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Home My WebLink About496 19TH ST - Building Permits� CITY OF COSTA MESA � BUILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fex (714) 754-0856 Job Address: 496 E 19TH ST Suite No Vicinity: Parcel �Nunmber: 42632111 Applieant: NOCK, RON Address: 11672 KNOTT ST GARDEN GROVE . CA PLUMBING PERMIT Owner: '�ALMEIDA, BEATRICE YVONNE Address 496 E 19TH ST � � COSTA MESA, CA Contractor: NOCKPLUMBING Address: 11612 KNOTT ST � ' �GARDEN GROVE , CA �. A�hlEng:,. -�� . '� � Address: WATER HEATER CHANGEOUT. ISSUE FEE Backtlow irrigation BackFlow Preventer Bathtub ' Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drein, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1�4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT szz.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qn Phone: 714 895-1246 Zip: 92841 Phone: Zip: 92627 Phone: 714 895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub I Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 k) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Conned $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar 50.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop ��$0:00 Spa (private) $0.00� Spa (public) $0.00 PERMIT NUMBER T7 FAIR DRIVE, COSTA MESA, CA 92626 _ ' ' ISSUED BY: an 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Appl{ed: 07/0111999 Issued: 07/Ot/1999 /�`/',il.� �7; . �� /j�i'J�,A; � '+�� % � //_L,� i% P/�L" �'. SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkBow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set � Waste and Vent System Water Cioset (Toilet) Water Heater I vent Waler Piping (Insl or Rep.) Water Re-pipe Water Service Water Soflener OTHER VIOLATION PLAN CHECK REINSPECTION AMT 50.00 so.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 511.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 TOTALCALCULATEDFEES: $33.00 Qrr 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 NOTICE: The work euthorized by this permit shall comply with all appliceble handicep accass requirements under Celifomia slatutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automatically expire end become void if work is not commenced within 180 days, or if work is suspended or abandoned for e period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicab�e codes, and all requlred Inepectione and finel epprovel must be obtained. Failure to obtein inspections and finel approval will result in tha axpira�ion of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARATON: �� I here�y atllrm under penelry of per�ury one of t�e following tladareNons: - ❑ I heve entl will mainteln e certlficate ot consent to sell-Insure Por workars' compensatlon, es pmvitled tor by section 3700 01 the Lebor Cotle, for the pertormflnce oi t�e w or which �his permi� Is Issued. I have antl will mainteln workers' compense6on insurance, es required by section 3700 0l Iha fabor Code, br the pertartnance of Ihe work lor which Nis permit Is iswetl. My worke�nsatloy I� � carriar endyollcy num�: �� U �Q � Cerder: . (�✓ ��, Policy Number. (TT/s sectian need not be completed i! the permif is veluetl a( one hundred dW/ers (3100) or less.) - ❑ I certify ihat In �he pertortnence of Ihe work tor which this permit is IssueA, I s�all not employ eny person in any manner so as la become suDjact to Ihe workers' compensation laws ol Calitomia, en0 egree ihat if I shoultl become subJect to the workers' compensation provisions af Sectian 3700 of the Lebor Code, I shall foMwith compty with these provisions. Applicant Signeture: Dete: WARNING: PAILUHE TO SECURE WORKERS' ODMPENSATIIXJ COVEMpE IS UNLAW FUL AND SW1L� SUBJECT PN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDRED THOUSAN� DOLLARE (5100,000), IN ADDRION TO THE CQST OF COMPENSATIIXJ, UAh1pGES AS PROVIOED F-0R IN SECfION 3)OB OF THE LABOR CODE, IMEREST, P.ND ATTOfiNEYS FEES. LICENSED CONTRACTORS DECLARATON: I hereby eilirm thei I am Iicensetl untler pro�Q51c lorce and eMect. Lic. a_y Contractofs Signature: T CONSTRUCTION LENOING AGENCY: wl�h Sectlon 7000) ol Dlvislon 3 of Ihe Business and Proteulyo 3Coda, antl my Ilcense is In tull _ Cless x � S.h _ Date: �• _7 ._� Q ❑ I hereby eMirtn thet there is e consWction lending egenry tor t�e peAortnance at the work for which this permit is Issued. (Sec. 3097, CIWI CoEe). Lontlefs Neme: Lentlefs Address: Signature: OWNER-BUILDER DECLARA710NS: Date: I hereby aflirm ihet under penelry of per�ury Ihat I em EXEMPT FROM TIiE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Busineu entl Protesslons Code: Any ciry or counry which requires a pertnit to construct, alter, Improve, tlemWish, or repair any sWcture, pdor lo Its issuance, elso requlres Ihe eppliwnt (or such permit to file a signetl statement t�at he or sha is licensed pursuant to the provisions of Ihe Contrectors Licensa Law (Chapter 9(commencing with Section 7000) of Division 3 of Ne Business an0 Protessions Code) or thet he ar she is exempt therelrom entl t�e basis tor t�e alleged axemption. Any violation of Seclion 7031.5 by any epplicant for e permit sub�ects the epplicant to e cMl penfllry ot not more Ihan fne hundretl dollars ($500).): ❑ I, as owner of the property. or my employees with wages as their sola compensation, WILL DO 7HE WORK, entl the strucNre is not Intendetl or ottered for sale (Sec. 70a4, Business antl Professlons Cotle: The Contrectore License Lew Coes not apply to an owner oi property who builds or impraves thereon, end who tloes suc� work himseH or herself or ihrough his or her own employees, proWded that suU improvements are not Intentletl or oHered for sale. If, however, the builtling or improvement is sold within one year ot completlon, the owner-builder will have iha burden ot proving that he or she dld not builtl or improve for Durpose of sale.). ❑ I, as owner of iha property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct �he pro�ect (Sec. 7044, Business ane Prolessions Cotle: The conirectors License Lew aoes nm appy to an owner ol properry who 6uilds or im0�oves thereon, and who contrecis lor such projad with a coniractor(s) license pursuant to the Contrectois License Lews.). �1rY��v�� A ❑ I am ezempt under sea� �UQ�� Business end Prolessions Cade lor this reeson: Signeture: "�✓ V ~ � Date: Owner ID veniied by drivefs licanse. �f�O �es ❑ No Drivef5 License No. Expire5: Vedflcation of Ownership Gy (type of documen6 i.e. - properry tex bill or deetl): DIVISION OF INDUSTRIAL SAFETV VERMR CERTIFICATION: ❑ I hereby certlfy that no excavation tive (5) or more leet In tlepth Into which a person Is requlred to descentl, will be matle In connectlon with work authorizeG by Ihis permlt, end t�a� no bulltlinp slrucNre, sceXolding, telsework, ar Aemolitlon or tlismflntling ihereof, wlll be more ihen thirty-sis (36) feet hlgh. (Chap. 32, Grp 2, Art 2, Sec. 341, Tule B, Califomia Adminisiretive Code). ❑ As owner-bulltler, I will not empby enyune to tlo work whlch woultl require a permlt from the Divislon of InOustrlel Safery, as no�etl ebove, unless such person has e pertnit to do such work irom Ihe tlivlsion. Sipneture: Date: Dldsion of Industdal Satery Pertnit Number. ICERTiFICATE OF COMPLIANCE AND AIfTTiOR12AT10N OF ENTAY: I certify under penal�y ot parJury that I heva reetl lhis applica�ion and s�ate Ihat ihe infortnation given Is I wrrec�. I egree to comply with ell state laws antl ciry ordinances relaling to builtling constmctlon, end aulhorize representatives ol the Ciry ot Cwla Mese lo enter upon ihe above-tlescnbed property for Inspectlon purposes. I egree not to occupy or ellow occu0ency of eny bullding euthorized by this Dermlt untll ilnel Inspection. COpE �. INSPECTIONTYVE QAjE I�E�oS 1818 Fisetl System Flnal Fire Prevention 1268 Pool Spa Final 200 Final RaRoof 201 FInaI BIocWRetelning Well 202 . Flnal Fectory Fire Plece 203 Finel Slgn 204 Final Dem zaaeae COOE I INSPECTIONTYPE 208 20B �Dete t--� �Dat� ? �g Final MeChenital Finel Plumbing �—O � 270 Finel Electrical 212 Final Flre Prevention 220 Final Plenning Approval 222 Finel Sile 250 Final BuildingiOccupenc dobnddress: 496 E 19TH ST Suite: Vicinity: FRONT EXT OF HOUSE Primary Occ: R3 Parcel Number: 42632111 Applicant: NEIDLINGER, MATTHEW Address: 12733 WESTERN AVE GARDEN GROVE, CA Type of Constmction: V-N Zoning: Owner: ALMEIDA, BEATRICE YVONNE Address 496 E 19TH ST " '. COSTA MESA, CA . , Contractor: JERRYS INTERIORS INC. Address: -- 2733. WESTERN AV�� _.