HomeMy WebLinkAbout175 21ST ST - Building PermitsCITY OF COSTA MESA
M q BUILDING DIVISION
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
PERMIT NUMBER: P10-00033
PERMIT TYPE PLUM STATUS: ISSUED
APN: 42619316 DATE ISSUED: 02/25/2010
ISSUED BY: BE
JOB ADDRESS: 175 21 ST ST CM Suite/Unit:
Vicinity: LAUNDRY ROOM
SCOPE OF WORK: ADD GAS HOUSE METER AND SERVICE TO EXISTING COMMON LAUNDY ROOM.
OWNER: CAVE, ROCKLIN C
Address:
18621 WARREN AVE
PHONE:
City/Stale/Zip:
TUSTIN, CA
APPLICANT: ROCKLIN C CAVE
Address:
18621 WARREN AVE
PHONE:
City/State/zZip:
TUSTIN
CONTRACTOR:
Final Site
License No.
Address:
PHONE:
City/State:
ZipCode:
CELL:
ARCHITECT:
License No.
PHONE:
ENGINEER:
License No.
PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $33.30
TOTAL FEES: $33.30
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 i. INNSSPECTI!._ TyECTIONT PE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re -Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
DAM INTITIALS CODE N
INSPECTION TYPE
206
Final Mechanical
208
Final Plumbing
210
Final Electrical
212
Final Fire Prevention
220
Final Planning Approval
222
Final Site
250
Final Building/Occupancy
DATE INPIIpLS
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'
compensation, as provided 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:
Carrier:
(This section need rrof pe completed eine pe m4 is valued al one hundred odlars ($1e0) or less.)
Policy Number:
❑ 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 lays 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.
Apppcant's Signature Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S 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 effect.
Lic. # Class #
Contractor s Signature
Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work fa which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's 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 subjects the applicant to a civil penalty of not more than
fv undred dollars ($500).):
7I, 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
com letion, the owner -builder will have the burden of proving that he or she
did of build or improve for purpose of sale.).
FI, 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) license pursuant to the Contractors License Lays.).
❑ 1 am exempt under sec.
Bust and Professions Code for this reason:
I,
Signature Date
30+6
Owner ID verified by drivers License. ❑ Yes ❑ 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 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, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2. An 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.
Applicants Signature
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? ❑ Yes ❑ 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 feel 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? ❑ 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 ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, cerltficelion and
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 and Safety Code been fully complied with? ❑ Yes ❑ 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 permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications fa 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? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safely 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? ❑ Yes ❑ 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.
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 CiYY--Qqf Costa Mesa to enter upon the above-described property for
ins p tiorypu osI I agree n t to o�upy or allow occupancy of any building
a ri �d by 1i peonit un fn p ction.
Signature of Legal Owner(sl Date
And/or Authoneed Appetant Date
0M: 175 21ST 'ST UNIT A-1
ROCKLAND CAVE
Ess: 175 E 21ST
C , 92626
714) 380-1288
ADDRESS:
'ARCHITECT OR ENGINEER: UC, NO.:
ARCIL On ENG.'S ADDRESS: UNT
{ calrnAGTaffs NAME
CONTRACTORS MNl1NG
AGORESS: UC. NO --
I I
LINT:
LICENSED CONTRACTORS DECLARATION: I hereby whim undw posey of perjury few I we licensed wrier provisions d Chaprw 9
(oommence, with Section 7090) of Divemn 3 of he Bu i. red Pmlessiord Code. and my keeess u in lull here end slice.
CT' LIC. NO.: LIC. CLASS: LIC. NO.: EXP:
Date: Coomactor:
OWNER BUILDER DECLARATION: I hereby, Affirm under pmety of owpwy Ihat I we exempt horn the Codredms License Law for he
foloysV neamn (Section 7031.5 Business red Pmleesiom Code: Any City w county ehich ro9uires a perms to coesum, aha, improve,
+smdeh, or regi Any Utuclum. pier w ha issuance, apo Mussel the strikers for such pwrM to Rb a sipred stelsmelu Nat he or she
licenced W ewant to the wovebns of the Contractors License Lew lChapler 9 (coremarlarq with Sermon 7000) of Dwislon 3 d the
noes and Rd.. Codel w thin he m she is exempt thwetmm and Ihe beau Ire the seeped exemplim. Arty violation of Section
7031.5 by Any appliem Ire a etmen subjects the oppticeel to a evil penalty of iss mate Than live hundrnd dollen 155h01).
n I. es owrar of he wopedy or my employee Me wepes n their Ade comMosation, well do the rend, and the Mrvmuns a net Wended
A wohwed for sub(Section 7044, Btnimn and Prole asses Code: The Cont.. License Lew close ml appy, to en owner of propend
wW Wads or inlwows thereon, and eeo does such oak himself w Mnelf or Ihrmgh h s or her own employees, pi v that such
impmveme ss we es, intended or offered for seta. h, h ,elms, the Wildir, or iromew est is eoM within one Year of completion, the
ownenW ilder will have the Codon of "I, M es she clM set WiM or improve he the puryese of sorb).
❑ I, es ovmer of the pmt wry, we exdusamly owracti g whh lieaneed omtractore to conmud the projed (Section ]ON. Business wet
Prolessio 9 Cab: The Corsre mon license Law does net owner d proem e1w Wilds w immsees thereon wet who
Centrocus lw such projects with a corona (el fcenand W to the orwact. Uomae
I am weep undo Sacf B. ti RC. Ire tree raew
eo: Corner:
Weereby omit, the I am aware of and undembnd the rep d Cetlfomie Neahh end S Cade Sxtiona 25505, 25533, end
and the I w Any Mitre Wildi, Ml sill I will a reel deed to comply whh pate codes end IM reRuiremarse ler
a ermhlor mnawmionwmodifielionhom the Ri u6-Tylrere9emant Dimrid. Rssiclenlsi oars ctbnepDkmionsen exemplfmmlhesa
prowcons.
