HomeMy WebLinkAbout384 16TH ST - Building PermitsflOJECT Aooeess: 3 B 9 E 1 6 TH ST
OWNEH'SNAME: J[J�ITH OSMER
nooaess: 3065 HARBOR BL, S,A,
754-6445
pHCHIENGINEEfl:
AOOHESS:
XEG.ND.:
uNir: 3 8 4. 5
UNIT:
PEHMITTEE: PRO'SPEC ROOFING ( 714 ) 744-4541
nooAess: 945 N, MAIN
ORANGE CA 92667
UCENSEO LONTNACTOP OECLAflATION: I hereby aifirm IAaI I am licensed unJer D�avisions ol C�apier 9(commencing wit� Seclion
7000� of Oivison 9 ol IAe Business and Pm� ssions Coae, ana my license is in lull lorce ana ellecl.
cirr uc.: 0425� srpre u.: 471616 cuss: C— 9 �
�aie: �' �' Signature: /�— -
WOBREB$' COMPENSRTION OECLANATION: I hereby aliirm ��at I have a cerii le ol consen� 10 Self-in5ure or a cehific' � o� Workers'
ComDensalion Insurance, a� a cenilied coOY ��ereol (Section 3800, La�. C).
POLICY NO.: E%P. OpTE:
COMPANY:
� Certiliea copy is �ereby Iurni5he0. ❑ Certified coDY �5 liled wilh t�e ci�y BuilEing Oivision.
�ate: Applicant:
ENEMPTIONFHUMWOPHEflS'fAMPEN5AT10N IAHRTION: (Thi55ecuonneeOnotCecompletetlifNe �rm�islor ehunUrea�5100�or1e55).
I ce�ity Ihat in Ihe pedormance af �he woB r which Ihis permii is rssue I hall no� employ any son in a anner so as �o become
5u�leci lo ihe �"'� er�o=pey;�'f�ii n La 5 oi Calilomia '
Oate: — V Signa�ure:
NOTICE: I�. alier making ��is eclara�ion, you s�ould 6ecome suble�� �o t�e Workers' mpensa�ion pmvis ns af the Labor
Coae, you must fonnvn�h comply with such pmvisions or Ihis permit shail be Oeemetl revokea.
CONSTBUCTION LENUING AGENCY: I �ere0y a�hrm Iha�ihere is a conS�NCtiOn Ien4inA agenLy br��e p¢d rmanCe 0� lhe work IOr
which Ihis Oe�mii is issuea (Setlion 3097, Civ. C�.
LENDEfl:
aooRess:
OwNEB BUILDEP OECIANRTION: I hereby affirm Ihat I am e�empl imm Ihe fAniraclors' Slale License Law for ine followinp reason
�Setlion 7091.5 Business anE Pmlessional CaUe: Any ciiy ol coun�y whith requires a De�mi� to conslmcl, alier, imD�ove, tlemolisR or
repair any slmcture. O��or Io iis issuance. also reduires Ihe applicani lor such Oermi� to �ile a signed slalement t�at he/she is licensetl
pursuant �o i�e pmvisians ol tne Contractors' Slaie License Law (Chapter 9(cammencing vni� SecliOn 7000) oi Oivision 3 0l Ihe Business
antl Pmlession5 Cade) or Ihal �e/s�e is exempl I�erelwm antl �he hasis lor the alleqetl ecempiion. Fny vioW�ion a� Seciion 7031.5 Dy
any applicant lor a Oermil subjetl5 Ihe apD���an� Io a civil penaliy of noi more t�an Irve hund�ed OaIWrs �5500�.
I, as awner of ine pmpeny or my employees with wages as iheir soie comDensatian, will ao ihe work, and the
❑ stmcture is noi inren0e4 or afieretl for sale (Section 7044. Business anA Pmtessional Cotle: T�e ConVacmrs' State License Law
tloes nol apply to an owner of a pwperiy w�o bui105 or improves thereon, antl who Eoes such work himSelV�ersel� or Ihmugh
his or her oxm empl0yee5. pwvitleE tha� suth imOmvemenls are noi inten0etl ar otlereG lor sale. I�, however Ihe builtling or
imomvemen�is solA wilAin ane year of completion.�he owner will have �he burden of pranng he/5he 4i0 not builtl m improve
� �or I�e Ourpose o� sale�.
I, as owner of ine pmpeny. am exclusively contracling wilh licensetl caniractors ta construct ihe project (Section 7004, Business
❑ antl Pmlessions CoUe: IDe Coniraclors' Sla�e License Law does no� appN to an ovmer ol Oroperry who EmIEs or impmves �he�eon
dn0 w�0 ConVa[Is �ar su[h pmjeClS wll� d COnVat�O�(s) lic¢n5¢ pur5udnt�0 �hP CO�Vdt�O�S' S�d�¢ Lit¢n5¢ Law),I am dwd�¢
I�al proof ol iheir Worker'S Compensa�ion insurance shoultl be Omvitle0 �o me.
�� I am erem0� untlei Section: B. 8 P. C.
I lot thi5 r2d50n:
Daie: Owner
I Do nere0y <enily Inal I am aware o� ana unaerstand Ihe reQuiremenls ol C
255Jd antl I�at I or any IWure builOmg occupan� willlwill nol (circle one) nee
permn loi conslmclion or mo0ilicalion Imm I�e Nii Oualiiy Managem�
Ihese provi5ion5. ` �
�
Date: _q � OPI¢an�:
I hereby ceriify ��at I have iea0 �his applic on antl Slaie Ihal lhe aoove inh
or0inanre5 ana 5taie lavrs relating �o Uuiltli consimclian and hereby au� k�
Owoerry �or insoeclion Ourposes
Dare: 9� .T � • / Signamre: _
Oriver's Gcense or Sociai Secuniy .:
—Applicanl: Pink—Pevenue: GolCenrotl—Awessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B
PERMIT NO; B 053700 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE; STR PURPOSE; OTH
JOB DESCRIPTION : REROOF 1600SF RESID W/COMP SHING SQ FT: 1,933
CLAIM VALUE: 1,933,00 CALC—VALUE: 1,933.00 GR P OCC• R-3 /
COMMENTS: REROOF 384&1/2 BUILDING BEHIND 389 E 16T �r�{t��+y���� ��
*rr�e*r*rr��r�r�t***�r***r�t�t�r�t�t*�t�t�t��t�t*�e�t�t�e�t�t�t�t�t**�t�t�r�t�tr*�tN�l J.7��V ��e �t*��t*�t�r
2 O N I N G R E(j U I R E M E . �OWc�
s E T B A c x s �
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGAT; FT IN LEFT; FT IN RGHT; FT IN
PARRING REQ• PROV; PARCEL; 42618116 ZNE; REF NO;
PLANNING N01'ES>
i
��r*�t�r�t�t�t�tr�r*******�e*�e*�e*+�*�r�r�e��r�r**�rr�**�r**�r*�t��t��rr�r�r*�r�t��e�r�e�x�*�t�t�t�r*�t�r�t***�**�t�t
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; v\ DATE: �
kifkifitMiEaf3fiEiEitiF�F�Fit3faFiFikifiF 1tiEMikiElEMikkit iF1k
ikiFMititif iflf�FiFlfltiFM�f�titkM�kfflkNM IEM�FM1f1kMiEififM�tlf iE1EM3fifiEiF*3f iEifMklfiflflFlEitifkifkiEifkkiEiEif 1FKMiEifiFiFafif3FiFiF
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 45.00 50
SMIP /T10N—RES
PLAN
ISSUE FEE
BUZLDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 45,50 0.00 0.00 45.50 45,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 95,50 OVER/SHOAT: ,00
BLDG PMT PLUMBING ELECTRIC HECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
45,00 .50
k�! k 1flf 1f 3t ff iF 3F k�f �F iE if iF iF if it if k if �F �E iE if it if k iF iF iE if if iF it if if 1f 1f iF 1k iE M iFiFiFif �f if iF1f %if iF k M�f 1F �f �f iF �f *�E IE iF �f iE k if iF iF �E �f iF �f !f !F
I N D I V I D U A L F E E B R E A K D O W N
TYPE (JTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1933 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 1,933,00
END OF FEES
v
Oi CQ096i46—�G046247 �C.I Y �'r'�
DATE� 09/Q3/91 Tit1E� 13'72
� CONSTRUCTION ANDPLANNING POO �PA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
\� 1. Temporary Electriwl SerJ3a,oc Pole 52. Pool & Equipment Location :✓ '�•
2. SoilPipe�Undrgrnd. rcy; 53. SteelReinforcement r�
k,��lecti�{al Con����tilitybq�,grnd. •` 54. Forms .
� , ��
ap � Electe¢al Con�uiU drgrnd'� 55. Electrical Bonding �'
i
^���teel,'j3einforcg�»�nt 56. Rough Plumbing & Pressure Test ' s
ti� pElectrical UFE$fyrnd. V 57. APPROVAL TO COVER�GUNITE `
a
���Footings OH �0 58. Electrical Conduit-Undrgrnd. tr
�� 8.'Foundation ,.r `�' 59. Gas Pipe, O Undrgrnd., Test y"
9;LWater Pi e�Undr rnd. � ! - ?,
P 9 ,�� 60. Backwash Lines, P-Trap, O Undrgmd. ��," Z�
10�Structural Floor System `4 61. APPROVAL TO DECK `� � l�
17. Property Sewer Lirre & Hqbse Connection 62. Backwash & f±eceptor-Pinal � j
c:;
12. Sewer Cap a y� 63. Heater & VenrFinal ' �
13. Roof Drains r� � �' 64. Plumbing System • Final �
, . .
, �
14. Rough Plumbi� `-' �' �. 65. Electrica6Final ./� G 9'
15. Rough Electrical�Cqndui "_' .-�� ' / 66. Solar System-Final � i% '�
n.
16. Rough Electri�iring i.� � 67. Fencing & Access Approval
�17. Rough Wiring'��I,gn `� 68. APPROVED FOR PLASTERING
'18. Rough Electricki�T Bar Ceilin9 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20'nR h E`dctot F�'eAlace i t:V) d,'! .+ �~�t+[r ��` �
Y O � C�,»: �74PPRDVR'!,'9:aCPectriit#--x � n^
U' :K I rt' !:: '� H '� 1 M1:H� '> 'k 7 C
;r. v: H '7x .. S:i7 t*! � [O
21 D,�c s, iw St'�ct �' � F F
�-+ . ., � Fs i•• -�-iS m 5 C:+�r r 70. l.�l'nderg�i Hq31ro a
22rDU[�s, t�kn�tir�Y i ��S x� � S, `� *•71. Produ� ' ing �C�ds �Oil
23`�Ga`Pio,`�Rou9h &' est � a: :•: t� i�x �- � i i .R c., �•
�- � � fS # t*! t' � px xc �.72. Underg_r`b�i�l Flus��, y: � a,
24pRqaf Fiaming �nx : HL • F * 7 v�^ � �t * 734�.'UndergrnFY.Stor -9_'Tank�'flGas ❑F311
�
25. R� f Sheathin �' z• n' � b"' M p N%�;` " ~"'o ^
� 9 C•� S v � C7 ;.+ N:k x 74-(�,verhead�iYdrq� r:
2E��T-�r Ceiling (Strueturall $�Jfenocoat w m 7 y.r. r. 7�rDry Chemical r�-+ '�'+ �
27�Frame d Flas � m '� � 't fi ra' C> ? S Cr 'X
b �•. �� .:��r, +. :°' Y taxc �: 76FD�ry Stan�'iP�Be !-�w x p
��28"Lathin � �ding�� c� �-!�� ^ .v; s' .. ..a� ;r 77C' FIXED 5't'S'iEf407,SINA� � ^ r
� 29. Insulatf^n "' "'"� � '� " " '� .k [T7 x � R !y
�P v s •. T: � x 76,�FIRE PREV. FI�1(,5' L �. � �, y
J � .�
='30. DrywaM-Naitaig Dx ? * H iidEALTI�rDEPFi REQI�IRf"aMENT
�� � ti t
'31. Plaster�rown Coai� :. j rr�r � �; � 79'�FINAL I�'ECT{�N ',�`R. J C -
. . r-i x . r .. , �- v.
•32-ElectriQe! Po�ver�te.t2y-Finali �s. N .:}: ,BO;,�FOOD C RTIFtEtATE 196 ED
- q, ^o �4
33`tFirpl E�ctr"1� ^:K � c 'x !:� x N4'YS' � �E yc J [�7
i� CD* f�7 I � . x '"! '7i�i �� O Ni*:
� 34;�Fir�elHeating&� ik onditiqrrr�g � X - i: u; S nx y: S dp
.�
35"nFirial G Pi�-T�tK � '"- � I . v .. :l 'T1S * tr SO
h � �::1 .:'r, w0 �7h� F:�.
E-� / a,. • r ?: w ��� . � �v �:
3G�Ho,gd qr�CanoPk�X p i[s"+ n. x;� � �' no * �4tr
y� TC� Y IT �"'Y�•
. 37'.J.Fin�Tdl F�ctory Fife�lai� � 5!r ro a[n � a: .. :l � p7
-+ Y. � H H '-� :k F!' �'� .� :! fli
-.38•Fi,r,plP mbin �i"� � � �
kti 9 t: N t ti :x I (�.. �: J F-+ x�m �J
.'�39. W�i�r SetvictFifR� i �� �� � : x- .^. l+.rl a� O
a :-x � i � a � ^� �: s
:.n40. Gas SefJice�,inal �� ,¢�.�.�. S X �,� � :;� pN tv�J -
541. Solar pomesficFirkfS ii� �• ?� Os f :* et�v �-+ a:
.Y.' i .T• . �: LT' '70 7 �. ;�
42SBackflow Prevente7^� N '0 F� "� N � ;Y. ,j
K N � � t� x C� � L-� • M C .-+
43. Backflow Ir15"gatiort� �" '-�SS * � K � � � �E-o � O �
�1 * tT. M M / k: ( : •
' 44. Landsca e� i S ste v' * x x - �
s] P '.Y R17tTICJ '... �!*7 b �7 Gx x N N x:J :K N O
:45ti:�Sound AtteB !f""S �-+ fr x� (� '� H* w H H tTrv t,�[ a. �
`> rr r w r t :% iT� [T7 t�� �c lY b' '2 • `-'C7 :%
�46E,;Handicap R� i'�� y .. . � � .. ..� K a S Oo �..5 <
47SFIR44LSTRC7 � R�BIlC4.DING '�/� _ h+oS C � F
�
48�FI�AL PLd1t1 I t�[r f x ., �
�.-� �c.E... XfU i .:Y : [�7 �t . (� ...
49o'Eleatric Relanse to:iEidi£on i :r. 1. ':r. � c� � x ��; a�
Y ., v� •!� x c:u
i'"50�Ga�flel�asetoSoujhE2rSCalifortiaGasCo Y � � �; �: - '.., � • ol� x ,� "''.
�51. C TIFICATE"OFiOCCUP,�N 7 x a t> i�o ;c ; t.. o
' No. Date "��
Appiicant to fill in all spaces except those witnin heavY �ortler Iines antl sign all aoProD��ate tleelarations.
CITY OF COSTA MES CON TR C PERMIT P MI TRACT NO. LOT NO. UNIT N0.
Project Address ��/2- �' ��� 1 ,� ^
Applicant'sMailingAddress ' � �� 'v�'`
Owner's Name Phone
Address
Arch/Eng. licenu No.
Address
Convactor's Nam � Phon �
Addresslmailing) ' �� � �Z
City License No. Z-
LICENSEO CONTRACTOR OECLARATION
I hereby ai(irm that I am licensetl untler provisions of Charter 9(commencing
with sectlon �000) oi Division 3 0� the Business antl Professlons Cotle, antl
my license is in (ull torce �eff L < 1� �A � p
Licensy Lic se N � � C.L
DateJ� Signature � R �'��
WORKERS' COMPENSATION DECLAR T101
' hereby atiirm that I nave a certificate o consent to selGinsure or a WrtHicate
! Workers' Compensation Insurance, or a certl8e0 copy tnereoi (Settlon
.800, Lab. C.)
Policy No. ' Company
8 Certifietl coOY i5 h¢reby f��nishetl.
Certifietl copy is fil¢tl with the city Builtling Division.
Oate AOPlicant
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis section neetl not be comple[etl if the permit is tor one huntlretl (EI00) or
less).
I ce�ti(y thal in the pe�formance ot Ihe wo�k fo� wM1ich thi5 perm�t is issuetl, I
snall not employ any person in any m r so as oODecome subject to tne
Workers' om tlo of Calito "
Date ' Si9nature
�NOTICE: i, af[¢r making this tleclaratiOn y0� shOultl become subject t0 [he
Wo�kers' COmpensatlon provisions of [ La�o� Cotle, you mu5t forthwith
comply with such provisions ot thi5 permit shall be tllemetl �evok¢tl.
CONSTRUCTION LENOING AGENCV
I hereby ai9rm that there is a consiruction lentlin9 a9ency for tne periormance
of tne work tor which IhiS Permit is issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's AUtlress
OWNER BUILDER DECLARATIOtJ
I hereby affirm that I am exempt irom the Contractor's License Law tor the
following reason (Section 7031.5 Business antl Professional Cotle: Any tlty or
counfv whith reauires a oermit to construct, alter, Improve, tlemolish or repai�
•erefwm an0 Ine basis for t�e allegetl exemption. Any vlolaUon ot SecLon
)31.5 by any applicanl fo� a Pe�mlt subjects the applicant lo a civil
Cl,ndlty ot not mOrG lhan tiv¢ huntltetl tlollars (§500j.
LJ 1, as owner ot tne property or my emo�oyees witn wages as their sole
comp¢nSatiOn, will tlo the wo�k, antl the struttu�e Is not int¢ntletl o� of/er¢tl
tor sale (Section �044, Business antl Protessional CoOe: The Contractor's
License Law tloes not apply to an owner of a praperry wno builtls or improves
thereon, antl who tloez such work himself/h¢rself o� through nis o� her own
employees, p�ovitletl [Itat such improvements are not intentletl or offere0 fo�
sale. II, ttow¢ver, the bulltlin9 or imOrovement is soltl within ono year of com-
pletion, the owner will have the burtlen of proving he/she tlitl no[ builtl or Im-
prove for lhe purpose of 5ale).
❑ 1 as owner o/ the property, am exclusivery contracting with licensetl con-
Iractors to construct Ihe projecl (Sec[ion 7044, Bu5ine55 antl P�ofessions Cotla:
Tne Contractor's Licenze Law tloes not apply io an owner of Droperty who
builtls or improves thereon, antl who contracts for such pwjects wltn a con-
iractor(s1 license pursuant�to the ConVactoi's License Law). I am aware that
o�oor of lheir Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section 8. & P. C. tor this reason
Date owner
I hereby cmtl(y that I have rea�
informalion is mrrecL I agree ro
Signature ,�
Drivers' Licens
CMF 0865-46, rev.
ng cons
r upon
� %�i �! 9 U
TVPE OF CONSTRUCTION NEW ADD LTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
J
TVPEOFPERMIT GRADING NDATION STRVCTURAL
❑ TENANT ❑ EI.ECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER
PROJEC7 DESCRIPTION 5a. F7. oCCUvnrvcv
CONSTRUCTION TVPE VA�UATION $
ZONE GRADING CU. VDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Foun[ains
Floor Drains
Floor Sinks
Gas Service Outlets
Zitchen Sink
Lavarories
?—Trep
Roof Drains -
ReinspeMion Fea $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ a� oo,000 eru � i oo,000 er�
—"��' I I Reinspeetion Fee I $15
White - Builtling: Canary - Appliwnf; Pink - Accounting; Goltlenrotl - AssesSor
Show¢r5
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet .
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration Syrtem
❑o-ioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K �eft
S
Pln9. Ref. #
Planning Notes:
5021 6/17/85
�
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAI
Automatic Washer Transformer ❑ 75-50 KW
Canstruction PoleSub. � SO+KW
Cooking Unit
Dishwasher •
Dryers ❑Gas ❑Electric
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW �5-15 KW
Meter Uup to 700 amps
Meter ❑over100amps
Sub Panel
Motors �61 HP 01'r5 - 8
Inc. Solar �9�75 HP 016-15+
Pole Light
Range
Si9n
; Standing Sections
Trash Compacmr
$ 3
Rainspection Fee $15 Issue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Buildin9 Approved By ,
Aoolintion Issued BY
$ 3
5a0:� Tl
2
O
N
I
N
G
R
E
O
M
T
S
FEES
5 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PWMBING $ .Sr• UO �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ / ,,.,�
MECHANICAL $ TOTALFEE $ �lL
PLAN CHECK 25% $ �
- CONSTRUCTION ANO PLANNING POO SPA �" -
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pqle � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. " 53. Steel Reinforcement -
3.' Elec[rical Conduit��UtilitY-Undrgrnd. 54. Forms '
A. Electrical Conduit:,Undrgmd. " �� 55. Electrical Bonding -
5. Steiel Reinforcement � 56. Rough Plumbing & Pressure Test '
-i
6. Electrical UFER Grnd. ` 57. APPROVALTO COVER-GUNITE ,.,i
7. Footings ••- - - 58. Electrical Conduit�Undrgrnd.
S:�Foundation � __ ,- 59. Gas-Pipe, O Undrgrnd.,Test
.9. Water Pipe-Undrgrnd. .' ��' # 60. Backwash Lines, P-Trap, O Undrgrnd. '�
�
10. Structural Floor System � � 61. APPROVAL TO DECK
�71. 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
t7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FactorV Fireplarx . APPROVAIS Permit #
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 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. FIXEDSYSTEMFINAL
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 f/9 �
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42.� Backflow Preventer
43. �Backflow trrigation
�
44. -landscape Irrigation System'
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILD�NG
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southem Calitornia Gas Co
5L CERTIFICATE OF OCCUPANCY
No. ' Oate
{ GtTY OF COSTA MESA, CALI 7NIA
INTER-OFFICE MEMORANDUM
�
July 31, 1969
T0: Building Department
Dick Hanhart
FROM: Andrew G. Gall, Jr.
SUBJECT: Drainage at 3842 16th Street
On July 30, 1969 I received a call from Mrs. Olga Lageson at the above
address. She is concerned about drainage from 377 16th Place, the property
behind her.
Apparently, water from a sprinkler or hose is draining onto her lot and has
caused damage to her floor tiling.
If you could find the time to call her and explain what, if anything, the
City can do, it would be greatly appreciated. Her phone number is 548-1668.
Andrew G. Gall, Jr.
AGG:ab
RECE�VE�
BUILDING SAFETY DEPT.
JUL 31 1569
,�;�q PM
%, �e�j�10,t1�12i1�2i3��'a�e$
�
V \
i �
PNOJECT RODflE55: 3 8 4 E 1 6 TH ST ' UNIT: ,�
OWNEWSNRME: JUDITH OSMER "`' ��
nooeess: 111 VIA CIRCULA
REDONDO BEACH
310 437-0736
ANCHIENGINEEfl: DON LEE NEG.NO.: C 1Q S S
ROUNE55: �1N��
2501 N, HARTMAN
PEPMITiEE: ORANGE CA 92665
nooxess: T�ITE OAK CONSTRUCTION ( 714 ) 645-6934
833 W 17TH ST 1
COSTA MESA CA 92627
UCENSEO CONTflACTOB OELLABATION: I here�y atfirm tha� I am lic¢nSeA un0er O�ovisions ol Chapler 9 �commencing vn�� Sec�ion
7000� ol Division 3 0l ihe Business anG Protassions Catle, antl my license is in lull lorce anG effact.
GTY UC.: Q z � q sraTe uc.: 4 2 3 2 31 u� B
Dale: ���_ Signature: �'
WOBI(EB COM NSRTIONOECLABATION: I�ere�ya�hrm atlAa acenilicateofconsenttosell�insurearaceniliwteaiworkers'
ComOensalion Insurance, or a cenifie0 copy ihereol (Section 3800. LaU. q.
Poucrxo.: 1200282-92 E%P.URTE: O%IOlI93
comrnNr: STATE FUND
CenitieE m0Y is �e 6y fumis�etl. }� Certifietl copy is filed witA IAe c y Buildinp Division.
ate: � ApDlicant:
EMEMPTION FNOM PKENS' COMPENSATION OECLAflATION' (This seclinn�n¢¢d noi �C compleletl il Ihe permit is lof one hunOreA ($100) or less).
I ceriily �hal in ihe pedormance al Ihe work lor whic� Ihis permil is i55ue0, I s�all not employ any person in any manner so as �o became
subiec� to the Workers Compensation Laws ol Calibmia.
Oa�e'. SignaWre:
NOTICE: II. atler making this tleclaralion, you s�oultl become sutlett lo IAe Workers Campensation pmvision5 oi the Labor
Coae, you musifotlhvn�� comply vni� suc� provisions or lhi5 permit Shall Ue OeemeU revokeG.
CONSTBUC�ION LENOING aGENCY: I nerehy allirm that there is a wnSlmcti0n IenAinA aAenCy fot the pertormante of the work for
w�ic0 I�is Oermi� is isSueE (Section 3W7, Civ. C�.
LENOEfl:
FUONESS:
OWNEfl BULLOEB �ECIAflPTION: I �ereDy atlirm (ha� I am eeempi �rOm IAe COnlfat�ors' Sta�e license Law for me follawing reawn
�Sec�ion 70.'f1.5 Business and Pmlessional CoOe: Any city ol couniy w�ic� repuir¢5 a Oermii Io constmc�, al�eL impmve, tlemolish, ar
rtpair any stmcture. prinr to its issuance. also requires ihe apDlicanl lar suc11 permil io lile a signeG statement Ihal he/she 6 Iicenu0
pursuant to ine Orovisions ol 1he ContractoR' State License law (Chapl¢r 9(commenting wit� Section 7000) of Diui9on 3 of the Buvness
an0 PmlesSions CoGe) or t1w111e/she 4 eeempt Ine2fmm and Ihe baz6 lot ihe alle0e4 eKempti0n. My vioWtion of Stttion 7031.5 by
any appliwni IOr a permit sublec�s �he appli[ant lo a civil Oenal�y a� not more llwn �ive �unGreG OOIla6 (55110�.
