HomeMy WebLinkAbout461 20TH ST - Building Permits(714) 754-5273 • Fe�c (714) 754-4856 • www.c�.costa-mesa.�UqLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 461 E 20TH $T ^���ATLv1�jV Status: ISSUED
Suite: � 1�1 � i� Applied: 1222/2005
Vicinity: �T�� Issued: 12I042006
Primary Occ: R3N1 Type of Const n'L� ��
Parcel Number: 42632404 oning: y �, �
npp�icant: FIORELLA CAVASSA
Address: 3419 VIA LIDO
NEWPORT BEACH, CA
Owner: CANFIELD, LEWIS C III
Address 461 E 20TH ST "
COSTA MESA, CA .
Contrector: SURDYKS DECORATING
Address: 3419 VIA LIDO,
SUITE 459
NEWPORTBEACH,CA
Zip: 92663
Arch :
Address:
Zip:
Phone:
License:
� �..
��`�Plt�� 49-28 -5880 ISSUEDBY:
Zip: 92663
Phone:
Zip: 92627-2315
Phone: 949-283-5880
License: 854996
Eng:
Address:
Y I ����
� ID �
p}t'SE
Phone:
License:
SCOPE OF PERMIT
CONSTRUCT ONE-STORY 402 SF ADDITION TO (E) SFD AND CONSTRUCT 77 SF ADDITION TO EXISTING CARPORT WHICH WILL ENCLOSE (E)
�QOSE CARPORT AND CREATE A GARAGE. WORK TO INCLUDE: DEMO OF EXISTING CONCRETE PATIO AND EXTENSION OF (E) LIVING ROOM; RELO
� CLOSET AND CREATE A WALK IN CLOSET; EXTEND (E) BATHROOM; REMOVE ASPHALT FROM CARPORT AND POUR (N) CONCRETE SLAB FL�
KITCHEN.REMODEL. EXISTING FRONT BDRM TO BECOME AN OFFICE.
EXISTING 2 BEDROOM, 2 BATHROOM SFD TO BECOME 1. BEDROOM, 2 BATH SFD.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$486.69
$748.75
$6.50
$0.00
$0.00
$0.00
$1,241.94
SETBACKS �
MAIN STRUCTURE Front 22• 6
ACCESSORY Front 0•0
PARKING Existin : �
Rear 0-0
Rear 0. 0
FEE SUMMARY
PLANNING & ZONING
Left 19- 6
Left 0- 0
Calc Valuation:
Claim Valuation:
Righl 5- 0
Right 0- 0
$65,000.00
$65,000.00
Reouired: 4 Pr000sed: 4
-'1
� / �
'�`��
op
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 780 days.
INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlons and finel approvel must be obtained. Failure to obtain inspactions and final approval will result in the expiration of ihis permit. �
FOR INSPECTIONS CALL: (714) 754-5626 ��
2A66-46(W00) `�'
WORKERS'COMPENSAnON DECLARAnON: -
I �ereby attirtn undar penelry of perjury ona of the following tleclarations:
❑ I have and will melntain e cartificete of consent to solbinsure for workers' compensetion, es provided for by section 3700 of tha Labor Code, for the pertormence of the
wark tar which this permit Is issued.
[�: I �ave and will maintain workere' compensation insurance, as required by section 3700 of Ihe Lebor Code, for the peAormance ot the work for which t�is permit Is issuetl.
' My workers' compensallon Insurenca wrrler antl po numbe{r �are: r^ ^ yn(j
Certier: ��"TG ���, J Polity Number. ��/ �� J U v S
�(This section need not be comp/eted i/ the permif is va/ued et one hundred dollers ($100) or /ess.)
❑ I certify Ihat in the performance oi the work for which ihls permit is issued, I shall not employ eny person in any menner so as to become subject to Ihe workers'
compansation lews at CalHornie, antl agree ihel Ii I Id become subject to t�e workere' compensation provislons ol Sectlon 3700 0l Ih Labor Cade, I shall forthwith
comply with ihese provisions. I
Applicant Signeture: Date: / Z/� 4 I4 (�
WARNING: FNLIIRE TO SEWRE WORKERS' COAAPEN ATIpN CO�/EMGE IS UNLAWFUL M1D SHr1l15UBIECT AN EMPLOYER TO CRIMINaL PENALTIES AND CML FlNES UP TOONE HUNDRED
hKK15ANDOOLURE(5100.00%,INAOpTIONTOiHE TOFCOMPENSATION,DAhNGE50.SPROVIDEDFORINSEClION31WOFTHEUBOPCOOE,INTEREST,ANDATTORNEI"SFEES.
LICENSED CON7RACTORS DECLARATION:
I hereby aHirm that I em
lorce end effact. Lic. a_
.Contractors SignaWre:
of Chep�er 9(commencing wi�h Sec�ion 7000) of DiNsion 3 ot �he Buslness9� d Protessions Code, end my license is in full
, Class'a l7 . C3 'J
— Data: i 2� 0 4 o co
CONSTRUCTION LENDING AGENCV:
� I hereby atlirtn that t�ere is e construciion lending egency for the peAormence of lhe work tor which this permit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lenders Aatlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby afflrm Ihet untler penelty of per�ury ihat I am El(EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires e permit to construct, elter, improve, demolish, or repeir eny structure, pnor to its issuance, also requires the applicant tor such pertnit
to file a signed Stetemenl Ihat he or she Is licensed pursuant Io the provisions ot Ihe Conlreclors Licensa Law (Chepter 9(commencing with Seclion 7000) of Dlvision 3 of lhe
BuSiness and Professions Cotle) or thet he or she is exempi therefrom end tha �esis for the ellepetl ezemption. Any Wolation af Section 7031.5 by eny epplicent for a pertnit
subjects Ihe applicani m a civil penelry o� not more then tive hundred dollars (5500).):
❑ I, as owner ol Ihe properry, or my employees wlih weges es t�eir sole compensation, WILL DO TME WORK, entl the structure is not iniended or oHeretl for sele (Sec.
7044, Business entl Professims Code: The Contractors License Ww does not apply to en owner oi property who builds or improves thereon, and who tloes such work
himself or herself or Ihrough his or her own employees, provided ihat such improvements ere not iniendetl or oNered lor sele. Il, however, tha building or improvement is
sold within one yeer of completion, the owner-builder wlll heve ihe 6urtlen oi proving ihat he or she did not build or improve tor purpose of sale.).
❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the Oraject (Sec. 7044, Business antl Protessions
Code: The contractore License Law does not epply to en owner ol pmperty who builds or Improves ihereon, antl who contracts for such project with a contrector(s)
licensa pursuam to the Coniractors License Laws.).
❑ I am ezempt under sec. Business and Professions Code lor this reason:
Signature: Data:
Ownar ID verified by dnver's license. ❑ Ves ❑ NO Drivers LiCense No.
Verification of Ownership by (type of document, i.e. - property tez bill or tlead):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
� I hereby certity that no excavetion tive (5) or mora teet In Oepth into which e person is raquired to descend, will be made in connection with work authorized by t�is �
permiL antl ihat no 6uilding siructure, scaHolding, felsework, or demolition or dismantling theieof, will be more ihan ihirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomia Atlministretiva Cade).
❑ As owner-builder, I will not employ enyone to do work which would require a permit trom the Division of Indusiriel Sefaty, as notetl ebove, unleu such persan has e
pertnit ta do such work from the division. �
SignaWre: Date:
Divislon oi Intlusinal Safery Permit Number.
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certify untler penalty of perjury ihat I have read ihis epDlicetion and state that ihe iMormation given is
correcL I agree to comply with ell state lews and ciry ordlnances relating to building consiructlon, antl authonze representetives of ihe Ciry ot Costa Mesa to enter upon Ihe
above-descnbetl property tor inspection purposes. I e�ree not to occupy or allow occupancy of eny 6uilding authorized by this pefmit until finel inspection.
Signature
COOE �. INSPECTON TYPE
1616 Fixetl System Final Fire Preventlon
1266 Pool Spe Final
200
201
202
203
204
Final Re-Rool
Final BIocWReteining Well
Final Fectory Fire Place
Final Sign
Final Demalition
PAIE 1[IIIDA4fl
� Z � ate/O �_
Date
y00E 1 INSPELTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa��sCTRICAL PERMIT �� FAIR DFIVE, COSTA MESA, GA 92626
Job Address: 461 E 20TH ST
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
LI11�JU�����
42632404 �Y�� ��
CAVASSA, FIORELLA PER �/
SUITE SgIDO P�yp�pC v� ISSUEDBY:
HedAf 8�L3 0
NEWPORTBEACH,CA
Owner: CANFIELD, LEWIS C III
Address 461 E 20TF1 ST �
COSTA MESA, CA , �
Contraaor: SURDYKS DECORATING
Address: 3419 VIA LIDO
SUITE 459
NEVJPORT BEACH, CA
ISSUE FEE
��� Temp service lest
�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 1000a
Motors l0 1 hp
Motors l0 10hp �
Motors lo SOhp
Motors l0 100hp
Motors over t00hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Inlermed Pole
Zip 92663
Phone:
Zip: 92627-2315
Phone: 949-263-5880
Zip: 92663
License: 854996
Status: ISSUED
Applietl: 12/05/2006
Issued: 12/05/2006
�x.�ZR��
ORTE 19 D
SCOPE OF PERMIT
CONSTRUCT ONE•STORY 402 SF ADDITION TO (E) SFD AND CONSTRUCT 77 SF ADDITION TO
EXISTING CARPORT WHICH WILL ENCLOSE (E) 490 SF CARPORT AND CREATE A GARAGE.
REF:B06-02340
20 LIGHT FIXTURES, 15 OUTLETS, 8 SWITCHES, 1 RES APPL, 1 SERVICE TO 200A, 1 MOTOR TO
1HP
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$22.00
$16.50
$8.80
$0.00
$4.75
$30.50
$0.00
$0.00
$4.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
20
15
8
0
1
�..
0
0
7
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighling
Busway/100ft .
Slanding Section
Misc Electrical Equipment
Transformew 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
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Eleclrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantiry
so.oa o
$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
ao.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTALCALCULATEDFEES 5��0.80
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and ielated
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepeetlona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626 � � .
zans-ae lrvoo)
WORKERS' COMPENSATION DECLARATION: ,
I hereby eHirm under penalry ot perjury one o� the following tleclarations:
❑ I have and will maintain e certificete of consent ro selFlnsure for workers' compensallon, as provided for by section 3700 of the Labor Code, tor ihe pertormence of ihe
work far which this permit is issuetl.
y:
0 I have antl wlll maintain workare' compensation insurance, es reQuired by section 3700 of Ihe Labor Code, for the performance of the work for which this pertnil Is Issued.
My workers' wfnPens,�a-t�ioTn Insuranc,� rner an'�d policy number are: I� 1:� F I�
Carriar. �T+'�,G J�J PolicyNumber. � �-F `�
(This section need not be crompleted i/ the permit is valued at one hundred dollers ($f00) or less.)
❑ I certify that in Iha perlormance ot t� r which this permit is issued, 1 shall not employ any person in any manner so as to become subject to ihe workars'
compensation laws of Califomia, that It I shoul0 become sub�ect m the workere' compensation provisions of Section 3700 of ihe Labor Cade, I shell torthwith
comply wilh ihese provisions.
' 2 � O Co
Applicent Signeture: � Dere: � �
WARNINO: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS IINLAWFUL AN� SHALL SU&IECT AN EMPLOVER TO CPIMINPL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSANDDOLLARE(E100,000),IN DITIONTOTHEC0.STOFCOMPENSAiION,DAAIAGESASPFOViDEDFOPINSECTION31080FTHEL4BORWDE,IMEREST,ANDATTORNEV5FEE5.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn lhet I em licen5ed
toroe antl eHect. Lic. N
ContractoYs Signeture:�
9(commencing with Section 7000) of Division 3 of iha Business� Profe�si�s Code, end my license is in tull
Class N 1 ✓ ` '�
` �Dete: - i Z O �� O�_
CONSTRUCTION LENDING AGENCY: �/
❑ 1 hereby attirm ihat there is e construction lending agency for Ihe pedormance of ihe work tor w�ich this permit is issued. (Sec. 3097, Civil Code).
Lentler'S Name: Lentler's Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Da�e:
I heraby eHirtn thet under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business en0 Professions
Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repair any sWCWre, prior to its issuance, also requires the applicant tor such pertnit
to tile e signed statement that he or she Is licensed pursuani to the provisions oi ihe Contrectors license Law (Chepter 9(commencing with Section 7000) of Dlvision 3 of the
Business antl Protassions Code) or that he or she is exampt therefrom and the basis for the alleged e:emption. Any violation ot Section 7031.5 by eny applicant for a pertnit
subjecis �he eppllcant to e civll penalry M not more �han fiva hundred dollars ($500).):
❑ I, es owner of the property, or my employees with wages as their sole compensation, WILL DO TT1E WORK, antl the sWcture is not intentletl or ottered tor sale (Sec.
7044, Business and Professions Code: The CoNrac�ors License Law does not apply lo an owner of properry who builds or improves Ihereon, antl who does such work
himself or herself or ihrough his or her own employees, providad ihat such improvemenis are not intentled or oflered tor sale. N, however, the building or improvement is
sold within one year of complation, the owner-builder will have the burtlen of proving that he or she did not build or improve for purpose of sale.).
❑ I, es owner oF the property, am E%CWSNELV CONTRACTING WITM LICENSED CONTRACTORS ro construct the project (Sec. 7044, Business end Professions
Code: The contrectors License Law Does not appry to an owner of pmpehy who builds or improves thareon, and who contracis for suc� projad wiih a contractor(s)
license pursuant to tha Contractors License Lews.). '
❑ I em exempt untler sec.
Signeture:
Owner ID venfied hy driver's license. ❑ Ves ❑ No
Business and Professions Code for Ihis reason:
Verification of Ownership by (type of document, i.e. - property tax bill or deetl):
OIVISION OF INDUSTRIAL SAFETV PERMITCERTIFICATION:
Dnvers License No.
Date:
Ezpires:
❑ I hereby certify ihat no excavation five (5) or more feet in Depth into which a person is required to descend, will be made in connection with work euthonzed by ihis
permit, antl �hat no building simcture, scattolding, falsework, or demolition or dismantling ihereot, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Ttle 8, Celifomla Adminisirative Code).
❑ As owner-huiltler, I wili not amploy enyone to tlo work which would require a pertnit from the �ivision of Industnal Satety, as noted above, unless such person has e
permit to do such work irom the division.
Signature: Date:
Division of Indusirial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury ihat I have read Ihis applica�ion end state tha� �he iniormation given is
correct I agrea to comply with ell state lews entl ciry ordinances releting to building consimction, antl authorize representatives of iha Clly of Coste Mesa to enter upon ihe
above-described property for inspection puryoses��ree not to occupy or allow acupancy of any building authorized by this permit until tinal inspection.
CODE t, INSPECTIONTYPE
1616 Fixed System Final Fire Pi
1266. Pool Spe Finel
200 Finel Re-Root
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
�� /pa,�j �/f7 (�
oate �
Qaj� I�$ �Qp�(i INSPECTIONTVGE
206 Final Mechenical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PA� L�fl
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, CA 92626
Job Address: 461 E 20TH ST
Suite No
Viciniry:
Parcel Number: 42632404
AppliCant:
Address:
Owner:
Address:
Contractor:
Address:
CAVASSA, FIORELLA
3419 VIA LIDO ,
SUITE 459
NEWPORT BEACH, CA
CANFIELD, LEWIS C III
461 �E 20TH ST.
COSTA MESA, CA
SURDYKS DECORATING
3419 VIA LIDO
SUITE 459
NEWPORT BEACH, CA
MECHANICAL E�SION
ALL� WEI)
PER..�_
EXPIRES � 8 �
ISSU BY:
Phone: 949-283-5880
Zip: 92663
StaWs: ISSUED
Applied: 12/05/2006
Issued: 12/OS/2006
Phone: T��D
Zip: 92627-2315 T1�� �,
i�+ �
'p
DA`i
Phone: 949-283-5880
Zip: 92663
License: 854996
SCOPE OF PERMIT
CONSTRUCT ONE-STORY 402 SF ADDITION TO (E) SFD AND CONSTRUCT 77 SF ADDITION TO
EXISTING CARPORT WHICH WILL ENCLOSE (E) 490 SF CARPORT AND CREATE A GARAGE.
REF:B06-02340
1 REPAIR/ALT COOLING/HEAT
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Re(rig 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 < t0000dm
AirHandlers> 10000cfm
Floor Furnace �
Floor or Suspend Heater
$23.50
so.00
$0.00
$13.70
$0.00
$o.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00'
$0.00
$0,00
$0.00
$0.00
$0.00
$0.00
�Quantiry
0
0
�, .
0
0
0
0
0
0
0
0
0 .
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorblion Unit
Repair / Alt Refrigeretion Unit
Ventillation System
. Evaporetive Coolei
Comme rcial I nci ne rato r
Domestic Incinerator
Comoressors / Absomtion Svstems
Upto3hpl100kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers ,- -
. . Up to 3 hp -- .
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
.�nvestigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
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
$0.00
$0.00
b37.20
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
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 Inspections and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permi�
FOR INSPECTIONS CALL: (714) 7545626 /
244fi-4fi (fi�00)
WORKERS' COMPENSATION DECLARATION: - �
I herehy eHirm under penelty of perjury ona of Iha toilowing tleclarations:
❑ I heve entl will malntein e certificate of conseN to self-Insure for workers' compensatioq as provided for by sectlon 3700 0l ihe Labor Cotle, tor Ihe peAortnance of the
work for which this permit is issuetl.
[� I have and will maintain workers' compensation insurance, as requiretl by secuon 3700 of Ihe Lebor Code, for Ihe pedortnance of the work for which this pertnit Is issued.
My workers' compansatlon Insurance car�and policy numbar ere: �� 4 3 � 1 �'
Carrier: `'Si-ATt F—'iJ N'ZJ Policy Number:
(Triis secfion need not be comp/eted il fhe permit is velued et one hundred dollare ($700) or less.)
❑ I certify that in lhe pertortnance of the wo���JJJ��� r which this permit is issued, I shall not employ any person in any manner so as to become suDject to Ihe workers'
compensetion laws oi Celifornla, end g�dthat II I shoultl become subjact to the workers' compensation provisions of Section 3700 ot the Labor Code, I shall forihwit�
comply with Ihese provisions. / � �.
Applicem SignaNre: Y � . � ° Date: 12. ('� � b.�J
WMNING�. FAILURE TO SECURE WORKER CO PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIELT AN EMPLOVEP TO CRIMINAL PENALTIES ANO CIVIL FlNES P TO IXJE HUNDRED
iFqUSAND DOLLARE (5100,000), IN ADDITIO THE COST OF CAMPENSATION, OAMNGES AS PROVIDED FOq IN SECTION 3]OB OF THE IABOR CO�E, IMEREST, PND ATiORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereby aHirm that I em licensed under pro ' ia
torce and ettect..Lic. N � �
Cantractar's Signature:
CONSTRUCTION LENDING AGENCY:
(commencing with Section 7000) of Division 3 of the Business end Profe$sions C e, antl my license is in full
Class a �'`�. �3 �
Date: ( ��-. �O \� O fo
� I hereby aflirtn that there is a construction lending agency for the pedormance ot Ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lenders Address:
SignaWre:
OWNER-BUILDER DECLARATONS:
Date:
I hereby effirm ihat under penalry of perjury t�at I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or county which requires e permit to constma, alter, improve, demolish, or repair any structure, prior to its issuance, also requires Ihe applicant for such permit
to tile e signetl statement thet he or she Is Ilcensed pursuent to the provisians of the Contrecmrs Llcense Law (Cheptar 9(commencing with SecNon 7000) of Dlvision 3 of the
Business end Protassions Cotle) or thet he or she is exempt thereirom and Ihe basis tor the allegetl exemption. Any violation of Section 7031.5 by any applicent tor e permit
sublects the applicant to e civil penalry e� not more than five hundretl dollers ($500).):
❑ I, as ownar of ihe property, or my employees with wages as iheir sole compensation, WILL DO TFIE WORK, and the structure is not inten0etl or offered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law dces not apply Io an owner of properry who buiids or improves ihereon, and who does such work
himself or herseli or �hmugh his or her own employees, providetl thet such Improvements are not Intended or ottered for sale. If, however, the building or impmvement is
sold within one year of completion, ihe ownervbuiltler will have ihe burden of proving ihat he or she did not build or improve tor purpose of sale.). �
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Protessions
Cotle: The contractors License Law does not apply to en owner of properry who builtls or Improves �hereon, end who conirac�s for such projecl wit� a contrector(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec. Business and Profassions Code for ihis reason:
Signature: Date:
Owner ID ventied by drivefs license. ❑ Ves ❑ No Driver's License No.
Venfication ot Ownership by (rype oi document, i.e. - property tax bill or deetl):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavation tive (5) or more teet in tlep�h into which a person is required to descend, will be made in connection with work authonzed by this
permi�, antl that no builtling structure, scaHolding, falsework, or tlemolition or tlismantling Ihereoi, will be more than thirry-si: (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title B, Calilomla Administretiva Code).
❑ As ownervbuilde4 I will not employ anyone �o do work which would require e permit from the Division of Industnal Safety, as noted above, unless such person has e
pertnit to do such work irom the division.
Signature: Date:
Division of Induslrial Salety Permit Number.
CERTiFlCA7E OF COMPLIANCE AND A1JT}IORVA710N OF EMAY: I certi(y untlar penalty of perjury thal I have read this application and state Ihat the inlormation given is
correct I egree to comply wit� all state laws and ciry nces relating to building consiruction, end authonze representatives of the Ciry of Costa Mesa to enter upon the
ebove-described property for inspection purpases. I ree�mot to occupy or allow occupency of any building authorized by this permit unlil final inspection.
Signature Of Le er(s Date
Lz/�O� OiO.
And/OrAut zedAppiicant Date
CODE t• INSGECTIONttPE �
1616 Fiaed System Final Fira Preventlon
1266 Pool Spa Final
200 Finel Re-Roof
201 Final BIocWRetalning Wall
202 Final Factory Fire Placa
203 Final Sign
204 Final Demolition ' '
Q�j� �yjfLIAL�^� �QQFP INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Elecirlcal
212 Final Fire Prevention '
220 Final Planning Approval
222 Final Site
250 Flnal Building/Occupancy
Q�j� INTIfI�IS
(714) 754-5273 • Faz (714) 754•4856 • www.ci.costa-mesa.��MBING PERMIT 77 FAIF DRIVE, COSTA MESA, CA 92626
Job Address: 461 E 20TH ST �1 ����1\���� StaWs: ISSUED
SuiteNo �� T ^��JT,�� Applied: 12I052006
1 �Y ➢�cc �r� Issued: 12/052006
Viciniry:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
42632404
CAVASSA,FIORELLA
3419 VIA LIDO
SUITE 459
NEWPORT BEACH, CA
CANFIELD, LEWIS C III
461 E 20TH S7
COSTA MESA, CA
Contrador: SURDYKS DECORATING
Address: 3419 VIA LIDO
SUITE 459
NEWPORT BEACH, CA
PER
EXPIRES
Phone: 949-283-5880
Zip: 92663
Phone:
Zip: 92627-2315
Phone: 949-283-5880
Zip: 92663
License: 854996
ISSUED BY:
EXP o oD
pp•'1�
SCOPE OF PERMIT
CONSTRUCT ONE-STORY 402 SF ADDITION TO (E) SFD AND CONSTRUCT 77 SF ADDITION TO
EXISTING CARPORT WHICH WILL ENCLOSE (E) 490 SF CARPORT AND CREATE A GARAGE.
REF: BO6-02340
t BACKFLOW IRRIGATION 1 BACKFLOW PREVENTER, 1 BATHTUB, 1 GAS OUTLET (1-0), 2 LAUNDRY
TUBNVASHERS, 1 LANDSCAPE IRRIGATION, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK,
1 WASH BASIN, 2 WATER CLOSETS, 1 WATER HEATERNENT, 1 WATER REPIPE, 1 WATER SERVICE
(CHANGE-OUT METER)
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Dnnking Fountain
Expansion Tank � �
Gas Earthquake Valve
Gas (1-0 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$9.80
$9.80
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
80.00
$0.00
$0.00
so.00
$0.00
$6.15
$0.00
$0.00
$0.00
50.00
$0.00
QTY
1
1
1
0
0
0
0
0,
0
0
0
0
0
1
0
0
0
0
0 _
FEESUMMARY
AMT
LaundryTub/Washer $19.60
Landswpe Irrigation $14.80
P-Trap $0.00
Pressure Regulator $9.80
Process Piping (per 10 ft) $0.00
Receptors $0.00
SepticTank $0.00
SewerCaptorDemo $0.00
SewerConnect $0.00
Sewer Private Line $0.00
Shower $9.80
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
Sink, service/mop � $0.00
Spa (private) $0.00
Spa (public) $0.00
gN
2
1
0
1
0
0
0
0
0
0
1
0
0
0
1
0
0
0
!:l1MMFWTC/CDFl:IA1 l:AWf11TIf1NC
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 (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$19.60
$12.30
$0.00
$9.80
59.80
$0.00
$0.00
50.00
$0.00
$0.00
5784.15
QTY
0
0
0
0
0
0
t
0
0
2
1
0
1
1
0
NOTICE: The work aNhorized by ihis permit shall comply with all applicable handicap access requirements under Calilomia statutes and related
regulalions. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapeetions and final approVal must be obtained. FaiWre to obtain inspections and tinal approval will result in the expiration of this permit. ��
FOR INSPECTIONS CALL: (714) 754.5626 �
24064fi (NW)
WOflKERS'COMPENSAnON DECLARAnON:
I hereDy aftirm untler penelry ol perjury one of tha tollowing declarations:
❑ I hava and will melntein e certllicate of consent to salt-Insure for workere' compensation, es provitletl for by section 3700 of the Lebor Cotle, tor the pertormence of t�e
work for w�ic� this permit is issued.
� I have and will mainlain workers' compensation insurance, as required by section 3700 of the Lebor Code, for ihe peAortnanca ot the work for which this permit is issuetl.
My workers' compensfltlon Insurance carrlar and policy number are: / \ R
Cartier. ���'-(� �iJ�li PolicyNumDer. I'O U�� 1v
(This secfion need nof be comp/eletl P fhe permit is velued ef one hundred dollars ($f 00) or less.)
❑ I certity thet In the pedormance of tha work �or which NfSpg.r�it is issued, I shall not employ any person In eny manner so as to bocome subject to the workars'
compensatlon lews of Californla, end egree fhet Ii I ou Ubecome sublect to Ihe workars' compensetion provislons of Section 37 0 of the Lpppbor Cotle, I shell brthwith
comply wlih these provisions. %p /o
Applicant Signature: Date: � 2� �� �O
WARNING: FAILURE TO SECURE WORKERS' COMPENSATI IJ COVERAGE IS UNUWFUL PND SiW1L SUBIECT AN EMPLOYER TO CRIMINNL PENPLTIES AND GVIL FlNES UP TOONE HUNDFED
TIIOUSAND DOl1AHE (5100,000�, IN ADDITION TO TME COST COMPENSAiION, DAhNCaES AS PROVIDED FOF IN SECTION 3'!O6 pF THE LABOR COpE, IMEREST, AND ATTORNEV'S fEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn ihat I em Ilcensed under praWsi�qs of ha e (yommencing with Saction 7000)af DlWsion 3 oi the Business and �P/ofession3,�Qde, antl my Ilcensa is in full
force entl eXecL Llc. q 75 cJ � b Class» �`). �- i j
Contracmrs SignaWre: �- Date: r'Z � 5 '� �
�l i
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that there is a wnsiruction lending egency for the pertormance oF the work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: Lendars Adtlress:
Signature:
Date:
OWNER-BUILDER DECLARA710NS:
I hereby aHirm Ihel untler penalry oi perjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any city or counry which requiras e permit to wnsiruct, elter, improve, demolish, or repair eny structure, pnor to its issuance, elso requires ihe applicant tor such pertnit
to file e signed sletement that he or she Is Ilcensetl pursuent ro the pmWsions ot Ihe Contractors Llcense Law (CheO�er 9(wmmencing with Section 7000) of DlWsion 3 of t�e
Business antl Prafessians Code) or that he or she is e:empt therefrom and the basis for the elleged ezemption. Any violatlon of Sectlon 7031.5 Cy any epplicant for a permit
sub�ecls the epplicant to e civll penelry c� not more ihan live hundred tlollars (5500).):
❑ I, as owner oi �ha properry, or my employees with wages as their sole wmpensation, WILL DO THE WORK, en0 the structure is not intentletl or oHered for sale (Sec.
7044, Business anC Professions Coae: The Coniractors License Law does not apply to an owner of properly w�o builds or improves thereon, end who does such work
himself or herseN oi �hrough his or her own employees, providetl Ihat such improvements ere not Intended or oNerad for sale. If, however, tha building ar improvement is
sold within one year ol completion, Ihe owner-builder will heve Ihe burden of proving ihal ha or sha tlid not build or improve for purpose ot sele.).
❑ I, as owner of Ihe property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tho prolect (Sec. 7044, Business antl Professions
Catle: The cantractors License Lew tloes not apply to en owner of propeny who huilds or Improves thereon, and who contracts for such prolect with e contrector(s)
license pursuent to the Contrecrors License Lews.).
❑ I am exempt untler sec. Business antl Professions Code for this reason:
SigneWre: Date:
Owner ID verifietl by tlrlvels license. ❑ Ves ❑ No Driver's License No.
Verification of Ownership by (type of tlocument, I.e. - property tez blll or dead):
Eapires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certlty that no excevatlon flve (5) or mora teet in depth into which a person is requlred to descend, will be metle In connactlon with work authodzed by this
permit, entl thel no building siructure, scaflolding, telsework, or demolition or dismantling thereof, will ba more then Ihiny-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, 7tle 8, Celitornie Adminlsirativa Cotle).
❑ As owner-bullder, I will not employ enyone to tlo work which would require a permit fmm the Division of Industdal Safety, es noted ehove, unless such person has a
pertnit to do such work from tha division.
Signature: Date:
Division of Indusirial Salery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I cenify under penalry ot perjury ihat I have reatl this ep0�ication antl state ihat the information qiven is
correct. I agree to comply with ell stete laws end ciry ordinances relating to huilding construction, end euthorize representatives ol the City of Gosta Mesa to enter upon the
ebove-descnbetl property for inspection purywes. I ag� not ro occupy or allow occupancy ot any building authonzed by this pertnit until final inspection.
GOOE�, INSPECTIONTYYE Q� INTRIALS
1616 Fixed System Final Fire Prevention
7286
200
201
202
203
Paol Spa Finel
Finel RB-Rool
Finel BIocWRelelning Well
Final Fectory Fire Place
Finel Sign
204 Finel Demolltion
CODEI INSPECTONTYPE
206 Final Mechanicel
20B Final Plumbing
210 Final Elecirical
212 Final Fire Preventlon
220 Final Planninp Approvel
222 Final Site
250 Final BuilCingiOccuOency
(2rPaJ o cF'
Dete
PAiF IrrmuLS
Pamela Canfield
Lewis Canfield
461 E. 20`" Sri'eet
Costa Mesa, CA 92627
(949) 650-5999
October 5, 2007
Ed Petros
Chief of Inspection (Building Division)
P.O. Box 1200
77 Fair Drive
Costa Mesa, CA 92628-1200
Reference: Pamela Canneld
Lewis Canfield
461 E. 20�' Sh-eet
Costa Mesa, CA 92627
Permit Numbers: BOS-02360; E06-01388; M06-00786; P06-00994 Addition
Dear Mr. Peters,
We are requesting an extension at this time. We are having a parting of the ways with our current
contractor. We do not feel he will do the job correctly, timely, or supervised properly.
We are in the process of getting some new bids from contractors we feel will do the job. We are
hoping to get started with something in December 2007. Hopefully our completion date will be
approximately 6 to 7 months.
We know the city is again offering free building permits this year. This is a wonderful incentive
to improve our property. If we need to pay additional fees, that will be at your discretion. We
would like to ]mow what those fees will be.
We have invested a lot of time and money in these plans and would like to use them. If you need
any further clarification of the situation please give me a call at our home, (949) 650-5999.
�
We look forward to our future remodel and hope to hear from you soon so we can go ahead with
our plans.
Thank you, - �./ /
y�>�Gt/C�����t/
Pamela Canfield
�
4/18/2008
City Of Costa Mesa
Att: Ed Petros
Chief of Inspection
714/754-5295
RE: Building Permit 6ctension
PROJECT: Pamela & Lewis Canfield
Private residence J remodel a�d addition
ADDRESS: 461 E 20th Street, Costa Mesa CA 92627
PERMIT NUMBERS: B05-02360, E06-01388, M06-00786, P06-00994
PROJECT ADDRESS: 461 E 20th Streei, Costa Mesa CA 92627
Dear Mr. Petros,
We very much appreciated the extension we were granted for our remodel. Unfortunately, due to
scheduling conflicts and family matters we were not able to start our project before the expiration
date. We now have ali of our issues resolved and our workforce is now in place and are prepared to
begin as soon as possible.
We're looking forward to starting our projeci and are hoping you can grant an extension of the per-
mit date without the addltional fees se as not to er,ceed our limited budget? We are requesYing an
additional 30 to 45 days.
We realize that we are asking a lot, but ihe improvements are very much needed and we are anx-
ious to get started.
Thank you for working with us. We apologize for any inconvenience and appreciate any help you
can provide in this matter.
Sincerely,
Pamela and Lewis Canfield
Tuesday, June �; 200i�11:04 AM
Roger Surdyk 9497227752
y�, ��
SURDVK'S UECORAiIIVG
Sent By: Roger Surdyk
Company: Surdyks Decorating
Fax Number: 949-722-7752
Voice Number: 949-283-5880
E-mail: sd@surdykedecorating.com
Total No. Pages:
•
Interior Design . Rzmodeling � Maintenance
3419 Vla Lido, Suite 459 - Ne�vporl Beach, CA 92663
Offce/Fax: (9491722-7752
Llcense tt 854996
www.surdyksdecorati ng.com
Recipient: Burt Morgan
sun�ect: Activlry Number # B05-02360
Company: City of Costa Mesa
Fax Number: 17147544856
Voice Number: (714) 754-5270
Date: 6/20/2006
Time: 11:04:11 AM
CONFIDENTIALITY STATEMENT: The information in this fax and its attachmants, if any, is confidential and may be
legally privileged. It is intanded for use only by the addressee. If you are not the intended recipient you are here6y
notified that any disclosure, copying, distribution or use of the information in this hax and its attachments is strictly
prohibited. If you have received this fax in arror, please notify the sender by telephone at the number listed abwe and
dalatad tha originel meaeaga from your ayatam. Thank you,
. / . IIQI06.
� v
1 � �y,
`• �'�U
/`�/l1 t
�
� ly,�o�
0
- 9PECIALTY FINI9HE9 - PLUMBINO • DEMOLITION • ELECTRICAL • INTERIOR DE910NER -
- GRANITEITILE - WOOD WORKING - PAINTING INTERIOR/EXTERIOR - REMODELING -
• HAFiDWOOD FLOORS - LANDSCAPINO - AUDIONIDEO - ARCHITECTURAL 3D PLANS •
p.01
Tuesday, June 2� 201iit11:04 AM
SURDYK'S DECORATING
3419 `i 4a Gido, Suite 459,
Nezvpon Beac�,
� 92663
License # 854996
Office/�F'a�;• (949� 722-7752
sdc�snidyks�fecorati rtig. conr
:vww.sur�yksdecoratirag. ccm:
Jurse 20, 2006
Roger Surdyk 9497227752
Burt �forgan
C�i�f'�'lans Examiner
Cily VE CUSrQ ��t'ICSQ
�Po 2so.� 12W,
Casta �tesa, � 92628-1200
ActiT�ty 9Vum6cr.�
�PrnjectAddress:
�arBurt �Morgan,
B05-02360
461 E. 20�� St.,
�osta �tesa, CA �2627
r1
U
p.02
'�'e 2voulda�recrate it if you cou(dgive us an e�tension on the actrvity rcum6er
Cut�d'a6ove as long as possi6l�, we cotttinue in process wit(a t(a project anrfzve are
waiting for ifta plans to 6e finu(:,
If you have any questions please contact us at tfie off�ce 949-722-TTS2.
,$'incerefy,
�a�s�.dyk.
Sur4'yk,�s �corating
Gicense # 854996
Specialty Fi�eiske.r —�Plun:6in�— �Denrolition —�El�ctncal— Iroteno��Duigraer— Gra�aite s'�
7iCe — �GiJnod 4Norkiieg — �Pairetir�g Ircterior o� �Eltrriar— Rynro�feCreg —.7Cardurond �Fl4nrs —
Gaadreaping —Aud'w cQ `Video —ArcfiitecturalcQ 3�D �Plans
�(��
OWNLR CARPE'NTER� DeIlIiis DATE 10-19-62
JOB ADDRESS 1 E. 20th St. BUILDING PERMIT NO. 1
GI3NERAI. CONTRACTOR W. W. Pearson VAi,iiF. S 1 5.00
pY No.110-8yj-1"( LOT TRACT
INSPI,C'CIONS � Signature
C
Water
F
FIR� ZONE DESCRIPTION OF WORK
DATP I GROUP .7 TYPE v 7.ONG
SU6CONTRACI'Olt
t0
/rj/1' WaL .S/G//%Q� � r4s �G7i'/��E�-eN DCGduS'E. /C/E lTerlSG' /S
J
GCi�c1�J7T �2� TFT/S T�/'!Q � S C�uv���T ,'fr� iat Te s�e d�� �f 7�'C
P2��rG ///% cciSE 8•�l��f/� /(d /�iE71 Q�l��PC.-
Y � t 8040
i{OSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOI[ 917 COSTA MEBM CAL�FORNIA
For Applicanf io Ffll In Complefely
TYPE OR PRINT
ADDRESS � � �
COSTA MESA. GALIFORNIA
OWNER � (� C
aooRess /.l-� � �i - eZfl Tf1 �51t
�'� �i���.� v �
ocT 1 � t�2
. F��pIVCE OEPT.
CITY OF COSTA �ESA
APPLICATION FOR PERMIT
BUILDING
For Ofiiee Use Only
R8Ce1PT NO. P���
[Il�°" I °��_"�'�°L�-��`-'�
ADB`nE�S ZONE N Y TVPE GROUP
CONTRACTOR / D� BYPROV DA� D � y
ADDRE68 O D T• Z� ING ,,�'
Z 8 NO. OP U8E OP NEW � /
CITY � I PLANB � I BUIIDINO '✓4
6TATE SD YG NO. L¢oA� LD� EL—�!3.�C i/
LIC. NO. DHBCqIppON
SIZE 0 � I NO. OP BLDpB. ' � � ,1 _ ��
OF LOT NOw oN LOT p, p, NO.
USE OF L``�� NG[' YARDS EVES
EXISTING BLDG G7 �= qppHOVED ALLOWED
6HT9ACK LINB FROM � IC[NT6R LINe 9T.1 �%
cervrca ov ernser REAR YARO O FRONT -J "I .� IN.
/ /
SIDE YARD I LEFT ' RIGHT ft. SIDE . FT. .S'�J IN.
DESCRIPTION OF WORK
�/ L.SIDE FT. / IN.
NEN' I VALTERATION I IIADDITION I/� e�.e ` y/ �^---/' ._.
I BUILDIN
pF �MS `� STORIES
I HBPHBY ACNNOWL8D06 TH�T 1 N�� RGD iM18 APPUGTION TM8 AMOUNT BHOWN YNDlR VALtlATION 18 POR Tfl[
AND 9TATH TMAT TH8 ABOVH 18 CORRECT AND AOP88 TO COM-
PURPOB¢ OP l9TABL18HINp � PERMIT F¢E ONLY.
PLY WIiN ALL GIlY OIiDINANCE9 AH ATB LAWB NEOUtATINO
BUtLO1N0 CONBTxu N. VALUATION +�
61GNATUfiE OF PERMIT FEE $ 7'�
PERMITTE a
S /�S- PI,AN CNECK S
i
AUTHORIZED AGENT p
TOTAL FEE �
LL
OWNER DOADI.'DR. THOMAS W. DATE
JOB ADDRESS libl E. 20th Street B[IILDING PERMIT NO. 8053
GFN$[�,�pNTRACTOR Barnev C. Lvons VALUE $-2,559.00 �
FIRE ZONE
GROUP I TYPE V ZONE RL PLAN NO.
'�ECTIONS � DATE � SUBCONTRACTOR
Test
I Y ' � •.. .� �i�UJ�
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31�
COSTA MESA. GP.LIFORNIA
FOR APPLICANT TO FILL IN
eui�oiNc �i � � GU�� Y
ADDRE55
COSTA MESA. CALIFORNIA
OWNER oa. �,��,-, �s a' o- n�
ADDRE55 '� G' I�• /�, �7 z� S"l.
CITV � .,ji. � �}j��`,C� TNO.�I �L'1�
ARCHITECT LIC.
OR ENGINEER - NO.
CONTRAC�R• --7��� GO N�JJfI✓ •• • NO. II �[
A�RE� �wJ I"�St N� 'i. 7r.C.
LEGPt LOT /
DESCRIPTION NO. BLOCK TRACT
A.P. NO. ^ — �
SIZE % NO.oF aLDGS. /
OF LOT (J+ now ON LOi
USE OF O, /�
E%ISTING BLOG, i/� //
SETBnCK LINE FRO ) � %��
CENTER OF STREETM � l REAR YARD �G�+�/'
SIDE VARD RIGHT — O-„EFT , =Q ���
DESCRIPTION O WORK
NEW q�TERATION ADDITION ^
REP� MOVING �EMOLISH
BUILOING• I NO.pF
SIZE ROOMS � STORIES !
IEXTERIOR WALL H� ROOF
COVERING �fivGG(� COVERING �i(��
USE OF NEW / / /` /'n I' �� �n % hn,M
BUILDING .tk✓e�J t- il ro
MEREBV 4CNNOWIEOGE TX<T I HPVi /�U lXIS P LICNTION GND
STTT[ THPT THE FBOVE IS CORRECT f�N� GREE TO CO�{ LV WITII ALl
CITY OROINArvCE��1�5T(y{E L4W5 RECuGATIrvG BVILfJI1�G CONSTPUC�
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APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
�
COSTA MESA. CALIFORNIA
.�ns �I [/
DATE
CORRECTIONS
CITY� O��r�
—f"�U �� T
..uBJECT TO
L� '.t �
4 n;ESA
�
UEf'T. REG.
/ �- � z�--_
• ��—� Z
VA UATION
PERMiT FEE 5
5 ���j\ PLAN CHECN S
/ TOTAL FEE 5
OWNER DOAN, DR. THOS. SEP 2 4 1957 DATE 3-7Ji-57 �
JOBADDRESS (ybl F',. 20th Street BUILDINGPERMITNO. #(i(�S9
GENERALCONTRACTOR R. E, Piichelson VALUE � Z,�OO.00
AP118-293-17 . , nn �.._
�oT a
GnJUP I
INSPECTIONS
Footing Trench
Foundation Forms and Grgde to G
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
Sewer, House Sewer, St.
Septic Tank or Cesspaol
Lathing,ln Out
� F�`�`erin
�, .. 9
P. libing, Final, Fixtures Complet
Plu�m �bing, Fin.al GasTest
Wiring, Final
Occupancy
� FORM 110 3M 10-^v0
K TRACT
���
SUBCONTRACTOR
PERMITSISSUED
DATE � NUMBER
�' ��40 . FEE RECEIVED
~�OSTA MESA BUILDING DEPARTMENT � �� � �. t �� � �� �
n. o. eox 3 i�
COSTA MESA. CALIFORNIA � FINANC�E DEPf�.gp
FOR APPLICANT TO FILL IN A�'LI�A9"R7NMFCJR PERMIT
ADD E�55 �'����-�T4� �T C� M.� BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
OWNER
CITY � S
AODi. e
�een� ILOT . O_
OESCflIPTION N0. (.i
A.P. NO. /�
SIZE D X
OF LOT
USE OF n £
E%ISTING BLDG. p
SETBwCR LINE FXOM �
CENTEN OF StNEET
SiJ
TEL.
NO.
LIC.
NO.
{..S�ITY NO. �� ! Zo�
7
G•O. h'�, NU. 3�82-M erPR��
ILOCK TRACT��
'3 - /
� NO.OF 9LDG5. �
SIDE YARD RIGHT ��" LEFT � T
DESCRIPTION OF WORK
NEW ALTERATION � ADDITION
REPA. MOVING II DEMOLISH
BUIIDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USEOF�"�/✓C/— ���.P�ii
BUILDING
�
L h
COSTA MESA. CA�IFORNIA
$V
DATE
CORRECTIONS
newenvi ce . ve wcno rris �rr�ic�riov �rvo
$T�TE TN�T TNE �BOVE IS CORRECT wN0 �GNEE t0 COMPLY WITX �ll
CITV ORDiNRNCE$ FND STOTE L�WS REGVl1TING BVILOING CONSTRVC-
TON. � VALUATION
SIGNATU(iE OF PERMiT FEE S
PERMITTEE
�� PLAN CHECK S
s � SDl7 —
AUTHORIZED AGENT TOTAL FEE B
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COUNTY OF ORANGE
, BUII.DING DEPT.
636 No. Broadway
Santa Ana, CaGfornia
Phone: KI 2fi211
r _
Applicalion for Building Permit
AND FOR A
Certificate of Use and Occupancy
Permit No..�r�A1-_.�L]..1
Date.---'---��. C.r �.....---� �--_-_"�'. �_5" z"
1. OWNER'S NAME.......--�_Y-�----�-----.P...c.�.-��°-'-�- ��-�-�-��---------•---- --� - �---- PHONE:...�_i..-- --I�I�`9__il�,
MAILING ADDRESS.........�Y—=c (:\_n C'�,�----�1Fr? p,� ��--• -� �-�.-��=- CITY. <<b. 5.�..�t�....---��5-��--�---:...
���4 4
Name.........�_.�--'--...�.QS..._��..�._�1K=-............ Name ..-------�✓�N�.).�.-��--^-"�li_\\_nl-�
� (Ar[hlcect-or-$�in¢ec) � (Contractor) .
Address._1-1._�x�..---._�:...... A .r.�.)..�5!5.--� -- ._........... Address ------...........----------------------�------------�------•--•-
Ctry... -C--�--�i--S--T-�--.......MF'�!� :..................... Cicy ..........-- --�-��--�� -- --..........---..........---...---------- --------
State � State
Lic. No.- � -- ............_.........-.--.. Phone---- �o. � 3..`�1.- �----- Lic. No.......-- - � -- -- - ------ -... Phone...----�-.._----------------..
PROPOSED
z�JOB
\
� (House NoJ � (Name oi Street) (Toam or School District)
NAME OF AND DIRECTION FROM NEAREST CROSS STREET.��. � ST_�.41�......�:.........` 4_.fS_��.�_�'�...:.....
3. LEGAL DESCRIPTION: Lot- -------------� !S__---------------------.Block --------------- ------- ....---...- -----...... Traa..._..- �=- �-�--------�
(Metes and Bounds Description—Use reverse side of form)
4. CORNER LOT ( ) INTERIOR LOT ( 1�� THROUGH LOT ( ) SLOPE OF LOT ) fZ� ,a o�v
i. SIZE OF BLDG.:....---------------- --- AREA:---_I_`� fl_.�-3..........SIZE OF LOT:----�"-V---T---,--�Y�---..AREA:...,- -:--�----- �--
i rr /
6. HEIGHT OF BLDG .:.............�=._L.�............CEILING HEIGHT:.._....._...�.�..�.........__.._.....NO. OF STORIES._........�..__..............
7. NO. FAMILILS .............�'-----------------......Size of Smallest Bedroom:-.-.�Q-,�---/_.�...._..... Sixe of Kitchen..-.-_�.�---.�.�.....�_�_
8. EXTERIOR WALL CONSTRUCTION:_�.TLL-..�.�...........INTERIORWALLCOVERING....P..L.A..S.T.��_'_...�.1.1��
(Frame, Stucco, Ete.) � (P]asterDrywall, Ete.)
ROOFING COVERING - �-'_ � .,l.:-z._:�:?.. `._5.... �.__....t-� n �'"= - . ............ - - - ... - .... -- ............--- - --- --
A STATE HOW MANY BUILDINGS NOW ON LOT AND GNE USE OF EACH......_....�`.%3-G� ..............................
10. SETBACKS: Front Yard From Center Line of
/ i
Nearest Side Yard._....._�........Reaz Yud....��........Distance in Feet Between Bldgs. on Same Lot ..............�"............__...__.._..
(Property line) (Property Line)
11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
r� ry
]2. (a) Footing: Width-_-..._..�...�<'..� ..............._---Depth in Ground.......-.-�-�--_.----WidthofWall---_.:..—�-----_-..
(b) Size of Studs:..._�.?!l_�.....Spacing....___��...'.,._"CC Material of Floor......._�.�!y�--�-�.!�.
(c) Size of Floor Joisu:......-----�-�-------�---........----Spacing....------- - ---------�-- �------ -��CC
.�
id Sizeof Raft�`rs:....._.....�=._� `�� ..S acin �� "CC
) ----.....--�------�- P 8....---------------.,..._......---
13. VALUATION OF PROPOSED WORK: Including all ]abor, plumbing, electrical wiring, heating, (ire sprinklers, painting and
sewage disposal 5.----.-•O_�. _4-=��---.........
14. J HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Si ned:...-----��-----�.�!_��. /�l��� � .:� x
..- ------ ------.. .-------' �-----� --
/G —� a — S � , '" � /f �� e���� - --�-----
Plans Filed :.......................... -...-�-------•--- '
..-------�-----......--
���^ r-.. a.. , ��!�_,
By"'-' ......................'-----'-'--`--•'-"-.....-------."'---"'_..__....... ..""'---"--"-"'
(Auchorized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: G U
Bldg. Permit - $...�..�..� J--_-.---.
Plan Check • $----..��-- p�Q ---------
Total , . . $.��..!�---------------------
Receipt No. • .��'.3��y_`{?�..-`.�.-----. -
Paid to • ' ---^�X-�✓-•1.--------..
Date ��_-..r�...G_..'_.S �.
--------�------� ----
GROUP--�.... - - �....
TYPE--�-----�--- ..............
DIST.
M.�-----�--R-`��---�-��---�-
SHEET NO.---=r---------------
�-.�-/
DATE....---�--.-�- ._LI��'-..Il...-.
s000-->-sn
C.�KING BY
APPLICATION. ___ . . HEALTH ............................
ZONING-----.-_-_.`.�---..- FIRE
MARSHAL...- ----- -- ...
PLANS AND �
SPEC'5------�----...... -- STATE...._.. •---------- ------.....