Date: Appliest
WORKER'S COMPENSATION DECLARATION: I hereby affirm undo penalty of perjury one of Ihe following dedaratbm:
❑ l hew and Ail meWan a cenlfnate of comers, to safflm ro W ewken'compens on. As yAdsd lw by Seders 3700 of the lobar
Cocle, for the pedormame of the work for wNch this pwmh is issued.
❑ I haw and w miasmas, smisss' compeeesm imuruv, w, rssuued by Section 37M of the Labor UCde, for the pedwmwwa d the
work for which this permit a issued. My waken' mmpenumm ireuronce Amer she policy number we:
Cama:
Policy Numbw:
s section need Trot M compbred I IM ptsmut is for one hundred donee /SIX) or less.!
n I e illy Net in the Wmmwnce d the work ha whish this pwmh a issued, I shah not employ wry person in se, a is to
became subject to [he worker' compensation laws of Cakfomia. and allies that 9 I shauM become subject to the emlows'
companies. previsions of $action 37M of Ihe lel or Coda. I shod! lcnhwhh campy wilt IMe pmveme
:'Date: Appliam;
Wem/np: F.Bun ro recurs workwi ronpwu.tlon oeysi 1. emes L and Alun soblsel ren wnPlaywW mlm'rul peseaNsa.rW
hCldl
fit..
W Is we hl.ltlretl thouswM dollar. (SIOR OD01, In scil/tlon W the cost of mmpwusadais dame ve As psayWM ler In
Sidon 370501 M Lai Cottle, Intwa.l, .nd.1forns .lea
. CONSTRUCTION LENDING AGENCY: I Iweby df undo partiallyd Wjury Use Nae e A m monssion lending a,,ency ler he
" pedmmeme of the work for which this pooh is eoued (Section 3097. CN. C).
LENDER'S NAME:
h LENDER'S ADDRESS:
d'cerdy the I the. red this application aid wee Nd the above information is comics, I ep. to comp, whh et1 ay and county odi.
end slate bee mlan9 to WildiN mnstrudim end hereby adhorrse neress ivee of the city to Was upon the ebwe-mWixecl prop"
Ire impectkn pwpmes.
JANE BAYRD
1 1 ,
Dee:
Ceery-Appkfant: Pink-Rewnua; OOMenmcl Acus amr
�y �►�;•7 �ijb^7fii.�T�F7 � =Ii71 i �f�F�.[�� D1:1 d! � r
PERM NO: E 078215
PERMIT NO: E 078215
PLAN CHECK NO:
N GOVT:
N SUPP: N
CONSTRUCTION TYPE: V—N
PERMIT TYPE: ELE
FRNT: FT IN
PURPOSE: OTH
JOB DESCRIPTION LEGALIZE
INSTALLED WASHER& DRYER
SQ FT:
REAR: FT IN
CLAIM VALUE:
CALC—VALUE:
GROUP OCC:
R-1 /
COMMENTS: X
RGHT: FT IN
PARKING REQ:
PROV:
iEiEiESEdE9E1E9E9EdE*1E*1E***iEiEs4**iE*iEitlEdE*d4d41E1EdEkdEiE*iEk*iE9E*1E
9E 9EiEitiElEdEiE*ifiE*dE9E*14iEiEkiE*RE1E*iEiE1E*****1ERE
ZNE:
Z O N I
N G R E Q U I R E M E
N T S
/
S E T B A C K S
,00
>
------------ MAIN
BUILDING
----------
---------
ACCESSORY
BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT:
FT IN
REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT IN
RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
00000000
ZNE:
REF NO:
PLANNING NOTES>
/
,00
>
30.50 OVER/SHORT:
,00
BLDG PMT
PLUMBING
1E♦E*iE♦E*1E 1E♦fk1E*RF 1E*1E/f♦E1E♦E/f
kiE 1E♦E 1f 1f 1E 1E 1E*dE 1t*4♦f 1E 1E♦f 1Ek♦E k1E 1E 1E*1E*♦E♦Ek♦E
1E 1E 1E*1E 1E>E
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D E V E L O
P M E N
T S E R V I
C E S R
E Q U I R
E M E N T S
ZONING APPROVED BY
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
k 1E 1E 1E♦f ♦E 1E ♦E 1E iE ♦E 1E*kiEk ♦E iE 1f 1E /E ♦f � ��
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 8,50
503
DATE:
DATE:
DATE: 44LE�
♦F if ♦F 1R IF NF AFJ4��
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
PLAN
ISSUE FEE
22,00
BUILDING—DIV—>
PERMIT
ISSUE
PLAN—CHECK
TOTAL PAID
DUE
TOTALS ---- >
8,50
22,00
0,00
30.50 30,50
/
,00
REVENUE DIVISION TOTALS--> COLLECTED:
30.50 OVER/SHORT:
,00
BLDG PMT
PLUMBING
ELECTRIC
MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
30,50
*1E 9E*dE SE 1E*dE 1E*9E 9E**M*9EiE dF 1E REMdF 1E 1E 1f*iE1EiEiEM*k1s*RE
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I N D I
V I D U
A li F E E
B R E A K D O W N
TYPE QTY
D E S C
R I P T
I O"N
UNIT COST
TOTAL COST
ELE 2 RES APPLIANCE NOT OVER 1.0 HP 4,25 8,50
END OF FEES
EXPIRED
Ifleam Tete Ir pection`�
_ 3 � ig-
TRUCTION AND PLANNING
)VAL$ Permit # Date
,
Inspector-
POOI ,PA
APPROVALS Permit #
Date
Inspector
,porary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
Elettrical Conduit Utility-Undrgrnd.
54. Forms
-
lectrical Conduit-Undrgrnd.
55. Electrical Bonding
-.•�Stee1 Reinforcement
56. Rough Plumbing & Pressure Test
6F:E'IectricalUFERGrnd.
