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Home My WebLink About132 19TH ST - Building Permits • PROJECT ADDRESS: 132 E 19TH ST UNIT: GARAG CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06540E i OWNER'S NAME: PETERMAN MARGARET (" ADDRESS: 3002 KILLYBRROK LN PERMIT NO: B 065406 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92627 CONSTRUCTION TYPE; PERMIT TYPE: STR • PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT: 830 ADDRESS: UNIT: CLAIM VALUE: 830 .00 CALC—VALUE: 830 .00 GROUP OCC: M-1 / PERMITTEE: MARGARET PETERSON ( 714 ) 545-4462 ADDRESS: 132 E 19TH ST COMMENTS: REROOF GARAGE W/COMP SHINGLES C.M. CA 92626 ****************+F*IrIE******** FIE*******x**kF*******+r*****************Er************ LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature:_ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY EXP. DATE: COMPANY: PARKING REQ: PROV: PARCELF 42626322 ZNE: REF NO: i rj Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > • c. • Date: Applicant:_ ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred WOO)or less). D E V E'L O P M E N T S E R V I C E REQUIREMENJT S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any nner so as to become _ subject to the Workers'Compensation Laws of California. ZONING APPROVED' .BY DATE: y'-- Date /��ad/7 .3 you should _1.2e4-0-144--YLBUILDING APPROVED BY : . NOTICE:If.a er making this declaration,you should become subject l�he Workers' ompeosabon provisions of the Labor DATE Code.you must forthwith comply with such provisions or this permit hall be deemed revoked. gOil CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: *'*' i DATE: l LI 0 t. 1E which this permit is issued(Section 3097.Civ.C). ****************************** ******'*'*****************************jF****** *** LENDER: ********************************************************************1F********** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES . GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 23 . 00 . 50' 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 SM I P/NON=RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE .l I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID c'. DUE l structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 23 . 50 0 . 00 0 .00 23 . 50 23 . 50 'i t .00 does not apply to an owner of a property 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. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 23. 50 OVER/SHORT improvement is soldwithin one year of completion,the owner will have the burden of proving he/she did not build or improve fororthe purpose offsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK s 23 .00 . 50 I,asrf owner of s the d ;properly, Co exclusivelytt 'S tecontracting with licensednot contractors to constructthe project builds or ov, thereon / ❑ and who contra tsdfo The project 'Slate License Law does not pursuant to an ownereoof property who or improvesI thereon and who contracts for such projects with acontrabmr(s)license pursuant to the Contractors'State License Law),I am aware **************4*****************4***********************4********4********4**4* that proof of their Worker's Compensation insurance should be provided to me. - INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section. B.&P.C. for this reason: TYPE _ QTY DESCRIPTION UNIT COST TOTAL COST Date; l *T/� a/7 Owner��Q SFR 830 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 ,j 830 .00 Ido hereby teddy that I am aware of and understand the requirements of California H h and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. !1 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 state laws relating to building construction and hereby authorize representatives of this city to enter on the above-mentioned properly for inspection purposes. l 2 '' 01 DO1`.