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HomeMy WebLinkAbout124 23RD ST - Building Permits AgOR ns6aLONn: `129 23RD ST DNE CITY OF COSTA MESA - BUILDING PERMIT 11 01NERS1 . ;OWN GEORGE & CAROL KORNIEVSKY PERM NO: P 084216 '''' 18'881 VON KARMAN #1260 IR CA 92612 PERMIT NO: P 084216 PLAN CHECK NO: N GOVT: N SUPP: N 714 ) 724-0891 APPL.UAl1NCADDRESS ARMAN CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH ARCHRECT ORENONEEN UC NO.: (,JOB DESCRIPTION : GAS REPIPE, ADD WATER HEATER - SQ FT: MICH.OR DOflA ENG'S DDRESS: DMT: CONTRACTOR'S Oki{ CLAIM VALUE: CALC-VALUE: GROUP OCC: R-1 / `' p� CQRRACfOR4 YMLINO COMMENTS: X ADDRESS: UC NO.: V ****************************fE1E*-0f***lfdEfE3kdf***if **1k****iE***lElhiEdfiffE****7E1E3E1Eif****iE*** utit ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby earn under peaty d perryry that I em licensed under provisions d Chapter S SETBACKS (commencing with Section 7000)of Dineen 3 of the Business and Professions Code.and my license is in hdl fate and Wed. CITY LIG.No.: UC.CLASS: LIG.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING Dene: Catena": 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 of perjury that I am sump from the Cakadas License Law for the ',v°.mden.or rectareason(�any`sutrucwre.prior ensewa��. require the appessions Code:Any city licant formm such pr file a sigunty whkh rewires a °needd statement to construct,wMoor, she PARKING REQ: PROV: PARCEL: 43942103 ZNE: REF NO: 'tensed pursuant a the provisions d the Contractors License Law(Chaps 9(commencing with Semon 7000)of Division 3 of the PLANNING NOTES> mess and Professions Code]or that he or she is exempt therefrom and the bate la the alleged exemption.My vlelelen d Section > -,p1,5 by any applicant la s a petted kied. applicant to advi penalty d o penalty dna more than Ewe hundred dors pow *********************************************jEiE3f*jElElf#i(-iEltikiEyEikiEiE3f lEiE1EiFNiFikjEiFiEitiE El I,as owner of the properly or my employees with wages nthei nate compensian.wit do No work,end the stupors is nor sanded or offered for ode(Section 7044,Business and Preen sCoe:The Connectors License Lew donnas appy to an inner property DEVELOPMENT S E R V I C E S,. , REQUIREMENTS who bolds or inprovea thereon.and who does such work tel insor hersel or tuotpt he or he own employees,Provided that such impmanerds re not Welled or&flared la sale.I.however,the building or inproverned a sold within ane year d completion,the - g( owneraadderwWhave the budendproving he a she didm bbd or Warw.fathe pumse of sale). ZONING APPROVED BY DATE: r e eI,as owner of the property.am exclusively contracting with licensed contractors to catnap the pond Sedan 7044.Business and ' Protests Code:The Contractor L ease Law don not apply lo anownerdpopsywho• '• • atprwn thereon and who BUILDING APPROVED BY : - ' .- DATE: .-: comma,for such projects wall, .. •own*own*rfceneed pursuant to the Contractors License coJP mma,am eexemptorder ern B.AP.C..for this reason:reason:en: APPLICATION ISSUED BY: \ DATE: i LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N I do . :. can 14 I am aware. . .understand I - ,•uirem. • . CaliforniaCaliomia Safety Cale Section • .25535.and and the Mare b ildvp occupant will/ • not(circlete oneneed to n h said tete codes and the •• eras for a ala.. . . anaddretionhmlhaAie1'yretagenwaDiana. •enapl n—aare ImmNw BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING " ' PERMIT 25 . 25 Date: Applicant: • 2 5% SM I P/NON-RES WORKE'S OMPENSATION DECLARATION:I affirm under penalty d perjury one of the following declaration: PLAN ❑ I have and willmaintaincertificate acertificate of.. . to sea4a nn for wakecompensation, d s' as provided for by Section 3700 the Luba ISSUE FEE T 22 . 