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HomeMy WebLinkAbout277 23RD ST - Building Permits 4° CITY OF COSTA MESA 4t `G ,►° BUILDING DIVISION F e y'�..9 DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER vi1 Rsa �"balsa m 601-01603 (714)754-5273 • Fax(714)754-4856 • ww.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 w BUILDING PERMIT Job Address: 277 23RD ST Status: ISSUED Suite: Applied: 10/09/2001 Vicinity: DWELLING AND ATTACHED GARAGE Issued: 10/09/2001 Parcel Number: 42608407 Zoning: Applicant: FAUBERT, BRAD ISSUED BY: Address: 8902 SAILPOINT Phone: 714-962-2203 HUNTINGTON BEACH, CA Zip: 92646 Owner: LE SHURE, DENNIS L Address 277 E 23RD ST Phone: COSTA MESA,CA Zip: 92627 Contractor: STAR COURSE ROOFING CO. Address: 8902 SAILPORT DR Phone: (800)854-0011 HUNTINGTON BEACH,CA Zip: 92646-2664 License: 532778 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE EXISITING ROOF TILE AND AND APPLY 40 YEAR COMP SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,600.00 Permit: $153.25 Claim Valuation: $7,600.00 SMIP Res: $0.76 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.01 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Lek 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 2448.46(WOO) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I hsend 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 aa rk for which this permit is issued. 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 km led. My workers'compensation Insurance carder and policy number are: Carrier: it. Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of •. "o for which t permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo _ - at if I •• Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi .- . / .- Q /f Applicant Signature: Date: WARNING:FAILURE T• E ' ' ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SI-MU.SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE - .',000),IN ADDrION 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 apter 9 mmencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.N Class a Contractors Signature: Date: / M��''1 1+ b -- V q - 1 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 end 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 pent. 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tltle 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 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 a plication a_oermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 Yes LI 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(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑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 purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ", rre Of Legal Ow • `/D , q NO I An. • . rifted Applicant Date 1 BODE I INSPECTIONTYPE MC miff LS CODE! INSPECTION TYPE Prig =AL5 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 a. PROJECT ADDRESS: _4277 23RD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NU: B OCii2i DWNEWSYIAME: DENNTS LE SHURE ADDRESS: 277 23RD ST PERMIT NO: B 049121 PLAN CHECK NO: 03768-90 L GOVT; N S:iPP : : COSTA MESA • CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE; ALD ( 714 ) 646-3092 /ICRIENGINEER: GREG PITCHER REG.NO.:NONE JOB DESCRIPTION ADD TO 1ST FL/. ADD 2ND FL/ ADD TO GARAGE SQ FT: 2, 50E ADDRESS: 15901 RED HILL Al. on: 1 10 k ' TUSTIN CA 92680 CLAIM VALUE: CPTC-VALUE: 159, 454 . 90 GROUP OCC: R 3 /I1 -1 PERMITTEE: DENNIS LE SHURE • (714 ) 646--3892 ADDRESS: 277 23RD ST , COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME, COSTA MESA - CA 92627 >n####################!t#####x##s;##,. #########:r######*####x*###x#####!,#####!:####!,# I'I LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section ZONING R E Q U I R E M, E N T S 7000)of Division 3 of the Business and Professions Code,and my license Is in tut fora and effect S I3 TB ACK S CITY UC.: STATE UC.: CLASS: _____ - _ Date: Signature: MAIN BUILDING ACCESSORY BUILDING --WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure ora certificate of Workers' FR N T: 25 FT S IN REAR : 37 FT 7 IN FRN T: FT IN REAR: FT IN '•mpensation insurance.or a ceAtied copy thereof(Section 3800,Lab.C). LEFT : 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN CY ND.: EXP.DATE:MMxr: PARKING REQ: 2 PROV; 2 PARCEL: 42608407 ZNE: R1 REF NO: Certified copy is hereby fumshed, ❑ Certifies copy is filed with the city Building Division. PLANNING NUTES> 2200 SF ADDITION TO N EXISTING RESIDENCE INCLUDING A NEW / > SECOND STORY, EXPAND THE 1ST STORY & ADD A GARAGE WORESHOP Date: - Applicant: ###!:##################fF##!