HomeMy WebLinkAbout870 19TH ST - Building Permits_ dP� FINti�. __ _. ___ _._._.
VIEST I9th STREET, 870 . {
4y7tl 92-s5- 1
�,�Q�{ y F_xP��rco� ;
959 - cortipleted Residence 510,384.
• 45706 - 7-14-65 Plbg. CIC CA.HJ i
: 68245 - 12-II-75 Plbg. PIC (Gas System) f
�50998t--c�i�-r•53 I,eqalize Non- 100. �
' � - elec. Wall Siqn - �
50999 (,�„�L e�Z.g� �T�galize N�- 25.. !
� - elec Conv, Sign - � .
�—ri ,
, .. .—Bi0295 � �
, (Re-roof)
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A
December 14, 2007
Alexander Hernandez
870 W 19�" St
Costa Mesa CA 92627
PERMIT NUMBERS
FOR:
PROJECT ADDRESS:
BUILDING DIVISION
EXTENSION NOTIFICATION
603-01691, E04-01183, M04-00594, PO4-00758
Addition
870 W 19th St., Costa Mesa
The letter that was sent to you on December 13, 2007 was in error. It should have said that
your permit is valid for 90 days. The new expiration date is March 12, 2008. You may cali
714-754-5626 for inspection at any time prior to this date. The iob must be completed.
fees will be required to finalize expired permits.
If you have any questions, piease contact the Building Division at 714-754-5273, between
8:00 a.m. and 4:30 p.m., and a staff member will assist you. We appreciate your working
with us to resolve this matter.
Sincerely,
Mary Jane Weidenkeller
OffiCe Specialist II
� � I
(714) 754•5273 • Fex (714) 754-4856 • www.ci.costa-me9t.ca.us
BUILDING PERMIT
Job Address: 870 W 19TH ST
Suite:
Vicinity:
Parcel Number: 42251222
Applicant: HERNANDEZ, ALEX
Address:
Owner: HERNANDEZ, ALEXANDER
Address 870 W 19TH ST �
COSTA MESA, CA �
Contractor: '� �- - ' �
'Address: ," �
Zip:
Zoning:
Phone: 949-574-1887 �
Zip:
Phone: �
zip: szs2� j
i
Phone:
License: .
77 hAIH UHIVt, GVJ IA MtAA, l:N tlGbZO
Sfatus: ISSUED
Applied: 10lOt/2003
Issued: 03l19/2004
ISSUED BY:
�
Arch : WILLIAM LUSHBAUGH ARCHITECT. - Eng: JOHN SON NGUYEN
Address: 2062 BUSINESS CENTER DR �" - Address: 1734 E BANYON AV
STE 140 Phone: 949-584-2166 CELL Phone: 714-503-3651
IRVINE, CA ANAHEIM, CA
Zip: 92612 License: C24867 92805 License: C051736
SCOPE OF PERMIT
ADD 2,656 SF TO SFD (1,163 SF AT 1ST FLOOR AND 1,493 SF TO 2ND FIOOR).-ALSO P,DD 450 S.F. ATTACHED GARAGE; 18 SF DECK, AND
'125 SF PATIO COVER AND ALTER EXISTINGBATH. SCOPE OF - " - �
WORK TO INCLUDE: DEMOLISH AND REBUILD EXISTING GARAGE,
806'SQ. FT OF EXISTING RESIDENCE IS BEING DEMOLISHED. (WILL BE CREDITED OIJ SCHOOL FEES)
CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A�4 BEDROOM, 4 BATH S.F.D.
REF: ZA-02-64
OVERALL BUILDING HEIGHT: 24'-9"
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$1,235.62
$1,900.95` . ' � "
$26.12
$0.00
$0.00
$0.00
$3,162.69
PLANNING & ZONING
Calc Valuation: szsi,nz.5s
Claim Valuation: So.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 7, 12•21•92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or If work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for Ihe work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetiona and flnal epproval must be obtained. Failure to obtain Inspections and Final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828
za+aae �doo>
WORKERS' COMPENSATION DECIARATION: ' '
I hareby eMirtn undar penalry of perjury one of the following declarations: �
❑ I have and will maintein e cenificete of consent to setf-Insure for workers' compensatlon, es provided for by section 3700 ot the Labor Cotle, tor ihe peAortnance of the
work lor whlch ihis pertnit Is iuuetl.
❑ I have and wlll malntaln workers' compensatlon Insurence, requlretl by sectlon 3700 W the Lebor Cotle, for the pertortnence of ihe work tor which this permlt Is Issuea.
My workers' compensatlon Inpvr�nqB cyartler end poJ�Gy r�rJr ber ere:
Certier.
Policy Number.
Th/s s tion neeU not be camykt4dll the permiT is ve tl et ohe huntlretl tlollers ($100) or less,�... „
� .a
I cenity that in Ihe pertortnance of ihe work for wh h this pertnit is issuetl, I shflll not employ eny peison In eny mflnner so es to become sub�ect to the workers'
compensation lews ot Celitomla, end e ree t�et It I ahould become sub�ect to t�e workers' compensatlon provisions oi Sactlo 3700 of th tebor Cotl , I shall fo�hwlih
comply with these provisi�ons. J
Applicam Signeture: ✓ � �4 �e *s �r Date:
WARNINO: FW WRE TO SECURE WORKERS' COMPENSATIqJ COVEMGE I5 UNIAWFUL M1D SMALL SUBJECT AN EMPLOVER TO CRIAU PE T 5 VI NES UP TOONE HUNDRED
THOUSAND DOLLARE (5100.000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DMMGES AS PROVIDED WR IN SECTIIXJ 3'lO5 0F TNE LABOR DE, IMEREST, AND ATTORNE`fS FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby aHirtn that I am licensed untler provisions of Cha.,2tar 9(commencing with Section 7000) of Division 3 of the Business and
torce and eHecL Lic. » `�'7S�i�/D Class a�
ContremoYs Signatura: isfC e «�, G2. Dete: i
CONSTRUCTON LENDING AGENCY:
❑ I hereby eMirtn that there Is e constmction lentling agency tor the pertormance ol �he work tor which Ihls permit is luued. (Sec. 3097, Civil Cotle).
Lentlels Neme: Lenders Address:
Signetura:
Date:
license is in full
OWNER-BUILDER DECLARATIONS:
I hereby aflirm thai untler Denalty ot perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far ihe tollowing reason (Sec. 7031.5, Buslness end Pmfesslans
Code: Any ciry or counry which requires e permit to consWct, alter, improve, demolish, or repeir eny structure, pnor to its issuance, elso requires the epplicent for such permit
b file e signetl stetement that he or she is Ilcensetl pursuant b the proNsions of the Contrectors Llcense Lew (Chepter 9(wmmencing with Sectlon 7000) of Dlvlsion 3 of the
Business and Protessians Cade) or that he or she is exempt therefrom and the besis tor the elleBed exempUon. Any violation of Section 7031.5 by eny applicant for e Dermit
subjects the epplicant to a civil penalty at not more than tive hundred tlollers ($500).):
❑ I, es owner oi �he properry, or my employees wi�h weges as their sole wmpenution, WILL DO THE WORK, and the structure Is not Intendetl or oHeretl tor sale (Sec.
7044, Business and Protessions Code: The Contractore License Lew does not apply to an owner oF properry who builds or improves �heraon, end who does such work
himself or hersetl or ihmugh his or her own employees, Provided that such improvements are not intended or offered tor sale. tl, however, the builtling or improvemant is
sold within one year of completion, Ihe owner-builder will have ihe burden ot proving ihat ha or she did not build or improve for purpose of sale.). '
❑ I, as owner oi ihe properry, am E%CIUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors Llcense Lew does not applY to an'owner ot pmpeny who builds or improves thereon, and who contracis for such project with e contredor(s)
license pursuant to t�e Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Coda lor this reeson:
Signeture: Date:
Ownar ID verifletl by tlriveYs license. ❑ Yes ❑ No Drivefs License No. E:pires:
Vedfication of Ownership by (rype ot documeN, i.e. - properry te�c blll or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I hereby certiy Ihat no axcavetion live (5) or more feet In depih Into which e person Is requlred to descend, wlll be mede in connection with work euthorized by ihis
permit, and thet no building structure, scattolding, falsework, or demolltion or tlismantling thereof, will De more lhan thirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Califomla Administretive Cotle).
❑ As owner-builder, 1 will not employ anyone to do work which would require e permit irom the Division oi Induslnal Sefety, es noted above, unless such person hes e
pertnit to do such work tmm the division.
SignaNre: Date:
Division of Industnal Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENfHY: I cenity under penelry of perjury thet I have reed this apDlication entl state thet the intortnetion given is
correct. I agree to wmply wlth ell stete lews end city ortllnences relating to bullding consiructian, anG euthorize represeniatives of ihe Ciry af Coste Mesa to enier upon ihe
above-described property for inspection puryoses. I egrea not to occupy or ellow occupency ot eny building euthorized by this pertnit until tinel inspection.
�--SI§aeWre� IOwner(s)
� �� �
And/OrAuthonzed Applicant
COOE I. INSGECTIONTYPE
161fi Fixetl System Final Fire Pravention
1266 Pool Spe Final
200 Finfll Re-Roof
201 Final Block/Ratalning Well
202 Final Fectory Fira Place
203 Flnel Sign
204 Flnel Demolition
PdIE It�4S
CODE� INSPECTIONTYPE
206 Finel Mechanical
20B Finel Plum6ing
210 Finel Eledncal
212 Flnel Fire Preventlon
220 Final Planning Approval
222 Final SAe
250 Finel Builtling/Occupancy
PdIF 1[III➢!LH
(714) 754-5273 • Fex (714) 7543856 • www.ei.costa•mesa.cs.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
870 W 19TH S7
42251222
Applicant: ALEXANDER HERNANDEZ
Address:
Owner: HERNANDEZ, ALEXANDER
Address,� 870 W 19TH S7 -� .
/
�.
ConVactor.
Address:
0
ISSUE FEE
Tenip servicelest
Res. a/c package � �
New Res (1-2 units)
New Res�(3+units) _
Pool I Spa � .
Lighting Fixts,\�- _�
Recept Outlets � '
Switches
Non Res Appl �
Res Appl
Service to 200a
Service to 1000a
Service over t000a
Motors to 1 hp
Motors to tOhp �
Motors to 50hp
COSTA MESA, CA -
OWNER-BUILpER
Phone: 949•574-1887 '
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 71I09I2004
Issued: 11/09/2004
ISSUED BY:
� .
