HomeMy WebLinkAbout244 15TH ST - Building Permits CITY OF COSTA MESA
0 ,.o',. CALIFORNIA 92626 P.O. BOX 1200
*4 :(17-1.e„gip.. .ha FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY
c.?PORWm°n':
July 13, 1978
Mr. Henry M. Ramsey
244 East 15th Street
Costa Mesa, Ca. 92627
Dear Mr. Ramsey:
Our records show no permit was issued by this department for the patio
cover at the rear of your residence nor for the electrical wiring and
plumbing in the room at the west side of your garage.
We must require that you obtain permits for these items, have them
inspected, and have corrections made, if necessary, within thirty (30)
days.
Failure to obtain permits is a violation of Section 301 (a) of the
Uniform Building Code, which is part of the Costa Mesa Municipal
Code.
Very trulyul/ yours,-
thr
RICHARD HANHART
Building Safety Director
RH:cb
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CITY OF COSTA MESA - //
qt, BUILDING DIVISION V '
DEVELOPMENT SERVICES DEPARTMENT B98-00968
rita�• a PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 244 15TH ST . Status: ISSUED
Suite: Applied: 06/04/1998
Vicinity: Issued: 06/04/1998
Parcel Nunmber: 42533110 Zoning:
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Applicant: SCHULTZ, BRIAN •-
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Address:
Phone:
Zip:
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Owner: PALMER, MICHAEL CHARLES
Address TR
NEWPORT BEACH,CA Phone:
1701 KINGS RD Zip: 92663
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Contractor: •SCHULTZ ROOFING
Address: 1201 FAIRHAVEN
195 Phone: 714-539-9603
SANTA ANA Zip: 92705
License: 650739
Arch/Eng :
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Address: •
Phone:
Zip:
License:
SCOPE OF PERMIT
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TEAR OFF EXIST.3 LAYER COMP.SHINGLES INSTALL 30LB ASTM&REROOF W/30YEAR COMP.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $74.75 Claimed Valuation: $3,0o0.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00 •
Inspection: $0.00
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Total: $75.25
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all _
required inspections end 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
DECLAIFATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
y, work for which this permit is Issued.
1g I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, agr ouid become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
co rvisions.
,S -- Date: .�r,tAxx G
W TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E - •IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm ti= am licensed under•rovislons of Chapter 9(commencing with Section 7000)of DtvLsioa3. Business and Professions Code,and my license is in full
force:.. : : 4 a • Callb39
yp:rf Signature: S• 1 w.ac �I G f3
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally 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 properly who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
. 0 As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65550.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 if a permit from the South Coast Alr Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
4naq M I e al Owners 1 Date
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And/Or Authod d Applicant D to
COOS L INSPECTIONTIEE DATE IM9L5 CODEF INSPECTION TYPE DATE Maki
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / ' ' 208 Final Plumbing
200 Final Re-Roof (2-#1: t C 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
098 -OD57J
;DRESS E I0ICTh 244 E 15TH ST UMT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 087330
•OWREFesRAREi>locir PALMER, MICHAEL CHARLES
• MDBEss TR
• 1701 KINGS RD PERMIT NO: B 087330 PLAN CHECK NO: 00105-98 L GOVT: N SUPP: N
' NEWPORT BEACH,CA 92663
kPPL.MAKING ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ADD
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aRonrEnoflel. wl: SANDBERG ENGINEERING UGNO- 25915 JOB DESCRIPTION : 1192SF 2ND STORY OVER 979SF NEW GARAGE SQ FT: 2, 447
ARGIL OR vial ADDRESS: 242 W MAIN ST DMT: 106
TUSTIN CA 92680 CLAIM VALUE: 120, 000 . 00 CALL-VALUE: 122, 645 . 62 GROUP OCC: R-3 /U-1
CONTRACTORSNAME: KELLER & SONS CONST ( 714 ) 631-5298
CONTRACTORS KRUNG 723 OHMS WAY COMMENTS : 68SF EXTERIOR STAIRWAY & 199SF DECK
ADDRESS: C.M. CA UCNo.: 390785 SE***Sk*sESE+E*+r*sESEM•* -*SE*.* -******+E*SE+r*********+E*******SERE******x-**+Ex+a*+r****+E********x-
92627 urn •; Z O N I N G REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby alien under penally of perjury that I am licensed under provleara of Chapter 9 , SETBACKS
(commencing with Section 7000)of Malin D of the Business and Professions Code,and my license is in fug forte and elf ed.
CITY LIC.NO.: ,4UC.CLASS: B UC.NO. 85 EXP : 00/00 MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN RE : FT IN FRNT: FT IN REAR: FT IN
y Dae 3h-7kt- contractor :-� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I em exempt from the Contractors license Lew far the
'ldfowig reason(Section 7031.5Basi.ae and Proleasions Code:Any city orownry which requires apermelo conswdt Mar.improve. PARKING REQ: 5 PROV: 5 PARCEL: 42533110 ZNE: R2MD REF NO: DR-97-11
demolish.a repel any structure.prior to as issuance,also requires the applicant for such permit to file a signed remanent that he or she
is licensed pursuant to the prounions d the Contractors License taw(Chapter 9(aarnnenong with Section 7000)d Melon o d the PLANNING NOTES> =ADD'A 1 , 192 S F 2ND UNIT OVER 1 , 111 S F 4 CAR GARAGE -<•
Business and Professions Code]or that he g she is exempt therefrom end the hese for the alleged exemption.My violation of Sedan >'
7001.5 by any applicant lore permit subpm tip applicant taaclef penally of nc(more than five hundred dollen(55001). ***************4***************************************************************
❑ I,as owner of the propedy or my employees wilt ivories as their sole compensation,will do the work,a.nd the structure e nol intended D E V E ,L 0 P'-M E N T SERVICES R E U I R E M E N T' S
jq offered for sate(Section 7044,Business andProfessions Code:The Contrarian License Law does not apply to an Owner of properly Q
arho builds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such y ,. .� / I
Improvements are nd imerdedordlmed In sale.lf,However.the building or improvement is sop within one ymrdoomdetion.Ne ZONING APPROVED'�BY �E DATE: 3.111
I ca
owner budder will have the burden d rioting Mor Medd not build or improve for the purpose of sate).
❑ I,as owner of the property,em exclusively,conVmfig rah licensed contractors to mrauud the project(Section 7044,Business and
Professions Code:The Contractors License Law does nr epply to anowner of property who builds or improves thereon and who BUILDING APPROVED BY ': DATE:
convects for sutlh pr jects with a conlradpr(e)licensed pursuant to the Contractors License Law). -
❑ lamexemprueerSacbn: i e.3Pc.. «the reeson: APPLICATION ISSUED BY. " S '`� d� DATE: 3I;1e1 '-9k
Date: ' Owner: ..
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I do hereby candy that I am aware of and understand the requirements d SectionsCalifornia Health end Safety Code 25505,25533.and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
25534.and that I or any haute building occupant will/wit nor(circle ane)need to comply wih said pale codes and the requirements for
apennhfor mnswdienOfmodification fromthe Ai y aagemenlDimtict.Redaentwranpndionappr:aliraareexemtfromthese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 1 , 002 . 25 ' ' 12 . 26
Date: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dedarations: PLAN 651 . 46
, y
❑ I have and MI maintain a certificate d consent to eehinsure for workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE 4-
ISSUE
5• t
Code,for the porlomaneof the work i«w himepemiteiesued. BUILDING-DIV PERMIT ISSUE PLAN=CHECK ( TOTAL PAID DUE
❑ I have and m5 maintain workers compensation insurance,es required by Section 3700 d the Labor Code,mr the performance of the
TOTALS > 1014 . 51 0 . 00 �G 51: 4 6% 1665 . 97 1665 . 97 . 00
work for which the permit is'issued.My workers'compensation insurance confer and pdky number we:
Canter: REVENUE DIVISION TOTALS--> COLLECTED: 1014 , 51 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This Seeion need nor be competed lthe pend is for one hundred dollars MOW or less) 1002 . 25 71 i r' •- 12 . 26
yI certify that in the performance d the work for whkh this pennil is issued,I shall no employ any person in any manner iso as to h" 1 '
P'� become subject to the worker.'compenepian lays of Cald«ne,and sores that N"mum became cabled to the wohen' **************************************m*****************************************
compensation provisions of Section 3700 of the Labor' ; ehejldp9}wyF�mmply� provisions.
w
Date:
;�(7�r r AptraaMdrrr///`J�j// INDIVIDUAL F fi E ,B R E A K D O W N
Warning:Failure to secure wopws'compensation coverage Is unlawful,and shell subject en employ.,to cdnlinal Ronaldes end TYPE QTY DESCRIPTIO N'✓ runUNIT COST TOTAL COST
civil fines up to one hundred thousand dollen
($100,000),In addition to the coat of contetious damages as provided by In /n
Section 3106 of ieLabor caa,arscattorney's rn 'af»a. nSFR 1192 DWE-TYPE V-WOOD FRAME :I' til
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of that of perjury there is a construction lending agency for the „' —GOOD 16 . 12 97, 148 . 00
SFR 276 RES—BALCONY, EXTERIOR STAIRWAY 16 . 12 4 , 449 . 12
performance of the work for whish the permit is issued(Section 3097.Cb.c). SFR 979 RES-GARAGES TYPE V 21 . 50 21 , 048 . 50
LENDER'S NAME: 'y
LENDER'S ADDRESS: END OF, FEES �aa�
I certify thin d have read this application end pate that the above information is cooed.I agree to comply with ag city and county ordinances
X .71.- '. EEJJaa�8��'”'
and state laws relating to building corutuction end hereby authorize representatives el this city to enter upon the above-mentioned property �' • 4)
for inapedionprposea a MAR 17 1998
MARK KELLER % a
-�/��%/� Pont theme _...
