HomeMy WebLinkAbout369 20TH ST - Building PermitsF
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(714)754-5273 • Fax(714)754-4856
� CITY OF COSTA MESA
B!/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job nddress: 369 E 20TH ST
Suite:
Viciniry:
Parcel Nunmber: 426304Q5
App�icant: BANNIER,ROBERT
Address:
Owner: BANNIER, ROBERT S
Address 369 E 20TH ST
COSTA MESA,CA
ContreIXor.
Address:
Zip:
Arch :
Address:
Zip:
Phone:
License:
BUILDING PERMIT
Zoning:
Phone:
Zip:
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
PERMI�T�ER /
B99-00086 V
77 FAIR DRIVE, COSTA MESA, CA 92626
SCOPE OF PERMIT
RENEW EXPIRED BPE28972, " ADD. 514SF DIN, OFFICE ,LAUNDRY ROOM & BATHROOM"
FEE SUMMARY
Plan Check: $0.00 Calc Valuation:
Permit: $0.00 Claim Valuation:
SMIP Res: $0.50
SMIP Com: $0.04
Other: $0.00 •
Inspection: $42.00
Total: $42.50
SETBACKS
ACCESSORY
PARKING
NOTES:
Front 0. 0
Front 0. 0
Existin : 0
Rear 0. 0
Rear 0-0
Required: 0
PLANNING & ZONING
Left 0. 0
Left 0. 0
Pr000sed: 0
Right 0. 0
Right 0. 0
Status: ISSUED
Applied: 0111811999
Issued: 01I19/1999
Phone:
License:
so.00
so.00
EXPIRATION: This permit shall automatically expire and become void it work is nol commenced within 180 days, or it 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
requlred inapections end finel epprovel must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of �his permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLAqATION: �
I hereby eHirtn under penalry ol perjury one of Ihe lollowing declarelions:
❑ I heve and will meintain e certificatg oi consent to setl-Insure for waBers' wmpensation, es provitled tor by section 3700 of the Labor COde, for the pertortnence of the
work for which �his pertnii is issuetl.
❑ I have and will maintein workers' cqmpensation insurance, es required by seclion 3700 01 Ihe Labor Code, tor ihe perfortnance of the work for w�ich this permit is issued.
My workers' compensation Insurance carrier anC poliry numDer are:
Cerrier: Policy Number:
(This section neetl not be comp/efed i! thy pe�it is velued et one hundred dollers ($700) or /ess.)
❑ I certify thet in ihe pedormance of the work for whic� t�is parmit Is issuetl, I shall not employ any person in eny manner so as to become su�ject to t�e workers'
compensation laws oi Celifomia, and egrae thet Ii I should become sublect to tha workers' compensetion provisions of Section 3700 ai the Lebor Code, I shall lonhwith
comply wit� these provisions.
Applicant Signature: Date:
WARNING: FAILUFE TO SECURE WOflKERS' �pMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENAITIES AND GVIL FlNES UP TOONE HUNORED
THOt1SAND DOLURE ($i�,GVp), IN ADDIiION i0 THE COST OFCQNPENSATKKJ, DAMAGES AS PROVtDED FOR IN $ECTION 3�O60F THE LABO(i CODE, lMEREST, ANDATfORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereby attirm that I em licensed under provislons ol Chapter 9(commencing wlth Sectlan 7000) ot Division 3 0l Ihe Business end Professior�s Coda, end my license is in full
force end eHecL Lic. # Class e
Contractofs SlgneWre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I heraby aHirtn ihet there I5 a constr�ction lenaing agency Por ihe peAormance ot ihe work for which this pertnit is issuetl. (Sec. 3097, Civll Cotle).
Lendefs Name: Lender's Address:
Signature: Data:
OWNER-BUILDER DECLARATIONS:
I here6y ettirtn ihat under penalry of per�4ry thet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor Ihe following reeson (Sec. 7037.5, Business antl Professlons
Code: Any ciry or counry which requiros � permit to construct, alter, impmve, demolish, or repalr eny structure, prior to its issuance, also requires the apPlicant for such permlt
to fifa e signed stetement t�et �e or she is licensed pursuent to Ihe provisions of the Contrecrors License Law (CheO�er 9(crommencinp with Section 7000) of Division 3 af the
Business end Professlons Cotle) or Ihet he or she Is ezempt Iherefrom end ihe basis for the ellegetl e:emption. Any violation of Section 7031.5 by eny applicant tor e pertnit
subjects Ihe applicant to e civ�l penalry oi not more than five hundred dollars ($500).): �
❑ I, es owner ot Iha property, or my 0mployees wlih weges es ihelr sole compensation, WILL DO THE WORK, and the stmcture is not intended or ottered for sele (Sec.
7044, Business end Protessians Code: The Contrectors Licensa Lew does not apply to an owner ot property who builtls or improves thereon, end who tloes such work
himself or hersetl or through his or her own employees, provltletl that such Improvemenls ere not intendetl or ofleretl for sale. If, however, the building or improvement Is
soltl wit�in one year ot complellon. the owner-builder will heve the burden of proving t�at �e or she tlid not build or improve for purpose ol sale.).
❑ I, es owner at Ihe property, em E1(CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to consiruct Ihe prqect (Sec. 7044, Business and Pro(essians
Code: The contractors License Law tloes not apply to en owner ol property who builtls or impmves thereon, and who coniracts for such project with a contrectoqs)
li se Oursuant to the Gonirectors License Lews.).
I em e:emp der sec. Business entl Professions Cotle lor this reason: —
Signature: � .�w+---i.�� Date: —
Owner ID verified by tlrivefs license. ❑ Yes ❑ No Dnvers License No. Expires:
Venficetian ot OwnBrShip by (type ol dxUmen�, i.e. - properry lax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PEpMR CERTIFICATION:
❑ I hereby certify thet no ezcavetion tiva (5) or more leet in depth into which a parson is requirad to descend, will be mede in connectlon with work euthorized by this
pe�mit, antl tha! no buildin8 slructwe, scafloldirrg, lalsework, a tlemolltbn w aismantling thereot, will be mwe than tbirry-six (36) teet Mgh. (Chap. 32, Gip 2, Art 2, Sec.
341, Title 8, Celitomia Atlministrativa Code).
❑ As owner-builtler, I will not employ anyone to do work which would require a pertnit irom the Division of InGusinal Sefery, as noted above, unless such person has a
permil lo do such work from the division. �
SigneNre: Date:
Division of Industnal Safery Pertnit NumOer:
CEFiTIFlCA7E OF COMPLIANCE AND qIfTHORIZATION OF ENfAY: I cenity under penelry ot perjury thet I heve reed this application end stete thet Ihe information given is
wrtecL I egr e Io comply with all stete laws end ciry ordinences releting to building construction, and authorize representatives of the Ciry of Coste Mese to enter upon the
ebove-de redP'properry t spection purposes. I agree not to occupy or ellow occupancy of any building authorized by this� rmit until fnelinspection.
/ (i
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SigneWre Of Legal Owner(s) Dete
And/Or AuNonzed Applicant
CQOE �. INSPECTIONTYPE
1616 Fixed System Final Fire Preveqtion
1266 Pool SDe Final
200 Finel Re-Roo�
201 Final B1ocWRetaining Well
202 Finel Fectory Fire Place
203
204
2a4G46
Final Sign
Final Demolition
7Ag It�elS
cooe. wsveenoNrrve
20fi Final Mechanical
20B Final Plumbing
210 Final Electrical
272 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Finai BuildinyOccupancy
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CITY OF COSTA MESA
BlIILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
��ia��sa-sz�s • Fex(714)754-4856
Job nddress: 369 E 20TH ST
Suite:
Vicinity: ADDITION @ REAR OF HOUSE
Parcel Number: 42630405
Appliwnt: KENNISON, LARRY W.
Address: 369 E 20TH ST
COSTA MESA, CA
Owner: KENNISON, LARRY W.
Address 369 E 20TH ST
COSTA MESA, CA
Contractor: O WN ER-B U I LDE R
Address:
BUILDING PERMIT
Zoning:
Phone: (714)608-3790
Zip: 92627
Phone: (714) 6083790
Zip: 92627
Phone:
NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 12I0317999
Issued: 02/24/2000
Zip: . License: 0
Arch : SCHILLER, ARTHUR R. Eng:
Address: 34072 ST. OF THE VIOLET LANTERN Address:
Phone: (949)489-2315 Phone:
DANA POINT, CA
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 523 SF ADDITION OF 2 BEDROOMS 8 BATHROOM TO REAR OF EXISTING SINGLE FAMILY RESIDENCE;
REROOF EXISTING HOUSE WITH COMP SHINGLES
Plan Check: $405.63
Permit: $624.05
SMIP Res: $4.77
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,034.45
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existi"a: 0
Rear 0. 0
Rear 0-0
Reauired: 0
FEE SUMMARY
Calc Valuation: sa�,�ie.so
Claim Valuation: 5a�,e9s.00
PLANNING & ZONING
LeR 0- 0 Right
LeR 0- 0 Right
Proposed: 0
0- 0
NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 7, 72-21-92)
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 �he work authorized under Ihis permit to be considered legal, such work must comply wilh all applicable codes, and all
requlred Inepectiona and finel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
V/ORKERS' COMPENSATION DECLApp7�ON:
i hereby attirtn untler penalty ot perjury one of the following Declarations:
❑- I have and will maintain a certifcate of consent to self-Insure for workers' compensation, es providetl tor by section 3700 ot the Labor Cotle, for Ihe pedormance ol the
work for which �his permit is issued.
❑ I have and will maintain workars' compensation insu2nce, as required by sec�ion 3700 oi tha LaDor Cotle, for Ne perfortnance of the work br which this permil is issuetl.
My workers' com0ensation Insuran�e wrrier and policy number are:
Carrier. PoliCy Number:
(This secfion neetl not be crompleted i/ the pertnit is valuetl af one hundre0 dollars /$100) or IessJ
❑ 1 cenify that In Iha pertortnenca oi the work for which this pertnit is issueQ I shell not employ eny person in any manner so as to become subject to the workers'
compensation laws of Californla, and agree that if I shoultl become subject to Ihe workers' compensetion provisions of Section 3700 of the LaDor Cotle, I shall tonhwith
comply with these provisions.
Appliwnt Signature: Date:
WARNING FAILURE TO SECURE WORKERS' �,pMPENSATION COVERAOE IS UNIAWFUL AND SHALL SU&IECT AN EMP�OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDFED
THOUSAND DOLIAFE (5100,000). IN ADDITION TO iHE COST OF COMPENSATION, OAMAGES PS PROVIDED f-0R IN SECTION 3106 OF THE LABOR COOE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRAC70RS DECLARqTION:
I hereby aHirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, and my license is in full
force end effect. Lic. a Class p
ConiractoYs SignaWra: Da�e:
CONSTRUCTION LENOING AGENCY:
❑ I hereby ettirm that there is a consimction lending agency lor the peAormence ot the work tor w�ich this permit is issued. (Sec. 3097, CiNI Code).
Lenders Nama: Lendels Address:
Siqnawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereDy aHirm ihat under penalry of perj4ry that I am E%EMPT FROM 7HE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions
Code: Any ciry or counry which requires $ permii to construc6 alter, improve, demolish, or repair any siructure, pnor to its issuance, also requires the applicant for such permit
b file a signetl statement thet he or she is licansed pursuam to Ihe provisions of Ne Contracmrs License Lew (Chepter 9(commencing with Section 7000) of Division 3 ot ihe
Business antl Professions Code) or that he or she is exempt Iherefrom and the hasis for the alleged exemption. Any violation of Section 7037.5 by any applicant tor a pertnit
subjects the applicant to a civil penalry of not more than fiva huntlretl tlollars ($500).):
� I. as owner of the property, or my gmployees with wa9es es their sole compensation, WILL DO 7ME WORK, and tha structure is not intended or oHered for sale (Sec.
� �7044, Business antl Professions Cpde: The Coniractors License Law does nol aDP�Y �o an owner of property who builtls or improves thereon, antl who dces such work
himself or herself or through his or her own employees, provided that such improvemems are not imended or oflered for sale. It however, ihe building or improvement is
sol�� n o��of com� n, t� er-builder will have the burtlen of proving ihat he or she did not build or improve for purpose of sale.).
❑ I, as owner o the mperty, EXC IVELV CON7RAC71NG WITH LICENSED CONTRACTORS to constmct the project (Sac. 7044, Business antl Professions
C The nira ors Lic se L oes not appty to an owner of property who builds or improves lhereon, and who contracts for such project with a contracmr(s)
li ns u uan the C tract License Lawsb
71
m
licensa.
Business antl Professions Cotle tor this reason:
Yes � No � Drivels LicenSe
it, i.e. - propeny taz bill or deed):
DIVISION OF INDUSTRIAL SAFETV P�pM1T CERTIFICATION:
Expires:
❑ I here�y certity that no eawvation five (5) or more feet In depth into which e person I5 requlred to tlescend, wiil 6e matle in connection with work authorizetl by t�is
permit, end t�at no building siructure, scaHoltling, falsework, or tlemolition or tlismantling thereof, will be more than thirty-si: (36) feet high. (C�ap. 32. Grp 2, An 2, Sec.
341, Titla 8, Califomia Atlministretiye Code).
❑ As ownar�bulltler, I will not employ enyone to tlo work which woultl require a permit irom the Division of Intlustrial Sefety, as noted above, unless such person has a
permit to tlo such wark irom ihe division.
Signeture: Deie:
Division of Industnal Setety Permit Numqe�:
CODE Y. INSPECTIONTYPE
1616 Fizetl System Final Fire Prevention
1266 Pool Spu Final
200 Final Re-Roof
201 Final BIocWReteining Wall
202 Final Factory Fira Place
203 Finel Sign
204 Final Demolition
2aa&a6
DATE 1 I L C9pF�! INSPECTIONTYVE
206 Final Mechanicel
208
210
212
220
222
250
Final Plumbing
Final Electrical
Final Fire Prevention
Final Plenning Approval
Final Site
Final Building/Occupency
P9IE
N AL
To
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NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
(� City of Costa Mesa
( ) City of Newport Beach
( ) County of Orange
Applicant:
Address:
Telephanc
3324 �°
District Receipt No.
Plan Check No. �4q�0142�
TracUParcel and Lot Number(s):
Locabon of Project:
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
Commercial/Industrial Project is: (Check One)
_ Warehouse
_ R&D
_ Movie Theater
_ Mini-storage
_ Heavy Industrial
_ Regional Shops
_ Light Industrial
This project is exempt because
32
Total Q�v� —
� � .
�: � ��,
;:� � � �
,�E�
i: i�i � 1
_ Motel CITY OF COSTA MESA
Bank
_ Neighborhood Shops
_ RacqueUHeatth
_ Hotel
Medical Office
Office Park
_ Preschool
_ Auto Repair
_ Hospital
_ Large Office
_ Office Bldg.
_ Restaurant
_ Fast Food
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Pertrtils for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District.
By:-s�,
Authorized
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true, then this cerfificate shall automatically terminat�
Date: �' V �
,.F C7c�%.a� �61���DER.
�' ' .r� : 4 MESA CONSTRUCT.ION
�
Applicant to fill in all spaces except tnose wilhin heavy Dorder Ilnes ana slgn all avProoriate aeelarations.
�
. Nra�e'�ct AyZ)ress J 17�, L+ c.�-+ �. p J ' `.� " V s�� ' ' _ - ' - .
Applicant'z Mailin�g JA�d__d{re�ss
" TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
La0 F> M�KCFi.� ;r O � � CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name Phone�L ESCRIPTION OF ORK/USE OF LDG. ��%D D t H� W� 6_ �_rn
Address S F1'^"�G , . �
arch/Eng. . ILicense No. �t � _ TYPE OF PERMIT GRAOIrvG FOVNDATIOrv STRUCTURAL
Address L�� � �^ �^Y1 �F�W � TENANT ❑ ELECTRICAI PLUMBING ❑ MECHANICAL
Contracror'S Nam �� ��� ��c � , Phone - � � � �OTHER C/!1
_ , t. __......_....., ^2
Address (mailin9)
City License No.
LICENSED CONTRACTOR DECLARATION
I hertby attirm tbat I am licensetl untler OrOvi5ion5 of C�arte� 9(Comm¢ncing
wi[h section �000) af pivision 3 ot the Bu5ine55 antl Prof¢szions Cotle, antl
�y license is in full force antl eltuct.
cense Class License No.
Jate Si9nature
WORKERS' COMPENSATION DECLARATION
I hereby attirm that I have a certificate of cqnsent to selM1insure or a certlficate
of Workers' Compensation Insurance, or a cer[ItieO copy tnereof (Sectlon
3800. Lab. G.) ' • .
Policy No. ' Compdny
8 Certifietl-coOY is be�eby turnlshetl.
Certifietl copy is filetl with the Uty Bullq�ng Dlvlsion. �_ '
Date Appli<ant—
EXEMPTION FROM WORKERS' COMPENSFTION DECLARATION
(Thizsettion neetl not be [ompletetl if the permit is ior one nuntlratl (E100) or
less).
I certify that in the performanco ot tne woYk fOr which this pe�m�t is ISSuetl, I
shall not employ any person In any manner so as to betome subject [o the'.
Workers' Co p@ ns tion Laws of Californla �
Date �S-�X'��% Signature�i �-�
'NOTICE: If, after making this tleclae%tion, you zhoul0 become Subject to tM1e
Workers' Compensation provislons ot Ne �ybor Cotle, you must fortnwith
wmply with such� provisions or this o¢rmit Shall b¢ ticemetl revoketl.
CONSTRVCTION LENDING AGENCV �
I hereby affitm that ttlere is a conrt�uction I�ntling agency fo� [na pertormance
of [he work for which tnis permit is ISSuetl (Section 309] Civ. C.)
Lentler's Name
Lentler's AGtlress '
OWNER BUILDER OECLARATION �
-i nereby aftirm that I am exempt irom Ihp �ontractor'z License Law for the
�.;;�Ilowing reason (Section 7031.5 Business antl Professlonal Cotle: Any city or
�!±;�'�unty wtlich requires a permit f0 const�uC[, alte�, improvo, tlemolish o� repair
`;�ny structure, prior to (ts issuance, also requlres the applicant for sucb �permit
to file a signetl statemenl that he/she Is lic¢nzetl pu�suant to the OrovisiOns of
the Contractor's License Law (Cnapter 9(commen<ing witb Setlion 7000) ot
DiviSion 3 of the Bu5ine55 antl Profe55io�s Cotle) or [ha[ he/sh¢ is exempt
Ihe�e(rom antl the basis fot the all29etl exemption. AnY violation of �Section
7031.5 by any applicant for a permlt subjec[s the appllcant lo a civil
�¢nalty of not mo�e than five huntl�etl tlo118r5 (E500):
I, as owne� ot the prop¢rty or my employee5 with wage5 d5 thai� Sol¢
mmpensation, wiil tlo the work, antl the sVucture Is not intentlea or otterea
tor sale (Section 7044, Business antl Protessional Cotle: The Contractor's
Licenu tdw tloes not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himseli/herzelt or through his or her own
employees, provitletl that such Improvemeryts are nOt Intentlatl o� ofteretl fo�
Sale. If, howev¢r, the Euiltling or {mproveTent i5 soltl wlthin one y¢ar ot com-
pletion, the owner will have the burtlen Of ptoving hG/she tlitl n0[ bulltl or im-
orove tor the ourpose of sale).
❑ I, as owne� of the property, am exUuslvely contrac[ing with IlcenSetl con-
fractors to consV uct [he Oroject (Section 7044, BuSiness antl Proiessions CoCe:
The Con[rat[or's LicenSe l.aw does nol apply ro an owner ot property who
builtls o� improves thereon, antl who con��act5 fOr SUCh projects wi[h d Con-
trattor(si license punuant to the Conlractor'S License l2w). I am aware that
proof o1 their Worker'z Compensation insu�ance Shoultl be provitle0 [o me.
❑ I am exempt untler Section B. & P. C. tor this reazon
Da[¢ �-'�'�-d'/ Owner --
I hereby certify tbat I have reatl [hi1 app���ation antl•State that th¢ abp,ye�
intormation is correct. I agree to comply W�th all clty antl county ortlinans,S.'
antl state laws relating to builtlin9 construction, antl nereby authorize reore:d
sentatives ot this city to enter upon the above-mentionetl property for
insvection urp s� A ♦ n
Signa[ure J,C1/Mv+ Date S Z�'�C
,-, o,��e,s�� �
.
�`A�0865-46, rev. 30/84 White - Builtling: Canary - Appll<ant: Plnk
�_
PRQIECT DESCRIPTION 5a.
. CONSTRUCTIONTVPE—
ZONE
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Dreins
Floor Sinks�
GasService Outlets
Interceptors
Kitchen Sink
Roof Orains
Reinspection Fee
Y" � - VALUATION$�UD"�
GRADINGCU.VOS. ACRE�S
O
G F� • !l .G8 a
PLUMBING FEES
' Showers
Service Sink
Sewer'Cap � '
Sewei'Connection % 7 ,
Solar Collectors �
Solar'Piping .
Solar�?ank �
Swimming Pool w/Spa ��
Urinal �
. Water Closet '�
Water Heater
Water Service
Auto-Wash
$15
Duct - Under Ground
. Duct-Struciural
�uct - Ventilating
Exhaust System ❑ Multiple
� Firepl/Fact.Blt.IC60�1`-
Heating System cting
. . ❑0-100.00 U 0100,000
IReinspection Fee I $15
Gomenrotl - Assessor
Issue Fae I $ 3
1ANICAL FEE
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration S '
❑410 BTU ❑t00,0006TU
ystem RepairlAlteration
Fire Dampers
Registers
Issue Fee � $ 3
_ �, e�;�= Fr_�� :
q•p• # ~ ;/ -� -�j Zone `
S Main Buildin9: Accessory Building:
E Z
T Front Q O
B fiear 6� . : N
A �
C Right C'� ' N
S Lett 5' � G
R
Ping. Ref. # Parking Req./Provided E
Q
Planning Notes: • M
r I�edUt- . 5 g
Automatic Washer
Construction Pole
Cooking Unit . "
�Dishwasher —L
Dryers L�JGas .L
Fan �
F.A.U.
Fixtures
Device Boxes �
OuHets
Switches '-
Garbage Dispoul
Generator DO-5 h
�
�
ELECTRICAL (,c�C.TCp�
Transtormer ❑ 15-50 KW
❑ 50+KW
',�5-15 KN
Fee. ,
�� 2oning APProved BY_
Building P:p`prowd By
��Applintion Issuad By�:
$15
Meter Llup to 700 amps
Meter �over 700 amps
SubPanel ((ro�P„
Momrs 041 HP � 1'h - 8
Inc.Solar �9-15 HP �i6-15+
Microwave
Pole Light
Range •
c:.... �
FEES
; Standing Sections "
Trash Compattor ��.
luue Fee S 3
NTS:
Date 5. 2 ,
� ..r. ^1f_.
�� •- SUMMARV F I
• BUILDING PERMIT $ I7q-�
� '
PLAN CHECK $
,' PLUMBING S • �0
• PLAN CHECK 25% $ - ,ZS�
ELECTRICAL $ I Co �(nO/
PLAN CHECK 50% $ � (r•• SO
MECHANICAL $
PLAN CHECK 25% $
ES , �
SMIP $5 �' g�
PERMIT
ISSUANCE $
ENERGV P.C. $'
GRADING $.;
MICROFILM $
TOTALFEE $ a�o.a4
� �jCONSTRUGTION AND PLAN G
.�APPROVALS Permit# Date
b �
f„fiemporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Util
4. Electrical Coqdyit-Und
5. Steel Reinf,orcement
6. Electrical UFER_Grnd
7 ,Footings i r.
- 8. Foundation -, �
9. Water Pipe-Undrgrnd.
10. Structural Flqbr System
11. Property Sewer Line & House Connection
12. Sewer Cap; � .
13. Roof Drairis �
14. ough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring Srf
�fP
- 17. Rough Wiring Sign
18. Rough Electrical-7�Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, iri Structure
22. Ducts, �(entilating ,
�
23. Gas Pipe-Rough & Test
24. Roof Framing � � .
25. Roof Sheathing �'
26. T-Bar.�Ceiling (Structural) & Monocoat
27. Frame'and Flashing
28. thing '��iding
29. Insulation
30.-Drywall Nailing '
31. Plastec. Brown Coat .�
32. Electrical Power Meter-Final
33. Final Electric .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final'Factory Fireplace �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final \
41. Solar pomestic-Final '
42. Backflow Preventer
43. Backflow Irrigation
44. �Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49.�Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Inspector
7-z1-8 3J�
7-z1-q,-I ��
j_z(-g% "BA�
n
t
POOL & SPA
APPROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60: Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
.67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry S[andpipe
77. FIXED SYSTEM FINAL
76. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUEp
Notes: 4, I�.,�-, Pl V T ... . o
0
/1/d•
0
�S/%�A�f�il�
Date Inspr.ctor
ZZ
�
^e�
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES'`
-NEWPORT-MESA UNIFIED�SCHOOL DISTRIC7'
�- 1 .
� _� j ;�
��-�.
., _� -,
. . � ,_ • L/'�, .
Developer/.Applicant: �%�Q� i�`�WN/�;
� ,. ,. -
Ad,dress: .� ri % �n 'N �%
, _ . ,
. L , . .
'1'elepho:ne Number: t ��'�� ��,� �7��%
_ � , ' / . �J! LJ '. %� . . �.'// " • � ,
T•cact/,Par.cel:.and Lot Number(s): ' ' ' '
e.�_ ._ ,
_ .�� � y r
Location of'P�r,`ojee�:'"'�'�' ��°1 �T/ ' �/� �
_ r' -'� . F -- . . ,
� ' C�� G-irl t�� �/`f � ' � �f
, . . � i .' . i
Number of •Squa're. Feet of '' - �� -9 6B
'.Residential-Space �— x $1.50 'Total � /�
,i i � "
Number o£ ,Square Feet, of ' � �
Commercial and . � �,�' � j
IndusCrial Space �x $0.25 Tota'1 ,
-� ' ��. ; ',. ,.
The provisi�ons� of 'Government Co`de �Sect.ion.�53080:'are ❑o't
applicable. ' . � �' _
, . � �1:; /
This cerhifies that the above-named'�Devel"oper/Applicant has paid
school facil'ity fees in compliance wiYEh:Government Code Sections
53080 and 65995. ,.,� �
. . . ! � ���
Checks are to be made payable to Newpo G-Mesa Unified School
� District-: - „�.� ., •.,d ..+. :y, . ' '' -' .
� . , i:fy� � � / �'`% � •-/ _./C �,. . _.
• , " ' Busines Manager
'Newp.ort-Mesa Unified School District
, i: ../ir . /i. . , .
The above representation as to square'��fooEage is true. '�
Developer/Applicant agrees that.if it`is later determined that
such representations are not true-�then thi`s certificate shall
automatically;terminate �and the,appropr.iate'City/County shall be >
notified. t-- � . � . ,=>� � _ _, � �,
�. �; e,
. , � _ . ;; •� f�
. , : j �^ - - , . ..` �
,
Date; � ��6- ��, .
� ' ; ,. - � � .
:�.i.
. Devel-oper�',Ap
/' '- !/�� '�`�"
/r _��
��
cant
,; �
? ro�� �J.rfG,,
Tn Ca�� ih Co+�cY.J�,
A
RANDAL JOHN WEBER
128 21st Street 92
Costa Mesa, CA 92627
November 17, 1988
TO WHOM IT MAY CONCERN:
We have a remodel project at 369 East 20th Street, Costa Mesa, California (permit
numbers BPE 28972 and PE 27839) that has not had ann inspection since February
1988.
At no time has more than 30 days gone by without some work being done, either by
the contractor or homeowner on the project.
Attached are receipts for materials and labor from February 1988 to November
1988. This should show proof that work has continued since the last inspection
and that the permits should remain in force.
7hank you for your cooperation.
�`�-�(1-� '
f%�`I/�
Randal John Weber
General Contractor
RJW:Gfs
NOV 2 8 1988
CIT" OF COSTA MESA
CALIFOn..�A 9 2 62 8-1 200
Insulation Certificate
P. O. BOX 1200
�
�C� � �-� , zo� �S'fi, C�� �'�_(1 �.�--�.
N�ev �a suu� c�ry
C5 -,nl G o
wcy s�ba��;�;� ►A�x,�t�
Description of Installation
ROOF �l � ��L6i��
Marerial Brand Name �i ���
7ttickness (inches) 'Itiectnal Resistance (R-Value)
EXTERIOR WALL. �%
Material `G • �� Bcand Name
'R�ickness (inches) TheTmal Resistance (R-
CEII.ING /�
Batt or Blanket Type (� •%� Bcand Name
'Itiiclrness (inches) 1l�ertnal Resisrancc (R-Value) _
I.00se Fill Type Brdnd Name
Contractor's min%mum installed weighVh lb Minimum thicirness inches
Manufact�er's installed weigfit per square foot to acheive'lliermal Resistance (R-Value) _
RAISED FLOOR
Material
'Iliiclrness (incl
SLAB FLOOR
Material
'It�ickness (inches)
Widrh (inches)
FOUNDATION WALL
Material
Thickness(inches)
Brand Name
'Ihecmal Resistance (R-Value)
Brand Name
Them�al Resistance (R-Value)
Brand Name
1Lermal Resisrance (R-Value)
Declaration
I heteby certify that the above insuladon was installed in the building at the above locadon in conformance with
the cwYent Building Energy Efficiency Standards for new residential buildings contained in Tide 24 of the
Califomia Admims uve Code.
� �- iG�-S'C� t .� � 3-�a'o
Generel Contracta Builder) License Number
Signature ard Titk Daa
Su6Contracinr (Insuletion Installer) License Number
� SignetureudTide
i
(714) 754-5273 • Fax (714) 754-4856
Job Address:
Suite:
Vicinity:
369 E 20TH ST
REAR OF PROPERTY
Parcel Number: 42630405
�
CITY OF COSTA MESA �---
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Zoning:
77 FAIR DRIVE, COSTA MESA, CA 92626
Applicanr. KENNISON, LARRY W. ISSUED BY:
Address: 369 E 20TH ST ..,
� � . �Phone:` (714) 6083790 � �
COSTA MESA, CA �; �, �-�, � � 2ip:� 92627 ' � � � : � -
r, . ,
.- .i.�"' � , � . ' -
Owner. KENNISON, LARRY W. -
Address 369 E 20TH ST� -, " � � . ' � . �� , � � � � � �
; r�� �- - i -Phone. - (714) 608 3790 _ � � � _
\
���iCOSTAMESA�CA� � ' ` ` � Zip�� 92827 '�=1=� - � . � � �' � ,;A
,
� '/ � � . �_�� . :-,�
' l:!"/� . � � , �-. �� .
Contracror. � p,n' �j,�� � � �
Adtlress: ���/''yW/ � ; j . �,�� ' '
- � ��� Phone: ���; � �
� ��� .
... !�Zipf /,i �/ License ,. � � �
� i �
r Amh .: ,�: � '' : : ' �, . . . Eng: ' ; _ . �' � . ,
i .
Address: " / ' � , % � Address: � �
�'�
' � � ' F� 1-Phone: �= . '� . - L Phone: � '
i
- ` � - ' . ^'i — • . _ . .
n � ' . >� , ' • -�`'. : - � r ' " . . ; - ' . ` . ,
` ZiP: � � � ,:: a � - .'. . Cicense: '' � �`;='Licens�e: -
• ..
� ' � ` ' � � SCOPE OF PERMIT � � �' _
, -�. CONSTRUCT 700 SQ. FT. (35'x20') 3-CAR,�DETACHED GARAGE LOCATED AT THE REAR OF PROPERTY, BEHIND
� EXISTING SINGLE FAMILY. RESIDENCE�. �' ' � ' � � - - � ' � � �
� � 605 SQ.FT. REAR YARD COVERAGE OK; 200 SQ.FT. PROPOSED. ._
Status: ISSUED
Applied: 07/09/1999
Issued: 09/07/1999
Plan Check: ' $154.21
Permit: +.' $237.25
SMIP Res: . $1.51
SMIP Com: '. , .$0.00
Other: " ,$0.00
Inspection: $0.00
Total: • �� � $392.97�
FEESUMMARY''.!
= i �
-. _ . � �
!
�
PLANNING'& ZONING
SETBACKS�:, � � � �
MAINSTRUCTURE�Front � 0.0 � _ Rear � 0=P . ,` � Left � � 0-0
\� � �
ACCESSORY Front � 29- 0 .� Rear 10- 0 Lek 5- 0 �
PARKING Existing: 0 Required: 2 Pr000sed: 3
NOTES:
Calc Valuation:
Claim Valuation: ;-
Right 0-0��
Right 35- 0
�
�
$15,050.00
$15,050.00
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 780 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetione and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
r.
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalry of perjury one of the following tleclarations:
❑ I have ana wlll meintain a cehificate of consent to self-Insure for workers' compensetion, as provided for by sedlon 3700 of the Labor Code, for ihe pertormance of the
work for which ihis permit is issued.
❑ 1 have antl will maintain workers' compensation insurence, as required by section 3700 of the labor Code, for the peAortnance ot the work for which this pertnit is issuetl.
My workers' compensation Insurence carner and policy number are:
Carrier Policy Number.
(This secfion neetl not be completetl it the permit is velued af one hundred dallers ($f 00) or less.)
❑ I certity ihat In the peRormance oi the work for which Ihis permit is issued, I shall nol employ eny person in eny manner so es to become subject to the workers'
compensation laws of Californla, and agree that if I shoultl 6ecoma su6ject to the workers' compensation provislons oi Section 3700 of the Labor Cotle, 1 shall forthwith
comply with ihese provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIQV COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CFIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF fAMPENSATION, �PN.4GES AS PROVIOEO FqR IN $EC�ION 3]O60F THE LABOR CODE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Code, and my license is in full
force antl eRect Lla k Class #
Contractofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat ihere is a consiruction lending egency for Ihe pedormance of the work tor which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Atldress:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I here6y aNirm �hat under penalty ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (SecJ031.5, Business and Professions
Cotle: Any ciry or counry which requires a permit to constmct, elter, improve, demolish, or repair any simcture, pnor to its issuance, also requires ihe applicant for such permit
to tile a signed statement Ihat he or she is licensed pursuant to the provislons of the Contracbrs Licensa Law (Chepter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Cotle) or thet he or she is exempt therefrom antl Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any apPlicant for a pertnit
sublac�s �he applicant to e civil penalry of nol more lhan tive hundred dollars (5500).): .
�I, as owner of t�e property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the strticture is not intended or ottered for sale (Sec.
7044, Busines5 and Professions Code: The Contreclors License Law does not apply to an owner of property who builds or improves Ihereon, antl who tloes such work
himself or herself or through his or her own employees, providetl thai such improvements are not intended or oHared for sale. If, howaver, the building or improvement is
soltl within one year of completion, the owner-builder will have the burden ot proving Ihet he or she did not build or improve for purpose of sale.).
❑ I, a owner of ropeny, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Professions
Co e trac rs Licenseygw tloes not apply to en owner oi property who builtls or improves ihereon, end who contracts for such project with a contractor(s)
lice � pu uant ihe Cpntraqldrs License Lpqls.).
n
m
Business and Professions Cotle for this reason:
�r's licens�. ❑ Yes ❑ No Driver's License
by pype of document, i.e. - pmperty tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICATION:
Expires:
❑ I hereby certity that no e:cavation five (5) or more feet in depth into which e person is reQulred to descend, will be made in connection with work authorizetl hy this
permit, and that no Duiltling sirucWre, scaHoltling, falsework, or demolition or dismantling thereot, wiil be more than ihirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, 7tle e, Celifomie Adminisirative Cotle).
❑ As owner-builder, I will not employ anyone ro tlo work which would require a permit from Ihe Division of Industrial Safery, as noted above, unless such person has a
permit to do such work tmm Ihe tlivision.
Signature: Da�e:
Division of Indus�rial Safety Pertnit Number:
CERTIFlCA7E OF-60M L�10E AND AUTHORIZA710N OF TRY: I certify under penalty of perJury that I hava read Ihis appiication and state ihat ihe information given is
co . I agree to co ly with allp1ate�and city ortlin �s relating to builtling constmction, and authonze representatives of the City oi Costa Masa to enter upon ihe
ab ve- scnbetl p erty tor ins 4c' ses. I re ot to occupy or allow occupancy of any building authorized by this permit until final�pe`tion. � �
7-
Signatur Of Legal Owner(s) Date —�—�
r Authorized ApplicaN Date
CODE t, INSPECTIONTYGE
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 FinalSign
204 Final Demolition
2M8-46
pRTE �NTRIALS
CODE� INSPECTIONTYPE
206 Final MeChaniCal
208 Final Plumbing
210 � Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Buildin9/Occupancy
DATE INTRIpLS
�
�
4L 5tN M�c 4
o �>
J���
pia� �sa-sz�s • Fax (714) 754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contrector:
Address:
EXISTING SFD.
REF:B99-01921
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
�
l�
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
369 E 20TH ST
NEW ADDITION
42630405
KENNISON, LARRY W.
369 E 20TH ST
COSTA MESA, CA . "
KENNISON, LARRY W. _ _
369 E 20TH ST
COSTA MESA, CA
OWNER-BUILDER
ELECTRICAL PERMIT
Phone: (714) 6083790
Zip: 92627
Phone: (714)608-3790
Zip: 92627
� Phone:
Zip:
License: 0
PER NUMBER
00-00748
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: I SS U E D
Applied: 02/24/2000
Issued: 02/24/2000
ISSUED BY: �
SCOPE OF PERMIT
10 LIGHTS, 8 OUTLETS AND 3 SWITCHES FOR NEW 523 SF SINGLE STORY ADDITION AT REAR OF
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$11.00
$8.80
$3.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
10
8
3
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Oist System / Lighting
� Busway /100 ft
" Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Voll Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Quantity
$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
$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
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 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
requlred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 754-5626 .
WORKERS' COMPENSATION DECLARATION:
I hereby afiirm under penalty of perjury one of ihe following declarations:
❑ I have and will maintain a certiticate of consent to self-Insure for workers' compensation, as providetl for by section 3700 of the Labor Cotle, tor ihe pertormance of ihe
work for w�ich this permit is issued. '
❑ I have and will maintain workers' compensation insurance, as required by sedion 3700 of Ihe Lahor Code, for the pertortnance of the work for which this permit is issuad.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section nead not be comple[ed iI the permit is valuetl at one hundred dollars ($100) or /ess.)
❑ I certify that in the pertortnance of the work tor which this permit is issued, I shall not employ any person in any manner so as to 6ecome subject to the workers'
compensation laws of California, and agree that if I should become subject to ihe workars' compensation provisions ot Section 3700 of ihe Labor Code, I shall forthwith
comply with ihese provisions.
Applicant Signature: Date:
WARNING: FAILUPE TO SECURE WORKERS' CAMPENSATION ('pVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDE� FOR IN SECTION 3]O60F THE LABOR CADE, IIJ�EREST, AN� ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y affirm ihat I am licensed under provisions ot Chapter 9(commencing with Sedion 7000) of Division 3 of the Business and Protassions Code, and my license is in full
lorce and eifect Lic. # Class #
ContractoYs Signature: Date:
CONSTRUCTION LENDING AGENCV: '
❑ I hereby attirm that there is a consimction lending agency for ihe peAormance ot ihe work for which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lentler's Name: Lentler's Address:
Signature: Date:
OWNEN-BUILDER DECLARATIONS:
I here6y aNirm that under penalty of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Protessions
Cotle: Any city or county which requires a permit to consiruct, aiter, improve, demolish, or repair any stmcNre, prior to its issuance, also requires the applicant for such permit
to fila a signed statement ihat he or she is licensed pursuant to the provisions of ihe Contractors License Law (Chapter 9(commencing wiih Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is ezempt iherefrom and Ihe basis tor ihe alleged eaemption. Any violation oi Section 7031.5 by any applicant for a permit
sub' s �he applicant to a civil panalry of no� more ihan (ive hundred dollars ($500).):
I, as owner of the property, or my employees with wages as their sole compensalion, WILL DO THE WORK, and ihe stmcture is not intended or offered for sale (Sec.
044, Business and Protessioris Cotle: The Contracbrs License Law does not apply �o an owner ot property who builds or improvas thereon, and who does such work
h sel r herself or ihrough his or her own employees, provided that such improvements ara not intended or offered }or sale. If, howaver, ihe builtling or improvament is
sol ithin one year� completion, Ihe ownervbuilder will have ihe burden of proving ihat he or she did not build or improve tor purpose ot sale.).
❑ I, as wner ot e pr perty, am CLU LY CONTRACTING WITH LICENSED CONTRACTORS b consimct ihe project (Sec. 7044, 8usinass and Protessions
Code The ntrectors Licens aw d nat apply to an owner of property who builds or improves ihereon, and who wntracts for such prqect with a contractor(s)
licens pu uant to ihe Cont tors � nse Laws.). � �
❑ Iarp��jAy�e sec.
Own��l6 verified by drive s Ilcense.
Verification ot Ownersh� by (type oj�
and Professions Code tor this
Ves ❑ No Driver's
nt, i.e. - pmperty taa bill or daed): _
Expiras:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavation five (5) or more feet in tlepth into which a person is required to descend, will be matle in connection with work authorizetl by this
permit, and that no builtling simcNre, scaffoltling, falsework, or demolition or dismantling ihereoi, will be more ihan ihiny-six (36) feet higR (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, California Administretive Code). ,
❑ As owner-builtler, I will not employ anyone to tlo work which would require a permit from the Division of Indusirial Safery, as noted above, unless such person has a
permit to do such work from ihe division.
Signature: Date:
Division of Indusirial Safety Permit Number:
HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
1 W ill Ihe applicant or present or future builtling occupam need to file antl cenity a Business Plan for emergency response to release or ihreatened releasa of a hazardous
material? ❑ Yas ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, ihat a Businass Plan be tiled with ihe Costa Mesa Fire Depariment by every
business which has at any one time during a reportetl year a quantity oi hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons,
or 200 cubic feet oi compressed gas at standard temperature antl pressure).
.............. .._.__._ . ........ __
2 Does or will the applicant or present or future bmltling occupant need ro file a registration form for acutety hazartlous materials? ❑ Yes ❑ No
(Section 25533 ot the Califomia Health antl Safety Code, with some ezceptions, requires registra�ion wi�h �he Costa Mesa Fire Department by each business which a� any
one time has on hand a quantity of acutely hazardous materials equel to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
comoressed Aas at standard temperaNre and pressure). _
3
4
5
6
7
8
Does or will ihe applicant or present or future bulitling occupant neetl to prepare an HmNr (Hise nnanagement ana rreve
❑ Ves ❑ No
(Section 25534 of the Caiifomia Healih and Sataty Cotle provitles lhat lhe Costa Mesa Fire Department may require the
Department of an RMPP 6y businesses which are raquired to register acutely hazardous materials with the Pire Depaqme
....... ....... ...... . . _ ............
If an RMPP is presently required, has Section 25534 of ihe Calrfomia Healih and Satety Code been fully complied with? �
cenification and filing with ihe Fire
No
Does or will iha applicant ar present or tuture buntling occupant requlre tor tne work wnicn is me sublect oi mis a pucation a germu tor sucn constmcuon or modincauon
irom ihe South Coast Air Quality Management District or from any other air pollution control district or agency? � Yas LJ No
(Section 658502 of Ihe Califomia Govemment Code requires ihat ihe requestetl information be fumished on applications for non-resitlential building permits).
"........... ._.... __ _
W ill any part of the faciliry to be consimcted under this permit be within 1000 teet from ihe outer boundaries of a school? ❑ Ves ❑ No
Qf'yes", the tacility must meet ihe requirement oi Sections 25534 and 42303 of ihe California Health and Satery Codej.
_"' ..__ . """.... ... ___... ..._"""_ ,.. __....__ _... ............ .........
If a parmit from ihe Sou�h Coast Air �ualiry Management Disirid or other air pollution control tlisVict or agency is required for the work which is ihe subject of Ihis
applica6oq have all of ihe disclosures prescnbed by Califorrna Health and Safery Coda Sedion 42303 been made? ❑ Yes ❑ No
. ..... ...._ ...... .......... ..___.... "_............ ...........__ .......
Qf 'yes', attach certificate ot compliance from the appropriate air pollution conirol officer).
CERTIFICATE OF COMPLIANCE: I certify ihat untler penalty ot perjury the iniormation given above is correct. I agree to comply with all state iaws antl city ortlinances
regartling Hazardous Mater/ia�l5� and Emissions.
Signature: �/ / � Date:
correct. I
IANCE AND AU7HOR TO ENTRY: I certify under penalry of perjury Ihal I have reatl this application and state that the information given is
with all stata laws d cit rtli �nce relatin 6 builtling constmction, antl authorize representatives of the City of Costa Mesa to enter upon ihe
�pc inspection uF e/ agr/�� G or allow occupancy oi any building authorize by this permit until=al inspectipn.
/ '�% /%%/
in ati fe Oi Leoal Owo r/s1 Da�e�
COOE M. INSPECTION TVPE
�� 1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Bbck/Retaining Wall
202 Final Factory Fire Place
� 203 Final Sign
204 Final Demolition
264&4s
� INTRIALS
CODEX INSPECTIONTYPE
206 Pinal Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Pinal Builtling/Occupancy
Date
OFTE INTRIALS
/��` -� fe
4G�� M� 9
J �
•�`O+Ao.mm rF
p�a) �sa-sz�s • Fax (714) 754-4856
.lob ndaress: 369 E 20TH ST
Suite No
Vicinity: NEW ADDITION
Parcel Number: 42630405
�
_.
CITY OF COSTA MESA '
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
npp�icant: KENNISON, LARRY W.
Address: 369 E 20TH ST
COSTA MESA, CA
owner: KENNISON, LARRY W.
Address: 369 E 20TH ST
COSTA MESA, CA
Contractor.
Address:
Arch I Eng :
Address:
REF:899-01921
OWNER-BUILDER
MECHANICAL PERMIT
NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 02/24/2000
Issued: 02/24/2000
ISSUEDBY: ��/ �/
Phone: (774)608-3790
Zip: 92627
Phone: (714) 6083790
Zip: 92627
Phone:
Zip:
License: 0
Phone:
Zip:
License:
SCOPE OF PERMIT
1 VENT FAN FOR NEW SINGLE STORY ADDITION AT REAR OF EXISTING SFD.
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
Repair I Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refng Sys <700 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfin
$23.50
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$725
so.00
$0.00
$0.00
$0.00
50.00
$0.00
Quantity
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
FEE SUMMARY
Repair I Alt Absorbtion Unit
Repair I Alt Refrigeretion Unit
Ventillation System
Evaporative Cooler
Commercial I nci nerator
Domestic Incinerator
Compressors I Absorption SYstems
Upto3hp/100kBTU
3 To 15 hp I 500 k BTU
75 To 30 hp I 1,000 k BTU
30 To 50 hp I 1,750 k BTU
Over 50 hp I Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
i5to30hp
30 to 50 hp
Over 50 hp
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by Ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetlona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalry of perjury one of the following tleclarations:
❑ I have and will maintain a certifica�e ot consent to seN-Insure for workers' compensatioq as provided tor by section 3700 of �he Labor Code, for the peAormance ot Ihe
work for which this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Labor Code, for ihe performance ot ihe work for which ihis permit is issued.
My workers' compensation Insurence carner and policy number are:
Carrier Policy Number.
(This section need wt be completed il fhe permif is velued af one hundred dollers ($ f 00) or less.)
❑ I cetlity �hat in �he pertormance o� �he work lor which this permii is issued, I shall not employ eny person in eny manner so as to become subject to the workers'
compensation laws of Celifornia, and agrea that if I shoultl 6ecoma su6ject to ihe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicanl Signature: Date:
WqpNING FAIWRE TO SECURE WORKERS' fAMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINPL PENALTIES AND CIVIL FINES UP TOONE HIINDRED
THOUSAND DOLL4RE ($100,000), IN ADOITIQ4 TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDEO FOR IN SELTION 3]O60F THE LABOR CADE, INTEPEST, ANO ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am licensed undar provisions ot C�apter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full
(orce and eNect Lia u Class a
Comractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I here6y attirm ihat ihere is a consiruction lentling agency for the performance of the work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendefs Address:
Signawre: Oate:
OWNER-BUILDEfi DECLARATIONS:
I hereby attirm tha� untler penalry of perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Pwfessions
Code: Any ciry or counry which requires a permit to conswct, aiter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant tor such pertnit
to file a signed stetemen� ihat he or she is licensed pursuant to the provisions of ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmfessions Cotle) or thal he or she is ezempt thereFrom antl t�e basis for the alleged e:emption. Any violation of Section 7031.5 by eny apP�icant for a permit
subj cts ihe applicant to e civil penalry ot not more than five hundred dollars ($500).):
I, as owner of lhe property, or my employees with wages as �heir sole compensalion, WILL DO THE WORK, and ihe slmcture is not intended or oRered for sale (Sec.
7044, Business antl Professions Code: The Contracbrs License Law tloes not apply to an owner of property who builds or impmves lhereon, and who tloes such worK
hims Ifor herself or ihmugh his or her own employees, provided that such improvements are not intendetl or ottered for sale. N, however, tha builtling or improvement is
sold �ithin one year of completion, the owner-builtler will have ihe burden of proving ihat he or she did no� build or impmve for purpose of sale.).
❑ I, as�ownar of the pe y, am EXCLUSIV Y CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cotle� The contr ors Li ense w tl t apply to an owner of property who builds or improves thereon, and who coniracis (or such project with a coniractor(s)
licens pursua to the C nV tors C se L ws.).
� I am s. B siness and Protessions Code br this reason:
Signa� e: / � � `�
Owne nfietl by tlrive ' ense. �Yes ❑ No Onver's License N. Expires:
Verification ot OwnershjQ by (type oi"BdE�ment, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cetlify that no excavetion five (5) or more feet in tlepth into which a person is required to tlescend, will be matle in connection with work authorized by this
permit, antl ihat no 6uiltling structure, scaHolding, falsework, or demolition or dismantling thereot, will be more ihan t0irty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, California Adminisirative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division of Industrial Safery, as noted ahove, unless such person has a
permit to do such work from the tlivision.
Signawre: Date:
Division of Indusinal Safery Permit Number
O�OF t. INSPECTIONTYYE 9� INTRIALS
1616 Fixetl System Final Fire Prevention
1266
200
Pool Spa Final
Final Ra-Root
201 Final Block/Reteining Wall
202 Final Factory Fire Plece
203 Final Sign
204 Finai Demoli�ion
244fi 46
C0� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
272 Final Fire Prevention
220 Final Planning Approval
222 Finai 5ite
250 Final Buildin9/Occupancy
�� TRAL
�0
(714) 754-5273 • Fax (714) 754-4856
Job Address:
Suite No
Vitinity:
U
- ,__,
CITY OF COSTA MESA �, ,
BU/LD/NG D/VISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
369 E 20TH ST
DETACHED GARAGE
Parcel Nunmber: 42630405
npplicant: KENNISON, LARRY W.
Address: 369 E 20TH ST
CA
COSTA MES ,.,'. , �
\
� . .
Owner. � KENNISON, LARRY W:
Address %� 969'E 20TH ST - _ -
i ^i���/ ' �,'
v�/ ��
�/ i COSTA MESA; CA
i: • A � ' / -
�n,��, � �/j, �/,
COIlif2C�Of.� LtiAI,.'�%
Address:- ��Vv�vLF-
� � ,
� -, . .
� - �, � . o . � .
�
ELECTRICAL PERMIT
'Phone: (774) 6083790 � , �
Zip: 92627 / .
/
/
NUMBER
7
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 09I07I7999
Issued: 09/07/1999
� .. ,. � , � � , . . - .
\�
Phone: (714)608-3790 � � - - � �
\
Zip: 92627 ' . , . .
�"
/
Phone: � . . . . � � � . .
: ' �
,. �Zip;. -. i � „
: .License: • '
' SCOPE OF PERMIT
PLUMBING PERMILFOR ADDITION OF NEW GARAGE. INSTALL 4-LIGHT FIXTURES, 7-OUTLETS, 8
3-SWITCHES. , � , , . ,
REF: 89401054 , , � ., � �' � , .
ISSUE FEE
Temp service test
Res. a/c package
New Res (7-2 units) .
New Res (3.units)
Pool / Spa
Lighting�Fizts
Recept Outlets ,
Switches
Non Res Appl _ ,
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to 7 hp
Motors to 70hp
Motors to 50hp
Motors to t00hp
Motors over 700hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
$23.50
$0.00
$0.00
$0.00
so.00
$0.00
$4.40
$7.70
$3.30
$0.00
50.00
$0.00
50.00
$O.bO
$0.00
$0.00
$0.00
50.00
$0.00
so.ao
$0.00
$0.00
$0.00
50.00
$0.00
quantity
0
0
0
4
7
3 -
0�
0
0 .
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY� � ' � ' ��
i
- - - � � '
Temp Dist Sys[em / Lighting
Busway I100 k'
Standing�Section`
� - Misc Electrical Equipment
�- � Transformers up to 1 kva/kw
� .........:......up to 10 kva/kw
. • � .................up to 50 kva/kw
.................up to,100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment,
Low Volt Wiring System / Ckt
Misa Conduit . �
. Misa Conductor -
Circus ( gen or ridej
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee � "
Plan Checli Fee
Reinspection Fee
Quantity
so.00 0
$0.00 0 '
$0.00 0
$0.00 -0
so.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
$0.00 0
$0.00 0
$0.00 ' 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E38.90
COMMENTS / SPECIAL CONDITIONS
c
NOTICE: The work authorizad 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectlona end flnal approvel must be obtained. Failure to obtain inspections end final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS' COMPENSATION DECLARATION: -
I hereby affirtn under penelry of perjury one of t�e following declarations:
❑ I hava and wiil malntain a certificate ot consen[ to sell-Insure For workers' compensetion, es Drovitled for by sectlon 3700 ot the Lebor Cotle, for tha pertortnance of ihe
work tor which this permit is issued.
❑ I hava and will maintain workers' compensatlon insurance, as requiretl by section 3700 of Ihe Lebor Code, for the pertortnance of the work for which Nis permit Is issued.
My workers' campensetion Insurence wrner and policy number are:
Certier: Policy Number:
(This section neea not be comp/efed il Ihe permlt is valueO ef one hundred dollers ($100) or less.)
❑ I certify that in the peAormance ol the work for which this permit is issued, I shell not employ eny person in any menner so es lo bacome subject to Ihe workers'
compensation laws of Califomia, end agree that if I should hecome subject to ihe workers' compensetlon provislons ot Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Dete:
WARNING FAILURE TO SECURE WOPKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOVER TO CPIMINAL PENALTIES AND CIVIL FINES UP TO dJE HUNORED
THOUSANO OOLLARE (E100,000), IN ADDITION TO THE COST OF WMPENSATION, OAhNGES AS PROVIDED FOR IN SECTION 3]O60F THE UBOR CODE, IPIrEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hareby aftirm thet I em licensed under provislons of Chapter 9(commencing with Section 7000) of Divislon 3 oi Ihe Business and Professlons Code, end my license Is in full
lorce and eRect Lic. x Class #
Contractor's Signeture: Dete:
CONSTRUCTION LENDING AGENCV:
❑ I hereby eHirm Ihet Ihere is a construction lentling egency for �he peAormance of ihe work for which ihis permit Is Issued. (Sec. 3097, Clvil Cotle).
Lendar's Neme: Lendels Address:
SigneNre: Date:
OWNER-BUILDER DECLARA710NS:
I hereby aHirm that untler penalry of perjury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires a pertnit to construct, elter, impmve, demolish, or repair any stmcture, prior to its issuanca, also requires the applicant tor such pertnit
to tile a signed stetement ihat ha or she is licensed pursuam to iha provisions of Ihe Conirectors License Law (Chapter 9(commencing with Section 7000) ol Division 3 ot the
Business antl Professions Code) or that he or she is e:ampi theretrom antl the hasis for Ihe alleged exemption. Any Nolation of Section 7031.5 by any applicant tor a permit
su cts the aDP�icant to a civil penelty of not more than five hundretl tlollars ($500).):
I, es owner oi the pmpetly, or my employees with wages as their sole compensation, WILL DO THE WORK, end the sWcture is not intendetl or attered for sale (Sec.
7044, Business antl Professions Cotle: The Contractoro License Law does not apply to en owner of property who builds or improves thareon, and who tloes such work
himsetl or herself or through his or her own employees, provitled that such Improvements are not intended ar ottered for sale. It, however, the builtling or improvement is
sold within ona year oi completion, the owner-builtler will have the burden of proving that he or she did not build or impmve for purpase oi saleJ.
❑ I, as owner oi property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha prolect (Sec. 7044, Business and Professions
Cotl The ntre rors License L w does noi appry to an owner of property who builds or improves ihereon, and who conirecis for such prolect with a comractor(s)
licen��e p uant the CorJlracig��icense Laws.).
Business and Professions Cotle for this reason:
❑ Yes ❑ No
Verification ot Ownership by (type of document, i.e. - property ten biil or tleed):
DnvefslJcense
DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICATION:
❑ I hereby canify that no ezcavation live (5) or more teet In depth into which a parson is required to tlescentl, will be made in connection with work authonzed by this
permii, end Ihat no bullding sWdure, scaHolding, felsework, or tlemolition or tlismantling �hereoi, wlll be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Celitornia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to Go work which woultl requlre e permit imm the Divislon of Indusirial Sefety, es noretl ebova, unless such person has a
permit to do such work from the tlivision.
Signature: Date:
Division ol InduSinel Safery Permi� Number:
CODE Y. INSPECt10NTYPE j�jE INTIfIA�S
1616 Fixed System Final Fire Prevention
1266
200
201
zoz
203
Pool Spa Final
final Re-Roof
Finel Block/Reteining Well
Finel Factory Fire Plece
Final Sign
204 Final DemoOtlon
2a48-d6
COpE I INSPECTION TYPE
206 Finel Mechenical
208 Finel Plumbing
270 Finel Electrical
212 Finel Fire Prevantlon
220 Finel Planning Approvel
222 Finel Site
250 Finel Building/Occupern
ryi��L'iliifSbj
!v-2G-G� �
4(���p M�s9
c. �
> _
�
J '
.��� �
(714) 754-5273 • Fa�c (714) 754-4856
- CITY OF COSTA MESA
BU/LDING DIV/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
�ob Address: 369 E 20TH ST
Suite No
Vicinity: NEW ADDITION
Parcel Nunmber: 42630405
Applicant: KENNISON, LARRY W.
Address: 369 E 20TH ST
COSTA MESA, CA
Owner: KENNISON, LARRY W.
Address 369 E 20TH ST
COSTA MESA, CA
Contractor: OWN ER-BU I LDE R
Address:
Arch / Eng :
Address:
OF EXISTING SFD.
REF:699-01921
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
PLUMBING PERMIT
Phone: (714) 6083790
Zip: 92627
Phone: (714)6083790
Zip: 92627
Phone:-
Zip:
License: 0
Phone:
Zip:
License:
NUMBER
00103
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 02/24/2000
Issued: 02/24/2000
ISSUED BY: � / ' /
SCOPE OF PERMIT
1 BATHTUB, 1 SHOWER AND 1 WATER CLOSET FOR NEW 523 SF SINGLE STORY ADDITION AT REAR
AMT
$23.50
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 P-Trap $0.00
t Pressure Regulator $0.00
0 Process Piping (per 10 ft) $0.00
0 Receptors $0.00
0 Septic Tank $0.00
0 Sewer Cap tor Demo $0.00
0 Sewer Connect $0.00
0 Sewer Priva[e Line $0.00
0 Shower $9.80
0 Sink, bar $0.00.
0 Sink, commercial $0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
SumpPump
Swimming Pool
Trep Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping pnst or Rep.)
Water Re-pipe
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
1
0
0
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 780 days, or if woik is suspended or abandoned
for a poriod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wi�h all applicable codes, and all
required Inspeetlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ot this permit.
FOR INSPECTIONS CALI: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I herehy aHirtn untler penalry of perjury one of the following declarations:
❑ 1 have and will maintain e certificate of consent to self-Insure for workers' compensation, as provitled for by section 3700 of the Labor Cotle, for the pertormance of ihe
work for which ihis permit is issued.
❑ 1 have and wlll maintain workers' compansation insurance, as required by section 3700 of the labor Code, for the peAormance ot �he work tor which ihis permit is issuetl.
My workers' compensation Insurance tarrier antl policy number are:
Carner: Policy Numher:
(This section need nof be completed il the permi! is velued at one hundred dollars ($700) or less.)
❑ I certify that in the pertormance of ihe work for which ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workars'
compensation laws of Califomia, and agree that if I shouid become su6ject to the workere' compensation provisions of Section 3700 of ihe Labor CoUe, I shall fotlhwith
comply with these provisions.
Applicant Signamre: Date:
WARNING FAIWRE TO SEGURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND pVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100.000). IN ApDITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTIIXJ 3]O6 OF THE IABOR CODE, IMEREST, AND ATTOqNEY'S FEES.
LICENSED CONTRACTORS DECLARATIOry:
I hareby aRirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Cotle, and my license is in full
torce and eNect Lia d Class k
ContrectoYs SignaWre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm ihat ihere is a consimction lending agency for ihe pedormance ot ihe work tor which this parmit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm that untler penalty of periury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the foliowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a permit to consiruct, alter, improve, demolish, or repair any structure, pnor to its issuance, aiso requires the applicant tor such permit
to file e signed statemeN that he or she is licgnsed pursuant to the provisions of ihe Coniractors License Law (Chapter 9(commencing with Saction 7000) of Division 3 of the
Business and Protessions Code) or that he or she is ezempt iherefrom and the basis tor Ihe alleged ezemption. Any violation of Section 7037.5 by any applicant for a permit
�sub' ts the applicant to a civil penalry of not more than five hundred tlollars ($500).):
I, as owner of tha property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, antl the siructure is not intentletl or oNeretl for sale (Sec.
044, 8usiness and Professions Code: The Contradors License Law does not apply to an owner ot propetly who builds or improves thereon, and who does such work
himself or If or through his or her pwn employees, provitled that such improvemenis a�e not intended or ottered for sala. If, however, the building or impmvement is
o ih one ear ot completion, the ownervbuiltler will have ihe burden of proving �hat he or she did not builtl or improva for purpose of sale.).
❑ I, as ner of t e property, am F.l(CLUSIV� LY CONTRACTING WITH LICENSED CONTRACTORS to constmct Ihe project (Sec. 7044, Business antl Professions
Cotl . e contractors LicenseXaw tlpey(ot apply to an owner of property who builds or improves thereon, and who contrects for such prqect with a contracror(s)
lic se u�ant to the Con(rpqfors Lir�ise Laws.l. /
0
O{�ner ID verified by dn s
Verification of Owners � by
and Professions Cotle for ihis
Yes ❑ No Dnvers License
7t, i.e. � property tax bill or deetl):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation five (5) or more feet in tlepth into which a person is requlred to descend, will be matle in connection with work authorizetl by ihis
permit, and that no building structure, sCattoltling, falsework, or demolition or tlismamling ihereot, wili be more ihan thihy-six (36) fee� high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Calitornia Adminis�rative Cpde).
❑ As owner-builder, I will not employ enyone to do work which would require a permit irom the Division of Intlustrial Safery, as noted above, unless such person has a
permit to do SUCh work fmm ihe division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSION6 CERTIFICATION:
1 W ill ihe applicant or present or future building acupant neetl m file and cenity a Business Plan for emergency response to release or ihreatened release of a hazardous
material? ❑ Ves ❑ No
(Section 25505 of ihe Calitomia Health and Safery Code requires, wi�h some ezceptions, ihat a Business Plan 6e filetl with iha Costa Mesa Fire Depanmem by every
business which has at any one time tluring a reported year a quantiry of hazardous materials equal m or greater ihan a weight of 500 pounds, or e volume ot 55 gallons,
or 200 cubic feet of compressed gas at standartl temperature and pressure).
2 Does or will ihe applicant or present or fqNre building occupant need to fiie a registration brm for acutey hazartlous matenals7 ❑ Ves ❑ No
(Section 25533 of the Califomia Healih and Safery Code, with some exceptions, requires registration with ihe Costa Mesa Fire Depanment by each business which at any
one time has on hand a quantiry of acutely hazardous materials equel to or grea�er than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic faet ol
compressed gas et standard temperaturg and pressure).
3 Does or will iha applicant or present or fUture huiltling occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutety hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the Califomia Healih and Satety Cotle provides Ihat ihe Costa Mesa Fire Depariment may require ihe preparatioq certification and flling with the Fire
Depariment ot an RMPP by businesses which are required to reqister acutaly hazardous materials with the Fire Department.
4 If an RMPP is oresentW required, has Se��ion 25534 of the Caiifomia Heal�h and Safety Code been fuiry complied with? ❑ Ves ❑ No
5 Does or will �he applicant or present or fuWre builtling occupent require tor the work which is ihe subjac� of ihis a plica�ion a permit for such construction or modification
from �he South Coast Air �uelity Managyment District or from any other alr polWtion control tlistrict or agencyl � Ves u No
(Sec�ion fi58502 of the Califomia Government Code requires ihat ihe requested information be fumished on applications for non-residential huiiding permits).
6 Will any pan of ihe faciliry to be constmc�ed untler Ihis permit be within 10001eet fmm ihe outer bountlaries of a school? ❑ Ves ❑ No
(If'yes", ihe feciliry must meet ihe requirement ol5ections 25534 and 42303 of ihe California Heal�h antl Safety Code).
7 If e
attach certificate
CATE OF COMF
�i aistnct or egency is reqwrea ior me v
42303 been made? ❑ Ves ❑ No
mce from the appropnate air pollution wntrol officep.
I ceqiy Ihat untler penalry of perjury the information given above is correct. I agree to compty with all state lews and city ordinances
Emissions.
Date:
OF COMPLIANCE�D A ORIZA710N OF EN7RV: I certify under penalry of perjury that I have read this application and state that tha information given is
�3� comply wit stat ws antl city ordinances relating �o building constmctioq and authorize representatives of the City of Costa Mesa to enter upon ihe
r perty fo u ,@ f �o �cupy or allow occupancy oi any huilding authorizetl by this permit un'=inal ir�epectiOn.
� �� 1G �/
Sionatu f Le al w a s1 �ate �'
CO�E M. INSPECTIONTYGE
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wail
202 Final Factory Fire Place
203 ' Final Sign
204 Finai Demoli�ion
244&d6
pATE
�
INTITIA COOEN INSPECTIONTVPE
206 Final Mechanical
208 � Final Plumbing
270 Final Electrical
272 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Buildin¢/Occupancy
Q T�E INTITIAL
� �/
ry
���
CITY OF COSTA MESA
� BlIILDING DIVISION �
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714) 754-5273 • Fax (714) 754-4856
Job Address: 369 E 20TH ST
Suite:
Vicinity: FRONT & SIDE PL
Parce�Number: 42630405
App�iwnt: KENNISON, LARRY W.
Address: 369 E 20TH ST
BUILDING PERMIT
Zoning:
PERMIT
77 FAIR DRIVE, CC�MESA, CA 92626
Status: ISSUED
Applied: 09/0117999
Issued: 09/01/1999
ISSUED BY:
- � �Phonef (714)608-3790 -
COSTA MESA, CA-_; i��- � _ �' Zip: 92627 � ".
�
Owner. KENNISON, LARRY W. � -
Address 369 E 20TH ST� - � � � � - ,
'�, �/: " - "'- �- � - , - Phone:_ (714) 6083790 . � � �
� � \,'_ : �r-•.., - ' �
..�'COSTA MESA; CA � - - - - ` Zip: 92627 - . � - — ,
: , . . , ��. � . .
�� '�� . - __ - . , . � - .
i - . . i -�'-� -, - � � _
Contracror. � i;�_ = - , , , � � - •-
; Address: � . //,,'.i � ��'� �', ' , .
� Phone:
� . .i,'-�% � . - , .
- . , . ;i. . . .
� � Zip: License: � �
� Arch : ' : : � _ .. �. : En9� � .
Address: � �' - , �� Address: ' ,
" _ . '� ..Phone:s . ' - � Phone:
� - , . . /'� ", � " � � - .i
�
� Zip: � ��' � License: �- � License:
�- ' SCOPE OF PERMIT '
'�. CONSTRUCT 70 LF, 6' HIGH BLOCK WALL IN FRONT OF AN EXISTING SFD..10' MINIMUM SETBACK WILL BE"
� PROVIDED FROM FRONT PL.. " , , ; ; � '
.
FEESUMMARY
Plan Check: � $33.12 ,., _ __ . ;, � . � ,, Celc Valuation: g�,aoo.00
Permit: , $50.95 - =. � ' ' � Claim Valuation: So.00
SMIP Res: $0.00 " — - ! i '
�� SMIP Com: ''�" $0.00 ` ; �
Other: $0.00
Inspection:. $0.00 • - -
Total:� �584.07 - . . ' . � �
� �. � � � PLANNING & ZONING
SETBACKS'- �
MAIN STRUCTURE Front , 0- 0��
.� i
ACCESSORY ���Front � 10- 0
PARKING Existin : o
NOTES:
Rear . 0- 0
Rear 0-0
Required: 0
Left 0- 0
left 0- 0
� Prouosed: 0
Right ' 0- 0
Right '. 0- 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
requiretl inapectlons end flnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I heraby aHirtn unaer Denalry of perjury one oi tha tollowing decleretions:
❑ I hava entl wlll maintain a certificate of consenl ro self-Insure for workers' compensation, es provitled for by section 3700 of the Labor Code, for the pedormance ol the
work br which this pertnit is iuued.
❑ I have end will maintain workers' compensation insurence, as required by sectlon 3700 oi Ihe Lebor Code, for ihe peAortnanca of the work for which this permit is iuued.
My workers' compensation Insurence cartier and pollcy number are:
Cerrier Policy Number:
(This section need not be campleteU ll fhe permiNs veluetl ef one huntlretl tlallers ($100J or IessJ
❑ I certily Ihat In the pertormance of the work for which this permit is issued, I shell not employ eny person in eny menner so es lo become subject to the workers'
compensation lews of Californle, entl egree Ihei If I should become subject to the workers' compensetion provisions oi Sectlon 3700 ot the Labor Code, I shall torthwith
comply wl�h �hese pravisians.
ADPlicant Signeture: Date:
WARNING: FAILURE TO SECURE WORKERS' ODMPENSATION COVERAGE IS UMAWFUL AND 5l1ALL SUBIEC� AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED
T10USAND DOLURE (5100,OW), IN A�OITION TO THE COST OF COMPENSATION, �AMAGES AS PROVIDED F-0R IN SEGTION 3�O60F THE LABOR CODE, IMEFEST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby attirm ihat I am licensetl untler provislons of Chapter 9(commencing wit� Section 7000) of Division 3 of the Business and Professions Cotle, and my licensa is In full
force end aMecL Lic, a Class A
Comractofs Signeture: Date:
CONS7RUCTION LENDING AGENCV:
❑ I heraby eNirm that there is a consiruction lending agancy for ihe pertormence oi ��e work lor which this permit Is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lenders Address:
SlgnaNre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby affirtn thet under penalry of perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business and Professions
Code: Any city or counry which requires a permit to consiruct, alter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires Ne applicani for such permii
to file e signetl steiement Ihat he or she Is Ilcensed pursuent m the provisions oi ihe Contractors License Lew (Chapter 9(wmmancing wlth Section 7000) of Division 3 of Ihe
eusiness antl Professlons Code) or that �e or she is eaempt Iherefrom antl Ihe basis for the elleged ezemption. Any Nolatlon of Section 7031.5 6y any applicant tor a permlt
su cts the appllcant to a civil penalry oi not more than live hundretl tlollare (5500).):
I, es owner of the properry, or my employees with weges as their sole compensation, WILL DO THE WORK, end the sWcture is not Intended or offered tor sale (Sec.
7044, Business entl P�ofessions Code: The Conirectors License Law does not epply to en owner of property who builds or improves ihereon, antl who Does such work
himself or herself or through his or her own employees, providad that such improvements era not Intended or oRered for sale. If, however, the building or improvement is
sold within one year oi completion, tha owner-builder will have ihe burden of proving thet he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of operty, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to consiruct the projeci (Sec. 7044, Business and Protesslons
Code: The iracto License Lew tloes not epply to an owner of property who bulltls or Improves ihereon, end who coniracts for such project with a contractor(s)
licens�e p uant to t e Contractop�ense Laws.).
❑ lam
Verification of
,_/L Business and Protessions Code for Ihis reason: — —
)�eV/
7
Ves, No Dnver's License No. � �� Expires: (7_• �%' D Z
by (type bt dwument, i.e. - property �ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certily thet no excavetion tive (5) or more teet in tlepth into which e person Is requlred to descand, will be made in connec�lon with work authonzetl by this
permit, antl that no huiltling stmcture, scattoltling, falsework, or demolition or tlismantling Ihereof, will be more than thlny-six (36) feet hlgh. (Chap. 32, Gry 2, Art 2, Sec.
347, 7itle 8, Celifornia Atlministretive Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom tha Division of Industrial Safery, as noted ebove, unless such person has a
pertnit to do such work from the division.
SignaWre: Date:
Division of Intlusinal Safery Permit NumDer.
CO�E �, INSPECTIONTYGE
7616 Fixatl System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 Final BIocWRetaining Well
202 Final Feclory Fire Place
203 Final Sign
204 Final Demolition
2446-d6
j�jE INT
� �� �
CODE� INSPECTIONTYiE
206 Final Mechanicel
20B Final Plumbinq
210 Final Electrical
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
DRTE INTRI�LS
�
� �
►
•'IHIS SI�7'4-I LS FOR INfORMA770NAL PURPC76FS
ONLY. APPLIUNT LS RFSPON�IBLE FOR PROVIDWG
AN ACCURATE REPRFSFNfAYION OF h�IIt PROPERTY
IN G1SE THE SHAPE AND SIZE DO NOT ODRRESPOND
WIIH TF� WFORMAI70N PROVIDID ON'[HIS Sl-�I'.
r39�R—Q i34 �
DIVISION OF BUILDING SAFETY
CITY O� COSTA MESA
APPROVED
• SOL1D WALLS/FENC�S BEIWEEN 2'�' k 6' IN Fff]GHT SHALL
BE SETBAIX A7 LFAS710' FROM FRONC PROPERTY LINE•
• SO[.m WAILS/FQJ�S SFIALL NOi HX� 2' 6' IN F�IfGHT
N71i�J Id OF IHE FRUNt PROPFR7Y IINE �70T CURB lAtE)_
• VERII7 DSI'ANC� FROM CURB TO PRUPERIY LQdE
� AND 9iOW ON P[AN. VERIi'IGIION FROM 77� Q1Y5
-� FNGQJEEItIIJC DIVSION 6 REQUQtED. GLL (714J 754-ai43
aoe wPow`unori.
9y�/ � pate��
fiis of plans � s fic�lior�s MUS? be kept on Uds job at aA tin�es and d is un�arAul tr
mak anyd�ange�aall ratioqorsame4�Ihoulwr�tenpemiasioniromlhe�iuisbnM ild'
of th} vioiation c
Th plans and
�voAc s nm comn'
�
i:��
any
6nd
W1o4e�
any Cily af Coste Mpsa Q�dine �0 RAd�on
�y hm�atiu me null en upl� fl q1p I
�C acl�ra �er�U3 �di r�ilha� 180 d�y� af
ovai
law.
9 01 amc�a
nce.
I '
�
� � �
� I �
RE4DEM� I
TE �
, � ion s
,P.�ANIy1.[�G.DiY S!C
---�--.�.
`���.F� (� � �1�'�
`, 4 ',;
CITY C6'�.�'JC."�"`YVH
p�.p,NNING Q��
SUBdECT. 70 BLDG. DEP_T. REG.
BY`//^/�,/,� i�
(�DATE �_,�!
REvo[N¢ I R[90d¢ I
1
I �
IL ,
. �
e' Ma @iooc_.�µ
� ��� -�-�-- -�
--- � --
_� STREET
RE90ENCE
---------------- / ,
-- �
LAYOUT FOR BUILDING PERMIT
�q� � 0/�°lca PLANNING DIVISION
TYPICAL
Ceme�t Coping Optional�—�
Channpl Bbck With 1�3/B�
Morito�tal Top ol all �
Fencet
For Fences 5' or Lest
Ven. Q�rs 3/8"yiat 4' �0" O.C_'
For Fences Nigher Than 5' �
Ven. Ban 3!8"� ac 32" O.C.�-,�
Fill Cells Solid With Grout .
WhereSteelOccurs �
Rem�nrcin9 Steel Slull �
Coniorm to Sec.A�15-39
A.S.T.M.
All Steel to 6e Lapped �-
26" or to Codt
NATURALGRADE
TWOJ/8"OBARS �
CONTINUOUS TOP �
d BOTTOM
HOQIZSTEEL MUST BE TIED IN
VLACE A� TIME OF TPENCM
INSPECTION.
a x
4 i-
u
Y W
a =-
> i
n
7 �
w o
u 1-
�
A^IpIN
/►—KIDTH
� SEE CHt
L BE�OW
0
6�� CONCRETE BLOCK
FENCE
GENERAL-- NOTES
MORTAR: pne Part Plasfic Cement, ond
Three Porfs Sund
GROUT: One Porf Cement Ttvee ann
One Half Parts S�and
COPING: One Port CemeM, Three
Par�s Sond
CONCRETE: Weil M�aed 1:2-I/2:3-i/2
Mo�c of )- 1/2 Gal;ons ot
Water Per Sack ot Cement
GNOVT MAV BE POURED FROM TNE TOV
OF THE FENCE IN CELLS WNERE STEE�
OCCURS.
CE�LS AND AREASOF MORIZONTAL REIN
FORCEMENT SHALI BE CLEAP, CLEAN 6
FREE OF ALl MORTAR DEBF15, ETC.
rl (.V' C4RTNTCOTH
VJ fr�E HE�GTti O� FENCE
�LOW BOTTOM OF �OGTiNG
SCA�E: I/2��= I'
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6� 5 4� -�
WIDTH . . . . 14'� . . . . . .14�� . . . . . . 12�. . . 12"
THICNNESS . .10�� . . . .10" . . , 8" 6��
DEPiH OF EARTHTOOTH 24�� . 20" ... 16�� 12"
SPACING OF EARTHTOOTH i2' 14' . 16' i6'
BUILDING DIVISION
I
` '
O MF
a �
0
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r
Jq�
w�io �
>:;,:;'v',::t.� ..�..x;, 7;�:'-:�::1' .
T�� �
1
CITY OF COSTA MESA � _.
B!/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
��ia� �sa-s2�s • Fax (714) 754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
369 E 20TH ST
42630405
BANNIER,ROBERT
BANNIER, ROBERT S
Address 369 E 20TH ST
Contractor:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a -
Service to 1000a
Service over t000a
Motors to ihp
Motors to 10hp
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
COSTA MESA,CA
ELECTRICAL PERMIT
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
PE�� M�
E99-0003'I
77 FAIR DRIVE, COSTA MESA, CA 92626
status: ISSUED
Applied: 01/18/1999
Issued: 01/19/1999
SCOPE OF PERMIT
REINSTATE EXPIRED PE- 27839.1 METER UP TO 2000AMP., 1MOTOR UP TO 7 HP., 4 LIGHTS„ 9
OUTLETS, 3 SWITCHES, 1 SU8 PANEL.2 MISC, FOR A DISHWASHER & A GARBAGE DISPOSAL".
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$4.00
$9.00
$2.00
$425
$0.00
$27.25
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.25
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
4
9
2
1
0
1
0
0
0
0
0
0
0
0
1
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft � �
Standing Sedion
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Voll Wiring System / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Eledrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
$0.00
$0.00
$0.00
$32.50
$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
50.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 5728.25
COMMENTS / SPECIAL CONDITIONS
Quantity
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
POR INSPECTIONS CALL: (714) 754-5626 ,
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm untlqr penelty of pe�ury one of the following tleclarations:
❑ I heve end wiil rriaintein a certificate of consent to self-Insure for workers' compensalion, as providetl tor by section 3700 of ihe labor Code, for the peAormence of ihe
work lor which lhis Oertnit is issued.
❑ I have and will meintain workers' compensation insurance, as raquired try section 3700 of �he Labor Cotle, for �he perfortnance of ihe work for w�ich ihis pertnit is issued.
My workers' Compensetion Insurance cartier and policy number are:
Canier. Policy Number.
(This secfion nee0 not be completed il fhe permi( is valuetl et ane Auntlretl dollars ($ f00) or IessJ
❑ I certity that i� the pertortnance of the work tor which this pertnit is issueQ I s0all not employ any person in any manner so as to become subject to tha workers'
compensation lews ot Califomia, and egree that if I shouttl hecome subject to the workers' compensation pmvisions oF Section 3�00 of the le6or Code, I shell forthwith
comply with thesa provisions.
Applicant SignaturB: Date:
WARNING FAILURE 70 SECURE WORKERS' CAMPENSATIIXJ CAVEPAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER i0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
TFIOUSAND OOLV+Fg ($100,000), IN ADDITIIXJ TO THE WST OF COMPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]Ofi OF THE LABOR CADE, IMEREST, AN� ATiORNEYS FEES.
LICENSED CONTRpCTORS DECLARATION:
I hereby aHirm that I am Ilcensed under provisions oi Chapter 9(commencing with Section 7000) of DivlSion 3 of the Business and Professions Coda, antl my license is in full I
force and ettect. LiC. # Class W �
Contradors Signature: Date:
CONSTRUCTION �ENDING AGENCY:
❑ I hereby atfirtn Ihat thera is a constmction lentling agency for Ihe pedormance of the work for which ihis Dermit Is issuetl. (Sec. 3097, Civil Code).
Lendels Name: Lendefs Address:
SignaNle: Date:
OWNER-BUILDEq DECLARATIONS:
I hareby affirtn that under penalry of perjury that I am E%EMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires e pertnit to constmct, alter, improve, demolish, or repair any stmcWre, pnor to its issuance, also requires the applicant for such permit
to file a signetl statement ihat he or she is Ilcensed pursuant to ihe provisions oi the Comractors License �ew (Chepter 9(commencing with Section 7000) of Division 3 of the
Business and Profgssions Code) or thet ha or she is exempt therefrom and ihe basis for ihe alleged ezemption. Any violation of Section 7037.5 by any applicant tor a permi�
subjects the applicent to e civ�l penalry of not more Ihan five huntlretl tlollars ($500).):
❑ 1, as owner of ihe proparty, or my employees with wages as thelr sole compensetlon, WILL DO 7HE WORK, and ihe siructure is not intendatl or oHeretl for sale (Sec.
7044, eusiness and Professions Code: The Contractors License Lew does not apply to an owner of properry who builtls or improves thereon, and who does such work
himselt or herselt or through his or her own employees, prov'rded thet such improvements are not Intended or oRered tor sale. If, however, the builtling or Improvement is
sold within oqe year of comptetion, ihe owner-builder will have tha burden ot proving ihat he or she tlitl not bulld or improve tor puryose of sele.).
❑ I, as owner of ihe property, am EXCLUSIVELV CON7RAC71NG WITH LICENSED CONTRACTORS to construct ihe prolect (Sec. 7044, Business and Professions
Code: The cbniradors License Lew does not apply to an owner of property who builds or Improves thareon, end who contracts for such project with a coniractor(s)
license pursuant to the Contractors License Laws.).
�am exem nder sec. Business antl Professions Code br ihis reason:
Signature: � �� - Date: —
Owner ID verifietl by driver's license. ❑ Yes ❑ No Driver's License No. Ezpires:
Veniication ot Ownership by (rype ot daument, i.e. - pmperty tac bill or deed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereDy certify that no excavation five (5) or more feet in depth Into which a parson is required to descentl, will be metle in connection with work euthorlletl Dy this
partnit, end Ihat no building structure, scaHolding, felsework, or demolition a tlismantling ihereof, will be more Ihen ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomie Administretive Code).
❑ As owner-Dullder, I will not employ enyone to do work which would require e permi� irom tha Division of Industrial Safey, as noted above, unless such person has a
permit ta do Such work irom Ihe division.
Signature:
Div"�sion of Indusinal Safety Permit Number:
Date:
Will ihe applicant or present or future building occupant need to file antl canify a Business Plan for emergency response to release or threatened release oi a hazartlous
matedal? ❑ Yes ❑ No
(Section 25505 of the Califomie Heelth end Safety Code requires, with some e:ceptions, that e Business Plen ba filed with the Costa Mese Fire Department by every
business which has at any one time during a reponed yeer e quentiry of hazardous matenals equel to or greeter than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic tget of comprassetl gas et stantlartl temperature antl pressure).
................................................................ . . ..................................................................................................................................... .........................................................
Does or will the epplicant or present or tuture building occupent neetl to tile a registretion torm tor ecutely hazerdous materials7 ❑ Yes ❑ No
(Section 25533 oi ihe Celifomia Health entl Sefety Gode, with some exceptions, requlres registretion with ihe Gosta Mesa Fire Department by each business which at any
one time has on hend e quantiry ot eately �ezerdous meterials equal to or graeter fhen e weight ot 500 pounds, or e volume ot 55 gellons, or 200 cubic feet of
comoressed gas et s�endard temvereture and o�essure).
oes or will ihe epplicent or present or
I Yes ❑ No
�ectlon 2553q o� t�e Calitornia Health
epenment oi an RMPP by businesses
...........................................................
an (iMPP is oresentiv reouiretl. has S
occupant neetl to prepare en
ihe
t the Costa Mesa Fire Department may r
ecutely hazardous matenals with ihe Fire
Ihe preparation, cetlification and tiling with the Fire
5 Does or will the epplicenl or present or future building occupant reQuire for the work which is ihe suhject of tMs �plication apermit for such construction or modification
from ihe South Coest Alr Quality Manegement District or from eny other air pollution control district or agency7 Ves LJ No
(Section 658502 ot lhe Califomia Government Code requires that the requested infortnation be furnished on applications for non-residential building pertnits).
.................................................................................................................................................................................................................................................................................
6 Will any pan of the faciliry to be consiructed under Ihis pertnit be within 1000 feet from the omer boundaries of a school? ❑ Ves ❑ No
(If yes", �he tgciliry must meet the requirement of Sections 25534 and 42303 of ihe California Healih antl Safery Code).
.................................................................................................................................................................................................................................................................................
7 If e permit frOm ihe South Coast Alr Oualiry Manegemant Disidct or other eir pollution control distdct or egency is requlretl for [he work which is the subject of this
applicetion, have all ot ihe disclosures prescnbed by Celifornia Heelih and Safety Code Section 42303 been metle4 ❑ Yes ❑ No
...................................................................... . . ....................................................................................................................................................................................................
B Qf yes", attach certi(icate of compliance from She appropriate eir DOIWtion conirol oNicer).
CERTIFICATE OF COMPLIANCE: I cetlity that untler penalry of perjury the infortnation given eDove is corred. I agree to comply with all state laws antl ciry ortlinances
regarding Hazardous Metenals end Emissions.
SigneNre: _ Date:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalry of perjury ihat I have read this application and state ihai ihe informatlon given is
correct. I agree to comply with all s te laws and ciry ordinances relating to building consWction, and euthonze representatives of the Ciry of Costa Mesa to enter upon the
above-descri property for in on purposes. I agree not to occupy or allow occupancy ot any building authonzed by this permit until final inspaction.
�� /- /� -�/ - 1� 9
eture Of Legal Owner(s) Date
• And/Or Au�honzed Applicant
400E t. INapECTIONrypE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Flnel Re�Rooi �
201 Finel BIocWRetaining Wall
202 Final FaCtory Fire Plece
203 Finel Sign
204 Final Demolition
2466-46
�97E
�y�$ S�QpE� INSPECTIONTVVE QASE
206 Final MeChenical
208 Final Plumbing
210 Finel Elecincel 7-f �-� �� �- Z�-�%Q
� 212 Final Fire Prevention . __
220 Final Planning ADProval
222 Final Site
250 Finai Building/Occupancy
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(714)754-5273 • Fax(714)754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber.
Applicant:
Address:
369 E 20TH ST
42630405
�,
CITY OF COSTA MESA �� �
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BANNIER,ROBERT
Owner: BANNIER, ROBERT S
Address 369 E 20TH ST
COSTA MESA,CA
ContrecWr:
Address:
ArchlEng:
Address:
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
Phone:
Zip:
License:
PE���ER
P99-00030 ✓
77 FAIR DRIVE, COSTA MESA, CA 92626
SCOPE OF PERMIT
RE-NEW EXPIRED BPE28972, "ADD. 514SF DIN, OFFICE ,LAUNDRY ROOM & BATHROOM"
REPAIR
LINE TO FJ(IST. HOUSE.
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Conned (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (7-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
Szz.00
$0.00
$0.00
so.00
$D.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
$0.00
$0.00
�
FEE SUMMARY
Laundry Tub / Washer
Landscape Irrigation
P-Trap
Pressure Regulator
Process Piping (per 10 ft)
Receptors
Septic Tank
Sewer Cap for Demo
Sewer Connect
Sewer Private Line
Shower
Sink, bar
Sink, commercial
Sink, Floor �
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
AMT
30.00
$0.00
$0.00
so.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
so.00
$0.00
an
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: 01/18/1999
Issued: 01/19/1999
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
so.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
$0.00
$30.75
Qrv
0
0
0
0 .
0
0
0
0
0
0
0
0
0
0
0
EXPIRATION: This permit shall aUtomatically expire and become void if work is not commenced within 180 days, or it 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 inapections 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
WORKERS' COMPENSATION D�CLARATION:
I hereby aMirm under penalry of perjury one of the following tleclaretions:
❑ I �eve and will maintain a certificate of consent to self-Insure tor workers' compensation, es providetl for by section 3700 ot the Labor Code, for ihe peAormence ot ihe
work br which ihis permit is �ssuetl.
❑ I have end will maintain workers' compensation insurance, es requiretl Dy section 3700 of ihe Labor Cotle, for ihe pedortnance of Ihe work tor which �his pertnit is issued.
My workers' compensation Insurence carrler and policy num6er are:
Carrier: Policy Number:
(7Tis section need not be campletsd i! Ihe permit is valued af one hundred dallars ($100) or Iess.J
❑ I certify Ihat in the pedormance of lhe work for which this permit is issued, I shall not amploy any person in any manner so as to become sublect Io ihe workers'
compensation lews ot Celifarnia, and egree Ihat if I shoultl become subject to the workers' compensation provislons ot Section 3700 of the Lebor Cotle, I shall torthwith
camply with these provisions,
Applicam Signature: Date:
WARNING: FAILURE TO SECURE WOqKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBJEGT PN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED
iMOUSAND DOILARE (5100,000). IN A�OITION TO THE COST OF CAMPENSATIqJ, DAMAGES AS PFiOVIDED FOR IN SECTION 3/O6 OF THE LABOF CADE, INrEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aRirm ihet I am licensed Under provisions of Chapter 9(commancing with Sectlon 7000) of Division 3 af the Business entl Protessions Code, end my license is in full
force and ettect Lia k Class N
ContractoYs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aPortn that ihere is e construction lending agency for ihe peAortnance of the work for which this pertnit is issuad. (Sec. 3097, Civil Code).
Lentler's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm thaf untler penelty ot perjury Ihet I am EXEMPT FROM THE CON7FACTORS LICENSE LAW for the following reason (Sec. 7031.5, eusiness and Professions
Code: Any ciry or counry which requires a pertnit to construct, alter, Improve, demolish, or repelr any sWcture, pnor to its issuance, elso requires ihe applicant for such parmit
to flie e signed statement that he or she is licensed pursuent to the provisions of the CONractors Licensa Law (Chapter 9(commencing with Sedion 7000) of Division 3 of the
Business and Protessions Coda) Or ihet he or she is exempt iheretrom and the basis tor the alleged exemption. Any violation oi Section 7031.5 by eny applicant tor a partnit
subjecis the applicant to e ciml penalry of not more than five hundretl dollars ($500).):
❑ I, es owner ot ihe pmpeny, or my employees with wages as their sole compensation, WILL DO 7ME WORK, and Ihe strucWre is not intended or oflered for sale (Sec.
7044, Business and Professions Code: TTe Contrectors License Law does not apply to an owner ot property who huilds or improves thereon, antl who tloes such work
himself or herseN or ihrough his o� her own employees, provided that such improvements ere not intanded or oHered for sale. If, however, ihe bullding or Improvement is
soltl within one year oi completion, ihe owner-builder will heve the burden of proving thet he or she did not bulld or impmve for purpose oF sale.).
❑ I, es owner of ihe property, em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, Business and Professions
Code: The contrectors License Law tloes not apply Io an owner of property who bullds or impmves thereon, entl who contracts for such project with a contrector(s)
Jisense pursuant to ihe COMractors License Laws.).
❑�I am exemp er sec. Business and Professions Cotle tor this reason:
Signature: ��� �.�7�,.�__n Date: — —
Owner ID v nfie by dnvefs licenge. ❑ Yes ❑ No Dnver's License No. Expires:
Verificetion oi Ownership by (rype of document, i.e. - property taa bitl or tleetl):
DIVISION OF INDUSTRIAL SAFHTy pERM17 CER7IFICATION:
❑ I hereby ceNfy ihat no e:cavetlon five (5) or more feet In tlepth inro which e person I5 requlretl to tlescend, will he made in connection with work euthorizetl by this
permit, end that no buildinq Siructure, scaHolding, felsework, or tlemolition or dismantling theraoi, will be more ihan thirty-si: (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Titla B, Calitornia Adminisiretive Code).
❑ As owner-builder, I will not employ enyone to do work which would require a pertnit irom the Division of Industriel Setery, es noted ebove, unless such person has a
permit to do such work from the division.
Signeture: Date:
Division of Industrial SeFery Parmit Number:
CERTiFlCATE OF COMFLIANCE pND AUTHORVATION OF ENTAY: I certify under penalry of perjury that I have read this application antl state that ihe information given is
correct. I egree to comD�Y with all state laws and ciry ordinances relating to building constmction, and authorize representetives of the Ciry of Coste Mesa to enter upon the
above-des ' d property for i ction purposes I agree no� to occupy or allow occupancy of any builtling authorize �y this permit until tinagl insype�ction.
n t — � � � G /
Signelure Ot Legal Owner(s) Date
And/OrAuthonzed Applicant
COOE I. INPPECTIONTYPE
1616 Fixed System Finel Fire prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 Final BIocWRetaining W�II
202
203
204
2646-A6
Final Factory Fire Place
Final Sign
Final Demolition
�ASE
�b5 yQpE� INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plum6ing
210 Final Electncel
212
220
Final Fire Pravention
Finel Planning Approvel
222 Final Site
250 Final Building/Occupancy
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���a� �sa-sz�a • Fax (714) 754-4856
Job Address: 369 E 20TH ST
Suite No
Vicinity:
Pareel Nunmber: 42630405
Applicant:
Address:
owner:
CITY OF COSTA MESA •
BUILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BANNIER,ROBERT
BANNIER, ROBERT S
Address 369 E 20TH ST
Contractor:
Address:
Areh/Eng:
Address:
COSTA MESA,CA
RENEVJ EXPIRED PE 27839, 1
DISPOSAL,,.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drein, Root
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (14 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
s2z.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$8.75
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
Phone:
Zip:
License:
P��� BER
P99-0003'I ✓
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 01/18/1999
Issued: Ot/19/1999
SCOPE OF PERMIT
KITCHEN SINK, , WATER REPIPE, 1 DISHWASHER, 1 GARBAGE
FEE SUMMARY
Laundry Tub / Washer
Landswpe Irrigation
P-Trap
Pressure Regulator
Process Piping (per 10 tt)
Receptors
Seplic Tank
Sewer Cap for Demo
SewerConneQ
Sewer Private Line
Shower ,
Sink, bar
Sink, wmmercial
Sink, Floor
Sink, kitchen
Sink, service/mop
Spa (pnvate)
Spa (public)
AMT
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
50.00
$8.75
$0.00
$0.00
$0.00
arr
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
COMMENTS / SPECIAL CONDITIONS
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOIATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
ao.00
$0.00
$8.75
$0.00
$0.00
$0.00
$57.00
orr
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapectiona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 754-5626
I hereby aHirrlTuhder peTeu} of peq�ly one of tf� follawing declaretions:
❑ I have end will mgintain a certlficete of consent to self-Insure for workers' compensation, es provided for by section 3700 of the Lebor Cotle, for t�e pertortnance ot the
work lor which this permit Is issued.
❑ I have end will meintain workers' wmpensation insurance, es requiretl by section 3700 of ihe Lehor Code, tor Ihe pedortnance of Ihe work for which this permit is iuuetl.
My workers' compensation Insurence carrler end policy number are: .
Cartier: Policy NumbBr:
(Thfs secfion need not 6e campferedlllhe permit is val�e� a! one hundred dollars ($100/ oi /ess./
❑ I certify that in Ihe peAormance ot the work lor which this permit is issued, I shall not employ any person in eny manner so es to become subject to the workers'
compensation IaWs ot Celifomia, end agree that it I shoultl Cecome su�ject to the workers' compensation provisions ot Sectian 3700 of the Lebor Code, I shall torthwith
camply with thesb provisions.
Applirant Signa[ure: Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION ppVERAC+E IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CPIMINAL PENALTIES AND QVIL FINES UP TOONE HUNDRED
THOUSAN� DOLURE (5100,pp0), IN ADORION TO THE COST OF CpMPENSAiION, DPMAGES AS PROVIDED WR M SECiION 31060F THE LABOR CODE, IMEREST. AND ATTORNEY'S FEES.
LICENSED COMRACTORS DECLARATION:
I hereby eltirm thet I arq licensed under provislons of Chepler 9(commencing with Section 7000) of Divislon 3 oi the Business entl Professions Code, end my license is in tull
lorta and eflect. Lla # Class a
Contrector's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirtn thet Ihere is a construction lentling egenty for the pertortnance of the wark for which this pertnit is issued. (Sec. 3097, Civil CoCa).
Lendefs Name: Lender'S Adtlress:
Signelure: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirtn thet undar penalry ot perjury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7031.5, Business end Protesslons
Code: Any Ciry or coun�y which r8quires a pertnil to construcl, elter, impmve, demolish, or repair eny slructure, pnor to iIs issuance, el5o requlres tha epplicant for such pertnit
lo lile e signetl statemant that he or she is licensetl pursuent to lhe provisions of ihe Contrectors License Lew (Chaptar 9(wmmencing with Section 7000) ot Division 3 of the
Business end Professions Coda) or t�ei he or she Is exempt therefrom and Ihe basis lor the allaged axemption. Any violation of Section 7031.5 Ey any applicant for a permit
sublecis the epplicant to e civ�l penalry of not more Ihen five hundred dollars ($500).):
❑ I, as owner ot the properry, or my employees wlih weges as their sole compensatlon, WILL DO TME WORK, and ihe structure is not intendetl or offared foi sele (Sec.
7044, eusiness and Professions Cotle: The Contractors License Law does not apply to en owner ot properry who huilds or improves thereon, end who does such work
himself or herseli or ihrough his or her own employees, provided that such improvements ere not Intentled or oHered for sale. II, however, the bulltling or improvement is
sold within one yeer ot completlon, the ownervbuil0er will heve the burden of pmving Ihet he or she did not builtl or improve for puryase of saleJ.
❑ I, as owner ot ihe property, em EXCLUSIVELV CONTRACTING WIiH LICENSED CONTRAC70RS to construct Ihe project (Sec. 7044, Business end Protessions
Coda: Tha contrgctors License Lew does not epply to en owner oi property who bullds or Improves Ihereon, and who contrects for such pmlec� with a conirector(s)
— /Ilcense pursuant 10 Ihe CoMractors License Laws.).
� I am ezemp er sec. –�-- Business and Pmfessions Code lor this reason:
SignaWre: '��ci -/�i.iJ2�.�� Oate: � —
Owner ID veritied by dfivers license. ❑ Ves ❑ No Drivefs License No. Expires:
Vedflcation of Ownership by (type of document, I.e. - proparry tax bill or dead):
DIVISION OF INDUSTq1AL SAFETV PERMR CERTIFICATON:
❑ I �ereDy certify that no eacavatlon live (5) or mora teei In depth into which e person Is requlretl to tlescend, will be made In connectlon with work authodzetl by t�is
permit, entl lhat qo building structure, sCeHolding, telsework, or demolition or tlismentling Ihareoi, wlll be more �han Ihirty-six (38) faet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Titla B, Celifomia Administretive Code).
❑ As ownervbuilder, I wiil not employ anyone to tlo work which woultl require a pertnit from the Division of Industdel Satery, as notea ebove, unless such person has a
pertnit to do such work irom the division.
Slgnaiure: Date:
Division oi Industnal Sefery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AIJT}IORIZATION OF ENTTiV: I cetlity untler penelty ot perjury lhet I heve read this applica�ion end stete Ihei ihe infortnation given is
correcL I egree to comply with all stete laws end city ordinances releting to builtling constmction, and authorize representatives oi the Ciry ot Costa Mesa to enter upon the
ebove-d� ri p�perty tor" ection Ouryoses. I agree not to acupy or allow occupancy of any building authorizad by this permit until tinal Inspecti
� �y�� j.
� .�-.�.�--
Signature Of Legal Owner(s) Date
And/Or Authorized AOPlicant
�QDE t. Ixe_YvF�noN?vPe ps¢ �AIS
1616 Fixetl System Final Fire Prevention
1266
200
201
202
203
204
26Cbd6
Pool Spa Final
Final Re-Root
Finel Block/Retaining Wall
Finel Facrory Fire Plece
Final Sign
Final Demoli�ion
�ppfj n+sveenoNTrve
206 Final Mechenical
20B Finel Plumbing
210 Finel Electdcel
212 Final Fre Prevention
220 Finel Planning Approvel
222 Final Site
250 Final BuiltlingiOccupan�y
OA7E URm9lS
I-�I-99 �
Appllcant to f711 In all spaces except t�osa wit�ln �eavy bortler lines antl sign all a00ropriate tleclarations.
PE IT NO. TRACT NO. LOT NO. UNIT NO.
CITYOF COSTA MESA CONSTRUCTION PERMIT A.P.91`-
T/( 3S'
Project AdAress 3� � t` �� ST _ 5 Main Buildi
TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR E
Applicant'iMailingAddress ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T FrOnt
Owner'sName ��� ��%wN��� Phone DESCRIPTIONOFWORK/USEOFBLDG. A Rear
Address sp*A�
i C Right
Arch/Eng. �+//i� LiCenSeNo. TVPEOFPERMIT GRADING FOVNDATION STRUCTVRAI K
Addrei5 —� - ❑ TENANT ❑ ELECTRICAL PWMBING ❑ MECHANICAL S Left
�� �,�.�� ❑ �oTHER Pln Ref. #
Contracror's Name /e�NDR! W��J� Phone �"�i[1 9'
�( 1 PROJECT DESCRIPTION St�. F7. � oCCUPANcv
AddreSS�mailing) �!�� ��- ST y'L �ililliMBA• CONSTRUCTIONTVPE VALUATION$ PlanningNotei:
Ciry License No.
LICENSED CONTRACTOR O CLAFATION
I hereby aHi�m that I am IicenS¢tl unde� provisiOnS ot Cnarter 9(�ommencing
witD�seciion ]000) ot Oivision 3 oi ��e Business antl Profess4on5 Cotle, antl
�rcense is in full force an effect. 41 �O �
nse Class Lic se No.
.e �-�� � Si9nature
W00.KER5' COMPENSATION DE LARATION
ereby aHirm Ihat I have a certificate of �onsent ro selbinsure or a certiBtate
Workers' Compensation Insurance, or a certlfietl <opy thereof (Sectlon
.,tl00, Lab. G)
Policy No. Lompany
eCertilietl copy is bereby fumisheE.
Cer[ili¢U ropy is filed wi[h the City Builtlin9 Division.
Dale APPlicant
EXEMPTION FROM W00.KER5' COM7ENSATION DECLARATION
(This sectiOn ne¢tl not be wmpletetl It the permit is for On¢ huntl�etl (§300) o�
less).
I certify that in lhe performance of the work for which this perm�t Is Issuetl I
snaii not employ any person in any manner s to become subiect to the
WOrkers' Co p ation Laws of Califor
Date?�'��� Si9nature � wl/�
NOTICE: If, a(ter making this tleclarat� n, you shoultl become subject to the
Workers' Compensation provisions of the Labor Cotle, you must �orthwith
comply with such orovisions o� tn�s pe�mit snall be tl¢emetl revoketl.
CONSTRUCTION LENDING AGENCY
1 hereby atiirm that there is a construd�on IenGin9 a9ency for tne performance
Of thu work for which this perrr��� is issuetl (Section 3097 Clv. C.)
l.entler's Name
Lentler's Aatlress
OWNER BUILDER DECLA0.ATION
I„ greby aHirm that I am exempt trom tne Contractor's License Law tor tne
'.��win9 reason (Section 7031.5 Businessantl Protessional Cotle: Any city or
�,}`-i,� o;�ty which requires a pe�mit to coPStruct, alte�, improve, tlBm011Sh o� repai�
'.9;r�Vutture, prior to its issuance, also requires the applicant tor such permit
��8'iile a Signetl statement thdt he/She is licensetl pursuant to tM1e p�ovl5lon5 of
!!+,e Con[ractor's License Law (Chaptel 9.(�ommencing with SecUon ]000) ot
-^.�ision 3 Of Me Bu5ine55 antl ProfCss�ons Cotle) Or that hefshe is exempt
";��iefrom� antl the basis for tne allegetl exemption. Any viola lon of SecNon
':'.31.5 by any applicant for a permit subjects the appllcant to a civll
�enalty o( not more than five nuntlred tlollars ($500).
LJ I, as owner of Ihe property or my emoloyees with wa9as as their zole
CompCnsation, will tlo the work, antl the structur¢ i5 nol In[entletl or off¢r¢tl
lor wie (Section 7044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owPer ot a property wno builtls or improvez
tnereon, antl who aoes such work himseli/herselt or throu9h nis or her own
employees, provitletl thaf Su<h imp�o�em¢nts a�e not int¢�tletl Or Offeretl fo�
sale. 11, however, the builtling o� imOrovement is soia witnin one vear ot com-
pletion, the owner will have the burtlen af Proving he/she tlitl not bulltl or Im-
prove for the purpose of sale).
❑ I, as owner of the property, am exUusively contracting wIN litensetl con-
t�ac[ori t0 mnst�uct the O�oject (Sectbn 7044, Busine55 dntl Proi¢SSlons Cotle:
The Contracror's License Law dOes not dPply to an owner ot property who
builtls or improves thereon. antl who �ontracts for such orolects with a con-
tractor(s1 hcense pursuan[ [o cne Cor�tractor•s License Law). I am aware that
proo/ o( [heir Worker's Compensati0� insu�ance shoultl b0 proviaetl (O m2.
'❑ I am exempi untler Section B. & P. C. for this reason
Date Owner
I nereby terUfy that I nave reai
.Information is wrrect. I a9ree ro
antl Stale laws relating to bui in
sentatives oi this y ter
InSpectiOn purp e
$ignature
Drivers' License or 55 $ —
tion antl st�
all citv antl
GRADING CU. VDS. ACRES
Remarks: a f/E /_�J ( 7i
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outletz
Interceptors
Ki[chen Sink
Lavatories
P-Trap
Roof Drains
/ RtA Ta sx �
Reinspection Fee $15
Boiler
Duct - Untler Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO �k
Heating System & Ducting
❑6100,000 BTU 0100,OOOBTI
Reinspection Fee $15
=_ OB65-46, rev. 5/88 White - BWltling; Canary - ApPlicant; Plnk - Accounting; GOltlenroG - AssesSor
PLUMBING
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeratlon System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
$ 3
FEES
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
DiShwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
QUtI¢t5
Switches
Garbage Oispoul
Generetor �65 KW C
zone
Req./Provided
ELECTHICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter Llup to 100 amps
Merer ❑over 100 amps
Sub Panel
Motors �0.1 HP �tYh - 8
Inc.Solar 09�15 HP �16-15+
Microwave
Pole Light
Range
I I Standing Sections �•
5 K� Trash Compactor
� Reinspection Fee �$15 � � Issue Fea
DEVELOPMENT SERVICES RE�UIREMENTS:
Zaning Approved 6y
Buildine APProved By �
Applicetion laued Bv
FEES
$ 3
SUMMARV OF FEES " '
BUILDING PERMIT $ SMIP ' $ -
PLAN CHECK $ —��- PERMIT � � �
PLUMBING $ � -l1lJ ISSUANCE ' y$
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRAOING�,' $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE, $ S. O�
PLAN CHECK 25% $ '
,�3Iq� �t ooaa��t�-cnoac�c� ����r
I � DA1E: 04/12l�° Ti";_: ;p:;�?�
N
1
N
G
R
E
Q
M
T
S.
-,r^
� CONSTRUCTION AND PLAN�.
��� APPROVALS Permit# ��
1�:.,TemporarV Electrical Service or Pole .
2. Soil Pipe-Undrgrnd. � .
3. Electrical Conduif Utility-Undrgrnd.
4..Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
t � •
6. Electrical UFER Grnd. '
7. Footings .
8. Foundation ' .
9. Water Pipe-Undrgrnd. �
10. Structural Floor System �
11. Property Sewer Line & House Connection
12. Sewer Cap ' �
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16�Rough Electric Wiring
i
171 Rough Wiring Sign
.;
18� Rough Eleariral-T Bar Ceiling
19% Rough Heating & Air Conditioning
f
20. Rough Factory Fireplace
21. Ducts, in Structure ,
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31 . Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co
57. CERTIFICATE OF OCCUPANCY
o, Date
Date
a
�O( SPA
Inspector qppROVA.., � Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test
5�. APPROVALTOCOVER-GUNITE
� 58. Electrical Conduit-Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
�.� 60. Backwash Lines, P-Trap, O Undrgrnd.
� � 61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. FiEQUIREMENT
APPROVALS Permit#
70. Underground Hyilro
77. Product Piping O Gas ❑ Oil
72. Undergraund Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74.� Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes �
e
Date �Inspector
,
4'
ADC�icant to fill in ali soaees exceo� ehose within heavy Ooraer Ilnes ana sign all appropriate Eaclarations.
u PERMIT NO. T C NO. LOT O. UNIT N0.
CI7Y oF COSTA MESA CONSTTRUCTI N PERMIT .� A.P. # — � 2ona
fProject Address ��� E. �V� �` C� �e3{i _ S Main Building: Accessory Buildin9:
�Ap� iiCant'S Maili Add�e55 S�iyYiP. TVPE OF CONSTRUCTION NEW ADD ALTERATION REVAIR E Z
/ ������� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER L C T Front f�� p
'O�wner'sName �� �A'NN�t'2 Phonec21�2-�11D DESC PTIONOFWORK/USEO BLDG. B Rear � N
^address S�m''� �1. A C�r�. _ 1
Arch/Eng. License No. TVPE OF PERMIT GRnDwG O ArlO STRUC7URaL I C Right N
Addtess ❑ TENANT ❑ ELECTRICAI. ❑ PLUMBING ❑ MECHANICAL S Left S� R
Contractor's Nam Phone ��o7HER Ping. Ref. # Parking Req./Provided E
PRQIECT DESCRIPTION 5�. FT. OCCUPANCV � n
Address fmailing) �j� Planning Notes: M
CONSTqUCTIONTVPE_ VAlUAT10N5�1�_,� ( T
CiLyLicenSeNo. ZONE GRADINGCU.VDS. ACRES $,
LICENSED CONTRACTOR DECLARATION
1 hcri�Qy af(irm tM1a[ I am licensetl untler provlslons of Chdrt¢� 9�y6unencing Remark5: sI
witn C tle, antl
my li s i u t a t - � s$ EIECTRICAL PEES
Licen LI N
Date Siqnature PLUMBING F ES Automatic Washer Transformer � 15-50 KW
'QKERS' COMPENSATION DECLARATION ConstructiOn POIe Sub. � 50+ KW
, :by aftirm thal 1 have a Certifica[e of consent l0 5¢H-insur¢ Or a C¢ftifltate Bdf $ink $hOW¢f5
Jorkerz• Compensation Insuran<e, or a certifietl copy thereot (5ection Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, �ab. c.) Dishwasher Meter ❑over 700 amps
Policy No. Gomoany Backflow Irrigation Sewer (:ap
8 certified coov is nereby tu�nishea. � Dryers ❑Gas ❑Electric Sub Panel
Certi(ietl copy is tiletl with the city Builtling Division. Bathtubs @r Conn
Date AOP��cani Fan Motors �0.1 HP �1'h - B
E%EMPTION F0.0M WORKERS' COMPENSATION DECLARATION ClarifiEri
I ss�ssection neetl not be completetl if the permit is tor one huntlretl (g100) or Dish 1 o ar iping F�A��� Ina Solar �y-15 HP �16�15+
I cerlify lhat in lne petfo�mance of tbe wo�k to� which thi5 p¢�m�t i5 i55u¢tl I FixW�CS
shall not employ any oerson in any manner so as to bec bject to t�e Dri Fount � Solar Tank Microwave
Workers' Compen5ation Laws of California.
Da[e Signature Floor Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If, atte� making thi5 tlecla�ation, you Sh cOme subject [o tn
Workers' Compensation provisions of the Labor you Floof S Urinal OutlCtS Range
comO�Y with such provisions or this Dermit 5 e . Switch¢5
RUCTION LENDING AGENCV � Ga55Ervi. Ouile[5 WaterCloS¢t Sign
'�m lhat there is a construction lentlin9 a9 the perfor Garba e Dis osal
rk for which thls permit is issuetl (' on 3097 i Interceptors Water H22[er 9 P Standing S¢ction5
ame Generetor �0.5 KW �5-15 KW Trash Com ctor
�dress Kitchen Si Water Service �
' UILDER DECLARNTION �
1 ne�eby �tfi�m lhat I am exempt f�om the COnt�actor ¢nse Law for th¢ L8v 25 AuLO�W
following reason (Section 7031.5 Business antl Professio Cotle: Any city or
wunTy whici.'?quires a p¢rmit to cons[ruct, alteq improve, tlemoli5h or repab P �
. any structure,--ii�or to its issuance, also requires the applicant tor such permit
to tile a Si9ned Sr'ament that he/She is Iicensed purSUant to [he prOvlsion5 of ��
� ^.ontracrorY LicEpse Law (Chapter 9(commencing with Section 7000) of Ro0 fdins
ion 3 of the Business antl Professions Cotle) or that he/she iz exempt Rai c ian �� $15 luue Fee $ 3
' :from antl [he Dasis fo� Ihe dllegetl exemptiOn. Any vlolation Of Section
Iu3L5 by any applicant for a pe�mit Subj¢Cts the apO�iCant lo a civil ��
' enalty ot not more than five nunarea dollars (5500). EL ENT VICES RE�UIREMENTS:
� I, as owner of [ne property or my employees with wa9es as their sole Reinspe io Fee $15 Issu9 Fee `�' �� P Y Date
wmpensation, will Eo the wOrk, antl Me Structure i5 not int¢ntletl or off¢r¢tl
(or sale �Section �044, Business antl Pmtessional Cotle: The Contracmr's MECHANICAL F S 9 AP �'�d By Date
. License Law tloes nol apply to an owne� of a prOPe�ty who builtls o� imp�Ov¢5
Ihereon, an0 who tloe5 such wo�k M1imself/herself or through his o� her own 1 ppllWtiOn ISSUBd By Dete
employees, provitletl that Suth improvemen[5 are not Intentl¢0 0� offer¢tl t0/ BOil2! HOO I
sale. Ii, however, the builaing or improvement is soltl within one year ot com- e II $ MM� ARY OF FEES
pletioq the owner will bave Ihe burtlen of provin9 he/she 41U not bulltl or Im- DuCt � UOd¢f G�OUnd
provetorthepurposeofsale). _ BUILDINGPERMIT $ S� SMIP $ • 1`�%
❑ I, as owner of the properry, am exclusively mntracting with li<ensetl mn- � ciural 'ger s em P�.AN CHECK $ PERMIT
tractor5 to tonstruct the project (Section 7044, Busines5 antl Prof¢Ssions Cotle: '
The Contractor's License �aw tloes not apply to an owner of property who uct - Ventila � ,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builtls or improves thereon. antl wno wnVacts (or zuch oroiects with a con- �
tractor(sl hcense parsuanc io me Concractors LicenS¢ Law). I am aware tna� �E haust Sysre I� System Repair/Alteration P�N CHECK 25% 5 ENERGV P.C. $
proot o( their Worker'S Compensalion InSu�an<e shoultl be O�ovitletl to me.
ELECTRICAL $ GRADING $
❑ 1 am exemo� untler Section e. & P. G. tor this reason I/Fac[ �� Fire Dampers PLAN CHECK 50% $ MICROFILM S
Date Owner H tem & Ducting Registers MECHANICAL $ TOTAL FEE $
1 hereDy certiry that I have rea0 this application antl siate tnat the aDove ❑4 00,000 BTU �100,0008T P�AN CHECK 25%
informaUon is correct. I agree to comply with all ciry antl county ortlinances $
antl state laws relating to builtling cons(ruction, antl hereby authorize repre-
sen[ Ives of thi city to enter u0on tne above-mentionetl property for
I 2CIi0O OUIp 5. � ^—/ �`�
ignature ��.ii.�v�l1 Date M qeins �
Drivers' License or ss �- pection Fee $15 laue Fee $ 3
OB65-46, rev. 5/88 White � Builtling; Canary - Applicant Pink � Amounting; Goltlenrod - Assessor
CONSTRUCTION AND PLANNING P�� `�` SP'0'
APPROVALS Permit# � Date Inspector �qLS ��rmit# Date Inspector
�� 1. Temporary Electrical Service or Pole 5't � Equipment Location
'2. Soil Pipe-Undrgrnd. � 53. Steel Reinfb�cement ,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � �
4. Electrical Conduit:Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6., Bectrical UFER�Gmd. ' 57. APPROVAL TO COVER-GUNITE
7. Footin9s . 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9; Water Pipe-Undrgrnd. � �� 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System � ����61?�.APPROVAL TO DECK
1 L.Property Sewer Line & House Connection f�^ 62. Backwash & Receptor-Final
i� v
12. Sewer,Cap 63. Heater & Vent-Final
13. Roof Drains � ' a64. Plumbing System - Final
14. Rough Plumbing 65:.,Electrical-Final
15. Rough Electriral-Conduit �,.�!�66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign F.� 68. APPROVED�•FOR PLASTERWG '"
t ' m
18. Rough Electrical-T Bar Ceiling` � "� 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
..r
20. Rough Factory Fireplace ' APPROVALS Permit # ' �
21. Ducts, in;Structure i iL -, 70. Underground Hy`dro ,'
22.Ducts,Ventilating ��T j�. � � 77.ProductPiping�Gas ❑Oil r
23.�Gas Pipe-Rough & Test ' � 72. Underground Flush
24. Roof Frsming �.,� �.� �,� 73. Undergrnd.StorageTank OGas ❑Oil.
25. Roof Sheathing : 74. Overhead Hydro
26. T-Bar,Ceiling (Structural) &�Monoc'oat 75. Dry Ciismical .
27. Frame?and Flashin . i � '
�, � 9 76. Dry Standqipe
'28., Lathing & Siding ��' � .'} 77. FIXED SYSTEM FINAL
ia. �
29. Insulation �, � � 7S. FIRE PREV. FINAL �
r•..
30. Drywall'Nailing �„ .� �,., � - HEALTH DEPT. REQUIREMENT
. �. J
31. Plas'ter;6rownCo�tr,.i • , a 79. FINALINSPECTION
32. Electrical Power Me[e�Final,J y S0. FOOD CERTIFICATE-ISSUED
33. Fina. Electric , � Notes: .,��.-�
34. Final Heating & Air Conditioning :�,
35. Final Gas Pipe-Test �
36. Hood or Canopy , *>.
37. Final Factory Fireplace '
38. Final Plum6ing �
-39. Water Service-Final
40. Gas�Service-Final
,41. Solar pomestic-Final
!
42. Backflow Preventer Y.,�
43. Backflow Irrigation ��
44. Landscape Irrigation SYstem '�
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co !'
51.. CERTIFICATE OF OCCUPANCY
No. Date
1
J
,
�
Aop�kant to t111 in all spaces except ihose witnin heavy ooraer lines antl sign all aoPrapna!e Geclantions.
C'�X OF COSTA MESA CONST'R/UfCTI PEpR-�MIT PERMIT NO. _ TRACT NO. LOT NO. dNIT N���
Project A7ddress '�]Gy � ul � 7 1-
ApplicaM's Mailing nAddress '
� Owner's Name yFl ��-T � ��F� Phone
Address -;G � � � � �
Arch/Eng. License No.
Address
Contractor'S Nam Phone
Address ( mai I ingl
City License No.
LICENSED CONTRACTOR DECLAHHTION
I hereby aftirm Ihat I am licensetl vntle� provislons o1 Char[er 9(commencing
with section 7000) ot Division 3 of the Busine55 antl Protessions Cotle, antl
-ay license is in (uli lorce ana eftect.
cen5e Clazs License No.
�ale Si9nature
WORKERS'COMPENSATtON DECLARATION
1 hereby aHirm tnat 1 have a certiticate oi consent to Self-inzure or a certiflCate
Wo�ke�s' Compensation Insu�ance, o� a certifietl coOY t�e�eof (Section
0, Lab. C.)
.oliq No. Company
P Certified coOY is he�eby tumish etl. �
LJ Certifietl copy is fileC with theJcity Builtling Division. '
EXEMPTION FROM WORKE
(Thissection neetl na[ be Com�
less�.
I certity that in [be Oet�fjj m_ai
Shdl� OOI 2lIlD�OV dfIV�2(i80�
NOTICE: Ii, after aking t
Workers' COmpen ation p
comply with suc p�o
CONSTRUCTION t
1 hereby at9tm tM1at [here Is
oi tM1e wo�k to� which
Lentler's Name
Lentler's Aatlress _
'ENSATION DECLARATION
ie perml[ is for one huntlreU ($300) or
work tor which this perm�t i5 issuetl �1;
anne�so as to becom�subject to�the
lar ior(, you Shoultl become subject to the
� of Ihe Ldbo� Cotle, y0u must fo�thwitit
�r this permit shall be tleemetl revoketl.
GENCV
rtructlon lentling agency fo� the pertormanGe
permit i5 Issuetl (Settion 3097 Civ. GJ
OWNER BUILDER DEC�RATION
I hereby afiirm that I am xempt trom the Contractor's License Law tor the
9owin9 reason (Section 031.5 Business antl Professional Cotln Any Uty or
mty wnicn requires a rmit to construcq alter, improvu, tlemolish or repair
/ StruGture, prior to I[5 Issuanc@, a1S0 r¢qWr¢Slhe ap0���ant tor Such pe�mit
.o filE a Signetl 5[atement that he/sh¢ is IlCensa� pursuanl to Ihe Provisions of
the Contraclor's License Law (Chdpter 9(commencin9 with Sectlon 7000) of
DivlziOn 3 of tne Business antl Professions Cotle) or Iha[ he/sho is exempt
�efrom ana tne basis for the alle9etl exemption. qny violation ol Sectlon
,.5 by any appli<anl lor a pe�mit Subjects tna appliCdnt to a clvll
.Ity o� not more than five nuntlretl tlollars ($500).
l�y I, a5 ownor of Iha Oroperty or my employee5 with waga5 as lheir solu
cdmpensation, will Co the work, antl Ihe structure is not intentletl or otteretl
fo� sale (Section ]044, Business antl PrOf¢sslonal Cotle: The Conl�actor'S
License Law tloes not apply to an owner of a property who builtls or improves
tbereon, antl who tloes such work nimsel(/herself or throu9h his or her own
employees, prOvitletl that such improvemonts are nol i lentloa or ot/cretl Por
sale. If, powever, Ihe bulltling o� ImprOvemen[ IS Soltl wlthin one yea� ot com-
pletiOn, Ihe owner will hav¢ the bwtlen of prOving he/sne tlitl no[ builtl or Im-
prOve fo� lhe purpo5e of sale).
❑ I, as owner ot the prop¢rty, am ezclu5ivery contrac[ing with Ilcensetl con-
tlactors to con5tru[t the O�oject (SeCtion 7044, BuSiness antl Profe55ion5 Cotle:
The Contractor's License Law tloes not apply to an owner of property wno
builtls or improves tM1ereon, antl who contracls (or zuch v�ojects with a mn-
tractor(S litens¢ pursuant to Ihe Conlractor'S License Law). I am aware [M1at
proaf o� tnei� Worker'S COmpensation insurance shoultl be provltled to me.
❑ I am exempt untler Sec[ion B. & P. C. Por [his reason
Date
ntl
mg
city
Signature � —r!—f-! 7
Drivers' License ar 55 �
TYPE OF CONSTRUCTION LI NEW U ADD LI ALTERATION L�YFSEPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCFIPTION OF WORK(lj,$� OF BLDG.= rF ���% ��
TVPE OF PERMIT LJ GRADING LJ FOVNDATION U STRUCTURAL
❑ TENANT ❑ E�ECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 54. FT. oCCUPANCV
CONSTRUCTION TVPE VALUATION 5
ZONE GFADINGCU.YDS. ACRES_
Remarkz: �A AYi M Qr\I �(� 1 I r 1� A�✓1K 1 �['1
nk
Irrigation
[ubs
Drinking Fountains
Floor Drains
Floor Sinks -
GasService �I1LI2I5
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct- UnderGround•
Duct - Struccural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepUFact.81L ICBO# �
Heatin9 System & D� g
❑ 6100,000 qylTL� 100,000 BT
ReinspeMio� Fee � $15
CMF 0865-4fi, rev. 30/84 White - Builtling; Canary - qppp�anh Pink - Acmunting; Goltlenrotl - Assessor
PLUMBING
Service Sink
Sewer Cap
Sewer Connection
$olar Collectors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
LaundrY Trays
Isue Fea
Haodor Typel �
Canopy Type I I ❑
Refrigeration S m
❑0-1� BTU ❑100,OOOBTU
stem Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
S 3
$ 3
A.P. �i`-
5 Main Buildin9: '
E
T front
ARear
C fli9ht
K
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Canstruction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Device Boxes
Butlets
Switches
Garbage Disposal
Generotor �0�5 KW
Fee
�� 4520 3/24/B7
Zone
Accessory Building:
ELECTRICAL
Transformei ❑ 15-50 KW
❑ 50+KW
Meter LJup to 700amps
Meter pover 100 amps
Sub Panel
Morors � 0.1 H P O 1 X- 8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Light
Range
15,40 Tl,
Z
O
N
I
N
G
R
E
Q
M
T
$'
FEES
_r
Standing Sections ..
5 KW Trash Compacior ,
i
$15 Issue Fae � � ' $ 3
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
BuildinB APP�oved By •��
SUMMARV OF
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $ 7-��
�nPLANCHECK 2596 $ �D
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
FEES
SMIP � $
PERMIT � '
ISSUANCE �5
�ENERGY,P:C. $
GRADWG $
MICROFII.M 5
TOTALFEE § !� � O
�
CONSTFiUCTION AND PLANN, lOL 7'� �PA
.APPROVALS Permit# Oate Inspector AppROVAL5 Pei._..:# Date Inspector
� 11fTemporary Electrical Service or Pole , 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. �Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
i t. 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 /1// 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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure �. 70. Underground Hydro
i
22. Ducts, �tilating . . 71. Product Piping �Gas ❑Oil
23. Gas Pipe�Rough & Test . 72. Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing " 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
�,30. Drywall Nailing HEALTH DEPT. REQUIREMENT
.\
' 31. Plaster Brown Coat- 79. FINAL INSPECTION
� �'s1. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning �� '�
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final � .
47. Solar pomestic-Final
42. Backflow Preventer ' ' �
43. Backflow Irrigation �
44. Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING � - '
48. Special Requirements Completed � G
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY �'
� No. Date
�
.Navember 17, 1988
RANDAL JOHN MEBER
128 21st Street f2
Costa Mesa, CA 92627
TO WHOM IT MAY CONCERN:
We have a remodel project at 369 East 20th Street, Costa Mesa, California (permit
numbers BPE 28972 and PE 27839) that has not had ann inspection since February
1988. ,
At no time has more than 30 days gone by without some work being done, either by
the contractor or homeowner on the project.
Attached are receipts for materials and labor from February 1988 to November
1988. This should show proof that work has continued since the last inspection
and that the permits should remain in force.
Thank you for your cooperation.
,2��
;,
, �'�-
Y
Randal John Weber
General Contractor
RJW:Gfs
Nov 2 a �saa
.
AOolicant to flll in all spaces except tnose witnin heavy boreer Ilnes antl sign all aporoo��ate tleclarations.
�CI.TY OF COSTA MESA CONST�JCTION PERMIT
PrOject Address 3C q �Q S7�
ApplicanYsMailingAddress f.bW2E'
, Owner's Name ��6 RAK�N /� Phone
Address ��'��` `
Arch/Eng. License No.
Address
Convector's Nam�
Address (mailingl—�„ �
City License No.
LICENSEO CONTRACTOR DECLARAY�ON �
I hereby atfirm tM1a[ I nm li etl untle� P/ovisions of Charter 9(comm¢ncin9
with section 7000) oi � is on th� Business ana Professions Cotle, and
my license is in full to e antl eife t.
License Glass � License No.
Date 519 t
WORKERS'COMPENSATION DECLARATION
I hCreby affirm that I have a certitica - - o� a certificate
�of Workers' Compensation , a cer i Rtl copy [hereof (Section
- 3800, Lab. CJ
Policy No. ComPany
eCertilietl copy is hereby furnishetl.
Certitietl copy is filetl with the city BU��tling Divi ' n.
Oate Applicant
EXEMPTION FROM WORKERS' COMGENSATION DECI TION
(TM1Is 5¢ction n¢etl not be <omplet¢tl If [hB Permit i5 for one huntl�e0 ($100) or
Iess).
1 certity that in Ihe performance Ot Ihe Work for which thi5 pe�mH i5I55ueG, I
shall not employ any person in any manne� so az to become Subject to the
Warkers' Compensalion Laws of Califo�tlia.
Date Si9nature _
NOTICE: If, after making this aeclaratioP. You shoultl become subject to tne
Workers' Compen5ati0n provi5ion5 Ot tn¢ LabOr Cotle, you must tonnwitn
comply witM1 5uc0 p�ovisions o� [nis Permit Shall be deemetl revoked.
CONSTRUCTION LENDING AGENCV
I hereby atfirm that t�ere is a cons[ructloP lentlinq agency ior the p¢rtormdnce
of Ihe work for which this permit is issuetl (Sec[lon 3097 Civ. C.)
Lentler's Name
Lentler's Atldress
OWNER BUILOER DECLARATION
I hereby affirm tnat I am exempt from �he Contractor's Licenze Law (or ine
followin9 reason (Section ]031.5 Business antl Professlonal Cotle: Any city or
coun(y which �equirez a permit lo consttuct, alter, improve, tlemolish or repalr
any Structure, p�Io� [o its issuance, als0 �equiret the appliGant fOr such pe�mll
to tila a siqnetl slatement lhat he/She is IiCanS¢tl purSudnt l0 the provisions of
tne Contractor'S Li<en5e Law (Chapter 9(�ommencing witn Section ]000) ot
Oivision 3 of the Bu5ine55 antl Pr0(eSsions CoOC) o� lhat he/5M1e u exempt
herefrom antl th¢ DaSiS 10r thC alleqetl exemption. Any violation of Sectlon
/031.5 by any applicant for a permit subjecls the applicani to a civll
[��e�d Ity of not more [han five huntlretl tlO��ars (E500).
`gl, as owne� of lne p�ope�ty Or my employees wlth wage5 a5 their 5018
compensation, will tlo the work, antl tni sVucture is not intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
licCnse l2w tloes nol apply to an Ownet ot a property who builtlz or Impmves
tM1ereon, antl who tloes such work himzeli/herself or through his or her own
employees, prOvitletl that such improveTenls are not intenaetl or offeretl (or
sale. Ii, howeve�, t�e bulitling or improvement IS SOItl within one yea� of com-
O�ecion, lhe owner wili nave tne burtlen ot proving ne/sne tlitl not bu110 or im-
prove tor the purpose of salo).
❑ I, as owner ot [he property, am exclusively contractinq with Iicensetl con-
Vactorsfo mniiruct tM1e projeG[ (Section 7044, Bu5ine55 antl Professions Cotle:
The Contractor's Licenze I�w tloez noi appty to an own¢r oi property who
builtls or improves thereon, antl wno co��racis for such proje<ts wlth a con-
tracto�(5 h[ense pursuant to tM1e Conitd«or's License Law). I am aware Ihal
proof o� thei� Worker's Compen5ation ��su�ance SM1oula bC provitl¢tl to me.
❑ I am exempt un0er Section B. 8 P. C. /or this reason
Date
f
Owner
me
Signature ��„y_
DriverY License or 55 �
tate thai the above
tl <ounty ortlinantes
:by autnorize repre-
ionea properry for
oaie `�i�'�,
C ,o� `-�%� ��' ,�....� ...,. �.,. ...,. urvii rvu.
TYPE OF CONSTFUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER �yp #
DESCfiIPTION OF WOFK/USE OF BIDG.
S Main Building:
TVPE OF PERMIT GftADING FOUNDATION STRUCTURA� T FrOnt
❑ TENANT V�LECTRICAI ❑ PLVMBING ❑ MECHANICAI B Rear
❑ OTHER �:
PROJECT DESCRIPTION 5Q. FT. oCCUPANCY C F7ight
K
CONSTRUCTIONTVPE VALVATIONS g Lef[
ZONE GRADING CU. VDS. ACRES Ping. R¢f. #
Rema�ks: y� �- C � �„ ti�� Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
GasService �U[I2I5
Kirchen Sink �
Lavarories
P—Trap
Roof Orains
Reinspaction Fae � $15
BDiler
Duct - Under Ground
Duct - SLruCtural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 sru O i oo,00a
Reinspection Fee � $75
CMF 0865-46, rev. 30/84 White - Builtling: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Coilectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
I�sue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
00-100,000 BTU ❑ 100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
S 3
$ 3
Automatic Washer
Consvuction Pole $ub.
Caoking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boaes
Outlets
Switches
Garbage Disposal
Generamr �0-5 KW [
Fee
3546 3/06/87
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ov¢r 100 amps
Sub Panel
Motors�U7 HP�1h-8
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compac[or
$15 Issue Fee
DEV ELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
8uilding APProved By _�
10.50 TL
FEES
$ 3
Z
O
N
1
N
G
R
E
Q
M
T
$
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ pERM1T
PLUMBING $ ISSUANCE S
PIAN CHECK 5% p g�c� ENERGV P.C. $
ELECTRICAL ��'�$ /�v GRADING S
PLANCHECK 50°� $ MICROFILM $
MECHANICAL $ TOTALFEE S ��.5�
PIAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# � Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soit Pipe-Undrgrnd. , 53. Steel Reinforcemeni
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5.� Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
6. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
70. 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 Pipinq OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing '73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheaihing ' 74. Overtiead Hydro ' 1
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Ghemical
27. Frameand Flashing � 76. Dry�Standpipe
28. Lathing & Siding '� 77. �FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing . HEAITH DEPT. REQUIREMENT
31. Plaster BrOwn Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80.. FOOD CERTIFICATE ISSUED �
33. Final Electric � Notes: �
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final �
41. Solar pomesticFinal . '
42. Backflow Preventer ;
�
43. Backflow Irrigation � ',
44. Landscape Irrigation System �
45. Sound Attenuation i
46. Handicap Regulations ,
47. FINALS7RUCTURE&BUILDING -
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATEOFOCCUPANCY. •�y_
No. Date ,
�► � ,