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Home My WebLink About859 19TH ST - Building Permits. u�►rt t, �� y, �' �,5; 6� � g U►�rt' �i, l °� �' .. S5 ��. vw,fi� t-ao-�� --/a-/i Uh,} p ��+rt� l2 �3 /y �S, 1(o��7r1� u„�t i ��a� wEST 19TH STREEi 859 � 5384 , i-3o-58 �, �;:� � l:y.;:::. ,;/ 1=�,;.,u I ., f _ •: �: .. $80, 4b293 - u-i9-65 ,�, �;; i;c (._ �'� , , k7275 - 5-9-� ;-�tc. i:c (�::�; 49i67 - 12=-6-66 =��c• '.�� i��=�i 542qp _ 6_2_69 pr��_. rc �:.,:. ? 54956 - 10-27-69 i>i r�, ,:r �::. :. ; 57816 - 10-27-7o r1�;,. 1::; (':;.;:,j,�, 58831 - 6-15-71 1' �_t �.. ;ac (',i. �'. ) 76949/0-a-99P�bg NC (Wtr Htr) — 17475 a-a�-BO MECH NC (Gas Piping) 77923 �_ �,8� PLBG NC (W.H. & Vent) _�I 79145 3_ a_S�Plbg. NC (lV.H.) j 'P-102- Plbg.(w. x.) .� .� 3�/g -� � �) _ B15714 . REitpOF $5,208 I ! "�/9/�7 � ':.=t'rra�.�C-�+':�Y�sK�7+a�-"'=:.i 3yt§+is-'s"�R;c3iLRfSC':i?42._w�,Q'{.,�. `it:: • '�� •• / / � � ' -... -."..::fTi V . .. y ... ._.1. . �. J._: ._ . � r. �:"rf:,n,.iF:. a .. •: � / r. . , � � F�� wf �� . �� a' FEE RECEIVED� � t - .. i-3o_� � _ C �1 W E� 8 !D G DEPARTMENT �'""'� � � � � �7 �' ' `�r �, P. o. aoX 3,� FINANCE DEPT. ' COSTA MESA. GALIFORNIA '; , CITY OF COSTA MESA ' FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING � � � BUILDING ADDRE55 • ' � COSTA MESA. CALIFORNIA !i FOR OFFICE USE ONLY /� RECEIPT NO. PERMIT /NO�. '/ OWNER ,/• / � b (/ q C • / REC IVEO 6YJ [l4iE RECEIV S Aq I55� ADDRE55 /�:J �i ` LA1T C LdCT NI1�V .%!�"f�/ O % v C)�/'L. ,%� CITV C�GROMA DEI /�1qR TNO. ARCHITEQ /` -� LIC. OR ENGINEER1 W. FCS IPR NO. ADDRESSz��,� G LAS/ CONTRACTOR �/G �%V1A�I�AI 2 �•Ss� �_% � T � t3 �. AODRE 5 �E�^� LOT /� K �DESCRIPTION NO.��Y V• BL( A.P.No� F,�(!�'�JLJO.� S�ZE �% � .Y 30U OF LOT k ��_: 115E OF E%ISTING BLDG. $ETBACH LINE FROM ��,� ' CENTER OF STREET � SIDE YARD RIGHT DESCRIPTION NEW � ALTERATION REPAIR BUI�DING SIZE E%TERIOR NO.OF ROOMS RO� LIC. NO. TEL. No.or a�ocs. now oN �or �, EFT pyy�R K,��' AODITION DEMOLISH OSTORIES V tf V . / 6' � ,�. G i2A ✓L� i7. �UI � COSTA MESA. CALIFORNIA t�. /G �rsC/_�7 _ a- �Y� / DATE CORR CTION SUBJECi TO �il�Uu'. DtPT. REG. PLAN � I XEREBY <CI(NOWLEOGE TNAT I MRVE READ TMI$ PPPLICRTION 4ND ' STRTE THRT THE RBOVE IS CORRECT /�ND RGREE TO COMPLY WITH /Ll CITV OROINiNCES RND STNTE lPWS FEGUL/�TING BVILOING CONSTRUC- iiON. ///� yqLUAT10N ( SIGNATURE OF / ��l//,A.1.7 �- PERMIT FEE $ , J O PERMITTEE � ��Y��L /� Q � $�0, 9�/ PLAN CHECK 5.�a. Z S AUTHORIZED AGENT TOTAL FEE $�� ` �� oMs � � � COSTA K1ESA BUILDING DEPARTMENT NO �AC B 1N East 2QSh Street �U Costa Mesa, California , � Date .............I..... ........� �...�._...�.�..�" CITV OF COSTA �MESA �� O �� CERTIFICATE OF OC�UPANCY�°"% . �� :L � / Building Permit No ...................Electr� 1 Per�No.:..�J..��l�,pPlumbing Permit No�.(.C.�.0 !f tt<.!� c� � .� . t��/u�s ..�. n d Useof Buildin9.__�/._.._ .................'�..'..................�.'.............._..._..._.._.._" "'.�...�..L..trL�_"'__"_ The building Ixated at......�. d,.�...�. ............._............'_........................ .. - .... ..,..................................._..... �%o� ' , . //�—o?o— .... .� ...................... .................... . ... Lot..l ........................................ I ck........................�............... Tract....�:.'�..L�:."':?..�......'_'_...... (See rcverse side for Metes and Bounds) has been inspec[ed end found to comply with the provisions oP all City of Costa Mesa Or- dinances applicable them[o for a oup........J.�y...... ....Occupancy. ,1S�§yEDTO: ^ � y�ARJ. VOLZ �L� fii it'stN �A v �'S 6'n ��en,� c�cy=e ilding {77pC �ar ...-------�----t ------- .........} . . . . BPia,er � ,��. % �� (Ownerof8uilding) By.��....�:��...._.��/.-.i......:.r.!.I.�:.wr... CC: ❑ Original—Owner ❑ lst copy—Gas Co. ❑ 2nd rnpy—Edison Co� 3rd copy—FYIe Form 206 GH 1M I2-6S COSTA MESA BUILDING—SAFETY DEPAHTMENT P.O, BOX IZ00 Cosh Mesa, Califoraia CONTRACTOR /Jn�,�� G ,Zn/StA� L E� �� Add.ss.7s5�� %/Y t,�/O/Yy CIry��E� �,�D/�E ZipCode9�165 Swtti license No.a// �9� Clau.,(a—/ City License No. �/'rJ. f(3 Tel. No.�'3 _ VUTIBER TYPE OF FIXTURE OR ITEM FEE Bathtub Luundry Tub or 7ray Automatic WashinR Machine Vent uocknow Hes or .. Fee� Tnnk Tarni. � � S � 6 0 CMF 0450-46 rnwcr LOT N 8283 7/07/81 RECD. BY/_ BUILDING USE � 5.00 TL /"" - /UG. DAT61B6UHD 7- �-�/ Addfess �-� 7 !si' /'7 =�I-G' Lc�c. •/b Owner /�/d � rff.9�0 naa�e:: �s 4�•/ 9�`=' �F�,T• �6 1 hereby acknowledge, [liet lyhave read this application and stare that the abQv"s is, coriect and agree lo comply wiN all City OrdinanoEs and;SUte Laws regulating plumbing. 1 certify�[Iiaf I+ptissess the above valiJ S�ate of Glifornia classi- ficetion or�{�1 am [he legal owner of the residential property de- scdbedybove. 1�Kfy that 1 have obtained a permit from Ihe Stale Division of Influs[rial Safety fo�excava[ions,o[her than awimming pools, (ive y feet deep or deeper and into which a person is requved to descend. � SignaMre of �p � � Permitfee in- � INSPECTION RECORD \ � R CITY OF COSTA MESA BI/ILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(71'4) 754-5273 • Fax (714) 754-4856 • www ci.costa-mesa.ca:us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC08-00424 1 - �- �. ��: � � ': . r _ ,..c .. PERMITTYPE: B COMBO STATUS: ISSUED Sub Type: RES_ALT _ DATE ISSUED: 09103/2008 � ._ . ISSUED BY: CAC _ ... • . . ...... �� .. , �. .-. .. �..�,.�c,. JOs aoDrtesS: 859 W 19TH ST CM_'`: ' ! Suite/Unit:,,' ,` APN: 42419105 � ��.'';�;� �:� ��Zoning: '. , �, -� � ' �i � , . , - . . � .. ' �, ��" _ .. ' -`_ Vicinity: 15 , PrimaryAcc: R1 Const Type: V-B � SQ: FT: � 0 , Val'uation: r; � _ SCOPE OF WORK: FIRE DAMAGE REPAIR TO UNIT 15. DRYWALL REPAIR BATHROOM. +' 1 FAUa100KBTU(35BTU) ,��' � '.�, � � 8 LIGHTS 15 OUTLETS 10 SWITCNES �� . -� �� ` /. � 52s,o0o.00 1 TUB 1 WASH BASIN KITCHEN.SINK�.1-TOILET 1� WATER HEATER � . � ---�'� -� �� - OWNER: SKORO, VAL TR �� - �',Addres"s: 1601 BAYADERE 7ER '. Unit: Phone: 949-212-5028 � "t � - � r Ciry/State/Zip: CORONA DEL MAR CA � � -' � ' ' ;,::,. .. ' �..' .� .�.� �. , .. - , .. � ,, "..; � APPLICANT: CATHY DELLIGATTA �,?,� � • „-_ �.Address: � 11779 CARDINAL CI :"' �� "�� Unit �;: `" Phone: 714-537•7200 ' �':'� � . � City/State/zZip:%. �GARDEN GRIVE, CA '-�� `� � � � , " ,_ ';- '�. .. �-. . , .,. .... ;, .. , .:� , � . . . _ ... w,:.,�a, -�., ' . cONiRnc70R: ROBERTS CONSTRUCTION � . License No. 389991 ' � , ' �' + Phone: 714-537-7200r � " �� :Address: 1�1779CARDINALCIUnit: �� • � Cell: - , . , ' , - City/State: GARDEN GRIVE, CA . __ ZipCode 92843 � . ARCHITECT: , � � License No. , � - FHONE: ENGINEER: ' � . � ' License No: • . � � PHONE: COMBINATION PERMIT FEE SUMMARY Building Plan Check: � $0.00 � Building Fees: - ' � $432.15 - ." - ' - � " Electrical Fees: " $59.80 , ` ' ,'i'.ss Mechanical Fees: � ��- $38:50 - - Plumbing Fees: ': �. $72.50 , ' � ,� ','! .,: � - SMIP Residential: � .