HomeMy WebLinkAbout130 21ST ST - Building Permits r • '1 CITY OF COSTA MESA
o tits, BUILDING DIVISION
�I
g"e e77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
." FOR INSPECTIONS CALL:(714)754-5626
*'�""* PERMIT NUMBER: E10-00192
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42612104 DATE ISSUED: 08/1012010
ISSUED BY: CAC
JOB ADDRESS: 130 21ST ST CM Suite/Unit:
Vicinity:
SCOPE OF WORK: UPGARDE SUBPANEL TO 125 AMP
OWNER: WARD,DONALD R TR Address: PO BOX 11833 Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: KEVIN NEPPL Address: 2338 BUNKERHILL WAY Unit:
PHONE: 714-743-8027 City/State/zZip: COSTA MESA,CA
CONTRACTOR: CORNERSTONE PROPERTY SERVICES INC License No. 903979
Address: 2338 BUNKERHILL WAYUnit: PHONE: 714-743-8027
City/State: COSTA MESA,CA ZipCode: 92626 CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00 1111�� C / (it'
DATE.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 1. INSPECTION TYPE DATE INTITIALS CODE r INSPECTION TYf DATE INTn1ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing p p A Q,.
200 Final Re-Roof 210 Final Electrical - R t)[1 S(•�I Kt 'Q
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by lever s licgnse. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
El I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy El I hereby certify that no excavation five(5)or more feet in depth into which a
number are: reef
person is required to descend, will be made in connection with work authorized
Carrie? (.o W eav r fl✓t �/1(—q P�ft C 4S UI by this permit,and that no building structure,scaffolding,falsework,a demolition
L ! �o or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This season need nt be competed//if1the�grmn i 3alued at one hundred dollars(E )orless)
2,Art 2,Sec.341,Title B,California Administrative Code).
POGcy.Numtier: C p c A 1D 5 �j
1 ❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code,I shall forthwith comply with these provisions. Applicant's Signature Date
B/// //0 Division of Industrial Safety Permit Number:
Apo san's Signature L ale=:r1_ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
13674P- 03 f ll71Class:#-^( C- (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
-" e )I /0 each business which at any one time has on hand a quantity of acutely
entractes&realm cs te----- hazardous materials equal to or greater than a weight of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the Califomia Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation. WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044.Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracta(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: • the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
ign a egal Owner(s) (ADate/4
Signature Date tO•T
3057-46 13/07) Iltllti7Auworized Applicant ". ��
•
_i
• CITY OF COSTA MESA
BUILDING DIVISION
*44 I- 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�. .` FOR INSPECTIONS CALL: (714)754-5626
="'^4 PERMIT NUMBER: E10-00192
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42612104 DATE ISSUED: 08/10/2010
ISSUED BY: CAC
JOB ADDRESS: 130 21ST ST CM Suite/Unit:
Vicinity:
SCOPE OF WORK: UPQARDE SUBPANEL TO 150 AMP
OWNER: WARD, DONALD R TR Address: PO BOX 11833 Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: KEVIN NEPAL Address: 2338 BUNKERHILL WAY Unit:
PHONE: 714-743-8027 City/State/zZip: COSTA MESA,CA
:1 0-00192
CONTRACTOR: CORNERSTONE PROPERTY SERVICES INC License No. 903979
Address: 2338 BUNKERHILL WAYUnit: PHONE: 714-743-8027
City/State: COSTA MESA,CA ZipCode: 92626 CELL: •
1r
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
_r
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODER INSPECTION TYPE DATE INTmAL$ CODED INSPECTION TYPE DATE INTITIAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining Wdll 212 Final Fire Prevention
'202 Final Factory Fire Place 220 Final Planning Approval
?03 Final Sign 222 Final Site •1 _
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
/y\I have and will maintain workers'compensation insurance,as required by
'section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit '.n issued. My workers' compensation Insurance carrier and policy
0 I hereby certify that no excavation five(5)or more feet in depth into which a
nu •.err re: person is required to descend,will be made in connection with work authorized
( OKI ov- Pc er 1—../
by this permit,and that no building structure,scaffolding,falsework,a demolition
•orris t! 'ry T or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
m need not competed 1the pemnI rs at acerae collars(Sleelor lees
L C A 05. 2.An 2,Sec.341,Title 8,California Administrative Code).
Poli Nu ber: /t
0 As owner-builder, I will not employ anyone to do work which would
❑ certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of —
the Labor +de,I sh- forthwith comply with these provisi. 5. Applicant's Signature Date
— �j .21—� Division of Industrial Safety Permit Number:
• i
.y lure oat, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAI U• TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has al any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
m�• se f is in full force and effect. /' a registration form for acutely hazardous materials? 0 Yes 0 No
drgo3q q as# G (Section 25533 of the California Health and Safety Code, with some
t p exceptions, requires registration with the Costa Mesa Fire Department by
����,a��� 13//a �� each business which at any one time has on hand a quantity of acutely
�Ir" = awre a hazardous materials equal to or greater than a weight of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors informalction65850.2nfu i the CaliforniaaGovernment Code requiresbuilding thnt thee requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential permits).