O I. as owner ai tAe pmperiy ar my employees with waAes as t�eir wle compensaiion, will Eo t�e waM, antl the
stmcmre is not intenaea or ollere0lor sale (Secuon 70ad, Buvness an0 Prolessional Code: The Contracmrs' Sute License Law
Ooes not apply �o an owner of a O�oVeriy who builEs or impmv¢s Ihereon, an0 w�o Ooes su[h work �imsell/�erseli or Ihmugh
his or her mvn emplayee5, proN4e0 lhat 5uch impmvements are noi in�entle0 Of Oifere0 fOr Saie. I�, �owever Ihe huilding or
impmvement is soltl within one year ol completion, ihe owner vnll have ihe 6ur0en of O�oving he/she tlid noi Dui10 or improve
lor �he purpose o� sale�.
I, as owner of the propetly, am exclusively conVacling with litensetl coniratlars lo cons�mc� �Ae projecl (Seclion 7044, Business
❑ anA Prolessions Cotle: The Contracmrs' Sia�e License law tloes no� apply lo an owner o� proDehY who bwl0s or improves �heaon
antl wAo ConlraCtS �or SUCh pmjec�s wilh a ConVattOqs)liten5e pur5Uan1 lo IhC Confrat�ors' S�aie LiCenSe Law). I am aware
t�al Omo� o� Iheir Worker's Compensa�ion insurance shoul0 be pwvidetl lo me.
� I am exempl untler Section: B. 8 P. C.
I loe IhiS reason:
Date: P+mar.
I Go nere�y cenity ihal I am aware oi and unaerstana ihe requiremenls ol Calilomia Healih anG Safery COCe Sections 25505, 25533, and
2553< ana �hai I or any �uture building ocapant will/will no� �circle one) nee0 �o comply wi�� saitl state co0e5 antl Ihe re0uirement5 br a
permi� �ar conslmclmn or motlilicalion imm Ihe Nir Ovali�y Managemenl Dislricl. FeSiUeniial conslmction aDD�ica�ions are exempt trom
Inese pmvisions.
Dale: Applicant:
I h¢ieby cerlity tlul I have reatl Ihis application an0 51ate thai I�e aboue iniormaiion is corr¢tl. I agree �a compty vrith a0 ciry and counry
a�Uinanres ana staie laws rela�ing ta �uiaing crosimaian antl hereGy tAorrze re�untatives of tlds ury to enter upon the aDove-memione0
o�openy torinspeclbn p poses.
Oate: l� SignaWre:
�river'S License ar ocial Securily N.�
—FopliCdnl: Pmk—RpvBnuB; G01 pnrOtl—ASSBSSOr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 058559
PERMIT NO: E 058559 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PQRPOSE: OTH
JOB DESCRIPTION ; TEMP. POWER POLE SQ FT;
CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /
CONMENTS: *
r*r��e�r�r*�r�r*�exxr�t�t�t�t*�t*�r�r�t***�r�t*r�t*+t*�t*��e�r*��rx��t�e�e�r�r�t*�t�t�t**�t*�r*x*r�r�t**�t�rr*�r+t�t***x�
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 HUILDING ---------
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: 42519115 2NE; REF NO;
PLANNING NiSTES>
�
ikitlf fF k ik iFif �kft k�F ft �t if k k �t M if iflf 1F �Elf �F�flt �f �F ik 1kk if k!F kk�tlt iF ftlF kif if M k 1Fif iEif iE�klE iFltlf if!! �F 1E fflf iFfk�k �t M �k k�F If k 3f ik k if iE
D E V E L O P M E N T S E�R V Z C E S R E Q U I R E M E N T S
20NING APPROVED BY DATE;
HUILDING APPROVED BY : DATE;
APPLICATION ISSUED BY: DATE; S— ��� �
�f �f 1F M M 1f k k 1flflF �Flf fF k1F M kiF if 1f M M�f if 1F �E 1f iklf iF M�£'£��F'{f iE if
MifiFkMlFifiFiElFififlFffMitlfkikitlFlfiFiFM�f�fiFKif ifM1FMiEifiFMMlflflflFiF�fif3fiklElElflFkififklflf3fiF�flfM�kiFiFifkklFklFiElfiF�fiEiE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUMBING ELE15R00 MECHANIC FIRE SMIP/RES GRADING
SOt SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15,00 15,00 0,00 30,00 30,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 30,00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECIC
30,00
3fMkMfFifMiflfifkiEifitltiflkMlfifkififlklFitiEMMiEiklfitifklEiEj!lf3FklfafftlfklFiElfiEffMiFifkiEMifkltllikM�F1E�flfiFiFkiEiflEifMkikifif
I N D I V I D U A L F E E H 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
ELE 1 TEHP SERV PWR POLE W/OUTLETS EA, 15,00 15.00
END OF FEES .
id " "
. . .7 t ' _ . - . . .
�
CONSTRUCTION ANDPLANNING POC SPA
APPROVALS Permit # Date Inspector� opROVALS Permit # Oate • Inspector
i
1.-`Temporary Elactrical Servi"cdo_r Pole .` ' .-�. Pool & Equipment Location '
�- � _ �:13_ �
2; �Soil Pipe�Undrgmd. � �, c4 � 53. Steel Reinforcemeat �
� .
3. Electrica�Cpnii�jjt,ll�;lity-C}'nd grn ��� 54. Forms
.i4. Electriwlfsp�ticnt,llrcdrgrnd. 55. Electriwl8onding
`nri $teel R�i�fo{cemet�it;, �'� �,,, 56. Rough Piumbin9 & Pressure Test �
�6, ElectricalltfER�Gr�I. v 57. APPROVALTOCOVER-GUNITE �
F.'Fo,ptinqs -� _= ��' 58. Electrical Conduit�Undrgmd. LL
;;�. Foundatiooa ;�'i�: .- ` 59. Gas Pipe, O Undrgrnd., Test _ °�
�9. Water Pipe�Und�grnd. ` -- � 60. Backwash Lines, P�Trap, 0 Undrgrnd.
70. Structural Rooi System ��' - 61. APPROVA� TO DECK �
11. Property SewEr_�ine'& Hottse Connection 62. Backwash & ReceptorFinai
12. Sewer Cap y � 63. Heater & Vent-Final
13. Roof Drains '� 'c I � � 64. Plumbing System � Final
14. flough Plumbir� � • 65. Electrical�Fina1
'
15. Rough �lactri �-Conduit 66. Solar SYstem-Final
16. Rough Eiedric@Viring 67. fencing & Access ApProval
�7. Rough Wlring Syn 68.-APPROVED FOR PLASTERING
18. Rough Elect���4-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
�'�19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Roueh F'acto FQeplace i�,*! �t�? � C �: Cx * APPRO.VA�&.=:PerltSi'it # < >- r
- +� -r x �- x x �1 :�:-. - x cT r
21. Ducts. inStructu�� ; • •``' _� * -� _'� " �" _ � Y `'�
i • .-:3 e ;� �� u � 0. �dergie,i..jd:.Hy. o :
22. Ducts, VentiRtin�-�� i �:S �'<t� u: i, ProducUPi@ing C�G�s ❑Oil
23. ,_(',as Pipe_Rough &'i,kst � � "` J c '�"` � 9T � a `� x ="
-� � r� � S "�; .� J2. Under toun Flus`fi� _ �
24. Rooi FraminQ• � i . - - �' +: � ;; � > a S73.viJndergmd?Stor�e= ank � Gas ❑ Oii�
•x
25. Roor,Sh�ihing � � :� .'� `r ; 'ti�._�."'� sjq,�verhead Hydro'-� �
26. T�Bar Ceiling (Structural) &;AAonocoai a a _ ?- <.s 75.-pry Chemical r� >� G -
2J. Frame and Flashing� _ A_ S `* 76.'-br Stand� � r `� r' s
r x:.« Y 2SP.F -,a Y J
L "4�Rau - JF.. L ' �.- W
� 28. Latlyng & Sding x-: -.S,r � � g •.< x 77,-FIXED SY&TENI=FiNAL�� J �V
..
'� .�-'..... j x :�1 r:. -: _-. ..�� .kJ Y
29. Insulation � _� ; y� 78. :FIRE PREV. FINAd. x> >
�� �; � '
.•'30. Drywall��tlai�ing x ` - ox � HBALTH�pEPTi�REQt3�RER/IENT
�:
'31. Plaster 8[flwn.Coat ' " '` T ]� �fINAL INSPLECTI� x � - s
.p. � • T f ti � X Y( �. �(
V
'32. �Electrical�Ppwer Meter;Final, � � � OOD CERTIFIeAT.61SSUED '
�33. Fina� Ele42ric� . �, y '^ " x >' _ �E * � r
otes�
- . .- � i T �� i . � _ -.*t z . � •�
;�- x � :c: � -. � i > _
4.,�Final Heati�B� Air,Cor�ditionipg; ,; � y � .- :S ��2 ��. �S i..
•35. Final Gas PiPe-Test�t �� * ; ..%=+ ,T� S � [� _
.
t'a a c F,] � i^ � -r
36. Hood or Cano • , r�
PY , r' i a+S S_ t'� '4 i]�'
37. .Finai FactolY FirepCac2 ^ � �'' �- - r i .. ,z .� �r
-� i ., ti
:� �� -
'38. Finai Plumbing . : � �� ._ � �.� x ,5 _ .� ,+
39. Water Service-Final � . . < , � (� + .' . r ='F
. 7: � x '�: �. m
40. Gas Service-Final � . ' �` ` - • •'
x ir .1t�',� 1 .� � � -. : N
:41. Solar pomesticFinal �_ : ' -.. _s i r- � -Lo �-+ f r
nt ' > >
-a2. Backflow Preventery � ; '� - S" `' -' �' x '
� tK ' �:
43. 8ackflow krigation^ z� 5 � i°' 1� �: -+
* v *
� 44. Landsca e Irfgatiop SYstem '� -'�j y , - � ° `� . `
P .t�,. , ?, .t. + � � • t .; V �.ti �:� :U .-
45. Sound Att¢nTiatiorw � r. � � � i .- '- ��� : � .- = o i2,2 �n � -
:.: ,r r �r�r ,. .,� ..� q x
A6. Handicap Regulations _ - : �r . •. . '' .« � � � '�� � � +
=w�c x s �r_ s
47.:E�NAL STRt�CTURE & BUI�DING s � , � 7� -7 .�i � � .�
� i
4B. F4NALPLARtNINC�. � T Y ;,� '•,; ;:�� � ' �:_.
-19. �Elec[ric Release to Edison j .« I � -�!Y . i � ' , _
�.
`50. Gas Release to Soui'fiem California Gas Co ' � ' � - . " L ` ,
:,� ` �' c%:" ` J
51. CERTIFICATE OF,OCCUPANC ., .; ,. � ,y ; � 'r , , _
No. Date
a�nooness: 369 E 16TH ST
owxensxnme: JUDITH OSMER
ROOHESS: 3OGS HARBOR HL, S.A,
754-6445
AflCN/ENCINEEfl:
RODflE55:
flEC.NO.:
uNrt: GARAG
UNIT:
PFflMITTEE: PRO—SPEC ROOFING ( 714 ) 744-4541
aoonEss: 9q5 N. MAIN
ORANGE CA 92667
LICFNSED CONTMCTOP DECIANRTION: � nereCy alfirm tlia� I am ficeme0 untler D�w�s�ons of CtuD�e� 9lwmmencin0 m�� Section
7000) ot Drvision 3 of I�e Business aiM P�of s CaGe. anG my license 6 in tW.l Io¢e dM elleti. I
c�,r uc.: 042611 srnrE u: 471616 c�9 j
Oa1e: Q-3-9_, Sigreture: �' �
WONNEPS'COMPENSATIONOECLAHRTION: I�erCGyallirmthd�lluv acetlif¢ateolconsenilaselbinsureorac iifica�¢OlWarkers'
Compensanon Insurance. ar a cerulieU coDY ��e�eol (5¢ction 3800. La�. q.
POLICY NO.: E%P. OATE:
COMPPNY:
❑ Cetli�ied Copy is �ere�y lUrnishetl. ❑ Cenilied capy is lilea witn tAe city BuilAing Oivision.
ele: Ap0licanC
E%EMPTION FXUM WOflKFflS' fAMPEN5,1T10N OE flATION: (TAit sec9on nee0 no� be mmpleteG il Ne pttmil h lor we •ntlretl (5100� or lesj�.
1 certity ��a� in I�e per� lormanc� � I�e wOrk lOr �i�� f�is Oerrttii is issue I 5hail nol employ any p.n in any er 5o as lo beC e
sublec� Io I�e Norke'rsj' ComDP� � on LaxS I Latilomia.
Date: _ � ✓ _.� Siqiuture:
NOiItE: II, aner making iNs aeUarati yrou ShoulO Oecame suGi�� �o ihe warkers fAmpenWibn o��s�on ol ine abor
Code. you must fonhwitn fAmoly witn sucn proviSianS or iNs permii Stull oe aeemea revokea.
CONSTBUCTION LENOING RGENCY: 1 �ert�y aihrm Itui lhere 5 a tan5irut(i0n IenEing agency �or I�e Dettor ant¢ ot Ihe wOrk �or
wAit� IIIiS p¢lm�i is i55ulG (Sttiiql J097. Crv. C�.
LENOEN:
AOOflESS:
OWNEN BUILDEfl OECUBRTION: 1 heREy altirm Ilul I am eeemp� trOm l�e fAnlfatlor5' State Lkense Law lor tne I011owinA mason
(5¢ction 7031.5 Business an0 Pmleuional CaOe: Any Gry o� rAunty wAich repuires a permii Ia mn5�mci, aller, improve, Eemolish, or
reoair any slmcWre. o��o� lo ils iuuance. also rtpuires Ine aoDlicanl to� sucn permit lo file a si0nea statemenl Ihat ne/sne is IicenseU
pursuant m ine o�ovisions ot ine Comractors' Stale Licenu law �COaO�er 9(cammencinp vnt� Sec�ron 7000) al Division 7 of Ihe 9usiness
an0 Pmtessions COOe) or I�al liels�e ¢ eremD� ��ertlmm an0 ��e bavs for ihe allege0 eKemption. My vioWtlon ot Sectlon 7071.5 Cy
any applicanl lor a permit su�leps ine apO�iWn1 to a civil penalty ol not more thdn live hunCrea aollars �5500�.
I. as owner of ine pwpeny or my employees wi�� waAes as t�eir wle compensation, will Uo I�e woA, an0 Ihe
❑ s�mcwre is noi imen0e0 ai allere0lor sale (Secuon 70a4, Business an0 Pmleuional Coee: i�e Coniractors' State License Law
aoes nol apvly lo an owner al a o�operty wlq Ouilds orimpmves ihereon, antl wno Uoes such work nlmselflhersell orlhrouAh
Ais or her own employees. D�o�iUeO ��at suc� im0�ovemen�s are not inlenaeU or olleie0 for sale. II, however Ihe building ar
impmvement is sole vninin one year of completion, Ine awner will nave ihe Durtlen of provinp helshe Oid no� 6uile or improve
Ior Ine ourpose of sale�.
I, as owner ol Ine o�oPeny, am eMclusively canVacling witn licensea coniradars to canslmct ina proiecl (Section 70Ga, Business
L� ana Pmlessions CoOe: Tha Comractors' Siaie Liceme Law Ooes �pt apply to an wmer of pmce�y � OUJGs or Improves tAerean
anC w�0 conVa[I5 lOr SutA D�%etls wil� a CMlira[lor�5) Ikenu pUrsUani Io I�e COni(at�or5' Slale littn5e Law�. I am aware
Itut pmof ol tAeit Worker's Comce��ion insuqnte slwultl be pmviGeG to me.
� I am eeemp� unEer $¢ciqn: B. 8 P. C.
lai I�is reason: '
Daie� �e�� —
I Ga �er¢Dy ceriily Ihdi 1 am aware nf anG unOerSunE t�e mpu'vemenls al CdYfornu
25574 antl Ilut I or any tuture buGCing acupdnt wilVwill not (GNe ane) nee0lo co
permit far conslmclion o� ma0iliw�ion Irom I�e An Oualiiy Mar emeni qsirict. F
I�ese pmvisions.
Oaie: _1 � � � � I ApDlicani: �
I hereUy cerWy I�ai I hav¢ reaE I�iS applita n anG Slaie I�al Ine a0ove intormaiion
artlinance5anO51alelavrsrelalinglobuilEm LMSIlIKIi011dI1O11CfCGydYIM�I� .O�¢5!
pmperly br inspection pwposes
Oale: q� �� �
—ApO���anr, Pink=Revenue; GWtlenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 0 3 98
PERMIT NO: H 053698 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: OTH
JOB DESCRIPTION ; REROOF 400SF GARAGE W/COMP SHING SQ FT: 400
�CLAIN VALUE; 400.00 CALC—VALUE: 400,00 GROUP OCC; M-1 /
COMMENTS: REROOF 38461/2 BUILDING BEHIND 389 E 16T
�t**�t�e*�e�e��*�r�t�t+t�t�er*�e�e�er�e�t�t**�e�t�t�e*+t**�t�r�t+t�t�t*�t�t��t�t�er�t�t�r*�t*�r��t�r�**�r�e*��er�r��rx�rrr+t*
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
------------ HAIN 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
PLANxNINGRN6'�ES> PROV; PARCEL: 42618116 2NE: REF NO:
i
***�t****�t***�t*�t�t�t****«*�r****a+�*�t�r�t**�t***�t*�t*r*rr*�t*�t�r�t*�*�t*�t**�t�t*****'«��t***�t�t**
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
20NING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUID BY• DATE:
kififMklfkiEMk�fifMMk1FMM�flflFM %�fifMiFklf�f�FM if
�t�t*+t�tr�t�*�r�t*�e*�e�e*��e�r*�rr****�e+t�e�r�e�e�t�t�t�t�t*ie�r*�e*�t�t�t�t�t�t*i{�r*�t*�t�t�t*�ri�**�e���t�t*�t*�e�r�r***�r
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 15.00 ' .' SO
PL� " ' � SHIP/NON—RES
ISSUE FEE .
BUILDING—DZV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15,50 0,00 .0,00 �15.50 15.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 1'S,50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANiC FIRE,ySMIP/TOT GRADING PLAN—CHECK
15.�0 ': . �� f ,5�
ItifMiE�EiE3fikififkififKifMiEMiFkMMM1f�FiFklfifiFlfiklE%MklEifkiflfifkMif�Fk�fMiFifkiFaFMMMiflflf�f�fikMiEiFkkiflf3fkklfkiFk�F1f
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 400 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 400,00
END OF FEES
. / ..
�—
CI QCJ9Eiti3—�GuS3Z4; `� � —r -..,
QA�E: C�Iil"aI4?. "iI;;'•e i;:_i
I� CONSTRUCTION ANDPLANNING POOLI 4
� APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Ser eJ�e;er Pole ,i � 52. Pool & Equipment Location ' �-�
f
2. Soil Pipe-Undrgmd. ro •) r! 53. Steel Reinforcement :,,i • t
, .�, , v •^
�.�r'�Electr�al Cond��,�ilityl7ndtgrnd. 54. Forms ' �
..:;4��Electrrsal Conduit�l�drgrnd� 55. Electrical Bonding .�
�'���teel�einforce��nnt , 56. Rough Plumbing & Pressure Test 5
ro` pElectrica� UFFi3xjrnd. �.- 57. APPROVAL TO COVER�GUNITE �
a
y�F�Footings O!-� �c 58. Electrical Conduit�Undrgrnd. :-
� 8. Foundation S `t' � 59. Gas Pipe, O Undrgrnd., Test .���, �'
9lWJater Pipe-Undrgrnd. �, � 60. Backwash LineS. P�Trap, O Undrgrnd. t �
10.aStructural Floor System ¢� • 61. APPROVAL TO DECK ' ' y
�.
71. Property Sewer LirtE�& HQus�Connection 62. Backwash & Raceptor�Final �' 'j
12. Sewer Cap a � / 63. Heater & Ven[�Final �� �
�
13. Roof Drains ro y� .`� 64. Plumbing System � Final -/ '� �
14. Rough Plumbi�f � �� ' 65. Electrical-Final ~y�'
15. Rough Electrica7-Condui��U �'� 66. Soiar System�Final •��
16. Rough Electri�iring '� s' 67. Fencing & Access ApProval
¢77, flough Wiring�jgn 68. APPROVED FOR PLASTERING
�78. Rough Electri�i�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. FiEQUIREMENT
- O'h-imF w Y N
20h?R .. h�ctoty F,:7*Place i Stn �ti � O M crR * PPfiHVRY5S:7JPermit #'- '„ �='
cr r R a ., •- �
� , i. � �� _x .. ti m * �n
21t �(s, �;Str�ct� � .... ��s * S G i.y* * .70. �dergrpgn H�glro �
22. DUCts, Y/YntUeti * t l�S x, � S �2� � 77, Produ � Ing �lias Q�OiI
/'� rl (�
23.L,�,Gay�iP�Ro h&�.p esc � � *` �T �+r t i i x ps
-+ :� .k i C�S * t*7 t7' tt O� � �2• Under r�eind F�.., * �. a
24rflo.� F(aming 6T* �[�:� -� �> O � * � 73bUndergrntl.Stoda 6Tank%OGas ❑9il
r :n ti � :a . �-. � x
25. Rosf S�'athing �� S �� �� � � v» �` 74jfl,verhead�Hydr�`'� �`
2&��T•Qqr Cei�ing (Stru¢tural) 8t�alerrocoat Y, a1 V �� x 7��p��y �hemical '� T-+ � �
^� ' r ,
27��Framea�ld FlasFfi��ic�; `a x � w'� 7��b�'ry Stan��e �m *, `� C
�� � OQa � tr' Y U7�: *
�:28. Lathin Siding-+�� v: y` ,r a �s � •• ••'� � 7 H FIXED ��9TE1C:61NAfF �[*'
, 29. Insulatt�n o"��` `� ~•• •• � �' � w 7�FIRE PREV. FIt' L M-, d
� a S •• r BE t�tQ! f„ a: ?�
� W
30.Orywall.NaiEngpz r M t-+ �71EALTI�i7DEP ,R.E�NIREMENT
31. Plaster�ow� Coat�s ��,,,,, � �,79'.�FINAL I�ECT�N � O c�
..
327Electricel Power�ate[, Finah V :� N I I :x �,BO:qFOOD C TIFI�RTE 1�96�UED�
��
331Fi I ctr�{. x i a' * M �*� No�s' ia �7C�n ✓� .' r. N �"'.�
� � '"Y �tl.t. !+7 I Q ?K . x �( T ' ✓
;.�34; ,Fir�;l H4 tin & �i�t � o�ditipriyig; :r . > a; �S �ci'x x S Ol7 �/
35 �Firial G, s Ptse�T�� �m '� x H .* � '�S pr`/T `n� �ci"'�y
:[ [� i r- ^ � ... 4= ��.7� h.,� �`,Gj -��
,y36. Ho9d onCanoPYi..�.r. a t[r'7 s rs c^. I .. x � '10 * 1[�
=`� ~ i �[ ` s tn r: : n �� � cn
• 37. FinSl F�tory Fife�ja�Cex ,� �, , . �: (�� /� �o f` �
� � .... w .� r.. - .,�_� (� �-S
H38. Fir�l P{ymbing :g N ' -+ x ( I• R s S �-� x� O
�39. We1@r Service�FiffLl� ` � 'o x i`� * !� /q m x_ C
a � E S_ i x. !t, I . # , �V ��C%`a�� _ ' :S
i�40. Gas SerVfce-�inal x[+� �2t��t� S t tT� � n. O-�� �: .•
:a
3'41. Solar pomeLFicFin�fS C� � •• � Cs �k x• C'v i, M
�-� xc rn * I I Ck .K C�' "70 (T >k 7C �
•� 4258ackflow Prevente . F N x.' �� ^� i '
� N a I . X' 4 ? F • * Cy v-�
43. Backflow �r6�'gatior'F �55 � � � �x R �:;"o Y � "'
s. r x" x> i x. !l
s t� � �
;h44. Lands4ape (i`igatign Systerr,v�q� � :y �,; p t7 p.y' :!: ' N N 7Ct� +k N o
�450Sound Attenuatio� �'s�" r' * �- E"' F" t�� � ^ "'' �'� aN �Q � ~
-� m s. �-+ .. .. C�! x.r. C C ct • F C 'K
�46FHandicap Rqqulati�ns ,y p »��' � y � s p'p � :+;
47SF1��4L STRi1CTUAE & BUTLDING J�/�� �� �� Na�: *
�l'"C . M � cr .r. F
48 jFI�L PLA�NNIN� j i��� x N ' W t•: K �� :r
o49bEldaric Relaese to�Edison i � ' . x � r� � r '7 �
,. �r. •n r: o
:o50�GasJRel�pse to Sou�hern Califpypi� Gas Co ',y'' � I «±: �... t7 • ani t� O •
,051. CF�TIFICATE 0. OCCUPANCV x %. w. � �n�; ;e Y ,. o °+
No. Date
r1
veo�ecr ao
OWNEN'S
Fi'`6TH ST
OSMER
CTRCULA
BEACH
UNIT: '
ANCN/ENGINEFH: 3 1 O 4 3 7-0 7 3 6 REG.NO.:
aooness: DON LEE ClgN411
2501 N. HARTMAN
PEPMITTEE: ORANGE CA 92665
aooxess: �ZTE OAK CONSTRUCTION ( 714 ) 645-6934
833 W 17TH ST 1
COSTA MESA CA 92627
uCENSEO CONiPRCTOB OECupATION: I nereUy allirm that I am licensed unUer prmtions of Cnapter 9(commer¢ing witA Section
7000) ol DiNsion 3 0l i�e Business and Pmlessions CoOe. antl my license is in iNl lorce antl eflect.
ciTr uc.: 0 3 2 2 7 4 sTnTe uc.: 4 2 3��ss�
nrt� i—to-'�7L Signaiur
WONI(Efl5' COMPENSRTION OECLAflFTION: I here afhr ihai I nave a cenilicate of consem t self-inmre or a cenifiwle o1 woneers'
Compmsa�ion Inmrance. or a cetlilied copy t�ereol (Secl n 3800. LaG. C).
raucrxo.: 1200282-92 E%P.URTE: O%IOLI93
comr�xr: STATE FUND
❑ C¢rtilied CopY i5 �ere0y IumiShed. � C¢tlilieU t00Y is ile0 wi[h Ihe ciiy BuilOing Div' 'Won.
