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122 23RD ST - Building Permits
MDRESsoF SMLORI0: 122 23RD ST UMT: CITY OF COSTA MESA - BUILDING PERMIT OWNER;YNAMEIFmCWN: PENJOYAN, RICHARD G TR PERM NO: B 083720 ADDRESS: 17321 ROB ROY CIR • HUNTINGTON BEACH, CA 92647 PERMIT NO: B 083720 PLAN CHECK NO: N GOVT: N SUPP: N APPL.MMUM ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENDINEER: LOC NO.: JOB DESCRIPTION : T/OFF RESHAETH & REROOF W/COMP. SHINGLES SQ FT; 5, 000 ARGIL OII ENG.'S UMBERS: UMT: CLAIM VALUE: 5, 000 . 00 CALC-VALUE: 5, 000. 00 GROUP OCC: R-.3 / CONTRACTOR'S uctosMALpl. COMMENTS: SMOKE DETECTORS ARE REQUIRED CONTRACTORS Y41dd0 ******************************************************************************* ADORFSS: UC.Ip_ UMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of penury that I am tensed under prvri'vv eof Cpar he9 SETBACK S (commencing with Section 7000)of Division 3 d the Business and Prof nions Coda,and my Nenee is in lull torp and effect. CITY LIC.NO.: LRC.CLASS: LRC.NO,: EXP: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Dale: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of penuy that I am exempt from IM Contractors License Law for the following reason(Section 703ts Busies and Pmfes:dons Cob:Any ckY or county welch nimble a Penna to ppeual,erre,introse, PARKING REQ: PROV: PARCEL: 43942103 ZNE: REF NO: demdoh,or regi any emxlurs,-tolls issuance.leo requires the applirem for such pent lD Bee signed statement Nm he«she PLANNING NOTES>- '•licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of DNeion 3 d the 'eines,end Professions Code]or that he or she a exempt therefrom and the basis for the alleged exemption.Any flotation of Section > J 31.5 by any applicantfor a permit subpde the applicant to a civil penalty of not more than live hundred dollen[$5001). *****************************************************************44**-*******:'t* nI.as ovmer ol the propeny or my employees wih wages as their sole compensation,will do the W0fil.and the structure i 1101 intended D E V E 'L 0 P M E N T SERVICES REQUIREMENTS or offered for sale(Section 7044,Business and Professions Code:The Contractors License Lew does not apply to an owner of properly who builds or improves thereon.and who does such work himself or herself or through hi«her own employees,provided that such improvements are not intended or offered for Bale.II,however,the building or improvement a sold within one year of completion,the ZONING APPROVED BY DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). ❑ Lgeownerall the provny.am exdustseynntrsdiq wth licensed canbect«smdswmu tnpojed(Sedcn 7°44.Businro'and BUILDING APPROVED BY : DATE: Professions Code:The Contractors License Law does not apply to an owner of property who builds or Syringe thereon and who centre,"for such woods win a commdons)[tented pmuum to the Contractors License Lew). I. ElIamexemptunderSect� in: B.APL.. «yReged� APPLICATION ISSUED BY : - DATE: h eI 3 a .r..9.-5.-.•-vera-ca--.°""r' LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y do.. _. certify that I am aware of and understand the requirements of Calomia Health and Safety Code Sedum 25505.25533.and pt ,and that Ior any future building occupant wi/wD not one)need n compy will said mate codes and the requ"iremetler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING eanafor constction«modification bomth At QualityManagemw District Residemot constrwcn eppicatbr are exempt horn these PERMIT 99 . 75 SO provisions. Dale: Applicant: SMIP/NON-RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following detlnmcns: ISSUE FEE 0 I have and vril maintai e certificate of consent to serf-insure Ira workers'compensation.