00Code.for the pedamarcedgawork la re . thispmbesued. BUILDING-DIV > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE o I have and wlmanua worker'comprdm• imaace.as naked by Soot ices 3700d Ne Labor Code.ter 0s asterisms of the TOTALS----> 25. 25 22 . 00 0 . 00 47. 25 47. 25 . 00 work for whin Nis permit is issued.My workers'compensation insurance tenor and policy number are: Cam REVENUE DIVISION TOTALS--> COLLECTED: 47. 25 OVER/SHORT: . 00 Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK a seaion need not be completed I the perm]is for as hundred doges(6l00)or less.) 47. 25 ❑ I certify Net in the performance of the work for which this penal is issued,I shall not employ any person in any manner so as to becomeaubpp to the workers'cess,ersabawe d California.and agree nor u l should beams skied to the workers' compensation provisions d Section 3700 d the Labor Code.I neo forthwith can*tan Nos pac ******************************************************************************* Date: Apgiunn INDIVIDUAL F E E BREAKDOWN Warning:Failure to noun worker conponsauon coverage is unlawful,and shall waded an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST cMl fines up to one hundred thousand dollen(SIwi000A In addition to the cost of compensation demean as provided ler In Section 3706 of the Labor Code,Interest,and ettomeya fees. PLU 1 WATER HEATER AND/OR VENT 11 . 00 11 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penny of perjury that there is e conanali n lending Cenci ter the PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5 . 50 5 . 50 performance of the work for which this permit is issued(Section 3097.Cie.C). PLU 1 GAS RE-PIPE 8 . 75 LENDER'S NAME:r- 87 5 LENDER'S ADDRESS:1 END OF FEES I certify that I have read Nis application and slate that the above information is cored.I agree to comply with ell city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. GEORGF KORNEIVSKY ©9-13-1997/81:49 N1/947.23 Print ,a,i \ ^ /01:4861-6610719 Date: k."/( ]f•-- PERMIT:084216 /J Signator ddwm/ApenVApphcent/Conit (5151d6.1?) Whit Mg A Soley:Oman-Fite:Canary ;Pink-Revenue;Goldenrod-Assessor ` CONSTRUCTION AND PLANNING POOL 'PA 1 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 ,i 3. Electrical Conduit Utility-Undrgrnd. •, 54. Forms 4. Electrical Conduit-Undrgrnd. '55. Electrical Bonding 5. Steel Reinforcement 7 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, 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' • 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 1• 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof'Framing - , 73. Undergrnd.Storage Tank 0 Gas 0 Oil • 25. Roof Sheathing , 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric r Notes: ' 34. Final Heating & Air Conditioning 35. Etna!Gas Pipe-Test • , 36. Hood or Canopy • ^ 37. Final Factory Fireplace 38. Final Plumbing 0���/� 39. Water Service-Final ` / 40, Gas Service-Final • r • 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 Si24/41• 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF MALM0: 124 23RD ST WIT: CITY OF COSTA MESA - BUILDING PERMIT I ONNERSR4YE IpIWOM71: PENJOYAN, RICHARD G TR PERM NO: B 083721 M ADDRESS: 17321 ROB ROY CIR HUNTINGTON BEACH, CA 92647 PERMIT NO: B 083721 PLAN CHECK NO: N GOVT: N SUPP: N APPL.MMUNOADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESHAETH & REROOF W/COMP, SHINGLES SQ FT: 2, 500 MCH OR ENG.'S ADDRESS: UNE CLAIM VALUE: 2, 500 . 00 CALC-VALUE: 2, 500 . 00 GROUP OCC: R-3 / CONTRACTORS NAME: CONTRACTORS MMUNG COMMENTS: SMOKE DETECTORS ARE REQUIRED ************************************************************************3:****** ADDRESS: UC.NO.: UNE ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full face end effect CRY LIC.NO.: UC.