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property,or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044. Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
(hereon,and who does such work himself or herself or through his or her own
8. (If yes',attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If. however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the roe am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
property,rtY.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
13 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
`- Liger(sl Date
Signature Date /�/G/—v e. . .e
3057-66(3/37) And/or Authonzr.nt to
r } • >_.
4`05w-t•. 9 \ CITY OF COSTA MESA
BUILDING DIVISION
fy Ziga"r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�• PERMIT
403-01052
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 130 21ST ST Status: ISSUED
Suite: A Applied: 06/19/2003
Vicinity: RESIDENCE A ONLY Issued: 06/19/2003
Parcel Number: 42612104 Zoning: ::59 _
-
Applicant DAVIS, DEBBIE ISSUED BY:
Address: 984 N ELM ST
Phone: (714)628-9525
ORANGE,CA Zip: 92867
Owner: WARD, DONALD R TR
Address PO BOX 11833
Phone:
COSTA MESA,CA Zip: 92627-0833
Contractor: DAVIS ROOFING CO
Address: 984 N ELM ST
Phone: (714)628-9525
ORANGE,CA
Zip: 92867 License: 509824
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: - License: License:
SCOPE OF PERMIT
REROOF RESIDENCE'A'ONLY:T/O EXISTING COMP ROOF,REPAIR/REPLACE SHTG AS NEEDED, 1 15#FELT,APPLY'20-YEAR COMP
SHINGLES.'13 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,010.00
Permit: $97.25 Claim Valuation: $3,010.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 •
•
Total: $97.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92.28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)750.5626
2446.46(6/00)
DECLARATIONS' r' ' .,
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
!have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My works mpen1sation Insurance carrier and policy number are: /� rj
Carrier: pec n }T1M� �t 1 Policy Number: 7i 05-v I'7 2,4
(This section ne d not be comp/et I (he perrn/f Is va ued a one hundred dollars($100)or less.)
O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation I Mamie,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with prove Ions. hi �1
LN
Applicant Sig urs: . � Date: a ( •t o
WARNING: E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAN DOLLAREf$l0goao),IN ADDmON TOTHE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and rseffect.
Sig Lic.atu e___7t VLA' oast t/ e- 6
Contractors Signature: ��((�L ff)) ..�� Date: O T
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097.Civil Code).
Landers Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Coda:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will havethe burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document.i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: •
❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code),
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building–occupant–need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes 0 N
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
_prop_. .... ___ _.__ _._.__._ ....
4 II an RMPP is presently required.has Section 25534 of the California Heal
th and Safety Code been fully complied with? 0 Yes 0 No
�._ such construction
_ —5 Does will the applicantsAiror present a future bustling oaom at require for the work which the or this application eppermit for Cor modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
prp.._ wo..___.._ subject
_..
7 If a permit from the South Coast Air prescnbed
ed by Californiaeal or and
airpollution–controldeSoon district3 agency is required for the work which is the ubeof this
application,have all of the disclosures prescribed by Celifoia Health antl Safety Cale Section 42303 been made? 0 Yes 0 No
.__ _ _prop.._te__—_._ _.i._ _ ____..._....._....
B (If"yes",attach certificate of compliance–from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the intonation given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
c_______SignettOf Legal Owners) A Dat
&� I e,
And/Or Authorized Applicant Date
cm I INSPECTION TYPE PAIL IILIQIELS BODE( INSPECTION TYPE PAIS Mall
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final O 208 Final Plumbing
200 Final Flo-Roof or ,t ` ' 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
c. pMFs+ CITY OF COSTA MESA
4 �,:` CALIFORNIA 926281200 P.O.BOX 1200
fC. DEVELOPMENT SERVICES DEPARTMENT
y`-"PORRifo`9yA
February 10, 1986
To:
Building Safety Division v Pacific Bell (2)
Business License Division Police Department - Ping. & Research
Communications Santa Ana Heights Water Company
County Administration Office Sanitary District Engineer
County Clerk/Board of Supervisors Southern California Edison Co.
County Registrar of Voters Southern California Gas Co.
County Tax Assessor State Board of Equalization
Engineering Division (2) Street Division
Finance, Revenue Division United States Post office, Adams Avenue
Fire Prevention United States Post Office, Santa Ana
Manager, MID Zip 4 - Santa Ana
Mesa Consolidated Water District File (2)
Newport-Mesa Unified School District (2)
The City of Costa Mesa wishes to advise you that in revising street addresses,•
the following addresses have been changed:
OLD ADDRESS NEW ADDRESS A.P. NO.
