HomeMy WebLinkAbout684 18TH ST - Building Permitsr
� CITY OF COSTA MESA �
BYILD�N6 DIVISION
F � 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754•5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: P07-00426
PERMIT TYPE PLUM STATUS: ISSUED
DATE ISSUED: 06121/2007
- ISSUED BY: SOK
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JOB ADDRESS: 684 W 18TH ST CM " " ' Suite/Unitc �'�� �.=
vicinity: /; . � ... .. �: . . �� -
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SCOPE OF WORK: REPLACE SEWER.LINE-ON PRIVATE PROPERTY. `' c�
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OWNER: GRIFFITH, BARBARA '- �� , -Address: � 78 BEACON BAY
PHONE: " ' '�� t �� � - � � . � • City/Slate/Zip: NEWPORT BEACH; CA`
APPLICANT: GRIFFITH, BARBARA . � ' �' Address: 2012 ORANGE AV :
PHONE: 949-230-0873 ' - `� - - CitylSlate/zZip: COSTA MESA, CA �-
CONTRACTOR: OWNER-BUILDER - �-- �., . - -. . _ LicenseNo. 000000�. •
Adtlress: � � � , . .. - . � _ . .. . . � . � . PHONE: - � �
City/State: • .. ZipCode: � CELL - �
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PLUMBING PERMIT'FEE SUMMARY : - "'
� . �„ �.. - � � .
PLAN CHECK FEE: � '. $0 00. •
PERMIT FEE: $48.15 ' � : t, , ,
TOTAL FEES: $48.15 ," . ` , . . t- �• .
NOTICE: The work authorized by lhis permit shall comply wilh all applicable handicap�access requirements under Califomia slatutes and related
regulatlons. (Ord. No. 92-28, § 1, 12•21•92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and flnal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expireUon of this permit.
CODE/, ixsr�cnoxme Q�r �� 4Qg� ixsvecnoxrwe � pdg �3
1878 Fized System Final Fire Prevention 208 Final Mechaniwl
1268 Pool SOa Final � 208 Final Plumbing ' � �� � n(
200 Final Ra-Rool 210 Final Electncal
207 Final BlocklRetaining Wall 212 Final Fire Prevention '
202 Final Factory Fire Place � 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION� .
I hereby aKrm under penalty of perjury one of the ng declarations: ..
❑ I �ave and will maintain a certificate o1 wnsent to selbinsure'!or v.oricers'�
compensation, as provided for by section 3700 of lhe Labor Code. (or the
peRortnance of the work tor which this pertnit is issued. '
❑ I have and will maintain wnrkers' compensalan insurence, as requiretl by
secl'an 3700 of the Labor Code, for the peRwmance of Iha v.ork !w which this
permit is issued. My workers' compensalion Insurance carner and policy
number are:
Carrier:
(This sen�on neednot Do mmpefM/lna pmnl's rdAw•Caf rn �ur�etl cblan (St Wl orkss.)
POlity Number:
certity that in the peAormance of the work tor which ihis permit is
i suetl. I shall not employ any person in any manner so as lo become subject
to the workers' compensation laws o1 California, and aqree thal il I should
become subjact to the workers' compensation provisions ot Section 3700 of
lhe La r C , I shall lorthwith comply with Nese pro�i ns.
(.
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WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,OOOj, IN ADDITION TO THE CAST OF CAMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, INTEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn thal I am licensed under provisions of Chapter 9(commencinq
vnth Section 7000) of Division 3 of the Business anA Professions Code, and
my license is in full (orce and eHec�.
Lic. k Class #
Conuaaor's Signawre
CONSTRUCTION LENDING AGENCY:
� I hereby af(um lhat there is a constructbn lentling agency for the
perfortnance of tha work for which this pertnil is issued. (Set. 3097, Civil Code).
