HomeMy WebLinkAbout134 19TH ST - Building Permits RESS: 0N1Ti
134 E 19TH ST CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05361C
AME:
. ALISON DODGE
1360E 19.TH62ST PERMIT NO: B 053610 PLAN CHECK NO: 03170-91 S GOVT: N SUPP: N
CMCONSTRUCTION TYPE: • PERMIT TYPE: STR PURPOSE: ALT
ARCHIENFT:RESS: flEG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : ADD WALL & FRONT DOOR SQ260
PERMITTEE: CLAIM VALUE: 260 . 00 CALC-VALUE: 260 . 00 GROUP OCC: 8-2 /
ADDRESS: ALISON DODGE ( 714 ) 646-9795 COMMENTS. ADD WALL & FRONT DOOR W/ STOOP •
] 36 E 19TH ST *****.***4*********** ************ Ti***** ****Tt***************Tr*****sou*#i**K****
CM CA 92627
000)LICENSED CONTRACTOR3 of DECLARATION:NI hereby affirm de tans I am licensed under provisions ot ecapter 9(commencing with Section ZONING R EQUIR EMEN TS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CUSS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sett-insure or a certificate o1 Workers' FRN T: FT IN REAR : FT IN FRNT: F T IN REAR: =T 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 NO.: EXP.DATE:
COMPANY: PARKING REQ, PROV: PARCEL: 42626319 ZNE; Cl REF NO:
'I, t Certified copy is hereby tarnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> TO LEGALIZE AN EXISITNG INTERIOR WALL OF AN OFFICE BLDG.
> (RECORD KEEPING FOR AUTO WHOLESALE)
_ate: Applicant: *****************************ae****iE*********!E****IE*)0*i'.a3e******#*****TF****ii*3i::*y.
EXEMPTION FROMWORKERS'COMPENSATION DECLARATION: (flussecom need not be completed if the permit is fa one hundred(S100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N. . S
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 n
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY A ( V ' 1 < . DATE:
Date: Signature:
NOTICE:U.after making this declaration.you should became subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY . _ DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. - T—
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED "C : -a--._ DATE: �7��
which this permit is issued(Section 3097.Civ.C). ******************,'-***xxxxxrz-�=.:. rxxx.r- -, t -77.-. ,..`or ' -. ..a't.ia -{F.**ac*1(,r•-`4,.; rig*it.R **
LENDER: *************.***.*****Rx.. „ .. ,crcxx*****'.***M***********************4.?X•**}:.****ji*
ADDRESS: LEGALIZATION:N F E E FUMMARY STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby al firm that l am exempt from the Contractors State License Law for the following reason BLDG PMT PLUMBING ELFC TRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any thy of county which requires a permit to construct,alter,improve,demolish,or P LRM I T 15 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
SM I P/NON-RES
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)of that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 9 . 75 . 50
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work. and the BUILD ING—DLV—> PERMIT .0.SSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 15 . 50 0 . 00 9 . 75 25 . 25 25 . 25 . 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 ate not intended or offered for sale. If,however the building or
improvement is sold within one year al completion,the owner will have the burden al proving he/she did not build or improve REVENUE DIVISION TOTAT .i--> COLLECTED: 15 . 50 OVER/SHORT,: ,00
torthepurposeotsate). BLDG PMT PLUMBTAG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project'Section 7044.Business 15 . 00 - . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who If ids or im,oyes thereon
and who contractsfor such projects with a contractions)license pursuant to he Contractors'State Li ense Law lam aware *.*,.****3i-********** • ***************************-**********************************
that proof of their Worker's Compensation insurance should be provided to NDIVIDUAL F E E BREAKDOWN
C2 am exempt under Section: BP704 4 B.8 P.C.
nmsreason,,,ALl'opfx BY OWNS'' ' ' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date `� �ne0 b� ' SFC 260 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 260 . 00
I do hereby cervi that I am eAare of and understand the requirements of California Health and Safety Code Sean; 5 25505,25533,and END OF FEES
25534 and thatJ r any future building occupant Air Oul not(circle one)need to comply wish Said state codes and.he requirements fora •
permit for construction or modification from the Air ua i Management District.Residential construction applica ions are exempt from
these pro ions.
