HomeMy WebLinkAbout469 20TH ST - Building Permits� �
(714) 754-5273 • Fau (774) 754-4856 • wvnv.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA. GA 92626
BUILDING PERMIT
�ob nddress: 469 E 20TH ST
Suite:
Vicinity:
Parcel Number: 42632405
Applicant: HENNINGER, NORM
Address: 13052 EDWARDS
WESTMINISTER
Owner: MADER, S7EPHEN
Address 469 E 20TH ST
Zoning:
Phone: 714-985-6677
Zip: 92683
Phone: 949-631-4057
COSTA MESq, CA Zip: 92627
Contractor. AFFORDABLE ROOFING & REPAIR
Address: 73052 EDwARDS
WESTMINISTER
Zip: 92683
Arth :
Address:
Phone: 774-985-6677
License: 755616
Eng:
Address:
Status: ISSUED
Applied: 09/05/2000
Issued: 09/05I2000
ISSUED BY: CLY'�
Phone: Phone:
Z�P� License: License:
SCOPE OF PERMIT
TEAR OFF INSTALL 7/16" OSB, 30 LB FELT AND 40 YEAR COMP. SHINGLES.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$153.25
$0.00
$1.52
$0.00
$0.00
$154.77
SETBACKS
MAIN STRUCTURE Fron� 0- 0
ACCESSORY Front 0-0
PARKING Existinq: p
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
57,250.00
57,250.00
NOTICE: The work authorized by this permit shall comply with all applicabla 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 it work is not commenced within 180 days, or il work is suspentled or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ali
required Inepectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 75A-5626
zaa�ae �aroo�
WORKERS'COMPENSATION DECLARATON: '�
I �ereby eHirtn untler penelry ot perjury ana ol the tollowinq tleGaretions:
❑ I heve entl wlll malntein a certlficato ot consent to sell-Insura for workers' compensation, as provitletl for �y section 3700 of the Labor Cotle, lor tha pertormance of the
work for which Ihis permit is issue0.
I have and will melntein workers' campensation insurance, es require0 by section 3700 ot Ne Lahor Cotle, lor ihe peAormance ot the work for which ihis pertnit is issued.
� My wyNce�c�� syipn Insura9�e cerrier and policy number are: � /�� ���� _ O D
Carrier. -S �Y� � ��,✓il Poli Numbec
(Th/s sectian need not be comp/efed i! (he permif /s velued et ane huntlretl tlollers ($700) or less.)
❑ F in the pertormance of lhe work lor which this pertnit is Issuetl, I shall not employ any person in any manner so es to bewme SubleM to Ihe workers'
com ensetio ws o Cellfo�la, entl agree that il I should become sublect to the workers' compansation provisions oi Secpppon 370ppp 0/ the Lebor Code, I shall lotlhwith
ipywu t e visl /%1,I � /' / �
AppllcenlSignaWre: (� Date�: / �— ��
WARNINO: FAILURE SECURE WORKER$' COMPENSATIp .MGE IS UNLAWFIIL AND SMALL SUBJECT AN EM TOR9Y�if CRIMINAL PENALtIES AND CIVIL FlNES UP TOONE HUNDRED
�HOUSAND E(5100,000�. IN ADDITION TO?HE W5T OF C QENSATION, DAMAGES AS PROVIDED FOF IN SECTION 3]OB OF THE LABOR CODE, IMEREST, nND ATTORNEY'$ FEES.
LIC ED CONTRACTO S DECLARA710N:
I y eHirm thet I em I' ense under pr ry�ions of C�epter 9(commenUng with Sectian 7000) of Division the Business en fessi�+3�i4�e, end my license is In tull
rce entl eNect. Lic. a 7.�� �6 � y q �-.3 J
Comrecmrs Slgnat � Dete: i� C: O
TION LENDING AGENCY:
❑ I hereby eflirtn Ihet there is e canstructian lentling agency lor Ihe peAormance ot the work tor which t�is permil is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendefs Atltlress:
Signature:
OWNER•BUILDER DECLARA710NS:
Date:
I hereby elfirtn that under penalry of per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Protessions
Code: Any ciry or counry which requires e permit to conswct, alter, improve, tlemolish, or repeir eny stmcture, prior to its issuance, also requires t�e epplicant lor such permit
to Ille a signetl siatemeni that �e or s�e Is Iicensed pursuant ta the proWsians ot t�e Contractors License Law (Chapter 9(wmmencing with Sectlon 7000j oi Divislon 3 of the
Business end Protessions Cotle) or ttiat he ar s�e is exem0� ��erefrom and the basis lor ihe ellegetl exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the epplicant to a civil penal�y ol not more than Trve hundred dollars (5500).):
❑ I, as owner of ihe property, or my employaes with wages es ihelr sole compensatlon, WILL DO 7ME WORK, and ihe structure is not intended or oMered far sala (Sec.
7044, Business and Professions Cotle: The Coniractors License Lew does not ep01y to an owner of properry who Duilds or improves Ihereon, antl who tloes such work
himsalt or herseli or Ihrough his or her own employees, pmWtled that such improvements are not intended or oHeretl br sale. If, however, the builtling or impmvement is
sold within one year of completion, Ihe owner-builder will have tha �urden of proving ihat he or she did not builtl or improve for purpose of sala.).
❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTNG WITF1 LICENSED CONTRACTORS to construct t�e project (Sec. 7044, Busineu antl Professions
Cotle: The contractors License Lew tloes not apply to en awner ot pmperty w�o builds ar Improves Ihareon, antl who contracts for such pmject with a wntractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec.
Signeture:
Owner ID verifietl by tlnvefs license. ❑ Yes ❑ No
Business and Professions Code lor this reason:
Venfication ol Ownership by (type ol tlocument, i.e. � properry tae bill or deed):
Dnvers License No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby ceM1ity that no excavatlon �Ive (5) or more feet in depth into which a pereon is required to descend, will be made in cannection with work euthodzed by this
pertnit, end that no building swdure, scaHolAing, falsework, or demdition or tlismanlling thereof, will be more than thirty-si: (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitomle Atlminis�retive Cotle).
❑ As owner-builder, I wlll not employ enyone to do work whlch waultl require a permit irom the Divlslon of Indusirial Selery, es notetl ehove, unless such person has e
permit to tlo such work from the di�nsion.
SignaWre: Data:
Division ol Intlustrlal Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOfiPJ1TON OF EMAY: I certity under penalry of perjury that I have read this application antl state t�at the information given is
correci. I agree to comply wlth ell ste�e laws entl ciry ortlinances relating m building consiruction, and au�hodze represenlatives ot ��e Ciry of Casta Mese to en[er upon the
ebovaEescribed properry tor inspecUon purposes. I agree not lo ocwpy or allow occupanry of eny building euthonzed by Ihis permit until tinal inspection.
COUE 1. INSVECTIONTYVE U —
1816 Fixetl System Final Fire Prevention
1266
200
201
202
203
Pool Spe Finel
Final Re-Rool
FInaI8locWRetaining Wall
Final Factory Fira Place
Final Sign
204 Final Demdition
�.I .1111.
i
%� /. /.
�
COOE� INSPECTIONTYiE
206 Final Mechanical
208 Final Plumbing
210 Finel Electriwl
212 Finfll Fire PrevenLon
220 Finel Planning Approval
222 Finel Sile
250 Final Building/Occupenry
Date
p. � .iii�i.149
•ona�ss av euaara: 4 � 5 h L G 111 S T
OWNERSN41EIfRlOWN: NILHULAJ, I.LI�lt(� lt(
aoopEsg' q b 7 tt G V�11'1 S T
CUSiA MESia,CA 526ii
APR. WUIP�O e0DNE54
ANCXRECT OR ENf�NFEN:
NCH OA ENQ9IDDRESS:
ua xo.:
°M° CiTY UF C�SIA M�SA - yuiLuiNG rERMiI
FfiKMI7 iVG: M "v85515 PLAN 113G1.11 NU: N
CGNS7�uCiIGN iYPE: v-N PERMIi 'iYYE: M£C
VNT:
��T�"� ALEE FLUME I.NG AND HEATING i 2 i 3)"I59-51 "vl
cam�croas�uiwa 5457 CAENSHAW bLVli
�� LVS F'l�`IGt.Lt$ l.A ��= L9V123b
90u43 �+T
LIGENSED COMFOCfON4 UECLAN�TION: I he�eby dlim uMx perely d pe�ury Net I em IiceiueE uMs pwiaoiv d Chaqx 9
(�.�w wnn s«uo� �000l a om.:M a d ub a�...oa a�d...�. code. w mr �+s m:, nm roR. �a .naa.
cmuc.r+o.:V.lG2G} uc.cuss: � jb c.No.� z'Lb EXP: lI/y!
me: D ` cwnraa«:�
P BUILDEN DECURRTION: 1 M'e�y eHum utla paWy d perjsy tIW I an exemq ham IM Catlrtlm liwme lew la iM
o0o�q reum (5eqian )W 1.5 &nims eM Rdmbro COAe: MY aY u wvqY r.fiid� nV�vn e D�i �o mmm�. etls. "vnWo.e.
��emd'eA a rpei eny abuclun, p'w w ia eaeMe, aYo ipu'vas IM eppliueu la ac� pemil lo fib e aqneE eltlmisil Met M a ahe
�s"-'wensed W�� �o iM prwi�bns d tM Conlrada� Ixeme Lew IClaqm B(�menarp xilh Setlion ]000) d Divbion 9 d Ihe
W Praleaiom Cadel rc �hm M a�he b vmmq rtsohan ud ihe bem /a ihs dbY� uanqian. My vidmion d Sw'vi
�-:. �A1.5 Ey ary appliceeu la � permE abpm tM epplirsm to e dvi peneEy d nq m«e ihen Ma hud�ed do0en �5500p.