57. APPROVAL TO COVER-GUNITE
-,I✓`/. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 17 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ 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 1^
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.Conditionjp_,w
,Q.K ,
a, FLgE WT.,REQUIREMENI
Pepnit# r
20. Rough Faytory Fir�ace tQ
ZZtJ.,
TaAPPFEOVAiOriE,
21. Duct :in Stru9Fur(g * " " "
n r.
[' "
70. oder _- H�e,pro
22. Ruci�,Ve,ntil�tngRF
x t7 <
0;_ t.
-71. ProduaY, Piping 0"Gas DOil
Pi e•Roue & r:.
23. Gas Telst
P -• r r•.. �•
r iT. �"
x c
< 0x
S ., ,'
h
72. Undergr �ry'"d F�slt T
24. F?oof-Fra' mg * , F-.
'
CC "Y
_-73 Undergrnd. Stora bnk•O Gas ❑ Oil
'
25. Roof�SheRhinga
4
" r ,",
t-5,• cc
74•: -'Overhead HydrQ ,Ir
y
. •l
..,-
26. L=BaI'Ceiling fS[ruct ral) & M�aoeoat
r m
: 0
, ,T7 ::
C, f
7EZ Dry Chemical F --o .r
27. frame and Flashing
-
> _t
76. Dry Sta42 "e r'�
rP i
28. Lathing &Siding
�29.
.r
77=, FIXED &Y'STEIM,i1NA!x. •- y
Insulation, S
7g FIRE PREV. FINiiL x'
T30. Drywall Nailing _
fx
'
S +� ALTttQJ P RE�UIRlMENT
31. Plaster Brown Coat v S r, t-
r
+
F -> ir'
- 79. FINAL I ECTliif-+.lv,'
32. �tectricalPow,e Mete rRiaal 1
* N
_
80�FOOD CERTIFAI E ISSklECH f '
_33. F.tnalElectric>
_,34. I�[alrHeaiing & Air C{,op(iSYioningS n
'r.�
_ FY
NQ?b(G ..i _G'Qj��C n
-
J: "ti' y,' ' `-' �.•.'�
35. Final Gas�Pipe-Test r
„36. F{Dodror �noPY o
" `
-37. Final Factory Fireplace :. h
-
r
i
of
c n
.38. Final`plumbing co
�39. Were,•Serirce•Final a 1
1 g
Gy +�
,T40. Gas Service -Final
::Al. Solar Domestic"Final,
~
42. Backflow Prevgnter n''
(
*
1 1*
rill G x F
43. Backflow Irrigations ••
.� o;
*
4 Landscape'I rri�ation'System c tr'•� Q
:,.
ail
C7 cox'
r"
45. Sound Atte,gVtion K ^'� _
+*
••K
rP c,
^1 ••H Y
48. Handicap Regulation
47;. FINAL- STRUCTURE & BUILDING
48. UPAL PLANNING " F'
r `''
49. Electric: Release to Edison
1
-
n
50. Gas Release to Southtrn California�3as Go
I lY
51'. CERTIFICATE OF OCCUPANCY
No. Date
(03/26/98) 4UILDING PERMIT SYSTEM
BP74 OWSE INSPECTION RESULTS
NUMBER: 175 STR: 21ST ST UNIT: A-1
PERMIT NO: E 078215 PLAN CHECK NO: 9602455 PARCEL:
NOTES: PERMANENT CERT. OCCUP:
TEMPORARY CERT. OCCUP:
CODE D E S C R I P T I O N DATE
0000 CARRY OVER 06/19/96
0000 CORR. 06/20/96
FUNCTION: F:FORWARD N:NEXT T:TOP U:UPDATE X:EXIT
NEXT CODE:
MSG: NO MORE RECORDS
J(10:32:16)
OCC: R-1 /
DATE:
EXP DATE:
INIT Y/N
RB C
RB F
FILE: ACT PRINTER: REM
"°0P0i 175 21ST ST UNIT.A-1.
EIP WOyN: ROCKLAND CAVE._.• _
ADDDEuk* 175 E 21ST
C. M. 92626
714) 380-1288
.PPL. MAILING ADDRESS:
ARCHITECT OR ENGINEER: I.M. NG:
ARCK OR ERG'S ADORM: UNIT:
CONTRACTORS NWB.:
CONTRACTOR'S MMUNG
ADORM: UC NO.:
UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby atlkm urhder perWy d perjury that I sm [caned under orwisions of Chader 9
(commenop with Sectun ]000) of Division 3 of IM Buumss aed Pmfeaacne Code, Seed my Eicemse s at lull tau and affect.
CRY UC. NO.: LIC. CUSS: LIC. NO.: EXP: _
Date: CwwMUh0:
OWNER BUILDER DECLARATION: I hemby affiml under penally of perjury thel I am vamp Mm the Commol. License Law for Uw
following reason (Section 7031.5 Business and PMevio m Code: Aw coy or county which requires a Mm h to construct, after, Improve,
'•molsh, or repair MY structure. Prior to hs eeuMKe, deo requires the applicant for such pamlh to fib a egad alalemenl Uul he or am
caned pursuant to the prwisiots of the Conlradon Licoroe Law [Chapter 9 (c mme cog with Section ]00)) of Motion 3 of the
A. end P ofom ions Code) or UW he or she s nempt Ihereham and the bees la the all gsd easmdln. My ykAation d Section
,031.5 by dry applicanl for a permit subjects IM applicant to a civil penally, of not mon Ihan two hundred dollen [$SW]).
it I, as owner of the pmpany or my employees with wages sou took sole compeneetion, will do IM work, and the structure is rld intended
7C or offered! for We(Seclian 7We. Business and Professions Code: The Contractors license Law doss ml apply to an owner of properry
who hulds or mroves Ihereen, end who due such work Mmse9 or herself or through his or her own employ. pwided Nat such
impmwmens
we rot imerhded or Wend for sale. t, however, the Wiling a'unprovemeM is sod within one year of completion, the
caner builder will have the Wrdeo of pmvip he or she did rhe Wild or improve for the purpose of We).
