HomeMy WebLinkAbout410 20TH ST - Building PermitsApplicant to fill in all spaces except l�ose within heavy bartler lines anA sign all app�o0�iala tleclaralions.
ci7Y0FCOSTn,nnyE.SA�A CO�+N' STRUCT�ONPERMIT
P�o;e« Add�es, • '/ �u � � F a� �
i
Applicant's Mailing Address -5/� /�'� � '
owner•s rvame '�� 'T• �rL ✓�.4I5 Phone,sy�•y��
Address , y l � • L a 0 � -
Arch/Eng. Licenu No.
Address
Contractor'sName ��Ah��NI ,kE,ar.�✓�pho�/y•]7,.'i9�Q%
Addresslmailingl �y/� �- �d �'ENT�RAL l�/Di{� �/!
Ciry License No. � ��a `u 6 6 �
IICENSED CONTRACTOR DECLARATION
� I hereby affirm Ihat I am Iicensetl untle� provislonz of Charter 9(mrnmencing
' with sectlon ]000) ot Dlvision 3 of the Business antl, Professions Cotle, antl
my Iicense is in tull force ana effect , ( 6 y
' License Class U�ense No
Date Q ' �'� ' 6 � Signa[ure
WORKERS'COMPENSATION DECLARATION �
I hereUy affirm thaP I have a certiticale ot consent to self-Insure or a certl8cate
o/ Wotkers' Compensation Insu�ance, o� a ce�tifletl coOY [hereof ($ectlon
�800, Lab. C.) - •
oiicyrvo„5'���45xN�7yN.PA company /iEin�A
�8 Certlfietl copy is hereby fuinishetl. �
Certifletl copY IS�filetl with tpe city Builtling D�vision. �" �.. ,�.
� Date:.y'�/•L4`yb APPlicanl�?�LG�L /{'�ee..�Li
(y E%EMPTION FROM WOi3KER5' COMPENSATION DECLARHTION
u (Tnis sectian neetl not ba Completetl if [he.permit is far one huntlretl (§300) or
leszj.
I certity that in Ne performance of the work for whlch this perm�t is Issuetl, I
shall not employ any person In any manner so as to become subject to Ihe
Workers' Compensalion Laws of Calilornia.
Date $i9nature
'NOT,ICE: H, aiter making Ihis declaration, you shoultl become subject to tne
Wo�ker5' COmpenSalion provi5ions of the tibo� Cotle, you must forthwith
comply wi[h such D�ovisions or this -pe�mit shall be Eeemetl revoketl.
CONSTRUCTION LENDING AGENCV .-
I hereby atfirm that there is a construction lentling agency tor the periormance
of [he wa�k for whiGh thi5 permit is issuetl (Section 3097 Civ. CJ
Lentler's Name,
Lentler's Atltlre55 �
OWNER�BUIL�EH fiECLARATIOfV ' - '
I hereby affirm'that I am exempt frdm tne ConVaCtor'S Licenze Law tor the
following reason (Section ]031.5 Business antl Protesslonal Cotle: Any cl[y or�
county whlch �equlre5 a pe�mit [o cons[ruct, alter, Improve, tlemolish o� �e0air
any structure, prior to Its Issuance, also requires tne�applicant for such permit
to file a signetl stafemen� that he/she is licensetl pursuant to tbe provi5ions o1
the Con[ractor's License Law (GhaO�e� 9(commencing with Secfion 7000) ot
Division 3'0l the Busine5s antl Professions Cotle) or that he/she is exempt
there(rom antl the�ba5i5 10� the allegetl exempNon. Any viold[ion of $ection
.�p031:5 �y any applicant for a p¢rmit subjects the applicant ,to a civil
:�-.,�r�.�ally of not more than tive huntlretl tlollars (E500).
