HomeMy WebLinkAbout245 16TH PL - Building Permits •
5t CITY OF COSTA MESA
4 9@@ BUILDING DIVISION -
FriatIMPIIMat
;1. DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
PERMIT
'` Pa.mra et B04-01057
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 245 16TH PL Status: ISSUED
Suite: Applied: 06/09/2004
Vicinity: ROOF Issued: 06/09/2004
Parcel Number: 42520111 Zoning:
Applicant: JOHN SKIRZYNSKI ISSUED BY:
Address: 10782 S MEADS AV
Phone: (714)771-0118
ORANGE,CA • Zip: 92869
Owner: HOSFIEL, KEITH W TR
Address P O BOX 2561
Phone:
NEWPORT BEACH,CA Zip: 92659
Contractor: SHARP ROOFING
Address: 10782 S MEADS AV
Phone: (714)771-0118
ORANGE,CA
Zip: 92869 License: 571575
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30 YEAR G.A.F.SHINGLES OVER EXISTING SHEATHING,REPAIR/REPLACE SHEATHING AS NEEDED,
15#FELT FOR 4-PLEX. 14 SQUARES.PARTIAL RE-ROOF.
FEE SUMMARY
Plan Check: $0.00Calc Valuation: . $3,500.00
Permit: $97.25 Claim Valuation: $3,500.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 .
Total: $97.75
PLANNING & ZONING
SETBACKS .
MAIN STRUCTURE Front 0-0 Rear 0-0 . Left 0.0 Right 0-0
ACCESSORY Front 0-0 ,Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
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
244646(6/00)
WORKERS'COM "NSATI6N DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this'permit is Issued.
---_,
❑ I-have and will maintai)t workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
"My workxss'co penotio sur nccee c/mer and policy number are: C q (I y
Cartier? ?-�� -4. �`^�" CPolicy Number: 23 S W 2. / Zo..0
—(This section need not be completed it the permit Is valued et one hundred dollars($100)or less.)
❑ I certify that in the performanc f the o 3 or w this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Ito ,and --r. -. hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply se pro 'si ns it' t n ` o ci
Applicant Signature: .L Date:'-- •./ C-C/
WARNING.^FAILURE TO SECU WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that lam licensed under provisiogs.W C•.pter 9(commencing with Section 7000)of Division 3 otthe•Business and Pr,%e Ions Code,and my license Is in full
force and effect.Uc.k — r I— Iasi, .! 7
Contracto?sBIgnaiure: - . II F_ , —� Moate:" ^i -o i
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
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:
0 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). ,
• 0 As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIll the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure). .
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program tor acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ormit 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 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 California Health and Safety Code).
7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 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.
/� /) l 1/�Si$�DLf Legal Owner(s) Date
9 JLl .,P`.0—'1 Jre Zc04
(And/Or Authorized Applicant — ^
e_., . ,Date
CODE# INSPECTION TYPF PATE JNi1TIALS CODE t INSPECTION TYPE ZEE infra
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof to-((Q"oy 1 I - • 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
PRO 245 16TH PL UNIT: 2 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 047382
OWN'. _ETH HOSFIEL
A' - :O 2561 PERMIT NO: P 047382 PLAN CHECK NO: N GOVT: N SUPP : N
NB CA 92663
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
714 ) 642-5722
ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION : GAS PIPE & WATER HEATER SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
PERMITTEE: O A B ( 714 )642-5722
ADDRESS: PO 2561 COMMENTS: RELOCATE WATER HEATER & GAS LINE TO WH
NB CA 92663 *******************************************************************************
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMEN TS
7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect. S ETD ACK S
CITY LIC.: STATE UC.: CLASS:
Date: signature: • MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POucy NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
mate;I AppfiWnt: **************************************444-******)* *******il***********************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it Oe permit is to one hundred($100)or less), DEVELOPMENT S ER VIC E S " R EQUIR E M EN TS
I certify that In the performance of the work for which this permit is is ued,I shall not employ any person in any manner so as to become �r
subject to the workers'Compensation Laws of California. p /� ZONING APPROVED B Y l' DATE:
---.. Date: S-? / — 9 e/ Signature: r f
NOTICE:If,after making this declaration,you should become subject to the Workers'Co nation provisions of the Labor BUILDING APPROVED BY : DATE:
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
CaiCONSTRUCTION LENDING AGENCY: Ihereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: D,�'
which this permit is issued(Section 3097,Civ.C). ************************* xxxx �3+ �I **********3F** *
LENDER: ******************************************* ****if*******************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I herebyaffirm 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,alter,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 2 5% SMIP/NON—RES
pursuant to Oe 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.My violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 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
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building orimREVENUE DIVISION TOTAL S > COLLECTED • 7 .00 OVER/SHORT• ,00
forpthevepurpose of sale)Nn one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 7 . 00
❑ and Profession Code: The Contractors'slate License Law does not apply to an owner of property who builds or improves thereat
and who contractsfor such projects cith acontractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compens.eon insurance should be provided to me. IND IV IDUAL F E E BR EAKDOW N
OJ I am exempt under Section: 7044 B.8 P.C. _
for this reason: OWNER DOING WORK /) f� TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
�
Date: -d � _� owner: E[1/ J PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of Califomia Health and Safety Code Seal 25505,25533,and PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 00 I
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and e requirements for a END OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from .
