HomeMy WebLinkAbout250 22ND ST - Building Permits Ar
COUNTY OF ORANGE =!- 1���/1
BUILDING DEPT. • ,
Permit No'. '
636 No. Broadway
Santa Ana, California Application for Building Permit
•
Phone: KI 2-6211 AND FOR A
Certificate of Use and Occupancy
�I// Date /0/P/S-7
1. OWNER'S NAME- M ( G PHONE
MAILING ADDRESS 2.5-0 '2_ �� CITY 4�
Name Name._ '..__. .._
(Architect or Engineer) n —
/O
(Contractor)
�s �
Address Address .-2— 3
City City ` A0"4-_J e
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State State el ^^ �•'� g Y ) [�
Lic. No. ,Phone _ . Lic. No. W ___.. Phone /V 6 7 ` 6 {�_ ,
PROPOSED USE: -.�J a^' �- - /2 "`{{{
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2. JOB LOCATION �`„. 7�- e' '�'�" Y �S �"�-^� •
(House No.) t� _ (Name of Street) (Town or School Distrix)
3. LEGAL Bounds
Lot ��" 30 Block Tract _____/-�--/-/----- ___________-- -�
(Metes and Bounds Description—Use reserse side of form)
4. CORNER LOT ( 00) INTERIOR LOT (x) THROUGH LOT ( T) SLOPE OF LOT ( )
5. SIZE OF BLDG.:.._/.P_x_-•'o.___AREA• ,27 /4 0 SIZE OF LOT:.Jt .X..L6rp
AREA:._.._L[
/ py Q�
Q0 /�-
6. HEIGHT OF BLDG.:. a ^ ^""„`CEILING HEIGHT• 0 NO' OF STORIES
7. NO. FAMILIES • Size of—SSmallest Bedroom: — Size of Kitchen:
8. EXTERIOR WALL CONSTRUCTION
Ser/4,4442 INTERIOR WALL COVERING
(Frame, Stucco, Etc.) (Plaster-Drywall, Etc.)
9. SETBACKS: Front Yard from Center Line of Street
lir/
'
Nearest Side Yard / f/._.Rear Yard / Distance in Feet Between Bldgs. on Same Lot 4
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width / "--- Depth in Ground / Width of Wall
Accessory / t/
Bldgs. and (b) Size of Studs: Z' x9 Spacing /¢ - "CC Material of Floor `vw"t-- •• `-
Similar
Structures:
(c) Size of Floor Joists: ,v $ i �� "CC
•
n if(d) Size of Rafters: 2 X / Spacing �7 0 C'°CC -_g
"V- 7--/e- 46,9 "vc
12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, ire sprinklers, paint-
ing and sewage disposal
6coao G-
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COUNTY OF ORANGE AND THE STATETEOFOF� CALIFORNIA APPLICABLE THERETO.
d
Signed•
.! -5--- k` • goe.A. 1-tA�k-
Plans File
/ - �i .r / ga , ef$11 -
By.
'l (Authorized Agent)
FOR DEPARTMENTAL USE ONLY
' FEES: CNG BY
Bldg. Permit rGROUP Jr-
APPLICATIOHEALTH
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Total - - $ d kDIST- ��Cir PLANS AND MARSHAL
(.2-- 1i'1T��--,
•
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Date /•0__0 ncu—' VERIFIED CAL
• PERMIT •
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CITY OF COSTA MESA
SERVICE REQUEST &PUBLIC ASSISTANCE FORM
Date \5 —(1-5 —73
Time .'o7)
Caller's Name i Crq Cr`E TA`
Address 1117 1(- 1=1. Phone 1075 t 57 1
Nature:'cl,Request:= (location, type. severity)
No
2 22 — �i lai CAS- D2AIQs ory
r . x r �
i6—n4 � 2 �fZop T AA
Aces) oeq. PP—oP.
Referredto
Call back X
: , yl _-i._—. Service Only n
Information Only •
Person Rcc'eivtngCall
CITY OF COSTA MESA
4 � BUILDING DIVISION
>i ..41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
u . PERMIT
It40earrn0e4. ✓05-00094
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 •
BUILDING PERMIT
Job Address: 250 22ND ST Status: ISSUED
Suite: Applied: 01/19/2005
Vicinity: ROOF Issued: 01/19/2005
Parcel Number: 42608121 Zoning:
Applicant: KIM MCCLAIN ISSUED BY:
Address: 12812 VALLEY VIEW ST -
STE 33 Phone: (714)897-1780
GARDEN GROVE CA Zip: 92845
Owner: GROTH, DAVID JOHN
Address -250 E 22ND ST - -
Phone:
COSTA MESA,CA Zip: 92627
Contractor: MCCLAIN ROOFING INC
Address: 12812 VALLEY VIEW ST
STE 33 Phone: (714)897-1780
GARDEN GROVE CA
Zip: 92845 License: 625013
•
Arch : - Eng:
Address: - Address:
Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30#ASTM FELT,30 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.
3,300 S.F. INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: $6,000.00
•
Permit: $125.25 Claim Valuation: $6,000.00
SMIP Res: $0.60
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $125.85
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)
DECLARATIONS ;
• ----TM
J CITY OF COSTA MESA `
44411111113.-.'4.\.
yl BUILDING DIVISION PER NUMBER
• DEVELOPMENT SERVICES DEPARTMENT
4. rkell •! PERMIT
4tberogmoo'4.
E99-00494
(714)754-5273 • Fax(714)754.4856 77 FAIR DRIVE,COSTA MESA,CA 92626
•
ELECTRICAL PERMIT
Job Address: 250 22ND ST Status: ISSUED
Suite No Applied: 06/10/1999
Vicinity: Issued: 06/10/1999
Parcel Nunmber: 42608121 /'/
ISSUED BY: (l �.
`-T
Applicant: BEASON, RICH
Address: 2462 MOONDUST
UNIT D Phone: 909-393-1563
CHINO HILLS Zip: 91709
Owner: PETERSON, CARL A JR
Address 250 E 22ND ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor RICH BEASON
Address: 2462 MOONDUST
UNIT D Phone: 909-393-1563
CHINO HILLS Zip: 91709 .
License: 758810
SCOPE OF PERMIT
4 LIGHTS,4 OUTLETS AND 4 SWITCHES REF B9900546.
120 SF ROOM ADDITION.
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 $4.00 4 up to 50 kva/kw $0.00 0
Recept Outlets $4.00 4 up to 100 kva/kw $0.00 0
Switches $4.00 4 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 $34.00
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 /
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.)
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 and agree t : 1 I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
late: oo- /�"1
' 97
SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEDE• AN EMPLOYER TO•-MAL PENALTIES ANIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR - •• •.. •-• E LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here. - •- at I am licensed un.- provisions of Chapter 9(commencing with Section 7000,of Jivlsl ne-»tri and essions Code,and my license is In full
•rce ant effect.Lic.# .T.R?Lc' Class#
Contrac•rs Signatu h _ " "/� _ Date: e.- /4C, - Ci
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 properly 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).
❑ 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 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 a emit for such construction or modification
ID
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No
(Section 65850.2 of the Califomia Government Code requires that the requested information be fumished 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 Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Siire 01 Legal Owner(s) •-•-
n ppl t� •ate
CODE# INSPECTION TYPE PATE lNTmAL5 CODE! INSPECTION TYPE Dan Smell
1616 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing•
//�/,�a ,'•.
200 Final Re-Roof 210 Final Electrical I I - ( -g-p (f,rI .i.'-E_
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 .
2446746
4:, .5.-17.12r.4.,,
J 4Z` CITY OF COSTA MESA
y' -4)4 BUILDING DIVISION PERM UMBER
f' ^"-3', ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT
'4•n,ma°
899-1111S4R
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 250 22ND ST Status: ISSUED
Suite: Applied: 04/20/1999
Vicinity: NEXT TO LIVING ROOM Issued: 06/10/1999
Parcel Nunmber: 42608121 - Zoning:
ISSUED BY:
Applicant: BEASON, RICHARD
Address:
Phone: 909-393-1563
Zip:
Owner: PETERSON, CARL A JR
Address 250 E 22ND ST
Phone:
COSTA MESA,CA - Zip: 92627
Contractor: RICH BEASON
.Address: 2462 MOONDUST
UNIT D Phone: 909-393-1563
CHINO HILLS
' Zip: 91709 License: 758810
Arch : DENNIS LA ROCHE Eng:
Address: 129 W WILSON ST Address:
Phone: (949)642-7126 Phone: •
' COSTA MESA,CA
Zip 92627 License: Zip: License:
SCOPE OF PERMIT
120 SF FAMILY ROOM ADDITION.ADDITION LOCATED TO REAR OF THE PROPERTY.
FEE SUMMARY
Plan Check: . $121.71 Calc Valuation: $12,000.00
Permit: $187.25 Claim Valuation: $12,000.00
SMIP Res: $1.20
-.SMIP Corn: $0.00
•
Other: $0.00
Inspection: $0.00
Total: $310.16
PLANNING&ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 101-11 Left 9-2 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 4...)
