HomeMy WebLinkAbout473 16TH PL - Building Permits(714) 754-5273 • Fax (774) 754-4856
Job Address: 473 16TH PL
Suite No
Vicinity:
Parcel Nunmber: 42515113
Appliwnk CLIFF
Address: 09911 LARSON AV
CITY OF COSTA MESA �� `�
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
GARDEN GROVE , CA
Owner: NEIIENDAM, HONNAH M
Address 473 E 16TH PL
COSTA MESA, CA
PLUMBING PERMIT
Phone: (714)530-2440
2ip: 92842
Phone:
Contractor: A-AMES PLUMBING & HEATING
Address: 09917 LARSON AV
Arch / Eng :
Address:
ISSUE FEE
Backflow irrigation
BackFlow Preventer
Bathtub
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earlhquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
GARDEN GROVE , CA
WATER HEATER CHANGE OUT.
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
orr
Zip: 92627
Phone: (714)530-2440
Zip: 92842
License: 250307
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap tor Demo $0.00
Sewer Conned $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
QTv
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PERMIT NUMBER
P00-00035
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 01/20/2000
Issued: 01 /20/2000
ISSUED BY: �
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
water Re-pipe
Water Service
Water Softener
OTHER
AMT
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$12.30
$0.00
$0.00
$0.00
$0.00
50.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for Ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby attirtn untler penalry of perjury one of tha following declarations:
❑ I hava antl will maintain a certifica�e of consent to self-Insure tor workers' compensa�ion, es provitle0 for by section 3700 of lhe Labor Code, for ihe pertormance of Ihe
111,,,...,,,��� work tor which ihis permit is issuetl. �
�I have antl will maintain workers' compensation insurance, as required by section 3700 oi the Labor Code, for the pertortnance ot the work for which ihis permit is issuetl.
My wo s�' 'or�pe ion Insurence carri nd olicy number are:
Cerrier. �"�T,�,�,�(�tf L-� ��'�v i`�.� Policy Num6er
(This section neetl not e completed i! Ihe permit is valuetl af one hundred dollars ($f00) or /ess.)
❑ I certity that in the pertormence of the work for which this permit is issueQ I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, antl agree th t if I should become suhject to the workers' compensation provisions ol Section 3700 of Iha Labor Code, I shall forthwith
comply with Ihese provisi i �yy/ �
Applicant Signature: �U// � Date: � �,d ���
WARNING fFILURE TO SECURE W S' COMPENSATION CAVEPAGE IS UNL4WFUL AND SHALL SU&IELT AN EMPLOYER TO CRIMINAL PENPLTIES AND qVll FWES UP TOONE HUNDRED
THOUSANOOOLLARE($100,000),IN IONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABORCAOE,INTEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am licensed under pro ' ions of Chaptar 9(commencing with Section 7000) ot Division 3 of the Business and Professions Cotle, and my license is in full
force antl eHect. Lia # �� Class a �' .�
Coniractors Signature: Date: uLd �O
CONSTRUCTION LENDING AGENCV:
❑ I �ereby attirm that there is a construction lendinq aqency for ihe performance of the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: lendefs Address:
Signamre:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm tha� under penalry of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit
to file e signed statement ihat he or she is licensed pursuam to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 ot the
Business antl ProFessions Code) or that he or she is exempt t�eretrom antl ihe basis for the allegetl e:emption. Any violation of Section 7031.5 by any epplicant for a permit
sublects the applicant to a civil penalty of not more than five huntlretl tlollars ($500).):
❑ I, as owner of the property,.or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe structure is not intentled or offered for sale (Sec.
7044, Business and Professlons Code: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or ihrougfi.his orher own employees, provided that such improvements are not intentletl or oRered for sale. If, however, the Ouiltling or improvemant is
soltl within one year of completlon 4he owner-builder will have Ihe burden oi proving that he or she did not builtl or improve for purpose ot sale.).
❑ I, as owner of the property, am EXCL�USIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct ihe project (Sec. 7044, Business and Professions
Coae: The coniractors'License Law tloes�not epply to an owner of pmperty who huilds or impmves thereon, antl who contrads for such pmject with a coniractor(s)
license pursuam to the Comractors Licerise'C_aws;)i�
❑ I am exempt untler sec. �� �
SignaWre: � '�r
Owner ID verified by dnver's license. ❑ Yes ' 0 No
Business and Professions Code for this reason:
Verification of Ownership by (type of document, i.e. - propeny laz bill or deed):
Drivefs License No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavalion five (5) or more feet in tlepth into which a person is required to descend, will be made in connection with work aulhorizetl by this
permit, and that no building stmcture, scaffoltling, falsework, or tlemolition or dismantling Ihereof, will be more Ihan ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle 8, Califomia Atlminisiralive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Intlusirial Safety, as notetl above, unless such person has a
permit to do such work from the tlivision.
Signature: Date:
Division of Indusirial5afety Permit Number:
CERTIFICATE OF COMPLIlWCE AND AUTHORIZA710N OF ENTFiY: I cetlify under penaVy of perjury that I have reatl this application and state ihat the iniormation given is
correct I agrae to comply with all state laws antl city ordinances relating to building construction, and amhoriza represenlatives of the Ciry of Costa Mesa to enter upon the
above-descri6etl propetly for inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by this permit until final inspection.
CODE Y, INSPECTIONTYPE
1616 Fiaed System Final Fire Prevention
1266 Pool Spa Final
200 Final Fe-Roof
201 Final Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
2696-66
D� INTRIALS
� �a
�� o�
Date
CODE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Finai Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finai Building/Occupancy
A� INTITIALS
'�
�
I �
PH0.IECT RODflESS: 4] j 1(7 T'�j PL
OWNEfl'SNAME: HANNAH NEIINDAM
� noos[ss: gpME
RflCH/ENGINEEN:
AOUHESS:
qEG.NO.:
UNIT:
UNIT:
. PEFMITiEE: GREATF.R PACIFSC ROOFING ( 714 ) 836-1966
. aooaess: 1016 E. F'IRS'C 5'P
SANTA ANA CA 9270].
I LICENSED CONTBACTOP DECIABATION: I Aereby atlirm Ihat 1 am licensetl untler pmvisions ot Chap�er 9(commencing wi�h Sec�ion
70110) o� �rvision 3 ot Ne Business an0 Protessians LoOe. and my 1¢e e Is ln full torce an0 eflecl.
cirruc.:05 858 STPTELIC.:6iS��� C-39
�a�e: SignaWre: _
WOPKEBS' OMPEN9 TION DELLABATION: I herehy affirm that I have a cenificate of consem ro self-insure or a certilicate oi Workers'
POLICY N0. n����e=� �l ��1e� yjF�/�e fo�c�ectiE%P. onTe b. ��1 / O 1/ 9 3
COMPANY: STATE FUND �
❑ Certilie0 copy is �ereDy Wmishe0. � Cetlifietl caDY is liletl wi� �i JB�ing Division.
�ate: O Appticant: �� � ��/�/�
E%EMP N FBO OflKEflS' fAMPENSRTION DFCIAflRTION: Qhis stttion neetl nat De completetl i� Ihe permit i or One hunereG (5100) or less).
I cetlity I�al in Ihe pedormanCe of I�e work �Or whit� Ihis permit is i55ue4 I S�all no� ¢mploy any per5on in any manner 5o as �o became
5u0jec� lo Ihe Workers' Compen5aiion laws of Calibmia.
Dale: SignaWre:
NOTICE: I�. a�ter making Ihis tleclaratiPn, you should become sub�ect b �he Workers' Compensa�ion pwvisions oi Ihe Labor
Cotle, you musl iart�wi�h compty wilh such provisions or lhls pe�rtnt shall 6e deemetl �evoked.
CONSTPUCTION LENOING 11GENCY: I �efeby alfirm Ihat lhere is a consiruction lentling agency lor �he performance ol ��e work fof
which Ihis permi� is issuetl (Sec�ion 3097. Civ. C�.
