HomeMy WebLinkAbout492 16TH ST - Building PermitsC. �Y OF COSTA MESL �
GURORNU Y2626 r.0. SOX 1200
FROM TME OFFICE OF TME DIRECTOR OF BUILDINO SAFETV
Project Address 'i �1 Z- � 6� �I,WC.�
Project Name
�
Ownecs Narm ST&.Uk.N ��- �AtiIS
Owners Address �ikZ � 6 �- -�C.1��.-
OwneLs Teieplune 6�f 6�f S� � b
v
��t�S//S6
�
� . �
City Use Qily
I STEU�r� �'I•���5 as Q.�mer, C-erttra�tac, AgeR6 (strike out all
except one) � hereby attest that �loyrtent of any person, or pecsons, is not
anticipated at the time of seeking the above-referenced pecmit. In the event that
any person, or persons, are ert�loyed under the prwisions of this permit, I shall
immdiately cause a valid Certificate of worlmiens Cc�ensation to be filed with the
Costa Mesa Huilding Division.
I agree to defend at my own mst, and to inde�ify and hold hannless, the City,
its offioers, agents and/or e�layees, fran arc3 against, arry arcl all liability,
darrage, cc�ts, losses, claims ard expenses, howscever caused, resulting directly
or indirectly fran, or mnnected with the improvement urKier this permit.
I further state that I have read and fully imderstand the i�licatiorLs arx] rr
sporLsibilities of the above statements, and will cmiply with all provisions of the
Contractors State License Iaw found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
ST¢�✓� FI• ��Avis
Print Name
s� a.
SignatUre
cMv om•as
(Z
te
PPLICATION FOR A BUILDING PE�"+IT
Vi
BUILDING PERMIT NO. E�ectr�w� W
Tratt Block Lol Pormit No. �
6
�/ < Plumbing , •
naa ess y>'L y� 4,C,c� �J / /�(� nne ne��cai a
n Cf055
Area / :, �Q Street Pormit No.
IA' �
Owner �,�G TYPe ot Prole<l: ❑ New ❑ Aitar ❑ Atltlitlon a
Atltlress �• ❑ IRepalr ❑ COnvcrt ❑ Demo ❑ OCCupanGy Pmt.
' Sup. Dist./
CIIY .µ( �[` Z�p���j�j PhOne�(/� �6 A. . IOSP. Arca
ArChitect/ �— Zo SP�. Pmt. No.
Dasigner Llcense No.
Sa[back P/� Fron[ C/L St. Stroel Witlth
Atltlrass
Vartls a g ear
CItY ZIP Phona
ave o. a g . .
« Engineor Ucense No.
C . r nq paces epu re ov e ovew
p Adtlress
m City Zip Phono Struct No.o/ No.of
Halg�t Storles Family
Y LICENSED CONTRACTOR'S DECLARATION Park Focs Yas Fea
u
� ReQuiretl No C.T. Recelpt
m I hereby otfi�m thai I am licansed untler provisiOns ai C�aptar 9
(commencing wixh Sectian 7000 of Division 3 of the Business antl Zoning Appro tl By: Date
� Protessions Cotle, antl my licensa ia ln full force entl effect).
� Litenso Clas= Licensa Numbai
T Dnte_ Contrector Misc.
E Atltlress Proposetl Usa
of Structure
jy CltyandZip ohone
H CONSTRUCTION LENDING AGENCV
� I hereby nffirm that thara is a consiruction lending agency for the
a parformance ot the work �or which thia permit is issuetl (Sec. 3097, O<0. TYPe Cotle
' Civ. C.1. Class Const. Vear
C Londer's Nama USE/OCCUPAN SI2E S�. FT.
Lender's Addrezs
'� OWNER-BUIIDER DECLARATION
Y I heraby aftirm xhat I am exempt from the Contratmr's Licansa Law 1�
� for the following reason:
� ❑ I, as Owner of the property, or my om0loyaef with we8e� as their 2.
wle compensation, will tlo [he work, antl the sb�ct�re ia not
�t„ intentlatl or offeretl tor saie, 3
� ❑ I, es ownar of the proporty, am ezclusively contraetin8 with
liceneetl rontmcton m consnuc[ tha pro{ac[.
� ❑ I am axempt untlar Sac. , 8&PC �o. chla remm� 4�
4 Deta Ownar
E WORKERS' COMPENSATION DECLARATION Total Valuation
� 1 herapy aMirm t�nt I hevo a<artificeto of conaont ro self-insura, EnGrOdchment Permll RBqulretl ❑ Ves ❑ No
or a certlficaw ot Workers' Compenmtion Insuraneo, or a teriifietl
C copy thoroof. GraCing Pmt. GraOing
}s Policy No. Compnny Roqulretl ❑ Vos ❑ No m.
� ❑ CertifleA copy is haraby furnishod.
6 Rou9h G�aEinq C
6 ❑ Carti(ietl mpy is filotl with pran8e Covn[y, EMA. qpprovetl by: Date °D
d Date Appllcont 3
CERTIFICATE OF EXEMPTION �
FROM WORKERS'COMPENSATIONINSURANCE 2
(Thie aeetion neetl not ba complatetl il pe.mit ia for 5100 or lessl. �
I carUty Mnt in tha porformnnca ol tho vrork for which [his permit ia �
iseuod, t shou not employ any perion in eny menner so as ro become PERMIT FEES �
subjact to t�e Workeri Compansation Lewe of Celifornia.
Datu Applicant .
NOTICE TO APPLICANT: If, after mokinp this Certificata of Struttural S Plan Cne E
Examption, yau sM1oultl bacoma subjact to tha Workers' Compensncion
proviaions of the Labor Code, yo� must forthwith comply with s�ch EIBCtriUl § SPetial s
provieiom or this permit shall be tleemetl ravokatl. Invesl.
1 CEPTIFV THAT f HAVE READ THIS APPLICATION AND STATE
THAT 'fHE ABOVE INFORMATION tS CORFECT. I AGREE TO �umbing S
COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBV AVTH- Mechanical E
ORI2E REPFeSENTATIVES OF THIS COUNTV TO ENTER UPON
THE A OVE MENTI O PPOPERTY FOR INSPE TION PUP- pre-Gratl<
PO5 2 �� Inspection E
Pre-Gratle Permit
Sign e ot App i Agent Date Rec. No. S Issue S
�TEv nl - �j�_
Print Applitant s AgenYs Name
All spaces within this box must be completed to proceu P�an luuance
Check BY: Approvltl:
i,mr wo>-co �nu-<a� rav. o/nv
PPLICATION FOR A BUILDING PE�"aIT
�
(� BUILDING PERMIT NO. E�ectriw� W
Tract / 7/ 7 Block Lo[ � Permit No. �,
a
Plumbing .
Atl'C�ress Z /6 � �jQ•U� �O � % � �ermit No. �
L D
w � Cro55 /�/� �! MeChanical �
SVeet Permit No.
Area �� G�
Owner ./ �J TYPe of ProjecL ❑ New ❑ Alter ❑ ACtlitlon �
Atltlress � G� �� ❑ Repair ❑ Conwrt ❑ Demo ❑ Occupancy Pmt.
CitY �" ,�y� ZIP 9�p� Phona� G G A.P. ' SuP. Dist./
InSp. A�ea
ArcNtett/
Designer Licanse No. Zone SPI. Pmt. No.
Atltlress T= Setbacks P/L Front C/L St. Street Witlth
(/ 4 %
/ Vartls le ght ear
cnr � i �ii c/� Z�P �� G�hona�a 3� S1b
ave o). e ig . .
Englneer License No.
� � ng $PaCaS equ �e rOvi ¢ ove�e
a Atltlress
m Cit ZI Phona $trutl No. ot No. of
Y P Heiqht Stories Famity
� LICENSED CONTRACTOH'S DECIARATION Park Fees Ves Fee
� ReQWretl No C.T. Receipc
m I heraby offirm that 1 am licensed under provisions of Chapter 9
L (commencing �vith Section ]000 of Division 3 of the Business end Zoning Approvcd BY: Date
�. Profazsions Cotla, antl my licanse Is in full torce antl effectl.
3 l.iconse Clas Licenee Numbor
> Dece Contrac�or M�sc.
E Address Proposetl Usa
ot StYu<tur0
y, City and Zip Phona
N CONSTRUCTION LENDING AGENCV
� I hereby aftirm thet t�era is a consnuction landing aBancy for the
a pariormance ot tho work for which thie pormit is issuotl (Soc. 3097, Oca Type Cotle
' Ci¢ QI. Class Const. Vear
C Lender's Name USE/OCCUPANCV SIZE S�. FT.
Lender's AtlAress
� OWNER-BUILDER DECLARATION
� I horeby affirm that I am axempt from the ConhactOr's License Law 1�
t° for tha following reamn:
� ❑ I, as owner of tha prope.ty, or my employees with wages es thair 2.
C sole compansation, will do [ha work, and tha svuctura ia not
r ��� ende0 or otterad far sela. 3
� �I, as owner of iha prpperty, em ezclusively contrectin8 �+'��h
licensetl contractorsto construct the project.
d ❑ I em xe pt under Sec. _,1f,L, B&P � or this �1pn a'
= //f� .�. 1L4 i
n Det Owner bf�=, c/Lc�
E WORKERS' COMPENSATION DECLARATION Total Valuation
� i noreby f�i.m cnax i haw e certificare ot consen[ co seH-insu.e, Encroacnmenl Permit Requiretl ❑ Ves ❑ No
or a certificata of Workers' Compensation Insurance, or a cartifietl I
C cop thereof. Gratlln9 Pmt G�atling
� P icy No. Company Requiretl ❑ Ves ❑ No Pmt. No.