Date: 'r Applicant:
I hereby certify that I have read this application and stat ha he f•r e information is comes . agre' n .amply with all city and county
oidin(�n�ces and state laws relating to building construction a'. reb�uthor'e represen.fives' Iscis •r iter upon the above-mentioned -
prop'"(y for inipeclion err�oses.r'�y ,.
_ Date. `K4 I C1I - ,, ..`- Cl CC"u95C74-CG2q_';r _; ..' 4.
11 Signature: �- L!I . On OU/22/X1 I.i_: 1 .:
Driver's License r Social Security#: I
1641-46 Whim—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
RUCTION AND PLANNING POO' 'A
__________
VALS Permit # Date Inspector APPROVALS Permit# _ Date Inspector
emporary 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 UF ER Grnd. 57. APPROVAL TO 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 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 ❑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 1 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 4,,,,l-q/ ,JJ.
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
J
_ _ _ _.
f Applicant to fill in all spaces except those within heavy border lines and sign.all appropriate declarations. •y. -- - •- -y
PERMIT NO. ; _ T ACT NO. _LOT NO: UNIn. I _ ' 9366 ' 3/Y 3/fj'' ='i^' i -
CITk OF COSTAIM'EjSA CONSTRUCTION PERMIT _ Q e.P�a.��G I t, 1 �/ — • - '-
Project Address 1'5+ •• l�i1 •
. 1�l U�.. • .H�1 r Vt - -1 I -
Applicant's Mailing Address' Al G •FII/ *A TYPE OF CONSTRUCTION. LI NEW - ADD Li ALTERATION U'REPAIR, •
'`�� py9 ❑ CONVERSION El DEMOLISH ,❑ OTHER-- A.R.# 4y/ _'2i$. — l,�-7. ` Zone CA.
Owner's•Name-- : --Phq`ne i' _ll!! „DES_CRIPTION.OF WORK/USE OF BLDG. - co
Address ' I , - - ' - �- — - S Main Building: - 'Accessory8uilding: ,
/3d /9— l'oss(.w ntS: . Gq, L Z IU ' E Z
TYPE OF PERMIT II GRADING ll FOUNDATION e STRUCTURAL $ ; Front �.�co ' fes-
Arch/Eng. - - License No. T •�F(�1/-�t7.>=b - - ' O ,
Address - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear Cj TJ ,( 4tf • - - ' N
❑ OTHER
Contractor's Nam one 6 ' I C Right '�'2,(o f - - N
PROJECT DESCRIPTION SQ. F - - OCCUPANc K - - G
Address(mailing)s�/.�/1• S� `i/ Left' f l'C ON ST RUCTI ON TVPE ✓ VALUATION $ S IO " 1 ICity License No. - cri•
- ZONE _ GRADING CU.YDS. 'ACRES - RLICENSED CONTRACTORPing. Ref.# Parking Req./Provided E-
l'hereby affirm that I im-licensed under provisions of Charter 9 (commencing Remarks: - I ' Plate Oin •Notes: p,/� ll..,,�� •/� D
with section 7000) of Division 3,of the Business and Professions Code,and _ - g L. =-1dLl Z� �T1� ' YwnO t›-Le-
With
M 1
my license is in full force and effect. , • - --0 Sly 1&(•, 17 �ArTI/A l fico cQ• - T
License Class 1 __ • I - Lice a N`€ I�,,�,� ' �'" (' a��, _`�^,,r,/�y� S
DatSignature • PLUMBING FEES fiiA.�f 'ja ( '�'�'�y,lZy% L-7GC_LA_L.t�x.. t�,t_I(J.t-a"�'c-+•Iu
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ,
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
-if Workers' Compensation Insurance„or a certlfietlj copy thereof.(Section . Backflow Preventer Service Sink -
, Automatic Washer Transformer D 15.50'KW
800, Lab. C:) • Automatic
No. Company Backflow Irrigation Sewer Cap ' , ''Construction Poie Sub. ❑ 50+-,KW
8 Certified copy is hereby furnished. .
Certified copy k filed with the city Building Division, Bathtubs Sewer Connection 'Cooking Unit 'Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers y Solar Collectors _ Dishwasher - .- Meter ❑over 100 amps , - - --
(Thissection need not be completed-if the permit is for"one hundred ($100) or -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for-which this a mit is Issued, I I .-
•
shall n e ploy any arson any mann s as to'beco subject to the Drinking Fountains I Solar Tank Fan Motors El 0-1 HP ❑1'h-8
Wor e m I - of Cali n I
g.