Lender's Name:
Lenders Address:
SiB�aWre Dale
OWNER-BUILDER DECLARATIONS:
I here6y affirm that unAer penalty of perjury that I am EXEMPT FROM THE
CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Cotle: Any city or wunty which requiras a permit to
consiruct, alter, improve. demolish, ar repair any struclure, priar to its
issuance, also requires the applicant for such permit to file a signed slatemenl
Ihat he or she is licensed pursuanl lo Ihe provisions o( the Contractors
LicenSe Law (Chapter 9(commencing with Section 7000) of Division 3 0( the
Business antl Pro(essions Code) or I�at he or she is exempl therefrom anC
the basis for Ihe allegetl exemption. Any violation o( Section 7031.5 Dy any
appliwnt for a permit subjects the appliwm to a civil penalry ot not more man
five hundretl tlollars ($500).):
❑ I. as owner of the property, or my employees vnth wages as their sole
compensation, WILL DO THE WORK, an0 Ihe structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does nol apply to an owner of propeAy who builds or improves
thereon, antl who tloes such work himself or herself or through his or her own
employees, provitled that suc� impravements are not intended or offered for
sale. If, hovrever, lhe building or improvement is s01d within one year of
completion, ihe ovmeo-builder will have lhe burden of proying lhat he or she
did not build or improve for purpose of sale.). �
I' s owner.of.the property, am EXCLUSIVELY CONTRACTING WITH
ENSED CON7RAC70RS to construct the project (Sec. 7044, Business an0
Professbns Code: The contractors License Law dces not appy to an owner of
property who Duilds a improves thereon, and w}w contracls for such project wiih
a contractor(s) Gcense pursuant to tha Cont2ctors License Laws.). �
❑ I-am exempl untler sec.
Business and Professions Cotle lor this reason:
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er ID venfed tiy driv se. Yes ❑ No
.�t,�_
• nver's License�No":�" : � � Expves�. � �� l
r� itation of Ownership by (lyDe ot ocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: �
❑ I hereby certNy that no excavation frve (5) or more feet in tlepth into which a
person is required to descend, will be made in wnnection with work autMrizeC
by ihis permit, and thal no building slructure, scaffdding, falsev.ork, or demolition
or dismantling thereof, will be more than Ihirty-su (36) feet high. (Chap. 32, Grp
2. Mt 2. Sec. 341, Title 8, Cali(omia Atlministrative Code�.
❑ As ovmer-builtler, I will not employ anyone to do work which woultl
require a permit from Ihe Division of InOuslrial Safely, as notetl aGove, unless
such person has a permit to do such vrork from I�e division.
AOoliwnl'S Sipnature Dale
Division of Intlustnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupam need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal7 ❑ Yes ❑ No
(Section 25505 of tha Califomia Health antl Satety Code requires, with some
exceptions, that a Business Plan De filed with Ne CosU Mesa Fire
Department by every business which nas at any one time tlunng a reported
year a quantity of haxardous materials equal [o or greater lhan a weight of
500 pountls, or a volume ot 55 gallons, or 200 cubic feet of compressed gas
at sWntlard temperature antl pressure).
2. Does or will Ihe applicant or present or future building occupant need lo file
a registration form for acutely hazardous materials7 � Yes ❑ No
(Section 25533 of ihe Califomia HeaIN antl Safey Coda, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hantl a quantiry of acu[ely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standarC
temperalure and pressure).
3. Does or will the applicant or presenl or fulure Guilding occupant need to
prepare an RMPP (Risk Management and Preven[ion Program for acutely
hazardous malerials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Safery Coda provitles ihat the
Costa Mesa Fire Depariment may require the preparation, certifiwtion and
filing v,ith the Fire Department of an RMPP by businesses which are requirad
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presentty requireQ has Section 25534 of the Califomia
Health and Safety Code been fully complietl with? ❑ Yes ❑ No
5. Does or v+ill the applicant or present or fulure building occupant require for
the work which is the subject of this application a permit for such wnstruction
or motlification from ihe South Coast Air Dualiry Management District or (ram
any other air polWtion wntrol tlistrict or agency7 ❑ Yes ❑ No
(Section 65850.2 0l the Cali(omia Govemment Cotle requires Iha� �he requesled
information be (umished on applicatbns fa non-resitlential builtlirg permils).
