HomeMy WebLinkAbout161 21ST ST - Building Permits 1 i -
1 CITY OF COSTA MESA
�\ BUILDIN¢ DIVISION
>• A
•• t.;,r. .,�. DEVELOPMNT< SE VICES DEPARTMENT PER T NUMBER
�
, PERMIT
dP E06-00803
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaEa.us LECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 161 21ST ST Status: ISSUED
Suite No Applied: 07/21/2006
Vicinity: Issued: 08/01/2006
Parcel Nunmber: 42619320
Applicant: ESCOBOZA, JOEY
Address: 161 21ST ST ISSUED By
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_ _Phone: 949-633-5762
COSTA MESA,CA ' - , /,%'Zip- '92627' -"- " -
- -
Owner: EHRET,'MIL'LICENT F
Address /ROBERTFLINKV `�, , - _ ,/,
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/COSTA MESA;CEA/ - Phone = ,�' N\/72569 AORANGAVE % Zip " '9227 >_ N `�. '
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NContractoOWNER,BUILDER . ;
Addiess:, "2,,,////'-',/// '
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Zip: . A.
License':000000 •
-
-SCOPE OF PERMIT- '
- - 727,UPGRADE SERVICE UP TO 200 AMPS. "- �/ v -
A.
"_ FEE SUMMARY `,
`. -. - �, , Quantity �'� N. Quantity - . • '•
ISSUE-FEE �, $23.50 ,/ - . - - Temp Dist System/Lighting ' $0.00 0 , , ,-- ,
Temp seryice`test' - • $0.00 / Tr',',,"' "117 1 `"�'BuswayZi00ft " r,�' ' y $0.00 0. I ,
' Res.a/c package $0.00 /. . ' .' StandingSection, _ - $0.00 0
:New Res(1-2 units) , $0.00 -- 0- - Misc'Electrical Equipment • $0.00 0 - -. ' ;•' I
New Res(3+units) $0.00 0 Transformers up to 1-kva/kw $0.00 0 !,1 �� ,
Pool/Spa - $0.00 0 -� _ up to 10:kva/kw $0.00 0 -
Lighting Fixts $0.00 _,- ,0 - - up to 50 kva/kw $0.00 0 ,'r, . -
r
Recept Outlets i '' , $0.00 ---'0 - - - -- -' updo 100 kva/kw `' $0.00 0 f / _ - . ,
Switches,_ - - \`:• ' $0.00 0 over 100:kva/kw $0.00
Non Res Appl - $0.00 I 0 Low Voltage Equipment $0.00 0 -, - _ - ,_ i
- Rds Appl ' , $0.00 .) 0 Low Volt Wiring System/Ckt . $0.00
Service to 200a , • 'H. - $30.50 1 Misc..Conddit- ,_ $0.00 0 / / - r r
Service-to 1000a v; \ /2 $0.00 , 0 Misc.Conductor $0.00 j0/ N . ,
Service pvert000a r $0.00 0 -:-.y '>•Circus
(gen or ride) $0.00 %",0 r
Motors to 1 hp / ' N�` .$0.00 1 0 -T7'..,-,3:-3,, Circus(mech ride or lights) $0.00,i/ ,0 ' - •
Motors to 10hp _ \x.$0.00 r 0 ChristmeeTree.Stand $0.00 .- 0 '
Motors to50hp, { , '`.10.02 0 Fireworks Stands'::_ _ L. $0.00/ 0 -) ,,c
Motors to 100hp\ $0:00‘.\ 0 T -Other Electrical Fee $0.00 /, i
Motors over 160hp. v$0 000 - "r /, ,- /y /
Communication drops c„; $0 00\�;: 0 - _Investigation Fee
Sub panel to 200-4 '\ r,/s -$0.00 -C--;-,:.0-,.-:: PIanCheck Fee $0/.00 - / /
Pole Light Pkg ,.` . ;$0 00 I '-^o� " = Reinspection Fee - $0.00 • - •
Sign Circuits \' \NN $0.00///��
Temp Pwr Pole N, c� .$0 00 ; 0--, -•. -- _ TOTAL.CALCULATED FEES\`$54 00
Intermed Pole 'N/ $0.00A�•,�'0)1rr �r A . - <2
'--1:,:r.,„1---,-_ '.COMMENTS/SPECIAL CONDITIONS .
