f the Labor Code, 1 shall forthwith / � Date: --�/ / I ATIIXJ COVERAGE IS UNLAWFLL AND 5lULL SUflIECT AN EMPLOYER TO CRIMIN/ PE IES AND CIVIL FlNES UP TO ONE HUNDRED COSTOFCOMPENSATION,DAMAGESASPPOVIDEDFORINSECTION3)O60FTHELABOFC �DE,INrEREST,ANDATTORNEV'SFEES. oi Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, end my license Is in futl Gtass x Date: CONSTRUCTION LENDING AGENCY: ❑ I here6y eHirtn that Nere is a construction lending egency br ihe pertormance of Ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lenders Address: SigneWre: Deta: OWNER-BUILDER DECLARATIONS: I hereby eHirtn ihat under penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor lhe following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry w�ic� requires a permit to consWct alter, improve, tlemolish, or repair eny strucWre, pnor m its issuance, also requires Ihe epplicant for such pemiit to tile e signed statemant that he or she is licensetl pursuant to tha provisions of the Conirectors Llcense Lew (Chapter 9(commencing with Sactlon 7000) of DlNslon 3 of the Busine and Pmfessions Cotle) or Ihat he or she is exempt theretrom antl the basis for the elleged esemption. Any violetion oi Section 7031.5 by any appliceN tor a partnit subj s ihe epplicant m a civil penelry of not more than fiva hundred dollars ($500).): I, es owner of the properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the swcture Is not intended or oftered for sale (Sec. . — 7044, eusiness and Professions Code: The Con mrs License Law does not apply to an owner of property who builds or improves ihereon, antl who tloes such work himself or hersalf or through his or her own e o as, provided thet such improvements ere not intended or oHered far sale. If, however, Ihe building o� Improvement is sold within oneyeer� ompletion, ihe ow u� er will have the burden of proving ihat he o� she did not build or improve tor purpose oi sale.). ' ❑ I, as owqer of the prop , am E%CL 1 L CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business end Pmfessions e:.TFa coniractor icense Lew tloe n pply to an owner oi property who bulltls or Improves t�ereon, antl who coniracts tor such project wlih e coniractor(s) icense pursuantt Contrectors,Lic ws.). 1'am exemDt er p� � Business end Protessions Code lor ihis reason: _/ �� P/ Owr�m-IB"Crifietl�j✓tlnvels licen5e. /�] Ves ❑ No Drivef5 LiCenSe No. Verification of Ownership by (type ot documen�, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby cerlify ihat no axcevation five (5) or more teet in depih Into which a person Is requiretl to descentl, will be mede In connection with work euthorized by ihis permit, and ihat no bullding structure, scaHolding, talsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (ChaD� 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlministretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division oi Industnel Sefery, as noted ebove, unless such person has e permii to do such work from ihe tlivision. SignaWre: Date: Division of Intlustrial Satety Permit Num�er: COOE t. INSPECTIONTYPE 1616 Fiaed System Finel Fire Prevention 1266 Pool Spa Flnal 200 Finel Re-Roof 201 Final BIocWReteining Wall 202 Final Fectory Fire Placa 203 Final Sign 204 Final Demolition PdIL INfffIALS (fJ_ZS �a'f �v_� COpE 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Buildin<yOccuDency Q� INTIiNLS �� i�� .e� ..�. .. . .... �. .�� . � . . ......._.. . JobAddress: 3148 YELLOWSTONE DR Suite No Vicinity: Parcel Number: 14153115 Applicant: ARTHUR, MARIA Address: 19911 WASHINGTON STREET CORONA,CA MECHANICAL PERMIT Phone: 714-434-9120 Zip: 92881 � Owner: HOME OF THE MINISTERING ANGEL Address: %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 111 W'17TH ST Zip: 92706-2718 Contractor: ARCTIC REFRIGERATION Address: 19911 WASHINGTON STREET CORONA,CA Phone: 714-434-9120 Zip: 92881 License: 523761 ISSUED Status: ISSUED Applied: 08/09/2004 Issued: 08/09/2004 SCOPE OF PERMIT REF B04-01351: LEGALIZE RECONFIGURATION OF INTERIOR NON- BEARING WALLS TO CREATE A NEW MASTEF2'BATHf200M IN A FOFiMER CLOSET AREA. KITCHEN WAS RELOCTED ALSO. SCOPE OF WORK WILL ALSO INCLUDE: REPLACEMENT OF 3 BEDROOM WINDOWS TO MEET EGRESS CODE, 2 KITCHEN WINDOWS, 1 DINING ROOM WINDOW. DINING ROOM WINDOW WILL INCREASE IN SIZE TO A 4 X 6 WINDOW. MISC ELECTRICAL WORK ALSO. MECHANICAL PERMIT IS FOR NEW HEATING/AIR'UNIT WITH COMPLETE DUCTING. ISSUE FEE Inst FAU <100 k BTU Inst FAU>100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refng Sys >100 k BTU Gas Piping Factory Fireplace. � Hood w/Mech Exhausf, � VAV Box Vent Fan / Single Duct �. Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers c t0000cfm Air Handlers > 10000cfm Floor Furnace $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 1 0 0 0 0. 0 0 0 0 0 0 , 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit _ � --Repair / Alt Refrigeration Unit , , ' Ventillation System � Evaporative Cooler � � ' Commercial.lncinerator � . " Domestic Incine�ator' � . - � Compressors / Absorption Svstems ' Up to 3 hp ! 100 k BTU - . , 3To15hp/SOOkBTU, � ,� 15 To 30 hp / 7;000 k BTU , � . � - � - 30 To 50 hp /-1,750 k BTU .. Over 50 hp / Over 1,750 BTU � , Bollers: . � , Upto3hp � � � 3To15hp � , � � 75to30hp : . 30to50hp � �" �. � Ove� 50 hp - Other Mechanical Fee ' Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 , . ' - $0.00 0 �,$OAO 0 $0.00 0 $0.00 0 �� $0.00 0 $27.15 1 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by ihis 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all required InspecHons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-0B (8100) WORKERS' COMPENSATION DECLARA710N: � I hereby a%irm under penalty oi perjury one of the following deciarations: „ ❑ I have and wiil maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of iha labor Code, for ihe pertormance of the wark tor which this parmit is issuetl. ❑ I have antl will maintain workars' compensation insurance, as required by section 3700 ot the Labor Coda, for the perfortnance oi the work for which this pertnit is issued. My workers' compensation Insurance carrler entl policy number are: Carner: Policy Numher: �(Tliis ecfion need not be comp/eted i/ the permit is valued et one hundred dollers ($100) or IessJ cenify that in ihe pedormance oi the work fior which this permit is issued, I shall not employ any person in any manner so as to become subjec� to the workers' compensetion laws oi California, end egree that it I should bewme sub�ect to the workers' compensation provislons oi Section 3700 of the Labor Cotle, I shall forthwith comply with these pro io " �j� Applicant SignaNre: �A/�/ � Date: �7 � WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVEFiAGE IS UNUWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDFED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDED FOF IN SECTION 3]Ofi OF THE IABOq CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CON7RACTORS DECLARA710N: I hereby aHirm that I am licensad under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl ProJgssions Code, and my license is in full force and ettect. Lic. A '�J� ��% �o � Class #_ r� �i �S Contractor's Signeture: Date: �C� —C, y CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirm tha� there is a consimction lending agency for ihe performance of the work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lender'S Name: Landafs Address: Signature: Date: OWNER-BUIL�ER DECLARATIONS: I hereby aHirtn thet under penalty of perjury thet I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Cotle: Any city or counry which requires a permit to constmct, aNer, improve, demolish, or repair any simcWre, prior to its issuance, also requires the applicant for such permit to tile e signetl statement lhat he or she Is Ilcensetl pursuent to ihe provisions of the Contractore License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Proteuions Code) or thet he or she is exempt therefrom and ihe basis for the elleged ezemption. Any violation of Section 7031.5 by any applicant for e pertnit subjects ihe appliwnt to a civil penaHy ot nat more than five hundred dollars ($500).): ❑ I, as owner of �he property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is not intended or oflered for sale (Sec. 7044, Business and Protessions Cotle: The Contractors License Law does not apply to an owner ot property who builtls or improves thereon, antl who does such work himself or herself or ihrough his or her own employees, pmvided Ihat such improvemems are not intendetl or otteretl for sale. If, however, the building or improvement is sold wit�in one year of compietion, 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 Ihe property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct ihe prqect (Sec. 7044, Business and Professions Code: The coniractors License Law tloes not epply to an owner ot propeny who builtls or improves thereon, and who comrects tor such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: SignaNre: Date: Owner ID veritietl by driver's license. ❑ Ves ❑ No Driver's License No. Verification ot Ownership by (type of document, i.e. - property taz bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more teat in depth into which a person is required to descend, will be made in connection with work euthonzed by this permit, and ihat no 6uilding strudure, scaHolding, talsework, or demolition or tlismantiing thereot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle e, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from ihe Division af Industrial Safery, as notetl above, unless such person has a permit to tlo such work trom the division. Signeture: Division of Indusirial Satery Permit Number: Date: CERTIFICATE OP COMPLIANCE AND AUTHORIZA710N OF ENTAV: I certify under penalty ot perlury that I have read this application and state that the intormation given is correct. I egree to comply with all stete laws and city ordinances relaling to building construction, and authorize representatives of the Giry oi Costa Mesa to enter upon the above-described propeny for inspection puryoses. I agree not to occupy or allow occupancy of eny building authorized by this permit until tinal inspaction. � n Signatu e Of Le Owner(s) �� „ Rate �6 ,� CJ�f And/Or pplicant Date COUE N INSGECTIONTYPE � � INTRIAL 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Plece 203 Final Sign 206 Final Demolition U N INSPELTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Finai Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency � � Y � , � AIPPROVED — PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, OP, CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. ` ,e �V -4 J � ��1 i 0 � �� ! � • � 1 � 3(y� frn � �le(lows4��, ! (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA. CA 92626 BUILDING PERMIT Job Address: 3148 YELLOWSTONE DR Suile: Vicinity: MASTER BATH AND KITCHEN AREA Parcel Number: 14153115 Zoning: Applicant: SMALL, DORIS Address: %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 714-547-6221 111 W 17TH ST � Zip: 927062718 Owner: HOME OF THE MINISTERING ANGEL Address %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 111 W 17TH ST Zip: 92706-2718 Contractor. Address: Zip: Arch : Address: Zip: Phane: License: Eng: Address: Phone: License: ISSUED BY: Status: ISSUED Applied: 07/29/2004 Issued: 07/29/2004 Phone: License: SCOPE OF PERMIT LEGALIZE RECONFIGURATION OF INTERIOFt NON- BEARING WALLS TO CF2EATE A NEW MASTER BATHROOM IN A FORMER CLOSET AREA. KITCHEN WAS RELOCTED ALSO. SCOPE�OF WORK WILL ALSO INCLUDE: REPLACEMENT OF 3 BEDROOM WINDOWS TO MEET EGRESS CODE, 2 KITCHEN WINDOWS, 1 DINING ROOM WINDOW. DINING ROOM WINDOW WILL INCREASE IN SIZE TO A 4 X 6 WINDOW. MISC ELECTRICAL WORK ALSO. RESIDENCE WAS FORMERLY A 4 BEDROOM/2 BATH RESIDENCE AND WILL BECOME A 3 BEDROOM / 3 BATH RESIDENCE. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $o.00 $167.25 $0.90 $0.00 $0.00 $0.00 $168.15 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0- 0 FEESUMMARY PLANNING & ZONING Left 0- 0 Calc Valuation: Claim Valuation: Right 0-0 ss,000.00 ss,000.00 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 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 ot 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetions end final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2anaae la�ao� WORKERS'COMPENSAnON DECLARATON: I hareby ettirtn under penaly ot perjury one ol lhe following tlaclarations: ❑ I have end will melntain a certiilcate of consent m self-Insure for workers' campensation, es provitled for Dy sectlon 3700 of the Le6or Code, ior Ihe peAartnence of the work tor which t�is pertnit is Issued. � ❑ I have and will mei taln workers' compensation I su2nce, as requiretl Dy section 3700 of Ihe Lebor Code, tor the peAormence of the work �or which this permit is iswed. My workers' wm�rts�tian)vtsy�n�ice car�er�9t� pglicy number ere: Certier: (1hls secfion need nof � I.iertiN ihat in11i Applicant : WARNING: I T/KIUSPND LICENSEDCONTRACTORS one Policy Number: or le'zs.) oi thdw lfor which Ihis permit is issueA, I shall not employ eny person in any manne so as to become subjact to ihe workers' i, e e thet H I shoultl become sublect to ihe workers' compensatlon provislons o Saction 3 00 of Ihe Labor Code, I ahell totlhwlth / — Dete: ` � 5 ENSAiION Q7VERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND NIL FlNES UP TOONE HUNDRED 'ION TO iHE COST OF CAMPENSATION, DMMGES AS PROVIOED WR IN $ECTIIXJ 3]OB OF THE LABOR CODE, INTEREST. AND ATTORNEI"S FEES. I hereby eflirm that I am licensed Untler provisions of Chepter 9(commencing wlih Section 7000) of Dlvlsion 3 of Ihe Business and Professions Code, antl my Ilcense Is in tull lorce and ettect. Lic. a Cless a CoNrectors SigneWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that thera is g construction lending egency for Ihe peAortnance ot ihe work lor which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lenders Address: Signature: Date: OWNER-BUILOER DECLARA710NS: I herehy attirm ihet untler penelry of Derlury thet I em E%EMVT FROM 7HE CON7RACTORS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business en0 Protesslons Code: Any ciry or county whic� requires a permit to constmct, elter, improve, tlemolish, or repalr eny siructure, prlor to its issuance, elso requires the epplicant for such permit to tile e signed stetement ihat he or she