� ;��4�
`�� /
/
9� � �
SCOPE OF PERMIT
ADD 2,656 SF TO SFD (1,763 SF AT 1ST FLOOR AND'1,493 SF TO 2ND FLOOR). ALSO ADD 450
S.F. ATTACHED GARAGE; 18 SF DECK, AND 125 SF PATIO COVER AND ALTER EXISTING BATH.
SCOPE OF _ . ' - ' . -. �
WORK TO INCIUbE: DEMOLISH AND REBUILD EXISTING GARAGE. -
85FIXTURES,730UTLETS,280UTLETS � ,
RE:803•01691 . , ,- . . . . , ._ .
. , _ , . , -. �' , .
Quantiry
$23.50
� 50.00
ao.00
$0.00 0
��50.00 0 ,
50.00 • 0
�569.45�� .. 85
-" �560.69 `- 73
527.84 . 28 �
30.00 0
. �" 50.00 . � 0 �
50.00 0
�� . 50.00 0�
�`..So.00 0 � .
ao.00 _ `- _ o
30.00�� � � 0-
so.00 � o -
FEE SUMMARY "
- � . � - Quantity .
Temp Dist System / Lighting $0.00 0, �'
, . Busway /100 ft $0.00 0 .
� � Standing Seclion 50.00 � , 0
Misc Electrical Equipment $0.00 .�'�, 0
Trans�ortners up to,1 kva/kw $0.00� ,' 0-
................up to 10'kva/kw - - $0.00 � 0
.................up to 50 kvalkw 30.00 0
:................up to 100 kva/kw , $0.00 � 0
..................over 100 kva/kw� . 50.00 0� '
Low Voltage Equipment $0.00- 0
Low Volt Wiring System I Ckt � 50.00 .� 0
Misc. Conduit $0.00 0 ,
Misc.Conductor- � � $0.00� 0
Circus ( gen or nde) �, $0.00 0
. Circus (mech nde or lights) .,,$0.00 0
_ ','Christmas Tree Sfand �-- $0.00 0
Fireworks Stand -, " - ' $0.00 0
NOTICE: The work authorized by this pgrmit shell comply wlth ell appllcable handicap access requirements under Califomia statutes and retated
regulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIRATION: Thls permlt shall eutomaticslly expire and become void if work Is not wmmenced within 180 days, or il work is suspended or ebandoned
lor a perlod of 780 days.
INSPECTIONS: In order for Ihe work aulhorized under this permit to be considered legal, such work must comply with e�l eppiicable codes, and all
requlred Inspectiona end final approval must be oblained. Fallure to obtaln Inspeclions and final approval will result In the explration of this permit.
FOR INSPECTIONS CALL: (714) 754-5628
2NBi8 (BNO)
WORKERS'COMPENSAnON DECLARAnON: � , , �
I �ereDy eftirm unde� penalry of perJury one oi ihe tollowinq declaretions:
❑ I heve and will malnteln e ceNticale ot consent ta selt-Insure tor workers' compensetion, es prodded tor by section 3700 oi ihe Lebor Cade, tor lhe pertortnence ol t�e
work tor which ihis pertnit is Issued. .
❑ 1 have en0 wfll meintain woAcere' compensatlon insurance, as redulretl by seMion 3700 of the Lebor Code, tor the pertortnance ot Ne work tor whiCh Uds pertnit Is Lssued
My workers' compensation Insurflnce cerrier and pollcy number ere:
Cerrier. Pollcy Number.
rThis section need not be campleted ii the permit is velue0 at one �wrdred dallers (5100) or less J ,
� I cenify t�at In Ihe pertwmence of the work tot which Ihis permll Is issueq I shell nol employ any person in any menner so as to become subject to the workers'
compensatlon laws of Celllomle, antl egree Ihat ii I should become subject to the warkers' wmpensation provislons ot Sectlon 3700 ot Ihe Lebor Code, I shell forthwith
comply with these provisions.
APPIIcanl SlpneWre: - ' .� Date: 7 �/'� �'� �
WARNINQ: FAILURE TO SECURE WORKER$' ODMPEN$ATION ODVEMOE IS UNL4WFUL PND SHALL SUBJECT AN EMPLOVER TO CRIM�NAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
TIKKISPND OOLLARE (5100.000�. W ADDITION TO THE WST OF C�DMPENSATION, DMMGES AS PROVIDED FOR IN SECTION 3'!OB OF THE LABOR CODE, INiEREST, AND FTTORNEY'$ FEES.
LICENSED CONTRACTORS OECLARATON:
I �ereDy eMlrtn that I am Ilcensed unCer pmWsions o� Chapter 9(commendng wlth Sectlon 7000) of DMslan 3 of the Business entl Pmlessions Code, anG my license Is in tull
fome entl eXect. Llc. a Cless s
Contrecbls Slgneture:
Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirtn that there Is e consiruction lending agenty lor Ihe DeAormance of Ihe work for w�lch this pertni� is issued. (Sac. 3097, Civil Cotle).
Lentlefs Neme: LenOers Adtlress:
Signewra:
Dele:
OWNER-BUlLDER DECLARArIONS:
I hereby effirtn iha� under penalty ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business entl Pratessions
Code: Any ciry or counry w�ich requires e permit to construct, elter, improve, demolis�, or repeir eny swcture, O�ior lo its issuance, also requires t�e epplicent tor such pertnit
to lile e slgned slateinent ihat he or she is Ilcensetl purouant to the proWsions ol tha Conirectors License Lew (Chapter 9(wmmenGng with Seclion 7000) ol DINSion 3 of [�e
Business end Prolessians Cotle) or thet �e or she is exempt therelrwn entl the basis tor Ihe elleged exempNon. Any violation oi Sectlon 7031.5 by eny applicent }or a pertnit
sub�ecis ihe epplicen� to e civll penelry of not more than five hundred tlollars ($500).):
Q'll, es owner of the pmparry, or my employees with weges as their sole wmpensation, WILL UO THE WORK, and the structure is not Intended o� offeretl for sale (Sec.
7044, Busines5 and Profeuions CoGe: 7Tie Contractors LJcense Lew tloes not apply to en owner of properry who builds or Impmves Ihareon, a�tl w�o does such work
him elt or hersa�f or through his or �er awn employees, provitletl that such improvements ere not Intended or ottered for sale. If, however, ihe building or improvement is
sold�i�hin one year ot wmpleUon, the ov.ner-builder will have ihe burden ot proving thal he or sha tlid not build or improve lor purpose oi sale.). '
❑ I, es ownar of ihe property, em EXCCUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to construct ihe D�alect (Sec. 7044, Business entl Pmtessions
CoOe: The rnnl�actore License Lew tloes not appty to an owner of properry who builds or improves theraon, and who camracis br such pmject with a conireqoqs)
license pursuan� �o Ihe Contractors License Lews.).
❑ _I.em exempt untler
Signatuie: ll
Owner ID verified by tlrivefs Iicense.
Verifiwtlan ol Ownership �y (type oi
Business and Prafessions Code for this reeson:
s ❑ No Drivefs License No.
I.e. - praperty tav blll or deed):
Daqte: � //-09'��i
� � Expires: �O O �
DIVISION OF INDUSTNIAL SAFE7Y PERMR CER7IFICATON:
❑ I hereby certity Ihet no excevatlon iNe (5) or more feet In depth into which e person is reqNretl to tlesCend, will be matle In Connection with work euthodzetl by Nis
permil, an0 tha� no building slmcNre, scattdding, falsework, or demWilion or dismantlinp ihereoi, will be more ihan t�irry-sia (38) feet Oig�. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Ca�ifomia AtlminLstrelive CadeJ.
❑ As owner-builtla�. I wlll nal employ enyone to do wark whic� would require e permi� from ihe Dlvlsian of Intlus�rial Sefery, es notetl ebove, unless such pereon hes e
permit to do suCh work Irom ihe Givision.
Signawre: Dete:
Dlvlsion ol Industrial 5afery Permit Number:
CERTIFICA7E OF COMPUANCE AND AUTHORVJITION OF ENTRV: I certity untler penelry at perjury thet I have read this epplication and state that ihe Inlortnation given is
correct. I egree to compN wlth ell stete lews and ciry orElnances releting to building constmctlon, entl euthotlze representatives of the Ciry of Coste Mese to enter upon the
above-descnbed prope for ' rposes. I agree not to acupy or ellow occupency ot any building authorized by �hi9 permi� until linel inspection.
.� ir-o9- �y
SipnaWre Oi Legal Owner(s) ,' Date "
And/Or Authorizetl Applicant
COOE �, INSPECTONTYPE
1818 Flxetl System Final Fire Prevention
1266
�201
202
203
Pool Spe Finel . ,
Finel Re-Roo1
Flnal BIxWPeteining Well
Final Fectory Fira Plece
Finel Sign
204' FlnaiDemolilion
Qsjf, � �Qyf,,,( INSYECTIONTYVE
206 Finel Mechenical
20B Finel Plumbing .
210 Finel Electrice�
212
220
Flnel Fire Preveniion
Finel Planning Approvel
222 Final Site �
_ � 250 Finel Buildi�glOccupancy
� It�
(714) 754•5273 • Fax (�ta) �5a-aess • wwa+.c�.costa-mesa.ca.us 77 FAIH UMIVt, (:UJ I A MtSA, GA 9Zti'Lti
MECHANICAL PERMIT
,lobAddress: 870 W 19TH ST
Suite No
Vicinity:
Parcel Number: 42251222
Applicant: ALEXANDER HERNANDEZ .
Address: ' � '
,
Owner. / HERNANDEZ, ALEXANDER
Address: �870 W 19TH ST .
Contrector.
Address:
COSTA MESA, CA
OWNER-BUILDER
Phone: 949-574-1887
Zip:
Phone:
Zip: 92627
' ' Phone: - � ' �
_ Zip(.
� " - Cicense:000000
Status: ISSUED
Applied: 11/09/2004
Issued: 11/09/2004
ISSUED BY:
�� � � �X�Z�� � �� � �� .
� �a o r�
DR� /
SCOPE OF PERMIT
, ADD 2,656 SF TO SFD (1,163 SF AT 1ST FLOOR AND 1,493 SF TO 2ND FLOOR). ALSO ADD �
' 450 S.F. ATTACHED GARAGE; 18 SF DECK, AND 125 SF PATIO COVER AND ALTER EXISTING ' � ,
- BATH. SCOPE OF , . � , _. � . . . . - - � �
-� WORK TO INCLUDE: DEMOLISH AND REBUILD EXISTING GARAGE.� - , � .
