HomeMy WebLinkAbout924 19TH ST - Building Permitsp14)75a•52�� • rau (na� isa-acx • www.ci.wsiu•masa.w.us
BiJILDING PERMIT
Job Address: 924 W 19TH ST
Suite:
Viciniry: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42252417
Zoning:
Applicant: FLEISCHMANN, SHAWN
Address: 1101 E CHESTNUT DR , "" "
, � � Phone: (714) 2851180
SANTA ANA; CA -' Lp: 92701 -
Owner: HOUSTON, DANIEL M
Address 924 W 19TH ST
� � Phone:
"� COSTA MESA, CA -'. �. Zip: 92627
Convactor. EVANS ROOFING COMPANY INC
- �Address: 1101 E CHESTNUT DR
- - " � - Phone: (714) 2851180
� � � SANTA ANA, CA �
Zip: 92701 License: 610549
Arch : " , . Eng:
Address: - � � Address,
< < Phone:
// fl�lf� Vlll V C� IiVJ I I� MCJM� li/1 JLOGO
Sfatus: ISSUED
Applied: 08I04/2004
Issued: 08/04/2004
ISSUED BY:
Phone:
' Zip: . License: , License:
_ SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. RE-SHEATH, COVER WITH FELT AND 30 YR COMP SHINGLES. INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: � $0.00
� ��,Total: ., $111.75
SETBACKS .� � " , �
MAW STRUCTURE`Pront ,0-0
ACCESSORY � F7ont ,0-0
PARKING Existlng: o
NOTES:
FEE SUMMARY
a
Calc Valuation:
Claim Valuation:
�
PLANNING & ZONING � �
�,
��, ,
� Rear�=� 0- 0 ' Left� 0- 0-
'� Rear 0- 0 Left 0- 0
Reduired: 0 Proposed: 0
- "" _ , � �- .
�- -� � �' :'/ /,�/
= �Right - ,0=0�; � ;;
. � i
_ , Riglil_ � 0- 0 - � %
� i� �
� '� i
sa,zoo.00
sa,zoo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 7, 7241-92)
EXPIRATION: This permfl shall automaticalty expire and become void if work Is not commenced withln 7B0 days, or II work is suspended or abantloned
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 applieable codes, and ali
requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zmem �doo�
WORKERS' COMPENSATION DECLARATION: -
I �ereby eNirm untler penalry of perjury one of Ihe tWlowing dedaretions:
❑ I heve en0 will maintein e ceNficate of consent to selFlnsure for workers' compensation, es proviAetl tor by section 3700 ot tha LeDor Code, tor the parformence of Ue
work far which Ihis pertnit Is issued.
I end will meintain workers' oompensatbn inwrence, es required by secUm 3700 of ihe LeDor Code, lor the pertarmence ot Ihe vrork tw whic� Ihis pemtit Is iswed.
y workera' compensatlon Insurance certier entl poliq number are:
Cartler: Policy Number.
(Thfs sectlon need not be completed I! the permit b veluetl et one hundred dWlars ($100) r.r less.)
❑ I ce�ify thet in the peRormance of tha work for which Ihis pertnit Is issueQ I ahall not employ e�Sy parson in any manner so es to hewme sub�ect to the workers'
compensetlon lews ai Celif mie, tl epree Ihet II I should become subJect to the workers' compensatlon provlsions oi ection 37 0 0l t�e Lebor Code, I ahell tort�wilh
wmply with these provisions. n �
Appllcant Slgnature: \ . � 1 \ �� Date:
WAHNINO: FAILURE T ORKERS' COMPENSATION COVERAQE IS UNLAWFUL AND SNALL SUBJECT AN EMPLOYER TO CRIMI IAL PE TIES AND CIVIL FlNE$ UP TO ONE NUNDRED
T/IOUSANDDOLLAHE�S100,000),INADDfPONTOTHECOSTOFO0AIPENSAT10N,�AA1hGESASPROVIUEDFORINSECfION31080FTHE BORCOOE.INfEREST,ANDATTORNEYSFEE$,
LICENSED COHTRACTOFS OECLANATON:
1 hereby eflirm thet I em licensed untler imdsla
larce end eflect. LJc. M �
Contrectofs Slanat .
(commencing wit� Sation 7000) ol Divlslan 3 at t�e 8uslness end Prolessions Coda, end my Iicense Is in tu0
Class q �
�C Date: / CL �
CONSTRUCTION LENDING AGENCV:
❑ I hereby eNirtn that there is e constructlon lentling epency for tha pertormance ol the work for which Ihis permit Is Issued. (Sec. 3097, Civll CoUe).
