HomeMy WebLinkAbout221 22ND ST - Building Permits 0 CITY OF COSTA MESA
` BUILDING DIVISION
fy ,.Al 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci sta-mesa.ca.us
-. FOR INSPECTIONS CALL: (714)754-5626
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PERMIT NUMBER- BX07-00104
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 42614406 DATE ISSUED: 09/04/2007
Zoning: , ISSUED BY: SHA
JOB ADDRESS: 221 22ND ST CM Suite/Unit:
Vicinity: Primary Occ: - • : • Const Type :??
SQ. FT: 0 ..• Valuation: $4;500.00- •
SCOPE OF WORK: REPLACE 9 WINDOWS LIKE FOR LIKE
OWNER: ABRAMS, GARY J TR . Address:: 221 E 22ND ST - Unit
City/State: COSTA MESA, CA - - Zip Code: 92627-1811
Phone: -
APPLICANT: DAVID BATIOFF - - Address: Unit:
City/State: , . Zip Code: •
.
-
Phone: 626-614-7051
CONTRACTOR: THE HOME DEPOT AT HOME SERVICES License No. 836021
Address: 12774 E FLORENCE AVE Unit: _
City/State: SANTA FE SPRINGS,CA . - -
Zip Code: 90670 Phone 562-981-1600 - Cell:
ARCHITECT: License No.
Phone - : -
ENGINEER: - License No.
Phone -
FEE SUMMARY
Building Plan Check: $0.00
Building Permit: $111.25 '
Electrical Permit: ' -$0.00 : .
SMIP Residential- - -$0.00
SMIP Commercial - $0.00 --
$0.O0TOTAL FEES - • $111.25, -
. I P 3
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to he considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE O. INSPECTION TYPE DATE INTmAL1 CODE r INSPECTION TYPE DATE INin1ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place • 220 Final Planning Approval
203 Final D Signm 222 Final Site 1
204 Final Demolition 250 Final Building/Occupancy 1:3/4L
4.
WORKERS'COMPENSATION DECLARATION . - . Owner ID verified by dri nse. ❑Yes 0 No '
I hereby affirm under penalty of perjury one of the following declarations: . • Drivers License No. Expires:
L7 I have and will maintain a certificate of consent to self-Insure for Workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: „/T person is required to descend,will be made in connection with work authorized
Carrier:
�� 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
(This sea' need not be completed if the permit is valued at one hundred dollars(St00)or less.) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number: 2q 2/.20 7
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date
the Labor Code,I shall forthwith comply with these visions.
__ _______—L__ Q—14_0 Division of Industrial Safety Permit Number:
Appnrant's Signature /// Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires, with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license issiinzfull force and effect. registration form for acutely hazardous materials? 0 Yes 0 No
tic.# pJ to 02.. 1 7—..—Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
�--- �l 7 9_y'�� each business which at any one time has on hand a quantity of acutely
7 Contractors Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code)- prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes”,the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the Califomia Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of , control officer).
completion, the owner-builder will have the burden of proving that he or she' ' CERTIFICATE OF COMPLIANCE: f'certify that under penalty of perjury the
did not build.or improve for purpose of sale.). . , . information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec, the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of Legal Owner(s) Date
Signature Date �� ��_ i �_[�_U3/
3057-46(3/07) And/or Authorized Applicant Date
d w . a
' CITY OF COSTA MESA
n
>,
t BUILDING DIVISION
F I ; ,I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
PERMIT
"'rlPomo1� P07-00370
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaica.usFLuMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 221 22ND ST Status: ISSUED
Suite No Applied: 05/24/2007
Issued: 05/24/2007
Vicinity: .
Parcel Nunmber: 42614406
. Applicant TEVIATA SULIAFU /X
Address: ISSUED BY: C f)
Phone: 800-454-8955
Zip:
Owner: ABRAMS, GARY J TR
Address 221 E 22ND ST
Phone:
COSTA MESA,CA Zip: 92627-1811
Contractor: FAST WATER HEATER COMPANY
Address: 12601 132ND AV NE
Phone: 800454-8955
KIRKLAND WA Zip: 98034
License: 877489
SCOPE OF PERMIT
WATER HEATER CHANGE-OUT
• FEE SUMMARY
AMT QTY AMI 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 H) $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 512.30 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) 50.00 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 II 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)
A " A
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.
,21 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: I'1 '`�(0 0
Carder: QJ� � l�aU� Policy Number:
(This section need not be iompleted if the permit is valued at one hundred dollars($1, )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, od agree th ' ould become subject to the workers'compensation provisions of Section 3700 of t e Labor Code,I shall forthwith
comply with these provisi ) /
Applicant Signature: C ' ! Date: 51241-
z D7 r
WARNING:FAILURE TO SECURE ERS'CCCIPENSA QN VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1%,000),IN DfTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under vi I of Chapter 9(commencing with Section 7 0)of Division 3 of the Business and Professions Code,and my license Is in full
force and eect.Lic.a_---1 �` Dates: a G —7
Contractors Signature: � � Date: urri •
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 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: Date:
Owner ID verified by drivers 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:
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,fatsework,or demolition or dismantling thereof,will be-ore 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 California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 aEEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? EILJ Yes I1 No
(Section 65850.2 of the Califomia 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? ❑Yes 0 No
(if yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Alr Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? 0 Yes 0 No
from
h.. p...r at...i.pollution
olunco tr control
. ...........................
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 end state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction.and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
^ .i• O Legal Owner(s) / ate
l I _ !/
��• n. • A horize• •pplicant Date
CODE r INSPECTIONTYPE PATE INTRIALQ CODE I INSPECTION TYPE Q1lTE 1NTITIALfi
1616 Fixed System Final Fire Prevention 206 Final Mechanical r
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical .9A e D A
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
vADD-RESS OFBBi;LIKNG: 221 22ND ST UMT: CITY OF COSTA MESA - BUILDING PERMIT
IWR4EWSNMIEIFRAOWN: ABRAMS GARY J /, PERM NO: B 076981
ADDRESS: 221 E 22ND ST
•
COSTA MESA,CA 92627 PERMIT NO: B 076981 PLAN CHECK NO: 01751-95 L GOVT: N SUPP: N
645-4249
APPL.MAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
ARCNDECTORENGNEER: PAIR OF PENCILS uc.NO.: C25739 JOB DESCRIPTION : ADD 374SF BEDRM SQ FT: 1 , 491
ARCR.OR ENG.'S ADDRESS: 11681 CHESTER AV we:
G.G. CA 92640 CLAIM VALUE: 30, 000 . 00 CALC-VALUE: 28, 676 .00 GROUP OCC: R-3 /
L'IXRACTO MMUt1: COMMENTS : ADD 374SF LAUNDRY ROOM BATHROOM & BATHROOM
CONDIACTORS YNLING 3E3E3b3E**ib*#**#****3F3E3E***3E3F3F3F3E3b3E3F**3E*3F**3b3F*#3E3F3b#**3E3b*361E**iE3kib*3E3E3E3E*iE3E163E*iE##3E3F3F3E***3E
ADDRESS: UC ND.: ZONING REQUIREMENTS
WIT: SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that I am licensed under provisions of Chapter 9
(commertng with Section 7000)of Division 3 of 0e Guineas end Professions Code.and my license n in full force and effect.
CRY LIC.NO.: LIC.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT: 5 FT IN RGHT: 9 FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the
fallowing reason(Section 7031.5 Buskers and Professions Code:Any ay or acmy which requires a permit to construct.eller,improve. PARKING REQ: P RO V; PARCEL : 42614406 Z N E: R1 REF NO:
mdleh,o repareny structure,pior to is issuance,also requires the applicant tor such permit to file a signed statement that Ise or she PLANNING NOTES> ENCLOSE '2 SEPARATIONS BTW A SFD & DET GAME ROOM & THE GAME
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Sedion 7000)or Division 3 of the
.Usines,and Professions Code]a that he«Me b exempt therefrom and the basis for the alleged exemptcn.An nn o Sedon > ROOM & DET -GARAGE. ENCLOSURES TO INCLUDE BDRM, BATH, LAUNDRY.
7031.5 by any applicant for a permit sublede the applicant to a civil penalty of not more than five hundred dollars]•$5001). *****33€***3€***N'***3€****3E*******3€*IE******3€*******3€*lE***St**3IE*3€3€331€M'##iE lE N"N'3f k"N'33*1h
❑ I.as owner of the property o my employees with wages wink sole compensation.wild do the wakt and to emrdure is nm imended D E V E' L O P M E N.. T SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of propend .
who bolds or improves thereon,andwho doe;such wk Nina!,or herself or through his or her own employees,provided that such
•2mmare mtimendnd adlerdd for sale f,however.the building aimprovement bsold within one❑ ye«doompbtion.the ZONING `APPROVED. BY w_ �` DATE; ///���
is will have the burden ofSte did he or not build or improve for the purpose of sale). �V
Tv ,
Las owner d the aopeMsie
.am exduly nontrading with licensed contractors b eansbad the project(Section 7044,Business and BUILDING APPROVED B Y : l%rt/� DATE:
Professions Code:The Contractors License Law does nit apply to an owner of property who builds«improves thereon and who ,
contracts for such prang with a comn«dor(a)tinned pursuant to the Contractors License Law). ,
.
.
OarebF
pond«sector:
B:APC..for Nsreason:
•
Q APPLICATION ISSUED BY: d DATE:
>
ft.-1.- s1 Owner: f( 2.�J *sF3e e3h E E F363e3E a e3F3E�F3e3E e F p�F 3e3E3 **9€ F p3F a F3E3F�F3e3F31 e3e 3e 3E 3e3F . . . . • . . 3E 3F
LEGALIZATION:N F E E S U M 1+-A R Y STRUCTURAL SEGMENT:Y
y certify that I am aware of and understand Na requirements of Cel u Maellh and Safety Code Sedira 25505.25533.and
one)and Or buildingwill BLDG PMT PLUMBING ELECTRIC MECHANIC • FIRE SMIP/RES GRADING
a perm*la«astnuctionor moddcal.onhanthe Ai Quaky Management Did rid,Residential construction appkatens are exempt from these /
provision,, PERMIT 278 . 00 _, •
2 . 87
Date' Applicant: PLAN 180 . 70 SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declension: ISSUE FEE ,
o thavea vamaicertificate consent b
ratedanlsel-insure laseekerip« prSanas othetabr BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK> h TOTAL PAID DUE
Code.for the peeo
rform« etwork isissued TOTALS----> 280 . 87 0 . 00 180 . 70 ' 461 . 57 499 . 60 -38 . 03
❑ I have andwB maintac workers'compensation insurance,as required by Sask.'s 3700 of the Labor Code,for the performance d the r
work compensation canier REVENUE DIVISION TOTALS--> COLLECTED : 280 . 87 OVER/SHORT: . 00
Carrier:
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE ' SMIP/TOT GRADING PLAN-CHECK
rats section need not becompleted ithe permit(orone hundred dolma 0s1Do1«less) 278 . 00 r 2 . 87
•
❑ I only that in the performance of the work for which this perm*a issued.I shell not employ any person in any manner so es to
beans subject to the eskers'compensation Iasis o Catdania,and the e d I should become wbjed to the workers' 3E3E3E3E*******3E****3E*3E*3E3E3E* '*3E3E*' **3EiE3E**********3E3E3F*3E3E3E3E3E3E3E3F*3E3E3E3E*iF**3E3E3E*3E*3E*3E*
compensation provisions of Semon 3700 of the Labor Code,I shall forthwith amply with those provisions. I N D I l AT A -2F E E B R E A K D O W N
Date: Applicant: /� ./pIL�� ///�AA,, .
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penalties and
TYPE QTY D E S CPR I P T /WRIT UNIT COST TOTAL COST
civil fines cc to one hundred thousand dollars(Sf04000A In addition to the cost of compensation,damages as podded for In /m • 100
Section 3705 of me Labor Code,Interest,utdatromeyl fess. SFR 374 DWE-TY V-WOOD FRAME /® ((ii 00I�'i74 . 00 27, 676 . 00
• CONSTRUCTION LENDING AGENCY: I hereby a under Pen°lry of perepy that them is a conYmcton lending neon or ge SFR 1000 ALTER VALUE RCg9Jp ENT IALwWO ONR�/OLip1 . 00 1 , 000 . 00
performance of Na mock for which this pemhkleissued(seas,3097,Civ.C). 754 END. .OF FEES e v��
LENDER'S NAME: /s
LENDER'S ADDRESS: '`:'. S626 •
Derr,
I certify that I name read this application and dale that the above idom,aton is correct I agree to candy with aD ay end nasty ordinances 1 Or I
end state laws reletist to budding construction and hereby augwrbe represenldsee of this ay 10 eater upon the aboe-mentioned MINIM '
f«irspedwn perpoaee. HENRY ABRAMS �.„. '54$627 ../ REQ/
Gk
osis disci/_ Dae: y'1-7i ..
Signior.d Owner/-. App t//
canontractor _
`51-48.WP) White-BuiIdisg A Safety:Green-Fle:Canary-Applicant Pink-Revenue:Goldenrod-Assessor
• CONSTRUCTION AND PLANNING POO. .SPA
I
(!,PROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
.-t •-
2. Soil Pipe-Undrgrnd. r- 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding
5. Steel Reinforcement T-170-44 as-e 56. Rough'Plumbing & Pressure Test { '
6. Electrical OF ER Grnd. q 3r37- C.cire 57: APPROVAL TO COVER-GUNITE
7. Footings L.f��- 58. Electrical Conduit-Undrgrnd.
8. Foundation (`3o may (✓ 59. Gas Pipe, 0 Undrgrnd.• Test
9. Water Pipe-Undrgrnd. - ' 60. Backwash Lines,P•Trap,D 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 D Gas 0011
25. Roof Sheathing 5�!_.ct _74,.Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat U' 75. Dry Chemical
27. Frame and Flashing 7 ate 4-2y 46 6-c,„/"., 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 012s' [b' 78. FIRE PREY. FINAL -
30. Drywall Nailing 1-1-2Q ‘alk 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 / 2-'-7€
35. Final Gas Pipe-Test _ L ✓ "G '�O•� V
36. Hood or Canopy 5:_Le7 p/� n - 4 4,dr--re-47,--f37. Final Factory Fireplace
38. Final Plumbing �„Zy f6-- „as, di. le,, - •
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 q-13_116 (Qce,.y_
48. FINAL PLANNING
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co -- _ _--
51. CERTIFICATE OF OCCUPANCY
No Date
City of Costa Mesa
California 92628-1200 P.O.Box 1200
Insulation Certificate
Permit Number 2 7 6_9 g I
p._
2a/ 22,21 (Ca_
Number and Street City
r _Q�# _c%
County Subdivision Lot Number
Description of Installation
ROOF
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
EXTERIOR WALL . /
Material El.ry f /nsia-�7A-' Brand Name Cer-, - v', (0770-/1't'
Thickness (inches)X 2 X6 Thermal Resistance (R-Value)
CEILING
Batt or Blanket Type Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Loose Fill Type Brand Name
Contractor's minimum installed weight/ft2_ lb. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
RAISED FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
SLAB FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Width (inches)
FOUNDATION WALL •
.Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Adminstrative Code.' // G
0 (Ariy)cpl vct)r Lo_ I t L/3 Z •
GGerynner__a contractor(Builder) y/Liiccenssee Numberf
Signature and Title Date
Dcaini
Sub contrac or nsulation Installer) License Number
t'
Signature and Title Date
1907 46
•
1 lI
ADDRESS OFBLALDNG: 221 22ND STuxr: CITY OF COSTA MESA — BUILDING PERMIT
OWNER'S NAME IF KNOWN: ABRAMS GARY J PERM NO: M 076984
A�DRES&: 221 E 122ND ST
COSTA MESA, CA 92627 PERMIT NO: M 076984 PLAN CHECK NO: N GOVT: N SUPP: N
645-4249
APPL.NAILING ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: ADD
ARCHRECT OR ENGINEER: PAIR OF PENCILS UC.ND.: C25739 JOB DESCRIPTION : ADD 374SF BEDRM SQ FT:
ARCH.OREND.'SADNfESS: 11681 CHESTER AV WIT:
G.G. CA 92640 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
coNrRACTaas xAME: COMMENTS: REF: B-76981
CO iTBACTOas YMLNG iE1EiE****1E9ERF1EifiE1E****iE***iE****1E*1E*iE********1E#*1E1E1E1EREi61E*****1E1E1E#iE1E#*#1E1EiERE9EiE#1E1 ******
WORM ANO ZONING REQUIREMENTS
SETBACKS K S
LICENSED CONTRACTORS DECLARATION:I hereby alum under penalty of perjury 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 lull force and affect.
Cm LIC.NO.: LIC.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWfolN�BeaILDER son(SSedion7031.5Bsinessand PATION:I hereby'Proeadions Code:Any of
yW athat
countymwhichrepuim namei construct,License Law PARKING REQ: PROV: PARCEL: 42614406 ZNE: REF NO:
demolish,or repair any structure,prior to its issuance.aro requires the applicant t«such permit to fib a signed statement that he or she PLANNING >
i licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the n`
dueinsa and Proanions Code)«Mai he«she a exempttherefrom and the basis for the .-7. >
alleged exemption.Arty violation d Section
7031.5 by any applicant for a permit subjects the applicant toacivil penaify of not more than Ma hundred dollars 1350011. iE 1E if 161E 16 dE 1E 1E 1E 1E iE iE if**iE 1E 1F*9E 1E iE 1E 161E 1E iE 1E 161E 16 iE 1E 1E 1F iE'iE iE 1E 1E 1E iE 1E 1E 1E 1E dE*iE 1E 1E 1E1E1E1E*161E i6*1F*iE iE iE if lit lit iE 1F iE 1F 1E d(-3(-if*if
❑ I,es owner of the property«myempbyees will wagesas their sole oompenaeton,will do the wok,and the snucfuree not intended ,_ DEVELOPMENT S E R tui I C E S REQUIREMENTS
or offered for sale(Section 7044,Business and ProfessionsCode:The Contractors License Law does not apply to en owner of property
who bolds or improves thereon,and who does such work limned or herself or lhrc gh hes or her own employees,provided that such C-' /.%
improvements are not intended or offered for sale.It however.the building orimprovem«e is sold within one year d completion,the .ZONING APPROVED BY DATE:
X owner-builder will have the burden of proving he or she did not bdld or improve for the purpose of sale).
❑ I,asownsdthe property,am exdesbely contracting with licensed wnvecl«efoconatrud the project(Section 7044.Business and —BUILDING APPROVED BY : /.�t DATE: _
• anions Code:The Contractors License Law does not appy to an owner of property who butt or improves thereon and who ! /t) , ^r
acts I«such projects with a mntract«(s)fcensed pursuant to the Contractors license Lew).
■ .xemqunder Sedion: B.AP.C..forthis rh: ?PPLICATION ISSUED BY: -` � ' DATE: Cif"
`L/ i9F*****ATION16 ISSUED1E BY.
ir 1E***DATE1EiEiE1E1E�F iE1E
°We LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
reby candy Mat I ern aware o and understand the regtbernents of Cell and Sefay Code Sectors 25505.25533.and r k,.
5534,and thatl«any future Wilding occupant will/wit not one)need to plywlh said stale codes and therequirementa for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction of modification from the Airaue ananagemero District.Residential construction appimloroero exempt from these PERMIT 20 , 00
provisions.
Dale: Applicant: PLAN � 25t SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally o perjury the d the Wowing declarations: ISSUE FEE 15 . 00
o Ihave and wllmsintaoacertificate oconsent ose9Jroure for waken•compenwlon.esproddedfor bySection 37C0otheLabor BUILDING—DIV—> PERMIT ISSUE PLAN.=CHECK TOTAL PAID DUE
Code,for the ped«mance o the work for wNch this perms is issued. TOTALS----> 20 . 00 15 . 00 '' K. 0 . 00 35 . 00 35 . 00 . 00
❑ I have end will maintain workers'compensation Insurance,as required by Section 3700 of the Labor Code,ler the performance of the
wok)«whchmlepermiteaed.Mywaken• omp«auoiwraceweandPdn«mberae: REVENUE DIVISION TOTALS--> COLLECTED : 35 . 00 OVER/SHORT: . 00
Carrier:
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed I the parol S for one hunched damn./S100)or Asa.) 35 . 00
❑ I certify that In the performance of the week for which this permit Is Sued.I shall not employ any person in any manner so as lo
become*object to the workers'compensation laws d Cddumia.and agree the if I should become subject to the workers' *****131LJL{LiC{C1(it******1�*#*4******1X4*4T,1�' *1E44#*4#4411144#4111�441�i1!{>#i1il11f444#44.4 44444*444
compensation provisions of Section 3700 of the Later Code.I shall forthwith comply with those provisions. I N D I V I D U A 'y^ ',F E E BREAKDOWN
Date: Applicant:
Warning:Failure to secure workers' w
•conpuadon coverage Is unlawful,and shell subject an employer to criminal penaltiesand TYPE QTY D E S C R I P T I O, N 1 UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(Sf0G000),In eddldon to the cost of compensation damages as provided for In
Section 3706 of Me Labor Code,Interest, MEC 1 REPAIR/ALT HEATING '"
gUNIT/SYS W/CNTLS 9 . 00 9 . 00
CONSTRUCTION LENDING AGENCY: I hereby lawn under peaty o perjury that there e e construction lending agency for the MEC 1 INST HOOD W/DUCTS FED;BY MEC EXHAUST 6 . 50 6 . 50
Performance of work for which the permit is naiad(Section 3097,CW.C). MEC 1 VENTILATION FAN CONN:1TO SINGLE DUCT 4 . 50 4 . 50
LENDER'S NAME . END-76F FEES
LENDER'S ADDRESS: Iyy
I candy that I have read this application and state that the above information unca
coed.I agree to comply with all cry and county ordinances <J
andstate laws noising to building construction and hereby authorize represematiuea of citythecityto enter upon the above-mentionedproperty
prope
1«inepedi°n purposes. HEENRY ABRAMS i">"
47
(� a Date: 647/—96
diode
` Sgnawre el d ndAppkant/C«Nract«
(5151.46.WP) I White-Building&Safety:Green-Fla Canary-Appicant:Pink-Revenue:Goldenrod-Assessor .
) • •
CONSTRUCTION AND PLANNING 7 POOL SPA
APPROVALS Permit# _ Date Inspector APPROVALS Permit# Date Inspector
1.tTemporary Electrical Service or Pole 9 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 Ell Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 2 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing System -Final
14. Rough Plumbing , 65. Electrical-Final
15. Rough Electrical-Conduit a 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 6-24-
24- I .9_1 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 El Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: _j' G' Yl .r._ 7 �S
34. Final Heating & Air Conditioning f" ^� L��''SS/ LL r /`--E7"
� 7`r�/r O rs91Z-
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
ADVESS OF BUIS.NG: 221 22ND ST EMT: w CITY OF COSTA MESA — BUILDING PERMIT
' 0NNEWSNAMEIF100wN: ABRAMS GARY J /PERM NO: E 076982
ADDRESS: 221 E 22ND ST
'COSTA MESA,CA 92627 PERMIT NO: E 076982 PLAN CHECK NO: N GOVT: N SUPP: N
645-4249
APPL.MAIUNGADORESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD
ARCHITECT OR BONER: PAIR OF PENCILS uc.ND.: C25739 JOB DESCRIPTION : ADD 374SF BEDRM SQ FT:
mica on ENG.'S ADDRESS: 11681 CHESTER AV ORI:
G.G. CA 92640 CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
CONTRACTOR'S NAME:
CONTRACTOR'SMNIING COMMENTS : REF: B-76981
***jE)ElfifiEaFlElf3f1Edf3f9E3E9EjE#IElEiEff#3EIEiE1EjE#iEiE*****K-*iFIE9E3E3E1EjElEl6dEjF#iE3EIEjE1EiEaE3EiEifiEdE1k3E9EdElEifif********
ADDRESS: UC.No. . urnZ ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby aflnm under penalty of perjury that I am licensed under provisions el Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in fug force end effect.
CITY LAC.No.: UC.CLASS: UC.NO.: ., EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the PARKING REQ: PROV: PARCEL : 42614406 INE; REF NO:
following reason(Sedion 7031.5 Biless end Professions Code:Any ay or=only which requires a pent d
to conseu ,eller,improve.
demolish,or repair any structure.prior to its issuance,also requires the applicant for such peen to file a signed statement that he or she PLANNING NOTES>
a licensed pursuant to the provisions of the Contractors License Law)Chapter 9(commencing with Section 7000)of Division 3 of the .
Business end Professions Code)or that he or she is exempt therefrom and the basis for Me alleged exemption.My violation of Section >
7031.5 by anyapplinsnl for apermi subjects the applicant to a civil penalty of not more than Fie hundred dollen 155001). )EIEiE9(-9E****iE1E1EiFiEi(-1F)E****iEiFiEiElf#i(-3EdE1hx{E{(**{({F{({670*.)(.{p.M.{E-)(-qF{f{(-{E{f{(*{F#{b.K..K.{({E{E.{(.*{t.Jt•{E*.IE.K..IE{[.j(.j(.{E{(.{E**
❑ I.as owner al the popery or my arnpkiyees with wages OS their sole compensation.will do the work,and the structure is nct intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply loan owner of property
who bolds or improves thereon.and who does such work himself or herself or through hs or her own employees.provided that such
improvements ere ret intended or offered for sale.ff,however,the building or improvement is sold within one year of completion,the ZONING APPROVED B Y DATE:
m
X owner-0uider will have the burden of proving he or she did not build or improve for the purpose of sale).
El I.as owner of the property.am exdusisely comradng with licensed contractors a construct the project(Sed n 7044,Business end B U I ISD I NG .APPROVED BY : DATE:
Professions Code:The Contractors License Law does not appy to an owner of property who builds or improves thereon and who _
contracts for such peers with a contractor(s)licensed pursuant to the Contractors License Law). - .• -•
exempt underSec0on: B.AP.C.,forthisreason: APPLIC ION ISSUED BY: DATE : (�7
�/ ********************** * * * **. 3. ****DATET**Cl �*
7 -7- 1` �""° LEGALIZATION:N F E E� S U M M A SUMMARY STRUCTURAL EGbENT:N
do hereby certify that I am aware of and understand the requirements of Caltomia and Safety Code Sections 25505.25533,and
25534,andmaIoranyfuturebuildingoccupantwill/walnor(circleone)needto pywihsaidstatecodesendtheregmrementsfor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modificalionhpmthe Air Quality Management District. 'denllal construction appfutioneare exempt from these
provision.. PERMIT 41 . 0 0
Date: Applicant: 50% SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affimr under penalty of perjury one of the following declarations: ISSUE FEE 15 . 00
❑ Ihave and wimaintain acertificate of consent toseff'insure for workers'compenston.asprov
iidedfor bySection 3700of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,tor the performance dthe work for which this pemhi.issued. TOTALS----> 41 . 00 15 . 00 0 . 00 56 . 00 56 . 00 . 00
❑ I have end wii mantas workers'compensation insurance,as required by Section 3700 of the Labor Code,for performance the perfoce d the
work for which this permit is issued.My workers'compensation insurance carrier and policy number are: REVENUE DIVISION TOTALS--> COLLECTED : 56 . 00 OVER/SHORT: . 00
Carver:
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(Tis section need not be completed i the permt is for one hundred dollars AIM or less) 56 . 00
❑ I become
that inthe performance wokstlhaenrk satiowhichs thof peen is and d,I agree Mat
employ should
y becmen fumannerthaomto *******************************************************************************
bccome hat int etf worrmance the compensation sere of California.rmiisand agree that lf became suin any wBoas to
compensation provisions of Section 3700 of the Labor Code.I shalt forthwith comply with those provisions. IND I V IDUAL F E E BREAKDOWN
Oats: Applicant:
Warning:Failure to secure workers'conpention coveragepenaltiess unlawful,and shell subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
es
civil lines up to one hundred thousand dollars($104000),ll addition to ate cost cd compensation,damages as provided for In
Section 37Ueofthe Labor Code,Interest,and attorney's fees. ELE 6 FIXTURES, LIGHTING 1 ST 20 EA. . 75 4 . 50
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the ELE 18 RECEPT/OUTLET 1 ST 20 EA. . 75 1 3 . 50
performance of the work forwhih this Penni is issued(Section 3097,Civ.CI. ELE 12 RECEPT/SWITCH 1 ST 20 EA. . 75 9 . 00
LENDER'S NAME: ELE 1 RES APPLIANCE NOT OVER 1 .0 HP 3 . 00 3 . 00
LENDER'S ADDRESS: ELE 1 SUB—PANEL 11 . 00 11 . 00
I certify that I have read this application and state that the above information ie coned.I agree to comply with all ally end county ordinances END OF FEES
and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned propertyfor "°°t°°pu`0°'° HENRY ABRAMS
pt
'tint' me
!/�� Date: {—/�/ir�
wawa/Signal a oi4!envApplicanuCantrator
1
(5151d8.WP) Whits-Building 8 Story;Green-File:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor -
r
CONSTRUCTION AND PLANNING ' < POOL a SPA
APPROVALS Permit# Date Inspecrtor,- APPROVALS Permit# - Date" Inspector
1. Temporary Electrical Service or Pole 1 52. Pool & Equipment Location -I
s _
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. C 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, ❑ 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 -!F 64. Plumbing System - Final
14. Rough Plumbing f. 65. Electrical-Final -;,-
15. Rough Electrical-Conduit r, 66. Solar System-Final
16. Rough Electric Wiring 6/iirlgr'& G� 67. Fencing & Access Approval
17. Rough Wiring Sign TT 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 ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
• 27. Frame and Flashing 76. Dry Standpipe
28. Lathing&Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 9_6-q(o 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
•
ADORE"SS.OFBUILBNO+ 221 22ND ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT
OWNENSNAME IF MOWN: AB RAMS GARY J PERM NO: P 076985
- ADDRESS: 2 21 E 22ND ST
COSTA MESA,CA 92627, PERMIT NO: P 076985 PLAN CHECK NO: N GOVT: N SUPP : N
-
645-4249
APPL.MAIUNG ADDRESS: '1 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD
ARCHITECT OR ENGINEER: PAIR OF PENCILS uC.NO.: C25739 JOB DESCRIPTION : ADD 374SF BEDRM SQ FT:
ARCN.ORENO.'SADDRESS: 11681 CHESTER AV UNIT:
G.G . CA 92640 CLAIM VALUE: CALC-VALUE: GROUP OCC : R-3 /
CONTRACTORSNAME:
caNTRAco sYMIWD .1',' COMMENTS : REF: B-76981
ADDRESS: 11C NO.: *******************************************************************************
UNIT, Z O N I N G R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am ken-td under provisions at Chaser 9 SETBACKS
(commencing with Section 7000)of Divismn 3 of the Business and Professions Code.and my licensees in full force and effect.
CRT LIG.NO.: LIC.CLASS: LIC.NO.: .L EXP : MAIN BUILDING ACCESSORY BUILDING
{. FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor • 1 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty d perjury that I am exempt from the Contractors License Law for the
following reason(Section 7031.5 Buainaas and Professions Code:Any city Or county which requires a permit to mntrun,alter,improve, PARKING REQ: P ROV: PARCEL : 42614406 Z N E: REF NO:
' demolish,or rept any structure.prior to es issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES>> y�
is licensed pursuant to the potions of the Contractors License Law JChapter 9(commenting with-Section 7000)d Delsfon 3 d the r L,'ler
Business and Pro/eesto s Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section > C a
7031.5 by ayapplicant for a permit subjects theappicant to acnil penally of not mere than fee hundred ddlaos)350011. **************************************dE******************SE*************8E*******
❑ Lwowner dtAeproperly«m with wages D E V E L 0 P M E N T S E R V I C E S R E Q U I R E M E N T §r
y employees wag compensation,will do the woke,end the structure u not intended / %•" r
or offered for sale(Section 7044.Business and Professions Coda:The Contractors license Law does net apply to an owner d prppeM
who bolds«improves thereon,and who does such work himself or hersee or through he or her own'employees.provided that such (fri 'ii
improvements ere ltd intended rdlered for sale.M. the building or vepu a sold within pro year d mmplaen,the ZONING APPROVED BY % DATE: +�
sy owner-builder will have the burden d proving he«she did not build or improve for the purpose dime). .
laI.as owner d the property,am exclusively contracting with licensed contractors to construct the project(Seat 7044,Business and BUILDING APPROVED BY Y /A / %I DATE: _
Professions Code:.The Contractors License Law does not appy to an owner of properly who bbggids«.improves thereon and who V r , `r./
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Lassa '�' 9 A. .
►. emptuMer,Sedion: B.3P.C..i«this n: A APPLICATION ISSUED BY: = �� �! DATE:
Lin
************************************* TE: • �FiFyE iE
. �� - - Owner: LEGALIZATION:N F E E Sikl MMARY STRUCTURAL SEGMENT: N
codify that I ern aware of and understand the requirements of Celno a Health and Safety Code Sections 25505.25533.end s
25534.and that l«any future building occupant will/will no(circle one)n ocomply with said state cedes and the requirements for BLDG PMT PLUMBING ELECTRICI MECHANIC FIRE SMIP/RES GRADING
' a permit for construction or modification fromthe Ak-6umy Msnasement Distil Residential construction applications are exempt from these
provisions. PERMIT 62 . 00 W.t
Date: Applicant: 25% j.,- SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perjury one of the following declarations: ISSUE FEE 20 . 00 ..4n I
❑ I have and will maintain a certificate of consent to self.insure for workers'compensation.as Provided for bySection 370pdthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK -. TOTAL PAID DUE
Code,for the performance of the work for which this permit is issued. TOTALS----> 62 . 00 20 , 00 1 "� ~
❑ I have and will maintain workers'compensation insurance,as required by Section 3700 of the labor Code,for the performance of the n 0'. 00 $2 . 0 O 82 , 00 . 00 •
work for which this permit is issued.My workers'compensation insurance senior and policy number are: ....+
Ca e: REVENUE DIVISION TOTALS--> COLLECTED: 82 . 00 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the perms is for one hundred dollars MOO]or less.) 82 . 00 /I 1 '
I cert mel in the ol the work for which thispermit is issued.I shall not emmanner / ',•
❑ n performanceplay any become
en in any theiso as m ^
become subject to the workers'compensation laws d California and Arae that R I shook become subject to the workers' **********************************‘**** ***************************************
compensation provisions of Sedan 3700 of the Labor Code,I shall forthwith campy with those provisions. IND IV IDUA L- FA E B ' R EAK D OWN
Date: . Appina l: •y "1
Warning:Failure to&scure workers'compensation coverage/s unlawful.and shall subject an employer to Minim,penalties and TYPE QTY D E S C R I P T I 0-. N UNIT COST TOTAL COST
civil fins u to one hundred thousand dollars(s100•IOOA In addition to the cwt of compensation,damages as provided for In l
secgon3706 of the Labor Code,Interest andetmmey'e fees. PLU 1 LAUNDRY TUB OR WASHER ix .17 7 . 00 7 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a m elt:lion lending agency for the PLU 1 SHOWER ' .� r't, 7 . 00 7 . 00
sod«maoeofthew«k1«whimmepermitisissued(Section3097,Ce.C). PLU 1 SINK, KITCHEN
7 . 00 7 . 00
LENDER'S NAME: PLU 1 WASH BASIN - - a 1 7 . 00 7 . 00
LENDER'S ADDRESS: PLU 1 WATER CLOSET ( TOILET_,) 7 . 00 7 . 00
Icertiythat Ihave read misapplication and detante,meaboveinf«metianis coned.Iagree tommpywimall tiyand county ordinen� PLU 1 WATER HEATER AND/Oft" VENT 7 . 00 7 . 00
and state laws relating to building construction and hereby authorize representatives tithe city to enter upon the abater-mentioned propend PLU 1 GAS PIPING SYS OF ' 1 TO 4 OUTLETS 5 . 00 5 . 00
rorinsped'wn Purposes. HENRY ABRAMS PLU 1 SEWER, CONNECTION TO\ BUILDING EACH 15 . 00 15 . 00
''END OF FEES
"int Name �Q
,���' � Dale: ..-1-1%.i
Signature. Je'T/Agent/Appbcanl/Contractor
7,7
(51St-a6 WP) White-Building&Safety:Green-File;Caney-Applicant;Pink-Revenue:Goldenrod-Assessor - I
-�CONSTRUCTION AND PLANNING v /. POOL 01 SPA
f APPROVALS Permit # Date Inspector •• APPROVALS Permit # Date Inspector
.f
1.•Temporary Electrical Service or Pole �"-52. Pool & Equipment Location
•
, 2. Soil Pipe-Undrgrnd. .4- 4e 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54, Forms
4. Electrical Conduit-Undrgrnd. I 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UF ER Grnd. 57, APPROVAL TO COVER-GUNITE 1
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, C Undrgrnd.,Test
9. Water Pipe-Undrgrnd. /n 60. Backwash Lines, P-Trap, C Undrgrnd.
•
10. Structural Floor System 61',-APPROVAL TO DECK fi
11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap :1; 63. Heater &
13. , , _.,�- , feel 6,249 " 64. Plumbing System - Final
14. Rough Plumbing
+r�`^�'� ��`--''(b� �•l�(�o �� 4 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring k 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 & Ai( Conditioning • FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #-
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating r 71. Product Piping El Gas Oil
23. Gas PiPe-Rough & Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank C 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
20. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79, FINAL INSPECTION �N i
32. Electrical Power Meter-Final 1 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning 4J-2 ? -12-621 -
35. Final Gas Pipe-Test Cr ZC gat)/
36. Hood or Canopy N,
37. Final Factory Fireplace
38. Final Plumbing q Zc--ta - -- --�-�
39. Water Service-Final
40. Gas Service-Final
41, Solar Domestic-Final
42, Backf low Preventer
43. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations !
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING - __-
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co -
51.- CERTIFICATE OF OCCUPANCY '
No. Date
OWNER BAYSHORE PARK DATE 7/13/59
JOB ADDRESS 221 E. 22nd St. BUILDING PERMIT NO. 9877 _
GENERAL CONTRACTOR owner-builder VALUE $ 4,000.00 O
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Nov. Reil":"d '''
INSPECTIONS / ev DATE I GROUP I & J TYPE V ZONE R14
I- -`rground Soil ...9.4-QU.G. Water f// PERMITS ISSUED
SUBCONTRACTOR
I, rground Gas k_ ,2�Q DATE NUMBER
Overhead Water and Gas �� ((
Rough Heating moi— _ _
Rough Plumbing 1, w/�/-$t� ',�y�ili2 X.�n.iv,, 7 - c7 / i
Miscellaneous
Prop. Swr.yine—Wiese Con. Swr. ( d/l,O/yy /(,r n�r �k)-IT./ ztia 1 I
Sprinkling System I •
Heating, Final _ ��' 4
Plumbing Fixtures /D-L2(S'Q ` _
Final Gas Test /Ca. /(� t be, /n.p/S-l9 i
Construction Pole ftei,40,4, .tet c L 2S_O=S_9 '117- '
Underground Power
Rough Wiring14ek.E�`i .. e _U v is- -,l J ''04-2/G
Trenches Forms Steel ¢4 �" y,-//' _f / �/
Floor System A#J27�' �?
Steel Reinforce Chimney Re-Rod - f Irk ,S-7
Bond Beam
Sheathing , . n„__,71
Frame and Flashing ®-.d- A-2...,....v. p_ -1 ,"`:i ,
Ili ng, In Out Q.t. to /3'.37 Al� A ' 7�
I-Mx er, brown coat 11 l i�. +�'4'
Plumbing Fixtures, Final L.6.- ' c_._ _
Electric Fixtures, Final -`tiy-/� /o—/3 .. // -/ ,3 'S 7
Building, Final p, ,r ,�I ,("y \ I 1
OCCUPANCY Al V J�” f U '���-7
Form 410-3M-439 9877
t . LE t:LL'mkt-
...i
9877 JUL 1 3 1959
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA ,
FOR APPL/CANT TO fill /N COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT. ) BUILDING
BUILDING nn i yLIADRESS ••'-‘ a ---- e
COSTA MESA, CALIFORNIA fOR Off/CE USE ONLY
^ yt LL e „ 'A,re-A< RECEIPT NO. we.ti- l
OWNER II,KI `` 1 `(`C�/�///' �/ (� /� / �rp I I [J'IJ qr.
ADDRESS 1'VL �.1� ) . c' Ct c+• l� (\JL,� Y VC{ 1 VED BY I �'ATT�E/TELE � )4E�
CITY n;rj�,u�C'� 1 �C, l� TN O.�I 1•�/(/_\V�Vv' ADLDING
DRESS , y�• jI `[]�j-I
Ar *TELT LIC. TVVV /GROUJ/j
ALIFORNIA
O 3INEER NO.
ADDRESS FIRE
`. - 1('1/�(y� W ZO 1 . P
CONTRACTOR �-1/[\ LJ�J,J•I`�/�..IC.NO. x,112'
--»JJ BY \p DATE /3-Arc
ADDRESS 1 . Of ZONING
LEGAL I LOT I I ZONE8 NO.OF USE OF NEW �y
DESCRIPTION INO. BLOCK TRACT '6`(// I PL/A�NS I BUILDING p� i
A.P.NO. ', Sr _11 0- eq NA
BYPROVYrE-D'1/i y79 DATE 7/l^�`Ui
SIZE .GO y �/ NOW ON LOT6 NV^i( YARDS
REQUIRED T 911,EVES
DATE
•-a
OF LOT CJ �I�
USE OF \\Ip� I' I (' (CENTER LINE ST.)
EXISTING BLDG. V `VI {FYI / / FRONT ,to FT. IN.
SETBACK LINE FROM r�+\, �{^ `/
CENTER OF STREET REAR YARD �� R.SIDE [S FT. IN.
/J V l
SIDE YARD I LEFT y ( I RIGHT L.SIDE q 5 FT. IN.
DESCRIPTION OF WORK REAR eA SJ FT. IN.
I I II ALTERATION I II ADDITION
REPAIR I II MOVING I II DEMOLISH I
BUILDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL (ROOF
COVERING COVERING
USE BU LDING (,S..WOR^I(TOII��B �
BE PERFORMED/�
iLa
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLYLAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
WITH ALL CITY ORDINANCE AND STATE
BUILDING CONST TIO Sl yK y/ fl —•
A`v'AV,'./I`' "- VALUATION / o-p
SIGNATUREEOF PERMIT FEE $ f
PERMITTEE �
�� ' j Wifjp� $ s(/ //�`�n/
N. PLAN CHECK $ re,
ITHORIZED AGENT +(A�'jA' V TOTAL FEE $ 70? -
`\
- ,.,,STA MESA BUILDING-SAFETY DEPARTMENT APPCATION FOR7STRUCTURAL PERMIT 96.90 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECj.___TitJ4tJ-__1
PERMITi] f�f3
/ T
For Applicant to Fill in Completely — Use Ink Only T Q
BUILDING C/l/_�/-"sr Q`�
ADDRESS L!.! !. vA.P. NO. 4,4. /4/4/-*OC
�� BUDDING n'/.-4.
n�
TOWNER NANTORa(,t4eQ/L02 ‘17111 edG./BW ADDRESS OrOC o�
UNIT OR
MAILING / SPACE NO.
ADDRESSOCn/;-� �/ c Sr_J
TR.NO. LOT 1BLK.
TEL.
CITY N
NEW •/ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER �l� C//O�_c
BRANCH D .4 ,7
OW NEI • CUzQ it (�OC�(/OGtJ
ADDRESS ���JJJ��_ 2 , ?BLUE$ �;SL
ARCHITECT TEL. USE Geta G r/
OR ENGINEER NO. (/�/ _
ADDRESS / ( ZONE ('� ( 4LYPEI.f .
GROUP 4
(lAi�/ _ APPRO ED 7/17/80
CONTRACTOR/li��!-�� BY DATE ` [ v
ADDRESS
TEL.
CITY NO.
F STATE CITY / R-�/ APPROVED SEI BACKS
LIC. NO. LIC.NO.
'OMREET) 110104
�/ /
W SIZE / NO.OF RLOGS.
a•
C�Cl/I I 0 ,.
tL OF LOTS0 )( NOW ON LOT i�A••4 A T. ]fQC(JYI
4USE OF � I -
CI) EXISTING BLDGs-, 4,...
"^ 1 I�t• _/_ I ,�/Ill I. i /
y
FSeparate permits are required for L. 3
O electric,plumbing and heating wor •
k. R FT. -7 /
[Ls). USE OF BUILDING AND WORK TO BE PERFORMED
'C P • NIN= •,:e /c L/ DATE
ate//GFi`-'rC iO ma /� D O/YIadd 'ter DATE APPROVEDof
�Q
Y —BA YPROVEy/I///�O� DATE L7 - / s/O
-I
S-��l//C�
a.
0 I hereby acknowledge that I have read this application and state r.
ad that the above Information is correct and agree to comply with
O. all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of
LA the State of California. O m
I hereby certify that I em Properly licensed as a contractor under SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHO UNDER VALUATION IS FOR to
am Chapterx9,p and that such
licenses aretIn full force and is utI -
THE PURPOSE OF ;-ABLISHING/1 PERMIT FEE ONLY: to
am exempt from the provisions of the State of California Business VALUATION .l. ref�llE/�E�E_ " en
and Professions Code,Diviion3, apter 9. PER
/
Signature of , •��// '. / Se ��'��`'_'s+t
Permittee ! �J 'w`J . _ a/
/ � TAX • O , {-s
Authorized Agent Date
e+s et 40 /2,4150TOTAL PAID $ ps'o
'D .
•
/ /
UR
-'`,- TSTA MESA BUILDING-SAFETYE , DEPARTMENT APPLI ATION FOR STRUCTURAL PERMIT
-./ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
—/ RECE D I PERMIT "'taro 49812 'o TL
7 . For Applicant to Fill in Completely- Use Ink Only ''Lt�1
BUILDING /fy/ 2 /i7 za A.P.NO. y' - /TT -0b
ADORES 6' �S.G (i (ifj( /J
OWNER OR L/. ,R2 o /J`�i2O a ADDRESS Ly/ 224-41SA
TENANT C��4/ /y (�'C ih CA)
/] UNIT OR
MAILING ADDRESS 2 i.r -&t 2i- /i�/A/J SPACE NO.
`JAIL TR.NO. LOT IBLK.
TE
CITY NOeS
_
Y.c�
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION /OAtV//
LENDER
BRANCH OWNER `S
EC.FA� regaj-
ADDRESS V UE , ie c
ARCHITECT TEL. , USE $ 3, 1
OR ENGINEER NO. I'.
ADDRESS �y ZONE k/ TYPE T r
// (_d�e�
APPROVED �J / s�
CONTRACTOR/�N/) BY DATE GROUP/ /7/O v
ADDRESS III
TEL.
CITY NO.
- /STATE CITY Q_ / APPROVED SETBACKS
LIC.NO. LIC.NO.
SIZE
{ Y
SIZE INO.OF BLDGS (FROM CA.STREET)
0• OF LOT NOW ON LOT FRONT FT.
Q USE OF
Ug„ EXISTING BLDG. R.SInE FT.
CO
(-0
Separate permits are required for L.SIDE FT.
CO electric,plumbing and heating work. REAR FT.
-
(.• USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a /�
�J^ —^ ^- DATE
(,C/J�/� (�(/V/yrf� APPROVED
APPROVED
} _HV DATE
C
W
0 I hereby acknowledge that I have read this application and state n'
GS that the above information is correct and agree to comply with
O. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of 2
CO the State of California.z41/7/]
I hereby certify that I am properly licensed as a contractor under �•`� SO. 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 OF ESTABLISHING A PERMIT FEE ONLY: -
to
am exempt from the provisions of : State of California Business
���IIII VALUATION PERMIT FEE $
and ProfessionsC•de Division 3 sip•tar 9. Op m
/ ry
PLAN CHECK S ice:OO 2
Signature of ( � `/—'/ D
Permittee ��� /.L UO V'-•`�✓_'•' $ 3 7V O u.
or t�j' I TAX $ 0. Q u
Authorized Agent Date 4 TOTAL PAID $ Z. 0
OWNER EDWARD A. GROCHC7W DATE 3-18-80
JOB ADDRESS 221 E. 22nd Street BUILDING PERMIT NO. 49812
GENERAL CONTRACTOR Owner/Builder DESCRIPTION of WORK Garage v
A' '0. 426-144-06 LOT TRACT FIRE ZONE VALUE $ 3,780.00
Ih .CTIONS Signature Dote TYPE v GROUP J1 ZONE R1
SOIL
GAS SUBCONTRACTOR PERMITS ISSUED
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND [xI POWER E C-C 3-15-45A)
fl{
ROUGH WIRING �-(C Hestina and Vent.
TRENCHES l? FORMS E STEEL REINF. �j I
FLOOR SYSTEM'� �G1
f
BOND BEAM I l STEEL REINFORCE n
SHEATHING Afila
#2)4102
FRAME AND FLASHING 3 s.IS'Ya
LATHING — IN ❑ OUT fl
PLASTER, BROWN COAT
5" 'URAL. FINAL D S 0-114479 (:)((.3Electric p
HE .1G, VENT., REFRIG. AND A.C., FINAL Nal0/� �7�C
PLUMBING. FINAL AND GAS TEST fl
ELECTRIC, FINAL �G 10il_429
BUILDING. FINAL
OWNER EDWARD GROCIFIOW DATE 3-18-80
JOB ADDRESS 221 E. 22nd Street BUILDING PERMIT NO. 49813
GENERAL CONTRACTOR Clwnpr/Rtiiicier DESCRIPTION of WORK Game an Add,
AP No. 426-144-06 LOT TRACT FIRE ZONE VALUES 12,800.00
'ECTIONS 5' eters Date TYPE V GROUP T ZONE R1
3-a6-le SUBCONTRACTOR PERMITS ISSUED
GASDate I Number I
Signature
WATER r�� ✓ r4y,Q Plumbing / / ,r.'
ROUGH PLUMBING �4� 1 .,V-80 1 43hWt 17 C -
PROP. SWR. LINE n HOUSE CON. CI I I """"""���lll...
SPRINKLING SYSTEM `'
MISCELLANEOUS 11631 R.(k .,r3 .1>< 5aI-9a
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
^L�
UNDERGROUND [L POWER d. 6_ 3-18
ROUGH WIRING r a ,. w Heating and Vent. .
TRENCHES /Z FORMS el STEEL REINF. U
FLOOR SYSTEM rIM
BOND BEAM n STEEL REINFORCE n G"
SHEATHING
FRAME AND FLASHIN 3.).. 'S-I
LATHING - IN OUT n r3 5--24.V7
PLASTER, BROWN COAT cc�� ��"" �/�
STRUCTURAL, FINAL -bs &.05-9 J —/ - Electric {, p /y/� ��ff
Hr G. VENT., REFRIG. AND A.G., FINAL /p/pO 517067 .—
PL" .ING. FINAL AND GAS TEST n p}--/- 6-3J-ii
ELECTRIC, FINAL A7/ 4,. .17--
FINAL 115 ,PC