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information Is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby thorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. �- 4 01 00061237-00061237 NT
7.00
—. Date: ,J�—�/ q signature: DATE: 05/21/90 TIME: 08:21
Driver's License or Social Security
1641.46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
I I
CONSTRUCTION AND PLANNING POOL 'A
APPROVALS Permit# �- APPROVALS Permit#
temporary Electrical Service or Pole 52. Pool & Equipment Location
Soil Pipe-Undrgrnd. •Date Inspector
53. Steel Reinforcement
Date Inspector
•
PElectrical Conduit Utility-Undrgrnd. 54. Forms ,
4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. '
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. -
10. Structural Floor System 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • .
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing . 11 1, HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning j
35. Final Gas Pipe-Test Willa la LW,
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing h(L IC-1
39. Water Service-Final C=C-�/.���
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
J
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co 'r
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
PERAT NO TRACT NO. LOT NO. UNIT NO.
CITV�F COSTA M SA`CONSTRUCTION PERMIT 3 /_^ig' A.P. Zone
'•� roject Address iC4/d /I� �,/ pia%E env A
S Main Building: Accessory Building:
Applicant's Malting ddress 'SAN y$i.O.fv (YNcviYhet/gap TYPE OF CONSTRUCTION LI NEW ❑ ADD U ALTERATION ❑ REPAIR
'i n.•_/ / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A� ' T Front 0
Owner's Name �/ / d Phona�p .$-71 Z• DESCRIPTION OF WORK/USE OF BLD iyG 0/'er r r� � B Rear N
Address/30 a 1�SZ.r/ /AZewicerlL A4 V 211/03 /,'C - uti//ft a e99.9—,I ( -S T C earN
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL I K RightG
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL I $• Left
e P )�5 "��r Ilo
T /o ❑ OTHER R
Contractor's Namneg -i/iR.27 I Ping. Ref. # Parking Req./Provided E
•
Address(mailing) /0-0!/ SRN /L12i) &eeiv'R P141-/‹._ PROJECT DESCRIPTION SQ. FT. /pp.SSt OCCUPANCYQ�0J+.i Planning Notes: M
0
CONSTRUCTION TYPE VALUATIONS ociat. M
City License No. 0.29—,-�.-�� T
ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION
S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: •
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. ))`` ��KK CoELECTRICAL FEES
License Class C' - 3 Ligse No. Hy /I/'
en-. Date}/11 Z,/PI$ Signature •
'�' JJJJ�• - /• PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
"„ WORKERS'COMPENSATION DEC LA'RATION, a Construction Pole Sub. • 0 50+ KW
W -hereby affirm that I have a certif to of consent to self-insure or a certificate Bar Sink Showers
Workers' Compensation Ins2pnce, or a leertifled copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
.00, Lab. C.)
\ Policy No. 2,f4S-'BS 20 Company -5'7' Awn Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
Certified copy Is hereby furnished. - Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Bui g Dlvlsio Bathtubs Sewer Connection
Date / -/ 2q Applicant �a�•itt iA/ Fan Motors 00-1 HP ❑1'h-8
EXEMPTION FROM WORKERS'COMPEf.J§ATION D LARATION Clarifiers Solar Collectors
(This section need not be completed if the dp mit is f ne hundred ($100)or F.A.U. Inc.Solar 09-15 HP 016.15+
less). Dishwasher Solar Piping
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fixtures Microwave
Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/SpaPole Light
NOTICE:If,after making this declaration,you should become subject to the — '
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range
comply with such provisions or this permit shall be deemed revoked.
