HomeMy WebLinkAbout1924 KAUAI DR - Building Permits CITY OF COSTA MESA
os n BUILDING DIVISION
N:It Si'Ai 1g" 77 FAIR DRIVE. COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesacaMov
fl . FOR INSPECTIONS CALL: (714)754-5626
`*•ri nso PERMIT NUMBER: P11-00185
PERMIT TYPE PLUM STATUS: ISSUED
APN: 13951105 DATE ISSUED: 10104/2011
ISSUED BY: KJB
JOB ADDRESS: 1924 KAUAI DR CM Suite/Unit:
Vicinity:
SCOPE OF WORK: CHANGE OUT WATER HEATER.40 GAL. SAME LOCATION
OWNER: MARTIN,BARBARA CAROL TR Address: 1924 KAUAI PL
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: KENNETH BLOCK Address:
PHONE: City/State/zZip:
CONTRACTOR: ALL STAR WATER HEATERS INC License No. 812894
Address: 30300 PUERTO VALLERTA
PHONE: 800-727-0977
City/State: MENIFEE,CA ZipCode: 92584 CELL:
NF
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
TOTAL FEES: $35.80
Lti
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE S INSPECTION TYPE DATE INTT6A4$ CODE 9 INSPECTION TYPE DATE IN7111ALS
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
204 Final Demolition 250 Final Building/Occupancy
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drives a license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
�pgAprfnance of the work for which this permit is issued.
(r
I have and will maintain workers'compensation insurance,as required by
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carder and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: r) ��.yy person is required to descend,will be made in connection with work authorized
Carrier: (9 v /
v, � i ilia.-�,e 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
(This section need not be comgetedAThe cermi aJyeC at ne hundred dollars($100)or less.)
Policy Number: /610' l//% 2 Art 2,Sec.341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the worke ' •: pensati.i laws of California, and agree that if I should•
become r.iiject ers' ••pensation provisions of Section 3700 of
Applicant's Signature Date
the - or / iij• •• ply with these pr sions.
/ OD at� / Division of Industrial Safety Permit Number:
Aar Signature a / HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARt G: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
Lic.# _ alli es'` Class# i (Section 25533 of the California Health and Safety Code, with some
• exceptions, requires registration with the Costa Mesa Fire Department by
aide/ each business which at any one time has on hand a quantity of acutely
`/%/_...a�I�.Z. re Date 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
CO. -UCTION LENDING AGENCY: temperature and pressure).
• I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lenders Name: hazardous materials)? ❑Yes ElNo
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes',the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044. Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If-yes',attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ 1 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
jt!•� r.}-1A. _ Date
Signature Date i /�—��///
3057-461107) '' i p r
ndlor Authorized Applicant Date
•
CITY/JF.COSTA MESA
� BUILDING DIVISION
$ 1 DEVELOPMENT •SERVICES DEPARTMENT • PERMIT BER
.• r��4. t
i PERMIT _ --- -- . ------ -- B -01982
• r
(714)754-5273 • Fax(714)754-4856-••www.ci.costa-mesa$.IMLDING PERMIT 77 FAIR DRIVE;COSTA MESA,CA 92626
Job Address: 1924 KAUAI DR Status: ISSUED
Suite: Applied: 11/02/2005
Vicinity: ROOF Issued: 11/02/2005
Primary Occ: R Type of Construction: V-N
Parcel Number: 13951105 Zoning:
Applicant: BRIAN WOLSKY
Address: 17662 METZLER LN
Phone: 714-847-9332 ISSUED BY:
HUNTINGTON BEACH,CA Zip: 92647
Owner: MARTIN, BARBARA CAROL TR
Address 1924 KAUAI PL
Phone: R .R... '\ p
COSTA MESA,CA - - - Zip: . 9,262
Contractor: TOM BYER ROOFING ,
Address: 17662 METZLER LN "
Phone: 714-847-9332
HUNTINGTON BEACH,CA
Zip: 92647 License: 575002
Arch : - Eng:
Address: - •_ Address:- •
•
Phone: Phone:
Zip: . License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 15#FELT,40 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS
NEEDED.3,200 S.F.INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 —• — Cab Valuation: 512,200.00
Permit: $223.25 Claim Valuation: .$12200.00
SMIP Res: $1.22
SMIP Corn: $0.00
Other: $0.00 -
Inspection: $0.00
Total: $224.47
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 thispermitto 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
2448-46(IYee)
DECLARATIONS ( Th
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty,of perjury one of the following declarations: •
❑ 1 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.
