HomeMy WebLinkAbout255 22ND ST - Building Permits1
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4`p p MFs9 CITY OF COSTA MESA
BUILDING DIVISION
>4 n,' \-�� DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
F 1 s...ss. D•
EVELOPM4. Ira P07-00101
So s
manor' ,fi
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa EJr1JMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 255 22ND ST Status: ISSUED
Suite No Applied: 02/20/2007
Issued: 02/20/2007
Vicinity: KITCHEN
Parcel Nunmber: 42615303
Applicant LOUFEK, RICHARD A
Address: 255 E 22ND ST ISSUED BY:
Phone: 949-650-1525
COSTA MESA,CA Zip: 92627
Owner: LOUFEK, RICHARD A
Address 255E 22ND ST. . •
Phone: 949-650-1525
COSTA MESA,.CA, , - Zip: 92627
Contractor: OWNER-BUILDER
, .
Address: •
Phone:
Zip:
"License: 000000
• - SCOPE OF PERMIT
PLUMBING PERMIT FOR A WATER REPIPE AND 1 GAS(1-4 OUTLETS)FOR A KITCHEN COOKTOP TO
ASFD. /1O7>anis
FEE SUMMARY
• AMT gf `,AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer ' -$0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer r $0.00 0 P-Trap ' $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 - Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 --- Process Piping(per 10 ft) $0.00. 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) • $0.00 0 v Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor , $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof ' $0.00 0 Shower .. $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain, .\$0.00 0 Sink,bar - $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank , $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $9.80 1
Gas Earthquake Valv ' $0.00 0Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $6.15 . 1 . " Sink,kitchen $0.00 0 . - Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe , $0.00 0-- Spa(private) $0.00 0 VIOLATION $0.00
Gas Service . • .40.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00/- 0 - REINSPECTION $0.00 0
Interceptors(Sand Auto)''\- $0.00 0 . '• - - -
TOTAL CALCULATED FEES: $39.45
COMMENTS I SPECIAL CONDITIONS
//
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92) /
EXPIRATION: This permit shall automatically expire and become void if work is not commenced Within 180 days,or Ihwork 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
2446-48 WOO)
! RICPENSAflONQEcLARATtON:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and wilt 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.)
/�=1 certify thatin the performance of the work fo which`this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
L compensation laws of . mia,and'. e•I at.if'I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these vont
Signature : (—Date:-7- 7 0 —C
j -WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,0(10),IN ADOmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.a Class If
Contractor's Signature: Date:
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
Les 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 loan owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursue the Contract s License Laws.).
❑ I am exe er sec. �7 .----- Business and Professions Code for this reason:
'Signature' �- — 1Dat "-"c--' ?co—or/
Owner ID verified by driver's license. 0 Yes 0 No Driveriskicensa No. — EzpL -i _ -V z7/t-O/n
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous '
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal t0 or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the iiii3licant or present or future building occupant require for the work which Is the subject of this application aEermit/or such construction or modification
from the South Coast Air°uglily Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COIOOiu PU CE AND A O3IZATION 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- • pl ith ell stgt-e 1 :rlld city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-desc'•:d. •p= for ins'ins.6tIkr ugeoses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �'y
_ / a /
7/ 7 . 7.
— O
Signa_tore'OLLegal Owner(s1—-a• 1._-_Daje
And/Or Authorized Applicant Date
CODE• INSPECTION TYPE OATS INTRIALE CODE I INSPECTION TYPE Mt INTTOALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �I �
1266 Pool Spa Final 208 Final Plumbing p(-2 —0%1
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 —
5T' F - CITe/1OFG STA MESA
44i .t BUILDING DIVISION
4•,, , a DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
14IP
i ' PERMIT B07-00193 IPI
BU
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.a....,ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 255 22ND ST Status: ISSUED
•
Suite: Applied: 02/20/2007
Vicinity: KITCHEN Issued: 02/202007
Primary 0cc: R3 Type of Construction: V-N
Parcel Number: 42615303 Zoning:
Applicant: LOUFEK, RICHARD A
Address: 255 E 22ND ST
Phone: 949-650-1525
COSTA MESA,CA Zip: 92627 ISSUED BY: ar
Owner LOUFEK, RICHARD A
Address 255 E 22ND ST
Phone: 949-650-1525
COSTA MESA,CA- Zip: 92627
Contractor OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
- Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
DRYWALL WORK FOR WATER REPIPE AND INSTALLATION OF A GAS OUTLET
REF#:P07-00101
•
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: $1,000.00
Permit: $38.75 Claim Valuation: $1,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $39.25
'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 Calitornia,stat tes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work/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)
MIIMIIIS;MIMISIIMIIMIIMMIMIIIIMIIIIMIMIIII• ' : '
• .
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'Compensation Insurance carrier 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.)
5`I certify that in the performance of the work for which thispermit is issued,I shall not employ any person in any manner so as to become subject to the workers'
�compensatlon'laws o/Cyl'.mia,antl agfee that if I shoulE tiecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these • r i '•ns.
(AppllcantSlgnaturs� .•. ✓ _ Dafe: -'�." �� '��
`WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.LiC.II Class x
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
_sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I?as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Lawy).
O I am exam Vac. Business and Professions Code for this reason:
Signature:- - --7-c' `
. L Expires: ZY ZO/O
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEPormit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yer,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 COMPLJA/ICE 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 ith all state .•s 9ncrc(y ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described opfor insp ion • es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
z - zv
C-Signe :IOf-Legal Owner(s) /Date-
And/Or Authorized Applicant Date
CODE! IfISPECT(QTL(YPE DATE INTRIAL5 COBE f INSPECTION TYPE DATA INTITIAL$
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �j
204 Final Demolition 250 Final Building/Occupancy j -ay
-P7 -‘,. -'
PROJECT ADDRESS: 255 22ND ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; M 04988f
OWNER'S NAME: RICHARD LOUFEK
ADDRESS: 255 22ND ST PERMIT NO: M 049887 PLAN CHECK NO; N GOVT: N SUPP: N
COSTA MESA
CA 92627 CONSTRUCTION TYPE; 5—N PERMIT TYPE: MEC PURPOSE: OTH
( 714 ) 650-7525
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : FORCED AIR UNIT CHANGE OUT SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
PERMITTEE: GRAHAM BROS. ( 714 ) 546-1653
ADDRESS: 2952 CENTURY PL COMMENTS: *
COSTA MESA CA 92626 *>F*******+r******rye+ETA**********+E*******************BETE+E*x+t**+F** ********+E********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Dimsron 3 of the Business and Professions Code.and m license is in full force and effect. SETBACKS
CITY LIC,: 0 0 5 9 6 3 STATE LIC.:2 4 8 CULss: — 0
r/-13=90_ signatu MAIN BUILDING ACCESSORY BUILDING
Date
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have acenificate of consent to self-insure or acenificate of Workers' LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
N—+enation LuywC9.;j rJL tige0.copy,Weool 1Section 3800.Lab.&8/0 1 /91
lNO.: LIBERTY MUTUAL EXP. ll PARKING REQ: PROV: PARCEL : 00000000 ZNE: REF NO:
L..%) LIBERTY r}}�� PLANNING NOtES>
�Certified copy is hereby furnished. L'7 Certified rpp Is file with the city Building ion. L.._._„ >
�(>,V1 \ • *******************************************************************************
Date:_�=/_3=�d Applicant. DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($700)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 ZONING APPROVED B Y
subject to the Workers'Compensation Laws of Calitoroia. DATE:
Date, Signature' BUILDING APPROVED BY : DATE:
NOTICE:If,after making this declaration.you Lure' become subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that(here is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• L DATE• /0.31.0
which this permit is issued(Section 3097, Civ,C). ****'***3't********'K')'******' *'**K'* *' *" * ***'*'K' `*'�'**'*'*'*'* '**/031.1.0
which '***
LENDER: ******************************T*4********** ******1**********************X-OF***
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 9 , 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 2 5 Z SMIP/NON—RES
pursuant to the provisions o1 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
�� t
.and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15 . 00
any applicant for a permit subjects the applicant to a civil penalty al not more than five hundred dollars($5110).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole Compensation, wit do the work, and the TOTALS----> 9 , 00 15. 00 0, 00 24 , 00 24 . 00 . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 . 00 OVER/SHORT• 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
'o for the purpose of sate).
