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HomeMy WebLinkAbout118 16TH ST - Building Permits p e I OW'Ws CITY OF COSTA MESA 4�wq BUILDING DIVISION )1. a c.“1•1•01'1`0' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT B07-00069 osm4o RF}f (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa...—Si—D1}"fd-P— PE P 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 118 E 16TH ST Status: ISSUED Suite: Applied: 01/22/2007 Vicinity: Issued: 01/22/2007 Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: V-N Parcel Number: 42543104 Zoning: Applicant: ALI MO UDEN Address: 14641 BROMLEY STREET Phone: 714-721-4149 ip WESTMINSTER,CA Zip: 92683 ISSUED BY: Owner: SHEEHAN, MICHAEL TR Address 1842 GALAXY DR - - - -" - Phone: ♦ • NEWPORT BEACH;CA Zip: 92660 _ Contractor DISCOUNT ROOFING DATE Mb. Address:, 14641 BROMLEY STREET Phone: 714-721-4149 WESTMINSTER,CA - - Zip: 92683 - " License: 860452 Arch : - Eng: Address: - • Address: Phone: Phone: Zip: License: • License: SCOPE OF PERMIT TEAR OFF 2 PLY CAP SHEATH HOT MOP AND PUT DOWN WITH SAME BASE 2 PLY CAP SHEATH HOT MOP,50 SQUARES. 10 SQUARES OF OFFICE AREA SHALL-MEET TITLE 24 COOL ROOF REQUIREMENT FOR OFFICE SPACE. FEE SUMMARY • - Plan Check: ' $0.00 - ' Calc Valuation: $8,500.00 Permit: $167.25 - Claim Valuation: $8,500.00 SMIP Res: $0.85 SMIP Corn: $0.00 e Other: .,.,. $0.00 - Inspection: $0.00 • Total: $168.10 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 _ Rear 0-0 Left 0-0 Right 0-0 ACCESSORY\ Front)/ 0-0 - - Rear 0-0 Left 0-0 Right 0-0 PARKING - Existinq> , ''Required: 0 - Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46 16/00) I/ F - ,t In « 1 r I, DECLARATIONS I r WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. �,r,,.,My.workers'comae satin Insurance�qrrier and �po py number are: �/ .Garde ,� /`Policy Number:,. 71(3;25 05/ , O LT.1,(,7hi5 section need n be completed if the peril is valued of one hundred dollars($100)or less.) l� o I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, d agree th t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Datei-- / p WARNING:FAILURE TO SECU ORDERS' PEN$ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT fEAPLOYER TO CRIMINAL PENALTIES AND CML Fl SUP TOONE HUNDRED THOUSAND DOLLARS($100, ,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under envisions of Qhap e (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full f, ora and.effact..Llc..e. 4 h Y/`_ / telassk r ..? 'CoPtredors Signatuie:'y _ � � ate:—"-- ; / t ? / ? CONSTRUCTION LENDING AGENCY: - ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS:. I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). o I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8.California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No - (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'ryes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ..4111 Signatur Il Owne - ate . 4017/7 y/ 2� And/• brized'�••licant"—;- r- e CODE* INSPECTION TYPE 2T€ INRTIAL$ CODE* INSPECTION TYPE -" OAST INTmALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical r12 6 Pool Spa Final 208 Final Plumbing 280 Finale-Roofer / p 21) Final Electrical itt0 Final: lock/g•q�ptainin Wall,e/ I ��11 212 Grief Fireini ^Preventtion `2002 Final Fatory'Fire Place • fit . U . 220 incl Pllanniing Approval. 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ .4 t - ; ti ' 4111,Mics CITY OF COSTA MEA . &". 9q.e BUILDING DIVISION };i ____ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I' i t PERMIT B07-00069 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c .SP Lu11Yb rLR1011T 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 118 E 16TH ST Status: ISSUED Suite: Applied: 01/22/2007 Vicinity: Issued: 01/22/2007 • Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: V-N Parcel Number: 42543104 Zoning: Applicant: ALI MOUDEN Address: 14641 BROMLEY STREET Phone: 714-721-4149 (..Aio_c____ WESTMINSTER,CA Zip: 92683 ISSUED BY: Owner: SHEEHAN, MICHAEL TR Address 1842 GALAXY DR' - Phone: NEWPORT BEACH,CA Zip: 92660 Contractor: DISCOUNT ROOFING Address: . 14641 BROMLEY STREET Phone: 714-721-4149 WESTMINSTER,CA Zip: 92683 License: 860452 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF 2 PLY CAP SHEATH HOT MOP AND PUT DOWN WITH SAME BASE 2 PLY CAP SHEATH HOT MOP. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,500.00 Permit: $167.25Claim Valuation: $8,500.00 SMIP Res: $0.85 SMIP Com: $0.00- ' Other: $0.00 Inspection: $0.00 Total: $168.10 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front - 0-0 Rear 0-0 , Left 0-0 Right 0-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 PARKING . Existing: 0 Required: 0 Proposed: 0 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not,commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) r ` e• I S. WOR(ERS'COMPENSATION DECLARATION: - • • i I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the .�llvork for which this permit is issued. I ha , ' •will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. • workeu'compensa i Insu�nca carrier tjpd policy number ar� C >� Z z / ; ..- r: Icy um.a _ �� • on need not be completed it the permit is valued at one hundred dollars(5700)or less.) � l . fy that*• he perfo • once of the work for which • : •ermit is issued 1 shall not employ any person in any manner so as to become subject to the workers' ' o •:•-- o la • Jlifornie ..re-t o•d b• - ..lec • •:Labor Code,I shall forthwith corn• .'th t ese provi '• ee A•• ant ignatu .: _... ...-...._llyy�--�, - ING:FAILU•- 0 SECURE •-KERS'COMP P ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EAxPLQYF8SD41iIMINAL PENALTI- AND CIVIL FINES UP TO ONE HUNDRED THOU ', ; .t URE($100,000 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby:I'm'thet I em licensed 7 e oyisi•n o!haQt�r 9(commencing with Section 7000)of Division of4he-Buskress and Profs/glans Code,and my license is in full for . :••_.re . C9 6/ -- Class is (� `�'_ rotors Signature- 41,--...n •—_-- p//2`7® , I / J CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property.or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Cale:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 has onf the hand alifornia Healthaacutely Safety Cos with materials exceptions,requires registration with the Costa Mesa Fire Department by each business which at any quantity y equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akpermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes jJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is • correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspop purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signe f. �r� r s) -- .. m 7 ,N,,,�{ •.• •€Am •lied Applid.