(##########- ################################tF#!E###;fir#if EXEMPTION FROM WORKERS'COMPENSATION DECLAIM (This section need not be completed if the is for one hundred(5100)or less). D E V, E L O P M-E N N SERVICES REQUIREMENTS I certify that in the performance of the work for which this mit is issued,I shall not empl y rso in any manner so as to become - _ subject to the Workers'Compensation Laws California. ZONING APPROVED BY B •-- DATE : _ q - Z9 -sl ]� J Date: �er `E q 0 'Signatur l Wo � pe 4�/LQ BUILDING APPROVED BY - / __ NOTICE:If,after malting this declaration,you should become subject to the Workers'Compensation provisions of the Labor / DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. -. • 1 ✓ CONSTRUCTION LENDING AGENCY: I hereby affirm that there's a construction lending agency for the performance of the work for APPL ICAT ION ISSUED BY• ' - 1 D_ K) (k— DATE: --Z,f. -�4 which this permit s issued(Section 3097,Civ.C). ################################### *J7 !e###################?e## ## .717--*#l.i##tri LENDER: ####################### ###########################################Y.K##!'##,:!'+.t:' ADDRESS: LEGALIZATION:N F E E S U M M A R,,Y STRUCTURAL SEGMENT:\ OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANI / FIRE SMIP/RES GRADING (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 849 . 50 - "41. 11 16 repair any structure,prior to its issuance,also requires the applicant for suchermit to the a signed statement that he/she Is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business / . r r SMIP/N U;I-RES and Professions Code)or that belshe Is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN 552 . 18 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I, as owner o1 the property or my em loyees with wages as their sole compensation, Will do the work, and the • BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK , L/ TOTAL PAID DU•' Sstructure is not intended or offered for sale(Section 7044.Busmess and Professional Code: The Contractors'State License Law TOTALS -> 860 . 66 0 . 00 552 . 18 • '14 1 2 , 8 4 1412 . 84 • 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himselimersetf or through his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED : •860 , 66 OVER/SHORT; 00 for theepurpls soldwithinone year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FI SMIP/TOT GRADING PLAN far me purpose al salol -CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 849 . 50 11 . 16 © and who Professions Code: The Contractors'jthSdoestate contractor(s)LitersOLawpurt suly atponhe ner ContrptorsrrywM buildsorLaw).roves ware #*ie############3###################### ######**7*##############i:######:F# ',###*r.4; and who contracts The protects rs'h a LicseLaw se pursuant to the Contractors'State License Law.I am aware / that proof of their Workers Dompensetion insurance should f. provided to me. INDIVIDUAL F E E B 'R E A K D O 3± N 0 I am exempt under Section: B.8 P.C. for this sjreason: �1 /F / TYPE QTY DESCRIPTIO N A--' UNIT COST TOTAL COST Date: -I -a'- I - 1 O / , .,.,��� �+ ' Al ,_ SFR 2245 OWE-TYPE V-WOOD FRAME3�6D 69 . 00 , 154 , 905 . 00 Ido hereby certify that l am aware of and understand the requirements of Cal, mia Hun and Safety Code Sections 25505,25533,and SFR 263 RES—GARAGES TYPE V / • 17 . 30 4 , 549 . 90 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES . permit for construction or modification from me Ai ality Management District.Residential construction applications are exempt from these provisions. I Date: Applicant: , r I I hereby certify that vis relating tthis applicationldand ti that the above information ist correct a comply with all city and county r A ordinancesfand inspection rposetoWilding h3lnAtion hereby authof¢e representatives city enter upon the abovementioned .' r - property for inspection purposes. , Dale: q"- --q-.