HomeMy WebLinkAbout165 19TH ST - Building Permits •
M CITY OF COSTA MESA
BUILDING DIVISION
°, •,_ I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 ••Mrtli
PPMI PERMIT
]B02.-01714
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 165 E 19TH ST Status: ISSUED
Suite: Applied: 10/18/2002
Vicinity: ROOF Issued: 10/18/2002
Parcel Number: 42523416 Zoning:
Applicant: PETE VAN GERVEN ISSUED BY:
Address: 3101 S FAIRVIEW ST
SPACE 49 Phone: 714-979-2774
SANTA ANA,CA Zip: 92704
Owner: MC KINZIE, VANS TR •
Address 165E 19TH ST '
Phone:
COSTA MESA,CA Zip: 92627_
•
Contractor: PETE VAN GERVEN ROOFING
Address: 3101 S FAIRVIEW ST."
SPACE 49 Phone: 714-979-2774
SANTA ANA,CA
Zip: 92704, License:- 757856
Arch : Eng:
Address: Address:
Phone: ' , Phone:.
Zip: License: - License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 30 YEAR, GAF COMPOSITION SHINGLES, USE EXISTING SHEATHING. 1,900 S.F.INCLUDES PART OF
RESIDENCE,'BREEZE WAY AND WORKSHOP.
. FEESUMMARY
Plan Check: $0.00 \ Calc Valuation: $2,900.00
Permit: $83.25 • Claim Valuation: $2,900.00
SMIP Res: $0.50
SMIP Com: $0.00 . • -
Other: $0.00
Inspection: $0.00 '
Total: . $83.75 -
•
„ .. � I_ PLANNING &ZONING -
SETBACKS
MAIN STRUCTURE Front 0-0 �� Rear -.0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 `Rear .0-;0 ,- Left 0-0 " Right 0-0
PARKING Existing:. 0'�-/1 .Required:- _ 0 Proposed:, 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46 WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
• ' I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
liAy workers'compensation,Insuran carrier and policy number are: 1 /
Cerner: " Stcur-f.. 'Apt It y. P11cy Numb!:: /t/Q I3-U -- 0(
(This'section need not be completed if the permit is valued at one hundred dollars($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,and a ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these
' Provisior
�Ii�rS pH-is-raw ' aD /0 IU
-o Z--
'WARNINorFAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND COJ ARE(5100,000),IN ADOMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I herebyaffirn'Dlai l am.ixens2.ds eiorp Pions of Chapter 9(commencing with Section 7000)of Division 3 oLthe.Business and Professions Code,and my license is in full
•-osa- etfe O Giasva C-39
forca:ei v;.? ' lo.x ,,//
Contractor's Signeturb: Az tat.... Datei 10 —! —0?—
Aehlt
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.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the Owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? U Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ppetSitetpr@(�f Legal r(s) /
ej{l /J pr/Oy Leg � v at
And/OrAathorized'Applcant �.- \,, ' Data J
.awSw..mmw -
;ODE I INSPEC110N TYPE PAH MEI CODE IBSPECTION TYPE PATE gi1 AIa
1616 Fixed System Final Fire Prevention 206 Final Mechanical _
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof /0—Z-9-0 Z ri2g9 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign 222 Final Site _
204 Final Demolition 250 Final Building/Occupancy
•
•
PROJECT ADDRESS: 165 E 19TH ST UNIT: CITY OF COSTA MESA — BU'ILDI'NG PERMIT PERM NO: E 045439 - '
• 'OWNER'S NAME: VAN MC KINZIE : - '
ADDRESS: 1.65 E. 19TH ST •PERMIT NO: E 045439 .. PLAN CHECK NO: N GOV• T : 'N SUPP: N •
CM CP. 92627 •
-01 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT
'714 ) 631-2121 • - ,
'•ARCH/ENGINEER: _ • '.REO.NO.: •
TOD DESCRIPTION : UPGRADE SVC 6 RAISE' WTHR' FID SQ PT: '
ADDRESS: ' UNIT: • _
. CLAIM VALUE: 2, 000 . 00 CALC—VALUE,: • . ' •- • GROUP .00C:. B=2', /
PERMITTEE: VAN MC KINZIE ( 714 ) 63.1-2121 -
ADDRESS: 165• E 19TH • COMMENTS: CABINET SHOP SVC 6 WTHR HD UPGRADE
CM CA 92627 ***prat ,Ear**** ¢**e¢gens-*******t ****N******_to-********************a¢ety<x**** *******4***N
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with SectionZ ONING R EQUIR EMENTS •
7W0)of Division 3 of the Business and Professions Cale,and my license is in full force and effect. S E T B A C K S • _
CITY UC.: STATE LIC.: CUSS: i ,
ri3r Signature: MAIN BUILDING ---------- ACCESSORY BUILDING -
HKER3'COMPENSATION DECLARATIDN: Thereby arfirni that Ihave acertificate of consent to self-insure oracertilkate of orkers' FRNT: FT . IN REAR: - FT IN FRNT : • FT IN REAR: , FT •
IN
,mpensation Insurance,ora certified copy thereof(Section 3800,Lab.C). - . "�L E FT: FT IN RGHT: FT IN .LEFT: FT. IN RGHT: I . F T • I N'- •
POLICY NO.: • EXP.DATE: • J
COMPANY: PARKING PEQ: P•OV: PARCEL : 425234'16 ZNE: • REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. '� PLANNING NOTES>
'l7�1 >
Date- Applicant: *************** . *** ********************* ****************************3e*******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed If the permit is for o ndred(S1o0)or less). D E T T E I 0• M E N T. S }:' R V' I C E S R E Q U I R E M E N T S .
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in an ner so as to become ,
subject to the Workers'Compensation Laws of California. /� ZONING APPF 0 it? /JAY DATE: _
---> Date: / ,J —0-1 signature: ��97 - ! t - • , 1 _, _•
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation Drovisl s of the L or BUILD I AEP 'C .1 • BY : _ DATE:
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 prior nce of the rk for AP PL I I.AT 14 N T.'SUED BY : C. DATE: I '1 B 'a9 . ,
which this permit is issued(Section 3097,Civ.C). - r ***** :**.y *'.********** ****** *' Nya7'.' '*************************IE- ***ie***
LENDER: r' * ' *,-***, ' *****:*********************** . ***********************'****************
AD0"ESt E; L P ION: N F E 'E S M N A R Y STRUCTURAL SEGMENT:N " .
•
•
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law f r the following re. .- BLDG PMT I P LAMBING 'ELECTR . C MECHANIC ' FIRE, SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,'mprove.demolish.. ' Rt. I T 29 . 50 '
repair any structure,prior to its issuance,also requires the applicant for such permit to fife a signed statement .t he/she is •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Divi'on 3 of the Busi -ss O$ S M:C P/NON-RES. •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.'Any violation • Section 7031.•by 'LAN , / • •
'ny applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 1 5 . 0 0
I, as owner of the property or my employees with wages as their sole compensation, wig do the work, an. the BUILDING-DI y > PERMIT ISSUE ' PLAN-CHECK TOTAL PAID DUE
• ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'.Srte Linen-•Law TOTALS----> 29 . 50 15 . 00 0 . 00 44 . 50 44 . 50 . 00 .
does not apply to eann owner of a property who builds or Improves thereon,and who does such work himself/he .If or rough . .
his or her own employees,provided that such improvements are not intended or offered for sale.IL however t . b •ding or REVENUE .D SON TOTALS•--> COLLECTED : 44 . 50 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build. improve
g for thepurposeofsale). BL7G ' T PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as ownet of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 44 :-50
® and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon - ,
and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).I am aware ********..**** *'Y 4*. ***************************************************ice********
that proof of their Worker's Ciompensation insurance should be provided to me: � . ND I: V I D U A L F E E BREAKDOWN •
❑ I am exempt under Section:i B.&P.C. 1 •
for this reason: Q " DESCRIPTIO N UNIT COST TOTAL COST
_ Date: �v�— ( � -�� Dwner.�� f� 1 SERVICES BELOW 600 V 6 BELOW 200 AMP 18 . 50 18 . 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MISCr
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 Cji)--./1
1 CONDUIT NOT L Lx T ED, REQ PERMIT 1 1 . 0 O 1 1 . O O
permit for construction or modification from theAir Duality Management District.Residential construction applications are exempt fromEND OF FEES
these provisions. - •
•
Date: 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 upon the above-mentioned - . - .
property�affor inspection purposes. r,�, � .