-
CONSTRUCTION LENDING AGENCVGas Service Outlets Water Closet Switches Sign Y
I hereby affirm that there is a Construction lending agency for the performance
-
of the work for which this permit is issued (Section 3097 Civ. C.) interceptors Water Heater Garbage Disposal Standing Sections .
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash .
following reason (Section 7031.5 Business and Professional Code: Any city or •
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Traits - •
•
any structure, prior to Its issuance, also requires the applicant for such permit - .
to file a signed statement that he/she Is licensed pursuant to the provisions Of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of .
''ivision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee -
,refrom and the basis for the alleged exemption. Any violation of Section $ 3
31.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). II DEVELOPMENT SERVICES REQUIREMENTS:
I I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or-offered Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICALI
License Law does not apply to an owner of a property who builds or improves FEES Building Approved By • Data
/�L
thereon, and who does such work himself/herself or through his or her own El Issued By - Dat
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I
sale. If, however,the building or improvement is sold within one year of com- Canopy Type II 0
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground $ SUM}YIV OOF�FE ES SMIP s-0prove for the purpose of sale). BUILDING PERMIT y S' $
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK
tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon.and who contracts for such oroiects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me, ELECTRICAL $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers
PLAN CHECK 50% $ MICROFILM $ _
Date Owner Heating System& Ducting Registers .S'0
$ /S
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL MECHANICAL TOTAL FEE $ ''!
Information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $
and state laws relating to •uilding construction, and hereby authorize repre- i
sentatives of t city nter upon the above-mentioned property for
inspection pur•• es. -
Signature /x - Date I*' 3 .
Drivers' Lic•n y.r SS ; Reinspection Fee $15 Issue Fee $ 3 01 00018579-00018580 TOT 45.50
0865-46,rev. /88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor DATE: 11/03/88 TIME: 12:04
..
--CONSTRUCTION AND PLANNING POO ;PA
'R APPROVALS Permit# • Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe1Undrgrnd. ; 53. Steel Reinforcement . . ti `
3. Electrical Conduit'Utility-Undrgrnd. • 54. Forms
4.'Electricals Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test
6. Electrical UFER ernd. ' 57. APPROVAL TO COVER-GUNITE ,
1
7. Footings I I• ^_ 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test '
•
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
I
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection I 62. Backwash & Receptor-Final
12. Sewer;Cap
63. Heater & Vent-Final
13. Roof Drains64. Plumbing System - Final
14. Rougti Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing &Access Approval
'17'Rough Wiring Sign 68. APPROVED FOR PLASTERING
18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19) Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat -1 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE/// ISSUED
33. Final Electric Notes:#4,/`. �A) .044 ��
34. Final Heating & Air Conditioning !` 6
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer ' ••' :r. •
43. Backflow Irrigation • - .
44. ,Landscape Irrigation System • 0
45. Sound Attenuation
46. Handicap Regulations tefile) % 7�_
47. FINAL STRUCTURE & BUILDING -- ;osS /fttckfCJ2le-
48. Special Requirements Completed
49. Electric Release to Edison •
• .
50. Gas Release to Southern California Gas Co " ) t ,
51'. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF C/ % MESA •
PARK FEES No 217
/Fee Payment Receipt
Project Address �Y' 5 E- /6Pi ' Park Area .73
A. P. No. /17 —/51 — /n
Building Permit No. t// 21 ,
Owner's Name ke,:-/---L
/745 17,1
Mailing Address /Q60 /�CD e . achie pr- etc"-
FEE
Single Family • No. of Units @ $455.20 =
Multiple Family ** No. of Units O @ $321.32 = I(ooc, . 6 a
Q �y 7 Cootal FeeFeee1126:6,. (,0
Planning Department Ap royal ate -J — a yBy C .2 VC °'
AApplicant's Signature � � i�/f�
' City Ordinance 72-44
** City Ordinance 72-45
"• City Resolution 74-124 _ n I� t INWhite-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 IU'
lz -.• a 4I921 •e —S-7-L—5-76c7—,COO 231 oh130.53
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• I 'LIC..TION FOR STRUCTURAL PERMIT
J For Applicant to Fill in Completely— se In 0 y r .. }} -
RE• I E•p- DATE RECEIVED F
ADOfl ESL 1 _ I �•�/���11 /
10141/4 OWNER Er�l.� DSFiEG 1 — a ERMIT NO.