❑ I. for ower of the propend. em eotllniwty lorNragihp with I'b rorWmct the prdect (Section TOM. Businees end
Pmfessiona Code: The Contractors License Law does nal to om oh r d pmOeM wdro Wilda or imprwee 1h cop cad who
comrade for such projects with a camrectoNsl licensed pat Inco to the Cm MUM Liosnee Law)
exs/{npl order S (xI lion: 9 //.., B. A PC for Ns reason:
Owner:
I by cardY Nat I em aware of and understand the requi Cdlomla lbdth end 3e 6edbns 25505, 8593, end
Y55W, end that I a any Mum Wiling compared wn / will (os am
recowl read to ply soh eeld arise and IM requMmahs for
Cote: Applicant:
WORKER'S COMPENSATION DECLARATION: 1 hereby afMm under tonally of perjury, Oat of Na following dad" .bre:
❑ I Mel ad coalmen a cad'dkats of mnsenl to aeyuwn for waken' amperwatipn, ee vovlad for by Section 37M of the Lobar
Cods. for the ,edamerca of the wok for which this permet s issued.
❑ 1 fine old wit madman wohra' mrnperuticn inaratMw. as required by Swion 37W of the Labor Code, for the performance of the
work for which IN. permit u Mouad. My waken' c mperwMion mitow cs corner and policy rumba aro:
Carder:
POW, Numbr:
section read pf he completed I Me proof s for pew humored dollars RIGGI or Lev.)
❑ I carry that In rite the
wo ger d om work far witch the permit a. slued, ehN red ampbt arty penman n caw mercer oro lo to
becorrw l p to the workers' com7W of the tom d d e4l dad end pros Nat M I shoal becorne subjw to IM waken'
ampenWion pmysiom d BMion 3]W d the labor Code, I alu0 faMwhh ampy with Nov pmvisbre.
Dns: Applcam:
Weminp: FORUM M sapid, wallows' Covsrepa Is Unlawful, andahell sublscr em employer No afmleW pwneldas and
dyll flnv W to we hundrN thouMnd dollen 17100000. M sblt/on he Me coal of romper oat l dertups om wayfood for In
secdon JIM of Me Labor Cob, lntersal end sffomay'a team.
CONSTRUCTION LENDING AGENCY: I hraby affirm under penalty of perjury that then s e construction Mrdi g panty hor Gov
,do.. of the work for which this perml is hued (8ectlon 3087, CM. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I catty that I hays reed Ns application and Made that the above imormtlbn Is coned. I prom to campy with all dry and only ordinances
and state laws Missing to Wild'ug construction GIM hereby Authorize naaeenWiyee of Ns dry fo smer upon the ebwa momlionad property
for inspection Wrpoaee.
JANE BYRD
Pdnl Nemo /y� L
Date:
Mum d M rector
(5111 Whin"i ildlhp A Salary;
Ca m"pplram; Pink -R mm; Goldenrod-Aesevor
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 078216
PERMIT NO: P 078216 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : LEGALIZE INSTALLED WASHER& DRYER SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-1 /
COMMENTS: X
iElEkdt****dEdE9E4il/EdFdFlEdEdF*K*R*iFdF 9FiFdFdFdF9FdFdFlEdFdfdEdEif9F1i*dE*iE9E*dtlfdErt*kM9E9EdE*9EdE*9E 9E 9EiE1EdEiE*iEdF*dE1EdEiEiE*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ----------
---------
ACCESSORY BUILDING---------
FRNT: - FT IN REAR: FT
IN FRNT:
FT IN REAR: FT IN
LEFT: FT IN RGHT: FT
IN LEFT:
FT IN RGHT: FT IN
PARKING REQ: PROV:
PARCEL: 00000000
ZNE: REF NO:
PLANNING NOTES>
>
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D E V E L O P M E N T S
E R V I C E S R
E Q U I R E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY :
DATE -
APPLICATION ISSUED BY:
DATE: G (
6
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LEGALIZATION:N F E
E S U M M A R Y
STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/RES GRADING
PERMIT 8.75
25Y
SMIP/NON—RES
PLAN
`_
ISSUE FEE 22{{.00���0ttii{{,,
qq tt
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REVENUE DIVISION TOTALS--> COLLECTED: 30.75
OVER/SHORT:00
BLDG PMT PLUMBING ELECTRIC
MECHANIC FIRE
SMIP/TOT GRADING PLAN—CHECK
30.75
df df dE dEM*M*dl dE**♦E♦E iEif iE*ickM*dENdE dE dE dE iE SE iEfE dE dE*if.M*MiP*if 9E*9E 9E dE*iE*dE**iF***dE*1E dE dE****dE*dE dl dP iE*dE**ick 9b dE*
I N D I V I D U A Lig F E E B R E A K D O W N
I
TYPE QTY D E S C R I P T I O.':N UNIT COST TOTAL COST
PLU 1 LAUNDRY TUB OR WASHER 8.75 8.75
END OF FEES
-E PIRED ,
l
NSTRUCTION AND PLANNING "
PROVALS Permit# Date
V
Inspector
POOI 'PA
APPROVALS Permit#
Date
Inspector
mporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
_3. Electrical Conduit Utility-Undrgrnd.
54. Forms
- -4,.hE lectrical Conduit-Undrgrnd.
55. Electrical Bonding
,
:b..Steel Reinforcement
56. Rough Plumbing & Pressure Test
' &"_J`lr-iv�trical UFER Grnd.
