HomeMy WebLinkAbout758 18TH ST - Building Permits1DOPESSOiBNLqNO: '% S A W 1 8 TH ST
o^"E"s"u'E'°'wm`": KAMIYA, TADAO
"o°"E'g: qq23 E OLIVE BRANCH WAY
ANAHEIM,CA , 92807
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1PCNRECT OP ENOMEFA:
u1CIl OH F.NO.'8100XE54:
uc. No.:
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LICENSED COHfNACTORS DECLAN�TION; I hareby dlim unEer penely d pa�ury �htl I em IcaneeE uMer ywi�bn� d Cheptar Y
(aommMa�q wN� Sclion 90001 M Divnian J d Ns Bu�IMv end Pmfm�ima Code. W mY licenw h in lull laro W W W.
cm uc. r+o.: ue. cusa: uc. xo.: EXP :
om.: co��a�:
OWNEN BUIL�EN DECLANATION: I hemby elfirm uMar penNy W perlury IhPo I em ewmq hom the Contrtdae Licenae Lew Im iM
'-Vowiq raeaon (�un )0.'11.5 &niwea uM WWesebna Code: AnY cry a muntY �� �Vuims e pe�millo mmVuet. eller. Impa.e.
noleh, a mpai eny ebuclvm, p�ia m ee uvuenm, ebo reQuiree iAe epplicem Im auch permn m Rb e epned sWemsnl I�el he or ehe
cenwE Wm+�� �o �he prorivone d IM Conlredon Licenae Lew �Chepter 9(mmmeix.irp wiih Sedion ]0p0) d D'veion � d IM
oueinees eM Vrdeeeiona Cada� or ihel he a eha ie exemq iherelmm eM �M baau la tM elbped a:�ampion. My vidmion W Saaion
]O�t.5 by eny epplirant lor e parmn eubl�e tM epplicenllo e aNl penelry of nol maro ihen IHe hundred dollen �5500�).
f.l I. av owner dtM propeM a my employeea wih wapea aa IMi ede camperoetbn. will Eo IM wwk. end IM vluWm e M inleMed
tr woMe�edloreele�Section]ae,eueineesendPrdeaeioneCale:TheConveeonLicenaelawdoeanrneppymenowrwrWproparry
who WIM a inpm'<a Ihereon. vd Mu Ew euch work Nmeetl or Mrse� n Waqh he a Mr own emDb/�. pa'�ded �htl sueh
improvemenla ere rat inieMeE a dlaed la eele. II, however, IM Wikiip a inpovemeM ie edtl wilhin one yw al canObiun, the
ow�wrbuildr vNl lave tM WrEen M povi�q he a ehe d'd M WiN « impwe In the puryme d eelel.
� I. es ow�wr d IM MWeM. em uduaivNy mmraquq xd� licenaed canlreclon lo constrw iM pM� (Seaion'Ioa. Buairve ard
a�da.�: coaa: rne comreaa. u�,� �. ao� m wdr �o � o� a rownr w�o aaw o. Kwo... m...o� .m wno
mn�racb lar pMi pMeae wdh e oMredMe) fcenaed Wrsuem io �M Contreaas Liceroe Iswl.
� I em eaemq uMr Seuian: B. b P.G.. br Nb raasm:
o�a: a.,�+«:
I Eo hereEy can'iM1/ ihei l em eware d ud uMenMM Ne reyui�emema d Celtwnie Haellh vd Salary Cade Senioro T5505. 255]3. end
2S53a. vd thet I a eny Mura EUYdv�O �P� v.iU / wil nal (amcle me) naeE ro mnNY wi� eaiE qeU mdsa W ihe �M����mb fa
....,.,,:w�.,.m�n:�nn.moda.a��onnominani�v arammentoisria.Rsridemielmrwwionmoiraianenexsmo�homiMaa
WORKER'S COMPENS�TION UKL�N�TON: I MreEy elfimi urtls penelty d perjury me d IM Idbxi�p Osdvaiaa:
� 1 Mw vd wil meiNen e eenil'iuts d miumt to satlieuwa br wakas' eompanwion. n pwiEeE ta by SWim �100 d IM labar
CoM, lor �M peAameMe d Ns xak la w1icA tho pami� b inueE.
❑ � neve w�i� meimen wa«n.• oomw�umon iim,,.rca.., �ea�=� M swn, mo d �n. lee« eoe.. en �n. v�«meMa d �n.
work Ia which ihiv pamii n wsued. M worMre' oomponaetion imureza rertier eM pdiry numbx are:
Camer:
Policy NumEe .
�lM1isseniunnesdimtbscamderoJ' P^^^I o Gdbn(S1Po/abss.)
� I wniy iAd in ihe peAormvice r whi esued. I sMll iwl employ vry penan in anY meniwr ao b io
beewne wM� lo IM waiMre' eanDe el tl 41ree Oua tl I aM1ouM beeom� wMb lo IM xoM1an'
compenae�ion D�'isiona d Senion �]00 hwil mmp�y vrilh ihaea provieione.
Dme: A
W�minp: fe/lun ro��cun wortsn'romprustlon coverep� Is �nl I, ane MNI ub/�cf en �rrp/oysr ro crlm'nal0��tlw en0
CIYII IIM! Yp (O OM IIYlldrotl fMYMM tl0111/. (i100�000). III Gd9/ b MI ro!f OI roI11pINGf1011� d!/Myl� �� proVIAW bI lll
Sxtlm ]106 0l l�� LeborCoM, /nlwa�f, �ntl �ttomsy� Isu.
CONSTHUCTION LENDINO AOENCY: I Mnby elfirm undar panely M per'ryry Ihel ihere u e convl�utlion bMinp apenry /or iM
rononneMe a �ne .wrk �v wnidi inc o�� a ewea �s«+o� �091. c'rv. c).
LENDEX'S NMIE:
LENOEN'3 4DDRE33:
I cenily ihet I heve raetl Ihu eppl'ratm uN nele ihet tla ebv+a iNmmNion b carrW. I q�rree to camply wilh ell my xd muniy advienm�
eM ewe lexe reletnp io Wibip canmrudion eM Mreby eu�lwrte npreaemetivea d Iho tltyto enter upan iM ebv+a�mentionad popery
Iw insqaion Wrpmes.
TADAO KAMIYA
Pmt Neme
Dme:
SyneWre d Oxner/I�penVAppifaM�Gonlreqa
(5151d6.WP) Whne-Buiknp 8 SeIeN:OreamFb: Cenery-Appirani: Hnk-Ravenue: (3ddm�od-Maeaea
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: H 074642
PERMIT NO: H 074642 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : DEMOLISH KITCHEN IN LIVING ROOM AREA SQ FT: 350
CLAIM VALUE: 300.00 CALC—VALUE: 350,00 GROUP OCC; R-3 /
COMMENTS: DEMOLISH ILLEGALY ALTERED LIVING AREA " KITCHEN " TO ORIGINAL
iE�t*�rx�iE*iE*itiE�+�it*�t�tat�at**�it�t*+r�r+r**+t+ritat*it*it***��*�*�***��*itat�t�tx��t**x�itit*�tx��r�r�it*+�*ic*ie�
Z O N I N G R E Q U I R E M E N T
S E T H A C K S �
------------ MAIN BUILDING ---------- --------- ACC
FRNT: FT IN REAR: FT IN FRNT; FT
LEFT: FT IN.RGHT: FT IN LEFT: FT
PARKING REQ: PROV: PARCEL: 42417210 ZNE:
PLANNING NOTES>
i
1E 1E 1E 1E IE 7E fE iE IE fE 1E 1F iF iE 1k iE 1E IF 1E 1k if iE 1E if 1k 1E ik ii 1k iE if iE 1k 1f 1E 1E if iE 1f 1f 1f iE 1f 1E if 1E iE IE
D E V E L O P M E N T S E R V I C E S
ZONING�OVED BY
BUILDI VED BY :
APPLICATI HY:
*�r�rxx�x�**�r �**
A E Q U I R E
'.DING ---------
. FT IN
FT IN
%P/� : --
�*�*�*+�**�**�
E N:T, S
DATE; '�
DATE: �'
.;
DATE: .