Lentlefa Name: . _.... _ _ Lentler's AtlAress:
Signetura:
Dete:
OWNER•BUILDER DECLARATIONS:
I hereby aflirtn Ihat untler penalry ot perjury that I em EJ(EMPT FROM THE CONTAACTOHS LICENSE LAW tor t�e tollowing reeson (Sec. 7031.5, Business and Professions
Code: My Gry or counry which requires a pertnit to construct, alter, improve, demdish, or repeir eny structure, prior ta its issuance, elso requires the appliwnt for suth permlt
�o flle e signetl statement thet he or ahe is Iicensetl pursuent to the proNsions ot the ContrectoB Ucense Lew (Chapter B(commendnp with SecUan 7000) of Division 3 0l Ne
Business end Professions Code) or that he w she Is exempt Neretrom end the besls tor the elleped e:empfion. Any vblation of Secllon 703/.5 by any appllcant tw a pertnil
sub�ects the epplicant to e Uvil penalry at not more than frve hundred dollers ($500J.):
❑ I, es owner oi Ihe property, or my empiqrees wlih weges as iheir sole wmpensation, WILL DO THE WORK, end Iha structure is no� IntenOed or oHered for sale (Sec.
7044, Business and Protessions Code: Tha Coniradors License Law does not eppty to en owner ot property who builds or improves ihereon, and who does such work
himselt or herself or through his or her own employees, providetl that such Improvemenis ere not Intended or ottered lor sele. If, however, the building or improvement is
soltl within one year of wmpletion, t�e owner-bulltler will have the burden ot proving t�at he or she did not build or improva for purpose oF sflle.). '
❑ 1, a5 owner oi the property, em EXCWSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to conSWCt the D�oject (Sec. 7044, Business and Pmtesslons
Cotle: The cantractors Llcense Lew does not eppty to an owner of Oroperty who builds or Impmves cherean, end wha cantrects for such pmject with e coniredor(s)
. license pursuant to ihe Coniractors Licensa Lews.).
❑ I em exempt under sec.
Signetura:
Owner ID veritiad by drivers license. ❑ Ves ❑ No
Business and Professions Code for �his reeson:
Vedficetion ot Ownership by (rype ot tlocument, I.e. - properry tex bill or deed):
Drivefs LiCenae No.
Dete:
Expire5:
OIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATON:
❑ I hereby cerlify ihat no ezcavallon five (5) or more feet in depth into which B person Is raqulred to descend, wlll 6e mede in connecllon wiN work euthorizad by Ihls
permit, end Ihat no buildng siructure, scaHoldinp, falsework, or demolltion or dismantling t�ereol, will 6e more then Ihirry-six (36) tee� �igh. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Callfomia Administretive Code).
❑ As owner-huilder, I will no� employ enyone to do work which would require e permit Irom t�e Divislon of Industrial Salery, es noted ebove, unleu such person has e
permll to do such work Irom the diNslon.
Signature: Dele:
DlNsion of Intlustriel Safery Permil Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I certity under penelty of perjury thet I have read this epplication entl state thet the inlortnatlon gNen is
wrrect. I egree to compy with ell stete laws enC dry ordinances relating to building constructlon, and euthorize representetives ol t�e Clry ot Costa Mese to enter upon Ne
flbove-described property for inspection purpases. l epree not to ottupy or allow ocwpenty of eny building authorized by thls permil until final inspection.
� ' n ture0 elOwner � /.� AOate
l �� ��
AnNOr Authorizetl Applicant Da�e
{�7T�1�I;F97li iFTf i19=
1616 Fixed System Finel Fire Preventlon
1288 Pool Spe Finel
200 Finel Re-Roof
201 Final BIaWRetaining Well
202 Final Fedory Fire Place
203 Final Sign
204 Finel Demolition
PdIF. Ii�ELS
9� �
CQ�E 1 INSPELTION TYPE
208 Finel Mechenical
20B Flnal Plumbing
210 Flnel Electdcal
212 Finel Fire Preventlon
22o Finel Planning Approval
222 Finel Site
250 Finel Building/Occupenry
P9IE It�EL9
�
,
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�ounsssaewiowc: 924 W 19TH ST
oxmexsruweirw�axr+: HOUSTON DANIEL M
nooxess 9 2 9 W 1 y TH S T
COSTA MESA,CA
.vx. Yuiwo �oox�ss
INCNRECTONFN(a!lEEA:
MCN OR ENRS M�RE55:
UM:
92627
uc./a:
UNf:
coe�m�cTarsr+u�: DN1t.�.�-
caNrn�croas�uuxc
AOORESS: 11C. NO.:
urr:
LICENSED CONTRRCTORS DECLANGTION: I hereby ellim uMx penMy d perjury tlal l am liceruatl uMx pwabm d Cheplr e
(canmantiiq xilA Se[Icn ]000) d Divisian 3 01 Ne &vinev and Pmfasfbns Code. eM mY 4odw u in /uA Ipca end aNatl.
cm uc. No.: uc. cuss: ue. No.: EXP :
Oms: Cormedm.
OWNER BUILOEN DECIAXATION: I liaeby elfi�m �mEs qnNy d perjvy OW 1 am azemq tmm tM CaMrtlwa llonee lew In Ihe
Idbw^i reswn (Satlian ]W 1.5 Busiioa end Prdaedom Coda: Am/ cty a rnwY r.fiidi �pwre+ a V�Y to mnNCY. Nbr.'vnpow.
Mmd"e�. a rper mry aUUUiva. piv b La'va�e�m. etio��piur Na appl'vaN fa su� pan�w �o fJs e ap�rE ptlmmM tlW M a e!r
r�+ee o�� �o me a�+• a u» com.mo�. u��.e �w Icn.pa e(�m.�,u wan sw:..� �oaol a o..:�m a a�ro
uu�wea vM Rdenune COEeI a �lut M a ahe'a,memp ihaehan eM Ihe b�s far Ne elbped ummqion. My videtion d Setlnn
103t.5 by mry eyWkaN /a a pemw eubj�tle iM epplium to e dvl pe�Wly d ml mas tlmi fxe huMnE AoOen �SSODU.
� I.eaownerdtMPODeM«mY�wihwaWaatMiadecanPeme�ion.vdldotMwh.udtMNUNne�wl'vilaNeA
w oNered lor vele (Secibn ]010. B�snen eM Pmteevione Cods: The ConumwsLimiue law Eoa not epplylo an owrix d pmpeity
who buitla a inP�� �harem. eMiNw doee e�ch i�wk Nmsell a Mne1 or Waph he a her own emVMw. p�� �IW axi�
imqwanams ere nal imeMad a dfmpE laseb.'tl. Mwever. �he WiMi�p a inqo.emM w eold wnhm arY� d aompMlian. Me
kQowrianEuiker will heve tM WNen d pmviiq M or ehe did m� buik or impewa M tM WP�e d ade�.
i. m o.Ms� d me wow�v. ��ew�r ooqireero �nn ��e ro m. wW� Isaeoo ra�. a�.��....�e
PMmdwu COEe: Ths Camreeva Licame lew Aou nal eGW an �xn r d ��nY rAa buitle a impw'u ihorean end Mn
convecn M wd� Orol�s �h e mnireaor(s) Ikansed Wn �o iM Ire,i a licene Law).
� I em sse I u dw Section: /�; ,� B. 8�P C.. tlm r �
7 �� '
Uate: �
I Eo haaEy ' N I em eware d erd uMestaM Ms, � d mis Ileatlh end Sdary Cods 9eaiwu 2YA5. 25'..1'f. end
25531. vtl thet I a uy Niva deldiq ompelu rYl / wa ro m�Wly w'th ak mis mM� aM IM �ePd�amwv br
eD�l«mnavunion«modifmionhomlM�i�iyRreixpemeN ' .RmitlMilmMv�'a�eDVG'�iauenaaemG�hamUrosa
pw+fimv.
om.: �vw�+:
WONKEP'S COYPENS�TON DECIAfl�T10N: 1 Mraby elfum wMx pmaXy d papvy oro d tM IaUov."vp Eedvtliom:
� IMweMwilmeintenacanArmaWawuwto�MimunbrwMse'camW��.uGrovtlWfaMSaeion�)OOdtMleEu
Cods. la �M1e pe�omwica d Na work i« wkch t�ia pemdl i� iwued.
� ❑ ine,.�e���m.:,..�+�.•oo�o����,�.a.�w�.ewsee�moame�n«cm..ro,m.w�«�.am.
wM lor whiN ihis G�� o wsusd. MY waken' eanWnmtbn iruueenee mrtiar erd O�Y n�mber m:
c�e,:
Pdicy Number.
mis eMiar mea Imr w cvnv� � u. w�� u a. m. nunm.e dalv.lsiaol w rm.)
•Q I r<nN � In Ne pariwmence d �M wak 1« Mht� t�ie pmmp ia�av ed. I�ell na emplv� e�y penon in ury memx o n to
Mrnro eubjetl lo IM xaM1 a' mmperedion bwe d Cel'da 'C enY e a tlW 'L I alnutl becon� �ubjatl lo tM woM�'
a ��o.�.oro a sea� a�ao w m. �e« coa.. i � s� o�dr.m, mo.. �.