� '�-1 0 _ Signet l-A Ati� T,,,.) .- Driver'sLicense orSodeSecurity a: /�'` �•' � 69.'�'ti'S'(f TINE: 'QFS.0 164146 White—Building;Green-Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod-Assessor —- —1 �— r—• `----/� (— — c- CON5TII4C?ION AND PLANNIN4 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. f 55. Electrical Bonding 5. Steel Reinforcement 101224q0Vq0 Pa 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, O Undrgrnd. 10. Structural Floor System /ply//n/�,o Qt/ 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 i 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING. 18. Rough Electrical-I Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 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 I 124ga 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing Y 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing •2.3p‘ 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing • 3 4 f / HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat Vi ` vb\II VCO 79. FINAL INSPECTION 32. Electrical Power Meter-Final ` 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:/// 34. Final Heating & Air Conditioning g f 35. Final Gas Pipe-Test rf -✓ -'Y�•�"E� �•J 36. Hood or Canopy 37. Final Factory Fireplace / ,/ WI/ 38. Final Plumbing '�\%'E `Z4 � / SiS 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • FINAL GRADING CERTIFICATION Project Address: a� • I. a3 ( • 657-4- ESA \' \ L Lot Number: • Permit Number: --tetI a I By Civil Engineer: I certify to the satisfactory completion of grading in accordance with the approved plans, specifications, local and state codes. AH drainage devices required by the grading permit, grading plan and grading ordinance have been installed. Adequate provisions have been made for drainage of surface water from each building site. The minimums are: 2% Fall from structures within 5 feet from exterior walls. 1% Fall for asphalt surfaces and landscaped areas. 0.5% Fall for concrete surfaces to approved disposal areas. The final monuments as shown on the corded trac ap -e s- . All final grading eleva- tions are within ± 1/10 of the s • d elevati.n p Supervising Civil Engineer g. , Reg. No. e—cr�/51 (Signature) � Date " •971- I" - zz— ( Z �\S�RE D AR�yy • VA I I I if A tt • r tsx Rye STAMP and SIGN , CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES - NEWPORT-MESA\ UNIFIED SCHOOL DISTRICT Developer/Applicant : J EN W t S Le SRuRE Address : G .7 ��� , J �/ 3n r ( Cts C / SQA C/7 9Z�o27 Telephone Number : 1 / "T� bcrb1 / "- 3 6 Q Z Tract/Parcel and Lot�Number(s) : of M Location of Project : a� C. �� r" „ // Co Q III CSCE 0 /1' gD-6a7 Number of Square Feet of ��jj Residential Space c9jc OO x $1 . 50 Total "'1.53Q0. a(0 Number of Square Feet of Commercial and AA Industrial Space ---CD --- x $0. 25 Total p/ I-P).1Commercial/Industrial Project is : (Check One) Mini-storage Motel Preschool Movie Theater Bank Auto Repair Racquet/Health Neighborhood Shops Hospital Warehouses R & D Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food The provisions of Government Code Section 53080 are not applicable . This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . Checks are to be made payable to Newport-Mesa Unified School District . �� A BusinessManager Newport-Mesa Unified School District The above - representation as to square footage is true . Developer/ Applicant••agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . Date : t —D—Lk— C0 � eveloper/Ap licant EMNIS le SH- uRC 1 -TY OF :.. `i MES ' ; • • CALIFORNIA 92628- P.O.BOX 1200 Insulation Certificate 77E. 3=`1 �n s7A /get/4 - /�J Number and Street City C.-E7 U N • 771 CSunty Subdivision - Lot Number • Description of Installation ROOF • Material 'Sr II3ER6LAss /AaSuLH7,cA Brand Name MAA/I/ -L< Thickness(inches) /O " 'Thermal Resistance(R-Value) EXTERIOR WALL . Material R-( ( Brand Name 1141)/V✓t 4-1-e Thickness(inches) >f;_ Thermal Resistance(R-Value) —1 ( • CEILING • Bau or Blanket Type B'7Brand Name 414 N!