HomeMy WebLinkAbout166 20TH ST - Building Permits City of Costa Mesa
Development Services Department CERTIFICATE OF OCCUPANCY No. i
Building Safety Division • l)111 G'10
P.O.Box 1200
Costa Mesa,California
The Building located at /AA, F. )nth street, Units B & C •
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
fora Group PS Occupancy.
Use of Building Duplex
Legal Description 426-191-05
(See reverse side for Metes and Bounds)
Building Permit No B 2R84A _ Electrical Permit No. E24461tE31425Plumbing Permit No. P 29545
Mechanical Permit No. Number of apartments 2 and/or guest rooms
ISSUED TO: Building Official William T. Howard
Sam Vann
166 S. 20th Street by - �.
rr1ata Mesa. CA 92627
Date May 25, 1988
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File
.9 O
�Pri /) • Applicant to fill in all spaces except those within heavy border lines and sign all apRSo Jute frplarations.
•, P MIT NO. TRACT LOT NO. U T NO.
• CI' Y�P t.OSTA iv1ESA CONSTRUCTION PERMIT nrs5 T ' . -.
a uaS$ Irn Nei�wr� PO�' 2J2 tj �G 9 .i! i :,
Project Address let, a• 20 St. -- G, M r .. C., Lir
r itpplicant's Mailing Address t3 &. �'. ,r.-1' Elk AV AirtAktL+M 51ec5 TYPE OF CONSTRUCTION ANEW _J ADD H ALTERATION REPAIR �/ /� q .e �f
• Owner's NametSt % & .J G STe-W fr ❑ CONVERSION ❑ DEMOLISH ❑ OTHE i � ) A.P.# T�sp- // V S I Zone R i.
Phone DESCRIPTION OF WORK/USE OF BLDG. LL.J {if<L/�i`��(
Address• it E Ls 5-t/ Cord Mon 1 / ,
nn}}.. y, �'r'E�o n� �y M.-FOUNDATION
�✓ L-4-STRUCTURAL
�y S Main Building: ,t /�� Accessory Building:
Z
Arch/Eng. Pb5 C61&iitW{1 Crt• License No.�s 5-6°-7-0 21' TYPE OF PERMIT a GRADING M FOUNDATION L-- STRUCTURAL T Front A yr 404 Sb D
, .Address -)(�O^, fsrr`•"ti """P yth, yea4731 fat/"/"" ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑1MECHANNICALti- '/ g� BA Rear /�.5/ fR,,�,,�AI 9. s N
Contractor's Name a -. ( �1 L t rio 7-°AA Phone 75d 7571 „z.THER • - '`'�`''`��''�
PROJECT DESCRIPTION SO. T. a- .9 OCCUPAN V a C Right � '7. S / v N
Address(mailing) L33G 6. KA't"'EII Ale , AaJ(6grM 91$CS - K S G
City License No. 04c1 Too CONSTRUCTION[� - 2_TVPE t VALUATION$ Fi sz g Left I R
'ZONE " GRADING CU.YDS. ACRES Ping. Ref.# pA�S7 Q1 Parking Req./Provided (of Co E
LICENSED CONTRACTOR DECLARATION Cl
I hereby affirm that I am licensed under provisions of Charter 9 (commencing. Remarks: Planning Notes: �/ n
with section 7000) of Division 3 of the Business and Professions Code,and n� ( -1. QNY1C.. �Q'k/1'L M
my license is in lull force and effect. �//�� /' —p �• /
License Cl.ss i cens ,No.T�6713 P� �. A�— (�� �SY - - 19 lit Y 11 •Ltlo
1r1, (ii $
elli
Date 's I 1 Signature .' __A sw • • or /PLUMBING FEES ` ML �{ 5r '
'•'ORKE RS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
10 treby affirm that I have a certificate of consent to self-Insure or a certificate
S Workers' Compensation Insurance, or a certified copy thereof (Section 4Backflow Preventer Service Sink ..
MW 3800, Lab. C) ./�} Automatic Washer • Transformer 0 15-50 KW
Policy No. S96f2 T/'8"' Company - Stitt e •
.Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
' .Q Certified copy is hereby furnished.
rtifie c p is filed with the city Bui in Di isipj' Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amp
Date 70 77 Applicant �""� /V - ./s7-i-r�:
EXEMPTION�I /OM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 ps
M (This section need33not be completed if the permit is for one hundred ($100) or Dishwasher
less). Solar Pipi - Dryers ❑Gas DElectric 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 Sol., ank Fan
workers' Compensation Laws of California. I - Mo • ❑D-1 HP ❑1R-B
Date Signature Floor Drains - wimming Pool w/Spa F.A.U.
NOTICE: If,atter making this declaration, you should become subject to the - n0.Solar❑9.15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks •
comply with such provisions or this permit shall be deemed revoked. Urinal Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service . Outle Water Closet Device Boxes
I hereby affirm that there Is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name Range
•
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 Lavatorie Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P- .p Laundry Trays Generator ❑O-5 KW❑5.15 KW Trash Compactor
structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of - • - • ' "
•ision 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
X31.5 by any applicant for a permit subjects the applicant to a civil
genaity 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 $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 SERVICE R,�j)IUIREMENTS: /_ ��
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 �Y( r0
�!�
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II Zoning Approved By Date
°.
the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). _ Building Approved By Date --
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural • Refrig on System I r Application Issued By Dat: . r
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 -100,000 BTU ❑100,000 BTU SUM V OF FEES
builds or improves thereon,and who contracts for such projects with a con- y
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust S stem BUILDING PERMIT $ 00 SMIP $ /•72
f y ❑ Multip System Repair/Alteration y
Proof o their Worker's Compensation insurance should be provided to me. PLAN CHECK $ •125 PERMIT
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. IC Fire Dampers j
PLUMBING $ ISSUANCE $
Date Owner Heating Sy & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑O- ,000 BTU 0100,000 BTU - GRADING $
information is correct. I agree to comply with all city and county ordinances \ ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to enter pon the above-mentioned property, for �1
inspection purposes / �� MECHANICAL' $ 53 is q7
Signature �� • l Q2,` Date /'r P� TOTAL FEE $ t
Drivers' License or 55# • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
A
CMF 0865-46,rev.10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
I
•
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector •APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement P44-1 1;4" 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. ,R/i,Y1r7 G-'/ 57. APPROVAL TO COVE R-GUNITE
7. Footings g Jf,� &r ' 58. Electrical Conduit-Undrgrnd.
8. Foundation f/(`y/._ � 59. Gas+Pipe;0 Undrgrnd.,Test r
9. Water Pipe-Undrgrnd. fY7 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System ,
y �/Z.�/� Gr✓ 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - . . 4ri
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framing tfr 32, g../..-73. Undergrnd.Storage Tank 0 Gas 0 Oil .
25. Roof Sheathing /f 3 e-' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat (((( 75. Dry Chemical
27. Frame and Flashing IZI`b el C.. 0. 76. Dry Standpipe
28. Lathing & Siding 12411 87 4.k" 77. FIXED SYSTEM FINAL
ti
29. Insulation _I - 1-1 10 G. rJ • 78. FIRE PREV. FINAL
30. Drywall Nailing t -16 aH HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ` t3 &$ (IV 79. FINAL INSPECTION .
32. Electrical Power Meter-Final l' 80. FOOD CERTIFICATE ISSUED -
33. Final Electric Notes: KO FOR SPECIAL R*QU ._ 5
34. Final Heating & Air Conditioning TA S1/2.7 CI1/_-1 flu netfpecrr --1
35. Final Gas Pipe-Test 4e4 g.oif G.it)
36. Hood or Canopy /y1()-14c DR-7L,.ALi. �(- Oat LA Cr&-Ni
1 1•
! ��'77� � v
37. Final Factory Fireplace f3-131k/ ('S Foy- VRY/-i.14 A-Ar eArg 6-.4'-
38. Final Plumbing 1}.I "I4� M " e7 Nom; K,Jr G,//�
39. Water Service-Final , A
40. Gas Service-Final ek /// 1
or49&) r�•
41. Solar Domestic-Final �t
42. Backflow Preventer
43. Backf low Irrigation -
44. Landscape Irrigation System
45. Sound Attenuation ;
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 11/x'7 & -'
48. Special Requirements Completed /033 M A/V f A
C/ ��..CCJJ • .
49. Electric Release to Edison •
t
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
n
No. Date •
•
' I
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-
CITY OF COSTA MEE.$A/' CONST8 JCTION/PERAMIT RMITjfJO_ _ �sI� TRACT NO. LOT NO. UNIT NO. 3027 /12/80 15.00 TL
'Project Address 1 6(j 1�. , aQ•�+ Di C�.l'1r �.L ,, LKJ ❑ ADD U ALTERATION U REPAIR
Applicant's Mailing Address 1S SC`A'x1� TYPE OF CONSTRUCTION U NEW
•� �.l ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. I Zone
Owner's Name +- 15'`K ce fh (A P nPhone DESCRIPTION OF WORK/USE OF BLDG.
