HomeMy WebLinkAbout289 16TH ST - Building Permits INSULATION CERTIFICATION i
2,. et C . ! 6 A Cditt1 c orehre E
Number ane Street City County
Suar.rbIon Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material reit el.'Iii Brand Name Give,. � e k dion 7
Thickness (inches) 6 ~. Thermal Resistance (R Value) ' If -a /9
•• EXTERIOR WALL /'� ,•
_
Material _____E, �i.-aj/LI%/ Brand Name Cur_an at pae;� ,'
Thickness (inches) Cr i Thermal Resistance IR Value) �ifj'�71s..�_
CEILING R�j //�� J C/�� ���/M
I,'�daft Brand Name V iIMM �
Batt or Blanket Type
Thickness (inches) 6e Thermal Resistance (R Value) R - / 7
Loose Fill Type Brand Name
Minimum Thickness finches) Number of bags Weight per bag lb
Area Covered (h2) Thermal Resistance (R Value)
FLOOR, ELEVATED.
Material Brand Name
Thickness finches) i Thermal Resistance (R Value)
FLOOR,SLAB i1
Material 'Brand Name
Thickness finches) Thermal Resistance IA Value)
•
Width(inches) _ • I
FOUNDATION WALL i
Material Brand Name r
Thickness finches) Thermal Resistance (R Value) 1
I
•
DECLARATION I
-
I hereby cenify that the above insulation was installed in the building at the above location in conformance with the i
current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the
California Administramave Codel.
_ c.
Gmt1Jl Contractor ( License NumUer 1
IR*,4.4.0.0 1. , - C. (IAA- A,e f ra-/4, i 1E r
Signature aria Title Date
I
Sub Contractor (Insulation Applicalor) License Number
_ Signature aria Title Date
Figure a -1 Example of a compliance certificate
4-9
•
INSULATION CERTIFICATION
8 9 G . ( 6 /A C o.iie. M ers 01.-4,4_, e
Number and Street City County
Subdivision Lot Number
•
DESCRIPTION OF INSTALLATION
ROOF
• Material / Brand Name
Thickness (inches) Thermal Resistance IR Value)
EXTERIOR WALL - C
Material FG• a Qf Brand Name f of a 0 I. I) 1/13
Thickness (inches) Z (
Thermal Resistance(R Value) ' /1 ii
CEILING
Batt or Blanket Type Brand Name
Thickness )inches) Thermal Resistance IR Value)
Loose Fill Type_ Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb
Area Covered (ft21 Thermal Resistance (R Value)
FLOOR, ELEVATED
Material _ Brand Name
Thickness(inches) Thermal Resistance IR Value)
FLOOR,SLAB I
Material 'Brand Name
Thickness (inches) _ Thermal Resistance (R Value) _
Width (inches) _ i
FOUNDATION WALL '
Material - Brand Name
Thickness finches) - Thermal Resistance(R Value)
I
DECLARATION • j
I hereby certify that the above'insulation was installed in the building at the above location in conformance with the I
current regulations setting Energy Conservation Standards for new residential buildings (located in Title 74 of the j
California AdministraYvs a Codde�)- t
\\/ I
( Dene,al Contractor (Builder) _— License Number i
ot.ine- / C -,'/d-. // l 6l ei
Signature ana Title Date I
Sub Contractor (Insulation Applicator) License Number
-" --
Signature and Title Date
Figure 4 -1 Example of a compliance certificate
4-9
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CIOF,C IESA PER T O. r- TRACT NO. LOT NO. •BLDG.NO. 4'•_ +t��L1,I—
F- 1 � � --
CONSTR UCTIOIITPERMIT f �j _
[.
Project Address 8 9 ) I f -� Ye L / TYPE OF CONSTRUCTI
Owner 3u m of C . it ab,e j'Phone6 -6079 0 NEW 0 ADD ALTERATION R
Address" 09 Vs,pfs, aay4 CM, 0 REPAIR 0 CONVERSION 0 DEMOLISH -�
Arch/Eng. License NO. 0 OTHER
ZONING REGULATIONS )))
Address DESCRIPTION OF WORK A.P.
Contractor p Phone ZONE PLNG. REF.5
Q j✓h f✓rV �f I� �46 -6�4' TYPE OF PERMIT BUILDING Tp gU �p L�
Address OO / SETBACK CJL ST 7RO PEIRTV GNE w�
>09 I/ffY4 �a 'c C �- 0 GRADINGFOVNDAT�I OJp1 0 STRUCTURAL SltI YARD
LICENSED CONTRACTOR DECLARATION 0 TENANT ELECTRICAL L10P LUMBING OMECHANICAL fSll[1EI YARD
I hereby affirm that I am licensed tinder provisions of Charter 9(com- R
mencing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, and my license Is In full force and effect. PROJECT DESCRIPTION REAR YARD(TO P/L)
License Class License No, - PKG.SPACE REQ. PROVIDED
Date Signature SQ'Fr---
WORKERS'COMPENSATION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE§
I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY I DATE
certificate of Workers' Compensation Insurance, or a certified copy
thereof(Section 3800,Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS:
Policy No, Company
-ertified copy is hereby furnished. REMARKS: S/9•/
ertified copy Is filed with the cItY Building Division. T
t—EMPTION FROM WORKERS' COMPENSATION DECLARATION /11Arr`,. - CJL-r-/n k/N. w'n '
(This section need not be completed if the permit is for one hundred
15100) or less). /2 -Z-Sri C.C.
