HomeMy WebLinkAbout152 20TH ST - Building Permits 4`,' ' 'F 9 C CITY OF COSTA MESA `
BUILDING DIVISION
>•A„,.„„,„,,..1. P MIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
F : PERMIT
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E05-00158
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 152 E 20TH ST Status: ISSUED
Suite No Applied: 02/28/2005
Vicinity: SIDE OF HOUSE Issued: 02/28/2005
Parcel Nunmber: 42619101 1
Applicant: RODRIGUEZ, JO ANN ISSUED BY: 1
Address: 152 E 20TH ST
Phone: 949-548-9584
COSTA MESA,CA Zip 92627
Owner: RODRIGUEZ, JO ANN TR
Address 152 E 20TH ST
Phone: 949-548-9584
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:000000
SCOPE OF PERMIT
UPGRADE ELECTRICAL SERVICE TO 200 AMP PANEL.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool I Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops S0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed lithe permit is valued at one hundred dollars($100)or less.)
DSI certify that in the perk) nce of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C Ifomla,an that if should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwith
comply with these� vis ns. _
Ap` pllcent,Signature: ! J,() CC _ (Dale:—•-.-_p+' z5 -yJ
WARNING:FAILURE TO S E WORKERS'COMPENSATION COVE: s- .- AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(MUSLIN ADDITION TO THE COST OF FMPENSA.r .0 GES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lk.a Class ft
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I horeby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097.Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Byyyyyyssssssiness and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
jests the applicant to a civil penalty Cl not more than five hundred dollars($500).):
Ipas owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursu t to the Contrac ors ' .nse Laws.).
❑ I am exe u dei sec. _ B Mess and Professions Code for this reason:
/ O ,,.&*-a. ' 0 ' °-"' ....-----
(Signature: bete:"- ,.2-2k'—O 9r
.. gOwner ID " by drivers license. A es 0 C-OrIvehstaense.No: Expires:-.a•I5-03
Verification of Ownership by(type of document,i.e.-pr erty tax deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomla Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a
permit to do such work from the division.
Signature: Data:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one limo during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
..___.._...._ —._ .i.__.. ___._ __..n R _._ _._......_.— _ls)?_...
3 Does or will the applicant or present or future building ax;upant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazartlous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the Califomla Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of This
application.have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF DMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree t comply with all s laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described roperty for inspectio urpos s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
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k t -srg__ Oils-gay — Data
And/Or Authodz(Q Applicant Date
CODE A INSPECTION TYPE PAIL I[IIIDbLi SODS( INSPECTION TYPE 2hff IN1RIAL6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
P MI NO.0t75;:, TRACT NO. LOT NO. UNIT NO. 4506 7/19/84 5.Ql T1
CITY OF dr ss jba GONSanCTJON PERMIT 1 � p
Project Address z {�, / U
Applicant's Mailin A ss TYPE OF CONSTRUCTION NEW U ADD U ALTERATION REPAIR
•gam ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' ` A.P.# I Zone
Owner's Name J I'''( 1.µ1'fC• Phone DESCRIPTION OF WORK/USE OF BLDG.
Address 1 sa 2 . ant4t . C I cTA __ _ S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING FOUNDATION U STRUCTURAL E Front 0
Address 0 TENANT 0 ELECTRICAL PLUMBING 0 MECHANICAL B Rear N
Contractor's NemeQ DOST 11 IILF'14A1 A °I ❑ OTHER A I
•� 1�' one C Right N
Address(mailing) p� IeZV7 G 1 n• PROJECT DESCRIPTION SQ. FT. OCCUPANCY K
G
C O N ST RUCTION TYPE VALUATIONS S Left • R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Re(. # Parking Req./Provided E
0
I hereby affirm 7 that) I am licensedion under provisions andf Charter 9(commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of t•• Business Professions Code,and -
my license Is in ull fo e • • effect.. T
License C a 0 License Nytt. .0 S.
