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Home My WebLink About259 21ST ST - Building Permits • • CITY OF COSTA MESA • `'111/14yp BUILDING DIVISION o • µ �w =( � 77 FAIR DRIVE,COSTA MESA,CA 92626 (714)754-5273 • Fax(714)754-4856 www.ci.costa-mesa.ca.us J. FOR INSPECTIONS CALL: (714)754-5626 • 0a PERMIT NUMBER: B11-00197 PERMIT TYPE B_ROOF2 STATUS: .ISSUED APN: 42621503 DATE ISSUED: 06/29/2011 ISSUED BY: KJB JOB ADDRESS: 259 21ST ST CM Suite/Unit: Vicinity: RESIDENCE AND ATTACHED GARAGE Squares: 3600 Valuation: $13,500.00 SCOPE OF WORK: TEAR OFF EXISTING COMP ROOF.COVER WITH CLASS A COMP SHINGLE ROOF. REPAIR/REPLACE SHEATHING AS NECESSARY. INCLUDES ATTACHED GARAGE.APPROX 3600 SQ FT.ROOF PITCH IS 4:12 NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s)is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: DOUGHTY,THOMAS L Address: 259 E 21ST ST Unit: PHONE: 949-955-6041 City/State/Zip: COSTA MESA,CA APPLICANT: BATIOFF,JOHN Address: 2219 W OLIVE AV Unit: :SUITE 282 PHONE: 8188485050 City/State/Zip: BURBANK,CA CONTRACTOR: MODERN ROOFING INC License No. 807881 Address: 2219 W OLIVE AVUnit: SUITE 282 PHONE: 8188485050 City/State/Zip: BURBANK, CA 91506 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $237.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $238.25 v., HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays New Years Day, Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related' regulations. (Ord. No. 92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE P. INSPECTION TYPE DATE INTITIALS CODE% INSPECTION TYPE DATE INITIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof k 7 2P—P Cl' 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 262 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy WORKERS'COMPENSATION I ECLARATION: Owner ID verified by drive ..cense. ❑Yes 0 No • I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): Vtion. as provided for by section 3700 of the Labor Code, for the te of the work for which this permit is issued. e and will maintain workers'compensation insurance, as required by 00 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: sp r person is required to descend,will be made in connection with work authorized 1w\�. by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed if l permit rsvalued al allone hundred dollars(5100)or less.) 2,Arty Sec.341,Title B,California Administrative Code). T Policy Number: ✓--) 2,62(x)9 ( p , 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's sgnawre Date the Labor Code,I - all hwit comply with these provisions. l r2-- r// Division of Industrial Safety Permit Number: Ap�t' ign W Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILU• TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is ip�f�1 I / 4.--)foorG£.anddeefffeecct. a registration form for acutely hazardous materials? ID Yes 0 No Lia# ' O r Q b Class# C. J C7 (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by 44 t- - ii ',/5-11 f each business which at any one time has on hand a quantity of acutely on:aclors Si. awe (Yate 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued. (Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safely Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. g Stgnaw gf1 0 7 r(s - ate-H/ Signature Dale 3057-46(3/0]I And/or t oozed Appbcanl Date Prescriptive Certificate of Comp.._.ice: Residential • fr CF-IR-ALT . Resi ntial Alterations (Page 1 of 5) . .Project Name: .z 53 i j Cl— Set Climate Zone N / #of Stories General Information Site Address: 7 -Ct -7 , Cr C,___ Enforcement Agency: Date: /2-77C,—// Building Type Single Family 0 Multi Family Circle the Front Orientation:N,E,S,W,or degrees Conditioned Flog Area(CFA): Project Type: 0 Alterations 0 Envelope 0 Fenestration 0 Roof 0 HVAC Replacement or Change Out 0 Dud R placement 0 Water Heater NOTE: This Jbrnr is not to he used fir Newly Constructed Buildings or Additions - Insolation Moes For Opaque Serfaces(far Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑Opening of framed cavity alone-Alterations that involve the opening of the framed cavity of a wall,ceiling, or floor must install the mandatory minimum insulation value per§150 for the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column H. ❑Replacement of entire assembly-Replacement of an entire wall,ceiling,or floor assembly requires the installation of Component Package-D insulation values in Table 151-C. Fill in Columns A-J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. .A B C D _ E ' - F j C H - -I • II- ;1 Proposed Sec Note L Standard _ Values From JA4 Table - Framing Thickness, Framed Continuous JA4 I Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly ID] or Type% and Size- or Others L factor" Numbers R-value R-Value7 Cell Values U-factors Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and r Furring Construction table belay. 1.For Tog/ID indicate the identification name that matches the budding plans. 2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For Wood, Metal, Metal Buildings,Mass, enter 2x4, 2x6, or etc...see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; M"or 24"OC;or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel,Logs,Straw Bale Panel and etc.... 4.Based on the Climate Zone;enter the Standard U-factor from Table 151-B, C or D for each different assembly Name or type. 5.Enter the Table number that closely resembles the proposed assembly. 6. Enter the R-value that is being installed in the wall cavity or between the framing;otherwise, enter "0". 7. Enter the Continuous Insulation R-value for the proposed assembly; otherwise, enter -0". S.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J 9.The Proposed Assembly U factor, Column.1, nuts"be equal to or less than the Standard U-factor in Column E to comply. Furring Strips Construction Table for Mass Walls Only A B C D _I E F G H I J K L M _ Proposed Properties of Masonry and Concrete I Added interior or Exterior Insulation • Walls From Reference in Furring Space from Reference Joint Appendix Table 4.33,4.3.6.4.3.7 _ Joint Appendix Table 4.3.13 6 0 - Y P a g,� y , Assembly z- o c m �' t e el' N L` ` - Final Mess Name or JA4 Table n -a F v m E a °o 't m v z " F Assembly Thickness' S_YI T re'' Number' c 7 S. .. U-factort's Comment , :> L � � LL C i LL C Iii C I I : I I I I Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alteration) (Page 3 of 5) Project Name: Climate Zone# 7s' #of Stories • ROOFING PRODUCTS (COOL ROOFS)§151(1)12 When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000 f?, whichever is less,the new roofing area must meet the roofing product"Cool Roof' of§152(b)IHi,152(b)1Hii,or 152(b)111iii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof"requirements. Note:If any one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in ,§1)8(i)are not applicable.Do not,ftll table below. Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch. �j�o9I Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less //than 51b/ft2. Alternatives to§152(b)1 Hi and §152(b)Hii,Steep-slope roof(pitch>2:12) ❑ Insulation with a thermal resistance of at least 0.85 hrft2.°F/Btu or ai least a 3/4 inch air-space is added to the roof deck over an attic;or ❑ Existing ducts in the attic are insulated and sealed according to§151(010;or .0 In climate zones 10, 12 and 13,with 1 ft'-of free ventilation area of attic ventilation for every 150 112 of attic floor area,and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or ❑ Building has at least R-30 ceiling insulation;or O Building has radiant barrier in the attic meeting the requirements of§151(02;or ❑ Building has no ducts in die attic;or O In climate zones 10, 11, 13 and 14,R-3 or greater roof deck insulation above vented attic. Exception to§152(b)IHiii,Low-slope roof(pitch<2:12) O Building has no ducts in the attic. Other Exceptions 0 Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria. .O Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft= is exempt from the below Cool Roof criteria. - Note:If no CRRC-I label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise, Check the applicable box below if Exempt from the Roofing Products"Cool Roof"Requirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number' <_ 2:12 >2:12 - < 51b/ft' > 5Ib/ft3 Type2 Refectance3'4 Emittance SRI5 ❑ ❑ ❑ 0 ❑4 l ❑ ❑ 0 0 ❑4 ❑ ❑ 0 0 04 . ❑ 0 0 0 ❑4 ❑ ❑ ❑ 0 ❑4 I. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.org/producis/search.nhn 2.Indicate the type of product is being used for the roof top,i.e.single-ply roof asphalt roof metal roof etc. 5. If the Aged Reflectance is not avai/able in.dre Cool RoofRating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation(0.2+0.7(p„rotas-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4.Check box if the Aged Reflectance is a calculated value using the equation above. 5.Calculate the SRI value by using the SRI- Worksheet at Map//www.enernrtca.gov/tide24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF-IR. To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating: ❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other 1 Registration Number: Registration Date/Time: HERS Provider: • 2008 Residential Compliance Forms ' August 2009 • • Prescriptive Certificate of Compliance: Residential • -� CF-1R-ALT $esidential Alterations (Page 5 of 5) , - )'reject Na nee: I Climate Zone I S' of Stories • • HERS VERIFI CATION SUMMARY The enforcement agent,'should pay special attention to the HERS Measures specified nr this checklist below. A completed and signed CF-4R Forn,for al/the measures specified shall be submitted to the building inspector before final inspection. Duel Sealing & Testing HERS verification is required for thia measure. ❑ YES 0 NO 1'ES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned space,the ducts are to be sealed per§152(b)IDii and the newly installed ducts are to be insulated pet 5151(1)10. 0 EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the ducts are to be sealed per§152(b)1Di. ❑ YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler, outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be sealed pet §152(b)IE. 0 EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS • verification in accordance with procedures in the Reference Residential Appendix RAS. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. _ ❑ EXCEPTION: Existing duct systems constructed,insulated or sealed with asbestos. Refrigerant Charge- Split System HERS verification is required_for this measure. 0 YES 0 NO YES:In Climate Zones 2 and 5-15,when the existing HVAC equipment is replaced(including the replacement of the air handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil;or the furnace heat exchanger)a refrigerant charge measurement shall be verified per§152(611F. Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw The ventilation requirements of§150(0)do not apoly to existing residential homes. :Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required,for this measure. - 0 YES 0 NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(H VAC equipment and ducting)is replaced.the airflow and fan watt draw shall be verified ner§152(b))Ci to meet the requirements of§15)(D712. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and co tete. Name: Signature: S'AnAe Y �7a�►o� U Company: nn f)J •n `n n(") W C Date: _ �j / Address. 11 ,��/L /4'-Y�` ��rj}t ��Z_ If Applicable❑ CEA m ❑ CEPEI � /ASII (Certification t!): City/State/Zip: 2 1,12. 5_^) Phone . 8-t13 .575 V5 Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the Californi Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • )certify that the energy features and perform ace specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I and 6 of the California Code of Regulations. • The building design features identified on tl s Certificate of Compliance arc consistent with the information provided to document this building design on the other applicable coin Aimee forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with Ibis building tern I application. Name: Signature: Company: Date: Address. • License: 4 111 Cm:'Smte lZip: ! Phone: For assistance or questions regarding the Energy Stands ds, contact the Energy Hotline at: J-800-772-3300. keg:Straam Nun bee f(egLnrntion Dac/Time: HERS Provider: 2008 Residential Compliance Farms August 2009 4 4 04111 S - CITY OF COSTA MESA •- BUILDING DIVISION )• •4 � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t V •jjIC/� PERMIT B05-01449 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.StMLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 259 22ND ST Status: ISSUED Suite: Applied: 08/30/2005 Vicinity: Issued: 08/30/2005 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number: 42615304 Zoning: Applicant: BOB SCHALOW Address: Phone: 949-515-9563 ISSUED BY: Zip: Owner: GANNON, LAURIE Address 259 E 22ND ST Phone: . 949-637-1153 • COSTA MESA,CA Zip: 92627 • Contractor: - - Address: - Phone: • Zip: .• License: Arch : Eng: Address: - Address: Phone: tt; Phone: Zip: License: License: SCOPE OF PERMIT EXTEND NON-BEARING INTERIOR WALL AT KITCHEN APPROX 2 FT.INTO THE EXISTING SFD.RE;B03-00412 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $250.00 Permit: $23.50 Claim Valuation: $250.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: - $24.00 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0Rear "" 0- 0 0 - teff. 0 Right 0-0 ACCESSORY Front • 0-0 Rear 0-0 - Left 0-0 Right 0-0 PARKING Existing: 0 ' 'Required:. 0, Pr000"sed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448.46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: 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 shall 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 TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lie.IS Class II Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt tin.t sec. / B '• and Professions Code for this reason' Signature: 'f d Date: /1 a' Owner ID verified by driver.license. 0 Yes 0 No Drivers License No. Expires: /O U/ Cl 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,faisework,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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No (Section 65850.2 of the California Government Codo requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the 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',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-describe ope for inspection pu osea.I a re occupy or allow occupan any building authorized by this pe it until f al inspection. a" 0 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date SORE I INSPECTION TYPE PATE 1NTRIAL$ CODE I p1SPECPON TYPE PEI IMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site p 204 Final Demolition 250 Final Building/Occupancy 0'31 05 jJC/tnI4c�}z • ' CITY OF COSTA MESA C 4 BUILDING DIVISION >:�Pe• •� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �: • PEFENIT 1.4111B03-00412 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c� ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 259 22ND STStatus: ISSUED Suite: !` Applied: 03/13/2003 19 Vicinity: KITCHEN AREA y Issued: 03/13/2003 Parcel Number: 42615304 Zoning: Applicant: GANNON, LAURIE 9 ISSUED BY: 4 Address: 259 E 22ND ST Phone: 949-637-1153 COSTA MESA,CA Zip: 92627 Owner: GANNON, LAURIE Ti�� Address 259 E 22ND ST LI NSIo Phone: 949-637-1153 ♦ T L� 1Jj 7■-�■1 COSTA MESA,CA Zip: 92627 �.L�-144Lnp Contractor: PER Address: EXPIRES - Q Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT EXTEND NON-BEARING WALL INTERIOR WALL AT KITCHEN APPROX 2 FT. FEE SUMMARY Plan Check: $15.28 Calc Valuation: $250.00 Permit: $23.50 - - Claim Valuation: $250.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $39.28 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 2446-4e(6/00) DECLARATIONS f I .. 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'compegsation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have end will maintain workers'compensatioh 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: Carver: Policy Number: Is coon need not be completed it the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Sec 3700 o the Labor Code,I shall forthwith comply with these proviionJ - Applicant Signature: �—lJv��`–'�-- 4n nOn Date: 1 1 WARNING:FNLURE TO SECURE WORKERS'COIAPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COI ARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: itI 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.4 - Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busine s 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 sub' s the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,em 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 ex mpt nder sec. Business and Professions Code for this reason: / -Signature: 1 CLUJ L � 0 `7 fl(,� Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of docu nt,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,wit 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:1 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- ascribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this ermit unt final inspection. � (..;r1j--)n(s3� I- e Signature Of Legal Owner(s)) Date And/Or Authorized Applicant Date SODS I INSPECTION TYPE PETE INRiALS CODE# INSPECTION TYPtt gLg INFIDELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition ' 250 Final Building/Occupancy • • • IF L:I i EOOV ILDING SAFETY * :=nTANK-LESS DWI'S o B COSV1/4 E D A .,..:TER LL 1 S 171 iSlotAYQgO e V,1-- Date R�anlawh-��^ ytallienesof8uitc + ST beop>,en :sitwontein �� n 1 �_ 1 st gThisset0Oss gsa�e ion1 by�toPeRn:a tobeac;aT15 _=C. - n16°4;101934 keanY�an9 of rpstaMe� gnsSNA'i mesa n� j,un r.., andteygof N�P�nandsPtanyCM anbbecomenuwa �BO1day�ot ' an. . utwnsoi. �( I • —_P , �e The e gio = PCO , ego 1 t UBC 4 r�1d)//L) no - l -.oai. - -- ... tA iheseP_`S•anti .wtamed � �" ✓ no i. 2 GAF. GA3AJ= . , a-RA*4 CITY OF COSTA MESA ty P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 f it{G`. a.� DEVELOPMENT SERVICES DEPARTMENT s BUILDING DIVISION EXTENSION NOTIFICATION March 15, 2004 Laurie Gannon 259 22nd St. Costa Mesa, CA 92627 PERMIT NUMBER (S): B03-00412, B03-00614, E03-00544, P03-00163 FOR: Remodel PROJECT ADDRESS: 259 22nd St., Costa Mesa This is to advise you that the request for an extension on the above permit(s) has been approved by Ed Petros, Chief of Inspections. Your extension is valid for 180 days. The new expiration date of the permits is September 12, 2004. The job must be completed, inspected and receive final approval by this date or your permit(s) will expire. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. We appreciate your working with us to resolve this matter. Sincerely, Goes . / , Mary Jane Weidenkeller Office Specialist II Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • vnvw.ci.costa-mesa.ca.us • March 8,2004 Mr. Ed Petros Chief of Inspection City of Costa Mesa PO Box 1200 77 Fair Drive Costa Mesa,CA 92628 Dear Mr. Petros, I am writing in response to the letter I received regarding the expiration of the following permits: $a3r00413 403-00i/.2_ B03-00614 E03-00544 P03-00163 We are still in the process of completing the work and would like to have the permits extended. The reason for the work not being completed is that we are acting as general contractors and doing much of the work ourselves. On top of this I got married in the middle of the project and that effectively shut down the schedule. Some of the work requires the replacement of doors and windows and we wanted to wait out the rainy season as well. We are ready to resume work this month and as such request a 6 month extension to complete the work. Thank you for your consideration in this matter. Sincerely, Laurie Gannon 259 22nd Street Costa Mesa,CA 92627 attributes : Costa Mesa Parcels • Page 1 of I • Map Layer Attrib.-es for Parcels Property Address Address 1 259 E 22ND ST Address 2 COSTA MESA CA 92627 Parcel Information Assessor Parcel Number 42615304 Legal NEWPORT HEIGHTS LOT 284 S ELY 48.96 FT NWLY 148.96 FT-EX SWLY 162.57 FT & S T- Range Township Section Quarter Section Area 6752.4358199999997 Acres 0.14999999999999999 Owner Information Owner GANNON LAURIE Owner Address 1 259 22ND ST Owner Address 2 COSTA MESA CA 92627 Property Specs Year Built 1963 Building Square Feet 1314 Building Count 1 Stories Number 1 Parking Spaces 2 Number of Units 0 garage Square Feet 0 Front Footage 48 Depth Footgae 137 Bedrooms 3 Map Layer Attributes For Address Points Address 259 22ND ST Apt/Suite City State Zip Building ID APT/Space Phoen SIC Code 0 Data Siurce parcels Plan Type http://mesagis2x/website/costamesa/parcel/default.asp?opt=attributes&sessid={50924820-52CC-427C-9... 02/27/2004 Property Profile • Page 1 of 2 DataQuicict — land and property data yw can bund on- Property Profile Primary Owner: GANNON,LAURIE Secondary Owner: • Mail Address: 259 22ND ST COSTA MESA, CA 92627 Site Address: 259 22ND ST COSTA MESA, CA 92627 ._., Telephone Number: 1 APN: 426-15304 , < Reference AP Census Tract: 632.014 CA'IFOG\^A s. 'R'X` Housing Tract Number: 516 Geo Level:0 Lot Number: 284 Page Grid Old: 31-E2 Page Grid New: 889-B2 Legal Description: NEWPORT HEIGHTS LOT 284 S ELY 48.96 FT NWLY 148.96 FT -EX SWLY 162.57 FT & S T- Subdivision: Property Characteristics Bedrooms: 3 Year Built: 1963 Square Feet: 1,316 Bathrooms: 2.0 Garage: Lot Size: 6,735 sq ft/0.15 acres Total Rooms: 6 Fireplace: Number of Units: 1 Zoning: Pool/View: Y/ Use Code: Single Family Residence Heating/Cooling: Sale & Loan Information Transfer Date: 02-24-2003 Seller: Document: 0000200447 Transfer Value: $520,000 Cost/Sq Feet: $395.14 Title Co.: Orange Coast Title First Loan Amt: $416,000 Lender: Wells Fargo Home Last Trans W/O$: Loan Type: Interest Rate Type: V Last Trans W/O$ Doc: Assessed& Tax Information Assessed Value: $231,274 Percent Improvement: 31.89 Homeowner Exemption: Y Land Value: $157,521 Tax Amount: $2,553 Tax Rate Area: 15044 Improvement Value: $73,753 Tax Status: current C 2004 DataQuick Information Systems.This information is compiled from public records and is not guaranteed. http://www.goti tle.com/cgi-b in/profile.asp?rmt=TOPS&graphic=%2Faccounts%2FT07378%2Fcompan... 02/27/2004 4 , r1 r'PROJLb ADDRESS: 259 21ST ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 060150 OWNER'SNAME: DOUGHTY THOMAS L. ,ADOREss: 259 E 21ST ST PERMIT NO: B 060150 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT 721-8956 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT. REROOF W/COMP. SQ FT: 5, 500 ADDRESS: UNIT: CLAIM VALUE: 5, 500 .00 CALC-VALUE: 5, 500. 00 GROUP OCC: R-3 / PERMITTEE: THOMAS L. DOUGHTY ( 714 )721-8956 ADDRESS: 259 21ST STREET COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME COSTA MESA CA 92626 *************************** *************************************************** LICENSED CONTRACTOR DECLARATION: I hereby attirm 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.: 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 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL: 42621503 ZNE: REF NO: L Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > *********************************************************************.********** Date: Applicant. DEVELOPMENT SERVICES R E U I R E M E N - T,:S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(51011)or less). Q 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 - subtecttotheWorkers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: BUILDING APPROVED BY : DATE: • NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor ' 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 BY. ( .. DATE: t ( 51 which this permit is issued(Section 3097,Civ.C). ************************ **** * l'I(* **************************** ***t ** * **** LENDER: ************************************** **************************,*********** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y 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 81 . 00 , 55 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 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 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE 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 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 81 . 55 0. 00 0. 00 81 . 55 81 . 55 ' . 00 does not apply to an owner of a property who builds ar 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.It.however the building or REVENUE DIVISION TOTALS--> COLLECTED: 81 . 5 5 OVER/SHORT; ..- - 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADNG PLAN-CHECK y, I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 .00 55 CI 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 *********************************************************************jE'********* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. .././ , tor this fico an: TYPE QTY DESCRIPTION UNIT COST - ,TOTAL COST /bate: to i� Owner: �Aid:L- iof /%%f11/ SFR 5500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 i 5, 500. 00 Ido hereby cenlfy that I am aware of and understand the requirements of California Health a •Safety Code r"ion- 5505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply wit`.id state cod. an r :requirements for a !•' permit for construction or modification from the Air(Malay Manage district.Reside constru 'on d�.'. s are exempt from 44'1 these provisions // — Date: Applicant: A././///'///// t 7 I hereby certify That I have read this application and state al the above informa on i5•area I.,_"to I[ Tcountyh all city and ordinances and state laws relating to building construction and her,. thorrze represen.titres of J ty 1. port the.•. ¢•mentioned property for in peon purposes. / Date:Zo•I' •/ - Signature: / 7 / / de ' / _.—..-•"'.....Driver's License or Social Security.: 1641.46 Whim—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;, .denrod—Assessor • r / ' CONSTRUCTION AND PLANNING POO SP,A 1 APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector L 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location :-r ,4 . a1-1.$oil Pipe-Undrgrnd,-.- 53. Steel Reinforcement .-.• " ' %-frt .-1•So.81'ectr+¢al ConZitiMitity-Undrgrnd. 54. Forms '(` •� • r ar_• a'ialrtiCctra'cal Con fNtlndrgrnd. 55. Electrical Bonding J NS 4tgel,f einforceq anti 56. Rough Plumbing & Pressure Test a 'I f9 a:J Ht§,-...run'''. E-LXectrical UFEQ=BTGd. 57. APPROVAL TO COVER-GUNITE I idOr _ii P4otings :DIP-- 58. Electrical Conduit-Undrgrnd. .ti . Foundation ,e en 59C-4 al . Gas Pipe, ❑ 7 .-Undrgrnd., Test - .. a• '-i. Water Pipe-Un�•rgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. % 2^r` �j rJ 10. Structural Floor System 61. APPROVAL TO DECK y/ j 11. 4,:operty Sewer Lin & House Connection 62. Backwash & Receptor-Final ,' /r/i i 12. Sjwer Cap o/ 63. Heater & Vent-Final N - ' tti' 13. Roof Drains rD 64. Plumbing System - Final r j: 14. Rough Plumbic "s 9 -9 ft) 65. Electrical-Final y �^ o✓* - �� r• ' r 15. Rough Electrical-Conduit 66. Solar System-Final •°l ,r./.• r 16. Rough ElectriEjNiring !f .f 67. Fencing & Access Approval ro�l 17. Rough Wiring$ign 68. APPROVED FOR PLASTERJG a 18. Rough Electril-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioningn _ FIRE DEPT. REQUIREMENT '. n s I m - -. rr c s yC. 1T t-i tr I• IX Y: ti , Cv 2d;CRa h ct y place 5! cCCK * -4cAPPFTV FPe lit#S w * ;. 2' tr A u E • -r :.`s .r a 4* • 1; 9_ S.-. C 1 r tr• 21.,;Dttets, IV Stgictejc ,c •• •• .-S ' a 1-* t :770. •UndergrotrW H.r�lro }. •T :11 S-4' \i-. •k /'t PY4 rY �. r_ �M1l r� , 22sDts, ntratiI1* CDS w u S �; z :471. Produ ting li'las �sOil •J i-. LC I :Z * 7 k :R - 71 I I v. L.S. "t.) 23..Gas.,Pipe..Rojgh &.gest [;S * to ce et 0* .• ''72. Undergrd.Ond FI�trhja• f• =• rJ - a--.-a--c•'3 rl.. _ _ _ r� . ,_, •y 7' - 24?Ro f Framing G: 1--' •i .X > ?; ,r .Y ;',',73F. Undergrna.Storz 'nkk 1 Gas 0l�il r ?,‘c 2. :U r. S ill Li tUv * - V 1-1,--0 Y 25. Roof Scathingtat .‹ . -- * J '> a..$ * 74: Overhead Hydro x 0 7 _ .' w_ _ S, 3. . 26-,T-07r Ceiling (Strbitural) &N71-¢ coat ` Iiia 1'11?- i 7 r Che cal �"- * I"' C u: 27;rFrag3e aPd Flas x x { �' s Ina Ur i. S In 'x t"K'� °Wit .s s T og-t -, 76. Ury Stanciluae t-tt:, x _ -•28. Lamhin Sidin * = ""L x ' T_ •• •• r*. 77-LFIXED r CSINA `t C :� � orzt� C x tr. : �I 29. Insulation • . x S .. > _ • 1a 7! FIRE PREV. FIft1L x > tt .0 o :c... S ... _ `'� • " « t30. Drywaf,P'1�Vaffmgm.,:,.- I r ; �ti + * `H�ALTNDEPT. REO:t/1144MENT d31. Plaster EBrown Coat? s i tri/T• * 7 * ,r74j FINAL IItECTIN *. Cl C 2 .. v; .n-' I s. .:. '.--,. .r tr,0- 4i. - tel 7,332; PolvertNlet&-Finap ' to '��+• * '1801'F00D CERTIFj 3RTE ISSUED •f '-� �+, ' r^.-� 1 J. -,. ;t , w Tr [^: S^ 1 y. I T .F_ to A^;: . 'i r .7 '7£ * In .3 Fi •I E ctri; .yy. tri I < x 6 * Notes: .-. '171 * - C ,-,t' ,,, v .4 ,. X . a r .0 �..1. k et t•,C1 -• :o34',FirgeI Heating & Air.Cohditionffilg C. c �c * S In;I: t 5 00 .1" 's .-, rr •.a 'ri In A ' -_`� x (. I r.-'‘C :t n 35�FinalGIsPr e-Ti` ow Ar-+ Ir rr. * ,, • x' ins * tT 0 -----:C. r / w .0ai •!'. ... r•1 r36. Hood or Canopus:* o i tr t a * (T z\'-: r_ (•0 a:tr' c rr• en r is r. I 'X m �, -. a: v .T r O k Irl .L1 74137'7'j irl�l F Ltory F( eta Iw F ;k lace,; I • �,i I l: ti u„ * 'Cc 38. Flail Plumbing ti _ • t • i r b zed- -----r. X39. Weser Servikd-Fina ' ` y I. ' ' corn V CC O 44, r40. Gas Service final »: to - .ytr.r S *, 'n I w - F * 7541. Solar Dom Zic-FirTals r •• + rs 4. * ,Q^_ r- x - 42. Backflow Preventep. ` 0.1 .x. J f : s >; Z." i-i Z D-- -- r a r17 -'I r r_r 43. Backflow Iragatio(: tt's.-- t[ w a l l t/rr-,.1 . 0 } J- x u,•,,. ,4 .'. I rJ C :144. Landsgape 5rigation Systemnn j 'x a 7# z: ! of CU :GC.) .t. o: 0 C - - ..,. .. , •r { -t. <' '5' r;, 0I * ' r4�Sound Atte,nuatioti i-rr`: t1• 'f 7_ :- [-' E•r t - ^1.. • IX * j46..Handicap R`egulatfons s: , � •- ,'`+ •g w +4� 7 LSTI@(1CTURE & BUl'LDINGY '..jr1 9'v f ~ ' ESWL/p I r hd. 0.4____ 46`,-_"jFIAL PL�7JNIN i ;-a Ea • * 2. `1 Y i. i 3 ('1 '4 C.a• t- v • X497 Electric Release to'Edison I .. en! i. .g Is• 1 t •~ n-' • V I ... •Z"--.4-t' a .'t ,7 •r, '.e o :50c,GardRelease to Southern California Gas Co - - -.: x -' •- C • ottri I. t • i �n r, . nt l X51. CERTIFICATE Ofi.00CUPAr3CS' / ,• a. - C' tr.0 X * 0 No. Date / Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 9653 10/08/1114 18.x.J` OF COSTA MESA CON$TRIJ9ION PERMIT PERMIT NO. s.eictACT NRT �M�0�, UNIT NO. �Ede- ' 11 y��J I S5-14 (c s 1'1 La • Project Address 111777 ❑ REPAIR ` SA _ TYPE OF CONSTRUCTION NEW JAC ADD Li ALTERATION Owner's Na •Wailing Address _ 4 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER,y� � �� A.P.# LL7/_ 24CP_\ Owner's Name ��' I-� ►� Phone _��. DESCRIPTION OF WORK/USE OF BLDG. end el ,,vathtt__��YIUf 4 7/•cCL i/.�•' 03 Zone Address 25 E �� S�j E�? / d »'( S Main Building: Accessory Building: EZ Arch/Eng. License No. TYPE OF PERMIT CIGRADING L FOUNDATION STRUCTURAL T Front /a cr-TA6 -FED 0 ,^ Address YOQ ❑ TENANT ❑ ELECTRICAL ��❑, PLUMBING ❑ MECHANICAL B Rear up ; N C) Contractor's Nam C' s. II . k ••s Phone11115Lp OTHER 77 �J LA) ^^'''' I /� r 1 •��s PROJECT DESCRIPTION SQ F 12f OCCUPANCY /c�� C Right 23 C,.. N Address(mailing) TA 7QF-F LAGUR BeN Qnbs' I/ K G --s� ( / CON ST RUCTION TYPE VALUATION$ �GlI�O 4/14., /� $ Left .SI R -1 City License No. "�lp C7 ZONE GRADING CU.YDS. ACRES !'/Tl `V LICENSED CONTRACTOR DECLARATION / Ping. Ref.# Parking Req./Provided E " I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Nates: Arm, I`/� 5rrE j yrj\ I M with section f of Division 3 of the Business and Professions Code,and = i+7s . 4) r .sFY sri'f '�--r `— 1�'� T �> my license is in f for a and effect. , C` s/P a•• e_ T License Class License o. Date Signature .a! dee /f .a. / j..1/ PLUMBING FEES • WORKERS'COMPENSATION DEC ARATION 1 I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink '00, Lab. 1) LMy /�`` /, •fit, Automatic Washer Transformer 0 15-50 KW (icy No. L� GI ' r ompany s 1t1V: �SUI\� 1 f . Backflow Irrigation Sewer Cap0 50+KW ,�(( � Construct for Pole Sub. p Certified copy is hereby furnished. D Cer "fled copyis filed with the city ring Divi }yy M Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date PT IO(' y Applicant (TM �/SCLLA//r./ ' - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Dover 100 amps s). eclion need not be completed if the permit is for one hundred($100) or less). Dishwasher Solar Piping _ Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is.issued, - — _ shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan. Motors❑Q1 HP ❑1'/r-8 Worker CompRation Laws of California „�+ Aa,,iii, — Date -a'' Signature �//i ccq/J/ - Floor Drains Swimming Pool w/Spa F.A.U. WoTIC : , ter making this onofith,you should ,becomeusubject to ith Microwave lar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. - Micro CONSTRUCTION LENDING AGENCY Gas Service Outlets Water ClosetDevice Boxes • I hereby affirm that there is a construction lending agency for the performance Pole Light t. • of the work for yipiFtl`f -permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets • Lender's Name r�lJ t1 - Range t Lender's Address - Kitchen Sink Water Service OWNER BUILDER DECLARATION Switches Sign 1 hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal •Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-TrapGenerator ❑OS KW❑$-1$KW any structure, prior to its issuance, also requires the applicant for such permit ' - - Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section ' _ . .� 31.5 by any applicant for a permit subjects the applicant to a civil Vr2ialty of not more than five hundred dollars($500). ' '9. I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • -Compensation, Compensation, will do the work,and the structure Is not Intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES , License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIRE N S: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By � Date $��-0��)MITT elation, the owner will have the burden of proving he/she did not build or im-. Duct-Under Ground Building Approved By Date C7�sI orove for the purpose of sale). /� 1� / I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural - Refrigeration System Application Issued By yt''ll J -Date -'S tractors to construct the project (Section 7044,Business and Professions Code: (J The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU ' builds or improves thereon,and who contracts for such projects with a con- SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ I tC7. .S() $MIP $ / .0 proof of their Worker's Compensation Insurance should be provided to• me. PLAN CHECK $ 1! .9'7_ PERMIT ❑ I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ISSUANCE $ Date _ Owner Heating System& Ducting PLAN CHECK 25% •S ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑4100,000 BTU DI 00,000 BR GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating:to building construction,and hereby authorize repre- sentatives of this city to en s upon the above-mentioned property for • Inspection ..yy uses. p�� MECHANICAL $ • Signature W/42/y/ ...07/077 Date O(ICAK• TOTAL FEE $- p Drivers' Li ense or 55# - Reinspection Fee '$15 Issue Fee $ 3 PLAN CHECK 25% $ /P3, es.3 CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING • ,, ' POOL t!".-2; APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector r 1, Tem .Temporary Electrical Service or Pole 52. Pool & Equipment Location a 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. ElectricalConduit'Utility-Undrgrnd:' _ •. 54. Forms 4. Electrical Conduit-.Undrgrnd. 55. Electrical Bonding • 5. Steel Reinforcement. /4it B• f1 56: Rough Plumbing & Pressure Test - /(71X. 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7.. Footings D (ky, 58. Electrical Conduit-Undrgrnd. G'i r 8. Foundation .. I . t 59. Gas Pipe, ❑ Undrgrnd., Test '9. Water Pipe-Undrgrnd: 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System . `I/g/gty j941761. 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-Coriduit - 66. Solar System-Final - 16. Rough Electric Wiring - 67. Fencing &Access Approval 17. Rough Wiring Sign' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T ear 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 �: I • 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough &Test 72. Underground Flush ' 24. Roof Framing ��l1 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing /y'L/` �� //l�v2l// 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Moriocoat 75. Dry Chemical 27. Frame and Flashing S-`•`R�' t°/Me En Icy II J/J 76. Dry Standpipe 28. Lathing & Siding ,.„---7E.62, /14am/ E/!7 77. FIXED SYSTEM FINAL 29. Insulation �', a/ Jvj A72-j 78. FIRE PREV. FINAL 30. Drywall Nailing /aj-✓EY .&i�j HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 4. r ! ./i-i m 4,g 79. FINAL INSPECTION 32. Electrical Power Metdr-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: /0/26�Sr/' al/ye- /,..�r"..., cx....-�,o2`2 34. Final Heating & Air Conditioning A �� /• .�-C. /-.. LU ., 35. Final Gas Pipe-Test /Q//V/^SLGft' ?i :.A-_ ,,,. ,' ttt""„„ -. ��,;,..iit .- 36. Hood or Canopy y�„(,' F �� ^ 37. Final Factory'Fireplace /d/IY(ey eh'^ 'vs-ocO3-t C 1ek -tet 38. Final Plumbing - y4.4r- Caw Q �i�F G-�e-/}G��,C_, 39. Water Service-Final �� 5_ /J _'� --ret1ix en 40. Gas Service-Final..( _ _ �.�ithilar -44 , / 41. Solar Domestic-Final • _ (�, -4�( ea, 42. Backflow Preventer r//7 c- 7v� r r ' �U_7[ 43. Backflow Irrigation /fin^1,..A do , , _- � 1.7,0-4,71 44. .Landscape Irrigation System. cit / n-. P • n<-7 • 45. Sound Attenuation • &s- 41.,...ec_e e // * t R /� rOT��If� o/.`�i 46. Handicap Regulations _ �G 041 P47,45- . OI 47. FINAL STRUCTURE & BUILDING F4% ./85"- k�-j//i7 , h/d� 'ter„ 48. Special Requirements Completed / /� �' /, 49. Electric Release to Edison ' . 50. Gas Release to Southern California Gas Co - _ 51. CERTIFICATE OF OCCUPANCY ,\ Date it. , , _- • I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 'mom PE,$p(IIT NO. TRACT NO. LOT NO. UNIT NO. C OF COSTA MEQ C ZR SYTION PERMIT i - —1 1803 11 /07/84 I oP00 - . Project Address •"+1.) ! Sf�J1 Applicant's Moiling Address 1 TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION ❑ REPAIR ^p .1 (l.0(L r A,l)7/jia 953-16_2q ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name 4^"'fJ3 W ALL /'VV ff(11 1 Phone' r )l A.P.# Zone .5'T DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING CI FOUNDATION El STRUCTURAL E Front O Address ry�� /J�,,�ff` ' mss,, ❑ TENANT CI ELECTRICAL ❑ PLUMBING CI MECHANICAL BA Rear N Contractor's NamC._�1� U•'1" `C- '� Phonell ❑ 'OTHER ^_ Address(mailing) 5r-30 /�•r ��++ /15 PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N 3 bs CONSTRUCTION TYPE VALUATION$ S Left City License NO. ZONE GRADING CU.YDS. ACRESR �- LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E NI hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ( 5'5-1 lL Planning Notes: M V with section 7000) of Division 3 of the Business and ProfessionsuCode,and s� I v T T M my license is in full for - and effect. 1� f�2Z t'J License lass •- .� Licen e,No. S Date Signature r.e./A // . 'az. SI PLUMBING FEES WORKERS'COMPENSATION DECLARATION - Bar Sink Showers ELECTRICAL FEES hereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - ' J00, Lab. CCJ .-.0 Automatic •Washer Transformer ❑ 15-50 KW Policy No. (,Lt 20''2--776 / Company OHIO CA at��-Y Backflow Irrigation Sewer Ca 0 50+KW P Construction Pole Sub. ffCertified copy is hereby furnished. - Cert`tietaopzis'f1'led withththe city Et itdipg Dlvlslop t/ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date CI rRi `t Applicant J'yrATION ECLARAM -EXEMPTION FROM WORKERS'COM ENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps. (This section need not be completed if the permit Is for one hundred ($100)or . less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel ' I certify that in the performance of the work for which this permit is issued, I ' shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1 h-8 Workers' ensmion Laws of California �•�� - . Date i- i`'1 Signature SO41 (//e_8n1?/Y1 ' Floor Drains _ Swimming Pool w/Spa F.A.U. 9-15 HP ❑16-15+ • 'NOTICE:If,after making this declaratlbn,you should become subject to the Inc.IncSolar Workers' Compensation provisions of the Labor Code,sou must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance - g of the work for which cif ,IX+rmit is issued (Section 3097 Civ. C.) Interceptors Water Heater - Outlets Range Lender's Name �/-�W l-. Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or Auto-Wash Garbage Disposal ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor any structure, prior to Its issuance, also requires the applicant for such permit p to file a signed statement that he/she is licensed pursuant to the provisions of ' ROOF Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of -`ivision 3 of the Business and Professions Code) or that he/she is exempt • refrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil - - , enalty of not more than five hundred dollars($500). ' O I, as owner of:the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - • - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044; Business and Professional Code: The Contractor's MECHANICAL FEES - . - _ • , License Law does not apply to an owner of a property who builds or improves • thereon, and who does such work himself/herself or through his or her own SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑ • sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By ' Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Data prove for the purpose of:sale). C*ES • ❑ I, as owner of the property, am exclusively contracting with licensed con- ' Duct-Structural • Refrigeration System Application Issued By Dat I tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,0000,000 BTU 0100,000 BTU A-.1-'vhQ-' " y— SUMMARY O FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law)- I am aware that , Exhaust System 0 Multiple 0 System Repair/Alteration _ BUILDING PERMIT $ IS 00 SMIP $ proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT 0 I am exempt under Section B.$P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ PERMIT ISSUANCE $ Date • OwnerHeating System& Ducting Registers • PLAN CHECK 25% $ • ENERGY P.C. $ .1 hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BT - GRADING $ information is,correct. Lagree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ - MICROFILM .$ sentatives of this city to enter up.n the above-mentioned property for inspection pun,. es. /-74 - MECHANICAL $ TOTAL FEE $ ' IR-oe� e .4 Ai .I,Al Date / T9 Signature Drivers' License or SS# _ —/ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POO SPA APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe=Undrgrnd. I 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, 0 Undrgrnd. 10. Structural Floor System .i 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection i i 62. Backwash & Receptor-Final • 12. Sewer,Cap63. Heater & Vent-Final 13. Roof Drains I 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16: Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign ' - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing I 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy r 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 ski/55-11941 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERT IFICATEOFOCCUPANCY _ LNo. Date Appliiant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 'i.J 1 rY IsCOT1.JCTION PERMIT PERMIT NO. y^`I)^ SACT nen LOT NO. UNIT NO. . , :roject Address- p•� + - __ t/ W PL�•1 FGt P/p (�9_�Z 2818 11 /26/84 150E0 TL Applicant's Mailing Address �'/ne ax��-. TYPE OF CONSTRUCTION LJ NEW ADD {L'J'• ALTERATION U REPAIR 1 Owner's Name ;Asti . - ks H 0 CONVERSION 0 DEMOLISH ❑ OTH • A,P,# I Zone �r� Phone D SC-IPTION OF WORK/USE OF BLDG. I• ' 0 /nem /"7 Addresst- el5r - -'/i./fl)V S Main Building: AccessoryBuilding: E Z Arch/Eng. License No. TYPE OF PERMIT . GRADING 0 FOUNDATION III STRUCTURAL T Front O Address �t / Q ,1 0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear . N Contractor's Name WOJ (2-4e Phone-{ 8U-�`108 ❑'OTHER C Right - - N (('' Jnr p��11 w�1 PROJECT DESCRIPTION SQ. FT. ��, OCCUPANCY CityAddess License(mailing) �l `"�-'<-F "' Fit)• ` is CONSTRUCTION TYPE VALUATION $ �/L oO g Left - . R City License No. ./�p7••/ ZONE GRADING CU.YDS. ACRES Py U/f Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION - Q I hereby affirm that I am-licensed under provisions of Charter 9 (commencing Remarks: (bI � Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and CJ� T • Li my license is in fu for e and effect. . 1�I 22 cen • Class P Lin se No.- • S Date C• -- .a� ' Signature .LTi ii A - A. Ii PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers , I hereby affirm that I have a certificate of consent to self-insure or a certificate -___ 'Z 00 ELECTRICAL 1 • FEES -if Wor ers' Compe sation Insurance,;or a certified copy thereof (Secti•n _ - Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW •Ie I0. ��• • a b it?e. pany S:f . i. ' /n/ Backflow Irrigation Sewer Cap Construction Pole Sub. • ❑ 50+KW •. r fie• �yw,�' fu nishe•. _ -,— NI er i ' , •[TJ ith he • ty B 411/1111W /Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps D. e 1.1.1. _ .• APP scant (W /- "�j — EXEMPTION FROM WORKERS'CO '� SATI• DECL•-ATIDN Clarifiers Solar Collectors Dishwasher Meter Clover 100_amps (This section need not be completed if the permit Is for one hundred ($100)or - - - ' .. _ less). Dishwasher • Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued,I , shall not employ any person In any manner so as to become subject to the" Drinking Fountains Solar Tank Fan Motors 00-1 HP 011S.8 Workers9(.b�nqap sats��ppn Laws of Califor .Date /C9 'at ld Signature �{.//� Floor Drains SwimmingPool w/Spa 'NOTICE:If,after m3�kkinthis declaratl {_s- p F.A.U. Inc.Solar ❑9.15 HP ❑16.15+ g you should become su lett to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures - - - comply with' such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet 2 00 Device Boxes Pole Li ht - I hereby affirm that there is a construction lending agency for the performance 9 of the work for. .Whjcry�this permit Is Issued (Section 3097 Civ. C.) —Interceptors '_ Water Heater Outlets Rane 'Z r1� 'Lenders--Name (.]6'f' �I� 9 T Lender's Address _ -- _ Kitchen Sink _ - Water Service ) Switches Sign 2 0OWNER BUILDER DECLARATION - - - - - - -- ' • ' --- - - - / I hereby affirm that I am exempt from the Contractor's License Law for the t Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or — Z� 9 P ,Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays Generator ❑Q5 KW❑5.15 KW Trash Compactor any structure, prior to its-issuance, also requires the applicant for such permit P to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - - the Contractor's License Law(Chapter 9(commencing with Section 7000)of •DIvision 3 of the Business and Professions Code) or that he/she is exempt - • . therefrom and the basis for the alleged exemption. Any violation of Section . 131.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars($500). ., I. as owner of the property or my employees with wages as their sole Reinspection Fee ,$15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL . FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own _ - - -- DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 - Zoning Approved By Date _ pletlon, the owner-will have the burden of proving he/she did not build or im- Duct-Under Ground •Building Approved By • prove for the purpose of sale). • - • _ Date '•1 ❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date ( 24° tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU builds or improves thereon, and who contracts for such projects with a con- - SUMMARY OF FEES tractor(s) license pursuan(to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP • $ proof o// their Worker's Compensation Insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration . PLAN CHECK ' $ PERMIT : ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire DampersPLUMBING $ CI.00 ISSUANCE $ •Date Owner Heating System&Ducting Registers PLAN CHECK 25% $ ( . 0 ENERGY P.C. $ • I hereby certify -that (have read this application and state that the above 00-100,000 BTU 0100,000 BT Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ (....-f0T GRADING • $ and state laws relating to building construction,and hereby authorize repre- j. 7V MICROFILM $ sentatives of this city to errr��eeer upon the above-mentioned propert for PLAN CHECK 50% $ Inspection puEEEEEppppposes. vi/ �,y Signature LI/}Y( f.0/.V// DateI 7 MECHANICAL $ - TOTAL FEE $ U• �O Drivers' Ld'ne or SS# $ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $iiiisolmlasilia _ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor , CONSTRUCTION AND PLANNING • - POOL PA Date Inspector Date Inspector -', APPROVALS Permit# APPROVALS Permit # , i . Temporary Electrical Service or Pole 1 ' 52. Pool & Equipment Location - . Soil Pipe-Undrgrnd, - 53. Steel Reinforcement ;Electrical Conduit Utility-Undrgrnd. 54. Forms .. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 1 , . pElectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • • . - 58: Electrical Conduit-Undrgrnd. ..8. Foundation 59. Gas Pipe, O Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd'. ' ' 60..Backwash Lines,P-Trap, f] Undrgrnd. 10. Structural Floor System, - 61. APPROVAL TO DECK ,11. Property Sewer Line & House Corinection ' . 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final , 13. Roof Drains • 64. Plumbing System - Final . • - 14. Rough Plumbing /.2///y n£' 65. Electrical-Final - 15. Rough-Electrical-Conduit - 66. Solar System-Final • 16.;Rough Electric Wiring - 67. Fencing & Access Approval -- - 17.'Rough Wiring Sign" /afc'Ir�� cc68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling l ! 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 O Gas 0011 • 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 - !-j/ .JsCI CO._ Notes: • 34. Final Heating & Air Conditioning / i l • j 35. Final Gas Pipe-Test - - ' • 36. Hood or Canopy z 37. Final Factory Fireplace 38. Final Plumbing 715 /f' 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 • - ' 1 46. Handicap Regulations ' - , • / 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed, - • 49. Electric Release to Edison - - ' 50. Gas Release to Southern California Gas CoI . • , 51.. CERTIFICATE OF.00CUPANCY - , - No. Date - "- FirApplicantto fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY Of COSTA M SA CONST UCTION-PPER I/T,— ..[ I PERMI/�•f/y��O. 3SS TRACT NO. LOT NO. UNIT NO. A P # - l •Zone ' Project Address -_ /Z/_ e�/5*S_L ! ( S Main Building: Accessory Building: Applicant's Maili Address is -J� L iNCO� A TVPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR E Z `pppggg', ,f ❑-60a CONVERSION ❑ DEMOLISH E OTHER ' T Front O Owner's Name Wn, ff✓V fit O/yV, V Phone b 6 DESCRIPTION OF WORK/USE OF BLDG. B Rear - N Address as �' 2Jc 1. sir A 1 Arch/Eng. ' License No. TYPE OF PERMIT 0 GRADING 0 FOUNDATION C Right N p ❑ STRUCTURAL Address pp(( � ❑ TENANT ELECTRICAL IPJ PLUMBING ❑ MECHANICAL S • Left • • • R Contractor's Name I k •• �!f"Q i-7S 1LW7M� Phon /..41.2-IZS3 El OTHER Ping. Ref.# - ' Parking Req./Provided - E /,r -3 PROJECT DESCRIPTION SQ. FTOCCUPANCY . Address(mailing) w, �i yG0 n/ !/� Planning Notes:S9-3 -" M QCONSTRUCTION TYPE VALUATION $ ,T City License No. ZONE GRADING CU.YDS. ACRES T, LICENSED CONTRACTOR DECLARATION _ I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect c--y ELECTRICAL • - FEES G— 6 CC-- :207 �`1 6 PLUMBING FEES License ass License No. - Date - i AT • Signature OD - _ Automatic Washer _ Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION Sink Showers Construction Pole Sub. - ❑ 50+KW I hereby affirm that I have a certificate of consent to self-insure or a certificate ' , workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter pup to 100 amps 300, Lab. C.) `I //}�( /v�� Backflow Preventer Service Sink Policy No.' a'7 File company tyJC��' ` Backflow Irrigation Sewer Cap • ' Dishwasher Meter Dover 100 amps Certified copy is hereby furnished. ( Dryers ❑Gas ❑Fleet(ic Sub Panel - Certifiey copy is filed with the city�giilding Div" hairBathtubs Sewer Connection Date__2/-30 � 88- Applicant 1/4..Ci Fan Motors❑0.1 HP 011/2-8 EXEMPTIONFROM WORKERS'COMPENSATION DELL RA ATION Clarifiers Solar Collectors ( (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. Inc-Solar 09-15 HP ❑16-15+ I certify that in the performance of the work for which this permit is Issued, I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/Spa 't a Pole Light NOTICE:If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range _ - • _ comply with such provisions or this permit shall be deemed revoked. • Switches CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) Garbage,Disposal Standing Sections Lender's Name Interceptors Water Heater • - Lender's Address Kitchen Sink ' Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit to file a Signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee 'erefrom and the basis for the alleged exemption. Any violation of Section $ 3 )31.5 by any applicant for a permit subjects the applicant to a civil Genalty of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: — LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee l $15 Issue Fee $ 3 • Zoning Approved By Date ' compensation, will do the work,and the structure is not intended or offered - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By ^ Date ' — _ License Law does not apply to an owner of a property who,builds or improves o CA) - �dII ( thereon, and who does such work himself/herself or through his or her own Hood or Type I 0 Application Issued By Det V `t! employees, provided that such improvements are not intended or offered for Boiler sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). - - BUI LDING PERMIT $ SMIP $ • ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon. and who'contracts for such orolects with a con- tractor(s) license pursuant to the'Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $ __ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $ O I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $ PLAN CHECK 50% $ Date ' owner i. Heating System&Ducting Registers (� ,� 'd L/� • O. -- TOTAL hereby certify that' I have read this application and state that the above KO-100,000 BTU 0100,000 BTU - - 7 MECHANICAL $ TOTAL FEE $ information is correct. I agree to comply with all city and county ordinances PLAN CHECK .25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property r ' • Inspection our�ases. L,/ �j,,,r 47 3° SI Signature C1 a4.1(.Q �)pv!yL�d-�� Date ! O G Reinspection Fee $15 Issue Fee C $ 4' 01 00015871-00015271 TOT 24.00 Drivers' License or SS f 09/30/888 TICIF: 11:55 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor i CONSTRUCTION AND PLANNING POO- SPA APPROVALS ' Permit Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &•Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Elect icel 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 Footings I 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test • 9:yWater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. • • Structural Floor System 61. APPROVAL TO DECK 1.•-Property Sewer Line & House Connection 62. Backwash & Receptor-Final 127 Sewer Cap 63. Heater & Vent-Final 1,3j.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 - . 47. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -20. Rough Factory Fireplace APPROVALS Permit# c21. 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 1Structural) & 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 t 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -• e-, 33. Final Electric {{ Notes: 34. Final Heating & Air Conditioning iOVs a'ic' 5/ 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 :( f' r 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . • y. • 50. Gas Release to Southern California Gas Co t• 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa IN:,JLATION CERTIFICATI..N Building Safety Division l2 J p �I ST CQ X21 mFSA og L Number and Street City County Subdivision Lot Number pf'rniT . No, R- 15514 DESCRIPTION OF INSTALLATION ROOF / Z. (6/�' (9 Material gAtkl Ot R Brand Name 71,45 Whig-- r Thickness (inches) 2- Thermal Resistance IR Value) EXTERIOR WALL i Material R-1( Brand Name IIA/lww// l/LClc Thickness (inches) Thermal Resistance IR Value) CEILING QQ Batt or Blanket Type /�.—Fl Brand Name in& Svi(rL I Thickness (inches) 5%5% Thermal Resistance (R Value) Loose Fill Type Brand Name Minimum Thickness (inches) Number of bags Weight per bag lb. Area Covered (ft2) Thermal Resistance (R Value) FLOOR, ELEVATED Material �._ 19 Brand Name ( ' IA{J5(,f;ILF Thickness (inches) 5 V2— Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) ' - Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Administrative Code). mC KFOCA4k) (p ucztIcrj0,0 l y.22. General Contractor(Builder) License Number ) 9t n 4 Gil mht/ER 7_029- h'f Signature and Title Date Sub Contractor (Insulation Applicator) License Number Signature and Title Date CMF 1106-30 RECEIVED 06 2 1 1985 CTv OF COSTA 0'1a4 P6;IN1&J& 4 C RAD) CERTI SIC AT loot 5w2-r- ma e GAN ��t3 SITE c2S`i c,71 s-r gE� t Rmr r B ISS-72-1 Mc Ke_owuJ �C�oos-r-RRUTou,/ s ATE ucc�sG# 4 �i1-,..�. ab , (//2-0/)X0 Gni /l dle l 0 • . : / Ad /• Cad/72011 u//nd- / > % , I � c "alr-67 ady ,2/, /2& ,BJECT PROPERTY INFORMATIC 1) Property: 259 E 21ST ST, COSTA MESA CA 92627-2155 C015 APN: 426-215-03 Use: SFR County: ORANGE, CA Tax Rate Area: 15007 Total Value: $266,000 Census: 632.02 Prop Tax: $2,877.36 Land Value: $189,958 Map Pg: 31-E2 Delinq Tax Yr: Impry Value: $76,042 New Pg: 889-B3 Exemptions: HOMEOWNER Assd Yr: 1997 Phone: % Improved: 28% Owner: DOUGHTY THOMAS L Mail: 259 E 21ST ST; COSTA MESA CA 92627-2155 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: 1,684 Transfer Date: 11/30/92 07/02/73 #Units: Sale Price/Type: $294,000 VERIFIED $40,500 VERIFIED # Bldgs: Document#: 817696 1077900844 #Stories: 1 Document Type: GRANT DEED $/SF: $174.58 1st TD/Type: $264,600 CONV Yrblt/Eff: 57 Finance: Total Rms: 8 Junior TD's: Bedrms: 4 Lender: SHEARSON LEHMAN MTG Baths(F/H): 3 Seller: ANTHONY ROBERT M & LUCIL Fireplace: 1 Pool: SPA Title Company: GATEWAY TITLE CO. Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Gond: CENTRAL Improve Type: DETACHED Lot Size: 70 X 135 Heat Type: FORCED AIR Zoning: R-1 Lot Area: 9,450 Quality: AVERAGE County Use: 1 Parking: DETACHED Condition: AVERAGE Bldg Class: Park Spaces: 2 Style: TRADITIONAL Flood Panel: 060216-0047E Site Influence: Other Rooms: DINING AREA;FAMILY ROOM;DINING ROOM;ATTIC Phys Chars: SLAB FOUNDATION;WOOD SHINGLE ROOF COVER;STUCCO EXTERIOR;PUBLIC WATER;PUBLIC SEWER;LAUNDRY ROOM;OPEN DECK;PATIO;GOOD FUNCTIONAL UTILITY;DISPOSAL;RANGE HOOD; Legal: L244/NEWPORT HEIGHTS NWLY 132 FT-EX NWL • Comments: Copyright© 1996-97 Experian Page: 1 of 1 a . OWNER JUDD, Harold V DATE 6-29-54 r JOB ADDRESS 259 21st St• BUILDING PERMIT NO. 354 • GENERAL CONTRACTOR MaX W. Pope VALUE $ 14,5500.00 Lor APM 118-11.10-1S5 BLOCK TRACT Residence & detached garage i I Gr '113 I TYPE V ZONE FIRE DISTRICT #363 PERMITS ISSUED INSPECTION8 ?Tit SUBCONTRACTOR �u//� r DATE NUMBER Footing Trench ,! J 7 / " � Foundation Forms and Grade to Garag ihy ,4�f17-/./4, Rough Framing r�-/t' a S / r:S4 Plumbing,Rough to Slab / -?".47C- Plumbing, vrr Plumbing, Rough Complete ))/1 it it e -t,, ., ? 42,‘ -/- -' tiT5 , Temporary Pole ` 1,..I� ! 4)AY' -5-7,-, Frdk /d7 G 7_ 7-47V 37 ;/ 5-({a . Wiring, Rough -. (��I i ��J'( / /TT Heating,Rough E £ &_ (/ -.11C, `/,� U 1n�7�' - 9 S' S Heating, Final I.✓-cr Sewer icei//-- 1/ r /lfu- 7m� ...Cab/ Septic Tank or Cesspool 'J Lathing I . t / b-:(J-W .. Plastering �� - it'/J J Pb•-bing,Final,Fixtures Completyiui -17 P. ,ing,Final Gas Test/S /O-/RJ e.¢Cy i - ,G-Jsy/ Wiring,Final /O� S i. "/'AJ' Occupancy TiLC/ etl.is-Sr 1e u-,v -AIA L l F( -rave aLe el( Form 210 G-H 1M 12-53 O i Costa Mesa Building Department APPLICATION FOR PERMIT . ��' 111 EAST 20th STREET x363 . BUILDING. 1 COSTA MESA, CALIFORNIA • FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. P milt No. AAddrress _ ' H i' % / 1 I - & 7 0 s----/ Received by Date Recd. I Date Issued Costa Mesa, California Nearests, ',,e^ Cross St. Alt /11 [.r_t..-A- Building • Address , Owner ,,r..a.¢..00 Costa Mesa, California Address If tj.y())cit , 0.01‹, lit-- " Nearest 1 . Tel. Cross St. City a' - t/j No. Zone y I No.of I Type V I Group— Architect or Y Lie. /� `- Plans V 1. Engineer / No. Approved /J _J �r by (mac. /� r/ ,c e -- � Date address T� - CORRECTIONS City tic. .:ontractor yL i{'(:t 7 fir No. - Address Legal Lot Description I No..7 M14 I Block I Tract - �` It it (Attach Metes and Bounds) /�'�0 �/�v- p 4 Size of L '•• Now Bldgs.onte r' Usei of No. I Roof JUN 2 9 1954 Gi XI Existing Bldg. "�• I Families Rooms Setback Line from Rear Yard 2 Center of Street Side Yard y DESCRIPTION OF WORK CITY OF COSTA MFSA r New I x I Alteration I I Addition I • Repair I I Moving I I Demolish I Building )/ No.of size /6 Rooms Stories tenor(,Nall Roof //�;� � , veering �j I Covertne}IfC APPROVALS Use of Ne I Building /2`�'- C 4, 4 Foundation Location Inspector Date �r Forms,Materials, j�,�"rtnespirn ` OQac e- Under-Pinning Frame: Fire Stops, Bracing,Bolts Lath. Int. I hereby acknowledge that I have read this Application l% and state that the above is correct and agree to comply r with all Cityes and State La regulating Lath. Ext. building cofstnlcnOn. eizi' Permseof Plaster, Int. Permittee W Plaster,Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ � Plan Check $ 3/(— Bond Beam $ / 4/ 5ZIC) Total V - Fee $ S "'-''-- FINAL FORM 204 G-M 2M e-04 C 0 J J d I-O.L. • a • - z* r 1-4.`"C:•i: ?i 3 • i; YXr'i t Street '. PLOT PLAN.' 3 n Show location and distances from - property line and between buildings. - • ,.• • _ OWNER JUDD, FRANK • DATE 6-6-57 JOB ADDRESS 259 East 21st Street BUILDING PERMIT NO. #5275 1��Eluv 9 TRACTOR Owner—Builder VALUE $ lUU.W AP. No. LOT 21111 TRACT FIRE ZONE DESCRIPTION OF WORK Redwood l'ence GROUP TYPE ZONE PLAN NO. # 310 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER T les - Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final Final Gas Test Co'gtruction Pole ground Power Rough Wiring Fixtures, Final OCCUPANCY (14— di/ /7 Form 210-5M-1-57 - V 5275 , � COSTA MESA BUILDING DEPARTMENT , , I 5310 P. O. BOX 317 ' COSTA MESA CALIFORNIA FOR APPLICANT T FILL IN C.L. OF STREET----- c,ADDRESS 7 / ' 1- ___ ____• PROP. LINE _ \ I Owner ��G2.•a C-f-C" �.' / :- ` r_._ 10 FT. FOR 60 FT. STREET 50 FT. 611T. FOR- -1 \\ 7 7 .2 / / 50 FT. STREET Mail Addres \' � :2 j City { z .j • Ph. No.��G�7 (o Y I I' • Contractor D L4l3.12/t. Ph. No. _ Address "I I ____ j 50 TIIF FRONT City Lic. No. State Lic. No. OF PROP. p 150 FT W Size of Lot 72 $ . iGAP N! // —/17/0 - S CC I- w i- Setbacks: C/L Street a--/- Rear ' -7`. W Z , ¢ `� / 0 U• Side Yard - Right Left f i- ----I % n 0 r a. a . • Type of Fence P, �I Io9cLd a ALLEY OR PROP LINEN. 0 p I-00- I 0. F=": .--....,.-. —7 `I I hereby acknowledge that I have read this application aZ. state J m 1L= tl that the above is correct and agree to co . : with all City Ord- tiit 1 " Nrp \ finances and State Laws egulating buil.ing c.nstruction. at-ices re r--- 10 APP OE Dof Per ittee ��l "— — FT CITY OF OF CCIISSTA MESOAgen R PLAN :ii•!f DEPT. 37 6 IN._ N. SU 3JE t Tie DEPT. R. FOR OFFICE USE ONLY Ft w _ 40 / z FT LIEca Permit No. ' w i BY PLAN lief-0 Co? !� I ' 60 FT ST. Received by Date Received Date Issued J I50 FT. ST. F' 1 L r- E REC I ED ‘ - ‘ -sy � - ‘-s t i_ _ _�PROP. LINE -- - 0 - - 1 — _ _ - - _� • r VALUATION \ • / t �-C9C Permit Fee $ -- \ �' IN,\NCE D , I CITY OF COSTA MlSA $ C 0 0 .-- Plan Check $ C.L. OF STREETS ? TOTAL FEE $ 1c.7 MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - --- MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS