HomeMy WebLinkAbout244 20TH ST - Building Permits CITY OF COSTA MESA
F BUILDING DIVISION
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.kI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.d.costa-mesa.ca.us
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PERMIT NUMBER. BX07-00090
PERMIT TYPE B_MISC STATUS: ISSUED •
DATE ISSUED: 08/22/2007
ISSUED BY: SOK
JOB ADDRESS: 244 E 20TH ST CM Suite/Unit:
Vicinity: REAR OF PROPERTY Primary Occ: 32 Const Type
:??
SQ. FT: 990 Valuation: $15,958.80
SCOPE OF WORK: 320 SQ. FT. DETACHED PATIO COVER AND ATTACHED 670.5 SQ FT PATIO
COVER FOR S.F.D. NO ELECTRICAL WORK.
OWNER: AUSTIN, JAMES R Address:: 244 E 20TH ST Unit
City/State: COSTA MESA, CA Zip Code: 92627-2218
Phone:
APPLICANT:JIM AUSTIN Address: Unit:
City/State: Zip Code:
Phone: 714-742-0586
CONTRACTOR: JH.R. AUSTIN INC. License No. 647211
Address: 03199 AIRPORT LOOP DR Unit:
City/State: COSTA MESA CA
Zip Code: 92626 Phone Cell:
ARCHITECT: License No.
Phone
ENGINEER: License No.
Phone
FEE SUMMARY -
Building Plan Check: $172.41
Building Permit: $265.25
Electrical Permit: - $0.001
SMIP Residential $1.60
SMIP Commercial $0.00
$0.00TOTAL FEES $439.26
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE O. INSPECTION TYPE DATE INITALS CODE INSPECTION TYPE DATE INTTALS
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 Anal Factory Fire Place 220 Final Planning Approval
203 Final Signm 222 Final Site
204 Final Demolition a1
m 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: • Owner 10 verified by drive .nse. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
c0--1,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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding.falsework,cc demolition
Ca Q�� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be oJmpleted if the permrtk ued at one hundred dollars 1St00)or less.)
2.Art 2Sec.341.Title 8,California Administrative Code).
Policy Number: — fid 0O/S2f -0 7
L_______ - 0 As owner-builder. I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions or Section 3700 of Applicant's Signature Date
the Labor C e,I shall lotthwii rr2 ly th these provisionyyy
/M�//� , �n Division of Industrial Safety Permit Number:
Applicant's g ure ��/��` ))) /// Da HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
r NING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. ,/J a registration form for acutely hazardous materials? ❑Yes 0 No
r � Y/�G
Circ—.71 6 �// tl,lass it (Section 25533 of the California Health and Safety Code, with some
/�'� L1// ' /// exceptions, requires registration with the Costa Mesa Fire Department by
G' _ �/%/tale (1 l 40 y each business which at any one time has on hand a quantity of acutely
Ccontraaw'sS naGhe" llJLate / 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Calibmia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 ho
thereon,and who does such work himself or herself or through his or her own
8. (If'yes". attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of,sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
ature of Legal/JD�w� �/lfl
Da
7
Signature Date eC /Y � A 7
305746(3/07)
Cnd,or Authorized Appiicant f Date
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
I PE MIT NO. TRACT NO. , LOT NO. . . UNIT NO. •
lciTYaF COSTA ME pA/ CONSTRUCTION PERMIT �� S
f'oject Address 9-4/ 5�2-0741 B� 7 � 7625 0
qq I /19/87 8000 TI
Applicant's Mailing
11Address .n/�yy//( C �ZO�"/-/ 2s� / �/ TYPE OF CONSTRUCTION NEW IJ ADD ❑ ALTERATION LI REPAIR
Owner's Name 9xiV/2/ z�/AJa&t Cfphone C.c'`ls/ ❑ CONVERSION III DEMOLISH OTHER A,R.# . Zone .
DESCRIPTION OF WORK/USE OF BLDG. Ill 0 wil M 1tQi� .
Address 23 re er a 0-no- 37 - r—1 r S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT IJ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front 0
Address ❑ TENANT I1V/ELECTRICAL El PLUMBING Ell MECHANICAL B Rear. N
s ❑ OTHER • A I
Contractor's Nam �
e' /' • • Phone • g- C Right N
PROJECT DESCRIPTION. SO. FT. OCCUPANCY
(+ OCCUPANCY K . ' G
Address(mailing) CONSTRUCTION TYPE �L.A ---, VALUATION $ S Left R
City License No. ZONE GRADING CU.YDS. 'ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
Q
I hereby affirm that i am licensed,under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Divisionsion33 of the Business and Professions Cotle,antl -
my license is in full force and effect. _ T'
License Class License No. S
Date Signature _ - ' PLUMBING FEES '
' , WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
tereby affirm that I have a certificate of consent to self-insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+ KW
Certified copy is hereby furnished. ,,,�
A
Certified copy is filed with the city Building Division. Bathtubs Sewer Connectio Cooking Unit i Meter L7up to 100 amps .