Signature dDw er/AgengAppl an otonlreder CITY OF COSTA MESA
(5151-46.WP) White-Building&Safety:Green-File:Canary-Appicanl:Pink-Revenue:Goldenrod-Assessor - /
pp
N
CONSTRUCTION AND PLANNING P(. . & SPA
. APPROVALS Permit # Dart Inspector APPROVALS Permit # Date Inspector
, ' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ._
7,3. Electrical Coh uit.Utility•UncJrgrnd. 54. Forms
• 4. Electrical-Conduit-Undrgrnd. 55. Electrical Bonding •
-5. Steel Reinforcement Opt j, a- a•ugh Plumbing & Pressure Test
6. Electrical 6FER Grnd. I IL't 57. APPROVAL TO COVER-GUNITE
_i.e.
48 /%�
7._.
ootin s '' �'
Footings - F� (b�81/fi • .8. Electrical Conduit-Undrgrnd.
'8. Foundation. r-t I // / 59. Gas Pipe, 0 Undrgrnd., Test
}Y! Y�:
9. Water Pipe-Undlprnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
-10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains -.-- 64. Plumbing System - Final
14. Rough Plumbing, - 65. Electrical-Final '
15. Rough Electrical-Conduit • 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiri6g 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 F[Eepiece - APPROVALS Permit # -
21. Ducts,in Structure , • - • - 70. Underground Hydro
22. Ducts, Ventilating.' i -. 71. Product Piping OGa's Q Oil
23. Gas Pipe•Rough& Test - - 72. Underground Flush I, --- -
24. Roof Framing - - _,' r y -•• ` ' 73t Undergr9d.Storage Tank 0 Gas 0 Oil
25.-Rood Sheathing • $t7-q7 S"- '- 74. Overhead Hydra
26. T-Bar Ceiling (Structural) & Monbcoat : - - - ' ' 1 75. Dry Chemical ; = - . .
27. Frame and Flashing;' n _�j- 1r� 6&y� 76. Dry Standpipe .
28. Lathing &SidingI` r"t- •- -
77.x. FIXEDSYSTEM•FINAL
29. Insulation 6T7 -,?T 647 78. FIRE PREV. FINAL -
/ ti
30. Drywall Nailing ' • 6-7149-a &a HEALTH DEPT REQUIREMENT
31. Plaster Brown;Coet ' 79. FINAL 1Al§PECTION - -_
. 32. ElectricaLPower Meter-Final 80. FOOD CERTIF2CATE '
ISSUED
- 33.-Final:Electric. - . R Notes: 1 m
34. Final Heating-& Air Conditioning ' 6� ��
C/
35. Final Gas Pipe Teat , - `�� i �O!/l�i'.'Cta-.y �� _��4
- 36. Hood or Canopy - - . • -- -4, r
• 37. Final'Factory Fireplace, : ..--6,4„,a-44.5
l/'tom„ -- Wag.--
Final Plumbing -t _ ,� _ -j- _%- •.•
39. Water Seri/ice'Final _
40. Gas Service-FinaI , ' _ - -.
- 41. Solar Domestic-Final I } . -
42. BackflowPreventer, - t - '
, • 43. Backflow Irrigation: _ t
• 44. Landscape Irrigation System - . .. '
45. Sound Attenuation - - ' '1 _
e
46. Handicap Reg lations
47. FINAL STRUCTURE & BUILDING -1.17.,20 6i_/i -
G N
48. FINAL PLANNING• - .
.49. Electric Release to Edison I a -
,
50. Gas'Release to Southern California Gas Co • -
51. CERTIFICATE OF OCCUPANCY -
No. Date
2415
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181 CC
To: (X) City of Costa Mesa District Receipt NoG� er
( ) City of Newport Beach p p
( ) County of Orange Plan Check No. 76-9-7n-
Applicant: Pn69CK
Address: 723 CV) �-S c�� (nC•J# (1-O 6Z?
(Telephone Number: 9' `( CO3( -Cs-Sq
Tract/Parcel and Lot Number(s):
Location of Project: t7 4' (—. c-t' ee nAt! S k ca'L .�1
Number of Square Feet of:
Residential Space p �-7 72. x $1.84 Total .E�1 z--1 ( f'7'
Residential! /,//`�
Sr. Citizen Space - " x $ .30 Total ����b
372-
Commercial and
Industrial Space x $ .30 Total
Commercial/Industrial Project is: (Check One)
Warehouse Motel Preschool
R & D Bank Auto Repair
Movie Theater Neighborhood Shops Hospital
Mini-storage Racquet/Health Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial _ Office Park Fast Food
This project is exempt because _AL-fr1� (/MOF.0 r-5(91) or? ? c
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School % 'ct. .
4111
By: . _
Authorized Representative
The above representation as to square footage is true. Applicant agrees that if itis later det: min-d,•.t such -presentations are not
true,then this certificate shall automatically terminate and the appropriate City/County� sh- I be notified.
Date: 3/7/�t'r - 'L •�j
pplicant
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Ii SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL •
jAQMID•
21865 E. Copley Drive,Diamond Bar,CA 91765-4182 (909)396-2000 hltp://vnvw.agmd.gov
'AUMDUSEONL'4sr. �SCREENBY': rh .RECEIVED •(,4,0f IPOSTMARKLr"`rij�-_`"11i' ENTEREDBY - I' "+NOTIFICATION0'4i
--..1'.47 .... 1 �,: ! d}j��it 'i,f ' iri
COMPLETED BY TELFORD COMPANY TIGHT QUARTERS, INC. PHONE 714 557-7901 ` I 1:- xf t`
DATE CHECK# FEE$ 26.20 PROJECT#
NOTIFICATION TYPE ORIGINAL REVISION DATES REVISION OTHER(highlight) CANCELLATION -•
•
PROJECT TYPE DEMOLIIIO ORDERED DEMOLITION RENOVATION(removal) EMERGENCY REMOVAL PLANNED RENO(annual)
SHE01"ORMATION SITE NAME Palmer Residence
SITE ADDRESS 244 15th Street CROSS STREET
CITY Costa Mesa STATE CA ZIP COUNTY Orance
DESCRIBE WORK LOCATION Single Story Garage & Attached Structure
BUILDING SIZE(SOFT) 1 3 0 0 NUMBER OF FLOORS 1 BUILDING AGE(YEARS) 4 0 NUMBER OF DWELLING UNITS
BLDG 1'RIOR f PRESENT USE CCe.WERCIAL HOSPITAL ' INDUSTRIAL Other OFFICE PUBLIC BLQG. RESNENCE SCHOOL SHIP URN/COLLEGE
SITEOWNER Mike Palmer ADDRESS 244 15th St .
CITY Costa Mesa STATE CA ZIP CONTACT Keller & Sons . PHONE ( 7141631 -521
REQ11111ED BUILDING ASBESTOS YES e ASBESTOS YES NO ASBESTOS YES /NO BUILDING TO BE NO
INFORMATION PRESENT? SURVEY? REMOVED? l� DEMOLISHED?
PROJECT DATES START 3-16-98 END 5-16-98 • WORK SHIFT(am/pm)
ASBES NOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED(add row).
REMOVIID(in square feet)
ASBIES FOS REMOVED FROM . SURFACES . PIPES COMPONEt!TS
DESCRIBE TYPE&AMOUNT OF ACOUSTIC CEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC
ASBES[OS
FLOOR TILES(VAT) DRY WALL PLASTER TRANSITE ROOFING OTHER
(describe)
CONTRACTOR INFORMATION CSLB LICENSE# 584915 OSFIA REG# 97-901537 AOMD ID# 97898 •
NAME TIGHT QUARTERS, INC. • • ADDRESS 2031 S. ANNE ST.
CITY SANTA ANA STATE CA ZIP 92704 SITE SUPVR TELFORD COTPAM PHONE 714 85.7-7901
WAS I E TRANSPORTER#1 LANDFILL
ADDRESS ADDRESS
ti
CITY STATE ZIP CITY • STATE ZIP
Rule 1403 and NESHAP Asbestos Notificalion Form REV 970620 1403FR97 Page 1 of 2
Sol-1115,h-;Wctions,and the Rule 1403 can be obtain via FAX-BACK by dialing ham a faxphone(909)396-2550 or through AOMD web site httpJlwww.agmd.govlprr/faxback.html
WASTE TRANSPORTER#2 • WASTE STORAGE SITE
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I ADDRESS ADDRESS
•
CITY • STATE • ZIP CITY STATE ZIP
CONTROLS: DESCRIBE WORK PRACTICES AND CONTROLS TO BE USED AT THE DEMOLITION AND RENOVATION SITE. FOR ASBESTOS REMOVAL
WORK,INDICATE RULE 1403 PROCEDURE#1,2,3,4 OR 5 OR COMBINATIONS OF PROCEDURES USED. FOR PROCEDURES 4 AND 5,SUBMIT PLANS
FOR AQMD PRIOR APPROVAL PROCEDURE It
ASBESTOS DETECTION PROCEDURE: DESCRIBE THE METHODS AND PROCEDURES USED TO DETERMINE WHETHER ASBESTOS IS PRESENT AT THE
SITE,INCLUDING THE ANALYTICAL METHODS(survey,bulk sampling,inspection,assumed ACWM,etc.):
•
•
FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL: •
•
FOR ORDERED DEMOLITION SEI!D A COPY OF THE ORDER AND GIVE THE AGENCY NAME: ' •
AUTHORIZING PERSON: TITLE
DATE OF ORDER: DATE ORDERED TO BEGIN:
•
FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECLARING/AUTHORIZING THE EMERGENCY, DATE
AND HOUR OF EMERGENCY AND DESCRIBE THE SUDDEN,UNEXPECTED EVENT:
•
•
EXPLAIN HOW THE EVENT WOULD CAUSE UNSAFE CONDITIONS,EQUIPMENT DAMAGE OR UNREASONABLE FINANCIAL BURDEN:
CONTINGENCY PLAN: DESCRIBE ACTIONS AND PROCEDURES TO BE FOLLOWED IF UNEXPECTED ASBESTOS IS FOUND DURING DEMOLITION OR NONFRIABLE
ASBESTOS MATERIAL BECOME CRUMBLED,PULVERIZED,OR REDUCED TO POWDER. ISOLATE CONTAMINATED AREA.