•t te a • CODE a IliritiIl4Hi�s PL INTITIAL5 CODES INSPECTION TYPE PALE 1NTTAI5 1616 Fixed System Final Fire Prevention / C 206 Final Mechanical 1266 8 nal ng Finalool Spa e-Final I."' ` /.4l 2010 Flinal Electricall 201 Final Block/Retaining Wall (� 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Si —.1G) P RMIT NO. TRACT NO. LOT NO. UNIT NO. 2S---• �/ M • q��C01 Ta me '• i Tie PERMIT EM 3SZ(�{, , A.P.qW � Lill 7 Zone� 6 - S Main Building: + Accessory Building: ��' TYPE OF CONSTRUCTION 1EW ADD ALTERATION U REPAIR E Z 'pp s�•a ' g- ddress •� - Front _ RP", K 10 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Cid l 2-a 1 Gv\ T 0 DES IPTION OF W RK/USE OF BLD B Rear N Address _ ♦ .: CSa tr4��T r��J/ - DO , e Ce/ .r A I Arch/Eng. License No. TYPE OF PERMIT ❑ dRADING ❑ FOUNDATION STRUCTU•ALC Right G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Lef /q ❑ OTHER E Contractor's Namp OAS Phone IR/ `Ping. Ref.# Parking Req./Provided E Address(mailing) PROJECT DESCRIPTION SQ. FT- OCCUPANCY // _ g ) ^ M Plannin Notes: ��ds `` 1 / { CONSTRUCTION TYPE VALUATION$ - •— - 72KQ r imitheo.Q•nsEL !' R1 l iter•[ City License No. i..S'OC I ` \ �1� T ZONE GRADING CU.YDS. ACRES '� sQ/'q �QJ�1�� /i1 ��C�`�� til C�/" S. LICENSED CONTRACTOR DECLARATION t Ps..?..--k-Sire---y 1 �j y/� / I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: L 41..`I Z� s A-?W\ [CJI✓k with section 7000) of Division 3 of the Business and Professions Code, and ��•••iY �'J� my license is in full force and effect. �+ .�•/- -afar, r 5/ ELECTRICAL • FEES License Class License No. 'Pe ia^ co •cr aS Pc 't- "'�•5/Z_• 'r f PLUMBING lI Automatic Washer Transformer 0 15-50 KW Date Signature FEES WORKERS'COMPENSATION DECLARATION Sink Showers Construction Pole Sub. ❑ 50+ KW •reby affirm that I have a certificate of consent to self-Insure or a certificate Nor kers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer {• Service Sink Cooking Unit Meter ❑up to 100 amps ,._JO, Lab. C.) - Policy No. Company Backflow Irrigation C-' Sewer Cap 1 - Dishwasher Meter Dover 100 amps ' Certified copy Is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection - • v �� ' Date IiGdnt / �,i% 7 • .y •EXEMPTION FROM WORKERS'COMPENSATION DECLARATION �J Clarifiers ' _ Solar Collectors Fan Motors❑Q1 HP L71 R-8 .�• (This section need not be completed if the permit Is for one hundred ($100) or - F,A,U. less). Dishwasher Solar Piping Inc.Solar❑9-15 HP 016-15+ •I certify that in the performance oft for which this rmi issued, I - ' shall not m to anyperson In an manne s as to beco ggg��p su ct o the DrinkingFountains Fixtures Microwave _' -. p Solar Tank 4 3 00 Work Laws of C ifornia. `; p Device Boxes -- DOe Signature O Floor Drains _ Swimming Pool w/See Pole Light ' . . NOTICE f r making this declare roil;the u s ould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks ` Urinal Outlets Range y comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets 7 ',/ Switches Sign • '- I hereby affirm that there is a construction lending agency for the performance Water Closet • of the work for which this permit is issued (Section 3097 Civ. C-) Interceptors Water Heater - Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service ' Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash a following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to Construct,alter,Improve,demolish or repair P-Trap Laundry Trays • any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains ' iv.:contractor's License Law(Chapter 9 (commencing with Section 7000) of _ 1 'Y'4Ision 3 of the Business and Professions Code) or that he/she is exempt Reins eetion Fee ,^'::}?efrom and the basis for the alleged exemption. Any violation of Section P $15 Issue Fee $ OO ��",J01.5 by any applicant for a permit subjects the applicant to a civil 'enalty of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee ` $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered J,, Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES .Building Approved By Date 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 ' Application Issued By Date �, .�� employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pletion, th owner will have the burden of proving he/she did not build or im- Duct-Under Ground 1$1-;. SUM ARV OF FEE (78. prove f e purpose of sale). BUILDING PERMIT $ /3n . 40 SMIP $ ' as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System :, rectors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU builds or improves thereon.and who contracts for such oroiects with a • tractor(s) license pursuant to the Contractor's License Law). I am awarea that PLUMBING $ ISSUANCE $ that ( Exhaust System ❑ Multiple ❑ System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's ComPenutlon insurance should be provided to me. tf V-•E LECTRICAL $ �� ` 00 GRADING $ � 0 f + — am exe pt un er Secth, B. . •.C.f. is reason Firepl/Fact.BIL ICBG# Fire Dampers 41 - PLAN CHECK 50% $ MICROFILM $ Date O it - Heating System& Ducting Registers ! I hereby c rtify that I have read this -pplication and sta e that the above ❑0-100,000 BTU ❑100,000BTL MI.-MECHANICAL $ 3 TOTAL FEE $ V-72-?1 information is correct. I agree to comply Ith all city and county ordinances PLAN CHECK 25% $ and - - elating to building conse tion,and hereby authorize reeepppre- - Isentnsp Slues of t s ity to en - upon e a•pve-men[Dane rp/Petty/ r Signa ion PurPo, .; 7 t 9 /p — 1 ,,Y1 Signe /4�L. : 0865-46,rev. 5/88 white - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor i 1 0.flC'1'.O-00031469 TOT - -„ •.9i. CC JT:.'.Y TMC: lh'2o ply :. t NSTRUCTION AND PLANNING PO( SPA ROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector mporary Electrical Service or Pole 52. Pool & Equipment Location - it Pipe-Undrgrnd, - 53. Steel Reinforcement Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding • " i 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. I^ 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test r'i 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 -.''i _ 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 -4• 18. Rough Electrical-T Bar Ceilidg f' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •200. Rough Factory Fireplace '- i./ APPROVALS Permit# _ 21. Ducts, in;Structure LI ,!�, Arm/, 70. Underground Hydro 222.. Ducts, Ventilating , ( 71: Product Piping OGas ID Oil 23. Gas Pipe-Rough &Test ,72. Underground Flush ;4- '24. Roof Framing ,1 n • 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing �'t� 74. Overhead Hydro r , 26. T-Bar Ceiling (Structural) &1Morjocoat 75. Dry Chemical 27:•Frame,andFlashing _`, •,, 76. Dry Standpipe 28.' Lathing? Siding ' 77. FIXED SYSTEM FINAL 29. Insulationi. -^. 78. FIRE PREY. FINAL • 30. Drywall Nailing 2;,, HEALTH DEPT. REQUIREMENT • 31. Plaster,Brown Coat ; - c' 79. FINAL INSPECTION 32. Electrical Power Meter:Final .4� FOOD CERTIFICATE ISSUED L=+4 r,' 33. Final Electric -'. 1�1 //Ark., f IA .0 .tes: 7/serf c- etio77.14 S-con ` 34. Final Uaatirrg&-art -eolidmtibning ,7J _,� y/gt "//h C /„....aLl a . of A`7 q -7--4.44;_cy en 9 35. Final Gas Pipe?Test r• -436. Hood or Canopy ' i •-37. Final Factory Fireplace • 38. Final Plumbing ; '-;,.....-- 39. ;%39. Water Service-Final ti -40. Gas'Ser vice-Final I •. ;- r 41. Solar Domestic-Final.