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HomeMy WebLinkAbout270 15TH ST - Building Permits . s CITY OF COSTA MESA 05`""'Fs. ' BUILDING DIVISION F 4'�'�I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • vnvw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 '` PERMIT NUMBER: M10-00150 PERMIT TYPE MECH STATUS: ISSUED APN: 42516105 DATE ISSUED: 12/07/2010 ISSUED BY: KJB JOB ADDRESS:t270�E-1:5TH:ST.-CM �. Suite/Unit: Vicinity: SQ. FT: 0 SCOPE OF WORK: CHANGE OUT MU. OWNER: ROSS,PHILLIP J Address: 270 E 15TH ST Unit: PHONE: 949-294-1436 City/State/Zip: COSTA MESA,CA APPLICANT: BEEKER,ANDREW Address: 1308 LOGAN • Unit:SUITE H PHONE: 714-979-2070 City/State/zZip: COSTA MESA,CA CONTRACTOR: KLONDIKE AIR INC License No. 754456 Address: 1308 LOGANUnit: SUITE H PHONE: 714-979-2070 City/State: COSTA MESA, CA ZipCode: 92626 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 • INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 X. INSPECTION TYPS DATE INT71ALS CODE# INSPECTION TYPEI DATE /� INTITII SL �� 1616 Fixed System Final Fire Prevention 206 Final Mechanical L l6"4Vt� P 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: 7 Owner ID verified by driv- .sense. El 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.-pr.perty lax uill� or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: • person is required to descend,will be made in connection with work authorized 4opirE--7 ,6..4-1,—ED by this permit,and that no building structure.scaffolding,falsework,or demolition (This section need nal be completed n the permit Is valued at one hundred dollars($100)a less) or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp '/ 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). y N LW C- /O9 (71.1 ❑ 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 wor : s' compensation laws of California, and agree that if I should becom' ubje t to theompe ation provisions of Section 3700 of Applicant's Signature the L..or C..-,I shall fo• r omp - th these provisions. o w_� Z _1 _ I -3 Division of Industrial Safety Permit Number: Date --s,_ !! �' n1's,Sigriamre i=� HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: 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— K G in3full force and effect. /' a registration form for acutely hazardous materials? ❑Yes 0 No tliMiL-1 / SL{ ¶t0 tart p-- -Zo (Section 25533 of the California Health and Safety Code, with some exceptions. requires registration with the Costa Mesa Fire Department by .-4/1 f 2 :7 i a each business which at any one time has on hand a quantity of acutely sSignalure ete ,--Ni- 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 CONSTRUCTION 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 Lender's Name: hazardous materials)? ❑Yes 0 No (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? ❑Yes 0 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? ❑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 Dale 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 ❑ I 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 purpose . I agree nor occupy or allow occupancy of any building authorized byyt it until fin- •-ction. a egal Owner( :' Dale / Signature Date Z � - D 3057.4o(3/07) ear zed Applicant te"�' Simplified Prescriptive Certifies'.. of Compliance:.2008 Residential HVAC, 'talons CF-1R-ALT-IfSAC 1 Climate Zones 1 and 3-7 Il Site Address: ,-y O (ST S i-1 Enforcement Agency: Date: Permit S- I 2.r�—1 O Conditioned Duct insulator Equipment Type' List Minimum Efficiency[ Floor Area requireme �� Thermostat • O Packaged Unit 1 CS Furnace 1314AFUE O COP Over 40 f f duc Served by system addedy re 1 n Setback ❑Indoor Coil OSEER O HSPF Teo sf me fiditio e pace (If 1101 already present must be O Condensing Unit 0 EER 0 Resistance CXR 6 (CZ 1, 3-5) installed) D Other Y 1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with t T formation •cumented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to orcement U• royal with the permit application.A w. • • Name: t � -(L Signature: 4 Company. Date l� . wA(.� Ai /t+L /1-7- (0 Address: f 3 O 2)— H- Lo tato License: 7 S Lry �� r City/State/Zip: C _ inn Cr n Co Phone: t Li Gj7C -?-&70 • • • 2008 Residential Compliance Forms March 2010 r (ENFORCEMENT AGENCY CAN CU _.&MJZE WITHLETTERHEAD/SEAL) t i _2008 Building Energy Efficiency Standards Residential HVAC Alterations Climate Zones 1 and 3 through 7 C'Z•-6 c e_asr79 ries*. BUSINESS AND PROFESSIONS CODE,SECTION 7110 Willful or deliberate disregard and violation of the building laws,including the California Building Code,and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to$5,000 per violation or suspension/revocation of a contractor's license. WHEN IS A PERMIT REQUIRED? A written construction permit shall be obtained from the enforcement agency prior to the erection,construction, reconstruction,installation,relocation,or alteration of any mechanical system,except as permitted in Appendix Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include,but are not limited to: • New IIVAC installation • HVAC Changeout • Replacement of furnace,coil,FAU,or condenser • Relocation of an existing HVAC unit _ .• - Adding or replacing more than 40f1 ducting in unconditioned space 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 61 REQUIREMENTS INCLUDE: I. Heating equipment must have a minimum 78%AFUE(Exception: Wall&floor furnaces;room heaters). 2. Central air conditioners&heat pumps less than 65,000 Btultu must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2, 4. A setback type thermostat(24 hr clock with four set points)is required for all alterations. 5. New or replacement ducts must meet the mandatory requirements of Section 150(m): All joints and openings in the in the HVAC system must be sealed. •• Only UL 181,UL 181A,or UL 181B approved tapes or mastic shall be used to seal duct openings. Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts must be connected using a metal sleeve/coupling. • Flex ducts that are suspended must be supported every 4ft.max for horizontal runs with no more than 2" of sag between supports and 6 ft.max for vertical runs. 6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. I • i • PRIVECTADDRESS: 270 E 15TH ST • UNIT: B CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 068800 OWNER'S NAME: FARLEY, GEORGE • AUDREss: 270 E 15TH ST PERMIT NO: B 068800 PLAN CHECK NO: 00416-94 A GOVT: N SUPP : N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION : 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT: 2, 451 ADDRESS: 1921 E CARNEGIE AV UNIT: 3-J S.A. CA 92705 CLAIM VALUE: 120, 000 . 00 CALC-VALUE: 108, 903 . 80 GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : 93SF LAUNDRY ROOM, 127SF CARPORT, NEW SFR OVER GARAGE - C.M. CA 92627 *********+F*****************+r**** +P+r*******************+e******Tr***RP********yP*ac+F* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMENTS 7000)of Diension 3 0l the Business and Professions Code,and my license is in full force and effect. S E T B ACK S - CITY LIC.: STATE LIC.: CLASS: EXP Date: signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate al consent to sell-insure or a certificate of Workers' FRNT; 25 FT IN REAR; 10 FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: 5 FT IN RGHT; 5 FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: ' 'COMPANY: PARKING REQ; 5 PROV; 6 PARCEL: 42516105 ZNE: R2 REF NO: DR-93-20 .] Certified copy is hereby furnished. 0 Certified copy is fifed with the city Building Division, PLANNING NOTES> 1 DU OF 2 DU APT PROJ. FT STBK IS SEPARATION, PKING IS > PROJECT TOTAL . P S E Elate: Applicant: • ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sectio need not completed if the permit is for one hundred($100)or less). D EV ELOPMENT SERVICES REQUIREMENTS 'y that in the performance of the work for which this per•_,may • ••••• • •• on in any manner so as to become ubie• tolptWorkers' omppeensation Laws of California. ,��= ZONING APPROVED BY \ I'sA DATE: 'a 249 ?c{ Date' 9--�— l Signa I _G�: a NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : W t I DATE: -e/ 0 Till Code,you must forthwith comply with such provisions or Alts permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY- DATE:' " • 9 LA which this permit is issued(Section 3097,Civ.C(. , *************************************Q. (.Q.2* .***.**,**.**.***.*.**.**.**,*,*.**** • • • *.N, LENDER: *********************************************************************** • ****** ADDRESS: LEGALIZATION : N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale 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 671 . 00 10 . 89 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business r 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 109 . 04 -,O any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my emVloyees with wages as their sole compensation, will 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----> 681 , 89 0 . 0 0 109 , 04 790 . 93 / 790 , 93 . 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 REVENUE DIVISION TOTALS--> COLLECTED: ----681 , 89 OVER/SHORT: 00 improvemefor the purppose ofd sale)nin one year of completion,the owner wits have the burden of proving he/she did not build or improve 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 67100 :> 1089 Ln 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 projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *********************************ef****************************************.***** that proof of their Worker's Compensation insurance should be provided to me. IND IV IDUAL F E E BR E AK D OWN ❑ I am exempt under Section: B.8 P.C. Mrthis lrra�son: / TYPE QTY D E S C R I P T I-O N UNIT COST TOTAL COST �, — (l °x SFR 1164 DWE-TYPE V-WOOD FRAME -GOOD 74 . 00 86, 136 , 00 ereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 93 RES-LAUNDRY RM. AP.'T COMPL X TYPE V-14 18 . 60 1 , 729 . 80 534 and matter any future building occupant will/will not(circle one)need to compty with said slate codes and the requirements for a SFR 181 RES-BALCONY, EXTERIOR STAIRWAY 14 . 80 2, 678 . 80 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from Y mese provisions. SFR 886 RES-GARAGES TYPE 5 18 . 60 16, 479 . 60 SFR 127 AES CARPORT 14 . 80 1 , 879 , 60 / Date: Applicant: k ID OF. FEES ✓/ I hereby certify that I have read this application and state that the above informal'.n is correct I a•ree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize r:.,..ya,f.Ives o t is city to en• r•. 'above•mentioned •• ) 0100167352-00162359 T[ET 681.39 'F DATE: 09/07/94 TIME: 11:46 'arty for insp'clion purposes. 4 ---.—L--JI ! ]ate: '••— � � Signature: i �\ _ ' 's License at Social Security#: / \ \ 1641-46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • N CON ST RUCTION AND PLANNING PC & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 11 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. 7%'/Qy Al- 57. APPROVAL TO COVER GUNITE 7. Footings 1frefry 58. Electrical Conduit-Undrgrnd. 8. Foundation /!/� ��fi 3_- - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. o' GGWW 60. Backwash Lines,P-Trap, 0 Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 1l. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit# 21. Ducts,in Structure 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-Bat Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' 78. FIRE PREV. FINAL 29. Insulation �- /7 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final ElectricNotcHOt FOR SPECIAL RE iliakilha 34. Final Heating & Air Conditioning • 35. Final Gas Pipe-Test A of' '- 7,166, 36. Hood or Canopy -� 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 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 .2 9 _�` i' - 48. FINAL PLANNING r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date iity of Costa Mesa - California 92628-1200 P.O.Box 1200 Insulation Certificate Permit Number i__ �J 6980 b 2-70 az S7.2 arr A Number and Street City °RANG County Subdivision Lot Number Description of Installation . ROOF • Material Brand Name Thickness (inches) Thermal Resistance (R-Value) EXTERIOR WALL �L, , / Material 1 747 Brand Name_Cc-2Wv 7r -� Thickness (inches) Thermal Resistance (R-Value) CEILING ��- Y��-�-� Batt or Blanket Type D`I-/-I Brand Name (6t2 a��tGD Thickness (inches) 'd7 I t Thermal Resistance (R-Value) Loose Fill Type Brand Name Contractor's minimum installed weight/ft2 lb. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISED FLOOR Material Brand Name_c 1E 4Lv T! Thickness (inches) • Thermal Resistance (R-Value) ( q 1 SLAB FLOOR • Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Width (inches) • FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Adminstrative Code. General Contractor(Builder) License Number • Signature and Title Date SS lizi -TOS o24 Trou `f SSZ r Sub-Contractor(Insulation Installer) License Number to,3 /14PCES Signature and Title • Date 1907.46 PROJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 068804 4x QWNE 'S ME: FARLEY GEORGE 270 E 15TH ST' PERMIT NO: P 068804 PLAN CHECK NO; N GOVT; N SUPP ; N • COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI /FMI REG.NO.: C JOB DESCRIPTION : 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT : ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S .A. CA 92705 CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS: REF: B-68800 C.M. CA 92627 *****t*i-****************it******** E**i6********t*ii***i+E*********iib*EE*ii***TE*i*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS . CITY LIC.: STATE LIC.: CLASS: EXP: • Dale: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to set-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 3300.Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL; 42516105 ZNE; REF NO; ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > - Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be comp):;'•ifthe permit is for one hundred(SHAG:less). DEVELOPMENT SERVICES REQUIREMENTS I unify that in the performance of the work for which this permit is is ed.I Sb nal empl i any person in any manner so as to become su.i•ct to the"bikers'Compensation laws of California. ....1 ( ZONING APPROVED BY DATE: D. L' • Signature: ` .0TICE:II.alter king this declaration.you should becom• . .• •e o! BUILDING APPROVED HY ny —Compensation provisions of the Labor DATE: .e.you must fonbwith comply with such provisions or this permit shall be deemed revoked. yyyy��J� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: " DATE- which y this permit is issued(Section 3097.Civ.C). ********************************it***it ********ititit**te3tittitit*** * LENDER: *********************************************************************** ******* ADDRESS: LEGALIZATION:N F E E S ,U M M A R Y STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 1031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 100 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 2 S SM I P/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 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE 20 . 00 I. as owner of the property or my employees with wages as their sole compensation. will 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——--> 100 , 00 20 . 00 0 . 00 120 , 0y 120 . 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 REVENUE DIVISION TOTALS——> COLLECTED- 5- 120. 00 _ �-- 1 2 0, 00 OVER/SHORT; 00 torptheepurpose of sale). one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Ai I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 120 0 0 _ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Stale License Law).I am aware *******************************it*********itit*it************it***it*******t*i*it.*.it**it that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B' R E A K D O W N ❑ I am exempt under Section: B.S P.C. - far this re sson: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date 6 �[ ' owner PLU 2 BATHTUB • 7 . 00 14 , 00 ereby candy that I am aware of and understand the requirements of Californi Health and fety Code Sections 25505,25533,and PLU 1 DISHWASHER - 7 . 00 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 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from PLU 1 SHOWER 7 . 00 7 • 00 these provisions. - PLU 2 WASH BASIN • 7 , 00 14 . 00 PLU 2 WATER CLOSET (TOILET) . 7 , 00 14 , 00 Date: Applicant: PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 • 00 I hereby cenny that have read this application and state that the above information is c'rect.I agree to comply with all city and county PLU 1 GAS SERVICE • 7 . 00 7 , 00 ordinances and state laws relating to building construction and hereby authorizers •I .' • if thisci to enter upon the above-mentioned PLU 1 SEWER, BUILDING / TRAILER • 15 , 00 15 , 00 I// property kir inspection purposes "illf_ PLU 1 SEWER, CONNECTION TO BUILDING EACH 15 00 15 , 00 i CtLI—`7r Signature; ,�e',:�_� END OF FEES 01 0016342-00167362 TOT 120.00 DATE: 09/07/94 TIME: 11:48 : is License or Social Security,y.: 164646 While—Building:Green—Godo Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor • 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. L=L��.50- 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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. S.•Foundation . 59. Gas Pipe, 0 Undrgrnd., Test 9..Water Pipe-Undrgrnd. 9,12-574 iT 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System ' ", 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection1, . I 62. Backwash & Receptor-Final LL 12. Sewer Cap • ' 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing /_9. 65. Electrical-Final 15. Rough Electrical-Conduit __(( 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Stgn 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. Duct§,in Structure 70. Underground Hydro 22. Ducts, Ventilating ��./�/�J 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 1(�_[ift( "% 72. Underground Flush . 24. Roof Framing - Yt 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:G1f,2131i.L�S .1;1 b r . 34. Final Heating & Air Conditioning -n DA-LoaRtscoece_kiiktrei_t_P_-- €2 35. Final Gas Pipe-Test f./3.rj75 / 9-2.1 arw _ I111,1 • 36. Hood or Canopy ' 37. Final Factory Fireplace • _1=13_!3 I C/ 11 1- nv 38. Final Plumbing 1-13 L. .A t.tT-(3-16- /13 16rg- `` , , ') /'j 39. Water Service-Final - l- -: •�/i �I-/ -CITSC az' aZ- b-P_L' t't - fia 40. Gas Service-Final _ 3 - r 41. Solar Domestic-Final - 42. Backf low Preventer 43. Backflow Irrigation _/_I? a r 74)13 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 PROJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 068802 OWNER'S NAME: FARLEY GEORGE ADDRESS: 270 E 15TH ST • PERMIT NO: M 068803 PLAN CHECK NO; N GOVT: N SUPP ; N COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI /FMI REG.NO.: C JOB DESCRIPTION , 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S ,A, CA 92705 CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS; REF: B-68800 C .M. CA 92627 *******************+H+EaH**+f*****Sr****iter** THSL*itiEaH** x•aril**arr************TH**yr+r*+t***x LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACK S - CITY LIC.: STATE LIC.: CLASS: EXP : Date: Signature: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV; PARCEL: 42516105 ZNE: REF NO; D Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date'. APPlicant: *************************************ir***************************************** EXEMPTION PROM WORKERS'COMPENSATION DECLARATION: (This section ne:.not be com' ted if the permit is for one hundred(5100)or less). D ENIEL OP MEN T SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued, /.hall not em I o an person in any manner so as to become s •• t to the Workers'Compensation Laws of California. —. _' ,ZONING APPROVED BY , • DATE; pate: x- Signator, -` �s1l,. 'OTICE:If.alter making this declaration,you should beco'e subject to th. Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 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 APPLICATION ISSUED BY• a DATE:which this permit is issued(Section 3097,Civ.C). A54AL'iLENDER: ******* 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 23 . 00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed • 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 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, will 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----> 23 . 00 15 . 00 • 0 . 00 38 • 00 38 . 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 ; - -38 . 00 OVER/SHORT: 00 torthepurposeofsate). 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 _ 38 . 00 • LA 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 promctssaith ansuranctoris)ucense provided to the Contractors'State License Law).l am aware ******************************aFil.*********.*.*..***..1/.****.Ik*******.**************,)r***** that proof of their Worker's Compensation insurance should be provided Io me. ' INDIVIDUAL F E E BREAKDOWN 8 ❑ I am exempt under Section: B. P.C. • for this reason: 1 TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST re' Date: 7 Owner: MEC 1 INST FORC—AIR/GRAV TURN <= 100 K BTU 9 , 00 9 , 00 I do h eby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 GAS PIPING SYS 1 — 4 .OUTLETS 3 , 00 3 00 25 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 NEC 1 INST HOOD W/DUCTS FED H Y MEC EXHAUST 6 . 50 6 , 5 0 rmit for construction or modification from the Air 0ualrty Management District.Residential construction applications are exempt from these provisions. MEC 1 VENTILATION FAN CONN TO .SINGLE DUCT 4 . 50 4 . 50 Date: Applicant: END OF FEES I hereby certify that I have read this application and slate that the above information is correct.I e ree to comply with all city and county j/ ordinances and state laws relating to building construction and hereby authorize re.r.;r .-. .,m the above-mentioned 01 00167360-00167360 T CE T 38.00 property for inspection purposes. moi— • DATE: 09/07/94 TIME: 11:47 rrAR� �"l 1 --`f y Signature, jA�.� _IMPL — ` 1 s License or Social Security#: 164146 White—Budding;Green—Code EnlorcemenC Canary—Applicant;Plnk—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING POOL & SPA Date ( Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # 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-GUN.TE 7.,Footings 58. Electrical Conduit•Undrgrnd. B. Foundation - 59. Gas Pipe, 0 Undrgrrd.,Test 9..Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final •• 14. Rough Plumbing - 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning //�C_c` ' 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-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: /l--9...O4 /n - tom_ ,o [•l ip; 34. Final Heating & Air Conditioning 1^13? Ea Z" Z(�a �_ P� /-I 35. Final Gas Pipe-Test l `� � t�C`¢• i+ ,", _C�t;CJ� 36. Hood or Canopy •J i G `� t- 37, Final Factory Fireplace • 38. Final Plumbing • 1 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 1 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 • PROJLCT ADDRESS: 270 E 15TH ST UNIT: B -01110C±TY OF COSTA MESA — BUILDING PERMIT PERM NO; E 068801 OWN:R'S NAME: FARLEY, GEORGE ADDRESS: 270 E 15TH ST PERMIT NO: E 068801 PLAN CHECK NO: N GOVT: N SUPP ; N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI /FMI REG.NO.: C JOB DESCRIPTION : 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3_J S,A, CA 92705 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS ; REF: B-68800 C.M. CA 92627 ****************+E+6** EEE*ar*ar***x*drx*a6 -** *********Ft*****+E+E+Ear*******rrFEaE***aE******* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T B A C K S 'CITY LIC.: STATE LIC.: CLASS: EXP Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FR NT; 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> • > Date: Applicant: - *******************************aE*********************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ru'section need not be co pleted if the permit is for one hundred($100)or less). D E V E L 0 P M E N T S E R V I C E S R E Q U I R E M E N T r S Hy that in the performance of the work for which this permit .issu• r. :i Hoy any person in any manner so as to become �X I ,a L� sub( t to the Workers'Compensation Laws of California. . _ �` ZONING APPROVED BY DATE: 2, 2 rate l'�1` 1 Signature: � 1144 .