HomeMy WebLinkAbout752 20TH ST - Building Permits��p����� 752 W 20TH ST
°w"Eas"'W"'aawrcDAWSON, RObERT
� ` j"D°"�DAWSON VERDA
6691 HtaRBOR KEY CIR
�. �wiwo �uo�ss:
HUNTINGTON BEACH,CA 92648
ANCXIfEtf ON FN[�NFiA:
ANCN.OB flIQ'4 AOOPE54:
UG Iq:
UNT: B
UNT:
ca^"uTarar� UNDERCOVER ROOFING ( 714 ) 842-2980
cam�croxs�uiwc 18196 SHARON LN
��H,B. CA ��= 687961
9Z648 u�:
LICENSED COMHAROFS DECIAN�TON: I hereby ellim uder pmely d pajvy tlW I mn ficwueE wdr povnbns W Cheper e
(mmmmtiq xv� Srmn ]OW) d Oivuion 3 d iM Buaaw vd Pmlmvu CoM. rW rm' fvos e n hm lan md ellea.
cmuc.xo.: �x.«.ss:�-39 "�"0 6 79n61. EXP:
om.: � .Z1/� � c�o-.ca.: (�M/'�
IEF BNLDEN OEClAfl4Tip1: I Ivob� tlf �vd> psWy d prjuy ihet I em memq han IM Catlfetlm Limma law Ia IM
7�Mq iamn (Ssaian lmf 3 Bwiia� eM Prulmoms COEe: /uryW a mu+v �tid� nmvm e c�� �o oavma. ela. innaa.
bmdsh. a repai airy eWtlue. pia b m efueiae. abo �apimes Ue epp&eN In ax�A pemii lo fib e eqneE eW mieN Nel he a 4w
. rcevad w�+w+ �o �ne va++� a me cavreeus Limnse law �Cheper s(aommr+tlnu wn seam moo) w oivelm a d ��r
Bus'vn» vd Rotm'vn COEeI a tIW M a 4n u me�np thaahvn and Ne bea W ihe +MO� mamq'v�. MY vidmun d Setlbn
)0�1.5 by eiry epp5uN I« a prma aLjan+ Ne eppGum w e dxl pereQy tl np mwe Ihv� fva huM�sd dolan �5500p.
� I.mownmdNeP�Wa�YamY�Ya+wYArep�nNvdemmD�.w7dotlwwkeMNseWtlweenol'vtlakeC
adferedlweeb ISecmn )OM. Bus"vies end Pmleasw Code: The Camrenve limme lawdom �MeWN�o an orrtierd papa�y
xta Wid� ar inP�+s Iheean. end Ma doae sufi wak h'vnaetl a henM a tivnqh hu a her rnm amNo'/�. pw� thel wM
Mw�� �e m wdwa «wm�e t«.w. e. m.«e.. u» aaamo «ma���v e.da w� o�,. w+� a�o��,. n.
awiwr-0uiltler wi0 hew �M di�den d pw'uq M a ehe Ek rc� ddd a"vnpow for Ne qrtpms d obl.
� I. u wmer d iM G�W�Y. em utliowlY murWnO wYA 4ensd oomranan n m�mua tM pM� (5w'nn ]DU. &uinma erd
r�a.�, code: m. com�aa. � i.. aoe. m ao'i m.� owb, d a�wm .no ewm «:�wo+m m..o� d,e »*o
mMrxb br wdi 0�9�+'W�+ a mvaaa(f) fce�uad pmuaru b IM CoiYr+tlm L'cvms laxj.
❑ I em eamnp wder Sermn: B. d P.G.. br N'v �aman:
Deia: Owner:
i eo n..nr �v uw i.m �s a m,e �w..W,d m. �.a:�.m«a, a c.uo� w�en w smw coe. s.nm. zssos. zssa�. �e
z55aa. vd tlw I a em Mun d:ld'n0 �d T i w na (acb ane) nsed ro cpndr rrtn .eie ams mer md ihs �eyu'vam.m br
.o«me�«mn.wctia,nnnaermiu,aamu.�k�i �eu.�w+uw�e.R.oa.ve�mm�uaa,eppim4w.n..enw�mmm...
a�.
Deta: Apprum:
WOFKER'S COMVENSATION DKL�fl�T10N: I Areb� elf uids pwv4y d psjvy ans d IM blbw'vp MAutliom:
� I hm ud wJ meiman a eanRma M mnwit �o woiemns br �vk»' mnpammion. m pwitlM la M 6euian �100 W �M LeEa
COM. la tM pManiwic� d Ne wk la whid� Nw pame b u�uad.
�ine..m,ewm.:v�.w..•mmw�+mu�:m�m,w.o�wm.eMs«ao,smoammeimncoe..wmso«rormem.dm.
work In Miid� Ne D�e b'v�ued. MY waYen' m�psuetion M�venu dnW eM poG.y rcvnber ma:
c.m« STATE FUND EXPIRES
Paev N�me�.: - 01 / O 1/ 9 9
�lihh e«riw n«a mr ro canpwee r u. v�t e �a. ons m.imae ma+is Ifraol n kn.)
❑ I cMN �� in iM pAmwice d ttr wak 1« xAirJi tM pxnd'e minE. I Nep np ampb� ury perem in ury menror n m io
Eecane wb'etl lo iM xaMmJ mnqemetian law� d CeHanu, enE epre� � I Nddd Exviw wbjetl to iM Men'
, omw eli R�+ons Safion 3'!0o d Ne leEa Cads. I Yjp6J hwekca M wh N.. p�wimv.
l
�Dele: /�pp4+m:
W /np: F�Nun b ucun workwi mmp�ruetlon corerap� I� uibMW, e ll u!/c! an w�vloyw lo u1M�ulqn�ltlu �M
N� nM. w ro on. nu�e�.e mouuro ad�.n lt�o4aaoA „.miw� ro � n or ronv«u.Hon a+�•W .. povw.e ro� �n
s.�ao� ane or m. t.eor coea ��.rut.�e.rtom.r'• �..s.
consrnucnoN �eNara �cewcr: i nm.nr ��., w�r d� mm mae p.��w� i.�d�m w�r n, me
pMamerce W �M wak b whirli ihe D�1 u bwed (SeCion �OB). fwi. CI.
LENDEN'S NAME
LENDEP'S ADUBESS:
I cenM �Am I hm reed Mo nGVrira/vi end vete Ihtl tln above idametion e oonsq. I ePM �o eomGN xith eY uYeM eauM' adinenm�
eM elete lews MmYq m duldM mrs4ueian ud MrebY awlv¢� �m�d� W Nu aY b aNs uD� �M ebwa�manlbrod piopaily
�����"����'�'�'�TOM S WYER
/ Prv4 Nem � �]�+
%\ Ome: �� �U
Su d benV 'aua
(5151ee.WP) M/kte�+Jdiq85elery:
Fink�M�wn: OalCenroE-Maauor
98-o I3
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 086711
PERMIT NO: b 086711 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTZON TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
iJOH DESCRIPTION : T/OFF 6 REROOF W/COMP. SHINGLES SQ FT: 1,700
ICLAIM VALUE: 1,700.00 CALC-VALUE: 1,700.00 GROUP OCC: R-3 /
COMMENTS: X
�***�*+����r���*�+���r��r�r�r�r*x�e**��******�**�r**+r�**+e***�r�*�+��***�r��*#�*****�+�**�***�
2 O N I N G R E Q U I R E M E N T S
S E T B A C It S
------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT ZN REAR: FT ZN FRNT: FT IN REAR: FT ZN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42228118 ZNE: REF NO:
PLANNING NOTES>
%
!E if iE iE iEl6 iE 3k if if ik iE 1E iE iE iE if ik 1E k iE iE iE if !E if if if 1k 3f 1F iE 1E if i4 iE 1f 1t iE iE fE af iE �E 1E 1E iElE fE iE iE �ElE fE fE iE if �)E �E fF iE iElf if iF iElE if iE iF iF if 3F 3' iE if iF iF iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . DATE:
BUILDING APPROVED BY
LEGALIZATZON:Y F E E S U M M A R Y
HLDG PMT PLUMHING ELECTRIC MECHANIC
PERMIT 106.00
DATE:
DATE:
�**����**** . . � d
STRUCTU A SEGMEPT:Y
FIRE SMIP/RES GRADING
50
SMIP/NON-RES
PLAN
ISSUE FEE
BUZLDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAZD DUE
TOTALS----> 108.50 0.00 0.00 108.50 108.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 108.50 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
108.00 .SO
i4 iE if i(� iFlF ie �t if 1f'1E iE i(' 1f # 1ElE if if i! iE fE if iE 7F if if !F 1E 1E dE if i! iE iE 1E iE 3E ik df iE iE'1E iE ik �1f 1!� fE i!� 1k ik 1k ik if i! iE iE'1E iFlk iE iF iE jE iE jE 1E iE if iF If iE !E iE iE if iF 3E iE
I N D Z V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1700 REROOF BY VALUE RESZDENTIAL NOZONE 1.00 1,700.00
END OF FEES
EXPIRED
DATE
81-22-1998/83:82 DM/f18B.5B
RCDTI:B1-8@18681
PERMIT:986711
�--:�
� . POG.. 6 SPA
� �CONSTRUCTION AND PIANNING
'APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector
4
i. TemOorary Electrical Service or Pole 52. Pool & Equipmenc Locatfon '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. E�ectrical Conduit-Undrgrnd. 55. Electrical Bonding .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAI TO COVER•GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundatio� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P�Trap, �J Undrgrnd.
10. Struaural Floor System 61. APPROVAL TO DECK
• 11. Property Sewer Line & House Connection 62. Backwash & Receptor�Firtal .
12. Sewer Cap 63. Heater & Vent-Final
13. Root Drains 64. Plumbing SYstem - Final '
14. Rough Plumbing 65. Electrical�Final -
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencinq & Access ApP�oval
17. Fough Wiring Sign 68. APPROVED FOR PLASTERING
18, flough Electricai-T Bar Ceilfng 69. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS _ Permit #
21. Oucts, in Structure 70. Underground Hydro
22. Duc[s, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rouqh & Test 72. Underground Flusli
24. Roof Framing 73. Undergmd. Srorage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical � �
27. frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FtRE PREV. FINAL �
30. Orywail Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster 8rown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �' � �
33. Final Electric Note:: ,�
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Fac[ory Fireplace
38. Final Plumbing � .
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. BackFlow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation " _
46. Handicap Reg�lations � � �
' 47. FINAL STRUCTURE & BUILDING - .`
48. FINALPLANNWG ', -u
49. Electric Release ta Edison �
�• rt
50. Gas Release to Southern Calitornia Gas Cv -.
51. CERTIFICATEOFOCCUPANCY ��
No. Date
�,
Li
AOD�Icant to 1111 in all tDaces except thosa wil�in heary Eortler Ilnes anU sign all aoo�ooriate Caclantlons.
, F COSTA MESA PE IT N TRACT N �;�LOT NO. BL . .