ADEQUATE WEAVING '10 PREVENT P..MMISSION. CONTACT AN ASBESTOS ABATEMENT CONTRACTOR.
TRAINING CERTIFICATION: I Certify that an Individual trained In the provisions of regulation AOMD Rule 1403 and NESHAP will be on site during the removal and evidence that the
required training has been accomplished by this person will be available for Inspection during normal business hours.
e:-
PRINT NAME OF OWNER/OPERATOR SIGNATURE OF OWNER/OPERATOR cx. —� DATE
•
INFORMATION CERTIFICATION: I certify that die above information Is correct and I have endosed any required attachments. '
PRINT NAME OF OWNER/OPERATOR TENA SWISHER SIGNATURE OF OWNER/OPERATOR • DATE
Notifications are not accepted without the required asbestos lee(AOMD Rule 301), Removals of less than 100 square feet are exempt from notification and fees.
Please make checks payable to*SCAQMD'..Fees are per notification, not refundable,and vary according to the asbestos amount to be removed. Fees are as follows:
FROM 100 TO 1900 SQUARE FEET • $ 10.40 DEMOLITIONS ' $ 26.20 .
FROM 1,001 TO 5,000 SQUARE FEET .5 78.60 REVISIONS $ 10.40 •
FROM 5,001 TO 10,000 SQUARE FEET $183.50 CANCELLATIONS $ 00.00
MORE THAN 10,000 SQUARE FEET $288.30 PROCEDURE 4 OR 5 PLANS $288.30
RETURNED CHECK CHARGE $25.00
'ATTENTION: STATE LAW REQUIRES THAT YOU GIVE A COPY OF DEMOLITION NOTIFICATIONS TO YOUR LOCAL BUILDING AND SAFETY DEPARTMENT. PLEASE KEEP A
COPY. STATE LAW DOES NOT REQUIRE PROOF THAT THE NOTIFICATION HAS BEEN RECEIVED BY AQMD. FOR YOUR CONVENIENCE MAIL ALL NOTIFICATIONS AND DO NOT HAND
CARRY THEM SINCE AQMD HAS NO STAFF TO RECEIVE THEM. CONTRACTORS ARE REQUIRED TO FILL AND MAIL THE NOTIFICATION. FOR QUESTIONS CALL 909.396-2336.
'MAIL ORIGINAL TO: SCAQMD,RULE 1403 ASBESTOS NOTIFICATIONS,P.O.BOX 4950,DIAMOND BAR,CA 91765-0950
• TELEPHONE: (909)396-2336 FAX: (909)396-3342
•
Rule 1403 and NESHAP Asbestos Notification Form REV 97062014030R97 Page 2 of 2
Forms,instructions,and the Rule 1403 can be obtain via FAX-BACK by dialing from a hrphone(909)396-2550 or through AQMD web site http:/Avvnv.agmd.gov/prRaxback.html
•
Insulation Certificate
2"4,r( ( S 1 a �� ( s- ra-•
Number and Sneer City
•
-C C C9j (3
County Subdivision Lot Number
Description of Installation
ROOF
Material C.Leckf Brand Name (+-'F1n .1i/- 1IC.
Thickness(inches) Yea " Thermal Resistance(R-Value) —
CEILING
Ban or Blanket Type (31.1 Brand Name Cer 4 ,.„--,-4.€rea_
Thickness(inches) G Thermal Resistance(R-Value) ( S'
Loose Fill Type Brand Name
Contractor's minimum installed weight/ft" lb Minimum thickness inches
Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value)
EXTERIOR WALL
Material r'dz-G1r1Si Brand Name Ccs
Thickness(inches) 3%, Thermal Resistance(R-Value) R—
RAISED FLOOR F,s-er Clc jf g \1 -
Material C _ Brand Name Cera •-.1/2-a. •
Thickness(inches) G-, Thermal Resistance(R-Value) 0-19, •
SLAB FLOOR
Material Car c E-1-C - Brand Name f" ,-..( .Q. 1-e -
Thickness(inches) 9 LI Thermal Resistance(R-Value)
Width(inches)
FOUNDATION WALL
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Administrative Code.
��c �soU cti � cmc 3 ro ?,�5-
General Conran actor(Builder) License Number(j' -eS Jp//IYIS o
Signart're and Title Date
Sub-Contractor(Insulation Installer) License Number
C14.-- c ,U-cfQLLc— Sq1 A /Si -
Signanue and Title Date
January 1, 1995
Compliance Forms
ADDREss ap SMlnfn 244 E 15TH ' ST DMT' CITY OF COSTA MESA — BUILDING PERMIT /fit �� 0 c�
DWNERSNuIE'FQICYIW PALMER, MICHAEL CHARLES PERM NO: E 087331
ADDRESS: TR
1701 KINGS RD PERMIT NO: E 087331 PLAN CHECK NO: N GOVT: N SUPP: N
NEWPORT BEACH,CA 92663
ADPL.YAWNS ADOREss: CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ADD
•
ARCNI¢cTORENm'EEm SANDBERG ENGINEERING "c."*.: 25915 JOB DESCRIPTION : 1192SF 2ND STORY OVER 979SF NEW GARAGE SQ FT:
AROK OR Ew'S ADDRESS: 242 W MAIN ST DMT' 106
TUSTIN CA 92680 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /U-1
c0NTRADTarSNAM, KELLER & SONS CONST ( 714 ) 631-5298
CONTRACTORS MMURO 723 OHMS WAY COMMENTS : 68SF EXTERIOR STAIRWAY 6 199SF DECK RE: B87330
ADDRESS:C.M. CA Ix-1.0, 390785 **************SrSEiE+ *******Sr*****SS*******+t****St4*****+c**+Ear*iE****)t*************Sr**
92627 wit ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby mfim under penally of perjury IN I ash Licensed under provisions d Cheger 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Business and Professions Code,end my bcende is in IW force and ted.
CITY UC,NO.:024574 LIC.CLASS: B uD.Ml3 �� EXP : 06/98 MAIN BUILDING ACCESSORY BUILDING
Date: 37/7/5r Contractor C FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury Mel I em exempt from the Contractors License Law for the
de"mOlish, .pelay.mdmie reason(Section �ree,pm Business1.5 iand ssuance.also Aheny city
appatlaauhpentofibepewit
sgnad mm'he«a"he
PARKING REQ: PROV: PARCEL: 42533110 ZNE: REF NO:
is licenced pursuant to the proWsions d the Contractors License Law(Chapter 9(commenting with Section]000)d Division 3 d the PLANNING NOTES>
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.MT videtion d Section >
7031.5 by any applicant tor apermit subjects the applicant toetivil penalty of not more than diva hundred dollars 135001). *******************************************************************************
❑ 1,as owner of the propend or my employees Sh wages as Mei sole compensation.will do the work,and the structure eriot intended
or offered for sale(Section 7044,Business and Professions Cole:The Contractors License Law doe not appy to an owner of property DEVELOPMENT S -E -R V ICES REQUIREMENTS
who builds or improves thereon.and who does such work timet or hereat or through his or her own employees.provided that such
improvements are net intended or offered for sale.If.however,the building or improvement is soli within one year d completion,the
mra
owuiMawill have the burden of proving heor she dmmlbuild or improve for the purpose ofsale). ZONING APPROVED BY - DATE:
o Profsds aas owner Codthe
ee:TheC«uracmL' enseLLausively wd�"netetap°wytopn od anownerofp` tltywho uilddsoorimproves Section t1 °ecs andwwhhoo BUILDING APPROVED BY : -
DATE:
contracts fa such prgeds with a errareda(e)keened pursuant to the Comrade(,License Law). "
❑ 'annexempt under Sed'on: B.4P.C.,for this reason: APPLICATION ISSUED BY: ' DATE: 1I 7 l et
*********************************************** * *****************************
Tele: Owe: LEGALIZATION:N F E rE / SUMMARY STRUCTURAL SEGMENT:N
I do hereby candy that I am aware of and understand the requirements of California Health and Solely Code Sections 25505.25533.and
25536.and that I or and Mum Wilding occupant_yanwill/wit not(circle one)need to comply wth said state codes and the requirements for
•
a ppermitfor masimction or moddmionhanthe Aeagrrrm District Residert'vlwndrudion applications are exempt from Nee BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prO On. PERMIT 90 . 80
Dale: Applicant: 5 0% S M I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedarmions: PLAN
22 00
❑ Ihave and nil maintain acertificate of consent tosefinwnbworker&compensation.asprodedfor bySecion370Odthe Labor ISSUE FEE
Code.for the pedamacedmkisIssued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and will maintain workers'compensation insurance,as resdred by Seclica 3703 al the Labor Code.for the performance al the TOTALS----> 90 . 80 22 . 00 0 . 00 112 . 80 112 . 80 . 00
wok for which ills pewit is issued.My woken'compensation insurance carrier and policy number are:
Carver REVENUE DIVISION TOTALS--> COLLECTED : 112 . 80 OVER/SHORT: . 00
Polly Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
las 112 . 80
I way that in the performance of the wait for which this permit Is Sued,I shat not employ any person in any manner so as to
become
/wl.Mdd�toe`the workers'compenemian laws°1 CaNana.and Wee that t I should became ebjed b the workers. *** ************,*,**,*************************************************************
compensation 3! / 7 / one d sedlon 3700 d the Labor cone.'shaltalb/wg � provisions.