Address 166 E. 4,0 f'� C-} e.{✓�, co,LI S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL T Front O
Address ' y ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Nam n EJx+ �+•rtl bPh�nelC Right
El OTHER A 1
}o. PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) •
1 C E+ P C 0. Ye P ¢tw• 1. K G
' Soo C ON ST RUCTION TYPE VALUATION$ S Left R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.4 Parking Req./Provided E
'I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and - T
my license is i+tk/yyeese�Vt fpyce and effect. L[ si ria
License la LI Lic Fa Nq 1 4, 1 l $
Date et Signature eA++ a� )• 7�n33. PLUMBING FEES
kJ'
WORK RS' COMPENSATION DECLARA ION (1 Bar SinkShowersELECTRICALFEES
4 hereby affirm that I have a certificate of consent to self-Insure or a certificate
• Workers' Compensation Insurance, or a certified copy thereof Section Backflow Preventer Servic nk
300, Lab. ) Automatic Washer Transformer 0 15-50 KW
Policy No, 104-11 —82 Company St0.+e Backflow Irrigation Sewer Cap0 50+KW
Construction Pole Sub.
U Certified copy Is hereby hthfurnished.
Cert' led hc filed with the city 1p�'u ding`Di Islon Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
(y'SAI Date Xy\1 L7 6 Applicant f�-a �• �yes.q�� •
U EXEMPTIO FROM WORKERS'COMPENSATrt N DECLARATIClarifiers Solar Collectors - Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 001 HP ❑1'h-B
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration, you should become subject to the — Inc.$Olay 09-15 HP 016-15+
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 9
of the work for which this permit is issued (Section 3097 Clv. 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 Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor
any structure, prior to Its issuance, also requires the applicant for such permit P
to file a signed statement that he/she is licensed pursuant to the provisions of
Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of - _-— -
Division 3 of the Business and Professions Code) or that he/she is exempt -
trefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil _ ,
natty of not more than five hundred dollars($500).
0 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 l 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 owncr will have the burden of proving he/she did not build or im- Duct-Under Ground .Building Approved By Date
prove for the purpose of sale). -- -- -- - — - -- - - ;��.
0 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 ❑100,000 BTU SUM V OF FEES
builds or improves thereon,and who contracts for Such projects with a con- tv7�p^p
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUIL ING PERMIT $ IS SMTP $
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK § PERMIT
O I am exempt under Section B.84 P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers
—
PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 BTL GRADING $
information Is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre-
sentatives of city to ' er up.n the above-mentioned property for
Inspection pur.• I a1 p MECHANICAL $ TOTAL FEE $ .Lc
Signature _ A . - Date ' r)�ll U
Drivers' License or S-' - * Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND'PLANNING POOL & SPA
• APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector '
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
fi. 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 GrAd. 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 Electri`I=Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
•
20. Rough Factory Fireplace APPROVALS Permit# •
_
21. Ducts, in.Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -r
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •
33. Final Electric Not : •
34. Final Heating & Air Conditioning ( '//
P d '3i to y1� if r
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
- 43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDINGKr"
-4.
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
'
No. Date /I_
T-
•
9992 E/19/177 1763.02 11
' CITY OF COSTA MESA 11/4
PARK FEES
Fee Payment Receipt 001084
Project Address ` I(o 10 E • 2O' sr.
A.P.Number 4247 — 19 - os
Building Permit Number
Owner's Name -r• &FAA ct va- sada k0 Lien 0
Mailing Address /66 E€ aoTh St• Cosa (1ML a. 1CG—•
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,810.50 =
Multiple Family **
•Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedroom 2 @ 881.51 = IJ 76 3- 0:2-
3-Bedrooms+
Z3-Bedrooms+ @ 1,229.38 =
MTotal Fee *** LATega. 02-(0/( •
Planning Department Approval Date 9/87 By / r• /11
Applicant's Signature
* City Ordinance 72-44 ** City ordinance 72-45 *** City Resolution 75-116 ��
CMF 0174-30,rev.7/55 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant U�
City of Costa Mesa INSULATION CERTIFICATION Building Safety Division
1 (,‘ E• aQt S-keee l Coc4c\ tc�'1 ' •
Number and Street City Cou,Z
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material Brand Name
Thickness (inches) • Thermal Resistance (R Value)
EXTERIOR W L C 4 /+
Material t Qr 'etSS — 1 _4«rP Brand Name Ota�ehiS - C.on_ 10
tt..f
� tr
Thickness (inches) '3 g- _ — Thermal Resistance (R Value) k
CEILING
Batt or Blanket Type twSS Brand Name 0Lee,4S —Cc>t'elt�pJ
Thickness (inches) Thermal Resistance (R Value) N 1 I S
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED //yy��
Material �r \DeCy\tSS 'UM&'.e.<I Brand Name Ow C'MS •-• �o nt ivc
Thickness (inches)) 6 Thermal Resistance (R Value)
FLOOR,SLAB
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
t< . n— to 'nrGti./ari— L4t' (9)--0 • C ( — Lf56 ? ?3
General Contractor (Builder) License Number
l
P . pl
• o.rcL 1 ec&
gnature and tle l� Date
Sub Contractor(Insulation Applicator) License Number
Signature and Title Date
CMF 1106-46
4104 E.K. INTERNATIONAL
Design&Development Corporation
1336 E. Katella Avenue
Anaheim, Calif. 92805
Phone 1714) 750-7577
March 10, 1988
CITY OF COSTA MESA
77 Pair Drive, Costa Mesa, Ca.
Dear Sir:
This Letter is to certify that the drainage at
166 East 20th Street meets all STATE and LOCAL CODES
and REQUIREMENTS. Building Permit No. B 28846.
e
bye2, // , iy President
E.K. INTERN TIONAL Design $ Dev. Corp.
CERTIFICATE OF COMPLIANCE
L y,
PAYMENT OF SCHOOL FACILITY FEES t.
NEWPORT-MESA UNIFIED SCHOOL DISTRICT• : 1)
f)eveloper/Applicant : �• < neffr LMZt( eSi kow4tttot .
Address : 13,-6 e-. �p �—G—I.�A At . A-t•) t `'n . 124302
Telephone Number : (114-9 156 _
Tract/Parcel and Lot Number(s) :
Location of Project : ' 6 E • X44" ' l • , (G silt M--sA---
•
Number of Square Feet oft 2� 2c o0
. Residential Space .1-�J O x $1 . 50 Total
Number of Square Feet of V
Commercial and
Industrial Space • x $0 . 25 Total
The provisions of Government Code Section 53080 are not
applicable ,
This certifies that the above-named Developer/Applicant has paid
school facility fees in compliance with Government Code Sections
53080 and 65995 .
Checks .are to be made payable to Newport-Mesa Unified School
District ., cyc-0,42'
Business Manager
Newport-Mesa Unified School District
The above representation as to square footage is true .
Developer/Applicant agrees that if it is later determined that
such representations are not true then this certificate shall
automatically terminate and the appropriate City/Co'unt'y shall be
notified .
/ vI, ( ---
Date : 4/7 ( s Developer/Ap% licant,
Exhibit A . - •
(10-25B3) •
f
PG -It 177 - c37A- .
ACCELERATED BUILDING PLAN REVIEW AGREEMENT
THIS AGREimarP, dated 3/009 /r7 , is made by the CITY CF CUSTA
MESA, a municipal corporation (CITY), mak- I'YLternah'On cA (DEVELOPER),
and _ S. / ( c, (ENGINEER) in Costa Mesa, California.
WITNESSETH
WHEREAS, the CITY has established a procedure thereby a DBVELCPER may
retain the services cf a qualified independent ENGINEER to perform the building
plan review normally conducted by the CITY or its private contractors; and
WHEREAS, DEVELOPER proposes to utilize the accelerated plan review pro-
cess in connection with the prcposed development of property located at
c . -2o 7t in the City of Costa Mesa; and
WHEREAS, ENGINEER represents that he is duly licensed by the State of
California, and that he shall meet all minimum qualifications and responsibilities
required by CITY as hereinafter stated; and
WHEREAS, DEVELOPER understands and agrees that no building permit shall
be issued until all requirements and conditions cf this agreement have teen satis-
fied; and
WHEREAS, ENGINEER represents that he has that degree of specialized exper-
tise contemplated within California Government Code Section 37103 and holds all
necessary licenses to practice and perform the services herein contemplated; and
WHEREAS, no official or employee of CITY has a financial interest in the
subject matter of this agreement contemplated within the provisions of California
Government Code, Sections 1090-1092; and
_y
WHEREAS, ENGINEER declares that he shall perform the services herein con-.
templated in cc pliance with the Federal and California Lams related to minim
hours and wages, (40 U.S.C. 276 A et seq and California Labor Code Section 6300..et '
sa3 and California Labor Code, Section 1410 et seq), to the extent saw are appli-
cable herein. •
NOW THEREFORE, in considerationof the mutual praxises of the parties, and
other good and sufficient consideration, the parties agree to the following;
I. BUILDING PLAN REVIEW SERVICES
A. CITY does hereby agree to accept ENGINEER to perform building plan review
in accordance with the terms and conditions herein set forth.
