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Home My WebLink About944 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosle-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 944 W 19TH ST Suite: Vicinity: Parcel Number: 42252413 Applicant: MARTINEZ, GILBERTO Address: 944 W 19TH ST COSTA MESA, CA- � � Owner: MARTINEZ, GILBERTO Address g44 W 19TH ST , COSTA-MESA, CA . � Contractor.� �. - - � Address: � . � " 2ip: Arch : Address: a Phone: Zoning: Phone: 94&5159829 HOME Zip: 92627 . Phone: Zip: 92627 � , Phone: License: Eng: . � � Address: Status: PC Applied: 11I24I2003 Issued: �SSUED BY: �-�- i � Phone: Zip: License: - License: ' SCOPE OF PERMIT V � 483 S�. FT. SINGLE STORY ADDITION. SCOFE OF WORK TO INCLUDE EXTENSION OF EXISTING KITCHEN AND NEW DINING ROOM. . , . , . , - . . .' .. . - � FEE SUMMARY Plan Check: $385.94 Calc Valuation: Saa,szs.zo Permil $593J5 . - ' �;, ; ; Claim Valuation: So.00 SMIP Res: $4.46 SMIP Com: $0.00 Other: $0.00 Inspection: . $0.00 � � , , �,Total: � $984.15 r�;! ' �i�� PLANNING & ZONING � '- � " "� SETBACKS ^ , � MAIN STRUCTURE Fronl 0- 0 ' � Rear 23- 0 Left & 0 Right , 0- 0,� ' � �� ' _ . - � � „ , - - � - ACCESSORY ,' Front 0-0 Rear � 0 0 - Left ��0-0 � Rigtit 0-0 ' � PARKING ExtsUnq: 4' Required: 4 Proposed: 0 NOres: KENNE S 10fo5/2004 PER SALEM, OK TO ISSUE PERMITS: �" NOTICE: The work aUthorized by this pertnit shall compty with all applicable handicep access requlrements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall autometically expire and become void II work Is not commenced withln 180 days, or II work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all apP��eble codes, and ell requlred Inepectlona and flnal epprovel must be obtalned. Failure to obteln Inspections end tlnai epproval will rasult In the expiratlon of lhis permit. FOR INSPECTIONS CALL: (714) 754-5626 taa�oe �eiao� � e �� _ � , . .. . .. .. WORKERS'.00�IPENSA�ON DECLARATION: � • . .�„ �':� , I hereby aHirtn under penalry of perjury one 01 the tdlowing dedaratlons: .o iy ❑ i heve end will mflintain e ceRlOwte of consent to sell-Insure tor wo'rkers' canpensation, as provided tor by section 3700 0l t�e Lebor Cotle, tor the pertormance of the work for which Itils pertnit is issuetl. ❑ I have entl wlll maintain workers' Cpnpe�satlon Insurence, as required by secUon 3700 oi ihe Labor Code, for the peAortnance of Ne work for which IhLs pertnit is IsweC, My workers' wmpensation Insurence terder and policy number ere: � Certler. Policy Number. (Thls section need not be complefed il fhe pB�lf is veluetl af one hundred dollers ($f 00) or less.) ❑ I certify Ihe� in Ihe peAortnance oi I�e work lor whlch lhis permit Is I55ueQ I shell not employ any person In eny manner so es to become sub�ect to the workeB' wmpensetlon laws of Califamia, and egrea that it I should become sub�act to the workers' compensetion provislons oi Sectlon 3700 0l the Lebor Code, I s�all larthwith comply with these pmvisions. Appllcenl Signeture: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATON COVEMGE IS UMAWFUT AND SHl�LL SUBIECT AN EMPLOYER TO CRIMINAL PENALilES AND CML FlNES UP TO ONE HUNDRED hKK1SAND DOLLARE (5100,000), IN ADDf710N TO TME WST OF OON.PENSATION, DAMFGES ilS PiqVIDED FOH IN SECfION 37080F THE LABOR OODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereDy aMirm ihat I am licensetl under provislons ot Chapter 9(wmmencinp with Sectlon 7000) of Division 3 oi t�e Business entl Prolessions Code, end my Ilcense is in full 10fCB BOd BHBC�. LIC. q CI059 M Contrectors Signewre: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby eflirm that Ihera is a constructlon Ientllnp egency tor t�e peAormance oi t�e work for w�lch this pertnit is Issuotl. (Sac. 3097, Civil Code). Lenders Name: Lentlefs Atldress: SlgneNre: Dete: OWNER-BUILDER DECLARATIONS: /�%�. s J: 1 � I hereby aflirm that under penelry of per�ury tPet I em'EXEMPT FROM THE CONTPACTORS LICENSE LAW lor tha tollowing reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requires a pe��t to constiiict, alter, impmve, demolish, or repair any structure, Dnor to its issuence, elso requires the epplicent for such pertni� to tile a signed stetement ihat he or she is Ilaensetl pursdant to the proNsians ai Ihe Contractors License Lew (Chepter B(commencing with Sectlan 7000) ot DINsIon 3 of the Business and Professions Code) or �het heAr she`Js�e:empt therefrom end Ihe basis for ihe alleged e:emptlon. Any violatlon oi Section 7031.5 by any epplicant tor e pertnit sublecis ihe epplicent to a civil penelty of not moie Iha'n flve hundred dollers ($500).): ❑ I, es owner oi the properry, or my empl0yees with wages as thelr sole wmpensatlon, WILL DO TME WORK, and the siructure Is not Intended or oflereG for sele (Sec. 7044, Business and Professions Cotle: The Contractors License Lew tloes not epply to an owner of propeny who builds or improves thereon, anC who does such work himself or herself or through his or her own employees, providetl that such improvemenis are noi intended or oHeretl lor sele. If, however, the building or Imprwement is sold within one year ot compleGon, the �+'�er-builder will have the burtlen oi proving t�at he or she dia not 6uild or improve lor purpose of sale.). • ❑ I, as owner of ihe property, em EXCLUSIVELV CONTFiACTNG WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business entl Professions Cotle: The coniracrors LJcense Lew Ooes not epply �o an owner ot pmperty who builtls or Improves ihereon, entl who contracts tor suc� pro�ect witti a cantractor(s) license pursuant to the Comraaors LicBnse Laws.). �I em exgmp` nder ec. Business entl Professions Code tor this reason: Si neture: � l � D te: fi Owner ID vedlied by ddver's license. �'es ❑ No D ver's Lice se No. �� zpires' [�,' 71 Veriliratian oi Ownership by (type ol tlocument, �.e. - praperty tex hlll or deed): DIVISION OF INDUSTRIAL SAFETY VERMR CERTIFICA710N: ❑ 1 hereby certity ihat no axpvatlon five (b) or more feet in depih Into which e person Is required to descentl, will De matle In connedion with work euthorized by thls pertn0. antl tha� no building structure, sceNdtling, falsework, or demWitlon or tlismantlinp Iheraof, will be more ihan t�lrry-six (38) faet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title 8, Celitomia Atlministretive COde). ❑ As owner-Euilder, I wlll not employ eny�a to do wark which woultl requlre e pertnit Irom the Division oi Intlus�rial Selery, es noted ehove, unless Such person has e pertnit to Uo such woAc trom the tlivision. Signature: Date: Dlvislan ol Industdel Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJfliOA¢A710N OF ENfAY: I certity under penalty ot perjury that I have read this applicetion antl state that the Information given is correct. I agrea to compry vnth all stete lews and ciry ordinances relating to bullding conswction, entl euthoAze representetives ol lhe Ciry of Coste Mese to emer upon the a e-d crib prope forJ'�'spectlon purposes. 1 egree nat fo occupy or allow occupenc/ ot any building euthorized by Ihis p mit untiyfinal inspectlon. tJ� af�t�'�C /O�Oc4/07+I SlgnaWre 0 Legal n(s) Da . AnNOr AuNodzeO Applicant Date CO�E I, IHSPECTIONME , 1878 Flaed System Finel Fire Prevention 1268 Pool Spa Finel . 