` RUCTION PERMIT �_ �.Z � �p��. �
Appllcent'S M3iling Add�B55 �' 8 TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R
PtojectAddtess � vr��'�T� • ❑ CONVERSION ❑ OEMOLIS ❑ OTHER
Owner'sName � ^��5� ��-L�'mt��� �hone Q��Z�7 DESCRIPTIONOFWORK �U�DQOl�NS �Q-
� Address ��%.\ �PQ.F\l.L.p �
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
Arch/Eng. �" LiCBnSB NO. ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECNANICAL
� Addrezs ❑ �OTHER
I,_ �'�-���0. '�, �hona V-\P,�S'7 PRQJECTDESCRIPTION SQ.F7.T_oCCUP
Contractor's Nama �
�� - :' �.., CONSTRUCTION TVPE y - VAIUATION $
� AddfMSlmeiling) ZON$ GRADING CU. VDS. Af
♦
� Licenm No. yi
LICENSED CONTRACTOR DECIARATION �y Remarkf: . � C• I-�+ S- �
1 �ereCy aHlrm t�at 1 am Iicanzetl untlar provisions of G�arter 9(commencing .
wltn SBction 7000) ot Divlslon 3 of the Buslness antl Proteszlons Cotle, antl
� y Ilcense Is In full force and ettett. '
Licansa Clau Llcense No. PIUMBING
Date Siqnatura Bar Sink Sewer Cap
wORKEHS'COMPENSATION OECLARATION
� �reDy af/irm that 1 nave a certlfltate ot consent to�sel(ansure or a CBrtlflWte g9pkflow Preventer wCr Cqnn2ttion
Norkers' Campensallon Insurance, or a cartllle0 copy Iharaof (SecHon • - -
L_..00, Lae. C.) � ' � Beckflow Irrigation $olar Collectors
� Policy No. Company = � � ' "- - - -
8 CartifieA copy Is �ereby furnishatl. Bethtu65 SOIa� Piping
Cartifled copy is flleE wit� t�e city Builtlinq Dlvlsion.
�- Date q- ��1-0.'� ADCliwnt Clarifiers SolarTank ,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' Dlshwasher SWimming Pool W�Spa �
(Thlssaction neeC not be ComO�etad if t�e permit Is tor one hunGretl (5100) or '
less). - Drinkin Fountains . Urinal �
1 cerlify that in the parformance ot tha work for,which lhis perm�l is Izsuetl I 9 .
s�all not amploy any person In any man nar so'a{2 p bacoma subject. to ti�e
worke s' Com ansatlon Laws ot Calitornla.�� `�� Floor Drains Water Closet •
Dale �� V � "� Signature �S� U -
NOTICE: If, aiter makin9 thiz tlaclaratlon\ypu ShoWC become suEject [o the FIOOr Sinks - - Water Heater '
Workers' Compensatlon provisions o/ the Labor Cotle, you must }orthwith
lomplY '�'��� suc� OroWslons or this permlt shall be GeemoO revokeG. Gas SCrvite ' Outlets Wacer Service � .
CONSTRUCTION LENDING ACENCV �
1 hereby alfirm that there is a constructlon lentling agency for t�e performance Int2rc¢pto�s '
of lhe work for whiph Ihis Dermit 15 luuetl (Settlon 30B7 Civ. C.)
ilontler's Name IVVAI
lantler's Atltlrasz
OWNER BUILDER OECLARATI
1 harebv affirm that I am exemo�
alty of not more than five
I. as owner ot�the.urooi
ana
saie, n, naweveq me ounamg or impro
platlon, tha owner will have the burtlen
�rove /or the purpose of sale).
1, as owner of the pioperty, am axc
[ractors to construct tbe project (Se<tloi
Tha Contra<cor's LicenSe Law does nc
bullds or Improvas thereon, antl who c
bdCtOf(5) IICB058 pOf511df1t SO LhB Contra
❑ I am exampt untler Section--y,
�
Date Owner _
I hereEvi cerlifv that I have reatl thls
or
e not mtenaea or onerea tor
IS SOItl wlthin On0 y0ar o/ com-
ring he/she tlitl not bu110 or Im-
contractlng�with Ilcansetl con-
BuSiness antl ProfeSsions Cotle:
to an ownnr o1 property who
' for such projects wlth a con-
Icense Law). �
— B. & P. C. for thl5 reaion
Kitchen Sink
Lavatories �
P-Trap
Roof Drains
Showers �
Service Sink '
Duct - Under Ground
Duct - Structural
Duct-Ventilating � .
Ezhaust System ❑ Multiple
Firepl/fact. BIL ICBO #
� Heating System & Ducting
-. ❑6100,000 BTU 0100,000
antl state I ws relating to Duiltling constructlon, antl hereby aulhoriza reD/e- ' HOOd Or T e I ❑ �
sentatives this city t enter upon t0e above-mentlonetl proDerty for �P �
Inspectlon o s �,�.�w' Cano T e II ❑
Signature vll .., � Dato �f.—'i1�1
Drlmrs' LI��� • «� '� - ' ��— Register5
CMF OB65-46 rev. 12/82 W�Ite - Builtling; Canary - AOP��cant; Pink - Accounting; GOltlenro0 - Assessor
PLNG.FEF.vW
LEFT $IDE VARD
PKG.SPACE REQ.
STREET WIDTH
SVECIAI CONDITIONS:
HOLD FOR SPECIAL
' � Reinspeaion Fee `,. $15:
laue Fee � " �:$ 3-
iANICAL � � v .
RefrigeretionSystem o_•, -,
❑0.100,DOOB7U ❑100,OOOe7U � . `
System Repair/Alteretion '
. r. .
. .
Reinspection Fee " $15_
Iswe Fee ' .S 3
Aummatic Washer
Cooking Unit
Dishwasher
Dryers ❑Ga
Fan
F.A.U.
Fixtures
�
�
�
;neramr DO-5 KW �5-15K�
�ansformer,[]75-50KW �,
.- !'05U+KW' .
1 ApPli�ation APVroved By
Application Issued BY _
�
REAR YARD (TO P/L)
RIGHTSIDE VARD
PROVIDED
/.�V PARU FEE S
-___��.si
Meter lJover 100 emps
Sub Panel '
Sub Pole
Motors DO-1 HP ❑iX-8
Inc.Solar �9-15 HP 016-15+
Microwave ' • �
Pole Light
Range
Trash
Settions
ReinspeMion Fee
�
- ' " ' " SUMMARV OF FEES O.SO
„ BUILDING PERMIT $ �p O�. ��.� , $MIP . • $ � _
'+'PLAN CHECK $ � PERMIT � .
PLUMBING � $ t % � ' � ISSUANCE : $ �
' PLAN CHECK' $ ` � � GRADING $ .
, EIECTRICAL ' $ $
• PLANCHECK $ � ' MICROFILM $
�MECHANICAL : -$ TOTALFEE $
" PL'AN CHECK $ LESS �
ADVANCEDPC S
�:. FINAL FEE $ �3,dz
-- - - - - - -- -- -
NSTRUCTION ANp.pL'ANNINGI �"-_ • � "'� ' . ' "' � "'.,- . POOL `A - . . - � . �
i ' - :Date � �Inspector � ' ` ' � �' Date ! Inspectoi
PROVALS. Permi;# �' - - . APPROVALS� "Permrc# ' -� .
A �t. Temporary Electrica�l $¢rvice or:Pole � ` � . ,. c� ` �' �.,52. Pool &_Equipment Location , � . � �
. n
��� 2. �Soil Pipe-Undrgrrid.: • ' �' �` � � � � ,� 53, Steel Reinforcement � � . , '
� n
3: Electrical Conduit Utilitv-Undrqrnd: �-. J 54. Forms ,- - �
- c � m • 1 '
4. Electr,ical Condui[-Untlrgrridl - ' C ' ��, `, ° � � ' `..•� `- ' � � �55: Electricel�Bonding� � � ��
�
5' Steel Reinforcement ' I y '� '_ , � n ' `� .o� + 56.. Rough Plumbing & Pressure T,est� � � . ' .
` ��' ' °• ` � � '�: - �57�„APPROVALTOCOVER-GUNITE
6: Electrical UFER Grnd.; ' z s ' ' �
i r.
7. Footings �.;��;Q� I � �,!� � � a, `g Q �� i' ' �58.� Electrical.Conduit-Undro:��i. '' - � .
6. Foundati �' Qe� � ��-„�L`-� �� 3 as Pipe,` �:Undrgr,nd., Test - .� '
.� �
9. W2ter Pipe-Undrgrn . i � �� �-� • ', � � �-.; � ��60. Backwash Lines,.P-Trap, O Undrgrnd. - . '
10. Sfructural Floor System � ;? �� � r"� �_ �� - � �
� ',.61. APPROVAL" 70'DECK
11. Property Sewer Line &�Ho,use�Connection; �. � i_ ; � •�62. Backwash & Receptor-Final � � - '
12. Sewer Cap ; ' � � ; "'� � � � i c _ - '• 63. Heater & Vent-Final � � �
13. R6of�Drains . �� ' � �� � . �} � � �'64. Plumbing`�SYstem - Finat " '
14. �Rou �h Plumbin " � : o - . . ' .. � . ' . . .
,..
g 9 � ,�� � ' �`65. Electrical-Final� � +• �
i.
i.
;, { 15.',Rough�-Electrical=Coriquit'� T "'-I� p � ' i i �' � ;66.- Sola`r'System-Final� � - - � "� � . '"' -
_ -16.!;Rough Electric Wiring, r � _' ' li � :�j- "�r-p j' �- .1� � _ �: � �67. �Fencing & Access Approval � ��. �-� - � �" ' "
�' ly. �Rough Wiririg Si9n� ti �;" �j ;�c j� �r ! J : I�; f, _�68i APPROVED FOR PLASTERING� ��
� 16.: Rough"Eleetrical=T;Bar,Ceiling' .� ;' j � � ! � '�i � �' 69.i POOL/SPASYSTEMS_FINAL -
19: Rougb Heating &;Air�Conditioning � � �� � � � ! � , FIRE DEPT.,REQUIREMEN7� ,.
i
20.�Rough.Factory Fireplgce, ' }� � �' � ` � I ' � � APPROVALS � Peimit # _
, 21. ;Ducts,-in Structufe�• " i � �I �? ( � � � � �70.. Underground Hydro -
'-22. �Ducts, Ventilating ,. '„ 1��' i I � I. I 1 I I � � ��� •� Product Piping O Gas ❑ Oil ' ' ,
23.' ��Ges Pi .e=Rou h & Tes � � .� ,� � "---� "' �-, � - - , � -- , . -�
�P 9 # � �, 'I ' �� II � ; � _ ... I � I . � .. i �72.� Underground Flush. . - � - i
U'c
: ,�9� Roof �f°ra+uiug, x��� �y � i �. � ,,,, 1;� ; � : � Z�-gy ��; • � �73.� Undergrnd. Storage Tank � Gas ❑ Oil � �
5. �Roof�Sheathing � � r � i �r; ��^ � , � �� � � � � ' � '74: Overhead Hydro - - �
' -. - _ � ., , ; �. i -L I : , �
-�6. ,T-6ar Ceiling 1Struc'tural) & Monocoaf ` � � � �� � � � ,75, Dry Chemical � � � �
� �
.. : Y � �
27. 1Frame and �Flashing� -� _ � � • � i � �3p.� �� � ,76. Dry Standpipe ' ' .