Dme: � Appl"
wam� aau ro..�w.won�.: W.ro..wuo� n�� N anJ�IWIubN�urMT�M�'roefMY�rIM�uW
clHl Iln�� �q h wro �,ndM thouxrd tldNn (if A M Ml n IM eost ol rompenutbM1 NmNu u prvvldM fw In
9�ctlon JlQ6 0l tlr� LeDorCob. IMem4 � etto
CONST1iUCT10N LFNUINO AGENCY: I hrsby elfirm uMw peneA/ d pxj�y 11� tlwa w a oorut�udion Isiti'q qpnry br tM
porMmeme d tM �wrk M wAiN Ihe peemi b bwW (Setlion �OBI. C'v. C�.
LENDEfl'S NAYE:
LENUEN'S ADONES4:
I cMih �� I hevs roeE Nu epplicelion enE deb Ihet iM ebove iNwmetion b oomtl. I apree to canply xilh all ti1y W muMy oMirimice�
vM elPoe kws rtltl�p to Wikvg wnfN�an ard IimebypulMr¢e reqaeentelrves d the tilyto eniw upan IM ebme.menliapd p�apeiry
IwinapMion purpoaes,
DAN �. U� a (!'�
(5151�B.WP)
Selery: dnm�Fb: Cenery-�G�: Rnk-Rew'p»: (bWavo�Nwun
CITY OF COSTA MESA - BUILDING PERMIT ���
� PERM NO: B 0336/0
PERMIT NO: B 083670 P`LAIN CH�FCK NO• N GOL'T: N SUPP: N
CONSTRUCTION TYPE: V-N F`Iv,��Li=/��pE gSl'� �7 PURPOSE: ADD
JOH DESCRIPTION : 242 SF 'SLAB W/FOOTINGS FOR FUTURE ROOM SQ FT: 242
CLAIM VALUE: CALC-VALUE: 1,885,18 GROUP OCC: R-3 /
COMMENTS: "HUSTON RESIDENCE FOOTINGS FOR FUTURE DINING ROOM
3f it dt it it it it 9t ik �E 3f aE iF i4 iE 3E �F it it �iE 3f jE it it jt it it 3E 3F it if it it it jF ic jF 3F jf iF?t * iE 3F it it it dk 3t if-�E aF �1f jE 3E # iE aE iE 349E i� 3F �1E if 3E jt iE it it iE iE at dt 3F � 3F it iE
Z O N Z N G R E Q U I R E M E N T S
S E T b A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ: PROV; PARCEL: 42252417 ZNE: R1 REF NO:
PLANNING NOTES> 242 SF FOONDATION FOR A NEW DTNING ROOM AND KITCHEN :SDDITION
> TO AN EXISTING SFD. 143 SF FOUNDATION FOR A PATIO.
i! if ?E 3E iE �Ik iE if if �lf iE if if iE'k 1E'JE'1E jE 3E'k if iF iE'1E �E i! iE iE 14'1f iE'lE'1E # iE'1E?E �lE iE'lE if iE if'1f'lf'H' iE 3f iE �)f i6?f �F?f iE 3E if 1h iE iE if 3! �lE dE i(-if'1f'1F # iE iE �1E if 3F 3f iF iF if
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY : T. Ce�M�S�LI.. ' DATE: 7-B'�
BUILDING APPROVED HY :� DATE: 7-� "9 �'1�
APPLICATION ISSUED BY: �� `�" ' � DATE: � -��
iE 1f ff jf iE jE iE 3f iE iE iF it iE'lElE iF fF iE iF if iE iE3f3f�FiF�iF�3iiFiF iF3F3�iFiF 3FiF �F iF �'if�iF iFii�iF�F3 ! iFi-F�iF if iE iE * �f �E 9f �E if �E iE f�i�3FiE iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 59.50 SO
SMIP/NON-RES
P LAN •4
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAZD DUE
TOTALS----> 60.00 O.OU 0.00 60.OU 60.00 .00
REVENUE DIVlSION TOTALS--> COLLECTED: 60.00 OVER/SHORT: .00
HLDG PMT PLUMHING ELECTRIC MECHANIC FZRE SMIP/TOT GRADING PLAN-CHECK
59.50 .50
3f iE iE if it iE if �E iE 1f it if if * �E iElF if 3E iE �f iE iE �lf� iE �E iE jE ff iF iE �14 �k iE 3E iE iE jE iElF 3f iF fk if %iE iklf �t iE iFlE �f iE if 1E iE �F jF i�idE iE if iF iF �E iE aE �E it iF �t iE iF �F iE iE iF iE
I N D I V Z D U A L F E E H R E A H D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 292 RES-FOOTINGS 6 SLAB FOR FUT. RM ADD 7.79 1,885.18
END OF FEES
87-BB-1997/83:�4 VNf68.8B
�cvra:ei�eae�e
PERMITa983679
� CONSTRUCTION AND PL-ANNING - ?OOL .PA
APPROVALS Permit # � Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole •�52. Pool & Equipment Location, � ,
2. Soi� PiPe�Undrgrnd. � �� 53. Steel Reinforcement " - �
3. Electrical Conduit Uiility-Undrgrnd. 54. Forms � �
4. £tectricat Conduit�Undrgmd. 55. Eiecirical Bonding '
