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HomeMy WebLinkAbout186 21ST ST - Building Permits • ' i r _ CITY OF COSTA MESA - r is q',>•!Y. BUILDING DIVISION F I ...': I DEVELOPMENT SERVICES DEPARTMENT PE NUMBER 4• +Ls • PERMIT P05-00589 - SP (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa OMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 186 21ST ST Status: ISSUED Suite No Applied: 07/29/2005 Issued: 07/29/2005 Vicinity: UNIT B Parcel Nunmber: 42613122 de Applicant: GULLICK, REBECCA Address: 21 HALF MOON BAY ISSUED BY: "...71..... 1 ..._ Phone: 949.246-8695 CORONA DEL MAR,CA Zip: ,92625 Owner ROSHAN, MASOUD Address 21 HALF MOON BAY DR •' - Phone: • - CORONA DEL MAR,CA Zip: 92625 - Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 000000 SCOPE OF PERMIT CHANGE-OUT OF A WATER HEATER IN UNIT B. . , REF:C0-05-0099 NO OTHER WORK AUTHORIZED WITH THIS PERMIT. : - FEE SUMMARY . AMT QTY AMT QTY - AMT QTY ISSUE FEE $23,50 . ' Laundry Tub/Washer _...$0.00 0. .. Sump Pump . $0.00 0 Backflow irrigation ' $0.00 0 Landscape Irrigation - $0.00 0 Swimming Pool • $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System .$0.00 0 Process Piping(per 10 ft) $0.00' 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0,00 0 Receptors • $0.00 0 Vacuum Brkr BktIow(5+) $0.00 0 Dental Units $0.00 0 , , Septic Tank $0.00 0 Wash Basin • $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo. $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect - $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 - Sewer Private Line „ . .. $0.00„,., 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 '0 Shower $0.00 '0 , , .Water Heater/vent $12.30 1 Drinking Fountain , $0.00 0 -' `Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00' 0. -- Sink,commercial , $0.00 0 - Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 . -. Sink,Floor $0.000 Water Service $0.00 0 Gas(1-4 outlets) $0100 0 ., Sink;kitchen - $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) -$0.00' 0 . . . Sink,-service/mop - . .$0.00 0 - OTHER $0.00 Gas Repipe $0100 0 Spa(private). $0.00/ 0 VIOLATION . $0.00 Gas Service $0.00 0 . Spa(public) $0.00 , 0 . - PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 . , REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 - -- - TOTAL CALCULATED FEES: $35.80 COMMENTS]SPECIALCONDITIONS 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 fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with aft 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 zus+s twool - DECLARATIONS` - u r a 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: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sec ion 3700 of the Labor Code,I shall forthwith �ply.wlththese troupe aa �'1 Applicant Signature: &ta. 7 2 9/o 5.- ,_...— WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS($loO. 0),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.A Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 ' is the applicant to a civil penalty of not more than five hundred dollars($500).): a iI,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. 044,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 contrector(s) license pursuant to the Contractors License Laws.). ❑ I am exemptoder sec. Business and Professions Code for this reason: Slgnatnre JFK- 11 �A [Date:. 3'09/29/o3 Owner ID verified by driver's license. Yes 0 No Driver's t enserNo. ( � Expires: 132-0 6 Verification of Ownership by(type of doc a t,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 Wit 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 materiel? 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)? 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? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aggermit 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 lJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 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 end Safety Code Section 42303 been made? 0 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.1 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-describedlproperly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �— 11/ Si n al Owner(s) 07/?q(//byte And/Or'Authodzetl Applicant—#.4- rODeter - CODE f INSPECTION TYPE PASS INTITtA14 CODE I/ INSPECTION TYPE QAg ) 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing R-25-0 s 1-Z EI 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 L250— 2I04 Final Demolition Final Building/Occupancy 1 07/29/2005 14:08 9497590999 1;ROSHAN L -. PAGE 01 FROM :c •re OF.COSTA MESA •, —��----i- — -- --–FAX NO. : 714 754 4855 Jul. 29 2805 12:01PM P1 7/7_,C9 0997 DECLARATION OF AUTHORITY Bldg.Permit FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Parmlt N -- Street Address: 'at? E. 2 1-th 44. 6 Co f /,t Of y9 AP Number. 1. I(we), C-hangar+a Ft7Ri8. declare that 1 em the Oester of nee of the above referenced real property,and that I(we)hereby authorise. • //� ?(i )\ lie. Q. cc& G y&i 'l L:.«,... Telepis0 Number:l_ ` 7 a" (j I St dress: /), I I4At.i Thbo,J r A �1 \\ •��// • +c.,t (in rDn& Ad in1a( f � ..... —/- sli R 6 35-- yr. to obtain permits In my brae,as owner/builder,for Vl.1A rie r bech'r 1 /2/(gym b r C]; fa,_ - et the above referenced property. 2. Should any person become an employes engaged In the Improvement of the property, I (we)shall immediately provide Worker's Compensation Insurance coverage end cause a certificate of that coveraoe to be filed with the Building Division of the City of Costa Mesa.as required by State of California laws, 3. As owPPerrouedar in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation 4. I sores to indemnity and hold the City of Costa Mese and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any otter Parties as a result at work authorized by the permits from the City of Costa Mesa. 5. !declare under the penalty of perjury that the foregoing is true and correct. Ekacutad this elkq'day of T5t,J Ly -- 20 os ,at ,California. Print Name. a{'I AtnAKT+ C42154- g t75fRA/ r:4� , / I / fir.