-$2.90 . - � ; �" � SMIPCommercial: $0.00��-� - � � . � . TOTAL FEES: $605.85 "Refer to fee receipts for all fees paid for proJect NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wilh all applicable codes, and all required inspedions and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of lhis permil. �E„�, INSPECTIONttVE 1878 Fized System Final Fire Prevention 7288 Pool Spa final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 20< .,) �Final Demolilion. PLTE ixmu�s cooe� iNsvecno�rwe 208 Final Mechaniwl 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevenlion 220 Final Planning Appmval 222 Fina15i�e 250 Final Building/Occupancy Il G � J�_ � N1 � WORKERS' COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one ol the tollowing declarafions: ❑ I have and will maintain a certifiwte of consent to self-Insure for v,nrkers' compensation, as provided for by section 3700 of the Labor Code, for the pe rmance of the work for which this pe�mit is issued. I have and will maintain workers' compensation insurance, as required by seclbn 3700 of the Labor Code. fw the peAortnance of tFre vrork (w which ihis p�,rmit-isiasued. �My workers' compensation Insurance cartier and policy me hw�Med cbuars � I certi(y that in the peRormance of the work for which ihis permit is issued, I shall not employ any person in any manner so as �o become subject lo the vrorkers' co pensation laws of Califomia, and agree that if I should become subje t to t e workers' compensation provisions of Sec�ion 3700 0( the Labor C , I sh orthwith comply vrilh these pr i ions. ppliranf ig Da WARNING: FAILURE SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION 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 aKrm that 1 am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Cotle, antl mY�license i5.in full force antl eflect. � CONSTRUCTIOPTLENDING AGENCV: ❑ I hereby affum tliat there is a construcibn lending agency fa the peAortnance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentler's Atltlress: SignaWre Dale OWNER-BUILDER DECLARATIONS: I hereby aHirm thal under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or lhe following reason (Sec. 7031.5, Business and Professions Code: Any city or wunty which requires a pertnit to consWct, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires the applicant for such permit to file a signetl statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged eaemption. Any violation of Section 7031.5 by any appliwnt for a pertnit subjects lhe applicant to a civil penalry of not more than five hundred dollars ($500).): , ❑ I, as ovmer o( lhe properry, or my employees vrith vrdges as iheir sole compensation, WILL DO THE WORK, and the struclure is not intended or offeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law dces not apply to an ovmer of property who builds or improves ihereon, and who does such work himself or herself or lhrough his or her own employees, provided that such impmvements are not intended or offered for 5ale. I(, howevei, the building or improvement is sold within one year of comple[ion, the owner-builtler will have the burtlen of proving lhal he or she did not build or improve for purpose of sale.). , ❑ I, as owner ot the�property, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to consiruct lhe projecl (Sec. 7044, Business and Professions Code: The contractors License Law dces rrot appty to an owner of property who builtls or improves thereon, antl who contracls for suc� project wilh a cm[2cla(s) license pursuant tothe Contractors License Laws.�. ❑ I am exempt under sec. Business and Professions CoOe for this reason: 305�<6�L01) Ovmer ID.verified by drive� _.�cense. ❑ Yes ❑ No Driver's License No. Ezpires: Verification of Ownership by (rype of document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:2 � ❑ I hereby certity ihal no excavation frve (5) or more (eet in depth into which a person is required to descen4 will be made in connectbn with work authorized by �his pertnit, and tha� no 6uilding sWCWB, sc�fdding, (alsework, or Oemoli�ion or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which vroultl require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permit lo do such vrork from Ihe tlivision. Ap01iwn1'S SignaWre Division of Industnal Safety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or fuWre buildinq occupant need to fle and certify a Business Plan for emergency response to release or threatenetl release of a hazartlous material? ❑ Yes ❑ No (Section 25505 of the California Healih antl Safety Cotle requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every 6usiness whic� has at any one lime during a reported year a quantity of hazardous matenals equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will ihe applicant or present or WNre building occupant neetl lo file a registration fortn (or aculely hazartlous materials? ❑ Yes ❑ No (Seclion 25533 0( the Calilornia Heallh and Salety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous ma[enals equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet o( compressed gas at standard tempereture antl pressure�. 3. Does or vnll the applicaM or present or fuWre builtling occupam need to prepare an RMPP (Risk Management and Preven�ion Program for acutely hazardous ma[erials)? ❑ Yes ❑ No (Section 25534 0( Ihe Cali(ornia Heal[h and Safery Code provides �hal Ihe Costa Mesa Fire Department may require the preparation, certification and fling with ihe Fire Depahment of an RMPP by businesses which are required to regis[er acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of lhe California Healih and Safety Code been fully wmplied vrith? � Yes ❑ No 5. Dces or will the applicant or present or (uWre building occupant require for the work which is the suDject of lhis appliwtion a pertnit for such construction or motlifcation from the South Coast Air Quality Management OisMct or Imm any other air pollution control district or agency? ❑ Ves ❑ No (Sectbn 65850.2 of the Califomia Govemment Code requires that the requested informa[ion be fumished on applica[ions for non-residential building pertnits�. 6. Will any part of the faciliry to be constructed under this permit be within 1000 feet from the ou[er boundaries of a school? ❑ Yes ❑ No Qf yes", the (acility must meet ihe requirement of Sections 25534 and 42303 of the Califomia Health and Sa(ety Code). 7. I( a pertnit from the South Coast Air �ualiry Management District or other air polNtion control tlisirict or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certifcate of compliance from ihe appropriate air pollution control oKcer). ' .. � ' . . CERTIFICATE OF COMPLIANCEi �I certify4hat under �penalry of perjury:tFe information.given a6ove is correcL I agree lo compty with all.stale laws and cily ordinances regartling Hazardous Materials and Emissions. �� Signalure ' Date " ' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penally of perjury that I have read this appliwtion antl state that the information given is correcL I agree to comply with all state laws antl city ordinances relating to building construction, antl authonze representatives of the Ciry of Cosla Mesa lo enter upon the above-described property for inspection purposes. I agree not to occupy oi allow occupancy of any Duilding authorized by this permit until final inspeclion. ' - Si ia reollepalOwneqs) �a�e A i I n iwnt L�Date ` � ' � � CITY OF COSTA MESA BYILDING D/VISION � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (7�4) 754-4856 • www.ci.wsta-mesa.ca.us, FOR INSPECTIONS CALL: (714) 754-5626 . PERMIT TYPE APN: 42419105 Zoning: , B_MISC JOB ADDRESS: 859 W 19TH ST CM . Vicinity: UNIT 15, KITCHEN AND BATHROOM ��- �? SQ. FT: 0 _ ; -_ . PERMIT NUMBER: STATUS: DATE ISSUED: ISSUED BY: - � - Suite/Unit: � , ', PnniaryAcc Valuation: . � � _ 55,000.00 �� - � � � � � ' BX08-00259 . ISSUED• 08/28/2008 RMD � Canst Type � SCOPE OF WORK: _ DEMO PERMIT IN PREPERATION`OF FIRE DAMAGE REPAIR TO UNIT 15 (KITCFiEN AND BATHROOM). OWNER: SKORO,VALSR� ;., Address: 1601BAYADERETER City/State: CORONA DEL MAR, CA ��` ' Zip Code: ,.92625 ,, ' Phone: - :%.� ... ' . . APPLICANT: DELLIGATTA, CATHY,'� � ,� -'� I� Address: 11779 CARDINAL CI ?� '" - City/State: GARDEN'GRIVE,G,A;j , - , ` ' ZipCode:;� 92843.,. ' '_ ,�_� Phone: 714-537-7200�.�, , , _ � . .: • Unit Unif: CONTRACTOR: ROBERTS CONSTRUCTION - License No. 389991 .''