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HomeMy WebLinkAbout225 16TH PL - Building Permits . y. G' J ,tCITY OF COSTA MESA y4, BUILDING DIVISION 1.1 """s. ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER sk li ; PERMIT "'nemm V B99-01382 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 225 16TH PL Status: ISSUED Suite: - Applied: 08/30/1999 Vicinity: Issued: 08/30/1999 ' Parcel Number: 42520107 Zoning: Applicant: LEE ROOFING OF COSTA MESA ISSUED BY: Address: 1653 SUPERIOR AV CA , -Phone.' (949)642-7222 COSTA MESA r./-' _ . Zip: 92627 i Owner MCGUINNESS, FRANKA /• Address 225E 16TH PL\,'. - t Phone. - COSTAMESA'/CA • - Zip 92627 '� "„ - ' I N Contractors/ LEE ROOFING-OF COSTA MESA '''.:“'\' ,` Address: `- 1653 SUPERIOR AV �'� CA Phone: (949)642-7222 COSTA'MESA i' ' Zip: 92627.7 License:: 349686 ' Arch • •. " ' � . ' Eng: • Address: ' - ' ✓/ �" _ - •IAddress: - ' . . :Phone: ' - Phone: ` - Zip: i , ,< •'ILicense: ',, License: - > SCOPE OF PERMIT ' . ' ' , TEAR OFF ROCK ROOF INSTALL NEW TAR BUILT UP. , _ . , , / i ' FEE SUMMARY ' Plan Check: , $0.00 _ Calc Valuation: $2,965.00 Permit: . $83.25 — --- 4` ‘.„,/. i. Claim Valuation: -$2,965.00 *. SMIP Res: , $0.50 - SMIP Com: ' $0.00 ..• ' Other: $0.00 - `Inspection: ;, ,,$0.00 _ — -._ . I , . Total: . $83.75 .' . PLANNING &ZONING • SETBACKS // - - . MAIN STRUCTURE Front /0-0 Rear 0-0 Left' 0-0 _ I 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 - ' DECLARATIONS o 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. t`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. y workers'compenzs7dlion Insurance carr0er end policy number are: (, Card571Ar^c Carrier: 1'OMID �&3 ?4' 7C' Policy Number: /ZOO (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,a .ree tha if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the : >is'-1 A . TO SECUR • •- -S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EY' •' - • RIMINAL•'NAL 'S AND CIVIL FINES UP TO ONE HUNDRED 'I 3 Col I ARE(S1c0,.t q,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I her:• . at a '..used under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full .roe and el= trUC.M --- S. Class L 3 • actor's Signe .. indrf/IA� -Date: _ stir CONSTRUCTION LENDING�G NCY: - ❑ 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 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 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • O 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). O 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 ❑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? In 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 0 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 Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this Application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 Califomia 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 Califomia 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 end 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. gnature•f Legal Owner(s) Date ---'1"And/Or Authorized '1-ptic@nt l aaIB---,... CODE• . ... I A' 263 INITIALS CODE I INSPECTION TYPE �• TE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final , 208 Final Plumbing 200 Final Re-Roof qy4 t9 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 • r l • .. CITY OF COSTA MESA • I ifi BUILDING DIVISION • i,- ....\ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • k 10014 FOR INSPECTIONS CALL:(714)754-5626 M PERMIT NUMBER: BX07-00038 PERMIT TYPE B_MISC STATUS: ISSUED DATE ISSUED: 07/24/2007 ISSUED BY: BJK JOB ADDRESS: 225 16TH PL CM,,,,r . ` Suite/Unit: Vicinity: UNIT A ;;:: !' ' Primary Occ: ' ::'Const Type :?? SQ. FT: 1000 - Valuation: $0.00 SCOPE OF WORK: UNIT A INSPECTION PERMIT FOR FUTURE CONDO CONVERSION FOR PA-07-21. OWNER: TIFT, WADE . , Address:: 225 E 16TH PL - Unit City/State: COSTA MESA, CA Zip Code: 92627 Phone: 949-608-2041 , APPLICANT:TIFT, WADE Address: 225' 16TH PL Unit: City/State: COSTA MESA,'CA, . . Zip Code: 92627 Phone: 949-608-2041 CONTRACTOR: OWNER-BUILDER License No. 000000 • Address: - Unit: City/State: - . . Zip Code: .. ‘ Phone Cell: ARCHITECT: - License No. • Phone ENGINEER: License No. • • Phone - - - • FEE SUMMARY . . Building Plan Check: ' i • - . .$0:00'_- • i...: • Building Permit: '. $0.00 Electrical Permit: • -"• $0.00 SMIP Residential $0.00 - SMIP Commercial $0.00 $0.00TOTAL FEES $100.00 - • 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE II INSPECTION TYPE .o.,6_Th INTITIALS CODEI INSPECI1ON TYPE all RITUALS 1816 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Root 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 7 WORKERS'COMPENSATION DECLARATION Owner ID verified by dri nse. ❑Yes ❑ No r •+ I hereby affirm under penalty of perjury one of the owing declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the.work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsewvrk,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sedan need not be completed/the pent is valued at one hundred dollars(5100 or leu.) 2,Art 2.Sec.341.Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, 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 provisions. Applicant's Signature Date Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect, a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (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 Contractors Signature Date hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she , CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). ' information given above is correct. I agree to comply with all state laws and 0 I. as owner of the property city ordinances regarding Hazardous Materials and Emissions. . 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 Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection p ses. gree not to occupy or allow occupancy of any building authortx ythffer unj Iinspection. - T/24�s7 Signature of Legal0 er(s)_ - Dam Signature Date ]os)-a613/o97 Ana/or Authorized Applicant Date D CITY OF COSTA MESA tom- P /5ar j ,a _ l C BUILDING DIVISION • 1 V� �L �; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.w.us FOR INSPECTIONS CALL:(714)754-5626 %steina PERMIT NUMBER: BC07-00044 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: SFD_NEW DATE ISSUED: 03/28/2008 ISSUED BY: KJB JOB ADDRESS: 225 B 16TH PL CM Suite/Unit: B APN: 42520107 Zoning: , Vicinity: UNIT B Primary Occ: R3/U1 Const Type: V-N SQ. FT: 1508 Valuation: $200,000.00 SCOPE OF WORK: REVISION TO PERMIT TO INCUDE AC UNIT. CONSTRUCT NEW 1478 SF S.F.D. (671 SF 1ST FLR AND 807 SF 2ND FLR)W/ATTACHED 240 SF GARAGE FOR UNIT B.ALSO CONSTRUCT 2 PATIOS AT FRONT AND SIDE WITH A TOTAL AREA OF 136SF. REF.:G07-00022. PA-07-21/PM-07.175. MISC PLUMBING, ELECTRICAL AND MECHANICAL WORK IN CONJUNCTION WITH DWELLING. OWNER: TIFT,WADE Address: 225 E 16TH PL Unit: Phone: 949-608-2041 City/State/Zip: COSTA MESA,CA APPLICANT: TIFT, WADE Address: 225 B 1671-I PL Unit: : Phone: 949-608-2041 City/State/zZip: COSTA MESA,CA CONTRACTOR: License NO. Phone: Address: Unit: Cell: City/State: ZipCode • ARCHITECT: License No. PHONE: ENGINEER: RICHARD GROW License No.C69889 PHONE:310-335-9900 COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $1,009.94 Building Fees: $1,553.75 Electrical Fees: $175.48 Mechanical Fees: $110.05 Plumbing Fees: $203.50 SMIP Residential: $20.00 SMIP Commercial: $0.00 • TOTAL FEES: $3,072.72 "Refer to lee receipts for all fees paid for project NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28.§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODEC INSPEC11oN1YPE4�Ef (APPALS CODE[ INSPECTION TYPE A INATIAL$ 1818 Fixed System Final Fire Prevention 208 Final Mechanicalof Stour-e-l� 1266 Pool Spa Final 208 Final Plumbing for No-A C. 200 Final Re-Roof 210 Final Electrical Pay .WY. (J_p 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site J 204 Final Demolition 250 Final Building/Occupancy t ( Io p,1 WORKERS'COMPENSATION DECLARATI Owner ID verified by rlllSlicense. ❑Yes 0 No ill I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. • ;Expires: ' R 14/o8 ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required.by section 3700 of the Labor Code.for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (This section need not be completed(the pemt is valued at one hundred cbears($100)or less) 2,Aril Sec.341,Title 8,California Administrative Code). Poli Number: ❑ As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless Cissued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the wo s' compensation laws of California, and agree that if I should become ubje t to th workers'compensation provisions of Section 3700 of the L or Code I shall r0 comply with these provisions. 