HomeMy WebLinkAbout721 20TH ST - Building Permits,. .
GTY OF COSTA MESA /
�' p MF q BlIILDING DIVISION
F�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
° � FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX09-00079
PERMIT TYPE B MISC STATUS: ISSUED
APN: 42226104 DATE ISSUED: 04/03/2009
Zoning: , ISSUED BY: RMD
JOB ADDRESS: 721 W 20TH ST CM Suite/Unit:
Vicinity: UNIT A FRONT pORCH Primary Occ: Const Type :??
SQ. FT: 0 Valuation: SB00.00
.�
SCOPE OF WORK:
TERMITE DAMAGE REPAIR TO FRAMING OF FRONT PORCH, LIKE FOR LIKE TO UNIT A. NO CHANGE IN SIZE OF PORCH OR
MATERIALS.
OWNER: MOHAMMED, NADIER P TR
City/State: COSTA MESA, CA
Phone: 714-557-2604
APPLfCANT: MOHAMMED, NADfER P TR
City/State: COSTA MESA, CA
Phone: 714-557-2604
Address:
Ciry/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER:
Phone
OWNER_BUILDER
FEE SUMMARY
Building Plan Check:
Building permit:
Electrical Permit
SMIP Residential
SMIP Cammercial
Bldg Std Admin Fund
TOTALFEES
Address:: 3185 SICILY AVE
Zip Code: 92626-2332
Address: 3185 SICILY AVE
Zip Code: 92626-2332
Phone
$0.00
$32.65
$0.00
$0.50
$0.00
$1.00
$34.15
License No. 000000
Unit:
License No.
License No,
Cell:
Unit
Unit:
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremenls under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed 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 expiralion o( this permit.
OE/ INSPECTIONTYPE DAIE IN7I71AL5 COOE/ INSPECTIONME O�TE INRilALS
1676 FixeO S}5tem Final Fire PreVention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final ElecVical
207 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site � , 1 � �
204 Final Demolition 250 Final Builtling/Occupancy � �-b�'^�"1
.-
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certifiwte o( consenl lo self-Insure (or workers'
compensation, as providetl for by gection 3700 of the Labor Code, tor the
peAormance of the work for which this permit is issued.
❑ I have and will maintain vrorkera' compensation insurance, as required by
section 3700 of Ihe Labor Cotle, (or the pertortnance of Ihe �+rork for which Ihis
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Cartier.
(T�is SeIXbn neetl rrol be wmde�� dthe ceim� is valued al we bundretl �ollars (8100) w lezs )
Policy Number:
-0� I certify lhaf in the pedorman�¢ of (he work for which lhis pertnit is
issued, I shall not employ any person in any manner so as [o become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 0�
the Labor Code, I shall forthwith compiy with these provisions.
,/�FuI�4.�w..u4r,1 �-f--s—oq
_ Iit�anCSSignaWre - Oa�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SURJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000�, IN ADDITION TO THE CQST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn Ihal I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Cotle, and
my license is in full force and effect.
Lic. # . _ Class #
Comractor's 9gnaNre Date
CONSTRUCTION IENDING AGENCY:
❑ I hereby affirm lhat theie is a construction lending agency for �he
peRortnance of Ihe �+ork la which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Dale
OWNER-BUILDER UECLARATIONS:
I heraby aKrm that under penalcy o( perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5,
Business and Professions Code: Any ciry or county which requires a permit to
construct, alter, improve, demolish, or repair any s[rucNre, pnor to its
issuance, also requires the applicant (or such permit to file a signed statement
thal he or she is licensetl pursuaN to the provisions of the Contraclors
�icense Law (Chapter 9(commencing wi(h Section 7000) of Division 3 0( lhe
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemp�ion, Any violation of Section 7031.5 by any
applicant lor a permil subjects the applicant to a civil penalty of no( more Ihan
five huntlred dollars ($500).):
❑ f; as ovmer of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the structure is not intentletl or
offere0 lor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes nol apply to an ovmer o( property who builds or improves
thereon, antl who tloes such vrork himsel( or herself or through his or her ovm
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year o!
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose o(sale.j.
❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conBWct the pmject (Sec. 7044, Business and
Professbns Code: The contractors license Law dces not appy to an ovmer of
property who builds or improves Ihereon, and who contracts for such project with
a contractw(s) license pursuant ro the Contractors License Laws.).
� I am exempt under sec.
Business and Pro(essions Code for this reason:
�`��n✓a.uu�� [%, —3 —Y� !
-.SiB�aWm oaie
305]<8 (9IOl) `—
Owner ID verified by d i�_. _ iicense. es ❑ No
Driver'sLicenseNo. ' Ezpires: 0�'"a7—iZ%
Verification of Ownership by (rype of tlocument, i.e. - pmperly taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I here�y certHy that no excavation frve (5) or more feet in Depth into which a
person is requiretl to tlescen4 will be made in connecl'qn vrith work authorized
by Ihis pertnit, and that no building slructure, scaffdding, falsewnrk, p tlemolition
or dismantling thereol, will be more Ihan Ihitly-six (36) (ee� high. (Chap. 32. Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As ovmer-builder, 1 will not employ anyone to do vrork which vrould
requi�e a permit from the Div"�sron ot tndusMal Safety, as noted above, unless
such person has a permit to do such work (rom the tlivision.
Appliwnl'S SignaWre
Division o! Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre building occupant need to fle antl
certity a Business Plan for emergency response to release or threatenetl
release ot a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safety Cotle requires, vrith some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantiry of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at stantlartl temperalure and pressure).
2. Does or will tbe applicant or presenl or (uNre building occupant need to file
a regisVa�ion form for acWely hazartlous materials7 ❑ Yes � No
(Section 25533 of the California Health antl Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cu6ic feet o( compressed gas at s[andard
temperature antl pressure).
3. Does or win the applicant or present or fuWre building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)7 ❑ Yes ❑ No
(Section 25534 0( the California Health and Safety Cotle provides that the
Costa Mesa Fire Department may require Ihe preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials vnth the Fire Department.
4. It an RMPP is presently required, has Section 25534 of the California
Health antl Safety Code been fully complied with4 ❑ Yes ❑ No
5. Does or will the ap0licant or present or fulure building occupant require (or
the vrork which is lhe subject of this application a permil for such constmction
or motlifcalion from Ihe South Coasl Air �uality Managemenl District or from
any other air polWtion contml district or agency? ❑ Yes ❑ No
(Sectbn 65850.2 of the Califomia Govemment Code requires that the requestetl
infortnation be fumished on applications for rron-residential builtling permits�.
6. Will any part o( the lacilily to be wnstrucletl under this permit be within
1000 feet fmm the outer poundaries of a schooll ❑ Yes ❑ No
Qf'yes", the faciliry must meet Ihe requirement ol 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 polWtion control disMct or agency is required tor the v.ork which is the
subject o( this application, have all o( the disclosures prescnbed by California
Health and Safery Code Section 42303 been made? ❑ Ves ❑ No
8. Qf'yes", attach certificate of wmpliance from the appropriate air pollWion
coniroloKceq.
CER7IFICATE OF COMPLIANCE: I certify that under penalty of perjury lhe
information given above is correcL I agree to compiy with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and s[ate that
the information given is correcl I agree to comply with all state laws and ciry
ordinances relating to building construc�ion, and authorize representatives of
the City oi Costa Mesa to enter upon the above-descnbetl propeAy for
inspection purposes. I agree not to occupy or allow occupancy o! any building
authorized by this ermit until final inspection.
,CcPi�i,a...,u,o-ee.- y---s—oq
SipnaWrealLegalOwner(s) Dale �—
Ana/OrNu1�On2¢dA00����� Oale
(714) 754-5273 • Fa�c (714) 754-4856
Job Address: 721 W 20TH ST
Suite:
Vicinity: REAR OF LOT
Parcel Number: 42226104
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
npp�icant: MOHAMMED, NADIER P
Address: 3185 SICILY AVE
COSTA MESA, CA
Owner: MOHAMMED, NADIER P
Address 3185 SIGLY AVE
COSTA MESA, CA
contractor: OWN ER-B U I LDER
Address:
Zip:
Arch :
Address:
Phone:
BUILDING PERMIT
Zoning:
Phone: (714)557-2604
Zip: 92626
Phone: (714)557-2604
Zip: 92626
Phone:
License: 0
Eng:
Address:
`.
P IT NUMBER .
ass-o�ss�
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 12/23/1999
Issued: 05/04/2000
ISSUED BY: _�
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT NEW 1175 SF 1-STORY SINGLE FAMILY RESIDENCE WITH NEW 162 SF ATTACHED CARPORT.
SECOND UNIT APPROVED UNDER DR-99-73.
Plan Check: $656.86
Permit: $1,010.55
SMIP Res: $10.29
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,677.70
SETBACKS .
MAINSTRUCTURE Front 77-0
ACCESSORY Front 0-0
PARKING Ezistin : 1
NOTES:
Rear 20-0
Rear 0- 0
Reouired: 6
FEE SUMMARY
PLANNING & ZONING
Left 5- 0
Left 0- 0
Pr000sed: 6
Calc Valuation:
Claim Valuation:
Right 10-0
Right 0- 0
$102,941.10
s�o2,sai.io
�❑
NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requiraments 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 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all appliceble codes, and all
requlred Inspectlona end 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
WORKERS' COMPENSATION DECLARATION:
I hereby aHirtn untler penalry ol perjury one af the tollowing declaretions:
d I heve antl wlll maintain a certificate of consent lo selbinsure tor workers' compensation, as provided tor by section 3700 ot the Lebor Code, for the pertormence of the
work far whith thl5 Dermit is issuetl.
❑ I have antl wlll meinteln workers' compensation insurence, as requiratl by sectlon 3700 of [he Lebor Cotle, for the pedortnence oi Ihe work for which ihis pertnit Is issuetl.
My workers' compensation Insurance wrrier and policy number are: .
Carrier. Policy Number.
(This section need not be completed i/ the permit is velued af one hundred tlWlars (5700) or less.)
❑ I certify that In Ihe pertormance of the work for which this Dermit is Issued, I shall not employ any pereon In eny manner so as lo become subject to the workers'
� compensation laws of Califomia, antl agree thet if I shoultl bewme subject to the workers' compensation pmvisions ot Section 3700 0l the Labor Cotle, I shell forthwith
wmply with Ihese pravisians.
Applicam Signature: Date:
WARNINO: FAILURE TO SECURE WORKERS' fAMPENSATION COVERAOE IS UNIAWFUL ANO SMALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO qJE HUNDPEO
THOUSAN� DOLLARE (E100.000�, IN ADDRIIXJ TO THE COST OF COMPENSATION, DAMAGES A$ PFOVIDED FOR IN SECTION 31W OF THE LABOR CODE.IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby ettirm that I em licensetl untler provisions oi CheD�er 9(commencing with Section 7000) of Dlvision 3 oi ihe Business antl Professions Code, and my license is in full
force antl efiect. Lic. q Class q
Contractafs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm that there is a construction lentling egency for ihe DeAormence of t�e work for which Ihis permit is issuetl. (Sec. 3097, Civil Code).
Lentler's Name: Lentlefs Atldress:
SignaWre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aNirm ihat under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7037.5, Business and Professions
Code: Any ciry or counry which requires a permit to consiruct, elter, impmve, demolish, or repair any stmctura, prior to Its Issuence, also requires the applicant tor such permil
m file e signed stetemem that he or she is licensed pursuent to Ihe provisions oi the Contractors Licensa Lew (C�apter 9(commencing with Saction 7000) of Divlsion 3 of the
Business antl Pmfessions Coda) or t�at he or she is exempt therefrom and the basis tor ihe alleged exemption. Any violation ol Section 7031.5 by eny applicent for e parmit
sub�ects Ihe applicant to e civll penalry of not more then five huntlred tlollars ($500).):
❑ I, es owner ol ihe propeny, or my employees wl�h wages as Iheir sole compensation, WILL DO THE WORK, entl the siructure is not intentled or offered for sele (Sec.
7044, Business and Pmfessions Code: The Contrectors License Lew does not appry m an owner of property wha builtls or improves Ihereon, and who tloes such work
himself or herself or through his or her own employees, provitled that such improvements ere nol intentlad or ottered for sele. If, however, the building or improvement is
soltl within one year of completion, ihe owner-bulltler will have the burden oi proving that he or she dId not build or improve for purpose of sale.).
❑ I, as owner ol the property, am E%CLUSIVELY CONTRACTNG WITN LICENSED CONTRACTORS to construct the praJect (Sec. 7044, Busineu antl Professlons
Code: The contrectors �cense Law does not epDly to en owner of property who builtls or improves thereon, antl who contracts tor such project with a contrector�s)
license pursuent to the Contracrore License LawsJ.
❑ I em exemp un r ec. 8usiness end Prolessions Code for this reason:
Signature: �����{� � Date:
Owner ID veniietl b�"tldveYs Iicense. ❑ Yes ❑ No Driver's License No. �� � "� � Expires:
Venfica�ion of Ownership by (rype ot document, i.e. - properry �a: blll or deed):
DIVISION OF INDUS7qIAL SAFETV PERMR CER7IFICA710N:
❑ I �ereby cenify �hat no exwvation tiva (5) or more feet in tlepth Into which a person is requiretl to descend, will be matle in conneciion with work authonzetl by MIs
permit, entl Ihet no building stmcture, scaHoltling, felsework, or tlemolition or dismantling ihereaf, will ba more l�en ihirry-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, 71t1e 8, Celifomia Administrative Code).
❑ As owner�builtler, I will not employ anyone to do work which would requlre e pertnit irom ihe Division of Indusirial Sefety, es noted ebova, unless such person has a
permit to tla such work from the tlivision.
Signeture: Data:
Division at Industrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AIITHORIZATION OF EMAY: I cehify under penalry of perjury that I have read Ihis epplicatian and state that Ihe infortnetion given is
correct. I aqree to comply with ell state laws antl ciry ordinances relating to building constmction, and euthonze representatives oi ihe City of Costa Mesa to enter upon the
ahove-described property for In pectio uryoses. I agree t to occupy or allow occupancy ol any �ullding euthorizetl by this pertnit until final inspection.
�f�-G��u-L"(� .� s�—o�
Signature Of Legel Owner(s) Date
AnNOr Authonzed Applicant
COOE 1. INSGECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final BIocWRelaining Wall
202 Final Factory Fire Placa
203
204
2C48d8
Final Sign
Final Demolition
PAg It�dLi
LOOEI INSPECTONTYVE
206 Finel MeCheniCel
20B Final Plumbing
210 Finel Electrical
272 Final Fire Prevention
220
222
250
Final Planning Approvel
Final Siie
Final Buildinq/OtcupanCy
�g
-pL
.w :
.•}• � ' - •
v �
� NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: (i�) City of Costa Mesa
( ) City of Newport Beach
( ) Counry of Orange
Applicant: N.arDI�K P �D��M M�D
Address: 1 Z� WI •?�fiT�# �iT' _ �`3iA� 1✓l��iiti . G!k
TelephoneNumber: 1��4-J S�� • 'Z�/��-
TractlParcel and Lot Number(s): �i'2Z• Z�o �•�'
3344
District Receipt No.
Plan Check No. � •Dlq�l
Location of Project: 1� �• ZO � �: �i���Vr �✓i��'-vi�a � Gi�
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
Commercial/Industrial Project is: (Check One)
_ Warehouse
_ R8D
_ Movie Theater
_ Mini-storage
_ Heavy industrial
_ Regional Shops
_ Light Industrial
This project is exempt because
_�_ x $1.84
x $ .30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueUHealth
_ Hotel
_ MedicalOffice
Office Park
Tota� `� 21(v2 - D�
Total
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
Fast Food
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code secdons
53080 and 65995. The Building Pemdts for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District.
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true, then this certificate shall automatically terminate and the appropriate City/County shall be notified.
(� PINY AS 288�/12:13 �N/f
�� / � _ B fl � /e/1/�`-/��c kCPi�:iil
Date: ��� ��
� � �
HOOK,GARY
From: BOUWENS-KILLEEN, WILLA
Sent: Monday, October 15, 2001 2:11 PM
To: HOOK, GARY
Subject: 721 W. 20th Street
Gary -- Planning is OK with Mohammed's new unit, parking, etc. Willa
Insulation Certifica ' ���— 6���i q7
�/�Y �.� � �`� �S-f=. (3 Co� lN�-eSo,
Numbcr and Sveec C��y
Subdivision Loc \umber
Description of Installation
ROOF (�
Material � 0.,Tf— Brand, lame CO �� � Y�
Thickness (inches) _4p �`�,���p S 'Ihertnal Resiscance (R-Value) �
CEILING � �
BattorBlanketType � BrandNarne �0 (�t%"1
7'hickness (inches) ` 'ITiermal Resistance (R-Valuc) �-
Loose Fill'fype Brand Name
Conrractor's minimum insulled weighUCc' Ib Nlinimum ihickness inches
;�fanu(acturer's ins�alled Weigh[ per square fcoc w acheive Thermal Resistance (R-Value)
EXTERIOR WALL /1 t� —
�fa�erial � BrandNarne l. � �{'� ( Y�J1
7i�ickness (inches) Thermal Resistance (R-Value) ._ —r,
,
RAISED FLOOR
ria[eria!
T'hickness (inches)
SLAB FLOOR
Material
'Iiiickness (inches)
Width (inches)
FOUNDATION WALL
htaicrial
'('hickness (inchcs) _
' Declaration
B rand Name
'Ihertnal Resisiance (R-Value)
Brand iv`arne
'Ihermal Resistance (R-Value)
Brand Name
"Riermal Resisunce (R-Value)
I hereby certify that the abo�e insula[ion was ins�alled in the building at the above location in confomance wi��
the cunent Buildine Energy Efficiency Standares for new residential buildings contained in 7'ide 24 of the
Califomia .4dminisvative Code.
� ��
Geaeral Concac[or (Builda; ) � Lice:ue Number
Signa[ure and Title pate
Sub uac r( lat' talle:) . I � �^ � h/ y�y2_
Y U
s� �e ��� os�
Compliance Forms January 1, 1995
(714) 754-5273 • Fax (714) 754-4856 . 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
721 W 20TH ST
NEW SFD
42226104
MOHAMMED, NADIER P
3185 SICILY AVE
COSTA MESA, CA
MOHAMMED. NADIER P
Address 3185 SICILY AVE
COSTA MESA, CA
Contractor: OWN ER-BU I LD ER
Address:
ISSUE FEE
. Temp service te5t
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept OvUets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1hp
Motors to 10hp
Motors to 50hp
Morors to 700hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
ELECTRICAL PERMIT
ISSUED BY:
Phone: (714)557-5604
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 0
Status: ISSUED
Applied: 07/11 /2000
Issued: 07I11/2000
SCOPE OF PERMIT
ELECTRICAL FOR NEW 1175 SF SFD, 1 RES APPLIANCE, 1 200 AMP SERVICE (17 LIGHTS, 28
OUTLETS 8 28 OUTLETS).
REF:B99-01997
$23.50
50.00
$0.00
565.80
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$4.75
$30.50
$0.00
$0.00
$0.00
50.00
$0.00
50.00
SO.DO
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
1175
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System I Lighting
Busway I700 ft
Standing Section
Misc Eleclrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kvalkw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Vollage Equipment
Low Volt Wving System I Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
30.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
50.00
$0.00
$0.00
TOTAL CALCULATED FEES 5124.55
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a penod of 180 days.
INSPEC710NS: In orde� for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetlon9 end final approvel must be obtained. Feilure to obtain inspections and final approval will result in ihe expiration of this permi�.
FOR INSPECTIONS CALL: (714) 7545626 /
WORKERS' COMPENSATION DECLARATION:
I hereby attirm unaer penelry ot Oerjury one of the lollowing tlecleretions:
❑ I heve and wlll meintain a certHlcate of consent to selt-Insure tor workers' compensetion, es provided lor by section 3700 ot the Labor Code, for tha performence of Ihe
work for which this permit is issued. �
❑ I have entl will maintain workers' compensation insurance, es required by section 3700 of the La6or Cotle, tor the peAormance of the work for which this permit is issued.
My workers' compensa�lon Insurence carner end policy number are:
Carner: Policy Number.
(This secNon need not be camplered il the pe�mit !s velued e1 one huntlred dallers ($100) or /ess.)
❑ I cenity that in the pedormance of the work for which this permit is issuetl, I shall not employ any person in eny manner so as ro become subject ro t�e workers'
compensation laws oi Celifomia, end agree ihet tl I shoultl bewme sub�ect to ihe workers' compensetlon prodsions oi Sectlon 3700 0l the Wbor Code, I shall fonhwith
comply with ihese provisions.
Applicant Signature: Dete:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN�RED
THOUSPND DOLLARE ($100.000�, IN AODITION TO THE CAST OF COMPENSATION, DAMAGE$ AS PROVIDED FOP IN SECTION 31060F THE LABOR CODE. IPIrEREST, AND AiTORNEV'S FEES.
LICENSED CON7RAL70RS DECLARATION:
I �ereby aflirm Ihat I am Iicensetl under provisions ot Chapter 9(commencing with Section 7000) ol Division 3 of the Business and Professions Code, and my license is in tull
torce and eHect. Lic. W Class M
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm Ihat there Is a consiruction lending agency tor t�e pedormance ot t�e work for which t�is permit Is IssueC. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm Ihal untler penalry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a pertnit to consimct, elter, impmve, tlemolish, or repair eny siructure, prior to its issuance, elso requires the epplicant tor such permit
ro tile a signed stetement that he or sha is licensed pursuent to the provlsions of I�e Con�rectors License Law (Chapter 9(commencing wit� Sectlon 7000) of Division 3 of the
Business antl Protessions Cotle) or Ihet he or she is e:empt I�erefrom end the 6asis for the alleged e:emptlon. Any Wolatlon of Section 7031.5 by eny applicam tor a permit
�s �ects tha applicent to e civll penalry of not more than five huntlretl tlollers (3500).j:
] I, as owner of tha property, or my employees wilh weges es their sole compensetion, WILL DO THE WORK, end Ihe structure is not intended or oHeretl for sale (Sec.
7044, Business and Professions Code: lTe Contractors License Law does not epply to an awner of property who builtls or improves thereon, antl who tloes such work
himself or her581f or Ihrough his or her own employees, provided ihet 5uth improvements are not intended or offered for sale. It, however, Ihe building or improvement i5
soltl within ane year ot campletloq Ihe owner-builtler will heva the burdan of proving thet he or she tlitl not builtl or impmve for purposa ol saleJ.
❑ I, as owner oi lhe properry, em EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to cnnstruct the pro�ect (Sec. 7044, Business antl Professions
Code: The conirectors License Lew does not apply to en owner of property who builtls or improves t�ereon, and who coniracts lor such project with a contractor(s)
license pursuant to the Coniractors License Lews.).
❑ I am e:e er sac.
Signawre: �
Business antl Prolessions Cotle lor this reason:
Date:
Owner ID venfetl by tlriver's license. � Ves ❑ No Dnver's License No. ��� `? �_ Expires:
Venfication of Ownership by (type of documem, i.e. - pmpeny tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: '
❑ I hereby cetlity that no excevatlon five (5) or more teet In tlep�h Into w�ich e person Is requiretl to tlescenQ wlll be matle in connectlon with work authorized by Ihis
pertnit, and that no builtling swcture, scattolaing, lelsework, or demolition or tlismantling �hereot, will be more t�en thlrty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 0, Calitarnia Adminisira�ive Coda).
❑ As owner-huilder, I will not employ anyone to tlo work which would require a permit Irom Ihe Division ol Intlustriel Safery, as notea ebove, unless such person �as a
permit to do suc� work from the tlivision.
SignaNre: Date:
Division of IndusMal Satety Permit Num6er.
CER7IFICATE OF COMPLIANCE AND AUh10iiIZATION OF ENTRV: I certity untler penelty of perjury that I heve read Ihis application end stete fhat tha infortnation given is
correct. I agree to comply with all state laws and city ortlinances relating to building constmction, and authorize representatives ol ihe Ciry oi Costa Mesa to enter upon t�e
ebove-described praperty for inspection purposes. I agree not to occupy or allow occupancy of any �uiltling aut�orizetl by tNs permit until ilnel Inspection.
'Sig Wre Of L g�Ow r(s
AnNOr Authorized Applicant
CpDE Y, INSPECTIONTYPE
1616 Fiaetl Sysiem Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Fetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
2446-d6
I�jf, 7�$ �QpE,a INSPECTIONTYPE
206 Finel MechaniCel
208 Final Plum6ing
210 Final ElecMcal
212 Final Fira Prevantion
220 Finel Plenning Approval
222 Finel Site
250 Finel Builtling/Occupancy
DATE INTRIpLS
� �
DECLARATION OF �.JTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
? 2 I (,J �' . 7,cr�1 �S'��
Sireet Address
Permit #
This Permit #
AP Number
1. I(we), , declare that I am the Owner of Title
of the above referenced real property, and that I(we) hereby authorize:
1� a�.r o�.c� �-J A�"
Name
C1�7
7c4 5ZS`—�3i�
Telephone No.
to obtain permits in my behalf, as owner/builder, for _� �`nl�Coc� �+Awri�-i �i?/.l��r,�
at the above referenced property.
2. . Should any person become an employee engaged in the improvement of the property, I(we) shall im-
mediately pro�ide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As ownerlbuilder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. I agree to indemnify and hold the City ot Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties as a result of work auihorized
by the permit5 from the City of Costa Mesa.
5. I declare under ihe penalty of perjury that the foregoing is true and correct.
Executed this �`� � day of �����at �U��"' California.
Na,d.+e�' Moh�mm�{ 7�/d��
Printed Name Date
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
`�%M ��� %• �� i'�. '. ; � �, ., , G
0779.a61pev. Z5t)
(714) 754-5273 • Fa�c (714) 754•4856 77 FAIFi ORIVE, COSTA MESA, CA 92626
Job Addres5:
Suite No
Vltinity'.
721 W 20TH ST
NEW SFD
Parcel Nunmbel: 42226104
Applicant: MOHAMMED, NADIER P
Addres5: 3185 SICILY AVE
COSTA MESA, CA
Owner: MOHAMMED, NADIER P
Address 3185 SICILY AVE
COSTA MESA, CA
Contractor.
Addres5:
Arch / Eng :
Address:
OWNER-BUILDER
PLUMBING PERMIT
Phone: (714)557-5604
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zip:
license:
ISSUED BY:
Status: ISSUED
Applied: 07/11/2000
Issued: 07/t ti2000
SCOPE OF PERMIT
2 BATHTBS, 1 DISHEWASHER, 1 GAS EARTHQUAKE VALVE, 4 GAS OUTLETS, 1 GAS SERVICE, 1
LAUNDRY TUB, 1 LANDSCAPE IRRIGATION, 1 SEWER, 2 SHOWERS, 1 KITCHEN SINK, 2 WASH
BASINS, 3 WASTE AND VENT, 2 WATER CLOSETS, 1 WATER HTR, AND 1 W!R PIPING FOR NEW
SFD.
REF:899-01997
ISSUE FEE
Backflow irrigation
Backflow Preventef
Bathtub
Clarifer System
Connect (Ice,Soda,eic)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over a outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceprors (Sand Auto )
AMT
523.50
$0.00
$0.00
$19.60
so.00
50.00
so.00
$9.80
50.00
$0.00
50.00
50.00
$0.00
$11.00
56.15
$0.00
50.00
59.80
$0.00
50.00
Qrr
0
0
2
0
0
0
1
0
0
0
0
0
1
1
0
0
1
0
0
FEE SUMMARY
AMT
Laundry Tub I Washer $9.80
Landscape Irrigation $14.80
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank g0.00
Sewer Cap for Demo $0.00
SewerConned $24.65
Sewer Pnvate Line $0.00
Shower $19.60
Sink, bar $0.00
Sink, wmmercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
nrr
1
7
0
0
0
0
0
0
1
0
2
0
0
0
1
0
0
0
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECT�ON
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
519.60
$0.00
529.40
$19.60
$12.30
59.80
50.00
50.00
50.00
50.00
$0.00
50.00
50.00
TOTAL CALCULATED FEES: E249.20
QTY
0
0
0
0
0
0
2
0
3
2
1
1
0
0
0
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for �he work authorized under Ihis permil to be considered legal, such work must comply with all applicable codes, and all
requlred Inepectlone and Iinal epprovel must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTION$ CALL: (714) 7545628 �
WORKERS' COMVENSATION DECLAFiATON:
I here6y eNirm untler penalry ol perjury one Of the lollowing dedarations:
❑ I heve anC will maintain e centlicate af �nseni to self-Insure for workere' compensetlon, as provided lor by secilon 3700 ot Ihe Lebor Cotle, for the peAormance of the
work lor whlch �his permit Is issuetl.
❑ I have end will maintain workers' compensatlon insurance, as required by section 3700 ot lhe Labor COCe, br ��e peAortnance of the work lar which this pertnit is issued.
My workers' compensation Insurence Carrier and policy number are:
Cerrier. Policy Number:
(This secNon neetl not �e comp/efed i! fhe pbmtiNs veluetl a( one bundred ddlers (5700J or less.)
❑ I certity thai in Ihe partortnence ol che work tor whic� this pertnit is issued, I shall not employ eny person in eny manner so es to bewme subjeq to Ihe workers'
compensetlon lews of Celifomia, end agree that If I should become subject lo the workers' compensetlon provislons ol Section 3700 0l tho Lebor Code, I shall lorthwit�
comply wlth these provisions.
Applicanl Signa�ure: Da�e:
WARNINO: FAILURE TO SECURE WORKERS' ��pENSATION COVERAGE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES M1D qVIL FlNES UP TOONE HONDRED
THOUSAND DOLLARE (5100.000), IN FODRION T07ylE CQST OF COMPENSFiION, DAMAGES AS PROVIDED FOR IN SECfION 3/O60F THE U20R COOE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm ihat I em Ilcensetl untler provisions ot Chapter 9(commencing with Section 7000) of Divislon 3 of the Business entl Prolessions Cotle, entl my license is In lull
lorce and eflect. Lic. a Class a
, GontractofsSigneWre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby effirtn thet there Is e construction lentling agency tor the peAortnance oi the work br w�ich ihis permit is Issued. (Sec. 3097, Clvil Code).
Lentlels Neme: Lentlels Address:
Signature: Date:
OWNER-BUILDER DECLARA710N5:
I hereby aHirm ihat untler penalry ol perjury t�ai l em EXEMPT FFiOM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires e p@rmit to conswct, alter, improve, demolish, or repair any sWcture, pnor to Its Issuence, elso requires Ihe epplicant for such permit
to file a signed statemem t�at he or she is liCensed pursuant m the provisions of Ihe Conireciors License Lew (Chapter 9(commencing wlth Sectlon 7000) of Division 3 of t�e
Business antl Professions Cade) or Nat he or she is exempt Iherelrom end Ihe basis for the elleged exemptlon. Any vlolatlon of Section 7037.5 by eny epplicam tor a permit
sub cts the eppllcant to a civll penelry oi nol more than five hundred dollars ($500).):
I, es owner of the propeny, or my employees with wages as their sole compensation, WII.L DO THE WORK, end Ihe siructure is not intended ar oMerad for sale (Sec.
7044, Business and Profeuions Cotle: The Contractors License Lew tloes not epply to an owner of propeny who builtls or improves thereon, antl w�o tloes such work
him5elf or herself or Ihrough hi5 or her own employees, provided Ihal such improvements ere not intended or oHered lor 581e. If, howevar, Ihe building or improvemeni is
sold within one year of completion, the ownerbuilder will have the burtlen ot proving ihat he or she did not build or improve for purpose of sale.).
❑ I, es owner of t�e properry, em E%C�USNELY CONTRACTING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business antl Pwfessions
Cotle: The comrectors License Lew dces not appty to an owner ot property who builtls or improves Ihereon, end who conirects for such pro�ect with e contractoqs)
license pursuant to the Conirectors License laws.).
❑ I am e�vmp ntler sec.
Siqna�ure: �
Owner ID varified by driver's license.
Busine5s end Profe55ion5 Code for �his reason:
❑ No Orivers License No.
Verification of Ownership by (type of daum�nt, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
Date:
❑ I hereby certify t�at no excavaHon flv0 (5) or more leet in depth imo which a person is requlretl to Aescen4 wlll �e matle In connectlon with work authodzed by this
parmit, antl ihat no �ulltling structure, Scatloltling, falsework, or tlemolition or dismantling thereof, will be more Uen t�lrty-six (38) feet �ig�. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Calllomia Atlministretive Code).
❑ As ownerbullAer, I will not employ anypne ro do work which would require e pertnit Imm the Division ol Industriel Salery, es noted ebove, unlau suc� person has e
permlt to tlo such work Imm the divisian,
Signeture: Dete:
Divisian ol Industriel Selery Pormit Numher:
CERTIFICATE OF COMPUANCE AND AUT!{ORVA710N OF ENTRV: I certify under penalty of perjury �hat I have read Ihis epplication end state Ihat tha information given is
correct. I egree to comply with ell state laws antl ciry orGinances releting to building consiructlon, and euthodze reprosentetives ot the City of Casta Mesa to enter upon the
above�described proporty lor InsOectlon purposes. I agree no� to occupy or allow occupancy of any building authorized by this permlt until linel Inspection.