Date •
- ApplicantClarifiers Solar Collec • s Dishwasher � Meter Dover 100
EXEMPTION FROM WORKERRCOMPENSATIONampsS' DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher _ Solar Pi.' gDryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which tht permit is issued, I •
shall not employ any person in any manner so ecome subjec o the Drinking Fountains Sol. ank • - Fan Motors 00-1 HP 01%-8 •
Workers' .m•e'sa •n Laws of Calif //
Date - Signature o //fl 074.4./€0 • Floor Drains imming Pool w/Spa ' F.A.U.
Inc.Solar 09-15 HP ❑16-15+
-NOTIC:: If,a ter aking this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks UrinalFixtures Microwave
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance - Pole Light
of the work for which this permit is issued (Section 3091 Civ. C.) Interceptors ' Water Heater Outlets Range
Lender's Name - _
Lender's Address Kitchen Sink - Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatofles, Auto-Wash Garbage Disposal Standing Sections• ,
following reason (Section 7031,5.Business and Professional Code: Any city or `
•
county which requires a permit to construct,alter,improve,demolish or repair P—Trap"."
any structure, prior to its issuance, also requires the applicant for such permit p, Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of •
Roof Drains .
the Contractor's License Law(Chapter 9(commencing with Section 7000) of • -
'vision 3 of the Business and Professions Code) or that he/she is exempt -. . •
• erefrorn and the basis for the alleged exemption. Any violation of Section '
1 .031.5 by any applicant for a permit subjects the applicant to a civil •
penalty of not more than five hundred dollars($500).
•
25-1, $ 3
1, as-owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee ! $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code; The Contractor's MECHANICAL - FEES - ..License Law 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 - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0
•
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). Q
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigerat' System Application Issued By s _"'D ate �0 / _
tractors to construct the project (Section 7044,Business and Professions Code: ,
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑O-1 ,000 BTU 0100,000 BTU SUMMARY OF FE S
• builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ ' SMIP, $
Exhaust System ❑ Multiple ❑ stem Repair/Alteration
proof of their Worker's Compensation insurance should be provided to me. - _ PLAN CHECK $ PERMIT -
. 0 I am exempt�unndd�er Section B.& P.C.for this reason Firepl/Fact.Bit. IC130# . Fire Dampers - PLUMBING $ 'ISSUANCE $
Date /69/49/$7__ Owner /4 . a— / _ Heating System& Ducting Registers - PLAN CHECK 25% $ ENERGY P.C. $
I hereby certif that I have read this application and state that the above ❑0-100,000 BTU 0100 0BTL— ELECTRICAL $ Ir.OC) GRADING $
• information is correct. I agree to comply with all city and county ordinances - •
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
. sentatives of this cite/ to Ai- upo the above-mentioned propert for
inspection • poses. / / MECHANICAL $ p`v��
_ Signature {� �
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
. CMF 0865-46,rev.10/84 White - Building; Canary/-Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING _ POOL&SPA '
APPROVALS Permit# _ Date Inspector. APPROVALS 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
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 &IHouse 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. Un Iergrnd.Storage Tank 0 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 is
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation i i 78. FIRE PREV. FINAL
I
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electrical Power Meter-Final 4 �i 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 i
38. Final Plumbing .
39. Water Service-Final I •
40. Gas Service-Final
.
141. Solar Domestic-Final
, 42. Backflow Preventer
43. Backflow Irrigation ! ,
44. Landscape Irrigation System
' 45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
tr
50. Gas Release to Southern California Gas Co • r
51. CERTIFICATE OF OCCUPANCY,
No. Date • -
•
' - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. —7111
C I�OF COSTA MESA CONSTRUCTION PERMIT P IT NO. TRACT NO. LOT NO. UNIT NO.
Project Address a414/ £ s,2ATH Sr 27 SSS Co °w9
/ Applicant's Mailing Address �3C r .0-4T1I 6.74- g,s•r. TYPE OF CONSTRUCTION NEW L ADD U ALTERATION U REPAIR rJ
Owner's Name ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p cls I UO0 d/IJd/O, Zone 194421 TL
///Q /iVOE1CYFiQphone_an'l50/ DESCRIPTION OF WORK/USE OF BLDG. S/'q c A.P.AioNF ��� _ a�' ^/� ��
Address a3G E �rel Sr- e./1 I 7 S Main Building: Accessory Building:
Arch/Eng.GGU�eg Des/9vece License No. TYPE OF PERMIT U GRADING U FOUNDATION [2V STRUCTURAL T Front f 0
• t.Address ./ ❑ TENANT 0 ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear g5 / N
' Contractor's Name t eseZ .Ru/Lde$42 Phoneh(s-/SV/ • 0 OTHER 1 A 1 I
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right 5 N
Address(mailing) . e. 1079 eV- F.H• �ZJ K /.s/ G
CONSTRUCTION TYPE VA LUATIOr ,,!! S Left /V R
City License No. ZONE GRADI NG CU.YDS- ACRESJ47�641-
LICENSED CONTRACTOR DECLARATION s ..11 ` Ping. Ref.dk 5� Parking Req./Provided3eevu E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Rernarks:pe 34(-II L fes P 0 37 CI) 53 o/3/e 5 Planning Notes: 0 0 'YF�CIAL 2EQUIREP EN'tb Q.p/ILl,G�2 M
with section 7000) of Division 3 of the Business and Professions Code,and s s LT 'I d
my license is in full force and effect. V T
License Class License No. - • S
Date Signature PLUMBING ' FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self4nsure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
300, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. _ Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
8 Certified copy is hereby furnished.
Certified copy Is filed with the city Building Division. •
Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
- Date Applicant •
� EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit Is for one hundred (5100)or
less). _ Dishwasher Solar Piping Dryers ❑Gas ['Electric Sub Panel
I certify that in the performance of the work for which this permit Is Issued,1
shall not employ any person in any ma�pner so as tg4ocome object to the Drinking Fountains Solar Tank . Fan Motors 00.1 HP 01`A-8
Workers Compensation Laws of Calif0�yt9qa. /){� _
X Date y+-7 -fl Signature/(j/?� �z.� - Floor Drains • Swimming Pool w/Spa F.A.U. - Inc.Solar 09-15 HP ❑1615+
- NOTICE:I rafter making this declaration,you should become subject to the - - '
, Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
/CONSTRUCTION
with such provisions or this permit shall be deemed revoked. Microwave
/CONSTRUCTION LENDING AGENCY Gas Service Outlets' Water Closet Device Boxes
/ I hereby affirm that there Is a construction lending agency for the performance - - POI¢ Light
of the work for hit this permit is Issued (Section 3097 Civ. C.) •
,� Interceptors -/ Water Heater Outlets Range'
Lender's Name -
. Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION • Sign
I hereby affirm that•l am exempt from the Contractor's License Law for the Lavatories ? Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05.15 KW
any structure, prior to Its Issuance, also requires the applicant for such permit _ Tm3h Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of •
Division 3 of the Business and Professions Code) or that he/she is exempt - r'
erefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
•nalty of not more than five hundred dollars($500).
1 ' I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Foe $15 Issue Fee $ 3
License Law 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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ ../
sale. If, however, the building or improvement Is sold within one.year of com- Canopy Type II ❑ Zoning Approved By - . Dat! v
plotion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground ��
rove for the purpose of sale). - Building Approved By - ��� Date 2 •ice
CI, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By aliDat: 2a".`
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMMM�1 V OF FEES
builds or improves thereon,and who contracts for such projects with a con- S 7
tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ S •00 - SMTP $ to •3�
proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple❑ System Repair/Alteration p�s
rJwft . PLAN CHECK $ '30,87 PERMIT
❑ 1 am exempt under Section B. & P.C.qfor this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
2- �// ,!' HeatingSystem&DuctingRegisters -Date -2... ...1- 2_7__�-- Owner/cfG �N 9 PLAN CHECK 25% $ .ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑O-100,000 BTU 0100,000 BT GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction,and hereby authorize repre- $ MICROFILM $
sentatives oi�hls city to,,,eel ter upon the above-mentioned property for , PLAN CHECK 50% - �`'''�j�/
inspection q(irposes. �� 'L_y'9�1 MECHANICAL $ TOTAL FEE $ �/ 7 7. 2/
Signature /dies es# �
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL& SPA .