8. ENGINEER shall review plans for compliance with pertinent City and State
regulations falling within the purview of the building official of the
City of Costa Mesa.
II. FEES FOR BUILDING PIAN REVIEW SERVICE
A. Fees for performing the building plan review shall be negotiated between
DEVELOPER and the ENGINEER and said fees shall be paid to ENGINEER by
DEVELLIER. The CITY shall not be responsible to ENGINEER to any extent
for the fee owed by DEVELOPER. CITY shall not be called upon to assume
any liability for the direct or indirect payment of the fee awed by
DEVELOPER or of any salary, wage, or compensation to any person employed
by ENGINEER
B. At the time the building permit is issued, an administrative fee equal
to 25 percent of what would norrally have been the plan Chedk fee, had
the plans been checked by the CITY, will be Charged and collected by the
CITY. This fee will be in addition to the building permit fee.
III. LIABILITY EXPOSURE AND COVERAGE
A. All officers, agents, employees, and suboontractors, and their agents,
officers, and employees who are hired by or engaged by ENGINEER in the
performance cf the building plan review, shall be deemed officers, agents,
and employees and subcontractors of ENGINEER only and city shall not be
liable for their acts or omissions nor responsible to them for anything
whatsoever.
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•
• B. ENGINEER and IEVELCPER shall each separately indemnify and save harmless • •
CITY, its officers, and its employees, frau and against any and all,dam-
ages to property or injuries to, or death of any person or persons, in
cluding property and employees of CITY, and shall defend, save harnnless',•
and indemnify CITY, its officers, and its employees, from and against• any
and all claims, demands, liabilities, suits, actions, proceedings, or •
judgments therefore, resulting frau or arising out of their awn negligent
acts or omissions or the negligent acts or anissions cf their respective
employees or subcontractors; except that neither ENGINEER nor DEVELOPER
shall hereby incur any such obligation for the negligent acts or omissions ••
of the other. •
C. ENGINEER shall obtain and maintain the following insurance coverage:
1. ., C IMPRE IEASIVE SAL LIABILITY coverage with policy limits of not
less than $1,000,000 combined single limit per occurrence, with CITY
as additional insured, and with an erdorsenent that the insurance
provided the CITY as additional insured shall be deemed primary and
nonoahtributirg with any other insurance of CITY.
2. PROFESSIONAL LIABILITY coverage for $1,000,000 with a contractual
liability provision sufficient to insure Paragraph III.B. above.
3. % REER'S CU'SEATICN INSURANCE in statutory amount.
4. The genneral and professional liability insurance shall provide con-
- tinned coverage for at least 12 months Soliciting completion of con-
struction of the project and shall not be cancelled, modified, or
reduced without first giving CITY thirty (30) days written notice.
D. ENGINEER shall .provide CITY certificates of insurance acceptable to the
City Attorney showing the above coverage and policy endorsements prior
to comnencement of any plan check services.
IV. GENERAL CONDITIONS
A. The ENGINEER shall wnply with all the provisions of the Worker's Compen-
sation Insurance and Safety Acts of the State of California, the appli-
cable provisions of Division 4 and 5 of the California Labor Code, and
all amendments thereto, and regulations adopted pursuant thereto by the
State Department of Labor and similar State or Federal acts or laws
applicable.
B. ENGINEER shall certify in a form and nanner acceptable to CITY that the
plans he has checked comply with all applicable codes, ordinances, and
laws relating to the particular type of development proposed and that
permits may be issued for the construction of same.
C. If omissions or errors in the plans are discovered airing the course of
construction, corrections shall be made at no cast to CITY, and, all work
performed shall be required to amply with the codes and ordinances of
CITY prior to final building inspection.
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D. DEVELCPER shall, prior to or concurrently with the building plan review `l
by ENGINEER, contact the Planning Division, Fire Marshal, and/or Public r
Services Department of CITY, the Costa Mesa Sanitary District and/or the
Mesa Consolidated Water District to determine any conditions or special
requirements which may be administered by those departments. Failure to
do BD may delay issuance of building permits.
E. The licensed architect, registered engineer, or other authdrized person,
entity, or corporation who prepared or supervised preparation of the
project plans, specifications, and/or engineering calculations being
reviewed, shall not be associated in any way with ENGINEER.
V. RESPONSIBILITIES OF ENGINEER
EWINEER shall review plans for compliance with pertinent CITY arca State
regulations falling within the purview of the building official of the CITY.
More specifically, the services to be performed by ENGINEER shall consist of
but not be limited to:
PLAN CHECK
a. Classify the building and verify compliance for the fallowing:
1) Cccrpancy group
2) Type of construction
3) location an property
4) Floor area
5) Height and number of stories
6) Ocoupant load
b. Verify compliance of the building with detailed occupancy requirements.
c. Verify compliance of the building with detailed type of construction
requirements.
d. Verify capliance of the building with exit requirements.
e. Verify caipliance of the balding with detailed Code regulations.
f. Verify compliance of building with engineering regulations and require-
cents for materials of construction.
g. Verify compliance with California Title 24 by .reviewing mechanical and
electrical plan schedules and monk sheets for thermal insulation.
h. Verify compliance with California Title 25 and Section 13-144 of the
Costa Mesa Municipal Ordinances by reviewing mechanical, electrical, and
plumbing plans, details, calculations, and any required Acoustical Engi-
neer's report.
i. Provide the fallowing:
1) Coordinate with City Engineering personnel for grades determination.
2) Provide drainage review by CITY Ordinance
3) Check drairgage flow "Q" calculations.
j. Review plumbing, electrical, and heating drawings.
k. Provide for review and verification of all of the above items until all
corrections are made arca all data are in compliance with all codes, ordi-
nances, and State and Federal Laws.
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W. CERTIFICATION
,\
The following certification statement shall appear on each page of the draw-
ings submitted and shall be signed and dated by the registered architect or
ENINEER:
ARCHITECT OR ENGINEER CERTIFICATICN
•
I hereby certify that the work proposed to
be done on these plans is in conformance
with all Codes and Ordinances of the City
of Ccs to Mesa and further, if omissions or -
errors are discovered, I understand that
the work performed will be required to oem •
-
ply with the Codes and Ordinances cf the
City of Costa Mesa prior to final building
inspection.
•
Signature Date State License
VII. PERMIT ISSUNC
Building permits shall be issued by CITY upon completion of all requirements
specified above and, upon completion, of all requirements of any other
affected department of CITY or other governmental agency.
VIII. ACKNOWLECGEMERIS
EUVEICPER and ENGI!WEER acknowledge that they have read and understand the
above statement of conditions, requirements, and direction and agree to per-
form accordingly. Furthermore, they understand that no building permits
shall be issued for any project until these requirements have been satisfied,
and they certify that no work has been undertaken by the ENGINEER involving
plan Check services prior to submittal of the required certificates of
insurance and prior to approval of same by the Costa Mesa City Attorney.
IX. SIGNATURES
A. The Director of Development Services or his designee is authorized to
execute this agreement an behalf of the City of Costa Mesa alien the
parties meet the conditions listed herein.
B. The DEVELOPER is defined as the fee title property ower or the tenant
for which the inprove entth are being constructed. If the fee title
property owner or tenant is a corporation or general partnership, an
officer of the corporation or a general partner shall execute this
agreement.
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C. If the ENGINEER is a corporation or general partnership, an officer of
the corporation or a general partner shall execute this agreement.
IN WITNESS %'EEREOF the parties have signed below.
�.K. (niVC liA p KDaa . , E6 7 CO/uGC L N l 5
DEVELOPER I C-4� S
ENGINEER
•
BY BY l fi- t A
kni--/ e
{(1-t-3)2k /- c- vl /° 6& 4 c`—'vilP�
TITLE TITLE
(If Developer is a corporation, officer (If Engineer is a corporation, officer
of corporation must sign; if Partner- of corporation must sign; if Partner-
ship, general partner must sign.) ship, general partner must sign.)
t33 E - Q UA AV‘, /9/r F. /'7 '-`� 57.
ADDRESS ADDRESS
i441 t wi CR . a 2-$e5 ffrvA- Get g270/
btf) 150 - s 7 (7/¢1 /frz
TELEPHONE TELEPHONE
CITY CF )STA MESA
BY 1 10 • 1 fer4- .