26. Lathing & Siding' �-� ` � i � '� ' � I � '� � ' 77. FIXED SYSTEM FINAL =
�. i � �
29_:lnsulatiori ` ; _�'�/�QI �` ! � � SU � �78� FIRE PREV. FINAL ' - �
.:; �
� � � ' i �Notes: � � < ..i%. �
30. Drywall Nailing =➢" " � � � _ _ . `T_ t �- a ._ .��
'31. Plaster Brown Coat: '� � � ii �,� --� j � � - - -� - '
,. I
�� �32. �Electrical Power Meter, Fir�al � �� �� � � � ` I
33. Final Electric ' i,, ,� ; �,� .� j � �
- 34. Final Heating &'Air Conditioning '� ' � ' i
s i, � p� 1
35. FinalGasPipe?TesT� �� `, � r,�; ' '` ';�; I`; _
F�
�
36., Hood or C�noPV - _ � - � _ � % � � � > _ � ,
37. Final Factory Fi}'eplape� � z��� � i': :� i- I• 1��' I
�
38. Final Blumbing � � � ' � ��� � �I � � � � � � _• � � �
39. Water�Secv'ice-Final- t � -� L' , I ` �'^ I i �
I � a i �
40. Gas ServicG-Final �, ' �i i�;� � ' � � i � � ' � � �
i �
41. Solar Qo,rr�s�tic-Final ( i .- ' . .' x ! ' ' ' _ _ " .
�+' . .. � _. .
42. BackflowPreventeri „� � . . ! � --� -� 1.. _' -y
`' �'1 Y' ' ' r
0
�� � -8`i ►Nsv� Hr
ti
I 43. Backflow Irrigation � , _ I j'� I r . V,-'i ^ ' y, : ' � � �:I ` ; . , � = CK ; � ��C � %
N � i , � ; � ,
44. Landscape'lrrigation,5y,terTir� � �s; - : � ,. . ; � �'. .i �
45. Sound iAtt,enuation ..!`. � r`I � �: i: � ��� I�� � �, I ':` . '
46. HandicapReguiationsl �' r �-,, i � �P ' � I . ;f� , `
47. PINALSTRUCTUR�&BUILDING%+ icg-� v �' ' 1� -
i t
i
48. Spec'ral Requirements Complete� , ,� ; �� � � +� , � �' � , j � -
, , .
49. Electric Release to �Ed ison� � � ., �, ,�_�__�_ I' I_ f i i , �� .�
i .�. �
_ �. . , . . . �: �
�
50. Gas R�elease to Southe�n Califorriia Gas Co � f �! , j 'i j; ''� f' �, �� V�
51. CERTIFICATEiOF. OECUPA'NCY �� � ' ' ' j . _� . i . _ ' _ _ ' �� " .'
t � ' � I
No Date � � . ' ' i
_.s_ .
�ND�no
�� OTlA
Y.c�
;C:,Q N
GGG� C'�
f_ _ � ADplicant to flll in all spaces exeept thosa witnin heavy Eortler lines anE si9n all appropriata tleclantions.
�CITY CaSTA MESA PERMIT NO. TRACT NO. LOT NO. BLD . N .
CONSTXiIJCTIONPERMIT �`//s93 5187 3/DI/84 13.d0 TL
, Project Address %.`� � LQJ .�(iTff bT. r`/ O TVPE OF CONSTRUCTION LJ NEw L� Aoo LJ ALTERATION LI aEaAiR
AppliCant'S Mailing Addre55 . � _e/. /7 r. y /eZi�� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner'S Name �R[ �@r� pho�e �GD_/GL3 DESCRIPTION OF WORK
Address �� 9/ �A/'RD/�_� C/R. �F � g.�G�—S�P TVPE OF PERMIT GRADirvG
Arch/Eng. LiCenSe NO. ❑ TENANT � ELECTRICAL
� Addre55 ❑ �OTHER
Contractor's Nam Phone PROJECT DESCRIPTION Sq. FT._
Address (mailing) �ON STRUCTION TVPE VALUATION $ _
ZONE GRADINGCU.VDS. ACR
City License No.
LICENSED CONTRACTOR DECLARATION Remarks: /e
I hereby aftirm that I am licensetl untler provizions of Charter 9(commencing
with Section ]000) ot OiviSion 3 oi the Bu51ne55 antl Pro(e551on5 Cotle, antl
my Iicense is in tull torce ana elfact.
License Class License No.
Date Signature
WORKERS'COMPENSATION DECLARATION BarSink
hereby attirm Ihat I have a cerUilcate oi consent to self-insure or a cartlficate Backflow Preventer
�( Worker5' Compen5ation InSurdnce, o� a certifietl copy [hereof ($eGtlon
3800, tab. C.) � Backflow Irrigation
Policy No. Company
8 Cer[i(letl copY is hereby furNshetl. Ba�htubs
Certitietl copy is filetl with tne city Builtling Olvision.
Oate Applicant Clarifiero
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION DiSh�MdShC�
(Thissection neetl not be completetl If [he permlt is for one huntlrotl (E300) or
iess). Drinkin Fountains
1 cerii(y that in the per(ormanca oi the work for which tnls perm�t it issuetl I 9
shall no[ employ any person in any manR er so as to become subject ro t{�a ,
Wo�ke�s�' C mp ��atio Laws ot Callfq�qyd:' p JD Floor Drains
Date Si9nature ��/�Aw A_ ��exJ
NOTICE: If,�atte� making MIs tlecla�ation, you Shoultl�become SUDjoct to lhe FI00� SinkS
Workers' Compensafion proWsionz of the I�bor Cotle, you musl forthwltn
comply wi[h such p�ovisions o� thi5 pe�mlt shall be tleemotl revoked. GasService
CONSTRUCTION LENDING AGEfJCV
I hereby aifirm Ihat lhere is a conslruction Ientlinq agency 10r the parformance IOLCttEptOR
of the work for which thls permit is issued (Section 3097 Civ. CJ
Lenaer's Name Kitchen Sink
Lentler's aaaress
OWNER BUILDER DEClA0.AT10N Lavatolie5 '
I hareby afflrm that I am exempt lrom the Contraclor'S License Law lor tM1e p_Tre
tollowing reason (Section 7031.5 Business an0 Profe55ional Cotle: Any cl[y or P
county w�ich requirez a p¢rmil to <onstrucq alter, improve, CCmOliSh or r¢pdir
any slructure, prlor to Its Issuance, alzo requires the apo��cant for suc� permit Roof Drains
to file a signetl statement that he/she Is Iicensetl pursuant to the provisions of
+he Contractor's License Law (Chapter 9(commencing with 5action 7000) of
�ivision 3 of the Business antl Professlons Code) or that be/she is exempt
�erefrom�antl tne basis for lhe allegetl exemptlon. Any violatlon of Saction _.
/031.5 by any dpplitant fOr d permit sub�ects the applicant [O a civil
�enalty of not more than five �untlretl tlollars (y500). Reinspec[ian Fee
I, as owne� of the p�operty or my amployees with wages as IhOir SOIB �
compensation, will tlo the work, antl the structure is not Intentletl or offeretl
(OI Sd�B ($BCI�00 JO4A� BI15I0855 dOd Pf0(CSSIOOdI �OdB: T�IB �OlIIldCIOI'S
Llcense l.aw tloes nol aDD�Y lo an owner ot a property who bulltls or improves BOil2!
thereon, antl who tloes such work himsalf/harself or tnrougn hls or har own
IFOUNDATION LJSTRUCTURAL
PLVMBING ❑ MECHANICAL
Outl¢t5
$25
employees, provitlea tnat such improvementz are� not intentlatl or offeretl for Dutt - Under Ground
sale. H, however, the bulltling or improvement is soltl within ono year of com-
pletlon, tne owner will nave the buraen oi proving he/she tlltl not bulltl or im-
�rova for the purpose of sale). Duct - Stfuttutal
1 az owner of the property, am ex<Iusively contracting with Iicensea con-
tractorsto construct tne o�oject (Sectlon 7004, Business antl Protasslons Cotle: � Duct - Ventilating
� The Contractor's License Law does not apply to an owner of property who
builtls or improves thereon, antl who contracts for such projects wltn a con- Exhaust System ❑ Multiple ❑
tractor(s)Iicense Dursuantto the Contractor's License Lawl.
❑ I am ezempt untler Sectlon B. & P. C. for thls rea5on Firepl/Fact Blt. ICBO #
Date 3—/ — 9f Owner Heating System & Ducting
I hereby certity_that I have raatl thls appliwtion antl state that the above � ❑6100,OOOBTU 0100,OOOBT'
Information is correct. I agree to comply with all clty antl county ortlinances
antl state laws relating to builtlin9 construtlion, an0 heraby authorl:e repre-
5entatives ot this tlty to enter upon lne above-mentionatl property tor
InSpattion � a5e5.
Si9nature � Date ��/--��
Drivers' Licensa or 55 � Reinspee[ion Fee $25
CMF 0865-46 rav. 12/83 White • Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Isue Fea
Hood or Type I ❑
Canopy Typell ❑
Refrigeration Sys[em
❑aioo,000eTu ❑ioo,000
System Repair/Altera[ion
Issue Fee
FEES
A.P. qW
$ Main Building:
E
T Front
A Rear
C Right
K
S �eft
Ping. Ref. #
Parking Req./Provi�
Use of Building:
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
�IShWdShCf
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �65 KW �
I Zone
Accessory Building:
Park.Fees $
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0-1 HP O 1'/: - B
Inc. Solar �9�15 HP �16-15+
Microwave
Pole Light
I I Standing Sections
5 KW Trash Compactor
$ 3 _
Reinspeetion Fee ' $25 Issue Fee
FEES
PUBLIC SERVICES REQUIREMENTS:
2oning Approved By
Building APProved ey
APOlication Issued By � �
$ 3
Z
O
N
I
N
G
R
E
O
U
I
R
E
E
N
T
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ � SMIP $
PLAN CHECK ' $ � PERMIT � ,
PLUMBING $ ISSUANCE � $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICA� $ I -�O GRADING $ ;
PLANCHECK 50% $ C�D MICROFICM $ ��
MECHANICAL $ TOTAL FEE $ 12 � �
PLAN CHECK Z5% $ � .
% �
i` � ' � .
%� -CONSTRUCTION AND PLANNING
-APPROVALS Permit# Date
�f. Temporary Electrical Service or Pole
� a. Soil Pipe-Undrgrnd. ,
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings -
8. Foundation '
9. Water Pipe-Undrgrnd.
10. Structural Floor Systein
17. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Dreins -
14. Rough Plumbing
75. Rough Electrica6Conduit -
16. Rough Electric Wiring�1 �Gpv z�
�
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
79. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure '
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing '
26. T-Bar Ceiling (Structural) & Monocoat
27. Frameand Flashing �
28. Lathing & Siding
29. Insulation .
30. Drywall Nailing
31. Plaster Brown Coat �
32. Eleciriral Power Meter-Final
33. Final Electric E
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final •
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation .
44. .Landscape Ir'rigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
.. P00. 3PA - . . . .
c- -
�Inspector AppROVALS Permit# � � °-Date'� Inspector
�,
� 52. Pool & Equipment Location � �
.53. Steel Reinforcement ' t ,"
i,
54. Forms - � � _ � � � �
55: Electrical6onding. ' , - _ • ,
, 56. Rough Plumbing & Pressure Test - � .