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 24 . 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).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: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 , 00
Ido hereby certify that I am aware of and understand the requirements of California Health and Safely 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.
Date: Applicant:
hereby certify that I laws relating ttl this uildingtion and tiiote that the.r ho -eformationresnt omrsof 1 a ree toov and county
I hereby easy ttat I havrthi bpplicgiconstruction t and Waolh' atis orrectt chi to comply on with
el above-mentioned artd
properly for inspection purposes.
Q� Signature: e' --- 1 0100074u03-30374003 TOT ci.00
Date: //— /— DATE: 11/13/90 Tin E: 09:01
Driver's License or Social Security H:
1641-46 While—Building:Omen—Code Enforcement:Canary—ApplicenC Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING • - • PO. _i.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 -
-
S,:Steel•Reinforce•meni 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 a• 63. Heater & Vent-Final
13. Roof Drains 'r- 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 # '
- J
21. Ducts,in Structure.• . ,- - _ 70. Underground Hydro •
22. Ducts, Ventilating . _ :71. Product,Piping O Gas Et Oil
23..Gas Pipe-Rough & Test .1 . . • - - 72. Underground Flush -
24: Roof Framing - - - ' •;73.'Undergrrid.Storage Tank ❑Gas 0 Oil •
25. Roof Sheathin 9 _ -`I 03.,. 74: Overhead Hydro_ ,
26. T-Bar Ceiling (Structural) &-.Monocoat -3 - 75. Dry Chemical -
27.. Frame and Flashing , r. . „ 76. Dry Standpipe ' • - -
28. Lathing& Siding _ .. ! 771 FIXED SYSTEM'FINAL - 'T
29. Insulation •_ .. . 78.. FIRE PREV. FINAL - - -
30. Drywall NailingHEALTH:DEPT. REQUIREMENT
31. Plaster Brown Coat' ( 1„:1, 79. FINAL INSPECTION _ `
•
• 32.- Electrical Power Meter-Final , it 80; FOOD CERTIFICATE ISSUED i -
33. Final Electric _ V-��' . Notes: • ; - _
.34, Firlal Heating & Air Conditioning - weje4o Z Z� - ..
_ •
35:Final Gas Pipe-Test I
F • - ' -
,36. Hood or CanoPY _ , - .,l;, • _
37..'Final Factory Fireplace, �-.4 ; ,' •
7. �i
38. Final Plumbing - 1 -• I , 1 ' .>r -
"39. Water Service-Final- - • it - '
i
, 40. Gas Service-Final "
r d • •
' 41. Solar Domestic-Final" 1 l' '
42. Backf low Preventeri • ' "•
. - •
r .
43. Backf low Irrigation ', ' ' ' 1.
, 44. Landscape Irrigation System s • _ _ i.. '
45. Sound Attenuation • - - _ i
•
46:Handicap Regulations . ` i - - ..
47. FINAL STRUCTURE & BUILDING - - '
48. FINAL PLANNING - ,/'
49. Electric Release to Edison • ( ,41: r
50. Gas Release to Southern California Gas Co 1 ; 'jet. • • - . •
51. CERTIFICATE OF,OCCUPANCY , , , C, . . r r
No. Date
ADDRESS OF BUILDING: 255 22ND ST UMI: CITY OF COSTA MESA - BUILDING PERMIT
OWNEas NAME IF1lNOWN: LOUFEK, RICHARD A PERM NO: B 074052
ADDRESS: LOUFEK GRETCHEN
FOSTA MESA,
255E LOUFEK,
ST PERMIT NO: B 074052 PLAN CHECK NO: 03538-95 L GOVT: N SUPP: N
CA 92627714 ) 650-1525
APPL.MAIIING ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ADD
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : SEE UNDER COMMENTS �" , SQ FT: 10, 000
ARCH.OR U1G.'S ADDRESS: UMT: CLAIM VALUE: • 10,000 .00 CALC-VALUE: 10,000.00 GROUP OCC: R-3 /M-1
CONTRACTORS NAME:
COMMENTS: ADD 18SF TO PORCH AREA CUT GARAGE BY 16SF & RAISE CEILINGS
caxTRACTORMToas xuLIuNG ********************************4**************itis******iter•**********************
ADORPS& MHO.: ZONING REQUIREMENTS
UNT` SETBACKS
UCENSED CONTRACTORS DECLARATION:I hereby Nim under penalty of perjury that I we licensed under provisions of Chapter P
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full torte and effect.
CRY LIC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
I FRNT: 20 FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
/ ',OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
llowitg reason(Section 7031.5 Business end Professions Code:Any city or county which requires a permit to construct,after.improve. PARKING R E 2 PROV: 2 PARCEL: 42615303 Z NE: R1 REF NO:
k asnsed
LawChepimtfor such frmmmpecingtyofileith s�sigonedsn �i nof nttthathision eonf he PLANNING NOTES> INTERIOR ALTERATIONS TO EX. SF RESIDENCE + EXTENSION OF
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Sedlffin > FRONT ENTRY.
