HomeMy WebLinkAbout217 20TH ST - Building Permits Y
ell 9 - CITY OF COSTA MESA
4 BUILDING DIVISION
IF y .4writirral I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
e. 111.410
� PERMIT 605-01779
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SU JLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 217 E 20TH ST Status: ISSUED
Suite: Applied: 10/04/2005
Vicinity: Issued: 12/05/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 42627308 Zoning:
Applicant: ISHIHARA, ANN HISAYO
Address: 1997 ORANGE AVENUE t /
Phone: 949-548-9524 ISSUED BY: Y
COSTA MESA,CA Zip: 92627
Owner: ISHIHARA, ROBERT TR OF '
Address SURVIVOR'S TR - _
COSTA MESA,CA Phone:
1997 ORANGE AVE Zip: 9262 111‘
Contractor: -
Address: - . '
Zip: License: - - .
Arch : MUSSER ARCHITECTS INC ' Eng:
Address: 730 W 17TH ST Address:
Phone: 949-5744987 - Phone:
COSTA MESA,CA
Zip: . 92627-4307 License: C15234 License:
SCOPE OF PERMIT - '
LEGALIZE/CONVERT A 238 SF PATIO COVERED AREA BETWEEN THE RESIDENCE AND GARAGE INTO ADEN/LAUNDRY AREA AND A NEW
BATHROOM IN AN EXISTINGONE-STORY SFD.
a06 - vO"L� . . . . .
' FEE SUMMARY ,-
Plan Check: $227.01 Calc Valuation: $21,99t.20
Permit: $349.25 . 2, Claim Valuation: $0.00
SMIP Res: • $2.20 , - .
SMIP Com: $0.00
Other: • $349.25 ' • --
Inspection: $0.00
Total: $927.71
RLANNING&ZONING
SETBACKS
MAIN STRUCTURE Front :0-0,5,a- -'Rear 0-0 . > Left, Or 0 ,-Right - 0-0 ,
ACCESSORY ' Front 0-0 - Rear "'0-0 ' Left 0-0 :' • Right 0-0'
PARKING Existing:- 0 :. Required: 0 -- Proposed:. =0• - ' -
-
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: '
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
I'ceriify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of alifornia, agre th if I shquld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these prdons. /q/ //p /fit' `/�1 /j� �'
Applicant Signature'` ALAI(i"+/_'_ r""Dete:r'E. "�.'1
t COM
WARNING:FAILURE ( SECURE WORKERS' PEN COST OC OVERAGE 11S UNLAWFUL AND SPALLDEDSUBJECT IN EMPLOYER CRIMINALPENALTIESCODE.INTEREST.
AND
ATTORNEY'S
HUNDRED
THOUSAND DOLURE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN RECTION 3706 OF THE LABOR CODE,IN7EREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.If Class II
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: _ Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exam nder sec. Business and Professions Code for this reason:
Signaturre: 4/P14/P1 't' • I 'V 0 ate:�o ; �_
�
_Owner ID verified by driver's license. Yes 0 No Driver's License No. --
F. Expires:f '07
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
�— �� /0
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? El Yes 0 No
V
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr erty for inspe I npu[�/seo I eery ngtt7to occupy or allow occupancy of any building authorized by this permit until fina�spectio�
Le
Sign_ature..16_'Cegal Owner(s): /L,�Date'"
t / rilulhorizgeTh.ppiwM`....„ Date
COVE I INSPECTION TYPE an JNT1T1ALS con! INSPECTION TYPE all 1I11IDAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition , 250 Final Building/Occupancy .J L 6
•
p •
CITY OF COSTA MESA
4
BUILDING DIVISION
• , .. , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
.I ��li I PERMIT
1.14114 , IB04-01001
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 217 E 20TH ST Status: ISSUED
Suite: A Applied: 06/01/2004
Vicinity: FRONT UNIT#A Issued: 06/01/2004
Parcel Number: c.42627308 Zoning:
Applicant: HOSKINS, ALAN ISSUED BY:
Address: 1286 WATSON AV
Phone: 714-496-9580
COSTA MESA,CA Zip: 92626
Owner: ISHIHARA, ROBERT TR OF
Address SURVIVOR'S TR
COSTA MESA,CA Phone:
1997 ORANGE AVE Zip: 92627
Contractor: HOSKINS ROOFING COMPANY
Address: 1286 WATSON AV
Phone: 714-496-9560
COSTA MESA,CA
Zip: 92626 License: 614309
Arch : Eng:
Address: Address:
Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
REROOF UNIT A:T/O COMP.SHINGLES ON PITCH AREA, INSTALL NEW SHTG.&ELK COMP.SHINGLES.T/O BUR ON SMALL FLAT AREA
CONNECTING GARAGE TO HOUSE&INSTALL DIBITEN MODIFIED ROOFING.