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN Dale: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I em exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city a minty which requires a permit to construct.alta.improve. PARKING REQ: PRO V: PARCEL: 43942103 Z N E: REF NO: iemolah,or re any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she S I.,--- licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Seion 7000)d Division 3 of the PLANNING N T E..�- i .usiness and Prdessbns Cade]or that he or she a exempt tnweirom and the basis for the alleged exemption.Arry violation of Section > I 7031.5 by any applicant for a permtsubjects the applicant to a civil penalty of net more than the hundred dollars IMOD. 'N'3('*iFjf'IPiI1Ed(1('dEj( lE'1(' '1f'% ?EiF'141EjFd!'1E*'1E'1E'IF'1P'1(k3E'1E'lEjfdh'1E'%3Ed4'7f'1hj4'7(1f'N1h#'%'1EjF'1E?hjh3(-j6'M'3t'7F3t'Ih'%'1Ej6d( M% NX'4'kifj('-k'1F'!f?Ejk-1E n I,asowner o the property or my employees with wages as them sole mm compensation, d n,win da the work,and the and intended D E V E ',L 0 P M E N T SERVICES REQUIREMEN (I' S or offered for ale(Section 7044.Business and Professions Code:The Contractors License Law does nen apply loan owner of property who bolds 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 a offered for sale.If,however,the building orinproyemen is sold within e yew o 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). ❑ I,as owner o the property.amexclusively centractmg with licensed contractors toconstrue the proied(Sednn 7044.Business and BUILDINGAPPROVED BY : DATE: .^ Professions Code:The Contractors License Law does m property with to an owner of propewho builds a improves thereon and who for such projects with a centrada(s)licensed pursuant to the Contractors License Law). a .xecunderse000n. B.BP.C.,lathiss rpewnAPPLICATION ISSUED BY : 4• DATE:. -\ V`3J ** ** ******** ** 4 dEgyp ;��rx- • . • 4* : >F**** Owner � `' \� V"� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y certify that I am aware of and understand the requirements of Cal'Loma Health and Safely Code Sections 25505,?col',and 25534,and that 1 or any future building occupant vita/yid!not 0:bob one)need to comply with said mawcodes and the requirements fot BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for construction of modification man the Ai Ouakty Management District.Residentei construction applcelkxa am exempt from these PERMIT 74 . 75 . 50 provisions. Done: Applicant: SMIP/NON-RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury OM d the following declaration: ISSUE FEE ❑ Ihave and MIm°intenecet3lcaedconsent tosdf4rwure for workers'compenWion,mpro dedfobyStlion3700othLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE the aa eoftewakr«which rhmpermit peeMa. TOTALS----> 75 . 25 0 , 00 0 . 00 75 . 25 75 . 25 , 00 ❑ I have and oil maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the pedomwre of the work for rAids this permit uee.My"v`I"re`amp"h'etion ins«an"`a`rie`and policy`u"mbe`a": REVENUE DIVISION TOTALS--> COLLECTED: 75 . 25 OVER/SHORT: . 00 Poore: Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK masection noel nor wcompletedrrho pomeifor one hundred dollars moo,orless) 74 , 75 . 