130 E. 21st St. , "A" 130 E. 21st St. , "A" & "B" 426-121-04
For your convenience we are listing the agencies above'that we have notified
of the change. In addition to those listed, you are advised to notify your
correspondents of the change in order to avoid any passible interruption of
mail service.
Your cooperation in this matter is appreciated.
Sincerely,re
MEL E. LEE
Planning Intern
MEL:alm
cc: Ward Investment Co.
Attn: Dee Ward
2110 Newport Blvd.
Costa Mesa, CA 92627
Code Enforcement/Business License (714) 754-5234
Building Division (714) 754-5626 Planning Division (714) 754-5245
77 FAIR DRIVE
A
41-
�F
iso et• 2 1 sr 5 Sr scAce ethonfe
a I srSTREEt
J
. . immilmEll
- f itnln heavy bordbr n gn all a,propriate dee are lens. -
COSTAM NS7RU TION PERMIT • SPE Ivu'-rvv. / RACT NO. LOT NO. UTAI O.
-3UA21st 5free „ Is ,r GE �a a1a I. 183 ' 4
a` Pr,,_.t Address , ,
•�,,a TYPE OF CONSTRUCTION LI NEW LI ADDf l
Applicant's Mailing Address 21 0 Newptlrt IDVO. #1 U ALTERATION LJ REPAIR 7F,Cfl 1 /! '7/ L
❑ CONVERSION III DEMOLISH ❑ OTHER-
'Owner's
'Owner's(Eames Don Ward •
Phone 642--2000 � A.P.# 426-121-04 I ZonaR_.2
DESCRIPTION OF WORK/USE OF BLDG -I
Address,' 7110 Newport Blvd. #1, C.M. . �- S Main Building: Accessory Building: •
Arch/Eng. ,Tnhn wells License No.C-M 42'32TYP�E1 OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL T Front i / KTj.� O
"a' Address ALJ TENANT ❑ ELECTRICAL ❑ PLUMBING ElMECHANICAL B Rear 7L 6 ie N
❑ OTHER A I
r Contractor's Nam. I.r.- a ._-_ _ Phone 642-2000 R_ C Right S-' � N
1 Nec'�po B •. #1 PROJECT DESCRIPTION $O. FT. 1S 0 OCCUPA Y
Address(mailinpg) ryp� ,v� K / G
{v7/A CONSTRUCTION TYPE ` — VALUATION$ C'a 3 Iv 9 S Left S R
City License N ZONE R_2 GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION �1 / �� /I Ping. Ref.#DA-S'S-Q Parking Req./Provided a / E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: P� !� �� — �\ .L-.1 Planning Notes: !! Cl
with section 7000) of Division 3 of the Business and Professions Code,and 2J v��s� � M
my license is in full force and effect. /-t..(1.<Oee 7 / q,•1t HOLD. FOR SPECiAL RFgt)egEr75AITb' $
T
License Class License No. PLUMBING FEES �-`^"-
Date Signature -
'
WORKERS'COMPENSATION DECLARATION • Bar Sink 1 Showers a —
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a Certified copy thereof (Section
Backflow Preventer Service Sink Automatic Washer Transformer
3800, Lab. C.) _ ^ 1 ❑-15-50 KW
;licy No. Company 1 Backflow Irrigation ,Sewer Ca ' Ciel
O` : • ❑ 50+ KW
Certified copy is hereby furnished. p 1 COn$lrpCllOn,Pale Sub. 1n
Certified copy is filed with the city Building Division. I Bathtubs Sewer Connection g. 1 Cooking Unit -Meter ❑up to 100 amps f r
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors 1 Dishwasher Meter Dover 100 amp2 /�
(This section need not be completed if the permit is for one hundred ($100)or , - at• I• CN
less). ' Dishwasher Solar Piping )— 1 Dryers as ❑Electric. Sub Panel 5, W
I certify that in the performance of the work for which this permit is issued, -
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solei Tank - - 'Fan -
workers' Compensation Laws of California.' Motors 1:10-1 HP 01 Ni-8
Date Signature - Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE:If,after making this declaration, you should become subject to the _ Int.Solar ❑Y-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures a1 �O
C comply with such provisions or this permit shall be deemed revoked. _ — 13 Microwave o •
CONSTRUCTION LENDING AGENCY •
Gas Service Outlets 3 Water Closet
I hereby affirm that there is a construction lending agency for the performance - Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. CJ
Lender's Name q Interceptors 1 Water Heater �., 29 Outlets. 1
Lender's Address /up1�� Range �/�, Q'�
Kitchen Sink Water Service Switches IY Ito
OWNER BUILDER DECLARATION 9 - • Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or 3 (Q ..- 1 Garbage Disposal !Standing Sections I DO
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry •Trays p Generator ❑0.5 KW❑5.15 KW