� 1.9fOMMf411hlVWO�YOlI�Ypn�i'b�MfMhW8QM6tIMlbblanDM�qn.willdONOxdk.LdIMMILiubmlpllMlMBE
«o1le�ad br eele (Seclion )Ma. ButlroaeM Prdeeebns CoJe: The ComreAae lioenw lawEom �wl W W loen owiwr d AOVaM
who buida a inV�'as �Mean. and Mn doas eurh xaek h'unWl a MnN a Ihrouph he a her oxn emWa+m. pa'� �1� mx�
'vnpwemmtla ve m� iiueMeE a Waed la eeb. tl. hvwever. �ha dvldiip a inpawneM a sald wnhm pn yavr d mmpk�in. tlie
. o.�«a�adx win neve me wb.� d o��o ne «.ne ma �a dub « imn� �a me o�• a.wl.
� I. u owner d Ihe P�WaM, em mduardY mntreeiq wn� XcenseA conveciwe �o eonnrud tM D�Ia (Swion TW. Bue'vime W
Prde»ime Goda: Tha Coniredas licema lew doae ml epply w en ow�w d papeny who builtle n impwes R�naon eM who
wnirew In aM V9�s xvh e mNrotlWe) liwnsed N�uW �o �he CaMratlas liunea Lawl.
❑ I em uemq uMar Section: B. 8 P.C.. br Nie rmmn:
DBIB: OwnBr.
� ao Mrebr cenM uw � em an,r. d vd wWmeiene ins �ew��emaw a ce�iomie Heean ane selelv coae seabm uws. usJ3. m,a
2S51a, eM Uut I a eny Mun Wiki�p omipent will / wll rid (dreb ane) nsed io wmply wYh veN ama mdo enE iM �equ'vemanb br
a peimn twmnatiucliana modif Wian homlhsAb�ueTiy},�enepemeM piqrip. RpiEeMW mnprudion appimtiwroaraezemqhomtheae
,.a��am�s.
Dme: Appliram:
WORKEN'S COMPENSATION OECL�H�TION: I Mraby dfi�m uidar pareXy d pejury aw d �hs tdbwiiq deduetiom:
� I haw eed wil meinten a caYfra�e d oomenl �o vepinwis M wakers' wmpeneelian, u povided for by Sadion �)00 d �hs Labv
�iOdB.�IXlh! pG1�0lRiGM:O 4�1�M NVM�I�IX W111C�11�10 pMRIY 4�i01b�.
fl ine��dm��m�wan�.��v���,r�.mnwn.eMswo��rooamei.en«coee.m.insw�a�am.
� wak fa v.fiich thia permit ie inueE. My waFe� wmpaneetbn imurvics cemer vM pdiry wm Wr ve:
c.�.�.�: CAL CUMF EXFIkES
PdiyNumber wQ7Siilf�Gi� OS%V1I58
'v aMim mad rrot Ee romplebd / IM pem�d "n br ms huMrM Ldkn /SiOJI a Nn J
�] I ca�lAy Ihet in Ilw perlamenu d �M woA br xfic� Ihie permil ia iawetl, 1 ehell rM empby ary paaan in any maniwr w m to
become wbjea to �he v.orkms' canqnemian lew� d a�nu�. �Wq pr ihel Y I ehou aubjse �o tM v.vlm�e'
/mmDe =pwuum d Seaion 9]00 d tM lnbor COM, 1 V.-��Y �� 1�
ei . �oorc.�c
Wem D: FWun b�ecun wroAws'ro�ro�dan rm'rN� l� wI�rIW. �M �IWI rl1� �n wMICYM ro almhrlOMM�dN uM
nu'q ro aw h�rtlird MounM adl�n (Jfa{000A 0+ ��M1+n ro �In cwt er ronpwu�Gon �rW a provlew ror In
�ctlon J]O6 0l N� LeDor Cob, /iMn�4 uM �ttomry'� Iwa
CONSTNUCTION LENDINO AOENCY: I hertEy dfirm uMer pmMy d pmjury �M� Ihae b a mnaewion Ir�dinp epeewy M the
parlamvwe d iM wrk br whiN Ihe D�i u isunE (Sedion 909). Civ. CI.
LENDEP'S NRYE
LENUEN'S �DOFE59:
1 cerlM Ilut I hr.� ned N'v eppl'ration ud pW Iha tM ebove iNamuon e cortw.l e0� lo oomNY xtlh eY rYY erd cavXy oMeu'm
eM atma lew nluiq m driltlip mmueion end MrsDy aWiace �apwNeYwa d Ne aCy ro aNa upan IM abwamMiw�ed popany
fa impenion pvpwes.
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CAL�-VALuE:
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COMMENTS: X
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------------ MAIN nUSLLIN� ---------- --------- ACCESSGxY BuILu3NG ---------
FRN?: FT IN REAk: Fi IN FRNi: F7 IN hEAR: Fi IN
LEFT: F2 IN RGHT: FT IN LEFT: F'T IN AGHi: FT IN
PAFCKING RESj: YRVL; FAitCGL: 'FLOJL'�V7 �N�: kEr' NO:
FLAhiNIt3G NuTES>
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LEGAiIZA7IGN:N F E E s U M A it ii SittIICiUkAi, • E�ME T:N
BLLG PMi PL.UMbING ELECTkIC MECiiANIC "rik�. SMIPittc:S �RAuING
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7UlALS----> 13.27 LL.I�V V,UV .f�.L7 S7.L� ,VV
REVENiJE LIVISIGN IuTALS--> CGLLECTEL:
HLUG PMT PLUMbING ELt�TRIC MECHANIC
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IB-38-1997/18:30 RM/f35.25
RCPTq:01-A014721
PERMIT:085519
CONSTRUCTION ANDPIANNING POOL �A
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Da2e Inspector
1. Temporary Electrical Seivice or Pole � 52. Pool & Equipment Location
2. Soi1 Pipe•Undrgrnd. - 53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical ConduirUndrgmd. 55. Electrical Bonding
5. Stee� ReinfOrcement' " 56. Rough Pl�mbing & Pressure Test
6. Electrical UFER Grnd. 5�. APPROVAL TO COVER�GUNITE
7. Footings ' 58. Electrical Conduit-Undrgrnd. �
� 8. Foundation �� . 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe•Undrgmd. � � 60. Backwash Lines; P•Trap, � Undre�rnd.
10. Structural Floor Svsrem ' 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Rec�ptor-Final
12. Sewer Cap . • � 63. Heater & VenbFinal -
13. Roof Drains 64. Plumbing System - Final-
74. Rough Plum6ing 65. Electrical�Final
15. Rough Electrical-Conduit � � 66. Solar Svstem-Final '
76. Rough Electric Wiring 67. Fencing & Access Approva� .
17. Rough Wiring Sign - � 68. APPROVED FOR'PLASTERING
78. Rough Electrical-T Bar Ceilin9 " - � 69. POOUSPA SYSTEMS FINAL
19. Rough Heaiing & Air Condi{ioning FIRE DEPT. fiEQUIREMENT
- - � - �, '
20. Rough Factory' Ficeplace ' � '� ' - � _ � '. APPF�VA4?".• . � Pe}mit # " " ,T•
4
21. Ducts, in STructurBi . •� • . _ -� 70. Wndergtound H�dro �
22. Dutts; Venu�ating '� : �_ � � ; � ' 71, product �iping CIGas OOiI
23. Gas Pipe�Rough &�Test . ., w�,�� • 7y, UndeigraUnA Flush �
24. Roof Framing � - •' ' � - . � 73. Undergrr�d.Stor�geTank�Gas ❑'Oil
25. Roof.Sheathing •;�� - �U �. ` 74) Overhoad Hydro �
26. T�Bar Ceiling (Strucrurall & Monocoat � - � 75. Dry Chemical J "- � �
�
27. Frame and Flashing ; -' � . ,� , 76. Dry Starulpipe �� . �
28. Lathing & 5�ding ' - ' i � ' " ',r 77; FIXED SYSTE,M'FINA�. :�
. :.
29. Insulation : r' i ' �. 78. FIRE PREV. FINAL " _
30. Orywall Na���ng ' ' ' � �?� ,HEALTN DEPT. REQUIREMENT
37. Plaster Brown Coat � i �� , 79: FINAL IN$PECTI.ON �� �.
32. Electrical Power Meter�Final �'i j ." 80" F000 CERTIF�fCATE ISSUED
� -
33. Finat Electric ' , , , , " � - Notes: • � _ �
34. Final Heating & Air Conditioning ' ?� .� ^� � ' - - . .. . _ -'
35. Finai Gas Pipe. Test -, ' '- "
�
36. Hood or Canopy . � � • � ` � �� . � - '
r
, 37. Final�Factory Fireplace _ � �� � `' � . � . ,
38. Final Plumbing � ' _ � - . . : . ' ---
39. Wa[er Service�Final � � � '� T' _ ,. - - � '.
40. Gas Service�Final . , . . . � � � � � _ �
41. Solar pomesticPinal - - .. . _ ,' � . ° ' -
42. Backflow Preventer � � � , - _ -�.
i�*
- 43. Backflow Irrigation : � - ' ' ' � '
44. Landscape Irripation System - �; � - � . . � . � �
45. Sound A[cenuation' • ' ' . , � �
46. Handicap Regulatioris � - • . ' _ �
47. FWAL STRUCTURE & BUILDING '
i. "
48. FINAL PLANNING . •
49. Electric Release to L'dispn � � ,
50. Gas iielease to Southem California Gas Co �� '• . .
57. CERTIFICATE OF OCCUPANCY . �
No. Da[e -
woxmsaew�aw: 469 E 20TH �ST `
oxm�asruxEiFa+o"'": NICHOLAS, CLAIRE TR
aooxEss: q69 E 20TH ST
COSTA MESA,CA 92627
631-3375
�vr�. �uur+o �oon[ss
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LICENSED COMFRCTONS OECL�RATION: I hereby ellim uMx peroly d pnjury Net I em licamed uMx proridon� d Cheqs B
(camme�anY xiih Secuon ]000) d Oivuion 3 W Ne &n'unu eM Pminwn Code, uW mY 4cmi» b In 1u91au W Wed.
cm uc. Ho.: uc. c�as: uc. No.: g}(p ;
Daie: Gowarfa:
OWNEP BUILDEP OECUfiATION: I heMy etfum undm paWy d perjuy ihm I mn wmq Imm tM Caqmdm Lkems Lew fa ihs
Idlowp reeson (SeUion ]031.5 Buavrosa uM Praleaiau Code: My try v oounlY �� �Qui�ea e pe�mu la oonsWcl. etlx. impraw.
demduh, u npei eiry eleueMe, qv io ua cauenee, ebo repunm Ihe epp&am la ach peemi� to fib e mproE alete�mM tlW M a ehe
u licanaed Wn�� lo Ihe prwis'vre d tlr Caurerlon Lim�ue !aw IChepr 9(�envnp xi�h SeUion ]000) a�'� J d Ilr
Busiriess ak PrMeaona Code� w ihet ha a sM1e b uamq iMrehan aM iM bstis la Ne elleped mamqion. My videlion d Sedion
)03t.5 by ury eppF eni in e pemtil wbptle �M eppfrem �o a rni paraEy d mi mas thm frva huMied do0us �5500n.