Date(F t �9 Signature: /V�`/ s.
y� 1 •
01 00049975-00049975 TOT ' 44.5]
Driver•sLicenseorSocial Security x_ - DATE: 12/18/89 'TIME: 14;34 1
164146 White—Buildino:Green—Code Enforcement:Canerv—Aoolicant:Pink—Revenue:Goldenrod—Assessor - , - . . . . ..
I •
V \,•'
CONSTRUCTION AND PLAt7,•.0 - POOL & SPA -
'i APPROVALS Permit# Date • Inspector APPROVALS Permit Date Inspector
••' 1. Temporary Electrical Service or Pole - 52. .Pool & Equipment Location 7-
r
2. Soil Pipe-Undrgrnd. • - 53. Steel Reinforcement ' -
3. Elec rical Conduit Utility-Undrgrnd. • 54: Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56/Rough Plumbing & Pressure Test
6: Electrical U,E.ER Grnd. 57. APPROVAL TO COVER-GUNITE -
7. Footings • 58. Electrical Conduit-Undrgrnd.
• `8. Foundation 1 - 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 i ' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - " - 69. POO USPA 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 0Gas 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 I 77. FIXED SYSTEM FINAL -
I 29. Insulation ! 4. 78. FIRE PREV. FINAL
/ 30. Drywall Nailing . • Il HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
_33. Final Electric - Notes: i.
34. Final Heating & Air Conditioning ' /,
35. Final Gas Pipe-Test i*`.'
_ 7
.36. Hood or Canopy :
37. Final Factory Fireplace
38. Final Plumbing •
39. Water Service-Final- .-
40. Gas Service-Final i
41. Solar Domestic-Final
42. Backflow Preventer ,-,
43. Backflow Irrigation . •
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING `,.
48. FINAL PLANNING •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co (L• .
51. CERTIFICATE OF OCCUPANCY
No. Date
pROJECT ADDRESS: 165 E 19TH ST UNIT: 0 • CITY OF .COSTA MESA — BUILDING PERMIT PERM NO: E 054325
OWNER'S NAME: VAN MC KINZIE _. .
ADDRESS: 165 E. 19TH ST PERMIT NO: E 054325 PLAN CHECK NO: N GOVT: N SUPP: N
CM CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER:
714 ) 631-2121
REG.NO.:
ADDRESS: - UNIT: JOB DESCRIPTION : UPGRADE SVC & RAISE WTHR HD SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
ADDRESS: VAN MC KINZIE ( 714 )631-2121
COSTA MESATH CA 92627 *******95ER•t**BApB*********�r***+r********D*****************+r***+t•*+a***+E***************
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.
CITY LIG.: STATE Lit: CLASS: SETBACKS
`.k Dale: 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 NO.: EXP.DATE:
'OMPANV: ' PARKING REQ• PROV: PARCEL : 42523416 ZNE: REF NO: .
Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ******************************* f•***********************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S EARVICES REQUIREMENTS
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
spblect to the Workers'Compensation Laws of California. ZONING APPROVED BY
• DATE
Date: - Signature:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; - A DATE
Code.you must fonhwith 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 APPLICATION ISSUED BY: (x� 444.:194;:
(.(�� 1 .* .
�
which this permit is issued(Section 3097.Civ.C). **************************"�F Bk Ef 444.:1194;: t * . **.L ***********D*****9�*W*B if Bf***
LENDER: ********************************'**jE,***** . ** �•'' *********************************
ADDRESS: • LEGALIZATION:N F/E EH S U M A R Y STRUCTURAL SEGMENT:N
/
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 SHIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT ` 29 U Y
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'Slate 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 penalty of not more than five hundred dollars(5500). ISSUE FEE 15 .00
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 DUE
O structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 28 . 50 15, 00 0. 00 44 , 50 44 . 50 , 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
4 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve •REVENUE DIVISION TOTALS--> ' COLLECTED: 44 . 50 OVER/SHORT• . 00
for the purpose of sale). BLDG PMT PLUMBING 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 • 44 . 50
and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *******************************************************************************
_ - -that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.S P.C. INDIVIDUAL F E E BREAKDOWN
for this reason: ', TYPE TYPE QTY DESCRIPTION UNIT COST TOTAL COST
r,
Dale:_I��$/9/ Own:, _I _i Lam/:
I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 2 05,255 d ELE 1 SERVICES BELOW 6 00 V & BELOW 201 AMP 18. 50 18 . 50
25534 and that I or any future building occupant YAWS not(chole one)need to comply with said state codes and the tequitement. r a ELE ' 1 MISC CONDUIT NOT LISTED REQ PERMIT 11 ,00 11 . 00
permit for construction or modification from the Air Duality Management District.Residential construction applications are exemp from END OF FEES
these provisions.