LEGALIZATIO F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PEAMIT 15.00 .SO
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15.50 0.00 0.00 15.50 15.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 15.50 OVER/SHORT: 00
BLD15P00 PLUMBING ELECTRIC MECHANIC FIAE SMIP/TOT� GRADING PLAN—CHECK
1I' 1l' I(' 1h 1h i%i4 if i%!E if i4 if iE if' i%if' ii' i(' i%i4lE iE i%i(' i%ih 1h ih'lE il' iI' iF ih 1I' iI"k if iE ih iI' 1%'If iE i%i%iE iE ih IE if 1E i4 i%')f'�E i%iE 1E if i%if'lE iE i4 if'iI' 1E i41ElE if 1E 1E if if ii' 1h if
I N D I V I D U A L F E E H 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
SFR 350 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 350.00
END OF FEES
GONSTRUCTION ANDPLANNING . POC SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
7, Temporery Electrical Service or Poie 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
��3„E�ectrical Conduit Utility•Undrgr�d. 54. Forms
�j4?�H�ectricai Conduit�Undrgrnd. 55. Electricai Bonding
;`5�Sf�eel Reinforcement 56. Rough Plum6ir�, Pr s ure Test
-:-6�:E ectr�cal UFER Grnd. 57. APPROVAL T � UNITE
.� ..' -
.�`�7?Footings - 58. Electrical Conduit
'� B.rFoundation 59. Gas Pipe, � Undrgm t
9?,Water Pipe-Undrgmd. . 60. Backwash Lines, P�ira Un nd.
tO:�Structura� Pioor SYstem 67. APPROVAL TO DECK
i t�R+bperty Sewer Line & House Connection 62. Backwash & Recepior-Final
w�
12�. Stwer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Piumbing System • Final
14, Rough Plumbing R; 65. Electrical�Final
15. Rough Electrical�Conduit cr 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access ApProval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electriwl�T Bar Ceiling 69. POOL/SPA SYSTEA7S FINRL
19. Rough Heating & Air Conditioning FIRE F�PT.�EQUIREMENT
�. - r� ti - a r� � [^ m•_� �{; � :K ��.. n)
20. Rpugtl F��tory?Fifgpiace � xm �� r s�� 'o", r��App�OV�LS�HPermit #��- R..._
�
21. 6�cts;in�3tru��rer,y � �• •� �5 � 5 r� �+�' 70. �ndertron"�HXdro �'
22. Ot��� Ve�tila3fngF`` ' id- *, .� � 77. Produci Pt,Ping L��as L�OiI
23. Gas P.ipe-�ouqFj & Test � m� � ti ' e' �'� � 72. Undergra`ind F�nsfi`-- � -'-
24. Rbof=�reHin9" �# '' � ^'` `y, .r�, ' 73tiUndergrrtd.Stocag,2Tank,I7Gas ❑Oil
25. Roof;$heathing �=�K � ���: �' �y � � 7q':8verhead Hydrd�r V t
26. �BatTCei�ing (Stru"�t��',ral) & hii�o�td�oat *� � �' 7�,�ry Chemical E,.,� x r �
'ameand-Flashin+` `V � �A " -•:- ti.. '. `- -r�
27• � 9.� �xcK s_� � �t� 6. Dry Stantlpipe
-.28. Lathing &'Siding `.* �•' ^<=� - '" � .. . .: 77=. FIXED S)'STEM�€INAL. � - ,3,
:, -^t cz.. o > ,
�,, j ' x 4 ,� .. .. � � �,
�29. Insulation. • �,: � _ •• + � � 78,i' FIRE PREV. FIMFFL • - �T
� 30. Drywall Nailing %''� u � H � `` � HEALTN�DEP�. REQUIR�EMENT
"� T C�Y , )' I �J l'.� V � ✓
-i31. Plaster BrowqCoat-yw ; ; rM x � .: . 79: FINAL INSPECTtON :�
32. Etectrical i?owrt Nfeter�"a� al y N , .� �''80,'y'�F000 CERTIFiCdTE i$SUED,_ _
• i-1 � v �
-33. �inal7-Ele�ic-. ��jr, t-� �t x � ,; No4es: - - 'x�-: r cun7
v34. Flna�}ieacing'& Air:�ond*tionint}"S !": r~ I in a = �:=� * �'-'�C
c H!' . � T^ I�A J :�-f ' E"'i �F :�i
35. �%na�Gas.Pipe�Tet . --m -� � � � � ; .�, � . _ ,_
. i:+ : �, i �r ;-� ::o -�:. +� `� i-,.-
36. �iood-or (:znoP4 � c'i: � i �%... �, , , �a g :�� � �� ..�
x � c :, m ::o 'J!*!
� Ct�� 3 A
-�37. F,(nal Facipry Firep`la,ce , _ .-. ,� -' I � x * ' ��
J �` .
-�38. finai'PluTbing ��� � v � � .�. ,, H � k � -
=39. Wate�Seryice-,Finai '� £ ` �' �s c � " � � R,`•' ; �" �`�
_ ,� _ _
`- 40. Gas Service-Fioel r-�r� r: c:;,;. -S t. r � �'^-� ":n� �
- _. �. m F ' * t"
��41. Solar Oomestic�Final, - �' ' :'� ' ` �`-�:^' � ��.
�t. . .C� .T K " �
�42. Backflow Prevente�;^ - t � ' + � >_ • _ '-
.. x �x '7 !'70^. � E ,
43. Backflow Irri�tion * - L'' � C y,; "� r�" �
:�,
¢�g. Landscaqa�lrrpati6n!6ystem - r:� �� O C��� C o. N ::G• 'r N o
t t^ C,' L '�'1 lJ �� �i .r
d3.�iundA;tenuation'� ;;:•.. •�E � c�, c_�� c T °:". �r�: �#�
4ii, Handicap Regu�atiad�s �� � � 'r c ��. • `' r+ � �= *
� � -nr...�1 �'� x
4�7. F7NA"L STRUG7U�F� & BUILOING / /`���b �'(�/�' l �` .-, .
C !
48. FtNAL PLANNING :: � f^:- *'� ; �i _� � y � " "
qg, ETect�rc Release to Edison � ',. � w' `^ f '� z,
�i: r e,� •it �
5�. 6�s Release to Southem CalifornlaGasCo '� -� .:'h r ��'
51. CERiIFICATE OF OCCUPANCY " .- .�' •� " r-
No Date
�ooxcssaeN�ou«+: %SS W 18TH ST
owr+Eas�^ME�Faax'": KAMIYA, TADAO
' ��+� 4423 E OLIVE BRANCH WAY
� ANAH$IM,CA 92807
n
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/JICMRECT Ofl FHCd�fEX:
CONiR1Ci0H'S N1YE
cam�croas wuiwo
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UNT:
uc. No.:
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110EN5ED COMRACfOP3 DECLAflATION: I Mraby Aim undar penely d pwjary Uut I un Ib�nssd uMv povidau d Cheqr D
(eommse�anp wilh Saelion 1000) d Diviaion � d IM BudMw ud Prdo�im� Coda. and mY Iben�s b In lull bree eM elletl.
cm uc. xo.: ue. euss: uc. No.: EXP :
Dete: Contraaa:
OWNER BUILDEF OECLANRTION: I ha�eEy etfi�m urdar penNy d pr�ury �hm I un wmq tmm tM CONrwm lbeiva law la Na
fdbwvq tmfon (Satlbn )W 1.5 Bufiiet� uW Adavaiant Cods: Airy Ny a muniY �fiiN'eW'up a Oe�G to mroW�t. edat.'vnprwa.
'Nnd'vh, a rpei eiry aUucNm, prior b d'swvice, eho nyuim �M eppl'vanl la ach pmW lo Rk e Npnod sWsms�u Ntl M tt�M
iK.�.ee w�wm �o m. ww�.�o�e a in. comreaa. uca�.. �. tcn.wa s loomm�ro wnn s.ao� r000> d a.mwn s a n.