' 57: APPROVALTO�COVER-GUNITE '
. - 58. Electrical Conduit-Undrgmd. . �
� 59. Gas Pipe, O Undrgrnd., Test. � ,
60. Backwash Lines, P-Trap, O Undrgrnd. � �,
. 61. APPROVAL'TO DECK � � � �
. 62. Backwash & Receptor-Final .
' • 63. Heater & Vent-Final � - �
64. Plumbing System - Final ' � . _ �
65. Electrical-Final - � - � �
66. Solai System-Final � - - � � ' , -�
67. Fencing & Access Approval� , , - - "' - - �"
� 68. APPROVED FOR PLASTERING . , ' ' .-
69. POOL/SPASYSTEMSFINAL - ' _
�
FIRE DEPT. REQUIREMENT � ' -� � •
� APPROVALS �Permit# � - �� ' �
70. Underground Hydro � � ��� �� ^ � i
71.' Product Piping � Gas � O Oil � . ��
! 72: Underground Flush � j
73. Undergrnd. Storage Tank, O Gas ❑ Oil
74. Overhead Hydro � � � � '
- 75. Dry Chemical � '
76. Dry Standpipe , � . � '
77. FIXED SYSTEM FINAL ' �
78. FIRE PREV. FINAL � � ?
lHEALTH DEPT. REQUIREMENT'
79. FINAL INSPECTION � ,
� 80.� FOOD CERTIFICATE IS$UED � �
(I /i Notes: � ' - � � �
�
i ,
I ` � �
1
CCUPANCY I � � . _ I.� _ - _
Date
a
M
:i
i
. . �' � i
t� •� �' "�' ". Applicant t0 fill in all z0aces exceD� those witnin M1eavy Eortle� Iines antl sign all appropriate Eecla�ations.
�CIT' F CO�.T%� MESA
RUCT.ION PERMIT � �
Project Address � 5 � r
ApplicanYs Mai�ling� Address •; � C.eF7ELD r.�% �/r�(y1���
Owner'sName 15LL s � Phone �'
Address ���• CL� �AQ/30? E�/ �/RCLf � �� ycy.'S�i�\
Arch/Eng. License No.
Address
Conttactor'sName ����k^E' Phone
Address��mailing) �A��
� City License No. _
LICENSED CONTRACTOR DECLARATION
I h¢r¢by affirm tM1at I am Iic¢nsetl untler provi5ion5 of Chdrter 9(commencing
with section 7000) of Olvision 3 of the Buslness antl Professlons Cotle, antl
my Ilcense is in full torca antl effect.
Llcense Class License No.
Date Signature
���ORKERS' COMPENSATION DECLARATION
Te.. hereby affirm that I have a cerHficate of consent to self-Insure or a certificace
�
'•5f Workers' Compensation Insurance, or a certifietl copy tnereof (Section
3600, Lab. CJ , � �
Golicy No. Company
BCertifietl copy is hereby furnishetl. � �
Certifietl copy is filetl with the city Builtling �ivision.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This seclion neetl not be completetl If the permit is for one huntlretl ($100) or
less). •
I certify that in tne performance ot the w or wnlch this oerm�t is issuetl I
shall not employ any pe�son in any anne so a5 to b¢COm¢ sub'ect to t�e
Workers' Comper�s tion Laws of Calif ,.� n � /1J �
Date �--_-' b� Signature � � � ���� '�
NOTICE: If,�after making this tleclaratwn, you shoultl become subject to the
Worl<ers' Compensation provisions of the Labor Cotle, you must fortnwitn
comply wltM1 such provisions or this permi[ shall be tleemetl revoketl.
CONSTfiUCT10N LENDING AGENCV
I hereby affirm that there Is a construction lentling ag¢ncy for the pertormance
ot the work for which this permit is issuetl (Section 309T Civ. CJ
Lentler's Name �u"��
Lender's Atltlress
OWNER BUILDER OECLARATION
I hereby aftirm that I am exempt trom the Contractor's License Law for the
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which require5 a permlt [o construct, alter, improve, tlemolisM1 or repair
any structure, prior to Its issuance, also req Wres the applicant tor such permit
to tile a signetl statement that he/she iz licensed pursuant to the provisions of
1e Contractor'S License Law (Chapter 9(commencing with SecHon �000) of
Ivlsion 3 ot the Business antl Professions Cotle) or that he/she is exempt
.�eretrom antl tne basis tor the allegetl exemption. Any violation of Section
7031.5 by any applicant for a p¢rmit subjects tlte applicant to a civil
�e alty o� not more than tive huntlretl tlollars ($500).
1, as Owner of the property Or my employe¢5 with waqes as their sole
compensatlon will tlo the work, antl the structure is not intentletl or offeretl
for sale (Sec{ion 7044, BuSiness antl Professional Cotle: The Contractor'S
Lltense Law tloes not apply to an owner of a property who builtls or improves
Ihe�eon, antl wM10 tloes such wo�k himself/he�selt o� tn�ougM1 his o� her own
¢mploy¢ei, provitletl tha[ such Improvement5 are not inte�tletl or offeretl fo�
zale. If, M1owever, the builtling o� Improvement is soltl wlthin one yea� ot com-
pletlon, t�e owner will have [he burtlan of proving he/she ditl not builtl or im-
-� rove for the purpose of sale).
I, dz owne� ot the O�operty, am e%Uusively contractlng wkM1 Iicensetl COn-
tractors tb construct the project (Section 7044, Business antl Pro�essions Cotle:
The Cont�acto�'s LicenSe law does not apply to an owner ot p�operty who
bulltls or improves thereon, antl who contraMs tor such projects with a con-
tractor(s) Iicense pursuant to tbe Contractor's License L.awl.
❑ I am ezempt untler Sectlon B. & P. C. for thi5 rea5on
Daie Owner ' ' �
I hereby certify that I have reatl this application antl state that the above
Informatlon is co��ect. I agree to comply with all city dntl county ortlinance5
antl state laws relating to building construction, antl nereby authorize repre-
5entatives of th' city to e er upon the above-mentlonetl property for
inSpeCtion purpos ^-f--
51 t % �G Q � i Y,�� Date a-�
i�'� "�.o d'3�4 I ,..��. .._. __. .._. --
�.
TVPE OF CONSTRUCTION NEIN�y ADD ALTE,JRATION
❑ CONVERSION ❑ DEMOLISH v�OTHE �%D (J � - %1 i
DESCRIPTION OF WORK n%OlJE -� � /-✓OlL.7E. i
TVPE OF PERMIT ' GRADING%,-Qy FOUN�ATION ❑_STRVCTI.
❑ TENANT � ELECTRICAL IKI.PLUMBING ❑ MECHANIGAL
❑ OTHER '
PROJECT DESCRIPTION S�.FT. oCCUaANy�
CONSTRUCTION TVPE VALUATION $ �
ZONE GRADINGCU.VDS. ACRES_
Remarks: _ � � �'
Bar Sink
Backflow Preventer � -
Backflow Irrigation
Bathtubs
Clarifiers
� ISfI WdSh2f
Drinking Fountains '
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors .
�. Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspection Fee $p5
Boiler '
Duct - Under Ground
Duct - Structural
Duct-Ventilating •
Exhaust System ❑ Multiple
Firepl/Pact. Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 eru O � oa,000
9na ure < � .» � .
Drivers' �Icenze or 55 � '�'�� I I Reinspaction Fee I $25
CMF0865-46 rev.12/83 White-Builtlln9:Canary-Appllcant:Pink-Accounting;Goldenrotl-Assessor
PLUMBING
Showers
Servite Sink
SewerCap
Sewer Connection
Solar Collec[ors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issua Fee
Hood or Type I ❑
Canopy Type I I ❑
Pefrigeretion Sys[em
❑aioo,000aru ❑ioo,000
System Repair/Alteration
luue Fee
REPAIR
FEES.
$ 3
$ 3
A.P. #
S Main Building:
E
T Front
6 Rear
A
C Right
K Left
S
Ping. Ref. #
�Parkin9 Req./Provi�
Use of Building:
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cookin9 Unit
Dryers LJGas LJE6
Fan
F.A.U.
Fixtures
Device Boxes
OUlletS
Switches
Garbage Dispoul
Generator �0.5 KW
3540, 2/02/E14
2one
Park. Fees $
.. ELECTRICAI '
" Transformer ❑ 15-50 KW �
❑ 50+KW
Meter C�up to 100 amps
, Meter pover100amps
- .Sub Panel .
Motors DO-1 HP � 1'f. - 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5-75 KW Trash Compactor
I Reinspection Fee I$25 � Issue Fee
PUBLIC SERVICES REQUIREMENTS:
Zoriing Approvad By
Building Approved By �
AppliptiOn IssUed By
0
FEES
$ 3
� SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $ �
PLAN CHECK $ PERMIT �
�,PLUMBING 5 00 ISSUANCE �$
�� PLAN CHECK 25% $ OO ENERGV P.C. $ :
ELECTRICAL $ �l�3•��-O GRADING $
� PLANCHECK 50% $ �•� MICROFILM �$
�' MECHANICAL $ TOTALFEE $ 2�,00
PLAN CHECK 25% $ .
ONSTRUCTION AND PLANNING
PPROVALS Permit#
. Temporary Electrical Service or Pole
�,2: Soil Pipe-Undrgrnd.
3: Electrical Conduit Utility-Undrgrnd..
� 4. Electrical Conduit-Undrgmd.
�
5. Steel Reinforcement
6. Electrical UFER Grnd.
f
�7. Footings �
8. Foundation �
i �
9. Water Pioe-Undrarnd.
10. Structural Floor System
11 . Property Sewer Line & House Connection
12. Sewer Cap �
13. Roof Drains -
14. Rough Plumbing
15.-Rough Electrical-Conduit �
16.!Rough Electric Wiring
��
17�. Rough Wiring Sign
T8. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace .' ' •�
21. Ducts, in Structure �
22. Ducts, Ventilating ; �
23. Gas Pipe-Rough & Test - � . ,
�
24. Roof Framing � -
25. Roof Sheathing �
26. T-Bar Ceiling (Structural) &�Nlonocoat
27. Frame and Flashing -�
:�
28. Lathing & Siding '�� .
i�
29. Insulation
30. �Drywall Nailing
31 . Plaster Brown Coat +.,
�..
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating &'Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace '
38. Final Plumbing ,
39. Water Service-Final �
40. Gas Service-Final -
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation ,
44. .Landscape Irripation System
45. Sound Attenuation �
46. Handicap Regulations � �
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
o. ' Date
Date
��
POG SPA
Inspector p�ppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement �
Lr � 54. forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
. 58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test �
� 60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor-Final
- 63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66.. Solar System-Final
� 67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
, FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd.StorageTank OGas ❑Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80; FOOD CERTIFICATE ISSUED
Notes: aL J2K/S'i hc �l _. �� �
Date I Inspectoi
�
l-
STA MESA
CONSTRUCTION PERMIT
_ Aoplicant to fill in all soatts ex<ept lnose within neavy EorEer Ilnes an0 sign all aporoo/�ate tleclarations.
'�'//Ff 6
. Project Address ' ,
Applicant's Mailing ddress .� �
Owner's Name ��—�/%- ! ��'�'j�-'� Phone y��—�G13
Addrea
Arch/Eng. ��License No.