•
FEE SUMMARY
Plan Check: $0.00 . _ Calc Valuation: $6,275.00
Permit: $139.25 Claim Valuation: $6,275.00
SMIP Res: $0.63
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 •
•
Total: $139.88
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-.0 . Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0\
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ tt have and will malrrt In workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
/ My workers compeysatlon�In urance carrier and policy number are: (/
Carrfei: C57% t� A'//%(/c7 City Number: /4'4,-;-S 9 9- d 00+,
`(Phis section need not be completed It the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perks •nce of the work f• ,is permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cr • la,and agree w sho Id be e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these
tAppliiCant Signature: Ir•( Q'_ z Dated •"—o/- O y
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND COLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37530F THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.
-•er.d -t
•
� � q Contractor's Signature:
\,Date: e)/- — n /— O '-/
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:My city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.It,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec.
341,Title B,Callfomia Administrative Code).
O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feel of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials end Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
CSignature Of,L§gat Owner(s) Date
A2Ani /J. /-/os1 c ' - iii —
And/Or Authorized Applicant Date
CODE t [ISPECTIONTYPE PATI PriilAL£ CODE( INSPECTION TYPE PATE II1)IIIAL£
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
Pt(200 Final Re-Roof 6-4-" l Zat• 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
`psi 9 CITY OF COSTA MESA
4 BUILDING DIVISION
F ,. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
-4• pica PERMIT
4%.0,100 1604-01000
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 217 E 20TH ST Status: ISSUED
Suite: B Applied: 06/01/2004
Vicinity: REAR UNIT#B Issued: 06/01/2004
Parcel Number: 42627308 Zoning:
Applicant: HOSKINS, ALAN ISSUED BY: • 4
Address: 1286 WATSON AV
Phone: 714-496-9580
COSTA MESA,CA Zip: 92626
Owner: ISHIHARA, ROBERT TR OF
Address SURVIVOR'S TR
COSTA MESA,CA Phone:
1997 ORANGE AVE Zip: 92627
Contractor: HOSKINS ROOFING COMPANY
Address: 1286 WATSON AV
Phone: 714-496-9580
COSTA MESA,CA
Zip: 92626 License: 614309
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: ': License:
SCOPE OF PERMIT
REROOF UNIT B:T/O COMP.SHINGLES ON PITCH AREA, REPAIR SHTG.AS NEEDED, INSTALL ELK COMP.SHINGLES.PATIO FLAT AREA:
T/O BUR&INSTALL DIBITEN MODIFIED ROOFING.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,090.00
Permit: $97.25 Claim Valuation: $3,090.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 •
Total: $97.75
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ,
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS •
WORKERS'COMPENSATION DECLARATION:
1 hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
'❑, I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compegsation4wance carrier and policy number are: ) ��� �_ off, ��n
',Carrier: ,1"9":4�71 'C/2) Policy Number. - /
(This section need not be co .feted it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in;rector. ,rice of the w • which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation I s of Cairo ,,nd at ee the ' sho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thfse prove.ions. • .'