200 Finel Re-Roof 201 Flnal BIocWRetaining Wall 202 Finel Factory Fire Place 203 Final Sipn 204 • Final DemWitlon � • � PAIE ��$ jQQF.,,( INSPELTIONTYPE 208 Final Mechenlcal 208 Finel Plum6inp 210 Flnal ElottdCel 212 Finel Flre Preventlon 220 222 250 Final Planning Approval Final Site Final Bulltlinq�Occupenry Qeg It� {�ia) �sa-s2�s • Fex (�ia) �sa-aess • www.a.cos�a-mesa.ce.us 77 FAIR DRNE, GOSTA MESA, GA 92626 MECHANICAL PERMIT Job Address: 944 W 19TH ST Suite No Vicinity: Parcel Number: 42252413 npp�icant: MARTINEZ, GILBERTO." , , Address: 944 W 19TH ST , �: COSTA MESA, CA - , - Owner: , MARTINEZ, GILBERTO Address: ,944 W 19TH ST COSTA MESA, CA Contrador. Address Phone: Zip: , 92627 Phone: Zip: 92627 a Phone: Z'P, License: - - Status: ISSUED Applied: 10/15/2004 Issued: 10I15I2004 ISSUED BY: � , E� � .� DA'1'B � � SCOPE OF PERMIT REF: B03-02040 - 483 SQ. Ff. SINGLE STORY ADDITION. SCOPE OF WORK TO INCLUDE EXTENSION OF EXISTING KITCHEN AND NEW DINING ROOM. � � MECHANICAL PERMIT IS FOR KITCHEN HOOD WITH UNDERGROUND EXHAUST. � FEE SUMMARY . � ` - � Quantity _. �., . _ .. �_ . � ,. , �. � _ . , . . . :.. Quantity , ISSUE FEE $23.50 -- � - ` Repair / Alt Absorbtion Unit ` 30.00 0 Insl FAU <100 k BTU $0.00 ' 0 � � Repair I Alt Refrigeration Unil , 30.00 0 Insl FAU >100 k BTU 50.00 0 Ventillation System i $0.00 0 Repair / Alt �CoolingMeat $0.00 0 Evaporative Cooler ' , ; 50.00 0 . Inst / Rep. Recess WaII�Htr • 50.00 0 Commercial Incinerator ,.�� 50.00. 0" Refrig Sys <100 k BTU '� 50.00 0 _ Domestic Incinerator ' 50.00 � 0 Refrig Sys ?100 k BTU �', � $0.00 0 ... -�'� � � • Compressors / Absorption Svstems �'��i ' " , i Gas Plping �'' � $0.00 0 .= z,-'-}� "� Up to 3�hp / 100 k BTU ��' 30.00 � 0, � Factory Fireplace � 50.00 0 � . 3 To 15 fip / 500 k BTU, �� 50.00' 0� Hood w/Mech Exhaust � . - $10.65 - 1 � � - - �, " 15 To 30 hp /�1,OOO�k BTU- -� '- � � - ' $0.00 � 0 VAV Box � �,, '��$0.00 0 '� 30 To 50 hp I 1,750 k BTU � 30.00 �� 0 Vent Fan / Single Duct � ! ��$0.00 0 �� . � � " � � �.Over 50 hp / Over 1,750 BTU, � � ; i � 50.00 0 � . i Appliance � '� '- � $000' �0 � � � " � Boilers - � . Fire Dampers `� � � ; ;,$0 00 �0�� - � � - - - Up to 3 hp ,- � " �' ; �$0.00 0 Smoke Dampers \�'� � ' ' 50.00' 0 � _ _ - - . � . 3So 15 hp� ; /�' �. �i � $0.00 0 Inst or Relocate Appl Vent � � $0.00 �- , 0' � - � - 15. to 30 hp � �" � =', � 30.00 0 Air Handlers < 10000cfm � � - 50.00 -' �0 � 30 to 50 hp� � � - . . �� 30.00 0 Air Handlers > 70000cfm � . � � 50.00 0 ' " � - � � Over 50 hp � � � 50.00 0 Floor Furnace �� 30.00. 0 , �� . Other Mechanical Fee Floor or Suspend Heater �50.00 - 0 - � ._ . . � � � Inyestlgatlon Fee ' , 30.00 � _ . Plan Check Fee- - � j' $0.00 � � ; _ - - -.,Relnspection Fee � 50.00 0 NOTICE: The woAc authorized by thls permlt shall comply with all applirable handicep access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shelt automatically explre and become vold if work is not commencetl within 180 days, or if work Is suspentled or abandoned lor a period of 180 days. INSPECTIONS: In order lor the xrork authorized under this permit to be considered legal, such work must comply wlth all applicable eodes, and all requlred inepeetlons end Iinel approval must be obtained. Feilure to obtain Inspections and final approval will result In the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545628 zaae-ae ��✓oo� WORKERS'COMPENSAnON DECLARAnON: . . _ I hereby ettirm.under penelry ot per�ury one of the tollowing declaretions: " ' ❑' I heve end will melntein e certificate ol consent to sell�lnsure for warkers' compensatlon, as provltled for by section 3700 of ihe Lebor Cotle, for ihe pertortnance ot the wark for which ihis permlt Is Issuetl. ❑ I have antl wlll melntein workers' compensation insurance, as :aquiratl by section 3700 oi the Labor Cotle, lor Ihe peAormence ol lhe work for which Nis pertnit Is Issued. My workero' compensation Insurenca carrier entl policy number ere: . Carrier: Policy Number. (Thls secNon need not be complefed i/ the permit is va/ued e( one hunOred ddlers ($100J or less.) ❑ I certity that in the peAormance oi the work for which this permit is issued, I shall not emplay eny person In eny manner so'as to become subjed to Ihe workers' compensatlon laws ot Calitomla, entl egree thet il I shoultl �ecome subject m t�e workers' compense0on provislons of Section 3700 of tha Labor Code, I s�all Fonhwit� comply with Ihese provislons. Applicant SipnaNre: Dete: WARNING: FAILURE TO SECURE WORKE0.5' WMPENSATION COVEMGE IS UNLAW R1L AND SHALL SUBJECT AN EMPLOVEP TO CflIMINAI PENALTIES AND CML FlNES UP TO IXJE HUN�REO TKKISAND OOLURE (SIOO,OOO�, IN ADDITION TO THE �ST OF COMPEN54MJH, DAA4IGES AS PROVIDED fOR IN SECfIqJ 3]080F THE UBOR CO�E, IMEREST, AND FTTORNEY'S FEE$. LICENSED CONTRACTORS DECLAFiAT10N: I hereby eHirm that I em Ilcensed under provislons ol Chapter 9(commendng wilh Section 7000) ol Division 3 of �he Business enA Professfons Cade, anE my Ilcense is in lull IafCO filld BflBCL L�C. M CI859 M contrectors signeture: oe�a: CONSTNUCTON LENDING AGENCV: ❑ I hereby aHirtn that there is e wnstruction lentling egency for the peAormanca ot the work for which t�is permii is iuued. (Sec. 3097, Civil CodeJ. Lentler's Neme: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eMirtn thel under penalry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for !he lollowing reeson (Sec. 7031.5, 8usiness end Proteulons Code: Any city or counry whic� requires e permit to consiruct, alter, improve, demolish, or repair eny siructure, prior to its issuance, elso requires tha applicant tor such pertnit b flle e sipned statement that he or she is Ilcensed pursuant to tha provisions ot Ihe Contrectors License Lew (Chepter 9(commencing with Section 7000) ol DiNsion 3 oi t�e Busine and P�ofessians Code) or ihat �e or,she is ezempt therefrom and the basis lor Ihe elleged exemption. Any violation of Sectlon 7031.5 by any applicent for e pertnit su s the applicent to a civil penelry of noPmore ihan live hundred dollers ($500).): I, es owner of the properry, or my employees with w8ges es thelr sole compensation, WILL DO TME WORK, and the structure Is not intended or ottered for sale (Sec. . 7044, Business and Proleuions Code: The Contreclors License Law does not apply lo nn owner of property who Duilds or impmves thereon, and who Coes suCh work himself or herself or through his or her own employees, provitletl �hat such improvements ere not Intentled or oHered for sale. It, however, the building or improvement is sold within one year o1 completion, tha owner-builder will have Ihe burdan ol proving Ihat he or she did not build or improve for purpose ot sale.). � ❑ I, as owner of the pmperty, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ta constmct the pwject (Sec. 7044, Business and Professions Code: The contrectors LJcense Law tloes not eppty to an owner of property w�o bulitls or Impmves thereon, entl who wniracts tor such pmjeci wiih a coniraaw(s) license pursuaM to tn� Coniractors License Lews.). ❑ liem exqnpt paae��c. � Business end Professions Code tor this reason: Signawre:l��b M •� Owner ID veritied by tlrivers license. Yes ❑ No Drivefs Licenae No. vedtiwtlon ol Ownership by (rype at aocument, i.e. - vroperty tu bill or dead): ' DIVISION OF INDUS7FilAL SAFE7X PERMR CERTIFICATION: Expires: ❑ I hereby ceNty t�et no excavation tNe (5) ar more feet in tlepth Into which e person Is required to CescenQ wlll be meda in connaction with work auNorizetl by this permit, end that no building struCture, scaHolding, lalsework, or tlemWitlon or dismentlinp thereoi, wlll De more ihan thirty-six (36) teet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Tltle B, Calllomia