7031.5 by any applicant for a permitsubjeda the applicant to advil penally of not more than live hundred dollars M5001). ***************************4* *************************************************
o 1,as owner of the properly or my employees with wages as then sola compensation,will do the work,and the structure is not intended DEVELOPMENT SERVICES REQUIREMENTS •
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not appy to an owner of proper&
improves who builds or proves thereon, himself or or and who doessuch work himself herselfthrough hi or her own employees,provided that such
improvements ere not intended or offered for sale.f.however,the building or improvement is sold within one yew of completion.the ZONING APPROVED BY L� DATE:
1 x
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
O I.as owner of the property,am esdusive&contracting with licensed contractors to construct the project(Section 7044.Business and BUILDING APPROVED BY : ... .11-j/y ` DATE: Afar j
Professions Code:The Contra4ors License Law does not apply to an owner of property who builds or int es thereon and who
contracts for such projects with a mntrmor(a)licensed pursuant to the Contractors lew). �M
lame pond Sect B.3P.C.,for.ds APPLICATION ISSUED BY: V`^ DATE: lir
s� �r ***********4**4*44444*4#***************************44*****4**** *** **
C Date: 7 6 ' �S Owner: LEGALIZATION:N F E E SUMMARY STRUCTURA SE MENT:Y
4do hereby candy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and •
;5534.and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the Ai ua�OThl-anagement(District.Residential construction applicalionsere exempt from these PERMIT. 117 .00 1 00
provisions. ) SMIP/NON-RES
Date:• • Applicant: PLAN 76 .05
r
WORKER'S COMPENSATION DECLARATION:I hereby elfin unaer penalty of perjury one of the following declarations: ISSUE FEE
❑ Ihews and wil maintain acenirat°of consent tosellinsurefor workers'compensation.esprovidedfobySxmn370odthe Lobar BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL . PAID DUE
- Code.for the podormanceoftework for which thimniu
pesued. TOTALS---->in118 .00 0 .00 76 . 05 194 . 05 194 . 05 . 00
. ❑ I have end will maintain workers'compensation insurance.asrequired by Section 3700 d s the Labor Code,for the performance el the
""kfor"width uiie°°.kyw° ee compensationma`a°a�daand°" number are:
REVENUE DIVISION TOTALS > COLLECTED: 194 .05 OVER/SHORT: 00
`` J ' Caner:
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need nm be completed/the permit is to one hundred dollars(Stool or keel 117 .00 • 1 .00 76 . 05
O I certify thamtht theperformanceworkers*
of theworkfor which this permit is issued,I shall not employ any person in any manner nes to ******************************************************** *********************it'
become subject to the a compensation leve d California. and agree that ft I should become object to the workers'
compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with these provisions. I N D I V I D UAL F E E B R E A K D O W N
Date: Applicant:
Warning:Failure to secure workers'compensation coverage le unlawful,end shall subject an employer to criminal penalties end TYPE QTY DESCRIPTION UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($100,000),In addition to the cost of compensation damages as provided kr In r
Section 3706 orae Labor Code,interest,and ahomey's leas. SFR 10000 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 10, 000 .00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that theta construction a construn lending agency for the END OF FEES
is
podormance of the wok for which this permitissued(Section 3097,Ci.C). ..
•
LENDER'S NAME: 1
LENDER'S ADDRESS: /
I certify a that I have read this application d stale that the above information is correct.I agree to comply with all ply and county ordinances n '
and stale laws relating to buildig construction and hereby authorize representatives'of this city to enter upon the above.mentioned property •
for inspection purposes. RICHARD LOUFEK - h
•
, --,
/ �• t Name
f 9- 6K- /-s 01 00189617-00189619 TOT 194.05
gnmure of.T /VApplcant/Contractor Del°' __ DATE: 09/06/95 TIME: 03:30
•
(5151'46.WP) White-Buildig'd Safety:Green-File:Canary-Apr.ramt:Pink-Revenue;Goldenrod-Assessor '
���AegESS OF WILDING 255 22ND ST WIT: CITY OF COSTA MESA – BUILDING PERMIT
` ONNEASNcer)(Kel: LOUFEK, RICHARD A PERM NO: B 074052
' ADDRESS: LOUFEK, GRETCHEN
'+ n 255 E 22ND ST PERMIT NO: B 074052 PLAN CHECK NO: 03538-95 L GOVT: N SUPP : N
:OSTA •MESA, CA 92627714 ) 650-1525
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ADD
ARCHITECT OREnNEER: UC.NO.: JOB DESCRIPTION : SEE UNDER COMMENTS SQ FT: 10, 000
ARCH.OR ENS'S ADDRESS: UMT:
CLAIM VALUE: 10, 000 . 00 CALC-VALUE: 10,000 . 00 GROUP OCC : R-3 /M-1
CONTRACTORSNAME: '
amACTOWS MOILING COMMENTS : ADD 18SF TO PORCH AREA, CUT GARAGE BY 16SF & RAISE CEILINGS
ADDRESS: UC NO.: 1EiEii*****iEii****ii**#**iH1Eib#1E*iFik♦EHEiEiEibiflElE*****#iEiEiE1(-1E#****ii******1EeE***M-1iiE♦E1 ****i ****df
UMT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby N'rm under penal,/Of Penury that I am loaned under govbbne of Chapter 9 SETBACKS
(commencing with Section 7003)of Division 3 of the&Mean end Profeeebne Code.and my license is In full force end effect.
CITY UC.NO.: UC.CLASS: ,UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
• FRNT: 20 FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally el perjury that I am exempt from the Contractor.License Law for the
following reaper(Section 7031.5 Business end Professions Code:Any city«county which requires a perms to construct,eller,Improve, PARKING REQ: 2 P ROV..: - 2 PARCEL : 42615303 Z N E: R1 REF NO:
demolish,«repair anyatnctun,prior 10b issuance,also requires the applicant for such permit to fibs signed Statement that Mor she PLANNING NOTES> INTERIOR' AI:TERATIONS TO EX. SF RESIDENCE + EXTENSION OF
's licensed pursuant t°the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the
;mines,and Professions Code)or that he or she a exempt therefrom and the basis for the alleged exemption.My violation of Sedbn > FRONT ENTRY.