6/74/a$ Applicant's Signature Division of Industrial Safety Permit Number: Date AppIcnrs Si re ALL( HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code req I s,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Cost Mesa Fire ATTORNEY'S FEES. Department by every business which has at any 9netiie during a reported year a quantity of hazardous materials equal tolor gre teen a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 ubicafee of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). •� with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will thea applicant or present futur b my license is in full force and effect. PP orf 9 occupant need to file a registration form for acutely hazard t feria 7 CI Yes ❑No Lic.# Class# (Section 25533 of the Califor Hee nd Safety Code, with some exceptions, requires registrati th the Costa Mesa Fire Department by each business which at any e • e has on hand a qua of acutely Contractor's Signature Date hazardous materials eq to r gre r than a weight of 5 0 ounds, or a volume of 55 gallons, 00 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature an r ssu . ❑ I hereby affirm that there is a construction lending agency for the 3. Does r wi th ppl ant or present or future`f it i cupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). pre.-r n RM ( • Management and ehh''1111ion rogram for acutely Lender's Name: hi. ma Is)? ❑Yes ❑ (STT on 5 o the California y Code provides that the Lender's Address: Co .' .-s Fire Department r Jlre the preparation, certification and filin. •th the Fire Department of RIVRP Dy businesses which are required to re'ister acutely hazardous mate- Is wit 1f the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter. improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fcr non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? .0 Yes .0 No • thereon,and who does such work himself or herself or through his or her own 8. (If"yes",'attach certificate of compliance from.the appropriate air pollution employees, provided that such improvements are not intended or offered for control sale. Ifihowever, the building or improvement is sold within one year of officer). • comp tion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the didof build or improve for purpose of sale.). • .information given above is correct. I agree to comply with all state laws and ' I,.as owner'of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. • LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of • Signature - Dare property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractors)license pursuant to the Contractors License Laws.). certify under penally of perjury that I have read this application and state that • ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinance: re:ting to building construction, and authorize representatives of Business and Prof ssions Code for this reason: the Qity .f Co. a Mesa 'is enter u on the above-described property for insp itio purpo -s. awe: •ot tr ;upy or allow occupancy of any building autho/ized by this. it u it ra�j'.ii action. / 1041, &tri e68 5� 6/ zips Signatureor Cegat P.megs) . Da 7 305]-d6(3/07) S nater - Da t6-- - And/or Authorized Applicant Date Fiove C ro 5*14 k�rce NQS V to%.i 91 n i/Th litn‘al;°I13 +1-6.2.11-..11 A/c • un } 44.6 s ITS owl k EI-i, T b," • L — L —h Freglcc la -1 FeKQ APPROVED t CITY OF COSTA MESA PLANNING DIVISION F 1 SUBJECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, S FT k F 5 +b4�kt OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. BY 4 Vii/ DATE: 1 25/0302 Sioxtc1 / I - w, LL4 -Gc,.,...I Cunit 14. 3(.Z - .,,,.•da7 a/n,.e. cyC ✓,h,i, %oral re os•D bt. . 2"{ Sin...I ,.-v,d...�S -.:.p n. kx,s+l141Horne_ ao B „ti tJ b VJWdoUJ3 an Ise -Floor na.OHIMj CITY OF COSTA MESA J A BUILDING DIVISION F '-i) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 4. ��'`' FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: BC07-00044 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: SFD_NEW DATE ISSUED: 03/28/2008 ' ISSUED BY: KJB JOB ADDRESS: 22513 16TH PL CM Suite/Unit: B APN: 42520107 Zoning: , , , ' Vicinity: UNIT B • Primary Occ: R3/U1 Const Type: V-N SQ. FT: 1508 , Valuation: $200,000.00 SCOPE OF WORK: CONSTRUCT NEW 1478 SF S.F.D. (671 SF 1ST FLR AND 807 SF 2ND FLR)W/ATTACHED 240 SF GARAGE FOR UNIT B.ALSO CONSTRUCT 2 PATIOS AT FRONT AND SIDE WITH A TOTAL AREA OF 136SF. REF.: G07-00022. PA-07-21/PM-07-175. MISC PLUMBING, ELECTRICAL AND MECHANICAL WORK IN CONJUNCTION WITH DWELLING. OWNER: TIFT,WADE Address: 225 E 16TH PL - Unit: Phone: 949-608-2041 City/State/Zip: COSTA MESA,CA. APPLICANT: TIFT,WADE • Address: 225 B 16TH PL Unit: : • ,1• •i lit •Phone: 949-608-2041 • City/State/zZip: COSTA MESA,CA CONTRACTOR: License No. Phone: Address: Unit: Cell: • City/State: ' - ZipCode ARCHITECT: - - License No. PHONE: ENGINEER: RICHARD GROW i License No.C69889 PHONE:310-335-9900 COMBINTATION PERMIT-FEE SUMMARY • Building Plan Check: $1,009.94 . Building Fees: . $1,553.75 , Electrical Fees: $175.48 (.•:.c-. Mechanical Fees: - $81.55 - - Plumbing Fees: $203.50 SMIP Residential: $20.00 SMIP Commercial: $0.00 .. TOTAL FEES: $3,044.22 . .- , **Refer to fee receipts for all fees paid for project 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. . - CODE O. INSPECTION TYPE DATE IN1111ALS CODER INSPECTION TYPE DATE INTf11ALS 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 WORKERS'COMPENSATION DECLARATION. Owner ID verified by dn.. s lice,.__. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: El I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed if the permit is valued at one hundred dollars(3100)or less) 2,Arty Sec.341,Title 8,California Administrative Code). Polio umber: ❑ As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safely,as noted above, unless Is ed, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become ect to t workers' compensation provisions of Section 3700 of Applicants Signature Date the eab r Co .I shat ortt comply with these p ovisl�ns. � / 3I tit( Cr]/ Division of Industrial Safety Permit Number: LApplicant's Signa re Date -j HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes El No Lic.# Class# (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 Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? CIYes CINo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and canrI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of osta Mea to enter upon the above-described property for inspection .urp,.ses. I Tee n t gar occupy or allow occu.ancy of any building / authori ed bythl p- mi nti i I spection. O . ' r^h Q I _ __ .fit i lir� II L/O • !_ - -.ure of Le 0 r(s) (Dae ,Signature �_ 3057-46(3/07), ---- _Dat , And/or Authorized Applicant Date . 6-%001 .P°1S 4;4 ' • NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 6832 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: (t City of Costa Mesa District Receipt No.1-21)3A0 ( ) City of Newport Beach r,7,��� ci ( ) Countyrf ofOrange � Plan Check No. Applicant: aJ. '/ ,'' cr Address: as S / ill Idj � * Telephone Number L(� ((T% - (poll- GY Q 6/ Tract/Parcel and Lot Number(s): )5- 6201 - 07 Location of Project: Number of Square Feet of � y, Residential Space /4/7 7 O x $1.84 Total & /-7 / I . S c� Commercial and Industrial Space x $ .30 Total CommerciaVIndustrial Project is: (Check One) Warehouse _ Motel _ Preschool R & D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage Racquet/Health _ Large Office Heavy Industrial Hotel Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. // By: XcC //k1 Authorized Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that ch representations are not true,then this certificate shall automatically terminate and the appro ate ' /Cou shall be notified. Date: 3/Z-d/�08-1 deg ki • 03/25/2008 10:16 FAX 1 949 608 2003 ..Grubb..& Ellis a 002 03/25/2008 10:27 FAX 7147544F-^ • [?J�02/002 ' 9 Z8 CITY OF COSTA MESA 28-1200 P.O.80X 1200 •S0,,„404. ro1m1 • FROM THE BUILDING DIVISION Date: 3/28/66 Attention: v/r 7/N/+C//1 , Grading Inspector Subject: Civil Engineer's(Architect's)Grading Grading�Certification 7 Reference Project: Grading Permit No.`T 07 8 d G Z Address 2.0C /G PlACC C05721 NTS/4, eq 7267/ Tract No 4N 412S-2°/-D2Lot(s) .53 , inclusive Permitted Yardage: Cut .5O yt3; Fill SO yrr I hereby approve the rough grading for the referenced OR I hereby approve the final grading for the project in accordance with my responsibilities under referenced project in accordance with my the Orange County Grading and Excavation Code. responsibilities under the Orange County Rough grading has been completed substantially in Grading and Excavation Code. Final grading has conformance with the approved grading plan which been completed substantially in conformance includes: Line and grade for all engineered drainage with the approved grading plan which include: devices (graded and ready for paving or Completion of all engineering drainage devices construction), staking of property corners for proper and retaining walls, setting of all monuments in building location, location and inclination of all accordance with the recorded tract map, location slopes, and construction of earthen berms and and inclination of all manufactured slopes, and positive building pad drainage. (All exceptions must construction of earthen berms and positive be noted.) building pad drainage. (All exceptions must be The volume of earth materials moved by cut and/or noted.) fill grading (agrees)/(does not agree) with the All structures constructed on property corners or permitted yardage stated on the grading plan. The property lines, and where monumentation is not revised volumes of material moved are: Cut_,yr' required, have been located in compliance with natural fill yr' borrow_yr' theapprovedplot plan. A 16. _ \ (12.0.E. k C`932/q�9 ) (A.LA. fi Ire alurc ) CQOEBrkll ,Ge/'OA> /S SQ-SEa DN 5L!/ ve ' NG ,e0/0,4, r � i e BY �Avitko ail-gee-7 e irt N d• 70 3n°° * 18)I4t OFC odpir 77 FAIR ORIVE { PHONE: (7)4)754-5273 • 100 (714)754-5214 - WWW.ci.cosu-mesa.Ca.us • • a,3S`p"FSS CITY OF COSTA MESA F l) CALIFORNIA 92628-1200 P.O.BOX 1200 �a4 o14'x. FROM THE BUILDING DIVISION Kit: Date: Attention: 1 �4t: I2/1/1 4-r 0 , Grading Inspector Subject: Civil Engineer's (Architect's) Grading Certification Reference Project: Grading Permit No. em -0000:a_. Address n 5 /1,711 P4Aer Tract No. Lot(s) , inclusive Permitted Yardage: Cut yr'; Fill yr' • I hereby approve the rough grading for the referenced OR I hereby approve the final grading for the project in accordance with my responsibilities under referenced project in accordance with my the Orange County Grading and Excavation Code. responsibilities under the Orange County Rough grading has been completed substantially in Grading and Excavation Code. Final grading has conformance with the approved grading plan which been completed substantially in conformance includes: Line and grade for all engineered drainage with the approved grading plan which include: devices (graded and ready for paving or Completion of all engineering drainage devices construction), staking of property corners for proper and retaining walls, setting of all monuments in building location, location and inclination of all accordance with the recorded tract map, location slopes, and construction of earthen berms and and inclination of all manufactured slopes, and positive building pad drainage. (All exceptions must construction of earthen berms and positive be noted.) building pad drainage. (All exceptions must be The volume of earth materials moved by cut and/or noted.) fill grading (agrees)/(does not agree) with the All structures constructed on property corners or permitted yardage stated on the grading plan. The property lines, and where monumentation is not revised volumes of material moved are: Cut yr3 required, have been located in compliance with natural fill yr3 borrow yr3 the approved plot plan. (R.C.E. # ) (A.LA. # ) Signature RAD EZ" ,$f. 33 / - oaf --. i3 t//LO iil 67i✓dlo,,,,p ' Ago g. 3�� `. LL,, ,, P.L.S.6723 I ,% 45...e- Cy 2971.46 3/' 5 ?- 77 FAIR DRIVE PHONE: (714)754-5273 • TDD: (714)754-5244 • vmw.ci.wsta-mesa.ca.us • Page 'f of 7 STRUCTURAL OBSERVATION REPORT FORM Report No. Structural Observation means the visual observation of the structural system,for general conformance to the approved plans and specifications,at significant construction stages and at completion of the system. Structural observation does not include or waive the responsibility for the inspections required by Section 108,1701 or other sections of the code. This report includes all construction work through 30th day of April , 20 08 Project Address: Structural Observer of Record Phone No.of SOR 225 16th Pl. (SOR) COSTA MESA,CA 92627 ANDY A.GHAZLANI (949)756 9700 Building Permit Structural Observation performed Professional Lic/Reg.No.of Phone No.of Observer �COjQQo C{(` by- ANDY A.GHAZLANI Observer C 60867 (949)756 9700 • OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED, IF NOT WHOLE • ❑Footing,Stan Walls 0 Concrete 0 Steel Moment Frame 0 Concrete. ❑Mat Foundation . 0 Masonry 0 Steel Braced Frame 0 Steel ❑Caisson,Piles,Grade 0 Wood 0 Concrete Moment Frame 0 Wood Beams • ❑Retaining Foundation ❑Other 0 Masonry Wall Frame 0 Others: Hillside Special Anchors ❑Others: 0 Others: • Observed Defcleneks: - '4 v • 0 - r • 1 . • ' (IQ cJov . 0A al. rod i•el00i Re.Of S(_GG') (( • 00,4 I declare that the following'statements are true to the best of my knowledge: I am the engineer or architect retained by the owner to be in responsible charge for the structural observation in accordance with the requirements of the County of Orange. 1. I,or another engineer or architect who I have designated above and is under my responsible charge,has performed the required site visits at each significant construction stage to verify if the structure is in general conformance with approved plans and specifications. 2. All deficiencies which remain to be corrected have been indicated above. 3. I recommend that acceptance of the structural systems by the County of Orange be withheld until all observed deficiencies are corrected. Signature: Date L(. 'l'D a P��GF:5SIp;�ry`., Form No.003 /Q/y GHni��, �2 n m "ti" �� PJC 6nAe 1; • " •! f��XG l���_ {Ir , `./ CITY OF COSTA MESA 010 BUILDING DIVISION 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. Ifs. 00022 e. FOR INSPECTIONS CALL: (714)754-5626 ca GRADING PERMIT Job Address: 225 16TH PL Status: ISSUED. __. _ Suite: Applied: 07/24/2007 Vicinity: Issued: 12/10/2007 • Parcel Nunmber: 42520107 • Zoning: - - • Applicant: SMITH, BRAD • Address: Phone: 949-631-3682 Zip. Owner: TIFT, WADE • Address 225E 16TH PL . • Phone:- 949-608-2041 COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: • Zip: License: . • Eng: MIKE ZCAJKOWSKI Address: Phone: 714-928-6220 Zip: License: • • SCOPE OF PERMIT CUBIC YARDS GRADING•IN•CONJUNCTION WITH'THE CONSTRUCTION OF A NEW 1508 SF SFD W/ATTACHED SF GARAGE FOR UNIT B. REF: B007-00044 CUT 50CY, NO FILL. PA-07-21/PM-07-175 50 • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $25,000.00 $0.00 Permit: $0.00 Other: $0.00 $0.00 Inspection: $0.00cnn c NOTICE: The work authorized tS�atrs permit shall comply with all applicable handicap access requirements under California statutes and related regulations,(Ord. No.92-28, §qq1�, 12-21-92)5rl EXPTS9P1bN: PERMIT EXPIReS�1D0 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INS the-work-e .. ' . .. ii�1 Iyf1 -fl ... • . .• . • ,� - -.. +:. - •.es, an. a required inspections and final approval must be obtained. Fail ':St =: ?-�'ulfk.:final approval will result in the expiration of this permit. CODE NOM1104 TYPE DATE INTTOALS GODE1 INSPECTION TYPE DATE, INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical : ::HED 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 1—�It,t 204 Final Demolition 250 Final Building/Occupancy l-0 Y WORKERS'COMPENSATION DECLARATIO . •' ., Owndr ID verified by dnnse. 