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HomeMy WebLinkAbout169 23RD ST - Building Permits I 71 PROJECT ADDRESS: UNIT: OWNER'S NAME: lb23RD ST A CITY OF COSTA MESA - BUILDING PERMIT PtRM NO: B 061482 MADDY KENT AD Ess: 169 2RD ST UNIT A PERMIT NO: B 061482 PLAN CHECK NO: 00650-93 L GOVT : N SL'PP: N COSTA MESA , CA 92627 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: NEW b 650-4965 • ARCN/ENGINEER:LES KEPHART REG.ND.:C37-7p JOB DESCRIPTION : DEMOLISH FIRE DAMAGED SFR BUILD NEW ONE SQ FT: 1 , 879 ADDRESS: L S.T UNI `• PERMITTEE:BALI BOA CA 92661 CLAIM VALUE: 90, 000 . 00 CALC--VALUE: 111 , 789, 20 GROUP OCC: R-3 /M-1 KENT MADDYHOLI (714 ) 650-4965 HOLD FOR SPECIAL REQUIREMENTS ADDRESS: 2033 HOLIDAY RD COMMENTS; 442SF 1ST FL 945SF 2ND FL, 492SF GARAGE NEWPORT BEACH CA 92660 ****/A*** ****-1 #A-*# #*********************x*##�6 **T¢xii#Kt -)E** ..... .. 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 full force and effect. S E T B ACK S J CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent toselhinsure or a certificate of Workers' FRNT: 20 FT IN REAR : 77 FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; 29 FT IN RGHT: 5 FT IN LEFT; FT IN RGHT: 7T IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQQ• 2 PROV: 2 PARCEL: 42606406 ZNE; R2 REF NO DR-93-02 a Certified copyishereby lurnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> REPLACING FIRE DAMAGED FRONT UNIT OF TWO UNIT COMPLEA > WITH 1879 SO FT. UNIT, P, F, E REQ Date: Applicant: A **************##****tE TE**.**# #*#*************%**#**#*lf*%k##'1(%#*if###1£3E###*lriF**f1 :E?f EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONI' (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIR EMEN T 'S - I certify that in the performance of the work for which this permit isil' I shall not employ any person in any manner to as to become - Tom+��-•� subject to the Workers'Woers' Compensation Laws DI California. ZONING APPROVED. B Y ;V �{`Cl DATE; 2 Date: 7 •f 3 Signature: ^ NOTICE:u.after making this declaration,you should become subject to t eaters'Compensation provisions of the Labor BUILDING APPROVED BY : AZA.-Pt- DATE: 3 • /V Code.you must forthwith comply with such provisions or:this permit shat be deemed revoked. 2 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED- BY; �.7r DATE; wnich this permit is issued(Section 3097,Civ.C). **********-************A -.txs .`* ** •Rk# **** x**********9E********rx: ft ft :t. :4 rt** LENDER: *****#******************************t****%®t.**********************************if 3E ADDRESS: LEGALIZATION:N F E E S U MM � M A R Y 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'-7•MEC`ANIC FIRE SMTP/RES . GRADING (Section 7031.5 Business and Professional Code: Any city at county which requires a permit to construct,alter,improve,demolish,or PERMIT 6 81 . 5 0 J 11 18 repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed pursuant to the provisions o1 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 442 . 98 3 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE '.I _ J 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 tot sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 692 . 68 0 . 0 0 ' _' 4 4 2/. 9 8 , 1135. 66 1135 . 66 . 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 sate.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; 69 2 , 68 OVER/SHORT: . . 0 0 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC ' 'FIRE SMIP/TOT GRADING PLAN- HECK _ I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 681 . 50 - ' 11 . 18 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon e• i and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law). I am aware *-.#-*-%.#.***********.*****.****.***-***#.**4E***3EW1E***,***#*****3E*3E*************ti4(,******** that pmol of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN c I am exempt under Section:B P 70 4 4 B.8 P.C. .) - mrthis reason: NO EMPLOYEES / BY SPLr TYPE QTY D E S C R Z P T T O N n [JNIT COST • TOTAL COST Date: 3`2 93 owner SFR 1387 DWE-TYPE V-WOOD FRAME -GOOD 74• . 00 102, 638 . 00 I do hereby candy that I am aware of and understand the requirements of California Health and Surety Code Sections 25505,25533,and SFR 492 R E5-GARAGES TYPE V- . 18 60 9, 1 51 . 2 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 for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from •END OF FEES ; these provisions. ! h '/I Date: Applicant: I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county f . ordinances and state lays relating to building construction and here yDDDyYYY��YYuP)pthor eze representatives of this city to enter upon the above-mentioned •- property lot inspection purposes. �r � 3-�3 -Date: 5.-�3_ Signature • Driver's License or Social Security R 1' 1641-46 White-Building:Green-Code Enlorcoment;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor • CONSTRUCT UN AND PLANNING POOL .PA 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. Electrics: Conduit Utility-Undrgrnd. 54. Forms _14.,_ Electrical Conduit-Undrgrnd. /, 55. Electrical Bonding 5. Steel Reinforcement q/f3 Qa 56. Rough Plumbing& Pressure Test S. Electric ' UFER Grnd. 1' 57. APPROVAL TO COVER-GUN!TE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water P,pe•Undrgrnd• 60. Backwash Lines, P-Trap, C Undrgrd 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 Vr 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 /r/'),/ 73. Undergrnd.Storage Tank Li Gas 0 Oi' 25. Roof Sheathing t1/BV - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat [j 75. Dry Chemical 27. Frame and Flashing fit/45effil- 76. Dry Standpipe ' 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation '02A . i4- 78. FIRE PREV. FINAL 30. Drywall Nailing 11 (((1i i HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat iiiji 79. FINAL INSPECTION 32. Electrical Power Meter-Final ( 80. FOOD CERTIFICATE ISSUED i 33. Final Electric i I NotesHOLD FOR SPECIAL REQUIREMENTS 34. Final Heating& Air Conditioning 1 S <' �t� r /y/,�_ 35. Final Gas Pipe-Test 93 �ry /1,GC' "lN 36. Hood or Canopy • 37. Final Factory Fireplace I 38. Final Plumbing 39. Water Service-Final t ' 40. Gas Service.FinaZ 41. Solar Domestic-Final ' 42. Backflow Preventpr ' 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation •46. Handicap Regulationsy_y-b------"--4:5V,,,J--7i 47, FIN/ L STRUCTURE & BUIL,DINyGn /" "48 ''r,,• 1 INh���i /t- I g /�.iy{ 6 E� '- f'°i°c� Cil !_a ' v 49. E :iatric Release to£r' ,on 50. Gas Relcase to Sot�rn California Gas Co • 51. CERTIFICATE OFACCUPANCY No. Date City of Costa Mesa " • • California 92628-1200 P.O.Box 1200' Insulation Certificate • (1�� (I Permit Number V C(. 1 D_Sao QcS L c-cs Number and Street City • County Subdivision . Lot Number Description of Installation ROOF rl r Material L�'-\ l U%M -co CIAS Brand Name Thickness (inches) Thermal Resistance (R-Value) 2.\a EXTERIOR WALL Material Q' \3 V.SMera CZA5 Brand Name Thickness (inches) Thermal Resistance (R-Value)>Q-3 CEILING 0# CsistAre Batt or Blanket Type V- �3 Brand Name Thickness (inches) 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 Thickness (inches) Thermal Resistance (R-Value) 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 Ad nstrative Code. General Contractor(Builder) License Number - Signature and Tiittllee Date Sub-Contractor(Insulation Installer) - License Number • Signature and Title Date 1907-46 WELLS INSULATION CO . TEL No . 714-539-0909 • Jul 1 ,93 7 :54 No . 001 P .01 • INSULATION RECEIwT INSULATION PS INSTALLED IN THE S'IROCIURE DESLRIimD DELON ir5 FoLLmw‘i: COVERAGE Article ITEM INS1ALLED II OF BAGS (BLOW ONLY) ROOF AREA R-19 Unf,l‘rpri 1,4t-* r. 11:11..1N15 FffiL.1-1 Ur GARAGE-- R--I3 Unfaced Beats ROOF ARFA ------- . uniate0 EXHER1UR WALLS- Untaced Ltt - KNJEEWPLLS OF LIVING AREA- R-•13 Kl'art F ;iced AIR - INFILTRATION PACKAGE- Cetulking Per litIte 2/r 1N1ERMEDIATE CEILING----- R-19 Unforced Batts PLL. MAJOR INTERIOR WALLS- R-11 Onfaced KMADDY 11532 11111 NAME rinVOY RESIDENCE 1.01 # ADDRESS 169 23RD STREET COSTA MESA DATE COMPLETED - • -) WELLS INSULATION UUMPANY, INC. 13Y IA)IC-1./147 SEPERILiTING CONDITIONLD FROMNON-OUNDITIONED SPAGES. PROJECT ADDRESS: 169 21RD ST UNIT:A CITY OF COSTA MESA -- BU1LD':.NG PERM .. i PERM NO: P 06 . 648 OWNER'S NAME:HADD Y KENT ADDRESS:169 2'RD ST UNIT A PERMIT NO: P 061648 PLAN C'IECK NO; N GOV" : N .,:::'-1: COS'•'A MESA , CA 92627 T CONSTRUCTION 'TYPE: V-N PE-MIT TYPE: PLU Pt.\?OSr:; O:r. ARCHIENGINEER:650 -4965 VES K'EPHART REG.NO.:C37.7R JOB DESCRIPTION : DEMOLISH FIRE DAMAGED SFR BUILD NEW ONE. SQ FS: ADDRESS:' L ST UNIT: BALBOA CA 92661 CLAIM VALUE: CALC-VALUE: GROJP OCC: 4-1 /' -1 PERMITTEE:'TiEE OTIS PLUMBING ( 714 ) 648-4227 ADDRESS: 1890 16TH ST K107 COMMENTS: RE: 861482 PRIMARY BUILDING PERMIT. NEWPORT BEACH CA 92663 **XX; *x*4*xuK**XxXX*ux*iE*********i(********x%****ui<*xN** x:x:.;r**uKXX***ac***(1-m*x*x LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REOUIREMENT S 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.:1:106944 STATE uc.2 7 2 6 9 4 cuss:C 36 Date:411 ti- signature:—Vi3tiC_at.• MAIN BUILDING - - -- ACCESSORY BUILDING - -------- - WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure era certificate of Workers' F RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT J N RGHT: FT IN LEFT: FT IN RGHT; FT ,AN POLICY NO.: EXP. DATE: COMPANY: PARKING REQ• PROV: PARCEL: 42606406 ZNE: REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date'. ' E Applicant' •• *X*********X**XXXX*-*X*********X***X**x *JC•**X***X**XX****x**X*.".XX*X*XXX*#*Xx X X X* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R V It C E S ' REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Wo kers',Compensation Laws of California. ./� ZONING APPROVED BY �- DATE: Date:ttu1 l Signature: C/'t �u'i • •' NO ICE: ,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: i DATE• Y 7� which this permit is issued(Section 3097.Civ.C). ****X***************** -ir* rt **it. itx rtirit X. it* y.xNA44*M*-X***********sr Ax*,.;,3txx : X* LENDER: *************XXx•X-X****x****1E***1E*i!*x*******XXX•',f* i( xX*X#***i(•******Xx*XiFXX#*z;**X . 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 SM I 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 7 5, 0 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 SMTP/,NON-R ES 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----> 75. 00 20 , 00 0 . 00 95, 00 95. 