HomeMy WebLinkAbout143 16TH ST - Building Permits (05/11 /98) ° IILDING PERMIT SYSTEM (09: 05:30)
BP74 ASE INSPECTION RESULTS
NUMBER: 143 STR: E 16TH ST UNIT:
PERMIT NO: E 073263 PLAN CHECK NO: 9502713 PARCEL: 42536107 OCC: B-2 /
NOTES: PERMANENT CERT. OCCUP: DATE:
TEMPORARY CERT. OCCUP: EXP DATE:
CODE DESCRIPTION DATE INIT Y/N
0000 PARTIAL 07/18/95 RB P
FUNCTION: F:FORWARD N:NEXT T:TOP U:UPDATE X:EXIT
NEXT CODE:
MSG: NO MORE RECORDS FILE: ACT PRINTER: REM
a
ADDRESS CPBMLGND: 143 E 16TH ST WIT: CITY OF COSTA MESA — BUILDING PERMIT
D"NEWSNANEWIe t IWAMOTO, GILBERT S TR PERM NO: E 073263
ADDRESS: 14 3 E 16TH ST
COSTA MESA,CA 92627 PERMIT NO: E 073263 PLAN CHECK NO: N GOVT: N SUPP : N
*DPI.MAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE : OTH
MLMRECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : LEGALIZE ELECTRICAL WORK SQ FT:
MCR.OR ENG.'S ADDRESS: MT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
CONTRACTOR'S NAME:
CONTRACTORS MARINO COMMENTS: X
ADORES& UC.NO.: IE IE iF iE fE fE fE lE i(-****lE iE if iE iP#iE 1E iF if i(-iF if if SE****iF. lf-3f iE 1E if 1E 3E if iF 1E 7E 3E iE lE ih iE iE iE 3P jF i(-lE iE iF if 1F-0F iE if iE iE lE if if lE ONE iE
LIMY: Z O N I ' REQU R E }( N T S
UCENS ED CONTRACTORS DECLARATION:I hereby afro under penaly a perjury that I am licensed under provisions of Chapter 9 SETH AC S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end Meed.
CRT UC.NO.: UC.CLASS: LIC.NO.: EXP : MAIN BUI % NG ACCESSORY BUILDING
FRNT: FT IN FT IN FRNT: FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN 'GHT: FT IN LEFT: FT , IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contreras'License Law for the
!e'"Lmduh,or repair�atnrcctue,psinils a reand Professions quireAny s pliamnforsuch permit to file aankh rewires a°�signed astaattemeentt thaati'himprove.hhePARKING REQ: PROV: PARCEL: 42536 ..07 ZNE: \ REF NO:
* a licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Dweion 3 of the PLANNING NOTES •
'Business and Professions Code]or that he or she is exempt therefrom and the b®s for the alleged exemption.Any violation of Sad loll \
7031.5 by any applicant mor a permit subpds the applicant to a civil penally o nolmae than fire hundred dollars POO)). ************ ************* * *** ********* *********************************
o I,asownerotthe property ormyempbyeeswihwages as their sole compensation.witdothe work.and the stnwlusenot inteded DE . EL OP MEN T VICES R E (� U I \R E M E N T S
or offered forsale(Section 7044,Business and Professions Code:The Contradma License Law does not appy to an owner of property Q \
who bolds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such
improvements are not upended or offered for sale.If.however,the building or improvement is sold within one yeas ofcmptten.the ZONING APP.'OVED BY h\DATE:
owner builder wit have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner a IM property,am exclusively contracting with licensed contractors to mmmud the project(Section TOM.Business and
Professions Code:The Contractors License Law does no apply to an owner of property who builds a inprwas thereon end who BUILDING APPROVED BY : �.. _ DATE: _
ontracv�apt such projects with a mmsdor(s)licensed pursuant to the Contractors License Law). ,
BP7044 O JER BUILDER APPLICA 'ION ISSUED BY: ► . A DATE:
Owner`( ******* ************** ******** ******* TF*3F �.
LEGALI ATION:Y F E E S M M A R Y STRUCTURAL SE MENT: N
'Op
hereby certify that I am aware of and understand the requirements of domia Health and Sally Code Sections 25505,25533.and -�
-.and that I or any future building occupant will/wil not(circle one)need to comply with said slate codes and the requirements for
a permit for crsmhmwn or rnodfiCiabl from the Ai3e yManyy angemmsa Dipdd.Residetialmnpdiom
nnappicatiome exempt from Nese PERMIT BLDG PMT qi '4 '1 t'G ELECT' I;MECHANIC FIRE SMIP/RES GRADING
provisions.
Dale: Applicant: 5 d $ SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby a fnn wider penally a onea the followingederafkm
g ds: PLAN
ISSUE ] EE 100
❑ Ihave and MImeintenacetSite:edmrseltosel-]nqusfor sued, axnperspfon,as provided for bySection 37DOdthe Labor BUILDI G—DIV—> PERMI ISSUE P •N—CHECK TOTAL PAID DUE
Code.:«tha petame« d
alhe wadf«which this permtebanee. TOTALS ---> 22 . .O 15 . 0 0 . 00 37. 50 37 . 50 . 00
❑ I have and all maintain wakes'compensation insurance,as required by Section 3700 of the labor Code,forth e PNormvre of the
work for which this permit is issued.My workers'compensation insurance carter and policy number are:
Lanier: REVENU DIVISION Ti 'LS--> •ELECTED : 37 , 50 OVER/SHORT: , 00
, Policy Number B , DG PMT PLU : ING EL TR MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
ionic section need nor be completed I the peseta is for one hundred dollars($fool or bee.) 37 -0
❑ I certify that in the performance of the work for which the permit is issued.I shall not employ any person in any manner so as to
berme subject to the workers'mnWeries:ion laws a California. and agree mat t ho
I skald become subject to the works"' *********` ****** '*****. ** ***************************************************
compensation pro.®nns a section 3703 a the Labor Code.I shat forthwith comply with those provisions. N 0 I ID UAL F E E BR EAKDOWN
Date: Apptnann
1
Warning:Failure tosecure worker:compensation coverage Is unlawful,andshWl subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil tiros up to ono hundred thousand dollars($504000A In addlfon to to coat of compensation,damps as provided for In
Section 3704 of the Labor Code Interest,and attorney's fssa. ELE 10 RECEPT/OUTLET 1 ST 20 EA. . 75 7 . 50
' CONSTRUCTION LENDING AGENCY: I hereby affirm under pesky of perjury that there is a mrmmwion lending agency for the ELE 5 RECEPT/SWITCH 1 ST 20 EA. . 75 3 . 75
performance of the work for which thin permit is issued(Section 3097,en.C).
