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HomeMy WebLinkAbout169 19TH ST - Building Permits PROJECT ADDRESS: 169 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 060817 OWNEWSNAME:HOEVEL ROLF W ADDAEss:P O BOf( 11064 PERMIT NO: B 060817 PLAN CHECK NO: 00298-93 S GOVT: N SUPP: N • COSTA MESA,CA 92627 CONSTRUCTION TYPE: C7 TYPE; STR PURPOSE: OTH ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : 5-42" HIGH BRICK PILASTERS SQ FT; 25 ADDRESS: UNIT: QOLF CLAIM VALUE: 500 . 00 CALC—VALUE: 250 . 00 GROUP OCC; R-3 / PERMITTEE: p HOVEL (714 ) 646-4837 • ADDRESS: 169 E 19TH ST COMMENTS• 25LF W. I . FENCE BETWEEN PILASTERS C.M. CA 92627 ***************3t**4*****r*****************Te*******************kr*****x********** 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.ora 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 REX: PROV: PARCEL: 42523415 ZNE: R2 REF NO; J Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building DiHsion. PLANNING NOTES> 25 L. FT. FENCE ALONG SIDE OF PROP. USING 42" BRICK PILASTER > FRONT FENCING EXISTING ! Date: Applicant. *******************************************************************de*9H5F******** EXEMPTION FROM WORKERS'COMPENSATION DECLAMTION::,(Thissection need not be completed if the permit is for one hundred ISI O)or less). DEVELOPMENT SERVICES REQUIREMEWT S I certify that in the performance of the work for which this permit is is d.I shall no a env any person in any manner so as to become l subject the lees Compensation Laws of Gakto ZONING APPROVED BY S<< DATE:j11A / 1.2 �Jwj�r I /gyp 7 Date i 7� Sigyou sit ul ! r NOTICE:It.tiler malting this declaration.you should'Cecome subject to a Workers' Compensation provisions of the Labor BUILDING APPROVED BY DATE: f/ : Code.you must forthwith comply with such provi or this permit shall be deemed revoked. / CONSTRUCTION LENDING AGENCY; I hereby affirm:Uat there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE- 2'(A � V1 which this permit is issued(Section 3097.Civ.C). v/// ******************************************** ******************BEjE**t*** ***** LENDER: . /• ******************************************************************'iF**,********** ADDRESS: J// LEGALIZATION:N F E E SUMMARY STRUCTURALjSEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE .. / GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish.or PERMIT 15 . 00 5 0 repair any structure.prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed SMIP/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)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 9 . 75 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 sore compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 15. 50 0 . 00 9 . 75 25 . 25 25. 25 . 00 does not apply to an owner of a properly 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.II.however the building or fortheepmpOseotlsaej one year of completion.the owner wig have the burden ol proving he/she did not build or improve REVENUE BLDGDIVISION PLUMB NG ELECTRICOMECHANIC FIRE• S SMIP5 O/TOT/SGRADING PLAN—000 HECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15. 00 . 50 9 . 75 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly 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 **, *,*******,**. ***.************************.".**********.********************{l.*****.* 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: 2/ a I Owner: L' /—J I do hereby certify that am a rare of and understand the requirements pf California Health a Safety Code Sections 25505.25533,and SFR 25 RES—PILASTER WITH WOOD ETC BET/ FT. 10. 00 250. 00 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 END 6F FEES • permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 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 budding construction and hereby authorize represent ' of his city to enter upon the above-mentioned properly for inspection pure es�.7 Date: 21// o 1 Signature: - . Driver's License or Social Security' [:Td 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor 'i3ONSTRUCTION AND PLANNING POO 'PA 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 - 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-GUN ITE '/. Footings Z 4: 258. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap,0 Undrgrnd. - 1 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 62• Backwas!,i & Receptor-Final II 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 Fireblace - _ T APPROVALS -,'--Perri it# • _ 21. Ducts, i6.Structure - - t 70. Underground:Hydro 22. Duct{, Vyntileting ., ` • X71. Product piping 0 Gas OOil 23. Gas Pipe-Rough & Test i + 72. Underground Flush'` ' +• 24. Roof Framing _ .• [ '.73. Undergrntf.Storige'.Tajk Q Gas J Oil 25. Roof Sheathing ' . >' , 74. Overhead Hydra. • 26.3-Bar Ceiling (Structural) & Monocoat _ 75. Dty Chemical . _ 1 27. Frame and Flashing. • 76. Dry Standpipe _-I 28. Lathing& Siding- - -t 1, 77.,FIXEDS'YSTEMFINAL' • 1 29. Insulation 78:'.FIRE PREY. FINAL 1 - -1 • 30. Drywall,Nailing 1 HEALTH•DEPT. REQUIREMENT 31. Plaster Brown Coat, i j• 79. FINAL INSPECTION - I - 32. Electrical Power Meter-Final' 80. FOOD CERTIFICATE ISSUED i 33. final Electric - (Notes: �•. _ . 34..Final Hefting& Air Conditioning I - 35. 'Final Gas Pipe-Test' 36. Hood or Canopy - • - - 37. Final Factory Fireplace - I 38. final Plumbing - - - - 39:Water Service-Final ,_ ; I . ` • 40. Gas Service-Final - t r I . t iI _ 41. Solar Domestic-Final -• ' ' • • - I • 42. Backflow Preventers , • I - 43. Backflow Irrigation - -''r• .: • 44. Landscape Irrigation System. • - _ 45. Sound Attenuation • - - • -, - • • r 46. Handicap.Regulations �i/I- - _ 47. FINAL STRKTURE & BUILDING •• 1, I ' ' 48.'FINAL PLANNING - r ' ' I 49. Electric Release to Edison UI ' - e 50. Gas Release to Southern California Gas Co I • • • • 51. CERTIFICATE OF.00CUPANCY • - • - No Date • • . . Applicant.to fill in all spaces except these within heavy border lines and sign all appropriate declarations. - - - - ' . ., CITY,OF COSTA MESA r/,, ON TRUCTI NP pP�ERMIT PE MIT NO. - TRACT NO. . LOT NO. UNIT NO. 1963 3/P,8/ ' - <� _ - `P`ojeciAtldress I l0� - . �JgS°t - 23e7. 37 '`7 psir. ? - • • Applicant's Mailing Addres at 1-kt�QJ OC1o>t klOGLI TYPE OF CONSTRUCTION U NEW yr ADD U ALTERATION U REPAIR - Ly.+�'M •' Si&fl Phone V4CX13 El CONVERSION- ❑ DEMOLISH ❑ OTHER A•P•# •yAS '7 / /Y-J S I Zone �a dr' Owner's Name t^� D �I?TION OF W.RK/USE OF BLDG. iS -7 Address ' I7R E PO fir ' - ' - - X ., O�-1. S Main Building: /,Z'� /,, _f Accessory Building: - Arch/Eng. Llcens o. T• YPE OF PERMIT�y.� GRADING n FOUNDATION STRUCTURAL T Front 10• croon/ UsR�fLJC.iSL r�J -tiro e.xls1J`• ,i ) O Address - a1 ❑ TENANT WJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - - -. N larree ..