=provided tor by Section 37mdthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code for the pedonwceathe work tor which this p. tem ed. TOTALS----> 100 . 25 0 . 00 0 . 00 100 . 25 100 . 25 . 00 ❑ I have and will maintak waken'compensation insurance.as required by Section 3700 el the Labor Code,for the performance of the work kf 'id'tt`° er. ed.k«yw«sem`'`p'pertsmi«h insurance pater and°a`y number`re: cedarder. REVENUE DIVISION TOTALS--> COLLECTED: 100 . 25 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK S section need not S completed d the pest is for one hundred dollars(3100/«lass.) 99 . 75 . 50 6.1 I candy that in the performance of the work for which this permt a issued,I shall not employ any person in any manner n as to become subject to the workers'compensation Iowa of California.and agree that R I dwukl become subject to the waken' ******************************************************************************* compensation provisions of Section 3700 of the Labor Cab,I shall fnhwith campy with those provisions. IND I VIDUAL F E E BR EAKDOWN Date: Applicant: Warning:Failure to secure workers'ccnyw«aton coverage Is unlawful,and shall sW/ect an en employer to criminal penalties anal aTYPE QTY DESCRIPTIO N UNIT COST TOTAL COST clad Ons up to one hundred thousand dollars($1040001,In addition to the cost of compensation damages as provided for In n Secti37°6oftheLaborCode,Interestandattomey'sfees. SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that then Is a construction lending agency for the END OF FEES performance of the work for which the permit is issued(Section 3097.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this appliance and state that the above kdamalin is correct.I agree to comply with all thy and county o dinances and state laws relating to b ling construction and hereby authorize repesentathee("this city to enter upon the above-mentioned properly or inspectiopurposes. PEGGY PENJYAN 07-14-1997/18:22 AN/$188.25 RCca.--- Date: ) I �1 l S± PERMIT:083720 Ignmumt e . .. .. cod• • (5151d0.WP) White-Building&Safety:Green-File:Canary-Appirant;Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit# Date Inspector i 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, ❑ 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 0 Gas 0 Oil 25. Roof Sheathing 7 /7--q7 Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat tr 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating&Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7.1.2.1-17 /_u4/ ` 7 • 48: FINAL PLANNING • / f� • 49.: Electric Release to Edison • 50. Gas Release to Southern California Gas Co . 51•. CERTIFICATE OF OCCUPANCY No. Date liA0 aBnkaND: 122 23RD ST °NT: CITY OF COSTA MESA - BUILDING PERMIT EIP*VA'N: GEORGE & CAROL KORNIEVSKY PERM NO: P 08421E 1°mut 18881 VON KARMAN #1260 IR CA 92612 PERMIT NO: P 084215 PLAN CHECK NO: N GOVT: N SUPP: N ApPL.MAILING AODREss 714 ) 724-0891 ARMAN CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH ARCNDECT OR ENGINEER: LC.N .: JOB DESCRIPTION : GAS REPIPE, ADD WATER HEATER SQ FT: MCI OR ENIL'S ADDRESS: WIT: CLAIM VALUE: 1 . 