-_-. .r I . ,-42. Backflow Preventer-S �• -- '• 43. Backflow Irrigation,1 r , i 44. Landscape lrrigation;Syrem _"'ii. :/ 4 45. Sound Attenuation;. A-. ,I /f , 46. Handicap Regulations 2aris.,, rr 47. FINAL/STRUCTURE &BUILDING s Af a ' nl 48. Special Requirements Completed �,• 49. Electric Release to.Etiison1 �� �4 .. / /. r 50. Gas Release to Southern California Gas Co �. :a �- 51. CERTIFICATE OF OCCUPANCY • ' ''\ ;t ! - t.. No. _ Date �• (' - '' ,•J n City of Costa Mesa .1) tri MEASURE "G" EXEMPTION Plan Check # 150-89s Exemption # 89-351 Permit # Case # Address: 118 East 16th Street Unit: Applicant: Southern Auto Body FACTS: Residential 0 Commercial/Industrial ❑ Other ❑ Existing Lot ❑ Not Part of Larger Project Project Description: Tenant Improvement (installation of a spray booth in existing building) No. of Dwelling Units NA Gross Floor Area NA Square Feet F.A.R. NA Estimated Traffic Generation: NA Avg. Trips/day FINDINGS: The above described project is exempt from compliance with Measure "G" for the following reasons: ❑ 1. Project is a commercial/industrial development which meets all of the following criteria: gross floor area is equal to or less than 10,000 square feet or has an average daily trip generation of less than 130 daily trips, has buildable floor area ratio of less than 0.5, on an existing lot, and is not part of a larger project. ❑ 2. Project is a residential project of four dwellings or less on an existing lot. 3. Project is residential construction that does not increase the number of permanent housing units on the parcel where the construction takes place, such as remodeling or rebuilding of an existing house. x 4. Project is commercial/industrial construction that does not increase the footprint or square footage or change the use on the parcel where the construction takes place, such as remodel- ing or rebuilding an existing structure. ❑ 5. Project is a public benefit facility, which is defined as public libraries, public administration facilities, public parks, public utilities, and religious facilities. ❑ 6. Project is a facility serving the health and safety of the people, which is defined as hospitals, police, fire and safety facilities, and schools. Exemption ratified by: • Planning Commission Date April 10, 1989 ❑ City Council Date 1648-30 -- 3�- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -F CCIITSYOFCOSTA MESA� CONSTRUCTION PERMIT 1 PERMI-O_ �I TRACT NO. LOT NO. UNIT NO. 7ni L i I654 3/24/85 Project Address IIS G,pST 1(. 1�Phone �Applicants Mailing Address — Saha TYPE OF CONSTRUCTION ❑ NEW DD ❑ ALTERATION U REPAIR ' OL' ' If a47Ri 's Name Spe T2 AA AS<C 644SL 33 El CONVERSION ❑ DEMOLISH OTHER A.P.# Zone DESCRIPTION OF WORK/USE OF BLDG. Address — S��{� —� S Main Building: Accessory Building: Z Arch/Eng. NON Cw License No. TYPE OF PERMIT U GRADING FOUNDATION U STRUCTURAL E Front O Ad7¢s5,w� El TENANT El ELECTRICAL LUM BING CI MECHANICAL B Rear N +:LerR.ec'tOPS Name �1+°t Phone —� ❑ 'OTHER C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address mailing) -- _-- — CON ST RUCTION TYPE VALUATION$ S Left R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - Planning Notes: aM with section 7000) of Division 3 of the Business and Professions Code, and - my license is in full force and effect. T License Class License No. S Date Signature - - PLUMBING FEES A ' WORKERS' COMPENSATION DECLARATION , I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink ELECTRICAL FEES of Workers' Compensation Insurance, or a certified,copy thereof (Section .2 Backflow Preventer �,� Automatic Washer Transformer 0 15-50 KW 3800, Lab. C.) Policy No. Company Backflow Irrigation �:. Construction Pole Sub. 0 50+KW — Certified copy is hereby furnished. _. Certified copy is filed with the city Building Division. Bathtubs • Sewer Connection Cooking Unit Meter Dup to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Cldrifiers Solar Collectors Dishwasher Meter Cover 100 amps (This section need not be completed if the permit is for one hundred ($100) or — - less). Dishwasher - Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for whit this permit is issued, I shall not employ any person in any mann r so as become subject to the Drinking Fountains Solar Tank Fan • - - Motors❑0-1 HP ❑i'h 8 • Workers'�Co/� a yyon Laws of California - Date �J�' 1SSa Signature Floor Drains Swimming Pool w/Spa F.A.U. Ina Solar ❑g-15 HP ❑1fr15+ 'NOTICE: If,after making this declaration, you houl become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes 1 hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address - - . Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P—Trap structure, prior to its Issuance, also requires the applicant for such permit p Laundry Trays Generator ❑0.5 KW❑5.15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9.(commencing with Section 7000)of . - Division .3 of the Business and Professions Code) or that he/she is exempt - - therefrom and the basis for the alleged exemption. Any violation of Section ' s • 7031.5 by any applicant for a permit subjects the applicant to2civil pe lty of not more than five hundred dollars($500). I, as owner of the property a Reinspection Fee ` $15 Issue Fee $ 3 will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - - 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. if, however, the building or Improvement is sold within ono year of com- Canopy Type II ❑ Zoning Approved By Date pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By - Date prove for the purpose of sale). - • 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued ByDat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owne of property who Duct- Ventilating 0o-100,000 BTU 0100,000 BTU S MMARY OF FEES builds or improves thereon,and who contracts for such . ojects with aeon- _ tractor(s) license pursuant to the Contractor's License .w). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration • BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation 1-s r.nce sh..Id be provi•-d to e. r �. .r t .- Firepl/Fact.Bit. ICBG# Fire Dampers PLAN CHECK $ PERMIT 0 • am exempt under Section y ;� TOO 'ISSUANCE $ • I �.O�As I .I I - PLUMBING $ TOO - Date STI. - Owner ir��!Z�7- VHeating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this app ic. on and state that the above 00100,000 BTU 0100,000 BT GRADING S. information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to buil ng construction, and hereby authorize repre- sentatives of this t to er upon the above-mentioned proper y for Inspection purposes. $ Opb MECHANICAL $ TOTAL FEE $ r/.12 Drivers' License or SS# . SignatureDate Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ I CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting;Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA 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 71. Product Piping O Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 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 Two (Nei gyp,- 43. Backflow-Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY • { L� No. Date - • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - GITY OF COSTA MEA CONSTRUCTION PERMIT P RMIT NO. TRACT NO. LOT NO. • UNIT NO. . - ! _ ZZ7y � 9356 2/13/86 moo'' 1'; • Project Address na fes r ♦ Erj�'� - - " SA.MG TYPE OF CONSTRUCTION ❑ NEW H ADD H ALTERATION LI REPAIR ' Apwne 's Na Mailing Address .