• - A7l/9G/�G/� Contractor's Nam- --. J a al.e • ❑ 'OTHER, �7` A - - I a��— • PROJECT DESCRIPTION SQ. FT < L7 OCCUPANCY M_ C Right S . , N Address(mailing/ nce N gl -�Isiil[ s a.c ej- . K . _ - G . ICS' q 1 • CONSTRUCTION TYPE V EVALUATION $ $ Left 3:�/ / City License No. 1V1��=���. J- { _�..a 2•-�p'7 • R ZONE GRADING CU,YDS. ACRES / 7 / Ping. Ref. # �J ParkingRe LICENSED CONTRACTOR DECLARATION _ RA-8S J£� Q./Provided a / E i-hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - • • Planning Notes: ea - 91(2.4/e�� /f sV,� 2!D� M with section 7000) of Division 3 of the Business and Professions Code,and ' (i �-cl-•/'L+r /'Y-"/Y.!L•!J my license is in full force and effect. • . / C' //X [�G - - t T License Class '' ' ' License No: �•' r . v -Q'`•-' s uni t) rte. CPTF`r AT, I:"•,ILj!t(Ci:7:•,,Y S Date Signature l PLUMBING FEES A WORKERS'COMPENSATION DECLARATION - , • Bar Sink • Showers - I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES ' Workers' Compensation Insuiance,•�or�a-certified-copy thereof,(Section-'- Backflow Preventer , Service Sink - i •00, Lab. C.) • - . I ._� - Automatic Washer Transformer D 15-50 KW Policy No. Company Backflow Irrigation Sewer Ca t • -. 4'- - 0 50+KW A Certified ropy I5 hereby furnished. `.' I I p -• Construction Pole Sub. I Certified copy Is filed with the city'Building Division. Bathtubs Sewer.Connection Cooking Unit i ' g Meter ❑up to 100-amps Date APPlicant - - - .• EXEMPTION FROM WORKERS'COMPENSATION DECLARATION- - • . _ Clarifiers _ -Solar Collectors - - - - - -4-- _ .._., j f - +- Dishwasher , � Meter ❑over 100 amps,- (This section need not be completed if the permit is for one hundred ($100)or ' less).cer ,y t Dishwasher Solar Piping .7l : ' ,� Dryers ❑Gas DElectric Sub'Panel -- 1 I certify that in the performance of the work for which this permit is issued I _ _• shall not employany p g any manner o'as t become subject to'the ' Drinking Fountains : ' Solar Tank ' '+'1 '' • Fan Motors1%1'8 Workers' type on Laws of California. keep(Yt; ❑0-1 HP ❑ , - 'NOTICE: If, ftEr akin thisifeFloor Drains i Swimming POOI W/$pd' rr��p person in ftT,s p ,Y ' 1 26 � _ F.A.U. Inc.Solar.❑9-15 HP ❑16-15+ declaration, you shout ecome subject to;the _ _ _ _ _ Workers' Compensation provisions of the-Labor Co e,-you-must forthwith' ^FOOr Sinks Urinal I D comply with such provisions or this.permit shall be deemed revoked. - - - • I / Fixtures , , Microwave I I ' Ze CONSTRUCTION LENDING AGENCY_ • ,_ - '- • ' ' Gas Service 'Outlets - Water Closet - Ft p Device Boxes t I hereby affirm that there is a construction lending agency for the performance i - , Pole Light ' of the work ,for which this permit is i uee-((SS con' 3097 Civ C'.)' ' •�' interceptbrsi - i- Water Heater - 1 Range Lender's Name rc',, -- �r� Outlets O %I. Lender's Address cJ1A-rc bre -- Kitchen Sink • Water Service - OWNER BUILDER DECLARATION I _ - - • ` Switches) - , Sign _ O zO. I hereby affirm that I am exempt from the Contractor's License-Caw for the • Lavatories' • - •Auto:Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or ' - - - - g P ; Standing Sections , county which requires a permit to construct,alter,improve,demolish or repair; P-Trap , 1 • j -- Laundry Trays 1 • any structure, prior to its issuance, also requires the applicant for such permit Generator ❑0.5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Root Drains - F - the Contractor's License Law (Chapter 9 (commencing with Section 7000) of - - - I ' i Division 3 of the Business and Professions Code) or that he/she is exempt _ I , - 'refrom and the basis for the alleged exemption. Any violation of Section ; i -- I 1 - , ' :1.5 by any applicant for a permit subjects-the applicant to a civil - - t t , _ - , lty of not more than five hundred dollars ($500). - i 1 , I, as owner of the property'p• p..,..'