Vr
d� �% —/o " iY pppiicam: (i \
E%EMVTION FNOM WOPREBS' COM7ENSpTION OECUflATW Q is section neea irol be completea if ihe permit is for one �unOreO (51 W) or less�.
I cerlity Ihai in ��e DetlOrmante 01 ��e work lOr w�iCh I�is ¢r il is i5Sue0, I Sha�l noi employ any perSOn in any mannef 50 as l0 �ecome
su�lec� Io Ihe Workers' CAmp¢n5alion LawS of Califomia
Dale: SignaWre:
NOTICE II, a�ter making �his aeclaralion, you shoultl become subject lo Ihe WOBers' Compen5aiion pmvisions o� �he Labar
Cotle. y0u mu5i �orl�wii� Comply with Suc� pmvisions Or Ihis Dermif S�all be tleeme0 f¢voketl.
LONSTPUCTION LENOING pGENCY: I hereby allirm Ihai Ihere is a conslmction lenaing apency �or ihe pedormance ol ihe work lor
which this permil is i55ue0 �Section 3097. Civ. C�.
LENOEN:
AOOflESS:
OWNEB BUILDEB DECLPPATION: I hereby allirm ihat I am eKemO� �mm ihe Contracmri State License Law for the followinA �eason
(5¢ciion 7031.5 Business ana Pm�e55ional Cotle: Any Cily ol counly whic� reQuires a permit Io constmcl, alter, im0�a�e, tlemolish, or
repair any stmclure. Orior to its Issuance. also requires the aOVlicant for sucA DQ�mii to lile a signetl statement ihat he/she is licensetl
pursuanl �o I�e O�ovisions ol the Comraciors' State License Law �C�apter 9(commencing with Section 7000) ol Division 3 of the Business
and Professians CoOe� or Ihal he/she is eKempl l�erelrom and �he 6asis for ihe allege0 exemp�ion. Any violation ol Semion 7031.5 by
any aDVlicant lor a Dermil subjeCts t�e applicant to a civil penalty ol not moa ihan five �untlretl Eollars (8500�.
I, as owner af Ihe propeny or my employees win waAes as their sole compensa�ion, will do Ihe wafk, an0 �ne
❑ stmcture is no� in�eneea or ollereC lor sale (Section 7044, Business an0 Prolessianal Code: T�e Contracmrs S�a�e License Law
does nol apply lo an owner ol a pmDerly w�o �uilds or impmves ��ereon, and who tloes such woB himseli/hersel� or ��muA�
�is or her Own employees. pmviAeO that suth impwvemen6 are not inten0e0 ar offeretl for Sale. B, however che 6uiltling ar
improvemenl is sWtl within one year of comple�ion, t�e awner will tuve the burAen of proving �eh�e GiE nat builA ar imD�ove
Ior ine Duroose of Salel.
� I. a5 owner ol ��¢ prOpehy. am exClusiv¢Iy Coniracting with Iicense0 coniractors �o cons�mci Ihe pmlec� (Sec�ion 7044, Business
❑ antl Pmleuians Coae: T�e Cantractors' State License Law aoes nat aDWY �a an owner ot propeM � 6mIAs or improves thereon
ana who contraps for sucA pmle��s wi�h a wniractorls) license pursuant to Ine Contractors' Stare License �aw�. I am aware
��a� pro01 of Iheir Worker'S COmp¢n5aiion in5urante S�ouIC �e pmviDeU Io me.
� I am exempl unA¢r Setlion: B. d P. C.
fOr IhiS reason:
Date: Owner.
1 Jo �ereby ceNfy ��ai 1 am aware of antl unaers�and I�e requiremenis ol Califomia Hwlt� antl Safety Code Sections 25505, 25533, anE
2553d and Itul I or any IUWre builCing Occupani vnlVvnll not (circl¢ one) neeU lo comDN �^t� uiG siate cod¢5 antl ��e r¢Quirem¢nts �or a
Oermil lor can9Ncibn or mOtlilicalion Imm I�e Air Oualiiy ManaAemeni Oisirici. FesiOential construtiion apD�iWtions are eKemO� «�m
Ihese pmvision5.
Uale: pDD�icanl: _
I h¢re0y cerlilyt�ai I �avereaUi�is ap0litalion ana Slale IOaI I�e
ortlinances antl Slalelawsrelating�o builaing conslmction antl herel
pmDeny lor inspection Ourposes. �
Oa el : 7���%'C7 � Siqnalur¢�
orrver's License or Social Seari�y x: ��
ma�ioni5 carrecL I agree�o comply vnlh alld�y antl cowry
representatives of ihis cily to enter uDon Ihe above-mentioneU
Pink—Revenue: Goltlenro0—Assessor
CI'TY OF COS,TA MESA — HUILDZNG PERMIT PERM NO: B 05811;
PERMIT NO: B 058113 PLAN CAECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: S'I'R PURPOSE: DEM
JOB DESCRIPTION : DEMO SINGLE FAMILY RESIDENCE SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000,00 GROUP OCC: R-3 /
COMMENTS; DEMO
**�r+r�r�t+t�**+�+�*�*�t�r�r�r�*x+t**�****��*x***��**��**�**x*x�+��*�t****�r***�*+��+�******�*x*x
2 O N I N G R E Q U I R E M E N T S
ssTBAcxs
------------ 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: 42519115 ZNE; REF NO:
PLANNING N6'I'ES> �
%
iE iF M if if iE iE iF it iE it iE iP if if iF iE IE if� It IE iF if if iF �E IE iF aF iF iE jf iE iF�f �f �1E iP iE N� IF iF iE iE af aF �E if if i� � iF 9E iF af iF if if 3f iE iE it iE iF iE it �F �14 it �ElF IF iE If if i4 if jE a(-
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 HY DATE: �
BUILDING AFPROVED BY � ��D� �-- DATE: " b 7�
APPLICATION ISSUED BY:� ` DATE: ��Z—
ikjfiFiE�fikifiE�k*iFkiFiFihififiEiElEifiE � lfikiEifjf•iFiFif#°1E iFiF
iEiEiEiElEiFif�lEifikiFlF±fiEiki4JfiF3EifltfFifibiEifiEifiE3fiE�lE�1F3EjF#iF3Fk 14 i(��l(-3ffFiEjEifiFN�i4ififiEiflFl4itifil�iF�IFiEifif�iEiEi(�1Ei'riFifififiFlF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG FMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMTT 25.00
SMIP/NON—RES
ISSUE FEE .50
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 25.50 0.00 0.00 25.50 25.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 25.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PlAN—CHECK
25.�0 ,J�
iF IF 1E ik if ik iE iF /E if iE if IF ik iF iE IE fE if iE if iE k 1f iE 1E ib fF iE 1E 3F #� k if if iE 1E iE if 1E iE 1f iE iE k if iE IE 1E if iF k)f if iE IE if iF k k if #f iF iF 3f �f iklE iP jE iE iE iE )F iFiE iE iE 3(�
Z 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
NO FEES WERE SELECTED FOR THIS PERMIT
G: �J1192't9- "1+ ";] -r'- —
O�P_; 0 �.1D�'i_^ 7i1.F. _. �.�u
i 1
� � r
CONSTRUCTION AND PLANI�ING POOL A %
AGPROVALS Permit # , ,'�ate Inspector AppROVALS Permit # Date Inspec2or
t. Temporary E�ectrical Service.or Pole �. ' 52. Pool & EquiPment Location
Soii Pipe�Undrgrnd. 53. Steel Peinforcement
actrical Cohduit Utility-Undrgmd. - 54. Forms
_ ctrical 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.
S. Foundation� -- � 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P�Trap, O Undrgrnd. ��
10. Structural Floor System ' 61. APPROVAL TO DECK
i l. Property Sewer Line & Nouse Connection 62. Backwash & Receptor-Final
72. Sewer Cap . , 63. Heater & Vent-final '
13. Roof Drains ' 64. Plumbing SYstem - f inai �
14. Rough Plumb�ng 65. Electrical�finat
15. Rough Electrical�Conduit 66. Solar System-Final
i 6. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPflOVED FOR PLASTERING
16. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. DuCts, in Structure 70. Underground Hyd�o
22. Dutts, Ventitating 71. Product Piping OGas �Oil
23. Gas Pipe�Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structural� & Monocoat 75. Dry Chemical
27. Frame and F�ashing 76. Dry Standpipe
26• Laihin9 & Sid�n9 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 MeterFinal i,� 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 pomestic-Final
42. Backflow Pre�enter � i .
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation .
46. Handicap Regulations - ' ,
47. FINAL STRUCTURE & BUILDING� _ � ,
48. FINAL PLANNING �
49. Electric ReleBse to Edison � �
50. Gas Retease to Souther� California Ga: Cn �� �
•��
51. CERTIFICAiE OF OCCUPANCY ,
No. Date
Pfl0.1ELT ADOXESS:
OWNEfl'S NAME:
pUOflESS:
H "S`i
uNir:
310 437-0736
ANCH/ENGINEEP: DON L�E PEG.NO.: C 1 O A S I
RODflESS: ZSOI N. HARTMAN uxir:
ORANGE CA 92665
PEHMITTEE: WAITt OAK CONSTRUCTION !%19)645-6939
AODNE55: $ j 3 w 1 7•t•H r�T 1
COSTA MESA CA 92627
LICENSE� CONTBACTOfl UECLAflATION: I hereby af�irm IPat I am IicenseE unGer provisions o� C�aD�e� 9(tammenting wilh Section
7000) ol Oivision 3 ot Ihe Business antl Pmlessions Cotle. anG my license i5 in lull �orte antl effect.
cirr uc.: 0 3 2 2 7 4 sTare uc.: 4 2 3 2 31 cuss: B
� !'/O�rj✓ SignaWre: � ---
WONKENS'COMPENS�TIONOEQAPATION: I�ereOyafirml allhaveacertilita�eOiConSent�o5ell-insureorarertili[a�eo�Work¢rs'
CompensaGon Insurance, o� a cendie0 coDY ��e�eol (Se � 00. La�. C).
POLCYNO.: �,LOOZEL-9Z exr.oaTe: 07/O1/93
comraxr: STATE FUND
❑ Ceni�ietl copY is Aereby fumishe0. [`k Certilietl coOY i �iled wi�h �Ae ciry Builtling Oivisio .
�� �'�Lc �iL pppliwm: �
E%EMPTION FflOM WOflNEflS' COMPENSNTION OECIANATIO . Ns seciu� neeU �rot Ee completee It ine pe it b for one hurMrN (5100� a less�.
I Cetiily Ihai in Ihe OeAormante 01 Ihe wOrk lor w�ith �his i� is iuued. I s�all not employ airy per5on in airy manner So as �o become
5u�letl Io I�e Workers' Compensation Laws ol Calilomi . '
�ale: Signa�ure:
NO710E: II, aller making Ihis tleclaration. you s�aulE Gewme su01e�� �o lhe WaM1ers' fAmOenutbn provi5ions af Ihe La�or
CoOe. you mus� lonnwiln comply wilh sucn pmvis�ons or INs permit sAall be OeemeO revoke0.
CONSTBUCTION LENOING RGENCY: I �ereby allirm t�althere is a consimction lentlinq agency lor 1he DeAormance ol IAe wark l0�
whiCh I�is permil i5 i55u¢U (Senion 3097. Civ. C�. ,�/
LENOEfl:
aooaess:
OWNEN BUILDEN DECUBR710N: I hereby affirm t�at I am exempt imm t�e Conlracmrs' Slate License Law lor the following reason
�Sectiun 703f.5 Business ana Pmfessional COaet Nny ciry ol counry whic� repuires a permit to LronsiNtt, alteL imDrove. OemalisA, ar
reDair any 9mcture. prior to its rssuance. alsa reQuires the aoPlicant lor such permit to file a siA�ee statement tlWl he/sne is litensed
pursuant to Ihe O�ovisions ot �ne Contrac�ort' Sla�e License L3w (Chapter 9(cammencing with Seclion 7000) ol 0ivision 3 ai ihe Bu5ine55
ana PmlesSions COGe) or t�ai �e/s�e is exempi Iheretrom antl Ihe basis lor t�e a�lege0 ezemp�ion. Any violation o� Seclion 7031.5 Cy
any applican� lor a 0¢rmil SUGjeciS �he appliwn� to a qNl penally of �wt more Ilwn IHe hunOreE Uollars �5500�.
I. as owner ol �he prapeny or rtry employees ��� wages as IAeir wle compensation. w01 Uo the xrork, anE ih¢
❑ stmcWre is not intenOeG or all¢re0 for sale (Setiion 7044, BUSin¢55 anA Pmtessianal CaUe: TAe Conlratiars' SIai2 LiCense LaW
tloes not aDDly lo an owner ol a D�oOenY w� 6ui1a5 or impmves thereon, an0 wAo dces such work himsell/hersell or thmuBn
his or Aer own employees, pmviOeU ihat such improvemenls are not mtentled or ottereE lor sale. It, however ihe builtling or
improvement is so10 vAlhin one year of comD�e�ion. Ihe owner will have Ihe ourtlen ol pmving Ae/s�e tlitl not build or imD�ove
for ihe puroose ol sale�.
I, as owner oi ��e propeny, am eKClusiveN coniracling wllh IicenseU canlrac�ors la consimct IAe O�oleci (Section 7044, Business
L� aib ProlessidR Cotle: Th¢ fqnVatlar5' State Lkense �aw Aoes not appy to an wmer oi propeM1y who EuilGs or imprmes lhereon
and who conVac�s for such prolec�s wilh a contracior(5� license pur5uani Io Ihe Conlra[tors' $lale Litense Law�. I am awdf¢
I�al pmoi ol I�eir Worker's Compensation insuranc¢ shoWA �e pmviaed m me.
� I am exempl under Section: B. g P. C.
for inis reason;
Oa�e: Ownec
i eo ne¢6y cenily �nat I am aware oi ana uneerstane ihe revuiremems oi Calitomia Healih antl Safery CoOe SeRions 255Q5, 25533, an0
25594 antl that I or any IUWre huildinp occuDanl wilVwill not (�ircle one) neeA to comply wiN saitl s�ate coaes anJ Ihe requirements for a
permit lar conslmclion or modilication imm Ihe Air Ouality ManaAement Dislrict, flesitlential wnsimclion applications are exempt imm
�ACSC pf0vi5i0nS.
Oa�e: Applicanc
I �ere�y C¢iidy Iha� I �ave reatl I�is ap0licalion antl slaie I�al IAe abave in�ormalion is torfetL I aBree l0 tomply wil� all tiry and Counry
artlinancesantlslatelawsrelalingloDuildinpconsimc�ionantlp e�yau�honzereprEsentaliueSo�IhiSci�yloenierupon�hea�ove�men�ioned
pmpetly br in50ection purposes.
p� 7�l0'4� SignaWre:
�river'S License ai Sociai Secunty M:
Pink—Revenue�, Galdanrotl—Assessor
PERMIT NO: P
�.U'Jbb /;/ � fi' / / J
CITY OF COSTA MESA — BUILDING PERM_TT PERM NO; P 058114
058114 PLAN CHECK NO: N GOVT; N SUPP; N
CONSTAUCTION TYPE; V-N PERMIT TYPE: PLU
JOB DESCRIPTION ; SEW CAP FOR DE,NO OF SINGLE FAM RES,
CI.AIM VALUE:
CAiC—VALUE:
PURPO�E: OTH
SQ FT;
GROUP OCC: R-3 /
COMMENTS: REF: BSf3113
x******+rx**�+r�r�t*�c��r+c�****�t*�tx�+��+����**��*�*�*��r***x��t��rat*v�*��r****�t*u*��cx*****xx
Z O N Z N G R E Q U Z R E M E N T S
S E T B A C K S
------------ MAIN H[7ILDING ---------- --------- ACCESSORY BUILD�ING ---------
FRNT: F7' IN REAR; FT IN FRNT; PT IN REAR: PT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: '-'FT IN
PARKING REQ• FROV; PARCEL; 42519115 ZNE; REF NO; .
PLANNING Ni3TES>
i
iE if iF iF iF 1k 1F fE k iE if If 1E IF if �lF jf if IE iF )f k iF i! iE iFiE �f� if iE ik iE it iE if iE )f if if if if� iF 1E if if iF if 1E iF iF ib 3f if if �le iE iM1 iF iE jF if fE if if iF iE aE �IF iE iE 3f iE 1f 3f �lE � 3F if lE
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 i S
ZONING APPROVED BY DATE:
BIIILDING APPROVED BY : DATE: /
APPLICATION ISSUED BY: c DATE; �GQ �Z
ifiFiEifiElEii3kiEiElfiE�kiFiEiEifiFlEiFlfiE'3FiFiFii i � t . �iFifiFiFif�jF�lFiFiEifiF��C���iEj(�
�fiEiFiEiflFiflEif�1(-iEififitiE�lEif#f�lfiEififi(�iEiEifiFlflEii�iFiEIF1h1E#iEiE�IE fFi41E1FiEaf#�iF�(-�iiEific#cM�iFiEifffii�iEfEiF�EifiEiFieiFififjF�lhif�u�i!-if
LEGALZ'LATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 2,00
258 �-` � SMIP/NON—RES
PLAN �� "
ISSUE FEE 3.00
BUILDING—DIV—> PERMIT ISSUE �i,AN—CH£CR TOTAL PAID DUE
TOTALS----> 2.00 3.00 � 0.00 5.00 5.00 ,00
<'
REVENUE DIVISION TOTALS--> COL'lECTED: 5.00 O�'ER/SHORT: .00
BLDG FMT PLUMBING EI�ECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
5,00 ',
iF 1f iE iE IE 1E IE iE fF if if iFdE iE 1E 1E iF iE iE iF iE !F iE If iE ic iF if iE i6 if iF 7E iE'if iE iF if 1f iE iE if ik #f If iE iE?f iF if af� �E if iE iE 1E af iF iElF it� iE � iF if jE if if If iE iF?f }_. iE � jF if 14 i!�
I N D I V Z D U A �L F E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N ONIT COST TOTAL COSI'
i� �
FLG 1 SEWER CAP / DEMOL11'ION EACH 2,00 2,U0
;;r�T3D OF FEES
CONSTRUCTION ANDPLANNING
APPROVALS Permit�
1. Temporary Electrica� Servicenr Pole
2. Soil Pipe•U�drgrnd.
3. Electrical Conduit UtilitY�Undrgmd.
Electrical Conduit-Undrgrnd.
.i Steel Reinforcement
�6. Electrical UFER Grnd.
�,
7. Footings �
„ B. FoundatiOn
9. 4Vater Pipe�Undrgmd.
'0. Structural Floor System
17. Property Sewer Line & HouseConoection
12. Sewer Cap
73. Roof Drains .
lA. Rough Piumbing �
15. Rough Electrical-Condu�t
76. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Geiling
19. Rough Heating & Air COnditioning
20. Rough Factory Fireplace .
21. Ducts, in St�ucture
22. Dutts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structuraq & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywali Nailing
31. Plaster Brown Coat
32. Electrlcal Power Meter�Final
33. Final Electric
�34. Final Heating & Air Conditioning
'35. Final Gas Pipe�Test
36. Hood or CanopV
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Finai
�41. Solar pomesticFinal
42. Backf�ow Preventer
43. Backflow Irrigation
44. Landscape Irrlpatlon System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE &��$
.t7Md
48. FINALPLANNING r
49. Electric Release to Edison
50. Gas Release to Souihern California Gas Co
51. CERTIPICATE OF OCCUPANCY
Date
ruu�r. �
Inspector pppROVALS Permit# Date I
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test�
57. APPROVALTOCOVER-GUNITE
58. E�ectrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-7rap, O Undrgmd.
61. APPROVAL TO DECK
62. Qackwash & Receptor�Final
�� 63. Heater & Vent•Final
64. Plumbing System - Final
65. Electrica�-Final
66. Salar SYstem-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOLlSPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping C Gas ❑ Oil
72. Underground Flush
73. Undergmd.StorageTank OGas OOiI
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
� - HEAITH DEPT. REQUIREMENT
�
., 79. FINAL INSPECTION
� S0. FOOD CERTIFICATE ISSUED
, Notes: j �,y�qj� No� �EAo'f" C�Fe.J
\+ � � S QZi
� l hbv- �y- c,�€.o
y�-zi-Q� r��� �?��:- �<�'T�
0
r
PflQIECTRDUPES°.<�I� jB4 E 16'PH ST
owFen�sxnrn¢: JUDITH OSMER '
pD�NE55: SSS VIA CIRCULA
' REDONDO HEACH
.�
UNIT:
• 310 437-0736
'APCM/ENGINEEfI: DON LEE flEG.NO.: CSO�I11
nooness: 2501 N. HARTMAN uxiT:
ORANGE Ci9 92665
PERMITTEE:WHITE OAK CONSTRUCTION (714)695-6934
� ADONE55: A 3 j W 1%TH S T 1
COSTA MESA CA 92627
IICENSEO CONTMCTOfl OECLAMTION: I tlere�y allirm IAa� I am IicenseA un0er provisi0ns of C�apter 9(commencing wii� Seciion
7IXq) ol Oivision 3 0l ihe Business ana Vroleuions COde. antl my licenu is in full lorce ane eflect.
cinuc.:C�032274 sTn,euc.:42323 cuss: B
Date: / ��� � Z' Signawre: _ �
WOBKFflS' COMPENSRTION DECIANATION: I hereby at�i t a� I have a certilitate of conse to sell-insure or a certilicate al Workers'
ComDensatian NSWdaCo a( �teA��ipd oppy Ihereal (Secli �. �ah. �� � O S/ 9 3
PoLICY NO.: 1 L V L L 7 L E%P. OFTE:
comraNr: STATE FUND
❑ CenilieU coDY is hereby IurnisheG. � Cenilied coDY is filetl wi�h Ihe ciry BuilOing Division.
.e: ���—� L ' APClicani:
E)IEMPTIONFAOMWOHNEBS'LOMPENSR710NOECUNR710N. i5seclionneetlna�becompleteOilthepermitisioronehun4reU�510�)o�less�,
I cetlily I�at in Ihe perlormance of �he woB for w�ich Ihis p il Is issued, I shall not employ any person in any mannet so a5 io Oecome
su�lec� to Ihe Workers' Compensation Laws ol Cali�omia. �
�a�e: SiAnaWre:
NOTICE: II, allei making �his tleclara�ion, you should become subjeci to Ihe Workers' Compensaiion pwvisions of 1he Labor
Coda. you must lonnwlih comply wilh such pmvlslonsbrtMs permit shall be OeemeU revokee.
CONSTflUCTION LENOING AGENCY: I hereby allirm Ihat �here is a wnSVuction lending agency br the periormance ol tAe work lor
w�ich I�is permit is issued (Section 3W7, Civ. C). "
LENOEfl:
aooRess:
OWNEB BUILOEB OECIAflRTION: I �ereby allirm Ihat I am eeempl �rom IAe Comrac�ors' Slate License Law for the following reason
(Section 7031.5 Business and Professional Coae: Any city of counly which reQuires a permitlo consimct,alter.improve, Oemolish, or
re0air any siruclure. prior to its issuance. also requires Ihe apPlicant lor such permit to file a siAnetl statement that he/she is licensed
pursuanl Io Ihe D�ovisions of Ihe Conlractors' State license Law (CAaO�er 9(commencing wiih Seclion 7000) ol Division 3 of the Business
anU Ptofessions Cotle) or ihal ne/she is eKemo� ��e�eimm ane ine easis for tne allepetl exemption. Any violation of Section 7031.5 6y
any ap0�icantior a permii suUlecis ihe apPlicant to a cidl penalty ot not moie t�an five hunEred dolWrs (5500�.
I, as owner oi ihe D�oDeny or my emptoyees wiih wages as Iheir sole compen5aiion, wiil Eo ��e work, ana �he
❑ slNCWre is nal inlenAeA or offered lor sale (Section 704a. Business ana Pmlessional Cotle: The Conlractors' State License Law
Aoes no� apply lo an owner ol a D�ope�y w�o 6uiltl5 or impmveSlAereon, antl who aoes such work himsel�/herseli or �AmuAh
�is or �er own employees. D�oviAeO that suc� improvemenis are not intentle0 or alleretl for sale. II, �owever the builAing or
impwvement is 501E vntnin one year ol compleiiun, Ihe awn¢r xill have Ihe huraen al proving he/s�e Gid not Luila ar imD�ave
Ior Ih¢ pwpose 01 5ale).
I, as owner oi Ihe Dropeny, am e�clusively comraclinA wilh Iicense0 conVacmrs m conslmc� Ne pmlec� (Sec�ion 7044, Business
J antl Pmfes4ons CoOe: The Cantractors' State License Law Aoes not aD7N �o an ovmer oi properry wtw �wl0s or impmves thereon
anA who wmracts lor such pmjec�s vnt� a contractoqs) license Oursuant to l�e Caniractars' State Laense Law�. I am aware
t�al proo� of IOeir Worker'S ComDensa�ion insurance 5h0uld Ee Dmvide0 la me.
� I am exempl unAer Seciion: B. 8 P. C.