5. Steel Reinforcement �-'�� 56. Rough Plumbing & Pressure Test �'.
6. Electrical UFER Gmd. , �r..�'7 �t{� 57. APPROVAI TO COVER�GUNITE
7. �Footings ' �.., � . . Electrical Conduit-Undrgrnd.
�
8. Foundation - - 59. Gas Pipe, � Undrgmd., Test �
9. Water Pipe�Undrgmd. - �� � gp; Backwash Lines, P•Trap, O U�drgrnd.
10. Structural Floor Svstem -- 61�. APPROVAL TO DECK �' � i
1}. PropertySewer Line & HouseConnection ' . 62. Backwash & Receptor•Final
12. Sewer Cap ' � 63. Heater & Vent�Final •
13. Roof Drains . � 64. Plumbing Sys[em � Final
14. Rough Plumbing . 65. Electriw6Final �
75. Rough Elecviwl�Conduic � 66. Solar System-Final �
16. Rough Electric Wiring , '. - 67. Fencin� & 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 QPPROVAI.S Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Dutts, Ventilating 71, Product Piping �Gas ❑Oil
23� Gas Pipe•Rough & Test 72, Underground Flush
2q. Roof Framing 73. Undergrnd.Stora9eTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26, T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
26, Lathing & Siding 77. FIXED SYSTEft1 FINAL
29, insulation - 78. FfRE PREV. FMAL
30, Orywall Nailing HEALTH DEPT. REQUIREMENT
37. Platter Brown Coat 79. FINAL INSPECTION
32, Electrical Power Meter�Final S0. FOOD CERTIFICATE ISSUED
�
33, Finaf Electric Notes:
34, Finat Heating & Air Conditioning
35. Fina� Gas Pipe�Test
36. Hodd or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. WAter Service�Final
40. Gas Service-Final
r' .:
41. So7ar pomestic-Final
42. Backflow Preventer
43. Backflow 4rrigation
44. Landscape Irrigation System
45. Sound Attenuation V ?
46. Handicap Regulations �
47;. FINAL STRUCTURE & BUILDING � „z!'�
��-,r
4$. FINAL PLANNING :��-�
. 49. Electric Refease to Edison - ?�'� .
+Pi'�l
50. Gas Release to Southem California Gas Co - ���
51s CERTIFICATE OF OCCUPANCY °"a"
No. Date
J \,
Applicant to 1II1 in all spaces except t�osa withln �eavy EorGer Ilnet anE sign all apProO/�ale Ceelarations.
CITY•OF,.COSTA MESA CONSTR CTION PERMIT PERMIT NO. TRACT NO. LO UNIT NO.
1i'ojettAddress ��� w�� I�� ��t ��r,a m�� � - /��98� .712 ��f�S
� � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
�Applicant's Mailing Addreu
❑ CONVERSION ❑ DEMOLISH ❑ OTH
�C Owner's Nam(�e��� � �1.�1—Phone DESCRIPTION OF WORK/USE OF BLDG. � ���CK L(.J�i L(_ A.P. �W
Address —/,d,�,'1` I /Ofi L%q �` .S /Lr. t" C. {'�. ' � ' S Ma' B 'Id'
d !
ArchlEng. License No.
Address
Contrector's Name � Phone
Address (mailin9)
City License No. '
LICENSED CONTRACTOR OECIARATION
I hereby affirm ihat I am IlcOnsetl untlnr provislons oi C�arter 9(Commoncing
with section ]000) o/ �ivision 3 ot the Business anC Protesslons Cotla, antl
my Iicense is in (ull force antl eftect.
Ucense Class Licensa No.