�d Certifietl copy ia hereby furNshetl. Rough Gratling V
G ❑ Cartif' opy is filed with Oran ounty, A. � m
Q AOProvetl Oy: Da[e
Date APPlicent 3
CERTIFICAT EXE P ION
FROM WORKERS'COMPENSA710NINSURANCE Z
(This seciion need not be completetl it permit is for $100 or less). �
I certity that in the performance af the work tor wMich [his permit is Q
issuetl, I shall not employ any pe�son in any menner so as to become �p
subject to Iha Workers' Componsotion Laws ot California. PERMIT FEE$
Det� Applicant
NOTICE TO APPLICANT: It, atter mekinB this Certi(icate ot Struttural E Plan Chetk §
Examptian, you should become subjec[ to the Warkeri Compensation
provisions of t�e Labor COAe, you must forthwith comply with such Electrlcal s SOe[ial s
provisiuns or this permi[ shall be tleemW revoked.
Invest.
I CERTIFV THAT I HAVE REAO THIS APPLICATION AND STATE p�umDing S
THAT THE ABOVE INFORMATION IS COFRECT. 1 AGREE TO
COMPLV WITH ALL COUNTV ORDINANCES AND STATE lAWS
RELATING TO BUILOING CONSTRUCTION, AND HEREBV AUTH� Mechaniral S
OFIZE EPRESE ITATIVES OF THIS COUNTV TO ENTER VPON
TNE OVE M NTIO 1 PROPERTV FOR INSPECTION PUR-
P Re-Gratle a
� 2 O Inspection
$ignature of Appli nt o A9e Oa %eGratle 5 Permi[ s
S��v�� � fe I}�{� I''� ReC. No. ISSu¢
�1_ �
(/CYAJG I
Print ApplicanYs/Agant's Name
All s aces within this box must be eom leted to roeess P�an Issuance
. P P P Chatk By: Approvetl:
CMF 0335-46 (BU-28) rev. 6/80
PN0.IECT�DOHE83: 'I9Z 16TH PL
owxee�s xaMe: MURRAY
�aoox��.SAME
642-6080
RflCN/ENGINEEN:
ROOflESS:
HEO.NO.:
uxir: CITY OF COSTA MESA - HUILDING PERMIT
PERMIT NO; H 048593 PLAN CHECK NO: 03754-90 L
CONSTRUCTION TYPE; PERMIT TYPE: STR
UNR:
PENMITTEE: MURRAY ( 719 ) 642-6080
pooxess: 492 16TH PLACE
CM ` CA 92627
LICENSEO CONTMCTOB OECLAMTION: I hereEy aflirm that I am IicenseE un0er provisions of Ctupte� 9(commencin0 ��h Section
7000) ol OiWsion 9 oi ttce Busness an0 Proless�o�s CaEe, and m§'Aunu I5 in full foru anE effect.
CITY UC.: ST�TE IIC.: CUSS:
`�dIO: S�D�d211f8:
� ��PRFNS' COMPFNSIITION DECUMTION: I �ereby attirm ihat 1 have a ceNficate o� cmunt ro setl�insure or a ceNllcate oi Warkers'
ip¢nsation Insurance, or a certitietl topy tperCoi (SCttian 3800, LaD. C).
dCY NO.: E%P. O�7E: �
� "LMP�NY:
Cehi�ied coDY 5 herehy fumiS�eA. ❑ CerGfieO coOY �s file0 wiN (Ae cfty BuilOinp Division.
"� -
Date: pppGwnt '
E%EMVfION FPOM WOPNFAS' COMPFMSITOX OEUAM710N_, �Ttis seNon nee0 not Ee mmpleteE if the permn ¢ M me hundre0 (5100) or kss�.
I cerlity that In tAe pedormanu oi the xrork lor wNc� INs pemut is issueE, I slall nat employ any permn in any manner m az ro Oecome
suUlect ro tha WaAers' Campenution Larrs ot CalAomu: �
Date: 6ipnamre:
NOTICE: Ii, atler maldng tAis GecWraGm, frou s�oulE Eewme subl�� �o I�e Workers' ComOenutbn prmrisions oi t�e LaCor
CoOe, yau must forthvnN comply wit� SUL� D«� ar iha permit shall Ee Oeemetl revake0.
CONSTNOCTION LENOING �GENCY: I �ereGy affirm that there is a consimctian Ien0in0 apency lor Ne Dertormance al Ihe vrork for
wtiich this De�mit is isSueA (��wn 3WT. Civ. CI. .
LEN�EP:
�ooness:
OWNEB BOILUEB OECLARATION: I �ereEy af��m ttat I am exempt imm tAe Coniracrors' State license Law for t�e fallowinp reazan
(Section 7031.5 Business antl Pmiesvonal Co0¢: NiY rib a� �ry �K� �e0Nre5 a permit ro canstruct, alter, Imprma, Aemolish, or
repalr any stmcturt, D�or to its issuanu, also �epuires tAe apD���� �or sucA permit ta lile a spne0 statement Ihat �e/sha Is Ilunsed
pursuant to Iha pmNsions of tAe Cont2ctors' State License Law (CIwD�ar 9(commencinp wit� Sectbn 7000) of DNision 3 0l t�e Business
anA Pmlessions Code) ar tlat MJSAe is eKemDt Nertlmm an0 Ne Uuis tor t�e allepeE exemptlon. My �ialation ol Sectbn 7031.5 Cy
�ny ap011wnt tor a Dermit su0lec[s Iha aD7lica�� �a a cNil penalry of nat mare than live hunUatl Uallars (5500�.
I, as awner al t�e pmperty or my employees vAth waqes as their sole compensatian, wlil tlo the wark, antl iha
�) J strupure is nat intanOeO or ottered lor 5ale (SaCuon 7091, Busineu anE Pmfessional CoEe: TAe Contactors' State License Law
�' does �rot apply to an awner ol a D�opefN �w CuilQs ar imprwes tAereon, and who does such work Nmsell/Aerseli or thmu0h
�is ar trer own employaes, provitleU tl�� sucA imDrmemenis am noi inten0e0 or ollam0 lor sale. II, �owever tAe DuilOinp ar
impmvement is mW wilNn one year al �m0letion, Ihe wmef v.ill Iwve lhe OurGen Oi Dmvinp he/5�! Old not EuIIE ar ImOmve
lor tAe Durpose ol ule).
y(, I, as owner of t�e Omperry, am eKclusively wnlracWp with IlcenseJ contractors to cansimct Ne prolect (Seclion 7044, Businass
LJ anE PrWessions CoOe: The CantrzMrs' SUte License Law Oces irot appty to an ovmu of Oroperry who builUs or improves mereon
and who cantractslorsuc� D�ojecis a;N a caniracror(s)license pursuant to Ne Contracmrs' St��e Luense Law),I am aware
IAat D�aal al their Worker's ComDens¢Uon msurance sMu10 be prwi0e0 to me.
�� 1 am exemD� unAer Section: B. 8 P. C.
lor ihis rcason:
oam: 8�- 6 ^ � ownec
I Ao hereEy certity tAat I am aware ol antl unOerstanOl�e repuiremenis al CatiPomia atlh an0 Salery Code SeRions 25505, 33, anE
25534 ana inat I or any hrtum EuilEinO �Want vrilUvnll not (drde one) nee0 to compry with said state coEes anE Ne repuirements lar a
permit for consimctwn or moCilication Irom t�e tir Oualiry ManaAemenl Distdct. HesiOential constmction applicatians are axempt imm
thesa pmNsions.
Date: pppliWnC
I herebVi cenity that I have reaC Ihis aDPlication an0 state tAat tAe a6wa infarmation is cartecL I a0ree to compty with atl city an0 counry
Oftli11dI1fR5dn0 Sldt¢ WWS 21dL110WDIlIWlflp Ld6���� � MRb/211f110fQEf2pfC5211Ut1VC4 O�1111$ plytOC�i¢IUp011tAp 3EM&fI1EfNMCA
property p/or insDection puryaus.7� //��,
Daie: � o���v � ( v ypnaWre: / /�
Dnver's �imnse or saia� Secunry x:
�\1BOL48 Whi�e—Buibing; Green—COEe En�orcemant; Cnnery—Applicent; Pink—Ravenue; Goltlenrotl—Assessor
JOB DESCRIPTION : ADD TO SFD
PERM NO: B 048593
GOVT: N SUPP: N
PURPOSE: ADD
SQ FT; 670
CLAIM VALUE: 30,000.00 CALC-VALUE: 46,230.00 GROUP OCC: R-3 /
COMMENTS: ADD FAMILY ROOM & STUDIO TO SFD y�+��}� #� �-�*� p
+t**�r�t*�*�r+r*x**�r�*�t�r***��rx�r�*****�*��r�rx�**x�****�r+�*x****�r***��VI��LJC I G�fl
I� Z O N I N G R£ Q U I R E M E N T
'� SETBACKS �� t}1RED
------------ MAIN HUILDING ---------- ------ ACCESSORY BUIL'D�C ---------
FRNT: 20 FT IN REAR: 20 FT IN FRNT: FT IN REAR: FT IN
LEFT: 5 FT �'IN RGHT: 5 FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ • 2 PROV: 2 PARCEL: 42515207 ZNE: R1 REF NO:
PLANNING N6TES> ADDITION TOTALING 670 SF TO AN EXISTING SINGLE FAMILY
> RESIDENCE.. � .-
***�t�r�t�r***�t�r+�*jtir**it�r*�t'ar�r*��t�it�tx��t*�r*�it+t�F�r**x�*u�+tx��t�rk*+ri�x�*�*x��t+t�t*x-x�*�t*+�+rx'�r�r*�r*+r�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'iBY ;� G, �. � � � .^ DATE: �jT-�y^90
BUILDING APPROVED BY ;.(iv` � r; DATE; B';l6�YO
APPLICATION IS$LIED BY: ! DATE: _�=16 fd
if ik ik ik i4 it it ik iE ik i! M it iE M�.if iE k iE iF i! iE iE ik iE iE iE %iE jE 3k iETiF i�£'it iF 3F iF �iFiF'iE iE
ikltiEititikK±FiFikkifil�ifititlkitiElfiEiE'itlfk3fitikiEilif�fit%itiEiE�iEiliElEiE. kiFiEikkil�iflE�tifiE%%iEifiFit%iE�EiElEiEitiFikiliEiEitifiFitiFif
LEGALIZATION:N F E E' S}U M M A R Y STRUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTRLC MECHANIC FIRE SMIP/RES GRADING
PERMIT 395,00 ; 3,Zq
•� SMIP/NON-RES
PLAN 256.75 � ' .� • .
