HomeMy WebLinkAbout198 20TH ST - Building Permits 4/4
"19 CITY OF COSTA MESA
4 @ BUILDING DIVISION
F ,.,,, 41'8 DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
iar
a ®C PERMIT
S' B04-00508
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 198 E 20TH ST Status: ISSUED
Suite: Applied: 03/10/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 03/10/2004
Parcel Number: 42619110 Zoning: ,,
er
Applicant: DURBIN, MICHAEL ISSUED BY:
Address: 1130 VICTORIA ST
UNIT 4 Phone: (949)642-0700
COSTA MESA,CA Zip: 92627
Owner: KERINS, JOHN CHRISTOPHER
Address 198 20TH ST
Phone: 949-548-1705
COSTA MESA,CA Zip: 92627-2257
Contractor: MICHAEL'S ROOFING
Address: 1130 VICTORIA ST
UNIT 4 Phone: (949)642-0700
COSTA MESA,CA
Zip: 92627 License: 672016
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING COMP AND WOOD SHINGLE ROOF,REPAIR/REPLACE SHTG ON COMP
AREA ROOF AND APPLY 7/16"OSB OVER SPACED SHTG, 1 LAYER 30#FELT,APPLY"30-YEAR COMP SHINGLES'2700 SO FT
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,425.00
Permit: $125.25 Claim Valuation: $5,425.00
SMIP Res: $0.54
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 -
Total: $125.79
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
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)7545626
2446-46(Woo)
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,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 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 is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
la I certify that in the performance of the work for which this permit is issued,I shall not employ any parson in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr70i-dee.-
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($IDO000).IN ADDITION TO THE KIST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 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.Lic.a ,ti 2,,-2/9/i5 Class It C 3 3f
Contractors Signature: /1r, er2 / Date: 5'— —, c7
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Coda).
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
Business 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
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(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 pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or 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,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 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 time 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 0 No
(Section 25533 of the California 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).
3 Does or will the appplicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous 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 Flre
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en RMPP is presently required,has Section 25534 of the California Health end 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 Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the Calif omia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 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? ❑Yes ❑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: Data:
CERTIFICATE OF COMPLIANCE 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 to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
_ ral
eget Owner(s) Date
A d/Or Authonzed Applicant Date
CODE r, INSPECTION TYPE PATE PIIII19L5 CODE! INSPECTION TYPE PATE II�ELA"
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �/ , 208 Final Plumbing
200 Final Re-Roof 7-/6-a%f 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
p5� 9 CITY OF COSTA MESA ..
4 � � BUILDING DIVISION
) •w r,__al._ DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
PERMIT E01-00497
morn
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 198 E 20TH ST Status: ISSUED
Suite No Applied: 06/14/2001
Vicinity: REMODEL OF EXISTING SFR Issued: 06/14/2001
Parcel Nunmber: 42619110
HfH____
Applicant: KERINS, JOHN ISSUED BY:
Address: 198 E 20TH ST
Phone: (949)548-1705
COSTA MESA,CA Zip: 92627
Owner: KERINS, JOHN &WINDY
Address 198 E 20TH ST
Phone: (949)548-1705
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 9
LIGHTING FIXTURES,20 RECEPTACLE OUTLETS,8 13 SWITCHES.
REF: B01-00905
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/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $9.90 9 up to 50 kva/kw $0.00 0
Recept Outlets $22.00 20 up to 100 kva/kw $0.00 0
Switches $14.30 13 over 100 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 $0.00 0 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 1 hp $0.00 0 Circus(meth 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 $0.00 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 $69.70
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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 I � � �
'
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,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 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 is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed i/the permit is valued at one hundred dollars($100)or less.)
❑ 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 workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OvIL FINES UP TOONE HUNDRED
THOI IRAND DO( ARE(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 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.Lic.# Class Si
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's 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
Busin ss 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
su cts the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as,owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or 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 c•ntractors 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••rsu:. t to the Contractors License Laws.).
O I am :xempt u`1• 5; Business and Professions Code for this reason: O
Signatur: r 'Date i
-
Owner I s verifies.. driver's license. 0 Yes 0 No - Expires:CHO 7L
Verification of Ownership by(type of document,i.e.-property tax bill or deed):- -
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 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,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 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 time 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 0 No
(Section 25533 of the California 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).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes 0 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L.I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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',arach 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:
CERTIFIC• OF •OMPLI• - . D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. agree to;����••yyyyyylllll •ly th all s ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-•escribe�+ y y sp;• Ion•. •-•ses.I agree not to occupy or allow occupancy of any building authorized by this permit until
lffi9gi inspecti n.