� I.uovmarW�MV�We�YamYemdw�xthwwom�haimbmmo�Qerion.wTdothexark.vdlhesvuaunum�"vaardad
rc oflereE Irc eeb (5ection ]OU. Bus'vbs� end Pmfessvu CaEe: The Canreeaa liowa lawEoea nd epply lo n owxrd prapery
who budda w inprovea ihereon. eM Mn daea sueh xak limrll w Mnel a Ihraph ho a Mr own emplveen, pewNed �het aueh
bnV�am me na imaMed a atlerod ta aab. tt. howv.er. �hs bWd^�0 a inqo.wnenl o rold wilhin ana Yeer d wndMon. tlr
�owrier-buikm xiU heve �M WNen d G�'�B M n aM Etl nal duM a'unP�a+lu tAe WR�e af eelel.
1. u mwwr d �ha popeM. am a�`4s�dY rauree�q waA 4rrwd mweclan ro camtrup ihs D�9eC (Senun ]641. Bus'uwaa eM
Pmfea+iana Code: Tiro Comretlaa Isema Lew does ria epply ia en owiwr W popeny xfw builds a impovn �heraon end wM
mnUeclf br vtl� PGetle Wh e odY2tloha14meed W�aueN l01!n CONrotJan lioeme lew�.
❑ e I em a 71 '^�4 /_�� B Owrwr. ��/ //.G!/�'/ NG-s�y
i do n«eW cen�N ind i�..�e d w uneenw�a ine mam�mm.w a c.uomie wew ene smw coee seaian. zsws. zss�u. e�a
2555a. eM ihn I a eoY Mure Wikirq oa�pun wiil / wil na (mcb one) med ro canGN xvh vid nms md» md iM nWimma�Ms M
aD��iwwnvueiionamodifwianhomlbl�i�i enq�emem0iqntl.ReoEw'elmMeWioneGV4mbroane*anqlmmNra
poviaiona.
WOPKEF'8 CONPENSATION OECL�N�TION: I hmeby df �vdv psutly d psrpny pr d ths bCow'uq ddvm'vn:
❑ � nm..ne w m.mt.n. cenCrm. d ooem,� �o.w;mw. a.un«.� oompa1vtl:�n. e. awle.E �> W swbn a)oo a �n.laba
Code. la ihe pulmiwce d tM waM la w1icM1 Nu perme u ivued.
❑ in�,.�a�;���.:,�.o�wa.•�v����..m�.a�n.enrsae�a�aoam.�w«coe..r«mewnw�.wm.
wark 1« whirh tAie pertnn ie iesued. MY waYen' oompemeiian imurerca fvrix md paGry nwnbsr va:
Cemer.
Pd'ry Number:
e(Th�i� eadrcn rieM rwf M ttmWMH l tMV�t e M ons hwiQnd JWen ISIWI a bnJ
p� I cenN Nq in Ne W�amence W Ne wark br xfiich �Irie Da�M o imatl. I nd emV�W NY Da*� in enY menror so m io
bewme subjed to IM v.wMen' eanpen�etion levn d Celilanu. eed Nm tl I elauk bseoms eu/bj/etl io iM woheri
Dem:mmWnamion ��W7�9Aod�he ��.'dW�qM cvmGNxiMO'm°!/�/7�
� [��
w.mi�ro: F.nw. ro..��.. »nn�...• �v.�wno� �o••.aw i. wn..nn..�a.rw� mlK� m«roiar« ro�nmw wwtl.,.�e
elvll flrws up ro ons �wErH thous�nd tlo/br� (11aqP�n1, In �Wltbn ro M� cut oI wmpxu�troM1 Mm�p� �� proHtlW br In
Sxtlon J�6 01 tl�� L�EorCods, Inllrut ��e �m7� Iww
CONSTFUCTION LENUINO R6ENCY: I henDy elfi�m uMx preAy d prjury ihm ihxs u e omarunbn bMiip epency M Ms
paAwmerce d iM xwk tor xhirh Inb peemi u ewaE (SeCnn b8). GH. CI.
LENOEP'S NNIE:
LENOEH'S �OOPESS: I
I ceMV �hm I he�e read Nu eVP�'raion nd tlme thet IM eEv.e iNomWion u conW. I epiae to canPM wu� N'ny W mm�y ad'uwm '
arM a1e�e kxs reklnp b buildmp tanaUudion vd hereby eNlw¢e �epesentelrvev dthu tAy Io enlm upon IM abwe.menlunod poperly
lor inspeaion purymae.
CLAIRE NICHOLAS
/`'Q'�/ �/� y��_ �`/
� / �/
'�/-�✓ w ����/� Dete: O — ! /�+
Sg�ture d Onnar/RpenUAppfunuCoritrmv
(S15t<fi.WP) Whne�Bu�lC'vp85ate�yGreeMFb:Careiy-Appicanl;Pink-Fawnue:GolCenmtl�bseamr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 079323 PLAN CAECK NO: N
CONSTRUCTION TYPE:
JOB DESCRIPTION .
CLAIM VALUE:
V—N PERMIT TYPE: PLU
REPLACE FIXTURES IN HATHROOM
CALC—VALUE:
PERM NO: P 079323
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT:
GROUP OCC: R-3 /
COMMENTS: REPLACE EXISTING FIXTURES
�r��t�r��*�atititit�******�ritit****�*it+f*it*�rie�r*it****etx�et�tat�r**�r�itie**ftrit��atatit*�r*�rie�r+��**�****
Z O N I N G R E Q U I R E M E N T 5
S E T B A C K S
------------ MAIN BOILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAA: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 42632405 ZNE: REF NO:
PLANNING NOTES>
� _ '
1f 16 if iE IE 1F 1E if 1E if 1f 1E if 1f 1E iE 1E'IE if if iE iE if if 1E iE 1E 1E iE 1E ik 1f li 1f 1f IElf if 1E ik if 1flE 1f 1E 1E �E iE fE iF 1E 3f iE 1E 1E 1E IE iE I! 1E iE 1E'lE 1E 1E iE IE iE ik 1h iF * IE if IE IE iE if IE
D E V E L O P M E N T S E R V I C E S-- R E Q U I R E M E N T S
ZONING APPROVED HY DATE:
HUSLDING APPROVED BY : - DATE: q
APPLICATION ISSUED BY: J DATE: O�'�
1EiFiE7FiEiEiklEIE1f1E1f1F1f1f1E1ElE1E1E1fak � ifiFiElE1EiE1FikMff ifiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
1725Y
22,��
PERMIT ISSUE
17.rJ� z2.��
SMIP/NON—RES
P.LAN-CHECK TOTAL PAID DUE
0.00 39.50 39.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 39,50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
39.50 :-
1E fE 1E 1E If 1E 1! iE �E 1E iE 1E 1E 161E 1E 1E 1E 1! 1F iE 1E 1f iE 1E If if iF 1k 1E 1E 1f if IE If iE iE 1k iF 1F fE 1E 1f if fE iE fE iF 1E If i6 if iE iE if if iF ik 1E 1E 1E i! IE iE ik fE �E ff iE 1f 1E �E it 1F iE 1E 1ElF iE
I N D I V I D U A L_. F E E B R E A K D O W N
TYPE QTY D E S C R I P T I•'O N. UNIT COST TOTAL COST
PLU 1 WASH HASIN 8.75 8.75
PLU 1 WATER CLOSET (TOILET)� 8.75 8.75
, END-� OF FEES
�
�"; '
CONSTRUCTION ANDPIANNING POOL PA
APVROVALS Permit # Date ��Inspector qppROVAIS Permit # Oate Inspector
7. Temporary Electrical Se�vice or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrntl. 53. Steel Reinforcemen[ '
�3, Electrical Conduit UtilitY�Undrgrnd. , 54. Forms
�4: Elecirical ConduibUndrgrnd. 55. Electrical Bonding _
' S. �Steet Rel�torcement 56. Rough Plumbing & Pressure Test
'6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE -
. 7. Footings 58. Electrical Conduit-Undrgmd. -
`' B: Foundation 59. Gas Pipe, O Undrqrnd., Test ,�
-9. Water Pipe�Undrgmd. 60. Backwash l.ines, P-7rap, O Undrgrnd.