LENDEH:
AOOflESS:
OWNEfl BUILDEfl OECLAflRTIDN: I hereCY allirm �hai I am exempt �mm �he ConVactors' Sia�e Lic¢nse Law �or IAe following reason
(Seclion 70315 Business antl Prolessional CoOe: Any cily ol coun�y whic� requires a permit �o cons�Nc6 al�eL impmve. Oemolish, or
repair any s�mcWre. Dnor m iis issuance. 915o repuire5 ihe apPlicant �or such permi� m �ile a sipne0 statemem lhai he/she is licensetl
pursuan�tolhe pmvisions oithe Conlrac�or4 Slate License Law(Chapter9�commencing vnth Section 7000�ofDivision 3 ol��e Business
and Pmfessions CoOe) or ihai �e/she is ex¢mpi ihereimm ana ihe basis for ihe allege0 eremD�ion. Any violation ol Section 7031.5 by
any apDlicam 1or a Dermit sublects t�e aDO�icam to a civil penalty of not more ihan five AunOreO Oallars (E500).
I. as owner oi ihe Ompeny or my employees with wages as their sole campensation, will do ihe work, antl the
❑ stmclure is no� intenaed or ofiere0lor sale (Seclion 7044, Business and Pmiessional Cotle: i�e Comracmrs' State License Law
tloes not apply �a an owner of a property w�o builtls or impmves �hereon, and who aoes such work himsell/hersel� or Ihrough
his or her awn emplayees, provitletl t�a� suc� impmvemenis are no� intentletl or otteretl �or sale. II, however the buil0ing or
impmvement is sala wi�Ain one ye2r ol complelion, the owner will have �he burtlen o� proving he/she ditl no� builtl or improve
for the purpase ol sale).
� I, as owner ol lhe pmpetly. am exclusively conimcting with Iicense0 contmctors to consiNct tAe Drolect (Section 70A4, Business
❑ antl Professions CoOe�. The CONrac�ors' State License Law Uoes not apDty to an owner of pmDehY who 6wI0s or improves ihereon
anA who contracts lor such pmlects wi�A a canVacior(s) license Dursuant Io �he Conirac�ors' S�aie License Law�. I am aware
�hat pmot af their WoBer's CompEnsation insurance s�ould be pmvidetl �o me.
� I am exempt unUer Seciion�. B, 8 P. C.
tor this reason:
Oale' Owner
I tlo hereby cerlily ihat I am aware of anA unUerstand Ihe reQuirements of Califomia Healih antl Salety Cotle Sections 255Q5, 25533, and
25534 antl Ihat I or any W�ure builtling occu�an� will/will noi �circle one� need to comply wi�h SaiA Slaie co0e5 antl Ihe requiremenis for a
permi� �or cans�mction or motlAicalion iroro �he Ai� Oualiry Managemen� Distncl. Restlential constmc�ion applications are exempt irom
IheSe ptovi5ions.
Daie: Applicant:
1 hereby ceriity thai 1 have rea0 �his aDPliCaliUn an0 Siale Iha� Ihe above in�g�malion is wrrecL I aBree lo comply vn�� all ciry and counry
ordinanws antl s�aie laws relating �o builtling �onstmclian and hereby aut ffze repre nta�ives o� Ihis ciiy ta enler upon ��e abwe-mentionetl
pmpetly iar inspe ion Ourposes.
Dale'. Q Signature:
Driver's mense or Social Securiry N:
I6a1 46 WMte—Builtlinq�. Green—Catle EnlorcemenL Canarv—Aoohcan�; Pink—Revenue: Goltlenrotl—Assessor
CITY OF COSTA .'NESA — BUILDING PERMIT PERM NO; B 05930"/
PERMIT NO: B 059307 PLAN CHECK NO; N GOVT; N SUPP; N
CONSTRUCTION TYPE; 5—N PERM"1T TYPE; STR PURPOSE; OiA
JOA DESCRIPI'ION ; T/OFF REROOr W/CLASS "A" SHARES 5Q FT; 7,2�0
CLAiM VALUE; 7,250,00 CALC—VALUE: 7,7.50,00 GRUUP OCC; R-3 /M-1.
COMMENTS; REROOF 22005F RESZDE'NCE 6 GAGAGE
x���xxx��*�c�cxx�r*x***x*xx�c�*u�x*x�r+���r+���**rt�t��*��*�xxxu**�c�*x*xx#*x**x***r���nx�*x
2 O N I N G R E Q ti I R E M E N T S
S E T B A C K 5
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN TEFT: F'T IN RGAT; cT IN
PARRING REQ• PROV; PARCEL: 00000000 ZNE; REF NO:
PLANNING NtST'ES>
>
iE aE iE i(� iE iP if il� iE �It 3t iE i(� 1E 1(� iF if� 3E iE iE �If if IE iriE iF 3F lE 1(� iF 3F 3E #if !E ib iF 7E iE il� 3h �E 3F if 9h i(�if if 3E if iE 3E iE iE if IF if iE if # iF �F iE iE k#�lE 3F ih! iF �f 3'r 3f ?f �1F IF iF iFif
D E V E L O F M E N T S E R V I C E S R E� U I R E M E N i S
7.ONTNG APPROVED BY DATE; n-
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY; pA'CE• l- o
3FiEi(�if#iEiElfiFihlEK�lfitiFlflF3fiFih3FiEt"FfT�iFiFTF��FR'iri'F�FieiFi�F�Tc�iF ���3FiF3F'iFt�Ff:iF7FifiFiFiT�lElfiFiF3Fj6i'ri(..lElE � �c . . .fr iili�
3E if iE il� if• 3F iE�IE it ih iElE �ElE iE iF if �f !f if if it df 1t 3F 1F if �t �1F!(� �1Ei(� IE dE iE ih if 3f� jf iE j'r iE iF iE !h iF3e iE iE lejhif lf 1E �EiF iF 1E # if iE dE 3(� 3k iE �N� iFlf�lf''�E jh iF �f iE iE �E iE # 3F
LEGALIZATION;N F E E S U M M A R Y STRUCtURALiSEGMENT;Y
BLDG PMT PL[JMBING ELECTRIC MEC.HANIC FIRE 5NSP/RES GRADING
PERMIT 99,00 ,73,
5MIP/UON-RES
PLAN �
ZSSIIE FEE 'Y
BUILDING—DIV—> PERMIT ISSUE FLAN—CHECK TOTAL PAID �� DUE
TOTALS----> 99.73 0.00 0.00 99,73 94.73 i..i ,UO
REVENUE DIVISION TOTALS--> COLLECTED: 99,73 OVER/SHORT; ,OU
BLD99PM�T� PLUMHING ELECTRIC MECHANIC FIRE SP:IP/T03 GRADING �LAN—CHECK
i(��1EiE-IFiFiE-%�EIFiE7fifi[�iFii�i(�iFi(�fFi4lFiFikiElEiF3kihlEi(�N�lEiklk3FiEiC��]Fih�:i�ifiE3E#iEi(�34iEifiElFielEiEltif�iF9hifiEihiL'if•�IEiF3Fifff�� -k#%�iEiFif�3FiPiE
I N D I V I D U A L F E E H R E A R D O W N �!'��. -
TYPE QTY D E S C R I P T I U N UNIT C05T TOTAL COS1'
r�
SFR 77.50 RERUOF BY VALiIE kESIDENTIAL NO2UNE 1,U0 fr'7,750,00
END OF FEES /t'
1
�
�
.^�.
�
Li �'.l''.: � .-L��._5:,;_ � - _
06.—� C _� = i:� _, ' .
1 �t � - .
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�Undrgmd. � - 53. Steel Reinforcement
3. Electrical Conduit Utlity-Undrgmd. ' 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electricai Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrica� UFER Gmd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical ConduibUndrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. , � � 60. Backwash �ines, P-Trap, O Undrgmd.