Address
Contractor's Nam ,_� ?hon=
Address ( mai I i ng)
City License No.
(.ICENSED CONTRACTOR DECLARATION
I hereby affirm tnat I am Ilcensetl under provislons of Charter 9(commencing
wi[h sectlon 7000) of Dlvislon 3 of the Bu51ne55 antl Profesiions Cotle, antl
my Ilcensa is in full torce antl ef(ect.
Ucanse Class License No.
Da[c Si9na[ure
WORKERS'GOMPENSATION DECLARATION
1 her¢by aftirm that I have a certificate of consent to self-Insure or a certiticate
of Workers' Compensation Insurance, or a certlfieA copy thereo! (Sactlon
3800, Lab. C.)
� Hlcy No. Company
J Certifietl copy is hereby fumishetl. ' . ;
L� Certllietl copy is (iled with Ih¢ city Builtling DlviSion.
Oate Applicant
E%EMPTION FROM WORKERS' COMPENSATION OECLARATION
(Tblsseclion neeC not be completetl it the permit iz fot one huntlretl (E100) or
less�.
1 certlfy [hat in the pertormance of th¢ work f0/ which [hIs perm�t ISlssuetl, I
5hall not amploy any person in any manner so as to become subje<t to lhe
Workers' Compansatlon Laws of Calitornia.
Da[e Si9nature
NOTICE: If,�after making this tleclara[lon, you shoultl become subject to tha
Workers' Compensatlon provisions ot the Labor Cotle, you musf forthwi[h
comply wltn sucn provisionz or tnis oermlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 nnre�y affirm Ihat theie Is a cons[�uctlon lentling a9enty tor the perfOrmance
oi the work tor which, tbi5 permit is ISsuetl (Section 3097 dv. C.)
I..entl¢�'S Namo
l.entler's atltlress �
OWNER BUIIDER DECLARATION ' '
I hereby af8rm tnat I am ezempt from the Contractor's'License Law tor tha
following reason (5¢ction ]031.5 Bu9ness antl Professional Cotle: Any city or
coun[v whlch roauires a oermit to construct. alter. imorove. tlemolish or reoalr '
to Its Issuance, also requires the applicant for such pormlt
ment Nat he/she is licensetl pursuant to tne provislons of
:nse Law (Chapter 9(CommenCing with S¢CtiOn ]000) of
/W1.S Dy any appllcan[ tof a.permlt SuO�ec[s [na appllCant [o a civll
n��alty of not more than five huntlretl tlollars ($500). ,- ' _
'`x%"" as owner of the property or my employees with wages as thelr sole
`�'•'+y`p¢nsaHon, wlll tlo the work, antl the StruCture is not int0ntletl or oft¢r¢tl
'. sal¢ ($ection ]044, BUSiness antl Professional Cotle: The Conl�aCto�'S
Licente l.aw tloe5 not apply to an owne� of a O�operty who builtls o� Imp�ove5
tM1oreon, anC who tloes such wo�k himself/herz¢It o� through hls o� har own
amployea5, p�ovidetl that sucn improvements are not Intentled or oflereC for
salc. If, howevar, the builtlin9 or improvement is soltl within one year.of com-
pletlon, the owner will nave the burtlen of proving he/she Oitl not builtl Or Im-
��OVB tOr th¢ pu�0osa o( sal¢).
I, as own¢r o( tha property, am ex<IuSively cOntracting wlth IlcenSetl con-
tractorstd constructthe oroject (Section 7044, Business antl Professions Cotla:
T�e Contractor'S License Law does not apply to an owner of property who
bu11tl5 or Improve5 the�eon, antl who cont�acts to� such p�ojaCtS with a con-
tractor(s) Ilcense pursuant to the Contractor•s License Law1.
❑ � am axempt untler Section B. & P. C. for this reason
Date �— /�_�1' i'. Owner (/. +��`+^—r�(' ��+�"ti
I hereby certlfy Ihat 1 have teatl thls apP�Icatlon antl ttate Ihat the aDOve
Informatlon Is correct. I a9ree to comply with all city antl county ortlinances
antl sta[o laws relatinq to builtling constructlon, antl hereby authorize repre-
SentatWeS 01 this tlly to nter upon tn¢ abOve-mantlOnatl property for
Insoection ose .
Slgnature Date 3 _ �Z_fly
TVPE OF CDNSTRUCTION LFiiCVf LJ ADD U ALTERATION IA1 REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p,p, #
DESCRIPTION OF WORK
S Main Buildi
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Front
❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL A Rea1
❑ �OTHER - C Right
PROJECT DESCRIPTION 5Q. FT. oCCUaArvCv K
CONSTRUCTIONTVPE VALUATION$ g Left
20NE GRAOING CU. VDS. ACRES Ping. Ref. #
Remarks: P2fking Req./Pr
� � Use of Building',
PLUM6ING FEES Planning Notes:
Preventer
Irrigation
Drinking Fountains '
Floor Drains. '
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories ,
P—Trap
Roof Drains •
Reinspaction Fee
- Untler Ground
- Structural
�
Exhaust System ❑ Multiple
Fiiepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6700,000 BTU 0100,000
Orlvers' Llcensa or 55 � Reinspeciion Fee $25
CMF 0865-46 rev. 12/83 White - Builtling; Canary - Applicanq Plnk - Accounting; Goltlenrotl - Assessor -
Service Sink
SewerCap
Sewer Connection
Solar Collecrors
Solar Pipin9
Solar Tank
Swimmiry Pool w/Spa
Urinal '
WdIC( CIOSEL
Water Heater
Water Service
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System �
❑0.100,OOOBTU ❑700,0008T
Sysiem Repair/Alteration �
Issue Fee
Auromatic Washer
Canstruction Pole Sub.
Cooking Unit
Dishwasher �
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
5850 3/12/B4
I Zone �
Acceuory Building:
Park.Fees $
ELECTRICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors061 HP �1Yh-8 '
Inc.Solar �9-75 HP 076-15+
Microwave �
Pole Light -
Range
Garbage Disposal
Generator �0.5 KW �5-15 KW
_ $ 3 � Reinspectian Pea � $25
FEES
PUBIIC SEHVICES REQUIREMENTS:
2oning Approved By
Building Approved By
APvlication Issued By � � /
$ 3
Standing Sections
TraSh Compactor
39.20 Ti
FEES
$ 3.
. SUMMARY OF FEES
BUILDING PERMIT S SMIP �$
PLAN CHECK $ PERMIT
PLUMBING. § �� ISSUANCE $
PLAN CHECK 25% $—�6., �! ENERGY P.C. $
ELECTRICAL S � GRADING $
PLAN CHECK 50% $ � � � MICROFILM $
MECHANICAL $ TOTAL FEE $ 3� �a
P�AN CHECK 25% � $
O
N
I
G
R
E
Q
U
R
E
M
E
N
T
`n DNSTRUCTION AND PLANNING I ,
�' PPROVALS Permit # �Date
I
ITemporary Electrical Service or Pole
�' � Soil Pipe-Undrgrnd.
.
�3. Elecvical Conduit Utility-Undrgmd.
�� 4. Electrical Conduit-Undrgrnd.
/ 5. Steel Reinforcement
1'
�_; 6. Electrical UFER Grnd.
� -7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
' 10. Structural Floor System
�'11. Property Sewer Line & House Connection
1
12. Sewer Cap �
� . 13. Roof Drains
1 14. Rough Plumbing
i
15. Rough Electrical-Conduit
16: Rough Electrlc Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. �ucts, Ventilating
23. Gas Pipe-Rough & Test
� oof Framing
25. Roof Sheathing �
2�i. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing ,
28. Lathing & Siding
29. Insulation ,
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric ' �.
34. Final Heating & Air Conditioning � ���
35. Final Gas Pipe-Test -
36. Hood or CanopY
37. Final Factory Fireplace
38. Final Plumbing � �
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation ,
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed �
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date
Inipettor
� POOL'& SP � .
APPROVALS '�Permit�F
52. Pool & Equipment Location �
53: �Steel Reinforcement _ , -
54. Forms �' . ' '
55. ElectricafBonding -� - " �
56. Rough Plumbing & Pressure Test ,
57. APPROVAL TO COVER-GUNITE _
58. Electrical Conduit-Undrgrnd. :
59. Gas Pipe,'�•Undrgmd., Test '
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVALTODECK �
62. Backwash & Receptor-Final � - ..
�63. Heater & Vent-Final .
�64. Plumbing System - Final . � � �
65. Electrical-Final � � • •
Date � � Inspector
[_ _
�:.
.66. Solar System-Final - - � " � �. '
67 � �Fencing & Access Approval -- -
68. APPROVED FOR PLASTERING
�69. POOL/SPASYSTEMSFINAL � �
, , FIRE DEPT.'REQUIREMENT' . - ,
APPROVALS Permit # � . � .
70. Underground Hydro '
71. Product Piping O Gas: ❑ Oil
�72. Underground Flush • '
73. �Undergrnd. Storage Tank O Gas ❑ Oil .
�74. Oveihead Hydro �.
J5. Dry Chemical . �
'76. Dry Standpipe' � ; . �
'77: FIXED SYSTEM FINAL �
78. FIRE PREV. FINAL . ' ,
� � HEALTH DEPT. REQUIREMENT
!79. FINAL INSPECTION
� � . .
80. FOOD CERTIFICATE ISSUED �
Notes:
. � �
.
�(o . -
L
i
u
: _ �
�
Aoolicant to fill in all soaces excao� thosa witnin neavy bortler lines antl sign a11 apo/ov/�ate eeetarations.
CITY OF COS7a MESn CONSTRUCTION PERMIT
Froject Address �s� zv. aory-sT
i
Applicunt's Mailing Address �l/� 9 Q �.
Owner's Nnme �nRi, 9 l�?�C1�1} ��:u�o � ahone 9�0 �� L�
Addreu
ArchlEng. License No.
Address
Contractor'sName �7,U�/L✓ti vhone
Address (mailingl
City License No.
. LICENSED CONTRACTOR OECLARATION
I M1areby affirm thdt I am Iicensetl untler provi5lOn5 0( Charter 9(commencing
witn soction 7000) af Division 3 ot t�e Business antl Protesslons Cotle, antl
my Iic¢nse is In full force antl etfect.
IJcense Class Llcense No.
Dale Si9nature
WORKERS' COMPENSATION DECLARATION
h¢reby altirm that I have a certitica[e of <on5¢nt lo seltansure ot a ce�U(icdle
,f Worker5' COmp¢nsation Insurance, a� a certlflGtl COpy Nereof ($ectlon
3800, Lab.'C.) .
Policy No. Company
eCertifietl mpy is hereby furnishetl.
Ce�tifietl Copy i5 filetl with the city Builtling DIVISion.
Date APPlicant
E%EMPTION FROM WOAKERS' COMVENSATION DECLARATION
(This section neetl not be completetl it th0 pe�mlt Is for one huntlretl ($100) or
less).
I certily that In Ihe pertormanCe Of the work ior which thi5 Oerm�t is i55uetl, 1
shall not amploy any perzon in any manner so as to become subject to the
Workers' Comp ensa�tjon Laws ot Calif r/na.
