The URL can be used to link to this page

Home My WebLink About375 21ST ST - Building Permits� � PflQIECT AOUflFSS: 3 7 S 21 S'1' S T OWNEP'SNqME: CRIVELLO ANTONIO i nooness: 375 E 21§T ST CUS'iA N,dSA,CA 92627 AflLX/ENGINEEq: ROOflESS: flEG.NO.: UNIT: UNIT: PEPMITfEF: JORDAN FOUF' COMPANY ( 714 ) 897-6105 aooness: gZ0 N. TOWNER ST, SANTA ANA CA 9�703 IICENSEU CONTflACTOB DECLABATION: I her¢Uy allirm Iha� I am licensetl uM¢r prOvisian5 oi Chapter 9(COmmenCinA w��h SeCtion 7000� ol Oivision 7 0l Ine Business antl PrO�ession5 Cotle, and my h nse is in full lorce and ellect. ciTruc.:0 5916 STPiELIC.:�OG7E3, �j�-39 �a�e'. �� ' _ Signature: �l1lb��' WOflKEfl$'COMPENSATIONDECIABAT10N: I�ereEya��irml�ai�ave eNhWleolcanSentlo5el6in5Ureoracerli�iWleolWork¢rs' CamDensation nsuranc o certilie copy t�ereot �Section 9800. Lab. voucrxo.: i10�2(��-9�1 E7(P.ORTE: S�OiI93 comvnxr: STATE FUND ❑ Ceriifietl copYL is here6y lumishetl. � Cenifietl copy is tileG 't� tAe ' Builtling Division. �a�e: �el�f1� ApDlicant: ^ EXEMPTION FflOM WOflKfNS' CUMPENSIITION OECIAPRTION: Rhit SeLtiOn rwt Oe mmpleteE ii Ne ce�mt is fa me huntlretl (510� or less�. 1 certify that in lhe DeAormance ai the work lor w�ich lhis Dermil is is5ue0, I shall not employ any Derson in any manner so as to become subleci lo Ihe Workers' Compensation Laws o� Calilomia. �ate: Signalure: NOTILE: II. alier making this tleclaratim, you s�ou10 become w�le�� o t�e Workers' ComDenutwn provisions of ine Lahor Cotle. you must fonhwith comply witn sucn provisions ar this oe�mit shall be aeemeA revoke0. CONSTPULTION LENDING RGENCY: I here�y aflirm t�ai I�ere is a wns�mction lending apenty Ior Ihe pedormance ol ihe work �or w�ich this Oermi� is i=sue0 (Sec�ion 3097. Gv. C�. LENOEfl: aooeEss: OWNEN BUILOEB OELUMTION: 1 liereby allirm ttut I am eKempt irom the Cantaclars' State License Law lor tAe follawing reason (Seclion 703L5 Husiness and Pmtessianal CAtle: Pny city of tounty whith reQuires a permit lo consirucl, alter, impmve, tlemolisR or repair any slmcime, prior totts issuance, also reQuites ine applicant lar sucA pemnl lo lile a sipnee statement ihat ne/sne is licensed pursuant io the Omvisions ol Ihe Comractors' State License Law �CtwD�er 9(wmmencin0 ��h Section 7000) ol0ivision 3 oi the Business ane Pwlessions CoCe) or t�at �e/s�e is exempt ��erelmm anE t�e Dasis lor ��e allege0 exem0�ion. Any violation of Semion 7031.5 by any applicant lor a 0¢rmit Su0itti5 Ihe apO�rcEnito a civil penaliy of no� rtwre lhan �ive �unCr¢C dollars (5500). ❑ I. a5 owner ol l�e D�oDe�Y a� my employ¢¢s with wages as ��eir wle rnmp¢nuiion, wiil Oa ��e work, an0 lhe stmclure is nol intende0 or oHereU br sale (SecOon 70Aa, Busineu antl Prolessional CoOe: T�e CAntractors' Slate License Law Ooes noi apDly to an owner of a O�operiy wlq builOs or improv¢5 I�ereOn, anE wt10 Ooes such waM1 himself/hersel� or Ihrough his or her own ¢mployees, pmviAeA ��at such imDmvemenls are n0i inlenaeA or ollereU for sale. II, however t�e builaing or improvemenl is sWG Hi1Mn one year ol complelian, Ne owner will �ave I�e �urEen of D�oNnO he/She tlitl nal Duiltl ar imprOve lor Ihe purpose ol sale�. I, as owner ol IAe O�opertY. am evtlusively comraciing wit� IicenseU wnirac�ors Io conslmct Ihe pmlec� (Semion 7044, Business ❑ antl Pmleuions CoOe: T�e Contraclors' State L'¢ense Law Eoes not appy la an ovmer of Droperrywlw buACs or impmves �Aereon antl w�o contracts lor such O�ojecls wi�� a con�ractor�s) license pursuam m the CaNraclors' State L¢ense Law). I am aware Iha� prool ol ��eir Worker'S ComOensation insurance shoul0 b¢ p�oviDeG lo me. � I am exem0� unCer $eciion: 8. d P. C. lor Ihis reason'. Oale: Owner. 