• - - - GG, CA , Zip:- 92841 _ Arch : . Address Zip: , ' � � . Phone: Phone: 714-898-3655 Zip: 92841 Phone: 949-548-2538 2ip: �92627 . ,:� i. Phone: 714-8963855 License: 673393 Eng: Address: ,' License:, � . � , � Status: ISSUED Applied: 11/16/2005 Issued: 11/16/2005 �//y)—� ISSUEDBY: �� J ` Plione: License: " " SCOPE OF PERMIT , ' AUTO DAMAGE REPAIR TO SFD. WORK TO INCLUDE: REPAIR OF EXTERIOR SIDING, INSULATION, DRYWALL, P AND FRAMING. , ' �_... ._ . FEE SUMMARY_�,_ .. .. L ; � Plan Check ' $0.00 • � -,a '" ' Calc Valuation: $z,000.00 Permit ;' S69.25 -'' � Clai ation: sz,000:oo SMIP Res. ' $0.50 . < _ SMIP Com: � $0.00 � � � � Other: $0.00 � ' � . ,;, " �: - ;`, �r: 'i`nspection: $0.00 �� - — ' � Total: - $69.75 PLANNING & ZONING SETBACKS � � � � � - � , - � MAIN STRUCTURE �Front 0• 0 �� . - Rear.� ; 0- 0 - `� � Left� 0- 0�„�z�' . . Right 0-�0'� •� . , � � �y'' ` " ,� . � . ACCESSORY �� Front 0-0 " "�`Rear 0-0 �� left'�- 0-0 ,� � Righl 0-0 PARKING Ezis�ina: .- o ' �' R�equired:. � o- � Pr000sed: �o-.-; - , � � . � �_ , ",:z,� . � ._. _ . . , : . . � . � . ,�s , ' . d q. _ y _, ` E ��., .. Y ..._, i E � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilomia statutes and related regulations. (Ord. No. 9248, § 7, 12•21-92) EXPIRATION: This permit shall autamatically expire and become void iF work Is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order (or ihe work authorized under this permlt to be consiCeretl legal, such work must comply with all applicable codes, and ell required Inspeetlona end tinal epprovel must be obtainetl. Fallure to obtain Inspections and final approvat will result in the expiratlon of this permit. j FOR INSPECTIONS CALL; (714) 7545828 �r o�aV,,, WORKERS'COMPENSAnON DECLARAnON: I �ereby effirm under penalry of per�ury one of �he following tleclaretions: /' ❑ I heve entl will maintein e certificate of consant to sell�lnsure for workers' compen3etlon, ee r�rovldetl for by sectlon 3700 ot the LaDor Code, lor the peAormance of the work for whlch this pertnit Is issued. �"I'ha erM'vw0,amintain workers' campensetlon insurance, as reQulretl by sectbn 3700 0l Ne Lebor Code, for the pertortnance ot the work lor whlcli 1hLa pertnit Is IssueC. .,�Myvrorkeis`com tlon suraxe carder end pollcy num6ar ere: c�7y eertler �� 11AP P IcvNumber. � / / — ��0�� L need rrof De canp/etetl I/ Ne pertnll /s velued e! one hundred dWlers ($/00) or Iess.J ❑ I certify thet in Ihe perfortnance of t�e work for which this permit Is issued, I sha0 no� employ eny peroon In eny menner so es to become sub�ect lo the workers' compensation laws ot Celifamle, end epree thet II I should Oecome sub�ect to Ihe workers' compenselion provlslons of Secti 3700 of Ne La6or Code, I s�all forihwlth comoy w�in u�ese provis�i jJ°��,ys- �� % AppNcerrt3 net�re: /UlG� ✓��ta//,� Dete: �� I�/G�OS E TO SECURE WORI(ERS' COMPENSA ION COVERFGE IS UNLAW FUL M1D 5lULL SUBIECT rW EM �IINA[ PENALTES AND CML FlNES UP TO ONE NUNDRED T1qUSAND DOl1ARE (5100,000), IN ADDRION TOTNE CQST OF COMPENSATION, DAALIGES AS PROVIDED FIXi IN SEGTI ��F`TfiE LABpq pppE, RJfEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLAHATION: ��:� I�[eby�a}firtn"�am�iicens�tl yyder�rovisions ol C�aO�er 9(commencing with Seccion 7000) of Dlvlsion 3 of the Business end my license is in tull CONSTRUCTON LENDING AGENCV: ❑ I hereby ettirtn that there is a construction lending egency for the pertormance ol the work for wNch this permit is luued. (Sec. 3097, Clvil Code). Lendefa Neme: Lenders Address: Slgneture: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn t�et untler penelry ot per�ury Ihel I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe lallawing reason (Sec. 7031.5, Busineu end Professlans Cotla: Any Gry or counry which requires e permit to wnstruct, elter, improve, demolish, or repair eny structure, prior to its issuance, elso requlres the epplicent for such permlt to ille a signetl stetement that he or she Is IlcenseC pursuant to the provlslons ot t�e Contrectoro Ucense Lew (C�apter 9(commenGng wlt� Sectlon 7000) of Division 3 ai ihe Business end Professions Cotle) or �het he or she Is exempt theretrom antl the basis lor Ihe ellegeA exemption. Any violetion of Section 7031.5 6y eny eppllcent tor e pertnit sub�eds Ihe epplicent to e civil penalry oi not more then five hunaretl Oollars ($500).): ❑ I, es owner ol the property, or my employees wit� wages as their sole wmpenselion, WILL DO THE WORK, antl the structure is not IntendeC or oMered for sale (Sec. 7044, Busineu and Professions Cotle: Tha Coniractors License law tices not eppty lo an owner of property who builds or imprwes thereon, and who does such work himsell or herself or through his or her own employees, provided that such improvements are not IntenCed or otlered for sale. If, however, iha building or improvement is soltl wit�in one year ot completion, the owner-builder will have ihe burden ol prmdng that he or she ditl not build or improva tor purpose of sale.). � ❑ I, es owner of Ue properry. em EXCLUSIVELV CONTRACTNG WfTH LICENSED CONTRACTORS ro construct t�e projaq (Sec. 704a, Business and Professions Cotle: The contractars lJcense Lsw does not epply to en owner at properry wM builds or Improves Ihereon, and who comrects br such proJect with e contractor(s) license pursuent lo fhe Coniractore License Lews.). ❑ I am exempt under sec. Business and Prafessions Code tor t�ls reason: SigneWre: Date: Owner ID verllietl Dy tlriveYs license. ❑ Yes ❑ No DrNels Licanse No. Expires: Vedflcetlon ol Ownership by (rype ot tlocumenL i.e. - property tar blll or tleatl): DIVISION OF INDU � IS AFETY PERMIT CEHTIFICATION: ❑ I �ereDy certity thet� o excavetion ilva (5) or more feet In tlepth Into which e person is reqWred to tlescand, wlll be made In connectbn with work euthodzed by this permlt, and that no building sqycture, sceflolding, falsework, or tlemolition or dismantlinp ��ereol, will be mare than thirty-six (36) feet high. (C�ep. 32, Grp 2, Ar12, Sec. 341, Title 8, Cellfomia Adr�fi�r�fanve coae). i ❑ As owner-builder, I will not employ enyone to do work which would require e pertnit Irom Ihe Division ol Indusirial Sefery, es noteC ebove, unless such person hes e pertnit to tlo suc� work trom the di 1. Signeture: - ' Date: Division ot Industrial Safery Pertnit Number� HAZARDOUS MATERIALS AND EMISSIONS CEH C N: 1 WIII the epD�� or presem or future bullding� neetl b tile end ceNty e Business Plan for emergenry response to release w threatened release o1 e hazerdous metedal7 ❑ Yes ❑ No �(. � (Section 25505 oi the Califomia Health end Selery Cotle requires, with some exceptlons, Ihet e Business Plen be filed with t�e Coste Mese Fire Department by avery business w�ich has et eny one �Ime tluring e reported year e quantiry of hazardous meterlals equel to or greater than a weight o1500 pounds, or a volume of 55 gellons, or 200 cublc teet of campressetl ges et stenderd IempereWre and pressure). ...........................................................................................................................................................................__...................._._............................................................................................. _...................... ..................................................... 2 Does or will the epplicent or present or iuture builtling occupant need to file e registration tortn lor acutely hazardaus materialsl ❑ Yes ❑�No (Sectlon 25533 of Ihe Califomle Haelth end Selery Cotle, wlt� some exceptlans, requires regisiretlon wlth iha Casta Mese Flre Depenmenl by eech busineu which et eny one tlme hes on hand a quentlry of eatety hezardous metedals equel to or greater then a welpht oi 500 pountls, or e vdume ot 55 gellons, or 200 cubic feet of compressea Bes et stendartl tempereture end pressure). ....._..__...._� ................_.........................................................................................................._..............................................................................................................._.......................................................................................... 3 Does or will Ihe applicent or present or fuWre building occupent need to prepare an RMPP (Rlsk Menagemem end Prevention Progrem lor ecuiely hazerOous metedals)9 ❑ Yes � No (Sectlon 25536 ot Ihe Califomia Healih entl Safery Code provides Ihe� the Coste Mese Fire Depa�ment may require Ihe preparetion, certllicatlon entl tiling wilh Ihe Fira Depariment of en RMPP 6y businesses whlc� ere required to register ecutety �azarOous meterials wit� the Flre Deperiment. ..