HomeMy WebLinkAbout810 19TH ST - Building Permits�,
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Job Address:
Suite No
Viciniry:
Parcel Nunmber:
81p W 19TH ST
42230114
ELECTRICAL PERMIT
Applicant: PRAUM, STEVE -
_ .�, � ,r_�_--. _
Address: 1049 MELROSE ,� j, � ' "" - : - �- -
/ %'; � �Phone: (714)231-7501 � . ,
PLqCENTIA CA', - �- � . Zip: 92887 , � � �
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� � � ��� VA . , � ' - .
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Owner:' WENZ, LEONA
/ ,bi / � /
Address�jP O BOX 624/���;"�
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\ -�//",%�/'� Phone:
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;�" WOODCAND HILLS, CA Zip: 91365
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Contractor.,, ` ORANGE ELECTRICAL CONTRACTORS
,
Address: �10,49 MELROSE � , ' . -
Status: ISSUED
Applied: O6/05/2003
Issued: O6/O6/2003
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� , ��Phone: (714)980-2300 . . �
. PLqCENTIA, CA " � Zip: 92887 " �
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, , �� _ � . -- License: 747129 �
. . . -' ., � � \,
� �, .,- - � , ,SCOPE OF�,PERMIT , � �
� CONVERT EXISTING OVERHEAD ELECTRICAC SERVICE TO UNDERGROUND FEED.
FEE SUMMARY '
Quantity = , � ,
ISSUE FEE $0.00 � - � � Temp Disl $yslem / Lighting-
� Temp service test'�, ; $0.00 Busway /100 ft�
�_Res. a/c package ��, ��:: $0.00 . Sfanding Section , �
New Res (1-2 units)� ��,,':�\ $0.00 � 0 Misc Electnpl Equipment
New Res (3+uniLs) ;'. �� �;, 30.00 0 � Transformers up to 1 kva/kw
Pool I SPa � " ' ' ' '. $0.00 0 '^'''''� :t :.:.:.........up to 10 kva/kw
\ � ' �, �d
Lighting Fixfs � - � �� ��, �$0.00 0 .: �+;..'-� � . . ...............'.up l0 50 kva/kw
Recept OuUets � ; ��� �$0.00 0 ,'..:, � ' ..................up to; �100 kva/kw
Switches '.� �, .� ,... - ..'..'� . .. ..:.... .. ....over 100 kva/kw�.i �
���$0.00 , 0
Non Res AppP� � " � � $0.00�� � � � 0' - ' - , �Low Voltage Equipment �� �
Res Appl ��;� /.-:. �$0.00�0; ,-�, _ 0 � Low Volt Wiring System / Ckt
Service to 200a - � , ." $30.50 � - 1_ � ' Misa Conduit
Service to 1000a � �� . � 50.00 �- � � 0 _ �- Misa Conductor
Service over 1000a�,A� - � 30.00 �. 0 . �� - Circus ( gen or ride)
Motors to 1hp ��� $0.00, � � 0 - � Circus (mech ride or lighls) �
Motors to 10hp �� `�$0.00 ;�� 0' �, - Christmas Tree Stand�.
Motors to SOhp �; $0:00 ', 0� � � Fireworks Sfand �
Motors to 100hp ��50.00 �' � 0 , ' Other Electriral Fee -
Motors over 100hp $0.00 �_ � � 0_
Communicafion dmps $0.00 � � 0,
Sub panel to 200a $0.00 �0�-�-_;'
Pole Light Pkg 30.00 0
Sign CircuiLs $0.00 0
Quantiry
$0.00 0
$0.00 0
$0.00 0
$18.20 1
ao.00 0
$0.00 ,: �0 �
$0.00 - r- 0
$0.00, � 0 .
$0 00 ' 0
$0 00 0 .
$0.00 , 0
$0.00 , 0
so.00 0
$0.00 0
$0.00� 0 ;
$0.00' � 0�
$0.00 . -� � 0
$0.00
Inves6galion Fee _ .� �� � $0.00
Plan Check Fee� � -� $0.00
. . Reinspection Fee 50.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all epplicable codes, and all
required Inspectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (71q) 7545628
zana+e �aw�
WORKERS' COMPENSATION DECLARA710N:
I hereby affirtn untler penalry of perjury one ol the tollowing declarations:
❑ I heve and will meintain a certificate at consent to sell-Insure for workers' compansation, es proWtled for by sectlon 3700 0l ihe Lebor Cotle, for the pertortnence of ihe
work br which thi5 pertnil is Issued.
� I have entl will maintein workero' canpensetion insurence, es required by section 3700 ot the Lebor Code, for the peAortnance of the work tor which Ihls pertnit Is issued.
My warkers' compensallon InsuJgnce cerner end policy number ere:
Cerrier. S i A i'�1 �� J ni (i Policy Number. 2 2.q'G �
(Thls sectiar need not be completetl il t�e parmit /s valued et one hundred dollars ($100J or Iess.J
❑ I ceNly that in the pertormance of Ihe work for which ihis pertnil is issuetl, l shall not employ eny person in any manner so as to become subiect ro the workers'
compensetion laws af lifami and epree that if 1 shoultl 6ecome subjea to the warkers' compensatian provislons of Section 3700 ot t�e Labor Cotle, I s�all forthwith
camply with these Orov� ons.
Applicent Signeture: / � Date: � '� — Q �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVEMGE IS UNL4WFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE HUNDRED
TFIOUSANO Dq1ARE ($100,000�, IN ADDITIIXJ TO THE COST OF COMPENSATIdJ, DAMAGES AS PRWIDED FOfi IN SECiION 310fi OF THE IABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARqT10N:
I hereby atfirtn that I am licensed u�r Ger proNsions o haptary (commencing with Section 7000) of Dlvision 3 of Ihe Busines �and Prolessions CoAe, antl my Ilcense Is in full
�orce ena ettect. uc. x ri �-1 I 19 �1 /I ciass a !4 112 �(
Contrectofs Signature: � Date: —6
CONSTRUCTION LENDING AGENCV:
❑ I hereby aflirtn that there is a construction lentling agency br ihe pedortnance ol the work lor which this pertnit is issued. (Sec. 3097, Civil Cotle).
Landefs Name: Lentler's Address:
Slgneture: Dele:
OWNEH-BUILDER DECLARATIONS:
1 hereby eMirtn that under penelty of perjury Ihat I am E%EMPT FROM THE CONTHACTOHS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires e pertnit to conslruct, elter, Improve, demolish, or repalr eny siructure, pnor lo its Issuance, also requires t�e eppliwnt for such pertnit
to lile e signed slatement that he or she Is licensed pursuant to the provisions of Iha Camractars IJcense Lew (Ghapter 9(commencing vrith Section 7000) of Dldslon 3 01 the
Business end Professions Code) or that he or she is exempt t�eretrom enA the Gesis for Ihe alleged exemption. Any violatlan of Section 7031.5 by any epplicent tor a pertnit
suD�ecis Ihe aDPliwnt lo a civll penelry of not more than five hundred tlallars ($500).):
❑ I, as owner of ihe properry, or my employees with weges es thelr sole compensatlon, WILL DO THE WORK, and tha structure is not intendetl or oHared for sale (Sec.
7044, Business and Professlons Code: The Contractors License Law tices not appty to an owner of property who builds or improves thereon, antl who tloes such work
himseN or herseN or thraugh his or her own employees, provided ihat such improvements ere not intended or ottered lor sele. If, however, Ihe builtling or Improvement is
sold within one year ol completion, lhe owner-builder will have ihe burden of proving that ha or she ditl not Duild or improve for purpose of sale.). � -
❑ I, es owner of Ihe property, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construci the projed (Sec. 7044, Business antl Professions
Code: The contractors License Lew does nat apply to en owner of pmperty who bulltls or Impmves ihereon, and who comrecfs tor such project wlth e conirecroqs)
license pursuant to ihe Comrectors License Lews.).
❑ I em exempt under sec. Business antl Pmfessions Cotle br ihis reason:
Signature: Date:
Owner ID veniied by drivefs license. ❑ Ves ❑ No Drivets License No. Expires:
Vedficetion oi Ownership by (rype ot tlocumenL i.e. - properry tex Dill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I here6y certity that no ascevetion five (5) or more leet in depth into which e person Is requiretl to tlescend, will be made in connection with work authorizetl by this
pertnit, and ihat no building structure, scattolding, lalsework, or demolition or dismaNling theraoi, will be more than ihirty-slx (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Titla 8, Califomia Atlministrative Code).
❑ As owner-builder, I will noi employ anyone to do work which would require a permit Irom the Division of Industrial Satery, es noted ebove, unless such person hes e
pertnit to do such work iram the division.
SignaNra: Date:
Division of Industrial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENfRY: I certify untler penelty of perjury that I have read ihia application and state that the information given is
wrrect. I egree to compty with ell state laws en0 ciry ordlnences relating to building conslrucilon, end authonze representetives of ihe Ciry of Coste Mesa ta enter upon Ihe
ebove-described roperty for inspection purposes. I egree not to occupy or ellow occupancy oi eny buiiding euthorized by Ihls permit until final insDection.
Si ature Of Legfll Owner(s) � J� Date
Antl/OrAut�orizedApplicant `O� Date
GOOE�. INSVECTIONTYPE QSIE L�A��S
1676 Fixetl System Final Fire Prevention
1266
200
201
202
203
Pool Spa Final
Final Ra-Root
Flnal BIocWRetelning Wall
Final Fectory Fire Plece
Final Sign
204 Final Demdition
COOE 1 INSPEGfION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final ElecMcal
212 Final Fire Prevention
220 Final Planninq Approval
222 Final Site
250 Final Builtling/Occupenq
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�PPLICATION FOR A BUILDING PEF�T
i'
BUILDING PERMIT NO. E�ettr�ca� po
Traci Block Lot Permit No. �
Builtling
Plumbing a
AtlCress �` !� � L��� " I C ��'� armi[ No. e
Cross �� G � Mechanical a
Area Strxt �J 0� Permit N2 a
m
Ownar ���.��.�„�t LL��,1; ��-IC ' L TyDe f Rojecb ❑ New ❑ Alter ❑ Atltlitlon �
ACCre55 ❑ Rapair ❑ Convert ❑ Demo ❑ OCCupancY Pmt.
CItY � Or d� M�%%� ZIP �hone •� .P. 5 sP� Atrea
Archilact/ Zone SPI. Vmt. No.
Designer Ucense No.
tbacki P/L Front C/L SL Streel WIA[h
aaeress
Vara Left R ght ear
CIIY ZIP P�one
vB O . 9 . .
Engineer Lltense No.
`C - fk flg SpdCAS equlf ov e oV¢f¢
p, AEtlress
� q�Y Z�P Pna�a Struct No. of No, of
Helqht Storles Famlly
� LICENSEU CONTRACTOR'S DECLARATION vark Feas ves Fee
�p I hereby e7firm tha2 1 em licensatl untler provizions o( Chepter 9 RaqWreE ryo 0.T. Reulpt
(commancing w�th Section 7000 of D���sion 3 of the Bufiness and
« Zoning ApProveO By Date
Professions Cotle, antl mYlicensa is in tu�� force and affe cl.
2� tYCBnSe CIdSs_ �� }�� ca�nsa Nu�nb r �
> Daxa Contractorrr.�i'a J • Mlsc.
E Aedrnss �14C� " — l. L:�- i_�.ta..t_ .e� ProPosetlUse
� af Structure
jL CitVand�'r �'��'� Phon �`
a CONSTRUCTION LENDING AGENCV
� I �ereby nffirrr� chet mere is e conztrvction lentling agency for tha
a pertormence of the work for whieh this parmit is iss�ed (Sec. 3097, Occ. Type Cotle
Cldii Const. Y6ar
' CiV. C.).
� Lentlar's Name "^� USE/OCC SIZE SQ. FT.
� LenCer's Atldrar�
'� OWNER-BUILDER DECLARATION
: I hereby nftirm that I nm exempt from the Conttactor's Licanse Law 1�
1° for the follawin9 reawn:
� ❑ I, es owner of the prOparty, or my emplOyees with weqas as their Z.
mie compensation, will do the work, antl the sttucture is not
= intentletl or Offered for ulo,
f' 3.
� ❑ 1, as owner o( the property, am exc�usively contraeting with
licansetl contractarsto construct tha projact.
� ❑ I em exampt �ntler Sec. , B&PC for this reaaon 4•
a Dat Owner
E WOpKERS' COMPENSATION DECLARATION 7ota� Valuation
� I hereby affirm ��et 1 hava e cen'rficare of consam :o aelf-insure, Encroachment Pormit Requlre ❑ Ves ❑ No
or e cer2ifiww of Workers' Campansation Insurance, or a certified
C copy theruof. Gratling PmL Gratlin9
� Policy No COmpeny Requl�Otl � Ves ❑ o Pmt. No.
�a ❑ Certifiotl copv is hereby fumishatl. qougn GraGin9 �
Q❑ Cartifietl copY Is tiled with Orange County, EMA. qpp�ovatl by: pate 10
Date Applicant 3
CERTIFICATE OF EXEMPTION �p '
FROM WORKERS'COMPENSATIONINSURANCE z
(Thia saction a¢ed not be completad if permit is tor $tU0 ar lessl. �
I tertify that in the parfo�mence o! [he work tor which this parmit is 3
issued, I aholl n�i employ eny per:on in any manner fo as [o become A
subjecr to the WPrkers' Compensation Lews of Californle. PERMIT FEE
Det Applicant
NOTICE TO APPLICANT: If, after making this Certificate of SVuttural S Pla Check y
Exemptlon, you should bacoma sub�act to the Worke�i Compansetion
provislons of the labor Code, you must forthwith comply with such Elettrifal 5 cial
provisiona or thi5 Parmi2 sholl be tlaumetl �ovaketl. E I est. s
I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE
�THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO P�umbing E
COMPLY WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATINGTOBUILDINGCONSTRUCTION,ANDHEf7EBYAUTH- Me<hanlwl S
ORIZE REPqE5ENTATIVES OF THIS COUNTV TO ENTER UPON
TFIE ABOVE ME�{NTIONeED PROPEflTV FOR INSPECTION PUR- RB-GraCe
PO S.�,v� �l ^'���- L r'C, '�O C. 8
� Inspection
� Pra-Gratle PerT
iB�ature of App��cant or Agent � Date S §
Ret. No. Iszue
fi .! tC e-L r- y _
Print ApplicanY4/A9anYs Name
Plan �ssuance
All tpaCes within this box must be mmpleted ta process Cnack ev: Approvetl:
CMF 0335-46 (BU-28) rev. 6/80
PNOJECT AOOHESS: 8 I O W 1 9 T$ CJ T
OWNEN'S NRME: WENZ LEONA
aooness: P O�OX 4 9 2 9
PALM SPFtINGS,CA
p��XES$:
UNIT:
92263
flEG.NO.:
UNIT:
'� PEflMITTEE: ROYAL ROOFING ( 714 ) 449-7750
aooxEss: 1351 W SANTA FE AV .
FULLERTON CA 92632
LICENSEU CONTBRCTOB OECNPFTION: I hereby aryirm ihai I am Iicense0 uneer pr vfSYons ol ChaD�er 9(commencing wit� Section
7000) ol �ivisian 3 oi ��e Business antl Pmfessions Cotle, a y licen is full l reelan0 e�fea.
cirruc.:046668 sra.euc.:43235 cuss. C 9
Date'. _/�/�/_�-`��—_ Siqnawre: _
wOFKERS' COmPENSai aN oECLAflATION: I here�y attirm that I have a ce i( te of consent to selbinsure Or a ceni�icate o1 workers'
CamDensaiion I s}�{a �p ti�ie �QDY �hereot (Sec�ion 3800. Lab. �
POLICY NU.: �"�J���—� J EXP. �pTE: 2�OS I
comPnxr: STATE FUND,..t
� Ceriilietl copy is here�y �umishetl. 19 CertifiGa �op ' 'letl il �h ity ildin Oivisi n.
Oa�e: �(��//� AODlicant:
E%EMP710N FHOM WOflREPS' COMPENSATION DECLABPTION: (This section neeA na�_ e c plete� i� t�e p¢rmii i5 �orone huntlretl ($100) af 1e55�.
I cerlily Ihat m ��e pedormance oi ihe work �or which �his permi� is issued, I s�all no� employ any persOn in any manner so as �o Oecome
suble�� �o the Workers' Compensalion Laws oi CalitOmia.
pyig; SignatUre'.
NOTICE: Ii. after making Ihis tlecla�a�ion, you spoulA 6ecome SuUject to the Workers' COmpenSa�ion O�ovi5i0n5 a� the Lahor
Cotle. you mus� torihwil� comDly wi�� such pmvisions or this permit shall be Oeemed revakeU.
CONSTPULTION LENOING RGENCY: I hereby atlirm Ihal lh¢re is a cons�mction lentling agency lor lhe pedormance ol Ihe work �or
w�ich ihis permit is i=sued (Seilion 3097. Civ. C).
LENDEP:
aooRess:
OWNEB BOIlOEF UECIAPATION: I hereby aifirm tha� I am exemp� �mm �he Contrac�ors' Siate License Law �or the tollowing reason
(Section 703L5 6usine55 and Pmlessional Catle: Any ciry ol coun�y whic� requires a permi� to cons�mct, alier, impwve, tlemolish, or
' repair any structore. pnor to its issuance. al5o requires Ihe aOW��ant (ol sbch permit to �ile a signea s�a�ement tha� he/s�e is Iicen5e0
pursuant Io �he pmvisions of ihe Coniractors' State LiCense Law (ChaD�er B(commencing wiih Sec�ion 7000) ai Oivision 3 ot ihe Business
anU Pwfessions Code) or ihat he/s�e is exempt t�erN��om antl t�e basis lor t�e aliege0 exemption. Any violation ot Section 7037.5 by
any applicani for a permii subjec�s Ihe apDlican� [o a civil penalty oi no� more Ihan live �untlrea Oollars (ESW�.
I. as owner of ihe pmoeny or my employees wilh waAes as iheir sole compensation, will do ihe work, anE ihe
❑ slmcWre is noi intenOeA or ol�ereU �or sale (Sec�ion 7044, Business antl Pmfessional Coee: The Con�rac�ors' S�a�e License Law
tloes not apPty �o an owner o� a pmpe�y who build5 or improves lhereon, antl who Ooes�such work himself/hersel� o� I�roug�
his or her own employees, pwvitletl Ihal SUCh impmvemen�s are nol in�entled or ofle�ed tor sale. II, however the builtling or
imOrovement is sold within one year o� completion. �he owner will have the burtlen oi pmving helshe Uitl not huilJ or imD�ove
lor �he purpose o� sale�.
I, as owner of �he propeny, am exclusivety con�mding with licensetl contrac�ors �o conslmci �he pmlect (See�ion 7044, Business
❑ and Professions Code'. T�e Conimctors' Slaie License Law does no� appty �o an owner o� pmDerty w�o hutlJs or improves Ihereon
and w�o contracis lor such pmlecls wi�h a Contraclm�s)license pursuan�to �he Coniraciors' S�ate License Law�. I am aware
t�at Droof o� t�eir Worker'S ComOensation ipsurance 5�ou10 he pmvitle0 to me. �
� I am exempt untler Seciion: B. 8 P. C.
lor Ihis reason:
Dale: Owner:
I ao hereby cenity thai I am aware o� ana unders�and the reQuiremems o� Calitomia Health an0 Safety Code Sec�ions 25505, 25533, and
25534 antl Iha� I or any tNure builtling occupant willl ill nol (circle one� neetl �o comply wlth saitl 5teie wdas antl �he reqWrements �or e
permit lor canslmction or mo�ificalian Imm t�e Air uali�y Managemenl �iSVicL ReSidenlial constmc�ion application5 are exempt Imm
IIIeSe provi5i0ns.
oaie: Aao��cam: •
I M1ere�y certify Ihal I have read I�is application and 5�aie Iha� t�e a0ove inlormation is ect. I agree to compty vnih all ci�y anE caunty
o�tlinance5andslatelaw5ielatinglo0uiltlmgconslmctionan �yaWh i sent ive oflhi5ciiylaenlerupontheabove-mentione0
pmPenY lor inSP¢tlian Purposes.
Da1e: �-�' �9� Si9na�pre'.
oriver's License or Social Securily a:
�64La6 Whne—Buildmg: Green—Cotle EnlorcemenC Canary—AppbcanC Pink—Revenue', Goltlenmtl—Assessor
� CITY OF COS'PA MESA — BUILDING PERMIT PERM NO; B 0 1 \
PERMIT NO; B 055225 PLAN CHECR NO; N GOVT; N:,SUP :
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: AiT
JOB DESCRIPTIUN ; T/O CAP SHEET, REROOF W/3 PLY BUILT—UP SQ FT; 1; 3,500
CLAIM VALUE: 3,500,00 CALC—VALUE: 3,500,(�0 GROUP OCC: B-2 /
�
COMMENTS: � �
�r****��r******�r**�r*******�r�*��***�r��**�**�r�r�r�**��r*�r��*�r*�r**�r�r*���r�r*�r*±r�r**��r*�*��
Z O N I N GS ERTEB�AUCIKRSE M£ N T S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING �--------
FRNT: FT TN REAR: fiT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT ZN RGHT; FT IN
PARKING RE(� • PROV; PARCEL; 42230119 ZNE: REF NO:
PLANNING N(STES>
i � �'
**�***��*****����*�*���,r����*��*+�*��*�***��**�e**+�*���r*,��*��x���*�*�*��*�**�e���*��«
D E V Erli O P M E N T S E R V I C E S R E Q U I R E M E•N:":T.S
.�;f _ 1�
ZONING APPROVED. BY DATE;''��' �
BUILDING APPROVED BY ; � DATE:
'3
APPLICATION ISSUED BY: DATE•
ifiFlF7ElElEifiEiE3EifkiEiEiEiFkiFiEiliEif 'iFTF'iFiiiF3fiEiFifiPiEiEiE�tiE '. 3Eik
iEiE�F�EifiEak3EitaflFif�f�EkiEiFiElF3fifiEif�EiFlFiEiFiEifikiEiEjFiEiF�FiEiP ikif iEiEiFiFifififif3FifiFifiEitiEaFiF�FiEjF3EifiFiFjE��fiFiElflEjFiE�1tlEif
LEGALIZATION:I3 F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 E�
SMIP/NON—RES
PLAN ` .74
ISSUE FEE �
HUILDING—DIV—> PERMIT ISSUE PliAN=CHECK TOTAL• PAID DUE �
TOTALS----> 63.74 0.00 0.00 63.74 63.74 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 63,79 OVER/SHORT; ,00.
BLDG PMT PLUMHING ELECTRIC MECHANTC FIRE SMIP/TOT GRADING PLAN—CHECK
63,00 .. - .74
if iE �E iFlf if iE iE iE if 3k if IE �F 1E iE �t 3E iE iF 3k 3k iE iE iF iF df iF ik aE iF 1E iF!! iE iE 3F 3E 3F iE iE IF If 3f iE �E 3F jf if jF If iE iE if iF if it fE 3F iE if �1f��f 3F iF 3E ik if ii iE iE i4 3F 3f �Fi(� jE IE iE
Z N D I V I D U A I, - F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O_N'� UNIT COST TOTAL COST
SFC 3500 . REROOF HY VALUE COENDROfiAFEESNOZONE 1,00 3,500,00
)
�Is�':�i �- � ��N � �� �,,,,:.,.-:���:��s: - -
D97E. i_,'O'. i?I'c: .. .G
r
,...
CONSTS't CTIC�V AND PLANNING POOI oPA
APPRO�VALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service'gr Pole i - 52. Pool & Equipment-Location
2. Soil Pipe-Undr�rnd. �%' .. /�� 53. Steel Reinforcement
� 3. Electrical Conduit�Utility-Undrgrnd..'� 54. Forms j'
, " 4 iElectrical Conduit•Undrgrnd. - 55. EleMrical Bonding ' "
, 5.�Sjeel Reinforcemeni� '- 56. Rough Plumbing & Pressure Test
6.:.HectricalUFE�R�Gmd. �� 57. APPROVALTOCOVER-GUNITE •'�
' 7.�Footings _ 58. Electrical Conduit-Undrgrnd, t'
,� 8. Foundation �� ." . 59. Gas Pipe, O Undrgrnd., Test `'
9. Water Pipe-Undrgrnd. 60. Backwash Lines; P-Trap, O Undrgrnd. �•�
70. Structural Floor System . 67. APPROVAL TO DECK
17. Rroperty Sewer Line & House Connection 62. Backwash & Receptor-Final �
S
12. Sewer Cap . � . ;, 63. Heater & Vent-Final _
13. Roof Drains � 64. Plumbing System - Final
14. Rough Plumbin`g 65. Efectrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final -
16. Rough Electric Wiring 67. Fencing & Access ApP�oval .
17. Reugh Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrital•T Bar Ceiling , 69. POOUSPA SYSTEMS FINAL
-19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
7 lC ' 1. •
20:� Rough Eactory Fireplace � �� U - :' '+'�� �qPPROVAL5�'=�Pe�mit # �'
u ��. ,: a... - u: �u: i � +
21��Ducis, in Str,�icture, � .... �T'� �i. � �.� w �;70. llnderground Hydro . '
22. Ducts, Yenti��ting • � � � ; t+ i_77 produtl'�� n �6as
t ai s 4,":o�i
23 , Gas Pipe�Rough & jest � �� S� ;, �„ . � ,� � r . , 72. Underground Flus�-� � ',` ��
24. Roof Framing . � �`i � - � i y, .� 73? Undergrnd�. Smr�g�'Tank��O Gasr O �il
� 25. Roqj SFyeathing ,' ' ' , .` ;�' -,�: 74; Overhead Hydr� `� .
26 ,T�Bar Ceiling (Stru¢tural) &'Monocoat 'i � • � 75= Dty Chemical � � '�
-., n
27'. 1Frame and �lashing � ` _ �I' _ • � , � � � �'; ' � =O
, A,, �. 76. bry Stan pipe . l
28.�Lathing.&Siding . . ;�.. _ 2. � ••f 77�F�XEDSYSTEIV��INAY' �� '
29. Insulat(Qn ' ; , � ��' ;. �" , _ 78r FIRE PREV. FINR;L �. -. r �
30. Drywall Nai�ing � � � � , -%Y ' HEALTH�DEPT. REQUIREMENT
/•
�31. Plaster �town Coaf ,_ : ;, '� �', d., 79\�FINAL IP}SP�ECTION � . i`�.-
32. Electri¢al Power Mete��Fina4 :� ^y 80.�•FOOD CERTIFI'CATE ISSUED� � �
y
33:`Pinal Electrir, ' , :i ; r t�� � �" ' - Notes: �' /J� � � (��
` �' . .�--esc �'y�-'w`.^.�- `��
� 34�Final Heating & Air Conditioning. -'_; � - . � � R .�i � , � �
35. Final Gas Pipe-Test; ,_ ' �" � •1,; ` ' ` ', '
364Hoodo�Canopy - • - ����, s• ��: � -
,�
37: Fin3'I Factory Fireplace . � �t � � • � �?Yi. , . ,
38. Fiqal Plumbing .: - � j ; � - . - --
� � 39. Wa{er Service�Pinal � � � •=�`� ? '� � -�
,� � �
,�40. GasSe�vice-Final y,• . -. r . � ~� � . � ',
> 41. Solar pomesticFimalS, �:� � ~ ' '
� t r " '
42�`Backflow Preventer � � ' . �. a., . � , �
43. Backflow Irrigation - `� �`� ' ' ' ' ` ; '' ,- a
� �;
. Y j. 4 - S
44. Eandscape Irrigation Systerq ,•,,. ,� . - .. �. ; . � �� '
> 45.. und Attenuation �'X��� � ' � F" ' ' " * � � �- ' �
II _ _ r r �I : - Y� . � . _ '
46:, � . � \
� '.•FINAL STRti1CTURE & BUILDING L. �'-' '�� '
� .
. 48 �FINAL PI.A . � ; ' f. .. •�� 4t, .
/ . i . _ _
� 49. Eiectric Release to Edison - ��i • • 'i. _ -
s
5d. GasjRele_'ase to Southem Cafifomia Gas Co : � , „ � ` � - . � r . - � -
51�. CERTIFICATEOF.00CUPANCY . . ,„ . : - . -+
IJo. Date
_ �
PHOJECT RDUNE55: S S U W 19'FH J" 1
�'',rJ�iS NAME: WEIVZ � LEOI�A
aoonEss: P O BOX 9 9 2 4
PALM SPRZNGS,CA
FPCH/ENGINEEfl:
FODflE55:
uxiT:
52263
flEG.NO.:
UNIT:
PEBMITTEE: (�OYAI: RO(]FFING ( 714 ) 449-7750
noonEss: 1351 'r7 SANTAFE AVE
FULLERTON CA 92632
LICENSEO LONTBRCTOfl OECLAflATION: I pereDy a��irm ��a� I am Iicen5e0 untler pmvisions ol Chapter 9(commencing wilh Settion
7000� of �ivision 3 0l t�e Business antl Pm�essions Code. a my license is in full tome and efiec .
cirru : n46668_ srnTeuc.;43235 � �zuss: C-39
-r �,_I- Si9nat re
WOBKEPS' COMPENS�bE�IABATION: 1 hereby allirm that I have a cetlifica�e al cons �o setl-insure or a certitica�e o� Workers'
Campensalion iPsg�aRc� p[ ��tilied yppy inereol (Section 38W. La0 f,).
POLICY NO.: 1 V y 7 25 7 EXP. ORTE: 1 2/ 01 / 91
camraxr: STATE FUIJD
� Ceni�ied coOY �s hereb �urnis�eA. � Cenilie0 copY is etl with �he ciry Building Uivision.
� C
NpPli[anl'
EXEMPTIONFflOMWONNEPS'COMPENSRTIONpECUMT10N: (Thissectionneednolbecomple�etli e0ermitisloronehunUreA�5100)arless�.
I certity �ha� in Ihe pedormance of the work �or which ��is permit i5 issueq I shall not employ any pe�son in any manner so as lo become
. subjectio �he Workers' Compen5aiion Lawg ol California.
Dale: Signa�ure:
NOTICE: IL a��er making Ihis tleclara�ion, you s�oultl 6ecome sub�ect to �he WOBers' ComDensation pmvisians oi Ihe Labor
Catle. you musl forihwith comply wiih suc� provisions or Ihis permit shall be tleemed revoketl.
CONSTHUCTION LENOING pGENCY: I her¢by afiirm �Aa� �here is a cons�mc�ion lending agency �or ��e pertormance of Ne work for
which this permi�is issuetl (Semion 3097. Civ. C). '
LENDEP:
aooxess:
OWNEB 6UILDEB �ECLAflATION: I �ereby a��irm Ihai I am exemp� irom �he Contrac�ors' Sia�e License Law �or the �ollowing reason
(Sec�ion 703L5 Business ana Pmfessional Code: Any ciry oi counry which requires a permi� �o construct, alter, imD�o�e, tlemolish, or
repair any slruCNre. prior Io its issuanCe. also requires �he applicant for SUch permi� to file a Signetl 5ta�emenl ��a� helshe is liCensetl
pursuam lo �he provisions af Ihe Comracmrs' S�ale License Law (C�apter 9(commencing wiN Section 7000) of Division 3 of Ihe Business
and Professions Cotle) or ihal ne/she is e�empt iherelwm antl ihe oasis for ine allegetl exemption Any violation oi Section 703L5 by
any applicani for a permil sublects Ihe applicanl �o a civil penalry of no� more �han five hundre0 O011ats ($500).
I. as owner oi Ihe Dmpe�y or my employees wilh wages as IAeir sole compensa�ion, will tlo the work, antl the
❑ stmciure is not in�entletl or oileretl for sale (Section 70C4, Business and Pwfessional Code: The Contrac�ors' S�a�e License Law
tloes no� apply lo an owner ol a prOperty who Duiltls or impmves �hereon, antl who tloes such work himsel�/herself o� �hrough
his or �er own employees. Dmvitletl t�at suc� impmvemenls are not intendetl or oifered for sale. If, however ihe 6uiltlinp or
improvemenl is soltl wi�hin one yea� o� comple�ion, the owner will have the bu�0en of pmving he/s�e tlid noi Uui10 or impwve
lor ine ourvose ol sale�.
I. as owner ol Ihe pmDerty. am e�clUsiveiy coniracling wilh licensea conlrac�ors ro cons�mc� th¢ pmjec� (Seclian 7044, Business
�❑ an0 Pmlessions CoOe: i�e Contrac�oK S�ate License Law tloes not apDly �o an ovmer of D�operry who �uilAs ar impmves ihereon
an0 who coniracts �or such pmle��S wiih a contraCior(s)license pursuan� �o �he Contraciors' Slate License Law�. I am aware
�hal pmo� ol l�eir Warker'S Comp¢n5aiion insurance 5�oW4 be pmviaed lo me.
� I am exempt un0er Seclion: 8. 8 P. C. �
tor Ihis reason:
�a�e: Ownec .
I tlo hereby cerlily I�at I am aware ol antl uqtlersland I�e reQuiremenls o� Cali�omia Healih antl Sa�ery Co�e Sections 25505, 25533, antl
25534 anA Ihal I or any IWure builtlmg occupant will/will nol (circle one) neeA �o com0ly wi[h said state codes and Ihe requiremen�s tar a
permi� �or constmclion or motlilicaiion Imm Ihe Air Oualiiy Managemen� Oi9ricl. Resitlen�ial constmc�ion applica�ions are exempl imm
I�ese provisions.
�a�e: ' Npplicanl:
1 hereby ceridy ��al I have reatl �his aOPlicalion antl s�a�e Ihat the ahove in�ormation is correcL I agree lo comply wilh all ci�y and counry
orainancesantlslatelawsrela�inglobuiltling�onsimc�ion herebyaN�orizereD�esema�ivesof�hismry en�erupon�heabove-menlionetl
p�mpeny {�r i�� n pur�sel S I� �
� � �, � .�.
n.h,or'c I I�onco nr Cn�ial Sorurilv M' '
t641-46 WbiPo—Bmitling; Green—Code Entorcemenl', Canary—Applicanl; Pink—Fevenue; Goltlenrotl—Assessor
CITY OF COSTA MESA — BliILDIhG P�RMIT
PLRMIT NO: B 059938 PLP.i�', CHECK NO: N
CONSTRUCTiON TYPE: V—N P�RMIT TYFE: STR
PURPOSE: ALT
JOB DESCRIPTION . 3/OFF �nSHT. REh00F W/COMP. S� FT; 3,500
CLAIM UALUE: 3,500.00 CALC—VALUE: 3,500.00 GROUP OCC; R-3 /
COMN,ENTS• SNORE DETECTOR RE�UIRED 3N THE HOME
**x�*��*i�x����c�x-u*�*�*�c;���* �*�**��**��cx**x�*��**x+�+���*�*��;*�:*����K�*����x�*xs�
� O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDZNG ---------
FRNT; FT IN REAR• rT IN FRNT: FT IN Rr.AR: •"',�$T IN
LEFT: FT IN RGHT; rT IN LEFT; FT IN RGHT: ; ;T I�7
PARKING REQ: PROV: PARCEL: 42230114 ZNa: REF NO:
PLANNING Nt3TES> ,
� :.
If iE iE �7F iF iE iE iElF-%iE if-�f �lf ff 3i jF 3E IE iE iPjF ��k ie iE if 3E-� if i't if�-7(� iF-lE iE jF �Jf �F iE iE iE 3f �1f if �lE 1f jE if iE3E �lf le �c )f if i4 3F if 1F 3e �7'r iE 3f 3E �)f �'t?E�N� #±e k iE?i ?E?%� ih 3't-X�
D E V E L O P M E N T S E R V I C E S R E Q U I R E iK E-N r�a -S 3
'LONING AAPROVED BY 11ATE: `
HUILDING APPROVED BY :
APFLICATION ISSUED BY:
��rr.�x*x��txx���**��x�-�*��'�sr�3 �
If3fiFiE�fielFiEiFiFiEif�fiEifiEit•�iF*jE�lf3Fii-9f�fiF#�Fi4�1kiF�Fii�ie-1F-JE ,
LEGAI,I'LATION: N F' E E 5
bLDG PMT PLUMBING ELECTRIC
DATE; „
DATE: I��
� . . .. . . >�3E3ri4�i-dElP#�ifiF.... n. .X..K.
��F 3(� �lE jf iE iE 3E 30i4 9F iF 1P iF 1F 3F ## 1l� iE iE+� #F �i+,- �k # iE jf # 3FjF} jF i(� ff ��f
M A R Y STRUCTURAL� Sr.GNENT:Y
MECHANIC rIRr. SMIP/RES GRADING
PERN,IT 63.00 SM3P/NO�—�ES
PLAN
ISSUE E'EE
AUILDING—DIV—> PERMIT SSSUE PLAN—CHECK TOTAL FAID DUE
TOTALS----> 63.50 0.00 0,00 63.50 63.70 ,UO
REVENUE DIVISION TOTALS—.—> COLLECTED: 63.50 OVER/SHORT: .00
BLDG PMT PL'JMBING ELECTRIC NECHANIC FIRE SMIP/TOT GRADING FiAN—CHECK
63.00 .50
if i! ih 1E aF IF iE ie !f tf iE !E iE jF if �'r 3f �F 1E 9E iE lE 3F if iE-k if iE jF iE 3E )f iE-%� aE if iE i4� it if if if 1ElF �1F iF if �E *�1EiE if iE 3E if 3F� iP 3f ik 3k iF fE 3F IF 3F #E 3'r ��F iE 3f ic 3i� iF 3c?i iF u
I N D S V I D U A L c E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UI��IT COST TOTAi COST
SFR 3500 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,500.00
END OF FEES
6�s �I� ���,� �
�1 CA.h���?—�71pIS53 'r �:�- .
�1d14i ����L.:/G: ,'Z'�Le ir.p. . .
� r
��CONSTRUCTION AND PLANNING 1 POO SPA �� �
��Date Inspector � Date Inspector
APPROVALS Permit # ' ' _ _ APPROVALS Permit #
--�
1. Temporary Electrical Service or Pole �� � 52. Pool & Equipment Location i �
2. Soil Pipe�Undrqrnd. '� �y - 53. Steel Reinforcement :
3. Eiectrical Conduit Utility-Un�rgrnd. �' . 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 j
7. Footings • ,� 58. Electrical Conduit-Undrgmd. +"'
8. Foundation � = -� 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. `�- _� 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System ! 61. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
. �
12. Sewer Cap �, . 63. Heater & VenbFinal •'
�
13. Roof Drains �. �'�� 64. Plumbing System - Final �
., �
14. Rough Plumbing ___ . 1 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#
27. Ducts, in 5tructure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test ' � 72. Underground Flush
24. Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
-�
26..T-Bar Ceiling �Structural) &(vlonocoat 75. Dry Chemical i v
27. Frame and Flashing . 76. Dry Standpipe � -�
/�. ;
28. Lathing & Siding • 77. FIXED SYSTEM FINAL � J-- '
�� 29. Insulation � 78. FIRE PREV. FINAL i" ��
30. Drywall Nailing '. HEALTH DEPT. REQUIREMENT �" %' �,
1
31. Plaster BroWn Coat � 79. FINAL INSPECTION �
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric - ' Notes: ' ty �
34. Final Heating & F,i� Conditioning �? -l-� y
35. Final Gas Pipe-Test i�1t ' „ '
36. Hood or Canopy � � . � . ,
37. Final Factory Fireplace y'�
38. Final Plumbing , � ' , � i
39. Water Service•Final
1
40. Gas Service-Final �
- 41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscap¢ Irrigation System ,
45. Sound Attenuation -
�� 46. Handicap Regulations
47. FINAL S7RUCTURE & BUII DING Z��
� 48.\ FINAL PLANNING . �
49. �Electric Release to Edison ��
50. Gas ReleaSe to Southem California Gas Co � ��,
51. CERTIFICATE OF OCCUPANCY
i
No. ° Date
Pfl0.1ECT►OONESS: �lO W 19TH ST
OWNEw'SNA�nE: WENZ LEONA
aooxess: p p�OX 4 9 2 9
PALM SPRINGS,CA
AflCH/ENGINEEfl:
RDDNFSS:
UNIT:
92263 + •
NEG.NO.:
ux�T:
PFRMITTEE: LEONA WENZ ( 619 ) 320-2039
PDDNES3: 4(J24 P 0. B�X
PALM SPRINGS CA 92263
LICENSED CONTqptTOB OECLpMTION: I �ere0y affirm Ilwi I am licen5ed uMer provisions ol Cllapter 9(comm¢ntin0 ��� Seclion
��) o� Omsion 3 of ihe BuSineu an0 Prat¢Stions CoGe, aiM rtry IirenSC 5 in IW Iwce anE eneci.
CITY L�C.: STRTE LIC.: CLASS:
Daie: Signamre:
P10PNEBS' COMPENS�TION OECIAMTiON: I AereOy afii�m Itwt I luve a certifiwte of rpnsenl to selbinsure or a certiliwta oi Workers'
Lamoensaiion Insurance. or a cenifiea copy t�ereol ISation 380D. LaU. C).
POIICY NO.: E%P. ORTE:
COMPRNY:
7 Cenilietl coDY �s hereCy lumishetl. ❑ Cenilie0 wpy ¢ lilee witA tne ciry Builynp Uidsion.
Date: NGD����
EXEMPfION FflOM WONNEXS' COMPEN511TION OECLRMTION; (itus seciion neeE not Ee comqeteU if Ne perml is ta oire huiMreO (f10U) or less).
� C¢nity ��ai in Ihe pertormanpe 01 Ihe work fOr whiCh ��is pErmil is is5ue0, I Shall nat empl0y any perSon in any manner 5o as lo becOme
suUlectio t�e Workers' ComOensa�ion Laws of Califomu.
Qaie: Signature:
NOTILE: It. aiter makinp �his tleclaratipn, you shoulG become suUject m t�e Workeri Compensation provisions ot tAe LaOor
CoOe. you mus� fonhwith comDty vnt� suc� prwisions ar tNs permii shall 6e GeemeO revoke0.
CONSTflUL710N LENOING RGENCY: I nereGy allirm Inat inere is a mnstmction IenOinq a0ency for Ine pedormanta of ihe work for
whicn ilres permft is issued f5ection 3097. Civ. C1.
tenoex:
nonness:
OWNEP BUILOEN DECIAMT10N: I �ere�y aflirm tlut I am e�empt Iwm Ne Cantraaori State License Law for ihe lollawinp r¢asan
(Sectron 7031.5 Busineu an0 Pmlessional fqEe: My dry o� muniy wliicl� repuires a perrtn� to m�struct, alier, imprme. Uemolis�, ar
�eDair any slNetua, orior ta i1s iuudnce. aI50 repuires Ihe appiUnl lor sucn permit to lile a sipneE statemenl Inai nUslle is IicenseA
Aursuam m iAe pmvisions ol t�e Comracmrs' Siate License Law (Chapier 9(commencinq wi�� Seclion 7000) of Oivision 7 0l the Business
antl Pmlession5 Cotle) or Ihdl he/sAe is e�emD� �heRlmm anG t�e hasis lar t�e a11e9eE e�emption. My violation ol Sectian 7031.5 hy
any appli[ant for a permit stlOj¢cts the appFcant to a c'rvil pMalty oiipt rtrore inan live hurMreO dollars (5500).
� I, as owner of the D�a7erty or my em loyees vnt� wapes as tneir Sale COmDenSation, will tlo ihe wark, and ihe
slmcwre is not inteneea or ollereG lor ule (�tion 70ad. Business an0 Pmlessional COEe: Tne Comractors State License Law
tloes nol apply to an owner of a prope�y w�w UuilOs or imprOves Itlere0n. antl w�o does suc� work himselVhersell or Ihrouq�
his or her own emD�oyees. O�oviOeE �nat suc� impmv¢menis am not intenGetl or ollered lor sale. Ii, however Ne builUinp or
improvemenl a 5010 within one ytar ol WmpletlOn, Ihe 0'+mer vn71 have �he Ourden of pmvinp hd511e tlitl noi 6uiIE or improve
lo� ihe Durvose al Salel.
I. as owner ol ihe DmDeny, am aclusiveIy wnlrattin0 ��h lic¢nse0 conlraclar5 io conslruci I�B D�ojec� �Section 7044, Business
❑ and Prolessions Co00: Ttre Contra�tors' State Lic¢nse Law Oces nat aDDN �o an owmer ol Drop¢rry wAo bm1Us ur improves tAereon
anA who comracis lar such pwjeas with a contraclor(5) licens¢ pursuant to Ne Coniracmrs' State License Law). I am aware
IIIai O�W� 0� IA¢if WOfkti 5 �.Ompell$dllOn iRSufdnCC SIIONO U¢ pf0Vi0EA �0 1110.
� i am eeemo� unaer Section: B P 70 4 4 e. a P. c.
io� m^u rea�so : W K BY OWNER ' S FACM� LY ///���// � I �
Da�e: �d /, � O'��� 6+mer/7C �if�'7'YC..i b"`�
I do �ereUy Cetiity Ihai I am awar¢ al an0 Urk!lSlanE Ille repuiremen6 01 iifomu Heatin an0 Satery CoGe Sectioirs 2550.5, , and
Q553C aM I�a� I or any Wture Cuiltlinp o[[upant wilUwill mt (tirde one) neetl 10 comOH ��� s2i0 state coUes anG the repuirements lar a
permil lor consiNction or moEilicalion irom Ihe Air Ouabry ManaAemenl Disirict. Resi�ential cansiruction ap0lications are exempt fmm
Inese pmvisions.
Date: l�ppticam:
I �ereGy cenity t�ai I have rea0 ihis aD�lication anU siate rtwl t�e ab inlormation is wrrect. I agree to compty wit� a1l cily an0 coumy
or0inanc¢5 antl statelaws relatingta builEinO tmstruttion aM Oeretry tlbritc repre5entatrves oft�6 rytoenterupon the above-mentioneA
pmper�y forr�ins eclpian..Dur oses. ^- / � nAn_
' Oa�e: .G � O yg�� � � /�/ r N Y/Y � / ��i
�, Driver's License or Social $¢curity a:
1641 n6 Whilo—Builtlinp: Green—CoOo Entorcemenl: Canarv—AooliwnC Pink—Revenue: GOIDenroO—Assxssnr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 05554
PERMIT NO: E 055546 PLAN CHECK NO: N GOVT; N S ,
CONSTRUCTION TYPE: S—N PERMIT TYPE: ELE PURPqSE: OTH
JOH DESCRIPTION : REPLACE HAZARDOUS WIRING& E(jUIP MONUTING SQ FT;
CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 /A-3
COMMENTS: THE "JOHANNA'S" BAR
�rx�+��r�r+��*�r*�r�**�rx *******�e*�e*x�x*+�***�r******�****x�****+r*�ex��**+�**��e**+r+r*�r*****�***�r
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: fiT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL:`42230114 ZNE: REF NO:
PLANNING N(5TE5> • �
�
iF k if �F 3f iF 1f i! 3F if iF jf 1f �f M it iE 1F if dF if 3E �f Ik iE jf if 3F iF if k if ik iF'!f if iE iF iF 1E i! jf jE k* 1f if it k�t k if iE if iF ff if i! k iF k if 3t iklE 3E �f �f iE k M iE iF ik �f k if �F �f
D E V E L O P M E N T' S E'�'R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY . � -� DATE•
HUILDING APPROVED BY ;
APPLICATION ISSUED BY; e9—�+
*�r��t�r�r�r***+riE***�*��r�t*�e
�e*�t�e�r�r**�tr+r�r*��e�r�t�t�t�rr�*�t�t*�r*�r�r+t*�t�it�r�t�t�t�r�e�r�t�r�t�t
LEGALIZATZON:N F E E� S U M M A
BLDG PMT PLUMBING ELECTRIC ;MECHANIC
PERMIT 88 00,
�OY,
PLAN '
TSSUE FEE 1S,00
BUILDING—DTV—> PERMIT ISSUE.,,PLAN—CHECK
TOTALS----> 88.00 15,00 0.00
Y
_ DATE;
�, DATE: �/2�� Sr
*�***�r�t�r�t�t �t+r
**�r��*****************�*�
STRUCTUAAL SEGMENT;N
FIRE SMIP/AES GRADING
SMIP/NON—RES
TOTAL PAIb DUE
103.00 103.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 103,00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
103.00
�f 3tlf 1! if it 3f !f iF iF 3f if if i!!f M!f !F iFlf �F it iF M iFlf if ff �F if iF if �fltlF it iE 1E iflflF 3E �f if iF iFlf �f if M �f if k 3F iF if if if M� it #�f * if 1F k k�F �FiF 1f iFaF �Fk �f 3t �)f if
I N D I V I D U A L F E E H R E A I( D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 4 MISC APPARATUS NOT LISTED RE� PERMZT 11,00 49,00
ELE 2 MISC CONDUCTOR NOT LISTED RE PERMIT 11.00 22,00
ELE 2 MISC CONDUIT NOT LISTED RE PERMIT 11.00 22,00
END OF FEE
�. - 3 r� - 9� Fin1 � �--
CONSTRUCTION AND PLANNING POO .PA
APPROVALS Permit,$� Date Inspector qppROVALS Permit# Date Inspector
•1: Temporary Electrica� Service or Pole 52. Pool & Equipment Location ' '
?,,, Soil Pipe�Undrgrnd. 53. Steel fleinforcement - • .
3, Electrical Condurt UtilityUndrgmd. 54. Forms • � �
`4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding
"5: St@el Reintorceril2�Y_ 56. Rough Plumbing & Pressure Te�t�� .
6. .EI'actrical UFER Grnd. 57. APPROVAL TO COVEfi�GUf�TE
7. Foptings c 58. Electrical Conduit�Undrgrnd.
� 8. Foyndation ` 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK �
1 t. Property Sewer LinO'& House Cannection 62. Backwash & Receptor�Final -
12. Sewer Cap . 63. Hea[er & Vent-Final � �
i�, Roof Drains 64. Plumbing System � Final �
14. flough Plumbing 65. Electrical�Finai
1F. Rough Elettrical-Conduit 66. Solar System•Final �
16. Rough ElectricWiring 67. Fencing & Access Approval '
. 17. Rough Wiring Sign g$. APPROVED FOR PLASTERIfdG �� �
18. Rough Electrica!•T Bar Ceiiing 69. POOL/SPA SYSTEMS FINAL :
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - - - m •.
20. `Rough Facto� Fireplace ' � �- x � _ �• • .APPRQVALS�.� CPerinit #
n - ,C S -. + ^ _.� - �
21."DuCts, in_St�uctu�e. . , � ' � - ' - �' •
1 .�• � �.70. ndergroemd:Hydio
22. Duct'a, Ventilating� • , .� _ `LR � -7�, productrP�ping 6Gas ❑Oil
23. Cias Pipe-Rough &`Cest � � ; �,. - ,,y � 72, Undergrovnd Flush�. ., '
24. �Roof� Freming � � - •� . � � z, �� � 5731=Undergmci'Storage-?ank �Gas OOiI
25. RooJ, Sheathing � ` - "., r� 74.-Overhead Hydro ! Y
26. T-Bar Ceiling (Structural) & Monocoat - c � %�' � � 75.-:Dry Chem�cal _ ' � �- �
27. Frame and Flashipg'- ; _ r,z ; 76. � Dry Stand'pipe � i ;��" ' - _
� 28. �Lathjng�& Siding� . � �,. • � •-' • 77..^FIXED SYS7EM�EINAL'" ' '
29. Insulation 't � "'" ,. Y` i � 78= FIRE PREV. FINAk. � i
�0. Drywall-Nailing �` � �� �' �� ' J NEALTHflEPT�. REQUIREMENT �
- .,,
31. PlasterBiown,Coat ' „,, � ",, �, ,79: FIN IN�PYECTIC�N`, _ � .- -
' 32.-Electricati,Power MezerFinal � J: �T-
i� � r80..rF00D CE�'TIFICAT�E ISSUED _
33. fina� Elettric ' . T��, -l�l _ ot' � �- . . .
'34.-Fina Heating& Air Conditioning- - ' � . , �5 . ; �
- � r -
35.'FinaYGas'Pipe-TesC ` - �te� 'a� ,:: c*�s . � :
LV < �l .T
.36. Hood or CanoPV . -,�Z , � � � � - � � � ' - � i
- - �:
_37.'-Final�Factory Fireplace^ - ' A � ' • > ' .� ` . -
. • : . .r .c .
-38. Final.Plumhing , � � :� �� - .• . ;: - �' _ s- . -� . -
.%
'39. Watet $ervice-Final�.� � i ' � � - � � r _ �
��, _
t40. Gas Service-Final � � r „ : , - �
;41. Solar pomesticFinal • ' ;+ �
�„ '
42.'Backflow Preventer, • ` �`" , I ' '' . _ "
.43. Backflow Irrigation - . • ' � '-�E ' ' - "' "
�
.44. Landscape Ir(gation SYstem.�r - ,^ i „ - � � , _ T:,,, '� ' -
45.:Sound Attewation � � � � - � - , � � �- " - ''
�� � _.
46. Handicap,Regulatidns - ' ` � � �" � - -' ��
n
�47. FINALSTRUCTURE&BUIiDING •'x . .. �
,
48�; FINAL PLANNING �' ,, "r r .i + -
r ' , '
49. Elecfric Release to Edison ���' _ .
' 50. Gas Release to SouThem California Gas Co �'� � � �� � .•
i�1 �-, .
t 51. CEEt71FICATE OF OCCUPANCY , �. ''� - �
No. Date
F
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W
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Q
h
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S
F
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F
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a
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2
3
•' COST� M�UILDING-SAFETY DEPARTMENT
p o. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADIDRESS ��[� �� 1 9�� ST, C• �
T�ENANT�R �i7�qY� 11 A �Yl �1C��I
MAI LI NG (��� y
ADDRE55 gIO �.i� . �`�-"� S 1'.
1 TEL.
cirv OSTA- YhocII No. (n�lt,�F
saaNcr+
ADDRESS
TEL.
ADORE55
CONTRACTOfC ]I/R'7��✓ .eDl . :
CITV NO.
STATE ' CITV
LIC. NO. LIC. NO.
S I Z E NO.OF BLOGS.
OF LOT NOW ON LOT
USE OF
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOfiK TO BE PERFOR�
I hareby acknowlatlpa thai i have roatl this application and svte
that Ne ebova Informetion Is correct and aBrea io comply with
ell lawa reBulating builtlinp conrtruction, entl I shell not amploy
any perton In violatlon of the workman's compensation lawa of
iha Staie of Celifornia.
I hareby eertify ihat I am proparly Iicansetl as e contracior unAer
ihe Steta of Callfornia Busineu entl Protessions Cotla, Division 3,
Chapter 9, and that zuch licenses are In full force antl ettect, or I
em axempt iram ihe provlsions ot the Stete of Celitornia 8usiness
antl Profnsslons Co �vislon 3, Chepier 9.
SlBneiura ot -
Permittea
or n�
Authorized ABe Date ��
� 1675 �2/19/80 10.5� TL
APPLICATION FOR STRUCTURAL PERMIT
RECEI VED 9V , PERMIT . .,, " . ;. ,. ;. ,.
A.P. NO. � I �
BUILDING � �O
ADDRESS �
UNIT OR
SPACE NO.
TR.NO. � � LOT
NEW ADD ALTER
OWNER
APPflOVED
APPROVEDSETBACKS
PLANNING ACTION
APPROVED
BLK.
REPAIR MOVING DEMOLI54
✓
, /J A �1-1 i9��1
VALUE
�. � A s .�7T
DATE
APPROVED
m
�
i
b
m
54. FT. �
7
THE AMOUNTSHOWN UNDER VAIUATION IS FOR ttl
THE PURPO6E OF FSTABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE S � , O�
m
� PLAN CHECK 5 �
%��( /�J 0
g SU`� TA% E �.J� �
u
TOTALPAID $ ��,L^�
�
I
.
CO§TA MESA BUILDING-SAFETY DEPARTMENT
[]70u Ip/07/QQ 14.50 T�
APPLICATION FOR STRUCTURAL PERMIT
/ •. . ��n acew
,% REC ,E V PERMIT �����
For Applicant to Fill in Completely — Use Ink Only ;
ADIDRESS tl��` (�(.,�. ..1' ' {' F �r�G `�' A.P. NO. 5� 3 sO _ � / .
�OWNEROR �j. � � BUILDING � /� / '
TENANT ���.' ADDRE55
`ST C�i il L J
MAILING UNITOR ' �
ADDRE55 � SPACE NO. .
�y / ] TR,NO. � ' LOT ' BLK.
CITV �l �� �-"E�'' NOL IG7f����Q�
. NEW ADD LTER REPAIR MOVING DEMOLISH
CONSTRUCiION
LENOER
BRANCH �
OWNER
ADDRESS US ��YSA;UE$ �+�C
ARCNITECT TEL. �� / J
OR ENGINEER NO.
ADDRE55 ZONE' ' TVPE GROUP- ' .
CONTRACTOR {'JRC JA(��� .4+/`�aL�.Tj%M1�`� ByPROVED DATE
ADDFESS 7�C� ^ �� ��- L QL vL`!� '
� /f TEL.
CITY . �LL�I�L"�,tiL� � _ N0.��4 • � . .
�STATE CITV APPR ED SETBACKS � _ •
LIC. NO. LIC. NO. - ' '
SIZE . NO.OF BLDGS. (FROM G� STRE T) ' �-
OF LOT NOW ON LOT FRONT F.
USE OF
EXISTING BLDG. � 7, '
Separate permits are required for � �. sioe FT.
electric, plumbing and heating work:
REAR FT.
USE OF BUILDING AND ORK TO BE PERFORMED P�qNNING ACTION
i. �
D TE
AP OVED
APPROVED
, I heraby aeknowlatlge that I have reatl this application antl state ' �
� that tha above information is correct entl agree to wmply wfth
� ell laws regulating bvilding construction, and I shall not employ >
eny pe�wn In violation of the workman's compensation laws of d
the Staie of California. .
I hereby certify that I am ptoperly licensetl as a contractor untler SQ. FT. �
7
the State of California Businass antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF ro
Chapter 9, antl Shat such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the p�ovtsions of the State of California Business a
- and ProfessionsCode, Division 3, Cha t 9. VALUATION PERMIT FEE $ Q oQ �
PLAN�CHECK $ p
Signature of � __.. .A�� ��� . �+ / �
Pe�mittee `�-��EG(l� c" �j $ (' �S • TAX $ �d �
Authorized Agent Date �a �^�� / TOTAL VAID $ D, 5Q U
PPOJECT RUOPESS: 8 1 O W 19 TH ST
OWNEN'S NAME: WENZ(� LEONA
FOONESS: P � CQX 4 9 2 4
PALM SPRINGS,CA
AflLH/ENGINEEfl:
RDOflESS:
UNIT:
� •
92263
FEG.NO.:
UNIT:
PENMIiTEE: LEONA WENZ ( 619 ) 320-2039
aooRess: 4924 P.O. BOX '
PALM SPRINGS CA 92263
UCENSEO LONTBAC70fl OECuflRTION: I nereey allirm tMl I am IiceM¢G mMer O�ovBians ol Cnapier 9lcommencinp wiin Seciion
7000� ol Division 3 atlhe BuSineA anU Prole55i0n5 COEe. anE rtry IicenSc is in IWI torce an0 etleCt.
CITY LIC.: ST�TE L1C.: CU55:
Oate: Si9namre:
WUflKEflS' COMPENS1ilON DELLAPATION: I nereCy aHirm ttWi I tuve a certilitate ol fAnSent to ulbinwre w a CeniliWte oI Warker5'
Compensation Insurance. or a cendieE copy Inereof (Section 380D. Lao. q.
PoLILY NO.: EllP. D�TE:
COMPRNY:
�] Cenitietl wpy a nere0y lurnishea. ❑ Certilie0 wpy R IiIM vnth ihe dry Buileinp Divisian.
Daie: ApDlicanl:
E%EAtPfION FflOM WONIIEN$' COMPENSI�TION OECIAMTION: (ilrts sec6on neeG not Ee mmpetN il Ihe pemii 5 ta me AuMrta (5f0� a less).
I t¢rtify Ihdi in ihe p¢tlarman[e 0� l�e work �or wNtli ttut petmii is rs5u¢G. I Shd�l nai emploY atry per50n in any mdnner 5o as to become
Subje[I to ��e Warkers' CAmpenSa�ion LawS 0� Caiilomia.
Date: Siqnalum:
NaTICE: II. alter making t�is OeGaration. you sMulU Eecome suEject m Ilce Workers' Compensation 0«y�s al t�e laEor
Code. rou must �onhvnth compry wim sucn o�witiars o� tNs oermit snau Ue Eeemea rewkeC.
CONSiHUt7I0N LENOING 1GENLY: I nereby affirm tAat there a a wnstruction IenOing aAency tor �ne pedormance af the wark tor
w�ic0 Ihis Oermit i5 isSueJ (Seclion 3097. Civ. C�.
LENDEfl:
AUOXE$$:
OWNEN BUILOEB UECLAMTION: I �ereby affirm t�at I am exempi irom t�e Caniraclors' State Licensa Law for Ne fallowinp reason
(Section 7037.5 Business an0 Pmfessional COAe: My dry oi county wkcO repuires a permit to constmct, aller, impwve, GemolisA, or
re0air any simcmre, prior lo its issuance. atso repuires �he apWicanl lor suc� Dermit lo lile a sipne0 statement iAat hrls�e is Iicense0
pursuam Io �he pmvi5ions al I�e Coniracbrs' Sia�e License Law (C�aO�er 9(commencing vrit� Seciion 7W0� nl Division 9 0l i�e Business
an0 Protessions CoOe) or tlwt he/stie ¢ exempt I�erefrom and t�e Oavs br t�e allepeE eeemption. My NOWtion ol Seclion 7031.5 by
any applicant for a permit suGiecis ine aoo���ant ta a Gvil oenalty ol noi more inan live nunUreO tlollars (E500�.
I. as owner al ihe pmDeny ar my ¢mployees with xapes as �heir sole compensation, wlll Eo tne work, an0 �he
❑ simcwre is nat inten0e0 or ollereU for sala (Secbon 70ad, Business an0 Prolessional CaOe: TAa Coniractors' S�a�e License Law
tlaes not aODN �o an ovmer of a piaDerty wM OuilAs or improves I�ereon, an0 who Eoes suc� wark �imsell/herse�i or IhmuAA
Ais or Aer own employees. provi0e0 t�at suc� impmvemenis a�e nat intended or oflereA lar sale. II, however I�e 6uil4inA or
imDrovGm¢nt i5 sola wil�in on0 year o� compleli0n, IAB ownEr will have Ih! OurGtn 01 DmWnq �e/she tlid n01 Cuila or impmve
lor �he purpose oi sale�.
I, as owner of ine prooeny, am exclusively comraclinq wilh Iicense0 contraaors lo conslmcl l�e pmject (Secllon 7004, Business
❑ antl Pwfessions COGe: The Contractars' State License Law Oces nat appty ia an owner ol D�operty wtw Guilds or impmves ihereon
antl who conlratls lor such O�ole��s vnih a conirac�oqs) license Dursuanl to ihe Conirectors' Stale License Law�. I am aware
thai pmof of t�eir Warker's Campensauon insurance s�oNE De O�ovi0e0 lo me.
I am exempt unGer Seclian: B. 8 V. C.
� mr tms reason: WORKPBY40WNER' S F LY ,� //}//
Date: �2 ^ /� ^�/ ��/M�S � /V
�
i do nereby cenify inai I am aware ot anG unEerstan0 t�e repuiremenis ol Cali omia Healt� an0 Salery CoEe Sections 15505, 533, anU
., 255Ja and t�at 1 or any luwre OuilOing occupant wiNwill no� (drGe onq neetl ta comply vnih sai0 state coUes antl t�e repuirements lar a
��. permit lor cons�mc�ion or moddication imm �he Au Ovalily ManaAem¢n� Di5lricl ResiGeniial [OnSlmciion aODlicalion5 are exemp� �mm
I mese o�ovisions.
oate: nVVlicanL
I her¢�y cetlily Ihal I haue reaC I�is appliCaiiOn an0 Slate IAaI i�e a�Ove in� ation is correct. I aA�¢e �o comply with all city anU county
ortlinances and state IawS relaiing la CuiWmq COnsir�i n0 h4reby autlq eW¢StnidtivES oi lh5 tily t Cnter UpOn tht a0pve-meniioned
prop¢tly lOrinSpedion purposes. �
Oate: ��—� �— /�/ `Si�tu�C
Orivei's License o� Socia� Secunry e:
t6<La6 Wbite—Bmltling; Green—GaEe Enlorcemeng Canary—NOWicanl; P�nk—Revenue; GOI4enraE—Assesmr
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IM 05559
PERMIT NO: IM 055547 PLAN CHECK NO: N GOVT: N SUPP; Y
CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC OTH PURPOSE: OTH
JOB DESCRIPTION ; GENERAL MAINTENANCE/REPAIR(MECHANICAL) SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: B-2 /A-3
COMMENTS: 'PHG: "JOHANNA'S" BAR
**�***�r�r**x �r****�e*x�r**�r*x��r�r**x�*��e*x�*x******�*�e*x�**�r�e*�r** ��r*�*�e x � *�r**�ex �e********
Z O N I N G R E{J U I R E M E N T S
S E T B, A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: ET IN REAR: FT IN ' FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT ZN LEFT; FT IN RGHT: FT IN
PARKING RE�• PROV: PARCEL: 42230114 ZNE: REF NO;
PLANNING N TES>
i
*���r*�r*�t�t*�t�r*�*�t�t�t�t�t�t**�t�r�r�t�t�t�e*�t�e�r�t�r*�e�t�t�r�r�r��r�r�r�tr�e�t*�t�t+t+t�t�t�t�r��r�e�r*+t�t�t�r�r�***�r*�e�*
D E V E L O P M E N T S E R:V 2 C E S R E Q U I R E M E N T S
T.
ZONING APPROVED BY ��� ! DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY•
x���r��r*�r�t��r*�r*�r*�t�r�t**�t
3FiFifiFkiFlFiflFkiEiFiFitkiFlfiFkiFifk�fkkifififkit ifaflfikif
LEGALIZATION:N F E E S
BLDG PMT PLUMBING ELECTR�C
PERMIT
DATE: .,/
DATE ; ��`/ � �
+r�e*�e�rr�r**� *�r
ifiFi lfififkitkkifkikklflfitifkiFikiFlFiF�fit�tifiFifklflflF�f�Fiflf
U M M A R Y STRUCTURAL SEGMENT:N
MECHANIC FIRE SMIP/RES GRADING
60 00
152 SMIP/NON—RES
PLAN '
ISSUE FEE '�
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 60,00 0.00 0,00 60,00 60,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 60.00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
;: 60.00
if it M if 1E if 1f iE ik iE if IF iF iE if if iE if k iE if M iF if k if if k if if ik iE iE iF if If if iF iF k iF jt iE iF iE k iF iF If aF if iF iF iF if 1E 1f M If jF 3k if if iF if �k �f 1f iE i! 3E iE k jF iF iF M If iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST
MEC 2 MECHANICAL RE—INSPECTION FEE 30.00 60.00
END OF FEES
� � �'�- �=�>ti� � r��
`
"��. _ - - _ ' _. _
�
CONSTRUCTION AND PLANNiNG POO. . SPA
APPROVALS Permit # Date Inspector qPPROVALS Permit # Date Inspector
1. Temporary Electrical $ervice or pole 52. Pool & Equipment Location � �
2. Soit Pipe-llndrgrnd. 53. Stee1 Reinforcement , '
• 3. Electrical Conduit.UtiHty-Undrgmd. 54. Forms
4.'Electrical Condull•Wndrgmd. 55. Electrical Bonding i' .
',5,; S(eel Reinforcetttenr� 56. Rough Plumbing & Pressure TAst < <
��6. :Elactrical UFER GrnC. 57. APPROVAL TO COVER�GUNFYE �� -
-7. Footings �''� 58. Electricat Conduit�Undrgmd. -- �
8. Fo�ndation � 59. Gas Pipe, O Undrgrnd., Test z •
9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P�Trap, O Undr j%nd. '
10. Structural Floor System 61. APPROVAL TO DECK �%
i
11. Pnonerty Sewer Line& HouseConnection 62. Backwash & Receptor•Final '
12. Sewer Cap 63. Heater & Vent-final ��
1:. floof Drains 64. Plum6ing Sysiem • Final
14. flough Plumbin8. 65. Electrical�Final
1�. Rough Electrical-Conduit 66. Solar System-Final
i6. Rough Electric Wiring 67. Fencing & Access ApProval ��
17. Rough Wiring �ig� 68. APPROVED FOR PLASTERING, ��'
78. Rough Electripl-T Bar Ceiling 69. POOI/SPA SYS7EMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - - -' �' 't -
20. iiou�h Factory Fireplace � �' _ '� a 7iPPROVALS%�';Perfiit # - ' '
� - _ - :, , r ..
21 . �ucts, in Structure .. , - - - ` 70. Undergrautid.Hydro � r �
22. DuctS,Veht<<dting t G'n ^ r " 1, Productf�iqingd�Gas ❑011
23. Gas Pipe'fiough & Test � , � , -a ' 72, Underground Flush� .� �
24. Roo{,Framing � _ � . �3.?Undergrnd;Srorage.jankOGas ❑Oii"
25. Roof Sheathing �; � - - " , ;. `74. �verhead Hydro -' '
26. �T�Bar Ceiling (Structural) & Monocoat �r ' T! 75. Dry Chemical - '
27. Fraqie and Flashing. _ '� ^ �, ,Dx ' 76. Dry Stand�ipe C: t; ;' c
.28.`Latliing & S�ding � - F. ^ ^ �� � 77,=FIXED SYSTEM F(NAL • . v � . �
29. Insulatiol� ' "' :, r"� 78:?�IRE PREV. FINAL ' '�
. ,. . -
.30. Drywall Nailing � � � . HEALTH.DEPT.REQUIREMENT
� 31. Plasrer Btown Coat � ._ ,, y, 79. FINAL IN$PECTIO,N � '' .
� $2. Electrica ��^' ". ""^'-' " � 80. FOOD CERTIFICATE �SSUED �
. Final Ele�tric . ' # I �' t� � bf�'s: 2-'S`4Z "-f`�o�-!7ali40Y-. C...�.Q..
�34. Fina�Heatin9:&AirConditioning._ ��yL ���.w �= ; r� . � � =
i
'iF L�...� r__: � _ . - . . ,' ' " - . . - _/_
• - � 3 �LC - I r .
� '�
36. HoOd or.EanoPY ." _ . . '.�� ". ^• - � � . � , x
_ ,.
37. Finat�FactorY FirepiSce • ' °% ' , l ' `
. �c �
.. .. Z- ... .V i� .
�38. Final Plumbing ;,; , � • . :,1�. ' .� � ,
.39. Water Service-Pinal • � � � `�^ .'. ' : ' �� ,� ' ��; •
ik Y t:+ '
40. GasService-Final ; _� ;.. y ; � y. ��r• �,_ " '
47. Solar�DamesticFinal - � � • ? ' " � '
_ r
42. `Backflow,Preventer . ' �' " � � � ' � '.
;,t • � _
43. Backflow Irrigation • � r S n � '� - , � `'
u
44. Landscape Irr(patioo System.��z'� � , - � . -
�
45.�.Sound Attenuation -� * �'" � '�'L �
46, ;Handicap Regulations = � � � � � ;, � .
�47. FINAL STPUCTURE & BUILDYNG � � i. : -
46. PINAL PLANNING ' , �; , . �fj . .q � -
.
49. -Elec[ric Release to Edison . �` � '� •
f �
50. �,as Release to Southern California Gas Co �' ' _.:' 1 r
i .
51. CERTIFICATE OF OCCUPANCY' *
No. Date
` �i _
_ � — `-
COSTA ME$A BUIL' 'G DEPARTMENT �TQ t
111 Ead 20lh Street Ir _
Costa M�aa, California
_ .
Date ...............�.--"---_'_�....`: _r%�
� CITV OF C08TA MESA
CERTI�F�CATE OFvO�c�CUPANCY
y.�i , /� �y
Butlding Permit No�/3.1.....Electriwl Permit NoS��.�.,...Plumhlnp Permit No7._�_! �
—
Ux of Builtling..._.. � • —.-=.
............... ... ..:....... ......._AL.. .....---'- ......... .. .
. . ...-----.. ....._
. .. ...........
`. ' _...
The building ixated �:.�� ��....�...Y.)l...�'.._,��. ---��-/-; �•j - �----....._�:5. ........------
/...�-L�:r_ �/t1� , r. _ ..,. ��:.r F�1 . -
Lot......."' ................................. Blxk...'...'_..............................'.... Traol�� ���...:��=Lt..���
(See reverse alde for Metea and Bounds) �
has been inspected and found to comply with qthe pmvisions ot all G�ty of Costa Mesa Or-
dinances applicable thereto for a Group..�..iSJ.......---Ottvpancy. � ,
ISSU£DTO: • �
A. J. VOL2
� 1�"���r ,Y �� � ` City-Building, �ief�l
. ��..�.�....`.:... �.........._.r�C.�......__......... . �
. (OwnerofBuilding) By-��G�.-` �..L�,�-�..
CC: D Orig,inal—Owner O 15t COpy—Gas Co. ❑ 2nd copy—Edison Co�% 3rd copy—F'lle
ro� zos aa iM i�ss
' � 5; ,8
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31'!
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
COSTA MESA. CALIFORNIA
OWNER �
MAIL
ADDRE55
CITV �
ARCMITECT
OR ENGINEER
ADDRE55
LEGAL LOT +
OESCRIPTION N�,
A,P. NO.
SIZE �
OF LOT �� �
USE OF
EXISTING BLOG. �
ISETB.�CN LINE FROM L
CENTER OF STREEi 4
FEE ,.�CEIVED
�nn� a�Jiy's�-9 �,
FINAN�E DtPT. �
CIfY OF CO$�p ���p
APPLICATIbTJ FZ7R PERMIT
BUILDING
FOR OFFICE USE ONLY
n'�l� TEL. BUILDING �/ � _' �1 ` �_
ary-µ NO. ADDRE55 N .�
��� N�o. �(fv�(J� COSTA MESA. CALIFORNIA
✓
QTV LIG ' rO
NO. OV
BLOCK ITRAC
'� ��F[e�ocs.
� IOW ON �OT
i I FIR
� ,
SIDE YAR� RIGHT LEFT
DESCRIPTION OF WORK
li
NEW ALTERATION I qDDIT10N
REPAIR MOVING DEMOLISH
BUILDING p�/ NO.OF /
SIZE /J /� /Zf� Z- FOOMS STORIES
EXTERIOF WALIJ/�ILG.O_ ROOF �,� �,/.�
Q IA�PPROVED DATE
CORRECTIONS
I HEREBV /�CRNOW GE TM.�T I XAVE R O TNIS APPLI TION �NO
STI.TE TN�T TNE • E IS CORHECT ANO REE TO COMP WITH /.lL
CITV ORD�NSNCES D STATE LAWS FEGULITING BUILOING CONSTRUC�
TiON. VALUATION � ��
I
SIGNATLIRE OF � ' I J� Q(� PERMIT FEE 5
PERMITTEE �A� ���� / ' �
P�AN CHECK $ '�
s� � - .
1�� i� r N O R i z E o w c E H r T O T A L F E E g���� ��r
� _
.� -
� �'_ "�42
� CGSTA MESA BUILDING DEPARTMENT
P. O. BO% 31� �
' COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING �i' � �_ /- �� �
ADDRE55 X 7\1
MAIL' '�
ADDRE55,.
QTY
ARCHITECT
OR ENGINE
ADDRE55
LEGRL •
�ESCRIPTION
A.P. NO. I.
COSTA MESA.�CALIFORNIA
�W S
y3.�.�`�JQe -�-�. �
�I�GN WW� TNO�'ys�{Y
LIC.
��!'�-"L NO.
1„�� CITV LIC.
�•�/V � NO.
� �/ � TEL.
�W NO.
7 BLOCK / � TRACT � `
-- 3•_� � - /�, -r .3 ' .
x 1 r 7 NO OF BLDGS'
NOW ON LOT
SET9sCK LINE FPOM �� /1
CENTER OF STREET �J � REAR VA
SIDE YARD RIGHT J/ LEFT /L1
DESCRIPTION OF WORK
NEW ALTkpATION ADDITION
REPAIR �� MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL 4 , ROOF
COVERING COVERING �:�
�
B
��i,,�G r R�,�,7` ,4.� _ _ .., .� �'�o
I$TATE TNAT TME �BOVE
CITY OR�INnNCES PND
TION. ^
SIGNATURE OF
AUTHORIZEO
� .'
��
_-_ -�'
. , �_
• �F E "�CEIVED - '�
`7 , � � ; l� ��� '' S � ;,
FiNANCE DEP�. �
CITY OF COSTA MESA
APPLICATION FOR PERfv11T
BUILDING '
t '
FOR OFFICE 1USE ONLY �
RECEIP,T NO. pEqM LNO.
� � t� :� � � ,
' / � / _ /
ILDING
DRE55 '
COSTA MESA. CALIFORNIA
FIRE
ZONE
IONE_, ' `^ . p�ANS
r ♦
! -i
PLaNNING DEPT.
pLAN
/7"o�h-„ �----' T.� - --
^ AT I XAVE PEAD THIS 4PPlICATION Frvp
CpqRECT RND 4GREE TO COMPLY WITH RLL
TC lnWS REGUI/�TING BUILOING CONSTFUC�
L��L� ��� �� VNLUATION pERMIT FEE 5
�
/! / g � 2 O � PLAN CHECK 5
' / f
- - i' � TOTAL FEE 5
'v i
S^ _� 9dr
' �i� —t � - .:.y,�„ �- _,��
�' �`�y 99 All 14pplications Must Be Filled Out By Applic�t
� R? � •- , - ;�� '
��,�G; �r�� O�Q ��.�' :� Department of Buildings` Appliccxtion No.— ��
E��P��cE°S�P - _ . � . �
O G APPLICATION FOR THE ERECTION OF SIGNS
To th��ilding Official of the City of Costa Mesa, Calif.: '
App]ication is hereby mdde Eor the erection ❑ alteration �, removal�'of an advertising-structure
in accor �jt y� mation_herein .set , forth. (Check sauare what is to be done).
�D11�1�� (Use.Ink or Indelible Pencil)�
C,��"'�iS I D E -�% L . � EA�ocnTiorr� _ _ _ _ . �,�/'� _ i
Building Addres^ � 'f� ��
Lot� Block—� Trac�A. P. No.��— � s� "� �/ Zone ��
�
Owner's Name � -� «�� Owner's Rddress �-�""�� �
Contractor's Name �1f� �' - State License No. '
Contractor's Address � Phone City License No.
DESCRIPTION•OF SIGN '
(Sketch showing location of proposed sign on back side oE this sheet. Plans and other data must also
be filed.) - � � •
' n Q_ �a..
I
Size oE Sign—Widtn�ft. Heigh � ft. Height above Grade '" ft.
�
Thickness �'�'�-' in. Weight�lbs. (Including Electrical Transformers, etc.)
State location of other signs on building �' !
The undersigned hereby agrees to construct the advertising stru re in str', accordance with the
provisions of Ordincxnce 95, Section 39, oE the Electrical Ordinance of Costa Mesa, and a]I ame
ments thereto. � �
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICAI�Ti'�INSPECTION MUST BE CALLED
FOR..i.ronnt l�f1MDiFTTnN . . - .,
A..�.��� ����
CITY O`= CQSTA M:ESA
pL>'thPdtt-'G CEFT.
SUBIECT TO BLUG. DEPT. REG.
. � : r� , � FOR
FEE
$ bZ- �
2141M 1-57
��
Here �� �
By
.RTMENT USE ONLY
Pjans Chec$ed •
�u/%' ?� j
Plan Examiner �
(over) _
j
�`i� :a:.
.
s
0
FOR SELF-SUPPO�G SIGNS
.�
� FTLL IN
SHOW
a; � j��,
` L
7'� / l 5
�/V
Size and Locahon � � S � ._{ ^} �} .^ �' R - ,'
Section 7 of Ordinance No. 95 � -"
- �, • r� � S'1
- �'. �.
�n .
. . . ._i'-caj�� . \
E --
Width�of Lot . ,-. �
r : - C/L
- S�i 'i � ��'._;;' _. .f'J
--- �� ' t�1(( 0�\�
. Sec. 6 of �Ordinauce No. 95
. �
�=�'��3t�i.� la.a�y� :
� � _ _ \� a%�.��i1 . �_ : . . .'
I~� �
, ' � �
�\vC�t
�
a.
�
d
�
IProperty
' Line
_ ��7 7.J.�JJ \�'�J `.�� '�
I - _.
I `
..._' ' _ _' ""_Curb - _ _-. . ._ . . . . .
- � � - • `'' a , �
STREET OR HIGHWAY � � • . j � ' --� . � � ' � �
' . , � " .. . � . . ' . , . �
' . +
— -'- �l --- , .r-" - - - � - ----- ' -- -- --� - --- ---- �i', ' `���
.��� � J
I
� ' ����
' C057A MES'rygUILDING-$AFETY DEPARTMENT
P.O. BOX 3f� COSTA MESA, CALIFORNIA
fOR APPL/CANT TO f/[[ /N COMPLETELY
� TYPE OR PRINT
�Y �5 / li )'C
MESA. CALIFORNIA
CITY /-�- G--.��
ARCHITECT _ , is .
TEL.
NO.
LIC.
NO.
LEGAL ILOT �J I D I
OESCRIviION NO. ( BLOCK TRRG'
A.P. NO. /������
SIZE I y / NO.OF 9LOG8.
OF LOT / I�y�\�1 �-�--�� r �o"/ o�
E% STING BIOG I 1�'-�"'�'6�'�"'�
SEfBACK LINE FHOM
CENTER OF HTREET REAR VAF
SIDE YARD ILEFT IRIGN�_
DESCRIPTI N OF WORK
I II MOVING I II DEMOLISH
NG� � Y � /� ROOMS / STORIE�.
/�
NGWALL �Ml_C�COVERING ��V ✓�
' BUILDINsi_ALD WOF7aC T¢�BE PERFORA}EDJ
a
�1 HEFE9Y ACKNOWLEOGE THAT 1 HAVE REAO THIS APPLICATION
AND STATE THAT TME ABOVE IS CONRECT ANO AGFEE TO COM�
PLY WITH ALL CITY OFDINANCES AND STNTE LAWS REGULATING
BUIIDING CONSTROCTION.
SIGNATURE OF '� �', n p ^ ,
PERMITTEE u �
AUTHORIZED AGENT
�U .
5PR-7-5S�P��Esna590i �*�Qfi�QO
��
APPLICATION FOR PERMIT
BUILDING
�v �
Fax oFficF usF oNcr
I RECEIPT NO. I PFryry1T�.
_ MV
EC ED BY /,� TE RECENED I 11TE ISSOEO
I/ � %-1 —/, �(
BUILDING y^ _ �/- ��{F
ADDRESS (1 JQ-. .I -� ' '�'�� _�
COSTA MESA. CALIFORNIA
ZONING
NO. OF USE OF NI
PLANS I BUILUING
�
(CENTER LINE BT.1
THE �MOl1NT SHOWN UNDER VALUAT�ON I8 FOR THE
PUNPO6E OF E8TABLI6HING A PERMIT FEE ONLY.
.UATION � ^ n
PERMIT FEE $ �
� �i� PLAN CHECK s Na,�/.e
� TOTAL FEE $ O� 0 D
� COUN,I'Y OF ORANGE „ ' �
BUILDING DEPT. � Permit No ... ......
636 No. Broadway ( � � �
SantaAna,CaG[omia Application fOf Building Permit '
P6one: KI 2•6211 AND FOR A
Certificate oF Use and Occupancy
D,u - �une....�$.th.........1952 - .......
1. OWNER'S NAME........ -- --....FI'E1i..d,--.Dudley- - - .....-- - -- .............. PHONE:...Be...��'S�'..........
MAILING ADDRESS_....812_.[�1..�...1.9.T,hr...�9G.......
Name
(Amhicett or Engineer)
Address
City.--...--- ..............--....-------"--------......------............_._.........
State
Lic. No ...............------"'----------- Phone.......----------...................
PROPOSED USE :.................All�p.-Sk18Bd
Idame ..-----------------......
Addre=_s .-------.....--------
Citv...-------------.........
State
Lic. No...------ ................
...._.....- - _ ..................
CITY.....COBt& MBB&
............ ...............
(Contrac[or)
2. JOBLOCATION •-.5�,2._{p[. 1.9th.,....St. ..........---Coeta..Me�a .................. - -- ---- -- ..............-- � ..........
(House No.) _ ( �a`�w(» veet)B`oCk n , . , (Town or School District) �
i./
3. LEGAL DESCRIPTION: Loc---��-�.�...... •�-..-.---••••,�••.,r-'-'r---c-- Tract..,�j.�..2--- ..........................
(Me[es and Bounds Description—Use revcrse side o( form) �
�. CORNER LOT ( ) INTERIOR LOT ( X) THROUGH LOT ( ) SLOPE OF LOT ( )
i. SIZE OF BLDG.:....2f)X� -ft. -AREA:.--�-20 --Sq. s' ZTIZE OF LOT:.�.50X1iS�B.........AREA:-------- ............:......._--
G. HEIGHT OF BLDG:.],1...�-------------------------CEILING HEIGHT:...��.�II...C.e11R�0. OF STORIES.....:�rie
7. NO. FAMILIES ................._.....................Sizc of Smallest Bedroom:...._............._....._..........._. Size of Kitchen.
S. EXTERIOR \VALL CONSTRUCTION:..........0�.2A .......................II�'TERIOR WALL COVERING___OPeri
� (Frame, Stucco, Etc.) (Plaster•Drywall, Etc.)
9. SETBACKS: Front Yard From Center Line'of Svicet.......�1.._i.�e...------------ ..............................-----------._...............------..
Nearest Sidc Yard..,_�I...�.........Rear Yard...�.S�S-����-��----Distancc in Feet Between Bldgs. ort Same
]0. A COMPLETE PLqT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH:
ll. . For (a) Footing: Width...:-3�.--------_ ..............._...Depth in Ground-.__Z�................._.Width of Wa1L..�?XB...POBLB..
Accessory
Bldgs. and ..."CC Material of Floor......._:...!...,.
Similar �b) Size of Studs: - ..................Spacing.... -_ jVu ii . s18b................
Scrucmies:
(c) Size of Floor
...... ._Spacing. -- - ......................'-.:'CC
(d)• Si:.e of Rafter=: -Z�ib-..... ................- Spacing- ���2t�---Q� Q�I1t.BICC
13. VALUATION OF pROPOSED WORK: Induding all labor, plumbing, electrica] �viring, heating, fire sprinklers, painting and
sewage disposal b �.00Q.-40- - .......... .... .
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
��APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORD;i TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICAI3TyFt THERETO. o
7/� Signed:
Plans Filed:......._L��.�/.......L..— .
B)�:
(�wner)
, (Authori±ed Agent) '
FOR DEPARTMENTAL USE ONLY
Bldg. Permit
Pla� Check
Total - -
Receipt No.
Paid to •
FEES:
- �..,........ �
....� --
" $-....��'�
. e i /Gi.
DATE.....��../,,(. L
5 M-8-51
GROUP.
TYPE...�.......--- - -
DIST �
MAP.... C....... � ...............
SHEET NO........��...... --- ....
PERMIT
PLANS AND ' /
SPEC'5..-- ----.........(�...
CORRECTIONS
�
FIRE
MARSHAL ... ..................
STATE_....---�� - - ............
ENGINE$R
� , Y _