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 : 95 . 00 OVER/SHOR Tom, ,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 95. 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law)• l am aware X-*..X.-x**X.**..X.*X..XX.*.x**.*.*X***#*X***************XXX****X**X*Xi*X-***X•X*X;Q-Xi X\***X***x**if that proof of their 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 reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date owner: PLU 2 BATHTUB 7. 00 14 , 00 I do hereby certify that lam aware of and understand the requirements of California,Health and Safety Code Sections 25505,25533.and PLU 1 LAUNDRY TUB OR WASHER 7 . 00 7 . 00 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 Quality Management District.Residential construction applications are exempt from PLU 1 SINK, BAR 7 , 00 7 . 00 theseprovisions. PLU 1 SINK, KITCHEN 7 . 00 7 . 00 PLU 2 WASH BASIN 7 . 00 1: , 00 Date: Applicant: PLU 2 WATER CLOSET ( TOILET) 7 . 00 14 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county pI,U 1 WATER HEATER AND/OR VENT 7 . 00 7 , 00 ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned PLU 1 GAS PIPJ NG SYS OF 1 TO 4 OUTLETS 5 . 00 3 . 00 property tot inspection purposes. I 11 ��f� END OF FEES �" Date-4r I k ^� Signature: f! zt, �- Driver's License or Social Security 0: 01 U01368d3-OU 13F843 T F_l�(' 79 oATEt 04/37/93 TIfE: 17.53 95.Lt. 164146 White—Building:Green—Code Enforcement:Canary—Applicant Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL ,PA Date Inspector Date Inspector APPROVALS Permit# 1, APPROVALS Permit # 1. Temporary Electrical Service,tor Pole 52. Pool & Equipment Location a 2. Soil Pipe-Undrgrnd. xyG713... �� 53. Steel Reinforcement !l 'r { .3. Electrical Conduit Utility-Ur grnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _ I -5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduii-Undrgrnd. 8. Foundation :.' ) S 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. } 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK •' 1 11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final 12. Sewer CaP • 63. Heater & Vent-Final -{ 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing j/7fJ 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 ❑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 i 1 HEALTH DEPT. REQUIREMENT 1 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 Of r !i! 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing / (f/fy 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer I 43. Backflow Irrigation J! 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: UNIT: 4 \ OWNER'S NAME: AODRES169 2 ST A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 061 .6 S:MAIADY KENT 169 23KENT ST UNIT A PERMIT NO: M. 061946 PLAN CHECK NO: N GOVT: N SUPP; N COSTA MESA , CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: O':H 650-4963 ARCHIENGINEER:LES KEPHART REG.NO.:C3718 JOB DESCRIPTION : DEMOLISH FIRE DAMAGED SFR BUILD NEW ONE SQ FT: ADDRESS: L ST UNIT. PERMITTEE:BALBOA CA 92661 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 ADDRESS:EALUNORTON ( 714 ) 54O- 593 3058 TAYLOR WY COMMENTS; RE: B61482 PRIMARY BUILDING PERMIT. C.M. ###########*###########x ### ##########N##n* ##### x• ### ##*#### ####*######**# ,/ LICENSED CONTRACTOR.DECLARATION: CA 92626 x• RATION: I hereby affirm 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 full force and effect. S E T. B A C K S CITY LIC.:049325 STATE uc.:575335 cusrJ;200 Date: 4—',el — -C3 Signature: c 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 FRN T: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cr. LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ; PROV: PARCEL: 42606406 'ENE; REF NO: 0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant: M#########if######:1F##########if###Y.####A-1E######iC################1############::##i: EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(S100)or less). D E V E L 0 P M E N T SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any per on in any manner so as to become ; subject to the v rkers'Compensation Laws of California. ZONING APPROVED BY DATE: ` Dale: LI—�~ 11 Signature: — _ c.‘.., NOTICE:II,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: c.- a which this permit is issued(Section 3097.Civ.C). DATE' 3 ###############-#######R*Iew—: .***#.ex>rx ltxiFx�-*A-w crx�exxxar#xfc##BP#####iE•#x r :xu•r, x<xK•# 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 SMI P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT / "9 ,00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed _ pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ..-- 25% 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 r any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEEc5. 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DTIV—> PERMIT ISSUE PLAN—CHECK u-a TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7144,Business and Professional Code: The Contractors'State License Law TOTALS————> 9 . 00 15. 00 . e0. 00 24 . 00 24 , 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 TOTALS--> COLLECTED : 24 , 00 OVER/SHORT: ,00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC TIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 24 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).I am aware #######?F###########################jE####)i•?e###-3E###############f(#####%########### that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P.C. INDIVIDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCR IP T I O N r UNIT COST TOTAL COST Date: Owner: I do herebycertifythat I am aware of and understand the requirements of California Health and SafetyCode Sections 25505,25533,and NEC 1 S NS T FORC—AIR/GRAV FURN <= 100 K BTU 9 , 00 9 , 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from n • these provisions. - • Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned - . property for inspection purposes. ', .4 F Date: 4 2— qZ— Signature:a - • 01 00138185-00138135 T 0 T 24.00 DATE: 04/29/93 TIME: 10:10 Driver's License or Social Security p:!' ,. J 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant: Revenue;Goldenrod—Assessor cant:Pink— CONSTRUCTION ANOPLANNING POOL _ .,PA APPROVALS Permit m_ D;;te I Inrpeetor AP'ROV ALS Permit Date Inspector ' TcTp .. EI erica, 53...`-;_:o` Pole _ 52. Pool 6: E4 u'Gr'-''t Lt cat on 7 cd-.: � �r ,..-^... I - _I � 53. Steel Heinfo.c.T,..rt I •7. E' Ct- . - C, rl',irt L. 'i'V•Ur drgfrd. 1 �5 -_- 4. Fnr^r• I -__ h G Co-durt•U i�Ct..�,'! i,Irymd I 56. Electrical Bn ig nn ;. St..-: Hrroforcemcnt 56 Rough Plumbing & Pr rssure Test G. E. r un E.F CC C nd. -_-J - ' 57 APPRUVAI TO COVER C.UI\'ITE --_- I i 58. E'ectrica Condo t•Ljn irgrcii -_--' __ I _ 58. G,: Pcr'.. L� -t 1 I -- -- - -- - - -- -1 - -- -- --- ---'- ---- r-- --- -' '0. S' _ct. .. 7 't:7 S, J_ 6'. 6'PROVA: TO _LE " . --_F, ^P`" _S L,na & '4oJsa Connectmnf - I -_ -� 1 62. E.,,.-...,,,, ,, A-L_,J; r, -_-1-- _-. -, . 63. Heater Et Vent-Final i 3. F,.it C•.;in. I _-- 64. Plumbing Syst^m F-nal _-_ I ___-_I d. ' ' sm,^ ''Iwnuiry 65. E.actrical-FinalL i 15 4 g`-. '.i t,n c.-.'•Condurt 66. Solar System - �I 67. rent ig & ACC r- , nn•p .r I r Hc',._'• ^ S nn 63. APPROVE? cCH 7 .AS H. :F --� ! 16 R,-_i,, c :C-'ca'_T Bar Cell rg -_.i--_ I 60. POOL;SPA :Y-i E' 3 ?:irL _ �19 N iE" 10 81 Au Cond troning ��/`jp�, /1/7� FIRE DI PT. H I. OLL,iL `:'E,ri I '^. (-!- _ ///' A' PRUVA'LS Pr ,: --- - - ---- - -- ---- - :'. ., otr..ctur . -_ 1- ____-_ 72. Daft:. ye- 'It!r7 I 71. .., " G.i. . . 'J , 1 73 G . p Nn 7h 5 e,' - - 72. 'J.:oer!•o.. d F ,, I 9t. R.aof Fram-g 1 _ 73. Undcrgrnd S•.ar.r�' 7„' k G. _- I_ _ -- 75 con! L'-_ath'n ! 74 O.erh^ad H„rin. 2E 1 Lir CoL rig (Stn nr.Tdrab R ..,o^ccod• r Ir6 Or, C;u:r.t •e' - 76 O 5, a__ _._.I • a u rg I 17. FIXE TFE ..S". ' A, I 1H J'-PT REC I:.Er' L )" 1 ' r. 2 a!YF .J_ ___. I �60 FC J „t .r I '.l' c , - . 1 . ";/ F ml N� A ct or r Cunditran\-- � � ` kAel�_' ' fit- _rinneld_Kv,"M C� . t7/ I 35. Fina! Gr.s Pipe-Test i 'G. 116;.a ci Cc-.apy 37. a' 1=_ct.i.,• Fir,•p!aia -46- /1y71 f_ r2i2e1( d -7 4ter„,d /(C/ dd. ..ter c'. .-r Final I--___ .____- .. -. t _ J::. Cor S. e. r:•^.31 I I - - -_ • [ 41 Suiar ❑nme.0 c.Final �42. B.ckflovn• Preventer ,3. it;ckflow Irrigation -_- ---" ---- • mac= InndsC:pC Irrigation SYStem 45. St and /tter.UdLOr - " - _ __ ___ C. F.•d RLgu'.. c 47, r' M1 AI. ST7UCTl.RE c: 6UILC ''.G -- --.I--- ---- - - - - ----- - - - -- - - - - - - y ro 71'.: ,L PLANNING - - -- -- - -- - - I r4(,. E ^C((Ir Re'a+'seto Edison ----- - ------- - ___ • 50 Gas Release to Southern California Gas col 51. CERTIFICATE OF OCCUPCtNCY 1No.._ Date -;--7---2.-„:2:- r I - - -- -- -.� PROJECT ADDRESS: 169. 2.3RD SI-‘. UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 062780 OWNER'S NAME:MADDY KENT ' ADDREss: 169 2RD` ST UNIT A PERMIT NO; M 062780 PLAN CHECK NO: N GOVT: N SUPP: Y COSTA MESA ,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH MCN/ENGINEEM 650-4965 REG.NO.: ADDRESS:LES KEPHAARR7Da1 T C33 JOB DESCRIPTION : INSTALL ONE FACTORY FIREPLACE SQ FT: PERMITTEE: BALBOA CA 92661r CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 ' ADDRESS:KENT MADDY ( 714 ) 650-4965 2033 HOLIDAY RD COMMENTS; 442SF 1ST FL 945SF 2ND FL 492SF GARAGE / RE• B61482 Fd RRA( BEACH CA .926§0ap **********************4*************4*************�r*****�6TE*** ****�P�6 x *�r�r+Jr*** LICENSED COion 3 o I ere y a irm that I am licensed under provsions apter 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 lull force and effect. CITY LIC.: STATE LIC.: CLASS: SETBACKS , Dale: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: thereby 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 j 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 REO• PROV: PARCEL; 42606406 ZNE: REF NO: , ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant: ******************************************************************************1E EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVEL OPMENT SER V I C E..S REQUIREMENTS I certify that in the performance of the work for which this permit is tissued,I shall not employ any person in any manner so as to become subject tP the Wo s oniplaggn Laws of California. t ZONING APPROVED BY / DATE: �— Date: l 0— ^_( / Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY a ' 9� 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: . t-- which this permit is issued(Section 3097,Civ.CL , „ A. , L3 DATE; ,0,/;,,g,, LENDER: ********************************************iE '*** 4#**************************** 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 7031.5 Business and Professional Code. Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 6,50 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'Stale 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 4 . 50 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----> 6 . 50 4 , 50 0 . 00 11 . 00 11 . 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 . 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 11 . 00 r ❑ 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 theContractors'State License Law).l am aware *,***,*,**,***,*,**,*,***,**,**,*,*,***,***„**,**,**,***,*,*,***,**,****,**,*,*,*K,*******_***************** that proof of their Worker's Compensation insurance should be provided to me. am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN r/ormisrea[son: O EMPLOYEES / BY SE TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST ---"C Date'. L..t+ �O—CC Owner: 4 l,.l� I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 FACTORY FIREPLACE 6 . 50 6 , 50 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Oualily 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 above information is correct.I agree to comply with all city and county ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned proper) for inspection purposes. Dater a 15ett 3 Signature: 01 00141827-00141827 TOT 11.00 Drivers License or Social Security a: DATE: 06/23/93 TIME: 12:59 164146 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING POOL ,,PA 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. $.,Foundation 59. Gas Pipe, O Undrgrnd.,Test -may. 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 66. 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 OOil • 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 i I i 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat i I + 79. FINAL INSPECTION 32. Electrical Power Meter-Final 2 I 80. FOOD CERTIFICATE ISSUED 33. Final Electric { ` -, Notes: 34. Final Heating& Air Conditioning 1 . 35. Final Gas Pipe-Test 36. Hood or Canopy I a f ' 37. Final Factory Fireplace 'a'ilifY. 38. Final Plumbing I •I 39. Water Service-Final �\ 40. Gas Service-Final � 41. Solar Domestic-Final 42. Backflow Preventer 1 41 Backflow Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDINGI 1 -1 48. FINAL PLANNING t I 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADORES: d69. 2-3RD ST UNIT:A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 061669 OWNER'S NAME:MADDY KENT ADDRESS: 169 23RD ST UNIT A PERMIT NO: E 061669 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA , CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH 650-4965 ARCH/ENGINEER:L ES KEPHART REG11 D.:C37.a JOB DESCRIPTION : DEMOLISH FIRE DAMAGED SFR BUILD NEW ONE SQFT: ADDRESS: L ST UNIT. PFflMITTEE;BALBOA CA 92661 CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /M-1 LESTER ELECTRIC ( 714 ) 675-8271 ADDRESS: 417 EDGEWATER COMMENTS: RE: 361482 PRIMARY BUILDING PERMIT. BALBOA ISLAND CA 92661 ******##*#########* *****-********************* **********#********************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONI NG R E Q U I R E• M E N T $ 70011 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK Sc.CITY LIC.'':)0) 56 963 STATELIC.553892 CLASS:c-10J' �/� p Date:— I ? Signature: q_JC./-ean4 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: 42606406 ZNE: REF NO: .❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > r,. Date: Applicant: iE##########*****######******######jE-******#####1Fit*###########*#######*#if#####1f*3F EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S-•E.92. V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner 5o as to become subject to the Workers'Cam enation Laws of California. ... .'...• ZONING APPROVED BY DATE: Date: q-O ry— /yy 3 Signature: ��d—e121-1 Qi NOTICE:II,alter 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. ,/9 CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: • lame which this permit is issued(Section 3097,Civ.C). Cite DATE: • ' *************************** • tt IGN ****** ** H. *************' .• .. x. .cc** LENDER: ? ********************************#if Al•*i6*#*iE###### **##*#****##**####x**iF**#**## ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate 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 65 60 repair any structure.`A(ior 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)01 Division 3 of the Business •_ 50% SMI 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 1500 • I. as owner at 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————> 65 . 60 15 . 0 0 0. 00 80 . 60 80. 60 . 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 : 80 . 60 OVER/SHORT- 00 lorthe 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 80 . 60 ❑ 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).I am aware ****.*,.*.i,e*.******.*******,**********#*#***####*#*#****#*#**#*#*****#******##**#*iF**# that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.a P.C. INDIVIDUAL F E E BREAKDOWN for nis reason' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 20 FIXTURES, LIGHTING 1 ST 20 EA, 75 15 . 00 25534 and that I or any lutwe building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 2 FIXTURES LIGHTING ADDITIONAL EA, . 45 • 90 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 20 REC EPT/OUTLET • 1 ST 20 EA. . 75 15 . 00 these provisions. ELE 26 RECEPT/OUTLET ADDITIONAL EA. . 45 11 . 70 ELE 16 RECEPT/SWITCH 1 ST 20 EA. 75 12 . 00 Date: Applicant: ELE 1 SUB—PANEL 11 . 00 11 . 00 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county END OF FEES ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter pon the above-mentioned • properly for inspection purposes. Date: q� ? Signature 01 00136941-00136941 04/08/93 e -1- 6 80.60 Driver's License or Social Security 1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL jPA 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. 1 I -- •3. Electrical Conduit Utdity•Undrgrnd. 54. norms .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough °lumbirg & Pressure Test 6. Electrical UF ER Grnd 57. APPROVAL TO COVER-GUN ITE I -1 7. Footings 58. Electrical ConduPUndrgrnd. 8. Foundation • 59. Gas Pipe, 0 Undrgrnd ,Test t -1 9. Water Pipe-Undrgrnd. 60. Backwash Lim)).P-Trap. 0 Undrgrnd. 10. Structural Floor System , 61. APPROVAL TO DECK _I 11. Property Sewer Line & Housetonnection 62. Backwash & Receptor Final 12. Sewer Cap63. 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 i 22. Ducts, Ventilating 71. Product Piping :]Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flus': 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oi: 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 i 77. FIXED SYSTEM FINAL 1 29. Insulation ' 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 1 79. FINAL INSPECTION 32. Electrical Power Meter-Final t 80. FOOD CERTIFICATE ISSUED 33. Final Electric Q� L -- / j ://6:7n �,1f�r'�Notesy�/ty4�1'�/� - -�9 0 -i 34. Final Heating & Air Conditioning .7 !� 35. Final Gas Pipe-Test 1 36. Hood or Canopy 1 1 37. Final Factory Fireplace -i ir _ { 38. Final Plumbing -? 39. Water Service-Final I ' J 40. Gas Service-Final i 41. Solar Domestic-Final • .c 42. Backflow Preventer { 1 1 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING i , I- • j 48. FINAL PLANNING 49, Electric Release to Edison 1 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date -1111 \\ l i. Applicant to fill in all spaces except those within heavy Corder lines and sign all appropriate declarations. ri Q COSTA MES CON TRUC ION PERMIT PER T N TRACT NO. LOT NO. UNIT NO. / role t Address I (f 1 L /� O3ao s — , /D/ FEB -5 1988 •! - Applicants Mailing/Address 3‘1 lC1QDt1..A'OD `�`� ! r TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION H REPAIR Owner's Name F-E�� SSb Phone �7 S`Oy`S El CONVERSION DEMOLISH ❑ OT I- q i A.P.4 '� ,,-t,,�,rl� Zone p IC10 DESCRIPTION OF WORK/USE OF BLDG. p� �^'-1 Address ,71,E QOV+4g0 LTi- �or\ ci -CtCr 1 �ry C0/40-/X-Co F S Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT LJ GRADING ❑ FOUNDATION U STRUCTURAL E Front 0 Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name Phone ❑ OTHER A N /// \ PROJECT DESCRIPTION 50. FT. OCC UPAN v C Right G Address(mailing) K CONSTRUCTION TYPE VALUATION 5 � 00410S Left R City License No. ZONE GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION Ping. Ref.4 Parking Req./Provided Q. i hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and T my license is in full force and effect. Ucense Class License No. S Date Signature PLUMBING FEES ' WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ' '800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW )icy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW dcertified copy is hereby furnished. Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred($100)or - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is issued, I • shall not employ any person in anymann s to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-B oo Workers' Co pe tion Laws of Californiaa \�, Date a-Q`bD Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: If,after making this declaration,you shout become subject to the ^ Workers' Compensation•provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such, provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there Is a construction lending agency for the performance Pole Light of the work for ,which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service OWNER BUILDER,DECLARATION - Switches Sign I hereby affirm that•I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5.15 KW Trash Com actor any structure, prior to Its Issuance, also requires the applicant for such permit - P to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions code) or that 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 , a)ty of not more than five hundred dollars($500). as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee $ 3 -.npensation, will do the work,and the structure Is not intended or offered ' Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ ZoningApproved ByDate sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground BuildingApproved y prove for the purpose of sale). pp ved B Date 1, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 0 Date tractorstO construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SU MA Y O FEES builds or improves thereon, and who contracts for such projects with a con- ep CO tractor s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ — `�' SMIP •$ • proof o// their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 )am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers PLUMBING $ ISSUANCE $ Date 7- 'ELK owner-- 4y Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and-State that the above ❑O-100,000 BTU 0100,000 BTL GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relatin to building construction,and hereby authorize repre- MICROFILM $ sen tat ives of th' ci to nter upon the above-mentioned property for PLAN CHECK 50% $ �� ��'� Inspection p1 MECHANICAL $ TOTAL FEE $ . '`-_" • Signatur Date dr 5--tg Drivers' License or SS tr Reinspection Fee $15 Issue Fee - $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL&SPA • Date Inspector Date Inspector APPROVALS �P,ermit • 1>Temporary Electrical 6e-ivice 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 4 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. ((.1 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 PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 'r 33. Final Electric Notes: 34. Final Heating & Air Conditioning r. 