^•,oaf ...stn •••�gac Ac +-nn', -.u.,__ - Reinspection Fee 1 . I $15 Issue Fee 1 $ 3 I CIISat}vm will do the work, and the structure isnot 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 who builds or improves thereon, and who does such work himself/herself.or through his or her own , - - I DEVELOPMENT SERVIC S REQUIR ENTS: , employees, provided that such improvements are not intended or offered for Boiler Hood or Type I D • \ i sale. If, however, the building or improvement is sold within one year of com- Canopy Type I I ❑ - . Zoning Approved By 1/ C- i ate 1� 0-�c+ I ,ion, the owner will,have the burden of proving he/she did not build or im- ' Duct- Under Ground ; - , r , J. Building Approved Byfit Datee= • • 1, as owner Of the property, am exclusively contracting with licensed con- rectors on- Duct-Structural Refrigeration System ApplleatiOn Issued By Dat tors 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 ❑0.100,000 BTU ❑100,000 BTU builds or improves thereon, and who contracts for such projects with a con- , ,SU MARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Multiple ❑ System $ ScBUILDING PERMITp proof o their Worker's Compensation insurance should be provided to me.' Exhaust System ❑ Repair/Alteration • 'SD SMIP i $ 042) 0 I am exempt under Section I B.& P.C.for this reason I Firepl/Fact.BIL ICBG# Fire Dampers PLAN CHECK $ Z'S,O Z PERMITISSUANCE $ A. • PLUMBING $ ���i_FIt/:1����'7� Heating System& Ducting Registers y Date v s _ Owner _ PLAN CHECK .25% $ I ENERGY-P.C. $ i hereby cert y -t I ave read this y•with atid•t and state (fiat the above ❑0-100,000 BTU Di 00,000 BTL . �j p,� GRADING ' $ ' information is correct. I agree to comply with all city e,county ordinances ' ELECTRICAL $ tJ•Q�1_ • and state laws relating,to building construction, and hereby authorize repre- - f MICROFILM $ sentatives of this city to enter upon the above-mentioned propert{ for • I PLAN CHECK 50%. $ inspection purpdses. M , ^ftig1 I Q ,U ,(JJ Date / MECHANICAL $ TOTAL FEE ; $ 6Q• ZZ • Y Signature Fee Issue e $ PLAN CHECK 25% v. -Drivers' License or SS Reinspection $15 IFe3 - $ ' L."' CMF 0865-46,rev. 10/64 White - Building; Canary -Applicant; PinK -Accounting; Goldenrod - Assessor _-------^ J .. _r CONSTRUCTION AND PLANNING POOL °A. . r . " ' APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector (..Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _ 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE .. 7. Footings sirbb r/G 58. Electrical Conduit-Undrgrnd. 8.:Foundation 59. Gas:Pipe, O 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 r 71. Product Piping 0 Gas El Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil - 25. Roof Sheathing 01 t/( UC_ 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing O/a� �6 � 76. Dry Standpipe 28. Lathing& Siding • L/(6 vv 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 w.3/� 04 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 r 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING G/(/X` VC.- 48. L48. Special Requirements Completed li 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY _±, : No. Date j l ' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. -- PERMIT NO. _ TRACT NO. LOT UNIT NO. CITY OF COSTA MESA STU`ZIpN PERMIT A.P.9W zona d(5�4 5 ' —1St35 ?3�f—� � til Project Address II'' `�t/ - S Main Building: Accessory Building: Applicant;5•Mailing Ad ass V ��k ,y V N« TYPE OF CONSTRUCTION U NEW ADD LI ALTERATION 0 REPAIR E Z �+ I 0 CONVERSION ❑ DEMOLISH OTHER 1 QG i r --e T Front 0 Owner'sName O X40 Vi° Phone (et 3'X ) DE CRI TION OF WOR /USE OF BLDG. �- - �/i B N Address 611.1.