Is Ilcensetl pursuent ro the pravlslons ot the Contrectors Llcense Lew (Chepter 9(commendng wli� Sectlon 7000) of Dlvislon 3 oi the Busin s antl ProfesSions Code) or thet he or she is azempt iherefrom and the besis ior t�e ellegea azemption. Any vloletion ot Section 7031.5 6y any applicant for e pertnit s�b ts the epplicant to a civil penalry ot not more ihan Ilve hundretl tlollars ($500).): as ownar of ihe 7044, Business ei himself or herself sold within one ye �I, as ownecof lhe Code:7Te comr license pursu i ❑ � am axemp E Signature: OYiner ver' etl Dy dd or my empl es wit� wages es their sole compensation, WILL DO THE WORK, entl tha structure is not Intentle0 or ottere0lor sale (Sec. sions Cyd T e Contractors License Law does not apply to an owner of property who builds or improves thereon, anC who Coos such work '1 hi 6r her n employees, provided ihat such improvements ere not Intended or oflered lor sale. If, however, ihe building or Improvament is p on, th owner-builder will have ihe 6urden of proving that he or she did not build or improve tor purposa ot sale.). ' e X USIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 70aa, Business end Prafessions � does not eDPly to en owner of property who builds or improves thareon, antl who coniracts tor such pro�ect wlth e contrector(s) r rs License Lews.). Businass and Profeuions Catle for this reason: - Date: �se. ❑ Yes ❑ No Drivefs License No. Eapires: by (rype oi tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7y VERMR CERTIFICATION: ❑ I hereby certify that no excevatlon tive (5) or mare faet in depth into which e person is required to Oescen0; will be matle in conneciion wit� work authodze0 by Ihis pertniL and that no builtling structure, scaflolGing, falsework, or demolition or dismantling t�ereol, will 6e more Ihen thirry-six (36) teel high. (Chep. 32, Gry 2, An 2, Sec. 341, Tlle 8, Califomia Adminisiretive Cotle). ❑ As owner-bullder, 1 will not employ anyone to do work which would require e permit from ihe Division of Industrial Satary, as notetl ebove, unleu such person has e permit to tlo such work from the division. SigneWre: Date: Division of Industnal Satety Permit Number: CODE 1. INSPECTIONTYPE 1616 Fi:eO System Final Fire p�evBnUon 1268 Pool Spe Final 200 Finel Re-Rooi 201 Final BIocWRetaining Wall 202 203 Final Faciory Fire Place Final Sign 204 Finel Demolition f1.ii�Giiil/149 COOE� INSPECTIONTYPE 206 Finel Mechanlcal 20B Finel Plumbing 270 Final Electdcel 212 Final Flre Prevention 220 222 250 Final Planning Approval Final Site Final BuiltlingiOccupancy BEIE ItlI�LS � f -1 ' -+ I � - � . � . , , . . . . t . � � . l. : . �. . . . . , M1 � � i � i I � , , ; � ' �, � � � ' I , '� _ . t - , . , . 4 , . . , i . a .. . , . . . ' . . .. . . . i - � i �— � — � 1 =_ <t— ,�— i � } i ! ..� � , —� _r_ —� i i � . 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Job Address: 3148 YELLOWSTONE DR Suite No Vicinity: Parcel Nunmber.�, 14153N5 Applicant: OLIVER, JIM Address: P O BOX 5993 ORANGE,CA PLUMBING PERM�T ISSUED BY: Phone: 714-209-3385 Zip: 92863 Owner: HOME OF THE MINISTERING ANGEL Address %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA 111 W 17TH ST Contrector: VALCO PLUMBING CO Address: P O BOX 5993 ORANGE,CA Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Phone: Zip: 92706-2718 Phone: 714-20&3385 Zip: 92863 License: 289587 Phone: Zip: License: SCOPE OF PERMIT COMPLETE WASTE SYSTEM INSTALLED: FIXTURES TO INCLUDE: 2 BATHTUBS, � GAS (1-4 OUTLETS), 1 LAUNDRY TUB, 1 KITCHEN SINK, 2 WASH BASINS, 3 TOILETS. AMT $23.50 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEESUMMARY QTY AMT Laundry Tub / Washer $9.80 0 Landsrape Irrigation $0.00 0 P-Trap $0.00 2 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 QTY 1 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 04/07/2004 Issued: 04/07/2004 SumpPump Swimming Pool Trap Primer Unnal Vacuum Brkr Bkflow(1-4) Vacuum BrkrBkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilep Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $39.20 $0.00 $0.00 $29.40 $0.00 $0.00 $0.00 �TY 0 0 0 0 0 0 4 0 0 3 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 7241-92) 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 tor the work authorized under ihis permil to be considered legal, such work must comply with all applicable cotles. and all required Inapeetlona and final epprovel must be obtained. Failure to obtain inspections and tinal approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 244&d8 (B/00) . ,., . WORKERS' COMPENSATON DECLARATION: I hereby eHirm under penalry of perjury one of the following tlecleretions: � ❑ I heve and will maimein a cartificete of consent to self-Insure lor workers' compensatlon, as providad lor by saction 3700 of ihe Lflbor Cotle, tor the peAortnance ot Ihe work lor which this permil Is issuetl. ❑ I have and wlll malntain workers' compensation ins rance, as required by section 3700 oi ihe labor Code, for ihe performance of the work for which this pertnit is Issued. My workers' compens�tfon lrtsyJe_4e cerrie�nd �ol� number ere: Carner. not et one or less.) Policy Number: certity thet in t�e peRortnence ol t�e wojk for which t�is permit is issuetl, I shall not employ eny person in any menner so es to 6ecome sub�ect to Ihe workers' wmpensalion laws o Ilfomia, and egree t t if I Should become sublec[ to the workere' compensation provisions of Sactlon 700 o Ihe Leb r Code, I shell forthwith comptywiththese ovi lans. Applicent Signeture: � Date: WARNINO: FAILURE T EC E WORKERS' GOMPENSATION COVEM6E IS UNLAW FUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PE LTIES AND GN FlNES UP TO IXJE HUNpRED TFIOUSAND DOLLARE ( 1 , ). IN ADORION TO THE CQST OF COMPENSATION, DAMAGES AS PROVIDE� FOfi IN SECTIIXJ 3]OB OF THE LABOR CODE, INrEREST, M1D FTTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm Ihat I am forte anA BNecL Lic. A_ Contwctor's Signature: CONS7RUCTON LENDING AGENCV: Chapter 9(commencing with Saction 7000) of Division 3 of the Business entl Professions Code, enA my license Is in full Class M Date: _ _ �1 [ O / ❑ I hereby alfirm ihat ihere is a wnstruction lending egency for the peAortnance of the work lor which this pertnit is issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lender's Address: Signatura: OWNER-BUILDER DECLARATIONS: Date: I heraby ettirtn Ihat untler penelry ol OeQury Ihat I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5. Business end Professions Code: Any ciry or counry which requires e pertnit to construct, alter, improve, tlemolish, or repair any sWcture, prior to its issuence, elso requires the applicant for such pertnit m file e slgned stetement thet he or she is Ilcensed pursuent to the pwvisions al the Comrectore License Lew (Chapter 9(commencing with Sectlon 7000) ot �ivision 3 0l the Business and Profeuions Cotle) or thet �e or she is exempt thereimm end the basis for �he elleged exemption. Any vloletlon ol Section 7031.5 by eny epplicant for e permit sub�ects the epplicant to a civil penelty ol not more Ihan Ilve hundred dollars ($500).): ❑ I, es owner of Ihe propeny, or my employees with wages es Ihelr sole compensation, WILL DO 7HE WORK, and