�or Ihis r¢a5on:
CZTY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; H 058863 PLAN CHECK NO; 02581-92 L
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR
JOB DESCRIPTION ; NEW SINGLE FAMILY DWELL, W/ATT. CARPORT
•7 ••,• .•.���
.�
SQ FT; 1,833
CLAIM VALUE: 80,000,00 CALC—VALUE: 108,646,80 GROUP OCC: R-3' /M-1
COMMENTS: NEW SFD W/ATT CARPORT dOLD FOR SPECIAL REQUIREMENTS
�r*+t��r****+r*x�***�**�**x��r�r***x�r��x*xx�*�*****�t�*+r*�+r�r**�x�t�*�r+�*�r�*�**�*���e� �t*��***
2 O N I N G R E Q U I R E M E N T S ��M '
sETaAcxs �.;__
!
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING -�------
FRNT: 20 FT IN REAR; 11 FT IN FRNT: FT IN REAR; F.T.� IN
LEFT: 36 FT IN RGHT: 5 FT ZN LEFT: FT IN RGHT: FT IN
PARKING REQ• 3 PROV; 3 PARCEL; 42519115 ZNE; R2 REF NO: DR;92-22
PLANNING NUT'ES> DEMO EX RES AND REPLACE W/ A NEW RES, PKING SHOWN ABOVE FOR
***�****��r��r�*�****��tD**�****�r*��r*x�******B*��r********�***+t*�t**��*�r*x ��v���r*��t�t*
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: : . , / 92
BUILDING APPROVED BY : C DATE: / 92
APPLICATION ISSUED BY;• DATE• , �-�
��������*�*��,���,���*�� ` ' �*�*�,����� 2 �
�EitiFiEltfFiEiE±EiFiE1FiE3F3fik3FifiF3EiE-1fiEiflEifiEiEifffjFiEifiEiEiElFiEiE iFiEifiliF�EiFiEiEiEiEiEit�fiElElEiEiEik�EiFiEikiEikiElElFiFdEiE9E1FiEiE1E
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 671,00 10,86
PLAN 436.15 :t: _ ,.. �SMIP/NON—RES
ISSUE FEE L> 1 �-'�•=�`X;\i_
BUILDING—DIV—> PERMIT ISSUE PliAN—CHECK TOTAL � r.PAID DUE
TOTALS----> 681,86 0,00 `" 436,SS , 1118,01 �1118;015 .00
m _, 1 . � .
REVENUE DIVISION TOTALS--> COL�ECTED; 681.86 OVERLSHORT;�t� 00
BLDG PMT PLUMBING ELECTRIC MfiCHANIC FIRE SMIP/TOT'1 GR'ADING PLAN—CHECH
671 .00 ,� „ 10. $6 , •
_ • �.�
3liE iE ik iE iE iE if iE iE k �E 1f if �f fE iF iE fE k iE iF 1E iF 1f �ElF iE �E iF k!E!E if� iE iE 1E iE iF �f iF if if ik i61t if iklk fE �ElE iF if iE fF if 1E iElFlE if 1Eif.it 1F �F iE1F k k iF iF iE IE if IElE
I N D I V I D U A'L F E E B R E A R D O W N `��
TYPE QTY D E S C R I P T`I-b N "" UNIT COS}T � TOTAL COST
Date: Owner. SF'R
I tla hereDy ceriify I�at I am aware ol anE unEerstanG �he repuirtmenis ol Calilomia Healt� an0 Salery Code Sec�ions 25505. 25533, and S FR
2557a and l�al I or any IWme 6uiltling occupanl will/will nol (circle one) neetl b com0ly wii� saiU slate cotles antl ��e re0uirements �or a
peimit br conslructian or moailication irom I�e Air Oualiiy ManaAemenl DiStrict. fle9Cential Conslmciion apDliwlions are exemp� imm
inese pmvivons.
Date: Applicant:
I hereEy cenily Ihal I have read Ihis apDlicalion antl slate Ihal Ihe above informalion is corBtl. I agree [o comDty wiN all ci�y an0 counry
o�0inance5 and siale laws relating �o builtlmg Con5lmciion anU �ereCy autllorrze repre5eniative5 of �NS ti�y �o enter upan the abwe-mentione0
pmpeny lor inspec�ion pwpo5e5. ^
Oale: `��—�L $ipnaWre: /-'I/.�/�i�
Drivers ticense or Saiai Secmi�y x:
; t6at-a6 Wn�te—Bwlainp; Green—Cotle Eniorcemem: Lanarr—Molicanl: Pmx—Revenue: GMtlenrotl—As essnr
1377 DWE—TYPE V—WOOD
956 RES—CARPORT
FRAME
�.�ND OF FEES
��
r.�
ti
h
—GOOD 74 , OO�I
14.80
101,898,00
6,748.80
I CONSTRUCTIOI'v AND PLANNING POOI E 1 ,
APP,ROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
Y �
7. 4emporary Electrical Service or Pole . 52. Pool & Equipment Location
, 2. Soi� P'rpe•U�drgrnd. 53. Steef fleinforcement
�} � 3. Electrical Conduit Utility-Undrgrnd. _ 54. Porms
4. Electrical Conduit�Undrgrnd. �/ (?'y Q� 55. Electrical Bonding
I5. $teel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7: Footings � 58. Electrical Cpnduit-Undrgmd. -
B.,Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgmd. . 60. Backwash Lines, P-Trap, C Undrgrnd. ��
10. Structurel Floor System ��j¢y.e� 61. APPROVAL TO 6ECK
11. Property Sewei Line & House Connection �f 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Pinai �-
13. floof Drainz� _. 64. Plumbing System - final
14. Rough Piumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Finai
76. Rough Electric Wiring 67. Fencing & Access AnProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA $YSTEMS FINAL
19. Rough Heacing & Air Conditioning FIRE DEPT. REQUIREMENT
r
20. Rough Factory Fireplace • � APPROVAL"S Permit #
21. Ducts, in Suucture . 70. Underground Hydro �
22. Ducts, Uentilating - 71 . Product Ptpinq LO Gas C� Oil
23. �Gas Pipe�Rongh & Test . � 72. Underground Flush �
24. Roof Framing �� � ' � 73. Undergrnd. Srorage Tdnk � Gas ❑ Oil �
25. Roof Sheathing �` (d/R�c�7i .Q�. ' 74• Overhead HYdro:
26. T-Bar Ceilin9 (Structural) & Monocoat t 75. Qry Chemical .
27.. Frame and Flashing �OI�y.� �Z: D� 76. Dry Standpipe -"
- l- `\-
28. Lathing & Siding `e �� :P� 77. FIXED SY�STEM FINAL
29. Insulation l0 � qy �J,'�.-- 78, FIRE PREV. PINAL -
30. Drywall Naiting � i HEALTN DEPT. REQUiREMENT
31. Plaster Brown Coat /� 79. FINAL INSPECTION
L/_9� 4�
32. Electrical Power Meter-Final I S0. FOOD CEflTIFICATE ISSUED
33. Final Eleci�ic � j'I . Notes: pOLD FOR SPECIAL REQUIREMENTS
34. Final Heating & Air Conditioning . .
35. Fina1 Gas Pipe-Test � � ' ' �
j� .
36.'Hood or Canopy ` 1 � �
37. Final Facto�Y Fireplace �
38. Final PlumUing , � � _ - O4�=f=���-
39. Water Service-Final ' i � � .
I
40. Gas Service-Fir� � � , _
�
41. Solar pomestic�inal i ,, } -
42. Backflow Preve��er � j- i"�p�'1 �
�i
43. Backflow Irrigat�'ion -�-_� Cl� �
44. Landscape Irri� STion System '�
�t�0.-.^"o`°xQ -
45. Sound Attenuation v
46. Handicap RegUtafions ' �
47. FINAL STRU ;%URE & BUILDING - /L/� � �
48. � � iv.... " . ^ S � t�t�-l� 1-i ��� Y
49. Electric Releasr�o Edis , � � , �� _ ,.
50.�Gas Release to �uthern California Gas Co � ��� j �� -
51, CERTIFICAT�OF OCCUPANCY
H-
No. Date
PEi: t r ' S2 1�J � 15 F 1 SCHM I D LH-F'Oh1i�FlH PRGE . OL 1
���'�•rzss�Z , �I�'Y OP �USi'� hi�.5� J � � .
�,cgx d �>y gJi S'�3S i
CAUIORM1I• 9Y630'�SCn a•O.AOXIMO
ti.s `
lnsulation Ccriificate ' �
{.
�F1'`� �, /6 � 5T. ___�__ �oS%s r��S�' �, CsL/�. .-- �
NumSc c�d Sore� C;:Y
� �la �
Co;enry '
RtSOF
Materi2l
Thldr.,ess (inchrs)
� Subdiwirim
�lescrip4ion ofTr�statlatiun
/ �kiER(Ok tt"A,i.L
*��ry� Piberglass� Batti.ng
7hicknessl;ncfxs) ' 3�" �..- --,- - - .
i.oc Nwnber
srmd Nart�e _ _�_
'Itkrrra! Rasis�r� (R^Value) _^.
BrzndName�ens Corning Piberglass
ThCmt3lResiszanCk(R.Valtr:) R-� 1 ___._
✓' C�Q.I?�IC ,
$mt ot $lanket Type ��t ' Braad fva.'neOwens Corning Fiber--.r_l�s
T1:ickr::Ss('u�i�e5} 6�� _ 'I�ertnalResis�tance47i•Valuc) R-19
Laose fiu, Tv�c ��" � T_.,, BrandName N�A -
Contz�tor's r,.iztimum inztal.ied weighr/h' „nra 1D 3atinimum thiCbTess�-�i�tchts
A{anutac,�cr's inr,alied wei�f+t (�tr square Caai to BCheire 7hG77�a1 ReSiStariCe {R-Yalue)
tL4!SED i-7 t:r1f�
Nia�riaV .. --. ___.__.. &randi3azne
Titi<kness {inehes) ---- _ --- Thenna} Resistan;z (R-Vaiw) _._.�
SL.AD 1-Y.pU i
h�'slEY4R�
't�icb�ress (inthcsl
�'idth ��tr hr,� _.. _
FnLT?�'DA710N WAY.,t.
Ma�rrial
Thitlrnex� (incFws} J
Brand Name .__ . _
"ihem�al Resinaz�ce(k-i%31ue)
Brand :`iam•
71i27F1731 RCSiSL311Ct(R-Vauw)
�C'C�?e.P'a�E�U}1
2?kreby certify ;har the a�ve insuIarian w'as ina2aUed in che buitding.at the above locapan in oaaiotit�arrce with
Ut" cturen[ Building Energy �fficienCy Standanls �or ncw resdentiai buiidings concaiRed in Ti�le 24 of the
Ca7rJomia Adminisrrative Caic. •
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—p Gnic
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4�....i(.4.__ .-- `j � C�e. l.E; ..:= Z2 i 317 C2
�^��t-Sub-2��uor � uiuion IrsWller) � �eree h7�-7%act ' _
Dovc� 5utherlcnd, Estimator C�� i' • �%
_..._. ,. . „ �vr - �... _—' _ '_ _ _ .. . . _._...�-� _.---�.
S:gn.:w+_ ard T;tlt -- f7ar
, _ - ,., ,,. , , , � _ �=,+ r��Tr��
,i-;,�----
. . . . , ... . • ,.
-- "` CITY OF C�A MESA
DEPARTMENT O LIC SERVICES
APPLICATION AND PERMIT FOR WORK DESCRIBED BELOW
VENDOR NO. U_� %�O.S
Address or Location of Work
Type of Work to be Done _
� �. /(osN 5%. . Cv57H i1�5A
�r
NO. �i6��1 "
Date 7���-�t'
JW"r_' � - OC /• f
Start Date Permit Not Valid ANe� (Expiration Date) Plan No.
Contractor's Name iNyl» G�K L'b��Si .—� p,ddress k33 w. /� � 5� � ��S1A ii�.SR
Telephone No. (Day) G��� ��!?Y (Nigh�) �s' &SZ/ Ciry 8 State 1-05yA i%�£SA, r4c 92 L2 "I
State License No.IClass "� yi ? Z 3� City Business License No.
Applicant'sName 7����5 W GKf% Address �3? W• �7{� $� �� �'OSrA i��`Sq
Telephone No. U�� - ��3 y �� � Developer's Name ������ �r CWST. Telephone No.
Name of Insurence Co. Insurance Cen. No.(s)
24-Hour Emergency Contact ���" OK7�/ )� b�/ S brS2 � Telephone No. 7��� &S� �SZ �
FEES PERMIT APPROVED FOR CITY ENGINEER
Bond 3 48 HOURS MINIMUM RE�UIRED C�� ��'� �
Casn oeposit S U A"— FOR PROCESSING PERMIT BY
Issuance $ � -� , Date � I � � � j 1
Account q (� J J U
Inspection $ � h)
�AL a ��— Underground Service Alert ID No. ��
Permiltee shall contad the City Inspeclor's ottice (7543035) at least 24 hours prlor lo cnmmencing eny work. FaiNre lo obtain proper inspeclions prior ro cammencemant at work
may be cause for its rejeClion. TNIS PERMIT WITH APPROVED PLANS MUST BE ON THE JOB AND AVAILABLE TO CITY REPRESENTATIVES AT ALL TIMES. You ere guiCBA
by MUMcipal Code Sectlons 1.33, 1525, 1527, 1527.1. 1539, end 15-48.
THE UNDERSIGNED PERMITTEE FIEREBY CEHfIFIES:
1. Thet all work ehell be perlorma0 in eccorCence with t�e StnnAerC Specificetlone for Public Worka Constructlon (latest edition); Stantlartl Drewings at I�e Ciy
ol Caste Mesa; special egenry provisions; end ell epplirable laws anA ordinances.
2. Conirol ot�ireflic shall conlorm to the Work Aree heHic Control Mandbook (W.A.T.C.H.) (Latest etlition). The parmittee shall furnish antlbr install all signs, lights,
barrica0es, trattic contml or warning tlevices, flagmen and flashing errow board The permittee shall o6tain approval of tha Bansportation Services Engineer tor all
siraet closures, detours, turn restrictions, perking prohi�itions entl methoAs af eccommoAating treilic. T�e permitlee shall notity Emergen�y, Fire antl Police services
antl resitlents ar businesses Iwenry-lour (2a) hours in etivence ol eny access limitetion or tretlic restnclions.
3. That e maximum ol�{ane�s) mey Oe closetl if necessary to peAorm rrork within the public rigM af way tluring the hours of 8:30 e.m. - 3:30 p.m. Montley
t�roug� Fr1Asy as IonB'es Iratllc can Ge meinteinetl in each tlireclion with Ilegmen unless otherwise a00�'� �' Ihe Bansportetion Services Engineer.
4. T�al Ihroughout all p�eses ol mnstruction the wOrk site s�ell be kept clean antl tree oi rubbis�, tlebris entl Aust end drainege shall De maintainetl.
SUBJECf TO TNE NOTES BELOW:
a
a.
5.
6.
7.
B.
8.
10.
fl.
12.
ia
14.
15.
7&
City will provide inspeclion between 7:30 a.m. and 3:00 p.m., Monday - Friday (except on City observetl Mlitlays)
Prior ro plecing Portlantl Cemant Concrete or Asphalt Concrete (A.Q), the tollowing will have been inspecletl anA approvetl; native O antl importeA ❑
subgrades and forms O. Flyash is not allowatl as e cemem substitute.
Curb end gutler shall not be removed on the day prior to a weekentl or e Ciry oDservetl �ollaay.
Fill in e�ees left by curb an0 guner remaval tlush wit� t�e adjacent pavement on �he same tlay �hat removal occurs.
Bare untler ell streets, curDs enA gutlers, sitlewelks, crass�gutters Bnd driveway epproeChes. Tunneling is not allowetl.
Open e:cavations must be hackiilled or plated wi�h spikes end A.C. lacked amuntl etlges tluring non-working hours.
Sitlewalk shall be mnstructed per City oi Costa Mese Stentlartl Drewing No. .
Drivewey opproech shnll be constmded per Ciry at Coste Mesa Slantlartl Drewing No.
No traNic allowa0 on wncrete tar minimum of seven days lor aring. Sae IraHic Control above.
Trenc� campaclion entl resurtecing shall cronPorm ro Ciry ol Coste Mase SmnEard Drewing No. 813.
Trenches enceading flve (5) iBat in tlepi� require e permit Imm the Division ol Inausiriel Selety, Stale oi California.
Perminee s�all pay for all S.E., compaction and materials tests Aaematl necessary Dy tha Ciry.
All tranches shall De permenently petCh00 wiihin tan (10) Oays of completion ol work Uelaw subgra0e.
Permittee shall prm�i0e iha Ciry vrith remrd tlrawings af petmitteE xrork belore finfll inspeclian by t�e Ciry.
Perminee untlerstands antl agrees to ihe �old-�armless agreement required by CMMC Section 15-Z7 antl printed on the reverse of this application.
Ot�er:
NOTICE: Conirattor must natily the following Utilily Companies Iwo xrorking Aays before sterting work:
Coatn Meee SenlMry Olairict Mesa Conaolitletetl Water Dlatrlct UNDERGROUND SERVICE ALERT
(714) 631-1731 (/14) 831-1Y00 Toll F�ee - 1-800-4YY-0133; Afler Hours 8 Nolitleys -(71C) 739•3031; (213) 6Y7•3111
INSPECfION RECORD Inspector of Recrords CERTIFICATE OF INSPECf10N
Date Remarks � hereby certity Ihat Ihe street work
allowe0 by this permit has been con-
stmctetl acmrtling to tha plans ana
spedfications antl I hereby accept Iha
work in this manner. �
8y:
Ingpenor
Dalo
o,e3ez.,�,.,Ao I certify I hav/e� re d and understand all of the above and that all statements made are correct and complete.
wnna . msoecwrs: : �/I,j/�/j/V �� ,� /0 '92-
Canery-EngineeA�g; ANU�
Pink � Financa: - '� � Applrcant§ Signemra Oata
GabenmE - Applicam
3 COPIES OF SKETCH�OR PLANS ARE REOUIRED PRIOR TO PERMIT ISSUANCE 03 OD1A`%73o• f�1191S4 '1T C.0 �' 1'7,Q��
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED AND VALIDATED ��7E: ��7iI,�,/9; lY'.�7 J,'.•^�
Sec. 15-27. Form of application
Applications for permits required by this chapter shall be filed with the city engineer upon printed forms
to be prescribed and supplied by him. The application shall be signed by the applicant and shall state:
(a)
(b)
(c)
(d)
(e)
The name and address of the applicant.
The location, nature, purpose and extent of the proposed obstruction.
The time during which it is estimated that the excavation, fill or obstruction will exist.
That the app�icant, if his permit is granted agrees to indemnify, protect, defend and hold harmless
the city, its elective and appointive boards, officers, agents and employees from any and all claims,
liabilities, expenses or damages of any nature, including attorney fees, for injury to, or death of,
any person, and for injury to any property, including consequential damages of any nature resulting
therefrom, arising out of, or in any way connected with the performance of the work for which the
permit is obtained by, or on behalf of, the applicant, including damages resulting or allegedly resulting
(a) from concurrent, but not sole, negligence by act or omission by the city, its elective or appointive
boards, offiCers, agents or employees in connection with supervision or direction of the work and
(b) from violation of any statute, law, regulation or other legal requirement concerning a safe and
healthful place of employment for workers.
That the applicant agrees that if any tank, pipe, conduit, duct, tunnel or other installation of any
nature or kind placed in the excavation, fill or obstruction for which the permit is issued shall at
any time in the future interfere with the use, repair, improvement, widening or change of grade of
the street, the applicant, or his successors or assignees, within ten (10) days after receipt of a writ-
ten notice from the city engineer to do so, will, at his own cost, either remove such tank, pipe, con-
duit, duct, tunnel or other installation, or subject to the approval of the city engineer, relocate them
to a site which may be designated by the city engineer.
(f) That the applicant has read, understands and will comply with the city standard specification manual
of warning signs, lights and devices for use in work upon highways.
(g) Any additional information which the street superintendent may deem necessary for the proper
disposition af the application. (Code 1960, § 7202; Ord. no. 66-9, 3-7-66; Ord. No. 80-2, § 2, 2-4-80)
Sec. 15-27.1. Insurance requirements.
(a) The applicant shall maintain at all times when performing work in the city right-of-way, appropriate
insurance policies, as stipulated in section 15-27.1 (b) and (c), covering workers' compensation and
public liability and property damage.
(b) To perform Glass B permit work the applicant shall comply with the liability insurance requirements
described in Section 7.3 of the current edition of "Standard Specifications for Public Works Con-
struction" (5ee section 15-2.) In addition, the insurance coverage provided to the city shall be primary
and not contributing with any insurance maintained by the city. CeRificates of insurance and any
other reque5ted evidence shall be provided to the city for its approval to show compliance with these
insurance requirements. No public liability and property damage insurance is required for a Class
A permit.
(c) To perform either Class A or Class B permit work, the applicant shall submit a certificate of insurance
to verify workers' compensation insurance coverage. (Ord. No. 80-2, § 2, 2-4-80).
Supp. No. 26, 2•80
FINAL GRA�ING CERTIFICATION
Project Address: �`� �' �V� `��• � ���Ta MG��
Lot Number:
Permit Number: � �5�����-''S�'�"
By Civil Engineer:
I certify to the satisfactory completion of grading in accordance w�ith the approved plans,
specifications, local and state codes. All drainage devices required by the grading permit,
grading plan and grading ordinance have been installed. Adequate provisions have been made
for drainage of surface wa[er from each building site.
` The minimums are:
2% Fall from structures within 5 feet from exterior w-alls.
1% Fall for asphalt surfaces and landscaped areas.
0.5% Fall for concrete surfaces to approved disposal areas.
The final monuments as shown on the recorded tract map were set. All final grading eleva-
tions are within ± 1l10 of the de�ned elevations.
Supervising Civil Engineer � � Reg. No. C ����
_ (Signaturc)
Date �2"Z�"�'�
�ED ARCy�
Uk�� ��PL� R, � �',�
� a° ``�m a
� No. C ioa�i �
cP REN.�L=� Q-
9T Q?�
�a�\FO
STA� and SIC�1
t89i aG
)
CERTIPICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA IJNIFIL�D SCAOOL DISTRICT
Developer/Applicant: ��T�i �K C(,YU$7�UG7"(O�
Address: 033 �(i, �7�` S7 �/ �$T�¢ /yl�A-, e.9-L �'ZL�1,�
Telephone Number: 7�y �Y� �`�1.3i�
act arc d—Lot Number(s):
Location of Proje'ct
Number of Square Feet
Residential Space
Number of Square Feet
Commercial and
Industrial Space
3�5' ,�, ib'� s>. ���- r��s�
of /%3 7 7
g � x $1.50 Total � �
of �397
x $0.25 Total
Commercial/Industrial Project is: (Check One)
Mini-storage
Movie Theater
Racquet/Health
Warehouses
Heavy Industrial
Regional Shops
Light Industrial
Motel
Bank
Neighborhood Shops
R & D
Hotel
_ Medical Office
Office Park
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
I'ast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995.
Chectcs are to be made payable to Newport-Mesa Unified School District.
� \ \
»usiness M�nager
Newport-Mesa Unified School District
The above representation as to square footage is true. Developer/
Applicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the appropriate City/County shall be notified.
Date: 9��'�%Z GvN"�!N �ES, u1/ltr� OA-k
e eloper/Applic nt �,pSr
e
sou. �cxw.vics
W A L L�i C E`' . N E L S 0 N R C. E. , FOti\'DA� � SPECT ONS�YG
� GEOTECH.YICAL ED7GII�'EERING CONSULTlNG
Cf�_ (3
NOTICE OF FOOTING EXCAYATION INSPECTION
,o� Lo�T,o,,: OSM�l2 P��P�'T Y� P,��A3',E.Z i�7�i� R�S,
���L �. �ti T`'` �� rr��.� 1SasS.ti. CQ.
9�-- t7�� ' "
wORK OaOEA Na: �
OrqER Oi! CONTRKTOR: �tll � L%� C_OfS�.S/-,�G LJG�rtI Q
-r
O�mEAS AOOiiEi
O.�.TE:OOTI„GStn.SPECTEO {i�l�[i��%�-� 6�{!� L�i �l7G.
T9T�l �BER Oi FOOTNGS OR�M35QfIS ��I!1 �o�%'l�lUBt� l�aC7TlNc�S
�� Nlv�A�� /L� ��/1�t� <Tis� u2I / �/ �fP /^n� �al �?nfi
�' � ���Ol.�..��D !�c,,Dif�l»d/!Q'✓ f [/91'V S • ,
7ESCRIPTOM Of f00 N OR GISSONS CO�EAED•BY nns wonc�:
.dl.� �T1r-S'. �is�l��OtvS lu.� letl rA�'c/'�� ��.�O��J �
Ct
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��N wr� �a��M�i is KCYaa�s� w�h ayr /�ce�rwrni�nons in �h� On7i�winm (oun�n��n rrp�rr �n� eF� �:Ninq [od• /// �
J i _ e _ . . _ . . � � 4/ (r.�
e
25512 WILLOW WO00 STRF,�T EL TORO, CAUFORNIA 92630 (714) 770-8898
" ('14) 770-2717
SOII. 1fECFIA?1IC5
tiV A L L A C E r. N E L S 0 N�. �. �. -- Fo`�StiE Ik SPECTIONS�YG
GEOTECHNICAL ENGII�'EERINC CONSULTSNG _
NOTICE OF FOOTING EXCAVATION {NSPECTION
,o� ��T�o,,: OSJL�I,�l2 P�'�l�.�t'%'Y - P��o�',�'.13 / ap�(1,2�'' oP�S",
_� �4 � , /� TH Si, CoS'i'"� Ifsl�S�, �,� ,
wORK OROER N0.:
G��"/%�rF• �
O�+BR OM COwTA�CTOR: Y�17I � O� G..Q���1�I �N
0'rMER'3
WTE RCOTMGS tnSPECTEO �(�'wli/7'� � 6/i/ cr7 G°F'� !/%(�
:OT/LL. �BER Of FOOTNGS Qft'C/IYSSCA'� ��� CQ�% /NU�� ��/N �.S
f2 �,�„�.D�" /8 ".D�'�"p �-"'Tc�S �/ �¢ ��t� ,"""�°P�lio�'
Q s P�r� .��f't�-o ���a�r�; crv ,�L.9yv s. '
OESCRiPT�ON Of ROOttna OR GiSSOI+S COVEAFD Br i1 wOME:
,4GL �7c: S. ��°�1��%/QN� w1�r',r� /��'c/'"�'�D.e��,�OuG',�',� �
�.�%a o D �
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v�.