LENDER'S NAME: END OF FEES
LENDER'S ADDRESS:
I certify that I have read this application and stale that the above information is correct.I agree to comply with all city end county ordinances
and stale laws relating to bolding construction and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purposes.
WAYNE IWAMOTO
Print Name
/ �� , : iG alD
- a me:7 —I7 —FS 01 JD1L6 CP CD1?53C^ TOTt7.SC
Signal - • ownerjAppkasrwcpamct« • DATE: D7/t7/95 TI1E: Cc:52
(5151ae.WP) While-Building&EMMY:Green-Fle:Canary-Appiwn:Pink-Revenue;Goldenrod-Assessor
1
CONSTR!JCTION AND PLANNINGPOC SPA
APPROVALS Permit# Date Inspector j 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 -. 1
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE -'
•
7. Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation < 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, D 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. POOUSPA 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 D Gas D 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: 71e-Q5-----
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. FINAL PLANNING
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
' No. Date
Pfl01ECT : 143 E 16TH ST a' ,r; UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 053455
OWNER'S
'S NAMENAME: -WAMOTO, GILBERT
ADORES.% 287r 1 /2 COSTA MESA STREET PERMIT' NO: r. 053455 PLAN CHECK NO; N GOVT: N SUPP: N
COSTA MESA, ' CA
CONSTRUCTION TYPE: PERMIT TYPE: ELSE PURPOSE; OTH
ARCH/ENGINEER: 646-5741 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : SERVICE UPGRADE SQ FT;
PERMITTEE: CLAIM VALUE: CALC-VALUE: GROUP OCC; B-2 /
ADDRESS:
2YNE 87
1 /2 COSTA MESA STREET( 714 ) 646 5750 COMMENTS: LEGALIZE EXPIRED PERMIT #E35426
COSTA MESA CA..926 / *x****�FxyE*at*a�¢****yE**#*kk¢****** Ft#*#Nor**k*******yrs*#**kix�HN******* ***** ar
***** t
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E U I R E M E N TSS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Dale: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificateol consent toself.insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: - FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: EXP.GATE:
COMPANY: PARKING REO• PROV: PARCEL; 00000000 ZNE; REF NO:
1 Certified copy is hereby furnished. ❑ Certified copy is tiled with the city Building Division. PLANNING NOTES>
> ..
Date: Applicant: #******************1t**********#0E****#********Y.***#*ac****3(********-3i-****1ia;.******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($700)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the pertormance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject o the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature:
NOTICE:0,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 1. DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance 01 the work for
APPLICATION ISSUED HY
which This permit is issued(Section 3097,Civ.C). v / , i DATE' r
LENDER: **#****MM.**************************#*** .' # :ki•*•*TV*******************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT; N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRESMIP/RES
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish.or GRADING
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 30• 25
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business . 5 0* SNIP/NON-RES
and Prolessions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by pLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSTJE FEE 15 . 00
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—D 1V > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 30. 25 15. UU 0 . 00 45 . 25 45. 25 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees. provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS > COLLECTED : 45. 25 OVER/SHORT: . 00
forme purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 25
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware y,**,**,*,*,*,*************************x-*********************************************
that proof of their Worker's Compensation insurance should be provided to me.
m exempt under Section: B.s P.C. INDIVIDUAL F E E BREAKDOWN
Int for this reason:
HP7044
,ALLWORK BY OWNER��W/q c-4 / TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Q
:are: ?- 1 'e / 1 Owner ({��
I do hereby certify that I am aware of and understand the requirements of California Hea4h and Safety Code Sections 25505,25533.and ELE 1 RECEP T/OUT'LET 1 ST 20 EA. . 75 • 7S
25534 and that l or any future building occupant wiltwill not(circle one)need to comply with said state codes and the requirements for a ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP . 18 . 50 18 . 50
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 1 SUB-PANEL 11 .00 11 . 00
these provisions.q END OF FEES
Date:S / / 9 / Applicant: �� ) .._
�(/ �6 LUzr a out;soca-CC v'=.L A:,
I hereby certify that I have read this application and state that the above Or
abort is correct.I agree to comply with all city and county ),T_: (k8`/1 y/o jr - - '
ordinances and state laws relating to building construction and here authorize representatives of this city to enter upon the above-mentioned T.u•.°
property for inspection purposes.
Date: �7-9( Signature: i/s . 99 .412,V/CU J/b
Driver's License or Social Security v:
1641.46 Whho-Budding:Green-Code Enlorcemenc Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING P00 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. I 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
4
12. Sewer Cap 63. Heater & Vent-Final •
43. 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 ❑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 9. FINAL INSPECTION
32. Electrical Power Meter-Final fife. - Rn . OOD CERTIFICATE ISSUED
33. Final Electric Notes: /7- 7_cf f ., f ,i-. 0kb
34. Final Heating & Air Conditioning [>CY L�LJS
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. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
r
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
_ PER Nri
S"�a TRACT NO. LOT NO. UNIT NO.