/ �S�I "ature Oi La I Owneqs) Dat
�E �M,✓li'I /� % �/ UY
Antl/Or Ihodzea Applicant e�e
COOE �. INSPECTIONTYVE Ijdj( 11fiIT11L5
1616 Fixotl System Final Fire Prevenlion
1266
200
201
202
203
204
264&ae
Pool Spa Final
Final Ro-Roof
Final8locWRetaining Wall
Finel Faciory Fire Place
Finel Sign
Final Demolition
LODEY INSPECTIONTYVE
206 Final Mec�enical
20B Finel Plumbing
210 Final Elecirical
2tt Final Fire Prevention
220 Final Planning Appmval
222 Final Sita
250 Finel Builtling/Occupency
Q� INTRIALS
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Number:
Applicant:
Atldress:
Owner:
Address:
Contrector:
Address:
Arch / Eng :
Adtlress:
721 W 20TH ST
NEW SFD
42226104
MOHAMMED, NADIER P
3185 SICILY AVE
COSTA MESA, CA
MOHAMMED, NADIER P
3185 SIqLY AVE
COSTA MESA, CA
OWNER-BUILDER
MECHANICAL PERMIT
Status:
Applied:
Issued'.
ISSUED BY: �
Phone: (714)557-5604
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zip:
License:
SCOPE OF PERMIT
7 FAU, 1 AIC UNIT AND 1 HOOD W/MECH EXHAUST FOR NEW SFD.
REF:899-01997
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech EXhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Insl or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cim
Floor Furnace
Floor or Suspend Heater
$23.50
$14.80
$0.00
$0.00
$0.00
$14.80
$0.00
$0.00
$0.00
$10.65
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEESUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercial I n cinerator
Domestic Incinerator
Compressors I Absorption Sys[ems
Uplo3hp/700kBTU
3To15hp/500kBTU
75 To 30 hp / 1,000 k BTU
30 To 50 hp I 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation F¢e
Plan Check Fee
Reinspection Fee
ISSUED
07/11/2000
07/i t12���
Quantity
$0.00 0
$0.00 0
$0.00 0�
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E63.75
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis permit shall comply with all applicabla handicap access requirements under Califomia statutes and related
requlations. (Ord. No. 92-28, § 7. 12-21-92)
EXPIRATION: This permit shall automatically axpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlons and Hnal approval must be obtained. Failure to obtain inspections and final approval will result in �he expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSA710N DECLARATION:
I hereby ettirtn undar penalry oi perjury ane oi the tollowing declarations:
❑ 1 have and wlll mainteln a certificate ol consent to self-Insure lor workere' compensation, as pmvided tor by saction 3700 of Ihe Le6or Code, tor the pertormance of Ihe
work for whlch this permit is Issuetl. �
❑ I have end wlll maintain workere' compensation insurence, as required 6y seclion 3700 oi Ihe Labor Code, tor the peAortnance ot the work for which Ihis partnit I5 Issuetl.
My workers' compensation Insurence carrier end policy number are:
Carrier. Policy Number.
(Ti�is section need nat be cromplefed i! fhe permit is veluea af one hundred dollars (S 100) or /ess.)
❑ I certify Ihet In the peAormflnce ol the work for which this pertnit I5 IsSueQ I shall not employ any pereon in any manner so as to become subject to lhe workers'
compensation lews of Califomia, end agree ihat if I should become sub�ect to the woBers' compensatlon provisions of Section 3700 oi i�e labor Cotle, I shall fonhwith
comply with Ihese pravisions.
Applicent Signature: Dete:
WARNING: fAILURE TO SECURE WORKER$' COMPEN6ATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT PN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE Hl1NDPED
THWSAND DOUARE (5100,000), IN AODRION TO THE �p$T OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQY 3]OG OF THE LABOR CODE, INTEREST, AND AT70RNEY'S FEES.
LICENSED CON7RACTORS DECLARATION:
1 hereby aRirm thet I am Ilcensetl under provisions of Chaprer 9(commencing with Section 7000) of Division 3 of the Business antl Professions Coda, end my license is in full
force antl ettect. Lic. tt .__ __ Cless H _
Contractofs
Dete:
CONSTRUCTON LENDING AGENCY:
❑ 1 hereby ettirm Ihet there is a construction Ientling agency for ihe performance oi Ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature:
oate:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm t�at under penalry of perjury t�at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires e pertnit to construct, altar, impmve, demolish, or repair eny siructure, prior to its issuance, also requires the applicant for such permit
to file e signetl stetemem thet he or she is licensad pursuant to the pmvisions of the Conirectors License Law (Chapter 9(commencing with Sectlon 7000) ot DiNsion 3 of the
Business antl Professions Cotle) or that he or she is exempt therafrom an0 the basis tor the allegetl exemption. Any violation oi Sectlon 7031.5 by any epplicant lor e permit
�s 6 ects iha applicenl to e civll penalry oi not more than five hundrad dollars ($500).): �
I, as owner ot the propeny, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe structure is nol intentled or otteretl lor sale (Sac.
� 7044, 9usiness and Pmfessions Cotle: Th0 Contractors License Law does not epply �o an owner of propeny who 6uilds or improves Ihereon, end who tloes such work
himself or �erself or through his or her own employees, provitled that such improvemenis are not intendetl or oHered for sale. If, however, the bullding or improvemem is
soltl within ona yeer ol completion, Ihe owner-builder will have the burden of proving ihet he or sha did not build or improve for purpose ot sale.).
❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Professions
Cotle: The contractors License Lew does not epply to en owner of property who �uiltls or Improves thereon, antl who contracts for such pwject with e contractor(5)
license pursuant to Ihe Comractors Licensa Laws.).
❑ I am under sec.
Signature:�
Business antl Protessions Code tor this reason:
Owner ID venfiad by drivefs license. ❑ Yes ❑ No
Venfication of Ownership by (type of document, i,e. � property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
Drivers Licensa No.
Date:
� � Eu;pires:
❑ I hereby certity that no excavaiion tive (5) or more feet in depth into which a person Is requiretl ro tlescenq will be matle in connection with work authorized Dy Ihis
pertnit, and thel no building structure, scaHolaing, falsework, or tlemolition or tlismantling thereol, will �e more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomia Atlministretive Code).
❑ As owner-builder, 1 will not employ enyone to tlo work which would require a pertnil fram Ihe Division of Industrial Safery, as notetl above, unleu such person has a
pertnit to do such work from the tlivision.
Signature: Date:
Division of Industdal Sefery Permit Number.
CERTiFICATE OF COMPLIANCE AND AUTHORIZpTION OP ENTRV: I certity untler peneliy of perjury that I have reatl this application and state that the intormation given is
correct I agree to comply with all state laws entl city ortlinances relating m �uilding constmction, and authorize representatives of Ihe Ciry oi Costa Mesa to enter upon the
above-tlescribed properry lor Inspection purposeg, I egree not to occupy or allow occupancy ol any bullding euthorized by this pertnit until final inspection.
�4 Sign re egal Ow / D t�
� AnNOr Authonzed qppliwnt � Date
COOE 1. INSPECTIONTYPE
1616 Fized System Finel Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
2d46-4fi
� IN�ilAlS
COOE I INSVECTION TYPE
206 Finel Mechenical
208 Final Plumbing
270 Final Electrical
212 Final Fire Prevention
220 Flnal Planning Approval
222 Final Site
250 Final Building�Occupency
5_�9•0l ,,.��
September 20, 1999
CITY OF COSTA MESA
CALIFORNIA 92628-1200 P.O. BOX 1200
DEVELOPMENT SERVICES DEPARTMENT
Mr. Nadier Mohammed
3185 Sicily Avenue
Costa Mesa CA 92626
RE: DEVELOPMENT REVIEW DR-99-13
721 WEST 20T" S7REET
Dear Mr. Mohammed:
The Development Review for the above-referenced project has been completed.
The various City Departments have recommended approval of the proposed
consiruction based on the foliowing project description and findings, and subject to
the fallowing conditions:
PROJECT DESCRIPTION
Development Review to add second, detached unit behind an existing single family
residence with an attached garage.
FINDINGS
A. Approvai of the development review wiil allow a use, density, and intensity
which is in accordance with the general plan designation for the property.
B. The project has been reviewed for compliance with the California Environmental
Quality Act (CEQA1, tfie CEQA Guidelines, and the City environmental
procedures, and has been found to be exempt from CEQA.
C. 7he project, as conditioned, is consistent with Chapter IX, Article 11,
7ransportation System Management, of Title 13 of the Costa Mesa Municipal
Code in that the development project's traffic impacts will be mitigated at all
affected intersections.
77 fAIR ORIVE
BuilCing Division (71d) 754-5273 • Code Enfarcement (714) 754-5623 • Planning Division (714) 754-52d5
Fnx (�ia� �sa-aase • Too ��ia� �sa-s2aa
DR-99-13
September 20, 1999
Page 2
CONDITIONS OF APPROVAL
�J
Ping. 1. Address assignment shall be requested from the Planning Division
prior to submittal of working drawings for plan check. The approved
address of individual units, suites, buildings, etc., shall be blueprinted
on the site plan and on all floor plans in the working drawings.
2. Prior to issuance of building permits, applicant shall contact the US
Postal Service with regard to location and design of mafl delivery
facilities. Such facilities shall be shown on the site plan, landscape
plan, and/or floor plan.
3. Street address shall be dispiayed on the fascia adjacent to the main
entrance or front door in a manner visible from the public street.
Numerals shall be a minimum 6" in height with not less than Yz"
stroke and shall conirast sharply with the background.
4. Except as necessary tor drainage, existing grades at property lines
shall be maintained.
5. To avoid an alley-like appearance, if the driveway is paved with
asphalt, it shall be developed without a center concrete swale.
Design shall be approved by the Planning Division.
6. Concrete wheel stops shall be installed 2' from the front edge of open
parking spaces, or where appiicable, landscape planters shall be
increased 2' in depth to a�low curbing to serve as a wheel drop.
7. All new construction shaii be architecturally compatible with regard to
buiiding materials, style, colors, etc. with the existing structures.
Plans submitted for plan check shall indicate how this will be
accomplished.
8. The applicant shall contact MediaOne Cable Television of Costa Mesa
at 200 Paularino, Costa Mesa, (549-3535) prior to issuance of
building permits to arrange for pre-wiring for future cable
communication service.
9. The conditions of approval and ordinance or code provisions of
Development Review DR-99-13 shail be blueprinted on the face of the
site plan.
10. The applicant sha�l contact the Pianning Division to arrange for a
"special requirements" inspection of the site prior to the release of
occupancy. This inspection is to confirm that the conditions of
approval and code requirements have been satisfied.
11. The northern most open parking stall shall be screened under the
direction of Planning Staff.
Eng. 12. Maintain the public right-of-way in a"wet-down" condition to prevent
excessive dust and remove any spillage from the pubiic right-of-way
by sweeping or sprinkling.
DR-99-13
September 20, 1999
Page 3
CODE REQUIREMENTS
The following list of federal, state and local laws applicatile to the project has been
compiled by staff for the applicant's reference. Any reference to "City" pertains to
the City of Costa Mesa.
Ping. 1. All contractors and subcontractors must have valid business licenses
to do business in the City of Costa Mesa. Final inspections, finai
occupancy and utility releases will not be granted until all such licenses
have been obtained.
2. Approval of the development review is valid for one (1) year and will
expire at the end of that period unless building permits are obtained
and business commences, or the applicant appiies for and is granted
an extension of time.
3. Development shall comply with ali requirements of Section 13-38,
(and Article.9, Chapter V) of Title 13 of the Costa Mesa Municipal
Code relating to development standards for multi-family residential
projects.
4. Minimum garage door widths shall be as follows:
. single-garage - 8'
. double-garage - 9'
5. The new carport shall be a minimum 9.5 ft. in width. Plans
submitted for building plan check shall show how this wiil be
accomplished.
6. The open parking space proposed between the existing residence and
garage shali be moved to the east outside of the backout area of the
northern-most open parking space.
7. All on-site utility services shall be installed underground or provisions
made for future undergrounding, if it is impractical at this time.
8. Installation of all new utility meters shall be performed in a manner so
as to obscure the installation from view from any place on or off the
property. The installation shall be in a manner acceptable to the public
utility and shall be in the form of a vault, wall cabinet, or wall box
under tfie direction of the Planning Division.
9. Any new mechanical equipment such as air-conditioning equipment
and duct work shall be screened from view in a manner approved by
the Planning Division.
10. Four (4) sets of detailed landscape and irrigation plans shall be required
as part of the project plan check review and approval process. Three
(3) sets shall be provided to the representative water agency and one
(1) set shall be submitted to the Planning Division for review. Plans
shall be approved by the water agency with two (2) approved sets
forwarded by the applicant to the Planning Division for finai approval
prior to issuance of building permits.
DR-99-13
September 20, 1999
Page a
11
12
13.
14.
15.
Bldg. 16.
17.
Eng. . 19
20.
�
�
Two (2) sets of landscape and irrigation plans, approved by both the
water agency and the Planning Division, shall be attached to two of '
the final building plan sets.
Landscape and irrigation plans shall meet ihe requirements set forth in
Costa Mesa Municipal Code Sections 13-101 through 13- i O8 as well
as irrigation requirements set forth by the water agency. Consult with
the representative water agency Mesa Consolidated Water District,
Ray Barela -(949) 631-1291 for requirements.
Landscaping and irrigation shall be installed in accordance with the
approved plans prior to final inspection or occupancy clearance.
Ail landscaped areas shall be separated from paved vehicular areas by
6" high continuous Portland Cement Concrete curbing.
All property line walls or fences shall be repaired or replaced as
necessary under the direction of the Pianning Division.
Comply with the requirements of the Uniform Building Code as to
design and construction and CCR Titie 24 pertaining to "Disabled
Access ftegulations".
Prior to or concurrent with submittal of plans for building plan check,
applicant shall submit a Water Quality Management Plan (WQMP) that
identifies the application and incorporation of those routine structural
and non-structural Best Management Practices (BMPs) outlined in the
Countywide National Pollution Discharge Elimination System (NPDES)
Drainage Area Management Plan (DAMP), Appendix G. The WQMP
shall detail implementation of BMPs not dependent on specific land
uses, for review and approval by the Development Services
Department.
Construction, grading, materials delivery, equipment operation or other
noise-generating activity shall not occur between the hours of 8 p.m.
and 7 a.m., Monday through Friday, nor between the hours of 7 p.m.
and 8 a.m., on Saturday, Sunday, and Federal holidays. Exceptions
may be made for activities that will not generate noise audible from
off-site, such as painting and other quiet interior work.
At the time of development submit for approval an off-site plan to the
Engineering Division and grading plan to the Building Division that -
shows sewer, water, existing parkway improvements and the limits of
work on the site, and hydrology calculations, both prepared by a civil
engineer or architect. Construction access approval must be obtained
prior to building or engineering permits being issued by the City of
Costa Mesa. Pay off-site plan check fee to the Engineering Division.
An approved off-site plan and fee shall be required prior to
engineering/utility permits being issued by the City.
A construction access permit and deposit of 5350.00 for street
sweeping will be required by the Engineering Division prior to the start
of any on- or off-site work.
DR-99-13
September 20, 1999
Page 5
21
22.
23.
24.
25.
Fire 26.
_)
Submit required cash deposit or surety bond to guarantee construction
of off-site street improvements at time of permit per Costa Mesa
Municipal Code Section 15-32, and as approved by City engineer.
Cash deposit or surety bond amount to be determined by the City
engineer.
Obtain a permit from the Engineering Division at the time of
development and then construct P.C.C. driveway approach per City of
Costa Mesa standards as shown on the off-site plan. Location and
dimensions are subject to the approval of the Transportation Services
Manager. A.D.A. compliance is required for all driveway approaches.
Private on-site drainage facilities and parkway culverts or drains will
not be maintained by the City of Costa Mesa; they shall be maintained
by the owner or developer of the property
Remove existing fence from public right of way.
Obtain a permit from the Engineering Division, at the time of
development, to mill and overlay, per mill and overlay resurfacing
requirements, if any street pavement on 20"' Street is open cut.
Provide approved smoke detectors to be installed in accordance with
the 1991 Edition of the Uniform Fire Code.
SPECIAL DISTRICT REQUIREMENTS
The requirement of the following special districts are hereby forwarded to the
applicant:
Sani. 1 .