//LLC Thickness(inches) C, 71( Thermal Resistance(R-Value) I —/ 9 Loose Fill Type Brand Name Contractor's minimum installed weight/ft2 a. lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) RAISED FLOOR Material iVJA Brand Name Thickness(inches) Thermal Resistance(R-Value) SLAB FLOOR `fix Material a Ai( SET E Brand Name Thickness(inches) • Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name •Thickness(inches) Thermal Resistance(R-Value) • Declaration • I hereby certify that the above insulation was installed in the building at the above location in conformance with • the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the alifornia Administrativ /2:0_ General Contract (Builder) License Number Signature and Title Date Sub-Contractor(Insulation Installer) License Number • Signature and Title Date RF '1:3 1 31 dpi • y \ • a PROJECT ADDRESS: ` 277' 23RD ST UNIT: A: CITY OF COSTA MESA - BUILDING PERMIT PERM NU: EMP 043 ..2.2 \ OWNER'S,NAME: DLNNIS LE SHURE ADDRESS: 277 23RD ST PERMIT NO: EMP 049122 PLAN CHECK NO: N GOVT : N SUPP : N COSTA MESA CA 92627 CONSTRUCTIO:: TYPE: 3-N PERMIT TYPE: ELE MEC PLU PUUPOSE: ADL (714 ) 646 3892 ARCHIENGIMEER: GREG PITCHER REG.NO.:NONE JOB DESCRIPTION ; ADD TO 1ST) FL/ ADD 2ND FL/ ADD TO GARAGE SQ FT : if ADDRESS: 15901 RED HILL AV UNIT: 110 TUSTIN CA 92680 CLAIM VALUE: CALC-VALUE: GROUP OCC : R-3 /M- 1 PERMITTEE: DENNIS LE SHURE ( 714 ) 646-.3892 ADDRESS: 277 23RD ST COMMENTS: REFER TO #B49121 COSTA MESA CA 92627 **s;###t.,****##tt:E******************* ***************-K****4: ****###*w3}33z>:* ###;.+:+" r; •LJCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQU IREMEN TS 7000)of DMLslon 3 of the Business and Professions Cade,and my license is in full force and effect. SETBACKS CITY LIC.: STATE lit.: CUSS: Date: Signature: - MAIN BUILDING ACCESSORY BUILDING ------ -- WORKERS'COMPENSATION DECLARATION: I hereby affirm that!have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FTS IN FRNT; FT IN REAR: FT I : h 'ampensation Insurance,or a certified copy thereof(Section 3804 Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OUCY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42608407 ZNE: REF NO; r] Certified copy is hereby furnished. ❑ Certified ' is tiled with the city Building I on. PLANNING NOTES> > //�� Date: -( '—a—*—`L/7 D APClicant: c � V. ti� #iN###***#*',:Y."#3:##ih#***##:;##i9#*#Y,"#*h*.*:.* :iia#***3E#*##iE##::*t:##**#*#*3:###*#Y***** : '::' EXEMPTION FROM WORKERS'COMPENSATION DECIMATION: (Ms section Med not be competed U the cisme is for one hundred($700)or less). - • DEVELOPMENT S E R V T l C E ,S REQUIREMENTS I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become -- ' subject to the Workers'Compensation Laws of California._ ZONING APPROVED BY - -- __ DATE; _ _ _ Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING- APPROVED BY ; DATE: _ — _--- Code,you must forthwith comply with such provisions or this permit shall be f emed revoked. • ,. /, ,, C, lf� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for thepertormance of the work for ;APPLICATION ISSUED BY; — DATE: — 2 T d which this permit is issued(Section 3097.Civ.C). **********3E***********************-*e ** 7F*****3E*********************Bit*###s CONSTRUCTION AND PLANNING POOL i.. .PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 1 2. Soil Pipe-Undrgrnd. (6:OW L./60 53. Steel Reinforcement I 3. Electrical Conduit Utility•Undrgrnd. 54. Forms • 1 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. (6J/fy 30 (ifcA 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection rait(go L, O 62. Backwash & Receptor-Finat - 12. Sewer Cap 63. Heater & Vent-Final • •13. Roof Drains i/ 64. Plumbing System - Final y/j 14. Rough Plumbing k( bit-7 65. Electrical-Final ' 15. Rough Electrical-Conduit -h 66. Solar System-Final 16. Rough Electric Wiring /•`2.4�'` 67. Fencing & Access Approval 17. Rough Wiring Sign r ! ' 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning /f�( Q( La) FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace 77 7v Gge APPROVALS Permit # I 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating WV (,0 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test ;rig Si," 72. Underground Flush IT 24. Roof Framing ` 73. Undergrnd.