-- -- .................................. _ ......_.._._.._...___............._........_...... —.....—....--'--....................._......_. 4 It en RMPP is presentty requiretl, has Section 25534 ot the Celifomia HeaIN enC Safery Cotle been fully wmplied wit�1 ❑ Ves ❑ No ' —_—"' ......................'_."_" "'.......__�........__.............................."""_"'_.._—............._............................_......_.. 5 Does or wlll Itie applicem or presem or fulure builtling occupanl require for lhe work which is Ihe suEject o1 ihis e plication ep� rtnii tor such construdion or modifcation Irwn Iha South Coest Nr Ouality Management Disttict or tran eny othar air polWtlon contml dlstdct or egencyl � Yes �J No (Sectlon 658502 ot the CaliFomia Gavemment Cade requlres thet Ue requested inlortnation ba turnlshetl on epplicauons for non-resitlentiel builtling parmits). .._..._._.......__...........__.._......_ ................................................................__.........................__."._............._......................................................................................................... .............................................................._._ 8 W III any pan of the taciliry to be constructad under this permll be within 1000 feet Irom the outer bounderies ol e school? ❑ Ves ❑ No (II yes', t�e taciliry must meet the requirement of Sections 25534 and 42303 oi t�e Calitomia Health and Safery Code). ..........................................................................................................................................................................._..__........._..'_'..................................................................'_"_'._...__...__................_.__.................'_ 7 Ii e pertnil from the South Coest Air Duellty Menegement DisMct or other eir pollution control dlsfnct or agency is requireC for the work which Is the subject of Ihls epplicetlon, have all ol ihe tlisclosures prescrlbed 6y Celifomle Health and Satery Code Section 42303 6een mada7 ❑ Yes ❑ No ........_ ...................._.............................................................................................................................................__...._..................................................................................._.....__..............................._............................................................... B (II yes', etlech certifcala of compllance irom tha eppropriate air pollution control oHicer). CERTIFICA7E OF COMPLIANCE: I cetlity that under penalry ot per�ury the infortnatlon given ebove is correct. I agree to comply with flll stete lews end ciry ortlinances regartling Harartlous Matenals and Emisslons. Sipneture: Date: CERTIFlCATE OF COMPLIIWCE AND AUTHOHVJITION OF ENTRY: I cenify untlor penaly ol per�ury that I heve read this epplicalion antl stete that the inlormation qiven Is wnect I egree to compy with ell stete lewa end ciry ortllnances relating to builtling wnstruction, entl authodze representatives ot the Clry of Costa Mese ro enter upon the ebove-descdbed D�W�hY �or Inspection purposes. I egreo not to oCcupy or ellow occupenty ol any building euthonzed by ihis permil until fina� inspection. Legal COOE �. IMSPECTIONTYPE 1616 Fixed System Final Fire Prevemion 12fifi 200 201 202 203 204 Pool Spa Finel Finel Fe-Roof Flnal BIocWRetaining Wall Final Faclory Flre Place Finel Sign Finel Demoliiion �.p��luu1L14i COOE 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbin9 210 Flnel Elecirical 212 Final Fire Prevention 220 Flnal Plenning Approval 222 250 Final Site , FinalBulldinglOccupanry �V �. � ,wi/.1F1 rwcrecr nooREss: q y� c, 1 9 TH S 1 owNexsr+an+E: ALMEIDA BERTHA B HzIN nooeess: Q96 E 1JTH 5T COSTA MESA,CA 92627 548-253fl AflCH1ENGINEEP: flEG.NO.: FDOHESS: UNIT: UNIT: PEPMITiEE: ASHMANS UALITY ( 714 ) 498-1005 noox[ss: 1 `l9 MA�EO SAN CLEMENTE CA 92672 UCENSEO CONTHFLTOB OECLABRTION: I hereCy allirm ihat I am licensea unUer pmvisions ai Chapter 9(commencing wit� Section 7000) af �rvision 3 0� Ihe Buslness anA Pmlessions CoOe. ana my license is in lull torce and efleci. cirruc.:054621 ^sraTeuc.:589940 � /JI�c,us: ^' "' — � ��I �'_I_�_ SignaWre: _�A1/1_ WOBREflS' COMPENSRTION DECLAflATION: I �ereby altirm Iha� I have a cenificate af consenl Io selbinsure or a certilicate of Workers' gumoensaiion Insurance, or a cenilied copy thereot ISection 3800. LaC. C). ,LICV NO.: E%P. ORTE: Cenifietl copy is here0y furnishe0. ❑ Cehilie0 copy is file0 with the ciry Builtling Division. �a�e: AODlicant: E%EMPTION FPOM WOflHEBS' fAMPFN5AT10N OECUflATION: QhiS 5ection neeA nol Ge Complele0 iI �h¢ permil i51or are �unOreO �5100) or less�. I cenity Inat in Ihe peAormance of Ihe work lor wnicn ihis permit is issue0, 1 shall not employ any person in any manner so as to become suble�� o t�e Workers' COmpensa�iun Laws al Calibmia. I' �,/ ' �k.--�f�J"3 � �q � Signamre: ��lel� NOTICE:I�. after makinq this aectaralion, you should become SUEjec� to ��e Wofrcers' Compen5ati0n pmvisions of 1he LaEor Code. you must fonhwith comDly with such pmvisions ar tNs permi� snall Ge UeemeO revokea. CONSTflUCTION LENDING pCENCV: I hereby aflirm tM1ai ��ere is a tOns�mCfion lending aAenCy br ��e pedormanCe of �he work for whicb Ihis permii is issuetl (Sec�ion 3W7, Civ. C�. LENOEP: AODHESS: OWNEfl BUILDEP OECLRflQ10N: I here0y aifirm �hat I am exem0� ��am Ihe Contrattars' Slaie License Law far I�e followinp reason (Setlion 7091.5 Busineu ane Pmtessional Coae: Any cily o� couniy w�ic� requirts a Dermil �a conslmci, alter. impmve, demalish, or repaii any simcture, prior to ils issuance, also require5lhe applicanl �or suc� permit Io �ile a 5igne0 stalemen� �ha� he/she is licensed pursuant lo Ihe pmv¢ions ol l�e Coniractors' State license Law (ChaO�er 9 �commencing vnih S¢ction 7000) al 0ivision 3 af ihe Business an0 Pmiessions COde) or I�al �e/s�e is ¢xemp� I�erefmm antl ihe basis fot Ihe alleqea exemD�ion. Any violalion ol $ecfion 7031.5 �y any applicanlfor a permit suGlecis Ihe applicant lo a civil Oenalry ol nat more ihan hve hunOr¢0 tlollar5 (E500). , I, as owner ol Ihe pmDeny or my employees with wages as iheir sole com0ensation, will do the work, an0 ihe �svucmre is noi intenCed or ollere0 for ule Isection 7044, Business an0 Prolessional Catle: T�e Cantractors' State License Law Ooes not apply Io an owner ol a Omperly who butlas or Improv¢SlAereon, antl wh0 does such woh him5¢I�/herselt o� �hrough his or her own emDloyees. pmvitled t�al such impmvemen�s are not inten0etl or ollere0 for sale. II, however ihe 6uiltlinp or imOmvemen� is sola wi��in one year of complelion. Ihe owner will have Ihe Uurtlen of Dmving �e/she tlid nol build or improve fot Ine Durpose ol sale). I, as owner ot Ihe pmpetly, am exclusively contrac�ing wiN licensetl con�raclors lo constmci tAe O�ole�� l5eciion 704d, Business ❑ and Prol¢svons Coae: The Conlractors' Stale License Law Ooes not apply to an owner of pmpeny w�o �mlas or improves thereon an� who convacis lor suc� pmlects with a conirac�or�s) license pursuan� �o �he ContracloK State LicenSe Law�. I am aware ihat pmol ot iheir worker's ComDensatbn insurance shoul0 be providea to me. � I am exempl under Sec�ion: B. 8 P. C. lor ihis reason: �ale: Owner. I ao hereby cenily Ihai I am aware ol and unEerslantl t�e repuiremenls ol Calibmia Healih anE Satery Code Seciions 25505, 25533, an0 2553d antl Inal I oi any iNure �uiltling occu0an� wilUwill nol (circle one) neetl �o camply wilh said state catles antl �he reQuiremenis for a permii bi conslmciion Or motlificati0n Irom I�e Air Ouahty Managemeni OisMc�. fl¢v0eniial conslmciion aDP�iwtions are exemp� Imm Ihese pmvisions. Oale: Nppncam: I her¢�y cerlilyihal I havereadlhis appliCaiion antl Sla�ei�all�e above inlarmalion is corretl. I agreeio Camply wiih allci�y antl [ounry ortlinances ana sla�elaws relaling�o OWIOing conslmciion an0 �ere�y au�hor¢erepresenlalives ollAis cily�o enter uponihe aAove-mentionea O�operiy foi inspec�ion Ourposes. �� p��=�(� ��.' --1 �_ Signature: oriver's �iwnse o� sociai security r: �6<t-a6 W�ne—Builaing; Green—CoOe Ento¢emenC Canary—Applicanl; Pink—Revenue; GolOanrotl—Assessor CITY OF COSTA MESA - B[3ILDING PERMIT PERM NO; B 5 81 V PERMZT NO; B 054810 PLAN CHECK NO: 09469-91 S GOV'I': SGP : CONSTRUCTION TYPE; V-N PERMII' TYPE; STR PURPOSE; UTH JOB DESCRIPTZON : REPLACE 4 WINDOWS IN EXISTING OPENINGS S(� FT: 1,�00 CLAIM VAiUE: 1,SUO,UO CALC-VALUE: 1,500.00 GROUP OCC: R-3 / COMMENTS: SMOKE DETECTOR RE�UIRED IN TH= HOME iFjFifiE3F1F�C};{fihiEi'�ji�j(�ffifit3(�Ik34jkif�ib±(�3Fif1f fF%�kiF3fifif3FihiEiEaEifiFiEiERifif1e3E1FiEieif!