HomeMy WebLinkAbout1016 19TH ST - Building Permitsf
(714) 754-5273 • Fax (714) 754-4856 • www.cLcosta-mesa.ffIJ1LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1016 W 19TH ST
Suite:
Vicinity: FRONT AND SIDE OF SFR
Parcel Number:
42253225
Zoning:
Applicant:
VALLADARES, JESSE
Zip: 92627
Address:
14039 SHERMAN WY
Permit:
Address:
SUITE 102
Phone: 800-441-1758
SMIP Res:
VAN NUYS, CA
Zip: 91405
Owner:
WHITE, MITCHELL C
$0.00
Address
1016 W 19TH ST
License: 740295
Arch : Eng:
Address: Address:
Phone:
Status:
ISSUED
Phone:
03/10/2003
COSTA MESA, CA
Zip: 92627
Contractor:
ALL STAR REMODELING
Permit:
Address:
14039 SHERMAN WY
Claim Valuation: $1,400.00
SMIP Res:
SUITE 102
Phone: 800-441-1758
VAN NUYS, CA
$0.00
Zip:
91405
License: 740295
Arch : Eng:
Address: Address:
Phone:
Status:
ISSUED
Applied:
03/10/2003
Issued:
03/10/2003
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
STUCCO OVER EXISTING SIDING IN THE FRONT AND SIDE OF A SFR.
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required 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
er;"
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: $7,400.00
Permit:
$50.95
Claim Valuation: $1,400.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$51.45
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0
Rear 0-0 Left 0-0
Right 0-0
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Right 0-0
PARKING
Existing: 0
Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required 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
er;"
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
I have and vNl maintain WwleeIS, drupe as req ' by section 3700 of the Labor Code, for the performance of the work for which this penNt Is Laved.
M workers' cern naafi rv( Ra r�d///°°/r and number re:
C rder:y Yb� (- Policy Number:
(This section need not be cornPVsd It the perm! Ns valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the ped enc of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws o Celifomi , and a roe 1 I It I a Id become subject to the workers' compensatlon provisions of Section 3700 of the labor Coda, 1 ahall forthwith
comply with these pr ions. Data: � )� (()I V
Applicant Signature:
WARNING: FAILURE TO SEW RICERS' COMPENSATION ODVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AAD CML FINES UP TO ONE HUNDRED
THOUSAND DOLIARE (5100 I, ADDITION TO THE 0057 OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ODOE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTO DECLARATION:
I hereby affirm that 1,
can ad under provisions of Chapter 9 ( mmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full
force and effect. Uc. N Class M
Contractor's Signature: Date:
CONSTRUCTION t7DING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
_
I hereby affirm that under
penalty, of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provislons of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DMSion 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pemdt
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend. will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such won, Ifom the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or pres�nt or future building occupant need to file and car ity a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a re red year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard Temperature and pressure).
...................._......................_._................__..__..........._.._._............_..__�......tneed_....file......._...................__................................................_.__.............___.. ..._.__........ __......___._-
2 Dces or will the aDPlicent or present or future building occupant need to Tile a regisiratlon form for acutely hazardous meterials7 ❑ Yos ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the appplicant or present or future building occupant need to preDere en RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes 13No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............................................._............................_.._.._._......___.._..._.................._........................._................................................................................................... ..................I..........................._..............._.__.............._
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No
.........................._........................_..................__.__._.___...................._................................................................._.................................._._...._.._......_..........._..._...........__..__................_.__........____...........
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apomit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? B Yes a No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
(If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade).
7 If a permit from the South Coast Air OualiN Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
_._....__....._..._._.....—.__. _...._....._.._.................................................._.._......_.................. _—____..
8 (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. 1 agree to comply with all state taws and dry ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application and state that the inlomlation given Is
correct. I agree to Ope with all state laws and dry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described operfy
or
inspectlon purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
r O gal Owner(s)
Anci/Or Authorized Applicant Date
CODE 1INS01515-TIONTYP 1NTrnA CODE,L INSPECTION TYPE QA3 INTMA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Buiif ing/OCxarpancy
CITY OF COSTA MESA
BUILDING DIVISION
F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754.5626 ��
PERMIT NUMBERf BX07-00026
PERMIT TYPE B_MISC
STATUS: ISSUED
DATE ISSUED: 07/17/2007
-
ISSUED BY: BJK
JOB ADDRESS: 1016 W 19TH'ST CM--
Suite/Unit:-`' ,
Vicinity: MASTER BEDROOM, . '':
��;-,-.'`'�
Pr Mary Occ: Const Type:??
SO. FT: 0 ''Valuation::,
$2,000.00
„i
SCOPE OF WORK: INSTALLATION OF A MASTER BEDROOM BAY WINDOW ON THE LEFT OF AN EXISTING SFD. WORK TO
INCLUDE CLOSURE OF AN ADJACENT WINDOW.
OWNER: WHITE, MITCHELL C; _
Address: 1016 W 19TH ST Unit:
PHONE:1' -
. City/Stale/Zip: COSTA MESA, CA
APPLICANT: WHITE, BEVERLY 1
Address: .1016 W 19TH ST Unit:
PHONE: 949-646-8963
City/State/zZip: COSTA MESA, CA
CONTRACTOR: OWNER -BUILDER
License No. 000000
Address: Unit: -. PHONE -
City/State: , ••-1 - ZipCode:
CELL: ,
ARCHITECT: _ - License
No. - PHONE: -
ENGINEER: License
No. PHONE:.,
MISCELLANEOUS PERMIT FEE SUMMARY.:
Building Plan Check: $45.01
Building Permit: $69.25
Electrical Permit: -$0.00
Other Fee: $0.00.1
SMIP Residential $0.00
SMIP Commercial $0.00'
"
TOTAL FEES $114.26
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval vAll result in the expiration of this permit.
�F it. INSPECTION TYPE DATE INIMALS CODEj INSPECTION TPE gATE INIIMLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place - 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penally of perjury one of the h,—wing declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers`
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(Thaseclvl neednotbemrnp@teddineperrretd vaNMofinehundreddadam(5100)crfes )
Policy Number:
I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the wor ers' compensation provisions of Section 3700 of
the Labor , I all 1 th comply 'th hese provision
r
Applipnrs Signature Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and
my license is in full force and effect.
Lic. #
Contractor's Signature
Class #
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code),
Lender's Name:
Lender's Address:
Signature
OWNER -BUILDER DECLARATIONS:
I hereby affinn that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
III dred dollars ($500).):
7hs owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovirer-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the.property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
Owner ID verified by driv. ase.IvYes ❑ No �y
Driver's License No. Expires:
Verification of Ownership by (typ ment i.e. -property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this pernit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty -sic (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or vAll the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required. has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be fumished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? []Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances; regarding Hazardous Materials and Emissions.
Signature,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally of perjury that I have read this application and stat t
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
� 0� era ILe9al ifs
Sig Lure Dale Dm/ J
apT )
ViWix Autha ted Applicant Aiine
ADDIRM Of, BURD010: 1016 W 19TH ST UNIT:
MOVSKUPIEDIGIDW HARLICH, SHERWIN
ADDREst
1016 W 19TH ST
COSTA MESA,CA 92627
642-4441
OPL. MUNG ADDRESS
ARCKRECT OR ENONEM NICN0.:
NICK OR ENG.'S ADDRESS: UNIT:
CONMACTDRS KUM
CONTRACTOR'S YAIUW
ADDRESS UC ND.:
UNIT:
LICENSED COWRACTORS OECLARATIOW I h lsI Y affam -der palmy d prjoy Shat lean Soarued briar Po ISO d Chep- 9
(ahmmendtq rob, 5 -Yon ]000) d Oivbon � d Na &®erns rod Pmlmebu Cods. W erns/ Tmtm b in hA bra -d MI -1.