.uainma vd Rdpe'vn COEaI a Ihe� he W ehe u usmq Ilwrelmm enE IM Estie In Na NkO� exemqion. My violetion al5atlion
]03t.5 by eiry epp&aru lor e permd v�Epea Ihe applicerq b e c� paWry W nd maa Ihan fxe Mvkrsd Eallen �SAOp.
Q I.a�ownardtMpiape�yamynnployeaswl�wepeamlMidecampemelion.willEolMv.ark.enENeet�uclu�aunaliMeMed
•• orMeredloraeblSectian)o1�.BuzmnuMPMnaionaCOAs:TheConVaaasLiwneelewdoeeroteGvNtoenownerdpoparty
who buiGs ar inpwe� IMrem. aM x1a Eoae euM xak Fim�aH a Mne� a Wnqh he a lim ovm emObtM�. po+� �hM wch
�,a�+«o... ou w�a.e «ai..e i� w.. u. row.+a. m. w�aua «mw�mu n.da wnn:, a» v.e� a�v�oa m.
wmerbuilder rill hew IM buedsi d pwiip he a she did m� duk a impws la �he puryws d ub).
� I. ea ovmer d �he V�WaM. em udwrveN oonlradM xilh limneed canVMore ro crosV W IM MMb (Satlion ]Ou. Buair�m vM
Rdmrim. coen: rne cwreea. l�erue IaW me. na wW m en owiw a n�w�r �,o wua. « imwwo mmean w.roo
wnvecu tar wd� pM� wN e mNredw(n) I'remad P�uem �o �M Cmurepws L�iae Inwl.
f� ��� ma �! SeUron/�� B.� , Ia �hro me : C
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25SN, vd IM1N I a erry Mure Wiki�p om�pen� will / wil iwl (ticb aw) neeE io canpy wY� sek atels m as eM IM nQuimmenb br
ePe�millumuwcYanamodAwionham�Mlv�iTie l.�y enepemmt0ivhf.Rsudavilama�uq'vneGGk'miwnenazempM1antMee
a�m,�..
Dale: ADdicenl:
wonKens corvas�naw oecun�noN: i n..ey mr� �w« �.ny w� o�. d u» i000.;�y e«wm:.,.:
❑ � ne�e d,d wi� meimen. cennwe a mnaem m..n:�wA n..on�e: canc.�wn�. m w�.d �o, M seaion a�ao d m. �en«
cod.. �« ine wnwmarice a in. �ork �a .Ni 1, �nu w�a u ie.ued.
❑ in�.w.u�m,:�.�..��o���,re�...�.aw.aws.a�»ooam.i.eo,coe..wmec.�a�wm.
wak lor xfirh thu parmN is ipued. MY wvken' oompenaetbn iruurenca ranw eM pdiry wmbsr vs:
c��:
Pd'cy Number:
n mdion neeE iaf 6e candaed / Ns Pa'^�t u br an hurMred dd/ara Iti0D1 w Nv.)
� I cMAy ihel in Ne peAamerce M IM work la whch ihu pertnn is inueA. 1 ehdl m� ampby enY M� in ury menner p m to
becama wbjetl to tM wvMn' oanprisetion lexw d Ce4fomie. vd epies Ntl 'd I MwN beeanis wibpe to tM waet<es'
Pomw��, w�o�. d s.ao� a�ao a m. �n« coa.. i.wi ionn.an oomoh wnn ub.. wwb�m..
oeie: Aodicenl
Wemliq: F�O�n ro ucuro woikwi romperu+tlon roverep� Is unlewNl, �ntlWll wD/�ct �n �mplayw ro crlM�ul p�n�ltlu ��M
clv/l flroa ap ro om huntlrW thouxntl CN/ar� (J�Oq000A M�ddltlon ro M� cos! o/ rompxueWn, Wrrups� �s proHMtl br In
Srotlon 9105 0l Ms laEor CaA, /nbnst. me efromry's /w�.
CONSTPUCTION LENdNO AGENCY: I hereW elf uMx psreAy d perjury IMt �Iw�e b e wn�ruqion bMieq paney la tlr
nen�aze a me woM r« .n�d� mm ro�n� u ewee (seaon ��. cw. cl.
LENDEP'S NAME:
LENDEF'S RDDHE%:
I cenily Ihel I heve reaE I�ia applketion eM qma thel �he ebove inlamelion ia cortoq. I epree ta compM �h ell uy enA caunly oNineMee
enE ste�e lem relmin0 �o buildn0 �����tlbn eiM Mreby amhorae re0�eeentelivae d Ihn My lo enbr upon ihe ebova�mentioned properry
�o��"��W��� TADAO KAMIYA
• Pnm Neme /
c4'�u-��,Y�__.._..�....... Uete: /D � �
(S151d6 WP) Whne-Buikip 6 Selary: areamFle; Cenery-Applrsni: Nnk�lsrsnw; (3ddmeobNxaw
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: B 074642 PLAN CHECK NO: N
PERM NO: B 074642
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : DEMOLISH KITCHEN IN LIVING ROOM AREA SQ FT: 350
CLAIM VALUE: 300.00 CALC-VALUE: 350.00 GROUP OCC: R-3 /
COMMENTS: DEMOLISH ILLEGALY ALTERED LIVING AREA " KITCHEN " TO ORIGINAL
****�t�t***�t*************************�*�*�*t�******x-****�e�**�-*******x�*****�*i�*****
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 HUILDING ---------
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: 42417210 ZNE: REF NO:
PLANNING NOTES>
>
!E if 1E if iE �If �lE �E if �l(-iE 9F �1E �E �IE 9f'IE iE jE iE iE 9E iE 1E iE iE iE iE 9E 9E iE 3E 3f �E iE 3E �F iE iE 1F 3E 9(-aE-0E iE iE a(- if 3FlE # iE iE 1F iE iE if �IE if �E iE iE iE ff if iF if �f �E 9E'lE 1E 3E'7E iE iE iE �E if
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:
HUZLDING APPROVED BY : DATE:
APPLICATION ISSUED BY: � DATE: I�— I�- Q�
iFiflfiEififiFiEiEiFiEiE3EiE9E�1EiEjE9E9EiE�E iE-..� �: iF ikiF�EiEiE�KiEiEafif���iEiE�r1F3f�fK
LEGALIZATION:N F E.E 5 U M M A R Y STRUCTURAL SEGMENT;Y
)
BLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SMIP/RES GRADING
PERMIT 15.00 50
PLAN . SMIP/NON-RES
ISSUE FEE ,:
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 15.50 0.00 �,' 0� 00 15.50 15.50 .UU
REVENUE DIVISION TOTALS--> COLLEGTED: 15.50 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHAN'bC FIRE SMIP/TOT GRADING PLAN-CHECK
15,,,�0 _ . 5 0 �
`ry } r.:
if K iE jE IE 1E 1E 3E 3F �3E 3E dE �' iF 1E'� i(� iE iF iE iE iE 1E iE 3F �)E iE 9E iF if iE 3EiF jE iE 3E 1Ei'�E iE if if if iE iE if if �E �E iE iE 3f 3E 3E iE iE iF iE 1E �F iF iF �E � iE iE df iE iE iE aE iE �4 if �1f 1E �E
��D I V I D U A L F'E E B R E A K D O W N
TYPE QTY �j ��Q� ��C R I P T I O N j UNIT COST TOTAL COST
�
SFR 350 �T�,� �Q VALUE RESIDENTIAL NOZONE 9..00 350.U0
'8N� END OF FEES
� �
� �0..,
_�
f
0! 41�192iSR-�3019235i u ��eY 15.Sp
Qr?ca 1G�l�i`:c'+ lilr :3:'[.
.