• Address: 11779 CARDINAL CI " UniC City/State: GARDEN GRIVE; CA Zip Code: 92843 �" �� . � ,Phone�' `�714-537-7200 , �, � Cell: . ARCHITECT: �- • " - � . License No. . . �� Phone � � . - � ENGINEER: - � License No. - Phone Building Plan Check: BuildingPermit:';� - Electrical Permit: � � SMIP Residential SMIP Commercial TOTALFEES FEE SUMMARY , , $0.00 $1:11.25 $0.00 $0.00 " � $0.00 - � $1�17.25 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Califomia stalutes and related regulations. (Ord. No. 92-28, § 1, 12•27-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � . INSPECTIONS: In order for the work authorized under this permil lo be considered legal, such work must comply with all applicable codes, and all required inspeetions and flnal approval must be obtained. Failure to obtain inspeclions and final approval vrill result in the expiration of this permit. CODE /. INWECl10NTYPE 1818 FixeC System Final Fire Prevention 1286 Pool Spa Final 200 Final Re-Root 201 Final BIocWRelaining Wall 202 Final Factory Fire Place 203 FinalSign 204 Final Demolition �/ !1 ' /P ljbg IN7111RL5 GOOEt INSPEL710NTYPE 208 Final Mechanical 208 270 212 220 �� 222 f2� 250 Final Plumbing Final Electncal Final Fire Prevenlion Final Planning Appmval Final Site FinalBuilding�Occupancy q9g iNmw� � WORKERS' COMPENSATION DECLARATION� . � 1 hereby anrtn untlar penaHy oi perjury one o5 iha follovring declarations: ❑ 1 have and will maintain a certifGate of consent to self-Insure (or workers' cOmpensation, as provided for by,section 3700 of the Labor Code, for lhe pgdormance of the work for whichihis permit is issued. ❑ I have and wiil mainlain workers' cwnpensalwn insu2nce, as required by � ss��bn 3700 of ihe Labor Code, for the peAohnance of t�e work for wtiich this pertnit is issued. My workers' compensation Insurance cartier and policy number are:/� ,r� ��,, ,� Cartier. �i'�-��, �rIAY V� (Tha section neotln-o�f b1e minpe�l�a perm<B rdhief0�al dte �unEred tloCars (E100) aMssJ pQlicy Number: 1 � L ��i 0 2C� l ❑ I certi(y that in l�e peAormance of the work for which this permil is is5ued, I shall not employ any person in any manner so as [o become subject to the workers' compensation laws of Calitornia, and agree that it I should become ub cl �o the worker5' compensation pmvisions of Sec�ion 3700 of iha Lab r Co�e, shall foAhwith comply with these pro isions. 1 , r/ b t's SipnaNre Da�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS (g100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PF20VIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND AYTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby aKrm lhat I am licensed untler provisions of Chapter 9(commencing wiCh Section 7000) of Division 3 0l the Business and Professions Cotle, antl my license is in full force and eflect. LiG. # Class # � " 4"-.�iC-fl� . C ' SiOnalure Da�e CONSTRUCTION ENDING AGENCY: ❑ I hereby aKrtn t�at there is a construction lending agency for ihe peAortnance of lhe work fa �+fiich this pertnit is issued. (Sec. 3097. Civil Code). Le�der's Name'. _ Le�der's Address: Sipnalure Date OWNER-BUILDER DECLARATIONS: I hereby aKrm Ihat untler penalty of peryury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW (or ihe following reason (Sec. 703L5, Business and Professions Coda: Any city or counry which requires a permit to wnstrvct, aller, improve, tlemolish, or repair any strucmre, pnor to its issuance, also requires the applicaN for such permit to file a signetl statement tha� he or she is IicenseC pursuanl to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0( the Bu9iness and Professions Cotle) or that he or she is ezempt therefrom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any applican[ for a permit subjects the applicant to a civil penalty of not more than five hundretl dollars ($500).): ❑ I, as owner of tha property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl ihe sWcture is not intendetl or oftered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves ihereon, and who�does such vrork himself or herse�f or.through his or her own employees, provided Ihat Such improvements are not intendea or otfered for sale. If, however, the building or improvemenl is soltl within one.year of completion, lhe owner-builtler will have the burden of proving [hat�he or she did not build or improve for purpose o( sale.). ; , . ❑� I, as owner of lhe property, am'�ExCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslNct the project (Sec. 7044, Business and Professbns Cotle: The cont2cta5 License Law dces not apply lo an ovme� of properry who builds or improves thereon, and who contracts (or such project with a cP�Uactor(s) Gcense pursuant to the Cont2ctors Ucense Laws.i. ❑ I am exempt untler sec. Bu5iness antl Professions Code for this reason: S�B�a�ure �- ' ' Dale 305Y<6(Y01) Ovmer ID venfied by dri�nse. ❑ Yes ❑ No Driver's�License No. Expires: Verification of Ovmership by (rype o( document, i.e. - propeny taz bill or deetl)�• DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.�.', �' '� ❑ I hereby certAy that no ezcavation frve (5) w more leet in tleplh into wfiich a person i5 required to descentl, will be made in connection with uork authori2etl by Ihis permil, and that no building strucWre, scaffdtling, falsev+ork, or tlemolitbn or dlsmanlling thereoi, will be more than fhirly-su (36) feet high. �Chap. 32. Gry 2. M 2, Sec. 341. Tille 8, Califomia Atlministrative Code). ❑ As owne�-builder, I will not employ anyone to do work which vrould require a permit from the Division o( Industrial Sa(ety, as notetl above, unless such person has a permil to do such work from [he division. ApWifanfs SignaWre Da�e Division ot Intlustrial Safety Permit Num6er. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certity a Business Plan for emergenq response 10 release or threatened release of a hazardous ma�erial? ❑ Yes � No (Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, that a Business Plan be filetl vnth the Costa Mesa Fire Department by every business which has a[ any one time dunng a repoAed year a quantity of hazardous materials equat to or greater than a vreght ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at slandard temperaWre and pressure). 2. Does or will the applicant or present or future building xcupant need to file a registrafion to� for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Salety Code, vnth some exceptions, requires registration with the Costa Mesa Fire DepaAmenl by each business which at any one time has on hand a quantity of acu[ely hazardous malerials equal to or greater than a weighl o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas a1 sianCartl IempereNre and pressure). 3. Does or will the applicant or present or future builtling occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materialsl7 ❑ Yes ❑ No (Section 25534 of the California Health antl Safety Code provides that the Costa Mesa Fire Department may require lhe preparalion, certifcation and Ning vrith the Fire Department of an RMPP by busnesses which are required to register acutely hazartlous materials with the Fire Department. 4. It an RMPP is presently required, has Seclion 25534 of the California Health antl Safery Code been fully complietl with? ❑ Yes ❑ No 5. Does or will ihe applicant or present or future building occupant require for the work which is the subject of [his application a permil for such construcGon or modiLcation irom the South Coast Air Quality Management District or from any other air pollution control district or agencyl ❑ Yes ❑ No (Section 65850.2 of the Calitomia Govemment Code requires ihat the requested information be tumished on applications fa non-residential building pertnits). 6. Will any part oi [he facillry to be construc[ed under this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No Qf'yes", the facility must meet the requirement of Sections 25534 antl 42303 of the Calitomia Health and Satety Code). 