}4 � A Rear /�P' S/T l� ✓Tlt(t v1 -4 v1 C UR 1 C Right N Arch/Eng. License No. TYPE OF PERMIT GRADINd LLJJ FOUNDATION KSTRUCTURAL Address ❑ TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL g�• Left G Contractor's Name % Phone ❑ 'OTHER ,Ping. Ref.9e Parkin Re ./Provided ^ E Address(mailing) PROJECT DESCRIPTION SO. FT- OCCUPANCY le 3 0 s/ PlanningNotes:��.� `1 �.� k ate,- M CON ST RUCTION TYPE N VALUATION$_ZID -� .( `Q /1 T City License No. ZONE GRADING CU.YDS. ACRES - 1Ai1 l/./'Gty(' Mon, I20 J/'� LICENS b CONTRACTOR DECLARATION • (/ J S. I hereby a . m that I am licensed un.- .• ons of Charter 9 (commencing Remarks: 1 /t • with section •:• .I Div' - o the Business and Professions Code, and ' ��`�t /-- /QH my license Is in'fu . . .- J _ ELECTRICAL FEES Datens. - License No. PLUMBING I FEES Automatic Washer Transformer ❑ 15-50 KW Date Signature - WORKERS' COMPENSATION DECLARATION - Bar Sink Showers Construction Pole Sub. 0 50+KW I hereby affirm that I have a certificate of consent to self-Insure or a certificate — �--. [1 .. of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps so, Lab. C.) Dishwasher Meter ❑over 100 imps No, Company Backflow Irrigation Sewer Cap i-J Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel .• — L I Certified copy is filed with the city Building Division. • Bathtubs Sewer Connection Date Applicant Fan Motors❑0.1 HP ❑i%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed If the permit Is for one hundred($100)or F.A.U. I Solar ❑9-15 HP ❑16-15+ less). Dishwasher Solar Piping p- I certify that in the performance of the work for which this permit Is issued I Fixtures / shall not employ any person in any manner as oma subject to the Drinking Fountains Solar Tank Microwave Workers' Coq-lent i n Laws of California. I 1. Device Boxes - Date JiSignature �I,/l{�`'0 Floor Drains Swimming Pool w/Spa Pole Light NOTICE: If,aerNk dig this declaration, Y shou become subject to the Outlets Workers' Compensation provisions of the Labor. Code, you must forthwith Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. Switches CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Sign I hereby affirm that there is a construction lending agency for the performance of the Work for which this permit is issued (Section 3097 Cis'. CJtors Heater Garbage Disposal - Standing Sections Interceptors - - Lender's Name i Lender's Address Kitchen Sink Water Service • t Generator 0135 KW 05-15 KW OWNER BUILDER DECLARATION J Trash Compactor I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays 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(Chapter 9.(commencing with Section 7000) of _ - Division 3 of the Business and Professions Code) or that he/she is exempt - Reinspection Fee J $15 Issue Fee therefrom and the basis for the alleged exemption. Any violation of Section $ 3 -^1.5 by any applicant for a permit subjects the applicant to a civil Ity of not more than five hundred dollars($500). DEVELOPMENT SERVICES FjEQ1JIRFMENTS: ///'��`"" as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 LPe (( �y compensation, will do the work, and the structure is not Intended or offered Zoning Approved By Data�/ / for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By p _ - a. / Date 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 Application Issued By - -�.