Date "I`it Signature -1,4�.� 7 .: PLUMBING I FEES
V
WORKS S' COMPENSATION DELL•/ATION Bar Sink Showers ELECTRICAL FEES
-
:'4ereby affirm that I have a certificate •f consent to self-insure or a certificate
. :Workers' Compensation Insurance, or a certified copy thereof (Section
`; 00, Lab. C.) - Backflow Preventer Service Sink - Automatic Washer Transformer El 15-50 KW
•Policy No, Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps
(This section need not be completed if the permit Is for ono hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel _
I certify that In the performance of the work for which this permit is Issued I
shall not pro an person in any manngr so as to beco e1/��bj/e�ct�t the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01 Ys-8
Worker'7 (r1s�e • n Laws af California ../1lJJ') cried
•r•-*^-� ❑
DateO �1�-11 Signature ullY Floor Drains • Swimming Pool w/Spa F.A.U. Inc.Solar 9-15 HP 016-15+
NOTICE: f,aft r m on this ions off h, you b o e subject to the
comply
such fpprovisions of the Labor Code, you et forthwith ked. F ddr Sinks Urinal Fixtures
comply with such provisions or this permit shrill be deemed revoked. - - Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance - D¢V ICs Boxes Pole Light
of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater '
Lender's Name p Outlets Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER OEC LARATI Otro J L1) IQQ/31yei A
I n affirm that amon exempt31.5from the Contractor'sofiol CLaw cot the Lavatories
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap
any structure, prior to its issuance, also requires the applicant for such permit Generator 00.5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of ' Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
^..[,vision 3 of the Business and Professions Code) or that he/she is exempt
^,refrom and the basis for the alleged exemption. Any violation of Section
44:31.5 by any applicant for a permit subjects the applicant to a civil
•`i'nalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered _ - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Approved By • Date
Trove for the purpose of sale). •
J� ,�
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ii) � Date �/ /g
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES '
builds or Improves thereon,and who contracts for such projects with a con- .
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me.
PLAN CHECK $ PERMIT
0 I am exempt under Section B.6 P.C.for this reason Firepl/Fact.BIL ICBG# PLUMBING $ s! ISSUANCE $
Date Owner Heating System& Ducting I ENERGY P.C. $
PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BTU_ ELECTRICAL $ GRADING $
information is cor •ct. I agree to comely with all city and county ordinances
and state laws a ng to building 4. s Mien, an�•/ hereby auth-rize epre' PLAN CHECK 50% $ MICROFILM $
sentatives of is pity to enter / •n the above entlonetl pop- t.�f•
Inspection pur•oses/ r / / Gy D
Signature . .ra�.r.2.l I/. As
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865.46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
• CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit#T Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. _ �-• 53. Steel Reinforcement
e i
• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. . _ 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings :• • 58. Electrical Conduit-Undrgrnd. ,',•
8. Foundation � C 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Und?grn>i. �• 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor,System 61. APPROVAL TO DECK •
11. Property Sewer'Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - . „ • 63. Heater & Vent-Final
13. Roof D gins . . ' 64. Plumbing System - Final
14. Rough Plumbinf; 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. bucts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Raugh & Test 72. Underground Flush
24. Roof Framing 73. Undetgfnd.Storage Tank C Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing tile ear c4
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
' Applicant to fill in al hose within heavy border lines and sign all appropriate declarations.
PERMIT NO. . TRACT NO. LOT NO. UNIT NO.
cJ7 iRCOSTA MESACONSTRUCTION PERMIT /4---1320:-/4---1320:- ?367 6/I B/7h 49. 17 TI
Z
Project Address 1S f—
_
> pplicant's Mailing Address 152 E "_0-11, TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION ❑ REPAIR s 0
VA-1Q' 11 Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • / ?Lei
wner's Name ��`r s -9s89 Ce.rat471CS ICI 1I/N A.P. gab-! Zone £2
xP DESCRIPTION OF WORK/ G
SE OF BLD
Address //749r�9LLTnil S Main Building: Accessory Building: - z
Arch/Eng. b License No. TYPE OF PERMIT GRADING U FOUNDATION U STRUCTURAL T Front O
Address ❑ TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear N
❑OTHER
Contractor's Name Phone C Right N
PROJECT DESCRIPTION SO. FT. OCCUPAN �z.,�
Address(mailing) CONSTRUCTION TYPE VALVATION$k� (�� . '+(� S Left G
R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARAT ON Ping. Ref.# Parking Req./Provided E
Q
I hereby affirm 7 that0) I am licensedion underfprovisions f Charter 9 (cCernq Remarks: Planning Notes: M
with section n full of en 3 of the Business and Professions Code, and
my license is in full I force and¢f l¢CI. T
License Class License No. S.
Date -_ Signature PLUMBING I FEES
WORKERS'COMPENSATION DECLARATION Bar Sink - Showers
-ereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer- • Service Sink
..d00, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred ($100)Or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that In the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑lA-8
Workers' CppfrpPpp��pqspp��((gqnn Laws of Cal`fomip
Dat e)e_{a_I1.(_L�Signature X `t1 Floor Drains SwimmingPool w/Spa
5 lI P F.A.U. Inc.Solar ❑9.15 HP ❑1G15+
NOTICE: If, fte making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY ' Gas Service / Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories
Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap
any structure, prior to Its issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
Nvision 3 of the Business and Professions Code) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
431.5 by any applicant for a permit subjects the applicant to a civil •
LIenalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law'does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By T Date
•
;Xenon, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By (�/IA'1/r Date 011r
LIrove for the purpose of sale).