CONSTRUCTION AND PLANNING � • ��� 'PA
„APPROVALS Permit# Date fnspector pppROVALS Permit# Date Inspector
�
1. Tempo�ary Electr(cal Secvice ar Pole 52. Pool & Equipment Location
2. Soi��ipe-Undrgr'nd. 53. Steel Reinforcement
3. Electrical Conduit UtilitY•Undrgrnd. 54. Forms .
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding '
5. Steel Reintorceme�t 56. Rough Piumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. -
8. Found2tion � 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 1 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
72. Sewer Gap � 63. Heater & Vent-Fina�l
73. Roof Drains 64. Piumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Elettrical�Conduit 66. Solar SYstem-Final •
76. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Geiling 69. POOUSPA SYSTEMS PINAL
79. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Duccs, Ventilating 77. Product Piping O Gas ❑ Oi�
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framin9 73. Undergrnd.StorageTank O'G�s ❑Oif
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 �;y�
29. Insulat�on 78. FIRE PREV. FINAL `�
30. Drywall Nailing HEALTH DEPT. REQUIREMEN7 •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrital Power Meter-Final . FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ��/ ell.�"-� �(�� �� `
34. Final Heating & Air Conditioning _ ���� � c
35. Final Gas Pipe�Test _, � �.�, ,�, �.,�� ,__ '��
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
47. Solar pomestic-Final
42. BackfloW P�eventer
43. Backflow Irrigation
44. landscape Irrigation System
45. Sound Attenuation
46. Handic2p Regulations �
47. PINAL STRUCTURE & BUIlD1NG ---�
48. FINAL PLANNING
49. ElectriC Release to Edison -�'
50. Gas Release to Southern California Gas Co
5L CEflTIf�CAiE OF OCCISPANCY
NO Date
PXOJECT PUUflE$S: 7 S B W 1 8 TH ST
OWNEP'SNpME: KAMIYA, TADAO
� aooness: ANAHEIM CAVE BAANCH 92807
' (714)637-6599
AflCHIENGINEEH:
AOOflESS:
UNI7:
flEG.NO.:
UNIT:
PEPMITTEE: PRIMO ROOFING (719)891-4956
nooness: 17066 PALMDALE ST
HUNTINGTON BEACH CA 94627
LICENSEO CONTflFCTOB UECIABRTION: I hereby a�lirm Ihai I am IicenSeU wder pmvisions of Chapter 9(commencinA with Section
7000� of Div� io o � usiness ana Pm�e i s C 0 a tl my I¢ense is in full forc antl e��ec[.
CITYUC.: �����[�� STRTELIC.:��I��(j��� —��}�CLAS�$: C—�9
� �� 2 7`�� � Signature: xJ 1.tlf l(. �
WOPREBS' COMPENSptION DECLABpiION: I hereby afiirm that I have a cenificate oi consent to setl�insure or a ceniliwte af warkers'
Compensation 16��22a>raZc¢sGliet�r�PY t�ereof (Sec�ion 3800, Lab. �.1 I O I I9 S
roucv no.: STATE FUND E%P. ORTE:
camrnNr: �[ ;,
❑ Cetlilie0 topy is �ere0y �Umishetl. L1 CertifieA coOY �51ileU with �he iry BuilOing Division. -
�✓ ` `� ^-1� APPlicanl: ��� ��1/�/\7� �FI�L. 1..0 '
E%EMPTION FflOM WOPREflS' COMPENSRTION UECIAPRTION: Qhis 5¢t�ion neeU nol be tomple�eA i� the permi� is �ar one hUnOreE ($ 011) less�.
I certily �hat in Ihe perlormance o� the work for which �his Dermi� is issued, I shall no� emDloy any person in any manner so as �o become
su0let� �o �he Workers' Compensa�ion Laws ol Califomia.
�ate: Signa�ure:
NOTICE: II. after makmg this tleclamtion, you should Uecome su6lect to ihe Workers' Compensation pmvisions of ihe La6or
Code. you mus� fohhwiih comply with such pmvisions ar �his permit 5hall Ue deemetl revoked.
CONSTflUCTION LENUING RGENCY: I hereby at�irm �ha� there is a Cons�mt�ion IenOing agency for Ih¢ pertormant¢ Of lhe work �or
w�ich �his permii i5 i55yg�$ecL0�y309�. f�tvRciPLEX
,LENOEB: !t FZVVt� .
• nooxess: REROOF TRZPLE}C
OWNEB BWLOEB OECLABR710N: I hereby afiirm tha� I am exempi irom the Contractors' S�ate License Law �or tM1e �ollawinp reason
(Seaion 7031.5 Business and Professional CoOe: pny city of caunry whicA requires a permit to consimct, aiter, improve, demolish, or
reoair any simtlure, prior to its issuance. also repuires ihe apPlicanl lor such permit to Iile a signed statement inat he/she is licensed
pursuant to tne pwvisions of Ihe Cantracmrs' Sta�e License Law �Chapier 9(commencing with Section 7000) oi Division 3 0� Ihe Business
antl Pmlessions Code) or that he/she is exempt theretmm and the basis lor lhe allege0 exemption. Any violation of Seclion 7031.5 Dy
any apDlican� �or a permit sublec�s lhe applicant Io a civil penatly of noi more �han �ive hunOretl Oollars (8500).
I, as owner of roe pmDerty or my employees with wages as their sole comDensation, wi0 Ao tAe work, ana the
❑ stmcmre is nm imended or ofleretl mr sale (Section 7004. Business an0 Professional Code: The Contractors' State License Law
aoes not apPly to an ownerof a propeny who 6uilas orimD�oves �hereon, an0 who tloes such work himsell/herself orihmugh
his or �er own employees, pmvi0etl that such impmvements are noI mtended or offeretl for sale. 11, however Ihe 6uil0ing or
impmvemem is soltl within one year of completion, Ihe owner will have t�e bur�en of proving helshe Oitl no� 6uild or impwve
far ihe purpase of salel.
I, as owner of ihe pmperty, am exclusively con�rac�ing with licensed conVaclors to cons[mct the Owlect (Sec�ion 7044, Business
❑ and Pmlessions Code: The Contracmrs' State License Law Uoes wt apply to an owner of pmperty who GudUs or improves thereon
antl who COntmtt5 �or SUCh pwlec�s wilh a tonVactoqs)liCense pursuan� �o lhe COnVactors' State LitenSe LaW),I am aware
thai pmo� ol ��eir Worker'S ComOensa�ion insurance shoul0 be pwvitled �o me.
� I am exempt under Section: B. 8 P. C.
lor I�is reason: .
Oale: Owner.
I tlo �ereby cenily Ihat I am aware ol an0 un0erstantl t�e requirement5 0l Calilomia Healih anU Safety CoGe Sec�ions 25505, 25533, an0
25534 antl Ihat I or any IWure huilaing ocwpan� will/will no� (circle one) neetl b comply with said slaie cotles and Ihe requirements lor a
permit lor con5imclion or motli�ication Imm t�e Fir �uali�y Managemen� OiSVict. PesiOential cons�mction apDlications are exemp� imm
Ihese pmvi5i0n5.
Oale'. APPlicanP.
I hereby cer�ify�ha� I have read Ihis application and Slaletha��he a�ove in�orma�ion is correcL I agree ta camply wi�h all cily anA county
or0inance5 antl 5latelaw5relaiing�o builtlinq conslmc�ian an0 hereby au�horizerepreSenlatives ofthis city�o en�eruponihe above-men�ioned
.p.m�perry� lar inspeclion purposes ��' ��
n � J� '� � ^�� Signalure:
orivers License or Sociai Secunry a:- %__ . _.
