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HomeMy WebLinkAbout251 23RD ST - Building Permits 6n CITY OF COSTA MESA 4 ' BUILDING DIVISION f Y•fS.A. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t 171 PERMIT waw B02-01553 (714)754-5273 • Fax(714)754-4856 • www.cicosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 251 23RD ST Status: ISSUED Suite: Applied: 09/25/2002 Vicinity: REAR OF PROPERTY Issued: 09/25/2002 Parcel Number: 42608402 Zoning: Applicant: REITANO, NORA ISSUED BY: Address: 251 E 23RD ST Phone: 949-650-0380 COSTA MESA,CA Zip: 92627 Owner: REITANO, HORACIO 0 Address 251 23RD ST Phone: COSTA MESA,CA • Zip: 92627-1809 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT IN-GROUND,460 S.F.,GUNITE POOL AND SPA IN REAR YARD. FEE SUMMARY Plan Check: $208.81 Calc Valuation: $20,000.00 Permit: $321.25 Claim Valuation: $20,000.00 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $532.06 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 8-0 Left 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: # I hereby arirnt under penalty of perjury one of the following declarations: fli ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: �(Th's section need not be completed if the permit is valued at one hundred dollars($100)or less.) Dq_I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws alifomia,and agree that If I should become subject to the workers'compensation provisions of Sellen 3 00 of the Labor Code,I shall forthwith comply with these p visions. .--.)„, B ^ 0 Applioant.Signamre:—. _ } ,, I , c,/ _ Dater, £S WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam:, ender sec. Business and Professions Code for this reason: Signature;,-• los :a a• � � Expires.-01 -.2£-0‘' Verification of Ownership by(type of doc A:nt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY -ERMIT CERTIFICATION: O I hereby certify that no excavati•n five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building stricture,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this appplication aapermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? (J Yes tJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection urposes.I agr of to occupy or allow occupancy of any building authorized by this permit until inal insction. �._ eeg. . _ we er 9 -2C ro 2., Signature begetOwner(s)-- And/Or Authorized Applicant Date CODE N INSPECTION TYPE PAIS )NTmALS GOOF ft INSPECTIONTYPE PATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy attributes : Costa Mesa Parcels Page 1 of 2 Map Lay. Attributes for Parcels Property Address Address 1 251 E 23RD ST Address 2 COSTA MESA CA 92627 Parcel Information Assessor Parcel Number 42608402 Legal NEWPORT HEIGHTS LOT 324 P OR OF LOT Range Township Section Quarter Section Area 12174.97351 Acres 0.28000000000000003 Owner Information Owner REITANO HORACIO 0 Owner Address 1 251 23RD ST Owner Address 2 COSTA MESA CA 92627 Property Specs Year Built 1986 Building Square Feet 1123 Building Count 1 Stories Number 2 Parking Spaces 1 Number of Units 0 garage Square Feet 0 Front Footage 90 Depth Footgae 137 Bedrooms 3 Map Layer Attributes For Address Points Address 251 23RD ST Apt/Suite City State Zip Building ID APT/Space Phoen SIC Code 0 Data Siurce parcels Plan Type Address 251 23RD ST Apt/Suite City Costa Mesa State CA Zip 92627-1809 Building ID APT/Space Phoen 949-645-4629 http://mesagis2x/website/costamesa/parceUdefault.asp?opt=attributes&sessid={50924820-52CC-427C-9... 02/27/2004 ttributes : Costa Mesa Parcels SIC Code 0 Data Siurce S.phone Plan Type Address 251 23RD ST Apt/Suite City Costa Mesa State CA Zip 92627-1809 Building ID APT/Space Phoen 949-645-6136 SIC Code 0 Data Siurce S.phone Plan Type Address 251 23RD ST Apt/Suite City Costa Mesa State CA Zip 92627-1809 Building ID APT/Space Phoen 949-650-0380 SIC Code 0 Data Siurce S.phone Plan Type Address 251 23RD ST Apt/Suite City Costa Mesa State CA Zip 92627-1809 Building ID APT/Space Phoen 949-650-1409 SIC Code 0 Data Siurce S.phone Plan Type http:Nmesagi s2x/website/costamesalparcelldefault.asp?opt=attributes&sessid={50924820-52CC-427C-9... 0E27/200' Property Profile Page 1 of 2 DataQue land and property data you can build on- Property Profile Primary Owner: REITANO,HORACIO 0 TR Secondary Owner: Mail Address: 251 23RD ST COSTA MESA, CA 92627 Site Address: 251 23RD ST COSTA MESA, CA 92627 ;,,i -„ . Telephone Number: (949) 645-4629 a APN: 426-084-02 Reference APN: CA'FORtM ,, Census Tract: 632.012 Housing Tract Number: 516 Geo Level:0 Lot Number: 324 Page Grid Old: 31-E1 Page Grid New: 889-B2 Legal Description: NEWPORT HEIGHTS LOT 324 P OR OF LOT Subdivision: . Property Characteristics Bedrooms: 3 Year Built: 1986 Square Feet: 3,283 Bathrooms: 3.0 Garage: Lot Size: Total Rooms: 10 Fireplace: Number of Units: 1 Zoning: Pool/View: Use Code: Single Family Residence Heating/Cooling: Sale & Loan Information Transfer Date: 00-00-2002 Seller: Document: 0000697296 Transfer Value: Cost/Sq Feet: $0.00 Title Co.: First Loan Amt: Lender: Indymac Bank Fsb Last Trans W/OS: Loan Type: Interest Rate Type: Last Trans W/O$ Doc: Assessed& Tax Information Assessed Value: $687,182 Percent Improvement: 45.67 Homeowner Exemption: Land Value: $373,346 Tax Amount: $6,850 Tax Rate Area: 15044 Improvement Value: $313,836 Tax Status: current O 2004 DataQuick Information Systems.This information is compiled from public records and is not guaranteed. • http://www.gotitle.com/cgi-bin/profile.asp?rmt=TOPS&graphic=%2Faccounts%2FT073 78%2Fcompan... 02/27/2004 RICHARD-LUIZ 6071 Loyola'Avenue Westminster, CA 02683 Report of Special Inspection Project Name & Address REITANO - 1251 E. 23rd St. , Costa Mesa -7 ?crit Nunber B02-01553 Inspection Typc(s) Gunite Inspection Datc(s) 10/24/02 [ J periodic [xxxx J Continuous Describe Inspection Made, including Locations: Continuous gunite inspection of the swimming pool @ the above address on 10/24/02 Tests •MaCie: Cast• giin Ee cylinder report to follow. - • pial lnspcdtion Time Each.Day: . • • Date 10/24/0°. Hours 51 list Items Requiring Correction, include uncorrected items previously listed Comments: • To the best of my knowledge, the work inspected was in accordance with the Building Department approved design drawings„specifications and applicable workmanship provisions of the U.B.C. esccpt as noted ab•ie dsor - - 10/27/02 -. — Date-- B .0 . 4 nt Fu!I Name Richard T Luiz Registration No. 1075691-49 • FORM 51-0:.>0 22 www.twininglabs.com A,�Twining ,rr Laboratories TESTING • INSPECTION• ENGINEERING ASVAr ,'1 k ovSOUTHERN c*LrfoRla.,Inc. Services for Over 100 Years "One Test is Worth a Thousand Expert Opinions" - "Equal Opportunity Employer" • Compression Test on Gunite CUSTOMER: LUIZ RICHARD EXAM NO: 92-1-288030 5071 LOYOLA AVE DATE: 11/20/02 WESTMINSTER, CA 92683JOB NO: 91109001 PERMIT NO: JOB NAME: RICHARD LUIZ : VARIOUS SITES OSH PD: (SEE BELOW "SAMPLE FROM" OSA AP #: ADDRESS : FOR JOB NAME & ADDRESS) FILE #: PAGE #: 1 ARCHITECT: CONTRACTOR: OWNER BUILDER ENGINEER: SUBCONTRACTOR: B . C. ADAMS TRI FORCE GUNITE INC. SAMPLE FROM: REITAN0k251 E . 23RD ST. , COSTA MESA BOTTOM OF THE -SWIMMING POOL PERMIT #B02 -01553 - MIX: 4 1/2 TO 1 SPEC. STR. (PSI) : 2000 SLUMP: N/A, - CAST: 10/24/02 DATE TESTED 11/07/02 11/07/02 SPECIMEN NO . 1 2 AGE (DAYS) 14 14 TOTAL LOAD (LBS) 81540 86000 LBS PER SQ IN 2740 2880 SPECIMEN SIZE 6 . 160 6 . 170 12 . 390 12 . 370 AREA SQ IN 29 . 80 29 . 90 SPECIMEN SHAPE: Cylinder • INFORMATION FURNISHED BY CUSTOMER LAB #1101281/TEST METHOD ASTM C39 SPECIMENS BY: CARLOS DELIVERED .BY: R. LUIZ RECEIVED ON: 10/28/02 DISTRIBUTIONS: • LUIZ RICHARD, 1 • All reports remain the property of TWINING LABORATORIES of SOUTHERN CALIFORNIA, INC. Authorization for publication of our reports, conclusions, or extracts from or regarding them is reserved pending our written approval as a mutual protection to clients, the public and ourselves. Corporate Office: 3310 Airport Way, Long Beach,CA 90806 • Phone:(562)426-3355 • Fax:(562)426-6424 Orange County: 5942 Edinger Ave., Suite 113, P.M.B.313, Huntington Beach,CA 92649 • Phone:(714)986.0830 • Fax:(714)960-0860 F CITYOF COSTA MESA 4 BUILDING DIVISION >:� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT E02-00881 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 251 23RD ST Status: ISSUED Suite No Applied: 09/25/2002 Vicinity: REAR OF PROPERTY Issued: 09/25/2002 Parcel Nunmber: 42608402 i Applicant: REITANO, NORA ISSUED BY: Slat Address: 251 23RD ST Phone: 949-650-0380 COSTA MESA,CA Zip: 92627-1809 Owner: REITANO, HORACIO 0 Address 251 23RD ST Phone: COSTA MESA,CA Zip: 92627-1809 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: IN-GROUND,460 S.F.,GUNITE SWIMMING POOL AND SPA.REF.: 802-01553 • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and al/ required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit., FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier end policy number are: - Cartier: x Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) .V.--31 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,ar agree that if I should become subject to the workers'compensation provisions of Section 3 00 of the Labor Code,I shall forthwith comply with these pro cions. (] q APPlirant'SiOtiatui ha Data-��lI�-S o& r.^_. - WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO GRIM! PENAL AES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ,trA I as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt u�I•er sec. le - Business and Professions Code for this reason: / ' LSigna�.. _.1 ,as � v } , ..Lp Expires:-O I—X =01 Verification of Ownership by(type of doc.me ,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY -ERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'Yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state,laws and city •rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectio purposes.I ano to occupy or allow occupancy of any building authorized by this permit untilfinal ins action. 