HomeMy WebLinkAbout268 16TH ST - Building PermitsWILDING'. E 16TH ST
Is�".NEIp FAWN: HEBERTS, CURT
237 17TH ST
Tz
rSA, CA 92626 631-6004
MICNIIECT OR ENL@LEEA:
BCH OR ENG'S ABORESS:
1111140,
UNIT: C CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 073358 PLAN CHECK NO: N
UNI.
"""'Tow"' YOUNG'S ROOFING (714)953-5444
CO/RRACTORSMAILYA 100 S HATHAWAY
ADD^EM SANTA ANA CA 1LN0' 568560
92701 UWI C000
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penefly of Prepay that I em ficraeE oder pr visia++d Chapter B
(commeacntl with Sembl 1000) d Division 3 a Ihe Buairsn amt Pmlaesiom Code, arm my arson u n MI was and moss.
CRY UC. NO.:048,128,Uc."":C 39 U„N0:,568560n,. EXP: 08/95
OWNER BUILDER DECLARATION: I hereby, affirm wdx pemly of Penal Ihat I atm eaempIFJm IM Cartltlae Lxre
ee law la IM
101bwiq reaepm (Secl 1001.5 Bueasse end Plommus ss Cods: Any .dy or counlY vdrkM mRu a permat to cpmbuct. was. improv,
damoleh, or rapek any 9lrudure, prig Im a eaueres, efeo repuima the eFpicerd /a ach pemd to fib a sV^ed ataemeru tl'a he a she
�,licensed Wnuenl to the povinom d the Comrmoro Lioerme Lew IChapx 9 (oanmeaim0 with Sedion ]000) of Oi+eion 3 d Ihe
14'"Ysrco enol Rdevion Coder a titer he a aha b eaampl therelmm eM Ihe bew Ia Os eAeped exemgion. MY �'iolaion d Sermon
' ]03t.5 fete nY epplipanl la a Fermi auebde IM appnam b a ciwl p«ulty d npl mss then live hentlmd da0en 15500p.
❑ I. n Duma d the pmpanY a mY empbyeee vdh ween n Ihai sob campensaion, wiA do the wak end the ehllceun a nal nlxded
imprevemeras we not intended or offered for vele. R, hnweeer, the building or enpmsxnem b sold wilhb one year of compel du
owespleaMer will hew Ihe burden of pro'drg he or she did rat build or improve f« the Flvpose of safe).
❑ I, as ownr of Ihe ampenY, am ..dueively mnlreaiq amh Seamed corwadm Io construct they pojea (Seation ]W e, Bninen end
Professions Coda: The Comrsdom License Lew don not apply to an own« of pmpery, who WAds a improves rhreorn and wfg
corrode for much prdedv with a mmredor(e) Ikensed Formal to the Contreaae Licene Law).
❑ Isn ea rats urdr Section: B.& P.C., lar this reason:
Dae: Own,.
1 do hereby certify Mal I we ew«e of «d Imderstad the rquitem«gs of Ca11«nb Health red Salary Code Seol 25505, 25533, ald
2553s, ad Iher I or my Mum bolding occupant will / will r m (ace on) welt to comply With said mate coda and the meuirememm M
w,wmelamnwtmdkvlamodifralion homlM1e Aa iv awmamem Diadd.Rridrmwl mnemdionemiwienem nemalrmm Moe
Dae: Appian:
WORKER'S COMPENSATION DECLARATION: 1 hereby affirm uMer pendr, of perjury on of the Idcenn decimations:
I hew end wit meirnmer a Olt
mrreenl h a is pamm M wakra' canlDameaion, n prwlded la by Sadion 3]00 d Iha labor
Cards. l« he pMomunca d rhe Bork la which this permit fe Inured.
❑ I have mrd wit meveen woMon' wrrmmpen+aen inaure«a, n reeuired M Seth«' 3]00 d the Labor Code. M Ihe Pedamemn d rhe
wok la which the Fenno n ItlINd. My waken' canpenaabn inwmrga wrier erld FOGq' rumen ere:
Carder: rPp'49 m EXPIRES
polipy Nmmbr: e.]n o 3 _. cr Q n n .- n om 04/24/96
9 asam need rat be cwpbfM y Us permT a M are hwrdred ddters IsfCDI a Aas.)
�] I wthy that in he pMamxgs d IM wak f« witch this permit o 6wed. I shell red amPloY erry person n ante manrw n n to
bocan wbjed to IM umrk«a' conmarsetion leve of Caafana. arm spree tha a I hour ,(rre aMiea I IM workers'
canperw lion pm arca d pion 3]00 d the labor Cade, I ompy we oe pre n.
Dam: ApplraN: /
ww,u/ p: ran. m secure wafers' rolryassaflon eoverpa is un/awNl, and Mal wA,*an wleyar M added peruMss and
civil Ores Wto pre hundred Ihousad caters (f10gODIS h, aldlid n N Ms cast of ro n u peovMsd As, 1.
Secdon 3106 of he Labor Cods, 1.1.4 and atomey's Nn.
CONSTRUCTION LENDING AGENCY: 1 hereby Over makerpewft d perjury Ihet them is e mntmaion bndpg agency lar the
padormacs d he wale f« wMdr the Fermi b tined (Season 3041. Civ. C).
LENDER'S NAME:
LENOER'S ADDRESS:
1 carry that I have mal INS appliwion ad sae Ina the meow idormetion is coned. I gree to campy esh aA ray and coumy odvaraaa
walgate W. real to bddm mnC^udsn end hereby elelamm reprnmtelivn d thisdry M emx upon the eboe-nlereionad popery,
Dam:
(5151dm.WP) WMa4Mdkg A Slay: Grnr,Rb: Cwry-AppFam: Pink-Raronn; Ooldenmc-Aa e«
PERM NO: B Oi:3.�58
R
GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : TEAR OFF AND INSTALL 4 PLY BUILT UP SQ FT: 3,800
CLAIM VALUE: 3,800,00 CALC—VALUE: 3,800.00 GROUP OCC: R-1 /
COMMENTS: REROOF WITH 4 PLY COMP/ SMOKE DETECTORS REQUIRED
Z 0 N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
42522114
ZNE:
REF NO:
PLANNING NOTES>
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I N D I
>
B R E A K D O W N
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D E V E L O
P M E N
T S E R V I
C E S
R E Q
U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE: 9,S7
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LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—>
PERMIT
ISSUE PLAN—CHECK
TOTAL PAID
DUE
TOTALS ---- >
63.50
0.00 0.00
63.50 63.50
.00
REVENUE DIVISION TOTALS-->
COLLECTED:
63.50 OVER/SHORT:
.00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
63.00
.50
* oft dE * oft 1E df iE iE dF dF if iE k *!E iE 1E lE lE * k!E if dE d! dE I(• df dE dE dE dh %i! ii df * dE df if 1E * iE
* * dF if �! dE in ik dE lE fE dE it df 1E 1e 4 iF * * * iE iE dE 9f !E df !f dE iE dE iE it 1F
I N D I
V I D U A L F E E
B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3800 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,800.00
END OF FEES
EXPIRED
LIP'"
CO- OF
1.A
r
CONSTRUCTION AND PLANNINGPOOI
APPROVALS Permit # Date
Inspector
PA
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-Undr9rsid.
54. Forms I
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
P. Water Pipe-Undrgrnd.
60. Backwash Lines, PTrap, ❑ Undrgrnd.
10, Structural Floor System '
61. APPROVAL TO DECK '
11. Property Sewer Line & House Comection
62. Backwash & Receptor-Final I
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
APPROVALS Permit #
20, Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑ Gas Q Oil
w
_-
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O 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
76. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Piaster 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-Finat
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
+
45. Sound Attenuation
' --
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
-
R
48. FINAL PLANNING
X49. Electric Release to Edison
i0. Gas Release to Southern California Gas Co
51, CERTIFICATE OF OCCUPANCY
Date
No..
' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTR U'PTION PERMIT
Project Address ILC^k r // 5-il
Applicant's Mailing Address
Owner's Name 14 • A- 1J.14-1 r;5 Phone
Address
Arch/Eng. License No.
Address
Contractor's Name �•"-f k1"* -j Phone
Address (mailing) 1;rC I«,, Z' tc- 1�=
City License No. W<_
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
With section 7000) of Division 3 of the Business and Professions Code, and
my license is in Iforce and effect. I
License Class sa- - - cense No. 3zNb3S
Date 771l-iri Signature
WORKERS' COMPENSATION DECLARA1q6N
I hereby affirm that 1 have a certificate of consent to self -insure or a certificate
of Workers'mpensation Insurance, or a -certified copy thereof (Sactlon
3800, Lab. C: S •� �s
P licy No. ompany
C tifietl py is h e y furni5 tl.
C ifie c p s f' etl Ith th cit Bui 9 Dlviz
D / cant
EXEMPTION FROM WORKERS' COMPEN SA N DEC RATION
(This section need not be completed if the permit Is for one hundred ($1001 Or
less).
I certify that in the performance of the c for which this permit Is Issued, I
shall not employ, any person in any ma t r so as t eco mB Subject to the
Workers' C�W�IPenS ton Laws of Callforni .
Date '! !_J Fil Signature
NOTICE: If, after making this declaration. you Id become 5 ect to the
Workers' Compensation provisions of the 1. bo otle, you rFi'Is forthwith
comply with such provisions or this permit shall be Deem tl revoked.
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit t0 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/she Is licensed pursuant to the provi SlO) S of
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
m031.5 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 or my employees with wages as their Sole
compensation, will do the work, and the structure is not intended Or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law tloes not apply to an owner of a properly who builds or Improves
thereon, and who does such work himself/herself or through his or her own
emploreeS, provided that such improvements are not Intended or offered for
sale. If, however, the building or Improvement Is Sold within one year of com-
pletion, the owner will have' the burden of proving he/she did not build or Im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con.
tractors l0 construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractor( license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Sectlon B. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws elating to bus ltling construction, and hereby authorize repre-
sentatives Otis city o enter upon the above-mentioned property for
inspection Pu ses.
Signature s't.r,. it Date 7 -L/ -S5
Drivers' License or-"
TYPE OF CONSTRUCTION U NEW LJ ADD
LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
A.P.
DESCRIPTION OF WORK/USE OF BLDG.
Backflow Preventer
S
Main Building:
_ Automatic Washer
Construction Pole Sub.
Transformer ❑ 1550 KW
❑ 50+KIN
Backflow Irrigation Sewer Cap
TYPE OF PERMIT GRADING FOUNDATION
STRUCTURAL
T
Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING
g MECHANICAL
B
❑ -OTHER
Solar Collectors
A
Rear
Dishwasher
Meter ❑over 100 amps
C
Right
PROJECT DESCRIPTION SQ. FT.
OCCUPANCY
KLeft
Dryers ❑Gas ❑Electric
CONSTRUCTION TYPE VALUATION$
$
Drinking Fountains
ZONE GRADING CU. YDS.