for which this permit is issued. ,
C
_ Lhave 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 worker ' ort nation Insurance carrier and policy number are: /(Q/OS
Ca ar:! / Policy Number: t
-(7i s'section need not be completed if the permit is valued at one hundred dollars(S 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 be me subject to the workers'
compensation laws• --'•. ia,and agree that if I should become subject to the workers'compensation provisions of Section 37 of th Labor Code,I shall forthwith
C
comply with thes •ro i: •nstu . I/ 2D�
P
y.
Applicant Signare;- � Date:"��-
_WARNING:FAILU E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
Lhereby affirm thattam 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
CBand effect.-Lic.4 5 ?5002- LClass ff— -3
Contractor's Signature: „7! '0C
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 penaltypf 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,Llmprove,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. _ _ Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)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 foracutely 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 a ermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? ❑Yes U 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 ❑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 Duality 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 comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ign lure al Owner(s) Date
—And Auth 'zed Applicant I Date
CODE r gISPECRON TYPE ' PdlE" r !MAW CODE 4 INSPECTION TYPE ItBIDELS
1616 Fixed System'Final Fire Prevention • 206 Final Mechanical
1266 Pool Spa Finalq • 208 Final Plumbing
200 Final Re-Roof 6/ V�y� 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
PROJECT ADDRESS: 1924 KAUAI DR 1pI
DPW: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 064577
GOVT: N SUPP: N
OWNERS NAME: MARTIN, L F
ADDRESS: 1924 KAUAI PL PERMIT NO: P 069577 PLAN CHECK NO: N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: NEW
• ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : HOUSE WATER REPIPE
• ADDRESS: UNIT: SQ FT:
•
PERMITTEE: K.C. PLUMBING (714 ) 998-4622 CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
ADDRESS: 2372 GLASSELL AVE A COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT
ORANGE CA 92665 ****************************+t**ar**-x***************+s*yk*************yk************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect.
CITY LIC.: 006559 STATE LIC.: /c.:281476 , CLASS: _36 SETBACK S
xiDate:JO— 2!— 9 3 Signature:_/C 1� k.T2 zf MAIN BUILDING ACCESSORY BUILDING •
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: P60ID6144B EXP.DATE: 09/24 /94
COMPANY: PACIFIC NATIONA PARKING REQ: PROV: PARCEL : 13951105 ZNE; REF NO:
' -J Certified copy is hereby furnished. Q4 Certified copy is filed with the city Building Division. PLANNING NOTES>
> ..
—7Dale: /e—z/—G 7 Applicant: E-V✓ !`C'.rCt<.-t—� **** •
***************************************************************************
/ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E R V I C E S, ,, REQUIREMENTS
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. ZONING APPROVED BY . :1' -/
• DATE:
Date: Signature: •
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY . , 1*- DATE:
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 AP PL I CAT ION ISSUED BY: .,w� J
i!- DATE: (,� .4
which this permit is issued(Section 3097.Civ.CI. ***************************************** f* *****************�*******Tail-4.414.51.1
�iFif*
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State license Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 7 • 0 0
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 20 . 00
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 7 . 00 20 . 00 0 . 00 27 . 00 27 . 00 • 00
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
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 27. 00 OVER/SHORT: 00
forthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 27 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such protects with acontractor(s)license pursuant to the Contractors'Slate License Law).l am aware ,**,*,**,******„*****,**,****,**,*******,************************************************
that proof of their Worker's Compensation insurance should be provided to me,
o I am exempt under Section: B.&P.C.
IND I V IDUAL F E E BR EAKD OWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date. Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and PLU 1 WATER RE—PIPE 7 , 0 7. 00
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 END OF FEES
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from
these provisions.