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 '74.qA80. FOOD CERTIFICATE ISSUED 33. Final Electric 7piII 0 , Notes: 7p2 34. Final Heating & Air Conditioning ef la bit LW ,/�___ 35. Final Gas Pipe-Test R/iZ/Q( Leo I 36. Hood or Canopy 37. Final Factory Fireplace 9/12/'T( [d�,k,�0 38. Final Plumbing ten 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45- Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date PROTECT ADDRESS: v UNIT: OWNER'S MME: • ADDRESS: PERMIT NO; EMP 049122 PLAN CHECK NO: 05864--90 N PAGE: 2 . #3E#######################################'1e####-####e:##34###K3t#Y.#3;##il##k# i:*%.*if: #i; ARCH/ENGINEER: REGMO.: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COLT ADDRESS: UNIT: PLU 2 BATHTUB 2 . 00 4 , 00 PERMITTEE: PLU 1 DISHWASHER 2 , 00 2 . 00 ADDRESS: PLU 1 LAUNDRY TUB OR WASHER 2 . 00 2 . 00 PLU 1 SHOWER 2 , 00 2 , 00 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section PLU 1 SINK, BAR 2 . 00 2 . 00 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect. PLU 1 SINK, KITCHEN 2 , 00 2 . 00 CITY LIG.: STATE UC.: CUSS: PLU 5 WASH BASIN 2 . 00 10 . 00 Date: Signature: PLU • 3 WATER CLOSET ( TOILET) 2 . 00 6 . 00 RKERS'COMPENSATION DECLARATION: I herebyaffim that 1 have a certificate of consent to selfinsure or a certificate of Workers' PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00 ° 7 cnmensation Insurance,or a certified copy thereof(Section 3800,Lab,C). PLU 1 WATER SERV ICE 2 . 0 0 2 . 00 j CYND.: EXP.DATE: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 00 COMPANY: PLU 1 GAS SERVICE 2 . 00 ... . 00 —I Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLU 2 BACKFLOW PREVENTER 2 . 00 4 . 00 END OF FEES Date: Applicant: EKEMPTiON FROM WORKERS'COMPENSATION DECORATION: (This section need not be completed if the permit is for one hundred($100)or less). I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provigions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Section 3097.Civ.C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she Is exempt therefrom and the basis for the alleged exemption.My 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(5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the 3 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that Such improvements are not intended or offered for sale. If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve Ifor the purpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or Improves thereon and who contracts for such projects 40 a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensttion Insurance should be provided to me. ❑ I am exempt under Section: B.&P.C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. iY 0 UIF•IL g r G+. yT I^ s-t' ` E-- "'-. , 01 OGO/U1i.°-91.1070291 -"f-•3- - o4, - • Date: Applicant. DATE: 00/24790 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county Vii, 0 j I - !C:`; ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: Signature: Driver's License or Social Security A: 1641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor r• J CONSTRUCTION AND PLANNIfvu ., OL 1PA 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 t. 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding. 77. FIXED SYSTEM FINAL 29. Insulation78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 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. CITY-OF COSTA.ESA CO ST` r PERMIT I r �� l r , 5263 2/17/80 5,00 TL Project Address .. r. [CV d- 13 � � / Applicant's Mailing Address �i �p �33 /7 1, em : - TYPE OF CONSTRUCTION H NEW H ADD LI ALTERATION Ld'siEPAIR Owner's Name -72YC In/' ❑ CONVERSION Cl DEMOLISH ❑ OTHER A.P.# I Zone nI Y�ei • Phonet t l� DESCRIPTION OF WORK/USE OF BLDG. Address -Y�L/'L,l,/ S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING ❑ F9UNDATION Ell STRUCTURAL E Front 0 Address /1 CI TENANT CI ELECTRICAL nv�-UMBING CI MECHANICAL B Rear N Contractor's Nam- 14/ // # p-Phone RI�Jq/10C Ell OTHER / Millr"i7- PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right N Address(mailing) i i (��` • 41 CONSTRUCTION TYPE VALUATIONS S Left City License No. �Oila R � ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E Q I hereby affirm 7 that) am licensedion under provisions Charterroi9 (commencing Remarks: Planning Notes: 7 M M with section 7000) of Division 3 of the Business and Professions Code,and VV my license is in full .r d effect. T , C 2 RECE���p FEB S License Cl.s �- i ifU;ce•�e G Date ' -.l '.