Date � �/ – �/— Y� Si9nature g��� � �h'^`�
NOTICE: It, af[¢r making this Ueclaratlon, you shoul become s�o7ec� to ene
Workers' CompenSation O�a�iSions oi the LabOr Cotle, you must forthwith
compry wi[h sucb Owvi5ion5 or this pmmll iball be tleem¢tl revOketl.
CONSTRUCTION LENDING AGENCV
1 hereby at�irm that NGre Is a ton5[ruclion lentling a9enCy for the perbrmanco
o/ th0 work fOr whic� this p¢rmil ii isiultl (Section 3097 Clv. C.)
l.entler's. Name
Lentler's HCtlresS
OWNER BUILDER DECLARATION
I horeby aHirm that I am exempt trom the Contractor's License Law for tho
rollowin9 reason (Settlon ]031.5 Business anU 7rofesslonal Cotle: Any cily or
county wbich rEquirez a permil ro ConStrucq aller, improve, Cemolish or rOPalt
any SlruClure, pNor to its issuanco, also reqWrei the applican[ for SUCh po�mll
�m m� a einnnn ara�wmnne fnae nniann iz Iieonmtl oursuanl to the orovislons ol
`�'heretrom antl the basisetor the allagetl�exemPHon. An�y vlolation ot SecUon
y"7031.5 by any applicant (or a permit sub�ecls tho appltcant to a civil
alty ol not more tnan tive huntlreU tlollars (f500�.
I, as owner ol tne omperty or my employces with wages as tholr sola
c mpensation, will tlo the work, antl lha itructure ii not IntenOed or ofleretl
1or sala (Section 7044, Business antl Prolessional CoUe: The Conlractor's
Li<en5o Ldw aocs not appty to an owner of a property who builas or Improvas
thereon, antl wno tloes such work hlmselt/hersell or through hls or har own
employeo5, provitlotl that sucn ImprOvement5 are nOl Intentletl or oitoretl tor
Shce. II howovor, tne bulltling or ImDrovament 6 soltl witnin ono year o( com-
plotlon, tM10 owner wlll �ave thu butden Ot Proving hC/sh¢ tlitl nOt bulltl or im-
�rOve io� lho pu�posa a/ Sale).
I, as owner of tne property, am Bxcluslvely Contractlnq wltn iicenzm con-
lracloR to con5[ruct LhG Projecl (Sectlon 7044, BuSiness antl Prof¢Szions Cotle:
Tho Contractor's License law tloes not apply ro an owner ot oroperty who
- builtls or improves lhereon, antl who conVacts �or sucn projecls wi[h a con-
Iraclor�5) Ilconse pufsuanf �t0 [he Con[rattOr'S License Ldw). I am aware thdt
prool of Iheir WorkeYs Compensation Inswanca ShOultl be prOvitletl to mo.
❑ I am exempt unaer Section B. & P. C. for this reason
narn n�., �'+^^��x. i
I hereby certity that I nave reatl thls application antl state that the abova
Intormation is mrrect. I agree to comply with all Nty antl county ortlinances
antl slate laws relating to builtling construcHon, antl �ereby authorize re0re-
5¢ntdtiv¢5 Ot tllls city to en ! upon tlle abOve-mentiOn¢0 plopefly -tor
in5pe<tlon purpq5�s �i
Signature !/��-✓ �'d^� DatelC�/���
orivers' Licenu or 55 $
� 3SbZ— -� - _ .-.
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,.�6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADIrvG FOUrvoA7loN STaUCTURAL T Front
❑ TEIJANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Rear
❑ �OTHER C Rlght
PROJECT DESCRIPTION 5�. FT. oCCUaANCv K
CONSTRUCTIONTVPE' VALVATION$ g Left
ZONE GfiADING CU. VOS. ACRES Ping. R¢f. �
Remarks: Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishevasher -
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P–Trap
Roof Drains
Reinspac[ion Fee S15
Boiler
Duct-UnderGround
Duct - Structural
Duct � Ventilating
Exhaust System � Multiple ❑
Firepl/Fact BIL IC80 #
Heacing System & Ducting
❑ai oo,000 sTu � i oo,aoo sr
Reinspaetion Fee � S15
CMG 0865-46, rev. 4/84' White - Builtling; Canary - Appliwnt: Pink - Accouniing; Goltlenrotl - ASsessor
Showers
$ervite Sink
Sewer Cap
Sewer Connectian
$olar Collettors
Solar Pipin9
Solar Tank
Swimming Pool wl5pa
Urinal
Water Clout
Water Heater
Wecer Service
laue Fee
Hood or Typel �
Canopy Type I I ❑
Refrigeration System
OO-t00,0008TU ❑100,000
System Repair/Alteration
laue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
1806 6/07/84
Zane
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Fan
F.A.U.
Fixtures
Device Boxes
Outlets •
Switches
Garbage DisUosal
Generator �0.5 KW 05-15 KW
Sub Panel
Motors DO-t HP �7 h� 8
Inc.Solar �9-15 HP �iG15+
Microwave
Pole Light
Range
Sign
Stunding Sections
Trnsh Compactor
$ 3
Rainspection Fee 515 Issue Fea
FEES
DEVELOPMENTSERVICESRE�UIREMENTS:
2oninp Approved By
Building Approved By
Application Issued BY
$ 3
5°0' TI
FEES
5 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP 5
PLAN CHECK $ PERMIT
PIUMBING $ SOO �SSUANCE S
PLAN CHECK 25% $ ENERGV P.C. S
ELECTRICAL $ GRADING 5
PLANCHECK 50% $ MICROFILM S \
MECHANICAL $ TOTALFEE $ SOV
P�AN CHECK 25% $
Z
O
N
1
N
G
R
E
�
M
T
$.
CONSTRUCTION AND PLANNING � PO�._& SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO 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, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
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 FINC,L
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
2�. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush
• �4. Roof Framing 73. Undergr�nd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frameand 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 Cpat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ���yy L
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer !y„�� . ���f--/�u _
43. Backflow Irrigation
44. �Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINALSTRUC7URE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date
Applicant lo /ill in all spaees excapt l�oie wit�in �eavv GorEar Ilnas anC sign all aooroorlale tleclantions.
CITY OF COSTA MESA PE IT NO TRACT NO. LOT NO. BLD . . 3�J� I 2IO2/B4 1 7.I]�.
CONSTRUCTION PERMIT �.- �Q �
PrO�EctAddress � • � • TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
Applicent'sMaili AddreSs, �In�l �A.QF/GGl� �.{� ❑CONVERSION ❑DEMOLISH ❑OTHER q,P.# Zona
OwnEr's Neme hOn2 DESCRIPTI F W
� -//. •3 ��_ S Main Building: Accessory Building: Z
Addreu G�� 9� f a�o� tv i,v��E �/.�3 , �—�� --- e o
TVPE OF PERMIT GRALJ DING U FOUNDATION STRUC7URAL T Front (.�
ArCh/Eng. LiCenSC NO. ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear � �
Address ❑ �07HEa A N
C Ri9ht G
Contractor's Nama 0�3 Phone PRaECT DESCRIPTION SQ. FT. ocCUaANC K - R
� CONSTRVCTIONTVPE VALUATIONS� S Leit E
Address (meiling) '
City l'IcenSe No. 20NE GRADING CU. VDS. ACRES Ping. Ref. � Pefk.F2C5 $ n
LICENSED CONTRACTOR DECLARATION Remark{: � 2 Parking Req./Ptovided u
I hareDy attirm tnat I am Ilcansetl untler Drovlilons of'C�arter 9(tommentlng R
with section 7000) of Divlslon 3 of tha Buslness antl Protesslans Cotla, and Use Of Building: E
my Iicense Is In tull forca antl elfect. Plannin Notes: M
LI<ense Ciass License No. PLUMBING FEES 9 E
te Signatura
N
r�OHKERS' COMPENSATION DECLABATION 88r Sink ShOw2r5 �
��iereby af/irm that I hava a certl/lcate o/ conzent to self-Insure or a tartlficate B2tkflow P�eventer Service Sink ' S
�,of Workers' Compensatlon Insurance, or a cerUfieE topy�thereot (SecHon
3Boo, Lab. C.). - Backflow Irrigation Sewer Cap ELECTRICAL � � FEES
Pollcy No. Company •
8 Certifletl copy is nereby tumisnetl. , Bathtubs Sewer Connection Automatic Washer Transformer ❑ 15-50 KW
Certitietl Copy IS /lletl with the <Ity BUIItlin9 Dlvlsion. Clarifiers $Olar COIIeCtOrs ConStruction POIe SUb. ❑ 50 + KW
Date Applltant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Di5hwd5hel Solef Pi in
(Thissection neetl not be completetl If tha permit is for one huntlretl (5100) or P 9 Cooking Unit Mete� ❑up to 100 amps
less).
I certify that In tne performanco o� the w6� tor whlch this perm�t is issuetl I Drinking Fountains Solar Tank Dishwasher Meter ❑over t00amps
sM1all nOt employ dny pe�son In an Tenn )o as t0 b ma S n���t to tti0
Workers' Compansatloq lawz of Ca�if "n pA \(/ Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panal
Date Z- �"' ��� i Slgnature /'a�,u � ����-� ` , -
NOTICE: If,iafter making tM1ls tloclaratlon, you shoul0 becoma sub7ect to the Ploor Sinks Ufinel Fan � MOtOfs �0�1 HP O1 h- 8
WOrkBrS' COmpOnsatlon provlslons af Ine Lnbor Cotle, y0u must fOrthwith
camply witn suc� OrovlSions ar this parmit 5hali be Eeemetl revoketl. GeSService Outlati WaterClos2t F.A.U. Inc.Salar09-15HP�1E75+
CONSTRUCTION LENOING AGENCV _
I hereGy aHirm that there Is a constructlon lentling aqency for Mo performance Int¢rcept0�5 Wat2r Healer FixWres Mitrowdve
of [ne work tor whlCh this Dermlt IS ISSuatl (SeCtlon 3087 Civ. 0.)