Applicant Signature: 'r La- Da 04 -0/- Dy
WARNING:FAILURE TO SECURE WORKERS'COMPE •TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
mgus ND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed and provis• of CIapter 9(commencing with Section 7000)of Division 3 of the Busine9 and Professions Code,and my license Is In full
fwce'a7nd effect.tic.# 2 r( /Gess(1 L"3 9 S
Contractors Signature: t r C Date:-/ e -D/ -O y
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 01 Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
C
Signatu a Of Legal Owners) Date 4?AE ). asAliA; C-) 6(; - 0/ - dy
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE PAIL INTITIALS CODE( INSPECTION TYPE PAIS 1MLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
L
200 Final Re-Roof t7-41'0 1c/ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 217 E 20TH ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 059458
ADDRESS: ISHIHARA, ROBERT N
1997 ORANGE AVE $ PERMIT NO: E 059458 PLAN CHECK NO: N GOVT: N SUPP: N1
COSTA MESA, CA 92627 S!{0-16Z"
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER: REG.NO.; JOB DESCRIPTION : ELECTRICAL SERVICE UPGRADE SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /
PERMITTEE: SANDOVAL J.C. ELECTRIC ( 310 ) 863-0132
ADDRESS: 11710 MAPLEDALE ST COMMENTS: SERVICE UPGRADE
NORWALK CA 90650 ***>E*xxx4****TEx***x*****+E****x **#*****+E****x**#x:6*x*x-xx*xx*FE***#*T6>E**x*x>E*FE3(*x
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect.. SETBACKS
CITYate:LIC/ 042836i STATE LIC.:47 1re: CUSS: C_,�1sz �"� "C
�' Date:/0—!2-9 2' Signature: Otis"� MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affir have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Secti 3800,Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING RE • PROV: PARCEL : 42627308 ZNE: REF NO:
0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES>
>
Date: Applicant: ************************************************RAE*x*******N:******x•********le it**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION; (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permi issued.I shall not employany pe n in any manner so as to become
subject to the Workers'Compensation Laws of California. // ZONING APPROVED BY DATE:
Date: /O —12 — 9 2— Signature: /G!
NOTICE;II,after making this declaration.you she ome subject to the Workers'Compensation provisions oft ober BUILDING APPROVED BY : DATE
Code.you must forthwith comply with such prov ns or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; • DATE: !iii. /2//�2
which this permit is issued(Section 3097,Civ.Cl. *********************** * **x- •* - **** le *x' *it****************.*** ***it x-te*1Fir se*
LENDER: ********************************************* ********************************
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 . 50
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0 Z SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S————> 18 . 50 15 . 00 0. 00 33 . 50 33 , 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.II,however the building or
. improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 33 . 50 OVER/SHORT; , 00
• for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 33. 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(S)license pursuant to the Contractors'State License Law). l am aware ****************D**E**S**C**R***I*P**T***I*O' N****I* *C**V*r **r*Y*
* *********
****************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason; TYPE QTY TOTAL COST
InCOMPlete Inspectin
Dale: Owner: ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP '418 . 50 18 . 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and El`?Hte&F "'S
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a yyi ////JJD'�4
permit for construction or modification from the Ail Duality Management District.Residential construction applications are exempt from _ / � Sig• "
these provisions.
Date. _ Aancst:
hereby certify that have read this application anddstate that the above information is correct. agree to comply with all city and county /.
I V////
ordinances and state laws relating to building construction and here authorize representatives of 's city to enter upon the above-mentioned
property for inspection purposes. '(/1// v
Date:/0—ti— 9 2 Signaler . • _ -
•
Driver's License or Social Security 4: •
r '46 While—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POOL PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date In791
_
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
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, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
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
�ti
15. Rough Electrical-Conduit 66. Solar System-Final
16/Rough Electric Wiring 67. Fencing & Access Approval
17. sough Wiring Sign - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing • 73. Undergrnd.Storage Tank 13 Gas 0 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 I I 77. FIXED SYSTEM FINAL