0 Yes ❑No I hereby affirm under penalty of perjury one of the following declarations:• - Driver's License No. xpires: $`14--�D ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for tbua---r performance of the work for which this permit is issued. / ❑ I have and will maintain workers'compensation insurance,as required by • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be comaetedethe permit is valued at one hundred dollars(5100)ot less.) 2,Art 2.Sec.341,Title S,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Apppynt's Signature Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (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 Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 55850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes".the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application.have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If yes",attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and VI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspecti•n p .•s•.. I agr-1 not tit o cupy or allow occupancy of any building r, �authori• d • this p-rmit un fin- �Nection. / /-(DItO o7 Signature of Legal Owner(s Da_411 Ite Signature Date/ 3057-4613107) And/or Authorized Applicant Date 03/25/2008 10: 16 FAX 1 949 608 2003 Grubb & Ellis 4002 03/25/2008 10-27 FAX 7147544850 CEJ 002/002 r • cO'r oCITY OF COSTA MESA _ . f 1�� CALIFORNIA 82029a 2Ga P,O.aOx 1200 ��• w,o,.,•�`� FROM THE BUILDING DIVISION Date: 328jU� / �- " Attentions r'�t 77/1/4-C,yI ,Grading Lispector Subject Civil Engineer's(Architect's)Grading Certification Reference Project: Grading Permit No. so7---276cC Z Address 7 ZC /6 I .P/A et i.:D sM 1tt-C C. 72(7/ Tract No.,4FN demc-e20/-0/Lot(s) ,3 inclusive Permitted Yardage: Cut Se) yr3; Fill SO yr3 I hereby approve the rough grading for the referenced OR I hereby approve the final grading for the project in accordance with my responsibilities under referenced project in accordance with my the Orange County Grading and Excavation Code. responsibilities under the Orange County Rough grading has been completed substantially in Grading and Excavation Code. Final grading has conformance with the approved grading plan which been completed substantially in conformance includes: Line and grade for all engineered drainage with the approved grading plan which include: devices (graded and ready for paving or Completion of all engineering drainage devices construction), staking of property corners for proper and retaining walls, setting of all monuments in building location, location and inclination of all accordance with the recorded tract map, location slopes, and construction of earthen berms and and inclination of all manufactured slopes, and positive building pad drainage. (All exceptions must construction of earthen berms and positive be noted.) building pad drainage. (All exceptions must be The volume of earth materials moved by cut and/or noted.) fill grading (agrees)/(does not agree) with the All structures constructed on property corners or permitted yardage stated on the grading plan. The property lines, and where monumentation is not revised volumes of material moved are: Cut yr' required, have been located in compliance with natural till yr)borrow Yr) the approved plot plan. • L. . (R.C.E. N C c7 S Z 71k7 ) (A.I.A. g • ) Si R alurc Q4OFssqtrhiS RCTOOf is � yl,C a' S/eRvE4/ 6feFog- r w � �o44 �rl Fyo 6 / MAPHt'h) A';t&ct7 a 3 No.00azwe a Sn Gr•6'. N 0, 6 7Z 3 Exp.0630/06 MP As 13 CIVIL Adotifre OFCAI>F 77 FAIR DRIVE PHONE: (714)75•-5273 • TOO (714)754-6244 • ww+r.41.406l9-me)12.W.u6 , °5�Q"FSQ ,< CITY OF COSTA MESA F i ��8a CALIFORNIA 92626.1200 P.O.BOX 1200 .e04;.--2.7-.-, FROM THE BUILDING DIVISION �{/� / Date: ' Attention: 1 ,�A_ If/Yl �'GR._ . Grading Inspector Subject: Civil Engineer's (Architect's) Grading Certification Reference Project: Grading Permit No. Gni -O00a Address 2Z 5 471 I a eeTract No. Lot(s) , inclusive Permitted Yardage: Cut yr3; Fill yr' I hereby approve the rough grading for the referenced OR I hereby approve the final grading for the project in accordance with my responsibilities under referenced project in accordance with my the Orange County Grading and Excavation Code. responsibilities under the Orange County Rough grading has been completed substantially in Grading and Excavation Code. Final grading has conformance with the approved grading plan which been completed substantially in conformance includes: Line and grade for all engineered drainage with the approved grading plan which include: devices (graded and ready for paving or Completion of all engineering drainage devices construction). staking of property corners for proper and retaining walls, setting of all monuments in building location, location and inclination of all accordance with the recorded tract map, location slopes, and construction of earthen berms and and inclination of all manufactured slopes, and positive building pad drainage. (All exceptions must construction of earthen berms and positive be noted.) building pad drainage. (All exceptions must be The volume of earth materials moved by cut and/or noted.) fill grading (agrees)/(docs not agree) with the All structures constructed on property corners or permitted yardage stated on the grading plan. The property lines, and where monumentation is not revised volumes of material moved are: Cut yr3 required, have been located in compliance with natural fill yr3 borrow yr3 the approved plot plan. (R.C.E. # ) (A.I.A. # ) Signature ?4.9 ez /19/. 33 +(—• o0 ' ._. • -0.0. ¢Ucreb Sit avrs ioy' .aa!+ 8✓ua0'41$ ae VaPPC" .r .• CrCt .4?-',...51 r;;;".-113'5E� . 1. . 1 .N' y i A tif ' di v 3/47,6 VA .,,8:. 1,i1.11‘T..0) 19(5 ,1-1 / 297 1.46 ., 5.:— 77 FAIR DRIVE PHONE: (714)754-5273 • TDD: (714)754-5244 • wew.ci.costa-mesa.ca.us • \ r \ • CITY OF COSTA MESA BUILDING DIVISION F4 �Ai 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us arca . FOR INSPECTIONS CALL: (714)754-5626 rat PERMIT NUMBER: BX07-00236 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42520107 DATE ISSUED: 11/19/2007 Zoning: ISSUED BY: RMD JOB ADDRESS: 225 16TH PL CM Suite/Unit: Vicinity: REAR OF EXISTING S.F.D. -Primary.Occ: 32 Const Type :?? SO. FT: 180 Valuation: $15,000.00 SCOPE OF WORK: CONSTRUCT 180 S.F. CARPORT ATTACHED TO EXISTING S.F.D. INCLUDES 1 OUTLET AND 1 LIGHT FIXTURE. OWNER: TIFT,WADE Address:: 225 E 16TH PL Unit City/State: COSTA MESA,CA Zip Code: 92627 Phone: 949-608-2041 �j !9�t A PLICANT: TIFT,WADE ate: ZAddress:ip Code: ■-IXTENSION Phone: 949-608-2041 ALLO O \ 9 CONTRACTOR: License No. - Address: Unit: PER e r City/State: • Zip Code: Phone EXPIRES i/ azo- ARCHITECT: ARCHITECT: BRADFORD C SMITH,ARCHITECT _ License No. C14146 Phone 949-361-3682 ENGINEER: License No. Phone • FEE SUMMARY Building PIan.Check: _ $163.31 Building Permit: $251.25 • Electrical Permit: $25.70 SMIP Residential $1.50 ip R SMIP Commercial • - $0.00 $O.00TOTAL FEES $441.76 3 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTION TYPE DATE IN1111ALS CODES INSPECTION TYPE DATE INTDIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing L' T 200 Final Re-Roof 210 Final Electrical 1`Le6bp, 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign • 222 Final Site i 1 l� t .,,, 204 Final Demolition 250 Final Building/Occupancy 4 tV?, �,^"'\ WORKERS'COMPENSATION DECLARATIO. Owner ID verified by dn,_s II. J. Yes ❑NoNo I hereby affirm under penalty of perjury one of the following declarations: Driveris.License No. CET -4-08 I' 0 I have and will maintain a certificate of consent to self-Insure for workers' CVerifioation of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition artier:) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp '(rhos: tie eed not be....toted Athe peon,is valued at one h - dollars($f00)or less) 2,M2 Sec.341,Title B,California Administrative Code). Policy. ober: a a _ ❑ As owner-builder, I will not employ anyone to do work which would Ci'7I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should beco bject to he workers'compensation provisions of Section 3700 of Applicant's Signature Date th L... ode I s III Ith comply with these provisions. - l l l i9 J61 Division of Industrial Safety Permit Number: Apl>Urant's Si store D - L— —, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# Class# (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 Contractors Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjurythat I am,EXEMPT-FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW.for the,following'iea'son (Sc::e7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code::Any,city or,county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter,,,improve, demolish,`or repair any'structure,'prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested that he or snails licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If"yes',attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control officer. 