BI HChWRD
Assistant Development Services Director/Building
-6-
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
e - PERMIT NO. TRACT NO. LOT NO. UN T N
CITY OF COSTA ME\SA CONSTRUCTION FERMI p 2- el le� °'-" " r /
Project Address \\ D� S.ot5tv tal(10-pTl�N c . 'CCC��s��'ryryry/� NEWLI REPAIR
Applicant's Mailing AsdAdrresss,.c).9` grOx loyy 1 A1v g&\ .1 DL TYPE OF CONSTRUCTION U ADD U ALTERATION
Owner's Name S' C#d\ v�V w phoranzz,im7 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.,H, Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address . S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING El FOUNDATION U STRUCTURAL T Front ZO
Address �.�r� ` ❑ TENANT ❑ ELECTRICAL X PLUMBING ❑ MECHANICAL B N
g S'r �V•!•r�biwI El OTHER A Rear I
Contractor's Name p Phone
ero Address(mailing) ` -b` cot:, �} y'4\ PROJECT DESCRIPTION SQ. FT. , OCCUPANCY C Right N
CID
a�' i t CONSTRUCTION TYPE -.- VALUATION$ S Left R
/ City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
1 Q
` I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Q 2 „sr '�hj Planning Notes: NI
with section 7000) of Division 3 of the Business and Professions Code,and J, I'
I my license is in full fo e a • of ect. � �� T
Ucen • Class - •n o,33 S
Date •'� Signature � ` �•' PLUMBING FEES
3RK RS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES `
.tereby affirm that I have a certificate of consent to self-insure or a certificate _
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab I:.) i , 1 • 1 //o Automatic Washer Transformer 0 15-50 KW
Policy Ne. L ��-/ -N7 Company e?l vw�_ti-'tLfl.CJ- Backflow Irrigation Sewer Cap Construction Pole Sub. D 5+KW
R Certified copy is hereby,furnished. 2 ,
Certified copy is filed with the city Building Division. `\ Bathtubs , Sewer Connection al 60 Cooking Unit Meter Duo to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher I Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100)or
less). Dishwasher Solar Piping /� 0,.., Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for which this permit Is issued, I t�
shall not employ any person in any manner so as to become subject to the • Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1-r-8
Workers' Compensation Laws of California. - /
_
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration, you should become subject to the - Inc.Solar ❑9- HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microw
CONSTRUCTION LENDING AGENCY 3 Gas Service Outlets '3 Water Closet t ,4c Device Boxes •
I hereby affirm that there is a construction lending agency for the performance P Light
of the work for which this permit Is issued (Section 3097 Civ. C.)
Interceptors 3p Water Heater 6i 1 Outlets Range
Lender's Name
Lender's Address v3 Kitchen Sink 1 Water Service 6 MU —
Switches Sign
OWNER BUILDER DECLARATION ��ss
I hereby affirm that I am exempt from the Contractor's License Law for the �-a Lavatories Auto-Wash 6 oil Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or J
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator ❑O-5 KW -15 KW
any structure, prior to its issuance, also requires the applicant for such permit - r Trash Compactor
'a file a signed statement that he/she is licensed pursuant to the provisions of - Roof Drains ,
ae Contractor's License Law(Chapter 9,(commencing with Section 7000)of i
)ivision 3 of the Business and Professions Code) or that he/she is exempt - -
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty 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 E. __- -- _ .-
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 D
sale. If, however,the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). .Building Approved By /7�j��/ Date j�97
❑ as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �V� L Data / /
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 ❑0-100,000 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 ❑ System R ' /Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. IC8O# Dampers PLAN CHECK $ PERMIT
PLUMBING $ v ISSUANCE $
-
Date Owner Heating System& Ducting Registers 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 L GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL 5
and state laws relating to buildin ns ruction,and hereby authorize repre- PLAN CHECK 50% $ .MICROFILM $
` sentatives of th y to a ter a above-mentioned property for
inspection purpo �i Dan' D'2147 MECHANICAL $ TOTAL FEE $ '�
Signature
Drivers' License or SS ��
-Applicant; Pink -Accounting; Goldenrod - Assessor
1'
CONSTRUCTION AND PLANNING POOL& SPA
'APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1� Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 2d( 7 LEO 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. Footirigs 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 9027 t(D 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 ,ig,,//p! „Or 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. FOOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# - -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test
.,42,4/F7 �1, 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing • 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric •
Notes: / )j,/ fprc.e� /' 4
34. Final Heating & Air Conditioning ] �"---ry y-
llf fevrical' /n /4/ %.n .5014tini•n rr
35. Final Gas Pipe-Test /6
"1/4//1Y 49ier f..017-09 214orrice /6 e{vr),nrr v�nno/36. Hood or Canopy
ace Zrffedti"// /
s / 1 zen o:4
37. Final Factory Fireplace
6t
/y/l7 /o Y �v l/]/u c/if �F
38. Final Plumbing 3///4r /457 )'4��',r-yl!ice.�T�/vr../d
39. Water Service-Final !!U//
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 I
Pr
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
PERMIT O. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONppSTR�JCTION PERMIT a S/S�l0/ 0 r,_y0`�'/mss h-f it
Project Address I S E . 20th- S t r C C t I
TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION U REPAIR
'Applicant's Mailing Address �K[ E • 20 t-h Strout 'A P - Zone
�Cb ElCONVERSION ❑ DEMOLISH ❑ OT ER
Owner's Name Phone 548-2572 - CT - I1/
Sam 20th Street
DESCRIPTION OF WORK/ SE OF BLDG.
Address 166 E S t rPP t 9.2 Ilk 0 to • III e - S E Main Building: Accessory Building:
Arch/En Z
9 ! Licon 4TYPE OF PERMIT U GRADING FOUNDATION STRUC RAL T Front O
Address , ,' / 1-._ _ / • a_ - f ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear N
q I
Cty Frlleet 997' ❑OTHER
Contractor's Name fl i s 1 One Allrl 1 2 6 C Right - N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY K . G
Address(mailing) a I - • a . CONSTRUCTION TYPE VALUATION$ S Left R
City License No. ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACT R DEC ION • Ping. Ref.# Parking Req./Provided Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the B 1$ess d Professions code,and, T
my license is in fulleforc And effect. ' / `.,� 0• 2
S
License Class ll.• V _ Li O
Date 7-7-86 Signature PLUMBING FEES
ler
S�- WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
0,0
W I hereby affirm that I have a certificate of consent to self-insur—a certificate _
I • workers' Compensation Insurance, or a certified copy t reof (Section Backflow Preventer - Service Sink Automatic Washer Transformer ❑ 15-50 KW
00, Lab. C. {1ompany!1q f1 _
'. •olicy No. i/C 73WC000 C 004 Nationwide Backflow irrigation Sewer Ca 050+KW
I ] Certified copyp Construction Pole Sub.
�. the cit is herebythr e
Certified copy is filed withcity I vision. Bathtubs Sewer Connection Cooking Unit Meter Out.,to 100 amps
Date 7-7—g6 Applicant .L',lGy.�
EXEMPTION FROM WORKERS'CO PEN TION DELL. TION Clarifiers Solar Collectors Dishwasher Meter�e'aer 100 amps 9, SL
(This section need not be completed if the permit is for one Bred ($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 001 HP 011/2-8
Workers' Compensation Laws of California. —_-.
Date Signature Floor Drains Swimming Pool w/Spa F,A.U. Inc.Solar❑9-15 HP ❑16-15+
'NOTICE: If,after 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 9
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 Auto-Wash Garbage Disposal ;Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
''-,:•,j31.5
,'ferefrom and the basis for the alleged exemption. Any violation of Section
..: j31 5 by any applicant for a permit subjects the applicant to a civil
I:,r?4ialty of not more than five hundred dollars ($500).
iJ 1, as owner of the property or my-employees with wages as their sole Reinspection Fee 1 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
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 nate
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By �\ Date_ n
prove for the purpose of sale). \��(1)�)' r7�-y/-
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date ( l7&
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-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ 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.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify t at I have read this application and state that the above ❑0-100,000 BTU 0100,00013T ELECTRICAL $ /a •SO GRADING $
Information is co e.t. I agree to comply with all city and county ordinances
and state laws r tat • buil•;.•.construction, and hereby authorize repre- MICROFILM $
sentatives o t•Is ; • enter; pon the above-mentioned pr per f r PLAN CHECK 50% $
inspection pu •.• es. ' 7 I
Signature Date MECHANICAL $ TOTAL FEE $' /0'66
Drivers' License or SS 0
- —
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
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CONSTRUCTION AND PLANNING POOL " 'PA
. APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1/Temporary;Electrical Service or Pole 52. Pool & Equipment Location
2. Soil;:ipe-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 J 58. Electrical Conduit-Un rend.
8. Foundation * I , 59. Gas Pipe, .. 1# .,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd.
10. Structural Floor System 61.. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing . 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19..'Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21.. Ducts, in Structure 70. Underground Hydro
.22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED
33. Final Electric 7-9'I' Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test • •
36. Hood or Canopy •
'
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations
4Y. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF.00CUPANCY
No.: Date
__ _
_^ _. ----------- _ Applicant to fill_in all spaces este pt those within heavy border lines antl sign all appropriate declarations. _ _ _ _ _
i 07 0 112/0'3%137 1 V 11.170,20--,TLPE• .R N TRACT NO. ;LOT NO.; UNI O. 4
CITY OF'COSTA MESA CONSTRUCTION PERMIT fL o'n r 1 j
// v i I ) � I 1 1 6
Project Address /h A E •2 O'-/L - r t r .'