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ADDCITY ESS �p� es NO.
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ADDRESS VALUE / /r�� -r1 f
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CONTRACTOR BY L DATE ,,2K, 6
ADDRESS f
TEL. ZO /,[ ANS USE OF NEVVVjjjLLL,,,
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F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE /?2
X/DO NO.OF BLDGS (FROM C/L ST ET)
0. OF LOT NOW ON LOT . FRONT 4 FT. FT.
USE OF /�^
V: EXISTING BLDG. Jj 0- R.SIDE 27-7FP FT.
F Aq
Separate permits are required for L.SIDE 3 7F/o it !JL✓CPSt Ml, I "¢-
electric,plumbing and heating work. REAR /SFT/0 FT.
W• USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN&
y - MAIN BLDGS.
CRP �G•' yW DATE
ACCESS. BLOGS.
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oI hereby acknowledge that I have read this application and state n
a that the above Information Is correct and agree to comply with m
00 all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of o
TST. the State of California.
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I hereby certify that I am properly licensed as a contractor under ;ri50. FT. m,v O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 0
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: lei
am exempt from the ovlslons of the State of California Business y
VALUATION PERMIT FEE E
and Profess! Co 'vision 3,Che ter 9 V
�— PLAN CHECK E /4J,/�
Signature of ` ��`��� e \
Permittee 5 S��AO TAX $ u.3,7• U(t��_.
Authorized Agent •
TOTAL PAID E 30 5 ""
e .r i /77/
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A L A ON FOR STRUCTURAL PERMIT
For Applicant'/to Fill in((jC`ompletely —Use Ink Only gg �/s
BUILDING �/ S- /I{•/JJ �� ./ �� RE ED DATE RECEIVED D E q Y/�
ADDRESS v b r..4 Y OL /
41 PERMIT NO.
OWNER /tC'TN Ale SFiF7. A.P.NO. y� /(f( (��(�
MAIL BADIDRE 5 o39 760^Pz ,4 3-sic--
I
ADDRESS /
0 TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION \NE/W ADD ALTER REPAIR MOVING DEMO!ICH
LENDER \ '/
BRANCH OWNER ! _4l W SP --1
ADDRESS VALUE
ARCHITECT TEL. u5E $
OR ENGINEER NO. ��
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITY NO. PLANS BUILDING
—
STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLOCS.
(FROM C/L STREET)
L OF LOT I NOW ON LOT FRONT FT. FT.
Q USE OF
Y EXISTING BLDG. R.SIDE FT. FT.
tR
F0 Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. REAR FT. FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLOCS.
4 VAR.vW DATE
Q �/
rV f? r C.U.P. APPROVED
7 APPROVED
} _EY DATE
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1
CI hereby acknowledge that I have read this application and state �
CC that the above Information Is correct and agree to comply with m
O. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of
04 the State of California. m
I hereby certify that I am properly licensed as a contractor under SQ. FT. tv
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m—
am exempt from the provisions of the State of California Business VALUATION IPERMIT FEE $ es
and Professions Code,Division 3,Chapter 9. Mm
PLAN CHECK $ "'
Signature of c
LL
Permittee $ TAX $ / , 2 /t
yU./
Authorized Agent TOTAL PAID $ �—p1_
PAs-
et - 41922 —c-7Fc---00 23n 121.01
COSTA MESA BUILDING-SAFETY DEPARTMENT
p.0.BOX 1200 COSTA MESA,CALIFORNIA 92626
APP I `T IIN FOR STRUCTURAL PERMIT
w(� For Applicant to Fill in Completely -Use ik i
N% ADIDRESS 02 ysE/� �' I �-•-� Ft EC_1/11,7 D E I i
1�zrr� a c g'I4rL A.P.NNO:, - IS//O s FIR fir?