� ' F,.,4652l3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone/ • Owner's NameVIILLLR S.V" Phone 7 DESCRIPTION OF WORK/USE OF BLDG. ?Address - S Main Building: i Accessory Building: SJON C4}laflt?�ll.� Jr292Q z Arch/Eng. �s /^s``,, ,�s� icer�r•N��� �2// TYPE OF PERMI ❑ GRADING U FOUNDATION ❑ STRUCTURAL T Front Address '�L3I /�ryGI stJ� 92 4 / Cl OTHERT ELECTRICAL CI PLUMBING CI MECHANICAL BA Rear • N • •Contractor's Name PhoneI PROJECT DESCRIPTION SQ. FT. . _ OCCUPANCY C Right N Address(mailing) --- K •Left - G CONSTRUCTION TYPE VALUATION$ S R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# • Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: -E' .'l /t frb L/ Af Uv. /�M!-1 � ���'� J Planning Notes: r, - NQ1 with section 7000) of_Division 3 of the Business and Professions Code,and • d- O—Q ( ( Atm F' my license is in full force and effect. . •3 yy. /i S. License Class License No. S!/ �! • Date Signature PLUMBING FEES • . ' WORKERS'COMPENSATION DECLARATION Bar Sink Showers • I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation _Insurance, or -a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cip Construction Pole Sub. , 0 50+ KW ❑ Certified copy is hereby furnished. ❑ • Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit, Meter ❑up to 100 amps Date Applicant - , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Clarifiers - Solar Collectors . - -• I - Dishwasher - - X Meter Dover 100 amps - (This section need not be completed if the permit is for one hundred ($100)or • less). Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for w lnh this permit is issued, I • shall not employ any person in any manner so to become subject to'the Drinking Fountains • Solar Tank `_ Fan Motors ❑0.1 HP ❑1'A-S Dorkers'Lgn gh�iJon Laws a Calif ornibs., — _ Date (!IJ' t// LL�r'•�b Signature IKer Floor Drains Swimming Pool w/Spa, F,A'.U. Inc Solar ❑9-15 HP 016-15+ NOTICE: f, f er making this declaration,y u should become subject to the • Workers' Compensation provisions'Of the Labor Code, you must forthwith' Floor Sinks . Urinal Fixtures comply 'with such provisions or this permit shall be deemed revoked. - Microwave CONSTRUCTION LENDING AGENCY •Gas Service Outlets Water Closet �• ' I hereby affirm that there is a construction lending agency for the performance ! Device Boxes' Pole Light of the work for which this permit. is Issued (Section 3097 Civ. C.) Interceptors Water Heater - Outlets • Lender's Name ' Range , Lender's Address Kitchen Sink • Water Service • i� ' . t Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • �a following reason (Section 7031.5 Business and Professional Code: Any city or T' Garbage Disposal !Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry any structure, prior to its issuance, also requi :res the applicant for such permit .t Trash Trays ' - Generator 00-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains ' the Contractor's License Law(Chapter 9(commencing with Section 7000) of 100 Vet]- 'Division 3 of the Business 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 - 9c2/f•p`f 9�?/"r'/-• �- alty of not more than five hundred dollars($500). - / as owner of the property or my employees with wages as their sole • Reinspection Fee I $15 Issue Fee $ 3 co Densation, will do the work, and the-structure is not intended or offered Reinspection Fee ! $15 Issue Fee • $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL - I FEES - , License Law does not apply to an owner of a property who builds or improves _ - - _ thereon, and who does such work himself/herself of through his or her own - DEVELOPMENT SERVICES REQ IRF�Jy1ENTS: employees, provided that such improvements are not intended or offered for Boiler • Hood or Type I 0 - /�` sale- If, however, the building or improvement is sold within one year of com- Canopy Type II 0 s Zoning Approved By / Date y L 'Potion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By �' Dater -�3-2y_ Drove for thwe purpose the pf ope). N `4 4' s owner construct ctt project exclusively contracting ing with licensedioncon- Duct-Structural Refrigeration System vj Application Issued By it Date-'/tractors TContractor's the Liproject s(Section 044, tBusiness o and Professions t Code: The Contractor's 'License Law does not apply to an owner of.property who Duct-Ventilating 00.100,000BTU0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tractor s) licensepursuant to the Contractor's License L.- I am aware that BUILDING PERMIT $ SMIP ( ). Exhaust System ❑ Multiple❑ System Repair/Alteration $ proof o their Worker's Compensation insurance shout. be provided to me. . _ PLAN CHECK $ PERMIT I am exempt under Sect111'000n„... • ' I r..& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers • • '/IyT l� (I/ ( ( I I PLUMBING $ ISSUANCE $ Date owner - �. _ Heating System& Ducting Registers ENERGY P.C. $ PLAN CHECK 25% $ • I hereby certif tha I have read his y with at:n and state that the above ❑0.100,000 BTU 0100,000 BTU �-^oO GRADING $ information is rorr c agree to ornply with all city and county ordin nces ELECTRICAL $ J ' and state laws rel .ui • ng construction,and hereby authorizer pre- PLAN CHECK 50% $ MICROFILM $ inspection of thise . 'e upon the above-mentioned4rppert fpr —_ • /m( inspection purpose I (�J'{f 113 &b MECHANICAL $ TOTAL FEE $ 3 Signature ��• ♦ • Reinspection Fee $15 Issue Fee ( $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 white - Building: Canary -App scant: Pink -Accounting: Goldenrod - Assessor • CONSTRUCTION AND PLANNING POO. .x SPA •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 r 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. Roughtlectrical-Conduit 66. Solar System-Final 16.E Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Elecfrical-T Bar Ceiling? 69. POOL/SPA SYSTEMS FINAL 19._ Rough Heating & Air Conditioning I FIRE DEPT. REQUIREMENT '20. Rough Factory Fireplace L 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 ❑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 i 77. FIXED SYSTEM FINAL 29. Insulation .% 78. FIRE PREV. FINAL 30. Drywall Nailing e- 2 HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final *L ? CC? 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: //fir? / new /t� Feet ED7inn) 34. Final Heating & Air Conditioning RC-ccrf.5 CA e • _ 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 48. Special Requirements Completed • 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. ,/'r/ f 4 PERMIT NO. TRACT NO. LOT NO. UNIT NO. 8661 2/05/86 tar r'1 CITY OF COSTA MESA CONSTRUCTION PERMIT E as 5�3 p /' wR C z ..;Project Address 116 E.' 1171sT •-1 NEWLI REPAIR • _. 