•
29. Insulation I - 78. FIRE PREV. FINAL
30. Drywall Nailing ,, HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 1 79. FINAL INSPECTION
32, Electrical Power Meter-Final i 'f i 80. FOOD CERTIFICATE ISSUED
33. Final Electric ,I Notes: 67_2 1 -Q3 a.-F _'e__
()toe-
34. Final Heating& Air Conditioning '
_ I
35. Final Gas Pipe-Test j
36. Hood or Canopy - l
37. Final Factory Fireplace •I !
38. Final Plumbing -�
39. Water Service-Final
40. Gas Service-Final .I
41. Solar Domestic-Final
I ,
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING I
.
48. FINAL PLANNING
49. Electric Release to Edison I
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY >
No. Date
•
`oma Li% CITY OF COSTA MESA
Q CALIFORNIA 926284200 P.O. BOX 1200
T.
14 'dDEVELOPMENT SERVICES DEPARTMENT
4cwAAcutari Ny0
October 31, 1994
Dear Costa Mesa Property Owner:
In reviewing past permits, we find that work has been done on your
property located at 217 E 20th Street Rear Unit, Permit No. B53031,
for a roofing permit. The permit is valid for 180 days from
issuance or your last inspection, per Section 303 (d) of the 1991
Uniform Building Code. Should we not hear from you within 10 days,
your permit will expire as stated herein and additional fees will
be required to finalize the permit. Failure to final a Building
Permit could possibly impact the future sale of your property.
To activate the above permit, please follow these steps:
1. Telephone (714) 754-5626 or 754-5627 .
2. Request an inspection; state address, permit number, and type
of inspection.
3. Be sure to have working smoke detector's as required per
Section 1210 (a) of the 1991 Uniform Building Code.
4. Have an adult present at the property at the time of
inspection to provide us access.
Should you have any questions regarding this process, please
contact me at (714) 754-5273 .
Thank you for your cooperation.
Sincerely,�� y,�
CLeid
Janda Huapaya
4I/ /
rmit Processing Spe alist
77 FAIR DRIVE
Building Division(714)7545273 • Code Enforcement CM)754-5623 • Planning Division(714)754-5245
FAX(714)556-7508 • TDD(714)754-5244
PROJECT ADDRESS: 217 E 20TH ST UNIT: REAR CITY OF COSTA MESA - BUILDING PERMIT PERM NU: ;a 053031
or OWNER'S NAME: ROBERT ISHIHARA
ADDRESS: 1997 ORANGE AV A 5/f/ 5'?O' ] PERMIT NO: B 053031 PLAN CHECK NO: N GOVT: N SUPP: N
. EG I CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : RE-ROOF 1300SF RESID W/COMP SHINGLES SQ FT: 1 , 500
'•.f%DDRESS: UNIT:
CLAIM VALUE: 1 , 500. 00 CALC-VALUE: 1, 500 . 00 GROUP OCC: R-3 /
PERMITTEE: LINNERT ROOFING INC. ( 714 ) 639-7040
;A. ADDRESS: 1065 N. BATAVIA` COMMENTS: X
ORANGE CA 92667 *.*********************TE*Tr**i ******Tc-******* *TrT *********** *r TEl6******* ********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIR E N /N/ Tp p S
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS �/,
CITY LIG.: 033883 STATE LIC.: 4 1270— LASS: C-39 SMOKE` DETECTOR
Date: 1-2'9=)/ ignature: J_ -�.r1, MAIN BUILDING ACCE � 1„B AJ, G
FRNT: FT IN REAR: FT IN FRNT: FT ext FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seZCIDSm�eca_certificate of Workers' D
Compensa6onlDsyJ({a�cG•°l GenieQ copy lnemollseaion39o0, Lab. LEFT: FT IN RGHT: FT IN LEFT: FT •G ': ''f FT IN
POLICY NO.: b7J�L1—y1 EXP.DATE: 0S/01 /92
,COMPANY: STATE FUNDrory PA: ING REQQ• PROV: PARCEL: 41920514 ZNE: REF NO:
( 1 Certified copy is hereby furnished. LO Cerofie py is file. 'th the city Building Division. S ANNING NUTES>
i (� p >
Odle' ��Z-I —7� Applicant: V - ***************:**********************************1***#***************iF*********
EXEMPTION FROM WORKERS'COMPENSATION DEC : i section need not be coin detect if the permm is for one hundred($100)or less). D E V 1=, L OPMEN T SERVICES R EQUIR EMENTS
I certify that in the performance of the work-.el. ' ' • ue'. s a not employ any person in any manner so as to become
subtect to the Workers'Compensation Laws of California. ZONING APPROVED BY • _. _ _ DATE:
Date: Sushoul BUILDING APPROVED BY : DATE:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: k}� DATE• 2
which this permit is issued(Section 3097.Civ.C). �
LENDER: ***************************************************************TP****)f**********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 35 . 00 . 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed / SMI P/NON-RES
pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE •
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law , TOTALS----> 35 . 50 0 , 00 0. 00 35 . 50 35 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through '
his or her own employees,provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 35. 50 OVER/SHORT; 00
improvement is sold within one year al completion.the owner will have the burden of proving he/she did not build or improve
for the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7144,Business 35 . . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **********************************'K'**********************x-*********************
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A .L. F E E BREAKDOWN
o I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY D E S C R I P T I OO N UNIT COST TOTAL COST
Date: Owner: SFR 1500 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 1 , 500 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I on any future building occupant will/will not(ciicle one)need to comply with said state codes and the requirements for a _
permit lot construction or modification from the Air Duality Ma gement District.Residential construction applications are exempt from
•
these provisions. . 11 v
//
Dale: _ _ Applica .
I hereby certify that I have read thislapptication an stale that the above info align is correct.I agree to comply with all city and co y
ordinances and state laws relating to building cons ction and hereby author'. r'presentatives 01 this city to enter upon the above-men ned
property for inspection purposes. . * ,^
Date: -9 I Signature: - u G'':1 C. Y I v'i_ .� _
Driver's License or Social Security P:
164t.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO •PA
APPROVAIt Permit # Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole ✓ 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 1 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit•Undrgrndr- 55. Electrical Bonding
' 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6, Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
•
•
. 8. Foundation ,' - ; 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. �'� • 60. Backwash Lines, P-Trap, Undrgrnd.
10. Structural Floor System - • 61. APPROVAL TO DECK
11. Property Sewer Line & Housp;Connection 62. Backwash & Receptor-Final
12. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
• 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS • Permit #
21. Ducts, in Structure 70. Underground Hydro
•
22. Ducts, Ventilating < 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test .•
72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank-❑Gas O Oil
25. Roof Sheathing 'l f W 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 j 78, FIRE PREY. FINAL .
30. Drywall Nailing I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I 79. FINAL INSPECTION
• 32. Electrical Power Meter-Final . 80, FOOD�CEERTIIFFa.
ICATE ISSUFD
33. Final Electric Note< % ''_ __• i%eey{ �.la
1Y
�V
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 .
I
41. Solar Domestic-Final i
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System - •
45. Sound Attenuation -
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING n{ c./ I&�- t l -
48. FINAL PLANNING l ri-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA PLANNING £EPARTMENT
A. P. No. loJ, 9,r34DEC -1-70ff;AO0 081Ro****40.00
Bldg. Permit
PARK AND RECREATIONAL FEES - Apartment Developments
Fee Payment Receipt
Project Address 217_1i FAST ZOU t •r
Owner's Name PO4E T TJ'I"4k4
Bachelor or 1 - Bedroom Units @ $25.00 =
2 - Bedroom Units I - @ $40.00 = $40.0C.