I, as owner of the property,am exclusively contracting with licensed Con- Duct-Structural Refrigeration System Application Issued By Dat:
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU 975 SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractors) Ilcense pursuanm
pursuant'to the Contractor's License Law). I aaware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT.. SMTP $
SD
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK / '/ PERMIT
❑ 1 am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ISSUANCE $
Date G/ Owner Heating System& Ducting PLAN CHECK 25% $ _ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 Bit ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city to eater upon the above-mentioned pro erty for -
i Signature
purposes. AI c{p,/ MECHANICAL $ TOTAL FEE $ x
Signature �V�L/bL,(/M/ -1/W Date 'I
) .--
CMF
CMF 0865-46,rev.4/84 white-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
-2 CONSTRUCTION AND PLANNING POC .SPA
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
e1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
-
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd: 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
t
Rough Factory Fireplace APPROVALS Permit#
Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL /z/t y 7r---7
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat •
79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final ,�y��o
40. Gas.Service-Final 9,u cc' _j'/t C •
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation .
46. Handicap Regulations • , •
47. FINAL STRUCTURE& BUILDING ,
48. Special Requirements Completed
49. Electric Release to Edison . ,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
CITY OF COSTA MESA
SERVICE REQUEST & PUBLIC ASSISTANCE FORM //p
Date 1 .— f :! - 77
• • Time a 7
VrACaller's Name /�pL/ �[ =
Address ! 5 � 02O Q Phone o ss- ,e707..? /
Nature of Request: (location, type, severity) .14_474.77:7
//it2-#72-1b
of if
Referred to C—/I/A, • - / /
Call backEl
Service Only n
Information Only
Person Receiving Call `E7
r
r i kY..Y`h. �" - day n H ;S�q 1� � �-�j � - �
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OWNER BRANDENBURG, PRICE DATE 10-21-58
JOB ADDRESS 152 East 20th BUILDING PERMIT NO. 7868
GENERALCONTRACTOR Owner VALUE $ 250.00
11Ap%2-1 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Reroof Res.
r`UP I J TYPE V ZONE R—LI PLAN NO.
IN0PECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil WIG Pipe Test
Top Out
Furnace
Gas Vents .
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final
P inq Fixtures, Final
F. Gas Test
Construction Pole
Underground Power
Rough Wiring
Fixtures, Final 004OCCUPANCY � N 11/444ST
Form 210—SM-1-57 ✓ 7868
V ls 'V- USitS `U. ISV .1 1. l/
/c -a I-S4
r` 7868 fiNANCIPtiffi,o¢ ***tea? nn'
COSTA MESA BUILDING DEPARTMENT COYOf C!A MESA
P.O. BOX 317
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ABUILDING
DDRESS / cc.' ' BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. geS
OWNER AL , I� , �/ h.r/ /.ral-.4' '
LT
) p DATE RECEIVED DATE ISSUED
MAIL
ADDRESS J _D pp O I - + I�llekliffl /0-ate A .0-2�_S8
TEL. • cBUILDING
CITY b , a/ NO. ,�- a .D ADDRESS
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
FIRE
ADD , ZONE
CITY LIC. PLANS
NO.OF TYPE GROUP
CONTRACTOR ,� /A'_4. NO. '
TEL. APPROVED
_ADDRESS NO. BY DATE
LEGAL LOT CORRECTIONS
DESCRIPTION NO. TRACT
SIZE reggn
OF LOT H. 6 0 k I0: .,
USE OF / IIIIIIIIINNWI=
EXISTING BLDG. ,ip . _ _ -
SETBACK LIST FROM REAR YARD. � 1• _
CENTER OF STREET
SIDE YARD RIGHT LEFT I A _
DESCRIPTI•N OF WORK BY_ W n E_
mialis
NEW
. ALTERATION ElADDITIONA �,S,J_
REPA MOVING
MIME --.-.