Date: _ Applicant:
I hereby certify that I have read this application and state that(he above information' orrect.I agree to comp wit all city and county _ •
ordinances and state taws relating to building construction and h reby authorierepre`ft.tives of this it/p upo eabove-meed 0100099145-0009914:, 'tF't u' r•'
property for msp tion pyDOSes. `` �'"n
Date: I0 5L"' 'j Signalu\ , _. A _A r GA?E 10/09/91 TI(E: i:: :<
L �
I
Driver's License or Social Security a:
1641.46 worm—Budding:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—A son '
IJ CONSTRUCTION AND PLANNING P00" Y SPA
• ' APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector.
^
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location --
2_ Soil Pipe-Undrgrnd. 53. Steel Reinforcement e•
3:-Electrical CondQit.Ujility-Undrgrnd. 54. Forms •4 -
r,4:.EleotricaI Conduit=CJndrgrnd. 55. Electrical Bonding -
'14. Steel Reinforcement'. 56. Rough Plumbing & Pressure Test
n'6;..Electrical UFER,Grnd. 57. APPROVAL TO COVER-GUNITE [�
w
r.rFootings ''t 58. Electrical Conduit-Undrgrnd.
11
• 8.'Foundation 59. Gas Pipe, 0 Undrgrnd.,Test - y
9. Water Pipefjndrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. e .
10.StructurayFloor System 61. APPROVAL TO DECK -_ } ; `
11. Property4.,ewer Line& House Connection 62. Backwash & Receptor-Final' - ,--±, ,
has12. Sewer Cap •
or • 63. Heater & Vent-Final -
13. Roof Drains rc 64. Plumbing System - Final '
14. Rough Plumbirjg- 65. Electrical-Final
15. Rough ElectricabConduit 66. Solar System-Final "' t
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-
_ Cr-,.p:- - ::In
20.:Rough Factory Fireplace I q q=i :. O 7* * •APPROVA1193,- :Permit # 'r
_ _ to ,1 of 4, 7;:r ; -c TC' :. SI 3* _. o - • ,--. +- 3 ,r.t'
�: 5:. - 7:.S :t + -t •-fig * 7 ��'7��{{ J+ * .'1
21.I.DuMs,in_Stritctu[p x •• .• ,1,S tt S a f-••r Y: 0. drideigrgtLndlH40 .t
22. Ducts, Ventilating-* .'S * ^ r eta .11 X71. Productt'fD5ing DGgs 0-Oil
23.C--,Gas Pipe}Rough&'Test i ';�` K3 ,T 1-72. Underground Flushes '`
24.- Root Framing- .--c. I :- , '., - > O • -t 73!1Undergrnd?Storage:TankCGas -0Oif
25. Roof,Sheathing ; J t -
.S :, i C 5 to 3, y, ' 74._Overhead rtydro,; -
26_T•8ar Ceiling (Structural) & Monocoat ,n .j •,:« r- 75.CDry Chemical -; - _ mi 27
. .-" ' . . - ._. .n,
27.`•Frame and Flashing', �' ,< 1 `7' �' r n • >: * •3 '`' '-"
0.3:.: 'a. _ ort 76. Dry Standpipe ,s ,. ::-C.