' j TYPE OF CONSTRUCTION •H NEW L-I ADD H ALTERATION REPAIR, r - I I
--
Owner's Name Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ - _ _ A-p-# _ _ +_—' I I I
Applicant's Mailing Address
Zone _
DESCRIPTION OF WORK/USE OF BLDG. ; +
Address'? S Main Building: ! ;Accessory Building:I , ! 1
A7ch/Eng. I� ' 1 Liicense No. TYPE OF PERMIT ••❑ GRADING ❑ FOUNDATION 0 STRUCTURAL T Front I I 1 I 1 I I D
Address.' - yyOe.,rI`21 'I) r ler t ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear I ' I I 1 N
I Contractor's Name ` 'N✓�b'� ✓2' Phone•SY7.'///J '❑ OTHER _ - 1 _ _ __ ____.- - C 'Right •_ - — .-r_ I1 _ _f ..-. ;___I- _ __ . .N.
t r I I PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) //i S o. C. LA../ S.• - • K l -_ I ; G
CONSTRUCTION TYPE VALUATION •
City License No. �•D 4 O 3 'ZONE - GRADING CU.YDS.. ACRES' $ Left j _ - i I 1 R
LICENSED CONTRACTOR DECLARATION' y`n / /// ���777 Ping. Ref.# ) _ • !Par kingReq./Provided I E
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / `, a 5,/_ 6 13y C) F j Planning Notes:) , 1 I = I I M
with section 7000) of Division 3 Of the Business.and Professions Code, and L` , IU - T
my license is in full force and effect, : •1 . I - 1 •
License Class c-/e - 1 License No. 3 7 O 2/Y -- - ' - _ •- r S)
Date /2-3—•Y 1 Signature 7�) j y - PLUMBING - I� FEES a r - -' 1 r ` I - ,. •-
I WORKERS' COMPENSATION DECLA eA'hON4--(L--"-_ i Bar Sink Showers - '� ' '� 1 rI
1 I hereby affirm that I have a certificate of consent to self-Insure or'a certificate -_ - t. I G ELECTRICAL; C I c , i I I FEES •
of Workers' Compensation Insurance, or a certified copy thereof (Section - .. - ❑ 1 ; r 7
I I Backflow'Preventer Service'Sink I -. I • I [ I -
1 -900, Lab. C.)Il - - _ _ Automatic Washer 'Transfor�er 11550 KW 'IL �
d icy No. Company Backflow Irrigation Sewer Cap -' 66
OI50+IKW
' ConstructlonPole Sub -,
d Certified copy is hereby furnished. 1 _ - - 'n _.. r
Certified copy is filed with the city Building Division: Bathtubs , _ _ _ Sewer Connection - Cooking Unit- , I - - I 3 - Meter Dup to 100 amps I y -+/S '00
Date • Applicant - + _
•
_ ^a^�
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers n' Solar Collectors.,: r _ - �- Dishwasher _ :Meter,❑over 100'amps O
' (ess).. ction need not be completed if the permit is for one hundred($100) or - - O� Da
less).. Dishwasher; - Solar Piping - _- c- r; . i - Dryers ❑Gas, LiElectrlc, -r • '; SubsPenel, '' ' _ '
I certify that in the performance of the work foywhich is p mit is issued;I - - - -
shall not employ any person in any mann r?so as t eco a subject to the Drinking Fountains Solar Tank I .4. r. 1 - Fan, I • 1 1
Worlds) Cgmp0nsayon Laws of California., ,(yn - - - I , r I I n ! Q. ;Motors 00.1 HP i/ 8. -• •a op
-
Date E: f, 0 /' ' Signature 11 - • +' Floor Drains' , I I ` - ;Swimming Pool vsf/Spa' D I ` F,.A.Uy �I v 1 I Inc Solar 0915 HP_01,6;15+.. ��
' -NOTICEeIf,after-makingprovi.declaotion;you-should-become-subject to-the— - � - - - --J — -- —J- -+ - -
1 Workers' Compensation provisions'of the Labor Code; you must forthwith Floor Sinks 1 I I ' !Urinal 1 I •I I I I I I 1 yI
comply with such 1 provisions or,thisi permit shall be deemed revoked. - 3� F,1Xtui¢5 I I I i • Microwave I I I �r
CONSTRUCTION LENDING; AGENCY 1 I Gas Service 'Outlets i I 'Water Closet 1 I ' • DeviceBoxes I I I I Pole Light l I I !
I hereby affirm that there is a construction lending agency for'the performance -
OWNER BUILDER DECLARATION , ) (Section
-- 7 Crv. C) Int¢rceptOfs ^ , I Water Heater ' I Outl¢Led1 i(rrsr ) Range -
of the work 'for which this permit is issued 309 ' ,
Lender's Name ' ,
- - - -- - =--- - �.-- -.. - • Kitchen Sink -, - r.- -Water•Service- - • - - t -- i-- '
S ,, L I
__ __ - I r- }-' 4- - Switches—, - - _ _ _ _ -Sign'-'_ T__' _ J-.
I hereby affirm that I am exempt from'the Contractor's License Law for the Lavatories ! I Auto-Wash 1 I LV
1 I _ Garbage Disposal I Standing Sections I —�
following reason (Section 7031.5 Business and Professional Code: Any city or _ I
• county which requites a permit to construct,alter,improve,demolish or repair P-Trap -
1 ' Laundry Trays , Generator ❑0-5 KW ❑5-15 KW ' 1
any structure, pr atom its issuance; a Is licensed pursuant applicant the Provisions
:permit Trash,Compactor I L
to file a signed statement that he/she I9 nsed to provisions of • ' 1
Roof Drains 1 1
the Contractor's License Law (Chapter 9(commencing with Section is7000)exe of , F 1 I 1
"therero 3te"Businessrand-Prdfessions"Code)-or-that-he/she 'exempt-- '- - - -- - -.- --- + -- - L-_..]_.__1_-__ __ __I therefrom and the basis for the aIle mption. Any violation of Section • I ' I I
7031.5,by any applicant for a permit subjects the' applicant to 'a civil I I I I I I I G ( I i I I
•allyof•not more than;five hundred dollarsl($500). ' , - — I U ! ! I !
I, as•dwner of the'property or my, employees with wages as their sole Reinspection•Fee I, $15 i r 'Issue Fee' $ ,3 I I I I -
.mpensation, will dotthe work,and the structure is not intended or offered I `' - I -` - Reinspection Fee I -1 x$15: Issue FeeI I e ' =s,$ 3. —
' for •sale (Section'7044,'Business and Professional Code: The Contractor's • I MECHANICAL ' '' -FEES I - '
• i 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, howeveG_the building or Improvement is sold within one year of com- Canopy Type II ❑ ' - - Zoning Approved By 1 I I ' ` Date - I -'
;pletion, the owner will-have the burden of proving he/she did not-build or im- Duct-Under Ground I
rove for the purpose of sale). • -_ _ ' - .Building Approved By - I Date ! - -�
%I„as.owner of the property, am exclusively contracting with Iicensed.con- Duct-Structural Refrigeration System - - Application Issued By : - Dat Z
' 1 tractors.b construct the project (Section 7044,Business and Professions Code: - I -
The'Ccntractor's--License Law does not apply.to:an:owner.of-property-who - Duct-Ventilating ❑0:100,000 BTU ❑100,000 BTU ' _ • ' .SUMMARY OF FEES d P
1 I builds or improves thereon;and:who:contracts for such projects with a_con- - - - - - ,_ i ' I I I , S
tractor(s) ncenseroursuant to the Contractor's License Law). i am aware that . ` BUILDING PERMIT- $,. - TSMIP c C $ ' _ I
1 I f Exhaust Sys-tem-0 Multiple ❑ System Repair/Alteration -
pro0t O their Worker's 'Compensation insurance:should be provided to me: _ - _ - - -
' , 1 - - 7 - I • PLAN,CHECK $-- - uPERMITR, ( I ? i --t
' ❑'I amexempt under Section - B.& P.G9or this reason ' Fire /Fact.Blt. ICBG# Fire Dampers _I I - �+
I s _ - _ P p PLUMBING '.L$ - o i ISSUANCE' U $ - -
Date ' ' Owner ' - ' - Heating System& Ducting Registers • _ •i - ENERGY.P.C._ $ - D
PLAN CHECK 25% $.