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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
subject to the Workers Compensation Laws of California. UW ELLfNG GARAGE
Date Signature BATHTUBS SHOWERS SO.FT SO FT
NOTICE: If after making this declaration, you should become subject TOILETS URINALS • GENERATOR 0-1 KW_1-10 KW
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50+KW
revoked. -4
KIT.SINKS DISHWASHERS MOTORS
CONSTRUCTION LENDING AGENCY ` 0-1 HP 1-10 HP
I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS / (INC.SOLAR) 10-50 HP 50 + HP
formance of the work for which this permit is issued (Section 3097 s' ! ` —
Clv.Lender's
DWh r✓ FLOOR SINKS FLOOR DRAINS I it f v FIXTURES OUTLETSA5SWITCRHES — 'Tr
Civ. C . Name
Lender's Address DRINKING FOUNTAINS , GAS TUBE SIGNS
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS �� POLE LIGHTS
I hereby affirm that I am exempt from.the Contractor's License Law for
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP ��ff LUNSI Hut, Rini
Any city or county which requires a permit to construct, alter, o� POLES METERED SUB
improve,demolish or repair any structure, prior to Its issuance,also re- WATER SERVICE c^^TERAT)QN PANELS MAIN SUB
quires the applicant for such permit to file a signed statement that he GF" 7/Oh
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE AO OUTLETS ` 4 --- SERVICE AMP
(Chapter 9 (commencing with Section 7000) of Division 3 of the r
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT
basis for the alleged exemption. APY violation of Section 7031.5 by -
ar- applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
r l more than five hundred dollars (5500). ,
as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS
sore Compensation,will do the worts,and the structure is not intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE
Contractor's License Law does'not apply to an owner of a property
who builds or improves thereon, and who does such work himself or ISSUE FEE - APPLICATION APPROVED BY DATE
through his own employees, provided that such improvements are not
intended or offered for sale. If, however,the building or ImprovementMECHANICAL PLAN CHECK SUMMARY OF FEES
is sold within one year of completion,the owner will have the burden
of proving he did not build or improve for the purpose of sale). BUILDING
HEATING SYSTEM 0-100,000 BTU
PERMIT $ SMTP $
❑ I, as owner of the property, am exclusively contracting with AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000+BTU PLAN CHECK § PERMIT
and Professions Code: The Contractor's License Law does not apply to — +'/ ISSUANCE $
an owner of property who builds Or Improves thereon,and who con- REFRIGERATION 0-100,000 BTV PLUMBING f
tracts from such projects with a contractor(s) licesned pursuant to SYSTEM GRADING $
the Contractor's License Law). 100,000+BTU PLAN CHECK $ •
❑ I am exempt under Section B.& P.C.for this
• BTU ELECTRICAL § 7- $
reason rj a J PLAN CHECK $ MICROFILM $
Date ROI / r Pi Owner /ansa . SYSTEM REPAIR,ALTERATION •
-
MECHANICAL $ TOTAL FEE§
I hereby certify that I have red his application and state that the above EXHAUST SYSTEM MULTIPLE • S - LESS AD-
information is correct. I agree to Comply with all city and county PLAN CHECK $ VANCE PC 5
ordinances and state laws relating to construction,and hereby authorize
representatives of this city to enter upon the above mentioned / /.
property for •///n�spection p rpo L`/ -
Signature `.1�� 1 ' `' Date /01 rel FINAL FEE 5
Drivers'Licen or SS 914 ISSUE FEE
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
Ilk.
CONSTRUCTION AND.PLANNING . POOL& SPA. �A ` ,
APPROVALS Permit# PP4 7 Date Inspector
APPROVALS .
Permit,# - Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn - 44. Steel Reinforcement -. •