ACRE$
Ping. Ref. #
Remarks: _ V�C7 n-"7
Motors ❑0.1 HP❑1%-8
Planning Notes:
6355 7/10/db
Zone
Accessory Building:
Parking Req./Provided
IdoOP TL
Z
O
N
1
N
G
R
E
O
M
T
S
Bar Sink
Showers
ELECTRICAL
FEES
Backflow Preventer
Service Sink
_ Automatic Washer
Construction Pole Sub.
Transformer ❑ 1550 KW
❑ 50+KIN
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Clarifiers
Solar Collectors
Dishwasher
Meter ❑over 100 amps
Dishwasher
Solar.Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
Fan
Motors ❑0.1 HP❑1%-8
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc.Solar 09.15 HP 016-15+
Floor Sinks
Urinal
Fixtures
Microwave
Gas Service Outlets
Water Closet
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range
Kitchen Sink
Water Service
Switches
Sign
Lavatories
Auto -Wash
Garbage Disposal
I Standing Sections
,P -Trap
Laundry Trays
Generator 00.5 KW 05-15 KW Trash Compactor
Roof Drains
ReinspectionFee$15
Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee -
$ 3
r
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
I Building Approved ByDate
Application Issued By Date
Boiler
Hood or Type ❑
Canopy Type II ❑
Duct - Under Ground
Duct - Structural
Refrigeration System
00.100,000 BTU 0100,000 BTU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ SMIP $
$
$ ISSUANCE $
$ P.C. $
S GRADING $
$ MICROFILM $
S Is'�� TOTALFEE $
$ 3 'OU
'
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBO #
Fire Dampers
Heating System & Ducting
X& 100,000 BTU ❑100,0008
RegistersENERGY
Z
lEb
Reinspection Fee
$15
Issue Fee
$ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit#
-
Date
Inspector
POOL ,PA
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 LIFER Grnd.
_
57. APPROVAL TO COVER-GUNITE
-
7. Footings
56. 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
7
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas .0 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0Oil
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
�ylZ y n
Graz
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
i
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.
4'v PE211'
R ITN TRACT NO. LOT NO. UNIT
I CITY OF COSTA MESA CONSTRUCTION PERMIT T/2V'(/n —'ZN
• Project Address Z -L S- F it x• $•-
Applicant's Mailing Address
Owner's N e�'r-'r/ Phone
Address � ✓-.L��s•r.e Grp-�yx/ "d
Arch/Eng. License No.
Address VV
Contractor's Name Ca, r r CL�s^-•s a- �i0' Phone
Address (mailing) ZL7/S p�.t-r'^=� `� S ss•':c, p
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the uslness and Professions Code, and
my llcense is In full ce nd effe I. 'I ,/ r
License Class — Y nie No. % 2�L jr]
Date _il=Z Signature
WORKERS' COMPENSATION DECLARA N
I hereby affirm that I have a earl) (icata of consent to sal -Insure or a certificate
,of Workers' Compensation Insurance, or a certified Copy thereof ISpCtlon
3800, Lab. CJ�
Policy No. Comp
Q Certified copy i5 hereby tum shed.
Certified CLo-py 'is4 6d with the city Buil Divi o
Da
he
V �S S Applicant
EXEMPTION FROM WORKERS-COMPENSA DECLA ATION
(This section need not be completetl if the perm) s for one hundred ($100) or
less).
certify that In the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit IS Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law farina
following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of
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
Lenalty of not more than five hundred dollars ($500).
0, 1, as owner of the property or my employees with wages as their sole
Compensation, will do the work, and the structure is not Intended or Ot/eretl
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
Sale. If, however, the building or Improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
rrave for the purpose of Sale).
I, as owner of the property, am exclusively Contracting with licensed can -
tractors to construct the project (Section 7044, Business and Pl OfesSIOna Code:
The Contractor's License Law does not apply to an owner of properly who
builds or Improves thereon, and who contracts for such projects with a can.
tractnr(s1 llcense pursuant to the Contractor's License Law). I am aware that
proof o// their Worker's Compensation Insurance should be provided to me.
❑ I am exempt under Section B. E P. C. for this reason
Oatp Owner
I hereby Certify. at I have read this application and state that the above
Inlormation is co act. I agree to comply with all city and county ordinances
and state laws r ting to wilding construction, and hereby authorize repre-
sentatives of t city ( nte4 upon the above-mentioned property for
insPectlon pure I 6 Lys�1/
Signature it Date
TYPE OF CONSTRUCTION '�N NEW LJ ADD LJ ALTERATION U REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OM;100
H Edi AP #
DESCRIPTION OF WORK/USE OF BLDG. ;1 0. -t(-J .l Gv; ti
S Main Building:
E
TYPE OF PERMIT GRADING 0 FOUNDATION 0 STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL R Rear
❑ OTHER A
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right
K
CONSTRUCTION TYPE VALUATION$ $ Left
ZONE GRADING CU. VOS. ACRES Ping. Ref. #
Remarks: x�-T.-s /� �, C�s7xN/��.�f Planning Notes:
6357 7/10/85
I
Zone
Accessory Building:
Parking Req./Provided
1r1e75
Z
O
N
I
N
G
R
E
Q
M
T
S
Bar Sink Showers
ELECTRICAL FEES
Backflow Preventer Service Sink
BUILDING PERMIT
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50+ KW
Backflow Irrigation Sewer Cap
$
Bathtubs Sewer Connection
Cooking Unit Meter ❑up to 100 amps
Clarifiers Solar Collectors
PLUMBING
Dishwasher Meter Dover 100 amps
Dishwasher Solar Piping
$
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
S ENERGY P.C.
Fan Motors 00-1 HP ❑1 X - 6
Floor Drains Swimming Pool w/Spa
F.A.U. Inc.Solar 09.15 HP ❑16-154
Floor Sinks Urinal
PLAN CHECK
Fixtures Microwave
Gas Service Outlets Water Closet
$
Device Boxes Pole Light
Interceptors Water Heater
$ TOTALFEE
Outlets Range
Kitchen Sink Water Service
25%
Switches Sign
Lavatories Auto -Wash
Garbage Disposal 'Standing Sections
P—Trap Laundry Trays
Generator ❑O.5 KW ❑5-15 KW Trash Compactor
Roof Drains
Reinspection Fee
Under Ground
$15
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
00-100,000 BTU 11100,000
Drivers' License or il,- _ I I namspecrlon rea
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Issue Fee
Hood or Type ❑
Canopy Type I1 ❑
Refrigeration System
❑0-100,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
S 3
FEES -
$ 3
1 Reinspection Fee 1 S15 I I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By
$ 3
SUMMARY Of FEES
BUILDING PERMIT
$ SMIP
$
PLAN CHECK
_
$ Xll� •-�.`� PERMIT
PLUMBING
$ ISSUANCE
$
PLAN CHECK
25%
S ENERGY P.C.
$
ELECTRICAL
$ GRADING
$
PLAN CHECK
50%
$ MICROFILM
$
MECHANICAL
$ TOTALFEE
��� �•7��
$
PLAN CHECK
25%
$
Fr?
CONSTRUCTION AND PLANNING
• APPROVALS Permit #
Data
Inspector
POOL ,PA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole.
52. Pool & Equipment Location
2. Soil Pipe Undrgrnd.
I
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 LIFER 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
i
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
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 0Oil
.23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing '
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing ;
74. Overhead Hydra
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
46. Handicap Regulations
47, FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electr(c 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.
CITYOFCOSTAMESA cCONSTUCTIONPERMIT
Project A�G
ddress
9 &1 S'>L
-Applicant's Mailing Addrelss ,/
Owner's Name Phone
Address
Arch/Eng. License No.
Address
�����
Contractor's Nam - "+- Phone seY_}19...AL
Address(mailing) S% S
.City License No. _
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of thpl Busines and Professions Code, and
my license Is in lull, rc antl f t. �/ �jgS/G�f
License IdSz — ,. a N0.1_i
Dale Signature _
WORKERS' COMPENSATION DECLAR N
1 hereby affirm that I have a certificate of cc sent to ser
e -Insure or a certificate
of Workers' Compensation Insurance, or a Certified copy thereof ( ction
3800, lab. Cf) �t c ( ) 11-11 i
rrrPoll800, ab Y% `✓ I Comp ny /—t'^
Certified copy is hereby furnished.
Certified copy is fiJBtl with the city Bu ding Divisl
Date —t S Applicant
EXEMPTION FROM WORKERS' COMPENS N DECLATION
(This section need not be completed if the per-Ortir is for one h nd red ($100) or
less).
I certify that In the performance of the work for which this permit is Issued, 1'
shall not employ any person in any manner so as to become subject to the
Workers' Compensation laws of California.
Date Signature
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Co. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
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
2031.5 by any applicant for a permit subjects the applicant to a civil
eaity of not more than five hundred dollars ($500).
n
J 1, 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 (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im-
prove efor the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors t0 construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who Contracts for sucn projects with a con-
tractor(sl license pursuant'[, the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify the I, have read this application and state that the above
information is torr. 1 agree to comply with all city and county ordinances
antl state laws to latm to bundrh construction, and hereby authorize fepre-
Sena
tives of this to e
ntgr inspection purposa�,�,ntgrIpon, the above-mentioned property for
inspection purposes /
Signature I Da[d� z��fS
Drivers' License or SS
. i a D`(q
I z. //
I S 7
_
1
TYPE OF CONSTRUCTION NEW ADD LJ ALTERATION U REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
A.P.
DESCRIPTION OF WORK/USE OF BLDG.
Showers
ELECTRICAL FEES
S
Main Buildi
E
TYPE OF PERMIT GRADING FOUNDATION STR VCTU RAL
T
Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
�r
Bathtubs
❑ OTHER
A
Rear
Cooking Unit -
C
Right
PROJECT DESCRIPTION Sq. FT. OCCUPANCY
K
Solar Collectors
CONSTRUCTION TYPE VALUATION $
S
Left
ZONE GRADING CU.YDS. ACRES
Ping. Ref, #
Remarks: I a 1 n 7— 5,J,_1 nL,"r_
Planning Notes:
3589 5/28/85 560TI
Zone
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
M
Reinspection Fee I S75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
110-100,000 BTU 01 00.000 8T
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee
$ 3
PLUMBING
FEES
Bar Sink
$15 Issue Fee
Showers
ELECTRICAL FEES
1ANICAL
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KIN
❑50+KW
Backflow Irrigation Sewer Cap
�r
Bathtubs
Sewer Connection
GJ
Cooking Unit -
Meter ❑up to 100 amps
$
$
$
$
$
$
Clarifiers
System Repair/Alteration
Solar Collectors
Dishwasher
Meter ❑over 100 amps
3
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
I
Fan
Motors [10.1 HP ❑1'h-8
Floor Drains
Swimming Pool w/Spa
F.A.U.