3 - Bedroom Units @ $55.00 =
4 - Bedroom Units @ $70.00 =
5 - or more Units @ $75.00 =
Total Fee $40.00
Total number of Dwelling Units 1
Planning Department Approval Date 17_•!n_7r1 Park Area No. g
By Anne Morris Applicant's Signature i" . 5 , tr
CITY OF COSTA MESA PLANNING .DEPARTMENT
PAID U@•��
A. P. No, c ,.,
i•_• DEC —1-70cnsaOO 081R�****
Bldg. PermitlNo. J 3� S-yj
PARK AND RECREATIONAL FEES - Apartment Developments
Fee Payment Receipt
Project Address ,17_II r.7 2r.th cTucF; tASP -TSA. Crtic
Owner's Name 11DgUi- i'sNl�i!tk71
Bachelor or 1 - Bedroom Units @ $25.00 =
2 - Bedroom Units i _ @ $40.00 = $0.00
3 - Bedroom Units @ $55.00 =
4 - Bedroom Units @ $70.00 =
5 - or more Units @ $75.00 =
Total Fee $40.00
Total number of Dwelling Units 1
Planning Department Approval Date 11.4t7.-70 Park Area No. 8
By Anne Harris Applicant's Signature
-OWNER TSCRTPR, CURT il_ DATE L 1-23-59 _
JOB ADDRESS 217 East 20th Street BUILDING PERMIT NO. 8),55
GENERAL CONTRACTOR Owner-Builder VALUE $ 110.00 •
AP.44101:3-093-3kOT TRACT FIRE ZONE DESCRIPTION OF WORK Redwood fence
r-- SUP TYPE ZONE PLAN NO. 8L55
INaPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out •
Plaster, brown coat -
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop.Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final
I' ging Fixtures, Final
I. Gas Test
Construction Pole
Underground Power
Rough Wiring
Fixtures, Final n ' r
OCCUPANCY (O,.A#- -in/KY-2 81155
Form 210-5M-1-57
M OWNER ISHIHARA, Robert DATE 12-1-70
%JOB ADDRESS 217 B E. 20th Street BUILDING PERMIT NO. 32503
4.GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Residence only
A" VO. 118-093-34 LOT TRACT FIRE ZONE VALUE $ 11,200.00
I, ECTIONS Signal re Date GROUP l TYPE V ZONE H'±
SOIL L— ! S '? PERMITS ISSI�ED
GAS •� SUBCONTRACTOR
/ / y Date Number Signature
WATER “6.._ (-.V-' )/- j'f'Li �l ty
y _ c�(l �iROUGH PLUMBING 5° `4 • I' ?/ / _,,PROP. SWR. LINE HOUSE CON. /�✓��r/ /f�j�j-� %�/ 7/L�j�6•p`-•/�hSPRINKLING SYSTEM - s_7,-7/ SR'4p91* 415-
MISCELLANEOUS A ,p C`" `l
ROUGH HEATING AND AIR CONDITIONING /053 '36 -7,'
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER n
ROUGH WIRING 3.5-1/ epti nrp,Jand Vent.��/JJJ
TRENCHES 0 FORMS0 STEEL REINF. 0 4u _A'I^/ //AJi/ /-t,ki/C/dLd. 3;�-7� 77 '
FLOOR SYSTEM gin VVV /VI ,//iJ
BOND BEAM n STEEL REINFORCE n
SHEATHING / C 9/ �I�
FRAME AND FLASHING
LATHING — IN Er OUT S s a,
PLASTER, BROWN COAT a t. Y '71
S. 'TURAL, FINAL //// ., �� E,l/e'6ttrri��L e� �/a
H. .NG, VENT., REFRIG. ANO A.C., FINAL !L/�'�J 7�SS�Z/ 11qvsti,C.XF( ZILIV. tictid c3-J-,7j '&/ l
PLUMBING, FINAL AND GAS TEST / 2-2 •`f/ a —
ELECTRIC, FINAL .V171
BUILDING, FINAL I % y:`7�
-1111
- 32503
PA I0