APPROVALS Permit# Date Inspector APPROVALS 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
5. Steel Reinforcement Abet G' 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grndt _ 111 7 6p/ 57. APPROVAL TO COVER-GUNITE
7. Footings .414.7 &7/ 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 System5RB /c/n. S� 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ��!! 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing ��j •
� 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing `J/30 - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat y 75. Dry Chemical
27. Frame and Flashing 447 76. Dry Standpipe
28. Lyjtijpg& Siding 4(1/' 77. FIXED SYSTEM FINAL
29. Insulation c4Q7 Gni 78. FIRE PREV. FINAL
30. Drywall Nailing Chit (s✓ 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 • Row FOR SFEflar
35. Final Gas Pipe-Test • ) -B£�IlIR6AiEAI
/a/q/87 ,^ L RLTh . Su‘-recr ro
36. Hood or Canopy
Slift 7.5 1024
37. Final Factory Fireplace LC-14.81 6
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
zlsl
47. FINAL STRUCTURE & BUILDING See pc
48: Special Requirements Completed /0/21/87
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY 1- "
No. Date
•
1- .
•
- _ RECtil E6 bEe 1 49U6 -
�3Gt2ory ,57
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- - , � rays /SG
DECEIVED DEC 1 1986
•
7,IMP/-,D-_bziA0C.X/-t,._ _
a__Yy E_;-rt r_. 4,er/_zfy_7We*r -_?_ifE 68 9e--4 •
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•
City of Costa Mesa INSULATION CERTIFICATION . Building Safety Division
a 0771ST eOSrA fle & D,Q,st-.[iyC
Number and Street City County
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
EXTERIOR WALL b„-�-�'
Material R& Fl Brand Name "VW fIL`E
//,�
Thickness (inches) 'a' — Thermal Resistance (R Value) /I
CEI LING
Ban or Blanket Type / .4 t7� Brand Name /ThilUtilit
Thickness (inches) `e Thermal Resistance (R Value) /47
Loose Fill Type _. _ . Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
FLOOR,SLAB
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
DuibueX_ £u,L4%K
General Contractor(Builder) License Number •
ave." 04msCR AV/7,n7
Signature and Title Date
Sub Contractor(Insulation Applicator) License Number
Signature and Title Date
CMF 1106-46
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ll' 1969 30060 TL
F COSTA ,M/E�SA nCONN,Sr/TRUCTION PERMIT PERMIT NO. a7� TRACT NO. LOT NO. UNIT NO. 1968 p/p9/87 p4e9p i
Project Address a Y 6 Ron/ sr-` lJ�-�
a-86 Efi07W sy'/ H- TYPE OF CONSTRUCTION �� NEW L I ADD LI ALTERATION Li REPAI R
Applicant's flailing Address n /"--" r ❑.CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# _ I Zone
Owner's Name 9fU4OT/O/.l�CeyC-7IE-A Phone VC/SO/ DESCRIPTION OF WORK/USE OF BLDG.
I Address r.36 £ 2-OrW Sr c Ata. .�,7) S Main Building: Accessory Building:
Arch/Eng.Oti)A)/A License No. TYPE OF PERMIT rn ❑ GRADING p�.�I❑I FOUNDATION ❑ STRUCTURAL T Front D
PILAddress ////pp ❑ TENANT 163 ELECTRICAL lel PLUMBING . MECHANICAL OTHER A Rear • N
Contractor's Name 0/8 PhoneC Right - N
• PROJECT DESCRIPTION SQ. FT. OCCUPANCY 3
Address(mailing/ K CONSTRUCTION TYPE VALUATION $ $ Left G
City License No. RZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION - ���fff a a
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ��ss �u7/��� ) [�{R/7r� ^j/ 5 S Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and !� /
my license is in full force and effect. TS
License Class License No.
Date Signature PLUMBING FEES
WORKERS' COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate Y 00 ELECTRICAL FEES
' Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink f
;00, Lab. C.) X CO / Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation 0 50+KW
9 Sewer Cap Construction Pole Sub.
ACertified copy is hereby furnished. _
Certified copy is filed with the city Building Division. / Bathtubs Sewer Connection 'a.Gl:. Cooking Unit Meter Igup to 100 amps
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION• Clarifiers Solar Collectors • / Dishwasher - Meter Dover 100 amps / 00
' (This section need not be completed if the permit is for one hundred($100) or
less) Dishwasher Solar Piping Cb ,; Dryers Gas DElectric - / Sub Panel 6 ao
I certify that in the performance of the work for which this permit is issued, I • -
shall not employ any person in any rrylnner sp as to ecome subject to the Drinking Fountains Solar Tank /9_ Fan Motors 00-1 HP 01%-8 �.30
Worker Co pensation Laws of Calif ia.