Dm.: S' .a' nook:antCod: INDIVIDUAL F E E BREAKDOWN
WamMg:Fegwa to secure worker+'corryandedon coverage leun/eyNA end Wish matfett an employe toeaiMnel penmdss and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
OW foe.u to one hundred thousand dollar.($10R0g0).M add/tion to the cost of conpwuetion,damages as provided ler In
Section 3706 of Ns reser cob,Interest,and attorney's lees. ELE 6 FIXTURES, LIGHTING 1 ST 20 EA. 1 . 00 6 . 00
CONSTRUCTION LENDING AGENCY:I hereby affim under perry of perjury that there is a construction lending agency ler the ELE 15 RECEPT/OUTLET 1 ST 20 EA. 1 . 00 15 . 00
performance of the work for which the permit oeeued(Sectiwh3097.Ch..C). ELE 1 SUB PANEL 16 . 25 16 . 25
LENDER'S NAYS: ELE 1190 NEW RES BLDG FOR 1 OR 2 UNITS/ SQFT .04 53 . 55
LENDER'S ADDRESS:
Icertiythmlhavereadthiapplcadd,anddalethattheaboetdamaioniscarred.Iagreetocomplywthatnyedmanyodinence END OF FEES /� /eek\,
and stale laws relating to building cone udion and hereby echorite repreeamdives d this city to enter upon the above-mentioned property hC A_
for inspection purposes. (A.p////A +i _
MARK KELLER
. l 1' Pdnt ...zr I �-
tee, -3/7/Te"" L MAR 17 1998
-Signature downer/AgenVApplcenuCerurma
(5151-46WP) White-Buildhg A Safely:Green-Ate:Canary-Applicant:Pink-Revenue:Goldenrod-Assesses �� 1 ?S fA MESA
CONSTRUCTION AND PLANNING POOL & 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
•
- J4. Electrical-Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFERtend. 57. APPROVAL TO COVER•GUNITE •
=:7. Footings • • 58. Electrical Conduit-Undrgrnd.
8. Foundation - , 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
: 11, Property Sewer Line & House Connection 62. Backwash& Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System • Final
14. Rough Plumbtnj_ 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING
1,
18. Rough Electrical:T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Alt Conditioning ,, . - - FIRE DEPT.:REQUIREMENT
20. Rough Factory Fireplace '. + _ .1, APPROVALS • r Peirit# .. •-
•
21. Ducts; in Structure: • t. r- 70. Under•r
_. ground Hydro
22. Ducts, Ventilating '- 71. ProducTt'Piging L -Das Q Oil
23. Gas Pipe-Rough & TtFst •T - - r -. - . '. 72. Underground Flush _
•
24. Roof Framing •-- .. -_ - ' 73; Undergrnd.Storage Tank OGas 0 Oil
25. Roof-Sheathing T - - - 7C Overhead Hydro -
26. I-Bar Ceiling (Structural) & Monocoat - •- - 76; Dry Chemical " ` • '
27. Frame and Flashing ' -,1 76. Dry Standpipe,••• c -• '-
28. Lathing & Siding 77,1 FIXED SYSTEM FINAL •
29. Insulation _ 78: FIRE PREV. FINAL - . -
30. Drywall Nailing - * 'HEALTH DEPT. REQUIREMENT
31. Plaster Brown.Coat= } 79. FINAL INSPECTION .
r 32. Electrical Power Meter-Final ',L2 80 FOOD CERTIFICATE ISSUED _
33. FinaLElectric, Jotes: 4'
34. - inal:Heating-& Air Conditioning a a•_
• 35. Final Gas^Pipe-Test • ,. , -y ', ; . ., _
- 36. Honor Canopy ;t - "•_ - _ _
- 37. Final Factpry Fireplace.' •• : . 1 '
1 38. Final Plurrlbing r . ' -
39. Water Service-Final• ' - • - • • -
40. Gas Servi'c'e-Final : 4 . " . , ,
41. Solar Domestic-Final -
-
42. Backflow Preventer . - , -
43. Backflow Irrigation t • _ .
- - i
44. Landscape Irrigation System . - e _
45. Sound Attenuation ' - " r• ' - -
- .. . r.
46. Handicap•Regulations •. _, . - - - .r.
47. FINAL STRUCTURE & BUILDING _
48. FINAL PLANNING ,
49. Electric Release to Edison -t
1.t.
50. Gas Release to Southern California Gas Co - -
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDREssmeIUImG 244 E 15TH ST WIT: CITY OF COSTA MESA - BUILDING PERMIT
ONNEWSNMLEIPmma PALMER, MICHAEL CHARLES PERM NO: E 087744
ADDNEss: TR
•
1701 KINGS RD PERMIT NO: E 087744 PLAN CHECK NO: N GOVT : N SUPP : Y
NEWPORT BEACH,CA 92663
APPL.MMUNDADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
ARCNITECTOREnIEmSANDBERG ENGINEERING uc.ND: 25915 JOB DESCRIPTION : SUPPLEMENTAL TO E-87331 SQ FT:
ARCNORENC'SADCREss: 242 W MAIN ST we: 106
TUSTIN CA 92680 CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /U-1
OONTRACTOWSNAME: KELLER & SONS CONST (714 ) 631-5298
CCfITACTRSMMLDC 723 OHMS WAY COMMENTS : REF:B-87330 .
ADDRESS:C .POI. CA uc.No.: 390785 **+E****************** Ear*******ir*ic********+E*RETE**********RERE**x*+ESE**************+ESE
92627 utT: Z ON ING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty a perjury Mat I am I. Chapter under provisions al Chaer 9 SETBACKS
çm
encing with Section 7030)of Division 3 d the Business and Professions Code,and y'..nee b in fun tome end Mect
sic.No: 51'49 sic.CLAss: B sic.No.: 9Jj EXP : 00/00 MAIN BUILDING ACCESSORY BUILDING
� C«mae« �yL €J0.lrs FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT : FT ZN LEFT: FT IN RGHT; FT IN
ER BUILDER DECLARATION:I hereby effum under penaly of perjry that I an- i ham the Cadreean Licems law la lfhe
waig reason(Section 7031.5&skiers and Professions Code:Any cty or paddy which requires a perp to awauctt reefer,improve, PARKING REQ: P RO V: PARCEL : 42533110 Z N E: REF NO:
•t ,licensed purnuiantt to theproclaims d are Contrac"inUanCe.tors License Law aPPrican IC 9(coomme�IwitheS«tctcnn7ioo0)a�Dv'esion 3 d theshe PLANNING NOTES>
Business end Professions Coder or that he or the S exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollen(55001). *******************************************************************************
❑ I.ere owwer a the property«my employees with wages as their sob compensation,will do the work.and the slncture S nW intended DEVELOPMENT S 'E R VICES REQUIREMENTS
or altered for sale(Section 7044.Business end Professions Code:The Contractors License Law does not apply to en owner a popery
who buids or improves thereon.end who does such work Nmself or herself or through his or her own employees,provided that such
improvements are not intended or offered for Sale.E.however.the building or inproernem S sold within one Yew a completion.the ZONING APPROVED BYDATE:
ownerituiler will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I•asowhe'el the pro0eny.amexda®`e"ntraengw°h kesedeonfraciel000r rid te°'q°e(Seebn 7044.etafres and BUILDING APPROVED BY ; DATE: _
Professions Code:The Contractors License Law does not appy to an owner a Property who Adds or umprovas thereon and wM -
contracts for such projects with a mdradar(s)licensed pursuant to the Contractors License Law).
❑ lamexempt under Section: B.SP.C..tor this reason: APPLICATION ISSUED BY: DATE: D
***********************************************K ...7<**** ********* * '**
Dale: novas LEGALIZATION : N F E E SUMMARY STRUCTURAL S GMENT: N
I do hereby certify thet I son aware of and understand the requirements of Cauomia Neellh and Safely Code Sections 25505,25533,and /
25531,and that laany tenure heildiag occupant will/wit ml(dmb ane)need to campy with said state alas and the vagdremenb ler BLDG PMT PLUMBING, ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the As Quality Management District.Residential construction appicadm
ons are exempt from Ira
provisions. PERMIT 22 . 00
Date: Applicant: 50% SM I P/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm rider penalty of perjury one of the following declarations: ISSUE FEE 6 . 50
❑ MEWS and will mamtaiiaaemdiwea consent toself-insure for makes'compensation,asproidedfor bySection 370Ddthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
code.f«the ped«man.athe work for :
which this a
apenbbaed. TOTALS----> 22 . 00 6 . 50 0 , 00 28 . 50 28 . 50 . 00
❑ I have and will maintain»velem'compensation insurance,as nequlred by Section 3700 a the labor Code,for the pedam«ne a the
work for which this permit is issued.My workers'compensation insurance canier and policy number are:
Carder; REVENUE DIVISION TOTALS--> COLLECTED; 28 . 50 OVER/SHORT: 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
( ' Sect/on need not be completed y the perms is for one hundred dollars[5100)or less)
28 . 50
certify that in the performance of the work for which this permit is issued,I shall employ person in any manner so es to
cite subject to the waders'compensation laws of California,and t d 1 become subject to the workers' i*********************************************************N*********************
mpenasiMaw/E of median 3700 d Labor LabCode,I shall fon provisions. INDIVIDUALs.