I Inc.Solar ❑9-15 HP ❑16-15+
Floor Sinks
Urinal
Fixtures
Microwave
3
Gas Service Outlets
Water Closet
Z 00
Device Boxes
Pole Light
Interceptors
3
Water Heater
(D Q')
Outlets
Range
Kitchen Sink
/
Water Service
�
Switches
Sign
3
Lavatories
Auto -Wash
0()
Garbage Disposal
' Standing Sections
P -Trap
Laundry Trays
Generator 00-5 KW El 5-15 KW
Trash Compactor
Roof Drains
Reinspection Fee I S75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
110-100,000 BTU 01 00.000 8T
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee
$ 3
1ANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By
Date
Date
Dat
Z
Hood or T
Type ❑
Canopy Type 11 ❑
Refrigeration System
00-100,000 BTU 0100,000BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$
$
$%,t^O
$ � I -OD
S
$
$
$
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTALFEE
$
$
$
$
$
$
System Repair/Alteration
F ire Dampers
Registers
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
Date
APPROVALS Permit #
Inspector
POOL • A
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-Uncirgrnd.' -
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 1
58. Electrical Conduit-Undrgrnd.
B. Foundation I -
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
i
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
_
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑ 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
Notes: -
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
r'S OS
p/J
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
L -J
p �D�p
11110 STATE LIC. No. 390785
CONSTRUCTION
723 OHMS WAY, COSTA MESA, CALIFORNIA 92627 - Telephone 714/631.5298
October 22, 1985
To: Costa Mesa Building Dept.
Re: Permit Numbers B18702 & B18703
This letter shall confirm that the subject property located
at 268 E. 16th Street, Costa Mesa conforms to the drainage
standards of 2 % grade away from structures within 5 feet
and 1% there after. All drainage is to the street.
Signed,
1W-A�eei
Mark Keller
City of Costa Mesa INSULATION CERTIFICATION Building Safety Division
;2-6 S? -E - / (::�n c- /" 7t41-5-lrr Z-, e
Number and Street City County V
ROOF
Material
Thickness (inches)
7
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
Brand Name
Thermal Resistance (R Value)
EXTERIOR WALL
Material _ Brand Name 0 c Pi" f —(fo
Thickness (inches) -7 / Ji Thermal Resistance (R Value) - /l J
CEILING
Batt or Blanket Type
Thickness (inches)
Loose Fill Type —
Minimum Thickness (inches)
Area Covered (ft2I
FLOOR,ELEVATED
Material /;Zl 7474<_
Thickness (inches) � / J/
FLOOR,SLAB
Material
Thickness (inches)
Width (inches)_
FOUNDATION WALL
Brand Name OC. 2 PI'S /J
Thermal Resistance (R Value) --/`t
Brand Name _
Number of bags Weight per bag Ib.
Thermal Resistance (R Value)
Brand Name OW 62/VS
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
1 hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new
residential buildings (located in Title 24
of the California Administrative Code).
OGlJN PCS �JJ+I �Q/Pv
/V a
General Contractor (Builder)
License Number
�i� COtye9,1 Ag-
/o-a-a-9�'
Signature and Title
Date
/Z/,Oy � S� /^/
/,
3 ! 0 7 b
Sub Contractor (Insulation Applicator)
License Number
Signature and Title
Date
CMF 1106-30
/wf I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CIT -«'4F COSTA MMESSAjjf��� CnynyA��n,71ycTR Cl! TIIcONN PERMIT PERMIT NO. TRACTcNO LOT NO. UNIT NO.
Project Address r O / /
N.Applicant's Mailing Address N5WPQ1:7 j2LVP 9Fi ml N TYPE OF CONSTRUCTIOy U NEW ADD LJ ALTERATION U REPAIR
Owner's Name--Lfa'T�G�ry ✓ -Phone
Address
(9/Eng, "Artolv)Trh No
//�����r
>j�
Address lNIVTVQr•',
Contractor's Name Phone
Address (mailing) C
City License No.
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Bty�n s dnd Professions Code, and
my license is in full force and
effect. (((f \J Iye�e�
License Class cense No.
Date Signature "''''PPPPPP"''''
WORKERS' COMPENSATION DECLARATION
,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
3800, Ldp. C.)
Policy No. Company
BCertified copy is hereby furnished.
Certified copy is filed with the City Building Division.
to Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be Completed if the permit is forone hundred ($100) or
less).
1 certify that in the performance of the work for wh [ this per ' s Is ed, I
shall not employ any person in any manner so bG�owd lec o to
Workers 'to mpey?a4on Laws of Cabt eia.
SO
Date ) 7.1 Signature 1
NOTICE: It, after making this declare ton, you should beconfe subject to th
Workers' Compensation provisions of the labor Code, you must forthwith
Comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address _
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
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
enalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with Wages as their sole
com ponsalion, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property Who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that Suchimprovementsare not Intended or offered for
sale. If, however, the building or Improvement is sold within one year of Com-
pletion, the owner will have the burden of proving he/she did not build or Im-
rpve for the purpose 01 Sale).
1, as Owner of the property, am exclusively Contracting with licensed con-
tractors to construct the project(Section 7044. Business and Professions code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con.
traclor(V license pursuant to the Contractor's LICen Se Law). I am aware that
proof o their Worker's Compensation insurance should be provided to mo.
❑ I am exempt under Section� B. & P.�jL. for this reaS"
Date Owner r
I hereby certify that I have res is ap plical oh a tl state that the above
Information is correct. I agree to comply with all City and county ordinances
and state laws relating to bull lig construction and hereby authorize repre-
sentatives of this City to er upgn t at
a -me �oneo property for
Inspection pure aes. �7 ,v
Signature
Drivers' License or 55 • I I Reinspection Fee
White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Cl CONVERSION
TYPE OF PERMIT ^�t LJ GRADING
U TENANT I�,LE�R����A4ICA
❑ OTHER // �J
PROJECT DESCRIPTION SQ. FT._�tr
CONSTRUCTION TYPE "
ZONE GRF
Remarks: PC F`CE
Sink
RUCTURAL
__ VA ION$
CU.YDS.. A(
Backflow Preventer
Service Sink -
Backflow Irrigation
Sewer Cap
Bathtubs
Sewer Connection
Clarifiers
Solar Collectors
Dishwasher
Solar Piping
Drinking Fountains
Solar -Tank
Floor Drains
Swimming Pool w/Spa
Floor Sinks
Urinal
Gas Service Outlets
Water Closet
Interceptors
Water Heater -
Kitchen Sink
Water Service
Lavatories
Ping. Ref. + O
P—Trap
E
Roof Drains
Rejnspection Fee
$15
Issue Fee 1 $ 3
CMF 0865-46, rev. 4/84
$15
Issue Fee 1 $ 3
2192 5/02/85 y6jp L TL
A.P. 0 411 Gl OZ 1 —14-4
Boiler
Hood or Type I ❑
Canopy Type II ❑
S
Main Building:
Duct - Under Ground
Duct - Structural
Refrigeration System
❑0-100,00013TU 0100,OWBTU
eZ
O
Duct -Ventilating
e?.r /
Exhaust System Cl Multiple ❑
System Repair/Alteration
C
Right Ci/
Firepl/Fact. Bit. ICBG*
N
K
S
Left
Heating System & Ducting
❑ 0.100,000 BTU ❑ 100,000 BT
G
R
Ping. Ref. + O
Parking Req./Provided
E
CMF 0865-46, rev. 4/84
$15
Issue Fee 1 $ 3
2192 5/02/85 y6jp L TL
A.P. 0 411 Gl OZ 1 —14-4
1 Zone A.� S
S
Main Building:
Accessory Building:
T
Front jg
eZ
O
ARear
e?.r /
N
C
Right Ci/
N
K
S
Left
G
R
Ping. Ref. + O
Parking Req./Provided
E
Planning Notes:
DM
T
S.
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter Clover 100 amps
Dryers Chas ❑Electric
Sub Panel
Fan
Motors ❑0-1 HP ❑1 h- B
F.A.U.
Inc. Solar 139-15 HP 016-15+
Fixtures
Microwave
Device Boxes _
Pole Light
Outlets
Renge
Switches -
Sign
Garbage Disposal'
Standing Sections
Generator 00.5 KW ❑5-15 KW
Trash Compactor
' Reinspection Fee
$15
Issue Fee $ 3
DEVELOPMENT SE VICE RE UI
Zoning Approved. By
Building Approved By _
Application Issued By'
ENTS:
Date
Date
Data s y
,r/ SU
BUILDING PERMIT "$O
- -PLAN CHECK _$
' PLUMBING $
.PLAN CHECK 25% $
ELECTRICAL S -
PLAN CHECK 50% $ '
MECHANICAL $ -
PLAN CHECK 25% $ -
Y OF FEES S, 9j
SMTP $ •
- PERMIT -
ISSUANCE $
ENERGY P.C. S
GRADING $ -
MICROFILM $
TOTAL FEE $ 3(o .3.34
CONSTRUCTION AND PLANNING
�`,• APPROVALS Permit #
Date
Inspector
POG_SPA
APPROVALS Permit #
Date
Inspector
I. 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
APPROVALS Permit #
20. Rough. Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping EJ Gas 0Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing .' '
73. Undergrnd. Storage Tank 0Gas 0Oil
25. Roof, Sheathing'Gll) �-#'
S
74. Overhead Hydro
26. 7-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
7
S
76. Dry Standpipe
28. Lathing&Siding _
G ,rj
-
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall,JVailing
HEALTH DEPT. REQUIREMENT
31. PlasterlBrown Coat (-
79. FINAL INSPECTION
32. Electri I Power 'Mete r-Final
80. FOOD CERTIFICATE ISSUED
33. Final dlectric
Notes: 4/o' / 5L� rt 72 A'1-kf f
34. Final Heating & Air Conditioning
-
35. Final Gas Pipe-Test
36. Hood or Canopy
N S
37. Final Factory Fireplace
38. Final Plumbing
S�t.a.>z.-� C.) 5' i
39. Water Service-Final '
40. Gas Service-Final
a i • r2 1
41. Solar Domestic-Final
42. Backflow Preventer
--
43. Backflow Irrigation
=�
44. Landscape Irrigation System
' •-r
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
149
-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTI FIC TE OF 0 Date ANC
N024 `
9S
G
.
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OAddres N�CDCa? Jy$TRU Tlf ON PERMIT
Project Address ��((ppO ���fe����1. Awes
Applicant's Maili1 Address ,—" � LIQ -p�._� n✓�K M �l% I
Owners Name t reqs r X5401 Phone
Address
V"/Eng T
I '�onse Nn
GqlfjG
Address AfF, .MFMRIICi
Contractor's Name Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of harter 9 (commencing
with section 70001 of Division 3 of the Business and Frofessions Code, and
my license is in full force and effect. }sem�
Llcense Class Lk:6( Sd
Date - Signature _
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
Df Workers' Compensation Insurance,, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company
BCertified copy Is hereby furnished.
Certified copy is filed with the city Building Division.