Ihe structure Is not Intended or oHered for sele (Sec. 7044, Business end Professlons Code: The Contrectors Ucense Law does not apply to an owner ot property who builds or improves thereon, antl who does such work �ImseN or herself or ihrough hls or her own employees, provided ihet such improvements ere not Intended or ottered lor sele. If, however. the building or improvement is sold within one yeer of completioq Ihe owner-builtler will heve the burtlen of proving ihat he or sha ditl not builtl or improve tor purpose of sele.). � ❑ I, es owner oi ihe property, am E%CLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the projecl (SecJ044, Business antl Pmfessions Cotle: The conlraciors License Law does not epply to en owner ol property who builds or Improves thereon, and who contracis for such pro�act with e conlrector(s) license pursuant to �hB Contrectors Licensa Lews.). ❑ I am ezempt under sec. Business antl Protessions Cotle tor this reason: SiqneWre: Date: Owner ID verifietl by tlnveYs license. ❑ Ves ❑ Na Drivefs License No. E:pires: Veriticetion ol Ownerehip by (type oi tlocumem, i.a. - properry taz bill or tleetl): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: ❑ I here6y certify ihat no excevetion five (5) or more feet In tlepih Into which a person is raquired to descend, will be made In connectlon with work euihonzed by this permil, and that no building structure, scalloltling, lelsework, or demoliiion or dismantling ihereof, will be more than t�irty-si: (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Titla 8, Califomia Administretive Code). ❑ As owner-builder, I will not employ enyone to da wark which waultl require a partnit from the Division ot Indusirial Salery, es notetl ebwe, unleu such person has e permit to do such work tmm the tliWsion. SignaWre: Da�e: Division ol Industnal Safery Pertnit Numbar: CER7IFlCATE OF COMPIJANCE AND AUTHORQA710N OF EMRV: I cenify under penalry ol perjury that I have read this ap0liwtion and stafe Ihat the intormation given is correcL I egree to comply with ell state laws end ciry ordinances releting to builtling consiruction, and authorize representatives ot the Ciry ot Costa Mesa to enter upon t�e above-tlescnbed properry for inspection purpwes. I egree not to occupy or allow occupency ol eny building authonzed 6y this Dermit until final inspection. CODE.I" INSPECTIONTYPE 1616 Fixed System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWReleining Well 202 203 Final Factory Fire Plece Final Sign 204 Final Demolition Qd¢, �§ 4Qp�� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final ElecMcal 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency � It� (714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 314g YELLOWSTONE DR 14153115 Applicant: SMALL, DORIS Address: kHqME OF THE MINISTERING ANGEL. °k GIBSO SANTA ANA, CA , Phone: 714-547-6221 111 W 17TH ST Zip: 92706-2718 Owner: HOME OF THE MINISTERING ANGEL Address %HOME OF THE MINISTERING ANGEL. % GIBSO SANTA ANA, CA Phone: 111 W 17TH ST Zip: 92706-2718 Contractor. Address: ISSUE FEE Temp service lesl Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixls Recept OulleLs , Swilches Non Res Appl Res Appl Service to 200a Service to 7000a Service over 1000a Motors to 1 hp Motors to 10hp OWNER BUILDER Phane: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 07/29/2004 Issued: 07/29/2004 SCOPE OF PERMIT LEGALIZE RECONFIGURATION OF INTERIOR NON- BEARING WALLS TO CREATE A NEW MASTER BATHROOM IN A FORMER CLOSET AREA. KITCHEN WAS RELOCTED ALSO. SCOPE OF WORK WILL ALSO INCLUDE: REPLACEMENT OF 3 BEDROOM WINDOWS TO MEET EGRESS CODE, 2 KITCHEN WINDOWS, 1 DINING ROOM WINDOW. DINING ROOM WINDOW WILL INCREASE IN SIZE TO A 4 X 6 WINDOW. MISC ELECTRICAL WORK ALSO. REF: 804-01851. ELECTRICAL TO WCLUDE: 13 LIGHTING FIXTURES, 14 OUTLETS, 8 SWI7CHES. 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $14.30 $15.40 $8.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 13 14 8 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway I100 fl Standing Section . Misc ElecUical Equipment Transtormers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conduclor Circus ( gen or nde) � Circus (mech ride or lighis) " Christmas Tree Stand Quantity $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 7, 7241-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO 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 requlred Inepections and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expira�lon of this permit. FOR INSPECTIONS CALL: (714) 7545626 26a8d8 (flq0) WORKERS' COMPENSATION DECLAFiATION: I hereby eMirtn under penalry ot perjury one ot the tollowing decleretions: ❑ I have end wlll mainlain a certiticele ol consent to setl-Insure lor workers' compensalion, es provided for by section 3700 ot the �ebor Code, lor Ihe peAarmance of the work lor whith t�is pertnit is issuetl. ❑ I have entl vnll maintain workers' compen ion Insurance, as requiretl by section 3700 of the Lebor Cotle, for Ne peAortnance ot Ihe work for whlch Nis pertnit is IssueC. My workers' cort(panrs�llopf Insurance�ryatl policy number ere: Carrier: I cetlify thet in ihe compensation law wm01y with ihe'se Applicant SlgneWj§: WARNINO: FAILUf� TO Policy Number: ' i3 val 40 et o huntlred dollers ($100) or IessJ f � hiCh t� pertnil i9 iuuad, I shall no� employ eny person in any menner so es to become sub�ect to Ihe workere' � at il I s, ald become sub�ect to the workere' compensation provisions�t $ect� 7��ot tl�e Labor Code, I shall fotlhwlth i � Date: ��•� ON COVERAOE IS UNLAWFUL AND SMA�L SU&IECf !W EMPLOVER TO CRIMI PENAL IES AND L FlNES UP TO ONE HUNDRED WST OF COMPENSATION, DM44GES AS PROVIDED WR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I heraby eHirtn lhai I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Code, anC my Ilcense is in tull force and ettect Lic. N qass k Contrectofs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a coreWction lending agency for lhe pedormance of the work for which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLAFiA710NS: I hareby eHirm thet under penalry of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or counry which requires e pertnit to construcL elter, Improve, demolish, or repeir eny structure, prior to its issuance, also requires the epplicant for such pertnit to tile e signetl statemern that he or she is Ilcensetl pursuent ta ihe prodsions of the Con�rectors LJcense Ww (Ghapter 9(commandng with Section 7000) of Dlvision 3 of the Business entl Professions Code) or that he or she is exempt t�eretrom enC t�e besis tor tha ellapetl exemption. Any violatian ot Sadion 7031.5 by eny eOPllcant tor e pertnit is e eppliwnt to e civil penalry ot not more then five hundred dollers ($500).): es owner of the property, or my employees with wages as ihelr sole com0ensation, WILL OO 7ME WORK, antl the siructure Is not intended or aXeretl tor sale (Sec. 7044, Business and Protessions Cotle: 71�e trectors License Lew tloes not apply to en owner ot Droperry who builds or improves thereon, end who does such work hlmself or herselt or Ihrough �Is or her o e loyees, providetl t�et such improvements ere not intentletl or o%eretl