1_ 1 i 1)-14.,— d-S os- Signature Oftegal.Owner(s) `- Sig Of:Legal.Owner(s) at,....._e-� And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE LATE INTITIALS CODE II INSPECTION TYPE PAIS 1NTR14LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • O CITY OF COSTA MESA• BUILDING DIVISION -; , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER fIwwiier A. a . PERMIT M02-00426 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 251 23RD ST Status: ISSUED Suite No Applied: 09/25/2002 Issued: 09/25/2002 Vicinity: Parcel Number: 42608402 ISSUED BY: Applicant: REITANO, NORA Address: 251 23RD ST Phone: 949-650-0380 COSTA MESA,CA Zip: 92627-1809 Owner: REITANO, HORACIO 0 Address: 251 23RD ST Phone: COSTA MESA,CA Zip: 92627-1809 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 OMST FAU<100K BTU. IN-GROUND,460 S.F.,GUNITE SWIMMING POOL AND SPA. REF.:B02-01553 FEE SUMMARY • Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS c-•, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) .3_Icpenify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomi and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these �cas�toars. ?`.� o iO Q APP Oaut.Sigfieb116: OVA •Q.ISC� �_,... -I ".J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI P TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRICN TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work mself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions ‘---Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am e ,mpt und,. •c. Business and Professions Code for this reason: . .»�. $� F�piraz':D-L1 9_0Z S 6 Verification of Ownership by(type of doc.men i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomla Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a�ppplication agermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectiopurposes. glee not to occupy or allow occupancy of any building authorized by this permit until inspection. 9SignAtOf:LegaI-Owner(s) to-'^7 And/Or Authorized Applicant Date cogs I INSPECTION TYPE DATE =BA coop INSPECTION TYPE PAIS MINI 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • CITY OF COSTA MESA BUILDING DIVISION > i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT '• %nanm`94. P02-00605 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 251 23RD ST Status: ISSUED Suite No Applied: 09/25/2002 Issued: 09/25/2002 Vicinity: Parcel Nunmber: 42608402 ISSUED BY: Applicant: REITANO, NORA Address: 251 23RD ST Phone: 949-650-0380 COSTA MESA,CA Zip: 92627-1809 Owner: REITANO, HORACIO 0 Address 251 23RD ST Phone: COSTA MESA,CA Zip: 92627-1809 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT PLUMBING TO INCLUDE: IN-GROUND,460 S.F.,GUNITE SWIMMING POOL AND SPA.REF.: B02-01553 FEE SUMMARY • AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§'I, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, anctall required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this p FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: A(r?C(T,hr3 section need not be completed It the permit is valued at one hundred dollars(5100)or less.) L.I=Mortify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' \r i.ompensation laws of California,and a ee that If I should become subject to the workers'compensation provisions of Section 700 of the Labor Code,I shall forthwith complgwith these provisiffs. r ,,' Appli Signature: � U�4A. iret we Dae WAING:FARN ILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMI PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO..ARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.P Class k Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). L:J as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,BusinessandProfessions L-�Cotle:The contractors License Law does not apply to an owner of property who builtls or Improves thereon,end who contracts/or such project with a contrector(s) license pursuant to the Contractors License Laws.). ❑J.em.exe t under a Business and Professions Code for this reason: Signature: , S' I E }retro-i%rd—Ulo Verification of Ownership by(type of dot./W.''']",,�t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit.and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? jID Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspect) purposes. ree not to occupy or allow occupancy of any building authorized by this permit until ljaljection. 'Signature Of'Legal Owner(s)" j_ le And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE PAIS ISMAL& COPPE INSPECTION TYPE PATE IBTrUALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical r 1266 Pool Spa Final 208 Final Plumbing 5//4/o1P Onr 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,4W 9 CITY OF COSTA MESA pi 4 BUILDING DIVISION Fk DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 1 PERMIT 01-00626 .uw (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 251 22ND ST Status: ISSUED Suite: Applied: 05/04/2001 Vicinity: HOUSE&ATTACHED GARAGE Issued: 05/04/2001 Parcel Number: 42615302 Zoning: Applicant: BLANKS, JERRY ISSUED BY: .."*------- Address: /Address: 205 S BERKELEY CIR Phone: (714)738-5848 FULLERTON,CA Zip: 92831 Owner: HOLSTEIN, SALLY TR Address 251 22ND ST Phone: COSTA MESA,CA Zip: 92627 Contractor: GREAT WESTERN ROOFING Address: 205 S BERKELEY CIR Phone: (714)738-5848 FULLERTON,CA Zip: 92831 License: 361389 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: ' SCOPE OF PERMIT. REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(25 SQ).TEAR OFF EXISTING ROOFING, INSTALL 2 LAYERS OF 15#FELT UNDERLAYMENT,&REROOF WITH 30 YEAR GAF COMPOSITION SHINGLES. • FEE SUMMARY ' Plan Check: $0.00 •- - Calc Valuation: . $5,000.00 Permit: $111.25Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 • , Inspection: $0.00 Total: $111.75 ' .- - •" PLANNING &ZONING ' -_ SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 . Rear 0-0 Left • 0-0 Right " 0-0 PARKING Existing: 0 " . Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) a.. ♦ kip DECLARATIONS ;_) 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintainrworkers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. "My work recompensatio Insurance cards nd policy numbe�r fl �L., f a 5943 > ( "Cartier 7 Vel � ,2 '} V (�I�U�SL'/ � �olicy,Number�—�l C � -(This'section need not be completed ii the permit is valued at one hund d dollars($100)or less.) ❑ I certify that in the perfo mance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of•alifomia,and agree that If uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr.,inions ,4 /J (Applicant Signature: i ��//% die:_ -_" ✓-/ a/ -WARNING:FAILURE TO STAIR •RI ERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIEgAND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE f$1••;••),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR 0O0E,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that l.am licensed un (,previsions off Chcn7pter 9(commencing with Section 7000)of Division 3 of the.Business and Profes '•ns Code,and my license is in full force and effect.Lic.Y-,y I {p / 3 O / , (Class a-� C-- Contractor's Signature:- - L A CONSTRUCTION LENDINJAGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license, 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California AdminiStrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes Ll No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all Mate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si. '•1,40: •f L;:.I er(s �/7 oD�te �I� i And/Or A uthorized Applicant. /Date - - CODE Y •'- DEE INTITIAL$ COOF1 INSPECTIONTYPE PATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / C.- 208 Final Plumbing c 200 Final Re-Root ••f�/ 7�,`C( (YA"'a� 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - •,CITY OF COSTA MESA . PE IT NO�-7 / / TRACT NO. LOT NO. BLDG.NO. Ct$NSTRUCTION PERMIT _ / 3 DPW /�p�iJ, 7773���s'� y • 9786 `6/03(63 .• 1 TI. Applicant's MailingAddress '2 �� .r TYPE OF CONSTRUCTION Li NEW ADD PM ALTERATION U REPAIR - Project Address -` / '3 WV y ' ❑ CONVERSION ❑ DE •-`' ISH ❑ OTHER, 1 VA A! GU4OTT Ph• one •• 12gz. DES IPTION OF WORK c� 7 - % • . Owner i Nam ♦ - ZONING REGULATIONS- - �Am Ed 8 1ST U(,U� G ,4c kr T 'rt '' • II n�7 4) • Address - TYPE PERMIT 'L I GRADING LiFOUNDATION -� STRUCTURAL A.P.gWy{26 Ogg-�02'ZONE Arch/Eng. `' • License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL PLNG. REF.# BUILDING ' Address - crT Arx rn CT ❑ OTHER ' TO BUILDING t` /�/ // * PROPERTY LINE REAR YARD (TO P/L) (e+ Contractor's Nam {'F��C����Phor� S ' PROJECT DESCRIPTION SO, FT OCCUPANCY •�s CONST RIJ,�TION TYPE VALUATIONS C V r/O.-i LEFT SIDE YARD Lr e// RIGHT'SI DE YARD �j Address(mailin9)�12q �Dp�•�fi G' 16- �1 r _ "�j • �'. '` License No. __4L•i'JR ' ZONE - GRADING CU.YDS. ACRES .PKC.SPACE REO. yIy• : PROVIDED _ W LICENSED CONTRACTOR DECLARATION Remarks: .K� LLE , 2/ng . �Z n p STREET WIDTH �• AQ D` PARK FEE$ with sectionirm 7000)1 of am Division 3 of the Businessd under is an/dCharter 9 Professionso Code,and PD• s/2../�3 • # s 6 SPECIAL CONDITIONS; At my license is in full f nd effect. e� `� / _ fI License, lass License No-[-Z'35I 1 PLUMBING I Date`��4 Signature Bar Sink _ Sewer Cap •- ELECTRICAL • AL_. WORKERS'COMPENSATION DECLARATION' - - 'treby affirm that I have a certificate of consent to self-Insure or a certificate - - Automatic Washer - 'Meter Clover 100 amps Markers' Compensation Insurance,.or a certified copy thereof (Section Backflow Preventer Sewer.COnnectiOn ' JO, Lab. Cj) �j r p '• p ' Backflow Irrigation Solar.Collectors Construction Pole Sub Panel Policy No, y�S3,pJ�:.. Z Company -74 �v�� - ' - iii:cert led copy is hereby furnished. / KA _ Bathtubs Solar Piping Cooking Unit • Sub Pole Ce n p led with the city /ii a7cik W /7.C� • Dishwasher Motors 00-1 HP 01%411 DatAppliwr4f �` Clarifiers Solar Tank - _ _ _ • EXEMPT! N FROM WORKERS'CO PENSATION DECLARATION - Dryers ❑Gas ❑Electric • ,Inc.Solar 09-15 HP 016-15+ ' (This section need not be completed if the permit is for,one hundred ($100)or Dish Hasher Swimming PO01 w/Spa • llacerti/y that in the performance of the work for which this permit is Issued I Drinking Fountains Urinal s . Fan • Microwave shall not employ any person in any manner so as to become subject to the - F.A.U. - • Pole Light Workers' Compensation Laws of California.. • , Floor Drains. Water-Closet - Date Signature • ' - . Fixtures NOTICE:If,after making this declaration,you should become subject to-the - '- Floor Sinks ' - Water Heater - -- Range- , - - Workers' Compensation provisions of the Labor Code, you,must forthwith `. Device Boxes comply with' such .provisions or .this: permit shall be deemed revoked. . Gas Service ' Outlets Water Service Sign, CONSTRUCTION!LENDING AGENCY ' ' •- • - - - .; Outlets ' ;obi I hereby affirm that there Is a construction lending agency for the performance' • Interceptors. - t r } ... Standing Sections of the work for which this permit Is issued (Section 3097 Civ. C.). - "�'"L��� v '1. Swltets -- Lender's Name' - - - Kitchen Sink •I (., \'lied+ - ,p `� Trash Compactor Lender's Address - • Lavatories _ nX E / to 1. (SL-4 s - . Garbage Disposal • OWNERBUILDER DECLARATION • - - ' I hereby affirm that I am exempt from the Contractor's License Law for the p—Trap - - Generator 00-5 KW 05-15 KW following reason (Section 7031.5 Business and Professional Code: Any city or p - _ : county which requires a permit to construct,ater,Improve,demolish or repair - - - •- - Transformer-015-50 KW any structure, prior to Its issuance, also requires the applicant for such permit , Roof Drains - 'p - to file a signed statement that he/she is licensed pursuant to therovisions of , O515+`KW the Contractor's License Law(Chapter 9(commencing with Section 7000)of - - Reinspection Fee $15' cion 3 of the-Business and Professions Code) or that he/she is exempt Showers _ ' Reinspection Fee '$15 :afrom and the basis for the alleged exemption. Any violation'of Section _ - . Meter pup to 100 amps J Issue Fee I • -$ 3 5 by 'any applicant for a permit -subjects the applicant to a,civil .. $ 3 _� _ _ 64 / 'elty of not more than five hundred dollars($500). Service Sink: Issue Fee . Zoning Approved By Date LO / %/}J,.}fs I, as owner of the property or my employees with wages as their Sole - - MECHANICAL ` t I �1 /�'�� compensation' will do the work,and'the structure is not intended or offered _ - . ." Application Approved By' Date for sale (Section 7044; Business.and Professional Code: The:Contractor's r / D License Law does not apply to an owner of a property who builds or improves Boiler I Refrigeration System S Application Issued By ' Date 6 A3 t? ' thereon, and who does such'.work himself/herself or through his or her own PP employees, provided that such Improvements are not intended or offered for ' ❑0.100,000 BTU 0100,000 BTU - ' sale. If, however,the building or improvement is sold within one year of com- I Duct-Under Ground, s SUMMARY OF FEESi elation, the owner.will have the burden of proving he/she did not build or im- ' ' J- ' move for the purpose of,sale). 1 Duct-Structural System Repair/Alteration BUILDING PERMIT $ L f sb • SMIP : $ ' 0 `ro LJ i,as owner of the property,am exclusively contracting,wlth'lcensed con- • tractors to construct-the project (Section 7044,-Business and Professions Code:-..- - Duct-Ventilating - -. - -.- -. - - PLAN CHECK. $ PERMIT , The Contractor's License Law does not apply to an owner of property who , builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 , • i '. PLUMBING $ - ISSUANCE $ $ tractor(s) license pursuant to the Contractor's License Law): !!PLAN CHECK $ ` GRADING $ i O Lam exempt under Section - ' B.& P.C.for this reason Firepl/Fact.BIt. ICBO# i $ . • Date ' Owner' 1 HeatingSystem& Ducting ' - • ELECTRICAL- $, - • I hereby certify that I have-read this application and state that the above - • 00-100,000 BTU'0100,000 BTI, i - PLAN CHECK $ MICROFILM $ information Is correct. I agree to comply with all city and county ordinances - -- - ' TOTAL FEE $ ' • - ate laws relating but Ing construction,and hereby authorize repro- Hood or -MECHANICAL $ • ' sentatives of this cit r o the bva-mentioned Type I ❑ • Reirsspection Fee $15 l LESS , • inspection ourposes`�V -� r •��� Canopy: Type II 0 1 PLAN CHECK Sr$ I ADVANCED PC • $ ' Signature Date - • - z Drivers' License or SS $ Registers j Issue Fee I $ 3 • FINAL FEE• • $ L3,3 60 CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor • • aLtIC,ONSTRUCTIONAND'PLANNING - 'i - -_POOL 'A __ • _ - 4 Date Inspector - - , Date Inspector: .' PPROVALS „ Permit#' " _ - - APPROVALS •Permit# ' - I. Temporary Electrical Service or-Pole . _ -' :52.-Pool & Equipment Location J - 53.;Steel Reinforcement 2: Soil Pipe-Undrgrnd , , - _ - - 3? Electrical Conduit Utility-Undrgrnd: t. ; _ 54. Forms ' - -. " 4: Electrical Conduit-Undrgrnd'. - t. , - _ - 557 Electrical Bonding - - 5. Steel Reinforcement: _ 56. Rough Plumbing-& Pressure Test •• - - 6r Electrical UFER Grnd. ' s " - ' -i- 57.. APPROVAL TO COVER:GUNITE - 7. Footings an• f°7�2.('`3': ) - i �S : 64...-7_% •58. Electrical Conduit-Undrorod.• - 8. Foundation, _ _ 59. Gas Pipe,,0 Undrgrnd.,Test , ' •9. Water Pipe-Undrgrnd. - - -.60. Backwash,Lines,P-Trap, D Undrgrnd. - 10. Structural Floor System I _ . _ : _m 61. APPROVAL TO DECK . 11. Property-Sewer Line'& House Connection j , 62. Backwash & Receptor-Final .- , 12. Sewer Cap • p .• . . '63. Heater.& Vent-Final 13. Roof Drains ; a i ; 64. Plumbing System - Final' _ - , a 14. Rdugh Plumbing " - - -65. Electrical-Final - 315: •Rough Electrical-Conduit - t- ^ -+--r -- I - - -r-66. Solar System-Final . ' - _ " - : :16:')dough Electric Wiring, I • i -- '^-• • 67. Fencing & Atcess Approval - -_• - _. - . _ -'17. Rough-Wiring Sign i ; : i - r. 68..APPROVED,FOR PLASTERING • - X18. .Rough'Electrical;TBar';Ceiling, I - •- � i I 69.(POOL/SPA SYSTEMS FINAL •- ,; 19.•Rough-Heating,& Air Conditioning , . • - I FIRE DEPT. REQUIREMENT- . • � • 20. Rough Factory Fireplace I l -. i , , I APPROVALS ' Permit# ' . r21. Ducts,in'Structure;. 1 l j t i 70.'Underground Hydro _,:22: Ducts, Ventilating ''I', ^ I I , 71. Product Piping 0 Gas 0 Oil ;:23.'.Gas Pipe-Rough&Test ''i- • I I 72. Underground Flush • i�'24`Roof:Framing` ''• . . y • -4;,, I" ' _ : 73.•Undergrnd.Storage Tank 0 Gas .D Oil • 25: •Roof Sheathin - L_2743' 48 -74. Overhead Hydro 26. T-Bar Ceiling (Structural):&.Mbnocoat• i • - 75. Dry' .- 27-> Frame and Flashing I , I 76.;Dry Standpipe . . ' ' : 28"Lathing&Siding c • : ' � 4 77,1 FIXED SYSTEM FINAL ' Q29. Insulation ' c a l 4 j 1 ' � , I i 78.: FIRE PREV. FINAL • •4x30. Drywall Nailing , : Applicant to fill in allejp ces exec t hose within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT P ITN°. LL TRACT NO. SLOT NO.. 4 `UNIT NO. �+L 11P -r/1}Q -S 2,y6 � 7789 6/19%86 69.97 TL Pro)ect Addfbss �� 2-3,rEd JG �/'•• -_I-r• r ' i - - "• -- TYPE _Applicant's Mailing Address''11 ' /��� -Q rPe� ���G/�.✓s��� TYPE OF CONSTRUCTION IJ NEW ❑ ADD ALTERATION LJ REPAIR A Owner's NameGP _41,1���4/_r ram Phone.t.a.�feu ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# LJ�1 /� ,� /11�7a�o'l Zone I .s s3z a'+^4 �j DESCRIPTION OF WORK/USE OF BLDG. BI n[_IC.- watt 7 �C (JAS oL s Addres yn .S'T� .t-Rll • S Main Building: Accessory Building: . Arch/Eng. --, License No. -- TYPE OF PERMIT LI GRADING LI FOUNDATION LI STRUCTURAL T Front 307/}f42i- .,., 0 I Address - • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear 7 / .4.1124.\.j - N Contractor's Name wive-n/0oe. /ePhon ❑ BOTHER �Q' e. _ � ��L- C Right 02 'I N Address(mailing)_I.2g° C .4T�4A�el:414.�7 PROJECT DESCRIPTION SQ. FT. I din . rT . OCCUPTIONS N Y OO CONSTRUCTION TYPE VALUATION$ r (>CO ' S Left O ' r • R City License No. - ZONE GRADING CU.YDS. AC RES • LICENSED CONTRACTOR DECLARATION Ping. Ref.# 1 Parking Req./Provided E t hereby affirm that I am licensedion f under provisionsnCharter i9 ns Code,(commencing Remarks: Planning Notes: I L '` ��� '� �� �0/( M with section of Division 3 of the Business and Professions Code,and C'L/`/Gr'(•'- • T my license is in full force and effect. y-A...( . /- .�.. G!? vial, /LQ�l /- $ License Class _ License No. -- PLUMBING FEES 7 sem! 7 Date Signature WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate _ .f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink BOO, Lab. C.) - Automatic Washer Transformer 0 15-$0 KW Policy No. ' Company Backflow Irrigation Sewer Cap I 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 ❑up to 100 amps Date Applicant - ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher - Meter Dover 100 amp (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 ma❑ner so as to become sybject to the Drinking Fountains Solar Tan Fan Motors❑ P 01%-8 Workers' Compensall n Laws of Califorr.'.- - (/�JVfbt(-/ Date -70-&� Signature /s�(/ all Floor Drains • Swim ng Pool w/Spa �— F.A.U. 'NOTICE:If,after making this declaration, you should become su ey('to the - Inc. ar 09-15-HP ❑18-15+ Workers' Compensation provisions of the Labor Code, you mu t forthwith Floor Sinks mal Fixtures ' comply with such provisions or this permit shall be deemed revoked, lcrowave 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 9 of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name -----Th Interceptors Water Heater Outlets . • Range Lender's Address Kitchen Sink Water Service Switches. Sign OWNER BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P ;Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 5 KW ❑5-15 KW 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 Drai 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 ' {yterefrom and the basis for the alleged exemption. Any violation of Section 1331.5 by any applicant for a permit subjects the applicant to a civil T:��t��n}Icy of not more than five hundred dollars($500). 1jT'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 1 - ' - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL L 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 SERV! R e UIR El S _ IO`fFfj, employees, provided that such Improvements are not Intended or offered for - Boiler Hood or Type 1 ❑ / 4� ! X96 sale. If, however,the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By / i % Date Al / pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground f� - /4Kf prove for the purpose of sale). Building Approved By Date ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration em Application Issued By �I - Dat, /tel/1{, tractors to construct the project (Section 7044,Business and Professions Code: .t The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 100-1 , 00 BTU 0100,000 BTU SUMMARY OF FEES 7 0 builds or improves thereon,and who contracts for such projects with a con- r 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 ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ PERMIT ISSUANCE $ i Date ��S--DL owner ' -e /i- Heating System& D mg Registers ENERGY P.C. $ .