10. Structural Floor System ' . 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection ; 62. Backwash & Receptor�Final '
12. Sewer Cap .' 63. Heater & Vent-Final
13. Root Drains � 64. Plumbing System � Final
14. Rough Piumbing 65. Electrical�Final
15. Rough ElectricabConduit - 66. Solar System-Final
16. Rough Electric Wiring 67. Fe�cing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOF PLASTERING
18. Rough Electrica6T Bar Ceiling 69. PQOUSPA SYSTEMS FINA�
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Veniilating 71. Product Piping �Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Fiush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEh1 FINAL
29. Insulation 78, FIRE PREV. FINAL
30. Orywall Nailing ! i HEA�TH DEPT. REQUIREMENT
31. Plaster Brown Coat � ( � 79. FINAL INSPECTION
32. Electrical Power MeterFinal ' � � S0. FOOD CERTIFICATE ISSUED
33. Final Electric � � � Notes:
34. Fina� Heating & Air Conditioning � � i
35. Final Gas Pipe-Test �
36. Hood or Canopy •
37. Final FactorY Fireplace •
38. Final Piumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer � ,
43. Backflow Irrigation
44. Landscape trrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �Q-.�„!t ��� _ g �� /_ �/
�(Q,Q�O��'
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ; � •
51. CERTIFICATE OF OCCUPANCY
No. Date
�' Applccant to Iill in all soaces exceDt tnose wilhin neavy Dortler lines ana zlgn all avvro0rlate tleelantions.
CI7V oF�COSTA MEsa CONSTRUCTION PERMIT
. ProjectAddress 473 16ih P18ee ' ,
Applicant'sMailingAddress 10422 Tra�sk Ave. G.G.9 64
Owner'sName H. Neiiendan - - PhOfe642-020
Addreu 473 16Ch Place CM -
Arch/Eng. License No.
Address
Contracmr'sName A-Ames P1Umb1Ag—HC8t1t1W,one 530-2440
addresslma�rnylln422 Trask Ave. G.G. 92642
City License No. 6664
LICENSED CONTRACTOR DECLARATION �
1 hereby af(irm that I am Iicensetl u r-prvvisie s of Charter 9,(co tmencing
with'section ]000) of Divisio ot the Businass antl Pr � ffin Cotle, antl
my Iicense iz in full force d te t. 07
'License,G�s2 � � License
�Date l� Si9na ur
WORKERS'COMiEN5AT10 LAR 10
\I he�eby affirm [haf I have a certifi ate co ent to selt-insure or a certificate
tof Workers' Campensation Insura ce or certifietl coOY thereof (Sectlon
900, Lab. C.)
Cl'� �u�y rvo. 978832 comP,,,Y ReDublic Indemity
Bertifietl copy is hereby furnisnetl.
�t�r=��-�5s niea w�rn �ne citv �u_i$yh$givp�pSm�bing
Date Applicant
( M1iz section neetl not be completetl if f� permit is one hu �e ($300) or
less)
I ert' E� ir]�he rfon � t wori r "� � pe � s�' suetl I
sh n enbfo�..a y er n n s ec Sct44SY�
Workers' ns ws ot Calif ".
Date Signat a
�NOTICE: If, after makinq this tlecla�ation, y Sh Itl ecome Subject to the
Workers' Compensation provisions of the bor Cotle, y0u must forthwith
comply wilh such provision5 or this rmi shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I M1ereby affirm that th¢re is a consVuction lentling agency fo� the performanGe
of the work for which tM1is permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNERBUILOER �ECLARATION
I hereby attirm that 1 am exempt from the Contractor's License Law for the
followinq reason (Sectian 7031.5 Business antl Professional Cotle: Any city or
wunry whic� requires a Oe�mit to const�uct, alter, improve, tlemoli5h or repai�
anv cr.ur�u.c v�nr in its isuance. also reauirez the aoolicant tor zuch Oe�mit
�
the ContractoYS License Law (Chapter 9(commenGing with Section J000) of
Division 3 of the Business antl Profezsions Cotle) or that he/she is exempt
therefrom antl the basis tor the allegetl exemption.-Any violation of Sectlon
=a;031.5 by any applicant fo� a' pe�mit subjects the applicant to a civil
`.`' Odity of not more Ihan five huntlretl tlolla�s ($500).
j
'✓� I, as owner of the property or my employees with wages as their soie
� compensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Se<tion ]044, Business antl Professional Cotle: The Contractor's
license l.aw tloes not apply to an owner of a property who builCs or improves
tbereon, antl who Coes such work himselt/herself or throu9h his or her own
employees, p�ovitletl that such improvements are not Intendetl o� otte�etl tor
sale. If, howeveq tM1e bulltling or Improvement is soltl wlthin one year ot com-
pletlon, the owne� wlll have Ihe burtlen of proving he/she tlitl not builtl or im-
prove tor the Duroose o( sale).
❑ I, as owner of the property, am ezclusivery contractin9 with licensetl con-
bactorsto construct the p�oject ($ection 7044, Business antl Professions Cotle:
The ContraCtor's License Law tloes not apPty to an owner ot property who
builtls or imorovez thereon, antl who contracts for such-prajects witn a con-
t�actor(5} llcense pur5uant�to�Ihe�ConVactor'S Llcense Law). I am awar¢ that
proof of their Worker's Compensation insurance shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date
I hereby ify t
informat' n is corr
antl st Iaws relt
sent ti ' of
in5pe o pur
$igna
Driver icense or
CMF O86 46, rev. ]0/
I have?ead thi
I aeree tb corn
�yo enter
tion antl state that Ihe above
all city antl county ortlinances
i, antl hereby authorize repre-
bqve-mentlonetl property for
TYPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ �EMOLISH O OTHER q,p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL A Rear .
❑ �OTHER � C Right
PROJECT DESCRIPTION 5�. FT. OCCUPANCY 'K.
CONSTRUCTION TVPE VALUATION $ g L¢Ft
ZONE GRADING CU. V�S. ACRES p�ng. Ref. #
Remarks: n...,i....., �.n.te,- une�cr fiSrM1Nl�i C n� PlanningNotes:
Sink
Preventer
Irrigation
0
Jrinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
I ntercepmrs
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Duct- UnderGround
Duct - Structural
$15
Exhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑0.100,000 BTU �100,000
Reinspeetion Fee
White - <ounting; Goltl¢nrotl - AssaSSor
$15
FEES
Showers
Service Sink�
Sewer C2p
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee I $ 3
'
Automatic Washer
Construction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generemr OO-5 KW �5��
6631 12/31/97
zo�e
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter LJup fo 100 amps
Meter �over100amps
Sub Panel
Motors O0.1 HP O1 �- 8
IncSolar �9-15 HP �16-15+
Microwave
Pole Light
Range
! Standing Sections
5 KW Tresh Compactor
� Reinspection Fee I$15 luue Fee
IANICAL FEES
Hoodor Typel ❑ . DEVELOPMENTSERVICESREQUIREMENTS:
Canopy Type I I ❑ Zoning Approved By Date
' Building Approved By - �� Data
Refrigeration System
❑o-ioo,000sru ❑ioo,000eTu
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � $ 3
'VOnI, IL
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $�
PLAN CHECK $ � PERMIT
PLUMBING $� ISSUANCE $ ��_
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ ' GRADING $
PLANCHECK 50% $ � MICROFILM $
MECHANICAL $ TOTALFEE $� 5_00
PLANCHECK. 25% $ ' � ,
Z
O
N
I
N
G
R
E
Q
M
T
S
' CONSTRUCTION AND PLANNING POOL 7 4 -
. APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
�• 1. Temporary Electric8l Service orPo�e �! 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. � � „� 53. Steel Reinforcement
. 3. Electriral Conduit Utility-Undrgmd. , =' � 54. Forms
4. Electrical Conduit-Undrgmd. � � 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-Undrgmd. '
8. Foundation �' _ , -• , � 59. Gas Pipe, O Undrgrnd., Test -
9. Water Pipe-Undrgrnd; t ' 60. Backwash Lines, P-Trap, � Undrgrnd. ' '
10. Suuctural Floor Sysfem - � .. � � 61. APPROVAL TO DECK
1]. 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 Electriral-Conduit 66. Solar System-Final
76. .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, Ven4ilating , 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ` _ 73. Undergrnd.StorageTank OGas ❑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
37. Plaster Brown Coat �� - - 79. FINAL INSPECTION -
32.tElectrical Power Meter-Final- 80. FOOD CERTIFICATE ISSUED
33..Final Electric . ' . Notes: � " �
34. Final Heating.& Air Conditioning
35. Final Gas Pipe-T,est �
36. Hood or Canopy - �
37. Final Factory Fireplace . :
38. Final Plum6ing , � 'C'� �� j�! �
39. Water Service-Final ��h"
40. Gas Service-Final r��'
41. Solar pomestic-Final '"� ,
�' .