Adminlsiretive Cotle). ❑ As owner-bullder, I will nol employ enyone to do work w�ich would require e pertnil Irom Ihe Division ol Intlustriel Sefery, es notetl above, unless such person hes e permit to do suc� work Irom t�e division. Signeture: Da1e: Divlsion of Indusirlel Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHOR¢ATON OF ENTRV: I certity under penelry ol perjury thet I have read this application an0 state that the inlortnatlon given Is correct. I egree to comp wlth all stete lews and ciry ortlinances relatinp to huilding constructlon, end euthodze representatives oF Ihe Clry oi Costa Mese lo enter upon the ebove�de�ribe�lpmpe�or ins tion rposes. I e• g�not to occupy or ellow occupency of any building eulhorized by ih�pe/r�ni�until inal inspection. L:-� � p�Y \'r1 e i � / 5/D'-i SignaWre Ot Legel Owner(s) 7 Date ) AnNOr Authonzed Applicant CODE t. INSPECTIONTYPE tele Fixetl System Final Fire Prevention 7268 Pool Spa Final 200 Finel Re-Rool 201 Finel BIocWPeteininp Well 202 Final Fectory Fire Place 203 Finel Sign 204 Flnal Demo�tlon � I�� yyp� wsvecnoxrrve 208 Flnel Mechenicel 20B . Final Plumbing 210 Final Electdcal 212 Final Fire Prevenilon 220 � Flnal Planning Approval 222 Final Site � 250 Final Bullding/Oaupency ��ia) �sa-s2�s • Fax (�ia) �sa-aess • www.ci.costa-mesa.ca.us 77 FAIH OHNE, C:OSIA MtSA, GA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: 944 W 19TH ST 42252413 ELECTRICAL PERMIT Applicant: MARTINEZ, GILBERTO Address: 944 W 19TH ST ' COSTA MESA, CA = �-, Owner: ,NIARTINEZ, GILBERTO Address � 944 W 19TH ST�� " COSTA MESA� CA ' Contractor. , � - . Address: �-� - � " Phone: Zip: 92627 . i Phone: Zip: 92627 � , � . . Phone: � ' - Zip: _ � . � - License: � ISSUEC Status: Applied: Issued: ISSUED 10/15/2004 10I15I2004 � 1�� ;�,. � Il, �D , ` OA� " . ' � �, . "' . � `. SCOPE OF PERMIT � REF: 803-02040 - 483.SQ. FT. SINGLE.STORY ADD�TION. SCOPE OF WORK TO INCLUDE � �. EXTENSION OF EXISTING KITCHEN AND NEW DINING�ROOM. ' � ELECT. PERMIT IS FOR 6 FIXTURES, 8 OUTLETS & 5 SWITCHES.,-, , . . . � Quantity FEE SUMMARY - - � � �� uantity = � ISSUE FEE 823.50 Temp Dist System / LighUng �� .$0.00 0 ��. � Temp service tesl � $0.00 Busway /100 ft � � '$0.00 0 � � . � �- _ , � Res. a/c package , $0.00 Standing Section .$0.00 -0 � ,' ,_ � , � New Res (1-2 units) , �� , $0.00 0 - � Misc Electncal Equipment 50.00 . � � 0- � . - , ' New Res�(3+uniLs) �' �� , 50.00 0 � Transfortners up to 1 kva/kw E0.00 .,: ' 0 � �� • �, , Pool / Spa� � . �� : 50.00 0 ' �. ;'.,. ............. : p to_10 kva/kw $0.00 � : � , u 0 Lighting Fixts-_-, ; `_56,60 6 ,. �'_ . � .....�...........up to SO,kva/kw ._ . $0.00 � 0 , - � / Recept Oullets, , , 58.80� � � 8 � , .................up to 100 kvalkw $0.00 0 � . � Switches �. � �, %; .$5.50`: � � 5 -� � � :...c.....:......over�100 kva/kw - , $0.00 � 0 Non Res App� - ` ' $0.00 � �- - ��0 - � Low Voltage Equipment . ' '$0.00�- - 0 i � �� Res Appl '-� . i 50.00,� � � 0 �� „� � � - , Low VOIt Winng Syslem./,Ckt' $0.00� � ', 0 , �� Serviceto200a A�-�. , $0;00'', � �0- '- Misc.Conduit �.'., -� i� $0:00��- 0%�- . Service to 1000a V �, �, $0.00 ' �" 0 � - - � � � `Misa Conductor- � , $0.00 � . �0� . Service over 1000a � � � � �$0.00- � - �� 0�� Circus ( gen or ride) �� , . � $0.00 ,- 0- � Motors to 1 hp �� $0.00 ' � � , 0 - / - , � - Circus (mech �ide oc lighls) � � $0.00 - -'0 Motorstol0hp '$0.00_� ' 0, ' � ChristmasTreeStand'.� - $0.00. � 0 Motors to SOhp $0.00 � -'- ; �o ' � � � � Fireworks StanG � � .- "$0:00 0 Motors to 100hp $0.00 ��`'0, .- �� Other Electrical Fee , ; ; � - - "$0.00 Motors over 100hp 50.00 -0 . � . Communicatlon drops $0.00 0 �- �_� lnvesfigaUon Fee " $0.00 NOTICE: The work authorized by this permfl shall comply with all applicable handicap access requiremants under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12•21•92) EXPIRATION: This permit shall eutomatically expire end become vold it work is not commenced wlthin 1B0 days, or If work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the vrork eWhorized under this pertnit to be considered legal, such wOrk must comply with all epp�icable codes, end ell required Inapectione end final approvel must be obtained. Failure to obtein inspections and flnal epproval will result In the expiration of �his pertnit. FOR INSPECTIONS CALL: (774) 754-5828 ...� .r;�r:iFi)1 WORKERS'COMPENSAnON DECLARAnON: - ' , - I hereby eMirm under penalry of perjury one ot the tWlowing dedaratlons: � ' � " ` � 1 heve end wlll meinteln e cenilicate of consent to selt-Insure tw workers' campensetlon, es provided tor by section 3700 of �he LeDor CoOe, for ihe pertormance of ihe work tor which t�is pertnil Is luued. ❑ I have entl will malntaln wwkers' comp9��on insurance, es requlretl by section 3700 ot the Lehor Cotle, lor ihe peAortnance of t�e work fw whiCh this pertnil is issued. My workero' campensetlon Insurance Certier antl pollcy number ere: Ce�der: Policy Number. (This sectfon neetl nof be camplefed /l fbe pB�� s ve/ued et one hundred dallars (S 100) or Iess.J ❑ I certihj Ihal in the pertormanca ot the work for which this permit Is issue4 I s�ell not employ any person in eny manner so�as to become sub�ect ro Ihe workers' compensetlon lews of Celltomia, end eg�ee that If I shoula become sub�ect to tha workers' compensa�ion provislons oi Sectlon 3700 0l Ihe Labor Code, I shall fonhwith comply with t�ese provisions. Applicent Signeture: Dete: WARNINO: FAI�URE TO SECURE WORI(ERS' WMPENSAiIOM COVERAGE IS UMAWFUL AND SHPLL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TMOUSAND DOLLARE (E100,000), IN ADDRION TO TME CQST OF CAMPENSAiION, DMNGES AS PROVIDED WR IN SECiION 3]O60F THE Lr1BOH CODE, IMEREST, AND ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm thet I em Ilcensed under provlsions of C�apter 9(cammencinp wlth Sectlon 7000) ot Divisian 3 of ihe Business end Protessions Code, end my license Is In full force entl efled. Lic. a Cless N Conlrectofs Signeture: Date: CONSTRUCTON LENDING AGENCY: ❑ I hereGy eNirm that there is e wnstruct(on lending agenty lor the pertormance ol the work Por which this pertnit is Issuetl. (Sec. 3097, Civll Codej. Lender's Neme: Lentlefs Address: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby efllrm thet under penelty ot perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business and Professions Code: Any cily or county which requires a pe�mit to construct, elter, improve, demolish, or repeir any simcNre, prior to i�s issuance, elso requires the applicant tor such partnit to file e signed stetemeN Ihet he or she is IiGensed pursuant to �he proNsions ol the Coniractors License Lew (Chapter 9(commencing wl�h Section 7000) of DiWsion 3 01 the Busine and Protessions Code) or �hat �e or she is exempt lherelrom end the basls for Ihe allegad examption. Any violetion at Sectlon 7031.5 by flny appllwN for a pertnit subj s the applicant to a civil penalry of not more than fiva hundred dollars ($500).): \as owner of ihe property, or my employees with weges as their sole compensatlon, WILL DO THE WORK, and ihe structure is not intentled or oHereC for sale (Sec. 7064, Business and Professlons Code: The Contradors License Lew does not apply to en owner of property who builds or improves thereon, end who Coes such work himself or herself or through his or her own employees, provitleG Ihet such improvemenis ere nm intendetl or oHered for sale. If, however, the building ar improvement is soltl within one year ot