DECLARATIONS
I
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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 if the permit Is valued at one hundred dollars($100)or less.)
Cia<-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'
compel . '.n laws • ia,and agree tha if I should become subject to the workers'compensa8 o ction 3700 of the Labor Code,I shall forthwith
G-- /0- 9 9'
-•-- • :FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED C C 5 DECLARATION:
I hereby m that I am lice sed under provisions of Chapter 9(commencing with Section 7000)of Division ess and Professions Code,and my license is in full
fort effect.Lic.# 1 2 'I! Alro
ntra tors Signatu . �.�/ — •.e:
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
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 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 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 ❑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 0 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
compressed gas at standard temperature and pressure).
future
ccu to ___------- -___-9 Pe. oga. _... materials)?3 Does or will the applicant or present or future buildingoccupant need to prepare an RMPP(Risk Management and Prevention Pro ram for acutelyhazardous materials?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.. '-----.._ -.._...__----
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ID No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any
the facility
tednder p
6 Will any part of 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.
- Signaturwner(s) Date
- 9
A <.a •uthorized •••licant Da.:
CODE I JNSPECTION TYPE PATE *TRIALS CODE I INSPECTION TYPE PATE INffiUL@
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 Well 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'/ el [q r 4"/
/�
2446-46
PRWEEIAD G: 250 22ND ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 057'8'
OWNER' AE: SCHNEIDER r)AVID
AO.•ESS: 250 E 22ND ST PERMIT NO: 8 057484 PLAN CHECK NO: 01479-92 A GOVT: N STJPP: N
COSTA MESA,CA 92627
CONSTRUCTION TYPE; 5-N PERMIT TYPE: STR PURPOSE; ADD
( 7: 4 ) 650-6633 CT JOB DESCRIPTION ; ADD 3BD RMS( INCL MAST BD RM) , BATH,HALL SQ FT; 990
SII AflCH/ENGINEEfl: REG.NO.:
ADDRESS: UNIT:
---1 CLAIM VALUE: CALL-VALUE: 68, 310. 00 GROUP OCC : R-3 /M-1
t
' • PERMITTEE: DAVID SCHNEIDER ( 714 ) 650-6633
ADDRESS: 250 22ND ST COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME
,� .
COSTA MESA CA 92627 ***'>F*#AF*x********#�c,c,F#***m**•>f ******�F*Hx***a ** ****vx*at*******1.***TPF#,rr.u***,.:*a
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
Date:WORKERS'COMPENSATIONDECIARATION: thereby affirmthat Ihave acertificate of consent to self-insure oracertificate ofWorkers' FRNT: 28 FT IN REAR: 52 FT 6 IN FRNT: FT ' N REAR: FT ` N
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: 38 FT IN RGHT: 5 FT 8 IN LEFT; FT IN RGH 1'; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV' PARCEL : 42608101 7.NF: R1 REF NO:
, I—] Certified copy is hereby furnished. El Certified copy is filed with the city Building Division. PLANNING NOTES> SOME INTERIOR REMODEL• ADD NEW-. 2 CAR GARAGE AND NEW BEDROOMS
> NEW BEDROOMS TO HE- ADDED TO THE REAR OF THE NEW GARAGE,
gale: Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: .(This section need not be completed if the permit is for one hundred(St®)rr less). D E V E L O P M E N -T S E R" V I C E S REQUIREMENT S
I certify that in the performance of the work for which this permit is issued,I . •.1 e• 'toy any person in any manner so as to become rr
subject tothe Workers'pCompensation Laws of California. r ZONING APPROVEU BY' : ,--1‹...„B J /� .r DATE: _j .14
Date: 52'72 Signature: #e / i 5-T '
NOTICE:II.alter making this declaration,you should • t BUILDING APPROVED BY : .-/e.sub• to the Workers'Compensation provisions of the Labor ..BUILDING ':. DATE: ��'Z
2 _
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. --- .-
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APP L 1 CAT ION ISSUED BY: � ,y /1/. - S ' DATE: 2
which this permit is issued(Section 3097.Civ.Cl. ',' *****AE*******Bf****•9j•***'"Wt Rtrx • .1.1,1* PI'..if 4•01/./.
-b r.************** x*x.*********jr ?F$*R?+. # S'
LENDER: *********************************it.***x®:*******3(*** ******Y.**********if********** /
ADDRESS: LEGALIZATION:N F E• lf E • SUMMARY STRUCTURAL SEGMENT: Y
OWNER BUILDER.5 DECLARATION:andIPN: hereby affirm that am exempt hic the Contractors' t State stnse Law for the ,oreason
BLDG PMT PLUMBING ELEC"I`RIC • MECHANIC FIRE SMtP/R'E GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5OO , OO ^ 6 ;$3
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 the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 81 . 25 • e' / SM I,P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by 1 '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S5®). ISSUE FEE ,
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL '-, PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> S06 . 83 0^ 00 • . 81 . 25 588 ,08 588 . 08% . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through • •
his or her own employees,provided that such improvements are not intended or offered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 506, 83 OVER/SHORT j 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 500 • 00 6. 8 3 ' �r
17 and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon , '
and who contracts lor such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *4(*********************************************************x.****:jt.*4.E**9F***?A44-*K bt (
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B R E A K D O 'TR N ire
❑ I am exempt under Section: B.&P.C.
for this reason: I ` / TYPE QTY DESCRIPTIONUNIT 'OST; TOTAL COST
Date: Owner. v le SFR 990 DWE-TYPE V-WORD FRAM& -GOOD ' 69 . 00 _ 68, 310 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and EN► OF FEES '
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements fora , . '
permit for construction or modification from the Air(belay Management District.Residential construction applications are exempt from '
(hese provisions. ( ��Jilt,� � �� �. •
Date'. / rr 'e'� Applicant �; • 7, , 4 i
\ll1 ale�i r/J•,�r•a•�// ♦ 0V
I hereby certify that I have read this application and stale that the above int rmalion is correct.I agree to comply with all city and county r (,�.9:C� j.�'�. t , ri.e�,
Dalences and slate laws relating to building construction and hereby autho erepre Matins of this city to ether upon the above.mentioned C�::.� ��5'- ; ,
property for inspection purposes. ,ar!IJ� /
q�T r
-� Dale: �Y2�12 signature: 1
•
Driver's License or Social Security A: ;: r • '
1 164146 White-Budding;Green-Code Enforcement:Canary-Aoolicantl Pink-Revenue:Goldenrod-Assessor V
. r
y
rCONSTRUCTION AND PLANNING POOL PA
L
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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings G 58. Electrical Conduit-Undrgrnd.
8. Foundation �it
2--
1� % 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 "u
tst
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing
73. Undergrnd.Storage Tank 0 Gas 0 Oil -2`
25. Roof Sheathing ?j4 __ri/(/ �L 2 '
�T/ 74. Overhead Hydro i
26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical MI i
27. Frame and Flashing (1(3,qq 64' 76. Dry Standpipe
m ...•28. Lathing & Siding 77. FIXED SYSTEM FINAL `' " r
i
29. Insulation 78. FIRE PREY. FINAL v j
30. Drywall Nailing fig ////'t, HEALTH DEPT. REQUIREMENT 1
31. Plaster Brown Coat _at__
79. FINAL INSPECTION
32. Electrical Power Meter-Final !ll4•7 R'. vc�. FOOD CERTIFICATE ISSUED
33. Final Electric A.012.
e I V_?5 3.4" d Notes: �/y I y_ eyta_kz , : '. .
34. Final Heating& Air Conditioning (-!'�- 9- E 1-27 /-p1_ ,adt1-` -
35. Final Gas Pipe-Test /0". f` ICI ,_ /0Orel< DP!. �Ql�
36. Hood or Canopy
37. Final Factory Fireplace /'�'��
38. Final Plumbing / -94 lad__
39. Water Service-Final '�!
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer 1-1a -16 i d C'e.4.1 CS _�6/^ Ce---4
43. Backflow Irrigation �// i
44. Landscape Irrigation System `
45. Sound Attenuation ((L-CIG1 c/ .6 B 07 slit -
46. Handicap Regulations L/_C -fs"{-3.L-ta,J et- -
47. FINAL STRUCTURE & BUILDING L 1cP 94 Gub.-
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Www—
CERTIFICATE OF COMPLIANCE O5
PAYMENT OF SCHOOL FACILITY FEES
J
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
Developer/Applicant : 9.111152k k'
Address : ^L&Q E c e if ag &SO
Telephone Number : 714 666 -66-32)
r-ac-t/ arj.ei—en'cflof Number(s) :
Location of Project : �X' & , alloo-1/e-
Number of Square Feet of °J.--
Residential Space 910 x $1 . 50 Total "XO c
Number of Square Feet of
Commercial and
Industrial Space x $0 . 25 Total
Commercial/Industrial Project is : (Check One)
Mini-storage Motel Preschool
Movie Theater Bank Auto Repair
Racquet/Health Neighborhood Shops Hospital
Warehouses R & D Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial Office Park Fast Food
. ; The provisions of Government Code Section 53080 are not applicable.
This:'certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995 .
Checks are to be made payable to Newport-Mesa Unified School District .
Business Manager
Newport-Mesa Unified School District
The above representation as to square footage is true . Developer/
Applicant agrees that if it is later determined that such representa-
tions are 'not true then this certificate shall automatically terminate
and the appropriate City/County shall be n tified .1,7
r, GULL/
Date a//fi
/ c
JJ Deve Vper/Applicant
1
PROJECT ADDRESS: 250 22ND ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05748`_
` OWNER'S NAME: SCHNEIDER DAVID
a 4&Ess: 250 E 22ND ST PERMIT NO: 8 057485 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ADD
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : NEW ATTACHED GARAGE ( 4224SF) SQ FT: 422
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: 7, 300 . 60 GROUP OCC; M-1 /
PERMITTEE: DAVID SCHNEIDER ( 714 ) 650-6633
ADDRESS: 250 22ND ST COMMENTS: RE: B57484 PRIMARY BLDG PERMIT
COSTA MESA CA 92627 *************x***** ********** #TL*********Xe#r**?t* -*v-**x- -x*** *********#axe ****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING - ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a cenificate of consent to self-insure or a certificate of Workers' FRNT: 26 FT TN REAR : 52 FT 6 IN FRNT: FT TN REAR: FT TN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: 40 FT IN RGHT: 5 FT 2 IN LEFT: FT IN RGHT: FT IN
POLICY ND.: EXP.DATE:
COMPANY: PARKING REQ: 2 PROV: 2 PARCEL: 42608101 ZNE: R1 REF NO:
0 Certified copy is hereby furnished. 0 Cenified copy is filed with the city Building Division. PLANNING NOTES> PROPOSED 2 CAR GAR. THIS PERMIT IS TO DELETE GAR. ON -
PLAN CK, 1479 . 92A
.ate: Applicant: ****************3f-*%****#** *IF********If****** *lE**iI'-******%.************k*ii Y.*i*x**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section n of be completed if the permit is for one hundred(511X1)or less). D E V L O P M E N T SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permi ' Ssued.I/4. no mplgy any person in any manner so as to become _
subject to
the" WWo/rkkeers'Co2enation Laws of California. 7"/"*.-.
/'/ , ZONING APPROVED BY DATE: -1Y2
Date'. 7221 " Signature: // R 4
NOTICE:If,after making this declaration,you should become suit ct to the Workers'Compensation provisions of the Labor BUILDING APPROVED B.Y ; / ' _ DATE; � %Z-1 .1..
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION I S$UED ;B Y; TIP — ./AI DATE: 5/(.1.=7/17.2,
which this permit is issued(Section 3097.Civ.C). *if-*******+f-************iv *: • ft . +• ` -.c&t' ) 5r)[***'***)r*************** 3.`)e **�
LENDER: *************iF**********1(-**If************* ®*********+:*************** t**********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt trots the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 99 , 00 73
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 SM I P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 99 . 73 0 . 00 0 . 00 99 , 73 99 . 73 . 00
does not apply to an Owner of a property who builds or improves thereon,and who does such work himself/herself or through I
his or her own employees,provided that such improvements are not intended oroffered for sale.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 99 . 73 OVER/SHORT: . 00
improvement is sold Within one year of completion,the owner wit have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 99 . 00 , 73
0] and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************Y.--!Fi!********************}**.x.*.***)c********?f**SO*Ni***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.&P.C.
for this reason: �. ' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: ./` Owner: i4iY,/� /
ir a 1
I do hereby certify that I am aware of and understand the requirements of California Hea h and Safely Code Sections 25505,25533,and SFR + 422 RES-GARAGES TYPE E V 17. 30 7, 300 , 604
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a f END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from E - 1 9'E p
these provisions. - G A
I her Applicant:d4�' P -
hereby certify that have read this application and state that the above information is correct.I agree to comply with all city and county ✓ A/
ordinances and state laws relating to building construction and 1 b author I se %Ivesel this city to enter upontheabove-mentioned el
property I r inspection urposes, — Nit --
-
Date: Signature: !!
Driver's License or Social Security a: i
I 641-45 While—Burldmo:Green—Code Enforcement:Canary—Ao0lic0M:Pink—Revenue:Goldenrod—Assessor \
CONSTRUCTION AND PLANNING POOL )A
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.
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 .� t
24. Roof Framing 7-y a, 73- Undergrnd.Storage Tank 0 Gas 0 Oil ('
25. Roof Sheathing 97,: 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat I 75. Dry Chemical
27. Frame and FlashinI `� it t
I� �3� (QW 6V 76. Dry Standpipe .;,, Ce
rn
28. Lathing & Siding 77. FIXED SYSTEM FINAL r7 n
29. Insulation
�"�7Y .�fv� 78. FIRE PREV. FINAL f-
1
30. Drywall Nailing .r. ..R[�6(ti,t HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION .' •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: /0 -((_, qY, "44_4_
34. Final Heating& Air Conditioning /� �
•
35. Final Gas Pipe-Test ca,
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 /l3�cr(� G'CL�
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 Mes..�'
California 92628-1200 P.O.Box 1200
Insulation Certificate T �/ /�Q
Permit Number ✓ o�0 ^ Ma
N✓
260. 5 al Glee."--- -_/_ -
Number and Street City
d� �
my Subdivision Lot Number
Description of Installation
ROOF
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
EXTERIOR WALL �� v
Material . _ ` ! Brand Name —Kan `` &
Thickness (inches) Thermal Resistance (R-Value)_ (
CEILING
Batt or Blanket Type_Ff /�I
r Brand Name_L g0171111-0 F16
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.
t •
..ntr.ctor(Builder) License Number
_7:kt
Signature and Title •
Date •
Sub-Contractor(Insulation Installer) License Number
Signature and Title Date
190746
PROWNE 'S NAME: 2A 22ND ST " UNIT: CITY OF COSTA MESA — BUILDING FERN.;.T ,/PERM NO• P O5735i
OWNER'S S('HNEI DF.R (IAV.D
4011
ADDRESS: 250 ^: 22ND ST PERMIT NO: P 057553 FLAN CHECK NO; :J GOVT: N SUPP: N
COSTA MESA, CA 97627
CONSTRUCTION TYPE; 5—N PERMIT TYPE; PLU PURYOSS: 0TH
( '714 ) 650 6633 JOB DESCRIPTION ADD 3Bll RMS ( IN( L MAST BD RM,) , BA. H, HALL SQ FT:
ARCH/ENGINEER: flEG.NO.: M•' T
ADDRESS: UNIT:
CLAIM VALUE: CAJ,C VALUE; GROUP OCC : R-3 /M-1
0 PERMITTEE: DAV TI) SCHNEIDER ( 714 ) 650-6633
ADDRESS: 250 22ND ST COMMENTS : RE; B57484 PRIMARY BLDG, PERMIT,
COSTA MESA CA 92627 **+F?6*** *�6** ****** Ott******+t**** 4******iE�E* ***** *******m*******st**;E***k**** 6*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 1 ONING REQUIREMENTS
71000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUIILDING —
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ.. PROV; PARCEL: 42608101 ZNE; REF NO:
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOtES>
>
Date: Applicant'
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section needs be completed if the petrelsfor one hundred(5100)or less). D E V E L OPMENT SER V II C E Sl;-•( REQUIREMENTS
I certify that in the performance of the work for which this permi ' ued,I s x •: - .y any ierr p in any manner so as to become i
subject to the Workeis'/ �compensation Laws of California. l/ ZONING APPROVED BY DATE:
� Date: 0�l.4a/ Signature: //..7II�/ dr ,
•
NOTICE: after making this declaration,you should b-come sub-c to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY _ DATE
IL
Code.you must forthwith comply with such provisions or this perm shall be deemed revoked. `.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the tperformance of the work for APP L I CATSON ISSUED B Y• L4/ . „ DATE• 6//./.0-2___
which this permit is issued(Section 3097. C). - *************************x* -*b. -7'. !'" 3c
.".�' ' * * '}F£-3�r4Fx.7E**k* *********'Wfl7e** **
LENDER: *******************************************i®ii-*iF***********ai*******7f•** ****-****
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 23 . 00 .
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5%. $M is P/NON—R£S
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
m
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 3. 00 • -
I, as owner of the property or ray employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK -'J TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Processional Code: The Contractors'State License Law TOTALS--——> 23. 00 3 . 00 0 . 00 26 , 00 26 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through •
his or her own employees.provided that such improvements are not intended or offered for sate.Ii,however the building or
improvement
pursold
within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE BLDGDIVISION
PMT PLUMBING—
_PLUMBING ELECTRICOMECHANIC ' ' FIRED SMIPO/TOT/SHORT:GRADING PLAN—CHE
for the alseCK
I,as owner o1 the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 26 . 00
® and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects With a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******-*************************************4�************.***************#*****M.*
that Drool of their Worker's Compensation insurance should be provided to me. 'E. ^^''
Z N D I V I D L' A L F EBREAKDOWN
❑ .am exempt under Section: R.8 P.C. 71
mr mi maim: TYPE QTY DESCRIPTION '_a
UNIT COST TOTAL COST
i � /2„,..
�— Date: •
Owner: OLU I 2 - BATHTUB (i 2 , 00 4 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and .PLU 1_ •UNDR Y TUB OR WASHER , ' 1 2 , 00 2 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comp*with said state codes and the requirements far a PLU �/ ( .cG 'S H A AS T N 1 2 , 00 4 . 00
' permit for construction or modification from the Air Quality Management Disthct.Residential construction applications are exempt from
these provisions. PI,TI �!IR'aiW����► �' DET (TOZLF.T) fj,p' 2 . 00 4 . 00
PLU �- '"s a y`l" �s-�f.1 ITER AND/OR VENT T 2 . 00 2 . 00
Date: Applicant PLTJ IP���', /`sibs g _NG SYS OF 1 3.O. 4 OUTLETS 2 , 00 2 . 00
I herebycertify that I have read this application and state that the above infor ton is co ct.I agree to complywith all cityand countyPT�T' f , `.A'� r �1ti''''... -1NNECT ION TO BUILDING EACH 5 , 00 5, 00
Y 9ru 1.a�t - �I'—.il'F I I I
ordinances and state taws relating to building construction and l�psa4l'author¢e a I qi th¢city to enter upon the above-mentioned :�( END GT`x FEES
property for�5pectia[1 rposes. L/
Date: C Signature: • ."
A
Driver's License or Social Security a: -.4 I •
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
RUC AND PLANNING
ION POOL & SPA
�• CONSTDate Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1.'temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 61(02, c 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4, Electricol 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, C7 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11„Property Sewer Line & House Connection Wttfit cep 62. Backwash & Receptor•Final
12. Sewer Cap63. Heater& Vent-Final •'
13. Roof Drains 64. Plumbing System• Final
•
14. Rough Plumbing
4/'344Z Geo 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# 3
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil a
23. Gas Pipe-Rough & Test
[�3 4t( 73/4 72. Underground Flush r• c• ,
24. Roof Framing �(
. Undergrnd.Storage Tank O Gas 0 Oil " '�
25. Roof Sheathing 74. Overhead Hydro ••
i t
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ) ,:
27. Frame and Flashing 76. Dry Standpipe 5 j
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 I{L
33. Final Electric Notes: r-/- -y fL. `02YtSr7 ref _J-E.L.77Ct
34. Final Heating& Air Conditioning - e-X/ i.. =n-r ex-73. A-->
35. Final Gas Pipe-Test / -U _C`s-- P - e,_-
36. Hood or Canopy /� S S c n... ema
dQ ,
_r
37. Final Factory Fireplace �P
1 30 -fib €-vim P/
38. Final Plumbing /-36)%6. C )
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
/ ...------4-• ii
•
r" A
PROJECT ADNAME:
UNIT:
OWNER'S
AO NAME: 250 22ND ST CITY OF COSTA MESA — BUILDING PERMIT ✓PERM NO: E 062718
•
ADDRESS:SCHNEIDER DAVID j
P 250 E 22ND ST PERMIT NO: E 062718 PLAN CHECK NO: N GOVT: N SUPP: N '
COSTA MESA,CA 92627
CONSTRUCTION TYPE; 5—N PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER: (714 )650-6633 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : ADD 3BD RMS( INCL MAST BD RM) , BATH,HALL SQ FT:
PERMITTEE:DAVID SCHNEIDER ( 714 )650-6633 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
ADDREss: 250 22ND ST COMMENTS: RE: B57484 PRIMARY BLDG• PERMIT.
COSTA MESA CA 92627 *********************************** ******* **+ PTP************I ** **************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ; PROV: PARCEL: 42608101 ZNE: REF NO:
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
-
Date Applicant: --� *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need m re completed it the permit is for one hundied($100)or less). ' DEVELOPMENT S:` E!R V I C E S REQUIREMENTS
I certify that in the performance of the work for which this per- • •SueO,I s oy an rerson in any manner so as to become
subject tot V rrkers'Compensation Laws of California. / ,� ZONING APPROVED BY DATE:
Date: ///3 Signature: ° ��� _
NOT( I.alter making this declaration.you should become sin'cl o the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this pe mit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE: co Z3/
which this permit is issued(Section 3097.Civ.C). ** * ***
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 78 60
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 50% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 1500
00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 78 . 60 15 . 00 0 .00 93 • 60 93 . 60 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 93. 60 OVER/SHORT; . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 93. 60
and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law),l am aware *,*,**,***,*,*,*,x*,***,***,******************,*************,******************************
that proof of their Worker's Compensation insurance should be provided to me.
0 I am exempt under Section: B.a P.C. ‘ INDIVIDUAL F E E BREAKDOWN
fen tm a // �� / TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
J
1 Date 6/[/ Owner . 4%r
I do hereby certify that I am aware of and understand the requirements of California ea and Safety Code Sections 25505,25533,and ELE 12 FIXTURES LIGHTING 1 ST 20 EA• . 75 9 • 00
25534 and that l or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 20 RECEPT/OUTLET 1 ST 20 EA. . 75 15 • 00
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 8 RECEPT/OUTLET ADDITIONAL EA• . 45 3 . 60
these provisions. ELE 14 RECEPT/SWITCH 1 ST 20 EA, . 75 10 . 50
Date: Applicant: ELE
1 SERVICES BELOW 600 V & BELOW 201 AMP 18 , 50 18 . 50
ELE 1 SUB—PANEL 11 . 00 11 . 00
I hereby certify that I have read this application and state that the above inform.ion is correct.I agree to comply with all city and county ELE 1 M I SC CONDUIT NOT LISTED REQ PERMIT 11 . 00 11 . 00
ordinances and state laws relating to building construction and h.eby aukBorize r ore •'tali of this citka to enter upon the above-mentioned END OF FEES
property for in/sspection purposes,
Date:41.i5 Signature: ./z) �i�. dad 01 DATE:D(<3S'v—D034]531 TOT
Driver's License or Social Security a: � ps/� /93 TM:
9J°L4(J
14:34
1641-46 White—Building:Green—Code Enforcement:Canary—Applicanq Pmk—Revenue:Goldenrod—Assessor
_l _ 4
1Jpp. CONSTRUCTION AND PLANNING POOL SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole e • 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 COVE R-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 r -
_
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , „
12. Sewer Cap 63. Heater & Vent-Final ,
y
13. Roof Drains '- 64. Plumbing System - Final •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit / ; /Set,
66. Solar System-Final
16. Rough Electric Wiring I/f 19/f // et 67. Fencing &Access Approval
17. Rough Wiring Sign v/ �` 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 _ r APPROVALS, Permit # -
21. Ducts, in Structure• ' " 70. Underground Hycfro
22. Ducts, Ventilating . : 171. 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
r 26. T-Bar Ceiling (Structural) & Monocoat _ 75. Dry Chemical _ -
` 27. Frame and Flashing.- . 76. Dry Standpipe -
l 28. Lathing & Siding - 77. FIXED SYSTEM FINAL: . L
I .
29. Insulation I 78.'FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I -79. FINAL INSPECTION .
32. Electrical Power Meter-Final //Rh7 a, 30. FOOD CERTIFICATE ISSUED
33. Final Electric 11 i 10- '
/C- yh5 . L Notes:
34. Final Heating"& Air Conditioning I - - -
35. Final Gas'Pipe-Test I . - - - ,
36. Hood or Canopyj I
37. Final Factory Fireplace - I .
38. Final Plumbing
39. Water Service-Final I j
40. Gas Service-Final • - -
'41. Solar Domestic-Final - I _
42. Backflow Preventer j I
43. Backflow Irrigation .
-44. Landscape Irrigation System: - - - '
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING I `•r1
48. FINAL PLANNING I � -
49. Electric Release to Edison -
i ,
50. Gas Release to Southern California Gas Co i I 1 • •
51. CERTIFICATE OF OCCUPANCY -
No. Date
��-
r�-pNOWNE 'S NAME: 250 22ND ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT 'PERM NO; E 062717 ,
owNER'sNAME:SCHNEIDER DAVID
AOORESS:250 E 22ND ST PERMIT NO; E 062717 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: ADD
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : NEW ATTACHED GARAGE ( 422#SF) SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: M-1 /
ADDRESS:DAVID SCHNEIDER ( 714 )650-6633
250 22ND ST COMMENTS. RE• B57484 PRIMARY BLDG PERMIT GARAGE PERMIT #B57485
�Q ATt ES� CA 924 7 it�r�E�r�r�r�E�EiF�r�r�e�r****�r�r********�E�E�E**********4***********************T��E�F�E****�L�F*****
LICENSED CONTRACT R TI ere y affirm that I am licensed under provisions a apter 9(commencing with Section Z ONING R E U I R E M E N T S
7000)of Division 3 0l the Business and Professions Code,and my license is in full force and effect SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORXERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a cenilicate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42608101 ZNE: REF NO:
7 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
Date: Applicant'. *****************************************IE****fk****IE***************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need n be completed it the permit is fee one hundred($103)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in 1 e performance of the work for which this permit' ved,15 ,I y any I.son in any man 'r so as to become
w` subject to orker 'Compensation Laws of California. ,�f�/r ZONING APPROVED BY DATE:
/ Date:_ Signature: 7('y���y '�
NO .d,after making this declaration.you should be ome sublet to the Workers'Compensation provisions of me Labor BUILDING APPROVED BY : . DATE:
Code.you must forthwith comply with such provisions or this per,it shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• ` DATE: `/
��
which this permit is issued(Section 3097,Civ.C).
LENDER: ***************************************** *********************** *****
ADDRESS: *************************************'******************************************
LEGALIZATION:N FEE • S U M M A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 6 . 00
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - 5 fit SMIP/NON—RES
and Professions Code)on that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLS
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 1-5 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
0 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 6 . 00 15, 00 0 . 00 21 . 00 21 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED' 21 . 00 OVER/SHORT. 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 21 . 00
iti and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contra tors'State License Law).I am aware *****,********,***********,****,*******,*,***, *,*,*,********,**,*****,*,**,**,****,**,*,***,****,*,*
that proof of their Worker's Compensation insurance should be provided to me.
❑ am exempt under Section: B.8 P.C. " I N D I V I D U A L . F E E B R E A K D O W N
for s anon: x _
� � •
/ %/ / % TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date:_ owner:
I do hereby certify that I am aware of and understand the requirements of California He. and Safety Code Sections 25505.25533,and ELE 3 FIXTURES LIGHTING 1 ST 20 EA. . 75 2 . 25
25534 and that l or any future building occupant wiltwill not(circle one)need to comply with said state codes and the requirements for a ELE 3 RECEPT/OUTLET 1 ST 20 EA. . 75 2 . 25
permit lot construction or modification from the Air Quality Management District.Residential construction applications are exempt from ELE 2 RECEPT/SWITCH 1 ST 20 EA. . 75 1 . 50
these provisions.
END OF FEES
Date: Applicant:
I hereby certify that I have read this application and state that the above infor• ion is correct.Pagree to comply with all city and county
ordinances and state laws relating to building construction and h' thoriz)(prey'es of this city to enter upon the above'mentioned
properly for In, notion purposes.
Date'._� Signature: int
�� r 01 00141532-00141532 TOT
21.00
DATE: 06/23/93TIME: 4 35
Driver's License or Social Security a:
164t.46 White—Building:Green—Code Enlorcoment:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •
Y -•
.I
,
.- CONSTRUCTION AND PLANNING POOH .PA
•�I Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Set ice 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 i 58. Electrical Conduit-Undrg,nd.
hh
8. Foundation /' -� "„ - 59. Gas Pipe, O Uritfigriic , Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System . e , 61. APPROVAL TO DECK r ;
11. Property Sewer Line& House Connection - 62. Backwash & Receptor-Final -
12. Sewer Cap - 63. Heater& Vent-Final -
-
13. Roof Drains , 64. Plumbing System - Final
t `
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit r 66. Solar System-Final !
16. Rough Electric Wiring EAT/43/ 67. Fencing & Access Approval
,
17. Rough Wiring((( Si9n 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air ConditioningFIFic DEPT. REQUIREMENT
20..-Rough Factory Fireplace APPROVALS" Permit #
1' '
21. Ducts, in Structure • 70. Underground Hydro
22. Duct , Ventilating - t .7 I. Product.Piping OGas 0 Oil
23. Gas Pipe-Rough & Test i '' i.72. Underground Flush
24. Roof Framing _ 73. Undergrncf.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 I 77. -FIXED SYSTEM.EINAL .
29. Insulation 78. 'FIRE PREY. FINAL
30. Drywall Nailing ' ' I _ HEALTH DEPT-REQUIREMENT
31. Plaster Brown Coat - I 79. FINAL INSPECTION _
32. Electrical Power Meter-Final ` j I {) ' 80. FOOD CERTIFICATE ISSUED ,
'L.�..._,._
33. Final Electric - ./(5/4151I.
C5/ , ( Notes: /r-u�,;�J- /
34. Final Heating& AirConditioning - I G LJ6245 293( y/6-70_ 19x17
35. Final Gas Pipe,Test . I K� e-
r
36. Hood or Canopy I - - -
37. Final Factory Fireplace I
I
38. Final Plumbing I I I _
39. Water Service-Final •
- i I +
40. Gas Service-Final I I
41. Solar Domestic-Final I •
I
42. Backflow Preventer ) I
43. Backflow Irrigation -
44. Landscape irrigation System - - - .
45, Sound Attenuation '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING I I _ I
48. FINAL PLANNING I .=--I'
49. Electric Release to Edison I :.i
50. Gas Release to Southern California Gas Co I I
51. CERTIFICATE OF OCCUPANCY +
No. Date
IPROJECT ADDRESS: 250 22ND ST- • /� UNIT: CITY OF COSTA MESA — BUILDING PERMIT "PERM NO: M 062719
OWNER'S NAME: SCHNEIDER DAVID '
ADDRESS: 250 E 22N5 ST x e PERMIT NO: M 062719 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: 0TH
ARCH/ENGINEER: ( 714 ) 650-6633 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : ADD 3BD RMS( INCL MAST BD RM) , BATH, HALL SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /M-1
ADDRESS: DAVID SCHNEIDER ( 714 )650-6633
250 22ND ST COMMENTS• RE• B57484 PRIMARY BLDG. PERMITMESA ,
LICENSED CONTRACTOR- STA otuLAARAIION: i hereby affirm that I am licensed undeerr provisionspro0 apter 9(commencing with Section
• 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. ZONING REQUIREMENTS
CITY LIC.: STATE LIC.: CLASS: S E T B A C K S
Dale: - Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT
Compensation Insurance, or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT N
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV; PARCEL: 42608101 ZNE: REF NO;
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> ..1✓. �
Dale: Applicant: > ' '�\ L
********************************************** ** ************ ***************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need a templet if the permit is for one hundred($100)or less). DEVELOPMENT S E R 'V I C E Sf'A E Q ¶ I R M E N T S
I cenlly that in the performance of the work for which this permi stt$d,I sh I ny perspn in any manner so as to become
subject Iryh }LJUls'Compensation Laws of Calilorni �'�" •
((�j' /IJ../(
ZONING APPROVED BY ':, DATE:
• \ Date: Signature:
/J N C :II,after making this declaration,you should came sub to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : /1 DATE:
Code.you must forthwith comply with such provisions or this per al shall be deemed revoked. /',r/� DATE• q'�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• l-/ Z 1�
which this permit is issued(Section 3097.Civ.Cl. **********************************`***.******** * ****************** **
• LENDER:ADDRESS: ***********************************.********************************************
LEGALIZATION:N F E E S U M- M A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed P ERM I T _ 1S,00
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business _ 2 5 t SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE c 15 . 00
00
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK .) TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 18 . 0 0 15 . 0 0 0 00 33 . 00 33. 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through s•
his or her own employees,provided that such improvements are not intended or altered for sale.If,however the building or i
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED 3 3 . 0 0 OVER/SHORT• ,00 --'
tor e purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC ( FIRE SMIP/TOT GRADING PLAN—CHECKi
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 33 . 00
and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
V
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.&P.C. INDIVIDUAL FEE -. BREAKDOWN
•
for this ason: ;-t
TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Dale:_6 � - Owner: •
I do hereby certify that I am aware of and understand the requirements of California Nealt and Safely Code Sections 25505,25533,and MEC 1 REPAIR/ALT COOLING UNIT/SYS -W/CNTLS 9 .00
9 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements lora MEC 1 REPAIR/ALT HEATING UNIT/SYS iW/CNTLS 9 , 00 9 . 00
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END OF FEES,k
these provisions. -/1
r
Date: Applicant: + '
I hereby certify that I have read this application and state that the above info ation is c• eel.I agree to comply with all city and county
ordinances and slate laws relating to building construction and h. .•.auThoriyr i i nt. sof this city to,pnter upon the above-mentioned
property lor n bon proposes. ��` / DATE:106/23/9314TIME: 1 31) 33.00
Date:_ !722 Signature: II / / ' '
Driver's license or Social Security a:
1641.46 'Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor '
•
CONSTRUCTI-ON AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1, Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6: Electrical OF 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.
I10: 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
f 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 O Gas 0 Oil
25. Roof Sheathing _ 74. Overhead Hydro -
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding i 77. FIXED SYSTEM FINAL
29. Insulation I 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat i 79. FINAL INSPECTION
32. Electrical Power Meter•Final - • I 80. FOOD CERTIFICATE ISSUED
33. Final Electric
E.
Notes: V.7 trf f/ffc 1�77Gr5 %dec,
34. Final Heating & Air Conditioning /�ji.91 / [�4- G�) G `r-/btI Nor(cc-e
35. Final Gas Pipe-Test I /a - -
36. Hood or Canopy i I �� r' ----
I / __3� A,//�•.-
0 IU % CM19/b !
37. Final Factory Fireplace I IL/,)
38. Final Plumbing I
i
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 I
i
49. Electric Releaie to Edisoni •
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 250 22ND ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06953E
OWNERS NAME: SCHNEIDER, DAVID
ADRES&: 250 E 22ND ST PERMIT NO; B 069538 PLAN CHECK NO; N GOVT; N SUPE ; N
COSTA MESA, CA 92627
CONSTRUCTION TYPE; 5—N PERMIT TYPE; STR PURPOSE; ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP SQ FT; 2, 621
ADDRESS: UNIT:
CLAIM VALUE; 2 , 621 , 00 CALL—VALUE; 2, 621 ,00 GROUP OCC; R-3 /
PERMITTEE: H,K, ROOFING INC ( 714 ) 895-9909
ADDRESS: 6348 IDUSTRY WAY COMMENTS; SMOKE DETECTORS ARE REQUIRED AS PER�H�r�EU,B ,C1991 ,
WESTMINSTER CA 92683 **** *4****�r�H+t�r�H+e***tr********* +r+tit*****�H****yEx+r*+r4* **ir�6*�t* *****************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 2 ON I NG REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
cITY UC.: 06 12 sT FUG.: 6614 cuss: —3� 9/99
ate:_� � signature: _ _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'C PENS ION DECLARATION: thereby alter that lhave aceNlicale of consent u o certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation ln5ufpe2oLa41ie09copy tnereol(Section 3800.Lab.Cal /01 /95 LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: 11..77 32724-94 EXP.DATE:
COMPANY: STATE FUND,—Y PARKING REQ• PROV; PARCEL; 42608101 ZNE; REF NO; ^
D Certified copy is hereby lumished. L]`Cenilied c. . filed with the city Building Di ' 0 PLANNING NOTES>
/ Date: p pi q ]- Applic. t: J/.. .. r , / . (, k *******************************************************************************
EXEMPTION ROM WS'COMPENSATION DECLARATION: (This section need not be completed if the per it .for. e hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I cenily that in the performance of the work for which this permit is issued,I shall not employ any perso-i any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY
I DATE;
Date: Signature: BUILDING APPROVED BY
NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; DATE; /0 (J (/
which this permit is issued(Section 3097.Civ.Cl **' ***'*********'* '**- '*'*** '**'******* 'N'***********************iF* *iF iF iF
LENDER: ********************************************************************* **** ****
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGM NT;Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 .00 , 5 0
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5006 ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 54 . 50 0 , 0 0 0 . 00 5 4 , 5 0 54 . 50 , 0 0
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED • 54 , 50 /OVER/SHORT; 0 0
improvement e of sale).is sold within one year of completion.the owner will have the burden of proving he/she did not buildbuildor improve
for the purpose BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 0 0 5 0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon *******************************************************************************
and who contracts Co for Theuch protects with a co license pursuant to the of Contractors'Slate License law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
O I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: owner SFR 2621 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2, 621 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
hApplicant:
I hereby certify that I have read this application anddstate that the above information is correct.I agree to comply with all city and county
/
ordinances and state laws relating to building construction.jby authorize representatives of this i to enter upon thabove-mentioned
properly forinn ppeeccttionr'purposes. I
Date: C1.J�/h( Signal*j • }•� . DATE: 10/26/941 01170261 TINf.a 08 7 54,50
Driver's License or Social ecunty.: .
((
/1641.46 WMe—Building;Green—Coda Enlorcoment:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
c )NSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit Date Inspector APPROVALS Permit # Date Inspector
-r'
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 ConduitdUndrgrnd. 55. Electrical Bonding
. 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test -
-- ••6: Electrical UF ER Grnd. r 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 1 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 • •• ,I • - 'APPROVALS .6Permit # • .
21. Ducts,in.Structure - - 70. Undergiounct Hydro
22. Ducts, Ventilating ;71. Product Piping IDGas 0Oil
23.-Gas Pipe-Rough & Test ,72. Underground Flush
24.,Roof Framing - • 7371Undergrnd.StorageTank 0 Gas 0 Di;
25. Roof Sheathing - • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat75.Dry Chemical
27.•Frame and Flashing t, t) 76. •Dry Standpipe
28. Lathing-& Siding . - •• •• • • • 77.- FIXED SYSTEM FINAL
29. Insulation , , it • ' 78-:-FIRE PREV. FINAL
'30- Drywall Nailing I I* • HEALTH:DEPT' REQUIREMENT
31. Plaster Brown Coat I` ., 79. FINAL INSPECTION
.32. Electrical Power Meter-Final •
4 80. FOOD CERTIFICATE ISSUED
i
33.-Final Electric I r; '' Nofes:
'34. Final Heating& Air-Conditioning -
35. Final Gas Pipe-Test • • - 1r _ •
r. .
36. Hood or'Canopy ` -
.37. Final Factory Fireplace . " : - _- -�--
38. Final Plumbing . ' ' t _
39. Water Service:Final • c 1* , -
40. Gas Service-Final . , _ .•
41. Solar Domestic-Final b
42. 'Backf low Preventer I
43. Backflow Irrigation - • 1 •
44- Landscape Irrigation System , - -
hc45. :Sound Attenuation- - . T - - - - " - -i* r. '
46. Handicap,Regulations " . -,
47. FINAL STRUCTURE & BUILDING /1�2...1g• /��1_ . ' - -
48. FINAL PLANNING. / ; • - ,; - ".
49. Electric Release to Edison • ' _, -
50. Gas Release to Southern California,GasOD - - - -
51- CERTIFICATE OF bCCUPANCY , . .
No. Date
I . I ,�
... Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-
CITY OF COSTA MESA CONST
.+}R�UCTION PERMIT PER/M�IrT NO. TRACT NO. LOT NO. UNIT NO. , C__ -i
Project Address LSOZ� 54-- 1I. ����
E 0IC (c t( -k CA,C Cl, TYPE OF CONSTRUCTION CI NEW U ADD LJ ALTERATION U REPAIR
Applibant's Mailing Address 1
Own's Name C1 tJ L.UC2 .' Phone 722'(IG`z J ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
J ` - DESCRIPTION OF WORK/USE OF BLDG.
-2-c )Address SG) •E -. -2-2-PbSU - 7,y9 _ S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT El GRADING C FOUNDATION ❑ STRUCTURAL E Front ZO
Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name r'' "v d1)emp44001,e 4705 "24 . C OTHER A I
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
C Right N
Address(mailing) 'fid 3 OF Ill, (02(4CLLl Ccc ,Q jet"(
2 ' CONSTRUCTION TYPE VALUATION$ $ Left R
City License No. `'/M1^+ ZONE ' GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: • Q
with section 7000) of Division 3 of the Business and Professions Code,and M
my license is in full force and effect. G 5 T
License Class C_ • CI cense No 5 (Z4 S
Date Co Signature �`/ PLUMBING FEES
WORKERS'COMPENSATION DE to of consent
ON Bar Sink Showers ELECTRICAL FEES
tiereby affirm that I have a certificate of coto self-insure or a certificate `_
Workers' Compensation Insurance, or a certified copy thereof (Section
400, Lab. C.) Backflow Preventer Service Sink , Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation - ❑ 50+KW
9 Sewer Cap Construction Pole Sub.
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit ' Meter0 100 amps 5•
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for whichlrerml ' ed, I
shall not employ any person in any ma - s' to e s bject o the Drinking Fountains Solar Tank Fan
Workers.' Cgypensalioa Laws of Califo,I
1` Motors ❑0-1 HP ❑1X-8
Date -( (Cv lS I Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration,you should become subject to the —
Inc.Solar ❑9-15 HP ❑15-1$+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
•
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches - Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays Y Generator ❑0-5 KW ❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit P
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of
Qivision 3 of the Business and Professions Code) or that he/she is exempt •
erefrom and the basis for the alleged exemption. Any violation of Section
)31,5 by any applicant for a permit subjects the applicant to a civil
e.nalty of not more than five hundred dollars($500).
LL I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee S 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES.
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own _ - DEVELOPMENT SERVICES REQUIREMENTS: '
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose sale). - 744:1-{c)
�/� �
0 I, as ownerrofof the
property, amexclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. - _ PLAN CHECK $ PERMIT
0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
•
Date Owner Heating System& Ducting Registers
• PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑D-100,000 BTU 0100,000 BTU C(-.- GRADING $
information is correct. I agree • comply with all city and county ordinances ELECTRICAL $
and state laws r Wing/b g cons :• and hereby authorize repre- - MICROFILM $
sentatives of iiss city r upo the ab•ve-mentioned property for PLAN CHECK 50% $
Inspection gQJIN' —
` $ �j .
Signature L/' Date �
�G 7 MECHANICALTOTAL FEE $ O
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SS# _ ( ' (^
CMF 0865-46,rev.10/84 white - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical 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 iy`
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil i
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 r
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 7-1741 ,..IC, Notes:
34. Final Heating & Air Conditioning • 1
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 /:' t;
42. Backflow Preventer VI r • �' '
• -43. Backflow Irrigation ' f
44. Landscape Irrigation System - (!-
'145. Sound Attenuation - +: C. : .
46: Handicap Regulations -
47..FINALSTRUCTURE& BUILDING n , .. ,
48.-Special Requirements Completed
4 1.
49. Electric Release to Edison '‘' r ?:�
50. Gas Release to Southern California Gas Co -
A -
51. CERTIFICATE OF OCCUPANCY
No. Date
n --)r3/Vo
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF CO4TA1vIESA CONSTRUCTION PERMIT - PERM NO. O TRACT NO. LOT NO. UNIT NO.
Project Address O0 g c?ArID/I1cs/T/ I,I �! f - 1' a3 / / I 1157 3/16/rE L. C IL
Applicant's Mailing Address /533 W • .C./A COLA) TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION U REPAIR ,
CTp /. ��1 `' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.# Zone
Owner's N(a�fne •--VP �T Or
/Phone"T'7 y�d) DESCRIPTION OF WORK/USE OF BLDG.
•
Address 1 —�0 i �/T' �� Or a/OAJ(Y e o4 r S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT C7 GRADING El FOUNDATION FOUNDATION STRUCTURAL T Front 0
Address �// ElTENANT III ELECTRICAL El PLUMBING El MECHANICAL - B Rear N
Contractor's Nam- d I, RA-f LA0 4 /•h•ne772-"/70 ❑ 'OTHER C Right - N
3 ./ PROJECT DESCRIPTION SQ. FT. OCCUPANCv
City Licensmailing) u)• /�/ �i� A fie://r) . G
ry CON STRUCTION TYPE VALUATION S Left
City License No. �J ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided - E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PlanningNotes:
0
with section 7000) of Division 3 of the Business and Professions Code, and `�s� y 1g�g N1
my license is in fqu/tg a and effect. ' 4in�57 RE EYED M K r T
License ss • (LICI }icenf ry6 / J �•( L'� S
\�' Date/' Signature PLUMBING FEES '
l0 'ORKERS'COMPENSATION DECLARATION Bar Sink Showers
lereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
1 _i Workers' Compensation Insurance, or-a certified copy thereof (Section' Backflow Preventer Service Sink
3800, Lab. C.) ,�/(JAI (/�/�7�,./ t1� Automatic Washer Transformer 0 15.50 KW •
PolicyQi No. U 10" 1D Company "a'-'v• K )�^-• Backflow Sewer 0 50+KW
P IrrigationCap 1 Construction Pole Sub.
certified copy is hereby furnished.
Ycerjifig ofpg1 filed with the city i ding D' is n.// C i Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps 1
Date / r�7 L(�1 Applicant �7 LLTD-�t--B/
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Clarifiers - - Solar Collectors • - Dishwasher - - - Meter Dover 100 amps • '
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers DGas 'DElectric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to,the Drinking Fountains Solar Tank Fan - Motors ❑0-1 HP 01%-8 '
Workers' Compensation Laws of California. _
.Date Signature Floor Drains • Swimming Pool w/Spa • F.A.U. Inc.Solar ❑9-15 HP ❑16-15+
'NOTICE: If,after making this declaration, you should become subject to the _ _ • ,
Workers' Compensation provisions of the Labor' Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
Comply with such provisions or this permit shall be deemed revoked. • - - '
CONSTRUCTION LENDING AGENCY - '• GService Outlets -Water Closet -
I hereby affirm that there is a construction lending agency for the performance - - Device Boxes Pole Light
of the work for .which this permit is issued (Section 3097 Civ. C.) - Interce tors Water Heater
Lender's Name P UD Outlets Range
Lender's Address - - Kitchen Sink - Water Service ' Switches
OWNER BUILDER DECLARATION - r Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or . 1 Garbage Disposal ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑O-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains '
'he Contractor's License Law(Chapter 9 (commencing with Section 7000)of . -
.ivision 3 of the Business and Professions Code) or that he/she is exempt - - .
serefrom and the basis for the alleged exemption. Any violation of Section
1031.5 by any applicant for a permit subjects.the applicant-to a civil - _
penalty otnot more than five hundred dollars ($500).
❑ I, as owner of the property or my,employees with wages as their sole ' Reinspection Fee $15 Issue Fee $ 3 •
.
compensation, will do the work,and the structure is not intended or offered Reinspection Fee ' $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL FEES - • -.
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own - - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler . Hood or Type I 0 '
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ - Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - • Building Approved By � Date f
prove for the purpose of sale). • (5::6_—,
� )��\ g y
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By V_� 3-1/2�a
tractors to construct the project (Section 7044,Business and Professions Code: ' . _ - - Date
The Contractor's License Law does not apply-to an owner of-property who Duct- Ventilating - ❑0-100,000 BTU 0100,000 BTU - SUMMARY OF FEES
builds or improves thereon;and who contracts for such projects with a con- __ - -
tractor(s) license pursuan(to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ ' SMTP $
proof of their Worker's Compensation insurance should be provided to me. —
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO.# Fire Dampers EL PLAN CHECK ' $ PERMIT $11°
PLUMBING gpr0"r4•j`- ISSUANCE $ -
Date • ownerHeating System & Ducting J Registers ENERGY P.C. $ '
PLAN CHECK 25% $
I hereby certify that I nave read this application and state that the above ❑0-100,000 BTU 0100,000 BTL - - GRADING $ '
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- - MICROFILM $
sentatives of tn- city. to enter up•n the above-mentioned property for • I PLAN CHECK 50%. $ ,
inspection purp•.e, ' �1 ('7/ 7)
- 8
Signature t !/s.A A 4 ' ffa 0 Date/ 'off-7-96, - •
MECHANICAL $ TOTAL FEE $ JJl
Drivers' License or;55# - - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor '
•
CONSTRUCTION AND PLANNING POr. .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.
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 ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑Oil
•25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 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:778//87 °meet, 45 pee 203 wit co
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing tri
39. Water Service-Final
40. Gas Service-Final e
41. Solar Domestic-Final C'
42. Backflow Preventer act,
43. Backflow Irrigation
44. Landscape Irrigation System -t`
45. Sound Attenuation
46. Handicap Regulations
' 47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY _
No. Date _
a. OWNER HAPPERLE, WALTER UP 2 4.1987 DATE 4-18-57
i JOB ADDRESS 2502 22nd Street BUILDING PERMIT NO. #4861
GENERAL CONTRACTOR Owner Bldr. VALUE $ 1;920.00
AP118-160-31
1isc294 &304 BLOCK TRACT Npt. Hgts. . Kit, add, to res.
' GROUP 1 TYPE V_ ZONE 114 FIRE DISTRICT 4893
PERMITS ISSUED
INSPECTIONS {`J}tep_—� �Df1�E7 SUBCONTRACTOR DATE NUMBER
Footing Trench v I/� //� "3J
Foundation Forms and Grade to Garhtfe I
I Rough Framing /d- _�
Plumbing, Rough to Slab j,,/9 5 721.0 044..1 eenatt
4- ars-7 9 a 3,6
Plumbing, Rough Complete I r-?-s-7
Temporary Pole ,,,�
Wiring, Rough MAY 1 , 1951 ICE . ,e � B,„,-dr St../V-$ J yZ a 3
Heating, Rough /2 v /LT� Cl
Heating, Final
Sewer, House d/f, Sewer, St. /ilk; '/-70-57
Septic Tank or Cesspool
L-....mg, In Out
Petering _
Plumbing,Final,Fixtures Complete MMS 9-?d-5'7
Plumbing,Final Gas Test
Wiring,Final - . _ 1
Occupancy O--J
FORM 210 914 I0.99 11861
t
,_ 4893
FEE. RECEIVED
COSTA MESA BUILDING DEPARTMENT ' o ,e/ v/q�J 9f`
P.0. BOX 317 FINANCE DEPT.
COSTA MESA, CALIFORNIA
CITY ofF c(a;nsTSrA FFee
FOR APPLICA T TO FILL IN APPLICATION' lut��2 PERMIT
BUILDING •/�� '�"�-(^/� I BUILDING
ADDRESS ^"COSTA MESA.12----;
CALIFORNIA�� `, FOR OFFICE USE ONLY
\(J[ ,( 1 n RECEIPT NO. PERMIT NO.
OWNER ( /iw LT A, P ? Y-.. LC 1' /
yy cc Yf I RECEIVED BY DATE RECEIVED
`}/GATE/ ISSUED
MAIL kr, O J C - V/�. I ! _+ �-S-7
ADDRESS
✓r
TEL. yvvv��' BUILDIN
CITY NOM- -ZS./c ADDRESS
R �, 1 T•���W 1Np, I COSTA MESA. CALIFORNIAI iJ�'Jo) FIRE
ADDI. .i / } �' , �4J ZONE
ZONE NO.OF TYPE GROUP
A
CITY LIC. PUNS
CONTRACTOR 1 'tov c NO.
ADDRESS �[J y NO. APPROVED . I IT DATE 4_/� 47
LEGAL LOT //�� ''— Y
DESCRIPTION NO. �.L`7 BLOCK CT ,
A.P. NO. j/E. — /6 d I �, , APPROVED
OSIZE NO.OF F LOT 7e X 1 NOW LON BLOCS.
OTS CITY OF COSTA MESA
r
USE OF e Lf.211CIytil�; DEPT.
EXISTING BLDG. ., G2 SUBJECT TO 6�L�G. DEPT. REG.
SETBACK LINE FROM j� B.-`G�'
CENTER OF STREET ,/ 2EAR YARD l By/'I��, DATP �� ir
SIDE YARD RIGHT FT ,( Pi AN""TECH-U.0 Z
DESCRIPTION OF WORK
/
NEW ALTERATION `,I ADDITION
I
REPAIh MOVING DEMOLISH
SUILDINGId 4 I4L NO. M
ROOS I STORIES /i
SIZE
EXTERIOR WALLROOF
COVERING �1>,�(' I J.y 9OVERING Q c et-
USE OF NEW �\/����' ��
BUILDING 1 '�'��- I Te
AV 5i 1 d iv ! V u FA.
I HEREBY ACKNOWLED THAT I HAVE REAR THIS APPLICATION AND
STATE THAT THE ABOV IS CORRECT AND A EE TO COMPLY WITH ALL
CITY ORDINANCES A STATE LAWS REG TING BUILDING CONSTRUC- _
TION. `/�.// / / VALUATION
SIGNATURE O �! //-r' _.�,f�1n Qn PERMIT FEE $ /'
PERMITTEE (,� (i!L `�C•
$ j
X9020- PLAN CHECK S
T
AUTHORIZED AGENT TOTAL FEE S e
5061 FEE RECEIVE
COSTA MESA BUILDING DEPARTMENT
1-. Q
COSTA MESA. CALIFORNIA � FINN UJ� , �/
E DEPT.
FOR APPLICANT TO FILL IN A P P L I°NileW OMESERMIT
BUILDING ZJ-o /a 2_7 "-.7uy: BUILDING
ADDRESS
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
g7 N ���� RECEIPT NO. PERMIT
OWNER YOOv J( i
MAILRECEIVED BY • DATE RECEIVED ��TDA TE ISSUED
ADDRESS .�-l� �A- 2...-1.. ."-'.4`f'7' /I � S.. /0.4 /O -S 7
TEL. BUILDING
CITY .5//7/1%-_,-,/ NO. ADDRESS
I
ARCHGENE LIC.
OR ENGINEER NO.
COSTA MESA..CALIFORNIA
FIRE
ADD ZONE
ZONE NO.OF (TYPE / GROUP //////
/ CITY LIC. //3 PLANS 'v/ //
CONTRACTOR�J �i'-�/y17l9iJdYA NO. A,_7_111 /l Sy\`////
ADDRESS al 2V��N'✓JA�A"� /J'/�NO: ' APPROVED DATE /V,
LEGALECTTONS}(
L
DESCRIPTION NOT oil' BLOCK 1x^�' I i App R oV E
A.P.NO. //r - /‘,42 -// Y
D
SIZE ( J� � ND.DF BLDG6. CITY OF COSTA MESA
OF LOT v C /L V NOW ON LOi -2._ PLATA.!l����!!I�yyIyIyCLLC DEPT.
USE OF //'' SUBJECT TO�DG. DEPT. REG.
EXISTING BLDG. �/�.5, /J i9/.�6:1=-
SETBACK LINE FROM _ /
CENTER OF STREET �/� • REAR YARD N..0 ' ✓7S---1(C) Q�"'�
r / / � 13I'-14Ltq ATE 7
SIDE YARD V RIGHT V LEFT PLAN TtCH�/7'(
DESCRIPTION OF WORKS Ip„
NEW ALTERATION ADDITION r
•
REPAIR MOVING DEMOLISH
BUZELDING/3 ?()/I/ 7 ROOMS / STORIES /
EXTERIOR F
.COVERING WAL�v • •O v COVERINGVreeWO '
USE OF NEW �J,_. 7 /
BUILDING ��7P.IJ pnii?
4-4- fD P06,riJ-1,v4
I HE E V ACKNOWL GE TH T I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC•
TION. VALUATION
SIGNATURE OF PERMIT FEE S "-
PERMITTEE
5 /7( V
PLAN CHECK 5
...6,1 TOTAL FEE S /� '
AUTHORIZ GENT ..0^��
OWNER DOUGHTY,• BYRON DATE 5_10-57 /
JOB ADDRESS 2504 22nd Street BUILDING PERMIT NO. #5031
ApG"ElN.ERgoCONTRACTOR E. L. Patterson VALUE $ 1,768.00 AS PER UBC
AP. No. 111 LOT 304 TRACTN.H. FIRE ZONE DESCRIPTION OF WORK Bedrm Add, to Res. .
C^OUP- I TYPE V ZONE R4 PLAN NO. 5061
Ii..,PECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
Q � DATE NUMBER
(9,/
U
Trcnche orms Steel it'd
Floor Syst m /
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing g--1--t ..?"--23-4,7
Lathing, In Out A
e..--&---6 ,C-2-3 ;.
Plaster, brown coat . G -3 S r
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents •
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final
I?'y�"�.;,31ing Fixtures Final
Fc',„"r27Gas Test
E nstruction Pole
Underground Power
Rough Wiring ., talky 9 1 1851 IC$-t. 0--.. o-c 7 Y 6 a-c
Fixtures, Final ( f r 7'C- £ — 6--/2. -S1 1
OCCUPANCY " 02.4a--- 4-/z^S'J
Form 210-5M-1-57 U • 5031