' '3. - Electrical Conduit Utility-Undrgrn 45. Forms •
i 4. Electrical Conduit-Undrgrn - 46. Electrical Bonding . _
5. Steel Reinforce • 47. Rough Plumbing & Pressure Test - -
. -6. Electrical LIFER Grn _ 48. APPROVAL TO COVER-GUNITE • - . -
7. Footings _ • ' 49. Electrical Conduit-Undrgrn • '
8. Foundation 50. Gas Pipe, ❑Undrgrn,Test
' 9. Water Pipe-Undrgrn 51. Backwash Lines,P-Trap, ❑Undrarn -
' 10. Structural Floor System 52. APPROVAL TO DECK - -- - -
11. Property Sewer Line & House Connection , 53. Backwash & Receptor-Final •
12. Street Sewer Connection . ' . • ,- 54. Heater & Vent-Final '
13. Rough Plumbing 1 kg) (0-)--KCI 55.• Plumbina System-Final • - - -
14. Rough Electric-Conduit ` :56. Electrical-Final . ..
-15.. Rough- Electric-Wiring•- - - -. - --- - •-- • / 3.5/ /pc, 57. Solar System-Final _, •• •• '• a - •-
/_
16. .Rough.Heating & Air Conditioning b8. Fencing & Access Approval
17. Ducts, in Structure 59. APPROVED FOR PLASTERING • - -
18. Ducts, Ventilating d _
19. Gas Pipe-Rough &Test + �O - � 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing - ' , , .
21. Roof Sheathing - ' ' r
22. Frame and Flashing • NOTES: - . .
23. Insulation • •
24. Lathing & Siding _ _
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final • '
28. Final•Electric . y-9-25Z, -(1 C '
29. Final'Heating &Air Conditioning -
30. Final Gas Pipe-Test �'Z 0 Q3 . '
31. Final Plumbing 4p U . .
32. Water Service-Final V •
33. Gas Service-Final '
34. Solar Domestic-Final • . - '
35. Landscape Sprinkling System . - .
36. Sound Attenuation - .
37. Handicap Regulations - .
, 38: FINAL STRUCTURE & BUILDING _ •
39. Special Requirements Completed
40. Electric Release to Edison - ' - - - -
41. Gas Release to Southern California Gas Co. r-R-�jo2 - . - - -
42. CERTIFICATE OF OCCUPANCY - --
• No Date - -
APPLICATION FOR A BUILDING PERMIT
/ 34- q� M �S /3 co
BUILDING PERMIT NO. ElectricalermNE.
Tract r BIOck, S 2YLot Permit No. E.
Plumbing
Building �8°) 6 w / / �s� 1 �/ �7 t// Permit No. us
Address % D t ilLe4. 4!/f
Cross " Mechanical a
Area St reeta q^ic A)n•AVL f/'9 Permit No. O-
/� 1 r m
(Tomes �Cr cev /` d4 44.6 Type of Project: ❑ New ❑ Alter ❑ Addition �j
Ownerl WW��
❑ •epair ElConvert ❑Demo ❑ Occupancy Pmt.
Address 3a q ✓%-./• ( ay. /
City C OS tit /1 C A CA Z1p 9t6'L9 Pho6 In'.OWA •. Insp.Sup. /
Area
Architect//�
Designer Ooeh Hd/ib✓t{ LicensefNo. 't. QS'3 ••ne SPI.Pmt.No.
AddressZ¢OOI P9 Vq.L. dt ~I4 At9v/ Fn-e,d Se backs P/L Front C/L St. Street Width
ea•s•vl ow
CitY 5/ Tot•s CA Zip /ZOOPhone•5S 6'•4f17/6'•4f17/ Y.
'•4f17/ V. ds L¢ft Right Rear
Eav- Pro/. Left Right F.P.
Engineer License No.
•c ------- -- "—'-"' --'•—'--- '---'•- Parking Spaces squired 11,7o7/i'd. J- oveTed
rya Address
m City ZIP Phone Struct No.of No.Of
Height Stories Family
u
LICENSED CONTRACTOR'S DECLARATION Park Fees Yes Fee
as Required 9 No C.T. Receipt
m I hereby affirm that I am licensed under provisions of Chapter 9
t (commencing with Section 7000 of Division 3 of the Business and Zoning APpr•ved By: Date
Professions Code,and my license is in full force end effect).
7y License Class License Number
T Date Contractor Misc.
E Address Proposed U-e
of Structure
LE City and Zip Phone
th CONSTRUCTION LENDING AGENCY
us
E I hereby affirm that there is a construction lending agency for the
0.. performance of the work for which this permit is issued (Sec. 3097, CCone Code
' Civ.C.I. Class Const. Year
y Lender's Name_ USE/OCCUPA V SIZE SO.FT.
E Lender's Address
Z OWNER-BUILDER DECLARATION
r I h r b affirm 1'
y that am exempt from the Contractor's License Law
0 fo he following reason:
I, as owner Of the property, or my employees with wages as their 2.
E sole compensation, will do the work, and the structure is not
« intended or offered for sale. 3
❑ I, as Owner of the property, am exclusively contracting with
licensed contractors to construct the project.
✓ 0 I am exemyyt under Sec. B&PC f t is ason 4.
a S. Z7 Date Owner (a�•v.�✓7 (�iWs
E WORKERS'COMPENSATION DECLARATION Total Valuation
3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required EJ yes III No
or a certificate of Workers Compensation Insurance, or a certified
C copy thereof. Grading Pmt. ,--, Gra•ing
3 Prof icy No Company Required Yes 11/No I P .No.
.a Certified copy is hereby furnished. Rough Grading
0. Certified copy is filed with Orange County, EMA. Approved by: Date co
Date Applicant 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less). 3
I certify that in the performance of the work for which this permit is 3
issued, I shell not employ any person in any manner so as to become et
subject to the Workers Compensation Laws of California. PERMIT F S
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchSpecial
Electrical $ $
provisions or this permit shall be deemed revoked. Inv¢St.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE plumbing $
THAT THE ABOVE INFORMATION IS CORRECT. f AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade
P ES. ^inous i7 a, 6`/ / /8/ Inspection $
are of Applicant CTl��^_'4_ Pre-Grade Permit
�7^ pplicant or Agent Date Rec.No. $ Issue $
c Gpstt r.—..e- (t A-.i.Ej
Print Applicant's/Agent's Name
Plan Issuance
All spates within this box must be completed to process Check By: Approved:
CMF 0335-46(BU-2B) rev.6/80
' Applicant to fill in all spaces within heavy border linet and tign all appropriate declarations.
i
STA MESA PirtMIT NO. TRACT NO. LOT N BLD O. •
CO STRUCTIOI?PERMIT lb— 2,i) .111' `L434 ,, y 2867 3/04/82 - 465.'11 ' 11.