wmpleGon,.ihe ownervbuiltler will have the burden ot pmving that he or she did not build or improve tor purpose of sele J. • � I, es owner of Ihe property, am EXCLUSIYELV CONTRAC7ING WITli LICENSED CONTRAC70pS ta canstruct the projecl (Sec. 7044, 8usiness and Professions Code: The contractors License Lew does not apply to an owner ot pmperty who bulltls or improves Iherean, antl who conirects tor such project with a conirector(s) license pursuant b he Contractors License LawsJ. � ei . ❑ I em e m nde ec. Business entl Profeuions Code tor Ihis reason: SignaWre: �1(j� 1� Date: Owner ID venfied by dnvefs license. es �. ❑ No Orivers Licens'e No. � �% �� _/_ Exoiras:� ri? 14 O� Verificetlon ot Ownership by (rypa at docume��, i.e. - property tex bill ar Aeetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity thet no excavatlon five (5) or more feet in tlepth into which e person is required to descend, wlll De matle in connectlon with wark euthodzed by this permil, an0 ihat no Guiltling structure, scafloltlinp, talsework, or demolition or CismaNlinp ihareof, will 6e� more ihan thirtyslx (36) feet hign. (C�ep. 32, Grp 2, An 2, Sec. 341, Title 8, Callfomla Administrative Code). ❑ As awner-builder, I will not employ enywie to tlo work which would requlre e permit Irom ihe Division of Industrial Selery, es notetl ebove, unless such person hes e permlt to do sucfi woAc from the tlivisior�. Signature: Dete: Division of Intlusirial Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AIJTHORIZA710N OF ENTRV: I certity under penelry of perjury Ihet I have read thls epPlication and State thet t�e informetion given is correct. I agree �o comply wiih all state laws enC ciry ortlinences relatinp to building construction, and authorize representetives of the Ciry ot Coste Mesa to enter upon Ihe above-tlescnbed property lor inspection purposes. I agree not to occupy or allow occuDancy of eny building euthorizetl by this pormit until final inspeciion. � r � cyn u`�'�I Owner(s) AnN r Authorized Applicent GOOE I. INSPECTIONTYPE 1618 Fized Syslem Final Fire Prevention 1268 Pool Spe Finel 200 Finel Re-Root 201 Finel BIocWRetaining Wall 202 Finel Faciory Fire Place 203 Final Sign 204 Finel Demolltlon ' Qdffi II�dL4 CODEt INSPECTIONTYPE 206 Final Mechanicel 20B Final Plumbing 210 Finel Elecirlcel 212 Final Flre Provention 220 ' Final Planning Approval 222 Final Site � 250 � Finel6ulltling/Occupanry � PL� It�Lfl (714) 754•5273 • Fax (714) 754•4858 • w++w.cV.costa•mesa.ce.us 77 FAIR DR1VE, CASTA MESA, CA 92626 lob Address: 944 W 19TH ST Suite fVo Vicinity: Parcel Nunmber: 42252413 Applicant: MARTINEZ, GILBERTO"-: '- Address: 944 W 19TH ST �. � -„_ .,5;-_. -- � . COSTA MESA, CA _ ^ � �, �� Owner:" .',MARTINEZ; GILBERTO � Address 944 W 19TH SL �" , ' ' COSTA MESA, CA .GonVactor �� Address: > ` Arch /'Eng: � � Address: PLUMBING PERMIT Phone: , Zlp: -92627 Pha�e: Zip: 92627 Phone: "- Zip: License: ISSUED � , ' t; .�� . - ,�,- , � . Status: ISSUED Applied'. 10l15l20�4 Issued: 10/15/2004 - -_ �. ' .�- � A 'r. .� �.,, . - �in- � — . . . �,. . : ( , . �i : _ z�_:: _ � _ ., � Phone: �- - _ - - - ,.� .. Zip: „ . ,_�., .r.�,�� -i=. ' _� - 5,. 1i- ,. - -- _ � - '_--License: ' � � _ � �� , _ °- - �, ., . ' - _ , i� , - - - , SCOPE OF PERMIT , - �' � REF: B03-02040- 483 S�. FT. SINGLE STORY ADDITION. SCOPE�OF WORK TO INCLUDE ,�,�', �—� ' �� EXTENSION OF EXISTING KITCHEN AND NEW DININGROOM. ' -� . � � � , `� �� ' '�. ', : „ � - . V��, ,' � i PLUMBING PERMIT IS FOR DISHWA�HER �GAS''OUTLETS (1-4) & NEW KITCHEN SINK.., �)� �_ � � � .I ��. � __ � i � _ / �i � ' �. � _ � FEE SUMMARY = , , `� . . � , _z-^ ' !i, . �. � -a\ AMT , .� QTY . V , . ., � . ��," AMT � QTY � � �- � ISSUE FEE � �" � $23.50 ��-,� �� 'Laundry�Tub / Washer ��% � $0.00 � 0 , Surnp,Pump , BackBow irrigation � � �� $0 00"; � _0 �'�Landsrape Irrigation -� � g0.00 0 ' ". Swimming Pool �� , Backflow Preventer �� $0 00"� •0 � � =�PTra � ' �� ' � - � �, 0.�, , 50.00 -0 Trep Primer � , . . Bathtu6 �� ` $OAO� � Q� .� - �Piessure Regulator� - . � $0.00 "0 - " , � = Uririal � % Clarifler System ��$0.00 -' 0! ' �' Process Piping (per 10 ft) $0.00 0_, .� ' Vacuum Brki Bkflow(1-4) Connect Qce,Soda,etc) `$0.00 . 0- :'�,- ,' ` � Receptors $0.00 0 � � � Vacuum Brkr BkFlow(5+) DentalUnits $0.00-��_0, ��, SepticTank � ,`!� � $0.00� �0 , WashBasin Dishwasher $9.80' � - ��t,-,`� � � Sewer Cap for Demo�', _: , $O.UO � 0. � ��, Wash 8asio Set Drain, Floor $0.00 �0�,\-', �� Sewer Connect ,\�„ i� �, ,$0.00 0 ��"Waste and Vent System Drain, Rainwater $0.00 0 � � �Sewer Private Line $0.00 .= 0- ��" �� " Water Closet (Toilet) Drain, Roof $0.00 0 �� Shower ' - - - .- -��_ . §0.00 � � 0 � Water Heater / vent i �"AMT � $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 a D 0 0 NOTICE: The work authorized by this pertntl shatl comply with all applicable haMficap access requfrements under Cafifomia statutas and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or it work is suspended or abandonad for a period o1180 days. INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such xrork must comply with ali applicable codes, and all requlred Inspectlona end final aDP�o�al must be obtained. Failure to obtain inspections and final epproval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7543628 2MN8 (6l00) . WORKERS'COMPENSATION DECLARATON: ' � I hereby eflirtn untler penalry 0� per�ury one of the tollowing declaretions: ' „ � ❑ I have and wlll maintain a certificate of consent to salt-Insura tor workere' compensation, as proWded for by section 3700 of ihe Lebor CoOe, for the pedortnence of Ihe work 1or which Ihis permil is issued. _ ❑ I have and will maintain woBers' compensation insurence, es requlred by sectlon 3700 of the I.ebor Cotle, for Ne pedortnance of the work lor which this pertnit Is Issued. My workers' compensation Insurence carner antl policy numher ere: Cartier: poliry Number: (Th/s section need not be comp�etetl il f�e, permi! is valued et ane hundretl tlollers (5700) or Iess.J , ❑ I certity ihat in ihe pertort�ance of the work tor whic� this permit is Issued, I shall not employ any Derson in eny menner so as to become subject lo the workers' compensetlon lews ot Callfomia, end egree ihat if I should become subject to Ihe workers' compensatian provislons of Section 3700 of lhe Lebor Code, I shell forihwith complY with these provisions. Applicant SlgnaNre: Date: WAqNING: FAILURE TO SECURE W�ERS' CDMPENSATION WVEMGE IS UNLAW FUL AND SFiALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CML FlNES UP TO ONE HUNDRED TFIOUSAND DOLIAFE (5100,000�, IN ADDITION TO THE CQST OF COMPENSATIpN, DMIAGES AS PROVIOED FOR IN SECTION 3]OB OF TNE IABOfl CODE, IMERESi, PND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihat I am Ilcensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and P�olassions Code, antl my license is In full torce enG eHecL Llc. # qass N Contractofs SignaWre: Date: CONSTRUCTON LENDING AGENCY: ❑ I herehy aNirtn ihat Ihere is a construction lentling egency for Ihe pedormance ot the work tor which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendar's Atltlress: Signeture: Date: OWNER•BUILDER DECLARPTIONS: I hereby ettirm thet untler pene�ty of per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons Code: Any ciry or counry whicP requires e parmit to consimct, elter, improve, demolish, or repeir eny s�ructure, prior to its issuance, elso requires Ihe applicant lor such permit m lile e signeC statement that he or she Is licensetl pursuent to the provisions ol the Contracto�s Licanse Law (Chapter 9(commencing with Section 7000) of Dldslon 3 ot ihe Busineu Professions Code) or t�at he or she is exempt therefrom and the basis for the alleged exemption. Any violefion of Section 7031.5 by any applicent for a partnit subje e applicant to a civil penalry of not more than five huntlred dollars ($500).): . I, as owner of the property, or my employees with wages as their 5ole compensation, WILL DO THE WORK, and Ihe strudure Is not inlenCetl or ottered for sale (Sec. '� 7044, Business and Professions Cotle: The Contracbrs License Law tloes not apply to an owner ol property who builds or improves ihereon, and who tloes such work himself or herself or throU9h his or her own employees, provided that such improvements are not intended or offered for sale. II, however, Ihe building or Improvement is sold within one year of completion, Ihe owner-builtler will have the Durden of proving ihat he or she did not build or improve for purpose of sale.). � O �, as owner of iha property. am E%CLUSNELY CONTRAC7ING WITH LICENSED CONTRACTORS to consWct Ihe project (Sec. 7044, Business and Professions Cotle: The contractors License Law does not appty to an owner ot pmpeny who Duilds or Improves thereon, and who contracts for such pmject wi�h a contracror(s) license� u��o th Contracmrs License Laws.). �am ex pt er se . ' Business end Professions Code for Ihis reason: Signemre: ! C� a-� �('� � , ,, _, .. Da�e: _ Owner ID verified by dnver's license. ,[%fVes� ❑ No�� + Driver's License No.' Venfication of Ownership by (rype oi tlocument, i.e. - property�lax bill or Aeetl): — -_ • � DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity that no ex�avetlon five (5) or more feet in depth into which a person is requireA to descend, will be matle in connactlon with work authonzed by this permit, and ihat no builtlin9 g�Ncture, scallolding, talsework, or demolition or dismantling thereof, will be more then ihirry-six (38) feet Oigh. (Chap. 32, Grp 2, An 2, Sec. 341, Tltle B, Celifomla Adminislretive Code). ❑ As awner-builder, I will not employ enyane to do work which woultl require e permit irom ihe Division of IndusMel Sefery, as noted ebave, unless suc� person has e permit to do such work trom the tlivision. Signature: Date: Division of Industnel Satery Pennit Number: CERTIFICATE OF COMPLIANGE AND AllT}IOF±IZATION OF ENTRV: I cenity under penalty ot perjury that I have read this epplication antl slate that the Information given is correa. I agree to w ly with all stete I ws and ciry ortlinances relating to building constructian, and amhonze representatives of the Clry of Costa Mesa to enter upan the ebove-d��; �pro for in tion urp��l agrea not to occupy or allow occupancy ot eny building authonzed by thi�pA p u�l �s� spection. / � L V I Ii/ SiBnature Of Legal Owner(s) ate , A�dlOr AUlhonzed Applicani COOE I. INSVELTIONTYVE 1676 Fized System Finel Fire Prevention 1266 ; Pool Spa Final , 200 Finel RB-Roof 201 Final BIaWRetaining Well 202 Final Facrory Fira Place 203 Final Sign 204 Finel Demollilon " ' Q� �� CQOE� INSYECTIONTYPE � 206 Final Mechanical 20B 210 212 220 Final Plumbing Final Electncal Final Fire Prevention Final Planning Approval 222 FinelSita 250 Final Buildin9/Occupenq � 1 .1111. �� e l.7G.ti)F� /�'� r August 31, 2006 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 9 26 2 8-1 200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Gilberto MaRinez 944 W 19th St Costa Mesa CA 92627-4146 PERMIT NUMBERS: FOR: PROJECT ADDRESS: 803-02040, E04-01101, M04-00540, PO4-00693 Addition 944 W 19th St., Costa Mesa Our records indicate the above listed permits were obtained for propeRy improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. If you need to request an inspection please cali our Inspection Requesi Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, your permits will expire on September 15, 2006. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goai and we appreciate your working with us to resolve this matter. S'ncerely, ��, ��'.%p-�cJ Mary ane Weidenkeller Office Specialist II Builtling Division (714) 754-5273 • Cade Enlorcement (714) 754-5623 • Planning Division (714) 754-5245 FAX (714) 754-4856 • TDD (774) 754-52<C • www.ci.tosla-mesa.ra.us . T CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job nddress: 944 W 19TH ST Suite: Vicinity: KITCHEN ADDITION @ REAR OF HOUSE Parcel Number: 42252413 Applicant: CORONA, JUAN Address: 2638 W.CHANTICLEER RD ANAHEIM, CA - owner: MARTINEZ, GILBERTO Address 944 W 19TH ST COSTA MESA, CA Contracror: OWN ER-B U I LDER Address: Zip: Arch : Address: Phone: Zoning: Phone: (714) 295-6794 Zip: 92804 Phone: Zip: 92627 Phone: License: 0 Eng: . � � Address: PERMIT NUMBER B00-00088 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 01/21/2000 Issued: 08I77I2000 ISSUED BY: �[`�Y � i�� / 0� � `,� � . � Phone: � Zip: License: License: SCOPE OF PERMIT � CONSTRUCT 483 SF KITCHEN & DINING ROOM ADDITION ATTACHED TO THE REAR OF EXISTING SINGLE FAMILY RESIDENCE. EXPANSION OF EXISTING KITCHEN� � - - � - - Plan Check: $366.24 Permit: $563.45 SIVIIP Res: $4.13 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $933.82 SETBACKS � � MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0. 0 .. PARKING Existina: 2 NOTES: Rear � 23- 0 Rear 0-0 Re uired: 2 FEE SUMMARY PLANNING 8 ZONING Left 8- 0 Left 0- 0 Proposed: 2 Calc Valuation: Claim Valuation: , �, Right 36-0 ' Ri9ht -0-.0" ' Sai,z96.so $41,296.50 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. g2-28, § 1, 72-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetlona end finel epproval must be obtained. Failure to oblain inspections and final approval will result in ihe expiration o1 this permit/ FOH INSPECTIONS CALL: (714) 7545626 / zaauae (arool . / / �WORKEHS'COMPENSAnON DECLARAnON: • I hereby affirm under penalry of pe�ury one ot Ihe following tledarailons: ❑ I have and will maintain a certificate oi consem to self-Insure br warkers mmpensatlon, as proNtletl for by section 3700 of t�e Lflbor Cotle, for the pertarmence of Ihe work for which this permit is Issuetl. ❑ I have arM will meintain workers' compensation insuranca, as requiretl by sectbn 3700 of the Lebor Code, for Ihe perfortnance of Ne xrork fw whiC� NIs pertnit Is Iswetl. My workara' compensalon Insurence carrier entl pdicy number are: Certier. pdicy Number: (This secnar need not be comp/ered u the pemutls velued et one nundred dd�ars (S roo) or less.) ❑ I certify that In the perto�ence ai Ihe work for which thLq pertnit is Issued, 1 shell not employ any peraon In eny menner so es to becoma sub�ect to the workera' compensetlon laws oi Gelltomia, end egree that It I shaultl Decome sub�ect to Ne workers' compensatbn provlslons of Sectloa 3700 ot the Lahor Code, i ahell foMwith comply vrit� t�ese prwisions. Applicant Signature: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION WVEMGE IS UNLAW FUL AN� SHALL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UV TO ONE HUNDRED THIX15PN0 OOLURE (E100,000�, IN ADDffION TO THE CQST OF COMPENSqiIpN, DAMAGES A$ PROVIDED FOR IN SECTION 3]OB OF THE UBOR CODE, IMEREST, ANU ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eXirm ihat I em IicenSeC untler proNsions ol C�apter 9(commendng with Sectlon 7000) oi D'Msian 3 of the Business and Professions Code, anA my license Is In tull lorce antl eXect. Llc. a Cless x Comrectofs Signature: Date: CONSTRUCTON LENOING AGENCY: ❑ I hereby eMirm Ihat iher0 �S e construqion IenEing egenq for Ihe perfortnance of t�e wark for whic� ihis pertnit is luued. (Sec. 3097, Civll CoCe�. LendeYs Name: Lendefs Adtlress: Sipnature: OWNER-BUILDER DECLARATIONS: Date: I hereby e111rtn thet under penalry ol perjury that I am El(EMPT FROM TME COHTRACTORS LICENSE LAW tor the following reason (Sec. 703�.5, Business and Professions Code: Any dry or counry which requires e permit to oonswct, alter, Improve, tlertwlis�, or repeir eny strucNre, prior to iis Issuance, also requires Ihe applicant for such pertnit to file a signed stetemeni Nat he ar she Is Ilcensed pursuent to the provisions of Ihe ConUedors License Lew (Chapter 9(commencing with Section 7000) of DlvLslrn 3 of the Busine and Protessitins, Code) oi Nat he or she is exempt therelrom enC Ihe besis tor the alleged esemptlon. Any violetion of Section 7031.5 by eny appllcant tor a pertnit sub� ihe applicant to a ci4il'penalry at no�more lhan live hundred dollars ($500)J: I, as owner af ihe propeAy, or�my employees with weges as Iheir sWe compensetlan, WILL DO TME WORK, antl Ihe sWCWre is nm Inientled or ofleretl for sele (Sec. 7044, Business and Protessions Code: The ConiraMors Licensa Lew tloes not apply to an owner of properry who builds or improves ihereon, end who Aoes such work himsetl or �erseB or thrwBh his or her own employees, provided that such improvements are not intended or oRered tor sale. If, however, the building ar imprwemem is sold within one year ot c�p�etion, the ownerbuilder will have Ne burden of proving Ihat he or she did not builtl or imprwe for puryose of sale.). ❑ I, as owner oi the propeM• em E%CLUSIVELY CON7AACTING WIiH LICENSED CONTRACTORS to constmct lhe project (Sec. 7044, Business and Pmtessions Code: The contraaors U�e Law tloes not appty ro an owner ol proparty w�o bullCs or Imprwes thereon, end who mmrecls tor such pm�ect wit� a coniractor(s) license oursuant k Eie Contr ctors Licenae Lews.l. ❑ I am exe t un r ec. Business end Professions Code tor this reeson: Signature: � Owner �D venfletl by rivefs licensa. ❑ V No Drivefs Llcense No. Venfication at Ownership Dy (type at document, i.e. - Droperry Wm bill or deed): DIVISION OF INDUSTAIAL SAFET' VERMR CER7IFICATON: ❑ I hereby certify that no ez�eratlw� �h'e (5) or more teet in Cepth imo which a person Is reQulred to descend, will be metle in connection with work euthodzetl by thls permit, and that no Duilding siruCture, SCettdding, falsework, or Oemditian or dismaniling thereol, will be more ihan thirty-six (38) feet hip�. (Chep. 3.2, Grp 2, M 2, Sec. 341, Title 8, Calltomia Administretive Cotle). ❑ As awner-builtler, I will not employ anyone ta tlo work which would requlre e permi� from Ihe Divlsion of Industriel Salery, es noted ebove, unleu such person has e parmit to do such work trrnn ihe division. Signature: Date: Divislon o1 Intlusirial Safery Pe�� Number: CEHTIFlCATE OF COMPLIANCE AN� AUTHOROAiION OF EMIAY: I certily under penelry ol perjury t�at I have �ead Ihis epplicetion entl stete Nat the InfortnaUon gNen is conecl.J'�gr o comp with etl ste x`s antl dry ortlinances relatlng to buildirg construc0on, and auihodze represenietivPs of ihe iry ol Cosle Mesa to enier upon Ihe ebove-IIe jcri prope for Inspesti uoses. I egree not lo occupy or ellow ocwpancy oi eny building authorized by � ormit un � I�,qpecfion. V� � v Sl9net re i egal Owner(s) Date AnNOr Authorizetl Ap011cant COOE t. INSPECf10NTYPE QAIE Q�EL$ 1818 Flaed System Finel Flre Preventlon 1268 200 201 202 203 204 Pool SDe Flnal Flnal RaHoof Finel BIocWReteining H1all Final Fectory Fire PIaGe Flnal Sipn Finel Damolilion �QOEI R15VECTIONTVPE 208 Flnel Mechanicel 20B Finel Plumbing 270 Finel Eledrical 212 Flnal Fire Prevention 220 Finel Planning Approvel 222 Finel Slte . 250 Flnal Builtling/Occupanty (714) 754-5273 • Pe% (714) 754-4856 • Wvnv.CI.COSte-mOSe.C2.uS i i rN�n uni v�, a.w � n mwn, v.. �wcv ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant Address: Owner: 944 W 19TH ST KITCHEN/DINING ROOM 42252413 MARTINEZ, GILBERTO 944 W 19TH ST COSTA MESA, CA MARTINEZ, GILBERTO Address 944 W 19TH ST COSTA MESA, CA C o ntra ctor: O W N E R-B U I l D E R Address: ISSUED BY: Phone: (949)515-9829 Zip: 92627 Status: I SS U E D Applied: OB/17I2000 Issued: 08/17/2000 Phone: *�� Zip: 92627 � 1 � Y � �I�'� Phone: Zip: License: 0 SCOPE OF PERMIT INSTALL 6 LIGHTS, 8 OUTLETS AND 2 SWITCHES FOR NEW 483 SF KITCHENIDINING ROOM ADDITION. - . . � � - - � REF:B00-00088 � ISSUE FEE Temp service test Res. alc.package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a , , Service to 1oo0a � Service over 1000a Motors to 1hp Motors l0 10hp Motors to 50hp Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $6.60 $8.80 $220 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 _ - - -.FEE SUMMARY Quantity 0 0 0 6 8 2 0 0, 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Temp Disf System / Lighting Busway/100 R . Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ...............:up to 10 kvalkw .................up to 50 kva/kw .................up to 100�kvalkw ..................over 100-kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit . Misa Conduclor , . Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand � Other Electrical Fee Investigation Fee Plan Check Fee Reinspedion Fee Quantity $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 so.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 ' 0 , 50.00 0 50.00 0 $0.00 ' 0 $0.00 0 50:00 0 so.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 541.10 COMMENTS I SPECIAL CONDITIONS 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, 12-27-82) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abantloned for a penod of 1 BO days. � INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetiona 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 2416d6 (8/00) WORKERS'COMPENSAnON DECIARATON: I here�y efllrtn under penalry oi perjury ane of iha following declarations: ❑ I have antl will meintaln e canificete of conseN to sell-Insure lor workers' campensetlon, es proWtletl for by section 3700 oi the Lebor Code, tor the peAarmence of ihe work lor wnich Ihis pertnit is Issuea. ❑ I have arW will melntein workers' compens&�on Insurance, es required by secllon 3700 of ihe Lebor CaAe. lor ihe peAormance ol the xroM Iw whkh thls pertnit is lswed. My workers' compensaUon Insurance carne� entl poliq numDer ere: Carrler: Pollcy Number: (This sectlon need nof be comp/ered ll tho permll �s ve/ued e! one hundred dW/ers (5100) or less.) ❑ I ceNty that in Ne pertormance ot Ihe work tor whiU this permlt Is issued, I sha0 not employ any person in eny manner eo as to becane suOJect to Ihe workers' campensation laws ol Califomie, and epree Ihat 11 I should become suD�ect to t�e workers' campensetlon provisions ol Section 3700 ot the Le�or Cotle, I s�all lorthwlth �DN with Ihese provisions. Applicant Signeture: Dete: WARNINO: FNWRE TO SEWRE WORKERS' COMPENSATION COVERFGE IS UMAWFUL AND SMALL SUBJECTlW EMPLOYER TO CRIMINAL PENALTES MID CML FlNES UP TO ONE HUNOqED T1qUS4ND DOl1ARE (5100,000� W ADOrt10N TO THE WST OF COMPENSATION, DAMFGES AS PF�VIDED FOR IN SECfIIXJ 31080F THE IABOR COOE, IMEREST, ANO ATfORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirtn Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Divislon 3 of the Business antl Pmtessions Code, antl my license is In tull torce anA eNect Uc. a Class M Contractofs Slgnature: Date: CONSTAUCTON LENDING AGENCV: ❑ I hereby eHiim t�at t�ere is a construction lentllnp egency tor Ihe peAortnance of the work tor which t�is pertnit is issuetl. (Sec. 3097, CMI Cotle). LenCefs Name: Lentlefs Address: Signeture: _ OWNER-BUILDER DECLARATIONS: Dete: I hereby etlirtn Ihet under penalry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031,5, Buslness flnG Professions Gode: Any dry or county wNch reQuires a pertni� to consWct, alter, improve, tlemolish, or repair any structure, pnor lo its issuance, elso requires t�e applicant lor such permlt lo file a ned statement t�et he or ahe Is Ilcensetl pursuant to the proWsions ot the Contrecrore Ucense Lew (Chepter 9(commendng wlth Sectlon 7000) of DlWslan 3 al Ihe Busin flntl Professions Cotle)'w Ihet he or she Is exempt Iheralrom entl t�e besU for tho ellepe0 ezemptlon. Any violatbn of Sectlon 7031.5 by eny appllcant far e pertnit suD' cts the epplicant lo e dvil penelrypf not more than tive hundred dallars ($500).): , �v r„L / i. i, as owner oi the property, or,my employeas with wages as iheir sde compensatlon, WILL DO THE WORK, antl the struc[ure is not intentled or ottereG for sele (Sec. 7044, Business antl Professions Code: ThB Coniractors License Lew dces not epply to en owner of property who builtls or Impmves tliereon, and who tloes such work himself or herselt or Ihmugh his or her own etnployees, provided Ihat such Imprwements ere not Intended or oflereC tor sale. It, however, Ihe buildinp or improvement is sold within one year of completion, the owner�buildar will have the burtlen at praving that he w she did not builtl a improve tw purpose of sale.). ❑ I, as owner of the properry, am E%CLUSIVELV CONiAACT1NG WRH LICENSED CONTRACTORS to construd the proJecl(Sec. 704a, Buslness and Profeulons Cade: The convecrors LI�,ensa law does not eppty to en owner of properry who �uilAs or impmves iherean, entl who contracts tor such proJect with e conirector(s) license oursuanLtn the Cbntractora Liceos� Lews.). " ❑ I am ex��n�l set� Signature: � { Owner ID vetltletl by drivets Iicense. Ye9 ❑ No Business and Prolesslons Code tor Ihis reason: Varllicatlon ol Ownershlp by (type oi Cocument, I.e. • praperry te�c bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON: Drivals License No. �pires: ❑ I hereDy ceNty Ihet no excevatirn fNe (5) o� more teet In depth Into which e person Is requlreO to descenq wlll be made In canneclion with work euthorizetl by this pertnit, and that no 6uilding struclure, scattolding, felsework, or tlemolition or dismanUing Ihereof, will be more than �hirty-six (38) teet high. (Chap. 32, Orp 2, Art 2, Sec. 341, Tlile 8, Celifomia Adminlstre0ve Codej. ❑ As owner-Cuiltler, I will not employ enyon9 to do work w�ich wou10 reGulra a pertnit Irom Ihe Division ol IntlusMal Safery, es noted ebove, unless such person hes e permil Io do such work trwn Ihe tllWslon. SignaWre: Data: Division of Indusirial Safery Permit Number: CERTIFlCATE OF COMPLJANCE IWD AUTNORIZATON OF ENTRV: I cenity untler Denelry of perjury that I hava reatl this appliCation end stete t�at ihe Inlormatlon given is wrrecL I epree to compy wit II stete lews end ��ry Mlnances reletlng to Dulldlnp construction, enC authorize reDresemetives af the Ciry oi Caste Mesa to enter upon the ebove-descnbed prope , tor pectlo puryoses oe nat to occupy or atlow occupancy of eny builAing eulhodzed by Nis pB� �uyntll fl�l� �tlon. O� / Signature Ot Legel P r(s) ata And/Or Authorized APPlican� Date COUE I, MSPECTpNT1PE 1616 Fixetl Systam Final Fire Preventlon 1266 Pool Spa Final 200 final Re-Roof 201 FInaI8lock/Reteining Well 202 Final Feclory Fire Place 203 Final Sign 200 Finel DemdlUon ueiE e�e� CODE 1 INSPEGTION TYPE 206 Final Mechanical 208 Final PlumDinq 210 Final Eleclrical 212 Final Fire PrevenGon 220 Final Planning Approvel 222 Final5lte 250 Final Bulltling/OccuperK.y � �� Y (71 a) �sa-5273 • Fax (7� a) 754-ae56 • www.cLwsta-mesa.ca.us 77 FAIH DHIVt, GUJ I A MhSH, GA `JZOCO Job Address: 944 W 19TH ST Suite No Vicinity: KITCHEN/DINING ROOM Parcel Nunmber: 42252413 Applicant: MARTINEZ, GILBERTO Address: 944 W 19TH ST COSTA MESA, CA Owner: MARTINEZ, GILBERTO Address 944 W 19TH ST COSTA MESA, CA Contractor: :OWNER-BUILDER nddre55:' Arch / Eng : Address: PLUMBING PERMIT Phone: (949)515-9829 Zip: 92627 Phone: Zip:. 92627 Phone: Zip: License: 0 Phone: Zip: License: Status: ISSUED Applied: OBI77I2000 Issued: 08/172000 ISSUED BY: � t N y� �y'/� � � s ' �� ` SCOPE OF PERMIT INSTALL 1 KITCHEN SINK FOR NEW 483 SF KITCHEN/DINING ROOM ADDITION. REF:B00.00088 ISSUE FEE BackFlow irrigation BackFlow Preventer�� Bathtub Clarifier System � Connect (Ice,Soda,etc) Dental Units � Dishwasher Drain, Floor Drain, Rainwater Drein, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over a outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 SO.OQ so.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 Qn FEE SUMMARY " AMT Laundry Tub / Washer $0.00� landscape Irrigation $0.00 P-Trap 50.00 Pressure Regulator $0.00 Process Piping (per 10 fl) $0.00 Receptors � 50.00 Septic Tank $0.00 Sewer Cap for Demo , �$0.00 Sewer Connect � $0.00 Sewer Private Line 50.00 Shower � $0.00 Sink, bar $0.00 Sink, commercial " $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, servicelmop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTV 0, .' ' 0 0 0 0 � 0 0 0 0 , 0 0 0 0 0 1 0 0 0 COMMENTS I SPECIAL CONDITIONS Sump Pump Swimming Pool Trap Primer � Urinal - - - � Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 50.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $o.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: E33.30 an 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or ii work is suspended or abandoned tor a penod of 180 days. INSPECTIONS: In orcler tor ihe work authorized under this permit to be considered legal, such work mus� comply with all applicable codes, and all requlred Inspeetione and final approvel must be obtained. Failure to obtain inspections and final approval wlll result in the expiration o1 this pertnit. FOR INSPECTIONS CALL: (714) 7545628 2468d8(BNO) / WORKERS' COMPENSATION DECLApATION: I hereby eKrm untler penelty of perjury one oi Ue lollowing tleGaretlons: ❑ I have erM will malntein e ceNflcate of consent to sefl-Insure lor workers' compensation, ea providetl for by sectlon 3700 ot Ihe Lebor Code, br the pertormance ot the work for which Ihis pertnit is Iswetl. ❑ I have arM will mainlain vrorkers' oompensation insurance, es require0 Dy sectim 3700 ot the Labor CoOe, for the peAormance ot the work for which ihis pertnil is iswed My workere' compensatlon Insurance cartier and pdicy numDer ere: Certier. Poliry Number. (Thls sectlon need nor be comp�ered R rhe permir Is va�aed et one nundred dollers (8100) or less.) ❑ I certly ihet In the peAormance ol ihe work for which this pertnit Is issued, I shall not employ any peraon In eny manner so as to 6ecome subjec� to the workers' compensation lews ai Caltlomia, fln0 egree Ihet ii i should becwne sub�ect lo t�e workera' canpansatlon pmNsions of Sectlon 3700 of Ne Lebor Code, I shell forthwiN compty wlth Ihese 7rovisions. ApPlicam Signeture: Dete: WMNIN6: FNWRE TO SEd1RE WOfV�RS' COMPENSAT70N OOVFRApE I$ UMAWFUL iWD SNAL� SUNECf AN EMROYER TO CRIMINAL PENALTES iV1D CML FlNES VP TOONE HUNDRED THIX154ND �OLLME ($100,000� IN ADORION TO TME COST OF QOMPENu�TpN, DMl4GE5 0.S GROVIDED FOH IN SECiION 37080F 7HE UBOR