Dale- Applicant:
I hereby certify that I have read this applaation and state that the above information is correct.I agree to comply with all city and county
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. '. 00149323-00149323 TOT 27.00
Q DATE: 10/21/93 TIME: 11:13
`T,
/ Date: /G—z/ - 3 Signature:
Driver's License or Social Security A: •
i
t 64 n46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
_z _
CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. E ectrical Conduit-Undrgrnd., 55. Electrical Bonding 4
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Foundation f / 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 1. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
.w _
10. Structural Floor System 61. APPROVAL TO DECK
�' I1. Property Sewer Line & Houle Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final
ft
14. Rough Plumbing �' Jr 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final 1
I
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
1
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro 7
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
•25. Roof Sheathing 74. Overhead Hydro j
1
26. T-Bar Ceiling (Structural) & Morocoat 75. Dry Chemical i
27. Frame and Flashing - 76. Dry Standpipe -
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
.
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 1
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test nth*/ t -1
-
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing /071-13 tier
39. Water Service-Final •C���
40. Gas Service-Final
41. Solar Domestic-Final
1
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OF BUILDING: 1924 KAUAI DR WIT: . CITY OF COSTA MESA — BUILDING PERMIT
OWNERSNAMEIP!NOmH: MARTIN, L F PERM NO: B 079880
I . - A?onEsr 1924 KAUAI PL
s COSTA MESA,CA 92626 PERMIT NO: B 079880 PLAN CHECK NO: 04149-96 S GOVT: N SUPP : N
APPL.MAURO ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: La: JOB DESCRIPTION : 30LINFT@6 ' HIGH & 20LINFT@3 ' RCMU WALL SQ FT: 50
ARCK OR ENG.'S ADDRESS: WIT:
Ct CLAIM VALUE: CALC—VALUE: 1 , 000 . 00 GROUP OCG: R-3 /U-1
aNTnAcrowsNAME: GLASSELL CONSTRUCTION ( 714 ) 434-7744
CONTRACTORSMAILING 2802 SHANTAR DR COMMENTS: 50 TOTAL LIN FEET OF RCMU WALL /30 ' @ 6 ' HIGH & 20 ' @ 3 ' HIGH
ADDRESS COSTA MESA CA UC.NO.: 454030 *x-****+ *****+t* -*+E***+E+E*******+EM********+f-***x-********************* -****x.***.N.***+E
92627 WI Z ON ING R EQU IR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter e SETBACKS
(commando with Section 7000)of Division 3 of the Business and Professions Code,and my license is i full force and effect.
CITY LIC.NO.: 036781�LlC.CLASS: B uc.No.: •4030/ ! XP�y /96 MAIN BUILDING ACCESSORY BUILDING
��' ('' ((!1� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of._ - I am exempt from the Contractors License law for the
?dosing reason(Semon7031.5 Smiles.and Professions Code:Any YYY. county whist moms a pnit toannawd.after.roma,. PARKING REQ: PROV: PARCEL: 13951105 ZNE: R1 REF NO:
'emd'eh.«repen any smwWre,pri«mlts issuance. the applicant for such penciltO flee signed Mei statement hot PLANNING NOTES> CONSTRUCT 30 ' LONG, 6 ' HIGH MASONRY WALL; AND 20 ' LONG,
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Sedan 7000)of Demon 3 d the
amrees and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.MryviSion d Fedion > 3 ' HIGH MASONRY WALL ALONG THE SIDE PROPERTY LINE.