To C�
2 i� �o,c!
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��fj�,E2� c� �N S �g v� n�J�� Tv . �' �,�.�- ��i��
Tiw ywM�ip�i hn iwsNer� rM (unwq �ila c��sw �+ee.ar�en� liar�� aM.� on N�� ni�rw�s�d oreN.ry e�d
�w� .�n� �.cna� �w ecsW�c� +irh w� r�caMww��nw� in �h� O���isiw�ry fwMet��n rrMrr r�J rh� 9r:l�inq �od�
'' � C; fY �F GosT1 A�'1�5�9 . �A �--��
C/G- C3) ow s��.
O/�
25512 WILLOW WO00 STREeT EL TORO, CAUFORNIA 92630 (714) 770-8898
' (714) 770-2717
PP0.IECT AOOPESS: 3 Q�i E 16 TH JrT
owr+:x•sxame: JUDITH OSMER
aooaes's: I11 VIA CIRCOLA
' • REDONDO BEACH
UNIT:
- 310 437-0736
'AflCN/ENGINEEfl: DON L EE NEG.NO.: C S O 4 S S
nooeess: 2501 N. HARTMAN uNiT:
ORANGE CA 92665
PEflMITTEE:WHITE OAK CONSTROCTION (714)645-6934
' aoosess: 833 W 17TH ST 1
COSTA MESA CA 92627
LICENSED CONTNRCTOP OECIANATION: I Aere�y aliirm �hat I am IicenseC untler pwvisions ol Chapter 9(commenCinA w��h Seaion
7pq� ol Oirvon 3 al Ine BusineSs antl P�ofe55ion5 Cade, an0 my littnse is in lull force anU efletl.
cmuc.:032274 SipTEuc:423231 cuss:B
Date: �—� � � L — Signamre: _ 'u�
WOPNENS' COMPENSATION OECNBATION: I �ereby afli ha� I �ave a ceni�icale of consent lo sel4insure or a cenilicaie ol Workers'
ComDensaiion Ins��cb e� 8ertiliert eoDY �hereol (Sect o 3ew. �ab.�� � 01 / 9 3
roucv xo.: STATE FUND P' opTE:
comvaxr:
❑ Cetli�lie+0 coOY �s �ereby Nmishetl. � Certitietl capy s �ile0 vni� t�e ciiy Bu Cinq Oivision.
Oa�e: —` —I�� L pPDlicanL
EXEMPiION FPOM WOflNEflS' COMPENSIITION OECUflATI� : his sepion nee0 not 6e complete� if t e pe�mi� is ior one hunOieA (5100) ar leu�.
I cetlity Ihat in I�e p¢dormance of Ihe work �or whicA �his il is issued. I shall not employ any pe�son in any manner so as �o became
sublect to Ine Woders COmpensatian Lax's ol Calibmia.
Daie: SignaWre:
NOTItE: II. aiter making this �eclarabm. Yau shoultl become subject ta the Workeri Campensation provisions of t�e Labor
CaOe. yau musifarlhvnlh compty vnth sut� D�oHsions ar �N5 permil s�all Oe OeemeO revokeG.
CONST8UC710N LENDING RGENLY: I �e�eEy allirm t�at ihere is a constmction lentling agency for the petlormance ol ��e work far
w�icll ihis permil is issued (Section 3097. Civ. C).
nooAess: FISQFTGMNOTCONEORIG PfiRM
OWNEN BWLDEB DECLRNPTION: I �ereby allirm ihat I am exem0� ��om t�e Coniramors State License Law for ihe lollowinp reason
(Sec�ion 70.31.5 Business antl Pmiessional Code: Any ciry of coun�y which reQuires a permii to constmci, alier, imp�ove, 4emoliSh, or
repair any simtlure. O��or to ils issuance, also reduires ihe applicanl lor sucA Dermit to file a signetl statement that he/she is IicenseA
pursuanl lo I�e pmvision5 0l Ihe COn�raClOrs' Sia�e License Law (Chapl¢r 9(commenting wi�h Sec�ion 7000) o� Divisi0n 3 0l ��e Business
antl Pmlessions Code) or �hat he/s�e is e!empt iherelmm an0 ine 6asis lor t�e alle9ed exemption pny violation ol Seclion 7031.5 hy
any applicanl br a permil sublects t�e apClicanl to a civil penally ol nal more ihan five IlunUred dollars (ESIp�.
I. as ownei ol t�e pmpeny o� my em0loyees vnth wapes az their sole compensa�on, vnll Oa the woM, an0 ihe
❑ slrucWre is nol intenGeG or offered br sale (Sectwn 70aa, 6usiness an0 Professional Coae: The CanlractoK Slate License Law
Uoes nol apPly to an owner af a p�oDerty wlp GuilCs or impmves Ihereon, an0 who Eoes sach work hirt5ell/Aerulf or IAmup�
his or �er own employees, pmvid� ��at such imprmements are not intenGeG oi offered for sale. It, however t�e DuilOinq or
imDmvemeni is sala vnihin ane yiar o� com0�e�ion, lhe owner vnll �ave ihe GurGen 01 pmving �e/s�e GiE noi DuiIG ar improve
lor Ihe Durpose ol sale�.
I. as owner ol ��e pwpeny, am e��lusively conVacling wilh licensetl conVactors b consimc� Ne pmlet� (Seclion 7044, Business
❑ an� Pmlessions Catle: The ConlrAclars' State Liunse Law Ooes not aDDty ro an ovmer o7 propehY w�o DwIOs or imprwes t�ereon
antl who conlracis for suc� pmie[ts with a roniracloqs) license pursuant m t�e Caniractors State License Law�. I am awara
I�at D�ooi o� I�eir Worker's fAmpensation inWrance shoNG Ge prOviEetl Io m¢.
� I am ezempl under Section: B. 8 P. C.
lor Inis reason:
Date: Ownec
I do �ereby cenify Iha� I am aware ol and unders�and Ihe requiremems o� Cali�amia Heallh and Safery Cotle Sec�ions 25505, 25533, antl
2553d an0 ��a� I or any luture EuilEing occuDan� will/will no� (circle one) neeU lo comply with saia sta�e cotles antl �he repuiremen�s �or a
permi� �or conslmtlion or moEi6cation �mm Ine Air Ouali�y Managemen� Dislrici. Residenlial consimction aODlica�ions are exempi imm
��ese pmvisi0ni
Oa�e: MD�kani:.
I hereDy tttlilylhat I �aue reaGlhis application and slaie
orUinances anG stale laws relaling �o builaing conslmclion i
pmperty br inspec�ion purposes.
o„e 9—r— �� SignaWre
oriver's ucense o� sociai Security r:
Il�e aUovein�ormatian is correct. I aA�eeto comply vrit� allti�y antl cauniy
hereGy author¢e reDiesen�alives ol Ihis ciry �o en�er upon Ihe a�ove-menlionea
i64L46 Whilo—Bmltlmg�, Green—Coae En�orcemen�:�nary—Appliwm; Pink—Revonue; Goldenrotl—Assessar
CITY OF COSTA MESA — BUILDING PERMIT , .
PERMIT NO: B 058864 PLAN CHECK NO: O�i3-�J'Z"S i; ;
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR ��^ �1� PUR'POSE; NEW
JOB DESCRIPTION ; BALANCE OF SQ FTG. FOR NEW SFD, SQ FT: �°� 58
CLAIM VALUE; CALC—VALUE: 4,292,00 GROUP OCC; A-3j,'/M-1
COMMENTS; RE: B58863 PRIMARY BLDG, PERMIT, HOLD FOR SPECIAL F�������TS
**�r�r**�**�r******�*+t*�t*�r�**�t**+t�r+r*�t*�r�r�t*�t�t*rt�t*�r�r*�**�r*�tr�r**�� �*******
Z O N I N G R E Q U I R E M E N T S `
S E T B A C K S •' �.
------------ MAIN 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; 42519115 ZNE; R2 REF NO;
PLANNING Ni5TE5> SEE ALL INFO ON PERMIT B58863 ISSUED 090192 RE; DR-92-7.2;;...
!
if k k it ik if ik iE it if iE iE if iF iF ik �E ik �E iF iF �E iF iE k iE if if iF iElE dE �f i! 1tlF 1f ff if iE if IE iF iE if if �EiE1E if �k iE iE iF iF �f iF it fE if if if iE iE iEiE if 7ElE i!
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
20NING APPROVED HY ;,� R DATE; �
BUILDING APPROVED BY ; V C DATE; �
i
APPLICATION ISSUED BY; � ' DATE;
if iF iE iE iE �E iE ik if fflF iFlE if if it if 1E iE ik k iE iE iF it if iE IElE 3E 1E it
lfikifiEiFiEfflflfiEiflEiFiEitiEftififiEifillflEiFiFfE�EiEiEiE�EillFiFiElEiEifiFiklE 1E1EiF�FItriklEiFiFiEifiElklEiFlEiliElEiF1FiFlEiP1PiE
LEGALIZATZON;N F E E S U M A R Y ST'RUCTURAL
iF1EiFiEiF
t
� 2
iFiF£ IF 1E
*+t***
ENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72,00 50
.t SMIP/NON—RES
PLAN 46.8U �
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72,50 0,00 R. 46,80 119,30 119.30 .00
REVENUE DIVISION TOTALS--> COI;I,ECTED; 119,30 OVER/SHORT; 00
BLDG PMT PLUMBING EL�CTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
72.00 �y; ,50 46,80
1F 1F 1F iPlFlElE1E iE �E M iElE 1Eif if iF IE If iE 1E iF iE 1E if 1E iF �f if 1E iE if i41E.iFiE K iE 1E if iE iF k iFlE aE iE dE iE iFif �If iE if Ik if 1k fE if If M�E IE 3E IE K fF �E iE 3F iE If iF fE iE if 1E fE IF
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'0 N UNIT COST TOTAL COST
��:
SFR 58 DWE—TYPE V—WOOD FRP.ME —GOOD "14.00 9,292,00
�`END OF FEES
.1
7, . _ .
CONSTR,UCTION AND PLANNING . POOL ��PA
, APPROVALS Permit # � Date Inspector qpPROVALS Permit # Datc Inspecto�
S
1. "temporary Electrical Serv'ice or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrit3� Conduit Utility-Undrgrnd. . 54. Forms
4. Electrital Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel ReinfprcemBni �, 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Fpotings 58. Electrical Conduit-Undrgrnd. '
8. �Foundation � , 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. �• . 60. 8ackwash �ines, P�Trap, O Undrgrnd.
70. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connectio� �_ 62. Backwash & Receptor�Finai �
72. 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-Fina�
16. Rough E�ectric Wiring 67. Fencin9 & Access Approvai
17. Rough bViring Sign 68. APPROVED FOR PLASTERING
18. flou9h Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace -• _ ,APPROVA�.S Permit #
21. Ducts, in Structure . . � �70. Underground Hydro �
22. Ducts, Ventilating � � 71. Product Piping OGas ❑Oil
23.-GaS�PiPe•Rough & Test ' _ , '� � 72, Underground Flush .
24. Roof Freming � � � �. � 73. � Undergmd. Srorage 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 INSPECTIQN
32. Electrical Power MeterFinal � � S0. FOOD CERTIFICATE ISSUED
33. Final Electric ` � NoteS:HOLD FOR•SPECIAL REQUIREMENTS
34. Final Heating & Air Conditioning -� : .
35. Final Gas Pipe-Test j " -
i '
36. Hood or Canopy , �' � � - .
37. Final factory Fireplace � �'' '
38., Final Plumbing �
39. Water Service�Final - I •
�
40. Gas Service-Finaj;, ' , _ ; .
�
�
41, Solar pomestic-�mal � - � � , _
42. Backflow Prevertter j �,
r+ •
43. Backflow Irrigation �
44. Landscape Irrigat�on SYstem , � _ -
45. Sound Atte�uation
46. Handicap Regulaiions " � � � � , _ ,
47. FINAL STRUCT'-0RE & BUILDING y�
^., • P� NI.� ..:�
�49. El.ctric Release��,v'Edis �
50. Gas Release to Southem Califomia Gas Co � , � j .
51. CERTIFICATEOQOCCUPANCY
No. � ' Date
�
PHOJECT AOOflESS: 'j $ q E 1 6 TH ST uxiT:
awxexsName: JUDITH OSMEk
nooncss: 111 VIA CIRCULA
' � REDUNDO HEACH
310 437-0736
AflCN/ENGINEEfl: DON LEE HEG.NO.: C I. O 4 S S
RDOflE55: ?SOL N, HARTMAN UNIT:
ORANGE CA 92665
PEflMITTEE: WHITE OAK CONSTRUCTION (714)645-6939
aoosess: 833 W 17TH ST 1
COSTA McSA CA 92627
LICENSED LONTflRCTOfl OECLABATION: I �ere�y a�lirm thai I am licensetl untler provisions o� C�apier 9(commencing wi�� Sec�ian
70001 al Orvision 3 ai �he Busness anA Prolessions Catle, antl my license is in full lorce and eflect.
ciTv uc.: 0 3 2 2 7 4 STqTE LIC.: 4 Z 3 Z 3 i CLASS: H
Date: �—�' � V Signature: .
WOflBEflS' COMPENSATION DECIABATION: I hereGy a��ir i t I have a cetlilicate oi consent m self-insure or a cetliliwte of Warkers'
Compensation inswap�¢, q pt�tifipy cppY thereo� �Seclio �. �ab.�� �O 1/9 3
POUCV NO.: 1 L V 1/ L 6 L 7! E%P. URTE:
con+rnxx: STATE FUND
❑ Ceriilietl copY is hereby �umishea. � Cenified copy is fil 0 witn tne city euilainq Division.
Dale: �� �� / Z� AOVlicant �
E%EMPTION iBOM WOflNEflS' fAMPEN$ATION OECIABA➢ON: �i eCliOn ne¢4 nal be com0lefetl il Ihe permi� is lorone AMUreO (81W) Of Ie55).
I cetli�y Nat in t�e pedormance ol Ihe work br w�ich Ihis per ' is issue0, I shall nol emDloy any person in any manner sa a5 io Uecome
su�lect �o I�e Workers' Compensation Laws o� Caiifomia.
Oate: Signamre:
NOTItE: II, after makin9 t�is tleclaration, you s�ou10 become subjecl ro i�e Workers' Compensation pmvisions of ihe Labor
CoOe, y0u muSi IaMvnlh Compty wi�� Sut� O�ovi5ion5 or W5 permil Stull GE Ge¢meA revakeA.
CONSTflULTION LENOING RGENCY: I �ereby a�firm ihat Ihere a a cons�mc�ion IenUing agency for I�e pedormante ol Ihe work for
w�ic� t0is permil is i<suetl (Section 3097. Civ. C�.
LENOEP: �
aooxcss:
OWNEfl BWLOEfl OELUflATION: I here�y af�irm t�a� I am exempl Imm Ihe Canirac�ors' Sta�e License Law lor �Ae I011owinA �easan
ISec�ion 7031.5 Business antl Pmlessionat Cotle: Fny ciry of county wnicn repuires a permit ta consiruct, alter, improve, tlemolish, or
re0air any sirucWre. prior lo i1s issuance, alm repuires ihe appliwnt for such permit to tile a signetl statement ihat Ae/she is IicenuA
pursuant m �Oe Dmvisions oi ihe Contracmrs' Sta�e License Law (C�apler 9(commencinq wit� Section 70W� of Division 3 of the Business
ana Prolessions Cotle) ar tha� ne/she is exemp� therefmm an0 the basis far tne allegeA exemD��on. Any Nolation ol S¢ction 7031.5 Ey
any applican� �or a permi� suDle��s I�e ap0licani �a a civil penalry ol noi moa �Aan five �unOreO Uollars (5500).
I, as owner ot t�e O�oOerty ar my employees wit� wages as tAeir sale wmpenutian, will Oa t�e work, aM the
❑ s�mc�ure a nolfntenGea orollereAfarsate�SeCtion 7044,Busmess anG PmlessionalCaOe: 7he Cantractors' State License Law
tloes noi apDN �o an owner o� a pmpetly w�o OuilAs or imDmves t�¢reon, anE wAo does such woA himselt/her5el� Or I�roug�
�is or her own employees, Orovitle0 Ilwi such improvemenls are nol intendetl ar oflereA for sale. II, however the Ouilding or
impmvemenl is sold vn��m one year o� comple�ion, Ihe owne� will have ihe Guraen ot proving he/s�e tlitl nol builU or imOrove
�or Ihe Durpose of sale�.
I, a5 owner ol I�e D�openy, am edclusively wnlraciing witb licensed mniractars to cons�mct ihe prolect 45ection 7044, Business
❑ and Pmlessions CaOe: The Contraclors' State License Law dces not appry to an owner of propeM � bwl0s ar improves Ihereon
and wno contracis for sucn o�ole«s wiih a coniradorlsllicense pursuantio tne Contracmrs' Siate License Law�.l am aware
��al proot o� their Worker'S Compen5diion insurar¢e shoultl b¢ pwvi0e0 �o me.
� I am exempi unaer Seciion: B. 8 P. C.
lar this reazon:
Oa�e: �ec
I tlo nere�y cenity t�a� 1 am aware af antl unaers�an0 �he reqwrements of Calilomia Healin and Safery Cotle Sections 25505, 25533. antl
2553d antl Ihat I or any fuNre Guiltling oca0anl wilVvnll not (circle one� neeE to camply mi� 5aitl stale ca�es anU Ihe requir¢m¢nI5 for a
permii lor con5lmciion or maEi�ica�ion Imm ��e Air Oualiry Management OiSlrici. flesftl¢ntial con5imclion ap0lication5 are e�empt �mm
Ihese provisions.
�ate: ApplicanL
1 hereoy cenify Ihat I have Bae inis appli Wtion anA state ihat ihe above inlormation is correcl. 1 agree lo compty wilh all ciry anU fAunry
ortlinances aM state laws reWling Io DuilGing constmnian anU hereby amtor¢e represenlalives ol tNs dry m enter upon 1�e aGwe-menlioneU
pmpetly lo� In50e��ion purposes.
�Date: ���'9v Si9nalure:
ori.er's �aense o� saiai Security a: �
16d1-06 W�ile—Builtling; Green—CoOe Enlorcement; Canary—AppliWnl: Pink—Revenue: Gol�enrotl—AsSBssor
' CITY OF COSTA MESA — BUILDING PERMIT x , 5
PERMIT NO; P 058857 PLAN CHECK NO; N 1; u,
CONSTAOCTION 'fYPE; V—N PERMIT TYPE; PLU PURPOSE; NEW
JOB DESCRIPTION ; NEW SINGLE FAMILY DWELL, W/ATT, CARPORT SQ FT;
CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /M-1
COMMENTS: REF:B58863 6 B58864 (SUP,B PERMIT)
*�r**�t*+�**�t�*�*x�**�t�r*x**+��x�****�*� �r�*�r��*µ��r+r*��r***�*�r*�t***�r*�r****�*�r�t**�r*�***�t�t
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 HUILDING ---------
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; 92519115 ZNE; REF NO;
PLANNING Nt7T'ES>
i
ik ik 1f ff iF if ik 1E 1E if iE 1E if 1Flf 1k 1f iF if ik 1F iE iE if ik k i! ik iF if iF ik iF iE k�E dE it if if !k ik i!!! �f 1Elf ik iE i! iEif iF iEif iE !E it 1f k 1E IE 1E i! k ik If 1f if iElE iE if iE iF iE if !F!f
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 r: �, D'ATE:
BUILDING APPROVED BY ; ` � .. DATE:
APPLICATION ISSDED BY; �' DATE; / 2
ififkifkiFikif�iliFiEiEiElEiFikiEiEiEiE1EiE �7FifiFlE1E1E1EiEifaEi(- iF3E
iEiFifiElFitiEiFiEif#iEiEiEiFlEiFiElEiEifiPifiEiFlElEiP1EiE1ElEifiFlEiEifiEiEiEifiEiEiE iE1EiFififiElFifkiflfifififlElE1liEiElFiFiFiEiEiEiEiEifiEiliEkik
LEGALIZATION;N F E E S U M M A R Y STROCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 98�5=
PLAN
ISSUE FEE 20.00
BOILDING—DIV—> PERMIT ISSUE PLAN—CHECR
TOTALS----> 98,00 20,00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
118.00
SMIP/NON—RES
TOTAL PAID DUE
118,00 118.00 ,00
118.00 OVER/SHORT; 00
FIRE SMIP/TOT GRADING PLAN—CHECK
if if if iE if iF 1f 1k itlElE K� if iE it fE 1k iE ik ik fF ik iE iF iF iF iE jElF if !F iF 1E iE k!E 1F iE if iE iE iE if iE 1k 1F iE If 7k iP Ik �E if iE k If iF 1f 1f IF iF1E 1FlFlE 1E k!f 1F Ik if ik f4 iElf ik if IF 3E
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
PLU
PLU
PLU
PLU
PLU
PLU
PLU
PLU
PLU
BATHTUB
DISHWASHER
LAUNDRY TUB OR WASHER
SINK, KITCHEN
WASH HASIN
WATER CLOSET (TOILET)
WATER HEATER AND/OR VENT
WATER SERVICE
GAS PZPZNG SYS OF 1 TO 4 OUTLETS
GAS PIPING SYS 5+ OUTL—PER OUTLET
SEWER. CONNECTION TO BUILDING EACH
�%, �0
7, 00
%,��
7,00
7,00
7,00
7.00
7,00
5,00
1.00
15:00
19,00
7.00
%,�Q
7.00
14.00
14.00
7.00
7.00
5,00
1,U0
15.00
�
CONSTRUCTION AND PLANNING POOL & SPA
� APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
i. Temporary Electrical Service o� Pole 52. Pooi & Equipment Location
� Z. Soil Pipe•Undrgmd. . _ C,�19�� �L 53. Steel Reinforcement
� 3. Electrical Conduit Utility•Undrgrnd. 54. Forms �
4. Elecirical Conduit�Undrgrnd. 55. Electrical Bond�ng
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footingz 58. Electrical ConduiPUndrgrnd.
B. Fo�ndation � � � 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P�Trap, � Undrgrnd.
70. Structural Floor Sysiem - 61. APPROVAL TO DECK �
1 i. Property SewenLine & House Conoection � 62. Backwash & ReceptorFinal �
12. Sewer Cap _ 63. Heater & Vent•Final
13. Roof Drains . ' 64. Plumbing System � Final
14. Rough Plumbing �v/ai/.9 �� 65. Electrical-Final
15. Rough Electrical-Conduii 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Eiectrical-T Bar Ce�ling 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
r
20. RoughFactoryPireplace - APPROVAlS �Permit# _ .
21. DuCts, in Siructure .. . 70. Under9round Hydro
22. Ducts, Yentilating � •� 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & 7est 72. Underground Flush. _�
24. Roof Framing • � •73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � " 74. Overhead Hydro
26. T�Bar Ceiling (Svuctural) & Monocoat 75. Dry Chemical - ' ,
27. Frame and Flashing _ 76. Dry Standpipe �
28. Wthing�& Siding: - .� � � „ 77. FIXED SYSTEM PINAL
29. Insulation ' � ( � 78. FIRE PREV. FINAL
30. Drywall Nailin9 : i ', HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � � . 79.� FINAL INSP�CTION
32. Electricai Power Meter-F�nal � 80. f000 CERTIFICATE ISSUED �
33. Final Electric � j Notes:
34. Final Heating & Air Cond�tioning - � j � I ..
35. Final Gas Pipe-Test ����� , � _ '
36. Hood or Canopy ' � •, �
37. Final Factory Firepiace '
i
38. Final Plum6ing ��� G/�O
L'
39. Water Service�Final ��f� � •�(p ,
_�
40. Gas Service-Final ` ' �js tj G1FD
41. Solar pomestic-Final -
42. BackflowPreventer � i �. .
43. Backflow Irrigation �
44. Landscape Irripation System - (�� L�i/J � . - �
45. Sound Attenuation •
46. Handicap Regulations
47. FINAL STRUCTURE & BUI�LDING . �
48. FINAL PLANNING � '
49. Electric Release to Ediso� .
50. Gas Release to Southern California Gas Co i j � � �
51. CERTIFICATE OP OCCUPANCY _
No. Date
- �
enaecr nooeess:
OWNEfl'S NAME:
nooaEss:
RBCN/ENGINEEP:
ROOPESS:
PERMITiEE:
FDDNESS:
flEG.NO.:
UNIT:
UNIT:
UCENSEU CONTflALTOfl DECIABRTION: I �ereby a��irm ihal I am IicenseC untler pmvision5 0� CtaD�e� 9(cammencing wilh Setlion
7000� ol Oivision 3 of IAe Business ane Pro�essions Coae. an0 my license is in full lo¢e an0 elt¢tl.
CITY LIC.: STRiE LIC.: CLASS:
Oate: Signature:
WOPNEflS' COMPENSATION OECIAMTION: I �ere�y afhrm �hal I have a certitiwtt ot tonsenl Io 5elt�in5ure or a cenilicaie ol Workers'
ComDensation inmrance. o� a ceNiiea coDY ��ereal (Sec�ion 3800. LaE. C).
POLICY NO.: E%P. OATE:
COMPANY:
❑ Cenifietl copy is nereoy fumis0etl. ❑ Cenitiee copy is IileA witA tAe city Builtling GNsbn.
Oale: Ayplicant
EXEMPfION FHOM WOPREBS' fAMPEN5NTI0N DEQAl1ATI0N: (i�is secGon neetl mt Ue comple�ed i� Ne perml ¢ iw me hwEretl (E100) or less).
