The URL can be used to link to this page

Home My WebLink About114 19TH ST - Building Permits0 0!99USaSufLONO: 114 E 19TH ST- uNT: aoN&SNAMElF1W7WN:YOU'IvH EMPLOYMENT SERVICE ADDRESS:11.4 E 19TH ST OSTA MESA, CA 92627 642-0474 APDL. UUUNG ADORES!: ARCNRECT OR ENGNEEA: UC NO.: ANCIL OR PNfi'S ADDRESS: NAT: calmAcfarsN -WIPPERMAN' S HOME REPAIR (714)646-8709 c,,,xTORSMYIWO 8400 EDINGER AV AppRm.HUNTINGTON BEACH CA ucNo,: 462557 92647 WT, T-106 LICENSED CONTRACTORS DECLARATION: I ha eby affirm under penalty of parte,, that I em loss under prw'uw of Chapter 9 (cbommdn0 wish Semon 7000) of Owision 3 of ter Boom, s awl Pmleasbm Code, and my fours is an loo force and affect. cmUC. NO.0A4826 UC. CLASS -8 uC.NO.: 62557 EXP: 12/96 Dere: I " Cwhostor: e'sf✓ OWNER BULOER DECLARATION: I hereby affirm toxim pemby of perjury, that I am exempt tr m 1 a Contrectbe l ora nse Mw Ib 9m tolbwnp monsoon (Section 7031.5 Bwomm and Pmlessions Code: Any city or county which reauiree a permit to eoneWet, after, b Monne. yrollsh, or repair any stmdure, prier to he iswance, also nmuires IM applicant for each perch to fib a signed sltlemMl thad M or she Mane, purvrot 10 the prmesierm of be Connector L'xamas Lew (Chapter 9 (mmmentnp wlh Sedian 7000) d Derision 3 of 1M uomssa sm, pmweiom Cade] or that he or one is a menpl Iherehbn and IM baps ter Na eloped exemption. Airy ndation of Section 7WiS by any applicant lar a permit wbjem the epplicent to a dvil pera0y of not more then f ret huMred dollen (SAO]). ❑ I, as owner of the properly or my, employee, Mh w roe se IMk sole oompemerion, will do the work ant 1M stmctun W rM InteMed or offered for sal ISectian 7044, Business and Pmlessiom Code: The Contmdore License Lew does rd appy to an poster of property who Wpde or inprovee thereon, and Wit does such ecrlr himsel or Mnel or Ihrbgh his or her own empoeyn ss, provided time each imgomwou be nal intended re phased for sab.1, hmemr, ter Wilding or inprmesn" is sold within arra two of completer, the owes ildar will have the Widen of promN he or ,M did not build or improve for the puryose of rob). ❑ I, As owner of the properly, ser odusivey co moon9 son licensed contractors to conoruo the project (Section 7044, Business end Prdessions Corer: The Contractors License Lew dose W appy to an owner of property who Wort, or improves thereon and who ccntrecta for such prof ds wM a cvrmbaor(el licensed pursuant to the Contraction Uorme Lew). ❑ I me exempt under Section: B. A P.C.. M this reesoe: Data: 0v .' 1 do hereby car ihy tho I em aware of and undentard the mauimmenM of Calpomb Hoebh and Salary Corte Seolibw 2 , 25503, red 25531, end PW I bury Man WJdin, ooaupers will / W1 not (dote one) mart fo oomply with said pate codes end the sgwON sets W epormulbmmWc9mbmoddrdion tMAi auiy uy9~Diuril.R®dentWppmpwoneppfcetomueuangtrom0we premia e. Due: Applicml: WORKER'S COMPENSATION DECLARATION: I hereby Affirm order prrely of pbjry we of ter fo0owkp dodutlers: ❑ I her sad vN mermen A ooref"e of consent to sedimure for workers'mmpemuion, As royi:Wl for by Semon 3700 of ter Leber Coda, for the cedbmeme of the wink her which this permit is blued. ❑ I hays and wit maintain wlwe' compeneatian imururce, o revuired by Section 3700 of the Ial,or Cont. for the pMbmuae of the wink her whim IMs permit is wood. My swoo re' mmpamoion nsuanee cert'ser and poky number alt: Certs, Pafiey Number; d NCllbl meed Ir01 ba MTPreyed %ter pannA Y AU font AVlldled dd{V9 (Sloth b Ascv.) X❑ I cent,, hu n er pedomerce d IM wink o wh h fhb per d ls sued. I ober no amp ry a peream n ury Ment er eo ea to Mane subject tp the corkers' canWerctslion to. of CelRarde, red some that it 1 merrld become abject to the wodurs' compensation peer i sio'Im d Sadia(nj3700 d IM labor Code. I she01 yygninf�ornpy too p� ooss—ow. Dere: 10— / � t Ap Ax,an: Wonting: F.H. to secure wp*..' opwwwsd0o cosewDe Is unlsrvhd, srW awl srb/sct me symslayer m bfrdrral PenaldN sod poll nswe up to one to dred thoweref "We (S/OAMA n o"Oun W be cost of compsmeWn dsmsPs M PyQ fo roc In Secdore 3705 of IM /aeon CocA Inoue k and snumsy'a fuss. CONSTRUCTION LENDING AGENCY: 1 hereby atfim w6m Pendry of perluny these then is e canetwoll n lerd'vp e9enuy ks the padbmence ot the work for whim this perm is owed (Section 3097, Cb. C). LENDER'S NAME LENDER'S ADDRESS: 1 cadrty 11hat I have road this application sad slate rho the above information is coned. I we to comp,, vdlh all pry end ammy ordnances end arms lows wrong to buik in9 consouctnn end hereby emhorbe represanmtivee of this ply to enter upon the abon-mentioned property for inspection purposesWInP WIPPERMAN 1 Print Nam - /- (//{'// � Dere: 10 - a 2- 9G Sig um of ndAppMa Wonlractor ' (5151_se.WP) Whum4toiN'vp A Sefey: Gwen- il% Cuuy-Appimnt; Pink-R,wnue; Goldenod-Aesneor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 080088 PERMIT NO: B 080088 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION ; T/OFF RESHEATH COVER W/COMP SHINGLE SQ FT: 600 CLAIM VALUE: 600.00 CALL—VALUE: 600.00 GROUP OCC: B / COMMENTS: COMMERICAL REROOF 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 RGHT: FT IN PARKING REQ• PROV: PARCEL: 42626118 ZNE: REF NO: PLANNING N TES> > IF 9f iF dF lE iF iE 1E*IE dF 1E 9F*9E**dF*1E 1E iE lE irk iE iE 9E 1E iF dE dE***dE ih iE df******1E dE**dE 1E iblE 1E 1E 1E de 9k*9E 9E 9E 9E iE iE i!**iE RE,ih dE dE dE 1E dE IE 1E dF* D E V E.' L 0 P M E N T S E R V I C E S R E Q U I R E M E N t -T S ZONING APPROVED BY DATE: %^ BUILDING APPROVED BY DATE: // APPLICATION ISSUED BY: 1 DATE: I�10 K♦E*if**149E 9E*9E 9E 9E 9E*9b dE df iF iE iE*?F�F3FiF7FiF7FiF'iF7i"iFiFiF'#3FiF3FiFiFTF iE�FiF3F3F3F3F3F�F 1E iE if lE lE iE iE iE iE iE ii iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 23,75 SMIP/NONN—RES PLAN .50 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 24.25 0.00 0.00 24.25 24.25 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 24.25 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ,23,75 .50 1E*9f 1E 1i dEkiEfEdE♦E**dE dE♦fdE*If*9E jE dE dE**9E df*lE9E*iE Ric 1E dE 1E 9f*it dE 9E*9E 9E dE 1E**1E***♦E**iE dF iElFIf *dE dE*iE 9E iF*1E*IE df *9k 1f 9E** 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 SFC 600 ALTER BY VALUE COMMERCIAL NOZONE 1.00 600,00 END OF FEES 01 00217643-00217644 T CET DATE: 10/22/95 TIME: 13:17 b� 24.25 CONSTRUCTION AND PLANNINGPOOI ` • APPROVALS Permit # 'Date -Inspector °, SPA . APPROVALS K .Jt #_ 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 1 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, B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash-Lines, P-Trap, ❑ 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 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test - _ 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing lQ-ZZ��(� �, 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 76. 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- qqj 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 �L 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date /moi PROJECT ADDRESS: 114 E 19TH �T�"� t UNIT: 0 OWNER'S NAME: GOLDIN,TIMERSji,�- ADDRESS: SAME, AS ABOVE 714/642-2275 ARCHIENGINEER: REG.Ilf ADDRESS: UNIT: PERMITTEE: EARL'S PLUMBING (714)772-3470 ADDRESS: 1533 W. LINCOLN ANAHEIM CA 92801 LICENSED CONTRACTOR 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 lull force and effect. CITY UC.: 00 938 ATATE LIC.: 217656 V� Date: �� 2 P! -- Signature: WORKERS' COMPENSAT N DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Idujagpe4 t}La certified copy thereof (Section 3800, Lab. TO/01/91 POLICY ND.: UU 99 ECS lJ EXP.DATE: COMPANY: BEAVER ❑ Candied copy is hereby furnished. CX Canniest copy is filed with the city Building Division. Date: ///.to Chieftaint' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed If the permit is for one hundred (51110) or less). I certify that in the performance of the work lar which this permit is issued. I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: It. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3D97, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from IN Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 live hundred dollars (5500). 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 (Section 7044, Business and Professional Code: The Contractors Stale License Law does not apply to an owner of a propeny who builds or improves thereon, and who does such work himself/herself or through his or her own employees. Provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve for the purpose of sale). and owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' tale license Law does not apply to an owner of proper% who builds or Improves thereon and whe contracts for such projects with a contractm(s) license pursuant to the Contractors' State License Law). I am aware that proof of (heir Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale: Owner. I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any future building acupinl will/witl not (Circle one) need to comply with said state codes and the requirements for a permit for construction or moddication (rpm the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and County ordinances and slate laws relating le building construction and hereby authorize rep/reesssee�ntttaat/ive(ess, Of this city In enter upon the above-mentioned property for inspection purposes rS .Pie Dale: // �'� t! Signature: Drivers License or Social security a: 1641.46 White—Building: Green—Code Enforcement: Canary—Applicant Pink—Revonue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT 968l PERMIT NO: P 049682 PLAN CHECK NO: N N—SIIPF: N— CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION WATER HEATER INSTALLATION SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: / COMMENTS: NO STRUCTURAL WORK BEING DONE Z O N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- FIRE --------- 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: 00000000 ZNE: REF NO: PLANNING Ni 3.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE MMMMMMMMMMMMMkitMMMMMM MIFMMMMMkMkMkMkMkkkMMkMkkMMMMkMkkkkMkMkMMMMMMMMMkkkkkkkkMkM 3.00 0,00 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 BUILDING APPROVED BY APPLICATION ISSUED BY: M MMMMkMMkMMMMMMMMMMMMM k MkkMkMkkMMMMMMMMkMMMMkMMMMM LEGALIZATION:N DATE: DATE: cll�ec MMMMDATE: M7Fa�F�/�MM kMMMMMkMkMMkk kMkMkkMkkkMkMkMMMMMMMMMkMMMkkkkkkkkk F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2 00 $5% SMIP/NON-RES PLAN ISSUE FEE 3.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 2.00 3.00 0,00 5.00 5.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 5.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 5.00 k MkMMkkMMMMkMMMkkkkkkkkMMkkkMMMMMMMMMkMMkkkMMMMMMMMMkMkkMkkMkkkkkMMMMMMkkkMMkkk 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 WATER HEATER AND/OR VENT 2.00 2.00 END OF FEES 01 00074855-00074855 T dK Y , DATE: 11/26/5C TIRE: 1;'10 i 5100 CONSTRUCTION AND PLANNING POI.` d SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Servs a or Polar 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. :i-"• rt,y 53. Steel Reinforcement "• r, r �lectr)cal Condiiu�ULtility4Undrgrndf0. �!, 54. Forms �i3 4.` Elects cal Conduit:Uncirgrnd. 55. Electrical Bonding M,51"-Steel'Reinforcemefn. 56. Rough Plumbing & Pressure Test �. •6. Electrical UFER-Grnd. �. 57. APPROVAL TO COVER-GUNITE " ,7.,f -Footings 58. Electrical Conduit-Undrgrnd. \-• v-, ` r1 B. Foundation :y 59. Gas Pipe, ❑Undrgrnd., Test O 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System .a -. 