7031.5 by any applicant for apermn subjects thasPptran to advil Penay of not more than five hundred doBan(5500)). *********************************************************************,**********
❑ I,as owrer of the property or my employees wbh wages as their[sale compensation,will do Ow work,and the enactor.is not wended DEVELOPMENT SERVICES REQUIREMENITS
or offered for sale(Section 7044.Business and Professions Cade:The Contractors License law does not apply to en bwner of property
who bolds or improves thereon.and who does such work himself a herself or through his«her own employee.,provided that such ��]] CC
improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY lq—E- DATE: .i.40/1/76;
owner-builder will have the burden of praying he or she did not build or improve for the purpose of este). "�y���� /
▪ I,esowner dthe popeM.«n exclusively contracting with licensed conlrectonmcanatrud the project(Sedan 7044.Business arid BUILDING APPROVED BY : 0 ' " 1 DATE: ley l7(9Co
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who
contracts for such projects with a ointractor(s)licensed pursuant to the Contractors License Law). //�'
o I am exempt under Section: AP.C.,for this reason: APPLICATION ISSUED BY: ( '/t/^r^_' * . DATE: GO ##
************************ ****** **** *** ********************** *eft*
°ate Owner: LEGALIZATION:N F E E SU MAY " STRUCTURAL SEGMENT: Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534,and Net I or any Mitre building occupant will/we not(circle ohe)need to comply wth said stale codes and the requirements Na
apermitfor construction or modification from the Ai Duality Management District,Residential corstnidian spermati«nan exempt from Nese BLDG PMT PLUMBING ELECTRICS MECHANIC FIRE SMIP/RES GRADING
provision.. PERMIT 34 . 75 . 50
Date: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affiunder penalty declarations:jury oneof the following declaratu: PLAN 22 . 59
rm
ISSUEIFEE
• Code,fMwipmeirman41 ce of certificate sell-insure lerssued, 'romo«,wiov,,esprovided for by Semon 3Taoathe LINA BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
cnde,f«the p.domvan.ea the work f«wl:dl this gamer i.i.a„ed. TOTALS----> 35 . 25 0 . 00 22 . 59 57. 84 57 . 84 . 00
flI have and veil maintain workers'compensation insurerce,es required by Section 3700 of the Labor Code,for the performance a the
work for which this permit is issued.My workers'compensation insurance carder end policy number are:
Carrier: CA COMP INS CO EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 57. 84 OVER/SHORT: . 00
Policy Number; 0967004308 07/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
/his section need nil be completed 1 the permit is for one hundred dollars(3'100)or lea.) 34 . 7 5 "• . 5 0 22 . 59
cattily❑ I cethat in the performance of the work for which this parole is issued,I I not employ • in any m r eo as to t/
become subject tothe orkere compensation laws aand.s '. hat N I /i. • a mania/ M workers' ***************************************************************
****************pgsthes bS" pedlaV 'comply with F .• IND I VIDUAL , F 'EE BREAKDOWN
Data /O— YQoIIA,
. • ,
Warning:Failure to secure werten'romperwgon coven I.and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTION / UNIT COST TOTAL COST
civil fines up to ons hundred thousand dollars($1pp000), r .on to fhs cost of compensation damages as provided for In /;
•
sscdan de
37PB of the labor co ,Interest and+fromey'e less' SFR 50 RES—CONCRETE BLOCK WALL /.. FT. 20 . 00 1 , 000 . 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penny of perjury m
that there is a nanwlending nding agency for the END•/ OF FEES
rm
perfoance of the work kr wham this perms is issued(Section 3097,Civ.C). 'n,
LENDER'S NAME: - r - 'q•
LENDER'S ADDRESS: v
I certify that l have read this application and stale that the above information is coned.I agree to comply with all city and county ordinances .)
an
d state laws relating to buildingconstruction cousd cityion and hereby authorize representatives thisto enter upon the above-mentioned properly
for inspection purposes. ../ {. ,
JOHN LASSELL
1.V. 01 00216718-00216720 T 4T 57.34
111
749,/ '�,7AS/
Dalt/0 ?' 19-( '' DATE: 10/09/95 TIME: 15:02
�., •ignature of Owner/AgentApplicant/Conuactor
1
(5151.45.WP) White-Building 5 Safety:Green-File:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING ,. POO ;PA '
Date Inspector Date Inspector
A2PROVALS Permit # - APPROVALS Permit # t
1. Temporary Electrical Service or'Pdle 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- `B,`(-' 6c.-1 56. Rough Plumbing & Pressure Test 1
6. blectrical UFER Gtnd. 57. APPROVAL TO COVER-GUNITE
7. Footings (a--1(-Rd ‘ 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 I -
63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final , , `
14. Rough Plumbing 65. Electrical-Final
i
15. Rough Electrical-Conduit 66. Solar System-Final 't
16. Rough Electric Wiring 67. Fencing&Access Approval - I
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & A4 Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit # - '
21. Ducts, in.Structure - - - 70,.Underground Hydro
22. Ducts, Ventilating. . . 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test - 72. Underground Flush
24. Roof Framing - . 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro-
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing - - 76. Dry Standpipe
28. Lathing& Siding, • - 77. FIXED SYSTEM:FINAL
29. Insulation • - - . 78. FIRE PREY. FINAL -
•
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - - , 79. FINAL INSPECTION - _
32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED !
33. Final Electric ., - - Notes: I
34. Final Heating& Air Conditioning . ' 0- /O -?e �� �/- Los-e._
35. Final Gas Pipe-Test - Cdccert/ (!/ey or fa* 4/ai( •
36. Hood or Canopy . -- '=-J
37. Final Factory Fireplace •
38. Final Plumbing - (9-16-96 ®/- 9i- `. 6
39. Water Service-Final - v 4 -/
40, Gas Service-Final -
41. Solar Domestic-Final - • - -
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System
45. Sound Attenuation . . . .
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING 6-3-q7 atve _
48. FINAL PLANNING - .
49. Electric Release to Edison - - ,
50. Gas Release to Southern California Gas Co • '
51. CERTIFICATE OF OCCUPANCY
No. Date
•
SURVEY OF (OT
• ' DIVISION OF BUILDING SAFETY Permit #3 7`7 Ts O a LUNE
CITY OF COSTA MESA THIS NUMBER MUST ACCOMPANY RE,��lRED
` APPROVED ALL INSPECTION REQUESTS
T.- Etl- ' /0Iy/Q6 SURVEY OF LOT LINE
This set of plans and specifications MUST be kept on this lob at all thus
MAY B E REQUIRED
and It b urdawkd to make any changes or alteration on same without writtn /, t
permission from the DMslan at Building and Safety.City of Costa Mesa. Toor
Q
The stamping a o1 fhb plan vi spoon f arty SHELL NOT be haler to permit
l ,PRO VEP ��5°4)p�L
/ (dA //
or to be an approval of the violation of arty provisions of any City of CostaiVe
Mesa Ordinance and/or State law. /
These Oars and permit shall expire bylmitationand become null andveldt! CITY OF COSTA MESA /�(
PLANNING DIV.
the Siding or work is not commenced and maintained active par UBC§303 �i
"kwitthin180days ofismice
:y____________UBJEC BLDG. DEPT. REG. / i
DATE / N. `t 6 �(SE d 'f c' �itj/Y
rn aSm-, n ✓ (/
„ pa .
ir
y
4 , • 1
RESIDENCE 14,0 RESIDENCE RESIDENCE RESIDENCE
ti • I-
,V IY
W h
IQ, M
IA
i
Alia\ r' 11A / STREET 6.
_
;Th. ;'tr,,,k . "il" ` ' TYPICAL 6tI CONCRETE BLOC —
FEN:C:EanuEgamamma r
•
Cement Coping Optional -- � 1 -1 CSVCrI �
GENERAL— NOTES
Channel Block With 1-3/80 11 r-U
Horizontal Top of all �e
Fences H � act 6LMOR7AR:`,-1One;Part Plasticteementoandmtr
�i I _ wt.„..,,__,rnr. Three-Parts-SandcC^�'jdt1C:.0
' For Fences 5'or Less la ^GROUJT.•, S- One3PartgCement'tThreecand:
Vert.Bars 3/8" at 4' -0"O. I 1
C. Idl. I`S One Half Ports Stand
�� ¢ ; = — e,i?bctilCoOPINt/Gc.:±7p0arret's.?ctialnrittrAn4r:Three c4r4 i�Jg1 ' tt ,, -r:.,n3c9tlnFor Fences Higher Than 5'\ ` tl� to
' imVert. Bars 3/8"¢ at 32" O.C. > w CONCRETE: WelI Mized'9E2 r/2:c3r1'%201R a cr = 0 .7tLY31:rn Max..0.11 1/2 Gallons,cof,,,:--R
Fill Cells Solid With Grout \ • fi.e , > z __ _ _ �" c�- atut. , • •Wafer;Per Sack afrCement • �rT.
ReiWhnforcing
Occurs' A > u, - - -; 1
'Reinforcing Steel Shall ' f � � —GROUT.MA.V.BE POURED-FROM-THE-TOP- ---/
a s OF THE FENCE IN CELLS WHERE STEEL
Conform to Sec.A-15.39 .`-1 ta 0 -- — -_-- - OCCURS.
A.S.T.M. 7 zo LR AND AREALo F HORIZONTAL REIN-
All Steel to be Lapped ` I NMI
1�� LL n ' FREE OF NT SHABE CLEAR,CLEAN&
pppp��e� FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code 1
NATURAL GRADE
II
a�
/�/Ar � •
CO ' .
O e a. n
TWO 3/8"0 BARS ' I e • _ .
CONTINUOUS TOP I
rag
& BOTTOM - I—WIDTH • TO 16 O.C. MAX. -e•
SEE CHART -• b.