COSTA MESA BUILDING-SAFETY DEPARTMENT DEC -1-705g-400 080 70.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RRJE�C/��IJ�(tD B if DATE RECEIVED DATE ISSUED
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BUILDISS a/o e_ o ``////nn/n/[G,//'' .0 `1 (cot -!/ ' 4R. . 1/—�7 ha, -- (d
OWNER A ls"^•e W'WIN A.P.NO. // O —D/ h- 3q PE3JZ`RMIT AID-,
MAIL 7 /� n BUILDING
ADDRESS / 9 9 Aza. O�Q Z.z.C•4-. ADDRESS, J7-. 13 E 70 St ar277•
W W �}- f TEL. r NPT• rt, T2• }I �0 3
Il U CITY (Oat Jiuo& -- NO. sr° Njk TRACT LOT BLOCK
Z
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI ISH
ON LENDER / __
a CO ✓ •
J D BRANCH (7 / �• / //
-IW ADDRESS OWNER /RakeR-r- - shIha 2.4�
CO J� /J VALUE p0
< ARCHITECT TEL. S +��P�sA a - $��
to OR ENGINEER NO
Z Q FIRE
Z ADDRESS ZONE TYPE AROUP
°•W APPROVED •�
w Z CONTRACTOR O'snr- -4 .- BY etsATE /z /- 70
In Z p ����y
-7/cc ADDRESS X779 044466 /fla-
w
= TEL. spy((/ ZONE PL0.4 gVILDING SE OF EWI�
rrZ F- CITY COSTA M&519 NO.fl/ %iv' �'
STATE CITY YARDS APPROVED YARDS APPROVED
c&2 LIC. NO. LIC.N0. MAIN BUILDING ACCESSORY BUILDING
Sj D SIZE NO.OF BLOCS. (FROM C/L STREET)'
OF LOT I NOW ON LOT FRONT , J, S-' FT. C FT.
Y
USE OF
\'(2J
EXISTING BLDG. R.SIDE CT. FT.
I"' SIZE OF NO.OF SFT. FT.
J ZZ NEW BLDG. ROOMS STORIES L.SIDE
U EXTERIOR WALL ROOF /SFT. FT.
_ COVERING COVERING REAR
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a
O MAIN S
LOGES.'(Or' ACCESS.BLOCS.
.i._... < R # DATE
/ 4Ca✓ [_fi//11j CUP --SY-70 APPROVED a-
a-7 V
~Zn _ BYpY61 r7/ DATE//- °'2740
"O r wn1 D FAR SPFr IA REOUTREMENTt
V I hereby acknowledge that I have read this application and state A e_Q— - - _ - c--C-/
that the above information is correct and agree to comply with �cC
cc all laws regulating building construction, and I shall not employ
V I- t�
any person in violation of the workman's compensation laws of C •
the State of California. ' e B
Z herebyI certifythat I am etc SO. FT. — O
properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s
Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ice
am exempt from the provisions of the State of California Business
VALUATION ���yyy
and Professions Code. Division 3,Chapter 9. a0 co
^ I '/, �J /� PERMIT FEE $ �j / D
Signature of/Cy`/) V/ ///W $ /// �zO� PLAN CHECK $ ` �r�B E
Permittee CLs/ ( t�4
Authorized Agent ` TOTAL FEE $ yo
,S O a
OWNER ISISIIARA, R. DATE 12-6-76
JOB ADDRESS 217 East 20th Street BUILDING PERMIT NO. 41111
RAL CONTRACTOR Gen o 3 os.; DESCRIPTION of WORK Patio Cover
Pg 118-093-34]LOT TRACT FIRE ZONE VALUE S1t500.00
INSPECTIONS Si Date TYPE V GROUP 3- ZONE R-1
SOILSUBCONTRACTOR PEJtMITS ISSI�ED
GAS Dab I Number Signature
WATER
Plumbing
ROUGH PLUMBING
PROP: SWR. LINE n HOUSE CON. n
PRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER n
ROUGH WIRING t Heating and Vent.