Project Address TJ 8 9 C/ 16 f•f — m4 TtOF CONSTRUCTION �•�
'Owner TQM Pl C.
• /R 0h P1-tr Phone61 "•l NEW ❑ ADD ❑ ALTERATION
Address 309 VJh !Jaya Coil4 Mcj4 0 REPAIR 0 CONVERSION ❑DEMOLISH • �/
ZONING REGULATIONS •
Arch/Eng.13oL Ho/5,ad r License No. 0 OTHER - 'AP'
P
Address - DESCRIPTION OF WORK ;04/2/2/- ed I'7 / • '425 — 104.' 14- - .
/ZONE G PLNG. REF.4, opi-U1—O9
Contractor Q Wgry Jac-idea Phone6%'607t TYPE OF PERMIT .- BUILOIN e I I
Address 0 GRADING/0 FOUNDATIO dSTRUCTy RAL• SIDE VARD. SETBACK L ST.[op T. � Milli-
u nil
LICENSED CONTRACTOR DECLARATION El TENANT ELECTRICAL PLUMBING •Int MECHANI CAL LS II EE YARD / •
TI .A
I hereby affirm thnt,I am licensed under provisions of Charter 9 (corn- RIGHT I I Off • :- '
mencing with section 7000) of Division 3 of the Business and '❑ OTHER- - • REAR YARD(TO P/L)
Professions- Code, and my license is In full force and effect. W i OA
PROJECT S RIP ON _ �7 IJ /��� e��b{Lll�) •
License Class Licehse No. __�Se �sa/ PKG.SPACE REQ. G�PLur n W.+� pOVIDED 2
SD.FT.
Date Signature STREET WIDTH PARK FEE$
WORKERS'COMPENSATION-DECLARATION ' - u - OCCUPANCY ee�I�1�TRUCTION TYPE _ ZONING APPROVED BY
DATE � ff ]]QQ..��
I hereby affirm that I have a certificate of consent to self-Insure or a -VALUATION •� 7T-- ZONE f�ir1G'Iil pI 3/`T Il
certificate of Workers' Compensation Insurance, or a certified copy SPECIAL CONDITIONS:pM
thereof(Section 3800,Lab.C.). _ GRADING CV.NDS. ACRES _ BOLD FOK JY�CI34L [J "r$
Policy No. Company
?ertified copyIs herebyfurnished. - - - - -
REMARKS:- .
:ertifietl copy I5 filed with the city BuildingSDivision. 9 �•� ..� �D ��� �� - •
(XEMPTION FROM WORKERS' COMPENSATION DECLARATION r FEE- 'vG�c..�,P •
(This section need not be completed if the permit Is for one hundred / ��, - _1 .. • ' _
($100) or less). - -
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 .PLUMBING ' PLAN CHECK ELECTRICAL PLAN CHECK '
subject to the Workers'Compensation Laws of California. UwtLLIMa ?I I CaAitAtat qs—f 22 dr
Date • Signature BATHTUBS SHOWERS co 5o FT 10 GL Sn FT f-1 .]