6. Will any part of the facility to be constructetl untler this pertnit De within
1000 teet from Ihe outer boundanes of a schooll ❑ Yes ❑ No
(If yes", the lacility must meet the requirement o( Sections 25534 and 42303
of the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Qualiry Management Dislrict or other
air polWtion control district or agency is required for the work which is the
su6ject of this application, have all of the disclosures prescnbed by Califomia
Health and Salety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate ol compliance from the appropriale air pollutlon
control otfcer). , � .
�� CERTIFICATE OF COMPLIANCE:�I cenify Ihat under penally o� perjury the
information given above is wrrect. I agree to wmpty with all state laws anC
� ciy ordinAnces regartling Hazardous Materials antl Emissions. � �
�' ' Signaiure Ddle
CERTIFICATE OF COMPLIANCE .AND AUTHORIZATION OF ENTRV: I
cenify under penalty of perjury that I have read this appliwtion and state that
the information given is covecL I agree to wmply with all state laws and city
ordinances relating to building wnstruction, and auihorize representaGves of
Ihe City of Costa Mesa to enter upon the above-descriDetl properry for
inspection purposes. I agree not to occupy or-allow occu ancy of any building
aulhoriz is permit until final inspeclion.
Si9naluwe�o�,epnl,Ovmer(� � Da.e��� �
Antllb Aul�Onietl Applifanl Dale
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�non�ss o� euRoc«+. 6 8 4 W 1 8 TH S T
wrtuxsru�ev�uawrt LOUD, BERRY
.00�ss 30'7 NARCISSUS AV
CORONA DEL MAR, CA 92625
/iVPL. WIWlO /iWNE54:
I/JMXffECT OR @10PIHA:
YKII OR B�10.'S 100FE55: VNf:
��T�"•„�. LARRY JONES ( �19 ) 650-3170
t0N1"�0 �o� CMO'l6 POMONA CA �� 401687
92627 uM:
LICEN$EO COHfRACTONB DECL�N�TION: I �ereby eNim unEer penely ol pe�ury ihet I em Ibemed uMer povi4oea ol CMpm 9
(mmm9��q wilh Gp��'/p'p)p ol D'rviaion 3 W Ne Buu� enE Piviaeeima Cod I' m in ht�u nd
CRY 4C. NO.: ��J J L� LIG CIALS: C+ v LIC. N_�/� X Y: I 9%
Data: /li Z�� /L Conlemor:
OWNEq BUI�DER OECLApATION: I In�eby eifimi uMx penM/ d peejvy� q han �M CanroCws lioems Lew Iv IM
"Wa+�9 �aemn (Setlian ]W 1S &qnaea enE Pmlpeioiu Coda: �ry cYY a mun�Y whid nV�e e M�i 10 apnh�wY. eEa. Lnpwe.
�4h. n rpar mry swcturo. peiar m Es iwanos. ebo �W��m �M eppfiraN fv arh priM lo fils e eqned pe�ama�a rtW M a vhe
fioery�d W�w to tM pro.+aioiu d the Lorurerlm Licmee lew [Cheplm 9lmvnen�0 xnh Seaion 1W0) d 0'vuion � d iM
euameo vd Praleaune Codel «�Ix� he « Me o u�mq �Mrdram ard �he bni� 1« IM d�WeE mmmWion. MY videtun d Seann
'!0]1.5 by enY applirant lor e prmA eubjetls �M epplcen� to a rnil penelly ol ml maa ihen Ma hu�Mred ddlen �S.�OOU.
� I,aaownerolihepropeMamyampbyeaexit�wepeautheieobmmpenealian,xilldothewo�k,vMiMeWCWn6�a11nlsMed
a dlmed Irc vab (Senion ]oM, Bua�nn aM Pmlavebna Code: Ths Camreeae lJcanee Law doei,at epplytoen owwd propery
'I1�1O �II�� M�IIp10lOD I�IlIlpl. Blld W�10 d0l1 SYf�I Mq�l �1IIIIlGM O! �1l9lr IX 1�1IMIQh �1C IX �Mf QMl tl11�p�M�. � 1�1M t11C�1
�nP��aua me nd'wenEeE a dleied la eeb. C. hwwer. lhe buitlin0 a inW�� o wld wnhm ona Yam d oomDwbn. iha
pwror.yu3ly wa My �ly duden d qwinp M a ehe Ak M Gdd ar "vnpra.a la IM puryue d�de�.
❑ I� o ownm d tM W^I�Y. em stl�awN mN�etlYq weA OoeiwaE canbectan b wmM Ihs p9� (SeU'vn ]WA. &siiep end
Pmimc�u COEe: TM1e Ca4recon Licaw lew Ews m� epp�y ro en owMr d qopely v.fio Eu�ds n impww Ow�an W who
convecu Ior vurh prqqs v.nh e caureGa�e) IcenwA punuen� �o tM ConVeAas LMsue Lexj.
� I� e�ynp uMx Section: B. 8 P.C., br Nu �ea+an:
Oeu: Pmr.
I do M�eby ceMy ihm 1 em ewere d vM wAemWM iha requimmapa d Celiortue Meellh W Setery CoM $Mioro 25505. 255�3. mE
P%J4, enE Nm I a anY �un WiW'uq mament vrill / wil na (tlrtb me) road �o camply wih uid ama wEw end �Ir �apuimnaMs far
sorm�utwmmtrunionamoEifca�ionhamlM�� e�iv.arewmeMOiatrid.Rssidemldmnp�WionappicmioruenuamplmmNms
ucw.:
uxr: B
om.: �,vrrsm:
WOflKEP'S COYVENSATION DECLM�TON: I Meaby dfum undar pauEy d pspry w d tlr b0owinp AedvW'vu:
❑ I heve en0 wil meiMen e cenilkme W wneent lo seMinwie lor xakers mmpenwbn, m prwided iw by Saeion 3100 tl �M leba
CoAe. la �M perlormenca ol �ha wA lor w1vc� I�u permit i� heued.
❑ in��a���m.:,,.on�a.•�v����w�.a•,•o��r.anrsee�a�oowu,e�wo.ca..i«m.o«i��.am.
Work Iw whidi Mb qemn b iseued. My warFen' eanpenwion inw�aeca faeier uM pdiry wmber ms:
co„�..:
Pdiry Number:
, mn wa;m nn.e na w canv�«.e r �ne w�. m m, on. nuneme ewars /s�rol a w...l
❑ i mn+r um m m. oeno�. a �b �.wx ro..,nrn me w�ma 4�a. i wu oa .mc�w d+r od.�+ n em m.Nw .o .e �o
n«om. wab �o �n. work«.• mnv�mion iv.. a ceNon:.. .�,e m« � a � dvAd n.oane adjw �o �n. wvla.•
compemelion pa'vpre d Swion 3A0 d IM Labor COEe. l du(0J[p���waj� /m�m(p�y
DMa: I D � I � AVdiu�tl: —�S� V I
YVem/np: Fellun ro�scun wont�ri rompenseCon cw�nW M1 unGwNl, and Il auD/�ct �n Nnplqw ro eilMtil p�uMu mM
e/vll M�� uy ro ons hunJrM tMuunJ Aollqn (110q000), In etltlltlon ro Ms cwl o/ compwatbrt 0emspp u qovldM br In
S�ctlq� 9106 0l CI� L+bor Cotlr, Intxu4 entl �ttamry'� Iww
CONSTRIICTION LENDINO ��ENCY: I M�eEy dfi�m unMr paiMy d pei�vy ihel ihra b e canq�uaion MNnp apacy br tM
pxlamenm d tM xwk la wAiM ihe G�i o neuad (Seqion �09]. CN. G).
LENOER'9 NAYE
LENUEfl'S ADDHE44:
I cenNY IIW I M+�aed Nu aGV�'cetim enE eime iMt Ns abova'vdamNian u cortetl.l ePM �o oomW wilh W M' eM mWY adbwwr
aM sWe leua nW M b 4dd'n0 oomtrumm ud herabY eNbca �epeventaGws d �he ely w ema uW� tM ebwsnaeuiaisE ryopsry
Dme: �
NAms-BuiIEnO 8 Se1W: O�am-Fb: Ce^W-AGP�^�: Pink-Rs.anus: CialdervoG#swmr
�—�
�TY'OF COSTA MESA — BUILDING PERMIT
PERMIT NO; E 080070
PLAN CHECK NO:
N
PERM D70: E 08007
GOVT; N SUPP; N
CONSTRUCTION TYPE: ;.� PERMIT TYPE; ELE PURPOSE: OTfi
JOB DESCRIPTION : ELECTRICAL METER INSTALLATION S(j FT:
CLAIM VALUE: CALC—VALUE: � GROUP OCC; B /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
*******�ti�+��c���*�t**+��r�r****rt�r**�**�-��r*�e*******�*�r�rx��e**�i��r*x-x�*�r�r�r+t**x-**�r*�r�-x��-irx+r�-�r*
. Z O N I N GS ERTEB�AUCIKRSE M E N T S
------- —�-- MAIN HUILDING ---------- --------- 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: 42424133 ZNE: REF NO:
PLANNZNG NOTES>
i �
1E fF 1E ff 1F ik 1E iFlE iE �E 1E 1ElE iE �E fE 1F iE ff fE 1E 1E 1l' iE 1E fE 1E iE Ik 1k IE if 1f 3f if if iE 1E 1E �E �E iE �IE 1E IE iE �)E iE 1E IE iE 1E 3E 1E 3E 7E iE IE IE iE 1E'N' 1E IE jE IE 1t iE 1E iE iE 1E 1f it IE iE ff 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 — DATE:
BUILDING APPROVED HY : _ DATE:
APPLICATION ISSUED BY: •--���'
iE 1E iE 1F 1F if iE 1E iE 3E iE iE 1E 1F if iE 1ElE 1E 1E iE 1f
LEGALIZATION;N F H'E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PEAMIT 27.25
SOt
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
22.00
PERMIT ISSUE PLAN—CHECK
2%.25 12,�� �.�0
DATE: �O� �S�
1fiEiEiflEifitifiEiE iE�E
STRUCTURAL SEGMENT:N
PIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL pAID DUE
49,25 49,25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 49.25 OVEA/SAORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CFIECK
49.25
**�at*�r+rat*�atit+�+t�atit**atit****�it**�xit�*�tit*iEit���**r*******at�**itit*it****�**if�*�r**it*�at+e*
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 SEAVICES BELOW 600 V S HELOW 201 AMP 27.25 27.25
END OF FEES
O1 002175E8-00217SE8 T�] T 49.25
DA'!E: 10/22/95 TIi2E: 24:"a2
�(« . � ,/
CONSTRUCTION AND PLANNING POC' '� SPA �s
APPROVALS Permit # � Date Inspector APPRQVAI.S hrrmit # � Date I,nspec
1. Temporary Electrical Service or Pde 52. Pool & Equipment Locauon ; .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit�Undrgrnd. � 55. Electrical Bonding