Date ' ' Si9nature
WORKERS' COMPENSATION DECLARATION
' hereby alfirm that I have a certificate of consent to saiitinsure or a certificate
F Workers' Compensation Inzurance, or a c¢rtifletl copy thereof (SettiOn
.800, Lab. C.) '
Policy No. Company
eCertifietl copy is �ereby (urnizhetl.
Certifietl capy i5 filee with tne city BUIltlinq Olvision.
Da[e /��Olicant
EXEMPTION FROM WORKERS• COMPENSATION DECLARATION '
�(This seclion nee0 not be comple[¢tl i/ the pe�mit i5 tor on¢ huntlretl (§300) o�
less).
I<ertity that in the perlormanG¢ Of the work for whiC is p¢ t is IssUetl, I
Shall not employ any p¢rson in any man r-e d5 [ m ject to the
Workers' Co�T1peq i ws of Californi . •
Date L : In �T/��Si9nd[urC
NOTICE: It, aiter makin9 this tleclaration, you shoultl ecome subje<t lo the
Wo�kerz' Compen5a[iOn provislons of the 12�0� Cotle, you muit tOrl�with
comply with suc� Provisioni or [his permit ihall be tlaemetl revokatl.
CONSTRVCTION LENDING AGENCV' �
1 h¢r¢by atfirm t�at tbe�e IS a Conitruction Ientlin9 a9¢ncy 1or tho pe�b�manCe
Of lhe work tor wNth thiz permit i5 BSueE (Sactlon 309� Civ. C.)
l.entler'i Name
Lenaer's Adtlress ,
OWNER BUILDER DECLAR/ITION�
I hereby aftirm that 1 am exampt from the Contractor•s Li<ense Law for tno
followin9 reason (Sectlon ]031.5 Business antl Pro(estional Cotle: Any city or
county which reqWres a permit to construct, alter, Improve, aemolish or repalr
any 5ttucturE, prior to its Issuance, also raquir¢5 the appiicanl IOr sucb parTit
to 171e a si9n¢tl Slatem¢nt �ha[ h0/She IS lic¢n50E purivant l0 tha p�ovl5lons 01
the Contractor'S License Law �Chapler 9(commenting with Secllon ]000) ot
Dlvision 3 ot the Businezs antl Prolessfons Cotla) or Ihat Ite/ihe IS ¢xnm0�
herefrom antl the basls for tne allegetl exemptlon. Any vlolation ol SecHon
031.5 by any ap0licant /or a PC/mit Subjects the aOD����< <o a Civil
. enalty of not more lhan frve huntlred tlollars (5500).
� I, as owner of the property or my emo�oyoos witn wa9es as their sola
compansation, will tlo Ihe work, antl the s[tucturo I5 nOt intenAotl Or 011Cfetl
for sale (Seclion 7044, Business and Professional Cotle: Tho Contractor'z
License Law Ooes not apply to un owner o� a prOperty who bulltlt or Improve5
thereon, antl who tloes sucn work himsetl/h¢rsaH or tnrou9n his or hor own
.Cmployee5, proWdetl that such imp�ovam¢nts are nOt IntentlaE o� ofte�etl 10�
� sale. Ii, hOweveq th¢ builtling cr ImprOvement i5 SOItl within ona yedr 01 com-
� pletlon, tha owner will have the burtlen oi proving he/she Ultl not Oulltl or Im-
�1rove /or th¢ pur0o5a o1 sale�.
U I, as own¢r ot tha proDerty, am ¢xclusively contrdCting wi[h Ilcan58tl COn-
tlactofito constru[t Ihe project (S¢tllOn ]044, Butiness antl Prota55lOns COtle:
Tne Contractor's Li<ense Ldw does not appry [o an owner Of Property who
builtls or improves tnereon, antl who conVactS for sucb pro�ecls wLLh a con-
bactor(Sl liCenie pursuant ro the ConVattor'S License �aw�. I am aware that
proof of tnelr Worker's Comp¢nsation insurance 5houltl be Provitletl to ma.
❑ I am ezemD� untler Section B. & P. C. tor this reason
�
Date owner
I �erebvi certity that I have reai
antl state laws rei ing to a
zentatives of'this c y t
Inspection p oses
Signature '
� Drivers' License or 55 � �
CMF 0865-46, rev. 4/84 . White
abovo
iances
m w i
E
TVPE OF PERMIT^ GRADirvG FOUNDATION $TRUCTURAL T Front
❑ TENANT LI ELEGTRIGAL ❑ PLUMBING ❑ MECHHNICAC A Rear
❑ ,OTH E R
PROJECT DESCRIPTION 5Q. FT. � Q OCGUPANCv C Right
K
CONSTRUCTION TVPE VALUATION $ Q S Left
ZONE GRADING CV. VOS. ACRES P�ng. Ref. #
i
Remarks: Planning Notes:
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Ges ServiCe Outlels
Interceptors
Kirehen Sink
Lavarories
P—Trnp .