5.6040 —' TYPE OF CONSTRUCTION . U LI ADD ALTERATION OApwner's Name Mailing Address & 3 SZ'�3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.,06 • Zone Owner's Name `3�L'D��12MhSK Phone I DESCRIPTION OF WORK/USE OF BLDG. Address — SA/Vir S Main Building: Accessory Building: .�y�.s� Arch/Eng. lflCi+A.R2 Ir.1 License No. TYPE OF PERMIT LI GRADING U FOUNDATION 0 STRUCTURAL T 2 Front O Address ❑ TENANT XCLECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear N ❑ OTHER A - - I Contractor's Name NI/ifs. if Phone C Right N OL, PROJECT DESCRIPTION SO. FT. OCCUPANCY K - G Address(mailing) CONSTRUCTION TYPE VALUATIONS Left City License No. ZONE GRADING CU.YDS. ACRES S • R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: U�2� �D O ,d/cv/G� Planning Notes: D M with section 7000) of Division 3 of the Business and Professions Code,and `' my license is in full force and effect. T License Class License No. S Date _ Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink '3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW ,, Certified copy is hereby furnished. _ Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred($100)or - less . Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I c rtify that in the performance of the work for which this permit is issued,I - sh It not employ any person in any man er so a o become subject to the Drinking Fountains Solar Tank Fan Motors❑61 HP ❑1'/,-8 rkers' C ion Laws of Cal'1�orni e. ate Signature/ 4..L.---••-- Floor Drains Swimming Pool w/Spa F.A.U. ❑ 'NOTICE:If,after making this declaration, yo should become subject to the Inc.Solar9-15 HP 016-15+ Workers' Compensation provisions of the La or Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater p Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal $Landing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0.5 KW❑5-15 KW any structure, prior to Its issuance, also requires the applicant for such permit Trash'tompactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains �..,/) r••�,�^1' ./S/s the Contractor's License Law(Chapter 9(commencing with Section 7000)of us Ly ly 0U-N10 role Division 3 of the Business and Professions Code) or that he/she is exempt �.s� therefrom and the basis for the alleged exemption. Any violation of Section ~�W (1 ���1J(.L:✓) 7031.5 by any applicant for a permit subjects the applicant to a civil p `�" te.alty of not more than five hundred dollars($500). $ 3 Za' �r('- ( )11/4- j/jli1ls , II I as owner of the property e. -5 a'nnlnyaa` ""'^ '-"9e' — the'--sole Reinspection Fee I $15 Issue Fee _ tf^•+ vs, r eitul.... . ., will do the work,and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves DEVELOPMENT SERVICES REQUIREMENTS: thereon, and who does such work himself/herself or through his or her own Boiler Hood or T e I ❑ employees, provided that such Improvements are not intended or offered foryp Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ ,,�// prove for, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ( Date ��5 prove the purpose of sale). / 0 I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑6100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insuranc should be provided to me. PLAN CHECK $ PERMIT 0I am exempt/ under Section B.& P.C.for this reason Firepl/Fact.BIL ICBO# Fire Dampers PLUMBING $ PERMIT ISSUANCE $ D e �'/_ _ OVner Heating System& Ducting Registers ENERGY P.C. $ ❑6100,000 BTU ❑100,000 BT PLAN CHECK 25% $ I hereby certify that I haverread tms a ith and state that the aboves ELECTRICAL $ GRADING $ Ind stat is correct. I agree to comply Iti all cidy ande y countyh orite repre- sentatives state laws relating to buil.' g construction, and hereby authorize repror PLAN CHECK 50% $ MICROFILM $ inspection fives of this. i to •er u•on the above-mentioned prop for _ inspection purpose- If f �� 2 3 , MECHANICAL $ _ TOTAL FEE $ Signature Date Drivers' License or 5S - -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &SPA 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. 6/. 57. APPROVAL TO COVER-GUNITE 7. Footings ,t-- 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing &Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas C Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION I _ 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED +I - 33. Final Electric 4b(p_�O424 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 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY , No. Date -- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. C_ ITYOF COSTA MESA CONZRRUUCTIQN PERMIT PERMITD. ��(y' TRACT NO. LOT NO. UNIT ND.- 9 42 2/?G/bL ^,2orp T . Project Address Jig tb �s,. ,sem— a,"(ng t 1 • Applicant's Mailing Address '��t �x 41..tc`w� -- /�,� TYPE OF CONSTRUCTION U NEW U ADD � I ALTERATION U REPAIR. • - # Owner's Name $cU)t 1Z'Vl'A-M-c Phone Cot SZ33 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone DESCRIPTION OF WORK/USE OF BLDG. - - Address S Main Building: Accessory Building: /�r�i � ' w.,s'A�` 1 • Z B 11`^V CAt/s// VZ4i Ltd' TYPE OF PERMIT ,,,ppp```111 GRADING ❑ FOUNDATION ❑ STRUCTURAL - E Front Archers . lcense No. � T O Address - ❑ TENANT ELECTRICAL ID PLUMBING ❑ MECHANICAL BA Rear N ❑ OTHER Contractor's Name —Ni� -" Phone C Right N Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCYK - G CONSTRUCTION TYPE VALUATIONS S Left . City License No. ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION /- � Ping. Ref.# Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks:�' ZaG4• r , \ • E 2 2. 6 I Planning Notes: • - M with section 7000) of Division 3 of the Business and Professions Code, and t'Wty 4 J'11 _ T my license is In full force and effect. License Class License No. - $ Date Signature PLUMBING FEES • • F • , WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate - • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - 3800, Lab. C.) .. Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap - Construction Pole Sub. ❑ 50+ KW Certified copy is hereby furnished. • - Certified copy Is tiletl with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps • Date Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors. - - - Dishwasher - • Meter Cover 100 amps - • - (This section need not be completed if the permit is for one hundred($100)or less). Dishwasher • Solar Piping Dryers ❑Gas ❑Electric Sub Panel - 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 at to become subject to the Drinking Fountains Solar Tank - Fan 2 Motors❑0.1 HPY,7`'/z-8 �� Workers' Compensation Laws of California. 3 Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: If,after 'making this declaration,you should become subject to the - _ _ Workers' Compensation provisions of the Labor Code, you must forthwith Flobr Sinks Urinal FixturesMicrowave comply with such-provisions or this permit Shall be deemed revoked. - CONSTRUCTIONLENDING AGENCY - Gas Service , Outlets Water Closet • Device Boxes. Pole Light I hereby affirm that there is a construction lending agency for the performance • of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater - Lender's Name p Outlets Range • • Lender's Address Kitchen Sink - Water Service. • - ' Switches Sign OWNER BUILDER DECLARATION • - I hereby affirm-that 1 am exempt from the Contractor's License Law for the Lavatories • Auto-Wash • following reason (Section7031.5 Business and Professional Code: Any city or - Garbage Disposal ;Standing Sections Permit county which requires a to construct,alter,improve,demolish or repair P-Trap Laundry Trays / Generator 00-5 KW X5-15 KW any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor 2 50 to file a signed statement that he/she is licensed Pursuant to the provisions of Roof Drains .n [� the Contractor's License Law(Chapter-9(commencing with Section 7000) of 7 /ISG Sal oec T.7 /41,-7 Division 3 of the Business 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 - _ patty of pat more than five hundred dollars-($500). - - - I $ 3 I, as owner of the property e , e Reinspection Fee I $15 Issue fee I I1y�y/,,, ...G.m, will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 r fossa le (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL • FEES 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 TypeDEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for . Boiler Hood or I 0 • Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 .. • plelion, the owner will have the burden of proving he/She did not build or im- Duct-Under Ground Approved By / .r Date I�Re prove for the purpose of sale). - _ - ll//-- 0 i, as owner of the property,am exclusively contracting with licensed con-j Duct-Structural Refrigeration System Application Issued By - Date ..arslJ'kC0 tractors to construct the project (Section 7044,Business and Professions Code: -The Contractor's License Law does not apply to an owner of.property who - Duct-Ventilating - 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License L.w). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUI LDING PERMIT $ SMTP $ proof o their Worker's Compensation insurance shou : be provided to me. - PLAN CHECK $ • PERMIT 0 I am'exe pt un-er Section -....& P.C.for this reason Firepl/Fact.Blt. ICBG# _ Fire Dampers PLUMBING $ ISSUANCE $ • Date '1r�.61$ Owner !alb.a ...a..... Heating System&Ducting Registers ENERGY P.C. $ ❑0.100,000 BTU 0100,06oBTL PLAN CHECK 25%' $ I r t ars c rect haverread thismy p pith (ion and state that the above ELECTRICAL $ GRADING $informationate a is correct. ogre di comply with all city and county ordinances and state laws hri Ling:to b nnding construction, and hereby authorize apse- PLAN CHECK 50% $ 5 MICROFILM $ sentatives of t^i it enter upon the above-mentione��operr • inspection purp is Signature Dat MECHANICAL $ TOTAL FEE $ ��'�5 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or 5 * — t CMF 0865-46,rev.10/84 White - Building: Ca ry - Applicant: Pink - Accounting: Goldenrod - Assessor • CONSTRUCTION AND PLANNING POG_ .3 SPA 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 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 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ,./ 80. FOOD CERTIFICATE ISSUED 33. Final Electric c /f4 �') Notes: 20 j4;4, dud ,i7;044.5,10/74 o 34. Final Heating & Air Conditioning ! - 35. Final Gas Pipe-Test Y�� �/ 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 • 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date y, -+ Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. CITX'OF COSTA MESA CONSTRUCTION PERMIT PERMINO./LZ TRACT NO. LOT NO. UNIT NO. Project Address Ilf £ /‘ tn/Sr M� -f q t 2240 7/2:/_; Applicant's Mailing{Address ' h r .f�C)./�/6 U' • '¢ TYPE OF CONSTRUCTION ❑ NEW N ADD LJ ALTERATION U REPAIR /7-Ri/z(�(� !/8./�) Phoned '5a • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER `- A•P•# Zone Owner's Name ? DESCRIPTION OF y��g l�/US OF BLDG. Address ei /if /`r /G .T, c e 1;t /L./�9Y}' ,4/•Sj16(a.C. ;<- •sop Gj ca /''T S Main Building: Accessory Building: rLJ` LMJ� E Z Arch/Eng. License No. TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL T Front 0 Address /�w� �s�� ,1 �J//�]/,�q[�, �s e ❑ TENANT ELECTRICAL ❑ PLUMBING gMECHANICAL B Rear N Contractor's Name CAufs40/4 War ///`Phone 9�-J�9O ❑ OTHER A • "OJECT DESCRIPTION SQ. FT. - OCCUPANCY C Right N Address(mailing) 22•422/- F�}7/C L.-11 -1-4-) g g K - G �/9��A CONSTRUCTION TYPE VALUATION 5 / d^bY! S Left City License No. `!f- ZONE GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and T my license is in f WI rte and effect. License Cl.ss C4"" i 'cense No a S Date .Y Signature _ -Or, _ ��It���� PLUMBING FEES WORKERS'COMPENSATION DECLARATION f1 1 hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers ELECTRICAL FEES u rf Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. CI.y1s Automatic Washer Transformer 0 15-50 KW ( Policy No.}{y`� �6t CompanySa�l� Nr1-� Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+ KW Certified copy Is hereby furnished. \ • Cer-77/2_, t7il/led copy is filed with the city gtt1191�/�ivision. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date by Zak OM Applicant MPE SPL/1 • - EXEMbT(ION ROM WORKERS'COMPENSATION DEC ARATION Clarifiers Solar Collectors - Dishwasher Meter Cover 100 amps (This section need not be completed if the permit is for one hundred ($100)or - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel • I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tan Fan r Motors 00-1 HPyX1 X-8 2 Co Workers' Compensation Laws of California. - Date Signature Floor Drains Swim mg Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16.15+ NOTICE:If,after making this declaration, you should become subject to the — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks mal comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range ' Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW 05.15 KW any structure, prior to its Issuance, also requires the applicant for such permit Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drai the Contractor's License Law(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt herefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil _� - penalty of not more than five hundred dollars($500). $ 3 ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date sale- If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date / prove for the purpose of sale). - �{ L gal I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural / Refrigeration System�- •410 B Application Issued By Date I - tractors to construct the project (Section 7044,Business and Professions Code: CN G } 4 The Contractor's License Law does not apply to an owner of property who Duct-Ventilating g0-100,000 BTU ❑100,000 BTU ✓V SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. IC6O# Fire Dampers PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting perc Registers MOO PLAN CHECK 25% S ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 17100,000BTL ELECTRICAL $ S OP GRADING $ information Is correct. I agree to c• ply with�611 'ty and county ordinances and state laws relating ' buildin• team, d ereby authorize repre- /V PLAN CHECK 50% $ j, o>. MICROFILM $ sentatives of his o enter • a•%e-mentioned' pr.