F E E BREAKDOWN
Dals. j' Ti ApdM:
ice _
hW Int:Fa eto secure wort«imm
npartloncoveragelaunlawN(andShallsubjectaneployertocriMnlpaultluand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
vll fines rep to one hundred thousand dollars($100,000),In addition to the cost of compensation damages as provided for In
Secton 3706 of IM Labor Code,InaNea&andettomeya lees. ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 22 . 00 22 . 00
' CONSTRUCTION LENDING AGENCY:I hereby affirm under Penaly d perjury that there is a consmieion lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and sale th e e above information is torted.I agree to comply with all city and county ordinances
end state laws relating to building construction. •,v.reby authorize representatives of this sty to enter upon the above.menlioned property
for inspection purposes.ROBE•T T./WE
04-15-1998/03:35 P6/528.50
/ • //a a PERMIT:087744
Dale:
Sig .tore of Owner Rel'., : v.ntneaor
(5151.45.WP) While-Building&Safely;Green-Fle;Cemry-Applcant;Pink-Revenue;Goldenrod-Assessor /l
J
CONSTRUCTION AND PLANNING POr SPA" -
APPROVALS .Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe'Undrgrnd. . . 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE - r•
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. ./
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap •
63. Heater & Vent-Final /
13. Roof Drains 64. Plumbing System Fin9I
14. Rough Plumbing • 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts. Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas ❑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 7' FINAL INSPECTION
32. Electrical Power Meter-Final 1t/{r9.Lie 4t FOOD CERTIFICATE ISSUED
33. Final Electric lFTd I 0 ores:
34. Final Heating & Air Conditioning
35. Final Gas Pipe:Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
r
_ 41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING _f
48. FINAL PLANNING -- - "
49. Electric Release to Edison -4 •!6
50. Gas Release to Southern California Gas Co ----
51. CERTIFICATE OF OCCUPANCY "-
No Date
ADDRESS OF SLALOM 244 E 15TH ST WIT: CITY OF COSTA MESA - BUILDING PERMIT P-Ic6^09n
ONNEWSN$ME'FIQMWT PALMER, MICHAEL CHARLES PERM NO: P 087333
AOM ESR TR
1701 KINGS RD PERMIT NO: P 087333 PLAN CHECK NO: N GOVT: N SUPP : N
NEWPORT BEACH,CA 92663
APPL.MAILING ADDRESS:' CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ADD
ARCMRECTOReNGNam SANDBERG ENGINEERING lnc'"O" 25915 JOB DESCRIPTION 1192SF 2ND STORY OVER 979SF NEW GARAGE SQ FT:
mcm"f'SADDREssn 242 W MAIN ST DMT: 106
TUSTIN CA 92680 CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /U-1
CONRACTORSNMI: KELLER & SONS CONST ( 714 ) 631-5298
CONTRACTOWS WARM 723 OHMS WAY COMMENTS: 68SF EXTERIOR STAIRWAY & 199SF DECK RE:B87330
ADDRESS C.M. CA uc.NO.: 390785 +e+r*Rr**Rr*x+LRr*******rRe**Rr****Sr+E+r*+r***+r*********k**+r+F******SRL+ ******SL***SF****RF�E*�F*
92627 UMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penally d perjury cast I am licensed under provisions d Chapter B SETBACK S
(commencing with Section 7000)of Divuun 3 d the Business and Profession Code.end my license is in fun force end effect.
CmuC.NO..:024574 UC.CLASS: B UC.NO.��3p� 5 EXP : 06/98 MAIN BUILDING ACCESSORY BUILDING
�:11%Done: 3/I7/5� camaagggP���1 >f� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
/ LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm wider penaly d perjay that I am exempt from the Coraredan License Law for the
'owing reason(Section 70315 Business and Pmeniona Code:Any city or county Mich requires aPermato coroew,altar.improve. PARKING RE PROV: PARCEL: 42533110 INE: REF NO:
now,or repair any structure.prior ton permit issuance.also requires the applicant for such peto file a signed statement that he a she Q
..Fceased pwaent to the poviskes of the Contractors License Law[Chapter S(commencing with Section 7000)d DNsion 3 of the PLANNING NOTES>
Business end Professions Code)or that he a she o exempt therein,'end the bans for the alleged exemption.Any violation of Seals. > .......
7031.5 by Ory eppfieeiit l«aperme mmpaa the applicant to Baal penally dnot more then lira hundred ddb,'MOOD. *******************************************************************************
O I.as owner of lha aopevY or my employees will wages as their sole compensation.will do the work,and the structure is not intended
adlaed for sale(Section 7044.Business and Professors Code:The COrtrmws License Law does no eppfyIO an 0vme(SPmpaty DEVELOPMENT SERVICES-- ,REQUIREMENTS
who builds a improves thereon.and who does such work tamer or herself or I111041 his or her own employees.provided that such r
oowner�iLdkferents wl have the burden proving he or Stee didded a offered for sale.tl, �mthe build buildingaimprove ffo thepumas is sold sa)a"y'md completion,the
ZONING APPROVED BY - DATE:
. 0 I,as water of the property.ant exclusively cordradig with licensed comrades to construct the project(Section 7044.Business and
Professions code:.Tln Catscta+License Lew mea not reply ta run owner 4 popertY who bolds Or improves mason and OW BUILDING APPROVED BY : DATE:
eonueds for mach projects with a mntrmor(s)finned pusuaa to the Contractors License Law). l
o Ie eagadasamon: B.AP.e.,for thbreeeo : APPLICATION ISSUED BY: •
DATE: 311 i cin
********************** **********************
Done: Owner
Ion understand certify that I am aware of end the requirements of Callomia Beath and Safety Code Sections 25505.?Ke .ark LEGALIZATION:N F E E S U •M .M A R Y STRUCTURAL SEGMENT:N
25534.and that 1 or any future building oowpenl will/wap nor(drub one)need lo comply with said stale codes and the requirements for
a permit for constmaion or modifcaan from the Aireu Y rnpemem District Residential construction applicatioroeroexempt from these BLDG PMT PLUMBING ELECTRIC ,r, MECHANIC FIRE SMIP/RES GRADING
provision. PERMIT 88 . 75
Date: Applicant: 25% ••• ,:.",(../ SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under Madly of per ury following One of the follong dedarat'vs: PLAN '
ISSUE FEE 22 . 00 •
❑ 'ha"andWmaintainacanticatedmwehls itosett4naushr mnpemmion.apwidelfabySedan3]004the
Labor BUILDING-DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance4 the work for which this perms issued.ted.
❑ Ihave and wamanta.workers'componential insurance,as required bySaton 3700of the Labor Code,for the performance ofthe TOTALS----> 88 . 75 22 . 00 /, 0 .,00:
erms 110 . 75 110 . 75 . 00
work for which this pS issued.My workers'compensation insurance carrier and polio/ w:y number _
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: ( 110 . 75 OVER/SHORT: . 00
Poky Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nor be completed I the permit is for one hundred dollars 111001 or less.) 110 . 75
" - r
I certify that in the performance d me work for which this permit is issued.I shall m employ any person In any manna so as to •.0 a i� 7
become subjed to l�workers'compensaion lave d Cstotnie.and spree ihm r I should become eubjm to the workers' ************************************3199*****• ********31*******************9499*****
compenmio s of Sedion 3700 of the Labor Code.I shall fin •"h with those provisions. I N D I V I D U A L F E E* B R E A K D O W N
Dona: >//7 [ APwaen✓� �� I.
Warning:Failure a secure workers'compensation coverage la unlawful,and W/ISW/acf an employer to cdMml penalties end TYPE QTY DESCRIPTIO N,,-- UNIT COST TOTAL COST
civil fines rpt to one hundred thousand dollars(t10g000A In addition to Me coat of cotpensst/ork damages as Provided for In
Section 3706 of the Labor Code,Interest and aromey's lees.
PLU 2 BATHTUB 8 .75 17 . 50
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there S a construction lending agency for the PLU 1 DISHWASHER ' -
8 . 75 8 .75
performance wthe work for which mepink sissued(sman3ow.CW.Cl. PLU 2 LAUNDRY TUB OR WASHER 8 . 75 17 . 50
LENDER'S NAME: PLU 1 SINK, KITCHEN 8 . 75 8 . 75
LENDER'S ADDRESS: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 50 c Icrniy Mm d have read this application end male that the above information i correct.I agree to complywah dl city and county ordinances PLU 1 SEWER CAP / DEMOLITION EACH � T� I:tand state srm relm'vg to building construaion end hereby authorre repreaentativss dlhbo toemer upontheabova mentionnd ProPabPLU 1 SEWER, CONNECTION TO BUILDING EACH . 0 2 . 00
fa rnepmen wrprnea.MARK KELLER END OF FEES 1111: g
.�G,(//)Jc (/ Date: 5//T[/ MAR 17 1998
'�
--) Signature d°wmer/Agm ,CO/Ap°ica" "raor CITY OF COSTA MESA
(5151 d6.WP) White-Building A Soley;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor -
It : - /..,1
Zii CONSTRUCTION AND PLANNING PC & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
a
•2. Soil Pipe-Undrgrnd. 4/16 �1 -Steel Reinforcement .-_
'3. Electrical Conduit Utility-Undrgrnd. v 54. Forms --
'-4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test _
6. ElectricalUFER'Grnd. 57. APPROVAL TO COVER-GUNITE
7, Footings - • 58. Electrical Conduit-Undrgrnd.