00 CALL VALUE: GROUP OCC: R 1 / CONTRACTORS NAME: CONTRACTOR'S SALEM COMMENTS: X ADDRESS: IIC.ND.: iE*kdE*dE**df***db*dER**k!E%*hEdbiEdEifiE lbdt%iF*dfdEdtiFd4****dEkiEdFdEifdf*kkdhdtdkdbibdfdtdfiEdF*itiliEdEdEdEiFdt*iFibhtifdfdkiE Der: Z O N I N G R E Q U I R E M E N T S LICENSED CONTRACTORS DECLARATION:I hereby df under penalty d perjury that I am licensed under provisions of Chador 9 S E T B A C K S (commence*with Section 7000)d Division 3 d the Business end Professions Code,and my license u n WO lora and shed. CITY UC.No.: LIC.CLASS: zee.No.: EXP: MAIN BUILDING ACCESSORY BUILDING Dae: Canada: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penaly d perjury Lha I am exempt horn the Contractors License Law for the following reason(Section 7031.5 Basilan and Professions Code:Any cry or county which requires a permit to Construct,elver,improve, demolish,arepeaany elmmre_pbrto teaueaalso sLicenseslw epp&sr (commencing comsuch penngtoth 70Wementlhahe ache PARKING REQ- PROV: PARCEL: 43942103 INE: REF NO: nneslicensed pursuant to the provisions d the Contractors License few(Chapter 9 basis nd g with Section 7000)d Division 3 e the PLANNING NOTES> ninon and Professions Cadet or that he or she S exempt a dei penalty and the bees for the alle0ed exempton.Any v olaton of Section > ha 051.5 by my applicant for apenS subjects the applicant bead peaMdrot more than fns hundred dollars 1550011, iF1EjEiEfElEiEiE****iE3k1E****1f1E1f1E1E1Eil•if3kff1E3EiEfE3EiEff3E3EdE1l�EfE****iE1EyEiEitlElEiEft#iE3fyE3E1fff1EitllfEilfElF****lflF`if iF'A` 0 I.as owner of IM property or my employees wish wages a thee sole compensation.w*do the work.and the Madura is not intended oroffered for sale(Section 7°u.Burn and Professions Cab:The CamrmorsLiimrue Law does not applyto an Myna?al property DEVELOPMENT SERVICES REQUIREMENTS rill who bolds or inpbvee thereon, henna and who does such work himself or he t or through by or her own employees,provided that • such improvements are not intended or offered for sale.If,however,the building or improvement is sold within sow year of oanWaon,the es owner-builder wlw halhe burdend a proving ha not build or Worthy for the purpose el me). ZONING APPROVED BY DATE: C bI.as owner of the progeny.em eoiniwly contracting with liwaed methadon to menus the project(Section 7044,Business and Professions Code:TM Catered=License Law does not applyb enowerd popery web builds or imrovathereon edwho BUILDING APPROVED BY : DATE: contracts for such projects with a oontrmovs)licensed pursuant to the Cant license - lam. eB.a P.C..for this reason: APPLICATION ISSUED BY: DATE: Da . t eV/\ 1- Dwwr: _ *********************4************************************4************************** if 3F##iFl ***lE*** Ido hereby pertly Ula tem awes on and undeceived the ,_ Lints el ew • . ers and Safely 25505.cant. -. • . s.25533.a .ad LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N 25534,and that I a any Mus builder*cmavewill/we •. .: le one simply with said state codes .the requirementskr a permit fam1rud orm es oddczeknhmlMAiOrnpsnere• • .• :. ial mMnrabnappkcabns exempt'Mtn these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25 . 25 Dae: Awrraa: 25% SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the blowier*. km: PLAN I have andwmaiden a certificated caned toee5a aufor smirkers'oomprtm ,a s isnprovided for by...'• 3703 of the labISSUE FEE 22 . 00 B Code,brthe pedamanced4*wakfor wha�meissued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ I hays and MI maintain workers'compensation insurance.as required by Salim 37C0 of the Labor Code. • the performance dthe TOTALS----> 25 . 25 22 . 00 0 . 00 47 . 25 47 . 25 . 00 work for whka this permit is issued.My wakes'compensation inrunnce orrice and policy number are: Ca1Aef1 REVENUE DIVISION TOTALS--> COLLECTED: 47. 25 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK his section need not be completed I the perm'is for one hundred dollars(51301 or lest) 47 . 