NOTICE: If after making this declaration, you should become subject TOILETS 2 URINALS- . to GENERATOR 0-1 KW1-10 KW
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER _ •
forthwith comply with such provisions or this permit shall be deemed LAVATORIES Z DOUBLE LAVS- me APPLIANCE 10-50 KW._50+ KW -
revoked. - ' - - - -
CONSTRUCTION LENDING AGENCY KIT.SINKS / DISHWASHERS...- I - OO MOTORS ' 0-1 HP 1-10 HP " - - "'
I hereby affirm that there is a construction lending agency for the per- .. SERVICE SINKS ' " SUMPS- r -- OO (INC.SOLAR) 10-50 HP 50+ HP - - ,
formance-oft,the•Work'for which-thisiper mit,is-issued"(Section 3097 ,
Civ. C.). • \." t "FIXTURES OUTLETS SWITCHES •
-
Lender's'Name --''Q'l'✓Oe--" - •��- . 5 FLOOR SINKS FLOOR DRAINS.-, y
Lent?er's Address U • - t • ,DRINKING FOUNTAINS, ' r GAS TUBE SIGNS' -' - '
OWNER BUILDER DECLARATION ` - - .r —s INTERCEPTORS'. _a ,CLARIFIERS POLE LIGHTS -
I hereby,affirm'that I am exempt from the Contractor's License.Law;for _ ' ' -
the following reason (Section.7031.5 Business and Professions-Code: SWIMMING POOL PTRAP -- (...UNP I KW-110N. -
Any .city or county which requirtai,a''permit to'-construct, alter,. ._ + . . • POLES METERED SUB
•
improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION . PANELS ' MAIN SUB / Ser. eo '
quires the apjicant for such permit to tile a signed statement that he
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE S OUTLETS - `2 00 . SERVICE JO 0 - AMP -
(Chapter 9 (commencing"with Section 7000) of Division 3 of the -
Business and Professions Code) or that he is exempt therefrom and the' WATER HEATERS s/ . BTU OUTPUT . .•2' to - -
basis for the alleged exemption. Any violation of,Section 7031.5 by - _ - ' -- _
5' applicant for a permit subjects the appliigant to a civil penalty SEWER CONNECTIONS J. - ) - O - "' -
1 more.than'ftve-hundred dollars ($500)..', r - -
as owner of the property,or my employees with wages as their ,SOLAR TANK ., CO LLECTO R_5., ) -- -- - --
Sore'compensation, will-do-the work, and the structure'is not intended .>` - -� - '
or offered for,sale.-•(Section;7044,'Business and Professions Code: The ;SOLAR PIPING SYS. ISSUE FEE p to
Contractor's-License Law dries not-'apply'to•an owner ol`a+p - 3'eo 'APPLICATION APPROVED BY DATF3/f$.[jj
who builds or improves thereon, and who does such-work himself or ISSUE FEE
•
through his own employees, provided that such Improvements are not -
intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK . ' SUMMARY OF FEES " �
is-sold within one year of completion,the owner will have the burden BUILDING /�,
of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU 2 PERMIT
ID "' $ - ;the: SMTP $ / • l/
—
I, as owner of the property, am exclusively contracting with AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000 + BTU �� PLAN CHECK $ PERMIT ' , •
- and Professions Code: The Contractor's License Law does not apply to -- - - AO - ISSUANCE $ -
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ ,
tracts from such projects with a contractor(s) Iicesned pursuant to- SYSTEM - GRADING $
100,000+BTU < PLAN CHECK .$
the Contractor's License Law). _ .r
❑ 1 am exempt under Section B.& P.C.for this BOILERS BTU • .ELECTRICAL $ 30•97 _.
reason in� � C; y., g ,� PLAN CHECK $ MICROFILM $
Date .� Owner Y1 /C�r,�'t"'`t SYSTEM REPAIR,ALTERATION J/• " TOTAL FEE$ I •
I hereby certify that I have read Is application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL' $
PLAN CHECK $ LESSANEAD-P
information is atlaws
I agreeito comply with cityand h VANCE PC $_
representatives
and state laws cityti to to t construction,and hereby authorize
sp this city to enter upon the above mentioned
property foinspection urg9�e
Signature �' 1`I _ ate.7/�R V
•
poi # ZQ 7 FINAL FEE $
Drivers' Lic` se or 55 � ISSUE FEE - �O —"/
CMF 0865-46 White-Building; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
•
CONSTRUCTION AND PLANNING POOL&SPA r
APPROVALS Permit# i ___3-erg Date Inspector APPROVALSPerrnit# - Date - - Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - --- - - -
2. Soil Pipe-Undrgrn 44. Steel Reinforcement . . - . -_ -
3. Electrical Conduit.Utility-Undrgrn • _ 45. Forms
. _4._ Electrical,Conduit-Undrgrn - _ `7,-1.. q, e 46. Electrical Bonding . -
5, Steel Reinforce 47. Rough Plumbing & Pressure Test - '
6. Electrical UFER Gm _ - ' ._ 48. APPROVAL TO COVER-GUNITE. . _ . - - - -
7. - Footings (, a r\hty.,) _- $- 4 -�L .�5 49. Electrical Conduit-Undrqrn
8. Foundation. ........ . . _ .- . _ _ 50.., Gas Pipe; ❑Undrgrn,Test -
. -9. Water.Pipe-Undrgrn . •- _ _. -, 1/13-4 7/ 51. ; Backwash Lines. P-Trap. 0 Undrorn • -.10._ ,Structural Floor,Systerrm _ _ . 52., . APPROVAL TO DECK- -- -- -
..11. Property n.Sewer.Line.& House Connection" 1� : - 3- �'' 53. .Backwash & Receptor-Final - . .