5. 5teel Reinforcement ' 56. Rough Plumbing & Pressure Test �^ � �
�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE �
7. Footings 58. Electrical Conduit�Undrgrnd.
B. Foundation 59. Gas Pipe, � Undrgrnd., Test
r
9. Water Pipe-Und�grnd. � � 60. Backwash Lines, P�Trap, O Undrgrnd.
10. 5tructurai Floor SYstem � � 67. APPROVAL TO DECK �
11, property Sewer Line & House Con�ection 62. Backwash & Receptor�final
12. 5ewer Cap ,� 63. Heater & Vent•Final "
13. Roof Drains - 64. Plumbing System - Final _
14. Fough Plumbing 65. Electrica4Pinat ,
15. fiough Electrica��Conduit � 66. Solar System-Final
16. Rough Electric Wiring � 67. Fencing & Access AnProval �, �
17. Raugh Wicing Sign � 68. APPflOVED FOR�PLASTERING. �
78. Rough Electrical•T Bar Ceiling � 69. POOUSPA SYSTEM1IIS FINA� . �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - . � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Duc[s, Ventilating '. - 71. Product Piping C7 Gas ❑ Oil
23.'Gas Pipe-Rou9h & Test '' 72. Underground Flush
24. Roof Framing - Z3. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing - - 7q, Overhead Hydro -
26. 7-Bar Ceiling (Strucwraq & Monocoat 75. Ory Chemical
p7, prame and Flashing 76. Dry Sta�dpipe ' �
28. 4athi�g & Siding� . . 77. FIXED�SYSTEM FINAL
29. Insul:p:ion 78. FIRE PREV. FINAL
30. d�Y�'i5�1 Nailing ,' . HEAL7H DEPT. REQUIREMENT
31. Plaster Srown Coac 79. FINAL,iNSPECi'tON
32. Eiectrical Power Meter-Final 80. FOOD CERTiFICATE ISSUED
33. F�nal Eiectric ' ' " Notes:
34. Final Heating & Air Conditioning - . ,
35. Final Gas Pipe�Tesc
36. Nood orCanopY � -
37. Final Factory Fireplace
38. Final Plumbing _ . ' �
39. Water Service-Final ' - '
40. Gas Service-Final �
41. Solar pomesdoFinal : . -
42. Backflow Preventer ' � '
43. Backflow Irrigation -
44. Landscape IrriGation SYstem � � -
45. Sound Attenuation �
46. Nandicap Regulations .� - .
47. FINAI STfiUCTURE & BUILDING -
48. FINALPLANNING
49. Electric Release to Edison
50. Gas Release to Southern Cafitornia Gas Co ,
51. CERTIFICATEOFOCCUPANCY
No Qate
�Iesa Baildin D�,..�rEment : _,- :�PPLiG'ATION �'UK Y�tt�v11'�
, P.O.Boxg� zqdE BUiLDING
OSTA MESA, CALIFORNIA
FOR APPLICANT TO FII.L IN FOR OFFICE USE ONLY
I Receipt No. Permit No.�
Buildin9 / (7 �/ �� B � O (
Addross (O 0 �)
Costa, Mesa, �'ialii0l'II18, Received by Date Rec'd. Date Issued
Nearest �� � � —� � � � / —� "
Cross St. �l/ euilding
Address
Owner �� Costa Mesa, California
Mail G G�
Address ., d ' O �� Nearest
Tel. Cross St.
Gty Gf G� No. �_ Zone �( No. of I Type Group
Arohitect or Lic. P�a^ %
Engineer No. Approved
b Date �� �
Addresa
ty Lic.
Contrector � /'D �-•
ACdress � O � '�
Legal Lot // - r 5 A P4ESA
Descriptlon I No. ���'7 I Block i rae� , �,�-„ ., ,
c�iaicrr rn u rc na�r o�
(Attach Metesand 8ounds)� ���p �"Q��"� �
No. of Bidgs. ' � �
Size of Lot �� � Now on Lot
Use of � • I No. of / I No. of � -B�� z
Existing Bldg. ,vt � Familles Roome PL�N T..0 _
�
Set6ack Line fram.7 /� Rear Var Z
Center oT Strxt �7 6� �,(7G . Side Yard '
DESCRIPTION OF �VORH �, � S ' - �i � •
New ` I I Alteration I I Addition I �'S
Repair I I Moving I I Demolish I o
Building o. of �
Size c�� ooms Stories �
Exterior Wa I Roof ~
Coverfng �- I Covering E]Pp$,QV�jj��'
Use oT New� Foundation Location Inspector � DatE
Building Q Forms, Materials,
Under-Pinning
. Frame: Fire Stops, ►+
Braeing, Bolts ev
I hemby acknowiedge that I have read this Application p
and state that the above is correct and agree to cromply �ath. Int. e
with all Clty Ordinances and State Iaws regulaUng
bullding constru'''///cti111on. // �f,l � Lath. Ext Q�
SlBnahra of � O D / . ////
Permittee e�� .LAti(GGiYI. X/.i21�J$C.(/IiCs plaster,lnt.