1 tlo here�y cenily Ihat I am aware ol an0 u�erstana ihe requiRments of Califomia Healih and Salety COOe Sections 255U5, 25533, ana 25534 antl Iha� I or any IUNre �uilding occupani willlwill no� �circle one� nee0lo compty vni� said s�ate codes ana Ihe repuirements lor a permil lor constmciion or mo�ilication trom t�e Air �ualiiy Managemen� Oistnct Nesideniial constmc�ion aODlications are exemp� trom lh¢SC pfOvi5i0�5. Dale: ApP�icanl: I hereby certily ll�al I liave rtad ihis aooliWtian ana slale thdt Ine aUove info�mation 4 torrect. l agree to comply with all ciry an0 county ordinancesantl5�alelawsrelalingtobuiltlingcon5imclionan0�erebyaNh ¢er¢DresenlaliveSOl�hiSciry�oenieruponlheabove-mentionetl pmpetly lor inspetlion purposes. Dale'. �O/W� Signaiure- oriver's �icense or Sociai Securi�y a: i64La6 W�ne—Bmltling; Green—CoOe Enlorcament; Canary—Applican�: Pink—Revenue; Goldenrod—Assessor CT_TY Oc COSTA MESA — BUiLD1NG PERMIT PFRN NO: B 0596�3 PERMIT NO; B 059653 PLAN CHECK NO: N GOV1': iV SU[�Y: N CONSTRUCTION TYPE; PENMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : REROOF W/BUILT UP O/CLEANED BUILT UP SQ F1: 4,9�0 CLAIM VALUE: 4,950.00 CALC—VALUE: 9,950,00 GROUP OCC; R-3 / COMMENTS; INSTALL 1.5" INSUL, AEROOF 1875SF RESID ` �x,�rrcrc—�, x��c�r#***±r�i�*x��+rxxxxx�st��*�#x�rtr#*#�***��r*�r##+�*+ttt��+��f��1 Ct� 1 V� Z O N I N G R E Q U I R E M E N T B E T B A C K S « �� ----------- MAIN BUILDING ---------- --------- ACCESS�'JNY' BUILDING -------.-,-..,;;; FRNT; FT IN REAR: FT IN FANT; FT' IN REAA: FT ZN LEFT; FT IN RGHT: FT IN I,EFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 42623225 ZNE: REF NO: PLANNING NUTES> � �IEiE#iEiF##�1flfiFiEiE�iFiEif-�lf##1E#iEif�f#�E7Eik#if�lEiEiFiElF#i6iEiE#iE#X�iEiF�lF1EiE1E�fiEi( iEifififif#####�!##iEiE#iEi(��3t###iF###3E 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 ti�',S ZONING APPROVED HY DATE; PUILDING AF+PROVED BY ; DATE; APPLICATION ISSUED BY• DATE; �b 22 � iEiEiEiFif3Eifitlf#3E1ElElEi!#iE##�E#iE3"r�iF��eiF3Fi��x'3F3FrtTt3ftFiFiF�F � x x� x� 3F�iFiEifiEiEiE#1(�lfiF ir �c lE iP iE iE N� iF iE # iE iF iE iE ib 1E �E if it iE 1F iE 7f it # iF # iF 1t iEif� iE # it iE �lE �! ## �lE if ## iE# if ##iE ik iE x jE1E # it # 11� rt## 1E # if i4 if A� iF # its£�JE.i[ iF fE 1F fE fE 1E �f� iE iE LEGALIZATION:N F E E 5,t9 M M A R Y STRUCTURAF.'SEGMENI;Y HLDG PMT PLUMBIhG ELECTRIC MECHANIC,. FIRE SMIP/RES GRADING PERMIT 72,00 , . 50 PLAN . ` �c� SMIP/NON—RES rssoe r•EE BUILDING—DIV—> PERMZT ISSUE PLAN—GHECK ��` TOTAI, PAID ' Dlit TOTALS----> 72 . 50 0, 00 0: 00 ��„ ��72 , 50 72 , 5U � , 00 REVENUE DIVISION TOTALS--> COLLECTED; �72:�0 OVER/SHOAT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC "�FIit$ SMIP/TOT GRADIPiG PLAN—CHzCF( %2. �0 � � � . `t � .5� , �lE�lflEi'riEiF1(�iEiEiE-lEf(•iEkiEffik#iEiFlElF##i6iF�F##iE#iEiEiFiFjFiFifiEibiE#i(###if{i�iE#3fit�##f4!( X�##iE#iffEiE#iFiEiE#iE!(��F�1F#�iF#Sf I N D I 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^ -i.. UNIT COST .