Roof Drains
Reinspection Fea �
515
Boiler
Duct � Under Ground
DuCt - $trucW fel
Duct - Ventilating
Ezhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑4100,000 BTU 0100,0008T'
II Reinspection Fee
AppliWnp Pink - Accoun[ing; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Waeer Service
Isue Fee
FEES
$ 3
�
Automatic Washer
Cons[ruction Pole Sub.
Cooking Unit '
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Baxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5-75
Zone
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over 100 amps
Sub Panel � � �
Motors �41 HP O l Y, - 8
Inc. Solar �9-15 HP �16-15+
Microwave
Pole Li9ht . .
Standing Sections
Trash Compacmr
FEES
Reinspection Fee $15 �Issue Fee � $ 3
IANICAL FEES
Hoodor Typel ❑ DEVELOPMENTSERVI SREQUIREMENTS: . / �]p
Canopy Type I I ❑ Zoning Approved By p -K/-1� Date SSi Q1Z'
Building Approved By _ Date �
Re(rigeration System
�aioo,000aru ❑�
System Repair/Alterat
laue Fee �
$ 3
Z
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G
R
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Q
M
T
$.
� SUMMARV F FEES �
BUILDING PERMiT $ /Qi� SMIP ` $ . $�
I R E�N CHECK $ � S PERMIT ' �
ISSUANCE $
II15p�P��U�J187NG $ ENERGV P.C.� $
PLANCHECK �25% $
ELECTRICAL $ GRA�ING � $
� S�gPL'A CHECK 50% $ MICROFILM $ ) �r
MECHANICAL S � TOTALFEE $ ( ��Ov
PLANCHECK ;25% $ - , �
�
� �ONSTRUCTIOMANDPLANNING P00. .SPA
�r APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
�1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location�
2. Soil Pipe-Undrgrnd. .� 53. Steel Reinforcement ' ��
3. Electrical Conduit U[ility-Undrgrnd. _ 54. Forms -
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding
-5:.Steel Reinforcement �� �J 56. Rough Plumbing & Pressure Test .
6 Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .,,
7. Footings ' ���= 58. Electrical Conduit-Undrgrnd..
8. Foundation 59. Gas Pipe, O Undrgrnd., Test •
9.•Water,Pipe-Unqrgrnd. , 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., Rough Electrica6Conduit. - ' 66. Solar System-Final
i 6. Rough Electric Wiring 67. Fencing & Access Approval �
17. Fiough Wiring $ign. 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathiny 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
�27. Frame and Flashing 76. Dry Standpipe
r28. Lathing & Siding ' 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioriing
35. Final Gas Pipe-7est �
36. Hood or Canopy .
37. Final,Faaory Fireplace '
38. Final Plumbing �� ' -
�
39. Water Service-F�nal � � • �
40. Gas Service-Final � ' ' • "
41. Solar pomestic-Final
. '�,
42. Backflow Preventer �
43. Backflow;lrrigation ��' = ;
44. ,Landscape;I�riyation�Svstem E X.p I R E D
45. Sound,-Attenuation • IfICOR1 lete fiSp
„ _
46. Handicap Regulations /, ' �%' SIQ -�
47.'FINAL STRUCTURE & BUILDING .
. „.
48. Special�Requirements Completed � i � I�
49. Electric Release to Edison � '
50. Gas Release to Southern�California Gas Co .
51. CERSIFICATE OF OCCUPANCY
No. Date �
� /�
�
'vrE52 igTH sT.Rr^.E^r 92'�
949 - Comp.
L9068 - u-22-66
b3969 - 7-26-73
38001 - 3-11-7G
f
3e ::de.^.cc= $10, 384
'- - i;C (::.a:�ir.5) '
�.� .
Pi3g. riC (Fes) �
.;_.. =_�.c:,,. 600.
�
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a
1
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P_o_ eoX 1200 COS7A MESA. CALIFORNIA 92626
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APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
flECEIV D BJ DATE flEC IVED DATE ISSUED
eui�oiNc 924 jq 19th St. ���" ��� 02-0�0-7
ADDRE55
P T�J .