ISSUE FEE '
B U I L D I N G- D I V-> P E R M I T I S S U E P L A N-� H E C K T O T A L PAID DDE
TOTALS----> 398.24 0,00 256.75 654.99 654.99 ,00
REVENUE DIVISION TOTALS--> COLL'ECTED; 398.24 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN-CHECK
395.00 y. 3,zq
iF iF if if i! it IF ik if if ik jf iE iF iE �E iE if �E if iF jf ik ik IF i! iE if iE iE ik iF if �k ik if iE 1E 1E iE fE if 1E ik �E i! i41f #� if iE jE if if ib 361F ik ik i(� ik i! iE M iE iF iF 3F iE �E iE iF i! if iE iF 1E it iF
I N D I V I D U A L� "F E E B R E A K D 0 W N
•i"" /l
TYPE QTY D E S C R I P T I O N • ONIT COST TOTAL COST
SFR 670 DWE-TYPE V-WOOD FRAME�� -GOOD 69.00 46,230.00
END•OF FEES
• ,' ,
• / ,
i
� '�' Gi OO�E7ri1-�C�1L�?12 1TEa"� ',-�; .
` OH7F: iiR; ib; i0 TI ,E: 14:?3 �-
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.: T... �
CONSTRUCTION AND PLANNL_ .
ILpPROVALS Permit �
�emporary Electrical Service or Pole
2. Soil Pipe�Undrgrnd.
3. Electrical Conduit UtilitY-Undrgrnd.
4. Electrical Conduit-Undrgrnd. I�
5. Steel Reinforcement '
6. Electrical UFER Grnd.
7. Footings
8. Foundation cJ�� /1 � ��
9. Water Pipe-Undrgrnd.
10. Structural Floor SYstem
11. Property Sewer Line & House Connection
72. Sewer Cap
73. Roof Drains
14. Rough Plumbing
15. Rough Eleccrical�Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign _
16. Rough Electrical-T Bar Ceiling
79. Rough 4eating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure � -
22. Ducts, Ventilating
23. 'Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing i�.�� ��
26. T�Bar Ceiling (Structural) & Monocoat
27. Frame and Flashin9
28. Lathing & Siding
29. Insulation '
30. Drywall Nailin9
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
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 pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation� �
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Jl , SPA
Date Inspector AppROVALS Permit#
52. Pool & Equipment Location �
53. Steel Reinforcement "
54. Forms
55. Electrical8onding �
�3-!%.p �.� 56. Rough Plumbing & Pressure Test �
57. APPROVALTOCOVER�GUNITE
�. (pi,v 58. Electrical Conduit•Undrgrnd.
.).3.t�5 (�'(�/' � 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTO DECK
62. Backwash & Receptor-Final .
63. Heater & Vent�Final
64. Plumbing SYstem � Final .
65. Electrical-Final
66. Solar System-Final '
67. Fencing & Access Approval •
68. APPROVED FOR PLASTERING � "
69. -POOL/SPA SYSTEMS FINAL
FIRE DEPT. REnUIREMENT
APPROVALS Permit #
S-�
� I' ' _
.'
70. Underground HYdro
77. Product�PipingOGas OOiI
72. Underground Flush
73..Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro �
75. Dry Chemical
76. Dry Standpipe •
77. FIXED SYSTEM FINAL
78.�FIRE PREV. FINA�L
HEALTH DEPT. REQUIREMENT
79. FINALINSPECTION I
80. FOOD CERTIFICATE ISSUED I
-ZK -R/-
i
Date � Inspector
fi
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-
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CERTIrICATE OF COMPLIANCE
PAYNENT OF SCHOOL FACILITY FEES
NEWPORT-HESA UNIFIED SCHOOL DISTRICT
Developer/Applicant
Address:
Telephone Number:
�� /vi,l�
�6� �/k�.
il�'� ��-Z ��0 0i�'d
arcel and Lot Number(s):
� - G �6S'
Location of Project: �jZ /%� �!�•Ce-t— C �^Y/
Number of Square Feet of �/7
Residential Space l"/// x$1.50 Total' �/i /)�S�U
Number of Square Feet of
Commercial and
Industrial Space
Commercial/Industrial Project is
Mini-storage
Movie Theater
Racquet/Health
Warehouses
Heavy Industrial
Regional Shops
Light Industrial
x $0.25
(Check One)
Total
Motel
Banic
Neighborhood Shops
R & D
Hotel
Medical Office
Office Park
,.
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies L-haL- the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995.'
Checks are co Ue made payable L'o
port-Mesa Unified School District.
�����
Business Manager
Newporl--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.
D a t e: p��K� ��v __�� /�/ i I,�iI�LL„�Gt/,%
Developer/Applicant
AU6 16 1990 S�eve �Gl r' /�-4 �
''[TY DF CUSTA
�:ALIFOflN1A 82628�1200
Insulation Certificate
M�°'�
P. O. BOX T200
y9Z /� -�G� �/�� _ G'osfi� /%�es�
Nwnba end Sveet Ciry
D��� �
caunry s�na;,risim, � L.o� Numbe.
Description of Installation
ROOF
Material 2 X
7tuclrness (inches) �
EXTERIOR WALL S/`� r°c �
���� z cy �„ " s-rz«
Tn�ckness cinches> '� , Z ,•
BrandName 0(/iCl�l C�r(/� I
'Ihermal Resistance (R-Value) _ _/g
Brand Name Ow�0.S /� %
'Ihertnal Resistance (R-Value) —
CEILING
Batt or Blanket Type Brand Name ��,u�(e�J N �
'Ihickness (inches) � 2.. 'Ihertnal Resistance (R-Value) e =/9 � 3(�
Loosc Fill Type Brend Name `!�rl.�s C-con'/�� y�y
Contractor's minimum installed weight/ft Ib Minimum thicFaiess� L �J
Manufacauer's installed weight per square foot to xheive'Ihermal Resistance (R-Vaiue) ��� ,� 'p�'�� �
RAISED FLOOR
Material 2 X � Z, Brand Name .f�,rti3 G o/r�i
71�ickness (inches) // t, Thermal Resistance (R-Value) o
SLAB f1.00R
Material (�Dn[ K'�'��
'Ihiclrness (inches) (� �,
Width (inches)
FOUNDATION WALL
Material /e,� c r`�'E_L
'Ihickness (inches) _
Brand Name
'Iliermal Resistance (R-Value)
Brand Narne
71�ertnal Resistance (R-Value)
Declaration
I hereby certify that the above insulaaon was installed in the building at the above locauon in confortnance wich
the cwlent Building Energy Efficiency Standards for new residential buildings contained in Tide 24 of the
Califomia Administrative Code.
�� �, �„ Ksfi— � y.��9y�
onvactor (Builder) ' Licrnse Number
u,rur �2- 3 -90
ignature Tide � Dete
SubContracinr (Insuletion lnstnller) . License Number �
� Signatute ud Title
�
City of Costa Mesa
California 92628-1200 P.O.Box 1200
Insulation Certificate •
NumDer e�tl
Caun�y
ROOF
Material
Thickness (inches)
EXTERIOR WALL
Material
Thickness (inches)
Permit Number
Ci�y
Subtlivision
Description of Installation
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Loi Number
CEILING
Batt or Blanket Type Brand Name
Thickness (inches) Thermal Resistance (R-Value) _
Loose Fill Type Brand Name
Contractor'S minimum installed weighUft2— Ib. Minimum thickness inches
Manufacturer's instalieq weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR
Material
Thickness (inches)
SLAB FLOOR
Material
Thickness (inches)
Width (inches) _
FOUNDATION WALL
Material
Thickness (inches)
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at [he above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Adminstrative Cotle.
General Conirac�or (Builder)
Signature and Tiile
Sub-Conireclor (InsUlaiion Installer)
Siqnature and 7itle •
t90)>8
Litense Num68r
Date
License Number
Date
PflUJECT RDOPFS3: q y 1
OWNEfl'8 N�ME: S�EAY
�ooeess.