any structure, prior to its issuance, also requires the.applicant for such permit a U Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains '
the Contractor's License Law(Chapter 9(commencing with Section 7000) of _
Division 3 of the Business and Professions Code) or that he/she is exempt -
therefrom and the basis for the alleged exemption. Any violation of Section , A��
7031.5 by any applicant for a permit subjects the applicant to a civil - �,
-'salty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 -
npensation, will do the work, and the structure is not intended or offered , I
-or sale (Section 7044, Business and,Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee �$ 3
License Law does not apply to an owner of a property who builds or Improves -_ __. _ _ __— s
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SEI3ICfaS RE• I:EI ENTS: �_/‘-"C56
� / ,
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ In
I } 56
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By (('''�� _ Date
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By - G� R Z.,I- Date
• •ye for the purpose of sale). A
i I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ger Date' I-1746
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-1 , 00 BTU ❑100,000 BTU • SU RV F FEES
builds or improves thereon,and who contracts for such projects with aeon- �, (��
tractor(s) license pursuant to the Contractor's License Law). I am aware that I _ BUILDING PERMIT $ _ '0 SMIP $ o
Exhaust System ❑ Multiple ❑ tem Repair/Alteration
proof of their Worker's Compensation insurance sho be provided to me. $LAN CHECK $ t7 5 PERMIT q
0 I am exempt under Section P.C.fo l rasson Firepl/Fact.Bit.ICBG# Fire Dampers ISSUANCE $
I�f 1 ay�'�,/ PLUMBING 7.. $ - , • 6 r.
Date 1 14 86 Owner __ Heating System& Ducting Registers PLAN CHECK 25% $ - 0 ENERGY P.C. $
I hereby certify that I-have read this application and state that the above 00.100,000 BTU ❑100,0 TL 2� , 1 rig% GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL -NP' l-
and state laws relatin• to building construction,and hereby authorize repro- - , MICROFILM $
sentatives of this to enter up n he b ve-men oned pr erty or PLAN CHECK 50% $ i�D ��
Inspection purpose /s / /�� op� /f _ MECHANICAL $ a�
Signature . 4 , �tr •rn 'I' I�Date-L�— r TOTAL FEE $
Drivers' License or SS# Reinspection Fee $15 Issue Fee _ $ 3 PLAN CHECK 25% $-
/
,� CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor J/
1
•
"'
" \
CONSTRUCTION AND PLANNING POOL&'
APPROVALS Permit# uate Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. SoiIPipe-Undrgrnd. 53. Steel Reinforcement
• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
J' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
11 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings _/(3a A ttC ein a4Ds 58. Electrical Conduit-Undrgrnd.
I
8. Foundation /`eiffif '7-P 59. Gas Pipe, 0 Undrgrnd.,Test ,
.11
I . 9. Water Pipe-Undrgrnd.4-0 p5 1(4_brrt 60. Backwash Lines, P-Trap, 0 Undrgrnd.
A 10. Structural Floor System 61. APPROVAL TO DECK ,
111. Property Sewer Line & House Connection (-g---jt, LArels. 62. Backwash & Receptor-Final
ii 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 ' /t Rjw 67. Fencing & Access Approval
'.
17 "Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling p 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning 3/t7/84 f1/' f' FIRE DEPT. REQUIREMENT
20:-Rough Factory Fireplace • APPROVALS Permit#
21.'Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
'I 25. Roof Sheathing
04 ka_. 74. Overhead Hydro
I 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing ,t/c;TG- y(ritic vcy 76. Dry Standpipe
w
ti 28. Lathing& Siding 77. FIXED SYSTEM FINAL
/29. Insulation Y/IG VC, 78. FIRE PREV. FINAL
30. Drywall Nailing A6/SG Of HEALTH DEPT. REQUIREMENT
31: Plaster Brown Coat 79. FINAL INSPECTION
-)2. Electrical Power Meter-Final 80., FOOD CERTIFICATE ISSUED
•
33. Final Electric 7 Notes:
. X86- +-• S-, >~ 3 " L,1/a�-&-_ A-,4 bg?rr:s4-�--.