tor sale. tl. however, the building or Improvement is within one ye 1 letion, th wner uilder will hevo the burden of pmving ihat he or she did not build or improve for purpose ot sale.). I, es own the pro , em E V Y CONTRACTING WITH LICENSED CONTRACTORS �o ton5�ruct the pro�ec� (Sec. 7044, Buslness entl Pro1955ions Code� e contrac icense tloe ot epply to en owner ol property who Dullds or Improves thereon, and who contrects for such praect wlih e contrector(5) lic e pursuant e Conir ors Lic e Laws.). ❑ m exempt r c. B' feuions Gode for this reason: Sign ture: Date: Owne enfi by tlnvels lic . s ❑ No Dnvefs License No. Eapir : Vedlicatlon oi Ownership by (typ� ot docum8nt, I.e. - pmperry tea bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no ezcavetion live (5) or more feat in depth into which e person Is required to tlescend, will be matle in connectlon with work euthodzed by Ihis permit, entl that no buildinq structure, scattolding, felsework, or demolition or dismentling Ihereal, will be more then ihiny-sla (36) feet hiqh. (C�ap. 32, Grp 2, Art 2, Sac. 341, Title B, CalHornia Administretive Code). ❑ As owneo-builder, I will not employ enyone �o do work which would require e permit Irom the Division of IntlusMel Sefery, as notetl above, unless such pereon hes a permit to do such work irom Ihe division. Signature: Date: Division oi Intlustrial Sefety Pertnit Number: COOE �. INSPECTIONTYPE 7616 FI:eO System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roof 201 Final BIocWRetaining W ell 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition (Ifeg �$ �F,( INSPECTIONTYPE 206 Finel Mechanical 208 210 212 220 Finel Plumbing Finel Elecincal Final Fire Prevention Final Planning Approval 222 Final Site 250 Final Building/Occupancy Pdg L�ki 1 - : � �'��.�: .lobAddress: 3148 YELLOWSTONE DR Suite: Vicinity: Parcel Number: 14153115 Applicant: MARTINDALE, JOHN Address: 25602 ALICIA PKWY tt427 BUILDING PERMIT Zoning: ISSUED I Phone: 949 661-9541 LAGUNA HILLS, CA Zip: 92653 Owner: HOME OF THE MINISTERING ANGEL Address %HOME OF THE MINISTERING ANGEL. °/ GIBSO � SANTA ANA, CA Phane: 111 W 17TH ST Zip: 9270&2718 Contractor: HORIZON UNDERPINNING Address: 25602 ALICIA PKWY tF421 Arch : Address: Zip: Phone: 949 661-9541 LAGUNA HILLS, CA Zip: 92653 License: 798014 Phone: License: NEW INTERIOR SLAB 5" THICK SLAB, #3 FIELD VERIFICATION PER B.MORGAN. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $223.25 $1.29 $0.00 $0.00 $0.00 $224.54 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0. 0 PARKING Existinq: o Eng: Address: Status: ISSUED Applied: 04/22/2004 Issued: 04/22/2004 Phone: License: a�.vrc vr r�rtnu i ON CENTER EACH WAY, DOWLED INTO EXISTING FOOTING; ALL WORK SUBJECT TO Rear. 0- 0 Rear 0. 0 Reauired: ,0 FEESUMMARY PLANNING & ZONING LeR 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 si z,soo.00 s�2,soo.00 NOTICE: The work auihorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) E%PIRA710N: This permit shall automatically expire and become void it work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2ddbdfi(W00) WORKERS' COMPENSATION DECLAFiA710N: I hereby aHirtn under penalry of perjury me of ihe following deGarations: ❑ 1 heve and will maintain e certificate of conseni to self-Insure lor workers' compensation, es provitletl for by section 3700 0l the Lebor Code, tor the peAortnence ot ihe work Por which Ihis pertnil is issue0. ❑ I �ave and will maintain workers' compensation insurance, es reQuired by section 3700 of the Lebor Code, for the pedortnance ot the work for which this pertnit is issued. My workers' compensetlon Insurence wrrier antl policy number ere: Cerrier. Policy Number. (This secfion need not be compleletl i! Ihe permit is velued ef one hundred dollars ($f 00) or less.) ❑ I certiy that in ihe pedormence ot the work for which thls pertnit is issued, I shall not employ any person in any manner so es to 6ecoma subject to the workers' compense�ion law ol Call�ornie, and egree ihat il I should become subjeci to �he workers' compensation provisions o15ec�lon 3700 0l �he Labor Code, I ahall lorthwith complywiththes ro Isions Appliwnt Signature: �� Date: �C �L. Z —� �, WARNING: FAILIIRE TO S ,RE WOHKERS' COMPENSATIIXJ COVERAGE IS UMAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRINJWLL PENALTIES AND CML FlNES UP TOONE MUNDRED i/qU5PND00LLARE�51 ,000),INAODITIONTOTHECOSTOFCOMPENSATIIXJ,DAMAGESASPFiOVIDEDFORINSECTION3/060FTHElABORCODE,IMEREST,ANDATTORNEVSFEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHirm that I am licensad under Drovisions of C�apter 9(commencing with Saction 7000) of Division 3 of Ihe Business antl Professions Code, anA my license Is in full lorca end effecL Lic. e l Class A l� Gontractors Signatura: n. Date: 4- L z- c•-r CONSTRUC710N LENDING AGENCV: ❑ I hereby aHirtn ihat t�ere is a consiruction lending agency for the pertormance of Ihe work for which ihis permil is issued. (Sec. 3097, Civil Code). Lendefs Name: . _ _ ._ _ _ Lendefs Address: __ _ _ _ Signature: OWNER•BUILDER DECLARATIONS: Dete: I hereby eMirtn ihat under penalty of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry whic� requires a permit b cons�rucL elter, improve, demolish, or repair eny siructure, pnor to its issuance, elso requires ihe applicant for such permit to file a signed statement thet he or she is licensed pursuent to the provislons of the Contrectors License Law (Chapter 9(wmmencing wit� Sectlon 7000) ol Division 3 ot the Business entl Professions Code) or thai he or she is exempt therefrom end ihe basis lor lha alleged ezemption. Any violation oi Section 7031.5 by any eppliwnt lor e pertnit suh�ects the applicani to a clvll panelty of not more than live hundred dollars (5500).): ❑ I, as owner of the property, or my employees wi�h wages as lhelr sole compensation, WILL DO THE WORK, and the structure Is not intended or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner ot pmperty who builds or improves t�ereon, antl who does such work himself or herself or thmugh his or her own employees, provitletl that such impmvements ere not intended or oHered br sele. Ii, however, the building or impmvement is sold within one year ol completion, the owner-builder will have the burden of proving that he or she did not 6uild or improve for purpase ot sale.). ❑ I, es owner of the property, em EXCLUSIVELV CONTRAGTING WITH LICENSED CONTRACTORS to construct the projeci (Sec. 7044, Business and Professions Cotle: The contractors Licanse Lew tloes no[ apply to en owner ot proparty who builds or Improves �hereon, and who contracts for such project with a contractor(s) license pursuant to tha Contraclors License LawS.). ❑ I am exempt under sec. Business and Pmfessions Cotle tor this reason: Signature: Date: Ownar ID verified 6y dnver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership hy (type of document, i.e. - property tax 6111 or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify Iha� no ezcevetion five (5) or more feel in tlepth into which a person is required to tlescenq will be matle in connection with work euthorizetl by t�is permit, antl that no building siructure, swNoltling, falsework, or demolition or dismamling lhereof, will be more then thiry-sls (36) feet hiqh. (Chap. 32, Grp 2, An 2, Sec. 341, 7tle B, Califomia Atlministrativa Code). ❑ As owner-builder, I will not employ anyone to do work which would require a pertnil irom the Division of Industnal Sefety. as notad above, unless such pereon has a permit to do such work irom Ihe division. Signature: Date: Division of Industrial Safety Parmit Number: CERTIFlCA7E OF COMPLIANCE AND AUTHORVA710N OF ENTAY: I certity under penalty of perjury t�at I have read this epplication end siate Ihat �he iNormation given is correct I agree to comply with ell state laws and ciry ordinances releting to buildinq construction, end euthorize representatives of tha Ciry of Costa Mesa to enter upon Ihe ebove-described property br inspection purposes. I aqree not to wcupY or allow wcupancy of eny building authorized by this permit until tinal inspection. Signature CODE tl/ INSPECTION TYPE 7616 Fiaetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIaWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition PdIE IrmnA�S — Z 'L CO�EI INSPECPONTYGE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Preveniion 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy Data pLti�IJ�tl/.l j � �i i C,•i ,. Q'_,., .� V� .-�- ' � Applicant to fill in al1 spaces exceot tnose within heavy Dortler lines ana sign all appropriale tleclarations. CiTv oF ZBSTA ME�"�C�NSTRUCTION PERMIT',�^ ProlectAddress s2��fS� yP//oW5`f�o�vE �l/// n Applicant'sMailingAddress ZQ✓�7a i�l'/2�.('f sQ..;�'�,�{{d" � � r `� Owner;s•Name `L Phone ' sb'l D . Aadress 2�3 %a °RN �-{ � - Arch/Eng. License No. . Address Contractor's Nam �� .a.�� Pho�e � Address (mailing) � , Ciry. License No. � LICENSED CONTHHCTOR DECLARATION � ' � - I hereby affi�m that I am licensetl untle� provi5lons of Chdrtet 9(commencing wlth section �000) oi Division 3 oi the Business'antl Professions Cotle; antl my Ilcense is in full force antl elfect. • ' ' LiCense Class license No. � Oate Si9nature � � WORKERS' COMPENSAT�ON DECLARATION •. � "�ereby affirm that I have a certificate of consent to self-insure or a certi�icate Workers' Compensatioq Insurance, or a'certifietl cOpy the�eof (Section � J0. Lab. C.) . , . �' / . Policy No. Company - ' 8 Certitietl copy is hereby �urnishetl. . � — Certifietl <opy is lilee with the city Builtlinq Division. Oate Applicant � '�.�. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' �� (TM1issection need not be cOmpletetl if tM1e permit i5 (or one hUntlretl ($100)br� less). � � ! � .- • ., I certlfy that in the pertormance of the work tor which this perm�Lis issuetl; I� shall not em0�oy any pe�son in any manne� so ds to becoTe subject to Ihe �1 workers' Compensation L.zws ot California. ' ' - „ Dale � $i9nature � ' NOTICE:Af, after making this'tleclaration, you should become subject to the Wo�ke�s' Compensation pYo��sions ot [he Labor Code, you must tortnwith comply with such p�ovi5�ons o� this Oe�mit Shall be tleemetl revoked. CONSTRUCTION LENDING AGENCY I hereGy atfirm that there is a Construction Ientlin9 agenty fo� the pe�fo�mance ot the work.for'which this permit is issuetl (Section 309� Civ. C.) Lentler's Name - Lenaer.'s Atltlress OWNER BUILDER DECLARATION I hereby affirm that I am ¢xempt �trom [he Contractor's License Law for the following reason (Section 7031.5 Business antl protes5ional Cotle: Any city or county which �equires a pQ�mit to construct, alter, imOrove, tlemolish or �epal� any structure, prior to Its issuance, also requires the applicant tor such permit to file a signetl statement Ihat he/She is IicenSetl pursudnt to the provisions of ihe Contractor's License LS�+ (ChaOter 9(commencM9 with Sec[ion 7000) of ^�vision 3 ot the Business antl Professions Cotle) orthat b¢/She is exempt retrom antl the basis for the allegetl exemption. Any violation oi Section ❑.5 by any applicant fOr a permit subjeCts [h¢ applicant to a civil .._ i�YrDt not more than f{�e huntlretl tlollars (E500). L�Y, as owne� of the proPerty " ' � will tlo the work, antl the structure is not intentle0 or ofteretl for sale (Section 7044, 6u5inezs antl Professional Cotle: The Contractor's License Law tloes not app1Y to an owner o! a properry who builtls or improves the�eon, antl wno tloes su�h work himself/he�selt o� tM1rough his ar her own employee5, provitletl that 4uch improvements are not intentletl or otfered (o� � Sale. If, however, the bulld�ng or Improvement is soltl within one year of com- pletlon, the owner will ha�e the burtlen of proving he/sM1e diQ not builtl or im- prove for the purpose of sa�e). ❑ I, as owner o( the property, am exclusively contracting with licensetl con- tractors td construct the pro�ect (Section �044, Business antl Professions Cotle: The ConVactor's License Law tloes not apply to an owner of oroperty who builtls or improves Ihereo�. and who contracts for SucM1 prolects with a mn- t�attor(5) I¢ense pursuan[ to the Cont�acto�'s License Law�, 1 am aware that proof of <M1eit Worker's Compen5ation insurance Shoultl be provitletl to me. ❑ I am exempt untler Sect�on � �" �+ �^'lfor this reason �� bate • I hereby intormatii antl state • sentatives \ inspectior $ignature � Driver5' L � 0865-46 Owner to �/� �E OF CONSTRUCTION LJ NEW 1�' ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCFIPTION OF WORK/USE OF BLDG. R�� TYPEOFPERMIT LJGRADING ❑ TENANT IY�` ELECTRICAL O OTHER PROJECT DESCRlPT10N 5Q. FT.- 1 FOUNDATION IL�J STRUCTURAL P�UMBING ❑ MECHANICAL �CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU.VDS. A( Rema�ks: . • Sink Preventer Irrigation Floor Drains Floor Sinks Gas Service , � Outlets Interceptors . � Kitchen Sink ' Lavatories �, P—Trap Roof Drains � � � Reinspection Fee $15 Boiler Duct - Under Ground Duct-Strucmral i Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑6100,000 BT.0 0100,000 Reinspec[ion Fee � $15 , rev. 30/04 WNte - Builtling; Canary - Applicanf; Pink - Accounting; Goltlenrotl - Assessor Showers SerJice Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water Closet . Wate� Service . Auto�Wash Lauodry Srays Issue Fee IANICAL Hood or Typel ❑ ` Canopy Type I I ❑ Refrigeration System ❑o-ioo,000eTu ❑iao,000 System Repair/Alteration Fire Dampers » Registers . Issue Fee FEES $ 3 FEES $ 3 A.P. # -� S Main Building: E T Front ARear ' � �Right Q� Left 'Q� Ping. Ref. # Planning Notes: , � 7804 6%18%86 � � Zone ' Accessory Building: Parking Req./Provided r�a_ I a _�� ?-6�»ti i %.IltOflld(IC Wd5f12! Construction Pole Sub. Caoking Unit � Dishwasher Dryers ❑Gas ��Elecvic Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generetor �0-5 KW C Fee ¢.. 302. 07 '�L ELECTFICAL ' ' ' FEES Transformer ❑ 15-50 KW ;. ' =. � ❑ 50+KW' =: i �_� i . t s: Meter �up to 1��amps' . Meter ❑o�er100amps -" , . Sub Panel ' • - - � � Motors�Pi HP07h-8 �.. InaSolar �9-15 HP'016-15+• • Microwave � . • Pole Light ' 'Range. Sinn � � Standing Sections 5-15 KW Trash Compactor . i $75 Issue Fee DEVELOPMENT SERVICES REQUIR Zoning Appraved 8y Building Approved B� $ 3 Z O N I N G R E Q M T 5 SU VOf�FEES. �i p� BUILDING PERMIT $ CJ SMIP .