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Cldid of build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and y, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Me a to enter upon the above-described property for inspectipn p po-es. I .%ree not occupy or allow occupancy of any building authorised . thi- i° nti nspection. rijC).0.4 .: �� - - � r-li� 19 07iliti 10' - Signature of Legal Ow r(s) `_- Dale'' `Sig aWre (�Dat 3057-06(3/07) Andlor Authorized Applicant Date o�p MFS CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 If 1 ;I / 2 *V dr' DEVELOPMENT SERVICES DEPARTMENT hC�RPONPhO New State Law: Swimming Pool Safety Act of 2006 (Assembly Bill 2977) Effective January 1, 2007 California Health and Safety Code Section 115928 "(d) Whenever a building permit is issued for the remodel or modification of a single family home with an existing swimming pool\ toddler pool, or spa, the permit shall require that the suction outlet of the existing swimming pool, toddler pool, or spa be upgraded so as to be equipped with an anti-entrapment cover meeting the current standards of the American Society for Testing and Materials (ASTM) or the American Society of Mechanical Engineers (ASME)." Address/Permit Number Permit Applicant or Contractor's Affidavit (Please check appropriate box): ❑ There is an existing swimming pool, spa, or toddler pool on this property. I will install an anti-entrapment device that conforms to this law, and I understand that the installation of this device is required prior to final building inspection approval. IV/There is no swimming pool, spa, or toddler pool on this property. Name(please^ print) U\\ `tEi ^ If I 19 f-7 Signature ate Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • ww.v.ci.costa-mesa.ca.us 05/28/2008 12:18 FAX 1 949 608 2003 • Grubb & Ellis 4100z 0 Eck ?e S T ce.cboe5fi aV1 C .#C-ns\av-‘. Q.. pe w tt 4 . 16X 0-7_ Oo23(a —On a h ,c v ka.0 ye."Nnne t CS re. ^4'0 van, cic 44 6 a 7 - 0°044'4 :ton WNIkc.i .4- VS Cuc'eake•liy Ordair ConS+Yocin cP.. av& Ltt neck- is ( � Sro 4 a �Q Qv-urn-L-44% Co vn vtf�(l GE'. Vr�+�� COY✓'pRc'-en � S aWt Q.S . kv� e�c�eis.on WV) C.11. u�ll \ c \l. � Q ager i unties -1/22 cowl-Q.4-1c J00 WI Netts s vo ;2-. S lla Cosmo Mesa. Cvt Lo — OLfle (L na45 Li a Og 2-04-1t `� CW 17 aV V 15l)2-Sil-Cn�S o f Cs a �e ✓SS . Y �tt s . CIYY OF COSTA MESA z , BUILDING DIVISION FX .Ai 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us tFOR INSPECTIONS CALL: (714)754-5626 a o' PERMIT NUMBER: BC07-00438 • PERMIT TYPE: B_COMBO %: ! / -/ STATUS: ISSUED o Sub Type: RES_RRIP mil /DATE/ISSUED: 12/10/2007 • , `i ISSUED BY: CAC I JOB ADDRESS: 225 16TH PL CM -- - Suite/Unit: APN: 42520107 - Zoning: , Vicinity: - •• ' • Primary Occ: Const Type: V-N SQ. FT: 0 Valuation: $6,000.00 SCOPE OF WORK: 01/03/08 REVISION: ADD ANOTHER 200 AMP SERVICE METER. DEMOLISH EXISTING GARAGE AND RELOCATE THE SUBPANEL AND METER. PANEL TO BE UPGRADED TO 200 AMP, 1 DISHWASHER 1 VENT FAN FOR LAUNDRY OWNER: TIFT,WADE _ Address: 225 E 16TH PL Unit: Phone: 949-608-2041 City/State/Zip: COSTA MESA,CA APPLICANT: TIFT,WADE Address: 225 E 16TH PL Unit: : Phone: 949-608-2041 City/State/zZip: COSTA MESA,CA CONTRACTOR: OWNER-BUILDER License No. 000000 Phone: Address: Unit: Cell: City/State: - - ZipCode ARCHITECT: • License No. PHONE: ENGINEER: - . - License No. - . PHONE: COMBINTATION PERMIT FEE SUMMARY - . �'" '�,*J' 1 . i a�� Building Plan Check: - - I_ '$81.41 - V L L?;Idw' Building Fees: . $125.25 . DATE: Electrical Fees: $115.00 Mechanical Fees: • $30.75 - • Plumbing Fees: $33.30 • SMIP Residential: $0.60 SMIP Commercial: $0.00 - • TOTAL FEES: $386.31 . —Refer to fee receipts for all fees paid for project 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODES. INSPECTION TYPE DATE IN1111ALS CODES INSPECTION TYPE ATE IN1111ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final . 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical M 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 i Z f i 1/6 O (, +4e/1 WORKERS'COMPENSATION DECLARATION. ,Owner IRverified by driver's licL . 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: (Driver's License No. empires,- $-4-og ❑ I have and will maintain a certificate of consent to self-Insure for workers' `Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feel in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm (This sector:need not be completed if the permit is valued at one hundred Collars($100)or less.) 2,Art 2Sec.341,Title 8,Califomia Administrative Code). Polic Number: ❑ As owner-builder, will not employ anyone to do work which would C,tel certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become --'ect to the workers'compensation provisions of Section 3700 of the a r• e,I s.11 f•r. with comply with these provisions. vapplicants Signature Date 11 31 o Division of Industrial Safety Permit Number: �_ _App .nfs'Egnalure _ ( 6 e_� HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be fled with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (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 Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors (Section 65850.2 of the California Government Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications fix non-residential building permits). Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Qualify Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the didnot build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and (LM'/_I,-as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of osta Mesa to enter upon the above-described property for inspectio •ure.ses. I -- ee not to occupy or allow occupancy of any building JQ� auth•rizer by thi permit{' :gait inspection. n _ L._ tua� _Date , Ir�J-�.V p >_�— ignature of Legal 0 •eqs) t_Date ----- —Signature - - 3057-46(3/07) And/or Authorized Applicant Date . 1, CITY OF CVSTA MESA ' •c v, BUILDING DIVISION 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us Vi ,,,,,, FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: BC07-00438 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: RES_RRIP DATE ISSUED: 12/10/2007 ISSUED BY: CAC JOB ADDRESS: 225 16TH PL CM Suite/Unit: ;13 APN: 42520107 Zoning: , , NINE Vicinity: Primary Occ: Const Type: V-N SO. FT: 0 Valuation: $6,000 SCOPE OF WORK: DEMOLISH EXISTING GARAGE AND RELOCATE THE SUBPANEL AND METER. PANEL TO B PGRADED TO 200 AMP 1 DISHWASHER 1 VENT FAN FOR LAUNDRY OWNER: TIFT,WADE • Address: 225 E 16TH PL Unit' Phone: 949-608-2041 City/State/Zip: COSTA MESA,CA APPLICANT: TIFT,WADE Address: 225 E 16TH PL Unit: Phone: 949-608-2041 City/State/zZip: COSTA MESA,CA CONTRACTOR: - License No. Phone: Address: Unit: Cell: • City/State: ZipCode ARCHITECT: • License No. PHONE: ENGINEER: License No. PHONE: COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $81.41 Building Fees: $125.25 Electrical Fees: $84.50 Mechanical Fees: $30.75 Plumbing Fees: $33.30 SMIP Residential: $0.60 SMIP Commercial: $0.00 TOTAL FEES: $355.81 **Refer to fee receipts for all fees paid for project 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE I. INSPECTION TYPE DATE, INIMALS CODED INSPECTION TYPE DATE INTITIALE 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 BuildingfOccupancy WORKERS'COMPEIISATION DECLARATIG. Owneri • . is li.. Yes ❑No ' o I hereby affirm under penalty of perjury one of the following declarations: j �(S�e No. . pires: `/S-q'Oa ❑ I have and will maintain a certificate of consent to self-Insure for workers' -enfication of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized r . �. by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: b e . •"• or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (This sedon needrrot becompleted rf the permit is valued at one hundred dpdars($100)w less.) 2,Art 2.5cc.341,Title B,California Administrative Code). Policy Number: -- — ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safely,as noted above,unless issued, I shall not,emat=d any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicants Signature Date the Labor Code,I shall•forihwith comply with these provisions. Division of Industrial Safety Permit Number: Applicants Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL"ANDP.SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES ANDtCML FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE• INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby afftrm•that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of:Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑ No Lic.