34. Final Heating & Air Conditioning 7404( C aS1) r - /
35. Final Gas Pipe-Test . ?///y4 J/L r 77Fr olt /kL 046 in _ vG
36. Hood or Canopy
37. Final Factory Fireplace - fir
/ �/ Veitt•(, /3/41 41. 7 tc PFFu.0,$ £oo,i/
38. Final Plumbing �X/y` �,f{ FLV,,yl4O I %3 v�`l Q
1J 39. Water Service-Final S/Z_A an y/j(/2{, Maia.4ri� -OLc > ,WD To ONO b€-
40. Gas Service-Final j2-1ft (,$D
41. Solar Domestic-Final • r-i-tt „nl „p C2a - �,�� n (`7, ,,,, ,
42. Backflow Preventer yYt GN Yom\ • :.
43. Backflow Irrigation U _ ,
44. Landscape Irrigation System ,
45. Sound Attenuation
46. Handicap Regulations Gf
47. FINAL STRUCTURE & BUILDING g//
�,/ Vu
48. Special Requirements Completed. 111 rL�
I -21-14 MM
49. Electric Release to Edison ' -
•
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
•
No. Date
- 1 -
John E. Wells ,�f is Architect & Associates AIA
tte,_ Planning Engineering Interiors
February 19, 1986
City of Costa Mesa
77 Fair Drive
Costa Mesa,
California 92626
ATTN: Building Division
RE: 2-Story Rental Unit
130 East 21st Street
Costa Mesa, California
Owner - Don Ward
Gentlemen:
The minimal amount of ground water found in the bottom
of the foundation trenches during our inspection, immed-
iately prior to pouring concrete, is acceptable. This was
displaced by the concrete during the pour.
r.
Yr
Jo n E. Wells,
Architect A.I.A.
JW:j
5160 Campus Drive, Newport Beach, CA 92660-2150, (714) 833-1171
- T y.tot`n o' 3 moi
V
t
& Associates AIA - ' ,. r kw> ,;:•
aRd Architect interiors -"....,----':,..--.3...-•�- ..
Wells
;It It` planning Engineering .- '�`•s%-• -- i '
Yy
—J'�,7 •r ;V' 1}- .;
E. _ -64 Via,
John •
:-: -'S
- „tr.-04-7'2, -�`
'-. - e19 198
Costa Mesa
�' / City of Drive , .;.:.=- --;--t .c, ,,,..,„
77 fairD , t
Costa s 92626
-- • -California y� e rFl
Division a
TTN: guildin
A �, - to
unit ��::'s;: .: Y_r.�.
-f 2-Story Rentalstreet r,,.:- -4a.•P , .Yr:: ....
• RE: ct 21st
130 E — i-,aWfornia r - ' ,F e.
Costa sa ,,'.•: ..
Ward
Owner - Don
' Y'l Gentlemen: Sound"in the b d e---F1.a r,<. �,
Dunt of ground water ins ectton,-imine
The minimal am es during our.• . P This was - '
tree concrete, is a e r . ..- `.g,--tt v ..:-,N.ry+ ,
' the foundation
eh
late1Y Prior to P concrete during. e bf ' J- •Y`-,.
th trill
b the
displaced Y =`T :' 2,trjt._ r Y
- - lett,\il Y; -
�• ./'i'. ft s:..b'°`1.w .. ...�r
—
• '-.- ..-- . �.r�- +„2�a..-5!. .:44-
t,,,
. ...-- n;g sw • ,.1e. ,t-119' • a• ;>w f
a Aa A .> i�‘' • -;.
. ,„. e itect e 5
-- J t„• ..} - r. -
{ ;S
"l
Mr.
• --.. -. .. _ _ .w ' tit sa...•S
c ,714) 833-1111 ••;,,.a -s' .
- 92660-215 --T
Beach.
•' 5150 Campus Drive, Newport
-7--; 73 4ed wal 7; eafie
0
WIH
WARD INVESTMENT CO. 2110 NEWPORT BLVD.,COSTA MESA,CALIFORNIA 92627 (714)642-2000
7a C ot ! ti>� 7A e D(--c I v�
, 0
e q
l T
�i7e h ('1 / a0SC �' / 74r 1-Cc 1r of
30 ge. 07/ 111L/
Po
pad yfr-ad/
-71 c c )- / Y
4,747 � ,9srt1
/ v - e iTh N/, (. )71,
Z i
P/Q- c n-i� �a
e 567 s e .40/it 4 " Quo Gc2 -/Xi
d 0 v 6 o ' . . a/ft` ft [X e ?C r � k y
a- rto_ a d /40 Cfrive 6.) `ic s
/C/DGJ�J Gtr o� v C�f � l- /D /I 7:6-0 14
�rok / a F yetg Aousr CD 74, elir6)
7i/ ��� US /6a
o .74 g S ?r cP
vel Tip G- eo-p Y Q vc/ Xto edeon
'l�'c C'r S� 7/0 ecic ai // t zeJ
7,/0 i . a)14 S'/o/ r d rl 7`4 07I i u 0
S a a " eei4 Cv ('vdI f `) //
" 'd% � ��� r� r Ste � � r7
;2„, 10/��g e v,, 90/ �`Q r
F it/P- ,‘ Co Gee-6r. Ou . 6 , 114
Applicant to fill in all spaces except those within h ae vy'bo der lines and sign all appropriate declarations.
PER T NO. TRACT NO. LOT NO. UNIT NO. 75411 1/16/86
st I ccO IL
CITY®F COSTA MESA CONSTRUCTION PERMIT y�f
Project Address 130 e, a 1 a 03 397 19-3 •-
Applicant's Mailing Address a ii 0 Akin?.f'I B(vd. # I •
TYPE OF CONSTRUCT ❑ NEW LJ ADD ALTERATION U REPAIR ///��'
J l �� ��n ❑ CONVERSION DEMOLISH ❑ OTHER s r AP.# // '7G -7 f --OCI Zone (-f-2
Owner's Name. • 1 ,r c• Phone (el lX (A 2l /`
//�1 1I11 DESCRIPTION OF WORK/USE OF BLDG.
Address alto �LWUO ry- AIUrf. •I L Car , f S Main Building: Accessory Building: Z
Arch/Eng. ( License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front O
Address ❑ OTHER ❑ ELECTRICAL ❑ PLUMBING El MECHANICAL BA Rear N
Contractor's Name Phone __ - C Right N
Address(mailing) PROJECT DESCRIPTION SQ. FT. OccU PAN�V K G
CONSTRUCTION TYPE VALUATION$ ,ODD .0a S Left
City License No. ZONE RP.-
_ GRADING GU.YDS. ACRES E
• LICENSED CONTRACTOR DECLARATION //I_ _ Ping. Ref. #' Parking Req./Provided
ci
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /y//�-t JI Planning Notes: - M
with section 7000) of Division 3 of the Business and Professions Code, and' CCC/.__.'��""""""'
my license is in full force and effect. T
License Class License No. - _ S
Date Signature PLUMBING FEES • '
WORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
:t/:ereby affirm that I have a certificate of consent to self-insure or a certificate _
b,x. 'Workers' Compensation Insurance3 c�a cer ' led copy ereof eection. Backflow Preventer - Service Sink -
-J800, Lab. c.) O ,�t}(h6 Automatic Washer Transformer 0 15-50 KW
Policy No. N 0/
b7 3a' Company `�✓�"'�' - 0 Backflow Irrigation Sewer Cap Construction Pole Suh. • 0 50+.KW
Cer - d copy is hereby furnished. -
ti ledfoppyvskw�ss filed wit the c' A •ing Diva,/ Imo. t Bathtubs Sewer Connection Cooking Unit Meter 0up to 100,amps
ate J-Y(sr 6l',/ ; Y %
EXEMPTION FROM WORKERS'CO -iioNSATIO DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps
(This section need not be completed if the permit is for one hundred($100) or '
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel •
I certify that in the performance of the work for which this permit is issued, I ,
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank ,_ Fan • Motors 00-1 HP 0114-8
Workers' Compensation Laws of California. —
Date Signature Floor Drains • Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+
'NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ.' C.) Interceptors Water Heater Outlets Range
Lender's Name .
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION - -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - Garbage Disposal !Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or -•
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW
any structure, prior to its issuance, also requires the applicant for-such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law(Chapter 9(commencing with Section 7000) of •
'vision 3 of the Business and Professions Code) or that he/she is exempt -- - - --
refrom and the basis for the alleged exemption. Any violation of Section • .
31.5 by any applicant for a permit subjects the applicant to a civil ' - ' '
•
enalty of not more than five hundred dollars($500). -
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 • Issue Fee ' $ 3
•
compensation, will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL FEES I
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own — DEVELOPMENT SERVICES REQUIREMENTS: •
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0
N-sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
\\, Ietlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved By �\ Date
6 ve for the purpose of sale). al
/—// 6h
sl, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
'Application Issued By Data 10�1
dors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU _ SU�M(1R� FEES $ SV
�
builds or improves thereon,and who contracts for such projects with a con- - •
tractor(s) license pursuant to the Contractor's License Law). I am aware that `I- ,BUILDING PERMIT, $ /c , SMIP f
proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration ,
PLAN CHECK $ PERMIT
0 am exempt under Section B.& o this reas•n Firepl/Fact.Blt. ICBG* Fire Dampers ISSUANCE $
/ PLUMBING - $
Date /_'�/S�G- Owner i!•. (' LIN I / /J • Heating System& Ducting Registers PLAN CHECK 25% $ - ENERGY P.C. $
—�- - p sV p-..r-s.
I hereby certify'that-I have read thi- application and st. e that the above 00.100,000 BTU 0100,000871. ELECTRICAL $ • GRADING $
Information is correct. agree to compl with • I city and county ordinances -
and state laws relati•• to building r io•, and reby authorize repre- PLAN CHECK 50% $ • MICROFILM' $
sentatives of this it. to ent• /•rt/ Jove- •rationed property for / /\�
inspection purpos:.. �/ f// /-/-5-4
,/S G — MECHANICAL $ •
TOTAL FEE $ L�`O✓
Signature ' �.i.�i `✓�
-
_ _ _ _ . - . .
