HomeMy WebLinkAbout244 21ST ST - Building Permits `04151 ,. `9 CITY OF COSTA MESA - r
4
BUILDINS DIVISION
>• r r ,,,,...,.`,i DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
/ PERMIT
�• B03-00136
lebenanarso(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caa..UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 244 21ST ST Status: ISSUED
Suite: Applied: 01/28/2003
Vicinity: Issued: 01/28/2003
Parcel Number 42614201 Zoning:
Applicant: UNKNOWN ISSUED BY: /1<ti
Address:
Phone:
Zip:
Owner: DINH, VINCENT BINH
Address 244 E 21ST ST
Phone:
COSTA MESA.CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
51 L.F.OF 6 FT.HIGH BLOCK WALL ALONG THE LEFT(WESTMINSTER)SIDE PROPERTY LINE AND A 22 L.F. RETURN AND 101 LF AT REAR
OF PROPERTY PER CITY STANDARDS.
FEE SUMMARY
Plan Check: $63.21 Calc Valuation: $3,480.00
Permit: $97.25 Claim Valuation: $0.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $160.96
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, 12-2192)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(WOO)
DECLARATIONS .
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performenda of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed it the permit is valued et one hundred dollars($100)or less.) .
1:1 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby 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.k Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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
Cale: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(5500).):
❑ 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 properly 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 exe p under sec. Business and Professions Code4or.this reason:
natur : ,(l((f0 (,( — --
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I WIII the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the Califomia Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one lime has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? EU Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Wilt any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",ailed'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 t to occupy or allow occ "anfy of any building authorized by this permit until final inspection.
_, % ( I
ne i=�a i-
enatur- ! :.: Own: s)VA n^f 4 ' / i ` £x— c
And/Or Authorized Applicante
tv,(t�/.(� //4' • Date
•
CODE z INSPECTIONTYPE PAIS INTRULS CODES INSPECTION TYPE PAI€ INTITIAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root �� 210 Final Electrical
201 Final Block/Retaining Wall 331-x3 155 212 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
•II-
1011-2"
•
C 6'-0" HI. CMU WALL
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DIVISION
o CI PPROVED AA W
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P) maYeibis set aPtans and ? M �.
anddCo n"OAg be—changes
ontftbJcbataBtinn� ah 4-
The "ga danar EXISTING RES nCk tsbn 1
of tl1e
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any provisions of StUL1Wpj �^ Y �l
wak is not cenna a bl y Ca m a y of Coma Mesa Ordinance aroma Slate law
enoedandLlai�ap DeruBC¢ (crefhinandIr ,ab or
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A P ROVED
/4/20
CITY OF COSTA MESA n n F coNG.
PLA ING DIVISION ogivElygy
SUB i CT TQ BLDG. DEPT. REG.
\ 1
NOTE:\DDITI S, DELETIONS, —
OR CO's ECTION SHALL BE
V
APPROVED :`THE PLA — — — — — — — '
CoNG• SIDE n"&-K
BYl�- //'!�.DATE: fl
21ST STREET
'��— ' SITE PLAN
SCALE: I/16. = 1'-0'
•
TYPICAL 6" CONCRETE BLOCK FENCE .
SA
Cement Coping Optional _ ; M, ---- =� -r GENERAL- NOTES
Channel Block With 1.3/8
Horizontal Top of all
MORTAR: One Part Plastic Cement, and
Fencesi� ' Si l Three Parts Sand
0 r GROUT: One Port Cement Three and
For Fences 5'or Less 11111 EMI
Ie One Half Ports Stand
Vert.Bars 3/e••¢at 4• o••O.C. d 0 COPING: One Port Cement, Three
Iii I'
)
u
For Fences Higher Than 5' 'ii Parts Sand
all I CONCRETE: Well Mixed 1:2-1/2:3-1/2
Vert.Ban 3/B"0 at 32" O.C. Y w - - -
Fill Cells Solid With Grout 1
lel a =
I.
of 7- 1/2 Gallons of
> = Water Per Sack of Cement
Where Steel Occurs a -�
Reinforcing Steel Shall �I 2 iO I
GROUT MAY BE POURED FROM THE TOP
I l OF THE FENCE IN CELLS WHERE STEEL
Conform to Sec.A•15-39 u O - eOCCURS.
A.S.T.M. - • CELLS AND AREAS OF HORIZONTAL REIN
All Steel to be Lapped I
IB�1 w LL n _, " �� FORCEMENT SHALL BE CLEAR.CLEAN&
' Si� FREE OF ALL MORTAR DEBRIS.ETC.
24"or to Code IN
NATURAL GRADE IL . „ ,
O_ s e
TWO 3/8•'0 BARS - �-1
CONTINUOUS TOP I _�
AIIIBOTTOM -�
1--�WIDTH 10 -16 0 C MAX a
SEE CHART — s
HOQIZ.ST EEL MUST 8E TIED IN BELOW DE PTH (.F E ARTHTCOTH
PLACE AT TIME OF TRENCH t 1/+ TrIE NEIGTM OF FENCE
INSPECTION. •
BE-Low BOTTOM OF FOOTING
3•. DIVISI OIlBUILDING SAFETY
�
' ID' 1
2• I • IP COSTA MESA SCALE: 1/2" a I'
-AFPROVED
FOOTING REOUfFMFNTc CHART
I WALL HEIGHT 6' Ii1B58ci persadat xfstuns'2pOstreoutspglelliiitessid. .to
WIDTH • 14" . •�7 easam/tl yersewrpwq lumf44 . •.. .
THICKNESS 10" "
DEPTH OF EARTHTOOTH 24" ���a �� ttintadalpARIArltot4e " I •
SPACING OF EARTHTOOTH 12' -' I�' Ann Al®grylmti®alrcmlaq d 'OMp� �9�1�".
1[hase atdpomE�11 m9�fl�eapO ealirtdpQidilfrkelituP4glgPf
-- wmlkisllmll atldm peralle ;,ll•: ngtOdlepati�SpPt :
BUILDING DIVISION
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•THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 7b•&6'IN HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBAIX AT LEAST 10' FROM FRONT PROPERTY LINE
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE 7HE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WALIS/FENCES SHALL NOT fl 6'IN HEIGHT
WITH THE INFORMATION PROVIDED ON THIS SI T. WITHIN 10'OF THE FRONT PROPERTY LINE(101 CURB UNE).
•VFRFEY DISTANCE FROM CURB To PROPERTY LINE
AND SHOW ON PLAN. VERIFICATION FROM THE arm
ENGINEERING DIVISION IS REQUIRED. CALL(714)754.5343
FOR INFORMATION.
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BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
. : f I,ia_.'I1_:_
DECLARATION OF AUTHORITY Bldg. Permit# 1303— o of 3
FOR AGENTS OF PROPERTY OWNER This Permit# $G ^^ti
TO APPLY FOR PERMITS
Street:Addre 244f -V srS T Cr,577+ 77PES4- AP Number:
1sact:(we), 'u' eetjr D/NH , declare that I am the Owner of Title of the above
referenced real property,roand thatatI (we)hereby/ authorize: /� 1 /�L r— ,//
Name_ Y /NCf,V/ D/Nf / T Ig_ephone Number: 614 ) (4 —4o 0
StreetyAddress: 244-.6- 2/ sr STS'-ter
Ci (',CSZA- /l&S4 State: �} Zip: 92627
6 • P
0
to obtain permits in my behalf,as owner/builder,for EPAICIet76 binocic Egger
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this `Ze, day of An. 2op , at o55/7}} /2Y ,i,Q- , California.
Prirj3ame: {//A1t tt T /NH
.aSignature: W LP/Virit 7E11461444./
Efate:- / 28/O;
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attomey to secure this permit in any behalf.
•
0779-46 trev.11/00)
' CITY OF COSTA MESA
441 BUILDING DIVISION
: '• `•c DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t 1.. iMI - PERMIT
4 402-00007
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 244 21ST ST Status: ISSUED
Suite: Applied: 01/03/2002
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 01/03/2002
Parcel Number: 42614201 Zoning:
Applicant: BARNES, TIM ISSUED BY: •
Address: 2251 W GOLDENWEST AV
Phone: 714-412-4430
ANAHEIM, CA Zip: 92804
Owner: DINH, VINCENT BINH
Address 244 E 21ST ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : Eng:
Address: - Address:
Phone: - Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O EXISTING COMP, REPAIR SHTG AS NEEDED, 1 LAYER 30#FELT,APPLY 3-TAB DIMENSIONAL
SHINGLES.30 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0.0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This 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 shell forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 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.Ar Class N
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
O 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 pem4'
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
IR 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.).
Al 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 u rsec. �---� �—��� � Business and Professions Code for this reason:
Signature: L
r/ "•`" Date: /—3—d
Owner ID verified by drivers lice- se. 0 Yes ❑No Driver's License No. Expires: l/ C. 5
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 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 California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
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.
Sig .tura Of Legal Owner(s) Date
a��i.
/ - o
An."• -uthorized Applicant Date
CODE INSPECTION TYPE, PAI€ INn1AI@ CODES INSPECTION TYPE PAIS 1NTn1AL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /n� ¢- 208 Final Plumbing
200 Final Re-Roof / !fj W L!/w�,y210 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
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS
Street Address: •0 Zig a f 5/j AP Number:
_
1. I (we), U (DCICi-.) ) , declare that I am the Owner of Title of the above
referenced real property, and that I (we)hereby authorize:
Name: //+'r ' Telephone Number:
412—1751301
Street Address: vv/ 5 c,63, c( ! A 7 ^ /'* �/
City: AAJA14c4 `. r
State: . Zip: 9a-8ty
to obtain permits in my behalf,as owner/builder,for 2 it/ /)CL,J �r
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of &OD 20 Off, at Cif/ , California.
Print Name: 1/ (rOCEA
Signature: Va1 /ianZa'+i "_r
,LNotDate: —OJ 0c)--
Note:
e: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
0779-46(rev.11100)
\-'14
PROJECT ADDRESS:, 244 21ST ST UNIT; CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05789E
OWNER'S NAME:
• "'' AoonESS: NELSON PHILIP F
DINH VINCENT BINH PERMIT NO: B 057896 PLAN CHECK NO; 01387-92 L GOVT: N SUPP; N
244 t 21ST ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
'ARCH/ENGINEER: 645-4610 REG.NO.: JOB DESCRIPTION : 591SF 1ST FL ADD, 171SF PATIO & 468SF GA SQ FT: 1 , 835
ADDRESS: UNIT:
--4 CLAIM VALUE: 50, 000 . 00 CALC—VALUE: 59, 197. 80 GROUP OCC : R-3 /M-1
PERMITTEE: VINCENT B .DINH-, / ( 714 ) 645-4610
ADDRESS: 244 E 21ST COMMENTS: 577SF REMODEL INSIDE RESIDENCE
CM - 0. CA 92627 ******** ***+6**y6*** ***************FE***************+E***+ESE********* **********?E*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and.my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: f' CLASS:
Date: Signature: "" MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm lhaLl have a certificate of consent to self-insure or a certificate of Workers' FRNT: 21 FT IN REAR: 10 FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: 10 FT 6 IN RGHT: 10 FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE: r
COMPANY: PARK G REQ: 2 PROV: 2 PARCEL: 42614201 ZNE: R1 REF NO:
ri Cenuiedcopy ishereby furnished._❑ Certified.copyisfiled with the city Building Division. PLANNING NOTES> 590 SQ. FT. ADDITION TO EX. RES. WITH 460 SQ. FT. GARAGE
( '7 ADDITION-
Date: Applicant( *************1�'*****************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is far one hundred($1001 or less). D E V E' L O •P--M E. N L T ' SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit issued,I shall not employ any person in any manner so as to became Z —4—'
subject to the Workers'Compensation Laws of California: ',t ZONING APPROVEI4 BY':' '. S " C•M.W. DATE: ' `Z y--q Z
Date: Signature:, 4 /_ �7�=
NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y : -• _ _ . DATE:
Cd,
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. -t /
CONSTRUCTION LENDING AGENCY: I hereby affirm that there.is a construction lending agency for the performance of the work for APPLICATION I5$UED BY: r DATE: h —L "'9 Z
which this permit is issued(Section 3o97'TCiv.C). ;• �• **.***.**-**.*.**-.N.{(**..)(.*.*.-)(.*.**..**.**v*. y *.***.******.**.****j(.****.**.******-*.***.*.**.E3ttt*********
LENDER: *****-1E*******if*****************************************************************
ADDRESS: LEGALIZATION:N F E E S U M .M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC - -MECHANIC FIRE SMIP/RES GRADING
(Section 703t.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 459 . 50 - - 5,92
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensedSMIP/NON—RES
pursuant to the provisions of the Contractors'State 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 PLAN 298 . 68 :� ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE i
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 465. 42 0 . 00298 . 68 764 . 10 769 . 95 -5. 85
• does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through V
Lot-
his or her own employees,provided that such improvements are not intended or offered for sale. It,however the building or
improvement
hin one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISIO
—
_ DOVER/SHORT;
forthepurpose of sae) BLDGPMTPLUMBING ELECTRIC MECHANICFIRE SMIPGRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 459 . 50 ) . , 5, 92
LA and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon 1
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C. 1
for this reason: TYPE QTY D E S C R I P TD L�O N UNIT COST TOTAL COST
`� Dale: 6'- '�9Z owner /7 ' / SFR 591 —. OWE—TYPE V—WOODfi\ FRAME —GOOD 69. 00 40, 779 . 00
t do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR t 577 DWE—INT. ALTER TYPE V—WOOD R —GOOD 13. 80 1 7, 962 . 60
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District:Residential construction applications are exempt from SFR 171 RES—PATIO COVER—POST 6 SOLI ROOF- ,....,: 1 3:-$t- S' 2, 359 . 80
these provisions. p� � SFR 468 g S�GARAGES' iSCE V 17,Z0 8, 096 . 40
'1 Ali '1Inr 144—alae END; OF F 5 E X p ) R E D�
=ate: �p -�. Lff "� Applicant: 1��jZ �'G'E/L 7 t
�9t8 )r>s'P�t °
I hereby certify that I laws
td this ingtion and stateithat the above auth rPe nares ist ties of 1 agree to complyruwith all cityv and county • al8'd UIQ.NlI iJ -, lncomP
ordinances and slate laws relating to building construction and hereby aulhor¢e representatives of this city to enter upon the above-mentioned »; r, /
property for inspection purposes. tl ) d X 3 . r'
/ qq'�•� n WhCEn t�-6/01,/a1-vr 3 .: Date Zi--1,-P/
` ' =sig.._
ile: to'U[{' �` Signature: /C./ ._T .. �� !
Driver's License or Social Security a: (' k
1641.46 While—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor `q: .' -. '
•
I"
•
!CONSTRUCTION AND PLANNING " POOL PA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
se
1..Temporary Electrical Service or Pole 52. Pool & Equipment Location
. 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Ufility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. �" 55. Electrical Bonding
5. Steel-Reinforcement 7-2(11_6c.pt 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 71-2(�y (G'e� 57. APPROVAL TO COVER-GUNITE
7. Footings 71-21-12..-1 6 ew1/ 58. Electrical Conduit-Undrgrnd.
8. Foundation 544 epv22 .11_at'42e 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 0Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush- fi
i'
24. Roof Framing 73. Undergrnd.StorageTank 0Gas ID
25. Roof Sheathing 2„.6..u„� 74. Overhead Hydro 1 /-
26.
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ( yy 76. Dry Standpipe
28. Lathing& Siding - !G 13/ 2.-2.-y'(4/77. FIXED SYSTEM FINAL _
29. Insulation . i r-it ' 78..FIRE PREY. FINAL .
•
30. Drywall Nailing p_(2jq'i1)197- HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat IIIR/ , opfr79. FINAL INSPECTION ,;
32. Electrical Power Meter-Final • " .80. FOOD CERTIFICATE ISSUED
33. Final Electric 'Notes: egt...-47.--- ,_, o-d_ \t/ r.
34. Final Heating& Air Conditioning - / U
35. Final Gas Pipe-Test Ilii-S177- OIC- V? `�-
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing � <_"
1
39. Water Service-Final - •
, -
40. Gas Service-Final
41. Solar Domestic-Final • rt
42. Backflow Preventer
43. Backflow Irrigation - r
44. Landscape Irrigation System, I
45. Sound Attenuation ' , -
46. Handicap Regulations .
a
47. FINAL STRUCTURE & BUILDING .
48. FINAL PLANNING ,
-49. Electric Release to Edison
50. Gas Release to Southern California Gas Co 1- - � f ,
51. CERTIFICATE OF OCCUPANCY .
No. _ Date
IL
/r .
arae
CERTIFICATE OF COMPLIANCE 3
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
•
/ Developer/Applicant : VINCE/ S . b/NH
Address : •
Mkt E. St STRffy COSTA01-72C7
Telephone Number : ON ) 617`.T 4616
'T r 61 t:/-Pate-1 'a.n d--L,9 t N.0 m b e r(s) :
Location of Project : a444e CLS �oli2
Number of Square Feet of p ry/
Residential Space / x $1 . 50 Total O see‘.... 1/4-5D
Number of Square Feet of
Commercial and
Industrial Space x $0. 25 Total
Commercial/Industrial Project is : (Check One)
Mini-storage Motel Preschool
Movie Theater Bank _ Auto Repair
Racquet/Health Neighborhood Shops Hospital
Warehouses R & D Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial Office Park Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995 .
Checks are to be made payable to Newport-Mesa Unified School District .
QramBusiness anaaUger
Newport-Mesa Unified School District
The above representation as to square footage is true . Developer/
Applicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the appropriate City/County shall be notified .
Date : G-l- 2- I/ /hC/uela0��
Developer/Applicant
/i
3Y«a'. I r N .:,� l 3e r.. f.i' y.:':° -' _ _ ... _ ,•'7r'ti•..r.
;+�
r '- CITY OF.0 TAiMESA 4: t� ••
'' ' ,.-'DEPARTMENT OF LIC SERVICES • F jITllSs T
r ' %_�-APPLICATION AND PERMIT FOR WORK DESCRIBED BELOW l r sF_ Na _ �,r ', t''
rtl t VENDOR NO. . Ail Al a-'.I"-„: i1Y; vs - c`c. l-'1
jr - I .;?..i.
P, F 'env�+ tr 1 '5S , /
Address or Location of Work rlik F - -m^' 1. .57-Ices 4.1.4) mz r "x%57 Date .4-.S7-,•, f •
-
Type of Work to be Done »1r 1, A-tfl i i cJA.y 10,, .R;44-4..?4,a
Start Date, ermit Not Valid Atter fExpiration Date) Plan No. . 1.4+ 4,
V s _
Contractor's Name iI. Address, " ' f' tom, - - :''
Telepho�e,No. (Day) /'1h1 •)f7-t.r re: (Niglit)i1J1/ 1!^.rw..r• i6. City 8 State_ - - , --
/ State License No./Class r�A !!1
s/ 0\S , - City Business License No. 0`S-5
, Applicant's Name I/f.Jf7- •Vii . /J /N
V Address 9+111' F. s. /St C,7EA `',G'T SY'•-:c7 .f-trr-s F_
. Telephone No. ^%^1 r- fits/0Developer's Name - Telephone(�No.' • ',
Name of.Insurance Co. 'L�- \« . `, ' ' •' Insurance Cert. No.(s), L.`\S
24-Hour Emergency Contact • _ ' -• - . .Telephone No.
• c,-;:,f,;
j FEES nY''' �`'P6a i PERMIT APPROVED FOR CITY ENGINEER ,
Bond $ 48 HOURS MINIMUM REQUIRED By eiC��� � rnCK•1 ,--a'�
Cash'Deposit .$ rcRt� ' • . ' FOR-PROCESSING PERMIT , .
1 L'
•
x„. Uj .1. .� •
Date,- s VrJ-'-----�- [�,,
Issuance $ r , h �1�Iy 7' -6(121:11-.....1_ - .4 {� i
In2;r• . : $ • Account R 1 ker.) (>.�-.'a Jr"•]%
• „TOTAL,�.Y'• it ,$ ',_- 1 • - ' ' 'Underground Service Alert ID No.
Permittee shall contact the City Inspector's office(754-5025)at least 24 hours prior to'eommenci g any work.;Failure to obtain proper inspections prior to commencement of work
may be cause for its rejection.THIS PERMIT WITH APPROVED PLANS MUST BE ON THE JOB AND AVAILABLE TO CITY REPRESENTATIVES AT ALL TIMES:You are guided
by Municipal Code Sections 1-33, 15-25, 15-27,`15-27.1, 15-39, and 15-48. : -St
.f i'. ! .
THE UNDERSIGNED PERMITTEE HEREBY CERTIFIES: ' . , , 'S tc,. ,-;I e tt �}
1. That all work shall be performed in accordance with the Standard Specifications for'public Works Construction(latest edition);Standard Drawings of the City ; •
of Costa Mesa; special agency Provisions; and all applicable laws and ordinances. ' - • .. • •• -
`2.•'t..-Control of traffic shall conform to the Work Area Traffic Control Handbook(WATCH.)(Latest edition).The permittee shall furnish and/or install all signs, lights,
', barricades,traffic control or warning devices,flagmen and flashing arrow board.The permittee shall obtain approval of the Transportation Services Engineer for ally
street closures,detours;turn restrictions,parking prohibitions and methods of accommodating traffic.The permittee shall notify Emergency,Fire and Police services , •
I,,,:! s
d, ' and residents or bu sses twenty-four(24) hours in advance of any access limitation or traffic restrictions. '1: ,
•3. That a maximum"o i lane(s)may be closed if necessary to perform work within the public right of way during the hours of 8:30 a.m.-3:30 p.m.Monday
j
- through Friday as long:as traffic can be maintained in each direction with flagmen unless otherwise approved by the Transportation Services Engineer.
•• ..t. " 4. 'That throughout.all phases of construction the work site shell be kept clean and tree of rubbish,debris and,dust and drainage shall be maintained. • 1,
t
SUBJECT TO THE NOTES BELOW:' ' . Vit' -
,1: .City will Provide inspection between 7:30 a.m.and 3:00 p.m., Monday-Friday(except on'City observed holidays)
t: •'„2. ' Prior.to placing Portland' Cement Concrete.or.Asphalt Concrete (A.C.), the following will have been inspected and approved; native O and imported-O '
.subgrades and-forms O. Flyash is not-allowed as a.cement substitute. - �-
. 3: Curb and-gutter shall not be removed on thefday prior to a weekend-or a City observed holiday.
''..11 4. �' Fill in areas left by curb and gutter removal flush with the adjacent pavement on the same day that removal occurs.
q,. . 5. Bore under'all streets, curbs;and gutters, sidewalks,cross-gutters and driveway approaches.Tunneling is not allowed. ,------- , ,”
• l-: , 6. Open excavations must be backfilled or plated with spikes and A.C.tacked around edges during non-working hours. •
. 7. • Sidewalk shall be constructed per City of Costa Mesa Standard Drawing No.
8. ' Driveway approach shall be constructed per City of Costa Mesa Standard Drawing No.. .
•
• 9. -No traffic-allowed on concrete for minimum of seven days„for curing.See traffiO control above -
10...." Trench'compdction and resurfacing shall conform Io.City of Costa Mesa Standard Drawing No. 813. ;-'"'-
' 11.'• Trenches exceeding five'(5)feet in depth require a permit.from the Division of Industrial Safety,State of California. , `7 '
12. Permittee shall pay for.all S.E., compaction and,materialatests deemed necessary by the City. '
.13.. ',All trenches shall be permanently patched-within ten(10)'days of completion of work below subgrade.
14. Permittee shall provide the-City with recorddrawings of permitted work before final inspection by the City. '
,15. Permittee understands-and agrees to the hold-harmless agreement required by CMMC Section 15-2710d printed on the reverse of this •application _
• 16. - Other: ' r-- - • f
-,- - . . ----, '
. "NOTICE!, Contractor must notify the following Utility Companies two working days before starting work: - r
r' • /r`- '
• Costa Mesa Sanitary District; Mesa Consolidated'Water District ' UNDERGROUND SERVICE ALERT
- .- (714)631-1731 '` . - . (714)631-1200 . Toll Free- 1-800;422-4133;After Hours_H lays-(714)739-3031; (213)621-3111 •
' INSPECTION RECORD' ' `1 c; Inspector of Records' CERTIFICATE OF INSPECTION .
Date Remarks'' . ' ' . I hereby certify that the street work •
.. allowed-by this permit has been con-
_ - • - /'" structed according to the plans and
, r` ' / specifications and I hereby accept the
- work in this manner.
y1.. ,
'g'.;^ ;�:, _ . - By: Inspector - •
.
. • . Date- - • I
.. I certif I have read and understand all of the above and that all statements made are correct and complete.
;( 0193-62.rev.Y)90 f Y P
White-Inspectors; y�f� /� /,/1�//....4.4,4-66,-1
/j / o
`, Canary'Engineering's • - , - J 4.1!.F:14;40)�C.L:Si/! r 1 6,-1 - to-All-IL. /f,'
' Fmk:•Finance; --':Applicant's Signature. 'Date- '
Goldenrod-Applicant
01 001.18115-7011811E T OT 54E„al I'
' • -3 COPIES,OF SKETCHES TOR PLANS.ARE REQUIRED.PRIOR'TO.PERMIT-ISSUANCE " - DATE: O6t.24147. 'ISE: 09t28'
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED AND VALIDATED •' - - •' 4 . .
`ti -
r `
•
Sec. 15-27. Form of application
Applications for permits required by this chapter shall be filed with the city engineer upon printed forms
to be prescribed and supplied by him. The application shall be signed by the applicant and shall state:
(a) The name and address of the applicant.
(b) The location, nature, purpose and extent of the proposed obstruction.
(c) The time during which it is estimated that the excavation, fill or obstruction will exist.
(d) That the applicant, if his permit is granted agrees to indemnify, protect, defend and hold harmless
the city, its elective and appointive boards, officers, agents and employees from any and all claims,
liabilities, expenses or damages of any nature, including attorney fees, for injury to, or death of,
any person, and for injury to any property, including consequential damages of any nature resulting
therefrom, arising out of, or in any way connected with the performance of the work for which the
permit is obtained by, or on behalf of, the applicant, including damages resulting or allegedly resulting
(a)from concurrent, but not sole, negligence by act or omission by the city, its elective or appointive
boards, officers, agents or employees in connection with supervision or direction of the work and
(b) from violation of any statute, law, regulation or other legal requirement concerning a safe and
healthful place of employment for workers.
(e) That the applicant agrees that if any tank, pipe, conduit, duct, tunnel or other installation of any
nature or kind placed in the excavation, fill or obstruction for which the permit is issued shall at
any time in the future interfere with the use, repair, improvement, widening or change of grade of
the street, the applicant, or his successors or assignees, within ten (10) days after receipt of a writ-
ten notice from the city engineer to do so, will, at his own cost, either remove such tank, pipe, con-
duit, duct, tunnel or other installation, or subject to the approval of the city engineer, relocate them
to a site which may be designated by the city engineer.
(f) That the applicant has read, understands and will comply with the city standard specification manual
of warning signs, lights and devices for use in work upon highways.
(g) Any additional information which the street superintendent may deem necessary for the proper
disposition of the application. (Code 1960, §7202; Ord. no. 66-9, 3-7-66; Ord. No. 80-2, § 2, 2-4-80)
Sec. 15-27.1. Insurance requirements.
(a) The applicant shall maintain at all times when performing work in the city right-of-way, appropriate
insurance policies, as stipulated in section 15-27.1 (b) and (c), covering workers' compensation and
public liability and property damage.
(b) To perform Class B permit work the applicant shall comply with the liability insurance requirements
described in Section 73 of the current edition of "Standard Specifications for Public Works Con-
struction" (See section 15-2.) In addition, the insurance coverage provided to the city shall be primary
and not contributing with any insurance maintained by the city. Certificates of insurance and any
other requested evidence shall be provided to the city for its approval to show compliance with these
insurance requirements. No public liability and property damage insurance is required for a Class
A permit.
(c) To perform either Class A or Class B permit work, the applicant shall submit a certificate of insurance
to verify workers' compensation insurance coverage. (Ord. No. 80-2, § 2, 2-4-80).
Supp. No. 26, 2-80
rill
PROJECT ADDRESS: 244 21ST ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PE.$M NO: P UDtitt /.i
, OWNER'S NAME: NELSON PHILIP F
AodREss: DINH VINCENT BINH PERMIT NO: P 058873 PLAN CHECK NO: N UOV1 : N SUPP; N
244 t 21ST ST
COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE; ADD
645-4610
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 591SF 1ST FL ADD, 171SF PATIO & 468SF GA SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE; GROUP OCC; R-3 /M-1
PERMITTEE: VINCENT B,DINH ( 714 ) 645-4610
ADDRESS: 244 E 21ST COMMENTS: REF; B57896
CM CA 92627 **3*****x**X*******Irl*********x****-*****%************************** 4t%***x.*.****
LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMENTS
70001 of Division 3 of the Business and Professions Code,and my license is in fun force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature' FRNT:
BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm Mat l have acertificate of consent to self-insure or a certificateot Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE:
CommoMPANr: PARKING REQ: PROV: PARCEL: 42614201 ZNE: REF NO:
PLANNING N TES>
7 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division.
>
*************************************************************************FE*****
Date: Applicant. DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($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 ZONING APPROVED B Y DATE
subject to the Workers'Compensation Laws of California.
Date: Signature: BUILDING APPROVED BY : Alf DATE:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor �� p
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y• /L /.``'� DATE: 2< �—
CONSTRUCTION LENDING AGENCY: Thereby affirm that there i6aconslructipir lending agency for the performance of the work for ********************** ********** *** ******
which this permit is issued(Section 3097,Civ.C).
LENDER: ************************************ ***************************************
ADDRESS: LEGALIZATION:N F E E SAMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING
)Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5% SMI P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 20 . 00
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 7. 00 20, 00 0 . 00 27, 00 27 . 00 . 00
❑ structure is not intended or otfered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon.and who does such work himselflhersell or through
his or her own employees,provided that such improvements are not intended or offered for sale.It,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 27. 00 OVER/SHORT: 00
improvement is sold within one year of comptelion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale).
27, 00
44 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
n and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon *,*,**,**,*,*,*******,********,*,*******************************************************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. IND I VIDUA L F E E B R E A K D O W N
❑ I am exempt under Section: B.&P.C.
for this reason: ��"" ��"" TYPE QTY DESCRIPTION UNIT COST T TAL COST
e 1 2' 92— wnec /7CltiG/ w� [�/L� PLU 1 WATER HEATER AND/OR VENT 7 7, 00
I do hereby certilyat lam aware of and understand the requirements of California Health and Salety Code Sections 25505,25533,and f END OF FEES E X P a C
25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a , .tiOt"
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from InCO
these provisions.
Date: Applicant: _
I _
.
hereby certify that I have read this application and state that the above information is correct.I agree to comply ,
with all city and county ele0 E
Sin
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. Iapo
Date:
7-- 212 Signature: j" 7tt44d,3(1,J i41,/ old 3 a 11 d X 3DU)
Driver's License or Social Security a: f _ ,,
f
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor i, . . - t _
' CONSTRUCTION AND PLANNING POO 'PA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1- Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7, Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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
"r
24. Roof Framing - 73.,Undergrnd.Storage Tank'O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding • 77. FIXED SYSTEM FINAL
29, Insulation j 78. FIRE PREV. FINAL
30. Drywall Nailing • I • HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat • 79. FINAL INSPECTION
1
32. Electrical Power Meter-Final I ! 80. FOOD CERTIFICATE ISSUED
33. Final Electric . I Notes:
34. Final Heating& Air Conditioning
I �
35. Final Gas Pipe-Test I ;
36. Hood or Canopy I -
37. Final Factory Fireplace
38. Final Plumbing I
39. Water Service-Final
40. Gas Service-Final • •
•
41. Solar Domestic-Final
42. Backflow Preventer 4 I
43. Backflow Irrigation
44. Landscape Irrigation System -`
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING - I
49. Electric Release to Edison I - I
50. Gas Release to Southern California Gas Co I I.': I.
51. CERTIFICATE OF OCCUPANCY
No. Date
I
PROJECT ADDRESS: 244 21ST ST 0N1T' CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05803`_
owNER'sNaME:'• NELSON PHILIP F
ADDRESS: DINH VINCENT BINH PERMIT NO: M 058035 PLAN CHECK NO: N GOVT: N SUPP: N
244 E 21ST ST
COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: ADD
ARCH/ENGINEER: 645-4610 NEG.NO.:
ADDRESS: UNI: JOB DESCRIPTION : 591SF 1ST FL ADD, 171SF PATIO & 468SF GA SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
ADDRESS: VINCENT B .DINH ( 714 ) 645-4610
244 E 21ST COMMENTS: REF: 857896
CM CA 92627 ****** ESE*****o6*+t***********>Ear**>E****+r*>FSE* * ****** >F***********>E>F*kE***>foEk6******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in fug force and effect. SETBACKS
CITY LIC.: STATE LID.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ PROV: PARCEL: 42614201 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NUTES>
>
Date: Applicant: . ;************************************************N•******************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less), . DEVELOPMENT SERVICES REQUIREMENTS
I certily that in the performance of the work for which this permit is iss d,.I shall not employ any person in any manner so as to become
subject to the Worke 'Com enation Laws of California. /LE{,� .:ZONING APPROVED BY DATE:
/A DA r
"' '7 L. Signature: / •
NOTICE:If.after makingthisdeclaration,you should become subject to the Workers'Compensation provisions of the Labor •:BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shalt be deemed revoked. �' < + —7.0, —.--•"--
which
�.•j
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the penormance of the work for `/A Tf N�.l I CAt1 f 1 I gguED BY: /�/ • ; DATE: 7--g /L/—S—__
which this permit is issued(Section 3097.Civ.Cl. K Ly'il l C' l
y1jt t��g,0�y� ti,ly, t4-t�,', V +�,�gf, 44'440'0:' E ' 'E1: fir' ')61E1E#0k?4,4 *******ate**********
UNDER: .a %IFRR(!t'7Rftt'FRYXY u,* y� ,)(. y.�L.�{�L�{�{,�E�Ey. �E�(.�(.,* ,*�( ,*
ADDRESS: tg0AYirrArren `e********"***441"BlHV0, #11W ..r #Att*t*********ttKUI_t JAAt*ggdAgNI rA
OWNER BUILDER DECLARATION: I hereby affirm that am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15,50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 251 SMIP/NON—RES
pursuant to the provisions of the Contractors'State 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 PLAN
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ sOucture is not intended or offered far sale(Section 7O44,Business and Professional Code: The Contractors'State License Law TOTALS——--> 15 . 50 15 . 00 0 . 00 30. 50 30 . 50 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 30. 50 OVER/SHORT• 00
improvementis solde)hin one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
sale).
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30. 50
IX and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant la the ContractorsState License Law).l am aware ************if******************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTION U_NIT.__COST- TITAL COST
�� � IL rr
� �Z Owner: NEC 1 INST FORC—AIR/GRAV FURN <= 10Q: K BTU 9per,., 9 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 FACTORY FIREPLACE E X P 68OA
25534 and that I or any lulure building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 6 . 50
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from _, EN OF FEES i7:30:13plete_Inss.iPec..g t50R5mese poo isions.
constr [ a}�C� y-�"'Date: Applicant: ���
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county �a.�` els me
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned s:
property for inspection purposes. _
' ••/Date: ""44_..— f_(� Signature: �" r 1ALA SUOI}� a I tj X 3 _' i ' _
Driver's License or Social Security Or Q 3
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor !'> _
r i (
CONSTRUCTION AND PLANNING I POOL ,PA
APPROVALS Permit# • Date • Inspector APPROVALS Permit # Date Inspector
•
1.:Temporary Electrical Service or Pole '! 52. Pool & Equipment Location
-2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
•4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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-Conduit66. 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 Y(29/ C FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace k///t!( Z Lto APPROVALS Permit # •
21. Ducts, in Structure ( 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush-
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing `74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat j 79. FINAL INSPECTION •
•
32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED
33. Final Electric 1.'• i Notes:
'34. Final Heating& Air Conditioning 5 i
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. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co i i„
•
51- CERTIFICATE OF OCCUPANCY -" -
No. Date
•
PROJECT ADDRESS: 244 21ST ST 0N1T' CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 058033
OWNER'S NAME: NELSON PHILIP F
AUDREss: DINH 1INCENT BINH PERMIT NO; E 058033 PLAN CHECK NO; N GOVT: N SUPP; N
244 E 21ST ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; ADD
ARCH/ENGINEER: 645-4610 REG.NO.: JOB DESCRIPTION ; 591SF 1ST FL ADD, 171SF PATIO & 468SF GA SQ FT;
ADDRESS: UNIT:
PERMITTEE: CLAIM VALUE: CALC—VALUE; GROUP OCC; R-3 /M-1
ADDRESS:TTEEVINCENT B.DINH ( 714 ) 645-461.0
244 E 21ST COMMENTS: REF; 857896
CM CA 92627 ***>E*tE+E**>Ftr*>ETExt ******kE***x kF****tE> ***x*>FtF+E***r**kETF>E** E •aE****> *****+E *ac*TE*+EtE***r.-
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQU IR EMENTS
7000)of Division 3 01 the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FR NT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL; 42614201 ZNE: REF NO:
El Certified copy is hereby furnished. El Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ***************!E***************************iF**************N-********************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Drs section need not be completed it the pervit is for cne hundred(5100)or less). DEVELOPMEN T SER VICES REQUIR EMEN TS
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 orkkeerp Compensation Laws of California. ,/��,s. L 4 ZONING APPROVED BY DATE:
D Z--- Signature: ,�O/�-�`^"�' c24,
NOTICE:If.alter making Ibis declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : i a..._ DATE: ///''''''
Code.you mLEtDINGwG with such firm that this permit shall be deemlending
ncked. "V2 .__ —541--x----
CONSTRUCTION
�/l�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction IeMing agency for the performance of the work for APPLICATION ISSUED B Y; DATE: /
which this permit is issued(Section 3097.Civ.C). ********************** r _ ***********4**********
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 3 0 90
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business t 0% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any appticanl for a permit subjects the applicant to a civil penalty of not more than the hundred dollars(55130). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS——--> 30 . 90 15 . 00 0 .00 45. 90 45 . 90 . 00
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 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 45. 90 OVER/SHORT• . 00
for the purpose ol safe). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
rn I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 90
t)II and Professions Code: The Contractors'State License Law does not apply to an owmer of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).l am aware *******************************************************************************
that proof of their Workers Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.IL P.C.
for this reason: �/ /y� TYPE QTY DESCRIPTION UNIT COST TOTAL COST
e" C 7— ` Owner: 4411,024,41 t ea
ELE 17 FIX URES LIGHTING 1 ST 20 1 EA. . 75 12 . 75
7 R EC P T/OUTL E� Xp
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ELE 20 REC P T/OUTL ET 1 ST 20 EA. . 75 15 . 0 0
25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a ELE S�1DD I T I ONAL EA. . 45 3 . 1 5
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from I RE
these provisions. ENAtiQF4 FEES
Ir��Plete 14u,...
Date: • Applicant: _ C
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and County V
ordinances and slate laws relating to building construction and here ' uthoriie representatnes of this city touter upon the above-mentioned oat!
O
property for inspection,puurrpp000ss'es. a4 �✓L.` .A�A/
Driver's License or Social Security 4: 1 i
164 t-46 While—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL . SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1: Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVALTOCOVER-GUNITErnd. ..
7. Footings 58. Electrical Conduit-Undrgrnd.
B. 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 '�-
P Y � 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System -Final
14. Rough Plumbing - •
65. Electrical-Final
15. Rough Electrical-Conduit . _ 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING' '
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - APPROVALS Permit#
21. Ducts,in Structure •• 70. Underground Hydro
22. Ducts, Ventilating ' 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing - - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe -28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat -- i 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric t/ Notes:
34. Final Heating & Air Conditioning ;i•�
35. Final Gas Pipe-Test 4 A
36. Hood or Canopy •
37. Final Factory Fireplace 1 •
i
38. Final Plumbing
39. Water Service-Final -'
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
• 46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING I ^
48. FINAL PLANNING /)
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co , v�
51. CERTIFICATE OF OCCUPANCY r
No. Date !
PROJECT ADDRESS: 244' 21ST ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05805:
OWNER'S NAME: NELSON PHILIP F
A'DDRESS: DINH VINCENT BINH PERMIT NO: E 058052 PLAN CHECK NO: N GOVT: N SUPP: Y
244 t 21ST ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD
645-4610
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 591SF 1ST FL ADD, 171SF PATIO 6 468SF GA SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: VINCENT B .DINH ( 714 ) 645-4610
ADDRESS: 244 E 21ST COMMENTS: REF: B57896 E58033
CM CA 92627 +6N*IE>FN*4st+Ex• •x*aE**x+E*16*+6>E>E>E*>E******->EaIRE***>E******N**>E*RE*>E>FSE******•>E«TE>E*SEN*>ERE**s6**
LICENSED CONTRACTOR DECLARATION: I hereby atlirm mat I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REO: PROV: PARCEL: 42614201 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ****************)F**********3e*******IE*****************iF*****************IE*******
EXEMPTION FROM WORKERS'COMPENSATION DECUBATION: (itis section need rat be completed if the ocrmt is IW one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ^^ 1 ZONING APPROVED BY DATE:
1 Date: 7 ( 2-- Signature: 1( Atka ( (/(�/
NOTICE:If,after r�king this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• DATE. —) feR(c
*which this permit is issued(Section 3097,Civ.C). 0**********************N******* e****s**** * ************ p******* ****
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 9 75
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business t 0 2 SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 4 . 50
I, as owner of the properly or my employees with wages as their sole compensation, will do the work. and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structures not intended or offered for sale(Section 7044,Business and Professional Cede: The Contractors State License Law TOTALS—---> 9 . 75 4 . 50 0. 00 14 , 25 14 . 25 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/hersell or through
or
mprrovements solor her own d within one year olatcompetiouch rir themownerate
win have intended
burden of offered
proving he/she did not bur ild or improvee iREVENUE DIVISION TOTALS--> COLLECTED: 14 , 25 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 14 . 25
and Professions Cede: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Sate License Law).l am aware **.***.*.*.*.***.*.*.**.***.***.*.**.*.*******.*.*.*,*.*.***.*,*,**.*.**.*,**.*,*,*,*,*.**,*,***,*,*****,***,****,*****
that proof of their worker's Compensation insurance should be pronded to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.6 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: 7— 6-- f 2- Owner: iC 2.1...-' /1 U(:eA
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 13 R EC EP T/SWITCH 1 F T E E EA, . 75 9 , 7 5
25534 and that I or any future building occupant wilUwill not(drele one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions,
Date: Applicant: ¶: EXP 1 R E D
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county act On$
ordinancesfrein state onlaws relating to building censiruction and hereby authorize representatives of this city to enter upon, above-mentioned nPlr3t n
properly andr s to ionrep ting t
s.
Date: 7 I Signature: ( 'V. '—a7 S(g ,'C i -
/ Driver's License or Social Security a: , , •� y
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor F
•
CONSTRUCTION AND PLANNING POOL £PA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
a 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
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace -
-
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECTa0DRE55: 11744 21ST ST 0NIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 058037
..- OWN�'SRAME: NLl1SON PHILIP F
ADDR s: DI H VINCENT BINH
it 244 fr 21ST ST PERMIT NO; P 058037 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD
ARCH/ENGINEER: 645-4610 REC.NO,:
ADDRESS: UNIT: JOB D CRIPTION : 591SF 1ST FL ADD, 171SF PATIO 6 468SF GA SQ FT:
PERMITTEE: CLAIM VALUE; CALC—VALUE; GROUP OCC: R-3 /M-1
ADDRESS: VINCENT B.DINH ( 714 ) 645-4610
244 E 21ST COMMENTS• REF: B57896
1
CM CA 92627 *****>t +e*LE***>F*>E**************** ****>E****IFN*>F*****>E*>F*********>E*** ********kE**
LICENSED CONTRACTOR DECLARATION: I hereby aftum that I am tensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 0l the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE UC.: CLASS:
Date: signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 38W.Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42614201 ''ZNE; REF NO:
❑ Certified copy is hereby famished. 0 Certified copy is filed with the city Btdtding Division. PLANNING NOTES>
,ate: • Applicant: - **************3E*lE*3E*3F****i6*iE****3E****3F*iE********lFiE16`iF3(**-1h3F***********1f IF***N-*****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (flis sectionneed not be*Meted it the permt is for one hundred(S1O0)or less). DEVELOPMENT SERVICES ,,R .E,. Q U I R E M E N T S
I certify that in the pejlormance of the work for which this permit is issued.I shall no�mploy any person in any manner so as to become
subject to the Workers`Compensation laws of Califon: /./ i. 4l • �] ZONING APPROVED B Y 9 ''i DATE:
,� Vote:%U. e."' Z Signature: �Qti(.� /,/ /LI
NOTICE:It, nerinaking this declaration,you should become subject to the Waiters'Compensation provisionsalaal the Labor BUILDING APPROVED BY : A_ •^ DATE:
Code,you ust.fonhwith comply with such provisions or this permit shall be deemed revoked. /rte _
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• • /' DAT£: 7
whim this permit i5 issued)Section 3007.Civ.C). *.*.**.**.***************{E*** ** **� ***********i!****************** k*** *
LENDER: ************************************* ' ***************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC ' MECHANIC FIRE SMYP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 8 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed
25t R SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt theretrom and the basis for the alleged exemption.Any violation of Section 7031,5 by PLAN '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3,00
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 8 . 00 3 . 00 0 . 00 11 , 00 11 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his iormprovement
herm own employees.witin provideder that such ion.the s are not intended or ufor she/.If.einothowever the or ilpor
REVENUE DIVISION TOTALS--> COLLECTED• 1.1 . 00 OVER/SHORT: . 00
lorptheepurrpose oil 5de)hin one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SHIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 11 , 00 ., /
Q and Professions Code: The Contractors'State License Law does not apply to an owner at properly who builds or improves thereon
and who contracts for such projectswlth acontractor(s)license pursuant to the Contractors'State License Law).I am aware *****ie*******************************************N****************.**It**.*****.***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: 6.8 P.C.
for this reason: M TYPE QTY DESCRIPTION UNIT COST TOTAL COST
6 Q owner: v' ' PLU 1 SHOWER 2 . 00 2 . 00
I do hereby certify t .t I am aware of and understand the requirements of California Heath and Safety Code Sections 25505,25533,and PLU 1 SINK, KITCHEN t 2 . 00 2 . 00
25534 and that I or arty future building occupant wiNwill not(circle one)need to comply with said state codes and the requirements fora PLU 1 WASH BASIN 2 . 00 2, 00
Ipermithese plee provisions. PLU
or modification from the Air(Malay Management District.Residential construction applications are exempt from PLU 1 WATER CLOSET (TOI(T) 2 . 00 2. 00
Date: App cant END OF FEES . ,
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
propryes and state p relating building construction and hereby autoatMS of the con to enter upon the above-mentioned
n
property toe inspection purposes. WI
/ Wiliitg Ya _�
. . Signature:
Driver's License or al Security Y: ' • ,
164ba6 White—Building;Green—Cade Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
(CONSTRUCTION AND PLANNING 1 POOL A
'APPROVALS Permit # Date ` inspector APPROVALS Permit# Date Inspebtor
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. Oki' Ca 53. Steel Reinforcement - - -
' ,,Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUM-FE
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 flak c- '' 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 1
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.StorageTank 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 l 78. FIRE PREY. FINAL
30. Drywall Nailing --e•,I. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coati : 79. FINAL INSPECTION
i
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
a
33. Final Electric (. ,,•, Notes: ,'-/I-� ,
?1/'fJ1/O7: G�. e
34. Final Heating& Air Conditioning i
71y'
•` 'J7r/4Y <J• L.
G i essi etsed�i✓ /Gi Coe<•
35. Final Gas Pipe-Test
36. Hood or Canopy -rte
7JsJ'i7 Y ./S
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final 77/2_ ift 14P -
40. Gas Service-Final
*Alt
i{li kCo
41. Solar Domestic-Final
42. Backf low Preventer
43. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
.5.
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER Algard Corp. SO49'T?2� DATE 12/18/53
JOB ADDRESS 244 Twenty-first St. BUILDI NG PERMIT NO. 7
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 8800.00
LOT 22 BLOCK TRACT 17559
GROUP I TYPE V ZONE R4 FIRE DISTRICT
INSPECTIONS / DATE SUBCONTRACTOR PERMITS ISSUED
.�{/J/ DATE NUMBER
Footing Trench P r
Foundation Forms and Grade to Garage
Rough Framing 7L(/r� f�Plumbing,Rough to Slab&lltt�/fE�` Z4L<</ hmSLido Plumbing 1/4/54 17
Plumbing, Rough Complete - >L C—I�
Temporary Pole -/
Wiring,Rough lad))/�e 3 9 /' 4e kJ4e!✓ A%c
Heating,Rough -
Heating,Final J� —) 8 ST
Sewer
Septic Tank or Cesspool /�/1jy(-1.;
Lathing ��
Plastering /y/�_gij /.S
Plumbing,Final,Fixtures Co o 12 ?
Plumbing, Final Gas Test , MEW 4/4. , " _
Wiring,Final 'j- - ' ';,4-4 1.7 r • ".vO • 113E_ __ —
occupancy It.. - A- /.'{r c_ L_ .. —�
Form 210 C-H IM 12-53 / /
` • Costa Mesa Building Department 7 APPLICATION FOR PERMIT
111 EAST 20th STREET B UI.L-DJ.N G _ t21.
COSTA MESA, CALIFORNIA ,'-- -
, FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Per ilt.No.
Building _
Address 244 Twenty-first Street
y
Costa Mesa, California Received�brDate Rec'd. Date Issued I
G, Q DEC 1b 1953 it/iYjs-
Nearest dd /
Cross St. Orange Avenue n
Address � /7-Q
-!
Owner A lgar& Crlrporatior Costa Mesa, California
Mail
Address 490 Bolsa Avenue Nearest
Tel. Cross St.
City Costa Mesa No. Bea. 6829 Zone //' No.of Type p9 I Group
Architect or Lic. �')" ' I Plans I I ! r
Engineer Hugh Gibbs • No. C-137 Approved .. //
by '{' Datei71rysJ
• '-'dress Long Beach, Calif • . 'CORRECTIONS
I ntractor Dike & Colsgrove City No. Lic. 170
•
Address 419 E. 17th St. Costa Mesa
LegalLot '
Description I No. 22 I Block I Tract 1759. .
(Attach Metes and Bounds) •
No.of Bldgs.
Size of Lot 75 x 101 Now on Lot none . . . - - •
O
Use of I No.of I No.of • .,•: 9
Existing Bldg. -- Families Rooms ,n
Setback Street 501
Rear Yard 271 - - - " - - - 1 Z
Centnter of Street 501 Side Yard ?0.11 � (►��. . y
DESCRIPTION OF WORK r
New X I Alteration I I Addition I `` _f�
Repair I I Moving I I Demolish I "�LL l !4
g; Building No.of
Size 28 X 53 Rooms 6 Stories 1 n t1
erior Wall I Roof ow ,J/t4', oh, iki i.
lacing_Stac CO Covering cnmpp `tea• • .
Use of New —
•Building 1 Family Residence Foundation Location Inspector Date
Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
Lath. Int.
d.hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building construction.
Signature of rn• F AND •1 EGROW Plaster, Int.
Permittee es.. ^^" Plaster, Ext
Authorized('Agt. ^ Masonry Reinforced
Valuation X 00 '` perm- Fee $ .L�/
GPlan Check $ '3 Bond Beam
$ " Feeal $ V••-•.-)0u FINAL
Worm 204 C-H 1M 12-53
j
r
0
c o
2 - 0
a 2
a
•
z -
- _
.
•
Street
•
-.
PLOT PLAN -
Show location and distances from
property line and between buildings.
- - .