50 ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any penin in any manner so as to become subject to the wolrrs'compensation awe of Callomia.end agree Net d l should become abject to the workers' ******************************************************************************* compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with those provisions. INDIVIDUAL F E E BREAKDOWN Dale: Applicant: Winning Fallen to secure workers'corperustlon coverage Is unlawful,and shall object en employer to criminal penalties end TYPE QTY DESCRIPTION UNIT COST TOTAL COST civil puns up to one hundred thousand dollars($104000),In addition to the cost of compensation,damages as provided for In Section 3709 of the Labor Code,Intend and attorney's lees. SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 500 , 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction fending agency for the END OF FEES performance of the work for which this semi is issued(Section 3097,Car C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and slate laws relating to building construction end hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. PEGGY PENJYAN 87-14-1997/18:19 AI1/f75.25 v: - Dae: 1l1y14l PERMIT:083721 igne r ' _ °nt/Applian .C.4-11/4-----tractor \ (515146 WP) While-Building 8 Solely:Green-File:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor - 4 CONSTRUCTION AND PLANNING POO. JPA 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 I 65. Electrical-Final 15. Rough Electrical-Conduit - • 66. Solar System-Final 16. Rough Electric Wiring • 67. Fencing_& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - - 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning- -' FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing Z7-q7 �'.(rf,{L 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat I I .r 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 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. Backf low Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING '7^sq �c_� - 4&. FINAL PLANNING • - , 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51: CERTIFICATE OF OCCUPANCY No. Date ` 926 2 7 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT TRACT NO. LOT NO. UNIT N6. CITY OF COSTA MESA cCONSTRUCTIOCN/PE/R� c • - 3614 3/09/B7 5.00 TL Projn ,address 1 .T G E . 23 ''II `` JT-`�P�e.. A 7 10/0 - Appl�nt's Mailing Address j S33 W Lt nev'n TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR ' -"egg ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone Owner's Name^ - - L. I ��/'sm -RA /- ll OD DESCRIPTION OF WORK/USE OF BLDG. Address Qa. D ?•'k t 1101 eu) C,1 Q . -RA I1 r Z�31 S Main Building: Accessory Building: . 2 Arch/Eng. - - - -License No. TYPE OF PERMIT ❑ GRADING al/PLUMBING FOUNDATION U STRUCTURAL T Front 0 Address n ❑ TENANT ❑ ELECTRICAL l/PLUMBING ❑ MECHANICAL B Rear N Contractor's Name lQ I�1 1`5 Plb5 c. phone�7��47v ❑ 'OTHER A C Right N Address(mailing) I ' 33 Ckj . --I`t1Co n PROJECT DESCRIPTION SQ. FT. OCCUPANCY K g - �,Q CON ST RUCTION TYPE VALUATIONS S Left G City License No. •v / ZONE GRADING CU.YDS. ACRES • R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: �+ M f with section 7000) of Division 3 of the Business and Professions Code,�tl RE EIVt❑ � Z T • A • y _` my license is in full • ce . • effect. ft MC v ria s-s0 ' License Cl.ss - L ense No. — aF. S i Date - . it Signature 4.i.. . o. L a. AS /t d PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate iof Workers' Compensation Insurance, or a certified copy thereof (Section , 3800, Lab. C.) pp ''`` Q� - _11^^��+ Backflow Preventer Service Sink Automatic Washer -Transformer ❑ 15-50 KW Policy No. Q�T�40 Company-1 en tie � �Y U ' Backflow Irrigation Sewer Ca ❑ 50+ KW Certified copy Is hereby furnished. p Construction Pole Sub. Certified copy Is filed with the cityr�Building Qlvll}ion/. (! Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Z'tts^fl Applicant Y-Can- LC* /O. 'Cl fele. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher ' • Meter Dover 100 amps ' (This section need not be completed If the permit Is for one hundred ($100) or less). - Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel I certify that in the performance of the work for which this permit Is issued, I ' shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank . Workers' Compensation Laws of California. ' - Motors 00-1 HP ❑1'h-8 .Date _ Signature - Floor Drains - Swimming Pool w/Spa F.A.U. - ❑9-15 HP 016-15+ NOTICE: If,after making this declaration, you should become subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet • Device Boxes I hereby affirm that there is a construction lending agency for the performance' - ,t Pole Light of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors I Water Heater 26C Outlets Ran e Lender's Name 9 • Lender's Address Kitchen Sink Water ServiceSwitches Sign OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or Auto-Wash Garbage Disposal ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Com actor ' any structure, prior to its Issuance, also requires the applicant for such permit P to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ' the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section , ; *7031.5 by any applicant for a permit subjects the applicant to a civil '$penalty of not more than five hundred dollars($500). I ' ❑ I,-as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not intended or offered 1 - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL - FEES - License Law does not apply to an owner of a property who builds or improves _ thereon, and who dues such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I ❑ ZoningApproved • sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II 0 pp roveBy Date prove the owner have the burden of proving h¢/she did not build or im- Duct-Under Ground Building Approved By Date prove for the purposewill of sale). ❑ I, as owner of the property,am exclusively contracting with licensed cane Duct-Structural Refrigeration System Application Issued By - Dat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who ' Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ _ PERMIT ❑ I im exempt under Section B.8, P.C.for this reason Firepl/Fact.Blt. ICBO# Fire,Dampers PLUMBING $ •cc ISSUANCE $ Date ' Owner • Heating System&Ducting Registers ENERGYP.C. $ PLAN CHECK 25% $ / I hereby certify that I have read this application and state that the above ❑D-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- - MICROFILM $ I sentatives of this city to enter upon the above-mentioned property for PLAN CHECK 50% $ inspection pu oses. I Signature W Ct &• Date . Us 9,7 MECHANICAL $ TOTAL FEE $ 57 ° Drivers' License or SS Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ `t CMF 0865-46,rev. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor - - - - ,CONSTRUCTION AND PLANNING POO L,&SPA #PROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector t. 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-Untlrgrnd. 55. Electrical Bonding • 5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TOCOVER-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 111 Property Sewer Line & House Connection _ 62. Backwash& Receptor-Final 12. Sewer6Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20: Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 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 - /1/497P� 1,PC 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 1 - 44. Landscape Irrigation System;-,� 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ;"r"• 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - - • No. Date . . . City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY N? 1916 C P. 0. Box 317 Costa Mew, California • ' The Building located at la vett nrd Bt's. A. S. C sad. D has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 8 ail Occupancy. Use of Building TAiWD3n Readout* lettb riettirted Canute Legal Description AIP,WD. 119.011.12 (See reverse side for Metes and Bounds) Building Permit No. 2C411 Electrical Permit No. 2121+56 Plumbing Permit No. Floor Load Signs have been installed as Room Capacity Signs have been instaled 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 101W and/or guest rooms ISSUED TO: Building Official B. W. Barna Date 6 Vara 2111 19 ► 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 au34-1at-11-63--S-B P OWNER BYRUM, E. W. DATE AUG 2 2 1963 <4JOB ADDRESS 12 E. 23rd Street, A-D BUILDING PERMIT NO. • 1 !]{ J GENERAL CONTRACTOR Owner-Builder VALUE § 44,202.00 AP No. J19-011-42 LOT TRACT FIRE ZONE 2 DESCRIPTION OF WORK4-p]ex.Res. ,Det 1INSPECTIONS Signature DATE GROUP H&J TYPE V ZONE R4 Gars H Soil ,C,C,L_ ,,, ,,76_3 PERMITS ISSUED ,`Il SUBCONTRACTOR DATE NUMBER p Wattr t l a• by �, Rough Com. efrig. ❑ Air Cond. 0 Rough Heating I,. / G• -JO-¢3 it 4.---2 -- /0- )-G3 ..77os — Rough Plumbing , ///g /0'12-6.3 .G(` ..ate-Zc-a,--- re-773-V 3 9.2 Y e-(v/ f, Miscellaneous • -/ ' 73 ` .J1 11 J.V., . . . / ��--.. /- 4 - c Se 52/6/ it Prop. S . Line pg/House Con. •71St. Swr. ❑_:_- - -61-e3 9-4—‘ 3 Yo o o d -,,./ Sprin ng-9pde - f ,.i,�_ _ .wr: � —-! --4-$ 4 r- c_. /" Construction Pole Nr: tfaigi La-t2-BQ - SW ,p-.7.1-c 3 20 a6 I2/14 Underground 0 Power ❑ Rough Wiring i , ' f0•1443 -7,,,,,,, . 9 op 7-L3 c,-7/ .T6 ( S) - Trenches❑ Forms 0 Steel Reinf. 0 3 1 e- 9- . — C� ,rs' Floor System _ e- �_C} - „/(' I Bond Beam 0 Steel Reinforce 0 • IL ' /, ' a Sheathing �fl1t- 0 —// /C�s V' lv 1 .,1. Frame and Fl �£ 94 �. - C 3 , „ Lathing—In Out ,, Plaster, brown coat Ijyyy7 // ..5-/Lt 7 G3 Refrig. 0 Air Con. 0 Final Hes**r/ Final -/ /-J..1/� / Ple,I,- g Fixtures, Final /.2/-{,y ��/// 1 Final Gas Testt/�s;,ao Act,.g1..er-snag `/� lq..,-, e1� �ry,'' 7 `� Electric Fixtures, Final Y/'.� /�z,e 41 // Building, Final �.'�-%- /- OCCUPANCY et7 3 //,L/ Form BU4-6M-3-63-S-B P '"oT.n .MR SpEPTAT. REQUIREMENTS 201411 (4,0 ler! 20411 COSTA MESA BUILDING-SAFETY DEPARTMENT - P.O.BOX 917 COSTA MESA,CALIFORNIA I FEEl yR�1nnE�t�44C�EIVED For Applicant to Fill In Completely AU�PPLICRYION FOR PERMIT TYPE OR PRINT ��// A F yNI� ADDFS /RV 2 Sod 3'4r. at ..fY Ob1r]�r�(P'V r) ITIEJII IY RECEIPT NO. ,12,7 ry0/ COSTA MESA, CALIFORNIA Q/7/ II " fr/ D TE ECEI ....2 TE SSUe fj za-t' adr . // CIN • /0 NO/.4//!1 c �-_. . :/1 I ARCHITECT /�� TEL. G '" _�fi - DATE j-.22�"b' OR"•'GINEER VI NO. � ZONING - L AD ..c55 ca./re/10 �� P•rvf ��''II w // +V ✓ � � CONTRACTOR (/ vr - Rs. 04r-, v • G' O Fne 19Y)0 7-12 o O DEGRIPTION)J ADDRESS /� / / /), CITY • A.P.NO. 1 i S — �/f ` [ _- L/ z____ NOTE: NO HAVE OVERHANG SHALL BE LESS THAN STATE TEL. 90'TO SIDE&REAR P.L. LIC.NO. NO. EAVES NO.SIZE OFN;OT' b ALLOWED (U.B.C.REQUIREMENT) OF LOT 6 6 X l 3 L YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. i (FROM C/L�S3 EET) SETBACK LINE FROM 1,..m.. FRONT•♦y C Fr. D FT, CENTER of STREET T J REAR YARD / J'� P!. r 1 R.SIDE ! 4 FT. SIDE YARD LEFT ! I RIGHT e� DESCRIPTION OF WORK L.SIDE` ' FT. . 161 SFT. NF ALTERATION ADDITION - REAR 4,7- /F7. - O FT. DISTANCE BET. BET.MAIN& REPAIR MOyINO DRMOLISH MAIN SLOGS. _ACCESS.BLOCS. tan.- 760 A VAR.# DATE BUILDINGh NO.OF SIZE rd./< 4 ROOMS 77 STORIES -2 C.U.P.* , APPROVED EXTERIOR WAL Ni°Od ROOF APPRO • ,�1� /,r -COVERING C )I COVERING G - BY L'l. ,� 1AAA DATE V �/ +' '•/•� ,/ / / -. i Y _ = • ^II I I : .+91 it1A i14•1 i t 1IhlL1� .1 /Y!/f i -N O/Q�tl ' Ace r(A8.n_, (�o`4 C�tL • S LG. D "Val x'44.4 SS f N /d O.2-so.FT. of 74;lO v 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. 0 PLY WITH ALL CITY ORDINANCES AND ' TB LAWS REGULATING VALUATION /�r p BUILDING CONSTRUCTION. PERMIT FEE $ SIGNATURE OF D PERMITTE ,ory ��� $/ S ., 0 AUTHORIZED AGENT i / 2- C TOTAL FEE