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor _
' 'CONSTRUCTION AND PLANNING POO SPA
APPROVALS Permit# Date Inspector APPROVALS Permit'# Date Inspector
•
1. ,Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
'
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ..
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . :?
7. Footings 58. Electrical Conduit-Undrgrnd.
/
8. Foundation. 'i 59. Gas Pipe, ❑ 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 Cap4 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
•
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
• 23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
I25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster-.Brown Coat 79. FINAL INSPECTION
32. Electrical'Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric - Notes: f� -
34. Final Heating & Air Conditioning Q ,. I idj aQc_/1 caA Raj
35. Final Gas Pipe-Test A.0 'l x IO�J C 111 t"'� v�
36. Hood or Canopy .
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 0t/4 /c •
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -
CITY OF COSTA MESA CONSTRUCTION PERMIT ��5 3/21196
�y _l • – PEF ,rT NO.�� TRACT NO. LOT NO. UNit NO. r c
Pfoject Address /30 12/^J a /� /t'I O`1C (_J1 �s�– _ !J l
Applicant's Mailing Address ��s/3 ZO5/ VI/4 nut 6 TYPE OF CONSTRUCTION CJ NEW U ADD U ALTERATION LJ, REPAIR
Owner's Name e £ /QQ' Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# - Zone
SQ DESCRIPTION OF WORK/USE OF BLDG.
Address ' • S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT El GRADING U FOUNDATION CJ STRUCTURAL E Front • Z0
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING &MECHANICAL B Rear • N
Contractor• 's Name • •• • x• v 'a• Phone/ -' ❑ 'OTHER A - I
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) • = ' 'p K •Left G
____ f • CONSTRUCTION TYPE VALUATION $ _
City License No. - , / 9AiZONE GRADING CU.YDS. j ACRES R
LICENSED CONTRACTOR DECLARATION "r _ Ping. Ref.# Parking'Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:�� / ' '� t�•j,• Pla nning Notes: •
Q
, with section 7000) of Division 3 of the Business and Professions Code, and s z'.4•– erm1�- Rpt,.
�•Zrr . M
my license is in full force and effect. �/ T
License Class C i1 ••••4._5 �' enjF No ��u O/ S
Date.•3 4t k3 Signnatur ✓ �*1f//Q PLUMBING ' FEES
WORKERS'COMPENSATION ECLARATION 7 Bar Sink Showers
hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL- FEES
f Workers' Compensattiolrn.y Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. C. Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer C. . ❑ 50+KW
P Construction Pole Sub.
ElCertified copy is h eby furnished.
–
Certifled copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit • Meter ❑up to 100 amps _
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ; Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(Thissection need not be completed if the permit is for one hundred ($100) or ' Dishwasher
less). Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for which this permit is issued I
shall not employ any person in any manner become subject to the Drinking Fountains Solar Tank Fan •
Motors 00-1 HP 01%-8
Worker.' C e�syaf�ssopp Laws of Calif fn' _
Date s�� CL Signal ura,�.�� ��'a ' Floor Drains Swimming Pool w/Spa F.A.U. - _ . Inc.Solar ❑9-15 HP ❑16-15+
•
'NOTICE: If,after making this-decl ation, you sh be ome subject to the - - "
Workers' Compensation provisions Of the Labor ode, you must forthwith Floor Sinks i Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance g
of the work for which this permit is issued (Section 3097 Civ. C.) •
Interceptors Water Heater Outlets Range
' Lender's Name 9
Lender's Address _.. – Kitchen Sink Water Service - SwitchesSign
OWNER.BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories _
following reason (Section 7031.5-Business and Professional Code: Any city or Auto-Wash Garbage Disposal ;Standing Sections -
county which requires a permit to construct,alter,improve,demolish or repair P–Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit p
to file a signed statement that he/she is licensed pursuant to the provisions of .Roof Drains
'he Contractor's License Law (Chapter 9(commencing with Section 7000)of
vision 3 of the Business and Professions Code) or that he/she is exempt •
arefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). '
0 I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered • -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL Reinspection Fee $15 Issue Fee $ 3
License Law does not apply to an owner of a property who builds or improves FEES -
thereon, and who does such work himself/herself or through his or her own . -a•Tn DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I L� 2 cO ZoningApproved
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II El pP By • - Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). p/
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data_ 'zi/21/p(p '
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES •
builds or improves thereon,and who contracts for such projects with a contractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT :
•
0 I am exempt under Section B.& P.C.for this reason - Firepl/Fact.Bit. ICBO# Fire Dampers ISSUANCE $
PLUMBING $
Date Ownerdip Hea System& Ducting f� Registers p .J0 PLAN CHECK 25% $ ENERGY P.C. $'
I hereby certify that I have read this application and state that the above 0-100,000 BTU ❑i00,000BTL;ay� �/
information is correct. I agree to comply with all city and county ordinances / z '�I► '[ 00 . ELECTRICAL $ • GRADING • $
and state laws relating to building construction, and hereby out •rize repre- - PLAN CHECK 50% $ MICROFILM $
sentatives of thi city t• enter •on the above-mentioned •rope f r - �•�
inspection p s. / 1M
Signature- f -.--:_'_-t.-. � � • - MECHANICAL , $ TOTAL FEE $ Z0•XJ
Drivers' License or SS %�• ' ' • •• _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ •
amissCMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
-
CONSTRUCTION AND PLANNING • POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole. - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, D 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 FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
+
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro ,
22. Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough&Test 72. Underground Flush r
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro '
26. T-B4 Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame.and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 3/,f/a,1 77,0/7„- se,
34. Final'Heating & Air Conditioning 6.9-86 Lee
` PM' Y2 mato 7;le 4t72.9,46%4t72.9,46% sate.