I cenity thai in ��e perlormance of Ihe xnrk lor w�ich Ihis permii is issued. I shall no� employ any person in any manner m as �o become
suble�� �o t�e Worker5 Compensalion laws of Cali�omia.
�a�e: Signaiure:
NOTICE:It. atler mawnA Ihis Aeclaralion, you shoWa hecome sublectto ihe Workers ComOensation D�ovisions of ��e labor
Cotle. you mu51 tarthwiU tOmpry with Such pmvision5 or (his De�mil 5hall Ge tle¢mea revaketl.
CONSTXOCTION LENOINC �GENCY: I hereEy a�firm IAat t�ere is a constmction IenGinq agenry �or I�e De�ormance oi Ihe work �or
w�ic� IhiS Dermi� is issue0 (Section 3097. Civ. C�.
LFNOEH:
AOONESS:
OWNEfl BWLOEB OECLABRTION: I �ereDy ailirm Ihal I am e�empt Imm t�e Comracmrs' Siate License Law ior I�e �ollowing reason
(S¢tlion 1Q31.5 Bu5inE55 an0 Pmiessi0nal COG¢: Any Ci�y 0� Counry whith reqUir¢5 a permil Io construcl, allef, imOmve, tlemolish, of
reDair any Simtlure. prior �o iis iSsuante, al5o /epuires Ihe applicani �or SutA Dermil rolile a Signed Sta�em¢ni ��al he/She i5 IiCenSeA
pwsuanito��e pmvisions olthe Conlraciors'Slaie License Law�Chapler9�commencinp with $eciion 70W)afUivision 3 aflhe 9usines5
and Pmfessions CoOe) or ihat �e/sAe is exempl Iherelrom antl the basis lor ihe alleAed exemDiion. My violation ol Stttion 7Q31.5 by
any aOP�itani lor a Oermi� suUle��s Ihe a001itant �o a tivil penaliy 01 nol mare �han fiue hUnOred ddlars (5500�.
I. a5 Owner ot Ihe O�Wetly or my employe¢5 wiih waBei as Iheir Sole compensa�ion, will Go ��e work, and �he
❑ strumure is no� imenGed ar oflered lor sale (Section 7044, 9usiness and Pmieuional Catle: The Coniractors' State License Law
Ooes not aDDty to an awner o� a pmperiy who builAs or imDroves �hereon. and who aaes such vroM1 �imseli/hersetl or Ihmugh
his or �er own employees. pmvide0 tha� such im0�ovement5 are no� intende0 or otlere0 �or sale. II, however the 6uiltling or
imD�avemeni is 5014 wi1Nn one year oI COmplelioq Ihe owner will hav¢ �ne hUfden of proNnp hUShe Eid no� builE or improv¢
tor fhe DurpMe o� saie).
i, as owner o� Ihe pmDeny. am exclusively conimctinp wi�h Iicense0 coniractors �o cons�m[� �he project (Section 7044, Business
❑ a� Prolessions COtl¢: The Contractors' Sta�e LicenSe Law tloes no� apply ro an ovme� af Drope�ty who Ouilds or impmves ihereon
anA who camracts for such prqec�s mtn a coniracmqs) license Dursuant ta t�e Cantranors' State License Law�. I am aware
�hat Dmoi ol lheir WOBer's Compensation insurance shoutd be pmviaeA Io me.
� I am exempi un0er Section: 8. 8 P. C.
for inis rtason:
Oate: 0�'ner.
I Do Aere�y cenify Inai I am aware oi an0 un0erstan0 t�e repuiremenis ol Catilomia Healt� anA Safery CaOe Seciions 25505, 25533, antl
2553d antl Ihal I or any IUWte UuilAinp Occupant wilVwill not (circle one) neetl la comDly with uiG state coAes an0lhe iequiremenls lor a
permil br constmction or motlilicaiion Iwm t�e Air Oualily ManaAemenl Oisinct. Fe5i0enlial ConsiNction aODlita�ions are exemD� ��om
I�eSe D�ovisions.
Oale: ADPIiCani:
I M1eteCy t¢r�ilyllu� IM1ave read I�is apD�ita�i0n and Slaleihal Ihe above informa�ionis corretl. Iapreeio tomply wilh allti�y antl tounry
or0inances and stale Wvrs r¢lating �o Ouilding consimclion antl hereby au�lar¢e r¢presenta�rres ol tN5 tiry �o ¢nier upon Ihe a6ove-men�ioned
O�o0erly lor inspeclion purposes.
Oate: Signalure:
Driver s License or Saial Searily x:
16aLa6 Whue—Bmlaina: Green—Cotle Enlorcement; Canary—Aoolicanl; Pmk—Revenue; Gdaenrotl—Assessor
PERMIT NO: P 0588fi7 -' PLAN CHECK NO; 03376-92 N ,
**�*�***�r�******x***��r**�*x*��******��x�� ��r*****x�*x�r*��*�**+r****�� x*****�r**+�*�r*
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
END OF FEES
�
CGNSTRUCTION AND PIANNING POOI & SPA
`� Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit #
t. Tr.mporary Electrical Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
� 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Elec[rical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steei Reinforcement �56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPROVAI TO COVER-GUNITE
7. Footings 58. Elec[rical Cqnduit•Undrgmd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, G�� Undrgmd.
10. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - final
14. Rough Plumbing 65. Electrical�Final
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electripl�T Bar Ceiling 69. POOLISPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21 � Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Product Piping OGas OOiI
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 (Structuraq & Monocoat 75. Dry Chemicai
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 Eleciric Notes:
34. Final Heating & Air Conditioni�g
35. Fina� Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestirFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. FINAL PLANNiNG ,
49. Etearic Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�/
exaccT�384 E 16TH ST uxiT:
' OWNEX'S,. UDITH OSMER
: noee 111 VIA CIRCULA
� REDONDO BEACH
310 437-0736
AHCH/ENGINEEfl: DON LEE REG.NO.: C 1 O 4 1 S
noon¢ss: 2501 N, HARTMAN uxR:
ORANGE CA 92665
reeminee: WHITE OAIC CONSTRUCTION (714)645-6934
aooeess: 833 W 17TH ST 1
COSTA MESA CA 92627
UCENSEo CONTHRCTOP OECLAIiAT�ON: I nereoy allirm inat I am licensea unAer D�a�siore al Cnapter 9(cammencinp wi�h Seclion
7000� ol Orvision 3 o11Ae Business anE Pmlessions CoOe, and my license is in lull lorce anU elleci.
cirruc./:]032274 sTereuc.:42323 cuss: B
Dale: i'�— � �' SignaWre: _
WOBREfl$'COMPENSATIONDEClAMT10N: IllereGyat Inailnaveacendicarootconsentmsell�insumoracertilicateolWorkers'
comoensauo� �sl�co u� ��rorr� r�uy mereoi �secu �e�. �ao.�� � O S/ 9 3
voucr xo.: STATE FUND EXP. OpTE:
COMPRNY: ,7�
❑ Cenifiea cooY is nereGy IumisAea. L'] Cenilie0 cooY s lilea vntA iha ciry BuilNnp ONision.
Uate: �—I � � L � Applitant:
E%EMPfION iBOM WOflKEflS' COMPFNSATION OECUflAT10 : ihis seciion nreC m� Oe WmpeleG il Ve pnmt is fa are ImMred �5100) w less�.
I cehify �hat in t�e perlormar¢e ol Ue xrork �w whiU� Ildt mi� is issue0. I shall not emd0' �Y De�n in a�ry mannM so as lo bewme
su�le�� �o ��e Wor4Er5' Compensation Laws ai Caiilarnu.
Oaie: SiAnaW�e:
NOTICE: It. atler maltinp t�a Cedaratian, you stroNO Oecame SuDI�� �o IAe Woders Compemation Drmisions al lhe LaOor
CaGe. you mu5t lonhvnin COmpty wirtl suc� o��s�ons ar inis permit Shan Ee EeertRO rCVOkM.
CONSTNUCTION 1FN01NG RGENCY:' I �ereGy aflifm Ilul I�ere is a consiruction IenOinp a0ency lor I�e plAOrmanca ol ��e wa�k for
i whic� �Ns permii is issue0 (SeCIiOn 3W7. Civ. q. ��
LENOEX: .
ROOflESS:
OWNEN BUILOEB aFCNMT10N: I hereEy aflirm Itui I am exempi Imm 1�e COnlraciors' Suta Lkense Law loi tne tollawin0 reason
(Secipn 70.31.5 Bu4ness aM Pmfessanal CoOe: My cily ol couniy whicA ¢puires a permit lo conswct, al�er, imp�we, Uemolis4 or
re0�� any sirutlwe. ptiw lo i6 iStuance. also reQuires ine aODlicant lot sucn permil to lile a 4pnea statemeni ihdl ndsne is Iicense0
Dursuanitol�e yovitions oi��e COntractor5' State License Law�Clwo�er9�fAmmentinp wit� $eClion 7000)olDivision 7 allhe Business
ane Pml¢ssions Co0e) or ilwt IrJshe ¢ exempt Inereimm and the Easis lar Ine allepeE eyem0�� /�Y �qon of Seciion 7091.5 Uy
any dppfirant fa a ce�mt wEjKis the aoW��ni to a Civil Oenalty of noi rtqre tlun five twnErW ENWrs (�).
I. az owner af t�e yopeny o� rtry employees wtn waAes u t�eir sole compensaiian. wm Uo Ine work, ana tAa
❑ sirucmre 6 not inteMed or oltered fa� sale (SeCtwn 70aa, Busineu anO Pralessional CoOe: T�e ConVacrors' Sbte Liunse Law
tices noi appy to an wmer of a pmDeny wlp Ouiltls or impmves tllerron, an0 wM Ooes such r.o4 Nmcell/hersell o� lNoug�
NS or �et Mm emDbCees. proviG¢E tlul suc� impwvemenls are nat intenUeO or allere0 for Sale. II, hOwever Ihe 6uddinp or
imprwement is soW r.itNn one year of comDletion, the owner will �ave tAe Eurden ol D�win9 �pJ51�e EiG not OuilU or improve
for lhe WrpaSe ol sale�.
I, at owner of t�e property. am extlusively coNracling with Iitense0 coniractors to fAnswn the proleci (Setlion 7044, Business
❑ arb Professions CoOe: The Coniraclors' S�ate License Law dces not apply to an ovmer ol O�Derty� OulCs or improves t�ereon
antl wno contraus mr wcn pmjec�s vrim a convacmqsl license Ourswnt m me Contracmrs' State Lrcense Lawl. I am aware
thal D��� of Neir Warker'S Campenution insurance s�oulG Ge proMOeC m me.
� I am aempt unGtt Seclian: B. 8 P. C.
Ior �n6 reason:
Date: Owner.
1 ao nert0y ceNiy Itu� I am aware al an0 uMerstanU Ine repuiremenls ol Califomia Healin anE $alery CoAe $ettions 25505, 25573, ana
255J< ano Itwl I or any lulute OuilNnp o[cupani wiNwill not (circle ane� neea to compty wiin 5ai0 siale cOGCS ana ine mQuiremenis lor a
p¢irttii Ior tonSUutiqn or m00ilipiion Iwm t�e Air ualny Manapemeni Oislricl. HevOential consimcliw appliWlions are evem0� �mm
mese o��sio�s.
Uaie: AOD�itant:.
I AertEy tttli�y ItWi I tuv¢ reaG INS aDP�%��� an0 Siale
orGwrces aM statelamrelaiinq�o Cudtlinqconslruciion+
pmp¢rIY lor inspeciqn purpoSM.
Dale: ( � � � � SiAnaWre:
Orivei 5 Llcense or Sadal Searily .:
—AOPlicant; Pink—Ravenoe: GOIEenroE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT �. tv ; t
PERMIT NO; E 058865 PLAN CHECK NO: N , ,
CONSTRUCTZON TYPE; V—N PERMIT TYPE: ELE PURPOSE; NEW
JOH DESCRIPTION : NEW SINGLE FAMILY DWELL, W/ATT, CARPORT SQ FT;
CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /M-1
COMMENTS: REF:BS8863 6 B58864 (SUP.B PERMIT)
�r�r��*�r�r�rx*r***�rx �r**�**�***�rr�e�r***��r�r*+r�r�r�r*�t�r�r�r+r�r**�r�*�r**�r*****�r+�**�***�r**�x��� *�
Z O N I N G A 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 RE • PROV; PARCEL: 42519115 2NE; REF NO;
PLANNING N TES>
> -
!f �f iE it ff if i! ik if �!lFiEiFi! ik �F i! ik k if iE �FiE �! Ik k 1F �f k i! iF if ff iE iF 3F IF ik iE iE iE if if IE if ik iF iF if IE iF iE it IF k it ikik iF iE iF 1F iE if iElE iE if if it k fE iF ik 1FlE iF iE If
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY + " DATE;
BUILDING APPROVED BY ; " �j�J DATE:
APPLICATION ISSUED BY:-------r��•• �i��l�/ DATE: ��� �,�9
x�x�it�rieltieitititititirkititkitfritir�tiF�F'ffiFiFF iF3EiE�iFiFiFi!"iF'iFiFiFiFie�eieitiE*iEiEirx- itiE
kiklkitkilifikMlfififililiEiEiFitkitMitiflE�EiklFiFiFit!li�ikifiFi kifiElfifiEiFiFifik3hikkilitififkifiElkifiEiFiEiFiFiEiFikkkitkiEikiE�EifiElfiF1!
LEGALIZATION:N F�E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 50,23
50t SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 50,23 15,00 0.00 65,23 65,23 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 65,23 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
65.23
iE if if iE iE if if if ik it if if 3t if !F k ik if if 1E if 1lif k k iE 1E if ik if iE ik iElFif ik if if if if Ib iE iE ik iE IE *iE iF IkiE iE if iE iF 1E iE iE if iE iF i! iE �E iElF iF �f iE iF iFiE * if if aE iF �E �F
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST
ELE 1435 NEW RES BLDG FOR 1 OR 2 UNZTS/ SQ FT ,03
END OF FEES
TOTAL COST
50,23
� � CONSTRUC710N AND PLANNING POOL & �rA
/kPPROVALS Permit� Date Inspector qppROVALS Permit# Date Inspector
�1..Temporary Electriwl Service or Pole 52. Poo� & Equipment Location
Soil PiPe�Undrgrnd. _ _ �3. Steel Reinforcement
3. Electriwl Conduit Uti�iry•Undrgrnd. QZ,{� ���L��E���Forms
7T
4. Electrical Conduit•Undrgrnd. f�l/S� ��55. E�ectrical Bonding
7G'
5. Steel Reinfo�cement 56. Rou9h Plumbing & Pressure Test
�• Electrical UFER Grnd. Gr,Z_Cf2 /P��57. APPROVA� TO COVEft-GUNITE
7. Footings 58. EleMriCal ConduirUndrgrnd.
S. Foundation � - - 59. Gas Pipe, � Undrgmd., Test
9. Water Pipe-Untl�grnd. � � 60. Backwash Lmes, P-Trap, � Undrqmd.
�0. S[ructurai Floor Svstem 61. APPROVAL TO DECK
11. Property Sewer Une & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & VenrFinal
13. Roof Drains 64. Plumbing SYst¢m � Final
t4. Rough Plumbing 65. Electrical�Final
15. Rough Electrical-Conduit 66. Solar SYstem�Final
1 G Rough Electric Wiring `o�3.GL � 67. Fencing & Access Anp�oval
7
17. Rough Wiring Sign 68. APPROVEO FOR P�ASTER�NG
18. Rough Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - � 'APPqOVALS ' Permit #
21. Dutts,in Structure � 70. Underground Hydro
22. Ducts, Ventilating 77, ProductPtping OGas OOii
23. Gas Pipe-Rough & Tesc . , 72. Underground Flush
24. Roof Framing ' �73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing _ '74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat _ • 75. Dry Chemical � - -
27. Frame and Flashing , . 76. Dry Standpipe �
28. Lathing & Siding - � 77. FIXED SYSTEM FINAL
29. Insulation �� � � �. 78. FIRE PREV. FINAL . �
�30. Drywall Nailing � HEAITH DEPT-. REQUIREMENT
31. Plaster Brown Coat _ � 79. FINAL INSBECTION �"
32. Electrical PoWer Meter�Final .9 I7 � 80. FOOD CERTIFICATE ISSUED
33. Final Electric /�U /L � Notes:
34. Final Heating & Air Condi[ioning � �
35. Final Gas Pipe-Test � �,. �
36. Hood or Canopy � �� �
37. Final FactorY Fireplace � �
38. Final Plumbing
39. Water Service-Finai i ' • '
40. Gas Service•F�nal �
�41. Solar pomestic•Final � ( .
42. Backflow Preventer � � ,�
43. Batkflow Irrigation
44. Landscape Irripation SYstem .
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING . •
48. fINALPLANNING , ' �
49. Electric Release to Edison � �
50. Gas Release ro Southem California Gas Co t ,
51. CERTIFICATE OF OCCUPANCY
No. Date
PN0.IECTROOflE55: 3E�4 E 16TH ST uxiT:
OWNEfl'SNRME: JUDITH OSMER
aooeess: 111 VIA CIRCULA
REDONDO BEACH
310 437-0736
ANCHIENCINEEfl: DON LEE XEG.NO.: C 1 O 4 S S
AOONESS: ?SOS N. HARTMAN UNIT:
ORANGE CA 92665
PEflMITTEE: WHITE OAK CONSTRUCTION (714)695-6934
nooxess: 833 W 17TH ST 1
COSTA MESA CA 92627
IICExSEo CoxiPACTOfl UECIABATION: I heieby anirm �nat I am licensed un0er pwvisions ot Chapter 9(commencing with Section
7000� ol Orvision 3 0� Ihe Business an0 Pmlessions Cotle, antl my license is in lull force and efleci.
ciTv uc.: 0 3 2 2 7 4 STRTE LIC.: 4 Z 3 Z 3 1 cuss: H
oaie: '�1—/' S v sqnamre: _
WOPKEflS'LOMPENSRTIONOECIAflAT10N: I�ereOya� r thailhaveaceni�iwtealtonseniro II-insureoracehiliwteolWarkers'
Compensation Wsr�a�� of $te�Ulie� o1vY ��ereol ISec n 3800, lae. �.� � O S/ J 3
� P0L1BY N0' STATE FUND Eze. onre:
ICOMPANY: ,y
0 Certifie/tl�,copy is Oere�y fumishetl. L"1 Certitied coDY is fileA vn�� (he city BuilAing Division.
Dale: ( —/��L AP7liwni:
E%EMPTION FBOM WOBKEBS' COMPENSATION DECIAXATIO : is seclion neeG not be comple[eG il �he permil is for one hwOreO (SiW� or less).
I Ceriity Na� in Ihe petlormance ol �he work lo� whith �his rmit is iuuea. I shall nol employ any person in any manner so as �o become
sub�ect �o the Workers' Compensa�ion laws o� Califomia.
�ate: Signature:
NOTICE: I�. afler making this Ceclaratian, you shoul0 become su61e�� �o I�e Workers' ComDensaiion D�ovisions oi �he Labor
Cotle, you must forihwi�h compty wilh 5uch pmvisions or �his permi� shail be tleemea revoke0.
CONSTPUCTION LENDING pGENCY: I �ereGy a��irm tlwi Ihert ¢ a wnSVuction lentlinq apency �or the DeAormance of Ihe vrork for
w�ich Ihis Dermii is issuea (Section 3097. Gv. C�.
LENOEN:
aooxess: .
OWNEH BWLOEN OECL�IBRTION: I �er¢�y afiirm Ihal I am exempl Irom Ihe Contracmrs' Slaie License Law lor Ihe follovnng reason
(Section 703t.5 Business an0 Pmfesslonal Cotle: Any ciiy ol county which requires a permit to wnstruct, alier, impmve, demolish, or
r¢pair any 51mcWre, Drior lo i�s issuance, also repuire5 i�e aDPlitan� br Such pBrmit Io lile a SigneA Slalemeni Ihal h¢/She i5licensee
Oursuan� �o t�e Omvisions ol ihe Coniracto�s' Slale LicenSe Law (Chapier 9(commencinq mlh Section 7000) o� Oivision 3 0� Ihe Business
ana Pmlessions Code) or roat �e/s�e is e�empi �herefmm anU Ihe basis lor i�e alteAed exemptian. Any violation of Section 7031.5 hy
any aOP�icanl for a p¢rmit suGjecis IAe applicant lo a tivil penalty ol not ma2 tAan INe hunOreU dollars (5500).
I, as Owner ol Ihe pmperry or my employees with wapes as iheir sole Cam0en5dtion, will tlo �ne woM1, and iha
❑ simcwre is noi imen0ee or oiferea lar sate (Secuon 70d4. Buvneu an0 Professional Caae: The Canlractors' Slate License Law
Goes nol apply to an owner of a propeny wl�o Euilds or improve5 I�ereon, antl wM does such wolx himself/herself or t�muAh
�is or her own emDloyees. D�oviaed tlui 5uU imD�wemenis are not intentleE or offereG for sale. II, however Ihe builtlinp or
impmuemen� is soltl vnihin one year o� compleiion, Ihe owner vnll hav¢ ��e burCen ol pmving h¢/S�e dia noi builtl or imD�ove
br Ih¢ purpose 0� Sale).
I, as owner ol me pmpeny, am exclusive1y contractinB ��� lic¢n5ed conlraclor5 io cons�ruc� Ihe Oroleci (Sec�ion 7044, Business
❑ antl Pro�essions COGe: TII¢ ContfaCloR' $�ate LK¢n5E Law GOCS �OI appty Io an Owil¢r ol prapetly who ONltli or imD�OvlS I�erCon
antl wAo [anirads br wch Omle��s wilh a coniractor�s�license pur5uan�10 I�e ConUac�ors S�ale Litense Law�. I am aware
Ihai pmol ol Iheir WOrkeYs Compen5aipn insurante SMuIC Oe proviGetl �o me.
� I am exempi un0er Seclion: B. 8 P. C.
lor Ihis r¢ason:
�a�e: 6rmec
i tlo nereby cenily Ihat I am aware ol an0 untle�stana tne reQuirements oi Calilomia Health ana Safery COAe Sections 25505, 25533, an0
2559A antl �ha� I or any IUWre building occupant wilVwill nol �ciale one) neea �o comply wi�� 5ai0 Slaie co0es anC the requirements lor a
permil lor cansimction or motltl¢alion Imm ��e Air Oualily Management Oisttitl. fle5idenlial constmction apD�ica�ions are exemp� Irom
�hese o�avisions.
Oa�e: Ap0liwnC
I �ereby certilylhal I Aavereatl this apP�ication ana stale�Aal Ihe aboveinlormalionis correcL Iagreeio compty wiih all ciry ana coun�y
orAinances antl 5�a�elaw5relalingloOuilUing constmc�ion anE �ere�y aulAodnrepre5enlaiives ol��is ciryto enterupon�he above-mentioned
propeny lorinsp¢tlion purpases. (� ' �AJI_
�ale: ` /�`�"' Signa�
Pmk—Revenue: GolEenrotl—Assxssm
CITY OF COSTA MESA — BUILDING PERMIT �1q-658'8bo�
PERMIT NO: M 058866 PLAN CHECK NO: N '�iJV'I c f�SLPP��
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: NEW
JOB DESCRIPTION ; NEW SINGLE FAMZLY DWELL, W/ATT, CARPORT SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /M-1
COMMENTS: REF:H58863 6 B58864 (SUP.B PERMIT)
�*�*+�+��*�*�r**�*�r�*�r****�x�*****��c*�*�*�r*��**�*�**��x �r**�*�r��*��**�+�**�***�*���*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN 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: 42S191I5 ZNE; REF NO;
PLANNING NOTES>
. �
','ib iE iFiFlFlFiElE fE iE 1EiE 1FiE fE 1ElF iE iElF 1E 1F 1FiE 1E iE iE 1E 1ElE iE if iF iF it iE i! 1E 1f !E iF iE IE iE i! iF 1E iE if 1E iF iE iE fF iFif iE 1E 3ElE iE iFiF IF 1F iE iE jE ik if if fE iE iElFlF 1F iE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
%ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE;
IAPPLICATION ISSUED BY; B DATE• �
� iEiFififlFiFififlflFklEiEiE�7FitiflElFlE1EiF �iFiFit7EiE3F1EklEikiEiE 3EiE
' IEjfifiFiElfiEiElfif%iE�EiliEiEififitiEifiEiFiEiEiE1E3EiflFifftiEitiEiE1E iEifiElFiElfaEklEiEikiEaf�EiEifiEiEifiFlflEiFikiEiflfiEif�EififiEiFiFit�E3F1EiFiE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT z�,�SY SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—>
TOTALS---->
15,00
PERMIT ISSUE PI:AN-CHECK TOTAL PAID DUE
20.00 15.00 0.00 35.00 35.00 .00
REVENUE DIVISION TOTALS--> COLLECTED; 35,U0 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
35.00
if �f 1F1F ak iFlE k i! 1F if �f iE if !E 1f iFlF 3E i(��E if 1Fil� it if 1E iE 1f if iE ik If iFlE if �E k iE !f if iE iF ik iE ik iE if iE IE fE �f �E IF iliflF fFlf iF IFik 3F 3FlElE iE 1E ib If Itr it IE IE �F iE IE 1E iE
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
MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9,00 9,00
MEC 1 FACTORY FIREPLACE ,, 6.50 6,50
MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 9,50 4.50
END OF FEES
�_r_�.....- " . .