CITY LIC. NO.: UC. CLASS: LIC. NO, EXP :
Data: Contractor:
OWNER BUILDER DECLARATION: 1 hereby affum under paned, of parjry that I atn stump from tlt Contractors License Mw for the
lowkh9 amen (Seoion =IS Busi aW and Plolmeom CodA: MW Cry or o unty which roWi ae • prmY Io mnWc1. a., improve,
nob,. or repair any atnhctua: prior to its bounc, ebo repMm tM app6rara for mrM prmY to file s gyud ualenrd Itud M or dhe
licenvd praaud to 1M pmoe,bm d Sr Cmtud-a License law (Chap- 9 (mmmenehp Wh Sma inn Y000) of DNbian 9 of IM
Beeaham and P na ae'ver Codel or Wu M or co is exempt t, -ah -n and IM Mis for tM aMped mempion. My violation of Ssaion
7001.5 by APy apPIWW for a Pannt attltjMa IM appG to a civil pen t y of M man then free hundred dollen RSwD.
Qi 1,mOrwdtaMop" or W mpbrea,n,h aapea m WAh anis mmPeroadoa. Wa do Sr wok erN Sw rnpMe is M Wended
or oRered far wins (Serson YOU, Bh®wa and Prdmaioo Code: The Ceraraoon Liomom taw dose not apply to manwd property
wM Wide,- mproaa IMnon. atd atb dose auW cork I naafi or MnsY or Waugh his or Mr own mhpnaw, provided that each
'vngwemmb Aro M horded ar dilated f- ask. S. however, We building or inpownwY is sold whkn one treat d otmplalm. We
O wonkier wa Mom tM btndan of proang M or and did M bald or Wp for Su prrpass of eala).
1. as Oavw d the or p". Ann mdh®vdY mdMih9 wdh mmeooa b mhmup Ns pV-a (Swbn 70-. a... and
Protea acamt Code: TM Comredm liranaA law dons M Owner d m>omv rob bu0da - Ihersun and ado
0000eco to, r wgeoa aSh a mrdrapr(A) Sceroed t Cerarw-a llorw law). �/ ,/ v
P I em mmol UMat Section: B. S P.C. :� �/ /. // %
rby crWy tfu I Am awua of And uWardand Ws nadrraerm AN CaUomb HseM And Safety Coda Swiw 25505.95 ST 3, and
ad Wat l or my Man bddap soaped wilt / will M (mole ans) mad to CoW ly "h mid seta Codea and IM mRuhenhaw for
frmhwoudbner moddhMimf atlMA 7 -up-Ma DmM.Reaid-htidconYnwfwh A00Enli are aacmp lr-n them
Data: APpbad:
WORKER'S COMPENSATION DECLARATION: 1 Mrabf effar oder PerutlY of Pel r" one of the kAOWinp drUAratiOm:
Code W tilme�Aeihec-trfor Nh aMLoue I. iwuad. mnprmtbn.m probed for by6Wvh 07004Ur lobo
COM, l- tM p-l-muce d IM w -k t- WSA 90 perm's mood.
0 I Mm and e l mo mein W doa '. brhmeerhn, as nRuhM by Section 3700 d d labor COM. be, the PWermerhn d IM
work
for which One prom is meed. my wabra' mhparuation ioureme redN and PoSCY comber an:
Card-:
Pavy Number.
(Ohio moot need not be cmaplwd I the Perrot at b one feadnd bynn (SIM( or h -J
t,aotWI nshh Sul in Ws perlomumm doraIaW of .Bonas av ,i anhplvf rry OraM b coy mmuw se m to
omr,a tuon o 1.nn WA wbn' mnp0 of the tem C CeMerria end qse Shu Y I shse oWeats mblact to IM worYArA'
mrnpmmatian prwbim a Swbn 0700 d ur labor code. I aAN farbwbh ovmpl/ with tlbe,A prodtloro.
Warning: Fall" b ascan Wlk-i mnVeraedOn coo -elle Is mt~" And slrtll - 1K an mployer b cctdnW PeneNles-d
CIO OMs W b -n htndred tluua-d "Reg (SI04=X In addition b Ow coal of MmpamelbM1 dearegW W pevMed be, In
Bead. 3m of SIA Labor Cob, WhrseL Arai "flarn 's Isms.
CONSTRUCTION LENDING AGENCY: I hereby effirn ordr Pmatly of Perim that Uwe ie e mrutnation lerdhp g7ane/ be, 1M
psrhxhmrca a IM wk for w Wb prmY b btoad (S'Won ]097. Civ. C).
LENDER'S NAME
LENDER'S ADDRESS:
I cw* jr, I fins read Oda app,,,oh and an, that Sb above fide mann is maw. I apse to oom* math m dly and mealy ord rartoes
and Wao lawn matin to building mmahrctim and hrebY euNOrbe npnaedaYma of thio otyio order upon tM d-aadionad Prop"
for impedbn p,poaee.
MARTHMARLLCH,
(515146 W P) WMe_Bdbiq A Salm,, Omwo i -F e: Cmuy-Appka d: P k-Planwte: Oddenrod-Nmsw
CITY OF COSTA MESA - BUILDING PERMIT'
PERM NO: B 082 1081
PERMIT NO: B 082708 PLAN CHECK NO: 01764-97 L GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: ALT
1
JOB DESCRIPTION INSTALL BATHROOM AND WINDOW SQ FT: 3,500
CLAIM VALUE: 3,500,00 CALC-VALUE: 3,500.00 GROUP OCC: R-3 /
COMMENTS: "RESIDENTIAL IMPROVEMENT
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN
PARKING REQ: PROV: PARCEL: 42253225 ZNE: R1 REF NO:
PLANNING NOTES> INTERIOR REMODEL, ADDITION OF WINDOW.
>
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 DATE:
BUILDING APPROVED BY C nc- DATE: _IZI I
APPLICATION ISSUED BY: cxfDATE:
LEGALIZATION:N F E E S U M M A R Y STRUCTUR'AI, SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 87.25 .50
SMIP/NON-RES
PLAN 56,71
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 87,75 0.00 56.71 144,46 144.46 .00
REVENUE DIVISION TOTALS--> COLLECTED: 87.75 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
87.25 .50
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3500 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 3,500.00
END OF FEES
05-02-1997/03:02 PH/07.75
RCPT#:01-0565775
PERPIIT:082708
t
D VSTRUCTION AND PLANNING
-A� ROVALS Permit #--�- Date
-
Inspector
POr ' SPA
APPROVALS Permit #
Date
Inspectof I
1. 1Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms��
4. Electrical Conduit-Undrgrnd.
Y-
55. Electrical Bonding
5. Steel Reinforcements
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. -
/
57. APPROVAL TO COVER•GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
. '.
9. Water Pipe-Undrgrnd.
`
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
% t
62. Backwash &Receptor -Final
12. Sewer Cap
i,
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
•1
66. Solar System -Final
16. Rough Electric Wiring
'' 1
67. Fencing & Access Approval
_
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
_
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas OOil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30, Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
-
37. Final Factory Fireplace
38, Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
(f748.
FINAL PLANNING
49. Electric Release to Edison
r
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
AOD F550FS1r00NO: 1016 W 19TH ST
EIFIDIONIL HARLICH, SHERWIN
`°M ESi 1016 W 19TH ST
COSTA MESA,CA 92627
642-4441
MPL. IWDNG AODRFSS:
ARCIIRECT OR ENGIN6J1:
ACK OR END'S ADURE59:
CONRIACTORS Kum
CORTRACTORSMNLM
ADDRESS:
UNT:
IIC.NOa
um.
INC NO.:
M.
LICENSED CONTRACTORS DECLARATION: I hereby affirm undo, pre,ly d pwpmy UW I we fawned ceder aovau of CMgr S
(oammanerq wtlh Section 7000) of Division S of the Buainms cod Pmlmrorle Code. eed my loen.s is in f W fees rd effect.
CITY LIC. NO.: LIC. CLASS: LIC. NO,: EXP:
Owe: Cod.gw
OWNER SOLDER DECLARATION: I hereby elfin urdw penalty of erjuq that I we .,I M1«n IM Corthadm license law for the
Idbwig nesw (Section ]OsSIS Bmile.and P.lemiau Code: Ary cry a oowMy which requires a prmS . ooromr; clear. knprme,
damp . o rapek wIy awcIce. poor to ws'wwenm, aiso remurm the eppl'Irad for weeh parmw to Ma a w7ad ww mems 0W M or she
keweed Peewwa to the paweptew d the Cadrectr. Licerve low IChegr 9 (wnunencong with Section 7(00) d Divide. g d the
oeineee sato Prdwuru Code] or the, he a she . emmpt Ihwelnan end IM basis b the Mapd a:amgion. AM violation of Section
7951.5 by w, a~ Ir It prow subleas IM applinWa to a cW penalty of nol mos then five IevsSed da0en R50c]R•
0 I,mowner d the poperly m M co to eiMh wages m their sols mmpemation, will ddtlw wak, end the etructwe is not Wrded
a dated W sale (Section 70W t. Budrom cod P.lmd«w Codd: The Codnotm Lcage low does ow eppry to en ow,w dpmprly
who Mads a inpree theem. and who dome such walk Mrud or heed or through his or her oven wo ouy.m. povuded that such
impronrnwm we not Wended or db.d la sib. 1. Mwevr, the Width; a wnp owehom is wk wchm ane yaw of mmplelbn, the
ownenMlder
will leve the brden of provkg M a eh, did not boll a W«oe la IM pyre of sele).
❑ 1, m owlw d the perry, we.&.ivol/ aovactm= mMecbn W ornlrW IM pe ed (Sed . 7 . ewinma eM
Prdemi«N Code; The Codre ten L. Lew does o oww d poLpgMr/yw�M 4dds a' it.. rd Mn
corwrn to woch pr*M wuh It coneeawte) fcw wwe nI Comwowe..e-FLaw) 0
f7.+Lem ammo u,der 9icU(n:A i B. .C., b r
Candy Nat 1 we awe. of end undernrd the regw.m.rm d CaOw is Hedh and Safety Code Section 258c)5. 25500, wd
Me, 1 a my hove biking wpew will / w0 not (duck aro) need k cw.pll' with mid get. codes and IM rmwreme,m for
Code: Applcar:
WORKER'S COMPENSATION DECLARATION: I hereby affirm nde, penalty of parlay oro of Ne blowing dedddiom:
❑ Cade. to the padpmmuedNe waklor wNNtoi mme we,i oomperodbn.m prwMMdla by Sagv157pldiM Lelor
❑ w*61 whit maWwr d it ect wd. My ion lwwwm, m regkwoewh Section 0]al d dw Lebo Codd. feat Ur pedrmerce d lM
work 1« wlddt Iia pwmw is imued. MY merlin' eomprNatbn'vrw.wm mnier rd PdcY nanbw w.:
cwdr
pricy Nambr.
h(4 eectlm need al to crnplred)the ywmd w/a oroW aced cbl .1$100/o/w.)
❑ twowhe eubpga the wakees' Icoe Vorwdipn laws of Cdl«de. and ' 1 and npl aI sou arty Perm b any 1. the w fw I'
epees Ike, i I howek buns wbleg to IM worlan'
coe.peruelim pegvisvu d Setlion 5700 d iM Labor Cods. I .hd lonhwkh conal with rime p.visvg.
Date: Apdcmt:
We tkV. F"we . weans webs' cwep.medon cove.pa Is tod"Ald and ehell dONcl m rrWPloysr to Cr wowl Penafdm sato
eMl Orw W he one buM/.d theowtd do0er. (SIM0001 It, nwydlden . the amt oy ccoolowoclOW1 derne9N IN p.vltl.d roe In
8.0. JIM .10. Leber Code Id L end anom.y. fw.
CONSTRUCTION LENDING AGENCY: I hww, aNm under penelly of Perjury IMt IMn b e mrW.dcn lWnddg peney for the
",for.. of IM wok la which Ihb poi is issued (Section 0097, Cb. C).