# Class# (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 Contractors Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control officer 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and CI I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Dote property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and •rofessions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection p ses. I a• ee not to occupy or allow occupancy of any building authorized permit .ntil fa ui spection. t V 1 e 7 Stgnatu r(s) \.LV'e 3051-46(31r J Dal And/or Authorized Applicant Date 12. ) 2o /57 ..ex4cWto =1 ce. ,,es-F an - 3„1�R �er .-t SBC - Orl Ooo4cif _ tML1 R2.Jk-1/4.t cAcJosL D �c..�.h•� JQs co51 1wlc5c,_ CA y9 - (0O9 - 2oq apciwahn o /tslog._. ,9c da `_" 4 �� nu; . • CITY OF COSTA MESA q` BUILDING DIVISION F I a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J• ' PERMIT gkdboarsd M04-00601 (714)754-5273 • Fax(714)754-4456 • www.cLcosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 225 16TH PL Status: ISSUED Suite No Applied: 11/12/2004 Issued: 11/12/2004 Vicinity: / Parcel Number: 42520107 ISSUED BY: ///, A Applicant: KJUE, JOHN Address: 10682 TRASK AV Phone: 714-539-0682 GARDEN GROVE,CA Zip: 92843 Owner: MCGUINNESS, MARGARETE Address: 225 E 16TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: GT CONSTRUCTION Address: 10682 TRASK AV Phone: 714-539-0682 GARDEN GROVE,CA Zip: 92843 License:763425 SCOPE OF PERMIT CHANGE-OUT OF 2 WALL HEATERS IN AN EXISTING SFD. 2 INST/REP RECESSED WALL HTRS NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY • Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 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 $29.60 2 Commercial Incinerator $0.00 0 Refdg Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refdg 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 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)154-5626 244846(6/%) 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 lork for which this permit Is issued. Er I have and will maintain workers'compensation Insurance,as required by section 3700 of the tabor Code,for the performance of the work for which this permit Is issued. My workers' pp nsatign Insurance carrier and policy number are: Cartier: S / � FN yr e_ Policy Number: / ( Z 7 / 3 - 2 bG 4j (This section need not be completed if the permit is valued at one hundred dollars(.8100)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 Califomia,and agree that If I sh uid become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those pmvisio Applicant Signature: Date: / / I- - Cf.Ci WARNING:FAILURE TO SECURE WORKERS' PE ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0X),IN ADDm 0 THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u der provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business a0g Professions Code,and my license Is in full force and effect.Uc.p 7 K 3 4., 5 /� �j Class M Business, Contractor's Signature: -/y i / I {'`—`F— Date: //-7Z` a CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense 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(5500).): ❑ 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 drivers license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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 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? ❑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 ❑No (Section 25533 of the California Health end 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 end Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aRermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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 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 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. Signa ur' sf Legal Ow •ir(sAle Date A d/Or • . !rize• ••plicant Date 61E INSs TYPPATE IKIRIALS 206 FinalINSPEec nE <C� _ �ff 1� ^� 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 bb CITY OF COSTA MESA • REFUND REQUEST FORM From: ❑ Finance Vendor#: ® Building Safety Permit#: M04-00658 ❑ Planning Amount: $ 53.10 ❑ Public Services ❑ Community Services Date: 12/28/04 ❑ Otherly aas /G VN Depart ient> nam lure Account Fund Organization Program Project/Grant Amount 415150 101 18300 20410 $53.10 _ Name and address of applicant: ALLIED PLUMBING, HEATING AND NC 422 JENKS CL_ CORONA, CA 92880 Phone: 714-998-4300 C! 0. h 1 \ } 7i:- <1- Appliceift's Signature Date REASON FOR REFUND: M04-00658 WAS ISSUED IN ERROR. THIS IS A DUPLICATE PERMIT FOR WORK COMPLETED UNDER M04-00601. APPROVALS: Finance: City Manager: 2401-22 MW ONLINE Sent By: R&K AIR COND. INC. ; . is 909 278 0691 ; Dec-28-04 9:58AM; Page 2/2 J a. y AMERICAN RESIDENTIAL SERVICES, INC. 4 I- - x 1 a i I To whom it may concern: 1 x a American Residential Services requests to witdraw permit for hvac installation of two wall furnaces. Due to the fjct that this is a duplicate permit please reference permit # m-0400601 i ,r all inspections. At this time American Residential Services is reques .ng a refund for the permit pulled by Contractors Choice permit lervice. 7 Wade Tift v. 22516`h Place Costa Mesa Cal. • 9 ,f • MOLA- 0010 h` Sinc ly Cm u er if ARS Install Manager Z a i tl Fl 4 i i g 11 22911 SAVI RANCH PARKWAY #YORRA LINDA, CA 92887 *!I4/998-4300 * FAx 714/998-7652 , y 4`5w9 'CITY OF COSTA MESA �`[- BUILDING DIVISION IF ,,,,,a� , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0• PERMIT s °`b4aam�o fi MO$ 00668 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 225 16TH PL Status: ISSUED Suite No Applied: 12/09/2004 Issued: 12/09/2004 Vicinity: ISSUED BY: Parcel Number: 42520107 Applicant: LAURA YENULONIS Address: 422 JENKS CI Phone: 714-998-4300 CORONA,CA Zip: 92880 Owner: MCGUINNESS, MARGARETE Address: 225 E 16TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: ALLIED PLUMBING - HEATING -AIR CONDITIONING Address: 422 JENKS CI Phone: 714-998-4300 CORONA,CA Zip: 92880 License:610780 SCOPE OF PERMIT C/O OF 2 35000 BTU WALL FURNACES. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 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 $29.60 2 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 i 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 Fumace $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 $53.10 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 . 2446461&00) DECLARATIONS 0 ' • - I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I •:ye 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 ork 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. workers'compensatio. Insurance carrier and policy number are: /� ��kt` •. •-. umber: ={3�1ED-L2?-o\ section need not be completed if the permit is valued at one hundred dollars($100)or less.) O I certify that in the ertormance 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith co ith these pr isions. �/'�) /� Ap azure: A Q fl Jh 1.X-�y�n A ,Q �BEfa: 1 a^ 1- T WA . AILURE TO SECURE WORKERS'COMP COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10p000),IN ADDITION TO E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereb am Nut(under rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Bu -. .nd Professi.ns Code,and my license Is in full force ' # ass# roil • C ractor's Signature: .. .. 'a. -9-o4 CONSTRUCTION LENDING AGENC ❑ 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ 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 ❑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? ❑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? ❑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 agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI 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). 