HomeMy WebLinkAbout273 21ST ST - Building Permits049
CITY OF COSTA MESA r
Bl►►LD►NO. D►VISION
r 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • wTwv.ni.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P08-00005
PERMIT TYPE PLUM STATUS: ISSUED
APN: 42621506 DATE ISSUED: 01/03/2008
ISSUED BY: SOK
JOB ADDRESS: 273 21ST ST CM
Vicinity:
Suite/Unit:
SCOPE OF WORK: REPAIR/REPLACE SEWER LINE ON PRIVATE PROPERTY
OWNER:
GIBSON, DARRELL
Address:
27321 ST ST
PHONE:
Pool Spa Final
City/State/Zip:
COSTA MESA, CA
APPLICANT:
ANDRE ASATRYAN
Address:
7949 AJAY DR :SUITE A
PHONE:
818-908-9583
City/Slate/zZip:
SUN VALLEY, CA
CONTRACTOR: GOLDEN BEST PLUMBING INC
License No. 796478
Address:
7949 AJAY DR SUITE A
PHONE: 818-908-9583
City/State:
SUN VALLEY, CA ZipCode:
91352
CELL:
ARCHITECT:
License No.
PHONE:
ENGINEER:
License No.
PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $48.15
TOTAL FEES: $48.15
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 1.
INSPECTION TYPE
1616
Fixed System Final Fire Prevention
1266
Pool Spa Final
200
Final Re -Roof
201
Final Block/Retaining Wall
202
Final Factory Fire Place
203
Final Sign
204
Final Demolition
2S INTMAL CODE
INSPECTION TYPE
206
Final Mechanical
208
Final Plumbing
210
Final Electrical
212
Final Fire Prevention
220
Final Planning Approval
222
Final Site
250
Final Building/Occupancy
DATE INMALS
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
(IJrfI 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: /
(This seCon nae naf Ee xvnpleleddthe mnvt is valuedal we h red dWars(5100)air less)
_Policy.Number.
❑ `I certify that in the performance of the work for which this permit is
issued. I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Cotle rfhwith comply with these provisions.
✓/� %. 7
Applicant's Signature _ Dat
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # 9 6 el 7S cuss # G 3
ConUador's Signature' - l e
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).):
❑ 1, 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 Wth
a contracta(s) license pursuant to the Contractors License laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verified by drip lict>. . ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feel 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, falsemork, a demolition
or dismantling thereof, vrill be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Aft 2, Sec. 341, Title B, Califomia Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires. with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reposed
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions. requires registration wilh 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 Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for Such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications 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 ❑ No
(if 'yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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 penally of perjury that I have read this application and state that
the information given is correct. 1 agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of Legal er(s) Date
Signature Date ' /.
305]-a6 (3/0])
L _Arb/or Authonzetl AplNiwnt t Die
PROJECT ADDRESS: 273 21ST ST
pygNER'SNAME: JAMES KNOST
ASBRESS:273 21ST ST
COSTA MESA
CA 92627
ARCN/ENANEER: REG.NO.:
AIDRESS:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B" 044803 —
UNIT:1 PERMIT NO: B 044803 PLAN CHECK NO: 01323-89 S GOVT; N SUPP: N
UNIT:
VRMITTTE
nosessODRESS: JAMES KNOST ` (714)631-0769
Ja: 273 21STSTNONE
J 'COSTA MESA CA 92627
LICENED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Division Divn 3 of the Business and Professions Code, and my license is in full force and effect.
CI% IC.: STATE LC.: - CUSS:
0t Signature:
ORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
ampensadon Insurance. or a certified copy thereof (Section 3800, Lab. Q.
LICY NO.: EXP. DATE:
COMPANY:
❑ Certified ro y'is hereby famished. ❑ Certified copy is filed with the dry Building Division.
Date:
Applicant:
EXEMPTION FROM WORMERS' COMPENSATION DECLARATION:(pus section need not be completed if the pemet is for one hundred (5100) or less).
I cenlfy matin 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.
Date: Signature:
NOTICE: if, 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
Which this permit is issued (Section 3097, Civ. Q.
LENDER:
ADDRESS:
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION ADD BAY WINDOWS (24 SQ FT TOT) SQ FT: 24
CLAIM VALUE: CALC—VALUE: 1,624.80 GROUP OCC: R-3 /
COMMENTS:
RfiE*rRERERE� RETIE*+e:ARErRrRE�r*RrRr*+r�r*�+r*RE�RERa*x•�it��RA*x�*sERE�ERERARE*r*sr*Rr+CRE+r*rRARE*RE�E�E��*x�x�*+r*iESEa*RE
Z O N I N G R E Q U I R E M E N T S
S E T B A C K.S
------------ MAIN BUILDING ---------- ,--------- ACCESSORY BUILDING =--------
FRNT; 17 FT 6 IN REAR: FT IN FRNT: FT IN REAR: i FT IN'
LEFT: 14 FT 6 IN RGHT: 4 FT IN LEFT: FT IN RGHT; FT IN•
PARKING REQQUIRED: PARKING PROVIDED: PARCEL: 42621506 ZONE: R1
PLANNING NOTES> OK TO PROCEED FOR 2 BAY WINDOWS
M MMMMMM MM M M MM MM MM M M M MM MM,MMMMMMiFMMM MMM M M M M MMMMMM MMM Mie MiiMMM MMMM M MMMMMM♦E iEM M MM M MMM M
D E V E L 0 P M E-.N'T S E R V I C E S R•E Q U I R E M E N T S
L
ZONING APPROVED BY l ? T DATE;11-3--1
BUILDING•APPROVED BY DATE:
APPLICATION ISSUED BY: DATE:
MM MM MieMMMMMMMMMMMM MM MM. MMMMieMM9e iE iE#P�%il/RS�iF ie M9F�F1f iE
ik Mie MieMMMMMMMM MMMMMMMMMMMMMMMieMMMMM MM MMMMMMMM MMM MMiEM MMMMMMMMMMMMMMMMM MM MMM MieMM
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: Ihereby affirm that l am exempt from the Contractors State License Law for the following reason
project
- 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, aper, improve, demolish, or
PERMIT
39.00
repair any structure, prior to hs Issuance. also requires the apNicant for such permit to fee a signed statement that heJshe is licensed
.50
SM I P / NON
—R E S
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000( of Division 3 of the Business
and Pralessims Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
PLAN
25.35
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
ISSUE FEE
Iny
I, as owner of the propend 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 — — — — >
39.50 0.00 25.35
64.85
64.85
-
does no apply to an owner of a property who Inside; or improves thereon, and who does such work himself/henell ar through
.00
his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or
improvement is sold vnthin one year of completion, the owner will have the burden of proving he/she did not build or improve
REVENUE DIVISION
TOTALS--> COLLECTED:
64 .85 OVER/SHORT;
00
for the purpose of sale).
BLDG PMT
PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT
GRADING
PLAN—CHECK
I as owner of thep ropeam exclusivel contracting with licensed contractors to construct this ro ect (Section 7044 Business
39.00
.50
25 35
nd. y
❑ and Professions Code: This Contractors' State License Law does not apply tW owner of property who builds or improves thereon
and who contracts for such protects with a contracto((s) license Dursu to the Contractors' S L as Law(. m aware
that proof of their Worker's Compensation insurance should be prow ed to e.
I am exempt under Section:7 0 4 4 B. S P. C.
for ihis reason: NOT REQUIRED /
Date: F1� ! "J Dine CJ
I do hereby cenity that I am aware of and understand the requlremnis o Cablo Hid Safety Sections 25505, 25533, and
25534 and that I or any future building occupant wilVwi11 rrot (circle one) eed t imply wi said state codes and the requirements for a
permit for construction or modification from the Air Gush Managamen Dis ct. Residential construction applications are exempt from
Data: Applicant
herby cenity That I have read this application and elate that Ih Ova Int W,corrI. CE io compl r allCity and county
ordinances and state laws mlating to building construction and eby aut e' rf I to ente the above-mentioned
property for inspection purposes.