7031.5 by any applicant for a permit eubpcs the applicant to a civil penalty of not mon than lire hundred dollars 135000. iEiE iPiE iE 1Eelf iEiE iE 1E 1E***1EHE1E**iE*1E ibW***di3E dE3E1k1EfE**iEib f6**1E1b1E*elfiE1E**1EiE iE***iE1EAEiE iE iE*iE*if iE0***ii iE iEiEii ii
❑ I,asowneroftheprppenyormyempbnmewithwagesasleisolecompendgn.willdothework,andtestmdurebnitintended D E V E L O P M E ' N T SERVICES R E Q U I' R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not appy to en owner of progeny
who builds or improves thereon.and who does such work himself or herself or through his or her own employee*.prodded that such - v /`/�-
impnsvennero°n not Mended adfered for sale.If.however,the buidieg«inprovemdseol within oneyeer of completion the ZONING APPROVED BY • Cat. DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). — - -
Pas rofvws me Code:The Contractors License Lawddmhot licensedap an cenowier of weeny whoowaste"thewds or improuwnsilweeon aanndeMs and BUILDING APPROVED BY' ,'")P' DATE: _51j
contracts for such projects with a odandoe(s)licensed pursuant to the Contractors Licena 77Law). i ••
.me3yvpqunder Sedm: B.aP.C.ra � APPLICATION ISSUED $Y: �/Y*'— DATE:
/ /- 9.s (Cf/ +E iE iE+EM-iE 3E 3E fE iE iE iE x-if iE iE jE jE N-iEIf l�if 3EtE hF 1F3F 3E iF 4F hEM-hF iF iF iF*.Elf iE jE i(-jF iF 3E iE 3E hE iF hE if 3F tF iE x-iE if iE iE iE if 4ElE iE+E iE 3fiF '. iF 3f if iE dE iE
° {' LEGALIZATION: N F E E S U M M A R Y STRUCTURA SE,MENT: Y
hereby mdM Net I em aware d and understand the ngaremew d Cellona Ilealh ed Salay Cods sadism 75505.Pxsnn,end
25531,end that l«any haus building moment wJl/wD not one) to awn*with said mate mdse and the requirements forBLDG PMT PLUMBING ELECTR'IC 'r MECHANIC FIRE SMIP/RES GRADING
a permit for c,rath m«modification frown the Aitiatrananagement District.Residential ppi
construction acelionsae exempt from theseproviions. PERMIT 117 .00 1 . 00
Dale: Applicant: SMIP/NON-RES
PLAN 76 . 05
WORKER'S COMPENSATION DECLARATION:[hereby*.firm under penalty of perjury one of the following declarations: ISSUE FEE
❑ Ihave and wMmemnbacenXlcdedmmhttos°Nimunforwaker°'mmperomim,saprwidedl«brSedbnJTWdtMLabor BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK r TOTAL PAID DUE
cede.t«tMp«omaceaN.woxl«wKnNbpemm .eeued. TOTALS > 118 . 00 0 . 00 76 . 05 194 .05 194 . 05 . 00
❑ I have and sill mainsail workers'compensation insurance.es required by Section 3703 of the Labor Code.for the performance of the
w«kl«*tin No ardorissued.M w«atoonpemato insurancem b and ponynumM we:
REVENUE DIVISION TOTALS > COLLECTED,: 194 . 05 OVER/SHORT: . 00
Carver:
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIE -FIRE SMIP/TOT GRADING PLAN-CHECK
his section nese nit be carp/steel y N.permit is tor M.hundred dale.1510010r sr1.1 117 . 00 1 .00 76 . 05
0 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to '
become sated to the wakes'compensation laws of California,and agree that if I should become subject to the water.' ***********************lf******3Elk********1Ek***************1E***********4E9E********
compensation«°.bions el Swim 3700 d the Labor Code,I end forthwith o«npy with Nese prmbbns. INDIVIDUAL •F 'E E BREAKDOWN
Dale: Applicant:
Warning:Failure to secure workers'canpensaron coverage b unlawful,and atoll subject an employer to criminal penald°a and TYPE QTY DESCRIPTIO N _ UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(5100,000),In addition to the coal of cnmennrlon damp
s as provided for In
Section 3706 of the Labor Code,Interest,and attorneys fees. SFR 10000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 10, 000 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performs ce of the work for which this permit is issued(Section 3097,Cir.C). Crani` / ( )Jou.
LENDER'S NAME: 1 e/J aQ g/'y
LENDER'S ADDRESS: r V 'P' KE E
I certify that I have read this application end stale that the above information u coned.l agree to comply with all city end county ordinances �, TEC Tor.'
•
and state laws relating to buidng construction end hereby authorize representMvee of this city to enter upon the above-mentioned property / (�mrinspsctbn wrpmse. •
RICHARD LOUFEK Q �+ iiii /'7r19 V .- ��K��R�—�"
�� Name
'/ Dale: T — b /� //�j 0160184417—C318?619 T 194.1005
L grWureal Applicant/Contractor //w ,t _ Z,. I DATE: 09:05/CT j7NC' OS:3O
(515id6.W P) White-Staking S Safety:Green-Flo;Canary-Applicant:Pink-Revenue:GaUennd-Assessor
,I Ci"1NSTRUCTION AND PLANNING • POOL 'A
' APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
�l. :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 Reinforcementqg j 656. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd. // 57. APPROVAL TO COVER-GUNITE
7. Footings 9..a--q6tew9� 58. Electrical Conduit-Undrgrnd.
8. Foundation .C.eet-e, 6wL. 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 Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing
691-M -fig-444- 76. Dry Standpipe
28. Lathing & Siding G . '_ 47/5-1 &t,{C. 77. FIXED SYSTEM FINAL
29. Insulation - (OILY�t(/� 78. FIRE PREY. FINAL
30. Drywall Nailing /%�,z_R'S 664-64 HEALTH DEPT. REQUIREMENT ...
31. Plaster Brown Coat • n 79. FINAL INSPECTION -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
•
33. Final Electric Notes: s
34. Final Heating& Air Conditioning /0_14/
0�/ '1 'FL> ("kik
_�,/ � j 1/-,1
35. Final Gas Pipe-Test
(' ! _GAV*
/ , ���/""[l�'_`L�L k47
-t(n
36. Hood or Canopy /rye"',`�/L!• 6 nVir`
37. Final Factory Fireplace le -Z3 _ -/• ✓
38. Final Plumbing
m
J er /�/c Eel"-
/1-15 ��iZZf//t///
39. Water Service•Final �[ GS "
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 o 6� fu
-Q7
48. FINAL PLANNING V G GGi W
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co - •
51. CERTIFICATE OF OCCUPANCY
No. Date
ApligESSOFSMLDPIG: 255 22ND ST ' LIMY: CITY OF COSTA MESA — BUILDING PERMIT
s OwNEWSNAMEwmanb LOUFEK, RICHARD A I 1."(PERM NO: M 078658
AgORESS: LOUFEK GRETCHEN
255 E `22ND ST PERMIT NO: M . 078658 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627714 ) 650-1525
APPL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: ADD
ARCNDECT ORENOINEER: LIC.NO, JOB DESCRIPTION : SEE UNDER COMMENTS SQ FT:
ARCM.OR ENG.'S ADDRESS: UNT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /U-1
CONTRACTORS NAME
CaDRACTOWSMMWND COMMENTS : REF: B-74052
ADDRESS: 13C NO. dtdkdEdriEdeiE****iEStd ********kibdEiE****ib*1f1FiE#9e*****k1ESEdE***Sbi *****iE******kib****dE****i ****
UMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury Net I em licensed under provisions of Chapter 9 SETBACK S
(Commencing with Section 7003)of[Maids 3 of the Baynes,and Professions Coda end my license Si.full force end effect.