_28. Lathing,& Siding?*!, -�
:1 • ;t; , * 2; ••I •- --- t 77.. FIXED SYSTEMiRINAL°
'29. Insulation ; Y ,?• a t`. x 78.?FIRE PR EV. FINAL ; -I c
:730. Drywall Nailing r� Yr. i I , r Ila HEALTHOEPTTrR.EQUIREMENT
,t_ 1. Plaster Biown.Coatk ,.� • ; t+. + i- i s . FINAL IN4PECTIQN+•
u
3 .,;E
2lectrical:Po er DBeieraFinal //7/ if if(t '' D CERs
TIFICATE ISSUED -c
w -,a • .!• �r C t . ter_,
>33'Fina7Electric ,I, ' it i •Z x:7.71. I i tis _ `"� 4' _ c. o. 0'
:t34rFinal Heating:& Air,•'Conditioniggc: I cc •v _-c : p x ,; N,.,,=
35:'Finat Gas Pipe-Test« 'x' `1 Y i ' '- L. X C10 r Wit' ,r -. :x tr •
•• ,.y ` 7: •• -A - 1• .ry 1. ,a ,I C] i -F .7;tto•
,,.36. Hood or.,CanopY -r ••+ I r•':1 •1 • I�. . .a 5" s, --IC .1 `7 •
'37: Final.Factory Firephce,+, 1 v1t' �I R to A 9ti. .„>. i3 in U+
I if,1,.. r , I I .;; ., . :c t C,v
`38. Final;Plumbing 7. ,:t; el ,: I 1i, ;r a x „ or.
G39. Water Service-Final*, S I - •• U: I •iV + ;>4. . tI ,T\
0. Gas Service-Final t 1 I* 4, _.I• ..
lc
'4 -
r
541. Solar Domestic-Final"..i.' t- • . hi 'T :Cr'• Cr `
n .r Zr" 70 r * Y- :J
42. Backflow Preventer4, N t.-r- 1 >.- :.I
43. Backflow IrriNation: 's.:.ti'1. 7 - .CF + C .. '
In.:Nation.: v TCC -r CO 4 '
I f - W .i 5 J,_'
44. Landscape Irrigation Systemx,ric. ,,; : .._, •:,� r a: t' eJ ;c oo
- ^- S S .
545":Sound Atter uatiory -.'- tr x >. - t-r - 'Cc::
•-, r -' - .• .. * .n ,n , t "- .. • -+C .,
_46.` Handicap•Regulatiojs ; t`t •• , . ,a.
^ •.-- c
47.-FINAL STRUCTURE & BUYLDING I ;i. :+ . = t
48.2FINAL PLANNING• V' 17,
:.; I /r , n
..:49.,..-Electric Release to Edison i :r 4 >1 . is - -r.
4450..Gas Release to Southern California Gas Co . I I r., L •
n
R51. CERTIFICATE OF;OCCUPANCY r -r ', r0 ^f - • 4-21t.-
No.
,-No. Date
...-
\
\I
' - Costa Mesa Building Department " APPLICATION FOR PERMIT
"r e_ '• 111 EAST 20th STREET yy36 BUILDING 1
r COSTA MESA, CALIFORNIA `,/i S
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. - Permit No.
5. �
Building1
Address £ ! - r , f
Costa esa, California - Received by ' Date Rec'd. Date Issued
Nearest b-T - I(^yy_S
Cross St. lit /c. L e , A Lam, Building •
Address
Owner 2' C _A _ 1 I Ca, ,N,z/F_ Costa Mesa, California
Mall
Address — i .44 S / • Nearest
Tel.
ss St.
Ci hitec<! /t� Lie. C /TJ y Crow I Plans No.of I Type I Group'
ArEngin. ��/NY L No. Approve.
''// b Date
Address /9/0 / '4' t e-5,e CORRECTIONS
•
.lntractor Bwatsiz Nio.tLlc.