���- L `ILA OTICE:If,alter making this declaration,you should become subjec to e Workers'Compensation provisions of the Labor BUILDING APPROVED BY , .' � DATE: G •) — /0— 1 Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. " - - CONSTRUCTION LENDING AGENCY: I hereby aflirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE- which this Permit is issued(Section 3097,Civ.C). ��' **********************************.* *.* ***********.**.*.******.******** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION: NF ' E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I 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 75 .01 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 S 1:‘,12 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 live hundred dollars($500). ISSUE FEE 15 , 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or otlered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 75 . 01 15 , 00 0 . 00 90 .01 90 . 01 , 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 one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE V — ODFIRE SMIP/TOT 90 . 01 -41VER/SHORT: . 00 forthepurpose of sae) BLDG PMT PLUMBING ELECTRICMECHANIC GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 90 , 01 La and Professions Code: The Contractors'State License Law does not apply to an owner of property who bmlds or improves thereon and who contracts lorsuch protects with a contractor(s)license pursuant to the Contractors' tate License Law).l am aware ***************aE*af****aE*.a4*******.1E.IE.1 ***aE**a(.*.lE.*.)E*.*ir**.x•*********.*************,***** that pmol of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N o I am exempt under Section: B.8 P.C. fur this reason' f c TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale 7`)—CI 1 Owner: ELE 2143 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT .0375 , 01 hereby certify that I am aware of and understand the requirements of Czbforni Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. hApplicant' hereby certify that have read this application anddstale that the above information is correct. gree to comply with all city and county (',/// I ordinances and state laws relating to building construction and hereby authorize eprese I. es of h; to enter upon the above-mentioned or fortespection purposes. \'�1 • 1j� _Sy ....emit 2.1.. DATQb 09/07/94. TIME: 11:43 90.01 ate. l ) Signature: ��.a�. • er s License or Social Security u: 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING PCwL & SPA i 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 UFER 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 �J/� 66. Solar System-Final 16, Rough Electric Wiring if 49 10 67. Fencing & Access Approval 17. Rough Wiring Sign I !�' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure - 70. UndergroundHydro 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 .7. Frame and Flashing 76. Dry Standpipe 428. 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 1_L/ . _ 00D80. CERTIFICATE ISSUED 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. 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 • I PROJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 068948 O�xER•s*CAE: FARLEY, GEORGE tDOREss: 270 E 15TH ST PERMIT NO: B 068948 PLAN CHECK NO: 03534-94 S GOVT: N SUPP : N LCOSTA MESA, CA 92627 L CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: NEW 650-0109 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONST NEW BATHROOM INTO EXIST GARAGE SQFT: 300 ADDRESS: UNIT: CLAIM VALUE: 300 . 00 CALC-VALUE; 300 . 00 GROUP OCC; M-1 / PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS: CREATE SHELVING IN GARAGE C.M. CA 92627 *Bre¢******a¢*x***er*er*+r*>E*N*+r***ater*a¢+e*yr*e¢**x*-xe6*+r*N*+r* *a*>E*e6+¢*******+¢*+¢>F>E**+6**e6** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R E Q U I R E M E N T S 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect $ E T B A C K S CITY LIC.: STATE LIC.: CLASS: EXP : Date: Signature: 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 addled copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: /-1PROV; �"P�A�R"CEL: 42516105 ZNE: REF NO: e ❑ Certified copy is hereby furnished. ❑ Certified copy is tiled with the city Building Division. PLANNING NOTES> '-(.VA Qid arty_ V . ) „ C+/. .... ✓ , at b � _ /1L- L/c L Date: Applicant: *****************************************************************`7*VI*"J****-l*_J********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sectio need not b:completed i r e permit is for one hundred($100)or less). D E V E L O P M, E N T SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issu+• I shall n t•u,. ., 'I in any manner so as to become ( . -- subject to lh worke�rsX Compensation Laws of California. 411.11 ZONING APPROVED BY �jW - DATE; _91. lq�A Dale: 1`-' / et` Signature: _„mai• NOTICE:II.eller making this decl ration.you should become sr.. o ers' e•mpensation provisions of the labor BUILDING APPROVED BY : DATE; _ Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: •cf f 20 19A.• which lois permit is issued(Section 3097.Civ.C). �****#*****#**********#B ***.:(FBF#* LENDER: ******************************************************************************* ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I 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 15 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed5 0 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business • SM I P/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 9 . 75 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILD ING—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----> 15 . 50 0 . 00 9 . 75 25 , 25 25 . 25 . 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 sale). BLDG PMTPLUMBING ELECTRICMECHANICFIRESMIP/TOT l le) one year of completion.Ihe owner will have the burden of proving he/she did not build or improve REVENU V O ODS OVER/SHORT ; forthepurpose oGRADING PLAN-CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(S' tion 7044,Business 15 . 00 . 50 9 , 75 m and Professions Code: The Contractors'State License Law does not apply to an owner of property who built or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State Lie: -• Law).l am aware *T(.+A..x.*ee**.*******{r**.***j(..**•****.****.****.******.x.**.***********,*********************** that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N ❑ I am exempt under Section: B.&P.C. for this reason: AIM T TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST e1-2aA------.T — -- Dale: �(� Owner: �`!de SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 I55 hereby certify that I am aware ot and understand the requirements of California earth and Safetytiode Sections 25505,25533,and END OF FEES 300 . 00 25534 and that I or any future budding occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the An Ouality Management Oistrict.Residential construction applications are exempt from these provisions. Date: Applicant: A I hereby certify that I have read this application and stale that the above information is correct.I agre o comply with all city and county / ordinances and state laws relating to building construction and hereby authorize repr sentativ s ot this cit o enter upon the above-mentioned property ler inspection purposes. . ( cTh 01 00168040-00168042 TOT 25.25 Date: CI 14- 2-0 X14 Signature: � -\_'. _ DATE= 09/20/94 TIME: 09:53 Driver's License or Social Security I: . 164646 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor _ . 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. 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, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P'Trap, ❑ Undrgrnd.. 10. Structural Floor System , . 61,. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 462. Backwash &.Receptor-Final - . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains - _ • • 64. Plumbing Systein14. 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 ailing 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 /40'W _ 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 •I 38. Final Plumbing 39. Water Service-Final 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 ritc4 48. FINAL PLANNING grit 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date DIVISION OF BUILDING SAFETY • CITY OF COSTA MESA APPROVED DI n,m 1 Zo This set of plans and specifications MUST be kept on this lob at all times and it Is unlawful to make any changes or alteration on same without written permission from the Division of Building and Safety,City of Costa Mesa. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City of Costa II Mesa Ordinance and/or State law. p co 8q 49 V3 0 1, These plans and permit shall expire by limitation and become null and void If --- TIVB the`bu`lding or work is not cord and maintc'n d active per UBC§303 1 O -. Cll. _. —.. . ..... , I �7 �A7H •.II l ` vi i4: / 1 e24 VIA wnlh0 rAti I SYCtntS ' • • • •li• • ip 1 - s i • i GA RAGE �_ 'o'0 • I Mtr. in- G1dGCITY OP l txutu COSTA 4: �]P, ADDITIONS, DELETIONS, OR CORRECTIONS SHALL "�"'"i BE APPROVED B1 THE PLANNING DEPARTMENT PLANNING f WT. -y., ''j /I1I10 10 UDS DBL Ifl . L(,ugh DA 940 :et Op PUMAS PROJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 068950 OWNEWS NAME: FARLEY, GEORGE ADDRESS: 270 E 15TH ST PERMIT NO; P 068950 PLAN CHECK NO; N GOVT; N SUPP : N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH 650-0109 ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : CONST NEW BATHROOM INTO EXIST GARAGE SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: M-1 / PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : CREATE SHELVING IN GARAGE, RE: #B68948 C.M. CA 92627 ****************######************####*##*##******#####+E#############7F*+r####*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: EXP Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FR NT : 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 'OLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the ci Building Division. PLANNING NOTES> > Date: Applicant: ****************#******************#*#********#******************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Th•secti, need not e completed if the permit is for one hundred($10O)or less). DEVELOPMENT SERVICES . REQUIREMEN TS I certify that in the performance of the work for which this permis issu d,I hall of employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. 1 I_.. ;ZONING APPROVED BY • Date'. �-26-91 Signa• c� „ ■ � DATE: NOTICE:It,after making this declaration.you shout• :• ome�'.. ct I''Compensa ion provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or I permit shall•- deemed revoked. 4 , '� 2 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: C l/"T 11 DATE: Q L rLt7lG which this permit is issued(Section 3097.Civ.C). *****************#*##***#****#******#*****#*****##************#**** *** iZ� 1t' 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 21 ,00 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 live hundred dollars($500). ISSUE FEE 20 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING DI V—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 21 . 00 20 , 00 0 , 00 41 .0:1 41 , 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 TOTAL S——> COLLECTED : 41 . 00 OVER/SHORT: . 00 for the purpose of sale). 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 41 . 00 C0 and Professions Code: The Contractors'State License Law does not apply to an owner of pro'erty who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contract.)'State License Law).I am aware ***##*##**.#.***iF.7f#ih*.N.****#*#..kL*,,E.)E.*.N..x.*.*****.*#.**#***#********.lh****,IE#,***#,*#,1E******** that proof of their Worker's Compensation insurance should be provided to .1,-. IND IVIDUAL . F E E BR EAKD OWN ciI am exempt under Section: B.&P.C. for this reason: c/ i —,scat TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: ��2"0 —9 \ �G,1�— PLU 1 LAUNDRY TUB OR WASHER . 7 .00 7 , 00 I do hereby certify that I am aware of and understand the requirements of Califor to and Safi•Code Sections 25505,25533,and PLU 1 WASH BASIN 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 a7. 