, 1 INST FAU < 100K BTU, 7FACTORY-FIREPLACES,-_1 VENT�FAN/SINGLE�DUCT � ,
. RE:B03-01691 , � � • �
�. �- - - " FEE SUMMARY � � � � � � �
. - Quantity � . - � . • - -' Quantity
ISSUE FEE $23.50
Inst FAU <100 k BTU � $14.80 1
Inst FAU >100 k BTU $0.00 0
RepairlAlt CoolinglHeat�� 50.00 0
Inst I Rep, Recess Wall Htr �-. $0.00 0
Refrig Sys <100 k BTU '; ;. $0.00 0
Refrig Sys >100 k BTU � �, $0.00 0
Gas Piping ,� � � � � � � : $0.00.. _ 0
Factory Fireplace. � $21.30 � 2 �
Hoodw/Mech-Ezhaust ,��, .�•:�$0.00� 0
VAV Box � , , $0.00 .- 0
Vent Fan / Single Duct. ., �' $725 ��--1 � �
Appliance , , "; $0.00 . 0 �
Fire Dampers , � � $0.00 � 0 _
Smoke Dampers . $0.00. 0 _
Inst or Relocate Appl Vent ��` �$0.00 0 -
Air Handlers < 70000cfm , $0.00 0 .
Air Handlers > 10000cfm �30.00 ��' 0.
Floor Fumace $0.00 �, 0-.�
Floor or Suspend Heater $0.00 0
, Repair / AII Absorbtion Unit
Repair /-Alt Refrigeration Unit �
Ventillatlon System
Evaporalive Cooler '� �
. ���Commercial lncinerator �� �
''-'�'' � Domesticlncinerator ����
.i t-�. , - �, � .
Compressors / AbSorpti0n Systems .
- - ' � sUpto3hp/t00,k-BTU'�._ ,i;.�/ �.
- � 3To15hp/SOO�kBTU�
' . - ' "15To30hp/1,OOOkBTU %_ �
- �30 To 50 hp / 1,750 k BTU - �
� - � Over 50 hp / Over9,750 BTU �� - �, � �'
' , �Boilers = ' _ �' ` % �
' _ �Upto3hp - � � � ' � , -
� 3To15hp - � , "
, ,, 15to30hp �
� 30 to 50 hp' , � �
•` - - . � ' Over 50 hp � . - . .
- ' ONer Mechanical Fee'`
, - -Investlgation Fee �
$0.00 0 ,
' $0.00 .0
$0.00 0
-�$0.00 0 � ,�
�� $0.00% 0 �
$0.00 0�,'
� � $0.00 ' 0�
50.00 , 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related
�egulations. (Ord. No. 92•28, § 1, 1247•92)
EXPIRATION: This permit shall autometically expire end become vold if work Is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under thls permit to be considered legal, such work must comply with all appliceble codes, and all
requlred Inspectlone end final epproval must be oblalned. Failure to obtein Inspections and final approval will result in ihe expiration of thie permit.
FOR INSPECTIONS CALL; (714) 7545828
2Meee Ierool / /�
W�
WORKERS' COMPENSATON DECLARATION: ' � - -
I hereby aftirm under penalty ot perjury one o1 ihe tollowing tleclaretions: �
❑ I�heve end will maintain a certificate of wnsent to sell-Insure tor workers' compensetlon, es provitled for by section 3700 of the Lebar Code, tor Ihe peAormance of the
work tor whlch Ihis permit is Issued. ,
❑ I heve and will meimain workers' compensatlon Insurence, as requiretl by sectlon 3700 0l the Labor Code, Por the peAortnance of Me work for whiGh Ihis permit is issuetl.
My workBK compensaUon Insurenca carrier and policy numher are:
Cartier. Policy Numbec
(Th/s sectlon need not be completed i! (he permif is va/uetl et ane hundretl dollars (5100) or less.)
�. . .
'� I certity tnat in the peAortnance of ihe work for which ihis pertnit is IssueO, I shall not employ eny person in eny manner so as to become subject to Ihe workers'
compensatlon laws ot California, end agree ihat II I should become sub�ect to the workers' compensetlon pmvlsions of Section 3700 of ihe Labor Code, I shall lorthwlth
comply with Ihese provisions. � c /�L},�/�
ApPlicant SignaNre: - – � �� Dete: � �/ `��/ '�/ �
WARNING FAILURE TO SECURE WORKERS' C/JMPENSNTIdJ COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYEP TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
T1qUSAND WLIARE (S10D,000), IN AUDfTIIXJ TO THE COST OF COMPEN54TION, DAhNGES AS PROVIOED fOR IN SECTION 3�Og OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby aHirm lhet I em licensed under provisions of Chepter 9(commencing with Sectlon 7000) of Division 3 0l the Buslness end Professlons Code, and my license Is In full
force and eflect. Lic. a Class N
Contractors Signeture: Dete:
CONS7RUCTION LENDING AGENCV:
❑ I hereby 911irm that there is e consiruction lentling egency for Ihe peAormence oi Me work tor which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lenders Address:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm Ihet under penelry of per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness end Professlons
Code: Any ciry D� counry which raquires e permit to construct, alter, improva, demolish, or repeir eny siructure, prior to its issuance, elso requires the epplicant for such permil
to file a signed s�etement �het he ar she Is licensetl pursuent to the provislons of the Contractors Licanse Lew (Chepter 9(wmmencing wlth Section 7000) of Division 3 ot ihe
Busirtess and Proiessions Gode) ar that �e or she is axempt theratrom aatl the basis for the fllleged exemption. Any violetion of SecGon 703�.5 by any applicam tor a peimtt
subjects Iha applicant to a civil penelry of not more ihen live hundred dollers ($500).):
�, I�es owner ot ihe propery, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not Intended or oNered for sale (Sec.
'7044,Business and Professions Cotle: The Contractors License Law does not apply to en owner ot property who builds or improves thereon, antl who does such work
himself or herself or Ihrough his or her own employees, Pmvidetl ihet such improvemenis are not intended or oHered tor sele. If, however, Ihe building or Improvement is
/, sold within one yeer of completion, the owneo-bullder will have tha burden o� proving that he or she did not build or improve for purpose of sale.). '
❑ I, as ownp� of the properry, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the prolect (Sec. 704a, Business end Professions
Cotle: ThB contractors Llcense Lewdoes not apply to an owner ot proDerry who bulltls or Improves Ihereon, end who contrects fw such pmject with e coniractor(s)
license pursuent ta the Conirectars license Lews.).
❑,_I em eaempt urd r sec. Business and Professions Code for this reason:
Signawre: a�-eq�ti— /�Mv-nGz.�
,� � Expires: `Z60 7
Vedfication of Ownership by pype ol doc ment, i.e. - pmperty tes bill or deetl): - -- � _ � __
DIVISION OF INDUSTRIAL SAFETV PEHMR CERTIFICATION:
❑ I hereby certify thet no excavetion tive (5) or more feet in depth into which e person Is requlred to descend, wlll De made in connection with work euthorized by this
permit, end that no building sWcture, scatfolding, lelsework, or demolition or tlismantling iheraot, will be more ihan thirty-six (36) feet high. (Chap. 32, GIp 2, A� 2, Sec.
341, Tltle d, Califomia Adminlslreilve Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which would require a permit Irom tha Division ol Industrial Safe�y, as noted above, u�less such person hes e
pertnit to do such work from the diWSion.
Signature: Date:
Division oi Intlus�rial Safery Permit Numbec
CEHTIFlCAIE OF COMPLIANCE /WD AUTHORIZATION OF ENfAY: I cenity under penelty ol perjury ihat I have read this application and stata Ihat the infortnation given is
wrrect. I agrea lo comply with ell stete laws entl ciry ordinences relating to building construction, and authodze representatives of the Ciry of Coste Mese to enler upon tha
ebove-descnbed properp�Ee'inspaol' s. I egree not to occupy ar allaw occupancy ol eny building eulhorized by Ihis permit until final inspection.
�� �__ ii-o9-�y _
SigneNre Of Legal Owner(s) _ " Date '
And/Or Autharized Appllcent
CO�E I. �y$Q�y4NiYCE . PeiE I�ID�::
1616 Fixed System Final Fire Preventlon
1266
200
i
201
Pool Spa Final .
Finel Ra-Root
Finel BIocWRetaining Well .
202 �Finel Fectory Fira Place
203 Final Sign
204 'FinelDemolition �
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing .
210 Final Electncal
212 FinePFire Prevention
220 Final Plenning Approval
222 Finel Site �
250 Finel Building/Occupancy
QdIF II�LS
(714) 754-5273 • Fax (714) 754-4856 • w�vw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 870 W 19TH ST
Suite No
Vicinity:
Parcel Nunmber: 42251222
Applicant: ALEXANDER HERNANDEZ
Address:
Owner: � HERNANDEZ; ALEXANDER
Address �870 W 19TH ST �.� . �
- COSTA MESA; CA
Contractor: - OWNER-BUILDER
Address: �� '
i �
PLUMBING PERMIT
Phone: 94&574-1887
Zip:
Phone:
Zip: 92627
`
Phone:
Zip. _
License: 000000
Status: ISSUED
Applied: 11/09/2004
Issued: 11/09/2004
ISSUED BY:
_ � � ', � , , , �
_ �� , .
\EXp� $
D�
�
Arch / Eng : �
Address: . . ' , , . . ' _ . � - - --' .
\
. -- ,.i: __. . _ . . _._ . �
Phone:
� ... Zip: ' , .
- _ _ _ � _ 'License:,. . .� . �,�',' ,. , _
SCOPE OF PERMIT
ADD 2,656 SF TO SFD (1,163 SF AT 1ST FLOOR AND 1,493 SF TO 2ND FLOOR). ALSO ADD 450 - �
S.F. ATTACHED GARAGE; 18 SF DECK, AND 125 SF PATIO COVER AND ALTER EXISTING BATH: ,
SCOPE OF � - - " , � �
WORK TO INCLUDE: DEMOLISH AND REBUILD EXISTING GARAGE. � - ��
, _ � / � ��
' 2 BATHTUBS, 2 DISHWASHER, 1 GASOUTLET (1=4),'t. LAUNDRY TUB/WASHER, 1 SEWER��CONNECT, ' � ,
2 KITCHEN SINKS, 2 WASH BASINS,�7�WASH BASIN SET, 3 WATER CLOSETS, 1 WATER',� �� ��
HEATERNENT . , " � '
RE:B03-01691� . .- � ^ � . . . ' " � � � � � ,
l �� `, . � , .� .
