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HomeMy WebLinkAbout177 22ND ST - Building Permits r, . 4 '• 9 - CITY OF COSTA MESA . _ BUILDING DIVISION • F '4( DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER nil ,J PERMIT E02-00351 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No Applied: 05/01/2002 Vicinity: LAUNDRY ROOM A AND B Issued: 05/01/2002 8Parcel Nunmber: 42613310 Applicant: LOGAN, MARK ISSUED BY: Address: 204 GRANADA AV Phone: 562-972-8282 LONG BEACH,CA Zip: 90803 Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE API • • • /' NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769I, ‘. - ' Contractor: ' LOGAN ELECTRIC Address: 204 GRANADA AV -Phone: 562-972-8282 • LONG BEACH,CA Zip: 90803 License: 641360 SCOPE OF PERMIT RELOCATE AND UPGRADE HOUSE METER FOR LAUNDRY ROOMS A AND B.CONDUIT FROM METER TO • EACH LAUNDRY ROOM AND 100 AMP SUBPANEL IN EACH LAUNDRY ROOM. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section - $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 • Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets .$0.00 _ 0 up to 100 kva/kw - $0.00 0 , Switches $0.00 0 over 100 kva/Rw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $18.20 1 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a ' $0.00 0 _Circus(gen or ride) $0.00 - 0 Motors to 1hp $0.00, 0 Circus(mech ride or lights) . $0.00 0 Motors to 10hp , $0.00 0 . Christmas Tree Stand $0.00 - 0 Motors to 50hp '-$0.00 0 Fireworks Stand $0.00 ' 0 Motors to 100hp $0.00 0 'Other Electrical Fee $0.00 Motors over 100hp $0.00 - 0 - / ' Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $61.00 2 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 • Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $133.20 Intermed Pole $0.00 0 • COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - , I hereby affirm under penalty of perjury one of the following declarations: I have end 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. nd will maintain worke compensati ' surance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. y workers'compensati ran carrier an alley num01 ere: Carrier: Policy Number: (.8 taco(a-0 (This section need not be complete if the permit is vattieed at one hundred dollars($1 00)or less.) O 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 ogre=that If I should become subject to the workers'compensation provisions of Section 3700 of e La r Code,I shall forthwith comply with these pr Islons. Applicant Signature: , � � A1 Date: / WARNING:FAILURE TO SECURE WORKERS'COM -!SATI I COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ARE($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 de¢P/�vJsyn5•f 17apler 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my lice is n fgII force and effect.Lie.# T I,Jil(J Class# / Contractor's Signature: ASS. s4 `- 1 -c • Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every • business which has at any one 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? l�Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature Of Legal Owner(s) -/ D An r Authorized Applicant Date ODE P INSPECTIONTYPE PAIL INmuLE POOE. INSPECTIONTYPE MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210Electrical 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 F 9 CITY OF COSTA MESA /1,4BUILDING DIVISION > �,,,,, �� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t f . PERMIT rosarro d. P02-00261 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT - Job Address: 177 22ND ST Status: ISSUED Suite No 4 Applied: 04/26/2002 Issued: 04/26/2002 Vicinity: BUILDING 4 Parcel Nunmber: 42613310 ISSUED BY: c--- CK ______ Applicant: GRIPPI, MARK ., Address: 177 22ND ST. , Phone: (714)548-8905. COSTA MESA,CA Zip: 92627 Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: - , SUITE?10 Zip: 92660-7769 " $9..., I. I Contractor: TYLER J CONSTRUCTION CO. 17 Address: 177 22ND ST. .& t Phone: (714)548-8905 . COSTA MESA,CA , Zip: 92627 ' License: 661717 - - - Arch / Eng: r- - -- - Address: Phone: -• Zip:.. - License: " I. SCOPE OF PERMIT ' PLUMBING TO INCLUDE:2 LAUNDRY TUB/WASHERS AND WATER HEATER.ALL TERMITE REPAIR WORK.REF: B02-00563 BUILDING#4 - FEE SUMMARY AMT QTY , AMT QTY • - AMT QTY ISSUE FEE . $23.50 Laundry Tub/Washer $19.60 2 Sump Pump $0.00 0 Backflow irrigation " $0.00 -0 Landscape Irrigation $0.00 0 Swimming Pool - $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr BkFlow(5+) $0.00 0 Dental Units $0.00 - 0 Septic Tank $0.00 0 Wash Basin , $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line , , $0.00 0 , , ' Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 'Shower $0.00 - 0 , Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar , ' , , . $0.00" / 0- Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $43.10 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 andfinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 244648(6/00) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) 742-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 visi s. G, /Appliwnl'Signatury: �� (-Date:-/, —/ OZC c tWARNWG:.FAILLIRE'TO SECUR ORKERS'O MIPENS TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license _underprovisions of Chapter 9(commencing with Section 7000)of Division 3 of the-Business and Profes$lons Code,and my license is in full (1torce-and'eneccucrth 7� 7 class aZ >d �/ c- `ContractoL's.Signature Irak:� n CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business 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 toe civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. - Business and Professions Code for this reason: Signature: N Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made In connection with work authorized by this permit,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 6,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 ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 Irom any other air pollution control district or agency? J Yes 1J No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all slate 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. Si. ature Of Legal Owner(s) Date "2"-2,26--o t,And/Or Authorized Applicant Date DODE I INSPECTION TYPE DAIS IMUS COBE! IN$PECPONIYPE DAIS j( 1616 Fixed System Final Fire Prevention 206 Final Mechanical �1 t (� 1266 Pool Spa Final 208 Final Plumbing -. n/l -2S`c l7 n( 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 e 4thin F CITY OF COSTA MESA 1 44.. 9 ,:4 • BUILDING DIVISION >:j,,,,,' •i. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1 4. /� I PERMIT '�*Pr,'"� PO4-00334 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No Applied: 05/12/2004 Issued: 05/12/2004 Vicinity: _cc-t-6;;C. ISSUED BY: Parcel Nunmber: 42613310 Applicant: MARK FOWLER Address: 10372 STANDFORD#0 ' Phone: (714)590-9964 GARDEN GROVE,CA Zip: 92840 • • Owner: STARNES, LES 0 TR • Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: y c �a SUITE 210 Zip: 92660-7769 •( \. isly �yJ1 44 - #ides Contractor: CALIFORNIA ROOTER & PLUMBING ar Y � Address: 10372 STANDFORD#Q • - - Phone: (714)590-9964 GARDEN GROVE,CA Zip: 92840 License: 703820 . Arch / Eng r Address: • Phone: Zip: License: SCOPE OF PERMIT PLUMBING TO INCLUDE: 1 WATER REPIPE FOR MULTI-FAMILY BLDG. REVISED 05/17/04: 1 WATER REPIPE FOR 7 ADDITIONAL UNITS WITHIN SAME BLDG. FEE SUMMARY • AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 cLaundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 -P-Trap $0.00 , 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 ''Receptors $0.00 - 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 ;Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect • $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 -Shower - $0.00 , 0 Water Heater/vent $0.00 0 i Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLAFrATIGiGNS WORKERS'COMPENSATION DECLARATION: elfele - 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. Er- 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 c der and policy number are: / Carrier: S t}Ct5 " MOD Policy Number: ,In 7p �3 �'yI 1 (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 w•• h this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and 4. 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: -r'7-L� WARNING:FAILURE TO SECURE WORKERS'C• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1o0,DOO),IN ADDITI• 0 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.# 7(>5 Zo��JJ--�� Class N C. 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business 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.It,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;amEXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. . Business and Professions Code for this reason: Signature: - Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,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,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. 1 Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 13 Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Le ner(s) _ /n/ Datea And/Or ed Applicant Late CODE1 INSPECTION TYPE LATE INTITIALg CODE• INSPECTION TYPE LAT 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 4217 ..411151 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 401 MF CITY OF COSTA MESA • BUILDING DIVISION .N ..L•. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I /f i PERMIT J !lonals*■1. PO4-00334 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No Applied: 05/12/2004 Issued: 05/12/20•• Vicinity: ISSUED BY: /�r Parcel Nunmber: 42613310 Applicant: MARK FOWLER Address: 10372 STANDFORD#0 Phone: (714)590-9964 , GARDEN GROVE,CA Zip: 92840 Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 Contractor: CALIFORNIA ROOTER& PLUMBING Address: 10372 STANDFORD#Q Phone: (714)590-9964 GARDEN GROVE,CA Zip: 92840 License: 703820 • Arch / Eng : Address: • • Phone: ( Zip: License: SCOPE OF PERMIT PLUMBING TO INCLUDE: 1 WATER REPIPE FOR MULTI-FAMILY BLDG. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 PrTrap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial - $0.00 0 Water Re-pipe $9.80 1 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 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 permytshall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 4 c. - DECLARATIONS I - WORKERS'COMPENSATION DECLARATION: r•—• • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance off the work for which this permit is issued. My workers'compensation Insure 0cp carr(ifr and policy number are: !(Q Carrier: t b r dPolicy Number 7DI3/03 (This section ne n t be complete ll the permit/`..-aloud at one hundred dollars($100)or less.) ❑ I certify that in the performance of the y. for wh is permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califvia,:���•VVV• ..gree that' • o Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis>J•'-. Applicant Signature: //, _ Date: ' WARNING:FAILURE TO SECUR- O RS'COMP' SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,••8),IN ADDITION TO ' E 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 uncle •rovisio . • Chapter 9(commencing with Section 7000)of Division 3 of the Business aUdfrofessions Code,and my license is in full force and effect.Lic.# a Class# :5 jo Contractors Signature: eArarat Date: 67-72--y-Co CONSTRUCTION LENDI' AGENCY: ❑ I hereby affirm tha 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 en 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. A Signature: Date: Division of Industrial Safety Permit Number: i HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 lime has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end 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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and cit ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe 'on purpos-.- :gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 'ignatureO -•. Owner(s) (17711r)le / //Date / - d/O - .•licant —f ' L1aa CODE 0 ESP .1•N TYP `/ DATE )NTITIALS CODE 0 INSPECTION TYPE PATE INTITIALS 1616 Fi ed System Final Fire Prevention 206 Final Mechanical ./� 1266 Pool Spa Final 208 Final Plumbing 2 1/,6/�Y 200 Final Re-Root 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 ;N'.ft�., 4 CITY OF COSTA MESA 4 BUILDING DIVISION e4 �\ F I ,,,�'> I DEVELOPMENT SERVICES DEPARTMENT • PERMIT NUMBER o . �4^= i si PERMIT B02-00565 b•• c r` (714)754-5273 • Fax(714)754-4856 • ww.ci.costa-mesa.cz®DILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 w Job Address: 177 22ND ST Status: ISSUED Suite: 25 Applied: 04/26/2002 Vicinity: BUILDING 25 Issued: 04/26/2002 Primary Occ: • R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 42613310 Zoning: Applicant GRIPPI, MARK • Address: 177 22ND ST. Phone: (714)548-8905 ISSUED BY: COSTA MESA,CA Zip: 92627 Owner: STARNES, LES 0 TR C r Address 1401 AVOCADO AVE illo NEWPORT BEACH,CA Phone: kkli - SUITE 210 Zip: 92660-7769 ��• ) r. . Contractor: TYLER J CONSTRUCTION CO. Address: 177 22ND ST. v -. Phone: (714)548-8905 COSTA MESA,CA „":'1 \ . Zip: 92627 License: 661717 ,;, , - $• \SI \\\ Arch : -•Eng: 1 I.c.".?. • .• Address: Address: .' i+, '. " Phone: Ph`o\ne: - Zip: License:/ • �, License: /- .SCOPE ORPERMITi ,t / .. . • REPAIR TERMITE DAMAGE.RE-INSULATE AND SHEET ROCK.BUILDINGI6t25 : - j`/ Plan Check: $0.00 ' Calc Valuation: Sl,000.00 Permit:,g;__.�$97.25 Claim Valuation: �� --,,ga,000.00 SMIPSR4.9, a4"'.i• $0.50 .y^` '; .'1 / SMTP Com c,. $01.00 1; aOttter;s ic1 ,$0.00 4In pecttonl , $0 b0 i t,/ otaI9775 'I PLANNING & ZONING r„-SET,BACKS . Jk:•. .,• V „MAINISTRUCTURL Front 0-0 . t Rear,,x;0-0 • Left 0-0 Right 0-0 1 ACCESSORY •'Froni t 0 0 , Rear .0- 0 Left 0-0 Right 0-0 • f PARKING `ExisLnq 0 Required 0 Proposed: 0 y. ..t.. is ±' / 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 it work is not commenced within 180 days,or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6ro0) 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 nave and will maintain workers'compensation insurance.as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed It the permit is valued at one hundred dollars($100)or less.) ❑ i certify that in the performance of the work for which this pormil 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 Inas it I should become subject to the workers'compensation provisions o1 Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Dale: WARNING,FAILURE TO SECURE WORKERS'ComPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLAPE($100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: /, ' I heroDy affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Codi,end my license is in full force and enecl.Lie.• Class a_ - ' 1- / Contractor's Signature: Date: • ' "t / - I CONSTRUCTION LENDING AGENCY: \ O I hereby affirm trial there is a construction lending agency for the performance of the work for which ads penM is ISsund.(Sec.9093 ;C1vIl Code). Lender's Name'. Lender's Address: "t � - — Signature: -" - • i .''4I Dare: I- - - / OWNER-BUILDER DECLARATIONS: I . r :V-,;- ' ' ' \;, .-1' ' I heroDy attiim that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW telthi following reason(See.703t.5.Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or ripier'anystructumo priol,fa its issuance;also requires the applicant for sucn permit to Ire a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencng withSection7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom-and the basis for tie alleged exempton.Any violation of Section 7031.5 by any applicant for a permit suo1eets the applicant to a civil penalty of not more man five nundrad dollars($500).): : ' I / r I ' 't.'1 ❑ I,as owner of the properly or my employees with wages as malt sole Compensation,WILL DOITHE WORK And the structures not Intel nded or offered for sale(Sec. 7044.Business and Professions Code:The Contractors License Law does not apply to art owner-01 properly/Who builds or improves thereon,and who does such work himself or herself or through his or her own employees/provided(hal such improvements are not Intended or offered for sale.II,however,the building or improvement is gold within one year of completion,the owner-builder wall hays tma.burden of preying 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'eonseuct the project(Sec.7040•Business and Professions Code:The contractors License Law.does not apply IO an owner of property who builds or improves meteor',and who contracts for such:projecl with a contractors) license pursuant to the Contractors License Laws.)! .-/ y' - . I I lV i- -/} II am exempt under sec. f.'c`: ' 1.:r i Business and Prglessions '� ❑ p Coda iso this mason: . Signature: A� - \ I 1 l•' - l l • 1 Date: V Owner ID verified Dy driver's(kenaez.„R❑Yat 1 ❑No 1 l':Drh'efe License No. I Expires: Vetdicalion of Ownershipyy/Itty3e of cUc ' nt,):e.-propeny tax bill or deerl)o-"z= I ,-_ .:( DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: r',r is - ❑ I hereby certify that no excavation five(5)or more feet in depth info which a person is required to descend,will be made in connection with work authorized by This permit.and that no building structure.scaffolding,falsewoik,or demolition or dismantling(mmol,will be mole than thirty-six(34)feel high.(Chap.3.2•Grp 2,An 2,Sec. 341.Title B,California Administrative Code). I ' ` i ' i ❑ As owner-builder,'l•wta not employ anyone to do Work whin h'wp ld require a permillifroom the Division of Industrial Safety,as noted above, unless such person has e permit to do seal-work from the division. _, Signature: I I -1 / Date: r . , ) r,: l C•. / Division of Induslriali5ateiy Permit Number: . • HAZARDOUS MATERIALS'AND EMISSIONS CERTIFICATION: I Will the applicant . Yt or-Dr '0 o deeding occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? Yee ❑N. .' •2+ / (Section 25505 Orilla California HealN.and Safely Code requires,with some exceptions, that a Business Plan be Nod with the Costa Mesa Fire Department by every business which has'at am/onetime duffing a reported year a quantity of hazardous materials equal to or greeter than a weight of 500 pounds,or a volume of 55 gallons, r Or 200 cubic feet of compressed gas al standard temperature and pressure). ... -„_ps -... 2 Does or will the aPeacamor.prorea.nYot future building occupant need to file a registration form for acutely hazardous materials'? 0 Yes 0 No , (Section 25533 of Ire 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 naod.a-quonlity 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 al 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 0 flu (Section 25534 of the Calcornia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Dapanment of an HMPP by businesses which are required to register acutely hazardous materials with the Fire Department, 4 If an HMPP is presently required,has Section 25534 of Ire California Health and Safely Code been fully complied with? ❑Yes 0 No 5 odes or will the applicant or present or future building occupant requite for the work which is the subject of this application apermil 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 Ll 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 Me Mollify lube constructed under this permit be within 1000 feet from the outer boundaries of a school'? 0 Yes 0 No (i1-yes',the facility must meet to requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 it a permit hon, the South Coast Air Quality Management District or other aim pollution control district or agency is required for the work which is the subject of this application,heat+all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No a (it yes".attach certificate el compliance from the appropriate air pollution control officer). CF-RTIFICATE OF COMPLIANCE: I cenify that under penalty of perjury the information given above is correct. I agree to comply with all stale laws and city oroinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I cenity under penalty of perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws end 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.l agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date LODE r INSPECTION TYPt DATE INTITtALS gygl r INSPECTION TYPE SIE INTRIALa 1616 Fixed'SyfflemFinalFUe-Prevention .C.— .-� 208 FlnafMethr/DS . , 7:77.r. /^T""r— 7 ,� �- 1 a't7#r 7 ' dn — / 'IIT%, i` 1266 f-PaDI Spa Final • • r-3, i i 205 Fra]Plrarlbiig' t- f y - .� 200(',-FInaI Re Rool 4+- r .'^' 21 I �•Fala Electncat T 11,. -.rte 1 r t-7 • .i f 'tr. 201 -,. Friel Block/Retaining Wall _ � I ' 212 FInaI 0Pr9wn tion' '-\KI :my (--.. . 1 al 3>An. ;;.:: h y. clrZN.',4---`:- ;Y 202"•'-Tz Fpjyactory Fire PI y r-.. t F - i 220 PAIN ManninApproval lm 203 •C•, Fall SIGnT. ,- pili 3�,,2t'r;/ #�kr, „•-+.-- :t z, 223 rr Fbiel• bite y �f..t > r 204 Final Dernolitan '� \ J+;�� 't �" h� - 250, Final Building/Occupancy I, - .0 ' ..- D ! • 1 figir . CITY OF COSTA MESA BUILDING DIVISION te- .4I DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 11.1141 . PERMIT ettymB03-00024 ro (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite: Applied: 01/06/2003 Vicinity: ROOF Issued: 01/06/2003 Parcel Number 42613310 Zoning: Applicant: TODD, DEBRA ISSUED BY: Address: Phone: Zip: Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE ' NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 Contractor BONDED ROOFING Address: 200 NIETO AVE SUITE 200 Phone: (562)427-1604 LONG BEACH,CA Zip: 90803 License: 758776 Arch : - Eng: - - Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT . TEAR OFF EXISTING ROOF.APPLY SBS BASE AND CAP FLOOD COAT WITH HOT ASPHALT AND EMBED 4/5 GRAVEL MIX.80 SQUARES FOR BLDG WITH UNITS#25-32 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,750.00 Permit: $111.25 Claim Valuation: $4,750.00 • SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING/8(ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 , ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/DO) 443 DECLARATIONS S' WORKERS'COMPENSATION DECLARATION: k_ 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 worker compensation Insurance carrier and policy number are: '1 V Carrier: V. C-(- ,14`� ? .....5 s. Policy Number: Pe yc) r '4-2(This section need not bd'Completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with th������see///��� Isions. .�/ Applicant Signature: GV Date: /-6 -0.33" WARNING:FAILURE T SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLAR 5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rovisions 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.# 7 $ 7/6 Class x C 3 9 Contractor's Signature: r L✓ f, Date: /-&-023 t 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 to a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,talsewark,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,ora 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 t (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 withr 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 as plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility lobe 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? 0 Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SIstefSI n tura Of Legal Owner(s) Date Ill /- 6 ' 03 And/Or Authorized Applicant Date SODE I INSPECTIONTYPE RAN HEW CODEI INSPECTIONTYPE PAIS 1I4MAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /� 208 Final Plumbing 200 Final Re-Roof 7-7-pe, , 210 Final Electrical 201 Final BIock/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 7 a _- 5111 M CITY OF COSTA MESA N-_' • - i � BUILDING DIVISION s.4A l DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER � . / PERMIT �, 03-00023 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ccaUiLpING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BJob Address: 177 22ND ST Status: ISSUED Suite: Applied: 01/06/2003 Vicinity: ROOF Issued: 01/06/2003 Parcel Number: 42613310 Zoning: Applicant: TODD, DEBRA ISSUED BY: . tV Address: Phone: Zip: Owner STARNES, LES 0 TR ' Address 1401-AVOCADO AVE, • NEWPORT BEACH,CA - Phone: SUITE 210 Zip: 92660-7769 , Contractor: BONDED ROOFING Address: 200 NIETO AVE SUITE 200 Phone: (562)427-1604 , LONG BEACH,CA Zip: 90803 License: 758776 Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: - SCOPE OF PERMIT- .- TEAR OFF EXISTING ROOF.APPLY SBS BASE AND CAP FLOOD_COAT WITH HOT ASPHALT AND EMBED 4/5 GRAVEL MIX.80 SQUARES FOR BLDG WITH UNIT#17-24 - FEE SUMMARY - Plan Check: $0.00 - - : -- ' Calc Valuation: $4,750.00 Permit: $111.25 , ' Claim Valuation: $4,750.00 SMIP Res: $0.50 , SMIP Com: $0.00 Other: $0.00 inspection: $0.00 • • , • Total: $111.75 • , PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0: ACCESSORY Front 0-0 Rear 0-0 .Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) o, DECLARATIONS WORI&RB''COMPENSATION DECLARATION: i . 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. Q. 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: p l Cartier: 7.ac.Ir"� 7: /� Policy Number: p -ems+-r/ r (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 0 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 hese Ions. Applicant Signatur �f Date: /-{Q'1 0-3 WARNING:FAILURE TO S E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARS($108000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 5706OF 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.Lie # 7LSFf77 G Class# C- 3 S Contractors Signature: OC1-, ' 2 ' Date: / - 073 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 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: Of 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,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation;certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air 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 Hmrdous Materials n Emissions. Signature:aC7 Date: /' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) _ O 3 Date �i2 -74/1And/Or Authorized Applicant r0 Date CODE t INSPECTION TYPE MIE IKIUAL9 CODER INSPECTION TYPE OAIE BEMIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof l�6 yy-.� 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 204 Final Demolition 250 Final Building/Occupancy , 're CITY OF COSTA MESA : 4 — 4 BUILDING DIVISION r o s DEVELOPMENT SERVICES DEPARTMENT PE NUMBER • PERMIT 03-00022 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 177 22ND ST Status: ISSUED Suite: Applied: 01/06/2003 Vicinity: ROOF Issued: 01/06/2003 Parcel Number: 42613310 Zoning: / Applicant: TODD, DEBRA ISSUED BY: iC� Address: Phone: Zip: Owner: STARNES, LES 0 TR Address /1401 AVOCADO AVE, - NEWPORT BEACH,CA Phone: , SUITE 210 Zip: 92660-7769 Contractor BONDED ROOFING , Address: 200 NIETO AVE SUITE 200 Phone: (562)427-1604 LONG BEACH,CA Zip: 90803 . License: 758776 . Arch : - Eng: Address: - . . Address: Phone: - Phone: Zip: License: License: r - SCOPE OF PERMIT . . . TEAR OFF EXISTING ROOF.APPLY SBS BASE AND CAP FLOOD COAT WITH_HOT ASPHALT AND EMBED 4/5 GRAVEL MIX.80 SQUARES FOR BLDG WITH UNITS#9-16 - ,: FEE SUMMARY ,. t Plan Check: $0.00 - — - - - .- - Calc Valuation: $4,750.00 Permit: $111.25 Claim Valuation: $4,750.00 SMIP Res: $0.50 .. SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 ,- PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 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-x6(6/00) WORKER COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: " Y ❑ I have and will this ea certificateisof 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. lir 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 worke✓rk •comps sation Ins rance carrier and policy number are: Carrier: y •J 1 tJ(- Policy Number: e end (This section need not be °mplered if the permit is valued at one hundred dollars($100)or less.) O 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 vi ns. Applicant Signature: Date: WARNING:FAILURE TO SECU E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).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 r9visions 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.Llc.# 7 T to' Class# C 3 S Contractor's Signature: —a7 Date: /— " -03 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).): O 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.). ❑ am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the 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 greeter 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 0 N (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 a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DE Yes D No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. opt, Of Legal Owner(s) Date / And/Or Authorized Applicant Date CODE I INSPECTION TYPE Egg INTRIAl& CODES INSPECTION TYPE DAIS INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 3."7 lt7 t! 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 R )7 ( M 9 CITY OF COSTA MESA y1 BUILDING DIVISION %j' ,� PE DEVELOPMENT SERVICES DEPARTMENT T NUMBER q. Fmk PERMIT .4. K03-00021 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite: Applied: 01/06/2003 Vicinity: ROOF Issued: 01/06/2003 Parcel Number: 42613310 Zoning: Applicant: TODD, DEBRA ISSUED BY: Address: Phone: Zip: Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 Contractor: BONDED ROOFING Address: 200 NIETO AVE SUITE 200 Phone: (562)427-1604 LONG BEACH,CA Zip: 90803 License: 758776 Arch : Eng: Address: Address: Phone: _ Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.APPLY SBS BASE AND CAP FLOOD COAT WITH HOT ASPHALT AND EMBED 4/5 GRAVEL MIX.80 SQUARES FOR BLDG WITH UNITS#1-8 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,750.00 • Permit: $111.25 Claim Valuation: $4,750.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury One of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: 7:_)p t; Y� etts4 L:carc e O2"z/o.V) Policy Number: A.vwrhpr �P.+-c) r (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 pr99��((Inions. Applicant Signature: 027 �" Date: /—G -03 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($103.0001.1N ADDITION TO THE COST OF COMPENSATION,OAhwGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.ft J 8- 77 G Class# C-35 Contractor's Signature: TAI Date: /_G-03 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 tile a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)01 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 en owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 0 N (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? Ul Yes El 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 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 California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No .._ - 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign tura Of Legal Owner(s) Date yVi 1 - 6-03 And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE PATE LNTIIIALS CODFt INSPECTION TYPE PAIS INRRAL6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 3 7 t e. 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 4 4<ecD CITY OF COSTA MESA BUILDING DIVISION • r DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER PERMIT J'S., 6° B02-00563 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite: 4 Applied: 04/26/2002 Vicinity: Issued: 04/26/2002 Parcel Number: 42613310 Zoning: , Applicant: GRIPPI, MARK ISSUED BY: Address: 177 22ND ST. - . Phone: (714)548-8905 - COSTA MESA,CA ' Zip: 92627 Owner: STARNES, LES 0 TR . Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 Contractor: TYLER J CONSTRUCTION CO. Address: 177 22ND ST. Phone: (714)548-8905 COSTA MESA,CA Zip: 92627- • License:- 661717 Arch Eng: • 1 ; Address: Address: 71, 1 Phone: •� • Phone: Zip: License: License: SCOPE OF PERMIT REPLACE DRY ROT 2X4, RE-INSULATE AND DRYWALL.ALL TERMITE REPAIR. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,0b0.00 Permit: $97.25 -_. . Claim Valuation: $4,000.00 SMIP Res: $0.50 • SMIP Com: $0.00 _ Other: $0.00 1 Inspection: $0.00 Total: $97.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 . Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(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 01 the Labor Code,for the performance of the work for which this permit is issued. . 0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued: My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: • (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) tp91 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 nd 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 rov s. EApplicent.Signature:- ' Dates WARNING:FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,C00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busin s and Professions Code,and my license is in full force.and eNea-Cic-x— --7 '6/ 7l 7 s'# /' , V C Con tractor's'Stgnawre /�j0Deter— r ' O ;� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 under sec. _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). r 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight'of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur f Legal Owner(s) Date 24-7 -ate Ann_OLAuthorizedaraplicant-- �Dete CODE I INSPECTION TYPE PASS INTmALS CODE f INSPEC1IQN TYPE PAIL MALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final /'�_ 208 Final Plumbing 200 Final Re-Roof 3'7-06 LAS" 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 MJ W Building Setety Division CITY OF COSTA MESA - P. A. F.O.BOX 1200 C• u...,, , +C ,,1 COSTA MESA,CALIFORNIA 92828-1200 ADDRESS SERVICE REQUESTED LI FE617'06 y^T) A? .]Q 0,3 9 . a \ �L7 4' IS C; C A H METEf,7"! n *i - CALIF. ROOTER & PLBG 10372 STANDFORD #O GARDEN GROVE CA 92840 cpt 2 441/Q EWOG ORDER EXPIRED - '• f3 -n.7: - •23:n ti _ _ _ ih•1!..!III!iI!!t!I!iiIWwIIIIl!Ili!I:ill!!li!I!I MJW Building Safety Division CITY OF COSTA MESA I ra r° P.O.BOA 1200 0.; s U.;.r;,s,, ;r„ '* COSTA MESA.CALIFORNIA 92628.1200 ADDRESS SERVICE REQUESTED FEB1Tu5 ji' G 0:5 9 / j)14�271L9 c A , !I METED . IC -l..r, kr TYLER J CONSTRUCTION CO 177 22ND ST COSTA MESA CA 92627 _.— -- - i- b. TO SENDER �1 INSUFFICIENT ADDRESS_ 1 1 f 11 111 1 1 I ` - '3- -� lt:zPizk Y .-._.v cot Ahliml.tlli1,,nillirlitlntlftl:itttnlitllliutllulllltli O Msc• CITY OF COSTA MESA \ , OW BUILDING DIVISION F•i -4UD1.1.1 Mitt .'g DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER !P PERMIT %%Rano tie P02-00262 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No 9 Applied: 04/26/2002 Issued: 04/26/2002 Vicinity: BUILDING# , 101-1--- ISSUED BY: Parcel Nunmber: 42613310 Applicant: GRIPPI, MARK Address: 177 22ND ST. Phone: (714)548-8905 COSTA MESA,CA. Zip: 92627 Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 Contractor: TYLER J CONSTRUCTION CO., - Address: 177 22ND ST. Phone: (714)548-8905 COSTA MESA,CA Zip: 92627 License: 661717 Arch / Eng: • Address: Phone: Zip: License: SCOPE OF PERMIT REMOVE AND REPLACE WATER TO WORK IN SURROUNDING AREA DUE TO TERMITE DAMAGE.BUILDING #9 r FEE SUMMARY AMT QTY - AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow inigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin . $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 ' Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 - Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 " Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier end policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and:gree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these• • 'sion Applicant Signature: `J — Date:! 1"2rZ —0Z WARNING:FAILURE TO SECU- W'1 ERS'•• 'ENSATON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Sloe000),I ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECI1ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# dee/ Class# e4' ,4":" Contractor's Signature: Dater '7-2 CI —0 I 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,Will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require o permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature; I Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W III 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? ❑Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one 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 to compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No • (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire ' Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a su plication a ermit for ch construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No B (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: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. atLegal Owner(s) Date �d/Qr A Authth orized Applicant Datir COPE I INSPECTION TYPE 2M MEAL/ oat lN2L r(TYPE PATE INmoLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ���y 1266 Pool Spa Final 208 Final Plumbing _ fl,.Jn 2 U 200 Final Re-Roof 210 Final Electrical YYYY 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 4`057/ F 9 CITY OF COSTA MESA • BUILDING DIVISION Irf G 4. " DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER : 1.1.4 PERMIT • 0 %ionan i' PO2-00263 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No 20 Applied: 04/26/2002 ��JJ ,,rr���� Issued: 04/26/2002 Vicinity: BUILDING# v`0 Parcel Nunmber: 42613310 - ISSUED BY: Applicant: GRIPPI, MARK . ' ' Address: 17722ND"ST.-' . . Phone: (714)548-8905 • COSTA MESA,CA - - Zip: 92627 - Owner: STARNES, LES 0 TR , Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: • SUITE 210 Zip: 92660-7769 Contractor: TYLER J CONSTRUCTION CO. - . • Address: 177 22ND ST. Phone: (714)548-8905 ' COSTA MESA,CA Zip: 92627 ' License: 661717 Arch / Eng: . _ ._ . .. - Address: . . Phone: Zip: -, License: SCOPE OF PERMIT REMOVE AND REPLACE WATER TO WORK IN SURROUNDING AREA DUE TO TERMITE DAMAGE. BUILDING # t),d FEE SUMMARY AMT QTY_ • - AMT QTY -- - AMT QTY r ISSUE FEE $23.50 - Laundry Tub/Washer $0.00 0 Sump Pump "$0.00 0 Backflow irrigation $0.00 '0 • Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 - P-Trap "" $0.00 0 Trap Primer " $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 " Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00" 0 • Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain.Rainwater $0.00 0. Sewer Private Line ` $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 .. - Shower $0.00 0 " Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar . $0.00 / 0 - Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS/SPECIAL CONDITIONS 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 244646(6/00) i DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by sectioni 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and wilt 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: I Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certifythat in theperformance of the work for which thispermit is issued,I shall not employ any p y person in any Manner a as to becomef subject to the,I shall f compensationh laws nofo California,and agree that it should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with these•ro ' ions. �/ Applicant Signature: ..-_ Date: I -/ %J2(l —0 WARNING:FAILURE TO SECURE •'KERS'•'• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN•DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. I LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed nder 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.x l 7/ 7 Class q ?Yr— h4/ C Contractor's Signature: ....a,. c: ;:z__________ Date: I 6,/ 'z_ a-0 7 CONSTRUCTION LENDING AGENCY: / ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit its issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: i 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.). O I,asd ow: her of era property, sem Law do not Y CONTRACTING an WITH LICENSEDtwhCONTRACTORS ro on,and the conecttracts (Sec.704Businessjetand Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. . . Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be moreithan thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health 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 feel of compressed gas at standard temperature and pressure). I 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500;pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a g.ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency?' IYes L I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 correi t. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature•f Legal Owner(s) IDate /'� LLL/,,,/// ��-o- Authorized Applicant v Da CODE# INSPECTION TVP PATH INIITIAI S CODE* INSPECTION TYPE PATE KE MP 1616 Fixed System Final Fire Prevention 206 Final Mechanical Q� rnt�„Y 1266 Pool Spa Final 208 Final Plumbing -. U 200 Final Re-Roof 210 Final Electrical PP 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 ADORESSOF BUILDING: 177 22ND ST MT CITY OF COSTA MESA - BUILDING PERMIT :am OWNERS NAME IF KNOWN: STARNES LES 0 TR ADDREss: 1401 AVOCADO AVE PERM MO: B US< ! S: SUITE 308 PERMIT NO; B 082732 PLAN CHECK NO: N GOVT; N SUPP : F1 • NEWPORT BEACH, CA 92660 I 01 APPL.MAIWIG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: 01H I ARCHITECT a+em+EER: Lit.NO.: JOB DESCRIPTION : T/OFF REROOF W/ CAP SHEET SQ FT: 4 , 850 ARCH.OR ERGS ADDRESS: WIT: CLAIM VALUE: 4 , 850 . 00 CALL-VALUE: 4, 850 . 00 GROUP GCC : U-1 / coemAcmaSNAME: ACE ROOFING ( 714 ) 680-6100 sen cTosumm 1442 S EUCLID ST COMMENTS : COMMERCIAL REROOF / GARAGE sawn FULLERTON CA UC.ND< 679543 **+ +e+L***x>t**>EtE****>E>E******>E*RLae***+E#+L>E*x-***eLttxit*te****iE***** ************+t**x•**x•* 92632 our: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby elm under penaly that I am under provisions d Chapter 9 SETBACKS (commencing with Section 7000)d Division S d the Business and Profession my license n fun force and affect. caruc.ND.: 0.,4110 UC7 .CLASS: C 39 UC.NO 0- 9543 EXP: 09 /97 --- - -- MAIN BUILDING - --- ACCESSORY BUILDING -" YFRNT : FT IN REAR: FT IN FRNT: FT IN REAR: FT 1.N �� oma: caiador: LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DE LARATION:I hereby Am,under penally d perjury that I am comp from the Contww License Lew for the tdlown9 reason(Sedim7031,5 Bushes,and Professions Code:any cly or county with requires apermt to construct,eller,improve, PARKING REQ: PROV; PARCEL : 42613310 ZNE; REF NO:A demolish.or(mai any structure.poor to as issuance.also requires the applicant for such await to file a signed statement that he or she if licensed pursuant to the provisions d the Contractors License Law(Chapter 9(commencing with Section 7000)01 Diieion 3 at the PLANNING NOT E S•> Business and Professions Code)or that he Cr end is exempt therefrom and the basis for the alleged exemption.My violation of Sedon • 7031.5 by any applicant foragert sap's the applicant taecivil penalty ci rid more than hove hundred dollars($5 001). ******************************************************************************** 0 I.a owner 01 the propenyormyemployees with wages mthee sole oompensaton,willdothe wrk.and teswcturesmintended D E V E L O P M E N T S E R V I C E S R E U or offered for ub(Section7044,Business end Professions Code:The Contractors license Law does not apply to answer d Properly Q I R E M E N T S who burs or inproves thereon.end elm does such work himself or herself a through hb or her own employees.prided that such ` improvements we not intended o offered for sate.It however.the building or improvement is sold within as yew d completion. ZONING APPROVED BY • owner-builder MI have the burden ol proving he or she did w build or improve for the purpose d sale). DATE: armor construct the ❑ PressesCode::The Contract=LIMOSusively Law dooewith Scented es not an oners er cit p who proem'Or"mrovaSolicit 704e•th eon andwhitwwnd hit BUILDING APPRbI�TED BY DATE: contracts ler such projects with a mirador(s)licensed pursuant to the Contractors License Law). , / ❑ lamexempt under SectoC Section: B.AP ..fammi this on: APPLICATION ISSUED BY : (� DATE: `S--v-97 Date: °wna � LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: Y I do hereby certify that I am aware d and understand the requirements of California Health end Safety Code Sections 25505,25533,and 25534.and that I or any Mum building occupant will/wit not(circle one)need to comply with said ewe codes and the requirements for a permit for conat anor modifmtonIran the Arouaky Management Distil.Residenlieloondm mudtonplcatms we exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING prmiam ia . PERMIT 99 . 75 Date: Applicant: SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one the following declarations: I LSU 1 . 0penaltyd ISSUE FEE ❑ Ihevec Imeirmanceenreedmmemhthisperrobrssued. 'compamaton,mpnwidedfabySedbn37oOdiMLetar BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for iM performance d the soak la which this penins mined. o I have end wit meintal+workers'wnpwwmion ommarrequired by SwaimdLabor d the 3703 the Code.kr the performance TOTALS----> 100 . 77 0 . 00 0 . 00 100 . 77 100 . 77 . 00 rx work for which this permit is issued.My workers'mmlwsmicn insurance carrier end pulley amber are: STATE FUND EXPIRES REVENUE DIVISION TOTALS > COLLECTED; 100 . 77 OVER/SHORT: 00 ` PdryNumm ')RS-4'/ LIMIT 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (Thissedion need nor be completedilM penal sfor one hundred dollars(S1001 se 99 . 75 1 . 02 0 1 Worm/ince rlh that n the d the work for which this peis issued.I �pthVat/y]'Jtenmploy any•-i any manner so as to become drat'compensation laws of California.and ,� d should •47.-bpd to the worken' *****************ii-********************************************.********..*.*.*******, Wiela23700 d the Labor Coda l shall hath iii`� mom 1 INDIVIDUAL F E E BREAKDOWN i\ Ap Dale: / can,: Warning:Failure to secure warners'compensation coverage la unlawful,and shall sub/act en amp one to criminal penalties and~ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST c/v/l Bras up to one hundred thousand dollars($100,000A In+ddltan to the cost a/compensation,damages as provided for In Becton 3705 of Ms Labor Code,interest,+ne+Mrners tem. SFC 4850 REROOF BY VALUE COMMERCIAL NOZONE 1 . 00 4 , 850 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES performance d the work for which,this perms is issued(Section 3097,Cb.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above iMontation is oared.I agate to comply with a9 dry and county ordinances and state paws ng to buildeg constrWion...hereby authorize representatives d this city to over upon the above'menloned properly fa inspwmon � AUST I JAN 0545-1997/12:51111/$100.77 FERIIRTP:00812-095.8.25�' /r difrP�. pnsturewsd... appimntContrwor Dm. � 3 jI (515146.WP) While-Building&Safety:Omen-RIe;Canary-Applicant:Pink-Revenue;Goldenrod-Assessor _! CONSTRUCTION AND PLANNING Pt, - & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or-Pole 52. Pool & Equipment Locatidn 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement • 3. Electrical Conduit Utility•Undrgfnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical.Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.. Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & 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 I 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil r 25. Roof Sheathing 5t_/•47 �4, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING '6,44/ 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date trir r CITY OF COSTA MESA ettBUILDING DIVISION F t''�"^4 . DEVELOPMENT SERVICES DEPARTMENT JF9R-00MB9 PERMIT PERMIT NUMBER dr (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 177 22ND ST Status: ISSUED - Suite No Applied: 05/11/1998 Vicinity: 38 UNIT APT BUILDING Issued: 05/11/1998 Parcel Nunmber: 42613310 ' Applicant: JOHNSON, FLORENCE Address: Phone: Zip Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 308 Zip: 92660 • Contractor: - Address: ' Phone: Zip: I . . , License: - Arch/Eng: Address: Phone: Zip License: SCOPE OF PERMIT STATE HEALTH AND SAFETY CODE SECTION 116049.1 PUBLIC POOL GFCI INSPECTION FEE SUMMARY Quantity Quantity • . • ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $1.00 1 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 • Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 - Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $23.00 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS - 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 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: T' ❑ 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 carver 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(SI C0.000).IN ADDrON 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.# Class a 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business 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.). JO I am axe under sec. Business�and�Professions. Code for this reason: ‘dSignature. '(,q�'",��" . - Y� Date: 5 — Owner ID verified by drivers lice e. 0 Yes ■ .. Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,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 buil0ing 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 end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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? ❑Yes DI 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 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 (11 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 es 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. - Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) / Oa—17 (�,�-. And/Or Authorized Applicant / Date • CODE I INSPECTIONTYPE BATE IMALS Oaf INSPECTIONTYPF DEE MURALS 1616 Fixed System Final Fire �Prevention -f �8 206 Final Mechanical 1266 Pool Spa Final GFT r65 f 13 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Flre Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 ADDRESS OF 9urumea 177 22ND ST WV: CITY OF COSTA MESA — BUILDING PERMIT gyNERSPUYEtFO ?t STARNES, LES 0 TR PERM NO: E 08457 ADOREss: 1401 AVOCADO AVE SUITE 308 PERMIT NO: E 084579 PLAN CHECK NO: N GOVT: N SUPP: N NEWPORT BEACH,CA 92660 MOMSAPPL.Mna ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT ARCHITECT ORUNSEEN L1CNO_ JOB DESCRIPTION : REPAIRS: REPLACE DOOR, REPLACE 2 F.J. SQ FT: SACK OR ENG.'S ADDRESS: WET: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / comucTORsIwe TYLER J CONSTRUCTION CO ( 714 ) 548-8905 CONTRACTORS MAILING 177 E 22ND ST #16 COMMENTS: REPAIR STUCCO, R/R DRYWALL, R/R WOOD SHINGLES ON WALL, #B84332 ADDREs& COSTA MESA CA taxa_ 661717 *********k,txAt-****ii•******iF<3fit*a[•#h*ii****x**jE****wwww ii•;Fifa:ii•riaE;i•iEx;:+tii•*itkis<s;t•dEiE******* 92627 WIT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby farm wider purely d prjray Nat lam licensed under pwidms d Chapter 9 SETBACKS (commencing with Section 7000)of Divisum 3 d the Easiness and Professions Code,and my license is in lull force and affect. CIrYUC.N 0{57435 UC.CLASS: B LIC.NO.: 661717 EXP: 04/98 MAIN BUILDING ACCESSORY BUILDING Done: 9 0, Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN vIW NER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the .olowig reason(Section 70.31.5 Busbies and Professions Code:Any city or tardy which rendes a permit tormwd.alter,improve. PARKING REQ: PROV: PARCEL: 42613310 ZNE: REF NO: demolish,or dre repeat any saume.Prio to issuance,Wei quires the MO iced la such permit to Se a signed statement that he or she is licensed purrs to the provisions of the Contractors License Law[Chapter 9(wmmrrn,g with Swan 7000)of Division 3 of the PLANNING NOTES> Business end Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Swan > 7031.S by any applicant for a permit subjects the applicant toe avis penally of not more than fwe hundred flan 155000. *****iF******************iF*******'******************iF****************ori*********** ❑ I,ELS ovmer of the POPWY Or rnY employee*with wages as thei sole compensation,win do the work,and the stnicture is not intended DEVELOPMENT V E L O P M E N T S- E R V I C E S R E or offered for sal(Section 7044.Business and Professions Code:The Contractors License Law does not applytoan owner of property Q U I k E M E N T S who boids or improves thereon.and who does such work lessen or herself or hsethrough he oremployees, c her own pathed that such improvements are not intended or offered for sale.n,however,the building or inpnortw is sold within one year of tomplrun,the ZONING APPROVED BY - DATE: owner-builder will have the burden el awing he or she did w build or improve for the purpose d sale). ❑ I.as owner of the property.am exclusively contractile with bombed contractors to construct the pitied(Scion 7044,Basics end Professions Code:The Contractors License law does not apply to an ownerd propertywla builds or imores0weon and who BUILDING APPROVED BY : DATE: contacts for such projects with a conoador(s)licensed pursuant to the Contractors License Laaw). • II ❑ Iamexempt under Swion: B.&P.C.,frtisreason: • APPLICATION ISSUED BY: ' ' DATE: ( � Date: Owner: ****w******bow*****w*** wwww bow bon wnnm0 , rely ' rc************w,Fw wrnn*li * I do hereby certify that Iam aware of and understand the requirements Californiaria Neat and Safety Code Swim25 Sections 25505. 533.and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGrequirements d g5534,end that I or any free butld'rp coconut!wR/wit not(circle one)need to comply rah said state codes and the reguimneris for a puma for cemrction r modification from the Air Ouakty Management District.Residential construction apvldiae are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 9 . 00 Dene: Applicant; 50% SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirms under penalty of perjury one of the following declarations: P LAN ❑ I have and will maintain atdm acenificensent to sell-insureb workers'conersat ,aswd ided fen by Sean 3700dlhe Labor ISSUE FEE 22 , 00 Code.for aso thepedonnceteworkfrwNdhthisprmiemued. rBUILDING DIV > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ thaveand sill meinsnwrs'mro krmpeehonbnSectionperformance tithe TOTALS > 9 . 00 22 . 00 0 . 00 31 . 00 31 . 00 00 work for which Nov permit is issued.My workers'compensation insurance anis and poli y ornbr are: Carrier REVENUE DIVISION TOTALS--> COLLECTED: 31 . 00 OVER/SHORT: . 00 Pony Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed it the prink is for one hundred dol/ars(51001 or ass.) 31 . 00 Q I certify t at t the performance of the work for which this permit is issued,I shall not employ any person in any manner so as 10 become fol to the workers'compensation NMI d California. end agree lh ' bhhld ecome subject to the workers' ***************:f*if***************************if*if********************iF********** w provisions of Section 3700 d the Labor Code.I Men forth P with Ina "sale. DWG: 9 B Apprica. INDIVIDUAL F E E BREAKDOWN Warning:Failure to securworkers'compensation coverage IsunlawNl,and shall subject an employer to cdMralprraMes end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollen($104000),M addition 10 the cost of compensation,damwps as provided for In Section 3705 of the Labor Code,Interest,and attorney's has. ELE 1 FIXTURES, LIGHTING 1 ST 20 EA, 1 . 00 1 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a consllnWan lending agency for the ELE 4 RECEPT/OUTLET 1 ST 20 EA. 1 . 00 4 . 00 padnmredthe work for wniwthis permit missued(Section SOa7,CW.c). ELE 4 RECEPT/SWITCH 1 ST 20 EA. 1 . 00 4 . 00 LENDER'S NAME: LENDER'S ADDRESS: END OF FEES I certify(hat I have read this application and date that the above idonnation s correct.I agree to candy with an dry end county ordinances and state ems constructionrelating to building and hereby authorize M ab e representatives of this Sty to enter upon Iove'mentsned propyl � rdnaledpn purposes. STEVEN GRIPPI 03/8-1997/09:35W.11/331.08 apt �1 • 9......_________. ____ ._ /e-4"7 RERMIT:084579 v 14 , Date: Signature of Omer/Agent/Applicant/Contractor (5151-4S.WP) White-Building&Safety;Green-RIs;Canary-App5cenD Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING &SPA APPROVALS Permit # Date Inspector APPROVALS Permit# Date';tliector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location. 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains t 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit / ' 66. Solar System-Final 16. Rough Electric Wiring 17/[97 67. Fencing & Access Approval 17. Rough Wiring Sign /�' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 114 _ 80. FOOD CERTIFICATE ISSUED 33. Final Electric .Q47st013,81) Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation .44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51.. CERTIFICATE OF OCCUPANCY .. No. Date P*T ADDRESS: 177 22ND ST UNIT: 27 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 066472 OWNER'S NAME: STARNES LES 0 TR • ADDRESS: 1401 AVOCADO AVE PERMIT NO: E 066472 PLAN CHECK NO: N GOVT: N SUPP: N SUITE 308 NEWPORT BEACH,CA 92660 CONSTRUCTION TYPE: V-5 PERMIT TYPE: ELE PURPOSE: NEW ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPLACE W/NEW SUB PANEL SQ FT: ADDRESS: UNIT: CLAIM VALUE: 250 . 00 CALC—VALUE: GROUP OCC : R-1 / PERMITTEE: JAMES ALLEN (714 ) 722-7810 ADDRESS: 181 22ND ST C COMMENTS: CHANGE SUB PANEL C .M. CA 92629 ###############aE##: #aF######################a *****#####%******#aerr*t: XPt*##***4t**M•e LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license rs in tun Mice and effect' S ETBACK S 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 setbinsure 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 TN POLICY .: EXP.DATE: 1)MPANV: REQ:PARKING RE PROV: PARCEL: 42613309 ZNE: REF NO: 'OMPAN J Certified copy is hereby furnished. C Certified copy is tiled with the city Building Division. PLANNING NOTES> > Date: Applicant. ################################tEu$:r####################################i;#####t EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This secwn need rat be completed it the permit is fur one hundred MOO)or less). DEVELOPMENT 4 ;E;R V I C E S REQUIREMENTS 1 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 u to theWorkers'compensation Laws of California.ei ZONING APPROVED BY /- DATE: �j i Q �Q 5gnature:�1(r+ +—i 1 s' Q , BUILDING APPROVED BY DATE: NOTICE:It.alter making this declaration,you shoe come subtest to the ores Compensation provision of me Labor Code,you must forthwith comply with such provisions or this permit shag 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: I R which this permit is issued(Section 31197.Civ.C). *********************************4‘4* *' ,.-' -************517 tr. ri +F LENDER: ################################lei#####################################34####+ ## ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT :N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the fallowing reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,atter,improve,demolish,or PERMIT 2950 . 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 PLAN 5 0 E S M I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis lar the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE C structure is not intended or tittered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 29 . 50 15 . 00 0 . 00 44 . 50 44 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himselllhersell or through his or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 44 . 50 OVER/SHORT• 00 fortheepurpeofs e). one year of completion,the owner will have the burden of proving ne/sne did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for Inc purpose of Sale). ,1/4., I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 44 . 50 L'9 and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contractsforsuchprojecfSwlih a COntractors)license pursuant to the Contractors State License Law).I am aware ############################################################################if#'k that moot al their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BREAKDOWN C I am exempt under Section: B.&P.C. lorthis reason: u ' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST � � � 7L19� °x�� ELE 1 SERVICES BELOW 600 V s BELOW 201 AMP 18 . 50 18 . 50 m ereby certify)hal l am aware of and unci¢stall the requiremen s of ornW Heal(h and Safety Code Sections 2550.5,25533.and ELE 1 SUB—PANEL 2 ♦ and that I or any future building occupant wilVwill not(circle one)need to comply with said slate codes and the requirements for a 11 . 00 11 • 00 permit for construction or modification from the Air Duality Management District.Residential construction appficalions are exempt from END OF FEES these provisions. Date: Applicant: I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned rty for inspection purposes. ^ 01 00157412-00157412 TOT 44.50 'I ate 14_11111._ Signature:C,.�-r�--TC/(!akik e—., DATE: 03/18/94 TIME: 12:04 Driver's License or Social Security A: 1641.46 White—Building:Green—Code Entorcemenr Canary—Applicant:Pink—Revenue:Goldenrod—Assessor J 4 • CONSTRUCTION AND PLANNING PC & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas C Oil 25. Roof Sheathing 74, Overhead Hydra 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 glectric q/Zz4yo21 Notes: 34. Final Heating & Air Conditioning /// 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No.5193 /I - OPTIONAL SECTION State of [ .�L/�0���� 6 CAPACITY CLAIMED BY SIGNER County of C RAW CYE Though statute does not require the Notary to +/�� / '�7� (�,, fill in the data below, doing so may prove 2 On Hike hi ts,/99 /-�/l� C 61114- c ,, /ti11 f PrA T C— — invaluable to persons relying on the document. y before me, I-t�NDIVIDUAL DATE NAME,TITLE OF OFFICER-E.G.,'JAE,NOTARY PUBLIC' lg ❑CORPORATE OFFICER(S) Lec.5 OD sIa.4es — personayappeare , 6 NAME(S)OF SIGNER(S) TITLE(S) PARTNER(S) LIMITED P 0 porsonoily Liu.,to Ute- OR -a proved to me on the basis of satisfactory evidence 0 ❑ 6 to be the person(,t() whose named) is/ ❑ GENERAL 6 subscribed to the within instrument and ac- ❑ATTORNEY-IN-FACT A ^ A ^ ^ ^ ^ ^ A. ^ ^ ^ ( knowledged to me that he/�1G/tt9ay executed ❑TRUSTEE(S) �"'�s BILL BENARD A the same in his/t1lthipefT authorized ❑GUARDIAN/CONSERVATOR �' � ? o�lt ; CD capacity(' ), and that by his/h /tt4r n COMM.#1009085 p ❑OTHER: -,`v' 1r15.! NDTARYPUBLIC-CALIFORNIA-.I signatureGkton the instrument the personct, 4 •' f ORANGECOIJNty - or the entity upon behalf of which the 6 yy.Corrin Erlplres Nov.11.1907 I ,� v v .r'w v d'w v N. person(9) acted, executed the instrument. c�c�If SIGNER IS REPRESENTING: 6 WITNESS my hand and official seal. NAME OF PERSON(S)OR ENTITYIIE$) i SIGNATURE OF NOTARY 6 OPTIONAL SECTIO THIS CERTIFICATE MUST BE ATTACHED TO TITLE OR TYPE OF DOCUMENT OtC etc 6.n 0 AU ueel THE DOCUMENT DESCRIBED AT RIGHT: NUMBER OF PAGES DATE OF DOCUMENT tlArte N 13 11977 / Though the data requested here is not required by law, /' it could prevent fraudulent reattachment of this form. SIGNER(S)OTHER THAN NAMED ABOVE '4 ©1993 NATIONAL NOTARY ASSOCIATION•8236 Remmet Ave.,P.O.Box 7184•Canoga Park.CA 91309-7184 • • DECLARATION OF AUTHORITY Bldg. Permit # IS ' FOR AGENTS OF PROPERTY OWNER This Permit # f�/, 647 2 TO APPLY FOR PERMITS • 177 E 22nd Street , including 175 & 181 Street Address AP Number 1. I (we), Dr. Les O. Starnes , declare that I am the Owner of Title • of the above referenced real property, and that I (we) hereby authorize: James Allen ( 714 ) 631 7376 Name Telephone No. • 181C E 22nd St , Costa Mesa CA 92627 Street Address • • City State Zip to obtain permits in my behalf, as owner/builder; for Breaker reDI art-meant at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. A 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. • 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this �J day of 2 t—t.€6 197r,datt, , California. Dr. Les O. Starnes 3 = ' ted Name Date re,..04115110677, „yip ' Signature NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. NOTARIZATION REQUIRED 0779-46(Elev.2)91) ADDRESS anum 1 / r °[NL 71 UM: OF COSTA MESA — BUILDING PERMIT OWNERS PLUM IF l0lOWll: STARNES, LES 0 TR ehtiN Nu: b Voy ». ADDRESS: 1901 AVOCADO AVE SUITE 308 PERMIT NO: B 084332 PLAN CHECK NO: N tUV1 : N SUFF' : N NEWPORT BEACH,CA 92660 a �ING� CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : REPAIRS: REPLACE DOOR, REPLACE 2 F.J. SQ FT: 18, 502 ARCHITECT OR Ei1 NEER: LIG NO.: ARCH.OR MI ADDRESS: DNT' CLAIM VALUE: 18, 502 . 00 CALC—VALUE: 18 , 502 . 00 GROUP OCC: R-3 / TYLER J CONSTRUCTION CO ( 714 ) 548-8905 CONTRACTORS NAME: 177 E 22ND ST #16 COMMENTS: REPAIR STUCCO, R/R DRYWALL, R/R WOOD SHINGLES ON WALL CaGNACTORS IMAM COSTA MESA CA B661717 ************************************4****************************************** ADDRESS 92627 GC,xo_ ZONING R E Q U I R E M E, N T S Wit SETBACKS LICENSED CONTRACTORS DECLARATION:I hereby Nim under penally of pettily that I ern licensed oder provisions of Chapter 9 (commencing win Division 3 d the Business end Professions y r n a in 1 end ��°i° `�°oe6 �iP "x /97 MAIN BUILDING ACCESSORY BUILDING CRY tic.No. tic.cuss: tic.No.: \ /� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN .� p, ,D R7 ContracNstttor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 0 NER BUILDER(Sedlen DECLAR)031ATION:.5 I hereby affirm«der perely dAnY persly or aury That lcountyrnuwhich reqexamq Iuimres ao 1M ellrlt to Conlradon LIcense.Wier.bLew l«Aha PARKING REQ• P ROV: PARCEL: 42613310 Z N E: REF NO /' bwig ration Buskesa end Profusions Cada: PConstructnpro'.e, llll" mdah, pianystructure.«'vbdaesuence.aiorepairstheepplkzral«pathpemtittoRbasgnedatetanrMMdheorshe PLANNING NOTES> a licesed pursuant to the provisionsal g e Contractors License Law(Chaps9(commencing withof Maslen Section 7000) Maslend n 3 lbs > • Bwinesserd Professions Code]or that he or she is exempt therefrom and the base for Use elbgedexemMen.AnY Malaita Dr Section *******************/if*W*****141(.*r****************************************iE******** 7031.5 by any applicant fora pemd sullied,the applicant to a ail penalty of not more!ban Ise hundred dollars(5.5001). ❑ I.as owner of the property cc my employees with wages as their sole mrnpenarian,will do the work,and the strudrre is not intended D E V E L O P M E N iT - SERVICES REQUIREMENTS or altered for sale(Section 7044,Business rd Professions Code:The Contractors License Law does not apply to an owner of property who bolds or improves thereon,end who does such wort inset or horse.or through he or heremployees, that own provided such ZONING APPROVED BY `� rDATE: improvements are rot intended or offered f« . sale. ,however,the building or improvement s sold within one year of complain,the ownereuilder sill have the burden of proving he or she did nal build or improve f«the ptvpoee d sale). • ❑ I,asownerdthe property,amexclusively contractiewith licensed contractors tomwtideproject(SectSion,Nosiness and BUILDING APPROVED BY; ,. / / DATE: Professions Code:The Contractors License Law does not appy b an owner d properly who bWds or improves thereon and who �' / =lands for roach projects with a maradon(e)licensed pursuant to the Contractors License Law/. /�r ; .I A I am exempt under Section: B.A P.C..for this reason: APPLICATION ISSUED 'BY— /I 5 DATE: t .( ❑ ******************************** t *** �***** **** ************ t ** • Dale: owner: LEGALIZATION:N FEE SUMMARY STRUCTURAL SEGMENT:Y I do hereby caddy that I am aware of and understand the requirements of Celfomia/lea,and Safely Cods Sections 25505.25533.end 25534.and that nor anyhdure bulking occupant wig/wRrel(circle oro)need t complywih said mate codes and Me requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit foro:mmctenor modification from the Air anagemrJ District.Residential constncdbn applications are exempt Irondiet* PERMIT 274 . 75 1 . 85 provisions. SMZP/NON—RES Date: Applicant: PLAN WORKER'S COMPENSATION DECLARATION:I hereby elfin"under penalty of perjury one of the tolore g decirm'as: ISSUE FEE t ❑ I have and MI maintain certificate al consent to selfinsum for wakens'compensdion.as provided tor by Sleben 3700 ol the Labor BUILDING—DIV—> PERMIT ISSUE PLAN'—CHECK TOTAL PAID DUE Cede.for the performance ddie work for Mich this permit is issued. TOTALS----> 276 . 60 0 . 00 0 . 00 276 . 60 276 . 60 . 00 ❑ I have end MI maintain workers'compensation insurance,as required by sedian 3700 of the Labor Cods,he the performance d the work for which thisprmuessaw.Myworkers'compensationnsuranensnirwpogrynumberere: REVENUE DIVISION TOTALS--> COLLECTED: 276 . 60 OVER/SHORT: . 00 Caner BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Policy Number. 274 . 75 , 1 . 85 gus section need not be completed(Ve pe mi S for one hundred dollen/11001 or less.) I certify that in the pedmrerce dlhe workhc which this peamue issued,!shell not empMany mason many mann so ea to **********************************sTF**-"***************************************** become on 0I th�ens wdersn1:037011071:: ao datte alabw«s cdodCeadoraD. f«andwagree that 4 I should become subject to the workers' INDIVIDUAL F E E BREAKDOWN Dat �f . ) / •7 Apgirats. m TYPE QTY D E S C R I P T I 'O N, UNIT COST TOTAL COST —warning:Failure to securehou compensation coverage Is unlawful,end shall sub*"an employer to criminal penalties and I chonehundredill fines rep to hundred ed thousand dollars(slogann addition to Ms cost of compenseUorc rapes as provided for In Section 3rosof eLabor Codalnereatand attorney's feesSFR 18502 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 18, 502 . 00 CONSTRUCTION LENDING AGENCY: I hereby elfinthere is under penally of perury that a construction lending agency for the ENDS OF FEES performance of the work for which the permit is issued(Section 3097.Cir.C). LENDERS HAMS: A LENDERS ADDRESS: ' I I candy that I have read this application end alae that the above information is c«res.I agree to comply with all dy end county odneces I and stale laws relating to bulking construction end hereby authorize representatives of the city to enter upon the abase-mentioned property t«inspecSompureoesa. STEVEN GRIPPZ AUG 2 01997 Pr— �/ /� CITY OF COSTA MESA ( Signal.'!%- - ApecVkaNT.errr Appa« C/ O.: a0 /L (Sl5tJ5.WP) Whim-Buldis 8sdGreen-RI.: Pink-Revenue;Goldenrod-Assessor __ __ _ CONSTRUCTION AND PLANNING PG 1 SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. 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. t0. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final I 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains • 64. Plumbing System -,Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit • - 66. Solar System-Final ..16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign '68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 9.�7 l 76. Dry Standpipe 28. Lathing& Siding 4. )J•'7 77. FIXED SYSTEM FINAL 29. Insulation 11/0" (17 1 78. FIRE PREY. FINAL :-' -30. Drywall Nailing 159-.frt... adz-- HEALTH DEPT. REQUIREMth'1L' 31. Plaster Brown Coat • 17' 7 ZIA- 79. FINAL INSPECTION 32. Electrical Power Meter-Final 60. FOOD CERTfFICATF ISSUED "f ///� 33. Final Electric Notes: S atm(7 ( c7k_ /�^,y1/1__ 34. Final Heating& Air Conditioning V/d'r ✓ anti., 1A44,- '` 35. Final Gas Pipe-Test /G • 36. Hood or Canopy • 37. Final Factory Fireplace • 38. Final Plumbing 39. Water Service-Final 40, Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. FINAL PLANNING / 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date i CITY OF COSTA MESA BUILDING DIVISION F •i "41 DEVELOPMENT SERVICES DEPARTMENT PERM T NUMBER 4. IPA PERMIT 41ta,,,aRWED P02-00253 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 177 22ND ST Status: ISSUED Suite No Applied: 04/23/2002 Issued: 04/23/2002 Vicinity: Parcel Nunmber: 42613310 ISSUED BY: Applicant: THEANDER, RANDY Address: 1531 W FIFTH ST Phone: 714-953-1111 SANTA ANA,CA Zip: 92703 Owner: STARNES, LES 0 TR Address 1401 AVOCADO AVE NEWPORT BEACH,CA Phone: SUITE 210 Zip: 92660-7769 • Contractor: JOHN FLYNN ORANGE COAST PLUMBING, INC. • Address: 1531 W FIFTH ST • Phone: 714-953-1111 SANTA ANA,CA Zip: 92703 License: 596002 Arch/ Eng: Address: Phone: Zip: • License: SCOPE OF PERMIT INSTALL NEW GAS MAIN SERVICE AND PIPING • FEE SUMMARY • AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 - Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower • . $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00" 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $43.10 COMMENTS/SPECIAL CONDITIONS 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)7545626 2446-46(6/00) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is Issued. J1 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 nIInsurance carrier and policy number are: / 9� Carrier:_� (Clt•'YizJ—(•y(fj�(/7�}.7(JeU _L./' �IOK�! (Policy Number—u•!L�//95-3.417? (Thls'sectl n need not be completed if the permit is valued et one hundred dollars($100)or less.) --- ❑ I certify that in the perform.• of the work for which this permit is issued,I shall not employ any person in any manner so as to become sub'ect to the workers' compensation laws of p;lAj'}0a,and-gr.• . y:uld become subje t to the workers'compensation provisions of Section 00 of the,L�Jaibor Code,I shall forthwith comply with these p�,. • s. / / '?/ 1 a ApPlloantSigr ture:yea, _r Dale:—"> C�� `/ WARNING:FAILURE To y��-Co-E WORKERS ••••ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLARS(5100,100).IN ADOrON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prof sions Code,and my license Is in full fort-rand effect..Lic.d,7 59 0 ( Class a--• C///3 ContrContrContractors Signature: ��' ��`or — C-- -- --t 2?��Z x. 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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). . ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 Calif omia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes le No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management Diarict 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 S correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. :ere nt . /�L!//`G. CODE f INSPECTION TYPE /// PAIL LNBRAU CODE# JNSPECTION TYPE R U EMU 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 5. I—O a -Err 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 .4 . 8t-2 'LT EEL LEW COSTA MESA BUILDING DEPARTMENT /- la: S9 v u P.O.BOX 317 FINANCE DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING ` �.�S,F � - _ BUILDING ADDRESS rt '- Y1- COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY �,(\ /�v `r` RECEIPT NO. �J-PPE/RMIT NO. I OWNER •>, ,L r at CATYRIn \l Ril S / F VEO BY DATE R CEIVED O E ISS MAIL ADDRESS �i ��� •k ' i_s y ..... (7/) �� �SOI\CC``5 ��� �X �'n ��`a ` TEL '^- %" q BUILDING / '7 -+j L•Z� CITY NO, ADDRESS / / ARCHITECT LIC. OR ENGINEER`\Cb&- (\�QNc\Cf,„Ls NO. COSTA MESA. CALIFORNIA FIRE ✓z.a{B €c & ADDRESS`);k C -.( a--.4...‘1%tTF � ZONE CIT I CNO.OF . / e Sp / ZONE PLANS TY E op UP CONTRACTOR NO,,_V-, .cf7 i f /�I' TEL APPROVED Z ADDRESS t7 3_s—,...44.4.7-61-1/4-4.4.7-e"� NO. ad� BY ��Te DATE 174/ LEGAL LOT CORRECTIONS DESCRIPTION NO.,(8l/v- BLOCK -,O i SIZE INO.OF SLOGS. ,^ 1,2e. 72 - OF LOT NOW F LOT V /� AL{�/b''(/� /—rsy USE OF HOL FOR ^^t?^'+ r '1 T�y � EXISTING BLDG. J ,*,F ,,•1, pppp ` IlJ / ' t 1 SETBACK LINE FRO ^,5V 1[/�p N` APP ri_r V • 40 CENTER OF STREET /.� RdR VA 0 �lS iii 11 YYYY ef���� I CITY O. COQ t 11 r..>%� SIDE YARD RIGHT (IJ"`" LE T /0 p1 .1, NI'r, n<PT DESCRIPTION' // OF WORK' SUBJECT 10 BLL.C. DLYT. REG. NEW V ALTERATION ADDITION 4 I g• T.s�ariei ✓ REPAIR ! MOVING I DEMOLISH PLAN T. C• . I BUILDING NO.OF 'OF SIZE 502t,•-1 ROOMS ' STORIES Z 1A�,t. V y r, to EXTERIOR WALL ROOF b vz r ,L : I '� i•I {�. 4a COVERING .'fNA,(L4.4D COVERING'$N�*L..,c-a,c4 --•1 1.... % W •J USE OF NEW \R4,W ��ai\kt ♦ , .' r �, it 4 4 f.-•p, I•� TM BUILDING p ' 7 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND A I It CITY ORDINANCES ASTATE THAT THE NNDEIS STw EO LAWS REGULATINGTO BUIL • C•NSTRUC VAR. No.ITH ALL FF'ItOVED 7-+S TION. 1 VALUATION �T—iy SIGNATURE •F PERMIT FEE S 6I V . PERMITTEEc + V . \t- ,a S 4(f / 'J 2 PLAN CHECK S an,5.0 AUTHORIZED AGENT TOTAL FEE 5 qI, \5-0 VBwh 41/4 OWNER HUFF,'RICHARD A. & CLOMA A. DATE 2-17-559 JOB ADDRESS 177 E. 22nd St• building "A" Unit 1 BUILDING PERMIT NO. 8412 GENERAL CONTRACTOR R. A• Huff. VALUE $ 111,113.00 AP. No. LOT 282 TRAC'I4ftFIRE ZONE 3 DESCRIPTION OF WORK Fight Plex GROUP H TYPE V ZONE Rit PLAN NO. 802 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED _ DATE NUMBER Trenches Forms Steel j�i ff , ._Jq-,$ el Floor System I Steel Reinforce Chimney Re-Rod Bond BeamY.,2 _,5,7 3 -V -3,„? h5 Frame and Flashing171 '-�, Lathing, In Out yf1- t:A el-.,, q Plaster, brown coat S-- --, 4- S -di / Underground soil/WS WIG Pipe TestrVAM a...-1.42--.S-Co' Top Out d.-74ir/ Furnace Gas Vents Rough Plumbing . '-4 1-/O—sty f/.(z.t, .>7—/cfr ; / 7,..7 �� t4 Cesspool Septic Tank j Prop. Swr. Lit.....- Houses St. Swr. '9 t.-q pi �L?tC 2. >-?13-1 lJ $'b'7C Sprinkling System �is,„--• /4)ot /21?O r — Heating Final 4i- /S'Vg Plumbing Fixtures, Final2.q- W-f dj-4/ t Final Gas Test AW- h/-/S•S� • Construction Pole Underground Power 4C/^ i r zd'TU v > Lf- .1-3- h-`) `�/.7Rough Wiring ,W3 7-J,('Se1 t ilex A _1-2i1 "i f / ems/ e•--- -• Fixtures, Final `, •OCCUPANCY / _ \ Form 210-5M-1-57 NOLO) rOR 'ECTAL REOUTREMFNTc UNIT 1 017.2 OWNER HUFF, 'RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "An Unit 2 BUILDING PERMIT NO. 8111,2 GENERAL CONTRACTOR VALUE $ AR No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. Rfli INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System /C"""0-,_ Steel Reinforce Chimney Re-Rod 4 _'Jt_ •-•,i, - S Y Piraiqq j4//t.e Q Bond Bram 4, 3 -In--C9 Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil /Mt t$ WIG Pipe Tent/A2-2o -S'6 Top Out 4T'-eV Furnace Gas Vents Rough Plumbing Mil-S 3/a-5'y Cesspool Septic Tank ' Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final /2 OS /j_ /Y'ce/ Plumbing Fixtures, Final L.j./ 44-ft.Ske _ Final Gas Test kW' 4_141 cr _ Construction Pole T Underground Power D�r,i«itg5/"I' Rough Wiring �� 7r/Cnt�/ /...14..a ine -.0—s 7. . / cY._/ Fixtures, Final 1/..--"- // /„...b.,14 'OCCUPANCY 141e'X --t c9 Form 210-5M-1-57 OLD FOR SPECIAL REQUIREM£ SUNIT 2 8412 •OWNER HUFF. 'RICHARD A. & CLUMA A. - DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "A" Unit 3 BUILDING PERMIT NO. 8h12 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OP WORK GROUP TYPE ZONE PLAN NO. 8412 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil 4'M-5 W/G Pipe Testi/M.512-2A b'1 Top Out :6-19.S0 Furnace Gas VentsI _ Rough Plumbing /II}/-( g-AO-.SY Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final . "'Mre./ Plumbing Fixtures, Final j, y/ V-/k=} Final Gas Test k WI bi/r- S— Construction Pole "L_ Underground Power J '''^ ��`y� Rough Wiring PC"; •5'//•CO Ji1M-e-C e4-cat.,:, 2-2it-s-_ /iC 3/ Fixtures, Final WOCCUPANCY � to 12:7-7 Form 210--5M-1-57 HOLD/FO SPECIAL REOUIREMENTSUNIT 3 8412 .OWNER HUFF, •RICHARD A. & CLOMA A. DATE 2-17-54 JOB ADDRESS 177 E. 22nd St.. Building "NA Unit. $ BUILDING PERMIT NO. 81112 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 80.2 INSPECTIONS I DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil 4445 WIG Pipe TestWc -2 a—p Top Out 4•111-./ _ Furnace Gas Vents Rough Plumbing 44,L( p_yp—rci Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final C///y 5-C- Plumbing Fixtures, Final L Final Gas Test .L'V 4/—/>t57 S1, Construction Pole/ Underground Power � �� f-X/i;� 7/• o'/. jy t r 5L- _ l Rough Wiring dlYi'i ?'/c/fro -�.{.e/c2i {�iT3.-�. —�d—5 k". Fixtures, Final //j. /yyff •OCCUPANCY Form 210-5M-1-57 r, iAB . ' et.1AL IREQ(J/REMENTq UNIT 5 8412 • -OWNER HUFF} •RICHARD A. & CLOMA A. DATE 2-17-59 _ JOB ADDRESS 177 E. 22nd St. Building "A" Unit 6 BUILDING PERMIT NO. 8h12 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK _GROUP TYPE ZONE PLAN NO. R41e PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam .. Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil/Intl W/G Pipe Test44,C1?-2,,_J-2 Top Out Z-/9-574 I Furnace Gas Vents Rough Plumbing AS'< '_A8-re? Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final 0,2M, Vim f-9 j Plumbing Fixtures, Final ,( J/}' zj•►/,S;frp _ Final Gas Test L le" 01-15 J/ ��G, Construction Pole ��erse. Underground Power air Rough Wiring / / 2_ . / o _ Fixtures, Final jJ y� - OCCUPANCY 147�v� �f=2'I-� For" 210-5M-1-57 HOLD FOR SPECIAL REQUIREMENTS UNIT 6 8412 • •OWNER RUFF, 'RICHARD A. & ULOMk A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "Aw Unit 7 BUILDING PERMIT NO- 81112 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 8412 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod I Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil/yj/-s W/G Pipe Test/44('2-20-3V Top Out Furnace Gas Vents Rough Plumbing 14.1-5 ?-/O -57 Cesspool Septic Tank Prop. Swr. Line House Con.✓ St. Swr. y-1 -J,g . -- j-21,6-9 /<moi Sprinkling System ' Heating Final 4.9Jif - i Plumbing Fixtures, Final ' tote {/-hrd/ Final Gas Test Construction Pole Underground Power Rough Wiring "'WA- �t.rC/ - • - -- '- -— - -Fixtures, Final O VJ /.. i7 .OCCUPANCY �j�i'�-9!Z�- Form 2I0—SM-1-54 HOLD POR PECIAL REQUIREMENTS=SIT 7 8142 •OWNER HUFF', •RICHARD A. & CLOMA A. DATE 2-47_59 JOB ADDRESS 177 E. 22nd St. Building "At' Unit 8 BUILDING PERMIT NO. Ail 2 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. ^tll2 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod I Bond Beam Frame-and Flashing Lathing, In Out Plaster, brown coat Underground soilW3 WIG Pipe TestfltS1-io-e-0I Top Out a-/9-ssy Furnace I Gas Vents Rough Plumbing /V}{-f ?_/4-_sy _ Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System • Heating Final /S 4//,Z.,--/ Plumbing Fixtures, Final (A/ �! ♦ Il_ 'Lib. 1-/P-r /7 44o ----- Final Final Gas Test 2-F •T//Seq r> �� \Construction Pole Underground Power i Rough Wiring _{� ,� 1t�y // Fixtures, Final . // tow ,7 ��"tt'�{O'�'7'�"`J � T 2^���-9 /rP�' d cice. aOCCUPANCY F/ / / / Form 210.-5M-1-57 HOLD FOR SPECIAL REQUIREMENTS UNIT 8 8412 "OWNER HUFF. 'RZCHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "A" Unit It BUILDING PERMIT NO. 81112 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. '12 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System I Steel Reinforce Chimney Re-Rod I Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soilA4tC W/G Pipe Test/11}(1a-219S/ Top Out .-+9'-Sy I _ Furnace I . Gas Vents Rough Plumbing /M-( 7-/a•-e4" - _ Cesspool Septit Tank Prop. Swr. Line House Con. St. Swr. _ Sprinkling System I I Heating Final ///J% Fr:/S' 5-4 Plumbing Fixtures, Final r y✓I W-f3 -J9 Final Gas Test A ys- JadS'-11 n Construction Pole \" Underground Power - � Rough Wiring - . - _i _ -e - '„ Fixtures, Final r2/1 /� i — --- -OCCUPANCY APAY "/.i gI 6 Form 210-5M-1-57 HID FOIz SPECIAL REQUIREMENTS UNIT- 11 81412 OWNER IIIIFF,_R CIJARD A. & CLONA DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building °B° Unit 9 BUILDING PERMIT NO. 81113 GENERAL CONTRACTOR R. A. YHuff VALUE $ 47,698.00 AP. No. LOk82 TRACT HIhisFIRE ZONE 3 DESCRIPTION OF WORK EightPlex _GROUP H TYPE V ZONE RIl PLAN NO. 413 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR g DATE NUMBER Trenches Forms Steel CZ.,.....- -4 .. -tc, -7 Floor System _ Steel Reinforce Chimney Re-Rod itz.4 1..c' -s. ;t' Bond Beam _ Frame and Flashing a/E-t. 3 -/7. i Y Lathing, In Out a-*.- 3 - -i` Plaster, brown coat R-. g. tt 4 - se —, Underground soils-i W/G Pipe Tcs{4gq-j 7=-3a G-P , Top Out 1ti4-6y • Furnace L Gas Vents ((�� • , Rough Plumbing L W 3//-6-7 /6/L :tldj.,_,: 3 -- o.,-/et--c7 l 7 41/ Cesspool Septic Tank 1 In Prop. Swr. L Hous{°,L'by n. St. Swr. N'4)-`I /' ..,),,L. 1't-1s '#c t'V , f y7I 11 Sprinkling System I 4 Heating Final Plumbing Fixtures, Final 's Final Gas Test 7 r�,jp iii-9449 Construction Pole %%%%4444'"' Underground Power gg /y�y_ �y Rough Wiring • s/iY.r.ct_�eiA: ...4.r"tr :2.r-- r�,//,pY L� \ ‘) Fixtures, Final - nti k11'f`/ / OCCUPANCY ,LQ{I,P -'27- Farm 210-5M-1-57 • HOLD OR SPECIAL REQUIREMENTS UNIT 9 8413 OWNER HUFF. 'RICHARD A. & CLOMA DATE 2_17_59 JOB ADDRESS 177 E. 22nd St. Building 1bB" Unit 10 BUILDING PERMIT NO. 81t13 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 53413 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel I 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 kV ?./,--5/' Cesspool Septic Tank J Prop. Swr. Line House Con. St. Swr. Sprinkling System �/ ,ii Heating Final Plumbing Fixtures, Final ti-- t✓ V74-49 Aro Final Gas Test 1W1 A,Vy/.. Construction Pole �!_ �7 aiq Underground Power 2_� 2-2._r� jir Rough Wiring -"de -7 4_` i Fixtures, Final y1? r,i -OCCUPANCY ,49 ,9-2,1. \ Form 210-6M-1-57 141.11.11 cm corrrAT, prnyprnrn rwrcUNIT 10 • 3 -OWNER HUFF, lRTCHARD A. & CLOMA DATE 2-17_59 • JOB ADDRESS 177 E. 22nd St Thti ldi ng "RB TTni t 11 BUILDING PERMIT NO. 8b.3.3 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 80.3 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE I NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod I Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test Top Out _ Furnace Gas Vents Rough Plumbing L, ly/ -47 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final2_N' I Final Gas Test )L 12.in,1�T- 5'Q Construction Pole 1 'T Underground Power r/ Rough Wiring -Ar � ./)I�l — _ e _c" '� Fixtures, Final , v. 'OCCUPANCY resi Form 210-5M-1-57 I Y :rq 3 MAT.n FAR SPFCTAL REOITIREMENT OWNER HUFF. RICHARD A. & CLOMA DATE 2-17-59 • JOB ADDRESS 177 E. 22nd St. Building itB° Unit 12 BUILDING PERMIT NO. 8613 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. A413 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches 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 Min= Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbin. Fixtures, Final /7 �/a*JQ�� Final Gas Test / priar rn onstruction 'ole �_ • — Underground Power r Rough Wiring �r _ _ Fixtures, Final '�• -`� �S -^OCCUPANCY• •! -OWNER HUFF, 'RICHARD A. & CLOMA DATE 2-17-S9 • JOB ADDRESS 177 E. 22nd St. Building "B" Unit 13 BUILDING PERMIT NO. 8141; GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 81113 INSPECTIONS DATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches 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 / n/J t' .l Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. . Sprinkling System Heating Final • Plumbing Fixtures, Final //J h/I J/-2j_ I I - Final Gas Test WALL fig/ )/--.2/- 1 I Construction Pole N - Underground Power ^A_ Rough Wiring - • • . . - _.• - %/_ ♦ % Fixtures, Final "i-' =OCCUPANCY An., y5 Z..rl Form 210-5M-1-57 HOLD FOR SPECIAL REQUIREMENTS UNIT 13 6413 • OWNER HUFF, •RTCHARn &. & CIOMD DATE 2-17-59 ._ • JOB ADDRESS 177 E. 22nd St. Building FA* Unit lit BUILDING PERMIT NO. 843. GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. INSPECTIONS DATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches 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 I Top Out J Furnace Gas Vents Rough Plumbing / p/ .1?-441 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System • Heating Final Plumbing Fixtures, Final 2.11/ {J{� Final Gas Test del-e L!/ 7-./_0s-9 Construction Pole Underground Power o'' T eti Rough Wiring 1ii Z--2.0 's� 2 � Fixtures, Final 4e) 711 :;09 •OCCUPANCY -Ste Form 210-5M-1-57 HOLD FOR SPECIAL REOUIREMENTSUNIT w 8h13 OWNER H1JFF, •RTCHARD A. & CLOMA DATE 2-77-59 _ • JOB ADDRESS 177 E. 22nd St... Building nRn Unit. 15 BUILDING PERMIT NO. 8413 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 8413 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil WIG Pipe Test Top Out Furnace Gas Vents Rough Plumbing �, W Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final ii..14/ Final Gas Test 11141kt/ yj/.Jtj Construction Pole Underground Power ee.. Rough Wiring � � fs' 1 2 —3_O a2esL Fixtures, Final vi'rN7 =OCCUPANCY APE Form 210-5M-1-57 f HOLT) MR SPECIAL REOUIPFMFwm UNIT 15 8413 -OWNER MIFF, 'RT('HARD A- R, rirnma DATE 2-17-59 _ ' IOB ADDRESS 177 E. 22nd St. Building "B" Unit 16 BUILDING PERMIT NO. 841.; GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OP WORK GROUP TYPE ZONE PLAN NO. 8413 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel ,53.--c.....-*; , .9/c.-_f9 Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing g -3'161-.2 I Lathing, In$( Out)( ,f$$ 4- Q.Zt( -,,f q' Plaster, brown coat Underground soil W/G Pipe Test I Top Out l Furnace Gas Vents Rough Plumbing A N/ g-7/(.-.4"9' Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System ' Heating Final Ki n.rib. / I a-/ c(-t''1 I7.). v/ --- Plumbing Plumbing Fixtures, Final / /A/ 4_2/-611 I / Final Gas Test , -,6 (( /<-9!-h( Construction Pole _�� .) Underground Power / LI- y �E' �un Rough Wiring .�7,h-� eat. L2--1 ,/-S/ l c.) i i Fixtures, Final �.12 ir-fff "'^^^ I \ -OCCUPANCY AQ/(%° Y yi— I Form 210—SM-1-37 unr n reto cnrrtat, RFOfimrMr'wrc UNIT 16 8413 • 8413 �l I E.CE1 Lb b. COSTA MESA BUILDING DEPARTMENT /- iii- Jy Yy P.O. BOX 317 FINANCE DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING S BUILDING ADDRESS . - COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY /� RECEIPT NO. PERMIT NO. OW NER�,C1\ % C `\{'1��\�,-A -%\ O T MAIL rT C�EIIV,(ED BY DATE RECEIVErSo OAT I55 D ADDRESS rt ly�Sge.iff�, .�, -PNvL % — I �C `J L al/ 7 5, cK . \ TEL.S �Z \ BUILDING 7 �_ '- ; CITY `'� 1 ,�c NO. ADDRESS 7 L Z ARCHITECT (1 a \\t‘,,..\,” � ` ” `,LS NO. LI C. OR ENGINEER`\l \Ul`n`A,\ 3COSTA MESA. CALIFORNIA • FIRE A DO RESS ��' T. a�P + k-C� ZONE yN , C LIC ZONE_ '/ NO.POF TYPE/ GROUP CONTRACTOR �jYl 1t NO. /{(A)��////- V TEL. APPROVED ' /fit,.�',� 2 ADDRESS NO. Y ( l ""1 It TE /,// LEGAL (J� /,./�/y/�/q CORRECTIONS DESCRIPTION NO. /5 p1 BLOCK _Y�� /1 • ////)�'" • A.P.NO. (-�Ay�'L� �—, C7 SIZE NO.OF BLOCS. Scv "� OF LOT '5/D1}}}111///x` NOW OBN�11L��.LOT VrD I EXISTING BLDG nn C^7^-1LIsE ,- SETBACK LINE FROM // // ' CaT t3 -.TA I \ MESA CENTER OF STREET \ REAR ARD 51 ' / ITL, it-,N1 DEPT. SUBJECt To BLDG. DEPI. Hti. SIDE YARD RIGHT LE � DESCRIPTION OF WORK 6‘ A1PTF4 7= NEW K ALTERATION ADDITION PLAN T:C . / REPAIR MOVING DEMOLISH ¶. V 1 P p {Ji r.rY :1 BUSIZE IDIN A?, ROOMS STORIES �� 1t/�F3 TiI! i.1 '�1 COVERIOGWALL ROOF11C�D COVERI N,� �`.� ( _ {i((1y /i(^;1, 1 I 1 I' I ,, 1%n \"J.L. `iLp CCCY4C ��f .I USE OF NEWrt, � �\ .� \ \ Fla 4r A '• '�/ BUILDING \ y \-L. L>,ai\1�l(' J a— -�) p� J�A]pI�F `' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND VAR, IC�� �� AI I I1QV�1]� - STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDIN NSTRUC. TION. t VALUATION ��1 ' SIGNATURE OFC-7 .., //�� \ PERMIT FEE S 7. V V PERMITTEE \ /�.V . ry ff111VVVVV y7 /G y PLAN CHECK 5,3 3 -S 0 5 (9 r C O Iuir AUTHORIZED AGENT TOTAL FEES D 6 . 5 8414 : (' EkCUVEU /. ,4-5/ uU COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA 11ESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING !-�^ /'�(r' /+ BUILDING ADDRESS .1., l f -1 .,2- SC• � q `�I COSTA MESA. CALIFORNIA \ FOR OFFICE USE ONLY \\\\ /� /� (�/j/y+^ RECEIPT NO. PE R(M�I NO. OWNE R CG�'�Y\ ck.�KL--\�N�L \.otYL \\ /! -/ lln MAIL R� Lf ^ I�v I Drn '�E E�C' DA/Ev E ADDRESS -23:,--3;c----..,c,...., r (C-/XV V TEL. BUILDING '7 l� �7 i/.� ' G CITYC �n - NO.�;��$O� ADDRESS /77 L ARCHITECTc� [ LIC. OR ENGINEER6 Hwl.kttys NO. COSTA MESA. CALIFORNIA ADDRESS �']_t) /L`a�y ,7,ive,� ZONE 3 �` ZONE NO.OF TYPE GROUP L \�-y CI LIC. PLANS CONTRACTOR NO. //�i�Yrj1�� ADDRESS TNO..''''"yJ��[j APPROVEEL. B ��� ATE �/ / / �7 LEGAL DESCRIPTION NO?c K� BLOCK T1(QC�/t• •' 7� CORRECTIONSi rip/ , S//1VVV - n -6-7 SIZE I NO.OF BLOCS. /� OF LOT Now ON LOT An?I 1 O r USE OF ^ ^ - OV pVf EXISTING BLOG.HOLT�/AOR SPECIAL ,�tE tJI L • N. . _ SETBACKLINESTREET FROM J2'Q� /�/J' 2c' • 1 • •, I� CENTER OF SE FROM /T REXR YARD /v Pi,-.:.Ni.,;(..; DEPT. BHT LE DV ‘ SUBJECT TO bLUG. OLET. REG. SIDE YARD RIGHT LEFT � DESCRIPTION OF WORK riffirir' n MILMIllaillElla NEW ALTERATION I ADDITION 71 REPAIR MOVING DEMOLISH rir, BUILDING 54"-D�.aA NO.OF11SIZE �^ -AO W ROOMS STORIES EXTERIOR WALL ROOF ii ti COVERING �7�L�C11 COVERINGgUI\,k\ i.c3c USE OF NEW p 996 L11 ir 07 I BUILDING v `.• Is • ,Y 8- 1 k¢ IATE a 4_14 ,I The. 'I I 'am,11 Pry 111.T.• , ;, I I I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND purpose of establishing a permit fee only. i STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY OROINANCEB AND STATE LAWS REGULATING BUIL STRUC• TION. r� VALUATION SIGNATURE OF I / 0� /`n PERMIT FEE $ c,PERMITTEE n f 'Y" •�( S` -. $ L 7 /q PLAN CHECK S6 I 7 / (� ! TOTAL FEE S I • 5t) 9ir AUTHORIZED AGENT T OWNER WWF?, 'RTCH D A. & CLOMA A. DATE 21749 _ • JOB ADDRESS 177 E. 22nd St. Building "C" Unit 17 BUILDING PERMIT NO. 8)414 GENERAL CONTRACTOR R. A. Huff VALUE $ 117,698.00 AP. No. LOT 282 TRACT gtS jFIRE ZONE 3DESCRIPTION OF WORK Ei erg Plex GROUP H TYPE V ZONE R4 PLAN NO. 8411 INSPECTIONS DATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER L Trenches Forms Steel c/�ir 1 -.2.4---.CV Floor System Steel Reinforce Chimney Re-Rod _ Bond Beam £/t-X r t —/(s-.5 X S Frame and Flashing -.--- f 'q / C - ��/ Lathing, In Out -- 'a .3 -Sq.9• S J Plaster, brown coat St1��-;A .1) , `' S)/ Underground soil kf W/S.Pipe Test44tC e - 4-3Yj Top Out -/P-41/ _ - Furnace • Gas Vents (� . Rough Plumbing ;-/?-7.5 /4 7,/t cI '.tc • k>2—/K-Sy /Z?512_. Cesspool SepticTank Prop. Swr.tine Hop¢(Con. St. Swr. 4.4 tf 5'q- 7„(..,e,,, 't-( 2-4/3-'1 I ,S3-7 1— Sprinkling System Heating Final Plumbing Fixtures, Final A kr /7--r' Final Gas Test L. it/ I1-17-4-' Construction Pole . Underground Power i _ - e`— Rough Wiring •-i?../1 ;!II�.v-a- -, mo o.. .2--7 ,3-" .i+7 )._r-_ - Fixtures, Final — .- - -OCCUPANCY is -ay- . Form 210-5M-1-57 H.LD FO• SPECIAL REQUIREMENTS UNIT 17 811111 OWNER HUFF, 'RICHARD A. & CLCMA A. DATE 2-]7-59 • • JOB ADDRESS 177 E. 22nd St. Building iCtt Unit 18 BUILDING PERMIT NO. 8411 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OP WORK GROUP TYPE ZONE PLAN NO. 8(111 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER L Trenches 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 /4-AS 3-"3-s? Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final 4-W If"/7-5 Final Gas Test ik,14. 1L.t/''_ Construction Pole `7 / . 7j Underground Power y- -p //�/ `p, '/ e, y �e- Rough Wiring / -/9 d!ji Yl�sr.�j/�-t"). &-•ZY s �o7 l 1 Fixtures, Final ,1 4'�l; 'it OCCUPANCY 4r a,-V U_ 1.y -,? y Form 210-5M-1-57 / 1 \ NOM FOR SPFCTAL RFOOMFMFI rs UNIT 18 8414 OWNER HUFF, •RICHARD A. & CLOMA A. DATE 2-17-59 • • JOB ADDRESS 177 E. 22nd St. Building "C" Unit 19 BUILDING PERMIT NO. 81:1�f GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT EIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 84114 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches 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 AtL5 3—/J-4-t9/ Cesspool Septic Tank - Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final / Plumbing Fixtures, Final 2. « *HMV Final Gas Test I y,/ q-i;— 9 - Construction Pole T �T— Underground Power / � -� Rough Wiring —7t—)IA�.�-Lf � �. c��� Jy O a� Fixtures, Final OCCUPANCY 4 C // 7. - Form 210-5M-1-57 HOLD FOR SPECIAL REQUIREMENTSNIT 19 Uli1L OWNER HUFF, 'RICHARD A. & LIMA A. DATE 2-17-59 . • JOB ADDRESS 177 E. 22nd St. Building "Cu' Unit 20 BUILDING PERMIT NO. 8111!1 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. $J11 It INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing Lathing, hi Out Plaster, brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents Rough Plumbing 7.44 5- ?-/3'3t Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final 1,41' Final Gas Test • Construction Pole Underground Power • / Rough Wiring .�—/��� 4 . _ a.. - -244" I - -- - Fixtures, Final 7 �IIMMI OCCUPANCY anForm 210-5M-1-57 OLD FOR SPECIAL REQUIREMENTS UNIT 20 ;N • OWNER HUFF, •RICHARD A. & CLOMA A. DATE 2-17-59 • • JOB ADDRESS 177 E. 22nd St. Building "C" Unit 21 BUILDING PERMIT NO. 841(1 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 841h INSPECTIONS DATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches 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 /!�/—lS i—/3-5-9 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final A. W 11a)--3 Final Gas Test 1„ W 461;- Construction Pole . '� Underground Power • // _ > \ Rough Wiring A/•-el izif���N/- a7, (i'sy .y�/6 lam_% =S _ Fixtures, Final ft Li/,LZ.fc� OCCUPANCY 4.(I',. ,t/.a.a— Form 210-5M-1-57 HOLD FOR S ECTAL REQUIREMENTS INT 21 Ball OWNER .I 131 . . ; I : Qu: : DATE 2-17-59 • ' JOB ADDRESS 177 E. 22nd St. Building "C" Unit 22 BUILDING PERMIT NO. 8111 Jl GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 811111 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches 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 ,4WS 3../3.s9 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final L Fy %I.j9 59 Final Gas Test & AV • Construction Pole Underground Power / , t, Rough Wiring �.r ..-.2 . I / _ / Fixtures, Final / ./(1/1 .f,. OCCUPANCY ,� 17,—).1.-—6—F Form 210—SM-1-57 HOLD FOR SPECIAL REQUmREMrwTs UNIT 22 84114 OWNER HUFF. 'RICHARD A. & CLOMA A. DATE 2-17-59 — ' JOB ADDRESS 177 E. 22nd St. Building "C" Unit 23 BUILDING PERMIT NO. 8414 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. Mil it INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches 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 A*1-S 3-/3-i'Y _ Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final 1._ i9' 4A-/j_99 Final Gas Test 1 * (L./7_c9 Construction Pole t Underground Power /��� Y<7 y Rough Wiring cs 112' � /P-a/ i'CLir.�'c_ ' .21-.�� Or--)/(t Fixtures, Final OCCUPANCY AV e f 1/41.2 S Form 210-5M-1-57 HOLD FOR PECIAL REQUIREMENTS UNIT 23 847.11 OWNER HUFF, 'RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building NC" Unit 211 BUILDING PERMIT NO. AM Ji GENERAL CONTRACTOR VALUE $ AR No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 811111 PERMITS ISSUED INSPECTIONS - DATE DATE NUMBER Trenches Forms Steel Floor System — - Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Undergroun. soil W/G Pipe Test Top Out lin. 11=1 Furnace Gas Vents Rough Plumbing S V- ?.-.(-Q _ Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr.• rr- Sprinkling System 'P. 0 i�l—/ —miu Heating Final - 11111MIN - Plumbin Fixtures, FinalmlUD�7 -1 , . 2 Final Gas Test Ui1 - Construction 'ole —=ni....7.�n‘ Underground Power —_/ ==.10., Rough Wiring �/'� .a __. Fixtures, Final - ���'� OCCUPANCY SW�&-22–a '� Form 210-5M-1-57 R/1T,fl FO' SPECIAL RFOOTPFMFirrc UNIT 2)4 814111 8415 �- �¢—b—y 1/ 1A. .LL,L.O'Un l COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING BUILDING ADDRESS `nn ;, <2_2,14. .5.—k—,S3�q�` COSTA MESA. CALIFORNIAA FOR OFFICE USE ONLY .[� / RECEIPT NO. PEVA IT NO� OWNERTK,A & 9va, L\t,R--'1 /'�lA Lt\s.,1., / RE EIVED BY DATE RECEIVED DR I55 MAIL ^ LI- r ADDRESS '2(3-2 —SV+,-W7'\1i1 V� ,— I Y-59 �� (/ 7 S `I TEL. BUILDING / 7 �-L �1 CITY � n' i-� �R. NL.1�`�-XEA ADDRESS ( 7 1 ARCHITECT LIC. OR ENGINEER\\ \< cAr "LS NO. '{COSTA MESA. CALIFORNIA DOFIRE ZONE / 1`. CITY LIC. ZONE NO.OS TYPE GROUP CONTRACTORCR,Rt.,.' ,(A LIC NO. {J\ y TEL. APPROV D '1 ADDRESS NO. BY a 'DATE �//J� LEGAL T DESCRIPTION LOT ��� CORRECTIONS BLOCK -"o w>�� A.P.NO. (2---24.-'12-.-'/-06-.-11, v-/-/ /�17� S-I SIZE NO.OF BLOCS OF LOT NOW ON LOT LiAPPF1 , USE OF 1 EXISTING BLDOL� Ft In �{fl� ^ (qF T _ SETBACK LINE FROM 1 a CITY 0:= CII ' I ., MESA CENTER OF STREET aa5 REAR YARD �9 p R't`e.. l— p1 L .t.,. . L rl n r SIDE YARD RIGHT LEFT ,� [ // "9 SU BJECf TO BLDG. GE?T. REG. DESCRIPTION OF WORK // ,NEW V/ ALTERATION ADDITION PLAN TC REPAIR MOVING DEMOLISH ..— `rff ' !+ BUILDING SO oda NO.OF �N R 4\ 1:-, 0 F t E,t7 C !L SIZE ROOMS-5'2_ STORIES 2 - a'.v. EXTERIOR WAL ROOF GG11 R, :' in �'I+ COVERING '\Lif_L,O COVERINGvy,\*VyR tt.<\C I1.1 I-. 'Y•1 ti 5 1 I " -: I USE OF NEW h �.:1 Q.'/ L BUILDING ��,-I;,�,; t k\ ^ / �j 3 J f- r .1_z- ±g—e - .1Ic m -Si ,.4 i, - -Ari-PROVED . „'„�. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP Y WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILD C.N$TRUC. TION. /� VALUATION ��`� SIGNATURE O/`�-+ 1 t, \ PERMIT FEE B � ' (/ v PERMITTEE -..C"\•-•-•=4 a $ /I I/�\ PLAN CHECK S 3o. 5 O AUTHORIZED AGENT �(/ TOTAL FEE $ q i , `5 O 19wt OWNER HUFF. RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "D" Unit 31 BUILDING PERMIT NO. 81.25 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP • TYPE ZONE PLAN NO. -415 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil4hc W/G Pipe Test/tffs 1-/R—3-9 Top Out 2.43-59 Furnace Gas Vents Rough Plumbing /y/.jt -AO--S1 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final 4/trif4 Plumbing Fixtures, Final .' 19-12Y-49 Final Gas Test k it/Pe/7,7i, Construction Pole �/', Underground Power Rough Wiring 4e., 34 •c-c, A,A�O�, -2--1 U-57 fi Fixtures, Final /7/fiJ /'/..c ry,�•/_ /'— _ OCCUPANCY /4'e Form 210-5M—I-57 UNIT 31 6415 HOLD FO SPECIAL REQUIREMENTS 4 OWNER HUFF, -RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "D" Unit 32 BUILDING PERMIT NO. 8415 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK . GROUP TYPE ZONE PLAN NO. .15 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel. Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing . Lathing, In Out Plaster, brown coat Underground soil 44'/C W/G Pipe Test4ii,q z-/q -ts, Top Out :4"/X'$7' Furnace Gas Vents ' Rough Plumbing /j//,jg -i.e-yy Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System _ Heating Final /1" ''',/YP. Plumbing Fixtures, Final /T�i/'?-_ Final Gas Test A / Q Construction Pole �_ Underground Power / 1 >_ Rough Wiring rpy T ire/ I / ."--1,1-6 If 1752 b _ S Fixtures, Final ti h�/,' •OCCUPANCY . Form 210-5M-1-57 UM n ma cornea. RFAIITRFMFNTS UNIT 32 RI.,C OWNER HUFF, 'RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St. Building "D" Unit 30 BUILDING PERMIT NO. 8!115 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. INSPECTIONS DATEPERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat • Underground soil/-48—SG 5� 1' /W/G Pipe Test4f{S ,�_/q—4 Top Out � Furnace • Gas Vents Rough Plumbing /y¢fs ?-/d !9 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System _ Heating Final/ /gyp �, Plumbing Fixtures, Final (y .sttr �./ Final Gas Test A-(.f/ Construction Pole /// \`n Underground Power \ s __ Rough Wiring "�'S ?. /1/S"Q il/"LL- .Z /6ct ' eQ--1C�—•1-) /0 /7 Ck— Fixtures, Final ��,t /� OCCUPANCY ��f4d •9/10 Form 210—S1GI-1-57 ��f+C.knTT..T1 PeR cppr iAL RFOTm)n*ae%vpe?JNIT 30 6415 OWNER RIME. 'RICHARD A. & CLOMA A. DATE 2-37-59 — . JOB ADDRESS 177 E. 22nd St. Building "D" Unit 29 BUILDING PERMIT NO. 8I175 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUPTYPETYPE ZONE PLAN NO. INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil/l4-4-<W/G Pipe Test/Vl•/f Top Out 2-/F Ste/ Furnace Gas Vents - Rough Plumbing .`.c T-/p'QYf Cesspool Septic Tank - Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating F al S Fj( tya(.C� Plumbing Fixtures, Final ({/ ./ lt1? Final Gas Test Lk/ / / Construction Pole 44-4?-4-9 Underground Power Rough Wiring y,n2,cc .CL.c.(( -J -2-010 S7 c/ Fixtures, Finalee 4-0,11 OCCUPANCY 4,'lyj Form 210-5M-1-57 HOLD FOWSPECIAL REQUIREMENTS UNIT 29 1f415 OWNER HUFF. 'RICHARD A. & CLOMA A. DATE 2-17-59 • JOB ADDRESS 177 E. 22nd St.- Building "D" Unit 28 BUILDING PERMIT NO. 8415 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 415 INSPECTIONSDATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches 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 Testi%4. -/57_4 Top Out Furnace Gas Vents • Rough Plumbing TS i-ia—S Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final �� ' - Plumbin Fixtures, Final Bali nia Final Gas Test lirrir� Construction 'ole —a� Underground Power IMIMINIrSialthi Rough Wiring Ff 7 ia%6 ,��__ — 1?�� .— —s Fixtures, Final /,.' _ OCCUPANCY %•. . ititaa Form 210-5M-1-57 14 Lb Fe ' SPECIAL REOUIREMFNTC UNIT 28 . 8415 OWNER HUFF. RICHARD A. & CLOMA A. DATE 2-17-59 JOB ADDRESS 177 E. 22nd St_ Building "Dn Unit 27 BUILDING PERMIT NO. 8!115 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. 1115 PERMITS ISSUED INSPECTIONS - DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil 4/.4-S W/G Pipe Testjl -/q"y • Top Out Furnace Gas Vents Rough Plumbing /Y¢fS Ic-io-S9 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final �. -/ fjrl Plumbing Fixtures, Final / /I/ L�-/).3YJ Final Gas Test h' 4Z49 Construction Pole 7 �\ n Underground Power p ����sw /�w� / \ ‘-C-•Rough Wiring �i/�7ICZEI IL alar» 2- Sr �I`7��, _ Fixtures, Final �/�j - OCCUPANCY / � .e* ' e / \ Form 210-5M-1.57 HOLD FOR SPECIAL REOUTRPMPNTA UNIT 27 Hltl OWNER HUFF, 'RICHARD A. & CLOMA A. DATE 2_17_559 JOB ADDRESS 177 E. 22nd St. Building "Do Unit 26 BUILDING PERMIT NO. 8415 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK GROUP TYPE ZONE PLAN NO. ‘L15 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel • Floor System Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing • Lathing, In Out Plaster, brown coat Underground soilWLf'f W/G Pipe TestM1S 2-/9—S9 Top Out - 9 Furnace Gas Vents Rough Plumbing A4"S W-/0-re) Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final t 4'./t'F/ Plumbing Fixtures, Final `v V'/3.47 Final Gas Test A, W 4t-0-op Construction Pole V N Underground Power ��/ ,'l � Rough Wiring i'- in. - _still at'/. -ill- ..056P Fixtures, Final .i.~ OCCUPANCY -. Y* , Form 210-5M-1-57 HOLD FOR SPECIAL REOCIIREMFMTc UNIT 26 8415 OWNER 141T" •RTCHAATI A R, CIOMA A. DATE 2-17-59 .- JOB ADDRESS 177 E. 22nd St. Building "B" Unit 25 - BUILDING PERMIT NO. 8425 GENERAL CONTRACTOR R. AHulf VALUE $ 41423.00 AP. No. LOT 282 TRAC FIRE ZONE 3 DESCRIPTION OF WORK - . Plex GROUP H TYPE• V ZONE R4 PLAN NO. 42-5 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR t _ DATE NUMBER Trenches Forms Steel a.....-tri a -" (• `'S t-j . Floor System Steel Reinforce Chimney Re-Rod • p_ -,j, -s Y Bond Beam Frame and Flashing F- &.--k 3 -//-.37 Lathing, In Out g�f. 1' 3 • /Q •e,� Plaster, brown coat h -- ' - ft 9 •i r Underground soil 114-tS W/Pipe Test/1¢6'2..-,q-,S-9 • . Top Out -te-si _.. Furnace Gas Vents � Rough Plumbing 44,01< x 41-n *<,;toe._C.t .�-wt/• 07/f;7 /1/4?�.--£-- N\ Cesspool Septic Tank I, Prop. Swr. Line— Hous�Qben. St. Swr. 1.410.p yCal.W Lis-4 J)"{ ()7 S-3 t Sprinkling System Heating Final ®,/A %./Ff tf!/ fl Plumbing Fixtures, Final ),-id IV r^14 Final Gas Test p/ )/-/Z.10 I Construction Pole Undg groundg Power SA /.2n•S'.� l _ -2Q-C- pi'? `Rou h Wirin / V- '/2t.<5.—• ..-n. i��e J'R! -2-.-A- / G}i f"Fixtures, Final /7///. /J ,,t,f pi OCCUPANCY wick- 4I-4 y 17 Form 210-5M-1-57 HOLD FOR SPECIAL REQUIREMENTS UNIT 25 81L15 8416 L ,-%1L c i- Tit-s? V b. COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O. BOX 317 CITY OF COSTA MESA COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING 1SS\ev 1 .9-- A _ C fit* BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY CC /� RECEIPT NO. .RMIT NO. OWNER G�Tc\ SA-• �\_ tel `.�-�[ " �/� MAIL ` EIIV E'D By ipPTE'RIECEIrVE /DOTE ISSUED q ADDRESS 90-n•}5-Spy.COO-AM TEL BUILDING• V 1 _\ M `J e? —o27--.(-/ CI TV S'3_.t `� n`0_ \ NO. V:sar-1/42ri ADDRESS ARCHITECT v (� LIC. . OR C+TyE(R�l� r� .�.'W1 , NO. COSTA MESA. CALIFORNIA JAI `S .J.Z4e FIRE ADDRESS ZONE CITY LIC. 2ON NO.OF PLANS TY E/ GP � /�,(p�� CONTRACTOR 7", 5;\ NO. (/ RO - i i TEL. APPROVED II •f `. ADDRESS NO. BY DATE LEGAL LOT lit CORRECTIONS DESCRIPTION NO. zAssa, BLOCK A.P.NO. / / •• .--• / g_"I �` {� SIZE �f ,_QQIyy��/,�=.� OF BLDGS. /�� •A S� ,, it �'�A OF LOT go X .J OO x/& OW ON LOT v USE OF CITY '_1 rZ r I MESA EXISTING BLDG. • v 1L.f 1 . SETBACK LINE FROM CENTER OF STREET 9.0....5‘ REAR YAR7r/ / SLIBJLc4 .I Ili •LuG. DcriT. REG. `` Ir/J/ SIOE YARD RIGHT \I] LEFT t v _ --7 �C� DESCRIPTION OF WORK By 44../. ..4 DATE --�"'/'7 LAI T.CH. S.77 NEW VI ALTERATION ADDITION REPAIR MOVING DEMOLISH SUILDINCy5NO.OF SIZE ._,%DO ROOMS STORIES , EXTERIOR WALL ROOF � �$ C COVERING COVERING USE OF NEW �� Inv a / BUILDING d r�/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY TH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING ON C. TION. VALUATION I PERMIT FEE $ 'S IJ..�/` 913 SIGNATURE O PERMITTEE L-1.,,, a• , )07_ cry �/ PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE 5 Si. 0-0 OWNER HUFF. 'R. A. DATE 3-17-59 JOB ADDRESS 177 E. 22nd St. BUILDING PERMIT NO. 88W4 GENERAL CONTRACTOR Corson Pools VALUE $ 3,000.00 ' 448. Ae.f2-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Swim Pool GROUP TYPE ZONE R4 PLAN NO. ng44 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED • DATE NUMBER Trenches Forms Steel Floor System Q I Steel Reinfor(/�i t Chimney Re-Rod ¶1,4 r4 ' Bond Beam • Frame and Flashing Lathing, In • Out Plaster, brown coat Underground ,,ee4 W/G Pipe Test Furnace re,w ,1 r. 3JiY 11 Gas Vents Rough Plumbing d 14.r,Ao7i, Ah/T-24½/ !1:a-1/44,4-,t 3-/7-59 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final Final Gas Test -� Construction Pole Underground Power Rough Wiring Fixtures, Final L�.2' 11. 41-0-A-1t-Z OCCUPANCY f 7 3 y,,oi Form 210-5M-1-57 881.1. 8844na� uvkk1 • r' • 11.11 17 In COSTA MESA BUILDING DEPARTMENT a P.O.BOX 317 FINANCE DEPT. COSTA MESA, CALIFORNIA CI11 OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING �7 7 s R 2.,..�— BUILDING ADDRESS COSTA/ /SA. (((jjjyyy'A It FORNIA FOR OFFICE USE ON (�) (/ ! L/ 1� RECEIPT NO. Y T/%JJ/ 4 OWNER {{{ 1 q ! K/ III--- e D17�b��% A R D 3,Ai7/..57 ADDRESS I 7 /� �/2� �/ /� CITY (�-� 1/:L(..v-4-Ea TEL ADDRESS / 7 / L — 2 ARCHITECT •OR ENGINEER es, r v LIC. COSTA MESA, CALIFORNIA FIRE ADDRESS/ Z'l �L6- -t.rq ZONE No.of TVP I3 QUP. CONTRACTOR 00-440-11,0-0-4,✓✓✓ CITY NGC_ PLANS - >WF- Ill d •ADDRESS $A • Eo: LS- no BYPRO (/ an. e1 DATE ( Q ` LEGAL Lo �''..^-4119. �1 �e-i- T t 1 DESCRIPTION /LOr. BL ('`I� - CORREC IONS A.P.NO. A •--- SF -- - U _ SIZE it t-- V 3 /D NO.OF SLOGS. ��� r I, 4y '�,� !, I+ !'I OF LOT LIJ /� NOW ON LOT y .L• L+ USE of1 CITY OF t 5T.4 MESA EXISTING BLDG. I c.c_{L..� T. �'�-�c f�•••,r. A., liEf, CENTERSETBACK oPLINSTREETEIRON Tp I/ _ �R�EAR YP D 16.15026/i6/ -P 9�CCE TO DG. DEFT. REG. SIDE YARD RIGHT j EFTT g-A-v ' .-S- ' . DESCRIPTION OF WORK BYJ40 '17! DATE r i pLN° Ti-CHCCE-'9 77 NEW >C ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING ♦ �/ t Na OF 512E ��/ X SROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF NEW w C ✓�BUILDING 'N The Amount shown under valuation is for the HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND purpose of establishing a permit fee only. T STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. /n/ VALUATION SIGNATURE OF J/ a �v 6„.. PERMIT FEE 5 /�_' PERMITTEE /NN{Y" "Lr✓tr"- _ 3 000. O ) PLAN CHECK S 5 I AUTHORIZED AGENT TOTAL FEE 5 jar OWNER HUFF, RICHARD A; & CLOMA A. DATE 2-27-59 JOB ADDRESS 177 E. 22nd St. BUILDING PERMIT NO. 81116 G NERAL CONTRACTOR R. A. Huff VALUE $ 710OO•00 2-23 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Bet, Cpt, GROUP H • TYPE V ZONE nit PLAN NO. 81116 INSPECTIONS DATE PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Trenches Forms Steely C S. 2 --.'f— . Floor System 't / Steel Reinforce Chimney Re-Rod Bond Beam Chimney, 9 -. -a 7 Frame and Flashing g-..--g; 5 4 .7 A. ,_CY Lathing, In Out $1---E f Plaster, brown coat F..--44 e-. ce•,s • 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 1 Heating Final Plumbing Fixtures, Final Final Gas Test ' • Construction Pole /� 1/ri 4. Underground Power /Y�1,�1 .I}q' - Rough Wiring ' a Fixtures, Final OCCUPANCY -eel u-n--c y Form 210-5M-1-57 RI 1( CIIAS'C AYAH'1'MMIV'CS ""'` 9-19-711 JOB ADDRESS 377, East 72nd Street BUILDING PERMIT NO. 42652 GENERAL CONTRACTOR 0TonerfBJdr DESCRIPTION of WORK Demo. 32 carports AP No. 118-074-27 • LOT TRACT FIRE ZONE VALUE E 1,900.00 INSPECTIONS Signature Date TYPE V GROUP _T ZONE R-2 SOIL , SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbing ROUGH PLUMBING §PROP. SWR. LINE 0 HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER n ROUGH WIRING Heating and Vent. • TRENCHES 0 FORMS 0 STEEL REINF. 0 FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER. BROWN COAT - STRUCTURAL, FINAL Electric HEATING. VENT., REFRIG. AND A,C., FINAL PLUMBING. FINAL AND GAS TEST n ELECTRIC, FINAL BUILDING, FINAL 0.Atilt. 7 42652PAW COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • PP IC• ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely—Use Ink Only R C ED :Y DATE RECEIVED D•TE ISSUED BUILDING I E e 1.,f - /� �/ ADDRESS /w` el 1.-) �/ �t PERMIT NO. OWNER COO -� .�f1 ' A.P.NO. (�- a ( 4- ..82_7 MAIL Y r. 11 BUILDING 7 E ^ �(, ADDRESS ADDRESS G2 µ� A�JST TEL. Niles S I L e2 BLOCK CITY NO. l CONSTRUCTION NEW ADD ALTER REPAIR (MOVINGMOr7F I ISFL LENDER \\/T/`'•` BRANCH Air, ir OWN ERC0451- Y , ADDRESS c4it ARCHITECT TEL. USE 32 cTR1 _ VALUE , OR ENGINEER NO FIRE .. ADDRESS ZONE T PE ROUP CONTRACTOR ���(� lAPPROVED BY [ DATE ei—I3'1 6. ADDRESS -Vt.TEL. INO.OFO USE OFf1Eiy •IT•, CITY NO. Y TE PLANS BUILDING F^ STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING GS ttU SIZE NO.OF BLD . (FROM C/L STREET) B. OF LOT NOW ON LOT FRONT FT. FT. a USE OF N. EXISTING BLDG. R.SID. - F FT. lA FSeparate permits are required for L.SIDE FT. FT. welectric,plumbing and heating work. REAR FT. FT. (.. USE OF BDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& '-/ =Q A3 MAIN BLDGS. ACCESS. BLDGS. DATE \ gyp Z�<IitPQ'1Il1J5 C UDP.tIEaa APPROVED �j .../r ).. RYPI z.V DATE —13 l ..l Iz W Q I hereby acknowledge that I have read this application and state n N 1:4 that the above information is correct and agree to comply with m 4 all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of a the State of California. .4 3 I hereby certify that I am properly licensed as a contractor under SO. FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, end that such licenses are In full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F EON am exem t from the rovisions of the Sta of ifornia Business �o p VALUATION w- PERMIT FEE $ and Profess ions Co ,Division 3 hapter . O_ n r _� PLAN CHECK $ en Signature I' o Permittee $ /In TAX $ L ///��_ ��_ U Authorized Agent TOTAL PAID $zg,f N 42646PAID cGp 13-76F,00 550 yryr* 173.18 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P I '• TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R rBV DATE REC V D D•7E ISSUE BUILDING yQ 1 . • 3- ADDRESS �u _• L OWNER �I A.P. NO. -� 4-C? 'MM. ` ' ' A , BUILDING 5 - ADDRMA II- ESS;fl /-• , &'957 /i'wy ND,;E, 7 G . Zg BLOCK ' CITY CA00 NO67f pppp. TRACT CONSTRUCTION ' NEW ADD ALTER (REPAIR (MOVING DFMOI ISH LENDER `T BRANCH ..-__ OWNER`` ,/. 4pgs ADDRESS . ' SE IJ 'Ji•r "• 1 44$ �lt1 / ARCHITECT TEL.¢` 4 OR ENGINEER L I )) / • k•• -KO y • FIRE I ADDRESS ��j a• �Uigsl f/!s/ -r2 ZONE if T/PE GROUP F•-/ CONTRACTOR 0kyiyAr l 1`//�a' : APPROVED ` DATE '• # • ADDRESS •//r' f TEL. NO.OFUSE OF NEW 15 • l CITY NO. PLANS Z BUILDING GAR•r sire., F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE NO.OF SLOGS. (FROM C/L STREET) /�_ o.. OF Lo-r_457 ?jz I NOW ON LOT 4 ROM FT. •v FT. hUSE OF NrU��at� � EXISTING BLDG. R SIDE FT, FT. Cl)i . / 5S Separate permits are required for L.SIDE FT. 4 FT. • electric,plumbing and heating work. Q IO REAR FT. 2-.9FT. •f (.,i USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& nQ _! • MAIN BLOCS. ACCESS.BLOCS. aDATE PjniI cuc' +t /S—MAWS �� • C URP.#te ":%-b90 APPROVEDB-f -'G T //d APPROVE• //�� 9../.7.-24:* .�.1 / fD x� A _ 1,4) DATE . w . . •LD FOR ' PECI , L REQUIREMENTS Q I hereby acknowledge that I have read this application and state ' N N rye that the above information is correct and agree to comply with N m 0. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of m Sthe State Of California. Zoo m I hereby certify that I am properly licensed as a contractor under SQ. FT. H the State Of California Business and Professions Code, Division 3, - TE AMOUNT SHOWN UNDER VALUATION IS FOR o Hy Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE O Lys am exempt from the provisions of the State of California Business ' /j. a and ProfoselO e, Division, Chapter VALUATION PERMIT FEE $ 10 m PLAN CHECK $ 2 Signature f l j ( �� ms���''''ssss//���/yy .....••• _ - s o Permitted -��"� �,� , $-'/_/ery V TAX $ / S. LL GRgOt Vw��� 6 U Authorized Agent . TOTAL PAID $ • CF? 13 ?fiPFln 4264709 54U + *** 126.1i6 - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A L C ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RE gH /D�E ijylVufr DATE ISSUED BUILDING r '7_. 1// / l ADDRESS /,7 4 ',lN S // ' `f, T A.P. NO. rale - Z PERMIT NO. OWNER /'/ I —1 BUILDING - MAIL I. -- ADDRESS I"(1 . LZ'/ ADDRESS wy ♦ /j / .1 TE CITY 02,44 NO. f 9,fl I`' T-A T Ei t l'• �OT"'r t BLOCK CONSTRUCTION NEW ADD ALTER I REPAIR MOVING DEMOI ISH LENDER �/ III l•-- 1J�` BRANCH OWNER • sr ) ADDRESS VALUE , ARCHITECT �/ 7 No /L , ,, S ry Lvy�. $ /// OR ENGINEER e./A �/ FIRE I ADDRESS 5®rs;/` 57 //'qi7 0J ZONE 4610 GROUPUP %,( . CONTRACTOR 0400,1,-/Z /�U/ .' is? BY APPROVED DATE / ' 7 ADDRESS /- TEL. Z NO.OF USE OF NEW 1% ice—, CITY NO. � IRO. BUILDING Chit,4._ sr, F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE / NO.OF BLDGS. OVVV (FROM C/L STREET) , OF LOT /�y/ 3/D NOW ON LOT �' FRONT FT. �FT. USE OF ! cn EXISTING BLDG, isivipm,gewas R.SIDE FT. 4'7 FT. F 49.Separate permits are required for L.SIDE FT. ' FT. electric,plumbing and heating work. - W _ _ REAR FT. FT. 64 �. 1 (..I, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& -2 MAIN SLOGS. ACCESS. BLDGS.DGN / -: CM/"TAI/br �fi /1 86aS i-f1Mg4J VRP.�JZ74: E -/30 APPROVED()-/4 - . Q APPROVEp� //J�_) /3-7‘. 2' // 0 _FLY (/L(J DATF b ct w 'OLD FOR SPECIAL REQUIREMENTS 0. --- 0 I hereby acknowledge that I have read this application and state n (>: that the above information is correct and agree to comply with am ell laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of u fsd the State of California. �t�s I hereby certify that I am properly licensed as a contractor under ��(/C/ O. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE O STABLISHING A PERMIT FEE ONLY: to am exempt from the provisions of the State of California Business �/� and Professio de,Division 3,Cha t VALUATION PERMIT FEE S 7 .L n PLAN CHECK $ I� . st �/I / n Signature /C/�/ o Permittee $ J (L/�/ TAX $ / O/. 2 (O U U Authorized Agent TOTAL PAID S /24 . 6, I • SC r G- ' �r-p 11-76x ;,00 546^ ****53,30 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A'P CA ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only BUILDING / I5� �.. , J REG D�T��RECEIVFjO' pATe si ADDRESS 7J'7�- f /2 Q N'j�' �^�/� -o71-4 -2-73_�!/1/n E!Q/ "(L�, OWNER �� 5I n�//H/�/`�1'� A.P. NO.IIB r7_ P FAv4�ri i^1 MAIL //�� ADIDRIE5517 I �,�pp(a�7(im, •_ ADDRESS f4C fl COAST Tf w7 �w�T �TS�V LO 2 BLOCK -et CITY eiily/ N0.6j� R'd� CONSTRUCTION �^ NEW ADD ALTER REPAIR MOVING DFMOI ISH LENDER �/ BRANCH I/�` ' ,� OWNER ��'],1�,� _ ADDRESS Q /�� /tacr • s ARCHITECT .,,-s/,.� r;27,E�. TEL./.;9_459)OUSE J GikiL i -ret, VALUE //-�T�+�v ADDRESSOR INEER 501:r tC;0244(/ v ZONE T •E GROUP f/��7 /i. � �� ��g FIRE APPROVED I CONTRACTOR S- _at tom ,, / v"� BY f As DATE ...--- ADDRESS 'per /, �J CITY NOL Z r '� IPLANS `� BUILDING EW — STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE [ .� NO.OF BLDGS. (FROM C/L STREET) (� o. OF LOT /tl L y l z9 NOW ON LOTFRONT FT. 2-_\ FT. j0a' Q USE OF J .�E EXISTING BLDG. MVI/IS c R.SIDE FT. Z-7 FT. ti cti �S Separate permits are required for L.SIDE FT, 137.- FT. s, electric,plumbing and heating work. REAR FT. 3o FT. , (.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Q / MAIN BLDGS. ACCESS.BLDGS. I: CO/Y073 r 11d -n3 S APPROVED �r dG ! ✓ C UVARP 11' '"•/0- PIG DATE p_/6`76, Q Off x .rl SO if '`) —B_V ROVErrj,l V SATE / /�/ _!`� W ,IOD FOV' SPECIAL REQUIREMENTS C. I hereby acknowledge that I have read this application and state N Q'. that the above Information Is correct and agree to comply with coL all laws regulating building construction, end I shall not employ Z any person in violation of the workmen's compensation laws of 2 Sthe State of California. �J) - I hereby certify that I am properly licensed as a contractor under rr✓ SO.FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in 4u11 force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provislo of the t'te t California Business y VALUATION PERMIT FEE $ [Y() and Professions Cod,Divitio ,CheSignature - 2• m PLAN CHECK $ . o a Permittee S 40,0 TAX $ • y/l LL ��V 'r f U Authorized Agent TOTAL PAID .5-3 3o 42649 Pa:u . - WP 17-,nF,.•.O0 5115* *f:* :53.30 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A'P • ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely-Use Ink Only RE : E D E - E D E ISS E BUILDING ADDRESS/1'77 'CI .A.,Sh? i .-`�-- A r ,. ��t -41.v n�!' OWNER /VBAC fyient /�lEA/r� A.P.NO. 118 -o74-2- �jP Ry]I No C MAIL ADDRESS /s7 e , Z2 ' '1 , ADDRESS a ••t J IA/ I NTS' / p�� .�p� /� TEL. • M( R • y or,LOT'UM BLOCK CITY ClM N47/19° - TR•CT CONSTRUCTION /� , NEW ADO ALTER REPAIR MOVING DFMOLISH LENDER .____. BRANCH -' T ..---- OWNER C-Q,ASY ADDRESS 4 ARCHITECT / TEL )_,/�-p USE g VALU$ �s___ OR ENGINEER 779M twin NO.�JJ-7171 FIRE -y`�v aA! Co'tfwy J Obi ZONE YPE GROUP APPROVE ADDRESS CONTRACTOR J„ 4 L j _...S • L BY DATE 09'/13 ADDRESS Z Fi•T C.--NO.OFr� USE OF NEWS • r-— TEL. 'V G.- IPLANS GBUILDING G . • CITY NO. � F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. ,,yy MAIN BUILDING ACCESSORY BUILDING (FROM A. OF LOT/I5LL1 SIZE \/ 7771/ • I NOW ON LOT NO.OF S FROT C/L STREET)FT. l FT.b�• -sE USE OF V) EXISTING BLDG. 4414/ 7/A-S1,.C,/YaEc _R SIDE FT. FT• It co r 7 FSeparate permits are Iequired for L.SIDE FT. 27 FT. t' electric,plumbing and heating work. REAR FT. OO Fr. t' " L21 USE OF BUILDING AND WORK TO BE PERFORMED K__ILI DISTANCE BET. BET.MAIN& L✓Y/ Q MAIN BLOC'S. y ACCESS. BLDGS. ..I / 107Rb/GT oA 1 /l" ‹ DATE VAR C UP,.i Ze% /+V APPROVED8-16--26:, Q / / APPROVE �G-�� 9 DATE /���-�10 w • HOLD FOR' SPECIAL REQUIREMENT( A. I hereby acknowledge that I have read this application and state n PO that the above information is correct and agree to comply withcc A. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of = the State of California. ♦ _ w m 3 I hereby certify that t am properly licensed as a contractor under 1/p_f-YIVI SQ. FT. ci the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: to am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ sr and Profession-Code, Division 3,Chapter 9. 32.-`I •,n el O�� PLAN CHECK $ �S CT o Signature •f / I[,� O �/ (//t/ LL Permitter . CAP* ��.' LLQ $ /Vf J TAX $ �) U !/'� s✓� Authorized Agent TOTAL PAID $ D V / • / 43 I 72 ':C 10-?6ERF,O0 611llc tt*;:*la IC COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Applicant to Fill in Completely POTION FOR STRUCTURAL PERMIT For p y — Use Ink Only f+ R I �D QV I DATE RECEIVED DATE ISSUED BUILDING Q7ratar „ t 9 (/_ ADDRESS l//y! lIr`�/�\ �I � yt�/1 //J�''J� �( /jam /�'J� �L�007�/ OWNER0OOC( / opudento Y/ / A.P. Mp AMAIL DDRESS P7/ t AD RIE S ' /I C1/CJ \�J�/usi._ TEL. CITY0Ana MjaacciNO. 44,741-11ACi ev!7, T7V-a BLOCK CONSTRUCTION NEW ADO ALTER RE AIR MOVING DFMOI ISH LENDER • x /J /� BRANCH OWNNE RR`/�LJJ3at -j" //(:thnet IQ ' ADDRESS ARCH ITEC TEL USE�7��-v.J('/(<fL(i //K.LUG�J/ OR ENGINEER/�� c p��) / -/N�,O) ZONE ALt E ' GROUP `z ADDRESS /Vr U ,S0 . he IO 6-eit t1 iv, �C�f FIRE ,90-10 X/ a�/I _ ) APPROVED CONTRACTOR /� J (J 'Cf(/(L/ AP DATE W ADD R ESSa3)33b. // ikAP g,j kidezd TEL ZO ' NO.OF USE OF NEW • a CIT LIS SS 1 I NO is es) : PLANS BUILDING - Algal f^' STATE CITY YARDS APPROVED YARDS APP"OVED C LIC.NO-A3�/laaLIC.NO. MAIN BUILDING ACCESSORY BUILDING DJ SIZE NO.OF BLDGS. (FROM C/L STREET) L OF LOT NOW ON LOT FRONT FT. FT. Q USE OF in EXISTING BLDG. B.SIDE FT. �/V . Ca H • Separate permits are required for L.SIDE FT. O FT., electric,plumbing and heating work. t y/� W - _ REAR FT. 'ai Ad FT.ey) [.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& G (� MAIN BLDGS. ACCESS.BLDGS. ��I I,( /v `Y VAR.tW AATE PPR Q, C.U.P.$ APPROVED/ J// >>" lay APPROV DATE /2 -/0-7 C tel a0 I hereby acknowledge that I have read this application and state m n. Cd that the above information is correct and agree to comply with m C• all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of o Sthe State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. H the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE LY: u am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E and Professions Colfa Division 3,Chapter m — 60 2 Signature of C G PLAN CHECK S / ^ �X / o Permittee `J0 ,l l / $ TAX S u. Authorized Agent1. / I\` -` iti ` TOTAL PAID $ U Jyo•./0