Address •
LeLot
De cr ption I No. ' I Block C I Tract3 A,
(Attach Metes and Bounds) vA,n ■ .w
Size of Lott' t X 1354 I Now on No.of B LotA Ij II�j_vi ,I 2..1..4---
Use
,
Use of watts ALG No.o1 No.of - � -1i�� � � `
Existing Bldg. 7 I Families' I Rooms LS n
Setback Line from�p,� ,� SRear Yard ide Yard 3 „ D
Center of Street ii
1 'd 141 I -.4 I 44 • r
I
New I I Alteration I I Addition la g 110) fl I _ I •
Repair I I Moving I I Demolish I
Buildingg....�, �y No.of
Size i[ c k .Z ' Rooms D. Stories I
i error Wath !� �t Roof aOM P. APPROVALS
Bring 5i0in 1 I Covering f
use of New
Building L() & t. L t Ni i - Foundation Location Inspector Date
Forms,Materials,
- 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
with all City Ordi..---- ate Laws lating Lath.Ext
building const
Signature • a �/ / •
e Plaster,Int
Permittee ` • / ,
Plaster, Ext.
Authorized Agt.
Masonry Reinforced
Valuation O v Permit Fee $ 7
Irn Plan Check $ Bond Beam
$ V Total0.4'
(
Fee $ • FINAL
FORM 204 0-H 2M 5-54
. I
•
u,.
. lc to
• ' -f • . .
•
0 6 '
uI- .
O. - .
. r
i
4N.:.Street ,
PLOT PLAIN .I • . .. ._
Show loeatlonj,'an,i:disncea from n. ,;' '^.
'1: ?•r r
property line and between buildings, r' • c' •
�r -
• 4, +'i
i'. ..f.
..- . . . _ - - - - •- j,
•
i . .
. .
•
. >
-I Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY,,FCOSTA MESA 'PERMIT NO. TRACT NO. LOT NO. •BLDG.NO. -
CONSTRUCTIONIPERMIT P 2,310 - ((7� 9 •• . q ( ' n9Q
Project Address�(DS e. \4 ' . TYPE OF CONSTRUCTION Cnr3 r21 7%jl 7�Sj TL
Owner CRtL N c-�C►. Lt PhOne$Cl.'4 ❑ NEW 0 ADD 0 ALTERATION _ _ •, _ IVo ID f e'-'14 T�
\ Address " S ()ME" ❑ REPAIR 0 CONVERSION ❑DEMOLISH •
Arch/Eng, - License No. 0 OTHER ZONING REGULATIONS
Ad re.s - DESCRIPTION OF WORK ' A.P.$
p ZONE PLNG. REF. 94
\7 Contractor�� • , ....ASIA, t. , Phone .;V1 TYPE OF PERMIT BUILDING TQ g�l�'pING
/ SETBACK C/LST. PROPS RTV LINE
Address SOS . . at. p(„Nb , t•tO, c4- 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD
LICENSED•CONTRACTOR'DECLARATION 0 TENANT 0 ELECTRICAL ❑PLUMBING ❑MECHANICAL IS.IEOFEE YARD •
I hereby affirm that I am licensed under provisions of Charter 9 (tom- RIGHT
mencing with section 7000) of Division 3 of the Business and 0 OTHER - - - - -
Professions Code ind my license is in full force and eff ct. REAR YARD(TO P/L)
PROJECT DESCRIPTION
License Class J' - icense N PKG.SPACE REQ. PROVIDED
Date-1 40 ` Signature �- SQ. FT.
7 ,�
D - - -
WORKERS'COMPENSATION DECLARATION - - OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE $
'1 hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY I DATE
certificate of Workers' Compensation Insurance,c1or a certified copy - - -
thereof (�pc ha a L ' mpany �y.y i L]�a GRADING CU. YDS. ACRES SPECIAL CONDITIONS:
Policy N Op l -
i7 Certified copy is hereby furnished.- - - - REMARKS: - - -
iCertlfied copy is filed with the city Building Division. •
4 )(EMPTION FROM WORKERS' COMPENSATION DECLARATION ' -
(This section need not be completed If the permit-is for one.hundred - _ -
($100) or less). -
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 PLUMBING ,- PLAN CHECK ELECTRICAL 'PLAN CHECK
subject to the Workers'Compensation Laws of California. - - - UWtLLirvO (�HHHVt - •
Date Signature BATHTUBS SHOWERS SO FT. SO FT
NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0.1 KW_1-10 KW
to the Workers' Compensation provisions of the Labor Code,you mustTRANSFORMER
forthwith comply with such provisions or this permit than be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50+ KW ' -
revoked. - - _
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS -- MOTORS 0-1 HP-1-10 HP
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS . ' SUMPS (INC.SOLAR)- 10-50 HP 50+ HP -
formance of the work for which this permit is Issued (Section 3.097 _ /�J
Civ, C.). FLOOR SINKS FLOOR DRAINS- L1 7 FIXTURES - OUTLETS SWITCHES -
Lentler's Name _ //
Lender's Address _-- - DRINKING FOUNTAINS ''��iV9 GAS TUBE SIGNS' .