HORIZ.ST EEL MUST BE TIED IN BELOWa A DE PTH OF EARTHTCOTH
PLACE AT TIME OF TRENCH p 1/3 THE HEIGTH OF FENCE
INSPECTION. L1.±
-• OW BOTTOM OF FOOTING.
los2.. �} SCSCALE: I/2° = I'
r
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 � 51 . 41 3'
WIDTH 14" 14" -• 12" - 12"
THICKNESS . . . . . . .10". . . . . . . . . . . . 10" 6 " 8 "
DEPTH OF EARTHTOOTH . . 24" . . . . . .20" 16" . . . . . . . 12"
SPACING OF EARTHTOOTH . 12' 14' 16' 16'
Nor p
City of Costa Mesa, California
Building Department .
.
0... !tED Nov.b2 -
_
it
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this /o 'Q` — day of
ln
e ,ae_�f1Q6 , by and betweer�/�i�rS�/¢t€ RS—_4V4lJiyj
hereinafter referred to as "LANDOWNER;' andCeMOL_ 1. nrc/7�iy�
hereinafter referred to as "ADJACENT PROPERTY OWNER."
It is hereby agreed that a party wall will be constructed on the property line
between /_gy__ Q / 2/4c GB—
(Address of Adjoining Properties)
/90 6 A, ?LIC
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book , Page of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER ADJACENT PROPERTY OWNER
ems .
(Signature) (Signature) /
Name(Typed or Printed) Name(Typed or Printed)
/72 •l c < <� 61,54-4
(Address) (Address) /
01454 Ct..
NOTARIZATION REQUIRED
1906-46
r . ..�
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this / day of
_Ocieda , by and betweeng },P�t�_
hereinafter referred to as "LANDOWNER;' and CARO_L_Le.wlcSileaiZ,
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between _/_9—Zy kAell , 4 Ge--
(Address of Adjoining Properties)
So Atg,t2Ai ?Lk
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book , Page of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER ADJACENT PROPERTY OWNER
• e �sl�
(Signature) (Signature)
-1;
Name(Typeeed/d or Printed) 6, - Name (Typed or Printed)
t/ PAfte-42-
(Address) cF-26-2.6 (Address)
NOTARIZATION REQUIRED
1906.46
ts3UWNtrc MARTIN. L. F. DATE 1-23-70
\JOB ADDRESS 1924 Kaui Place BUILDING PERMIT NO. 31319
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Community Block Wall
AP No. 139-511-05 LOT 4 TRACT 6384 FIRE ZONE VALUE $250.00
IN"'ECTIONS Signature Date GROUP J TYPE III ZONE R-1
SUBCONTRACTOR PERMITS ISS ED
GAS Date I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Mooting and Vent.
TRENCHES �_t FORMS 9 STEEL REINF. ' �-217/O
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT El
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HF 'G, VENT., REFRIG. AND A.C , FINAL
PI. i NG, FINAL AND GAS TEST IC
ELECTRIC, FINAL
BUILDING, FINAL 3i10-7D
Pi
~ 31319
JAN 76 70CpID 712 v*** **5.��
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Filltin //II plate/ RECEIVED BY DATE REC IVSD DATE ISSUED
BUILDINGADDRESS 1°P-Yr k'AVA-t. I. acYY+- f-I Cs/f n / D I�Z}��/��
OWNER L .1' f" me-rnk A.P. NO. / B / -- SII—OS PERMIT.ATj `-i
BUILDING p n'! s
MAIL y� ADDRESS / / G7 K (�(,(d f P
ADDRESS 5)?-N�l Tp }I ,
0.0 CITY S A-1111 C---- NOLSL/D-C1. .7 TRACT 13 84 LOT BLOCK
I—.Z
Z C CONSTRUCTION ,ate r NEW A ALTER REPAIR MOVING DFMOI ISH
- I— LENDER N (�
J• D BRANCH NON
OWNER . .
d ADDRESS VALUE — ry
m ARCHITECT NON L' NO. S Ste`
J Q OR ENGINEERa.
U Q FIRE
W 2 ADDRESS ZONE TYPE GROU
0.Ill
q APPROVED ,Q 1 I s
J Z CONTRACTOR GW SLK-. BY
(�f�/. DATE / io
CO Z U 4it,.