�-o,rr PLAN CHECK 25% $ - - - 1 hereby certifysthat I haverread thismapplication all and state that di ancee 00-100,0006 100,000 BT ELECTRICAL $ GRADING $ _ information correct. I agree to comply with all city and county ordinances • IL and state laws relating to building construction, and hereby authorize repre- MICROFILM $ sentatives of this city to enter upon the above-mentioned property for PCA1N CHECK 50% $ inspection p [pp . MECHANICAL¢s / /�/�//. Date ��� $ TOTAL FEE $ Date Signature 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 'A 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 / 6 57" 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. �J ��" ��J- 57. APPROVAL TO COVER-GUNITE 7. Footings 4- -at, 61118-6 / a 58. Electrical Conduit-Undrgrnd. 8. Foundation W V"r" 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.fRough Electric Wiring67. Fencing & Access Approval r T/ � Ot 17:�Rough Wiring Sign 68. APPROVED FOR PLASTERING • 181, 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 fr22. 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 ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structiiral) &•Monocoat 75. Dry Chemical 27. Frame and Flashing. • 76. Dry Standpipe 26. Lathing Siding, 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL y30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 1. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43.•Backflow Irrigation 44'3 Landscape Irrigation System 45. Sound Attenuation 46-Handicap Regulations 4 47, FINAL STRUCTURE & BUILDING 1740 ��` ,J/tL/ f 48. Special Requirements Completed 49. Electric Release to Edison 50:Gas Release to Southern California Gas Co 51.. CERTIFICATE OF OCCUPANCY No.I.- , Date , • -t _A s ,,1 Lo .3 1 s _ - i 13301S • . 4 a a kL `1 M • ti 31"I A M -1 ret A r 1ant11 1111 13001011 ••' f713011111 4 P. 1 i V hPPROVED i. CO Mesa Building De t STRUCTURAL APPROVAL ONLY SEPARATE PERMITS ARE REQUIRED p„i io swumBTTHESE PLANS MUST BE ON JOB OA All TIMES FOR ELECTRICAL, PLUMBING, �YO V�jj� a!((�9I FXFXE NO. CHAti s WITHOUT PRIOR APPROrAC HEATING. VENTILATING AND �d OEGEfl REFRIGERATION WORK .�f•Ip0 •0019 Ol 1D3f9n`. '1J30 JNINN'd1d � PIE SSSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLA$S AND SPECIFICATIONS SHALL NOT BE CONSTRUED 07 d0 Air:. TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION Permit #13Q4-21 0/q % OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT.PRE. rf A O �Q{ SLIMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE THIS NUMBER MUST ACCOMPANY .711 PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN.SO ALL INSPECTION REQUESTS FAR AS THE WORK OR USE WHICH.IT AUTHORIZES IS LAW@IL. .;t THE ISSUANCE OF A PERMIT BASED UPON PIANS AND SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL: fOR BUIl01NGS WHERE PERSONS ARE TO BE FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS FOR BUIEG,WE SUGGEST THAT THE STATE Of IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING DIVISION OF INDUSTRIAL SAFETY BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHIN C E O CALIFORNIAR N S LIL I E D FOA T I ST I O F A Y IN VIOLATION OE THIS CODE OR OF ANY OTHER GROJHA E REQUIREMENTS. • Of IKE Girt. TYPICAL 6" CONCRETE BLOCK FENCE a • • . 1; • CementarBloCopck kWith Optional 19. 1 I 1 . I I GENERAL— NOTES ., Channel Block With One 3/8u� FeneesHorizontal Top of all • Ili r MORTAR: One Part Plastic Cement, and 5 ' I 1 Three Parts Sand For Fences 5'or Less Is GROUT: • One Part Cement Three and / r ; r t I f. I e One Half Ports Stand Vert.Bars 3/8'0 at 4' -0"O.C. .e ? Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . PERM( NO. TRACT NO. . LOT NO. UNIT NO. 1 1' L-St -rt -',.- - CITY OF COSTA MESA CONSTRUCTION PERMIT 4535 9297 7 ��yy//J 31.8 r� • Project Address 25/ e- 03.&o 57 4 - �'�:"s T.�' ��""1 Applicant's Mailing Address TYPE OF CONSTRUCTION fsu NEW L I ADD L I ALTERATION LJ REPAIR .'r'., Y �, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.V,6 Owner's Name �--/ 5, a'7 Z. T,41, Phone Chi j$A' DESCRIPTION OF WORK/USE OF BLDG. Zone Address -S Z �/U S, g� .�n/��Q SA S Main Building: Accessory Building: 's tif Arch/Eng. License No. TYPPEE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front Z • Address . ) 0 TENANT ❑�iELLEEC/T�R�AAL ❑ PLUMBING LI MECHANICAL .B Rear N Contractor's Name multi " .1alc,efl Phone 5—!16-3 F/ I M1-LD r C. Right N Address(mailing) 3•-90 S. STAt�DAAP . 5,4 PROJECT DESCRIPTION S1, FT- 54 � OCCUPANCY K G CON ST RUCTION TYPE VALUATION $r S Left City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION yy•ss / Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 3 242 `¢_ J Planning Notes: Q with section 7000) Of Division 3 of the Business and Professions Code, and CCl TTTT"'' a 7 M my license is in full force and effect. _ T License Class License No. S Date Signature PLUMBING I FEES • WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES `f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 800, Lab. C.) Automatic Washer • Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cap ❑ 50+KW 8 Certified copy is hereby furnished. Construction Pole Sub. 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 any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP 01`A-B Workers' Compensation Laws of California. - Date Signature Floor Drains Swimming Pool w/Spa - F.A.U. Inc-Solar 09-15 HP 016-15+ NOTICE:if,after making this declaration,you should become Subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions Or this permit Shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that ) 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 StaPding Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap LaundryTrays Y Generator (]0.5 KW ❑5-15 KW T arar sh any structure, prior m its nce, also requiresicesthe tcto applicant for srochvi perions f - Compactor to file a Signed statement that hp/she is licensed pursuant to the provisions 5 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 - vt,,g erefrrefrom 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 • fern.of not more than five hundred dollars($500). VS I, as owner of the propcirty Reinspection Fee I $15 Issue Fee $ 3 ' and the structure is not intended or offered -, for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee f $15 Issue Fee - $ 3 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 pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Srov)for the purpose of sale). Building Approved By 4a---...7...... Date LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By tractors to construct the project (Section 7044,Business and Professions Code: Date r-y The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU - SUM V OF FEES • builds or improves thereon, and who contracts for such projects with a con- J'^ tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ r (yam SMIP $ a EC of Exhaust System 0 Multiple 0 System Repair/Alteration DI proof their Worker's Compensation insurance should.& P.C.pfor dedthis to me. - PLAN CHECK $ / ; PERMIT r ❑ I am exempt under Section �'��B/A.f&re�. .for this reason Firepl/Fact.BIL (CBO# Fire Dampers PLUMBING $ ISSUANCE $ ✓D'ate __,/22_.-..._,&_. Owner ZlC�EiY�� / i Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ • I hereby certify that have read this application 6ntl statet at the above 00-100,000 BTU 0100,000 BTU 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- sentatives of this to e to o e ahoy--mentionedproperty for PLAN CHECK 50% Q/' inspection purpose ,(� MECHANICAL $ �� 07 �Slgnature i ' /] �c Al' Date �� �-� • TOTAL FEE $ .-76-rivers' 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 ;r ? 'CONSTRUCTION AND PLANNING POOL &SPA ?APPROVALS .'iPermit# 'Date Inspector •APPROVALS Permit# Date Irctor 1:-Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 'ft• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms _. 4. Electrical Conduit-Undrgrnd. AQ55. Electrical Bonding 5. Steel Reinforcement k. entail r- �D 56. Rough Plumbing & Pressure Test 4$� 6. Electrical UFER Grnd.? F� hIM/l ��t04 57. APPROVAL TO COVE R-GUNITE • .• 7. Footings 644. g.7. 1,4 qif/o 58. Electrical Conduit-Undrgrnd. 8. Foundation ,- .h 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd. �' - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor Systerri 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 �N9A/ 0 • � /1L/ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •„ .moi 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 O Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank U 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 ..r' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �.`. 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final .41. Solar Domestic-Final X42. Backflow Preventer ?43. Backflow Irrigation '44. Landscape Irrigation System 45: Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7/10 / �,�L • 48:4Special'Requirements Completed' �'y1/ 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY.: • No. Date - -, , TYPICAL 6" CONCRETE BLOCK FENCE a' Channel CopingOptionalrr g • I ' I u • : I ;I :GENERAL- NOTES Channel Block With One 3/8 t II , Horizontal Top of all Fences • I I- MORTAR: One Part Plastic Cement, and i 111 I . Three Parts Sand I $ GROUT: One Port Cement Thee and For Fences 5'or Less_ til; 2 I I 2 I �' One Half Parts Sand von.Ban 3/8'6 et 4' 01AO,C. e 1 00 = •COPING: One Part Cement, Three ill: 2 I 1 I Parts Sand For Fence,Higher Than 5' ; • v Ven.Ban 3/8'1f$ at 32"O.C. e y m CONCRETE: Well Mired I: 2 : 3%2 e = Fill Cells Solid With Grout ;111 h > z I I I I Max. of 7/2 Gallons ofWater Per Sack of Cement Where Steel Occurs r — Reinforcing Steel Shall # : 2 I I I GROUT MAY BE POURED FROM THE TOP I OF THE FENCE Conform to Sec.A•15.38 ee W 0 ` A.S.T.M, j ' ;i�! ~ 2 I I I 'CELLS AND AREAS OF HORIZONTAL REIN. All Steel to be Lapped- - .. 9 I w n .