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Home My WebLink About358 19TH ST - Building Permits( .lob Address: 358 E 19TH ST Suite: Viciniry: Parcel Number: 42630122 App�irant: KRIS WATSON Address: Owner. SIMOS,'JAMES TR Address 358 E 19TH ST - COSTA MESA, CA Contracror. MODERN ROOFING Address: 221g W OLIVE AV SUITE 282 9URBANK,CA Zip: 91506 Arch : Address: Phone: BUILDING PERMIT Zoning: Phone: 909-23&5593 Zip: Phone: Zip: 92627-2351 Phona: 888-311-7663 License: 807881 , . Eng: Address: Status: ISSUED Applied: 01/16/2004 Issued: 01/16/2004 ISSUEDBY: �� Phane: Zip: License: License: -, � SCOPE�OF PERMIT - T/OFF AND REROOF 2200SF RESIDENCE W/COMP SFIINGLES. � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $83.25 $0.50 $0.00 $0.00 $0.00 $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: 0 NOTES: FEE SUMMARY � Caic Valuation: gz,iss.00 - -- - Claim Valuation: g2,i&9.00 Rear 0- 0 Rear 0- 0 Reouired: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Right 0- 0 Right 0. 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: in order (or the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result In the explration oi this pertnit. FOR INSPECTIONS CAL�; (714) 7545626 zaa�ee lerool WORKERS' COMPENSATION DECLARATION: - � ,, I hereby aflirtn untler penelty of perjury one o1 Ihe following declarations: ' � ❑ I have antl will mQinteln a certificate of consent m setl-Insure for workers' compensetion, es provided for �y section 3700 0l the Lebor Cotle, for the peAormence ot Ihe work for w�ich this permit Is issuetl. ❑ I have antl will maintain workers' compensatlon Insurance, es requireA Dy sectlon 3700 of the Labor Cotle, tor the peAortnance ot the work for wNch this pertnit is Issued. My workers' ca pe%� tion In�nca c rder end policy number are: Cartier. S�t7G //K�� / Policy Number. QQ��(9R�i - Z OOZ (7hfs sec(ion neetl not be comp/eted il fhe pem�it is velued al one hundred dollars ($100) oi /essJ ❑ I cenify Ihet in the pertortnance ol the work for which Ihis permit is issued, I shall not employ eny person In any manner so es to become subject to ihe workers' compensetlon lews of Calitomia, end egree lhat it I shoul� become subject to t�e workers' compensation provl5ions oi Sectlon 3700 of Ihe Labor Code, I shall torthwlth camply with these provisi� Appliwni5igneture: '�— Date: _ f-��p-O�i - WAflNING: FAILURE TO SE E WORKERS' COMPENSATION GUVERAGE I$ UNLAWFUL AND SFULL SUBIECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDRIIXJ TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTIIXJ 31O60F THE IABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby aflirtn �hat I em Ilcensed under provisions of Chapter 9(commencing wit� Sectlon�p 00) of Division 3 of Ihe Business antl Professions Code, antl my Ilcensa is in full mrce and eHect. uc. p ��i�ll / Class p C-39 � ConlrecrorsSignature: �'"lr�� / Dete: /'/�i-D(� CONSTRUCTION LENDING AGENCY: ❑ I �ereby aHirm ihat Ihere is a construction lentling agency br ihe peAormance ot Ihe work for whic� ihis pertnit is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lentler's Atldress: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I �ereby aftirtn ihat untler penalty of Der�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sac. 7031.5, Business and Protesslons Cotle: Any ciry or county which requires e permit to consiruct, elter, improve, demolish, or repeir eny structure, prior to its issuance, elso requiras the applicant for such pertnit to tile a signetl statement thel he or she is Iicensed pursuent lo Ihe provisions oi ihe CoNractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Prolesslons Code) or ihet he or she is exempt theralrom and the besis for the alle9ed exemption. Any vialation oi Sectlon 7031.5 by eny epplicent for a permit su6jects the applicant to e civil penalty of not more than tive huntlretl tlollars ($500).): ❑ I, as owner of Ihe property, or my emplayees with wages es their sole compensetlon, WILL DO THE WORK, an0 the siructure Is not intentletl or ofleretl for sele (Sec. �Oa4, Business end Professions Coda: The Contractors LJcense Law dces not apply to an owner of property who builtls or improves Ihereon, and who tloes such work himself or hersell or Ihrough his or her own employees, providetl ihat such improvements are not intende0 or oHered for sale. If, however, ihe building or Improvement is sold within one year of completion, the owner-builtler will �eve the burden ot proving �hat he or she did noI builG or improve lor purpose ot sale.). ' � I, as owner oi the pmperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the project (Sec. 7044, Business end Pmtessions Cotle: The comrectors License Lew aoes not eppty to an owner ot propeny who bulltls ar improves t�ereon, antl who contrecis br such