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CITY OF COSTA MESA
B!/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 7545273 • Fax (714) 754-4856 • �wwv.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E10-00204
PERMIT TYPE ELEC
APN: 4262311 S
JOB ADDRESS: 356 A E 20TH ST CM
viciniry:
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit: A
ISSUED
08/26/2010
RMD
SCOPE OF WORK: ELECTRICAL PERMIT TO RELOCATE FAU TO ATTIC AREA AND THE INSTLLATION OF A NEW A/C UNIT FOR UNIT "A"
ONLY. NEW RES A/C PKG, 3 LIGHT FIXTS, i OUTLET, 2 SWITCHES AND SERVICE PANEL UPGRADE TO 200A.
OWNER: MOSS, JOHN Address:
PHONE: 949-722-0731
APPLICANT: MOSS, JOHN
PHONE: 949-722-0731
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
City/State: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $115.10
Reinspectian Fee $0.00
TOTAL FEES $115.10
%GEORGE MOSS Unit:LOS ANGELES, CA
City/State/Zip: 4360 WORTH ST
Add�ess: 356 E 20TH ST Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
NOTICE: The work authonzed by this permit shall comply vrith all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permil 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 pertnit.
L UE�. INSPECiIONTYPE DAT INTf11AL5 CODEN INSPECTIONTYPE UAiE IN117UL5
1616 Fized System Final Pire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ���,� /
zoo PinalRe-Roof 2�o FinalElectncal x/D-14-�D I�IYT
20t Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Pinal Demolition 250 Final Building/Occupancy
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WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalry of perjury one of the follovnng declarations:
❑ I have and will maintain a certifcate of consent to sel!-Insure for vrorkers'
compensation, as provitletl tor by seclion 3700 of the Labor Cotle, for the
pedormance oi ihe v.ork for which this Dermit is issued.
❑ I have and will maintain workers' compensation insu2nce, as required by
secibn 3700 of Ihe Labor Code, lor the performance ol the work for which this
pertnit is issued. My workers' compensation Insurance wrner antl policy
number are:
Carrier
(Th¢ sertdn neetl nd De cymdete0 atheperma a vdNetl a1 me nurMietl de9ars (5f 00) w less )
Poli Number:
C�I�certify Ihat in Ihe pertortnance of Ihe wnrk for which this permit is
issued, I shall nol employ any person in any manner so as to become subject
to the vrorkers' compensation lavrs of Califomia, and agree that if I should
become subject to Ihe workers' compensation provisions o! Section 3700 of
the Labor Code, I shall (orthwith comply with these provisions.
-g�'�°� x-z<���,
rani's' na�� lDal21
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), 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 aKrm Iha[ I am licensetl under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of t�e 0usiness and Protessions Code, and
my license is in full force and effect.
Lic. # Class #
Comaaor's Signa�ure Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affvm that [here is a wnstmctbn lentling agency for Ihe
pertortnance of [he woM (a w4ich [his pertnit is issuetl. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
Signatore
OWNER-BUILDER DECLARATIONS:
I here6y affirm that under Denalty of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for lhe (ollOwing reason (SeC. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
constmct, alter, improve, demolish, or repair any sWcture, prior to its
issuance, also requires the applicant lor such pertnit to file a signed 5tatement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant ro a civil penalty o! not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the structure is nol intended or
oflered for sale (Sec. 7044. Business and Professions Code: The Contractors
License Law does not appty to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provitletl that such improvemems are not intended or oKered for
sale. If, howevei, Ihe building or impmvement is sold within one year of
completioq the owner-builder will have the burden of pmving that he or she
did ot build or improve for purpose of sale.).
��as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the prqect (Sec 7044, Business antl
Pmfessbns Code: 7he contractors License Law dces not appy to an ovmer of
property who builds or improves thereon, and vfio conlracts !or such project with
a contractor�s) license pursuam ro the Contractors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
vn � 2 6�_
�' gna�. g Dat
J05]<6 (3I01)
Ovmer ID verifed by driv�ense. ❑ Yes ❑ No !7
Drrvers�Lice-��No.(�_/)�� Ezpirese� '�p—��
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Verification of Owneahip Dy (ype oi document, i.e. - propehy tax bill or tleeG):
DIVISION OF INDUSTR�AL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more (eel in tlept� into wfiich a
person is required to tlescend, will be made in connection with work authonzed
by this permit, antl that no builtling sWCWre, scalldtling, falsexork, a demolition
or dismantling thereof, will be more Ihan thiAy-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Adminis�2tive Code).
❑ As owner-builtler, I will not employ anyone lo do work which would
require a permit from the Division o! IndusMal Satety, as noted above, unless
such person has a permit to do such work from Ihe division.
Applicanl's SignaWre Dale
Division of Intlustrial Safety Permit NumDer.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. will the applicant or present or tuture building occupam need to file antl
certify a Business Plan for emergency response ro release or threatenetl
release of a hazardous matenal? ❑ Ves ❑ No
(Section 25505 of the Califomia Health and Sa(ety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time tluring a reported
year a quaniiry of hazartlous materials equal to or greater than a vreight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressetl gas
al standard �emperature and pressure).
2. Does or will the applicant or present or (uture builtling occupant need ro file
a regislration form (or acutely hazardous malerials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Cotle, 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
hazartlous materials equal to or greater Nan a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature antl pressure).
3. Does or will the applicant or present or fuWre builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acu[ely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of lhe Califomia Health antl Sa(ety Cotle pmvitles that the �
Costa Mesa Fire DepartmeM may require Ihe preparation, certification and
fling vrith the Fire Department of an RMPP by businesses which are required /
to register awtely hazardous materials wi[h the Fire Department.
4. If an RMPP is presently required, has Section 25534 0( ihe California
Health and Safety Code been fully complied vnth? ❑ Yes ❑ No
5. Does or vnll the applicant or present or future builtling occupan[ require tor
[he work which is the subject of Ihis application a permil for such consWction
or modification from the South Coast Air Quality Management District or from
any other air polWlion control district or a9ency? ❑ Yes ❑ No
(Sectbn 658502 of the Calilomia Govemment Code requires that the requeSlEtl
infortnation be fumished on applications fa non-residential building permits).
6. Will any part o( the faciliry to 6e constructed untler Ihis permit be within
1000 feet (rom the outer boundaries o( a school7 ❑ Yes ❑ No
(I!'yes", �he facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Sa(ety Code).
7. If a permit from Ihe South Coast Air Qualiry Management DisMct or oNer
air polWtion conirol tlistricl or agency is required for the vrork which is Ihe
subject of Ihis application, have all of the disclosures prescriDetl by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Q( "yes", attach certifcate of compliance from the appropriate air pollulion
control offcer).
CERTIFICATE OF COMPLIANCE: I certify lhat under penalty of perjury the
in(ormation given above is correcl. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signawre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cerlify 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 builtling construclion, and authorize representatives of
the City ot 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 lhis permit until fnal inspection. p,
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CITY OF COSTA MESA
BUILDING DIVISION � � �
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M10-00083
PERMIT TYPE MECH
APN: 4262311$
JOB ADDRESS: 356 A E 20TH ST CM
Vicinity: ATTIC AND REAR SIDE YARD
SQ. FT: 0
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit: A
ISSUED
08/26/2010
RMD
SCOPE OF WORK: REPLACE AND RELOCATE FAU TO ATTIC, REPLACEMENT OF DUCTING, INSTALLATION OF NEW A/C
UNIT LOCATED A7 SIDE/REAR YARD FOR UNIT "A" ONLY. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY
PERMIT.
REF#:E10-00204
OWNER: MOSS, JOHN Address:
PHONE: 949-722-0731
APPLICANT: MOSS, JOHN
PHONE: 949-722-0731
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
City/State: ZipCode:
MECHANICAI. PERMIT FEE SUMMARY
MECH ITEM FEE: $66.80
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: � � $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $66.80
%GEORGE MOSS Unit:LOS ANGELES, CA
City/State/Zip: 4360 WORTH ST
Address: 356 E 20TH ST Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under Califomia slatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
required inspections and final approvai must be obtained. FaiWre to obtain inspections and final approval will resWt in the expiration of this permit.
COpE/. INSPECiIONTYiE ORT INIIPALS CODEt INSPECTIONTYPE �% DRiE INRIIAlS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 7` 10 � 5�l D �f�M b
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Elecirical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aHlrm unCer penalty of perjury one of Ihe following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as provided for by sec�ion 3700 of the Labor Cotle, for the
performance o( the work for which Ihis permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for [he peAortnance of [he work for which this
permit is issued. My workers' compensa[ion Insurance carrier and policy
number are:
Carrier.
(rn�s section need rrof be mmp/eletl AMe ce�rt is valued af one huneretl dollais (St00) orless )
Policy Number:
l�Pcertify tha[ in ihe peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as ro become subject
lo the workers' compensation laws of Califomia, and agree [hal if I should
become subject to lhe workers' compensation provisions of Section 3700 of
the Labor Code, 1 shall forthwith comply with these provisions.
'�i ���,,, c'15s $ -Z G• I b
}�PPttcan's'SiooaWre�"' Gp�e�.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm [hal I am licensed under provisions o/ Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full (orce and eflect.
Lic. # Class #
Controctor's SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a construction lending agency (or the
peRortnance o( the work fa wtiich ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OW NER-BUILDER DECLARATIONS:
I hereDy affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5,
Business and Professions Code: Any city or counry which requires a permit to
construct, alter, improve, demolish, or repair any slmcWre, prior to its
issuance, also requires the applicant for such permit to file a signetl statement
that he or she is licensed pursuant to the provisions o( Ihe 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 exemptioa Any violation of Section 7031.5 by any
applicant �or a permit subjec�s ihe applicant to a civil penalty of not more ihan
frve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and ihe structure is no[ intended or
oRered for sale (Sec. 7044, Business and Professions Code: The CoMractors
License Law does not appty to an owner of property who builds or improves
thereon, and who does such vrork himsel( or herself or through his or her own
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year of
completioq the ovmer-builder will have the burden ot proving that he or she
did ot build or improve for purpose o( sale.).
�4.as ovmer of the property, am EXCLUSIVELY CONTR4CTING WITH
GCENSED CONTRACTORS to construct Ihe pmject (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply lo an owner of
property who builds or improves ihereon, and who contracts for such project with
a contraaor(s) license pursuant to the Contractas License Laws.).
❑ I am exemp[ under sec.
Business and Professions Code for this reason:
k � h,. 1�- �! R-7 6-(c
i` _.�ig'��� � �a�...e�rr..._
305]-4613/0]) �� ' °`.•"". .
Owner ID verifed by drivers license. ❑ Ves ❑ No
Dirv�-Licerise�No � �pires� ay l3 I�
Verifcation of Ownership by (type o( tlocument, i.e. - propert�z bill or tleed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certRy Ihat no excavation frve (5) or more feet in depth into which a
person is required to tlescentl, will be made in connection wi[h wurk authonzetl
by ihis pertnit, and tha[ no building s[ructure, scaftolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32. Grp
2. M 2, Sec. 347, rtle 8, Cali(omia Administ2tive Code).
❑ As owner-buiider, I will not employ anyone to do work which would
require a permit from Ihe Division of Industrial Sa(e�y, as noted above, unless
such person has a permi[ to tlo such vrork fmm Ihe division.
ApP���nfs SignaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to Poe and
certify a Business Plan for emergency response to release or threatened
release of a hazardous malerial? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
DepaRment by every business which has al 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 o! compressed gas
at standard lemperature and pressure).
2. Does or will Ihe applicant or presenf or future building occupant neetl to file
a registration form for awtely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Health antl Safety Code, with some
exceptions, requires registralion with ihe Costa Mesa Fire Depariment 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 o( 55 gallons, or 200 cubic fee[ of compressed gas at stantlard
tempereture and pressure).
3. Does or will the applicant or present or future building occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the Califomia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with Ihe Fire Department.
4. I( an RMPP is presently required, has Seclion 25534 of the California
Health and Safe[y Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or �uture building oCCupaN require (or
ihe work which is Ihe subject o( this appliwtion a permit for such constmction
or modification from the South Coast Air �ualiry Management District or trom
any other air polWtion control tlistrict or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
infortnation be tumished on applications for non-residential building permits).
6. Will any part of the faciliry to be consWcted under Ihis permit be within
1000 feet fmm the outer boundanes of a school? ❑ Yes ❑ No
Qf "yes", the facility mus[ meet Ihe requirement of Sections 25534 and 42303
ot the Califomia Health and Safery Code).
7. I! a permit from Ihe South Coast Air Quality Management DisMcl or other
air pollution contml district or agency is required for the vrork which is the
subject of this applicatioq have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (I('yes", attach certificate of compliance from the appmpriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE I certify that under penalty of perjury ihe
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
Signawre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cerfify under penalry 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 builtling cons[mction, and authorize representatives of
Ihe City of Costa Mesa to enter upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until fnal inspection.
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f �
Certificate of
Climatc Zones 7 and 3- 7
2008ResidentialHI�ACAlterations C7�-1R-ALT-HVAC
SitcAddreas: ��� �.�A� � . I Enjorceinen�A
IJ
I Conditioned
Floor Area
u racrcageo unn � �
Over 40 f f duc s
❑-fiirnace ❑ AFUE7 , ❑ COP �'O� ❑ Setback
� S�'vy�{,¢y syslem added re h n
❑IndoorCoil ❑SEER� ❑HSP i��yA�, % ({fnorolreadi�prese��t,mus�be
O'Condensing Unit ❑ EER _ ❑ Resis[anc -V�= sf nc nditio e pace �,:s�alled�
❑ Other R G(CZ 7, 3-5)
!. Gquipment'fypc Choose [he equipment being installed; if more Ihan one sys[em, use anolher CF- I R-ALT-�IVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Desianer's Declaration Statement)
• 1 cehify lhal this CeniSca[e of Compliance documenta�ion is accurate and complete.
• 1 am eligible under Division 3 of �he Califomia Business and Professions Code to accep� responsibility for the desigtt identified on this
Certificate of Compliance.
• 1 certify that the energy features and pedormance specifications for the design identified on this CertiFcate of Compliance confoem to the
requiremems of Title 24, Pans 1 and 6 of the Califomia Code of Regulations.
• The desi�i feamres identi5ed.on this Certificate ofCompliance aee consistent with the information.documented on,othecapplicable. .. .. .
compliance forms, worksheets, calculations, plans and specifications submitted ro the enforcement agency for approval with the permit�
Address:
3 S� e
City/State/Zip: (� „
0
Tµ S�
Si�ta[ure:
Date: U _ Z (O— �.�
License:
2008 Residentiul Compliunce Forms Mm�clr 2010
` `� . �
' (ENFORGEMENTAG&NCY . , ,
CAT?=QUSTOMIZE N�ITHlETTERHEA7J7SEAL)
2008 Building Energ�� Ef'ficiency Standards Residential I3VAC Alterations
Climate Zones l and 3 through 7 GZ�-6 _ �asrr, n�s�9�
BOSIN�SS AND PROFESSIONS CODE, SECTION 7ll0 - -
Willful or deliberate disregard and violation of the building laws, including the CaliSornia Building Code, and
local permit requirements constimtes a cause for disciplinaq� action from the Contractors State License Board
working in conjunction with the local building depanment. This action may consist of fines up to $5,000 per
violation or suspension/revocation of a contractor's license. �
N'HtiN IS A I'GI2MIT RI'sOUIRGD? .
A wri[ten construction permit shall be obtained from the enforcement agency prior ro the erection, construction,
reconstruction, installation, relocation, or alteration of any mechznical system, except as permitted �in Appendix
Chapter 1, Section 112:2 of the 2007 California Mechanical Code. Projecis reyuiring permits include, but are not
limited to:
• New HVAC installation
� • HVAC Changeout
• Replacemenl of fumace, coit, FAU, or condenser �
� - �• Relocation of an existing�HVAC unit -� � � - �- ' - - - � � � � �- � , �-�
�• Adding or replacing more than 40ft duc[ing in unconditioned space
200R BUILDING EN�RG]' GFRICIENCY STANDARDS (7'itle 24, Part 6) REOLJIREIVI�A`TS INCLUDG:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall B. floor fumaces; room heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. �
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacemeni ducts must meet the mandatory requirements of Section 150(m):
�• All joints and openings in the in the FiVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic sha11 be used to seal duct openings.
• Connections of inetals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected usine a metal sleeve/coupling. _
• Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2"
of sag benveen supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspecror will colleci
this form and verit"y that the model numbers are the same as the installed equipment.
(714) 754-5273 • FaX (714) 754-4856 • www.ci.costa-mesa.���LDING PERMIT n FAIH OHIVE, GOS IA MtSA, GA y16Lti
,lob Address: 356 E 20TH ST
Suite:
Vicinity: ROOF
Parcel Number: 42623118
Applicant: RICHARD ALAJOKI
Address: 25672 TALADRO CIR
SUIITE E
MISSION VIEJO, CA
Owner: MOSS, JOHN
Address %GEORGE MOSS
LOS ANGELES, CA
4360 WORTH ST
Contractor. JA ROOFING
Address: 25672 TALADRO CIR
SUIITE E
MISSION VIEJO, CA
Zip: 92691
Arch :
Addr¢ss:
Zoning:
Phone: 949-481-8917
Zip: 92691
Phone:
Zip: 90063
Phone: 949-481-8917
License: 735404
Eng:
Address:
ISSUED BV:
Status: ISSUED
Applied: 12/16/2003
Issued: 12/16/2003
Phone: Phone: -
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1/2" OSB SHEATHING, 30# FELT, ELK PRESTI�UE, 50 YEAR COMPOSITION SHINGLES. 2,600 S.F.
Plan Check: $0.00
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: 0
NOTES:
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$a,9oo.00
$a,soo.0o
NO710E: 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, 72-27-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 780 days, or if work is suspentled or aDandoned
for a period of 1 BO days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepections end final epproval must be obtained. Fallure to obtain Inspactions and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaae �doo)
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm under penalry of perjury one of t�e following declaretions:
❑ I have antl will meintain e certitiwte of wnsenl ro self-Insure for workers' compensetion, es pmvidetl for by section 3700 0l the Labor Code, for the pertortnanca ot Ihe
work for which ihis pertnit Is issued.
� I heve end will malntain workers' compensa6on Insurance, es requiretl �y sectlon 3700 of the Labor Code, for Ihe pertortnance of Ne work for whlch thls pertnit is issued.
My wo ers' compen�etion Insurance carner antl policy number ere: �/ r�
�a��B�: �.SrAr� �.DIv1 P�1i lS/kTloN /N,S(/RAAI ��((N�D POI1cy Number: J S!��GOO�
(This sectlon need not be comO�etetl it (he permit is velueO et one hundre dallers ($100) or less.)
❑ I certify thet in the peAormence of Ih work for which this pertnit is Issuetl, I shall not employ any person in eny menner so es to become subl�� to the workers'
compensation laws ol Califomia, a egree that it I s�oul beco sublect to ihe workers' compensation provislons of Sectlon 3700 of the Lebor Cotla, I shell farthwit�
comply with these proWsio .
Applicent Signature: � n� � Dete: /�L/��i �O 3
WARNINO:FAILUHETOSECURE ORKERS'W!APENSATIONWVE OEISUNLAWFULANDSHALLSIIBJECTANEMPLOVERTOCRIMINALPENAL ESANDCIVILFlNESUPTOqJEHUNDRED
THOUSAND DOILARE (5100,000�. IN ADdTIIXJ TO THE COST OF COMPENSATIdJ, DAM4GE5 AS PROVIDED FOR IN SECiION 3]OB OF THE LABOR CODE, ItJrEFE$T, ANO AiTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I em
lorce and eflect. Lic. » _
Conirectofs Signature:
ot Chapter 9(commencing with Section 7000) ot Divlsion 3 of the Business antl Professions Code, end my license Is In tull
Clessk �C
Dete: � A�
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby attirm that Ihere is a construction lending egenry tor Ihe pedormance of the work for which ihis permit Is Issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lentler's Address:
Signature: Date:
OWNER-BUILDER OECLARATIONS:
I hereby ettirtn ihet under penelry of per�ury Ihet I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professions
Code: Any ciry or county which requlres a permit to construci, elter, improve, demolish, or repair eny structure, prior fo its issuance, elso requlres the ep011cflnt tor such permit
to iile e signetl stetement that he or she is licensed pursuent to ihe provisions ot the Contraciors License Law (Chapter 9(commencing with Saction 7000) oi Division 3 of the
Business entl Professions Cotle) or that he or she is exempt therefrom end the basis tor the alleged exemption. Any violation oi Section 7031.5 by any applicant for e pertnit
su6jects Ne applicant to a civil penalry of not mare than tive hundred tlollers (5500).):
❑ I, as owner of the properry, or my employees with wages es their sola compensation, WILL DO TME WORK, and the siructure is not Intendetl or oHeretl for sale (Sec.
7044, Business and Professions Code: The Contractors License Law Ooes not apply to an owner of property who builtls or improves Ihereon, and who does such work
himselt or herself or through his or her own employees, provitletl that such improvements are not Intended or oflered lor saie. N, however, i�e huiitling or improvemenl is
sold within one year of completion, the ownerbuilder will have Ihe burden of proving that he or she did noi build or impmve lor purpose ot sale.). �
❑ I, as owner ot the properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe Drolecl (Sec. 7044, Business antl Professions
Cotle: The coniractors License Law tloes not apply to an owner ot property who 6ullds or Improves ihereon, antl who contracts for such praiect wilh a contrector(s)
licen5e pur5uent to the Contractors License Laws.).
❑ I am enempt under sec. Business and Professions Code for ihis reeson:
Signature: Date:
Owner ID verified by dnver's license. ❑ Ves ❑ No Drivefs License No. Expires:
Verificetion of Ownership by (type of tlacument, i.e. - properry terz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby ceniy thet no excavation five (5) or more fee� In depih Into which e person is required to descend, will be mede in connectlon with work authorized by Ihis
permit, end thet no builtling simcNre, scaflolding, falsework, or demolition or dismantling Ihereof, will be more �han ihirry-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomle Administretive Cotle).
❑ As owner-builtler, I will not employ anyone to tlo work which would require e permit from Ihe Division of Industnal Sefery, as noted abova, unless such person has a
permit to do such work irom the division.
Signatura: Date:
DiNSion of Industriel Sele�y Perml� Number:
CERTFICATE OF COMPLIANCE ANO AUiHORVA710N OF ENTAY: I cenify under penelty of Derjury Ihat I �ave read ihis epplication and state that the informetion given is
correct. I agree to comply with all state laws end ciry ordinances relating to building cons�ruction, end authorize represen�atives of tha City of Costa Mesa to enter upon the
above-descnbed property for inspection purposes. I egree not to occupy or allow occupancy of eny building euthonzed Dy this permil until finel inspection.
COOE �. INSPECTIONTYPE
1616 Fixed System Finel Fire Prevention
1286 Paol Spe Finel
200 Finel Re-Rooi
207 Final BIocWRetalning Well
202 Finel Factory Fire Place
203 Flnal Slgn
204 Final Demolitlon
Pdg IIII�LS
l� �
Data
�z�/o�
� Data
COOE 1 INSPECTION TYPE
206 Finel Mechanical
208 Finel Plumbing
210 Finel Eleciricel
212 Flnal Fire Prevention
220 Finel Planning Approval
222 Finel Site
250 Finel BuildingiOccupency
P�ff It�
/ \
(714) 754-5273 • Fax (714) 754-4856 • w�w�.ci.cos�a•mesa.ce.us
BUILDING PERMIT
Job Address: 356 E 20TH ST
Suite: B
Viciniry:
Parcel Number: 42623118
Applicant: JOHN ALAJOKI
Address: 25672 TALADRO CIR
SUIITE E
MISSION VIEJO, CA
Owner: MOSS, JOHN
Address °hGEORGE MOSS
LOS ANGELES, CA
4360 WORTH ST
Convactor: JA ROOFING
Address: 25672 TALADRO CIR
SUIITE E
MISSION VIEJO, CA
2ip: 92691
Arch :
Address:
2oning:
Phone: 949-481-8917
Zip: 92691
Phone:
Zip: 90063
Phone: 949-481-8917
License: 735404
Eng:
Address:
Phone:
i i rv.m unrv t, ��a i�+ m�aN, �.r amm
ISSUED BY:
Status: ISSUED
Applied: 01/26/200a
Issued: 01/26/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF FALT AND SLOPED ROOF TORCH DOWN ON THE FLAT SIDE . 7/16" OSB, 1 LAYER 30 LB FELT AND 50 YEAR COMP. SHINGLES.
UNITS B,C,D,E.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$139.25
$0.67
$0.00
$0.00
$0.00
5139.92
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0. 0
PARKING Existinq: o
Rear 0. 0
Rear 0. 0
Required: 0
FEESUMMARY
Calc Valualion: 56,700.00
Claim Valuation: Ss,�oo.00
PLANNING & ZONING
Left 0- 0 Right
Left 0- 0 Right
Pr000sed: 0
ao
0- 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and re�ated
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRA710N: This permit shall autometically expire and become vold if work is not commenced within 1 BO days, or if work is suspended or ebandoned
for a period of 180 days.
INSPECTIONS: In order for the work euthorized under ihis permit to be consldered legal, such work must comply with all applicable codes, and all
requlred Inepeetione and final epproval must ba obtelned. Failure to obtain Inspections and final approval will result in the expiratlon of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
2at&a8 (9/00)
WORKERS' COMPENSATION DECLARATION: -
I heraby aRirm under penalty of perjury one ol ihe tollowing declarations: t'
❑ I have entl will mainteln a cortilicete ot consent to sell-Insure lor warkers' compensatlon, es proWtled for Cy sedion 37p0 of the Labor Code, for the pedartnance of the •
fk lor wNc� ihis'permit is issuatl.
eve Bnd will maln[ain workers' compenseti0n in5u2nce, 85 required by 5ectlon 3700 0l Ihe Lebor C peAortnance of the work br whlc� thls pertnit is issuetl.
� My orkers' co.m+p�ens�etlan Insurence rder entl policy number are: C/
Cetrier. �tA iC ��� PoliCyNum r: 2��—�57L��p l
cfion neeO nof be canp/efetllt the permil ls valuetl e( one hundred dollers (5100) or Iess.J
❑ I ceriily Ihel in the poAormence 01 �he w c lor whlCh Ihis permit Is I55uea, I 5hall no� employ eny per9on In eny mennpr 50 85 to become subject to Iha workars'
camp on laws of Calilor e, entl a e t�at It I shaultl become sub�ect to the workers' wm rovislons oi Sectlon 3700 ot t�e Lebor Code, 1 shell forthwith
/�(ply ose provlsio . /z IO L
AppII Ignatu : Date� � �/ /
RNINO: FAI E TO SECURE W RKERS' PENSATIIXJ COVEM�E IS UNLAW FUL AND SHnLL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUN�RED
T RE (5100,000), IN ADDITION C�THE WST OF CpMPEIJ$ATION, DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE, IMEREST, AND ATTORNEI"5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hor y aNirm the am Ilcensetl under pwvisic
CONSTRUCTION LENDING A({E
❑ I hereby eHirtn Ihal lhere is a
Lenders Nama:
Signature:
Chepter 9(commencing wlih Section 7000) ol Oivisldn-3TR1aBu 'ness andCPratesslons Code, end my license is in tull
�. �lass A
@�— l aG1^ �/
lending apency lor lhe poAormance ol tho work lor which this portnit is I55ueU. (Sec. 3097, Civil Cotlo).
Lendnrs AEtlress:
Dete:
OWNER-BUILDER DECLARA710N5:
I herehy eXirm thet under penalry of perjury ihet I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW lor Ihe tollowing reeson (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry w�ic� requires a permit to construct, elter, impmve, demolish, or repair eny structure, pdor to Its issuance, elso requires �he apD���nt for such partnil
ro file a signed slatement thet he or she Is Iicensetl pursuant to Ihe proNslons of Ihe Gontractors Ucense l.ew (Chepter 9(�ommendng with Secilon 7000) ot DMsfon 3 of the
Business antl ProFessians Catle) or Ihet he or she is e:empt �herefrom end the �esis lor the elleBed ezemption. Any vidation of Section 7031.5 by eny applicant tor e pertnit
sub�ects the applicant to e civil penalry ot rqt more than frve hundretl tlollars (5500).):
❑ I, as owner ol tha properry, or my amployees wlth wages as their sde wmpensetlan, WILL DO T1E WORK, and ihe structure is not IntendeE or otteretl tor ule (Sec.
7044, Business end Professions Cotle: The Contrectors License Lew does not apply to en owner ot properry who builtls or improves ihereon, antl who tloes such work
himself or hersel( or ihroug� his or her own employees, provided Ihat such imprwemems are not imended or oHerad br sele. It, however, the Duilding or impmvement is
sold wiihin ane year ot completion, the ov+ner-builtler will have the burden of proving that he or she did not build or imDrove lor purpose of sale.). '
❑ I, es owner ot lhe properry. am E%CLUSIVELY GOMRACTiNG WITH LICENSED CONTFiACTORS to construct the pmject (SecJ044, Business anC Pmfessions
Code: 7tie comrectors Llcense Lew does not eppty to an owner ol pmpeny who builds ar impraves thereon, end who contracis for such project with e wntrector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec. Business and Protessions Cade lar ihis reeson:
Signature: Date:
Owner ID verified by dAvefs Ilcense. ❑ Ves ❑ No Drlvers License No.
Verilicatian of Ownership by (type ot tlocumeni, i.a. � property tac bill or deed):
Ezpires:
DIVISION OF INDUSTRIAL SAFETV PEPMI7 CERTIFICATION:
❑ I hereby cenify thel no exwvailon tiva (5) or more feet in deplh into which a parson Is required to tlescentl, will he made In connectlon with work euthorized by this
permit, flntl t�ai no Duiltling structure, scaftdding, telvework, or Oemditlon or tlismantling thereal, will ba more ihan thirty-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B. Calitomia Adminlstrative Cotle).
❑ As ownerhuilder, I will not employ nnyone ro tlo work whic� woultl raquire a pertnil Irom Ihe Division ot Industrial Salery. es noteA ebove, unless such person hes e
pertnit to tlo suc� work frwn the division.
Si9neture: Date:
Division oi Industrial Salery Permll Number:
CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I cenity under penelry of perjury thet I heve reed ihis epplication and state ihat the infortnation given is
correct. I egree to comply wlih all sta�e lews end ciry ortlinances relating to bull0ing consimclion, entl authodze representetives ol t�e Clry of Costa Mesa to enter upon Ihe
above-descnhed praperty for Inspaction purposes. I�ee not to occupy or ellow occupency ot eny building authorized by ihis permit unlil (inel inspection.
COOE�, INSPECTIONTYYE
1616 Fixetl Systam Final Fire Prevention
1266 Pool Spe Finel
200 Finel Re-Roof
201 Finel Block/Retaining well
202 Final Fectory Fire Placa
203 Finel Sign
204 Final Domolitian
ueie u�i
�.[��=� �
COOE I INSPELTION TYVE
208 Final Mechanical
208 Final Plumbing
21a Final Electdcal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupency
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
.lob nddress: 356 E 20TH ST
Suite No
Vicinity: UNITS B, C, D& E
Parcel Number. 42623718
Applicant:
Address:
Owner:
Address:
BRIGGS, JOHN
5457 CRENSHAW BL
LOS ANGELES, CA
MOSS,JOHN
%GEORGE MOSS
LOS ANGELES, CA
4360 WORTH ST
MECHANICAL PERMIT
Contractor. ADEE PLUMBING & HEATING
Address: 05457 CRENSHAW BL
LOS ANGELES CA
ISSUED BY:
Phone: 213-296-8787
Zip: 90043
Phone:
2ip: 90063
Phone: 800-554-5858
Zip: 90043
License: 240786
SCOPE OF PERMIT
� CHANGE OUT WALL FURNACES IN UNITS B, C, D AND E.
� . . , . , . __. _ , '_
ISSUE FEE
Insl FAU <700 k BTU
Inst FAU >700 k BTU
Repair / Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
ApplianGe
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$59.20
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
FEE SUMMARY
Repair I Alt Absorbtion Unit
_ _ - . Repair/AltRefrigerationUnit
Ventillation System
' Evaporative Cooler
Commercial I n ci nerato r
Domestic Incinerator
Compressors / Absorption SVstems
Upto3hp/100kBTU
. ' �3To15hp/SOOkBTU
� 15 To 30 hp / 1,000 k BTU
30 To 50 hp /],750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15 to 30 hp
30 to 50 hp
Over50hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 12/78/2001
Issued: 12/1812001
Quantity
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00
$0.00
$0.00
E82.70
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
tor 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 ell
requlred Inspectiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae-as �sroo�
WORKERS' COMPENSATION DECLAIiAT10N:
I hereby aHirtn untler penalry oi Oerjury ona af tha following tleclerations:
I e end wlll maintain a certificate of consent to selt-Insure for workers' compansation, as provitletl tor by section 3700 of the Lebor Cotle, for ihe pertormence of the
ork tor which this permit i� issue0. -
I have antl will malrrtain worl�ers' Qom nsation insurance, es required by section 3700 oi the Lsbor Code, for the petlortnance of the work br whic0 this pertnit is issuetl.
My workers' com{yQs@tion hsura(k�tarder and policy number are:
Cerrier:
(This se
one
❑ I certify ihat in tha peAortnanc��the work for which �his
compensatlon laws ol Celitom , antl agree t�el I� I shoult
comply wi�h Ihese provi5i0 �
/
Applicant Signeture: ' �
WARNING: FAILURE TO SE E WOHKERS' COMPENSATION R
T/i0U5AND DOIURE (51 ,00p), IN ADOITION TO THE COST OF COMP
IICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I am licensed under provis ns of Chapter 9
force end effect. Llc. a
Coniractors Slgnature:
CONSTRUC710N IENDING AGENCV:
Poliry Number:
ired dW/ars ($100) ar less.)
is iuue4 I s�all not employ any person in any manner so as to become subject to the workers'
pe sub�ect to the workers' compensation provislons of Sac' �00 q� e Labor Code, I shell forthwith
Date: � / (
FUL AND SHALL SUBJECT AN EMPLOYER TO CflIMINAL PENALTI pND CML FlNES UP TO ONE HIINDRED
NMGES AS PROVIDED WR IN SECIIIXJ 3/O6 OF THE I/�BOR COOE, IMEREST, AND ATTORNEY'S FEES.
with Section 7000) of Division 3 ot the Business and PrP tessions Cotle, antl my license Is in full
Class M 1 / � ...� �
� Date: ��
❑ I hareby eRirm Ihat ihere is a conslmction lentling egency for ihe peAormence of Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle).
LentleYs Nama: Lenders Adtlress:
Signature:
OWNER-BUILDER UECLARATIONS:
Date:
I hareby eHirtn Ihat under penalty ol perjury thet I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Buslness end Professions
Code: Any ciry or county which requires a permit to conslmct, elter, improve, demolish, or repair any 5trucWre, prior to its issuance, also requlros the applicent tor such permit
to ille e signetl stetement thet he or she Is Ilcensetl pursuent to the provislons of the Conirectors License Law (Chapter 9(commencing wlih Section 7000) ot Divislon 3 of ihe
Busine55 and Professions Code) or that he or she is exempt �heretrom end �he besis for iha elleged enemption. Any violation of Sec�ion 7031.5 by any epplicent tor e pertnll
subjects ihe aOPlicant to a civil penelty of not more Ihen fiva hundretl tlollars ($500).):
❑ I, as owner of Ihe properry, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and ihe structure is not Intentletl or oHeretl lor sale (Sec.
7044, eusiness and Pmfessions Code: The Contractors License Law does not apply to an owner of property who builtls or improves Ihereon, end who tloes such work
himself or herself or through his or her own employees, provided Ihat such improvements are not intentletl or oNeretl for sale. If, howevar, �he building or Imp�ovement is
soltl wit�in one year ot completion, ihe owner-builder will have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of ihe pwperty, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct Ihe project (Sec. 7044, Business and Professions
Code: The contrectors License Lew tloes not epply to en owner of pmperty who builds or Improves thereon, entl who contracts tor such projact with a contractor(s)
license pursuent to ihe Contrectors License Lews.).
❑ I em e:empt under sec. Business and Professions Code for this reason:
Si9nature: Date:
Owner ID venfietl by tlriver's license. ❑ Ves ❑ No Drivers License No. Expires:
Venfication af Ownership by (type of tlocumeN, i.e. - property tez bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATON:
❑ I here6y certity that no excavation tive (5) or more feet in Cepth into which e person is required to descend, will be made in connecNon with work euthodze0 by this
permit, and Ihat no building sWaure, swflolding, lalsework, or demolition or dismaniling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title 8, Celilomia Atlminis�retive Cotle).
❑ As owner-Duiltler, I will nat employ enyone to tla wark which would requira a pertnit from ihe Division of Industrial Safery, es noted ebove, unless such person hes e
permit ta do such work from the tlivision.
SignaNre: Date:
Division oi Industrial Safery Pertnit Number:
CER7IFlCATE OF COMPLIANCE AND AIJfHORIZATION OF ENITiV: I certiy under penalry ot perjury that I have read ihis epplication antl state Ihat the infortnetion given is
correct. I agree to comply with all stete laws entl ciry ordinances relating to builtling construc�ion, end authonze representetives of ihe Gty ol Coste Mese to enier upon Ihe
ebove-tlescribed properry tor inspection purpwes. I egree not to occupy or allow occupancy ot any building authorized by this permit until finel inspeqion.
GOUE �. INSFECTIONTYPE QAIE U�L$
7616 Fised System Final Fire Prevention
1266
200
201
202
203
204
Paol Spe Final
Finel Re-Roat
Final BIacWReleining Wall
Final Fadory Fire Place
Final Sign
Final Demolition
I ' � � i Date
�— Date
CQOE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plum6ing
210 Final Elettntal
272 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Oaupency
' I-al ��SN
�
(714) 754-5273 • Fax (71a) 75a-4B56 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA. CA 92626
Job Address:
Suite No
v�����r�:
MECHANICAL PERMIT
356 E 20TH ST
A
Parcel Number: 42623178
qpp�icant: BRIGGS, JOHN
Address: 5457 CRENSHAW BL
LOS ANGELES, CA
Owner: MOSS, JOHN
Add�055: °/aGEORGE MOSS
Contractor:
Address:
LOS ANGELES, CA
4360 WORTN ST
ADEE PLUMBING & HEATING
05457 CRENSHAW BL
LOS ANGELES CA "
CHANGE OUT FAU IN UNIT A
Quantity
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair I Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood wlMech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfm
Floor Pumace
Floor or Suspend Heater
523.50
814.80
$0.00
$0.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
ISSUED BY:
Phone: 213-296-8787
Zip: 90043
Phone:
Zip: 90063
Phone: 800-554-5858
Zip: 90043
License: 240186
SCOPE OF PERMIT
FEE SUMMARY
Repair / All Absorbtion Unil
Repair / Alt Refrigeretion Unit
Ventillation Syslem
Evaporative Cooler
Commercial I nci nerator
Domestic Incineralor
Compressors I Absorption Systems
Upto3hpl100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Uplo3hp
3Toi5hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee �
Plan Check Fee
Reinspection Fee
Status:
Applied:
Issued:
ISSUED
12/182001
�vieizoo�
Quantity
$0.00 0
$0.00 0
90.00 0
$0.00 0
90.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
50.00
50.00
50.00
TOTAL CALCULATED FEES 538.30
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
E%PIRATION: This permit shall automaticaliy expire and become vold if work Is not commenced within 1 BO days, or it work is suspended or abandoned
lor a period of 780 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapeetlona and final approval must be obtained. Failure to obtain inspections and tinal approval will result In the expfration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2dt8�8�6W)
WORKERS'COMPENSATON DECLARAnON:
I hereby eHirtn under penelry ot perjury one ol the following tleUara�ions:
❑ I have entl wlll meinteln e cenificate ol consent to self-Insure lor workers' compensetlon, es proWtletl for 6y sactlon 3700 oi ihe Lebor Catle, tor t�e OeAortnance oi the
� /� ork lar which this permit I5 issuetl.
�I have entl will melrVain wo ers' compensetlon insurance, es reQuired by seclbn 3700 of the LeOor Coae, tor t�e pertormance ot ihe work tor wfiic� thiv pertnit is Issuetl.
My workers' co pensatlon nsur c carrier end pdiry number era:
Cerrier: ���� �, Policy Number:
(This section
❑ I cartiry thet in the per
compensatlon laws of
comply with these pro
Applicant Slgneture�
WARMNO:FAILURET WF
LICENSED CONTRACTORS DE
I hereby eftlrm tha� I em liCensed
force entl eMact. lJc. a
Contractols Signature: �
one
oNess.)
� work lor which thls permlt is Issued, I shall not employ eny person in eny manner so es to become subject Io the workers'
egree lhei I Should becom �ect to Ihe workers' compensatlon provisions ol Secii 3700P 1 the Labor Code, I shall forthwilh
- oe,a: IZ�1 �1 D 1
ENSATIIXJ COV GE IS UI� FlJ D SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE !WD GVIL FlNES UP TO ONE MUNDRED
� TME COST OF COMPENSATION, DAl.iAGES AS VROVIOED FOR IN SECTIIXJ 3')08 OF THE LABOR CADE, INTEPEST, AND ATTORNEY'S FEES.
ol Chapter 8(commencin'p/y�ith Sectlon 7000) of Divislon 3 ot the Business and Pr tesslons Code, entl my Ilcense Is In full
n i // _ /7 C�855 « _ P ,
Date:
CONSTRUCTION LENOING AGENCY: - �
❑ I hereby eHirtn that there I5 e constrtiction lentling a0ency for ihe peAormanco of Ihe work lor which Ihis pertnit is issuetl. (Sec. 3097, Civll Cotla).
Lenders Neme:
Signature: _
Lentler's AdOress:
Date:
OWNER-BUILDER DECLARATONS:
I hereby ettirtn t�at unCer penalry ot perjury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or wumy which requires e permit to conswct, eltaq improve, tlemolish, or repeir eny strudure, prior to its issuence, also requires the epplicant for such pertnit
to tile e signed stetement thet he or sha is Iicensed pursuent to the provisions of the ContraQors License Lew (Chapier 9(commendng with Sectlon 7000) ot DlNsion 3 of Ne
Business and Professians Cade) or that he or she is exempt therefrom enE t�e basis for the elleged exemption. Any violatlon ol Section 7031.5 by eny appllcant tor e pertnit
su6jects tha epplicant to a civil penalry of nat more than Ilve hundretl dollers ($500).):
❑ I, as ownar of the propeny, or my employees with wages es Ihelr sole compensetion, WILL DO TME WORK, antl the struc�ure is not intendetl or oflereA for sale (Sec.
7044, Business and Professions Cade: The Conirectore License Lew does not appty to an owner ol property who builds or improves thereon, and who does such work
himselt or hersetl or �hmugh his or her own employees, provided Ihat such improvements are not intended or aHeretl for sele. If, �oweve4lhe building or Impmvemeni Is
sold within one year of completion, the ownerv6uiltler will have the burtlen of proving �hat he or she did not build or improve tor purpose oi sale.).
❑ I, as owner at the praperty, em EXCLUSIVELV COMRACTING WfiH LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business entl Protessions
Code: The contreciors License Law tloes not eppy to an owner ot pmperry who Cuilds or Improves thereon, antl who contrects for such project with e contracror(s)
license pursuant to the Comractars License Lews.).
❑ I am exempt under sec.
Signaiure:
Business entl Professions Cotle for this reason:
Owner ID verifiad by drivefs Iicense. ❑ Ves ❑ No Drivers License No.
Veriticetion ot Ownership by (rype of tlocument, i.e. - property te�c bill or tleetl):
DIVISION OF INDUS7RIAL SAFETV VERMR CERTIFICATON:
Date:
Expires:
❑ I hereby certlty that no eacavatlon tNe (5) or more leet In Eept� into which e person is required to descend, will be made in connection wilh work authodzed by this
permit, entl t�at no builtling swcWre, sceHoltling, lalsework, or demditlon w Cismaniling Uereot, will be more than Ihirry-six (36) feet �igh. (Chep. 32, Grp 2, An 2, Sec.
341, Tltle B, Celitomle AdmlNSUetive Cotle).
❑ As owner-builder, I will not employ enyana to tlo wark which woultl requlre a permit Irom the Division ot IndusMel Sefety, es noted ebove, unless such person has e
pertnit to do such work Irom �he tlivision.
SigneWre: Date:
Divislan of Intlusirial Selery Permit Number:
CEH7IFlCATE OF COMPLIANCE AND Al7IHOROATON OF EMAY: I certity untler penalry of perjury ihat I have read this application and state Ihat Ne Informatlon gNen is
wrrect. I egree lo wmpty with all stete laws entl dty ordinences releting to builtling construction, antl authonze representatives ot the City ol Coste Mese to enter upon ihe
ebove-descrlbetl O�operty lor inspection purposes. I egree not to occupy ar ellaw accupancy oi any building authorized by t�is Dermi� unlil linel inspection.
CODE I, INSPECTIONTYVE
1616 FIzeO System Final Fire Preventlon
1268 Pool Spe Finel
200 Final Re-Root
201 FInaI8locWReteininp Well
202
203
204
Final Fedory Flre Place
Finel Sign
Flnel Demolition
l Z ( g p� oa�a
�� oa�e
GOOE I INSPECTION TYPE
208 Final Mechenlcal
208 Final Plumbinp
210 Final Electrical
212 Final Flre Preventlon
220 Final Planning Approvel
222 Final Site
250 Finel Building�Occupancy
�. � ����. ;
� � L
y; � PHOJECTADOflFSS: 3SE E 20TH ST
OWNEH'SNAME: MOSS JOHN
��� aooeess: 356 � 20TH ST
COSTA MESA, CA 92626
�
�
�
PPCH/ENGINEEfl:
ADDPESS:
flEG.NO.:
UNIT:
UNIT:
PEPMITTEE: JOI'IN i"i�$$ (%19)%ii—�%31
ADONESS: 3SE) E 20TI�I ST
C,M. CA 92626
UCENSEO GONiRALTOB OECLAflATION: I hereDy atlirm I�al I am bcenseA unCer Dmvisions ol C�apier 9 �commencing wi�h Section
7000� ol �msion 3 0l t�e Business anA Pmtessions Coae, anU my license is in tulllorce anE ethct.
QTY LIC.: STATE LIC.: CLA55:
Oate: Signamre:
WONREPS' COMPENSR7ION oECLAflATION: I nere�y allirm inat I hdve a cenificate of consent 10 self-insure or a certiliCate af WaMers'
Comoensation Insurance. oi a certified coOY �hereol (Sedion 9800. LaD. C�.
POLICY NO.: E%P. OPTE:
COMPANY:
�0 Certilied copy is hereCy Iumis�eA. O LerlilieG copy is IileA wilh the ciry BuilOing Oivisian.
Oate: p�0���ant:
E%EMPTIONFflOMWOflNEflS'LOMPENSATIONUECNflRTION: (TNsse[IpnneNnotOecompletMiiNepermilislaanelmnErCd�57qqorIP55�.
I tertily Ihal in �ne Dedorman[e ol lh¢ work lOr whith IhiS permil is issuetl. I Shall nol emDloy any person in any manner So a510 OeCom¢
SUG�etl lo I�e Warkers' Camp¢nsati0n Lavrs a� Calilamia.
Date: _ � � -� � �-: Sipnature:
NOTI E: II, atler making Ihrs Geciara�im, you shoWa become subjea lo t�e War ers' Co ensation pmvisions ol t�e laEor
CoOe. yau musl Iort�wilA camDly with such provi5ions or ihis Dermit s�all Ge Ge¢med revokeA.
CONSTBUCTION LENOING RCENCY: I �ertUy altirm ��a� (h¢re i5 a mrt9mtlian IenOing aqenq br IAE Dedofmar¢¢ ol Itre work lOr
whic� this p¢rmit is issuetl (Seclion 3097, Civ. C). :
LENDEN:
AOUHESS:
OWNEP BWLOEB OECLAHATION: I �ere�y allirm Iha� I am exempl Imm Ihe Cantractors' Stale License �aw for tAe Iollovnng reason
(Section 7031.5 Business anU Pmtessional CaOe: Any ci�y oi caunty w�ich reQuires a permit lo wnstmcL alter, imprwe, demolish, or
repair any slmclure. O�ioi lo iis issuance. also requires t�e apO�iWnt br sucA permil to lile a signeE statement thdt hPJs�e i5license0
pursuan� to t�e prOvisions ol IAe ConVaclors' S�ate License Law �Chapter 9(commencing wilA Sec�ion 7000) of �ivision 7 0� the Business
an0 Pmtessions Catle) or Ihal nelsne is exempl lneretmm antl Ihe oasis lar Ine aile0e4 e�emption. Any violation of $ettion 7031.5 by
any apPlicantlor a permil subiecls tAe aDOlicanl to a civil penalry of not more tnan five nunarea EOIlarS (E500).
I, as owner of ine o�openy or my employees with xa0es as ineir sole compensation, will Ao ihe work, antl the
❑ slmcWre is not inlenEed or olleretl for sale (Seclion 70Ea, Business antl Prolessional Cotle: T�e Contractars' Slate License Law
Ooes no� apply lo an owner of a pmperly who builtls or impmves thereon. and who does suc� work himself/Aerself or ihrough
�is Or her own empl0y¢es. pmvidea Inal 5uth impmv¢menls ar2 nol inf¢na¢d or oflere0 lor sale. Ii, however Ne EuiiAing of
improvement is soltl wit�in on¢ year 01 comDlelion, �he owner wi0 have ��e �uraen oi Omving he/she ditl no� builtl or impmve
fot ine ouroase of salel.
I, as owner of Ihe pmDetly, am exclusively conlractinq with licensea contracbrs �o tonstruci Ihe prolec� (Section 7044, Business
� antl Prolessions Coae: 7he Comractors' State License law aoes nat aDPN �o an mvner ot 0�operty who �uil0.a ar improves ihereon
antl who contracls for sucn pmiecis with a conlrador�s) license pursuant lo Ihe Coniractors' Slate License Law). I am aware
thal pwOf of their Workei s Comp¢n5aiion in5urance ShoulA be O�ovitled lo me,
� I am eremD� un0er Section: 8. 8 P. C.
lor tnis reason:
Oaie: _3=l � (��_ Owner: �'�L�o,� yl t}/ f
I eo nereby cenily that I am aware ol ana waemantl Ihe repuiremems ol Calilomia Healih an0 Salety Cotle Sections 25505, 25533. an0
25534 antl Ihat I or any INure 6uilding occupant will/will not (circle one) neetl to comply with saia slate co0es and the requiremenls tor a
permi� far cons�mc�ion or motlilica�ion Imm Ihe Fu Oualny Management DisVicL Pesitlenlial constmction apDlications are exempt imm
Ihese provisions,
Oale: Applicanl:
I �ere�y cetlily Ihal I �ave reatl Ihis appliCaiian anA Slale Ihal Ihe aboveinlorma�ion i5 tOrret�.l aAreeto tomply wi�� allciry anA COunly
oiainances an0 s�aie laws relatin0 �o Duilaing cons�mnion antl herehy authoriie �epresentatives ai ihis city io enter uDon tAe aUove�mentione�
properiy ipi inspeclion pmposes.
Daie: _� � �� y Signatwa �I��SE
Dnver's lme�se or Sociai Secudty a:
i64ba6 Whne—Buddmg�, Groen—COCe EnlorcemanL Canary—Applicanl; Pink—Ravenue: Goltlenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066"l4]
PERMIT NO: B 066241 PLAN CIIECK NO: 00743-94 S GOVT: N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : INSTALL WROUGHT IRON FENCE W/SLIDNG GATE SQ FT: 86
CLAIM VALUE: 1,000,00 CALC—VALUE: 860.00 GROUP OCC: R-1 /
COMMENTS: INSTALL SECURITY GATE S W,T. FENCE
�r***�r�r�rx�*�rx�**+�***i�x�+�*�r*�r**xx***�ri�i�*�t*�r**�t**+rx�*�r�*�t**�r�****�r�r**x�******�r+,r**�r#+�ic*�r
Z O N I N G R E Q U Z R E M E N T S
5 E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FANT: FT ZN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGFiT: FT IN
PARKING AE • PROV; PAACEL: 42623118 2NE: R1 REF NO:
PLANNING N TES> INSTALLATION OF SECURITY GATE WITH A FRONT SETBACK OF 58'4".
> APPROVED BY TRANSPOATATION SERVICES.
*�r�r+��t�r*ir*+r**�rx�**i��r*x�***tr�rx��r�rx+ex��-*+r*+r�t�t***+��r*x�**�r�r+�****�-*x�****x+r*+�-�r*��c�*****�**+r*
D E C� E L O P M E N T S E R V I C E R E Q U I R E M E N T S
ZONING APPROC�ED HY � � � � DATE: �� ( (�t �
BUILDING APPROVED HY : DATE:
APPLICATION ISSUED HY: DATE:
x****.�**+�***�t**u*�x+�** ******�r**�r , �k *�
iE it iF iE if ff iE iF iF fF 1E dF �E iE aE IE if if iF iE it iE iE if iE ii 1f iF iE iE !f 1E iE 1E if if if iF iF f! M 1E 3E iE if iElE if iE ih iF i! if iE i! iE 1E iE ic iE iE if 1E iE %%iF i! jc 1f if if iE iF #'-iE iE �f iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 23.00 .50
SMIF/NON—RES
PLAN 14,95
ISSUE FEE
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 23.50 0,00 14.95 38,45 38.45 .00
REVENU£ DIVISION TOTALS--> COLLECTED: 38.45 OVER/SEIOAT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC £ZRE SMIP/TOT GRADING PLAN—CI-IECK
23,00 ,SO 14,95
iE if if iE 1f iE-1(� it iE iF iE 1E if iE 3F iF if iE iF iP if �E iF iE jE it it if iE if iE iE iE 1t fE i! it if it if if �)f %i! if 3F jf iE M if iE if if 9E 1E iE if if iE jE iE 1E iE 3F iP iE+F iE iF iE iE 9f if iE iF if ?E 1f it
I N D I V I D U A L F E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 86 RES—W, IRON/C$AIN LINK FENCE / FT. 10.00 860.00
END OF FEE5
01 00156327-00156829 T C�T 33.SS
DATE: 03/02/94 7IME': 16:06
,�,%-.
CONSTRUGTION AND PLANNING POOI 'A
APPROVALS Permit # Date Inspector APPROVALS Permit # �ate Inspector
�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soii Pipe-Undrgrnd. 53. Steel Reinforcement . '�
3. Electrical Conduit Utility-UndrgrnU. 54. Forms '
4. Elearical Co�duirUndrgrnd. 55. Electrical Bonding � �
5. Steel Reinforcement 56. Rough Plum6ing & Pressure Test �
6. Electrical UFER Gmd. 57. APPROVALTO COVER�GUNITE
7. Footings 3`�-R� ��� 58. Electr�cal Condu�t�Ur.dryrnd. a
8. Foundation 59. Gas Pipe, C7 Undrgrrd., Test
i
9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, � Undrgmd. ,-� �
10. Structural Floor Syscem 67. APPROVAL TO DEC�C
1t. Property Sewer line & HauseCo�nec:ion 62. 8ackm�ash & Receptor�Fina1 `� �
12. Sewer Cap 63. Heater & Vent�Final . •- (
13. Roof Drains ' 64. Plumbin� System - Final `
14. Rough Plumbing 65. Electrical-Final
15. Rough Elettricai-Condu'rt 66. Solar System-Pmal � I
16. Rough Elettric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTEfliNG
78. Rough EleCtrical-T Bar Ceiling 69. POOUSPA SYSTEM11S FINAI
19. Rough Heating & Air Condit�oning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # �
21. Ducu,in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Pipiny C7Ges ;JO�I
23. Gas Pipe�Rough & Tes[ 72. Underground Flush
24. Roof Freming 73. Underymd. Storage Tank O Gas ❑ 0�1 I
i
25. flooi SheaChing 74. Overhead Hydro ,
i
26. T-Bar Ceiling fStructural) & Monocoat 75. Dry Chemical I
27. Frame aod Flashing 76. Dry Standpipe i
28. �athing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH OEPT. REQUIREMENT
31. Piazier 8rown Coat 79. FINAL INSPECTION
32. Elzctrical Power INeterFinal 80. FOOD CEfiTIFICA7E ISSUED I
33. Fina� Electric Notes:
34. Finai Heating & Air Conditioning
35. Final Gas P�Pe-Test
I
36. Hood or Canopy �
37. Final Facto�V Fireplace �
38. Pinal Plumbing
39. Water Service�Finai
40. Gas Service-F�nal
41. Solar �omestic-Final .
42. Backflow Preventer 3.�1��4 (,• � .5 f��� •
43. Backflow Irrigation � ' �
44. Landscape irrigation Synem �
45. Sound Attenuation
46. Handicap f7agulations _
47. FINA� STRUCTURE & BUI�DING (.� �p-�(f �(�a1
48, FINA� P�ANNING •-
49. Electric Reiease to Edison •
� 50. Gas Release :o Southern Califor�ia Gas Co
51. CERTIFICATE OF OCCUPANCY ��
No,_ Dace
►a
.
PHOJECT PODFESS: 3 S 6 E 2 0 TH JrT
OWNEfl'S NAM1`.: MOSS JOHN
i. anoxe5s: 356 � 20TH ST
COSTA MESA. CA 92626
" RflCHIENGINEEfl:
nooeess:
flEG.NO.:
uxir:
�:l �
uxir:
PEflMITTEE: K S B ELECTRIC (719)439-1108
nooness: 17951 MT. HERMANN H
FOUNTAIN VALLEY CA 92708
LICENSEO CONTHPCTOfl OECLAPATION: I �ereoy allinn ihai I am licens untler provisions of Chaptar 9(commencing wil� Section
7000� ol �rvis�on 3 0l Ihe Business antl Prolessions COGe. antl ¢ is i Ilforce nU C�.
urr uc.: �f �'/are uc.: 6 3 3 3 8 —��
�ate �� `"S � ` � Signature: ,
WONHEBS'COMPENSPTIONOECLAPATION: I�er¢Gy irmlhaU�aveattlilicate0�con5en1i05e11-insur¢oratertiliW�pO�WOrkerS'
Compensation Insurance, or a cerlilied coDY �he�eoi (Section 3800. LaD. CI.
roucrNo.: 1332271-93 E%P.ORTE: IOIO1�94
comenxr: STATE FUND
'H cenu�ea �ooy a nereny mr�rsnea. ❑ cennrea coov' � ��� n am �� � fi�
�� � ,/'
oa� : Y" 'ZS — Y AppliWni .
,
%EMPfIONFNOMWOBRENS'fAMPEN5ATI0NaECtAM710N: QAi55enionneM ol0 omoleteeiithepermtistoranenuMrea�51001or1usl.
I ce�ily that in the petlormance ol �he work br w�ic� t�is permii is issuetl. I shali not employ any Derson in any mann¢r w a5 io becom¢
su�le�� �o tile Warkers' fAmpensation LawS 0� CaliPomia.
Dale: Signalure:
NOTILE: II, aller making Ihis tleclaralion. you ShoWU bewme SUGIeti to Ihe Workers' Compensation provisions of the La6or
CoOe. yau must lonhwitn comply witn such o�ovisions or inis permit sAail be OeemeO revoketl.
CONSTflULTION LENOING RGENCY: I �¢reGy al�irm Ihai thefe is a conslmC[ion len�ing agenCy tor �he petlormante Of Ihe work br
which Ihis permii is issued (Setlion 3W7. Civ. C�.
LENOEH:
FODflESS:
OWNEfl BUILDEB OECLAHATION: I hereby a�firm Iha� I am exempi Iwm I�e Contracrors' Stale License Law Ior Ine lallowinp reason
(Section 703L5 Business ana Pmlessional Code: Any city ol counry which requires a permit to consimct, alrer, improve. Oemolish, or
repair any StmcWre. prior �o iis issuance, also requims lhe applicant br suc� permi� �o �ile a sipned s�a�ement iha� he/s�e is licensea
pursuam to the O�avisions ol Ihe Contradors' State License Law (CAapter 9 �commencing with Section 7000) of Division 3 al ihe Business
antl Professians Caa¢) m Iha� he/she is ecempi iherefmm and t�e basis br Ihe alleAed exemplion. Any violation ol S¢ciion 70315 Ey
any apPlicanifar a Dermit suUiecls ihe applicantlo a civil penalty of not more than tive huntlretl tlollars (5500�.
I. as owner ol Ihe O�oUeny or my employees wiN wages as their sole compensation, wilt Do I�e work, anE ihe
❑ simcWre is nm imendee ar oifereA lor sale (SecUon 7044, Business antl Pmfessional CoOe: The Cantractors' State License Law
Ooes noi apPly �o an owner ol a pmpeny w�a �uilAs or impmves thereon, anC who �oes such wofk himselflAersell or �hrouAh
hi5 Or �er own em0�oy¢es. pmvitl¢E Ihai SUCh impmvem¢n�s are noi int¢ntletl or o�tered fOr Sale. I�, howevef Ihe Uuiltling or
impmvemeni is 5010 witnin one year ol comDlelion. ihe owner vnll have ihe buraen ol pmving he/s�e Aid not buil0 or imD�ove
lar I�e DurOose ol sale�.
I. as ownerofthe o�operly.am exclusively coniracting with Iicense0 coniractorsto conslNcitne pwject(Sectlan 70.1a, Business
!❑ ana Pwlessions CoGe: TAe Convaciors Slaie License Law dou not aDON �o an owner ol properry who GmIGs or imD�m'es tAereon
� antl wM conlracts lor sucn Orojecls wii� a contractoqs) license ouRuani Io the Conirac�ors' State License Law�. I am awdre
� t�a� pmoi oi �Aeir Workefs Compensa�ian insuranre shoWE be OmvideA �o me.
� I am exempl untler S¢clion: 8. 8 P. C.
lor I�is reason:
Date: Qwne[
I Uo �ereDy cendy rtwi I am aware of anG unG¢rs�and I�e fequiremen�s ol Calilomia Health anG Sa�ery Code Setiions 25505, 25533, ana
25534 anU I�al I or any tuWre Guilamg occupant wilUwill not (cirCle one) neea to camply with SaiO slate cotles and I�e requiremenis for a
permit for cons�mction or moEilication Imm I�e Au �uality Managemeni DisVicL HesiAen�ial conslmclion aDD�ica�ions are e�empt Uom
Ihese provi5i0n5.
Oale: Applicani:
1 AereDy retlily�hal I �averea01�i5 appli[aiion an0 51aie Iha��he a�avei maiian i5 rt L I agr¢e�o w ply wilh allCiry an0 [oun�y
oreinances ane sta�e laws relating lo buildinp conslmtiian an0 he y a Ih r e reF�es a' ol t�is ' 1 er uDon Ihe a�ove�men�ioneC
pm erry lor inspeqi0/n �p..u�rpases. 2
Date: ���� / � $ignaWre: G
nver's License or Saciai Securiiy a:
, i6aba6 Wlnte—BmlOing; Gmen—CoOe Enlorcamml; Canary—Applicant; Pmk—Revenoe: GolOenroO—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06692�
PERMIT NO: E 066925 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION ; ELEC FOR WROUGH IRON FENCE W/SLIDNG GATE SQ FT:
CLAIM VALUE: 410,00 CALC—VALUE: GROUP OCC: R—i /
COMMENTS: REF: B66241
*+r+r*�t�t�--�*+rir�r***��r**�**��*�-�-***-�t�r*+r-��t+r**+e�**�r+��t**-�t-*+��r-�x�*x�*�r�r*rt*��r�r*+t***+r�r�r�r+t**+r-��.
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGAT; FT IN LEFT; FT IN RGFIT; FT IN
PARKING REtZ: PROV: PARCEL: 42623118 ZNE; REP NO:
PLANNING NOTES>
>
+r�rx*�*�r*x�**�+r�r****��x�rx*�r**�*+r*x�rx�*�e�r*�r�e�r**+�**�r�r�r�r**��x**r�r***+�*��r***�r*���r*�r�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
/'
�
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: 1�1 DATE: ����+��
*****�t*�r*x-x��r+r*�rit*i�**�r*�Tr�**i��r+��*����'�r�r*�*�TF+r�r****�rx�**�** t* �c +r
iEiE!!1E%ifiEiEltlfit#'-ifiEiEillElEfEffkifiEifkififitlEifififflkiEiEifiFlElfiEiEM1ElEififMifMififiElfifiEifMiElfiEiEifiElfiEifiElFiFiEif iEiEilif3RiF
LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 3.75
503 SMIP/NON—RES
PLAN
ISSUE FEE '15.00
BUILDING—DIV—> PERMIT ISSUE PL'AN—CHECK
TOTALS----> 3.75 15,00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
18.75
TOTAL PAID DUE
18.75 18,75 ,00
18,75 OVEA/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
iE 1f iE iF if iE k iE if it M 1E iE iE iF �E 1E iE iE iE iE iE if it if iE iE iE if if if M i6 if if IE iE fF iE 1E iF jE if if 1E iE %� K it N� if �E �[-if aE IE if if 1E 3E iE if iE it if if iE �F if� iE 1E K if iE iE iE iP iE if
I N D I V I D U A L� F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O'N UNIT COST TOTAL COST
ELE 1 RECEPT/OUTLET � 1 ST 20��RFEA. .75 .75
ELE 1 MOTOR/POWR APPARATUS 0. 0� =. � 1, Q H�POT15 3. 00 3. 00
END OF FEEStE if.sPE-�'
�� ���.�p�,�..-
C1/�/ ,�I �1■�y,/1 y°s `"�I �`� y"'.� '
V V 1 l.
� ol 0015447i-0o159471 T�J T 28,i5
DATE: �4/2`/�4 TI17E� ]1:i3
CONSTRUCTION AND PLANNING r^ P00 SPA
N,PPROVALS Permit # �ate Inspector APPROVALS Permit �' Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
4
�
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3, Electrical Conduit Utility-Undrgrnd. 54. Porms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Piumbing & Pressure Test .
6. Electricai UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Eiectrical ConduirUndrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrntl., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P�Trap, O Undryrnd. •
10. Structural Floor Svstem � 67. APPROVA� TO DECK
1 i. Property Sewer Line & House Connectio� 62. Backwash & Recepmr�Final
12. Sewer Cap . 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System - Final
74. Rough Plumbing 65. Electrical-Fina1
75. flough Electrical�Conouit 66. Solar System-Finai
76. Rough Electric Wiring 67. Fencing & Access AnP�oval
17. Rough Wiring Sign 68. APPROVED FOR PLASTEflING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FacCory Fireplace APPROVALS Permit #
21. Ducts, in S[ructure . 70. Under9round�Hydro
22. Duas, Ventilating 77. Product Piping QGas ❑Oii
23. Gas Pipe•ROugh & Tesc 72. Underground Flush
24. Roof Framing ' 73. Undergmd.Stora9e,Tank �Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro �
26. T�Bar Ceilin9 (Stroctural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe ' �
28. Lathing & Siding . 77. FIXED SYSTEM PtNAL
29. Insulation 78. FIFE PREV. FINAL
30. Drywall Nailin9 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat , 79. FINAI INSPECT�ON .
32. Elecencal Power MeterFina� 80. FOOD CERTIFICATE ISSUED �/
33. FinalElec:ric Notes: l�_Z6-C�l� A� ��� /,,,�e L' �
! �cr /�
34. Final Heati�g & Air Conditioning . '
35. Final Gas Pipe�Test �
36. Hood or CanopV �
37. Final Factory Fireplace , �
38. Final Plumbing
39. Water Service�Final �
40. Gas Service�Final .
41. Sotar pomestic-Final
42. Backflow Preventer •
43. Backflow I�rigation �
44. Landscape Irripation 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 ~ °, -
(03/27/98) '�JILDING PERMIT SYSTEM � (11:14:39)
BP74 JWSE INSPECTION RESULTS
NUMBER: 356 STR: E 20TH ST UNIT: .
PERMIT N0: E 066925 PLAN CHECK N0: 9401443 PARCEL: 42623118 OCC: R-1 /
NOTES: PERMANENT CERT. OCCUP: DATE:
TEMPORARY CERT. OCCUP: EXP DATE: ,
CODE D E S C R I P T I 0 N DATE INIT Y/N
0000 FINqL , 04/26/94 RB F
0000 FINAL 04/28/94 GH P
0000 ELEC FINAL 10/08/96 RB C
0000 EXPIRED 02/04/98 KC F
FUNCTION: F:FORWARD N:NEXT T:TOP U:UPDATE X:EXIT
NEXT CODE:
MSG: NO MORE RECOROS FILE: ACT PRINTER: REM
r�
PflQIECT ROOBESS: "� S G� E 2 0 TH S T
OWNEN'SN1ME: CHRIS ROLANll .
eooxess: �56 E ?.OTii ST .
' COSTA MESA
CA 92627
�OCH/ENGINEEfl: � � 1 4� 5 � 1—�� 1� 6
ROUflE53:
UNIT: �
( +
eec.xo.:
' uxrt:
PENMRTEE:GGORCiG QRAZIL ($OO)�I43"iIS9
1DDflE3E: '.�OZZ F1E.SPCRIAN WAY
SANTA ANA CA 92706
LICENSEO CONTMCTOfl OECLAMTION: I her¢hy aflirm�lwtl am IicenseA unCerprOvisions ol Chap�er9 (commencinp wit� Sectlon
7000) of �ivision 3 0l lhe BuSiness an0 Prolessions CoOe, an0 my license is in full loru antl ellec�.
cm uc.: 0 2 9 91 �T�cre:,uc.: q q 3 - cuss: �_� G
Oate: �/ 2 — � �� / . Sipnat r.��� �—�
WOBNEBS' COMYENS�TION OECUIUTION: I hereby affir alfi I have a ceniilcate ent to selM1insure or a cetlificate ot WOM1ers'
Compensation Insurance, ar a certifieU copy ihereoi (Secti n 3800, LaD. C�.
Pol1CYN0.:WCSZ;.!jOE)i , ��1%, 1���
cornrnxr:AMFRICAN HOMF:
❑ Certife0 copY is �ereby IumisAed �I CeNfietl coD ��b ��h the dry BuilAlnq Division.
�ate: r 1 — � � � AppliwnL
IXEMPfION FPOM V/ONNEfl$' COMPENSITION OECIAMTI :(Ihis secuon neM nol he com �lNe permil is fa ane hunOreO (5700� a less�.
I cenify that in t�e peAorma�e ol tAe work tar wNch tAi t is iuued, I slWl not emDl any person in any manner so as m hecome
suhl�� �o the Wnrkers Compensation Lawa al Califomia.
Oate: - SiqnaWre:
NOTICE: Ii, arier maknp tNs Eedaratian, you shoul0 6ecome su�l�� �o IAe Wo�kers' Campensation D�sians ol the Lahor
CaEe, you must IotlAwith comDly vnth such proNsions or t�is Oermii shall Ee OeemeO revoked. �
CONSTBUCTION LENDINO �GENCY: I �ere0y affirm t�at there is a construction Ien0in0 a0ency far IAe Oetlorrtwnce ol t�e xrork for
w�ic� I�iS pCrrtlii is iSSUCd ($ttli0n 3097, Civ. C). � �
lENOER:
ROOflEBS:
OWNFB BOILOEB OECLAMTION: I AereEy affirm that I am exemD� f�om [he Cantroctors' Stala Licensa Law lor iha followiny r¢ason
(Section 7031.5 Business antl Pmlessional Cotle: Any ciry oi counry w�ich requires a permil ro constmct, alter, improve, tlemolish, or
repair any stmcNre, D�iar to its issuanca, also reQuires t�e apDlicant far such permit to lile a sipnetl statement lhat ArJshe is IicenuE
pursuant to Iha provisions of Ihe Con[rzctors' State Licensa Law (Chapter 9(commencinp witA Section 7000) ai ONismn 3 al lhe Business
an0 Pmtessions Code) ai that he/she is eaempt tAereimm an0 tAe basis for the alle0e0 eKemptlon. pny violation ol Sectlon 7031.5 hy
any aDDlicant lor a permlt suDlects t�a a071iwnt ro a Uvil Denalry oi not more ttun five Aun�aO Uollars (f500�.
I, as owner ol the O�oOertY or my employees wit� waAes as t�eir sole compensation, will Oo Ihe work, and the
❑ stmcwm is not IntenEeE or allereG br sale (Section 704a. Businas anA Pml¢svonal Code: The Contractors SWte License Law
Goes �wl appty to an ovmer ol a D�operry who EuilEs or impmves thereon, anA wM Ooes such woM Nmsetl/hersetl or I�roug�
�is or Aer own employaes. OroviEeA roat suc� improvements are not inten0ed ar atlem0 lor sale. Ii, �owever t�e builOinq or
imprmement is soltl mlNn ona year ot completlon, tAe owner wiA�have tAe EurUen of O��nO he/s�e tli0 not GuiIE or improve
lor tAe Durpose al ule). �
� I, as owner of Iha Droperry am evUusivety mntractlnA ��h IicenseE coniracrors to cansiruct tAe Dmlect (Section 70/d, Business
❑ an0 Pralesswns CaOe: Ttk CanlracWrs' State Lice�e Law Ooes not appN to an wmer of Droperry who Ewbs or improves Nereon
. anO.wAo cantracts far suc� D�I� �+�� a controctor(s) license Oursuant ta ihe Cantactors' Stata License Law�. I am awaie
that D�� ol tAelr Worker's Compensation insumnce s�oulA be D�deO to me.
,� I am exempt unGer $eciqn: B. d P. C.
, lor Ihis reason: � �
Uate: Ovmer:
I Oo here0y certiy t�at 1 am aware of anG untlerstantl I�e repuirements of Califomia Healih an0 Safery Cade Sections 25505, 25533, an0
25534 antl that I ar any tuNre builtlin0 occupant vnlUwill not (circle one) nee0 lo comply with said stata coGes anE IAe requiremenis for a
permit for conslmciion or;modifitation �mm Iha Air �ualiry Management Oistrict Resiaential consimctian aDPlications are exempt Irom
ihese O�a��ions. ' '
Wte: Applicant:
I heaby ceRiry tAat I �ave reatl ihis aODlication an0 state that t�a aEwe information is correcL I apree to compry with all ciry an0 caunry
ordinances anA state Wws retatin0 �o GuilGinO constmctian an0 he26y aut�onze representa[ives of iMs ciry to enter uDon tAe a6ove-mentioned
pmcem lor inscection vurP�s.
Date: � �--' �J '� � $ipnat r� '
Onver's Licenu or Saial Securiry d� � �
1661-CB W�ite--BuilElnq; Gree�COEe Enforcement; nary— ¢anK Pink—Revanua: GolOenroC—rleaessor
. ;
C7TY UF CGSTA MESA — DUILD'1NG.F?ERMTT
PERMIT NO; P U45472 PLAN CH1iCK NO:
CONSTRU�TION TYPE: 5-N�� PERMIT TYPE: PI.O
C.✓
.)OB UESCRIPTIUN . '�2 HEATF.R CHANG£•./OUT
CLAZM VALUE: CAI,C—VALUE:
PERM NO: P 04547"l
GOVT: N SUPP: N
PORPO.�'iE: ALT
SQ FT:
GROUP OCC: R-3 / '
COMMGNIS: I10 'i3' YF'RMI't TO R�FERCNCE.
ih fE �IE fE jr 3f ii fE !i % N� 3f !t k f"t k lE 9f # 1f if # fE iE IF iF-%1E 3E if -1E if if iE 3E dElE 3E IE iE iE #E iE ib i!� 3E ?e iE iE iE ik ik 1E ik if ik �1Flf iF it'k iE iF 3E 3E iE � iE� iF� iE 36 3( It iE 1( 3f %if
Z O N I N G R E� U 2 R G M C N T S _
a E T ri A C R S , .
------------ MAIN BUII,DING ---------- -------- ACCESSORY'AUILDING ---------
FRNT: PT It� REAR: ' FT IN FRNT: I'T IN REAIt: FT IN
LE:FT: FT IN kGHT: FT IN LEFT: FT IN RGHT; FT ZN
PARKING REQ: PROV: PARCEI,: 4262]llfl `LNE: RF.F NO: '
PLANNINC NOTFS% ,
�**�*+���r�i�r±�***�u�***,*r�*+�*�-�r**+�+t?��t**i��t�rx-x�ti�*�r�r**-�*x�***�e�t*�r**��#*****���;���e�t��;t-r�i�
U E l' H L O P�M E N T S E R V I C L" S' i R E Q U Z R E M E N 7 5 , •
'LONZNG APPROC�ED DY .
BUILDING APPROVEp BY :
APPLICATION ISSOED AY: ��''� / ��� `"
ik#itfklElf�lfiflEiEjEltitifiElE3!��FIEiflEiFgiFlF#T("?FiFi�if��i. '�l�Fi�F f i�. �i�SF
i�iEiEf;�iEil�EillEiE�EiE1ljliE9EdEiE3E�EdE1E9E1EiE�lEiElEi:iElk�lE1!)klfiEif�itiEiEibiEiE3Fi '.iliEiE!(-
LEGALIZA'TION:N F E E S U M M A R Y
� :f
BLDG PMT PTUMAING ELECTRIC MECHANIC
PE1tMIT 1.00 • ,c
?rJ$
PLAN . � '
ISSUE FEL• ].00 ', �'
DUILDING—UIV—> PERMIT ISSUE PliAN•-CHECK
TOTALS----> 2.00' 3.OU ,0.00
REVENUE UIVISION TOTALS--: COLLECTED: �
DLDG PMT PLUMDING ELECTRIC MEC}IANIC .
5.00 • '
DAT�:
DATE: _ _
DATE : ��-�`�
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if �1F itlE if ff i! iE iE # dE fElE iElE K� iE # iF �%iE iE �� df !F 1t iE �1F iE
STRUCTURAL SEGMENT:N
FZRE SMIPfRES GRAi�ING
SMIP/NON—RF_S
TOTAI. PAID DUE
5.00 5.00 .00
5.00 OVGR/SHORT: .00
FIRC SMIP/TOT GRADING PLAM-CfIFCK
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I N D I,V I D U A L� L' E E' B R L A K D O W N
TYPE QTY D�� C R I P T I 0•N "' , UNI'C COS'P TO'CAL COST
PLU t � IiEP.TER . A10D /UR `• VE1dT 2. 00 . 2, 00
Etdll QI•' FE�S �
�
' r .
u: �
I�i �� 01 OOOSUZ31-00050231 T G T
' • DATE: 12/20/89 TIME: 14:04
• v.
0
9
0
5.00
:
CONSTRUCTION AND PLANNING � . POOL _ oPA
'APPROVALS Permit # ' Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locafion
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 Gmd. , 57. APPROVAL TO�COVER-GUNITE
7. Footings 58. Electrical Conduit�Undigrnd. �
8. Foundation . � 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgmd. - 60. Backwash Lines, P�Trap, O Undrgrnd. -
10. Structural Floor System. � 61. APPROVAL TO DECK
17. 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
�N��7. Rough Wiring Sign �. 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL `
19. Rough Heating & Air Conditioning � �� �FIRE DEPT.�REQUIFiEMENT� �
20. Rough Factory Fireplace APPROVALS . Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas � Oil
23. Gas Pipe-Rough & Test ' 72. Underground Flush
24. Roof Framing � 73: Undergrnd.S[orageTank OGas ❑Oii
25. Roof Sheathing ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical - ,
27. Frame and Flashing � � 76. Dry Standpipe
1.
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 -,x S0. FOOD CERTIFICATE ISSUED '
33. Final Electric � � 1, �,%.,� Notes ��_ �T` _�v
34. Final Heating & Air Conditioning '•� J"
35. Final Gas Pipe-Test � ! ' �
36. Hood or Canopy � �, �� ` Z_�d _ �, ���
37. �Final Factory Fireplace. - 'S""'
38. Final Plumbing / / c!0 (� }
39. WatBr Service-Final �'
40. Gas Service-Final _ �
41. Solar pomestic•Final �
42. Backflow Preventer
43. Backflow Irrigation � .
44. Landscape Irripation System . _-
45. Sound Attenuation �
46. Handicap Regulations _.
�
47. FINALSTRUCTURE&BUILDING �. � ��
/
48. FINAL PLANNING ' 'ct �
49. Electric Release to Edison , j, '
50. Gas Release to Southern California Gas Co `� � -
'tj
51. CERTIFICATE OF OCCUPANCY
No. Date
.� � 72? 1PR 24-70PajoO01516�+ **�216.00
c�sn
/�� .. COSO. BOXE 200 CIOSD7IA M SAFCA I ORN�IA 9 626 T
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC IVED B DATE REC VE�D/ D TE ISSUED
BUILDIN�G2 — '�— — � �l� `3 �� (/ �' ��-7O
ADDRESy-/j�O wentieth St•
PE IT
OWNER R1Ch3rd Sewell A'P' N�' ���' /�` �
Z ADDRESS � 3 1 E� ],7t.�S St• /
ADIDRE SJ) �f�/' -L—D'F � %U
a U CITV Ci�StiEi Mesa N0.042— � ACT / �j��7�a16 gLOCK
Z
Z Q CONSfRUCT10N W A D
O N LENDEF v
n. m
J � BRANCH
J N pWNER
m J ADDRESS /,/ / � /' VAWE .// a
J m ARCHITECT TEL. S/ Y�Y 5�� �
a OF ENGINEER N
U N FIRE d-
Z a ZONE TVPE GROUP
W K ADDRE55
a W APPROVED
W Z CONTRACTOR BV DATE
J Q
m Z �
J � ADORESS gtJO e
W w TEL. Z E NO.OF USE OF NE
�= CITV NO. � P�� BUILOING
Z F
w 0 STATE CITY �'ARDS APPROVED VARDS AP ROVED
j O LIC. NO. 2 81 LIC. NO. 8 MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS. (FROM C/L TREET}�
A S_
OF LOT NOW ON LOT RONT O FT��++ FT.
USE OF �
EXISTING BLDG. E
F" SI2E OF �] � NO. OF
Z NEWBLDG. G ROOMS 16 STORIES Z L.SIDE FT. FT. i�
a EXTERIOR WALL ROOF �hingle & � �`_ ,
V COVERING COVERING :�EAR FT. FT.
J USE OF BUILDING ANO WORK TO BE PERFORMED DiSTANCE B .i ,g ET. MAIN&
°� C ons t1Iuc t n' b i i F MAIN BLDGS � � 41cc�. e�ocs. --� -
a
a attached �arage • VAR.3P oa.re
O C.U.P.� APPROVED '���D
� APPR O o
y � —��O —
Z (� � �—Gl��'I
O
I hereb ecknowled a that I have reatl this e pliceNon antl state �
� �ne� me eno�e ��ro me��o� �� �o.,e« a„a aBPea to comply wlth H�LD FOR SPEC AL RE UIRF <
� ell laws regulating builtlin8 consvuction, antl I shell not employ
r eny pe�son in violatian ot the wOrkmen'S compensation laws ot
y the Stete of Celifornia. � �� y� �y� 6 �
� � 6 0
Z I hereby rerUfy t�et t em properly licensetl es e contrecmr untler SQ. FT.Ib
the State of California Business antl Professions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDEF VALVATION IS FOF j
Chapter 9, and that such licenses ere in tull forca entl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt trom t�e provisions of tha State of Celltornia eusiness ¢
antl Profasslons Cotle, Diviaion 3, Chapter 9. VALUATION �/� . j�G` m
r PERMIT FEE $ 1� � j
Permlttee�' $ /� � PLAN CHECK $ /� • �, E
L � y / `o
Authorizatl Agant �fP TOTA� FEE $d'�P �' LL
z
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. 31726
" COSTA MESA BUILDING-SAFETY DEPARTMENT
P0.7G
hPR24-7Qcrsr001517" ***1Z0.00
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicanf to Fill in Completely
RECEIVED B A E RE EIVED D TE ISSUEO
BUIIOING GQ.S� 2 D %/ �O
nooRess35�" Twe ie "sw
�lg�. �.� �l a-"r'PEFfv11YN'6:-'^
OWNER Richard Sewell A.P. NO. - -��� � '
BUILDING „ � � �
ADDPESS 1 E t. S .4DDRESS -^ - � �
ai s--a✓e
CITV No`.� 6 2- 9 AAC �� LOT BLOCK
CONSfRUC710N W A � P
LENDEfi
BRANCH
OWN
ADDRESS
� /�i VALUE
ARCHITEGT TEL. 5 'W soZ D0�
OR ENGINEER N .
FIRE .
ADDRE55 ZONE TVPE GROU
CONTRACTOR R. S@47011 BYPROVED OATE
A D D F ESS �- ��'�
TEL. ZO NO.OF USE OF NEWu� Q�'�
CITV NO. P�� BUILDING ,
STATE CITV YARDSAPPROVED VARDSAPPRO D
LIC. NO. 'Z � LIC. NO. MAIN BUILOING ACCESSORV BUILDING
SIZE r l r NO.OF BLDGS. (FROM GL STREET) / --� 'l
OF �OT �JZ � J� 16O � 17 NOW ON LOT O FROM S�T. '! r v FT.
USE OF
EXISTING BLDG. / � FT. FT.
SIZEOF NO.OF '�[', // C �'�ZQ�`IO
NEWBLOG. ROOMS � STORIES 1 L.SIDE FT.
EXTERIOR WAL ROOF Shingle
COVERING �tiUCCO COVERING REAR I D FT. FT.
USE OF BUILOING AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN &
ConStY�uct S7. MAINBLDGS. ACCE�.BLDGS.
with attached garage• VAR.#E' OATE
C.V.P. �— ��� APPROVED 3 �-a-7a
APPROV [ � � :{y � 7.)
/7 / ll
� 7�
1 hereby ack�owiedea that 1 have reatl ffiis epplicetion and sxate EC AL REOUIP.�Prf�NT�
that the above iniormation is correci antl apree to comply with
all laws re8ulat7nB b�iltling consvuction, antl I shall not employ
any person in violation of the workmen's compensation laws of
ffie State of Wlifornia. � � �� � �'
I hereby certity that I am properly licensetl as a contractor untler SQ. F
the State of California Business antl Professions Cotle, Divisicn 3, THE AMOVNTSHOWN UNDER VAL ION IS FOIi
Chapter 9, end thet such licenus ere in full force and effect, ar I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of Calltornia Business VALUATION �(
antl Protessions Cotle Division 3, Chapter 9. PERMIT FEE $ (I ��
C
s�e�ec�.a.or y �
Permittee $ �.+ PLAN CHECK $ D�
. � � s� _ µ
Authorizetl Agent J TOTAL FEE $ e�D'
City of Gosta Mesa
Building Safsty Deparimenf
P. O. Box 317
Cmto Meso. Californio
CERTIFICATE OF OCCUPANCY ]�j� 2729 C
The Building lowted af 3�0 'i�.'%t ��i� �� i�i6 ��i'
has been inspected and found to comply with the provisions of all Cify of Costa Mesa Ordinances applicable thereto
for a Grovp II� Occupancy.
Use of Building -�� �� g� r•$�F�H ��'y —__
Lega) DescripYion ���`�7
(See reverse side for Matas and Bounds)
Building Perm�t No. �� Electrical Permit No. � Plumbing Permit No. �
Floor Load Signs have been insTalled as Room Capacify Signs have been instaled as
required under Sec. 2308 U. B. C. — . required under Sec. 3301 (1) U. B. C. —
17050. CERTIfICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operafor has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article S.
Number of aparTments— b and/or guest rooms
ISSUED TO: Building Officiol
� �d, by /,",{.QA,.<_v_iS—��1 ,(.s����
Date OCtO�S 16.�
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 Sea 306 (e) U.B.C. Fo:,,, sua�im—v-sa_s_s r
��
,
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BQAEAD �F FlREA pp � FNTIUN ____ _
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�y pF COSTA IdESA
p�ANNING CFPT•
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y p I F.: APp�c''al aPP indtoa�
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ndrod, °�a eublw'� � �
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uoieon. � 1enCl. . . _ . '" ". . ._ " ""'__' ' _ "� _'_""'�_ e�.�"—" ' _
..e�Hon end ecven j
pN1SION OF BUII..DING SAFETY ��
„ _ --
" � APPROVED
�
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pqns and speclfM;atbns MUST be kept an this job at aA dmes
ro maka enY d�a�g� or ekeration on same without wr�lten --- ----- --- ---.. .,. __..
' hom Ihe D'rvisbn o� Bu&6np and Safery, Ciry of Costa Mesa. •
�- � �p 'ficstlafs SHALL NOT be held to � � - �
�..�. i. - ---- - � -
or !p pe an approva ot Ihe violation M a� pry�ovisi�ons /o arry dy o �
M�9i Or�ar� M SUIe law. � ��XOIo Z� � � �
11Mse D� P8 d Shall exDue b1l brt!�aVon arM becane nutl a�d void � '" - --
� ue - ��i�--- �------
�. tig Wdddg or wak not commenced a�'maintained active per UBC
:� : (� vdUdn 180 days t issuarua �' _. ..
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VGSAFETY
MESA •
�UNaw�w,� ��•,•.._ _ ,
trom Ne Dlvision ot 8����ng a^ '
��� oroval ot lhe n�olat a10 ottanY P°+ "o�
�p�Qiaz ce and/pr State �aW
tans and De�� Shall expire by �imitat: '�'�
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buBdin9 0� woAe is not commenced an
yyflhin 180 tlays o1 issuance. __�
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; job at all times
�t written
esa.
be held lo permit
any Ci�Y �� Costa
me nuli and void ii
;ive per UBC §303
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�?= ?-'---�-.-�-- .----.�1A�b+1 Df FIRE PREVE� ' �'
(t�' � �. . - IOA � �:
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