.d'!s.`�t` I, as owna� of Ihe property or my employees wi[h wages as tnel� sole
' t�mp¢nsation, will tlo the work, antl Ihe st�ucture i5 nof intentletl or otf¢retl
for wle (Se<[ion 7044, Businezs antl Protessional Cotle: The Contractor's
License ldw tloes nOt apD�Y to an owne� of a proper[y who builtls or improves
tbereon, antl who tloes such work himselt/herseli or tnrougn his or her own
employ¢es, provitlea that such Improvemenis are not intentletl or oHeretl tor
sale. It, nowever, tne bulltlin9 or improvemenf is Soltl witnin one year ot com-
O�etlon, Ihe owncr'will have }he burtlen of proving he/she tlitl mt DUIItl or im-
p�ove torthe pu�pose oi zale).
❑ I, az owner oi t0e properry, am exclusivety contrac[inq with Ilcen5e0 con-
, tractors to consVuc[ [he Oroject (Section ]044, Business antl Proteszions Cotle:
The COn[ract0/'s LicenSe Law tloes not apply to an owner of Property who
builtls or improves tM1ereon, antl who con[racts tor such O�ojecl5 wit� a con-
tractor(s1 license pursuant to the ConVactor's License Law�. I am aware that
proof o( their Wo�ker'S Compensation insurance shoultl be p�ovitletl to me.
�
❑ 1 am exempt unaer Sectiori B. & P. C. for this reason
Daie Owner �
I nereby certify tnal I have'reatl�tnis application antl state that the above
Information is,correct. I�agrea to comO�Y �'ith all city antl county ortlinances
antl state.laws relatin9 to bWltling construction antl hereby authorize repre-
sentatives ot this city lo enter upon the above-mentionetl p�operty for
inspectlon pu�pos 5. . p . -
� Signature ��� %� / Date4' \ Z ` �S
Drivers' Licunse or 55 # ��� ��
�N% 0�0%5 � � ' � � �. �" ' � _
TYPE OF CONSTRUCTION � NEW ADD ALLJ TERq71oN REPAIR
❑ CONVERSION ❑ DEMOLISH O�OTHER
DESCRIPTION OF WORK/USE OF BLDG. :
TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
O -OTHER
PROJECT DESCRIPTION SQ. FT. � oCCUaArvCv
CONSTRUCTION TVPE VALUATION 5
ZONE GRADINGCU.VDS. ACRES
Remarks: . '
i i
Bar Sink '
Backflow Preventer
Backflow Irrigation
Bathtu6s
Clarifiers
Dishwasher �
Drinking Fountains �
Floor Drains . '
Floor Sinks '
Gas Service Outlets
Kitchen Sink
Lavarories '
P-Trep
Roof Drains
0
Reinspection Fee $15
Duct - Under Ground
Duct-Structural •
Duct - Ventila[ing
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
�9 ai oo,000 eTu � i ao,000 er
peinspection Fee � $15
CMF OB65-46, rev. 30/84 White -'guiltling: Canary'- Applicant; Pink - Atcounting; Goltlenrotl - Assessor
Showers
Service Sink
$ewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9 -
Solar Tank
Swimming Pool w/Spa
Urinal
Water Clout
Warer Hearer
Water Service
Auto-Wash .-
Isue Fee
iANICAL
Nood or Typel ❑ '
Canopy Type I I ❑
Refrigeration System
❑0-100 000 BTU ❑ 100,000
,System RepajdAlteration
t.
F ire Dampers
Registers ' �, ^^
Oate _ _
laue Fee
FEES
$ 3
FEES
e
A.P. qW
S Main B�
E
T Fron[
e Rear
A
C Right
K Left
S
Ping. Ref. #
Automatic Washer
Construction Pole Sub.
Caoking Unit
Dishwasher
Dryers OGas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5-�
03B"u 9/13/�5'
� Zone
Accessory Building: -_
Parking Req./Provided
ELECTRICAL ,
Transformer ❑ 15�50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors O0.7 HP O1 K- 8
InaSolar �9�75 HP 01645+
Microwave
Pole Light �
Range ,
...y��
; Standing Secti
5 KW Trash CompSc
. -. i
�OOe. ,TL
Z
O
N
�
N
,� G
- �R
� . . E
�
M
T
�' S
FEE� ,
1
Fee � �$75 � � luue Fee , , � $ 3
DEVELOPMENTSERVICESREQUIREMENTS:'; ; , ,
Zoning Approved By � Date
Building Approved By ,�\ Date�T
' SUMMARV.OF FEES s�-�" � �
BUILqING PERMI7 $ SMIP $
PLAN:yCHECK $ PERMI7
PLUMBING �g �SSUANCE
� PLAN CHECK 25% $ ENERGV P.C.
.. OfIS , GRADING�
J ELECTRICAI $
PLAN CHECK 50% $� I MICROFILM
_ SI � =��HANICAL $ ��
TOTAL FEE
$ 3 PLAN CHECK 25% $
`� - - POOL A � �
CONSTRUCTION AND PLANNING �
Date Inspector " ' Date Inspector
, APPROVALS Permit # , � APPROVALS Permit # .
�� 1. Temporary Electrical Service or Pole 52. Pool.& Equipment Location
r.
2. Soil Pipe-Undrgrnd. � , . 53. Steel Reinforcement � ,
3., Electrical Conduit Utility-Undrgmd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . �
'.5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
, 6. Electrical UFER Grnd. . 57.. APPROVAL TO COVER-GUNITE
•�� 7. Footings 58: Electrical Conduit-Undrgrnd. '
8. Foundation . � 59. Gas Pipe, O Undrgrnd., Test ,
� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
, i 10. Structural Floor System . � 61. APPROVAL TO DECK �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .
12. Sewer Cap � 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
��1�6., Rough Electric Wiring 67. �Fencing & Access Approval
- 17.' Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-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. Undergmd. Storage Tank O Gas ❑ Oil
i
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,.
27. Frame and Flashing ' 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29: Insulation � 7S. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT .� �
31. Plaster Brown Coat . , 79. FINAL INSPECTION '- ,.
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' �
33. Final Electric Notes: � ,
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-Test ' �
36. Hood or Canopy � ' ' ,
37. Final Factory Fireplace , .
38. Final Plumbing � , '
39. Water,Service-Final ,
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ,
43. Backflow Irrigation � E X P I R E D
44. .Landscape Irrigation System ncompete Inspections
45. Sound Attenuation Uate oYo �
S O
46. Handicap Regulations � � . � �
47. FINALSTRUCTURE&BUILDING `� - .
�,r.- . .
48. Special Requirements Completed . � ' , � -
49. Electric Release to Edison ' � - � �' � - � .
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY � - - -
No. � Date � _ _, , � � _
OWNER
DATE
JOB ADDRESS 1.�10 Fast 20th Street BUILDING PERMIT NO. 98%3
GENERAL CONTRACTOR �_ T Rpnt)Pp VALUE S i00.00 _
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK b10Ck Wall
I' 'ECTIONS I DATE
SUBCONTRACTOR
Form
�'� � • ` JO�J
C057A MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPUCANT TO f/LC /N COMPLETELY
TYPE OR PRINT
BUILDING y� � z
ADDRE55
COSTA MES , CALIFORNIA
OWNER � � � _Q A�/Ii✓!
�
ILEGAL I LOT
DESCRIPTION NO. BLOC
e c nin � � � � � �i —
'SIZE I NO. OF BLDG9.
OF LOT NOW ON LOT
IRIGHT
ON OF WORK
REPwiN I IIMOVING
BUILDING NO.OI
SIZE ROOM
EXTERIOfi WALL IROOF
�
.�s� ��� -�-,p
..� -.r.-- �
rl l� N +� �i� :�l
�.C;;r-JUL 14.1959
FINANCE DEPT.