Jff
35. FinalrGas Pipe-Test y[�1iT1 u/Y 4yiJ�e -", h�
36. Hood or Canopy ,: - ¢; ,
'..
'37. Final Factory Fireplace '^ 1„ ✓: r , 1u
t38,. Final Plumbing i. ;' 4.'
'.86/Water Service-Final - '
•''40. Gas Service-Final .
41. Solar Domestic-Final -i" '
•.,;42. Backflow Preventer -
•,43. Backflow Irrigation
i,7
44. 'Landscape Irrigation System
`:451 Sound Attenuation 0 ', r. +4,
'46. Handicap Regulations • ' "-. ti +
n-•
47•. FINAL STRUCTURE & BUILDING i.
% °
.
48.'Special Requirements Completed- , '"
. Y •
•
49: Electric Release to Edison +• •^
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - - t
No. - Date
' r
OWENS-CORNING
Fiberglas •
Building Insulation
The contractor named below certifies that the Owens-Corning Fiberglas
Building Insulation used carries the NAHB Research Foundation, Inc.
label for assured thermal performance and that the Building Insulation is
installed in conformance with current energy conservation regulations,
• California Administrative Code,Title 24,State of California,in the building
located at:
/�130 E. 21 Street Costa Mesa CUSTOM HOUSE
/ 1 Address City Tract Number
Exterior Walls BAT TS 32 11
Owens-Corning Fiberglas Type Insulation
Thickness R-Value
Cei
igs
lns-Corning Fiberglas Type BATTS Insulation 91 30
Owe
Thickness R-Value
ltnor _ GARAGE CEILINGBtA 61 19
Owens-Corning Fiberglas Type Insulation z
Thickness R-Value
Foundation Walls
Manufacturer Type Thickness R-Value
WARD INVESTMENTS
General C t actor //��,,��� License No. n o
By 0/ apt, /i/ y"</'T04-1 eitle Ot e Date O — d
IsIonaiuwl - , INVE TME NTS
..-_ AWN.. �•.�/I/I� License No.
Byr. `?` Date
0 k, g
O,,' (Sightly if /
OWENS/CORNING
Homeowner opy( hite) FIBERGLAS
State Copy ellow)
Builder Copy(Pink) ' °'""'�
OWENS-CORNING FIBERGLAS CORP.
Pub.No.16-13L-6995-13Insulation Operating Division
Litho In U.5 A.,Jan.,1982 Copyright a 1982 Owens-Corning Fiberglas Corp. Fiberglas Tower,Toledo,Ohio 43659
• y .
.
CITY OF COSTA MESA 7589 1 /17/86 '^'' /71"
PARK FEES '' -t o't
Fee Payment Receipt 001025
Project Address /30 F , pc/ JiLG[f
A.P.Number 4a O'/
,Building Permit Number
9� �
Owner's Name {�—� u_.b'zc
Mailing Address , . I !e7 1/1./.072/11-44. 6g/ur,(
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,810.50 =
Multiple Family **
Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedrooms @ 881.51 =
3-Bedrooms+ I @ 1,229.38 = /2 a4- 35'
Total Fee *** aq* 5S'
Planning Department Ap• Date a/'•i;� '.1 4_L_'
Applicant's Signature
* City Ordinance 72-44 ** City Ordinance 72-45 ***City Resolution 78-116 p5� IDE//r...+++
CMF 0174-30,rev.7/85 White—Planning;Canary—PV' 'ng;Pink—Finance;Goldenrod—Applicant C�JIa
1\ -