HomeMy WebLinkAbout816 19TH ST - Building Permits- :•JESTH19rH S7'R..x'EI', i:'_6; 818, 820
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� 10172 - 2-18-60�'! coi.`1 stores $20,490
, 11663 - 4-14-60� -n= orindovr w/stone 50Q
,�l'd856 - 9-13-60 ✓ elec roof sign 350
��14825 - 7-30-63� int, alt, lol
19�+66 - 11-1-63�✓ int, alt. 20
- 956 - 10-10-62 HiE. NC cusn htr 818 �
� ' '-�692 - 12-3�-64 Ht�. iJC �susp htr�816
� �926i - 11-26-74�7cr. r^,7.ec.%Ja11 Sign 100.
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA, CALIFORNIA
fOR APPL/CANT TO f/LL /N COMPLfTELY
TYPE OR PRINT
BUILDING f�ri. 1�.�8 �$ �v - 1Q T�.. �
AODRESS �/
GOSTA MESA, GALIFORNIA
OWNER �^V� 1�' STOI�I C
MAIL ( L ,��� i
ADDRESS�GG���i
oescAivnoN � NOT / I BLOGK � I TRACT fr
A.P.NO. I /S- � �— ��
f
SIZE � - o � I NO. OF BLOGS.
OF LOT 'G � �' NOW ON LOT
USE OF = v � E D�i� �
EXISTING BLDG. �
SETOACK I.INE FROM ^ `�
y� V �
CENTER OF STREET ✓ O� Q REAR VARO �� S O
SI�E VARD LEFY � I RIGHT 7 S!� ,�
DESCRIPTION OF WORK
BUILDING ^ r_ NO.OF 1 !
SIZE �O X V� ROOMS In� STORIES
E%TERIOR WALL ROOF Nv'�7 P E� D
COVERING {T6CG(i COVERING
I LISE �F 9111LSINd AND W�RK TO BE PERFORME�
I XEREOT TCRNOWLEOGE TH�T I HAVE FEAD THIS �PPLIC/�TION
ANO STATE TNqT TME A90VE IS CORNECT RNO pGREE TO COM-
PLY WITH /�LL CIT✓ OROINqN 5 �NO TAT��// LA 5 flE�L�NG/
BWLDING CONSTRUCTI��t/LILy� �// , � �
_�
SIGNATURE OF C `
PERMITTEE � , G!J �
AUTHORIZED AGENT � L
A �G �d54
��, ii� )'l'�
, , .�NaV
APPLICATION FOR PERMIT
j�a,� BUILDING
FOR OFf/CE USE ONCY
RECEI9T NO. j PERMIT
I����
'IVEO BY DATE PECEIVED E IS'
n I Q_,:_�4 I �P.,,:
COSTA MESA, CALIFORNIA
FIRE
ZONE �e Grou
APPROVED �/
BV / OATE v
Z NING
20NE� / I rvO.OF „ I VSE OF NEW�'�
PL6N5 / / �VILDING
YARDS r �
REQUIRED
ICENTER LINE ST,) �/
FRONT J
o mn� /O
J
TME AMOUNT SHOWN UNDER V.�LUATION IS FOR THE
PURPOSE OF ESTABLISHING N PERMIT FEE ONIY.
UATION -
PERMIT FEE $ �-Q. O O
�� � 9 O. PLAN CHECK $ QCC�. V'O
' TOTAL FEE S �n b. C
�
_ i� : 1�8b:�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P• O. BOX 917 COBTA MHBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
eu��oiNc f y�{r
ADDRE58
COSTA MESA CALFORNIA �
I� SI2E
� TEL.
FEE RECEIVFO � `1
�� JUL 7 �1 I
� FINANCE OEPT. � 30-(v3
CITY OF COSTA MESp � ,./,��
APPLICA710N FOR PERMI7 �h"�""�
BUILDING
For Offlce Use Only
RHCEIPT NO. „ PBRI�IzHO.�� I
PECBIVCD
FIHE
MESA. CALIFORNIA
�V' '� ZONING
ZO� _ I No. OP I U88 OP !
PUNB BUILDINO
TEL. L¢aAL 1.. .{— n l% I i
NO. OP BIDOB,
88TBACK LINB FROM '
caMeR OR eTReHi REAR YARI
SIDE YARD LEFT I RIGNT
DESCRIPTION OF WORK
�� BUILDING
IR7
YARDS
APPROVED
�CHMBR LIN6 BTJ
(Zv�e� 'V
i .S v .
EVES
I HEM4V ACKNOWLHD66 THAT 1 NAVE RCAD TXIB APPLiGT10N THH AMOUNT BHOWN UND¢N VALUATION IB POR TXH
AND 6TAT8 TNAT TH8 ABOV¢ f8 CORRHLT ANO A3RH¢ M CAM- pUiiP086 OP 89TABL18XING • PCRMIT PEE ONLY.
PLV W17H ALL CITY OND�NANC69 AND 8TAT6 U1W9 IifiOULATNG
Bu1LDINo coNeT[uLT1oN. VALUATION �p
SIGNATIJRE OF ��f'���` . PERMIT FEE $� • —'
PERMIT�
� $ 10/ PIAN CHECK $ "�^
AUTNORIZED AGENT / � �
TOTAL FEE ��
PpOJECi AOONESS: 8 I G W 1 9 TH ST
OWNEN'SNAME:BILL KEELER
� noosess: g 16 W. 19 TH STREET
COSTA MESA
642-9292
ANCNIENGINEEH:
RDOHESS:
nec.r+o.:
uxiT:
UNIT:
PENMITTEE:THUNDER ROOFING (�714)646-4122
aooeess: $54 W, 19TH STREET
COSTA MESA CA 92627
EO CONTflRLiOP OELIAflRTION: I nereW atlirm Iliat I am IicenseE un0er provisions o� Ctupi¢r 9(commencinp wii� Seclian
I Oivision 3 0l I�e BuSineu an0 P�aleuions COOe, atM my license 6 in tu0 torce antl eft¢Ci.
c.:0 5 5 sT�r ic.6 3 B•14 � 9
Sipnamre: �=�1 �—
BS'COMPEN ONOECIAM N: ItlertoyaffirmtlutllNveattnifiCateatContenita5¢INnsureoracenititateofwarkers'
iution Insu�ance. or a cenilie y t�ereot (Section 3800. Lab. Q.
NO.: EXP. �RTE:
��� Cenifiee coDY �s nereey furnisne0. ❑ C¢nifie0 tapy is IileE vntA t�e ciry 0uilaing Division.
Date: ApPliWni:
EXEMPfION FPOM WOPIIEPS' COMPENSATION OECIAPATION: (Th¢ section nee0 no� �e comDleteO il Ne pemn is for one hwWreO (5700) or less�.
1 certily Ih I in Ihe Oe�Orman o� the Ior whiC� IhiS Oerrttil i5 issue4 I Shall nol emDloy any person in any manner 5o as l0 6ecOme
sue�ect t t�e worker ' oensation ws ol Califomia. Q.
�e: Signa�ure: I '� (� " I �
ICE: II, a�ler a inp Ih' c a IIOtI. y00 SIIOUId U COrtI¢ WUjCC� IO �hC WOlk¢f5' Compensa�ion pmvisions ol the LaOor
C Oe. you musi lotlh tOmply 1� 5ut� O�ovi5ion5 or IMS p¢rmi� Shall be GeemeE revokea.
C N POLTIDN LEN nGENCY: I r¢Gy a��irm ��a� Ih¢re i5 a tonilrut�ion 1¢nGing agenCy lar Ihe pedormante a� ltle work tor
w' Ihis permi� i, sue0 (Setlion 3 . Civ. C�.
OWNEP BWLOEfl OECLAHRTION: I her¢by a��irm ��a� I am exempl Imm I�e Contraciors' Siate License Law lor Ihe foliowing reason
�Seciion 7031.5 Business an0 Pwlessional Code: Any ciry ol coumy w�ic� reQuires a permit ta construc6 alter, impmve, aemolish, ar
repair any simcture. D��o� �oits issuance, al5o repuires Ine ao7lipni lar sutn Oermil ta file a signea statement inat he/she is IicenseA
pwsuant to the provisions al the Comractori Sta�e License Law �Cnapte� 9(cammencinp wit� Section 7000) of �ivision 3 of i�e Business
an0 Pmlessions COUe� or I�at ne/s�e is exempl tAertimm ane I�e Easis lor Ine alleqetl eKemption. My violalion ol Section 7031.5 Oy
any applicant lor a ce�mit su6iecis tne applitdnt lo a civil penalty ol not more Ihan Irve nunEreO dallars (3500).
I, as owner ol i�e pmpetly or my employees vrit� wages as t�eir sole comDensatian, will Go t�e wor�, ana me
❑ strucma is rrot imeMetl or alhreE lor sale (Sectwn 76aa, Business an0 Prolesvonal CoOe: TOe Coniraciors' State license Law
aoes nol apDly to an owner ol a pwpeny wno ouilOs or improves inereon, an0 wno aoes sucfl woA himself/nersell or ihrougA
�is or �er own employees. D��eG tlut sutJi im0�wemeni5 are rrot intenJeO or ofl¢Rd br sale. II, however ihe DuilUinp or
improvemenl is so10 wit�in one yea� ol complelbn. lhe awne� wJl tuve Ihe EurEen of proving A¢/she OiU nol 6uiIE or impwva
loi ina pWDose ol Sale1.
� I, as owner 01 I�e D�oOeriy, am e.UuvveN contraciing wit� licensetl contractors m constmcl t�e proiect (Section 70e4. Business
❑ anU PmIe55i0n5 Coae: ihe Comracmrs SWte Lkense Law Oces not appy to an ovmer ol prapeM � bmWs or imD« ��e��n
ana wno contratls lor sucn prqects vntn a mnUactoqsllkense pursuanita ihe tantracrors' State L¢ense Law�. I am aware
Ihat Dmol al I�eit Worker's CAmp¢n5aiion insurance sMUIG be O��OeO to me.
� I am erem0i unOer Seciion: B. d P. C.
lor ��is reason:
Oaie: Or�+�er.
1 ao �ereby cenily Ilut I am aware ol an0 un0erstanG t�e repuirtmenLS of Catilomu Hwlt� anE $afety CoGe Stttims 255115, 25533, antl
25534 ana Inal I oi any lulure OuilCing Omupdni wilVwill no� (urGe one� neeU �o rompry wit� SaiO siate cotles anE ��e repuiBmenis lor a
Oermit Im can5lmciion or modilication Imm IM1e Air Ouahiy ManagOmeni U51rici. Heveen�ial con5tmciion apD�ica�ions are exemp� Irom
Nese pravisions.
Daie: Applicani:
I hereby certily Ihal I �ave rea01hi5 aDDliw�i0n an0 Slale Ilul lhe abov¢ inlormaiion is torretL I agree Io wmply wilb all u�y antl Couniy
o�amancesanOslatelawsrelatingto�uilEingconslmctionana�ere�yamMrixer semalivesotl�is�lyloenierpp9n�heaboy��memioned
pmpetly �oi inspec�ion pur�5e� � A „-n r�. ,_
D�iverS License or Social SecuriiV w: ,
164L46 Whne—Builtlmg', Green—LOEo Enbr em: Canary—ApPlican�;
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; B_ 060695 PLAN CHECK NO; N
CONSTRUCTION TYPE: PERMIT TYPE: STR
JOB DESCRIPTION : T/OFF RESHT, REROOF W/BUILT UP
CLAIM VALUE; 3,500.00 CALC—VALUE: 3,500.00
PERM NO; B 060695
GOVT; N SiJPP; N
PURPOSE; A� �
`� ; -
SQ FT: 3,500; -
�il% '
GROUP OCC: B-2. /
COMMENTS: *
�r��r�t��r�t�t�r**+t�t*�e�r***�e*�*�t��r**�r*�**�e�r*�r*�t�t*�t�r�r�r�r�r�r��r***�ex+t*�r*r�r��r*�e�t*�***�t****�r�r
Z O N Z 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 HUZLDING ---------
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT; FT ZN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 42230116 ZNE: REF NO;
iPLANNING Ni5TE5>
�
1F �F iklF iF iE iFi! M if k iFik if �k k�f ik iF iF k iF iFit iF if ki! iF if iF 1f if �k iF if iF iF iF if iE iF ik iFdf if 1f �t �f 1t i! M if k if if iFik k ik iE k!E �f ik iF iFif iF �E if �E iF iF if if iE �f �f
D E V E L O P M E N T S E R V I E S R E Q U I R E M E N"T S
ZONING APPROVED BY DATE: '
BUILDING APPROV,ED BY ; DATE;
APPLICATION ISSUED BY: DATE: ,�:r
ik it it if 1k If �M 1f 1FM M if if i4 ik k M 3f kiF iF M �f k M iF iE ik k if 1f if��7Fk ik
1Fifit�fllifit�FikiFikitiFifilkkkkkklFk�kk�EifkiFikififlFiFifkkiFiFklfifik if ikifitltifkiFif�fifikifikif�FafififiliFilit�E3tiFiFiEikitklkiF
LEGALIZATION;N F E E S U M M R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 63,00
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 63,74 0,00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
63.00
SMIP/NON—RES
.74
TOTAL PAID DUE
63.74 63,74 .00
63,79 OVER/SHORT: 00
FIRE SMIP/TO� GRADING PLAN—CHECK
iFkk3fkMMMkififfflE1F1E1FMiFifiFkifkkifakiEiFififkif�fM�fikIFklFiFif�ElfiFiflfifitiEiflFifiFiFMiflfiEifkiFififikiEiflfiliFifiFififklFlFiFiFiF
I N D I V S D U A L F E E H R E A K D O W N
TYPE (JTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 3500 REROOF BY VALUE COMMERCIAL NOZONE 1,00 3,500,00
END OF FEES
Ol G/] r y. . �
�i4'�
9
CCONSTRUCTION ANO PLANNiNG -
t'�PPROVALS Permit #' - Da
�, Temporary Electricat Service or Pole
2, Soil P,�e-Undrgrnd. '
3. EJectrical ConduiT�UiihtY-Undrgrnd.
'� 4. �IectriWl Condoit•Ui'rdrgrnd. '
� 5: �5teel iieinforcement• �
'- ¢. ��ectrical UFER Grnd. ,
7.,footing: ,.
8, ioundation - - '
9. VJater Pipe-Undrgrnd.
10. Structural Floor System �
11, property Sewer Line& HouseConnection
12. 5ewer CaP 1
13, aoof �raint _ . �
14. Rough Plumbing �
15. Rough Electrical-Conduit
76. Rough Electric%Niring
17. F?ough Wiring Sign
18. Rough Electrical-T Bar Cei�ing
19. Fough Heating�& Air Conditioning
r
20.y�Fough F,acco�V Fireptace _ �
21. Ducts,in-5ttucture • '
22._ Ducts, �lenti�ating , - ;
„
23.�Gas Pipe-Rovgh & Tesc � i� � r
24:'�qoof Framing ': - " - ` =�
25. F1oo! Sheathing �: �. �/ z:
26F 7�85r Ceilin9 (StraCtural) & Mor;ocoat � '
27,= �rame and Flashing _ _
� 28. lathing� Siding - - . - _
29. Insulation � - •
i
`�30. Drywall'Nailing '
-31. P�aster &own CoaC �
32.�Electrica� Poyver Mete:-FinaF " ��
,-33:;Final Electri� . < �
�*34ti ���nal He3ting & Air Conditionmg
3� 5 inal Gas Pipe-Test " . .
36. Hood or Canopy �� ' � - �� " �
37�F��a1 Pactory Fireplace._ � � � ` ��
�38. Final Plumbing , � t �.�
39. Wat�2r Service=Finaf � '
40. Gas Service-final • � _ :�
W �
41. $olar pome,StirFin�ai T . ' -
' 42. Backflow Preventer. R ~
43. Backftow trrigatior� '_' '�
. 44. LandscaDe Irriga[ion System "' . • •
..�.L . ... ' .. � �
'46:. Hand i ca p R egulat ions
47'�If�AL STRl1CTURE & BUZDING �,
48, FI�ALPLANNING
"49.'E�ectric Release to Edison
_50. Gas Release to Southern California Gas Co
51. CERTIFICATE OP.00CUPANCY
No. Date
� POOL..�PA �
Inspector APPROVALS Permit # Date lnspector
52. Pool & Equipment Location �
53. Steel Reinforcement "�'
� 54. Forms �-
55. Electrical Bonding � �
56. Rough Plumbing & Pressure Test i
57. APPROVAL TO COVER•GUNITE �
58. Etectrical ConduibUndrgmd. _�
' 59. Gas Pipe, Cl Undrgrnd., Test _� �
60. Backwash Lines, P-Trap, O Undrgrnd. � ,
61. APPROVAL TO DECK �
62. Backwash & Recep[or-P�nel _ i
63. Heater & Vent-Final ,. �
r,`
64. PIum.Uing SYstem � Final � � i
. �
65. Electrical•Final -
:--1:
66. Solar System-Final ' " i
67. Fencing & Access ApProval ��
�
68. APPflOVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL i
FIRE DSEPT. REQUIREMENT �
. �' i
� - . z APPROVALS ""Petq�it# �' '
• '�" r 70. Undergro.und Hy[iro �� I
- ,� -` � � %71. Product-P,�inc� C�Gas C�,�Oil
� fi �•72. Undargrdund Ftusf1 �- • - �~
� : ' .'73.'Undergrnr�.Storag�Tank OGas ❑Oil ;
�•�j ��• �74.'Qberhead Hydro:. ^
` -"� 75.-DivCherpical ' � " " '
\' T
76. Dry Standpipe � •i � � '
_ - _ i
i t'"; 77. FIXED $Y�iEAl RINAI,'� _ . '� I
_ �
� 76.'FiRE PREV. FINAL ' - - ' ;
.i .
;' '� �EALTH.DEPT.REQUIRF,MENT �
�^��. -79.�FINALINSf'ECTIDN ��� � _�
� ' 80.� POOD CERTIFf�f4TE ISSU,ED , �
_� > Notes: �-- ' : _ * I
'a.il �
c
� ._i� � ,
�x 7 '
x
( � S
� • K
,. J
�.= w �
� -� -t � ;
,� • ` .
(714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
dob Address: 816 W 19TH ST
Suite No
Vicinity:
Parcel Nunmber: 42230116
Status: ISSUED
Applied: O6/OS/2003
Issued: O6/O6/2003
�
Applicant: PRAUM, STEVE - - �; � „ , `- � �� � ISSUED BY:
Address: 1049 MELROSE �r ��'��� � " � . � _ ' -
��� i.
���-�� "' -� Phone: (714)231-7501 � � - _�
PLACENTIA,�A"%� ' � , Zip: 92887 � � �
�, �', � V � '
,�� �% :' •, �, � � " _ - . . , .
Owner.' i�'-KEELER, WILLIAM-HTR � "_. �
/.
Address' i1858 SAMAR PL : -
� , j ' � �. � . .�
. , '� �� �i�, -'� Phone:
�� � COSTA"MESA, CA Zip: 92626
' ' �i'�%i
;.
>>;.
�
Contractor: , ORANGE ELECTRICAL CONTRACTORS
�. �. � -
. Address: . 104g MEIROSE � � � `
� � _- �
� �
; � RLACENTIA; CA�� -�
! �. � -
, '���� �� � � � _.
,. � �
. -,'Phone: p14) 980-2300
� Zip: 92887
License: 747129
.,�,�
� `�.
�\
� �' .
� � , .A
��C>�: i�- .�
.� . � . . :�� ',_
`� ��� , � . ��
\
, . ; ,SCOPE OF PERMIT , ; �
CONVERT EXISTING OVERHEAD ELECTRICAL SERVICE TO UNDERGROUIJD FEED.
� :
�; ' , .� �� � t�� FEE SUMMARY� �� ,;''; �'�: „
. .' - (3uantiry-= - � - � - - `
�ISSUE FEE' � � $0.00 � '� ` � � ' � � Temp Dist System / Lighting �
. Temp service test .� $0.00 Busway.l100 ft
Res. a/c package��.'�: $0.00 ,. Standing.Section , �
New Res (1-2 uni4s), ����., � $0.00 . 0 Misc ElecVicafEquipment
New Res�(3+unitsj; �'���� $0.00 0 , Transfortners up to 1 kva/kw
Pool /�Spa � � " � �`'� �1 $0.00 0 ,,,� , � - .. ....up to 10 kvalkw
.
..,
Lighting Fixts ��-- � '�A. , $0.00 � 0 ,, ;�:���; o � ' .......... :.:.up to 50 kva/kw
Recept Outlets ` �$0.00 � 0 � � � ..........:..up'to�100 kva/kw
- •:. .
.
. -_..
Switches'; �; . - $0.00 ., 0 •� � � ...::........:...over 100 kva/kwC�
Non Res A'ppl �;�, � � $0.00 � � �0-,- � �� � - L'ow Voltage �Equlprrient .
Res Appl �� ��� , - � $0.00 ' � �� 0 � Low Volt Winng System / Ckt
Serviceto200a�. ��;-� ", '� $30.50 ��` _ �1_ � MIsc.Conduit
Service to 1000a �� �� �_ � $0.00 � ;,0, � � Misa Conductor " �
Service over t000a�� �;� , � �$0.00 j' � �.,, 0 � . - _ Circus ( gen or ride) � �
Motors to 1hp � `� �. $0.00/j �, .�0 � ` � _ - � �Ciras (mech ride or lights) � �;
Motors to 10hp �.��=�� $0.00,'��-� . - 0_ ;,, �� _, � Christmas Tree Standl -
Motors to 50hp ��' $p:00 � ,� 0 - � -•Fireworks Stand�. �
Motors to t00hp �$0.00 -� . 0:. (_, � Other Electripl�Fee
Motors over 100hp $0.00� � - 0_ � ' �
Communicatlon drops $0.00 � - _� �0_ � - -- _ � � Investigation Fee � , . � �-'
Sub panel to 200a $0.00 -�0�--��� `- ' . _ ` - PIan.Cfieck Fee � �- �
Pole Light Pkg $0.00 0 " ��- -- _-. , Reinspection Fee
Sign Circuits $0.00 0
Quantity
$0.00 0
$0.00 0.
$0.00 0 ,
$1820 �1.
$0.00 ,�- 0 , �
�$0.00 ,c �'0 '
$0.00%;i,�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, - 0
$0.00 �%� 0
$0.00�
$0.00
$0.00
$0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO 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 woik must comply with all applicable codes, and all
required Inspeetiona enq final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. .
FOR INSPECTIONS CALL: (714) 754-5626 I,
266W6(fi/00)
WORKERS'COMPENSA710N DECLARAnON:
I hereby eXirm under penalty af perjury one of ihe tollowing decleretions: �
❑ I have and wlll maiNain a certificate ot consent to self-Insure for workers' compensetion, as providetl for by section 3700 of the Labor Code, tor Ihe pedormance of Ihe
work for which this permit is issuatl.
[r I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for fhe pedortnance of �he work for whlch Ihis pertnit is issuetl.
My worke compensation Insurence cartier antl policy number are: p
Carrier: �� W i� FJ .y /1 Policy Number % 2 I-0�
(Thls sectiar need not be completed ll fhe permit is valued ef one hundred dollars ($100J o� Iess.J
❑ I certify thet in the p rformance of Ihe work for which this pertnit is issued, I shall not employ eny person in any manne� so as to become sublect to the workers'
compensatlon laws f Cal' rnie, end egree that if I should become subject to Ihe workers' compensation pmvisions ot Section 3700 of ihe Lebor Gotle, 1 shell forthwith
comply with thesa p visi s.o
Applicant Signeture: � oQ� Date: � ��'��
WARNING: FAILURE TO $ECURE WOPKERS' COMPENsqTIIXJ COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVI� FlNES UP TOONE HUNDRED
THOUSAND DOl1ARE (5100,000), IN ADDITION TO THE Cp$7 OF COMPENSATION, DAMAGES AS PFOVIDED FOR IN SECfION 3]O60F THE LABOR CODE, IMEREST, M1D ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn that I am licensed under rovisionS of haptpr 9(commencing with Sectlon 7000) of Dlvislon 3 ot the Business and Professions Cotle, entl my license Is In tull
torce and ettecc uc. a 'l �-I 1 I� CI � II . Ciass x (
Conirector'sSignature: � � � Date: ��^O
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that there is a constmction landing agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lentlers Name: Lender's Atltlress:
Signature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm ihat under penalty of perjury ihet I em EXEMPT PROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Cotle: Any city or county which reQuires a permit to construct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicant tor such permit
to file a signed stetement that he or she Is Iicens�d pursuant to the D�ovisions of the Contrectors License Law (ChaOter 9(commencing with Sectlon 7000) of Divislon 3 ot the
Business and Professions Code) or ihet he or she is exempt therefrom and t�e besls for the allegetl exemption. Any violatlon of Sedion 7031.5 Dy flny appliwnt for a permit
subjects the applicant to a civil penalry of not more Ihan fiva hundretl tlollare ($500).):
❑ I, as owner oi Ihe properry, or my employeas with wages es their sole compensation, WILL DO THE WORK, and ihe structure is not intentletl or ottered for sale (Sec.
7044, Business and Professions Code: The Contractars Licansa Law does not apply to an owner of properry who builds or improves ihereon, and who does such wark
himselt or herself or ihrough his or her own employees, O�a�ided that such improvemenis are not Inlentletl or oHered for sale. If, however, the building or improvement is
sold within one year ot completion, the owner-builtler will �eve{he Durden of proving Ihat he or she tlitl not build or improve for purpose oi sele.). '
❑ I, as owner of the property, em E%CWSIVFLY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, 8usiness and Pmfesslons
Code: The coNrectors License Lew tloes nm apply to an owner oi property who hulltls or improves thereon, and who coNrecis for such project with a contractor(s)
license pursuant to the Contractors License Lsws.).
❑ I am esempt under sec.
Signature:
Owner ID verified by driver's license. ❑ Yes ❑ No
Business antl Protession5 Code for ihi5 rea5on:
Veriilcation of Ownership 6y (type of tlwument, i.e. - pmpeny tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CEpT1FICATION:
DriveYs License No.
Date:
Expires:
❑ I hereby cerlity �ha� no excevetion fiva (5) or more feet in depth into which e person is required to tlescentl, will be made in connection with work authonzed by ihis
permit, and ihat no building siructure, scaHolding, felsework, or demolition or dismantling ihereof, wiil be more than ihirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celifornia Administrative Code).
❑ As owner-builder, 1 will not employ enyone to do work which would require e permit from ihe Division of Industriel Setety, as noted above, unless such pereon hes e
pertnit ta do such work irom the divislon.
SignaWre: Date:
Division ot Industnal Safery Pertnit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUiHORITA710N OF ENTRY: I cenify untler penalty of perjury Ihat I have read Ihis application and sta�e thal the informa�ion given is
Correct. I agree to comply with ell state lews end ciry ordinancas relating ro huilding construction, end authorize representatives of the Cily of Costa Mesa to enler upon ihe
ebove-describad ropeAy r inspeciion purposes. I agree not to occupy or allow occupancy of any building euthorized by this permit until finel inspection.
Si � eNre Of Legal Owner(s) Date
�� -q-o�
nNOr Authorized Applicant Date
COUE I, MSPELTIONTYPE f�jF
1616 Fixed System Final Fire Prevention
1266
200
201
202
203
204
Pool Spe Final
Final Re-Roof
Final Blxk/Retaining Well
Final Fectory Fire Place
Final Sign
Finel Demolition
INTITIRLS �QpE( INSVECTIONTYPE
206 Finel Mechanical
� 208 Final Plumbing
210 Final Elecirical
212
220
Ffnal Fire Prevention
Final Planning Approvel
222 Pinal Site
250 Final Building/Occupancy
PAg
i ��
1[�LH
� n
�pj _� :� .. ��►.9466 � �,,- �til�� ' � �. ����li�i��
COSTA MESA BUILDING-SAFEfY uEPARTMENT w�� 2 1 1963
P. o. aox �„ COSTA MHBA, CALIFORNIA �� � u FIN,4IC�E DEPT.
For Appllcanf fo Fill In Complefely /�OChe/APPLICATION FOR�PERCMORTA MESA
TYPE OR PRINT BUILDING
For Offica Usa Only
BUILDINO �j (^
ADDRES9 : � �/ l7 Ree[trtrvo. r ryy r�+p.
COSTA MESA, CALIFORNIA , � �14Y1R
�f�
Y 6HTB�CK
THL.
DESCRIPTION OF
BUILDINO
SIZE
EXTERIOR WALL
1 XEq60Y ACKN� LO8D0[ TXAT 1 HAV6
ANO 8TAT8 TX�T THH ABOV6 IB O!{q1
PLY WITH ALL cITV OAQf�NiR��N6 i
� AUTHORIZHDAGENT
' ZONINCi
NO.OP UY[
�una v eui�
YARDBAPPROVED
MAIN BUILDINO
tOM C/L STREET 1
eEr
VAR. iC
G. U. P. ij
APPROV[O
Y
SHALL BE LESS THAN
VARDSAPPROVHD
AGGESSORY BUILDINO
eer. Mw�n e
ACCE99. BLD69.
DATE
APPROVED
�--ii..
O
$�. FT. _
TN6 AMOUNT BXOWN UNOEH VALYATION IB POH TH8 8
PUNP088 Ot 68TABLIBMINO A pHPMIT FEE ONLY. �
VALUATION � — m
PERMITFEE S �
�
�y m
s � Y � -- �- o
r..r.. Q« a � � r
�
: - _-_. ����� (=EE R`� �tsU�� .
COSTA MESA BUILDING-SAFETY DEPARTMENT ,��3��16r
P. O. BOX 917 C08TA MEBA. GLIPORNIA FINA�lCE DEPT.
For A I�eanf fo Fill In Com lefel f�n QF rOsTa �Fgp /rn
PP � P Y , APPLICATION FOR pERM1T �� �
TYPE OR PRINT gU1LDING ��' � /
BUILDING ST� ,�,w �� ,� J
ADORESS „� « w�
COSTA MESA. CALIFORNIA FOr Office US@ �f1��1
�� /� _ RHCEIPT NO. PERMIT NO.
■ STATE
� s[TBACK LIN6 FHOM
Y �
TEL.
j NO.
TEL.
NO.
TEL.
NO.
INO. OP BLDGB.
DESCRIPTION OF WORK
I, II ALTERATION I/� II ADDIilO
ILDING
e
fER10R WALL
VERING
RhOP BUILDING
ROOF
COVERING
K �O BE PERPORMED
,fl a�.t7 %�✓ _ IL% �1
COSTA MESA. CALIFORNIA
FIRE
ZONE I NO. OP Q � UBH OP N
`PLl.N6 9UIlDINO
LEGAL
OE6CNIPTION
A. P. NO. �� �.�� U 'lFl
YARD6 EVES
APPROVED ALLOWEL
IGENTBq LINH BTJ _ /
�
J
�
1 HHfl6BY ACNNOWL8Op8 TXAT I HAVB R6AD TH18 APPLIWTION }HH AMOUNT BHOWN UNDER vALUATION 19 FOR TH8
AND BTATE TXAT rxe ABOV6 IB GORReCT AND A�qEH TO GOM- pUPP098 OF EBTABLIBXING • PERMIT FEE ONLY.
PLY WITX ALL CIiY Op�IHANCEB AND 9TAT6 UWe q80UlATINO
9UILDINo CONeiAUGT1oN. VALUATION � L��.
SIGNATURH OP PERMIT FEE $
PERMITTE �q /Q—�J
$ V ✓ ". PLAN CHECK $ ��
■ AUTHORIZED AGENT