642-6080
"r tir
UNIT:
� pHCjIIENCINEEfl: flEG.NO.:
ROOflESS: UNIT:
PEflMITTEE: MURRAY ( 714 ) 6 4 2— 6 0 8 0
��� RODPE38: CM49z 16TH PLACE CA 92627
LICENSED CONTMCTOB DELUN�TION: I �ere0y affirAi ��t I am Ikense0 mMer prov¢ians of ChaO�e� 9l�mmencinp wilh Section
7000) al �ivision 3 oi ihe Business an0 Proleuions Cade, anA my license k In full larce an0 ellect.
CITY LIC.: ST�TE UC.: C1A33:
^+:e: Sipnamre:
iKFBS' COMPENSpT10N OELUMTION: I �eahy a�irm tlut I have a ceNGcate ol crosent to selbinsure ar a ceNilcate oI WaBers'
npensation Insurance, ar a certilied copY ��ereof (Se�tian 3800, Lab. C�.
Iroucr xo.: exa. o�n:
^OMP�NY:
CerlifieE copy is hereby fumishetl. ❑ Certifietl GaOY a filetl whh t�e cfty BuilEinp DNision.
Date: Applicant:
E%EMPfION FPOM VNHNEBS' COMPEN&IlION UECIAMIION: (�5 se�tia� neeE rot Ee canDleteE d Ne penriil is for one AunOreA �f100) or kss).
I CertiTy �hat in �he p¢�ofmanc0 of [Ae xrork � whic� Nis Ve�� � issueE, I shall rrot employ any persap in any manner so as to hecome
suhjeq to t�e Warke ComOe�sation La oi Calilomil� � i _...' A �
y w✓{.,z�yl
Oate: � ^�—L� 5pnature:
NOTICE: If, alier maMinp ihis EeGaratan, yau shoNd 6ewme w6ject to tAe Warkers' Compe prwisions al the La6or
COEe, you must foritm�ith comDN �+�� such D�a'�O�s or IRs:permfl shall �e OeemeO revoked.
CONS7pUCT10N LENOING RCENCY: I hertEy atArm tNt Nere k a m�trucuon lentlinp aAency for ihe DeAormance ai the work for
w�ith �his De�mii is issuetl (Sectian 3097, Civ. C�.
lFNOEfl:
RODBESB:
IOWNER BUIIDEB OECIAMTION: I Aerzhy allirm ttut I am exempt from the Contactori Stata License Law tor the lollawinp reason
(Sectlan 7031.5 Busineu aritl Pmfessiooal Catle: My ciry ai wunry w�ic0 reQulres a permit ro canstmct, alter, Improve, demolish, or
reDair any slrucWre, D�or �0 14t issuance, also repuires t�e apWipnt for such pemut m file a si0�e4 statement ttut hNs�e is Iicense0
pursuant to tAe provisions al tAe Comractors SWte License Law (CMpier 9 �commencinp wii� Section 7000) ol Uivislon 3 0l tAa Busin¢ss
an0 Prohssions Cotle) or ttut IwJs�e a eaemD� themimm �4 the �asis for Ne allepeE exemD�ion. My NOWtion ai Seclion 7031.5 by
y aDPlicant lor a permit su0lats t�e apDliwnt �o a cM� Ve�atry of not mom than INe Aundr¢d Aollars (5500).
I, as awner ol t�e D�oparry or my employ0e5 wit� wapes az Iheir sole compansation, will do t�e work. and the
�� I❑ simcWre is not intenGeE or ollera0 br ule (SeCtlO� ��4. Buvneu anE Prolusional CoCe: The Cantractors' State Licensa Law
Aoes not apDty to an ownar of a D�operry wlm bUilas or imprwes Ihereon, an0 who does such work �imself/herself or I�roupA
his or �er own employees, provqetl Ihat suc� imD«men6 am not IntenOetl or ottereC for sale. Ii, hawever t�e CuilElnp or
improvement is sold wlt�in one year al campleti0n, tAe owner will �ava I�a hurtlen af provin0 he/s�e Oitl not Dui10 or improve
for Ihe purpose ot sale�.
X I, as owner ol ihe pm0erry, am axUusNely contra��np wii� IiunSeA cantractors to constmct tAe prol�t (Sectlon 7044. Business
❑ antl Pralessians Caae: The Comractors' Sute License Lrx Oces irot appN to an mmer oi properry wno OutlAs or Imprmres tAerean
anA who contracis for such projects i¢h a contfactoqs) license Dursuant to Ihe Contractars' SWta License Law�. I am awara
that Drool ol tAeir Worker's Compens.L'on insura�ce sInNO Ge DrwiGeE ro me.
� I am exempt un0er SecGw: B. 8 P. C.
lOf this feasan:
oa�e � � �� — 9 U �e�: '^^�— (
I do nere�y cenity IAat I am aware oi anE un0eretand t�e aquiaments of Glitornia Mealtn antl Safery Coda Section 505, 25533, anA
2553d anE tlut I or any futum OuA01n0 �upant vnlUwill noi (circla one) neeU ta wmDh ��� �4 sWte cotles an0 the reauiremenu lor a
permii for consimcibn or mo0ification from tM N�ManaAement Ustnct. HeSiEentlal consiruction aD7lications are exempt Irom
t�ese D�a�isions.
Oate: Apd��nt:
I here0y certiry that I nave reaG this applicauon anE state �� Ue aDove inlartnation is wrrect. I apree to comON with all ciry anE caunry
or0inances aM sWte Wvrs aWllng to Eui1EN0 �Inictlon a�0 MreOy autMr¢e reD���� of N¢ dry to enter upon Ihe aCwo-mentiongd
pmperry for inspection purpous ///j� � /
Oate: � 7� D ��aUr� � �� 1
Oriver's License or Social Securiry M:
.\ iBObaB W�ite—BuilCing; Oreen—CoEa EnlarcemeN: Gnary—Applicant; Pink—Revenue; Goltlenrotl—Asseawr
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO: MP 049305 PLAN CHECK NO: N
CONSTRUCTION TYPE; PERMIT TYPE: MEC PLU
JOB DESCRIPTION : ADD TO SFD, REFER TO #B48593
CLAIM VALUE: CALC—VALUE:
I PERM NO: MP 049305
� GOVT: N SUPP: N
PURPOSE: ADD
SQ FT:
GROUP OCC: R-3 /
COMMENTS: ADD FAMILY ROOM & STUDIO TO SFD
it ik if Ik k ik 1! ik it ik ik k if if iF if 1F ik ik ik ik Ik ik it iE iE if if M M ik k k if if ik iE if ik iE if %If ik iF iF if ik iE if if ik iF if iF iE ik if iF ik if if iF ik iE iF fF M�k 3! 3! IE iF Ik iE 1F if iF iE
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 HOILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT I13 RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 42515207 ZNE: REF NO:
PLANNING N(STES>
>
9E if iE 1k ik if ik ik iE i! ik 3f iE j! iE 1E 3E if iF iE 1E if iE iE iE iF iF ik ik k ik iF fF �t fF iF fE 7! 3k,if if iE iE ik iF 1F it iE it jE ik ii iE iE if iF 1E it iF iE iF if iF jk±E 9E iF if �f %it iF iE 1E iF if iE iE 3F
. 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
�, i
��ONING APPROVED BY � ti� DATE:
HUILDING APPROVED BY ; "� y DATE:
/�
,
�APPLICATZON ISSUED HY; �, ' r'' DATE: I��
ik3fikikkiFiFitifikitikiFifilififlf�kitiF�k . kkifitiEiFiElfilaE iFiE
it jf if it ik ik if dk iE i! k if k iF if M if ik it if ik if Ik 1F it iE ik if ik ih it±k±t ik it it k it iE if 1E iF �f �k if i! if if iE iF if M ik iE i! 1P iE Ik ik M it 1k M fk fE ff iE M iE iF iE iF if 3t it k�f iF if
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PEAMIT 2,00 9,00
25R 25R SMIPJNON—R£S
PLAN
ISSUE FEE 3.00 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 11.00 18.00 0.00 29.00 29.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 29,00 OVER/SHORT: 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
5,�� 24,a�
3t it it if if ik if i! i! it ik if k ik it if ik i! if it ik ik k ik k iF if jf if 1k it k 3k 3F if i! aE ik if ik iE it 7F it iF it i! ik ik M iE k if if it it 4 if it iF ik it i4 iE it �1f iE iF it Ik It if it �F if af 3F if 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 REPAIR/ALT COOLING UNIT/SYS W/CNTLS
PLU 1 SINRS, SERVICE / MOP
END OF FEES
2.00 2.00
OCT 3 1 90
CITY Of COSTA MESA
CONSTRUCTION AND PLANi. .i , �Ol . SPA
ADPROV�ti�S Permit # Date Inspector APpROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
� 2y�Soil.Pipe-Undrgrnd. 53. Steel Reinforcement
�3: Electrical Conduit Utility-Undrgrnd. 54. Forms
`0j,4. Elect�rical Cond'uit�Undrgrnd. 55. Electrical Bonding
5. Steel-Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER'Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings -y 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgmd., Test -
9. Water Pipe-Undrgrnd. 60. Backwash Lines. P�Trap, O Undrgmd. '
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Llne & House Co�nection 62. Backwash & Receptor-Final _ .