J 2 ADDRESS
W W ZONA / IND.OF ,S USE OF NEV✓iLP._. I
ZF CITY NO. PIANS pt. BUILDING "" "._
_ w
W 0 STATE CITY YARDS APPROVED YARDS APPROVED
to X LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
X O (FROM C/L STREET�)/ Qs
OL Go X ( I +NO.OF BLOTS. FRONT r V
SIZE LOT (Y t) NOW ON LOT FT. FT.
USE OF nt c j�
EXISTING BLDG. /G t q SIOF UFT. FT.
I— SIZE OF NO.OF _
2 NEW BLDG. ROOMS STORIES ^ I.SIDE r_ FT. FT.
U EXTERIOR WALL I ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
_ MAIN BLOCS. ACCESS.SLOGS.
Q VAR.. DATE
OC.UP.qWAPPROVED
) �l t *Y0ts
RYP/N Dl Ll' p __L OATF I —�T, U
O
f~.1 I hereby acknowledge that I have read this application and state
D that the above information Is correct and agree to comply with
Lr all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
CO the State of California. m
I hereby certify that I am properly licensed as a contractor under SQ. FT. O
the State of California Business and Professions Code, Division 3,- THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business CC
VALUATION
and Professions Code,Division 3,Chapter 9. Cr, chi
n PERMIT FEE S
D
Signature of L m
Permittee F t Clhi(w�w, 5 z So 04.
PLAN CHECK 5 E
o
Authorized Agentu.
TOTAL FEE 5`., -
14 - Tract 6384
I 1-AR
270•
13: it ( ,r PAID
• HAY 25-67uisr,001396 *** 121;..50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1974 Kanas Placa
COSTA MESA. CALIFORNIA For Office Use Only
I RECEIPT NO.
owNEClub House Road Joint Venture Iet� ` Q
MAIL RE rY OA RECEIVE^ ATE ISSUED
ADDRESS 2850 Mesa Verde Drive l� :a,�_G ..za-lo7
cm' Costa Mesa NEo-549-039; BUILDING
ADDRESS
ORARf -ECT TEL_
E.G. altenbach NLc647-804E COSTA MESA. CALIFORNIA' LI �//��{/
ADDRESS 1823 E. 17th St, Santa Ana ZONE TYPE (/ GROUPIE/Pit
CONTRACTOR Republic Homes Corp. APBYPROVED DATE
ADDRESS 2850 Mesa Verde Drive ZONING
NP USE EV{/ n"]-'�
CITY Costa Mesa, Calif. ZONE � PLANO.OB yI BUILDINGOFNGIS U✓`�� '
STATETEL. 0395
549- LEGAL
L �/ ^(�A, /b I%2am/
IC.No. 197838 NO. DESCRIPTION ✓`--'-.4 I • 3J/
SIZE
OF LOT 60 x 100' I NO. OF BLOTS.
NOW ON LOT A.P.NO.
USE OF YARDS EVES
EXISTING BLDG, APPROVED ALLOWED
SE�RROP STREET 43 ' REAR YARD 24 ' FRONT
(CENTER LINE ST.1
FRT Aar FT. IN.
SIDE YARD I LEFT 5 ' I RIGHT 5 ' R.SIDE `—FT. IN.
DESCRIPTION OF WORK L.SIDE sT5 FT. IN.
NE I XII ALTERATION I II ADDITION I REARSET.!//////T 7^ FT. IN. �/
REPAIR I II MOVING I II DEMOLISH I BYPROVEIf// (I 1 ATE S--1. 1�- 4?/
SZELDnioo85 . ft . ROOMS 7 STORIES 1 (•1 YYYfff------
EXTERIOR WALLOd�ROOF
COVERING St•'OuC Coo COVERING Wood -
USE OF BUILDING AND WORK TO BE PERFORMED
T-470.70 /Q/f,//
�C
. ' r�
l e" OOd v7,5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UN VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STAT LAWS LAWS REGULATING
BUILDING CONS.. BION. J VALUATION
--
SIGNATURE O: // PERMIT FEE $ l� Oi
PERMITTEF r "'- ry ,/ �a
4 %J//� /, $,714',6733 PLAN CHECK S
AUTHORIZED AGE S L� /W� J 22 5-0
.• - TOTAL FEE O
6