� �$ ZJ'� PLAN CHECK $ PERMIT PWMBWG $ OO ISSUANCE $ PLAN CHECK 25% $—. • S'0 ENERGY P.C. $ ELECTRICAL $ � I GRADING $ PLAN CHECK 50% $ � MICROFILM- $ MECHANICAL $ TOTALFEE $ �� PLAN CHECK 5% •$ ' � �.' u ` � ' CONSTRUCTION AND PLANNING � POOL & SPA � APpROVAIS Permit# Date Inspector APPROVALS Permit# Date Inspector' v� 1. Temporary Electric8l Service or Pole 52. Pool & Equipment Location � ' 2. Soil Pipe-Undrgrnd. •, 53. Steel Reinforcement 3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �'. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6� Electrical UFER Grnd. 8 (, 57. APPROVAL TO COVER-GUNITE � 7. Footings, � � � , � � •� a(, 58. Electrical Conduit-Undrgrnd. = 8. Foundation� i: �b 9�- 59. Gas Pipe, � Undrgmd., Test � 9� Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System B% 6 61. APPROVAL TO DECK . i l. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System � Final � 14. Fiough Plumbing _ 65. Electrical-Final 15. Rough Electricai-Conduit 66. Solar System-Final 16. Rough Electric Wiring �� , bb. �l� g7. Fencing & Access Approval � r 17. Rough Wiring Sign � �G_�_fr` i ^� 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 Firepiace APPROVALS Permit# � 21. Ducts, in Structure 70. Underground Hydro 22. pucts, Ventilating� 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. RoofFraming _ 73. Undergmd.StorageTankOGas OOiI 25. qoof Sheathin9 � �6 � 74. Overhead Hydro 26. 7-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical 27. Frame and Flashing �03 � ��. 76. Dry Standpipe - •� 28. Lathing - � 7� p� 77. FIXED SYSTEM FINAL 29. Insulation /6 �. B(� i�/j 78. FIRE PREV. FINAL 30. Drywall Nailing �a 7�,p/� HEALTH DEPT. REQUIREMENT . 31. plaster 8rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED �� , 33. Final Electric v_ a� Notes: 34. Final Heating & Air Conditioning �� `� 7 � 35. Final Gas Pipe-Test . r�_2�j-YG L/�-' b� 6 �1 - 36. Hood or Canopy � �% �' t^ , r� 37, Final Factory Fireplace . `� -Z'��(, F�iAS i`lCY `�,n;r �„�� 38. Final Plumbing � �� , �,Q � � ' 39. Water Service-Final ? n - %�j•.l-f� ^onnti/Zli... GvfY! c�IT �O �l$Li� ) S 40. Gas Service-Final � (J, �; GD/jo � Jl .'w..0 � /ivlt yc.,,, /� b � 41. Solar pomestiaFinal G-/-f�o,i(/p w C�llc� i J' fl-%v4�- ooi�te�'� 42. Backflow Preventer � y, &` _ % 43. Backflow,lrrigation � � . 44. Landscape Irrigation System 45. $ound Attenuation 46. Handicap Regulations . 47. FINAL�$TRUCTURE & BUILDING /p �-�J; L� r 48. Special Requirements Completed ', ' � 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co i 51. CERTI F ICATE OF OCCUPANCY . N0. Date � • . _� , n. •-f 1 �I � - .` CityofCostaMesa INSULATION CERTIFICATION� suildingSafetyDivision 3 I�� 1/iF-�' IL.I/�U�L' _� � J �� 0� Number and �eet City Counry Subdivision Lat Number DESCRIPTION OF INSTALLATION ROOF r Material Thickness (inches) � __ EXTERIOR WALL� Material � Thickness (inches) _�/ CEILING Batt or Blanket Type Thickness (inches) Loose Fill Type Minimum Thickness (inches) Area Covered (ftZ) FLOOR,ELEVATED Material Thickness (inchesl FLOOR,SLAB Material Thickness (inches) Width (inches) FOUNDATION WALL Material Thickness �inches) Brand Name Therma I Brand Name Thermal Brand Name Thermal Resistance (R Value) Brand Name Number of bags Weight per bag Ib. Thermal Resistance (R Value) Brand Name Thermal Resistance (R Val Brand Name Thermal Resistance (Fl Value) Brand Name 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 regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Administrative Code). _ _ , _y _ Sub Con ector Ilnsulation Applicato�) Signature and Title CMF 1106-46 License Number �/,� ;�.`7�-��-- Date License Number Date 0 ADD�i�ant to till in ali spaees excevt those within neavy DorOer lines ana slgn a1l approvriate Oaclarations. CITV OF COSTA MESA CON�$]TR1UCTION PERMIT�//'/ Project Address ��R `-+p �(V �y� a%'e— (�!{{ Applicant'sMailing dd/re�ss Z 77 � r� h� ��.( Owner's Name �aL� �—�— Phone Addreu 7 ��-- �/Y Arch/Eng. License No. Address Contractor's Name— hone Address (mailingl City License No. LICENSED CONTRACYOR DE ARA ION ' ' I hereby aHi�m [hat I af� licensetl untla� O�ovi5iOn5 oi Cltarter 9(commencinq wi[h section 7000) of Division 3 o( tbe Business antl ProfesSions Cotle, antl my Iicenze is In full fOrCB antl effect. . ' license Class � Licensa No. Date yi9nature `N00.KER5'COMPENSATION DECLARATION iereby aHlrm that I ha'/e a certiticate oi consent to salf-insure or a tertlilcate Workers' Compenwtion Insurance, or a certifietl toDY thereof (Sectlon 3800. Lab. C.) Policy No. Company Certitietl coOY Is M1eveby furnishetl. Ccrtifletl copy�is filed w�th th¢ tlty Bulltling Divlslon � Date APPlicant ' � � EXEMPTION FROM WORKERS' COMPEfJS�q 1 C RAT N (This section neetl not tio compleled i( tfie o m� s r '� dn tl($100) or less). ' � j / ' I cOr[iry Iha[ In the perlo�mance of tna, yk e�mk ISlssuetl, I NOTI�E:if,�l(ter MajEin9 tnis o lar ou � Id become subject to the. Workers' Cortlp¢nsdtion Provi o 5� otle, You must forthwith comply with such pra��sions r 1 all ne tleemetl ravoketl. CONSTRUCTION LENDING AGENC I hereby aiflrm tnat tnera Is a mnstr ion le tling agancy tor Ihe pertormance of the work tar w�ich tnis mit I5 issuetl� (Secbon 3097 Civ. CJ Lentler's Name �entler'S AGtlreSs OWNER BUILDEH DEGLARATION� � ' I hereby af(irm that I am exempl (rom Ihn ContractOr'S license �Law tor the followinq reBson (Sectlnn 7031.5 Business antl Professional Cotle: Any city or county which �equires d Pe�mit to conStruGt, alter, ImprOve, tlemolish or �epair any s[rut[ure, ptlor lo its is5uante, alm requires Ihe applicant (or such permit fn file a cionntl clatemnOl Lhdl ne/sne is Ilcensetl oursuant to tne orovisions of- Irom antl the basis �or the alle9etl exemption. Any violation ot Section .5 by any applica��_ for a permit subjects the appli<ant to a civil [y of not more tnaP ��e huntlretl tlollars (5500�. as owner ot the Property: ' ' � � will tlo the work, antl thc ilructUr¢ IS not i�tentletl Or Otf¢r¢ se Law tloes not apP�Y �o an owner ot a properry wno owws or improves )n, antl who Oo¢5 SUCh wo�k himself/h¢rselt o� Ihrough his o� her own >yees, provitletl tM1a� such improvamentz are not Intentletl or offeretl for If, howeve�, tne bU��tling o� imp�ov¢ment IS Soltl within one yedr OI com- m, the Owner will have the burtlen of proving he/sne �itl nOt build o� Im- for the purpose ot sale). ' az owner ot the property, am exclusivery contractin9 with licensea con- builtls or improves thereon, antl who con s tor s� ro�ett$ wi�n a con- tractor(s) litense pursuant to thc Con r' '� aw) �I 4n are that proof of thelr Worker'S Compens ' n� W � u d�f o' etl [O me. ❑ I am.exemot untler SFction �� 6' on�eason Da[e, Drivers' CMF 0865-� [hal � P 4� li�n antl state Ihat the above ;iS . all clty antl county orainances lat 't uc�0 ,��W hefeby authoriie rep�e- ova-mentionntl Oroperty_op� . _ �.