-iOPAL COST SFR 4950 REROOF BY VALUE RESIDENTIAL NOZQt�E END OF FEES - . f J i � 4,950,00 4 �ONSTRUCTION AND PLANNING POOI i a APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soii Pipe•Undigrnd. 53. Steel Reinforcement 3. Electrical Conduit Ut:6ty-Undrgmd. 54. Forms 4. Electrical Condw[�Undrgmd. 55. Electriwl Bonding 5� Steel Re�nfarcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE I 7. Footingz 58. Electrical Cqnduit-Undrgrnd. B. Foundation 59. Gas Pipe, O U�drgrnd., Tcst 9. Water Pipe-Undrgrnd. • 60. Backwath Lines, P-Trap, O Undrgrnd. ".. 10. Structural Floor 5ystem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal 12. Sewer Cap 63. Heater & Vent•Final 7 3. Roof Drains 64. Plum6ing Sys[em - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final i 6. Rough Eiectric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, qPPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOLlSPA SYSTEMS FINAL 19. Rough Heating &%+�r Conditioning FIRE DEPT. REQUIREMENT 20. Rough factory Fireplace APPROVALS Permit # 21. DuCts, in Structu�e 70. Underground Hydro 22. Ducts, Ventiiating 77. Product Pipin� O Gas O OJ 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank QGas �Oil 25. Foof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling (Struccuraq & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding � i 77. FIXED SYSTEM FINAL 29. Insulation � � 78. FIRE PREV. FINAL 30. Drywall Nailing i i HEALTH DEPT. RE�UIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power MeterFinal i � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: �o sn,�� {/S ��'` "� Cs�� / ,a. 34. Final Heating & Air Conditioning � ��(/j�(�c2 myL . /0/�O✓c�� 9Mr� //(/,S� 35. Final Gas Pipe-Tese � _r �ccr/_f-v�0 i'l_a.u,r /L- 3-Y_Z� 36. Hood or Canopy �, � 37. Final Factory Fireplace � � 5 � D�QLi-��- _ 38. Final Plumbing � ' ��//J �� 39. Water $ervice-Final , i i �� ( /_-�� i�%(�� '^ - i � 40. Gas Service-Final � � ��'� � 41. Solar pomestic-Final I 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING �' . ',� A _ �� _ /-� 48. FINAL PLANNING ' ~ 49. Electric Release to Edison 50: Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No._ Date � Applieant to fill in a1l soaces exceDt those within heavy baraer Ilnes ana sign all appropriate Oeclaratians. CITY OF COSTA MESA GUNS I li UG I ION Y/tJ�{. �Iyj�I I I PERM O. .TRACT NO. LOT NO. UNIT NU. Pro�c'l�Address �%S �� a l 4.�i L!_/��ga� A ;Applicant'sMailingA dress �'r�-+'�1 �/i�L� �iT � C= Owner's Name � ^�-�� Phone Address �N�-QJ Arch/Eng. License No. Address � ConVacmr'sNam ` �y Phon �`�j.1-�2r_.�,.]� Address Imailingl ' }_.L�i�. a• City License No � O 6� LICENSED CONTRACTOR DECLARATION 1 heteby atfi�m that 1 am licensetl untler provi51on5 of Charter 9(commencing with sectian ]000) of �ivision 3 of the Business antl Professions Cotle, antl my license is in full orce ana eitect. License lass Li PssenNo.��3,5� oate O Si9nature i � f� 1.--� WORKERS' COMPENSATION D ARATION 1 hereby a((irm that I have a certi te of consent to self-Insure or a certiflcate ` Workers' Compen5afion InSuran<e, or a tertityi ,tl opy ther ot (Section . 800, lab, c.L-�� C� Policy No. �� Company ( eCertifietl copy is hereby turnlshetl. , Certifi tl co�% is f'��ptl wi[h [he cil iltli Si � � �� ,�y�� Dafe ` i O[ AOplicant �fY'� EXEMP ION�� PROM WO �RKERS' CO P NSATION OEGLARATION (This section neetl not be compietetl ' e pe�mit Is to� one huna�etl ($300) ot less). 1 tertify [hat in the perfo�mance of tne wo�k fo� which [his perm�t is Issuetl, 1 shall not employ any person in any manner so as to become subject to the workers' Compensaiion Laws o( California. Date Si9nature NOTICE: If, after makin9 thiz tleclaration, you snoultl become subject to the Warkers' Compen5ation provisions of the ldbo� Cotle, you must fortM1witM1 comply with such O�ovisions or this permit shall be tleeme0 revoked. CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construction lentling agency Por the pertormance of the work tor which this permi[ is iszuetl (Section 309"] Civ. C.) Lentler's Name � Lentler'S Htltlress OWNER BUIL�EN DECLARATION I he�eby affirm Ihat I am exempt from [be Cont�actor's LicenSe Law for tne tollowing reason (Section ]031.5 Business antl ProfeiSional Cotle: Any city or county which requires a permit to const�uct, alt¢r, improve, demolish or repair any structure, prior to.its issuance, also requires the applicant for zuch permit to file a signetl statement that he/she is licensetl pursuant to the provisions oi ihe Contractor's License Law (Chapter 9(commencinq with Section ]000) of Division 3 of the Busine55 antl Profe55ions Cotle) or that he/sbe is exempt �erefrom antl the basis tor the allegetl exemption. Any violation of Sectlon )31.5 by any applicant for a permit subjects the appliCant to a civil t-e�nalty of not more than five huntlretl tlollars ($500). LJ 1, as owner of tne property or my employees with wages as their sole <ompensation, will do the work, antl the structure is not intentletl or otferetl tor sale (Section J044, Busine55 antl Professional Cotle: The ContraCtor's License l.dw does not apply [o an owner o( a property who builtls or improves thereon, antl who tloes such wo�k himself/her5ei! or throu9h his or M1e� own employees, providetl tM1at zuch improvements are nnt Intentled nr nHeretl for sale. If, however, [he building or improvement is soltl witnin one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- p�ov¢ for the purpo5e of sale). ❑ I, as owner of the pro0erty, am ezclusively <ontracting with licensetl con- Vactors to consiruct tM1e project (Section 7044, Bu5ine55 antl Professlons Cotle: The Contracto�'s License Law tloes not apply [o an owner of property who builtls or improves thereon, antl who contracts for such projects witn a con- tractor(51 hcen5e pursuant to tM1e Cont�actor's LiCensE Law),I am aware Ihat proot of thei� Wo�ker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untle� Sec[ion B. & P. C. for thi5 reason Date Owner _ I hereby certi(y tnat I have reatl this information is correct. I agree [a comp Signature Drivers' L CMF 0865-4� t the above orainances viie repre- operty for ,�"a�'a �s� TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTH DESCR TION OF ORK/USE F BLDG. '� TVPEOFPERMIT GRADING ❑ FO NDATION STRUCTURAL ❑ TENANT ❑ ELECTR CAL ❑ P MBING ❑ MECHANICAL ❑ OTHER PROJECTDESCRIPTION 5[.t.�FT. oCCUaANcv CONSTRUCTIONTYPE VALUATION$ r�.�(S[➢ e%t ZONE GRADI U.Y�S. ACRES Remarks: 3ar Sink • 3ackflow Preventer 3ackflow Irrigation 3athtubs �larifiers �ishwasher Jrinking Fountains ; loor Orains Floor Sinks . 