(CITY OF COSTA MESA CONSTRUCTION PE MIT A.P.# Zone
Pro,act Address / 4/' I E' /S i�p S Main Building: Accessory Building:
IIF 3 C ! e,Ls 5-7 TYPE OF CONSTRUCTION Li NEW Li ADD LI ALTERATION LI REPAIR E Z
Na Mailing Address/� -� .e/ Front
G I L st.4T iLAI t rIC7:Phone( GS 7�r
El CI DEMOLISH ❑ OTHER B 0
Owner's NameDESCRIPTION OF WORK/USE OF BLDG. A Rear
Address /(6 3 a 74-ts .1J' I
TYPE OF PERMIT ❑ GRADING U FOUNDATION III STRUCTURAL C Right N
Arch/Eng. License No. K- G
Address ❑` ❑ TENANT ❑ ELECTRICALPLUMBING 117 MECHANICAL i $- Left
- R
Contractor's Name °U �-//2' LD 1I` Ile CI Ile Ping. Ref.# Parking Req./Provided E
Q Phone PROJECT DESCRIPTION SQ. FT. _ - OCCUPANCYQ
Address(mailing) - -- . Planning Notes: • M
CONSTRUCTION TYPE VALUATION$ I T
City License No. ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and ELECTRICAL FEES
my license is in full force and effect.
License Class License No.
Date Signature PLUMBING FEES Automatic Washer Transformer 0 15.50 KW
•
"----ii WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. 0 50+KW
.l hereby affirm that I have a certificate of consent to self-insure or a certificate
,of Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter ❑up to 100 amps
3800, Lab. C.) Backflow Preventer Service Sink
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher I Meter Cover 100 amps rf .--0
,.., Certified copy is hereby furnished. Dryers ❑Gas DElectric I Sub Panel 'I, 0Cery'tied co y is filed with the city�quil,Uing Division. Bathtubs Sewer Connection ,
Date `TION F OM Applicant MPE F Fan Motors 00-1 HP 01%-8
EXEMPTION FROM WORKERS'COMPS NS TION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit Is for one hundred ($100) or Dishwasher Solar Piping F.A.U. Inc.Solar ❑9.15 HP ❑16-15+
less).
I certify that in the performance of the work for which this permit is issued, IFixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,after making this declaration, you should become subject to the .
N
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal I Outlets "Range
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign _
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name -
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05.15 KW Trash Compactor .
OWNER BUILDER DECLARATION -.f
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 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
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 Reinspection Fee $15 Issue Fee 115 $f
..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). DEVELOPMENT SERVICES REQUIREMENTS:
1rpf I, as owner of the property o.--Ru/ stn �-- Reinspection Farr I $15 Issue Fee $ 3 Zoning Approved By 4 , r Date
.Y rm
mmensatin0, will do the work,and the structure Is not intended or offered A
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date 1�
License Law does not apply to an owner of a property who builds or improves n /
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 Application Issued By Date 7/Z�'
employees, provided that such Improvements are not Intended or offered for
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 $ ---
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration SystemPLAN CHECK $ a 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- ENERGY P.C. $
tractors license pursuant to the Contractor's License Law). l am aware that Exhaust System 0 Multiple 0 Systet Repair/Alteration .PLAN CHECK 25% $
proof of their Worker's Compensation insurance should be provided to me.' 0 I am exempt under Section B.& P.C.f or this reason Firepl/Fact.Blt. ICB0# Fire D} 'ELECTRICAL $ GRADING $
�• MICROFILM $
[�c ]
Date -2�-'W owner jVc EXPIRED PLAN CHECK 50% $Heating System&Ducting Registers MECHANICAL $ TOTAL FEE $ 7.7 •.^5
I hereby certify that I have read this application and state hat the above ❑4100,000 BTU ❑100,000 BT • II It.01 I IIJItltt: Iii pectic 11 PLAN CHECK 25% $
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre-
sentatives of t-i5 city to enterpon th- above-mentioned property for
inspection • r•,ses. / Date - - IP -' --"—
Signature _ ,/ L ..At Date -2�-' 01 00015253-00015253 TOT 45.25
Drivers' License or SS# - • Reinspection Fee $15 Issue Fee $ 3
- t DATE: 09/22/88 TIME: 15:58
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor if. i
Si 1
COSTRUCTION AND PLANNING POO'&SpA
r Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • ;- I
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - •1 I
ii
3.'Electrical Conduit Utility-Undrgrnd. 54. Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • i1'
1
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 ystem 61. APPROVAL TO DECK !
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer Capi 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
JI'
•17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
'19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
'20. Rough Factory Fireplace APPROVALS Permit#.
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro ' ' '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe - -
28: Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 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 • [ t ' '
43. Backflow Irrigation - • .1
44. Landscape Irrigation System EXPIRED ,
Elco pieta Inspections
45. Sound Attenuation .-
46. Handicap Regulations Date 7 727SIg -.-.-...-
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison r'
50. Gas Release to Southern California Gas Co ,-• -- '?
A.
51. CERTIFICATE OF OCCUPANCY
I))
No. Date , ; n 2' r'
1
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CO ST/R UTI ON PERMIT PERMS. 95�0� TRACT NO. LOT NO. UNIT NO.
Project Address �4 3 t �6 Sr ILL//!l���
- Mt:::* TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION U REPAIR
AppiicanYS Maili Address 5
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name b r L geaerAeLlif frepir Phone 6e6.--S ., A.P.yW `.R„� I Zone .
DF,SCRIPTION OF U 1K/USE OF F.