Date Applicant - -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for wh h this per it is issued, I
shall not employ, any person In any manner so ay(p�serp�to bje to t
Workers' Co .P n}at�on Laws of Calif or a. yiC/ /1g/
Datq �'�S• Signature 6%�
NOTICE: If, after making this declaraAnn, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address _
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
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
terefrom and the basis for the alleged exemption. Any violation of Section
)31.5 by any applicant for a permit Subjects the applicant to a Civil
enalty 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 (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does Such work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-.
pletlon,
the owner will have the burden of proving he/she did not build or im-
rove for rthe purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
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
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s1 license pursuant to the Contractor's License Law). 1 am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section8. & P, IS rea
_s
Date Owner
I hereby certify, that I have read this application and state.that the above
information is correct. I agree to comply with all city and county ordinances
and stale laws relating to building construction, and hereby authorize repre.
inspection
of this ci� to ,enter pgrl th �ve-lrl>�tionetl property
Inspection of th%S. /L7.� iyS�Frl/�LOS
o asi s� -7 -Ji OF CONSTRUCTION NEW DD ALTERATION
GG ❑ CONVERSION ❑ DEMOLISH v OTHER_
TYPE OF PERMIT LI GRADING LJ FOUNDATION �TRUCTU
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO.
CON STRUCTION TYPE—
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
I, N• VALUgIION $ _
GRADING CU.YDS. s.rf/f�Fr— ACF
C Z
3 -ify-s
PLUMBING
Showers
Service Sink
Sewer -Cap
Sewer Connection
Solar Collectors' r„
Drinking Fountains
Floor Drains
Floor Sinks
Sas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
00-100,000 BTU 0 100,000871
1 I Signature �L _ _ ��� Date
J]. Drivers' License or S5 # I I Reinspection Fee I $15
1111061—
MF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod ,Assessor
Solar Tank
Swimming Pool
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Type ❑
Canopy Type I1 ❑
Refrigeration System
❑0.100,000BTU 0100,000
System Repair/Alteration
Issue Fee
2191 5/02/85 51.0: Tt
REPAIR
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
�T
A.P. 46 d� —��
Zone R
S
Main Building:
Accessory Building:
E
T
Front
ARear
T
$ 3
_
C
Right
S
Left
Ping. Ref. # .
Parking Req./Provided -
dlilt
Planning Notes:
FEES
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub,
Transformer ❑ 15-50 KW _
El 50 + KW .
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter Dover 100 amps
Dryers ❑Gas ❑Electric
Sub Panel -
Fan
Motors 00.1 HP ❑ 1 h - 8
F.A.U.
Inc. Solar 09-15 HP 016-15+
Fixtures
Microwave _
Device Boxes
Pole Light
- Outlets
Range
' Switches
Sign
—
Garbage Disposal
Standing Sections
Generator 00-5 KW ❑5-15 KW
Trash Compactor
$ 3
Reinspection Fee
$15
Issue Fee $ 3
FEES
DEVELOPMENT SERVICES RF
Zoning Approved By
Building Approved By —
Z
O
N
I
N
G
R
E
O
M
T
S.
S—d'bS
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ .�rS-n SMIP
$ PERMIT
$ ISSUANCE
$ ENERGY P.C.
$ GRADING
$ MICROFILM
$ TOTAL FEE
$
$ �•S�
$
$
$
$
$
$ 3
_
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POO SPA
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
Ce,
56. Rough Plumbing & Pressure Test
6.•Electrica1-UFERGrnd.
57. APPROVAL TO COVER-GUNITE
'
" 7'. Fooiings ' .
S
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Struciural Flobr 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
APPROVALS Permit #
20. Rough Factory Fireplace
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
z !
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
7 3
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Elec'tr'ical Power Meter-Fihal
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:C
34. Final Heating & Air Conditioning
_
pe
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Fac{ory'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
!J 2
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Q)
,
51. CERTIFICATE OF OCCUPANCY
No. Date
CIR 3 I ( Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
$:ITY OF COSTA M SA /CON TR UCTION PEq[MIT y, PERMIT NO. TRACT NO. LOT NO. UNlS NG.
Project' Address Tia p L -T � �i V'('d A21
Applicant's Mailirrrn```L g Ad ess �``y-6 L.V,O Hfw
//li�
Owner's Name NftS Phone
Address'"
Arch/Eng. License No.
Address I�
Contractor's Nam SJ Phone
Address (mal' g) U srry �a—/Z
City License No 5 2
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed untler provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in f fore d effect.
Licen Cl a Li rtse o.
Dat Signature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate
%of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company
H
Certified copy is hereby furnished.
Certified copy is filed'with the city Building Division.
Date "^ Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less). '
ce rtify'that in the performance of the work for which this permit is issued, I
shall not employ any -person in any ma/lYler so as to subject to the
Worker/ Cppj{;!��pee�r� LawS of Califo_W1SyKl,—LLI
Date Lav
NOTI
if.
after laking tM1is declaration, you oultl ec me subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
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). ._
❑ 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 offeretl
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or,through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or,im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con.
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
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
proof of their Worker's Compensation insurance should be provided to me.
❑ I.am exempt under Section B. & P. C. for this reason
Date Owner -
I hereby certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and State laws relating to building construction, and hereby authorize repre-
sentatives of is city to enter Ipon the above-mentioned prop rty for
inspection our
Signature
Drivers' License or SS #
TYPE OF CONSTRUCTION L-1 NEW U ADD U ALTERATION LJ REPAIR —
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P.#
DESCRIPTION OF WORK/USE OF BLDG. - - - $ Main Buijdi
E
TYPE OF PERMIT GRADING ❑FOUN DATION ❑STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 A Rear
❑ OTHER
C Right
17OJECT DESCRIPTION SO. FT. OCCUPANCY K
CONSTRUCTION TYPE VALUATION $ --
S Left
ZONE GRADING CU.YDS. ACRES Ping. Ref. #
Remarks: (}�) y7'] n7 Planning Notes:
4536 6/10/85
Zone
Accessory Building:
Parking Req./Provided
ar dci TL
Z
O
N
I
N
G
R
E
O
M
T
S
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
PLUMBING
FEES
Bar Sink
Showers
ELECTRICAL
FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
Backflow Irrigation Sewer Ca
9 P
Bathtubs
Sewer Connection
Cooking Unit
3 Meter Kup to 100 amps
/S
Clarifiers
Solar Collectors
Dishwasher
Meter ❑aver 100 amps
3
Dishwasher
Solar Piping
Dryers as ❑Electric
Sub Panel
S
Drinking Fountains
Solar Tank
-
Fan
Motors ❑0-1HP❑1h-8
3
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar 09-15 HP E116 115+
Floor Sinks
Urinal
Fixtures -
- Microwave
Gas Service Outlets'
Water Closet
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range
Jib A
Kitchen Sink
Water Service -
Switches
Sign
Lavatories
Auto -Wash
Garbage Disposal
Stand ing,Sections
P -Trap
Laundry Trays
Generator 005 KW 1:15-15
KW Trash Compactor
Roof Drains
Reinspection Fee
$15
Issue Fee
$ 3
Reinspection fee
$15 Issue Fee
$ 3
-
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
Application Issued'By Date
Boiler
Hood or Type ❑
Canopy Type 11 ❑
-
Duct - Under Ground
Duct - Structural
Refrigeration System
00-100,000BTU 0100,00OBTU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ SMIP $
$ PERMIT
$ ISSUANCE $
$ ENERGY P.C. $
$ l70.00GRADING $
$ Z'fl-Sa MICROFILM $
$ TOTAL FEE $
$
��+5
Exhaust System ❑ Multiple ❑System
Repair/Alteration
Firepl/Fact. BIL ICBO #
Fire Dampers
Heating System & Ducting
110-100 000 BTU ❑ 100,000 BT
Registers
Reinspection Fee
$15
Issue Fee
$ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
✓ CONSTRUCTION AND PLANNING
'- APPROVALS Permit #
DatePOOL
F1,,peor
i�
. SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or. Pole
,' r
52. Pool & Equipment Location
2. Soil. Pipe-Undrgrnd
53. Steel Reinforcement
3: Electrical Conduit Utiility-Undrgrrid.
Z Ts
C!C-'
54. -Forms
4.•Elecirical Conduit-Ufidrgrnd.
55. Electrical Bonding
5. Steell Reinforcement's
56. Rough Plumbing &Pressure Test
}
6. -Electrical UFERGrnd;�
57. APPROVAL TO COVE R-GUNITE
-� -.
7. Footings "- ;� ":
=?•�
58. Electrical Conduit-Undrgrnd.
-
8: 'Foundation �'� ,
' '
59. Gas Pipe, O Undrgrnd., Test
9'..Water Pipe-Undrgrnd. ' !
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System'
i
61. APPROVAL TO DECK
11 . -Property Sewer Line & House Connection
- _i
62. Backwash & Receptor -Final
12.;Sewer Cap
,Roof
63. Heater &Vent -Final
11 Drains` !"
64. Plumbing System - Final
14. Rough Plumbing",.;--
65. Electrical -Final
M
15. Rough ElectricaljCohduit
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
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. *Ducts, Ventilating
71. Product Piping ❑ Gas ❑ Oil
23.)Gas Pipe -Rough & Test
72. Underground Flush
24.,RoofFraming
73. Undergrnd. Storage Tank 0 Gas El 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
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
wDREss OFAMlmtO: HEBERTS, CURT DIR:
OWNFA'S NAYEIF MOWN: 237 17TH ST
ADDRESS:
'OSTA MESA, CA 92626 631-6004
APPL. NAIUNO ADDRESS:
ARCHITECT OR ENOWEER: Lit NO.:
ARCH. OR ENG.'S ADDRESS: UNT:
YOUNG'S ROOFING (714)953-5444
CONTRACTORS NAME: 100 S HATHAWAY
cov RAcTOR'SMYm SANTA ANA CA 568560
ADDRE59: 92701 UC.NO.: C000
UNT:
UCENSEO CONTRACTORS DECLARATION: I yamby affirm under paneAy of perjury Dia I em Hollow uMer,pro.4ors of C er 9
(opmmolcing w*i SSdor17DOW d D i ion 3 d tM Bep tam 3rd Prdae.ioro C5d6 ^� Iif-l° I. In &r. !nd .04 / 5
CITY UC. N0. UQ CLASS: 10.:
�� cpinreo U
OWNER B ILDER DECLARATION: I hereby affirm under wmby d mrj ry tha I ant gram rom tM an Lkams Lew fa the
fdlowaq l.m.m (Section 7W1.5 Bueneee ad Ndevons Code: A" o'ry or aowty wh. uiro a perm to M= Ner, image,
wemdish. or rwei any etNmm., poor to n aw,eno.. Ando Muirm tM appium fa Such psnnb to rue. atoned marraynt that M a.M
is licenead pursuant to tt pr s of it Coro a ton lioenss few [Chapter 9 (oo n aemuV yeah Seoion )OW) of dv'slon 3 of tM
Budnase end Prdmiom Coag] or that M or end s ..pt Ihaehom and tM Wes fa thea0egod e.empton. A, vomon of Satlon
7091.5 by pry aPpli[eN to A permA svbjsas the mppr ID • C PawAy of rpt ma. Zhao rrro hundrnd doom [$.ADD.