3as Service Outlets Interceptors � Kitchen Sink Lavatories P—Trap Roof Dreins Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact BIL ICBO # Heating System & �ucting ❑ 0-100,000 BTU � 100,000 BT - Applitanp Pink - Accountin9: 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 Auto-Wash Issue Fee �Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-t00,0006TU ❑100,000 System Repair/Alteretion Fire.Dampers Registers Issue Fee $ 3 $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. �k Planning Notes: Automatic Washer Construction Pole Sub. Cookin9 Unit Dishwasher Dryers ❑Gas �Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW C Zone Parkin9 Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter �over100amps Sub Panel Motors 00.1 HP �1 %- 8 Inc.Solar �9-15 HP �i6-15+ Microwave Pole Light Sign Standing Sections 15 KW Trash Compacmr � Reinspectian Fee !$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approvetl By Building Approved�By Application Issued By � FEES $ 3 2 O N I N G R E Q M T S SUMM Y O EES � T BUILDING PERMIT $ � SMIP $ S `+ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. 5 ELECTRICAL § GRADING $ � PLANCHECK 50% $ MICROFILM $ �/' MECHANICAL $ TOTALFEE $ L� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector p�PpROVALS Permit# Date Inspector i i. Temporary Electrical Service or Pole 52. Pool & Equipment Location , � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. , 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, � Undrgrnd., Test ' . 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O,Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � , 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � _ �.' r 21. Ducts, in Structure 70. Underground Hydro .!�• 22. Ducts, Ventilating 71. Product Piping O 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-Bar Ceilin9 (Structural) & Monocoat � 75. Dry Chemical . " � 27. Frame and Flashing 76. Dry Standpipe .�, . 28. Lathing & Siding 77. FIXED SYSTEM FINAL ` � 29. Insulation 78. FIRE PREV. FINAL �� 30: Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - 37. Final Factory Fireplace • � � ' 38. Final Plumbing � , . • • 39. Water Service-Final . ' • , � ,1' 40. Gas Service-Final ' f� � 41. Solar pomestic-Final • ' ' 42. Backflow Preventer � � - 43. Backflow Irrigation • • . 44. ,Landscape Irrigation System - J � , . -45. Sound Attenuation � , . � ' "46. Handicap Regulations c �. , , , 47. FINAL STRUCTURE & BUILDING �, ��- ' , � . � 48. Special Requirements Completed ' ' .`' . 49. Electric Release to Edison ` � r 50. Gas Release to Southern California Gas Co • • r 51. CERTIFICATE OF OCCUPANCY . , !- No. Date �� N ❑ CITY OE COSTA MESA BUILDZNG SAFETY DEPARTMENT CERTIFICATION As the undersigned, I am fully aware of the responsibilities as wner bu.11der. i hereby cartify that the personnel listed below, who are presently performing work at �/-5� � « 5/ �� are employed by me. I will withhold Social Security deductions, State and Federal income taxes. They are also covered by Workmen's Conpensaticn Insu:ance as prescribed by the State laws of Califorr.ia. Neu� u A^u^uFESS Date � � /�/ — / � --- OCCUPATION Signed: � �� -^ <Yc��- Address• ��75 �- oZ/ � �s-�-� /'�1��. .