CITYUC.NO.: LK.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contredm LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty re perjury that I am exempt horn the Contractors license Law ler the
Idle tg reason(Section 7031.5 Busies,and Profession Cade:An ay or county which respires a permit toacnabud,atter.improve. PARKING REQ: PROV: PARCEL: 42615303 ZNE: REF NO:
ismdsh,or repel any structure.prior lo its issuance.also requires the applicant tor such permit to filea signed statement that he or she PLANNING NUTES>
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commedng with Section 7000)d Division 3 d the
Jusinesa and Profession Code)«that he or she S exempt therefrom and the hem to the alleged exemption.My violation of Sedan >
7031.5 byeny applicant for a permit subieds the applicant to advt pendryd not mere than fee hundred dribs lSSODf. ifiElEiFiFlflEiflE#1E1E#1E1Fik#fllEfl1F1E1E1f1ElElEifiEiElfikiF1E1E1E1EfE#1E1E1E1E1FiE1E1EiF1k#IE1ElE##IEiE1E1EiE1E1fiEM1E1EiEfE1E1ElE1FlFiFfEfFSE1ElE
❑ I.as owner of the propeny«mYemPloyees with wages asthae sole oonpenaawn,wa do the wank,and to structure is netimended DEVEL OPMENT S E R ICESS REQUIREMEN TS
or offered 10 (SectionsalBusiness
7044.Bend ProfessionsCode:The Contractors License Law does not apply to an owner d propertyYl'
who builds or inproves thereon,and who does such work himself or head or through his or her own employees provided that ouch
Improvements are it intended or altered for sale.If.however.the bribing or improvement is sold within one year d completion.the ZONING APPROVED BY DATE:
is owner-builder will have the burden d provingor heshe did not build«
improve 1« purposethepurpose of sale).owner-builderowner-builder I•asowner dthe property,amexdnm"y contrdig with kensed contractors to construct to project(Sedan 7044,Bad:sees and BUILDING APPROVED BY : `
Professions Code:The ContractorscontLicense Law doe*not apply to an owner el properly who/P. .a..1..therein end who DATE:
contracts f«such prciedro
s with a nnador(.)licensed pursuant . . . tractors L
❑ tam a� an:� / B.:P.c J APPLICATION ISSUED BY: / DATE: h U
.
*********************4*************** iEdAiESEiEREdr Sh SEibdEdEdEiFRt#RbiE#iEkdEiFiEREiE **
LEGALIZATION:N F E E U M M A R Y STRUCTURAL -EGMENT: N
--
hereby randy that I am aware of and understand the requirements d CaM«ria Health and Safety Code Sedans 25505,25533,and
25531,end Nafl«any More building occupant wcl/soil nd(dmb ave nerd rocampy with eels steae odea and the requirements ler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a panne t«Drahuction or modification from the Ak .thy mperom District.Residential construction ap Eo�aro are exeenpi from these PERMIT 17 , 75
provisions.
252 SMIP/NON—RES
oma: Applicant: 25i
WORKER'S COMPENSATION DECLARATION:I hereby affirm under welly of perjuy one of the blowing declarations: ISSUE FEE 22 . 00
❑ Ihaveand wtimemuaacendamedmme"toselnsureforwvits.c prsea ,esp
nrvidedt«bySedan37OO°NeLabo BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code. d N.w«kI«wlhidr this permit i.issued. TOTALS----> 17 . 75 22 . 00 0 . 00 39 . 75 39 . 75 . 00
❑ I have and wit memtaa workers'compensation Imusnos.as required by Sdion 3700 d the Labor Code.lepe
r theperformance of the
w«kr«whah this pnerielasso « wm
insuranceissued.My
owner and policy number are:
Garner: REVENUE DIVISION TOTALS--> COLLECTED: 39 , 75 OVER/SHORT: , 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
This sedan need nor be compered 1 da permit is for one hundred deeers 1s:001 or less.) 39 . 75
❑ I early that in Me performance d the work ler which this permit is issued.I shall d employ any person in any manner so as to
become subject to the wrkere'compensation taws d Cardomie and agree the if I should became eubj,d to the workers' ****RE*Rh****SEdb*****************************#***************1E*****1E**************
compensation pmwsars d Sedan 3703 of the Labor Code I sou fo thweh Dandy with those provisions. I N D I V I D U A L F E E BREAKDOWN
Date: Applicant:
Warning:Failure Nsecure workers'rompensaion coverage b unlawful.and shall subject an employer to crfMnsl penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines Up to one hundred thousand dollar($104000),in addition to the cost of /
conpenaa
tion damages Provided forIn '
Secton3706ofteLaborCode,lntrar,andamrnysfaea. MEC 1 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 12 . 25 12 . 25
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d perjury thea titre a a onmredan lending agency for the MEC 1 GAS PIPING SYS 1 — 4 OUTLETS 5 . 50 5 . 50
performance 01 the work for wiiids this petit'a issued(Section 3097.Civ.C). END OF FEES
LENDER'S NAME: •
LENDER'S ADDRESS:
I sanity that I have red this application and date that the above int«metion S coned.I agree to comply with a0 city and county ordinances
and state laws relating to building eauuudion end hereby authorize representatives of this drys,enter upon the above-mentioned property I J' .
for inspection purposes. RICHARD LOUFEK ..
erecter/ Dm:/ -/r- `v
Sgnature f .. VA.. .. tContrador
1 (5151d41.WP) White-Building&Saltily:Green-Re;CarsryrKPORe nt:Pink-Revenue;Goldenrod-Assessor
•
F
CONSTRUCTION AND PLANNING POO' IPA
f� '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. I 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. SttLctural Floor System r 61. APPROVAL TO DECK I
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 . - - - T, = ARP:AOCALS Permit# ^-
21. ducts, in_Structug e - �c 70.`.Undergrougd klydro
22. Ducts, Ventilating-r S•
C
;r 71• Product.Piping'C$G is TRJ Oil
23. Gas'Pipe`Ro4gh&Test ,..._ a: y ._ 72. Underground Flush :
24,__Root Framing: , - .. -- - t -. = 72. Undergrnd.Storage Tank D Gas 0-Oil
25. Roof;Sheathing -•' * - - r %;r 74. Overhead Hydro- •
26.,T-Bar Ceiling (Structural) &:Morlocoat j r- r 75. Dry Chemical - - _
27._Frame and Flashrf1g= "��, i. m 773• Dry Staffpipe�
28. Lathing:& Siding" K =,�'_ - r - . ., .. 73. FIXEDSYSTEM FINAL -
- - C; • _ _.
' 29. Insulati5D * '' I e 7 FIRE PR EV. F.I{�AL K _ r.