57. APPROVALTO COVER-GUNITE
-7. Footings
58. Electrical Conduit-Undrgrnd.
3. Foundation
59. Gas Pipe, O Undrgrnd., Test
3. Water Pipe-Undrgrnd.
60, Backwash Lines, P-Trap, 0 Undrgrnd.
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 M
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. POO USPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning_ -. �.
_
,.. FI�Rf,,41PT.�EQUIR,EMENj
;,APPrWr VAR�r•t.. Pet,' it# f -
20. ^u' Fetor•µ Fir�jace ,,r
r
21. @t cts in 3tru&ur `
70. Vndergrb�F'21 Hjdro
22. 6ucts�., Ventil�fing :•
w 7 c
„ �•+�:
J 71. Produc iFf ing d_&s lJOil
23. Gas Pipe-Roues & Test
72. UndergroFo Flush y`, •`'
24. RoofFrac�wng'*�Y
•73�,Undergrnd.StoTaZOGas OOil
yHydrc�,_
25. Roof.Sheaihing r eC
ut
- Nz
74? Overhead
26. t-Bar`Ceiling (Structkral) &IUt aoyoat
•y
^x
7!j Dry Chemscal f.- r v
27. irarrte andlFlashing
76. Dry StantNpe F �"
^28. Lathn ldin x -Qs zr
9 $`t5 9 t rQc. C
S
X
<
c' ff -Igo x
7Al FIXED W,5- [ttD1AL
29. Insulation-, :r - S
•
r-
*
7F-SIRE RQEV. F(N'WL x o' l'-
~30. Drywall Na ling . ,y
e E
1
Sr .� LTFr4VIDEPt REOUIR MENT -
,n
_
-31. Plaster Brbwn:Coat X S "^tT'
y
79.^ FINAL I1r�ECTrON
`32. ElectricalPovva{ MetrrrFinal'80�FOOD
CERTIF� ATE ISSEQ Z
-33. 4,al:Electi icy
r 34. F hal Heating _Si Airao tfitioning<S
N�tes:r.// x�m
35. Final�Gasi pe•Test »: aL
M r-
x •,
p;-1 X - m
m. a
.36. Hood-or �nopy ir
_37. Final Factory Fireplace .: FF�-
s
J38. Final,glurijbing
_
' -
cr ~
39. Water Service-Final E
i tr
'«
i•
^•40. Gas Service-Final * r7 trrr 5
f :-n
=41. Solar Domestic-Final,
42. Backflow Prevpnter ' n%
r. -
"
x H
x
c'-
m tr. C, x_
43. Backflow Irrig�ion yt`"
t
r• 3
41.Landscape-lrrigation"�ystem p''I•
k t- _
" _u
ti a
45. Sound Attenuation + -y ....
'K 7
rn
1-1 1 ;
••I ••�
r-• <IJ FC•
•s
46. Handicap Regulation{ S •�
x ^
'^ S 7:v
tr7 3 x
_
47. FrNAL STRUCTURE & BUILbING
48. FjN ,PLANNING'`
rJ
r s
a
49. Gtectric Release to Edison
, 't,
.1 C •t-, x
50. Gas Release to Southjrn Califo4rrgGias Coti
*
?S :D� �� L t,
51. CERTIFICATE OF OCCUPANCY
No Date
- ^ pv
i
M
OCT 7 1957,
City
01 COS13 McS3
%WIdmB Dent'
Garden Grove, Calif.
8901 Trask Ave.
got. 3.1957
0
We and Mrs, Jack Lowelling
175 Be flat, street
Costa iiesa. California
Dear We wt MTs, Bewellings
ft are sorry to hear that the cesspool
has been giving you trouble. Since a complaint
was.turned in to the Health Dept.s apper ently be-
fore we were informed, we have received a notice
from the Building Dept, of Costa Mesa d this con -
U tion and it becomes mandatory that we o onneot up
to the sewer. This, we are not able to do while
we have renters in our house*
to, therefore:.- request that you vacate
the property at 175 Me-$3st. Street at your oarliest
convenience, since this condition conatitutee a
haAlth hazard to yon.'
Very truly yours.
A, Aeil Boyce
It,
P. Be We are sending a copy of this letAter to the
Building Department of Costa Mees to Info= them of
our lotion_following receipt of th®ir notioG,
CITY OF t TA MESA
PARK FEES N2
Fee Payment Receipt
Project Address Park Area
A. P. No. //0¢
Building Permit No. 4 22
Owner's Name A, T T�
Mailing Address 1 2�OZ v R �+( ��� I/'t_
FEE
Single Family * No. of Units @ $455.20 =
Multiple Family ** No. of Units 6 @ S321.32
Total Fee �� Z (. Q Z
Planning Department Al
Applicant's Signature_
• City Ordinance 72.44/
*• City Ordinance 72-45
••• City Resolution 74-124
White - Planning; Canary - Planning; Pink - Finance; Goldenrod - Applicant CMF 0174-2
.sr
RATKE ISt Algis "^1L 7-/-/b
JOB ADDRESS 175 E. 21st. St. BUILDING PERMIT NO. 41951
AL LUNTRAL IUK Owner-Bldr. DESCRIPTION of WORK Demo. Re
"o o nco 1G I nT o-- 0/.0 TRArT N—i- u..FIDF 7nNF VAI IIF t Snn
AZx
I "= .CTIONS
Signature Dote
TYPE GROUP
ZONE R2
SO'iL
SUBCONTRACTOR
PEPMIT-S ISS ED
GAS
Dote Number Si nature
WATER
Plum in
ROUGH PLUMBING
_ 6
PROP. SWR. LINE ff HOUSE COW. Lj
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Heatin Pnd Vent.
TRENCHES Lj FORMS M STEEL REINF.
FLOOR SYSTEM
'
BOND BEAM STEEL REINFORCE
I
SHEATHING
FRAME AND FLASHINO
LATHING — IN OUT
PLASTER, BROWN COAT
S--TURAL, FINAL
F. ,4G. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
RPFf JAI RFOIIIRFMFNTS
yr
' 41951PAi�
r -7rv, -00 3751. ***f %5.5C
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in mpletely —Use Ink Only
RECEI V D .DATE
RECEIVED DA E ISSUED
(� /(,r
7 S- I Sis
ADDLDINGRESS C lam' /
Q ••/
A
-� 6 �-/ PERMIT NO.
OWNER I3 GrS �/r0 rt�b'P
.NO.
MAIL �/
ADDRESS 4Z 2 � in�
UILDING
A DRESS 1
14
�-
CITV /+�f,/TS'��• /�' TOL7`O �3 �T
T ACT
O _BLOCK
CONSTRUCTION �lG/r
W AD
P
LENDER
/ N
BRANCH V/'/
,
//s
bi✓
OWNER
ADDRESS (I�r
VALUE
ARCHITECT TEL 63_2q�
S
§
OR ENGINEER �'�•
,/� / , U q
ADDRESS ZJ7/ 91-ci e �l YJ s
FIRE
ZONE TYPE GROUP
n/ 4S
CONTRACTOR /J
APPROVED
By
DATE
A DDR ESSSA �(a 4 V /Y
--C�•
TEL. (
�,�6 -?
ZO NO. OF
NS-( PLABUILDING
USE OF NEW
CITY /V~"� /.e �! NO
.F.i
i
STATE �---/� O� CITY
LIC. NO. �I J L/ / LIC. NO.
YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACa ESSORY BUILDING_
W
SIZE/ J �J /�_�., NO. OF BLDGS
y I
FROM C/L STREET)
0.
OF LOT f7 J J t/ V NOW ON LOT
ONr FT.
YTIP
Q
USE OF
S k
•�.
EXISTING BLDG. % `"L.
7,
rA
FSeparate
permits are required for
L. SIDE
T.
electric, plumbing and heating work.
in
REAR FT.
FT.
[..
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. IN &
QMAIN
BLOCS.
ACC . BLDGS.
VAR,DATE
C.U.P.91E
APPROVED
}
APPROVBy
5�71�]
DATE /
.1
Or.
W
0
1 hereby acknowledge that I have read this application and state
I%
that the above Information Is correct and agree to comply with
m
4
all laws regulating building construction, and I shall not employ
any .person in violation of the workman's compensation laws of
m
{Z8
�.
the State of California.
m
3
I hereby certify that I am properly licensed as a contractor under
SO. FT.
r
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Buainesa and Professions Code, Division 3,
m
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING
A PERMIT FEE ONLY:
am exempt from the prow n to tate I ornia Business
o
VALUATION
PERMIT FEE §
and Profssslons Co rvislon , Chspt
J,
Signature of
w
m
0
PLAN CHECK § 1
TAX E
•
Permittee
S v
LL
2
Authorized Agent
u
TOTAL PAID § • S lJ
OWNER. RATKELIS, Al ' DATE
JOB ADDRESS 175 East 21st Street BUILDING PERMIT NO. 42982
GENERAL CONTeACTOR Valdez Const. DESCRIPTION of WORK Trash Encl.
is-o6`t-
�. LOT
TRACT FIRE
ZONE
VALUE $ 500.00
I
IR:?�°esti C710NS
Si narun Dorms
ITYPE V
GROUP ZONE
SAIL
SUBCONTRACTOR
GAS
Dare Number
Si nafura
.WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
,TEMPORARY SERVICE OR POLE
UNDERGROUND Lj POWER C]
ROUGH WIRING
Heatinu
and Vent
TRENCHES FORMS Lj STEEL REINF.
FLOOR SYSTEM
BOND BEAM Lj STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN n OUT
PLASTER, BROWN COAT
TURAL. FINAL
HL...ING. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC. FINAL
-
09 0a
BUILDING. FINAL
42982
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS //IS
//J oC �/' [ny /
OWNER /1 /Y ]('/1/(� / / S / Y 1
CITY
CONSTRUCTION
LENDER
BRANCH
CONTRACTOR
TEL.
NO.
rEL.
VO.
Qfl 277
APP�LIVATION FOR STRUCTURAL PERMIT
REC I D
I DATE RECEIVED
DA ISS_UBD /
A.P. NO. '
PE pa+
BUILDIN
AD,PRESS
.S�
_ 21
CY
USE OF NEV;
/"LQ BLOCK
W JAQD I ALTFA
CITY SI NO.S�� Cr[1.
I 145PAIR
PLANS
OWNER
F'
r—k,45 ovG VALUS
n
S
R
� r
4
FSeparate
ADOH tss / V fs /fi • /10 J r4
SLOGS.
L. SIDE FT.
r
FT, f
ZON
NO, OF
USE OF NEV;
TEL.
CITY SI NO.S�� Cr[1.
VAR. 46
PLANS
BUILDING
F'
STATE CITY
YARDS APPROVED
YARDS A
BET. MAIN &
LIC. NO. C C' LIC. NO.
MAIN BUILDING
ACCESSOR
SIZE
NO. OF BLDGS.
(FROM C/L STREET)
W
d
OF LOT
NOW ON LOT
FRONT FT.
Q
USE OF
C
.�.
EXISTING BLDG.
q1QF PT
k7
� r
4
FSeparate
permits are required for
SLOGS.
L. SIDE FT.
r
FT, f
electric, plumbing and heating work.
i
/J
2,q
VAR. 46
REAR FT.
FT.
W
f
USE OF BUILDING AND WORK TO BE PERFORMED
C. U.P. qb
DISTANCE BET.
BET. MAIN &
CMAIN
SLOGS.
ACCESS. SLDI
/J
2,q
VAR. 46
DATE
Q
-fC
C. U.P. qb
APPROVED
>
APPROV
}
C
k7
L
1 hereby acknowledge that I have read this application and state
Q:
that the above Information is correct and agree to comply with
fL
all laws regulating bullding construction, and 1 shall not employ
Z
any person In violation of the workman's compensation laws of
_
W
the State of California.
/
2
3
I hereby certify that I am properly licensed as a contractor under
(� SO. FT.
the State of California Business and Professions Coda, Division 3,
THE AMOUNT SHOWN UNDER VALU
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERI
am exempt from the provisions of the State of California Business
antl Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE b
,l
PLAN CHECK b
Signature of ////11 1 / ��
Permittee 'J-/R� `/Cf'V^�r(
$ rvgUJ'
�`
TAX b
Authorizedgent
TOTAL PAID E
ON IS
FEE O
Ie
42852
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — ke Ink Only
3UILDI qq 17S' /' 2
OWNER
/ S t�"'V _ — -'�
MAIL
1�
L62
ADDRESS
1
�J
/ TEL.
fir'
T
CITY
V NO. o�
CONSTRUCTION
I NDER
(//.if(�C J
BLDGS. 2s
NO. OF ON LOT
NOW
n
BRANCH
ARCHITECT �/_ -�r„ti TF`& --3-N1
OR ENGINEER / NO. L�
/Aj /'O
ADDRESS /*J-1 1ee�
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Q`�/
CONTRACTOR d- /L a
•l
ADDRESS(,42,CZ
�J
CITY tnl.<5--t6ti ��V%y
t�f,
NO./�l/-rr"i
J
STATECIT�j 5-69
LIC. NO. ✓t J 699—
LIC VNO.
512E i . ? O�
SI LOT ..++ J
-
BLDGS. 2s
NO. OF ON LOT
NOW
Separate permits are required for
electric, plumbing and heating work.
BUILDING AND WORK TO BE PERFOW
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
trio State of California Business and Professions Code, Division 3,
Chapter 9, and that II force and effect, or i
em exempt fr ovisionz of the State f brnia Business
antl Profes ns COAe ivision 3, Cha A
Signatur of //�� t
Permittee
Authorized Agent
T 11-7`r!":=no 61 ` 10.5C
APPLICATION FOR STRUCTURAL PERMIT
REC6dV60 BY I DATE RECELVED nnro e.'
A.P. NO.
BUILDING
ADDRESS r
TRACT LOT BLOCK
OWNER
VALUE /
.$
FIRE V
ZONE
APPROVED
ZON I NO. OF USE OF NEW
r( PLANS BUILDINGARDS APPROVED YARDS APPROVED
1
I / MAIIN BUILDING ACCESSORY BUILDING I
(Fj10M C/L STREET)
DATE
URCP. 46 I APPROVED
APPROVED
n
m
SO. FT.
m
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR
D
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
e
VALUATION
PERMIT FEE $ O
v
N
m
PLAN CHECK $
♦/_
^
o
/�/. /��
S /'✓ s' (/
TAX $ s. ,
✓
u
TOTAL PAID $
�OWNER RATKELIS, Alois DATE 10-11-76
JOB ADDRESS 175 East 21st Street BUILDING PERMIT NO. 42852
GENERAL CONTRACTOR Owner/Bldr. DESCRIPTION of WORK Dry Standpipe
LOT TRACT FIRE ZONE VALUE Ei nnn_nn
SUBCONTRACTOR
PROP. SWR. LINE I I HOUSE CON.
ING AND AIR CONDITIONING
TJWU:
AND FLASHING
u - IN n
ING. FINAL AND GAS TEST
i
n
Pa:6
WAR 15-76cM5-00
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
695 ***194.16
For Applicant to Fill in Completely — Use Ink Only
A C ION FOR STRUCTURAL PERMIT
RE V
DERE p'
p�
IF! 7d
BUILDING , /
C/
ADDRESS Jo_
/� p(�
OWNER $ ICQIlS'I s'C hQ —Lr Wsr
AG % J?alk p 0 /'l M✓
P. NO. 8 �D���
P T �.
ADDRESSGG2cG VeLDING
MAILbi N/
ADIDRESS� /S /
ll
CITY 1-14 �S/GVI ,/ic, NOL 7a --;W76
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LENDER
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ADDRESS ,,./6/J- /elve r
USE V �N VALUE QG
ARCHITECT G (/�/_ TEL.
OR ENGINEER _4" ? /r'(>➢iYt [„1 H 1 N �j -211Z
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ADDRESS SBp Rl C'K( pe-, r/%t r
FIRE
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CONTRACTOR G1 1 S IC"A-pi L/s
BVPROV EC
DATE �j
ADDRESS Ce26.2' a/ !» GC16
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CITY /-S�SJi�t'I 1/1'C"ONOLs C
ZO
NO. OF USE OF NEW U
PLANS'?-- BUILDING
SATE CITAP
LTC. NO. -3 /6-0 %S LICVNO.
VMA NS BUILDING ACCESAPPROVEDDSORV R ILD
SIZE j //��,� NO.OF RLDGS. J
OF LOT b x VV NOW ON LOT J
(FROMC/L TREET)
RO=T IMFT. I U F
USE OF 'l /
EXISTINGSLDG. t4 4d lrYfl�/rT Pt✓(
B. SI E FT.
Separate permits are required for
electric, plumbing and heating work.ALL
L. SIDE FT. 114" 11�kJ
0
REAR FT�—[�
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
MAIN SLOGS.
//
G 3 pt/NJ✓J'1 p�
VAR. #
C.U.P. ROVED
APPROVE
k1t R, E91 a1ENT
I hereby acknowledge that I have read this application and state0-0
that the above information is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am Properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the s. to of 1 fornia Business
and Professlo o e, Division 3, Chapter 9.
Signature f
Permittee &
1p II �1
s1
/J9/. T
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u4n SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALU
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$
RMI T..FEE $
PLAN CHECK $
TAX $ �,,�
Authorized Agent
TOTAL PAID $ 1+
vi1-70 PA16
[,S'00 547 �,t368.00
' COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A P C ION FOR
STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
RE ED V DATE
RECEIVED DAT SU—�s
BUILDING r , L
ADDRESS C. Sm
T N .