•2`8F-00i525E9y,Ts=t 23.50 Oa1e. �l/�,-O signature:_ /� / �' DATE: 12/21/93 TIME: 15:27 Driver's License or Social Security w._. . . 1641.46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING ..% PA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole • ' . 52. Pool & Equipment Location . ..,..,,,Soil Pipe-Undrrrnd., 53. Steel Reinforcement -•;telectrical Cond`uit.{}tility•Undrgrnd. 54. Forms • -l'Z..•Etectrical Condit=Undrgrnd. 55. Electrical Bonding r, T' • r{ gee! ReinforcRrient 56. Rough Plumbing & Pressure Test zi,6? ectrical UFEtR Grnd. 57. APPROVAL TO COVER-GUNITE 'c SOotings �l 58. Electrical Conduit-Undrgrnd. t- �., O't, .• of Q. v$xFoundation NE.... • 59. Gas Pipe, 0 Undrgrnd., Test C. r - T9eter Pipe-Undtgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Strn uctural Floor System ;- 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection t 62. Backwash & Receptor-Final 12. Sewer Cap . rt 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 EJ I 16. Rough Electri rt/iring • 67. Fencing & Access Approval • ce,:17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' .'•18. Rough ElectriWl-T Bar Ceiling i 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT 2QTRd�gh Vacuity "replace I `-C T -" 3\PPItp VA3'S-'OPetmit# " * I,. - _ a1 ` 15 r. ri . X......."0-• r . 211. Dtr..ts, EDStNUctu`rpj; �,5 * ^ G r r * 70. Undergo hind Hiro A. 22. Dutsts,5ientp tiri 1 !JS x: ? `t'z >. "t 71. Produ I ng c'i�'i'is f 'rZ O r i7 < to r< � �7 cPS �;QII 235Gai'iqe Rath $ gest5 _ e "* > 72. Underground Fl tt n x f-i x, - C •v > :-) * . a 247 RoFf Framing "1% I r...-,1,- T ✓ > O 7' * x 41:7 2 Undergrrr..Stor {i"=tankxJ Gas D Oil 25. R4iIf S' •athin9 .; J2-Z24) 6cidTt.yr, - 74 yOuerhead Hydrc8~- =13+ 26--. T.--Sr Ceiling (Structural) &.-Motrocoat i ., e "Ix * 75Zg1y Che cal "" -� '['.i ,; ., 2,-r c S u •t n ao .. J �+. ,,_,.....11 • F� 27"Frame pg-id Flasnn ` t * F' G J2. * `' M t' -. v r ., m* i 76. 'Dry Standpipe t” O • 428. Lathinor& $iging7+ -3 x :_ •- ••_ 7713'' FIXED 3_17f EM INAt 1.'429. Insulation . .;:x 5 .. x 4- •x 78 FIRE PREV. FINML . > 't >+ J •-. -e . „ r I v--•f .. .•-30. DrywalslNailing :2/ ti • ic I I * H HEALT •DEP x R'EQUIR MENT `;31. Plaster;Brown Clot; s _ X f , x 79. FINAL Ih1yFECTI=)N x kis t• •y r-•32:'Electrical Pdwer MatetFinall * al 21 80t:FOOD CERTIFILATE ISS ED -33.5E451 Ectr E tr T ` r•, x "Nos• 7 i` it ~ t=1 ti.:;, L, .T y .� �'.{ r U. 1 F. t - .L -:.S itj34C1Firl Hating,& ,iraConditignjig; la.. ,rt rx , Cry s t..: -n .. G 1-... . .r 4. ti^. r. s ,t .. n1 '' Fi1. I G 5 Pim-Test' II:" , x' it. x t• 1-15 • m 5;.. �Cano < x .; -'r, "t•i;-tet 41ic;36vi : Hood of py t M" c. f y S (^t0 v r,--r, v r] �' ♦ I , 1 ;j37GFir!el Fgytory Firetia'cerz F ", �r„ I ' '. `� x M 13 ?t LU I - rs S •t 1. r38. Pucci P •robing * ., w * ' i S •-, * CJ 0 039. Warr Service-Final' =A tk * r-- 01 fl •+; tE 0 .. t > t r 1•:. q +?t Cu ••••h40. Gas Service�F,nal ` t! x u " rr`+-- Y- J * +l ✓:^:^ A" r7 f rr •K c•. -' e X•111 I* ,. 'a r_ 241. Solar DomesAc-FinalS r 't G; I :, wZ,L ^ti ' Y - 42. Backflow Preventert, r' x ' I *. >F • . o 43. Backflow Irl anon x•55 * rho ' O I -f. x t-, 1 i x N ri44. Landscape l igaticgn System-J. 7%- I' 1-1 ' c, cn • J: n.: CLI ":Z• x :a L_ Cr _<` a. .E E :S S -=-0-- -* " h FA5QSound AttefiLation ^ - - x2 r i-' i•-*r .Hc''-. _ .s * -, -.. 7 .. m m 7174 >t r " < • F-CI '. v E"' L. •- 1. Tp .. .. ..i ',t. / M-iKy X46. 1andicag Redulatigns ,a C -K ,;. * .s tIo t 47sFINAL STR-JCTURE & BUILDING 3.