7. If a permit trom the South Coast Air Quality ManagemeN Disirict or olher air pollution conirol district or agency is required for the work which is the subject of this application, have all of the disclosures prescnbed by California Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No S. Qf'yes", attach ceAificate of compliance fiom the appropriate air pofluiion control officer). - ' � � - • CERTIFICATEbF COMPLIANCE: I.certify�that under�perialryfot peryury the information given above is corzect. I agree to comply wi(h all�state.laws.and city ordioances regarding Hazardous Materials and Emissions.,, '' Signawre ' Date � � . ' CERTIFICATE OF COMPLIANCE ,4ND AUTMORIZATION OF ENTRY: I cenNy under penalty of perjury that 1 have read this appfiwtion antl�state that the information given is covect I agree to compty with all stale laws antl city ordinances relaling to builtling construction, and authorize representatives of tne Ciry of Costa Mesa to enter upon the abovedescnbetl property for inspection pur�es. I agree not to occupy or allow occupancy of any builtling authorized by hi permit unlil final inspection. ., . � Lepal Ovmeqs) Dalel �� POOIIWN OJIe � (714) 754-5273 • Faz (774) 754-4856 • www.ci.cosia-mesa.ce.us ii rAm urove, waiH m�ah, �n aaom BUILDING PERMIT ,Iob a.ddress: 859 W 19TH ST Suite: Viciniry: Parcel Number: 42419105 App�icant TIM MC CARL Address: owner: SKORO, VAL TR Address .160'I BAYADERE TER Zoning: Phone: 94&548-5569 Zip: Phone: , CORONA DEL MAR, CA Zip: 92625 Contractor: GARY REES DBA CRANK BROTHERS ROOFING Address: 126 COMMERCIAL WAY ,�, ; � Phone: 949-548-5569 COSTA MESA, CA Zip: g2627 License: � 736549 Arch : Address: Phone: Eng: Address: Status: ISSUED Applied: 02/23/2004 Issued: 02/23/2004 ISSUED BY: ' Phone: Zip: License: � License: SCOPE OF PERMIT T/OFF AND REROOF 3100SF RESIDENCE W/HOT MOP AND�GRAVEL. - - ' Plan Check: $0.00 Permit: $153.25 SMIP Res: $0.77 SMIP Com: $0.00 Other: $0.00 Inspection: . $0.00 Total: $154.02 SETBACKS ! MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq:. o NOTES: FEESUMMARY PLANNING & ZONING Rear 0- 0 Left 0- 0 Rear 0- 0 Left 0- 0 Re uired: 0 Pr000sed: 0 Ca�c Valuation: 5�,�3z00 Claim Valuation: S�,�azoo Rigbt 0- 0 Right 0-0 I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 deys, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlretl inepectlona end final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of lhis permit. FOR INSPECTIONS CALL; (714) 7545628 , zusss �doo� WORKERS'COMPENSAnON DECLARAnON: I �ereby attirm under penalry ot perjury one oi Ihe following declaratlons: ' ❑ I heve and wlll maintein e certificete af consent to self�lnsure for workers' compensetion, es provided for by section 3700 of the Lebor Code, lor the petlormence a� Ihe work lor which ihis permit is issue0. ❑ I have and will meintain workers' compensation Insurance, es required by section 3700 oi ihe Labor Code, for the peAortnance of the work for which this pertnit is Issued. My worke mpe1n99tion Insurance carrie entl policy number ere: Cerrier. �� t� � K�n � l� Polity Number: I7 iZ �i q'r( ;Z - ZO O_� (This section need not be cromple(ed i fhe permit is velued et one hundred dollars ($ 00) or less.) � ❑ I certity Ihat in the compensation lew comply with these �Applicant Signature: _ WARNING FAI W RE TO SE TFIOUSAND DqlARE (E1p Ihe work for which this permi! Is issued, I shall not employ any person in any manner so as lo bacome subjec� to the workers' �d�gree t�i I shoul�Decome sub�ect to the workers�compensatlon provlsions oi Sectlon 3700 of the Lebor Code, I shall tort�with /� l v�,t[� ll o/ Date: 2 I "L h/ C`� . DRKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINA� PENALTIE� FINES UP TO ONE HUNDRED ADDITION TO THE 00.ST OF COMPENSATIIXJ, DANAGES AS PROVIOED FOR IN SECTIIXJ 3)080f THE LABOq CODE, INiEREST, ANO ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARA710N: ' I I hereby aNirm Ihat I em Iicensed under provisions of Chepter 9(commencing with Section 7000) of Division 3 of Ihe Business and Prolessions Code, end my license is in futl rorce end eftect. Lic. s Z3i�5 LI "I � Class a �'_ 3�1 --� CoNrectors Signature: �--{�/ I O.l.l, _. n � Date: _L �, �T o l� a CONSTRUCTION LENOING AGENCY: ❑ I hereby alfirm that there is e construction lending egency for the peAormance ol the work for which t�is permit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lenders Addreu: � Signature: OWNER-BUILDER DECLARATONS: Dete: I herehy eHirtn that under penelry of perjury Ihet I em EJ(EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Protessions Cotle: Any ciry or counry which requires a permit to construct, alter, improve, demolis�, or repair eny sirucNre, prior to its issuance, also requlres the epplicant for such permit to flle a signed statement that he or she Is Ilcensed pursuent ro ihe provisions of Ihe Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 ot Ihe Business end Professions Coda) or that he or she Is ezempt iheretrom and the basis for t�e allegetl axemptlon. Any violation ot Sedion 7031.5 by eny applicent far e permit subjects Ihe epplicent to a civil penelry of not more than five huntlred dollars ($500).): ❑ I, es owner of ihe property, or my employees wi�h weges as iheir sole compensatlon, WILL DO THE WORK, end Ihe structure is not intentle0 or otfered for sale (Sec, 7044, Business antl Profeuions Code: The Conirectors Licensa Law tloes not aOPly to en owner ot proparry who builds or improves ihereon, antl who does such work himself or hersalt or through his or her own employees, providetl Ihat such Improvements are not intended or oHeretl for sale. It, however, the building or improvement is sold within one year oi completion, ihe owner-builder will have the 6urden ol proving that he or she did not build or improve for purpo5e of sale.). ' ❑ I, es owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contraaors Ucense Lew does not epply to an owner of pmparty who bulltls or Improves ihereon, end wha comracts tor suc� proJect with a conlractor(s) license pursuant to ihe Coniractors License Lews.). ❑ I em ezempt under sec. Signature: Owner ID venfied by drivefs license. ❑ Ves ❑ No Business and Prolessions Code for ihis reason: Verificetion ot Ownerehip by (rype oi documenL i.e. - properry taz bill or daetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: Driver's License No. Date: Expires: ❑ I hereby cartify ihat no excavetlon fiva (5) or more feet in tlepth into which e person Is required to descend, will be made in connection with work euthorize0 by ��is pertnit, and that no building structwe, scaHolding, lalsework, or demolition or tlismantling thereot, will be more than thirry-six (36) teet high. (Chep. 3.2, Grp 2, An 2, Sec. 341, Title 8, Celitornie Atlministretive Cotle). ❑ As awnerbuilder, I will not employ anyone to do work which would requlre e permit from the Division of Intlustriel Sefety, as notetl ebove, unless such person hes e permit to tlo such work irom Ihe division. Signature: Date: Division of Industrial Safery Permii Number: CERTIFlCATE OF COMPLIANCE AND AIJTHORIZATION OF ENTHY: I certify under penalty of perjury ihat I heva reatl t�is application and stete Ihet ihe intortnation given is correct. I eqree to comply with all state laws end ciry ordinances relating to tuilding consWdion, and authodze represeniatives ot Ihe Ciry of Costa Meu to enter upon the ebove-descnbed property lor inspection purpases. I egree not to occupy or allow occupancy ot any building authorized by this permit until final inspection. COUE �. INSVECTONTYPE 1616 Fi:ed System Final Fire Prevention 1266 Paal Spa Final . , 200 Final Re-Rooi 207 FIna181ocWRetelnlnp Wall 202 Final Fectory Fira Place 203 Final Sign 206 Final Demolition owne�cs) Applicant QdIE lti�4fl �` `B � �` �� / / 6� Dat 40DE� INSPECTIONTYYE 206 Final Mechanical 20B Final Plumbing 210 Finel Electncal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Slte 250 Finel Building�Occupancy �.111i�Ctl1iI.1Fi .� ;� (714) 754-5273 • F8X (714) 754-4856 • www.Ci.Costa-rt18Se.Cd.Us 77 FAIR DRIVE, GOSTA MESA, GA 92626 BUILDING PERMIT Job Address: 859 W 19TH ST Suite: Vicinity: Parcel Number: 42419105 Zoning: Applicant: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING Address: 126 COMMERCIAL VJY - -- Phone: 949-548-5569� ._ COSTA MESA, CA ' ' Zip: 92627 � Owner. Address Contractor. Address: Zip: Arch, : Address: Zip: � ' SKORO,VAL'TR \ 1601 BAYADERE TER . � - ' ' � � ( � � . . . Phone: . - . . ' CORONA DEL MAR, CA - - �Zip: "92625 � � j. . . -'i � . . G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING � 126 COMMERGAL WY - �� -- - i" Phone: 949-54&5569 � COSTA'MESA, CA - 92627 . License:-�828379 ' . � - �. Eng: Address: Phone: - ' � - � License: Status: ISSUED Applied: 11/30/2004 Issued: 11/30/2004 ISSUED BY: Phone: - � ,License: SCOPE OF PERMIT REROOF: FLAT PORTION OF ROOF USING.HOT_MOP AND�GRAVEL-CLASS A MATERIAC (5 SQR'S) ,,� � � - � � _ ' - �7 � . :_ i � ' - i- ' FEE SUMMARY Plan Check: $0.00 Calc Valuation: S�,azS.00 Permit: . $54.00 - , � Claim Valuation: Si,azs.00 SMIP Res: . $0.50 - -- . ._ `_ _ _ _ _ �', ,` - , SMIP Com: $0.00 � ' ' ; � % � _ Othef: $0.00 � �i;_ ;- � � � ' Inspection: , $0.00 _ , ' . - ,' ' ; � t ', �= ;iotal �. �554'.50 . ; � � < � � �� ..