.�r'_ . _ . .. '
CONSTRUCTION AND PLANNING - POOL &_. A
APPROVALS Permit # Date Inspector AppROVALS Pennit # Date inspector
, i. Temporary Electrical Service or Po�e 52. Pool & Equipment Location
2. Soil Pipe�Undrgmd. � 53. Steel Reinforcement
3. Electrica� Condui[ Utility-Undrgmd. 54. Forms
4. Electrical Conduit•Undrgrnd. 55. Electricai Bonding
' 5.'Steel Reirtforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. 57. APPpOVA� TO COVER�GUNITE
7. Footings � 58. Eloctrical Conduit•Undrgrnd.
8. Foundation � - � 59. Gas Pipe, O Undrgrnd., Test' -
9. Water Pipe�Undrgmd. � 60. Backwasb Lines, P�Trap, O Undrgmd. -
70. Structural Floor SYstem � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal
72. Sewer Cap , 63. Heater & Vent-Final -
13. Roof Dreins ' . 64. Plumbing System - Final -
14. Rough Plumbing 65. Electrical�Final
75. Rough E�ectrical-Conduit 66. Solar System-Final
i 6. Rough Etectric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 D��/u+' � FIRE DEPT. REQUIREMENT
!¢�•
20. Rough Factory Fireplace � , : ����`� APPROVALS : Permit # �' �
. - - , r � � :. .
21. Ducts, in Stwctu.re � . � 70. Underground Hydro
22. Ducts, Uentilating � � _ " - 71. Product Piping O Gas ❑ Oil
23.'Gas Pipe�Rough & Test �� � i 72. Underground Flush
24: Roof Framing - 1 • ' 73. Undergmd. Storage Tank � Gas ❑ OII
25. Roof Sh�athing ,; ' - ,_ ' 74." Overhead Hydro
26. T�Bar Ceiling (Structurap & Monocoat � 75. Dry Chemical •
27. Frame and Flashing .,. 76. Dry Standpipe � ' �
28. Lathing& Siding . ,• 77. FIXED SYSTEM FINAL
29, ln:utation • � 4 y, 78. F1RE PREV. P1NAL -
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 ' � Noies: � �/ •
. !D'!G-%� �cYcwt rd! /uxm�Tcd in
.34,. Final Heating & Air Conditioning /��,{�y/ �
l(i 7�'TT" I dv�� �✓a/�.� - , 'o ���
35. Finai Gas Pipe•Test - �
36.�Hood or Canopy • ' - -
37.-Final Fa�torv Fireplace ((j3Q�4L (��
38. Final Plumbing � . � �
��
39. Water Service�Final ( ! . •
40. Gas Service-Final ' � �
41 . Solar pomesticFinal � � � .`
42. Backflow Preventer � �
43. Backflow Irrigation - .
44. Landscape Irripation SYstem � . _ �
45. Sound Attenuation ' �
46. Handicap Regulations
47..FINALSTRUCTURE & BUILDING '
48. �FINAL PLANNING •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co j � ��
51. CERTIFICATE OF OCCUPANCY -
No. Date
�
PflOJECT F��XESS: .3 8 4 E 1 6 TH J�'T . UNIT:
OWNEN'SNAME: SUDITH OSMER
nooeess: 111 VIA CIRCULA
REDONDO BEACH
" ' .310 437-0736
AFCHIENGINEEH: DON LEE NEG.NO.: CS O4 S S
aonREss: 2501 N. HARTMAN uNiT:
ORANGE CA 92665
PENMITTEE: �ITE OAIC CONSTRUCTION ( 714 ) 645-6934
ROOflE55: 833 W 17TH ST 1
COSTA MESA CA 92627
LICENSEo CONiflRtTOP OECIANATION: 1 neteey aflirm itW1 I am IicenSeG unaer o�ovi5ioR5 0l Chdpkr 9lcommenGnp wiln Settion
7000� ol OMsion 7 ot I�e BuSiness antl Pmfessions Coae, an0 rtry IicenSe is in IuA force antl efleCl.
cirruc.:032274 sT�TEuc.:q23231 cuss:g
'py¢; /2'�/"�% � Signama: _
WOBREBS'LOMPENSRTIONDELLAM710N: I�ereEyall mi atltuveaceniliwiealwnuntlo I-insurearaceniliwleolWorker5'
ComDenution insurance or a anilied opy tnereoi (Sec 0. laE. q.
PoucrNo.:1200282-9�1 E%P.ORTE: O%IOII9j
cornrnnv: STATE FUND
❑ Certilie0 copy is �ere0y IumislreG. � Cendied wpy i5lileG vnth 1Ae ciry Building Oivision.
.p@te: �Z' / �' / ii qpplicanl:
EIIEMPfION iNOM WOflKEflS' WMPENSATION OEClAMPO lis stt�m me0 not Ee cmqMetM i Ih pxmi ¢ la ane Inm7rttl (5100) a Ipss�.
I ceriity Ilwl in t�e peAOrmdMe at Ihe wVrk lOr w�ith IN5 t is isSueG. I S�aO noi employ any person in any mannBr so as lo become
su0ie�� �a �Ae Warkers' ComOensation Laws al Calitorn' .
�a�e: SignaWm:
NOTICE: I�. alier making I�h tleCWratiafl. yau S�ou10 bemrtce SUEj¢CI Ia llle Workers Campenutqn Drovisions of ine LaOor
COGe. you mu5i forihxith compty xitll 5uU D�a'�sa�s ot IIiS pGriNt ShdA Ee OeemeO revOk¢G.
COkSTBUCT10N LENDING AGENCY: I �ereGy attirm rta� ��ue is a constmction IenGing aAency lar t�e perlarmance ol ihe work lor
w�i[h t�is permii a i55ue0 �Se[�ion 3W7. Civ. C).
LENOEX:
RODflESS:
OWNEB BWLOEB OELLAMTION: I hereDy affirm ttNt I am exemD� �rom the Conuacto�2' State LItt16E Law lor Ihe iqlmvinq reason
(Section 7031.5 Buyness anU ProiCssional COae: pny uty al [ounty wNc� r¢puires a petmit lo CanstNt6 alter, improve. Aemolish, or
reDair any sVutture, prior to its i55uance, also repuir¢5 I�e apqiqnt lor sutA permil Io lile a SipneC ttalemenl Illat Ae/s�e is licensed
pursuant to me provisbns ol �ne Coniractws' S�ate L'¢enu Lm ICtuGtu 91w�ndnp witn SecUon 7000� ol Division 3 0l tne euvness
ana Pmfessions CoOe) o� Itul h¢/511e 6 exempi Inerefmm an0 tne GaSiS lor Ille dlle0� ¢KQmDlion. My violdtion af Section 7031.5 ey
any a001icanl lor a p¢rmii 5u0ittt5 I�e aDD�iWnl to a Uvil ptnalty ol tqt male ItWn live �unOrlE GOAars (55110�.
1, as awner ol Ihe D�openy or my em loyees xil� wapes as iAeir mle campe�rsation, wlll Go i�e work, an0 t�e
❑ structure ¢ noi imeMeE or afhreG Iw sa�e 1�� 70aa. Buvrcss an0 Pmlessiatul CoAe: Tne Contractors' Sute License Law
Coes nol apply lo an awner ol a propeny wla ouilas or imprwe5 iher¢On, ana wlq Cces such work nimselllherself oi ihmupA
�i5 ar her own ¢mployees, Dmvi0e0 Ilul SuU imD«men�s are no� inICnON Or OflertA lo! sale. II, Ipwever I�e Guilainp Or
imD�ovement is Sola xitnq one y¢ar al wmpletpn. Ihe owner vtil have ihe euraen of Dmvinq hNshe Uitl not Dui1E ot improvu
lor Ine vuroase ol sdle).
1. as owner ol Ihe pmperty, am evUusiveN wniractinp wi�n licensea comractars Io canslmci i�e D�ojec� (Seciion 70A4, Business
, aim Prolessions Coae: 7he Cantractori SWte Lkeroe �aw aces not appy to an ovrtcer ol prope�ty wlp �NIOs or improves tAerean
an0 who convacts lor wc� Orojecis wit� a contractoqs� �icense purswm to t�e Contncmrs' State License law�. I am aware
I�a� 0��1 0l I�eir Worker'S ComDensxii0n in5urance 5hoW0 Oe prwiOeU Ia me.
� I am eKempi unCer $ection: B. 8 P. C.
lor t�is reasan:
Oate: Owner.
I do �ereby cetli�y Ihai I am aware ol an0 unEerstanG t�¢ repuiremenis ol Calitomia Health anG Sal¢ty COEe S¢ciions 255U5, 25533, antl
2553E antl Ihal I or any WWre Ouflding otcuDanl wiNwill nol (cirde one) nee0 to compy wit� SaiU state co0es antl t�e repuiamenis far a
p¢rmi� lor consimclion or mo0iliation �mm ihe Air alny Manapemenl DizincL ResiEemul canslmction applications are erempt Imm
�nese omvisions.
Daie: Ap0licanl:
I her¢Gy [enify �hai I �ave reatl ��¢ appliwli0n an0 State �hal l�e a0ove inlormaiion a mrr¢ci. I agrtt l0 compty vnih all ti�y anA wuniy
ordinancesantlstalelavrsrelatinglo�uil4ingconslmctionanA� e0yaulhor@erepreSenlalive5oi��isuty�oent¢rupOnthea�ove�menlionetl
pmDeny for mspeclion Ouiposes.
�Oate: ���� � � SignaWre:
ori�ers ucense or sociai Secudry x:
—Appliw^I: Pink—Revenue: GOIEonroE—Assassor
CITY OF COSTA MESA — HUILDING PEAMIT PERM NO; P 06029
PERMIT NO; P 060298 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PEAMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : INSTALL SPRINKLER SYSTEM SQ FT:
CLAIM VALUE: 400.00 CALC—VALUE: GROUP OCC: R-3 /M-1
COMHENTS: NEW SFD W/ATT CARPORT REF;B58863
�r��r*�r�x�rx*�r*�r*�e�r+��r***�r*�r�r�rx*�r�r�r�rx�r�r�er�x�*�e�r�r+r�e*+r�r�r�r�r�r��r*�r**�r�r*�**�r�r�e+r�r�e+��***�r�r*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ HAIN 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; 42519115 2NE: REF NO:
PLANNING NaT'ES>
�
�flk M M 1F if ik if 1E M k if if 1! i!!f if k Mlk�f iF if ff 1F �flf �t �ElF �f if if iE IF iF iF 1k�f iE iF Mi! kiF iE iF iF k iFiklf �F �f M iE kif if �k if'fF if if ik 1F IE k if iFiF ik ik it M iF iEM k
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 :
APPLICATION ZSSUED BY:
iflflf if iF k IF k iF 1f i! k if M iF iF iF if 1f it if iF
iFkMkitikif kMififMiFifikiEiFifMklEifiFkifiFiFkififiFiFif kififikifiF�k�flfkk�flFiF
LEGALIZATZON;N F E E S U M M A R Y
PERMIT BLDG PHT PLUH�Ioo ELECTRIC NECHANIC
�si
PLAN
ISSUE FEE 20.00
HUZLDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 14.00 20,00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBZNG ELECTRIC MECHANIC
34.00
*
k
STROCTORAL SEGMENT;N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
34.00 34.00 .00
34,00 OVER/SHORT; ,00
FIRE SMIP/TOT GRADING PLAN—CHECH
MiFMifMlFiFkiFitifMkfEkMlFiFMMiFifiFiFMklfitlFMMiEiFiFIF�fkifMififMiEMifitifk1f1k1FM1EkiEitiliFifififffMkMkMMiFilitMMMlFiEikMiE
Z 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
PLU 2 LAWN SPRNKLER SYSTEM ON 1 METER 7,00 14,00
END OF FEES
CONSTRUCTION AND PLANNING POOL & S
APPROVA45 Permit # Ddte Inspector APPROVALS Permit � Date Inspector
� 1. Temporary Electrical Serv�c2 or Pole y � 52. Pool & Equipment Location �
� 2. Soil Pipe•Undrgrnd. � � - � 53. Steel Reinforcement
' 3. EIycV�qal,Coridu;_LTfility•�ndrgmc(.-'" � 54. Porms
A..£Iectriu�.CoredolFdiRdrgrnd. = 55. Electrica� Bonding
r -
5. Sreel Fteinf�rcen:r��fJ `�" 56. Rough Plumbing & Pressure Test
' 6. Electc�cal P1FER'lrrid. . 57. APPROVAL TO COVER�GUN�TE -
• r•
•-7. �otings � _ ' �_ 58. EleciricalCqnduit-Undrgrnd.
k 8. �o�ndation t� (� � 59. Gas Pipe, O Undryrnd., Test �
9. Water P�pe�Undr9rnd. 60. Backwash Lines, P�7rap, O Undrgrnd. �
10. Structural Floor System . 61. APPROVAL�TO DECK
11. Property Se�ver Lin r& Ho..seConrrxtion 62. Backwash & RecepmrFinal
12. Sewer Cap Y � , 63. Heater & Vent�Final �
73. Foof Drains � - 64. Plumbing System - Final �
14, fiough Plumbt�j,g ' 65. Electrica�-Final
15. Rough Ekctrical-Conduit 66. Solar System-Finaf
16. Rough Elettric W��ring 67. Fencing & Access APuroval
77. Rough Wiring �qn 68. APPROVED FOR PLASTERING
18. Rough Electri��T Bar Ceiling 69. POOL/SPA SVSTEMS FINAL
19. Rough Heai�nq & Air Conditioning FIRE DEPT. REQUIREMENT
- .r :f .�r� .�� p�
20.`RoGgh F3Ctor�y F�r�lace ��� T. a= � !" b� r- +�pppR�VllF���Cpermit #�
7. .L G `� 1 S- Y a� S 7 x• _+ . � .,
27: Duffs, iLrStructuiy� , .... . ,c� Y S - ;� ., =70. td�de�groahdi Hyr]ro -
22. Ducts, V3nt�ati � �� ' .�:� �' ':?� ` 'j71. Product�P}�ing Li�(�ds OOd
�•u a, " f - < • «
23��Ga � ip ou1 h &' si � '� ~ r ��' " , � � - - ,
$ � 4� .9 � � �s7 , . ..r v :'�!' _ -�z• UndergrorNd Flush:
24:�Ro0t F�aminB %� �'�' " y� R _; k�73.ryUndergmci'.Stor��fankfiJGas OOiI
25. Roqf Sf�athing :� � � ` `� :� �: ` `- � '" ,
� � n 74; ,Overhead Hydro:'
26::.T�Bar Ceiling (S[inauraq &Yt9onacoat � •n{ _� 75,sDry Chemical ` _ " -'� � -
27;� FrarPe and Flashi� 3_ a �• y .r 4 76: Dry $tandf�y�e �� � �r ' � 3
, 28. �Lathing� Siding� . .. ;:t� - . G "y' K 77, - FIXED $YSTENp�I AL�` ••
� 29. Insulation �.'� S��'� .. ; T' r n 78�"FIRE PREV. FINAi n;> S
30. Drywall Nailinq -.- � � + �� - � � -HEA�THi�EPT�, R�EQUIREMENT
r
37. Plasrer �rown�Coat; � ' �, �,; � r �79:•F�NAL�I'NS?�ECT16N � " ' '
r32.ElectricsjPwverlvloter,•Final� _ 80.�FOOOCERTIFFCATEISSUED
„
33,'Fin�l Elgctric "' ;. ' � No�t¢s: " =x ;` _ �
c � r` c, .�
� '` /
;,34, Finai Heating�_& A'v.�Conditioni49' + ' s � . �� - � ¢ -
,r ' -
35:^Final Ga5 Pipe-TestX "" n R` � c_ �^.5 � � �.0
�� _
� X ` �. �
_36.�Ho0d ot;Canopy�r. - , z . - - s_ ; c -
_ - � S-T
37.--Final FactPry FirepTaC2� S '' �- ��n ' .' �' `. ' '
:, .�
38. Fin21 Plumbing :� M .� i � � � (� � y � x ; -C
:-39. Water Service-Final- � - '' k �+ • • �
r � X b L �
40. Gas ServicG�Final r r S:-,r j r, � %� � -.� .; '
�. �
. 41. Solar pomestirPinal ". c'. • Y C• 2-= •- �
a b '. - =0 - •� -
42.'�ackflow Preventer,. " _' ,
a - '
43. Backflow irrigatiorw .:i - � . '" :..- -
r � +� -J i � �•
�A4. Landscape IrriGation System _ ��'-' t'I(s , (,ti0• �� < � 7 _ .; �� -
1
•45.'Sound AttenLation� - . .�. _ , -' - � ' �.
r , s +' T _ .� ' �.
�'46�.Handicap Regulatio?�s ' ' � ' ' '� ; � , _ � .�
47.�fiNAL STRI9CTUR'E & BUd�01NG � � �' �, �
48.'FINAL PLAfdNING` ,.. ~ . , .
4�. �Electric Release to.Edison i c � • • '
� 50.,Gas Release tg Southem Calitocnia Gas Co .' I " . _° . - ".
51. CERTIFICATE OF OCCUPANCY : �_ � , , , ,_ .
No. Date
b
AoO��cant to fi11 in all soaces except tnose within neavy Oortler Iinas antl sign ail aDo�oDrlata tleclarations.
CITY OF COSTA ME� C NS�U�TJ�I P��VjI_T
Project Address ��'"> � � ��«�
Applicant's Mailin9 Addres i � S'! ]_ �`�
Owner's Name L hone
Address
Arch/Eng. License No.
Address �
Contractor's Nam p � �� Phone �� �
Address (ma ���g� ^ "� � - � � �' � t�
City License No � ���i
LICENSED CONTRACTOii DECLARATION
1 hereby a(firm lhat I am Iicensetl untler provisions of Charter 9(commencin9
with sectlon 7000) oi Oivision 3 0( the Business antl Professions Cotle, antl
my Ilcense is in tull torce `Hpst. ����/.yv
License CI s � Li e se No. 3� '/�
Oate Si9nature � ���1��
WORKERS' COMPENSHTION DECLAR 10 �
I M1ereGy affirm that I have a certificate of consei t to self-tnsure or a certiflcate
of Workers' Gompensation Insurance, o( a certitietl wpy t�ereof (Section
3800, Lab. C.) .
Polfcy No. Company
eCertifietl copy is hereby tumishetl.
Certified copy is filetl witlt tne city Builtling Division.
Date Applicant
E%EMPTION fROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if the permit is for one huntlretl (E300) or
less).
I certity that in (he performance o( [he work for which this percn�t i5 is5uetl I
shall not employ any pe�son in any e� so a o become subject to t{�e
Wo�kets' Co pen o�s ot Cali r'.
, Date ���, � <ignature '
'NOTICE: If, after making this tleclaration, you 5 oultl become subject to the
Workers' Compensation provisions of Ih Labo COtle, you must forthwith
comply with such provisions or this permit shall bG tle¢metl revoketl.
CON5T0.UCTION LENDING AGENCV
1 heroby affirm that tM1ere is a const�uctlon lentling agency tor [he pertotmance
of tne work tor which Mi5 permit i5 issued (Section 309] Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILUEH bECLARATION
I hereby atfbm tnat I am exempt lrom the Contractor's License Law tor the
followin9 reason (Seclion ]031.5 Business antl Professlonal Cotle: Any city or
county which r¢quires a p¢rmi[ to const�uci, al[er, improve, tlemolish o� rapdir
any Strutture, prior to ils Issuance, also requires the applican[ for Such pnrmit
to file a Si9nGtl statement thal h¢/sh¢ IS Iicensetl punuant to the provi5ion5 ot
ihe Contractor's LlcenSe Law (Cnapter 9(commencing with Sectlon 7000) of
OlviSion 3 of the Busine55 antl Protessions Cotle) or that hC/She Is exempt
therefrom antl the ba5i5 fOr the allegetl exemptiOn. Any violatlon ot Section
7031.5 by any applicant for a permi[ sub�ec[s tne aDVlican[ to a civil
�enalty of not more than flve huntlr¢tl t1011are (E500�.
I, as owne� of the prop¢rty or my emplOyees with wages as lheir Sole
compensation, will tlo the work, antl [he 5tructure is nol intentletl or offereC
for sale (Seciion ]Oa4, Businass antl Professional Cotle: The Contractor's
�icense Law tloes not appy to an owner of a property wno �uilas or imp.ovos
thereon, ana who tloes suth work himselt/herself or tnrough his or hor own
employee5, provitletl that such Improv¢menis are not intentletl o� oHeretl for
sale. It, however, the builtling or improvement is soltl wit�in one year of com-
Dletlon, the owner wlll have the burtlen ot proving he/she tlitl not bulltl or Im-
prove for the purpose of sale).
❑ I, as own¢r Of the pro0erty, am ezclusively contractlnq with licensetl Con-
VactOrs to consl�uct the project (Section 7044, Business antl PrOfe55ions Cotle:
The Contractor'S License. Law does nol apDly lo an owner of property who
builtls or ImDroves thereon, antl who conVacts for such projects witn a con-
tractor(s1 license Oursuant�to the Contractor's License LawJ. I am aware that
proof oF lheir WorkerY Compensation insurance shoultl be provitled to me.
❑ I dm exempt untler Settion B. & P. C. for this reason
�ate
1 he
info�
Signature�
Drivers' Licen
CMF 0865-46, rev.
Owner
upon
C
TYPE OF CONSTRUCTION LJ NEW U ADD Lfi'ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER • A p #
DESCRIPTION OF WORK/USE OF BLOG. �
1 � S Main Buildi
TYPEOFPERMIT GRADING� F�NIODATION STRUCTURAL T Ffont
❑ TENANT ❑ ELECTRICAL 'L-I PLUMBING ❑ MECHANICAI B Rear
❑ OTHER A
PROJECT DESCRIPTION 5�. FT, oCCVPANCv C Right
K Lett
CONSTRUCTIONTVPE VALVATION$ $
ZONE GRADING CV. VDS. ACRES Ping. flef. #
qemarks: Plannina Notes:
Sink
<flow Preventer
kflow Irrigation
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Intercepmrs
Kirchen Sink '
Lavatories
P—Trap
ftoof Drains
Reinspection Fee � $15
Boiler .
Duct - Under Ground
Duct - SVucmral
Duct- Ventilating
Exhaust System ❑ Multiple
FirepUFact. Bit. ICBO # '
Heating System & Ducting
❑0.100,000 BTU 0700,000
(O�/�`ii J
� Reinspaction Fee $75
White - Builtling; Cana�y - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service �
Amo-Wash
laue Fee
Hoodor Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑o-ioo,00aeTu ❑ioo,000sT
System Repair/Alteration '
Fire Dampers
Re9isters
Isue Fee
FEES
�%
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas' DElectric
Accessory Buildin9: .
(' '
ZonO
ELECTRICAL •
Transformer ❑ 15-50 KW
❑ 50 + KW
Meter ❑up ro 100 amps
Meter ❑overi00amps
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor �0.5 KW �5�15 KW
Sub Panel
Motors �P7 HP � 1 h- 8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Light
Range
Sign
! Standing Sections
Trash Compacmr ,
FEES
2
O
N
I
N
G
R
E
Q
M
T
S
$ 3 I
� Reinspection Fee $15 luue Fee $ 3
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approvad By Data
8uilding Approvad By Date�/�,/)�� �
Appliwtion Issuad By Date�_
�_-
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN.CHECK $ PERMIT
PLUM8ING $ S. OC� ISSUANCE 3
PLAN CHECK 25%� $ ENERGY P.C. 3
ELECTRICAL $ GRADING S
� PLANCHECK 50°� $ MICROFILM S
MECHANICAL $ TOTALFEE $ 5'p�7
$ 3 PLAN CHECK 25% $
� CONSTRUCTION AND PLANNING POOL & SPA
r APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement -
' 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms
4: Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding �
i '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
`7.� Footings . _ " 58. Electrical Conduit-Undrgrnd.
8. FoundBtion � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. -� 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System ' 61. APPROVAL TO DECK �
1�1. Property Sewer Line & House Connection 62. Backwash & Receptor•Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final . ,
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. floof Framing � 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheattiing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame 9nd Flashing 76. Dry Standpipe
28. �Lathing & Siding 77. FIXED SVSTEM 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 Condi[ioning � �
_
35. Final G�as-Pipe-Test� '� �`7/ � Q, � �
36. �Hood or Ca on py ^ � � � � �
37.�F�nal Factory Fireplace-� �
�_- _ - -
38. Final Plumbing
39. Water Service-Finai
40. Gas Service-Final
41. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation �
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release�to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
r �+-�
PflOJECT RDONESS: UNIT:
OWNEfl'SNFME: 3H4 E 16TH ST
nooaess: JUDITH OSMER
111 VIA CIRCULA
REDONDO BEACH
AflCM/ENGINEEfl:D�N LEE_0736 flEG.NU.:C.l 1
AOOflE55: Z S O L N. HAR TMAN ����
PEflMITTEE:ORANGE CA 92665
nooAcss: WHITE OAIC CONSTRUCTION ( 714 ) 645-6934
833 W 17TH ST 1
COSTA MESA CA 92627
LICENSEO CONTBACTOB OECIAMTION: I t¢re0y ai�irm Oul I am li[ertu0 unGer prwisions ol Ctup�er 9(commencin8 vnlh Section
7IXp) ol Drvision 3 0l Ine Business anG Pmlessions CoOe. anC my li[enu 6 in lull force and ellect.
ciTvuc.:03227 sT"'Euc.�423231 cuss:H
Oale: _���� Sigfldiure: _ . . — .
WOBREflS'COMPENSRTIONOEC(ABRTION: IllereUya� m tlnaveacenificatealwmentt n-insureoracertiliwtealWarkers'
Compenu�ion Inswance. or a ttnilie0 wvY �nereot (Se ian , Lae. q.
roucrNo.:1200282-92 o�TE:07/O1/93
camrnxr:STATE FUND
❑ CenifieE cooY is �ere0y Iurnis�eE. �J( CertifieU cooy' liled with ttre ury 0W ing Uvision.
'�aie: � � 7 ' 7 J APDlitani'
E%EMPfION FXOM WOflKEflS' LOMPENSATIOX OECIAMTI IL � Itis sectqn nttG m� �e canpkteJ il Ne permn B tor me twikrttl (5700) or less�.
I ceriily Ihal in the Oedormance of �he wnrk far w�ich �� per il is i55ue4. 15hall nai em0�oy any person in any manner so as lo become
Sublec� Io I�e WorkerY Comp¢n5aiion LavS ot Calitom
Date�. Signamre:
NOTILE: If, atler making Inis aecWratiOn. you shaula eeCOme suoieq to the Worker5' Compensdtion Orwisians ol �ne LaOor
Catle, you mus� lohhwith compry wii� suc� pmvisions or IAis permil s�all Ce EeemEO rewke0.