00 7 . 00 permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from PLU 1 WATER CLOSET ( TOILET) . 7 . 00 7 . 00 these provisions. END' OF' FEES / Date'. Applicant: 1 �r �/ I hereby certify that I have read this application and state that the above int,oration'.correct.I l,ree to comply with all city and county01 00168038-00168038 T CE T 41.00 ordinances and state laws relating to building construction and hereby authorie:represe.tati • ••• theabove-mentioned • ***1 ` property for inspection purposes.s. , .meat DATE! 09/20/94 TIME: 04:52 y Date: — C-0`" L Signature: \`! 1 I Drivers License or Social Security x - 1641-46 Mee—Building:Green—Code Enforcement;Canary—Applicant Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING f- _ L & 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 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation _ 59. Gas Pipe, 0 Undrgrnd., Test 9.'Water Pipe.Undrgrnd. _ _ i 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11.'Property Sewer Line & House Connection - a 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing (C//.�?aj 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 aczeir 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-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning [// _ (� -CI 41-• 2��t 35. Final Gas Pipe-Test ! t-I-SLS- _ _ 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 1-1347_11411t5 13.7_1 1411 ) 39. Water Service-Final I [_s_� 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 , 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 068945 • OWNER'%NAME: FARLEY GEORGE ADDRESS: 270 E 15TH ST PERMIT NO; E 068949 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE: OTH 650-0109 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; CONST NEW BATHROOM INTO EXIST GARAGE SQFT: ADDRESS; UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : M-1 / PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS: CREATE SHELVING IN GARAGE, RE: #B68948 C .M. CA 92627 *****************+fief*+ESE**************+e**********aF*+F+Fer****+E**********e6****er****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON INC R EQU IR EMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E TB ACK S CITY LIC.: STATE LIC.: CLASS: EXP ; Date: . Signature: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV; PARCEL; 42516105 ZNE; REF NO; ❑ Certified copy is hereby furnished. El Certified copy is filed with the city Building Divisi. . PLANNING NOTES> > Date: Applicant: ********************************eEie********************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION; (This section eed not be -mpleted if the erns is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issue. I shall not g plo an .e on in any manner so as to become ` subject to the Woorrkerss''Compensation Laws of California. i 1�— ZONING APPROVED BY -3 Date: 1'—`CJ '—L..E\ Signature: \� DATE: l NOTICE:If.alter making this declaration,you should becom to'he Wor en/Com.•n -lion provisions of the labor BUILDING APPROVED BY DATE Code.you must forthwith comply with such provisions or this permit s all be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: which this permit is issued(Section 3097,Civ.CIFf4„'"��** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 , 25 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 MO)01 Division 3 of the Business 5 C/* SM I P/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($500). ISSUE FEE 15 . 00 I, as owner of the properly 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 TOTAL S——--> 2 . 25 15 . 00 0 . 00 1 7. 2 17 . 25 . 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 : 17 . 25 OVER/SHORT: . 00 for the purpose ol sale). 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 projeci(Section 7044,Business 17 . 25 (X and Professions Code: The Contractors'State License Law does not apply to an owner of properly who.olds or improves thereon and who contracts far such projects with a contractor(s)license pursuant to the Contractors'State LI I ense Law).I am aware .**********.**************•**.*.********,.k,**************,*,>(,************,***,************ that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.A P.C. I INDIVIDUAL F E E BREAKDOWN for this/reason: p ��t� TYPE QTY DESCR IP T ION UNIT COST TOTAL COST Date: _`�" C...0 l Owner: _y_ _,-i_ I do hereby certify that I am aware of and understand the requirements of Calitorni.Hea•and .fetv,Code�/ions 25505.25533,and I. ELE 1 FIXTURES, LIGHTING 1 S T 2 0 EA. . 75 , 7 5 25534 and that I or any future building occupant will/will not(circle one)need to cam.. 'h said state codes and the requirements for a ELE 1 RECEPT/OUTLET 1 ST 20 EA, . 75 . 75 permit for construction or modification from the Air Quality Management District.Resi.ential construction applications are exempt from ELE 1 RECEPT/SWITCH 1 ST 20 EA, . 75 . 75 these provisions. END OF FEES Dale: Applicant: I hereby certify that I have read this application and state that the above information P orrect,I agr e to comply with all city and county ordinances and slate laws relating to building construction and hereby authorize represe .-der upon the above-mentioned 01 00148039-00168039 mi. 17.25 property for inspection purposes. u . :: DATE: 09/20/94 TIME: 09:52 c1, or—et / a. Date: 1 Signature: wli --,, Driver's License or Social Security n: 1641-46 While—Building;Green—Code Enforcement Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • • CONSTRUCTION AND PLANNING F� ,L & 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. =' Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12, Sewer Cap 63. Heater & Vent-Final 13. Roof Drains _ , 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval { 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 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-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. 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 PROJECT9DRESS: 270 E 15TH ST UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 068805 OWNER.NAME: FARLEY, GEORGE ' ADDRESS: 270 E 15TH ST PERMIT NO: B 068805 PLAN CHECK NO: 00415-94 A GOVT: N SUPP : N , COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI /FMI REG.NO.: C JOB DESCRIPTION : 840SF 1ST FL, 758SF 2ND FL, 230SF GARAGE SQ FT: 1 , 828 ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J ` PERMITTEE: GEORGE H. FARLEY . . CA 927014 ) 650-0109 CLAIM VALUE: 120, 000 . 00 CALC—VALUE: 122, 530 . 00 GROUP OCC: R-3 /M-1 ADDRESS: 270 E 15TH ST COMMENTS; NEW SFR C .M. . CA 92627 ***yF+ETr****yraE+E•*yr*+E**eraF+e*ae*yr**yE***a6***+t********T6*it*are6+r**e6xs6*Tr**** *xx****a6+r****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMEN TS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETH ACK S CITY LIC.: STATE LIC.: CLASS: EXP Date: Signature: '. MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent o self-insure or a certificate of Workers' FRNT; 20 FT IN REAR: 25 FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: 5 PROV; 6 PARCEL: 42516105 ZNE; R2 REF NO; DR-93-20 J Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> 1 DU OF 2. DU PROJ — INCLUDES ATT GARAGE. REAR STBK IS SEP— > ARATION, -PKING ABOVE IS PROJECT TOTAL . P & E Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: Dissection need not be compled if the permit is for one hundred($100)or less). D EV ELOP M E N T SERV ICES R EQU IR E M E N .T S I certify that in the performance of the work for which this permit is issued.I s II not empl any person in any manner so as to become ` ` q b slate' leo the .rkers'Compensation Laws of California. ZONING APPROVED BY V�� 3� DATE; <� �'/ date: 1 t" — Signature: �� • ' 'TICE:II,after making this dee aration.you should beiome su lett to the orkers'Compensation provisions of the Labor BUILDING APPROVED BY : ' ', \\ DATE: Z (/ I Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE-;_ in which this permit is issued(Section 3097.Civ.C). *. , **.*******.*************.*****.********** F****,k**,*****,*************, ?, •*"I LENDER: ********************************************************************** •**** ' ***t ADDRESS: LEGALIZATION; N F E , . SUMMARY STRUCTURAL SEGMENT:Y 4m1OWNER BUILDER DECLARATION: Ihereby affirm that lamexempt ffromthe Contractors'State License Law forthe followingreason BLDG PMT PLUMBING EL;„OTRIC 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 720 . 00 , repair any structure.prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed12 25 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business /� pq �SM I P/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 117. 00 I' U FOR SPECIAL lei any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE — -- I. as owner of the property or my employees with wages as their sole compensation, will 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 ProfessioaCalt: The Contractors'State License Law TOTALS----> 732 . 25 0 . 00 v. 117 . 00 849 • 25/ 849 . 25 . 00 does not apply to an owner of a property who builds or improves e(tereod,and Jr dilEs such work himself/herself or through y5" his or her own employees, provided that such improvements are hot intended of for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • ----732 . 25L/OVER/SHORT: 00 improvement is sold within'or�,y@abof completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale): lax BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner dike property,am exc1. lusively contracting with licensed contractors to construct the project(Section 7044,Business 7 2 0 , 0 0 ' 12 . 25 La 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 a contractor(s)license pursuant to the Contractors'Shite License Law).I am aware ***************************.****.*.*.lot x*.**.*..N.*.**.**.***.**.N.*.**.N.*.*,*.****.**,**.**,*.IE*****.*****, that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUNAL F E E BREAKDOWN ❑ I am exempt under Section: B. 8 P.C. i�• F turmi CIL'?— et- 1 Owner —�\ice\��_ TYPE QTY D E S C R I P T I N UNIT COST TOTAL COST Ido hereby certify that am aware of and understand the requirements of California •alth and Safety Code Sections 25505,25533,and SFR 1598 DWE—TYPE V—WOOD F ME —GOOD 74 . 00 1 18, 2 5 2 , 0 0 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements fora SFR 230 RES—GARAGES TYPE 18 . 60 4 , 278 , 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from ND OF FEES these provisions. • Date' Applicant: I hereby certify that have read this applicationn anddstate that the above information is correct. .gree to comply with all city and county / ordinances and state taws relating to building construction and hereby authorize rept- entatives of xis city to enter upon the above-mentioned Oty for inspection purposes. a_ 01 00167356-00167357 TOT 732,2` er Y/L Signature: ! DATE: 09/07/94 TIME: 11:46 � s License or Social Security#: . 164146 mite—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor i. F -N. .CONSTRUCTION AND PLANNING POS ,v SPA APPROVALS Permit Date ' Inspector APPROVALS Permit Date Inspector t. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms a 4. Electrical Conduit-Undrgrnd. I 55. Electrical Bonding 3 T 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 1,2/17't/ //N��, """ 57. APPROVAL TO COVER-GUNITE 7. Footings q/k/Q /"f �lfi58. Electrical Conduit-Undrgrnd. f(8. Foundation 459. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. (-• 60. Backwash Lines, P-Trap, ❑ Undrgrnd. f 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . . 12. Sewer Cap . . . r F 63. Heater & Ve rival 13. Roof Drains 64. Plumbing Sy}em - 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 6S. 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 Sheathing74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat • , 75. DrY Chemical 27. Frame and Flashing nn•n76. Dry Standpipe c 28. Lathing& Siding fe2L-y((/ 77. FIXED SYSTEM FINAL 29. Insulation • . fra/cj/.w✓✓` 178, FIRE PREV. FINAL !! 30. Drywall Nailing #1t-9Y , • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i 79. FINAL INSPECTION 32. Electrical Power Meter-Final 880�0, FOO '':ERTIFICATE ISSUED 33. Final Electric rX�.n+9) _ SPECIAL RECISIMIIIIII 34. Final Heating & Air Conditioning . - __„0/( 'par' - ra 35. Final Gas Pipe-Test � - 36. Hood or Canopy _ kH 37. Final Factory Fireplace • ' ' �'. 