42. Backflow Prevenier r ' � �
43. Backflow Irrigation ' � `--; �
44. Landscape Irrigation SYstem M'
45. Sound Attenuation � ' � �
46. Handicap Regulations "
47. FINALSTRUCTURE&BUILDWG � '
48. Special Requirements Completed �
49. Electric Release to'Edison '
50. Gas Release to Southern California Gas Co .
51. CERTIFICATEOFOCCUPANCY � �
No. Date
APVlicant to fill In all
CI7Y oF COS7a�1nnESn C/ON TRy�UCTION PERMIT
Project Address -f 7.�J �U,// � 7' �Q C'�
Applicant's Mailin Add ess y�3 �� 4C �'
'. L-OYO
Owner'sName �NNati NauPnx�am Phone
Address k73 ��{t�Y—p/4c �.
Arch/Eng. Licenu No.
Addreu
Contracror's Nam �hone
Address (mailing)
City License No. �'
LICENSED CONTRACTOR DECLARATION
I hereDy ai(irm [Itat I am licensetl untler provisions ol Charter 9(commendng
with section ]000) ot Dlvision �jf the Business antl Pmfezzions Coae, antl
my Ilcense is in (ull forca antl�/ cY �
utanse Class 0� License No.
Da[e Si9nature
WORKER$'COMPENSATION DECLARATION
I hereby atfi�m Ihat I have a ce�tlticate of con5ent fo self-insure o� a certlficate
. �t Workers' Comvensation Insurance, or a certitietl copy thereot (Sectlon •
800, Lab. C.)
.'olicy No. Company
eCertifi¢tl copy is herCby tumishetl.
Ce�tifietl copY is filetl wiN the city Builtling Division. ,
Oate APplicant
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION
(This section neetl not Do com0�etetl if [he permit is for one huntlretl (5300) or
less�.
I certify tha[ in the perlo�mance o( the work fo� whlch tltis pe�mit is i55uetl, I
shall not employ any parson in any manner so as to become subject to tne
Workers' m en�ws of Calit nia. � O,s %
Dat¢ � 99�atur¢
NOTICE: If atter making thiz tleclara�on, you shoultl became subject to the
' Workers' Compensation provisions ot the Labor Cotle, you must torthwith
comply with suc� p�ovlsions or this pe�mit shall Ee tleemetl revoke0.
CONSTRUCTION LENDING AGENCV
I hereby aHirm tnat t�ere is a conztruction lentlin9 agency tor tne performance
ot Ihn work for which� thii permit is issuetl (Section 309] Civ. CJ
l.entler's Name
LPnder's AEtlress -
OWNER BUILDE0. UECLARllT10N� �
I hereby atflrm that I am exemp� from the Contractot'S LicenSe Law tor th¢
foilowing reason (Section 7031.5 Business an0 Professional Cotle: Any city or
county whiGh requires a p¢rmit to con5truc[, alteq improve, tlemolish or repai�
any structure, prlor to its issuance, also requires the applicant for such permit
to fiie a signe0 statement tnat he/5M1e is licensetl pursuant to lhe provisions of
tbe Contractor's License Law (Cnap[er 9(commencing with SecNon 7000) ot
Division 3 of the Business antl Protessions Cotle) or that he/she is exempt .
tner¢from dntl lhe basis fOr Ihe alleged ex¢mption. Any viola[ion of SeGtlon
'031.5 by any appliCant for a permit subjects the applicanl to �a civll
endlty of nol more than five huntlretl tlollars ($500). .
❑ I, as owner ot the prooerty or my employees with wages as thelr sole
com0en5alion, will tlo tM1e work, antl the structure is not intentletl or of/¢retl
for sale (Sectlon ]044, Business �antl Professional Cotle: The ConVactor'S
License Law does not apply to an owner of a property who builtls or improves
ther¢on, antl who Eoes Such wo�k himself/herself or tnrough his or her own
employces, provitletl lhat sucM1 improvements are noi intenUetl or offeretl (or
sale. It, however, the builtling cr improvement is soltl within one year of com-
pletlon, the owner wlll nave Ihe burtlen ot proving he/she tlitl not builtl or Im-
rove for the purpose oi sale).
I, as owner Of the p�operty, am exclu5ively cont�acting wlth Ilcensetl <on-
r ctors to tonstruct the project (Section ]044, Business antl Professions Cotle:
The Gontracior'i License Law doe5 not apply to an owner ot properry who
bullds or improves thereon, antl who contracts for such projects witn a<on-
tractor(51 Iicense pursuan[�to tne Contractor'S License Law). I am aware that
pwof o1 thei� Wo�ker'S Compensation insurance SM1oultl be provitlCtl to me.
❑ I am exempt unCer 5eclion B. & P. C. (or this reason
� Data Owner
1 hereby certify tnat I have reatl his appli<ation antl state that the above
intormation is Correct. I agr¢e [o compty with all city antl county ortlinanc¢5
antl sta[e laws rela[ing to builtling consiruction, antl �ereby authorize repre-
sentatives o/ this city to enter upon tne above-mentionetl pro erty for
inipettlOn 0 poses. ' �
519nature Date
Iines ane sign all appro0riate Oeclarations.
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p.#
DESCRIPTION OF WORK/USE OF BLDG.
" $ Main Buildi
E
TYPE OF PERMI7 ❑ GRADIrvG FouNDATION S7RUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER p'
C Right
PRQIECT DESCRIPTION SQ. FT. OCCVPANCV K
CONSTRUCTIONTVPE VALUATION$ g Left
20NE ' GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: . Plannin9 Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspaction Fee
$hOW¢fS
Service Sink
1 Sewer Cap
Sewer Connection
Solar Collecrors '
Solar Pipin9
� Solar Tank
Swimming Pool w/Spa
Urinal
Outlets Water Closet
- Water Heater
1 Warer Service nRN
$15
Boiler
Duct - Under Ground
Duct - Svuctural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU 0100,000B7
� Orivers' License or 55 � I I Aeinspeetion Fee
CMF OB65-46, rev. 4/84 White - Builtling; Canary - Applicant; Pink - Accountin9: GOlden�o0 - As5e55or
$15
Issue Fea
HooJ or Type I ❑
Canopy Type II ❑
Refrigeration System -
❑0.700,OOOBTU ❑100,000
System Repair/AI[eration
laue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A,U.
Fixtures '
Device Boxes
Outlets
SWitches
Garbage Dispoul
Generator �0-5 KW C
7589 9/U4/84
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Merer lJup to 100 amps
Meter ❑over 100amps
Sub Panel
Motors �0.1 HP O1'/: - 8
Inc.Solar�9-15 HP 016�15+
Microwave
Pole Li9ht
Range
� Standing Sections
5 KW Trash Compactor .
u,OG TL
FEES
�� Reinspection Fea $15 Issue Fee $ 3
FEES � ,.