- FORCEMENT SHALL BE CLEAR,CLEAN& P , LL FREE OF ALL MORTAR DEBRIS,ETC. IS"or to Code If i I I I , 1 NATURAL GRADE , l p 1 I BONDS SHALL BE PROVIDED BY LAYING IIIH111- a 111=111. i ` 1 I II(_ BLOCKS IN STRETCHER COURSES SO THAT �e f VERTICAL JOINTS ALTERNATE IN EACH r ;•.o 'O . f .� • ' e COURSE. TWO 3/8" BARS i�E.alli O r • .• • • •.. • . CONTINUOUS TOP 1 o. &BOTTOM -iPy o WIDTH �� TO IB 0 C. MAX, '„ o• f) t. SEE CHART p0. '• O 10 BELOW . O^ ' ' DE PTH OF E ARTHTCOTH a b o. I/3 THE HEIGTH OF FENCE o • BECOw BOTTOM OF FOOTING. •O . • 3Lif. i' 6r �iQ I lo" 1 2 ,,,_ SCALE: 1/2 I' _FOOTING REQUIREMENTS _ WALL HEIGHT 6' 5' 4' 3' WIDTH OF FOOTING 14" 14" 12" 12" uoi THICKNESS OF FOOTING 10" 10" 8 " 8 " DEPTH OF EARTHTOOTH 24" 20" 16" 12" SPACING OF EARTHTOOTH 12' • 14' 16' 16' ...-- OWNERS NAME: City of Costa Mesa, California JOB ADDRESS: _ _ _ . Building Department •• IT C m ;9 y C +,.�- --� W Cl) -7 ynOOC = TO C ,n0Zt _ D y at m m D C 2 - o o r Si,gyp- rZ y DS n ti C O C`C', C T -, T c Vlr- 74 tao *g 2 �. y_ Z mm c -4 Di g* tn-om ~ Cl C) .. D z m m x 9 < a s r T 9 T{- m en -0 2 < r _�/Jy =?iKy ay r- 72 10M 23 COI •••••z -4 N 2D � D S 133111S2° Ss -4 i0nH 02m ny �� m i- a = m � ZZC pm � ''W p y zyyy y D m rO y ti Z O <2 T Om - r a n, T T V a Y x„ r C.. S.- s -'ate I K h _ CI • C-s -Ste, a --i- c--2C e M 'S a lb 0 ra n NN. ill a N It J 404 I� VS ?9� a 0 iPROV1fla Nt. CB* 4 Costa Mesa Building befit, • n'IESE PLANS MUST BE ON JOB AT ALL �MESAMU k bite iNQ � WITHOUT PRIOR APPROVAL y 7OINH ISSUANCE OR GRANTING OF A PERMIT OR APPROVALfig 1 PUIAIS AND SPECIFICATIONS SHALL NOT BE CONSTRUED I JO ANY OF FOR, OR AN APPROVAL OF, ANY VIOLATION SLA11tNG TO GIVETHE V�IONS OF MIS CODE. NO PERMIT PRE. - PROVISIONS OFf AUTHORTTY TO VIOLATE OR CANCEL THE FAR VSIHE M IS CODE SHALL BE VALID, EXCEPT 1N SO OR USE WHICH IT AUTHORIZES IS LAWFUL, ! CE OF A sPsoFROM F1CATlONS SHALL NOT PREVELT NTBASED UPON PLANS AND TH THE OFFICIAL I INSAID EREAFTER REQUIRING THE CORRECTION OF ERROnS �� yob fr. L33N15 USAID PLANS AND SPECIFICATIONS OR FROM PREVENTI•I, BYIOIA OPERATIONS BEING CARRIED ON THEREUNDER V,;•j;., OB DIEM i�OE /1118 CODE OR OF ANY OTHER DRC;: i���. ... 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . QTY OF COSTA MES�7A LCONST�7RUC/T�ION PERMIT PPEERRMIT NO. TR¢ACTI,N%T LOT NO. - UNIT NO. 3651 4/2"/95 Project Address .G 5 //� c1 3 r? AST, j IJE— SSW LIN"�" I G nTS po Q �3 2 Y Applicant's Mailinn Address _/G1 j/ Z"JA et � C �y TYPE OF CONSTRUCTION NEW pILi ADD LI ALTERATION U REPAIR 1 / (�/� �i Owner's N e y ,4 P L-. Phone,-ZZ"3547 ❑ CONVERSION ❑ DEMOLISH LD OTHER ' / ' _ A.P.9W �ZY— J 7 O 2 I Zone /C�- apJ ____ D SCRIPTION OF WORK/ SEOF BLDG. k A •D�1- 7'L Q S"�j¢ Q�.t) S. e• t 'C«SgeR hL n. ,• S Main Building: • Accessory Building: Address .ta?Z S' IS N �' E 2 Arch/Eng. License No. TYPE OF PERMIT Li GRADING LJ FOUNDATION E_STRUCPC<AL T 5,ront it 2/ 7D "aim 8,-4.0 Address __// - ❑ TENANT�/❑ ELECTRICAL, ❑ PLUMBING 0 MECHANICAL/lea? _D A7 ear 7.S / N - I Contractor's Name 0-�/I�'�/ //Ge4Phone S OTHER (16�1�i) Oak Cj']��j4%e�1(-� IJ—'15ea( ((.• �r --141 44 F� A -/U C Right /-jy• S ' / N Address(mailing) 3�4U •�a• PAral) 5 de P OJECT DESCRIPTION SQ. F.T7 OCCUPAN V A I / CONST RUCTION TYPE �Y/ VALUATION b e/ $ Left S R City License No. ZONE -J CR !NG CU.YDS. ACR 5 r - LICENSED CONTRACTOR DECLARATION Ping.Ping. Ref.# • Parking Req./Provided • E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: �• F� 6j /� O Planning Notes: J G with section 7000) of Division 3 of the Business and Professions Code, and - �'`' �� / Z P.(./ J ���G g t e Q 4 l I Z� Qh e/�f s'�s n Q M my license is in full force and effect. P (/� / A J r�..�Js�s CI /t J T License Class License No. • / C• # /7D—�`•' v ) a_5ed S Date Signature PLUMBING FEES Oe'Fa,C,heO WORKERS'COMPENSATION DECLARATION ' Bar Sink Showers _ ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 800, 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 Dula 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 OGas DElectric Sub Panel I certify that in the performance of the work for which this permit is issued,I . shall not mploy any person in any mann so as to beco subject to the Drinking Fountains Solar Tank Fan Motors 08-1 HP 01'f.-6 Work omggensat�l p Laws of Califo la rr Date —ler Signature i f Floor Drains Swimming Pool w/Spa • F.A.U. Inc.Solar 09.15 HP 016-15+ - 'NOTICE: It,after making this tleclaratio nu shou be qme su )e to the - - - Workers' Compensation provisions of t Labor Code, you m t forthwith ^Floor Sinks Urinal oFixtures 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 Water Heater Lender's Name P Outlets Range W Address Kitchen Sink Water Service Switches wn OWNER R BUILDER DECLARATION �' Sign 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 005 KW❑5-15 KW -Trash Compactor any structure, priortoits 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 erefrom and the basis for the alleged exemption. Any violation of Section 5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars($500). ��1 I, as owner of the property or Reinspection Fee I $15 Issue Fee $ 3 \7 will do the work,and the structure is not intentled or offeretl Reinspection Fee I $15 Issue Fee $ 3 for sae (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 RE EMENTS: ,Q employees, provided that such improvements are not intended or offered for Boiler Zoning Approved By ���_t sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground - Building Approved By Dat 2.1prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Ddb Application Issued By )•' 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 •al III s 0100,000 = SUMMARY OF FEES Uuilds 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 ❑ Multiple'0' BUILDING PERMIT $ l Fero SMTP $ _ - O 50 proof oftheir Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT • 0 I am exempt under Section / B. & P.C.for this reason Firepl/Fact.Blt. ICBG# •• • PLUMBING $ ISSUANCE $ Date/ ]_ OwnerX £/L-r "C, t e $ ENERGY P.C. $ - - co ' ' . PLAN CHECK 25% I hereby certify that I have read ll application and state the above 00-100,000 ■ 11111 s GRADING $ • information is correct. I agree to co ly with all ity and co ordi� es ELECTRICAL $ � 0 and state laws relating to building construction,f1��d hereby .v;• re- r MICROFILM $ sentatives of th' c' to e er upon/he ab• " ne• •• `or • PLAN CHECK 50% $ 1 4 •'•� inspection pure��� - _ • MECHANICAL S TOTAL FEE $ sa•o� Signature ..SiA'fl.. a._ Dat: 4"/ ' Drivers' Lie nse or SS - •� • — � Ilnrod - Assessor •/ / —A- 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, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final i 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -16. Rough Electric Wiring y I 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final � �'� 80. FOOD CERTIFICATE ISSUED 33. Final Electric '�/ /c. tai Notes: • �,Q � J�, _Q Q 34. Final Heating & Air Conditioning (� Vj%. Z/ga, f-a 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 _ A 47. FINAL STRUCTURE & BUILDING Y171)6 Vry 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - w No. Date _ • / ilnrdam 1 '-" fa l • Applicant to fill In all spaces except those within heavy-bordelines.--and sign all appropriate declarations. - 9574 9/1;4/}1 ti i.:�e,.(7 II PE MIT NO. TRACT NO. LOT NO. . UNIT N6. `CIT1F COSTA SR. CC NpST�RUCTI�ON�PE-aR- MIT _ 20 9/ 32V • • Projec;Address /'.� 3 fV.i .�o�/ • �' • Applicant.'s Mailing Address 32�0 S. Sr4NA4ZD Sq.927o TYPE OF CONSTRUCTION I NEW ADD ❑ ALTERATION U REPAIR _ - �� lSffi 3R/3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • A•p-# /.�/_ �� � /•7 •"1' - Zone�/ Owner's Name77GE,2/}CD �. �i�/ Phone03 DESCRIPTION OF WORK/USE OF BLDG. ./c1 �•/ (47 C� ..0 Address J2 af0 S. STspJJQ#EA AYE' S.A. !2705 ray/ S Main Building: ,�Q Accessory Building: PweMEng. L . L%.iDSEY License No. - TYPE OF PERMI ❑ GRADING 0 FOUNDATION IJ STRUCTURAL T Front a7/ 'O•[s`/1 Q Address • '12C W QO/J AI/E:. SO/7E' /07 (An O/A4 $ ❑ TENANT ELECTRICALSRPLUMBINGpMECHANICAL - B / N Contractor's Name 06JI&JE2 PhoneSSX-38 3 ❑ 'OTHER DE4C V87 • A Regarg to, ets! areles '(. t� Address(mailing) 329•0 S• STAB-c14QD AVE-LS-A-. PROJECT DESCRIPTION- SQ. FT.3/347 • OCCUPANCY Q3 K' Right i P 'C (//Q G NA CONSTRUCTION TYPE VALUATION S /79, 000 ' $ Left L/• 1/4 v4 R City License No. 927oS ZONE GRADING CU.YDS. ACRES Pang-Rat-#41, re" =/5956,2 Parking Req./Prov�dbd 2ca'n LICENSED CONTRACTOR DECLARATION • BeI hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 0 C. .C1EE i �/. 70 pp r 7//9/'5 Planning Notes: k/ �/ ce 9j- tj)1/J co-r_ Bg/2'�- M with section 7000) of Division 3 of the Business and Professions Code, and / / ���/// T" my license is in full force and effect. /h' /•. j - . 3 z -es- t (7n-T/f ,'^.sn/Tc /1 rte D�yn-i. e'D /.n i.agiczw $ License Class - License No. /"' C� yT" f / A` IG� /7K� 1��. �L�c�i/ G/6I-l� GY Date Signature PLUMBING - FE9ES WORKERS'COMPENSATION DECLARATION / Bar Sink 3 Showers v OO ELECTRICAL FEE ^I I hereby affirm that I have a certificate of consent to self-insure ora certificate ` of Workers' Compensation Insurance, or a certified copy thereof (Section - Backflow Preventer -- Service Sink Automatic Washer Transformer 0 15-50 KW 3800, Lab. C.) �+� Policy No.WC 76YSS00/�ns/Company �'��10N^1UT Backflow Irrigation Sewer-Cap Construction Pole Sub. • 0 50+KW • . �y Certified copy is hereby furnished. • fj��9//�—- - 2 ,l,.� 1 LJJ die copKjs filetl with the city B : in D' i fZ� t c en l ! Bathtubs Sewer Connection 00 /� Cooking Unit . - Meter Duo to 100 amps /V 00 l Date c/tt FROM WORKERS'COMPENSATION DELLA ATI Clarifiers Solar PipingLOrS / Dishwasher Meter u/over 100 amps t7 (This section need not be completed if the permit is for one hundr $100) or cY ,�.� Q less). 