� � CITY OF COSTA MESA PLANNING DEPARTMENT A. P. No. Bldg. Penni . -! ... t� 7�fA7GOO�S��IRC1�if5YOo0.00 PARK AP1D RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address v7�; _ F�ct �let. �rrrnf �n�ta '"^•3� �'n11f97'�18 Owner's Name pT�,;y K�rh�rt Bachelor or 1- Bedroom Units 2 - Bedroom Units 3 - Bedroom llnits $25.00 = $40.00 = $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total number of Dwelling Units � Si'�. pQ Total Fee �:� �� Planning Department Approval Date �_ �_ � Pa k Area No. � By U.;,,:i, A�� Applicant's Signature .0�� Q�,`Q\((�QJ�y( . J 1�-7;��,:°001514R�**c�'80.00`I CITY OF COSTA MESA PLANNIN� DEPARTMENT A. P. No. Bldg. Permi `N6': `'- "` PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt erojecc nddress 375 [ast 21st. Strr�ct. Cnst, ;t�.;,, P�lifnrni� Owner's Name Ralph itr�hal't Bachelor or 1- Bedroom Units $25.00 = 2 - Bedroom Units � @ $40.00 = ��.�� 3 - Bedroom Units $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total Fee $y30.J0 Total number of Dwelling Units � Planning Department Approval Date �_7�_7� Park Area No. �_ By N.LD. Anne Applicant's Signature _��L�\.1 �� 1�it=�.i �.ti / r �. � I �OWNER JOB ADDF � 'ERAL ? t.. �Jo.17 �INSPE�TIi SOIL GAS KEPHART, RALPH ss 375 EaSt 21st ONTRACTOR owner -222-02LOT c W FTER ROOGM PWMBING PROP. $WR. LINE CPFINNI INf. CVCT UNOERGftOUN� FLOOR SVS' BOND BEAM SHEATHING nia coNoiri OR POLE POWER I� STEEL REI FRAME ANO FLASHING � � L'�'+ING — IN OUT 'ER, BROWN COAT S1nUCTURAL, FINAL HEATING, VENT., REFRIG. ANO A.C. PIIIMBING, FINAL AND GAS TEST � ELECTRIC, FINAL E DATE BUILDI ION of WORK du' E VALUE SUBCONTRACTOR 6-1 I:G7 ► �- " 34776 " COSTA MESA BUILDING-SAFETY DEPARTMENT P.0.80X1200 COSTAMESA,CALIFORNIA92626 � For Applicant [o Fill in Completelyp�� BUIIDING �S __�1 .� /�_ //-- �n ADDRESS l.c��et t'�� OWNER (� ! `j n � ADDRESS ��'0 ov�r —h'�y �� CITY /1P(y Q�" No`.� �y6/I CLOENDERCTION ;,, �r Q � —. N � BRANCH OW Q rG � — AODRESS Z1� �J%-Qlj� ARCHITECT 1 __-.� _ l/ I _�TEL. /� 1 r� aooaess L S�C — l7ll! D04 CONTRACTOR /'I(ry�Q�r l ADDfiESS a� Y Q�/Q�^ TEI. /� l, GTV N�w;or NO. (�Y�V�' STATE CITY LIC. NO. LIQ NO. SIZE /�OXI� y INOWONLO S ( OF LOT lD 0 EXISTING BLDG. DYPi llI M CI NEWBLDG./��X� / NO.OF ROOMS STOfl1ES � EMERIOR WALL ROOF (-� COVERING S�UGLQ COVERING IrOG � USE OF BUILDING AND WORK TO BE PERFORMED � ///.n/O.X � • =•-�;�`��p0i?az�:� ��u47.57 APPLICATION FOR BUILDING PERMIT RECEIj[�D By DATE RECEIVED nATP Issu Q� BUILDING ^� ADDRESS ✓�� J1��„�/-f �H FIRE ZONE APPRi ZOf�L� � NO.OF USE OF NEN /` PLANS �. BUILDING VARDSAPPROVED VARDSA MAIN BUILDING ACCESSOR (FROM GL STREET) RONT SFT. 3 �r. -T'u�-•-� I SFT. L. SIDE ~ REAR SFT. DISTANCE BET. �j � BET. MAIN & MAIN BLDGS. �7 ACCESS. BLD VAR. � � ,� _ � � DATE _ I hereby acknowletlge tha[ I have reatl this apD��cation antl state � -='�� that the above information is cor�ect and a8�ee to comply with all laws regulating builtling construction, and I shall not employ any person in violation of the workman's compensation laws of r' the State of Califo�nia. ��O I hereby certity that I am properly licensetl as a contractor under Sn' F tha State ot California Business antl Protessions Cotle, Divlsicn 3, THE AMOUNT' Chapter 9, antl that such licanses are in full force antl affett, or I THE PURPO6E O am ezempt trom the provisions of the State ot Californie Business VALUATION antl Protessions Cotle, isi n 3, hapter 9 SiB�ature of Perminee 8 � / OQQ Auihorizad Ageni i ED � D �s�12�1�� o IOWN UNDER VALUATION IS FOR � ESTABLISHING A PERMIT FEE ONLV: m ¢ m