❑ I. as owner of lM properly a my wplpVees yeah wepes as tl oewe oanpmelion, will do it wrk. And the m ms m aa.Mal
or offered la ems (Saroo t 7011, Butlnaaa AM Ptulweom Code: The Commfon ticeme few clow red apply to m owner of property
wM WAas a anpwal theram, AM oro dose ouch work Nmaeff IX 1na9 a 0w..,h M or her ow employe», pr wiad llw tuN
impmemeras are not Wendnd or world for os. 9. howwar, tM Winding a anpwanera s wU withn ore yea of oomplaion. dye
owmrbudder aiS have tM Wrden of prwiW M or end d i rpt build or anp la tM puryces of We).
❑ 1, as ower of tM popery, Am exdwiwly cerarmrp wN licensed ooraedcre W canmuo do poled (Seaoo TOM, Bwares end
Prdo code: TM CIXaretlon licerm Lew d0ae na apply W an avers of aopeny w1W Wills or anprwas 1Mram W who
oantroms for � Wqw. nvll a cora ada(s) rcewed puauenl to ft Contradae License Lew).
❑ I em exempt under Sedi o: S. A P.C.. Wr the lseaan:
Data: Onner:
1 dD hereby cenwy that I em awaa of AM tm erdaxl its r WramerM of Collars IteeAh and Satery Coda Septum 25505. 25533, end
2553e, ad that I or any haws Windup w.4 as MU I wR not (ciWs ono) need W o ..ply wih swill M. mwas W tM nqu'vernape to,
spamdfawnya duonamMGrationtr lh.Ai uy aupensa 0ianci. Rsailaasloawrwnn appMetioroall ssempt front Nre
awsima.
Dae: Apprcera:
WORKER'S COMPENSATION DECLARATION: 1 hereby aftrm ceder paruby of papay ars of the fpgowhp wed ioml:
❑ I have end oil meimm� a oMdcate d omont to saffimun Wr waken' ComPanaalon, n awWM la by Semm 3]00 d 1M lobar
��_�ss,,,,/////////GMS. fIX IM pedamaKA d DM wall fIX WlCll Ihs llemla s sluts.
l neve w wD meaner oak«.' awncersaaW t cauiie 3709 d lM Leber cod., mr if p t gSy»
oak Ice olid ttaanst Pertarn is ' cur My waken order and o f ftmmoberAn:
Caller: WP9'A-5?9900-02 04/24/96
Poky Number.
(This oder mad m( oe cwrylamy AVs p x it b ms hunired clvgers/51001 or AaeJ
❑ I mrlly M in 1M pM� d lM oak far which thb p h s ieaM, 1 NeilM am o>y poem in airy mamw o n to
become a bd to t s wakal' comparotaion laws d C end ep wta w Mud eoonw eubjad IO tM when'
////// compeneeti n pro e d don 0709 d the lobar Coda./y dTi mmp /wIN a WelonA.
a(Date: AppfcanF (�//,
11 __Wemhrp: Failure ro AAc.m rorkaA'romparwpon eo✓ArApA Italy", and slWl adfAd r smplo yo aIMrW paul0u AM
CIM l/nee w to IXn hrndrad Nuusarrd ddsn ($10400111 In aWhbn W Dye cwt of rooO.Wm dlloago e as "Wood lo, In
CONSTRUCTION LENDING AGENCY: I hereby Atfim under Papallyd penury Ihal IMn s e oonelrl m sting at; n I* Us
pedormence
of IM wok fa wfiirh this p A is saved (Ssoon 3097, Civ. C).
LENDER'S NAME
LENDER'S ADDRESS:
I ceniy 1M1 I Mw rend this applicator end pate that do above inlIXmmlon ie cants. I ep. to canpy wish dl ciy AM count,o inancea
end alae laws ream, W Wath, mnaaudim t end hereby a 4. reaeeenl.iHee d [hie wy W.nlerupon IM ebowroo tionM mpaly
lona papceee.
r
dm Ne
Dae:
Signature of H enVA UGonlraotm
(515146 WY) Whd6 fbUllaag 5 Satay; Urmn chile: Geary-AppafBnt: Pink-H.v ua: UaaM1W-baler
_.,v5"PA MESA — BUILDING PERMIT
PERM NG P
O O C
PERMIT NO: B 073356 PLAN CHECK NO: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION TEAR OFF AND INSTALL 4 PLY BUILT UP SQ FT: 3,800
CLAIM VALUE: 3,800.00 CALC-VALUE: 3,800.00 GROUP OCC: R-1 /
COMMENTS: REROOF WITH 4 PLY COMP/ SMOKE DETECTORS REQUIRED
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN
BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
42522114
ZNE:
REF NO:
PLANNING NOTES>
63.50
.00
REVENUE DIVISION TOTALS--> COLLECTED:
63.50 OVER/SHORT:
00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT
GRADING PLAN—CHECK
63.00
.50
###############################################################################
D E V E L O
P M E N
T S E R V I
C E S R
E Q
U I R E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED
BY :
DATE: _
APPLICATION ISSUED
BY:
c7
DATE: /
LEGALIZATION:N
F E E S U
M M A R Y
STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
SMIP/RES GRADING
PERMIT 63.0050
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTAL
PAID
DUE
TOTALS ---- > 63.50 0.00 0.00
63.50
63.50
.00
REVENUE DIVISION TOTALS--> COLLECTED:
63.50 OVER/SHORT:
00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT
GRADING PLAN—CHECK
63.00
.50
###############################################################################
I N D I V I D U A L F E E
B R E A K D O
W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3800 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,800.00
END OF FEES
EXPIRED LV�
DATF G2__�_
O JUL 211995
y OF COSTA MES
All
r
.*
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
-POG _ SPA '
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
& Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNI,TE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, O 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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
F
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
I
29. Insulation
78. FIRE PREV. FINAL
��'
1
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
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. FINAL PLANNING
49. Electric Release to Edison
- _ -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
jjkRE**`lMLDwL HEBERTS, CURT UNIT:
SNANEIRMNOWN: 237 17TH ST
ADDREM
:OSTA,MESA, CA 92626 631-6004
ADPL. At" ADDRM
ARCNIfECT OR ENGINEER: LIG NO:
ARCH.OR FNC'w ADDRESS: DMT:
YOUNG'S ROOFING (714)953-5444
CONTRAC701119191111E: 100 S HATHAWAY
coNrRAcroITsewLMO SANTA ANA CA 568560
ADORES& 92701 LIC NO-- C 0 0 0
UNIT:
LICENSED CONTRACTORS DECLARATION: I Iroreby Mnm under penalty of Erhrm/ Ow I on licensed! Imderprorielons of C 9
(amm.ndrq w;p)SiQ 17W4! a Division 3 a N. BL2aesd [3rd Prauwor s czpe, 6CAE& w e le 47(41 end ili % y
JCITY LIC. NO.: LIC. CLASS: LIC. NO.:
Dae: ( Comredor. C.
OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury Ihn I themaaaw Licame I.A. la IM
Indoor, l(Soaion 7031.5 &anroes and Pmfeeoone Code: Any cry aoamty mne m.toamtrua. Mar, improve.
dema'eh, or repair any structure, µ'la to is ser mics, also revues the sposianl for such perms to fib a signed swemem tMt he or aha
Is licensed proem to IM proveorw a Na Congracto i Lyase Lew (Chooser 9 lammeavhp orh Sadion 1000) of Division 3 of IM
Bulinrop and P ofwmiom Codal or thn M or she o uempt therelmn And the bene for the deforest asemµion. Arty violation of Semon
7031.5 by my applicant for a peon objects IM eppfca t to a dN penalty of not move then five hundred dollen (55001).
❑ 1, as owner of IM property or my alnploess Wh owes as their sae ampaission, wlTdo the siodi. end the nrwsims is not rdended
or Mored for sale (Sanion 70,64. Business nd Probaecre Cade: The Conwwre License Lawdop not appytow owner of popery,
ohe builds or nnpnoves Invention. end wino does such cork hi mall ov hasty or Nra,h he or her own empoyees, provided aMl sNN
impnaantas
we W intended or offered for wile. 1. however. the dul lm, or knprownM is sad wnhsh aro year of connotation, the
owrwr-0 da will have IM MNerh of proving M a end did not bad a imfsoys la the puhpoee of vele).
❑ I, p 0. of the ons omy, sm saWtivNy oordrecti, wish Rcwed mrmastas A, ahhwi ct d s pope (Sadph TDIA, awinaee and
Pofesdons Cade: The Ccrmre sore Lioeme Lew does nor apply to an owns of properly o)ho buitle a kmpovp thereon and who
,wwAw or eta pnjwp sm o ows"who l lcessed Fanwa to the Caaraaae Lt... Lew).
❑ I an examµ under Section: S. d P.C., or the naesm:
Data: Coir:
I do hwreby comity that I em ewers of end uedaneWd the rsamennema of CeOardo IMetlh and Sdery, Cab Saaiom 25,505, 25533. end
2553e, end the I or ny Mur bsleep oeopam oil / wig not (@ate oro) noel to mmphy obi said wide alae end the rary"vemme he
A perms for ane Wcfonamodlfolionban the A'a eengphwn Digria. RaddatlielanpuWon epp4miaren uanle hone Nate
aarisiowe
Dae: Appfrma:
WORKER'S COMPENSATION DECLARATION: I Ministry aRem oder perrolty, of perjury, aro of Na ollooi, dadakiom:
I hove And oil mmeaih a confun of aavMa lig eetluhaae 4 enrkse' amprhWion. as provided for by Season 3700 of the Labor
Cada, for the peel. of the oak or wliah this Iromb a hewed.
(3 I neve andw mmseih wakes• mmpenWah Seaton 311, a drw Lobar CoM, or the p0 Teptq NM
work la MSA 0is Dorene b muad. Ay woken' kdrVMkM6iJnedremos arts nd Poky rumba ai t A'Y 1 tt Ga5
Cada: WP93-529900-02 04/24/96
Poky Number.