% �'
� - � FEE SUMMARY � , '
� ' � �AMT� ; . QTY - . � AMT _ QTY�- � � , � - � " . � AMT
ISSUE FEE $23.50 � � �Laundry Tub / Washer $9.80 1 � � Sump�Pump � $0.00
Backflow irrigalion ��$0.00 � 0" � Landscape Irrigation �$0.00 0 Swimming Poof; $0.00
BackFlow Preventer �$0.00 . 0 - � P,Twp $0.00 0 7rap Pnmer , $0.00
Bathtub $19.60 2, � �.PressureRegulator " $0.00 0 Unnal"� ' $0.00
Clarifler System $0.00 . 0 . Pmcess�Piping (per 10 ft) $0.00 � 0� .Vacuum Brkr Bkflow(1-4) $0.00
Connect Qce,Soda,etc) $0.00 �0��.�� ' � Receplors - '. . �$0.00' 0 . � �" .Vacuum Brkr Bkflow(5+) $0.00
Dental Units $0.00 0 - - Septic 7ank $0.00 , , 0 - = " Wash Basin $19.60
QTY
0
0
0
0
0
0
2
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void II work is not commenced within 180 days, or if work is suspended or ebandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considared legal, such work must comply with all applicable Codes, and all
requlred inapectlone and finel epproval must be obtained. Failure to obtain Inspectlons and final epproval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zao-sa (eroo) �.
WORKERS' COMPENSATION DECLARATON: . . , - �
I here6y aHirm under penalry of per�ury one ot �he following tleclarations: -
❑ I heve entl wlll maintain a cenificate of consent to self-Insure for workers' compensetion, es proNded lor by section 3700 of the Lebor Cotle, tor �he performance of the
work for which t�is permit is Issued. �� .
❑ I have and wlll malnWin workers' compensatlon insurence, as requiretl by secGon 3700 ot ihe Lebor Gode, for the pertortnanCe of tha work for which �his pertnit IS Issued.
My worker3' wmpensation Insurence carrier and policy number are:
Cerrier: Policy Numbec
(This section neBd nat be comp/eled i! fhe pe�mif is ve/ued et one hundretl tlollers ($100J or less.) .
'� �I certify Ihe� In ihe pedortnance ol iha work for which this permit is issuetl, I shall not employ eny person in eny mannar so as to bacome subject to t�e workere'
compenseUon laws of Californla, antl agree thel If I should �ecome sub�ect to the workers' compensetlon provlsions of Section 3700 of the Lebor Code, I shall forihwith
comply witn ihesa p�ovisions.
ApplicantSlgneWre: '� � "� Date: > ���9'Oy•
WARNING FAILURE TO SECURE WORKERS' COMPENSATION WVERAGE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOVEq TO CRIMINAL PENRLTIES AND CIVIL FlNES UP TOIXJE HUNDRED
TFKKISAND DOILARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAM4GE5 AS PFOVIDED iOP IN SECTIIXJ 3108 OF THE IABOR WDE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTAACTOFiS DECLARATION:
I hereby aHirtn thet I em licensad untler provisions ot Chapter 9(commencing with Sedion 7000) ot Divisian 3 ot Ihe Business and Professlons Cotle, and my Ilcense is in tull
lorce and eHect Lic. a Cless q
Contrectofs Signature: Date:
CONS7RUCTION LENDING AGENCV:
❑ I hareby aHlrm ihat Ihere is a conslruction lending egency lor the pedormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Adtlress:
Signature: Date:
OWNER-BUILDHA DECLARATIONS:
I �ereby aNirtn that unCer penalty of perjury the� I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Protessions
Cotle: Any city or counry which requires e permit to conslmct, alter, improve, tlemolish, or repair any strucWre, prior to its issuance, also requires the epplicaN tor such pertnit
to tlle e signed statement ihat he or she Is licensed pursuant to the provlsions ol the Conirectors License Ww (Chapter 9(commencing with SecNon 7000) 01 Division 3 oi the
Business antl Pr0lesslons Cotle) or that he ar she is exempt iheretrom antl the basis for ihe alleged exemption. Any violetion of Section 7031.5 by any epplicent lor e pertnit
suhjacis ihe epplicent to a civil penelty ol not mora Ihan five hundred dollars ($500).):
� I� as owner oi Ihe properry, or my employees wl�h wages es �heir sole compensation, WILL DO THE WORK, antl �he siructure Is not intendetl or oftered lor Sale (Sac.
- 7044, Business and Professions Code: The Comrectore License Lew tloes not aqply to an owner of pmperty who builds or improves Ihereon, antl who does such work
himsetl or herself or through his or her own employees, provided Ihat such improvements ere not intendetl or offe�ed fo� sale. If, howaver, the building or improvement Is
sold within Ona year of complelion, ihe owner-builder will heve ihe burden ol proving thet he or she diG not build ar improve for puryose of sale.). �
❑ I, as awner oi ihe pmperty, em EXCLUSIVEIV CONTRAC7ING WITH LICENSED CON7RACTORS to consimct the praject (SBc. 7044, Business and Professions
Cade: The Ga��rectors License Lew does not epply to en owner ol property w�o builds or Improves theraon, end who cantracts tor such project with a contrector(s)
license pursuant to the Contractors License Lews.).
❑ I em BXamPt undef
Signamre: -r
Owner ID varitied by tlnvers license.
Verification of Ownership by (type of
Business entl Pmfessions Code tor this reason:
Yes ❑ No Driver's License No.
�L i.e. - properly taa bill or tleetl): --
DIVISION OF INtlUSTRIAL SAFE7Y PERMR CERTIFICATION:
❑ I hereby cer�lly that no excavation fiva (5) or more leet in depth in�o which a person is required to descend, will be matle In connedion wlih work authonzed by Ihis
permit, and ihet no building slrucNre, scattolding, falsework, or demoli�ion or tlismamling t�ereof, will be more Ihan thirry-six (36) teat �igh. (Chap. 32, Gry 2, An 2, Sec.
341, TMe 8, Celifornia AdminisVative Code).
❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Industriel Sefety, es noted ebove, unleu such person hes a
pertnit to Oo such work irom Ihe Civision.
SignaWre: Date:
Division oi Indusinel Safary Pertnit Number:
CEHTIFlCATE OF COMPLIANCE AND AUTNORVA710N OF ENTHY: I certify under penalty of perjury Ihet I have read this epplication and stete that ihe infortnation given is
wrrect. I agree to �mpty with all state laws and ciry ordinances relating Io building construction, and authonze representatives of ihe Ciry of Costa Mesa to enter upon tha
above-descnbed property for i� a����� ;_ e ree not to occupy or allow occupancy of eny building authorized by Ihis pertnit until tinel inspection.
�� '�� j/-6�' ��/_
Signa�ure Of Legal Owner(s) _� De�e '
i
And/Or Authonzed Applicent
COpE t. IN
1616 Fixed Sy51em Final Fire Prevention
1268
200
201
202
203
204
Pool Spe Finel
Final Re-Rooi
Final BIOCk�Retaining Well
Final Fec�ory Fire Place
Finel Sign
Final Demolition '- �
P7.�I�r,iiimbj
COOEt INSVECfIONTYPE
206 Final Mechanical
20B Final Plumbing
270 Final Electncal
212 , Finel Fire Prevention
220 � Flnal Planning Approval
222
25
Final Si�e " �
Final Building/Occupancy
PAIE
�
�I5u19cj
.
.
(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
870 W 19TH ST
REAR OF HOUSE
42251222
Applicant: HERNANDEZ, ALEXANDER
Address: 870 W 19TH ST
COSTA MESA, CA
Owner: HERNAfVQE7_, ALEXANDER
Address 870 W 19TH ST
COSTA MESA,CA
Contractor: O W N ER-BU I LDER
Addres4: ' � �
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Phone: (949)574-1887
Zip: 92627
Phone: (949)574-1887
2ip: 92627
Phone:
Zip:
License: 0
SCOPE OF PERMIT
ELECTRICAL SERVICE CHANGEOUT.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
50.00
50.00
$0.00
$30.50
$0.00
$0.00
$0.00
so.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
Quantity
FEE SiliviYlARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 700 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Cirws (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: Oi/05/2001
Issued: 01/OS/2001
ISSUED BY:
• f .
1 ' �L�
. ,
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 554.00
COMMENTS / SPECIAL CONDITIONS
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit Shall comply with all applirable handicap access requiremenis under Calilomia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-27-92)
EXPIRATION: This permit shall automatically expire and become voitl If work is not commenced within 180 days, or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all
requlred Inspectlons and finel epproval must be obtained. Failure to obtain inspec�ions and final approval will result in ihe expiration of this pertnit.
FOR INSPECTIONS CALL: (774) 7545626
266Bi6 (fY00)
WORKERS'COMPENSATON DECLARAnON: �
I hereby atfirtn under penalry of per�ury one of the following�declarations:
❑ I �ave end will maintaln e certificete of consent to self-Insure for workers' compensatlon, as providetl for Ey section 3700 of ihe lebor Cotle, for the pertormence of �he
work For which this pertnit is issued.
❑ I have antl wlll melntain workers' compensation insurenca, es required by sectlon 3700 01 Ihe Lebor Catle, for Ihe pertortnance of the work Por which Ihis permlt Is IssueO.
My workars' compensetlon Insurance cerrie� end policy number are:
Carder. Polity Number.
(Thls section need not be wmp/eted i/ Me permit is veluetl e! are hundretl dol/ere (5100) or less.)
❑ I certity Ihat in the peAortnence of ihe work for which t�is permit is issued, I shall not employ any person in eny menner so as to becoma subject to Ihe workers'
compensation lews af Celitomia, end agree that it I shoultl become sub�ect to the workers' compensatlon proWsions oi Section 3700 oi Ihe Lebor Cotle, I shell forthwi��
comply with ihese pravisions.