Date --- ' - 87 Signature /(?�D Bti� ' Floor Drains Swimming Pool w/Spa F.A.D. -
NOTICE:If,after making this declaration, you should become bject the ' Inc.Solar 09-15 HP 016-15+ / /O
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
Fixtures Microwave O
comply with such provisions or this permit shall be deemed revoked. ♦ O
CONSTRUCTION LENDING AGENCY Gas Service Outlets 3 Water Closet 00 • '
•
I hereby affirm that there is a construction lending agency for the performance G Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors / Water Heater O��/ Outlets-
Lender's Name ! M27 - Range f O SO
Lender's Address / Kitchen Sink • / Water Service y BO p_r .Switches - Sign it a0
OWNER BUILDER DECLARATION / - e •
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories • / Auto-Wash ., - /2 cC / Garbage Disposal _ f 00
following reason (Section 7031.5 Business and Professional Code: Any city or L� 9 - P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator ❑0.5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit -� Trash Compactor - / 00
to file a signed statement that he/she is licensed pursuant to the provisions of Roof'Dreins -
the Contractor's License Law(Chapter 9(commencing with Section 7000) of . .
Division 3 of the Business and Professions Code) or that he/she is exempt -
vrefrom and the basis for the alleged exemption. Any violation of Section
• 31.5 by any applicant for a permit subjects the applicant to a civil _
tatty of not more than five hundred dollars($500). 3
1��.g.Vp 1, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $
tompensation will do the work,and the structure is not intended or offered _ _ Reinspection Fee I $15 Issue Fee $ 3
_
for sale (Section _ -7044, Bsiness and Professional Code: The Contractor's MECHANICAL FEES
License Law 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 ownDEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler' Hood or Type I ❑
sale:If, however, the building or improvement is sold within one year of com- - - Canopy Type II 0 • Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By _Date
prove for the purpose sale). ..
1:1of
I, as ownerthe property, exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By (T-� Date
tractors to construct the project (Section 7044,Bus lness and Professions Code: n
The Contractor's License Law does not apply to an owner of property who Y Duct-Ventilating 00-100,000 BTU 0100,000 BTU 6 bG • SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that ExhaustSystem ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ _ PERMIT
0 I am exempt under Section B.& P.C.for this reason• g Firepl/Fact.Blt. ICBG# Fire Dampers ' o0 PLUMBING $ -5700 ISSUANCE $
Date —,1_•3_7__._92- Owner _ - - !"" Heating System& Ducting /2. Registers /2_0(7 ENERGY P.C. $ •
(f PLAN CHECK 25% $ •
I hereby certify that I have read this application and state that the above 1 'KO-100,000 BTU 0100,000 BT GRADING $
information is correct. agree to comply with all city and county ordinances _ V(J ELECTRICAL $ 00
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50°/, 1s -� MICROFILM $
sentatives of this city to e er upon the above-mentioned property for $ 33-dO
inspection p ses. S MECHANICAL O TOTAL FEE $
Signature ni�� Date,2. 7'. �/
i
Drivers' License or 55 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ / V✓ • 3S ^7�
`�865-46,rev. 10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
POOL & SPA
CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. Alit yOrea 53. Steel Reinforcement
Fed3. Electrical Conduit Utility-Undrgrnd. 70,87 Wed 54. Forms
4. Electrical Conduit-Undrgrnd. NN 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 Undrgrncl., Test
9. Water Pipe-Undrgrnd.�Ct,� , , t 3/1-7/t1 G A/ 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System61. APPROVAL TO DECK
• 11. Property Sewer Line & House Connection 2.4.tt 43 /�yY' 62. Backwash & Receptor-Final
12. Sewer Cap / // 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing r/im ��/�,/. ` 65. Electrical-Final
15. Rough Electrical-Conduit l �� 66. Solar System-Final
16. Rough Electric Wiring t7'r:64v'G , 67. Fencing & Access Approval
17. Rough Wiring Sign 68.'o`aAPPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning f/y/ri FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace 1/y,/r? G�/ APPROVALS Permit# • _
21. Ducts, in Structure //`f d 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 0 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 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION •
32. Electrical Power Meter-Final / FOOD CERTIFICATE ISSUED f /
33. Final Electric oir '%J7 / _ _ _ - 9L3/$7 Check 7Dt wincLou)
34. Final.Heating & Air Conditioning /ayfI urn !' /n+
+nt u FP✓ /'OM�:N'on af- >F'-Jxi/
35. Final Gas Pipe-Test �
36. Hood or Canopy r
37. Frriat Factory-Fireplace 101}10 c&2 ,
38. Final Plumbing 10013-Y7 £10
39. Water Service-Final /04317 CC
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY . -
No. Date _ - - � .'