8. Foundation . 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System -- 61. APPROVAL TO DECK
: 11. Property Sewer Line & House'Connection 62. Backwash & Receptor-Final
12. Sewer Cap -. 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing. 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign . - . 68. APPROVED FOR PLASTERING.
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & fljr Conditioning: _ FIRE DEPT. REQUIREMENT ' ' _•
-.-. . ' .. .. -�-
20. Rough Factory Fireplace - .; .APPROVALS ' Permit #
21. Ducts, in Structure- -; 70.-tinderground Hydro -
22. Ducts,Ventilating , - - • 71, Product Piping 0-Gas OOil
23. Gas Pipe-Rough & Test - I. _' •^ • 72. Underground Flusli -
24. Roof Framing r' n• ?1 11- ' : 73 UndergrncL Storage'Tank 0 Gas 0 Oil
25. Roof_Sheat-hing .. ", 74. Overhead Hydro' - ••
26. T-Bar Ceiling (Structural) & Mond-coat ' - 75; Dry Chenjical
1- .
•
27. Frame and Flashing _ 76. Dry Standpipe _. . • • •- •
28. Lathing& Siding . _ 77; FIXED SYSTEM-FINA.. ` r. .
- 29. Insulation - - 79i-FIRE PREV. FINAL k '
30. Drywall Nailing - : t4iEALTH DEPT. REQUIREMENT' . '
31. Plaster Brown Coat ,, 79. FINAL INSPECTION
32. Electrical Power Meter-Final I 80.- FOOD CERTIFICATE ISSUED
;-.i
. 33. Final,Eledtric Er Notes: ? -, -
t 34. Final-Heating& Air Conditioning ' ^
35. Final Gas Final-Heating
J3(oAo
Z(o �� �) '
- 36. Hood-or Canopy i• • 4 . ' 1 • (Q// r9c eba- /� - - .
.i 37. Final Factory Fireplace ,; / L
38. Final-Plumbing •• -- •. :J '$ 4' ' .,o.. •
39. Water Service-Final:.
40. Gas Service-Final . -
41. Solar Domestic-Final 4 ' ,
42. Backflow-Preventer ' - - • -.
43. Backflow Irrigation . ' . -
44. Landscape Irrigation-System • • ... - _
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING • ' + -'� '
1 -
48. FINAL PLANNING_ . . .
49. Electric Release to Edison • 4
50. Gas Release to Southern California Gas Co i .. - - -
• 51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OR BUILDING: 244 E 15TH ST UMT: CITY OF COSTA MESA — BUILDING PERMIT
o*NEIrSNAMEIVIDaom+: PALMER, MICHAEL CHARLES L' PERM NO: M 087332
ADDRESS: TR
1701 KINGS RD PERMIT NO: M 087332 PLAN CHECK NO: N GOVT: N SUPP: N
NEWPORT BEACH,CA 92663
a.RAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: ADD
ARCHITECT OR ENGINEER: SANDBERG ENGINEERING uclfo.: 25915 JOB DESCRIPTION : 1192SF 2ND STORY OVER 979SF NEW GARAGE SQ FT:
Mb OR EMS ADDRESS: 242 W MAIN ST UPC: 106
TUSTIN CA 92680 CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /U-1
CONTRACTCNSNAME: KELLER & SONS CONST (714 ) 631-5298
CaNIRACTOWSMMING 723 OHMS WAY COMMENTS : 68SF EXTERIOR STAIRWAY & 199SF DECK, RE:B87330
ADDREssC.M. CA um.NO.: 390785 *+E**RE*RE*****+t*x**iE**itttaEatRr+L�E�E****jt*atatatatR6at*** ERE*+tip*it******Rt*at*+E*+t********+tRtat*****
92627 UMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby effkm under penally of penury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CITY LIG.xo.:02g574 UC.CLASS: B UC.NO.: 3 078 EXP: 06/98 MAIN BUILDING ACCESSORY BUILDING
Done: 3�/7t convagp��7 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaky of perjury that I am exempt from the Contractors License Law for the
•glowing reason(Section 7031.5 Business and Professions Code:Any city a county whidl requires a permit to construct,aper,improve, PARKING REQ: P ROV: PARCEL: 42533110 Z NE: REF NO:
emoliah,or repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she
A licensed pursuant to the provides of the Contractors License Law[Chapter 9(commencing with Section 7000)of DNnlon 3 of the PLANNING NOTES>
Business and Professions Code]or that he or she S exempt therefrom and the basis for the staged exemption.Any violation of Section >
7031,5 by any applicant for a permit subjects the applicant to a chit penalty of not more than fWe hundred dollarslS50011. ************************************M M*****************************************
❑ I.as ovmer d the properly or my empbyees with wages as their sole compensation.will do the work.end the structure is not intended DEVELOPMENT SERVICES R E U I R E M E N T S
or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does wl appy to an owner of properly
who bolds a improves thereon,and who does such work himself or herself or through his or her own employees.provided that such
improvements are ml intended or offered for sale.D,however,the building or improvement S sold within one year of completion,the ZONING APPROVED BY DATE:
ownerbuilder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.as owner of the propeM,am exclusively contracting with licensed contractors to construct the project(Section)pita,Business and
Professions Code:The Connecta.License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(*)licensed pursuant to the Contractors License Law). . t..1
❑ I am exempt under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: - DATE: rll-11
*********************************************** ******************* ** ******
Date: oXBe LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby cerliy Owl 1 en,aware of and understand the requirements of California Neahh and Safety Code Sections 25505.25533.end L
25534,and that I or any future building occupant Will/win nol(circle one)need to comply with said state codes and the requirements for
a permit for construction or modificationu
horn the Ar Ouakty Management District.Residential construction applicationser
e exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT — 32 , 75
Anoka/it:DatAnoka/it: 25% SMIP/NON—RES
PLAN .'9
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally d perjury one of the following declarations: ISSUE FEE 22 , 00
❑ !have and loll maintain a certificate of consent to self-insure for workers'compensation.as provided to by Section 3100 of the Labor
ce.for the performanceme wa,far which permit is issued.
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code. of
❑ I have and wil maintain workers'compensation insurance,as required by Section 3700gthe LaborCode,for the performance dthe TOTALS----> 32 .75 22 .00 ,/,-:0 . 00 54 .75 54 . 75 . 00
work for whidi this permit is issued.My workers'compensation insurance miner and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 54 , 75 OVER/SHORT: .00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
s section need nor be completed I the part is for one hundred dollars($5001 or less.)Re
5 4C 7 5
I eerily that in the performance of the work for which this pensnot q is issued.I shall employ any person in any manner so as to
become subject to the waken'compensakm laws d California.end agree that i I could become sub$d to the wakers' **************************************`*****************************************
compensation/provisions d Section 3700 of the Labor Coda I shall fon h whh t ions. INDIVIDUAL F E E BREAKDOWN
Date: 3 /7/1 er Applkan
7 Waning:Farme tpsuns workers compensation coverage Is unrswN(and shall subject an employer to admiral penalties and TYPE QTY DESCRIPTIO N C' UNIT COST TOTAL COST
civil flus up to one hundred thousand dollars($104000).In addition to the cost of compensatory damages as provided for In /�x v
Section 3106 of the Labor code,Interest and afromav's rasa. MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 13 . 25 13 . 25
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a cmnsnwion lending agency for the MEC 3 VENTILATION FAN CONN TO SINGLE DUCT 6 . 50 19 . 50
performance of the work fa which this permit is issued(Section 3097,Cb.C).
LENDER'S NAME: END OF FEES
LENDER'S ADDRESS:
Indnly eta have mad this application and state that eb a ulhe lire repr se is coned.of t agree totcomply with all dry end county ordinancesartpp
and sten taws relatingurpoe to building wnmuction and hereby ehahone representatives d this city to enter upon the above.mentioned property
for inspection purposes. ,I
MARK KELLER
e: print Name _a MAR 17 1998
.� ��a. Date:?//?(,
Signature of Owner/Agent/Applicant/Contractor
• CITY E C3STA MESA
(5151.46.WP) White-Building&Safety;Green-File;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING PO(,.. & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd._ - 53. Steel Reinforcement •� ..
;3. Electrical Conduit Utility-Undrgrnd. 54. Forms -
•=:4. Electrical'Conduit-Undrgrnd. 55. Electrical Bonding
x
5. Steel Reihforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER'Grnd. 57. APPROVAL TO COVER•GUNITE -1
.-,.7, Footings a4. 56. Electrical Conduit-Undrgrnd.
-8. Foundation- 59. Gas Pipe, 0 Undrgrnd.,Test
i
.9. Water Pipe•Undrgrnd.- 60. Backwash Lines, P-Trap, 0 Undrgrnd.
'10. Structural Floor System ._ 61. APPROVAL TO DECK
•
•11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater &Vent-Final
13. Roof Drains r • 64. Plumbing System - Final
14. Rough Plumbing - < 65. Electrical-Final .
15. Rough Electrical-Conduit •. 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ,J,-e I- . 'z . FIRE DEPT:•REOUIREMENT
�. . - •-, ..I t
-
20. Rough Factory Fireplace _ - ,1 74
'r _APPROVALS `w Permit# " _
21.`Ducts, in{Structute e5-• k " ' 70. Underground Mydro
22. Ducts, Ventil2tingt. 7 y - •- `'` t 77, O.Gas
-� r _,y, ; Product-Piping - QOiI
23. 'Gas'Ripe_Rough &test = ! - '' `' 4• - 72. Underground Elush n.