7• Dishwasher Solar O 'Dryers ClGaS Sub Panel certify - that in the O / L7Electric / cP So I 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 I 3 Fan 1 Motors❑O1 HP 01'A-8- 3 00 Workers' Compensation Laws of California. `_ - Date Signature Floor Drains Swimming Pool w/Spa 2 F.A.U. Inc.Solar 09-15 HP 016-15+ 2 00 NOTICE: If,after making this declaration,you should become-subject to the - - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal 5'O Fixtures - / -Microwave // Oo comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY. . Gas Service Outlets 3 , Water Closet 6 00 Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance - 9 of the work for which thig ,perin-iLise issued (Section 3097 Civ. C.) ' 9 Lender's Name /V /VB - Interceptors 2 Water Heater• OD 70 Outlets' Range �� •j0 Lender's Address / Kitchen Sink Water Service 2 00 Sb Switches Sign /0 OO . OWNER BUILDER DECLARATION 44 I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories / Auto-Wash /0 00 /' Garbage Disposal ;Standing Sections / 00 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 • 2 00 Generator 00-5 KW ❑5-15 KW / Trash Compactor / OO 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 ofRoof Drains / 13/DET 2 oO - - 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 - enaity of not more than five hundred dollars($500). r - - - I, as owner of the property or my employees with,wages as their sole Reinspection'Fee $15 Issue Fee $ 3 co pensation, will do the work, and,the structure is not Intended or offered - Reinspection Fee $15 Issue Fee ' 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 SE VI E REQUIREMENTS: • employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 • - r • �j•K Data'i-`Y// -g sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By pe the owner have the burden of proving he/she did not bulla or im- Duct-Under Ground :Building Approved By • Date provrovt Prove for the purposese of Sale). _� v ❑ I, as owner of the property,'am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By._ Date 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 3 Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU 6 00 •• • 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 / �/ MultipleSystemRepair/Alteration3 00 BUILDING PERMIT $ A 3Q3. 00 SMIP $ �2.S'7 proof off their Worker's Compensation insurance should be xhaus yst 0 0 PLAN CHECK �L• $ •/• 7S PERMIT P provided to me. s ❑ I am exempt under Section -B.& P.C.for this reason 2 Firepl/Fact.Blt. ICBG#/S8/ Fire Dampers e 00 PLUMBING $ it/. 00 ISSUANCE $ -- Date Date 9'y- r Owner _. / _ A A.-1.,A. He ting System&Ducting Registers - PLAN CHECK 25% $ 9. SO ENERGY P.C. $ I hereby certify that I have read'this application and state - the above 2 IM0-100,000 BTU 0100,000 BTU .7 00 ELECTRICAL $ 73. 00 GRADING $ - information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- OO MICROFILM $ PLAN CHECK . 50% $ 3S. inspection of this city to ter upon t e above-mentioned property for y/�9 inspection pry9P ses. MECHANICAL $ 2,4. 00 TOTAL FEE $ Q 7 J r 07 Signature ./r./�IDate - Drivers' License or SS# ' t÷ Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ S. 2.7 SWIMS CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor I CONSTRUCTION AND PLANNING POOL&SP• A APPROVALS Permit Date Inspector Date Inspector APPROVALS Permit# A sii e•. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe:Undrgrnd. - rt 53. Steel Reinforcement • , i 3. .Electr,ical Conduit Utility-Undrgrnd. 54. Forms 4-.Electrical Conduit-Undrgrnd. - . 55. Electrical Bonding 5. Steel'Reinforcement -• •' 56. Rough Plumbing & Pressure Test • e 6. .Elecfrical LIFER Grnd. r'" 57. APPROVAL TO COVER-GUNITE ' } ' 7. 'Footings - 58. Electrical Conduit-Undrgrnd. . k 8. 'Foundation ✓ . 6144 11/74, .-5 59. Gas Pipe,0 Undrgrnd.,Test - 9:,Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. , tot Stiucturel Flo r System ln'Ia.9 hr p 61. APPROVAL TO DECK , 11. Property Sewer Line& H se Conn e ion " 62. Backwash & Receptor-Final 12. Se*e•r.Cap 63. Heater & Vent-Final • 13. Roof•Drains • 64. Plumbing System - Final 14. Rough Plumbing • jJ�y/%/ ,W4' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 2-4/4 ;Le, 67. Fencing &Access Approval ., • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' : l 18.; Rough Electrical-T Bar Ceiling• 69. POOL/SPA SYSTEMS FINAL '` 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • , 20..Rough Factory Fireplace -7/57e ' 6.6_S'J 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 0il - 25. Roof Sheathing, IZ//g/ D. 74. Overhead Hydro 126. T-Bar Ceiling (Structural) & MOnocoat 75. Dry Chemical I/ 27. Frame'and Flashing _b- 76. Dry Standpipe 28. Lathing &Siding 77. FIXED SYSTEM FINAL 29. Insulation r,/,,tffi ' c 78. FIRE PREV. FINAL 30. Drywall Nailing 3. ///7/ S'c p 5 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat F' LU cs 1a� ' 79. FINAL INSPECTION .1 32. Electrical Power Meter-Final I/ ! 80; "FOOD CERTIFICATE ISSUED 14 33. Final Electric L'4fL' • Notes: pQ� «' g%, n 6r ��-t 34. Final Heating &Air Conditioning t t z746 Ljc/2 r Sl n)2� 1Je 2�ec�1� Co FRearra.:arc 35. Final Gas Pipe-Test t : • 4-Z-f6 (,go a. po.o.A.._-S A40t 36. Hood or Canopy. • 1 i cL� i 4 /1. OIL `•' 'Q/j /n _ 37. Final Factory Fireplace , - F-2-,o . Cre,7 • 38. Final Plumbing .! - - I G-z. -W4. an 39. Water Service-Final i - • 40. Gas Service-Final ' 41. Solar Domestic-Final • ' 42. Backflow Preveriter - 43. Backflow Irrigation 44. ,Landscape Irrigation System • - : • 45. Sound Attenuation- - '• - • : - 46. Handicap Regulations - ' - 47. FINAL STRUCTURE &.BUILDING 'J%/o 6 D4. 48. Special Requirements Completed - f7 /o go M 0,49. Electric Release to Edison / , SO. Gas Release to Southern California Gas Co . ' 51. CERTIFICATE OF OCCUPANCY s - ' • No _Date" - , ' - :� .. _ I CITY OF COSTA MESA BUILDING DIVISION CERTIFICATION OF GRADING ADDRESS: 251 23rd Street OWNER/BUILDER: Jerry Tripp I hereby certify that I have graded the lot at the above address in conformance with all local and state codes . 8/25/86 Jerry Tripp Ow /Builder City of Costa Mesa INSULATION CERTIFICATION . Building Safety Division , 251 23rd Street Costa Mesa Orange Number and Street City County Newport Heights 324 Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF BATT Manville Fiberglass Material Brand Name Thickness (inches) 6" Thermal Resistance (R Value) _R-22 EXTERIOR WALL BATT Material Brand Name Manville Fiberglass Thickness (inches) 4 Thermal Resistance (R Value) R-11 CEILING Batt or Blanket Type BATT _ Brand Name Manville Fiberglass Thickness (inches) 6 Thermal Resistance (R Value) R-19 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 BATT Brand Name Manville Fiberglass Thickness (inches) 6" __ Thermal Resistance (R Value) R-19 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). Owner/Builder çLtIAY General Contractor(Builder) License Number Owner 8/25/8Signa end Title Date Sub Contractor(Insulation Applicator) License Number Signature and Title Date CMF 1106-46 Applicant to fill in all spaces except those within heavy beer lines and sign all appropriate declarations. ` 7447 I /15/B6 1 Pon CI V'O,COSTA MESA CONSTRUCTION PERMIT PE Rt•QIT�NIJ. a-37, TRACT NO. LOT NO. UNIT NO. )� 'Project Address 251 23 RD ST �`�� O^t1 I Applicant's Mailing Address121 S. GRAND AVE. TYPE OF CONSTRUCTION NEW U ADD 1J ALTERATION U REPAIR 4 TRIPP 6314636 ❑ CONVERSION ❑ DEMOLISH' LI OTHER .A.P.# Zone _ owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address 3240 S. STANDARD AVE. , SANTA ANA > S Main Building: Accessory Building: E - Arch/Eng. License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBINGXa MECHANICAL A —Rear N Contractor's Name SIERRA ENVIRONMENTAL Phone 957-8991 ❑ OTHER C Right N 2121 S. GRAND AVE. , SANTA ANA PROJECT DESCRIPTION SQ. FT. OCCUPANCY • K G Address(mailing) CONSTRUCTION TYPE VALUATIONS S Left R City License Na. 024912 ZONE GRADING CU.YDS. _ ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECL• RATION G I hereby affirm that I am licensed •-r provision of C arter 9 (commencing Remarks: G20491 Planning Notes: M with section 7000) of Division 3 o he Business .nd •rofesslons Code and T my license is in full force and effect. 40519; I License Class I 'cen �! S Date 7, Signature I�1 �1Ayj , PLUMBING FEES WORKERS' CO •ENSATION DECL' ION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate •f consent to self-insure or a certificate f of Workers' Compensation Insurance, or a certified copy thereof (Section 'Backflow Preventer Service Sink 3800, Lab. C.) „ Automat ic.Washer • Transformer 0 15-50 KW Policy No. Nm 07123OWCCo •.ny Backflow Irrigation •• Sewer Cap Construction Pole Sub. 050+KW Certified Copy is hereby furnished. -, `" • Certified copy is led with the city Bui .ing Di:'sion. ; Bathtubs Sewer Connection • y, Cooking Unit Meter ❑up to 100 amps Dale 1/15 /JY ' Applicant �� J - EXEMPTION FROM WORKERS'COMPE (rATION DECLAryya 1b Clarifiers Solar Collectors • ^— Dishwasher Meter Dover 100 amps (This section need not be completed If the p.,mit is for one hun•red ($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 i Fan Motors 00-1 HP 01'h-8 • workers' Compensation Laws of,California. - - Date Signature Floor Drains • l Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ 'NOTICE: If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet Device Boxes Pole I hereby affirm that there is a construction lending agency for the performance , 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 Disposal 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 Trays Generator 00-5 KW 05-15 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 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 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 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 0 sale. If, however, the building or Improvement is sold within one year of com- Canopy Type 11 0 Zoning Approved By Date pielion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date 1I Prove for the purpose of sale). r-Is 8L V ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By + Date u 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 • 00-100,000 BTU 0100,000 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 thatExhaust0 System Repair/Alteration BUI LDING PERMIT $ SMIP $, proof of [Heir Worker's Compensation insurance should be provided to me. System 0 Multipler PLAN CHECK $ IDI am exempt under Section B.