30. DrywalliNailing i. 1 x rk -HEALTH DEBT'.-REQUIREMENT
31. Plaster Brown Coat_ , r I I ` _ 79. FINAL±kNSPEC'tI'ON y '
C� \
.. 32. ElectricajPov�er Muer-Final I - . - 80: FOOD CEf TIF-J ATE YSSUED - --
1 33..5Finaf Electric * '. ` Notes: !_3-29124 <^Li�1-C_ Xi y
., 34.-Finale Heating& Air„Conditioning._ jit: i 3 -9p Pr
c:. � -
r
35.rFina7 Gas Pipe-Test ..:-• _ • ,
_
36. Hood or Canopy { ../ _ ^^ •i t
T_ i i +
37. Final Factory Fireplace - r 1 - I r rr r.' `.I`
i 0 =- ..1
38. Fina) Plumbing i _ , i' `S , -t
, 39. Water Service-Finals - _ .. 4 - -.
t"., 40. Gas Service-Final . _ _ ,, C c
41. Solar Domestic-Final g + '. Ct - _
r- , .Y - • -
_
42.-8ackflow Preventers. - r I .r - t :
43. Backflow Irrigation- - ' •-'I-
• T it. f
` _L.
44. Landscape Irrigatiop System,trs _ - r t , - -
245..Sound Attenuation- - - - '- = - :r.<21
;46.-Handica{5 Regulations _ - '• �. - r
47. _FINAL STRUCTURE & BUILDING . 7 - ,1 •
F
48.9INk1L PLANNING . -R -
49..:-Electric Release to Edison .: `
_ • -1 - -
50. Gas,Release to Southern California Gas Co ' • - - - - : .
51, CERTIFICATE OFtCCUPANCY - .
No. Date
' rADOS3OFBUILDING: 255 22ND ST WIT: CITY OF COSTA MESA - BUILDING PERMIT
b OWNE+SNAMEr&MgWN: LOUFEK, RICHARD A PERM NO: E 074346
•
*MESS: LOUFEK, GRETCHEN
255 E 22ND ST PERMIT NO: E 074346 PLAN CHECK NO: N GOVT: N SUPP: N
•
COSTA MESA,CA 92627714 ) 650-1525
APPL.MAIUNG ADDRESS) CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
ARCHITECT ORENGNEER: UC.NO.: JOB DESCRIPTION : SEE UNDER COMMENTS SQ FT:
ARCH.OR ENG.'S ADDRESS: UHT:
- CLAIM VALUE: CALL-VALUE: GROUP OCC: R-3 /M-1
CONTRACTORS NAME:
CONTRACTORS MMUNG COMMENTS: ADD 18SF TO PORCH, CUT GARAGE BY 16SF & RAISE CEILINGS REF B74052
ADDRESS: UC.NO.: *******************************************************************************
UHT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby tiff irrn under penaky of perjury that I am licensed under protheses of Chapter S SETBACK S
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY LIC.NO.: LIG.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dau: Contractor: LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors license Law for the
folbwag reason(Section7031.5 Business end Professions Code:Any city oroouny which requires a permit tommvuct,alter,improve, PARKING REQ: PROV: PARCEL : 42615303 ZNE: REF NO:
...ash,or repair any structure,prior a its issuance.also requires the applicant for such permit to fib a signed statement gal he or she PLANNING NOTES>
licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the c)
usiness and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exempfon.My violation Of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than We hundred dollars(S500]). ************if******************************************************************
0 I,as owner of the property or my empbyeee with wages as rhea sole compensation,will do the work,end the structure a not Intended D E VEL OP MEN T S E -R V ICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply loan Owner of propend NN
who buids or improves thereon,and who
does such work himself or herself or through he or her own employees,provided that such li •
improvements are not intended pr offered forsale,9,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY t- DATE:
V owner-builder will have the burden of proving he or she did not build or Improve for the purpose d ale). -
-
0 I,as owner of the propend.am exclusive&contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : `
contracts foro Code:The with o License Law does not apply to the owner of property L builds or Improves thereon and who -- DATE: � i-
contrects sde projects writ a mcendoes pupant to r rs License Law). '
lam em under tion: B.AP.C., e • .�� / APPLICATION ISSUED BY: • '"- DATE: Z Ci:
C,..O�,////��rr [ Sgc �Ocik,A ILD Gcoi--,:- **************************************** ************************ **
Date: // v'/ 95 ownCA LEGALIZATION:N F E E 'i SUMMARY STRUCTURAL SEGMENT: N
I do hereb certify the I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and
25534,end Mat I or any future building occupant will/will n01(circle one)need to comply with said eleteoodes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction,:f modificationfromthe Ai a6-TManaagenent DistrictRnidendal d
conmctiom
n appibns are exempt from these PERMIT 61 - 55
Provisions.
Dale. Applicant: PLAN , 50% SHIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby eMn,,under penalty of perjury one or the following dedantion: ISSUE FEE 15 . 00
0 I have and will maintain a cenificee of consent to sell-Insure for viorkers'compensation.as provided for by Section 3703 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,tor the pedoaenadthe woof ler which this permit is Issued. TOTALS----> 61 . 55 15 . 00 . 1 0 . 00 76 . 55 76 . 55 . 00
0 !have end will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,ler the performance of the
work for which this permit is issued.My waken'compensation insurance Canner and policy number are:
Carder: REVENUE DIVISION TOTALS--> COLLECTED : 76 . 55 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
this section need not be completed A the pemaA is for one hundred dollen(Stag)or leas) 76 . 55 I
❑ 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
apneaCalifornia, should become subject to the workers' *******************************************************************************
compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with those provisions. IND I V I D U A L- F E E BR E AK D OWN
Dale: Applicant:
Warning:Failure to secure walkers'compensation coverages unlawful,and shall subject an employer to credal pens/ties and TYPE QTY DESCRIPTION UNIT COST TOTAL COST
civil Das up to one hundred thousand dollars($100,000),In addition to the coal o/compensation,damages as provided ler In
Section 3706o the Labor Cors,Interest,and afrorney'alees. ELE 20 FIXTURES, LIGHTING ?... 1 ST 20 EA. . 75 15 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of penury that there e a camruction lending agency for the ELE 12 FIXTURES, LIGHTING.- ADDITIONAL EA. . 45 5 . 40
performance of lite work for whish this permit a issued(Section 3097,Cb.C). ELE 20 RECEPT/OUTLET , 1 ST 20 EA. . 75 15 . 00 ,,,///
LENDER'S NAME: ELE 7 RECEPT/OUTLET ' ADDITIONAL EA. . 45 3 . 15
LENDER'S ADDRESS: ELE 16 RECEPT/SWITCH C 1 ST 20 EA. . 75 12 . 00
I sentry that l have read this application and stele that the above information is correct.l agree to comply with all city and county ordinances ELE 1 SUB-PANEL - , 11 . 00 11 . 00
and este laws relating to building construction end hereby authorize representatives of this city to enter upon the above.mentioned property END OF FEES
for• inspection purposes. RICHARD LOUFEK 01 0O1.90908-00190908 TOT 7/6,55
P' me cr�fTed / elTeals,A w- DATE: 014/26!9:, TTE: 13:05
• 4 �e7sorosir (a sl7�
Date:
Sip re a nVAppecanuGonuector
r 1A.