project with a contrecmqs) license pureuanl to ihe Coniracbrs License Lews.). ❑ I em exempt un0er sec. Business end Professlons Code for this reason: Signaiure: Date: Owner ID verified by drivefs license. ❑ Ves ❑ No OAvers Licensa No. Expires: Verification oi Ownerahip by (rype of document, i.e. - properry tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: ❑ I hereby certity thet no excava[ion five (5) or more fee� in dep�h into w�ich a parson Is required to descend, will be mede in connection with work authoAzetl by Ihis pertnit, and �het no building sWcture, scaflolding, felsework, or tlemolition or tlismanUing IhereoF, will be more than thirty-sia (38) feet high. (Chap. 32, Grp 2, A� 2, Sec. 341, Title B, Celifomla Adminisiretive Cotle). � As ownervbuiltler, I will not employ anyone to tlo work which woultl require a permit Imm Ihe Division of Industnal Satery, as noted above, unless such person hes e permit to do such work irom Iha division. Signature: Date: Division of Intlustnal Satery Pertnit Number: CERTIFICATE OF COMPLIANCE AN� AUiHORVA710N OF ENfAV: I certity under penalty of perjury that I heve read this application and stata ihat ihe information given is correct I agree to comply with all state laws end ciry orGinances relating to builAing consiruction, and aut�odze representaqves oi the Ciry ot Casta Mesa to enter upon the ebove-descnbed property lor insDection purposes. I eqree not to accupy or allow occupency of any building authonzed by �his permit until tinal inspeclion. '-� � AnNOr Authon COOE �. INSGECTIONTYPE 1616 Fized System Finel Fire Prevention 1266 Paol Spa Finel 200 Final Re-Rooi 201 Finel BIocWRetalning Well 202 Final Factory Fire Place 203 Final Slgn 204 Final Demolltlon Owner(s) Applicam PAIE INTRIALS 'L� i� ,(�' � CODE 1 INSPEC710N TYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Eleclrical 212 Finel Fira Preventian 220 Finel Plenning Approval 222 Final Site 250 Final Building/Occupancy PA7E It�IALi PflOJECT AO�flESS: 3 S 8 E OWNEH'$NAME: TUPY� J noneess: TUPY C 358 � 1 COSTA M AflCHIENGINEEX: 92627 xec.No.: UNIT: FOONESS: UNIT: PEpminEE: NOCK PLUMBING ( 714 ) 895-1246 nooeess: 11610 SEAHOARD CIR - STANTON CA 90680 �� LICENSED CONTHACTON DECLANATION: I hereby ailirm Ihal I am licensed untler D�ovisions o� Chapier 9(commencing with Senion 7000� ot OF i usiness and Pmi n tl m license is in I lor 0 efleq. osa�'�� °�Y3�i� Y l-�5' CITY LIC.: �t STATE LIC.: ClA$S: Oale: � / ' � _ � D Signaiw¢; ��yl,�— _ WORNEBS'C0�1Pf,N��Ef�I�N�TION: inere6yallirmihallnaveaferlliC�ifiolc��¢nitosel4insureoracertificaleofworkeri Compensation ms7� �`�f� copy thereof (Section 3804 Lab. �pd / V 91 voucv No.: STATE E%P. OATE: COMPANY: ❑ Cenifie� copy is hereby Ivrnished. Ceni�ietl copy is �iled wi�h Ihe ciry BuilAinA Division. wre: I �.' 3'�'/ d Ao�u�anr `��-u-u �il-L�� E%EMPTIONFPOMWOBREBS'fAMVEN5ATI0NOELlFPATION: QAi55ectionnecdnotDecampleteOil��epermi1.i51arOneAunAre0�5100�orIe55�. I cenily inat in the oetlormance of ine work lor which this permit is issuetl. I shall not employ any Oe�son in any manner so as to �ecome Su0leci IO Ihe Workers Compensation Laws ot Calilomia. Oa�e: Sipnamre: NOTICE: II, aiter malwg t�is tleclaration. you shoNe become subject to the Workers' Compensalion pwvisions o� Ihe La�or Cotle. you musl fa��vnth comDly vnt� such D�aWsions ar IN5 permit shall De Oeemetl r¢vakeA. CONSTflUCTION LENOING AGENCY: I hereby allirm �hat ��ere is a constmtlion lentling aQency �or Ihe peAormance of the work lor which inis permil is i=SueC (S¢ciion 3097. Civ. C�. LENUEfl: AODflESS: OWNEB BWWER �ECIAflFTION: I hereby aHirm ��a� I am exemp� �mm �he Con�raciors' State License Law �or the following reason ISeclion 7Q31.5 Business antl Pmfessianal Cotle: Any city of county which repuires a p¢rmit to consiNct. alter, impmve, tlemolish, or repair any s�mclure, prior lo i�s issuance, also requirgs I�e applican� for 5uch permil to lile a signetl statemen� Iha� he/she is licensed pursuam to Ihe pmvisions oi the Convactors' Sta�e License �aw �ChaD�er 9(commencinp vritn Section 7000) ol 0ivision 3 of the Business ano Prolessions Coee) or that he/sne is exemo� �herelmm anA ihe oasis �or ine alle0¢a exemption. Nny vialalion ol Section 7031.5 by any appliWnl lot a Dermit suble��s t�e a001icant to a civil penairy oi not rtwre ttWn five �untlrod tlollars (5500). I, as owner of ihe pmpeny or my employees wim wages as their sole compen5alion, will Ao Ihe work, antl tne ❑ stmcwre is not imendetl ar oilerea lor ule (Se��ian 70aa, Business an0 Professional CoOe: The Contracbrs' SWte License Law Eoes not apply lo an owner ol a pmpetly wh0 Dui105 or impmves lhereon. and who Ooes Suc� work himsel�/herself or IhmuAh his or her own employees. o�oviAetl ttut such impwvements are not intenEed ar