Applicant Signature: Date:
WARNING: FNLURE TO SECURE WOFKERS' WMPENSAiION COVERAGE IS UNUWFUL M'D SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE NUNDREU
TMOUSAND DOLLARE (5100,000), IN ADDITIIXJ TO THE COST OF COMPENSATION, DMUGES AS PROVIDED F-0R W SECTION 3)OB OF THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION: �,
I here6y aHirtn thet I em Ilcensed under provisions of Chepter 9(commencing wil� Section 7000) of Divislon 3 of Ihe Business and Protesslons Code, end my Iicense Is In tull
torce entl eHect Lic. a Class a
Coniredofs Signature: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby aHirtn ihet �here is e construction lending agency for the peAormance of iha work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Name: Lender's Address:
SignaNre: Date:
OWNER•BUILDER DECLARATONS:
I hereby aHirm thet under penelry of per�ury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7037.5. Business and Professions
Cotle: Any city or counry which requires a pertnn to consWcL alter, improve, tlemolish, or repair any strucNre, prior to its issuance, elso requires Ihe applicant tor such pertnit
to file e signed stetement thet he or she is licensad pursuanl b the provisions of Ihe Contractors License Lew (ChaD�er 9(commencing wit� Sectlan 7000) 01 DlWsion 3 0l the
Business and Protessions Cotle) or that he or she is exempt t�erefrom and Ihe basis for the elleged exemptian. Any vloletion of Section 7031.5 6y any epplicent far e permit
sublects ihe epplicent ta e dvil penalry of not mae Ihan tive hunOretl dollars ($500).):
� t, as ov.ner of the properry, or my employees with weges es their sole compensallon, WILL DO THE WORK, end the structure is not IntenOeG or ottered for sele (Sec.
7044, Business�and Pmfessions Code: The CoMractors License Law tloes not apply to an owner of properry who builds or improves Ihereon, and who tloes such work
himself or hersell or,llirough his or her own employees, providetl ihat such Improvemenis are noi intentled or oHered lor sale. If, however, ihe building or Improvement is
sold wi�hin one year o�t'comple`ion, Ihe owner-builder will �ave the burden of proving �hai he or she did not build or improve for purpose of sale.).
❑ I, as awner oi the propany,-am�E%CLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct Ihe pmject (SecJ044, Business end Protessions
Cade: The mntractors Llcense Law Eoes,not apply to en owner oi property who builds or improves thereon, antl who contracts lar suc� pro�ed with e comrectar(s)
license pursuantto the Contraqors License LewsJ.
u
ID verified by drivers license. ❑ Yes ❑ No
Business an0 Professions Code for this reason:
�Data: �� •�
Dnvefs�GcenseNo. � Expires: TO�
Vedflcetion oi Ownership by (type ol document, I.e. - pwpeny tex bill or tleetl): �—'—�- -- �
1.
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTFICATION:
❑ I hereby certity Ihat no exwvation tive (5) or more feet In depth into which e person is required to Gescend, will be made in wnnection with work authorized by this
permit, end thel no building sWcture, scaHoltling, falsework, or demolition or dismantling thereoi, will be more ihan Ihirry-six (38) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle 8, Celitomie Adminis�re�ive CoOe).
❑ As owner-builder, I will not employ anyone to do work whlch would requlre e permit from the Division of Intlusirial Sefery, es nofed ebave, unless such person has e
permit to do such work from the division.
Signature: Date:
Division oi Industrial Selery Permit Number:
CERTIFlCATE OF COMPLJANCE AND AIfTHORVATION OF EMRY: I certity under penalry of perjury that I have read this application en0 state that the infortnation given is
wrrect. I aqree to wmpty vrith all stete laws and ciry ordinances relating to building construction, and euthorize representaWes of the Ciry of Casta Mesa to eNer upon Ihe
aDove-describetl property for inspection purposes. I agree not lo occupy or ellow occupancy of eny building euthorized by ihis permil until linel inspection.
�- ��� (
r Slgnature Ot Legal Owner(s) Date _
AnNOr Autharized Applicenl Date
COOE �. INSPECTIONTYVE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Rooi
201 Final BIocWReteining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolilion
�j[ f�� �� INSPECTIONTYFE
206 Final Mechanical
208 Final Plumbing
210 Finel Elecirlcel
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupancy
� I��
(714) 754-5273 • Fax (714) 754d856 • www.ci.costa-mesa.ca.us
BUILDING PERMIT
,lob Address: 870 W 19TH ST
Suite:
Vicinity: SIDE PROPERTY LINE /
Parcel Number: _42251222 Zoning:
Applicant: HERNANDEZ, ALEXANDER
Address: 870 W 19TH ST
COSTA MESA, CA
Owner: HERNANDEZ, ALEXANDER
Address B70 W 19TH ST
Contractor:
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Phone:
Phone: 949-574-1887
2ip:
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
T7 FAIR DRIVE, GOS I A MtSA, GA 92tiZ6
ISSUED BY:
Status: ISSUED
Applied: 09/25/2002
Issued: 09/25/2002
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 6 FT HIGH BLOCK WALL 100 FT IN LENGHT ALONG SIDE P.L. W/ 3FT HIGH WITHIN 10 F00T FRONT SETBACK.
Plan Check: $45.01
Permit: $69.25
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $114.26
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0. 0
Rear 0-0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
LeR 0- 0
� Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
s2,000.00
So.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspanded or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under lhis permit to be consitlered legal, such work must comply with all epplicable codes, and all
requlred Inspections and flnel epproval must be oblained. Failure to obtain inspectlons and final approval will result in the expiretion of lhis permit.
FOR INSPECTIONS CALL: (714) 7545828
�
WOHKERS'COMPENSAnONDECLARAnON: _
I �ereby aHirtn under penalry ol perjury ona ot the Iollowing tleclaretions:
❑ I have and will meintaln e cenificate of consent ta selt-Insure tor workers' compensation, as proNded lor by section 3700 of ihe Lebor Coda, for Ihe pertortnance of the
work for which this permlt Is issued.
❑ I have and will mainteln workers' compensation In urance, as required by sectlon 3�00 oi ihe Lebor Code, br Ne pedormance of t�e work ior wry�h hisyyaa � it Is iuued.
My workers' camper�etlon sy�ence cerrler poli .number era: ,+�1 1
Cerrier. l �� � �Policy Num�er. U �
is secnon neetl no p Athe pe /uetl et one hundred dW/aro (S100J or /ess.)
rtity that in t�e pertormence of the work for which ihis partnit is issued, I shall not employ any person In any manner so as lo become s �ect to the warkers'
compensatlan lews of Celltomia, end egree Ihet If I should become sub�ecl to Ihe workers' wmpensellon provisions of Sectlon 37 h bor C , I shell forthwith
comply with these provisions.
Applicam SignaWre: .-� Deta:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIpJ COVEMGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOVEH TO CRIMINAL PENALTIES AND IL FlNE UP TOONE HUNORED
THOUSAND Dd1ARE (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR WDE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTFiACTORS DECLARATION:
I hereby affirtn that I em Iicensed under proNsions of Chapter 9(commencing wit� Section 7000) of Divislan 3 of Ihe Business end Prolessions Cotle, entl my license is in hll
lorce entl eNect. Llc. p Class p
Contrectofs SignaWre: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm thet Ihere Is e construction lending egency for tha performance ot the work for which ihls permit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lender's Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eftirm ihat under panelry af perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business end Protessions
Cotle: Any ciry or counry whlch requires a permit to consiruct, alter, improve, demolish, or repair eny structure, prior to its issuence, elsa requires Ihe appllcent tor such permlt
to file e signed stetement Ihat he or she Is licensetl pursuent to the proNsions ol Ihe Coniractors License Lew (Chapter 9(commencing with Sectlon 7000) ol DiNsion 3 of Ihe
Business Profeuions Cotle) or that he or she Is exempl therefrom en0 Ihe besis tor the allegetl evemptlon. Any violetion of Sectlon 7031.5 by eny epplicant for a pertnit
,subja a applicant ro e clvil penelry of not more than flve hundretl dallars ($500)J:
I, as owner of the property, or my employees with wages as Neir sole wmpensation, WILL DO THE WORK, and ihe structure is not intendeE or oHeretl for sale (Sac.
7044, Busineu antl Protessions Code: The Contractors License Law tloes not apply to an owner of properry who Duilds or improves �hereon, and who tloes such work
himself or herself or ihrough his or her own employees, provitletl �ha� such Imprwements ere nol intentletl or oflered lor sale. It, however, the building w improvement Is
sold within ona year oi complelion, the owner-builtler will have t�e burden of pmdng that he or she tli0 not build or improve for Ourpose ot sale.).
❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTOfiS to construct ihe proJect (Sec. 7044, Business enC Proteulons
Cotle: The conirectors License Lew does not epply to an owner ol property who builds or Improves ihereon, and who conlrects for such project wl�h e coNrector(s)
license pursuant to the Coniractors License Lews�.
❑ I am exempt und raT�7 Business entl Professions Cotle lor ihls reeson:
SlgnaNre: � Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License Na. �'( Expires� _"7�0 y
VerlticeUon of Ownership by (type ot document, i.e. - properry tex bill ar tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I here6y cerlity that no excavetion fiva (5) or more feet in tlept� into whlch a person Is required to descend, will be made in connaction with work euthorizetl by Ihis.
pertnit, and ihat no 6uilding strucWre, scettolding, talsework, or demoll�lon or tlismantling ihereot, wlll be more than ihitly-sis (36) teet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title B, Calilomia Adminisirative Code).
❑ As owner-builtler, I will not employ anyone to do wark which would require e pertnit tmm the Division of Intlusinal Selery, es noted above, unless such person hes e
permit to tlo such work Irom Ihe division.
Signeture: Oate:
Dlvision of Indusiriel Sefery Permit Number:
CERTIFlCATE OF GOMPLIANCE AN� AUTHORIZATION OF EMRV: I certlfy under penal�y ot perjury Ihai I have read thls eppf tion entl state that the intortnation given Is
correct I egree to comply wlth ell state laws end ciry oMinences relaqng lo building constructlon, antl euthodze representatives of the Ciry of Coste Mese to enter upon ihe
ebove-tlescribed p ' ' . not to occupy or ellow occupancy of any building euthorized by i yYyn ' i�
�� C%
Slgnature Ot Legel Owner(s) ie
And/OrAuthonzed Appllcant " Date
COUE 1. INSPECTONTYPE
1616 Fixetl System Finel Fire Preventlon
1266 Pool Spa Flnel
200 Finel HB-Rool
201 FInaI BIocWRetelning Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Final Demolition .
�. i. .�w.
I � • :. i..