BUILDING NO.OF
SIZE ......-ria ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW
BUILDING it,_en--e-0 L5_, . . .,. .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. I VALUATION
IMMITIFLIZI
SIGNATURE OF /
PERMITTEE /I Pr'..: • 1 .44t0.....:141.1
$ AS y� 5 P / .l//�
/ -J PLAN CHECK $
AUTHORIZED AGENT . TOTAL FEE $ a. �0 VBMF
Rf711BT(UF7, Joann v-`+ru
JOB ADDRESS 152 East 20th Street BUILDING PERMIT NO. L711 ;
GENERAL CONTRACTOR DESCRIPTION of WORK Blockwall
Modern Coast. Co.
4" Mo.118-063-24 LOT TRACT FIRE ZONE VALUES 872.00
)An
1 ECTIONS Signature Dote TYPE III GROUP j ZONE R-2
SOIL PERMITS ISSQED
GAS SUBCONTRACTOR
Date Number I Signature
WATER Plumbing
, f ROUGH PLUMBING
-SPROP. SWR. LINE CJ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING •
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER 0
ROUGH WIRING / Heating and Vent.
TRENCHES 4 FORMS STEEL REINF. IS /)' (P /'rlb
FLOOR SYSTEM
BONO BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND f1
FLASHING�-�
` •
LATHING - IN OUT n
PLASTER. BROWN COAT
ITURAL, FINAL Flertric
1. NG, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL / j I '
BUILDING, FINAL , 1/ "i iiirlAA, V7 v /tea —mrn' _ _- _ . ' _ • T/l/
,:***
421 .1.5 R ,6A..00 3891. 9sc
COSTA MESA BUILDING-SAFETY DEPARTMENT
p.0.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
REC�IV$D BY p{�=E =C�,L�FD D TE 1$�jUEj)_�1
BUILDING CSL �, do ` U/Il /(/O Y 7
ADDRESS //�V �s� /�/�/S Q MZJ�C{//�19
OWNER <J.{j 44/4 1V a it BUILD NIIB —LJL/J —2- l P Wire.
MAIL
ADDRESS/'V Aj L,ArI�� , 2(7 /71 'ry / ��AV�D DWSR��{E 7SS�,I�s�y��� , 24631 ��.
CITY V . 44 , TENOLJ/0 ...j. '^" T Tt 1 7s. LOT 21L BLOCK
CONSTRUCTION / NEW ADD ALTER REPAIR MOVING DEfvtOLISH
LENDER
BRANCH OWNER / ,44/4/ p c •
ADDRESS I LUE G rJ 1
ARCHITECT TEL. USE °CIC Id-hi'( E p 1-,aI
ADDRESSOR IENGINEER NO. ZONE TYPErGROUP 1
�J / FIRE
CONTRACTOR
�ym QJt�.i--_ ,,L )-2./� Lo •
APPROVED a �/) DATE 4'e 3-14
ADDRESS / /V S• :Y'-'I FP C ' ��•v
/J ZON�EJ_2�) NO.OF USE OF NEW t
CITY �G. ._ e-- et/t—G, NO4 V3/tTy t"�' PLAN BUILDING t LK toALI`
F' STATE77 6 / CITY YARDS APPROVED YARDS APPROVED
2
LIC. NO. — 0 9 7 4 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INZ?O.OF BLDGS. (FROM C/L STREET)
O. OF LOT [NOW ON LOT FRONT FT. L—/ FT.
Q USE OF //JJ��
EXISTING BLDG. be> C/L L( et 't.- fl SIDE FT, FT,
co
ES Separate permits are required for L.SIDE FT. '"---(efre FT.
electric,plumbing and heating work. REAR FT. --a FT.
kl USE,OF BUILDING .a ND WORK 0 BE PERFORMED
DISTANCEp , BET. AEC.MAIN&
/0
MAIN BLDGS. ACCESS.BLDGS.
4 C �Q // i I /�/ VAR.* DATE
Q ��/,4_- p( (/�`C�>) C.U.P.As APPROVED Sys `�
>-,
1.4 { rY ' . APPROVED ROVEO� V ' DATE � �Cl� / �
I:6
GU •
a. I hereby acknowledge that I have read this application and state n
u
12 that the above Information Is correct and agree to comply with
co
G. all laws regulating building construction, and I shall not employ ai
Z any person in violation of the workman's compensation laws of
x the State of California. m
I hereby certify that I am properly licensed as a contractor under SO. FT. N
• the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR te
Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
us
am exempt from the provisions of the State of California Business ////yyyy V
VALUATION PERMIT FEE E 9iiO4 u,
and Professions C Division 3,Chapter 9. n
p/s PLAN CHECK $ rn
7 K/
Signature of o
Permittee / �/�+� - (0u't_• $ J{ � TAX $
Authorized Agent TOTAL PAID $
s