atlere0 lor sale. II, nowever �he huiltling or impmvemem 15 sold wil�m one year ol complelion, Ihe owner will have the GurOen of pmving he/s�e Di0 no� bViltl or impmve �or IM1e DurOose ol sale). I, as owner ot Ihe pmpeny, am exdusively coniradinp wit� licensetl conlraclors lo conslNct ihe prolecl (Section 7044, Business ❑ ana Pm1e55ion5 COtle: The Conirat�ars' State �icense Law Uoes not aODly m an owner of pmpeny wha bmtOs or imOroves iAereon antl wbo conVacls �or suc� pmlecls with a coniraclor(5) license Dursuant �o Ihe Coniractors' Sta�e License Law�. i am aware Iha� O�ool o� �heir Worker'S ComOensation in6uranCe s�oultl be pmvidetl Io me. � I am exem0� untler Semion: B. 8 P. C. br I�is reason: Date: Ov+nec I do nereby cenily i�at 1 am aware af antl unaers�an0 t�e reQuirements ol Califomia Health an0 Safery Coae Sections 2550.5, 25533, and 25534 and ihalloi anylulure huiltling oca0anlwill/willnol (circle one) needto ComO�Y �� saiA state co0es anet�e repuiremenisfor a Oermil br consirutlion or rtwdilica�ion �mm Ihe Air 0'ualily Managemenl Distric�. Pesitlenliai rAn9m[Iion apDlica�ions are exempi Imm Ihese Dmvisi0ns. I Da�e: APPlicapl: I 1 nereby cetlily ��al I have reatl �his ap0�ita�ion antl slale Ihal Ihe a artlin;mces and Slaielzwsrelaling�o builtling conSlmciipn dntl hereby pmpetly lor inspec�ion purposes. { �� oale: _�.4�—� Siqnawre� I � Orivei's License or Saial Secunry x: correcl.lagree b camply wit� all�ity antl county itives of Ihis ciry to ej�cr upan the above-men�ionea i64La6 Whi�e—Buileing; Green—Coda Enlorcemant: Canary—Applicant: Pink—Revenue: Goltlenro0—Auessar CITY OF COSTA MESA - BUILDING PERMIT �� , PERMIT NO; P 050110 PLAN CHECK NO: N ' 66V�; A7 �rf3�:—A� CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTA JOB DESCRIPTION : REPLACE DISHWASHER SQ FT: • CLAIM VALUE: CALC-VALUE: • GROUP OCC; R-3 / COMMENTS: REPLACE DISHFiASHER -**MAIL IN PERMIT** ****�*******�r**�r********�r+�*�r*�r�r**�r*�r�r***+r�r+rx��r�x*�r�*****+�***�r**�r*****�r*��r*****�r* Z O N I N GS ERTEH�AUCIKRSE M E N T S ------------ MAIN HUZLDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 43914220 ZNE: AEF NO: PLANNING NOT'ES> i �**�r**�t�t****�trrr*�r�t***�t�t*****�t�t+t�tx�***�t**�t*�t*x�***�t*+t*�t**�tx�t�t�t*�t�t*�r�r**�**�t*�t*+t*�t* D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED HY ' DATE: BUILDING APPROVED BY : � DATE: APPLICATION ISSUED BY• - DATE: �� 3t�FitMlF3titik3F1Fi1ititiFitki61E1tikitiEiFiF3E7FiFTf7Fi F'{E�F1F7 �Fif�FlFiF3FiF�F�EiE7fiF£if�t�t�tiFlEiEiflfiP itif iFifMiFiEMiEiFitMlE�tif�FiEifMifiEiFifiFMIFMiFIf�Eitlflfl(�kiFlfiEiElEiE E�fitiFlFkiE3FifaElfiElfihkiFl4ififlfikiFiFi(�KiFiFiFiEifiFifiEiFiEififitlk LEGALIZATION:N F E E S U M M A R Y . STRUCTURAL SEGMENTcN BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2 00 �15� SMIP/NON-RES PLAN ISSUE FEE 3.00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 2.00 3.00 0,00 5,00 5,00 .00 REVENUE DIVISION TOTALS--> COLLECTED; 5.00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK rJ , Q Q i! M if if iE 3FiF MiFi1 M 1f iF �f iF iF 1F iF k 3f if iE iE iE If 3f if iE fk iflt 1t if 1E ik 1f iF iE iEii iEiE iE iE if iE if iE 14 if 1tlk if:f iElflk iE 1f iF 1t iE iE iE iF if 1f iF iF if iF iE iE if �Elf iFM fF I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLiJ 1 DISHWASHER 2,00 2,00 END OF FEES Qi 000?5�23-060755?7 T R7 Y OAfLr t2/fJ�✓�SQ i2i��6 ,�"1' . rtt�,4:T $: ' � �1 11�J;;�.: '?rl;, 12/n.;/�C u' .fE?U�'�g��n�"� ��CEPE="�� Oi �Q�7�.`r2%'QQ07J,`i27 1 G �' .._. DATE� 12/Osi4Q tEttE� 12�33 � � '� \ CONSTRUCTIpN AND PLANNING POOL & SPA - APPROVALS Permit# Date Inspector APpROVALS Permit# Date Inspector 1. Temporary Electrical Ser�ice or PQIeL 52. Pool & Equipment Location _2_ Soil Pipe-Undrymd.. �_� ��?C 53. Steel Reinforcement -3;;El�ectrical Cond�C,Utility Undrgred� - 54. Forms � ��'4'Electrical Co d6i$r,Undrgrnd. a 55. Electrical Bonding '' �5,;,�`S�GeI Reinforce�?erlt 56. Rough Plumbing & Pressure Test t ��S6-cfxl€ctrical UFER'Gmd. '^ 57. APPROVAL TO COVER�GUNITE � �. • J7;FPo�tings s� 58. Electrical Conduit-Undrgmd. u' .-�8:. Foundation � , 59. Gas Pipe, O Undrgrnd., Test � �=9. Water Pipe�Und[9rnd. 60. Backwash Lines, P�Trap, Q Undrgrnd. _ J 10. Structural Floor System 61. APPROVAL TO DECK t t. Property Sewer L'f�ne & House Connection 62. Backwash & Receptor-Final 12. S�wer Cap �, , � . 63. Heater & Vent�Final 13. Roof Droins � � 64. Plumbing SYstem � Final , m 14. Rough Plumtiii+g `� 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar SYstem�Final r, 16. Rough Electr,"'Lc Wiring 67. Fencing & Access ApProval 17. Rough Wiring:5ign 68. APPROVED FOfi PLASTERING 18. Rough Electri�al-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - - - �.^ � c- �z - - . 20: RoLgh:Facf�ry�Fireplace � � =7 S"'� O = c'-�. .