� Oate TVPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p# DESCRIPTION OF WORK/USE OF BIDG. S Main Buildi TVPEOFPERMIT GRADING ❑FOUNDATION STFUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf ❑ OTHER A PRO�ECT DESCRIPTION 5�. FT. oCCUPaNCv C Right K Left CONSTRUCTIONTVPE VALUATION$ $ ZONE GRA�INGCV.VDS. ACRES PIng.ReL'/k Remarks: ��p�m � � Planning Notes: Sink Preventer Irrigation . Dishwasher , Drinking Fountainsf � Floor Drains �^ Floor Sinks � - GasService • Outlets InterCeptor5 Kltchen Slnk . Lavatories P—Trap Roof Drains � Reinspection Fee � I $15 Boiler �uct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple � Firepl/Fact. Blt. ICBO #�°JO Heating System & Ducting ❑ ai oo,000 sru � i oo,000 e Reinspeetion Fee � $15 White - Bulltling; Canary - Applicant; Pink - Accounting; Golaenrotl - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solai Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fea FEES $ 3 Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher ' Fan F.A.U. ., Fixcures Device Boxes Outlets GaPoBge Disposal Generator �0-5 KW �5-15 3758 9/25/86 � _�one Actessory Building: Parking Req./Provided EIECTRICAL Transformer � 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps Meter �over 100 amps Sub Panel Motors061 HP�iX-6 IncSolar �9�15 HP Oi6-15+ Micwwave Pole Ligh� • Range Standing Sections Trash Compactor Reinspection Fee $15 Issue Fea IANICAL FEES Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS: , Canopy Type I I ❑ 2aning Approved By _ Building Approved By �� Refrigeration System 00.100,OOOBTU ❑700,000 System Repair/Alteration Fire Dampers Registers , Issua Fee '$ 3 BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ 8.00 TL Z O N I N G R E Q M T S FEES 3 3 OF FEES — SMIP $ , � _ PERMIT _ ISSUANCE � $ _ ENERGV P.C. $ GfiADING � $ � MICROFILM $ (''�� 7� ,.J� TOTAL FEE $ 1S�dL_ CONSTRUCTION ANDPLANNING PO� ,SPA : APPROVAL$ Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Fooiings 58. Electrica! Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O 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 1�4. Rough Plumbing • 65. Electrical-Final 75. 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 Ct.?�p_ �� APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Foof Sheathing . � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) � Monocoat 75. Dry Chemica! 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEP7. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning . 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace �tl_�,yL L� 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING • � 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. Date � � OWNER ��Y, JAMES W. DA•I.E 1-22-62 aos nnnx�ss 314�8 Ye11.ow�bzive s�iLnirrc rrRn�iT No.i6225 GENERAL CONTRACTOR OW71T-B1dT. VALU� $�� AP No. LO'IS TRACT 450O RIRG ZONE DCSCRIPTION OP WOR[{B OCk�- 41a11 IT`�P�CTIONS c DA7'li � GROUP TYPE ZONE � SUBCONTRACTOR = ' -� E s�2� COSTA MESA BUILDItJG-SAFETY DEPARTMEN7 P. O. BO% 917 C09TA MEBA. CA6IFOFiN1A For Applicanf to Fill In Complefely TYPE OR PRINT BUILDING p r Q ADDRE66 �/ l. �� J ��%(� . %� 1� G COSTA MESA CALIFORNIA � MAIL ARGHITECT t,�' y� OA �•GINEER �'✓ R e i ADL.nESS �' CONTRAGTtlR `-'�� ADDRE65 an STATE ----�� LIC. NO. s�ZE /Q�o x �6.�{S OF LOT � B6iHAGK LMf PROM TEL. _ NO. TEI.. ,�� 73 � I NO.OR BItGB. NOW ON LOT OF WORK F E RECEIVED JAN 2 1 FINANC� ��PS. CITY OF COSTA MESR APPLICATION FOR PERMIT auaoiN� For Office Use Only RPCEIPT NO. PERNIT NO. _ BY COSTA MESA, CALIFORNIA FIRE ZONING Z$NiE NO.OF BH�OR %K / I I PLANS BUILDIN o- LEOAL / . -�� /l � IC6NT8R YNH OT.] EVES J BY / L� / DATE � i� � BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL IROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED O C t /� O � � � / � F��, �isa 1 HERBBY �GKNOWLlOGE THAT 1 HAVE RBAD THI9 MP4IGTION TXE AMOUNT BHOWN UNU6R VqLUAT10N 18 FOR TNC AND BTATE THAT THE ABOVE IB CORREGT ANO AGREE TO GOM- PUiiP086 OF EBTABLIBHINO A P¢qMIT FE6 ONLY. PLY WITH A�L GI ORDINANCE9 AND BTATE 8 HE611LATING eu��nlNo coNe ci�ax. VALUATION - SIGNATURE OF � PERMIT PEE $ PERMITTE ' ' S . � �.��. PLAN CHECK $ AUTHORIZ AGENT � / ^ TOTAL FEE I,ot S Tr . `� - :�_�4:�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIPORNIA For Applicant fo Fill In Compleiely TYPE OR PRINT COSTA MESA. CALIFORNIA TEL. NO. TEL. � STATE � ./ /nn•�� I u0'•oF,BLD69. .� � 86TBACK LINH FROM % ` i LEFT RIGHT DESCRIPTION OF WORK EXTERIOR WALL ROOF $OC]C COVERING COVERING U8E OF BUILOING AND WOftK TO BE PERFORMED Sinir_i c�nu�i v Rrcinrrarr ni FEE RECEIVED `��- MAY 17 t°St fINANCE DEPT. CiTY OF COSTA MESA ' APPLICATION FOR PERMIT BUILDING For Office Use Only � RECEIPT NO. e P,gtM�T(M'Oq JL.A�$��5��Y !Y I O��I�EI`E� I. )�/lC�S�/ BUILDING ADDRESS COSTA MESA. CALIFORNIA � APPROVED ZONING �;�, ae� ZONE NO. OP /� U6E OP NE y. R�� PLAN6 G BUILDINQ[� HtV �jAl • LEOAL �'t' S• L1aC� �JVV OEBLRIPTION YARDS EVES APPROVE� ALLO (C6NTER LINC 9TJ. ( s� APPROVED ev W. L. D. rlb. O � iS.�oO/ � HEPEBY ACKNOWLlO6E THAT 1 XAVE REA� TH18 APPUGTION TNE AMOUNT BHOWN IINDER VALl1ATION 19 FOR THE AND BiATC THAT THE ABOVE ib CORNECT ANO AGRE6 TO COM- pUPPOBE OF E9TABLIBHING A P¢RMIT FEE ONLY. PLY WITN ALL CITY OMINANCEB /�ND BTATE LqW3 REOULATIN6 Bu1LoiNo cOXeiRUR10N. � VALUATION SIGNATURH OF PERMIT FEE $.�5� N PERMITTE � �— $ ��/ �� PLAN CHECK $ I %^S J AGENT UWNtK tc�LLY� �ames UAIt � io io LOT SUBCONTRACTOR E ROIIGH PLOMBING I I�i ��JA�. r��- �_ ' ,, - 7„�_xy�_� I 3 PROP. SwR. LINE MOOSE CON. L�Yr � /% I LANEOUS ROUGN HEATING ANq q�R CON�ITIONING TEMPORARY SERVICE OR POLE UNDERGROUN� � POWER � ROUGM WIRING TFENCHES FOAMS STEEL REI FLOOR SYSTEM REI SNERTHING FRAME ANO F�qSHING LATHING — IN r] PLASTER.BROWN Cba H! .G, VENT., REFRIG. AN� A. PLlIM91NG. FINAL Ruft f.a5 TEST _ � 41434 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant ro Fill in Completely — Use Ink Only BU�LDING �I Q � C�\ w �a� � AtlDRESS p OWNER ,4 l ADDRESS 1� ItZ�Y\� Cti 17 � TEL. cirv C...\�-c. M scr No. S�� 7i qpCH pq EN AODR TEL. �� _ v�io �a _ .,. 11 !;nr, �e-�d�,�'.00 886'� ***•-1O.�C APPLICATION FOR STRUCTURAL PERMIT RECF�IVE�1 BV D��A=E REf�EI�j O�E IS; V�' ��i�� iu a BUILDING ADDRES: OWNEF — FIflE 20NE APPROVED (.p- eY �� DATE A�DRESS 11 �p I� �np�t ` TEI. ZO NO.OF USE OF NEW CIY�' GQN N O U C NO. i Q�Z�% P�� BUILDING � STATE CITV VAFDS APPROVED VARDS APPROVED ^��! LIG. NO. a�� UC. N. MAIN BUILDING ACCESSOflV BUILOING {a] SIZ'� ryp,pp �pGg, (FROMGLSTREET) 0. OF LOT NOW ON LOT OM FT. FT. a USE OF � EXI�ING BLDG. FT. h FSeparate permits are required for L. SIDE T PT. � electric, plumbing and heating work. REAa FT. FT. W� USE OF BUILDING AN WORK TO BE PERFORMED OISTANCE BET. BET. MAIN & MAIN 8LOG5. ACCESS.BLDGS. i VAR, iW DATE � Y� C.U.P.qW APPROVED Q ^ � APPROVED , 1 3 � IQ �i �., V p \o ...1 a � � I horeby acknowletlBa that I have reatl this appliceNon antl cteta � � Mat che abova Informetion ia corract enE aprae to comply with m a ell laws reBulatlnp builtllnB construetion, entl I shail not omploy y Z any percon In vlolatlon of the workman's compensation laws of m � ihe State of Californle. - � I hBroby certify t�ei I om proparly Ileonsotl aa a con[reeior untlar SQ. PT. a tho Smte af Cellfornla Busfnaza entl Profaufone COCe, Dfviston 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF m C�ePter 9, end Met �uch Iicanws or¢ in tull torea end eftoct, or I THE 7URPOSE OF ESTABLISHING A PERMIT FEE ONLV: � am exampi from tho provislona at No State ot Ifornia Businass a VALUATION PERMIT FEE S Bntl P�o}eSSIOnS Cotl DlvifiOn 3, Chaptel 9. � � PLAN CHECK S "� Slpnoture of � � Po�TIKeo $ LL �, TAX S � U AuChoAied Apppt � T�TAL PqID § �