i6aba6 W�ne—Builtling: Green—Cotle EnlorcemenC Canary—Applicant: Pink—Revenue: Goltlanroe—Assessor
.—�, CITY OF COSTA MESA — BUILDING PEAMIT ,
PERMIT NO; H 066`539 PLAN CHECK NO: N , ,
CONSTAUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE; ALT
JOB DESCRIPTION ; REROOF TRIPLEX / AEMOVE ROCK, APPLY ROCK SQ FT: 4,113
CLAIM VALUE: 4,113.00 CALC—VALUE; 4,113,00 GROUP OCC: R-1 /M-1
COMMENTS: SMOKE DETECTORS REQUIRED PER 1991 EDITION OF THE UBGr� ��� �
itx�t�t�t�tititit��t�t�tir�r+tx�x�**i�ititx��titx�ir�tit*itit�t�t�t�rx��r�r�r��tr�r�t�t*it*it�titit�t*xx��t r *��[.�E
Z O N I N G R E Q Q I R E M E N T S�1'� WG i
S ETBACKS ��Q UIRED
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT .IN FRNT: FT IN REAA: FT IN
LEFT: FT IN RGHT: ET 'IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 42417210 ZNE; REF NO:
PLANNING NtSTES>
i
**x��**��r�rx��r�r***+r�r*�**x�x+�*x�r�**+rx��r*�rx�+�*�r�rx*�e�r*�rx *x ****w*�**x�**x�x�xx*w�x�x+�****x�+��r*
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 APPAOVED BY : DATE:
APPLICATION ISSUED BY: DATE;
iE iF iF M M if ih 1E 1F iF 1F M iE 1E 1E iF M iF iE fE �lt iE iF if if iF if iE iE iE iF 1E���F�F;F�FA�iE
iklEiEiElEifillElEfl1E1E1F1F1F1ElfiflEiFlflElFiElEiflEiflkiFlfiEiffflkif1F1E1flfiEiFMiF1t% 1EkM1E7fiFiFifiEMlF1EiF1EiEiEifiElFiE1likikiFiEifiFlfit7fiE
LEGALIZATION:N E E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNZP/RES GRADING
PERMIT 72.00 ,50
'-' .SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72.50 0,00 0,00 72,50 72,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 72,50 OVER/SHORT; .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING pLAN—CHECK
%2,00. ,50
!E!f iE 7F it if if 1E iE iE 1E it iFlE iE iF 1F 1k iF iE iE iF iE iE 1flf if iF k k ik it k iE 1E if if if fElE iE 1f ik 1f iE 1E 1! 1t 1E k 1k if iE if ik if if ik k iF iE it 1F if M i! it itlF ik iF 1f iFlF itlf iE iF i!
I N D I V I D U A L F E E B R E A K D O W N
TYPE __QTY
SFR 4113
D E S C R I P T I O N
REROOF.BY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1.00 4,113,00
01 00157747-00157�48 TG T 72.5D
QP.?E� 03(25/94 TII1E� 10:32
v� .:e
G�NSTRUCTIQN AND PLANNWG POO� & SPA I � I
qPPROVAI,S Permit # Date Inspecior AppROVALS Permit # i Oate Inspector 1
I
7. 7emporary Electrical Ser�ce or Po1e ; � 52. Pool & Equipmen: Location � . �
2, Soil Pipe�Undrg:nd. �r. �fi`.;, 53. Steel Reinforcement � "
V.3:��lec'-.,�F'cal Coriff�ts7tility{lndrgrnc��' �' S4. forms � � (
;jA: �`}ectucal Con`c,�uy:Llndrgrnd.� �_, G•� 55. Electricai Bonding -
- 5 Steer-Reinfor� �'t "' �' , 56. Rough Plumbing & Pressure 7est '
. .-, , , . �- :
�
�.'��,fi.',:Electr,fcai UP�.F_=�nd. �• :.�;�; 57. APPROVAL TO COVER�GUNITE :ti i
•.<7TFooY�ngs `-'�".a '-' 58. EtecVical Conduit-Undrgrnd. " '
r'a �n ^.�
'�; � Foundation �1'� � �' � �'M 59. Gas Pipe, O UnUrgrnd., Test �' i
�� Water Pip2�Undigrnd. ' 60. Backwash Lnes, P�TraR, Cl Undrymd. {
.�
�
10'Structural Ploor Svstem �, 67. APPROVALTO �ECK , ;
17,%�eoperty Sewer �i� & Ho.use Corylection 62. Backwash & Receptor�Final !
12, Sewer Cap Q, �� � 63. Heaxer & Vent-rinal �
73. Roof Drains �� �� 64. Plumbing System � Final �
14. Rough P4umb"�g '�` fi5. Electrical�Final
15. Rough Electr�c�I�Conduit i 66. Solar System-Final '
i
76. Rou9h Elecvis•Wiring � 67. Fencing & Access ApProval �
- . i
17. Rough Wirin95ign �' 68. APPFOVED FQR PIASTERING �
I
18. Rou9h Electri2ai-T Bar Ceiling � 69. POOUSPA SYSTEiViS FINAI � �
19, Rongh Heating & Air Conditioning FIRE DEPT. REQUiREMENT `
20y Ryngh�fract�ry �irePlace i;.;.7 .;' 1 � C? c�:? x �-iAPPFf9VAl�5� C� P�eitnit # Y � ( I
n .* r�� � c �� r++:.� y r � x-. L^. d�„ �„ � s i t' � �
21�DuCts,�{�SfrZCt�,} I'� ^::= x r+ ''7r k• r^-�y� � C�7 I
.r ,k i.. .. r-� ;' .+� S - x* 70. ,llndCryr.cr ngl F�;c;ro r i
2T. Dutts,�,i�,'ent7atiPg', i ^� � n �� *'' 71. �Produ�yF.piny�'R3as 60i1
2�G�SPiP��R�9h&;T'est i �c �. � � x ~. �� y 72. Undergiourid F�y?,', z "� ._4.., I
� „ } , .. "� . a . , -..
24;�,Rqqf �iamic:� F.= i Ff-� � � 'i ' + ' 73y Undergrr�'7.Storac�:'Tank'OGas ❑3i1 '
3 .-.. .y i s ,
25. Roaf Sh'_eaihin "�y" F `� � 9 � '� � `� "'r"C �` �
9:: • L y_y ^ 7� Qverhead Hydre�
T ..a . � . �G� �� . t x r i
_���-
2�T��ir Ceilin9 (St�eturai) &;ytonocoat -:� � c-� '+ tri.x'x 75T Dry Chernica! � «`+ - _c :
_ 'l"_ ^'. 1-p 4n ^. "f] �I
2}ti'Framea�d Flastfin' �7 ~ `' ' t � ' � � �'=� '" �� j
� r.^ ;T+� >> x c� c�x' T 79-' ary Star�pe �; j = ;�
� � m � • � � �-, r•, c,: . . _ ..: �,
�28: LaEhin�& Siding.,: �.� ;,,�y � • �•�x �: 777' FIXED &+f�T�:".'1�INA� _ t' �
•'29. Insula l n"' T` �. " .. � � m j � i` ' 7� FIFE PREV. FIN{�l x. - �' !
. . 7i �� S -�r .�, L � K :- -�: :
�30. Dry�va�l,Nar;ing;r,i " � r. I �� ,�� n r-+ r1iEALTH;OEPT,�FtEQUIitEMENT --�
, -, i
-� 31. Plaster�rovd.,n C��. .^ � „�. �" , � {� *. 79? FINAL l'�SF'EC�i�JN x `-' '� `� j �
�-, *' .-, 1 i r_�r.. . .� >+ 'i�'T-�----s-,-,
;32TElectric,�l PowerMlAete,;�Final, � N � �,�* a t78�;F00D C��RTIF;r�TG I�SUED �
.. . ^. .-. x :.-k,_�,,,�-�--�
1 f H Y�
33= Fi �1 Electric r . . V i c+ x ? ' �'� ` . , NOYes: - ' '` �
v rn '� x �: 'K � "] '7.' '7 V 7' 1
i .., �
�34 Firfal N�eati � &�}�� CbnditionN,'-'g n � � fx ;, � _ :i� � , cr �
^ I,
�35r,Finel �5 Ptpe'TeSt. ' �, , x ^ I Ef ? , r, mt r ;-+ S :� �
�' c l--1 fP, k. 1 ti Y r' ^ i
, Y ,' .. ;. c , ,.� .. �,. r . � n� ^ . x ,., �,
936'.'�HdQd qt;Canop��� ^� i ;n., .i x..� } ` � ^c ; �ti:' i
_ " i 3y ^_P-'
-�370Firial Fa�c,orY Firepl��, � .��T y �r• t*7 � �.� : � C� � !T� ^ j
,_`-',38. Final Psumtring �':. 's�.. � '", J.i .� .� � ,v n,.;; �S ---r--�_-_-._�.---�----�
� f' � x
:�39. Waier Service-Fiaat. " � � `. ; , ��"• y �. �-•
., � � . -�
�:�40. Gas Ser`v'�ce:�ina� �� `,r,t, ``_' * �, i i �t�� rvm r: �:
2,41. Sotar DemesticF.inal_i fi .. x G ' `` �' ,� v --. *�J
.-i �, �, -� ,T i
-42=9ackfiq'�ri- Preven"{e� F" � x' " � ;� � � �• F� . � � � �
�: • - ��: 1 ��.-,r- - �- - - ,
43. Backflam lrcigaYior{-.��, cr,_,=; + � = t � �F^G >. i� � �-+ ' i
i X $ ij. �
`��44. landscaAe ,K,��9ati � 5Ystem�,�,_'� c: .: :�, O CJ C> � ; c� �,' :� �T. ro .�
�
� J �� lv �. . r �. �' . . . .
��45:;Sound "AtteDuatio ��, r•" s £ F � Fk y �-+ -� S-+ �� * y ;
�
v � . R7 .. .. � ��y �. H;y. ...-�
`46�"'Handic2;�i Re�ulati �tti ,� # x.. t h• �7 c i j
..47�FIN„pl STftkJCTUR� �LDI(dG ,,, �l?y cjs �(„tt � ' ni�.^ s _ � !
V46'tifli�F'ALPtANNtIVI�`i'! :::. �p'[r x i �tx u c; ^ , v ' �
� -.,._ _ F. x;� j I {� . r, n; � v �, a
�� • +� � ' � .. , �
�49;,•E�@�iris`ReI2d502PyE'(Ii50F� � -y � ;�r . : a; i � - �-
e t :z . n ��'1 -r
"=50,_Gas,Re�ease to Sou�hern Cal�fo.r,ni�a Gas Cv k � • � * _ `�'' . J x * ` � "'.
,� . x a � -+ 7 0[*] '+ O
��51 CE�TIFICATE OFyOCCUPAtdC�' y. � > �;: ;��o „ • ;- � ,
No. '' Date
'
►
�
Avolinnl lo lill in all spaees axceDl tnase within �eavy bortler Ilnes an0 sign all aoProoriate eeclantlons.
CITY OF COSTA MESA
CONSTRUCTION PERMIT
ProjecfAddress - ��
Applicant's Mailing Address .
Owner's Name .��-M %J��p/,���G ,���}�/J � Phon^�/���
Address� �rn� � ' ' �/
Arch/Eng. License No. ,
Address
Contracmr's Nam • C. P� Phon s �
Addresslmailing) �. ��%�. � �= �/Q'J C�N���
CityLicenseNo. �31��'SZ
LICENSED CONTRACTOR DEGLARATION ,
I hereby aftirm thai I am licensetl untlar provisions of Charter 9(commencing
wi[h section 7000) of Division 3 of the Business antl Professions Cotla, antl
my Iicense is in tull f ce antl e tect.
ucensec ss �' 3 0;��9�/00
Date l Signature
VORKERS' COMCENSATION DECLARATION
hereby affirm that I have a certiflcate of conzent to selLinsure or a tartifl<a[e
of Workers' Compensa[ion Insurance, or a certlfietl copY tnereot (Saction
3800, Lab. C.)
Policy No. Company
BCertifietl caOY �s hereby furnishetl.
Certifietl copY is �iletl with the city Builtling Division.
Oate Applicant ,
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thizsection neetl nat be completetl ii Ihe permit Is for one huntlretl (5300) or
less).
I certlfy that in the pertormance of tne work tor whicM1 this permit is issuea I
sM1all not employ any person in any manner sO�a come bjett to t�e
Workers: ComO¢r1YddOn-Ldv✓s o( California. �.��i� ,
Workers' Compensation pravislons of the Labor Coae, you must rormwim
comply'wlth zucn provisions or tnis �permit shall be tleemetl revoketl:
CONSTRUCTION LEfYDING AC.ENCV '
I h¢reby attirm that there i5 a Cons[ruclion Ientlin9 agency for the performanca
Of the wark for whiGh. tnis permit is izsu¢tl (Se<tlon 30B] CW. C.)
Lentler's Name
Lentler's AqGress � '" _
OWNER BUILDER DECIARATION '
I hereby affirm that I am exempt from the Contractor's License Law for�tne
u I,' a5 owner oi ine� propa
compensation will tlo Ihe wa
for sale. (Secflon 7044, BuSi
License Law tloes not apply d
[he�eon, antl'who Does SUCh
employees, piovitletl that sucl
saie. u, nowever, ma builtling
pletion, the owner wlll have t
�rova�for the,purpose of sale).
1, as'own¢v ot the p�op¢rt
tractorsto constru<tthe proje
Tne ConVactor's License La�
builtls or improves thereon, i
traCto�(s) Iicense Du�suant t0�1
❑ I am�exempt untler Sectlor
�ate Ov
I�nereby cerNry tnat I have
information is correct. I agrei
antl� state laws relatlng to Cu
sentatives o( th city to e
InSpettion pu �
vrotesswns coae7 or mac ne sne a er
allegetl exemptlon. Any viola lon o� Se
a oermlt sublec[s tbe aoalican[ to a
ty or
k, antl
es5 ar
an ow
t1011a�s ($500)'...u. .......... .. .we�. ...�e
or impro
ie burtler
, am ex�
t (Sectioi
does n<
�tl who �
ie Conta
ner. _
reatl thls
a property wno Dwms o� improves
/he�self or th�ouqh bls or he/ own .
rt5 are not'intentletl Or oAer¢tl'for '
ient Is soltl wi[hin one year of com-
proving he/sh¢ tlitl nOt bulltl ar Im-
vely contracting with Ilcensetl con-
)44, Buslness antl Professlons Cotle:
pply to an owner o( propertywho�`
ract5 io� such proj¢Cts with a wn-
�'s LIC¢nte Law1: �
B. & P. C. (or thls reason
above
iances :
repre-
y,for
TVPE OFCONSTRUCTION LJ NEW U ADD '�11�ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTIONOF,WORI* - ' q� �L
TVPE OF PERINIT LI GRADING�FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa.FT. OCCUPANCv_
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VOS. ACRES—
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Founlains
Floor Drains
Floor Sinks
Gas Service Ou�lecs
Interceptors
Kitchen Sink •
Roof Drains' � �
Rainspectian Fee � , .$25
Boiler ,
Duct - Under Ground �
Duct-Structurel �
Duct : Ventilating �
Exhaust System ❑ Multiple �-.
Firepl/Fact Blt. ICBO #
Heating System & Ducting �
❑ 0.100.000 BTU O 7 00.000 BTl
Slgnaiure �
�T I I Reinipection Fea I�'$25•
CMF 0865-46 rev. 12/83 Whi[e - Builtling: Canary - Appllwnt; Plnk - Accoun[Ing; Goltlenrotl - Aszessor
Showers
Service Sink
Sewer Cap
Sewer Connection�
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
�WaSef CIOSei
Water Heatei
Water Service
laue Fee
IANICAL
Hood or Typel
Canopy Typell
FEES
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
laue Fee
A.P. #
S Main Building:
T Front
ARear
C Right
K Left
S
Ping. Ref. #
Parking Req./Provi�
Use of Building:
Planning Notes:
Automatic Washer �
Construc[iOn Pole S�
Cooking Unit
Dishwasher - `
Dryers ❑Gas ❑EI
Fan .
F.A.U.