•ert for q Inspection /- / 1 $ l s20 TOTAL FEE $ e /'u0 %e � eat_ / ' MECHANICAL Signature a, / �ti ea - - �, �J Date 5 ps,AN CHECK 25% Drivers' License or SS _ 2FeWReinspection Fee $15 Issue Fee �- $ 4 pD S eir/ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor =` / CONSTRUCTION AND'PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector' 1.,.Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55K 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, D Undrgrnd.,Test . 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 / r 12. Sewer Cap 63. Heater & Vent-Final '3. Roof Drains 64. Plumbing System - Final 14:-Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Roigh Electric Wiring 67. Fencing & Access Approval 17. ,/tough Wiring Sign 68. APPROVED FOR PLASTERING :8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 19. Rough'Heating & Air Conditioning FIRE DEPT. REQUIREMENT I 20. Rough Factory Fireplace APPROVALS Permit# - i 21. Ducts, in Structure : 7 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas DOH23. 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 ~x-3'7 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 i 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33.• Final Electric 72S47 £40 Notes: . 1 34. Final Heating & Air Conditioning 743-17 LAW • 2 ' ` 35. Final Gas Pipe-Test ; 36. Hood or Canopy ,•• 37/Final Factory Fireplace ,. .• . - , 38_,•Final Plumbing �% '39'Water Service-Final . 40. Gas Service-Final . 7 'f ' 41. Solar Domestic-Final , I142< .Backflow Preventer .7,, : I 7j ' . . {.43. Backflow Irrigation I ' .'44. Landscape Irrigation System - - >- ' ' "45! Sound Attenuation • • - 246. Handicap Regulations � . 47.,FINALSTRUCTURE& BUILDING - . 4B..:Special Requirements Completed - ' 491:Electric Release to Edison ; 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date - ' —� Bldg. Permit # NOTARIZED STATEME OF RESPONSIBILITY TO WHOM IT MAY CONCERN: This Permit# • 118 1(114 • /V/4.0 Street Address C / AP Number I, Ll/.047/✓/a /y��% -- , as Owner in Title of the above referenced • property, do hereby authorize: Nsf=WC l tSti _ I''} &4G 523?, Name • Telephone No. l l6 (r.;. (Lill- 5i.+�" Street Address Cosi is tit Sri Ch • 424,7-7 City State Zip • C to obtain permits in my behalf, as owner/builder, for the construction,alteration, moving, demolition or repair of the above referenced property. Should any person become an employee engaged in the improvement of the property, I shall immediately provide • Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. Printed Name Date • Signature • State of California 1 • County of Orange ) SS City of Costa Mesa 1 at On this 9 — day of ffefeM1F < //14" personally appeared before me U/ ILIfEL _�'��/i// EA/— SLfflEI/,J� known to me (or proved to me on the basis of satisfactory evidence) to be the �.. . OFFICIAL SEAL person whose name is subscribed to this instrument,and acknowledged that �7n�p JUNE I.JOHNSON i ."a NOTARY PUBLIC-CALIFORNIA ( he/she executed it. Vs: if ORANGE COUNTY MY Comm E.Pner Feb..loQ6 In Witness Whereof, I hereunto set my hand and official seal. i• CMF 0779-46,rev.3/63 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. IPERMIT NO. TRACT NO. LOT NO. UNIT NO. P CTY OF COSTA MESA CONST-iUCTION PERMIT E 3-1 8 Go Z A.P.# Zone Project Address //f E. /4 ST. U REPAIR S Main Building: Accessory Building: TYPE OF CONSTRUCTION LI NEW Li ADD LTERATIOry Front Y�1�YDc�E ,4.--4,-Co. Q2866 A E Z Applicant's Mailing Address any ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T 0 Owner's Name _5.-.. ,,&V �� Fie AY Phone 650 -01455 DESCRIPTION OF WORK/USE OF BLDG. 1 B Rear N Address //V S. /L t'1'(. A I TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL C Right N Arch/Eng. License No. K A G Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $• Left R /,_ n .2 ❑ OTHER I Ping. Ref.•/h ParkingE Contractor's Name/s+�+'nrr i a.g✓S Filcl. a�•pone 7I8''L33v Req./Provided PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes: Q AddCity ess License in. D 9 Q • f�zPO fL M CONSTRUCTION TYPE VALUATION$ T City License No. ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION 1 hereby affirm tht I am licensed under provisions of Charter 9 (commencing Remarks: ' rO ! L -�I n • \ �,v��_ • with section 7000) of Division 3 of the Business and Professions Code, and 1V ' -( C_ e r my license is in full force and effect. ELECTRICAL FEES License Class - O ' ens No. 34./S-75— i Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW D'ORKERS'COMPENSATION DECLARATION • Construction Pole Sub. 0 50+ KW reby affirm that I have a certificate of consent to self-ins a or a certificate Bar Sink Showers Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 3800, Lab. C.) - Policy No. Company Backflow Irrigation Sewer Cap . - Dishwasher Meter Dover 100 amps 8 Certified copy is hereby furnished. — Dryers OGas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection n Date Applicant — �.r Fan (� Motors�0.1 HP�1'h-8 S �'1• EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors eisjs section need not be completed if the permit is for one hundred($100)or Dishwasher Solar Piping o F.A.U. Inc.Solar 09-15 HP 016.15+ lI certify that in the performance of the work for which this permit is Issued, I 1� Fixtures shall not employ any person in any er sot a o becom• subject to the Drinking Fountains Solar Tank Microwave Workers' omppnsatjpp Laws of Cali _ Date 5 —7.-- Signature ._ - - �� Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE:If,after making this declaration,yo should •ecome su•'.• to the , Workers' Compensation provisions of the Labor Code, you m '.rthwith Floor Sinks Urinal Outlets Range comply with such provisions or this permit shall be dee revoked. CONSTRUCTION LENDING AGENCY Switches Sign Gas Service Outlets Water Closet g I hereby affirm that there i5 a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Garbage Disposal Standing Sections Lender's Name Interceptors Water Heater - Lender's Address Kitchen Sink a Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION - -- _ - - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Train ' any structure, prior to its issuance, also requires the applicant for such permit I to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains l\ }+.g Contractor's License Law(Chapter 9 (commencing with Section 7000)of -..,":1,:.gnsion 3 of the Business and Professions Code) or that he/she is exempt - Reinspection Fee $15 Issue Fee .