Ohio peon mad not M aanpNereA it tb Fane! u M grin hurlds,d dollies (31pD/ a Am)
❑ 1 eemfy dw o Ne padamwwe a Oro oak s,9 which the penes a ipuwa I a th not al Ah wnR' perm s arty mauve sop o
bcame subjod 10 IM woreenw' n 3M of the www a Caflomi d prise the d 1 baoma •rbiact to the oorkere'
ampaner i/oro Sadiron 3700 a dM Nebo Coda, I N I cop ws Ih vdaorhs
lir Dae:'T Appfrara: /
WamA,: r m. to awcun wakwn• PPnpm- ff., ,,, mi, b sehb *4 erad wllsl a! N aryl o eMbW perWtlp and
chill Dau rig o one Lhurcrd Nua
aoaM data (3tOltMI Is wisdom,co
wisdom,o Mor l of tions damage se Fravldsd ler In
$smon 3706 of Ire Mor Cods, Iowa". And adornyw. Ips,
CONSTRUCTION LENDING AGENCY: I hereby Mom oder powly, of perFaY tied Bra e o ovatnuson tendk, age y for she
pxldmence of IM work or odmic h IM Pons is eased (Swoon 3oe7. Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I comity then I have reed this appfrabm and state Ihol the above kdametion is nen el.I sone to campy win M city W assay ordinances
end ewe Iowa retain, o willing ansouction W hereby simonize reppnueCna of Ne my o order upon the ebove.rtroNoned propoty
for inspecon N,swess
2R �
L Nomms,
Dae:
Signature of neer/AD ppkraru/Couraao
(5151-46.WP) Whn- rdna 5 Soley: Gresi Caro y-Appkrant: Fnk-Revanm: Goldenrod -Assuan
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 073355 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: SIR PURPOSE: OTH
JOB DESCRIPTION TEAR OFF AND INSTALL 4 PLY BUILT UP SQ FT: 3,800
CLAIM VALUE: 3,800.00 CALC—VALUE: 3,800.00 GROUP OCC: R-1 /
COMMENTS: REROOF WITH 4 PLY COMP/ SMOKE DETECTORS REQUIRED
N NN N N NNN N N N NN N N N NNN N N NNNN N N N N N N N N NNN N NNN N N NNN NNN N N N N NN N NN N N N N NN N N N N N N N NN N N NN N N N
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------
MAIN BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT:
FT
IN REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT:
FT
IN RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING
REO:
PROV:
PARCEL:
42522114
ZNE:
REF NO:
PLANNING
NOTES>
>
N NN N N N NirkN
NN N
NNN NN N N N N N NNNN N NNN NN NN N N N N N N� NN N N NN N NirkNNN
N NN N NN N NN N N NN NN NN NirkNNNN NN N
D
E V
E L O P M E N
T S E R V I
C E S
R E Q -U
I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY DATE:
APPLICATION ISSUED BY: DATE:
NNNNNNNNNirkNNNNNNNNNENNN NiFNN *NNNNNNiF NN
LEGALIZATION:N F E E S M M A R Y - STRUCTURAL-SEGMENT:Y-
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
PLAN SMIP/NON-RES ,
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 63.50 0.00 0.00 63.50 63.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50. OVER/SHORT:00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP-/TOT GRADING PLAN -CHECK -
63.00 .50
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN'NNN�_y
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST ' TOTAL ICOST'-
SFR 3800 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 :13,8;0000
END OF FEES
EXPIRED
11
DATE�A
L V " Dr
I w
,lllL- 2�11995-: -
CITY OF COSTA MESA,
17
CONSTRUCTION AND PLANNING _ ; POG . SPA
j I APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
IL I
Sr5
1. Temporary Electrical Service or Pdle
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 LIFER 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 Collnection
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑ Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑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
v<�
29. Insulation
78. FIRE PREV. FINAL
�.
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT ov )
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
ry..r..
44. Landscape Irrigation System
-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
- ti
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. OG13+91
P. 0. Box 1200
Costa Mesa. California
The Building located at 9fp v 1F c�-m«_Llnit 11rn12-r].1
has been inspected and found to comply with the provisios of all City of Costa Mesa Ordinances applicable thereto,
for a Group n-1 Occupancy.
Use of Building A," i 9nrl of-nrar snit -c
Legal Descriptiona_95-991-1d
(See reverse side for Metes and Bounds)
Building Permit No n1A'709ru1Q'70'4 Electrical Permit No. c10311 Plumbing Permit No. P1Qfloo
Mechanical Permit No. Ml a9n1 Number of apartments `annd//or gueess'ty rooms
ISSUED TO: Building Official
Cates and rlyeBb
446 N. Newport Blvd. Ste #101 Y
Npwrxrrt }each. CA
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
CITY r 'OSTA MESA 2190 5/02/85 1719e5h TL
Pi- .,C FEES
Fee Payment Receipt N* 906
Project Address GWv L I & pe' ZX -
A.P. NumberrJ — — 14 Park Area
Building Permit Number'f7146-707- -4-C 3
Owner's Name i4e*-6&-4, (,-.a"
A �
Mailing Address 464 <'A,v�� Ayo . Q ewaai AL G 9243
FEE: Single Family' Number of binits
2 -Bedrooms or Less
@
$ 861.76 =
3 -Bedrooms
@
1,205.67 =
4 -Bedrooms
@
1,545.62 =
5 -Bedrooms+
@
1,810.50 =
Multiple Family '"
Bachelor or Studio
@
474.37 = ilil
1 -Bedroom
3 @
573.18 4,7 12 S4
2 -Bedroom
@
881.51 =
3 -Bedrooms+
@
1,229.38 =
Total Fee "' 3►�'
Planning Department Approval Date
Applicant's Signature -
City Ordinance 72-44 •• City Ordinance 72.45 ••• City Resolution 7e-116
CMF 0174.32 Rev. 6/79 White—Planning; Canary—Planning; Pink—Finance; Goldenrod—Applicant -
.1 V.
C--
0 . .10.
Owner-BuilderV gJ�6f ` VALUE $V L22000.,00 AddJStm.Ba..&
LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORKLaun.t0 AptS.
INSPECTIONS
Signature
DATE jG7ROUP J TYPE V ZONE R2
Soil
-2S
SUBCONTRACTOR
7
PERMITS ISSUED
DATE NUMBER
Gas
Water
_
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
�
Prop. Swr. Line ❑ House Con..❑ St. Swr. ❑
Sprinkling System
Construction Pole
Underground E] Power:0
Rough Wiring
Zy" J.
Trenches I a Forms ,fes Steel Reinf. ❑
' p
Floor System
Bond Beam O Steel Reinforce ❑
Sheathing
F*^me and Fg
lashi
I yg — In Out ;❑
Piaster, brown coat
Refrig. �❑ Air Con. ❑ Final
Heating, Final
Plumbing Fixtures, Final
1
_
Final Gas Test �
i
Electric Fixtures, Fina]
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23391 1 FEE RECEIVED
JAN 8 1965_
' .COSTA MESA BUIL COSTA ESA, DEPARTMENT FINANCE DEPT.
P.O. BOX 317 COSTA MESA, CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill in Completely APPLICATION FOR PERMIT
TYPE OR PRINT. BUILDINGBUILDING For Office Use Only
ADDRESS (O 1
RHCHIPT NO,
PEfNf_,
COSTA MESA. CALIFORNIA ✓S
A C RHCE DHY O ER6 IVHD
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS gEGULATINO
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'ECTIONS
Signature
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TYPE V GROUP
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ISS ED
cns
Date
Number Si nature
WATER
Plumhin
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON.
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MESA BUILDING -SAFETY DEPARTMENT
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P.O.BOX 7200 COSTA MESA, CALIFORNIA 92626
/APfiLIOTION FOR BUILDING PERMIT
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BUILDING / (� / (!
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hereby acknowledge that I have read this application and stIth
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that the above information is correct and agree to comply w
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any person in violation of the workman's compensation lawsthe
State of California.
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hereby certify that 1 am properly licensed as a contractor un$D.
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THE AMOUNT SHOWN UNDER VALUATION ISFORChapter
State of California Business antl Professions Code, Olvisicn
9, and that such licenses are In full force and effect, o
am exempt from the provisions of the State of California BusinVALVATIONand
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
Professions Cotle, Division 3, Chapter 9.�dPERMIT
FEESi
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nature ofPermittee '�V$
BTW r^e t� L✓c"`
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OWNER PARKER, OAKLEY DATE 10-7-59
JOB ADDRESS 268 E. 16th St, BUILDING PERMIT NO. 10488
GENERAL CONTRACTOR Character Const VALUE S 3,200.00 _
AP. No. 117-191-5&6 LOT TRACT FIRE ZONE DESCRIPTION OF WORKSeMi—Pub. Swim Pool
Ir ''ECTIONS
DATE
GROUP J TYPE 3 ZONE RLI
_rground Soil \ U.G. Water
Underground GassG�(.
G*e# t"and Gas
Rough Heating
_I
%
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DATE
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—
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Floor System
Steel Reinforce Chimney_ Re -Rod
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Sheathing
T e and Flashing
L_.._mg, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
Building, Final
OCCUPANCY
— / —4(tj
Form 210-3M-4-59 10488
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
foR APDL/CANT To f/LL /N COMPLETELY
TYPE OR PRINT
BUILDING
ADDRESS21,G
COSTA MESA, CALIFORNIA
sE RECENED
`eta) 16; - 7 J
FINANCE DEPT.
APPLICATIONFF�OR��P1, IT
BUILDING
foR Off/CE USE ONLY
/
RECEIPT NO. PERM
OWNE I
Q DV
MAIL B
RECEIVfi
BV T R EI ED DATE 15OUED
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ADDRESS 6 _ /b
BUILDINW
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COSTA MESA, CALIFORNIA
ADL. _.. S� 6 b I L�
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BYPROVED
DATE /
ADDRESS Z— ow
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NO. OF I (ISE OF NEW
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BYPROVED
+�
/ DATE I
4N OF BLBcs.
SILOT i i.
YARDS
EVES
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ALLOWED
USE OF 1
ExISTI NG BLDG. I
(CENTER LINE
FRONT
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'
DESCRIPTION OF WORK
II
NEW
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MOVING I I DEMOLISH
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ROOF
COVERING
COVERING
US�`E OF BILDING AND WORK TO P%PERFQRM ED `®
il/
Z Q f r y� a C dL
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
PURPOSE
OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTnRUC ION. .../�J
�
VALUATION
PERMIT FEE $
SIGNATURE OVI _ _ J /
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PERMITTEE CLLCCC////// _ _ "'� J `��
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Q LAN CHECK $ �
AUTHORIZED AGENT
0'_
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TOTAL FEE 5
OWNER PARKER, 0AKLEY G: DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 9189
GENERAL CONTRACTOR C)wner-Builder VALUE $ 5.600
AP. No117-191 -05 & OT TRACT FIRE 'LONE DESCRIPTION OF WORK 12 Space Carport
V 'ECTIONS
DATE
I GROUP J TYPE V ZONE Rh
;rground Soil U.G. Water
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas
—
DATE
NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
_
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
IFinal Gas Test
Construction Pole
Underground Power
Rough Wiring
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re -Rod
Bond Beam
Sheathing
F e and Flashing
L- ..ng, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
Building, Final
OCCUPANCY
1
Form znr-am-e-ar nuLlu rwm arLlLI , IJ
nl n
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C65TA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPL/CANT TO f/LL /N CONNEWY
TYPE OR
`PRINT
BUILDING
ADDRESS b /,
COSTA MESA, CALIFORNIA
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
fOR Off/CE USE ONLY
RECEIPT NO. PFT;? MIT NO.
OWNS 7
I I
MAIL
RECEIVED BY REC 1'ESO DATE ISSUED
ADDRESS
IDATE
TEL.
BUILDING
CITY O N •3.�
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ARCHITECT LIC
COSTA MESA. CALIFORNIA
OR ENG (NEER-L(/)2✓✓(/ NO.
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FIRE I
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APPROVE
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USE OF NEW
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DESCRIPTION
NO. V'
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BY DATE
SIZE NO. OF BLDGB.
YARDS EVES
OF LOT NOW ON LOT
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USE OF
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EXISTING BLDG.
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R. SIDE FT. IN.
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USE OF BUILDING A D WORK TOBE PERFORMED
a-cO ad C
—'--
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THETA OE IS CORRECT NO AGREE-TTQQ COM-
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CIT O NANCE AND STAT SLAWS 4EGULAT G
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONS UC ON.