� � AppROV4�LS=� Pe7mit # ' �' - ' I.i 2'. � � S_*' t�. �t S.. T'r cC ti w.-� ,� 1 c� � . ..� `� ' `� T x - � '� � - . 2L: Ducts,in SGuctUre ,.... _S S t� _: , � 70.:-Undergraund tEqdro � 22. Ductsy�Yenyilat��g` � CJ.S f �� r �` �, 71,,produtt,PiRing�Lr}:('ias �Oil 23� G,a`� Pip'p�R�gh��4°Test � �S �� ;. p�� i i- 72. Under`�i �� ,� _ :�. - g ¢und Filush 24': Robf F�aming .r'�'.,* : t-F •d� i� 9 G+ �?� �� 73� Undergrnd. Std�age Tanl�' � Gas ❑�Oil 25. R� f Sheathin . ' �'� '`' }' ' � �'" T � ' ' � gD ,� 9 � .• v� n:-. :. 7� Overhead Hydro.� +� 26. TtBar Ceiling (Scrncturall &Monocoat s t*•'' �^ 75', Dry Chemical �-= `�' �' - C K � - �l :i 27' Frame.and Flashi; 'n � � � �` ` rn p� :` S `' �.. - 9 Dx��: ? � - .�x x 76. Dry Sta�AiPe.-sr. `r. .. t� 28� LeIhirjg & Sidingr �� S,Z x � E •� �7: FIXED!S - TEAh'F'�fVALV �., t ' 29. Insula�ibn � :; `� s .... 7 � � ;-;; - ,;. 7ff. FIRE PREV. FINAL �t �+�. �J �J � � ' 30. Drywall Nailing%'� � �-+ •�+ w'-HEALT:H DEP7�-REQUIREMENT . .-�->.,. ,�,., '.' 31. Plaste�Brown Coats � ir�.. �;� 73'.�FINAYINSPECTION '" ;� 33�. Electri�l PoweaNleSerFinal� � = N � 80: FOOD CERTI�IfqTE ISSUED _ .. , _ � _ . 33r Fi�al �lect�ic ��_ �;. � ,_ , ; � ` Notes: - r5 x * _ , ' j 3,4: Final yeating &_?ir Conditio�ing � j� i± a S �� . S , _ ,r 35? Final Gas Pipe-Test,_`r' � " -'k . �� r =�-5 "� �? . , . � s - . � z:c. ...-, . .a: .. . . � . ..� , , 7 36. HDod or CanoP.Y' x;7 t P' - � . n r?' :S. :' p J' i. �+ 37: Flnal Factory Fiie�l3c f �'• °' • `9' ". `.� .. �� i >. . S: � :_ � .., � :s . ; . . ,-,... • .:� . .. - _ 38. Final Plumbing;- n; � �; •� %� :5 � x rt .Y ` 39. Water Service-Final � � c '� � _ �'� � ` � 'r. T < �s. ' • . 40. Gas Service-Final i QR.- - ,;s- . G,� ;x" � "41. Solarpomestio-Fina4: "'. •• _ � � s. ¢c - � �: �r. ;r O - � 4T. Backflow Prevente`r`� iv `" I �; .. '� 7� z c_ 43. Backflow liiigatidn �CSfi � � ^ ::. � � =S' � �-� � `� ; �. :.�x xx: x ' 44. Landscapedrriqation System r � b; -. .r, r_• :� < ,� :. ;� c�� t;. ,i _ ' 45: Sound Attenu2tion �JF - t*" F'z' - F'-, f r -�' J^: ^`? . - r.�. ,r r � -t� � ! 46., HandiEap Regulat4ons _ 5 ; ' � � a: . � � -q � � ,j 4 � 47,: FINAL STEiUCTI�RE & BUILDING �� _ < - �i� ` � � t r- s :: �' '- 4B� FINAL PL`fCNNIlyG � �� `�� ` A � :'' 'i y� l - �, -(-� .N � I r--J Ci 2 4$. Electric Release to Edison , ��. �i; � i � , S �r'� x ' ' 50. Gas Release to So,4them Ca;lifor�ia Gas Co ,: I �; ;, ;: _ �- . �,q ,r � `. ; 51. CsF,RTiFICATEO OCCUPANCY {. ::�. < i; th�: ,. i-� :_ No. Date J AOP��cant to �ill in all�zpacez except those within heavy boraer lines ana sign all appropriate tleclarations. CITpOFCOSTA�� I�I� RU�� 'HM��6�� Project Address U � Appllcant's Mailin/g (Address S� � � ' � Owner'sName <„�n F� � ��'1 �V�Phone�y Address . /'� '_ Arch/Eng. ��'�t��y LicenseNo. � Address . Contracmr,'s Name - Phone ' Address (mailin9l Ciry License No. � LICENSED CONTRACTOR DECLAHATION � 1 hereby affirtP that I am licensetl untler provisions of Charter 9(commencing wi[h SeCtion 7000) of Dlvlslon 3 of the Business antl Professlons Cotle, antl my Iicense is in �ull force ana effect. , L�CBOSC CIdII l.fcense iVO. Date Siqnature WORKERS' COMPENSATION DECLARATION � ' hereby atfirrr� that I htve a certificate of consent to self-insure or a certiticate ! Workers' Compensation Insurance, ar a certifietl-mpy thereoi (Section'� .800, Lab. C.) ' ' , � • Policy No. ' Company e�Certifietl cePY is hereby fumishetl. Certifietl taPY �5 filetl with the city BOildinq Division. Oate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thisseclion nCetl noi be completetl if the permit is tar one huntlretl ($100) or . less). I certify Ihat i� the performance of the work �or which this perm�t is issuetl 1 shall mt employ any pe�son in any m ner as to bec m¢ Subject to t{�e Workeysj,�[q� �[ion Laws of Calif n: � Date ._2[ � Si9nature ' 'NOTICE: It, atter making this tleclarati , you shot become s ject to the Workers' ComPensation provisions o1 he Lzbor Cotle, you must torthwith romply with Such p�ovisions or this permit shall be deemetl �evoketl: � CONST0.UCTION LENDING AGENCV ' ` 1 hereby aHirm that there is a cons[ruction lentling age5n€cy; tor the performance . of lhe work for yopich thi5 per is iss ey d( c idn 309] Civ. C.) Lentler's Name .