8 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 ❑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 ❑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. ^ 3tpe :(si /fl�J 6 C OE 0, INSPECTION TYPE DATE. INTrfIALS CODE It lN$PEGTIDN TYPE RAIF INTITIAL$ I6"3 Fixed System Final Fire Prevention 206 Final Mechanical 126C 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 PROJECT ADDRESS: 225 E 16TH ST UNIT: CITY Or COSTA MESA — ,BUILDING PERMIT PERM NO: P 044689 OWNER'S NAME: ALAN BALDWIN ' ' moms: •225 E 16TH ST PERMIT. NO: P 044689 ;PLAN CHECK NO; - N GOVT • : 'N SUPP: N . CONSTRUCTION TYPE: PERMIT TYPE; 'PLU PURPOSE.: ALT ' •ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : GAS LINE & WATER SERVICE • SQ FT: ' ADDRESS: UNIT: • ' CLAIM VALUE: CALC—VALUE: - GROUP OCC: / PERMITTEE: BROTHERS PLUMBING ( 714 ) 662-1300 . ADDRESS: 1675 SUPERIOR COMMENTS : - - C.M. CA 92627 ******************************>F * -**ri*****�s*******>t+�N****� k>tai***** -*** *>E** - *** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section • ' • Z O N I N G . REQUIREMENTS • 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S' E T B A C K S CITY LIC.:037597x�$ STATE LC.:N/A (-CLASS: , Date:10-2&-a9 ' (signature: -----`— MAIN' BUILDING -- --- 'ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: Ihereby affir at l have a certificate of consent to -insure or a certificate of Workers' FRN'/: FT IN REAR: FT IN FRNT: FT IN REAR: FT . IN Compensation Insurance,or a certified copy thereof(Sect n 3800,Lab.C). ' LEFT: ' FT IN' RGHTS FT IN LEFT: FT IN RGHT: FT IN' POLICY NO.: EXP.DATE: • COMPANY: PARKING REQUIRED: PARKING PROVIDED : PARCEL : 00000000 ZONE: • T3 Certified copy is hereby furnished. Cl Certified copy is filed with the city Building Division. PLANNING NOTES> . • . —, oate: - Applicant: *******************************************14***'***********de*9(-****************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E C7 E L O P M E N T, S E R V I. C ESREQUIREM E N T $ . I certify that in the performance of the work for which this permit is issued,I shall not employ a person in any manner so as to become -- , subject to the Workers'Compensation Laws at�alilom' . — n ZONING APPROVED BY - • • DATE: Date' k0�aG `SO"j - /Signature: r�ri BUILDING APPROVED BY DATE: NOTICE:If,after making this declaration,you should bec a subject to the Workers'Compe on provisions of the Labor - Code,you must forthwith comply with such provision r this permit shall he deemed revoked. O _ ��— 1 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for , APPLICATION ISSUED B Y: �:• DATE: l• which this permit is issued(Section 3097,Civ.C). ***********************************************- **************a* • UNDER: ***)f*3c-*******:1E****** ***************************iE****************************** -ADDRESS: LEGALIZATION:N - F E E S • U M M- A 'R Y , -STRUCTURAL' SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC • FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,atter;improve,demolish,or PERMIT ' 4 .00' repair any structure,prior to,its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON—RES ' pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN - • . . and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by , _ - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). . . ISSUE FEE , ' ' 3 - 00. - • as owner of the property or my employees with wages as their sole compensation, will do'the work, and the BUILDING—)IV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S————> • 4 . 00 • ' 3 . 00 0 . 00 7 . 00 7 . 00 . 00 does not apply to an owner of a property who builds or.improves thereon,and who does such work himself/herself or through , - . i his or her own employees,provided that such improvements are not intended or offered for sale.lf,however the building or REVENUED I V I S ION TOTALS---> COLLECTED• 7 . 00 OVER/SHORT • 00 improvement Is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve • . farthepurposeofsale). DLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SMIP/,TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business . ' ' ..O O , ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon , and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **************************.)E**************************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN • ❑ 1 am exempt under Section: B.&P.C. - • • for this reason: ; TYPE QTY DESCRIPTIO N UNIT COST, TOTAL COST Date: Owner: PLU 1 GAS SERVICE 2 .00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ' PLU '1 . WATER' RE—PIPE • 2 . 00 2 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a _ - . - END OF F E ES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. • - I Date: • Applicant: . I hereby certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives this city to enter upon the above-mentioned •. . - ' property for inspection purposes.ses.Q • , _ __ Date: tO �dCQ Z71 ISi9nature: % • PYi -•';.:2•:_••!;.',' ' .. Driver's License or Social Security ' 1\ 1641-40 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;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 A. Electrical CondLit-Undrgrnd. 55. Electrical Bonding • • 5."Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7.-Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation __ • 59. Gas Pipe, ❑ Undrgrnd., Test 1 9. Water Pipe-Undrgrnd. 60. Backwash Lines; P-Trap, 0 Undrgrnd. i 10. Structural Floor System r 61. APPROVAL TO DECK I 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap63. Heater & Vent-Final • 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit - 66.: Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69: POOL/SPA SYSTEMS FINAL 19..Rough Heating& Air Conditioning - FIRE DEPT. REQUIREMENT 20.- Rough Factory Fireplace APPROVALS _ :Permit# 21. Ducts,in Structure . . . t 70. Underground Hydro - 22. Ducts, Ventilating ,` r -71. Product-Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test - . 72. Underground Flush 24. Roof Framing 7 •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 v 80. ,FOOD CERTIFICATE ISSUED • '33. Final Electric Notes: * - 34. Final Heating & Air Conditioning ,, - . 35: Final Gas Pipe-Test- ' , _ 4000'Q CO. - - ' 36. Hood or Canopy r .. : _, 37. Final Factory Fireplace - 38. Firial Plumbing . /ry�7a C. 7• ; 39. Water Service-Final - 40. Gas ServiceFinal _ . •-. • 41. Solar Domestic-Final - - - 42. Backflow Preventer -. " ' 43. Backflow Irrigation . - • 44. Landscape Irrigation System . . • 45.-Sound Attenuation - - - - _ - ' 46. Handicap Regulations i ' • 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 C BU TY OPNG ORANGE • Application for Building Permit • o EPT. 636 No.Broadway AND FOR A Permit No. . 14 Q Santa ,California Certificateof Use and Occupancy Phhone:one:KI 2-6211 panY (' Date. a- 3 i - / ; L 1. OWNER'S NAME f k..)- MAILING y19 �� t✓ .. 2�.• �PHONNE• MAILING ADDRESS (/ .62-4-4-• �/ /5 C�AACIITA�Y, ,,e--16' / 1)-• 4 a � Name Q-�/ii%(J Name iS (Architect or Engineer) .76.73-4 /6 i(Conttrractor) Address Address �A 2 ..../?- 9' %fie !� City City -----...- '61'2' dC/ -(-f 0r," de i State State Lic. No Phone Lic. No Phone it PROPOSED USE• yq QLL /f�/�_2—�7 /j 4 �j 2. JOB LOCATION t4__ .6 `.6 ��,� e-,0-C 6/7(7...a ca, (House No.) (Name of Street) /� (Town or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET (9 -r � 0"-.t1-Ar• 3. LEGAL DESCRIPTION: Lot..C.? / a OA Block . /✓} O ' '6-2-r-Tract es.a- (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( <' q') INTERIIOR LOT ( ) ) THROUGH LOT ( ) SLOPE OF LOT ( ) N. SIZE OF BLDG.:.p.:.1...A..SiAREA- 76 y SIZE OF LOT- AREA 6. HEIGHT OF BLDG.:-/-.•l T�r G ' CEILING HEIGHT ? NO. OF STORIES / f 7. NO. FAMILIES Size of Smallest Bedr.om- // X /15 Size of Kitchen.//1X 7 8. EXTERIOR WALL CONSTRUCTION:.-<. .... -. .at - GTERIOR WALL COVERING/-heO! ydd/aO/ (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) ROOFING COVERING ---t'.4-Pc-IRS 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH J 10. SETBACKS: Front Yard From Center Line of Street gr. 1 J .6 Nearest Side Yardff. (� Rear Yard q-i nDistance in Feet Between Bldgs. on Same Lot IC y .- 8...--a! (Property Line) (Property Line) 11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 12. (a) Footing: Width / V...��^' Depth in Ground /4d. Width of Wall �iV%—y��i (b) Size of Studs 1--, `I Spacing /<•' r "CC Material of Floor -v/L°-e (c) Size of Floor Joists- Spacing -CC (d) Size of Rafters! i x 6 Spacing q " /1.1--;-< --- "CC 13. VALUATION OF PIIr�'OSE,�1D•WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $ �jj��``9'!rl 14. 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 A PLICA,BLLB THERETO. c Signed �! A? /�k/J ' —...2..... (/ (Owner) Plans Filed• 4----7. /• By• (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: SING BY ` O� Bldg. Permit - $---1..V..a-� GROUP.. APPLICATION J' HEALTH Plan Check - $ 3 od TYPE ZONING n ARSHAL E Total - $./.1 DIST. // PLANS AND . 1 Receipt No. - ...../- r.�-7 MAP--E�-- ' 4 SPEC'S 1 TATE Paid to - - SHEET NO...cS CORRECTIO S ENGINEER Date /i._-J/ ---5- •7— VERIFIED.........................__.CAD - _ ll� isl:k .$t Y c Ns cct : i -, ' � ,o rlUsf�:ctt�R DATE 4— J ( ,5 J- _;,� . •. or .- 5O0q--7-52 \` --- 111111111 METES AND BOUNDS DESCRIPTION: oz�o 310 4,0 s� o 610 OWNER CAMS, DUIYLUtLU DATE 5-11-70 ,*JOB ADDRESS 225 E. 16th Place BUILDING PERMIT NO. 11816 iGENERAL CONTRACTOR A.J. Deflphino DESCRIPTION of WORK Add Bath to Res. / 0.117-151-14 LOT TRACT FIRE ZONE VALUE $ 2,500.00 \IN.,?ECTIONS Signature Dote GROUP I TYPE V ZONE R3 SOIL i0SS--+3 7a SUBCONTRACTOR PERMITS ISSUED GAS Dote Number Signature WATER(•(.44 S4 -,J. _70 //n//// /yR.l u�m i /wJ�.// �'/ ROUGH PL DUMBING 1145.4=2"---n.; /��L.L�,y�Xi/' • it/2- n if7e7,734‘ PROP. SWR. LINE❑ HOUSE CON. '�S 1� / SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER in ROUGH WIRING n ,-.70, Heating and Vent. TRENCHES 0 FORMS ❑ STEEL REINF. 370 FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n // SHEATHING `ocie- in�122/, 0 FRAME AND FLASHING 6�j„Ph J& � 19 LATHING ,- IN r©�OUT lJ�/1 S SIO PL -TER, BROWN COAT S rURAL, FINAL '�� 'Elec HEATING, VENT., REFRIG. AND A.C., FINAL Neth rat/ L -€ 17e 3/73r / PLUMBING, FINAL AND GAS TEST n M 5Y. •,z -2.1 ELECTRIC, FINAL _Cede l0-f.r Zr _ _. n d3 ,. L. •�_ 31816y4Y 11-70P=nsa1DO0 328* ***'311.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely ,�[ A [� RECEIVED B DATE RECEIVED DATE ISSUED BUILDING ,.[ a //_ Ts/ F J4cE C_/ ,� 4--li— 1 ADDRESS a {/tLL /�iii [s /57- Lir OWNER p•9P1 !Nit CAft/A A.P.NO. ,i -j / (.t"• PERMIT NO. MAIL I[ �[ r BUILDING r Z ADDRESS Kd u /6rN to /Ace ADDRESS as ? . S Lu U CITY TEL. ',�s H Z COSTA P1CSA NO. G�ar'o3y� TRACTt�'y'cL L T JC""j BLOCK ZQ CONSTRUCTION NEW (ADD ALTER REPAIR (MOVING InFMOLISH — I- LENDER am ' J D BRANCH ' J to OWNER IIUyy e__ ( K7 mill J ADDRESS• ! J z VALUE.r \/�S CO ARCHITECT �OYty s�Q.. NO. S!-� b[,�L.(i $ J Q OR ENGINEER U Q FIRE Lu m ADDRESS ZONE TYPE Jr��f� GRO URJ/ /� O- W • APPROVED S l/'V"" J O CONTRACTOR lC} .;1-, d E LAJ4 ;No BY I ATE ,,'' Zi m cc ADDRESS /6 a3 YJPSA 04 0.-6i ' r Ww TEL / Z E NO.OF USE OF NEW ~ BUILDING o- t 7 Z CITY SANTA AIVA ND.Llg^N&8 YARDS APPROVED YARDS AP ROVE - � C .[G —0 STATE CITY N IT LIC.NO. / qy Cfra LIC. NO. Ian MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET SIZE NO.OF BLDGS. OF LOT a( `$ NOW ON LOT RONi .Tag FT. USE OF EXISTING BLDG. _ R.SIDE FT FT. I— SIZE OFJ 9 NO.OF /; / 2 NEW BLDG. 6 G T ROOMS 81St STORIES Oh.G L.SIDE el( FT.— FT. Q EXTERIOR WALL ROOF , I W �p ' O COVERING S7"CCO COVERING !der nY/ _REAR '7 pFT. FT. '\'-- J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& a BLOCS.BLD . ACCESS CLOGS. ' o • . - a 4t - • mil- t4 Jlta^!o'w C U.P# APPROVED 1 - �[ �s APPROVED / / / c~n kin'N /�AT V![TIJ•{ �J1TtI �Y tAA DATE 17 1/11-62 0 V/ oI hereby acknowledge that I nave read this application and state M that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of [he workmen's compensation laws of rAthe State of California. CO m zI hereby certify that I am properly licensed as a contractor under7 SQ. FT. o the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 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 from the provisions of the State of California Business it VALUATION �aa fI m and Professions Code,Division 3,Chapter 9. PERMIT FEE $0.1.3. . . N D Signature of 0 s^-/1 m Perm lttee ��;-/A�^� $ Q PLAN CHECK $ �/I a E no J )[ /D . J (/ LL Authorized Agent TOTAL FEE $3 • ' • O . -OWNER PARKER. Oaklev G. . DATE 14-23-58 JOB ADDRESS 225 E. 16th St. Ce 4-o \I BUILDING PERMIT NO. 6631 GEN AL CONTRACTOR Owne -Builder VALUE $ 11 ,828.00 P. o. LOT 143 TRACT P ',q FIRE ZONE DESCRIPTION OF WORK Duplex w/att gar. 'UP I & J TYPE V ZONE Rh PLAN NO. INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches• • Forms Steel E6--0 . -9 -.,4-fn' Floor System Steel Reinforce Chimney Re-Rod Sdiem eirft.- GJuis Frame and Flashing Z.y-//� Lathing, In (4,4 Out . ''�,(� //16/,S'S Plaster, brown coat Underground soil//gMS'W/G Pipe Tessiatic r=k--c-fr A{ ' - C�N C-? etre' / .9 5-4V "— Top Out 5^-7-St' - Furnace L.% er a-4 W - Gas Vents Rough Plumbing Lfe . 6-. -5 ft Cesspool Septic Tank r Prop. SwtXiae Htut4(Con. St. Swr. 7 (1,r✓ (° r "7 "sets-- /1 t l rs-- 13 ' Sprinkling System /.� Heating Final hJ.44/lar, W� p'59-5y+y / /� f ing Fixtures, Final � i�.n, DV Fi,.ai Gas Test ,i4b J-s l0, 2-5a �I Construction Pole Underground Power _ a� j1(�y / Rough Wiring Iii �/ g),. n „ "f- ,EL/hd 6- 7 ce raS�</ , Fixtures, Final Q_ % fp i OCCUFANCY i, f y 4 o r -ce c Form 210-5M— -57 - I AAi1 ,1� ' 6631 U �� ��� ViL`'� COSTA-MESA BUILDING DEPARTMENT 4I2t/6s P.O.BOX 317 MANCE DEPT. COSTA MESA. CALIFORNIA CITY 07 MTA C.:En FOR APPLICANT TO ILL IN APPLICATION FOR PERMIT BUILRESSDING d2$/T/6 �/ BUILDING ADD COS,A MESA. CALIFO- N de FOR OFFICE USE ONLY • Jr / / RECEIPT NO. PERMIT NO. OWNER O� /Jf �I /� 1 (0& 3 / 11'' E ISSUED MAIL ADDRESS . 707.� ��/// RECEIVED -&TE /-U� ?T� (1 Y/�/C/////• TEL. /Tl�BUILDING //-q// CIT �,(/ Airco' NO�/ fa 76-a DDR ESS ARCHITECT o' LIC. COSTA MESA. CALIFORNIA OR ENGINEER 7�Li NO. FIRE ADD. S ZONE ZONE NO.OF TYPE / GROUP CITY LIC. PLANS �iQ�� CONTRACTOR (� .. NO. afk TEL. APPROVED ADDRESS NO. BY DATE LEGAL LOT N/ ' I CORRECTIONS DESCRIPTION NO. � BLOCK //�T//ACT 1 (�/\,) A.P.NO. l/ 7-1W- /�5/ ` cub J ,/./96) SIZE �+ NO.OF BLDG& OF LOT tJ O / / L5 0 NOW ON LOT j4.X ,k P R ®V 1,u USE OF CITY or: 'Ism MESA EXISTING BLDG. SETBACK LINE FROM PLA.NN IG DEPT. CENTER OF STREET 1.5-O REAR YARD' 2 s SUBJFCT TO DR OFPT RFG SIDE YARD RIGHT if- LEFT [tel DESCRIPTION OF WORK BYrlare' DAT — a I`LMi T,GIY-.-'7 NEW ALTERATION ADDITION I REPAI. MOVING I DEMOLISH BUILDING )�j �// NO.OF ROOMS � STORIES/ SIZE CX/ /J /I b EXTERIOR WALLIROOF . COVERING COVERING / / , USE OF NEW / RW/O1c. �� BUILDING / .1_,./ / U, f X —jam— .i,c� A �o�6 I HEREBY ACKNOWLEDGE THAT I H E 'CAD THIS PPLI TIJ /J STATE THAT THE ABOVE 1 PEC -JILNG CO LY N L //A�N -- O / aape CITY ORDINANCES AN T L.A `TION. VALUATION SIGNATURE O `�/ PERMIT FEE $ 3 —PERMITTEE ; �/v /// - / / 1�� I�` PLAN CHECK $ / 7 — $ r Q o _ AUTHORIZED AGENT // TOTAL FEE S S / SwF OWNER p4RRvR n 3 DATE 9-8-58 JOB ADDRESS 225 East 16th Street BUILDING PERMIT NO. 7558 GENERAL'�ffCONTRACTOR (timer—Rlti l rlap VALUE $ 98_0 A11.717371414'25 LOT TRACT FIRE ZONE, DESCRIPTION OF WORK Rerhmnel fence r UP TYPE ZONE PLAN NO. 7558 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER , Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing Lathing, In Out • Plaster, brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System He-ting Final F ing Fixtures, Final Final Gas Test Construction Pole Underground Power Rough Wiring Fixtures, Final '—N � / OCCUPANCY Q � r/,S JT Form 210-5M-1-57 r 2c::A * COSTA MESA BUILDING DEPARTMENT 1 0. • BOX 317 .n ' !4� P. COSTA MESA CALIFORNIA f-�- Y1wLt " �'" I 7558 FOR APPLICANT TO FILL C•L. OF STREET N,4N(,f MITT. - — - �l, Pr: n ;TAI Pnccq BUILDINS -.4?, I___ __-I- PROP. TINE _ 12 FT. 6113��0� -I i Own efr,-�� / -- at 7-1:4C/ ' / I I 10 FT. FOR 60 FT. STREET-FF50 FT STREET Mail Addres q� � ita �� /p ��� City Ph. No. / C-2 3 6 I Contractor , ti, Ph. No. Address •I .50FTI IF FRON I City Lic. No. State Lic. No. 10F PROP. 1- I 50 FT, �l �l l 7- /gilt--r� - Size of LotISO Sb AP No. A i- wcc if I i N I Setbacks: C/L Street \-C-17Rear e Id W D� ct la. I Side Yard - Righ Left --- N t--.---Th --C. D ` I, Type of Fence / Y/z 6% T LL ALLEY DR j0P, LINE I W 01 cc! 0 • I freY /O, I F= , ,p I hereby acknowledge .at I have read this application and state co = l SD ' F I that the above is correct an agree to c�nply with all City Ord- V aip I, > ¢ ?;o w 1 finances and State La r ulati 'bu But construction. 1 i r-� o a Signature — � 8 '5? m ___,10Fri 1 of Permittee •- ,' • t. G a pie x FT I Agent atO -z - a 37 6 IN._ •C )- es z FOR OFFICE USE ONLY FT z '� U N � n_ FT ] J _ Permit No. a u 19 _ " I 89941 0 IN0 J 60 FT ST R 'ved by Date Received Date Issued d 1 I ' `f K 'J Hil 1150 FT. ST. i i ll ( — 6-----S7 " -6 -� � .�iPROP. LINE.__ _ i` 1 _ _ - - - - � I VALUATION \ Permit Fee $ - ' • • I \ tO �}--')) I I I $ ,e• L' v Plan Check $ r • C.L. OF STREET-, 1 TOTAL FEE $ • ' ' MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - --- MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS