HomeMy WebLinkAbout264 16TH PL - Building Permits I PROJECT ADDRESS: 264 16TH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066257
OWNER'S NAME: SLUSAREK, KARL A
ADDRESS: SLUSAREK, LOUISE PERMIT NO: B 066257 PLAN CHECK NO: N GOVT; N SUPP : N
ie 264 —C 16TH PL
COSTA MESA,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
( 714 ) 646-1480
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : T/O ROCK&APPLY NEW COMPO(LESS THAN4 /12 ) SQ FT: 4 , 888
ADDRESS: UNIT:
CLAIM VALUE; 4 , 888 . 00 CALC—VALUE: 4, 888 . 00 GROUP OCC : R-3 /M-1
PERMITTEE:BEST ROOFING ( 714 ) 557-4040
ADDRESS: 765 ST CLAIR B COMMENTS : SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC
COSTA MESA CA 92626 #########################******************************************************
LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: 051718 STATE LIC.:60332 % D S` C—3 9
Da :_ 1_7,-A7 Signature:_ _ MAIN BUILDING ACCESSORY BUILDING
ERS'COMPENSATION DECLARATION: Ihereby affir that l nave a cub ate 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.Cf. LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN
POLICY ND.: 1137512-93 EXP.DATE: 06/01 /94
COMPANY: STATE FUND PARKING REQ• PROV; PARCEL : 42522220 ZNE: REF NO:
❑ Certified copy is hereby furnished. Di Certified copy is file with t ity Building Division. PLANNING N TES>
2 19 >
Date Applicant' *#*****#******************##*********************###****##*#***#####'#****#####*
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not a completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued I shall t employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE: '
Date: Signature:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y:
which this permit is issued(Section 3097,Civ.C). ************************* **'r* • iiFL7PV.t **#*****#**D****#rix-'#3F/f.'i i V**
LENDER: **************************#************* ** *******************#**********#***
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: Ihereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 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 . 50
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(55001. ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 72 . 50 0 . 00 0 . 00 72 . 50 72 . 50 , 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS > COLLECTED : 72 . 50 OVER/SHORT: . 00
for the purposeot sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 72 . 00 . 50
❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).l am aware *..1F*.x.****.*#***{t.**.y.*.x.**.*.x.****.*#****.IE***+E**.*******{(.**.**.**.)[.**.**.***.*.*.*yL.**.*.x,**.*******
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.g P.C. INDIVIDUAL F_E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dare: OwnerSFR 4888 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 888 . 00
I do hereby certify that I am aware of and understand the requirements of California_Heatth and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a
permit far construction or modification from the Air Ouakty 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 stale laws relating to budding construction and hereby authorize representatives of this city to enter upon the above.mentioned
property for inspection purposes. 01 00156417-00156418 TOT 72.50
Date, -t Signature: •
DATE: 03/02/74 TIME: 15:05
river's License or Socia Security*:
1641.46 White—Building:Green—Code Enforcement Canary—APPhcant: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
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating I 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24- Roof Framing j 73. Undergrnd.Storage Tank Q Gas 0 Oil
25. Roof Sheathing 3--Y_Cq[f 6444- 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning , .
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING 3-6`4q 4W41
48. FINAL PLANNING •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 264 16TH PL UNIT: C CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 067401
F. "UWNER'D NAME: SLUSAREK, KARL A
Fr ADDRESS: SLUSAREKLOUISE PERMIT NO: B 067401 PLAN CHECK NO: 01942-94 S GOVT: N SUPP : N
264 —C 16TH PL
COSTA MESA, CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ADD A NON—HABITALBLE 121SF SUN ROOM SQ FT: 121
ADDRESS: UNIT:
CLAIM VALUE: 4 , 000 . 00 CALC—VALUE: 4, 477 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: BOB WILSON & SONS ( 714 ) 646-1740
ADDRESS: 485 E. 18TH ST . NONE COMMENTS : ONE 121SF SUN ROOM / THIS IS NOT A HABITABLE STRUCTURE BY CODE
COSTA MESA CA 92627 *.m....F** ,..****a6*,,,,************.** ******** *x****.************1****;***�E****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU IR EMEN T S
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS HOLD FOR SPECIAL RE
CITY LIC.: 025966 STATELIC.: 377487 CLASS: B QUIREMENTS
Dare _G' /- 9S' Si nature:Wert$. MAIN BUILDING ACCESSORY BUILDING
1 g FRNT: 26 FT IN REAR: 35 FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: 5 FT 3 IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800:Lab.C).
POLICY NO.: EXP.DATE: PARKING RE 5 PROV: 5 PARCEL: 42522220 ZNE: R3 REF NO:
COMPANY: ,ya� PLANNING NOTES> 11 ' X11 ' SUNROOM ATTACHED TO EX, REAR UNIT ( 2—UNIT COMPLEX)
0 Certified copy is hereby furnished. LJ Certified copy is filed with the city Building Division, > 40% OPEN SPACE REQ SATISFIED .
rate. ApplicantBuilding Divi SERVICES R E U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). Q
I certify tool ine performance of the work for which thisrnpermit is issued, shall not employ any person in any manner so as to become IL
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Dat'' 6.-/- 99 Signature: —�
: a! g DATE: /
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor —
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ,/
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED .B Y; AO 1' 0 // — DATE: / /9
which this permit is issued(Section 3097,Civ.C). ************* ********* '**, * * ***,t**- *** IE**** ******************-41.1; -** ****
LENDER: - *************************ie*****************' **********************************
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 72 . 00 . 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 46 . 80 •
-
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500).
BUILDING—DIV—> PERMIT ISSUE .PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 72 . 50 0 . 00 .:,46 . 80 119 . 30 119 . 30 . 00
❑ structure is not intended or altered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 119 . 30 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
for the purpose of sate). BLDG PMT PLUMBING ELECTRIC MP+CHAN IC FIRE SMIP/TOT GRADING PLAN—CHECK
72 . 00 . . 50 46 . 80
I. Professions
f owner of s the d :property, Co exclusively tecontractingLicense
withw licensed contractors oconstructpro therl project hb ills or ov, reon :•
1
❑ and who cointractsdfo The ojectswith State contractor(s)
does pot rsuly atoo theownerotfctors'SLicense improves
I thereon ********************************* *********************************************
and who contracts for such projects with a license pursuant to the Contractors'State License Law).I am aware �'
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAIFEE BREAKDOWN
❑ I am exempt under Section: B.8 P.C. -
for this reason: TYPE QTY DESCRIPTIO Na' UNIT COST TOTAL COST
Date: Owner: SFR 121 RES—PATIO COVER—ENCLOSED PATIO 37 , 00 4 , 477 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and .END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ouality 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 budding construction and hereby authorize representatives of this city to enter upon the above-mentioned -�
property for inspection purposes. ,_/- o- _ ' —
Date 4-/-99 Signature: G��PRI'� 01 00161439-00161441 TCST 119.30
Driver's License or Social Security 0: DATE: 06/01/94 TINE: 09:06
1641-46 While—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POOL L a
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement a -XI€1 4,14-6/ 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57, APPROVAL TO COVER-GUNITE
7. Footings 6-7.-q1( ¢61.40 58. Electrical Conduit-Undrgrnd.
8. Foundation , 544 fin" 4 _Z_et(,( 4L 6 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap. O 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
29. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73, Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 6 -!c1 �y tical 74. Overhead Hydro •
26. T-Bar Ceiling (Structural) & lvtonocoat 75. Dry Chemical
27. Frame and Flashing /-/Y_qq 64A1 76. Dry Standpipe
28. Lathing & Siding b-2(-G(/ (,Wij 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30, Drywall Nailing (-z7_cjq au HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat7 fC_qff !0. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric - NotesHOLD FOR SPECIAL
t SPECIAL REQUIREMENTS
34. Final Heating & Air Conditioning 7/ qlc(�sXe �g „ 1CJcC
35. Final Gas Pipe-Test
36. Hood or CanoPV `✓V 9. filial IT
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final C)
42. Backflow Preventer
43. Backflow Irrigation :'
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING (Q � 614-
48. FINAL PLANNING I V`
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCcIPANCY
No. Da ie`
r-
•
City of Costa Mesa
California 92628-1200 P.O.Box 1200
Insulation Certificate •
Permit Number e "v6 7'/C/
.2e l /' '- N _c s/ads'4
Number and Street City
Oran?e.