25 0 I comfy that in the performance ol the work for which this came is Sued,I shall non employ any.. .,n any mazer so as to amesubjnto ion workers'compensation Lan California.and d ahtc.Nat I become subject to the workers' compensation provisions of Sed 370e of the Labor Code.I shall tanh ah ply with those ptb f d *d3*#3*d * E fk*** rb* b3*3*3kbdd #*3d3d *d *3*dbd33**af ** f*Cf *3***3*3*33*3*4h33*33** Date: Appt pent: INDIVIDUAL F E E BREAKDOWN Warning:Failure bacon workers'compensation coverage Is unlawful,and shell sublet,an enitrionr re aferlrrl Penalties ed TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil Ona w to one hundred thousand dollars(5104000),in addition to the cost of conpens teen,ragesprovided for In Seddon 3rosardnLabor Code,lnracend attorney's r«« a PLU 1 WATER HEATER AND/OR VENT 11 . 00 11 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty d perjury Out then is a oonatndion lending agency for the PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5 . 50 5 . 50 performance of the work for which this peon'is issued(Seaton 3097,Civ.C). LENDER'S NAME PLU 1 GAS RE-PIPE 8 . 75 8 . 75 LENDER'S ADDRESS: END OF FEES I tarty that I have read gra appfrction and este that the stare bdonnation a comp.I Apse to comply with all city and courtly ordinances and stale laws retah*to builder*cermuction and hereby authorize representatives d this oilyb enter upon the above-mentioned property for inspection mpesa. BB-13-1997/B1.S9 Pfl/f47.25 GEOGE KORNEIVSKY47)411÷_i RCPT0:©1-L•u1375 PEkP1ITe084215 ///��� ma Dona: / , Sgrlaure Apent/Appl o Or (5151<6.WP) Whis-Buldiq&Soley;G :Cerory-AppSunt;Pink-Revenue:Goldenrod-Assessor POOL PA CONSTRUCTION AND PLANNING s 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 OGas ❑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 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78: FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning - 35. Final Gas Pipe-Test 36. Hood or Canopy • - 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 09/ - 40. Gas Service-Final - 41. Solar Domestic-Final 1 42. Backf low Preventer , r 43. Backf low Irrigation 44. Landscape Irrigation System _. 45. Sound Attenuation - - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - -. - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Col Z6j51 ft 51. CERTIFICATE OF OCCUPANCY •`� No. Date City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY N° 1915 C P. 0. Box 317 Costa Mesa, California The Building located at 122 'ti ' 23rd Magnet, A. B, C end D has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto • for a Group D & a Occupancy. Use of Building 81!'tt%teaar alb Dtanhed Care Legal Description A.P ffiD. 19.4111.h2 (See reverse side for Metes and Bounds) Building Permit No. 201112 Electrical Permit No. 21055 Plumbing Permit Na. 27 Floor Load Signs have been installed as Room Capacity Signs have been instated as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms ' 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments ' and/or guest rooms ISSUED TO: Building Official A. V. BM& Date PiWel 1211, 194 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form Bv34-1at-11_13-8_B P Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. . CITY,OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO. CONS iUCTION PERMIT P1 c- , c2 _.Project Address/RatE 2 9V^"`- r71- #4n7 7) TYPE OF CONSTRUCTION Owner Fired I (j.?r, AA, hn/. Phone fA�np9ff 0 NEW 0 ADD 0 ALTERATION ��Q 7258 10/ /81 5e00 TU Addresso,36 /-////y//eJ /"////ey*oJs-q_ 0 REPAIR 0 CONVERSION ❑DEMOLISH 'r) ZONING REGULATIONS Arch/Eng. License No. .0 OTHER --- - DESCRIPTION OF WORK A.P. # Address' 6 / ./ ZONE PLNG. REF.9P Contractor)' ,,.c Q,4 Alen h///A l�f/.hone7f2 -35/ . TYPE OF PERMIT z 1 'SETBACK W�tIk.R Address/..q4 Gil .0/,JeQLT /R/ / 0GRADING 0 FOUNDATION 0STRUCTURAL SIDE YARD/LST. P I YNLINE LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL ['PLUMBING ❑MECHANICAL g IiDEYARD I hereby affirm that I am licensed under provisions of Charter 9(corn- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Code, and my license is in full force and effect. REAR YARD(TO P/L) PROJECT DESCRIPTION License Class _ -� Licen Se No.7/ bU-� PKG.SPACE REQ. PROVIDED Date /11 '-*-2-'Ci signaturerheti'l<9/Ait'r C 11.,...