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 and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
24-46-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensaioon,as prodded for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 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 permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This sect/ need not be completed if the permit Is valued at one hundred dollars($100)or less.)
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'
I_---compensation laws of California d agree that I should me subject to the workers'compensation provisions of Sod 37 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: ,--Date: 0Rpp
WARNLNG:.FAILURE TO SECURE W�� PENSATI COVERAGE UNIFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIWY PENAL TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION THE COST OF COMPEN ON,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 DMslon 3 of the Business and Professions Code,and my license is In full
force and effect.tic.# Class
Contractor's Signature: Date:
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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I 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
subjep the applicant to a dvil penalty of not more than five hundred dollars($500).):
C =I,as owner of the property,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 Code: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 have the burden of proving that he or she did not build or Improve for purpose of sale.). '
❑ I,as owner of the property,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)
)/cense pursuant to the Contractors License Laws.).
I am,exem t uncle c. — Business and Professions Code for this reason: �D
Signature:- p /
f0 a Ez�ires:_�l -/ 4^anC
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 five(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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,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:
I 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 file a registration form for acutely hazardous materials? 0 Yes 0 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 greeter 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 ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes Us No
(Section 65850.2 of the California Govemment 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).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (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 information 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
,.. .nature w•' eget 0,=er(s /! }te��
t art
`A,SOr Authorized -.pr•:nt J D
CODE I INSPECTION TYPE RAM EMU CODE! INSPECTION TYPE PAIL g411MLA
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
cal >1
200 Final Re-Roof 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
I(
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DECLARATION OF AUTHORITY Bldg. Permit#
•
FOR AGENTS OF PROPERTY OWNER This Permit# rift-
TO APPLY FOR PERMITS
--Streetin
Address: / L f E. 5,}" s4424 AP Number:
1.rl ( Sreer7i A , declare that I am the Owner of Title of the above
referenced real property,and that I (we)hereby authorize: p t�/� / �/L
Name: f OCT Era c '"02_0 Telephone Number: 0% I ) /, 3 "3/ v
Street Address:
16 j (= I S7 s¢.-t f' IR)
City: C d s-19 '" asg State: e " Zip: 1_D 2
to obtain permits in my behalf,as owner/builder,for -P1-9--C--Aim
GC-- \ ` G � ��
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of 20 , at , California.
Print.Name: e306 cid, .ik lieurtGI
-a'.
Signature: .
\ s
pair 7/3V/U
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attomey to secure this permit in any behalf.
0779-46(rev.11/00)
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
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CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. Y �O TRACT NO. LOT NO. UNIT NO. A P # Zone
t Project Address /11 li z� -a ST/{^-€ !K" IV /�o Main Building: Accessory Building:
oe TYPE OF CONSTRUCTION H NEW H ADD U ALTERATION U REPAIR
-
ApTAicant's Mailing Address
❑ CONVERSION ® DEMOLISH ❑ OTHER I T Front • 0
Owner's Name f� lll necNr [NrgA� Phoneey�' Tb'//6� DESCRIPTION OF WORK/USE OF BLDG. B Rear N
S)
A, ss /G/ iF Z / s` 57-Bri �rq
t 2✓_ S tiaa ro I; PT" A
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING LJ FOUNDATION ❑ STRUCTURAL C Right G
Address 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ • Left
Contractor's Name / 4E, Phone CIR
.OTHER /4-/ Ping. Ref.# Parking Req./Provided R
PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes:
Address(mailing) CONSTRUCTION TYPE VALUATION$ /, OD O �- t _- M
City License No. T
ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATIONS.
I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks. p G/-1/D
with section 7000) of Division 3 of the Business and Professions Code,and
my license is In full force and effect. ELECTRICAL FEES
License Class - License No.
Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
WORKERS' COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub. - ❑ 50+KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate
',Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
DO. Lab. C.) - - _
rolicy No. Company Backflow Irrigation ( Sewer Cap too Dishwasher . - Meter Dover 100 amps .— —
Certified copy is hereby furnished. Dryers ❑Gas ❑Electf is Sub Panel
- Certified copy is filed with the city Building Division. Bathtubs Sewer Connection - -
Date ApplicantFan c, Motors 00-1 HP-011/2.-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher F.A.U.
less). Solar Piping Inc.Solar 09-15 HP ❑16-15+
I certify that in the performance of the work for which this permit is issued, I -•Fixtures -
shall not employ any person in any manner so a become subject to the Drinking Fountains Solar Tank Microwave
Worke o_ nsat§e Laws of Cali n�J .
--
Dat < (" IY3K
Dat / < (" IX hisnatcre Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
• WoTICE:Compensation
making thisdeclaration,is you Code,become subject h ite Outlets
Workers' such
psionsio nr of the Labor you et forthwith Floor Sinks Urinal Range .
comply with such Erovisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AG ENCV � Switches
Gas Service Outlets Water Closet Sign
I hereby affirmk that there is a permit ser issue (Section
Scfor the perfCiv. C..)
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater GarbageDisposalStanding Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION - '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to Construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit
-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 . Reinspection Fee I $15 Issue Fee $ 3
;x.refrom and the basis for the alleged exemption. Any violation of Section
'-,-4.,31.5 by any applicant for a permit subjects the applicant to a civil
-/ salty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work, and the structure Is not intended or offered - /
for salese (Sectione Businessonand f aProfessional Code: The Contractor'smroves MECHANICAL FEES Building Approved By /�/ Date 8 /7 7 Leal
License Law not apply to owner of a property who builds or improves - �Y�('� (/r!y/f/x o
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By Date SJ
employees, provided that such improvements are not intended or offered foryP
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑' SUMMARY OF FEES
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ 2 c.uJ SMIP $ 'St
O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK
tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU PLUMBING $ $. of ISSUANCE $
builds or improves (hereon. and who contracts for such oroiects with a eon-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ - ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers
PLAN CHECK 50% $ MICROFILM $
Date owner Heating System& Ducting Registers Sf 4h
I hereby certify that I have read this application and state that the above DO-100,000 BTU 0100,000 BTL - MECHANICAL $ TOTAL FEE $ .7
Information Is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ 3•S o
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to -nter upon the above-mentioned property'for
Inspection spores. / / Date R.24-8e
Si•gnator Reinspection Fee $15 Issue Fee $ 3
Drivers' License or SS# "
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01 00012905-00012907 TOT 33.50
0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 08/25/88 TIME: 10:51
' CONSTRUCTION AND PLANNING POOl PA
" AP?13,0VA•LS 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, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16: Rough Electric Wiring 67. Fencing & Access Approval
.17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
X19. 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 ❑Oil
23. Gas Pipe-Rough &Test 72. Underground Flush •
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
1
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 Cqat 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 f417038. Final Plumbing pe39. 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 //A0 B�
48. Special Requirements Completed ((/j'
49. Electric Release to Edison • ��fJ„•,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
LIMITED STATEMENI JF RESPONSIBILITY Bldg. Permit #
TO WHOM IT MAY CONCERN: This Permit #
fr!o/ /; 2// t� .S %2 r• /_ % Co s rrfn/E-Srp
Street Address AP Number
I, 127//L/f CE N i F /= /1)a 12, , as Owner in Title of the above referenced
property, do hereby authorize:
F ,r/k 6 /iA, /j' 6 7
Name
Telephone No.
2- S 9 Oi2/t4/C T ,4c 00 ST/4
Street Address
City State Zip
to obtain permits in my behalf, as owner/builder, for l'#.erjCc - S' i Gt plo R 13 i
at the above referenced property.
Should any person become an empinyvp engaged in the improvement of the property, I shall
immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company Or corporation.
I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties.
MILL KICc"NT IT /= /{ lac- /92
Printed Name ate
v
Signature
0779-46,rev.6/87
- J
4.
BEACH ELECTRIC
151 E. 21ST. St. 49
Costa Mesa, Ca. 92627
(714) 722-1906 October 7, 1988
To Whom It May Concern:
The electrical system at 161 East 21ST. Street in Costa Mesa, Ca. is in
proper working order for the age of the house and existing wire. Replaced
damaged meter cover.
Thank you,
BEACH ELECTRIC
obleasig Of °ft '
Steve lowbrow, i
OWNER REINHOLD, Maria DATE 1-15-58
JOB ADDRESS 161 E. 21st Street BUILDING PERMIT NO. 6287
GEN RAL CONTRACTOR Owner-Builder VALUE $ 112.00
J.4-01p2-3.8 LOT 242 TRACTPS FIRE ZONE DESCRIPTION OF WORK Garage Add.
GROUP J TYPE V ZONE E4 PLAN NO.
PERMITS ISSUED
IT' "ECTIONS
DATE NUMBER
Trenches Forms Steel / --a
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing ."
Lathing, In Out InffirMitiallIMIMMENI
Plaster, brown coat -.9.FS I lira rEgg a r a NM
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final •
Plumbinf Fixtures, Final Miii.M.inrL�+•�!��.r1 ii
Final Gas Test •
Corx- ation Pole
Uru 'found Power
Rough Wiring I
Fixtures, Final \
OCCUPANCY — .S
Form 210-5M-1-57 • j
J
6287
COSTA MESA BUILDING DEPARTMENT //�
P.O. BOX 317 COSTA Q 1A***Z.11�
COSTA MESA, CALIFORNIA JAN 15-s8tI3jt n 961a
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDINGR /6/ � , IF BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
'''�'/���'jM��^�/,,,//IIII �(��f/�� /�/�/ �/l�1 RECEIPT NO. /PERMIT NO.
OWNER • / a- •*/ gal_ /'(,4/ W.2 O /
/'(/� RECEIVED BV DATE RECEIVEDI, DATE ISSUEDMAIL
`_
ADDRESS / 6/ - �T %- IS - .r6 /-c_,s dI
q/ TEL. BUILDING
CITY h "SO.410•114/1 NO. ADDRESS A
IT
ARCHECT
OR IT,NEER --......"•-•....- �NO.LIC._ COSTA MESA, CALIFORNIA
FIRE
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CITY LIC.
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CONTRACTOR /(,V"Yj,Pij/ NO. v
TEL. APPROV
F ADDRESS //�� /1/ NO.
ni I (� A BY DATE
LEGALDESCRIPTION NOT J-- /- BLOCK ITaACT CORRCCTION�
A.P.NO. 118 -- 0 - It ,y/
APPROVED
OIF LOT7 & -0 X 7 UD..)cIINOW ON LOT CITY OF COSTA MESA
USE OFPLA I� G DEPT.
fesQQ..��,`
EXISTING BLDG. M4�/� sun IFCT 'L BLDG. DEPT. REG.
SETBACK LINE FROM it a C A�
CENTER OF STREET REAR YARD ',/
'CO-
p /
5-Z#
SIDE YARD /0 RIGHT LEFT BY DAT
PLAN T.:CH,
DESCRIPTION OF WORK 1.
NEW ALTERATION ADDITION V
REPAIR MOVING DEMOLISH
BUILDING I LI NO.OF
SIZE ROOMS ST RIE
EXTERIOR WALL jT�,�c .�.. ROOF 99 $ ((
COVERING F/WW� COVERING A � EY.I-/,(I//
USE OF NEW II 1 ^� h n Anti /
BUILDING ,.x/J wVu� i
4- `k ( y- ° ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE'IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION' (/� VALUATION aO
SIGNATURE OF J Cl`v� ��e.41/4.tre PERMIT FEE S
PERMITTEE `l - f
4 PLAN CHECK S
, 5
AUTHORIZED AGENT TOTAL FEE S a , by `er