Address �4 3 F 16 5 r - e MO �J f I oti .�/t —( •uoQ,f1 S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION STRU0 A- �� T Front O
Address
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear N
Contractor's Name 0 Phone ❑ OTHER A �� �� I
Address(mailing) PROJECT DESCRIPTION SQ. FT. /1 C3 OCCUPANCY K Right ,U` G
CONSTRUCTION TYPE VALUATIONS S Left •
_/yyaa,, xn t�l R
City License No. ZONE GRADING CU.YDS. ACRES "' 51r5 s
Ping. Ref.# (�[ CO Parking Req./Provided E
LICENSED CONTRACTOR DECLARATIONf`ly t/1 O
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: 4 M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. T
W.. S
License Class License No. -
Date -Signature PLUMBING I FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
r hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
. Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) - Backflow Preventer Service Sink _ _ Automatic Washer Transformer 0 15-50 KW
Policy No. Company _ Backflow Irrigation Sewer Ca 0 50+KW '
8 Certified copy is hereby furnished, p COn$tr Ct100 POIe Sub.
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 Clover 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 mann r so as to eco ct to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1 h-8
Workers:-moo# e i� Laws of Califo is . .- . .
Date -! L7 Gignature 4 L Floor Drains Swimming Pool w/Spa - F.A.U.
NOTICE:If,after making this declaration, yo•f shout become subject to the Inc.Solar❑9-15 HP❑15.1 S+
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
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 Range
Name
Lender's Address Kitchen Sink Water Service
OWNER BUILDER DECLARATION ,-._ _ $witches Sign
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 ❑5.15 KW Trash Compactor
any structure, prior to its issuance, also requires te applicant for such permit Pa
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
',vision 3 of the Business and Professions Code) or that he/she is exempt
erefrom 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
9.e alty of not more than five hundred dollars($500).
as owner of the property a Reinspection Fee I $15 Issue Fee $ 3 —
- will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
• or 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 one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground • Building Approved By Date
Love for the purpose of sale). �y
I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date.
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 • SUMM V FEES �z
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 $ f > I/
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.BIt. ICBG# Fire Dampers ISSUANCE $
PLUMBING $ --
Date �01ravctar owner r#/_ .tea_` Heating System& Ducting Registers •
PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this app cation and state that t e above 00-100,000 BTU 0100,000 BTL GRADING 'S
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building onstruction,and hereby authorize repre- - - $ MICROFILM S
.
sentatives o thi• city to enter/pon the a•ove-mentioned property for /' - PLAN CHECK 50% [-
inspectiono -s. Data-2-2=27` • MECHANICAL $ TOTAL FEE $ /bp� •
Signature /I_ _ _ ��
Drivers' License or S /-• - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
e
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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts,in Structure 70. Underground.Hydro
22. Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE 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
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation r/yo
[�
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING _ 3O!31 irkei0Qco*B
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 fines and sign all appropriate declarations.
• •
CITY OPCOSTA ESA CONSTRIJ-TION PERMIT PERM NO.��/� TRACT NO. LOT NO. UNIT NO.; -
4-3 F �.6• s� o�l El' 682 �ioeie6 e.00 TI.
•Project Address �...
Applicant's Mailing Address s TYPE OF CONSTRUCTION ❑ NEW LI ADD ALTERATION ❑ REPAIR •
//// nab Phone6�-6�$f ❑ CONVERSION ❑ DEMOLISH IDOTHERA.P.# 'I Zone
Owner's Name iDESCRIPTION F ORK/USE OF BLDG. , IY atitL —kb1
Address X43 6,' St' S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE O PERMIT��11�� GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front O
Address IDTENANT IytLECTRICAL .❑ PLUMBING ❑ MECHANICALB Rear • N
•.❑ OTHER A I
Contractor's Name Phone C Right N
PROJECT DESCRIPTION SQ. FT. 1 ' OCCUPANCY
Address(mailing) CONSTRUCTION TYPE VALUATION$ S Left R
City License No. ZONE GRADING CU.YDS. ACRES .ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: E. "1 5/ 01.2a Planning Notes: 0M
with section 7000) of Division 3 of the Business and Professions Code,and e[ •
my license is in full force and effect. T
License Class License No. S
_
Date' Signature PLUMBING FEES
WORKERS'Cm that I a N DECLARATION IIIL
I hereby affirm that I have a certificate of consent to self-insure ora certificate
. Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) s
Policy No. Company
tJISti IIItEINWLB Certified copy is hereby furnished.
Certified copy is filed with the city Building Division- Bathtubs Cooking Unit • Meter \ up to 100 amps • CO
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 Dryers ❑Gas DElectric •
Sub Panel - •
1 certify that in the performance of the work for which this permit is issued, I •
shall not employ any person in any man -r so as . •- - - subject to the Drinking Fountains
Work s' omens m ws of Calif,r i.. ' • Fan Motors DO-1 HP ❑1'h-8 •
Date �Z Signature, „ — —.e. Floor DrainsSolar F.A.U. - -
- NOT E: ,after.making this declar. ton,. .0 should become subject to the. - Inc Solar ❑9-15 HP ❑16-15+
, Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks
comply with such provisions or this permit shall be deemed revoked. Microwave
•CONSTRUCTION LENDING AGENCY Gas Service. Outlets Device
• I hereby affirm that there is a construction lending agency for the performanceBoxes _ Pole Light
of the work for which this permit is Issued' (Section 3097 Civ. C.) Interceptors Outlets •
Lender's Name • • • Range -
•
Lender's Address . - Kitchen Sink Switches -
• OWNER BUILDER DECLARATION - Sign I
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories
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 forsuch permit p 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 •
1031.5 by any applicant for a permit subjects the applicant to a civil
alty of not more than five hundred dollars($500).