�
10. Structural Floor SYstem 61. APPROVAl70 DECK
1 t. Property Sewer Line & House Connection 62. Backwash & Receptor�final ,
72. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing Sys[em - Finaf
14. Rough Plumbing � , 65. Electrical-Final
15. Rough Electrical�Conduit _, � 66. Solar System•Final
16. Rough Elearic Wiring � 67. Pencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Ceiiing 69. POOLlSPA SYSTEhAS FINAL
19. Rough Heating & Air CorWitioning FIRE DEPT. REQUIREMENT
r - -
20. Rough Factory Fi�eplaGe � - -� - . � _ - APPROVALS � Permit # -
21 . Duct;, in Str�cture:�; , ,�; _ / � � �; - 70. �Undenground Hydro
22. DucCS,Ventilating- _ -.'c- 71.�Product�Piping:O�Gas GOiI
23. Gas Pipe�Rough & Test -_ �` - "'� �' 7Z, Underqround Flush
24. Root-Praming. � . � - � •- _ - 73: Undergmd.�StoregaTank OGas 00'rl
25. Roof Sheathing y '� �' :' ' ,- 74. Overhead Hydro r
26..J�Baf�Celiing (StructuraQ & Monocoat - -• 75. Dry Chemicai "
27. �Frame and Plashing _ , . ; 76. Dry Stand'pipe - _ '
� 28.'"Lathing & Siding � - - ... s; .. � �, 77r, FIXED�SYSTEM-FINAL
- 29. Insulatidn - . ' - ` ' 78..FIRE PREV. FINAL • '_ �
30. Drywall Nailing �� � , �. HEALTH DEP7.�REDUIqEMENT
, 37. Piaster Biown Co� * _ _ _ ` � 79. FINAL INSPECT�ION � - "'
. 32. �Electrical Power Mete,•Final - ' : 80, FOOD CERTIFICATE ISSUED
33. Final'Elettrie ' _ � � � - Notes: �RRLrF o�-/+(o rtE !-S U!;D
_ q-ao_qt,` �A,�to �l.�aks� �./�
34. Final: Heating& Air CoOdittoning-- . . p� �
- �as��=�_Ho�_; �uPP�.Y i.lNE�1.FAtctniG a�
� 35..FinahGasRpe-Test '- ' - �O'31_cl� T__ '�'I-,./A��Y� �_
- Lu i1
36. Hoodor.�anopY ' ., - „ - _ - - , ��y � � � � � -
37. Fina� FaEfbry Fireplade c�' - �'4' , ;� - -
". 38. Final.Piumbing -, - .. . c b.`�.'ib � x � = � --
. 39. Watec Service�Pinal � ' � � . , -
.
' 40. Gae Service-Final ' �-" ' - �
<' K• � F �j 1 .
: 41. Solar pomestic-Final . ', �• + �` , � � ��
a i r "
� 42. �Backflow Preventer' ' '; '� '' I �, - : -
43. Backflow Irrigation - - � � � - -
�
40.. landscape lrriqatioq-System..�- - _ � -, , . ' - "
45. Sound Attenuation � . - T �� T .. - _' -+ � '� � � :' �
-, - ' c;
�46. Handiwp Regulatioqs = ' ' � . ' , .S �
47. FINAL STRUCTURE & BUILDING � � ,. . � . � �
48. FINAL PLANNING � ' � � � "
.49. �Electric Release to Edison � � W ;. -
�:
50. f�as Release to Southern California Gas Co : _' - _. ' �
57. CERFIFICATE OF OCCUPANCY _ ,.
H0. tlate
`
�
/
�oonasaew�w�c: q69 E 20TH ST
°"'"E"s"""E'°'°'°""' NICHOLAS, CLAIR� TR
�oo�ss: g69 E 20TFi ST
COSTA MESA,CA 92627
MPL. WJWq AOOREA4
MCXRECT OF ENdNEEN: �� ���
1qCIl OP ENG.3I�DONE55:
UNi:
unt:
wxmaTa+sw� THOREEN CONST S DEV ( 719 ) 662-1088
CCMRACT078YN111G 1819 SAPIAR DR
�oopEss COSTA MESA CA ��� 599418
92626 uNT:
LICENSED COMflACTOfl3 OECLFNATION: I Mreby dlim uMx pnellY d pajwy Hut I em Icmwd uMa pro.vioro d CMqa B
(mmmaan0 wn� 6ec�ion )oa0) d Oivision 9 W ttie &mmae end Pra� � de. eM mY Gceess u i ull lau end efled.
cmuc.r+o.:051719 quc.cuss: H uc.N. 5994 XP; 09J95
Ome: �"/ � � —" / f— Comnen:
OWNEN BUILOEN OECLAHATION: I herab/ elfirm �nder penely d PerlNiy �he� I em uamp Imm IM Camrmon lioema lew la tM
fdbx*q �eeaon (5edan Jm1.5 &niwsa eed Rdeada Coda: Am'W w mm�Y Mudi'quva e G�i to mnwet. adr.'vnpwa.
Aemd'ah, a �epei e�ry e�niclure: pia w ea eauence, ebo rpum tM ePWinM �a euch pvmn lo Ne a eqmd Nalament tlW M a eM
u iice�ued w��� m me uoh.�on. w m. cwreu«. wsn. isw lcnew.. s 1�«�u wn s.ao� �000l a a.eon a a m.
Busmsw en0 Prolmeuro Cadal a ihel he a ehe b mmmq ihsehom xM tM Euie b Ur eAepW axemqion. /M'vidmion d Swion
]W t.5 by anY eGW�� lor e permG abpqe tM epd� �o e r'wil pe�eM d M mon Ihen Ixe �urtlied Edbn �i500�1.
� I.mowmrdihaqapenyamyemplv/eear.ihweponthaiqbcampenee4m.r�AOIMMo�k.endNs�Vu.YunenolimeMed
«on«ea �«.eb (s«iian )ou. euvrmene vedea�aa code: Tne coive.e«. umn..l..em. �a wW m an b.�..d nw.n
Y/�p ol�i Of �IIpW!! 1�1l1?]11. YId M�p d0lf f WI NV{'. �1lfllyM IX 11Ml� IX ��1lWih �1O V �1Y OWIIlTpOM�. p1Wb041�W RC�1
impwemenu ere rM imerMeU a dlerad la eda. tl, hows.er, tM W�b��p a inprv.ameM ie �dtl wil�in ons yeer W camqelion, IM
o�.e�,aa.. �o ne.�. in. n�d.o a v�+��ro n, «.n, au �a wue «�,w� �o, m. wmo.e a..b).
� I. m ox�nr d �M pWe�Y. em uMuiveN oonlreaM wilh licane� conVeciwe ro cma�rve Ma Molb (SWun ]Ot�. &uirr� vd
Rafea'vm Cada: The Cav�aeon lieeme lew Aoea nol eppt/ b en owerr tl popsnY wla buJda a mwa'w �hmson ud who
eonrceeb for wtli p�qeaa wnh a aaqemor(s) Iceved quaueN �o Ihe Canlretla� Lioeme lew).
❑ 1 em ummp uMr 5 tcn: B. d P.C., br Nb ieem:
oai.: owo.r:
i m n.nnv oand� inm i� e..ae a w ��ea.w�d ub Ac���amr a cmiomv r�nn �e sdnv coe. sm�oo. assos. usv. �e
zssaa. d,a m.� i a un nn�. n�daan �o .;n i.w �a la�ci.e o�e) n.ed �o m�wN an.rd em. ooas..m n. �.c�«v, a
Dete: Apqicant:
WOFKEN'S COMPENSATION OKLAfl�T10N: I Iwraby elfmm uMM perol�V �1 peiNV «is d tM bAowLq dedaretipn:
❑ i n..�e.�a .J me'vnen. c«idw. d mu«v m.m;mw. �« r�.: camv��... wwidsd �> M swian slao a �n.lmu.
Cade. ld �M VaAmrerce W IM xIXk IM WFkh IMf W�ma ff u01Nd.
❑ i n,...�e .0 m,w,n.oM1n.� eamv�:M m*,e.no.... r.am•a W swian a�ao w m. �m« cae. w.u. o�a�« a m.
wak lor whirh Ihn peimn is baueC. My waken' mmpeneatbn i�reurencv fartiar eM pdic/ numEr ua:
carn«: CTATF Fnntn EXPIRES
POGcy Number. � �� z� o+_ o e 0 7/ 12 / 9 5
se�rtn me0 iwt M ttmP�ateE l Ne Y�t c b me �ulMlea Jmen R� W/ n Isv.)
I eanh ��� G��a d iM waN fa wliich ihc pmmG u I eMtl m� amploy siry pmm� n ury mamnr w m �o
ba.me wbjetl to �M v.arkxl mmpenwion lawe G CefdM�e. tM E I ehwld wbjq lo �M warYan'
mmoenm�ion om.00n. ot Seeion s�oo a ine lebar Coda. I ahdl I n n aomoH �is.
o�e: Y c r—I � �od�m: `w-^- c_:�V---
wembip: Fauun ro wcun Mw:teri eonpw�tlon cov�rap b un�+M'•d. �ndWl� wb/.ct m w�np�qw ro�ilrNrW pneftlu �rd
cIN/ llroa �.p ro wrs l�'ntlrotl �In�uM AWkn (f10QPW1, M WM�n b M� cwl ol rompxwtbM1 Wrmp�i u pvHleC b� In
Sxtlm 9]P6 0l tln Lelor Cad, Infers�S � ettumry'a /wa
CONSTilUCT10N LEHDINO AOENCY: I Meby e/firm unMr pabM d pxjury �lel IMs c e ow��ueian Mrdvp apenry br tM
�no�o� a m..wk �« �m me w�� s=.,.e cs.d� aoe�, c:. q.
LENDER'S N4ME:
LENOEP'S ADDFE55:
ICBf1EY1� 108A�I109GD�K���Y0b1I10�UNGWIOINOfIN�d1000RW.I4jIpp10CM1NYW11AMM'��Y011I111YICb1
�d.ime �m�emw�wero�+,�wm�en«awdnno�a�aa�mm�.ainear�oan«�o�m.�.�n�,.dpo�
faim WN�e. ��'
Pnrv Neme
o�.: y� p—P�
s iwurcao.,�«iroa�vnw��a+vma
(5t51d6WP) Whna-BuJdiqBSelaly:Giaem�FJe:Genery-Appirent;HnF-Revenue;(3dAenio�Mmm
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 07195
PERMIT NO: B 071955 PLAN CI-IECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRIPTIOPI : REPLACE TUB RETILE AROUND IT SQ FT: 400
CLAIM VALUE: 400.00 CALC-VALIIE; 400,00 GROUP OCC: A-3 !
COMMENTS: REPLACE TUB
iE iF iF if iF iE �F iF i4 if �h M'R ih if if if� iF iF i� if if Y� ii if ii if AF �1E iF i� ik iF �lf iF �N-iR iF A1� W i!� iF if �4-)f �Y ii iE iF'k' iR aF1f M' iR if -74 if IF if �1f if -1E+f �Y-if �Y if -Y-IF i� ik JFY� �R 1F Y� if -V'
Z O N I N G R E Q U Z R E M E DJ T S
S E T B e1 C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDID7G ---------
FRNT; FT IN REAR: FT IP7 FRNT: FT IN RE1,R; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN AGHT; FT IN
PARKING REQ: PROV; PARCEL: 42632905 ZNE; REF A70;
PLAD]NING NOTES>
i
iE if 1F iF if if if iF il� iE it iF iE M if� i� iF M�Y 1f if 1f 1E M �t k K if �lf if if iF ih if 1F if if i�-iR 1f M Y iF i� if i4±E if if K iR i� � iE �lf iV iE iF iR 1f i1 iF jf i� �lf 3s ic i4 is af Y iF if �14 * iE �)c iF 1F
D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N•T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY : �
DATE:
APPLICATION ISSUED HY: �f-� DATE; 19� S-
iEifiEjflfMlflEifjfl4ifiliFiE4iFiF�fiEififi4lfjtKaR�fif �if ififiF%3fiEifiFYiRiFAf iE�FiRltifiFMic jFKlfiFiFl4ii{fifltMif i4 iFiEi:iFifiilFac
LEGALIZATION;N F E E S U M M A R Y STP.UCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADITIG
PERMIT 15,00 ,50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 15.50 0.00 0.00 15.50 15,50 ,00
REVENUE DIVISIODI TOTALS--> COLLECTED: 15•,50 OVER/SFiORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/TOT GAADZNG PLAA]-CHECK
15.�� ,SO
iEif Y�rt iflf if 1f 1F if 1f'1F i! 1ki! 4 4 1f if 1f k�Y if 1f 1E 1f !f�'!f if'M if N'i! M if * if iR 1f if �h �E if if ifif Y 1E11 if lfif if iF if ifiFiF M af itjf if iR M M M iM'M iF+f if iF iF ifiG it�f iF
I N D 2 V I D U A L F E E B P, E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 400 ALTER BY VALUE RESIDENTIAL N020NE 1.00 400.00
END OF FEES
ai oolsa2U8-OD1802C9 T�] Y 15.54
OA7E: 04/19195 TIhlE: ID:04
CONSTRUCTION AND PLANNING POOL & $PA
APPRpVALS Pennit #-= Date Insuector qppROVALS Permit # Date inspector
1, Temporery Etearical Service or Pole 52. Pool & Equipment l.ocation " �
2. Soi! Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Conduii-Undrgmd. 55. Electrical Bonding
5, Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings - 58. E�ectrical Conduit-Undrgmd.
8. Foundation 59. Gas Pipe, � Uncirgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, O UPdrgmd.
S0. Structural Floor Svstem - � 67. APPROVAL TO DECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap , 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System - Pinal �
14. Rough Plumbing - 65. Electrical-Final
75. Rough Electriwl•Conduit .66. Solar Svstem-Final
i 6. Rough Electric Wiring 67. Fenciny & Access ApProval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI.
79. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace _ APPROVALS Permit #
21. Ducis, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rouqh & Test 72. Underground Flush
24. Roof Praming � 73. Undergmd.StorageTank OGas ❑Oil
25. Roof Sheaihing 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoai � 75. Dry Chemical
27. Frame and Flashing . 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electricai Power Meter-Finai 80. f00D CERTIFICATE ISSUED
33. Flnal Eiectric 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 �omestic•Final
42. Backfiow Preventer . �
43. Backflow irrigation
44. Landscape Irrigation System �
45. Sound Attenuation � ��, �
, n.
46. Handicap Regulations � � . -
47. FINAL STRUCTURE & BUILDING - �G�j �
48. FINAL PLANNING � � �
49. Electric Pelease to Edison �
50. Gas Release to Southern California Gas Co
51. CEFTIFICATE OP OCCUPANCY
No Date
/
/
r
�ooncssaem�wxa: q69 E 20TH ST
wnhRsxweivivawn: NICHOLAS, CLAIRE TR
���5 969 E 20'PH ST
COSTA MESA,CA 92627
ur�.�u�nw �ooxEss
AIMNIiECT OR fNfiNffN:
ARCN.ON FHQ'S ADURE55:
uc ao.:
UNT:
UNT:
cartw,�crarsru� THOREEN CONST & DEV ( 714 ) 662-1088
cwm�cTars�uiwc 1819 SAMAR DR
euoeEss: COSTA MESA CA ucno: 599418
92626 uNr:
LICENSED COHfNRCTOFS UECL�PATION: I Mreby ellim uMs peroly d pmjuy Ihel I em IiuneM uMer prwiYm� M Cluqr Y
�oomm.�,o wn s«�� �000� a ww� a a m. ad�.. w am�...o�. cod...�d mr c�e. e m iw n�. �e .n.e.
cmuc.No.:p51719 uc.cuss: g uc.Nfo��"599�418�`%� EXP: 09/95
Dms: Y l / `�� Canreua: !//K. // /.2�.'..<�
r T
OWNER BUI�OEN DECLARATION: 1 Mrab�� elfum wMs pauty d psrjvy iMt I em exemq han ihe Cadrtlon licame lew br IM
Idbwiq �envon ($etlion ]0315 &pneff eM Rdesao�u ('.ods: My C�y w wuMy xfiid� npuirw e pormil lo MNVutl. alla. vnprde.
Eamdsh, a repi eny Nruclure. prior ro ds evence, eho �u'um IM epplimni lor wc� prmn lo fib e eqnad uaiament Nn M a�M
u �imsd w+� �o �na amivan. d the cauream l;om.a len ICAw« 9(awiunmac wan seabn rom) H oMuon s d �n.
Bumnam W Rdavabne CoCe� a Um M ar ehs u ezemq �MrMmm erd tM Eam lor IM elbpeA mamqion. My vblelon d Sepion
]031.5 by mry app4uN Iu a prml eWpCf IM applicaY b a dri psuM/ d nd mm Ilun /'xe hundnd doWn �5500�.
� I.mowwrdtlrpopMyamyamplv/eesMhwepmnlheiobcompmetion.�wTEolMxaF.endlM�Nclun'sml'uqaNeE
a dlsad Ia eeb (`��� J�. Buvma eed PeolwaiomCade: TM Contnpon Licwus lawdoea m applyto en owner d propMy
vM buida a inpwp Ilwiem. ad �}p Aoee suN xak limaetl a henN a Uvaqh he a Iw mm emGbtM�, pw'ked IM wth
impv.emenb ve nd'v4ended rt oflmeE la veb. 0, howew. IM Euitlirp a inpwenatl u wltl wGNn aw yau d wmpbtion, Ne
owrorbuJder will hevs iM buken d c�u'irro M« eM did nd duk ar ima� In �ha wTae a eebl.
� I. m o�mee W Ihe pW�Y. em uti,ti�NY ouqratliq wYh fanssd eaVraeim b eanebutl Ms pojsd (9atlion )O11. &v"vw� eM
Pmlevima coEa: Tne Coniraaw+ licenm lew Eom m� eVDh lo an ovmer a pW�Y who bu0da « wwa'r �hnaon eM r.fio
convecb tor erh w9a� wul� e mm�eqw(e) Ica�vxE P�uen lo � r Cav�rtm liorua lawl.
� I em u/em�q urtls Seciion: p�- B. d P.C.. la IM e an:
Dale: "/"���—� J Owew: �. Yf_1-
i eo n�nv �nuv u,d i.m ...,. d.�,a �.b..i.�d u» �.ma�«v, a cwom. w.m� .m s.i.n cm. sea�. uws. zssxa..�w
25531. eM thei 1 a M' Mwa buiYlvq omqw. vri0 / wi nal (acb ans) nseA b canW wth uid mt� aoCn mM Ihs nN��M+ lar
a 0�� la wuvuciion a madd� ian han I M Ar�iuiyl�anepamni Dinrip. Rsudavitl ww vavn eOG�idu en awnN ham Ilw�s
a�.
oms: �oq�u:
WORKEP'S COYPENSATipI DKUN�TON: I AnWy elfmm wder pwuly d pa�uy one d Na IaOow'vp Astlua�iom:
❑ in.ro.m.u�w�.wnc�.aca�im..n:�.n,.w�.Aw�we�n�.e,ww�awe«Ms.uona�ooam.�.n«
cade. i« m. o«�o�. a ub wx io..m�e� w wm+ e e.wa.
❑ I hew vd wi1 meimen wwYen' oompeme�un imurw. m epuired by Sspian ��p d iM LeOn Cods. br iAe prlamvioe al tM
wM In whirh Nu DMb u'waueA. M' waMn' aomGe�bn imurerce u�riar eM W�Y mimEx us:
c.�: STATE FUND EXPIRES
Pa� rn�e« — 0 7/ 12 / 9 5
,��a �a w os,�dw.e i m. c«m.:. ro, o,�. n�m.e adw. rs�wl o. we.�
i mnry w� �� ma c«imronca a me � w..n�, mu rom�n m eu.e, i.nen �a .mWw e„ 9d� in env mermr o n m
wbjetl !o IM xa4re' ronpemetbn kwa d CelJanie. OM � 4 1 Nw abjW to tM xoM1a�'
canpam(m��ian pwui9om d SQetlion J)W d tM lebor COEs. I ehell 1 J� A mm '' .
Deb: i �! �/ � MG�iraN: .cc� �!�-c "
Wemlrq: HNun ro�eeun woMwi rorr�wru�tlon eov�rp� l� �nl�wN4 �ndW/l wUpct m wmplqw ro crlMNlpwltlx uM
NHI Mu �q ro aM �'nCrM NouuN OaiNn lSf00,000A „�Idon b M� cw! ol rortpmulbM1 Lamp�i u pvoHMd br In
Sxtlan J106 0l N� Lebor CoW, Imslul. uW �ttomry's /ws.