2.
3.
4.
5.
Schl. 6.
Developer will be required to construct sewers to serve this project, at
his own expense, meeting the approval of the Costa Mesa Sanitary
District.
Orange County Sanitation District fees, fixture fees, inspection fees,
and sewer permit required. prior to issuance of building permits. To
receive credit for buildings to be demolished, call (714) 754-5307 for
inspection.
Developer shall submit a plan showing sewer improvements that
meets with the District Engineer's approval to the Building Division as
a part of the plans submitted for plan check.
Developer shall contact the Costa Mesa Sanitary District at 5714) 754-
5307 for trash collection requirements or exemptions for this project.
Developer is required to contact the Costa Mesa Sanitary District at
(714) 754-5307 to arrange final sign-off prior to certificate of
occupancy or utilities being released.
Pay applicable Newport Mesa Unified School District fees to the
Building Division prior to issuance of building permits.
DR-99-13
September 20, 1999
Page 6
_�
Upon receipt of this letter, your project has been approved, subject to the above-
listed condition5• A copy of the conceptually-approved plans are enclosed. The
decision will become final seven (7) days from the date of this letter, unless
appealed by an affected party or a member of the Planning Commission or City
Council.
If you have any questions regarding this letter, please feel free to contact me, at
714-754-5153, the best time to get a hold of ine is between 8 a.m. and 12 noon.
Sincerely,
WILLA BOUWENS-KILLEEN
Senior Planner
Enclosure: Conceptually approved plans
JO
cc: Engineering
Fire Protection Analyst
Water District
Building Division
ClTYOFCOSTAMESA CONSTRUCTIONPERMIT��-
�
a,�i�,{ nnd,r� 1 �_.1 \� 1_Zt�'_'��_c r� i=-� —
•APPlicanl'sMmlin9llddress ��}C) r ^�fu.fT✓�__(/._t_��1i-�-�/a�_
iOwuci's Nanic �V `1 (�� ` i f' [ j��fC f� C�i_Phone 1.cJJ�.�:.�dC.J
� A��li�:s _.Ji..� .�'_� i..Li�_..�-T ii.t.�
ArchJ@ng. �-�- License No. -
Address — � —'""
Comrecmr'sName�saal�l�1 -�" ��a PLMb.phone 5'-13` (73Co
AddressOneilin9l ��l> UE' `i�r+1TP. Ll-q0.�-
City Limnse Nu. � u, � 9 Z-
IICENSED LONTHACTOR OECLAfiATION �
1 herehy allinn Iha� I am licensetl untler pmvisloni of Charter 9(cmnmen<Ing
wilM1 secticn 9000) ul Oivizion 3 ot lhc 9usiness anU Pwlessinns Cotle, antl
iny Ilr.ense is In full /orce ann ellecL � lp� .
Ucense Class._.__�.5'11 --�license Nn.�'f_:"1'Cr�S�"�
r.�aie�ll_t�_ s�4nacure �✓nr�=f��' 7i.�.�_�--
WOfiK[RS' COMPENSATION D[CLARATION
I hereLy altirm Inat 1 Oave e cmtilicale ol consen� lo sell�insuic or a cerlili[ate
� I Wnrken' Compema�ion Insurance, rn a eertllletl eopY ���crool (SeSllon
.000, La�. CJ
PolicY No. ��=-� ^'-=�� ComPanY���"'�T"T�v � .
ry B CerlllieQ CopY ii hareby_lumishetl. � . ,�
CC CerUlietl cnp I Illed with the city Builtling Olvisinn.
051i��� HPPlican:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thitseclion neetl not Ge completetl if ihe permil is /or ono h�mdrod ($1�'0) or
Icss). . `- . -
I cerlify lhat In lhe petformance of thc vrorl<.for which lh6 pefm4 IS IsSuetl; 1_;__
Shall not em0loy any person In any manne 4 as lo bewrt78 �u � tl lo lno "'
Workers' Cpm Oepsy(�on lzws ot Californl . �`� �- J -
� Oale y^/`_Z'}.t$ Slgnaluro- �
NOTICE: II, aitcr making thlz tleclaratlon, you should bo mo sub7act CO e�-
Worker5' Cornpensalion proNsions of lhe I�bor Cotla, you must forlltayJl
'�cOmply wlth suM provisions or thi5. permll snall bu tleeme� revoketl. -
CONST0.UCTION IENDING AGENCV ' � �
I imreby a10rm that there is a canstructlon lentlin9 aoency lor t�e parlorrnance
'Of tl�e work �or wnich lhix permit is issuetl (Seclion 3097 CI��. CJ
.. Lentler's Name �—
Londc�'a iatltliess —
' OWNER BUILOEH UECLARATION
I ho�eby af/1nn that I am exampt from lhe CoOVa��o�'S LlCense Law fo� tM1e �'•
fo�lowing reason (Sectlon ]031.5 Buslness antl Pw/ezslonal Cotle: Any ;Ity or �
county which reaW�es a permil to conztruct, aller, improvu, aemolish oi repalr
dny SlruGlure. �dOr to It5 is5uance, a150 reqWr¢S the applicant lor suGh oerml[ '
to /lle a signatl ilatemnnl �hal he/she Is Ilcenzetl pursuant to lhe prUvlslon5 O/ �_
tne Con[raetoPs Li<unse law IChapter 9(cammencL�g wlth SecUon 70L'0) ol
DIvi5lon J a/ lhe Buslnesz antl Pmfes5lons G��he) or that he/shc is eaempt
Ilierelrmn antl Ilie basis lor lhe ailegcA exemptlon. Any violaliun o1 Sec�lOn
l03L5 Uy any appll<anl lor a permi: subjecK lhc apP������< <� +�ivil
'nenally of no! more man flve huntlred dollars (E500�.
❑ I, as ownm ol Ihe properlY or my employucs wilh wa9es as IM1cir sole
, compensalion, will Oo �he work, nntl Il�e sl�uctura is not Intentletl o� o1/Cietl
1or sale (Sec�im� ]044, �usiness antl Prafessiona� Cotle: Tha Contiactor's
Li[onse Law tloes no� apply lo an owner ol a propmq� whu builJ^, oi In`proves
lhcreon, dntl wM10 tlocs such worl< hilnself/hersel� Or llvMi9M1 his o� hi:r Owr�
empluyaos, piovidetl Ihal mch impiovements aic nol Intentletl ut 011aiatl br
salB. I/, howeveq lhe bulltlin9 0� Improvement is soltl wllhln ono ycar of com-
pletl0n, lM1e ownGr will have Ihe burtlen of proving nc/she tlitl nol bullU or Im-
�rave lor the purpose ol sale).
I, as owner o� �he piuperty, am exclusivety mNraclln9 wilh ilconsatl cnm
�ractors lo con.lrucl lhe prulecl (Setllon ]044, [3u5ine55 antl Piufnsslons Cotlo:
The ConlraUnr's Llcense Law does not apply to an ownor of prunerty who
bulltls or Improves Ihereon, antl who mntracls br 5uch pro�ecls wlth a con-
Liaclor�sl.bcunse purivaid to lhe Gonlrador's Licinse Law). i am awiro ll�al.
prool o( lhcir Worl<er'S Compensation insu�ance choultl bo proddod lo mo.
�� L7 I am exempt untler �ction e. A P. C. lor this reason
CPI
Uata
I hereby cCrtily ihat
infurmation is conoct
rntl state laws relatin
5¢p(d1�V25 OI lfllf.tl(
InipeCilOn pUrpp ^S�r
519naturc ���,,,
Orivvrs' Licensa or 55
{F OB65�4b; rev. 10/B4
_ UwO2! —
1 have raaA this
1 agree lo camo
�mbuiltlin9 con
.fo entcr;hpor
iplicaUon antl s�ate Iha! Ihe abovv
with all clty antl couMy oitlh�ances
udinn. anJ hnrebY r�dhnrire rcp�e�
he aUOve-menUonetl plope�ty �yof
��"%F DateLl� Y(' G li
lo till in a11 sv��es evicep� thosc �r.thin heary bordu Ilnes antl sign a11 aou�ou�iu:e uccla
',MI7' NQ _ ,. I TRAC7 NO. � 1_OT NO. UNI7 NO.
TYPI�E OF CDNSTRUCTION LJ r�[wI -�Cj"'�ADf] LJ n� i�e�en'rio�i LI Hernux
LJ CONVHI'UIUP! � U[h'GLiSi�l l� i�?;-ILIl __—__---
DESCRIPTION OF WORK/USE OF �LDG. — —
TYPE OF PERMIT LJ GRAOING LJ FOVNDl�TION U STRUCTUR/�L
❑ TENANT ❑ ELECTRICAL �'�LVM1iBING ❑ MECIiANICAL .
❑ OTHER .
PROJECTUESCRIPTION SQ.FT. —OCCVPANCV
CONSTfiUCT10NTVPfl_ VALl/AT10N$
ZON� GRA�ING W.YDS. ACRES
Rmnarks:
Bar Sink
Backflow Pr�ventcr
Backllow Irrigalion. _.
............ .e . . . .
Ioor Dreins�; � �,
ir Sinks �, � .
Service' � Outlets
Kitchen Sink
Lavatories' - ' �
P-Trap
Root Drains
Reinspeclion Fae
ri.uMaiNc
ShOv^:cr5
Service Sink
Sewer Cap _
Sewer Connection
� Soiar Collectors
Solar Pipin9 ,
� �Solar.Tank •
Swimming Pool w/Spa
Urinal
Water Closet
Water Acatcr
Water Service
Auto Wash
Laundry Trays
$15 � � Issua Fcc
BOiluf
Duct - Under Ground
Duct - StrucW rnl
Duct � Ventilating
Exhaust System ❑ Multiplu
Firepl/FacL Olt. ICRO �/F
Heating Systum P+ Ductiny
❑ o i oa o0o ATu O� oopon
Reinspection Fee� � S1G
Builtling; �anary - APPllwnh PIOk - Accounling; GOltlen�otl - ASSCssot
M
HOOfJ Uf Ty�)L' I ❑
Canopy Type I I ❑
Rnfrie�erution Syslem
❑0-t000008TU ❑100,0006T
Sysiem Repair/Alteration
Fire Dampers.
Registcrs
luuo Fee
FEFS
5 3
;S 3
A.P: �
S A7am euilJing:
E
7 Front
B Hear
�A
C Right
K
g Lcit
Ping. Ref. �/k
Plannin� Notes:
_._. �:%ii/'"_ _
w'�
Zoua
Accessury UuilJiny:
C
ri
I
�.:
C
' Parkinp Req./PinviJed 'E
(I
M1i
T
- - $
ELECTRICAL f-EFS
Au�omntic Washcr Traia�ormer ❑ 15�'vO KW
ConstructionPoleSub. � � �50+KW
Cookin9 Unit Meter ❑up to 100 amps � � -
Dishwasher ' � Meter ❑over t00,mps � �
Dryers ❑Gas ❑Elecvic ... Su6 Panel . . .
Fan ' � . " - Morors �0-1 HP �1'h�� 8� �.
F.A.U. ' . Inc.Solar �9-15 HP �16�15*
Fixtures � Microwavc �
Device �ores Pole Light . �
Outlets Range� '
Switches Si9n
Garbngc Disposal Standing Seciions '
Generamr �0�5 KW �5-15 KW Trash Compacror _
frtu � 575 � � Issue Fce � $ 3
- DEVELOPMENTSERVICESRE�UIREMENTS:
2oning Approvad t3y Datu ' .
,rRuildin9ApprovndBy - Data -
r
APPlication luuod 6y _n�� ��� Ontn y/� �
F� ., !
� � -�SUMMARV OF FEES .
- UUILDING PEFiM1T $. SY11P S .
- ' PLAN CHECK $ PERMIT
- PLUMBING $ _j • t�YJ ISSUANCE $
.t PLAN CHECK 25% 5� CNGIIGY P.C. 5
. . ELECTf�ICAL $ GRADING S .______
� PLANCIi[CK 50°a S � � N1iCROFILM 5____ _
/�- :.
- �dECHANICAL $ TOTAL f-EE S '.\J '
PLAN CHECK 25% $ � ' - C
� _ - - - -_--- ."'
: � ^ . _ . . . _ .. .... _ .. - _. , r . � . ..... . .
.
. .... ..
• , . :°��.° �
' � COnSTRUCTION `AND PLANNING �; � � � � ,� ,�,i,.�, � ,,,; � ,�,.�. �:;?OOL & SPA � , . .
�- ' � ��� � ��Date�.`� �I�nspector• '`" " 1' � � ' . Date Inspecto-
APPROVALS �`�Permit�� � �.• � APPROVALS Permit�
. �� .�q..�'��� . .;,I'_ �.
1: T.emporary Electricaf.Servic> or Pole , . � , 52.� Pool �& Equipmen; Locztion . ,
2. Soil Pipe-Undrgrnd. �' � � � � . . � .' _ 53. Steel Reinforcement ' • '
3. Elecvical Conduit Utility-Undrgmd. ! � � � ' �54. Forms' : � �
- 4: Elecvical Conduit-Undrgmd. ! , � ' '55. Electrical,Bonding . � �
� 5. Steel Reinfo;cement � � . 56. Rough Plumbing £i Pressure Test ,
.� I 6. EleccricaiUFER�Grnd.� . ... ' _57. APPROVALTOCOVER-GUNITE .
� . '.'
� 7. Footings . ���, . � (.,' -. �58: Electrical�Condui,-Undrgmd. � '
(. J,. .
f
8. Foundation . "- � - ' ., - •� . ' 59. Gas Pipe, O Undrgrnd., Test ,
9. Water Piqe.Undrgrnd. " _ � _ . , . .. � 60. Backwash�Lines, P�Trap, � Undrgrnd.� �
� 70. Structural Floor System .- � . j ' � • 67.. APPROVALTO DECK � '. .
71. Property Seti�er Line & House,Connection : �� � 62. �Backwash & Receptor-Final �
72. Se��er Cap � ' j-..� . . � �� 63. Heater & Vent-Final � , .
1�3. floof Drains'. ,� , ' , , . .. � 64. Plumbing System � Final � � - .
i4: Rough Plumbing. , : � �� : 65. Eleetrical-Final .. � � .
15. Rough Electrical-Conduit ..� , `� :'�.66. Solar:�System-Final � , ���� �
�' .
_ .„7G. Rou9hclectric:N/iring�_td.7:_._ .. ._ . '1=i: _:_•,__.� '_t�'•'.';' _... .. _ _,..".' ' '
•I'-'���"'�-- �� 67=�=Fencing &:�.'ccess Approval
..'.7..50uyhlNirin9.Si9r;�. �;',;�:r�: . ':yi}4f,��i_^;�;:"� �'i-w:;68:'APPROVED'FORPLASTERING ..- ':f � . -� -.
l'r' �:
,78: 'Rough Elec[rical,-T Bar Ceiling � ��.;.�:; �;'.: 'i �• 69. P001./SPA SYSTEMS FINAL
�' 79.�Ro�gh�Heating'& Air Condi:ioning - ' `�� ; .;� :.�;{; P,IRE DEPT. REQUIREMENT � �
: "1':�: `., , � ��
-20. Rough Factory Fireplace� � ,�<` ; �';'�•�..'��- � AP,PROVALS'�%,�Permit,� '
21. Ducts, in Structure_ � ' � : f; "% _ 70: �Underg'rou�nd Hydro ' '
22. Ducts, Ventilatirig , , ,. . � i ' �71. Proiiuct Piping O Gas ❑ Oil �, . �
23. Gas ?ipe-Rough & Test � r . � �; �' _ _ �72. Undergrourid Flush ' .
24. Roo`. Framing' ;� ' . ��._�: .,:a�.'d: `73. Underg}hd:�StoraaeTankOGas OOiI .
25. Roor Sfieathin � � - �
. 8,.:�� .. . , .' i�Y� •" .. '?41� Overhezd HYdro
26. T-9ar Ceiling (Structurall & Monocoa: �''�' i � �k;:":;;� ;' ..��751 Dry Chemical • . •'}
i I. �. �
27.�Frameand Flzsliing . � �'�:' �.:';��,��t�;�;:i'-�' ':76: �Dry.Sfandpipe .
28. La,hir.g & Siding , _ � i' �• ' �; �jr'..i.:• "77. ' FIXED SYSTEM FINAL
�• '' Ii:�.- �_ .
29. Insula:ion '�•�i .� , � . o�._;;��'j'..' �jg.'FIR�E�PREV.�FINAL .
30. DryuvellNailing? �� �„ - . � �i�i�,_;��,:j ��;;�.;:;k!j�i�:;_.,;i?,j; �.�;,;,'HEALTHDEPT.REQUIREMENT : `�'�;
� 31. Plaster 3rown Coat � � . � 'ti: , -i°r;t : �,79 FINAL'�INSPECTION �
�._ .