38. Final Plumping . : 39. Water Service-Final r 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 l . 48. FINAL PLANNING / + 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - - • DECLARATION OF AL 1 HORITY Bldg. Permit # FOR AGENTS OF PROPERTY OWNER This Permit # TO APPLY FOR PERMITS • • 2.701 l�— Sc e, g /Street Address / AP Number • 1. I (we), C�//• ' #- J , declare that I am the Owner of Title of the above referenced real property, and that I (we) ereby authorize: �i Mk CS A. ST4110Vv-R 01' g 32 t Name Telephone No. t2 —t02 ziG` a 6\7 WAY Street Address A -1USTt. Q Ck , a2G City State Zip • to obtain permits in my behalf, as owner/builder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall im • - mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. ,,/) Executed this15frli day.of /� j 19 Y ¢at 1 2 1 fl , California. ric-eLry q Printed Name Date C/// Sign ure NOTE: This authorization does not grant authorization to perform the w rk as ner ' olely ro de for limited power of attorney to secure this permit in any behalf. • r' OFFICIALSEAL „0t > SANDRA LEE WILSON ura CRiCE IN• NOTARIZATION REQUIRED . ' O0 r) MM Y, ....l 1. 1994 . 0779.46(Rev.2911 . NEWPORT-MESA UNIFIED SCHOOL DISTRICT .'1333 CERTIF.-,ATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 - �f�i TO: ( City of Costa Mesa District Receipt No. /r ( ) City of Newport Beach ( ) County of Orange Plan Check No. 7/<a- 97.--- " n Ccx) Applicant: l) eo2�1- v ��t`l �` r XtX - 3113. G�Rd"P- Address: 30( EnitsiJwC ST{R LAW- E . CA . `t?_CGO Telephone Number: (4-1, 650 — O C O 9 Tract/Parcel and Lot Number(s): Location of Project: 2:7c> �. (.5 S-C. CAA. c_A izsa. a 7SY Number of Square Feet of 90 a �!f/J a i1 /�d - Gni Residential Space p /�/ x $ 1.72 Total �J a d Residential/ /o .J J Sr. Citizen Space x $ .28 Total Commercial and Industrial Space x $ .28 Total Warehouse Space x $ .2235 Total Commercial/ Industrial Project is: (Check One) Warehouses 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 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 Scho istrict. f By: /doll A ed Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified. Q ? i .-C� A- Sft c ,E 7' svCC - Date: / 1 Applicant duty of Costa Mesa _) California 92628-1200 P.O.Box 1200 • • Insulation Certificate /Lo • Permit Number ! ago 2Z0 1 `"`' StQ &-` --#13 cos. 74 A-( el( /^/ Number and Street City O9_�AJ ' County Subdivision Lot Number • Description of Installation ROOF Material Brand Name Thickness (inches) Thermal Resistance (R-Value) EXTERIOR WALLAA Material 1- 4 Brand Name_(-( 4-S-- Thickness (inches) Thermal Resistance (R-Value) 12? CEILING Batt or Blanket Type C7/4 i( Brand Name C-�127�t.uT( Thickness (inches) (O " Thermal Resistance (R-Value) 3v Loose Fill Type Brand Name Contractor's minimum installed weight/ft2_ lb. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISED FLOOR p �� _ Material tom[ S( Brand Name C e'et-r6S'E'V 7 (L--(,£b Thickness (inches) Thermal Resistance (R-Value) tc( SLAB FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R-Value) • Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Adminstrative Code. General Contractor(Builder) License Number Signature and Title Date SUPS Q2.( t,uS TfO r✓ `-f .5" 5 2 1 Sub-Contractor(Insulation Installer) License Number • loto M*its pi cit 2-- G Signature and Title Date 1907-46 - 2'7D r /6 NUMBER STREET UNIT NU BER .I .9.3- PERMIT NUMBER REFERENCE NUMBER NOTES: � ' q�S - G�.th at dab ENGINEERING L'ANNING• • FIRE 2/0/41 g� r 193646 E PROJECTAOORESS: 270 E 15TH ST UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 068808 OWNER'S NAME: FARLEY, GEORGE . - ASORESS: 270 E 15TH ST • • - PERMIT NO: P 068808 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 • CONSTRUCTION TYPE; PERMIT TYPE: PLU PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION : I 840SF 1ST FL, 758SF 2ND FL, 230SF GARAGE SQFT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J I S.A. CA 92705 CLAIM VALUE: CALL—VALUE: GROUP OCC : R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : REF: B-68805 C.M. CA 92627 ************d6*+ ********E*****+ *****dEyESEx*x****** *****yE**** *e6******************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU IR EMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CITY LIC.: STATE LIC.: CUSS: EXP: Date: Signature: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO: 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > • - Date: Applicant: 1 ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be coleted if the permit is for one hundred($100)or less). DEVELOPMENT SERV ICES R EQU IR EMEN TS I certify that in the performance of the work for which this perm is issue`I shall not errrrrr!!S!!S I person in any manner so as to become su.` to themarke)Compen 'on Laws of California. ZONING APPROVED BY • Khe DATE: Date Signator . NOTICE:If.alter making this declaration.you should become subject to the eers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must lonhwith comply with such provisions or this permit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; fir •- - DATE: y which this permit is issued(Section 3097.Civ.C). - ********************** --- •, • • -* •*.**** .y.**.*,****.**. (it* LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E S U M M A R -Y STRUCTURAL SEGMENT :N OWNER BUILDER DECLARATION: I hereby affirm that lam 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 98 . 00 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25* , SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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($500). ISSUE FEE 20 , 00 I. as owner of the property or my employees with wages as their sole compensation, will 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----> 98 . 00 20 . 00 0'. 00 118 .00 118 , 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; — 11.8 , 00 OVER/SHORT; 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK GsI.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 118 , 00 antl Professions Code: The Contractors'State License Law does not apply to an owner of property w builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the C.ntractors'Stat License Law).I am aware ***********************************.;**.*.)E*************.**. ***.*.**.*.*..**.*.*..**.*.*.*,*.*,**.**.* that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR E AK D OWN o I am exempt under Section: B.8 P.C. or thisrmjson: r��ni TYPE QTY DESCRIPTION ' UNIT COST TOTAL COST A4' l � Z tcF ��'1�...� . Owner: PLU 1 BATHTUB .0 hereby certify that I am aware of and understand the requirements of Calif. nia Health and Safety Code Sections 25505,25533,and PLU 1 DISHWASHER 7 , 00 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 fora 7 , 00 7 , 0 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from PLU 1 LAUNDRY TUB OR WASHER 7 . 00 7 , O O these provisions. PLU 2 SHOWER 7 . 00 14 . 00 PLU 1 SINK, KITCHEN 7 , 00 7 , 00 Date: Applicant: PLU 2 WASH BASIN 7 . 00 14 . 00 I hereby certity that I have read this application and state that the above information is coir I.I agree to comply with all city and county P L U 1 WASH BAS IN (SET) 7 . 0 0 7 . 00 0 / ordinances and state laws relating to building construction and hereby authorize rel resentativ: of this city to enter upon the aboveimentioned PLU 3 WATER CLOSET (TOILET) . ' 7 , 00 21 . 00 Draper or inspection purposes. al PLU 1 WATER HEATER AND/OR VENT • O3 OOYbJ0:0;-00167354 TGT 7 . gl°v.Q=t q Signature: �� > PLU 1 GAS SERVICE DATE:•)90CP/p4 TIt1E: 11:44 7 . 0 END OF FEES ..ter 5 License or Social Security I.: i,N 1641.46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor .I y„4 . a r ,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. li06 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 OF 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. et..22 � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System l 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 Plumbing9165. Electrical-Final �l-91/./. ( ' 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 OGas OOiI 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 p HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ! 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes .20 vacJ �_ - vT CL 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 1-L3S?CXXXS�" 4-14 7 2? 2 4 _:ett:lL�-- -v_2. �e 36. Hood or Canopy ct_ G 5.7 M�c�C c� �i 37. Final Factory Fireplace - n 38. Final Plumbing (-US_9sC: r G1l-l3 QL� ,��i(JU LJO 39. Water Service-Final N134. :►�j' r �- l� f /3-5_5M- 2a-Acc sk-iir taC 40. Gas Service-Final '1.139st fiv, 41. Solar Domestic-Final / 42. Backflow Preventer I . 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 /J PROJECT ADDRESS: OWNER'S NAME: 270 E 15TH ST PARLEY{ GEORGE, • 0NIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 068807 • ACTRESS: 270 E 15TH ST PERMIT NO; M 068807 PLAN CHECK NO: N GOVT; N SUPP : N COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: NEW 650-0109 ARCM/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION : 840SF 1ST FL, 758SF 2ND FL, 230SF GARAGE SQ FT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S.A. CA 92705 CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : REF: B-68805 C.M. CA 92627 ****arxlydrar+rd6**dE************ *ac-**+E*+r1F*+rpE*x-**arx-kE+r*TP***** *+E***a6x*+6+E****x-******+E*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)01 Division 3 of the Business and Professions Code.and my license is in lull force and eftect. CITY LIC.: STATE LIC.: CLASS: EXP: SETBACKS Date Signature. MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure ora 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.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN ) POLICY NO.: EXP.DATE: COMPANY: PARKING REQ; PROV: PARCEL: 42516105 ZNE: REF NO: 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant' . ********************************************.*********************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if t permit is for one hundred(MOO)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I sh II not enaloy an a ,manner so as to become ct tot vorke 'Compensation Laws of California. `• ZONING APPROVED B Y y DATE: Oa / Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor .BUILDING APPROVED BY : 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 'APPLICATION ISSUED BY• DATE: which this permit isissued(Section 3097,Civ.C1 *************************************** * ** ************** * *. LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I 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 PERMIT2 9 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to Zile 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($500). ISSUE FEE 15 . 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----> 29 . 50 15 . 00 0 . 00 44 . 50 44 . 50 • 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 REVENUE DIVISION TOTALS——> COLLECTED : - 44 . 50 OVER/SHORT: , 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve for the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusivelycontracting with licensed contractors to construct the project(Section 7044,Business 44 . 50 LA and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon • and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *********************************************************.*{e****.*-fie.***.x.***.".***..**.