CONSTIIUCTION LENOINO 1GENCT: I M1aeb/ elfirtn uMw perotry d perjury RW �Mn u e aon%iuCion bMvp qpcy tor ihe
pen«me�e d me �k ia w,�d� mo w�i u eeuea Isaeo� �, c�. c�.
LENDER'S NMIE:
LENUEN'9 RODPE%:
Icen�hthetl edt�oePV���Welets�hmMaebovsinlormetionbcortep.lVlrae�ocanVNwA�eYmYenEcouM�/adironce�
Wntemb re iobuiuvqconxrwbneeAMroWeNhorrse�epreeentetivaed�hiedlytoemar�ponlMebwa�memiwiedpapaM
iairupea' .
L.
Neme Q c7
Dele: �� ��^C �
SiprWurp d Ovnror/ApenVAOG������etla
(5�5�J6 WP) WhntBuiWnp d Se1Ny; OreerFb: Canery-Appfunt: Rnk-Hevanua; pokenmFMfepor
CITY OF COSTA MESA — EUILDIA7G PERMIT
PERM NO: P 071956
PERMZT NO: P 071956 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; PEP,MIT TYPE; PLU PUP.POSE: ALT
JOB DESCRIPTION ; P.EFLACE TUB RETILE AROUND IT SQ FT;
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: REPLACE TUE, RE:�H71955
*�c*�f*#r�i�*+t+n�(��µac*asa.*r�-r�ai-��*«�*�tfic*�K*�3t+r�u-+t�1F#*i�s+r-N�*.r.ac.r.mjs*acx,a+r�Y*-r.��f 1�as.u*r**-v-.Y�-��r-�rrrac.v.�.+tiE+r
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDI�IG ---------
FRNT: FT IN REAR: FT Ir] FRP7T; FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IT7 RGiIT: FT IN
PARKING REQ: PROV: PARCEL: 92632405 ZP]E: REF PIO:
PLANNING NOTES>
i
'N' if 1F % if iF if if iL iL if iE IF Y iE 1E if if �4 if ik iR if i�- if iF if� iR jR {F jf Y if iA if'1f aL 1�-Y ik i� iF iF iM1 d4 if iR Y*'1F �f'1F #�f ii if af iF iF iF � iF'lf iL �1F Y{F iF if �f if aF if �f af if iF �f 1f
D E �' E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROI�ED BY __ DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: DATE; �/�/'/�
Y'I�'i�'iF 1f'If 1f if if if'N'if jF 1f if ii iE *'� 1f'M'if . . iR'V"lf 1MiE'IF Y if 1F if i:W�iF�1f if
LEGALIZATION:N F E E S U M M A R Y STRUCTUAAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHArIIC FIRE SMIP/RES GRADIP7G
PERMIT 7,00
25k
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK
TOTALS----> 7.00 20,00 O.QO
REVENUE DIVISION TOTALS--> CULLECTED;
BLDG FMT FLUMBING ELECTRIC MECHAP7IC
27.00
TOTAL
27.OQ
SMIP/NON—RES
PAID DUE
27.00 .00
27,00 OVER/SHORT; ,00
FIRE SMIP/TOT GRADING PLAN—CHECY.
4 if 1E k rt4if if if iFif 1f if �f i�+f k iE�f if #F Y ifik i1 iF k 1t if M M�iF�V V M Y 1fiFu N if ?f jf if iEiR k 1E ifiF if1F 1f M KiF +i iE i4 k if iFit iF if +c �f+4 af if if * fF1f M iEiE�f af-
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
PLU 1
D E S C R I P T I O N
i:iti�:iiiZ7
END OF FEES
UNIT COST TOTAL COST
7.00 7,00
�i O�1v0207—�QiP!)7�J% T9] Y ?%.Od
GA?E: tib/i4�v5 TYttE: 16:n3
CONSTRUCTION AND PLANNING POO� & SPA
APPROVALS Permit # Date Inspector qppROVALS Pennit # Date inspector
� 1. Temporary Electrical Service or Pole • 52. Pool & Equipment l.ocation
,r
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Etectricai Bonding .
5. Steel Reinforcement ' 56. Rough Piumbing & Pressure 1'est
r
6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE
7. Pootings - 56. Electrical Condurt�Undrgmd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe�Undrgrnd. • 60. Backwash Lines, P�Trap, L� Undrgrnd,
10. Structural Floor System 67. APPROVAL TO DECK - .
11. Property Sewer Line & House Conneclion 62. Backwash & Receptor-Final
12. Sewer Cap ' � 63. Heater & Vent-Final � .
13. Roof �rains , 64. Plumbing SYstem - Final �
14. Rough Plumbing � � 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar SVstem�Finat �
16. Rough Electric Wiring 67. Fencing & Access ApProval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
78. Rough Electriwl-T Bar Ceiting 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE �EPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. DuCts,in Structure • 70. Underground Hydro
22. Ducts, Ventilating 71. Product Pipinc� �Gas ❑Oil
23. Gas Pipe�Rough & Test • 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocoae 75. Dry Chemical
2�. Freme and Fiashing 76. Dry Standpipe
28. Lathin9 & Siding ' � � 77. FIXED SYSTEM FINAL
29. InsWation . � '� � 78. FI(iE PREV. FINAL
30. Orywall Nailing HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coac � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Finai Electric Notes: .
34. Final Heating & Air Conditioning .-�. - `� _`�"� y; ..,Y ' � %�� K_ �a..: �!��
35. Final Gas Pipe�Test . �
36. Hood or Canopy
37. Final Fattory Fireplace
38. Fina� Plumbing 3�q (�/
39. Water Service�Fina�
40. Gas Service-Final
41. Solar pomestic-Final � -
42. Backtlow Preventer -
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuatio�
46. Handicap Regulations
47. FINAL STRUCTURE & BUtLDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Oate
PflOJECTqD�HESS: 969 E 20TH $T
OWNEfl'SNAME: �.JICHOLAS� CLk�.I.riE TR
nooness: q69 E 20TH ST
COSTA MESA,CA 92627
AflCHIENGINEEfl: 6 31 — 3 3 7 5
noosEss:
flEC.NO.:
e
UNIT:
CITY OF CUSTA MESA — HUILDIP]G FERMIT PERM P10: E 070U0:
PERb1IT P70: E 070002 PLAN CHECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N , PERMIT TYFE: ELE PORPOSE: ALT
uxiT:
PENMITTEE: MATTHEW P, COOK (714)645-5761
aoosess: z035 PLACENTIA AVE H
COSTA MESA CA 92627
LICENSEO CONTflACTOP OECIARFTION: 1 �ere6y aliirm �ha� I am IiCensed under pmvisions of C�apter 9(commencinA wiih Section
7000) of Division 3 0l I�e Business antl Prolessions Cotle. antl my IitenSe is in full lorce an0 ¢Ilect.
cirr uc.: sTaTe uc.: 6 7 5 3 71 ciass: C 0 EX P:
G,u; /// � S Signalure: ��
WOflKEflS' COMPE SRTION OECIABATION: I hereby ailirm I�at I have a cenificaie oi consenl lo sel4insure or a cenilicate of Workers'
Compensalion Insurance. or a cerlilie0 copY �hereof (Seclion 3800. Lab. C�.
POLILY NO.: EXP. ORTE:
LOMPANY:
❑ Cerii�iea tODY �5 �ereUy lumi5�etl. ❑ Certilied taDY is IileO wiih t�e City BuilEinp DiviSion.
Dale: Fpplicant
E%EMPiION FBOM WONKENS' COMPENSIITION DECUBATION: (Thi55eciian neeG no� be compl¢�ed il �he permil is for one hunOrM (3100) or less�.
I cetlify that in ��e petlarmance oi Ihe work lor whic� �his permi� is issued, I shall not em0loy any person in any manner so a5 io become
su�len �o �ne orkerY Compen5aiion Laws o� Calibmia. �� �y— '
por^ /1 LI 9 Sipnamre: �1�"�i+/�� �+��
NOTICE: If. alle making ihis tleclaration. you shoula oetame subject ta ihe workers' CAmDenSdtion O�ovision5 al the La�Or
Cotle. you mu5�lori�val� comply vn�h 5uc0 Orovisinns or �his permit shall be G¢¢meC revokeU.
CONSiPUC7lON LENOING RGENCY: I nere0y allirm inat there is a constmc�ion IenOing apency tor ihe pedormance of the wark for
wnich Ihis Oermii is issue0 (Sec�ion 3097, Civ. C�.
LENOEfl:
aoos[ss:
OWNEB BUILOEB OEClA8RT10N: I �ereby a��irm itWi I am ¢eempl IrOm ��e CqntrattoR' State License Law for tAe iWlowinA �eason
IS¢ction 7031.5 Business and Pmlessional COAe: Any city ol county wnicn repuires a permit to construct, atter. imDmve. Cemolish, or
�¢Oair any stmclure. O��oi Io its issuance, also repuires I�e aODlicanl far such permii �o lile a signeE Stalemenl tlwl hals�e is licensed
pursuant �o me O�ovisions ol me Camracmrs SIaIe License Law (Chapter 9(commendng wilA Sec�ion 7000) o� �ivision 3 0l �he Business
ane Pmfessions Coee) or ihal he/she is eMempl inerefmm anU Ihe basis for Ihe alleqetl eKemption. Any violation of Section 7037.5 by
any applicanl br a permi� Subjecis �he applicant Io a civil penal�y ol na� more Ihan live �unAreG Aollars (E500�.
I. as ownei of ine pmpeny or my em4loyees wiin wa0es as lheir Wle com0en5alion, vnll do tile wofk, antl Ine
❑ stmcWre is nal inteneee or oneree lor sale (section 70a4. Buvness an0 Protessional COCe: T�e Caniracrori State License Law
does not apDly to an ownet of a property wlw GuilGs or improves t�erean. and w�a Uces suc� work �im5ell/AerS¢II or thmupA
�is or �er Own employees. proviUeU �hal SUC� improvemGntS a2 n0i inlenAeA Or oifer¢0 lOr sale. If, howev2r IA! GuilEing ar
impmvemeni is sald wil�in ane year ol complelion, Ihe owner mil luve I�e UurOen al O�odnp he/s�e Oitl not builC or impmve
lor Ine purpose ol sale).