/ `Signature Of Legal Owner(s) Date Olt '
And/Or Authorized Applicant Date
CODE N INSPECTION rot DATE MUMS CODE( IfISPECTIONTYPE Mg INTTMLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 20 Final Plumbing
J. 200 Final Re-Root 210 Final Electrical s
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
� . ,
i •
MF CITY OF COSTA MESA
BUILDING DIVISION
F• Vet �) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
.11411 PERMIT
/B01-00905 B01-00905
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ccaU�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 198 E 20TH ST Status: ISSUED
Suite: Applied: 06/14/2001
Vicinity: REMODEL OF EXISTING SFR Issued: 06/14/2001
Parcel Number 42619110 Zoning:
Applicant: KERINS, JOHN ISSUED BY:
Address: 198 E 20TH ST
Phone: (949)548-1705
COSTA MESA, CA Zip: 92627
Owner: KERINS, JOHN &WINDY
Address 198 E 20TH ST
Phone: (949)548-1705
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : • Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
INTERIOR REMODEL OF EXISTING SINGLE FAMILY RESIDENCE, INSTALL NEW 6'SLIDING GLASS DOOR,AND ADD
NEW NON-BEARING PARTITION WALLS.
FEE SUMMARY
Plan Check: $72.31 Cab Valuation: $5,000.00
Permit: $111.25 Claim Valuation: $5,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $184.06
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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 j
2446ie(9/00)
r • -•-.
DECLARATIONS 1 ;
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,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are: -
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
•
❑ 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 workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Llc.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's 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
Business 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
sub' is the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the properly,'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: 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)
lican'•puffs nt to the •ntractors License Laws.).
❑ a exem -ec. Business and Professions Code for this reason:
j gnatur•• "`,i !iat,• t ...-
Owner
Owner ID verified by driver's license. 0 Yes 0 No Onver's.License No. ----Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or 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,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 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 time 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? ❑Yes 0 No
(Section 25533 of the California 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).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous 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 0 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 Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 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:
CERTI ATE OF OMPLIAN AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
corre . I agree to omply ' all tate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abo e-described o e r inspe tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permi mil(in' in pecfion.
Ignature Of Legal Owner(s) Date- --•
And/Or Authorized Applicant Date
CODE I jNSPECTION TYPE GATE INTmALS POE• INSPECTION TYPE BATE 1NTfTIALS
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 .5--9-02,9-02, s__
Southw it Inspection and Te ing, Inc.
10826 South Norwalk Blvd., Santa Fe Springs, CA 90670
(562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026
Swc �'} Date
REGISTERED INSPECTORS'S DAILY REPORT % a—oi
TYPE OF 0 Reinforced Concrete 0 Structural Steel Assembly ❑ Quality Control
INSPECTION ❑ Post Tensioned Concrete 0 Fire Proofing Other /� �y
REQUIRED 0 Reinforced Masonry 0 Asphalt ,,.$ '7, 0.i^/'
Job Address98E:a 0
T1/-- City ecnit
r--f
Job Name is, a P' gto,o09o5,_ I55 e'O n .'7A ao_
Type of Structure C'•(US"•fV�R Y(J"� ArTh ihitectit ' (���,(,(L
?erial De riptrgtry7peryour 16€2,? Engineer e n uo/ Si�h:acJ r C/(7
• /C A00 eR ,5a.79 Contractor ^ /
Inspectors)Nome 1 i cro It a LAnlsa tt) Subcontractor
V TESTS PERFORMED
TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES
. /' /
INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT-AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED,NUMBER,TYPE&)DENT.NO'S OF
TEST SAMPLES TAKEN: STRUCT.CONNECTIONS(WELD MADE H.T.BOLTS TORQUED)CHECKED,ETC.
D,ie,+tle +,,,,,,M r, c.V. ,'77=02,2. C,.9ux5 i a.i ,eu()
- • ' - 1 . ti,7o' . ..de y77-- a aim. ,Y,.. ..en,>•,...� 1-
D s" . . ! b. . ( -� lt�e.4a,Cpd.a� �r�C r
e.,_„ Set' al e ' . - /C/3o ER 4'5.2,7 �,o4- -e0Q �a s �:�
Ceo . ) .
Jet" Ai,q 7,
rye/es?0 c y 0
CERTIFICATION OF COMPLIANCE CONTINUED ON NEXT PAGE 0 PAGE / OF _L_
I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED TIME IN TIME OUT REG.HOURS O.T.HOURS CYLINDERS
WORK UNLESS OTHERWISE NOTED.I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, 11.00 S: O O --..