61. APPROVAL TO DECK 11. Property Sewer Line:& HouseConriection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains r 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrica'1-Conduit - 66. Solar System-Final 16. Rough Electric^Wiring 67. Fencing & Access Approval '>17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electri ai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 1 Q Iu r,tDF < •r C 'APPROVA159JC.Permit # 20 ,Rough Factory Fjreplace tYaj �= O u = t 1' t7-* I. l W 'Icur- .•z W. tt• -1 21 rtt rtt , t . 1. gP❑d�ro _a. 22' Ducts, Ventllatingr 1; < S <L'r Prod ucP 1 ping GI Gas 0"0il .r I - 23.-'GatPip�-Ro, • h &'fest I • "• ''+x' "" I I R p, .72. Under roan F us Ary•. UWP _ ; 24:rRotlf Framiig > O tr J. x. "737JUndergrrt7t. Stofr�a TanktO Gas, O Sil - 25. Roof Sheathin �" Z• 9 i--: ._ „1 If)O 0 -f e 74 <t t7 ^. Na >. 50verhead�-lydro t. 26.a.T-Bar Ceiling (Structural) &`Menocoat r to to x 75?Dry Chemical Lary % rt v 27CIFrame and FlashjY!" 76�.'Dry Stankie(- �28" Lathing.& Sidings`:l tr: . ;9 z. i, 77,;^ FIXED SYSTEMS ALx "29. Insulation ' + l� 78,x• FIRE PREV. FINAL - _ t• , > 30. Drywal6Nailing ;•: � r �' �! r-J•.+ w,HE ALTH;DEP'L. REQUIREMENT ,Btown Cot° ' 31. Plaster - r ti ,_ ,r n•,r' r79•.`'FINAL�IN�jPECTfON I: l �: ;ter-Final ' PowerMe ,, I .. L: CERTIFIGfiTE ISS EDr O ..32.--Electrical v � i Y. q80-tF00D 33=Fi al Ele�ctri� ' t`1 I A •9; 1NOzes: F ,..:C+1 Y O c tq X34: FinalHeatinq&AicConditiPF 0nt.g ! `� , I{,, a S n 7 S`✓t7 35 tFinal Gat PPpp-Te4tl + I /: • ? C1 n n1 - r SO b36-'Hood o ~Canopy ,�<`• • tr=y o_ !:."1 1 �;.+ 1 - S_ cla•t r� I r -•379Fingl Factory Fireglace� ' :E: tr o t, vI I Y 1 ,'r; 38. Final Plumbing .i �N S N a tD .^39. Water Service-Final= tr, v ,,40. Gas Service-Final t; _.T r i I pn oN y t r ^ x}41. Solar Domestic-FinelS �I• •• * � � I j� . Co =-+ :.42 Backflow Prevents;: r" r'1 43. Backflow Irr:igatiorr o;;S x t' 'X t- t. C �+ r. U ♦. 6' '•' Y •i C1 Liz t4 .1,44. Landscape 15rigatiQn Systems ,X z ,,, C 7 t7� C OJ C! :i: r; tv o z45 Attenuation „'.Cts tr t 1, t H F: s II H ra! u ., - .. , m .,4fi: Handicap R yulatiOs ~ n ! ' ~S 47SFINAL STRUCTURE & BUILDING r r48:;FINALPLANNING tr 7 F it n- irl.[ ''irl 1r-•F ---.49L-•Eleciric Release to Edison + / EE x ii; i e. ,-i z50._Ga`Release to SouThern California Gas Co .51. CERTIFICATE Or OCCUPANCY No. Date �- -� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. OTYOFCOSTAMESA CONSTRUCTIONPEERMIT Project Address I eJ-'f a 5,T Applicant's Mailing Rall Owner's Name L c�� `-'� H •pry e Address I y 1 d s7 I c. m . Arch/Eng. License No. Address Contractor's Nam Address (mailing) o City License No. 1G ¢d LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force aritil elifect. Licens Cl ss V31 License No. ''So Date Signature WORKERS' COMPENSATION DECL I I hereby affirm that 1 have a Certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section ' )0, Lab- C.) (1& _ QQ r,olicy No. �J_SiJILV Company 8 Certified copy Is hereby furnished. Carti 'ed opy Is filed with the city B I Dale Applicant EXEMPTI NF WO RKERS' COMPENSATI DEC ATION (This section need not be completed it the permit is for One hundred ($100) or less). 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. Date Signature NOTICE: If, after making this declaration, You should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Le.der's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/She is exempt '•er6from and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit Subjects the applicant to a civil nalty of not more than five hundred dollars ($500). Ll 1, as owner of the property or my employees with wages a5 their sole compensation, will do the work, and the structure IS not Intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such Work hlmSelf/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 