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approved 8y Date
Building Approved By Dateq�����
,. Appliption luued 8y - � � Date—L_L-L
$ 3
SUMMARV OF FEES
BUILDING PEfiM1T $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ �7.C`X� ISSUANCE $
PLAN CHECK 25% $
� ELECTRICAL g GRADING $
„ PLANCHECK 50% $ MICROFILM S
MECHANICAI $ TOTALFEE $ �-L��
PLAN CHECK 25% $
z
O
N
I
N
G
R
E
Q
M
T
S.
CONSTRUCTION AND PLANNING
APPROVALS Permit #
�1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
�3. Electrical Conduit Utility�Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical�Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electric8l-T Bar Ceiling
19. Rough Heating & Air Conditioning
Rough Factory Fireplace
Duc[s,in Structure
Ducts, Ventilating
Gas Pipe-Rough & Test
�d. Roof Framing
25. Roof Sheathing '
26. T-Bar Ceiling ISiructural) & Monocoat
27. Frameand Flashing
28. Lathing & Siding
29. Insulation .
30. DrY�'all Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. FinaP 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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas
51. CERTIFICATEOFOCCUPANCY.
o. Date
POOLt A
Date Inspector p�ppROVALS Permit# �
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding .
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final'
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd.Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: .,, /.. r,t Y,!_ _ ___, . __,
Date
InSpector
,�oon�ssarem�m'c: 473 16TH PL
°"'"E"'s""'E'°'wm�": NEIIENDAM, HONNAH M
"�+�5 473 E 16TH PL
COSTA MESA,CA 92627
�vr�. wmwo,�oox�ss:
UMT:
�xcxrrectonu+aN�n: ACTEL ENGINNERING ���"��' 17009
�xcx.ox�a.•s�oon�ss: 1660 N. MAIN ST °Ni'
OR CA 92667
coNm�crarsru�: pENNING, DAVID ( 714 ) 633-1360
cawt��croxs�uimc 8 0 1 N ELMWOOD
eoo�ss ORANGE CA uur�o.: 332182
92667 uur:
110EN5EU COMPFCiOflS DECLAPATION: I M�eby alfrm uMar parolly W pe�jury Nel I em li nseE uMer povisionn d Cheqm 9
(canmemin0 �wl� Seclion ]OW) d Drvie'ai 3 d iM &ri�wn eM Pmleaabna CoEe. uM mY lioe e in fuA Mce erd eHetl.
�No.:063104 Jc.cuss:g uc.No.: 332 8 EXP: 09/95
1��23-G 5 �����
OWNEX BUILDEfl DECLAflATION: I Mreby elfiim uMer paneXy d perN�Y �het I em eumq Imm Ihe CoMredae Licenee Lew lor iM
IOlbwin0 ro%w^ (�ion )0�1.5 Buai�esa enE Prdmeione Cada: Any cilY a counlY �� �9uirea e permu lo camVuct. el�x. impraro.
Eemdah, or repee eny slmcWm, pior �o na uwerce, ebo repuima Ihe epplirent lor such permN lo file e aqneC etnlemenl Ral he a eM
'� licensed Wm+�� �o ihe povisiom d IM Conireaon lianse lew �Cheqm B(canmerciiq xnh Seaion ]OW) d 0'vuion 3 d �he
luunw erd Prde»iona Cade� w ihm Ae ar eM ia ezemq Ihxehom eM IM buo lar iM elbged memqion. My violetion d Sepnn
1m1.5 by anY eod�� for a permtl wbpae Ihs apWira�t m e dril perely d iwl mae Ihen I've hueMra! dd4n �5500�.
� I.asovmard�Mprapenyamyempbyeesxihwepeamtheieobcompen�eton.willdothexwk.aMlheeNxY�naimiimndad
a dlered M seb (Seclion 10aa. emMa erd vMessbre Code: The Canirmae liorue lewEoea M eOPNto en owrixa qapeny
,H,o wwa « ma�. m«.o�. d,e,.no eo«.� won ��u «n�e� «u'«ron n: «n> e,.� «�dw�. v�d mm.�n
impwemema ere m� imsded aWmeE lor eab. tl. howeuer. �M WYEiip a inqownmt a eold wnhin ma Y� d wmpluion. tha
owror-0uider �till heva �M WNen d povirq M a tlre d'd nu Wik a impv.a lor tM Wryoee W seb).
� 1. ea wmer d ihe YWaM, em utluei+W conlrediq wM 4cmaed conheciwe ro caWrW iM M9� (Satlion ]UM. BueiMee eM
Vrofesaiare Coda: TM Contredon license lew doea ml eppFy to an owiwr d qopMy wlw buiWa a impwn �Mraon erd M1n
eonveeia for auM prqeels wilh e wmeeaor(e) IcenxE punueM Io tha Comrwae Lkeme lew). / 1 p� O��
� I em eeemq under Sxtion: B. 8 P.G, for thin reeeon: t i I y j
Oe1a, �a:
i eo ne�eM �.�v u�m i� ewa,e a ene �nam.i.�a u,a �a�+��n w cdaomy He.nn �e smero coae saeo�. zssos. �
z553a. eM Nm I«anv Mure buiMi�q oowP+�t will / wil na (dmAe aw) rieeE to canOM w1n uid qme codes vd Ihe �e9uiremmn
a pdmil l«miulrud'an a moE�mibn hanlMA'r�ityl.raregement Dim�. Reeidantel mmtrW ion eppf�miomenexamd fmm IMea
wmd�+..
Dme: ApqieN�
WORKER'S COMVENSITION DECIARATION: I MreEy elfmm imder penMy d pajury me d Ne Idloxi�p Eetle�etiom:
❑ I haw uM wil meimen e ceMif'We d roneent io eW-imure M wa�kere' cwnparonbn. n provkeE lar by &edion 9)00 d IM lebar
cad.. �or �ne vM«mence a �M woh �o, wNcn mis aemiX Is Isvuae.
❑ i nave e�a �;� mdm,:� �n�.• oomw��n� m.�,.�,..,w��a M senian s�oo d m. ienw cade, m, m. w��m�oe a me
wak lor which Ihie permA ie iauad. My waYse' mmpensation ineurance ra�ibr eM poliry numbar are:
ce„� .
PolicyrNumber:
aecfmn need na be compbleE l IM pmrl is b one huMred dol/ers (SfOJI a Iw.)
eenM � in Iha perlamerv;e d iM wak la whieh Ihie pmmp o ba �I MeA m� ampay eny nan in anv menew o m m
wbjea to the xorkwa' compenaeiion lewe"d Celilortue. � e�ae Nm tl I ehouk�icoms wbjetl lo iM wa�k�s'
c ruetbn qwis'wre d Seeian 9100 d iM lehar Cade, I duA ly� h mpy h tlaeq'rorieiore.
♦ �
�, o ^L 3 -�f �— ww�: i �d �
Wem/n0� F�Ilun ro ucuro wortxi romperu�tlon coverep� la �nlawNl, enE �lull ubJ�cf en smployar to crlMrol psneMu eM
c/W/ l/rros up ro aro hintlrod thouurd ldlen (Sf00,000), In erKltlon lo Me cwt ol rompxwtlon, eemepes �s prvv/ESL br In
Sxf/on 9106 0/ IM Lebor Cotls. Inhro�f, entl ettorvroY's leu.
�. CONSTHUCTION LENDINO ROENCY: I hereby elfirm under penelry M perlury thd iMre ie e mnelrudion bMi�p epency la tM
'� parlormence ol Iha wak br which t�o pemin is eaued (Sedion 308), Civ. C�.