�[1��nA- ,'f1jC T'fK Lentler's Atltlress ��j' Bz� (A lj �'� NFS � OWNE0. BUILDEH �ECLARATION I M1ereby aftirr� that I am exempt from the Contractor's License Law for the tollowing reason (Section �031.5 Business antl Professional Cotle: Aoy city or county which requires a permit to ConStruct, diter; improve, tlemolish or repai�, any Structure, Pnot to its issuance, also requires [he applicant for Such permit ' to file a signeP Statement that he/she is licensetl pursuant to thE provismns Of . the Contractov's License Law (Chapter 9(commencing with Section 7000) o( '�ivision 3 of the Business antl Professions Cotle) or that ne/she is exempt erefrom antl [he basis Tar the alle9etl exemptlon. Any violalion ot Section i31. by ahY applicant tor a permil subjects the.applicant to a civil ��y of not more than five hundretl tlollars ($500). . � I, as owne� of the property, �r—cWe �rep, will tlo the work, antl the structure is not intentletl or otferetl for sale (Section 7044, Business antl Pro/essional Cotle: The Contractor's License l.aw tloes nol apply to an owner of a property who builtls or improves thereon; antl who tloes such work himselt/herselt or tnrou9h his or her own ¢mploy¢es, prP��tletl that sucn imprOvemen[5 ara not Intentletl or offeretl tor sale. If, howeYer, the builtlin9 or impvovemen[ is Soltl within one yea� ot com- Olelion, the oWn¢r will have tM1e burden ot proving he/she tlitl nOt builtl o�, Im- , nrove for the durpose of sale). - � . ❑ I,'.as owner of the property, am ¢xcWsively contracting with licensetl con- � Vactorsto construct the project (Section 7044, Business antl Protessions Cotle: The Contractor's License Law tloes not apply to an owner of property who � builtls or impfaves thereon, antl who cont�acts for suth p�Olec[5 wi[h a con- Vactor(5} litep5e pu�suant to the ConVacfor's License Law). I dm aware that proot oi tneir worker•s Compensation insurance shoultl be provitletl to me. ❑ 1 am exempt untler Section 8. & P,. C. for tM1is reason Date O I hereby certifY that I have reatl tl i�pplicati antl state that tne above � information is correct. I agree to compty with all city antl county ortlinances antl s[ate laws relating fo builtlinq construction, antl hereby authorize reore- senta[ives of ihiz city to ent¢r upon the above-mentionetl property fOr IOSpECIl0l1 plll{>OS Signature Date � TYPE OF CONSTRUCTION . LJ NEW LJ'ADD LJ ALTERATION LJ REPAIR. — -• ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' �� A P # DESCRIPTION OF WORK/USE OF BLDG. ' � � S Main Buildi TVPE OF PERMIT ' GRADING ❑ FOUNDATION ❑ STRVCTVRAL T Front _ ❑ TENANT� ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI.� �g Rear ' ❑ ,OTHER ' � • . . . � A PROJECT DESCRIPTION 54. F7, oCCUPANCV C Right K Left CONSTRUCTION TYPE ' VALUATION $ ' $ � ZOIVE GRADING CU.YDS. � ACRES P�ng. RCf. # Remarks: _ aalS ' ' PlanningNotes: Bar Sink Backflow Preventer Backflow Irri9ation Bathtubs Clarifiers . Dishwasher � i Drinking Fountains � Floor Drains Floor Sinks � � Gas Service - Ou mcercepcors . Kitchen Sink : ' Lavatories . � , P—Trap � Roof Drains ' • ' Reinspection Fae ' $15 Boiler Duct- Under Ground , Duct - Structural Duct - Ventilating ' � - ' Exhaust System ❑ Multiple � Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ 0-100,000 BTU 0100,000 B� peinspaction Fee I Dnvers' License or 55 � _ — �' I - CMF 0865-46, rev. 10/84 White - Builtling: Canary - Applicant: Pink - Accoun[In9: Goltlenrotl - Assessor $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs � Solar Piping' Solar Tank Swimming Pool w/Spa � Water poset � �Water Heater - Water Service - • � Aum-Wash � Laundry Trayf � Issue Fee' Hood or Typel ❑ Canopy Typell ❑ i � � Refrigeration System ❑aioo;000aTu ❑ioo,000 System Repair/Alteration Fire Oampers Registers ! � Issue Fae Automatic Washer Construction PoleSt, Cooking Unit Dishwasher Dryers ❑Gas ❑EI Fan F.A.0 � Fixtures' • Device eozes OuUets Switches Garbage Disposal Generator �0-5 KW e - ;__ __ 6264 5%28%86 Parking fleq./Provided B.II'0 , TL . 2 O o N I' N G R E Q M T S ELECTRICAL � . FEES Transformer ❑ 15-50 KW ❑ 50+KW � I Meter up to 100 amps - �Meter ❑over,t00amps • Sub Panel Motors �0-t HP O1'/: -.8 Inc.Solar �9-]5 HP �76-15+ ' Pofe Light ' Range Sign � !Standing'Sections � 15 KW , Trash Compactor , � $ 3 Reinspection Fee $15 Issue Fee FEES � DEVELOPMENTSEflVICESREOUIREMENTS: 2oning APProved By � ' Building Approved By Application Issued By � i� g a 0 ' $ 3 SUMMARY OF FEES , BUILDING PERMIT $ SMIP � $ PLAN CHECK � $ � �PERMIT � � PLUMBING $ �ISSUANCE $ ENERGV'P.C. $ ' PLAN,CHECK 25%. $ ' j�� ELEC7RICAL . $ �— �Ij IX�RADING ; $ ' � 7� MICROFILM ,5 � PLANCHECK 50% $ .-�-� /U _b � MECHANICAI � S � TOTAL FEE ` $ � PLAN CHECK Z5%' $ , , ' 19 CONSTRUCTION ANDPLANNING �'APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. � 3. EleGtrical Conduit Utility-Undrgmd. , 4. Electrical Conduit-Undrgmd. 5. Steel Reinforcement . 6 EleGtrical UFER Gmd. 7. Footings 8. Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System i t. Property Sewer Line & House Connection 12. Sewer Cap 73. Roof Drains 14. Rough Plumbing 15. Rough Elec[rical-Conduit 76. Rough ElectricWiring 17. Rough Wiring Sign 18. Rough Electrical-T 8ar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & 7est � 24. Roof Framing 25. Roof Sheathing � 26. T-Bar Ceiling (Structural) & Monocoat 27. Frameand Flashing 28. Lathing & Siding 29. Insulation 30. Drywa�l Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test- 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Wate� Service-Final 40. Gas 5ervice-Final 41. Solar pomestic-Final 42. 