�,; refrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). • . DEVELOPMENT SERVICES REQUIREMENTS: U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 • Issue Fee $ 3 • Zoning Approved By Date compensation, will do the work,and the structure is not Intended or offered - for sale (Section 7044, Business and Professional Code:: TheThe Contractor's - MECHANICAL L FEES Building Approved By Date Q�7 License Law does not apply to an owner of a property who builds or Improves e —'� -�LT thereon, and who does such work himself/herself or through his or her own Application Issued By J!` Dat employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 sale. if, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ O I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con • - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 , System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. Z( A. % GRADING $ O I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers ELECTRICAL $ JV PLAN CHECK 50% $ MICROFILM $ Date Owner Heating System&Ducting Registerstom' ❑0-100,000 BTU ❑100,000 BTL MECHANICAL $ TOTAL FEE $ 3c� — I hereby certify that I have read this application and state that the above PLAN CHECK 25% information is correct. I agree to comply with all city and county ordinances $ and state elating to building construction,and hereby authorize repro- ientatly- of t is city ,• enter pon the above-mentioned property for inspect in p r••ses.v _ Date 4-9 D- rivers' - -- - - Reinspection Fee $15 Issue Fee $ 3 t' ,:OQ2Z493 TOT 4'- v0 Drivers' License or S - �' • _ 01 00C2.4'3- 1. 0865-46,rev. 5/88 White . Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 63,:;..,:39 Tili_e 12:1; CONSTRUCTION AND PLANNING PO 1 SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# w 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. " •" 53. Steel Reinforcement - { Electrical Conduit Utility-Undrgrnd. LI/ 54. Forms 4;tElectiical Conduit-Undrgrnd. 55. Electrical Bonding 'i t 5. Steel Reinforcement-Jr 56. Rough Plumbing & Pressure Test 6: Electrical UFER:Grrie 57. APPROVAL TO COVER-GUNITE Z. Footings " 't . / 58. Electrical Conduit-Undrgrnd. r .I • 8. Foundation �,. .. 59. Gas Pipe, 0 Undrgrnd.,Test . I 9. Water Pipe-Undrgrnd.• �' ! 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10:St?uctural Floor System 61. APPROVAL TO DECK •,I 11.•Property Sewer Lined& House Connection 21 62. Backwash & Receptor-Final 12. Sewer Cap ( ' : 63. Heater & Vent-Final � 13. Roof Drains i 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 ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74, OverheadHydro 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 33. Final Electric 3/ q9 Notes: 1/r coin/bre j sot 5 34. Final Heating& Air Conditioning st /' 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 L• 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison / 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . , • No, Date - esa Building Lepartment - --7--Arr- APPLICATION FOR PERMIT STREET COSTA MESA,CALIFORNIA11..1.51 Eifi: BUILDING 11 •d FOR OFFICE USE ONLY , FOR APPLICANT TO FILL IN 1 Receipt No. 1 Permit No. Building77Address / % 0... �(O Costa Mesa, California /,�/:Receeived by I Date Reed. Date Issued/ Nearest -7� ".�///'w I��/S�� I 2%/ 'r� Cross St. Sci"e�/Yl1�� S� • Building /*/,‘",..4./...t,- c�,r�� Address Owner�a`ie 'n �e o -'_.t Costa Mesa, California Mail /Q � 5 y-- Address / • Nearest Tel. Cross St. / City CV' e'SW No. Zone�A. I No.of I Typrazi- Group . Architec or Lic. y /�y� Plans ......��...iiK« Engineer nA9)9,e No. , A�proved /^ �' - • !i _ / Date 5:4-(47-3-‘ Address ` ye. ORRECTIONS l/ City LI .tractor 4, L.. Ar r No. ,y,er A Address / 35/7 /e .0/ i '- :oo .. Legal I Block Lot I I Description No. I Tract • (Attach Metes and Bounds)4/91/712/s No.of Bldgs. / Size of Lot/ *lrZ/ I Now on Lot Use of No.of No.of M Existing Bldg. S7 P€e1t I Families I Rooms �, Setback Line from Rear Yard 2 Center of Street e}'/S�n��g Side Yard > DESCRIPTION OF WORK • r New I `I Alteration IX I Addition I �Q Repair I I Moving I I Demolish I - Buildin o.of _ _Size g ��� ��/N0 Rooms Stories rior Wall I Roof t .ring Covering APPROVALS BulldiUseofryNew Foundation Location Inspector Date ��e, /ft N9' ��-"9� ! � Forms,Materials, �, (Pee 5' , Under-Pinning ���� Frame: Fire Stops, if: Bracing,Bolts vfl I hereby acknowledge that I have read this Application . -a and state that the above is correct and agree to comply Lath. Int. o with all City Ordinances and State Laws regulating 21`.; building construction. . Lath.Ext nI-1 Signatureof1�� / -1 Permittee C�•rl //� , --e Plaster,Int vi Authorized Agt. ,,,,Z,.,/,41.3.71 Plaster,Ext. PR F4 7 Valuation Permit Fee $ S 1/-. 0 0 Masonry Reinforced CJe Plan Check$ ti • O 0 Bond Beam -t $` L� �� Total � / . i Fee �710I 0 0 FINAL n FORM 204 S-BP 2M 6-55 A 00 -00 0 • C 0 o. .. - . •. _ - - _ a` a` • • Street - . PLOT PLAN Show location and distances from property line and between buildings. esa Dunning Department run rticcivxl<r ePPIPlin 111 EAST 20th STREET 20'30 B U I L D I N G COSTA MESA, CALIFORNIA c� _- FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BuildinG • / I Receipt No. I Permit Address //$ .a. ./(o d` fit , _• A Costa Mesa, California Receiv • by Date Redd. Date vv -c.76--3---St-76 ` I Nearest I A6�J JI ,/�¢ AL Cross St. o5"P7R/c+e hilt Address'//8 — /6 z`,�i" Owner ibtogieniii PEJcarTn2 Costa Mesa, California Mail Address `[s g, /L �+; ° Nearest ..... " L Tel. : Cross St. 4'{� City Cc.ST,¢ A/ �. No. i Zone A A/ I o.ofIType Gioup�j Architect or Lic. �V� Plans 'f' Engineer No. ( Approved by Date 1dress e CORRECTIONS .to or ¢g�G. Ca2P. City. 7/:3 , Address2t, f . /fd:tyfocr 8LuO, ,,, Legal I Lot I I Description No. Block I Tract 1 (Attach Metes and Bounds)HP I/�. .p7/.. S j .�i O No.of Bidgs. , Size of Lot p0 x, g'L Now on Lot Use of I No.of I No.of 0C, I 2 6 t,JJ 70 Existing Bldg.7C4yq Families Rooms JJ ri Setback Line from Rear Yard E X 2 Center of Street Qf/S/yye BLA' Side Yard En /t 7V OF 7/+ MESA � DESCRIPTION OF WORK CI 1 l COS 1 A New I I Alteration I Kt I Addition I ' Repair I I Moving I I Demolish I Building No.of tr Size Rooms Stories rior Wall I Roof ing APPROVALS Bring Cover Use of New 1 Building `ToC ee/8 � / ' Foundation' Location Inspector Date �� `^'`"'s^" S Forms,Materials, / , C_ r r4e___. Unde . Frame: Fire Stops, '. Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of Permittee tc4vj2.e././e /.rTjW Plaster, IAL Authorized Agt. _ Plaster,Ext' Valuation Permit Fee $ O U Masonry Reinforced $ 6s6� PlanlCheck$ !, 0 O_ Bond Beam D 0 /J Fee $ • FINAL \cnnle .mi c_AD 9M N_55 C • u J c 0. • a a a nn co ST! OCT 26-55ruifi ^ 75a a n+r;c-47.0Q • _ Street PLOT PLAN • Show location and distances from property line and between buildings. I 1.. 28400 • APR--1. 017 d*****9.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92625 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT // BUILDING BUILDING o - Gyp a For Office Use Only • ADDRESS / - • RECEIPT NO. 23400 n. R[C[IV •: BY �. CEI [i • T[ISBUID t / r I 'Padat 4 w,/ BUILDING t W , MAIL ADDRESS .. • ` `` 1 4442 / L r ADORES! i �. / •' FIRS _ • ` pral Si, , { ZONE TYPE GROUPea I" APPROVED /}t# -‘ I :