*•..../ SQ. FT. — WORKERS'COMPENSATION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE $ I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers' Compensation insurance, or a certified copy thereof(Section 380Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: licy No. C-'41--2•171/1Company Ye-r -rk IC ti,i, ,ertifie0 copy is hereby furnished. REMARKS: ,'4 ertified Copy is filed with the city Building Division. eXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I Certify that in the performance of the work for which this permit I5 issued. I shall not employ any person In any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers'Compensation Laws of California. uW ELLING GARAGE Date - Signature _ BATHTUBS SHOWERS SO FT SO-FT NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER • forthwith comply with Such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW_50+KW - revoked. CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS - MOTORS 0-1 HP 1-10 HP I hereby affirm that theretis a construction lending agency_forthe per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+HP formance-of the workdor which this permit is issued'(Section 3097 - - Civ. C.)., FLOOR SINKS FLOOR DRAINS FIXTURES' OUTLETS - SWITCHES :Lender's Namat f - --- - - '�• - Lender's Address - , DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION t INTERCEPTORS CLARIFIERS POLE LIGHTS bhereby-affirm that I am exempt from the`Contractor's.LiSense Law-for c. the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL ` P TRAP 1..UNS I NUL IIUN Any city or County which requires a permit to Construct, alter, POLES METERED SUB Improve,demolish or repair any structure, prior to Its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed Statement that he , is licensed pursuant to the provisions of the Contractor's License Law I3 SSFRVICF _ OUTLETS SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and thee yygTER HE ATF3i� BTU OUTPUT 0' QD basis for the alleged exemption. Any violation of Section 7031.5 by "—.1:,--rappllcant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ' .,"tet more than five hundred dollars ($500). ` as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS . ' so e compensation, will do the work, and the structure is not Intended -` or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. r ISSUE FEE Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself or ISSUE FEE 9 Ob APPLICATION APPROVED BY DATE through his own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK _ _ SUMMARY OF FEES Is sold within one year of completion, the owner will have the burden of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING $ SMIP $ ❑ I, as- owner of the property, am exclusively contracting with AND DUCTING licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to - ISSUANCE $ ' � •� n an owner of property who builds or Improves thereon, and who ton- REFRIGERATION 0-100.000 BTU PLUMBING 55' tracts from such projects with a contractor(s) Iicesned pursuant to SYSTEM GRADING $ the Contractor's License Law). 100,000 +BTU PLAN CHECK $ ❑ I am exempt under Section • B.