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 2/6/gg CE- 48 Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF O,CCUPANC` No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. VS3W VISO3 JO A I I') CITY OF COSTA MES/AA �CONS�T�R pUCn�N PERMIT PERMIITTT NO. TRACT NO. LOT NO. UNIT NO. Project Address r/f0 at? 5//rte/ /� 'L/ 2'� rI 11 € 8861 - add An licant's Mailing Address /1�/ ea,�pr sy. !GS/4 tp, 22p./rF TYPE OF CONSTRUCTION ❑ NEW D ADD H ALTERATION U REPAIR r wn y ,,/ �,y / J ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# 1 1� Zone • Owner's Name Kezvn Mack., Phon DESCRIPTION 0 WORK E OF BLDG. - Address r'?/I tig7/� A'IP/hyy(eg t ,, �� &. _ �� G, '✓� ter O S Main Building: 1 ki i�@�cd¢Stiry Building: Z Arch/Eng. License No. TYPE OF PERMIT II GRADING U FOUNDATION C STRUCTURAL T Front O Address �y {�, y ['� r ❑:iJENANT Li ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name r' Psct "eo191e Q••... • Phon4 474,5n- ism OTHER R PROJECT DESCRIPTION SQ. T. I<BO OCCUPANC C Right N Address(mailing) /! ' et - . • �/ /}y �v0 K Left G Z CONSTRUCTION TYPE 1•-••1‘) VALUATION$ /LOIDA S City License No. _ is �� �� 7� R ZONE GRADING CU.YDS ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION c -q .J Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ft C 014- - sot Q �/u2it --_��. 's'r, _ i_i5// pi- Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and• / /s �1w1 +J r sots.-1T my license is in full tf_rce�ptl effect. 4 as-1r `ic(S5,A. Fi e&c 5 S ,f rS S License I ss r _ Lice se No a '. A / Date Signature - Daly _ PLUMBING FEES WORK RS'COMPENSATION DECLARA ONBar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate a; f Workers' Compensation Insurance, or a certified copy thereof (Section . Backflow Preventer Service Sink y n Automatic Washer Transformer 0 15-50 KW 300, Lab. C.) ,�,,��!/ry Macre Fat+ 0 So+KW Policy No. ge-67/ Company �t Backflow Irrigation Sewer Cap Construction Pole Sub. N ❑ Certified copy is hereby furnished. ertif ted co 3r i filed with the city iqg Divisi . Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant f"cQ �7/� L Clarifiers N EXEMPT ON FROM WORKERS'CO PENS TION ECL RATION Solar Collectors Dishwasher M ¢f Clover 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric ub Panel I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar TankFan Motors 00-1 HP 01'4-8 7 Workers' Compensation Laws of California. s—_ Date Signature Floor Drains S mming Pool w/Spa F.A.U. olar• ❑9-15 HP 016-15+ NOTICE:If,after making this declaration,you should become subject to the — Inc.. Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave Acomply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance Iof the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name r Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor 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 Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt serefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars($500). 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 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 Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not intended or offered for Boiler sale. if, however,the building or improvement Is sold within one year of com- Canopy T pe II 0 Zoning Approved By Date pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date LILI for the purpose of sale). �Q —7 I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrige tion System Application Issued By ate —3S tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00 0,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware thatExhaust System 0 Multiple 0 ystem Repair/Alteration BUILDING PERMIT $ a-7-00 $MIP $ r '� proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date owner Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 06100,000 BTU 0100,00 T ' - GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws rel- g to building const uct on, and hereby authorize repre- MICROFILM $ sentatives of t.aS to en it ' above-men Boned pro�itlk fpr- PLAN CHECK 50% $ inspection pur•J r" �J/ 7i/ (/n!�' MECHANICAL $ TOTAL FEE $ 37i s° Signature J��tee.` ' ` - Date . Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' Li se or SS# I CMF 0865-46,rev. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND:PLANNING POOL& SPA APPROVALS .Permit# Date Inspector APPROVALS Permit# Date Inspector 1.4emporary 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-Urjdrgrnd. 55. Electrical Bonding 5. Steel Reinforcement'c , 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gin-0.v 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation .� II 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgr4.1B0. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor Systrm -' 61. APPROVAL TO DECK 11. Property Sewer Liner House Connection 62. Backwash & Receptor-Final 12. Sewer Cap I 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 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 F I NAL : -1'•' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT t't LI 20. Rough Factory Fireplace APPROVALS Permit# • a 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 OGas 0 Oil 25. Roof Sheathing '/'/9C/��// 8 444- 74. Overhead Hydro �- ;i 26. T-Bar Ceiling (Structural) & Monocoat f ..-75. Dry Chemical q, •' 27. Frame and F15shing 76. Dry Standpipe CI '• 28. Lathing & Siding 7 77. FIXED SYSTEM FINAL 7. 29. Insulation 78. FIRE PREV. FINAL 30. Drywall/Nailing HEALTH DEPT. REQUIREMENT • 31. Plaster Browri at 79. FINAL INSPECTION ;: �4 • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED I I„ 33. Final Electric Notes: - i i'lr 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 I • 40. Gas Service-Final I ' • '. 41. Solar Domestic-Final ' I i 42. Backflow Preventer • 43. Backflow Irrigation - I j - ' 44. ,Landscape Irrigation System . - . 45. Sound Attenuation i . 46. Handicap Regulations I - •47. FINAL STRUCTURE & BUILDING 84, \ , 48! Special Requirements Completed • • ,:49. Electric Release to Edison : • 50. Gas Release to Southern California Gas Co - . , 51. CERTIFICATE OF OCCUPANCY 1 v No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MEg C ST UC ION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. !�S C 326-71 Project Address /�y • 0103 4/04/811 I I0013 TL Applicant's Mailing Address MtTYPE OF CONSTRUCTION NEW U ADD U ALTERATION U REPAIR Owner's N s• Phone ❑ CONVERSION Cil DEMOLISH ❑ OTHER A.P.4 Zone 9rtse DESCRIPTION OF WORK/USE OF BLDG. r Address /� r I S Main Building: . Accessory Building: ' Arch/Eng. License No. TYPE OF PERMIT 1!J GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front 0 Address /, i,/ ❑ TENANT ELECTRICAL ID PLUMBING El MECHANICAL OTHER B Rear N Contractor's Nam- a ,j,z,.....4 C r �f= hone +r C Right N PROJECT DESCRIPTION SQ. FT. I SIL 43 OCCUPANCY Address(mailing) /07 / ; fAlAi • CONSTRUCTION TYPE r VALUATION$ S Left G City License No. O�! ZONE - _ GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION Ping. Ref.4 Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q with section 7000) of Division 3 of the Business and Professions Code,and lypdt �.. 32�-3� M my license Is in fullforr 5 and effect. �ne.�i�/ 7 T License Clas Cx N/ License o. ��J'1 /fr7 S Date Signature PLUMBING FEES WORKER 'C MPENSATION DECLA ATION Bar Sink Showers ELECTRICAL FEES ,I hereby affirm that I have a certificate of consent to self-insure or a certificate .rf Workers' Compensation insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ;"t800 Lab. C.) Automatic Washer Transformer 0 15.50 KW Policy No. 4")4445'V3 Company" 6Ys -f,',r Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW miffed copy is hereby furnished. _ Certifiecla led with the city n i i on. _Bathtubs _ Date r Sewer Connection Cooking Unit Meter ❑up to 100 amps Applicant EXEMPTIO F OM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or Dishwasher less). Solar Piping Dryers ❑Gas ❑Electric Sub Panel /// I certify that in the performance of the work for which this permit is issued, I -- shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'/x-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16-15+ NOTICE: If,after making this declaration,you should become subject to the 1 Workers' Compensation provisions of the Labor Code, you must forthwith Floor$inks Urinal Fixtures CSH I comply with such provisions or this permit shall be deemed revoked. Microwave Y- CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet • Device Box ..••••• 1 hereby affirm that there is a construction lending agency for the performance Pole Light \ of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlts 1'J Lender's Name eRange V Lender's Address • Kitchen Sink Water Service Switches 41 Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories " Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap 0-5 KW❑5.15 KW Laundry Trays Generator any structure, prior to Its issuance, also requires the applicant for such permit ❑ Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of New 'ze51 Dal Cr 1 g I yXO.03i. (02 LI Division 3 of the Business and Professions Code) or that he/she is exempt 7 L lerefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 - Issue Fee $ 3 I S IN compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $--3- for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date citation, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date prove for the purpose of sale). - ` 0 I, as owner of the property, am exclusively contracting with.licensed con- Duct-Structural Refrigeration System ' Application Issued By (251\ Date LI__� ^80 6 tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100.000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof o// their Worker's Compensation insurance should be provided to me. CHECK $ PER 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG 4 Fire Dampers • PL PLANMIT UMBING S ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 Bta 42-T ' $ Information is correct. I agree to comply with all city and county ordinances ELECTRiCAUSIZXQoiI— 7, and state laws relating to building construction,and hereby authorize/epre- - PLAN CHECK 50% $ �j 1,�\ MICROFILM $ Inspection of this t to /nter upon the above-mentioned pro erry_ fp Inspection p �/ � / y-0%-/[!//'p17{ Signature �,/ Date • MECHANICAL $ TOTAL FEE $ Drivers' License or S 4 �� Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ I I o CMF 0865-46,rev.10/84 white - Building; Canary -Applicant; Pink -Accounting: Goldenrod - Assessor •LONSTRUCTION AND PLANNING - POOL&SPA APPROVALS Permit I 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. 5-42-83 H/f® -55. Electrical Bonding 5. Steel Reinforcement LL 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings58. Electrical Conduit-Undrgrnd. 8. Fou}fdation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap i 63. Heater & Vent-Final 13. Roof Drains :Y. ll" 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit •• / ��K66. Solar System-Final 16. Rough Electric Wiring q,(s/ .-[ -__4 67/ Fencing & Access Approval 17. Rough Wiring Sign S� � 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 ❑Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro - - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe /' - 28. Lathing & Siding 77. FIXED SYSTEM FINAL"- 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT . 31. Plaster Brown Coat 79. FINAL INSPECTION •C 32. Electrical Power Meter-Final •7-'ZI- 3 9.,,,,k_ 80. FOOD CERTIFICATE ISSUED , 33. Final Electric ' 7 -ef Lie-,� Notes: 7_..?7-fes Cc,�';.�c 5€rd r V 1. eCe Tact-Wt 34. Final Heating & Air Conditioning U J 35. Final Gas Pipe-Test 36. Hood or Canopy 1 37. Final Factory Fireplace 38:-Final Plumbing ✓r -% 39. Water Service-Final ./ /.. 1 40. Gas Service-Final ( J • 41. Solar Domestic-Final , , 42. Backflow Preventer .:r 1 •,' ...r. :,- r . I 43. Backflow Irrigation 44. Landscape Irrigation System /�• j,• 45. Sound Attenuation , •-' 46. Handicap Regulations - '. - 47:f/FINALSTRUCTURE & BUILDING - ( '• -• . - ) • 48. Special Requirements Completed X }r� ( • S I 49. Electric Release to Edison -f 50. Gas Release to Southern California Gas Co n ` 51. CERTIFICATE OF OCCUPANCY / , No. Date - - _ • ,I 1 PROJECT ADDRESS: UNIT: ' OWNER'S OWNER'S NAME: 169 23RD ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BP 061444 • • ADDRESS:MADDY, KENT J MADDY LAURIE L PERMIT NO: BP 061444 PLAN CHECK NO; N GOVT: N SUPP; N 2033 hOLIDAY RD NEWPORT BEACH,CA 92660 CONSTRUCTION TYPE: S—N PERMIT TYPE: PLU STB PURPOSE; DEM Q ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: : SQ JOB DESCRIPTION DEMOLISH SINGLE FAMILY DWELLING FT: PERMITTEE: CLAIM VALUE: 1 , 000 . 00 CALC—VALUE: 1, 000 . 00 GROUP OCC: R-3 / KENT MADDY ( 714 ) 650 -4965 ADDRESS: 2033 HOLIDAY RD COMMENTS: DEMO OF BLDG. 'A' ONLY NEWPORT BEACH CA 92660 *****x**iEiElli(iEiFiE#lE1LiEiEi( IEIliE******** (-lEiEah3keFlEBf#N**** ****#Xlfiix***lEitlEihlE****iE******4(*#3C 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 lull force and effect. CITY LIC.: STATE LIC.: CLASS: SETBACKS Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that 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.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42606406 ZNE: REF NO: 0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: **********,************************************************************Jt******** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section needDateompleted if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issue* employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BYilliK DATE: _ Date: 3�Q�j Signature: NOTICE:II.after making this declaration,you should become subject to the Wor s'Compensation provisions of the Labor BUILDING APPROVED BY >- DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed.revoked. // , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION 155 U D B Y• �S �1� � DATE• which this permit is issued(Section 3097.Civ.C). *.***iE{(-{(.{E{EflfElFfEiE!!!E***Bk****** • ff*1F It ik. A. . IFR.—yr.** a"•te*****K.****$*Irx. cart** LENDER: *******141E#1E*!(lEiEl6***1F*3f*ifiPi ***1fltifif#1 ****-1E*.*,•.' IflE3(-****3E#*fE1E****jf**********lFilfEl ***K 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 p ERM I T 2 5 • 0 7• 0 D repair any structure.prior to its issuance.also requires the applicant tor such permit to fife 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 • 50 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, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or ollered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 32 , 50 20 , 00 0 , 00 52 .'50 52 , 50 . 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 awn employees.provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year al completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLY;ECTED• 52 . 50 OVER/SHORT• 00 forme 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 25. 00 27. 00 ; . 50 and Professions Code: The Contractors'State Lkense 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).I am aware *,*,***,***.**,**************OE***************************le**********-1f*iE****-********* that proof of their Worker's Compensation insurance should be provided to me. o I am exempt under Section: B.&P.C. INDIVIDUAL- F E E BREAKDOWN or this reason: ( TYPE QTY DESCRIPTION UNIT COST TOTAL COST r— Crate: .. `k.Ct T 3 Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 SEWER CAP / DEMOLITION EACH 7. 00 7 . 00 25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements tor a .END OF FEES permit far 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 above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize rep sentatives of this city to enter upon the above-mentioned •property for inspeciron purposes. . ' Date: 3-(R.-43 Signature: Driver's License or Social Security': _• ,. 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POO. 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 - 1 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 Cocduit-Undrgrnd. 8. Foundation 59. Gas Pipe, '-) Undrgrnd.,Test • 1 -a 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, Undrgrrtd 10. Structural Floor System i, 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 'W'3Cao 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 1 ~ 16. Rough Electric Wiring 67. Fencing & Access Approval ~- 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-I 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 22. Ducts, Ventilating 71. Product Piping '7 Gas G Oil 23. Gas Pipe-Rough& Test g 72. Underground Has': 24. Roof Framing 73. Undergmd.Star ase Tank i7 Gas 9 Oii i 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 r 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL I 1 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat t3. FINAL INSPECTION 32. Electrical Power Meter-Final ! 80. FOOD CERTIFICATE ISSUED - ' 33. Final Electric • , ", la � �l(pr'�j��ppt{ Notes: '� - 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test } H 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 ` 111 ~` 43. Backflow Irrigation J 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING G 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co •• � 51. CERTIFICATE OF OCCUPANCY No. Date > > a oS`Q `'Fs CITY OF COSTA MESA 04 LiarLI L CA` CALIFORNIA Q628 1200 CO.BOX 1200 O I, � t J0 DEVELOPMENT SERVICES DEPARTMENT . '^o.cno to` January 1, 1990 TO COMPANIES & CONTRACTORS WHO RENOVATE OR DEMOLISH BUILDINGS THAT MAY CONTAIN ASBESTOS Rule 1403- Asbestos Emissions from Demolition/Renovation Activities Recently the South Coast Air Quality Management District adopted Rule 1403 Asbestos Emissions from Demolition/Renovation Activities. It became effective January 1, 1990. This rule specifies work practice requirements for demolition and renovation activities and the associated disturbance of asbestos-containing waste material. Demolition or renovation operators must meet the following requirements: o notification O removal techniques for asbestos-containing material clean-up procedures, and �a waste storage and disposal requirement • Failure to comply with the provisions of this rule may result in e penally of up to $25,000 per day. Enclosed art copies of a fact sheet,which describes the major features of Rule 1403, the Notification form, and the Notification form instruction sheet Should you have any questions,please call AQMD staff at (818) 572-6283. I hereby acknowledge I - e read the above. 3-(S-93 moi, DATE Sr ATURE • i City of Costa Mesa Development Services Department r n ( Building Safety Division CERTIFICATE OF OCCUPANCY No. 002603 P.O.Box 1200 Costa Mesa,California The Building located at 169 23rd Street, .Unit B has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group R31IMl Occupancy. • Use of Building Single Family Residence •Legal Description 426-064-06 (See reverse side for Metes and Bounds) Building Permit No B 32433 Electrical Permit No. E 32877 Plumbing Permit No. P 32564 Mechanical Permit No. M 32880,, M 32855 Number of apartments - and/or guest rooms • ISSUED TO: Building Official William T. Howard Rant Maddy • 311 Coronado by J f r,... ( Balboa, CA 92621 Date August 2, 1988 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev.1/63 White-Owner;Ce Numerical File;Pink-Bldg.Permit File YI Pr, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY (tF COSTA MESA CO NSIJIUCTION•PERMIT PERMIT NO. T ACT NO. LOT NO. UNI NO. '1(0 `7 23 Sr _ 6 32A 33 fit,58 6245 3/07/8[7 469n52 Ti `'ro- •Address �^ / li �± ‘Applicant's Mailing Address 5'O 4 �-9/• /`t`/e'f. TYPE OF CONSTRUCTION NEW LJ ADD H ALTERATION U REPAI R p/tr 'lin-pay f _J 4© ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �F �S Owner's NameI f`� t t L Phone U �s�tr'T t%^ p A.P.