LJ
TRENCHES [ J FORMS STEEL REINF. n
FLOOR SYSTEM
BOND BEAM il STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
P 'ER. BROWN COAT
S :TUBAL, FINAL Electric
HEATING, VENT., REFRIG. AND A,C., FINAL
PLUMBING. FINAL AND GAS TEST n
ELECTRIC. FINAL / .J- y .
BUILDING. FINAL R G it -.t
ilr
SP =c —6"76Ph11,
- 0 207-> ,:tc *
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely- Use Ink Only `�
RECEI I I DATE RECEIVED' PATE yBSUEDD
BUILDING .c'7 / Y a ��j�" 12J(P- 7
ADDRESS yG "„C
G }�.� (/ �)Q/� .�
OWNER fi . 2"...5-
7 1 ,5 /'7 /4- I\ G9 A.P. NO�/� O ✓'c J'/ PERMIT NO.
AMAIL
DDRESS YYY 4- E', C+)‘../
J BUILDING. ' n , �O t^ 7
AODRE / J
CITY C. -'%-. TEL
. ` "'A T• ,/S � LOT-12:233BLOCK
CONSTRUCTION- NEW I/1Dp ALTER REPAIR
REPAIR (MOVING DEMO( ISH
LENDER ,
BRANCH /
OWNER , r-S/5f7G//llt,
ADDRESS ��//1/��/ A,✓/ �+
ARCHITECT TEL. USS /U d.. 2(Jtc UE I✓
et i
OR ENGINEER NO.
FIRE
ADDRESS �`y ZONE TVP ' GROUP
APCONTRACTOR `�.al-2.� .fir, , BYPROV ED / (/W DATE/�[[[[[[//////15.74
LLLLLLI /
ADDRESS /f;9 ([//f_a -fit.- ZON� NO.OF USE OF NE/yr- (� Y//
/:7j�
TIL. -4b __,A.1
/ PLAµ //1 BUILDING /� &/�/
CITY ` NO. rT/ ( "'T 7` �7 ` VZ
ISTATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. 6...,- s• /q UC.NO. MAIN BUILDING ACCESSORY BUILDING
ia SIZE I r NO.OF Burk$.CcdL //FROM C/L ST' :ETI
6. OF LOT Xs'l 3-\ NOW ON LOT&gee,. FRONT FT.
USE OF 1TT1 //��,�yy.. ..�� 3 `
y EXISTING BLDGIA;-4• .. /a S.i6'' -tip..n�,- R.SIDE # .0 01
'FT FT.
/
E`9 Separat permits are required for 0 L.SIDE 1/ FT. FT.
electric,plumbing and heating work. /
�
W (/tr
REAR / FT. FT. I
I,,, USE OF BUILDING AND WOJK TO BE PERFORMED DISTANCE BET. BET.MAIN&
'et j5£ .., . //Y �� �G MAIN BLDGS. ACCESS.BLDGS.
7.1
/% y /1 J VAR.. APPR
Q e��r r-. .4. i/-l.e,.,-� -a.-.9_41,-;,..e.
/tis VAR.ok �_.y/ /[�/r('
APPROVED
/ !�J/
/J ,y,'� ROVEf )r` ' SATE /2-6 -/ G'
... ( JrC./-CSC.,!. GT" / -.J/yC.C+C�/I Y r
IL
0.
0 I hereby acknowledge that I have read this application and state n
PIL that the above Information Is correct and agree to comply with m
0. all laws regulating building construction, and I shall not employ
Z any parson In violation of the workman's compensation laws of LI
the State of California.
3 I hereby certify that I am properly licensed as a contractor under
SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business .r
and Profession code,Division 3,Chapter 9. VALUATION PERMIT FEE $/�� t70 y,
7 Con
Signature of t- I PLAN CHECK $ y 0
i�� _ $ / oo 51 u
Permittee TAX E 0
U
Authorized Agent c '... i�,e��Cky TOTAL PAID S 23 00