32. Elec.rical PoweriMeter-Finzh � r'ir!�� r"�.,�'j� .�F;;�;�,j�;f.:.;� "80`�FOOD CERTIFICATE ISSUED � �' .. '
. u- 6:
.. . . ...: � . �.�. � .
33. Final Electric • � � . � � .,�„!.;;;: i.g�?:��;.��'. ',.Notes:i � . ...
n��
34. FinalHeating&�ArrConditioning :"i:,a:.lf:'I; :,�;':�i;i�L:=; ".;'�^^li. :I�: . , . __;..r
� . .;p:� .q„e,. .i,::�. .,.r-;t�..,;.i:;��':�ii;
35. Fir,zl Gas Pipe-Test �.i�:�•,. '_:: ,. . �',:la'r�.f!ii;l! ;i;S�E�:S�_AI�'::.i:;t??�:i° F•' �.;°II. � . :�
3G. Hood or Canopy �.. � � � •.' . . �.. .
' c� `
37. Final Factory F.ireplace � , yi.'r;�� ` �'! :,.: _` :: - ' . � ' � ;. ' �
, , �. : �F i ' a,<` �P� .. .
'38� Final,Plumhirig� ` , t�. . � �. . r�.�•�� .,� � ..[ i �i �. ' ..
-�' I!i'�. .
39: Wa*.er Service=Final � . � . r"::^; ;..i5 �,ti;; 1:! dj ' i, . . ..� . . � :�
. , �.''u . � i .
., ar,, ,,
n0. Gas Service-Final �.. � . . .,, � �c�!;' �; � „' .�,',Y' , . c, , � '' • :.��
•ti'� - • , ; - �i� :�
'4'. So:ar pomestic-Fi^al • (�' ... �, l�i�. �t.���� . _. ., �' 9, :�.;g.
. ;,;.�; ;f: i� .. .. �
•'42. Backflow Preventer � , . t .:,•: ..� . � ;' .. . . . ,�i; , , . . � . � ! � i• �. .
�'43. Backflow Irrigation _ � .. ��, � , . , . � � , �;� . ' . , ' �
.'. . . . .. . .� , . �.. .e
�:44. LandscaPe Irrigation SYstem. � : . ..� .... : �. ' : � ��'„�. ;� .. � ... i, a �......"
� .
�,�q5. Sound Atcenuation � - _' . � .- ' � "„ . ' �.�' --
�: ,Y r � r.
�46. Handicap Regulations -. . '; '._. � ', !.: ;,,: .:,; ',. . ;!' �''_ ,. ' . .
�.:
... . . . . . • ..., .. ,. ... '_ ....
47�. FINAL STRUCTURE�& BUILDING ' ' � � � �' ; �� "
. .... ����'� i�, . � . ..�
48 ^Special Requirements Completed ` - �; � � . ' . - y
I, ,�
. 49. Elsctric Releaseto Edison , , �� ,�;e� �'��i� ' � '"
.... . � .. .. . .,:-�. �.,.;.,�.,. � :: .. �
50. Gas Rclease to Seuthem California Gas Ca � � �� � •' �' ""�}'�'' �i' : . ' �- •"r' �, ; , '�
�� �
51. CcRTIFICATEOFOCCUPANCY � � �� •�,,�� � .
. . . . . . , . . , �' �j,; _ �
PXf�FCT RDOflE33: 7 2 j j+J 2 �'r]i $'r
�jNEfl'SNRME: MARIA CASTRO
, qBDNESS�p.N]E AS AHOVE
714/631-3838
RNCHIENGINEEP:
RODflE53:
NEO.NO.:
uxrt:
UNrt:
PEHM�nEE: MARIA CASTRO (714)631-3838
ponn�ss: 721 W 20TH ST
COSTA MESA CA 92627
LICENSFD CONTMCTOB OECIAMTION: I hereby alli�m ��a� I am Iicense0 under pmvision5 0l CnaD�er 9(cammencinq wit� Section
7ppp) m UiNsion 3 ot tAe Business and Professions Cada, anE my license is in full force anE ellect.
cin �ic.: sTaTe uc.: cuss:
�
' OaV Signaiure:
��WPNENS' COMPENSATION UECIAMTION: 1 hereEy affirm Nat I have a cerliliute of conunt ro selNnsua ar a cMificate ot Workers'
npensation Insurance, or a cerlifieG copy thereot (Section 3800. LaO. C).
JCY NO.: EXP. ORTE:
COMPANY:
❑ CertifieA copy is hereby fumishe0. ❑ CertifieA copy is file0 with tAe ciry BuilUing Division. .
�ate: AppliWnt:
IXEMP710N FPOM WOflKEflS' COMPENSITION DECWUTION: (ihis utvon need noi be mmpleteE if Na permil ¢ for one hunGreA (5700) ar less�.
I cenity that in the pedormance of t�e work for which this permit is issueU, I s�all not em0loy any De«n in any manner so as to become
subject to tAe Workers' Campensation Laws oi Califomia. %�
. �ate: �D " y — � � SiAnature: _%'Jl�!}1-.✓ � `G� �M
NOTICE: II, atler maltinA �his declaration, you 5Aou10 become su6iect ta the Workers' Campensation pravisions ai ihe La�or
CaUe, you musl tort�with comDN ��h sucA provisions or t�is permit stwll be tleemeU revoketl.
CONSTBUCTIUN IENOING �CENCY: I hereby affum tAat there is a constmction lenainp a0ency for ihe pedormance of Ne woM lor
which ihis permil is issuetl (Section 3097, Civ. C).
LENOEP:
aDDRESS:
OWNEH BUILOEH DECIAMTION: I Aereby aifirm t�at I am exem0� imm tAe Contractors' Stata Licenu Law br tAe followinA reason
(S¢ction 7031.5 Busine55 an0 Pm7essional Cotle: My ciry ot counry whic� requires a permit to cOnstNp, alter, impmve. demolish, or
repair any simcNre, O�or to its issuance, also requires the aDPlicant for suc� permit ro file a sipneA statement tAat he/sAe is Iicense0
pursuant �o �Ae pmvisions o� Ihe Conlraclors' Sta[e License Law (Chaptar 9(commencinA with Settion 7000) o� Oivlsion 3 0� Ihe Business
anG Pmiessions Cotle) or IAat he/sAe is exempt [he2lrom antl ihe basis tor t�a allegetl exemption. Any violation a/ Section 7031.5 by
any appiicant lor a permit suhlects t�e apDliUnt to a civil Denalry o/ not more Ihan Me huntlreU Uoliars (55110�.
I, az owner oi Ihe pmpeny or my employees witA waAes as lheir wle campenutian, will do t�e woM, antl tAe
� stmcWre is not intentleG or olfere0 for ule (Section 709d, Business an0 Pmlessional Cotle: TAe Contracrors' State License Law
aoes no� appN �o an owner ol a D�opeM who Euilds or imDmves tAereon, ana who dces sucA wark himsell/herseli or ihroup�
his or her own employees, O�ovi0e0 that such improvements are not intenAeA or oflered for ule. tl, �owever tAa huildinq or
imOmvement is solU within one year of completioq Ihe owner will have tha hurden of provinp he/she tliJ not build or improva
for tAe Durpose o( sale�.
I,az ownerofthe propeM. am exclusively contractinA with IicenseA contractars ro consiructlhe Drole�ISection 7044, Business
❑ antl Pmfeuions Catle: The Contractors' State License Law Oces not appty to an owner oi D�apeM �o Duilds or improves therean
, an0 wAo cantracts for such prolects :tth a cantracmr(s) Gcensa pursuant to [he Contraclors' State �icense Law). I am aware
that D��� ol t�eir WOM1er's Compen5.4ion insurance should be provi0e0lo me.
� I am exempt untler Section: B. 8 P. C.
tor ihis reason: Q /� r
Wte: � � ' '1 — f � Owner. /'/'( n/1! ✓ sZ _ `� co /!b
I Aa �erehy certiry that I am aware ot anA unUerstan0 t�e apuirements al Califomia Healt� ana Safery CoOe Sections 25505, 25533, anE
25534 anG that I ar any /uwre GuilOinA occupant vnNwill not (circle one) neeE ro comON ��h sai0 state coEes antl ihe reQuirtmen(s for a
permit tor conslmclion or maEifitation Irom [he Nr �ualiry ManaAement Distnct. Fesidential consfmction aODlications are exempl irom
IheSe pfoVisi0n5.
Date: L r`y �• Y.- 7 V e..-�:""".. .-Y� w ne - ��. �� �A n 7
I here0y c¢rtity Ihai I have reaA Ihis apDliwtlon an0 Slaie Ihat Ihe above information i5 correct I apr¢e �a compty wi�h all ciry anE counry
OtA�OdOCPS d0A S�dIC WWS 2WIIp0(p �p�I410QC0I15[NC1�00 dI1411ER�`/dI1ShOfIZC RpIESCIIUIIVC5M1AI5CIlyfO CO�Ef OPOI1�hC dbOVEfIlEpYOfICE
property �orinspeciion purposes. /�
�ate: `a -- y � ,� 0 SiqnaNra: � (j�t � C�.4s �/%��
onver's ticense or Sada� secunry d:
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: P 049308
PERMIT NO: P 049308 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : REPLACEMENT KITCHEN SINK/GARHAGE DISP. SQ FT:
CLAIM VALUE: CALC—VALUE: GAOUP OCC: /
COMMENTS: PLUMHING FIXTURES ARE AEPLACEMENT
***�*�r*�r�***�*�x�r**�r***�rx��r�r�����rx*�r�r��r��r��r�r�r*�r�r*�r�r+r�r*x �r��***���*+r+r��r�*�r�****�r**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 92226104 ZNE; REF NO:
PLANNING NlSTES>
>
�t 3E �F iE iE iF iF iF if if 3f ik iE if if ik i! ik it k �k 3k 1F iE 1E 3F 3F f! 3k * 3E iE ik if if iE if iF if 3F ik M if ik 3k 1E ik ik iE'!F fk iF iE 3E if iE ik if if iE Ik if ik 1f iF it k iElE iE iE iE iE if 3! iE iE IE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY � DATE:
HUILDING APPROVED HY ; .. DATE:
l �
APPLICATION ISSUED BY; .',� DATE:
***�**�r*�r*x�r�r�*�r*****� �r+r*x****�* ��r
i! iE if ik it if if ik iF it iE if ik if iElF it i! iF iE k±k iF i! if if ik it iE iF if iE iE 1f 1F iE 1E iE iE iF i! ik if if iE i! it it fk ik dE * iE if 3E if if it it iF iF iF iF iP iE iE iE iP iE iE iF 1E �E 3E iE iE i! if iE
LEGALI2ATION:N F E E S U M M A R Y STRUCTUAAL SEGMENT:N
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 4,00
253 SMIP/NON—RES
PLAN
ISSUE FEE 3,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 4,00 3,00 0,00 7,00 7.00 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 7.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
%,��
ik 3t 3E iE iE ik iE iE iE if iF 1k 1f iE k iE iF 1F iE �E 1t 4 43F iF 1E iF iE iE ik 7f k if iE it if if iklE 1t it iE iE iE �E ik iF iE it iF If it iE �E 3! ik ik 3F 1E iF iF iF IE iF IF iE iE iE iE iF af if 9F iF iE iE 3F iF iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
PLU 1
PLU 1
1641�46 W�ite-8uIlEing; Graen—CoCe Enlorcamant; C¢nary—Applicant; Pink—Revanue; Goltlenrotl—hxveamr '
_� ---'�-� ��—�'
D E S C R I P T I O N
SINK KITCHEN
FIXT�IRE SET/TAAP W/PIPING 6 BACKFLOW
END OF FEES
UNIT COST TOTAL COST
2,00 2,00
2, � 0 , 2, � �
Oi l�nQ7i1..�_CC�7)1Fq 7'da�r' 7.�0
itAlEw 10lG4/90 7?ME: 09:18
r
i {' i
CONSTRUCTION AND PLANN��- OL & SPA
� APPROVALS Permit # Date lnspector AppROVALS Permit # Date_ Inspector
�
1.�.Temporary Electrical Service or Pole 52. Pool & Equipment Location
.2�.�Soil Pipe�Undrgrnd.� 53. Steel Reinforcement _ • .
3:�Electrical ConduitUtilitY-Undrgrnd. 54. Forms. �
'4F;Electrical Condurt�Undrgrnd. 55. Electrical Bonding •
�5. Steel Reinforcementi - 56. Rough Plumbing & Pressure Test
''6;�Electiical UFER`_Grnd. 57. APPROVAL TO COVER�GUNITE
� 7�Footings ` � . 58. Electrical Cqnduit-Undrgrnd.
� S. 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 Linei& 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 .
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING '
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79,.Rough Heating & Air Gonditioning ._ ._ C, ..FIRE�DEPT. R�EQUIREMENT, --
. .. . ' ::� ,^• . �.
20.�Rough Factory Fireplace - ��;,_ ;, ��' � . -APPROVAL�S�� 'Permit #
� �+. - �-- ,,r
21!-DuCts, iri Structure � . .. .. ' - ^ '� �' � �' , � •'' ':,-'-' J�' °
�., ,� �� ., : y; ;70. Wnder9round Hydro ,_
22�-0ucfs, Ventilating r � +' :� r�� � L71. ProducE�P.iping � Gas O�OiI
23. �Gas-Pipe�Rough & Test ' �'7�= °- � "� %` �" '7z, Under round Flush' � ,
i'� t*' � I: a: 9 �,
24: Foof Framin = ` � * �� „ I
9 f,73: �Undergrnd. Storage_Tank �O Gas ❑ Oil^
25. Roof Sheathing ' • � " k _ - , � � �, 74:�'Overhead Hydro�Jr, ,-
26.`T�BarCeilin (Structural) &'Monocoat Y , _� ���� � � ' � �� -�
_ . 9 �.�; r; 75:_DryChemical n
27 �Frame And Flashing� '-�� z � �=' � ` 76. Dry Standpipe `-''�'- '� _ '�
� n � w :4r: > a:,; �'�
�i'[fr� 1 4 c"'. ••!.fi -T !-V'.J A. _.
_28. Lathing&Siding�';`�' ',.x�. - . � . � 77r'FIXEDSYSTEM�FiNAL . '�t
29. Insulation �, " y. �; � � 4. ;; 78�FIRE PREV. FINA'L ' ' �"-"
' i' lf ( X .Y: -y •' ' . . _
30. Drywall,Nailing � .� � x c.. �« ,. .�'p _, ,� HEALTH DEPTa REQUIREMENT
�31. Plaster Brown.Coai� =� T'�'" � � �'•` '"79.�FINAL IN�PECTION � �
`�32.-.Electrical Power Meter'•Final � ''� , x`'�SO:nF00D CERTIFIGATE ISSUEDF.
-�33�Fina1 Electric� -+� � '� � � ��; � �Notes: 7 ;r `� T' - "
* *.
y34: .Final Heating�& Air�Co�tlitioning �l x � , � Y .; ; -' �'y' � '
- i.
� <� y
35. Final Gas Pipe-Test- ;:� ` �� "�+ i � F^ �� -� � ���' u 1 '
-n ,.-i
�36..�HooB or CanoPY� � r : r~ _., . � .-. i' -: � - - ^io % - �.�
37 Finel Fectory Pireplace%; �'=' X" � I ,%� ?' � �" �' 'r��
.r :� fr: _ .^.' <* +
�38. Final Plumbing -� '� � �� � � _; '� �i J
��39. Waier Service-Final+ � :- -. ; �> ; + � -
x x t -�
' ;40. Gas Service-Final " `7 '�'�' . � �.� � '� ' `� �� �"• -
.� � � �. . o.. -
�41. Solar pomesticFinal"' *t � � i �� y ?o " . -
� n; . . �* x� :-: ,> � x .. -
42. Backflow Preventer�; ,; J�iF,. ., X.: i! -,.:� * --
43. Backflow Irr,igatiorn. +� � �r i� � ^: X "� ' '
i �] .l
��;44._ LandscaPe Irrigation SYstemC��CJ _ '`7 �7 b 'x '< ^ "i ^ 3; - � , � ,
_ •6„ . a' ' . .. .,�. '� .