Fixtures
Device Boxes �
Outlets
Switches � '
Garbage Dispoul
Generator 00.5 KW
20I0 4/29/85
I 2one
Accessory Building:
Park. Fees $
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700 amps
Meter �over100amps
5KW
� Reinspection Fee � $
PUBLIC SERVICES RE�UIREMEN7S:
Zaning Approved By
au�ia��a nav;o�d ey '
I
$ 3
Sub Panel
Motors ❑
Int. Solar
Microwave
Pole Light
Range
0.1HP�1X-8 'I '
❑9-15 HP �16-15+
Standing Sections
Trash Compactor
Issue Fee
r •
$ 3
5a��
2
O
N
I
N
G
R
E
Q
U
R
E
L
� � SUMMARV OF FEES '
BUILDING PERMIT $ SMIP $ �- �
PLAN CHECK $ PERMIT ' �
PLUMBING $ � _s:(7Ci��UANCE $ ,
PLAN CHECK 25% $ ENERGV P.C. �$
ELECTRICAL $ � GRADING $ '
PLAN CHECK 50% � $ MICROFILM $ �
MECHANICAL� $ TOTAIFEE $ '� ��
PLAN CHECK 25% $ _ �
� �/
� CONSTRUCTION'ANDPLANNING - � POC SP,A;��� ._ _ 'r.
Date ° Inspector ! ' " � '°Date° Irispec[or'
.APPROVALS Permit# APPROVALS Permif#'-
- - �
' 1.. Temporary Electric8l Service or Pole�� - 52: Pool & EquipmenY Location �` -' - " -
2: Soil Pipe-Undrgmd. � , `53. Steel Reinforcement � . = �i `'
` 3` Electricai Conduit Utiliiy-Undrgrnd.�'.' � - 54. Forms . ' . ' . � � L ' _ '. ."� , I '
: 4: Electrical Conduit-Undrgmd. , _ � 5_5: Electrical Bonding - . � _ `"� � .
5. $'teel Reinforcement � ' 56. Rough Plumbing &�Pressure Test ' �
6. Electriea(UFER Grnd: �' ' . �57.� APPROVAL TO COVER-GUNITE _ ' . -
7. Footings �; ,•• � � •�. �, 58. Electrical Conduit-Undrgrnd. � � . - . ,
8. Foundation ' '- ' Y/'� � 59. Gas�Pipe,O�Undrgrnd.,Test - � � ��_^ ;�
9. Water Pipe:Undrgrnd. ,� g0. Backwash. Lines, P-Trap, � Ondrgmd.:" � I`
10. Structural Floor System . 61. qPPROVAL TO DECK - - r
11. Property Sewer Line & House Con�nectlon ;� - 62. Backwash & Receptor-Final - - ' ��-
12. Sewer Cap ' � � ��63. Heater &�Vent-Final� � _ . : � �
13. Roof Drains - �, • - .64. Plumbing System - Final _ - �
_ �-
14. Rough Plumbing '. " 65. Electrical�Final - � ..-� . . ' �
15. Rough E�ectrical-Conduit 66. �Solar System-Final � , � ' � ' ' ' - --. -
16. Rough Electric Wiring ,_ 67. Fencing &-Access Approval � ' _; t-- i �I �
17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING � � '-��
� 18. Rough Electrical-T Bar Ceiling 69: POOL/SPA SYSTEMS F.INAL �� , +�
19. Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT -' . � � . �
20. Rough Factory Fireplace , . APPROVALS � Permit # �
�
21. Ducts,�in Structure � � 70; Underground Hydro �' '• ; �� I -
, '.
22. Ducts,Ventilating � ' 71. ProductPiping�OGas� ❑Oil � � ,
23. Gas Pipe-fjough & Test . . 72. Underground Flush -� � � , � .
'24. RoofFraming . , � 73' Undergrnd.StorageTankOGas ❑Oil ° �
° 25. Roof Sheathing -, � 74: Overhead Hydro ' .� � j � i
� 26. T-Bar Ceiling (Strucwral) & Monocoat . � ' � 75. Dry Chemical ' � � , - � f
. 27. Frame and Flashing 76. Dry Standpipe � �" , , -
28. Lathing & Siding � ' �77: FIXED SYSTEM FINAL ' _ � -
29. Insulation . � , 78. FIRE PREV. FINAL �
30. �Drywall Nailing � � . HEALTH DEPT. REQUIREMENT, �,
31. Plaster Brown Coat 79. FINAL INSPECTION ��
32. Electrical Power Meter-Final � 80! FOOD CERTIFICATE ISSUED �
33. Final Electric Notes: � �
34. Final� Heating & Air Conditioning � � � � . � . .
35. Final Gas Pipe-Test - � � � : � ' � � _
<o � `i z
36. Hood or Canopy � � - , - ��, . - _ ' �
37. Final Factory Fireplace ' � � � = ' , - � - �
38. Final Plumbing , � LE(� ' ' � '
39. Water Service-Final, � � � , , � ' � '
40. Gas Service-Final � � � ' � � ��� � - �
'.,. ,
41. Solar pomestioFinal , - � - - - - - - ,
42. Backflow Preventer ' � � � � ',
43. Backflow Irrigation � � � � � � �
44. ,Landscape Irrigation System , . �' . � , .
45. Sound Attenuation ' ' _ � � ' ' ' - �� �- � - ��, � �
46. Handicap Regulations ' - � � � � � � •
47. FINALSTRUCTURE & BUILDING ' - , �
48. Special Requirements Completed i ` � � � , ' : � ' . �
49. Electric Release to Edison ' � � ' � � "� � � � ' - ; � ' - � � ��� � � '
50. Gas Release to Southern Califomia Gas Co � � i ; '- , -�� . ��
51. CERTIFICATE OF OCCUPANCY � - - - -- - ' '� •
' � . � l �
No. Date -'-. . • - - _ " - ' � " .
� �oonEss a;sw�oun: 7 S 8 W 18 TH S T
OWNEA9NAMEIFqqWN: F��iyA, TADAO
� �o�% 4423 E OLIVE BRANCH
' ANAHEIM,CA
LPPL. WIIlNO AOOPE59:
u�cxrtect on �++ur+¢n:
APCN. OP ENO.'B 11DORE53:
� � UNT:
92807
uc r�o:
UNT:
CONiPACTdf81UME:
CONfPACTORBYNIWO
wn�ss ueno:
uxr:
LICENSED CONTfl�CTORS OECL�P�TION; 1 MrWy Aim uider paWy N pepury tlW I em fioennd uds pMeiau d Cheqr Y
(oommendM wG� SacYon'loaol d ONuun J W Na Bu�ea ad Pdxnao Cod�. W mY fonn b'v� IiA bw end allw.
cm ue. No.: uc. euss: ue. No.: E X P:
�ele: Camedr.
OWNER BUILDEN DECL�NATION: I Iws� tlfirm u�qm pyWy d perjry �hx I em aomq Irpn tM Com�atlm Lioems Lew Iv IM
IdbwnO �ae+on (Setlion ]031.5 Buaiia� end Prdwqm CoM: MY W a cauM' xliitl� n0uim s G�X lo wnsWci. Mx. impo++.
demdih, a rapai eny ewnuro. pia ro 4 ie�uuo, a4o rpwu the appliraN tn wrJi pertnE to fJs e NpnW MaterteM Nq M w sM
h liamsd W�1 to �M pewis'vu d IM CON�atlaa lieave law IChapr B(mmm�nonp wGh 9epion'l000) d DN6ion a d IM
Buvinea enC Prdeaaiwa COEe� a thu he a 4ro u eaamq Iherehom aW tM Wao la Ns dlped evempion. My vioblun d SW un
10�1.6 bY a^Y eD0liunl lw a parmit wbjods tle epplicp�t b e avd pendry d iM mas ihen Ma hunEled do0us �SSOOp.
Q I.mownerdlMpropenyormyempM��i�rpaanthsdsmmpe�mtion.WlldotMxwk.endlMsUuciurecndNtaMaE
a MxaE br eeb (Sw�ion 10u. Bue'uruand PMauon CaAe: Tha CON'erlon Liw� Lew daas M WWYto en owner W popm/
wM Wida n'vnprtr+ea �haean. end who daae ush xak h'vnsetl m MeaN a Waq� he a Mr own empbyee+. povHeE �het eue�
imponmems ms nd inieMaE a dlaad tp eeb. tl. hw�owr, �hs bdldinp a inpvwn�N b wltl wNNn ar ymr d mmquion, �M
awMr-0uilGr L heva tM dnden d pwinp M a qr 6tl m� deld a'vnpw� la iM qvpou al oMl.