_ I, as owner of the property dr a Reinspection Fee I $15 Issue Fee ,
•
• r.ernpensehon, will do the work,and the structure is not intended or offered •
Reinspection Fee $15 Issue Fee
for sale (Section.7044, Business and Professional Code: The Contractor's - MECHANICAL FEES '
- License Law doesnot apply to an owner of a Property who builds or improves • _ _
thereon; and who does such work-himself/herself or
Intended hisor
or herd for Boiler Hood or Type I ❑ .. DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements ZoningApproved
sale:If, however, the building or improvement is sold within one year of com- Canopy Type 11 0 pP By - • Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground @wilding Approved By • Date
prove for the purpose of sale). / �—� vf-
❑-1, as owner it the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By - G��\�f Date Dlr�`J
tractorsto 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 , ❑0-100,000 BTU -:100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- -
tractor(s) license ursuant to the Contractor's License Law). I am aware that ■ II. BUILDING PERMIT $ • 'SMIP $
Exhaust System ❑ Multiple ❑ System Repair/Alteration
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ _
❑ I am exempt under Section B.& P.C.for this reason 1. Firepl/Fact.Bit. ICBG# ill Fire Fire Dampers ER PERMIT $ . •'
• PLUMBING $
Date Pt ' •. Owner . fa. Heating System & Ducting Registers ' - ENERGY.P.C. $ •
r - PLAN CHECK 25% $
I hen-%y c rtify that I have read this plication and state that the above ❑0-100,000 BTU 0100,000 BTL - 18.106
r T -
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ O•ov GRADING $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ • MICROFILM $
sentatives of. th's city t 'enter on the above-mentioned property for Q� DO
inspection rpo es. cc,,..y� n6 - _ - MECHANICAL $ - - TOTAL FEE $ R-
Signature • Date/—7'�J
Drivers' License or S# �� '"_ 7 Reinspection Fee $15: Issue Fee $ 3 PLAN CHECK 25% $
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. 7 .PHga ,3'�,fi 54. Forms
4. Electrical Conduit-Undrgrnd. .� rrt, 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. -.24f6 ref, 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 '7-)4-a) tem 66. Solar System-Final
16. Rough Electric Wiring7-..d /y 76-JS 67. Fencing & Access Approval
• 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION ('. 1
32. Electrical Power Meter-Final 1 • 2.9- F•P.b 80. FOOD CERTIFICATE ISSUED •
33. Final Electric - 7. tb Notes:9'cPW �� rest Cdr so •1 3 P Wleiep
34. Final Heating & Air Conditioning /nv ,Ki YJ •••. •
•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 •i',
44. Landscape Irrigation System y '
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 +
a a
r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. .-a
• CITY OF COSTA'MESA CONSTRUCTIONPERMITi PER T O. TRACT N0. LOT NO. UNIT NO. 7025 ; 6%09/86 ' 6a00 _ Tt.
/q-3 E. /b ST f `` NO. TRACT 7a �y
Project Address /�' r /� U ALTERATION IJ REPAIR f '
O 'TIL •
TYPE OF CONSTRUCTION LI NEW LI ADD
•
Applicants Mailing Address ❑ CONVERSION ❑ DEMOLISH El OTHER A.P.#. .I Zone
Owner's Name .6'11.- ZWAmO7o Phone���•.S7�D DESCRIPTION OF WORK/USE OF BLDG. lt,OOi.. j-foP -
Address /9 3 , . k..Td Sr S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT, GRADING ❑ ❑FOUNDATION STRUCTURAL T Front Z
.{ LI 0
Address ❑ TENANT En ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear OTHER N
Contractor's Name /Phone C Right, •- - - N
Address(mailing) ��11'�t� �((��,yQ[,(,/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY •
K ' G
CONSTRUCTION TYPE VALUATION'$ 7s $ Left R
City License No. • ZONE GRADING CU.YDS. - ACRES ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION Q
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 -
my license Is In full force and effect. S
License Class - License No. _ -
Date Signature
PLUMBING I - FEES
' WORKERS'COMPENSATION DECLARATION Bar Sink, Showers , v .
eby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
w• /orkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink '
bva0, Lab. C.) - - Automatic Washer Transformer' 0 15-50 KW
• Polley No. Company Backflow Irrigation - Sewer Cap . .❑ 50+KW
8 Certified copy is hereby furnished. Construction Pole Sub. -
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection - • Cooking Unit Meter' ❑up to 100 amps 1
EateXE WORKERS'AECOMPENSATION Clarifiers . Solar Collectors - - ' Dishwasher Meter
EXEMPTION FROM DECLARATION ❑Over 100 amps
' (This section need not be completed if the permit is for one hundred ($100) o -
r
less). r- Dishwasher Solar Piping - Dryers ❑Gas ❑Electric -
Sub Panel _
I certify that in the,performance of the work f0 which this pe • It is Issued._• -
. shall not employ•any person in any manner o - tt'r •pe
y, Drinking Fountains Solar Tank Fan Motors
Worker.y1. Compensation Laws of California.�./ s
Date J4-4-1-It b//4r(/• Signature /_a / Floor-Drains Swimming Pool w/Spa �.