12. Sewer Cap 63. Heater & Vent-Final -
S
� 13. Roof Dreins , � �_ 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 -
77. Fough Wiring,Sign . 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
, 19. Rough Heating & Air Conditioninq,.,_� � .,Q �Qy � . _ r F.IqE.D�PT.:REQUIREMENT - -
_�..-.-�
20:' RougM1=FactoryjFireplace - �= � -�y: i�;, APPR.OVQLSI:-. Peimit#+� ^ ^�=
.-..� . - - ..,
27: Oucts;in5tiuctu�e "' " �
;H « r �' : �,; x. ^ 70.�Unde ground Hydro ;
22: D ctsiVeri�latin9� � Y �+x > 71. Product:P.iping,��O'Gas OOiI �
23: Ga3 Pipe�Rough &'Test .• � ,�� 4 " „T, i; �'r � ^ 7z, Underground F(ysfi ' �
2A: Roof Framing `� -', 'yF� ••�- �' _ �` 73: Undergrnd. S[oYa9A Tank O Gas ❑ Oil
25. Roof Sheathingr, �: � " �� ;� � i ;` 7q Overhead Hydro �, a�
26, T-Bar Ceiling (Structuraq & Moi�ocoat ;� ) ys, n� �� 75: Dry Chemical �p v� � [�.,
2T.. Fra'me•and Flashin '� �:'= "�r',� y; � � ���
n� '� �9 �rnr. n 4� �..:. 76. DryStaindPiPeS� c0 '.I r� �
. � r; "' a. i' `t -�`. G " s 5_ . .. q. a: r-r �-r � � .� q. „ •
�, 28. Lathing & Sidingx -�F�, �. � ,r. s. 77: FIXED!SYSTENI:FINA�L�� .^. i
"� ' -.. ,; :. �' . - r � � _. '7m
29. Insulai�ion >_ �, Y .c � ,, 78;. FIRE,PREV. F,I,N'AL � ;._ {
s+ -a. ^ 4 � ' �r q. r :•.: :y.�...� -n
30. Drywall Nailing ,. � �. p. ; i ��� �or� or HEALTH DEPT. REQUIR'6MENT
�� 31. PlasterBrownCoatS c%" �� � i ��''` 79. FINALINSPECI'(bN � • ^ �„��
�. c� - r 1: n �.� .: '7 r
F � ' ... t ' .. .. S: '1 ,ti ? �7 __ , �.
• 32. Electricpl Powei:;Meter;Final p ,., -: 80; FOOD CERTIF.j,CATE fSSllED�
; 33'. Flnal EtectFic � �r :Tt � � �# ' Notes. "� �� T' " "7 � ��'
r' L f� T k �S' � Y f 'ij('. #
� � � 39: Final Heating &-'F�'I_r.Conditionirig � �{-1�-R( `� - � " _;��" '' "'� `
�1 cL j
� . . . . . . _ � --' _
35i Final Gas Pipe�Test'� .. ���Y L�0` = �� � Jn' �_ „n
' , 36. Hobd or Canopy � -' � `� y " ' " * ' ' � ,' '' ' '•; ;+
�. : �r� - x ( Lw .. [.+'! "'; o f: ?i �T:
� �i 37,� Pin�al Factory Fireplace. . °':- � „ ' �" _ _ � ..' * _ .-� .
c- / �,. � a c. a.• v »:
: 39. Fin31 Plumbing �. ... � '-.� �-� `�'Q. � � p�� v � ;�
" 39. Wafer Service�Final s � � � r; �i => �� a� � t V F
'.c >. -, c.t - ,
'• 40. Ga`sService-Final^' C� ��' �- �''' , ' `r'. � '' '"'i= � -� '
V � 4� Y � �,( � � ' ' �. k �
� '
; ; 41. Solar pomesticFinal' �r � �� j .r �� �� �-io • � � ', �
- - � � .., r'�.. _ .
� _ - � 1 i: T . - .
42. Backflow Preventer _. _ ' �. , �_` �
43. Backflow Irziga[ion . " � � ' '
: c �-,; .., a c
; 44. Landsca e�l�ripation S stem ` ` `" '� C'' "'' �` -�`= � ' _ -�c. ,,,r. _��__ �
P Y ��- .Z �;.: x' ... :�' 1� S L� � -'ti
" 45' Sound;:Attenuation j�... ' ��" Ti a `7* o- F � e� . F•=7 t �'• � _ ��.'_-
.,. ,- , * - >-
i 46': Handicap Fegulations ' � * �" :'� S "" �� ' �! r t�
� y < f� i '
: 47° FINALSTRUCTURE&BU�ILDING r _ � " i �: '� c' � �C,: •� =-'
' _ e n � , y ' �. ,.y7
48' FINAL PLANNING � ' ' � �" ' " y `" '' 'L � � � , ;
r, a p� C� s ? n; c.� �I .
;, 49:. Electric Release to. Edison ; f :��d. i� r 1T � � � `p -
:-i - � �'
� � _• • �, . �- '.-. � ,
' � 50�� Gas Release to Southem California Gas Cn � "� r • `i _,� � ' �� ti� , , ,. '
' 51. CERTIFICATE OF OCCUPANCY ' ' - '" �" ' ' �_ -•
No. Date
YP0.1ECf FDUHESS: �} 9 Z 16TH PL
owx¢e•s xnrne: MURRAY
RDOBES�: $.�MiE
� .
UNIT:
642-6080
RNCIIIENGINEEq: NEU.NO.:
�UONESS: _ UNR:
PFNMITTEE: T�NNYSON CONSTRUCTION CO. ( 714 ) 695-0572
�ooeess: 391 LA PERLE LN
COSTA MESA CA 92627
UCENSED CONTMCTON DECIAMTION: I �ere0y aflirm ihat I am Iicense0 wEer D�ovisions of CAapter 9(commencinq with Sectlon
7000) al Divisian 3 of the Business antl Pmtessions CoOe, and my license is In lull lorte and eflect.
cirr uc.: 0 7 3 3 2^ $TpTE uc.: 4 3 5 9 4 2 uss�; B/i/
Oate:����� SlOnature: � '�"��� ��'�� -
WOflKEfl3' OMPENSRTION OECIAMTION: I �ereby affirm IAa� have a urtifiwte of consent to self-insum ora ceNllcate ai WOAers'
fqmDe��tion ywanJce; m a�art'�N'e�A capy thereal (Seclion 3800, LaG.�G)� � O 1� 9 1
raucr xo.: STATE E%P.ORTF:
LIMPRNY:
`J CertifieC copy is �ereby/umished. � Cenilied copy b�7�')e0 vnt� tAe ciry B/uilO�inp Divislon.
�ate: ` �% Fppliwnl �y �'w� v(._/� ����
FXEMPTION iNOM WOBNFIIS' COMPE713ATION DFCIAMTION: (tMs sectlon neeU noI be mmplete0 tl Ihe pemdl i5 far one hunEreA (5100) a less).
I cenity Ihat in tAe pedormance of Ihe work for wAich tha permit is issue0, I shall not employ any person in any manner m as to bewme
suhlect to tAe Workers' Campensation Laws oi Califomia.
Date: SiqnaNre:
NOTICE: Ii, atler makinp th¢ Aeclaratian, yau shoul0 Dewme suble�� �o ttre WOMers' ComDensation pmvisions ol Ihe LaOor
CoAe, you must forthwith comDly witA such Drovisions or INs Dermit shall 6e UeemeO revake0.
CONSTflUCTION LENOING RGENCY: I herehy aifirm Ihat tAere is a cansiruction lendinp apency for [he pertormance of Ihe work /or
which Mis permit is issued (Section 3097, Civ. C).