LENDER'S NAME
LENDER'S ADDRESS:
I c"* IOW I hww teed, this epFimhrt W gate Illd the above WonvMn is oorrw. I elm to corn* with d dy wd coeuey aEkwlom
and rola hem realnp to buibig oo u snd hereby eu0wraa eePrwdelivm of Nb city to mw upon IM ebws.memioned«opeM
r"
MARTH IIAR7y1'%!f
Dde: ?��:yAft
(515146.WP) mit.431 I TDgr& Safety: Gate ,R.: Canvey- ppiran: Rnk-Rwaew; ylMw d-Aasama
CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: P 08271
PERMIT NO: P 082710 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: PLU PURPOSE; ALT
JOB DESCRIPTION h1 ^^-:d SQ FT:
[E�ogU2.tiio� off' �RTa'Q�
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
COMMENTS: "RESIDENTIAL IMPROVEMENT REF:B-82708
###############################################################################
Z 0 N I N GS ERT E B Q A U C I K R S E M E N T S
------------ MAIN BUILDING ----------
---------
ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN
FRNT;
FT IN REAR: FT
IN
LEFT: FT IN RGHT: FT IN
LEFT:
FT IN RGHT: FT
IN
PARKING REQ: PROV: PARCEL:
42253225
ZNE: REF NO:
PLANNING NOTES>
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
I-.
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY :
�/
DATE;
APPLICATION ISSUED BY:
^�
DATE: /
LEGALIZATION:N F E E S U
M M A/R Y
STRUCTURAL SEG
ENT:N
BLDG PMT PLUMBING ELECTRIC
MECHANIC
FIRE SMIP/RES GRADING
PERMIT 35.00
25%
SMIP/NON-RES
PLAN
ISSUE FEE 22.00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK
TOTAL PAID
DUE
TOTALS ---- > 35,00 22.00 0.00
57.00 57,00
,00
REVENUE DIVISION TOTALS--> COLLECTED:
57.00
OVER/SHORT;
00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE
SMIP/TOT GRADING PLAN -CHECK
57.00
I N D I V I D U A L F E
E B R
E A K D O W N
TYPE QTY D E S C R I P T I O N
UNIT COST TOTAL
COST
PLU 1 SHOWER
8.75
8,75
PLU 1 WASH BASIN
8.75
8,75
PLU 1 WATER CLOSET (TOILET)
8,75
8,75
PLU 1 FLOOR DRAINS
0.75
8.75
,END OF' FEES
05-02-1997/03:01 PH/$57.00
F'ERMITo082710
cmra ,RUCTION AND PLANNING
1, APPROVALS Permit # Date
Inspector
POOL PA "
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole.
52. Pool & Equipment Location
-
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
--
55. Electrical Bonding,
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
•- '
57. APPROVAL TO COVER•GUNITE
7. Footings
58, Electrical Conduit-Undrgrnd.
�j•
8. Foundation
r
59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd.
-
60. Backwash Lines, P -Trap, O Undrgrnd.
'•
10. Structural Floor System
61. APPROVAL TO DECK
'
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
'
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System • Final
14- Rough Plumbing
65. Electrical-Final��
15- Rough Electficat•Conduit
_ �'
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Ceiling
-�
69. POOL/SPA SYSTEMS FINAL
'
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
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.Storage Tank OGas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. 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: r" K•-Ue�.� scjys
34. Final Heating & Air Conditioning
N 6,/
/���,
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing'7/9?