County Subdivision Lot Number
Description of Installation
ROOF
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
EXTERIOR WALL // / / M
Material Stir- rberq lit s S Brand Namet...A /Amyl/ e,
Thickness (inches)_31" Thermal Resistance (R-Value)--/3
CEILING // !�,�/
Batt or Blanket Type_/�aTt �i/erq�R=� • Brand Name✓oRt7-_.<K/-an-ra.
Thickness (inches) S3 Thermal Resistance (R-Value) R;-/
Loose Fill Type Brand Name
Contractor's minimum installed weight/ft2_ lb. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
SLAB FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Width (inches)
FOUNDATION WALL - •
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Adminstrative Code.
S /, 4//do Co.?.5 /e 377re7 •
General Contractor(Builder) License Number
>ere ,9. LA ) z30- >y
Signature and Title Date
Sub-Contractor(Insulation Installer) License Number
Signature and Title Date
.
1907-46 •
1 PROjECTADDRESS: 264 16TH PL UNIT: C CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 067403
OWNER'S NAME: SLUSAREK, KARL A
ADDRESS: SLUSAREKLOUISE PERMIT NO; E 067403 PLAN CHECK NO; N GOVT; N SUPP : N
264 -C 166TH PL
COSTA MESA, CA 92627 CONSTRUCTION TYPE: V-N PERMIT TYPE; ELE PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ADD A NON-HABITALBLE 121SF SUN ROOM - SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE; GROUP OCC : R-3 /M-1
PERMITTEE: BOB WILSON & SONS (714 ) 646-1740
1 ADDRESS: 485 E. 18TH ST. NONE COMMENTS: ONE 121SF SUN ROOM/NON-HABITABLE 'STRUCTURE BY CODE/RE: B67401
COSTA MESA CA 92627 ****************************************k*;-*.N- +t******yc#*ac#*******aE*********##*X
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T B A C K•1 S
CITY LIC.: 025966 STATELIC.: 377487 CLASS: B
Date4-/-•9it 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
POLICY EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42522220 ZNE: REF NO:
0 Certified copy is hereby furnished. El Certified copy is filed with the city Building Division. PLANNING NOTES>
****#*******************************#******************************************
late: Applicant: DEVELOPMENT SERVICES R E U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). Q
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE:
4111. - -1-9 Signature: ''a' .1n^+ BUILDING APPROVED BY •
NOTICE:y:II,after making this declaration,wihu should become i subjectmithe Workers' rempensation provisions of the Labor ���� DATE:
A---
Code.you must foNG with such firm that this permit shall be deemed revoked.
/ / 7„
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; /, DATE: v
which this permit is issued(Section 3097.Civ.Cl **'*'**"**'*"**'*'><"***'*3E iF**** ` n.f. . r ' �k***** ' **********' • 'x -x*#
LENDER: **********************************/********..*** ****i(-**************************
ADDRESS: LEGALIZATION; N F E E SUMMARY 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: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 2 .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 5 0% 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 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
TOTALS----> 1 2 . 00 1 5 . 0 0 0 . 0 0 2 7.0 0 2 7 , 0 0 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--L> COLLECTED: 27 . 00 OVER/SHORT: 00
improvement ie o01s withinone year of completion,the owner will have the burden of proving he/she did not build or improve
fororthe purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27 . 00
❑ and Professions Code: Thectors'Stale 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 Lzw).t am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
'❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: ELE 4 FIXTURES, LIGHTING 1 ST 20 EA. 75 3 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 8 REC EP T/OUTLET 1 ST 20 EA. . 75 6 . 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 ELE 4 RECEPT/SWITCH 1 ST 20 EA. . 75 3 . 00
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from END OF FEES
these provisions.