Authorized Agt. Plaster, Ext. �_
Valuatlon Permit Fee $ — Masonry Rcinforeetl �
O .� Plan Check $ �—
Bond Beam
g /O Total �7
Fee
�a — I FINAL �
conm aoa io.ee o. r. e s. �
Show locatlon and distancea �from
` property Iine and bMween buildlnpa
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
OWNER
MAIL
ADDRE'
CITV �
ADDRESS
qRCMITECT
� � ZS'%(VAi.'On7�i�1'` f�.�ir;Y48.5�
[61
TION FOR STRUCTURAL PERMIT
DATE RECEIVED neTc iccucr
Wa '/• (f O A.P.NO �V" �
�y BVILDING
�/ ��jp � ADDRESS �B � �{ �
TEL. RACTJ �1
- NO. , y
W A D A R P
OWNER (r � �• Fc
TEL.
FIRE
ZONE
APPROVED
RMIT NO.
S i �K
t_��1V�.l�VW�1 VALV$ IQ,C�Q�
GONTRACTOR f/-/✓/T%/ Y, (�-(/ J a N t3Y 'v ���'
ADDRE55 f �qMiy_.
TEI. Z NO.OP�,
G�TY NO. �� P��
F STATE CITY VAROS APPROVED
i 41C. NO. N LIC. NO. � f� MAIN BUILDI
I
�,ay yIZE NO.OF BLDGS. 1FROM C/L STR
L pF LOT � O 3 p O. NOW ON lOT �Z. FRONT �
a USE OF I
� �XISTING BLDG. I �1 e us G � G n-p ALG
� F
FSepara[e permits are required for L SIDE Fi
� electric, plumbing and heating work. REAR Fi
W USE OF BUILOING AND WORK TO BE PEFFORMED
F DIS7ANCE BET.
q r E L[) CH'T-� MAIN B� G5,
Q �eo vG d8 c �. .�w
� APPROVED
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aa � hareby acknowlatl8e thet I hava reed this appllcation antl state
that the ebova Informatlon Ia correct antl apree co comply with
�+ ell laws raBulatfnp bullEing eonetrUction, and I shell noi employ
wa�Y Parson (n violation of the workman's compensntion lews of
x the State of California.
3 I hereby certify that 1 em p erl lieensetl as e eontractor under SQ. F'
ipe Stata of Californla Busines d Professiona Code. Dlvlsion 3, THE AMOUNT'.
Chapter 9, antl that such Iic es e in full forca antl effoct, or 1 THE PURPO6E O
am axempt fram She prov ons of e Stata of Cellfornia Bus(ness VALUATION
aptl Professlons Catle, DI sion Chapter 9.
Signature of /� . .� � �
Permlttae �-�t•«•��- 4-�- § �OO
O(y'
Authorized Agant
C�
USE OF NF�p/ l.dZ-Cd�C
BUIIDING
VAflDS APPROVED
ACCESSOPV BUILDING
BET. MAIN 8i
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ro
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N
VN UNDER VALUATION IS FOR m
'ABIISHING A PERMtT FEE ONIY: �
PERMIT FEE § / `�
J�
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PLAN CHECK 5 � 0
TAX E LL
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TOTALPAID S r ��
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant [o Fdl in Completely — Use Ink Only
ADORESS � �:/ � W ' � �� S /
OWNER G . �� '�'C �C.�T �'L SO �
ADDRESS �� I W♦ I� L S T
^,�— TEL. o
CITV /7S� I ✓ �c� 1c NO. �o�i���AJ
LENDER
BRANCH
ADDRESS �
ARCHITECT _
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
A.P. NO.
