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HomeMy WebLinkAbout184 21ST ST - Building Permits r7� • n CITY F CC!%TA MESAABUILD NG DIVISION o,i �G F I _-_-a IV6rQ9r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT -`1Mo.mrs 05-01868 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cMILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 184 21ST ST Status: ISSUED Suite: Applied: 10/18/2005 Vicinity: ROOF Issued: 10/18/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 42613122 Zoning: Applicant:ddressBILL GROVEAAN Address: 1007 W AV UNIT D Phone: (714)997-9449 ISSUED BY: ORANGE,CA Zip: 92865 Owner: ROSHAN, MASOUD Address 21 HALF MOON BAY DR Phone: CORONA DEL MAR,CA Zip: 92625 Contractor: FAIRWEATHER ROOFING INC Address: 1007 W GROVE AV UNIT D Phone: (714)997-9449 ORANGE,CA Zip: 92865 License: 770565 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT . TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 15#FELT,30 YEAR GAF SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.46 SQUARES. FEE SUMMARY . Plan Check: $0.00 Cab Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.90 SMIP Com: $0.00 Other $0.00 , Inspection: $0.00 Total: $168.15 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 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 2446-48(WOO) 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'compensation;as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ' °Ihave antl 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. l I My work rs'comppPsation Insurance carrier and policy number are: cCarrier Crz [ :it rz,^,-, ;., Policy'Nu ti -6U17gc9(O 0/0/ riffitsLsection"need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ 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 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 p • 'sic/ applicant Signe e` // -�. - - ,' pada; :/0 cir---�{— i-_ -yWAgNSMIDFARURE TO SECURE WO' • 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 1-THOI'SAND DOLLARS(sloo,000),IN AD' ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby afli0n that.)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 f fdroe end effect.Lic #s.- "7 C7e-C C Class#'• :. �' --S c 1l±rC nvec4or'sSignature:-"•m •.%I low-,----77,727 AC'-0 C C 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). 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 end 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 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) 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. 0 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,end 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 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 ❑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? ❑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 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 Califomia 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and 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 aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LIE 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? ❑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? ❑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. `/:(;// ) Signature Of Legal Owner(s) Date ` r-And/Or Authorizetl_Applicant =, - ..t.: _ ' [ Date;__,_.: - CODE k ftlaPECTION TYPE I.--- . . WE INTRIALS , Coon INSPECTIONTYPE Daji ____1& 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final /! 208. Final Plumbing ,,200 Final Re-Roof /(��!J 210 Final Electrical 201 Final Block/Retaining Wall 212 Final pire Prevention._ • 202 ' Final Factory Fire Place . . - 220 'Final Planning Approval - 203 Final Sign 222 Final Site - • 204 Final Demolition ' ' •' 250 •Final Building/Occupancy '-- '" . -• ' BtDING AND SAFETY DIVIS ,N FIRE DAMAGE INSPECTION REPORT . (Required Prior To Permit Issuance) tf 0Address: ' Sit 2 Unit: C Owner: fel f'ke IZo Sti a h — 9(Iq— 7 CI 0999 Owner's Address (if different from above): 27 kali Mcm N F . Street • City State N. Structural permit required. Repair or replace as necessary. ❑ Plans required. J Comments: L I'1 r t, A v Cry L'4 // �G- Sate, a e e t �f ,// L—/l/r 'hi y Vdo'y pocci Ale pkat /4i /ka4 45e - 5ato e dc.n, .. ( c /' it kit - p 4-- 7 J / 4— Alb Peony ptrc.ti'7t re1e4 (ke2C 1 Electrical permit required. / / Repair or replace as necessary. /� J Comments: step /a c� Gr.a..rs- •e je c/I lti ;et 5' , e /,, 5-1 fir-, 7-1r of r i ii d r..