Lentler'i Name -�lu•�'��l' Kitchen Sink Water Service Device Boxes Pole Light
l2ntler'S Atltlress �evatOri¢5
OWNER BUILDER DECLARATION �utl¢LS • Renge
I hereby affirm that I am exempt irom tho Contractor'z Llconse Lnw for tha p-T�a
following reason (Section 7031.5 Buslnass antl Protaislonal CoEe: Any city or P ' Switches � g�y�
county whlch requlras a permit to construct, alter ImO�ove, Eamolish or rapalr
. any structure, orlor to Its Issuance, also requlrez t�e aoplicant for sucn permit Roof Dreins Garbage Disposal Standing Sections
��.� flle a signea statoment that he/she Is ticensatl purivant to tbo provlslons of
,�� e Contractor's Litanu Law (Chao�er 9(commoncing with 5ettion 7000) of Generator �0.5 KW �5-15 KW
=v:�ivislon 3 0l the Buslnass antl Profezslons COEo) or that he/she I5 exempt Trash Compactor
`�Tharefrom antl Ne Dasis for tha allaqatl axemptlon. Any vlolation of Sectlon
7031.5 Dy any appllcant f0� d p0/mlt subjOCtS th0 apptitant to a civll qei�3 eti011 FBB
enalty of not more tnan ilva hunaretl tloilars (S50o). 7e 525 Isue Fea g 3
I, as ownBr o/ tho DrOporty or my emplOyees with wages as lhelr Sole ReinSpection FBB $25 Issue Fee $ 3
< enutlon wlll tlo tne work, antl the structura Iz not IntenOeG or offeretl MECHANICAL FEES
tor ule (Sac�lon 7044, Business anG Profeulonal Cotla: Tha Conlractor•s PUBLICSERVICESRE�UIREMENTS:
IJcanSe Ldw tlaei nol apply to an OwnBr Of e p�opa�ly wl�o bull05 Or imp�oves BOil2! HOOd O� TypC 1 ❑
tharaon, ana who Eoes suth work himself/herself or througn his or �ar own - Zoning Approved By Date
employ eez, provitlatl tnat such Improvemanls are not IntantleO or offeretl for Duct - Under Ground ��opy Type I I ❑
sale. 1}, howevar, t�a DUI1tliny or Imo�ovoment Is soltl wlthln ono yaar of com- $uilding Approved By — Data
DIBtIOn, lha Owner wlll nava tna burtlan Of prOvinp he/Sh0 Oltl not builtl Or Im-
�rova for tha purpase of sale). Ouct - Struciural Refrigeration System Application laued By P Dat
1, as owner of tha prooerty, am excluslvely contratting with Ilcansetl con- ❑4100,000 BTU ❑100,000 BTU
tractorstd construct the orolact (Sactlon 7044, eusiness ana aroresslons Coae: Duct - Ventilating SU�OF FEES f�
The Contrattor's Litanse Law does not apply to an owner of pro�erty who BUILDING PERMIT �� �• J �
bulltls or Improves tneraon, and who contracts tor sucn oro7ects wlth a con- Exhaust System ❑ Multiple ❑ System Repair/Alteration $ SMIP $
tractor(s) Ilcense pursuant to tho Contractor's Litense law). PLAN CHECK $ PERMIT
❑ I am axempt untler Settlon B. & P. C. for this reason Firepl/Fatt. BI[. IC80 # PLUMBING $ ISSUANCE $
Date 7- Z `3'�1 Owner �/� i Heating System & Ducting PLAN CHECK 25% .$ ENERGV P.C. $
I heraby terlify that 1 �eve reatl lhls applltatlon an0 State that lhe abova ❑6700,000 BTU �100,0008 � GRADING $
Informatlon Is correct. I agrea to com0�y M'��h all clty antl county ortlinances ELECTRICAL $
antl state laws r lating to bulltling constructlon, antl hereby authorize repre- PLAN CHECK 5096 $ MICROFILM $
sentatives of�tfil tlty to r uDon t�e above•mentlonetl property tor
insoectlon p rpo s A MECHANICAL $ '�7, tl O
Signaturo _� , /�l�(�i . � �/-ai ! .� Date Z-2--$ TOTAL FEE $
DNvers' u se o 55 � '� � - /) Reinspec[ion Fee $25 laue Fee � � S 3 PLAN CHECK 25% $
CMF 0865-46 rav. 12/83 White - Builtlinc: Gnarv - Aooliwnt: Pink - Accounting; Goltlenrotl - Assessor '
_
'CONSTRUCTION ANDPLANNING . PO� .SPA . .
APPROVALS ' Permit # 5����� �Date Inspector AppROVALS Permit # r Date Inspecto��
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-Kjndrgrnd. 55. Electrical Bonding '
5.* Steel Reinforcement ' S6. Rough Plumbing & Pressure Test -
: i
6� Elecrrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Pootings . 58. Electrical Conduit-Undrgrnd. '
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. 8ackwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ?//y���f � 62. Backwash & Receptor-Final �
12. Sewer, Cap � 63. Heater & Vent-Final
13. Roof Dreins 64. Plumbing System - Final
14. Rough Plumbing - � 65. Electrical-Final � �
15. Rough Electrical-Conduit - 66. Solar System-Final � -
76.. Rough Electric Wiring � � 67. Fencing & Access ApProval '�
.
17: Rou�h Wiring Sign' . 68. APPROVED FOR PLASTERING �
18..Rough Electrical-T Ba� Ceiling 69. POOL/SPA SYSTEMS FINAL
19! Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
201�Rough Factory Fireplace � APPROVALS Permit # '
21. �Ducts, in'Svucture, � 70.� Underground Hydro �
22. Ducts, Ventilating . 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test , 72. Underground Flush
24. Roof Framing '� . 73. Undergrnd. Storage Tank O Gas ❑ Oil '
25. Roof Sheathing . �. 74. Overhead Hydro
26. T-8ar 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. Orywall Nailing ' � HEALTH DEPT. REQUIREMENT �
i�
31. Plaster Brown Coat � � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes: �
34. Final Heating & Air Conditioning . .
35. Final Gas Pipe-Tes[ �
36. Hood or Canopy� . � . -
37. Final Factory�Fireplace - ' , � - � I
38. Final Plumbirig � N
39. Water Service'Final � � �
40. Gas Service-Final - � �� �
41. Solar pomestic-F�inal �
42. Backflow Preventer _ . . . � � .
43. Backtlow Irrigation • .
44. Landscape Irrigation System _
45. Sound Attenuation • _
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Speciai Requirements Completed
49. Electric Release to Edison , � •
50. Gas Release to Southern California Gas Co � � �
51. CERTIFICATE OF OCCUPANCY � � � . ' �
No. - Date
COUNTY OF ORANGE,
BUIL4ING DEPT.
636IVo. Broadway
Santa Ma, CaG(omia
, Phonc: KI 2fi211
Application for Building Permit
AND FOR A
Certificate of Use and Occupancy
Permit No. �'7..�.� 0..�
� ^
Date-----....f .1...'.....c:T..�.-�- '��- � �-�L'---.....--
OWNER'S NAME_:!1��..4�1.1�(1/�ULEti.._�C'J'_����..----�-----.......------- ............... PHONEur�r�,.,.Ic�S:G�o`'
� �,�L /��
MAILING ADDRESS.....Z_5..�".�.....��. � - � U.-.'..�f1 ..................--....----•--....... CITY._C�Gt;�t.s._CJ�t.lti':.'.�---'--
Name
(Arthitect or Engineer)
Address
Name
Address
City............................_......:................ ..........- ......... -- -........ City ..........-- .......--'---.........------..__............----'-'--------.........----
S[ate State
Lic. No.---��-------..... ----�- ...._. Phone--��------------------ -- .......... Lic. No....- -...........................--....... Phone.............--•• ��-- -----------
PROPOSED
z. JOs I,OCa�
3
4
`-�{ y� j
�� �� `^' l ��l l: /�
-=------------ -------•----.....::....
(House No.) (Name of Street) (Town or School District)
NAMI OF ANll llIItECTION FROM NEAREST CROSS STREET .......:.................................... ..................................................
�,c ,Q.�1 3 yXHo -
LEGAL DLSCRIPTION: Lot---�_ 7�1:,Y/__ . J�c.'1_.---.......Block ----- --1��-----�� -...----... - .. Tract..--•---� --� ��.__—..- �--
(Me[es and Bounds Descri [ion—Usc reverse side of form)
CORNER LOT (� INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( )
i. SIZE OF BLDG.:. �I.._?�--�}- I.---- AREA:--� .............................SIZE OF LOT:...L.�:.Z.�...-7 �--AREA:_..--.......-----------.._...--
G. HEIGHT OF BLDG.:_I..�%-.t _�►'/_..-...� ..................CEILII�'G HEIGHT:.......�%f _:......_.....NO. OF STORIES____........._...............___
7. NO. FAMILI[S____..�1�12.d .................._Size of Smallest Bedroom:...��_�...�.�..............,. Size oE Kitchen......._.1.....!�...y.........
�
8. EXTERIOR WALL CONSTRUCTION:.. �_�.U..�. G.,Q_._,.....INTERIOR WALL COVERING....�.I.�.�Y._.�� ���.....
(Prame, Stutt�yEcc.) p � (Plascer-Drywall, Etc.)
ROOFINGCOVERING.....l.rt..ltvn�.�l.•.._...._-!;�.:�...:-.. - ... .....-- ............................................................... ... .-......._-
9. STATE HOW MAI�'Y BUILDINGS NOW ON LOT AI�'D GIVE USE OF EACH .............1Y11Y..�......_...._....._...............
�
10. SGTDACKS: Front Yard Frc,m Center Line of Street..:..._Jl o.........�....� .. ... ........----.............---.........................._.......---.....-----
Nearest Side Yard ���..: __.:Reaz Yazd......�.4..G.tDistance in Feet Betwcen Bldgs. on Same Lot............l��..�......e........
(Pruperty Line) (Vroperty Linc)
tl. A COMPLETE PLOT PLAN IS REQUIIiED, SHOWING ALL STItUCTUR�S AND USE OF EACH.
12. (a) Footing: �Vidth---_.�.%�...i.-.---_�....._---Depth in Ground----..°}..:�..�::!�....Width of Wall ......................._---.--.
(b) Size of •Studs:_�".,7�.._.��....._.._Spacing_...�.fA.,....�..�..."CC Matcrial of'Floor..__.....�� P'�
/ - ------ - -....._...--•-�-
(c) Size of Floor Joists:...._R---�----�---.......-_-----.Spacing....----'.I..�°--L-_...U.k,r....:'CC
(d) Size of Rafters:.......:1-. �{• H... -'- ---....------Spacing.---• �---1 U--�..._�.....%r...i'CC
] 3. VALUAT(ON OF PROPO �E111 V�9RK: Inclading all labor, plumbing, cicctrical wiri�g, heacing, fire sprinklers, painting and
sewage disposal $.----��..,� ....----"------"----'--' . �
14. I HERE6Y CERTIFY THAT TO THE B�ST OF MY KNOIVLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. ,
� Signed:
Plans Filed:....-'{-�-Z��'- ---.�.......�..—....------' BY:.
Bldg. Permic
Plan Check
Total - -
Receipc No.
Paid to •
Dare ....._----
FEES:
7- ----�' �S-?�
(Owner)
(Au[honzed Agen[)
FOR DLPARTMENTAL USE ONLY '
GROUP------ ----- -- ------------
TYPE-----�----- -------------�----..
DIST. � �
MAP........---�----. ...._.. --- �� ---
SHEET NO.------- ---.....--.--
APPLiCATION
TH-------...-----�-----..
ZONING........------------. - FIRE
�� MARSHA L---- .................-
PLANS AND ��
SI'EC'S---------...--� .............. STATE.------.............--�-------
CORRECTIONS ENGINEER
INSPECTOR
s000--�-s� ��..�� ����
COUNT'Y OF ORANGE
BUILDING DEPT.
636 No. Broadway
Santa pna, Califotnia
i Phone: KI 2fi211
2.
3.
4.
i.
6.
�.N-.R. Jar !� ��
Application for Building Permit
AND FOR A
Certificate of Use and Occupancy
Q' �-'-.
Permit No..... ..�.�..-�.7_--.-.-
=;
�u✓�-� f� / Date-----..Ll..----�l�-- .....:�? .. � ..............