OWNER 4
MAIL DDD /Odit` /)� ADDRESS .� yJ ‘ b 1 ./ ?
_1 ADDRESS ��/ �. (� G�,t C/ /��I(/�[�r'y/�,,` 1I(
V CITY Nso n $GMC6' NO1-412 Sni z"T RACT 1 75 LOT . BLOCK
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r OWNER
-{W ADDRESS /-//�� ///altos et.
OR ENGINEER NO.tE FIRE LAI/ /Cli!'(Syt'oS U
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ADDRESS ZONE /Aj �TYP �_ GROUP
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APPROVED �A A �f // �‘
CONTRACTOR 6Lv-•p�y�� BV (/V�' ///"`��� DATE "`///
ADDRESS
TEL. Z% �r O.OF USE OF ,an
CITY NO. • -- , LAI S BUILDING
i •1:rn i 4!...0"
STATE CITY YARDS APPROVED YARDS APPROV
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUI %INC Of
W SIZE /97 ! 0 4) INO.OF BLDGS. ›,4,...P.
_/ (FROM Cr? TR/y��iT)
0. OF LOT {/ NOW ON LOT / FRONT (/Q I6T.pVl�"" FT.
USE OFf� /
.E. EXISTING BLDG. 2-,/S
R.SIDE FT. FT.
FH )/ /
Separate permits are required for L.SIDE i/FT ,P// FT.
electric,plumbing and heating work. S -`'�
REAR / . FT. s
W
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& '•r
J%� VS I'/� MAIN BLOCS.
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44//��O/�J//�}/ O(/ G� DATE
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/ oaxe -t '��O DROVED /�// 1/\/C-/DATE 9 c/ U�A
ee w C:a. ., i-:- SPECIAL REQUIREMENTT
o I hereby acknowledge that I have read this application and state —� Ln
Lthat the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ m
Z any person in violation of the workman's compensation laws of
/6/,
o
the State of California. 7 /� //w'/��s,s
3 I hereby certify that I em properly licensed as a contractor under /• 30 SQ. FT. / O GL `+MA6�N Q
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o 4"
Chapter 9, snd that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u sc
am exempt from the pr visions of the S to of California Business VALUATION PERMIT FEE $ o
end Professions d ivislon er 9 u, v
/ $ /17,6Sm ,
PLAN CHECKo zv
Signature of /��i LL(1`
Permittee -� $ (/V a TAX $ ' f
Authorized Agent nJ U
TOTAL PAID $/G/ IO,
di, ,/g�g ?s -"t,= "' CF i 519 : . 1111MG
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in pletely— Use Ink Only AP I A ION FOR STRUCTURAL PERMIT
` 0 s/ �te RE V DATE RECEIVED D IIS lJ -7y
/`BUILDING CY //
ADDRESS
C( F/�_� PERMIT NO.
DOWNER / � A.P.NO.
MAIL BUILDING 4 6 /� A n//2
ADDRESS ADDRESS �Lff {{{{YYYY '!� (� !�
TEL. TRACT f LOT BLOCK
I CITY NO.
CONSTRUCTION t�EWx/\' ADD ALTER REPAIR MOVING DEMOLISH
LENDER \/
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OWNER/<` ^� QS f/El
•
ARCHTE ��� V U$
ARCHITECT TEL. US
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
rajSIZE NO.OF BLDGS. (FROM C/L STREET)
P., OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
Cp EXISTING BLDG. R.SIDE FT. FT.
C/1
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. —
REAR FT. FT. r�
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& --
MAIN BLDGS. ACCESS. BLDGS.
J / �
VAR.# DATE
', ddAherS / esrniert C.U.P.# APPROVED VED
Q -
APPROVED
} BY DATE
N •
2
w I
0.• I hereby acknowledge that I have reed this application and state n
g that the above Information Is correct and agree to comply with m
0-. all laws regulating building construction, and I shall not employ
Z any person In violation of the workmen's compensation laws of 2
Ltl the State of California. ,c
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT EDNL
am exempt from the provisions of the State of California Business
VALUATION PERMIT FEE $ Bf7 all
a itti
and Professions Code,Division 3,Chapter 9.
PLAN CHECK $ o
Signature of o
Permittee $ TAX $ 2
......5U
Authorized Agent TOTAL PAID $/�j