*. that proof of then Worker's Compensation insurance should be provided to me. INDIVIDUAL "F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this r son TYPE QTY DESCRIPTION UNIT COST TOTAL COST rCrtp( e: T y Owner • MEC 1 INST FORC—AIR/GRAN FURN <= 100 K BTU 9 , 00 9 , 00 hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 GAS PIPING SYS 1 — 4 OUTLETS 3 , 00 3 , 00 25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from MEC 1 FACTORY FIREPLACE 6 , 50 6 , 50 these provisions. MEC 1 INST HOOD W/DUCTS FED BY MEC EXHAUST 6 , 50 6 , 50 / MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4 , 50 4 , 50 ✓ Date: Applicant: END OF FEES I hereby certify that I have read this application and state that the above information is correct.I gree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize rept' entative oft .cit to enter upon the above-mentioned DI Q31 7355—DD26735� -r property for in ea` uurrp=ses� �. DATE: 09/D7194 TII1i: 1:4 44.50 ff, ! js' S. 11:45 ate' ''( Signature: ` �� k• . Driver's License or Social Security N: 1640-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor '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 I 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation' 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1C•. 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 . t 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 ///�/J1 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning /LL3_94.7 - -"•vv - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace GC L T APPROVALS Permit 21. Ouct3,in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil 23. Gas Pipe trough &'Test 72. Underground Ruth 24. Roof Framing. 73. Undergrnd,Storage Tank 0 Gas 0 Oil! 25. Root 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. ElectricalPower Meter-Final 80, FOOD CERTIFICATE ISSUED 33. FinaYElectric I Notes: (_i co t2-m-vzoi_ o 1a, sexffie r 34. Final Heating& Air Conditioning �, Citilitega tea 35. Final•Gas Pipe-Test 94-_ _ - si_'y 36. Hood or Canopy 1 37. Final Factory Fireplace I 3,?s- (4 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 '48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 270 E 15TH ST UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 068806 OWAIEWSN*4IE: FARLEY GEORGE AtbRESS: 270 E 15TH ST PERMIT NO; E 068806 PLAN CHECK NO: N GOVT; N SUPP ; N COSTA MESA,CA 92627 CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION : 840SF 1ST FL, 758SF 2ND FL, 230SF GARAGE SQ FT; ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S ,A, CA 92705 CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H, FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS: REF: B-68805 • C.M. CA 92627 ******ak+FTF*******************+F***************+H*yH*aF******+F*ar*****+FTc*****+r* ****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU I R EMENT S 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: EXP: Date: Signature: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE; REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: *********************************iE********************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be co eted if 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,1 shall note oy any person in any manner so as to become ` •.,,,� suit to th Workers`1/4' .aCompossation Laws of California. ZONING APPROVED BY DATE: I 1 Signaturet • OW If.after making this declaration,you should becosu iect to rs'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: CQdE.you must forthwith comply with such provisions or this permit shall be deemed revoked. . p, CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; DATE; I �4 which this permit is issued(Section 3097.Civ.C). ***************************�..)(.****.* *.x.*****.k.X.*****.x.****.N.********* © *eF 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 6 3 , 98 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 PLAN 0 SMIP/NON—RES and Professions Code)of that he/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). ISSUE FEE 15 , 00 I. as owner of the properly or my employees with wages as their sole compensation, will 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----> 63 , 98 15 , 00 0 , 00 78 , 98 78 . 98 , 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • - 78 , 98 OVER/SHORT; 00 imforptheemnt is purpose ofd sae). one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 78 . 98 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 projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware ***********************************************.******************************** that proof of(heir Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this ren/. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST ate l �7` .1(‘i Owner: ELE 1828 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT . 03 63 , 98 o eby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Dale: Applicant'. I hereby certify that I have read this application and stale that the above information is correct.I agree comply with all city and county ordinances and state laws relating to building construction and hereby authorize rertesentativ .s of this cit r-. • ••• ,•...ye-mentioned property for ins.- tion purposes. �ti — 78.9F DATE: 09/07/94 TIME: 11:44 tate' Signature: _��►_�� • ••r's License or Social Security a: 1641-46 While—Building,Green—Code Enforcement.Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 'CONSTRUCTION AND PLANNING POOL & SPA - • %APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector S1! 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 IFFER 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 & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit 21. Ducts,in Structure , . 70. Underground Hydro 22. Ducts, Ventilating • 71. Product Piping 0Gas ❑Oil 23. Gas Pipe-Rough &'Test 72. Underground Flush' 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Root Sheathing 74. Overhead Hydro 26. T-Sar Ceiling (Structural; & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. lnsu'ation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 79. FINAL INSPECTION t 32. Electrical Power Meter-Final �� 80. FOOD CERTIFICATE ISSUED fI 33. Final Electric I 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. 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 I4IIOJECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 068802 OWNER'S NAME: FARLEY, GEORGE • ADDRESS: 270 E 15TH ST PERMIT NO: E 068802 PLAN CHECK NO: N GOVT: N SUPP ; N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; NEW 650 0109 ARCH/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION , 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S .A. CA 92705 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H, FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : REF: B-68800 FOR TEMPORARY POWER TO BOTH UNITS A & B C.M. CA 92627 **********************+a*+t*ac*********a6*a6*****+e**afar**arn**aE*TE***Te**** ***x6+r******Tr LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CITY LIC.: STATE LIC.: CUSS: EXP: Date. Signature: 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.: EXP. DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO; ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: *********************************jE********************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be co i t eted if the permit is for one hundred($100)or less). DEVELOPMENT S E R V ICES REQUIR EMEN TS I certify that in the performance of the work for which this permit is ssued.I sr all note •r oy any person in any manner so as to become subject to 4Worker 'Compens. inLaws m California. `1 _ ZONING APPROVED BY . x . DATE; c , rate, Sigoatur• I TICE:If,after making this declaration.you should become sutteee th^'ers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: ode.you must forthwith comply with such provisions or this permit shall be deemed revoked. • (�� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: • 4 DATE: 11" which this permit is issued(Section 3097.Civ.C). *********.**********{E**.*********..)F******* * *************.K.*,*,*,********* If -** LENDER: *******************************,iE*************************************** ** - ** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL S' GMENT: N OWNER BUILDER DECLARATION: thereby 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 1 5 , 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed sj 0% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 , 00 I. as owner of the property or my employees with wages as their sole compensation, will 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----> 15 , 00 15 , 00 0 . 00 30 , 00, 30 , 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 REVENUE DIVISION TOTALS——> COLLECTED : ,__----30, 00Got OVER/SHORT; 00 imforptheepurrposeof sale)�in one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 ,00 Ln and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *************************************-****.*.*******.****.*-*.************************ that pmol of their Worker's Compensation Insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section. B.&P.C. for this reason: j TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date etc{1 • ELE 1 TEMP SERV PWR POLE W/OUTLETS EA, 15 , 00 15 . 00 hereby certify that I am aware of and understand the requirements of Cali nia Health a d S y Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. hApplicant: hereby certify that have read this applicationn anddstate that the above information is correct.J agree to comply with all city and county / I ordinances and state laws relating to budding construction and hereby authorize representatives of its city to enter upon the above-mentioned property for pennon purposes 01 00167361-00167361 TGT 30.00 44 DATE: 09/07/94 TIME: 11:47 ae _7_el c.--;:->,q Signature: /1 r r's License on Social Security a: E' 1641-46 White—Building,Green—Code Enforcement,Canary—Applicant;Pink—Revenue;Goldenrod—Assessor r POL -v SPA ♦ CONSTRUC'71ON AND PLANNING APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. TemporaryElectrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement if 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ,. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System -Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS 'Permit# - I 21. Ducts,in Structure 70. Underground Hydro !I 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-Final l n(L�1n 1, 80. FOOD CERTIFICATE ISSUED 1� Y 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. 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 rrp.IECT ADDRESS: 270 E 15TH ST UNIT: B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 068802 OWNERS NAME: FARLEY, GEORGE ADDRESs: 270 E 15TH ST PERMIT NO: E 068802 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92627 CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: NEW 650-0109 ARCH/ENGINEER: ESI/FMI REG.NO.: C JOB DESCRIPTION : 1164SF 2ND FL, 181SF DECK, 840SF GARAGE SQ FT: ADDRESS: 1921 E CARNEGIE AV UNIT: 3—J S.A. CA 92705 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS ; REF; B-68800 FOR TEMPORARY POWER TO BOTH UNITS A & B C.M. CA 92627 **********************************************+tabs****sr************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: EXP: Date: signature. MAIN BUILDING ACCESSORY BUILDING Date: S'COMPENSATIONDECLARATION: Signatury e. oratenificateofWorkers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN WORCompensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PCMY : EXT.,DATE: PARKING REQ• PROV: PARCEL : 42516105 ZNE; REF NO: COMPANY: PLANNING NOTES> Certified copy is hereby furnished. ❑ Certified copy is filed with the city Buildir;/'TMftyro • F'�' * �`yF **********************************.********************************************* Date: • Applicant: D E V E L O P M E N T S,.E R R E Q U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be comp neer n s ,r o jhundred 15100)or less). 7 (J',^.�� I certify that in the performance of the work for which this permit is issued, shall not employ any person m any manner so as to become (/ 1) subject to the Workers'Compensation Laws of California. ZONING APPROVED BY 1 1 1 J M DATE; Date: Signature: v \.J1 jU% NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY 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 APPLICATION ISSUED B Y: H DATE• which this permit is issued(Section 3097.Civ.C). ***'*******'*******'******ir******************************************************* 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 PERMIT 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 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0 t SMIP/NON—RES pursuant to the provisions ot the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 15 . 00 15 . 00 0 . 00 30 . 00 30 . 00 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.Il,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 30. 00 OVER/SHORT: . 00 fortheepurpose of sold le)hin one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 5A, I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 0 0 LJ and Professions Code: The projects with License Law does not apply to an owner of property who builds Law). thereon ******************************************************************************* and who contracts for such projects with a e License )license pursuant to the Contractors'Slate License Law).1 am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.&P.C. torthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15 . 00 15 . 00 I do hereby certify that I am aware ot and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. croir-,v I her n andcst: r.,. CR �� hereby certify that I have read this application and state that the above information is correct. agree to amply with all city and county ordinances and state taws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned ) property for inspection purposes. r Dale'. Signature: Driver's License or Social Security a: 164146 Wane—Buedmg;Green—Code Enforcement Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ., : CcJtJSTRUCTION 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._Electric'ei eof+dujt4.1tility-Undrgrnd. 54. Forms :i•+4::Electtical CondUS-Undrgrnd. 55. Electrical Bonding 5: Steel Rediorcerrient 56. Rough Plumbing & Pressure Test 6. ElectricalcUFER.Grnd. 57. APPROVAL TO COVER-GUNITE Ir •P . I z?7:"Footings •f• Cr- 58. Electrical Conduit-Undrgrnd. 0. d. -� 8. Foundation :a._ 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water PiptUndrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. StructurarFloor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap n. u f 63. Heater & Vent-Final 13. Roof Drains- 64. Plumbing System - Final 14. Rough Plumbing ;, (l )) 65. Electrical-Final 15. Rough Electrical-Conduit '��;_-g 66. Solar System-Final 16. Rough Electric_Wiring •� 67. Fencing & Access Approval s17. 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 ug ; , 20:.Roh Factory Fireplace ' •C :c;:-.1 & J ?; c" y 'APPROVALS # ' i. 1 21..-Ducts,kr Structure; . .. .- _ - -t r? i e a ^70. Nndergrbctnd Hydro r 22.-Du'9ts, Ventilating hu J ,. 71. ;IPlpny 0Gas 0 Oil r 23:GasPipe-Rough & rest * ;r `, - -.72. Underground Flush i 24:Roof Framing ,. , - _' ' .N . ,:73:Under rn Stor• e.Tank OGas ❑Oil ./25. Root Sheathing ' :' -' i: -74`iOverhead Hydro^ f� 26 T-Bar Ceiling (Structural) & Monocoat t -• •=f '1 ' 75=Dry Chemical - -' ' I I 27;Frame aqd Flashir;g meq. ; >. ; 76.-Dry Standpipe - 1/4 •� ,28 Lathing.& Siding' _ i' ••I •'h ° 77,2i FIXED SYSTEM FINAL , .. 29. Insulat pn .• _. t .1 I•I I , 78 FIRE PREV. FINAL 30. Drywall-Nailing v, •,- HEALTH DEPT. REQUIREMENT •'31. Plaster Brown Comat; _ i 1, a ,79.-'FINAL Ii SPECTION. i. ' -•32.7Electrit27 Posver Meter-Finall •5//y15.--/TVr$0.'FOOD CERTIFICATE ISSUED t 33:,Fin Electric, ;: ; ` - ` Notes: -- ,t " • . - - .. 34. Final Heating)&Air-Conditioning. I • r •'' -_ 7 ,35 :Final Gas Pi Pe-Test' '' -. ' h _ ~^ -> : _ . i : II H ... . . . -36. Hood ofiCanoPY•- I + I I � " >.. .L o 1' :37.;Fid4l Fectory Fireplace,. :,•'r it '`- i ;, ;t; `. l .38. Final Plumbing 7• . Z11 ( r •39. Water Sol-vice-Final' ' ,40. Gas Service-Final 4 .I, -. 3. 4: 41. Solar Ddinestic-Final.: ' i •. :. e• I. ; c:: i. • ,rt • i I Ir . °r r 42.-Backflow Preventer, - / - 43. Backf low Irrigationro r-- 7,44. Landscape Irrigation Systema n - - - - t: l` -45.Sound Attenuation `"°:r, �'i - '1 `t 4cii 6.:Handicap' Regulations _ •' - , . • 47.'FINAL STRUCTURE & BUILDING _ I. I I * o' ' r i It $ I 48.r-FINAL PLANNING i LI I n . =49..:Electric Release to Edison 1. 50. Gas Release to Southern California Gas Co • ' 1, + •=- - - • - 1 I V '51. CERTIFICATE OF OCCUPANCY - , - No. Date • IPROJEriTADDRESS: 270 E 15TH ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05979-Ihj__-- ,/ OtillR'S NAME: JARSEN GLADYS RUTH TR ADDRESS: 270 E 15TH ST PERMIT NO: B 059791 PLAN CHECK NO; N GOVT: N SUPP; N COSTA MESA,CA 92627 CONSTRUCTION TYPE; V-N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: 645-5965 gEG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : T/OFF REROOF W/COMP SQ FT; 2, 000 • CLAIM VALUE: 2, 000 . 00 CALC-VALUE: 2, 000 . 00 GROUP OCC: R-3 / PERMITTEE: RICHARD ALLEN ANDINO ( 714 ) 531-9515 ADDRESS: 16549 LASSEN COMMENTS; SMOKE DETECTOR REQUIRED IN THE HOME FOUNTAIN VALLEY CA 92708 ********±E*%*%# #TP#%�F*�F#**** *#*%****1E%#r>E# #***%*****x*#*#%**%*#x##**#****** *i, LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(comme ' g with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in fullnil effect SETBACKS CITY LIC.: 051441� STATE LIC.:Lt 5 1 5 6 D • CJ Dale: e —, - 7.�-- Signature:_! MAIN BUILDING ACCESSORY BUILDING �_WORKERS'COMPENSATION DECLARATION: I hereby affirm that l 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO: 1 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NO T ES> > Date: Applicant: ************************************* *************************************M*** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be com if the permit is for unfired )or less). DEVELOPMENT SERVICES REQUIREMENTS certifyI t toot ine e kerCamce of do work for which this permitd` not toy any p on in mann as 10 become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE ��Date': ///---_.7 ',P2- Signature: BUILDING \ NOTICE:It.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor B UI LD ING APPROVED BY : DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. I\A /19 _` _^ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• ' V s.. ` DATE• IL .,%i `� which this permit is issued(Section 3097,Civ.C). **********************1*******%***x*YYY:stir . - ##%*ir%**ft*#*%****#*#-iF**fh*rtxitsexxtr,Eicx#* LENDER: ****%***%********%****i(****************J(***%*tE*************i(******************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES JGRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,.or PERMIT 45 , 00 50 ' repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed SMIP/NOiV-RAS pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN ' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE , I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID . DUE ❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 45. 50 0 , 00 0 . 00 45 • 50 45 . 50 . . 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 im rovements are not intended or offered for sale.If, however the building or e improvement is solithin one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 4 5. 50 OVER/SHORT; 00 for the purpose of sale). 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 45 . 00 5 0 ❑ 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 projects with a contractor(s)(cense pursuant to the Contractors'State License Law). l am aware *******%******#********#*#*******4*******3!#*#************#***#*##!(-#i(-it 9(3(*%*#**#* that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U AsL ' F E E BREAKDOWN ' ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY D E S C R I P T I �T.N UNIT COST TOTAL COST Date: Owner: SFR 2 �0 REROOF BY VALUE RESPDENTIAL NOZONE 1 . 00 2 , 000 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ' permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from EXPIRED these provisions. Incomplete Inspects '- ,, Date: Applicant: ' I hereby certify that I have read this application and state that the above information is cot; t.I agree to comply 1h all city and county i Sig ' - ordinances and state laws relating to building construction and hereby authorize r• r sal thisyyyttLYLo enD rpon the alt. -mentioned Date —,--•••a—^ properly for inspection purposes. l� -4 \ \ 3 �_ Date: 74-.7 '92- Signature: / I Drivers License or Social Security et .1 1641-46 mite—Building:Green—Cade Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor ..• t. _I CONSTRUCTION AND PLANNING • PO, 1 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 Drains64. 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.StorageTank 0 Gas 0 Oil - 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical • it 27. Frame and Flashing 76. Dry Standpipe ,1 28. Lathing & Siding 77. FIXED SYSTEM FINAL I29. Insulation - ( 78. FIRE PREY. FINAL . 30. Drywall Nailing I , I HEALTH DEPT. REQUIREMENT'; 31. Plaster Brown Coat I I 79. FINAL INSPECTION 32. Electrical Power Meter•Final I . ; 80. FOOD CERTIFICATE ISSUED I 33. Final Electric �_ Notes: J� p ram yam; ! 11 / -✓W. 34. Final Heating & Air Conditioning I - � `/ D „-� { -,/ 35. Final Gas Pipe-Test t 4 /_ i r 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final I 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System u i45. Sound Attenuation j '`' 46. Handicap Regulations EXP 1 WE0 47. FINAL STRUCTURE & BUILDING - -Incomplet,-In55 ' i 48. FINAL PLANNING f Date ���r I: 49. Electric Release to Edison -`" 50. Gas Release to Southern California Gas OD 51. CERTIFICATE OF OCCUPANCY , No Date PROJECT ADDRESS: 270 E 15TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 065921 OWN'%S NAME: GEORGE H. FARLEY . ADDRESS: 270 E 15TH ST PERMIT NO: B 065921 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: OTH 714 ) 650-0109 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : DEMO EXISTING STUCTURE SQ FT : 4 , 000 ADDRESS: UNIT: CLAIM VALUE: 4 , 000 , 00 CALC—VALUE: 4, 000 , 00 GROUP OCC: R-3 / PERMITTEE: GEORGE H. FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS: ONLY DEMOLITION C.M. CA 92627 ****************drFFa6errlknle+r*****aEx*x**Trx*dr*a6a6*x*lydr*****+r*+6Tr**er r*+61F+r+ra6FFxar********d6 LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONI NG REQUIREMENTS 7000)01 Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CUSS: Date: Signature: 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' FR NT: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42516105 ZNE: REF NO; D Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES> > Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This s on need n'4 be ed it mit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify lb ''n the performance of the work for which this permit i issued,I h-I oy an .n in any manner so as 10 become sub: to le.W,02rs/,E/pmpegp ALawsofCalifornia. ZONING APPROVED BY • DATE; 'Date: /� ✓— Signature: r ICE:If,after making this declaration.you should bec0 subject to rte orkers'Compensation p visions of the Labor BUILDING APPROVED BY : DATE:Code.you must forthwith comply with such provisions or tet permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: ` DATE; which this perms is issued(Section 3097.Civ.C1. *****************,*.****.*.************ * iE'al"ftiF********************* LENDER: ********************************************************************** **** *** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y 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 63 . 00 , 50 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 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 live hundred dollars(S500). ISSUE FEE I, as owner of the property or my employees with wages as their sole compensation, will 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————> 63 . 50 0 , 00 0 . 00 63 . 50 63 . 50 . 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°tiered for sate.If,however the building or improvementpuof sae) BLDG PMTPLUMBING ELECTRICMECHANICFIRESMIP/TOT completion.hin one year alcompletion.me owner will have the burden of proving he/she did not build or improve REVENU DIVISION OD63. 50 OVER/SHORT: . 00 fortepurpose GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 , 50 ® and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware ***{e*******************.**.**.*.**.*****{f{t.****.*-*********{t.*****.ie**.N.******.****.**.****.*.