NOTICE:If,after making this declaratiofr Sr6 should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor SinksUrinal
comply with such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING, AGENCY Gas Service Outlets Water Closet •-
vice Boxes , Pole Light i -
I hereby affirm that there is a construction lending agency for the performance '
of the work 'tor which this permit is Issued (Section 3097 Civ. C.) Interceptors - Water Heater '
Lender's Name
Lender's Address Kitchen Sink Water Service
OWNER BUILDER DECLARATION Sign -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections •
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 - Generator ❑0-5 KW❑5-15 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 Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of ,
Asian 3 of the Business and Professions Code) orthat he/she is exempt - - -- - - -
;gfrom antl the basis for the alleged exemption. Any violation of Section -
.- .,1.5. by any applicant for a permit subjects the applicant to a civil - -
enalty of not more thamfive hundred dollars($500). - -
s t$ I, as owner of-the property ern+9�mPtd9eaCwtt}rw t az Bole Reinspection.Fee $15 Issue Fee $ 3 . •
;/ rewapawzgtton 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 notapply 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 one year of com- Canopy Type If ❑ Zoning Approved By nate
•
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date
orove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 6, —4-Fd,
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 47o-100.000 BTU ID 100,000 BTU -
builds or Improves thereon, and who contracts•for such projects with a con- - SUMMARY OF FEES _
tractor(s) license pursuant to the Contractor's License Law). I am aware that. Exhaust System❑ Multiple ❑ , System Repair/Alteration 'g BUILDING PERMIT $ - 'SMIP - ' ' $
proof o1 their Worker's Compensation insurance should be provided to me. _• PLAN CHECK $` PERMIT
011am exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers X P I R It ' PLUMBING $ _ ISSUANCE $ '
Date K'4# .nr o�9,—/ ICOwner - — , -/!t/� Heating System& Ducting Registers Incomplete IIISQeC''JOns , PLAN CHECK 25% $ / - ENERG :P.C. $, --
I here certify th t I have read th ./application and state that the above'. 00-100,000 BTU 0100.000 BT ELECTRICAL $ G.oa GRADING $ '
information Is correct. I agree to co Ply with all city and county ordinances • _ -
antl state laws relating to building co•struction, and hereby authorize repre- Uate �„ - PLAN CHECK 50% MICROFILM $
Senlatives of this ci o e• er u•' h' a••ve nention¢tl property for Sig _ $ • / ��
Inspection purpo - j !/ _ /Ar 442 i MECHANICAL $ TOTAL FEE $ 1O
Signature /�,��;�% i/. .. %/� Dte TUA6 5 rt%• _
Drivers' License or '!# �__ _ Reinspection Fee $15 Issue Fee $ 3 - PLAN CHECK 25% $
4 _
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor -L
H
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 e�
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test s
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE t^
7. Footings 58. Electrical Conduit-Undrgrnd. C
8. Fouridation • 59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof.Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
•
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing • 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE 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
43. Backflow Irrigation I .�
44. Landscape Irrigation System EXPIRED
45. Sound Attenuation incomplete InSpLCt10F5
46. Handicap Regulations Date 7/ +444
$1$
47. FINAL STRUCTURE & BUILDING FF
48. Special Requirements Completed I is
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY A
No. Date
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT'NO. BLDG.NO. '- •' w'
CONSTRUCTION PERMIT $ — (o / 23
Project Address 11f-3 E 16Th S I• • TYPE OF CONSTRUCTION A 343: I /24/113 �'.6oflu T.
Owner GI e.j3¢•a JW mµ0.-toPhonef s , `sQ ❑ NEW 0 ADD 0 ALTERATIOfI • �/ - • -
Address I, LI- /= t t_ 5r • ❑ REPAIR 0 CONVERSION 'Gt.(EMOLISH �]/!�' -_
(• • ZONING REGULATIONS
Arch/Eng. License No. - -❑ OTHER 1,
Address - DESCRIPTION OF WORK ne 4LAt7
o Q-e, ' O 5e- A.P.* •
•••
ZONE PLNTGo. REF.It
Contractor ^ Phone TYPE OF:PERMIT-
SETBACK C/L ST. PROPERTY LINE
Address . - 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD • •
LICENSED CONTRACTOR DECLARATION- - 0 TENANT LIELECTRICAL OPLUMBING DMECHANICAL SIDE YARD
I hereby affirm that I am licensed under provisions of Charter 9 (com-
mencingfJLls�fd/•-> RIGHT
mencing with section' 7000)-of Division 3 of the Business and 0 OTHER f REAR YARD (TO P/L)' " ' -
Professions Coder and my license is in full force and effect., 'PROJECT • •N
License Class License No. ST 11 .� PKG.SPACE REQ. - PROVIDED .
Date Signature ' - STREET WIDTH -- PARK FEE$ '
WORKERS'COMPENSATION DECLARATION - OCCUPA` - CONSTRUCTION TYPE•
ZONING APPROVED BY I DATE -
I hereby affirm that I have a certificate of consent to self-insure or a VALUATION' ZONE
certificate of Workers' Compensation Insurance, or a-certified copy - SPECIAL CONDITIONS '
' thereof (Section 3800, Lab.C.). GRADING CU.YDS. ACRES : - .__
Policy No. - Company -- -' --
0 Certified copy Is hereby furnished. REMARKS: I.\ N. .
0 Certified copy Is filed with the city Building Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - ` ' R.
(This section need_notbe completed if the permit is for one hundred " ..
($100) or less). - - - - - -> • -
I certify that in the performance of the work for which this permit Is - _ -
Issued, I shall not employ any person in any manner so as to become PLUMBING . PLAN CHECK - _ __ ELECTRICAL' - - PLAN CHECK
subject to/glthG� kJ`ers'CompensSignature
L.ayvs of Oalifprnip: ,' BATHTUBS SHOWERS - �_ UW LLLIrvc- • c.H KHGE -
x Date 4 ./yJl 4/1/ , -1 SO FT SQ FT -
- NOTICE: If after making this declaration,you should become subject TOILETS - , URINALS - ' ' GENERATOR -'0-1 KbV=1-10 KW •
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER
, forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS - ( - APPLIANCE 10-50 KW 50+KW - - - -
revoked. - -- - - - KIT.SINKS ' ' ' DISHWASHERS - MOTORS • - - -0-1 HP_1-10 HP -
CONSTRUCTION LENDING AGENCY
I hereby affirm.thzt there IS a.construction lending.agency for the per- - SERVICE'SINK$ • SUMPS - -(INC.SOLAR) - 30-50 HP 50+HP•
formance of the,work-f or whiCh,this permit is Issued. (Section 3097`� j FLOOR SINKS'.. - FLOOR DRAINS - FIXTURES-" ' -OUTLETS -- SWITCHES --Lender's -
Name 1biG{- Of I/t2�Gc,/s -\v- s ` . . -.
Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS --- • - - -
OWNER BUILDER DECLARATION' - •
INTERCEPTORS - CLARIFIERS POLE-LIGHTS- -- - •- - '- - - -
I hereby affirm that I am exempt from the Contractor's License Law for _ '
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL "' - P TRAP — -. - C.UNO IKuc,I IUry_ -
Any city or county which requires a permit to construct, alter, POLES METERED SUB - -
improve, demolish or repair any structure, priorto its issuance,also re- WATER SERVICE-' ' ' 'ALTERATION -" ' - " _ PANELS- - MAIN - SUB - -
quires the applicant for such permit to file a signed statement that he -
•is licensed pursuant to the-provislons-of the Contractor's-License Law -GAS SERVICE - OUTLETS - • 'SERVICE -- - _- AMP - -
(Chapter 9 (commencing with Section 7000) of Division 3 of the _
Business and Professions Code) or that-he is exempt therefrom and the WATER HEATERS -_-BTU OUTPUT ' ' '- -- - ., - - - -
.basis for the alleged exemption. Any violation of Section 7031.5 by r -- -
!ny applicant-for a permit- subjects the applicant to a civil penalty' SEWER CONNECTIONS - /' 'J 'Oo- - _ -
of not more than five hundred dollars ($500). ` -
❑ I, as owner of the property, or my employees-witfi wages as their SOLAR TANK -""' - 'COLLECTORS - - -- '-' - - • --- '- - -
•
sole compensation, will do the Work, and the structure is not intended _ _ _
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. -• ISSUE FEE' - - - >
Contractor's License Law doesrnot apply to an owner of a property ISSUE FEE -- -- •3 �� APPLICATION-APPROVED BY DATE��Z J
who builds or improves thereon, and who does such work himself or - V-- ,/// "
through-his own employees, provided that such improvements are not - -
intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK _ SUMMARY OF FEES
is sold within one.year of completion,the owner will have_ $
the burden �-
)�1 of proving he did not build or improve for the purpose of sale). - -- - BUILDING - - "/7 s0 .SMIP $ Cf Sb
I, as owner of -the property, am exclusively-contracting with HEATING SYSTEM 0-100,000 BTU PERMIT
Section 7044, Business AND DUCTING
licensed contractors to construct the project PLAN CHECK $
( 100,000 +BTU PERMIT
and Professions Code:-The Contractor's License Law does not apply to _ ..ISSUANCE .$
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $
tracts-from -such projects with a contractor(s) licesnetl pursuant to SYSTEM • •GRADING S - -
theheContractor's License Law). 100,000 +BTU PLAN CHECK S - • - - -
❑ I am exempt under Section - - B.& P.C.for this BOILERS BTU ELECTRICAL $ - " 5
reason • - - - J- �r •� a - - -- - PLAN CHECK $ -. iMIC ROFILM S.
1 la J10c,- 3 —...---1—
....• SYSTEM REPAIR,ALTERATION
Date '3- ll..� Owner MECHANICAL S TOTAL FEE$
I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE "LESS AO-
information is correct. I agree to comply with all city and county PLAN CHECK $ VANCE PC -$ - -
ordinances and state laws relating to construction,and hereby authorize , '
representatives of this city t0 enter upon the above mentioned - - 9//�r/y�
property- tons PQctic)n qu(�PoSes. FINAL FEE $
Signature.,,-."U..G(HA x Li Date i'IY -fT1 --
11, Drivers' License or SS f -ISSUE FEE • - - -• - - - - . .- -
,'\ CMF 0865-46 White-Building; Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
•
•
CONSTRUCTION AND PLANNING22 POOL &SPA
•
/J
APPROVALS Permit # -('IC-j Date Inspector APPROVALS Permit# Date ` Inspector
_
1. Temporary Electrical Service or Pole •- 43. Pool & Equipment Location ' • - -
2. Soil Pipe-Undrgrn - _ _ 44. Steel Reinforcement • - ..
3. Electrical Conduit Utility-Undrgrn - _ . 45. Forms -
4. Electrical Conduit-Undrgrn46. Electrical Bonding -
. 5. Steel Reinforce- - 47. Rough Plumbing& Pressure Test • . .
- 6. Electrical UFER Grn_ 48. APPROVAL TO COVER-GUN ITE - -
-
7. Footings. . . . 49. Electrical Conduit-Undrqrn • -
8. Foundation - 50...-.Gas Pipe, GI Undrqrn,Test' • `
9. Water Pipe-Undrgrn _. 51. Backwash Lines,P-Trap. ❑ Undrqrn . . .
10... Structural Floor System . . 52: -APPROVAL TO DECK - • - -
11. Property Sewer Line.& House Connection- 53:• - Backwash & Receptor-Final
12. t Sewer CflariffEjAn /V . 1/4/9"/ ',re 54. Heater &Vent-Final ,
13. Rough Plumbing .. •
55 - Plumping System - Final -
14. Rough Electric-Conduit �/J� -56. Electrical-Final - '
15. Rough Electric-Wiring - 57. Solar System-Final
16. Rough Heating &Air Conditioning - -g/- - _ b8. Fencing-&.Access Approval
17: Ducts, in Structure - 69. APPROVED FOR PLASTERING _
18. Ducts,-Ventilating - - - ._ . . ' , - . . , - ...t'Y
19. Gas Pipe-Rough&Test • . - 60. POO.L/SPA SYSTEMS FINAL. '
20.- Roof Framing - __ . - - - . _ _ •
21. Roof Sheathing - - - - - - .. r
22. Frame and Flashing - -- --- . . -- • _ •- - NOTES: /✓ / //
C-ix��n��.. n �ier»fiT� - m�vl w,,,
23. - -Insulation . • - . _- -_ ._ .' _ . - .. .. - .. . - _- . -. - .