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
oSTAg1,§c,/ /'PONSTRTUCTI N PERMIT - PER N /b/ TRACT NO. LOT NO. UNIT NO.
8554 10/29/87 6475 TL
Pioj•ect Address d�7 7 e• .�-m / PT, O� - _
t G TYPE OF CONSTRUCTION LI NEW ❑ ADD U ALTERATION LI REPAIR
Applicant's IVlaiiingynAfdId'r¢ss L 1 s XZ��� 547 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name D19-V �� d/././���%C�Fflone C YL—/SL� A.P.# I Zone
Address is-� DESCRIPTION OF WORK/USE OF BLDG.
+�X. F a..oT/f- Sr S Main Building: Accessory Building:
Arch/Eng. 0.6 - License No. TYPE OF PERMIT LI E
GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front • Z
El TENANT CI ELECTRICAL CI PLUMBING ❑ MECHANICAL B Rear N
Address ❑ OTHER A
Contractor's Name O6 • Phone - C Right N
Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY K
CONSTRUCTION TYPE VALUATION$ S Left R
City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: �/ Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license Is in full force and effect. S
License Class License No.
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ' ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow PreventerService Sink
)00, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. _ - Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
8 Certified copy Is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors Dishwasher - Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for whicty this permit is Issued, I
shall not employ any person In any manner sO- rA/LJbecom s bj t to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑t-8
Workers'So _e 5Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
71 ws of Calif i �3+=/%L' —
Date -�!/
NOTICE:II,aft r making this declaration, you should become subject t the
Workers' sati pn provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply withith such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY �( Gas Service 7 Outlets/ Water Closet 3,'OO Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance ,\ Outlets‘
of the work for which this permit Is issued (Section 3097 Civ. C.)
Lender's Name Interceptors Water Heater Outlets Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW ❑5.15 KW Trash Compactor
any structure, prior to Its issuance, also requires the applicant for such permit Pa
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
D 31.5 by any applicant for a permit subjects the applicant to a civil
salty of not more than five hundred dollars($500).
IA 1, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
Co pensation, will do the work,and the stru • .• ntend-d o offered - - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Busines . • • • :sslonal o•e: on r. • 's MECHANICAL FEES .,
C1tChse-Law 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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 ZoningApproved
sale. If, however, the building or improvement Is sold within one year of corn- pP
- Canopy Type II 0By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat sem✓ �]
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or Improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof o/ their Worker's Compensation insurance should be provided to me. PLAN CHECK $ ,J^ /s V s� PERMIT
❑ I am exempt under Section B.& P C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers W y
PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting RegistersPLAN CHECK 25% $ / ENERGY P.C. $
-7
I
hereby certify that l have read this application and state that the above 00-100,000 BTU 0100,000 BTL— _ ICAL GRADING S
ELECTRICAL information is correct. I agree to comply with all city and county ordinances $
and state laws relating to building\construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
ives o this city,to en upon t ab•v• entioned property for
inspection u p ses. /')�J�/efj �•�
Signature .fer. � /_ Date/0^�9'�) MECHANICAL $ TOTAL FEE S
Drivers' License or SS# _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION ANC/PLANNING - POOL& SPA
APPROVALS Permif# Date Inspector APPROVALS 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
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
4'
7. Footings', 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O 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
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 ANAL
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 O Gas CI Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL �.-
29. Insulation 78. FIRE PREY. 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 ia/x9hl?S
36. Hood or Canopy
37.. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
441. Solar Domestic-Final
42. Backflow Preventer '
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound'Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date • _
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
:OSTA ME,SAE QN R-ON PERMIT PERMIT- oa$� g c Na LOT NO. UNI_No.
Address a�.�'Y U57– p �� ��� !(•!�A{,�1y'1V lot 2�g es: _� :�
�66 �.�N • C.�� • TYPE OF CONSTRUCTION _LSdNEW�IJ ADD H ALTERATION U REPAIR 4
Applicant's Mailin Address r
Owner's Name _stux /�fl Phone i U CONVERSION ❑ DEMOLISH ❑ OTHER - A'p •
# �Z&- � — Zone
�slG/so/ 1 l4 l �1
DESCRIPTION OF WORK/USE OF BLDG.' •
Address /��e�20T*-S' t eoST� or L,-3 c( !,. �!� ��� S�A - • S Main Building: j i 'Accessorywilding: ��j'}�$0 Z
Arch/Eng.IT.c-iw/�.CO G. /94fr7 �.w�/�License//Id��o..��j0/O ,,�,,/r TYPE OF PERMIT H GRADING& FOUNDATION L�4TRUCTURAL T FrontlV I ��/�.(��t 1 -` - - O
Address r!/JJWF�/'�j (9(K1L�� lT TENANT ELECTRICAL PLVMBING ❑ MECHANICAL •
s B . ylear es I. `- _ - ��/ fore-
p, N
Contractor's Name a
CI OTHER l.i V IJ OTJ-C�
rvi-- /',{'. Phone C (Right -fes�gl r • N
Address(mailing/ i PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ ,0V , n
CONSTRUCTION TYPE VALUATION$ /O1000 S Left 7i2. •f '(g• 7r G
City License No. R
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION et Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: C- a C91-87;
9'�-O'7 Planning Notes: M
with section 7000) of Division 3 of the Duslness and Professions Code,and a? }' Y
my license is in full force and effect. f r //74 F S
License Class License No. .l
Date Signature - _ _ PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink -
.800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap ' 0 50,KW
Construction Pole Sub.
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter. Dup to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed If the permit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers OGas 'CElectric Sub Panel
I certify that in the performance of the work for whit this permit is Issued I
shall not employ any person In any manner.sods become bj t to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-8
WOrkeri Cp pen n Laws of CdlifefThia. //
Date fe�1-�- Signature /✓QtP�GY 4f-yr Floor Drains ' • Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declar ion, you should become subject to the —
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoker]. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affIrm that there Is a Construction lending agency for the performance Pole Light
of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION •
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry y Tra 5 Generator
any structure, prior to its issuance, also requires the applicant for such permit )00-5 KW 05.15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencIng with Section 7000) of - �? 130/Ar Q'
—ivlsion 3 of the Business and Professions Code) or that he/she is exempt - S'4Ii1A1s"s`.W R r �d
.�
refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil —
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 ' Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered Reinspection Fee $15 /
0 Issue Fee . $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL ES
License Law 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 DEVELOPMENT SERVICES REQ I' ENTS: 3
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 4 t 0•
sale. If, however, the building or improvement Is sold within one year of com- — Canopy Typ• Zoning Approved By a► Date
pletlon, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By '' A Date m8
raire for the purpose of sale).
I as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refr'• .tion System Application Issued By T _ . a:-_infise r-.... Dat: • S
Ctors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0-100,000 BTU 0100,000 BTU SUMMARY 0 FEES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multi System Repair/Alteration BUILDING PERMIT $ Qd • so SMTP - $ r 70
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ .5-333 PERMIT
0 I am exempt under Section napB.& P.C.for this reason Firepl/Fact.Blt. I # Fire Dampers PLUMBING $ co ISSUANCE $
Date.. -.2 —
�/ �_L Owner/ ��1 Heating S m& Ducting Registers PLAN CHECK 25% $ •75 ENERGY P.C. $
I hereby certify that I have read this application and state tnat t • above 0,000 BTU 0100,000 BTL ELECTRICAL $ 12.00 GRADING $
Information Is correct. I agree to comply with all city and county Ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ N. a MICROFILM $
sentatives of this city to enter upo above-mentioned property for
inspection p Poses. .s� I ^'7Q
Signature�i2/.(/YQ�U.4C Date J'A'I+s7 MECHANICAL $ TOTAL FEE $ �t `v
Drivers' License or SS - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting;Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit#• Date Inspector APPROVALS Permit Date Inspector
1..Temporary Electrical Service or Pole 52. Pool & Equipment Location - D ha-
2.
g2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3/11 eat
3. Electrical Conduit Utility-Undrgrnd. 54. Forms /g7 PO-
4.
-4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding nQ aft?a,,t
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test U ( /f/ a9q-
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE D
7. Footings - 58. Electrical Conduit-Undrgrnd.
4/411 �(g
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 plot 7 a
14. Rough Plumbing 65. Electrical-Final ///
15. Rough Electrical-Conduit 66. Solar System-Final •
`e
16. Rough Electric Wiring 67. Fencing & Access Approval Pits '7 P0-
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ai pit
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 0/1-.p
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 0 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 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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 Domestic-Final •
I
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. Special Requirements Completed
49. 'Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. bate
•
•
_o�W '��' . � ?veining Laboratories �f sou to eaWWo , S ri
�'I' , /( 3310 Airport Way/Mailing Adeins P.O.Box 47/Long Beech,CA 90501 /(213)4264355/(213)636-2366/(714)6254432,
TESTING BRANCH OFFICE: 1514-0 North Susan Street/Santa Ana,CA 92703/(714)554-2645
•
September 21, 1987 EXAMINATION NO. 87-12605
COMPRESSION TESTS ON GUNITE CYLINDERS-
•
Elmer G. Volden
14509 Dalwood Avenue
Norwalk, California 90650
PROJECT • SWIMMING POOL hi/SPA
ADDRESS 244 E. 20th St. , Costa Mesa, CA
•
ARCHITECT CONTRACTOR
David Poindexter
ENGINEER SUBCONTRACTOR
B.C. Adams D.J. Gunite
SAMPLE FROM lA Shallow end floor walls & beam. 1B Deep end floor
walls and beam.
SPECIFIED
MIX 4: 5 - 1 STRENGTH 2,000
DATE CAST 9_9_87 SLUMP ___ SPECIMEN SIZE 6" x 12"
DATE TESTED 9-21-87 9-21-87
SPECIMEN NO. IA 1B •
COMPRESSION 12 days 12 days
TOTAL LOAD LBS. 110,500 131,000
POUNDS PER SO. IN. 3,910 4 ,630
AREA. SD. IN. 28.27 C
COMPLIANCE 12 day tests comply with specified strength. •
MADE BY: DELIVERED BY: RECEIVED ON:
SPECIMENS T.L. E. Volden 9-17-87
DISTRIBUTION 11154") G)-Z 2-97
Elmer G. Volden - 3
Building Dept. - Costa Mesa
ljs 4
ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS AUTHORIZATION FOR PUBLICATION OF OUR REPORTS CONCLUSIONS OR EXTRACTS FROM OR
REGARDING THEM IS RESERVED PENDING OUR WPITTEN APPROVAL AS MUTUAL PROTECTION TO CLIENTS THE PUBLIC AND OURSELVES
Gunite
REPORT Of INSPECTION: ON Masonry
• Concrete
j e`
To: r Pe _ ( :
y
V
t
Address: yQ J_cf • c//9 6-4
OWNER: ►) .i) Y3
//'it-
PROJECT: c Sirb.40 4 r..LJ IN /cio L_ i. /S Y/4' Report No. .
Address: c vci n 7 c _ a _ n Permit No.:?,,=r? c
Architect : Contractors OW Joe,- 2i7L.2,-
Address: Address: orlft 47c7Eh,,T':C/✓L=
Engineer: , a fqs7Bj/S Subcontractor: ; c-P,
/"� �/ (Gunite, // //
Address : lS�r-J7eN 6r-t) Masonry or 4dc/,sl//4/ -721..() i9Mt
Concrete)
Address :
i Mix Used: *S=l Rebar:
Slump, inches: • •
Admixture: Brick:
Designed Strength, PSJ : e2ry
Inspector : _EAMer t/0 .,/ '4619 A. 1 F7 38 Block:
The following Inspection was performed In accordance with the approved drawings.
Cu.Yds. No. of •
DATES Placed Cyl . Remarks
075 ( 6 ✓ (l.:vt,r '/ ,TAS ,S%ee&,C. co-
_
FoxJ tv..cc
i
• � i ,Cr 6-cd 4 ire iAn
%P ri sit G- fLin r--�R Fye
.5/, Sos r.Zore Pe 711,-,t/e i7 VVI 2; ed ,14?/`-e �� .
�y/.LL �6r4C',�'� C.- *474,C���✓T /✓v^yJ' ��i7,.S47 ;7
,mi/, it ; C i4o1J er (/'t.Dr ?r-esse,J
. 7,4 is)
Copies of
Reports to: (INDICATE WHICH BLDG. DEPT. i FURNISH ADDRESS OF ANY NOT LISTED)
/
t fia
330.2
I
CITY OF COSTA MESA
PARK FEES 1564 2/02/87 1205.67 TL
' Fee Payment Receipt 001070 • -
Project Address a Lig E . a pTh ttbuti
' A.P. Number "t Lp — ave I`f
Building Permit Number
Owner's Name .0c un cI p(J]/n-0�'1-7�t7Ctn
Mailing Address rico f,. 0rithh CMA-Lt
FEE: Single Family ' Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms I @ 1,205.67 = aCan
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,810.50 =
Multiple Family "
Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedroom @ 881.51 =-
3-Bedrooms
3-Bedrooms+ @ 1,229.38 =
�'1 Tot/al,F.eee-"' /a05r 627
Planning Department App al Date B 4 �
-�!- !- - w
Applicant's Signature //,�i r CY,,,,„,- ���j�
' City Ordinance 72-44 v• City Ordinance 72-45 ••• City Resolution 78-116 ,v,,.�i�, -1',-�,;
CMF 0174-30,rev.7/85 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—AOpilcant �V�1�t11LJIJIflI UJ