& P.C.for this BOILERS BTU $ ELECTRICAL $ reason MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION PLAN CHECK $ TOTAL FEE$ d'{{ "-el I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL E Information is correct. I agree to comply with all cityand countyPLAN CHECK $ VANESS EAPC P Y VANCE PC $_ ordinances and state laws relating to construction,and hereby authorize representatives of this city to enter upon the above mentioned property for spection,,��PPurposes. 6j I A Q12 re /o-1 C% FINAL FEE $ r �' ' Signature pate Drivers'License or SS yt . ISSUE FEE CMF 0865-46 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 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms • 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation - 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap, ❑Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55. Plumbina System -Final 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring - 57. Solar System-Final 16. Rough Heating &Air Conditioning b8. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing NOTES: caged alt 7 o_ az-$/ - 4 4 23. Insulation -Cl,4-q -4. �,�,, ftmoray 24. Lathing & Siding r.ate,u'! /o - . 3-7C! . 9lo .444.L.j 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final • 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test - 31. Final Plumbing - /Ojd7/S/ 2vf 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date 11 rte^-- "-- rte+-,4- OWNER BYRUM; E. W. DATE AUG 2 2 1853 \ JOB ADDRESS 122 E. 23rd Street, A-D BUILDING PERMIT NO. 20412 - GENERAL CONTRACTOR Owner-Builder VALUE $ 44,202.00 AP No, 119-011-42 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK4-Plea Res.&Det 1 IY"ECTIONS Signature DATE GROUP H & J TYPE V ZONE R4 Gar. 5 rAL f-? A PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water ,� t /3 I Rough Corn. efrig. 0 Air Cond. 0 _ • Rough Heating 7.(( /o•ep-/1 i , dee - • /a- 7-63 m77a G \*YY Rough Plumbing 1 44-Ps- /O-1'AY.`l .�-c�" e- _3_43 _ 3 f a 9 7 (4) - Miscellaneous s `,--.0 "It" ,•- - C.---/--,-,--- ----'- c- a r -� , i___ Prop. Swr. Line ' House Con. C 'St. Swr. 0 CA/'-ice 9/L/H3 ,y -xt,,,-,/, c„_Ze.-.- 9- a - 6 3 a{ .4 .. „t• e a(1 Construction Pole .� Underground 0 Power ❑ 1121 Rough Wiring �T ..64^titi )fr -✓Kite- °/..77-63 ... ,,o CS- (£L Trenches❑ Forms ❑ Steel Reinf. ❑ ig'%/e_ — ' - (.-,Z Floor System /a1 c- ”— _ .., 3 cid- Bond Beam 0 Steel Reinforce 0 , 41 ,r•"' Sheathing m`Y J 0 - • — el 3 . .',' I. U Frame and Fl sh' a- / _ - - (03 N" .. i ' ' Lathing - In Out Lr /- I. 3 iI " fl Plaster, brown coat -22G1 o_ — 'lc, 3 / P .1. ❑ Air Con. .p Final / I. .ng, Final / Plumbing Fixtures, Final S JsJ-��f! ! ,c.,, Final Gas Testfyrr. '4.1 *.o L /�G0 �_'4'/- /1/ G '/ Electric Fixtures, Final Wof ZC' , Building, Final '-i / I OCCUPANCY /-, -�Z./ Form BU4-5M-3-63-S-B P fE�DDDDDff FAP c rTA . RFAIITRFMRINPPR 9/1h1 o .wt' ` 11 I • 20412 COSTA MESA BUILDING-SAFETY DEPARTMENT FEERECEIVED P.O.BOX 517 COSTA MESA.CALIFORNIA 14198 For Applicant to Fill In Completely 1 AfflrygVM^Q L,f, PERM IT TYPE OR PRINT tf (Va/L� � Y CIT'pKp�' �pS1X5IpIy BUILDING ADDRESS ' -O - L .'ri— a RECEIPT NO. ;FIT NOP. 2 COSTA MESA. CALIFORNIA 5yrtp//� LyLyY/�iElp ,./��JJgQO /pD may,/ in /`Erg gD A.2 ut5. OWNER L� �' BUILDING /Z -L J! / • ADDRESS /( .. ADDRESSMAIL //1POJ YY J RC �/�/J r TEL ZONE TYPE i' GROUP /7 /� FIRE CITY 5 ) /L CA��'& NO.A4, /i L,.24. �� n / //ppi ARCHITECT 4 TEL. BYPROVED' DATE I%'ZZ'ro5. OR^`IGINEER fitii,‘ ier�L. NO./,CLba35/ rr ZONING AD:-..ESS /`'a7iev"It ../ I ZON NO.or E OF NEW ( Iil/� �� PLANS _ BU LOIN• in 1• . CONTRACTOR 0/0*VW l•-• - At../ch✓ I n - 1�{ �T-�� - DEOAL PI . 