& P.C.for this reason 2 Firepl/Fact.Blt. ICBG#/f'4 Fire Dampers g OPERMIT 7 PLUMBING $ ISSUANCE $ Date Owner Hating System& Ducting Registers N. 0C PLAN CHECK 25% $ ENERGY P.C. $ I hereby certi y that I have read this application and state that the above 1 0-100,000 BTU 0100,000 BTL • ELECTRICAL $ GRADING $ information is erect. I agree o comply with all city and county ordinances • and state laws, elating to ui1•Jn const uc ion, and hereby authorize re re- PLAN CHECK 50% $ MICROFILM $ sentatives of t is city to ent r upon h:l -•ove-mentioned pr perty/f r 9 P Q p inspection pun des. - t / — MECHANICAL $ TOTAL FEE S. I "• 11 Signature l_ . Mg Date t I —7 r,, Drivers' Licens.i- # • V —.'•- Reinspection Fee $15 Issue Fee lir PLAN CHECK 25% $ �o VV CMF 0865-46,rev. 0/84 white - Building; Canary -Applicant: Pink -Accounting; Goldenrod - Assessor !CO N;TRUCTION AND PLANNING POOL ?A `APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector .1. Temporary Electrical Service or Pole f 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 _ 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. Uridergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro V 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: -fin j �yrcl /- 22 •-ckF 4 34. Final Heating & Air Conditioning /' 2 8‘ (-CO 35. Final Gas Pipe-Test �o - 36. Hood or Canopy 37. Final Factory Fireplace 6-Z??(. Leo 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 OF OCCUPANCY ' No. Date ..., c-.o.0 I Far Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. GUY O.FJOSTA M94 CONSTRUCTION PERMIT P. MITT NO-ZaC � - TRACT NO., , LOT NO. UNIT NO. 1 . 'Project Address 751 23rd Street �5/— as. `'Y/ - - . Applicant's Mailing Address 3240 S. Standard. SA 92705 TYPE OF,CONSTRUCTION. LI NEW ❑ ADD U ALTERATION U REPAIR I / , -7 Owner's Name Gerald I Tripp Phone 55Fi-'iRl 3 - ❑ CONVERSION IL Si DEMOLISH ❑ OTHER A.P.# '"'7/-siO — ORy — d oZ - I Zone DESCRIPTION OF WORK/VSE OF DG�DE/U C Address 3240 S. Standard Ave. , SA -92705 p�Ef �- CllU.t/ S Main Building: • Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT LI GRADING FOUNDATION U STRUCTURAL T Front 0 Address I ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear A01-2.1f N C• OTHER A 'Contractor's Name Owner-Bu it der Phone 556-3813 - C Right -Or !z rite/7 N Address(mailing) 3240 S. Standard Ave. , SA 92705 PROJECT DESCRIPTION SQ. FT. • OCCU PANC/y ,,M pp Left G CON ST RUCTION TYPE - VALUATION $ it COO 2 S R City License NO.• NA ZONE GRADING CU.YDS. ACRES ' N LICESED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided - E Q I hereby affirm that am licensed under provisions of Charter 9 (commencing Remarks: _ Planning Notes: Mwith.section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. T 17License Class License No. - S tv 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 • Automatic Washer Transformer U 15-50 KW 3800, Lab. ) •-� / � 5 bey No. C /6�.�5o0/r�6dm¢any Ala'+0�/4UT Backflow Irrigation 1 Sewer Cap S Op Construction Pole Sub. ❑ 50'+ KW 7pppoli Certified copy is hereby furnished. VU Certllgwtl copy iissa filed with the city B II ing DiviSi /J T '_is Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date / N FROM WORKERS'Applant �A Q� /-/LwOA'fNU)7� Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps EXEMPTION FROM COMPENSATION DECLARATI (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, ' shall not employ any.person in any manner so as to become subject to the Drinking Fountains Solar Tank • Fan Motors 00-1. HP ❑.1'h'-R ' Workers' Compensation Laws of California. Date Signature - Floor Drains Swimming Pool w/Spa } F.A.U. Inc.Solar ❑9-15 HP❑16-15+ 'NOTICE: If,after making this declaration, you should become subject to the — Workers' Compensation provisions of the Labor Code,.you must forthwith Floor Sinks Urinal - Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY / Gas Service Outlets Water Closet I hereby affirm that there is-a construction lending agency fortheperformance Device Boxes Pole Light • of the work for which thi permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name /VC Jae - p Outlets Range • Lerider's Address Kitchen Sink Water Service Switches ' OWNER BUILDER DECLARATION 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 065 KW 05-15 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 - - 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 ' 7enalty of not more than five hundred dollars($500). ' f • IR 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 I 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 Type I ❑ DEVELOPMENT SERVIC S REQUIREMENTS: employees, provided that such improvements are not Intended or offered for 1� //�r - • sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By b - Date prove , the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date rep prove for the purpose of sale). —� P ❑ I,as owner of the-property, am exclusively contracting with licensed con- Duct-Structural ^Refrigeration System Application Issued By Dat 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 projects with dcon- -�/ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ /7 So SMIP $ 14,J 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 $ G'yy ISSUANCE $ ' Date y_Y owner .'. -*-( .-.a Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY Pt: $ I hereby certify that I have read this application and state that he above 0o-100,000 BTU 0100,000 BT - I - - - ELECTRICAL $ GRADING $ ' information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $� MICROFILM $ I sentatives of this city to enter uggoon the above-mentioned property /)rr�a.s� inspection pyre es. 1 / p,� • MECHANICAL $' TOTAL FEE $ '�•J JV Signature./.-/ /��,,(/p/+ Date , Drivers' License or SS# ca . • Reinspection Fee I I $15 Issue Fee $ 3 PLAN CHECK 25% $. L51 4� CMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING POOL A ('APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector YTemporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - .59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final • 12. Sewer Cap O//o/(� !So D,e 63. Heater & Vent-Final 13. Roof Drains It r( 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16: Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • • 19 Rough Heating & Air Conditioning 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 Flaming 73. Undergrnd.Storage Tank 0 Gas 0 Oil - 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe - 28. 'Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall,Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer - 43. Backf lowIrrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING $/I 48. Special Requirements Completed 49. Electric Release to Edison • - rt ;) • 50. Gas Release to Southern California Gas Co 51.ICERTIFICATE OF OCCUPANCY . ' No Date • CITY 0. "STA MESA 9_576 9/04/85 )545.62 IL PAI... FEES - Fee Payment Receipt N! 1008 Project Address ,aI�1S a3'' i-d ST-WY— A.P.Number L]a61_ ©8'-//I - Q-7., Park Area Building Permit Number Owner's Name 6e.c Z,/d /WIPP �/ Mailing Address 340 5. S*zndara ao-e J.cVSC ez4 4� C' 9a 703- FEE: Single Family ' Number of Units 2-Bedrooms or Less @ $ 861.76 = 3-Bedrooms @ 1,205.67 = 4-Bedrooms / @ 1,545.62 = 1,5-4 hs. 5-Bedrooms+ @ 1,810.50 Multiple Family " Bachelor or Studio _ @ 474.37 = 1-Bedroom @ 573.18 = 2-Bedroom @ 881.51 = • 3-Bedrooms+ @ 1,229.38 = .y.,J� ,• , ^,' /1 Total Fee "' � S1/� .. Planning Department Appr al Date i °y /(/e/�, / L/cioeA s Applicant's Signature • City Ordinance 72-44 •• City Ordinance 72-45 •'^Gl ty Resolution 78-116 II1yIyr ikl CMF 0174-32 Rev.6/79 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant Ilk 1T _- Applicant to fill in all spece.i..x-i- rr a1Catepropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT NO. I- UNIT NO. B 2 Y 5-9 • q P # Zone Project Address 251 731Th �" IZEF.T - / t f S Main Building: Accessory Building: Applicant's Mailing Address 2S1 73Rf1 STREET TYPE OF CONSTRUCTION U NEW �..� ADD LJ ALTE RbU TION REPAIR E Z ❑ CONVERSION ❑• DEMOLISH ❑ OTH • T Front 0 Owner's Name _ _P.! u! •• Phone 792-6418DESCRIPTION OF WO'K/USE OF BLDG. 1 " x- - . i .6. 4 .- 1; B Rear N Address i'11Di1 CTDFFT 2 - es _/ A. f. - -' Arch/Eng. NONE License No. TYPE r •ERMIT la GRADING 111 FOUNDATION N STR TURAL , a Right N G Address ❑ TENANT ill ELECTRICAL ❑ Left PLUMBING ❑ MECHANICAL $ R Contractor's Name OWNER Phone El -OTHER __C7✓ LA,. e R� I Ping. Ref. 4 t Parking Req./Provided E a Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: M CON ST RUCTION TYPE t - VALUATION $ II 000 •--- : T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and -- my my license is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature PLUMBING FEES Automatic Washer Transformer ❑ 15.50 KW WORKERS'COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub. 0 50+ KW I hereby affirm that I have a certificate of consent to self-insure or a certificate - Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps )0, Lab. C.) -olicy No. Company Backf low Irrigation Sewer Cap Dishwasher Meter Dover 100 amps 8 Certified copy is hereby furnished. — ' Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Date Applicant Fan Motors ❑0.1 HP 01%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors �_ _ (This section need not be completed if the permit is for one hundred($100)or - F.A.U. Inc.Solar 09-15 HP 016-15+ less). Dishwasher Solar Piping I certify that in the performance of the work for which this permit is issued, IFixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. - • Device Boxes Date Signature Floor Drains Swimming Pool w/Spa Pole Light /: NOTICE:It,after making this declaration,you should become subject to the . Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range - comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY Gas Service Outlets Switches Sign I hereby affirm that there is a construction lending agency for the performance Water Closet _ of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Generator 00-5 KW 05-15 KW Trash Compactor Lender's Address Kitchen Sink Water Service p ' 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 r county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays 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 Reinspection Fee $15 Issue Fee $ 3 refrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil lty of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: • 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 1 Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date License Law does not apply to an owner of a property who builds or improves O thereon, and who does such work himself/herself or through his or her own Application Issued By Date p Z employees, provided that such improvements are not intended or offered for Boiler Hood or Type) 0 sale. 11, however, the building or improvement Is sold within one year of com- Canopy Type II 0 pietion, the owner will nave the burden of proving he/she did not build or im- Duct- Under Ground SUM ARV re prove for the purpose of sale). - BUI LDING PERMIT $ 2.