•.t. Signature _� 7_ PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink ShowersELECTRICAL FEES ' hereby affirm that I have a certificate of consent to self-Insure or a certificate - _ of workers' Compensation Insurance, or a certified c ov thereof (Sectio Backflow Preventer Service Sink Automatic Washer Transformer 0 15.50 KW 3800, Lab. C) Policy No. /LH Dot COmpao Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50 5 KW Certified copy is hereby furnished. Date tied o y f led with the city Idipppyyyppp lily. /( / .� Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps Date Pt- ¢WORKERS' Applicant NDE �/(/v - EXEM ION FRSIM WORKERS'COMPE SATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Cover 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas DElectric 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-8 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 Range Lender's Name _ Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License'Law for the Lavatories Auto-Wash 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 Laundrys any structure, prior to its issuance, also requires the applicant for such permit Tra y Generator 00-5 KW❑5.15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of 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 penalty 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 ❑ sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletlon, the owner will nave the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Datei,� prove for the purpose of sale). 0 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat tractors to construct the projectSection 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 that Exhaust System 0 Multiple ❑ System Repair/Alteration BUI LDING PERMIT $ SMIP $ proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ T PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ 5. 00 ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT GRADING $ information Is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter up. the above-mentioned property for —/•� inspection ieuses ( / EO AP MECHANICAL $ TOTAL FEE $ r51 Signature -JIM/ -_ Sr Date c, e O Drivers' Licen e 0 5 of Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White . Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING POOL& SPA '' Date Inspector Date Inspector APPROVALS Permii# APPROVALS Permit # 1F'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms C"' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •--I 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. - 57. APPROVAL TO COVERSGUNITE 7. Footings .: 58. Electrical Conduit-Undrgtnd. 8. Foundation i 59. Gas Pipe, O Undrgrnd.,�'est 9. Water Pipe,Undrgrna. 60. Backwash Lines, P-Trac O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECIW / 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final 7 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 I 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# -- - 21. Ducts, in Structure 70. 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 .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 rq/bli • 39. Water Service-Final 40. Gas Service-Final v 41. Solar Domestic-Final • u , 42. Backflow Preventer •: 43. Backflow Irrigation - . 44. Landscape Irrigation System ' 45. Sound Attenuation - 46. Handicap Regulations - 47. FINA LSTRUCTURE & BUILDING 48. Special Requirements Completed , 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY _ No. Date COUNTY OF ORANGE BUILDING DEPT. 7 636 No. Broadway Permit No..__.-t'-�-- -/-- Santa Ana, California Application for Build�g Permit Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy Date 1. OWNER'S NAME_-/ y� A ^—n_ PHO GTO S 2 4C7 MAILING ADDRESS e2/ 2 - ^, //�/� CITY._ ._..__4 _ Name Name9�.f:W_`�--eX(C ntact-r-- (Architect or Engineer) (Contr ctor) Address Address�2 77 - .2 3 �0- City City w^"?..st. /?t''4-0.• State State Lic. No. Phone ��l� Lic. No. .12 / 2 re 2 Phone PROPOSED USE: 444ct1/ y4 i1//��iQ2r ire Wit �L 1 /} 2. JOB LOCATION )7 .. [-2a f/.