� ��'� ; '. . �� - ' � ` � ��: � ,� �' PLANNING&ZONIN�G�.�_':�+'_-._- ; - � � SETBACKS: �,'. �.�� - , � � � MAINSTRUCTURE Front � 0=0_ ,�Rear �`0-0 - � �Left� 0=0 � - RigFit �,0-0� . �; � : � � ,i .; - ___�: . - - � _ _ -- . . , . . . ACCESSORY ��_`Front "0- 0 � . �Rear' 0�0 - � Left 0. 0 _ " " RighE - 0-�0 � ' � . � , , � . _ - ' . PARKING Ezistin ' � 0 ��- � Re uired� -� 0 Pro osed� �0 � � � ' �. .. . �. . , P . . � . _ NOTES: '�.�:� --� ' ,-_.:� ,� � . , NOTICE: The work authorized by this pertnit shall comply with all applicable handirap access� requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it 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 requlred Inspections and finel approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 � 2aas-aelvool ____ .__ _.__ . . _ ... . . _._ WORKERS'COMPENSPnON DECLARATON: '� � I hereby aHirm under penalty of perjury one of the following declarations: ' -�' �� ❑ I have end wlll meln�ain e certitica�e of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Lebor Cotle, for ihe peAormence�of the work for whicfi ihis permit is issued. _ ,� I have and wltl malntain workers' compensetion insurance, as required by section 3700 of ihe Lebor Cotle, for the pedortnance of the work tor whlch this pertnit is issued. My work�er�' co pensalion Insurance cd7rrier and policy number are: �I Carrier. ��`'F"-��"L ��n e.. c\ PolicyNumber. l`1 1 L`1 `I ') - 7_:� C>Y (This secNon need nof be completed il the permit is valued et one hundred dollers ($f 00) or less.) � ❑ I certify that in the p6�ortnance of the work tor which this permit is issued, I shall not employ any person in any manner so es to become subject to the workers' compensation lews of �California, entl agree that if I should become subject to the workers' compensetion provisions of Section 3700 of the Lebor Cotla, I shall Forthwith comply with these pfo si ny/. `� � /,'y - � 4'f � AOOlicent SigneNre: �iV\ 1" Y .[^�'�\ Date: � I ' �� - / �% � WARNINO: FAILl1RE TO SEC WORKERS' dJMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL P NALilES D CIVIL FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 3]O6 OF THE LABOq COOE, IMEFEST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hareby affirtn that I am IiGensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Prolessions Code, end my license is in full torce antl ettect Lic. N��.' )// i^• � Class a�,3_ `j Contractor's Slgneture: Da�e: CONSTRUCTION LENDING AGENCY: ❑ I hereby effirm that there is e constmction lending agency br the pertormance of the work for which this permit is issued. (Sec. 3097, Civil Code�. Lender's Name: Lender's Adtlress: Signeture: OWNER•BUILDER DECLARATIONS: Date: I hereby aNlrm Ihat under penelry ot perjury �hat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Profession5 Cotle: Any city or counry which requires a permit to consiruct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires �he applicant for such pertnit to file e signed stetement Ihat he or she Is licensed pursuant to the provisions of ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Divislon 3 ot ihe Business and Professions Code) or that he or she is exempt iherelrom antl the besis for the alleged exemption. Any violation oi Sec�ion 7031.5 by any epplicant for e pertnit subjects Ihe applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ 1, as owner of ihe prOpehy. or my employees with wages as iheir sole compensation, W ILL DO THE WOPK, an6 iha siructure is not iMentlad or oHeretl tor sale (Sec. 7044, Business and P�ofessions Code: The Contractors License Law tloes not apply to an owner of property who builds or improves Ihereon, antl who does such work himself or herselt or �hmugh his or her own employees, provided that such improvements are not intended or otteretl for sale. H, however, tha building or improvement is sold within one year of completion, ihe owner-builder will have the 6urtlen of proving that he or she did not builtl or improve for purpose ot sale.). � ❑ 1, as owner of the properry, am EXCLUSIVELY CON7RACTING WITM LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business end Professions Cotle: The contrectofs License Ww does not apply to an owner of property who builtls or improves thereon, and who coniracts for such project wl�h e comractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt undar sac. Business and Prolessions Code for ihis reason: Signature: Date: Owner ID verilied by tlnvers license. ❑ Ves ❑ No Driver's License No. Verification oi Ownership hy (�ype of tlocument, i.a. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby cetlity that no excavation five (5) or more feet in depth into which a person is required to descend, will be mede in connectlon with work authorized by this permit, and ihat no building structure, scaflolding, felsework, or tlemolition or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Title B, CeliFomia Administrative Code). ❑ As owner-builder, I Will not employ enyone to do work which would require e permit from the Division of Indusirial Safety, es noted ebove, unless such person has a permit to do such work fmm the division. Signature: Date: Division oi Intlusirial Safery Permit Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that �he infortnation given is correct. I egree to comply With all state laws and city ordinances relating to building construction, and authorize representetives ot ihe Glly of Costa Mesa to enter upon the ebove�described properry tor inspection puryoses. I agree not to occupy or allow occupancy of eny building authorized by this permit until tinal inspection. COUE I. INSPECTIONTYPE 1676 1266 i200 201 Fizetl System Final Fire Prevention Pool Spa Final Final Re-Roof . Finel BIocWRetaining Wall 202 Final Factory Fire Place .203 Final Sign 204 . Finel Demolition � � P6IE It�L4 22� � COOE� INSPEC710NTYPE 206 Final Mechanical 208 Final Plumbiag 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site � - 250 Final BuildincyOccupency Q� INTRI�LS 0 AOP�icant to flll in all spaces except thosa within �eavy bortler Ilnes antl sign all approvriate tleelarationz. � CITY OFCOSTA MESA - � " 'PER IT NO. ' TRACT NO. � � LOT NO. BLD . . - - � C�NST.RUCTION PERMIT � ( `j � � • PrOj��:1re55 �� W_' �9'fh S'h.� (�_M .: . TVPEOPCONSTRUCTION NEW ADD. ALT.ERATION REPAIR ❑ CONVERSION'Q DEMOLISH ❑ OTHER. ApplicanYs Mailing Address � 1 iFi (:nmmarp in I� Wn� (`n c+n Mo c � , A.P. 5W ' " - • DESCRIPTION OF WORK ., 0030 10/12/84 Zone 42e�4 'Tl � Owner's Name Vol Sknl"o Phone$�..�� - S Main euilding: . . Accessory Building: . �� Z Address 1Fin1 Ravn'riara ��^ry._(`p'/�J, TYPEOFPERMIT .GRADING ❑FOUNOATION ❑��STRUcrUaA�� . T Frant � � � , � � N Afch/Eng.- . , LiCenSE No. O'TENANT ❑ ELECTRICAC O PLUMBING ❑ MECHANICAL � A Reaf • � • , � � � - " � . N � AddtCsS, '� ❑'�OTHER � ' � , , , %� Contraccor's Name(�rnn/f Rrnc Rnnf �.,., i�.. phone t��,Ng PROJECT DESCRIPTION Sc3. Fr.1�� Q I oCCUPntvcv C Right • � R e �e=- K � Addresslmailing) ��F, r � � / �� /' + ne.. .. noc�7 CONSTRUCTIONTYPEO�P'i'//IA/'1'I'.S VAWATION$�f.�.� � $ Left . . . . E ZONE ' GRADINGCU.VDS. - ACRES PM Ref.# Pefk.FeeS $ Q I Ciry License No. � 005999 9. . �Y LICENSED�CONTRACTOR DECLARATION � ' ' v , , ' � , . . ' � � ' " ' , � - U J Remarks: - Parking Req./Provided � ' � I hereby attirm tha[ 1 am Ilcensetl untler provi51on5 Ot'Chdrt¢r'9 (commencing . - . . � with section 7000) oi �ivision 3 of [he Business ntl Professio Cotle, antl � � �,' � � ' - � . � Use of Building: � ' ' � � ''. E � �� my Iicense is in tull force antl etfecL � / / - - � , � . M I License Class - � � e 8�7� � � . , PLUMBING , � FEES Planning Notes: - � ozte 1 n�RLi 5ignatu , � � � , . . , � E � WOHKERS' COMPENSATION � LARATION _ � Ba� Sink � ShowC�s f � ,.� � N � ` hereGy atfirin tnat I have a cert icate of consenC to self-insure or a certlflcate � getkflow Prevenier Service Sink � - � T � Workerz'� Compensation Inzurance, or �a� certitietl�, coOY thereof (Section � - - S se0o, Lab. C.) � Backflow Irrigation Sewer Cap ' ' � ELECTRICAL , �� FEES Policy No. �S-»�� ' Company . - , . - ' � �Certitiea mpy is nereby tumisned. � � i � ; Bathtubs � � Sewer Conneccion � ' Automatic Washer � Transformer ❑ 15-50 KW � � � Certifietl wpy iz tiletl with th crty ��I n�q� j��j]5i n. � �. oate ' Aoai ��'�j � Clarifiers I . � Solar Collectors • � Construction Pole Sub. � � 50'+ KW �EXEMVTION:FROMWORKER�ENSATION�DECLARATION -�� DiShWashef �- " " � - SolafPiping ' ' . ' �' -('qokin Unit ' � ' ' Meter ❑u tOl00am 5"-'• ' (This section neetl not be complet if the parmit is for, one huntlretl (E300) or I . . 9 P' , P . less)' . � � � � � ' Orinkin Fountairls ' ' ' ' ' I certity [hat In the pe�formdnce of tbe wo�k to��whiGh thi5 pe�m�t is issuetl, I 9 Solar Tank - • Dishwasher . .Meter ❑OVCf 1008mpS � � . shall not emo�oY any person In any manner so as to become sub7ect to the - � . , . . � � workers' Compensation Laws oi Calitomia. • , Floor Dreins• ' � Swimming Pool wl5pa � Dryers �Ges ❑Electric ' Sub Panel � -�. • � Date � Signature � � NOTICE: If,-after making this tleclaration, you shoultl become sub�ect to t�e FIOOr Sinks �, . Urinal � Fan� � ' � � � � ' � � � . Motors�0.7HP�7'b-8 ' Workers' Compensation provisions' of itbe 'labor Cotle, you must forMwiln , - - - - - -- � -� �- • comply,with suc�-O�ovisions o� lhi5�p¢rmit;5hdll b9�tleemetl revok¢tl. (�id5$2rviCf i �UIICtS� Wdt¢�CIOSCL ' _ �� F.A.U. � � � .InaSolarO9-15HP��16-15+ ' CONSTRUCT,ION•IEN�ING AGENGY'. � + � " -' � - ' - - ' - I hereby afTirm tliat there is a,con5truction Ientling agency (or the pertorman<e iuterce ro�s � � Water�Heater � Fixtures � ' � ' � of th0 �wotk �for whiCh � thi5 permit �is � issuetl �(Se<tlOn' 3097 Civ. C.) � P -_ - MiCroWdV¢ ! Lentler'r Name � � = i Kitchen Sink ' � WateriService . ' - _ Device Boxes � - � Lenaer's 'Atlilress. " '. , . , ' I ' � � f . . � . . . . . �Pole Light .t 1 OWNER BUILOER DECLARATION - , � . ' ' ' � ' ` ��atori25 �� . ' � - . � ' � �OUt�ets r ' � Rangf ' ' I heraby, atfirm.[hat I am eKempt irom the� Contractor'S Llcense Lnw for the , p_Tra ' - ' � � � following reason.(Section7031.5 Businessantl Protesslonal Cotle: Any citY or , P - " _' � -�`. Switch¢5 . Sign � � counev wnicn raquires a permit to construct, altei, improve, Gemolish orrepair � i `' � . � _ - ' • • �any structure; prlor to Its Issuance, also requlres tha�applicant tor su<h permit � - ,ROOf Dfains �� i ' ' '_ '. �'.' ' � Garbage Di5p0521 ' � Standing Sec[ions � • � 'tu file a�signetl statemept that,he/she is licensetl pursuant to the Provisions o/ ' ;, , .' i� , � • • � ihe Contractor's License Law (Chapter 9(commencing with Sectlon 7000) of '' ' _ ' ; i - � - � Generator �0.5 KW 05-15 KW TraSh Com actor Oivisfon 3co( the:Business antl Protessions Cotle),or that be/she.is exempt � � '" �� ,. • _ P . herefrom'anB the ba5i5 for'the allegetl exemptlon. Any vlolation,of Section � � � � • /031.5 by any- applicant for a• permit subjects' tne� appli<ant �to a clvil ' ' - ; � ' ' � - ; 3 ' � ' ' � � enalty ot not more than five huntlretl Collars (y500). -' � � ., • Reinspection Fee. i $25� ` � Issue Fee � $ i �� 1; �a5'. owner Ot the � O�ope[ty Or my employaes' with wages as theit zolo � RBiI15peCtiOn FeB � ' $y5 � Issue Fee'. � �$ 3 compensation, wi11 do the work, antl the�sVucture is hot Intentletl orofterea �� ' MECHANICAL - FEES � for sale'(Section;7044, Business antl Vro{essiohal•Cotle: T�eiContra<tor's '� . � �, . PUBLICSERVICESPE�UIREMENTS: � � License taw tloes nol appty lo an owner ot a property wno,builtls or improves ' goiler �` - : � HoOd or Type I ❑� _ ' � ' � . thereon; antl'who,tloes such work himself/herself or throu9h his or her own � - � Zpning Approved By ' � �ste employees, provltletl that suth improvements are noc intentletl or oHnretl for � • �nOpy ;. Type II� �' � . , � . , � , , sale. It, howeveq the builtlin or improvement is.soltl wlthin one ear of com- � Duct= Under Ground : . � . . - 9 y I Application Approved By Date pl¢ti00, Ihe owne� will.have the bU�tlen Ot prOving hE/She tlIE not bulltl o� Im- � . � rove foi the puroose oi saie). Duct-Struc4ural Refrigeretion System . ;' Appliption Issuad By �A,�7 Datn , �n � L � I, zs owner ot the property, am exciusively cbntiactlng;with Ilcensetl con- ❑0.]00,000 BTU ❑100,000 BTU MM ' tractorsto construct the project (Section 7044, Business antl Professlons Code: Dutt - Ventilating . SU ARV F FEES ' The Contractor's License Law does.not apply to an ownar.of proparty who . _ . . - .. _ .. ._.. . .... _ ,(� ^^ ' ' builtls or improves thereon,'antl who contracts for such projects wlth a con- ExhaustSystem ❑ Multiple ❑ Syslem Repai�/Alteretion ' BUILDING PERMIT �$ � SMIP .$ . S� tractor(s) Iicense pursuant to the Contractor•s Llcenu Law). � � � � � PLAN CHECK ' $ � PERMIT � ❑ I'am exempt untler Se<tlon , B. & P. C. for this reason '� Firepl/FacL Blt. ICBO # - � � PLUMBING �$ � ' ISSUANCE ;$,� � PLAN CHECK $ I ' ENERGV P.C. $ Dale � Owner; � Heating System & Ducting ' • I hereby certlfy that I hav¢ reatl Inis appllcdtlOn antl stdte that th¢ above ❑0.100,000 BTU �100,0008T ' • � � � information is correcL I agree to'compry with a11 city antl countY ortllnances' - -- ' �� ' -- ELECTRICAL $ GRADING '$ . antlstate laws relatin9'to bqll i construc on, antl hereby authorize reDre- � , • � � . � PLAN CHECK $� MICROFILM �$ sentat � this.city to e r upon t above-men[lonetl property for . . . , . inspe tion pu . - � �,p � - - ' � , $ , TOTAL FEE $ � 5�gna ' � _ Date . MECHANICAL Z• �J (� D�i'vers' Li se or 55 � - � 8 Reinspec[ion Fee I$25� laue Fee , � $ 3 PLAN CHECK - .$ �CMF�0865-46 rev. 7/83 White - Builtling; Canary - Applicant; Pink - Actounting; Goltlenrotl - Assessor � - - � - � � - . . _ ' , _`_ . . . . . . . . _. _ ' ! t� � l"^NSTRUCTION�'AND PLANNING - � . � - �. POOL _ SPA - - �� Date Inspector � - Date Inspector : Ai2ROVALS ,-Permit # � APPROVALS Permit # _ �T 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ; 2. Soif Pipe-Undrgmd. '- 53. Steel Reinforcement -�'r� � .3. Electrical Conduit Utility-Undrgrnd. ,- ' 54: Forms � �,i 4. Electrical Conduit-Und�grnd. _ � 55. Electrical Bonding , : � � 5. Steel Reinforcement , . _ 56._ Rough Plumbing & Pressure Test ��--� 6: Electrical UFER Grnd. �-;j I '�� 57. APPROVAL TO COVER-GUNITE '':= 7. Footings �- `��. 58. Electrical Conduii�Undrgcnd. ' S. Foundation �� ' i 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �� - � , 60. Backwash' Lines, P�Trap, O Undrgrnd. � ./ ^ 10. Structural Floor System . �- - 61. APPROVAL TO DECK ., 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ' � ' ' � 63. Heater & Vent-Final . � 13. Roof Drains � � � 64. Plumbing System - Final � 14. Rough Plumbing - 65. Electrical-Final � 75. Fiough 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 ❑ Oil 23. Gas Pipe-Rough & Test 72. Undergrouhd Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ 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: I 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 pomesticFinal ' , . . � � - - 42. Backflow Preventer ' ' , ' � � 43. Backflow Irrigation � i � , � 44. �Landscape Irrigation System - - . 45. Sound Attenuation • • 46. Handicap Regulations � ' . � � � 47. FINALSTRUCTURE&BUILDING G� '�'6 �T �� /i✓59Cc. � 48. Special Requirements Completed . � 49. Electric Release to Edison ' '� ' - 50. Gas Release to Southern California Gas Co .