39. Water Service -Final
77
is.
r- -
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44, Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
a swtDun: 1016 W 19TH ST
WkUlIEWWOWN: HARLICH SHERWIN
ADORE33: 1016 W 19TH ST
COSTA MESA,CA 92627
642-4441
APDL. tunD/c ADDRES4:
ARCHTECT OR EN30IEER:
i ARCH. OR ENG.'S ADDRESS:
lX NO.:
CONTRACTORS KAIM:
CONTRACTORS MMID10
ADDRESS: M NO:
UNT: CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: E 082709 PLAN CHECK NO: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: ELE
JOB DESCRIPTION INSTALL BATHROOM AND WINDOW
UNIT.
CLAIM VALUE: CALL -VALUE:
UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby df uM« pwvay of perjury Mt I em ficamed liner «oriuon d Chapter B
(mmmertdry with S ioo 7000) of D ion 3 of Ow Busmen aetd Ptol.ri Code, ud my boenn u m h0 lorw W ~.
Cm UC. NO, UC. cuss: UQ NO.: EXP:
Del.: C ot,.
OWNER BUILDER DECLARATION: I hefty NRrrm u perWy d Perjury Oto I am emmpl from On C«ArWcf Uoerus taw 1« Ow
tloMiN rearm (Section 70315 S vine erd PRdenau Code: Am dY or om«y which reptmn a psmO m mrvp0a5. Wer. knprow.
molbh, «r«ai ury etrlcMe, prir m 6'vawnn, dw nermr we appfimA mr surd pmnii I.*. eierwd eeemem Oto Mor afro
. kcerved Wn to IM pro+vime of we Cora o Liarve taw (Chept« S (oormnetatp w SWian 7000) of Dr Won 3 of IM
Bueir a e Pralseabn Code) or Owl M or M it, exempt IMrebaf and IM tan for Ow all.Sed sx m ian. Am Violation of SW ion
7031,5 W fry epptiw for a perm! nblecb IM app) aY to a o i Penury of M mot then Me hwdred do0af ISS00j).
�] I. n owrte d tM property or my empbyw"It wglse m IMA ads �p«nation, wN do tM work, erd Na epl cob not mlaMed
or offend M sot(Sedco 70u. Sulvm eM Pro4wsion Coda: The C riotm Ixeve taw dwe rotnppty 1. on owner of progeny
wM Mics «=pause tMea.n, std wM dose turd work NrttseO or hwvoN or dw«gh Ne or Mr OMT ernploY . wov the such
ion«varnema we W intwM Or Bleed for sat. U. how.ver, tM Wilding or inprawned is Bold wnhn One your of mmpblion. Ow
ownerAAdder Mi0 hew IM burin of pOving M «eM did not baa or "unprov 1« On pupae of nb).
❑ I. ea owner d tb pto0ey, em axd a dy comracti p wnh sdof m ratmw On prapd (Section 70eA, &eons e d
Prdaseun Code: TM CWfnm Lianas taw eon owtw d prapMy Wm tu&727=1
« n IMean end MSm
convect b surd P wou, wIh a C.C.10 s) m ComrW«e Lbo Lew).
we I ern ewes of and measuud Ow I41ram of Cdiormm Ilsebh eM Sdely Cods SW kau 24505.25533. end
u erry
Mort, building o w l / wD not (dm* Owl wW to wow wh tail seta mdm aM tM repuimmun by
dim«modifmionbamtMAiai yuTu Aisnegenam D'Wrid. Mrder W mWuaion eppfrelton ere asemp horn e
Dee: Appfcem:
WORKER'S COMPENSATION DECLARATION: 11w.W Wfelm under pwrWy d pwjury one of Ota mbovion, dactaretorw:
❑ I hese artd M11 melnun a wnluab d mmferd to Wanure l« verken' avnperveion, n povMM f« by 6acttan OM0 d the Lobar
Cada, l« IM part«rriuce d Ots MOrk t« wNd thio penin b bawd.
❑ I Mxw eetd Mil meimen wpMn' oomperweon bmnnenoe, n muted by SWbn 3700 of Ow tabor COM. br IM perlormetoe of tM
waM
for w cob pem11 Is ba W. My w ' aomp iowt'uwuencs ean'w u pdicy number us:
Ce :
Pricy Number.