LENOER:
nooxess:
^ CITY OF COSTA hfESA - HUILDING PERMIT PEAM P:O: E 049065
PEAMIT NO: E 049065 PLAN CHECK N0: N GOVT: 1N SUPP: N
CONSTkUCTION TYPE; PERMIT TYPE; ELE PURPOSE: ADD
JOB DESCRIPTZON : REF H48593 ADD TO SFD 55� FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
COMMENTS; MUST DO 3 KTRADES OR MORE/CHECK SUB LIST
�**�t*�*�r+�x�***#�r�*�r*�.�*�*�r+��r�r���#��**�r�*u���r��*#**�r�r+t#****#�xx**:,�**#�**���#�r*tt
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REO• PROV: PARCEL: 42515207 ZNE; AEF NO:
PLANNING Nd'I'ES>
>
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D E V E L O P M E N T S E�� V Z 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 HY�--j—� L
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LEGALIZATION;N F E
M
OWNEB BUIIDEB OECIAMTION: I Ameby affirm Ihat I am exempt Irom �Ae Comractors State License Law for Ihe followinp reason BLDG PMT PLUMB I NG EL ECTR I C /.�7E
(Section 7037.5 Business antl Pmfessional CoUe: My ciry ot counry which requias a Oermit ro constmct, alter, imDmve, Oemolish, ar P ERM I T 3 7, 2 S (
reDair any stmcWre, O�or to its Issuance, also requires the appliwm tor sucA perma ro lile a si0�e4 statement Inat hUsna is Iicense0 5 0 v `
pursuant Io IAe proNsions ol ihe Contractors' Stata License Law (ChaD�er 9(commencinp vnt� Section 7000) ol OivLUan 3 of Ihe Business p LAN
anE Profeuions CaOe) or that hUshe is exempt tAerefrom anG t�a Casis ior the alleAeA eeemOtion. My violatlon of Sectlon 7031.5 hy t
any apD�icant for a Dermit suOjects the apDlicant to a dWl penalry of not more �han iNe hunEred Oallars (5500�. i S S UE F EE 1 �, � 0
BUILDING-DIV-> PERMIT ISSUE PLIaN-CHECK
I, as awner al me DropeM or my employees witn wages az ineir sola wmDensation, will tlo the wnM, antl ihe TOTALS----> 37 , 25 15 , 00 ' 0, 00
❑ simcture is not intendeA or otterea for sale (Secimn 7644, Business an0 Prolessional COEe: TAe Coniradars' State License Law '
Oces not apDty to an owner oi a pmperry wAo huilds ar imprwes therean antl wtw tices suc� woA �imutf/Aerself or t�mup�
DATE: Oq ����
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A R Y STRUCTURAL SEGMENT:N
ANIC FIRE SMIP/RE.S GRHL�ING
SMIP/NON—RES
TOTAL PAID DUE
52.25 52,25 .00
his ar her own employees. D�ovitled t�a[ such impmvemenis are not inten�etl ar atleretl lor ule. II. Aowever the builUinO ar REVENUE D I V I S I ON TOTAL S--> COLL ECT ED : 5 2, 2 5 OV ER / SHORT ; � 0
t imOmvementi55olOwithmoneyearoicompletion,tAeormerwillluvetheburtlenofDrovinp�e/shatlidnotbuilEorlmD�a�e BLDG PMT PLUMBING EL£CTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECIt
for the purpose of sale�. 5 2, z 5
I, as owner ol the D�operty, am exclusivety contractinA ��h licensetl contrattors ro construct IAe Drolect (Sectian 7044, Business ;
❑ anUProfessimsCade: TheContactors StateLicenseLawticesnotappN�oanavmerolpraperry whoGmltlsorimpraveslhereon *#iE3liEjEiEil�iEiEi@�F�fititiEiF#iEiF�kiEifif�kiEi!#iE#itiEiE##ifjE#16#iE#itif3FitlEit#itiF##�F�K�####itiE#iElkit##�F3F#IE1k###i4###
anE who contractstor such pmlecis yN a contractar(s)Ikense pursuant to Me Contranors' State License Law�. I am aware
tnat proof al their Woncer's Compensztion msurance slwma be o�aviaetl to ma. I N D I V I D U A L F E E B R E A K D 0 W N�
� �amexemptunderSection: s.aP.c. TYPE QTY D E S C R I P T I O N UNZT COST TOTAL COST
tOr Ihis reas n:
oate: � - ELE 12 FIXTURES LIGHTING 1 ST 20 EA, ,75
I Oo hereby certiry itut I am aware of an0 un0erstantl t�e requirements of Calilornia Healt� anA Safery 3e�3ections 25505. 25533. ana EL E 8 R EC E P T/ OtJ TL E T i S T 2 � EA , , 7,�.r
25534 anA that I or any future EWIEinp occupant wilUvnll rrot (circle one) nee0 ro wmpy with said state coEes an0 tAe reQui�ements for a EL E S R EC E P T/ SW I TC H 1 S T 2 � EA . , 7 5
permit for consimctbn or matlitication tmm Uie Air �ualiry Manapement Oistrict. NeSiEential consimction apD�iwtions am exemD� ham EL E 1 S ER V I C E S B EL OW 6 � 0 V 6 B EL OW 2 � 1 AM P 1$. S �
ihese provisions. END OF FEES
Date: Applicant
1 hereby certity tAat I Aave read ihis apDlication antl state that the ahove inlormation is wrrect. I apree to camDly wiN all clty antl wunry
oNinances aM state Wws relatinp to ouAainO �N�� ��r Irorhe represema' s of t�is ciry ta enter upon the a�ovamentloneA
properry forinspection pu`ryoses.
Date: ���/1� SipnaWm: �
onvers License or Sociai Securiry ;r:
1661-48 W�i�e—BuilCing; Graorv—CoEe Enbrcemem; Canary—Applican�; Pink—Pevenue: OOIEenroC—htseaaor
9,00
6,00
3.75
18.50
D: OOD6SQZ2-L:^Oo4S2" � l�.T
DATE� 09I14/90 rff�E: 10:c5
�
4
, �
CONSTRUCTION ANO PLANNING ��
AP?ROVALS Permit #
1. Femporary EleGtrical Service-or Pole
2. Soil Pipe-Undrgmd. � �
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Gmd.
. 7. Footings
8. Foundation
9. Water Pipe�Undrgrnd. _ '
70. Structurel Floor System �
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Fioof Drains ,
74. Rough Plumbing
15. Rough ElectriWl-Conduit
16. Rough Electric Wiring �
17. Rough Wiring Sign
78. Rough Electrical-T Bar Ceiling
79. Rou9h Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in StrucCure
22. Ducts, Ventilati�g
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashi�g
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
37. Plaster Brown Coat
32. Electrical Power Meter�final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or CanopY
37. Final Factory Fireplace
38. Final Plumbing
1 39. Water Service�Final
�40. Gas Service-Final
111. Solar pomestic-Final
1
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL P�ANNING
49. Electrlc Releas¢ to Edison
50. Gas Reiease to Southern California Gas G
51. CERTIFICATE OF OCCUPANCY
No. Date
S
�
Date
POD'& SPA
Inspector qppROVALS Permit #
52. Pool & Equipment Location _�f
53. Steel Reinforcement .
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test �
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test ,
60. Backwash Lines, P-7rap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final �
63. Heater & Vent•Final
64. Plumbing System � Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access ApProval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
Y�
�
N
Date � Inspector
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd.StorageTank OGas ❑Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIfICATE ISSUED
�
rewEcr aooxess: MURRAY
OWNFWSM�ME: SAME
naoeess:
� 642-6080
►XCHIENCINEEH:
� �DORESB:
v�qMmFF: MITRRAY
�ooeeas: �M49z 16TH PLACE
uxir:
HEO.NO.:
UNIT:
t714)642-608�
CA 92627
LICENSEO CONTMCfON OEClAN1TI0N: I �ert0y aRum t�at I am Ocense0 uMer provaiwu ol Ctupter 9(commendnp wltA Sectbn
7000) ol DiNslon 3 0l IAe Business antl Professions CoOe. aM my Ikenu is In lull lorce an0 ettttt.
CRY UC.: STRTE OL.: CIASB:
Dale: Sipnature:
WONKENS' COMPENSATIOM OFCLAMTION: 1 hertDy atlirm Wt I lave � aNfrate of mium lo ulbimure or a CCrtifiwU ol Workers'
�penution Insurance. or a certilietl mpy IMreol (�tian 3800, La�. C�.
JLY NO.: F%P. OIITE:
COMP�NY:
❑ Cenifie0 copy is heaDy fumisheE. ❑ faMeO copy's I�eU vrith Ne dry BWOinp Divisbn.
Oate: NppGcant:
EXEAIFfION FPOM WOBFfltt' COMPENSITION OECUMTION: (ili'¢ ucUm meE not Ge amqe�eE it tM pmm ¢ la me AwdrtE (f10Q� a less�.
I ceNty IM in ihe pMarmance ot Ure work lar wtich Itris ce�t ¢ asuetl. I s�ap mt emD�N' �Y De� ��Y �ner w az to heco �
suEject to tM WorkeZrs' Compasation L%�'� ot CaGlomu.
Date: IO �/'��( U 1 Sip�umre: �
NOTICE: II, allu malanq N¢ EeUantian, ya stwW wqen ro Ne Wohers' CompersaUon ra at the Lahor
CaEe, you must twltrwit� mmpry wit� wcA prorisim5 or N6 pertnt shall Ee EeemeO revoke0.
fANSfHUCTION 1EN01NG �GENLY: I Icere6y atfirm itut Ihero a a mistruction ImEinO aOe��Y �or Ihe pulwmaixe al tlro xrork lor
which Ihis DermA is issuetl (Section 3097. qv. C).
IFNOEfl:
nooxess:
OWNER BUILDEP UECIAMTION: I heaUy aKrm IAat I am eumpt I�om tAe Cantanors Stata Lkense Law for t�e IoOowinp reason
(SecUon 7037.5 Business an0 Professional CoOe: My dry oi counry whkA reyWra a perMt ro consWtt, alter. ImOrove, OemollsA, or
repair am� strucwre, D�r to Its issuance, atra repWres Na app0unl lor wch permn �o fik a slpne0 statemmt ttut nNs�e Is IkenseE
pursuant to Na prwisians al Ne Contractors' State Lkeme Law (Chaptu 9(ammencinp wii� Sactlon 700D) ol OFAslan 7 0l tAa Business
anE Prolessiarts COAe) ar W� MlSM c exe�t tlrerefram arq Ure Easis la Ne aAe�E ezemptmn. My vidalian ot Sectqn 7031.5 Dy
any apqiram Iw a oerM� woi�+ �a eDo��� to a dvu cenmry ol fat mwe than INa huneree eollars (f5001.
i, az owner o� uro o�oceM a� mv empIoyees �.itn wapes az mNr sde campensatlon. vnn na me war�, and tha
struclure Is not inten0e0 0� olfere0lo� sale (Sectbn 70ad, 9uvnea aM Professional Catle: TM Contnctors State IJcense Law
Ooes not appry lo an awner ol a pmperry wtq OWIOs or improves Nerean, anC wlio Ooes suc� work �imSell/Aarsell or NmuOA
Ns or her own empbyees, wwi0e0 W� sucli ImprovemenU are mt NteMeO or otlere0 lar sale. If, Mwever tAe EWIAInp ar
impmvement is mIU witNn ona year ol compleGan, t�e owner wIA luve lAe UurEen ol DroNnp �rJs�e Gi0 not DuiIE or imD�a�e
lor Na Durpose af salel.