cirr o� r,osrn �,9ESA
APPLICATION FOR PERMIT
BUILDING
fOR OFF/CE USf ONLY
I HECEIPT NO. I Pjci�1�LZ�1
✓ll
IVED BY �/p ATE 'R/ECEI�VE�Q +/� UATE(�188UED
� I /—�Y �i � /-� T`_�
NG �
i5
COSTA MESA, CALIFORNIA
ZONE TYPE (� GROUP /
�/ APPROVED �
!G BY DATE
ZONING
ZONE I NO. OR �( I 1188 OF NEW // n ��
PLANS �/ BUILOINO��� �/�/��j
= APPROVED �/ (��/� // �--(
BY /V /-�` 41Y11 / DATE ��Ic/-�J
YARDS EVES
REOUIRED ALLOWE�
(CENTEH LINE 8Tq ,�, �
I HEftEBY ACKNOWLEDGE THAT I HAVE REA� TNIS APPLICATION
ANO 6TATE TNAT TXE RBOVE IS COPNEQ AND AGREE TO COM-
PLY WITH ALL CITY ONOIN 1 ES ANO STATE LAWS REGULATING
BIIILOIN6 CONSTRUCTION.
SIGNATURE OF
PERMITTEE
AUTHOftIZED AGENT
✓
�
S
na
THE �MOUNT BHOWN UNDER VALUATION IS FOR THE
PURP09E OF EBTAeLI8HIN0 / PERMIT FEE ONLY.
VALUATION
PERMIT FEE $ p,�� -�
g ��_ PLAN CHECK S
/
TOTAL FEE $ �, �
OWNER R.T. STEVh'NS ' DATE �_23�59
JOB ADDRESS BUILDING PERMIT NO. 9OHZ
GENERAL CONTRACTOR Owner-Builder VALUE $ ��50,00
A. o� � LOT TRACT F1RE ZONE DESCRIPTION OF WORK Add.F3n1.R2t1� K1t.Bed.BBth
��UP I TYPE V ZONE PLAN NO. qnA9
INSPECTIONS
coat
Line
P._..�
DATE � SUBCONTRACTOR
_�y_.
PERMITSISSUED
DATE NUMBER
S—'>�
nnAn
, ; .
;�' . ����
COSTA MESA BUILDING DEPARTMENT
a.o.eox3n
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
"5 �io � � c c'¢ �
COSTA MESA. CALIFORNIA
MAIL
ADDR�
CITY
ARCHITECT
OR ENGINEER
AOG .
LEGAL ILOT
DESCRIPTION NO.
A.P. NO. —
SIZE ���j X
OF LOT Q
USE OF �
E%ISTING BLDG.��
SETBtCN IINE FflOM
cErviER pi STwEET
_ ,�T� d�/VS
- .� � -d �
TEL.
N
LIC.
NO.
CITY IIC.
NO.
U �U
NO.OF BLOGS. /
NOW ON LOT
�/, w y f ��.e ��
�
� REAR YARD eTS
DESCRIPTION OF WORK
NEW ALTERATION � ADDITION
REP/. � MOVING I DEMOLISH
BUILDING ' ��ya� NO.OF
SIZE � , ROOMS �� STORiES
EXTERIOR WALL b!� ROOF � y�
U=(�� ��.C�6�(��
l�._2� _-Sh `..:t
FlNAh10E DfPY.
APPL�i'C�ATION�FORP ERMIT
BUILDING
FOR OFFICE USE ONLY
/ �d L' Zn�
COSTA MESA. CALIFORNIA
� MESA
M �� v Nl> � F /_'(U, .5 /3 N � " ,.�-6 `'
%� . � Q/� �, / Tho Amnunt shown under valnalinn ie for the
1 HEREBV �CHNOWLEDGE TMwT I M�VE RE�D THIS �PPLIGTIOH �ND '
ST�TE TNAT iRE ABOVE IS CORRECT �ND �GflEE TO COMPLV WITH �LL purpose oi esiablishing a permit fee unly.
CITY OflDIN1NCE8 /.NO STATE L�W6 RE6VL/.TING BUIL�ING CONSTXVC.
iioN. VALUATION
��• /
SIGNATURE OF ./ _ PERMiT FEE $ "
PERMITTEE �� �
� %�� � PLAN CHECK 3 �
$ J �
AUTHORIZED AGENT TOTAL FEE S vZ �
9"