*. that proof of their Worker's Compensation insurance should be provided o me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for his reason: a ,, 4 ( TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date L`(i� /� Owner: 4�� I • SFR 4000 DEMOLISH BY VALUE RESIDENT, NOZONE 1 , 00 4 , 000 , 00 to hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 5533,and t END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requir mens for a permit for construction or modification from the Air Oualrty Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state th..the above irfor .iis correr gree to comply with all city and county ordinances and stale laws relatingfurldint Construction am hereby Iv a r'esentatives• city to enter upon the above-mentioned erty /iirsae our / ( 01 00154769-00154770 TOT 63.50 ate: // /� Signature: ', DATE: 02/02/94 TIME: 14:09 r s License or Social Security a: 164-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING r POC SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • ' 1 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 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, C Undrgrnd. - 10. Structural Floor System r, 61. APPROVAL TO DECK - - 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Fmal 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 PLASTERINC- 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 Oii 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank DGas ❑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 11-21-91 �� 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. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 12 S �� 48. FINAL PLANNING - ' - 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date PRnJECT'ADOflESS: 270 E 15TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: GRA 066132 OWNER'S NAME: FARLEY GEORGE ADDRESS: 270 E 15TH ST PERMIT NO; GRA 066132 PLAN CHECK NO: 00417-94 A GOVT: N SUPP: N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE; GRA PURPOSE: NEW 650-0109 ARCH/ENGINEER: ROBIN HAMERS ASSOC REG.NO.: C3a420 JOB DESCRIPTION ; GRADING FOR 2 SINGLE FAMILY RESIDENCES SQ FT; ADDRESS: 234 E 17TH ST N ' 205 C.M. CA 92627 CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /M-1 PERMITTEE: GEORGE FARLEY ( 714 ) 650-0109 ADDRESS: 270 E 15TH ST COMMENTS : X COSTA MESA CA 92626 ***+6#***+E*#** ***+t**+r+r*+t**s6x**********TE*+E+F******sr**+r *+r***********TE*T6******SE+rdET6 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU I R EMEN TS 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: S E T B ACK S Date: Signature: 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.: EXP.DATE: COMPANY: PARKING REQ. PROV: PARCEL: 42516105 ZNE; REF NO; ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING N T ES> > Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This ecoo needmplet''' he permit is for one hundred($100)or less). DEVELOPMENT S ER VICES R EQUIR E M E N' T S I certify that in the performance of the work for which this perm issw r. s•I t emplo person in any manner so as to become subtest to Woxq,•9gnpensatmn Laws of California. 1 ZONING APPROVED BY /gyp/y L!//_ ; DATE: Date: !l— Signature: 11 NOTICE:II.after making this declaration,you should become ubject to he Workers'Compensapon provisions of the Labor BUILDING APPROVED BY : DATE Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. // RR t7 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; •V c DATE: 2�2(�� which this permit is issued)Section 3097,Civ.C). *********************.*.****.**********. *.7(.** .*jE* *iF**********lf*9f9E******.,*lf***CI k ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I 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 p ERM I T repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 33 . 00 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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 5 . 63 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I, as owner of the propertyr or my employees with using as their sole compensation,Code: TContractors' do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID 3DUE . 00 ❑ structure is aptytotandodoofaforsale(hhocbuils0oiBpvesshereon.andiwhlCods. The CormhiseltState Licen se Law TOTALS----> 33 . 00 3 , 00 5 , 63 41 . 63 41 . 63 00 does not on toe employees, owner of a property who builds or improvestsarnot into ands who doesresuch ale. I hi wlUherthe or ldr or his roro herm own eopl within onevidedyear of that mpl ion,the o me are note the btl or sof pr for shIhowever d buildingr 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 : 36 . 00 OVER/SHORT: . 00 for the purpose of sale). 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 protect(Section 7044.Business 36 , 00 Pe 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 projects with acontractor(s)license pursuant to the Contrac r 'State License Law).l am aware *******.************************************************************************ that proof of their Worker's Compensation insurance should be provide r me. 011/ IND IV IDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. CI mrm7isreason�/J //7� _ v I , I TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: — K/ `� Owner: — A/PItlan AtIY I do hereby certify that I am aware of and understand the requirements of CaliforniaHealth and Safety Code Sections 255 5,25533,and NO FEES WERE SELECTED FOR THIS PERMIT 25534 and that I or any future budding occupant will/will not(circle one)need to comply with said state codes and the re. irements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant'. I hereby certify that I have read this application and state that the at,ye informayon i • est.I agre I comply with all city and county ordinances and stale laws relating to building construction and hereb authorize ed'esti .tires of this cit t enter upon the above-mentioned properly f • nspecti p Days I i'' ' _ 01 00155786-00155786 TOT 36.00 (� Dale: Signature: DATE: 02/22/94 TIME: 14:25 �_,/[ Driver's License or Social Security a: 1641-46 Wmte—Building,Green—Code Enlargement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POO, ei SPA APPROVAL• 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 - - • I- 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 6B. 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 PREY. 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. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDINGME-er48. FINAL PLANNING 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • FINAL GRaING CERTIFICATION Project Address: 270 E. 15th Street Lot Number: (eV 67 A. 0. Harris Sub 1 M. M, 8/69 • Permit Number: — By Civil Engineer: I certify to the satisfactory completion of grading in accordance with the approved plans, specifications, local and state codes. All drainage devices required by the grading permit, grading plan and gradiing ordinance have been installed. Adequate provisions have been made for drainage of surface water from each building site. The minimums are: 251 Fall from structures within 5 feet front exterior walls. 1Jc Fall for as halt surfaces and landscaped areas. Q5, Fail for concrete surfaces to approved disposal areas. The final monuments as shown on the recorded tract map were set. All final grading ele'.a- dons Cr: within ± 1,10 of the desist:- d �elevvations. Supervising Civil Engineer �'1r'" Reg. No. 31720 (Signa..r.l Date 2/9/95 • • PROF ESS/0 41 • 449,40 1-1441-7ece wt �' m ro E 1 31/96 `P C/VIl �Q' �9Ten CAIiFOP� sm.ix.SP and SIQ `City of Costa Mesa, Development Services COMPLAINT INVESTIGATION Coip pl:tinant: Complaint Location: N _ • 770 E 15 —. 7 P onenami adre.a se- 74542-N52 (Name el&mni—lf Applicable) {� y,,r/�� iName or Property Oencrl Complaint Received By: ' t I• r '1• p bWdn+V Date: Z• ' I I 't Time: (City I (Slam) Zip, • nhMphnnel Describe Complai iC _ 'rc VD. no , ` _ -\-k - ask w - i- � m t . s -rft- Tr. I c� in Me --kyn et- l �'kirr ct - • CMMC Section(s): Action: 2 —//2-- �— /�'�- 54€- „4-esi — 0;6,-•Cliv�G�. �5— 'Awe.-lc 4 ct-i'5 . I /'c T/ Year _ , Cc nt l• f i/C I— .— c., lcr-eeos s v'Gist.e'cI — Sop Gjeftri--- at/2 A •-"C /€ C74.-02,74�i PIG, f— ,� ���- — h c (y% e J /Y acev,,y-c- &, id Yo,T/ elf a� y a. B4 c ✓�li,� o—i- e c. r� S' w,,o, tqc( For Office Use Only Assigned to: 6 (1�/ Case No. XB 9.4 1 —L%54 ❑ Code Enforcement S. Building Division A.P. # ❑ Planning Division 0 Health Department Date Complaint Received ❑ Other Received By: Ilniiiul.l 1253-30 rev.2193 l 4„....,_...4.e . CITY OF COSTA MESA OQ` 9 f CALIFORNIA 926281200 PO. BOX 1200 " iuo-xmu a laz V., �'• DEVELOPMENT SERVICES DEPARTMENT February 10, 1995 To: Building Safety Division Newport-Mesa Un. School Dst. (2) Code Enforcement Pacific Bell Communications Police Dept. - Ping. & Research Copley-Colony of Costa Mesa Santa Ana Heights Water Company County Administration Office Sanitary District Engineer County Clerk/Bd. of Supervisors Southern California Edison Co. County Registrar of Voters Southern California Gas Co. County Tax Assessor State Board of Equalization Engineering Division (2) Street Division Fire Administration U. S. Post Office - AIS Fire Prevention U. S. Post Office, Adams Avenue Manager, MIS File (2) Mesa Consolidated Water Dist. The City of Costa Mesa wishes to advise you that the following addresses have been changed or added: OLD ADDRESS NEW ADDRESS A.P. NO. 270 E. 15th St. 270 E. 15th St. 425-161-05 A and B Your cooperation in this matter is appreciated. Sincerely, i Bouwens-Killeen __ enior Planner /jjt(C:PORMS ADDCHANGE.LTR) cc: George Farley 270 E. 15th St. , "A" Costa Mesa, CA 92627 • 77 FAIR DRIVE Building Division(714)754-5273 • Code ENorcemenl(714)754-5623 • Planning Division (714)754-5245 FAX (714)556-7508 alley It 15m Vi154-h 5treck SAUER OWNER S0:TEM, Helen DATE 2-27-62 JOB ADDRESS 270 E. 15th St. BUILDING PERMIT NO. 16488 GENERAL CONTRACTOR Glenn P. Colt VALUE $ 1900.00 AP No. 117-181-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add z bath &en, INSPECTIONS Signature DATE GROUP I TYPE V ZONE R-2/Studio in Soil PERMITS ISSUED res C� SUBCONTRACTOR DATE NUMBER N .r Rough Corn. Refrig. ❑ Air Cond. 0 Rough Heating Rough Plumbing A-}f5 �-y2 .7-1 _l/�, q.,_ �� f. Miscellaneous 0 ��o�/✓ Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring Trenches 0 Forms 0 Steel Reinf. 0 _ Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, brown coat Rang. 0 Air Cond. ❑ Final bin ting, Final Ao 1--at4:bing Fixtures, Final Jl et:1, 1'itiA1 Gas Test /A7✓ tel c-/ A Electric Fixtures, Final -�S' Building, Final OCCUPANCY �9 16488 EEE RECEIVED • FEB 2 7196? COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT > BUILDING RS Z 70 1 /5 r45 ADEIS ,,.EE/ COSTA MESA. CALIFORNIAgig y1 ) moi For Office Use Only OWNER �i Z1W J/-/V t/\ ,1 RECEIPT NO. / Rlyij X107 MAIL �` RECEI Y •/I OA ,'R:C E� T(0.0)�(E/YD/� ADDRESS , S�hJtll.' /y7 'S-/VL/. /Y/_ /n 0J'TQ di TEL. BUILDING CITY / �'f� NO. ADDRESS ARCHITECT �� TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE ' ADDRESS • -- -- CoZONE PJDATE9 GROUP07 CONTRACTOR ecL/0ti y a CI Jr APPROVED ,�// A.r/ G.2- ADDRESS ADDRESS ZSo r yirr•�Sr/L6er t ONING Tt. -,- )097457.1", ZONE$ _2. I NI..O. a I USE OF NEW r(1}Cr(or' CITY C /� D/ PLANS BUILDING A.1 tractie>~r STA LIC.rE NO. 2 O y 78 4' No.'N/a nLEGAL 3 or 6 fl.a, ,4/flea DESCRIPTION C NO. OF OF LOT .5SIZE "/ ,1 / Z' ' I NOW ON LOTS 4 A.P.NO. /I7 - i 8/- d4, USE OF YARDS EVES EXISTING BLDG. kkri 42/3f/L/6 APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.I CENTER OF STREET REAR YARD FRONT FT. (j . IN. SIDE YARD I LEFT I RIGHT R.SIDE T. V IN. DESCRIPTION OF WORK 5 -t FT. IN. //� t- L L.SIDE \ NEW I AL.TERA�oN�1�II ADDITION T� REAR �� FT. IN. REPAIR I II MOVING I II DEMOLISH I BYPROVED W DATE 2 -_7/E 1 BUILDING v` NO. OF / VV/n`6�' SIZE �QQ ROOMS / STORIES EXTERIOR WALI . ROOF r COVERING �JL/Casa I COVERING C6MM) USE OF BUILDING AND WORK TO BE PERFORMED /�/�%// .� (� /• �� CES/y ji-a,c/0 .4/ea `ii C/w . /� �'C"_. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ' ' 5 CO;'ECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLy WITH ALL CITY O'•INANC - 'D STATE LAREGULATING BUILDING CONSTRU •14 .;/lA VALUATION cp 40'0 SIGNATURE OF / 7 PERMIT FEE $ N c‘N PERMITTEEI EN ) • 41-0 P I $ 1�0Der h� PLAN CHECK S AUTHORIZE T / E--0iiiiiMIIIIIIrltaille TOTAL FEE $ 10? • 0