' J ,� _ _ . � . � '__ ' �
''45.:Sound Attenuation: � •� . ��� tT;x� '• tr' _ � t-.'� �r�
- s !-� .!' •-1!'� .i �
=46.'Handicap Regulations � ,�, - y � �r' '
,i : 1 s
�-47.-�FINAL STRUCTURE & BUILDING ��� r- � i = ` �J �
� v. ,e ,; r,� �� < O
48=-FINAL PLANNING ` ' '"' � ' ' -� fi
- > )r.c� .� _
49.f. Electric Release to Edison . �, ,.�. -� = •.', +
'i c�-
50 `Gas�Release to Southem Califoinia Gas Co Y '.�r�r` ? " ' ' -' ' '�c�' " - -� �
a- � � �
51. CERTIFICATE OF OCCUPANCY " ' � "
, `.
No. Date
.�
t
fl
5
L�
AOC���ant to fill In all s0ates exceDt ihose within �eavy bortler Iines antl si9n all apDrOPriate tlaeliralions. 7 /
NSTRU�TION PERMIT _ PER NO. � � TFACT N0. LOT NO. UNIT NO.
CITYOFGOSTA�MESA CO, ':
�Z;Q ` 4-c�'«�f
Pr01P�t%�ddress � ��5 � C���� LL(�,2� TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
"� QQ2'� �p�T¢� Phoneyp�i-�l8{) �❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap ,� Za�g
rf1ASl�l s Name DESCPIPTION OF WORKlUSE OF BLOG.
Add�eu �Z� l/� �.�1� gT f«-Z ' S Main Building: Accessory Building:
Z
A�ch/Eng. LicenseNo. TVPEOFPERMIT GRADINGp�� FOUNDATION STRUCTURAL T FrOnt p
Addres5 —��— .� � TENANT ❑ ELECTRICAL �p-�'WM81NG ❑ MECHANICAL 6 Rear N
Convactor's Nsm �' v�—�.� � a p�-Mb Phone S�-i�' �l�O � OTHER A I
PROJECTDESCRIPTION 5a.F7. ocCVaArvGv C F7ight N
Addresslmaf�ing) ��� qE' S��T� �—�-��� � � K G
City LicenSe NO. �� V Qq � - CONSTRUCTION TVPE VAWATION $ g Left
ZONE GRADINGCU.VDS. ACRES E
LICENSED CONTRACTOR DECLABATION - PIOJ. RC1. # Parking Req./Provided
I M1e/eby affi�m that I am licensetl under provi5ion5 0/ C�arter 9(�ommencing Remarks: Planning NotCs: ry�
wi[I+ section ]000) ot Division 3 at the Business antl Professlons Cotle, antl T
my I�cense is in full force antl eHecL ' • � '
ucenze ciass � � �cense '�8�4 S6 S
Datc y����� Signature - PLUMeING FEES
WORKERS' COMPENSAT�ON DECLARATION ' Bdr SinK ShOW¢r5 �
�meby aifirm Ihat I nave a certificate ot consent to soli-insure or a'cerdncatE . ELECTRICAL FEES
Workers' Compensation Insurance, or a certiiletl cooY thareot (Soction BackflowPreventer ServiceSink
p, �p. C) �"� : Automatic Washer Transformer ❑ 75-50 KW
Poiicy rvo. 1L1-2a nG� company Vr�sra�i '�_- ���ID Backflow Irrigation Sewer Cap Construction PoleSub. � 50+ KW
� Ger[ihietl copy is hereby turnlshetl. ' -
�m ifie co i fileC with the tlty Builtlin9 Division. Y• Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
F 4 8''d
�-+ AOPiicant
EXEMPTION FROM WORKERS' COMGENSHTION DECLANATION Cla�ifi¢f5 SOId/ C0112ct0�5 Di5hw25h¢� M¢te� ❑OVEr 10� 2rtIp5
(ThiS��tion ne¢tl not be <omplelatl if the permit is fo� One hUntlr¢tl ($]00) or'
less�. � Dishwa5her Solar Piping Dryers ❑Gas ❑Electtic Sub Panel
I certlfy that in lhe performance of the work fpr w th this oeyM1l�t is Issuetl, I'
Shall not emplOy any Oerson in any mannvA f to beco 6" t to ihe - Drinking Fountains $olar Tank Pan
WOrMer}� Cpp� peL s�[ion l.aws of Calimrni // � Motors �0.1 HP �1X � 8
Date Y�[('L1LS Si9nature Roor Drains Swimming Pool w/Spa F,A.U. Ina Solar �9-15 HP �16-15+
NOY�CE: 11, alt¢r making CM1is tleclaration, you Shoultl De me subject e —
Wo�l<e�s' Comp¢n5ation p�ovisions of the Labor Cotle, you must fort � ROO�Sinks U�inal FiXtu�¢5 Miuowave
romply witit such provi5ion5 or this permi[ shall be Geem¢tl revoketl.
CONSTRUCTION LENDING AGENCV Gas Service OUtICIS �Net¢� CIOS¢L D¢vic¢ BO%ES P012 Li ht
I h¢raby af(i�m that thlre IS a construction lentling agency for tne performance 9
oi Che work !or wM1ich thi5 Oermi[ i5 Issuetl (Section 3097 CIV. CJ
Interceptors Water Heater Outlets Ran e
L.ender's Name 9
Lender's Atldress Kitchen Sink Water Service � Switches
' pWryER BUILDER �ECLARATION 5�9�
I hereby affirm that I am exempt irom tha ConVaclo�'S LicenSe Law fo� Ihe lavatories AutO-WdSh � O
follOw�ng reason (Section �031.5 8usiness antl ProteSsional Cotlo: Any city or Ga�bage Di5po5al Standing Sections
county which requires a permit to construct, alter, improve, Gemolisn or repair P—Trap Laundry Trays Generator �0-5 KW �5-15 KW
any structure, prior to Its issuance, alm requires the applicanl /or such permit Trash Compactor
to fi�e a signetl statement Ihat he/she is licPnsea pursuant to tne pravisions of Roof Drains
lne Gontractor'S License L2w �Chapter 9 �commencin9 with SecUon 7000) of
Div6ion 3 of the Business antl Prot¢s5ions Cotl¢) Or that be/sne is ex¢mpt
refrom antl Ine basls f0/ tM1e alle9etl exemptiOn. Any vi0ldtion of $ection
31.5 by any applicant for a pe�mit 5ubject5 the appllCant to d civil
nBttY of not more than five huntlretl tlollars ($500�. g 3
❑ I, as owner of [he property or my Cmploy¢es with waSes as thei� sole ReinSpectiop Fae $15 IRu¢ Fe¢ �
com�ensation, wili do the work, antl the structu�e is not intentletl or o��eretl Rainipection Fee $15 .luue Fee $ 3
lor sale (Section 7044, 9usiness and Proiessional Code: The Contractor's MECHANICAL FEES
Lice�se Law tloes nol applY to an owner ot a property who bulltls or improves
thereon, antl who tloes such work himseH/hersetl or through nis on c�r own DEVELOPMENT SERVICES REQUIREMENTS: .
employees, p�oviaetl that SucM1 Improvement5 are not IntentlEtl or offeretl for BOiIC� HOOd 0� Typ21 ❑
sale. It, howeve/, the bulltling or improvemen[ is soltl within one year o� com- CynOpy Typ¢ I I ❑ Zoning ApproVed By Dd[B
pletion, Ihe owner will bave Lhe burtl¢� of provin9 lie/sM1e tlid not buiia or im- Duct - Under Ground Buildin0 p.PProved 9y Oate
�rOVa for thc purpose Ot sale). A e ,,
L.1 I, as owner ot the property, am ezcluslvely mntractin9 with lirensetl con- Duct - SVuctural Refrigeration System Application Issued By �L Dat ���
tractors to consVuct tne project (Section 7044, eusiness antl Professions Cotle:
ThG Contractor's License law does not apply to an owner ot property who Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU SUMMARV OF PEES
builAs or Improves [M1ereo�, antl who ronVacts for such 0/ojects witn a com _
tractor(z) i¢ense pursuant to the Convactor's License Law). I am awa�e that Exhaust System ❑ MWtiple ❑ System Repair/AI[eration BUILDING PEflM1T $ SMIP $
prod5 ot thalr worker`s eompensation imurance shoWa be provitletl to me. _ pLAN CHECK $ /� PERMIT
❑ I am exempt untlei SecUon B. & P. C. ior mis reason PirepVFact. BIL ICBO # Fire Dampers PWMBING § S. W ��UANCE $
�ate Owner Heating System & Ducting Registers pLqN CHECK 25% 5 ENERGV P.C. 5
I hareby certify that I have reatl thiz appiication antl state thai the above ❑P100,000 BTU �100,0006T GRADING S
'm5ormation i5 mnect. 1 a iee to comp�Y with au t{ty antl county orainances ELECTRICAL $
antl state laws rela t builtling coPStruction, antl he�eby autM1oriie /epre- � MICR�FILM $
sentntives ol tnis n er nn e abo�e�mentioneG property for PLAN CHECK 50%
insoe�tion purp . �` � 7�
Signa�ure Date MECHANICAL $ TOTAL FEE $ � Dv
Drivers' License or 55 � Reinspection Fee $75 luue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46, rev. 10/84 White - Builtlin9: Canary • Applicant; 71nk - AccoUnting; GOltlenrotl - qsses5or
CONSTRUCTION AND,PLANNING . POOL & SPA
APPROVALS Permit,# Date Inspector qppROVALS Permit# Date Inspector
i.,� iemporary 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. Foundatiori -" 59. Gas Pipe, O Undrgrnd., Test
9. Water Pip�iUndrgrnd. 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 SVstem - 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 i'� 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling �..y 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 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing 74. Overhead HYdro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,�
27. FrameandFlashing _�pi� 76. DryStandpipe � �i-
^' o .
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �` �
i:
31. Plaster Brown Coat 79. FINAL INSPECTION .;r.,�
32. Electrical Power Meter-Final 80. FOJ�D CERTIFICATE ISSUED i�
� n
33. Final Electric � Notes� � �b �.� ^�° �-� 4�r
34. Final Heating & Air Conditioning � � s ....
35. Final Gas Pipe-Test �
36. Hood or Canopy %.2Fj"$� L�Fr C���- L•���� .
37•. Final Factory Fireplace ,�'(2'� �a ,p �,��I�� � p��J. •
E�JlY1 I 1,
3S. Final Plumbing � __- - ��7�,3 (j,PG�� L'�L,•� 'r �� � � y
39. Water Service-Final % `�,• I� ��, . � �� ��
�, i .
, 40. Gas Service-Final ` � - " '��
� ;, t�
�� 41. Solar pomesticFinal ' � � - � 1
� .. . � � ��� ."V �- i
��42. Backflow Preventer . r! � � ' n, . �
�� 43. Backflow Irrigation �, � �� � ' � � �` �%
i .
i' 44. Landscape Irrigation System �i'� � � ` � '' � � '
,
,� 45. Sound Attenuation . - , � >' �� ��1
� 46. Handicap Regulations . 1�' �'I ' �/,�
47'. FINAL STRUCTURE & BUILDING � � � �� ��1 � � '�
l`� i. '1
48;?Special Requirements Completed � - ��i �r� �. �f � � �-'
49. Electrie Release to Edison � . � ', • ' ��
50. Gas Release to Southern California Gas Co �� . .�' I�'
51. CERTIFICATE OF OCCUPANCY ,�
No. Date � � ' j;
._ . _ ` _ • I. �
ADo�icant to IIII in all soaces ezcept those witnin heavy Dortler lines ane sign all aDP�opriate aeclarations.
�I7Y OF COSTA lMESA ( C•ONSTRUCT��ON PERMIT
Project Address /1 ��Q��n �?` � �
\l�y��
Applicant's Mailing Address gT�r=-�4�C�t$*4�:'1k'
Owner'sName MC.� MQ,�_S!��k�Q_Phone 63/-iP3y'
Address �L� �. 70�'' ��
Arch/Eng. � LicOnse No.
Address -_�-�__'T"M� �%�'} �uk+ p����7iNm "
Contractor's Nam Z Phone��
Addreulmailing) R10 B .$ti Tr. LLARI4 -
Ciry License No.• � �C(q Z
LICENSED CONTRACTOR DECLARATION �
1 he�eby affi�m that I am Ilcensetl untle� provizlon4 oi Charter 9(commincing
with sec[ion 7000) of Division 3 OI the Bu5��a55 antl Protes5ions Cotle, antl
my license is in full force antl ettect.
l.icense Class Q' C icense o. ��u� �
Date�'-Zu - � Signahre —
W00.KER5' COMPENSHTION D LARATION '
I hereby atfirm that I have a certHicate ot consent to self-insure or a tificate
Worker5' Compensatlon Inzurance, Or d c¢rt1Pe0 COpy [hareof (Set[ion
�o, �an, c.l . ��N
rolicy No. ComOany
�Certifie� w0Y is he�eDy tumishetl.
Certifiea copy is tiietl with the dry Builtlin9 Div�slon. ' ,
Date ApplicaM
EXEMPTION FROM WORKERS' COMPENSATION DECLARqTION �
(This section neetl not be completetl i( the permit B�or one hunEretl (5100) or
Iess).
I certi}y that in the performance Ot the work fOr hiCh thf ermR is i55ultl I'
shall not employ any person in any man� as t me z'ect to t�to
Warke�o e f}�n Laws of Califor ,
Date �_�(Q_Si9nature -
NOTI E� If, after making inis tletlara io , you 5 oultl become subject tha
Workers' Compensation provisionz of Ihe Labor Cotle, you must (or ith
comply with Suth prOvisiOns or lhis pe�mil shall b¢ tl¢emeE �evoketl.
CONSTRUCTION LENDING AGENCV
1 hereby af(irm that ther¢ is a construction lenaln9 59ency for tna pertormance
of the work for wnicn his permit is issuetl (Settion 309?'Civ. C.)
Lentler's Name �
Lentler's A40ress ^ � �^
OWNERBUILDER pECLARATION
I hereby afflrm that I am exemot irom the Contractor's Ucense Law for thn
following reason (Sec[ion 7031.5 Bu5ina55 antl Professional Cotle: Any city or
county which requires a vermit to construct, alter, �mprove, demolis� or repalr
any structure, prior to ils issuance, also requires Ine applican[ tor such permil
to file a signetl Statemenf that 11e/she i5 IiCensetl pufsuant to tM1e prOvisiOns o1
the ContraGtOr'S Lic¢nse Law (Chapt¢r 9(commenaing with SeCUon 7000) oi
Division 3 of the Businass antl Professions Cotle) or ihat he/she is exem0�
'•erefrom antl [he basis for (he alleqe0 exemptio�� A�Y ��Oldllon of Section
31.5 by any applitan[ fo� a permit subjeGtS [he applicanl to a clvll
nalty of noi more than five nuntlretl tlollars (5500).
L� 1, as owner of the proDerty or my, employeas with wages as tneir sole
compen5ation, will Oo lhe work, antl the structur6 �5 nOt IntenGetl o� off¢r¢tl
for sale ($ection ]064, Business antl Professional Cotle: The ContractoYs
License Law Uoes nol apply to an owner ot a proparty wno Uuiltls or improves
thereon, ana who tloes such work himself/nerself or Nrough his or her own
2mployee5, plovi0¢tl tM1dt SUCh impfOVCT¢f1I5 dI8 POS iflf¢lltl8tl O! 07fC!¢tl f0�
sale. If, however, the bulltlln9 or improvement i5 SOItl wi[hin Ono yea� of com-
pletion,-the owner wilP have tne burtlen of provinG ne/she tlid not builtl or Im-
prOve for the purpose of sale).
❑ I, as owner ot the p�operty, am eztlusively coqtracting witn Iicensetl con-
Vactors to construct t�e project (Sectlon 7044, BuS�ness antl Professions Cotle:
Tne Cmvaclor's .License Law tloes not apPly to an owner o/ property wno
builtls or ImO�oves Ih¢r¢on, an0 who contracts ftlr such projects with a con-
tractor(sl Imense-pursuan[ t0 the Contracto�'s License Law). I am aware that
proof o( Iheir Worker's Compen5atlon in5urance shOultl be provitletl to me.
❑ I am exempt untler Section _ B. & P. C. tor IhiS reason
Date Owner
1 nereDy certify that I have rea
informatlon is carrect. I ag ee to
and state laws reiatin to uiltlir
sentatives ot tnis c ter
InspeGtion purpo
. Signature
Drivers' License or 55 �
CMF OB65-46, rev. 30/84 WM1ite - E
tate that the abovo
y county ortlinancos
:by authorize re0re-
ionetl property fo/r
Date���L�(/j
TYPE OF CONSTRUCTION LI NEW LJ ADo LJ qLTEanTION
� ❑ CONVERSION ❑ DEMOLISH ❑ OT ER
DESCRIPTIONOFWOFK/USEOFBLDG. ������'Y
TYPE OF PERMIT ' LJ GRADING LJ FOUNDATION LJ STRVCTURAL
❑ TENANT ❑ ELECTRICAL �LUMBING ❑ MECHANICAL
❑ OTHE(3
PROJECT DESCRIPTION S�.PT. oCCUPANCv_
CONSTRUCTION TVPE VALUATION $
20NE GRAOINGCU.YDS. ACRES—
Remarks:
$ink
Preventer
Irrigation
Clari/iers ,
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceprors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspactian Fee
Under Ground
$15
Exhaust System ❑ Multiple
Fi�epl/Fact. Blt. ICBO #
Heating System & Ducting
❑ ai aa,000 sTu O i oo,000
Reinspection Fae � S75
Icant; Pink - AGcountin9: Goltlenrotl - AsSesSor
PLUMBING
Showers
Service Sink
Sewer Cap
�SewerConnection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
water Closet
Water Heater
Water Service
Auto-Wath
Laundry Trays
Issue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000aru ❑ioo,000
System Fepair/AI[eration
Pire Dampers �
Registers
laue Fee
FEES
$ ,3
FEES
$ '3
A.P..;1� .
S Main Building:
E
T Front
ARear
C Ri9ht
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures '
Device Boxes
Outlets
Switches
Garba9e Dispoul
Generaror �0.5 KW �5-15
i
d046 7/24/86 �
Zone
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL . '
Transformer � 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter �over�100amps
Suti Panel •
Motors DO-1 HP �1'h - 6 .
Inc.Sa�ar Og�15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
� Trash Compactor
Fee '� $15 � � Issue Fee
5.00 TL
FEES
$ 3
Z
O
N
I
G
R
E
Q
M
T
5
DEVELOPMENTSERVICESRE�UIREMENTS: �
Zaning Appraved By - Date
Building Approved By __�ate�u,�y,./��
Appliwtion luued By _q Dat���l-7Jy{
SUMMARV OF FEES '
BUILDING PERMIT $ SMIP $
PLAN CHECK $.�- � PERMIT
PLUMBING $ v � UV ISSUANCE � $ �
PLAN CHECK 25% $ ENERGY P.C. $
. ELECTRICAL $ - GRADING S
PLANCHECK 50%" $ MICROFILM $ ��� -
MECHANICAL $. TOTAL FEE $ � �LL�
� PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspecto� qppROVALS Permit# Date � Inspectoi'
. ,v
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 Bonciing �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer CaP 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing Sysiem - 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
w
20. Fough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Produc[ Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74, Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electriral Power Meter-Final � 80. FOOD CERTIFICATE ISSUED '
33. Final Electric Notes: � .� G
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test '
4n �'
36. Hood or Canopy' G� C'
/
37. Final Factory Fireplace -'
1
38. Final Plumbing ��9/� �� � •
i
39. Water Service-Final .
40. Gas Service-Final � . ,
�41. Solar pomestic-Final � � �
42. Backflow Preventer ' � � '
43. Backflow Irrigation , �, �
44. Landscape Irrigation System , !
i
�45. Sound Attenuation ' � .
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING � -
48. Special Requirements Completed . , •
49. Electric Release to Edison .
50. Gas Release to Southern Califomia Gas Cu �
51. CERTIFICATE OF OCCUPANCY
No. Date
Ci7Y oF COS7A MEsn CONSTRUC�TION PERMIT
Projeci Address � Z � L-h � �-Q � S'C f G C�
Applicant's Mailing Address �� � � ` A� �Y�- LL f+(. /�d-
i� ���'2(�-� C�a,TC'c� Phone(.��--'1�
i Owner's Name
' Address 1Z1 Lw� Z(1'f'^� �lTl��T
Arch/Eng. �� Licence No. —
Address ' ' —'�—
Contractor'sNamo Tc��� ir �+h� PLhb.phe�e5`i�-lZ�o
Addresslmailingl �i� E CI�L�ITA LLAfL�-
Ciry License No. � ti� q 9 z-
LICENSED CONTRACTOR DECLARPT�ON
I �ereby atfirm ihat I am liconsetl�untl0r provislons o1 Charter 9(Commencing
with sectlon ]000) 01 Division 3 o1 tPe Businesz antl Proiassions Cotle, antl
my license is In full force antl eflect.
Llunse Gass � e '� �ense Jvo.y�4'+`' S�?
Oate y� ��'g� _ Si9nature �
WORKERS' COMPENSATION DECLARATION �
I nereby aHirm tnat I have a cerUfiw[a o� consent to salNnsure or a certltifate
o� Wo.kers' Comvansation Inzurance, or a certHietl copy tncreof (Settlon
3'-' Lab. C.)
f rvo. .�=i !1�—:'i ComPanY �;,,. n. Fs' �uf3=. ....
rry� ..ertlfied copy is hereby_furnisnea.
�u Certilietl copy�tiletl with tne Ciry Builtling Division. .
�05i'T'^�'�'-� Applicdnt —
EXEMPTION FROM WORKERS' COMPENSATION pECLARATION –
(T�issacllOn neetl nOt be complatatl II tpe permit i51or one bundretl (E3�'O) or
Iess).
1-certlfy Ihal in the pertarmance ot the M'ork for whic0 thls Oerm�t is iss��ed, I
shall n01 emplOy any pe�5on In any rt�annan, as to becoT@ 6uDf t b tha
Workers' G 0! s iOn tavi5 Of CnIHOT�
Date N-9T—�� slgnature� / �
NOTICE:'H, after making tnis tletlarati0�. You snoultl ba me suojec:�to� e�--
Worke6' COmpMSation provisions Of (he LubOr Cotle, you mu5� forU
�comply wlth zuctl 'provisions or tnlf Oermit shall ba tleeme0 revoue0.
CONSTRUCTION LENOING AGENC�' "'
I t�oreby afptm that [here ii a construGtlO� IenOing d9enty 10� tbe PeriOrmdnG!
o( the work tor wliic� this permli is i5suetl (SectiOn 3097 Civ. C.)
l.entler's Name .—
Lender b :.tltlress _ „
OWNER BUILDER �ECLARATION
I hareby affirm :Oat I am ezampt lrorr� the Con[ractot's Llcense law rOr thG
foilowin9 reason (Section ]031.5 Business antl Protessional Cotle: Any clty or
county wnich requires a Plrmit to consbuct, alter, improva, tlemolisn o� repalr
any sVucWre, otlor to Rs issuance. a1s0 �equires Me applfcant tor sucn 9ermlt
10 fil¢ D sionetl itatement �hat he/ihe ib ���P�Setl pU�iudOt [O Ih¢ proVl5i0�5 01
tne Comracmr's License Law (Cnapter 91�ommencing wiM Sectlon ]OCO� ot
Division 3 of Ihe Busine55 antl Drnleisions GotleJ or tbat ne/sbe ii e%empt
lherafrom anC the basis fo� lhc alleged?xemption. AnY violation o1 �clion
)^'1.S oy any aOPbcant �or a perT�1 subjec[5 �he appliceid lu � civil
'ty o/ nol more than five huntlretl dollars (E500).
as ownei of the oroocrtv or mY employces with wages as Uieii sole
twnpensation, will tlo tM1e work, antl tPe structure is not IntenUctl or nfieretl
for sale �Seclion 7044, Buslness ann �rolessional Cotle: The Contr3cmYs
L¢ense Law tloes nol apply lo an owne� o� � P�oPerly wliu builds m' in',proves
thereon, antl wno tives sucn wor�. nimsciVnersen or �hmugn nis m ni•.r own
employaes, p�ovitletl that such improvements arc nul intentletl or oite�etl fOr
a1e. II, nowevcr, the bullaing or Impro�nman� is sold wllhln one ycar o( wrm
oletlon, tne owne� witl Oave tne burtic0 0� P�ovinq hc/sttc tlltl nOt DUIIU or im-
�rove ior tne purpose of sa�e).
I, as owner ol the proper�y, am exG�usivery cOntraCNn9 w��n Ilcens.�d con-
Vactors �o conslroct lhe piojeCl (Section �044, 6uiln¢55 antl Proleislon[ COtla:
The Conlrattor's License ldw tloei n0� apPly to an owner ol prapetly wh0
builtls or improves Ihereon, antl who tonlracts tor suth prOlaClS will: a con-
t�ac[o��5 bcense Oursuanl to lhe ConVatlor's License Law). I am awere thdt
proot o� Ibeir Worker's Compensa�fon insurance ihoultl be provitletl �o me.
❑ I am exempt untlar $action 8. L P. C. f0/ this �eason
Ua�e Uwner
I nereby certuy tnat I have reatl tnis apn�icatlon antl state inrl me above
inlmmation is correcL I aoree to como�Y �'ith all cliv antl coun[v oitlinances
Iantl state laws relalinq to�builoyn9 cons��uction, antl hareby rulbmixr repro-
sentatives ol l�rs.city to enter ,Upod �he above-menlionatl propni�y to�
InspeCtlon purpqrvs.
Signamre ^ � "'����i %���7�� DateLl� /'' L '
Drivers' Ucenze or 55 ��'_�`�.!�� �
TVPE OF CONSTRUCTION LJ NEW !�P.DD LJ ALTERATION LI REPA�R '�
❑ CONVERSIOfJ ❑ �EMOLISH ❑ OTNER A:p:,�
DESCRIPTIONOF WORK/USE OF BLDG. _
'S Main Buildi
E
TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTFIGAL �LUMB�NG ❑ MECHANICAL B Reaf
❑ OTHER A
PROJECTDESCRIPTION SQ.FT. OCCVPANCV C Right
K
CONSTRUCTION TVPE VALUATION 5 g Left
ZONE GRADING CU. VOS. ACRES �. Ping. Ref. #
RlTilki: . P�dOfllOq �VOIPS:
Bar Sink
Back(low Preventer
Becktlow Irriga:ion ..
Cleritiers - �
Dishv.asher" ' " �
Drinking Fountains
Floar Drains"
Floor Sinks �
Gas Service � Outlets.
InterCeprorS '
Kitchen Sink
Lavatoriez
P-Trep
Roof Drains
Reinspection Fae
S75
BOiler
Dutt- UnderGround
Dua � Structural
Dun � Ven�ilating
Exheust System ❑ MWtiple
Firepl/Fact. Blt. ICBO #
Heating Sysiem & Cluctiny
Uo ioo.000 eTu Oioo,000
Reinspection Fee � S75
PLUMBING
Showers
Service Sink
Sewer C3p ,
Sewer Connection
Solar Collectors
� Solar Pipin9
Solar Tank
Swimming Pool wl5pa
Urinal
Water Closet
Water Reacer
� Water Service
� AUto-Wash
Issue Fee � $ 3
��
.
Zone
Atcessory Building:
G
� N
c
Parking Req.IProvitled E
G
N
T
5
ELECTRICAL
Autometic Washer Trensformer ❑ 75�50 KW
Construction Pole Sub. � � 50+ KW
Cooking Unit Meter ❑uo to 100 emps
Dishwasher - . _ Merer ❑over100amps
Dryers ❑Gas OElecvic ,. Sub Panel
Fen ' - ' Motors �0�7 HP �l Y, � 8
F.A.U. . Inc.Solar �9-15 HP 016-15+
'F iztures Miaowave
Device�Boxes Pole Light
Outlets Fiange
Switcnes Sign
GarWgc Dispowl Standing Sections
Generator �0.5 KW �5-15 KW Trash Compactor
FEES
Reinspection Fee I 315 I I Issue Fee
IANICAL FEES
Hood or Type I ❑ DEVELOPMENT $ERVICES RE�UIREMENTS:
Canopy Type I I ❑ Zo�inB APProred By
Buildinp APProved By --,
Refrigeration System
❑o-ioo,000aTu Oioo.000
System Repair/Alteration
Fire Dempers
RegiStr.rs
�ssue Fne � S 3
CMF 0865-46, rev. 10/B4 Whi1� - Builtlinq: Fdnary - Applitanl; Pink - ACcounlinp; GO�tlenrotl � qS5G55m' -
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ .-�-� • vv ISSUANCE
PLAN CHECK 259d S CNCf1G1' P.C.
ELECTRICAL $ GRA�WG
PLANCHECK 50°p S �v1iCROFILM
�dECHANICAL 5 TOTALFEE
PLAN CHECK 25% 'a ,
$ 3
$
� � CONSTRUCTION �AND PLANNING • .. ; : . : ; . . , , POOL & SPA
� � '�' ��� �-SOate ?� �I�nspector+ � � �� � � �� � Da[e Inspector
APPROVALS �� � Perrdit.3� ' � : . �� '' APPROVALS Permit #
. . � � . , �. �: , i i I . .
� 1�� Temporary Electrical:SerJice or pole. ;: � i . `' ' . 52.� Pool §� Equipment Location
r' • 'i- � �1', �
2. Soil Pipe-Undrgrnd. ���� � ` �4 '• � �� � � ' , 53. Steel Reinforcement �
3. Electrical Conduit Utiliry-Undrgmd. �- � � � ; . 54. Forms
' 4: Electricel ConduirUndrgrnd�. � � ' � 1 . � � ' 55. Electrical Bonding ' �
5. Sreel fleinforcemen[ ., , � � 56. Roiigh Plumbing & Pressure Test
6. Electrical UFER Grnd. . i j�� , ';57. APPROVAL TO COVER-GUNITE
.� 7.�Footings � � (-.�'; : I �' •��� � � � �58: Electrical Conduit�Undrgrnd. �
�
6. FoundatiQn , � �-'' � . � ' , . � 59. Gas Pipe, O Undrgrnd., Test
„ 9. 1Nater Piqe�.Unclrgmd. � : �. , � ,. �.. : . I. ,,:.., '. , , 1 . ' . 60. Backwash �Lines, P-Trep, O Undrgrnd.
' 10. Structural Floor System� �. .�',,�;,`;� ;! j. ,: ' � 61. APPROVAL TO DECK
�,
� 11. Property Sewer Line & House Connection; � ;. �� � �, bZ.:Backwash & RecepcorFinal
� 12. Sewer Cap ; �� ;� ! �' � � � .. 63. Heater & Vent-Final
. ,1�3. Roof, Dreins:'; �.;, : ' ' ! '� � � 64. Plurn6ing System - Final
14.c Rough Plumbing . , 'i -: ,' �� i. I .�� � ;�. � 65. ElectricabFinal . �
i
15. Rough Electrical-Conduit � �..: � .:, :; ; �.;��� : , � • 66. Solar.Systein-Final
'' ..,16..Rough.ElectiicWinn9 ';! � '- �` ..M-^.% �.:�.,� '�I `67�;�Fzncin"'&iQ�cessAPProval -� � -��-
9 ..
.:17. Rough.Wirinc� Sign � � ��w," ;,..��;;;, :���',;��: '(r' ��687 APPROVED FOR PLASTERING �
18: Rough Electrical-T Bar Ceiling� �� . . j.: , 69. POO VSPA SYSTEMS FINAL
� 19. Ro�gh Heating�& Air Conditioning �',i �� '., ( FIRE DEPT. REQUIREMENT
� � ,
20. Rough Factory Fireplace �� ' 'i� �� `� � '��.� , � ��! 'r':� � � APPROVALS ? �Permit # ,
21: Ducts, in Structure i�; , ��':- �� �70. Underground Hydro
22. Ducts, Ventilatirig �, , ` ' i 71. Proiluc[ Pipiny L7 Gas ❑ Oil .
23. Gas Pipe-Rough & Test : , � � � . .72. Underground Flush
24: Roof Framing� .���• ' � � �„i " , ��73. Undergrnci.�StorayeTank OGas ❑Oil
� ,.;. '. �: ..
25.� Roof Sheathinj � �: � . :'�i.`�� � � ,74° Overhead Hydro
. . :. . ...: : '' . .. . .
2G. T-Bar Ceiling �Structurall�,& Monocoat � • � .�; ; .'�jl;;�;�;'•• � .,75: Dry Chemical � �
9 ; �,�..;:....,.,,' ' �',, `_.,.�� /;;;;','' ,� . ':76 DryStandpipe
27. Frame and Flashin �. �.:; ..
28. Lathing & Siding ' '� � ' � ��� .� .i..:���_,: �� � �.7j,; FIXED SYSTEM FINAL
29. Insulation � � . . -i. � , ' ;�! ������ 78.� FIRE PREV. FIfJAL
30. Drywall Nailiny . �- .. ��,?. �;,: j: _ �� HEALTH DEPT. REQLIIREMENT '
37: Plaster Brown C:oat �� � • �� `, � � � �� ' � 79i' FINAL INSPECTIOPd .-
;t,Y',:: d.�
32. Electrical Power,Meter,Finsl ,� �. ' t {'=80:;; FOOD CERTIFICATE ISSUED
' 1' � �I;I��::.I4.( 'V:.
. � ' . . �..,. ...��; ��.. -� ' I • 1
33. Final Electric � ' � �! .. .r�i1 'i� ;Notes>�
34. Final Heating & A�r Conditioning� " �'�`� ��;;,-�'��P `'� ���t�'- �� ! : � �.;.��
` , : : i:��;.,>���.;.i,:;l",: :�:i},;-;�.;;. ; j ,i.
35.FinalGasPiPe-Test 'S�: :�, :'�??ixi�,.'':i[-�;�;6.1%^_f;t. ?'��}:•:�:� ..1:._,
,.
.. .r. ; . .. ,,�. ; :
... . �.----'--�...::__ . . , ..... : .; , �:'
. . . �,.
36. Hood or Canopy �.. . � � � � '' �
� ir, .:d; ; :
37, Final�Factory�Fiieplace �� � i ' � � - � �
38: FinalPlum6ing �, , . , . '����: � (i•t���' . � ��. �� � '� � •
39" Water Service�Final � �'�" � N ' � � ' -'
. . , 7- , i� t . i
. 40. Gas Service-Final '� � .. ., �� �f�;,' �;.. �f� . '�� , , - • .
��1A7. Solar pomesticFinal , � :.'� � � ����� . o �.. � ..' �
.. �;�; � �y� _ . t:Y
� ��42: Backflow Preventcr � . , . . ;: i ��., . ;, . . i��.; �+.. �. . , .. j:. - � -` � , , �
�'43. Backflow Irrigation � . ' � � �,.� � � '���'� . � ' '� �� ' . • �
.. .,. . (;• . .
f�44. �.Landscape Irrigation SYstem; , � ' - , , . � , ' , ' ' ; i • I , � ,
��.q5. Sound At[enuation • � . � ''. -� . �� ` . �' � ,
'� ,-. r
.46. Handicap Regulations ' � � ;!' �'� "� � �� �
��.:.., : . ''. � . � � ' . � � � . � '� . .
,7'. FINAC STRUCTURE & BUILD�NG ' ' � .� �
, . .. . . . . , �. 1 ; �
.48,?Special Requirements Completed. � '' �' I�'r ', i r � ' �
I��.. �o
� 49. Electric Release to Edison � ' � r'� '� ,' `,� '. ,�. � ' `
:i;'
c. � . �.,;; .
50. Gas Release to Souihern Califomia`GasCo . : `, ��� ' ^'�` �" �.�� �. . � . � �
ik^.< �I� ..a.
'51. CERTIFICATEOPOCCUPANCY� i. �,'+,� � �
• No. ' � �.... ;Date �;�, � I . .
' ----- -- . . . .. �,i. . .. . �, L �
e
COUNTY OF ORANGE
BUILDING DEPT.
636 No. Broadway
Santa Ana�'California
Phone: KI 2-6211
1. OWNER'S
♦ -- -
ti - .,
Application for �Building Permi} - Pe"""No.`�/��_�__
AND FOR A
Certificate of Use and Occupancy
..
-..
-- ,
„ Da�e - -- --� --_�9� d---- ---
PHOIVE:
�Q _0/ O o L
MAILING ADDRESS -------- P_ �_ �-'---�%`__-----`3----�'---- --- - --- -------- CITY .�%�.c�--�Y��i-a�--
Name _...________.__�1. (i�l_'_=—_ — ___________.___________..________.__ Name.__.�.4s.+::'�.e�__._____.
- - - - -
-------------------- ----
(Archirett or Engineer) (Contr ror)
Address :---"-------- - L�Y��------------------------------'---- Address -----
. !Q-GiIaoR--�-._._---------------------------------
City._ - -------- -- ---
$tate
Lia No. _--"-------------- ------. Phone
City ___.
$tate
Lic. No.
..__._. Phone
PROPOSED USE: - -------1�Y !/.i....Q�- -�_.....�'�---- - ---- ------- - - - -- ... ----- -- ----- - ---
2. JOB LOCATION_--�vC.._L-----���.@.--�-�—tC:_�_��%6�n.--�-40�S�4.c�C-�--------------
(House No.) v (,Name of Sareec) (Town or School Disvict)
3. LEGAL DESCRIPTION: Loc �1L�. �
1 �C�-I�/1_.oZ--.�__Block ---------- ----- -----Tract -----�/?{--- -------
(Me�es and Bounds Description—Use re rse side oE form)
4. CORNER LOT ( ) INTERIOR LO�(��)�q �I'HROUGH LOT ( ) SLOPE OF I�OT ( )-
�,//� G� ����/// ry
5. SIZE OF BLD�7���.1�'j'__AREA: ��._.SIZE OF LOT: ____�O�/.-� EA: _._��!_.�
/ �/ � A / �
6. HEIGHT OF BLDG.:.___.__�Z_�<____.CEILING HEIGHT:__.____..���.._.__NO. OF STORIES_ �____..____�__
O
, .�
-._ 7. NO. FAMILIES __._.._._.____1..__.______..._...Size of Smallest Bedroom: __ _��_ .. _.____. _ Size of Kitchen*/J;:a,n,s __�i���_l'_
_ �.
-8: EXTERIOR WALL CONSTRUCTION:____._��'..C.O_____.__INTERIOR WALL COVERI[VG ___��.r�,J______.__
(Frame, Smcco, Etc.) (Plaxer-Drywal�/Em.)
9. SETBACKS: Front Yard Erom Center Liae of Sneec_'__' �'a'pe'j / __.��_.__________._____. ______ __._________._._
Nearest Side Yard.__���._Rear Yard._.__���c_..Distance in Feet Between Bldgs. on Same Lot ____.. ��c�'-_____
1U. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. ,
�� i/ �r
11. For (a) Footing: Width _���.._______. Depth in Ground -/�i-•^�--�------- Width of Wall �_ _C�'+t�'___
Acressory
/ a
Bldgs. and �b) Size of Studs: __._�. f-�.____._.._.Spating.___.___�4 �- �
Similar -- --+�+�--=--"CC Marerial of Floor __ . �'�1� ..__
$tructures:
(c) Size of Floor Joists: __...______.______________________.Spacing _____—__._...__.____.__._.___ CC
(d) Size of Rafters: ------m-1---Y7----�'-----'------.Spacing ---�---J-�--`�'.�-`--------� CC
12. VALUATION OF PROPOSED WORK: Indud'n�all labor, pLumbing, electrical wiring, heating, fice iprinklers, paino-
in and sewa e dis qsal' 6_ -�-�__�_ -._.�..r_____ � � ,
S 8 P �-----`/
1;. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND B6LIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COUNTti' OF ORANGE AND THE ST OF CALIFORNIA APPLICABLE THERETO.
Signed:-----$--����---�- -- -------
y-� ----------------------
Plans Filed:.--_----_____----_ �
v �
C ---��--� -
-
ner
. ' ' "'____" BY:""_"_'___"'_"'_______"__""_"___'_"_"""""""'"'__""'""'
""_'"""_""'_""""__'
(Auohoriz¢d Agen[)
FOR DEPARTMENTAL USE ONLY
FEES:
Bldg. Pcrmit -
Plan Check -
Total - .+��—/�j
Receipt No. / �-�
Paid ro - -
Da[e -------------"._..
fJ'�� �i
GROUP.--,�-�-_' ---- - - - -
---- -
<C��_ TYPE ------- ---- ------- -
--
--
v'0 DIST.
�
' MAP.-_ _--- -----�-r�
- -
. SHEET [VO.-------------------
DATE --- - --"- -}- -----� v---`�6 �----
$M-] 50 /
CH�CKING BY
APPLICATIOprjq%/� /HEALTH ____.
�r� �'�� FIRE
ZONING_____�--r MARSHAL_______ — __.____
PLANS AND �
SPEC'S.--- ------ -- ---- - TATE - - --------- ---
CORRECTIO[V ENGINEER
VERIFIED - ----------- ----- CAL.--- ---- ---- -- ----
PERMIT IS D BY:
' l'L/ ------ -- - -- -- - --- -- -- - "!�'� - ---
- ----- - - -----
G Y�"
COUNTY OF ORANGE
BUILDING DEPT. "'
636 No. Broadway
Sanca Ana� Californie
Phone: KI 2-6211
1. OWNER'S N
\
Application for Building Permit �
AND FOR A
Certificate of Use and Occupancy
MAILING.ADDRESS--_-_-_'�-`_-_(L_-�---- .- -
--
,
�
Name .._. __1LbrI's_.AJ__ ___. _ __.. __'.______.__.______
� (Archicec[ or nginee
Address __,�cQtfy+sA�...
City ----` - ----- ;�t1M���.------ - - -` --- - - --' --' - ---
$tate
LicNo..____"_'.__.'..._____'.._____.__. Phone ___'..._r___..___.'_..____'_'__
Permit N����-l-----�---`'•�--
Date---'--(J�<viC----I�.--- �%-�--
------ -- PHONE: _--� --- ------- ------- -
CITY�,.�� �sG�l�./
� n n
Address --'--/�:��L----- -----'---
C�ry --- �y1.�.vo�bL_— ------ -- ' - ---- --- ----- --- --- ---- -
Statc
LiaNo. ----"--------...-'-'-`-----'--- . Phone---------------------"'-....."-'
PROPOSED USE: -----------ry-- -�-- ------- - - -- - -- -- --- ----- - - .... - -- ---
2. JOB LOCATION - -- -- -/ _� L----- �----o[,d---� ------��.� -��a..- -l- a
(House No.) (Name of Stree[) (Town or School Dis¢icc)
a.� �
� GAL DESCRIPTION: Loc _��.-�---�r--'-�-[-'------Block -----------7^__.---'-----.---------Tract _------
(Meces and Bounda Descripoion—Use reserse side of form)
-i ..
_ � � y--- -----
p��4. CORNER LO�( ) INTERIOR LOT (✓j �TI IROUGH LOT ( ) SLOPE OF LOT (
.
u� JG
5. SIZE OF BLDG.;.��0_-I-._/�AREA:___.___/.L�_O_______._..SIZE OF LOT:_�O.__-��c�.AREA:_.___.__
6. HEIGHT OF BLDG.:___/.���_._..._.__..CEILING HEIGHT:._.. .�, __.._.r_��c-..,,NO.OFSTORIES._._....�________._._
� � l^ ' ),,
7. NO. FAMIJLIES ._._____._._� .....:................. Size of Smallest Bedroom:.l J,f? L.i.._____..._ Size of Kitchen: ....C1._ (Q.�._____._
8. EXTERIOR WAI_L CONSTRUCTION:---..a9�1'.1�-uG�.'.Q.-------..I[VTERIOR WALL COVERING.--�.-0.?%�r----------
(Fcame, Saucco, Em.) / � P�er•Drywall, Em.)
9. SETBACKS: Front Yard From Center Line of Street-------.'---___--'-__----I�.�D -___--_----_--------_'--_--__'_--------_----_'-'-_--------_'_'-
� Nearest Side Yard_e�.�� Rear Yard._T-y�Distance in Feet $etween Bldgs. on Same Lot _._.. ���._._
� � -
10. A COMPLETE ALOT PLAN IS REQUIRED, SHOWI[VG ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width ._..__.��_t�.�.<.__ Depth in Ground.____f��+rr_�____ Width of Wall __�+:�+.__�_.-
cessory
gs. and b �___S acm ��..c..,,�.___._"CC Material of Floor. � " ,."" y....
imilar �) Size of Smds:.__.�..-X-- -- p g_-'_--'- _�/J'(��.ie.e.eC--
Strucmres:
(c) Size oE Floor Joists: -'--------------- ---------'--.Spating -'-'------------- '_.._.._._"CC
� (d) Size of Rafters:,..--- �--�-T-.. _"__'-""_ Spacing .....'o�-��,�".,.��-�.-'-'_` CC
., /
1?. VALUATION OF PROPO D RK: Induding all laboq plwnbing, clettrical wiring, heacing, fire sprinklers, painb
ing and sewage disposal �._ � V
--- ----'----------------`-'---
1>. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT A[VD THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE CpUNTY OF ORANGE AND THE ST �'E OF CALIFORNIA APPL ABLE THERETO.
CI
. Signed:.__'_��__� _ ___ ner ____. ,
. ______.__'________.__________
/� ' )
Plans Filed:.___________�Q_ ___�(! _ -g�
. _ __.__.____._.._______ By;._.___'___'_'_____'_'.._'_____�_______________.._______'_'-__________________'_'_____'
(Au[horized Agent)
FEES:
Bldg. Perinit -
Plan Chec.l- -
Total - - �
Receipt No.
Paid to - -
�---2--=-� --
$ -------''S Q---
FOR DEPARTMENTAL USE OIVLY
GROUP--.------V ` _..
TYPE.-------��
DIST.
MAP------�-- --- -----
SHEET NO.___________�____
DATE --- -- - �-�s'� -��� - -
!M-].]O I/
APPLICA
ZONIIVG.__..
PLANS AIV
SPEC'S. - - ------------------
CORRECTIONS
VERIFIED ________.___.__.
%G BY
HEALTH ------------- -----
iFIRE
M.4 RSHA L-------,---------
STATE _---- ---- - ----- -
ENGINEER
PERMIT ISSU Y:
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UAINNING FOUHIAINS• WATER COOLEAS • EMERGENCYEQUIPMEM
Represented by
SPECIFICATION SALES
6007 Bandini Blvd. • Los Angeles, CA 90040
(213)724-1120
,- --�`-- - -
_—�--i1-�—� -•-- - - —$/3/88' -
iI�'"
-i-, � ;-,-� - -
; City of Costa Mesa - -
� Building Dept., � ,
� CoSta� Mesa, CA - i
- —i -�—j-- -. - . , . .
J._�_ �__'__�__ _ _
� I � i i �: Permit P 32958 I
-� -,- - ,
-��-`-�-�-' -'- ' � � � 721 �FI. -20th St.- �
-�-�- �-- �- - � - - Costa Mesa, CA -
� �, � I I � ,
-I r-r-,- , , ' ,
-I-I�. �Ber,t �- � ' _
_I I I � _j _
! Ettclosed is a�copy,of my file copy of the
; permit that!was pulled�for the wvrk doiie
� at�the above address. Atl of the,p�per wvrk
_� was suY"a2ifEed"to'Mr. Alex Skarbelc�in-the
-'--Reclevel:opment Ioan Program. Note the
-I-clate=ancl-initials of tlie inspector on-the -
�-k'�aacic;'-this was -signed at the jobsite with --
-�-one-of-the-boys there-at the-jobsite-ha�xling
_I the_pexin.it-tn-the-inspector. --, . _._.
�
I_We:have._received our_payment for the.job.
_I i � i
�_Aope ;thiTs,_wi�l help with your e.nd of the
/� ny' & n Plwnbing �
Tor�vv�s & seca �zur�:�:�i::�
�io �. sa�za c�ar�a avE.
n . ��ta ava. cn s2aas
TC3NiY'S � SOhV PWAABIRIG
° 810._�. Santa Clara Ave
Santa Ana, CA 92708
�na� saaar3e
State Contractor's Llcense Na 484958
Icueroru
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-:�0 � L�JOG�a OaDC� ��
No: 00��2;�
. ' . . ono[n 1�ecn er
ML E�X
' � _ ` " Q'DAY�WORK ;.
. . . , 4' [�CONTRACT...
92626 • - ..•:,,
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r`S ' . . . . � � .. . '
, � . '
� '.1"' . _ - u .� JO� �NONE . ... ., T
�� �:' _ t . " 20 Q]Btd r'iesd � 631-3838 '
'bncevt`ox or,woea .. . . - - .� ' .
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•.:� ' T..N.�77�F{�n �f �.achiM �r.i�i� irv�hrnn" . -.
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� - a� r��: S4so.00 --
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� ,.: � ��PY of Qoastr�t anl Pennit Db. P .32958. �c.lv�.�e3 .. �" . :' =
� ., V � for.Your file: --_= ;`'-, -
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- • _ . � No one home I
�� Signaiure�", '
'„��'� " --'I'hNeOy acknowle0ge t�e salislactory a
al Ine above tle5cri0e0 work.
JWO 86P3 `
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roT�� ueoa
t�z
TOTIIL FMWNT f � �
I amwnt,Gue.,, 6.' j.Q Total billing ro
�oovrwork:.a •';��,S:Yjybe madea aner
n.f .•f,•,�_ _\. f ednoletion
6.1.c.L�_��. �.Ci:...ot..wnrk. _.. . .