(�if�1E�(�jFiEiFK�itiFiFifif�jf�3Eif�if3f3elEifif�K�)f1i• Z O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDZNG ---------- --------- ACCESSORY BUILDII�'G --------- FRNT; FT I13 REAR• FT IN rRAT: FT IN REAR: FT IN LEFT: FT IN RGHT: F'I' IN LEFT: FT IN RGHT; FT IN PARKING REp - PROV: PARCEL: 42632111 ZNc; REF NO: PLANNING Nt5TE5> 7 i! � it 1f �t iE i{� if iE iF fF �1F iF'.h iE if 3E �lE iF !f if� iF ik 9E ii� iE 1f if 3F 1E k iE lf �!E 1E iflE if IE it jF iE �f �i iF 3F iE if �E 3F ik iE-1(� iF 3f lE iE iE iF Y iF ji• iF iP �'..y �!P?? �f 3E iF #E 3E if ?F i'r ic 36 D E V E L O P M E N T S E R Cr I C E S R E Q i7 I R E M E N��1 S 'LONING APPROVED BY DA'TE: f�� BUILDING APPROVED BY ;�C_.,,�� DATE; �-T—q— APPLICATION ISSUED HY• �'"" DATE; W�r ��r � if3FiEifiFif�iFieif�!f1E3ElEj(�3Fii�i(-3i�jElFiFiE �ir 3fitiffe�FiFlEjEiciE7��1biF 1E �1F iF 1E lk?E IE �1f� iF dk 1Elf ff �f fE If 1F iE%�lf if ib iE iE ik iF if 1f �le ib ih �)f �lf ii if !E iE 3e 36 ff if �1f 3E iE �lE if iE iE iF aE Y� ih 3F iF if iF ic if 1F iE �� F iE lE iF K- iE if 3F 1f� iF if if iFlf 3F # V�1F LEGALIZATION:N F E E 5 U M M A R Y STRTiCT'URAL SEGMENT:Y HLDG PMT PLUMBING ELECTRIC MECHANIC FiRE SMIP/RES GRADING FERI;IT 35. 00 , 50 SMIP/NON-RES PLAN 22.75 ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PL'AN-CHECK TOTAL PAID DUE TOTALS----> 35.50 0,00 22.75 58,25 58.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 58.2; OVER/SHORT: 00 HLDG PMT PiUM3ING nLECTRIC NECHANIC FIRE SN.IP/TOT GRAUING PLAA'-CHECK 35.00 ,50 22,7; if 3c i'r }; i!� � if 7h iF 1E 3ElE iF �lF iE 1k if� �lf 3!+f ih �lE if iF jE if ?E 1F 3f iF 3E iE if ii if iE iF N• iE fk iF 3(� iE if 3f if i's ie k j't ?f iF iE iE lE if l6 iE #' K� If iF 1f 3F ii� if if 1t !E 3F � IF ii� 3't #E iF 3E iE 7f I N D I V I➢ C1 A L' c E E H R E A R D O W N 'I'YPE QTY D E S C R I P T I�O•N iJNIT COST TOTAL COST SrR 1500 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 1,500.00 ENL OF FEES _, ' — ':,� � � ' - :: ._. -- .- - . .. � ' �. , ; ` sPn � CONSTRUCTION AND PLANIVINL� � � � APPROVALS Permit# r Date �Inspector qppROVALS Permir# Date Inspector � t. Temporary Electrical Service. f Pole , � � 52. Pool & Equipment Location -' 2. Soil Pipe-Undrgrnd. �,;; ? . 53. Steel Reinforcement . �^, 3. Electrical Conduit Utility-Ur�y�rgrnd. � 54. Forms � 4. Electrical Conduit-Undr9rnd: � " 55. Electrical Bonding -� 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57.. APPROVAL TO COVER�GUNITE 7. Footings 58. Eiectrical Conduit-Undrgrnd. 8. Foundation _-; _;' 59. Gas Pipe, O Undrgrnd., Test "� 9. Water Pipe�Undrgrnd. 1: ,; ., 60. Backwash Lines, P-Trap, � Undrgrnd. _'L' 10. Struttural Floor System �� - 61. APPROVAL TO DECK � �. 11. Froperty Sewer Line & HousrConnection � 62. Backwash & Receptor�Final � '� 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains ' 64. Piumbing SYstem � Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 76. Rouqh Electric Wiring 67. Fencing & Access Approval 77. Reugh Wiring Sign 68. APPflOVED 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 Structwe 70. Underground Hydro 22. Ducts, Ventilating 71. P�oduct Piping � Gas ❑ Oil 23.,Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI 25. Roof Sheathing 74: Ove�head Hydro 2fi. T-Bar Ceiling-IStructuraq & Monocoat 75. pry Chemical 27. Frame and Flashing i� �(, C'� � 76. Dry Standpipe 28. Lathing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation ' � '�, 7$. F�RE PREV. FINAL 30. Drywall Nailing �� - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat �� 79.'FINAL INSPECTION 32. Electrical Power Meter-Final ,� 80. FOOD �ERTIFICATE I-S�SUED 33. Final Eleciric � '-� � Noter. ,,�� , _�,----;1 �_\-'"`. � � 34. Final Heating & Air Conditioning -_ 35. Final Gas Pipe•Test �� 36. Hood or Canopy ' �! C�_ 37. Final FactorY Fireplace ' �� 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final . . • 41 � Solar pomesticFinal � 42. Backflow Preventer � , 43. Backflow Irrigation 44. Landscape Irripation SY'siem . 45.•Sound Attenuation • 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING ��(�„�� 48. FINAL PI_ANNING -r 49. Electric Release to Edison � � 50. Gas Release to Southem Califurnia GasCo �� j � 51. CERTIFICATE OF OCCUPANCY No. Date : � . � DJ@C9 POONESS: q 9 6 E 1 9 TH ST OWNEN'S NAME: �MEIDA BERTHA H HEIN nooxess: 496 E 1 JTH ST COSTA MESA,CA 92627 APCHIENGINEEfl: ADOHESS: uxit: XEG.NO.: UNIT: PEHMITTEE: O' CONNELL ELECTRICAL ( 714 ) 858-1315 aooness: zZ552 AUBURNDALE IICENSED CONTHFLTOfl oEeuqOIONO I �ereGy allirm I�al I am IicenseG unGe opo i�95 06 30 9(�ommencinp wil� Section 7000) ol Oimsion 3 otl�e Business an0 Pmtessions Code. an0 my licenso is in lulllarce anU efleci. urruc.:054164 si"'Euc.:584190 ypc1Ass: C�-10 O/ _Q� Oaie: g—f_� 9� Sipnamre:—'Y_" —_ "— G-__��.C� WOBNEBS' COMPENSR710N oECIABRTION: I nere0y allirm that i nave a cendicate a Ons¢nI105¢I4in5ure a/ a cetlilicaie 01 Workers' CAmOensalion Insurance. ar a cerUlieO copy Inereol (Seclion 3800, Lao. C). raucrno.: 1105091-90 EXP.DRTE: 10 01�91 COMPFNY: STATE FUND � Ceniliea caoY is nereoy Wmisnea. C� Cenilietl capy is file0 wiin t ciry BuilGinp UNis/roy. //// oaie:—�/%Z�/�� APPlicant: ^��!Li��ir' (/r[_�SN� E%EMPTION FflOM WOXNEXS' COMPENSIITION OECIAflRTION: hi5 SetGon med rol Oe m��ER4G II NE pPrmil i5 �N ane hunCfeC (5100� Of Ie55). I cenily tlWt in Ihe oetlormanCe ol ine xrork lor whicn th¢ permit is iuuea, I sliall not employ any per9on in any m2nner 50 as to become suoi�� m me Workers' Comoensa�bn laws ol Galifamia. Date: 5lpnature: NOTILE: II. atler maMinA ��¢ declaraGon, you s�ou10 Uecome su�l�� o the Workers' Compe�natpn Orwisions al t�e Labar CoG¢. you must fariRnilh compty vrii� suc� Dmdsions or INS Oerrttii stwll be Otemed revOkCE. CONSTNIIC➢UN LENDING aGENLY: I �¢r¢Ey allirm t�al lhere is a ConSlmtii0n Ie�Minq a0en�y lOr Itre pldarmante ai 1�0 work br wnic0 tnis Oermii is iuue0 (Seclion 3W7. Gv. C�. LENOEfl: ADDNESS: OWNEfl BWLOEB OECIAHAT10N: I �¢r¢Oy allirm Ihal I am e�em0� ��am i�e fAnirattori Slaie License Law for t�e followinq reason (Senion 7037.5 9usine55 anU Pmteuianal CoOe: Any city ol county wllicll repuiru a permit lo consiruct, atler, imprwe, demolis0. or repair any slNcture, priot to its iuuance. al5o repuires Ine aoDlicanl for sucn permil to lila a Si0ne0 slaiement Itul n¢/sne is licensea pursuam Io t�e OrONslorts ol 1ne Canlraclari SIaIe license Law (ChaO�e� 9lcommencinp wii� Settion 7000� al Divisian 3 0l l�e Business anG Pro�esvons CoOe) or tlut �e/s�e �s eKempt i�ere�mm antl Ne basis lor t�e altepe0 exemplim. My Nolalian oi Seciion 70.31.5 by any appliWnt lar a permt suGl��s i�e appliUnt to a civil penalty ol not rtroR itun live IlunEreO ENlars (5500�. I, as ovmer ol t�e D�aperty or my empbyees wi�� wa0es as Ineir wle wmpensatlon, win Oo Ine wonc, ana i�e ❑ sirutturt a nol fnlendeA or oflere0 lor Sale �SecOon 71Wd. Business antl Profe55ional Cotle: 7he fAniractors' Slaie License law tloes nol apoly to an axner of a proDetlY w� Ouilas or im0�oves ihereon, an0 wlia GO¢5 su[n wOrk tlims¢If/herself or through �is a� Iler awn emproyees. O�oviaetl tlut wc� impmvements are na� intenUeG or oflereE tor ute. II, however Ihe builaing or imprOv¢menl ¢ SOIC vntNn On¢ year oi com0le�ion, �he owner vnll luve ��e OurOen o� prOvinp �C/SbE EiA nni 6uilU or impwve for ine purpose ol salel. I, as awner al Ue pmpeny. am eulusively contractinA wit� Iicense0 mntrapors m consirun Ihe pmleq (Section 70aa, Business �I ❑ ana Pm�e55ion5 COEE: T1le Coniratlors' S�ate License Law Ooes nat appry to an armer af Oroperty who OuAas or imorovcs Ihereon ana w�o [onVa[�5 lar Sut� pmlecls wiN a conVacioqs�licensn pursuanilo IM1e CanlrattOrS' $Iaie License Law),I am aware Ihat 0�� oi t�ert Worker's CamDensation insurance 5h0uIG Ge OmviQetl �o me. � I am eAemD� un0e� Seciion: B. 8 P. C. lor Inis reason: Daie: Owner. I ao ne�eoy cerlify Inat I am aware ol ane unaerstane Ine requiremenls al California Heattn ana Shcety CAae Seclions 25505, 25533, ane 2553< and itut I or any luture buildmg occu0anl willlwill not (circle one� need to comply with SaiE 5taie cOEes an0 ihe ieQuiremenis lor a Oermil lor mnslmt�ion