24. Roof Framing •• t _- j _ :; -1 • 73i Undergr4d.StorageTank0Gas ❑Oil
+ z V . J
25. Roo
.Sheathin9 _ _ 74. Overhead Hydro_r »
26. -T-Bat Ceiling (Structural) & Mo'nocoat r .. 75: Dry Cheipical ^ :Tar
27. Frame and Flashing; -.1.--.:z.' r x . r, 76. Dry Standpipe ;,-a -
28. Lathing & Siding , 37.. - 77. FIXED'SYSTEM-FINAL-'
29. Insulation :. r c c 7$. FIRE PREY. FINAL t -
.
30. Drywall Nailing ' - i CHEALTHDEPT,i'tEQUIREMENT
7 31. Plaster Brown:CoWt; ' _ , 'x 79. FINAL I$4 PECTJQN - _ ;,
32.-Electrical Power Meter-Fihal i t 801 FOOD CERT CATE ISSUED'
- _ . t -• -; .. Ti - ♦.
33.'Final.Electric. ` '1 - if
i. ' - •
34.;Final Heating & Air Condtioning T, g7/QB '7ef -Mg,9 Z� dK
35.:.Final Ga's-Pipe=TeW. - , •' ,. -
36. Hood or CanoPY •'1 • - :T - ,
37, Final-Factory Firepl ce. ' „ • - I I" t�„ • -- ;
' 38. Final Plumbing - r - ! �: +
r . _
39. Water Ser-vice-Final ' r r -. i, '
. -. I r' - s
40. Gas Service-Final I C•
-- - _
r. .
41. Solar Domestic-Final -_ - -C
42. Backflow+Preventer • , . . - • r - - - - -
43. Backflow Irrigation; - r, ,..- -
-44. •Landscape Irrigation System----
- it. t - _ ... _ - _ r, - -
45. Sound Attenuation ' _. • '' ' •T ' '
• 46. Handicap•Regulations l .7 ..
- :47. FINAL STRUCTURE & BUILDING '
48. FINAL PLANNING. : i • * -
49. Electric Release to Edison I: '1 .I "`
50. Gas Release to Southern California.Gas Co v
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ~
Pr NO. TRACT NO. LOT NO. UNIT NO. 9957 9/I I /85 154..E TL'.
CITY of COSTA MESA CONSTRUCTION PERMIT IT 0 S 4
Project Address 2/<u E. 15th St. , C.M. I '
Applicant's Mailing Address 126 `. TYPE OF CONSTRUCTION NEW' U ADD `h' ALTERATION LI REPAIR
OrgmerC/0/ Way, C.M. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Zone
Oy+ner'S Name Micecl Palmer Phone - ' DESCRIPTION OF WORK/USE OF-BLDG.apartments, remove exist in
•
•• Address 1201 Kings Rd.-,_ blewpnrt B each• CA • nnri: re_rnnf d Ther9Jn$,$ E Main Building: Accessory Building: Z
Arch/Eng. ,License No. - TYPE OF PERMIT •❑. G RAD(rv��FODUNDATION Li STRUCTURAL -/ Front 0
Address CICITENANT ELECTRICAL '❑ PLUMBING ❑ MECHANICAL B Rear N
•
Contractor's Name-Cmak_�o� Roofing Phone 548-5569 ❑ 'OTHER ' . - - A 1
PROJECT DESCRIPTION SQ.- FT. 650 OCCUPANCY_mE{-/_ C Right N
Address(mailing)_126 Commerc Lal Way, Costa Mesa, CA1~'f-�l'e i; G ,
-CON STRUCTION TYPEIIpactmentS VALUATION$_,m51...n0 $ Left
City License No. 5993 ZONE ' - ' GRADING CU.YDS. ACRES •
r •
R
- Ping. Ref.# Parking Req./Provided. - E
LICENSED CONTRACTOR DECLARATION 0
I hereby affirm that-I am licensed under provisions of,Charter 9 (commencing Remarks: Planning Notes: - M
with section 7000)lull of Divisiono3 of he Business andProfessionsand T
my license Is in l/u/�'�ll force and effect., •
S•
License Clats LCL Jr . License 77
-
Date_9/9/R5 Signature thew ems, - PLUMBING • I FEES
\s/z:
WORKERS'COMPENSATION D- L• -ATION Bar Sink Showers ELECTRICAL •
1 FEES
hereby affirm that I have ace cafe of consent to self-insure or a certificate •
'N. if Workers' Compensation •rance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW 3800, Lab. C.) _ �
1 Policy No. _lit:/t844i2 company Home Ins. Backflow Irrigation Sewer Cap • Construction Pole Sub. - 0 50+KW ;
\ Q Certified copy is hereby furnished. - -
XXCer(f�{i'1f,;pQ F is filed with the city B l i w Bathtubs • Sewer Connection - Cooking Unit Meter 0up to 100 amps ,
Date?/y/ Applicant �`���� ��°85. Roofing Co.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiefs Solar Collectors Dishwasher Meter Dover 100 a•mpst
(This section need not be completed if the-permit is for one hundred ($100)or - -
less). • Dishwasher - Solar Piping Dryers OGas ❑Electric Sub Panel -
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 Drinking Fountains Solar Tank Fan Motors 00.1 HP Eli 14.8
Workers' Compensation Laws of California. •
•
Date Signature - Floor Drains Swimming Pool w/SpaF.A.U. Inc.Solar 09-15 HP 016-15+
'NOTICE:If,after making this declaration,you should become subject to the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures - -
comply with. such provisions or this permit' shall be deemed revoked. Microwave
•
CONSTRUCTION LENDING AGENCY Gas Service Outlets, Water Closet •
Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors - Water Heater Outlets
Lender's Name _ Range
Lender's Address ' Kitchen Sink• - - Water Service Switches Sign
OWNER BUILDER DECLARATION - '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories .- Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or _ 9 P ;Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap . Laundry Trays Generator 00.5 KW 05-15 KW Trash Cam ctor '
any structure, prior to its issuance, also requires the applicant for such permit Pa
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains ' -
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that hk/she is exempt •
.herefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a perthit subjects'the=applicant to a civil - - '
ee nalty of not more than five hundred dollars($500).; '- -
LL I, as owner of the property or my.employees'with wages as their sole -Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044. Business and Professional Code: The Contractor's ' , MECHANICAL I FEES
License Law does not apply to an'owner of a property who builds or improves • 4
thereon, and who doe; such work himself/herself or through his or her own - i DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler ' ' ' • Hood or Type I 0 -
sale, If, however, the building or improvement is sold within one year of com- - Canopy Type II 0 - loping Approved By Date
pletlon, the owner will.have the burden of proving he/she did not build or im- Duct-.Underi Ground I Building Approved By Date
prove for the purpose of sale). '
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration9-Y
-SS
System Application Issued By Date 7 —O_]
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU SUM V F FEES
builds or Improves thereon, and who contracts for such projects with a con- - - -- - p/�/.��1 .7
tractor(s) license pursuant to the,Contractor's License Law). I am aware that - BUILDING PERMIT $ 7 I F SMTP $ r v
f Exhaust System 0 Multiple 0: System Repair/Alteration •
proof o their Worker's Compensation insurance should be provided to me. ' _ PLAN CHECK $ ' PERMIT
Diem exempt under Section - B.& P.C.for this reason J Firepl/Fact.Bit. ICBG# ' • Fire Dampers PLUMBING $ ISSUANCE $ •
Date - Owner - Heating'System& Ducting Registers _ PLAN CHECK 25% $ ENERGY P.C. $
hereby certify that I have read this appilca "•n end s rte that the above ' 00.100,000 BTU 0100,000BT .. . . ._ ... . ... ELECTRICAL $ GRADING $
information is ect. I agree to comply wit. all • y a • county ordinances
and-state law- •ting to building col,tru• ion end h: eby authorize repre- - - j - MICROFILM $
sentatives of ci to enter .•.. /•• --m: boned property for PLAN CHECK 50% $ `�
Inspection pu .•ae//'` /� �. Date - MECHANICAL $ TOTAL FEE ' $ /S'"'
Signature _ '
Drivers' Li`-5- orSS# ' - — 9/9/85 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
ali
CMF 0065-•• rev. 10/04 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
r
CONSTRUCTION AND PLANNING PO%_ & SPA
APPROVALS Permit Date Inspector APPROVALS Permit - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2.&Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains i 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20; Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
. 27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING q/Zzl7i,s•-- ? S
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas,Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
PATIO COVER DETAIL 6/ 1 /67
TYPICAL JOIST ANCHOR
STATE--`-----Y 111411111111111111111111 ire
SPAN �e —
SPACING r RNi
SIZE / a - ;....•
OVERHANG 1MM / i t'� •-
_r0 . FOR DRAIN �' y s
,�.-�SLOPED � I ' 0
STATE LENGTH
MAXIMUM /_ CONTINUOUS p. ,_,,,, -,—� 3/6x5 Lags 32% LEDGER ._Cis . Blockingf/�//��� 4• % },{AXIMUM Predrill Ledger '
Predrill Existing '/s-3 Deep �I
1�11� JOIST HANGER
or other approved methods NOTE : USE REVERSE SIDE FOR PLOT PLAN.
AM of support • tie.
warm
STATE SIZE NO I RAFTER — 1-1 , 'T NO 2
A ALL LUMBER DOUGLAS FIR FOR OPEN EGG CRATE
ALUMINUM OR PLASTIC
rOR SOLID SHEATHING.
� LarL*V g/I6X2��-T-STRAP CONSTRUCTION" GRADE SHINGLES OR BUILT UP
,, ROOF COVERING ROOFING.
MAXIMUM SPAN SIZE SCIG MAXIMUM SPAN
17' 0"" 2x6 I % 15' le
s 16' 0" 2'x 6' I %ems 3' '
= POST-BEAM 15' 0 C2'x 6' ' 2' % .
10' al�
-I f CONNECTION 12' 0' 2-x 4 I • O/t —��g' II"
(- r- I I ' 0' 2'x 4' 16% 8' 8'
\\I
POST 10" 0' 2 x 4" 24 7' I"
'� msg. 17 ' 3 - NOTE: FOR PROPOSED OR FUTURE R0. ,OR WHERE PA 0
' SHOW IZE SHOW SPACING WALLS ARE TO BE BUILT. USE No. CHART e • Y.
u
SHOW LOCATION ON REVERSE SIDE. WIDER RAFTER SIZE MAY BE INTERPOLATED FOR
' SPACING ONLY.
DROP PATIO FLOOR • FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO
MTs f— SLOPE TO DRAIN
_ e WALLS ARE TO BE BUILT SUBMIT COMPn HO IS
'` AND ADDITION PLANS
•: " • PUDDLED SAND FILL a.
,fix 2 : .• .' Remove Gross And Weeds Down To Natural Grade
Si Mt' ' ..... .
12' CONCRETE MIX 1:3:4 MAXIMUM WATER ' CONTENT
POST ANCHOR 1 I �..'. 7# GALLONS PER SACK CEMENT. /�
For Pipe Post. Embed t__12� Provide 26 Ga G.I. Flashing At Wood Floor Const. COSTA MESA BUILDING DEPT.
Pipe In Footing.
Provide Flange Or Weld Plate Screwed Or Bolted To Frame.
• 77 FAIR DRIVE 556-5273
FORM BU-.o
•
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raorrys OF
SUBJECT NN NG o a ESq/ \
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4644 r
COSTAOBOXE 200 COSTA MESASA , DEPARTMENTETY 0413 7/24/78 CALIFORNIACA I ORNIIA 9 6 T26 04 3 7/24/78 1'0.50C1iLQ-
AP I AT ON F6114 .sa'RligIEWISAfilP. ERM1-T--> Ae
For Applicant to Fill in Completely —Use Ink Only a
REC I D DATE RECEIVED DATE ISS
BUILDING
gae7 ADDRESS //a ,y/y OF /s z-A 21-t�,t r- y
OWNER //e /v �? / rI ? R IVI l 4Q Y A.P.NO./77-7,(/•-•2.7 /
BUILDING G /� -�, �� /
MAIL r /�i _/ �,1 ADDRESS VL.
ADDRESS G I`4. 4i� c:
.
�/
O
TEL. TRAC?"fO ' LDT�/�BLOCK
CITY S- c /I e C NO.,CV8'z3yy
CONSTRUCTION ALTER REPAIR MOVING OFMOI ISH
,
LENDER ///���s�
BRANCH n /�(- radar
• ,G
ADDRESS q ,, � VALUE J
ARCHITECT TEL. C sad' /2 ,ill , a " :_ S `�
OR ENGINEER (DAf )JR_ NO.....3 ft At 42 - - - ,
FIRE
ADDRESS •S 6/ ME ZON T PE GROUP I/
� APPROVED _ AS
CONTRACTOR D Lk) "R_ e_ BY M DATE ` �� Mir
ADDRESS •S a_16__<•• '• - I �— it
TEL. ZON • •` USE OF NE 4 / O
CITY Q 05 r n m.e S q NO.,i, f5- . • _ BUILDING
••• STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. /1/-Q A/-c LIC.NO. /116 A/t- MAIN BUILDING ACCESSORY BUILDING_
W SIZE • NO.OF BLOCS. !, (FROM C/L STREET)//
o• OF LOT Q '" NOW ON LOT y -•NT L/ F I"3/� - FT.
Q USE OF /
,)., EXISTING B • R SIDE /(p FT. FT,
ca
/
9 Separate permits are required for L,SIDE Le -`—: FT.
C electric,plumbing and heating work. REAR 5 FT. FT.
Lq US OF LD �/"Af/0251 TO BE PERFORMED
I- �� �N(.." G AINDISTANCEO BET. BET.MAIN D
Q TYi' MAIN BLOCS. ACCESS.BLDGS. �
..l p s,.,, / 0 y //I/ge VAR, A
ATE
`14 �Xl C.U.P.,9W n APPROVED ^XJ
} IO , _BAPYPRO fli, / DATE -7/'i /
C �V
G. I hereby acknowledge that I have read this application and state in
O N
p: that the above Information Is correct and agree to comply with m
0• all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of o
Tthe State of California.
3 I hereby certify that I am properly licensed as a contractor under abidSG. FT. 5
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full f• e d effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY!. e
am exempt from the pr ons of th State • Califo nla Business �f/ Q
and Professions Code, Ivislon 3, apter 9 VALUATION PERMIT FEE S �
/fi/ 'PLAN CHECK E 1e
Signature o� ' /�� /� .� o
Permittee -Q ...e7S /_-• /7//� •
TAX E _ U
Authorized Agent / I TOTAL PAID $ e /
•
OWNER CLARKE DATE 10—lb-58
JOB ADDRESS 244 East 15th St. BUILDING PERMIT NO. 7846
GEN RAIr CONTRACTOR Lovett VALUE $ 469.00
1]A7P. il-Y LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Fence
GROUP TYPE ZONE PLAN NO.
INSPECTIONS DATE SUBCONTRACTOR PERMITS__ ISSUED
S.--Ent
'r � DATE NUMBER
Trenches Forms Steel &- t /0 '2d '.5Y
Floor System
Steel Reinforce Chimney Re-Rod -f /O —ST/_�S"X
Bond Beam •
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final —I
Plumbing Fixtures, Final
Final Gas Test
Construction Pole
Underground Power
Rough Wiring LTi
Fixtures, Final t —t-- /dam.�7 a
OCCUPANCY
Form 210-5M—I.57 7646
NO COSTA MESA BUILDING DEPARTMENT
(fit$ P. 0. BOX 317 I 846
,c.-15 45 COSTA MESA CALIFORNIA
' b FOR APPLICANT TO FILL IN e4 A
1 �T C.L. OF STREET---- 6}} I
I e; Zv eip � � t tv1'SA I BUILDING ADDRESS Q-4/ C, / S � --
I A •
O� _ __ PROP LINE _ �` O% GDC% . ikEC• AlOwner YYl a. )14-A-4- to 0,,h1 -
10 FT. FOR 60 FT. STREET `SOFF sSTREt GP OI `OG ! ' Mail Address P. tell?
B&!t j0
u rV OP,'E1 City C. —a i - — Ph. No. •
—
' I tAN SEC-• I Contractor AO 1"," 7`T4 Ph. No. CA 7--•)`e�G
? Address 91 r ! .540a-nit". G `-°�
1 50 F111F FRONT I City Lic. No. ® State 9
Lic. No. /73 5��7
IOF PROP. F I - -
50 FT_ -\-------
r
_ W I Size of Lot ��� • L d AP No.�� 7 - ��� "
rc
F ( W I ` Setbacks: C/L Street S V �' Rear u
cc
!, r �al� / J� co
as. Side Yard - Right ,��,,pp 11
Left ��'
y , r- -� )14,-:.
� 7�'
—071c.. 0 Type of Fence ���� * n4'
LL ' ' \ALLEY OR PROP. LINE 21 ci
O. WZS kin 1IV) re,— \ al
F:-
.--1 I hereby acknowledge that I have read this application and state
m Z that the above is correct and a ee to ompl th all ®rd-
j Nvp I inances artd Stats ws re in
I
Signature /a r
1 10 I of Permittee • �'
IAgent O7.r4t- '
37 6 IN. I FOR OFFICE USE ONLY
FT. I 40
la
z I FT Permii,Na46
J !LLSS
a
¢ 60 FT ST Date Received Date Issued
50 FT. ST. r i I 1�� 0 - � -
PROP LINE "Fo) I T ' g 'TION
- 1�- =-- y-- -- - - - - - - - -� �� Permit Fee $ • MO
• j// I $ 1 6 y. OD Plan Check $ A /
C.L. OF STREETS I
TOTAL FEE $ r _r
MAXIMUM 4 FT FENCE MAY BE PLACED ON DOTTED LINES -- - ---
MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS
OWNER RANsnx. HENRY M.it
DATE 7_?4_78
JOB ADDRESS 244 East 15th Street BUILDING PERMIT NO. 46447
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK iF gali7e patio Cover
er
AP No.117_141-27 LOT TRACT Nnt.Hts.FIRE 20NE VALUE $ 440.00
NSPECTIONS Signature Date TYPE y GROUP J ZONE A-2
x SOIL SUBCONTRACTOR PEPMITS ISSQED
GAS Date I Number I Signature
4 WATER ^I'�-P-lu-mbin J I' /�
ROUGH PLUMBING 4•fN/[.Jf/V � Rei. -a-ip ��(��7
PROP. SWR. LINE I] HOUSE CON. 0 GGG
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER 0
ROUGH WIRING Heating and Vent. .
TRENCHES Li FORMS Li STEEL REINF. I j
FLOOR SYSTEM
BOND BEAM 0 STEEL REINFORCE f
SHEATHING
FRAME AND FLASHINGr--�
-
L I
LATHING - IN OUT n
PLASTER. BROWN COAT ,/♦
STRUCTURAL. FINAL r( 4-//.-"Z �y.�,,,, 'Electric )�/� q.yn
HEATING. VENT.. REFRIG. AND A.C., FINAL e•.•�11.6Q- ,(d • /4y 41/.711-
PLUMBING.
.�(/q /7 i�
PLUMBING, FINAL AND GAS TEST rl S‘gt-;RW-tif
ELECTRIC. FINAL )<BUILDING, FINAL 44,P/� yz.t 97t _
Irk& wait a- ice- iD-so-c-
r- 3 - '--d:""` •