VALUATION
S
SIGNATURE F
_
PERMIT FEE
PERMITTEE
/l
S )
Yl
PLAN CHECK S
TOTAL FEE S a e"
AUTHORIZED AGENT
/
OWNER PARKER, OAKLEY G. DATE5-6-59
JOB ADDRESS 268 E. 16Th St. BUILDING PERMIT NO. 9146
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I'ECTIONS I W
DATE
I GROUP TYPE ZONE
L-_.drground Soi16$-6fU.G. Water ^e
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas I n
/_' /ice
DATE
_
NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing-,fy
.=r%,i: �«<�,; 'j'
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Final Gas Test 4-4,'", (iY'
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Plumbing Fixtures, Fiaal
Electric Fixtures
Building, Final %`
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OCCUPANCY .I'
'I -IC -Ai
Farm 270-3M-4-59
HOLD I OR SPFCIAi. RF(II tTDC%scxr•rc UNIT 10 91
OWNER PARKER OAKLEY G. DATE 5-6-59
JOB ADDRESS 268 E. 16th K. BUILDING PERMIT NO. 9146
GENERAL CONTRACTOR Owner Builder VALUE $ 3([.005,00
AP.Nol17-191-0 LOT TRACT FIRE ZONE DESCRIPTION OF WORK 4 Unit Apts.
r ECTIONS )-al
DATE
I GROUP H& J TYPE V ZONE R 4
p
U,...erground Soil py U.G. Water
-
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas ' L�
DATE
NUMBER
Overhead Water and Gas
Rough HeatingL {0/
Rough Plumbing
Miscellaneous
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Sprinkling System
Heating, Final
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-
Final Gas Test {' i, _ /.t/
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Lathing, In Out
1�5
Plaster, brown coat 0,1
Plumbing Fixtures, Final
Electric Fixtures, Final
_
Building, Final/y_(a
OCCUPANCY
Form zlo—aM—a-sv - HOLD FOR SPECIAL REQUIREMENTS UNIT "( Q1)'0
OWNER PARKER, OAKLEY G. DATE 5-6-59 _
JOB ADDRESS 268 E. 16th St, BUILDING PERMIT NO. 9116
GENERAL CONTRACTOR _ VALUE $ _
AP. No. LOT TRACT FIRE ZONE .DESCRIPTION OF WORK
I ECTIONS
DATE
I GROUP TYPE ZONE
L....erground So .G. Water
_
SUBCONTRACTOR PERMITS
DATE
ISSUED
Underground Gas
NUMBER
Overhead Water and Gas
Rough Heating /
/-
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Plaster, brown coat 71
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Plumbing Fixtures, Final L G/
Electric Fixtures, Final
Building, Final
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OCCUPANCY
- iG�Lol
7E
OWNER PARKER, OAKLEY G. DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 911
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I=CTIONS /, a,
DATE
I GROUP TYPE ZONE
U,-erground Soil,a-,e� Y,U.G. Waler�
Underground Gas
SUBCONTRACTOR
PERMITS
ISSUED
DATE
NUMBER
Overhead Water and Gas
_
Rough Heating
Rough Plumbing
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Building, Final/F�Fu
OCCUPANCY
Form 210-3M-4.59
HOLD
FOR SPFrim. RF(!titocuovro :;SIIIIT 9 91
L6
91.46
CQSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPLICANT TO f/LL /N COMPLETELY
TYPE OR PRINT_ i ))y, M
COSTA MESA. CALIFORNIA
I ■arae
■ ARCH
SETBACK LINE FROM i
CENTER OF STREET• V REAR YARD
PP%to ct rl Q3e Tw f2h
SIDE YARD LEFT 'r�zT �iS I RIGHT $ A9
DESCRIPTION OF WORK
REP,...
I
II DEMOLISH I III
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DESCRIPTION OF WORK
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1 11 MOVING I
II DEMOLISH I III
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NO. OF
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PLANS
COVERING
� Ioe_CO
COVERING
E„�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
AND STATE THAT THE ABOVE IS CORRECT AND AG
PLY WITH ALL CITY OROtMI,N 9 ND ST E LAWS
BUILDING CONSTij4fCT N�
J /
SIGNATURE Gv/
PERMITTEE
AUTHORIZED AGENT
QA, (,_aR P. IS *10&,
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
fOR Off/CE USE ONLY
RECEIPT NO.PERMIT N
RECEIVED BY OAT ftECEI ED DATE 16 4ry `L
BUILDING
COSTA MESA. CALIFORNIA
FIRE
BY
Al /0711P
l t iy CDATE
THE A; NT SHOWN UNDEfl VALUATION
IS FOR THE
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NO. OF
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TOTAL FEE S
OWNER PARKER, OAMY 6. - DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 9145
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
11 'ECTIONS
DATE
GROUP TYPE ZONE
l Wates Ul
- -
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas °
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DATE
_
NUMBER
Overhead Water and Gas
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Rough Heating 1"W
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Miscellaneous
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Plumbing Fixtures
Final Gas Test L IA.-'—
7 ' 5'-+1
Construction Pole
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Rough Wiring
Trenches HIS Steel
L;VWC 7
Floor System
y' V
Steel Reinforce Chimney Re -Rod
Bond Beam
Sbaathing
15'
I e and Flashing
La..,mg, In Out
'
Plaster, brown coat
9
Plumbing Fixtures, Final
-
Electric Fixtures, Final
Building, Final Z4,
OCCUPANCY a
OI
Form 210-3M-4-59 HOLD
FOR SPECIAL REOUIREMENTS
UNIT K 91)
PARKER, OAKLEYO.
DATE
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 9].1.15
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I' 'ECTIONS
Sground Soil 4WU.G. Water g.Ul
Underground Gas
Overhead Water and Gas /�-�
DATE I
GROUP TYPE ZONE
SUBCONTRACTOR
PERMITS
ISSUED
DATE
NUMBER
Rough Heating
�f
X p�S�
,-;fG.G �_ /�
/-- -5
/V ;
Rough Plumbing ,(
Qy �/
._,: e,
-5- - 5 5
Miscellaneous
Prop. Swr. Line House Con. St. Swr,
Sprinkling System
_
Heating, Final
Plumbing Fixtures
Final Gas Test �"
Construction Pole
Underground Power 4gi
1
Rough Wiring
_
17% /1
Trenches Forms' Steel
g/S
° U
Floor Syste'
Steel Reinforce Chimney Re -Rod
0
Bond Beam
Sheathing
I e and FlashingSP•-
L—.mg In Out
Plaster, brown coat '1
;c"�7-7
Plumbing Fixtures, Final
Electric Fixtures, Final
/-. .6u
Building, Final
OCCUPANCY
Form 210-3M-4.59
HOLD FOR SPECIAL RFOl11RFMFNTc UNIT 6 91
5
OWNER PARKER, OAnEY G'4'- DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 91J45
VALUE $ 25,403.00
AP. N0.117 -191-05&06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK .5 unit Hpuu.
R- -'ECTIONS J-,yV
DATE
I GROUP TYPE ZONE H 4
,rground Soil6'.�yf�j9 U.G. Water
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas 1
`.�'�
DATE
NUMBER
Overhead Water and Gas
Rough Heating_ -j
U,
Rough Plumbing iC_ lf/
cf Ll. Cd P - ,;l
Miscellaneous
—•'6/S'y
Prop. Swr. Housf• �il. St. Swr.
/ !"r/
7 eY
Sprinkling System
Heating, Final
Plumbing Fixtures
_
Final Gas Test
2 Wlm
Construction Pole
UndergroundPower /�_
=
RoughWiring.
S F' <. u i
5= J-9 5/
Trenches Forms ✓ Steel
Floor System
Steel Reinforce Chimney_ Re -Rod
Bond Beam
Sheathing
9^'�-
/p /✓ i
F e and Flashing ' .�
_
4 -Y'
L ---ng, In Out
4, `
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
p
Building, Final
/.. /y •6 e
1
OCCUPANCY
Form 410-3M-4-59 HOLD
FOR SPECIAL
T 4 9
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA, CALIFORNIA
I fOR OPUMNT TO f/LL /N COMPLETELY'
TYPE OR PRINT
COSTA MESA, CALIFORNIA
6
4, ---APR 2 u 1959
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
fOR Off/CE USE ONLY
OWNER
RECEIPT NO. PERMIT NO.
S
MAIL
/-
ADDRESS i/ _IDI-
RECEIVED BY DATE RECEpIVEDt GATE IB/gUED/
71
/ -�O
TEL
TEL.ILDING
^ I 2
CITY / O - [9 NO.
ADDRESS
ARCHITECT LIC
OR F" NEER NO.
COSTA MESA, CALIFORNIA
FIRE /
AODRc55
ZONE }+L
,
9
`'
CONTRACTOR L C NTO,
BYPROVE +
DATE 0 S
ADDRESS
ZONING
LEGAL
LOT
ZONE
NO. OF
I
USE OF NEW
DESCRIPTIory
NO. L q 7
BSL
1
TRACTP. U��
PLANS
BUILDING
•VVV
}O'C`K ,�/
`C/ "-T-
APPROVED
A.F. NO.117'-1,9'1 V O
DATE
SIZE..((
'(OD
No. OF BLDGS.
(/ARDS EVES
OF LOT X �, 07
Now ON LOT
REQUIRED ALLOWED
USE OF
(CENTER LINE ST.)/
EXISTING BLDG.
FRONT .lJ� FT. IN.
SETBACK LINE FROM .A
CENTER OF STREET y V REAR YARD 13
R. SIDE FT. IN.
cel
SIDE YARD I LEFT �L
RIGHT n
q
SIDE , j g n ti �j
FT, IN.
DESCRIPTION OF WORK
Va ^ E3 s
AR FT. IN. I
NEW
I iviI ALTERATION I
II ADDITION
I
REPAIR
MOVING
DEMOLISH
1
BUILDING NO.OF
F T�
SIZE 5 ROOMS STORIES
EXTERIOR WALL
ROOF
(COVERING
: ^,12 Ivp AI-Pi2OVED 3-t 6=
COVERING
US OF BUILDING AND NrK TO B PERFOR ED
ll'JL r t• .Df'cCIAL _QUI 'MEN
5, �o �Ld
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDEirVALUATION IS FOR THE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE•Tp COM-
PLY WITH ALL CITY ORDINAN 5 ND STAT 'LAWS REG L �ING
PURPOSE OF ESTABLISHING q PERMIT FEE ONLY.
BUILDING .IHSTR C11oN..
/
VALUATION
/-
FEE $ -7
SIGNATURE O
PERMIT r
PERMITTEE
PLAN CHECK $
V ✓
AUTHORIZED AGENT
TOTAL FEE $ (J/ 7 J O
eErMT11
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 911
GENERAL CONTRACTOR owner-Du"uer VALUE V,"-^
AP. No. LOT 5 TRACT 251 FIRE ZONE DESCRIPTION OF WORK Res&dente Demolished
ILJPECTIONS
coat
Gas Tut
ZONEn4
DATE SUBCONTRACTOR
DATE NUMBER
91111
OWNER PARKER; OAKLEY G. DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 91W -t
GENERAL CONTRACTOR Owner -Builder VALUE $ 25,409.00
AP. N0,1.17-191-05 & CDT TRACT FIRE ZONE DESCRIPTION OF WORK 3 Unit apts.