OWNER'S NAME..J. � !..<..2t�_s:.......`--'..•_��.�xi!..7_�.a�...........— ---.....-------- ................. /PHONE:..=.�.-..r.,...I�S_GGEU
MAILINGADDRESS -...:./__���.�.....� ^� ��O---SS--r�-------------�----------- -- CITX'-..C.P-e�+.-�-t..��/..�.�--`--=
Name....--.....--------- ...... .......... . ............... ................. ��-- - Name ..........................- ..... .... -- -.._...... - -------------�- •------...--
(Amhicect or Engineer) ' (Contractor)
Address--`--'----------------------......---------.'---.....----------------------- Address --------"---'-----.._ ...........................'----"-----'------......-•-'-'--'---
City- ......... - ...----` ........ . ..........._.........--- -'--'------- --- . City -- '- --..........---�--...-- -- -----................----......--�---- -----'--"-
State State
Lic. No. - - - -- - -- ..... .... Phone ........... ..-.....-- ---- ---- Lic No.__......--- •--------- --- -- . Phone............. ---...........-�----
PROPOSED USE:
JOII LOCATION --� �'� �..--�--.......`.,�..--t....-Z-�- ----..�.....---�-----......!....[u.u�...UYl1y.Gct.-!�..:-------....._-----------
(House No.) (Name of Streec) (Town or School District) �
NAM� OF AND DIRECTION PROM NEAREST CROSS STREET..y ..............................::.........................................................__
'P/' .��% °`�D
CO WI�' ��-----Block --------------- -----------------'-__..._ Tract---�--�-Z---'---"-------
LEGAL DESCRIPTION: Lot__!^...� ............................. �
(Mctca and Bounds Description—Use reverse side of (orm) �
CORNER LOT (�es) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OP LOT ( )
SIZ$ OF BLDG.:...�r�...y:--�--'----AREA:-------�----------�-------- -SIZE OF LOT:.-�-�-7-v---.Z_P......---.AREA:.-�-------------� --- --..
HEIGHT OF BLDG.:.....II�I.T-.�-_�'!`..:��CEILING HEIGHT:___._��.. r......... NO. OF STORIES ......................__......
7. NO. FAMILIES____.._.__ .% ...........................Size of Smallest Bedroom
Size of Kitchen ...................'------..........
S. EXTERIOR WALL CONSTRUCTION::S.__,1....�! �: �'..!2._.........INTERIOR WALL COVERING.........:�!.r?._:'.�.'.
•-- • - - -� ----- -�---'
(Frame.5wcco Etc.) .......................... '.... (PlascerDrywall.Etc.)
ROOFING COVERING -�- �-R--(.'.-�.. ---- --- -- ............ - � .... -- -�- -.._
9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH_..........._�i..r.....^.�.(-:...._ .......................
10. SETBACKS: Front
11
]2
Nearest Side YaR1; ;i�'.t
(Property Line) �
A COMPLETE PLOT
(a) Footing:
(b) Size of
Center Line of
(Yroperty Linc) �
FI$,REQUIRED,
(c) Size of-Floor Joists:......f::."�
l
ance i�e�Between Bldg�s. qn'Same LoG-----------.1-�^-�!-------------
G E.TLL STRUCTURE$ AI�,'D USE OF EACH.
pth�in Groun`d......�-..�krr---Width of Wall ................................
�!_`f1...1„�....:'GC� Material of Floor.......�.P� ...:..........._.---
' ��" CC
_ (d) Size of Rafteis:__..._t� :K�.l�---...---.-------....Spacing...........L_lP....'._:.Y..:d.`"CC
--. ,
1;. VALUATION OF PROPOSED VOC�.^�K: Induding all la or plumbing, eleccrical wiring, heaung fire sprinklers, painting and
f%
.� a __
sewage disposal $--_-.--_ ..'�1-�"`"7..—.-l..-.�% C�-� ��
14. I H�REIIY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
TH$ COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Si ned :, fJ/n n ./,//.�itw.c.�... r �,� (
L
g .: ..�..._r...._...�.""'........"'"".... . .�."_''2 c
" "" ' ' "' �'""""""' ................
% l r (Owner
Plans Filed:--'-'t'-.�1...%..._"d------�""""...'---'...-------'
/ R.,� _. ._--------- . ._.---- - -
(Authorized Agent) �
FOR DEPARTMENTAL USE ONLY
FEES: � C C G
Bldg. Pcrmic - S.---....-`1"�---."� GROUP-- ,. 1------------------- APPLICATION.......�..�..` IQ AL�H.----.....................
--....
TYPE......... vPIRE
Plan Check - $..... - �-- • - .......---- -- - - ZONING ....................
�p� �---
DIST. MARSHAL .........................
Total • • � $��{y------- =�1"'fJ'(I"" G � PLANS AND •
Receipc No. • MAP.-----..._... ------.... ._.
`-� -- - - ....--��----�:., ! ' SPEC'5..-------------...---� � STATE........-�---..-�------..
Paid to - • • ' .. ................_..,�� CORRECTIONS ENGINEER
SHEET NO._.. ...------.-----
Date ........------------�'�-�----..�:.=�'�-- ------ .............. �--_--------�- .. VERIFIED---......--..... - CAL.........----.........
Ii'� n.iU'.��
� ^�
DATE....----'...�.�.�...-:.. .----a..-----------....
�000.•�-sz
OWNER ECHOUTEi MRS• i�1AURICE V DATE 5-26-5l1
JOBADDRE88 %52 W. 20th Street BUILDINGPERMITNO. �193
GENERAL CONTRACTOR Owner-Builder VALUE s �. ���.��
� 39 & 4o BLOCK B TRACT 6�.2 Bed Room 12� X 1$�
GROUP I TVPE V ZONE RI.� FIREDISTRICT �O].
PERMIT$ ISSUED
INSPECTIONB I OATE I SUBCONTRACTOR I
DATE I NLIMBER
Foundation Forme
to
Pole
Se�•�c �Tank or
l. g g/�-1
Plumbing, Final Gas
W iring, Final
Oxupancy
Form '2I0 GH IM 12-68
� Costa Mesa Building Department
� � 111 EAST 20th STREET
' C05TA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
ndaaes9 7� 2_�j1�- ao . �
Casta Mesa, California
crosa st.//{��/tLPfil�< �}- '�
Owner���ii.�i,. �+ T_
Mail y �,v�
Addrcss `,� ' /v— �� � .
City
Architeet or
Engfnee�
'ddress ,G�/% �!/ /
Gontrector
Address
Legal t�ot
Deseription I No.�9'�. Jj D Bloek
(Attach Metes a�d Bounda)
No.
Size oT LM 'ib � `�- ] Nov
Demollsh
BtZedin9 /� '/ .� Room:
.terior Wal�� I R
_a�«��s i]./.��a. c�
Use oi Ne
Bulldina � � - � _
APPLICATION FOR PERMIT
501 BUILD:LNG `�
FOR OFFICE USE ONLY
Recelpt No. I Permit No.
Tj 3
Received by � Date Rec'd. � Date I�LLed
Costa Mesa, California
Nearest
Cross St.
Zonee/��j � No.oT � Type ;/ i
I hereby acknowledge that I have read this Application `
and stote that the above is rnrrect and agree to comply �
with all City Ottlinances and State Iaws regulating —
building constnlction.
Si natureof �' . �J P
Permittee '-�j ���il_u�� % �. �"�
_ P
Authorized Agt. n
Valu,ation �� Permit Fee S 6 Q o
Plan Cheek $ � 8
$ , � Fee I $ �� F
FOHM 204 p-M 2M tl-94
I�
APPROVAIS
mndatian Location I InspeCtoi
Forms, Materials,
Under-Pinning
•ame: Fire Stops,
Bracinp. BOlta
Ext.
� Reinforced
:s
�
-
O
z
G)
Z
D
r
Show locatlon and distances irom � ,
i��)�.�tiF, ��T';i'�. ''n �{'; :,
property.line�and;between bulldingsi ;yf ,
_ Do You carrY.l9orkman's Go�:Pensation" "
• Ye.s �� Ido �
Insurance? . • the State
I afl a�rare oY Provic_cn 37�� of emPloYer
Labor Coze ��=='-�= r��iaires eVery for, .
Z� pe insured a�ai17�t liability
cowPeil�ation.,. �-�
1ltoT]LID�� � -
/ ii in.i n 1 �
SiEne6a '�d�
� . ' `,
\
- - ,: .. . ..
OW NER ECHAUTE, CORINNE / DATE 6-11-56 �
i
JOBADDRESS %5Z w• ZOYll S}.. BUILDINGPERMITNO. '�l�JS -e
GENERALCONTRACTOR Owner-builder vnwE a 2,22L.on
Bedroom addition to drrelling
� aP 115-3L3-6 BLOCK TRACT R. riA{,�_�Y,��.te ga2,3o9
TVPE V ZON
INSPECTIONS I DATE I SUBCONTRACTOR I DATE PIRMITg'NUMBI
Foundation Forms and Grade t� G
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
Heating, Hough
Heating, Final
Sewer, House Sewer, St.
Seotic Tank o/r� Cesspool
L n9� �� [.—QY�dIC Out '
Plastering I
Plumbing, Final, Fixtures Comple'
Plumbing, Final Gas Test
Wiring, Final
Occupancy �
C
FOflM 310 3M 10�'J9
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R Costa Mesa Bailding Department :�PPLICATION FOR PERIVIIT
P.O.Box3�� 320� BUILDING �
COSTA MESA, CALIFORNIA
FOR OFb'ICE USE ONLY
FOR APPLICANT TO 1�'II.L IN Receipt No. Vermit No.
Building
Address Q � � � �
Costa, Mesa, California aece�ved by Date Rec'd. /Date Issued
Nearest �/��'� :f '��' � � C�` "��-\
Cross St �Q- �. �, � ('_ �
Owner �Ly/),(/1nn�1E 7
Mail
Address %j �., . �, �./
l�/� v/N�P-
Clty
Architector �
Engineer ��
+dress
..ontracMr L7�,L .
Address
oe crptton I No �7T Ii �I fi
(Attach Metesand Bounds)
SizeofLot `�Q— �a-�
l�se of �
Existing Bldg.
Set6ack Line trom
Center of Strcet ��� �
DESCR ON
New / I I Alteration
Repair , � . ,` viny,,,
Building ��"� T �I�Vo^�
No. Y( -d"�+1 /
Lic.
N o.
City Lfc.
No.
ck �I
I Traet �
���
No. of Bldgs /
Now on Lot
No.ot NT
Famil�es � I Rooma
Addition I �
Demolish I
Stories �
Builtling
Address
Costa Mesa, Califomia
Nearest
Cross St.
Zone�_ � I No. of I Type /
Plans
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APPROVALS
Foundation Location Inspecto
Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracina. Bolta
I hereby acknowledge that I have read this Application
and state that the abme is correct and agree to comply Lath. Int.
with all GYty Ordinances and State Iaws regulating
bui]ding construction. {� �ath. Ext
Signatureof /..�%.�/iA/YYYIl C�� Afrl�� '
Permittee � A' .� Plaster, Int.
Authorized Agt Plaster, Ext.
Valuatlon � Permit Fee $ Masonry Rel
cJ '�
• �( �/ ~ Plan Check $
Bond Beam
$ �/ � ToWI
Fee � ^ FINAL
RM 304 IO�M1! D. P. e S.
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PLOT PLAN
Show loeatlon and distances trom
property Iine and between buildings,
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