— nature: ilir:/; / 1. /. re.. 3, Date: 0 IV la/O Note: This authorization does not grana authorization to perform the work as owner, s Eley provides for flied power of aeomsy M secure etre penile. in any behalf. • 07M-le(rer.11,94) -3111'1:t„ • CITY OF COSTA MESA 4 svILDt Nt DIVISION ,1 it F ( '` I DEVELOPMENT SERVICES DEPARTMENT PERMIT NtlMBER 4•I�qr� PERMIT q(/�/ ` 05-01870 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cey1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 186 21ST ST Status: ISSUED Suite: Applied: 10/18/2005 Vicinity: ROOF Issued: 10/18/2005 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number: 42613122 Zoning: AN Applicant:Address: BILL GROVE AV Address: 1007 W GROVE 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.UNITS A-D. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.90 SMIP Corn: $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)754-5628 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: 0 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. CTT I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Cade,for the performance of the work for which this permit is Issued. " My workers'compensation Insurance airier and policy number are: Carrier: ti�;-FO/n c' ..� S • Policy Number: (-76EX7tC?L 0(0/ (This section need not be completed if 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 provi ' . ApplWARNI ntG SigFAILURE TE( SECURE WORN COMPENSATION PENS IS UNDAMAGE AND SHALL PROVIDED SUBJECT I AN EMPLOYER TO CRIMINAL R CODE,I AND CIVIL FIDES TO N ONE HUNDRED THOUSAND GALLATE(5100,000),IN ADD ON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3106OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 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.p '7p>0 �6 Sof Class 0 C.—- `J Contractors Signature: �c /C�-/ wL Date: !O CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the 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 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,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: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia 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 lime 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 25519 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 Safely Code been fully complied with? ❑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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Coda requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Sal ely 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 end Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Legal Owner(s) ./0 Date ��Andtr Authorized Applicant Date CODE# INSPECTIONTYPE PATE IMRIAL$ CODER INSPECTION TYPE 2Aff. IBIIDALS 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 - CITY•OF COSTA MESA BUILDING DIVISION • t , PERMIT BER ) $ DEVELOPMENT SERVICES DEPARTMENT PERMIT r+ ww 05-01871 -`" ooam (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cEwjLOING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 186 21ST ST Status: ISSUED Suite: Applied: 10/18/2005 Vicinity: ROOF Issued: 10/18/2005 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number: 42613122 Zoning: Applicant: BILL MCFEGGAN Address: 1007 W GROVE AV UNIT D Phone: (714)997-9449 ISSUED BY: _ L 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.UNIT$E-H FEE SUMMARY Plan Check: $0.00 Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.90 SMIP Corn: $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 2448-48 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 thaperformance of the �,(' work for which this permit is Issued. `i 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: (� . Carrier: r-.1 / .2/'n --. _i,-,_i,-, $ Policy Number: / /oo gr.C.24-0./40/ (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio.i i Applicant Signature: ��'- Date: /b -71,-,-OS--- WARNING:FAILURE TO SECURE WORNr.�COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARE(VOODOO),IN AD• ION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.IJc.# -7 70.5--a f Class# r - 3 S Contractors Signature: Date: /0—/$—nen 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). 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 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,es 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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑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,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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or 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 apermit 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 P No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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 Duality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. I 1 Of Legal Owner(s) Date /''i�� ____— /Q it oc And/Or Authorized Applicant Date QODE I INSPECTION TYPE PATE . 1NTITIALS. ODE IBSPECTION TYPE PATE INTIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final . 208 Final Plumbing //�.200 Final Re-Roof / Z7 S 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- - .VIOLATION NOTFI CE J • Cityyf Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626 The CityapCosta Mesa Municip / O & 2/G-7- goy ming this location: L_� t hQh g)(-, does not permit ❑ Disposal of heavy objects on private/public property(CMMC 8-85) ,t. ❑ Excessive weeds and/or rubbish(CMMC 8-105[a]) ❑ Conducting business without a city license(CMMC 9-1) ❑ Vehicle advertised for sale on public property(CMMC 10-188(a)) ❑ Vehicle advertising item or event on public property (CMMC: 10- 186[b]) ❑ Illegal storage in public view(CMMC 11-56) ❑ Storage of inoperative vehicle or parts thereof(CMMC 11-65.1) ❑ Living in garages or commerciaUndustrial unit(CMMC 13-26) ❑ Outdoor work,storage or display without a permit commercial(CMMC 134) ❑ Outdoor work/industrel(CMMC 13-53) ❑ Use of residential yard areas for parking/storage of vehicles (CMMC 13-86) ❑ Garage sales in excess of two(2)per year(CMMC 13-30) ❑ Portable signs on private or public property(CMMC 13-112[g)) ❑ Flags, banners and pennants not in compliance with code (CMMC 13-112[d]) ❑ Erection of signs in public right-of-way(CMMC 13-112[e]) ❑ Placing oil on streets or in sewers(CMMC 15-6) ❑ Vegetation protruding into street or sidewalk(CMMC 15-140) ❑ Living in trailer or RV (CMMC 17-6) ❑ Other.CMMC§ Viola ion: 1/i1/rC2 "'r v (/1"". i/CI OO @t-' Crejlizird a--- 4.12 i \Acta htNeves ,Pe �� - Failure to resolve the above violations)by may result in the Issuance of a citation or referral to the City Attor a for prosecution. o►Ol b—as—q3 PRINT Issuing OMcer Time Phone Number. y'.S 1-St0Z-2S ❑ Citation Issued 0 Referred to Code Ent.