I, as owner al Ihe pmperiy, am extlusively tonVat�ing wiih litens¢tl cOniraGiors lo ton5lmci IAe pmjeCl (Seclion 7044, BUSine55
❑ ane Prolessions Cotle: The Comracmrs' S�ale License Law tloes not appry m an ovmer al DmpeM w�o hmlas or improves the2on
antl who conVatls lor suc� pmle��s wit� a coniraclor�s�license pursuant �o �he Coniractor5' State License Law),I am aware
Ihal pwol ol �Aeir Worker'S Campen5aiion insurante Shou10 Oe pwvitle0 t0 mp.
� I am exemD� untlei Section: B. 6 P. C.
br Ihis reason:
JOH DESCRZPTIOP] : ADD FIXTUAES AND OUTLETS . SQ FT:
CLAIM VALUE: 400.00 CALC—VALUE: GAOUF OCC: R-3 /
COMMENTS: NO OTHER WORY. PERP92T, SA90Y.E DETECTOR REQOIRED PRIOR TO FINAL
*+�+�v+�**�«u.�**+�*+�+�*+��c� �*x*+t****�c**u+��r*+�+t*■*******+��***K+�*�a�***�*xx,.�*u+�*x*+r��***
Z O N I N G R E Q U I P. E M E N T S
S E T E A C K S
------------ MAIN BUILDZNG ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IPd FRNT: FT IN REAR; FT IN
LEFT; FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN
FARI(ING REQ: PF,OC': PARCEL: 42632405 ZNE: REF NO:
PLAP]D]ING NOTES>
>
it iF if Y 3f �7F af aF iF x-if r iF 3� if ii� iE �f if it it ac {f it� if if if iE+f 4* r�Jf �If �c+c iE r ir if it+t i� if iF � it jE �F �rt *�v ic+t 1t if if it iF ic Ic ic {f i: �Y+f ic if ac AF x ac+f +x iE r. iF+E
D E �' E L U P M E N T S&.R V I C E S R E Q U I R E M E N T S
ZONING APPP.00'ED BY .
bUILDZNG APPROVED HY ;
G
APFLICATION ISSUED BY;
iFifiliEiEjE�Eit+PiEikiEifaE#�itifif+Faf�cif�.'x.'�cx.:�xic:'�.xx.r..' \
afafM�fiEYiFiF�FiEaE�Fif�#'#Vif�ijfY-i4itifif�M4Yifi�ifif!lif�ifiMaFif�f��n
LEGALI2ATION;N F E E S U M
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 3.75
5�&
PLAra
ISSUE FEE 15.00
BOILDING—DIV—> PERMIT ISSUE PLAN—CF?ECK
TOTALS----> 3.75 15.QQ 0,00
�— DATE:
DATE:
DATE: � �
��fiFjf�E+EifihiFifit % �� o- r. iFiE
itlFifiF�ifif�Elftfif MMrifriFitilriEitiErt+iEifiFif+f
Y STRUCTURAL SEGMEP]T:N
FIRE SMZP/RES GP.ADZNG
SMIP/NON—RES
TOTAL PPID DUE
18.75 18,75 .00
REC�ENOE DIVISIOTI TOTALS--> COLLECTED• 18.75 OVEP,/SHORT; 00 '
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GP.ADING PLAN—CHECK
18.7J
if if if iE 1f-lF iF iE if If iF if ifY-'k Y��F M iF if if�1Y * 1Fdfif iFif 1fY )F if if if iFiE if iEi� 1f 1f iFiE 1f K V-1f'1fiF iF iF'K if �E% K iE 1f af iF�)fif iL M K Y if-iF Y if iF aFK�Y 3FiGi4 if iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
oa�e�. Owner. I
I tlo nereoy cenify inat I am aware ol ane uneerstana ihe reQuiremen�s ol California Healtn an0 Salety Code Sections 2550.5, 25533, antl EL E
25594 and thal I or any IWure buil0ing occu0am willlwill nol (cirtle one) nee0 lo comply vn�� sai0 stale cotles ana Ihe repuir¢ments far a EL E
permit lor cons�mnion or moAificaiion imm Ihe Air ualiiy Manapement Disirict. Fesitlential conslmction apD����ions are e�emp� imm
Ihese pmvisfons.
Daie: AODlicam:
I nere�y cerOfy I�at I have read ihis apPlication and slate ihat iM1e a�ove infarmation is corBcl. I agree lo compty wilh all cily and county
oramanws antl Slale laws relaiing Io building con9mction anU �erehy aulharize represenlaiives ol Ihis ci�y to enter uDon Ihe above�mentioned
pmperty lor mspectian purpases. �{�.
ate: �/ ' � — 9 I Si9nalure: — ' " T�^ ' �
�riverS �icense or Sociai Seari�y a: �. �
16aL46 Whne—Bulltling; Green—Gado EnlorcomenC Canary—Applicanl: Pmk—Ravenue; GolGenrotl—Assessar
D E S C R I P T I O N
3 FIXTURES, LIGHTING 1 ST 20
2 RECEPT/OUTLET 1 ST 2Q
END OF FEES
UNIT COST TOTAL COST
EA. ,75 2,25
EA. ,75 1.SQ
V
dx �L+372i4p—QDii224D T C��," lo.i5
oATE= iir21;94 TTtiE: 11:?6
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# � Date Inspector qppROVALS Permit# Date Inspector
1. Temporary ElecVicai Serviceor Pole 52. Pooi & Equipment Location
2. Soil Pipe�Und�grnd. 53. Steel fteinforcement
3. Elecvical Condo�t Utiliiy�Undrgcnd. 54. Forms
4. Electrical Conduit•Undrgmd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plum6ing & Pressure Tesi
6. Electrical UFER Grnd. 5J. APPROVAL TO COVER�GUNITE
7. Footings 58. Eiectrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgmd., 7esc .
9. Water Pipe•Undrgrnd. 60. Backwash �ines, P�Trap. � Undrgrnd.
10. Struciural Floor System 61. APPROVAL TO DECK '
i i. Property Sewer 4ine & Housa Connection 62. Backwash & Receptor�Final
72. Sewer Cap 63. Heater & Vent�Final '
73. Roof Drains 64. Plumb�ng System � Finai
74. Rough Plumbing 65. Electrical�Final
15. Rough ElectricahConduit 66. Solar System•Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Siyn 68. APPROVED FOR PlAS7ERING
78. Rough ElectricaPT Bar Ceiling 69. POOUSPA SYSTEMS FiNAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory �ireplace APPROVALS Permit #
21. Duas, in Structure 70. Underground HYdro
22. Ducts, Ventilatiog 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd.Stora9eTank OGas ❑Oil
25. Rooi Sheathin9 74. Overhead Hydro
26. T�Bar Ceiling (Suucwraq & 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. Dry�vail Nailing HEALTH OEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Finai Electric ,��p�,s� Notes: \.
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Tes2
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 Irripation System
45. Sound Attenuat�on
46. Handicap Regulations
47. FINAL STRUCYURE & BUIL�ING �
48. FINAL PLANNING �
49. Electric Release to Edison
50. Gas Reiease to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date
��
�
I
AOPIi<ant to fill in a11 soaces exceot those witnin heavy boraer Ilnes antl sign all apDraD/iate aeclarations.
CITY OP COSTA Iy1�S CON �TN TION PERMIT PERMIT TRACT NO. LOT NO. UNIT NO.
Project Address �'+� �.�/�/�
ApplicanYs Mailing /A�d/d�ress ._ �,1�.La1 ��/ .
Owner's Name - /U�/`C�AL.IiS Phont+�7
Address ✓A�%E
Arch/Eng. License No.
Address
Contracrot's Name. C _�Ll1��A ,Phone �o � �/
Addresslmailingl�p �
City License No :l
LICENSED CONTRACTOR DECLARATION
1 hereDy aftirm that I am licensetl untler provi510n5 Of Chdrter 9(commentlng
'i wi[h zection ]000) ot Division 3 of the Business antl Professions Cotle, an0
', my license is in Iull %(�rce Ptl e(/ect.
'� Licons la C '�(��. '�nn� f�L�����
�oac�fo?�-�9�'T s9 c �/�L��-v��.—
�� WORKERS'COMPENSATION DECLARATION
�I I hereby atfirm thal 1 have a certiticate of mnsent to self-Insure or a certilicate
' o/ Worker5' Compensati/o,n/ InSurance, Or a certlfietl cOpy th¢reot (Se<tion
Pol�'�c�Y No. C.1��/� `�(� ComPanY �aLER �AJS
[ifietl copy is hereby furnishetl.
erJiJjeqfqp�iy�iletl with [he ci[y 'Itling jy�sjon/� �A'�� )
Date /r�l /�' % APPlicant Ll' / /•5 /
E%EMPTION FpOM WORKERS' COMPENSATION DECLARATION
(This section neetl not �e completetl it tbe pe�mit is fo� one buntlretl ($100) or
less).
I<2r[ify tha[ in �he performance of the wo�k fo� wltich NIs permR is Issuetl I
shall not employ any person ln any manner so as to become subject to t e
Workers' Compensation Laws of Califomia.
Date Si9nature
NOTICE: 1/, aiter makin9 this tleclaration, you snoultl become subject to he
Workers' Compen5ation provlsions of [he labor Cotle, you must forth itb
'� comply with Su<h provi5ion5 or (hi5 permit Shall be tle¢metl revo tl.
I CONSTRUCTION LENDING AGENCV
' I her¢by attirm that there iz a constructlon lentlin9 a9ency for the performa ce
oi the work tor w�ich [his Oermlt is issuetl (Section 3097 Civ. J
Lentler's Name
I Lentler's Atltlre55
I OWNER BUILDER DECLARATION
I hereby affirm that I am exempt hom the Contractor's L.icense Law for t
lollowing rea50n (Seclion 7031.5 BuSinesS antl ProfesSional Cotle: Any city o
cOunty which requires a P¢rmit to consi�uct, alter, imprave, tlemolish or repai
any st�ucture, prior to ils issuance, al5o rGquires tite apP�icant for 54ch pe�mit
�n li�n a aonntl cfatemnnt that M1e/she is licensetl oursuant [o [he orovisions of
C�
]031.5 by any applicanl for a permit subjects the-aOPlicant to a civil
�enalty of not more than five huntlretl tlollars (E500�.
I, as' owner of Ihe property o� my, employees wilh wages a5 th¢ir sole
compensation, will tlo the wo�k, antl the st�ucture is not inf¢ntletl or offeretl
lor Sale (SeGlion 7044, Bu5ine55 anC PrOfe55ional Cotle: The ContraGtOr's
License Law tloes not apply to an owner oi a property who builtls or Imoroves
thereon, antl who tloes such work hlmself/herself or throu9n his or her own
a.mployees, orovitletl that sucn improvements are not intentled or otteretl tor
Sal¢. It, howeveq lhe builtling o� improvement is Soltl wlt�in one year of com-
pletlon, ihe owner will have the burtlen of prOvinq he/she tlitl not builtl or im-
prove for the ourpose ot sale).
❑ I, as owne� o/ the prOperty, am exUusively con[raCting witM1 IicenSetl con-
�racto�sto construCl the pwjecl (5ectlon ]044, Business antl Professions Cotle:
The Contractor's License Law does not apply lo an owner of property who
Duiltls or improves thereon, antl who contracts for such projects witn a con-
tractor(s1 iicense pursuant m the Contracior's License �aw). I am aware that
proo/ of lh¢ir Wo�ker's Compensatlon insurance shoultl be provitl¢tl [o me.
❑ 1 am exemo� untler $eciion B. & P. C. for Nis r¢a5on
Date
I hereby certity lhat
InPormation is wrrecl
and state laws relatin
senta[iv¢s o/ lhii cit
Inspec[ion pu��py$b ��
Siqnature �(d
Driverz' License or 55
IF 0865-46, rev. 10/B4
. Owner
have reud this applicatlon antl state tbat the above
agree lo Comply wi[M1 all city antl county ortlinances
o builtling construction, anC hereby autho�ize repre-
to�efler upon the abOve-mentiOnetl properly_for
3a1�3
TVPE OFCONSTRUCTION NEW ADD, ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WOfiK/USE OF BLDG.
TVPE OF PERMIT LJ GRAOING LJ FOUNDATION LJ STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER _
PROJECT DESCRIPTION 5Q. Fr. occuPANCv_
CONSTRUCTION TVPE VALUATION $
ZONE GRADING CU. VpS. ACRES—
Remarks:
Preventer
Irrigation
athtubs
iking Fountains
�r Drains
x Sinks
Service Outlets
Kitchen Sink
Lavatories
Roof Dreins
$15
Boiler
Duct - Under Ground
Duct - Svuctural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0-100,000 BTU �100,000
Reinspec[ian Fee � $15
Wnite - Bulltling; Canary - Applicanh Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
SewerCap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-t00,000BTU ❑100,OOOBT
System Repair/Alteretion
Fire Dampers
Registers
luue Fee
A.P. #
5 Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
4782 2/OB/Q9
Accessory Building:
ELECTRICAL
Automatic Washer Transformer ❑ 75-50 KW
ConstructionPoleSub. � 50+KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electtic
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal �
Generator DO-5 KW �5-15 KW
Zone
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP�iX-8
Inc. Solar 09-15 HP 016-15+
Microwave
Pole Light
Range
Si9n
Standing Sections •
Trash Compactor
$ 3 I
�- Reinspaction Fee $15 Issue Fea
FEES
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approved By
Building Approved By
Application Issuad 6y
$ 3
5,00 TL
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP � $ .
PLAN CHECK $ �y� PERMIT
PLUMBING 5 iL•4� ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50%. $ MICROFILM $
MECHANICAI $ TOTAL FEE $ ��� '
PIAN CHECK 25% $
Z
O
N
1
N
G
R
E
�
M
T
S
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1.:Temporary Electrical'Service or Pole 52. Pool & Equipment Location
2.'� �Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �u
5. Steel Reinforcement 56. Rough Plumbing & Pressure �est �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GU�'TE
7. Footings ,� �� 58. ElectricalConduit-Undrgrnd��
8. Foundation 59. Gas Pipe, O Undrgrnd., Test.;,
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O �L�drgrnd.
10. Structural Floor System 61. APPROVAL TO DECK ��
11. Property Sewer Line & House Connection. 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
74. 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
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � 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 FINA�
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT {+"
37. Plaster Brown Coat 79. FINAL INSPECTION -
r
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 2..((�,�Y '
39. Water Service-Final � �
40. Gas Service-Final .
41. Solar pomestic-Final • . �
42. Backflow Preventer � � "
43. Backflow Irrigation � � �
�44. Landscape Irrigation System - � �
45. Sound At[enuation -
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 '
, ;
ADDRESS
or
BUILDING PEftMIT NO.
SUBCONTRACTOR
0
=� •` . . 2'7 f 28
CQSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O. BO% itW - COSTA MEBA, CALIFORNIA YX2!
For Applfcant to F711 In Completaly
TYPE OR PRINT
BUILDINo .//A_ f zO �Sr
ADDRB89 /�!'7 e
COSTA MESA, CALIFORNIA
■ MAIL
STATE
LIC. NO.
6IZ8 / O
OF LOT Ly
USE OR
EXISTINO BL�O.
t6TGAGK LIX[ IROY
6�
DESCRIPTION Of WORK
BUILDINO
SIZE
EXTERIOR WALL
1 NHPHeY ACRNOWL[Dp6 TNAT I1VI
ANO BTATH Tl�AT TM[ ABOV6 COp1
PLY WITX ALL CITY OqDINA AND
BUILOINO COHBTRURION.
BIGNATURE OP
P6RMITTB -
AUTHOIIIZBD AO[NT
mNa
)Uil-1-67cMs�00 009 �'�:•.*>'.��.it7
APPLICATION FOR PERMR
BUILDINf3
f0! Off7ca Use Only
■acnrt Ho.
ZONING
Ho. o� ' ua� o� H�
�ux� ew�omo
YARD! MPROV6D
MAIN BUILOINO
1 �j.� l �O
BHALL BH LE88 TXAN
VAROS MPflOVHD
ACCELSORY BUILDIN6
�- ,
RUR �'cG�vr. m
DIYTANC[![T. BBT. MAIN d
MAIN BLD ACCHBG. Bl.�
VM. �C DATB
G. U. P. MPROVHD
MP11DV[O� (�% / `
SY W � V OAT! Vi
(��� 0.
�
i �
80. Pr. V v �
0
TX[ I�YOYIR ONOWN UND6R VALU�TON IB POR TH6 j
rYHPOOt O! [llAGLIBHIfiO A PBPMIT I88 ONLY. i
vw�uwrion � pd a�
/� � � PERMITFEB p
0
: .7 ,{' w
TOTAl.FE6 $ � D �
OWNtK pTCKr'i°P� GEORGE H.
JOB ADDRESS 469 E. 2Qth Street
GENERAL CONTRACTOR p�er-u„tider
AP No. LOT TRACT
1' iCTIONS Si nar�
s�
GAS
iWATER
ROUGH P�UMBING
PFOP. SWR. LINE � HOUSE CON. �
SGRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUN� POWER �
ROUGH WIRING
TRENCNES RORMS STEEL REINF. �
F�OOR SYSTEM
BOND BEAM STEEL REINFORCE
SHERTHING(�p.r� ✓..�,.�`i1,pc(_�.,�t <l�yF /Ff�(' •
FRAME AND FLASHING
LATHING — IN OUT
PLPSTER, BROWN COAT
SiPUCTURPL,F
H IG, VENT.
PL.,.nBING. FIN.
BI/ILOING, FINAL
GAS TEST
DATt b-lt3-btl
BUILDING PERMIT N0. �
SUBCONTRACTOR
/ ^
�� �V�O�
COSTA /rIESA BUILDINGSAFETY DEPARTMEM
P.O. BOX 1200 GOSTA MESA. CALIFORNIA 82020
For ApplicaM ro fili in CompbMly
TYPE OR PRINT
�UILDINO
ADORHDY Q — T
COSTA MESA, CALIFORNIA
ior J-Q � auR
err S� re�a�rr
DESCRIPTION OP WORK
BUILDINO NO.
SIZE ROC
EXTERIOR WAW �U<f��l R�
B[P[R�ORM[D
--.�_ _ •
JUt118�0�1359• ****13.50
AfPLICATION FOR PERMiT
BUILDINO
fo► Offlc� Ur� Onfy
li��'.�]
uea or xrx�
OYIlO1M0
No.
�. no. / �„f'j - .3 � S — / c-.
I'E: NO EAVH OVBRHANO BNALL EE LC88 TXAN
'TO81D8aPPARP.L
E8
.OWBD (U. B. G. RlOUIREMBNT
YARDDAPPROVlD YMDBAPPROVHD
MAIN BUILDINO AGC6880RY BUILDINO
h
DI6TANCCB6T. BET..
MAIN BLD6H. ACCC
/ ^AR.# • Deev
e w
iac+-.�ca t .� ^i n.�sgiunr.es.0
lLY d^�O.�M/!
1 M6P6CY ACKNOWL[00� iNAT.i NAV6 R�AD U AP�LIGTOl1
wND eTwT6 TNAT TM� AlOV[ �B COAR[R O AOR6l TG COY.
PLY WITX ALL CITY GROIN11NCfl A(1D IAW� 9[OYlATNO
BUILDINO CONBiRUR10/M/�/J
816NATURCOr f4 �.i . ���
- U � � a
w
�
m
� so. rr. �
TX[ AMOYMT BMOWN UHO6R VALYATON 19 POp T118 �
PYRPoB[ ON fiTApLIGXINO A P6AYIT P66 OHLY. �
VALUATION � 7
PERMIT FE8 �
'/�Ov, � w
TOT�tl. PE6 � O