• - -_.- _ sat: ,©a employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ _ �� sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 SUMMARY OF FE pletion, the owner will have the burden Of proving he/she did not build or Im- Duct-Under Ground �.(� orove for the purpose of sale). - - 3,3L-BUILDING BUILDING PERMIT $ 3 O . O SMTP $ . S� C I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ ...;r0 7 PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or license s thereon.and who contracts'siorce such Law).oroI as with a con- ENERGY P.C. $ tractf o license pursuant to pe Contractor's License beI ov aware that Exhaust System 0 Multiple ❑ stem Repair/Alteration I PLAN CHECK 25% $ proof off their Worker's Compensation i ranee should be provided to me. ELECTRICAL GRADING $ rigC1 am exempt under Section ,o' B.& P.C.for this reason Fire I/Fact.Blt. ICBG* Fire Dampers $ MICROFILM $ /�" ./ r--- PLAN CHECK 50% $ Date Y""-- owner 11( 4122SL'-1 Heating System& Ducting Registers MECHANICAL $ 41 Q 2-CI hereby certify that I have read this application and state that the above 00-100,000 BTU 0100 OB TOTAL FEE $ information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $ and state laws relating to building construction,and hereby authorize repre- sentatives of this city en n tth„e��above-mentioned property for • ' ISignatl nspection ure purposes. y}{ Date J 20 - Drivers' License or SS,'1' - I . Reinspection Fee $15 Issue Fee $ 3 01 00028676-00028678 TOT 40.25 DATE: 03/20/89 TInE: 10:19 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING r POOL 8 -et APPROVALS Permit I Jate Inspector• APPROVALS Permit.# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipmdnt Location ry . 2. Soil Pipe-Undrgrnd. t 53• . Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. ', 55. Electrical Bonding - 5. Steel Reinforcernent ' I 56. Rough Plumbing & Pressure Test 6''Electrical UFER Grnd. r 57. APPROVAL TO COVE R-GUNITE o i_ . j7.'Footings i . 58. Electrical Conduit-Undrgrnd. i' 8.•Foundation 59. Gas Pipe, 0 Undrgrnd.,Test I 9.}Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 107 Structural Floor System • - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final i 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 17i Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceilirtg 69. POOL/SPA SYSTEMS FINAL 1,9) Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ry ' APPROVALS Permit# 21. Ducts, in Structure •f;1 70. Underground Hydro 22. Ducts, Ventilating• .� 4: 71. Product ct Piping 0 Gas 0 Oil ' 23. Gas PipetRough &Tit -,'' 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 "s' 75. Dry Chemical 27. Frarne!and Flashing 76. Dry Standpipe /28. Lathirig&•Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall.Nailing PJ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 1 79. FINAL INSPECTION 32. Electrical Power Metrir-Final 80. FOOD CERTIFICATE ISSUED 33. Final-Electric Notes: 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-Final2 , •42. Backflow Preventer_. 4 t n:.- • 43. Backf low Irrigation!' _ - r •• • 44. Landscape Irrigation-System 45. Sound Attenuation-7 46. Handicap Regulations :A ''// ,,�/ 47. FINAL STRUCTURE,& BUILDING y/7A/G'0 ` [e- 48. Special Requirements Completed / // (( '49. Electric Release to Edison _ 50. GasRelebasetoSouthernCaliforniaGasCo • 51. CERTIFICATE OF OCCUPANC. No. . Date ' ij J 6365 - E R CEtVED CQSTA MESA BUILDING DEPARTMENT ySyN. P.O. BOX 317 FINANCE DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING i6 y k-- /9�� s-•�-. ADDRESS BUILDING COSTA MESA• CALIFORNIA FOR OFFICE USE ONLY Vial f /A� RECEIPT NO. i HMll.