CONS7BUC110N LENOING AGENCY: I �ere�y allirm ilwt t�ere is a constmction lentlinp agency for the peAormance oi �he wmk for
which Ihis oermil is issuetl (Seciion 3W7. Civ. C�.
LENOEN:
ADOflESS:
OWNEP BIIILDEP OECUBpT10N: I AereGy aHirm ihat I am e.empi Irom i�e Comrac�ors' Slate licenu law lor ihe IoilowinA �easan
(Semion 703t.5 Business an0 Pmlessional Cotle: Any city ol coumy w�ic� reQuires a permit io constmct, al�er, impmve, 4emolisR or
repair any Slmcium. pri0r lo IIS issUanCe. a150 rEpuiR5ltle aODlitanl �or Sut� Oermil lo lile a 5ipned Slalemeni Ihai �¢/5�e i51icen5¢A
pursuant io ine omvisians ol tne Camracmrs' Slale License Law (CAaO�er 9(commencing with $etlion 7000) ol Uivision 3 0� ��e 9usiness
an0 Prolessions Cotle� or I�al �e/s�e is eaempl t�ereimm anOl�e Oasis lor t�e a11eAeE eremD��on. Any tiolation ol Section 703t.5 Uy
any aOVlicant tor a permit sublecis I�e applianl to a tivil penalty ol not rtqR t�an live IlunOreO Oollars (5500�.
I, as owner ol tAe pmpetlY or my employea wi�� wapes as t�ei� sole compensa�ian, witl tla ihe work, anG t�e
❑ SlruClure is nol inle�dea Or oller¢0 tOr Saie (Sttiion 70aa. Busineu an0 Pmfessional CoGe: TAe Comracrors' State License Law
Oces nol apON to an owne� ol a O�ap¢rty wiq OIMGs or imprWES t�erzOn, anC who Eoes suc� work OimSell/�ersell or t�rouq�
nis ar Mr own emoloyces. O�ovi0e0 ItWI such impwvements are not intendetl ot offereE lor sate. II, Aowever t�e Uuilding or
im0�ovemen� b 5dE vnlNn ane ytar ot tAmpletion, t�e Wmer vnll INve t�e OUraen ol proving he/s�e GiG nol huJO or imOmve
lor me o��oose ol salel.
I. as owner ol t�e pmDeny, am eKclusivety comraclinq wit� IiwnseG Coniracmrs to wnslmc� ��e D�ole�� (Seciion 70ad, Business
J and Protessians CaOe: T�e Conirac(ws' State License Law Eces not apW to an owner ol proputy wM OuilQs ar improves Inereon
anJ w�o tontrat�5 lor suc� Omjecis vnl� a conlraCtOqS)license pmsuant to lh¢ Conlractor5' Slaie License Law�.l am aware
inal prool ol tneir Worker's fAmpCnulan insuran[e stqUa oe prOvbea to me.
� I am eaempi un0er Sectqn: B. 6 P. C.
lat IN5 ieason:
oate: O�mer.
I ao nere�y cendy itWl I am aware ol an0 unaerslaM Ine repuiremenis ol Caltlorttid Healin aM $diery CaOe Sections 25505. 2553J, an0
2553d antl ��al I or any IWwe �uilainp acupani wilVvnll nol (circle One) nee0 ia comply vni� sai0 slale wUes antl the requiremenls lor a
Dermii lor Con9mQion or mpEiliCaliOn IrOm Ille Au aLiy MaNg¢minl Di5iritl. flpSiJenlNl LOnStmtlbn aDaiWli0n5 are ¢K¢mpl hom
tnese orovisions.
Date: Ap01iWnL
I h¢ieby Cetlity IAaI I have r¢aa I�is appGwtion anE slaie Ilui I�e aDove iniormaiion ¢ Correci. 1 agtee lo tompty with all Ciry and Caunly
Ortlmance5an05lalelaw5relalingloUuiltlmgtonS�mtlionanOher¢EyaulhorizerepreSenlaiivesoll isciryloenleruponihea6ove�menlion¢a
pmpetly lorinspeclion purposes.
oate: /—/�I�� Si9naWre:
Oriver's License or Sncial Secwilv �:
�64t�a6 Whne—BmlCing;Green—CoaoEnlarcomom;
Pink—Rwenue; Golaenma—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 060635
PERMZT NO; E 060635 PLAN CHECK NO; N GOVT: N SUPP: Y
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION ; ELECTRICAL METER PERMIT(SERV,RELOCATION) SQ FT;
CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /M-1
*�*****���**irB�****fe�eB*****�e****irB�e*�*****+t*�r******it*�r�t�e�r*�**��*�t�r�*�r�e�r**�r�e*�r�r+r
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ----
FRNT: FT IN REAR; FT
LEFT; FT IN RGHT; FT
PARKING REQ• PROV;
PLANNING N25T'ES>
�
kikkif klkiFitkifiEifiEiFiEikifiFifiFiliFiFififkiFiFkiEk
D E V E L O
ZONING APPROVED BY
'BUILDING APPROVED BY'
APPLICATION ISSUED HY
it M ih if 1f if iF �f 1t k k if it �f if it it M iflk if
it if k iE if �lf iF ik k if kit 1F k 1E ik If iF if it 1f
LEGALIZATION;N
BLDG PMT
M E N T
---- --------- ACCESSORY BUILDING ---------
ZN FRNT; FT IN REAR; FT ZN
IN LEFT; FT IN RGHT: FT ZN
PARCEL; 42519115 ZNE: REF NO:
it if iF 3F ik 3f 1f ik if if if i! iF �f lkif M k If kif if iF if if iE 1f 3E itit ik iF if ik iE if iF k k k if IF iF 3f If iF k iF
S E R V I C E S R E Q U I R E M E N T S
�
DATE;
DATE;
k 1E iF k k k k k iF k k iF iF if if �F �f if k �F If It M 1�If/If if if 1F3f k if iF M if ik ik if if iE Ik k iE iF Ik k M 1f i! 1E if if IE if if if iE 1f
F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT PLUMBING ELE18R50 MECHANIC FIRE SMIP/RES GRADSNG
JOr
PLAN
ISSUE FEE 4.50
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 18.50 4.50 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMHING ELECTRIC MECHANIC
23.00
SMIP/NON—RES
TOTAL PAID DUE
23.00 23,00 .00
23,00 OVER/SHORT: ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
kkkititkifkif�hikMikif�fifMifitifkMik�fiFiFiFififilifififlFifiFkikkkififiFkifififkklfkkfFMifkkkifMkMMkifkkkkkkikiliFiFikiflfiF
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
ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18.50 18,50
END OF FEES
I
; CONSTRUCTION AND PLANNING
APPROVALS Permit �`r Date
1. Temporary Electncal Service or Pole
2. Soil Pipe-Und�qtnd. � ' ' ' . .
_ :`-ri
3. Electrical Conciuit-Ut+lity•Undrgmd.�
' 4. ElectriCal Conduit�Undrgrnd.
5. Stcei Reinfo�cement�
; 6. Elnct��cal UFEE2 Gmd.
8. Foundation
9. 1":ater P�pe•Undrgmd.
.'_ "_.___ I _
I 10. Structurui Fioor Systam �
�
11. Property SerJer Line & Hou<� �nnect�on
I 12. Se�ver CaP . ' .
�= - -
13. Roof Ora�ns ' . "
14. Rough Plumb�ng
� 15. Rough EtBctriWj-Condurt
; i6. RoughElectriclNiring
_ . . ._- � -- . _ _--------
17. Rough Wiring Sgn
18, Rough Electrica6T Bar Cedmg
19. Rough Heating & Air Conditioning
c
20. Roiah factory FireA�ace . , _ - -
2/. Ducts, in Strucmre ' " �
�
22. DutTs, �Jdntilating __�� � �
23. Gas Pipe-Rou9h & T�tst �� '
r,
24. Roaf Framing " � , .
25. Root Sheathing . ,. � �
26. T•Bar Ceiling �Stracturaq & R�pnoc�at ;,
27. Frame ard Flashing � ..
28. LatRmg.L� Siding _- � -
29. Insulati�n � � •
30. D�W:all,£lait�ng
37. Plasier Bro�vn Coat • ' � * . �
32. Electnc:.i Por}er tvlejer�Final.
i
33. �Final Elettriy� , „ �� `
34: Final Heating& kl� ConditionT�� � `
4
35, Final Gas Pipn�Test i � .
36. Hood or Canopy "' - � '' = ' ' -
1; r �
37. Final Factorv Fireplace ' � - �
38. Final Plumbing . ' "
39. Water Service-Final , ' .
4Q. Gas Service�Final *. . L.� •
41. Solar pomestio-Final r, . -
42. Backfiov,r Preventer . � �
43. Batkflow Irrigation, ' _
44. Landscape Ir�iqation System - •
45. Sound AttenuatioR . . ' �
46. Handicap Reyulatians " ^
47. fINAL STRUCTURE & BUILDING
48.- FINAL PLANNING - -
-,49. EleRric Releyse to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPFiNCY
No. Date
POOlB a
Inspector qppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rou9h Plumbing & Pressure Test
57. APPROVAL TO COVER-GUN�TE
• 58. Electrical ConduibUndrgrnd.
59. Gas Pipe, LJ Undr9rnd., Test
, 60. Back�vash Lincs, P�Tr�p, � Ur.u•o�rd. �
61. APPROVAL TO DECK
62. Batk•.:a;h & Re[splor�Final
63. Heater & Vent•Final
64. Plumbing System - Final
65. Eiectrical-Final
66. Solar System•Finat
67. Fencing & Acces: Anp�ovat
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS fINAL
, FIRE D�PT. R.EQUIREMENT
_ s
' y'.� ' ,P.PPRC�Vq65: : Vernjit #� �
`- " ' =70. Underground� Hydro "
.-
_ z<� .
. = ;]1. Product,Pjping C7Ges ❑Oil
r . T�' 72. Underground FI,�sN� ^
�� . .73. =Llndergrnd. Stor�geTank C] Gas '� 0�;
- 74: �Overhead Hydro '
,-; . 75.;DryChemkal '"
- ---+--�-+--
- 76. Ory Stand�i}:e ' - "
'i � �� 77. FIXED SY$jE�4 C-1NAL� . ,
I I + 78: �FIRE PREV. FIhAL " •
' HEALTH�OEPT, REQUIRHD,IE�T
I• 7g, p�NAL INSPECTION - a I
Q_��. �AO. FOOD CERTIFICATC ISS�UED � �
1�1_ � �u�
Notesr . • •. . � -.
S . L •
_ t
_ ,.7
� �
+- ' -
. • t t
Date � Inspector �
--t
I�
I /
Pfl0.1ELT RODHE55: 384 E 16TH ST
OWNEN'SNpME:OSMER JUDITH A TR
eooaess:lll V`iA LA CIRCULA
REDONDO HEACH,CA 90277
ANCM/FNGINEEfl:
aooeess:
HEG.NO.:
uxir:
uxiT:
PEHMIiTEE: COAST ROOTER 6 PI�UMH ING ( 714 ) 7.41 —1414
aooRess: z�37 S CRODDY D
SANTA ANA CA 92704
IICEN$EU LONTBRCTOfl OEClAPA710N: I �GreOy albrm I�a� I am Iicense0 un0e� prOvi5ion5 al Ctwp�er 9(Commencinp wil� Se[Iion
7000) ol DmLon 7 0l t�e BuSineu aM PmleiSions COde, an0 my license 4 in full lo6e an0 ell¢ti*`��
ciTr uc.:04 514 0 srere uc.r� z g 12 � cuss: _
Date: �� �O ' 9� Signamrc: _ ' _ ' _
WOBREflS' LOMPENSATION OECIABRTION: I AereUy Bilirm Ihai I have a Cetli�kaie 0 Conu o ull-insurt ar a cenifkale ol WOMeri
ComDensation Insurance. or a cerlibe0 cooY ��Q�eo115ection 3800. Lao. C�.
voucrxo.:pC943520 E%P.DPTE:OS�OS�94
camraxv:REPUBLIC It�,DEM
❑ Cenilie0 coDY 7is nereby lurnisnea. }U Cerlilie0 ropy is file he city BuilOinq/7Oivision.
�a�e: %J �XJ'�3 PCPlicanL �n^ s��l��c� "�e� '
E%EMPiION FflOM YlOPNEflS' LOMPENSNTION DECUX,I710N: (T�is section nettl noi be eampktM il Ne permit is tm ane huM20 �5100) or kss�.
I CeNly I�al in I�e p¢tlorman[e ol I�e work �or wtiith Ihis permi� i5 i55ue4, I 5�all nOl emObi a�ry person in any manner 5o as ro Dttome
subect to t�e Workers' Comcensation Lavrs of Calilornia. �
Oate: S�pnamrp: '
NOiItE: Ii. aiter ma4inq this aecWration. you 51iopIA became suei�� �o the WOAers' ComDewtian prwisions ol �he La�ar
COde. rou musl fontmitn fAmply wiin sucn pmvi;ions or Ihis p¢rmit shdll be tletm¢0 rtvoke0.
CONSTBULTION LENOING RCENLY: I �ereby allirm Nai I�ere is a consimction IenGin9 apency �or I�e OeMormance ol Ihe work lor
whicn inis oermii is issuee (Section 3097, Crv. C�.
iexoen: '
AOUNESS:
OWNEfl BWIOEN OECUMTION: I heRGy a��irm Iha� � am eeempi Imm I�e fAnlratiors Sute License Law lor the lollowinp reason
�Seciian 70�7.5 Busineu aM Pmt¢ssional CoOe: Any city of counry whicA repNrts � ce��� �o artstmct. alter, improve, Cemolish, or
Rvart any sUutWre. o�� ta ies issuance. al5o reQuires ine aDDlitant for suth permt to lile a 5ipneE statement ihdt nNsne R IicenuE
pursuant to ine o�w¢ions o� tne Comraciors' Staie License Law (C�ao�er 9(cammeMinp wit� Section 7000) of Division 3 of tAe Business
anG Pmles9ons COde) oi IIWI �¢/s�e 6 exemD� I�ereftom an0 t�e basis lor I�e aAepeO eAempGon. Airy vioWtion ol S¢ttion 7031.5 hy
any apDliwn� lor a Oerrttii SUClecls IOe aOV���n1 lo a Civil penatly ol not more Itun live �unCreO OdlarS �5500�.
I, as owner al i�e propeny or my empioy¢es wit� wages az meir mle campensa6on, wi0 Uo Ihe won, ana me
❑ simnure i5 noi imen0etl or ollere0 for sale (Seqion 70aa. Business anC Pmfessional Cotle: T�e Comracmrs' Slate License Law
Oces no� apply to an ownet ol a pioperiy who Duiltls or impmves ��ereon, ana wlq do¢5 such wark �im5elfl�ersell ot ihmup�
Ilis or �er own employees, p�ovi4eE Ihdl such impmvemenis are no� intenEeG or ollere0 for Sale. If. however Ihe builainp or
impmvement is sold wilhin one year of comple�ion, ihe owner will have ��e Gurden af Dmving he/she di0 not Uuiltl or improve
tor I�e purpose ot sale�.
I, as Owner ol Ihe pmpetly. am eMClusiv¢ly con�raqing wilh IicenseU conVactors m constma lhe O�ole« (�ctian 70oa, pysin�
❑ anE Pmfe55ion5 Co4e: T�e Coniractors' S�ate �icense Law Eoes nolaOPMto an Ovmerolpraperly vRq OuilQi or unpmvest�er
antl w�o conira[Isior Suth pml��5 wi�h a toq��ador�S�liCense pur5uani la I�e Canvattors' State �kense Law�. I am aware
I�at proa� ol Iheir Warkei 5 ComDensati0n inSUrante Shoultl G¢ provitle0 lo me.
� I am eyemD� under SectiOn: B. 8 P. C.
mr uns reason:
Oate: Uvner.
I tlo nereoy cenily tha� I am aware al anU unAerstanG IAe �epuimmenis ol Cahbmia Meali� anC Safery COGe Seclions 25505, 2553J, ana
2557d antl IIWt I or any Iuiuro Ouilaing acupant wiluwil n 1(circle one) neea to comply wilh 5dia stale totles ana Ihe reQuiremenis lor a
permil Im conslmction or moEAiption bom Ihe Air ualiry Management Ui5Vic1. HevEen�ial conitm[lion apDlicalions are ¢xempl Imm
IhCSC plOVi51001.
Dale: pDDlicanP.
I �¢r¢Gy [eildy I�al I �ave rea0 �his applica�ion and Slal¢ I�at Ihe aGove in�ormalion is correct. I aA�� �o comply vnl� all city and county
or0inance5 an0 sta�e laws reWiing Io OutlOing [onslmclioq an0 �eie�yNN ' e repreuntaiives al IN5 ory ro e r u he a0ove�menlioneU
pmpetl/y lo'r mSDeclion Omposes. �
Date.('J �'� —� 3 9gnaW�e:
Oriver's Lianse a� Saral Securny •:
164na6 White—BwlOing; Green—CoOe EnlorcemCm; Canary—ApPhcant; Pink—Revenue: GolEenroE—Auessor
CITY OF COSTA MzSA — BUILDING PERMIT PERM NO; P 062836
PERMIT NO; P 062836 PLAN CHECK NO; N GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE; PLU PORPOSE; OTH
JOB DESCRIPTION ; SEWER LINE REPAIR SQ FT;
CLAIM VALUE: CAI,C—VALUE: GHOOP OCC; /
COMMENTS: REPAIR LOCATEU IN THE PARKING LOT OF THE APARTMENT BOILDING.
�r**�r�*��*xx*��e*�*�**ir�x*�r*x x***�***+�+t*�r�tx+r�e x x�r*�r******�r+r*�r*x*�r**� �r*�r*+r*x �t�***�r�r
Z O N I N GS ERTEBQAUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LcFT; FT IN kGH7'; FT IN
PARRING REQ• PROV; PARCEL; 42519122 ZNE; REF NO;
PLANNING N(STES> ,
i
iE iF iF 1! 1f 1f it 1f k if iE iE iE it iF if 1E if if if i! 1E 1f iF 1E if iE iE 1f k iF iElt iE ik iF iE 1E iE if lE itlf !E 1E 1E 1E i(� iE iElf 1E )f Ik 7E if 1E 1Flt iE !E fE ik if it iE if !E iEiE !f 1E iE i! iE 1E !E iE jk
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; -3 O
itiEkklliEitifillkiFkkiFfEkltitflitfEfflF'iF�F if7EiF �f iFiF iFi iFiFiF 7fifiFiF iF7fif7f7FifklFiEiFiFikiEi(�!E e if
kiFifififlElEiElklkifitlfkifiPiEiflhlFiFlFiFikifitiEkilkifiFiFiEififiFiEikilklE141f1 N1FititilikklEihiflEilltiflkkiElflEil��lf1l�ifiFkltiFikiEiEififik
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTR'IC MECHANIC FIRE SMIP/RES GRADING
PERMIT SS�St 'i � SMIP/NON—RES
PLAN "
ISSUE FEE 20.00 • �
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15.00 20.00 ., , 0;00 35,00 35,00 ,00
REVENUBLDGVPMT�PLUMBING ELECTRIC�MECHAN�I� FIRES�SMIP�/TOT/SGRADING PLAN—CHECK
35.00 , - '
.,, +.
i! 1E 1k it if iE if ik iE if iE if if 1f k iE lt ik iE fE k iElf iE ik iF i! if fF 1E if iFlE 1E iEik fE 1F it if if 1Elf fE if k iE if iF iF iElk 1f iE 1F ik iF iE it if 1f 1E if iE iE iE iF 1E ik ik 7E iElE ik if 1E 3E If if
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
PLU 1 SEWER, BUILDING /,TRAI.LER 15.00 15,00
END OF'.FEES
I �
. �
P "
�_ �
. L
01 0014?075-00142p75 TiJT 35.00
DATE: 06/30/93 TI11E� 14-56
CONSTRUCTION AND PLANNING POOL 'A
APPROVALS Permii � Date Inspector qppROVALS Permit � Date inspector
i. Temporary Electriwl Service qr Poie 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
� 3: Electrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrica� Condurt•Undrgrnd. 55. E�ectrical Bonding
5. Steei Reinforcement 56. Rough Plumbing & Prassure Test
s. Efeccrica� UFER Grad. 57. APPROVRL TQ COVER-GUNITE
7. Footings 58. Electrical ConduirUndrgrntl.
B. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water PiPe-Undrgrnd. , ' 60. Backwash Lines, P-Trap, O Undrgmd. '
10. Structur8l Floor System � 67. APPROVAL TO DECK I
1 i. Property Sewer Line & House Connection 62. Backwash & Receptor�Final . 1
Bl�lz'�_ _.
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Or9ins 64. Plumbing System - Finai
14. Rough Plumbing 65. Elec[rical-Final
15. Rough Electrical-Condwt � 66. Solar System�Final
16. Rough E�earic Wiring 6J. Pencing & Access Appruval �
i
17. Rough Wiring Sign 68, qPPROVED FOR PLASTERING
i �
18. Rough E�ectricai-T Bar Ceiling 69. POOL/SPA SYSTEfvIS� INAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. fiough Pactory Fireplace � APPROVALS Permit �
21 . Ducts, in Structure 70. Underground Hydro
22. Ducu, Ventilating 71. Product Pipin9 C7 Gas C Od '
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas � Oil
25. Roof Sheathing 74. Overhead Hydro
�
26. T-Bar Ce�ling (Structural) & Monocoat 75. Dry Chemical �
27. Freme arx! Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEAS FINAL
i
29. Insulacitln ' , 78. FIRE PflEV. FINAL
30. Drywall Nailin9 � � HEALTH OEPT. REQUIREMENT
31. Plaster Brown Cqat j � 79. PINAL INSPECTION
32. Electrical Power Meter�Finai � , 80. FOOD CERTIFICATE ISSUED _�
33. Final Electric �'� tiote5:ry_ j=y,� G�,�,�, /t� fQ� Y
� l�
34. Final Heating & Air Conditioning �-/y� � � j�C��• � iN?�
-/ l/ �,.�. ..,_ _ owur_� D_, _ _.f_i_/l"--{,
35. Final Gas Pipe-Test ' � � � ✓ �(f� I
: .ti[.�n �/� Gpp!"flf.�`a. t ..�. t!/G S-�N7+-^'/ "'-�'�i
36. Hood or Canopy � �
l �
37. Final Fattory Fireplace !
38. Final PlUmbing � i . . -- -
39. lNater Service-Final � ' '
40. Gas Service-Final � �
41. So�ar pomesticFinal � �
i j
42. Backflow Preventer �
43. Backflow Irrigation �
44. Landscape Irripation System �
45. Sound Attenuation
46. Handicap Regulations -y
47. PINAL STRUCTURE & BUILDING �
48. PINALPLANNING ' �
49. Electric Release to Edison � �
50. Gas Release to Southern California Gas Co � �
,
51. CERTIFICATE OF OCCUPANCY
No. Date
COtMPLl�;+1lT INVESTIGATION
Received by ��� ///���
Made by: �/JG� �%%�'�--
Ageinst: �%wn.� i" n. y��
r
Direc[ions: —
Nature of Compleint:
Action
�i�--
Complete:
COSTA MESA BUILDING SAFETY OF RTMENT
P.O. BOX 1200
C0.STA MESA, CALIFORNIA T�% (
646 2411 �] Date: �
Address d�� 2 � b- "'�� f� Ph. No�.7
Address -� � � � � � ��^-�
Complainant Yes � �
BY .
No Interviewed: No Date:
FORM BU41-2M-5-B4-CP
ro
.;
\
P
�
ADDRFSS
F7
DATE
SUBCONTRACTOR
J
i7/iJ `/.7'.�.1 _ _ -!�\ '"'�_
� - - ' � - - /vL/�, t.lU-tu� � - ---� .�- "-
4_ 5�85
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING .� � �
ADDRE65
COSTA MESA CALIFORNIA
MAIL
ADDRESS
cm •'G
ARCHITECT
rr/3�ac
TEL.
OF LOT A� �l �v V i I S I Now oN �Qoa.
USE OP
EXISTING BLDG �
B6TBACK LIN6 PROM
CeM'cR OP 8TRe8T S j REAR YARD
SIDE YARD I LEF'� I RIGHT
DESCRIPTION OF WORK
■ BUILDING
�' NO. OF
ROOMS
ROOF
%<C[ � COVER
AND WORK TO B
FEE RECEIl1ED
OCT 1 81961
FINANCE OEPT.
APPLICA'�1�9N �FOR'�T�"Mit�ESA
BUILDING
For Office Use Only
aeceiwc NO. PLRMI no.
ev I o�G��/ J'�O�I /(/w2 ,sj/�
�� �
?�g5/� �. I ��"-' �.
COSTA MESA. CALIFORNIA
FIRE
�bNING �;
ZON! NO. OF U9C OP NEW /Z
�� PLANB � BUILD�NO�
L60AL � � �• �_ , �
DGBCRIPTION /' (P
A. P. NO. I" / / —' � / I — /CG/
YARDS EVES
APPROVED qLLOWEO
�CBNTER LINH BT.) � � ,�
1 HlRHBY ACKNOWL8D68 THAT 1 HAVH RBAD TH�9 MPLIGTION TMe AMOUNT 9HOWN UNDHR VALUATION 18 PON THe
AND BTATB TMAT TH8 ABOVE IB CAPH¢GT AND AOR86 TO CON- pUl808¢ OP EBTABLI9XING • PEpMIT FEE ONLY.
PLY WITX ALL GT' OPDINANCEB AND 9TATE W6 R86ULATNO
9UILDINo CONeTRurnox. VALUATION �f
SIGNATURE OF � �v/� ;/J/�' � PERMIT FEE $ J�'�
PERMITTE $ /(/'� " �� � puN CHECK $ ��
AUTHORIZED AGE'1T L�S
TOTAL FEE /
0
1
1