�
eooe� iNsvernoxTrae
208 Finel Mechanical
208 Finel Plumbing
270 Finel Eledrical
212 Finel Flre Preventlon
220 Finel Plenning Approval
222 Final Site
250 Finel Building/Ocapency
OAg II�Lfl
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosW-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob Address: 870 W 19TH ST
Suite:
Vicinily: FRONT OF PROPERTY
Parcel Number: 42251222
,4pp�icant: HERNANDEZ, ALEXANDER
Address: 870 W 19TH ST
COSTA MESA, CA
owner: HERNANDEZ, ALEXANDER
Address 870 W 19TH ST
COSTA MESA, CA
Con tra cto r: O W N E R-B U I L D E R
Address:
Zip:
Arch :
Address:
Phona:
Zoning:
Phone:
Zip: 92627
Phone:
Zip: 92627 '
Phone:
License: 000000
Eng:
Add�ess:
Status: ISSUED
Applied: 05I09/2003
Issued: OSI09/2003
�,i�. �
��1L�
Phone:
Zip: � License: License:
SCOPE OF PERMIT .
INSTALL 6 FT HIGH BLOCK WALL 10 L.F. PER CITI' STANDARDS. SETBACK 30 FT FROM FRONT PROPERTY LINE AND 12 Ff FROM RIGHT
SIDE SETBACK FOR COURTYARD IN FRONT OF SFR. " ��
Plan Check: $15.28
Permil: $23.50
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $39.28
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0. 0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Lek 0- 0
Prooased: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
szoo.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 1 BO days, or if work is suspended or abandoned
for a period of iB0 days.
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, end all
required Inapectlone end Iinel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS'COMPENSAnON PECLARAnON:
I hereby effirm under penalry of perjury one ot the following dedara9ons:
❑ I heve and wlll maintain a GertlTiwte at consent ta self-Insure tor workars' compensetlon, as provideA for by sectlon 3700 of ihe Labor Cotle, tor the pertormance of Ihe
work for which t�i5 pertnil is issued.
❑ I have entl wlll mainWin wofkers' compensation Insurance, as required by section 3700 of the LeGor Code, tor Iha perto�mance ol Ne work for which ihLq paimit is Lswed.
My workers' compansation ��surence cartler end pollcy number are:
Carrier: Policy Number:
(Thls sectlon need nor be camplereo i! rhe permiNs velued er one nundred dalaro ($100) or /ess.)
�.I cetlify t�at In the pertorm8nca of the work tor whlch Ihis pertnit is Issuetl, 1 shall not employ any person In eny manner so as to become subject to ihe workere'
cempensetlan lews oi Califomia, entl egree that it I s�oul0 becoma subl�� �a �he workers' wmpensatlon provislore oi Section 3700 of the LeDor Cotle, I shall tonhwith
comply with these proWslo� � Q/' ��\
Applicanl Signeture: Dete: ' - ( G �
WARNINO: FNLUHE TO SECURE WO�ERS' �OMPEMSATION COVEM4E IS UMAW FUL AND SHALL SUBJECf Ml EMPLOVER TO CRIMINAL PENALiIES AND dVIL FW ES UP TOONE NUNDRE�
T/IOUSrWD DOIlARE (E10U,000�, IN A�DR10N TO THE 00ST OF CqAPEN$ATIpN, DM4IGES AS PROVIDEU FOR IN SECTION 3]OB OF TNE LABOR CODE, IMEREST, AND ATfORNE1^$ FEES.
LICENSED CONTRACTORS DECLAHATION:
I hereby eHirm thet t am ticensed under provisions at Chepter 9(commendng vrith SeIXion 7000) of DlWsion 3 oi Ihe Business and Professions Cotle, entl my Iicense ISIn full
lorce and eMect. lJc. M Class q
Contractofa Signeture: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirm thal there is a constructian lending aBency br ihe peAarmence of the wark lor w�ich Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Neme: � Lendefs Atltlress:
SlgnaWre: pa�a;
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn that under penalry of perjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor lhe tollowing reason (Sec. 7031.5, Business enG Professlons
Code: Any ciry or couny which r0quires e permit to construct, alter, impmve, demolis�, or repair eny s Wcture, pdor to its issuance, also requires Ihe ap0licant for such pertnit
to file e signetl stetement that he or she Is IlcenseC pursuant to Ne provisians ol ihe Contractors IJcense Lew (Chepter 9(cammendng with Section 7000) ot Divislon 3 ot the
Business end Prolessions Cade) or ihat he or she Is exempt therefrwn end the basis tor the ellegatl exemption. Any violalion oi Section 7031.5 by any epplicent fw a pertnit
subJects the epplicent to a civil pB�alty oi not more then Ilve huntlretl ddlers (5500)J:
❑ I, es owner ol t�e property, or my employees wlih wages es their sole compensation, WILL DO THE WORK, antl t�e strucWre is noi intentleC or otteretl tor sale (Sec.
7044, Business antl Prote55ions Code: The Contractoro llcense Lew does not appty lo en owner ot Omperry who builds or improves Ihereon, and who tloes such work
�imself or herself or ihrough his or her own empbyees, provitled thai such improvemenis ere not Intended or oHeretl for sale. If, however, �he building or imprwement is
soltl within one year of wmP�etion, the owneo-builder will have the burden of pranng that ha or sha tlid not builtl or imD�ove tor purpose of sale.). �
❑ I, as owner of t�e properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 704d, Business and Profeuio�s
CaCe: The contrectors License Law does not appty to en owner ot properry who builds or Improves thereon, antl who con�racis far such project wit� a contractor(5)
license pursuant to ihe Con�racmrs License Lews.).
'0' I em eaempt under se=�_
-SlgnaNra: -�
'Owner ID verifietl by driver'S IicenSe.
Verlllcation of Ownership by (rype of
_ Business and Professions Code for this reason:
— oate: � Y�O '
❑ No Dnvels Licensa No. _ � Expires: � Fj
property tac blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION:
❑ I hereby ceNty Ihet no exca�ation tNe (5) or more feet in tlepth Into which e person Is requiretl to descend, will be mede in wnnection wiih work euthorized by IhiS
pertnil, end that no building structura, SCeHolding, lalsework, or tlemolition or dismantlinp thereof, will be more I�en thiry-six (36) feet high. (Chep. 3.2, Grp 2, M 2. Sec.
341, Tltle B, Calitomia Administretive Cade).
❑ As ownor-builtler, I will not employ anyone to do work which woultl require e permit from Ihe Divislon ol Indusirial Satery, es noted ebove, unless auc� person has e
pertnit to do such work Irom the division.
Signature: Date:
Dlvislon ol Intlustrial Selery Permit Number:
CER7IFlCATE OF COMPLIANCE AND AllIHOROATON OF ENTRY: I certily untler penelry of perjury thal I have read this application entl state ihat t�e infortnation gNen is
correct. I agree to comply with ell state laws and clry ordinances releting to buil0inp construction, end euthorize representatives ol the City oi Costa Mesa to enier upon Ihe
eDove-descrlbed propeny for in«wct�o� ourooses I earee not to acupY or ellow occupancy of eny building euthorized by this permil until finel inspection.
�� � G!'!^O`I~o�
� Signature Of Legel Owner(s) Date
1
And/Or Authorizetl Appllcent Dale
cone�. INSPECfIONTYPE OAIE I�9��
16i8 Pixed System Final Fire Preventlon
1288
200
Pool SOa Finel
Finel Re-Rool
201 Finel BIocWRetaining we��
202 Final Factory Fira Place
203 Finel Slgn
204 Finel Damolitlon
COOE� INSVECTIONTYPE
208 finel Mechanical
20B Finel Plumbing
210 Finel Elecintal
212 Finel Flre Preventlon
220 Finel Planning Approval
222 Finel Slle
250 FinalBuiltling/Occupancy
PAg UIIIDALS
(714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mese.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
Job Address: 870 W 19TH ST
Suite:
Vicinity: SIDE PROPERTY LINE
Parcel Number: 42251222
npplicant: HERNANDEZ, ALEXANDER
Address: 870 W 19TH ST
COSTA MESA, CA �
Owner: HERNANDEZ, ALEXANDER
Address 870 W 19TH ST
COSTA MESA. CA
Con vacto r: O W N E R-B U I L D E R
Address:
Zip:
Arch :
Address:
Phone:
N
Zoning:
Phone: 949-574-1887
Zip: 92627
Phone:
Zip: 92627
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 04/07I2003
Issued: Oa/01/2003
Phone:
2ip: � License: " � License:
SCOPE OF PERMIT
INSTALL 6 FT HIGH B�OCK WALL ALONG 90 L.F. ON PROPERTY LINE BETVJEEN 864 P,ND 870 W. 19TH ST PER CITY STANDARDS.
Plan Check: $41.05
Permit: $63.15
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $104.70
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY �Front 0-0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0-0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0. 0
Left 0- 0
PropoSed: 0
Calc Valuation:
Claim Valuation
Right 0. 0
Right 0- 0
51,800.00
$D.00
NOTICE: The work authorized by this permit shall comply with all applicable handlcap access requirements under Californla statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRA710N: This permit Shall autometically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned
Por a period ot 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inepaetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
24Krd8 (8�00)
WORKERS' �OMPENSATION DECLARATION:
I hereby ai(Irm under'aenalty of peQury one oi the tWlowing declaratlons: ' ' „
❑ I �evo end wlll melnteln e certiticete at wnsent to sell�lnsure lor workers' compensation, es provltled lor by sectlon 3700 0l t�e Le6or Cotlo, for the perlortn9M1ce ol the
work br whic� thls parmit is IssueO.
❑ 1 have arid wlll malnteln workors' compensetlon Insurance, as requiretl by seclion 3700 oi ihe LaEor CoOe, tor the pertortnence W tho work tor wNch this pertnit is issuetl.
My workers' compensetlon Insurence cerder entl palicy number are:
Cartier:
hundred dollers (3f 00) or Iess.J
Poliry Number:
�Ucartity thet in the pertortnance ol the wark tor which Ihis pertnit is Issued, 1 shall not employ eny person in eny manner so es to become sub�ect to the workers'
compensatlon lews of Celibmie, and egrea t�at it I should become subJect to Ihe warkers' compensation pmWsions of Section 3700 oi the Labor Code, 1 shall forthwlih
comp with Ihese provislons.
rant Sl netu� a: � ��- �
yaaw e_ �--""� oaia; . `7— O 3
W�UHE TO SECURE WORKERS' WMPENSATION COVERAOE IS UNIAW FUL M1D SHALL SUBJECf rW EMi!I.OYER TO CRIMINAL PEN�LTIES AND CIVIL FlNES UP TO ONE HUNDRED
TiqUS4NU DOLLARE (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DpM4GE5 AS PROVIDED F-0R IN SECTION 31080F THE IABOR CODE, IMEREST, AND ATTORNEYS FEES.
L4�7�iE1�d�hPYI:T_C�lI�7:b3�I��I7_TT_i1TrPF
I hereDy eNirm Ihet I em Ilcensed under pravisions oi Chepter 9(commencing with Section 7000) ot Division 3 0l Ihe Business entl Protessians Cotla, entl my license is in tull
force flnd ettecl. IJc. M Class M
CAntractoYs Signature:
Date:
CONSTFiUCTION LENDING AGENCY:
❑ I hereby eRirtn that there is e consiruction lentling agency tor Ihe peAortnance of the work tor which this pertnit Is iuued. (Sec. 3097, Civil Code).
Lentlels Name: LenGers Address:
Slgnature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eRirtn t�et under penelry ol per�ury that I em E7(EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowf� reason (Sec. 7031.5, Business end Prolessions
Code: Any dry or canry which requlres e pertnit to construct, elter. Improve, demolish, or repair any structure, pnor to Its issuance, elso requires Ihe applicant br such pertnit
to lile e signed stetemeN t�et he or sha ls Iicerued pursuent to the provisions of Ue Contrectors IJcense Lew (Chapter 8(commandnp wlih Sectlan 7000) ot Divislon 3 of t�e
Business and Pmfessions Code) or that �e or she is exempl therelrom end the basis for the alleged a:emptlon. Any violation of Section 7031.5 by eny epplicent tor e pertnit
suG�ecis the eppllcant to a civll penelry of not more ihan flve hundred dollars (55W ).):
❑ I, es owner af ihe properry, or my employees with wagas es their sole compensation, WILL DO THE WORK, and the siructure Is not intendetl or oNered tor sale (Sec.
7044, Business antl Professions Code: Tha Contrectors License Law does not apON to an owner of properry who builds or improves thereon, and w�o does such work
himself or hersetl or Ihrough his or her own employees, provitled that such impwvemants are noi intentlad or oflered for sale. If, however, iha bullding or imprwement is
sold within one year oi completion, the owner-builder will �ave �he Ourtlen of proving ihat ha or she tlid not build or improve for purpose oi sale.). �
❑ 1, es ov.•ner of t�e property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqact (Sec. 7044, Business and Pmfesslons
Cotle: The comremors License Lew tloes not epply to en owner of pro0erty who builds ar Impraves thereon, and who wntrects lor such pmject wlth e coniranar(s)
��nw�nm�qerk, to1he Contractars License Lews.).
eusiness and Professions Code for Ihis reason:
Ow�ner ID vedfletl by tldwr's Ilcense. '-Yes ❑ No �
Vedticatlon ol Ownerahip by (type of tlxument, I.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICA710N:
❑ I hereby certlfy t�et no excavation five (5) or more feet in depih into which e person is required to descen4 wlll be made In wnnection wilh work euthonzed by this
permit, end that no Gulltling siruclure, scaflolding, falsework, or demolition or dismantling thereot, will Oe more than thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tllle 8, Celifomia AAminlstratNe Catle).
❑ A5 ownerbulltler, I will not emplay enyone to tlo work which woulC require a permit trom t�e Division ot Intlustnfll Sefery, es notetl above, unless such person has a
permit to Oo such work irom the dlvision.
SignaNre: Date:
Divisbn ol IndustAal Sefery Permit Number:
CEHTIFlCATE OF COMPLIANCE AND AUfHORQATION OF EHTAY: I certiy under penalry of perjury that I heve read this epplicetlon entl stete thel Ihe infortnatlon given is
wrtect. I egree to compy wlih ell stete laws end city ordlnances releting to bullCing construction, and aulhorize represenlatNes oi the Clry ol Coste Mesa Io enter upon Ihe
above-described pm ytorfispee!' es. I agree not to occupy ar ellow oaupancy of eny building eu�honzed Dy Ihis permit until final inspection.
� -� ����7'a02i
YSgrnature,OflLe�l'Owner(s) i Oate
And/Or Aulhonzed Applicent Date
GOOE �. INSFECTONTYPE
1616 Flxetl System Final Fire Preventlon
1266
200
201
202
203
Pool SDe Final
Finel Re-Roof -
Finel BIocWRetelning Wall
Finel Faciory Fire Plece
Final Sign
204 Finel Demolition
P/�jE INfRIALS
COOEI INSVECTONTYPE '
206 Final Mec�anical
20B Final PlumDing
210 Finel Electrlcal
212
220
222
250
Final Flre Prevention
Final Planning Approval
Final Site
Final Building/Occupano/
� Itl�
� P
APPROVED
City of Costa Mesa uifding Dept.
BY_._��. DATf�� �13....1$C
THESE PLANS MU T BE ON JOB AT ALL TIMES
MAKE NO CHANGES WITHOVT PRIOR APPROVAI
OF DEPf.
THE ISSURNCE OR GRANTING OF A PERMIT OR APPROVAL
OF PlqtlS FND SFECIFICRTIONS SHALL NOT 8E CONSTRUED
TO BE A PERMIT FOR. OR FN APPR04AL OF, PNY VIOLFiION
OF ANY QF THE PROV7SIINVS QF TkfS COOf. NO PERMI7 PRE�
SUMING TO GIVE AUTHORITY TO YIOIATE OR CANCEI THE
PROVISIONS OF THIS CO�E SHALL BE VqLID, E7(CEPT IN SO
FpR RS THE WORK OR USE WHICN IT AUTHORI2ES IS LAWNI
7HE �SSURNCE OF A PERMIT BASE� UPON PLANS AND
SPECF:CpTIOnS SHALL NOT NREYENT THE BUILDING OFFICIAL
FRO:' "^ER�AFTER REQUIRIN6 iHf CORRECT(O(I �` ERP,ORS
IN Sf�� PiANS AYp SPECIFICATIOi�S OR FRDIA PREVEN71flG
BUILDIf' i�ER�TICN: BEING CARRIED ON THEREUNDCR WHEN
IN VIOLiI." '"0 `� CODE Oo 7` uM� OTNFP Oa9RJ!•'1�'
OF THE Cit
j STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE RE�'IIZED
FOR ELECTRICAL. PlU"•�?4''^,
HEAiiiV6, VENTfL11T(�dG A�dD
REfRIGERATIOP� WORK
i�2Y�it #__� C7 �`�i�
7NIS idUi?9�_�2 ;;'^; ACCO�iP NY
ALL INSPECiIQi� REQUESTS
FJ ��;:L^.:' ;.- oc.'.S�7iJS ARE TO � i
GE '.::'-:: �_ ._- - _3T THaT THE
�' 1-_ � .:,,i O�VISfON OF
` � � 'iI�S�LTED FOR
! .,..: '. ..::,,! :�ri�NTS.
�. ��,
:: `1 -
.;
' '"
KAHLE REALTY
870 WEST 197N STREET
COSTA MESA, CA 92527
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� Costa Mesa Building DeparLment (� (� APPLICATION FOR PERMIT �_
:. -_�• _ 11T EAST 20th STREET �75�7 ✓ B U I L D �� N G '� 2
* COSTA MESA� CALIFORNIA
FOR OFFICE USE ONLY � y
l FOR APPLICANT TO FILL IN � I ipt No� �r� r�o.
Building
Address
osta Mesa, �i811fOTI113� Received by I Date Rec'd. Date IssuW
Nearest �� "� 3 ��
Cross St. Building
Address
owner � Costa Mesa, ri3��OPll18�
Mai1
Address Nearest
Tel. Cross St.
City No. Zone �/ I No. of I Type � I Group .,�
.__�..__. . . . .. � :,, vlans C
■ �_.�tractor
N0.
Sfze
ao2 $ X4
� •ior Wall /
LiC.
Block I Tract
No.of No.oT
Famiites Room�.
Rear Yerd �—
SideYard fi�—/
Demolish
- APPROVALS
Foundation Location Inspector
— Forms, Materials,
Under-Pinning
Frame: Fire Stops.
I hereby acknowledge that I have read this Application
and sta[e that the above is rnrreM and agree to comply
with all City Ordinances and State Laws regulating
building constructi/on. 7
Signatureof�:}�/„ � O _ � l /j �K '
Permittee ��(!�� /�4�t+
Mawnry Rei
Valuation Permit Fee $
/O ��� w Plan Check $ 5 Bond Beam
$ Feea1 $ �� � FINAL
"•204 G-X RM 5-54
Date
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2
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' Yd.OT PLAN -- ' .
-, ,. • •., , �: �, �
Show locatlon and Oistances from , • . _ _ - � ,
' property line and between buildinps. ��;�,....� ' �.�;? �-� -
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PpOJEtTAUOflE55: 870 �q 19TH ST
OWNEN'SNAME: F(AHL�, OMAR
noosEss: g z q ppGFI00D S T
COSTA MESA,CA
646-0359
AflCHIENGMEER:�
AODflESS:
UNIT:
92627
flE0.N0.:
UNIT:
PEflMITTEE: LEE ROOFIP]G OF COSTA MESA ( 714 ) 692-7223
aouxess: 1653 SUFERIOR
COSTA MESA CA 92627
UCENSED CONTflFLTOfl UECLAPATION: 1 �ereby al�irm �hal I am litensetl under provisio ol Cnapter 9(commencing witn Seclion
7000� ai Uivismn 3 0l Ine eusiness and Pmiession M�y��Swa a� L
ciTruc.: 028741 srareuc.:3996� �uvss: C E:{P: 03/95
Oa�e: � Z�� 4/ — Signamre: _ ' L
WOBKENS' COMPENSR7ION DECLAqpTION: I hereby atfirm tAat I have a cenificate al cansem m selbinsure or a certificate oi Workers'
Compensaiion Insurance. or a cen�lietl copy thereol ISec�ion 3800. LaG. C).
. roucvxo.: 1300998-99 EXP.UATE: O6I3O/9S
i comvaxv: STATE FUNL�
� Cerlilietl CaOY is herelly lUmished. ��Cehifie is ie w� �n.
�ate: /� � 9 y APplica � ���-
E%EMPTIONFBOMWOBNEflS'COM7ENSATIONOECIAflATION: Qhi55ttUonneedna�bewmOkleOi�IhepCrmliSforonehun020(5100�Ork551.
I certity Nal in I�e Oarformante oi Ihe work br whit� Ihis permii is issuetl, I Shall p01 employ any Derson in any mannef 50 a5 io beCome
subjeq b t�e Worker5' Compensa�ion Laws o� Calilomia.