(This section rrdnot M COntplstW i Ow p Ab boos hWKct dOSus 1$100) or bj
❑ I afrtiy OW n Ow pMamwncs d Ow work for MStich Ihb DerrW b'vewd, I ehd W enploy erry poem m arty nnwwr n n Ip
bacanw wbpd to IM Mmrkare' oplperuYion bwe of Camo de. and aprn 0te A I dndd bacons ,biw to tM wMwf'
mrnpe i.n pwbnn of Section 0700 d IM Lob« CoM. I N 1a .ith opnply MOh Otws poMaione.
Ode: Apptiaem:
WaminW Faduf m Aacun w sk"' mmpwatlon c nrpa la mn ,, And owl x4j.e l an employes to cdwwpesum. erW
clvll Hrwe W m este hundrM lhpueerm ddb) ($100000A b addldon m 01e cal of pest tkm demapn n prv~ for In
Sndon DIMS of On Labor Coda, I/Oesnt our albmey'* fw.
CONSTRUCTION LENDING A(3ENCY: I hem* elf19 under pewby d pwpiv, the IMT b a omeructbn b^di9 agency for Ow
Prrlpnnece of IM work for "h Div Perm b -wed (SW ion 3041. Civ. C).
LENDER'S NAME-
LENDER'S
AMELENDER'S ADDRESS:
I cmily the I have IoM this eppietm eM st a 1M we above idmntiat ie oonect. I apse to oomply wilh W city u ooumy oo irl
.d %eSTA.rtttotM to WWM wrubudipn end hereby euOwce tepreaerualhw of thio rGy to em«uP tM oboe -m imn property
MARTH HAVaLYCII
(515146,WP) WMe-Butldig 6 Sddy: Orse�: Cuvey-Apply l: Pnk-Revenue: OOMemod-Aa.
PERM NO: E Of127U'1
GOVT: N SUPP: N
V
PURPOSE: ALI
SQ FT:
GROUP OCC: R-3 /
COMMENTS: "RESIDENTIAL IMPROVEMENT REF:B-82708
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
--------- ACCESSORY BUILDING ------- -
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42253225 ZNE: REF NO:
PLANNING NOTES>
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 - DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
LEGALIZATION:N F E E- S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
PERMIT )3.00
502
PLAN
ISSUE FEE 22.00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL
TOTALS ---- > 3.00 22.00 0.00 25.00
DATE:
DATE:
STRUCTUR*EGMENT-N
SMIP/RES GRADING
SMIP/NON-RES
PAID DUE
25,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED:
25.00
OVER/SHORT:
,00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN -CHECK
25.00
###########################################################**##################
I N D I V I D U A L F E
E
B R E A
K D O W N
TYPE
QTY D E S C R I P T I O N
UNIT COST
TOTAL COST
ELE
1 FIXTURES, LIGHTING 1 ST
20
EA,
1.00
1.00
ELE
1 RECEPT/OUTLET 1 ST
20
EA,
1.00
1.00
ELE
1 RECEPT/SWITCH 1 ST
20
EA.
1.00
1.00
END OF
FEES
85-82-1997/83:82 [41/525.88
74
F'ERMIT:080og
CONSTRUCTION AND PLANNING
APPROVALS Permit # Date
PO r SPA
Inspector Date Inspector
APPROVALS Permit #
I. -Temporary Electrical Service or Pole
52. Pool & Equipment Location
- 2. Soil Pipe•Undrgrnd.
53. Steel Reinforcement
-
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
i+
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
'
6. Electrical UFER Grnd.
57. APPROVALTO COVER•GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P•Trap, 0 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
,
15. Rough Electrical -Conduit
. •-�ji
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign _
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
-
69. POOL/SPA SYSTEMS FINAL
•� •-
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 00il
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0Gas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling IStructuralf & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32, Electrical Power Meter -Final
33. Final Electric
8n. r )OD CERTIFICATE ISSUED
i as:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
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THE MOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions otle, Division 3,
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THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
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