¶3 G_ I . J c-,-, * _ 484Ir4L PLAFININC I ` ; I , d * -� S a49_ Electric Release to:dison ; a i *. X.-r! i _ co y50sGasjtetitase to Southern Calitgtoi3 Gas CO r 4 i t4 -; R + . C-..73. 51. CE i -IFICATE OF:OCCUPAN'CY a e �. C. tT;o : .4114.- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA - . - i" PERMIT NO. _ T.RACT NO. LOT NO. BLDG.NO.. ' _ - CONSTRUCTION PERMIT /67s7 "rr'' ' e • Project Address •132 E. 19th' Street TYPE OF CONSTRUCTION U NEW L-I ADD'U ALTERATION ® REPAIR -r - 3666 •2/03/84 - - 9.75 it ratihiLeant's Mailing Address : •Killybrooke [in: 92626 - 0 CONVERSION '❑ DEMOLISH ❑ OTHER- A.P.# Zone are ' Gr Owners Name Mar t A. Ppter(8an - Phone 546-4462 ' DESCRIPTION OF WORK Rnnf - 426 0 - I �^ S' Main Buildining:g: . Accessory Building: Z Address '3002 Ki l lyhrooke I ane. CM 92626 E - - - 0 TYPE OF PERMIT U GRADING U FOUNDATION U STRUCTURAL T Front - N Arch/Eng. License No. __ _ �❑�--Ii TENANT ❑ ELECTRICAL ElPLUMBING ❑ MECHANICAL B Rear I Address • I Z1 OTHER . Rppal r . Contractor's Name ^ 0/6 Phone' PROJECT DESCRIPTION SO. FT. a•2-� OCCUPANCY_. C Right G Address(mailing) ` ' CONSTRUCTION TVPEFaIT). RPs. VALUATION $1100 ' S Left - - E - ZONE Cl GRADING CU.YDS. ACRES City License No. ping Ref.# Park.Fees $ D U LICENSED CONTRACTOR DECLARATION Remarks: ' Parking Req./Provided •I hereby affirm that•I am licensed under provisions of Charter 9 (commencing . R with section 7000) of Division 3 of the Business and Professions Code, and , 'Use of Building: • E my license Is in full force and effect. License Class - License No. PLUMBING • FEES Planning Notes: M Date Signature E 'ORKERS'COMPENSATION DECLARATION Bar Sink Showers - N " ereby affirm that I have a certificate of consent to self-Insure or a certificate • Backflow Preventer 'Service Sink - - - - T Workers' Compensation Insurance, or a certified copy thereof (Section S 3800, Lab. C.) • Backflow Irrigation Sewer Cap • ELECTRICAL FEES Policy No. Company ' , R Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50 KW ' Certified copy Is filed with the city Building Division. • ' Clarifiers Solar Collectors Construction Pole Sub. 0 50+ KW Date Applicant _ _ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION in Dishwasher , Solar Pi (Thissection need not be completed if the permit Is for one hundred ($100)or Piping Cooking Unit Meter ❑up to 100 amps 'less). DrinkingFountains ' • I certify that In the performance of the work for which this permit is Issued I Solar Tank Dishwasher Meter Dover 100 amps ' shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel • Date Signature -- — • - - NOTICE:If,oafter making this declaration,you should become subject to the ' Floor Sinks - -' Urinal - - - - -- - Workers' Compensation provisions of the Labor Code, you must forthwith Fan _ Motors 00-1 HP ❑1''4-8 . comply with' such provisions'or this permit shall be deemed revoked. - Gas Service 'Outlets Water Closet, .1 • I F.A.U. Ina Solar ❑B-15'HP ❑ie-15+ ' CONSTRUCTION LENDING AGENCY - I hereby affirm that there.is a construction tending agency for the performance- ' Interceptors Water Heater Fixtures - i •Microwave - of the work for which this permit is Issued (Section 3097 Cly: C.) - Lender's Name _ • Kitchen Sink • 'Water Service - Device Boxes Pole Light - Lender's Address OWNER BUILDER DECLARATION Lavatories- - .. Outlets Range I hereby affirm that I am exempt from the Contractor's License Law for the p—Tra - following reason (Section 7031.5 Business and Professional Code: Any city or p Switches Sign • -. county which requires a permit to construct,alter,Improve,demolish or repair ' . any structure, prior to Its-issuance, also requires te applicant for such permit ' Roof