. Date • nater ]f�t -d Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16.15+
"NOT CE:If,after making is decla atiot n, you shone dd ecome subject to the _
Workers' Compensation!provisions of the Labor Code, you must forthwith . - Floor Sinks --- - Urinal i - - . Fixtures , • Microwave
comply with such provisions or this permit shall be deemed revoked. - _ _ ' _ - - '
CONSTRUCTION LENDING AGENCY ' - Gas Service Outlets • Water'Cioset •
Device Boxes Pole Light �-yJ
1 I hereby affirm that there is a construction lending agency for the performance 1 _ I
of the work for. which this permit Is issued (Section 3097 Civ. C.), - , Interceptors l Water Healer -
Lender's Name ' - - p - - - Outlets Range •
Lender's Address - - _ ' ' • , Kitchen Sink. - Water Service '- Switches �I'
OWNER BUILDER DECLARATION - Sign
I hereby affirm that I am exempt froth 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 1
county which requires a permit to construct,alter,improve,demolish,or repair - P-Trap , - •r .. Laundry Trays T Generator ❑0.5 KW❑5.15 KW
any structure, prior to its issuance.'also requires theapplicantfor such permit - - Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of •ROOPDralns r • - -- .- ,
the Contractor's:License Law(Chapter 9 (commencinglwith Section 7000) of - - • , .
Division 3 of the.Business and-Professions Code) or,that-he/she.is exempt - - - • . .
•1 th¢refr and the basis for the alleged exemption. Any violation of Section n a< - .r
13 by_anyapplicant for a permit subjects_the -applicant, to a civil i • I
Ity of not more than five hundred dollars($500). - - - • - $ 3 ,
owner of the property or my employees with wages as their sole Reinspection Fee ♦l I '$15 • Issue Fee •.
compensation, will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee ! •$ 3'
for sale (Section 7044, Business'and Professional Code: The.Contractor's _ MECHANICAL FEES .,
-
License Law 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 I •Hood or Tyke I 0 DEVELOPMENT SERVICES.REDUIREME _
employees, provided that such improvements are not intended or offered for Boiler -,. ., I V q '
• sale. If, however, the building or improvement Is sold within one year of com- - CanopyType I I 0 - ; Zoning Approved By ��� ` •
Date -• CJS
pietion, the owner will have the burden of proving he/she did not build or im- • Duct-Under Ground Yp • /►,����� ��
prove for the purpose of sale). Building Approved By Date
•
/� �y
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural I Refrigeration System ! 'Application Issued By '`� Dat: - �C/�
tractors to construct the project (Section 7044,Business and Professions Code: ; - 1 • ,
The Contractor's License Law does not apply to an owner of property who Duct_Ventilating . _ ❑0-100,000 BTU ❑100,000 BTU _ $DMM RVEF FEES
builds or Improves thereon,and who contracts for such projects with-a con- G�
tractor(s) license pursuant to the Contractor's License Law). I am aware that1Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ // CC SMTP $ o:_J�
proof off their Worker's Compen-- •• 'nsurance should b: •rovided to me- , PLAN CHECK $ ljJ i:)� PERMIT
❑ I am exempt under Section
Aa.; B.• & ••!for this reason Firepl/Fact. Blt. ICBG# Fire Dampers •
ISSUANCE $
HeatingSystem& DuctingRegisters I PLUMBING $
Date Il(�__�,e�ner eta Y 9 • PLAN CHECK 25% $ - ENERGY P.C. $ •
' I -hereby ter fy that I have read this application and state that -¢ above l ❑0-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information Is correct. I-agree to comply with all'city'and county ordinances -
and state laws relating to building c.•struction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives b(•this city enter u:� the above-mentioned •roe• ty /. /J�'/