# && Q 6/4/-040 Zone Rpt DESCRIPTION OF WORK/USE OF�LDG. W 2 rt- .n 1. S Main Building: Accessory Building: Add! 5s 'II 1 G 4''--�J+tlx?/i�' �3r'acrC,'r L�'/9-r..f " Fr • _ 7 PE OF E / Z Arch/Eng. //,,' /rt•f� .- c H License No. �I G /^7 TYPE OF PE RMI GR DINGI�❑ FOV NDATION ❑ STRUCTURAL 'T Front c20/ .. 0 Address �V `L' N'�u. IF'� 114 0-13`(70f ❑ TENANT' ❑ ELECTRICAL—LI PLUMBING CI MECHANICAL B Rear 8/•r'3N / N r Contractor's Nam Phpne�7S"4'Y4s ❑ OTHER !�i$F2 �1rt 1 c Right 5/ N \ ;_PROJECT DESCRIPTIO Y BaANCY G Address(mailing) �\1 ckeYan ' 0.Ats , A �A OK Left / CON ST RUCTION TYPE v VALUATION$ wS 5 R City License No. - ZONE GRADING CU.YDS. ACRE /1:t072? LICENSED CONTRAC OR. DE L RA s� M Ping. Ref.# (0a(R��-}�8 egS p lir rParking Req,/Provided r E I hereby affirm that I a d nde.- sions of Charter 9 (commencing '-Remarks: _ f'G O/9-�i �Cg'T 2St r10( lam\ ,Planning Notess1Ut.11 F K SPECIAL 1e11�•VIRLIVItisl IS M • with section 7000) of Division 3 f the Business and Professions-Code,and 1 0 !l/JJJ my license is in full force and effect. T - ,'L:Iv INA 10 IL4s 1 C•telAljtC A 30 u(kf($7 S License Class License No. "1 `T l L V Date Signature • PLUMBING FEES it in CQf 't/Octio/1 w,'fh ylt-ex (,tiro_}' YORKERS' COMPENSATION DECLARATION t Bar Sink Showers ' ELECTRICAL FEES hereby affirm that I have a certificate of consent to self-insure or a certificate ' of Workers' Compensation Insurance, or a certified copy thereof.(Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company ' ' Backflow Irrigation - Sewer Cap Construction Pole Sub. ❑ 50+KW ' ❑ Certified copy is hereby furnished. -. ❑ Certified copy is filed with the city Building Division. ( Bathtubs Sewer Connection Cooking Unit Meter Lula to 100 amps. Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION . Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or - less). -. Dishwasher Solar Piping Dryers DGas ❑Electric Sub Panel ' ,, I certify that in the performance of the work for which this permit is issued„1 .' shall not employ any per in any manner to bg6ome subject-to the f - Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8 Workers' / sation sof Californi (xl -” Date Signature J›.. OQ Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑0-15 HP ❑16-15+ NOTICE:Compensation makingrovisodeclaration,you become subject to ite • comply such rprovisions of the Labor Code, you et forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Watec Heater Outlets Range Lender's Name - _ Lender's'Address - - Kitchen Sink - Water Service Switches Sign OWNER BUILDER DECLARATION -' I hereby affirm that I-am exempt from the Contractor's License Law for the Lavatories '- Auto-Wash following reason (Section'7031.5 Business and Professional Code: Any city or - Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap ., - Laundry Trays Generator 00-5 KW 05-15 KW any structure, prior to its issuance, also requires the applicant for such permit _Trash Compactor . +f-' file a signed statement that he/she is licensed pursuant to the provisions of /• - . - .-e Contractor's License Law(Chapter 9(commencing with Section 7000)of flOOf Drains vision 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 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 Boiler Hood or T ❑ DEVELOPMENT SERVICES REQUIREMENTtki employees, provided that such improvements are not intended or offered forype Welt' sale. if, however,the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By `"' — Date ' �• 88 pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved By Date ISrove for the purpose of sale). r� I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ' Ds' Date—�-7� tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTUUMMARV OF FEES •-t OS' builds or improves thereon,and who contracts for such projects with a con- O / tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration • - BUILDING PERMIT SMIP $ proof of their Worker's Compensation insurance should be provided to me. $ �� PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers &[.PLAN CHECK PLUMBING $ • ISSUANCE $ Date -a —7 .„...---Fiwner Heating System&Ducting Registers • PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify-that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BTU GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $and state laws relating to buil g construction,and hereby authorize repre- • PLAN CHECK 50% $ MICROFILM $ sentatives of this city en er upon the above-mentioned property for �� inspection purposes. �� MECHANICAL $ Signature Date TOTAL FEE $ Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 / PLAN CHECK 25% $ CMF 0865-46,rev.10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor / - 'CONSTRUCTION AND PLANNING POOL &SPA •APPROVALS jPermit#r� Date Inspector APPROVALS Permit# ,Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ti .�i 2. Soil Pipe-Undrgrnd. t'S • • i 53. Steel Reinforcement �! 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • I 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding C / 5. Steel Reinforcement 1/"-, . 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grad(. .r- a.''/(O FF /1(.� 57. APPROVAL TO COVER-GUNITE / 7. Footings >1 5ii *L. ' 3 p�gat 4 58. Electrical Conduit-Uridrgrnd. 8. Foundation'-`u' J 59. Gas Pipe, 0 Undrgrnd;, Test • 9. Water PipeUndrgrnd. / 60: Backwash Lines, P-Trip, 0 Undrgrnd. ', 10. Structural �Floa;,System 3/r7('Y 9E 61. APPROVAL TO DECK 11. Property SeweiLLine & House Connection 62. Backwash & Receptor,Final 12. Sewer Cap 63. Heater & Vent-Final-: 13. Roof Drains 64. Plumbing System 'Final -c' ' 14. Rough Plumbing • 65. Electrical-Final l''1.' L+ .' 1 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 /If.:' 1. . 19. Rough Heating & Air Conditioning ' 7 r• 9 _ _ FIRE DEPT. REQUIREMENT:,"i 20. Rough Factory Fireplace APPROVALS Permit# 1 - 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 _ r• 24. Roof Framing 73. Undergrnd.Storage Tank CGas 0 Oil ; '• 25. Roof Sheathing /fI!n 74. Overhead Hydro ' ` ( •- 26. T-Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical _ ' 27. Frame and Flashing pel 76. Dry Standpipe y`-4! .J ---Y 28. Lathing & Siding 811-111" 77. FIXED SYSTEM FINAL' ' 29. Insulation Q�i/ 78. FIRE PREV. FINAL ti" t' 30. Drywall Nailing "fes 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 HOLD FOR SPECIAL REQUIREMENTS • is 35. Final Gas Pipe-Test 113: 31i�88 Jar- �`,90 09f- 36. Hood or Canopy ea OK qo c i tn-pw 7404 '37. Final Factory Fireplace Qy . ® -p-b- 38. Final Plumbing ?ill 7` Li, L_14-1 bt't 39. Water Service-Final • 40. Gas Service-Final • ' 41. Solar Domestic-Final 42. Backflow Preventer . • 43. Backflow Irrigation + •t. ` • 44. Landscape Irrigation System -- 45. Sound Attenuation 46. Handicap Regulations - i- 47. FINAL STRUCTURE & BUILDING b% • 48. Special Requirements Completed )/J7,/ . /4dA 49. Electric Release to Edison l V r,V' r' _ ,; .. 50. Gas Release to Southern California Gas Co 4 51. CERTIFICATE OF OCCUPANCY• _ . _ No. Y Date ." i r I d 1 taw mew 6243 3/07/88 1229P38 TL CITY OF COSTA MESA . PARK FEES Fee Payment Receipt 001119 G ' Project Address /Log CS aarer A.P. Number 4194 — &Si — 04' Building Permit Number /� ,,a J Owner's Name &&I2 f // Mailing Address 3' 11 toJ-cZatto ea.s& '& FEE: Single Family * Number of Units 2-Bedrooms or Less @ $ 861.76 = 3-Bedrooms @ 1,205.67 4-Bedrooms @ 1,545.62 = 5-Bedrooms+ @ 1,810.50 = Multiple Family ** •Bachelor or Studio @ 474.37 = 1-Bedroom @ 573.18 =- 2-Bedroom 2-Bedroom @ 881.51 = 3-Bedrooms+ / @ 1,229.38 = /aa9.38 t� Total Fee *** /aa91'6(3 Planning Department App •val Date - ' • 88. By 4! ' • — Applicant's Signature a 4- _ _Ab * City Ordinance 72-44 ** City Ordinance 72-45 *** City R. olutlon 78-116ryrII CMF 0174-30,rev.7/95 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant Wile lit rye C • • CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant : 14-04-1 / / A-''JP Address : J / I C 014,4 /41/..9 130L-&94 Telephone Number : 1975-- tP `fi--`75 Tract/Parcel and Lot Number(s) : 7/C #/l¢ 3 LD*7 5 il�Q� C zfr 6057 oFteeCr Location of Project : &I • Rel sr `�UsP7a /n \ C,0c,lE' Number of Square Feet of 00 Residential Space kg&O x $1 . 50 Total 2700 �(rl� Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total The provisions of Government Code Section 53080 are not This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . Checks are to be made payable to Newport-Mesa Unified School District , e.''anco,c /fi ,Q� zc�ct 1 Business Manager Newport-Mesa Unified School District The above representation as to square footage is true . Developer/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 , Date : a / 7 Ag Developer/Applicant I l • t X150' 11'41"W hFD NAIL $ TIN NFD. NAIL 1 TIN I 23 RD STREE4{F . L. TA& .5. 2312, TD N CONC. FOOTING, 1J0 REF. , N50°U'41'W G0.51SE 'LY. '0.04' 1! SW'LY o.04-: • SURVEY OF WW'LY. GG5I' �, �n OF LOT 58 , TRACT NO. II4, ch N c N � 4 M. M. I I/14. Cli d n (PORCH) vi CITY OF COSTA MESA, z lil J m rroRCN) m COUNTY OF ORANGE,CA o �t z ICn9 L 0Y..--7, n_ ��, I_ STORY //�� '-' O FRAME DOUGLAS (0. FOSTE , L.5.4599 o o CERTIFICATE EXPIRES: 9/90/87 -,, HOUSE i DATE OF SURVEY : 5/2/87 m J J a7 31 - i$,aS �1 °e _ e G O.51' `'o. ,. r-- r -. COIIr3LA3 p 3 FOGTE.R r o K W LI * 5'i rt � , � ��, N0. 469 ��r • .00 • GARAGE d- of c n��F 2 z AFD. 3/4" 1. P "L.S. 2312 om IN CONC. FOOTING, UO RF,, ', 5E 'LY. 0.07' 1 5W'LY. 0.03' e N5o°1142" W 60.51' —' _ Fa 2" I. P "L. S. 4749" ' .j k', j ;'' C5 I PER TR. II'168,M.M.505/4- 5. r:% ,t • /r tip �_Q..2.G� ikt pT r City of Costa Mesa INSULATION CERTIFICATION . Building Safety Division l(ock c QC \-\ � AwCunis Number and Street City County Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material Brand Name Thickness (inches) Thermal Resistance (R Value) EXTERIOR WALL 1p � C^t kr-Lt �V l\6 Material }v`�Ec=�1.asS Brand Name ` Thickness (inches) y 'N Thermal Resistance.(R Value) // CEI LING Batt or Blanket Type //0.