-S.- OD SMIP $ •J-0 ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT 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 PLUMBING $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ - 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers MICROFILM $ Date Owner 1 i4 .�✓..... • Heating System& Ducting Registers PLAN CHECK 50% $ '1y MECHANICAL $ TOTAL FEE $ 'L5'- Sb I hereby certify that I have read is appy ation and state that the above ❑0-100,000 BTU 0100,000 BTL Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and-hereby authorize repre- sentatives of this city to ent-r upon the above-mentioned Jproperty for - inspectla. urposes. $+/1 p� _ - Sigpatur.O,x - Date / - Reinspection Fee $15 Issue Fee $ 3 C.' :'i'.:9.'=-' 983+x65 (O Drivers' ' ense or 5 ariref�D/ rev. 5/99 White - - ny�i r-- --} TIC: Ly-1 Building; Canary - Applicant; Pink - Accounting;Goldenrod - Assessor - - -` !// CONSTRUCTION AND PLANNING POOL °A 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 Wining Sign 68. APPROVED FOR PLASTERING 1$. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Hating & Air Conditioning FIRE DEPT. REQUIREMENT 1 20. Rough Factory Fireplace APPROVALS Permit# 121. Ducts,n Structure 70. Underground Hydro \22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 123. Gas Pipe-Rough& Test 72. Underground Flush 2L4. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 0. ?5. Roof Sheathing. 74. Overhead Hydro f e i n t • i6. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical w I7. Frame'and Flashing 76. Dry Standpipe O. �8. Lathi`g& Siding 77. FIXED SYSTEM FINAL i29 nslnsl ulation . 78. FIRE PREY. FINAL / 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric l Notes: i 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing I 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System I '' • 45. Sound Attenuation I - 46. Handicap Regulations . /�� 47. FINAL STRUCTURE & BUILDING 12-% a, 48. Special Requirements Completed '�-� 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co• 51. CERTIFICATE OF OCCUPANCY • • - N0. Date J 6/9/83 MR Mk COSH" III SPEED LETTER In the interest of speed and economy, we are replying to your request / inquiry: Ci With marginal notes/comments. lit In note form, as follows: i/fE DEMOL/Tro,J /eaA1/T 4441; AMS F/µACED, 771E Buac411 4 pee MIT f b2 THE CAEAQE WAS NoT• PLEASE CbME hl) AAJD 77.1KE our .4 AJEW BUILD/u' /A Mil. FEE Gu1L4 BE Cook ,,OF bel 0/AJAL pEeMIT 444)7* Xo 21 Sb.ee ' Fba 7tf/S /NCcw - a / [Iv With the attached information. If you need additional information, please call or write the: Development Services Department P.O. Box 1200 Costa Mesa, CA 92626 Name kC.4uS STRASGH/L Title IOLAAJ CHECKER- Telephone HECKE -Telephone (714) 7,534 - 5-615- IEVELOPMENTVERVICES DEPARTMENT BUILDING SAFETY DIVISION CITY OF COSTA MESA -c.:_--7.-. "- =~-M y P. O. BOX 1200 !%�. 61. t'",--. _.: --.7 COSTA MESA, CALIFORNIA 92626 .J. ry U'.: _� S.�.J.��Jlitt;: .! JUN-9'83 :1"!%:.-.4:: _41 'Fty\q /l'tl ezas0 .51. _ 1:' <j�fF 1.� ^t 1! G /f1 Fi. . py C.FF 'b t3 FIECa © , Ave,s,Nest,' Gilt OF 005'1A ML'E1A 11>4/;F. BUILDING DNI51014 •�`%r, • Mr. Dale L. Fletcher JUN 1. I' 1383 251 a 23rd Street PM Costa Mesa, CA 92626 7$ 1110,111]2111213141516 OWNER FLETCHER, DALE L. DATE 10-12-78 JOB ADDRESS 251 East 23rd Street BUILDING PERMIT NO. 46874 G AL CONTRACTOR Owner-Rldr. DESCRIPTION of WORK Garage A 'j. 118-164-33 LOT por,32Oi 1} TRACT Nypt.Hts IRE ZONE VALUE $ 7A S00.00 INSPECTIONS Signature Date TYPE v GROUP T ZONE B-1 `SOIL PESMITS ISSUED cns SUBCONTRACTOR Dote 1 Number Signature WATER Plumbing ROUGH PLUMBING ^ PROP. SWR. LINE n HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING - TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER O ROUGH WIRING � Meeting and Vent. TRENCHES 'kr FORMS •••••- STEEL REINF. -�;�71,1SW4C/7^ P FLOOR SYSTEM BOND BEAM In STEEL REINFORCE n SHEATHING cJ4 44J-Y9 -- CANCELLED FRAMEAND FLASHING LATHING - INrIOUT n DATE,2.-1SW Q { PI, P. BROWN COAT STL__fURAL, FINAL Flertric HEATING, VENT.. REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL BUILDING, FINAL ,_ - . •— -- - _ _ _ ____ _ .OWNER FLETCHER, DALE L. DATE 10-12-78 JOB ADDRESS 251 East 23rd Street BUILDING PERMIT NO. 46874 GENERAL CONTRACTOR Owner—Flr3r. DESCRIPTION of WORK Garage AP No. 118-16)4-'13LOT pnr,124 TRACT pt.Ht. IRE ZONE VALUES 7 500.00 INSPECTIONS Signature Date TYPE V GROUP 7 ZONE F_1 SOIL SUBCONTRACTOR PESMITS ISSUFED GAS Date I Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON, ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE • UNDERGROUND 0 POWER 0 ROUGH WIRING Heatin• and Vent. . TRENCHES _ FORMS - STEEL REINF. ?t 4e,./21 ' FLOOR SYSTEM BOND BEAM [3 STEEL REINFORCE ( f SHEATHING (Na' ft) 41 )' CCA NCELUD FRAME AND FLASHING - IN OUT r] DHCr-14W + JIdee-- —. --- PLASTER, BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST n ELECTRIC, FINAL BUILDING. FINAL . SPECIAL REQUIREMENTS UTILITY NOTIFIED, GAS n ELECT. n OCCUPANCY CMF 0486.46(BU 4) • 46874 046874 COSTA MESA BUILDING-SAFETY DEPARTMENT 6814 ..1x(112/76 P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 6614 f.& 2/78 my, For Applicant to Fill in Completely—Use Ink Only AP; I r AT N FCRUiSIOHI2fA���1?If4NIT I, F' y REC I OB/ DATE RECEIVED .. D^TE ,+ BUILDING LIQ - A///1 /' s / ADDRESS v OWNER ' A.P.NO 'se A /i r 1.. MAIL S � ABUILDRI S 07 34_4, sr ADDRESS c2 / �3s(CITY aSz4 `ti s4 NO. 74e3 9 CT RRr3y/ BLOCK CONSTRUCTION NEW ADD ALTER MOVING DEMOLISH LENDER LQ{fe- / BRANCH OWNER Zs; G,. te-7-�jD/L ADDRESS / w / VALUE (J v1? ARCHITECT TEL. USE .tIf46 C $ !. OR ENGINEER NO. FIRE ^ ADDRESS ZONE apIC GROUPAPPROVE ACALCONTRACTOR � BV4JYPE DATE 0 fol ADDRESS TEL. ZON NO.OF USE OF NE /'� CITY NO. PLANS2 BUILDING I / STATE CITY AR S APPROVED YARDS A'ROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING I.I SIZE NO.OF BLI DGS. t/ (FROM Cl STRE ) / 1 e OF LOT 9d f jf %_7s Tf 31 I NOW ON LOT p , FRONT I 9 �/7 FT. / Q USE OF a—•--ar<—+�V / // VI EXISTING BLDG. �O/// E R.SIDE FT. ,�� FT. D NH Separate permits are required for L.SIDE 0 FT. F�TD�/—'',�y L7 electric,plumbing and heating work. REAR FT. FT.C_/ // QW USE BUI DING A D W RK TO BE PERFORMED F AINDISTANCE BET. BET.MAIN& GI — '/fie MAIN BLOCS. ACCESS.BLDGS. ////(•t� ], '�'///''' �� VAR.# DATE aG..-/Q'�� C�7,ck S C.U.P.# APPROVED e=2?-/ line X �S �.�/I Q �VC/PR( _ DATE/Q �7 7, a / W pI hereby acknowledge that I have read this application and state n (d that the above information is correct and agree to comply with -- 6, all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a W the State of California. j� I hereby certify that I am properly licensed as a contractor under V(JSQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F LAVs '- am exempt from the provisions of the State of California Business �f7 a VALUATION PERMIT FEE and Profession /DD iivi�s' n 3, ter 9-// A $ Jf..,(, "_- � �j — PLAN CHECK $ ^r Signet • /}� Fermi. - - ✓ $ (//I (/JI TAX $ 54/ V Authorized Agent ` TOTAL PAID $l �i ca OWNER FLETCHER. DALE L. DATE 10-12-78 JOB ADDRESS 251 East 23rd Street BUILDING PERMIT NO. 46873 G v;eut AL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Demo Det. Garage 4FIREA! $ . 118-164-33 LOT TRACT ZONE VALUES 500.00 INSPECTIONS Signature Date TYPE v GROUP j ZONE p-1 SOIL PERMITS ISSUED �GAS SUBCONTRACTOR Date I Number I Signature w•T ER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 • ROUGH WIRING Heating and Vent. • TRENCHES FORMSSTEEL REINF. LJ FLOOR SYSTEM BOND BEAM n STEEL REINFORCE pi SHEATHING FRAME AND FLASHING LATHING — IN R OUT El PL ; R, BROWN COAT —PlSTR..S?URAL. FINAL Electric HEATING. VENT.. REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST I^I ELECTRIC. FINAL y� J �/{ BUILDING. FINAL 0-.1 kr et 43./4 UMW a 046873 6815 Lp/12/78 5.50 TL COSTA MESA BUILDING-SAFETY DEPARTMENT Al „ I P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 '`'.F�'�/ APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUEn_- BUILDING1�'5/ s2,�,D c`. 'it � /II� ADDRESS `- .. / ... I 7 P.r IT/ • OWNER c , `' A.P. NO. : I i-.7 . S i • _ rMAIL BUILDING/�� i1k32 - ADDRESS,,cil % � r�3r /j>, S ) �} ADRES /City 6T1•' %% STN0.4 �y�Q •BLOCK CONSTRUCTION NEW ADD LTER AIR MOVING D MAI LSH LENDER BRANCH e. 5 ADDRESS � /� TEL. US Denfh /l cre c,�U ARCHITECTs Sed/ OR ENGINEER ZT NO. FIRE ADDRESS ZONE /� /els TVPEr GROUP ����// ^L��F4 APPROVED (r///. 2iJ//•/{/ CONTRACTOR GJ G� BY l�/ll�( e,/ DATE y�+O/ pt // p ADDRESS ��Si ��(, S� 202e/f NO.OF USE OF\N �rr+- '/1 CITY �' /Jy, NO.TE ''JJ��`` PLANS BUILDING! a JIB///` 5F. STATE CITY. YARDS BUILDING APPROVED / LIC.NO. LIC.NO. MAIN BVILDIVE ACCESSORY APPROVED La SIZE / NO.OF BLDGS. (FROM C/L STREET) a. OF LOT USEOF 9L'x /322/ INOW ON LOT FRONT //FT. /9 FT. 41 EXISTING BLDG. B,_SIDE ' ECA Separate permits are required for L.SIDE FT. G electric,plumbing and heating work, REAR FT. W USE OF BUILDING AND WORK TO BE PERFORMED I" DISTANCELD BET. BET.MAIN& 0 MAIN BLDGS. ACCESS.BLDGS. K DrICIfie VAR.# DATE Dm o:II • C.U.P.# ///J� APPROVED7..1C ,V' APP V II t DATE!! — q— / Y te W 00 I hereby acknowledge that I have read this application and state n Cr that the above information is correct and agree to comply with m C all laws regulating building construction, and I shall not employ s Z any person in violation of the workman's compensation laws of u Zthe State of California. m I herebycertifythat I amSQ. FT. ry properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; e am exempt fr o provisions of the State of Coll Alia Business VALUATION PERMIT FEE $ c.- v end Prof ns Cod slon 3 Che er 9. • m 1 PLAN CHECK E co SiPer A ature of ..er (/}/�/1 /''//''//��JJ//�/, 0 Authorized Agent $ �" `� %`e TOTAL PAID ES SD U