(754-5623) ❑ Violation Cleared 0 Referred to City Attorney Reinspected by/date 2274-30 PLANNING (rev.398)mw White-Violator;Canary Officer;PIM-Hie v Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. _ CIT�OF CESTA MESA CONSTRUCTION PERMIT 8721 9/24/84 54, r - ' Niko // ;5/.S3y .EIS . 7sz� , Project Address / 4 Q /�O E-+l/�.5� / ?NEW Applicant's Mailin Address 5-33 L✓.Ccr7$.€ �! 44,4(4 .1 TYPE OF CONSTRUCTION ?NEW ❑ ADD U ALTERATION U REPAIR 3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ,2-C-/ �7� A.P.# 4/2 � —/ -5 ) '- 2 Zone R 2. Owner's 70Name OI $ i 'C. 11"y�1_A117 Phone DESCRIPTION OF WORK/USE OF BLDG. Address /3°% Si GvC I A /PrAli /'� a?- S Main Building: Accessory Building: Arch/Eng. 9/B License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION U STRUCTURAL T Front 23 4/ ' 0 Address111TENANT 0 ELECTRICAL ❑PLUMBING 0 MECHANICAL B Rear 0 1 N Contractor's Namv-c/S,4z'zs rel 1f(in G7'( Phone 9ber( ❑ 'OTHER // // Q 7� p PROJECT DESCRIPTION CO. CTS/-2S- -G.,--s�C' OCCUPANCY C Right 0 r N Address(mailing/ W.A.- 2 re•/h. .444.0 .7 e4 (�i S O G CONSTRUCTION TYPE ALUATION$ OQd. Od Left City-License NO. �A ZONE GRADING CU.YDS. ACRES R LICENSED CONTR yin DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: / 1 � �0 y-A fi24 Q,'.��R�/ M with section 7000) of Division 3 of the Business and Professions Code,and .�1 " `� I my license is in full force and effect. �� `,?1/ 767 • ///e j a2/o _ O • S 1j,9 A�[r'S(�((Ora \I Set a 741 &'7e fee? stripT S- / ` License Class License No. ` / / '/� / U / L/ O 7 1 J , / Date Signature PL MBING I FEES o. WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer I Transformer 0 15-50 KW 3800, Lab. C.) Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW Certified copy is hereby furnished. 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 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 yQ Wo , Lar ors'll not employ a y personws of CIn any al' o m er so as to become lubject to the Drinking Fountains Solar Tank '/a Fan Motors❑0.1 HP ❑1 -R Lai Date 4' . L Signature L1J/4 ///..C/A /) Floor Drains Swimming Pool w/Spa NOTI E: ,of ' m. ing this declarat ,you shoa/ become subject to th0 F.A.U. Inc.Solar 09-15 HP ❑iB45+ Td Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked- Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets' • Lender's NameRange Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION - Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the LavatoriesGarbage Disposal I I following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap any structure, prior to Its issuance, also requires the applicant for such permit Generator 00-5 KW 05.15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of • Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil - enalty of not more than five hundred dollars($500). C 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 Foe $15 Issue 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 wno does such work himself/herself or through his or her own DEVELOPMENTSERVICES 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 /CC-/eiQC Date �--SI- V pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By DatO r ve for the purpose of sale). - �� 7 as owner of the property,am exclusively contracting with licensed con- Duct-$fru Structural Refrigeration System Application Issued By Dat¢ con- tra tors 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 00100,000 BTU Ell 00,000 BTU SU MARY 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 ❑ ❑ System Re air/Alteration BUILDING PERMIT $ ''S-0 SMTP $ ' �� proof of their Worker's Compensation insurance should be provided to me. Exhaust System MultipleRepair/Alteration PLAN CHECK $ Pn/ 1.. 2--. PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# PLUMBING $ ISSUANCE $ Date5�,-121 - Owner .-_ /„..if Heating System& Ducting PLAN CHECK-"PN. $ - ENERGY P.C. $ I hereby certify that I have rea•/ is application an. tate that the above 00100,000 BTU 0100,000 BTL information is correct. I agree to comply with all city and county ordinances • - ELECTRICAL $ GRADING $ I and state laws relating to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $ sentatives Of this city to enter upon the above-mentioned property for _ inspection pu •ose O Signature _. Date f=.7�-,f'y MECHANICAL $ TOTAL FEE $ /"'Z� Drivers' cense or SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ —1CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor i J' CONSTRUCTION AND PLANNING POOL &SPA 'APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1/Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement fb'rh F+v/.vy/su cm lllzf(/I -44 CTM 56. Rough Plumbing & Pressure Test 6`fElectrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 431)54 CM 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 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 OGas OOil 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: 1/2 / r/ r ,{G'.4l Ut! Mei- I Vr)s,?d.� 34. Final Heating& Air Conditioning a�C,aat, 4�' J 35. Final Gas Pipe-Test /_l1//_ C9�'/E40�ct*L 57- aZ- 36. Hood or Canopy A/l,/, (P it S Iivst rTr I 37. Final Factory Fireplace by 80eT n II--pi- exisLe_ag 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 /j J �, ,� 47. FINAL STRUCTURE& BUILDING Illl($c (,� rv, 48. Special Requirements Completed 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF.OCCUPANCY No. Date • City of Costa Mesa I A 3 LATI O N CE RTI F I CA1 .J N Building Sa, ty 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 1 Brand Name Minimum Thickness (inches) 32 Number of bags Weight per bag _lb. Area Covered (ft2) 1080 SQ.FT. Thermal Resistance (R 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 U WNL' H • ' rel-Cenereceotk(Builder) License Number l �= .� r,C d ,//// 7/3/85 gre, file &NNE RS Date Sub Contractor (Insulation Applicator) License Number Signature and Title Date CMF 1106-30 ✓ ' --,- 44 Applicant to fill in all spaces except those ssithin...heal• j border lines and sign all appropriate declarations. mil Y 0 • TA MESA CONSTRUCTION PERMIT PEWIT N = • TRACT Nr LOT NO. UNIT NO. G �' G171 9/I jun/, •Roject At_2sr4tVc' /F6 ,,/ �r• 3T g y- 1 '-��-7� V - �s, por a5� l ge 4, i6p - . 'Applicant's Mailing A dress 476, 5 40ls�Id.1,G A• TYPE OF CONSTRUCTION U NEW'L-'hAa ALTERATION H REPAIR ✓ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# �.aco — JOi-a�, I Zone A ` Owner's Name �• A- e Phone,27Jsfr3/ DESCRIPTION OF WOEK/USE OF BLDG. • Address /�C�4 a c/sd /_���fj7.r tes.�.�.•.• (- fl-Cu) LA-V1 f t-`. S Main Building: Accessory� Building:}u Arch/Eng./Pap/94e/. Q / / l5 License No./Y • A p-� ❑ ❑ TVPE OF PERMIT GRADING FOUNDATION LISTRUCTURALT Front ' ..l CI b/ I ''_ T_ a Address X30 9 5 ' r/•CA• "lye ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear 81 N. . Contractor's Name Phonr7�•atc5 / ED OTHER I 0�� 33 C Right /f N Address(mailing) PROJECT DESCRIPTION SG. FT. OCCUPANCY // e� -G CONSTRUCTION TYPE VALUATION$ II�fs0%' S Left /3fR City License No. ZONE GRADING CU.YDS. - ACRES - E LICENSED CONTRACTOR DECLARATION Ping. Ref.# ID pr. - �j Parking Req./Provided{' I hereby affirm that I em licensedtinder provisions of Charter 9(commencing Remarks: 1 Q Sy j. 3Mt PlanningNotes: (4,0°01 O • with section 7000) of Diviti 3 of/�ffe Business and Professions Code, and �C' �•�7 _U� 7 ^ lam{ a—¢ `lJf ' r M my license is in full force and ff t. ' License Class License No. —nC e "��•rrnr2,^• -" S. Date Signatur PLUMBING FEES t1VLU CU JS Gs,w1. +••eu•••a..u•••••� • WORKERS' COMPENSATION DECLARATIONBar Sink ShowersELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate t - Workers' Compensation Insurance, or a certified copy thereof (Section 0, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW Policy No. ' Company _ Backflow Irrigation 1. Sewer Cap - 4 f Construction Pole Sub. ❑ 50�KW S e BCertified copy is hereby Furnished. c Certified copy is filed with the city Building Division. Bathtubs ^j.. Sewer Connection /Zs CO Cooking Unit .1_ Meter 7iup to 100 amps /0 CO Date Applicant / 'v EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors ." Dishwasher Meter Dover 100 amps I Z (Thissection need not be completed if the permit is for one hundred ($100)or �J-�%� less). . •{ Dishwasher Solar Piping f-+- co 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 Do-i HP 01%-8 ' Worker om Densation Laws of Califon ia. z_ �— - Date �- Signature � € ' • 4- `-��- Floor Drains Swimming Pool w/Spa !L F.A.U. Inc- Solar 09-15 HP 016-15+ 2- (Y) NOTI E:If,aft gakIng this declar ion,you should ld ome subject to the — - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal of Fixtures comply with such provisions or this permit Shall be deemed revoked. < _ (,, MICfOW¢V¢ (�} CONSTRUCTION LENDING AGENCY Z Gas Service Outlets ✓ Water Closet 8 CO/14. Device Boxes Pole Light 2� I hereby affirm that there is a construction lending agency for the performance1/4 K 11 Cs' of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name ..L p Z OC.) `�[/ Outlets Range S Lender's Address L Kitchen Sink i Water Service are, ,f/ Switches Ilisn OWNER BUILDER DECLARATION y'l Q Sign .Z bQ I I hereby affirm that I am exempt from the Contractor's License Law for the ! Lavatories rr�� following reason (Section 7031,5 Business and Professional Code: Any city or v OO Z Garbage Disposal Standing Sections Z '•i N� county which requires a permit to construct,alter,improve,demolish or repair v P-Trap Trash Compactor tact Generator❑0-5 KW❑5-15 KW any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of /" ._ „(ir'}S/ K1/1 Division 3 of the Business and Professions Code) or that he/she is exempt " 'from and the basis for the alleged exemption. Any violation of Section -- • 5 by any applicant for a permit subjects the applicant to a civil - .Ity of not more than five hundred dollars($500)., I - $ 3 . L i 1, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee ' , compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee I $15 . Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or improves - i thereon, and who does such work himself/herself or through his or her own Hood or Type 0 ' DEVELOPMENT SERVICES EQUIR MENTS: I employees, ever, ed that Such improvements are not intended or offered for Boiler - pfd �,y sale. If, however,the building or improvement is sola within one year of com- Canopy Type I I 0 Zoning Approved By 1, Date �3 L�� pleilon,the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date l� lAt ve for the purpose of sale). - !I I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural _, Refrigeration System Application Issued By Date R1-(3"U tractors to construct the project (Section 7044,Business and Professions Code: ❑0-100,000 BTU ❑100,000 BTU - The Contractor's License Law does not apply to an Owner of property who Duct-Ventilating SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- §O tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ A-•gQ' $MIP $ $' proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT I 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO#, - - PLUMBING $ �•Oc. ISSUANCE $ Date y'"2"441 Owner 'in/Sr-Kt 41 r(//' Heating System& Ducting PLAN CHECK 25% $ 1`'f-00' ENERGY P.C. $ I hereby certify that I have read is application and state that.the above ig4100,000 BTU 0100,000 BTL €co ELECTRICAL $ 41•(co GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repro- t - PLAN CHECK 50% $ 23.30 MICROFILM $ sentatives of this city to enter upon the above-mentioned property for i • "f , ,I-7 inspection Dur.oses r MECHANICAL $ 11 .00 TOTAL FEE $ f f•7� Signature- - .j ... - Date. �r t` Drivers' License or 55# w .. • • - • _ -1 Reinspection Fee $15 Issue'Fee $ 3 PLAN CHECK 25% '$ 2-w CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting:Goldenrod-Assessor v CONSTRUCTION AND PLANNING POOL 'PA APPROVALS • Permit# Date Inspector • APPROVALS Permit # Date Inspector Temporary-,Electrical Service or Pole 52. Pool & Equipment Location *:.'Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit'Utility-Undrgrnd. - 54. Forms •4. Electrical Conduit-Undrgrnd. I/) /5 . RC7 55. Electrical Bonding 5. Steel Reinforcement !obit Le S-4156. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd. (Ip/81$[r - or? 57. APPROVAL TO COVER-GUNITE 7. Footingstgiollef 2' to( !gv t 2,1 58. Electrical Conduit-Undrgrnd. - 8. Foundation tJ 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 5'Pa14.„ (a/r/Cy d14-161. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer'Cap'.' 63. Heater & Vent-Final 13. Roof Drains, 64. Plumbing System - Final , 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 3466- ,[Y, 67. Fencing & Access Approval 17. Rough Wiring Sign, �f""' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air'Conditioning FIRE DEPT. REQUIREMENT Y 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydrot7P4N'./W ' (2l' ' cj C' 22. Ducts, Ventilating I 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough&Test 72. .Underground Flush • 24. Fioof Framing . 73. Undergrnd.Storage Tank 0 Gas O Oil 1111���� 1 25.,Roof Sheathing 74. Overhead Hydro a 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing Q.aasp VP 76. Dry Standpipe (�,C,�ycwe,4 /-3.7-8'.rCidir 28. Lathing& Siding ,/,..y1/4„e/°1"� 77. FIXED SYSTEM FINALj9 29. Insulation �'t' - 78. FIRE PREV. FINAL /-rye 4./ e/2;tr ; 30. Drywall Nailing UI r 1 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' - /02 /7fr7/21 79. FINAL INSPECTION • 32. Electrical Power Meter-Final ;04-1 At 80. FOOD CERTIFICATE ISSUED l 33. Final Electric D/ 'et Notes 514 fly.. S *t?4/,�LL a ie. C0/&. 34. Final Heating & Air Conditioning - 9 kC F h)- 77 5 A) a fi A-e-n-1 sh -{ 35. Final Gas Pipe-Test 9/29471- /51Z/t7- C-'E.-Ei. O. >;. 04.i 13 L . Witt Li c.ti-c. 36. Hood or Canopy 1,4/1-s � P a _ f37. Final Factory Fireplace V - i(,/� 1.--60;." / r 38. Final Plumbing ry�� F �i19�. /w -4-t,[ c/'/ e -7 39. Water Service-Final � �f//d� Er 40. Gas Service-Final jf/�O,/H"/?c _`' �p c'4/y •- 41. Solar Domestic-Final fit 7- if /`, ri 6)�/agr 42. Backflow Preventer - 7/� sa �/Y;00 ///i''4F J 7/0 - 43. Backflow Irrigation - Al LM/ 02' Ilia ! !!rri t ale 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 7/3/'WS �O t"i rn - 48. Special Requirements Completed ( % 49. Electric Release to Edison \ 50. Gas Release to Southern California G4,Co. 51. CERTIFIC7T OCCUPA,N7C� �,p o. /IIr Date /,.r B f D /rx- L J . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ PERMIT NO. TRACT NO. LOT NO. , UNIT NO. CIT'P•GF COSTA MESA CONSTRUCTION PERMIT 5331 I /I 0/d5 I:745 IL I04 ISL, r. 2,f's CI E I �qq 7 ' • •Project AddressI anI'7 �7 47 Ld/H n!/?s? ,4 c.. 172. TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION U REPAIR ts Mailin�gs1Address ,1� CI CONVERSION ❑ DEMOLISH CI OTHER A,p # Zone Owner's/figpliName FPI .F01- L M1 P. Phone Address I 0 tp C P)2.1 -. 101U 4�rQ,. DESCRIPTION OF WORK/USE OF BLDG. - S Main Building: Accessory Building: E Z Arch/Eng. License No. TYPE OF PERMIT GRADING 0 FOUNDATION ❑ STRUCTURAL T Front 0 Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑I MECHANICAL BA 'Rear . ` N Contractor's Name (t) 'Phone ❑ OTHER /p��j/-,p Qw r/ y�{/(/y'j/1 r/(({�((l/=y I PROJECT DESCRIPTION SQ. FT. ' OCCUPANCY Q Y1(/ C Right N Address(mailing) G CONSTRUCTION TYPE VALUATION$ S Left City License No. ZONE GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided E Q I hereby affirm that I.am licensed under pr v' Ion of Charter 9 (commencing Remarks: Planning Notes: M with sectionis 7000) of a 3 of the B nes a Professions code,and T • my license is In full force and effect. S License Class Lie s o. PLUMBING FEES 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 , %/at Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - - Service Sink - - " '3800, Lab. C.)- Automatic •Washer-` Transformer ❑ 15-50 KW Policy No. - Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW eCertified copy is hereby furnished. - Certified copy Is filed with the city Building Division. Bat• htubs Sewer Connection Cooking Unit 'Meter ❑up to 100amps Date Applicant • ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps _, • _ - (Thissection need not be completed If the permit is for one hundred ($100)or • 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:mot employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan • Workers mpensxI of Califor;711. (�� - Motors❑0-1 HP ❑lh-8 . Date /� //7 .3 Si9nat ure i-'c"/j /'!/.l��U Floor Drains Swimming Pool w/Spa . F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE. If,aft making this declaraji6n,you shouldlbecome 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 . 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 II. Water Heater - Outlets 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 . Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or — county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - - Laundry Trays ' Generator 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)ofG / �Q Division 3 of the Business and Professions code) or that he/she is exempt — - - - .---j--_ aAe/ C <l a iC�=^4c c(J i) A X jC fat (as therefrom and the basis for the alleged exemption. Any violation of Sectionrp n 7031.5 by any applicant for a permit subjects the applicant to a civil ' _ �.l-! 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 $15 Issue Fee $ 3 compensation will do the work,and the structure is not Intended or offered - Reinspection Fee I $15 Issue.Fee '$ 3 • for sale (Section 70441, 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 tom- Canopy Type II 0 • Zoning Approved By Date • pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground i • Building Approved By Date prove for the purpose of sale). - I O ❑ I, as owner of the property, am exclusively contracting wit h.licensetl con- Duct-Structural 'Refrigeration System Application Issued By Dat 1 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 Dubt-Ventilating , 00-100,000 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). 1 am aviare that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ _ SMIP $ proof of their worker's Compensation Insurance should be provided to me. PLAN CHECK $ - - PERMIT 0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIt. (CBO# Fire Dampers • I PLUMBING $ ISSUANCE $ ate Owner - .- /_!��. Heating System& Ducting Registers • ENERGY P.C. i$ • PLAN CHECK 25% $ i hereby certify that I have read is applicatl. and state that the above ❑0-100,000 BTU 0100,000 BT • ELECTRICAL $ _ t�J •�d • GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repro- PLAN CHECK 50°.6 $ MICROFILM $ i inspection fives of t s city to = ter upon the above-mentioned property for inspepurpo es. // // ` TOTAL FEE $ Signature 2 �_ _ CM 0865-4ev.10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor $ . "T- C054STRUCTION AND PLANNING POOL& SPA ' 'APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1 • . 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. /(!l ' et, 54. Forms , 4. Electrical Conduit-Undrgrnd. 55. Electrical,Bonding 5:Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 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 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 4 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 //I'/GU ,rc Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test orC 36. Hood Factory ao ■ ------ ' 37. Final Facttoryry Fireplace 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. "OSTA MESA�i CONSTRUCTION PERMIT P IT N-O7.^ / • TRACT NO. LCT NO. UNIT NO. 44(G 12/21 /Q(1 5110 1 2 IL ess /D Y - /5-4 AE,V5/- $i / / /L.>fl • - ailing A/(/d/dddress l TYPE OF CONSTRUCYION U NEW U ADD U ALTERATION U REPAIR �rn ' / w Owners Name /� El CONVERSION El DEMOLISH 1:11 OTHER A.P.#//3/ 073_Com/ I Zone p y s' t955.(- ' / 4-4-- Gr tf Phone - DESCRIPTION OF WORK/USE OF BLDG. J!/ Address /; % SCw[�z/ /Q-f'� /'I�"a I.,� S Main Building: Accessory Building: Arch/Eng. 5y�iLAy n�,..7,lcsr License� No. TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑.STRUCTURAL E Front O Address ¢ 3 7 �T re-ft/L./A.4- Attat-'- ❑ TENANT ❑ ELECTRICAL D'PLUMBING ❑ MECHANICAL B Rear - N •Contractor's Name +$�tQCF . �n.h,7- 'Phone .64f//if9I ❑ OTHER A I PROJECT DESCRIPTION SQ. FT. - OCCUPANCY C Right N 5 .wit ar:a /p-� s Left Address(mailing) 20Kr 01/41./4'' CONSTRUCTION TYPE VALUATION $ K G City License No. 3053-6. � R 1 Ref. ZONE GRADING CU.YDS. ACRES ping. # Parking Req./Provided E LICENSED CONTRACTOR DECLARATION �}�•��t.-�1�- a� Q whereby affirm that-1 am licensed under provisions of Charter 9 (commencing Remaks: V V /IE_ .d 1 ^n . Planning Note's: with section 7000) of Division 3 of the Business and Professions Code,and 4 l'9'�L+M/4 lfu-�,F+C./ : M my license is in full forte nd'effeect. y 8 J.71/,,73 .7(/�3 S License Class 44 Licenjo No. 7 • Date /�'/1 'tic Signature eztr - PLUMBING FEES • WORKERS'COMPENSATION DECLARATION • Bar Sink Showers i-, I hereby affirm that I have a certificate of consent to self-insure or a certificate • 1 ELECTRICAL . FEES of Workers' Compensation Insurance, or a'certitied copy thereof (Section - 3800, Lab. C. ! / - Backflow Preventer Service Sink' - - Automatic Washer Transformer 0 15-50 KW • Policy No.7?i"G,,4e m ct., Company �OriD-1 h.rr.�` Backflow Irrigation Sewer Ca 0 50+ KW P Construction Pale Sub. Certified copy is hereby furnished. . �Certifi d copy f' flied with the city BuildinguiDlvlApn./ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date -I/-4 -' Applicant i 44a[F fl+' :vS-y 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 Iless). 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❑0-1 HP ❑1'/,-8 Workers"Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE: If,after making this declaration, you should become subject tothe Inc.Solar ❑0-15 HP ❑16-15+ s1 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 • 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 HaterOutlets Range Lender's. Name Lender's Address - - __ - Kitchen Sink' Water Service ' Switches OWNER BUILDER DECLARATION - Sign I hereby affirm that I am exempt froth the Contractor's License Law for the Lavatories Auto-Wash Garbe a Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 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 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 3 . ❑ I, as owner of the property or my employees'with wages as their sole Reinspection Fee I $15. Issue Fee $ compensation, will do the work,and the structure is not intended or offered . 1 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES Reinspection Fee I $15 Issue Fee $ 3 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 DEVELOPMENTSERVICES REQUIREMENTS: • employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By � ��// n/J Date • pietle the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By I 42.�e)4v s-�s�± �J— Date!2/'at1'ie� shrove for the purpose of sale). �n((�� �//� rL4/ �(!(� r I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural ' Refrigeration System • Application Issued By Date a/ rS 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 MMARV 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 thatExhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ ' 5-0 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 Dampers PLUMBING $ PERMIT ISSUANCE $ Date Owner Heating System& Ducting Registers _ PLAN CHECK 25% $ _ ENERGY P.C. $ I hereby certify that I have read this application andstatethat the above 00-100,000 BTU 0100,000 BTL - GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- - MICROFILM $ sentatives of this to enter upon the above- entioned property for PLAN CHECK 50% , $ • inspection purpose //// �/ ' Signature .4.R A."J/�"' /t+' . Date L2—/hrri MECHANICAL $ TOTAL FEE $ ��'�� Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • . STRUCTION AND PLANNING POOL &SPA OVALS Permit# Date Inspector APPROVALS Permit# Date Inspector liorary 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 UF ER 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 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15..Rough Electrical-Conduit - 66. Solar System-Final - - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro /-3/-FS- her 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush X24. 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 /,''r . 28. Lathing & Siding 77. FIXED SYSTEM FINAL ft r i 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 48. Special Requirements Completed . t 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. STA MESA )C(,O/NSTRUCTION PERMIT PERMIT NO./l_7 TRACT NO. LOT NO. UNIT NO. 7036 B/2]/014 31 .85 IL 55 /sr? /7V x/ sr 3r. FR I GS/ -- A veiling F�ddre55 �•3 C7g 5 �.('i�. '�AaS TYPE OF CONSTRUCTION NEW ❑ ADD U ALTERATION ❑ REPAIR /� / / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Tit.j/d�l7 pC A.P.# //g-40 73- 0� Zone C� Owner Name /Q //r_' y� ,/Phone -1`�f DESCRIPTION OF WORK/USE OF BLDG. /_ Address /.7.4•3 5 S aee/•crhei MIe /44k4/6-#1/I S Main Building: Accessory Building: Arch/Eng. �t.—i{ye2�d5 License No. 4 i • TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION E Z CI T Front O Address • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N ��a �� ❑ OTHER Contractor's Nam Phone C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K - G Address(mailing) CONSTRUCTION TYPE VALUATION$ /CZ.Cie S Left City License No. N41 • ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. i9E��/T j =J[// Z S. Licende Class License No. ,r3// '.L7 /� G r/"y Date - Signature PLUMBING FEES •.- WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ' 3800, Lab. C.) Automatic Washer Transformer D 15-50 KW Policy No. Company • Backf low Irrigation Sewer Cap Construction Pole Sub. D 50+ KW 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps Date Applicant '1 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 D0-1 HP 01%-8 Worker mp sation Laws of Califor is Ad .` Date—' 1.! Signature ( Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar D9-15 HP D16-15+ NOTI If,after making this decla on, you should b ome subject to the Workers' Compensation provisions f 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. • Device B xes 1�f/ 1 hereby affirm that there is a construction lending agency for the performance fVp1 Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets• - Range Lender's Name Lender's Address ` Kitchen Sink Water Service _ Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories GarbageDisposal 'Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct,alter,improve,demolish or repair P—Trap ' Generator DO-5 KW D5-15 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 _ 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 - . - - - enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES . 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 REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood • 0 • r' sale. It, however, the building or improvement Is sold within one year of com- Zoning Approved By_ Date pp� C-(7, elation, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground •• O//,i/�/ r ve for the purpose of sale). Building Approved BY Date ,��S91 as owner of the property,am exclusively contracting with licensed con- Duct-Structural '- Application Issued By Date g/oZ7/.y /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, ' 0100,000 ' • SUMMARY OF FEES builds or improves thereon, and who Contracts for such projects with a con- pp tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ ' BUILDING PERMIT $ ' /( •/i`D SMTP $ 'SO proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ �e —35 PERMIT D i am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# • PLUMBING $ ISSUANCE $ Date _7- P9' Owner C y . ' ' r't (•L-a Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that haverread is y with all and rt o that the above ' DO700,000 BTU 0100,000 BTL . ELECTRICAL $ GRADING $ • information is correct. agree dtoi amply with all city and countyriz ordinances and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to a ter upon the above-mentioned property for / �`_ Inspection put.•se MECHANICAL $ TOTAL FEE $ `I J Signature / SS • ci "✓ Date . - Drivers' Li ense or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ - CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor Ilit STRUCTION AND PLANNING POOL&SPA / OVALS Permit# Date Inspector APPROVALS Permit - Date Inspector iporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. 'Soil Pipe-Uridrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4: ElectricaiConduit-Undrgrnd. 55. Electrical Bonding . , 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. . I 57. APPROVAL TO COVER-GUNITE , 7. Footings - 58. Electrical Conduit-Undrgrnd. . 8. Foundation : i 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 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 O 0il 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. Insulation78. 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 G '. !/�g� /J 35. Final Gas Pipe-Test • J �/)e(Ln-v -7- rla1r dyi1r/ 36. Hood•or Canopy -do/d/CW re `"/` MA", / I / 37. Final Factory Fireplace �-4,-e / F-. /4 70 is 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 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' • City of Costa Mesa Development services Department CERTIFICATE OF OCCUPANCY No. 001/11 Building Safety Division P.0.Box 1200 Costa Mesa,California ;' The Building located at IPA r. tag gti-•"4.54- has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group Occupancy. Use of Building orseiA.,..a; -,l Legal Description 496-131-72 . 11R—n73-06 (See reverse side for Metes and Bounds) Building Permit NoD15399. 614678 Electrical Permit No?16997, G14678 Plumbing Permit No.P16729, G14678 t-- Mechanical Permit No. Number of apartments and/or guest rooms Reinspection Permit No. 114678 Fire Permit No. F16706 /n �y // / - ISSUED •TO: Building Official / CXR. / Robert & Joan Miller 1309 S. Euclid Avenue by Anaheim, CA 92802 7 Date Z fij'�an^-Y//G 7 S. y/ 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 CITY Or TSTA MESA • 6151 6/I3/P_4 «' PAI... FEES 4it07n 1 TI pp Fee Payment Receipt N-° - 9 61 Project Address 89 t 0 (L)- ;cifA.P. Number I Ib — 23 40 -62117 Park Area Building Permit Number Owner's Name Our baccn h anon .o ./- ,�" ,, • Mailing Address—1? CC3 I C./�� on, Newpnrt &&A Lin FEE: Single Family * Number of Units 2-Bedrooms or Less @ $ 861.76 = 3-Bedrooms @ 1,205.67 = 4-Bedrooms @ 1,545.62 = 5-Bedrooms+ @ 1,810.50 = Multiple Family ** Bachelor or Studio @ 474.37 = 1-Bedroom @ 573.18 = �L _ 2-Bedrooms iJ @ 881.51 = --! i ,56' 3-Bedrooms+ @ 1,229.38 = QQ p,/ r ,�},,� . Total Fee *** Planning Department Approval Date 01130-I By LAja7J,.jJ...tJYt-0 Applicant's Signature • City ordinance 72-44 •* City Ordinance 72-45 ••• City Resolution 78-116 CMF 0174-32 Rev.6/79 white—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant IJU J� �1 f OWNER TAYLOR, CLAUDE DATE 6-28-60 JOB ADDRESS 184 E & F East 21st St. BUILDING PERMIT NO. 12423 GENERAL CONTRACTOR Starview Hames, Inc. VALUE $12,160.00 AP. No. 118-073-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Dup.w/att.Gar. INSPECTIONS 7-2.9-to DATE I GROUP I & J TYPE V ZONE Rig I rground Soil kV( U.G. Water �� PERMITS ISSUED L ,rground Gas f A • SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating tO Or- fr .1� _'S9 -ea Rough Plumbing MU:.7t- , �al� i/_.-. Al — G Miscellaneous IIIIIIIIIMERM Prop. Sw '. " Ho Aon. St. Swr- mi® es - . minagwr f �' Sprinkling System Mar Heating, Final edIMIEFta . 0 \� G Plumbing Fixtures effifil AIMI, S i Final GaTest '_C.Ida - Conststruc4on Pole i Underground Power Rou•h Wirin_• f.-, , 11 i i�: s . s<. - Trenches Forms Steel 35.CA • FloorSystem Steel Reinforce Chimney Re-Rod Bond Beam Sheathing :Tier IOWA - • Frame and Flashingal«e1,- d I ag, Inq 9 Out /?/1 1 WM P.,.,,Ler, brown coat MI 10.41- O Plumbing Fixtures, Final Electric Fixtures, Final Fa 1. la Building, Final ...Ari . OCCUPANCY 1 ' .- - Form 210-5M-11-59 5-6 P E & F 12423 L )ri 1 1- Flo.vi 12423 ll COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED P. O. BOX 917 COSTA MESA. CALIFORNIA (;- �Q •(0—"�a , — o o For Applicant to Fill In Completely AFliLI Uc1O ERMIT , I/ TYPE OR RINT CITY GIBERGG BUILDING /I Elf EI .9-/ L,- ING ADDRESS , y COSTA MESA. CALIFORNIA For Office Use Only OWNER cl rrMAIL (Tu176 TA flora • I RECEIPT NO. I /2PERM1T T NO. ADDRESS �0 / 5, �.i =r Rec- - I D/. R1- 9/. I OAT 15:1.1.70A.7 I�^�T TEL. BUILDING / /i L/ '91--/-) CITY COI�. ,/ti17L S PI. NO. ADDRESS ,{' I .... ).„,,,L ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS FIRE II,, ZONE TYPE ROUP �f CONTRACTOR �/�'RV IEQJ _ ({O.4T I.�. S 1 NC BY APPROVED tell DATE----n �" ADDRESS Tot*-1- p1, f 9C13o2. 13Lus, ZONING Lit/ CITY SIQIy1Y4 1 '7N IQ zOT,q i- I rye �(y�)/`IeuILOIHa� (�,�1I-,,y LIC.NO. / y5701 I TNO. TA, 1-1q-S-3 DEySCR O6 p 1-1 lift-74L fl4 L SIZE /qq ,�// LERCRIPT ON n / I OF LOT Id.Jr /4 33 I NOWo. OON LOTS A.P.NO. / / 9 - G / 3—o 4 USE OF YARDS EVES EXISTING BLDG. _ APPROVED ALLOWED SETBACK LINE FROM rD I REAR YARD I D/ (CENTER LINE ST.) ,•�1 FT. IN. CENTER OF STREET �Jp FRONT JJ LL-/ �`/� SIDE YARD ILEFT Si I RIGHT ( 0 I& ,I R.SIDE FT. "�/ - IN. DESCRIPTION OF WORK FT. IN. / L.SIDE 7 NEW t-------- ' I II ALTERATION I II ADDITION I REAR l0 FT. IN. REPAIR I II MOVING I (DEMOLISH I APPROVED A-. /� E / .)-1 J ./C BUILDING I I NO OF ( 4• f/ /V� A �9 diL- SIZE BUILDING/00 k 3 7 ROOMS STORIES 1 EXTERIOR COVERING WALL Ste« I COVERING COA I PD /I S y US OF BUILDING AND WORK TO E'PE FORME 1 r� / X19 0 ,7 t-14.44 a,/ pwrarrv$r %_/ STT a Gi9R 6/9R, _..._!...../ 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 OROIN CES AND STATE WS REGULATING BUILDING CONSTRU VALUATION Pr SIGNATURE OF PERMIT FEE $�(// �_ eg PERMITTEE N.:\ /JF• $/�, J6 D PLAN CHECK $ / � AUTHORIZED AGENT / _ "*v/ l 0 TOTAL FEE 4 OWNER TAYIDR, CLAUDE - - DATE 6-28-60 JOB ADDRESS 184 G & H East 21st St. BUILDING PERMIT NO. 12424 GENERAL CONTRACTOR Starvlew homes Inc. VALUE $ 12,160.00 AP,No. 118-073-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Duplex.w/att.Gar. INSPECTIONS f�-/-60 DATE GROUP I & J TYPE V ZONE Rio r 'erground Soil/ C U.G. WaterA/s.I- PERMITS ISSUED arground Gas /r� jt.; SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating iv Oita -2 0 4 - 7-6-do 0 _ '7 6 "- Rough Rough Plumbin /,/I 7.-1.,.Ct .. !S. t-.to_/e Miscellaneous V 441 /D--6/ - �'./2,,e-a,' i/Cu- '�- (a / - Prop. Swr�,ine ' oule-46. . Swr. /Ci 1/ .2" 4 / f Acat117�/ - Sprinkling System _ ' r Heating, Final /y/, y h/-/p'G/ ��` -/ �� Plumbing Fixtures /yvg y./olt e,4.2 Final Gas Test eO/lj' ryytj U./o-6/ Construction Pole Underground Power ' Rough Wiring "t4.4� q-( -(or. . R >C -� P--?-2-Co /3-' f7- Trenches Forms Steel C . g q-7-(or Floor System Steel Reinforce _ Chimney Re-Rod Bond Beam Sheathing .44 9 'wits c Frame and Flashing &'/1 7-44 •,67•0 I ng, In/Mild- Out 007 ').1— /0-y- 60 I. .er, brown coat (RAIL l b-)1-Go Plumbing Fixtures, Final 4 1i-fog-GI • Electric Fixtures, Final Building, Final j,u'O I(42741 OCCUPANCY t ` . / Form 210-5M-11-59 S-B P G & H 12424 0JESC /frtaIt 12424 . COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 517 COSTA MESA. CALIFORNIA vEc RECEty ED J For Applicant to Fill In Completely APPLIC N_ PERMIT � itill r•' TYPE OR PRINT I9 n ` I I ° G BUILDING F ,/ S 7- CNA COSTA MESA ADDRESS COSTA MESA. CALIFORNIA Far "Office Use Only / i4 �p `/ / RECEIPT NO. FIRM/I� O(!j OWNER Ch I/U pli Tri / h()IZ I I „,2.9 MAIL /A / 3I 3 r �� L REC 106 I D�'1E-18�IlPrD / / ADDRESS 1- T� (C �.(OY lO Co �.,�I _ 'n TEL. BUIL 1 1 j/ J r"7 CITY Co S114/T ...44 1= 3 F7 NO. ADDR S x-- / / ARCHITECT TEL. COSTA MESA. CALIFORNI OR ENGINEER NO. BY ADDRESS FIRE T'�q / /1/4-4, ZONE TYPE GROUP Vf ,/ CONTRACTOR+n5/ ,YR�( W .� I t`)C.. APPROVED r .DATE 6 4%U 6�// ADDRESS �9 -c N • NpRl3ojt 03L L'D ZONING CITY S/111 1 Y) N 11 ' I NO.OF 9,..,-. U88 OP N8W G'�,,�� y r, T PLANS BU OINNG qqn` ( //I LIC.NO. I J / 7 IL. ry- PINS 3 DESCRIPTION v' J 7/', SIZE �I yy NO. OF BLDGS. / / /� /� OF LOT J' /) 3 V o NOW ON LOT A.P.NO. l C 3 —o / 1 -' O 4 USE OF YARDS EVES EXISTING BLDG, APPROVED ALLOWED SETBACK LINE FROM 't / 1 (CENTER LINE sr.)CENTER OF STREET / / REAR YARDFRONTFRONT ., FT. IN. ti/ SIDE YARD I LEFT ‘/'/ I I RIGHT 7O ,I, /, R.SIDE to FT. / IN. DESCRIPTION OF WORK L.SIDE �. FT. IN. (--- NEW v V ALTERATION I V ADDITION REAR �/ .�7 FT. IN. REPAIR VMOVING I II DEMOLISH APPROVED BY // C t1 .R DATE � ' 1 ry G-4` BUILDING DING /� x '(,/ ROOMS J STORIES / 1 / I�Jv EXTERIOR WALL / ROOF '' COVERING 4TUCCQ I COVERING CO e '^-1 J/ -1_ USE OF BUILDING AND WORK TO BE PERFORMED -/7`/ / 9. FA-w,&%/ Pal EILiHer cu / rt) A - - 1S7i, 2 cs9iz• cI4R, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE S REGULATING BUILDING coHBTRUCTI VALUATION SIGNATURE OF pp PERMIT FEE S��/ PERM IEF y I �., n TT 15/ 21 a 0 PLAN CHECK S � ' F AUTHORIZED AGENT .5h, M O . TAL FEE