PERMIT FEE $ � r 7 PLAN CHECK $ - •✓�/ S E LL TOTAL FEE $ �� OWNER JOB AC GFN�R o. INSPE( ;� SOIL � GAS �� WATER ROUGH P PROP. 5' ING St. SPRINKLING SYSTEM ^ MISCELLANEOUS ROUGH HEqTING AND AIR CON�ITIONING TEMPOA!AY SERVICE OR POLE UN�EAGROfIND � POWER � ROUGH'MIFING TRENCHES � FORMS � ST�EL REINF. FLOOR SVSTEM BONO qEAM ❑ STEEL REINFORCE r] SHEATH�NG FRAME ANO FLASHING LATHING - IN n OUT n P 'ER, BROWN COAT 5 .7�RAL, FINAL HEATING, VENT., ftEFRIG. AN� A.C., FINAI PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL BUILOING, FINAL DATE _ -10/16/72 BUILDING PERMIT N0. SUBCONTRACTOR " ' � 35563 COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 C0.STA MESA, CALIFORNIA 92626 Z . aU Z Z Q ON am J7 J � Q W m J •fL J Q U N 2a W � a u,+ w Z J Q m Z J ¢ W w o= Z� w� �O F z Q U J a a Q � F N Z O F U � � � N Z Foi Applicant to fill in BUILDING .�7 � � Ps � OWNER MAIL AO�RE CITV BRANCH ADDHE55 ARCHITECT CONTRACTOR ADDRESS CITV � STATE � UC. NO. S12E � OF LOT VSE OF ExISTING BLDG. SIZE OF � � � �� NO. Of TE N�`. G YG(r,S CITY LIC. NO. NO.OF BLDGS. NOW ON LOT Z BUILDING ADDPESS FIFE ZONE nvvaov PA70 1CT th-7i�;f5;,O0 601+f �'^**��S.�Z TION FOR BUILDING PERMIT � (� g�pCK �r� NO.OF VSE OF NEW /Q�� '� �.. PWP6 � BUILDING ��L` VARDSAPPROVED VAROSAPPROVED OISTANCE BET. MAIN BLOGS. VAR. qW I hereby acknowledBe Mat I have reetl Mis apP��catlon entl rtata that the abova information ia corract antl apree to comply wiM all laws requlating builEinB constructlon, antl I shal� not amploy any pe�son in vlolation of Me workman's compensetlOn lawa Of the StetB ot Celifornle. I he�aby c¢rtify thet I am p�ope�ly I(censatl es e contrector untler che Siete ot Cnlifornle Businezs antl Profassiona Cotle, Divisicn 3, TME AMO Chapter 9, antl that such licensas are in full torce entl eifoet, ar I THE PURF em exampt trom the pro�isions of iha Siote oi Calitornia Buflnasf VALUATION antl Profezsions COEe ivizlon 3, Chepta 9. , Slpnatureof /// ✓ w. ` �/ / Permlttee r G✓IA � S �v Aut�orizetl Apent BET. MAIN ACCESS. BI DATE V � TW(� 0 � O VALUATION IS FOR � A PERMR FEE ONLV: Q m E $ r� � J - m K$ E � ° LL $ . j�J OWNER TEMPLETON� Ken �JOBADDRESS q75 F.ac „ IERAL CONTRACTOR Own '.� .,, No. 118-222-02 LOT �INSPECTIONS Pool Location � Forms Main Drain Steel Reinforce Elec. Bond — Approval to Cover Underground Electric _ Gas Piping Test Filtering System Lines _ Backwash Lines and Recep. Electrical Final er and Vent Final _ Filter System Final Backwash and Recep. Final TRACT DATE 8-14-74 BUILDING PERMIT N0. Zpp DESCRIPTION of WORK Pvt.Soa FIRE ZONE VALUE S 3 000 0 GROUP TYPE ZONE SUBCONTRACTOR PERMITS I Date Numk Electric /9wna.� � . 3 7 ° Plumbing iXirn�a�, �RP�_ 4-3-75� !06/ � ' 3a�b� COSTA MESA BUILDING-SAFETY DEPARTMENT 2 . d U Z Z Q O� a m J � J N Q lJ! tt1 J . Q1 J Q U N ZQ W � aw J Q m Z J � W w � _ Z � W � N � �O aaic �.C� qiir iL-74�M��00121y;r �an,t< P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fi!! in Completely AP LI ATION FOR BUILDING PERMIT R EI E�V DATE RECEIVED D E IS ED ADIDflESS .77� �. �/ y� �• � — '/ PER IT (1n OWNER �N �l,i. E.t.�iN(_E_-7!