ot moJdicali0n Imm Ihe Air Oualily Managemenl �i5iritl. FeSfCen(ial tonslruclion applitalions are exempt Imm Inese vrovisions. Da�e: pp0�icant: I herCDy Cerlilylhai I �ave iea0thi5 appliCalion and Slaie�ha� Ihc a6oveinl0rmalioni5 rortetl. IaO�eeio tomply wilh alltiry ortlinanc¢5anO51alelavrsrelatinglOGUAaingcon5lmclionantlhere0yauttqrue�m¢5entalivesoltltistilyloen�eruponfhea v pwDerly Glo�r in50ection putpases. Oaic' 1 � 2_ (—� SignaWre' _%. � Oriver's L¢ense o� Social Secunty p: t6<La6 Whib—Bmltling; Green—Code Enlorcemem; Canery—ApPlicant: Pink—Revenue: GolOonroO—Assessar CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 053831 PERMIT NO; E 053831 PLAN CHECR NO; N GOVT: N SUPP; N CONSTRUCTION TYPE: 5-N PERMIT TYPE; ELE PURPOSE: OTH JOB DESCRIPTION : ELECTRICAL SERVICE UPGRADE S(j FT: CLAIM VALUE: CALC-VALUE; GROUP OCC; R-3 /M-1 COMMENTS• SMOKE DETECTOR(S) RE�UIRED IN HOME, *�**�r�r+��rQ*�r�r�e�r*�r��r�r�r**��e**�*�* �e�r+r�***�r��r�+e��r�r�r*�*��r�r�r+r�r�r*�r**�r�r+r�r*�r**�r�r+r�r�*�r** 2 O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- 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: 92632111 ZNE; REF NO: PLANNING N01'ES> i k iE if if �F 3F iF iF ft 3f if ik IF iF 1E if IF Ik iE ikiF iF iE 3f 1f iE i! 1f iE iE iF �f iE if iF k iF M iF 1f iF if iE 1E k if 1f if af �k ih 1f iF ik if iF iE iE �f iF 1f iF M 1E fE iF iF if M 1F �f �F iF k �f if if if iE 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 BY `l :� DATE• BUILDING APPROVED BY • APPLICATION ISSUED HY•;F�� 1F �f 1E ak �E 1E 1k iF if iE if iF If IE if k iF k it if iF if iF iF if iF IF iF iF �F iF if iE iF ibiF iF k iE iF 1E if iE ik ff iE 1E If iF �t DATE; �-+. DATE • /.2 lfkltiFlkiEiFlEiFif �EM ffkifififk ikiFitif�FifitiFiFifMklfikifaFitifklfiFiFifififif�E�EifiFiElfikififkM LEGALIZATION:N F�E E? S U M M A R Y STRUCTURAL SEGMENT:N • ; PERMIT BLDG PMT PLUMBING. EliE18R50C MECHANZC FZRE SMIP/RES GRADING �O! SMIP/NON-RES PLAN ISSUE FEE 15,00 BUILDING-DZV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 18.50 15.00 0.00 33.50 33,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 33,50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 33,50 if if iE iE IE iE iE iE it 1E iE if if iE iE �E iF iE if IF iF iF If iE IE iE �t IF iE iF k 3E iF if if IF M!f 1E if IE 1F iE iF k iF k iF If if iE it if iE iE if if iEif iF k ik 1f iE 1F �E if iE if �f iF iF iE �F 1F if 1F k iF 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 ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18,50 18.50 END OF FEES V 'S GGG4t��'-: Jib97r IT�� ' ',..� �AT�: 09�22;;'1 T}%iF: ;t:i� ! CONSTRUCTION AND PLANNING � PO : SPA ( APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electriral Servicebr Pole L "� 52. Pool & Equipment Location j. 2. Soil Pipe-Undrgrnd. ��(� oS :.( 53. Steel Reinforcement t� . , 3.,`E�gctrical Cond"ui�`Unli[y�U�tdigmda 1q � 54. Forms ;,/'. �04:;�leCtrical CondulI-UfSdrgrnd.� � : � 55. Electrical Bonding t� �'�5; S��eel Reinforceil�e�� '=� � � 56. Rough Plumbing & Pressure Test � :t ��3:tEltctricalUFER�Grnd. �-�+� 57. APPROVALTOCOVER�GUNITE �� '�'Feqtings -Y � � 58. Electrical Conduit�Uodrgrnd. �� . , o -_ �r Foundation , � j. � 59. Gas Pipe, O Undrgrnd., Tes[ y� , 9': Water Pipe-Undr�grnd. %'� , fl 60. Backwash Lines, P-Trap, � Undrgrnd. ,j !a 1Q; Structural Floor=System '� w � '' 67. APPROVAL TO DECK :/ +� ' 1 b: Pnoperry Sewer Line"& Ho�ne:Co ection r �S ''�^- a 62. Backwash & Receptor-Final ; i' 12. SC�'ver Cap ,U "'�� ! �. ' 63. f-leater & Vent�Final ; � � 13. Roof Drains 2 �� : �� 64. Plumbing System � Final ''r•�, 14. Rough Plumbirig �� • j ,� 65. Eleotrical-Final � 15.� Rough ElectricaCConduit � 66. Solar System-Final .% 16. Rough Electric Wiring �"� 1 67. Fencing & Access Approval .': �_` 17. Rough Wiring S�gn - G_� 68. APPROVED FOR PLASTERING � 18. Rough Electrical'-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Fough Heating & Air Conditioning " FIRE DEPT. REQUIREMENT - - - - � .r - :�. . :n 20. �..Rough FT to� FKe�lace � C:: Q' t O 7.a i�PPROVA�I=Sv '-.Perrnit # "'` 21.�ucLt,iqStri�ctu _,.y .... F'S x ;� �: .', p �0. lTdderg'ro�d Hy�o > ' 22. Dua3, V'entiGting.:y � :'J� r S t.; *�1. Product�Piqirig Q`Gas 60i1 23. ��as'P'pe• ough &"�est ' `� 1 * ' s _• y. •. �n � p .'' - .� `�i � i in.,- x in ,r ,r �_ y iJ2. Undergrounc( Flu`sh� � 24. Aoo�Framing� >;� � :-+. •'� . ,j � •- � n73. ndergrnd?Smra�,}7ank �Gas OOi1 25. Roo Sheathin •' �• ''' ` '� `'� �' ;'�.� "' .� Ci {, Y f, 9 ,,.- , j , „c �;� �. -74.•�Uverhead HYdro� . 26.�5-Bar,Ceiling (Str�iuraq & AAonocoat �-� '%�: C b7+� = 75.=pry Chemical �� -� L t'j �t- v �.�. � �,. -�� 27..�rarPean� Flashii�•. �n T � `D ' k '..� C>. :e:S �a �z , �.�;.,;; y „ i., 76.� Dry Stanc�,iQe _,� f, � '28.�Lathing�8i Siding�: .. ' 1E�; ' _� s: .. .. ..:z -: 77.- FIXED Sl`SiEMtiEfiNAL� � � .ti -�'29. Insulatio� `�r p � .••. ^ ; �` � � Q 78.jFIRE PREV. PItVl� :,: > r �� 30. Drywall�Nailin9 --rt�' `� »�� a a HEALTH.DEPTaR-EQUIREMENT �1. Plaster Brown,Co�i,� � � rc•ir � ; � � „� .,79.�'�INAL IfV�P�ECTI�N`, ; � - - � , � `�� Yf' OD CERTIFICA'T2ISSUED v � 32.;ElectriwHPowar fjdeteriFinal � . n.�� 33. fina� EleCtric� `��' t ` �'�'.c)/�� R� i�K '� ^y. � S i 1 Cs. w 1 h tC � � �'+ � :�1 x"' - ~*' . � - �"'_q : ,.. n34.;Final�Heatin9_&Av:.�onditio5�i�� .i r� � � �� r i�: •v •�i. :1:i: . 5 - .� .. , ,. 35. F�nal Gai Pipe•Tesl� � " i °�� "�� G�.Lo �� t c:l� . .,. r + ;,y�6.�Hoodor�anoPY ^� n n . <� , ,' .. • , � .� r _ � �� ' i F. S ',o ' •lyl� Y 37.�Fin21%FaFTory Fir�Face.� 1 �``� ° `*: � i t,' � ? � , '�.J .r- w ++ ... � LS Y i�. ��. � .�8. Final;Plumbing .� tJ i --' • � ;�r r S -� • w � 39. WatNr Service-Final" . . � '-' .^ i �r � , .. n ,'. �s' * "= x>: :1. U: I '' �� Y w ti rC � . , i. ,-p0. Gas Service-Final x:�� q,r,,� � c� . � � �e �r �;:� vN . 'T � "41. Sotar pomesticFinaY :S " � ^ •. �' ` I ' 'x�� ' � t �r :r I �� t� 7J 7 '� Y ♦. •. � . . . .� o- r- ,: i �. 42.'Backflow Preventer, • ;�_ ' � � �a .x ,r - i . 43. Backflow Irrfgation_ � S>' �� ' � •` `� v " � � ;t, a '-04. Landscape li�agation Systemyi,�;; �., »� �r, - Cx � :. N .:.:: � e %35.�Sound AttenuatioR �`��' �'' '> : " "'�"" ,. ' _ `x•T ' ".. tr l . q. e� .�r �n a q 'y �' - . ,.i � 1 Y � It� s`46. Handicap,Regvlatior�s . ` _� � � .- � .�; S � �,.��o .s w 47..'fcINAL STRUCTURE & BUI'L`DING �" � I �'(� Y 1�'� '? J + �- •f' � A � � �.1` 11' � • Y. 1� 4 ' 48.;FINAL PLANNING, �•�-.. . z; I I�+,�.: ;,� n� �� - - i � :49.�.Electric Release to Edison i > i i'�'` !� '<'. ��. y - . - �; � + . t S �. ., l v 50..Gas,Release to Sout�em Califprnia,Gas Co � ; ;� .. ; - • �.�, � ' • 51. CERjjIFiCATE OF OCCUPAjJCY" ; ti.�- , ;��.a s .. , c No. Date / � PHOJECT qDDNE55: q 9� y� �1 r� �� ` OWNEfl'SNAME: ��N.G.TDA BER'�'riA B HtIN RDOflESS: 496 G 1(�1•�� $T COSTA MESA,CA 9262% RNCN/ENGINEEH: 9 S I— EJ S 1 3 flEG.NO.: aooxess: UNIT: uxir: PENMITTEE: B�ATRiCE hLMEIBA (714)95i-65i3 aooeess: 496 E :9TE ST C.M. CA 9262.6 IICENSEO GONTHRLTOB OECIABATION: I �eie0y a��i�m t�at I am Iicen5e0 under provisions of Chapter �J (commencing with Sectian 7000� ot Division 3 0l ��e Business antl Pwfessions Cotle. anA my license is in full lorce antl e��ecl. CITY LIC.: STATE LIC.: C1A55: �a�e: Signature: WOBIIEPS' COMPENSATION OELLABRTION: I here�y allirm tlut I have a cenilicate of consem m seli-insure or a cenificare al Warkers' ComDensalion Insurance. or a certilie0 coDY �ne�eol ISection 3800, La�. C�. POLICY NO.: EXP. ORTE: � COMPANY: ❑ Cenilietl copy is hereby tumis�ed. ❑ Certilietl copY is liletl wit� ihe ciry BuilOing Uivision. �aie: AODlican��, EMEMP710N FNOM WOBHEBS' COMPENSFTIDN UECLAXRTION: (This section neeU na� be campletea if ihe permit is lor one hunOreO ($100) ar less). I tertify Ihal in Ihe p¢Aormance ol Ihe work �or whith Ihis permil i5 i55ueQ I S�all noi ¢mploy any persOn in any mannef 50 as �o betome 5u�leci lo I�e Workers' Campensa�ion Laws ol Cali�omia. �ai¢: Signaiure: NOTICE: II, after making Inis Oeclaration, yau shouid eefAme subiett ta ihe WOBers' Compensatian pmvisions ol ihe Labor Coae. you must fonhwith tqmoly with sucn provisions or inis permii shall be tleemea revoked. CONS7PUC710N LENOING AGENCY: I here0y allirm t�at t�ere is a consimction lentling aAency for ihe Dedarmance al ihe work lor which t�is permi� is issue0 (Seciion 3097. Civ. C�. LENOEfl: nooeess: CITY UF COSTA :�£SA - T3U'iL,i�ING 'P�r�MIT P�.RN NO; P U534b3 PErZMiT ?�O: P U53963 PLAN CHECK NO: N GOj,�T: iV S:II�P; iv CONSTRCCTION TYFE: PER,uIT TYPE; PLU i�liRPOSH: OTA JOB DESCftIPTION ; i2E-PSP: RESIDENCE gQ ;T'; CLAIM VALUE: CALC=VALtIE: GROUP OCC; / COM�lEN7'S: NO STRC7Ci(iRAI� WpRK PER•�I?'i'TED �l'e if �!E % iE N- N�� lE K. �'3f-1E # k#dE-)C IF �k )f �Y �lfil� �Ti Y! iE �%# 1E #)E iE # K K IE �iF af St k� �Jc k# N li if?F :K� it if 3E lr �1F�K?f M# k�lE �k Y. k Y�1� �iE fF �iF �Y i( jE iE iE �f �k # Jt iF # Z O N Z N G R E Q U I R E v E N P S . S E'f A A C K S --•---�------- MA?N HUILDi:NG --- — ---- --------- ACCESSORY HUILDING --------- FFNT': FT CN REI�I'c: FT IN FRNT; FT IN P.EAR: F'C Ita LEF'f: FT IN RGHT: FT ZN I�EFT: FT IN P.GHT: FT 1N PARKING REQ� PROV: PARCEI,; 42G�iLIS1 ZNE; i"2Ec^ NC); PI,ANNiNG N(5'PES> j i%if 1? iE iF If� # N-iF �f if � if #(� 3c u. if ii� iE 3f if iE # if� If rt l:� i�: 3E ie iE 3i� iF if ,r. w� if iE 1f iF �k�'r: -i't if if 1�A"�x� # if iF 7i±F a� iE 3!� ie lf iE iP �:.; iE i jf�i4 k 3'r ii� iE le iE i'r if � it i: ii� i¢ U E V E L O f�' ,�f E N T 5 E R V I C E S=-- R E�i U I R E,�, E N T S ZONING APPr-tOVED BY � D7�,g'p,: BUILDING APPROVED HY : _ -'_�__ DATE: APPLZCATI.ON ISSUnD BY; �� DATn; � I ieitiei:9EiFlf#1t�aFif�ciEii�lFiEkii-}!�ieiE#x �icw��F3F3rsrir'�Frieirr.�r��zrTa3�3F�kiFiFi .�.3��£3E�h'3i-iE>l�.fK�R�E�'Td�x �!��# ii ie iPlf fi� ii� }} 7's 1E iE i£� ir #?f i4 �k i� k if 7e i't u�?F �1f� ii ii� if iF !f #'� iF if i't ie iFiE if� � ielE ii� ik iF #}:-ir ii� i"riF !E-1E ��'. ie ii� ii� if ii��} ii� 341k ie ?i� ii-1:� i4 if 1e ie L i+} ;.'r. i'r 3e 1'r iE }i LEGAI.I7.ATION:N F E E 5 U M M A R Y STRJCTURAL SEGMENT;I� OwNENeOILOEBOECIAMtION: Ihere�yaflirmihailamexempiimmtneComracmri State�icenseLawlonne�ollowingreason $LrJli P.�T PI.171�'�3SNG ELr.CTRIC MECHAi\IC FIRE S�'�iSP/RES (iRADING (Seclion 7031.5 9usiness and Pro�essional Coae: Any cily ai couniy w�ich reduir¢5 a p¢rmit Ia conitmcL alter, impwve, aemalish, or p ERK I T .�. 0 Q �e0air any simciure. pnot �o itsissuance, also reQuires ihe applicant lor suc� cermit ta lile a signeE statement ihat Ae/she is licensetl . pursuan� lo the pmvisions oi Ihe Conira[tors' State License Law (Chapier 9(cOmmencinq witA Section 7000) ol Oivision 3 al �he Business 2 5 2 . SN I F/RTON-R E5 an0 Prolessions CoOe) or �hat �e/she k ezempt ��ereimm ana t�e Uasis for t�e allepe0 exemp6on. Any violatian ol Sectron 7031.5 Oy p(,� any appliWni for a perrtu� subjects I�e applicani to a civil penally of no� rtwre llun live �untlreG dollars (3500). 1SSU: F�fi 3. OU �i. as owner ot tne pmoeny or my empioyees .nin waqes as meir soie comvensanan, wiu aa ihe work, antl tne �UII,DIN('i-171V—> Pc.RN1T ZSSUE � PLAN-CHcCK '1'OTAL PAID Diln Simcmre is nol intenCeE or ollere0 br sale (Section 70a4. Busmess ana Pmfessional Cotle: ihe Convacmrs' State Licenu Law TOTALS-- --> 2. 00 3. 00 0, � � 5, 0 U 5, 00 , U 0 tloes no1 aDD�Y Io an ovmer ol a pmDe�Y w�o OuilCs or impmves I�ereon. an0 wtw Ooes such work �imsell/hersel� or thmugh nis or her own employees, pmvitlea Nai such impmvements are not intenUeA ar oHereO for sate. Ii, however me euilding or REVEh�7E D I VL SION TO1 AI,S--> �OLLECTED • 5, 00 OVER /SHORT • impmvemen� is soltl wn�in one year o� comple�ion, Ihe owner will �ave Ihe Durden o� proving �e/she ditl not builtl ar impmve Q � mnneourooseoisaie). BLDG PMT PLU�vHING ELECTRIC i"4ECHANZC �IRE S,✓.IP/TOT GRADING PLAN—CHe.CK I. as owner af �he D�operty, am exclusively comracting with licensetl comraclors �o constmc� the prole�� (Section 7694, Business S, � U ❑ antl Professions Code'. IDe Comracmrs' Staie License Law Ooes no� aOPly to an ovmer of proDeny who builOs ar impmves thereon ' anOwhocontracisforsuchprolectswithacomractor�s�licensepursuantto�heComractors'S�ateLicenselaw�.lamaware •{�.y.�.*.*.�.*�.µ�.x.�•�.{�*�{p�(.*.�..x.*'r.lfititll3Eik3FiFisiFifY-i:iE#iffEififlb#iEiEit�Yifk�iEfi•#3fY.�liiE3c}{p±:�.{�-�..y.*.*.{�.�.�..k�r.�.{�.�y,.y mat pmm oi meir worker's Compensauon insurance showd ee nmvinen io me. I N D I V I D U A L F E E B R... A'cC D O"v7 N � � 1 am e�empt untler Seciion: B. 8 P. . rormisreason: TYPE QTY D E S C R I P T I O N LTN1T COST TOTAL COST Dale: ' � �/ Ownec PLu I no nereUy cenify Ihat I am aware ol antl untlerstantl the requiremenis of Calilomia HeaVh ane Safety de Sections 25505, 25533, and 25534 and Ihai I or any fulure builtling occupanl will/will noi (circle one) neetl lo compty with said 5taie cotles antl �he repuiremenls for a permil lor conslmc�ion or motlihcalian Imm Ihe Fir Ouality ManaAemen� �isirict. Resitlenlial conslmc�ion ap0lica�ions are eremp� irom Ihete provisions. ' Oate: � � �' � / Applicani I h¢ieby cetlily fial I have reaA Ihis apDliCaiion a a S�ale Iha11hC a6ove inlormalion is Corret�. I agr¢¢ Io comply vnlA all ciry anA oun�y arainancesaMstatelavnrela�ing�oEuilGingco INCIiOnanChereOyaui��qq yy� erepreienla�ivesa� � Ciry�Oeni¢rUpOn�heabove-me tionetl pwpenY �m insoect-on pur� l9=e=� // �� a�e' _ / Signalwe: _�� _�—' Uriver's License nr Social Securi� 9 164i�a6 Whi�e—Boiltlinq: Geeen—CoOe Enlortement: Canary—hpplicant; Pink—Revenue; Goltlenroa—Aueswr 1 WATr.R RE-AIPE . - END OF FEES 2,U� �.00 ca' . . , , . i_ . .. .. CONSTRUCTION AND PLANNING� F�SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector f 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . o „� 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ;jr U'. "� � 3. Electrical Conduit Utility•Undrgrnd. . 54. Forms - �i �� , �� 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding "( � � yli' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �� / � �6. ElectricalUFERGrnd. 57. APPROVALTOCOVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test � iT t9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. �'� , 10. Structural Floor System 61. APPROVAL TO DECK � � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �� /; .i . 72. Sewer Cap 63. Heater & Vent-Final � .�i 13. Roof Drains 64. Plumbing System � Final �� 14. Rough Plumbing 65. Electrical�Final r,�,�! � 15. Rou h Electrical-Conduit �- � 9 66. Solar SYstem-Final ,_ f 76. 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 1 79. Rough Heating &'Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PflEV. FINAL 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F�INAL INSPECTION 32. Electrical Power Meter�Final ' ; I 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & F,ir Conditioning � � � 35. Final Gas Pipe�Test � 36. Hood or Canopy � 37. Final Factory Fireplace - 38. Final Plumbing �(��q L� � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINA�STRUCTURE&gUILDING � 48. FINAL PLANNING � � 49. Electric Release to Edison 50. Gas Release to Southem Califomia Gas Co � !- 51. CERTIFICATE OF OCCUPANCY No. Date PflOJECT RUOPESS: t� 9 fj E 1. 9 YH S T OWNEN'S NRME: ALMEIDA BERTHA B HEIN aooness: q g 6 E 1 3 TH S T COSTA MESA,CA 92627 �I AflCM/ENCINEEP: AOUNESS: flEG.NO.: uxir: UNIT: PENMITTEE: CONSUMEA SERVICES ( 714 ) 754--1533 aooecss: 1745U MT HERMAN B FTN VLY CA 92708 LICENSEO CONTflFCTOB UECLABATION: I �ereGy aflirm �hal I am IicenSeA urMer D�ovi 'ons o� C�apter 9(commencing wit� Section 7000) ol Division 3 otl�e Business antl Pmf¢5sions COAe. an0 m en e' in tulllor ntl efiec�. c�rruc.:044683 sTpTE��c:q24349 � , Dala �.--- ( �G� Signature: • _ WOBREflS' COMPENSRTION OECIABATION: I �ere6y allirm a� I h ve a t tli' aie o� ton o Selbinsure or a tertiliCaie oi WOtk¢r5' Compen5aiion Insurance or a rertifietl copY �hereoi (Section 3800. Lab. C�. vo��cvNo.:1105091-90 E%P.ORTE: 1��1 carnrnuv: STATE � � Cerlifie0 copY is here�y Wmished � Cerii�ie� copy is �il � h �e ti�y ii ' g Division. Oate'. �� — C� ApPlican�: ^ EXEMPTIONFflOMWOPREP$'COMPENSATIONOECIAMTION: � seciqnn irotbeto let Jlheperm�isloronehunOrea�S140)arless). I certity that in the Oetlormance of �he work far which this Dermii is i55ueQ I shall noi DI any person in any manner so as lo Oecome sublec� Io Ihe Worker5' Compensa�ion laws of Califomia. Oate: SignaNre: NOTICE: I�, a��er making I�is 4eclaraiion, you 5hou10 �ecome SUGject �o the WOBers Comp¢nsatian pmvi5ion5 0( �Ae La�o� Cotle. you must torihwith comD�Y with such pmvisions or Nis permi� shall be tleemed revoked. CONSTPIICiION LENUING RGENLV: I Aereby ailirm t�at IAere is a con5tmcli0n lentling agency br Ihe pedormance ot Ihe work lor whicn this oermi� is issuetl �Section 3W7. CN. CI. LENUEfl: AUDHE55: OWNEN BWLOEfl UECLABATION: I AereOy atfirm ihat I am e�empt Imm tne COniractot5' Slate License Law far the following reason (Section 70.31.5 Business and Pmtessional Cotle: Any ciiy ol cowty w�ich repuires a