inspection pur.. ' — MECHANICAL •$ TOTAL FEE $ 1G” !/�
'1
Signature . �'_ .4 •
ea ' i� Ar Dat- CI In a , - '
g �, • Reinspection Fee $15 Issue Fee ! $ 3 PLAN CHECK 25% ,$ l
Drivers' License or$S*
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor '
if CONSTRUCTION AND PLANNING POOL ,'A
I APPROVALS Permit# . Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
1:2. Soil Pipe-Undrgrnd. I 53. Steel Reinforcement
. 3. Electrical Conduit Utility-Undrgrnd. . . 54. Forms
4. Electrical Conduit-Undrgrnd. - r 55. Electrical Bonding ,
'
5:'Steel Reinforcement - 1 - 56. Rough Plumbing & Pressure Test
. 6. ElectricalUFERGrrid. - 57. APPROVAL TO COVE R-GUNITE -
7. Footings . .. 58. Electrical Conduit-Undrgrnd. ,
8. Foundation ,1 59. Gas Pipe, 0 Undrgrnd.,Test •
t 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 66. Solar System-Final
,1 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
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 ,
gi
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
I)44. -Landscape Irrigation System- ,
'45. Sound Attenuation
16. Handicap Regulations
i. FINAL STRUCTURE & BUILDING 113/6( CG<o
t Special Requirements Completed
'Electric Release to Edison '
1 - 'Gas Release to Southern California Gas Co
CERTIFICATE OF OCCUPANCY i ....-
I
I Date
-
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY(1F COSTA MESA[ CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. ' UNIT •NO. I . IQ.OQ. 7L
Project Address T y ! rn S'' r I E I a( LZ 'U I .. 1.006 WI 1'.195 -,1
�Z 7 l W 'GoLL/n rt Oe6 G4 TYPE OF CONSTRUCTION U NEW ADD U ALTERATIO�EPAIR 1 .
Applicant's Mailing Adtlress - - _
AL /S 0 N D0Q /9'p•'p� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.s1L Zone
Owner's Name GfPhon s !/ DESCRIPTION OF WORK/USE OF BLDG('Nei s-e-e SLer-T To
Address / 3 C. ! 9 ref �S r - ' - •liNnritc-Q • •' S Main Building:' ' ` - - Accessory Building: -
- ��j-r���� E z
' Arch/Eng. - - License No. .. TYPE OF PERMIT L I GRADING U FOUNDATION U STRUCTURAL T Front ' - 0
•Address �p (`� 0 TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL• A Rear _. N
•CO Contractor's Nam- _a '.i Phonce0�" �0 0 OTHER C Right - - N
Q PROJECT DESCRIPTION SQ. FT. - OCCUPANCY g
Address(mailing) / � � CO CNS QR/4 N�'F CONSTRUCTION TYPE VALUATION$ • S Left ( _ G
City License No. D2.--/ z S 7 '7 ZONE GRADING CU.YDS. • ACRES t -, R
LICENSED CONT•RACTOR DECLARATION • �) Ping. Ref.# Parking Req./Provided E
•I hereby affirm that I am licensed under provisions of charter 9(commencing Remarks: I71 3c • Planning Notes: , M
with section 7000) of Division 3 of the Business and Professions Code,and - - ,
my license is In full force and e fact ♦ • _ - - T f
License Class. a ♦♦it�./ 9ltr✓i / •
- S
Date • - Signature yl W n .c : .rr- PLUMBING FEES -
WORKERS'COMPENSATION DECLARATION Bar Sink , Showers ,
I hereby'affirm that I have a certificate of consent to self-insure or a certificate - , ELECTRICAL i , FEES I
d Workers' Compensation Insurance, or a certified copy thereof:(Section - r _ __
Boo, Lab. ) _7-� 1;,, ;�- Backflow Preventer. _ , _ Service Sink Automatic Washer ; - r- - - Transformer 0 15-50:KW
Policy No. c `7 J`-�SS4 Company Jam- Backflow Irrigation • Sewer Cap j Construction Pole Sub. • • : 0 50+KW
�Certified copy is hereby furnished. •
Ce t)'fietlyppY f' with the cit ulld g/evisio Bathtubs • Sewer Connection Unit ' ; Meter ❑u to 100 amps '
Date`�'- `' theAnglicant ee-♦�At/'�/IS')'E^-+�'�M a i Cooking P P
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers i Solar Collectors Dishwasher I MeteOver 100 amps.