I hereby certify:that-I have read this a hcatiln and state that the above • ❑0.100,000 BTU 0100,000 BT - - - I ” e '-I
;information is correct .1 agrettto•complypwith all city and county ordinances - - ELECTRICAL • $c -.GRADIN •
G $ (7
and state laws relat ing'to i(ding construction;and hereby authorize repre- • - _ - - - - ` - ,.
sentatives 'oi ht btyut ent r; u on'the 'above-mentioned - • PLAN CHECK 50%7, $ ._�L�.�JL - MICROFILM $
J4 P propert Y.•for -
inspection pupaeyes qq .-. ._ l
Signature (.- - - -"-
Reinspection Fee - . $15 ' - Issue Fee - $ 3 - PLAN CHECK 25%- $ - ' 1 • I, I I
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
it
• POOL&SPA
.CONSTRUCTION AND PLANNING
Date- : Inspector - Date - Inspector
APPROVALS • Permit.# ; 'APPROVALS , Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. ` 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55., Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO.COVER-GUNITE
7, Footings ( 58. Electrical,Conduit-Undrgrnd. .
8, Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. W7ater.Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
•
10. Structural Floor System . 61. APPROVAL TO DECK
11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12, Sewer Cap 63. Heater& Vent-Final
13. Roof Drains • 64. Plumbing System - Final
14, Rough Plumbing • 65. Electrical-Final
•
15. Rough Electrical-Conduit - 66. Solar System-Final •
- -
16. Rough Electric Wiring ►a-7t +'7 Wick. 67. Fencing &Access Approval
17. Rough Wiring Sign - t 1 • 68. APPROVED-FOR PLASTERING •
18. Rough Electrical-T BarCeiling 69. POOL/SPA SYSTEMS FINAL i, -
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# • _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil •
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas ❑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 3/48 7 80. FOOD CERTIFICATE ISSUED' - 1
33. Final Electric 3/ if ,06 Notes: /a/ undco n Air rya.'r
��s� pd
34. Final Heating & Air Conditioning Opelec
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final '
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer - • - -
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations • •
47. FINAL STRUCTURE & BUILDING •
•
•
48. Special Requirements Completed ., •
I
49. Electric Release to Edison
a.
50. Gas Release to Southern California Gas Co _ - -P
•
51. CERTIFICATE OF OCCUPANCY
No, • Date
1 .
/ - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . /18/7/I B/86 1840 7C
CITY m COSTA MESA CONSTRUCTION PERMIT PERMITNO. TRACT NO. LOT NO. UNIT NO.
pr„¢ct Address (� �t �''gcrigb ��t ,y - P rXT !C' r
/4-pplicant s Mailing Address ��=-.e bL'ht �_ �` TYPE OF CONSTRUCTIO IJ NEW H ADD H ALTERATION H REPAIR h
��cc�� �..�� ❑ CONVERSION DEMOLISH ❑ OTHER
• Owner's Name nte-e tri cearn ‘ Aitken PhoncU-Q 11::' •,fl ,may A.P.`N' -. I Zone
DESCRIPTION OF WORK/USE OF BLDG. i"-'If'?� I ' r l'�
Address t(do'Ea t Q.0-ria et. as �a,,�- �z�- -� - Ai tea— 14' Aa J.. •••• • S Main Building: Accessory Building:
E 2
Arch/Eng. Lice se No. TVP- • PERM ' GRADING III OUNDATION 1111 STRUCTURAL T Front 0
❑ TENANT ❑ ELECTRICAL ❑ PLUMB • S • ICAL
Address �/' /J - \ B_�ear • \_ N
Contractor's NameJ._L!�/! _� 1:1 OTHER _ _ _ �— � Riht' ` s' --�_" N
�w�wllllVV////ll1L11777777 PROJECT r - RIPTION SQ. FT. OCCUPANCY •
Address(mailing) - K Left G
• ST RUCTI TYPE VALUATION$
City License No. /ZONE GRADING CU.YDS. RES J • R
LICENSED CONTRACTORfrA/t/OZIA
ATION n - /�// /1 / PI Refer#' r ye `Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: r•'//h,J`/a / . I�/ jp/ t'Y"v PS 4-62 /2�0a-1/� / Q
with section 7000) of Division 3 of the Business and Professions Code, an• Mt
Y�fC M
my license is in full force and effect. „` .1(_ �li� j , S
License Class License No. e/a LI es.
Date Signature ' - - PLUMBING I FEES --
WORKERS'COMPENSATION DECLARATION i 7► . In .,Shower FEE$
I hereby affirm that I have a certificate of consent to self-insure or a certificate
' Workers' Compensation Insurance, or a certified copy thereof (Section - ,- ate—
lo, Lab. C. r—'--...'
.— Back • • • ice.Sink Automatic Washer Transformer 0 15-50 KW -
,,iyy No. p y Backflow Irrigation Sewer Cap ❑,50+KW -
U Construction Pole Sub.
Certified copy is hereby furnished.
er 'fie• op 's filed with the cit s I dJ�:�isi. - '� .^ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date a:_. •. e _ _ _• _
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 • 1
less). Dishwasher Solar Piping Dryers Gas Electric
I certify that in the performance of the work for which this permit is issued I Sub Panel
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank
Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. , •
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. - -
NOTICE:If,after making this declaration,you should become subject to the Inc.Soler ❑
g-15 HP 016.15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater e Outlets Ran
Lender's Name - 9
-
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm-that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
• following reason (Section 7031.5 Business and Professional Code: Any-city or -
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap LaundryTrays • '
•
any structure, prior to its issuance, also requires the applicant for such permit • y Generator❑0-5 KW ❑5-15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of •
Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and-Professions.Code) or that he/she is exempt -
t„grefrom and the basis for the alleged exemption. Any violation of Section '
'l-5 by any applicant for a permit subjects the applicant to a civil
II ?^'+Ity of not more than five hundred dollars($500).
:_-'1, 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 ❑ Zoning Approved By • Date
pletion, the owner will have the burden of ptoving he/she did riot build or im- Duct-Under Ground Building Approved By
r
Drove for the purpose of sale). Date /7 y
•�F9.1 as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By jJ Date ' / �(1�a
st rectors 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 ❑0.100,000 BTU ❑100,000 BTU _
SU ARV OF FEES _
builds or improves thereon, and who contracts for such proiecsi with aeon- 1 L D
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ 71 sn J
SMIP $
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section s.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers ISSUANCE $
PLUMBING - $
Date —'t CCN- Owner lAIWeaIr-pHeating System& Ducting- Registers ENERGY P.C. $ -
PLAN CHECK 25% $
I hereby certify that I have read thi : pli • 1• and s ate that the above 00-1 00,000 BTU 0100,000 BTL . GRADING $
Information is correct. I agree to com• y w • city and county ordinances ELECTRICAL $
and state laws relating to building constructio , and hereby authorize repre- • MICROFILM $
sentatives of this city to e - upo the .bove-mentioned property for • - PLAN CHECK 50% $
Inspection purposes- /• ��r� MECHANICAL $ °O
Signature _ 4 f Date 1 f Il I Ztl7TOTAL FEE $ r r
Drivers' License • SS - .., Reinspection Fee I $15 Issue Fee - $ 3 - PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA .
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
en
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough.Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
tv
7. Footings 58. Electrical Conduit-Undrgrnd. o.
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush ��
24. Roof Framing 73. Undergrnd.Storage Tank LJ±Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing •
76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final • •
42. Backflow Preventer - -
43. Backf low 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 /+
) Bldg. Permit# 13 c2Y&OIC
NOTARIZED STATEM, I OF RESPONSIBILITY •
•
TO WHOM IT MAY CONCERN: This Permit #
i 1pei0 felt)'-iia r
Street Address AP Number
I, 14KE lov1 Gln IM ( AP-nc) , as Owner in Title of the above referenced
property, do hereby authorize:
I�
Ma ry YI k�Kn ( .4P_nn (rt j'-►� ,Cg--e- N -o3sC
����p y�Name�(- -Telephone No.
I(� f+/D6 ' /o4 ic . _
Street Address
•
4P ri'a (2-4 i /. '70417
City State Zip
to obtain permits in my behalf, as owner/builder, for the construction, alteration, moving, demolition or repair of
the above referenced property.
Should any person become an employee engaged in the improvement of the property, I shall immediately provide
Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building
Division of the City of Costa Mesa, as required by State of California laws.
As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person,
company or corporation.
I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim
resulting in damage or personal injury to myself or any other parties.
" .Ke 1/1(41 knn l,1-49.10 Sol L/ I(c ) (97/i?
Printed Name Date
/
Signature
State of California 1
County of Orange 1 SS
City of Costa,Meessaa )
On this /'C'7 -day of .L!-� /%e personally appeared
//// /� re�rr
before me f city G eiyte OFFICUI SEAL
known to me (or proved to me on the basis of satisfactoryevidence) to be the MARILYNN J. KILLER
IN Z NOT/NPU&IC-CALIFORNIA
0, �,0. PkiNCIPAL OFFICE IN '
person whose name is subscribed to this instrument,and acknowledged that f , "''.r OpANCECOUNry
�vq.�-n,•.•� My Compissicia Ella OK.t,_1989,
he/she executed it.
i
In Witness Whereof, I hereunto set my hand and official seal. •
qq
y . / 1 �li��A-/
CMF 0779-46,rev. 3/83
pl icant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 7515 15.0c) TI
CITY OF COSTA MESA I
CONSTRUCTION PERMIT 1 ' PERM��jN TRACT NO. LOT NO. UNIT NO.
Project Address 1 O e- • It •- L9 M; B !��3 9 7
Rr
Applicant's MailingAddress 1331 latiottelR. Au, pokit h+ 11605 TYPE OF CONSTRUC'[`IgON �Q NEW U ADD U ALTERATION ❑ REPAIR
L. .a DP1°"' °Name �Pt t•!• , • PhoOef { '2'511-- Li CONVERSION n DEMOLISH ❑ OTHER AP,# Zone
•�•z' -.-? •` DESCRIPTION OF WORK/USE OF BLDG.
Address I66 -'• tt4 It-.... of s. hits Pt 114 2- S Main Building: Accessory Building:
/ `, E Z
Arch/Eng. Rtis µs11sy S , License No. SOD2 Y TYPE OF PERMIT ❑ GRADING U FOUNDATION ❑ STRUCTURAL T Front O
Address 3140- J AIQ�QL.o-t'�t,,y,_pz1 - OS h�MysA 4=626- 142 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name '$/ tank;;"W tae y'�.Phone 110-7571 OTHER QC�6LA oVt C Ri ht N
Address(mailing) 1330 rate - A/• QWSf[.n1M egts95 PROJECT DESCRIPTION SQ. FT. - OCCUPANCY �u S Rigt G
G CO ST RUCTION TYPE VALUATION S / R
City License No. 4So ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
Cl
I hereby affirm 7 that) I am licensedion under provisions charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and ��e J
my license is In full force and effect. ` 4•s,•✓C.y7-0•.t s 4Q^a 51.A8 •8.15/0 fif(h0 L " "i ) . T
/o License ass ice e N•.� 7 '{ f-r [ S
Date f Signature —0 PLUMBING FEES
•o WORK RS COMPENSATION DECLARATION 7
f�
I hereby affirm that I have a certificate of consen to self-Insure or a certificate Bar Sink Showers el ELECTRICAL FEES
'Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
)0, Lab. C.) Automatic Washer Transformer 0 15.50 KW
S'19.1",( - S7 ct - •E 4 A"-v — —
1 rolicy No. Company Backflow Irrigation Sewer Cap0 50+ KW
Construction Pole Sub.
M EfCertified copy is hereby furnished.
Certiffiief co is filed with the city II in iv ion. Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps
Date tI 3 ApplicantRS'
enr
Sate ION M WORKERS'COMPS NSAT ON DEC RATION Clarifiers Solar Collectors Dishwasher Meter ❑over 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 Ta Fan Motors❑0.1 H 1'h-8
Workers' Compensation Laws Of California. _
Date Signature Floor Drains Swi • mg Pool w/Spa F.A.U.
NOTICE: If,after making this declaration, you should become subject to the - _ Inc.Solar -15 HP 016-154
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks .rinalFixtures Micr ave
comply with such provisions or this permit shall be deemed revoked. • •
CONSTRUCTION LENDING AGENCVGas Service Outlets Water Closet Device Boxes Ie Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water HeaterOutlets
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that),am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbo a Dis oral
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P $Landing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑05 5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof D .ins
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
-efrom and the basis for the alleged exemption. Any violation of Section ,
.5 by any applicant for a permit subjects the applicant to a civil _
.Ity 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 $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 0 Zoning Approved By Date
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved B Date
prove for the purpose of sale).
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration em Application Issued By 016 • - Date C-7--19,7
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 00110••10 BTU 0100,000 BTU SUMMARY O FEE
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 D Multiple 0 ystem Repair/Alteration BUILDING PERMIT $ 17• S7] SMIP $ ' 5-0
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System&D ing Registers PLAN CHECK 25% S ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑chi 00,000 : • ■100,000 BTL GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- IPLAN CHECK 50% S MICROFILM $
sentatives of this city to e ter upon the above-mentioned jr ort for
inspection purpose. T P MECHANICAL $ D
Signature A.
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit#_ Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Uridrgrnd. 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, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final -'
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe •
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT , ✓j
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 - -�
- t
35. Final Gas Pipe-Test W '
36. Hood or Canopy
37. Final Factory Fireplace - -
38. Final Plumbing -
•'39. Water Service-Final • ,
;.
-40. Gas Service-Final - - -;1•
41. Solar Domestic-Final • )
. b'
42. Backflow Preventer
Backflow Irrigation
3I'
44. Landscape Irrigation System
:45. Sound Attenuation f(
r
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING s J �� • t, .y -
/c� 'TY �S t •
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER KINSFATHER, SAM tDATE t5-24-66
JOB ADDRESS 166-164 E. 20th Street BUILDING PERMIT NO. 26067
GENERAL CONTRACTOR Owner-Builder DESCRIPTION OF WORK Block Well
AP No. 118-063-29 LOT TRACT FIRE ZONE VALUE $ 390.00
y.R- ECTIONS Signature Date GROUP j TYPE III ZONE R-2
�, PERMITS ISSUED
SUBCONTRACTOR
Gas Date Number Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0 _
Sprinkling System _
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0 I
Rough Wiring Heating and Vent.
Trenches® Forms 0 Steel Rein!. lig 4)110 9-[-#6
Floor System
Bond Beam D Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
_
'ng, Vent., Refrig. and A.C., Final
l-.,..nbing, Final and Gas Test 0
Electric, Final
Building, FinalCeankT.'rl' AfliWY fMsPfcTi=-.- /}h'inl' 4-/3-`.6
{' 26067 1 AUG 24-66 00 991 1*****3.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 8262E
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT / BUILDING
BUILDING/7
V �� �J(/ For Office Use Only
ADDRESS f/i•0 /(!%
RECEIPT NO. PERMIT NO.
COSTA MESA.
/CALIFORNIA /(� /n�.� //J [ Gi
OWNER?/'F 44 /r71/qqf ,4,'cs/C4r/ t t/ \ RICe�S[b1.Y /�yA .1 C[ [D� e reps
MAIL / G'G ..,.LO /IC / ADDRESO /6j/V�/`f//714 13 gr ADDRESS /' ADDRESS Q
CITt/� '7-/� Al `t+ lN� TE //. FIRE
i(A / 4--Ah-,./ /' NO.. �I ^/�:,Z ZONE -E )it. •ROUP
J APPROVED /p_!26
'-":NITER TEL BY i_ / DATE n p/ d C
'NGINEER NO.
ZONING
ADDRESS //�� ^ J� ,(f' ZOM NO.or u8[or NEW /34/ (40 ,•.n
CONTRACTOR./ kJ /V / \ /C� PLAN Bu1L.DDII'X�JJA[''1F /.)"�O L-�Ly
ADDRESS �� DESCRIPTION
CITY A.P.NO. !� ( } -
- NOTE: NO[AVE OVERHANG SHALL BE LESS HAN
STATE TEL. r-- -._ SO'TO SIDE a REAR P.L
LIC.NO/ NO, EAVES
SIZE
F LOT / 4, I NOW ON LOT 7 ALLOWED AU.B.C.REQUIREMENT)
USE OF YARDS APPROVED YARDS APPROVED
EXISTING BLDG. cz a,".1....../... (FROM MAIN BUILDING 71.A.9--Lr
j�/O,, ACCESSORY /BUILD)NGtt/C /j"-.5.4.)SETBACK LINE PROM FROM _.� ET. P.
CENTER OF STREET REAR YA-D
Cel, 2 a - Le 'TS •"'//
SIDE YARD I LIFT RIGHT �_ R.SIDE PT. PT.
DESCRIPTION OP WORK L.SIDE Fr. rr.
1 X X ALTERATION ADDITION REAR 6iT. FT.
�—
DISTANCE BET. BET.MAIN it
MAIN . ACCESS.BLOCS.
REPAIR ram NO _DEMOLISH y
BUILDING NO.OF VAR.# DATE
612E ROOMS STORIES C.U.P.# APPROVED
U;
EXTERIOR WALL ROOF APPROVED
COVERING I COVERING BY ` 'y. " DATE a'Y 6
USE OF auILDIN8 AND WORK TO BE PERFORMED 9
,/ 6/- ( • 1 ./,�� ifrM' 1
eo.rr. X
I HEREBY THAT E AB VE I I HAVE READ D APPLICATION THE AMEUOF ESTASHOWN UNDER VALUATIONMIF FOR THE j
AND STATE THAT THE ABOVB]E AND SRTAND AGREE UL COM. PURPOSE OF [DTABLIBXINO A PERMIT FEE ONLY. N1
PLY WITH ALL CITY ORD) NCE[AND BTA LA�OlU—LATINO q��
ouILDINO CONSTRUCTION,/ ' „Vc ALUATION 6C, ol]
PERMIT FEE 5 3 p
SIGNATURE OFA//J� / G
PERMITTEE " '��11/L-- / �� '�-�f /� ///'11) �\ w
` / S /'��/ / / PLAN CHECK S
3 CO
AUTHORIZED AGENT <GJ/ ` llV//
q '
a OWNER KINSFAT}IER, SAM DATE JAN 2 9 1964
JOB ADDRESS 166 E. 20th St. BUILDING PERMIT NO. 21505 . _ .
GENERAL CONTRACTOR Owner-Builder VALUE $ 1,500.00 '
AP No. 118-063-4 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Reloc.Gar.Safe
INSPECTIONS Signature DATE GROUP J TYPE V ZONE R2 Lot
S PEISSUED
SUBCONTRACTOR DATE TS NUMBER 1
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating
Rough Plumbing • _
Miscellaneous
Prop. Swr. Line 0 House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole I
Underground 0 Power ❑ i(/dentet/_
o2- J-4b d3? 77
Ron,_________ iO�o,�a-✓ /�J-o/6s .2 3 3 -
TrenchesForms ar" Steel Reinf. 0 64,4 3 -lo.4J./ j{)e_se e077459 $n.P- : " . - - / W l• -.• ,o
Floor System J �1 ,Wr,
Bond Beam ❑ Steel Reinforce ❑Sheathing
Frame and Flashing
Lathing —In 0 Out RI _ 17 a
Plaster, brown coat
l;c'?iig. 0 Air Con. ❑ Final
ag, Final .
thing Fixtures, Final
Final Gas Test
Electric Fixtures, Final r'{I? Z.2-‘ S
Building, Final /r A' 2 .2-6 C
OCCUPANCY
Form BV4 SM-3-63--S-B P 21 SOS
21505
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT
JAN 2 9 1964
P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT.
CITY OF COSTA I EJA
For Applicant to Fill In Completely APPLICATION FOR PEKm
TYPE OR PRINT BUILDING
// j/ For Office Use Only
BUILDING/w b,_ � .�`..
ADDRESS 4Y Gl T/ RECEIPT NO. PERMIT NO.�.
COSTA MESA. CALIFORNIA Rcg AndS
/.� ,I/ �J'''/. // ' REeal Vf,(l aY /ATG^�-VWDT f DATE ISSUED
OWNER l�� IFI �l/I cF / ///- "//�\ /'v!//J� /W_!T/' (���� f
/ „Y7JY//' BUILDING /J o' tD� 7t`(/
ADDRESS/�O 6 T E,.zO • ADDRESS
!(� tl ,.I�
FIRE
TEL ZONE TYPE GROUP j
CITYr7STA MESA No.' �o1L
APPROVED !/�� r/ /J
ARCHITECT TEL. ^ BY /lam ATE/4j 1,
OR rNGINEER NO. ./
• INC • •,,
AL. .ISS
• ,ZON{'Y NO.or USE or NEW
1 �) / II(.(` PLANS - BUILDING Cfj 3�
CONTRACT°'At A 1. A Y i 2.-, 5 ,,((�� �,/ I. Ir%•7a:7-
DESCRIPTION
LEGAL /'/� a ^/
ADDRESS v ,,pp..�� O411/439
CITY l A.P.NO, / I R— L�4a- l
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL, SO'TO SIDE a REAR P.L.
LIC.NO. NO.
/3354 3 CO, J5 I NOWON LOT EAVES
SIZE OT ( NO.OF SLOGS. -g-
NOW
ALLOWED (U.B.C.REQUIREMENT)
OF L
YARDSAPPROVED YARDSAPPROVED
USE OF �j �y MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG./LS//.J r—
n .�-y�, 1 (FROM C//L,STREET) ���. //4 /(
SETBACK LINE PROM ,,,,ch. /� REAR YARD l' ✓ FRONT ¢ FT. 17Y, �`.
CENTER OP STREET n
SIDE YARD I LEFT 94 / I RIGHT 2/ R.SIDE 7FT. Fr.
DESCRIPTION OF WORK L.SIDE J"L/FT. 9dFT.
NE'' ALTERATION I ADDITION _� REAR PPT.-f /�/ V FT.
\/J DISTANCE BET. BET.MAIN B (/ r(
REPAIR MOVING 7l DEMOLISH
MAIN!SLOGS.
ACCESS.BLOCS (�
BUILDING. // N/ I ROOMSNO.OF
/ —^ STORIES VAR �F DATE
SIZE OS r /� fig_ / C.U.P.# APPROVED /
EXTERIOR WALL S_I`er, I COVOERING ea 9 gniC HDYI ,/7 DATE I �p f 411
COVERING t}( W lV�ry t
BB OF BUILDING ANQ.WOR BE pERFOR HD
,�'F_ �.gr. 77 . ty/.5 TO Ova
A F or ';c3 0' ' /
./� SO�' ,ANIS r 'Liv
SQ.FT. •
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT ENO 'N UNDE' VALUATION IS FOR THE _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDI ANGELI AND T8 WS REG TI � p G
BUILDING CONSTRUCTIO r/ VALUAT N __.R. . . et-e2 n
=� �'nA PERMIT FEE
PER MTTE SIGNATURE O /L/LV� oft f-V `'fD i
=.sao-
D
�0 LL
AUTHORIZED AGENT TOTAL FEE
OWNER KjN$FATHER"� SAM MAR 11 1957 DATE 10-8-56
JOB ADDRESS 166-E. 20th St. BUILDING PERMIT NO. #3799
GENERAL CONTRACTOR Owner Bldr. VALUE $ 6,120.00
AP118-060-011
212 BLOCK TRACT Garages & Storage
GROUP G TYPE V ZONE R!1 FIRE DISTRICT 3835
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE _ NUMBER
Footing Trench . ,9U '21-3 ‘
Foundation Forms and Grade to Garage
Rough Framing rf 4-1747/3 t.
Plumbing,Rough to Slab L ' ' • -
Plumbing,Rough Complete
Temporary Pole
Wiring, Rough Al" 1 • ' T No'vvt.. ip2¢—C . 3-V--7 VOCo a-" ---
Heating,Rough
Heating,Final
Sewer, House Sewer,St.
Septic Tank or Cesspool
Lashing, In Ouu�t////��j�y — S; �,'
I :ring a / Man"
Plumbing,Final,Fixtur s Coni fete
Plumbing,Final Gas Test
Wiring,Finals MAR 1 ' 1957 VCB
Occupancy rest // APR 1 11957 •'j Cb
CORM 210 31.1 10.55 (/ 1799
Costa Mesa Building DepartmentIIly
r APPLICATION FOR PERMIT
P. O. Box 3!7 gRJr- BUILDING 1
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
Building 3 7I V
Address 166 E. 20th St., Costa Mesa,
Costa Mesa, California Received by Date Recd. Date IssuedQ
Nearest /0 '� O �+ `�
Cross St. Orange Ave., Building
Address
Owner Spm )(I nsfpfher
Mail Costa Mesa, California
Address 166 E. 20th St., Nearest
Tel. tiar. 6191 Cross St.
City r.-,n-in Vision Cali f, No. Li. 8-1020 ZoneR � No.of Type Groun
Architect or " " 2 ' Lic. I ,/Plans lam %
Engineer Self No. Approve
by Date
Address 166 E. 20th St., CORRECTIONS
City Llo.
ntractor ,se]f' No. APPROVED
Address - CITY O)- COSTA MESA
LegalLot LI PL N!NG DEPT.
Description I ^'
No. For 21P Block I Tract
sUBJECI TO BLDG. DEPT. REG.
(Attach Metes and Bounds):A P 118-060-04
Size of Lot 132 x 330 No.Now of onBldLotgs a
-12(6--)-.1L• DATE/O-21-5-4
Use of No.of No.of PLAN T.CI�'/yj z
(j
Existing Bldg. Res . I Families I Rooms I)
Setback Line from / Rear Yard 1 A u 1 / Z
Center of Street /.,�D Side Yard il5-7// ---.0 5 -7 1- y
DESCRIPTION OF WORK r
New x I I Alteration I Addition ( •
Repair I I Moving I I Demolish I a
Building No.of
Size 24 x 60 Rooms 1 Stories 1
`erior Wall Roof
ering Si cling I Covering COnin. APPROVALS I
Use of New Foundation Location Inspector • Date
Building Garages & Storage Forms,Materials,
/ Under-Pinning Al
/1/ 17440dFrame: Fire Stops,
Bracing,Bolts C
I hereby acknowledge that I have read this Application
and state that the above is correct and Cgree to comply Lath. Int. AlN
with all City ces and tte Laws r-_ lating R
building constru n. M Lath. Ext.
Signature f ��
Permitt �1/1�_ i ; AeA Plaster, Int.
Authorized Agt. - Plaster,Ext. p
.o
Valuation Permit Fee $ /er— Masonry Reinforced ,Q
$ Co, /pl./ / Plan Check$ / — Bond Beam
Total o
/ Fee $ FINAL O
FORM 204 10.55 O.P.8 S.
w
u
5 y
111111
-J •
4
4 4
o. L
a
c•
•
•
•
' n. i
•
•
Street- - - - -'
PLOT PLAN
Show location• and distances from
- property line and between buildings.
0
I J
tn •
I-
•
v
IA
0
0
m
•