LENDEfl'3 NAME:
LENOER'S ROUNE55:
I cenity Ihel I hew reeE Ne epdr�� � d�e Ilul Na ebwe inipmetion o wrteU. I epree to canpF/ wilh ep ory vd counry wdi�
eM emte lewe Mel'vp to Wik'up conXrutlion vd MrMy eu1Mr¢a �epaente�ivee W Ihin tiry lo enler upon IM ebove.manloneE properly
ta inspatlbn Wrposea.
DAVID�ENNING
Deb:
(5151�48.WP) Whne-Buildiip 8 Selery: Oreeo-Fle: Cenery-RppliceM; Pink-Remnue: Goldanm�-Aasesw
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: H 072926
PERMIT NO: B 072926 PLAN CHECK NO: 02302-95 L GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION ; ADD 58.SSF DINNING ROOM SQ FT: 5,000
CLAIM VALUE: 5,000.00 CALC—VALUE: 5,000.00 GROUP OCC: R-3 /
COMMENTS: ENCLOSE EXISTINING BACK REAR " DINNING AREA " SMOKE DETECTORS REQ
�*�*******�***�����*�**�r**�**�**�*�*�r*+r*�***��*�*�r��x�*�**��+r*�*��****�*�****�**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: 26 FT 6 IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: 5 FT SN LEFT: FT IN RGHT; FT IN
PARKING REQ: PROV: PARCEL: 42515113 ZNE: R1 REF NO:
PLANNING NOTES> EXPAND EXISTING DINING ROOM AT THE REAR OF AN EXISTING
> SINGLE FAMILY RESIDENCE.
3E iE iE iE 3E i(� if iF K iE if iF 1E iF iE iE if df iE iE if iF-lE aE if iE iE iE iE iE iE 1f iE iE iE iE iE iE 9E iR iE aE iF iE �f 1E if if iE if i(�if if if iF aEiE iF iE iF if ik iF iF iF iE jf if iF iF iF if �F 1f �E 3E iE if if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPAOVED BY �!C/�C /�� DATE:
BUILDING APPROVED HY : �/l�\ DATE: ' ��
��_______'" _�_"___ _"" /+` ____ .
PERMIT
N
HLDG PMT
72,00
PLAN 46.80
ISSUE FEE
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
STRUCTURAU SEGMENT:Y
FIRE SMIP/RES GRADING
50
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72.50 0.00 46.80 119.30 119.30 .00
REVENUE DIVISION TOTALS--> COLLECTED: 72,50 OVER/SHOAT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
72,00 .50
iF iE if iE k iE 1f 1E 1f Ik iF k 1E if if if 1F if if k 1E it 1f iElE iE iE iF fE iE iE 1F 1E iE iElE iE 1E ik �E 1! iE k iF iF iE 1F ik k 1E if iE 1E iE iE fE 1E �k iE fE 1E iF 1E fE fE �E iE 1E �E 1E 1f if iE iE 1E iF iE iElf
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 5000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 5,000.00
END OF FEES
U1 JJ1DYl%Y-'.li..UO%�J �t+ 1 _�S�J
C�aiE; �_t.; ��, iG i,�;E: 23:oC
CONSTRUCTION AND PLANNING POOL �PA !
APPROVALS Permit # ' Date Inspector p�ppROVALS Permit # Date Inspector
1. Temporary Elactricai Service or Poie 52. Pool & Equipment Location �
�
2, Soil Pipe�Undrgrnd. ' 53. $teel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electricat Conduit-Undrgrnd. ,' S5. Electrical Bonding � �-
5. Stee� Reinforcement 56. Rough Plumb(ng & Pressure Test �
��6. E�ecvicai UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings � 58. Electrical Conduit-U�drgrnd. ' _�
$. Foundatior� 59. Gas Pipe, � Unorgrnd., Test ' / j
�
9. Water Rpe�Ur,drgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Ploor System � 61. APPROVAL TO QECK" �
11. Property Sewer Line & House Cort�ection 62. Backwash & Receptor-Final �
72. Sewe� Cap 63. Heater & Vent-Finai '� �
13. Roof Orains - - 64. Plumbinq SVstem � Final , .
14. flough Plumbing 65. Electricai�Fi�al '
15. Rough Electricai-Conduit - - 66. Solar System-Final
' �
76. Rough EleCtr(c4Viring - 67. Fencing & Access Approval I
77. Rough Wiring Sign '"68. APPROVED FOR PLASTEflING
18. Rough Electr=.ca.i-T Bar Ceiling j'•� ', [.'�g. POOI./SPA SYSTEft�S FINAL
79. Rough Heazing & Air Conditioning � _ FIRE DEPT. REQUIREMENT
20. Rough Facmry Pirepiace ' _ T�', .APPROVALS' Permit # 1
21. Ducts, in Structure � _. '7-0. Underground Hydro
22. Dutts, Ventilatin9 . - � 77. Product Piping � Gas D Oil
23. Gas Pipe-Rough & Test � 72. Underground Plush �
24, Roof Framing � . 73. Undergrnd. 5toraye Tank � Gas ❑ OiI (
25. iioof SheatM�g � 74.� Overhead Hydro
26. T�Bar Ceilin9 (Structurall & Monocoat � 75. Dry Chemica! �
27. Frame and Flashing , 7 1Q1�� �(��L 76. Dry Standpipe '
28. �athing & Siding _� -`� r Cf_!�C �Ltia' j7. F�XED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywail �NBiling �l,.i�� u�L; - , HEALTH DEPT. REQUIREMENT
31. Plaster Brotvn Coat � /-"�� 79. fINAL INSPECTION
32. �Electrical Power Meter�Final 80. POOD CERTIFlCATE ISSUED .
33. Final Elect��c . � Notes: ., � - -.
34. Final Heating & Air Conditioning ��
35. Final GasfiPe�Tezt ' - • � -
,i ,
36. Hood or Canopy -�� .� � - _ "
37, Final Factory Fireplace �
38. Final Plumbing � - _
39. lNater Service�Final ' � ._
40. Gas Service-Final _
47. Solar pomesticFinal . , � _ -
42. Backfiow Preventer � -
43. 8ackflow irrigatron - . . �
44. Landscape Irrigation System � ' � ' � � ' •
45. Sound Attenuation , � � - _ .
46. Handicap Regulations �
�-.
47. FINAL STRUCTURE & BUILDING Y,�c. �(��- ,
7 �
48. FINALPLA{VtSiNG ,.'� .
49. Elec[ric Re�ease to Edison w '
50. Gas Release to Southern California Gas Co - � �
51. CERTIFICATE OF OCCUPANCY •
No. Date -
�oonFss a em�awo: 4 7 3 1 6 TH PL
°�'/"ERs"""E"'Q'°"": NEIIENDAM, HONNAA M
�noness: q � 3 E 16 TH P L
COSTA MESA,CA 92627
�vri. xuuxc �ooxFss:
u/n:
�xcxnecTonu+aN�n:ACTEL ENGINNERING �� 17009
�Kop�o•S�o�E�s: 1660 N. MAIN ST UNT:
OR CA 92667
car+m�cTarsru�e pENNING, DAVID ( 714 ) 633-1360
CQRPACTOR4YI11JN0 $O1 N ELMWOOD
eooxEss:ORANGE CA �� 332182
92667 �NT
LICENSED COHfFRCTONS DECLAflRTION: I heraby eR'rm uMx perely d pmjury the� I licenoed uMx povieime d Cheqx 9
( ' p xrh Saetun ]OW) d Oiveian 3 W Ihe &reimae vd Pmfaeapns Code. and mY I ia in IuA twea eed Wetl.
uc. r o: 0 6 310 4� cuss: B uc. no.;� 3�8��E, X f 0 9/ 9 5
a: c�.ma �
N BUILDEN DECLAN�TION: I hmoby dfirm under penely d per'Fuy thm I am uemq tmm iM COM�eeon lirome law la tln
� B�_^^ (�� ]OJI.S Bueime enE Pm/wons Cole: Airy ciy a awmty xfiidi repu'ves a paimu lo combuct. allx. impws.
deh. a repei vry eV�ciure. priar lo in bwerce. abo requiree ihe epplivm la auch prmu �o fib e egneE etetemeru �hm he n eM
� i��a w�,�,i io ine wo+�.�. a ins cam�ao� �� i.. [cnaq« s I�m«��e wan s.d�, i000l d a.s� a d n,.
usirwas eM Prdeasvu Cadel rc ihet he m aha b uemp tMreimm enA iM Eavo ta IM elbpeE exemqion. MY violation W SeCion
lmi.5 M�,y ecWimm �w e wrmn w4�+ �na wpiceiu �o a i 1 pene�ry d na mae �nen Me huMred ddWa �ssrop.