-(This section need not be completed if the permit-is for one hundred ($100)-orI '
less). Dishwasher Solar Piping Dryers OGas DElectric 'Sub Panel
I certify,that lin the performance of the work for.which this permit is:issued, I
shall not employ any person in any manner so:as to become subject to the . Drinking Fountains Solar Tank ' Fan 1
Workers' Compensation Laws of California. ,Motors❑0.1 HP ❑115-8
. Date • Signature Floor Drains ' Swimming Pool w/Spa F.A.U.
Inc.Sola- ,-.: 5 HP 016-15+'NOTICE: If,atter making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal _ .. Fixtures . - - - Microwave I - -
comply with. such -provisions or this permit shall b¢ tleemetl revok¢tl. _ '
CONSTRUCTION LENDING AGENCY Gas Service - Outlets Water Closet _ , -
•
I hereby affirm that there is a construction lending agency for the performance - Device Boxes ' Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) •
Interceptors - - Water Heater Outlets Range i ,
Lender's Name ` - _
Lender's Address I _ Kitchen Sihk i Water Service - Switches •i Sign
OWNER BUILDER DECLARATION - . - - -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . . , Auto-Wash Garbage Disposal ;Standing Sections
following'reason (Section 7031.5 Business and Professional Coder-Any city or • -
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - I Laundry Trays •
Generator ❑0.5 KW❑5.15 KW Trash Compactor '
any structure, prior to Its issuance,also requires the applicant for such permit -
:to file a signed statement that he/she Is licensed.pursuant to the provisions of ' -
ROOF Drains'
the Contractor's License Law(Chapter9 (commencing with Section 7000)of - - -
_Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom-and the basis for:the alleged exemption. Any violation of Section . .• .
'031.5 ,by any applicant for a permit subjects the applicant',to a civil ' _ -
($
•
.,ehalty of not more than five hundred dollars 500). - i
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not intended or offered - - — - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - _ - _ MECHANICAL FEES •
License Law 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 - - DEVELOPMENT SERVICES REQUIREMENTS: I
employees, provided that such improvements are not intended or offered for Boiler - Ci Hood or Type I 1 0 ' - ZiBy '
sale. If, however,. the building or improvement Is sold within one year of com- Canopy Type II 0 Approvedppng
Date
pletlon, the owner will have the burden of proving he/she did not build or im- . Duct- Under Ground Building Approved By
prove for the purpose of sale). Date
❑ 1,as owner of the property, am exclusively contracting with licensed con- Duct-Structural , , Refrigeration System Application Issued-By Date ''"` It '
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 Duct-Ventilating 0o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES '
builds or improves thereon;.and who contracts for such projects with a con- 1 ' - - - ' I i
tractor(s) license pursuant to the'Contractor'i License Law). am aware that . Exhaust System ❑ Multiple❑i System Repair/Alteration BUILDING PERMIT $ SMIP • $
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK ' $ PERMIT •
O l'am exempt under Section B.& P.C.for this reason , Firepl/Fact.Bit. ICBO# . Fire Dampers PLUMBING $ I ISSUANCE $
Date I Owner ' Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25%' $
I hereby certify that_: have read this application and state that the above . ❑0-..100,000 BTU ❑100,00087 - - - 1 ELECTRICAL $ �h. .S� GRADING $
'
information is correct. I agree to comply with all city an county ordinances ' •
and state laws relating t bunts g construction, a d h authorize repre- PLAN CHECK 50% $ • MICROFILM $ 4
sentatives of ��f1y's'city o en o the ab -me I ed property fox_ •' - II hh
inspection pu/Jyases, �q MECHANICAL $ TOTAL FEE $ l l\ 5O
Signature Ut
ate/74-g-os I ,
Drivers' License or 55 , Reinspection Fee I $15 1 Issue Fee • $ 3 PLAN CHECK 25% $ ,
• - _ - - _ - - - _ __ _ _ ... . .