OODE, INTEREST, FND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm that I em Ilcensed under praWsions of Chapter 9(commenGng with Sectlon 7000) of Dlvision 3 0l tha Buslness antl Prolessions Cotle, and my Iicense Ls in full lorce and eflect. Llc. a Class x ContracroYs SlgneNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that t�ere is a constructlon lending agen�y for Ihe peAortnence ot the work for whiCh this pertnit is Issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lendefs Address: Signeture: OWNER•BUILDER DECLARATIONS: Date: I hereby attirm that under penalry of perjury t�at I em EXEMPT FROM THE COMRACTORS LICENSE LAW for Ihe tollowing reasan (Sec. 7031.5, Business entl Professions Code: Any city or counry which reQuires a pertnit to construct, elter, impmve, demolish, or repair eny strucWre, pnor �o its issuance, elso requlres ihe epplicent for such pertnit to flle e signed statemanLtliet he or she is Iicensed pursuant to the provlsions at the Camrectors License Lew (Chepter B(cammencing wlih Saction 7000) of D'Msion 3 ot Ne Business flnd Profession's'Co"de)'oi,ihat he or she Is exempt therefrwn antl the besls for t�o elleged exemption. Any Nolatlon ot SecNon 7037.5 by any epplicant for e pertnit subJe the epplicent to e dW perialry' ut rrot more than tive hundred tldlars ($500).): I, es owner ot the ro �� p parry, or iny employBes wilh wages as Neir sola compensaUon, WILL DO THE WORK, and the structure is not Intended or otferetl for sele (Sec. 70E4, Business and Pmtassions Code:�The Coniractore License Lew dces no� appty to an owner of properry who builds or improves thereon, anO who does such work himselt or hersetl or Uiough his or her ovwn;eiriployees, provided Ihai such imprwements are not intended or oHereC for sele. It however, the building or improvement is sold within one year of wmpleGon, ihe owner-builder will have ihe burden of proving that he or she tlitl not build or improve for purpose of sflle.). ❑ I, as owner of the properry, am E%CLUSIVELY COMAACTING WITH LICENSED CON7RACTORS to canstruct the project (Sec. 704d, Business antl Professions CoCe: The coniractors License Lew tloes not eppty ta an awner of pmperty who bulltls or Improves ihereon, entl who coniracis tor such praect with e contreqor(s) license puy�uary�to Ihe Qbniractors Lic�nse Lews.�. , ❑ I am ax �t u er se Business end Professions Code ior this reeson: Signature: � e • � , Owner ID verified Dy drivera license. ❑ Ves ❑ No Dr'rvers License No. Verificetion of Ownership by (type of document, I.e. - property �az DIII or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFlCATION: ❑ I hereby cenily thaf no escavation Me (5) or more feet In Oepth into which a person la reQulretl to descend, wlll be matle in connection with work authorized by ihls permit, and ihat no Duilding structure, scaHdAing, falsework, or demdition or dismentling Nereof, will be more Ihan ihirty-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calltomia Administretive Cade). ❑ As owner-bullder, I will not employ enyone to tlo work which would require e permit trom the Divlsion ol Industnal Safery, es notetl ebove, unless auch person has a pertnit to do such wwk Irwn �he dlNSion. Signeture: Date: DlWsion of Industnal Satery Pertnit Numbar: CERTIFICATE OF COMPLJANCE D AUTHOHIZATION OF ENTRV: I cenity under ponelry of perjury Iha� 1 have read thls epplicatlon entl state I�aI Ihe fniormetion given is corcect I egree to comply �y� el tete la s end Gry o dinances reletlng to bullding construction, and euthonze representetives Qf Ihe CI o1 Costa Mesa to enter upon the ebove-Uescnbed property 6�ns Uon p rpaaes e nal to occupy or ellow occuDency of eny building euthorizetl by this Aper�/ju ue.n�til f el inspection. q " /7` /-� / �i� Si mre Ot Legel er(s) -�� Date Antl/Or Authorized ApDlicent Date GOUE �, MSPECl10NTYPE 7618 Fixed SyStem Finel Fire Preventlon 1288 Pool Spe Flnel 200 Finel Re-Root 201 FIneI BIocWRetelning Wall 202 Final Fectory Flre Place 203 Finel Sign 204 Finel DemolWon �g � COOE� INSPECTIONTYYE 20fi Finel Mec�enical 208 Finel Plumbing 210 Finel Electdcal 212 Finel Fire PrevenUon 220 Finel Plenning Approvel 222 Final Slle 250 Final Building/OCCup9nCy PdIE Q�ELfl F � L a .y. y T F C W F l .d a > } .J a � o. 0 � a z{y S 3 ^ � �Y t} 'U . .-�, COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use [nk Onty OWNER nvvl+tss l-7 �1 W < < \ � 1 CITY G O.i�t► �' NOL 7S BRANCH AOORESS TEL. CONTRACTOR ADDqESS �J TE L.�� CITY�iY..yrJAz��n NO. • STA7E CITV LIC. N0.3 ZZ-q � IIC. NO. 512E � O NO.OF BLOGS. OF �OT � x 1� Q � NOW ON LOT i USE OF �vJCta'l`fG' E%1571NG BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUIIDING AND WORK TO BE P�RFORMED _G..o •/��/i' �la�i iL FOR STRUCTURAL PERMIT A.P. NO.[/ �'j ' / 7 � � BUILDING AODRESS �- TRACT �� 9 ZONE ( NO.OF I �� PV1P6 � VAFOSAPPROVED DbTANCE6Ef MAIN BLO(;5. VAR. � I horaby eeknowletlpe that I havo reatl t�is applicntinn antl arote ihat t�e obova information Is corract anG ep�ea t0 eomply wlth ell law� rap�latln9 builtlinB conrtrucHon, antl I sholl not amploy eny perwn In vlolation of the warkman's compansetion lawa of Ma $teia of Calitornla. I he�eCy certlfy that I em praperly Iicanaed uz a co roctor untlor tha Btpte of Ce�Ifornie Bu�iness nntl Profa om Ca , Division 3, THE AMO Chepter 9, end thet �ueh Ilcensee ere in f II� tl etfect, or I iNE PURP( em examOt }rom the provliions of the St � f Callf Businea VALVATION antl Profossi Cotle. Dlvifia hn�ar . SlqnBtun of �J /� Permittae S J( L LJ� Authori:etl Apant PERMIT NO. :�,� J / _ K VALUE USE OF NEW BUILW fJG �� VARDSAVPROVED ACCESSORV BUILDING T/C /�rI'fFT �7VGL 19S P�2- BET. MAIN & ACCES'.a. BLD �� S .� VN UNDER VALU 'ABL6HING A VERI PERMIT FEE E PLAN CHECK S TAX S TOTALPAID S Costa Mesa Building Department APPIdCATION FOR PERMIT --' .' 111 EAST 20th &TREET �$ g U I L D,t N G ' -�.. � +++ COSTA MESA, CALIFORNIA FOR APPLICANT TO FOR OF�'ICE USE ONLY e eipt No. . Py,r�ml't�N�o Bullding � / / Addross ' Costa Mesa, Ci&I1fOTllla, Received by I DaSe Rec'd. I Date Issue F'S7 rcss Address Costa Mesa, California Nearest rvo. zone rvo. ot // Lio. Plans �KiLLee� No. Aooroved Description I No� 3S � I^B�ock I Traet/% (Attach Metes and Bounda) No. of Bldgs &ize oi Lot ��o j( f i Q Now on Lot Uxof No.oT No.oi Existing Bldg. Familles Rooms SetbaekLfnefrom 5 RearVard 35 Center of Street S 31de va�d C_ X Addition a S.Y �! 8�Rooms � Stories l Roof arPxovAr.s Foundation Loeation Inspecto Forms, Materials, Under-Pinning Frame: Fire Stops, �I hcreby acknowledge that I have rend this Applicatlon Lath. int. and stnte that the abwe is correct end agree to comply Lath. Ext with all Clty Ordinances and State I.aws regulating building construction. Signature of Plaster, Int. Permittee � • _ Plaster, Ext. Authorized Agt. Masonry Rel Valuation Permtt Fee $ y Go Plan Check $ � Bond Beam S � 3 $"f / Total / � Fee $ � ��_ FINAL .\enwu �na r..0 vu a_sa z � Z D � p. � Show locatlon and distanees Trom . ' property Iine and between�buildinga ; , � . - ". : ' - � . . . r , . . � I . r' ,. i 1.i i : �I! . . . ' . . . � . � \, 1' . .. . . � f a. � . - : • .) ,f �- � �\ - � _ . � � \ � ` � . � 1 � � l _ _ � . _.. _ ___ _ . . . _ _' , �� . . .L � . .r . � _. .. .:i:, _ .. , , !c . hn . . _ .. '� / a .. - . � v: '. . . ... . . .. . . .I1 � . i `� . � • _ t: � r � ; ' . . . _ �. . 11 ' . • . i_ ,,�, .. ti' .,) ' " � �, . � . . �)-.� .. . - : - — � 1 —' _ ' _ - ; " _ _' � ' ' . ._ . . — i . . ' _ . .'` . j ' . ; „ ., � , �