12. Street Sewer-conneptioc `t,,;; , ' .-. - - 54. Heater & Vent-Final-
!1 i".T3:"?`RBUgh PGrnbirig F,`; Fts' -_ _ /2-i 3'?2 1
� � 55 Plumbing System - Final - - - • - -
14. Rough Electric-Conduit - .r - - '56.- Electrical-Final •-
15. RoughElectric-Wiring -- - • - - -- a-7�pS3- - -dc_ - - . 57: 'Solar Systern:F.inal. -
•
16. Rough Heating &Air Conditioning -- - -- - /I:t7-y1 � r _58. Fencing &.Access Approval
17. Ducts, in Structure _ - - - 59. APPROVED FOR PLASTERING
-18. --Ducts, Ventilating . _ _ . I_ _ -•
19. Gas Pipe-Rough &Test S.6.✓JIaaI PO _ 3--!/we'd.. 60. POOL/SPA SYSTEMS FINAL _ - .
20. Roof Framing - _ . .
21. Roof Sheathing / -5'-� 2. - - 5'7-Y7 • ' . . . . - '
22. Frame and FlashingNOTES: 1 /�
2-0_. Zp7�83 - � �-�y-s1 F �QC����,,�W'i en,.,...ray � r�P1QB+.rnsaA
23. Insulation `" -V •l .f4-&-43 Y-& 3 9 ` - a,...„ ,I 1Q. - 0 /r' /./
24. Lathing & Siding . _
tl- (.-v‘ - �OV1 A.�tnn.v .-vw.�. .-ViQn- 7- .Kwr.�lM - �i•aatt
25. Drywall Nailing - S_t/, Sr>• o-ti-l-bu , z.A_ ��,r,�r.�:��„' .
26.- .Plaster Brown Coat ,tr'-ss .23 2y - �,_J a.G.Qa"d u++ •r•m„ /yew;.,, vV-' 7
27'. Electrical Power Meter-Final jamb-,//03 -QC_ nnTYcaa? 9-,Zp 3',z --SM":" '
28. Final Electric . - = . / . - - / . •
29. Final Heating & Air Conditioning Q t 6s � /Oh//,f/ - Cs-p TrTyo,�r;ndr T
30. Final Gas Pipe-Test . - . • .EXTiid Tm - FY-rr_ vawa •c/ aL-.. 7 aa7jide
31. - Final,Plumbing 7- '3 fJ i G'your . o l - 7131%47.7 y,�
- 321 Water Service-Final _ _ ✓O.r.awu. • 6->raes�rl' Sa Xn ry ii6• 1 -- • -Mir
r
' 33. - Gas Service-Final - - - V
34. Solar Domestic-Final • .•
35. , Landscape Sprinkling System .- - • •
36. Sound Attenuation _ _ . '
37. Handicap Regulations -- - -
•
38. FINAL STRUCTURE_& BUILDING p--6.i3 /2.. - 3 p,"l • - _
39. Special Requirements Completed 3r5� AUS/�KC - -
40. Electric Release to Edison - ' / - - - - • - - -
41. Gas Release to Southern California Gas Co. - - . . - '
42._ CERTIFICATE OF OCCUPANCY _ - -No - Date _ , - - -
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. •
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO. -
COMSTRUCTION PERMIT C—/61
Project Address Z 8 q E / 6 M s'�- ee 1 ` TYPE OF CONSTRUCTION thy �' - - ,
Owner J C. R o b et�{t. Phc'�/7/''�D/ 6O7f ❑ NEW ❑ ADO ❑ ALTERATION .---- 1 1 /05/81 IB.00 Tl.
Address 3 n 9 V int. `� 417Q Cos/+ Men 0 REPAIR 0 CONVERSION ❑DEMOLISH
Arch/Eng. License No. 0 OTHER ZONING REGULATIONS
DESCRIPTION OF WORK A.P.
Address /7 ZONE - PLNTG.. REF.#
Contractor 0 k,7)er / [/(i//Jet, Phone TYPE OF PERMIT BUILDING
C/L ST. TQ BUIIL INLINE
Address 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD
LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL OPLUMBING ['MECHANICAL LSIEOEE YARD
I hereby affirm that I an-ilicensed under provisions of Charter 9(corn- RIGHT
mincing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, and my license is In fun force and effect. PROJECT DESCRIPTION .REAR YARD(TO P/L)
License Class License No. PKG.SPACE REO. PROVIDED
Date Signature SQ. FT. -
WORKERS'COMPENSATION DECLARATION - OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE$ ,
I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE
certificate of Workers' Compensation Insurance, or a certified copy SPECIAL CONDITIONS:
thereof(Section 3800, Lab.C.). GRADING CU. YDS. ACRES -
Policy No. Company - —
-.edified copy is hereby furnished. REMARKS: --s
:ertified copy Is filed with the city Building Division. / n
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -/ se 11�.- O
(This section need not be completed if the permit is for one hundred - C C
($100) or less). ger
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 PLUMBING PLAN CHECK ---ELCTRICAL PLAN CHECK
subject to the Workers' Compensation Laws of California. UWEBBING bAHHIoE
BATHTUBS - SHOWERS
Date Signature SO FT SO FT ,
NOTICE: If after making this declaration, you should become subject TOILETS URINALS - GENERATOR 0-1 KW_1-10 KW •
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW_50 + KW
revoked. .
