HomeMy WebLinkAbout2941 GRACE LN - Building Permits I i ;/
ji L!m. . CITY OF COSTA MESA
\@ BUILDING DIVISION
>4:
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
C[] 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 workprs'compensation Insu nce carrier and policy number are:
Carrier: 51A - &(tih� Icy Number.,-- 2.` 9
(fps section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Secttottll 3700 of the Labor Code,I shall forthwith
comply with these provisiJne- /ly ,X, Dere:----�.•Q. 1/ g /0
APpkcenLSlgnature:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN AODMON 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
fo ce"end effedb-Lic.
# 5-1)0 S6t-clesy g G(0
Oont acrors'S�fghitiTh-l (J On PA-4.'5 cpAe{7r' 8—4 -o S
CONSTRUCTION LENDING AGENCY:
In I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI 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 Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration Corm for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 1:1o ❑
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)?
No
(Section 25534 of the Califomia 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 Califomia Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? a 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 prescnbed by California Health and Safety Code Section 42303 been made? ❑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 COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/p.n. n✓ "l p ignature Of Legal Owner(s) r/
/gDy4D s_
/' A`&OrAuthodzed'Applicant. LDaate, � •
coos I MSPEcTION TYPE PEE BMW ODE I IN PECTION TYPE PATE. MOW
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -.
200 Final Re-Roof 210 Final Electrical %1EWS
201 Final Block/Retalning Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
t 08/30/2005 00:21 7148713744 JCE INC \ P7aGE ii," P
' •.. (OF COSTA MESA.BUILDING SAFETY DTVI: 1
POST IN CONSPICUOUS PLACE ON THE JOB
NOTICE
Schedule inspection one workday In advance.To schedule Inspections.call(714)754-5626.Provide the following information:
1)Permit number,2)Job address,3)Inspection item number.
-
emlmes merest 0rr
11 C11--41 _• Lk) 13 owe i, W-TJ1 Lit .
enures Parra e. sone pemmt.-Etq--ZOO 5 4) _Cantor 30hrl Ghri-vyh-tr G Itt�}r,L i•
Ikehanral Ramata Plumbing Pewit t Jab Onapkn
hew ACO K*vy - rgors ionic DErntsa g[ telly N71,�ra/�4_."jd-Jlj,<-, F4'+n.41 -I4o 2[Jvf�-
PERMITS EXPIRE✓ 180 DAYS (6 MONTHS) FROM ISSUANCEJ _ OR LAST INSPECTION
CONSTRUCTI. APPROVALS
u.me STRUCTURAL Dal* wp.nmr Ib.re POOL BSPA Dm Impact
3 Job Site Consult 94 Pool&Equipment Locatbn -
4 FooengsAlter Ground 96 Steel Reinforcement
6 at 100 Electrical Bonding
8 Structural Fbor 102 Rough Plumb 8 Pressure Test
11 Pre-Inspect Roof 104 Approvalto Caves-Ganes
12 Root Sheathing 106 Else Conduit-Underground
14 T.Bar Ceiling-Structural 108 Gas Pipe/Underground Test
16 Shear Panel 110 Backwash Lines,P-Trap,
18 Frame&Flashing Underground
20 Leering 8 Siding 112 Approval to Deck
22 Insulation 116 Pool Plumbing System-Final
24 Drywall Waling 118 Pod Electrical-Final
26 Plaster Brown Coat 122 Fendng/Access/Alanns Approval
30 Pre-Grout 124 Approval for Plastering
33 Disabled Access 126 Pool/Spa Systems•Final
FIRE DEPARTMENT APPROVAL
1610 Overhd HydrorOverhd Rough
1612 Dry Chemical
1614 Dry Standpipe
ELECTRICAL 1616 Final-Fixed System
36 Ufer Ground
38 Flee Conduit-Underground FINAL INSPECTIONS
44 Rough Elec-Wiring (M.st be completed prior to requ.sling occupancy.)
46 Rough Elec.Conduit Call(714)754.5626 for 1M following: on hepsce&
48 Dec T-Bar Ceiling200 Final Re-Roof
50 Sec Power Final [9915e/s- 201 Final Blodrt7etaining Wall
51 Temp Power Final 203 Final Sign
204 Final Demolition
206 Final Mechanical
208 Final Plumbing
PLUMBING&MECHANICAL 210 Final Electrical S
pi
52 Soil Pipe•Underground Call(714)327-7400 for the following: OM Inspector
54 Water pipe-Underground 2121 Fatal Fire Prevention
55 Underground Gas Call(714)754.5671 two(2)working days DO EnpiM.r
62 Rough Plumbing prior to 011111.
63 Prewrap 2161 Final Public Svs.Dept Approval
64 Rough Mechanics Call(714)754.5245 for the following: Deb Inspector
66 Rough-Factory Fireplace 2201 Final Planning Approval -
68 Sewer System Call(714)754.5626 for the following: DO i aVsaer
72 Gas Pipe-Rough Test 222 Final Ste
90 Gas Pipe Test-Final 250 Final Buildmg/Oavpancy
92 Waller Service-Final
•
NOTES: SEE REVERSE
055945 Inv.11WI
'08/30/2005 e:21 7148713744
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Fax number: 714 754-4856
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From: Chris Rankin
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Fax number: 714 871-3744
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":,G' : Date: August 30, 2005
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Regarding: 2941-B Grace Lane Costa Mesa
Number of pages: including cover sheet 2
Sa .
, Comments:
. -
-,
;2, i.).i•
.,. John Christopher Electric, Inc.
,;. 717-F S. St. College Blvd. Fullerton, CA 92831
-.: Office 714 871-8895 Fax 714 871-3744
jcelectricasbcglobal.net . : f
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1* 40;",'il,5:P tig41-707:4:1%."',,-;1. 4,KO 5; ".3' . ..45 '4::1,t,i•CIF
;1114n. r
�c., CITY OF COSTA MESA
1- 4 7O;1-7-:' *!)
,04 BUILDING DIVISION
• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4I . .../.. PERMIT
/B00-01689
4 wn 4• V
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.thLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2941 GRACE LN Status: ISSUED
Suite: Applied: 10/18/2000
Vicinity: Issued: 10/18/2000
Parcel Number 14122116 Zoning:
Applicant: COOTER, LYLE ISSUED BY:
411---
Address: 23261 DEL LAGO
STE 5 Phone: (949)583-1858
LAGUNA HILLS, CA Zip: 92653-1330
Owner LICATA, LUCILLE E TR
Address 162 N GLASSELL
Phone:
ORANGE,CA Zip: 92866
Contractor: PRO-TECH WEATHERPROOFING
Address: 23261 DEL LAGO
STE 5 Phone: (949)583-1858
LAGUNA HILLS, CA
Zip: 92653-1330 License: 620476
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O EXISTING BUILT-UP CAP SHEET ROOF&REROOF WITH GAF BUR. 125 SQ FT.
' FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $14,500.00
Permit: $251.25 . Claim Valuation: $14,500.00
SMIP Res: $1.45
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: • $252.70
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'
NOTES:
/
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
.4 o
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.I have and will maintain Insurance
nte compensationrid poli y as required are: 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.)
O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. r.
2
��
Applicant Signature: Date: YD
WARNING:FAILURE TO SECURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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.# — Class#
Contractor's Signature: Date: /r1 /O zo 0 o
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: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O 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.).
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license, 0 Yes 0 No Driver's License No. _ _ Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
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 tile and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap.ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required far the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of L.r. •wner(s) Date
And/ "fIzed Applicant Date .
CODES INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
•
1266 Pool Spa Final // 208 Final Plumbing
200 Final Re-Roof /(W VO 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 • .
204 Final Demolition _ 250 Final Building/Occupancy
r
PROJECT ADDRESS: 2941 GRACE LN UNIT: • CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 051614 •
OWNER'S NAME: JOHNSON GERALD H
ADDRESS: 12365 rtRNANDO DR PERMIT NO: SB 051614 PLAN CHECK NO: 01208-91 S GOVT: N SUPP: N
SAN DIEGO, CA 92128 •
CONSTRUCTION TYPE:, PERMIT TYPE: SSTR SIG PURPOSE: OTH
ARCM/ENGINEER: REG.NO.: JOB DESCRIPTION : NON LUMINATED 8 WALL SIGNS SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 2, 120 . 00 CALC—VALUE: 2, 120. 00 GROUP OCC: B-2 /
PERMITTEE: DICKERSON SIGNS G GRAPHIC ( 714 ) 546-8150
ADDRESS: 2930 GRACE LANE A COMMENTS; X
COSTA MESA CA 92626 ******>ESE** ******** rF***** **#*)i*a.;?raF* ***)f****x. * ua<****Y*TF+r***>F***** ****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section SIGN INFORMATIO N
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. DISTRICT: 3 TYPE: WALL ILLUMINATION: NON CATEGORY: NEW
CITY LIC.: 009700 STATE LIC.: 3 151 q 7 CLASS: C 45 . DIMENSIONS: 1FT 00IN X 3FT 10IN AREA; 30, 40SOFT LETTER HT: 6
Date: Y/VV signature:_ STREET FRONTAGE 1 : 100 . 00 STREET 1 : GRACE' LANCE
WORKERS'COM ENSA ION DECLARATION: thereby of r that I have a certificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 : 0 , 00 STREET 2:
Compensation Insurance ora certified copy thereof(Se ion 3800, Lab.C). PARCEL: 14122116 ZONE; MG LOCATION > FRONT:: X REAR:
• PouCYxO.: 0638651-91 EXP. DATE: 04 /01 /92 BUSINESS NAME: MISCELLANEOUS > LEFT; RIGHT:
' COMPANY: STATE FUND OTHER TOTALS GROUND SIGN
❑ Certified c• y' hereb furnished. CR Certified cop is ••d with the city B Ming Division. THIS ACTIVITY 30 , 405 FT OVERALL HEIGHT; OFT 01N
THIS SITE 30 , 40SQFT GROUND CLEARANCE: OFT OIN
Date: q Apphcamu• • •
ITEMS OF INFO 1 PLANTER AREA: O , OOSQF 1
EXEMPTION FROM WI'KERS'COMPENSATION DECLAR'Hip! (This section need not be completed if the permit is for one hundred($100)or less). ITEMS FOR ACTIVITY; 1. BLDG SET BACK: 1OFT
I certify that in the pertormance of the work for whirl spermit is issued,I shall not employ any person in any manner so as to become COPY VERBIAGE MISCELLANEOUS BUSINESS NAMES ON WALL SIGNS — 3 . 8 SF, EACH
subject to the Workers'Compensation Laws of California. '
•
Date: Signature: PLANNING NOTES :
NOTICE:If,alter making this declaration,you should become subject to theWorkers'Compensation provisions of the Labor *' *****9t'*'''*'v`a('**'******Y'******************K******M*9'iE*1:****}.*,(.*}•*******j(.*..)E.}*.y.***)
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVELOPMENT SERVICES R E Q U I R M E N ') S
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(Section 3097,Cm.C). ZONING APPROVED BY (L DATE; /.. ..1L_
•
LENDER:
ADDRESS: BUILDING APPROVED BY : DATE:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason APPLICATION ISSUED BY; LM,� DATE; L�^L _J,��
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or **************************ifa?tIrT ir'-£ ii�iF'3FF**iF irir 3E*K1F***#**Te£' a:.**V,.******3! 'A.. iE'ir•3.`, **,
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SNIP/RES GRADING
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the PERMIT' 54 , 00 30 . 40
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law SM I P/NON—RES
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through p LAN 35. 10 •
x his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or ISSUE FEE • 50
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS----> 84 , 90 0 . 00 35 . 10 120 . 00 120 . 00 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware REVENUE DIVISION TOTALS--> COLLECTED• 120, 00 OVER/SHORT: . 00
that proof of their Worker's Compensation insurance should be provided to me. BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
❑ I am exempt under Section: B a P.C. 54 . 00 30 . 40 . 50 3 5. 10
for this reason:
***************)F***M'*)****X*a:******k*3E*-*ii.*********** **K*************.*..k*:t*****
Date: Owner: . INDIVIDUAL F E E BREAKDOWN
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
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 TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
these provisions.
NO FEES WERE SELECTED FOR THIS PERMIT
Date: Applicant:
I hereby 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 state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for i speccioion pur ses.
Date' / ! / Signature' _!'.' 2' CGGr'& i:p_.a:'.I.5 -
Driver's License or Social Security a: Ce-Tr.: 0:—/C7,91 Ili:• 1" .1
1641-06 White—Building:Green—Code Enlorcemem:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •
CONSTRUCTION AND PLANNING & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 4.47•1( &VI 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
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
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 6. (- 64.16,
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
411,"AUTOMATIC" SPRINKLERS of the PACIFIC INC.
-..•r - EXECUTIVE OFFICES
720 WEST 17th ST.
manufacturers / engineers / installers COSTA MESA•CALIF.
of approved fire protection devices LIBERTY 8-3445
SPRINKLER CONTRACTORS' INSPECTION OF
SPRINKLER EQUIPMENT AND UNDERGROUND PIPING SYSTEMS
This Inspection should be made by a representative of the owner of the property accompanied by a representative
of the contractor. This blank should be filled out during the inspection. It should be signed by both in triplicate, one
copy to be kept by the owner, other copies to be sent to Superintendent of Installation for distribution to proper Inspec-
tion Division. All defects noted should be corrected while the contractor's men are on the ground.
It-Is understood that the signing of this report by the representative of the owners in no way
prejudices any claim which they may have against the contractor for faulty material, poor workmanship,
or failure to comply with the requirements of the Insurance Companies or Local Ordinances.
PROPERTY OF DATE
11 Vii .& ��ril L Q �� /:, I _
STREET
-?-1VI G K t- N t
CITY STATE OR PROVINCE
SUBMITTED FOR ACCEPTANCE ACCEPTED BY (ORGANIZATION) DATE
PLANS [-44 f NO
PIPE SIZE -TO PE AND CLASS OF PIPE USED
UNDER— ,-i / -/
GROUND f / IN.
CONNECTIONS FROM
YARD MAIN RrUBLIC MAIN A) /- , 1 / /•/l i I / j
PIPE AND TYPE OF JOINT ARE ALL FITTING6 ' HAVE PROPER CLEARANCES BEEN
FITTINGS 1/) �1 I fir/PROPERLY STRAPPED ,./re-
YES 0N PROVIDED AT WALLS AND FOOTINGS, [ YES ONO
OR BACKED AND AT FLOORS IN EARTHQUAKE AREAS
NUMBER INSTALLED TYPE AND MAKE - ALL PROPERLY SET
0 YES n NO
HYDRANTS PROVISION MADE FOR DRAINAGE ALL OPERATE SATISFACTORILY
I IYES 0N DYES ONO
Branches from existing or new underground mains to inside sprinklers shall be flushed out thoroughly before
connecting the sprinkler riser. Where an outside underground piping system, constitutes a part of an installation,
such system shall be thoroughly flushed out under pressure at recommended flows through hydrants or blow-offs.
It is the responsibility of the contractor installing the sprinklers to make certain that underground piping has been
thoroughly flushed before connections are made to sprinkler risers.
A flow of at least 150 gpm. shall be established in 6-inch lines and smaller, a flow of at least 1000 gpm. in an
8-inch line; at least 1500 gpm. in a 10-inch line; and at least 2000 gpm. in a 12-inch line.
HAVE MAINS FOR SUPPLY TO NEW CONNECTIONS BEEN
THOROUGHLY FLUSHED IN ACCORDANCE WITH THE SPRINKLER RULES O YES ENO
UNDER HOW WAS PLOW OBTAINED FOR FLUSHING MAINS THROUGH WHAT TYPE OPENING OTHER
IIORBRESERVOIR' TANK FIFIRE PUMP nHYDT. BUTT E OPEN PIPE (SIZE IN.)
GROUND
HAVE LEAD-INS THEMSELVES BEEN THOROUGHLY
PIPE FLUSHED IN ACCORDANCE WITH THE SPRINKLER RULES O YES 0 NO
HOW WAS FLOW OBTAINED FOR FLUSHING LEAD-INS THROUGH WHAT Y-CONN. TO FLANGE & SPIGOT OTHER
FLUSHING 1�PUBLIC WATER, TANK, ri FIRE PUMP TYPE OPENING
IOR RESERVOIR OPEN PIPE (SIZE IN.) -
AND Hydrostatic test should be made at not less than 200 lb. for two hours or 50 lb. above static pressure where static
pressure is in excess of 150 lb. In systems with differential dry-pipe valves the clappers should be left open
HYDROSTATIC during this test to prevent damage.
LEAKAGE Underground mains should be tested before joints are covered. Water leakage through the joints should be
measured by pumping at the specified test pressure from a calibrated container into the section of pipe being tested.
TEST Care must be taken to expel all entrapped air and have the main completely full of water. Permissable leakage
per 10 joints per hour is 2 1/2 quarts for 6-inch pipe, 3 1/4 Quarts for B-inch pipe, 4 quarts for 10-Inch pipe, 5 quarts
for 12-inch pipe, 6 1/2 quarts for 16-Inch pipe, and 9 1/2 quarts for 20-inch pipe.
ALL NEW UNDERGROUND PIPING
HYDROSTATICALLY TESTED AT )l ',) LB. FOR HRS.
PIPE SIZE GIN. 8 IN. 10 IN. 12 IN. I8 IN. 20 IN.
NUMBER OF
JOINTS
TOTAL AMOUNT OP LEAKAGE MEASURED IN HRS. GALE. QUARTS
L . . .
BUILDING EQUIPPED NO. OF SYSTEMS NO. OF SPRINKLERS MAKE & MODEL
(TOTAL.)
WET IDRY ,
SPRINKLERS MARKING ON FRAME: DEFLECTOR: YEARNIGHTEMPERATURE NEEDED INSTALLED
NEAR UNIT
.SPRINKLERS IN
NER9
HIGH TEMPERATURE AREAS 'I"-" �NO HIRE nNO
BUILDINGS EQUIPPED ALARM CHECK VALVES FLOW INDICATORS(Vane type or others)
NEW ' NUMBER MAKE NUMBER MAKE
SPRINKLER ALL ALARMS LEFT IN SERVICE
ALARMS MAXIMUM TIME TO OPERATE THROUGH SYSTEM TEST PIPE MIN. SEC.
piYESNO
BUILDINGS OR AREAS CONTROLLED MAKE AND MODEL IS INSTALLATION OF DRY PIPE EQUIPMENT
NUMBER COMPLETE
INSTALLED TI YES nNO .
DRY
BUILDINGS OR AREAS WHERE QUICK WERE F. M. APPROVED TRIMMINGS PROVIDED,
PIPE OPENING DEVICES PROVIDED GAGES AUXILIARY DRAIN, ALARMS, ETC? I I YES I INO
VALVES ON DRY PIPE VALVES
TIME TO TRIP DRY PIPE WITH QUICK OPENING DEVICE WITHOUT QUICK OPENING DEVICE WERE SYSTEMS AND
VALVE THROUGH I -IN. MIN. SEC. MIN. SEC. ALARMS LEFT IN I I YES n NO
SYSTEM TEST PIPESERVICE
BUILDINGS OR AREAS CONTROLLED NUMBER MAKE AND MODEL
INSTALLED
DELUGE SYSTEM SUPERVISED OPERATION HAS AN ACCESSIBLE HEAT RESPONSIVE DEVICE I
DELUGE ❑YES ENO n PNEUMATIC 0ELECTRIC BEEN PROVIDED IN EACH CIRCUIT FOR TESTING Li YES nNO
VA LVES DOES DELUGE VALVE RELEASE MAXIMUM TIME IS INSTALLATION OF DELUGE EQUIPMENT COMPLETE.
OPERATE FROM EACH CIRCUIT ❑YES 0 N MIN. SEC. YES I INO
DOES DELUGE VALVE RELEASE WERE SYSTEMS AND ALARMS LEFT IN SERVICE
OPERATE FROM THE MANUAL TRIP [1YES [iNO n YES nNO
AND/OR REMOTE CONTROL STATIONS
Hydrostatic test should be made at not less than 200 lb. for 2 hours or 50 lb. above static pressure where static
pressure is in excess of 150 lb. In systems with differential dry-pipe valves the clappers should be left open
during this test to prevent damage.
SPRINKLER Dry pipe systems should also be tested at an initial air pressure of 40 lb. with loss not exceeding 11/2 lb. in
24 hours.
SYSTEMPressure tank tests should be made at normal water level and air pressure with loss not exceeding 1/2 lb.in 24 hours.
ALL NEW SPRINKLER OR WATER SPRAY
TESTS PIPING HYDROSTATICALLY TESTED AT ).. LB. FOR "o•/, HRS.
AIR PRESSURE AT WHICH AIR PRESSURE LOSS PRESSURE TANK TESTED AT
DRY SYSTEM TESTED LB. IN 24 HRS. LB. LB. FOR HRS.
IMPORTANT
BLANK NUMBER USED LOCATION ALL REMOVED
TESTING n Yes 1 INo
GASKETS
CONTROL WERE ALL VALVES LEFT WIDE OPEN DATE PROTECTION PERMANENTLY LEFT ON SYSTEM
VALVES uYES 1-1 NO
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO
INSTRUC— LOCATION OF CONTROL VALVES AND CARE OF THIS NEW EQUIPMENT: uYES pi NO
TIONS
HAS A COPY OF INSTRUCTION AND MAINTENANCE CHART BEEN LEFT AT PLANT? [H YES n NO
REMARKS
THE INFORMATION ON THIS FORM HAS BEEN EXAMINED AND THE INSPECTION AND TESTS HAVE BEEN WITNESSED BY:
NAME OF SPRINKLER CONTRACTOR FOR PROPERTY OWNER (SIGNED)
- o)1/f� i. . '4.A,
TLE
SIGNATURESFOR SPRINKLER CONTRACTOR (SIGNED)
w -2z-1-»
PROJECT ADDRESS: 2941 GRACE LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 062448
OWNER'S NAME:LICATA LUCILLE E TR
ADDREss: 162 N OLASSELL PERMIT NO: F 062448 PLAN CHECK NO: 01804-93 L GOVT: N SUPP: N
ORANGE,CA 92666
CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : BACKFLOW RETROFIT SQ FT:
PERMITTEE: CLAIM VALUE: 3,800. 00 CALL—VALUE: GROUP OCC: /
ADDRESS: FIRE CONTROL TECHNOLOGY ( 213)861-6666
9102 FIRESTONE BL R COMMENTS: X
DOWNEY CA 90241 ■*******4***+E*******+E�EEr�EEP�Er****�E+er+Err*+rr�E�E�E**�E**�Err�Er+E*r�E*******�E******�E*+E�E�E+E�E*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions o Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CITYLIC.:054833 STATE LIC.519461 CLASS:C-16 SETBACKS
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab,C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO,:W 2 710 2 41 EXP.DATE: 07/01 /9 3
COMPANY:CA COMP INI CO PARKING REQ. PROV: PARCEL: 41918131 ZNE: REF NO:
❑ Certified copy is hereby furnished. Certified copy is Bled with the city Building Division. PLANNING NO+ES>
jj... t' '� >
Date: AA 2- 1 9/ Applicant: rrrrr*rrrrrrrrrrrrrr*************r*r*r***rrr*rr*r***rrrrrrrr*r*rrr*******rr****
EXEMP N FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become
subject t the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Dat00l' Signature',
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: 6 /Z,
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency far the performance of the work for APPLICATION ISSUED B Y: — DATE: �L//
which this permit is issued(Section 3097.Civ.C). ********************rr*** *** * ******************************M.**** **C* ***
LENDER: ***************************************************************************r***
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,after,improve,demolish,or PERMIT 63 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
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70110)of Division 3 of the Business gJ 5 t SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 40.95
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 63. 00 0.00 40. 95 103. 95 103 . 95 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 63.00 OVER/SHORT: . 00
torthe purposeof sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63.00
❑ 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 ***,**********r*r.******r***********.*.*****r****************r*******r*************
That proof of their Worker's Compensation insurance should be provided to me,
❑ I am exempt under Section: B.a P.C. IND I V I D UAL F E E BR EAKDOWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: FIR 63 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1 .00 63. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit lar construction or modification from the Air Quality Management District.Residential construction applications are exempt from - ..
these provisions. WIC,
,
Dale: ivy air C • 215 Applicant:'/ '
I hereby 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 stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property I/o'i inspection purposes. �X r
Date;. (�7Z ' 73 Signature: e . a�
1¢�f/ • 01 00140328-00140328 TOT 63.00
Ori s License or Social Security x: ORITEA 06/02/93 TDIE, 16151
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POOL & SPA 1
Date (!Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit 0
r 1. Temporary Electrical Servicm or Poi2,; 52. Pool & Equipment Lccat.on
•
2._S`d Pipe-Undrq;nd,- •
_ 53. Steel Reinforcement I
r -t-x it - -: I --I
?3'EM$'Ctrical Condt1 it-lity-Undrgrndt'X 54. Forms
IJi Ef;-tinceI Condis-i 'irgr,d. _ 55. Electrical Bonding
�rL5.ix,el ReinforceSevt _ •�s < 56. Rough Plumbing & Pressure Test -
rn_- -n•
rfi<,w ren ca: UFEEfil-nd. Q, L _ 57. APPROVAL TO COVER GUNITE I -
-r;1Footngs
T 58. Electrical Co rduaDl,ndrgmri. c-
8. Foundation - 59. Gas Pipe, .7 Lnucgr^u., Test
9. s'.ater Pipe-Unci-•d. 60. Back r:ash Lines, P-Trap, = Unc rg•r❑
I _ -
1C` S uciura' Floo[_Sysiem 61. APPROVAL TO DECK
11. Pieper t '1ine.& House Confliction Y Sewerr 62. Backe:ash & Reerpru' Flnal
rr
12. Scorer Cap - r c' 63. Heater & Vent-Final _L_ __,'
13. Rot Drains _• 64. Plumbing System Final I_ I
1_ 4. Rough plumbing 65. e _ctrtca LFinal
'E Rc.;gh Electricc1Condt 33
u6. Solar S/strnq'.
. -F�. i ' I
'6. Ro,.gh Electric ti irin9 67. Fend^.g & Accu, Aopro:a'. I -{
{ I J
•7. Rough Wiring S-5n 68. APPROVED FOR PLASTERING
18. Rough Electric-cCT Bar Ceiling 1 69. POOL/SPA SYSTET.:S FINAL I I I
19. Pouch Hearin & Air Conoitionin c
___ r. 9 : #' 1 ^ 9 a"?' x ✓ .�_6Msr; 7_i: .. `FIF� DI?T. F3 .QUIREfi`VIEN�_
,_, .-.yn FFctej' r ile.17.a ce i S•r s r. tr* x cttPPRZVA14y•,-P'ernjrt -r,-Lr I I
=lac x -E 'L s -' I _- _ _
21 [£..,pct, u\.str�.`tutt .. .. K Cs�. .�•i C:t Y sJ O. UUilderg-o� i��Hy[�..o y i
x t J ,r'. x r'>, .-.: x t--� ~
22.S'i4Fri Lint:r.'•:InP_x C: x c ' c x ji. Prodccr (i . g G:- -'.J.: - I
7-3. Ca r-p1-Ros:xh Y st •
rte_ �S = :r S_x+ 2. Unde.i.a rvFl 1C F > ^ 6-71 '11 w 50 i
24.t`Roda F•3,ming x . F- .:Y x > C:�c x x '- is, w
a -r ,-- x ./3.-sindergrnrT.&'.orr Turik sc Ga: _ U
25 Roc'r•Sh tthing xa -: V + > A 7q,r7jvenc�atl Hydro
r.
26.�' Ba Ce;(ing IStr uc�turau $' 1cs-npcoat .x 'o 73 IC < 75.- r Cite al -- --i - - ---
T .0* Y ries .� x .-
.z: . n •- qt -tat.----x-S-- .`_3-_� -- __-_-
21.cF sine amI F:ashingx ^.e^ x S r -Z.it V 76. Dry Stanc*ee i-.r' x _ 1 -- �_
- .^ - ir - c - - x ',.�x -} . `r_-. 'S�. t4
'2.8. Lath•ng +�,5�' Signg ti i< Q? rs A S. .. .. "x r 77.;FIXED S.-SERVE:If.ALY. •- r
i )
i'2.9. Ic ua l J S • * � e < 78. IRE PREY. FI` x � ^ 7
C xr ra x __-kx 7.1°g3iw,�1,
'�'30. 'J•vva�iallir3g 'c _ ' -x r g 1•iEELTF`.bEPT,`.-F OUIR;�.;E"'T
r „ �..- -_---r ---i----r'- {
C31. ?tastes 2-ro.: S . .r.r x . . - < *Itr79. •FINAL INS/T- CT!3:: x _ r ! I
z - a x s. _ __
32.`GIectr:cif:tPo er Meet 4nai 1 7 Y ! `80.4OOD CERTIFIE L ,Sx1 40;_ 1; -� -- - --- ,
r .
122yr-rte i u g -�. - .. -T-•-'7--�-' - 1- - -�
33.5- nc Eleetrlp x r 1 S + ix < Notes: o: x _ r „T -__ I
-.r -L -- \- i . : •t r r _r .. 41-___:4;12 " -1
4.CE11Heating Aictdritlationtrifs r >t > * * tr. I.
S -c S - _
4.
.35.;?-iral Gas Pipe,Test,. -• e i . ,•>=c .1.- `< - ,-- ----4
�(y�u. Ho 1 Canopy ` r •' x •- Y ' X > nab r
J ^ or Caro x r� I -z'*t .., c t :n T• .>:1-
-$7.`fina..Factary •Fireproce:r - = _ ' a: x .r t
' 8.1;IrM P'umb ng t .:3 .. .k . > S - X x .- -{
x 12 s: i- a k S : • x _ `'_- 1
i 0i it . ' i - c -r. ,.
39. .ater Service-FinalY ; x x I . >, -- o x -
r40. Gas Service-Final '•I . <: x in " =- ' -
1 i rt ;-' x c a - • O X -+ Q i
"41.1Solar Domestic-Fina c �"s z x r-y C ` i. - f • X.
42. Backflow Preventerx .- -�-I-Y ` - " �+ e -- --- - �~
43. Backfloev Irrigation, a- x %.. t ;s - t •` _ i
'4 s
4. Landscae Irfigatioh System sris- ' r C i r ,r S >, zt; __ _..
• 7-2,47.t ,. G ,2 Z< 7:3 2 2. 7 G T. x 5 -
ti- ^fyr .Y _ '
45.-Sound Attertiation. . . .„ -r ;nx . c S • r .. -
.A6. Handicap•Regulatiois - x *cc s 5
-
at itI
• tr
' S 1.--I_1St. ;
c K y .r. J
r x
.07..-FINAL STRUCTU6E & BUIPDING is :- - I -t t• -- •
_
48. 1NALPLANNING' •- , I ,* s' - x
- 4
-t19.jiectric Release to edison I l. s' -
-y
�"-=5 5 a d:
-o0...CasCtelease to Southern California Gas Co I�r• ' • 0 _
X. . x ST c c
81. CERTIFICATE OF'OCCUPANCY V '• `- --c'
No. Date
PROJECT ADDRESS: 2941 GRACE LN UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 06777i
OWNER'S NAME: LUCILLE LICATA
ADDRESS: 162 N GLASSELL PERMIT NO: E 067771 PLAN CHECK NO; N GOVT : N SUPP : N
ORANGE 92666
CONSTRUCTION TYPE: V—SP PERMIT TYPE: ELE PURPOSE: OTH
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : CONSTRUCT 378SF PAINT SPRAY BOOTH SQ FT;
ADDRESS: UNIT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: H-2 /
PERMITTEE: SPRAYKING SPRAY BOOTHS ( 310 ) 862-8135
ADDRESS: 11018 PALMER AV COMMENTS: REF: B-67770
SOUTH GATE CA 90280 ********-x*-x-->f**-><->E****aF**->E>F+c--x** *yE**d¢->E*sFd¢*#********->EA**pry¢ -*******x-d6*yF** ** **** rN
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E Q U I R EM E N T S
7000)of Division 3 of Oe Business and Professions Code.and my license is in lull force and effect. S E T B AC K S
CITY LIC.: 04452 STATE tic.: 509896 cuss:: b EXP: 09 /92
Date:
biteF
6y Signature:_, � MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR; FT IN FRNT : FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION:yLQI hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers'
Compensation IJotDD4nry aserneta 3copy Ul thereof(Section
3SEXP.DATE:Lb C1 /01 /95 LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
POLICY0MPAN.: YYG000llLDENN EAGLE PARKING REQ; PROV: PARCEL ; 14122116 ZNE: REF NO:
COMPANY:
•
❑ Certified copy is hereby furnished. 21 Certified copy is filed ' the city Building Division. PLANNING NOTES>
Date: Vt.-ft/7/51
Applicant: ie*3E iE*****#*iE it#*!f*3E*****iE****1F*IE****iE iE iE*##**iE*******#**1E#it****#****#*iF 3E********#
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D E V E L OP M E N T S E R V I C E S R EQU I R E M E N T S
I certify That in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BYDATE:
Date: Signature: BUILDING APPROVED BY
NOTICE:y:II.aver making this declaration.you should become subjectmis the deem rempensation provisions of the Labor DATE:
Code.you must lorthvnth comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; DATE: M `�--
which this permit isisued(Section 3097.Civ.C). **********************************3i.*.,xctfh************************te%*%*Et ****: * **
LENDER: ********************************************************************* .*********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 6 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the BusinessPLAN ()% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE 15, 00
L as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 16 . 50 15 , 00 0 , 00 31 , 50 31 . 50 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. If.however the building or REVENUE DIVISION TOTALS--> COLLECTED; 31 , 50 OVER/SHORT: , 00
improvement
hin one year of completion,the owner will have the burden of proving he/she did not build or improve
forthepurpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 31 , 50
❑ 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. I ND I V ID U A L F E E B R E AK D OWN
❑ I am exempt under Section'. B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: ELE 10 FIXTURES, LIGHTING 1 ST 20 EA, . 75 7 , 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 2 R EC E P T/SWITCH 1 ST 20 EA. . 75 1 , 50
25534 and that I or any future building occupant wi0/will not(circle one)need to comply with said slate codes and the requirements for a ELE 1 MOTOR/POWR APPARATUS 1 . 1 — 10 . 0 HP 7 . 50 7 , 50
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. END OF FEES
Date: Applicant:
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposejj 01 00162997-00162997 T O T 31.50
G/fit/9 H DATE' 06/28/94 TIME: 12:06
Date: ! Signature:
Driver's License or Social Security a:
1641,46 White—Budding:Green—Code Enforcement,Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service br 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test •
9. Water Pipe,Undrgrnd. I 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 ❑Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 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 8 FOOD CERTIFICATE ISSUED
33. Final Electric 5 i1,9 otos:
34. Final Heating& Air Conditioning !!!"'"""((( ; 1
35. Final Gas Pipe-Test
36. Hood or Canopy •.
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
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 -c
No. Date
•
Applicant to fill in all spaces within heavy,border lines and sign all appropriate declarations.