permi� lo constmti, aller, impmve, tlemolisR or repair any structure, prior lo i�s issuance. a15o requires ine appiicant far suth permit to Iile a signeA statemen� ihat he/she is Iicense0 pursuant to t�e O�avisions oi �ne Coniractors' Siate License Law (Chapter 9(commencing vrith Section 7000) oi �ivision 3 0l ihe Business ana Professions Coael or Iha1 he/sne is ecem0� ��erefmm ana ine Dasis lor ihe allegee exemplion. Any violation ol Section 7031.5 by any appiicant for a Oermit subjects t�e aDPlicant to a civil Oenalty of not more t�an Irve tlundre0 �ollars (5500). , I, as owner ol t�e D�aVeny of my empl0yees witA wdAes as lheir SOIe compensation, will tlo the wark, antl ihe (� stmcture is not imentle0 or ollerea lar sale (SecUon 70a4, Busmess ana Prolessional Code: T�e Contractors Slale License Law does nol applY �o an owner of a pmpeny w0o Uuilds or im0�oves t0erean. anA who tloes such vrork himsell/hersell or IhmugA his or �er own ¢mDloyees, provitletl Ihat SucA �mDmvemenls are nol inlenUeA or oilered lor sale. I�, however I�e huildinp o� 1 impmvemeni is Sold wiihin one yWr o� tom0leiion, Ihe owner will Aave IOe Uurtlen 0� D�ONnq �US�e Oia noi �uild or impmve r �or tne purpose al sale�. I, as owner of ��e pmpeny. am evclusively comraciing wii� IitenseC conVat�ors lo conslmcl �he prole�� (Sec�ion 70dd, Business ❑ anO,Pmiessmns COEe: i�e Comractors' Siare License Law Oces nol aOdY �a an ovmer oi pmperty wtw CUAEs or improve5 ��ereon antl w�o conbacls lor suc� pro�ec�s wiih a cantracloqs�license pursuan� lo �he Cantractors' State License Lawl.l am aware Nat pmol ot Iheir WOBer'S Com0en5aiion insurance s�oula 6e Orovitle0 lo me. � I am ezemp� un0er Settian: B. 8 P. C. CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 052960 PERMIT NO: B 052960 PLAN CHECK NO: N GOVT: N SUPF: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; AL'I' JOH DESCRIPTION ; RE—SHzATH 6 RE—ROOF W/ASPHALT COMP SQ FT; 3,400 CLAIM VALUE; 3,400.00 CALC—VALUE; 3,900.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME. iF1FlfififiEiFif�FlFiFiFiEKiEiFifiEiFifiFifiEiF3fiPlEiFN-!f itiEiEaEiFiFififlEiEafiE-1fiFiFifif*1EifikiEiEif3EifiEifiFifiFN�iEiEiEiFiEiFiF)F�7fiFifiPifiEiFif Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRN1': FT IN REAR: FT IN FRN'f; FT IN REAR; FT IN LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARRING REQ• PROV; PARCEL; 42632111 ZNE: REF NO; PLANNING NtSTES> i **�*��**�,�*�*,��«**�**��*****��**��*�****�***,��*��*�*��x**��*�+�*�,��****�x**� D E V E L O P M E N T S E R V I C E 5 R E Q U Z R E M E N�'T-S ZONING APPROVED 9Y DATE: � - HUILDING APFROVED BY : DATE: APPLICATION ISSUED BY� � DATE: �� 1EiF3FiEfEiEiffFlEiE-1E3EIE�EiElkif3E�EiflE)F i �F3F 1FiF�T3F�iFiFiF�F3EiEiFaFiF�ElFifiFif *�E lEif�iEifiFlfiffE3E3faFIFiFlFIFIFk�kleiFMifitkilkiEiEkiliFiEifiEiEififik ififif 'itlflPiElfkitifiFltifikiF#fF*iEi6lfkaEiEfEiE1F1EiEifkif�E#'�iEiE�F LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT' 63.00 .SO SMIP/NON—RES PLAN - ISSDE FEE — BUILDING—DIV—> PERMIT ISSUE P.I.AN•-CHECK TOTAL PAZD DUE TOTALS----> 63,50 0.00 " 0.00 63,50 63.50 ,UO REVENUE DIVISION TOTALS--> COLLECT;ED: 63.50 OVER/SAORT: 00 BLn63P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TO�T GRADING PLAN—CHECK aE iE IE 1F if 3E if if lE 3F �f 3F iE iF 1E �F iE if iF �F iE �E �iF ik K• iE if iE if iF * jE 7f iE �I,E iE iF'iF iF iF 1E i6 �E 1E 3E i!� jf aE if if iE 4!E iF if it iF * af iP iF if iF iF iF If af 3E if iF if iF 3F fE iEiF �E 3F �i- I N D I V I D U A L"" F E E H R E A K D O W N ror inis reason: TYPE QTY oaie: a+"ef SFR 3400 I tlo hereby cenily that I am aware ot an0 un0erstan0 t�e reQuirements ai Calilarnia Heati� antl Salery CoOe Setlions 25505, 25533, and 2553a an4 ihal I or any lulure builtling accupanl will/will nol (circle one� neeA to compiY wiih saiU s�ale codes an0 �he iequirements for a permit br conslmclion or mo�ilicalion Imm Ine Ai� Ouahry Management Ustrict. flesiGential conslmciion applications are eKempi �mm Ihese pmvisions. Dale: pPDlicanl: — I �erelly [eriily��at I �ave rea0ih15 aOPlicatian and 51a�elhai t�e ortlinances antl slatelawsrela�ingio �uil0ing conslNclion a t propeny far inspeciion pWposes Date: ��L/ Signalur : oriver's License ar Social Securiiy n: 164L46 Wtiite—Buil�ing: Green—Cotle EniorcemenL Cana I I agr¢e lo comply with all ti�y antl counry hiSCityIO ¢ni¢rupOnlh¢d�Ov¢-m¢nii0n¢� Goltlenmd—Assessor D E S C R I P T I O N REROOF BY VALUE RESIDENIAL NOZONE END OF FEES � � . UNIT COST TOTAL COSi 1.00 3,400,00 G.� �i aae�2sgs-aaoszses �-r�-� a�,s�; DATE= U7i14191 T;IiE: 13:?� \� CONSTRUCTION AND PLANNING� F��PA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector ; . i. Temporary Elec[rical Service or Pole `r 52. Pool & Equipment Location ' 2. Soil Pipe•Undrgrnd. �' .• �. 53. Steel Reinforcement $. Electrical Conduit Utility�U�idrgrnd, n^ 54. Forms - � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '! ' 5: Sfeel Reintorcem€nt� 56. Rough Plumbing & Pressure Test � 6. Electrical UFEfl Grnd. . 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. 8. Foundation , 59. Gas Pipe, � Undrgrnd., Test �� 9. Water Pipe•Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ' . 61. APPROVAL TO DECK 1l. Property Sewer Line & House Connection 62. Backwash & Receptor .Final ' I 12. Sewer Cap ' , - 63. Heater & Vent-Final � i 13. Roof Drains � ' � 64. Plumbing System - Final 74. 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. Raugh Heating & Air Conditioning - FIRE DEPT. REQUIREMENT 20. kough Factory Fireplace �� • ' - APPROVALS Permit # . 21: Dutts, in Struc[Uie.. � .. i' 70. Undergroun� Hydro . 22. OuMs, Ventiiating • _ - , � •71. Product Plping OGas ❑Oil 23: Gas Pipe�Rough & Test . .- � 72. Underground PIusF ; ' ' 24.� Roof Framirg � � - _ 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing . ' ' � 7q. Overhead Hydro . 26. T•Bar Ceiling (Structural) & Monocoa[ � 75. Dry Chemical � ' 27.� Frame and Flashing , 76. Dry Standpipe _� 28� Latbing & Siding . • 77; FIXED SYSTEM FINAL 29. Insulation ^ .. , ' I�, 78,- FIRE PREV. FINAL �, � 30. Drywall Nailing �� `� �� . � �HEALTH DEPT. REQUIREMENT 31. Plaster Brown Co�2t � '1 79. PINAL INSPECTtON , - - 32. Electrical Power Meter.�Final ' ' -.r�� ,• 80. FOOD CERTIFICATE ISSUED 33. Final Electric " � � ,i� i Notes: �� jp��_T�� ,� Y�.�.� V� ��r�� rc..a� 34, Final Heatiny & F,ir Conditioning - - �,(q� . � ' _ �• f! [� 35. Final Gas Pipe-Test " i.° _ � :�, • 36. Hood oiwCanopy . , - �. f'. . . 37. Final Fa�:tory Pireplace. - '� � �� , 38. Final Plumbing . _ � � /l � � i 39. Water Service-Final � L � • � ' 40. Gas Service�Final . � .. � � � � 41. Solar OomesticFinal � • . �' • ' ' , 42. Backflow Preventer ' . � . , � 43. Backflow IrYjgation ' � • � � . 44. Landscape �rrigation System , � _ � � > 45: Sound Atteauation - � � � � ' 46. Handicap Regulations � � , � � . 47. FINAL STRUCTURE & BUILDING V_�� . - • � 0 I 48. FiNAL PLANNING . '� � 49. Electric fielease to:�Edison � �y^• • 50. Gas Relaase to Southern California Gas Co � I '' 51. CERTIFICATE OF OCCUPANCY - . No. Date ' ` PP0.IECT p00NE55: 4 9 6 E 1 9 TH ST. owNen�sxame: pi,MEZDA BERTHA B HEIN aoosess: q96 E 1JTH ST COSTA MESA,CA 92627 548-2538 pflCH/ENGINEEfl: flEG.NO.: �OUflE55: uxiT: CITY OF CO5TA MESA — BUILDING PERMIT PERM NO: E 06027 PERMIT NO; E 060276 PLAN CHECR NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PEAMIT TYPE: ELE PUAPOSE; OTH UNIT: PEflMiTTEE: LITEPRO ELECTRICAL ( 714 ) 857-2212 aooeess: 3752 HENDRIX IRVINE CA 92714 UCENSED LONTBACTOB UEClABR710N: I �ereGy allirm ihat 1 am Ncens n0er O��sions of Ctwpt 9 �cOmmencinp wi�h Seciion 7000) ol Oirsion 3 of Ile Bu9ne55 an0 Pmleubns CoOe, aM my license i IWI lorce and eflect. citruc.� srnreuc.:640703 �u C-10 . 