�a`i ' rat ,:rsCiz9/.57'•�j!/�'f
24:- Lathing & Siding - -- - - - - U
25. Drywall-Nailing - ._ _ _ ._ _ _ _ _ _ _ - -, -
26. --Plaster Brown Coat - ' - -._ - - -- . _ _ ._ _ _ _ .. _ - • - • ' - ,
27.- Electrical-Power-Meter-Final , -- .-- --- • _. _ -_ -_ . - • _ _ - • - ..
_ _ _ - - -
29. - final Heating & Air Conditioning.-- - -- -- _. . .- _-__ . . :' - -. • . . - -
30. Final Gas Pipe-Test . _ _ _.. - .. .. _ .- .- - .
-31. Final Plumbing .__ - . . _. - .. _ _ ._ . . _ . - . • - • -
. .32. - Water Service-Final- - - _ - . . •
•
.-33. - Gas Service'Final - __. - - - - . -
.34... Solar Domestic-Final' . ;,; _ • - - - • -
' 5:`- Landscape Sprinkling'$ystem' - .
`3 -
36. Sound Attenuation r
37. Handicap Regulations ' ' ' -
38. FINAL STRUCTURE & BUILDING _ _ • ••
39. Special,Requirements Completed" " • - - -
40. Electric Release to Edison . . •'-4 ',. '', - -
41. Gas Release to Southern California Gas Co. . - - .
42,.e CcERTIFICATE OF OCCUPANCY . - _ •
.. . :6No - • Date '
- _ .. . , ...
_ - -- - < .
. ,
• BUILDING STY DEPARTMENT • N? 1409 C
P. O. Boa Nq
Costa Mesa,"e.difornia
Date CsFPr ? In
CITY OF COSTA MESA
CERTIFICATE OF OCCUPANCY
Building Permit Noll�A 1Y Electrical Permit No Plumbing Permit No.
/
Use of Building t n y Lip- QC / it y
The building located at /(43 r 14714 .ST' C. M
Legal Description
(See reverse side for Metes and Bounds)
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordin-
ances applicable thereto for a Group t - 2 Occupancy.
ISSUED TO:
ARI/1 A/ L. ?Erg k cin A/ City Building Official
AO
(Owner of Building) By 1-r er.-+4-�'-+ `i"'I
, • . ems
•
CC: ❑ Original—Owner ❑ 1st copy—Gas Co. 0 2nd copy—Edison
o 0 3rd copy—File
Form 206 S-B P 1M 1-60 y
. , _
1 61
F EE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT _3( 4s./C a J Lt
P. O. BOX 317 COSTA MESA. CALIFORNIA
FINANCE DEPT.
For Applicant to Fill In Completely PERMIT
TYPE OR PRINT
BUILDING
BUILDING / 13 , J„' -7 / -:& t1
I ADDRESS / y
COSTA MESA. CALIFORNIA For Office Use Only
y{, RECEIPT NO. P/r,R/p/IT/NO.
OWNER MA AJ#/T/y 4 . "A r,es0k/ /{/y F/y y7&
MAIL jA(/� � . // deli'* R�Y/ Y j� EI//J O Il-v� /I
ADDRES/S� tI ( L , {RECEI y /
CITY ( o .) t ' ..� NO. /. P ADDRESS /�/l.�J /� )4
ARCHITECT OWN
r fl TEL. COSTA MESA. CALIF*RNIA
OR ENGINEER �'1 !- kC NO.
ADDRESS "ZIRE - yam'
ZONE TYPE ,"J/GROUP /
CONTRACTOR Q f�/� /� BBYPROVED Si DATE.3 ir4 #
ADDRESS sG NING
ZONE NO.OF qqqT�� USE OF NE /J
CITY �7/ PLANS BUILDING mtlh�. i /'
STATEIC.N TEL. LEGAL e,0/>_ .fO-4' `I/ �w✓✓✓ ��,///LLL LC'��(a .1/
LIC. N II"'
DESCRIPTION J I
SIZE ` r�/ v 3 Q a ' NO. OF BLOTS.KY`
\ A.P.NO. II J — v 67.:-- 3
OF
NOW ON LOT
USE OF
YARDSEVES
EXISTING BLDG.
APPROVED ALLOWED
SETBACK LINE PROM (CENTER LINE ST.) 4/� I
CENTER OF STREET REAR YARD FRONT +� FT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE .J5FT. IN.
DESCRIPTION� OF WORK
L.SIDE a. 3FT. N.
NEW I _ IIALTERATION I I ADDITION REARL `p���� FT. 0 .N./(N4 I.
REPAIR I II MOVING I II DEMOLISH I AIPR%(TA .,Lf%� t Di
-. -' -/.(1
BUILDING y Q] ANO. OF Y tl d 1S !d .- k Aa A -h' yJ fL t--
SIZE
SIZE j A 1 7� ROOMS STORIES _ uI
EXTERIOR WALL5j ROOF 1 • i+� -
COVERING LLI��COVERING 11( to e j I1;, 'L 1) j a
USE OF BUILDING AND WORK TO BE PERFORMED • �+ OI i
AT F —4. 2'14
U , VAR. No. '«7ArPROVED J -d/4�l u ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE D.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. EA
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.QQQ������, VALUATION < co Q
SIGNATURE OF K`1� PERMIT FEE $a�S IL f�
PERMITTEE L����JJJJ �' �, „J) ft-rip a C \``
5/1T(0?
/4 [,��/- •L'!" PLAN CHECK $// 1 Q n
AUTHORIZED AGENT A/ (L/ ��/ V n p0') „/
TOTAL FEE Vim- cd° \p