•
•, ctTY-C:-COSTA MESA P RMIT NO. TRACT N9'. LOT BLDG-N - - - - - -
CONSMIUCTION PERMIT CEP- 2�!! ,%5 '� / yo . , i • ,
• Project Address a9y Gt# F a� • ['Ha
TYPE OF CONSTRUCT ION ','.. ''•- .QJ_�I /20/t321
62e 62 T�
Owner No RMA4i KL-ti•-cl. Phone557--q(r336, 0-NEW ErA DD 0 ALTERATION ' ire
- -`+ - - - -
Address - Co- .._ ey.�Kq FUd) N., cm , 0 REPAIR 0 CONVERSION ❑.DEMOLISH _ ��+ - •
-ZONING'R ZONING-REGULATIONS -
Arch/Eng. - VA • License No. ❑ OTHER q P ,! _
DESCRIPTION OF WORK yiP,g/ IOR/A/T /'Y �� 7
Address _ "' /> GO T/7 / s 'ZONE o(e2.� J� • PLNG. REF.* -
rContractor - Phone - - ' BUILDING_ _ - Tp . r
6/� .TYPE OF PERMIT . . - PROPEIRTY LINE '
Address-" -- . ��y/.•' • SETBACKS5C/L ST.
0 GRADING _ 0 FOUNDATION � *STRUCTURAL SIDE
YARD .- . ,
LICENSED-CONTRACTOR DECLARATION 0 TENANT Ij�'ELECTRICAL �lP LUMBING ❑MECHANICAL SIDE YARD . .- - / . �F �t
-I hereby affirm th;.t-I am licensed'under provisions of Charter 9(corn- RIGHT '
mencing with-section 7000) of-Division-3 of the Business and ❑ OTHER.
1Professions Code, and my license Is In full force and effect- . REAR YARD(TO P/L) - - " ' -
PROJECT DESCRIPTION•
License Class License No. - - r - PKG.SPACE-REQ.- -- "' - PROVIDED; -
Date- - - " '- Signature '- --' •
SO. FT. • _ --- -. - _ - - -
WORKERS'COMPENSATION-DECLARATION OCC UPANCY_CONSTRUCTION TYPE STREET'WIDTH ' ARK FEE $
,I hereby affirm that have a certificate of consent t0 self-insure ora '�ri • - ZONING APPROVE : - DA7 �i�r.
certificate(e of Workers'Lab.C.).Compensation. Insurance, or a.certified copy VALUATION ONE yr—
.7----7/Y 1
(Section 3800, C.). - " .SPECIAL CONDITI NS' - //'thereof
GRADING CU.YDS. ACRES ..
No. - _. _ -Company '- - ' . . . - . . . --- _ _.- .' _- -
Or AY
• -."kertlfied copy is hereby furnished. . _ ..- -- REMARKS: ' _ _ _ _ - '
L.LCertified copy Is filed with the city Building Division. . - ---
'EXEMPTION-FROM-WORKERS-COMPENSATION DECLARATION- - - ' - - - •- - - • - . ' • ' ' '
1(This section need not be completed it the permit is for one hundred - --
MOO) or less). • ._ - .. _ _ _s ._ . - -
'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 PLUMBING - n - • PLAN CHECK - - ' - •• -- -�ELECTRICAL- -- -- - PLAN CHECK' -- - - -
subject.to the.Workersl Compensation Laws of California.'-' UWELLINU- -- “ARMC
BATHTUBS- - SHOWERS ' '- -
- - - 1
!Date f Signature - - '50 FT en 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 LAYS--- -s - - - APPLIANCE-- --10-50 KW=50-50.• •
.revoked.. . _- _ __
- "-' KIT.$INKS" - - -DISHWASHERS- ' MOTORS •
!CONSTRUCTION LENDING AGENCY - --.
l hereby affirm that there isa construction lending agency for the per- SERVICE SINKS. . ,T,-„;SUMPS- ----"- -• -- �. I(INC.SOLAR) 10,50.Hf_SO +HP 'iL . LI
Iformance of the work for which this permit Is issued (Section 3097 - - - S
jCiv: rs " ' - -FLOOR-SINKS -- 'FLOOR'DRAINS" - -- - - FIXTURES OUTLETSZ�SWITCHES-"- - ---. . .�01
Lender's Name i ,
,Lender's Address - -- DRINKING FOUNTAINS •-7; - - -- - •- *GAS TUBE SIGNS . . _ . ._. _' -- ... _ ". '
•
OWNER BUILDER DECLARATION- -- ----- - -- - - " - '{
- ' INTERCEPTORS- " -CLARIFIERS ' - - - - -- POLE LIGHTS- . - - ' I
II hereby affirm that I am exempt from the Contractor's License Law for - ,- -
the following reason--(Section-7031.5 Business-and- Professions Code: SWIMMING POOL - ' -P-TRAP _ -' - - c,UNSI HUL I ion
-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- - . oqs PANELS- - MAIN - :SUB '
quires the ap.licant for such permit to file a signed statement that he oL - _
.1s'licensed-pursuant to the provisions of-the Contractor's License Law GAS SERVICE "OUTLETS'" ' ., '-- SERVICE -- --
(Chapter 9 (commencing with Section 7000) of Division 3 of the -
((Chapter
Professions-Code) or that he is exempt-therefrom and-the- - WATER-HEATERS - -BTU OUTPUT
to" for the alleged exemption. Any violation of Section•7031.5 by - •--- -- -
^'applicant-for a-permit subjects the-applicant-to a-civil-penalty SEWER CONNECTIONS - - - - j
'hot more than five hundred dollars ($500).w - - - - - • --- • "J - -- - _
I, as oner of the property, or-my employees'with wages as their SOLAR TANK COLLECTORS - - - -- --- - - ,
le COmpen salion,.will do the work, and the structure is not intended '
for offered for sale. (Section 7044, Business and Professions Code: The SOLAR-PIPING SYS.- - (I--- "- - " - ' - - i ISSUE FEE - - -
'Contractor's License taw does not apply to an owner of a property c
:who builds or improves thereon, and who does such work'himself or ' -- ISSUE FEE - - -- I --'" -' "-'- j .' 3 --APPLICATION APPROVED BY_- DATE/ 7
,
'through his own,employees,,provided that such improvements are not _ _ - ( �_I
(intended or offered for sale, If, however, the building or improvement- MECHANICAL PLAN CHECK - -' - -
lis sold within one year of completion, the owner will have the burden ( SUMMA RY.OF FEES
;of proving he did not build or improve for the purpose of 'sale). - - -- 5-100-,000 - - - - BUILDING -- -•,• -•,-.•••
HEATING SYSTEM BTU I PERMIT $ 32e.1 B- SMTP� , •$--
❑ I;-as-owner- of-4he property,-am-exclusively-contracting with AND DUCTING- q _
licensed contractors to construct the project (Section 7044, Business 100,000.+BTU I PLAN CHECK $_�I• In - PERMIT y 1
and Professions-Code: The Contractor's License Law does.not apply to — -_- _ __ _
Ian owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU '. PLUMBING �� .ISSUANCE' $ - ,
{tracts -from such- projects with a-Contractor(s)..licesned.pursuant 10 -SYSTEM - _ $ _' ' 'GRA DING' $ -
the Contractor's License Law). 100,000e BTU' 7 -. - . 3-. "-- , PLAN-CHECK '$ - - • - '
❑"I am exempt under Section - -- - -- B:&-P.C:for this ' BOILERS BTV - _ ELECTRICAL i$ 't-5•• S --- •- -- - $ - .
_ i- MICROFILM $
_
•
+-� - SYSTEM REPAIR,ALTERATION -PLAN CHECK -$
(Date /--/y'-- ��Owner io 1 �® _ • - - - - . MECHANICAL-$ -- - . TOTAL FEE$ -
•
J hereby certify that I have read this applicatioif and state that the above EXHAUST SYSTEM MULTIPLE - j{, - 'LESS AD-
•
information is correct: agree to comply with all City and"county - PLAN CHECK $ - .. VANCE PC •$_
'ordinances and state laws relating to construction,and hereby authorize
representatives- of this city t• -.ter upon the above mentioned l • ,42L� 1
property for��[lsp/ectio . p•-es c' o
'Signature Gam/ Date /-i g'-S L _ FINAL FEE $
Drivers'License or SS - - - - -ISSUE FEE _ . . _ - • - - -
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNI .- ' r POOL& SPA a s
APPROVALS Permit# _Z Date Inspec3or APPROVALSv ,.v 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 .
50. -Gas Pipe, LIUndrgrn,Test - -
- 9. Water Pipe-Undrgrn_. . - ___ - 51. Backwash Lines.-P-Trap, E Undfgrn - - -
--10. Structural Floor.System _. - . - 52. APPROVAL TO DECK -
-1.1- .Property Sewer Line.&-House_Connection. . . -. . . . -_ - 53.. _Backwash-& Receptor-Final • ' •
-
-12.- Street Sewer-Connection- _. ' _ _. r . -- - 54. Heater & Vent-Final •
- 13. Rough Plumbing. - _ - __ - _-. 55 Plumbing Svsteni-Final - -
14. Rough Electric-Conduit - '- - - -- -56. •Electricat-Final I' -
15. Rough Electric-Wiring '- - ---- - 57. Solar System-Final . . '
, 16. Rough Heating & Air Conditioning - - - - 58. - Fencing.&Access Approval '
17'.- Ducts, in Structure - - -- - _ 59. APPROVED FOR PLASTERING , ' -
18. --Ducts, Ventilating - - - - • - - .
19. Gas Pipe-Rough &Test - - -- - 60. POOL/SPA.SYST.EMS FINAL -- •
'20. -Roof'Framing - - -- - ' -- __ -- - - -
21. Roof Sheathing -- - - - - • %-
22. Frame and Flashing _ NOTES: 7 �.c J Jl .'..y-L2+48 Z. /&ei N
-23. Insulation - _ - - - -- -_. U
24. Lathing & Siding - - - • - - --- - _- - - - - - . - - '
25. Drywall Nailing -- - . - - - . ' - • " - _._ - p •
26. Plaster Brown Coat - - - - - - • •
•
27. Electrical Power Meter-Final - - - - i
28. -Final Electric - - - - - /_-ZS SL of'G - -
29. Final Heating & Air-Conditioning - - - - • - - ' ''
30: Final Gas Pipe-Test - - - - • -
, 31.. final Plumbing - - -JS-47-.. Re• - - - -
-32: -Water Service-Final - , . - , - -
' 33. - Gas Service-Final - -. ---- - _ .- . - l •
• 34. Solar Domestic-Final' - .. . .. - .. •- - •
• 35:- Landscape Sprinkling System--- ' I - -
•
36. Sound Attenuation - •- ' -- . . -
37. Handicap Regulations - - - ' ' •
38. FINAL STRUCTURE& BUILDING er-jfi.n- 'ft-. _ - • .
39. Special Requirements Completed _ -
40. Electric Release to Edison • - •
41. Gas Release to Southern California Gas Co. - • - •
A?i, .CE.RTIFICATE OF OCCUPANCY -- '
No. Date - - - '
wool-) I Cl) IJ b/=\f-1 i-0
2S'-( i GraaL: L n .
. U n I f 111-1 "
Costa Mesa, Cal ,
•
? SPRR'( 1300Th .
-� WINp
S P RLN 1k L. ER SN IELD
S YSTC CO i•:
Insped1lor ' Insulation
door 1 /
COUPLE TO EXI-�TIN.IL^ SY`itc.I4 it
f--- ♦ - - u CEILI/4C. .
Vb. I v k 3 j
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•
motor i % .
'Zi PRA? SOCII`I-{ -1$1.- Ey
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®= SPP.INF;I_ER
/72.0182
Appnyill
City of Costa Mesa Building Dept.
BY
THESE PLANS MUST BE ON JOB AT ALL TIMES
MAKE NO CHANGES WITHOUT PRIOR APPROVAL
OF DEPT.
THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL
OF Pi n•ut
ti.
- . = �.
' .
SINGLE I)wE LL � nfG Ht'-t 5 .
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GRACE
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a : _,./..,- r ! ,r5 - 2,' I Grace Lane c_esta mesa Ic .A , c X
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Area nu
Far �L (e. te.pa1 , c ��-M-,, 5nir-10
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GI P 1111 G V E
Pity of Costa Mesa Building Dept.
T �/ ..DATES,. AIM -tin THESE PLANS MUST BE ON JOB hT ALL TIMES
I —"-"'--"' K.1
MAKE NO CHANGES WITHOUT PRIOR APPROVAL
COt-f P „10 OF DEPT,
`n)Of-. THE ISSUANCE OR GRANTING.OF A'PERMIT OR APPROVAL
OF PLASS AND SPECIFICATIONS SHALL NOT BE CONSTRUED
kI •r?1{+i..G: I TO BE'A PERMIT,FOR, OR AN APPROVAL OF, ANY VIOLATION
( { "�' 11'� OF ANY OF THE PROVISIONS OF THIS QQOUE. NO PERMIT PRE- •
! ,._.i \`"C SUMINC TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF THIS CODE, SHALL BE VALID, EXCEPT IN SO
` FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL.
JT+', 1 THE ISSUANCE OF A.PERMIT BASED UPON PLANS AND
j -S SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL
•
tV FROM THEREAFTER REQUIRING THE CORRECTION OF LDR03S 1
�.` I` r /-' 1 I_ ,•I,-A I� - 0. , N,IN SAID PLANS AND SPECIFICATIOOR FROM PREVENTING
`--------_.-_.._.. I. • 1 I BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN
- IN VIOLATION OF.THIS CODE OR.OF ANY OTHER ORDINANr'
DF THE CITY_
.
-_ - STRUCTURAL APPROVAL ONLY
��1, r
��.1. \.dot-K ' l-2;_ 1'\t " ( Sr4IMLE55 STEEL. r
m •
SEPARATESTRPERMITS ARE REQUIRED
•—..--.-..—.. ---._.._._._.--_•- ._.._.- K . ' , FOR ELECTRICAL, PLUMBING,
HEATING, VENTILATING AND
REFRIGERATION WORK •
c��RO \ ( r THIS NUMBER P UST ACCOMPANY
—2- e `odaV' 10 ALL INSPECTION REQUESTS
COST• ME A
PLANNING DEPT. FO' BUILDINGS ttHERE'PERSONS ARES TO
art/Ea-TO BLDG. DEPT, REQ
BE EMPLOYED, WE SUGGEST THAT THE
BY_� CDATE STATE OF CALIFORNIA DIVISION OF
DIRECT R 1 INDUSTRIAL SAFETY BE CONSULTED FOR I
OF PLANNLN6i ADDITIONAL REQUIREMENTS.
B1 BEVEN - HERRON , INC .
H7 DECEMBER 12, 1990
B-H JOB#90-288
Department of Building and Safety
t:±71°;?, - CITY OF COSTA MESA
77 FAIR DRIVE
COSTA MESA CA 92626
Contractor: MR. & MRS. DANIEL DICK
2941 GRACE LANE UNIT G
COSTA MESA CA 92626
Subject: DANIEL DICK BUILDING
1351 LOGAN AVENUE
COSTA MESA CA
Gentlemen:
Enclosed herewith are inspection certificates for the
glu-lam beams on subject job.
Yours truly,
B N-HERRON, INC.
encl .
cc: Contractor for information and file.
California State License No.184071 Arizona State License No.23571
Los Angeles Fabricators License No.372. Nevada State License No.6112
•
14511 INDUSTRY CIRCLE • LA MIRADA, CALIFORNIA • (213) 944-7971 (714) 523-5870 - -
PLEASE ADO ALL MAIL TO P.O. BOX 9.8 • LA MIRADA. CALIF( . 90837 - -
•
• r `,ITE OF TIM A
4fy
AITC 2 •
CER IFICATE OF lCENSEF CONFORMANCE
HE UNDERSIGNED MANUFACTURER HEREBY CERTIFIES
that the products identified below and on attached sheets Nos. are marked
with the Collective Mark of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION (AITC)
and were manufactured in conformance with applicable provisions of American National Standard
ANSI/AITC A190.1-198 tructural Al Laminated Timber, and that such manufacture has
been at our plant in homey , which plant has a quality control system
approved by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
and inspected periodically by such Bureau.
The manufacture of these members complies with the manufacturing and fabricating provisions of
Chapter 25 of the Uniform Building Code.
JOB NAME: Beven-Herron, Inc. for Daniel Dick Building
135 o an AvQpue
.108 LOCATION: COs Mesa, C:A �M/
CUSTOMERS ORDER NO. 10/90-288 DATE -1�" MFGR'S ORDER NO. 8378-A
24F-V4, WP clue Ind App, Load Wrap
�Lf
SIGNATURE }.� ^`w,.. / '��- p {,COOMPANY American Laminators
TITLE Quality Control ADDRESS 10y 99, S""-S , DATE 12-7-90
AITC HEREBY CERTIFIES that the said company at its said plant is licensed by the
AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Mark in respect
of products which comply with applicable provisions of said Standard, that the adequacy of the quality
control system in effect at said plant is periodically inspected and verified by the Inspection Bureau of
the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION, and that, in the judgment of AITC,
said company is capable of complying with applicable manufacturing and testing provisions of said
Standard in respect of products manufactured at said plant. Conformance with the Standard in respect
of any specific or particular product is the sole responsibility of the manufacturer;AITC's guarantee
hereunder being that the said company is qualified to produce a product meeting the said Standard
and that its plant is periodically inspected and verified by the AITC Inspection Bureau.
ZE OF a/e AITC Certificate No. 73862 A
' °PPDFS " .9 • AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
/_` SEAL
; C::
1952
zi;
6'�am'''
�... + - ":'
T ? ' ® 1983 AMERICAN INS' )TE OF TIMBER CONSTRUCTION
AITC FORM IBCA
The glulam members of the jc vered by this certificate are stamped'with c ' the
following type quality mark_ ech qualified plant has an individual qua,..,,_ation - -
designation. The designation "P-143" shown on the typical quality marks below is not ,-,
. �•
assigned to any plant and is used only for the purpose of illustration.
A TYPICAL CUSTOM PRODUCT QUALITY MARK
.
.
•
P-143 ' AITC designation of qualified licensed
. , plant .. -. „
•
I:
::
ftlQUALITY ® ANii
SIfAIT
INSPECTED ' , ' •
A190.1-1983
Indicates that the designated licensed plant
has met all requirements for qualification
and maintains an acceptable quality control Indicates conformance to •ANSI/AITC
system which is periodically inspected by . . . . • - - -A190:1-1983, Structural Glued Lamin-
AITC ated Timber
A TYPICAL NON-CUSTOM PRODUCT- QUALITY MARK
Identification of structural use, desig-
- • nated by symbols: :.
B—simple span bending member; • C—
. . • . _compression member; T—tensioh mem-
ber: CB—continuous or cantilever spa
-USE ARCH .-bending.
member
bendingember
•
Designates appearance grade. IND—
P_143 Industrial. ARCH—Architectural.
PREM—Premium
r SPECIES NN AITC designation of qualified licensed
AITC
plant And. .wet-use adhesives.: When
dry-use' adhesives-are used, the letter
QUALITY ® 000.00 00F—XX Disadded
INSPECTED Name of wood species used
ANSI/AITC
A190.1 -1983 Designates applicable AITC laminating-
specification and combination symbol;
for example: "117.85,24F-V3".
Indicates that the designated-'licensed plant Indicates -conformance to ANSI/AITC [2 „, , ,, , , ,,D
has met all requirements for qualification A190.1-1983, Structural Glued Lamin-
and maintains an acceptable quality control ated Timber -
system which is periodically inspected by - •
DEC 12 1990
AITC -
• BEVEN HERR• ON •
Di. For custom rodi*rts, the details coveringtheproduct are included in applicableINC'
p documents.
► For non-custom iucts, essential details are included on the stz
DATE : 11115/90 • • •
LARK I ILAY-IPRE-IFACEIFIN ISHIPI DIMENSIONS I RDILRMITYI COMB. I I FOOTAGE I FINISI:1 I
M. ' I OTY I UP IGLU IGLU TEND ITALLI WIDTH x DEPTH x LENGTH I ONI # IPEI . GRADE I CAMB.. I EACH I TOTAL I APP. WRAP SEAL,
------I I====I====I====I====I====I- - ---- I===I===I==1 • 1===`=___=I
1 . 11 I I . 1 I . I 13 1/2x 27 x 16 - 11 I 2 1181 AI 24F-V4 19 I 216 1 216 1 IND LOAD ENDI
I' I ---I-- 1 --1--- I ---I • 1---I---1--1 I I -I 1
18 , I I • .1 I I I 3 1/2x 27 ' •x 57 - 5 12 A 181 AI 24F-V4 1 3 . I 729 I 5832 1 IND LOAD ENDI
• -
-------I I----I----I----I----I----I- -• I--rI ---I-•-I- I---...:---I I- -• I
18 • 1 • I I I I I ' 3 1/2x• 27. x 57 - 5 12 1181 RI 24F-V4 I3 , 1 729 1 5832 1 IND LORD ENDI
I 1----1----I----1----1----1- 1- -I---I--I I-• - 1
1 1 5 • 1 1 I I I 13 1/2x 27 x 57 ,- 5 I 2 1181 RI 224F-V4 I 3 1 729 I 3645 1 IND LOAD ENDI
I I----'I- --I----I--- I -- I 1---I---1--I I I I I
: . 1 . 5 • I I I I • I ' I 3 1/2x 27 x 57 - , 5 12 1181 AI 24F-V4 13 I 729 I 3645 I IND LOAD ENDI
I-.---1----I,- -1----1-- -I- ' - i---1---1--I I I I 1
2 ' 1 I- I 1 I I 31/2x 27 x 57 - 10 1 22 1181 Al 24F-V4. 1 3 I 734 1 1468 1 IND LORD 7 I
I I----I----I----I----I----I - I---I---I--I I I I - -I
. 1 2 . I I I I I . I 3 1/2x 27 x57 - . 5 12 I. 181 RI 24F-V4 13 1 729 I 1458 1 IND LORD ENDI
•-• - I I-- -I----1----I- -I-- 1- • 1---I---1--1 I -I I I
1 1 2 . 1 I I I I 1 3 1/2x 27 x 57 - 4 1 2 1181 Al 24F-V4 1 3 I • 728 1 1456 1 IND LOAD •ENDI
I I----I----r----I----1----i- - I---I- I--I I 1 I I
I OTY 1 2 x 4 1 2 x 6 I 2x81 2 x 10 1 2 x 12 1 TOTAL I WEIGHT 1 '
I I I I I I 1 I
PAGE TOTALS . I 33 . 1 23,552 1 0 I 0 I 0 I • 0 I 23, 552 I 40,038 I
I I I I I I I - I -
JOB TOTALS I 33 1 23, 552 1 • 0 I 0 I 0 I 0 I . 23,552 1 • 40,038 I 6 ,
1
•
Ilk '�.% .
•
USTOMER: BEVEN-HERRON CUST PO # : 90-288 INSP : RITC PAGE 1
O B NAME: Daniel Dick . CUST JOB# : NOTE : HIT & MISS;7-14Y. MC JOB # : 8378
O CRTION: Costa Mesa , CA SHIP DATE : 12/07/90 $ 0 • / -7
PROJECTOWNEWS NAME: 2941 GR.CE LN UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 06897;
owNEflsNAME: LUCILLE LICATA
ADDRESS: 162 N GLASSELL PERMIT NO: M 068977 PLAN CHECK NO: N GOVT : N SUPP : N
ORANGE 92666
CONSTRUCTION TYPE; V—SP PERMIT TYPE: MEC PURPOSE: OTH
ARCH/ENGINEER: flEG.NO.: JOB DESCRIPTION : CONSTRUCT 378SF PAINT SPRAY BOOTH SQ FT;
ADDRESS: UNIT:
PERMITTEE: CLAIM VALUE; CALC—VALUE; GROUP OCC : H-2 /
ADDfless: SPRAYKING SPRAY BOOTHS ( 310 ) 862-8135
11018 PpALMMER AV 7 COMMENTS : REF: B-67770
LICENSED CONTRALTON DECLARATION:OUA e6 affirm lhallam licensed antleCAr ovisio9S0f'ChBp[er9(commenCinp with Section ********k**** *************' #it**iflfif-#itdfitit* it7FM-1fiEi ***teiEie***lE****i!ll****ifiFiF-7fif--ktt- ***
7000)of Division 3 0l the Business and Professions Code.and my license is in full force and effect. ZONING REQUIREMENTS
CITY LIC.: STATE LIC.: CLASS: S E T B A C Y. S'
44522 5098 XP: 05/9
IDate:—=2._t. Signature: —_ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800, Lab,C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICYNO.: PWC21069301 EXP.DATE: 09 /05/95
asp
mem: GOLDEN EAC T E PARKING RELQ• PROV; PARCEL : 14122116 ZNE; REF NO:
Certified copy is hereby furnished. bit Certified copy is filed with wading Division. PLANNING NOTES>
>
Dale. /'2.2•�� Applicant: ik iE iE iElE*iE iF it it i(lt if it iE iE it it if illE it if iE iElE lE ft iE ltiE iE jF if iF 3r'iElElElt iElE ffftie iE iE iE if iE iF it if it iEll iE iflf iE if iE ie iE iFlEfF iE it iE iE if*ff iElf jE iE iP
7 EXEMPTION FROM WORKERS'COMPENSATION DECUBATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R' V I C E S R E Q U I R E M E N T S
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California.
Dale: Signature: ZONING APPROVED BY DATE;
NOTICE:If.atter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. DATE:
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED H Y
which this permit is issued(Section 3097.Civ.Cl. **********************************************�-t'Y't�******************* ,* F�N,**
LENDER: **********************************************.1*EV*t ijE'*****3E***If***IF1EfF'k9E1hil**********
ADDRESS:
LEGALIZATION ;N FEE • S U M M A R Y STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT f 4 ,50
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(3500). ISSUE FEE - 15 , 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 4 , 50 15 , 00 0 . 00 19 . 5 0 19 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
N his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 19 . 50 OVER/SHORT: 0 0
or the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 19 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).I am aware .***************************************,4***************************************
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.&P.C. INDIVIDUAL F. -E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date; Owner: •
I do hereby certify that I am aware of and understand the requirements of California Health and Salety Code Sections 25505,25533,and MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4 . 50 4 , 50
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 END.. OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby 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 state laws relating to building construction and hereby authorize representatives of this city to enter upon thea enlioned
property for inspection purposes. 01 00168253-00168253 TOT 19.50
—I 9 �� fry.( DATE: 09/22/94 TI8E: 13:28
Dale: ^Z2 • Signature:95C-o`�` •vim
r
Driver's License or Social Security a:
1641-46 Write—Building,Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO$SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
?d. 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 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 �k17;2
36. Hood or Canopy ll�-� / _G�l 7/ (a
37. Final Factory Fireplace (y.�
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
PROJECT ADORERS: 2941 GRACE LN UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: b 0C1171
OWNER'S NAME: LUCILLE LICATA
ADDRESS: 162 N GLASSELL PERMIT NO: B 067770 PLAN CHECK NO: 01490-94 L GOVT: 14 SUPc- ; N
ORANGE 92666
CONSTRUCTION TYPE; V—SP PERMIT TYPE: STR PURPOSE: OTh
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION ; CONSTRUCT 378SF PAINT SPRAY BOOTH SQ FT: 14, 000
ADDRESS: UNIT:
CLAIM VALUE; 14 , 000 . 00 CALC—VALUE: 14, 000. 00 GROUP OCC: H-2 /
PERMITTEE: SPRAYKING SPRAY BOOTHS ( 310 ) 862-8135
ADDRESS: 11018 PALMER AV COMMENTS : CONSTRUCT 378SF PAINT SPRAY BOOTH
SOUTH GATE CA 90280 ######################################################*############nx;;**xxY.4s-kas#i
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMENTS
700(1)of Division 3 of the Business and Professions Code.and my license is in lull force and effect.
SETBACKS
CITY uc.: 094522 STATE LIC.: 509896 CLASS: Bi EXP ; 09/92
Dater Signature:_ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPS SATIN DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT - IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cl. LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PoucYND.: PWC21069301 EXP.DATE: 01 /01 /95
COMPANY: GOLDEN EAGLE PARKING REQ; PROV; PARCEL; 14122116 ZNE; MG REF NO;
0 Certified copy is hereby furnished. a Certified copy isfiled wi the city Bitd Division. PLANNING NOTES> INSTALL AUTOMOTIVE SPRAY PAINT BOOTH. AQMD PERMIT HAS BEEN
y/q�/ > FILED BUT APPROVAL NOT GIVEN. AQMD APPROVAL REQUIRED !
Date: �'/"�� Applicant: ############################################################## ####l: K>I.#f;:-”*
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is foe one hundred($10O)or less). DEVELOPMENT SERVICES R E Q U I R E M E N T S
I cenily 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 8-
subtest to the Workers'Compensation Laws of California. ZONING APPROVED BY .•
DATE; 41e.-1
2S I
Date: Signature: ��//ff ,,//��/�s Q
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; (A,oil* DATE: ) i'"'
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / n
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: E_/f/�� DATE: ( h "(�Q
which this permit is issued(Section 3097.Civ.C). #######################ie######yr####+e###kiE###r-##h#****+r****########3f- {fV//`--- #Tc�FFr—"'x"` -3Ei:-�
LENDER: ##################3c#################################################+:-# :##K it###K
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 153 , 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
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3(Atha Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 99 . 45 2 . 94
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 155 , 94 0 . 00 99 . 45 255 . 39 255 . 39 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 155 . 94 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
153 , 00
I.asrf owner of s the property,amCo exclusively tecontractingLicnwithw licensed not contractors to
an construct l project hbuilds(Sectiohimproves ov,Btsereon 2 . 9 4
❑ and who coinsCode:tfuce projects vii Slate License Law dens not rsua to o ownertf properly ahs or 1ar thereon
and whocontractsfor such projects be provided
the Contractors'State License LaW),I am aware ###############################################################################
that proof 01 their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFC 14000 ALTER BY VALUE COMMERCIAL NOZONE 1 .00 14 , 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a
permit for construction or modification from the Air Aar Management District.Residential construction applications are exempt from
these provisions, -r
V.
Date: Applicant: •
I hereby 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 state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
properly for inspection purposes.
Date: 7%/!e/9 Y Signature: 01 00162998-00163000 TOT 155.94
Driver's License or Social Security 4: DFATE: 06/28/94 TIME: 12:07
164146 White—Bvitding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
Al\
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines,P-Trap, 0 Unclryrnd,
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
h Plumbing •
14. Rough 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
I'
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 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
I
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 alibi;! /y
48. FINAL PLANNING ((
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •-
No. Date
PROJECT ADDRESS: 2941 GRACE LN UNIT: A CITY OF COSTA MESA - BUILDING PERMIT PERM NO: F 067772
OWNER'S NAME: LUCILLE LICATA
ADDRESS: 162 N GLASSELL PERMIT NO: F - 067772 PLAN CHECK NO: 01491-94 L GOVT: N SUP P ; N
ORANGE 92666
CONSTRUCTION T1SPE: V-SP PERMIT TYPE: FIR PURPOSE: OTH
T
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION • INSTALL FIRE SPRINKLERS FOR SPRAY BOOTH SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 1 , 500 . 00 CALC-VALUE; GROUP OCC: H-2 /
PERMITTEE: SPRAYKING SPRAY BOOTHS ( 310) 862-8135
ADDRESS: 11018 PALMER AV COMMENTS : CONSTRUCT 378SF PAINT SPRAY BOOTH
SOUTH GATE CA 90280 *******yr; ******kFVE***vE***********************vE***********;6v6******+F**>t+E,evr* ***r.-#
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMEN TS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACK S
CITY LIC.: 044522 STATE LIC.: 509896 ss: B EXP : 09/92
Date: 6/,,/99 Signature: • MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: PWC21069301 EXP.DATE: 01 /01 /95
COMPANY: GOLDEN EAGLE PARKING REQ: PROV: PARCEL: 14122116 ZNE : REF NO:
' ❑ Certified copy is hereby furnished. [2.Certified copy is filed with the city Building Division. PLANNING NOTES>
�./c >
Date: Kcf--799 7 Applicant: ***fE***1f•***********iE************************************************yE**********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V ELOP MENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY •
DATE:
Date: Signature:
. NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. C / C J
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: „ we I a— DATE: (. 8 35--X-
LENDER:
�1�G}
which this permit is issued(Section 3097.Civ.CI. **********************' • - • ..*.e ' -" ' ' • ' • • • *- •it- ' ' ********** 4 iF!s*'#
LENDER: *********************************** 1*********************************Y *********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from theContractors'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 35 . 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
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 65% SMIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 22 . 75
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I, as owner of the properly or my employees with wages as their sole compensation, will do the work. and the BUILDING-DIV->. PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 35 . 00 0 , 00 22 . 75 57 , 75 57 . 75 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 35 . 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
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 35 .00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *********************.x********************************It********cit#* %*****N*k *** T
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
O I am exempt under Section. 8.a P.C.
for this TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: FIR 35 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1 . 0035 . 00
Ido hereby cenily that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.24539,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(or a
permit lot construction or modification from the Air Quality Management District.Residential construction applications are exempt from .
these provisions. r
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county • -
ordinancesandslatelawsrelatingto building construction and hereby authorize representatives of this city to enter upon the above-mentioned 01 00162996-00162996 Tn T
property for inspection
purposes.04-- c DATE: 06/28/94 TIME: 12:05 35 DD
Date: j �/� Signature: _
Driver's License or Social teecmity.:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrrd.,Test
9. Water Pipe-Undrgrnd. '._ 60. Backwash Lines,P-Trap. 0 Undrgrnd.
r
10. Structural Floor System ` 61. APPROVAL TO DECK i {
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer COP 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 Q Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
- 1 25. RptSheathing 74. Overhead I 4
1114
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL aJ'n/' 4
29. Insulation 78. FIRE PREY. FINAL &L12.1q { .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • - '9 79. FINAL INSPECTION
32. Electrical Power Meter-Final -• - 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' i• Notes: .
34. Final Heating& Air Conditioning - •- '
35. Final Gas Pipe-Test
36. Hood or Canopy {1
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
PROJECT ADDRESS: 2941 GRACE LN UNIT: CITY OF COSTA MESA — BUILDIIG PERMIT PERM NO: E 070507
OWNER'S NAME: LICATA LUCILLE E TR
X ADDRESS: 13712 RUSHMORE LN PERMIT NO; E 070507 PLAN CHECK NO; I N GOVT: N SUPP: N
SANTA ANA,CA 92705
CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE; OTH
538-2269
ARCM/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL EXTERIOR SECURITY LIGHTS SQFT;
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
PERMITTEE: W D H INCORPORATED ( 714 ) 850-0173 •
ADDRESS: 17660 NEWHOPE AV F COMMENTS: NO STRUCTUAL PERMIT
FOUNTAIN VALLEY CA 92708 **+E**+ESE+E+r*** -************ ****BE********aE**+rd *********** **+Ear+EBrjr*******r*BE**Br***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code, and my license is in lull force and effect. SETBACKS
CITY LIC.: 028803 STATELIG.:404265` S C 1 4EXP: 05/95
Date: 12-1.2-9 Signature _ CSMAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
Compensation Insranc .or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PDLICYN0,: 93148812381-94E EXP.DATE; OS/17/95
whCDMPANY:CONTINENTIAL PARKING REQ: PROV: PARCEL: 14122116 ZNE: REF NO:
Cl Certified copy is hereby furnished 0 Certified copy is filed with the city Building D' isi . PLANNING NOTES>
t-1 > •
Date: ) 2-2-2-9 l Applicant: e .� *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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 t0 the Workers'Compensation Laws of California. ZONING APPROVEDBY •
DATE;
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY ; DATE:
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. Ip
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for APPLICATION ISSUED BY: ? DATE: 1, �Iil"t
which this permit is issued(Section 3097.Co.. ******************************************** * *************** **** * *
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 • 2 5
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 1500
00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—D IV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 5 . 25 15, 00 0 , 00 20 , 25 20 . 25 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered the sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 20, 25 OVER/SHORT; 00
improvement
rptheepurpose of losale)mn 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 SMI P/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 20 . 25
❑ 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
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date:_ OwnerELE 7 FIXTURES, LIGHTING 1 ST 20 EA,
I do hereby certify that I am aware of and understand the requirements of Caldornia Health and Safety Code Sections 25505,25533,and . 75 5' 2 S
25534 and that t or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from
these provisions.
Date: Applicant-
I hereby 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 state laws relating to budding construction and hereby authorize representatives his city to enter upon the above-mentioned 01 00174002-00174002 TOT 20.25
property for inspection purposes,
f .x 1 MATE: 12/23/ 94 TIME: 15:32
T Date: (--Z 2-s( 1 Signature-
Driver's
Driver's License or Social Security.: E0
46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING .. POU.. & SPA
d
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Serve or Pole,,, 52• . Pool & Equipment Location ,
x
2. Soil Pipe-Undrgrndm m ' M.:0. 53. Steel Reinforcement
1.
cil'At stictrjeal Coni dGcti1•ty-Ylndrgrnc 54. Forms
rer`: Mi
•-4.••Ekactrtdal Condllit•tdndrgrnd •-'5 55. Electrical Bonding
-CJ a'H
5-heel $'einforcepj jsi 1 < 56. Rough Plumbing & Pressure Test `,
rIfravElectrical UFERIGrnd. 0 . 57. APPROVAL TO COVER-GUNITE
C.• •,y .. r,
,y17::.footings 0.1rj 58. Electrical Conduit-Undrgrnd. s;
•�aFoundation ci <•t1 -- i 59. Gas Pipe, 0 Undrgrnd.,Test
Pa.=Water Pipe-Unth! rnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
N
161 Structural Floor System r.; 61. APPROVAL TO DECK
11, Property Sewer LinE•& HODse Connection "' 62. Backwash & Receptor-Final
s r . .
12. Salver Cap a, c n, . 1 63. Heater & Vent-Final
y
13. Roof Drains _ 0 1'j '1 64. Plumbing System - Final
t.14. Rough Plumbir)g 65. Electrical-Final
.l
15. Rough Electrical-Conduit 0 66. Solar System-Final
16. Rough Electric_ /iring
�,y� c;, 67. Fencing & Access Approval
J
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
'H
18. Rough Electric36-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
r- .. _ ..-1 --•r•t -•-• +t ..• . n m 0 C 5-473E-, CK l H t'1
20.,?jlo _jh Fitctd� FReelace 1 -;m �`-1 t :7 ^` 91PPRQ.VAASi'0 cher it# -1
21.:Duct• s, in_Strgytu(� 1 •• ••
•-• a S. Ci :-4 a * 070. UndergrtStiiid%Hydro
C, m [_. -s a 'i-1 it 1' S ... r• 'l )
22. Quei'S, Vehtit'gting` ; *4,; c; r; .1 ;-: 'y 71. Produce fpisg 1.15As OYOil
n I LL. 2 _ .---•:* a Y, : 1 v kJ
23.9:3-
3.:as ipe4loL+gh & Test 1 cp.:. » 71 Cs 4 -72. Undergrotltd Flush-a r F
,8 .. _� 17 -6 S ' ' ,. • r
24.tr"tooiFraming -l: . ' - '•� " % O m 4I.` -73IUndergrntrrStoraijelTanktlGas 0Oi1
t, t.--,*
U i l '.•-• ,, DI til C) .1)* }
25. Roes,Shathing ;ti" s - a _ U p;' . V74i:Overhead Hydro:. -
26.- ri)
:-Bat Ceiling (Stc�turall &S�71oh coat �. J jG JT . 75-.Dry Chemical 2. �,71tt -1 C ,r
v * a; a Tr r'
27. frame apd Flashiiigi :71:/r: a ' >. to a t_ 76. Dry Standxtipe p-•7: 4 F
_
c rt
-28. Lathing Siding' 0<X ' " .• \'a ° 77�='FIXEDSF'STEM L',
7' r • to Y 1+ 78.FFIRE PREV. FlNAQ r •^
>29. Insulatio x * : 7;
_. :.r ._ ...w v
030. Drywall Nailing <^! ' E--•
It ,---1Ptt ALTFFiREIPT'. REQDIRc1ENT
x,31. Plaster Qtwn,Coart; S I •n,,t •s I . 179. FINAL I EECT10N J
-�, n;-�-• £'.i^ + i- :,-i .- . . 0 -
i-82.•--Electrica :Power MerenFinal I a p3 I li t'30.1IF0OD CERTIFIeAT'E'ISSSUjD ;;..'
' 1 l? . %i4 . p ts. •-
•23. `inr�,tEleptric, �, 1 ,�17 I fi No(es: -•y y_r; r 0 tri
't34.cfina#Heating-& Air Conditionia4' y it 0: •'i •'r r S Cl
." ^• r, r. 'I • '1 m t ;• t ' to m i1_) 0 1 f-.< 4 '-t
35.NinfttGaiPipe'Testac .. rH ax ;r%, c - 7 c';•*
^_ . i- 01-- .- C. a i,. t
h36. Hood orsCanopy a c) tr"1 a ;-1 ! Ia -: i- r l-,o a t*'
_.:J r r. - in 1 ti:to C. 4 M a [>I ^:J i 01 a tr,
,i7. indT),Fat:tory Fireplace.:. I i�E, :; '. rII I a y -, r:
y c'
�L38. Finah Plurnbjoe_- •` 't ' II r i a S s 7
a n ; .. " k 4 �t . Cr! '-1
r39. Water Sejvice-Final t o • Q I t'1 a7`1 • m
:q0. Gas Service-Final 5 c'r -Cr""' S a Pt .D0-lot s
1.11. Solar Domestic-Final ' ;i • y tet..1 •-• 4 -
r42.Backflow Preventer a r; I I i' } C; .,;y4 0 ;.:0•.a ' y 4 t Ti ,111'1 a
43. Backflow Irrrg"ation Vic:S * r r :..:7.E-. r O
,., r C; s 4 Al i a l
;44. Landscape Irrigation Systems,mt•J c; a Pi 0 ci _ta 4 6; 01 iU t ) 4 N r.,
•45.;bound gt,ten' ation; "oz`, n' a F t-4 + '+ ro 0 -C
. , F•1 r 01 ni rrt a s F _ _ v^• • r--40, t
746. Handicap.Regulations .-• :j t • r•• Ct - r
S .. : r I i Ii l .---• r1. . t 3
47.-FIN'rL STRUCTURE & BUILDING I I4 ; ` o ;r � o
48._SINAL PLANNING- 1 -E• t ,ti r' s n} ill C •r Ft
'49. 'Elect'dic Release to Edison I r4- '
.. .. I I I r !a : = °;
rr
`S 0. Gas Release to Sout:ern Catifprnia•GasCo : I I. e. = E•- ,✓ 0 • :r a %' •
i I. . .. - ;.-r Cl' .,t
:El. CEFUFIFICATE OF OCCUPANCY S 0;0 r• -J
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lOCAI$W1 VOIrnNPs ' UO RFC HIS CURB A 0 C BKA CIF MI RFC110 0 01,/.1147,7", c LOCATION
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Building Safety Department ,' ,' CERTIFICATE OF OCCUPANCY `- 2 ' 2832
P,O. Boz 1200 i '` ,
Costa Mesa,California - I ° _ a r .. • ' f•
• _ The'Building located at - ',bat t`,Y.r.,*ni ine.. -
has been inspected and foundvto comply with the provisions of all City.of Costa Mesa Ordinances applicable thereto
for,a.Group '%..'7 'Occupancy, .
Use of.Building .^. . ,' ' R lfrrtt �fnsltJLia1 Pact liftnn+ • ' - I
Legal Description 4 4 y ' - C 4'4, Atii-14.2)i-Lel f CA 17 - ' - -.
' „• _' r• .' (See reverse side for Metes and Bounds) ' .: Cr
I ' k
Building Permit No 1141g;* Electrical Permit Npr o, rht d_' n•taa7 Plumbing Permit No.-44.r4- i '-I•-
I
'
1' . '- Number of a artments f
... p l -and/or guest rooms. x 1,-•
ISSUED TO '! — Building Official
P-
9 c i by
6 •
Alii 41.465 it;:ogtk t , d . _ ..._ .,r I - - - _
t a: Date . I.
-t4nrr 1 : 11112
This Certificate of Occupancy SHALL BE.posted in aconspicuous,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,Bf .C. - ,»
- _
SUPPLEMr" ''ARY PIRA SPRINKLERS INSPECTION 'PORT -
OWNER:: "7--(2/Y ��CILCL (i( ISSUANCE DATE: '7`OZO/�a
ADDRESS: g67277 Oj7 PERMIT NO. : 5/-0-7,S7
CONTRACTOR:[.(:.6L-7^446(` �� �/e„j t y e VALUATION:$,/ Off
PERMIT FEE: $ 4// ) �� r
gam, 7 /fir S y- may-2
G3 crnFo N-as 7s
OWNER HUNSAKER, S. V. DATE 4-20-72
JOB ADDRESS 2941 Grace Lane BUILDING PERMIT NO. 34598
'ssr`NERAL CONTRACTOR AutomaticSprinklers of DESCRIPTION of WORK Fire Sprinklers
49. 141-221-16 (OT e racirtkACT FIRE ZONE VALUE $ 9.000.00
INSPECTIONS 17 Signature Date ,GROUP TYPE ZONE
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER n
ROUGH WIRING Heating and Vent.
TRENCHES FORMS n STEEL REINF.
FLOOR SYSTEM
BOND BEAM Ln STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
TER, BROWN COAT
JCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL CP+b 7 freart»-._ y-3[-%2
Palfi ,r L..—*
CO� 9 9 41 3
TR b6Rc�0 952* ****41.63
3459 R 21 -nT 5r
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RE 3, V ppp/{AA-E RECEIVED
BUILDING ^ /L/ t[ /y-7� D EJ$aU 7 y
ADDRESS 2941 Gen LA,.,¢ / r�J / ,// n-OQy/r
OWNER Si U, Wu0 s-A tc ele. "sit'• - A.P. NO. /I//" c29 /dr/7 7 •7
MAIL BUILDING T Vt'r (�_
ADDRESS D'7 e C PM vi-d ADDRESS oC 7/�'L�i.Q
tuuiZTEL.
0- O Y CITY TU LL..�1L'TrD.J NO. 871-410 TRACT I LOT BLOCK
H
Z < CONSTRUCTION/ NEW ADO ALTER REPAIR MOVING DEMOLISH
I- LENDER C- 2.OGICEQ WI:MITT-haRas./1‹...
am //I f
Jr BRANCH Lo,> f1y,JGFI _c-J i
_Jo) // _ r� /p� //�� OWNER r dL/ G-/L1Zd-^VL
m III J ADDRESS I'o rB-gl to t..i7 Tt _TEBM. Nrd NEX LI) . �//II,�xx// ' ALUE
J m ARCHITECT 1/ 1 '1 TEL.. 7 •Lel S ///�/yic./? $ glpOO J
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an
APPROVED
p GO 32t''llV 'SPOlrJlf Le eS a.-'Tb1F�ALI(u_..),_1( BY DATE
COHI Z � �)q
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cc ADDRESS-MO 17 rte- S .1
W W TEL ZONE .OF USE OF NEW
0= C /� P NS BUILDING
Z CITY CS'�r� ei4 l[ RLI F No.61-4-foto
0 STATE CITY ���� YARDS APPROV D YARDS APPROVED
Ln-
0 _LIC . NO. 71 g Cr LIC. NO, MAIN BUILDING ACCESSORY BUILDING
SIZENO.OF BLDGS. (FROM C/L STREET/
OF LOT NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. R.SIDE FT. FT.
I- SIZE OF NO. OF
Z NEW BLDG. ROOMS STORI ES L.SIDE FT. FT.
1..1 EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAI
0-
0-
MAIN BLOCS. ACCESS BL
a A
O Z ' I ,Fi ez ‘5pk/NFLL (L� rJ ey'2 , C.U.P.qi& APPROVED
y
I. LOA -e WAVY &on Oj APPROVED DATE
OI hereby acknowledge that I have read this application and state sr/IT:\ \
✓ that the above Information Is correct and agree to comply with 3
CC
all laws regulating building construction, and I shall not employ
F- any person in violation of the workmen's compensation laws of (' .
CO the State of California. m
Tax
? I hereby certify that I am properly licensed as a contractor under SQ T. 0
the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: S
am exempt from the provisions of the State of California Business
VALUATION
and Professions Code,DIvision 3,Chapter .1 /— az
�) PERMIT FEE $ ex
O
Signature ofof
Perminae A..a. -.Le. . .e' rt-3-6-1
_.1 AS/ 4 PLAN CHECK $ 7 E
A/
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Authorized Agent /dec TOTAL FEE $
OWNER NEWCOMB, Stuart - • DATE 7_5_78
JOB ADDRESS 2941 -B Grace Lane BUILDING PERMIT NO. 46338
ENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Leg. paint booth
A' . 141-221-16 LOT 6 TRACT 3837 FIRE ZONE VALUES 500.00
1N>. ECTIONS
1Signature Dat. TYPE V GROUP F-2 - ZONE M-1
OIL
SUBCONTRACTOR PESIAITS ISSI{ED
GAS
Dote I
�WAT ER Plumbing Number I Signature
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. LI
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND ED POWER U
ROUGH WIRING 'Noonan and Vent,
TRENCHES 0 FORMS U STEEL REINF. E r
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING rANcELLED -...,�/�
FRAME AND FLASHING z / .4) By //-+/�/
LATHING - IN I OUT n DATE t `� ~/
PlrER, BROWN COAT
Sl URAL, FINAL Electric
HEA,'NG, VENT., REFRIG. AND A.C.-.IFINAL QLC/Q4 ,/- P A_.. 17-6-745 L�hL/S3
I-
PLUMBING. FINAL AND GAS TEST L I
ELECTRIC. FINAL
BUILDING. FINAL
6220 7'06 10,50 T
t
40ti3
8
~/',VISTA MESA BUILDING-SAFETY DEPARTMENT
0.0.BOX 1200 COSTA MESA,CALIFORNIA 92626
APL A ON FOR STRUCTURAL PERMIT
For Applicant to FIJI in Completely—Use Ink Only
7 per/ j''''' RE rD I DATE RECEIVED O I�.SUBUILDING />
ADDRESS o7/
C / - se L7 rare 2,1 (-- (` (Y
5-17 -27-/—
/ PE MIT NO.
OWNER , /-� .1 � c a � A.P.NO. z(� /
f ? BUILDING • /
MAILADDRESS R0 So . d • �L / ADDRESS — . fid a ��
CITY Bal , 2"S• 12442N0..7 6S;JaiS TRACT 7 LOT CO BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH /L I C���
OWN R !AY/
ADDRESS /.n�yr
ARCHITECT TEL. / $
OR ENGINEER NO -�/+ t L
ADDRESS ZONE YPE J� GRO�UsP [ _
40z,..,
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APPROVED -/_S � ?IX
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ADDRESS ZONyE�SyR,/.� Ir.OF USE OF NEy/y�v2`/fT�f1%IA•�//s
TEL. ' / 1 IPLAh6 BUILDING ZeG Upc_
CITY NO. Y
(-1 STATE CITY YARDS APPROVED YARDS APPROVED
gLIC.NO. LIC.NO. MAIN BUILDING ACCESS RY BUILDING
LN SIZE INO.OF BLDGS. (FROM C/L STREET)
fa. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
EXISi1NG BLDG. R 5111E ill FT.
InIn
F Separate permits are required for L.SIDE / •
FT.
electric,plumbing and heating work.
wREAR 1 FT. FT.
I.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q /1 j.`/ MAIN BLOCS. ACCESS.BLOCS.
�` ClQ`� 7 ,S�/`tr //L VAR.tW DATE
Q Sy C.U.P.f APPROVED
' APP O I E 7
9-•
V x 1O .$`L "`✓ DATE
W
C I hereby acknowledge that I have road this application and state in
N
ce that the above information is correct and agree to comply with m
fl• all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of e
Sthe State of California. ,.fit
I hereby certify that I am properly licensed as a contractor under j`j (/ SO.FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UN LUAT ON IS FOR m
Chapter 9, end that such licenses are In full force and effect,or I THE PURPOSE OF ESTABL H PE FEE OW yr
am exempt from the provisions of the State of California Business !!�� o
and Professions Code,Division 3,Chapter 9. VALUATION P IT FE $/O �� m
Signature ci Ilk le cis 0 PLAN CHECK $ 'n
o
u.
Permittee -_ ✓ - .- '--- IA ••au-...fan�_�. $ �(� TAX $ g lc�ent , U
Authorize. TOTAL PAID $ /22fS�
\
- 33 (69 PA:r
'ICI 77-71-Et- et11716 u.• . • ..9. .L_
COSTA
.: . . :.9, .--
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
Af
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely %2A I
n 1 �- /,. 'i✓e )� RECnEIVE,) 7
D/B/'}/ DATE RECEIVED DATE SSU/5D I
BUILDING Q9V/ L::�,ocs /Aim- A-%-I /tom ��IZ-��••-7 /7�j//.7�
ADDRESS /IE��R/ W KI/
OWNER J/MN I4UAII4r1 A.P. O. ��//22/^/6n / P MIT O.
BUILDING
MAIL ADDRESS 29'/ _ .C.Q_..,z A l.-
Z • ADDRESS �j
W W TEL. TRACT 7/ 6 L�T�7 BLOCK
d U CITY NO.
ZZ
< CONSTRUCTIONlaN NEW ADD ALTER REPAIR MOVING own;lSH
0-c0 �(,J LENDER �'
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m J ADDRESS s�/)'/'/,/l. fi L LUE go
m ARCHITECT v/ / TELN /// I USE
y!/ �/�/.{yJ,/tom $ r/U
J N OR ENGINEER /t n./ il�1ES NO. %J7 Vu/ / .1 z
U Q FIRE t/ 2 l/
W 2 ADDRESS �Qr 41t gtnat',S/� zerr,�.tm NsyAr ZONE TYP GROUP
a.Ly
W Z APPROVED
J O CONTRACTOR e51/244,44, BY DATE
noz
JCC ADDRESS
WW TEL. ZONE NO.OF USE OF NEWz /
z= CITY NO. 'PLANSBUILDING
H
W O STATE CITY YARDS APPROVED YARDS APPROVE
In CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILD NG
7 0 (FROM C/L STREET)
SIZE NO.OF BLOCS.
OF LOT MO% 239 3 NOW ON LOT--O" FRONT C01, FT. FT.
USE OF
U 2 EXISTING BLDG. �c//pAft-/✓ R.SIDE 45'FT. ��/] �j% FT,
I— SIZE OF NO.OF
Z NEW BLDG. 1/320 CI ROOMS '-- STORIES- L.SIDE C'O FT. (� -'�v FT.
EXTERIOR WALL ROOF /e
V COVERING &pAle COVERING OpazcT-t//0' REAR 'S"L�
FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d
a. MAIN SLOGS. ACCESS.BLOCS.
Q �/J VAR.# DATE
O /Liter F4 Ld s/C Tz 7--Jr C.U.P.# APPROVED —/
Z �/ -A` APPROVEDL/z�✓rJ DATE i/ [ /7/
0
VI hereby acknowledge that I have read this application and state •S o p /Jz� O��'-- T �pght$ST�
D that the above information is correct and agree to comply with :27---EClAL
- }0.`���
CC all laws regulating building construction, and I shall not employ _ yn1) Sts
I— any person in violation of the workman's compensation laws of L'1lw'�-
fa the State of California. Lco 1'1
ZI hereby certify that I am properly licensed as a contractor under / 3 i 0 SO. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: rt
am exempt from the provisions of the State of California Business VALUATION
and Professions Code, Division 3,Chapter 9.
PERMIT FEE $
Signature of „® 91, 2s
J m
Permittee �/ $ PLAN CHECK $ - E
Id, a�cwU.
Authorized Agent TOTAL FEE $
33769 t� ;y-7 f .00 GS . I5, .'..
is
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY DATE RECEIVED DALE ISSU�fED
AUILDING /[
ADDRESS 294 �• 7L'7
1 Grace Ln., Bldg. D, Units
PERMIT NO.
OWNER Sim Hunsaker A-H A.P.NO. 141-221-16 & 17 337A9
MAIL BUILDING
Z .
ADDRESS ADDRESS
W W TEL
O. CITY NO. TRACT LOT BLOCK
— Z CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOIISH
Z,II— I- LENDER
d m
J 0 BRANCH
—ILO OWNER
CO J ADDRESS VALUE
J
m ARCHITECT TEL. USE $
Q OR ENGINEER NO
V W FIRE
w m ADDRESS ZONE TYPE GROUP
O.W
APPROVED
mZ CONTRACTOR OWAer. Bldr. BY DATE
Z
J cc ADDRESS
W W TEL. ZONE NO.OF USE OF NEW
0= CITY NO. PLANS BUILDING
ZF -
W O STATE CITY YARDS APPROVED YARDS APPROVED
tO CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
0 SIZE NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. R SIDE FT. FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT. •
FT.
VEXTERIOR WALL ROOF (\
_ COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
d
a MAIN BLDGS. ACCESS.SLOGS.
Q VAR.* DATE
0 8 Unit Light Mfg.Bldg. C.U.P.* APPROVED
I- APPROVED
fA __ELY DATE
z
0
UI hereby acknowledge that I have read this application and state
O that the above information is correct and agree to comply with
CC all laws regulating.building construction, and I shall not employ
1"' any person In violation of the workman's compensation laws of
H the State of California. B
ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: O
CC
am exempt from the provisions of the State of California Business
VALUATION y
and Professions Code, Division 3,Chapter 9. PERMIT FEE $ 196.5o N
D
Signature of _ m
Permittee $ �G PLAN CHECK $ E
O
Authorized Agent 196'50
LL
St. TOTAL FEE $ 96•SO