� . ' ' �•51. CERTIFICATE OF OCCUPANCY � ' . No, ' ' Date � � 1 ` V� Applicant to illl In all spaees excepl those within heavy Dortler Ilnos antl ti9n all apP�opriata Oaclarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project-Address 859 W_ 19th St. F;�pplicant'sMailingAddress 126 Commercial. C.M. 92627 Owne�i5 Name !�1a1 SkOYO Phone 720-7E Address 1b01 Bayar�Pre--_Terr , �c1M_92625 A�hlEng. � Licenu No. Adciress � � Comractor'sNam�ra7lk BTOS. ROOf1Clq phone 548-556! Adtlrewlmailing) 126 CommerCial, C.M. 92627 � � c�ry ��e�:e rvo. nniq9� LICENSED CONTRACT00. �ECIARHTION I hpreby a(firm tnat I am Iicensea uneer provisions ot Charter 9(commentlng wlth section 7000) ot Dlvlilon 3 Ot [hG Busine55 antl Prpf¢SSions COtle, anC my Ilcense is in tull Porce ana etiec4 �ate�LJcenS� 1a=5 M ATION DE� Q`�Cense lo, bZ% / �gnature � WOq ERS'C 1 hgreby aHirm tnat I have a certitl of consent to solt-Insure or a cartifitata ' Workers' Componsafion Ins o, or a certifiea coOY thereol (SecHon 00, Lab. CJoc o� Io�icy No. _.Zp,,ff�L}..8? COm an � Certifietl co y is here�y furNshetl. ceq�' ea � z�y(�!1Iv �m me a�y a�u PiB�o� Da�eaC��=�-N--f- APOlicant (T�is zection neatl not be completetl i h permil is fo� one huntlretl (§300) or less). ��e��(y (hat in Ihe perlormance oi wo�k for wM1lch 1h15 petm�l IS iszuetl, I Sha�� not emplOy any p�fson In any manner 50 as lo bCcomB SubjBct [o [h0 �Norkers' Componsatlon l.aws o! California. Date S�9naWra NqTICE: 11, diter making lhis tleCldralion, y0U ShOWU beCOTe sUbjeCt t0 lhe Workers' CoinDensatiOn p/oviiions ot the LabOr Cotle, y0u must /Ort�wii� COTpIy wllM1 such proVitiOns or�lhis pe�Til shall b0 tleem<tl �evok¢tl. CONSTRVCTION LENDING AGENCV 1 hereby aftirm that tKere Is a constructlon len�ing a9ency (or the pertormance of the work ior wiicn thiz permit is issuetl (Sect(on 3097 Civ. C.) Lentler's Name LCfICBf'S Adtl(¢55 . � � OWNER BUILDEN OECLARATION i1 hemby aHlrm that I am exemp[ irom the Contractor'S License Law tor the lollowin9 reason (Section 7031.5 Business antl Protesslonal Cotle: Any city or toun�y whlth requlres a permit lo construct, 311er improve, tlemolish or reDalr an., <.nceu.n n.inr to In issuancn. also reaWres t�e aoollcant for such parmit Contractor's License Law (Chapter 9(commencing wlth Se<lion ]000) o� ision 3 ot tha Business�antl Professions Cotle) or that he/shu I5� exempt ¢from antl the basis tor the allegetl exemptlon. Any violaHon of Section 3.5 �y any applicant for a permit suDjects [he applicant [o a civil alty ot not more than five hundree tlollars (y500). I,�as owncr o� the property or my employees wttn wa9es az theii sole IpenSdtion, will tlo tpe work, antl the struCtur¢ i5 not Intentletl ol otf¢rCtl sale (Section 7044, BuSiness antl Prolesslonal Cotle: The Contractor•s ;nse Law tloo5 not apply t0 dn ownlr Of d prop¢rty wh0 bulltl5 or Improves reon, antl who tloes such work hlmselt/hersalt or througn hls or her own oloYees, provitlutl that sucn improvements aro no( intentletl or ofleretl br � II nowe�e�, me bUlltlln9 or ImprOvomen[ I5 SOIA wi[hln one Yoa� of Com- ,ion, the ownor wlll have t�e burtlan of provin9 he/s�n tltE not bu(Itl or tm- ve torthe purpose otsale). 1, as owner oi�[he property, am excluslvely contracting with Ilcensetl con- :tors to construct tne project'S¢ctlon 7044, Business antl Prolei5ioni Cotla: f Contrattor's License l2w doos nof aOPly to an owner of properry wlto Itls or improvos [nereon, antl who contrac[s tor such projects with a con- :tor(5) IKense pursuant to th¢ Conlracfo�'s LiGense Law). 1 am awa�e tbat at Of [heir Worker's COmpenution insurante shOultl'be prOvitletl to me. I am exempt untler Section 8. 6 P. C. for this reason Date Owner _ I her¢Dv certiiv that I have reatl this Signatura Drivers' t CMF 0865-4� Data or55� above TVPE OF CONSTRUCTION LJ NEw L-1 a.DD `�1 ALTERATION L1 REPHI R L ❑ CONVERSION ❑ DEMOLISH �° Remove exisitnq, aPP V DESCRIPTION OF WORK/USE OF BLDG. 3-�]�ss sv eL— TVPEOFPERMI7 ❑GRHDING FOUN�i\TION STRVCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJEC7 DESCRIPTION 5�. FT. �,� �8� OCCUPnNCY m�—Lt_._ CONSTRUCTIONTVPE ar�artmetns VALUATION$�Q�� ZONE GRAOINGCU.VOS. ACRES Remarks: Prev¢nter Irrigation iking Fountains �r Drains >r Sinks $Qry1CQ �OLIQLS Kitchen Sink Levatories P-Trap Roof Drains Reinspection Fee � $15 Boiler 7uct- UnderGround Duct - Svunural Duct - Ventilating Exhaust System ❑ MWtiple Firepl/Fact. Blt. ICBO # Heating SVstem & Ducting ❑ o-i oo,00a aru � i ao,aoo Reinsvection Fee � S75 ]0/84 White - Bulltlln9: Canary - AOCllcant; Pink - qccounting; Goltlenrotl - AssesSor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors $olar Plping Solar Tank Swimming Pool w/Spa Urinal 1NB22f C1052L Wa[er Heater Water Service Auto-Wash laue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeraeion System ❑0-100,0006TU ❑100,000 System Repair/Altera[ion Fire Dampers Registers laue Fee FEES A.P. # S Main Buildin9: E T Front ARear C Right gLeft Ping. Ref. �p Plannin9 NOtes: Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers L7Gas ❑ Fan F.A.U, Fixtures Device Boxes . Outlets a , 1429 12/14/g7 Zone Accessory Building: , Parking Req./Provitled ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW awiicnes , - Garbage'Dlsposal Generator �0-5 KW �5-15 KW $ 3 S 3 Meter LJup to 700 amNs Meter �over 100 amps Sub Parte7 Motors OO-1 HP O1 X- 8 Int.Solar Og.15 HP ��6�75+ Microwave Pole Li9ht Range Sign Scanding Sections Trash Compacmr � Reinspaction Fee �$15 • � � luue Fee DEVELOPMENT SERVICES REUUIFEMENTS: Zoning Approved By Building APProved By � Appliption Issued By n SUM A�VDEFEES � BUILDING PERMIT $ S �J SMfP � PLAN CHECK $ PERMIT PLUMBING § ISSUANCE PLAN CHECK 25% S ENEPGY P.C. ELECTRICAL S GRADING PLAN CHECK 50% 3 MICROFILM MECHANICA� $ TOTALFEE PLAN CHECK 25% S \ 15,�U :7L FEES $ 3 3 • �� Z O N 1 N G R E Q M T S t$ $ $ $ -�= CONSTRUCTION AND PLANNING APPROVALS tPermi �# 1. Temporary Elecirical Service or Pole 2 Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement ' 6. Electrical UFER Gr�d. � 7. Footings - g. Foundation � 9. Water Pipe-Undrgrnd. 10. Structural Floor SYstem , 77. Property Sewer Line`& HouseConnection I I12. Sewer CaP � 73. Roof Drains � 14, Rough Plumbing � 15, Rough Efectrica4-Conduit 16. Rough Electric Wiring 17, Rough Wiring Sign 1g, Rough Electrical-7 Bar Ceiling 19, Rough Heating & Air Conditioning 20, Rough Factory Fireplace 21. DuCts, in Structure li 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test I 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling �Structuraf) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 37. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 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 pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Reguiations - � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed . 49. Electric Release to Edison - 50. Gas ftelease to Southern Galifornia Gas Co 51. CERTIFICATE OP OCCUPANCY No. _ Date � _ I POO C & SPA Date Inspector qppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Hectrical Bondin9 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 67. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent�Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 6S. APPROVED FOR PLASTERING 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # � 70. Underground HYdro 77. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED. Notes: 0 Date � Inspector � u PflOJECT AOONESS: 2j S 9 W 1 9 TH S T OWNEfl'SNRMF. �:fR, C�AL Jr1i�R� "'�' noosess: 1601 BAYADERE TERRACE CORONA DEL MAR CA 92625 6'73-3456 PHCH/ENGINEER: flEC.NO.: AODPESS: UNIT: UNIT: PEflMIiTEE: HI—TECH SECURZTY WORKS ( 213 ) 755-9090 aooncss: 12615 SOUTH MAZN LOS ANGELES CA 90051 LICENSEU CONTBRCTOB OFLNBATION: I hereUy a�brm ttial l am Iicen5e0 untler D�ovlsions I CAaD�er 9(commencinp wi�h Setlion 70110) 01 �IYSi00 UI IIIE USII@SS hcld Pf01Q55i0f15 fA42. d0A Illy IICEfISE IS 1 II IOftC d CI�CCI. ciTvuc.: sTnreuc.:667889 c p EXP: —p�=7 Signa�ure'. —�L _�_ WOPREBS' C MPENSp ION �ECUIBATION: I hereDy aflirm �hai I have a certifiCa� 01 consen� l0 5elbinSUre or a tertifiCate of Workers' Compensation insurance, ur a certifietl copy ihereof (Secuon 3800, Lab. C). roucveo.: 1»alj9'�q E%P.OR1E: UG/OZ/9S cornrnxv: SiATE FUND ❑ Cenifie0 capY �ere0y umis�ed. � Cenifietl coOY is ' wit0 I�e ry uilainq D' 'on. Applicani: , E%EMVIIONFBO WONKEB'COMPENSRTIONDEClABp71UN: (Thissectionnee �bec pleteailt�epermitisforonehunAreO(51001orlen�. I tetlify �hal in Ihe pedormante o� Ihe work for whith t�is pefmil i5 issued, I Shall not employ any person in any mannef 50 as �o �ecome sublact �o ihe Workers' Compensa�ion Laws ol Califomia. Date: Signamre: NOTICE: II. a�ter making �hi5 tleclaraiion, you shoul0 Uecom¢ 5u01e�� o t�e Workers' Compen5ati0n 0�o'^sions o� Ihe LaEor CoOe. you musl toM1hwilh camply vnt� Su[� O�ovi5ion5 or INs pefmi� shall Oe OeemeO revokeG. CONSTNI/C710N LENDING �GENCY: I �ereby a8irm tAat there is a constmction IenGing aOe��Y �ar t�e pedormance oi I�e work lar wnicn �his oe�mit is issue0 ISection 3097. Civ. C). LENOEfl: ADOflESS: OWNEN BUILOEB oECLAPRTION: I hereby atiirm that I am exempt Imm 1�e Contractors' State License Law far Ihe lallowinp reason (Section 7031.5 Business anA Professional Cotle: Any city of county wnicA reQuires a permit to constmct, alter, imDrove, tlemolish, or rtDair any simclure. O��or to its issuance, also requires the aOVlicanl for suc� permit to lile a signetl statement ihat he/s�e is licensetl pursuam m the provisions of the Contracmrs' State License Law (Chapter 9(commencing wit� Section 7000) oi Oivision 3 oi the Business anU Professions Cotle) or tha� he/she is exemp� Iherelmm antl t�e Uasis �or Ihe allege0 exemption. Fny viola�ian oi S¢clion 7031.5 by any applicant lor a permil Su�jecis Ihe applicani Io a civil penalty al no1 more ihdn five huntlro0 dollars (5500). I. as awner of ine D�oDerlY or my employees with wapes as ineir sole compenuiion, will Uo ihe work, an0 t�e ❑ simcwre is na� inlen0ed ar a7fereE for sale (Section 70aa, Busineu antl Pmiessional CoOe: T�e Contractors' State License Law Ooes not ap01y lo an owner ol a property w0o 6uiltls orimproves ihereon, anJ w�o tloes suc� wod Ilimself/herself or t�rouph his or �er own employees. pmviEeE t�at such impwvemenis are nol imentle0 or o11ere0 for sale. I�, �owever lhe �uil0inp or im0�ovemen� i5 soltl wiihin one year o� completioq the owner vnll �ave the 6urden of Dmvinq he/sfle AiA na� Uuild ar impwve lor Ihe purpose ul sele�. I, as owner oi Ihe pmperty, am exclusively contractinA wi�h licensed mntrac�ors to consimct t�e pmlect (Seclion I044, Business ❑ antl Protessions Cotle: The Contramors' stale license Law Ooes not apply ro an owner ol properiy wAo builtls or im0�oves Ihereon and who contracts lor such pmle��s witA a coniractor(s�license Dursuanuo the Comractors' State Licens¢ Law),I am aware Ihat pwo� o� IAeir Warket'S Camp¢nSaiion insurante ShoNC Ae proviU¢tl to me. � 1 am exempt unGer Seciion: B. 8 P. C. for �nis reason: Oate: - Owner I Ao here�y cenify tnat I am aware ol ana unAerstane ihe requirements ol Calilornia Heal�n an0 Safety COEe Sections 25505, 25533, antl 25594 and iha� I or any �uWre �uiltling occupani willlwill nol (circle one) nee0 �a comply wiih saiA sla�e cotles anA Ihe requiremen�s lor a permil br cons�mction or modificalion Imm t�e Air Ouality ManaAemeni OisVict. Fesiaen�ial consimctian apPlica�ions are exempi Irom I�ese pmvisions. Oa�e: pOD�icanC I here�y Ceriity I�ai I havE read ��is apPliCa�ion antl S�ale ��ai Ihe a0av¢ infOrmalion i5 torr¢tL I aqr¢¢ IO tOmDN `M�h all City antl COunry ortlinancesan4slaelawsrellingla0uil0inpconslmclionanUAereDya rizereprysentativesol�hiscitytoenleruponi�ea�me-mentionetl o�aoehY �o�fD bon pur oses. �' �_ /_� � ' �� SipnaWre: �� od�er's �icense or Sociai Secunry x: 1641�46 W�ite—Bulltling: Green—Codo Enlorcemem: Canary—Applicam: Pink—Revenue: GolOenrotl—Assessor CZTY OF COSTA ;;ESA — BUILDING PERtAIT PERM NO: E 068107 PERMIT NO: E 068107 PLAV CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSB: OTH JOB DESCRIPTION : ELEC. MOTOR FOR AUTOMATIC GATE SQ FT; CLASM VALUE: 4,000.00 CALC—C�ALUE: GROUP OCC; R-1 / COMMENTS: +" �t�*f*#�+e�t�x#*�****�c�:**x�**fr*�c*#i�**�t#w-�******�tx�w*��***�ci�i��t�r+t�*��****i�#i�***+�*�;��;:�� Z 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 BUILDING --------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT II� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN pARKING REQ: PROV; PARCEL: 42419105 ZNE: REF NO; PLA�7NZNG NOTES> > ##iE�IElfiliEiFlkiF##1t######Y.•iEfE####iEiEiEik#1E##fi##1�. iEiEiEifiFYciF#iElP#EfP###iE#iklklf�if#1(�iEiEdEiF�Ef4Y.�#i(�##3E##i+#��5:� D E V E L O P M E N T S E R v i^ E S R E Q U Z R E M E N T S � . ZONING APPROVED BY , BUILDING APPROVED BY : APPLICATION ISSUED BY 3FiEiE#i6iFiF%if#iFif-X-iF#iFit%•##iE 9f 1E:E iE �IF 9E iE �IP IE ## i' iE 3E ii� ##?F #� jf 1E LEGALIZATION:N '� -� ��iO�� K F��i� j �`T� DATE: /— - � -' DATE: i Q DATE: S/`� ��h.• ..�f. �# t1t (�!F �F'r (�'1F #il-#ii�ifiEi:iEif#��t��iF/1Fif1F`-1E�: !F1(1fjF1f�Y..'K1FiE#####1l'i� `#iFi6iE####�K�'K'KiE#i(�#1FYr#�IEiF�%#�#iEk`#X�#t�K�Y,.K F E E 5" M M A i Y STRUCTURAL SEGMENT:N ELECTRIC MECHANIC FIRE SI;iP/RES GRADING PERMIT 3,00 5�% PLAN • ISSUE FEE 15,00 HUILDING—DIV—> PEAMIT ISSUE PLAN—CHECK TOTALS----> 3.00 15.00 0.00 REVENUE DIVISION �OTALS--> COLLECTED; BLDG PMT PL[SMBING ELECTRIC MFCHANIC 18.00 TOTAL 18.00 SMIP/NON—RES PAID DUE 18,00 ,00 18.00 OVER/SHORT; 00 FIRE SMIP/TOT GRADING PLAN—CHECIt if iE iE iE 3E iF iE if iF iE 3F iF # N� iE #!F iE iE iF 9E iE iF 3E iE iE ii� iE iF i�- # if� 3F it �x� iM1 rt iE 3F iG iE i41f iE iE iE rr iE iM1 iE �F �If iE # iF # iF ih if iE �Yr iE iF iF # if if� # iE if 3f M k#iE # 3f� iE # 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 I P T I O N UNIT COST TOTAL COST ELE 1 MOTOR/POWR APPARATUS 0.0 — 1.0 HP 3.00 3,00 END OF FEES I O1 0016420E—OF3164?OE T�] T 18.�0 DATE: 07/16/44 tI4E: 1`:02 ! , �� . . ; CONSTRUCTION AND PLANNING � POOL a �PA � �� apPROVALS Permit # � Date l�spector qppROVA�S Permit � Date 4nspettor 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. $oil Pipe�Undrgrnd. 53. Steel Reiniorcement 3. Elec:rical Conduic Ui:lity-Undrgrnd. 54. Forms " 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Stee! Reinforcemenc 56. Rough Plumbing & Pressure 7est 6. Electrical UFER Grnd_ 57. APPROVA� TO COVER-GUNITE 7. Footings � 58. Electricai ConduiFUndrgmd. 8, Foundation 59. Gas PiPe, 17 Undryrnd., Test . 9. Water Pipe�Und�grnd. 60. Backwash Lines, P�Trap, � Undrgrnd. � 10. Structural Floor System " i 67. APPROVAL TO DECK 11. Pronerty Sewer Llne & House Conneccion '� 62. Backwash & Receptor�Pinal '� 12. Sewer Cap . 63. Heater & Vent�Final 13. Root Drains � 64. Plumbinq System - Finai 14. Rough Plumbing �� 65. Electrical�Final 15. Rough Electrical-Condu�t 66. Solar System-Final 16. Rough Electric Wirin9 67. Fencing & Access ApP�oval 17. Rpugh Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEPIIS FINA4 19. Rou'yh Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Firepiace APPROVALS Permit # 21. Duc:s, in Structure 70. Underground Hydro 22. Duets, Ventilating 77. Product Piping L7 Gas i�0il 23. Gas Pioe�Rough & Tes: 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Rpof Sheathing � 74: Overhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. L2thing & Siding 77. FIXED SYSTEM PINAL 29. Insulation 78. FIRE PREV. FINAL 30. DrYtvali Nailin9 '� � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electricai Power AqeterFinal ••�" 80. FOOD CERTIFICATE ISSUED 33. fina� Eleciric / :�'. Notes: 34. Final Heating & Air Conditioning �` ,�� ^ 35. Final Gas Pipe-Test � �7 �' 36. Hood or Canopv • 37. Finai Factory Firep�ace ' , 38. Finai Plumbing 39. Water Service-Final 40. Gas Szrvice-Final 41, Solar pomestic-Finai 42, Backflow Preventer 43. Backfiow Irrigatian 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FtNAL STRUCTURE & 6UILDING 46. FINAL PLANNING � 49. Electric Release to Edison '�_ 50. Gas Rslease to Southern Caiifornia Gas Co 51. C�RTIFICATE OF OCCUPANCY , No. Date i