X I, az owner oi IAe property am ezclusivery canlnctln0 �U Ikensa0 contracton to conswct IAe D�oiea (Sectlon 70aa, Business
❑ ard Prolessims CoOe: The Coniractors' Sute �kaae law Eoes rot apply ro an ownv al Drope�ry xM 6wIEs or ImD�s t�ereon
antl who cantrazis lor sucA OroIK� hi� a cantractor�s) license Dursuant Io IM Comractors' Siate L¢ense Law�. I am aware
ihat mool ol tnrir workeh CamD��s:tbn hsurance sIq�AE Ce oroviaeO eo me.
� I am axem0� �aer Section: B. 8 P. C.
tOr I�iS reazOn: 1/ //y���^ - _ I . /w
03�0: / Q / --� O \ Q�MBf' / // • ' " VVVV�
I Oo hereUy mrtity I�at I am awara at an0 unOarstanE t�e reQuiamenis ol lilomu Healtn an0 Satery COEa Sectlons O5, 25533, an0
25534 an0 tAat 1 or any INum EuONnp arupant willMill nol (drde we) neeE ro comDN �N saitl sWte catles an0l�a repWrements lor a
permit for consiruction or moOilication irom tM N�r 1�Manapement D'atricl. NesiCentlal construction aDD��atlons are exempt Imm
t�ese Dmvisians.
Uate: Rpplicant:
I hereby cetlily ilwt I have reaG IAis applicaUon anE state ttai lM aDove inlormation is cormci. I apree Io wmpty wlt� all ciry an0 counry
ordinances an0 state laws 2latin0 �a Euil0in0 c/� trucllan anC tcereby aNtpAze reD�nWWes al tNs ciry to rnter upon t�e a0ove�mentionad
pmperry for in5peciion Durposes. \ �/�/l�/�.�/�/
Date:- ,J ^ �� �Q� ��� " .T
Driver's liunse or $ocial Secunry N:
WMto—BuilOirp; Groan—COEe Enfwcement; Cenary—Applkant; Pink—Revenue; GdEenrotl—Aueaaor .
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 049306 PLAN CHECK NO: N
PERM NO: B 049306
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
ij4j� �j�3CRIPTION : AEROOF 2940SF RESID W/COMP SHINGLES SQ FT: 3,000
�LATM L�ALU�: jsO00.00 GALG—YALUE: 3,000.00 GROUP OCC: R-3 /
COMMENTS: ADD FAMILY ROOM S STUDIO TO SFD
*�r**x�r�r�r���*x�r*�r�e�e�e�r*******���r�*�r�rx*�e�e�r*�*�r�+r*+r�**�*�r�+�**�rr*�*��r+r�*+�**x��rx�**�x�
2 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 ---------
FANT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGiiT; FT IN
PARKING REQ• PROV: PARCEL: 42515207 ZNE: REF NO:
PLANNING N�STES>
>
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE: r
APPLICATION ISSUED BY; DATE: I,O l��
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kitiFkikkikikiFiFkifif4kikkkiFiFkikkikifififikifikilifklkiEkiflklkMlEikMikiFiFMjFMiF1flfkiFiEiFikMiEkMk%MiE1flEikiEifiFMitMikibiE%iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.00
PLAN
ISSUE FEE
HUILDING—DIV—>
TOTALS---->
PERMIT ISSUE PLAN—CHECK
54,50 0.00 0,00
5�
SMIP/NON—RES
TOTAL PAZD DUE
54,50 54.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 54,50 OVER/SHORT: 00
BLD54P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING PLAN—CHECK
kifkkifikifkiflfkiFft%ififiklFifMM3fifakjkifiFiFifitMitiFiFkikikififMlEikikltkiFiEkMMMkifikikiFMikikikifkMkklklEiFiFMlEififitikiEMlEit
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
SFR 3000 REROOF HY VALUE RESIDENIAL NOZONE 1,00 3,000,00
END OF FEES
�r::,�11�.
.� ' �� t i
' '�
/ . ..i/ /
� �
CONSTRUCTION AND PLANNIh_ )L & SFA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
--2; SoilPipe�Und.ryrnd. 53. SteelReinforcement
:3: Electrical Contluit Utility�Undrgrnd, 54. Forms
"�; 4. Elect7ical Cond'uit-Undrgrnd. 55. Electrical Bonding
5. Steel�Reinforcement 56. Rough Plumbing & Pressure Test t�
6. Electrical UFER'Grnd. 57. APPROVAL TO COVER�GUNITE "
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test -
�;
9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
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 �
u
13. Roof Drains ._ - 64. Plumbing Sysrem � Final
74. Rough Plumtring 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 Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning.,,� FI.R.� PT�. REQUI EMENT -
. � a: . r• ^ . .. v. K = �: r �<� � $
2Qi Rough factory�FKeplace , S�r �+� S i� C>,- 3: ,^ APPI�OVqLSi� Permit #� ^ �
v v� c -r-�.. m
2�1'! D}l�ts,'�,�riStiucture ;"" "'^ S� 'J�`'� 70.`�Undei`�r�u�dF! dro '`
�. , i �� S� �� �,� �: � F 9,4 �' x
22: Ducts,-Ven4ilating, � "',j � p � � ;��: �: V 71. ProducuFiping���'Gas OOiI � •
23: Gas Pipe•Ro'u h Si'Test "'�= ' � � `-���'�� ~� ' ' �" F' �
: i �:9 s�• m� x � r* C 7z• Undergrt0uynd F,I�usFir, „ � �
e-� F :. c 7 c.. � F-. ✓ .-� �. .
24: Rdof Fiaming �� �-, � Ha• *� • 73 Undergrnd.Stor.atje=iank �Gas ❑Oil
25. Roof Sfieathing^T: "� `` � V�y � 74t�Overhead Hydr��Ao, *
1{' y i� � l, [Q �: K � J s
26: T�Bar C.eiling 1$tjuctural) &'�Qonocoat g p �, ,,,r' q: 79;-Dry Chemical �> * c�i
27.e Frame_Bnd Flashing ��x �� �' ��� �' 76. Dry StandaSpe`� '' ^ �
.-n a r* x �+�: �: r, a'-1 4' V N �
. � 28. Lathing & Siding� " �¢F., � � ' ��� �I ��� �; 77, FIXED:SYxST�.MJFINFVL-' C�
29. Insulation = y v S •• � � � x 7$, FIRE PREV. F�NA� ��' a�"
� 30. Drywajl Nailing�i " �- � I 'i .�r. S ;.jHEALTN DEF1T. REQUIREMENT
' 31. Plaster=8rown CoatS �� [�:�'� Y � � �+' x n 7g, FINAL�fN�PEC7i'ON a` ~ �
L C. i � !A .R l� "y 1l �J [--� 4!
� 32, Electr cal Powe4Meier�:final 'L I � ;x � r 80 FOOD CERTIF,�CATE I�.SS�IEDi
_ , .. � ., - ' .' _ -� '^
: 33: Firial ElectBic � t4 �. " �' � Notes: `" �"• ��'� =� v�"•
r- rv� ..r t.. r^- c t+' I ' 'r <: i+?C'1 Y: �S
I T ' i1Y ' �^l^ �'I L ' ifY :1 [1�: $ �. �J
�' 3A'. Final HBatiaj &-Air,Conditioning ., :; y, � � �r � r. r-+ F�4 t ?t
35� Final Gas Pipe�Teit ` •• "'� � � � = ^u 7 � i � -y�
c I !s s T . ..'"t f: . C
� 36. Hood or Canopy ��� r y s�. t Cl , �? x< .T_ .^.O a' -i:^
: 7 a - � 4T; :� e !K * t+7 ;. o X. �l rt1
'� 37� Fireal Factory Fireplace: E�:-+ -' ` � � N' +�' �" ^ '
r tFkv # .. ;r 'F
�' 38. Final Plumbing �� � � r , { hr � .'1 = j ' ;i�
- �^7 �-
� 39. Water Service-Fina{ g ' - ' ��, s ; � � � � � � _
_ :-„� T.
40. Gas Ser'vice•Finalt�'y ^--`� - � `'' � � N � `��` .-�� � ,
. l • Cl .ti F Td ! ie' .> F• O � '�
; 41. Solar pomestic-Final' : " � "� � � -
n ti i q' Y: y` O n x,^ �
- I � i M' S
42. Backflow P eventei �� r^ f v- X c, ,>- . * o •-+
�, x;i �"-i rH 'F* R. Y^�:3 i c�
...� n .
43. Backflow Irrigation n � • "� � _' "-'- _
: � p ix�.:.�
� �� 44. Landscape�liripation SystemQ �, �y "y, `' d , � � � K � - � ,� �-� . - p... ��-t' � �_
.. , ^ L - _ ^. . ._
' 45� $ound:-Attenuation -��� ' �: :7 �': ;�a. r = e' t^ � • ✓G � ''-� I ;-
..x i i i-�•,� v c rr
' 46: Ha�ndicap Regulations �� ` ^ ." �� `` `z ''� �'� � �Y ��y� � � �
f� t z�G ITi'L" i. r � � I �J
; 47' FIJVAL STRUCTURE & BUILDING ��,Z�1� �y��G �V v... _ k `" "' 1 r-
C� f�"! i '�=
48% FINAL PLANNING � ``J � �" � ' r r f C� v " � • �_' `y '
_ , _ r '-i
; 49.. Electric Release to Edison � i `y� ,. �, � •c� i � -.,'�
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50a Ga3 Release to Southem Califomia Gas Co �� ' �' � ; c,,; ^°� � : °T= - ..