BUILDING
ADDRESS
OWN
L. S
FIRE
TEL.
NO.
CITV
LIC. NO.
NO. OF BLOGS
NOW ON LOT
, Separate permits are required for
electriq plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I� Po rzc-� �� tz H��cs E
I heraby acknowiadBe that I have reatl thls appllcatlon and state
thet tho ebova Informetion is corract an� aBrae to comply with
ell lows reBulatlnB bulldlnp constructlon, end I shell not ampioy
any perwn In vlolat(on of Me workmen's compensotion laws of
the Stote of Colifornle.
I hereby cartify ihat I am prope�ly Ilcentetl as a contrector untlar
ihe Stato of Californle Buciness enA Professions Code, Dlvialon 3,
Chapter 9, entl thet such Ilcenua aro In full force antl aftect, or I
nm azampt from the provialons of the State of GaIl4ornie eudneu
antl Profasslone Cotla ivislon 3, Cha ter 9.
Slpneture of
P¢rmittea � �
Authorizatl Acent
FB 1ll'7�PA�L�D 79..- � $E
F ��� �".�: iri:�:?:{'^.
FOR STRUCI'URAL PERMIT
DATE RECEIVED naTc iscucr
ZONE NO.OF/J
PLANS L
VARDSAPPROVED
MAIN BUILDING
(FROMGLSTREET/)' /�
FRONT � � FT (�
�
R.SIDE �� FT. �
/ , \�i
L. SIDE I I FT. v
REAR /X� �L�'�F�/
DISTANCE BET.
MAIN BLDGS.
VAR. �
VALUE
S
�
� GR(
DATE
VAROSAPPROVED
DATE
THE AMOUNT SHOWN UNDER VALU
TNE PUFP�E OF ESTABLISHING A PER1
VALUATION �/ PERMIT FEE S
, r �/ PLAN CHECK E
7�5 TAX E
TOTALPAID E
P
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Appticant to Fill in Completely — Use Ink Only
BUIIDING /' �y/L r _ ) { lY.�I. +
OWNER 17��(�� /�'�
ADORESS G O � � �'
CITV � �
CONSTRUCTION
�vninco i/�A�
BRANCH
ADDRESS
ADDRESS —
CONTRACTOH
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
��h�
Ga u 1 I
PI
TEL.
NO.
TEI.
NO.
pTV
LIC. NO.
NO.OF BLOGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
BUII�ING AND WORK TO BE PERFOR�
PAIO
SEP —6-77�NSqOO 188� +�*��*5.50
APPLICATION FOR STRUCI'URALPERMIT
ECE DATE RECEIVED g}�TE�SUGi
Y i
BUIL
AOD
FIRE
ZONE
APPROVED
NO.OF �
PLAP5
VARDS APPROVEO
DI5TANCE BET
DATE
USE OF NEyy�
BUILDING�K
VARDS API
ACCESSORV
MAIN &
I hareby ecknowledBe ihat I haye read ihis epplicetion antl rtate '^
n
that the above Information is eorrecc antl eB�ea to comply with m
ell lows repulatlnB builtlinp cony7ructlon, and I s�ell not amploy �
ony percon in vlolation at Me Wp�kman's eompenwtion lewa af m
Me Stoto ot Coli/ornla.
I haraby cartify Nat I am propa�ly Ilcansetl aa a contrector untlar SQ. FT. w
the State o} California Busineu and Profaolons Codo, Divlalon 3. THE AMOUNT $HOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such Ilcenmx are in full force entl eftect, or I THE PURPOSE OF ESTABL6MING A PERMIT FEE ONLV; b
em exempt from Mo provislons Of the S[eto o( Celltornia Bu�ineu VALUATION PERMIT FEE E C 4
nnd Pfofesslo otle, Dlvislo 3 C Bptef 9. J i'�� u+
n
�� PLAN CHECK S � o
SIpnBLUfB �% LL
Parmlttae $ O"� TAX E � Q U
Authorizatl AOent ' TOTAL PNI D $ f.i�� �