2— Si9reture: _ _ - WOflNEflS' C MPENS TION OECUMTION: I nertby a11um OWt I ldve a tertilitdte of wnSeni to set6insure or a cenilicdte of Worker5' Comvensalion Insurance. or a unilieU copy Inertol (Setiion 3800, LaG. C�. �, POLICY NO.: E%P. O�TE: COMPRNY: ❑ Cetlitietl [opy is hereby lurnis�etl. ❑ CenilieU wpy ¢/iletl wt� Itre city BuilGinq Oidsion. Daie: MV�� E%EMPfION FNOM WOflKENS' WMPENSATION OEClAXI1T10N: � npt Ee mmpktd if pc per b lor me haqre0 (5100� ar kSt�. I[enity iha� Oetlorman� � c� t�e work fof wNth INS p¢r . is i� . I Slull noi empby any per� in any manner so as t0 �eCome su�iecu e arkeri m0ensa on Laws of Calilomia. = ,��e: S�g�aiure: NO710E: I, alter maldng t�is Ceclaratqn. you sIwNO Eemme suqect to t�e Workers' Cortpematian D�wisfons o1.Ne Labor CoOe. yrou must �anhxiln camoN m�� such prOvaiortS or tltis pprrtut Stull OC aeeme0 revake0. �- CONSTflUtTION LENDING RGENCY: I �ereGy aflirm ItWt thero 5 a tansiruttian IenUing apency tar t�e Detlormanca ol Ne work lor whic� I�is pe�mi� 6 issue0 (Seciion 3097. Civ. C�. � LENOEfl: ADOflESS: OWNEB BUILUEF DECUMTION: I �ere0y affirm i�at 1 am exempi ��am ine Coniractors' State License law lor t�e follovnnA reason (Seamn 7031.5 Business aM Pmfessional CoOe: My dry al county wluc� repuires a permii to canstmct, alter, imprwe. Uemolis�. or repair any slrucWre. Driar lo i6 i55uance. a150 Rpuires Ine appliUnl lor such pumit to lile a sipne0 slatemenl ihat he/she is Iicenu0 pursuant io tne o�ovisions ol me Coniractors' State License Law ICnapter 9(crommencin0 witn Sectqn 70001 al Oivisian 7 al Ine Business anG Pmleuions COEe) ar Rwt �Ushe is exempt t�erelmm aM Ne p�5is lor I�e allepeG e�emD��on. My violation ol Seclion 7031.5 by any aODlicam �or a Oermi� wClectS I�e aD0lican�lo a civil penallY ol not more I�an live �unAreO Oollars (SSOIp. I, as owner ot lhe pmpeny oi my emyloyees wii� wapes u their sole compensation, will Ea lhe woM. an0 t�e ❑ simaure is nol imenAeO ar oltered lor sale (Sectron 704a. B�yneu anE Prolessional Coae: IDe Coniractors' Slate License Law aoes not appy to an owner of a pmpeny wtp OuilOs w imomvu therew. anE wno does sucn woM nlmself/Aersell or ihmuqn �is or �er own employee5, provi0¢G I�ai Sut� improvem¢qi5 are nnt inlenUeO Or 011¢aE lof Sale. II, hOwBv¢r IAB buil0inp ar im0�ovement is 5010 xi��in one year ol completion, ihe ovmer will tuve t�e OurOen of DmWnO hrlshe Aitl not 6uiIE or improva lor ine ouroose ol sale). I, as owner of tne propeny, am erclusively toniractinp with licensea coniractoB to consimcl lna pmject (Section 7044, Buslnoss ❑ antl Pmfeuions CWe: The Coniraztors' State License �aw c� npt appty to an awner of pmperry wlro EuilCs or imD�� hemon antl who coniracis lor sucn proiecis vnih a coniractor15) litense oWsuant to Ine Canbactars' Staie 4censa Law�, I am aware I�al pr0o� 01 Iheir Worker'S Compenu�ion in5uranCe SMuld pe Drovi0e0 la me. � I am eKempl un0er Seclion: B. 8 P. C. for inis reason: Da�e: Owner. I ao nereEy cenily ihat I am aware ol an0 unaerstana �ne reauiremenl5 0l Calilomia Heatln an0 Salely Coae Sec�ions 25505, 255�3, and 2553C anU Iha� I or any IUWte Euilding atupani mlVwill rroi (tirUe One) nee0 lo Compty wiih SaiE S�a�¢ CatleS an0 lhe r¢Ouif¢ment5 for a permi� for conslmclion or motlilicalion Imm Ihe Air Oualiry ManaBemenl Dislric�. ResiOential cons�mclion aDPlicalions ara eKemD� �mm Inese provisions. Oaie: Applicant: I h¢re�y terOty �hal I have reaa IhiS a001ita�ion and Slale I�at �� aCove inl alion is correct. I aqree m c ply with ail ciry antl coumy oi0inancesanOSlatelaw5relalinqlobuil0inqfAnslmclionaMAere uliprrz rCYntativ¢So�IAisd�ytot rupOnt�eabOv¢�meniionetl pmperty lor in Oeciion urp es. -gy¢.� � Signature: � od�ers ucense a� Saci t secwny n: 164F46 While—BuilOina', Graen—CODe EnlorcemenC Canarv�Aoolicant: Pink—Revenue: GOIEenroO—Assessor JOB DESCRIPTION : ELEC, PERMIT FOR REMODEL OF KITCHEN SQ FT; CLAZM VALUE: 2,235.00 CALC—VALUE: GROUP OCC; R-3 / COMMENTS: PERMIT NOT FOR ANY OTHER WORK—RE�UIRE HUILDING PERMIT FOR KITCHEN �t*�r�t*�e**r�e**�r�e��r�rx*�r��r�r*�t�t*x�+e�rr**�t*�r�rr�t�e �rx*�r*�r�t��r***�t�r�e**�r*�r*��r�r*�r��e�e�rr�rr��r�r Z O N I N G R E Q U� I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- 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: 42632111 ZNE: AEF NO: PLANNING NtSTES> > !E!f M iF �f iF iF If �f k k 1F ik if ik ik i! iE if k i! iF if if iF itlkiF iE iE iE 1E 1F iE if ik iE ikiF ik iE if iF iE iE 1klf if 1E ikif if iE ik k if ik if if 1E 1E It i! ik ik ik if iF ik if ik iF iF iF iE If �E if 1f 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 BY . BUZLDING APPROVED BY : APPLICATION ISSUED BY;�� ititMkifiliFkMMkitiFiFiFikikiElflFkiF it ik k 1f it �klF M M iF k iF If ik if iF if iE iF iF iF iF �E 1f ik 1F If iFif 1t k if 1F iF �t!! IE if LEGALI2ATION:N F E E 5 U DATE: DATE: DATE: �"�' IE ik 1Eif iE M if If if if k if fk k iFik M%M iF if iF �! it ik k �f fk k!f it �f �f iF A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 21 75 �Ot SMIP/NON—RES PLAN ISSUE FEE 15,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 21.75 15.00 0.00 36.75 36.75 .00 REVENUE DIVISION TOTALS--> COLLECTED• 36,75 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANI� FIRE SMIP/TOT GRADING PLAN—CHECK 36,75 �flf �f �F �f 1F1f iflf if iFik1F ik if 1f if k ik if If �flk k k!f 1f k if 1F 4 iflf M if 1f If 1f k 1! ik 1f �f iF 1k k iF M M k If �t 1f 1F 1f 1f k iF If fflf if iF iki! k if ik ik iF if iF ih iF M 1f iflk k I N D I V I D U A L F E E B A E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 10 FIXTURES LIGHTING 1 ST 20 EA, ,75 7.50 ELE 7 RECEPT/OUTLET 1 ST 20 EA. ,75 5.25 ELE 9 RECEPT/SWITCH 1 ST 20 EA. 75 3.00 ELE 2 RES APPLIANCE NOT OVER 1,0 HP 3,00 6.00 END OF FEES J CONSTRUCTION AND PIAN(JING POOL & SPA � �. APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector t. Temporary Electrical Serviceor�pole 52. Pool & Equipment Location - v . Z, _S4i� PiPe�Undrgmd: �� 53. Steel Reinforcement ; , � , - , 3>1¢lectriqal Conduiy�l ility-I,J�dtgrnd. 54. Forms ' `= 4i-�Electrical Condait=Uadrgrnd. 55. Electrical Bonding `�'�5.r$t;�el Reinforcement 56. Rough Plumbing & Pressure Test ��6'.��El�ectricalUFERGrnd. � 57. APPFiOVALTOCOVER-GUNITE . "��:�otings :� � � 58. Electrical Conduit•Undrgrnd. ,�._ F8: Poundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Un�grnd. 60.� Backwash Lines, P�Trap, O Undrgrnd. 1Q: Structural Floor System 61. APPROVAL TO DECK � t:i, P�operty Sewer Line & Ha']i se Connection . 62. Backwash & ReceptorFinal r 12. S�y+er Cap ,� , 63. Heater & Vent-Final � 13. Roof Drains - 64. Plumbing System � Fina� 14. Rough Plumbipg � -_ - 65. Electrical-Finai 15. Rough Electrical-Conduit , 66. $olar System-Final ' 16. Rough ElectriEWiring �7 - �� ,�/ 67. Fencing & Access ApProval 17. Rough Wirinq Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Cei�ing 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - tr u.r.x::_ �. E. -•.r r�.. 20:"jio�h �acto0y F"vrtplace � x T. Z ', - _ 1 A ^ PPRi7VLti£.: _�Per�Slit # ' �' '-"� � �' '.� �. Q F.' ,.� r �.t a J':. .t , S �:. ' ri*' r� : r •� - t '.. � -. . w '- � u ;y 21:_Ducis, i�rStrvau�e. . •. ��S : - - � , ;70. l�dergrocm�Hydro x 22�Ducis. Ventit@ting;� � '� � r_- � '. _:s : 77. Product` -i' g O'i�s O�OiI 23�;Ga i o h&� est � '' '� �� . v� � Pg�A uq � i .:. S x;,' �; r*- .72. Undergio�m Flus�*; � r,-L.5 24.�Roat Framing .'< � E-�[^ . � = , .r % j �73?UndergrncT.StorA�efiank��E7Gas ❑6i1� �-� 25. Roof Shpathing �; - a ,, �' ' � r '74^Overhead }iydro�F y 26.cT-Bar Ceiling IStructuraq &'iNonocoat �- ^ - - 75.^.Ory Chemical -� ^ - � �'' i �= ' y . �r z .: .. • �.' v� a � <r �.0 27,�Frarqe apd Flashfn� :, ; � 7 t„ , 76: Dry Stand,��pe p. L , ' . r �-28.� Lathing_& Sidingr; c� _:y,� n •- . < . 77= FIXED $Y9TEF(PRNAL'� y •+ �y -� r-. .� ,.._ � v. n . T29. Insufation '; 'r, " - � � ' '� Y ,;r 76;�fIRE PREV!FINAi . � 1C j � r30. Drywall�NaitAig +< 2 �Y > I - HEALTHDEPT=rR�EQIiIRENtENT� . �- ��.� �31. Plaster Biow� Coaz� S , C• 1 • Y> n79�'FINAL INSP_ECT16N'', � ' ' '� '��32.tElectrical Power N1oteGFina�� • � ' 80.*f00D CERl'IFICATH ISSUED - � �.33SFirtal Electri� `� , � �. 'ly� No�fes;� _ '� z � - " J _34rFin_ Heating�& Air_Conditioniog- (1 x I � � � -`' [ i � S -. . -y 35:`.FindIGaSPipe-Test` _ - ' �'.t.4' �,' .�S . '? . - s36:�Hoodoi,CanoPY,�,> �` • - . - x, j C ' �;,• " � . r. r - _ '^ �37�Finel Factory Fite�5lace= , �'r ` K ; " � • ' ''. '' =38. Pinal Plumbing -.-.. ~;,, � � � .� . ti �` .a . � � � - �39. Watei $ervice�FinaP ' � • � �= ^ `' ' J ta �: j X. n` T. Y - T: � fi • �. --AO. Gas Ser'vice-Final�;, - ,L ,- r -- _ . • • • :41. Solar poinestirFinel� � �� •• - � -x � � --42. 8ackflow Prevenler ' - ' � , ' . i � � � : � 43. Backflow Irr[gation� -� ='� "' ^ " _ , , - S- A . V .-� � .`, J • '�44. Landscape IFiipation Systert�;,?,., � : . � � � � -a �45`Sound Attenuation' � r;� �� " � � �- _ 0 3 : . � r "�_ .. _ :46: Handicap,Regulatians � � � y ! � �� 47.. FINAL STRUCTURE & BUILOING ` - , • � * . � ,� I r, .:48:`FINflLPLAiVNIN�. Y:.�. ... � . . - .49.=Electric Reiease to ��Edison � i � . �- � • �� . ..- ,r �0. Gas�Release ta Southem Califomia Gas Co ` � �'. ', ' - � ` � _ _ " T51. CEFTIFICATEOF�OCCUPANCY � T a a . ` � �• F ' ..- No. Oate '