SPECIFICAATTIIggNN•S.ANpAPPLICABLE SECTIONS OO E GOVERNING BUILDING LAWS. ).A. p.M• 4K. O
e. rt ^AAll inspections based on a minimum of 4 hours and over 4 hours-8 hour
minimum, In ad '' ,any inspection extending past noon hour will be an 8
JP SIGNATURE OF REGISTERED INSPECTOR hour minimu
V 50. Ara - • Approved by
SPECIALTY NO. A )dY f Project Superintendent
WHITE - OFFICE COPY,CANARY - ACCOUNTING COPY,PINK - INSPECTOR'S COPY,GOLDENROD - JOB SITE COPY
I I V I
•
ADDRESS OF BUILDING: 198 E 20TH ST Wit: CITY OF COSTA MESA — BUILDING PERMIT
OWNERSNAMEIF MOWN: EVANS, DONALD D TRRM NO
TRPERM
ADRES% 198 E 20TH ST : M l ,l7�470
_
COSTA MESA,CA 92627 PERMIT NO; M 072470 PLAN CHECK NO: N GOVT: N SUPP : N
548-0559
OK MUM ADDRECONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: 0TH
ARCHITECT OR ENGINEER: LK.NO.: JOB DESCRIPTION : REPLACE 2 WALL FURNACES SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 I
WNIRACTORSNAME: A.B .C . HEATING & A/C ( 714 ) 540-0972
RA
CRACTORS KAMM 2951 GRACE LANE COMMENTS : REPLACE 2 WALL FURNACES
ADDRESS: COSTA MESA CA UtI .: 133298 *+ ****- *-Ic*x****+t+rr+r*+Ex.x*::+c*>rakac**aF..;,k*->r-->Fr+raFac****+E+f+ **a*-x•***ac*Ic<+r*-if*a µ*kat--icracac*-le*µ>t
92626 UMT: ZONING REQUIREMENTS
LJCENSED CONTRACTORS DECLARATION:I hereby allin under penaly of perjury that I am licensed under positions of Chester 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
Cm LIC. 006041 USS: C-20 UC : 7 31 98 EXP : 36/95 MAIN BUILDING ACCESSORY BUILDING
\ t' 73� 93e- D � FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
7LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exam m the Contractors license Lew la the
following reason(Section 1031.5 Business and Professions Code:Any city or county which r me a permit to constant.alter,improve. PARKING REQ• P RO V: PARCEL : 42619110 Z N E: REF NO:
depmnolish,or repair any structure.prior to its issuance,abo requires the applicant for such permit to file signed statement that he or she
!licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Dimon 3 of the PLANNING NOTES>
ulnen end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation d Section >
1031.5 by any applicant for a permit wbMds the applicant to a asl penalty of not more than Me hundred dollars 15503D. ****i4**********************************aF***************************************
❑ I,asownerdthepropendormyemployeeswishwagesastheirsolecomperuction,will do the work,and the structure bnot intended
DEVELOPMENT V E L O P M E N T S E R Lr I C E S R E ri U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not applytoan Owner or properly X
who buildsat,ds or improves thereand who does such work Nmseff or herself or through his or her own employees.prodded that such
improvements are not intended oroffered for sale.If.however,the bAlling or inprovement is sold whhin one year of completion,Me ZONING APPROVED BY DATE:
owner-builder wit have the burden d proving he or she did net build or improve for the purpose of sale).
❑ I,as owner of the property,am exdusinely contracting with licensed contractors to construct the prc4e d(Section 7044.Business and
Professions Code.The Contractors License Law does not apply to an owner d property who brikb o improves thereon and who BUILDING APPROVED BY . . DATE:
contracts for such prged°with a contractor(s)licensed pursuant to the Contractors License Law).
❑ lamexempt under Section: B.AP.C.,for this reason: APPLICATION ISSUED BY: S--AA- DATE: 1 ZZ I fl
*******************************r***************f•***********************40#.33**
Geta: OMT°r LEGALIZATION:N .F E E SUMMARY STRUCTURAL SEGMENT: N
I do hereby certify that I am aware d and understand the requirements of California Health and Safety Cade SWIMS 25505.Pcca3,end
• al or any building occupant°t (circle Bedt„ewith'eton '
• aWnso di ionf i .agerneao�iaRwdiil liaa.r exanffit fram these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prowSons. PERMIT 18 , 00
Date: Applicant: 258 SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:l hereby mfimt under penalty of pa/joyone d the flowing dada/tons: PLAN
Ihave°MameSain a certificate consent tosenia
nme for workers'compsuwion.=provided for by Setd h i3700the Labor ZSSUE FEE 15 , 00
❑ iCode.fortheprlmnenadlMwakforwlnidnNispermitSSued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE.
❑ Ihave atmaintanaloofM
workers' TOTALS > 18 . 00 15 , 00 0 , 00 33 . 00 33 . UO 00
and MI
welt for which this permit is Sued.My workers'compensation insurance caber and policy number are:
Caner: REPUBLIC EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 33 . 00 OVER/SHORT : . 00
Poky Number. Prti41",7',, 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
section need net be completed f the permit is for one hundred dollen($too)or less.) 33 . 00
LI I caddy that in the pedommance of the work for which this is issued,I shall not employ any person In any manner as to
become subject to the workers'compensation laws of Calif le, and agree Nath should become subject to the re' *****************************************************************r****if********
cora 2°tion F:veaiaadsedipyr°g dthe Labor provleiau.
Dab: V - /fT J INDIVIDUAL cE E BREAKDOWN
Warning:Fegure to swum warners'compensation cover s unlawful,end shall subject toyer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines req to one hundred thousand dollars($100,000A addition to the cost of co non,damages as provided ler In
s«tian310gorthe LeborCode,mfnstand attorney's fess. MEC 2 INST/RELOC RECESSED WALL HEATER 9 . 00 18 , 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that them is a construction lending agency for the END OF FEES
performance of the work for with this permit is issued(Section 3097,Cir.C).
LENDER'S NAME:
LENDER'S ADDRESS:
-I comfy that I have read this application and state that the above information is coned.I...eeeN��eeee to comply with all city and county ordinances
and ale enpmleoeto Midvp and Myby authorize reaeaenlmivm aL/M1p city to enter upon lMebae.Mentioned properly
�� pedon purposes. v/,/ �GL
Date: TIME 01 001E2523/9518 39: 33.00 DATE: 05/23/95 TIME: G9:`33
(5151-445.wP) White-8ddig A Se1My,Greer-Fb:Candy-Applicant;Pink-Revenue:Goldenrod-Assessor
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 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation. , 59. Gas Pipe, 0 Undrgrnd.,Test •.
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap. 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ; 63. Heater& Vent-Final
13. Roof Drains 64. Plumbing System - Final
14, Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring , 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
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 Chemicat
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 rAW ,gfe '
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
DOWNER EVANS, Donald D. & Nelda E. DATE 2-19-71
JOB ADDRESS 19; East 20th Street BUILDING PERMIT NO. 327 0
"� G ERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORKAtt.garage to res.
r`<` 118�63-09 LOT TRACT FIRE ZONE VALUE $2,762.00
3 •
-3INSPECTIONS
.DSignature Date GROUP J TYPE V ZONE R-2
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
.-"..,,WATER
�PI mb�ROUGH PLUMBING J4 7 -7.-7 -?I - x-5c-7/ % apf
PROP. SWR. LINE Q HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
X
7-15-2/UNDERGROUND M POWER Li /-Ir�/
ROUGH WIRING r� .��-152/ Heating and Vent.
TRENCHES 0 FORMS U STEEL REINF. 0C -y//,/11FLOOR SYSTEM �C ( 111
BOND BEAM fl STEEL REINFORCE FiI
SHEATHING ��� _
LATHE AND FNASHING ��
LATHING IN n OUT ¢r
P( }LITER, BROWN COAT 7� i
, ':TURAL, FINAL ��.,.��E�I chi
_.]
H TING, VENT., REFRIG, AND A.C., FINAL J �J /{ ���,� v!//G!///NC'i d vd—�0-7/ V,90-
41
PLUMBING, FINAL AND GAS TEST l /C, %f/-72
ELECTRIC, FINAL &// of ii•2z-
BUILDING,
L
BUILDING, FINAL � ri(-72-.,
PAID
•
227:RC1FED 19-7107 00 665 0*****5.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
ger _/ RECEIVED DATE RECEIVED DATE ISSUED
J
BUILDINGDDRES (J„_./ � wF//- •D•--�,/^ 7/ .Z-./% - //
ADDRESS / �T.
,, ! t v' �V A.P.NO. -(7�3'-Oc� PERMIT NO.
OWNER t �J � .y-/,
Z AMAILDDRESS / y�4 1--1 S ADDRESS BUILDING ` I a- . 00 `-` / `
La VI /� Q pp .. 4
el U CIT` ; S r , est NOL p°S LOTS y" BLOCK
~ZCONSTRUCTION NEW ADD AI TFR REPAIR MOVING DEMOLISH
ON LENDER / ,
0. m
J J BRANCH /fes _ J
J In -- OWNER 1„41044#14-/r------
4
t/✓�Y✓eI
co J ADDRESS _ 'l/Jf/'/} ,C/Y/�/� V LUE
CO• ARCHITECT TEL. USE Divlr la-. S /� l
J Q OR ENGINEER NO
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FIRE
Z Q ZONE TYPE GROUP
0-141 W< ADDRESS ^ n
JZ CONTRACTOR 0 w N a FL_ APPROVED `r 7bATEpv y^7 )
co Z Vyj!
Jm ADDRESS
W W TEL. ZONEt[n O:OF USE OF NEW -
0= CITY NO. V PLANS ® NEW----
0BUILDING
Z
WU STATE CITY YARDS APPROVED YARDS APPROVED
to IL LIC.NO. LIC.NO. MAIN BUILDING ' ACCESSORY BUILDING
DU SIZE I NO.OF BLOCS. (FROM C/L STREET/
OF LOT NOW ON LOT FRONT (--RT-Z9 FT.
USE OF
EXISTING BLDG. R.SIOF . FT.
I— SIZE OF NO.OF
ZNEW BLDG. ROOMS STORIES L.SIDE FT FT.
Z
< EXTERIOR WALL ROOF
COVERING I C/
COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a' MAIN SLOGS. ACCESS. SLUGS.
1 I I VAR.# DATE
Qo P e-440//t S, FX l S T/ ti 9 C.U.P.Al APPROVED
I— dI
F
fA v .1 f"a APPR HY atEDL .ATE —/9—77
Z
0
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
F any parson In violation of the workman's compensation laws of
CA the State of California.
m
I hereby certify that I am properly licensed as a contractor under SD. FT.
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR f:
Chapter 9, and thesuch licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: CC
am exempt fro a provisions of the State of California Business VALUATION
and Professions de,Division 3,Chap er 9. �Z- rff m
PERMIT FEE S Qr _ D
Signature of / co
D
Permittee G / S ir� V PLAN CHECK S E
-- o
Authorized Agent ,I u
TOTAL FEE S r A
4 OWNER EVANS, Donald D. DATE 2-19-71
V JOB ADDRESS 198 East 20th St. BUILDING PERMIT NO. 32739
vtINGENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Demo.garage
0 '0115-063-09 LOT TRACT FIRE ZONE VALUE $100.00
IA_. ECTIONS Signature Date GROUP J TYPE V ZONE R-2
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER
ROUGH WIRING Heating and Vent.
TRENCHES fl FORMS n STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM in STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
t N:TURAL, FINAL Electric
. 1;.:;
HE`M ING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL //'' T ""�� '' //,,__
BUILDING, FINAL 4 /,,07/72/ >el* y� 41 ee L!�/f f t-pf ,t2 L) g!,4-l-
• 32740 FEB 19 71 CKSfl PAID 666# ***34.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completeely �q /)
BUILDING 4 r re ms /' RE / BY I a-/Y-7(
T /RECEIVED��^/-/ rt/
ADDRESS
�/// /� ��¢� �O/J d // (� /'•�Y �J
rLID�/7/��Z NPJ/�/� F//!/'/$ A.P. NO.//O—rV 10 Z1-0/ ( PERMIT NO.
OWNE ye
Z /y0 ,e-C.(721:9
i 7.+ Iy �r ADDRESS q , , y0 •
MAIL J"V
ADDRELL ul /SS^ 2 t �/
O O CITYC ,,S"7:09 �GS1t NEEatiry LQ�/ BLOCK
Z NEW ADD ALTER REPAIR MOVING DFMOI ISH
Z < LENDER TION �y/d N��
Q cn LENDER /!/ )4.:
/
C- m T -//�///���
J C BRANCH / 42,/"-r g
J COOWNER/!1
Q w ADDRESS
m J VALUE s(CG
ARCHITECT TEL. USE •`/'�2�C� $� /W�
-IQ OR ENGINEER QC���/P� N FIRE /
Z Q ZONE TVPE� GROUP
0-w ADDRESS
�.G' �Q� APPROVED /—p^ rr����
JO CONTRACTOR /I ��C/ � BY Cid DATe.2�/ / 7/
DO Z
JCC ADDRESS rat/ r
LU wZO NO.OF USE OF NE�) ` ,
Z
= CITY NOL y PLANS -' BUILDING 'C
W O STATE CITY YARDS APPROVED VAR APPROVED
(nix LIC.NO. vSe/30 X / . ' •NO.OFLIC. OBLOGS. (FROM C/ BUILDING ACCESSORY BUILDING
SIZE t I
OF LOTs-0 X ion n I NOW ON LOT a. FRONT 40 6D --F'-T:/CI
USE OF I
EXISTING BLDG. R.SIDE FT. FT.
I- SIZE OF n�r``/ �/ p iO.OF 4
Z NEW BLDG.�.7 XtY 410. /
ROOMS STORIES / L.SIDE ,SFT. FT.
IC EXTERIOR WALL. ROOF//..ee �J
C.) COV ERF"IN(Sr//LC � ICOVE RTNG� 's,1. /6S REAR /r�FT. FT.
0El- t //G D G AND Y�f arRK T�BE PER ORM a MAIN BLDGS.NCE ACCESS.IBLDGS.
a C J_ (I/�q VAR. rr)) 7
O fd�.s/ C/'e NC e� . C.0 P.CC�,-71-� / APPROVED //cL- /
O . • up • ; • •IAL RtOUTRE'MENt!z
UI-hereby acknowledge that I have read this application and state �/A//1-P _ r
O that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ ./�
F any person in violation of the workman's compensation laws of
Nthe State of California. ^^ ca
zI hereby certify that I am properly licensed as a contractor under r .0 SO. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and the such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: d
am exempt from a provisions of the State of California Business rt
and Professions e,Division 3,Chap 9. VALUATION �3 M ^ 03
PERMIT FEE $ r(J ni
D
Signature �AAs ���//� p c.., m
Permittee A// /�����"'K/ $� 7 h i"ty PLAN CHECK $ 1/. or E
j 011 i � '/ o
Authorized Agent /LL LL
TOTAL FEE $ ccc////// eee���
1UIIVCIt EVANS, Donald D. UMIC 12 b l'd
JOB ADDRESS 198 E. 20th St. BUILDING PERMIT NO. 35763
GENERAL CONTRACTOR Owner Builder DESCRIPTION of WORK Refinish Exterior
.e 118-063-09 LOT TRACT FIRE ZONE VALUE $ 100.00
I '£CTIONS Signature Date GROUP I TYPE V ZONE R-2
‘ SOIL
PERMITS ISS4ED
SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND Q POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES ❑ FORMS LJ STEEL REINF. U
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE [-]
SHEATHINGFRAME j��
LATHING AND
IN ^FLASHING OUT [Tt" ./,/yn C/Z-/a,->].-
PLAQTER, BROWN COAT
S (URAL, FINAL Electric
HE,..ING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL y/ �J
BUILDING, FINAL ✓'1VQ /y�2.---
35763 2rC c 7 PAPAID
,•.00 2o2,z. :<,:::, ,:5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely Ai CATION FOR BUILDING PERMIT
ED
REw€I E BV 7.
ASTE ECFZ VED DA E ISSUED
BUILDING (.- t. / �12�
ADDRESS rcg., i S 72 �(0�(
t// //n- 2 3 R-7L PERMIT
OWNER
�/ I I/ Ori -4 A.P. NO. X C/
MAIL /J BUILDING "I�' �f 1
Z ADDRESS ,, /LU lit �� ADDRESS G Sr
2 U CITY(a.0.-.2./'i!G�h' C-4._' TEL. 531' TRACT
a -�{. vd?
CITY TE O Eye LOT flY BLOCK
I-Z
CONSTRUCTION / / NEW ADD ALTER REPAIR MOVING DEMOLISH
ON LENDER /L� C /C/ �
am
J D BRANCH }�'
Q LU ADDRESS OWNER l C\r/A.N
m -I r•-• _ VALUE
ARCHITECT TEL. USE KtR7IvL'4On�$JQ
OR ENGINEER NO.
U Cn FIRE
W D: ADDRESS ZONE TYPE GROUP
d W q `/ APPROVED r1 ' �/�
mZ CONTRACTOR (jlWti � EVi /Jet'r BY 14 DATE 12-6,^/ L
Z �� � � q / '
J 2 ADDRESS •Ci.-s./L�C-.�
W W TEL. ZONE NO.OF USE OF NEW i e-f/N/Sf�
ZI- CITY NO. -' PLANS — BUILDING ein/e�
Li/0 STATE CITY YARDS APPROVED YARDS APPROVED
to CC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING -
SIZE l O NO.OF BLDGS. / (FROM CAL STREET)
OF LOT `¶ 0 ,X( ( 0 I NOW ON LOT FRONT FT. FT.
USE OF /
EXISTING BLDG. 719/4/2
4 A� � - (Cat-a o R,SIof / ' l FT,
I- SIZE OF NO.OF 'r//
44#
Z NEW BLDG. ROOMS STORIES L.SIDE FT.
UEXTERIOR WALL ROOF
COVERING COVERING ` REAR FT. FT.
J USE F UILDING AN, OR TO BE PERFOR D '
CL ;Set, }N DISTANCE BET. BET.MAIN&
fY"/fit' MAIN BLDGS. ACCESS. BLDGS.
0 � -> C Or C.U.P. DATE
O C.V.P. APPROVED
I-
APPROVED /� / �j
2 HY �}�I DATE !7
Z J
0 OATS
0 I hereby acknowledge that I have read this application and state f-0
0 that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ s
I- any person in violation of the workman's compensation laws of
CO the State of California. ' to
e
ZI hereby certify that I em properly licensed as a contractor under SQ.FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
CC
am exempt from the provisions of the State of California Business
VALUATION /-1;t09---of
and Professions de,Division 3,Chapter 9. l° PERMIT FEE $ `) ! N
�`--' D
Signature of J�//////���(/// 2� �� m
Permittee �/ $ (OO PLAN CHECK $ C E
E
Authorized Agent
U.
TOTAL FEE $
OWNERWARS 'Donald n. DATE 9/20/72
JOB ADDRESS 198 E. 20th St. BUILDING PERMIT NO. 35413
'IERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Slumpstone wall
No. 118-063-09 LOT TRACT FIRE ZONE VALUE $ 200.00
� INSPECTIONS Signature Date GROUP 3 TYPE FI ZONE R-2
'\ SOIL PERMITS ISSUED
GAS SUBCONTRACTOR I`
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE El HOUSE CON. f
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING f/ Heating and Vent.
TRENCHES ❑ FORMS STEEL REINF. /�� �
FLOOR SYSTEM �
BONO BEAM n STEEL REINFORCE ❑
SHEATHING
FRAME AND FLASHING
I 'THING - IN n OUT n
TER, BROWN COAT
Si HUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL^
PLUMBING, FINAL AND GAS TEST IJ
ELECTRIC, FINAL
..... ....... �..... a 4_ 7 n�
J .
PAID l # 4:it ir>:
354 13 SEP ?O-7?uj..00 69 5.01
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP IC. ION FOR BUILDING PERMIT
For Applicant to Fill in Completely I
R- :V D. E RECEIVED D•TE ISSUED
BUILDING / �f �O �• a— 'PO._
ADDRESS�/`�� (J w
OWNERan If( 0.
/ 1 / ///q/ I-ERMITNO.
,(/ A.P.NO. /, —0r LI 4 I '
G
ADBUIDRESS
/�� 7, ii( `r
MAIL /,n i - ADDRESS �V l
Z ADDRESS a//�•.+ “tweager
0-U CITY 7 �
*/4Q / N Oft/9D5f 9 TR ACT//6/6p+/S LOT/�.2,., BLOCK
ZZ NEW AJJD ALTER REPAIR MOVING DEMOS ISH
Q LENDERNSiRUCTIDN ✓/
O N
am
J 0 BRANCH
_IV) OWNER D'IIAC0 6.-uArcse
CO J ADDRESS 4 ))�I VALUE ////// B el
m ARCHITECT TEL. USE/.S Atte-tie- /if/A �-L $ /C/
J Q OR ENGINEER NO
Z N
Q FIRE
Z cc ADDRESS ZONE T P GROU
a.L171
LU Z BYPROVE /�_ !Jy
mO CONTRACTOR Celia BY G/ DATE 1(J /L—
Z
-M-,gADDRESS
W w TEL. ZONE NO.OF USE OF NEW/StacieZ I- CITY NO. ��� PLANS BUILDING euA t-�/
tL o STATE CITY YARDS APPROVED YARDS APPROVED
Lig X LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D SIZE ^ , // NO.OF BLDGS. (FROM C/L STREET) /J
OF LOT Sd/3 X /(n) NOW ON LOT FRONT FT. 7 FT./J r
USE OF //
EXISTING BLDG. R.SIDE FT. AerFT/
I— SIZE OF NO.OF //
Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT/ �.
V EXTERIOR WALL ROOF // `/
COVERING COVERING REAR FT. FT/ \-
—I...- USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
a MAIN BLDGS. ACCESS. BLDGS.
Q / / `/ VARP. DATE
O J79j S L , 3 yvtc/ L(1a'z// VAR.#V+ DATE
APPROVED ']/}
(n �O/ u/ 3�//�/fl/YJJAS/O�G �`L// _HYROVE/� Dsoll DATE / --�O -/af--
2
o C\\
I~.1 I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with al laws regulating building construction, and I shall not employany person In violation of the workman's compensation laws of
the State of California. e
? I hereby certify that I am properly licensed as a contractor under SO. FT, o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Ie
am exempt from the provisions of the State of California Business ;;ALUAL)T1(20N /��
and Professions e,Division 3,Chapter 9. _�s m
}� /..(! rPERM IT FEE $ .. _ j
Signature of J{ V� r'mPermittee / �{.�� r (Q PLAN CHECK $ r E
,412
Authorized Agent TOTAL FEE $ �
-OWNER EVANS, Donald D. DATE 11-17-55
JOB ADDRESS 198 E. 20th BUILDING PERMIT NO. 2076
AE$N660RAL CONTRACTOR Owner-Builder VALUE $ 3,136.00
P. No. - LOT TRACT FIRE ZONE DESCRIPTION OF WORK Bedroom & Bath
r -UP I TYPE V ZONE R4 PLAN NO. 2098
INSPECTIONS uu DATE SUBCONTRACTOR PERMITS ISSUED
/✓i e f< UL 1-, • 3- ly.St.. DATE NUMBER
Trenches a`:_Forms Steel i/-iW.-�?
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam _
Frame and Flashing `` . E-t4 /I s.17-.t
Lathing, In V&' kjOut X 4.tl.b-.'tt4 51sT/I- 2-.54.
Plaster, brown loaf
Underground soilm _ W/G Pipe Tesj/9/?/.�,6 G
Top,Out
Furnace /b//1-S /o-2..S-S-75u>-K-01.--/ ti /D 45e-57 U '1 ✓
Gas Vents
Rough Plumbing Mt*. C i/-J-moo U.-ytr.ne‘ Re 2n /1-/I s ' �'7 I7 L./—
Cesspool
Cesspool Septic Tank -
Prop. Swr. Line House Con.a/St. Swr. .91/-vS
Sprinkling System /
Heatingto Final 44 ' "O-$S^� c/ I /
P inFixtures, Final /N b`S 6-2S-S'7 Li//:•-�.,
F.. Gas Test /j" --nat Q
-4lct / .-C et- '' l
-
Construction Pole •
/Underground Power
Rough Wiring y lD/s. 7 :,2 en) f
Fixtures, Final �(r f .,
� -3-7 �L,(�t'r /
OCCUPANCY N-( o yg
Form 21$-5M-1-57 2076
Costa Mesa Building Department PLICATION FOR PERMIT
• 111 EAST 20th STREET
COSTA MESA, CALIFORNIA 2,9-8 BUILDING
• FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
. Address/9£r 4L4f z ' O 7,
-• Received by Date Recd. Date Issued
Costa Mesa, California
Nearest j�� . //`/71" //-/ 7-�
Cross St.°fp�ttAq Ri 'Rut.... .' Building /
AIL ]T gyp_ Address
Ownergrit T/h/. OA` Costa Mesa, California
Mail /75 � a0a }�, >. Nearest
•
Address a �,)•(,7L,Qp�
- • Tel. ,... Cross St.
City _>i. ••. . No. -T L .3 `> Zone /. I No.of I Type ,/// Group L`
Architect or - Lic. _ . Plans
Engineer No. . Approved '
by Date
Address S CORRECTIONS
City Lic.
Contractor SS, No. •
Address S
Legal I Lot I I
Description No. Block I Tract
��Pe/7d-- Oho-?d,e°4s e..
(Attach Metes n Bounds) TClCAM/fin i� ¢�
Size of Lot 2,3 / . Qo /l Now oNo.of n Lot
� � Pr(-4,41 :S � 1'11H
UV o
Use of No.of No.of -- �--✓ Zi
0
Existing Bldg. p/y/E I Families I Rooms, `�� _ L,
Setback Line Bldg/dip/11g
/ 'Rear Yard 5-r �� • 1 I U 1 17 r..,5 Z
Center of Street ai 5 n//j�ryside Yard C to y
DESCRIPTION OF WORKr
New I Alteration I I Addition I X - C1TY OF COSTA MESA
•
Repair I I Moving I I Demolish I — -
Building i o/ NO•of /
Size /y X ,2O Rooms .2- Stories '
Exterior Walt Roofq
Covering/743f,e$Ta$-*M CCovering7o�Z&/ / APPROVALS
BUuilde dingNFoundation Location Inspector Date
g s����M " G �'l Forms,Materials,
Under-Pinning
tit; Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that l-llave read this Application
and state that the above is correct and agree to comply Lath.Int
with all City Ordinances andState Laws regulating ,
chop. in Lath.Ext.ll�� (LP
building cons
Signature of li ,}6J
Permittee Plaster, Int.
Authorized Agt. • Plaster,Ext.
Valuation 3i'3 ‘.. Permit Fee $/,a, ' ' *.onry Reinforced
d l -.
o
Plan Check $ ,`fes • Bon. =e.
$ Total o
Fee $/`/4' igt FINAL f
FORM 204 S-BP 2M 6-55
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:}Z 1 ,
•
I .
' ti.l:
. . _ Street - '
1 '.••8_ ---.-7.•
__ lit_-__ ___,
PLOT PLAN T'` r�• _ <r:_ _
Show location and distances from _
property line and between buildings.
- --- - _ - — -- ---- - - -'
I - - -- - - - --
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