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS ,I`I POLE LIGHTS - •
I hereby affirm that I am exempt from the Contractor's License Law for 7799
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP -' Lurvbl HUL 1 wry . _
Any city or county which requires a permit to construct, alter, POLES METERED SUB •
Improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION - PANELS _ MAIN SUB
quires the applicant for such permit to file a signed statement that he _ •
Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP -
(Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT • - - - - • -
basis for the alleged,exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS -
.v „yrt more than five hundred dollars ($500). / - ' •
,,,$):as owner of the property,or my employees with wages as their SOLAR TANK / COLLECTORS / ea — -' -• .
'1 sl. compensation, will do the work, and the structure is not Intended -- n
I or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ,� Oc ISSUE FEE - .•l
Contractor'shlds License Law does not apply wh td ansuch
owner r a prims if tyor j '— APPLICATION APPROVED BY -�C 9-is_R
who builds or improves thereon, and who does such we rk himself or ISSUE FEE DATE
through his own employees, If, however,
that such Improvements are not
Intended or n oned for sale. If, however, the buildinger or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
IS sold within year of completion, the owner will have the burden '
of proving he did not build or improve for the purpose of sale). BUILDING -
❑ I, as owner of the property, am exclusively contracting with HEATING SYSTEM 0-100,000 BTU PERMIT $ - SMTP •$ -
licensed contractors to construct the project (Section Section 7044, Business AND DUCTING -
100,000 +BTU PLAN CHECK $ PERMIT
and of p pert: Thebuild orContractor's License hereon, a not apply to �I ISSUANCE $
an owner of property who builds improves thereon, and whoa con- REFRIGERATION 0-100,000 BTU PLUMBING $
'14 tractsC from such .projects with a contractor(s) licesned pursuant to SYSTEM GRADING $
the Contractor's License Law). 100,000+BTU PLAN CHECK $ 1
o 1 am exempt under Section B.& P.C.for this BOILERS BTU ELECTRICAL $ $ ((��N
reason PLAN CHECK $ MICROFILM $ ve
SYSTEM REPAIR,ALTERATION / I
Date Owner TOTAL FEES
I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE
MECHANICAL $ CR
information is correct. I agree to comply with all cityand countyPLAN CHECK S LESS AD-
9 YVANCE PC $_
ordinances and state laws relating to construction,and hereby authorize
representatives sof his city fn ter Lon the above mentioned _
property or '` i n purposes 3 f `O b I
Signature `` r V Date G FINAL FEE $ f/•
Drivers' License or SS#
ISSUE FEE • - - - - --
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessdr •
CONSTRUCTION AND PLANNING • POOL&SPA r._. `�
Date Inspector Date - Inspector "
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location•
2. Soil Pipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
5. Steel Reinforce 47. Rough Plumbing & Pressu're Test •
6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE - • - I
7. Footings 49- Electrical Conduit-Undrgrn
8. Foundation 50. Gas Pipe, ❑Undrgrn,Test
9. Water Pipe:Undrgrn_ 51. Backwash Lines, P-Trap: El Undrgrn •
10. Structural Floor System 52. APPROVAL TO DECK • •
11. Property Sewer Line & House Connection 53. Backwash& Receptor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing 55. Plumbina System-Final •
14. Rough Electric-Conduit .56. Electrical-Final
15. Rough Electric-Wring 57. Solar System-Final
16. Rough Heating & Air Conditioning , b8. Fencing &Access Approval
17. Ducts, in Structure - 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing -
21. Roof Sheathing - -
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing ..
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric •
_
29. Final Heating & Air Conditioning
30. -Final Gas Pipe-Test
31. Final Plumbing • -
32. Water Service-Final
33. Gas Service-Final
34. Solar Domestic-Final 9.i1$.8/
Landscape Sprinkling System
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date - -