CONSTRUCTION LENDING AGENCY KIT.SINKS- DISHWASHERS MOTORS - 0-1 HP 1-10 HP
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS ' - (INC.SOLAR) 10-50 HP 50 + HP •-
formance of the work for which this permit is Issued (Section 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES -
Lender's Name _ _ --
Lender'sAddress DRINKING FOUNTAINS - GAS TUBE SIGNS
OWNER BUILDER DECLARATION - INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for ,
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL - P TRAP LOINS I HUI-I!UN
Any city or county which requires a permit to construct, alter, . METERED SUB
improve,demolish or repair any structure, prior to Its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN / SUB
quires the applicant for such permit to file a signed statement that he - - ` ..„...,,,,,,,,,,//////
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS - ' - SERVICE( 9) SOD AMP JO
(Chapter 9 (commencing with Section 7000) of Division 3 of the X11
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT '
basis for the alleged exemption. Any violation of Section 7031.5 by
- ',applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS -
ot more than five hundred dollars ($500).
, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS '
sole-compensation, will do the work, and the structure Is not Intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE —
Contractor's License Law does not apply to an owner of a property APPLICATION APPROVED BY DATE
who builds or Improves thereon, and who does such work himself or - ISSUE FEE
through his own employees, provided that such Improvements are not _
intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
is sold within one year of completion, the owner will have the burden
of proving he did not build or improve for the purpose of sale). BUILDING
❑ I, as owner of the property, am exclusively contracting with HEATING SYSTEM 0.100,000 BTU PERMIT $ SMIP $
AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ PERMIT
and Professions Code: The Contractor's License'Law does not apply to - ISSUANCE $
an owner of property who builds or improves thereon, and who ton- REFRIGERATION 0-100,000 BTU PLUMBING $
tracts from such projects with a contractor(s) Iltesned pursuant to SYSTEM . GRADING S
the Contractor's License Law). 100,000+ BTU PLAN CHECK $
❑ I am exempt under Section B.& P.C.for thisBOILERS BTU ELECTRICAL $ / $
reason ��Q�1r� y- PLAN CHECK $ MICROFILM $
Date 1LOwner U C f S—LeN SYSTEM REPAIR,ALTERATION TOTAL FEE$ --
I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $
VP
AD-
information is correct. PLAN CHECK $ AN agree to comply with all city and county LESS E $_
ordinances and state laws relating to construction,and hereby authorize
representatives of -this city to enter upon the above me cloned • ^
property .fo-_aInnsspecttion pur e 1/
Signature ✓"-/ • f `+/ Date//�'r e/ FINAL FEE $-
Drivers' Lic se or SS r' ISSUE FEE
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL&SPA - .4
APPROVALS ,,Q/0 I Permit# �-� Date Inspector APPROVALS Permit Date Inspector'
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45.. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
- 5. Steel Reinforce 47. Rough Plumbing& Pressure Test
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undrgrn
8. Foundation 50. Gas Pipe, ❑Undrqrn,Test
9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap. ❑ Undrgrn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final •
12. Street Sewer Connection _ 54. . Heater & Vent-Final
13. Rough Plumbing - _ 55 Plumbing System - Final
14. Rough Electric-Conduit 4 ' • -56. Electrical-Final
15. Rough Electric-Wiring . , 57. Solar System-Final
16. Rough Heating & Air Conditioning - - bB. Fencing & Access Approval
17. Ducts, in Structure _ 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathing -
22. Frame and Flashing NOTES:
23. Insulation .
24. Lathing & Siding , . .
25. Drywall Nailing .
26. Plaster Brown Coat
27. Electrical Power Meter-Final ;a 3 ott
28. Final Electric - - -
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test '
31. Final Plumbing - .
•
32. Water Service-Final a. •
33. Gas Service-Final
34. Solar Domestic-Final
35. Landscape Sprinkling System
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed'
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date .
CITY O- TSTA MESA
PA. . FEES
Fee Payment Receipt( N 862
Project Address S J/
A.P. Number /6!/- ei/� Park Area
Building Permit Number �--2,65:- V
Owner's Name Jn,pn -p
Mailing Address 2n� �� 27a r C in
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
' 5-Bedrooms+ @ 1,810.50 =
Multiple Family **
Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedrooms @ 881.51 = / S,!
3-Bedrooms+ @ 1,229.38 =
/ Total ee ° ______
Planning Department Appr val Date - - ,_ By/ (4-e :L�i
Applicant's Signature I \ C
* City Ordinance 72-44 ** City Ordinance 72-45 ***City Resolution 78.116 (1lj(�
CMF 0174-32 Rev.6/79 White—planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant NS I liU[p1
.1 lI
Costa Mesa Building Department APPLICATION FOR PERMIT
' 111 EAST 20th STREET 2414 BUILDING
., 1
COSTA MESA, CALIFORNIA
• FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN I -Receipt No. I Pruitt No.
Building •
.0 J
Address 289 Sixteenth Street •
Costa Mesa, California • Rec iv by I DateRe te Issued
Nearest 4,//26 S� t%c;
Cross St. Santa Ana Avenue Building •
' Address
Owner Qyrns H. & E. Merle Gates Costa Mesa, California
Mail •
Address 306 Ramona Place Nearest
Tel. Cross St.