� I.maxnerdlMqopMywmY�dW��hwap»mlheieobcompansetian.vnllEoMexwk.eMlhaeViMumurMimeMed
a dlxed fa ub (Section )OM. Buvrov eM PMevaiona Code: The Canumwa L'rarua law doea rat e00Mlo en ownmot popeity
wla WiM a inpovaa iM1araon. end who Eoas suM work NmxM a hene� or Nrouph he a her own empbyeae, po+ided thm eucA
impmvemenls ue ml inleMed n dleieJ la eale. II. Irowmer, IM WiNiip a'vnqwemenl b wN xilhin pr yav d mmpl&un, IM
ownar�WiMer Mill heve IM WNen d provi�q he or aha d'M � WiN or impova la Ne W�C�e d mle�.
❑ �. av oxn. a in. wowM. em utluarvdr mnvmne wnn �icen.ee wnv.ciwn m rnmne ine wdea (swia, �au. anfnm. ene
Proleeeims Code: The Comreaae L'eense law doea m� eppy �a an owrer d popaM ��ilda or impoves ihmaon eM v.ho
comrens fa wch prqeda wnh e ooMredor�a) Ikerued punueM lo ��e ConlreUaa Limnee lew). ,
❑ I am ezemq under Seclion: B. 8 P.C., br I�is ree.van:
Deie: O+mer:
I do Mreby ceMM �hel I em ewera af eM undentenC ihe raQuiromend d CelCanie Heellh eM Sefety Code Sadime 25505, 2553�, vM
2553a, end Ihei I a eny INura W ilEinp oavpenl will / will nM (drcM ane) need lo canply wYh eeid tlele oodm enJ tM requiromenle br
e permil formnevuciion ar modifi•alionhom IM Ri�arepement Diatriq. ReaideMiel mmtiueion appYmiwu en eumpt Irom thma
prwiaionn.
or.: novi���:
WONKER'S COMPENSATION DECLAX�TION: i Mreby elfirm uMar penelly d perjury me d tlw Idloxi�p tlederazbna:
❑ I hm uM xil meimen e cerltlicme W mment io aatlinaure fa �wike�s' canpenaetion. m prwkeE lor by Setlion 3)OU d �M lebor
Coda, la tM peNormence d tM wA la which ihia peimit u iasueE.
❑ i neVe e�a �;� mvme:� woMn.• mmre�=aa� m.���, m�w���a M see�m aiao d m. iae« cme, r« me wnormenm a m.
work la whiW Il�ia perm� ia inueE. My warkers compenulbn insurence mmer eM pdiq number ara:
I Cem .
PdiryrNumber:
,., ,aa� �,.ed �a ee comd�ee r n» w�+�e u ro. are nuneree edwrs /siool a bsv.�
cenAy thel in iM pMwmerce M the work tar whc� Iho pe�mA e ssuetl. I sheA M emqry erry in vry memx � n ta
tx«ne .ud� m �n. wonwn' comv�� �w. a celiloma. eo� �nn ii �.nwk wbjetl �o ine wonen�
com enaaibn prowione d Saqpna]00 d IM1e lebor Coda. l ehel/l( h h mmpy xiM thoae I .' .
� noo�c+m: /A � � IA/�^-�--�-
Lrp: FaNuis ro ucvro wortm' m�oeiwtlon coveraps Is unlewN( antl ahellWb/�cf en anplo�w ro cNrNnl ps�Wtlq eml
I clvll flnu �q ro om h,ndrW fhouurMOo/Nn (5f04000), M MNfbn N fM cwf o/ rompwwfbM1 C�m�p�a u poHtlM br In
Ssctlon 9)OS o/ Ms LeDor C00r, IMrest, ur! attomsy i/su.
CONSTflUCTION LENDINO A4ENCY: I Mraby etfi�m uMer peeuM1y d perjury thm thsa e e mmtivabn bnCMp epeney lor ihe
paAOrmarKe d IM wark IIX whiM �ha pemiY c eeued (Saqion 309). Cx. C�.
LENDEF'4 NANE:
LENUEN'S �OORESS:
I cen'dy ihet I heva reeE Ihu epdkd� � p�e Ihel �he ebave informe�bn is conecl. I aprea ta cpnply vmh dl ay uM mumy adirenou
arM slPoe kx+reltlng lo buildvq consUWion ud hereby aullarize ra{xeaente�ives dthia tilyto enler upon IM ebove�meMoneE popeR/
lorinspeabn Wrposes.
DAVID P,aNNING
�
(St51-C6.WP) Whno-Buildinp b Sefely; Oreeo-Fle�, Cenery-AOVIiceM; Pink-ibvenue; OoldenroFAeeesaor
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: E 072927
PERMIT NO: E 072927 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
iJOH DESCRIPTION : ADD 58,SSF DINNING ROOM SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
COMMENTS: REF: B-72926
*�**�*��***�*****�*****��*��****x+�+�***�x��***�+�****�***�**�+�*x ***�**��-***�r+�� **�r*
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT ZN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42515113 ZNE: REF NO:
PLANNING NOTES>
i
iE 1E iE if 1E 1E 1F 1E k iE iE 1E fFlf iE iE iE 1E IE aE iE fE 1E iE fE if iElE 1E fE IE iE iF iE iF iE 1E if iE 1F iE iF if if 1E if if 3f iE 1f iE3Eif if iE iE if iE 3E IE iE iE 1E aF 1E 1E �E if if if iE iE If iE iE 3F iF * iE
D E V E L O P M E N T S E'R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY
HUILDING APPROVED BY :
APPLICATION ISSUED BY: �
iE iE iF iE ik 1F iE �F iE 1E i(� iF iF if aE jE i(� If if iF ik iE iF��F
LEGALIZATION:N F E E S M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 3.00
50�
DATE:
DATE:
DATE: � �)
�E�{FiEiEiEdEi4iflEiE1E7E iEiE
STRUCTURA SEGM NT:N
FIRE SMIP/RES GRADING
SMIP/NON-RES
PLAN
ISSUE FEE 15.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 3.00 15.00 0.00 16.00 18.00 .00
,
REVENUE DIVISION TOTALS--> COLLECTED: 18.00 OVER/SAORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
18.00
ff if 1E iE 1E if 1E iF iE 1E iF iE iF iF iE jf iE iE iE iE iE iE 1E k iE 1E iE if if iklFlE iF ik iE if 1E 1E 1f 1f !E 1E 1f 1E iF iElF iflF iE 1EfE iElE �E 9f 9f iE iE 1E if 1E iE if 1E iE 1E 1E 1f if iE ik i! IE iE iE Ik 1E ik
I N D I V I D U A L F E E B R E A K D 0 W N
iTYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 1 FIXTURES LIGHTING 1 ST 20