CMF 0865-46,,rev. 10/84 'White - Building; Canary Applicant;-Pink -Accounting; Goldenrod - Assessor - -
•
' ', CONSTRUCTION AND PLANNING POOL. SPA
±•••1 APPROVALS Permit# L Date Inspector. Date Inspector
_ APPROVALS Permit#
•`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;iEledtrical Conduit-Undrgrnd. 55. Electrical Bonding
5: Steel Reinforcement 56. Rough Plumbing & Pressure Test
6.' Electrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE
7..Footings 58. Electrical Conduit-Undrgrnd.
i8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
49: 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 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 ANAL
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 ❑Gas ❑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
32. Electrical Power Meter-Final • !f /Po 80. FOOD CERTIFICATE ISSUED {IL
33. Final Electric 4 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 . . -
48. Special Requirements Completed •
49. Electric Release.to Edison, - - - F
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY, - - •
Yo. - ' Date • '
•
41695 PAIL
APR 20-76001066::- ****46-70
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RE 1LI A ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
BUGATE RECEIVED E SUED
ADILDING DRESS 1 3 / /; 17 7H S % i ('�- 4 'Z'O 110 - r����l
-/ A.P. NO.I 1 b -01S—DsMAIL PE IT NO.
OWNER SINWSq��J,QL/?SoN U _
ADDRESS 20 tatSum D/?TE *A�DDDRE s ► 3Ade
�1 1��h S
CITY COS7iq fli,ys4 NO. S'6 227) ` ) A4 ���IIIssslI LOT 04 BLOCK
NEW AOp ALTER REPAIR MOVING DFMOI ISH
CONSTRUCTION C 4sN
LENDER
BRANCH �/�/
OWNER •rI • S�1knOnGitc00
ADDRESS � VALUE p['�7�
ARCHITECT j] TEL. SE s�s4\ T\,• �+-�Y)(/(/
OR ENGINEER fr4R.f- /T VSSI'4E. NO. XY9-2s 2A y r,
a FIRE
ADDRESS /-17/3- 'A) m4c 44(luf ZONE VPE 1 GROUP r r- 2 \(�
APPROVEDgi) '1� /�� / �\!
CONTRACTOR AARgi WAh slum0n/% BY DATE �Af/7�
ADDRESS 40 7_, 4 (/OGADO AV? ��11"�' 111✓vu\
TEL. / ZiNE NO.OF USE OF W
CITY CO/?o,t4 Orl.. "Pint R NO. ‘7531# L-+- 1 PLANS Z BUILDING ^
.--i STATE CITY YARDS APPROVED YARDS APPROVED `�.
LIC. NO. 2. y /O 3 O LIC.NO. MAIN BUILDING ACCESSORY BUILDING
ia SIZENO.OF BLDGS. (FROM SsC��/L STREET) �
0. OF LOT ..5-0 )(/ t o NOW ON LOT FRONT PITT FT. FT.
Q USE OF 11
EXISTING BLDG. sat s /�
R.SIDS FT. FT. Ll
F Separate permits are required for L.SIDE 5 / 'FT. FT.
electric,plumbing and heating work. //��
WREAR70 FT. FT. j
I.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QMAIN BLDGS. ACCESS. BLDGS.
MI /34111 C.U.P. DATE
�` W CW�c C.Up/Pv.�yW APPROVED /)
�., 4• CO F! ft. /PC•1elm— _RY . s"2aj W.7�Z DATEq—� G 1p
..7 l 1
cd •
w .
o.
Q I hereby acknowledge that I have read this application and state 'n
r.
g., that the above information is correct and agree to comply with
re
Cl" all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of o
TW the State of California. 'q
I hereby certify that I am properly licensed as a contractor under SO. FT. a
the State of California Business and Professions Code, Division 3, THE MOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE URPOSE OF ESTABLISHING A PERMIT
�FEE
�ONyLYJ• n
am exempt from the provisions of the Stateof California Business VALUATION PERMIT FEE E c1! % g
and Professions Code, Division 3,Chapter 9. '�Y/ M
" . Q(f PLAN CHECK E /
.eiQ LLSignature ofI W � QN' P —/
Permittee 4,rj 5.5547Z � _ TAX $ OV
2
u
Authorized Agent TOTAL PAID 5 4• ala
•
COUNTY OF ORANGE ..2.1 C/.J�("/7
BUILDING DEPT. • - Permit No.. ...�1
636 No.Broadway Application for Building Permit
Santa Ana,California
Phone:KI 2-6211 AND FOR A
Certificate of Use and Occupancy
Date.- Ili / V 1,•5 --a--
.
1. OWNER'S NAME if?z.-4 V ;7..1/kr o,6 PHONEE& S;17/
MAILING ADDRESS
�I- 4l, , /q #- /CITTY - / _2/t4. 4 }
Name -�C//f / Name --49/1_,---/2
• (Architect or Engineer) ./ : (Contractor)
Address Address
City City •
State I State
Lic. No Phone l/ Lic. No` /• Phone
PROPOSED USE• 1-6/—#9.cc-7A P"/ ' — aGeGte/
2. JOB LOCATION 1 3 7 Cetrkist
v y 1 -'w
•
(House No.) (Name of Street) (Town or School District)
3. LEGAL DESCRIPTION: Lot 17 / Block 1 7 Tract
(Metes and Bounds Desscription—Use reverse s�)
4. CORNER LOT ( ) INTERIOR LOT ( ✓) THROUGH LOT ( ) SLOPE OF LOT ( )
L _I
5. SIZE OF BLDG.:.../S- ./11../.4 AREA ANo-oi, /I SIZE OF LOT• 4. ...X..L. s;3 AREA A 2.a"1°d,--e/a-
a. HEIGHT OF BLDG - / Y---274— CEILING HEIGHT V 4,-7 NO. OF STORIES /
7. NO. FAMILIES Size of Smallest Bedroom Size of Kitchen
mit.
8. EXTERIOR WALL CONSTRUCTION:...-C/..!2�-il' INTERIOR WALL COVERING-_44 .tiec.ti
(Frame, Stucco, Etc.) ( (Plaster-Drywall,Etc.)
9. SETBACKS: Front Yard IFrom Center Line offStreeetc1 �0��
Nearest Side Yard ,/ Rear Yard p..4//r.Distance in Feet Between Bldgs. on Same Lot • 4-6
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
I1. For (a) Footing: Width /.±.....t?: Depth in Ground ,/aC.kr✓ Width of Wall /!/-.r-sJ. '
Accessory
Bldgs. and " / /
Similar (b) Size of Studs r2...%V Spacing.--./ "CC Material of Floor.... ....:crcl/ •
Structures:
(c) Size of Floor Joist P�qq,r Y/ a Spacing 16 .. "CC
qq �r u
(d) Size of Rafters d, /A y Spacing ./2/19
V "CC
- 12. VALUATION OF PROPOSED WORK: Including all labor, plumbing,electrical wiring, heating, fire sprinklers, painting and
, sewage disposal $ 191..O.6...0 0
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
f .��3
/ r/ / Signed:.. �..�t�.Qa/f..�.--� /.�
Plans Filed:.. l.j�r...b../1.�� / (Owner) -
/ ([[ /r By•
�� J (Authorized Agent) •
FOR DEPARTMENTAL USE ONLY
FEES: LoCCHHiE ING BY
Bldg. Pe it $
/ - 00 GROUP APPLICATION..I/. . HEALTH
�
Plan C eck - $ �..-.Q'LI TYPE -
ZONING if FIRE
Total - - $ •0 0 DIST. MARSHAL
Recei No. r MAP PLANS AND
SPEC'S STATE
Paid - - bei SHEET NO / CORRECTIONS ENGINEER
Date S..'Ir. VERIFIED CAL
•
PE• . fr COUNTY BUILD
�. �
\ 0 $i C
r, �diy i`r t�:'o F'..CTOR
yr/s _ �
5 M_g.g
/ja, # 53C (] I
METES AND BOUNDS DESCRIPTI /j n Az _,,,„_,10.74 /ti., 7L_ �, ,./--.•
-G .9` _ 71, . .1./ _ /.4r % /moi ' a':r‘ .. et.- . ' A /1i '. ;
•
. .)//..e. /r'. 44- .�. , e•--- / ,,-
1
l0 SIO 310 4,U 510 60
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