com- pletion, the owner will have the burden Of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builtls or improves thereon, and who contracts for such projects with a con- traclor(s license pursuant to the Contractor's License Law). I am aware that proof d� their Worker's Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason CP Date I hereby certify tha information is correc and state laws rela Sentatives of t in Spaction our e Signature Drivers' License or S: IF 0865-46, rev. 10/84 . Owner have read this application and state that the above agree to comply with all city and county Ordinances 0building construction, and hereby authorize repre- l.ePk%(_ upon the above-mentioned progerty for I I Roof, Drains I I I I I Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 110-100,000 BTU 0100,000 Reinspection Fee 1 $15 White . Building; Canary-tAppllcant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type LJ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 FEES DEVELOPMENT SERVICES REQUI Zoning Approved By Building Approved By Application Issued By Issue Fee so SUMMARY OF FEES BUILDING PERMIT $ 63.0 D SMIP $ .53 0629 5/16/E^ TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR` PERMIT - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Z Zone DESCRIPTION OF WORK/USE OF BLDG. ISSUANCE $ S Main Building: Accessory Building: $ $ +-00 $44Sb�b ENERGY P.C. GRADING MICROFILM S $ $ E Z TYPE PERMIT GRADING FOUNDATIIOl�N STRUCTURAL T Front $ O _QF TENANT ❑ ELECTRICAL ❑ PLUMBING LJ MECHANICAL ElRear $ 3 N ❑ OTHER ...- A $ I PROJECT DESCRIPTION SO. FT. OCCUPANCY — K Right G CONSTRUCTION TYPE VALUATION $�S� $ Left C—� R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req.lProvided E Remarks: Ci AL Planning Notes AA M 3k 3t2- T PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Cap - ConstructiomPo le Sub. ❑ 50+ KW Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Uover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0.1 HP OVA , 8 w Floor Drains SwimmingPool /Spa' F.A.U. Inc. Solar 1:19-15 HP 1116-15+ Floor Sinks Urinal 5 Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors _ Water Heater S Outlets Range t Kitchen Sink Water Service - Switches Sign Lavatories Auto -Wash _ Garbage Disposal Standing Sections P—Trap�'. Laundry Trays Generator ❑0-5 KW ❑5.15 KW Trash Compactor I I Roof, Drains I I I I I Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 110-100,000 BTU 0100,000 Reinspection Fee 1 $15 White . Building; Canary-tAppllcant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type LJ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 FEES DEVELOPMENT SERVICES REQUI Zoning Approved By Building Approved By Application Issued By Issue Fee so SUMMARY OF FEES BUILDING PERMIT $ 63.0 D SMIP $ .53 PLAN CHECK $ PERMIT - PLUMBING $ ISSUANCE $ PLAN CHECK ELECTRICAL PLAN CHECK 25% 50% $ $ +-00 $44Sb�b ENERGY P.C. GRADING MICROFILM S $ $ MECHANICAL $ TOTAL FEE $ $ 3 PLAN CHECK 25% $ �I 1"C . i`- CONSTRUCTION AND PLANNING , I APPROVALS •Permit#tom ,� Date :. Inspector POOL & SPA APPROVALS Permit Date Inspector�� n f ' 1. Temporary ElectiicahService or Pole 52. Pool & Equipment Location �' •� •' 2. Soil Pipe-Undrgrnd. r,% 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrrid. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test; 6. Electrical UFER Grnd. i•r;'r 57. APPROVAL TO COVER-GONITE� " 7. Footings 58. Electrical Conduit-Undrgrnd:ti 8. Foundation, ti 59. Gas Pipe, ❑ Undrgrnd., Test .1 9. Water Pipe-Uhdrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrri6." 10. Structural Floor system 61. APPROVAL TO DECK » ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final. 12. Sewer Ca P 63. Heater &Vent -Final �� -'� 13. Roof Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65: Electrical -Final -' 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring Sj 1 t 7. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .1 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 ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush j 24. Roof Framing 73. Undergrnd. Storage Tank DS as ❑Oil - 25. Roof Sheathing 74. Overhead Hydro r 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 (p �$ 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 3p BB �/� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy .3�7' Final Factory Fireplace t' 38. Final Plumbing , 39. Water Service -Final - ,- 40. Gas Service -Final - r41. Solar Domestic -Final - y ..42. Backflow Preventer ' • r' ` -" ; • ' X1.43. Backflow Irrigation 1 44. Landscape Irrigation System 45., Sound Attenuation ' 46. Handicap Regulations - • _ .. . _ r 47. FINAL STRUCTURE & BUILDING 48.,Special Requirements Completed i, 1v 49. Electric Release to Edison " 50. Gas Release to Southern California Gas Co ' V• 51. CERTIFICATE OP OCCUPANCY No. Date �l Y •..^2 •." � COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely ' TYPE OR PRINT MESA. CALIFORNIA FEE RECEIVED JAN 21 1953 rr FINANCE DEPT. APPLg6XTR6N"Wk 01WIT BUILDING For Office Use Only H 6 DD �Y RECEIPT NO. �qv1 OWNER 11,OV1 �tm1LT Vri1Vl MAIL REG VED BY ADDRESS I-R77.IDEM7-! TD L TEL. ryp BUILDING CITY NO bF ADDRESS ARCHITECT --- TEL. COSTA MESA. CALIFORNIA OR ]NEER NO. 'rte FIRE -7 ADDRESS ZONE i E GROUP ✓2- �_- / CONTRACTOR APPROV BY 1 DATE -------`-""--_:._�___�` / ZONING ADDRESS ZONE NO. OF / USE OP NEW CITY PLANS I �> BUILDING I STATE TEL. LIC. NO. -a LEGAL DESCRIPTION SIZE yC. V /�� NO. SLOGS. , OF LOT // /� L% 99 NOW ON LOT / O A P NO V USE OF YARDS EVES EXISTING SLDG.j PPROVED ALLOWED SETBAGK LINE FROM (CSNTER LINE ST.) CENTER OF STREET REAR YARD FRONT- FT. IN. SIDE YARD I LEFT I RIGHT R. SIDE FT. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEY (ALTERATION I\ I ADDITION ' REAR FT. IN. REPAIR I II MOVING I DEMOLISH I APPROVED AM By DATE r BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF ILDING D W RK TOB PERFORMED 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF, ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION - BUILDING CONSTRU ON. SIGNATURE OF �) PERMIT FEE $ PLAN CHECK S PERMITTE AUTHORIZED AGENT TOTAL FEE �� H 6 DD �Y r, COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 +' 2 TL C M I REc I P321 6T,�i 26 , 132, For Applicant to Fill in Completely — Use Ink Only ,�3 BUILDING //iK E /�7X1 y� A.P. NO. ��p / ADDRESS T OWNER ORADDRESSLDING BU C ! / 74 TENANT6jar G , UNIT OR MAILINGSPACE ADDRESS NO. TEL. �^N.Oy_.,6 LOT ;2-BLK. V (� � CITY G • NO. NEW I ADD ALTER REPAIR IMOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER 6;01-QE1,j E S ADDRESS �� USE !• C.1 Iw A LV E$3D �,'^ L'iL/ ARCHITECT EL GIVY✓ OR ENGINEER N 0.,_ g ADDRESS . ZONE TYPE GROUP A -J CONTRACTOR APPROVED DATE S 0/ N,17r?i C.7to✓ , ADDRESS 7,IVI TEL. 7% CITU M Gtf1•,1 UiL O NO-77072qVJ(G • mtJ STATE CITY APPROVED SETBACKS LIC. N0 LIC. NO2-124Z9l SIZE/// 7o2cLam/ /�. / GS, FROMCS/LSTRFTr (PONT OF LOT NOW ON LOT USE OF EXISTING BUDG.AffW—qZ—C1TL7-4nq R. SIDE FT.%}G Separate permits are required for L SIDE FT. ,46HO electric, plumbing and heating work: REAR FT. fL/¢AI UStE/OFyB']U/IL�DING AwNDD WORK TO BE PEFOR PLANNING ACTION Ir(�{/s / ��/ r !/�•� APPROVED • APPROVEt VR/5.. W l.�N/ I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. / 1 hereby certify that 1 am properly licensed as a contractor under -7SO. FT. the State of California Business a d Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such license are I full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from th ro i hs f th tate of iforn'a Ysiness and Professions Cod D' . VALUATION PERMIT FEE $ Signature of Permines t / PLAN CHECK $ 30, ZTQ TAX $ -- $or 2• �Z- Authorized Agent Date TOTAL PAID E 3 2 TL C M I