' 51. CERTIFICATE OF OCCUPANCY - " "' '
No. Date
OWNER
JOBADDRE89 492 - 16th P]ace v BUILDING PERMIT NO. ]1GZ
GENERALCONTRACTOR T81CObt Sc JA� VAWE � ]z�Q�� ,(b
�
�or 17 e�ocK TRACT 1714 Residence & attached earaee
GROUP I TVPE V ZONE +ui FIRE DISTRICT ZI.6T
INSPECTION$
Footing Trench
Foundation Forms and Grade to
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
Sewer, House S�
Septic Tank or Cesspool
� Lathing,lnX
Plastering
Plumbing, Final, Fixtures
Plumbing, Final Gas Test
Wirino. Final
/3
:�
G
8UBCONTRACTOR
r
G
f
PERMITSISSUED
I NUMBER
f�
vbsta Mesa Building Department / APPLICA'1`ION FOR PERMIT
i�� 171 EAST 20th STREET ,/ 1i6`� B V'' L D �L N G '
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eneu 1nn !]�u 9u F-R6
,
PLOT PT.AN
Show locatlon and distances irom
� property line and between buildings
,� cosrr � �.,7��;33.00
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
n�C 15-75�F''—�00 5f6�r **°'*IE•5�
. � �s,
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completety — Use Ink Only
BUILDING �/ �yy �/ +-�- �L�GC REC�I qP�;�RL.'IVED pp7E��
ADDFESS 7 / b `C n, � �
'�/ /J,/-/ A.P. NO. � ��� `� � PEflMIT NO.
OWNER/�� ! /'/�v(U�
BUILDING � � � .
ADDRE55 /� /L ' �� ADDRESS �
TEL. /r ,�y TRACT � �� LOT` BLOCK
CITV � NO. µ('�QJ /d
CONSTRUCTION W A P
LENDER
BFANCH �
OWNER
ADDRESS VALUE �� �
ARCHITECT TEL. S L' O L' S
OR ENGINEER
FIRE ��
ADDRESS ZONE TYP ROUP
APPROVED
CONTRACTOR D BV DATE 2� I'
ADDRESS
TEL. �ON NO.OF VSE OF NEYf��
GITY NO. P�� � BUILDING �
STATE CITV YARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLOGS. (FROM C/LSTREET)
OF LOT NOW ON LOT qONT FT. FT.
USE OF
EXIS7ING BLDG. ��T. FT
Separate permits are required for L. SIDE � FT. FT.
electric, plumbing and heating work. -�
FEAfi FT. FT.
USE OF BUIIDING �+ND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
LUJN 1 Iv 11,N T/ O O✓ E MAIN BLDGS. ACC65. BLOCv^.
VAR.,$ DATE
� 3 X C.U.P.3y'+ APPFOVED
APPROVE Z��S� S
1 heraby aeknowladBa thet I have reatl this applleeNon antl stata �^
n
thet the abova infofinetlon Is corract entl eB�ea to eomply wlth m
ell laws reBulatlnp bulltllnp eonrtr�etlon, antl I shall not amploy �
ony person In vlolaT�on ai Ma workmen'a compensallon laws of m
tha State of Celitorn�e. L �
m
I heroby canify ihat � nm properly Iicensatl aa e contractor untlar SQ. FT. a
tha S[ata of Collfornla Businass antl Profeulons Cotla, Divislon 3, THE AMOUNT SHO UNDER VALUATION IS FOP m
Chap[er 9, entl that such Ilcansas ere in full force antl effec[, o� I THE PVRPOSE OF B S I HMIT FEE ONLV:
nm examOt from thB Provlsions of the Stem ot Celifornla Businen �O
VALUATION p
ontl Profossiona Cotle, Dlvislon 3, Chapter 9. S � in
/ /� PWN CHECK E "�
Slpnatur O n ''' • �// �%[ �� o
Pormltt � ���LG� � �/" 5 /GJ TAX E .J�� �
U
AuihorlZed ABant TOTAL PAID E �
\ =.
�
�
WSTA MESA BUILw�;��:;:�'�-SAfETY DEPARTMENT pPPLI( .ON FORSS�I�RUC7UK'aLPERMI'f Z2'60 TL
Y.O.tlUXILW GOSIHMtJA,I:ALIYUHIVIAtlLtiLti
REGEI PERMIT �
For Applican[ to Fill in Completely — Use Ink Only rN° 5 0 3 2 7
ADDRESS �/� T- �4 A•P• NO. �3 �j �. �
BUILDING � �
OWNEROR �+tNl� I�-�. ADDRE55
TENANT U � WKN UNITOR
MAILING � / �/ • /���' SPACE NO.
ADDRE55 �" ( ' �
TR.N / LOT BLK.
TEL.
CITV ��/ NO. � ��L
NEW ADD LTER REPAIR OVING DEMOLISH
CANSTRUCTION
LENDER —
BRANCH � �
OWNER
ADOFESS USE ,(Je(� �y . v EE Q`�
ARCHITECT TEL.
OR ENGINEER —�
ADDPESS ZONE TVPE � GflOUP �
�+ APPROVED
CONTRACTOR �(%'T.(�j� BV DATE Z ��
ADDRESS
TEL.
CITV NO.
STATE CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
SI2E NO.OFBLOGS. (FROMC/LSTREET)
OF LOT NOW ON lOT RONT FT
USE OF Q��
EXISTING BIOG.
Separate permits are required for L SID 'r. ��
electric, plumbing and heating work. i /i
REAR FT.
USE OF BUILOING AN� WORK TO BE PERFORMED PL.4NNING ACTION
��'L� 4( . �GL�j�. . APPFOVE i� V
A VED �
I he�eby ¢cknowletlpe that I have �eatl thia eppllcatlon antl rtete
that the above intormation is corract end apree to comply with
all laws reBulating builtling connruction, entl I shell not employ
any Oerson in violatlon of Me workman's compensatlon laws of
the Stata ot Calitornia.
I hereby cartlfy that I am prooerly Ilcensetl as a contractor untler � SQ. FT.
tha Stata ot Californle Buainess antl Profassiona Cotle, Dlvislon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Cheptar 9, antl that such licenses are in full forca entl affect, or I THE PURPp$E OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from the provisions of the S[eie of Callfornia Businass
VALUATION PERMIT FEE S
antl Protessions Coda Division 3, C aptar 9. �
PLANCHECK 5 2 ,��
Signatura af
Permlttee l� � S���� TAX § O,�
Or
AuthorizatlAgani Date TOTALPAID E �6
COSTA MESA BUIG:�"a.,-SAFETY DEPARTMENT APPL l ON FOR STRUCTURAL PERMIT• �.
P.O. BOX 1200 COS� MESA, CALIFORNIA 92626 0
REC I V , -
For Applicant to Fill in Completely — Use Ink Only N° 5115 6
BUILDING �� / < A.P.NO. S�I�Z�� (
AD�RESS (i
BUIIDING
OWNER OR ADDRE55 Z
TENANT
VNIT OR
MAIUNG I/ -t'� 1� SPACENO.
ADDRE55 Z b Y �
TR.Np. LOT�� BLK.
TEL. l.�.
CITV .V NO. Z
NEW ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH �— � / .
OWNER /0
ADDRESS ALUE
ARCMITECT TEL. USE � E �6�OD
OR ENGINEER
r�
ADDRESS � ZONE TVPE � GROUP ��
APPqOVED
CONTRACTOR D BV DATE �Z � Z�
ADDRESS
TEL.
CITV �" NO.
STATE �— CITV APPROVEDSETBACKS
LIC. NO. LIC. NO.
SIZE NO.OF BLOGS. (FROM Ct/ STREET)
OF LOT �- NOW ON LOT qONT � l FT.
VSE OF /J
EXISTING BLOG. .--�� � L
Separate permits are required foc �. sio6–�—� FT.
electric, plumbing and heating work. REAR F7.
USE OF BVIIDING AND WORK TO BE PERFORMED VLAfVNING ACTION
DATE
� Y APPROVED
� „P` �E C� 1Z l�
I hereby acknowletl8a that I have reatl this application antl s[eta °i
n
that the above Information is correct antl aB�ae to comply with �
ell laws regulaiing building construcNon, antl 1 shall not employ �
any person in violation of the workman's compensation laws of v
[ha State of Celifomle.
m
I hereby canify that I am properly licansetl as a convactor untler SQ. FT. N
Me State of California Business entl Profeulons Cotle, Divblon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licenses are (n full forca antl effect, or I THE PUFiPOSE OF ESTABLISHING A PEPMIT FEE ONLV: �
am exempt from the provisions of the State of Celifornia Business VALVATIO v
PERMIT FEE S
antl Professions Cotle„Division 3, Chap r 9. yn • 00 m
V �� Od PLAN CHECK E �' �
Signature ot
� - � o
LL
Perm��ttee TAX S O rD u
� V
Authorizetl Agent Da[e TOTAL PAID E
TI.