City Costa Mesa No.Li 8-7976 , zone .rl,/ No.of I Type dfu�
I r,.y
Architect or Lic.
i.: GC. 7" Plans
Engineer Carlson & Middlebrook): , Approved
l` by Date
Address Garsien Grove CORRECTIONS
City Lic.
ntractor Dike & C01ei{r'OY8 No. 770
Address 43.9 E. 17th St., Costa Mesa
LegalLot
Description I No. 13 I Block I TracQ934
(Attach Metes and Bounds)
No.of Bldgs.
Size of Lot 531 x 137.51 Now on Lot none • 0
Use of No.of No.of - - - - s
Existing Bldg. one Families 62
Rooms _ 6
Setback Line from Rear Yard 63.51 • i
Center of Street 501 Side Yard 51 ' " D
DESCRIPTION OF WORK _ -
New I $ I Alteration I I Addition I , .
Repair I I Moving I I Demolish I -
Building No.of
Size 1205 Sq. FtRooms 64 Stories 1
error Wall Roof
ering Fr.StuccO I Covering Comp. • APPROVALS
..se of New
Building Single Family Residence & Garage FoForms,undationMateriaLocationls, Inspector Date
r Under-Pinning
Plan # 2511.BR Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application Lath. Int.
and state that the above is correct and agree to comply ' Lath.Ext
with all City Ordinances and State Laws regulating
building construction.
Signature of , Plaster,int.
Permittee
/i • 117/ 3 Plaster, Ext.
Authorized Agt. e Ci, _, _` _
` Masonry Reinforced
Valuation Permit Fee $ as -
Plan Check $ // — Bond Beam
$ 9,000.00 Total
Fee $ a3 — FINAL
FORM 204 O-H 2M 5-54
•
ti
0 •
O
cotr z
FES 2��-5FPDr,,r�aa• r,i.i6(ce- o'.1.r:33.r,n
•
•
•
•
a ..
i
Street •• - Fr.
PLOT PLAN
•
Show location and distances from •
property line and between buildings. .�� ; to '
•
•
•
•
0
•, )
• r..
-
. -. •1
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLCATION FORISTRUG'fURALPERMIT 113.56 TL
P.O.BOX 200 CALIFORNIA•
MESA,C92626 - -
REC PERMIT S7 ge //
For Applicant to Fill in Completely— Use Ink Only 7 T
ADDRESS
BUILDISG z & 9 & - /g 14 S+reel � 4_A.P. NO. 6 .. k14-14
n BUILDING fee? F // ,i `Iii.
OWNER „Tames Chew RO,r� ADDRESS (rj cc
ii.
UNIT
MAILING /� SPACE N NO.
ADDRESS 3o q V,S. /34yQ TR.NO LOT A 1BLK.
TE .CITY C.41, Al f.PC CH NOL G4.OZ6
NEW ADO ALTER EPAIR MOVING DEMOLISH
CONSTRUCTION /�
LENDER y 1*-net-
BRANCH V• ?EI/ D l
OWNER ��/�'Q
ADDRESS //�� L/ �• VALUE
OARCHITECT R ENGINEER/..'t IT Otjp/, ,l. TELNO.SSG•�'�7, USE �n�!A� OV4 s P�
ADDRESS ec
Z_ •O/ H'/e/..ir the JO/ ZONE rZ TVPE GROUP
CONTRACTOR 0 Wgpr ^ ) '
APPROVED
(/�,.}7� /^21/ /
�� �� 3(�y�/e��.y BY V ( DATE �l
ADDRESS 3 a 9 y,f* CA/ 9 _
/,.�J� d TEL.G4t-titer
CITY csea / IrNO.
(—I STATE CITY APPROVED SETBACKS
LIC. NO. LIC. NO.
�` �• LDGS. (FROM C/L STREET) ii
L OFSIZE LOT/J 3 /" /j 3 7 I NOWNO.OF ONBLOT / FRONT 2--CI
ET.° N
t • USE OF /)C / / of~AC R.SIDF L—I rFT.
„�. EXISTING BLDG. (1 M+s /Y d
i•-• Separate permits are required for L.SIDE ArrAeCaerin
O electric,plumbing and heating work: REAR f/rr
FSE OF U LDING AND WORK TO�E PERFORMED PLANNING ACTION
�¢ e ren P)ASE
/s w//o•-' acaen7e
S YGloeu�e DATE
'...1 YC9s.0 WSD C 40 9.1....c /'I APPROVED
> invY� hAsh ot•w-- ir 'te s
APPRoveD /aj�•� �• G �Zc� i
>".
�V /"`�yl(-+� DATE
a
w
L • I hereby acknowledge that I have read this application and state n
N
that the above information is correct and agree to comply with
Q. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of
•'W.C•' the State of California. —
re
I - eby certify that I am properly licensed as a contrac • •. er SO' FT. n
the State • . . - . Mess and Profe •- ••e, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR CO
Chapter 9, and that such licen - :- •rce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
e
am exempt from th • -• dons of the State of Cal or as VALUATIONPERMIT FEE $ ►-y v
and Prof. '. ode,Division 3,Chapter 9. Q .u V
�?�,2+. : vy. Sam
Signature of i \ _ PLAN CHECK $ 'O
Permitteeoo $ I TAX $ D •CC O
SZ '
Authorized Agent Date TOTAL PAID $
. S.