0 19 DL• `. OT.-3°0 ADDRESS DESCRIPTION y+ CITY A.P.NO. I I / J O I I '— 'Z�, NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL 90'TO SIDE a REAR P.L. LIC.NO. NO. OEAVES (S F LOT 6 X I3 Z I NNOW OF O.ON BLDOS.LOT O ALLOWED (U.B.C.REQUIREMENT) � _ _� YARDS APPROVED YARDS APPROVED USE OF L MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. �-� ( - (FROM C/L STREET//j11�� �r�q(/)�. (/� SETBACK LINE FROM // SF,.I v-. e -/ •.J CENTER OF STREET �%� / REAR YARD FRONT LLLL�sss ' SIDE YARD I LEFT I RIGHT g R.SIDE e5FT. • i(yEFT.7 Q DESCRIPTION OF WORK L.SIDE I .( d•C NE' f ' ALTERATION _ ADDITION — REAR g4,7.2011---- © PT. DISTANCE BET. BET.MAIN a REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.BLDGH. BUILIdo 'O/ NO.OF ,,,t7 VAR.# DATE D' SIZE jS Z / ROOMS / / STORIES At. C.U.6R#�//�� APPROVED EXTERIOR WALL µ10o ROOF ('/ /, APPRp�p/ ',1 C X1-63 COVERING .1 Slatc,0 I COVERING SJaA QS' BY 1Il)Wl1`JIW'YRI..'' •` DATE USE OF BUILDING AND WORK TO BE PER)9RMED/ HOLD ORGIAL RE /Vo - Co+s/.- of /ses,clo.�/•/ ���__ QUIRE ENT$ 57ei ivweS 7Af 1/o- /&,-A fes ,i( s ' / / �j / 7�6J-ec.FT. / /� o r' / sis 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE z AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. D PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION T - BUILDING BCONSTRUCTION PERMIT FEE $ eCd(y SIGNATURE OF /CJ� C.-a•r.� D PERMITTEE /✓ iA(/"`��� $ L�02o�- - A C. C C AUTHORIZED AGENT E • TOTAL FEE $ /0;�J - . CGSTA MESA BUILDING—SAFETY DEPARTMENT P. O. BOX 1200 3:110 8/12/8I 70011 11 Costa Mesa, California E fIT NO. PLUMBING PERMIT APPLICATION TRACT NO. RECD. BY P5q/ CONTRACTOR -Tit Ef tu.s hl LOT NO. DATE ISSUED .VI BUILDING USE Address 1533 W . L-1 IJC7W g'/a- / / City h �E c/YL Zip Code (-128,9. A dress I a s E . a 3 S' Sr, State License No.a�l bs 7 Class. 6-3 Co Owner FRCP GRAhAI ? w� City License No. 93$ Tel.No.-77a310,0 Aail ddress AP-30 W- Li.Vitt Q NUMBER TYPE OF FIXTURE OR ITEM FEE w11 ek 4at , b -/dll nn od O Bathtub City f Tel.No. -r Laundry Tub or Tray I hereby acknowledge, that l`have read this application and Automatic Washing Machine state that the above is coitect and agree to comply with all City Ordinances arid'State.Laws regulating plumbing. Shower I certify [heal Ijptissess the above valid State of California class'. Sink, Bar ficatioh,orgl am the legal owner of the residential property de- !Y Sink, Kitchen scribedtabove. W Wash Basin(Lavatory) w/11 I certify that I have obtained a permit from the State Division of 1 Water Closet(Toilet) i\ \\ , Industrial Safety for excavations,other than swimming pools,five O feet deep or deeper and into hich person is required to descend. CC Drinking Fountains ,t('p `' {,L''" _ ( �1 ,,/r / �,rr CL — Signature of K44 ,J (lam tha T�114s PLin p/ Floor Drains _*1 " \f ? Permittee ��tN�..YYy`wwv ,DI Z Interceptors 1\J I�` = Receptors .. / '. >v INSPECTION RECORD S Sinks,Commercial-or lndustrihl Sinks, Floor .,nm W. l m Sinks,Servide \r», - 5 Swimmini`Pdoi CC W `_ Urinils) r a. 'L' Dishwasher CC 3\-,Garage Disposal D Water Softener u O I Water Heater and Vent ti CC ♦ A ›- Gas System ...Outlets... 1 „ P P R O V M LS Roof Drains N Water Piping Alteration INSPECTOR DATE I Backflow Preventer U/G Soil 1 i- Lawn Sprinklers(Res or Non-Res) U/G Water 1 Property Sewer.. . Feet Services—Water 0 Gas E I Solar Piping _Rough Plumbing Cesspool,Septic Tank Sprinkler System Sewer Cap Gas Miscellaneous Property Sewer Pool Receptor Filter System Sub-Total Pool Heater Reinspection Fee Miscellaneous Processing Fee J2 OT) I Final Gas TOTAL FEE I I Plumbing Final 1-4.,O t --2/@(J Utility Co. Notified CMF 0450-46 BLDG. PERMIT NO. AAL U