Date: 11 3 I Signature:
License or Social Security N:
-�• .mvenue; Goldenrod—Assessor
M MMM M M M M MMMM M M M M M M MMMMMMMM MM MMMMM M MM Mie Mie Mie MiE M M MMM MM M M M MM MMM M MMMM MM MieMMMMM MMM MM M
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 24 DWE—TYPE V—WOOD FRAME —GOOD 67.70 1,624.80
END OF FEES
,A
Aid
--
OOL & SPA
CONSTRUCTION AND PLAN�'I C'
Date
Inspector
Date
Inspector
APPROVALS _P,o---•••'
APPROVALS Permit #
1. Temporary Electrical Service or Pole
52., Pool & Equipment Location - -
- "•
2.�Soil-Pipe-Undrgrnd. ,
53. Steel Reinforcement - -
~•
--3-Electrical CondYii Utility-Undrgrnd.
54. Forms -
.--
�'4 Electrical Conduit-Undrgrnd.
55. Electrical Bonding
"' ;5.`SteeY ReinforcemEtt��f•
rJ
56. Rough Plumbing & Pressure Test"'
L�E1 ctrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
'-• 7. FootingsS[��e•
u i g�
�j�--
58. Electrical Conduit-Undrgrnd.
v
8. Foundation
59. Gas Pipe, O-Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
-
61. APPROVAL TO DECK
11. Property Sewer Line& House Connection
62. Backwash & Receptor -Final
-
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains ,;;
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final 11 •�
,
15. Rough Electrical -Conduit
66. Solar System -Final '' '•
16. Rough Electric -Wring
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. REQUIR�MENZ,
x
APPROVA_LS)r.=Perrnit # -
20 �Rorth Fact oi,Y Fireplace Sr
x
Cx +:
2L^Duffs, irt,7StriictuTe '• " y
i
X70. underground Hydro x
rt.
22, -Duds, Qent.lating, ::
:r ^.
H c:x x:471.
Product-. O_G_as 6011
_;�
ping
23.'Gas Pipe RoPh & Test
=
< " �
X72, Underground Flu -5p, x -
24"Roof Framin• .r. -•--• �•-•
_ 9 x -:*1
_ _
x s
ryY. k'
_ - ageJa x
•.73-Undergrnd. Storage:Tank:O Gas O CF
^747,Merbiacl
25.Sheathing `= = �`• '
l(i�
r K
Hydr62-
_Roof
_
26„T -Bar Ceiling (Structural) &"1Ylorrocoat z
75^Dry Chemical
27. =Frame and Flashing: :1 --
r- ^
>' t -x *
76. Dry Standpipe
-_`,28. Lathing'&Siding x'.� ���'
,-
77yFIXEDSYSTEM FINAL-.
,
Insulatione. ` Q
(j,
78 FIRE .REV. FINAL -
_29. _,
^30. Drywall -Nailing r -ti-
)^ HEALTH DEPT' REQUIREMENT
=31. Plaster Brown Coai = -t"
-79. ✓FINAL INSPECTION
-
-:c
32 F
80'yFOOD CERTIFICATE ISSUED-,
•e<
-r
33sFina1 Electric, x ���
•'
<�'
Nofes: '= -1 M. ) 17 =^`<
_M;__
-
•yg'.
is
K.34-'Finai He_atin,& AirRConditiornng tiK
)
v 7
;.
. `' -' `-'�
35^Firial Gas Pipe -Tests C),-.-",
x ,-�
�" kr: a
,^_ jam• e
-036.-Ho'Fd d or, Cana '
PY
a'
1:4,°
z n
_ . r C, 77
.37. Final Factory Fireplace,-,
'-138_Final Plumbing-
td39.'Water Service;Final:
-
I :•i: .-
-. 9 r
_
`"40. -Gas Service -Final + ^
''tJ
.W .'Solar Domestic -Final' r ;.7
•
* `�
.« t
-• 'w7 c x %.
-
42. Backflow Ptyventet'; t'�
X
i
- > x r
43. Backflow Irrigation'.
r-.
X44.IrrigationSystem: `� ao
'q
^x
a: _-
l CJ s c
_Landscape
E '-
`45lSound Qttenuatiort ^1 •• •• c
-
.q I^a: r
_� t- _ < =C
_46. -Handicap Regulations'-
�_.3477FIN-AL STRUCTURE & BUfLDING-
48:=FINAL PLANNING • "'`'
.e
�'* is
r '- -
249",EIe7ctric_Rele5se to�Edison
.''
,
•50.` -Gas _Release to Southern California Gas CD
- =
S :mac f•_. :� -
t-51. CERTIFICATE OF"OCCUPANCY
x
J ^
No Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
C1T1(OF COSTA MESA CONSTRUCTION PERMIT �T
iTojeet Andress 2�3 Z11T
STtZ6ET, COSTn N*5A Cs,
Applicant's Mailin Address SAnnE Q'LJp2-�
Owner's Name NAMES t. K#JoST Phon X14 63f -67L
Address 2i3 ST ST, C: PA . C.p. .
Arch/Eng. License No.
Address
Contractor's Name Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
License Class License No.
Ate Signature
IORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company
eCertified copy is hereby furnished.
Certified copy is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit Is for one hundred ($100) or
less).
certify that In Incperformance of the ark fOr which his p rmII is Its etl I
shall not employ any person in any n r o c �. s the
Worker sation Laws of Calif rn' /
Dale Signature
NOTICE: 1 of r making this tleclarat n,l ou shoobec m subject to the
Workers' Compensation provisions of he Labor Code, you us[ forthwith
comply with such provisions or [hi permlt shall be deemed revoked.
CONSTRUCTION LENDING AGENCY`
I hereby affirm that Mere is a constructslending agency for the performance
of tireor work fwhich this perms is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I'am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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
p file a signed statement that he/she is licensed pursuant to the provisions of
ie Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 Of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
¢rally 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 (Section 7044, Business and Professional Code: The Contractor's
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
employees, provided that such improvements are not Intended or offered for
sale. If, however, the building or improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ 1, as owner Of the property, am exclusively contracting with licensed con-
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
builds or improves thereon, and who contracts for such projects with a con-
tractor(tl license pursuant to the Contractor's License Law),I am aware that
Proof o// their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Ownel
1 hereby certify that I have rea
Information Is correct. I agree to
Signature
Drivers' LI
CMF 0865-46,
SS
I this application and state that the above
comply with all city and county ordinances
8 construction, and hereby authorize repre-
upo lf�_a bove-mentioned propert for
� \ Date 12 22 8;
- Applicant; Pink - Accounting; Goldenrod - Assessor
1 FOUNDATION LI4 STRUCTURAL
PLUMBING ❑ MECHANICAL
OCCUPANCY
VALUATION $___7
CU. YDS. ACRES -1
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type I ❑
Canopy Type It ❑
Refrigeration System
❑0.100.000 BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K
S Left
Ping. Ref. #
Planning Notes:
4927 2/09/6,.
R��nb Zone
Acces ry Building:'
Parking Req./Provided
1
4137E TL
Z
O
N
I
N
G
R
E
0
M
T
S
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15.50 KW
❑ 50+KW
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter ❑over 100 amps
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors ❑0-1 HP ❑1 % - 8
F.A.U.
Ina Solar 119-15 HP 01615+
Fixtures
Microwave
Device Boxes
Pole Light
Outlets
Range
Switches
Sign
Garbage Disposal
Standing Sections
Generator 1:10-5 KW ❑5-15 KW
Trash Compactor
$ 3
Reinspection Fee
$15 1 1 Issue
Fee
MMIM I$ 3
FEES
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved By
Application Issued By
REQUIREMENT
CZr
—Date../—"1
q '
Date 2L
Date
BUILDING PERMI`I`
PLAN CHECK
PLUMBING
PLAN CHECK
ELECTRICAL
PLAN CHECK
MECHANICAL
PLAN CHECK
'7�SUMMARY F FEES
$ �SMIP
�`f PERMIT
S ISSUANCE
25% S ENERGY P.C.
$ GRADING
50% $ MICROFILM
$ TOTAL FEE
25% $
$
$
$
$
$
4 /, 7f
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit#'
Date
Inspector
POOL & SPA -
APPROVALS Permit #
Date
Inspector
.. 1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
'
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
�.8'
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
-
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas []Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
-
33. Final Electric
Notes: 8 �;3
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Cement Coping Optional
Channel Block With 1-3/8¢
Horuonul Top of all
Fences ,
For Fences W or Lou '
Vert. Bars 3/8" Il5 at 4' -0" O.C.