-0; sL Brand Name �A•si..) 6 Thickness (inches) r `"' Thermal Resistance (R Value) _ iS Loose Fill Type Brand Name Minimum Thickness (inches) Number of bags Weight per bag lb. Area Covered (ft2) Thermal Resistance (R Value) FLOOR, ELEVATED Material Brand Name . Thickness (inches Thermal Resistance (R Value) FLOOR,SLAB 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 regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Administrative Code). V-c.�* 07% Geral Contractor(Builder) License Number Signature and Title Date Sub Contractor(Insulation Applicator) License Number Signature and Title Oath CMF 1106-46 1 • k,_,-cam-L G\�La��,� - -A lDek _isk-A i - -- • _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ' Com/OF COSTA MESA CONSTRUCTION PERMIT pMJ=f�p. _ , I' TRACT NO. LOT NO. UNIT NO. Project Address 1� 1..? Fo • 'S'T- ' �!/`J•-✓C L!� - � App!¢ant's Mailing Address 91 h 1:C'\:'Tr. N N + C ,M • TYPE OF CONSTRUCTION yi NEW U ADD U ALTERATION U REPAIR ❑ CONVERSION ❑ DEMdLISH ❑ OTHER •1 A a1 o-, _Phone 4•. /- ''� ' A.P.# - --•. Zone Owner's Name _ �(Q P)'1- P u' { - - - - r ♦ _ ( DESCRIPTION OF WORK/USE OF BLDG. Address 311 costs. uPASO -•r" l-% ` Il I Y,2��i S Main Building: u (s r� (�A(ccespsory Building: Z Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL E Front VJ7� `1J�J x7 "��`f Address / / ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear '-•�� N Contractor's Name / et ` Pho e/_Ci/1�'•F{x! it OTHER A 1 "� 5 It 7 C Right p861 ST T adVd N 1� PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) �• ([{/d,/`[, ��k���T\97f•/V • �.. I CON ST RUCTION TYPE VALUATION$ $ Left City License No. �� _I ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DEC ARATION Ping. Ref.# v _ Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:t.r 4 '' S�0133 Planning Notes: "'-i'\ - ay' 0 with section 7000) of Division 3 of the Business and Professions Code,and ss• 1 my license is in full force and effect. i T License Class -3fa j',w LIen a N�. 2'Z-/i 01k S, Date { rat Signature JPLUMBING FEES • WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I nave a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section — Backflow Preventer Service Sink 3800, Lab. C.) / Automatic Washer Transformer 0 15-50 KW Policy i>. Company Backflow Irrigation Sewer Cap ❑ 50+ KW Construction Pole Sub. 8 Certified copy Is hereby furnished. - Certified copy Is Med with the city Building Division. 2. Bathtubs t Sewer Connection I I d0 Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This'ection need not be completed If the permit is for one hundred ($100)or Dishwasher less). ./ I. Solar Piping 2,_0-0Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is Issued, I p shall not employ any person in any manner so as to become subject to the ' Drinking Fountains Solar Tank Fan / \ Worker cempepAsioPy Laws of California./ � s - Motors 00-1 HP 01%-B Date ,�r i t /(3'{�, Signature ' �� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE: If,afterina ung this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service g Outlets U Water Closet ID fit. Device Boxes Pole li hl I hereby affirm that there is a construction lending agency for the performance , / g - of the work for wnich this permit is issued (Section 3097 Civ. C.) , Lender's Name a Interceptors { Water Heater Z'0 Outlets Range Lender's Address • a ( Kitchen Sink / Water Service 4 JJ Switches Si OWNER BUILDER DECLARATION I hereby'affirm that I am exempt from the Contractor's Llcense.Law for the 4 Lavatories ' following reason (Section 7031,5 Business and Professional CodeyAny city or Auto-Wash I,� 0 , Garbage Disposal Stand in ctitns county which requires a permit to construct,alter,improve,demolish or repair P—Trap structure, prior to Its issuance, also requires the applicant for such permit p Laundry Trays Generator 00.5 KW 05-15 KWTrash Compactor r to file a signed statement that he/she is licensed pursuant to the provisions of ^ the Contractor's License Law (Chapter 9(commencing with Section 7000)of Roof Drains . Division 3 of the Business and Professions Code) or that he/she is exempt herefrom 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 ,_ • enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL .FEES 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood Or Type I 0 sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct:Structuraln,,'' . - Refrigeration System Application Issued By G�--��'r�d���.��. Dated-"'I/%84 K hetors construct the project (Section 7044,Business and Professionsfproperty Code: - •�� The s Contractor'smproLicense Law doeswnottraapply to ans owner hia who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU builds or improves thereon,and who contracts for such projects with a con- SUMMARY O' FEE. tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration - BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. 0 I am exempt under section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers I PLAN CHECK $ PERMIT PLUMBING $ y2.00 ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ t.7-5— ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL--" GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ . and state laws relating to•building construction, and hereby authorize.repre- -PLAN CHECK 50% $ MICROFILM $ sentalives of this City o enter,{]� upon the above-mentioned propert for _ inspection Purposes 't^• //__j r2 - MECHANICAL $ TOTAL FEE $ ✓! •7`S Signature LgJbt^ Dale{.�Ly_�xa Drivers' License or SS 9f Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor —.----- - -f— '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. ' 3// 'a7" 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 _ i 7. Footings;; / ` 58. Electrical Conduit-Undrgrnd. _• 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test - _ 9. Water Pipe Undrgrridl /�9 ...aa 60. Backwash Lines, P-Trap, 0 Undrgrnd:_: ^= 10. Structural Floor System 61. APPROVAL TO DECK •- ' 11. Property Sewer Line.& I-louse Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing t//�/p9 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 `.1/ - - -•,-, 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL •* 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT "-T" 31. Plaster Brown Coat trri 79. FINAL INSPECTION : - - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED s . 33. Final Electric Notes:INity d --'v f 34. Final Heating & Air Conditioning /`/ G en r/ _el-// 35. Final Gas Pipe-Test t' 36. Hood or Canopy - L, ' V. Final Factory Fireplace - .. r 4 38. Final Plumbing 2/qq���/'/�, 'le/ - j- 39. Water Service-Final ^7 7i�s� • f, '" 40. Gas Service-Final ' 41. Solar Domestic-Final • •r 42. Backflow Preventer ,.' - • - . 43. Backflow Irrigation .,a - '1) ' t 44. Landscape Irrigation System . 45. Sound Attenuation • • r- 46. Handicap Regulations TJ , 47. FINAL STRUCTURE & BUILDING it - L ? A - 48. Special Requirements Completed ...... . a• - 49. Electric Release to Edison -- •• r 50. Gas Release to Southern California Gas Co Ii; t' "• 51. CERTIFICATE OF OCCUPANCY ,k No. Date i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA C N`e��T—RUCTTION PERMIT t PERMIT NO. OO O TRACT NO. LOT NO. UNIT NO. • Project Addrese 169 `'s-.r, M 1J L IIXX''�� I'>at Ba 1,cA 1539 D'hsaria #6 TYPE OF CONSTRUCTION E1 NEW ❑ ADD LJ ALTERATION L REPAIR , 0099 4/04/811 g I TL Kent Applicant's Mailing Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name 23rd Phone 675-6495 DESCRIPTION OF WORK/USE OF BLDG. A.P.# I Zone I Address 169 23Ld Qbla 1 , S Main Building: • i Accessory Building: E Z Arch/Eng. License.No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATIONIIyy�� ❑ STRUCTURAL T Front o Address �1�'�.�.} • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING L'J MECHANICAL B Rear N ......1+,a... Aare . j3[6Phone642 575 ❑ OTHER A I Contractor's Nam¢1539 t'mecca Ace. #6 I .pmt 13 1,CA 92663 C Right - N PROJECT DESCRIPTION 50. FT. OCC UPANCV Address(mailing) 029041 • CONSTRUCTION TYPE VALUATION $ S Left R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. Parking Req./Provided E ' I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: R 3 '7 1/3 3 _ Planning Notes: • 0 with section 7000) of Division 3 of the Business and Professions Code, and cs O'l, my license is in fuRrce and effect. 4,27 27T License Cla s CLU S ' Date -� Signature PLUMBING I FEES WORKERS'COMPENSATION DECLARATION , Bar Sink Showers ELECTRICAL ! i I hereby affirm that I have a certificate of consent to self-insure or a certificate FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Service Sink - 3800, Lab. C. T� �4 • Automatic Washer Transformer 0 15-50 KW Polic No. M-87 444802--01 company ' r'u-+It UI Backflow Irrigation ' Pone), P g Sewer Ca 0 50+KW P , Construction Pole Sub. ❑ Certified copy is hereby furnished.city ( '• - - Da Cer[ifie < p ,s filed with the city Building Bathtubs Sewer Connection 'M Cooking Unit Meter pup to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATCLARDE ATION Clarifiers Solar Collectors Dishwasher _ Meter Clover 100.amps (This section need not be completed if the permit is for one hundred($100) or - - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Drinking Fountains,' Solar Tank - • Fan Motors❑0-1 HP 01%-8 Workers' tion ws of California. . Date Signature Floor Drains- Swimming Pool w/Spa F.A.U. NOTICE: If,after making this declaration,you should become subject to the - Inc:Solar ❑9-15 HP 016-15+ 0.3 Workers' Compensation provisions of the Labor Code, you must forthwith i Floor Sinks - Urinal ' co comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light I of the work for which this permit is issued (Section 3097 Civ. C.) - Interceptors Water Heater Outlets Ran ¢ Lender's Name 9 �' Lender's Address •' , Kitchen Sink • Water Service - i - Switches Sign OWNER BUILDER DECLARATION • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code:Any city or Ili county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays - any structure, prior to its issuance, also requires the applicant for such permit Y Generator 00-5 KW 05.15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provislons,of ROOF Drains . . the Contractor's License Law(Chapter 9,(commencing'with Section 7000) of , Division 3 of the Business and Professions Code) or that 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 malty of not more than five hundred dollars ($500). t . - `. LJ I, as owner of the property or my employees with'wages as their sole Reinspection'Fee ' $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business-and Professional Code: The Contractor's . ' . MECHANICAL Reinspection Fee . IIssueFee $ 3 License Law does not apply to an owner of a property who builds or improves FEES $15 thereon, and who does such work-himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: I employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I ❑' 't • sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II ❑ ,,, Zoning;Approved By Date pletion, the owner will have the'burden of proving he/she did not build or im- Duct-Under Ground' Building Approved By' Date prove for the purpose of sale). - - 88 ❑ I, as owner of the property, am exclusively contracting with C con- Duct-Structural Refrigeration System Application Issued By Date_4"' '" tractors to construct the project (Section 7044,Business and Professions Code: / The Contractor's License Law does not apply to an owner of property who 'S Duct-'Ventilating a /•K17 ❑4-100,000 BTU ❑100,000 BTU [ 3 2 builds or improves thereon, and who contracts for such projects with a con- s ' SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ _ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0-1 am exempt under-Section B.& P.C.for this reason / Firep 1/Fact.Bit. ICBO p Fire Dampers • 6z, . PLUMBING $ ISSUANCE $ Date Owner He ing System& Ducting rs • ENERGY P.C. $ . I hereby •certify that I have read this application and state that the above / 0100,000 BTU ❑100,00057 - PLAN CHECK 25% $ • information is correct. I agree o • ply with a . .nd county ordinances Din ELECTRICAL $ GRADING $ and state laws relating to •� o.•z. •n ntl hereby authorize repre- sentatives of this city t. {7� � /ove-mentioned property for '. PLAN CHECK 50% $ ' 1(�%r inspection purposes. •% /�.1 / L. MECHANICAL! $ `f 1cl •• Signature / . +. Date I� •TOTAL FEE f $ ' �✓ Drivers' License or SS# — - • • � Reinspection Fee I $15 Issue Fee -4--3- PLAN •CHECK ' 25% $ '7 CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor I-l fr CONSTRUCTION AND PLANNING PG .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 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 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 '///1 { ' FIRE DEPT. REQUIREMENT �/tel 20. Rough Factory Fireplace 94 �/M`L '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 Framingx 73. Undergrnd.Storage Tank 0Gas CI 11 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///tom ,72J-771:7# D ! 1'OISSUED 33. Final Electric Notes: _4 • 34. Final Heating & Air Conditioning Oei it 35. Final Gas Pipe-Test VV'"'', /��L • 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. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OFOCCUPANCY No. Date -4 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. , CITY OF COSTA MESApCONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address I (.01 E /�-3¢o 5-1' (� ((\ M 3 2 S'5 3 8002 4/01 /OU 2;^lo 13 -I'I- Applicant's Mailin ddress alk QOQeuriat0 54— Y.)fi\syyA TYPE OF CONSTRUCTION LI NEW H ADD H ALTERATION ❑ REPAIR ' kQ•i.ADOJ Phone (OS--( 9S ❑ CONVERSION ❑ DEMOLISH El OTHER A.P.# I Zone Owner's Name DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING H FOUNDATION YJ STRUCTURAL T Front 0 Address ❑ TENANT 111ELECTRICAL ❑ PLUMBING ®/MECHANICAL A Rear — N Contractor's Name 0/4/3 Phone ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY 3 C Right N Address(mailing) K Left G CONSTRUCTION TYPE VALUATION$ $ City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 0 with section 7000) of Division 3 of the Business and Professions Code,and M my license is in full force and effect. f3 3 Z O .2 ". T T License Class License No. T 7 Date Signature PLUMBING I FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers '.1 hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES i. ,lot Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dap to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collec •f5 Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or less). Dishwasher Solar Pip' g Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for wh ch t•,,,IIILLL Permit is issued, I .' shall not mploy any person In any anner s• - /•• b: •me s biect to the Drinking Fountains Solar ank Fan Workery}po p Ion Laws of Calil.rm�]n ia. Motors 20.1 HP ❑1%-8 Date/ „—T— \7 Signatursl -- 4 Floor Drains S ' ming Pool w/Spa F.A.U. Inc. olar ❑9-15 HP ❑16-15+ NOTICE: If,after making this declaration, you should bacon Sr bject to the —� Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks rinal Fixtures icrowav2 comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ely; Gas Service Outlets Water Closet Device Boxes I hereby affirm that there Is a construction lending agency for the performance Pole Light of the work for which this permit is Issued (Section 3097 CIv: C.) Interceptors Water Heater Outlets Range Lender's Name "� g Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law'for the Lavatories Auto-Wash Garbage Dispo following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry y Tra s Generator ■05 KW❑515 KW any structure, prior to its Issuance, also requires the applicant for such permit eneraor - - Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9(commencing with Section 7000) of `Ivision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section .031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not Intended or offered _ - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or improves L thereon, and who does such work himself/herself or through his or her own • DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ sale. If, however,the building or Improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground _ Building Approved By ���sst•••��� / Date rprov, for the purpose of sale). y L /sem I—br I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By h'�=�Date T O tractors to construct the project (Section oe 7044,Business and Professions Code: - - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that —Exhaust System 0 Multiple El System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. �f PLAN CHECK $ PERMIT 0 1 am a ^Y_pt under Section .& P.C.for this reason J Firepl/Fact.Blt. ICBG#'�'S Fire Dampers —{ & PLUMBING $ ISSUANCE $ Date y^/ Owner Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this applicatio state that the above 00-100,000 BTU 0100,000 BTI. ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relatin• to bui ng construction, and hereby authorize repro- MICROFILM $ sentatives of this ' y .o ypon the above-mentioned property for PLAN CHECK 50% $ inspection purposes_` C1 y_/_CCP rs 0 J MECHANICAL $ a l. 5� TOTAL FEE $ V Signature — CJS Reinspection Fee $15 Issue Fee $ PLAN CHECK 25% $ - 6'3 a3 , 13 CMF 0865-46,rev.10/84 White - Building: Canary -Applicant; Pink -Accounting; 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 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, O 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 /jet/ ..et APPROVALS Permit# 21. Ducts, in Structure ',j/ iYl� 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 ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe $ . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE 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 7/o /j f 32 ' 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. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co r7 51. CERTIFICATE OF OCCUPANCY No. Date J OWNER WORLEY, JACK DATE 2-14-62 JOB ADDRESS 16rEll 23rd Street BUILDING PERMIT NO. 16283 GENERAL CONTRA OR ' Jack Cornair VALUE $ 20,651.00 AP No.118-084-12 LOT TRACT . FIRE ZONE DESCRIPTION OF WORK dupl Watt ga INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R2 :CC s --2-1 L� PER ?SITS ISSUED G... _4y SUBCONTRACTOR DATE NUMBER Water di* f � L Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating L �>✓��‘1311/[1.14244t 9i ,„Rough Plumbing fi/-4 ------40,6. /q�y _fl7 9F6 ) Miscellaneous Prop.Swr.Line ❑3douse Con. l]••8t'Swr. ❑ /c �� ,' L// .�u�A \ I ` Sprinkling System �/ G / / / � / T VI Construction Pole n Underground 0 Power 0 Rough Wiring L2 j-c2.`_eS , '�-/�- (2, ](7 �.�?bt_i.� Trenches 0 Forms ❑ Steel Reinf. 0 n__-3- - (j �.- Floor System ; y Bond Beam 0 Steel Reinfor e 0 q �, Sheathing /14 r j — [ --� M----- Frame - qq Frame and Flashing _��� /7"SSR •,"J / . Lathing — In 0 Out ❑ S &° C` . S- 44 -6,. 7� ,Ati .,/ Plaster, brown coat /'m Si- �-. 6-a/ ,\` V R-` g. ❑ Air Cond. 0 Final , � l , 1 i� I ng, Final J 7-24i c• Plumbing Fixtures, Final oP a2 Final Gas Test ��G�?� o� g „iii, Electric Fixtures, Final 7f /('(n G Building, Finalt a a 9 6 P 6 N , OCCUPANCY i• r.,-, ° �- ��•`� FORM 8U4.5M - 7.t11ULU FOR SPECIAL REQ _ 16z83 Jar 16283 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN DEPT P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.. CLQ CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING '//j ( •t 4J BUILDING ADDRESS /6 4—% a{7 er. Cnn-TA•IHe--4 1 COSTA MESA. CAUFORNIAG` For Office Use Only OWNER JAL._*c V40IEL.[t/l I RECEIPT NO. GIF NQy� MAIL RETv�YH? BY DATE RECEIVED - TE ISIS(/EED ADDRESS 153 • f.) LU PO b fin../. /-30-62, I - - CITY CO 46-14. IUIrc4A TNEkm16-Cog BUILDI 8 ARCHITECT TEL COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE J ADDRESS ZONE TYPE J(� GROUP I CONTRACTOR •tAC� (can)A,I P. APPROVED / /l (d_V(/'_DATE /��/ ADDRESS 53 . N(clJP�o t Y LAID. ! /�-ZONING rn^ /� ZONE(J �JNO.OF /� USEOFNEL•ITY (a% /� I I %� ��IPLANB /-IBUILDING /!/ nTATEyy¢� //�IIN�Zy�id/ �� ii LIG..NO. 3 -IJP % NO.A1a (t-So tO LEGAL r1� ' /� DESCRIPTION /K` OP LOT (oO )C. 1 s5 SIZE (NO. OP BLOT v NOW ON LOT O A.P.NO. /I 3 � O l7 4--t USE OF YARDS EVES EXISTING BLD APPROVED ALLOWED SETBACK LINE PROM 1 11 1 DI( (CENTER LINE ST.) �^ CBNTER OP STREET 5O - G REAR YARD SLS FRONT J L) FT. IN. SIDE YARD I LEFT S I-O II I RIGHT 2.0 I_U II R.SIDE ,.9.. Q FT. IN. DESCRIPTION OF WORK r II Ip' L.SIDE �J FT. IN. NEW I ✓I ALTERATION I VI ADDITION I REAR ,SFT. IN. II MOVING I DEMOLISH I BYPROVED%,.��`R� DATE Z/G/ai•Z REPAIRI N BUILDING (� NO. OF I - SIZE 2- $S ROOMS ~I STORIES 4{ EXTERIOR WALL ROOF COVERING 'STUCCO I COVERING CCM PO• HOLD FQR SPE IAL REQUIREMci.1 J N. USE OF BUILDING AND WORK TO BE PERFORMEDc�. gaxe CluPLEx Dto tin16 LAI/Arra-cl o �s0"J /�.v�'wd� N° �'"`� GA! . 7 C 4.51.1r .5 c�ewt,&• .,Y/rc .. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH AU. CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION °.e /• V SIGNATURE OF f Jl�• ' an.f ��I PERMIT FEE $ �0 n PERMITTED '-v/e H $ VI) PLAN CHECK $ o24 I AUTHORIZED-AGENTa+ E TOTAL FEE - - 0