PERMIT NO.
1
OWNER F F.
A.P. NO.
MAIL
BUILDING
E 2 sr S
ADDRESS
ADDRESS
TEL.
CITY NO.
TRACT
LOT BLOCK
CONSTRUCTION
P IR MOVING
LENDER
BRANCH
/
Ly�
�
OWNER
L~L
ADDRESS
(f/
VALUE
ARCHITECT TEL.
S
$
OR ENGINEER
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR
BY
DATE
ADDRESS
TEL.
ZONE NO. OF
USE OF NEW
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDGS,
(FROM C/L STREET)
OF LOT NOW ON LOT
O FT.
FT.
USE OF
EXISTING SLOG.
F
F
Separate permits are required for
L. SIDE FT.
FT.
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
-
MAIN SLOGS.
ACCESS BLOGS.
VAR. 46
DATE
C.U.P,06
APPROVED
APPROVED
DATE
I hereby acknowledge that I have read this application and state
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n
that the above information Is correct and spree to comply with
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all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
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the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT.
N
THE AMOUNT SHOWN
UNDER VALUATION IS FOR
D
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING
A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
y
antl Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE $
LAN CHECK E
m
al
Signature of
0
Permittee
$a
TAX $
U
TOTAL PAID E
Authorized Agent
Y
42068
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely —/Use Ink Onl
BUILDING /-�� '��' / Sf, C—'yl• l
ADDRESS //�/ Q�� //
OWNER A1sr �s Ca Ae sts — P"i f7l•.
MAIL
ADDRESS2162c2 VM
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CITY NO.
CONSTRUCTION & 14 _
1 FN TR I✓ to 4
BRANCH (�PJ!�r / w+•'l. yrs
ADDRESS r'�
ARCHITECT 13, /� nin,;w NEIL
!IL
OR ENGINEERR
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ADDRESS 471 �L AI
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CONTRACTORpLfli/yr '�A
ADDRESSTE
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CITY^59_% (/) L �, NOL /bL'Z`�.�iyl�
F_STATE ) yTY
LIC. NONo-. LIC. NO.
d SI ZE LOT (j 3 3 �� NOW ON SLLO
a F
O
USE
.�.. ESE ING BLDG. Gam." 1✓� ass^Tr
y
Separate permits are required for
G electric, plumbing and heating work.
[wy USE OF BUILDING AND WORK TO BE PERFORMED
a
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a
a
w
1 hereby acknowledge that I have read this application and state
A. that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of
the State of California.
3 I hereby certify that I am Properly licensed as a convector under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses force
effect, or I
am exempt from v lions of the Stet f rnia Business
antl Profasslo otl Div n 3 frt r 9.
Signature o+ t
Permittee
Authoriz tl Agent
A.P.
OWNE
FIRE
ZONE
APPROVE
PAID
—1-76,.;:00 066:`
FOR STRUCTURAL
DATE
BLOCK
ZON jl IPO._ I BUILDING YA) 4 �J'/)l,
YARDS APPROVED YARDS APPR OVEDYARDS APPR OVED�O
MAIN BUILDING ACC ESSORV BUILDI
DISTANCE BET.
MAIN SLOGS.
VAR. #
VALUATION
OF
BET. MAIN
ACCESS. BL
DATE
n\s
m
si {OQas
VN UNDER VALUATION IS FOR
mQ
'I PERMIT FEE ONLY;
PE IT FEE E
n
PLAN CHECK E
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TAX E $
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UL
TOTALPAID E h
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� 42064
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IICI-1-71Ja"Q� 065:`
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- , COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
A L A ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use lah y
RE V D DATE RECEIVED D TE I SUED
LDING �J ] '
Z j S�1
ADIDRESS J /`-/ ✓
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OWNER GIi �cZ iLB ('/S _P�/ , pl.r CL•,M �/
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A.P. NO. -05 �'`
MAIL 'J % //2 V1M X01 f
ADDRESSIiESS
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ARCHITECT �N %� X2,4 y. 'C/Nf
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OR ENGINEER'."t N JJ 111.
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CITY vs�lS Sfyr/1G CA iNOL[Cc�`L-
ZON NO.OF USE OF NE
PLANS BUILDING
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STATE�..- /� CITY
LIC. NO. LIC. NO.
YARDS APPROVED YARDS APPROVED IL
MAIN BUILDING ACCESS RV BUILDING'
SIZE /'1 I{ /I-�. NO. OF SLOGS. '
(FROM C/ TREE ,
p.
OF LOT O J .JV NOW ON LOT
FRONT
Q
USE OF
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S
FT
FSeparate
permits are required for
L. SIDE FF T.
FT.
electric, plumbing and heating work.
w
REAR OFT.
FT.
ti
(..
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
0
MAIN'BLOGS.
ACCESS. BLDGS.
QC.U.P,+
3
VAR..$
DATE
APPROVED
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7
APPROVE
, Vv
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HOLD FOR SPECTAI
REOUIREMENT�
40
1 hereby acknowledge that I have read this application and auto
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that the above Information Is correct and agree to comply with
m
9+
all laws regulating building construction, and 1 shall not employ
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any person In violation of the workmen's compensation laws of
o
the State of California.
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3
1 hereby certify that 1 am properly licensed as a contractor under
SO. FT.
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 0,
m, I
Chapter 9, entl that such I full to e d effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am .Xampt fro provisions of the State form Business
end Profen ns C,"' iv on 3 r
c V
\/
VALUATION
PERMIT FEE E
Signetur of//
PLAN CHECK E
(`•\�"
TAX E
Perm ltteo
5
v
f
Authorized Agent
TOTAL PAI 0 E