-v ti avec - (L i'i/. kat C tri, ❑ Plumbing permit required. ❑ Repair or replace as necessary. Comments: ii 4//111 . ❑ Mechanical permit required. ❑ Repair or replace as necessary. Comments: iv/7_, C4-2 ' 1/4v. 'cot- 1-/--.21-9q 7 /L/- 7551- 5'6/7 Inspector , Date Phone • 1872-46 Triplicate:Original.Owner:Yello -Contrator: Pink-Building Division �1 •���_ , � � CITY OF COSTA MESA • 0 BUILDING DIVISION f' ' DEVELOPMENT SERVICES DEPARTMENT RRMT PERMIT PERMIT NUMBER ` 1 19R4. friC1/# Pomo 41. (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 y BUILDING PERMIT <6i Job Address: 184 21ST ST Status: ISSUED C (.., Suite: I Applied: 06/24/1998 Vicinity: Issued: 06/24/1998 Parcel Nunmber: 42613122 Zoning: Applicant: ROSHAN, MIKE Address: Phone: 714-759-0999 . ,. Owner: ROSHAN, MASOUD- Address 21 HALF MOON$AY DR- '' - /..f/moi CORONA"DEL MAR CA/\ i - - Zip • = DECLARATIONS (^1 1 WORKERS'COMPENSATION DECLARATION: r 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 carder and policy number are: Carder: Policy Number. (This section need not be completed l/the permit is valued at one hundred dollars($100)or fess.) ❑ 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 laws of California.end 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 Signature; Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OOLLARE($160,031),IN ADDmON 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 DMsion 3 of the Business and Professions Code,and my license is in full force and effect.tic.4 Class 4 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,CMI Code). Lenders 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 DMsion 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(5500).): .2----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) license pursuant to the Contractors License Laws.). t__-❑ I am exempt under sec. • Business and Professions Code for this reason: Signature: �1^ A t -- D;tta:/ r 7 // Owner ID verified by drivers license. Wren 0 No Drivers 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,or demolition or dismantling thereof,win be more than thirty-six(36)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: 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 0 No (Section 25505 of the California Health end 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 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,certification 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? 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 permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 17 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII 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 roperty for inspectionI agree not tooccupyor allow occupancyof any building authorized b this permit until final inspection. purposes. 0 —z 9� Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE L INSPECTION TYPE Deg ItaMAALS f-ODEI INSPECTION TYPE PA¢ MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 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 ! # 2446-46 • l CITY OF COSTA MESA CALIFORNIA P.O. BOX , 317 From the Office of the Planning Department Auger, 3, 1961 Wo. tram Taylor 184 E. 21at Street Apt. D C.Mta Vasa, Califcamts Dear Mko. Taylor: The City of Costa Mesa wishes to advise you that in revising street addresses, the numbers listed below were changed: Old Address New Address 164 E. 21st tt. 13,17,1M. 184 U. Ma Ct., A, B, co D. 184 E. 21st St. A,DAID 186 E. Mot St., A, B. C, D For your convenience we are listing the agencies below that we will notify of this change. In addition to those listed, you may desire to notify your correspondents of the change. Your cooperation in this matter is appreciated. Very truly yours, W. L. Dunn, Director of Planning By: Dave Leighton, DL:rlb Planning Technician cc: Southern California Edison Company Southern Counties Gas Company Costa Mesa County Water District Pacific Telephone Company Post Office Public Works Department Engineering Department County Clerk (4) DR.M. ROSHAN 14 Monterey Circle Corona Del Mar,CA 92625 v , tv 20 v^-t-I �:�..w✓J/l�w:. �. I 12-p-2.4—enr. a.6 I Ine • ; 5: te_inwetc"-._ 17frvi..... aL-13,- CO y � .. • • July 3 , 1985 Department of Building and Safety City of Costa Mesa City Hall Costa Mesa, California Subject: Final Certification for Project at 184 and 186 E. 21st Street (DR-84-18) Gentlemen: By this letter I hereby certify that the final grading and drainage for subject project is in substantial conformance with the approved plan. ery truly yours, illrr Al Itt II -s J. McCarthy 11E . 1 069 JJM:gjr 4-112"6 n 3fl /pt� City of Costa Mesa I NJ LATI O N CE RT I F I CATIN Building Safety Division • 184 & 186 E . 21ST STREET COSTA MESA ORANGE Number and Street City County Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material Brand Name Thickness (inches) Thermal Resistance (R Value) EXTERIOR WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value) CEILING Batt or Blanket Type Brand Name Thickness (inches) Thermal Resistance (R Value) Loose Fill Type X Brand Name Minimum Thickness (inches) 32 Number of bags Weight per bag lb. Area Covered (ft2) 1080 SQ.FT. Thermal Resistance IR Value) FLOOR, ELEVATED Material Brand Name Thickness (inches) Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Administrative Code). ROBERT L. MILLER & JOAN Y. MILLER N/A WNhH roFferserecao-(Builder) License Number r .re . , itle to ERS Date Sub Contractor(Insulation Applicator) License Number i Signature and Title Date CMF 1106-30 Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. - PERMIT TRACT NO. LOT NO. T CITYNO. UNINO. OF COSTA MESA CONSTRUCTION PERMITP ��7 2� 4570 12/26/84 5.50 TL Project Address /71/ E -41- I . X073 5 MRn, 5 j Ito t TYPE OF CONSTRUCTION ❑ NEW El ADD ❑ ALTERATION ❑ REPAIR +r Applicant's Mailing Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name ides- Phone DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: Ln 00 Arch/Eng. License No. TYPE OF PERMIT El GRADING FOUNDATION ❑ STRUCTURAL E Front O I Address //��// ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N VContractor's Name se /e“ XS4ritf/ 4 Phone GY//'19c ❑ 'OTHER QJ 7 - C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY G Address(mailing) tie; 7 5 Am=,;. fr KLeft 1 C O N ST RUCTION TYPE VALUATION$ $ c9City License No: 3 � ZONE GRADING CU.YDS. ACRES R J' LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E CI I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: It:- Lj"jQln Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and ww ``�I'' my license is in full force an T / feet. _ S License Class ` -�Licgnse No. 6 1'g Date 42' Signature 0-0"-- PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES 7---':hereby affirm that I have a certificate of consent to self-Insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab- C.) Automatic Washer Transformer DI15-50KW Policy No?Aver.-40774)-490+" "Company . 4i7'1 O" •;✓ •7Z S. Backflow Irrigation Sewer Cap El 50+ KW 9 Construction Pole Sub. ❑-Certified copy is hereby furnished. Anter.G • erti ied copy is filed with the city B in9 Div to� p Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date J �6 -*if Applicant - t i/�d�rr•i- fleet% P44 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 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 1:10-1 HP 0114-B Workers' Compensation Laws of California. - Date Signature •" Floor Drains Swimming Pool vv/Spa/Spa F.A.U. Inc..Solar 9-15 HP ❑16-15+ 'NOTICE:If,after making this declaration, you should become subject to tine „ - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets 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. C.) Interceptors Water Heater Lender's Name p Outlets Range Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION 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 Garbage Disposal Standing Sections county which requires a permit to construct,alter,Improve,demolish or re air any structure, prior to its issuance, also requires the applicant for such permit p-Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains Pry c'T��h /9jL 2 cc 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 - :herefrom 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). - LJ 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 ! $15 Issue Fee' $ 3 for sale (Section 7044, Business and Professional Coder The Contractor's MECHANICAL FEES 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 Boiler Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not intended or offered foryp ZoningApproved sale- If, however, the building or Improvement is sold within one year of com- - Canopy Type II ❑ 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 LJrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- ' Duct-Structural Refrigeration System Application Issued By Dat zlo tractors to construct the project (Section 7044,Business and Professions Code: llU// The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES ' 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 Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMTP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire DampersPLUMBING $ J .DO ISSUANCE $ • Date owner Heating System& Ducting Registers PLAN CHECK 25% $ •-SC) ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BTU - - - GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ andstatelaws relating ,to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this :moi/may ttoo�enn tteee upon the �a bove-�entionetl propertyefor • inspection purpo/ /i X-�lil •- / Signature �O%,'Gr�.-_ Date ! MECHANICAL $ TOTAL FEE $ 5.�1.� Drivers' License or.L. Reinspection Fee $15 ' Issue Fee $ 3 PLAN CHECK 25% $ 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. 157. APPROVAL TO COVER-GUNITE • 7. Footings - 58. Electrical Conduit-Undrgrnd. '8. Foundation - 59. Gas Pipe, 0 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 I 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• '. 7, s' �(� 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 O Gas, 0 Oil 25. 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 PREY. 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: /./P p 7 '' j'r 9 � ��'9ln /I /�1`i 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation , 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 1 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 MES K CON y[{/AUC I E LT - PEa1161.7 NO. ^ TRACT NO. LOT NO. UNIT NO. • ',.•Project Address / �n/ dad q� �� r -- /� I•Applicant's Mailing AddressMM .r!•�s�sfpEd. 6 gateW/c- TYPE OF CONSTRUCTION LI NEW 0 ADD U ALTERATION U REPAIR !'� C./•✓ Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P # Zone Owner's Name �� DESCRIPTION OF WORK/USE OF BLDG. Address 'l' fyy� S Main Building: Accessory Building: r,� lI_ ^� Arch/Eng. `+ MII ll I L. enssse�No.� •� � TYPE OF PERMIT U GRADING U FOUNDATION Li STRUCTURAL T Front i =- • • 1 F �l i1� p • Address _ Z GH� OA RAI ❑ TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL B Rear I:I N Y7 N 4 A 4 I ••••C •9 ' J• El OTHER C Right J! DEI; 2 0 1V84� 11a Contractor's NamePhone �� ! N w �y PROJECT DESCRIPTION SO. FT. OCCUPANCY Address(mailing) ��y emu t �/'ral KI B` G CONSTRUCTION TYPE VALUATION 5 S Left II �s/y�1[ �g qTl6s�f, R City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref.9IE Pac1�Vl9 ^SR.U�J'i'fY'rvI F(s� D LICENSED CONTRACTOR DECLARATION J"1 I hereby affirm that I am licensed under provisions Charter 9 (commencing Remarks: 1/ r /_ 1 e Planning Notes: M with section 7000) of Division 3 of the Bu a d yf�fessions Code,and l`(10 ` 1 T my license is in full force and effect. -L License Class LIC 5e $ Date Signature PLUMBING I FEES WORKERS'COMPENSATION DECLARATION Bar Sink ti Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ;800, Lab. C.) Automatic Washer Transformer ❑ 15-50'KW Policy No. Company Backflow Irrigation ,Sewer Cap Construction Pole Sub. 0 50 t KW Certified copy is herebyw thr e Certified 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 Clover 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 0o-1 HP 01W-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 Pole Li ht I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name p Outlets Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby of firm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or P ;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 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 Division 3 of the Business and Professions Code) or that he/she is exempt - •herefrom 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 enalty of not more than live hundred dollars($500). . O I, as owner of the•property or my employees with wages as their sole I Reinspection Fee I $:12.....„.....---) Issue Fee $ 3 compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I. FEES 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 sale. If, however, the building Or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date Diction, 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 Approved By Date ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 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 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES 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 Exhaust System 0 Multiple❑ System Repair/Alteration - BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT O I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIt. IC80=/h Fire Dampers PLUMBING $ I S-Op ISSUANCE $ Date Owner - Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I. have read this application and state that the above 00-100,000 BTU 0100,000 BT - GRADING '$ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relatin• to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICflOFILM $ sentatives of t to e. upon the above-mentioned pro• rty •r • Inspection pur Signature - i Date MECHANICAL $ TOTAL FEE $ S r� Drivers' Liceri •r SS Reinspection Fee • $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 white . Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor I • -CONSTRUCTION AND PLANNING POOL .;PA - ' •• 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 1 • ., 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . r 4. Electrical Conduit-Uridrgrnd. 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, 0 Undrgrnd.,Test • . 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1.1. 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 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. 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: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING r7A/F _ °v -may, 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 NT,R UCJI,QEE,� PERMIT NO.��� TRACT NO. LOT NO. UNIT NO. -T - - — — - -- ��'' / 1� I r z I/ i t• �1 Project Address f I ''t LI] 16 IVF 4/©I{ •3 I CJa V'l dl� I 309 S. 4b TYPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATION LI REPAIR ' Applicant's Mailing_A �es5 s��. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name v i Phon / •3' A•P• - Zone DESCRIPTION OF WORK/USE OF BLDG. Address ' n • VC Q • trn • S Main Building: Accessory Building: , •Arch/Eng. ' �� ice se No. TYPE OF PERMIT U GRADING U FOUNDATION U STRUCTURAL E Front •' - p Address4.309^e Fue[40/ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - N I Contractor's Name fI� Phone ❑ 'OTHER A • • I • PROJECT DESCRIPTION SQ. FT. • --. _ OCCUPANCY C Right • 'r N Address(mailing) CONSTRUCTION TYPE VALUATION$ - S Left ,r City License No. ZONE GRADING CU.YDS. ACRES E I LICENSED CONTRACTOR DECLARATION - Ping. Ref-# Parking Req./Provided • Q. i % I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: \ // Planning Notes: M i with section 7000) of Division 3 of the Business and Professions Code, and U ./‘ my license is in full force and effect. Ti (� s I License Class - Lic s °i\� PLUMBING FEES • 1 • Date Signature _ , WORKERS'COMPENSATION DECLARATION Bar Sink Showers +. I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES , it Workers' Compensation Insurance, or a certified copy thereof (Section • 3800, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW PoNo. Company - Backflow Irrigation Sewer Ca . I 0 50+KW P Construction Pole Sub. li ECertified copy is hereby furnished. • Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Dover 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 •r which hi-per, it is issued, I shall not e loy af y p rson in any ma.n- • to •e••me -ubject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'h-8 • Date(y o Laws of Caldor`— 7 • Date(-s/� Signature Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE: I ,after ma ing this declarat •n, yo sh•uld •-come subject to the Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the .•or Code, you must forthwith Floor Sinks - Urinal Fixtures • ' comply with such provisions or this per it 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 HeaterOutlets • Lender's Name Range • • 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 following reason (Section 7031.5 Business and Professional Code: Any city or 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 Com actor • 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 ' 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 - • ' 'herefrom and the basis for the alleged exemption. Any violation of Section I • ' '031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). - I ' ❑ I, as'owner of the property or my employees with' wages as their sole • 'Reinspection Fee ! $15 Issue Fee • $ 3 • I compensation, will do the work,and the structure is not intended or offered - - Reinspection Fee I $15 IIssue Fee $ 3 for sale (Section 7044, Business and Professional Code:' The Contractor's . MECHANICAL FEES ' 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 ownDEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 - Approved • pletion,sale. • If, ehowever,wthe building dof pro isgsold one year of com- - Canopy Type 11 ❑ Zoning pp By • Date rofthe owner se have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved BY Data r e for the purpose of sale). - • Z• /I I as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By - - Date I, to construct the project (Section 7044,Business and Professions Code: - he Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU _ SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- ' tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration - DING PE MIT $ • �S• SMIP $ proof oftheir Worker's Compensation insurance should a provided to me. PLAN CHECK $ PERMIT I 0 I am exemp and r Se ion .& .C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers • ISSUANCE $ PLUMBING $ Date - �Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. , $ I hereby cer ify that I have read this ap lication nd state that the above 00.100,000 BTU 0100,000 BTL ' GRADING I $ • information is correct. I agree to comply ith all city and county ordinances ELECTRICAL $ • and state laws relating to bull. ng •nstr ction, and hereby autho •ze r-pre-- . I MICROFILM $ - sentatives of th' 't . • en -r •one above-mentioned -r•per PLAN CHECK 50% $ • inspection purp..e / — • MECHANICAL $ Signature Dat TOTAL FEE $ �� - ' CMF 0865-46,rev. 10/64 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor - _ _ _ _ _ - - • A . 1 CONSTRUCTION AND PLANNING POL _&SPA ' APPROVALS - Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole v) 52. Pool & Equipment Location • 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical'Conduit Utility-Undrgrnd. t 54. Forms ' -'. L • 4. Electrical-Conduit-Undrgrnd. 55. Electrical Bonding '•• r5. Steel•Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE -I •t7: Footings. i• • 58. Electrical Conduit-Undrgrnd. 8: Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test •••' . 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - - 10.Strudtural'Floor System 61. APPROVAL TO DECK • l • 1.1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ' r : - .12. Sewer•C3p 63. Heater & Vent-Final • 13.'Roof,Drains 64. Plumbing System - Final •: 14'.:Rough Plumbing 65. Electrical-Final r 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# r • 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 D Gas D Oil 25. 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: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test • 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final - 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 74/ry 48. Special Requirements Completed 49. Electric Release to Edison - - - • 50. Gas Release to Southern California Gas CO 51. CERTIFICATE OF OCCUPANCY No. Date 7 1/d/j-P - i- % ( ) VTN C• I OLIDATED, INC. c c4 ri a subsid r of CPE ENGINEERS,INC. S. e. SI X51 Pta c ON I 2 0l .us Drive cSC,°�\\-AG 0�' 'ne,I�alifornia 92715 /�� �u1 }/ 0 1�u e� ct I� t 4) 51-5200 '�G� ,n_ 1 t �V`~T �1 '�i 3 �,g W`lu X30 ltK April 3, 1985 10 ` / / Aterd / 1 Building Department e 114* City of Costa Mesa / 77 Fair Drive I� 1� /, Costa i. Mesa, CA 92626 / , / , / J Subject: Occupancy Permit for Project Address: i ' 184-186 E. 21st Street, Costa Mesa Gentlemen: A topographic survey was taken for subject site under my supervision on April 1, 1985. The survey indicated the following: 1. In order to salvage existing construction, the drainage around the new units cannot be accomplished by a graded swale as shown on the Site Plan. A one percent grade cannot be accomplished without considerable demolition. To avoid demolition, I suggest that a concrete ribbon gutter be constructed with the high point at the mid-rear of the units, at a flow-line elvation of 102.70, which is 0.70✓below the lowest finished floor elevation of the two new units. The ribbon gutter would be concrete 24"wide, 6" thick, with a Jiro( 1/2" reverse crown at the cent The concrete gutter would /,l ie' flow around each unit at 0.32% grade and exit at the end of the N4^ parking space in front of each unit. The City' s minimum grade for such a device is 0.30%. 2. The sump pump size and location is such that it would be effective only for nuisance water and minor storms. In the event of major storms, the open area in the vicinity of the two new units will pond up to elevation 101.70 at which point it will then drain to 21st Street via the existing concrete driveway. The ponding will be localized in the vicinity of the sump drain inlet and will be pumped dry during and after the storm. Note that the lowest finished floor elevation of the two new units is 103.40' . Zia 0c . - C —B' % s ENGINEERS PLANNERS SURVEYORS •- . • Page Two City of Costa Mesa April 3, 1985 3. The construction of a 6" P.C.C. curb adjacent to the existing (11° 011,1and the newly constructed driveway would be of no benefit to the project and would, in fact, tend to block drainage from the existing units to the driveway which carries the drainage to the bt ihny/k"'1 public street. I request that the requirement for this curb be �j eliminated. D If you have any questions or comments on these matters, please contact me. Very truly yours, VTN CONSOLIDATED, INNCC. Ites J. Carthy 170 JJM/ccb cc: Jack Hyatt OWNER TAYLOR. CLAUDE - . DATE 6-28-60 JOB ADDRESS 184 A & B East 21st St. BUILDING PERMIT NO. 124125 GENERAL CONTRACTOR Starview Homes, Inc. VALUE $ 12,160.00 AP.No. 118-073-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Dup.w/att.Gar. INSPECTIONS is u/ '--- DATE I GROUP I & J TYPE V ZONE Rh 'erground Soil6"40 jQU.G. Water/4/5��� PERMITS ISSUED erground Gas /Y/ SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating ., _ .e.. - _,l 4-.i yam/-So d.5 ic -. Rough Plumbing . - 9!4Cl (�{T�/%; j-,R y'-Co 6 Miscellaneous , _ ,. 1 - -io - -, _a %IL -,1-)- Gi 0 - V Prop. Swr. Li.: .utI on. St. Swr, G/ J V / V Sprinkling System l;.1 if Heating, Final bra 1//MG! l3' A Plumbing Fixtures - Z5 4/.10-6., 1 3 Final Gas Test D- i'' /4//P, rents-L/ Construction Pole Underground Power Rough Wiring '�' _I-n-0 -'''7" d' y�-�/ �_a�-co i3.4 z .,/ Trenches ✓Forms 4•*"...-Steep, o_.- 7 — J 1, —4 o Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing ss4 X ^.1- < 6 Frame and Flashing2`S' 40 J 'ng, In Out •Bo d e 1 ,er, brown coat r /3 l'G d Plumbing Fixtures, Final _ rob ri-p0-S, • _ Electric Fixtures, Final Q /� _ Building, Final G 4 1 OCCUPANCY ` \. Form 410-5M-11-59 5-B P A & B . 12425 Ers45r cgGMa - 12425 • 1 COSTA MESA BUILDING-SAFETY DEPARTMENT ECEIVED P. O. BOX 917 COSTA MESA. CALIFORNIA EE .R Lv v '-4 CO -Zratt .2J=6o For Applicant to Fill, In Completely APPLICATI •, I �TYPE OR PRINT fa4,g •BUILDING i�,y_ye- ' -I .fir 8� 1, STA MESA ADDRESS COSTA MESA. CALIFORNIA For Office Use Only /7/a- CI/�./4U 0 1 'TA 1 A/1 OIZ RECEIPT NO. PERMIT�}1 3 OWNER r • MAIL E. /) RE,CBy��VED BY RECEI /�D DTE Ij3 ADDRESS tri F• 2/ -r V 19A/RECyD G °6D• ,1 TEL. BUILD 4 /t a) �A) CITY CO STW ./1�ES /1 NO. BUILDE5555 �( _ ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS FIRE 2T�/y `T- 1 ZONE TY///��IPE GROUP y '///{/�flj CONTRACTOR J I ✓4R•Q1 fLL,I 6/644ES / QC. APPROVED �-/. DAA �jy di ADDRESS Q As- N, NnRi3oiz. /34 VD, (92/,:d NING R.. 5/9/1/ I9` n {9 ZO ( NO.OF USE OF NEW J CITY `�,r/'/I I� ��l// 1. I PLANS I BUILDING / 7 7I- II/53 LEGAL n R I q '/1 /l� LIC.NO. / a S � / NO. ��, DESCRIPTION l'JDI\ '�U ���� I'll (/%() SIZE OF LOT /2.5 A 3 30 (NO. OF BLOTS. // i -0 9 3 -Q -6 NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM M I / I (CENTER LINE ST.) CENTER OF STREET �1 EREAR YARD p-iC) FRONT FT. r IN. SIDE YARD I LEFT 7pp/I I II I RIGHT ,6-I R.SIDE SFT. DESCRIPTION OF WORK L.SIDE q� FT. f/lKi///T/� IN. NEW LI II ALTERATION I IV ADDITION I REAR //0 11 FT. ,40.--,74' (AX/ ( IN. REPAIR I MOVING I I DEMOLISH I BYPROVED (,` /1 �' 1 nDATE 4 ---)-47-60 SSIZE DING lD�, X ZI/ ROOMSF STORIES I w (51-------- EXTERIOR JV EXTERIOR WALL ,.•.j 1J)�I ROOF I, COVERING y/�a-O COVERING �'('/r USE OF BUILDING AND WORK TO BE PERFpORMED a. /=w-1.111_4 pcuga1 ii W 1 rhi • a vr. • v%►y - j9 rr J c/912- 6/9/Z . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OR ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDIN NCE, . D STATE WB REGULATING BUILDING CONSTRUCTVALUATION SIGNATURE OF 6t_ i \I,4„• PERMIT FEE $(�v ?-12R PERMITTEE S72 /6 °I \ PLAN CHECK $ A' ).-r ✓ F AUTHORIZED AGENT / .- O TOTAL FEE $ E OWNER TAYLOR, CLAUDE- - DATE 6-28-60 JOB ADDRESS -184 C & D East 21st St, BUILDING PERMIT NO. 121126 GENERAL CONTRACTOR Starview HRmeS, Inc. VALUE $ 12,160.00 AP. No, 118-073-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK p•w/att.Gar, INSPECTIONS I Imo," DATE I GROUP I & J TYPE V ZONE R14 1 rground So' 1*(,QU.G. Wates////5"2 ‘•e0)-- {��7 L�� SUBCONTRACTOR PERMITS ISSUED L :rground Gas /y DATE NUMBER Overhead Water and Gas Rough Heating - 4_, _6-,,c, a 579? ✓ Rough Plumbing 'r ' " ' r"" .T r ' #Pr - - - — / Miscellaneous, ' 1241/..Ery r/-'a- / grit-f L Q„c,c.C51 _ V-)-h/ 4.--9 1 Prop. Swr. ' ' Hotter on. St. Swr. 1.14( esti -c&_ V714/ 1 S9't— Sprinkling SystemlYjl�/ 6/ Heating, Final ta. GI 3 Plumbing Fixtures !yam W./c 4 / �%t Final Gas Test -1%---I it *ye24 4/. ler Cd Construction Pole Underground Power Rough Wiring e $-Z -(O?1 Gln, 4• s-.u-2 p.....„....7-cc, /3...7/..36," Trenches L.-Forms '- Steel 7;,/ °-- '—A 6 O Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing �/l,�' Frappe and Flashing *kJ- -. O A. a Iq{'.>,::;;wg, In Out w�1 Pi..Zer, brown coat Plumbing Fixtures, Final /Y0=1 14/10,-Cf . ElectricFixtures, Final Building, Final / 'htgab( OCCUPANCY Form 210-5M-11-59 S-B P C & D • 121126 Fj4J7 J?Evv r2 . .41 •A 12426 .. COSTA MESA BUILDING-SAFETY DEPARTMENT , ��r D�CE'v � . [, P. O. BOX 817 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APC- 1 ,WV C RTR(ERMIT TYPE OR PRINT /+ Ila i'N( A BUILDING 1 4 -- /B / D ^ 1 5 r yt� IV ADDRESS �+ T FT ./- COSTA MESA. CALIFORNIA For Office Use Only OWNER L � �( C,/AIp 'n Y /O I RECEIPT NO. PSRIZITY H4 MAIL RECE�Iy:AyD BY D///AAA���EEE ECEIV 0 TE ISSUED ADDRESS 11y E. L1 Sr V1 j p b bTEL. l 'P ^ CITY COST" --LI gS4 • NO. ADDRE S //LJ p kat P4j) ADDRESS J� / L/ ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER • NO. FIRE a� 1 ADDRESS -gyp�j ZONE TYPE'. GROUP l CONTRACTOR 5 7 9 R✓I E[(J J4j 5 /Mc• APPROVED } DATE ���� ADDRESS 9 A r/, i-/rgre33oti 13I 4-149, ZONING //,/ �/f�A 'F��d �/�- [1 zott NO.OF •fl USE OF NEW/4 / CITY �/'T 1-I 1 •'/ `•%I��rT _4 ( I PLANS ✓ I BUILDING / STATE t 1 TEL. T l� LE ///I �] /U-0- / V LIC.NO. I C.r77-.[/ NO. Ye /-1 • 5 3 DEBCLLLRIPTI Vr O /I 1^(� -c- SIZE OF LOT ( p�S $ �7 I NO. OF NOW ON LOTS A.P.NO. / /i' rO 93-6‘ USE OF YARDS [[[ ((f EVES EXISTING BLDG. _ APPROVED ALLOWED SETBACK LINE FROM 1 ( (CENTER LINE ST.) p/ CENTER OF STREET J I REAR YARD / FRONT /pd FT. - IN. SIDE YARD I LEFT 78-1/'III I RIGHT 5-1 R.SIDE :) FT. IN. DESCRIPTION OF WORK SIDE L ? �FT. � IN. 6-------- / . NEW V II ALTERATION I II ADDITION I REAR ....3 FT. IN./ REPAIR II MOVING I III DEMOLISH I APPROVED 0. J/// DATE (.� - 3 (9 o BUILC‘-- -- SIZE DING !oo y 2 ti NO. OF ROOMS �J STORIES / ` Alr^f1( COVERING EXTERIOR WALL A`7J a0 I COVVERING �M pLI . l 9 V USE OF BUILDING)AND W•RK TO BEP / FO MED 4�+I�\ /«EWELL! WITtI • s����_ 19-TT- t a• G'/9Z cn z . 7,.,---,-_-., I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCE AND STATE WS REGULATING BUILDING CONSTRUCT N. VALUATION m� ----,SIGNATURE OF {�-� PERMIT FEE $ b� O PERMITTEF CCyyFF.J' r �. N $ / / /14; PLAN CHECK $1J `R — O�+ AUTHORIZED AGENT ` .1 ///!!!/// 4/S.Js�i E TOTAL FEE 5 I a 1 a Insutatinn Vtrrtifirate • This certifies 5 • that the building 6A- OSA /72.<43, 1 r• located at ��y �8� � 2 cc • j ,• Has Been Insulated With F! Lerj1/47-c-c-S Insulation. { - In The Following Areas CEILINGS WALLS ill ? • To An "R" Factor of /C . J� , - / / ? Material was installed in accordance with standard contracting practices and business 5 s code requirements. F,• Insulation Contractor — Angelus Air Conditioning, Heating 8 insulation, Inc. ;= State Contractor LicenseeN mber 328-253 ;• Date Installed / 5 - ��L • Signed fi• �.Gf���C>.— 61-7C52 .,•: --� c AA"%VIZi!'lu•1Jw1LS!fl•! •AL:!/JUPL 'SAP. •.IMASA JVVJ VIAD.•.lP•N City of Costa Mesa (� Development Services Department CERTIFICATE OF OCCUPANCY No. 00/411 Building Safety Division P.0.Box 1200 Costa Mesa.California The Building located at ]on c. tof o has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Occupancy. Use of Building Legal Description 496-111-99- 1111—n71-0g '- (See reverse side for Metes and Bounds) Building Permit NoR15399. 614678 Electrical Permit Ne216997, G14678 Plumbing Permit No P16729. G14678 Mechanical Permit No. Number of apartments and/or guest rooms Reinspection Permit No. 114678 Fire Permit No. F167061 , ISSUED TO: Building Official /' e / ���� Robert S Joan Miller ` l!M , f , 1309 S. Euclid Avenue by Anaheim. CA 92802 L�// Date eL 2- /f(Yt// { f This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File 11 1 CITYOr COSTA MESA P, : FEES 6172 8/13/E4 2458e75 T\ � , ( 4F�ee Payment Receipt N! - 9 6 2 Ik LIY Project Address a) 134.0 B Z)a.t 5 I A.P. Number 14A 6 — 131 — o22---, Park Area Building Permit Number Owner's Name Joan C' T1/�,, Mailing Address 1SG South Euclid I tout nn Cit 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 @ 47437 = I 1-Bedroom .@ 573.18 = 2-Bedrooms @ 881.51 = 3-Bedrooms+ a @ 1,229.38 = 5-710 1 ' \�/�`� � '� '� "�� � Total Fee •*• r�45Fi•it' / Planning Department Approval Date s)l i a)814 By ( A.4801�(_ AXit_.o / 4 Applicant's Signature _.....641...... .A4 ele/"' ! City Ordinance 72-44 City Ordinance 72 •••City Resolution 76-116 • COSI a1IQOd CMF.O3�32 Rev. 6/79 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant I . r-