Date'. Applicant.
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. 01 00161438-00161438 TOT 27.00
Date G-hvY Signature: Vert 41 DATE: 06/01/94 TIME: 09:05
Driver's License or Social Security 4:
\ 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
tT
CONSTRUCTION AND PLANNING POOL E 1
1:
1 v APPROVALS Permit# Date Inspector APPROVALS Permit # Date ' •
Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, 0 Unclrgrnd.
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 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
- i
33. Final Electric es/
/�h Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopym:
37. Final Factory Fireplace•
•
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38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42, Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46, Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
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,�.,r,,, COMPLAINT INVESTIGATIO' •
Received by 7`J 9–?•r - Date fj `)"‘C
Made by: Address 4 l Ci 4-2? /tfcc...Q ' Ph.No.
Against: Address
Directions: n j� n
Nature of Complaint /41.4" Cat fit".20 ./(� _.---4%.0-..
�BAR–, C'e A-4_– 0-4.-i Cr_
!r i&%A. -rSPo /:4-=- , i'! e,,,,_ i�.�!` --c/ .. ,. �,.<.,i...eri/ Lr'•c VA41
'(7-.,-, 27.11:2-z. t� .-„,.. _ ; � .../ , ;L../..a. 0 ,.. its-li
- Jf f� �' / r
Lr/,t,s....G4..._- C, CJ cJ1 - A�tif �-:.
4
0d ' (:5.11----.:,C/'�. .7 ...--e-4,-,-,—(--7 /c . /t_ ..... "--4-7--, Gt���.
Action taken: .AYr n t..ti j 0-.-, .i"C,c_c ” iA-4,�-"Z e !
I
Complete: Yes V Complainant Yes By:
Interviewed: ,-
No G- No Date: .7 s _ ? I'-f ,y'
.% . .. .ip,
•
9374
COSTA MESA BUILDING DEPARTMENT % , uu n14DEPT.
P.O. BOX 317
COSTA MESA. CALIFORNIA `1i' ' fir eh n tli_Cf
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILOING
ADDRESS 264 - 16th Place, A, B. C BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER Santa Ana Patio Homes. Inc. f�D.7i7
1555 Placentia MAIL
RECEIVED BY DATE RECEIVED _S-7 7
ADDRESS 1/4.S.VIC
S7 (�
LDING
CITY Newport Beach, Cal. TND, NI 6-3227 ADDRESS
ARCHITECT 98mg LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
FIRE
ADC same ZONE
COrV I RA\tOH X11 Const. Co. ND 1217 ZONE NO.OF TYPE GROUP
CITY LIC. p/ PLANS
TEL. APPRO� o� S� ��-
ADDRESS same NO. same BV Q'Nh 2s ATE 2./ S
LEGAL LOT CORRECTIONS
DESCRIPTION NO. 18 BLOCK TRACT 2996
A.P.NO. I � -L I . M t III t _.
SIZENO.DFBLD0 IN 7 .{�
SFF0 x 12 LOT NOW F LOTT
USE OF !'
EXISTING BLDG. ' }C1
CENTER OFSTR
SETBACK LINE FROM p � Cil L , • V' _ A 141/4EET 81R.' REAR YARD 15 to i I]P /
i - in/Mai
SIDE YARD RIGHT i-.A LEFT
DESCRIPTION OF WORK 3/4I
I
NEW % ALTERATION II ADDITION
REPAI MOVING IIVgII DEMOLISH
BUIDING 3123 ROOMS 16
SIZE STORIES 2
EXTERIOR WALL ROOF
COVERING Stucco COVERING hot-mop
USE OF NEW
BUILDING • '
Triplex residence and att. garage.
Plan 4-XD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCE AND STATE LAWS REGULATING BUILDING CONSTRUC'
TION. C/� • , VALUATION 46.00
SIGNATURE 0
PERMITTEE
.ISN_}-(/D///��_ L/// PERMIT FEE S
PLAN CHECK $ 23.00
$ 26,378.00
AUTHORIZED AGENT
TOTAL FEE $ 69.00 Jar