OWNER F Skeen A,P, NO � — '�
MAIL BUILDING __/, }'% �
ADDfiESS 924 w LBt.11 St. NDDRESS t[i
CITY COSt.3 M�sa No�' 646-46. ` TRACT LO BLOCK
CONSTRUCi'IOf�1�11C� W
LENDER
BRANCH
OWNER
ADDRE55 VALUE
ARCHITECT Knowlton TEL.EX3-3O2 S - $ D�
OR ENGINEER N
FIRE
ADDRESS 1220 Lincoln SdT1tcZ Monica �ONE TVPE GROUP
APPROVED
CONTRACTOR Airflo Alum Awn CO BY DATE
ADDRESS 13012 Crenshaw Hlvd.
ZONE NO.OF USE OF NE
aTv Gardena No`973-5407 � P✓+�� BUILDING ��
STATE 232111 CITV �'AROSAPPROVEO �'AF�SAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDGS. (FROM C/l STREET)
OF LOT NOW ON LOT ROfYT F � FT.
USE OF
EXISTNG BLDG. j� S T FT.
S12E OF 1 95 NO. OF
NEW BLDG. ROOMS STORIES L SIDE FT.
EMERIOR WALL ROOF
COVERING COVERING REAR .G FT.
USE OF BV ILDING AND WOflK TO BE PEPFORMED DSTANCE BET. BEf. MAIN &
32'6"x6' Patio Cover MAINBLOGS. ACCE�.BLDGS.
Alum Acon attach o front of dwcll. ��RP � APFROVED
ICBO#Z13ES (% APPROVED �}_
o(
I hereby acknowledge that I have reatl this application and state , ��t `
Nat ihe above intormation is wrract anC aBree to comply with �
ali lews regulating builtlin8 construction, antl I shall not employ'
any person in vio�etlon of Me workmen'c compensation laws of _
tha Stam o/ Californie. % �
I hereb cartif t�nt I am B. FT. o
V y properly Iicensetl es e eontractor untler ��
the Steta of Californio 8usiness entl Profesetons Cotle, Dlvlsicn 3,�' TNE AMOUNT SHOWN UNPEF VALUATION IS FOR �
Chaptar 9, entl that suc� licenzes are in full forca antl effett, or I THE PVRPOSE OF ESTABL6NING A PERMIT FEE ONIV: m
am exampt from tl�e prov(sions ot the Stnto Ot Colifornia Businosa ¢
VALVATION m
antl Grofessione Coue, Division 3, Chepmr 9. � . an PERMIT FEE 5 �
, i�=��L�=� `! — - ,
SIO�a[ure of � � m
Permittee $ � ` P�AN CHECK $ ^�' E
Or� `o
Authorizetl Apent � OC� ,� LL
TOTAL FEE 5 ��
Costa Mesa Building Department AP CATION FOR PERMIT
�;�r , 111 EAST 20lh STREET � �� ���g U 1 L D� N G '
- . .- COSTA MESA� CALIFORNIA (�
FOR APPLICANT TO FII.L IN FOR OFFICE USE ONLY
R cefptNo. I�_ ��itN
Building CL `) �_
Address ' T ��
Ci05� MPS&, Cia.�OTRI& Received by I ate Rec'd. I Date I u
i-i�
Mail
Address
City
Arohitect �j � (�� •
Englnee� R,GW�,,, /Y�t.l.�
nddress
..itractar ��A���� �4
Address
Legal Lot
Deserlption I No.3g-S 61�
(AttaCh Metesand Bounda)
size oi �ot (� 6 k �( 0 I
Use oi I
Existi�g Bldg.
SetbaCk Line from s�
Centef of Street
DESCRIPTION i
New I /�� Alteratfon
No. of
S X �g �Room�
■ u� or
No.
o. of Bldgs
ow on Lot
o.of No.oi
amillea Rooms
Storfes
I hereby acknowledge that I have read this Application
and state that the above is rnrrect and agree to rnmply
with all Clty Ordinances and State Laws regulating
building constructlon.
Signature M
Permittee
Authorised Agt.
Valuation � Permft Fee $ 2
/ . ! Gv Plan Check $ �$
s / �� '��� s Total v�o
Fee $ 31 �`
CI1NM TO6 �-X 2M B�S4
�1
� ?/i.0 :.'r6 -- �,1�%s-=:�.�
Costa Mesa, California
Nearest
Cross St.
Zone No. ot Type . / I G
/ I Plans // �
Approved
CORItECTIONS
APPROVALS
Foundation Loeation Inspector
Forms, Materials,
Under-Pinni�g
Frame: Fire Stops,
Bracing, Bolts
Lath.lnt.
Lath. Ext.
Plaster, Int.
Bond B
FINAL
:l I
Date
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� PLOT PLAN -` . , �: . . .
Show locatlon and distances irom ����• � � � �� � � "
, , .j .
� ;.property line and hetween buildings . ,_ ;,� . � � � �
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