DrainsGarbage Disposal Standing Sections to file a signed statement that he/she Is licensed pursuant to the provisions of - tllje Contractor's License Law(Chapter 9(commencing with Section 7000)of - - Generator ❑0.5 KW❑5-15 KW -i4fision 3 of the Business and Professions Code) or that he/she Is exempt ' Trash Compactor ' t tirefrom and the basis for the alleged exemption: Any violation of Section — — . - ':'4315 by any applicant for-a permit subjects the applicant to a. civil • Reinspection Fee enalty of not more than five hundred dollars($500). Pe '$25 Issue Fee $ 3 I, as owner of the property or my employees with wages as their sole - Reinspection Fee • $25 Issue Fee " $ 3 CCCo___mpensation will do the work,and the structure is not intended or offered • MECHANICAL FEES for sale (Section 7044, Business and Professional Code: The Contractor'sc PUBLIC SERVICES REQUIREMENTS: ' License Law does not appiy'lo'an owner of a property who builds or Improves Boiler • • Hood or Type I 0 .. ' thereon, and who does such work himself/herself or through his or her own - Zoning Approved By bate employees, provided that such Improvements are not intended or offered for ' Canopy • Type II 0 , - sale. If, however, the building or Improvement is sold within one year of com- Duct-Under,Ground - , Building Approved By (� Date elation, the owner will have the burden of proving he/she did not build or Im- /q, ) ii/ . �/� /�� rove for the purpose of sale). : Duct-Structural Refrigeration System - • Application Issued By 7 1'r / Date • O I, as owner of the property, am exclusively contracting with-licensed con- ❑C 100,000 BTU 0100 000 BTU tractors t0 construct the project (Section 7044,Business and Professions Code: Duct-Ventilating - • SU A V OF EES The Contractor's License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ 7, L) SMIP • •$ i S(J tractor(s) license pursuant to the Contractor's License Law): • PLAN CHECK $ PERMIT 0 lam exempt under Section B.& P.C.for this reason ' Firepl/Fact.Blt. ICBG# ' PLUMBING $ ISSUANCE $ Date I Owner: a _ . .....• .. - e . : Heating,System&Ducting r PLAN CHECK 25% $ ENE RG V'P.C. '$ I hereby ce ify that I•have read this appl y.tion and state that the above-' - - 00.100,000 BTU ❑100,000sT -'"-:'47• -- - - - GRADING. $ Information is correct. I agree to comply wi all city and county ordinances ELECTRICAL $ and-state laws relating to building construction, and hereby authorize repre- MICROFILM $ sentatives of«this city,to enter upon the a• -v--mentioned property for PLAN CHECK 50% $ Inspection pure• ' MECHANICAL $ 1. Signature '/ sate 2/3/84s , I TOTAL FEE $ ' /. /� Drivers' License or SS 4 . Reinspection Fee • $25 , Issue Fee $ 3 PLAN CHECK 25% $ ), . - N. CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - CONSTRUCTION'AND PLANNING . - : POOL PAS. - _ - Date Inspector , - Date- Inspector APPROVALS Permit# ' - ,APPROVALS• Permit# - ?. : 15' . 1.-Temporary Electrical Service or Pole • - 52: Pool & Equipment Location .' I •c ' i F r2. Soil Pipe-Undrgrnd.' _ • 53. Steel Reinforcement = _ s _ 3`Electrical Conduit Utility-Undrgrnd. 54. Forms ' - Y4. Electrical Conduit-Undrgrnd. - _ - 55: Electrical Bonding _,� .-' _ _ r. • 5:Steel Reinforcement' _ 56.•- Rough Plumbing & Pressure Test - - '- n 6. Electrical VEER Grnd. - 57. APPROVAL TO COVER-GUNITE I 7. Footings • - 58. Electrical-Conduit-Undrgrnd. - ' ' 8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test '•• ' 9. Water Pipe-Undrgrnd. - 60. Backwash,Lines, P,-Trap, ❑^Undrgrnd. : ' , I . • 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. . .. - , r • 14. Rough Plumbing . ' - 65. Electrical-Final- . - - '15. Rough Electrical-Conduit- - 661 Solar System-Final -- - - ' -" - - - ,- 16.'Rough-Electric Wiring - 67. Fencing &Access Approval- . - . , r . I -, '17. Rough Wiring Sign ' - 68. APPROVED FOR PLASTERING . . : - . "'18. Rough Electrical-T Bar Ceiling , 69; POOL/SPA SYSTEMS FINAL - • • ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT , - - '- . -20. Rough-Factory Fireplace APPROVALS, ' Permit# t -" - 21. Ducts, ih Structure , • , ; ' • 70. Underground Hydro i V •'22. Ducts, Ventilating ' 71.1 Product Piping OGas ;0 Oil I ' ', 23. Gas Pipe-Rough & Test • ; 72. Underground Flush . ,72a. Roof Framing - : 73. Undergrnd.Storage Tank 0 Gas ❑Oil ' ) 25. Roof Sheathing 74. Overhead Hydro - - • 1 . '-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 g 32. Electrical Power Meter-Final - - • ' • ' 80. FOOD CERTIFICATE ISSUED ' I p • 33. Final ElectricNotes: _ _ __'_ _ __' 34. Final Heating &'Air Conditioning . : '- . 35. Final Gas Pipe-Test • - , 36. Hood or Canopy. - I" . 37. Final Factory Fireplace ;- - 38. Final Plumbing ' '-' • 39. Water Service-Final - - ', 40. Gas Service-Final ' • • - , 41. Solar Domestic-Final -- - - - . , 42. Backflow•Preventer • ' • - t _ _ - 1 , .I 43. Backflow Irrigation - - i 44. ,Landscape Irrigation System ' + :• 1 45. Sound Attenuation' - I - • - . n• alLe .46. Handicap Regulations • �`I�(y�(G '�- ^ .`'��' �f� �47. FINAL STRUCTURE & BUILDING fit? � (. .-1kof -- tea14 48. Special Requirements Completed; _ll l'u a( 49. Electric Release to Edison � ' • 50. Gas Release to SouthernCalifornia Gas Co I + + ' 51. CERTIFICATE-OFOCCUPANCY . - • - - - - - - - Nnr• Date _ - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. BOB72/2r_/db _[. _ IL CITY OF COSTA MESAggCOMSTR TJON P RMIT PERMIT/NO.� �� TRACT NO. LOT NO. UNIT NO. - ro'e ddress >- i/JZ• ,�• i T��1 ✓p - r I . - Kant s Mailing Address 30A AD - t • ,-u .Cm-_o - TYPE OF CONSTRUCTION LI NEW U ADD U ALTERATION LI REPAIR ' I�QYA q Fejt A. L 'L-re✓ n Phone Y'3 al" .❑ CONVERSION ❑.DEMOLISH El OTHER" • A,P,# I Zone wner's Name ✓✓ ma h n S ;ir-y{•Z DESCRIPTION OF WORK/USE OFBLDG. . _ • V�ddress. Sy m c S Main Building:' _ • Accessory Building: . E Z Arch/Eng. License No. ' TYPE OF PERMIT U GRADING- U FOUNDATION ❑ STRUCTURAL T- Front - - Address ❑ TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL B• Rear - N • ❑ OTHER A I Contractor's Name //� - Phone C Right - I N PROJECT DESCRIPTION SQ. FT. I OCCUPANCY • Address(mailing) CONSTRUCTION TYPE VALUATION$ S Left 1 - I R City License No. ZONE - GRADING CU.YDS. ACRES ' LICENSED CONTRACTOR DECLARATION - Ping. Ref. # Parking Req./Provided - _ E • I hereb affirm that I am licensed under + • • yi provisions of'Cha ter 9 (commencing Remarks: Planning Notes: - with section 7000) of Division 3 of the Business and Professions Code,and - - - - - - M my license is in full force and effect. I , T License Class /,nry License No. • - . S Date - • Signature D V PLUMBING ,I FEES + WORKERS'COMPENSATION DECLA ATION '• • ' Bar Sink Showers ELECTRICAL 1 'FEE$ l I hereby affirm that I have a certificate of consent to soli-Insure or a certificate ' � 1 I If Workers' Compensation Insurance, or a certifiedcopy thereof (Section . Backflow Preventer _ ._ Service Sink Automatic Washer - - Transformer 0 15:50 KW' -- '�800.-Lab. C.) - - _ _ _. . ;..__� Policy No. -Compa• ny Backflow Irrigation Sewer Cap ❑ 50+ KW + Construction Pole Sub. A Certified copy is hereby furnished. • v-�/ - 1 — Certifletl copy is filed with th0 city Building Division. I Bathtubs Sewer Connection Cooking Unit ;Meter YJllp t0 100.amps 4'1 Date Applicant" — - + , V EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers i Solar Collectors Dishwasher ;Mater Dover 100 amps • (This section need not be completed if the permit Is for.one hundred ($100) or -- less). • - Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel 1 I certify that in the performance of the work for which this permit is issued, I - - ' ' f shall not employ any,person in any manner so as to b•come z bj•ct to the 1 I Drinking Fountains Solar Tank • Fan .HP ❑1%-8 , Date Signature ��/. _ Floor Drains, 1 I Swimming Pool w/Spa F.A.U. 'NO ICE: I after making this declare ion, you - ould become subject to the , — - - Inc.,IncSolar ❑B-15 HP ❑16.15+ Workers' Compensation provisions of the Lab•r Code, you must forthwith Floor Sinks ' • Urinal - comply with such provisions-or this permit 'shall be:deemed revoked.- , - - - - Fixtpres - - 'Microwave i - - - - - �- - CONSTRUCTION 'LENDING AGENCY • - Gas Service .Outlets' ;Water.Closet. . - 1 ) Device •Boxes Pole Light I hereby affirm that there is a construction lending agency-for the performance -. - • - 9 ( of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors .. .Water.Heater - n ""Outlets ' Lender's Name ' - Range 1 1 Lender's Address - Kitchen Sink • . ' Water Service . - Switches Sign OWNER BUILDER DECLARATION I hereby affirm that'I am exempt from the Contractor's-License Law for-the Lavatories - + Auto-Wash i following reason (Section 7031.5 Business and Professional Code: Any city or • - Garbage Disposal , ;Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - any structure, prior to its issuance, also requires the applicant for such permit - - Laundry Trays • Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of . . Roof Drains- ' •,. —~ - ' the Contractor's License Law(Chapter 9(commencing with Section 7000) of - ' • Division 3.of the Business and Professions Code) or that he/she is exempt - _ i therefrom and the basis for the alleged exemption..Any violation of Section , ._ • - '031:5 by any applicant for a, permit subjects the applicant••to a civil • enalty of not more than five hundred dollars($500)., - r 1 I I .0 I, as owner of the property'or my employees with wages as their sole .Reinspection Fee 4 $15 Issue Fee 3$ ' compensation, will do the work, and the structure is not intended or offered ' • for sale•(Section 7044, Business and Professional Code: The Contractor's - • MECHANICAL FEES - Reinspection Fee $15 Issue Fee $ 3' License Law does not apply to an owner of a property whoibullds or improves - - • thereon, and who•does such work himself/herself or through his or her own • - DEVELOPMENT SERVICES REQUIREMENTS: I I employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sate. If, however, the building or improvement is sold within one year of com- - - Canopy Type II ❑ Zoning Approved By - Date proveif, the owner se ha le)the burden of proving he/she did not build or im- • Duct- Under Ground + Building Approved By Date % / t prove for the purpose of sale). • ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat d tractors to construct the project (Section 7044,Business and Professions Code:, I The Contractor's License Law does not apply to an owner of property who Duct-Ventilating + DO-100,000 BTU ❑100,000 BTU SUMMARY OF FEES • builds or improves thereon, and who contracts for such projects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that : Exhaust System 0 Multiple ❑' System Repair/Alteration -` B• UILDING PERMIT $ $MIP 1 I$ + proof of their Worker's Compensation Insurance should be provided to'me. -_ - PLAN CHECK $ PERMIT - r ❑ I'am exempt under Section B.6 P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PL•UMBING $ ISSUANCE '$ • Date owner Heating System&Ducting , Registers ENERGY P.C. $ f PLAN CHECK 25% $ I hereby certify that I have read this application and state that the above , -. 00.100,000BTU 0100,000 BT _. • - ` ELECTRICAL $ dr, , rJ GRADING $ ' information is correct. I agree to comply with all city and county ordinances , and state laws relating to building construedo and hereby authorize repre- • + PLAN CHECK 50% $ I MICROFILM $ sentatives of-this city to enter upon the ve-mentioned property for + inspectio Ir ses. ' - I Signature 9• Date 2-14S - — -- MECHANICAL $ TOTAL FEE :$ O • Q Drivers' License or SS , 1 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ . • • CMF"0865-46,rev.10/84 White - Pink -Accounting; Goldenrod - Assessor - - ( TRUCTION AND PLANNING,,, • POOL SPA ROVALS Permit# Date Inspector APPROVALS Permit#• Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,. 2. Soil Pipe-Undrgrnd. • - 53. Steel Reinforcement 31, Electrical Conduit Utility-Undrgrnd. 3j' _ �V 54. Forms 4: Electrical Conduit-Undrgrnd. 1. 55. Electrical Bonding 5. Steel'Reinforcement 56. Rough Plumbing & Pressure Test '6. Electrical UFER Grnd. Silk 4 57. APPROVAL TO COVER-GUNITE • 7: Footings . /// `' ' 58. Electrical Conduit-Undrgrnd. - 8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test ; , 9. Water,Pipe-Undrgrnd. - 9 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. SewerCap - 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 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION I. . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE E ISSUED/ �/ 33. Final Electric / - I - Notes:406 y4i/s �/7,�RirU/1r�I i7,, A D71%' 34. Final Heating& Air Conditioning u� � '�I - 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. Special Requirements Completed . 49. Electric Release to Edison - - „. ' 50. Gas Release to Southern California Gas Co , • 51. CERTIFICATE OF OCCUPANCY . • No. ' Date Costa Mesa Building Department " ✓ APPLICATION FOR PERMIT 111 EAST 20th STREET 14 8 BUILDING I COSTA MESA, CALIFORNIA 4 O FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY • _ .Receipt No._ Permit No. Building /3 C. /f7/ 4 j Si' /53-42/ Address Received by' Date Recd. Date Issued Costa Mesa, California Nearest / _6-� d �-er 6 - /–f� Cross St. CA arr_A 577 Building Address Owner 4. N. ��tcrnya Costa Mesa, California Mall Z E. Address /3, /, Sit Nearest Tel. Cross St. City No. Zone_ / I No.of I Type •/ I Group T Architect or Lia Plans Plans Y �/ Engineer No. Approved by Date Address CORRECTIONS Y ! City Lic. tractor Dun [/i'"/ soF„„No./+p. Address /1/7 K/ ' �i51 5. 4. LegalLot ^ ', � Description I No. ole I Block I Tract/c�6 :QA: 1 ,:, (Attach Metes and Bounds)AP ,M//l/9/,3-- 20 j .,._-._.:,b ,c, i . �Q,//7 NNoow,ofonBlLgts ?Size of Lot SO Use Of I No.of No.of - ''•� 700�, Existing Bldg. >� Families/I Rooms T O t, Setbackntr from �.0 Side Yard Rear Yard e X CI I Y OF COSTA MESA r ” Center of Street DESCRIPTION OF WORK New I I/�tteration I I Addition I - 4 r Repair I V Moving I I Demolish I ' Building No.of Size Rooms Stories r ',rior Wall I Roof /n•^ .��, ;ring Covering Wz� ` ,ech / APPROVALS Use of New Building Foundation Location Inspector Date E,�// Forms,Materials, r t4 pI- ,TQ 4 Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath.Ext. with all City Ordinances and State Laws regulating building construction. Signature of / l 7.G-. Plaster, int. Permittee �/ L Plaster, Ext. Authorized Agt. Masonry Reinforced Valuation i5 Permit Fee $ , e–o PlZ an Check $ Total 1 B $ .2-ea ond Beam Fee $ 02. FINAL or.ou .ria r,.0 >u s-aa . N . . . . u c u J c . . :i . 6 La Li: a • I Street r -r 'I,'- . .I PLOT PLAN - V . . Show location and distances from r I 't ' property line and between buildings. • i,p. I. i_„r .- _ _ . .. - I 1, '