(For Fences Higher Than 5'
Van. Bars 3/8" O at 32" O.C.
Fill GIN Solid With Grout
where Steel Occurs
Reinforcing Steal Shall
Conform to Sec.A-75.39
AS.T.M.
All Steel to he Lapped
24" or to Code
NATURAL GRADE
TWO 3/8-0 BARS
CONTINUOUS TOP
a BOTTOM
HCW,=STEEL MUST BE TIED IN
PLACE AT TIME OF TRENCH
INSPECTION.
TYPICAL 611 CONCRETE BLOCK FENCE
•a
l WIDTP
a SEE CHI
t BELOW
aI
FOOTING REQUIREMENTS CHART
GENERAL -NOTES
MORTAR: One Port Plastic Cement, and
Three Parts Sand
GROUT: One Part Cement Three and
One Half Ports Ssond
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well Mixed 1:2-1/2:3-1/2
Mos. of 7- 1/2 Gol:ons of
Water Per Sock of Cement
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN i
FREE OF ALL MORTAR DEBRIS, ETC.
H OF EARTHTCOTH
1/3 THE HEIGTH OF FENCE
$FLOW BOTTOM OF FOOTING
SCALE: 1/2"s V
WIDTH . . . . . .... ...
14- . . . . .•.
.. . . .14
i..l,�
12"
THICKNESS . .
.10".. . . ..
. ... .10" . . . . .
. . ... . . 6".
e"
DEPTH OF EARTHTOOTH
24'.
.. .. .20" . . .
.. . 16'.. . .
12"
SPACING OF EARTHTOOT .
. 12' .
.14. .. .
..... 16'. . . ..
16'
OWNERS NAME: _ _
Cit of Costa Mesa alifornia JOB ADDRESS - -
Y 7 PERMIT NUMBER'_
Buildina Department SIGNATURE
APU'98170-Vi - 0
City of Costa M'Au' !c iw ept.
BY DAT9-17
THIMc PLANS N:U°T $c ON JOB AT AlL 7{"1cS MAKE
NO CHANGES WITI-1- JT PRIOR APPROVAL OF DEPT.
� 3,2/ y z.
THEHESUANCE UP CRAN.1NG CP q PERMIT Otf .'PPROVAL OF
PLAN: /„^'L' SPE''IFICAT!0n5 SH,I i w--! ZIN'T WED TO BE A
PE N'i” n': R, O: Al,, AvCPtT'AI. r,few"; `l rt;:ni.ON OF ANY OF
THE ^=VISIONS C:F Tt tu, :•O:cn-diVf!SL.+LING TO GIVE
AUTHC.mHY TO V',AAG '.a<'—r:C—n Tr," 7?OViS.OK5 OF THIS
CODE SHALL BE VALID, EhC:'PT 50 PAR AS THE WORK OR USE
WHICH IT AUTHGAQES 5 LAV.FUIL
THE ISSUANC: 0- .A rE7WT BA EL' UPON' PLAN5 AND
SPECIFICAT;O!.'.. SI..ALi F:;T r'Pf.Y°:J'. 'IIiE FUIID!NG OFFICIAL
FROh, THETE—.!L'.' GiGU:ANG IH' C_'I'P.£CTION OF ROR I !
SAID PLANS AND SPECd�Cf.T;C qS OR PROF °
BUILDING OPERATIONS BE:NG CARRIED ON THER J c vHE
IN V40LATION OF TH!5 CODE OR Cr ANY OTHER ORCLNP,�,ji0!
THE CITY. V(/
SCI>Y OF COSAb�A
PLANNING DEPT.
$uSJECT TO SLOG. DEPT. AEG.
D,) I (, d 1 DATE
Y 1J 4 L F- ! 8Y 0"t OA OP PLANNINO
J I M KrMhT
suai
�AIATE
i21 t1,
t[t10[LIC[ tplptMCt
t[tit[�C[
m
L- 213
STREET d
a'ri'le*t e-eHf'
PSI o6w i 4AAI
E� wyl�
FSA
5(e('�
arm
J
I
THIS AGREEMENT, made and entered into this day of
COtAGNJ
948aMies Jar— .
rFrt�G�, 183,, by and between' n
hereinafter referred to as "LAND OWNER", and ►' `}Q 4 Miffs 4AM S kt�o s -r
hereinafter referred to as "ADJACENT PROPERTY OWNER".
It is hereby agreed that a party gall will be constructed on the
property line between Z7--3 4 2gl- ZRE' STYLC�T�
Cos -r», Moot
in the City of Costa Mesa, County of Orange, State of California, as per map
recorded in Book, Pagef Miscellaneous Maps, in the office of the
County Recorder of said County. Tire party wall shall be permitted to encroach
IN WITNESS VHEREOF, the parties have entered into this Agreement the
day and year first above written.
LAND OWNER
[OR
O-OHEO
•2-11 �-. 21st. C®ski Irl
(Address) 9 Z Z�
ADJACENT PROPERTY OWNER
(Signature)
% JAMCS
Name (Typed or Printed)
-Z J3 E lZISf 5k (osier
(Address) me/� _ CA
RECEI V Ep b� 2 2 1987
(NOTE: Please see reverse side for notary's statement)
STATE OF CALIFORNIA )
) ss.
COUNTY OF ORANGE )
On before me, the undersigned, a
and for the Canty of Orange, State of California, personally
known to me
to
be the person(s) whose
names) is subscr
instrument
and
acknowledged to me that
(he/she/they) ex
WITNESS my hand and official seal.
Signature
Name (typed or printed)
STATE OF CALIFOMIA )
ss.
COUNTY OF ORANGE )
On
Public in and for
Public in
to the within
d the same.
(SEAL)
, before me, the undersigned, a Notary
of Orange, State of California, personally appeared
known to zhandaand
the person(s) whose name(s) is subscribed to the within
instrumenacknowledged to rte that (he/she/they) executed the same.
WITNESS official seal. (SEAL)
Name (typed or printed)
THIS AGREEMENT, made and entered into this IS- day of
Iqe;�,
-boc�(-,2 eJL, 1983', by and between M P, 4 mle6 44"" - > i_N0, —%
hereinafter referred to as "LAND OMER", and (o!-ke'd
hereinafter referred to as "ADJACENT PROPERTY OWNER".
It is hereby
agreed that a
party wall
will be
constructed on the
property line between
,n-3
f 2q}
,��A MhA / (Address of Adjoining Properties)
/:
W A (�EWP02t L4 FU3 iT's LOT Zb4 PACCCLA 4L(o'2(5 —DJo • SOIO,
in the City of Costa Mesa, County of orange, State.of California, as per map
recorded in Book, PageU�7of Miscellaneous Maps, in the office of the
County Recorder of said County. The party wall shall be permitted to encroach
IN WITNESS WHEREOF, the parties have entered into this Agreement the
day and year first above written.
v TAMeS `E . ,KQos-r
Name (Typed or.Printed) � . -f
24 3 21`'T 5 t Corm MEs A CA,
(Address) s)
RECt1VE� pEC 2 2 138'
AWACENT PROPERTY OMER
(:�10,_eCL0
(Siglnature4--��
�Nt C�i
Name, (Typed or Printed)
4
rf
(Address)
.4, ...- Ch- RgeL1
RECEIVED ^!7'' 2 2 1957
(NOTE: Please see reverse side for notary's statement)
STATE OF CALIFORNIA
ss.
COUNTY OF ORANGE
On before me, the undersigned, a
and for the Canty of Orange, State of California, personally
known to me to be the person(s) whose name(s) is subscr
instrument and acknowledged to me that (he/she/they) ex
WITNESS my hand and official seal.
Signature
Name (typed or printed)
STATE OF CALIFORNIA )
ss.
COUNTY OF ORANGE )
On
Public in and for th Cour
in
i
to the within
d the same.
(SEAL)
, before me, the undersigned, a Notary
of Orange, State of California, personally appeared
known to me to the person(s) whose name(s) is subscribed to the within
intstrument acknowledged to me that (he/she/they) executed the same.
WITNESS nob hand and official seal.
Name (typed or
(SEAL)
i
ADORES$ OF BUILDING: 2/3 21ST ST
MERSNAMEIFIDmt KNOST'JAMES E
ADDIIEss: KNOST, DEBORAH KAY
273 21ST ST
OSTA MESA,CA 92627646-7671
APPL. MAULING ADDRESS:
ARCNrtECT OR ENGINEER: I.C. NO.:
ARCH. OR ENG.'S ADDRESS: UNIT:
CONIRACTIXI's NAIL: NOCK PLUMBING (714)895-1246
CONIRACTORsl,UBUN011610 SEABOARD CIR
ADDRESS: STANTON CA MIND.: 707775
90680 DMT:
LICENSED CONTRACTORS DECLARATION: I hereby affirm uncle, arlelty d perjury that 1 am keneed mom, provisions d Chapter 9
(mmmencim with Swion ]WO d Davison 3 of the Suainea and Prolawpons Cade, and m license a in full face aft effect.
CITY UC.NO.:05038 "?
CLAS4:C-36 uc. .. 7 75 EXP; 02/97
Dale: Conlnwor.
OWNER BUILDER DE RATION: I Mmby affine water penalty of perjury [hot I am memyl Imm the Comrwo , license Law 1« the
following reason(Section 7031.5 Bueuwas aft I'Messume Code: Any coy or county which requires a permit to aretmm, after, improve,
damohm, or repair any structure, pior to he iaaena, also requires the applicant for such p«mlf to file a signed statement oral M «aft
b livened porsuem to the provision; d the Contract. Licenaa Law [Chapter 9 (mmmeodog vrh Section 7000) d Division 3 d the
Ba,lrre59 and Prolaaiors Co* «IMI M «aft o eaempt thermom and the basis for the alleged exempt'.. My violation d Swan
7031.5 by wry applicant t« a Permit subjade the applicant to a civil penalty of not more than five hurdrad doMre Rs77j).
I, m o ere , of the property m my empldyen woh wages as their sole compensation, will d0 the work, and the etmdum is not intaeded
«offered for seb (Section 7044, Bu inm wool Professions Cade: TM Common Lianse Lawdo m not appy loan ower of property
who Miers or improve; thereon. and van dale eudn work himself «hereef «through his or her own emplo mr , prodded that aucb
impraemmts act not intended or offered for Bale, ff. however, the buiNirp « inpraemenl u acid within one year of completion, the
ow 4mid« will have IM Mrden of proving M or she did w build or improve for the pmpone d sale).
I, n owner of the prnpemy, an, eedusireM contracting wfh licensed commolom to construct the Project (Section 7044. Business aft
Professions Coda: TM Contractors Licence Law does not apply to an career d nproperty who build, or improves th«M w
eon arho
contracts lor sudr profess wilh a amrwor(e) Roamed pursuant to the Contractors License Law).
I am exempt order Section: B. 8 P.C., for this nesson:
Date: _ Ower,
I do hereby artily that I am awns of aft ureestere the requirements of California Health aft Safety Code Became 25505, 25533, aft
25531, aft that I or any future building omipant will / wit not (once me) need to comply such said orale codes and the requirements for
a pemf laanmMion« mcol6olionhomlMA'a ray anagement Di W.Rao« ialmmrwioneppiraliora n mptlmntMa
proviaim.. -
Dae: Applicant:
WORKER'S COMPENSATION DECLARATION: I hereby alfiml uMer penally of perjury ons of the foliowop dwempion:
I have are wit mdmae a a0i/oale d or erhi h thi. name er w«k«a' canpenaaton, n provldad 1« by Section 3700 d the labor
Code, l« the pedom.ce of 7ne work for wrych the pamf is issued.
] hove are wilt
wmaimeMyr it is mes' anon inurace, n required ler Swion 37D0 d Na Labor Cotle.1«the penormana d the
work for which alfa permit ts ad. MY woM1e«;�pgoygHigq yuurg{rq remecerrd pdkY "on' ea: EXPIRES
dwicy Numbest NPICU 32 t4tOt 09/01/97
(This swim need not be completed f her Perms is aur one hmohmd dollars 1$107/ or Isar)
1 anfy the in Ihe pedmnaca d the work i« which Chia pemk a issued. shall rho eLnpby any person in wry manna eo as to
become subod to tDO wwkae'/grnpenalon eves of Cailomie, m4,egrft mat A ld became abject to the norms,
Wamin9: F.du« 44e a a main' ever anawl o co.V I. unMwTr.ne,n.u.rtll,cr en mrproya to admhhal
nM Arm, rpt W «r, hundred thousand Miare ($10470,11 In addltlon W rhe cost or companndar, damages . pnvMsd ror In
Secdon 3708 of the lapor Coda, Inr«e,t, and 4MM.". fan.
CONSTRUCTION LENDING AGENCY: I hereby Wim under penalty of perjury that Ihsun ere e a come ending agency f« fire
performance of the work ler whioh the pemo ie sauced (Section 3097, Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I caddy Iha I have read the appl'caim and dole hat be above information is cones. I a9me to campy a th all dry and aunty ordinanaei
and were lens relating to building construction and hereby au7crae representatives d this city to enter upon the above-mentioned property
for Inspection Purposes. RO NOCK
dnl Nams
V
Date: —✓ ��
Signature of CeamdAgen Appiaant/Conuwor
(51514g.WP) WhMAuildig B Salary: Grow,Fe: Cavry-Appicent:
CITY OF _COSTA MESA — BUILDING PERMIT
PERM NO: P 081709
PERMIT NO: Pr 081709 PLAN HECK/NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERrIT
JOB DESCRIPTrION : C/O DISHWASHER
CLAIM VALUE: CALC—VA UE
COMMENTS: NO OTHER WORK AUTHORIZED B
iE iElE 1F RE**fE iE lF dE iF if*1F iE 1E iE 9E**if*****tt 4E 9E BE if*iE YB
Z O N I N G R
S E
iTYPE: PLU_ PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
HIS PERMIT
df * 1F fE BF lE 1E iE 1E lF * iE 1F 1E iF RF iE * iE * 1E 1F 9E 1E lE iE K dE iF * * iE iE 1f * iE lE 9F fE dE
Q U I R E M E N T S
A C K S
------------ MAIN BUILDING -----------1 --------- ACCESSORY BUILD.ING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 42621.506 INE: REF NO:
PLANNING NOTES>
1E*5F 1t iE IF 1F iE*iEfEdF iF**1flflE lE 9E RE IE*iE Rf of iE iF lF if iF iE iE 3E iF**iE 1E***kiF dE iF**MiEk*fE kdE 9E iE dE SE*9E**iE*9E 9Ek*iE*iEiF it strtklE iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY DATE:
APPLICATION ISSUED BY: DATE;
1F 1E*♦E*fE 9E iEM if iEM*dF lE*iE*3E iE if 1E 9E 1EiE iE 1E iE 9F**iE fE1E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 8,75
258 SMIP/NON—RES
PLAN
ISSUE FEE 22.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS--- 8.75 22,00 0.00 30.75 30.75 .00
REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30.75
N1EN9E***lE 1E kfE iE lE**1E lF lE*1E *iF iE SFMM iE fF iE SE dEkif dFlF%1f fF*dFN SEM IE***lF iF 1F*iF iF 1f*!E*9E IE 1E 3k iE 1E if RE fE 9E 9E lE dE iF iF**dE iFk9F 1E
I N D I V I D U A L F E E B R E A K D O W N
TVpR .QTY D E S C R I P T I O N
PLU 1 DISHWASHER
END OF FEES
XPIREDD
UNIT COST TOTAL COST
8.75 8.75
n DSII.. ..
FF3 26 1997
,I ry OF COSTA MESA
CONSTRUCTION AND PLANNING
APPROVALS Permit
Date
Inspector
_ JL & SPA
APPROVALS Permit #
Date Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
- -
53. Steel Reinforcement
I -Electrical Conduit UtilityUndrgrrid.
54. Forms
4. Electrical Conduit-Undrgrnd.
-
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6.^Electrical LIFER Grnd.
57, APPROVAL TO COVER-GUNITE
7, -Footings
58. Electrical Conduit-Undrgrnd.
• B. Foundation -•
59. Gas Pipe, 0 Undrgrnd., Test
1
9. Water Pipe-Undrdrnd.- -
60- Backwash Lines, P -Trap, C Undrgrnd,
10. Structural Floor System '
61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final t
12. Sewer Cap - I
63, Heater & Vent -Final
13. Roof Drains
64- Plumbing System - Final,
14. Rough Plumbing
65. Electrical -Final i
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 j
69. POOL/SPA SYSTEMS FINAL ,
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT _
APPROVALS Permit #
20. -Rough Factory Fireplace - -
_
=
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
-
71. Product Piping n.Gas 0Oil
23..Gas Pipe -Rough & fest -
-
-
72. Underground Flush -
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas ❑ Oil
25. Roof, Sheathing
74. Overhead Hydro`
26. T -Bar Ceiling (Structural) & Monocoat
-
75. Dry Chemical -
27. Frame and Flashing
-0
76. Dry Standpipe - -
28. Lathing & Siding- -
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE-PREV. FINAL
30. DrywaIPNai ling -
- - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat -
79. FINAL INSPECTION
32::Electrical Power Meter -Final
-'
60. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: - - --
34. Final Heating & Air Conditioning-
35.'Final Gas Pipe -Test-
36. Hood or Canopy
-
37: -Final Factory Fi eglace
38. Final Plumbing -
-'
39. Wafer Service -Final' -
-.
40. Gas Service -Final --- _
41. Solar Domestic -Final
42. Backflow Preventer
z;
43. Backflow Irngat;on -
-
-44. Landscape lrrigatlonSystem
- 45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BU1•LDING
Y48.
FINAL PLANNING
ca
49. Electric Release to Edison.
50. Gas Release to Southern California Gas Co
-_
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 273 21ST ST UNIT:
`G" REF'S NAME: KNOST JAMES E
ADDRESS: 273 21ST ST
COSTA MESA,CA 92627
ARCH/ENGINEER: 631-0769 REG.NO.:
ADDRESS: UNIT:
PERMITTEE: JAMES KNOST (714)631-0769
ADDRESS: 273 E 21ST ST
C.M. CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Beal and Professions Code, and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure ora certilicate of Workers'
Compensation Insurance, or a certified copy thereof (Section 3800. Lab. C).
t1LICY NO.: EXP. DATE:
COMPANY:
Codified copy is hereby furnished. ❑ Cenifled copy is liked with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORKERS* COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred (SIOO)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 co as to become
subject to the WorkersCompensation Laws of California.
Date: Signature:
NOTICE: IL alter 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 tot the performance of the work for
which this permit is issued (Section 3097, Ci, CL
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the foddering reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (3500).
h 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 (Rection 7044, Business and Professional Code: The Contractors' State license Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Cantractws' Slate License Law does not apply to an owner of property who builds of improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' Stale License Law), I am aware
that proot of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under //� Section: B. 8 P. C.
for this mason:
/
Date: ✓ L O / Oconee
I do hereby certify that I am aware of and understand the requirements of Cali rni Health and alely Code S c ns 25505, 25533, and
25534 and that I or any future dancing occupant will/will no (circle one) need 0 c mply with said stale codes and the requirements for a
permit ler construction or modification from the Air Ouald Management Di. ri . Residential construction applications are exempt from
these provisions.
Date: Applicant: _
I hereby certify that I have read this application and tate lhM
ordinances and sial laws relating to building erns clidn ori l
property for m pe ion o/—Slduray$:m/ilile�ss C
Dale. _L _[ �l_1 ignature: _
Dowers license or Socr
with 4 city and
1541.46 white—building: ureerri Enforcement: l:dnary—wpprmam: nnr—nevenue, amuemw—naamw�
CITY OF COSTA MESA — BUILDING PERMIT
?ERMIT NO: B 053804 PLAN CHECK NO: 03480-91 S
:ONSTRUCTION TYPE: PERMIT TYPE: STR
PERM NO: B 0]-�
GOVT: N SUPP: N /
PURPOSE: ALT
JOB DESCRIPTION INSTALL SKYLIGHT IN KITCHEN, SQ FT: 600
=LAIM VALUE: 600.00 CALC—VALUE: 600,00 GROUP OCC: R-3 /
=OMMENTS: ICBO#NER216
f K 1E 3F * * 3E 3f M 3E 15 iE i5 iE iE iE 3f iE N 3F 1EfE 1f * iE iE 153E 3E 3E iE * if * 1f 1E fE 3E 3E iE * 3E3E * 3E iE3E 3E M 3E 3f 3f 3E fE iE 3E .)E * 1F1E 3f 1f M 3E 3E fE 3f fE3E * 3f 3f 3E 3E * if 3E fE M
Z O N I N GS E R T E B Q A U C I K R S E M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
?ARKING REQ: PROV: PARCEL: 42621506 ZNE: R1 REF NO:
?LANNING NOTES> ADDING SKYLIGHT TO EXISTING KITCHEN OF SFD.
>
IF 3F iF iF 351F iE iE iE 3E 3f 353E 3515iE*3E 3E 3F 15153E fE 35 fE 3E 3F 3E 3F iE 3E 3f 3E 3E*1E*3f 3F fE 3E lkfE fE*1F*k1F***♦f iE iE 3E 1F*1F 3F*3F 3f *3E 1E 3E 3E *3F 3F 3E iE 3E *35 K3f•
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
9PPLICATION ISSUED BY: it"17 DATE:
f if 3E if fE iE ♦E 3f 3E iEif 3E *fE 353E *fE iE fE 1f 3E *iE 3E3E**fE fE fE 3f k3F
f1E 3f *3E 3F *3f 15 iE iE 3E iE 3E iF if **3E 3E**kkit3E*3E*it**3E3Ek 15 kiE*3E 3E 3E*fE*fE***3f 3E3E 3EfE*3E 3E*3EiEit*fE 3t 3E 3f 3E*1F*iE 3E 3E 3E 3E 3E iE*3E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 17,00 ,50
SMIP/NON—RES
PLAN 11.05
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 17,50 0,00 11.05 28,55 28.55 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 28,55 OVER/SHORT;00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
17.00 .50 11.05
IE M3f iE 3E 3Fk k3F iEk 3EitfE**3E iiiE 3F 3t if*3E it*if 3E 3E 3F k3E 3E 3t if 3f 3f**k*3E*iE 3f iE**3E*it*3E 353E*k*fE3E 3F*3E*****3E it 353E it iE fE 3E 3E 3f*
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O." UNIT COST TOTAL COST
SFR 6 0 ALTER BY VALUE RESSiSENTIAL NOZONE 1,00 600,00
END OF FEES
Exv►aE
C1 00,39677-
AND PLANNIN(>�
SPA
CONSTRUCTION
,PPROVALS 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:;XElectrical Condit l�t:jlity-Undrgrnd.
54. Forms
d.. Electrical Conclq'1 Undrgrnd.
55. Electrical Bonding
_:5.;8" 1 FFtinforce'ri6t
56. Rough Plumbing & Pressure Test ,
s
�nBlectrical UFE.fj�`Grnd.
,
57. APPROVAL TO COVER-GUNITE'
ry
�'T. FSotings
•
58. Electrical Conduit-Undrgrnd.
2
Foundation
59. Gas Pipe, 0 Undrgrnd., Test
cc
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd,
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Ling-,& House Connection
r
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 ElectriQ-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
_3.
Petit
n4PPRQVAL'S:;.J=M
20.`lRou9h F,bctory Fireplace ' �r n �' =
- `•
21.TDuc'Y5, irk-$tructu e;
&hderg' untl; H4ro
;70. x
22. Ducts, Ventilating r,_
'v
S �'-
'n
y71. Prod uctTP.t in acs OsDil
_ 1.
v
23.L(,>as Pipt!'Rough &'Test ryg
c
i'* -c
-72. Undergrr-du_ntl FI`u�t*_,
t„ s
24.1Rodf Framing• - ,: - "-
, > p
.- ''.. ,•
J73TUndergrndc Store�eTank []Gas' 0 Qtl
25. Roo„Sh! ing = w
r
^ ;?� 7
�74'pverhead•Hydro.j= ;.
26., -Bar Ceiling (Structural) &,-61onocoat <
x _ w
- twr 'R
75mDry Chemical + . -Z, ct
27.-frame and Flashings ?_'•f/�O�.p2
/� i�J/ x
76. dry dant (pe �: n
28. 'Lathing & Sidin i
9 r -lxrX. crr
i;
••.0 „
77.T FIXED SVSTEM:PaNAL-u v
?Q -•�
_
>29. Insulation
7"r
r
]$FIRE PREY. FI(UQL>
'f
t9
530. Drywall Nailmg
V
x
1 HEAL-6hDEPT REQUIR ERY
_31. Plaster Biowp Coat` '
='
I ' t
79rFINAL 1,'PECTIaN -T
« -
r a.
t*
_
32:-Electrical Power Mate;-Final
CERYIF16¢TE ISE15ED-
. a: I
, x
r80rr;F00D
EI'ectric
riNdf>;s:
-,-33.tine1
.,34.-FinSi Heating-& Ai` i}Conditi on in%
*
iK
t,
r
x
S i . z: x S'
35."Finai Gas_ Pipe-Test**
I
-
Y-
36. HooJ or, Canopy
Fai'tory Fireplace_
_37.CFinat
z
r
I t»
Cl
Final Plumbing r
Y
;� �� '., nl J
_38.
I
.,39.' Water Service-Final gin':
'}
I (~ 'a
✓in x' u• -
>. >
040'Gas Service-E(nal •$
.q � '� ytn r%' S
:rt
�. Y
1
``'' ' � `"
� .> •JCI d
591 Solar Domestic-Finals %� •.*•
�
i tx
.-Cry
: i
s
T r
`42! Backflow Preventer
43. Backflow Irr�ation.•
Ti- o -
44. Landscape litigation Syste ' 'r:
'F
' '
' } '' 0
s45.�ound Attenuation ?+
5' t-
n
tr [
tt> tn. a
r. �• 4.
C46. Handicap Regulations
J
:r
* R
r, LV t7 ti a
'47..FINAL STRUCTURE & BU.fj-DING
.
>
` klu
I.
48 F`FIN=AL PLANNING' n':
I
r t
p
k}
t "C
:49 .'L,Eleo ric Release to Edison
� •r p
-50. GaselEase to Southern California Gas Co
X51. CERTIFICATE 01 OCCUPANCY
1 0. Date
DJECT ADDRESS:UNIT:
KEN'S NAME: 273 21ST T
273 2 JAMS E
ADDRESS:
273 1ST ST
COSTA MESA,CA 92627
ARCNIENGINEEfl: 631-0769 REG.NO.:
ADDRESS: UNIT:
PERMITTEE: JAMES KNOST (714)631-0769
ADDRESS: 273 E 21ST ST
C.M. CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing valid Section
7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure or a certificate of Workers'
Compensation Insurance, or a certified copy thereof (Section 3800. Lab. C).
POLICY it EXP. DATE:
ICOMPANY:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division
Date. Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(SI00) 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 WorkersCompensation Laws of California.
Date. Signature: ` I
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
which this permit is issued (Section 3097. Civ. Q. _
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the hollowing reason
(Section 7031.5 Business and Professional Code: Any City of County which requires a permit to Construct, alter, improve, demolish, or
repair any structure. prior to its issuance, alto requires the applicant for such pound to file a signed statement that heishe is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 0l the Business
and Professions Code) or that draftee is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant lar a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($al` 10).
I. as owner of the property or my em levees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work 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
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).
I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ antl 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 contractogs) license pursuant to the Contractors' Slate License Law). I am aware
that proof of their Worker s Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P.C.
for this reason' ? 1//
�j/ � _ ltd
Date: T �6 7l -- Owner:
I do hereby certify that I am aware of and understand the requirements of ldor la Health nd Safety Cotl Sections 25505, 25533,and
25534 and that I or any future building occupant Coil ll not (circle one) ed Comply with said state odes and the requirements lot a
permit for Construction or modification from the Air uality Management - trict. Residential construction applications are exempt from
mese provisions.
Dale: Applicant:
I hereby cerlily that I have read this application and stale that the owe information is correct I ee to camp th all city a9� county
ordinances and stare laws relal�g to builtling �onshuction apd ereby ho� epi se was s y ro en n the at ove7- mtione.
property for inspetri perp es. (//�j�
Date: % Signature: L
Driver's License or Social Security x:
1641-46 Whue—Bmlding; Green—Code Enforcement; Canary—Applicant; Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 056610 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE
JOB DESCRIPTION : INSTALL SKYLIGHT IN KITCHEN,
PERM NO: E 05661 \
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
COMMENTS:
E3eiE9IEiCEBO#NERI*6IE�EREE:#B53804
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN
BUILDING
----------
---------
ACCESSORY
BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT:
FT IN
REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT IN
RGHT: FT IN
PARKING REQ•
PROV:
PARCEL:
42621506
ZNE:
REF NO:
PLANNING N TES>
>
iP ifkk**it iE********dE iF*kip*iE
it•**iFiP*iEiE*iE SE**iE*k*kiPit stir it**kik
k Bf iE iP*it ik iE*iP**resp
*BF ick*iE***�E*iE *Bt RE
D E V E L O
P M E N
T S E R V I
C E S R
E Q U I R
E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY; DATE•
3 I�
k itMkkiF iE**#iE ie*iE*Mif ie ie 3Eie* *iE RE RE*iE**9F 8e iFk
kkkBkk kit iE kie k ieM Mif ie Rewe Re ie klflEk ie*le*kkie Re rase kRE Re ie****Rase Be rase****rase*****iE iEie Re Re *ie ie**ie Rete*ie ie Re ie ie RF ie
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 9,75
50t SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 9,75 15,00 0,00 24,75 24,75 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 24,75 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24.75
k Mif iF iF ie lF M ie iE SF kiE 3E*kIf*M***iF*kIE*Be M SF ie iF+eie ie*Re iek if***ie****IE Rek*4t*Re Re Re*OE BE*Re *Re ie fE ie Be ie Reie RE ie *ie ie Re Be*
M�+�OMIlf-k�SpC�tian�
I N D I V I D U A L
F E E
B R E A K D O W N
TYPE
QTY D E S C R I P T I O N
UNIT COST TOTAL COST
ELE 41
11 FIXTURES LIG MING 1
ST 20
EA, 75 8,25
ELE
2 RECEPT/SNITCH ! 1
ST 20
EA, ,75 1,50
c X P i R E O END
OF FEES
M�+�OMIlf-k�SpC�tian�
A. .CONSTRUCTION AND PLANNING -
APPROVALS Permit #_
Date
Inspector
f, _ & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Sgil Pipe-Undrgrnd,-
53. Steel Reinforcement
3.' Electrical Conduit{ltlllty-Undrgrnd.
54. Forms
4.' Electrical Condt)it-Undrgrnd.
55. Electrical Bonding
:.`f. Steel ReinforceTent
56. Rough Plumbing & Pressure Test
'Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
--`7. Fgbtings
58. Electrical Conduit-Undrgrnd.
-
8. Foundation -
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
cr
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electrid-Wiring
/'-/-QL
N.
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18, Rough Electric -"-T Bar Ceiling
69, POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVAL'S- Permit # �'
20_•Rough Factory FS�replace ' -
-
-
21.~bum, in-Structur`e,. � . • -�
--
-- a
30. Underground Hydro
22. Ducts, Ventihating•
`;/1. Product.Piping 01G5s Obil
X
23.;taasPiWRough&'rest
-
;,
72. Underground Flush --
24. Root Framing
'!73.tUndergrnd. Storage Tank O Gas 00il
25. Roof Sheathing
9 -
�74. Overhead Aydro--
'
26rT-Bar Ceiling (Structural) &-Monocoat
75.'Dry Chemipal ' -
4 e:
27. 'Frame and Flashing X_
28 -Lathing.1 Siding,
t
>
r. _
76. Dry StandpiRe
77.= FIXED SYSTEM?FINAL•
29. Insulation _ "
I ;
78. FIRE PREY. FINAL r
y
.30. Drywall Nailing
HEALTH. -DEPT. REQUIREMENT a
_31. Plaster Brown Cdat, _
79. FINAL INSPLCTICjN
-32. Electrical Power MeteC-Final'•
*80. FOOD CERTIFICA-TE ISSUED
33: :Final Electric r
'• r
I
-Notes: - -
34. Final Heating`.& Ai r,Conditioni�gs
,
:.
• L� : n
35. 'Final Gas Pipe -Test'
-
r
_36. Hood or Canopy - - -
_
�
i �- ,.,D
-37.-Final Factory Fireplace ` `
-38. Final Plumbing-
_
.39. Water Service -Final =
i
- '
r
'740. Gas Service -Final y -
-;�31. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation,
-
-44. Landscape Irrigation System
-
45.. -Sound Attenuation
n
m r
f +
46: Handicap Regulations
47.,FlfrALSTRUCTURE &BUILDING
48. FINAL PLANNING
,
49. -Electric Release to Edison
50. .Gas Release to Southern California Gas Co
,- -
.51. CERTIFICATE OF OCCUPANCY
No. Date
"
11067CT ADDRESS: 2 7 3 2 .I. ST ST
owNER's Hilli J Am, R 1 ill T'
aoDREss:2'73 2'I.ST ST
COSTA MESA
CA 9'2627
UNIT:
ARCHIENGINEER: BEG.NO.i
ADDRESS: UNIT:
PERMITTEE JAMES KNOST ( 7.14 ) 631 -0769
ADDRESS: 273 21ST ST NONE
COSTA MESA CA 97.627
LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.,
CITY LIC.: STATE LIC.: CUSS:
late: Signature:
ORDERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
compensation Insurance, or a Certified copy thereof (Section 3100, Lab, Cl,
POLICY NO.: EXP. DATE: ,
COMPANY:
❑ Certified copy is hereby hindered. ❑ Certified copy is filed with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORXERS' COMPENSATION DECLARATION: Qhis �ccoon eed not be complatgd if the mit is for one In red ($100) or less).
I certify that in the performance of the work for which this permit Is is2 d, shall not on oy any is n in any on so as to become
subject to t`he1Workers' Compensation Laws of Califomi /
Date: NGif 19, Signature: /
NOTICE: If, after making INS declaration, you should become subject to'6e Workers' Compensation provisions of the Labor
Code, you must forthwith comply with such provisions orlthis'permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that the`r s a construction lending agency for the performance.of the work for
which this permit is issued (Section 3097, Civ, Q.
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Cotle: Any city of 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/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
-rid Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
r applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
1, as owner of the property or myemployees with wages astheirsole compensation, will do the work, and the
El structure is not intended or offered for sale (Section 7044, Business and Professional Cade: The Contractors' State 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 employees, provided that such improvements are not intended or offered for sale. If, however the building or
.Improvement is sold within one year of Completion, the owner will have the burden of proving he/she did not build or improve
'for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Cotle: The Contractors' Slate License Law does not appy to an owner of property who builds or improves thejeon
and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law).'l am 333wwware
that proof of their Worker's Com pensation'insurance should be provided t me. /
® I am exempt under Section:'7 0 4 4 B. &P
for this eas�o/n: , NGOTT RE U.IRED
Date: QV w Owne.
)A6� —
I do hereby cerh that I am awar of and understand the requirements of California Health and Safety Code Secti ns 25505, 25533, and
25534 and that I or any future building occupant will1will not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District., Residential construction applications are exempt from
these provisions.
Date: Applicant: —
I hereby certify that I have read this application and state it
ordinances and state laws relating to building constructbn an
property of ins an purposes.
Date: O It Signature: _
Driver's License or Social Security A:
is correct. I some to comply with "tv and
Pink—Revenue _ Goldenrod—Assessor
CITY OF COSTA MESA BUILDING PERMIT PERM NO: E 045159
I
PERMIT NO: E 045159 PLAtl CHECK NO: N GOVT: TI SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: ELE PURPOSE: NEW
JOB DESCRIPTION : ADD ELECTRICAL FIXTURES/OUTLET SQ FT:
CLAIM VALUE:• ` CALC--VALUE:' GROUP OCC: R-3 /
COMMENTS: Sp Q
Z, O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING -----'---- ----- --'- ACCESSORY BUILDING---------
FRNT: FT 'IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: -FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42621506 ZNE: REF NO:
PLANNING NOTES>
###############################################################################
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY _
DATE:
BUILDING APPRC)VED BY :
APPLICATION ISSUED BY:
DATE-
DATE:
LEGALIZATIONi N
F' E -E STMMARY
STRUCTURAL SEGMENT: N -' ,
BLDG PMT PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/RES GRADING
PERMIT
3.75
50t
SMIP/NON--RES
PLAN
ISSUE FEE
1.5.00
BUILDING -DSV-> PERMIT
ISSUEPLAN-CHECK
TOTAL PAID DUE
TOTALS ---- > 13.75
1.5.00 0,00
1.8.75 18.75 .00
REVENUE DIVISION TOTALS-->
COLLECTED:
18.75 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC
MECHANIC FIRE
.SMIP/TOT GRADING PLAN -CHECK
18.75.
I N D I:V
I D U A L F E E B
R E A K D O W N
TYPE QTY D E S C R
I•P T I O N
UNIT COST TOTAL COST
ELE 4 FIXTURES,
LIGIiTING 1 ST 20
EA. 15 3.00
ELE 1 RECEPT/OUTLET
1 ST 20
EA. .75 -75
END OF FEES
01 00048351-00058351 TOT 18.75
DATE: 11/28/89 TIME: 11:26 ��
.../ice
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement _
3. Electrical Conduit Utility-Undrgrnd.
_
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
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
APPROVALS - . Permit # -
20. Rough Factory Fireplace �
�
-
21: Ducts, in Structure-
70. Underground Hydro
22. Ducts, Ventilating
-
71, Product Piping O Gas ❑ Oil
23. Gas Pipe -Rough & Test --
r
-'
72, Underground Flush
24. Roof Framingzz73.
Undergrnd. Storage-Tanl<Z Gas ❑ Oil
25. Roof Sheathings'
+
74. Overhead Hydro
26., T -Bar Ceiling (St gctural) & Monocoat
:.
75. Dry Chemical
27. Frame and Flashing
•'
76. Dry Standpipe -
28. Lathing & Sidingv
77. FIXED SYSTEM FINAL-
INAL29.
29.Insulation -
_
78'. FIRE PREV. FINAL
30. Drywall, Nailing
-- HEALTH DEPT. REQUIREMENT
. 31. Plaster Brown Coat
'-79. FINAL INSPECTION -
. 32. Electrical Power Meter-Final
80..'FOOD CERTIFICATE ISSUED _.
33. Final Electric
Notes: r '
.34. Final Heating & Air Conditioning
_•
- -•
35. Final Gas Pipe -Test
-�•
_
-36.. Hood or Canopy
�•''
-37. Final Factory Fireplace
I
.38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final'
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
-47.-FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -
-'-
49. Electric Release to Edison-
- 50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF,OCCUPANCY
No. Date
.Ti701I315i
JOBADDRESS
E. 21st
DA
BUILDING PERMIT NO.
l
ERAL CONTRACTOR Max W. Pope, Inc. VALUE 510,824.00
LOT AP# 118-1110-22 BLOCK TRACT Residence & attached garage
GROUP I
TYPE V ZONE R4 FIRE DISTRICT (x)1326
INSPECTIONS
DATE
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench
% _
Foundation Forms and Grade to Garage
Rough Framing
Plumbing, Rough to R�'p ir/ ,f
�`i `
- _
Plumbing, Rough Complete
14,
g C,
Temporary Pole/
Wiring, Rough '7i
)-
'77V SS
/,j O
Heating, Rough
Heating, Final,—j�(h,.,
c r, House/ . Sewer, St./
.c Tank or Cesspool
Lathing, In Out
Plastering
Plumbing, Final, Fixtures Compl
Plumbing, Final Gas
Wiring, Final 54,9
/
Occuoancv i "'114
1
Costa Mesa Building Department PLICATION FOR PERMIT
,y ttt EAST 20th STREET
COSTA MESA, CALIFORNIA
DUILDING
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN
Receipt No.
Permit No.
Building
Address
-Costa Mesa, Calibiirma -
Received by
Date Recd.
Date Issued
1955
Nearest '
Cross St. Santa Ana Ave
Building
Address
Owner Max
Costa Mesa, California
Mail
Address 407 Bolsa Ave
Nearest
Cross St.
Tel.
Clty New Ort Beach No. 8-228
Zone ,/
i
I No. of
P ns
I Type I Group
1AMR
Architector Lie.
Engineer No.
Approved
by / Date'
AddressORRE
ONS
city Lie. 1513
Contractor I4IaX PiPo e - Tntl
- -
Address Same
Legal I Lot '/ iB�c
Description No. Q
ract
_
(Attach Metes and Bounds) (Over)
O
No. of Bldgs.
Size of Lot Nowon Lot n
Use of I No.of
Existing Bldg. 0 Famlliea
No.of
I Rooms
2!
0
Z
Setback Line from Rear Yard 5 •
Center of Street 501 Side Yard 5
'�", r`. 1 `' D
DESCRIPTION OF WORK
New I XI
Alteration I
I Addition I
- CiTV OF rn.
Repair I I Moving
I
Demolish
Building No. of
Size 1353 Sal Rooms 6 Stories l
Exterior Wall
Covering StUCCO
I Roof
Covering Compo
APPROVALS
Use of New
- Building Res & attach''d garage
Foundation Location
Forms, Materials, -
Under -Pinning -
Inspector
Date
Frame: Fire Stops,
—Bracing, Bolts
Lath. Int.
I hereby acknowledge that I have read this Application
and state that the above is correct and ee to comply
with all City Ordinances and StatS regulating
building construction.
of _ 6 I
Permittee
Permittee
Authorized Alit.
Lath. Ext. E, ti
-
n
Plaster, Int. ••
P
Plaster, Ext. P
r
Masonry Reinforced
valuatiop� Permit Fee $ `
y Plan Check $ -�
$ V 0 Total
Fee $ O
w
Bond Beam
FINAL
FORM 204 G -H 2M 5-54
The Se'1y.'66.0,' of the Nwlly
312.0' of the Nel1yl20-.0'
of lot 244, Npt Hgts.
Street 7. '
PLOT PLAN
I Show locatlon*. and distances from - ..
property line and between buildings. :^ r,..• -
pn
to i,.p..:� ..
d.1.
l;nncN UMST 1NVk;b'PMKN'T6 UAIt u cU-1}
rJOB ADDRESS p7Z p_ p1 Rt St.- BUILDING PERMIT No. 37614
1. i1A-14a—OS LOT
IW;ACTIONS
Signature
Date
TYPE v GROUP
J
ZONE
Rl
'IsoIL
SUBCONTRACTOR
M
I55
ED
.GAS
Date Number
Signature
WATER
Plumbin
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER
ROUGH WIRING
S
Mactina and Vent.
TRENCHES FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
L
FRAME AND FLASH G
C
LAT RING — IN OUT
a+
PLA—ER. BROWN COAT
o.
— �Q-
51 URAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL
36
7
PLUMBING. FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
�%'%
Z
aU
Z
ZF-
O to
o. m
J �
J rn
Q W
M J
m
J Q
U to
Za
wm
(L W
W Z
JO
mZ
J 2
w W
Z I—
w U
to =
Z)O
-� 37614
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
PA?d
:1V ?S -73F,,,001 o91 v-** *39.50
PP IC TION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RE E
D E RECEIVE
7
D i ISSyED
2 �
BUILDING., _ ^
ADDRESS 73
G.
O
MIT NO
OWNER ILS % =.�(iEly/�! `�a7
A.P. NO. -
MAIL
BVILDING
ADDRESS [.) <w �/! �i f'-v�
ADDRESSa
CITY en NOL J 1
TRACTy LOT BLOCK
CONSTRUION /Va ZK
W
ADD
A P
13RANCH
OWNER
ADDRESS
VALUE eve
USE $ J �J
ARCHITECT �, TEL.
E O
OR ENGINEER V % NFIRE
ZONE ./ TY GROUP
/TT
ADDRESS b�L. /%?/Z
'
APPROVED
CONTRACTOR F L F
BY DATE L
ADDRESS
TEL.
TE
ZONE
NO.OF
USE OF NEW
CITU
PLANS
UILDING
STATE CITY
YA RDS APPROVED
YARD APOPRD
LIC. NO. LC. NO.
MAIN BUILDING
ACCESSORY BUILDING
S1ZE// y NO. OF BLDGS.
0 / Z (] /FRONT
(FROM C/L STREET)
OF LOT (0 /\ NOW ON LOT
FT.
.J FT.
USE OF
EXISTING BLDG.
I FT,SIZE
OFT.
rX ILr /
IFT.
NEW BLDG. t?LLT//
ROOMS STORIES
L. SIDE FT.
EXTERIOR WALL 1V"-,)
ROOF CA Pn 1p
COVERING
COVERING YA. <<
REAR FT.
F7.
USE O BUILDING N WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
v✓ Ix F .2 % C
MAIN BLDGS.
ACCESS. SLOGS.
VAR. #
C.U.P.#
DATE
APPROVED
APPROV P6 -//--42.9-7L5
— —7 ij
DATF V
SS pts
I hereby acknowledge that I have read this application and state
,
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT.
THE XMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Divisicn 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
am exempt from the provisions of the tate of California Business
and Professions Cnde, Division 3, Ch to,-
VALUATION
PERMIT FEE $ G
Signature v/� P,,..�
per—
Permittee /
$ 3 (/
PLAN CHECK $
n's •� ,,/-
Authorized Agent 010 12 %� y�":�/=>/ ^^""" S
TOTAL FEE $
UUdLT1' llVVP;C�1R°1C,1V'1'S ✓M I L u, c _ I -,
ZJOB ADDRESS m + c+ BUILDING PERMIT NO. 47615
SUBCONTRACTOR
rI mmn
ROUGH PLUMBING
L(fyLQy
"3/
_ PROP. SWR. LINE L] HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Heating and Vent.
TRENCHES D FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLA' -FR, BROWN COAT
f�
51 URAL, FINAL
HEA,NG, VENT., REFRIG. AND A.C., FINAL
)t,%/ dit.
J�'S'% 3754
PLUMBING. FINAL ANO GAS TEST
owl
ELECTRIC, FINAL
BUILDING, FINAL
a'
37615
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A tY*
ar,V?s-73PC,1S 001oso*•v 39.50
e
r40_5
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
AEC—ESR
I E
pA E ED
BUILDING
ADDRESS R 7 3OWNE •. (Jl/S
.� ��
A.P, NO.
MAIL
BUILDING C
4
�I
ADDRESS — %��./ a!z-
ADDRESS, G- ��
TEL.
w ae d2
CITY ey
TRACT E' LOT BLOCK
CONSTRUCTIO
W
AAFFAIR
LENDER 6
BRANCH
OWNER
ADDRESS
f @zc9r'PIlC� VALUE
S r L $
ARCHITECT
_� ��,C NEL. O
OR ENGINEER ��G
ADDRESS f --Z - �- r y .
FIRE
ZONE TYPE GROU
APPROVED —2
CONTRACTOR C.._ /C
CONTRACTOR
By DATE -
ADDRESS
ZONE
NO. OF
USE OF NEW �Nres^tb/`
CITY NO.
PLAN12
UILDINg
STATE CITY
YARDS APPROVED
YARDS APPRJfVED
LIC. NO. LIC. NO.
MAIN BUILDING
'ACCESSORY WILDING
SIZE NO. OF BLOGS.
IF ROM C/L STRE ET)
J'lF.
OF LOT O %� NOW ON LOT /
PONT F
USE OF
EXISTING BLDG.
FT
$IZE OFN� x p NO. OF
0
NEW SLOG. 0 ROOMS STORIES
L. SIDE
EXTERIOR WALL
ROOF J
COVERING 'l�Lrl
COVERING /
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. SLOGS.
'u /✓✓/�.7��y7 E Di r�ri-> �=?7 c
. 4h
C.U.P.R y
DATE
APPROVED
~ 6't TiF .
APPROVED
DATE
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
✓
the State of California.
1 hereby certify that I am properly licensed as a contractor underSO.
FT. \ X
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Profession. Code, Divisicn 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am m ro
exempt froUe pvisions the State of Calif nia Bus;,7s
antl Profession a, Division , Chap1�9.
VALUATION
PERMIT FEE $ 0((�
G /�f/sr//J
u R S
QO
Signature of
_
Permitted
$ J®O
PLAN CHECK $
Authorized Agent
TOTAL FEE $ 3
e
r40_5