'W (5151-46.WP) Whim-Building A Safely:Green-Rte;Canary-ADpeant:Pink-Revenue Goldenrod-Assessor !�
1 •
CONSTRUCTION AND PLANNING POOL ,PA •
w 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, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11.. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing , 65. Electrical-Final
15. Rough Electrical-Conduit /}�x'0l• 66. Solar System-Final
4 16. Rough Electric Wiring '/ D7 ) 67. Fencing & Access Approval
17. Rough Wiring Sign ` ' lL 68. APPROVED FOR PLASTERING
18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning `FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26, T-Bar Ceiling (Structural) &•Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
•
28. Lathing &Siding 77. FIXED SYSTEM FINAL •
,1
29. Insulation 78. FIRE PREY. FINAL
30.•Drywall Nailing HEALTH DEPT. REQUIREMENT ,,
31. Plaster Brown Coat 79. FINAL INSPECTION -
:
32. Electrical Power Meter-Final O. FOOD CERTIFICATE ISSUED 1
33. Final Electric '-6117 O.
/Q-1.6 `Ys ! a,-/rcj 7 fOC174 al
Ate
Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy _•
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING
48. FINAL PLANNING
49. Electric Release to Edison --
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
BUILDING PERMIT LOC
0
EMPLOYEE:
ADDRESS: 2SS 22n4
PERMIT NUMBER: C'- 7y 3 ya TYPE OF PERMIT:
VALUATION: SQUARE FOOTAGE:
s�
PERMIT FEES: / 7(�
DATE: TIME IN TIME OUT ACTIVITY
Rs Jo -/6-95 ioNs In/6 Kouyh /nspec/'on -r?orrectbascY'Co4Su/Ae/oma 50.1+%4
cr-/n? T tbncwwfeo' arCi
n
ONLY ONE ADDRESS PER SHEET—TIME IS TO BE CACULATED TO THE NEAREST 15 MINUTES
PLEASE BE AS SPECIFIC AS POSSIBLE IN RECORDING ACTIVITIES
ADDRESS OF BUILUDIO: 255 22ND ST UMT: CITY OF COSTA MESA - BUILDING PERMIT
OWNER'S NAME IF KNOWN: LOUFEK, RICHARD A PERM NO: E 074346
ADDRESS: LOUFEK GRETCHEN
255 E 22ND ST PERMIT NO: E 074346 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627714 ) 650-1525
APPL.MARINO ADORES& CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : SEE UNDER COMMENTS SQ FT:
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /M-1
CONTRACTORS NAME:
CONTRACTOR'S AWNS COMMENTS: ADD 18SF TO PORCH, CUT GARAGE BY 16SF 6 RAISE CEILINGS REF B74052
ADDRESS: UC.NO.: ************************************************W******$**3e**********ilii*****$*
UMT: ZONING REQUIREMENTS
UCENS ED CONTRACTORS DECLARATION:I hereby affirm wider penalty d parry Nut em liaised under provisions of Chador 9 SETBACKS
(commenting*eh Section 7000)of Division 3 of the Business end Professions Code,and my area is in full face and effect
CITY LTC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Corrado LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contradcn License Law for the
Mang reason(Section 7031.5 Busbese and Professions Code:Any Caa or county which requires a penni,to ocneticl,eller.Improve. PARKING REQ• PROV: PARCEL: 42615303 Z N E: REF NO:
demolish,or repair any sticture.per bis issuance.ebo requires the applicant for such pane to fide a eyrod current that he or she PLANNING NOTES>
's licensed pursuant to the provisions d the Contractors License Law(Chapter 9(mmmendng with Section 7000)d Division 3 of the
arsine's and Professions Code)or this he or she is exempt thralnm and the bene for the aged exemgion.Any violation d Section. >
not.5by any applicant for a permit subjects the applicant lo adwl penalty drice more than True hundred doll=MOOD.• **IEiEihiE'LF9fiFiFiEih1E1EY;1EiEiE7EMfFfE1E1F1E1E1E1f1EifiE1E1E1fififlElfiflFlEeFlfiElf•***IE1E1f1EIEiE1EIf1E1F1EIE1E1E1fiF1E1F1E1fif1fiflL'149EIFiF***
❑ I.OS°WTw d the pmpenyor my amebae wA wean thee sole compensation.will do the work and the stricture a not intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sae(Section 7044,Business and Professions Code:The Contredal ors License Law does nappyto an owner d property
who bolds rr
inone thereon.and who does such wak himself or heal or through he or her own employees,provided that such
improvements are rd iraended rolfered for sae.lf,however.the building rra'a
inment iswithin sold ata year d
completion,the n ZONING APPROVED BY s DATE:
owner-builderd provingr
will have the burden he she did nal bib or unrae for the pupas of see).
I.asotweraf the progeny.rn exclusively contracting with 9coeed contraction bconstruct the project(Sedan 7044,Business and BUILDING APPROVED BY DATE:
Professions Cods:The Crradors License Law does not apply to an ownr d progeny who bilks or bndoves thereon and who
contracts for such cem
such projects with a contror(s)Ied pursuant to the Contrary License Law).
lam trio rind" B.aP.c.. .� / APPLICATION ISSUED BY: DATE: ! ci
/ 6 95 oww��r � cgA/LD L�ufP/� *RFS9****#******iE�F** ERE*f ***AE E*****RER9BNS *** SE REVERE*****BN+t*****BER ******* . . . . . . . , . **
°at ' LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do cattily I am aware d and understand the requirements of Cal/ods Flea h and Soley Code Sections 25505.Patty.end
25534,and thellreny Mune building omrup vel/erg DOI one) bcrnpy whsaid due mala and the rpuirernanbM BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for cos:mabn r radiation from uSyMan
the Ai agenent District Resierubl construction n ion eppireens eexempt these
e
provisioprovisions.ovs. PERMIT 61 . 5 5
Date: ApplUm: PLAN 508 SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby am under penalty d perjury one d the Wowing de tions: ISSUE FEE 15 .00
o Ihave and wiImaWaeecefbiutedconsent tossitrawefor waken'compensation,eprovidedforbySedion3700ofthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for thep.drm.n.dthe waklrw:ahwmabissued.
TOTALS----> 61 . 55 15 . 00 0 .00 76.55 76 . 55 .00
❑ I have and oven malnb worker:mmpen.atian Insurance,as required by Saco 3700 of the labor Code,for the performance d the
work Ir which the pad is ilea.My wan'companion tsar e
ance cad policy number re: •
Caner: REVENUE DIVISION TOTALS--> COLLECTED: 76. 55 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
This section need not be completed/the permit b n»one hundred dollars(strol et tsnj 76 . 55
❑ I panty that in the performance d the work for such this permit b issued,I shall not employ any person In any manner so as to .
become subec to the workers'compensation laws d Cekrnie,and agree that/ sutra I should become suto the waken' *******************************************************************************
compensation provisions d Section 3700 of the Labor Code.I shall forthwith comply with those provisions INDIVIDUAL F E E BREAKDOWN .
Deno: Applicant:
Warning:Felon to secure workers'compensation coverage is unlawful,and shall subject an employer to cdminsi penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines up to one hundred thousand driers(5104000),M addition to the cost of compensation,damages es provided for In
Section 3706 of the Labor cob,Interest,end erbmeys fees. ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. . 75 15. 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there islending agency a construction ency for the ELE 12 FIXTURES, LIGHTING ADDITIONAL EA. . 45 5 . 40
performance ofthe work frwhichthe pemiLiebd
eued(Sealn3097,Cw.C). ELE 20 RECEPT/OUTLET 1 ST 20 EA. . 75 15. 00 /
LENDER'S NAME: ELE 7 RECEPT/OUTLET ADDITIONAL EA. . 45 3 . 15 ,00/
LENDER'S ADDRESS: ELE 16 RECEPT/SWITCH 1 ST 20 EA. . 75 12 .00
I candy that l have reed this application and date that the above lnlormder,a coned.l agree to comply with all ply and county ordinances ELE 1 SUB-PANEL 11 .00 11 . 00
and stale laws Muir to building construction and hereby authorize representatives of this ply to enter upon the above.mentioned properly END OF FEES
for inspection purposes. RICHARD LOUFEK • 01 00190908-00190908 TOT 76.55
///�,,/// `//Jy/// / 51.5-
:.....„.."
` DATE: 09/26/95 TIME: 13:05
✓ /�/ ;(n� P m/�a.1 rear Date. 72 Zi b - 7 J '
rere
15151-45.WP) White-Buidmg a Safety:Green-File;Canary-Appicant;Pink-Revenue:Goldenrod-Assessor '
OWNER STYLELINE HOMES, INC. DATE 2=19-62
JOB ADDRESS 255 22114-St. I3UILDING PERMIT NO.161C37
GENERAL CONTRACTOR Owner-B1dr. VALUE $16,190.00
AP No. 118_150_34 LOT TRACT FIRE ZONE DESCRIPTION AIF WORK Res.w/att.Gar.
INSPECTIONS Signature DATE GROUP I & 3 TYPE V ZONER1
soil Ault- S 3 -Z- a. PERMITS ISSUED
C - A74S 3-29-67.. SUBCONTRACTOR DATE NUMBER
w.,.er Wei 74-e-S 3 C--62-
Rough Corn. Ref rig. 0 Air Cond. ❑ _ _
Rough Heating
Rough Plumbing C 3-2 ` 2 - - �� .
�1 H� 3 s4-G� c V—.���z _dd�S
Miscellaneous �y _ ,,,//q 0
Prop.Swr.Line ❑?louse Con. �St.Swr. ❑ y�e_ of i ly 3 j(id i g T2
Sprinkling System /
Construction Pole
Underground ❑ Power [] _
Rough Wiring vi )-7-C L 1
Trenches [re- Forms Steel Reinf. 0 ,vrip_ 3- L--(.J� b� 7 ��
C.-C)..-
Floor System 3 7—L2 �y 1A r�_ ?
Bond Beam 0 Steel Reinforce 0 �✓"�Y - '
Sheathing G F7, 9./I a
Frame and Flashing e a„-..7"
Lathing — In 0 Out ei1.ail"'
Plaster, brown coat Mina- 41- - -6 y A': v
Refrig. 0 Air Cond. 0 Pima p / I
1-kv Ang, Final 3-27- 7 U
ir,.: ing Fixtures, Final ,/,6' (:P ' A., _ �° ;__74_
F al Gas 'Fest Y6c;71• -'•� 1,,�' �,f, _ J4-_-_,>0
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Electric Fixtures, Final , � �2q' _ �.ol�/' (�� �
Building, Final J�7-�t. � '
OCCUPANCY
mRM R114.SM � 7.61 unt.1] FOR sEECIAL RCQUIRE &D1Tc 164it
16437 F E RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT 1
P. O. BOX 317 COSTA MESA. CALIFORNIA J FINANCEE DEPT.
Applicant to Fill In Completely CITY OF COSTA MESA
For
P Y APPLICATION FOR PERMIT
TYPE OR PRINT .
BUILDING
BUILDING )—` h 1- p
ADDRESSJ 4 K S /'
COSTA MESA, CALIFORNIA For Office Use Only
STYLEL I NE HOMES, INC. I RECEIPT NO. far?
OWNER `ey /Y 1l{�J4 /
ADDRESS��� L �I A A� /� RECEIVBbiBY DATERECE� D ` D iT917562
7
CITYAIeLJ ?o,-r 13ec.c. ,:g-TEL. 7G-3Stc BUILDINGDRESS C_ / Y
ORARpHITECTENGINEjERO /CI- + GJI Lu€C nNO/H4 07/36 COSTA MESA. CALIFORNIA/ /^/ 1^y"
i.
ADDRESS/ o O Cal /I1 co. /`l/� l'..I \ FIRE
ZONE TYPE GROUP per' ��T{
CONTRACTOR ocu !V e c APPROVED DATE
U
ADDRESS ZONING
ZONE^ NO.OF USE OF NEW '�9 �A,�/IS
CITY ,q PLANS I BUILDING W,
STC.TE TEL.
NO. NO. LEGAL O ®�/- -L j, V m 7-4._
/ rr C' DESCRIPTION -I ro
n61ZE CO �J 7• S`d , NOWOHOT � //? — / �u — 3 �j
or A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM / )/ (CENTER LINE ST.)
CENTER OF STREET `�O REAR YARDS/�/ / FRONT r-5—FT. IN.
SIDE YARD I LEFT G '6' e. I RIGHT ,1 )' R.SIDE `5— FT. C IN.
DESCRIPTION OF WORK s— G
L.SIDE FT. IN.
NEW I X D ALTERATION I II ADDITION I REAR 98 FT. IN.
REPAIR I MOVING I II DEMOLISH I APPROVED(4"14/C
4 b,t DATE 27, Y/CL
BUILDING A NO. OF f`
SIZE /��V ROOMS OF 7 J/STORIES / HOLD//�7FO�R/JSP//ECIAL,/REQIIIIIRPMENT„
F
COVERIING WALL.>C C 0 I COVERINGROVSA/,-, v e ` 42, / "„t-'1 4 at, l/'G..�-Lr.
USE OF BUILDING AND WORK TO BE-+PEE�RFORMED / U
` I.:4., ek Zi.7 / .,I: a . Tc6C'L•/ 0/
Oc:.'NC
42 te IP/ # 8'O ✓ _1 /5 ..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF 1 PERMIT FEE $ 3
N
PERMITTEF / I C // // Q�'
$/ �j'/ 9 oma PLAN CHECK $ / Q "--- 13
•
AUTHORIZED AGENTrte/ 0
dimmummmila. TOTAL FEE $ ✓ j — 2
. /
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