>V A•P• NO. 1 �Z'LZ—OZ LS MAIL BUILDING �� C ` �, '� (+� ADDRE55 d��'S E. �/ �T �' �+'D`DRESS 3 �\ - CITY CngT�y �/%3q NO`[p1'r�-�G ry'^"CT��S. �COTZ--t�p BLOCK CANSTflVCrION W ADD LENDER BRANCH OWNER ADORESS V LUE ARCHITECT TEL. S $ OR ENGINEER N FIRE � AODRESS 20NE TVPE GROUP APPRO D CONTRACTOR � / �� BV DAT — ADDRESS p�5� TEI. Z� • Y 2 PLAfJS Z BVILDING EW �� CITY NO. 1� STATE CITV VARDSAPPROVED YARDSAPPflOVED LIC. NO. LIC. NO. MAIN BUILD�NG ACCESSORY BUI�DING SI2E NO.OF BLOGS. (FROM C/L STREET) OF LOT NOW ON LOT ROfYT FT. O FT. � USE OF EXI5fING eLOG. � T S FT. SIZE OF NO. OF NEWBLDG. ROOMS STOR�ES l.S{DE FT. ��FT. EXTERIOF WALL ROOF 1A^ COVERING COVERING REAR FT. � FT. IJN USE OF BUILDING AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN & MAIN BLOGS. ACCFSS. BLDGi. � � / VAR.# DATE 8 /7- S/�F7 �yRGu�-� C.U.P.# APPROVED APPROVEDI \ C1 13 �� c�I V" lh F I hereby acknowledge ihat I heva reatl thiz applicaxion entl state t�at ihe above intormation is corract and aBree xo comply with all laws r00ula[Ing builtling construction, antl 1 shall nOt employ . any Oerso� 1n violatiOn of the workman's comp0nsetion lews ot the State of Calitornia. '�( I hereby certify Mat I am propefly licensed as a contrector untler $Q. FT. Me Stata of Calltornia Business Bntl Professions Cotle, Divisicn 3, HE AMOUNT SHpWN UNDER VALUATION IS FOR Chapter 9, antl that suc� licenses are in full torce antl atfect, or I THE PURP�E OF ESTABLSNING A PERMR FEE ONLV: am exempt f�om [he provisions Of Ihe Steie ot California Business VALUATION /j ane Professions Code Division 3, Chapter 9. /� � PERMiT FEE $ .� SiBnature of n �/� �//� ��y M`/1') Permittee CXr /��`�N�`�-�Tr7 $ p�`�O PLANCHECK$ � Authorizetl Ageni TOTAL FEE $ '7� J � � K� � 'r' — _ • i ��yy � �' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 Z . aU Z Z Q O v~i am J � J � Q W C] J -m J Q U N Z a W � p, W W Z J Q m Z J ¢ W w 0 = zr w� � � �� PAil' J auiri:9�.5C1 � � .-%"'�r. '�� 515 0' APPLICATION FOR BUILDING PERMIT ForApplicanttoFillinCompletely qECE1VEDeV DATERECEIVED BUILDING / O//ATE ISSUED ADDRE55 � v�/� / � PE IT OWNER �/ A.P. NO. I —O � MAIL BUILDING ` �/ _ . ADORESS ADDRESS TEL. TRACT l0T BLOCK CITV NO. CONS�RUCTION W A A R LENDER BRANCH OWNEfl ADORESS VALUE ARCHITECT TEL. $ OR ENGINEER N FIRE ADDRESS 20NE YPE GROUP APPROV E /� � � �� CONTRACTOF 8V W✓YY�.Q�P.TE ADDRESS TEL. �ONE NO.OF USE OF NEW CITV NO. P�� BUILDING STATE CITV �'ARDSAPPROVED VARDSAPPROVED UQ NO. UC. NO. MAIN BUILDING ACCESSORV BUILOING S12E NO.OFBlDGS. (FROMC/LSTREET) OF LOT NOW ON lOT RONT FT. FT. USE OF EXISTING BLDG. FT. FT. SIZE OF NO. OF NEWBLOG. ROOMS STORIES L.SIDE FT. FT. EXTERIOfl WA�L ROOF COVERING COVERWG REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN & """ ��ry MAIN BIDCv^. ACCESS. BLDGS. � � VAR. # DATE C.U.P.# APPROVED APPROVED I �ereby acknowletlge [het I have read this apPlication antl state that the above information is correct antl apree to comply with all laws regulating builtling construction, antl I shall not employ eny Oe�son in violetion of the workman's compensation laws of Me State ot Californie. m � I �eraby certity that 1 am properly licensetl as a contractor under SQ. FT. O the State of Californle Businass antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, antl ihat such licanses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m am ezempt from She provfsions of the State of Calitornia Business ¢ and Professions Code, Oivision 3, Chapter 9. VALUATION m PERMIT FEE $ � S � ] SiOnature of �� m Permittee $ i C / PLAN CHECK $ Q Authorized Agent LL TOTAL FEE $ �