Date: Siqnature:
NO710E: II, alter maWng this tleclaration, you shoula Lecome su�ject to tne Wofker5' fAmDensalion provi9ons of tne Lahor
Caee, you must lonhwith comply vnth such Dmdsions or tnis permit shall De Ueemea revoke0.
CONSTNUCTION LENOING AGENCy; I A¢re�y allirm ��a� Ihere is a constmclion Ien�inB aAency �of �he pedarmante o� tne vrofk lor
whic� i�is uermit is i55ue0 �Seclion 3097, Civ. C�.
LENOEfl:
nooxess: REROOE 1700SF RESIDENCE
OWNEB BUIlOEB OELLABATION: I hereby affirm Ihal I am exemp� imm Ihe Conlrac�ars' Slate Licens¢ Law lar t�e f011owinp reason
(Section 7031.5 Business and Profo,ssional COUe: Any cily of county w�ich requires a permit ro cans�mc�, alter, impmve. tlemolis�, or
repair any simcture. prior lo its is;uance, also reQuites ine aDPlicant for such permil ta lile a siA�ed statement ihat he/sne is licensetl
pur5uani lo t�e O�a�isions ol ��e CantraclorY Slate License law (C�apter B(commencing wiiA Section 7000) of Oivision 3 of ��e Business
ana Professions Coae) ar that he/she is e�empt thereltom and the baAs for ine alleqeA exemption. Any violation ol Section 7031 S �y
any app�iCanlfor a permil subject; t�e applicantta a civil Denalty of not more ihan five �undrtE Oollars (5500).
I. as owner of the pmpeny or my employees vnih waAes as their sote tOmpensation, will Jo ihe work, anA ihe
❑ simcm�e is not imenCea or oHeretl lor sale (Section 70G4, Business antl Pmiessional CoGe: 7he Contractors State License Law
Ooes noi aOPly Io an owne� o� a prop¢riy w�o builds af impmves lhereon, and who Does such work himself/hersel� or Ihmuph
his or ner own emD��Yees, provi0etl �hai such imD�ovemenis are nol intenQed or atlerea fo� sale. II, however Ihe Ouiltlinp or
impmvement is solG withiq one year oi complelion, �he owner vnll have I�e �urden ol pwving �e/she Oitl not huilA or improve
, lor the purpose of salel.
I. as owner ol the pmperty, am eKclusively wmractinq wit� licensetl contractors to consimct ihe pmlect (Section 70aa. Business
❑ ana Professions Coae: The Coniracmrs' S�ate License Law does not apDly to an owner ai Dmperty who 6uAds or impmves inereon
antl w�o comracts lor such pmle��s with a comractar�s� license Oursuani �D Ihe Contrac�ors' State License Law). I am aware
inal O�ool otl�elr WorkeYs Compensation insurance s�oultl he DroviCed to me.
� I am erempl untler Sec�ion: B. 8 P. C.
lor Ihis reason:
Da1e: Ownec
I tlo hereoy rertily that I am aware oi ana un0erstanE i�e requiamems of Califomia Healih and Safery Cotle Sections 2550.5, 25533, ane
2559d an0 Ihai I or any INure Cuiltling occupant vnlllwill nol �circle one) need to comply wit� saiU slate co0es and the requiremenis lar a
permil br conslmction or madificatian Imm t�e Air �uaiily Management Disirict. Residential constmction aDPlications are eKempl irom
ihe5e provisiont
�ale: Applieanl:
I nereUy ceililyinal I have reatl this aov�ication antl5 �ove intormation is correct. I apree lo comply wiih allciiy and county
or0inancesanOslatelawsrelalingto�uildingconslmcl�o�1➢ecChyam on eMati�a �toenteruponlhea�ove�mentioneG
pmpetly lor insDeclion purposes.
Da�e�� � Q Signam�e:
Oriver's License oi Sociai Searity >: �.�
I6aLa6 W�ne—BUAtling; Gree�—Gatla EnlorcemonL Canary—Appl¢an�; Pink—Ravenue: Goltlanrotl—Assessor
CITY OF COSTA MESA -�BUILDIt]G PERMIT F'ERM NO; H 07�29'
PEP.MIT NO: B 070295 PLAN CHECK NO: N GOC'T; N SUPP: N
CONSTRUCTION TYPE: V-N PEP,MIT TYPE: STP, PURFOSE: t�TH
JOH UESCRIFTION . R_n^�: .-.-��--;:�� :"'-----,- P SQ FT: 3,Q00
��n��� o��c� ca�7. Go..�g •w�GMP
CLAIM VALUE: 3,OL�.UO Ct�LC-VALUE; 3,OOJ,00 GROUP OCC: R-3 /M-1
COMPIENTS: SMOKE DETECTOR� REQUIRED IN EV£�Y BEDROOM E HALL��31�T���`{d
1�1fiEar.if-j(-JL�fiEil�rtiE�!##iflEyt4#E#9FifiE?Eif#ifififViEiFVaf�lFjfiFdtM-k�FlfiEi�if1E#+FacY-ifk4�h�lEsf1F i( if > +v,+f�
Z O N I N vS ERTEB�AUCZKR E M E N T S �E���RE� .
J . _....Jc:
------------ NAID1 BUZLDING ---------- - --------- ACCESSOP,Y BUILDING ---------
FRNT; FT IN REAR; rT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 42251222 ZNE: REF NO;
PLANNING PJOTES>
>
�)t -1E Y df iE �E i/� �IF if ic 1P 1f if 4 if� iF �t+F b aF #'- iF iF iF if �F it i: r af if 3f if. i: # iF if w� if i(� iF iE 14 if iE af +f aE 3F rt�?t!F iE 1f n i4 if !E aF 1E K* iF it r, M- i� iF iF jt if if if ii Y a{R #+F
D E V E L O P P9 E N T S E R V I C E S R E Q U I P. E M E T] T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : UATE:
AFPLICATIOD7 ISSUED BY: � DATE; �
iE�lt�7t-�fifiF�ttaEiEiFiririE?E+F+rkiFit�x-*�-:F'�.i�sz3ziciriF3FiFiFiFiF���t'FiFiF�iFiFTr ""' �r.K:�r�Ti�iFzit*atx+c�tc+r�c-v.�u�riF�w� +Fii���*�lt
if jf iP if it if iF iE �F aE if iF 1f iF iF # it iF it iE if iE fc iF if 9F iE ic iF af iE af �1E i�- iE if 1E iE 3E iF ac it jf iF iF af aE aF+Y�?�-+F iF+E it jF ii +f 1E iF jf R-1f iE aE iF ii ac x�f 1F iE?F �7F iF �M�?' af :c �E
LEGALIZATION;A1 F E E S'U M M A R Y STP.UCTURAL SEGMENT:Y
BLUG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GP,ADING
PERMIT 54.00 ' .50
, '. SMIn/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-�HECK TOTAL PAID DUE.
TOTATS----> 54.50 O.OQ -� 0.00 54.50 54.50 ,OQ
�
REC'ENUE DIVISION TOTALS--> COLLECTED; 54,50 OVER/SHORT: / 00
BLDG PMT PLUPIBING ELECTRIC MECHANIC FIRE SMIP/TOT GP,AD2NG PLAN-CHECK
59_00 ,50 �
. �
iFif 1F if'X�iE if'Yf'lf 1f'1E iF it if 1l�f'MY #+f +f'Y-�1")f if�4 iFaf iF if if if if if iE if i4jh 1f'lE if 1: M if 1k if��f 4 iF w'IE +f �E M if if iF if iF afiFiE af if 1E if M M:f 1Fit if �f 1lif aF Y#'�iE
I N D I V I D 0 A L` F E E B F. E A R D O W P7 /
TYPE QTY D E S C R I P T I O Pl UP7IT COST � TOTAL C65T
SFR 300Q REROOF BY VALUE RESIDENTIAL CIOZONE
END OF FEES
• • ,
�. , � �� � �� �. -
�
1,OQ 3,OOQ.00
01 001?3133-00173l37 T U T 54,;0
�nTE� 12/08r94 TIME: 10�33
CONSTRUCTION AND PLANNING ` POO ;PA �
APPROVAIS Permit# Date Inspector qppROVAIS Permit>.'k Date (Inspector
1. Temporary Electrical Service or Poie 52. Pool & Equipmen; Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrica� Conduit�Undrgrnd. 55. Electrital Bonding
5. Steei Reinforcement 56. Rough Plumbing & Pressure Test
s. Etearlcaf UFEfl Grnd. 57. APPROVALTOCOVER�GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundati0n 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, L7 Unclrgrnd.
70. Structural Floor SYstem 61. RPPFiOVAL TO DECK
11. Property Seaver Line & House Connection � 62. 8ackwash & Receptor�Final
12. Sewer Cap ' 63. Heater & Vent-Final
13. Roof Dreins 64. Plumbin� System - Final
14. Rough Plumbing 65. E�ectrical�Final
I
15. Rough Electrirai�Conduh 6fi. Solac System-Final �
76. Rough ElCctric Wiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL,'SPA SYSTE�S FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping GGas OOiI
23. Gas Pipa�i�ough & Test 72. Underground Flush =� � °=
24. Roof Fram�ng 73. Undergmd.StorayeTank OGas ❑Oil ;'��'� 1�
25. Roof Sheathing 74. Overhead Hydro � !
26. T•Bar CeiUng iStructuraq & Monocoat 75. Dry Chemical �
- �
27. Frame and Flashing 76. Dry Standpipe � �
i
28. Lathing & Siding 77. FIXED SYSTEM19 FINAL
29. Insulation .�. 78. FIRE PREV. FINAL
30. Drytivall Nailing HEALTH DEPT. REQUIREM[NT
I
31. Plaster BroeJn Coat 79. FINAL INSPECTION
32. Electrical Powzr Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Noter �
� 6_? G�tfiNF OY�r Z_(��./i o�
34. Final Heating & Air Conditioning -� �/ / �
�i)_l �_!L�/_: �d �_Kt�iT f/�. �2-��y
35. Finai Gas Pipe-Test �-
.{/O ar � 6+G.r� e / �-- � -Y f - -
36. Hood or Ganopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Pinal �
40. Gas Service-final
41. Solar pome'stic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriyation System
45. Sound Attenuation i
46. Handicap Regulations
47. FINAL S7FUCTURE & BUILDING
46. FINAL P4ANNING -
49. Electric Release to Edison -� .
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No, Date