(NOe OWNER VF�/!�'�Fl k/r IS j.EY 1!/ bJ ADDRESS 2/�/9A6 ( �?A Cr 14Nr 4 ED BY y9tE�RE O VAT;IS ;XIV' CITY CoJ CIA Mg-C s. ` TEL. SqSG 7t � A�/ ARCHITECT LIC. OR F 'NEER NO. COSTA MESA. CALIFORNIA FIRE ADDRtSS ZONE ZON • NO.OF TYPE ROUP CONTRACTOf/4Vc 4W "WU N110C, /•r� �/�L r AN� v t j/ r ) 41 ADDRESS 1 • AQ. '0 - ' NO.VL C. BYAPPROV • Ohi tc '1 DATEV / '24 S LEGALLOT CORRECTIONS DESCRIPTION NO. g BLOCK TRACT 47 c / 7- :9- S/-a / i A.P. NO. 1 SIZE ) it / J I C • ., OF BLDG& / 1 r yy It 41 NOW ON LOT USE OFf �� �� ' CITY Oh STA MESA EXISTING BLDG. �JfathjC c/ Lyy///�G i.R1 Ns; DEPT. SETBACN LINE FROM ✓/ /� �� , CENTER OF STREET 721 REAR YAREL.J" � SUBJECT T6 LDr'' DEPT. REG. 510E YARD RIGHT C LEFT I F ` DESCRIPTION OF WORK AwA��� - NEW, :ALTERATION ADDITION REPAIR MOVING DEMOLISH (p- x La — 360 ..• C�7 2 7 ZV 1 BUILDING NO.OF SIZE S � 1-0 ROOMS ROOMS I STORIES I � r K to &Qn'vt4A(� I_COVERING EXTERIORWAL�v�/"•-�1_ VERING COV `0t ? . v /H 36 P' .Z/ CO USE OF NEW BUILDING `s A 4AC �(,{-" // C p C .0 c_ - /J to C.:3- \z. --s,c--- urs / I HEREBY ACKNOWLEDG H T I HAVE READ THIS APPLICATION AND / STATE THAT THE ABOVE 5 C RECT AND A• -EE TO COMPLY WITH ALL CITY ORDINANCES ANO 5 AT LAWS REG i TIN !LADING )/DING CONSTRUC, `CLOG / 0 TION. VALUATION SIGNATURE OF w PE MIT FEE $ TO PERMITTEE .�a�a _, I n, �' y //� �A / $hs g�0 PLAN CHECK S 4 �� I AUTHORIZE AL�G'Q/P'N1J`�f / L 6 TOTAL FEE $ f_ adr Imo ' • rtt KEUEIVED 20866 ocr 1 7 1963 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 917 COSTA MESA.CALIFORNIAsf CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ILDING !I For Office Use Only NUM; L C. /9 RECEIPT NO. PERMIT NO./ 6 COSTA MESA, CALIFORNIA ..1 eJ lYr/If/' (�^ RECErvPD•Y DATE RECEIVED/ DATEAISSUED `.\ OWNER /2.AA/_7 if1 E "Si. lD�/7(O3/L'i a,j- //�� ,(/jJ!/ a I MAIL g BUILDING ADDRESS ,-J/o n� ADDRESS '// AAS{/ _�.�110[�` n� '' ��� TEL. 67� FIRE 1 f!/ CITYOA7 DNA, Q F�1'l1 !A^ - NO. wry �J ZONE TYPE GROUP / APPROVED ARCHITECT TEL BY DATE OP •INEER `J NO. ZONING • A, ADDRESS (\�' ZO 24...No.OF ) �UBE TCW, A ✓w` \���///VVV �•w rr}} CONTRACTOR I/ 7 LEGAL ,nn 1/2_ADDRESS DESCRIPTION-� Up^/V �1 � ��A.P.NO. I/ / ---A11. — \ CITY NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. Sr TO SIDE @ REAR P.L LIC.NO. NO. _ EAVES SIZLEOT 15 7 )(/6/ •.5--- J(( NO.O / ON LOT LOGS. ALLOWED (U.B.C.REQUIREMENT) OF NOW YARDS APPROVED YARDS APPROVED USE OF I MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. .tLL/_ t..n..�P (FROM C/L REET SETBACK LINE FROM i , • CENTER OP STREET �/Z - REAR TARO �]� 4 FRONT FT. Fr. SIDE YARD I LEFT 47 I RIGHT /2 R.SID= FT. DESCRIPTION OF WORK FT. / REAR "30 FT. FT. F NE ALTERATION ADDITION ji x DISTANCE BET. BET.MAIN @ MAIN REPAIR L– MOVING}(/ DEMOLISH SLOGS. ACCESS.SLOGS. BUILDING/DKu NO:OF APPROVED# DATE SIZE 4 I J tROOMS STORIES - i EXTERIOR W ROOF ///lll ��_ 'Y. APP-.'(• / D r l c '��[[[ Q1 COVERING I COVERING ( / BY ���r ,(ADATE L ] a7W USE BUILDING AND WORK TO BE PERFORMED o .4110 r' -14,7 r�h Q la a'ef 2 % 'G-J-et u /-"ea iiPT -67 yin• _ A � F-V t; N t a. SQ.FT. a; .C.. G CO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATR'IS FOR THE £ at AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION G. SIGNATURE OF4 / O� PERMIT FEE j co PERMITTED a,1,,Al�y w�a..° �,rJAi // $ �3 , if,--•-r ¢- •AUTHORIZED AGENT /I (/ / ii. \ TOTAL.FEE 5 Q /