If"ECTIONS Aw
DATE I
GROUP H & J TYPE V ZONE R
I rground Soil /QU.G. Water
- ._
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gas
/moi do
DATE
NUMBER
Overhead Wafer and Gas
Rough Heating
. t/, 6✓.'7'Z7
/, -.S x i
i6 w-' i
Rough Plumbing
Miscellaneous
Prop. Swr. L' Houon. St. Swr,
/ T{
,,y'Y.�"t-0`-
/T 1Tf
_ (f /
Sprinkling System
'
Heating, Final
Plumbing Fixtures
Final Gas Test
-
Construction Pole
-
r3ic.y.go
a' 07�-'3�
9/7 7
Underground Power
Rough Wiring
... _3G
S tb, u. 4.s/
= a' Y- Sy
�T/ J �7
Trenches Forms) / M/J Steel
L
J c" 7 y'
'�
1�
Floor System
Steel Reinforce Chimney Re -Rod
` U
Bond Beam
Sheathing
F e and Flashing��
L- -ng, In Out
- 0
Plaster, brown coat
-.2/-
i
Plumbing Fixtures, Final
Electric Fixtures, Final
5 -
Building, Final
OCCUPANCY
Form 410-3M-4-59
HOLD VOP SPECIAL REQWAV—WN'P 99 UNIT '1
91L4
PARKER, OAKLEY G.
F 54-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 9144
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
IP`ECTIONS ,Cw
DATE I
GROUP TYPE ZONE
rgiOUnd SOB rwg.-SV.G. Water Y_,W
Underground Gas �/y
dPERMITS
_
ISSUED
DATE
NUMBER
Overhead Water and Gas
Rough Heating �j
e �• [a v ./
t. - -_S -
,- -i ✓''.�
Rough Plumbing .1 Ad�,�'
t��s%
.- - - S •'
i. .i .�-
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
_
Final Gas Test / / liter
4i
Construction Pole
Underground Power %
Rough Wirin g
�
fT-2l/.75
S
-a9-59
C!/6/)
re
Tnches/ Forms $! Steel
Floor System
6 -f& -s
Steel Reinforce Chimney Re -Rod
G to
Bond Beam
1
Sheathing
_
F !c and Flashing
L. ..ng, In Out
Plaster, brown coat
'
Plumbing Fixtures, Final
/
Electric Fixtures, FinalG_
Building, Final -2
T: O-6
OCCUPANCY
/.- /C- frJ.
Form 210-3M-4.59
HULD VUR SPECIAL REQUIREMENTS
UNIT 2
S/4V
OWNER PARKER, OAKLEY G. DATE 5-6-59
JOB ADDRESS 268 E. 16th St. BUILDING PERMIT NO. 91 )
GENERAL CONTRACTOR VALUE $ _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I' 'ECTIONS p/
DATE I
GROUP TYPE ZONE
sgrouud Soila'S}jQ'IJ.G. Water
SUBCONTRACTOR
PERMITS
ISSUED
Underground Gns/ µ/
Overhead Water and Gas
/i_
(O
DATE
NUMBER
Rough Heating
Rough Plumbing—'
'
_ - -
Miscellaneous
_
Prop. Swr. Line House Con. St. Swr,
Sprinkling System
Heating, Final -
Plumbing Fixtures
_
Final Gas Test
Construction Pole
Underground Power
Rough Wiring
_
-. . yr
,.,
Trenches 6 Forms i*Steel
Floor System
Steel Reinforce Chimney Re -Rod
Bond Beam
cr
Sh-alhing
Ie and Flashing
_
L --ging, In Out E
Plaster, brown coat
-Z -
Plumbing Fixtures, Final
Electric Fixtures, Final
0
Building, Final
/—I - Ara
OCCUPANCY
/-/4 _ Zr i
Farm 210-3M-4-59 I .OLD FOR SPECIAL REQUIREMENTS UNIT 3 9141]
CESTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA, CALIFORNIA
FOR APPL/CANT TO f/LL /N COMPLETELY
TYPE OR PRINT
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
CELL RECEN"o
APR 23 1959
FINANCE DEPT.
CITv of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
fOR Off/CE USE ONLY
CEIPT N E MIT NO.
OWNER
�,
E ED BY I
/7'
FJjtl A U�
'-JJ//''
MAIL �.
ADDRESS
or
CITY
C NO.BUILDING
TEL.JTRACT.ZSI
ADDRESS (7 6
IADDI,
ARCHITECT
ARCHITECT
LIC.COSTA
MESA, CALIFORNIA
OR
) NO.
FIRE
ZONE
09
STATEAPPR
t
CONTRACTOR
LIC. NO.BY
DATE
ZONING '
ADDRESS
LEGAL11
ZONE
INO. OF
USE OF NEW
DESCRIPTION
O. \5
BLOCK
PLAN9
BUILDING
APPROVE
ZA)DATE
A. P. NO.
BY
YARDS
LLQ
EVES Z
SIZE
NO. OF SLOGS.
OF LOT Q b
6
NOW ON LOT
REQUIRED
ALLOWED
USE OF/�
(CENTER LINE 6T.)
EXISTING BLDG. L
/ Ul f �i h O/
FRONT
FT. IN.
SETBACK LINE FROM
CENTER OF STREET
REAR YARD
R. SIDE
FT. IN.
SIDE YARD
ILEFT
(RIGHT
L. SIDE
FT. IN.
DESCRIPTION OF WORK
REAR
FT. IN.
NEW I II
ALTERATION I II ADDITION
REPA... I II MOVING II DEMOLISH
BUILDING
NO.OF
SIZE
ROOMS STORIES
EXTERIOR WALL(ROOF
COVERING
COVERING
Uj^ OF BUILDING AND WORK TO BE PERFORMED
i e )Pin)
I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLICATION
AND STATE THAT THE
ABOVE IS CORRECT AND TOM-
THE AMOUNT SHOWN
UNDER VALUATION IS FOR THE
PLY IT.ALL CITY O
_CES !jD $fATE LAW �REGUI[ TIN
PURPOSE OF ESTABLISHING
A PERMIT FEE ONLY.
BUILDING CONSTRU
SIGNATURE OF
/
VALUATION
/)A
PERMIT FEE S
PERMITTEE
n /
PLAN CHECK S
/Cly �r
0
AurHQRIZED AGENT
TOTAL FEE 5O
91.44
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA, CALIFORNIA
FOR 4PPIX01' TO F/LL /N COMPLETELY
TYPE OR PRINT
BUILDING / 5•
ADDRESS 6
COSTA MESA, CALIFORNIA
RMAIN
'ARCHITECT
OR ENGINEER
LEGAL
GESCRIPI
A . NO.
SIZE
LIC.
NO. OF
SETBACK LINE FROM r __/
CENTER OF STREET 1„J V REAR YAI
e Tau
SIDE YARD (LEFT /0 / RIGHT A
DESCRIPTION OF WORK
REP. _
BUILDING
SIZE
EXTERIOR
COVERING
II
HEREBY ACK HOWL
ANO STATE THAT E
PLY WITH ALL C Y
BUILDING CO TRU
SIGNATURE F G_.
PERMITTEE
AUTHORIZED AGENT
NO. OF
ROOMS
no
I HAVE READ,THIS
(3 dw"APR 2:_ t959
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
I-�L-3
FOR OFF/CE USE ONLY
RECEIVED
COSTA MESA. CALIFORNIA
BY j7
I V11'— I I, DATE
ZONING t�
ZONE
NO. OF ^ I USE OF NEW
PLANS l/// BWLO'.G
BYPROVED
%`
1/
PATE Z I
YARDS
REQUIRED
EVES '
ALLOWED
(CENTER LINE ST.)
FRONT
. SIDE.T
F71. ri V rlA•7 1N.
R �
.SIDE b J :T..
FT.� 1 J IN
EAR frya •1
SFT: 1 �I
I
r
nl -r c
t F FNTS
—e--. LJ
Af�Pft7VEQ�_(6-S
Sf `�
THE AMOUNT SHOWN UNDCR VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION C� pLp
PERMIT FEE
PLAN CHECK
TOTAL FEE $ /G /• S
10331
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPC/CANT TO F/LL /N COMPL£T£LY
TYPE OR PRINT
BUILDING z- �6 C
ADDRESS J
COSTA MESA. CALIFORNIA
FEE RECEIVED
y/to �r
��77FyIINANCrrNEnn/ccTTD��E
APPLICATIONCFOpFPER_MESA
BUILDING
fOR Off/C£ USE ONLY
RECEIPT NO.
PERMIT NO.
OWNER
/
MAILRECEIVED
BY DATE RECEIVED
DATE ISSUED
ADDRESS
may[.
Q :
J L
BUILDING
CITY ) (f
O.
ADDRESS
ARCHITECT
LIC.
COSTA
MESA, CALIFORNIA
OR ,INFER
NO.
FIRE
ADbSS
.
ZONE TYPE GROUP
STATE
APPROVED
/
CONTRACTOR )
LIC. NO.
BY
DATE
ONING
ADDRESS
LEGgL
(LOT
ZONE
OF
�/
USE OF NEW
DESCRIPTION/
NO.
BLOCK
TRACT
IND.
PLAN9
(�
BUILDING
APPROVED
A.P. NO. // �•�
.1
BY
DATE
SIZE
NO. OF SLOGS.
(NOW
YARDS
EVES
OF LOT Q
ON LOT
REQUIRED
ALLOWED
USE OF
(CENTER LINE ST.)
EXISTING BLDG.
FRONT
FT.
IN.
SETBACK LINE FROM
C .{
CENTNTER OF STREET V D
REAR YARD
R. SIDE -40_`
FT.
IN.
I
SIDE YARD LEFT 2,
RIGHT 2
L.SIDE
FT.
IN.
DESCRIPTION OF WORK
FT.
IN.
, JJII
NF' I LAALTERATION I
II ADDITION I
REP.IR I II MOVING I DEMOLISH
BUILDING NO.OF
SIZE ROOMS
STORIES
EXTERIOR WALL
ROOF
(COVERING
COVERING
opo
Lr
L -V OF BUILDING AND WORK TO BE PERFORMED
n
I HEREBY ACKNOWLEDGE THAT I VE
R T I6 APPLICATION
AND STATE THA5!THE OVEJ ORR
ANO AGR TO COMLYWITHALLCOV
THE AMOUNT SHOWN
UNDER VALUATION
I6 FOR THE
WITH AL. IC qN
TATE W EGULATING
PURPO6E OF E6TABLISHING
A PERMIT
FEE ONLY.
9U
VALUATION
SIGNATU O
PERMITTE
7 Sri
PERMIT FEE S
62-0
PLAN CHECK S
S
0-�7
AUTHORIZED AGENT
TOTAL FEE S
ID