6ackflow Preveoter 43-Backflow Irrigation 44� Landscape Irrigation System 45:�Sound Attenuation 46�Hand�caP Regulations 47�FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electtic Release to Edison 50�,Gas Release to Southern California Gas Co 57=CER7IFICATE OF OCCUPANCY 0 o. _ . _ _ Date � Date 9 POOI ;PA Inspector pppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electriral Bonding 56. Rough Plumbing & Pressure Test . 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., 7est 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical•Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT.REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: 6 Date � Inspector r # : �. . , ; � �.� ^ ._ - '^ "� ' Applicant to flll in all spaees except tnose witnin heavY Doreer lines antl sign all apvropriate aeclantions. �Y O:,CQ^Z4 MESA CONSTRUCTIO PERMIT PERMIT NO. TRACTl10 LOT NO. UNIT NO. . ProjectAdd�ess �� yF '� �� />Z7 /�pp�ieant'sMailin�Address'/1 �!�i/1� /��/ Owner's NamJe` � k%�7 /� 7�YN7/IrW .,_�TPhone �2.7=.0-.La Address ��-7� � ��1t� �• Arch/�ng.�M �:�:�r+eCnc,� LicenseNo. ;Address Contractor's Nam � hone Address (mailing) City l,icen�P Nn LICENSEO CONTRACTOfi DECLARATION I h¢teby afflrm tnat I am licensetl under prOviSions ot Charter 9(commencing with zection ]000) of �ivision 3 of tne Business and Protessions Cotle, antl my license ts in fu11 lorce antl e(fect. . Litense Class ' License No. Da[e Slgnature WORKERS' COMPENSATION DECLARATION I h¢reby affirm Ihat I have a certiticate ot consent t0 selNnsure Or a certiticate it Worken' Compensation Insurance, o� a certifletl coOY thereot (Section �aao, �o. c.� • Policy No. Company 8 Certifietl copy is hereby (urnlshetl. ' ' CeYtifletl copy is filetl with the city Builtlinq Dlvlsion. Dat¢ Applicant' � EXEMPTION FROM W00.KER5• COMPENSATION DECLARATION '' (This geclion neetl not be com0�etetl if the pGrmit is to� one huntlretl (E100j o� less). I c¢rtify that in Ihe perfo�mance of the wo�k for whicb this perm�t i5 issuetl � zhall qp[ empioy any pe�son in any man ¢r 5 s to b§GOy� subject fo [�e Work@ri•'r�q�pRr�satlnn Lyws of Calitor i. /I J . ye .Date 1L�/-__rKS Signature �Y71 r.. �,(„L.-+,�'��^-� �NOTICE: I/, after makinq this tleclaratio you shoultl come su jec6 t to the WorkB�s' ComOensatiOn 0/ovision5 of tne Labor COtle, you musl fo�thwi[h comply �y�[h such p�ovi5ion5 0� this pe�mit shdll b¢ tleemetl revoketl. CONSTRVCTION,LENDING AGENCV ' I hereby affirm tnat ere is a construttion'Ientling agency for the performance. of the work tor hich thi5l perm' s is�u¢p ( tion 3097 Civ. C.) Lentler's Name «nilleA �/'e�Li'� ��rC(,✓(..QR Lentler's Aadress /!7n .r Ci `'7 2-%!� C] OWNER BUILDER dECLARATION I herpby affirm that I am exempt trom the Contractor's �Icense Law tor tne . " folloWing reason (Sec[ion 7031.5 Business antl Professlonal Cotle: Any tlty or I counN whlch requires a Dermil to cOnStrucq alt¢r, ImOrove, Aemolish or r¢pair �r. h¢retrom antl Ihe bd5i5 fo� the allegetl ezemptbn. Any violdtlon Ot Secuon W1.5 by any ap0licanl Tor a pe�mit subject5 Ihe appliWnt to a civil �ena oi not more than five hunCretl tlollars (5500). as owner oi the property or my employeas with wages as their sole comp¢nsatlon, will tl0 the work, antl the ztructur0 i5 nOt Int¢ntletl or offeretl for Sale (Section 7044, Business antl Prote55ional Cotle: Th¢ ConVactor's LiceqSe Law tloes not apply to an owner of a proper[y wno bulltls or imp�oves thereon, ana who tloes zuch work nimselt/herseH or throu9n his or her own employces, provltletl Ihat such Imp�Ovements are nOt Intentletl o� ofteretl fo� salu. ii, however, the builtling or improvement is soltl wiihin one year of com- pletlOn„the owner will Itave the bu�tlen of proving he/she tlltl mt bUild or im- prove tor the purpose ot sale). ❑ I, as owne� ot lhe property, am exclusively cont�aCting with IicenseC con- tractorsto construct tha project (Section']044, Business antl Professlons Cotle: Thc Contractor's license Law tloes nol apply to an owner oi prooerty who builqs or improves tnereon, antl wno contract5 for such projects witn a con- trac[or(51 ilcense purkuant�ro tne Gantractor'S LicenSe Law�. I am aware [hat proof of lhei� Wo�ker'S COmpensation insu�ance shoultl be provltletl to me. ❑ I em exempt untler Section . B. & P. C. ror this reason Date � Owner I hereby certity that 1 have reatl iniormation is correci. I agree to e antl S(ate laws relatlng to builtlin5 sen[a{jye5 ot [his i to Q ter InsOe�(lon p ,pos� / Signature � J- - G L / J - a�- TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT,iER DESCRIPTIONOF WOFLS/USEOF�LDG.!nonoa��P * A(O M-� TVPE OF PERMIT�../ tJ GRAoiNG ❑ TENANT LJ ELECTRICAL ❑ OTHER PROJECT DESCRIPTION SQ.F7._ CONSTRVCTIONTVPE � � VALUATION$ GRADINGCU.YDS. A( I FOVNDATIO�N�t L7 STRUCTURAL PLVMBING L�1 M�CHANICAL flemarks: L'^ E'E . �• a Bar Sink Backflow 7reventer • . Backflow trrigation ' Bathtubs � Clarifiers � Dishwdsher -'i � . D'rinking Fountains.,� Floor Oreins� � Floor Sinks GasService � Outlets Intercep[ors Kitchen Sink ' zLavatories P-Trap Roof Drains Reinspection Fae $15 Duct�UnderGround Duct - StrUCW rel Duct - Ventilating Exhaust System ❑ Multiple ❑ � Firepl/FacLBILIC80#ZS7Q IH�e� ing System & Ducting L76100,000 BTU 0100,000 BTi I��rs' License or S$ � ^ I I Reinspection Fee I $75 CMF OBfiS-46, r¢v. 30/Ba Wnite - Builtling; Canary - qppliwnt; Pink • qccountin9; Goltl¢nrOtl - Asu550r Showers Service Sink Sewer Cap � � � Sewer Connection- , .� ; Solar Collec[ors= ' % Solar Pipin9 .y Sofar Tank -` - Swimming Pool w/Spa Urinal Water CbseC Water Heater - Water Service Auto-Wash Isue Fee Hood or Typel ❑ Canopy Typell C� Refrigeration System Oo-ioo,000eru dioo,000eTu System Repair/Alteration Fire Dampers Registers Issua Fae FEES � � S 3 FEE 3 $ 3 A.P. # �� — %J�� - S Main Building: E T Front B Rear L.,+ � A C Right / g Left Pln9. Ref. # �� . -� Planning Notes: �� (..(_.(.�-�1�.��""' � HOLD FOR SPECIAL RG( Automatic Washer Construction Pole £ Cooking Uni[ Dishwa5her ' Dryers ❑Ges ❑E Fan ' F.A.U. Fixtures Device Boxes . Outlets . � � � 6201 12/20/R� � 2one Accessory Building: Parking Req./Provided ELECTRICAL -- � Transformer ❑ 15�50 KW ❑ 50 +: ICW r: Meter ❑up to 100 amps / Meter ❑over 100�mps � Sub Panel � C' Generamr �0.5 KW �5-15 KW ,y r ' Reinspection Fee $15 DEVELOPMENT'SERVICES REQUI Zoning,APVroved By' Building Approved By 'Moto�a'IJO-7 HP U1%-6 �•' I�Solar �9-15 NP 016-15+ Microwave Pole Light Range Sign ; Standing Sections � Trash Compactor Issue Fee :�ic�� .._ FEES $ 3 2 O N I N G R E Q M T S � S�151MMARV OF FEES �� BUILOING PEfiMIT $ GSI, SD SMIP $ 2. ps � � PLAN CHECK � $ —��— PERMIT •�� PLUMBING $ L � � DO ISSUANCE $ � PLAN CHECK 25% $ '�• SD ENERGY P.C. $ ELECTRICAL� $ �O GRADING $ PViN CHECK 50% $ O MICROFILM $ .� MEC�fANICAL $ � '� TOTALFEE ' $ ' � •�� PLAN CHECK 25% $ 3. %S CONSTRUCTION ANDPLANNING P00� oPA . � APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector . Temporary Electrical Service or Pole 52. Pool & Equipment Location , ,!. Soil Pipe-Undrgrnd. ��%/ �(s 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 UFER Grnd. � j 57. APPROVAL TO COVER-GUNITE 7. Footings P dQ/ 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 2j � GLD 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing s_�_�6 (,'t/i 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Etectric 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 � • r, �� APPROVALS Permit # - 21. DuCts, in Structure � . 70. Underground Hydro . 22. Ducts, Ventilating � 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough &_T.esf 72. Underground Flush 24.��Roof Framing , • � 73. Undergrnd.StorageTank OGas ❑Oil 25.,Roof Sheathing _' /�� G 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemiral 27. Frame and Flashing . .� v� 76. Dry Standpipe � 28. Lathing & Siding �j G �� 77. FIXED SYSTEM FINAL 29. Insulation �� /� 78. FIRE PREV. FINAL 30. Drywall Nailing . 2,D G HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electriral Power Meter-Final � . , 80. FOOD CERTIFICATE ISSUED � 33. Final Electric • �i� Notes: ' > � 34. Final Heating & Air Conditioninc] % fj�fs�. � G� � ' Q L 35. Final Gas Pipe-Test %�� GA� (J-(i(�S(G- f�u, O^k4 t-ld�.,f� �..K� 36. Hood or Canopy . �e'� fV0 m��L., 4 LE�Q.. � 37. Final Factory Fireplace '7 �� C,(9 ��„9 p cKf !'Z ,�j� ��Q-�' 38. Final Plumbing S�� << � TQ �� 39. Water Service-Final . � 40. Gas Service-Final ' ` � 41. Solar pomestic-Final 42. Backflow Preventer ' � . ' ' 43. Backflow Irrigation � �•: . ' . • 44. ,Landscape Irrigation System 45. Sound Attenuation � � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING ¢� 48. Special Requirements Completed •Z2• 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY � � No Date � - " � • �OSTA MESA BrUILDING-SAFETY DEPAqYMENT �---• ` � ` ' � . P.O, e0X 12G0 59� s��'/-'1.6/_7.g 6.OQ T1� . Costa Mesa, CaliPornia Sst�r,r,+;.6/ I�/ie. . . 6�OOCK7C .U� � � � i � � i � I .,��ti,. .. ,.. . PERMI �NO.' ' � TRACT NO. RECD. BY CONTRACTOR JUSt P1Umbin LOT NO owre �ssuso BUILDING USE / A Address 2426 New ort Blvd. :P � �ih Costa Mesa. Zip Code 9p(y] Building naa�ess 358 E- 19th Street State License No. j00948 C1Ou• C96 Owne� Ann Eaton w City License No. 73g9 Tel. No.642-4111 Address 358 E- 19th Street� Qp NUMBER TYPE OF FIXTURB OR ITEM FEE ��` V b' Uathtub City COSCB Mesa u'�,1 `Te1.No.5�-6231 � Laundry Tub or Tray � hereby acknowiedge!Iha[ I�h�a"ve read [his application and � Automafic Washing Machine state [ha� [he above, is coirect and agree to comply With alI City Otdinances'�and Stzte'I.aws iegulating plumbing. Shower 1 cerfify,�[ha[GI%possess the above valid Sta[e of Califomia classi- � Sink, Bar fication odl 2m -Ihe legal owner of Ihe residential property dr � Sink, Kitchen scribed,a6ove. w Wash Basin (Lavatory) � ��cecfi[y Nat [ hav o6tained a pecmit Crom the Sta[e Division of a Industrial Sa[ety excava[io other [han swimming pools, five � WaterCloset(Toiley �� 1 'feefdeeporde �an nto ichape�sonisrequiredtodes nd. � UriakingFountains �q(y\�yy�' a Floor Drains �-`� `1 �.. Signatu/e of Permirtet � In�erceptors `L � �� W Hece tors .c A :r ➢ x INSPECTION RECORD � Sinks Commercialor;I�dus`trialr r Sinks Floor ..'f( Y- \1 D� � Sinks, Serviee �r� �1�j' � � � Swimming Pool" W . Urinals�/ 4- ' Dishwasher a Garage Disposal � 9 � Water So(tener 0 Water Heater and Vent Gas System .. . Outlets ... A P P R 0 V A L S RooP Drains y Water Piping Alteration Q �Ma�eeron Dnre � 6ackilow Preventer U�G 30�1 � � f. lawn Sprinklers (Res or Non-Res _ u/G Wefet � � T�T� � � 6L 00 CMF 0450-46 � . . . , • - COUNI'Y OF ORANG& BUILDING D6PT. ' 636 No. Broadway Santa Ana� Califotnia • Phonei KI 2-6211 Y L OW[VER'S MAILING Name ....__.. Address .._. Application for AND Certif�cate of U� �� - 3 5—� �, sy ,� '--'--^--------------- (Archirect or Engineer) 0 Ciry..... .... .... ......-' - -- -- -- ------ $tate Lic. No. -------------... .------"_'_ Phone PROPOSED USE: ._ a'��`�D'`______. ___ �"� 2. JOB LOCATION._3_}-Y__��_�9 ��" _________________'_______________ (House No.) (Name of Scr � 3. LEGAL DESCRIPTION: Loc__.___.__/�__>y,t1_-4e? .'-- (Meres nnd Bounds Description—Use reserse�side of form) 4.� CORLVER LOT ( ) INTERIOR LOT ( x) /=yr%, _�� 5. SIZE OF BLDG.: �"$ __. AREA:___�1J»-��.2�j �f � 6. HEIGHT OF BLDG.: _��°'�.__'_ �__ ______.CEILING v 7. NO. FAMILIES._____�_______..________._____._..Size of Smal 8. EXTERIOR WALL CONSTRUCTION:_L.i/ta (Frame, Scucco, Ecc.) ' 9. SETBACKS: Front Yard from Cencer Liae of Nearese Side Yard ______�'._._.Rear Yard.__{,}� lU. A COMPLETE PLOT PLAN IS REQUIRED, SHO' n I l. For (a) Footing: Width _�___.Li�_�2z.__.________ Accessory " ; - Bldgs. and (b) Size of Studs: __c2_�i.�___.---.-._Spaci Similar Struaures: , (c) Size of Floor Jois�s: _��_�._______. +? (d) Size of Raf[ers: .__ `�_ ''- � ( - - - -- "-----------= - •• C'eiLi�q o:'sfs ' .2X� ' IZ. VALUATION OF,PROPOSED W�K: Including all la6 �i ing and sewage disposal �._-�� "��___--_..---- -- ` -' - ; li. I HEREBY CERTIFY THAT TO THE BEST OF THIS APPLICAT.ION IS CORRECT AND THAT LAWS OF THE COUNTY OF ORANGE AND ' Plans Filed:.----"------��_-"__._� l —' -�+__ �___.,_ ---'-- ----"""_-- --- Bldg. Perinit Plan Check Tocal - - Receipt No. Paid co Date .--'----' SM-)�SO FEES: U �> ' ' $ - �_ � V-� ' �----------- � -g-;�_-. � FOR ng Permit Occupancy � .�1 Permit No.�_� � �-� ..-- ---- - PHOIVE:_��---� -� �--��' . �� . CITY ---------�------- - ------- ------------ (Contraaor) Ph o n e------------..."' ------------ �i 7�- - %� �1--� '"//�_!-�'.t--c� .i---------------i--�-�---------------'_T_ ".---...- ------...--- k: • . �jief�o� ��G�'.yU1.. ____._______________________ ___________""_________'___________.'____. �� — •,- :.. GROUP---__-_-_��.z_ ___ � "IYPE ------- -- ------- -------- DIST. G — � � [� MAP ------ --- --- ----- ----- SHEET NO.-------�--------- DATE----��- ---�--�---- —`�----G--- (Town or School Dis[rict) --------- ..__..T�a« ..._#. _�.�..9.----- ----- 3H LOT ( ) SLOPE OF LOT ( ) OF LOT: S�!%-.LS.D_�AREA:.rI--S_��_.�;�.�-��s D° - ---� � --- ---- IVO. OF STORIES ---�jr�'-?.- -.. : ._.�� .�ti�-�.� �--'-- Size of Kitchen : . _9 �_ /i._� 7.- /-...-"' TERIOR WALL COVERING.___��.�___._..._ � (Plasrer-Drywall, Etc.) �et Between Bldgs. on Same Lot �,� =�A- STRUCTURES AIVD USE OF EACH. .__�pa Q...._. "CC a . ----.--_Width of Wall-.%�/.��hT�„�onc Material of Floor.�,�...d}�._..�� - �� --� << �- �------ CC q - ,L.2 ------'�'1 ------"CC /� '' c>. C' . .bing, e(ec[rica( wiring, heating, fire sprinkkrs, paint- EDGE AND BELIEF THE INFORMATION IN CRUCTIOIV WORK WILL CONFORM TO ALL OF CALIFORNIA APPLICABLB THERETO. (Authorized Agen[) �,7� CHECKING BY APPLICATION.__._�' HEALTH.__.._._____________________ FIRE ZONING -- --------------- - MARSHAL.--------- ------- - PLANS AND SPEC'5-------------------------.. STATE..--- ------------- - - --- CORRECTIO[VS ENGINEER PER Y•; COUNTY BUILDING V. V�uHUE� INSPECTOR --------- ------"'- - �-�--- -----,'�------"'-------'- --'-' ' - - . - -- ----------- -------------- �G � f�' �EPUTv . //� ' � ` � / �� `-A' � �Y -