-+r�P ( 74A ,-,A. l'-a•" (House No.) (Name/ of Street) (Town or School District)ri� 3. LEGAL DESCRIPTION: Lot 3/2J Block Tract �LCeln tg�!/ v/�1• (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( /) THROUGH LOT ( ) SLOPE OF LOT / ( ) 5. SIZE OF BLDG.: ._D.__.,Y/._.._..AREA- B.9__b,/ SIZE OF LOT-_-S3 X/3S AREA- ./ ,1'2 oD 6. HEIGHT OF BLDG • 9 CEILING HEIGHT: ____..--3" NO. OF STORIES 7. NO. FAMILIES / Size of Smallest Bedroom- ..10-se.1+S. Size of Kitchen: _ n1-tr^--- - 8. EXTERIOR WALL CONSTRUCTION: ratan•-g- INTERIOR WALL COVERING . (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street.____dr , / / a Nearest Side Yard...2.r /� Rear Yard _p..d Distance in Feet Between Bldgs. on Same Lot C22: :2 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width I/ Depth in Ground /2- Width of Wall Accessory , Bldgs. and (b) Size of Studs: at.,/1 7/ Spacing a Q n C Similar J "CC Material of Floor ....._ Structures: (c) Size of Floor Joists: _.141.4'—L... Spacing . _ "CC (d) Size of Rafters: ____.__1`,o! Spacing ....._...3.2 "CC 12. VALUATION OF PROPOSED ORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal $ 0.� 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signed:_/ t -- • `�'si a (Owner) Plans Filed• / By- (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY a e)Bldg. Permit $—41 GROUP . APPLICATION Gam/ HEALTH . FIRE Plan Check $._..t.410 4 Q TYPE ZONING.-3'1__.'__i MARSHAL Total - - - $_�,_/_S_Q DIST. PLANS AND --7-, Q C MAP C- k -- 1- �,, Receipt No. - G"� SPEC'S STATE Paid to - - -Aa1_- SHEET NO CORRECTIONS ENGINEER Date e1 'e2 AA., VERIFIED • CAL PER IC.I� d?U HUEI COUNTY BU L�, b - .-- DATE ' 5M-7.50 C COUNTY OF ORANGE BUILDING DEPT. ^ / II 636 No. Broadway v -•' Permit No _...._ Santa Ana,. CalifwApplication for Biaildi g Permit ` Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy /� Date 1. OWNER'S NAME.__`:._.. ___ 2�^-��^ /�PHOONE:l7� G C 7a MAILING ADDRESS._12 77- C . 2 .,_ CITY._SA'�' 7/AC/ Name Name 72.-1-/c• �. 2 3 City ___.. City o' /��a.- State State 2 Lic. No. Phone Lie No./ /2 Y2-1 Phone PROPOSED USE: AQ_.. ' - i 1 2. JOB LOCATION X77• • -23 A� �l�aa (House No.) `(Name of Street) (Town or School�/ ) 3. LEGAL DESCRIPTION: •Lot._...J.2 7 Block Tract✓ l�? (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR, / LOT ( X ) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG.?°.�".-44 _..AREA- 1-44 O _ SIZE OF LOT:..J. 1I)-3d AREA: _.7 `23 o 6. HEIGHT OF BLDG.: 9"- CEILING HEIGHT- O a NO. OF STORIES 7. NO. FAMILIES ____` SizeofSmallest Bedroom• Size of Kitchen: '' 8. EXTERIOR WALL CONSTRUCTION• /�4,r-&- INTERIOR WALL COVERING .__aa"-R— (Frame, Stucco, Etc.) ppyy^^ ,y� (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street L.J!__Yt+ •- - e u>�- t �' __ Nearest Side Yard i.___. Rear Yard 3.2/7-Distance in Feet Between Bldgs. on Same Lot-_.,11-411"-17--- 10. . 11.411"•-17---10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. Accessory ' For (a) Footing: Width /G Depth in Ground....ez / s ' ,♦Width of Wall , Bldgs. and (6) Size of Studs: .._ ."e1/ Spacing.____.1-o "CC Material of Floor 1-°- Similar Structures: (c) Size of Floor Joists: ..0%-en--4- Spacing "CC (d) Size of Rafters: _..._. _._r2Xi.6 Spacing 2 *11, "CC 12. VALUATION OF PROPOSED WORK-Including all-tabor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal $ 9 4.1.6.1 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE, COUNTY OF ORANGE AND THE STATETOF CALIFORNIA APPLICABLE THERETO. Signed:-_! _6 �0+--✓ Plans Filed: P_ 1 - (Owner) s By• _ (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY Bldg. Permit - $__ ___ GROUP___..-___.� APPLICATION !/ HEALTH Plan Check - $ I t..6.n_ LI , „ FIRE Total - - - $ C"d� DIST. /' . I? .... IA-- ZONING ANS AND 7��- MARSHAL Receipt No. - Q MAP C SPEC'S STATE Paid to - - /S!!!q SHEET NO -c CORRECTIONS s - ENGINEER Date q__ 11�) VERIFIED p� L1' I[ CAL t , - In1�NOHUL COUNTY F"•PERMI ,< « „DATE .0 V 5A17.50 - C METES AND BOUNDS DESCRIPTION: 7Z /c .ru r.f, s y . __e ✓�.i, „„71...,• /. ALo / :4.z..--._,40a ' j6 3•g%Ge9`' czs IO„ 20 X�30 • 4I05I0 610 - - ■ ■■ ■ MM ■.■■ ■ ■ ■■■■ ■■ ..I1 ■■: ■ ■ M ■■ Mann■MEMO .■. .N. .■■■ . . .■.. ..■.:... - •: •.. ..... ........•••.....:....::: ....C....::::■. 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