ELE 2 RECEPT/OLTTLET 1 ST 20
ELE 1 RECEPT/SWZTCH 1 ST 20
END OF FEES
EA. .75 .75
EA. .75 1.50
EA. .75 .75
Ut '.G '�- ;�I3�:7':' F :t� :o.���
�F�'�• .:� .. � , 7L.F: .s: _ . _
CONSTRlJC7lON AND PLANIVliJG \' � ( �'G�� `'Pf° � � �
APPROVALS Permit # �� aaie I Inspector AppRQVA�S PermiY# Date lnspector
R
7. Temporary Electricai Service or PoEe 52. Pool & Equ+pment Locatian .
2. Soif Pi�e-Undrgrnd. 53. Steai Feinforoemer,t .. � �
�3: Efeciricai Gor.t3utC U;iilty-Undrgrnd. 54. Forms i ���
4..Electricai C?ndu;i-Undr�rnd. � f E 55. Electrical 6onrting � �
5: 5teel ftein',orcarnent 58. Rough Piumbing & Pressure Test � ' � 1
�
.�� .E3Pctrical IJFER Grnd. 57. APPftQVti� TO C6b'ER�GUNITE
7-. Footings, � ��� 58. Electrical ConduiY-Undrgcnd. � �
i : ��
$. Foun.dation 59. Gas Pipe, G Un�rgrnd., Test i,
9. N.'ater Pipe�Undrgmd. � Bp. 6ackwash Lines, P�irap, :: Undrgrrd. j
14. Struaura� ��oor Systern � 81. APPR4VAL TO DECK � ' (
7 t Properey Sewer �ine & House Connection � 82, Backvvash & Receptor��ina7 -
- � i
72. Sewar Cap _ 63. Heater & Ve.�t-Pi�ra! �
i
13. Rooi Dralns - g4. Plumbi��g SysYem � Finaf '
14. Rough P(urntaing 66. Electrical�Fina: -� >
�
75. Rou9h EieUtricabConduit , 6 lar System-Finai
i fi. Rough EleCtric lVirinc� � 7Z` n/_ ' �encin{7 & Access Approvai � I
'7,7
17. Rough 1Viring Sign 6B. APPROVED FOR PLASTERING
78. Rough EleGtricai-7 Bar Ceiliny 69. POOUSPA SYSTEN�S PINA� �
19. Rough Neating & A�r Canditioning . FIRE DEPT. REQUIREMENT , �
20. Rough Factory Pirepiace � "APPROVALS �.' Peimi2,�-- �
21, pucts, in 5ructure _ ' - - , 70.'Underground Nvdro
22. Quets, VentileYing � . t-� 77. Rroduet Piping C.7Gas :�Oil
23. Gas Pipe-Rough & Test � � 72. Underyround Flusfi '
24. R�af �raming .' ' - . 73: Undergmd. SCoraye Tank � Gas �� Oii
25. Roof Sheathing _• 74. Overhead Hydra, .
26. 7�Bar Ceiling tStructuraq & Monocoat -, 75. Dry Chemical - �� .
27. Frame and Flasfiing .. - 76. Dry Standpipe " • - �
28. Lathing & Siding . ' 77. F1XED SYSTEM FINAL
29. 3nsulation � � i 78. FI(�E PREV. FINAI.
30. Drywail Na��hza '_ , ; - HEALTN DEPT. REQUIftEIl4ENT
37. Pias.er Brown Coat � � 79. FINAL INSPECTION�
� 32.'Efectricai Yowet Meter-Finai �� ,. 80�; FQOD GERTIFICATE ISSUEp
- 33. Finab Electtic � _ -f�e� Notes: � �
34. Fi�al Neating & Air Cond�tioning � ' . " _, -
35. Finai Gas PiPe-Test � . �
' 36. Hood or Canopy _ , � � � �
,r::�
37. Finai Factnry Firepiace -� . .
3&. Final�Plumbing ' ' . '
i
39. Water Service�Finai ,
, 40. Gas Service-Finai � � �
At. Solar pomestio-Finai � �
42. Backflow Preventer �
43. Backflow frriQatton , ,- .
44. Landscape irripation System `i ` _ ' �'
45. Sound Attenuation , �� ' � � � . �
46. Handicap Fieguiations - _ �
47. FINALSTRUCTURE&BU�LDING , "��- � ` .
48. FINAL P�ANNING � � � . " _
49. Electric Re�ease to Edison � � , ' .
50. Gas Reiease to Southern Cafifornia Gas Co � �- �� ' �
51. CERTIFICA7E OF OCGUPANCY `
N0. Date
OWN
� �._ _._ _ ,- _� „ _ .. _ _
JOBAbDRESS Ii73 l(�th Plaoa BUILDINGPERMITNO. ].5�(
GENEkALCONTRACTOR Talcott & Jav vA�uE ����nnn_n�
L 11 BLOC
GROUP I TVPE
INSPECTIONS
Footing Trench �'�/
Found�tion Forms and Gratle to Gara
Rough Framing
Plumbing, Rough ta Slab
Plumbing, Rough Complet �,,g.c.�" �
Temporary Pole � c.�.
Wiring, Rough
Heating, Rough
Heating, Final G��
Sewer, Hause � Sewer, St.
V `ng, I
Plumbing, Final, Fixtures
Plumbing, Fin,al Gas Test
Wiriny, Final
Occupancy
,;•'_.�n,n,- c.,c�n, ce
ZONE [t!t
SUBCONTRACTOR
PERMITS ISSUED
I NUMBER
-ai-ss•. /ao
-7-r5 i�F�/.3
'�-�S- 1�ro
�-i -Ss' 3�-aG .
• Costa Mesa Building Department APPLICATION FOR PERMIT
• � . 111 EAST 20th STREET ��� B U I L D�� N G �
• ' COSTA MESA, CALIFORNIA
I+'Oit APPLICANT TO FIa.L IN �Odt OFFICE USE ONLY
_Receipt No. Permft N
naade� �' 3 i� J.5�3f�
Costa Mesa, C&�017La Receive y Date Rec'd. Date Issu
Nearest T/� � �3 J � ��� �
Cross St. LLiC �if/C� Building
Address
Owner �, KJ. h O �'�- Costa Mesa, California
Mail
Address Q Nearest �
/I � Tel. Cross St.
City [�ps/4 I�Giw No. '� Zone No.of Type I Group
Architector Lfc. I Plans I �
Engineer � No. Approved , /
by !/ Date
Address CORRECTIONS
City Li
�tractor /� 9� No. O
Address %1..'�f5�� ^'�>� �AS�d�G. 7. /`t �
(Attach Metes and Bound � . Z��.��
p� 9�' G
Size of Lot �.�KlJ v ` Nowon Lot
Useof No.of ..[Vo.of
Existing Bldg. I Famfllea Ro3m ,
Setback �ine (rom � Rear Yard.,tyn_ / r.
Center oT Street , Side Var �CI
DESCRIPTION OF WOR p'�
New I' I AlteraHon I I Addition I
Repair I I Movinp I I Demolish I
ounamg �� y
Size J
^-terior Wall 'S7a6
ering 7y�m,o
_ �9 of New �
I hereby acknowled�
and state that the al
with all City Ordin
building constt'u w
Signature of
Permittee �
Authorized Agt. �
Valuation
s %%y ou� �
'IRM 204 �-H 2M 5-30
Roof
APPROVALS
�n Location InSpecto
Materials,
�inning
re Stops,
that I have read Uus Application
�e is correct and agree to mmply
ices and State Laws regulating
� Plaster, Int
/�
� Plaster, Ext.
i
Masonry Rei
Permit Fee $ , � o
Plan Check $ ?�, o a Bond Beam
Total
Fee s 3 3. o o FINAL
�_ I
�
2
D
r
. a �.v.�. a r,ara�
$how loCatlon and distahcee from
property line and between buildinga
r' - .
. 1 �. . - 'j ` . .
JOL 1 �-5;P�uesnn',9Qi ��`�''33.ra
` . .
J . � � . � , �
i , l, _
i
' � t �. '
� . • . ' �,�• . . '
� � . �
_ t ,
- .` .
"_ ` _
�1
.. ., r
. _ , ,
_1 . .
. , . . � - ..
` .
_ - �
1 , • ' . .
. . . . . "f `_"
n_
:� .