� 1. m oxnar d Ihe V�W!M. am udumMY mm�etl�p xilh Ws�d mntrrton m mmbud iha p4b (bwion ION. &oiiw� eM
Profaqiom CaGe: The Canmaan Licanw taw tlw m� eGN/ b en oww W PWMY Mw build� a impv+u Ihereon eM wlq
eonbM� la arA P�d�+ wdh � mNreCM�) fumy Pm�yq m tM Caqexta� llo�en� le'M.
� I w axemq uMu Sxtian: B. 8 P.C.. br Nu ruwn:
DMe: On+wr.
I do �+isby cMiM WI I em awen d uA ivdrs�enE iM niw'wnaib d CdiaNe Maetrh ud BehtY CaG� SWbm 25505. Y55�]. W
256�1. ud Ihel I a eiry hrtun EuiN'up oonWu�t xill / wil na (�Y one) roaE ro oomply wth Wd m�a ooEp uM IM rpulnmaM� br
epertnilfaeoruvu/cl�y/ modifui ho/mi1qA'r u ly yupemx%upp na.9 ridxuiel/pm� prWbneppiWiwuenavemptlmmNew
pror�'ona. I . I /. !�� ✓ / _ / // �—.
J/WIKER'8 COMiENSATION DKWiATION: I Mr�py yrym �y p�py d pMW ar d Ur IWpWlpb Eadeiatbm:
� IhewuMMlmdiv�eeantl"r,p�dmwWb�atl�ro�v�brwaksimnpriWbn.aporiaisiabyBWionY/OpWiMlebor
Cod�. la IM palmrorc� d IM wM1 b wlic� Ne pmd u Iousd.
� IMnaMwllmeiMenwaY.�n'aomP�ianMWrana.n�pimMMSaaim9l00d�MleborCoh.bIMP��edIM
wak ta r.t�kh Nu n�ro b muW. NY Maten' �mpnnion hmnanc� unNr rd D�Y mimNr en:
Cemer:
Pdiry NumWr:
!hu uaion rreM nd M mnWand l tM pmr! u b aw �uMM CWan (5�00) n lew.l
� I cenW Nn in iM M��� a�M wak 1« whMl� �Iw p�mp o imwd. I dWl nq �mplvy erry panan In ury menno w u m
w�om. wa.= �o �n. •w�.�� �o.�..�� 4w� d Cddanu. uM e0M Ntl G I 4wuW bcmw wMatl lo ih� ,w�.�
compeneetbn pmviebne W Setlbn �)00 d th� lApa ���. I ehell fonhxilh wmpty xMh Raw pmvidm�.
Daia: Aop�:
W�mlrp: F�Nun ro��cwv roA'�n'romprwtlon o�wp� �i ��yw/�( �y y�/�Wp�� ur �rrployn ro u1rNrW ppMltlu �nJ
�nn nn, w ro on. n�e�.e mowu.a eorr� (rioq000a M.mmo� ro m. co.r o� �oma.�wrron e.mro�• .. nro.ro.a ro. in
s.cuon ame o� m. L.eo� coe.. �nru..c me.rcom.yy ry.,.
,
CON9TAUCiION LQIDINO �GENCY: I hwWy dfnn ivdr pruRy d ps�ry thtl Ilr� u� amq�udion MMinp epancy lar iM
y..rorm.nc. a �n. Mvx w...tutl, �nu v«m� b:w.e (s.aion bDl. civ. c>.
LENDER'S NAME
LENOEN'S�ODNES4: REMOVE ILLEGALY BUILT
I caMY ihtl I heva neE Na e0diraiian N�Wi_JR0 � atlals3damqid� b~ia3ed.,f�ae �ocomON vNh atl mf' eM mumy adinenu�
enE �bia levn rNmnp io butld'sq wnmuCim dd hera4y eiahoe¢s nperoNaiw al lhe my to eMr upon tM ebo.a-maMqepd popqy
tw leuo�a^ v�rwb..
TADAO ItAM I YA
v�1�ryA �. (/
.. _ .. AR—li:� Daa: � �a �
G ...__ _ of_.!_ �__`__.LY_.
(S15tJp.WP) �a�b�qdSdMy:Gns�Fiy:Canery-AppkaN:Pinkaiwaru»:(3oWeruoJ-Nuaw
CITY OF COSTA MESA - BUILDINC PERMiT
PERMIT NO: P 074643 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU
JOB DESCRIPTION : OER AOUSING CODE VIOLATIONS
CLAIM VALUE:
CALC-VALUE:
PERM �10: P 0'7464:
GOVT: N SUPP: N
PURPOSE: OTH
SQ F`T:
GROUP OCC: R-3 /
COMM£NTS: DEMOLISH KITCHEN BRING BACK TO ORZGINAL LEAVE WASH HASIN
1E iF if !k iF iE if !E iE 1F it fF iE iF # iF # IE 1E # 1E iE 9c # iE if ik iE if if M-9E �)E iE IE if if �E iE if iF fF 1E 3F ik iE if� iF iE iE iE iF iE iE �E �f 1f 1E 1E If iE iE # iE iE df �F # iF iE iE iE ik iE if ## 1E #
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 ItJ REAR; FT IN FRNT: FT IN REAR: FT ItJ
LEFT: E'T IN RGHT: FT IN LEFT: FT IN RGHT: FT�, IN
PARKING REQ• PROV: PARCEL: 42417210 ZNE: REF NO:
PLANNING NbTES> _
> L+ �
i(� iE if iE iE iE 9E if if 1E �E �lE if 3E iElE iE iE iF 3E 3E jf iE 1E �E 1E 1f iE iE iE iE if iE 9E 3E iE 1E 9E iE 3F i(� 1E �If !! iE iElEif iF iE iE iE iE iE iE iE iE jE ff-1f !E 1E �)f 1f -If �E iE iE iE iE iE if iE if 1E if iF iE #
D E V E L O P M E N T S E R V I C E 5 i� R E Q U I R E M E N T S
ZONING APPROVED BY � DATE:
HUILDING APPROVED BY
DATE:
APPLICATION ISSUED BY: �'� DATE: "! J— I(�'P��
dE IE iE iE if iE aE iE iE 1F 1E iE �E 7F if iF aE i! iE jE 1E iE R iF iE 161E i6 ik iF iF iF if ik�% �3f #�c iFif ik
LEGALIZATION:N F E E SL, �M�M A R Y,� �_ STRUCTURP;L SEGMENT:N
V � _ �
HLDG PMT PLUMBING ELECTRZ�C -�N[E�HANiC �� � r•zxE ��� SMIP/RES GRADING
PERMIT 28.00 � � '"
25$ � ' � � : �' � �- ^ SMIP/NON-RES
PLAN : �' - : i% %' 1�
ISSUE FEE 20.00 � ` `• '� � ; i� /� ^,i "'
BUILDING-DIV-> PERMIT ISSUE PLiAN-CFiECK �',� �'OTAL '� �, PAID DUE
TOTALS----> 28.00 20.00 � 0�,00 , � �'48�00 ly � 48.00 ,OU
REVENUE DIVISION TOTALS--> COL�ECT�D: �" 48,r-'06 Ol'£R/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC "�'I�E i�S�?iIP/TJIT 7 QRADING PLAN-CHECK
48.00 "" r
�i r' / � /
,� v r/� �� ' �
iE1EiEiEiEiEiElEiEatltlERlEiEiFifIF9Fk3E�1E9EiEi63EdFiEiEitifiEifiFiE3EiEf�aif3E�eiF�.�EfE}iE9t �N�IEiFiF.dFiEif3E�.iE�iEM��iEiEKiiEiE3fiEiEjfiEfkiF�EiEi1��EiEifie
I N D I V I D U A �, 'F l.E � �nB�R''E �'A� K D�:O�W N
.. 1' ii �� l
TYPE QTY D E S C R I P T I O; N �: r•� � ti[�NIT �C 51� TOTAL COST
� ;• � �/ � ' 1
PLU 2 WASH BASIN (SET) ^ ��� .- � ?``� �ap ia.00
PLU 1 REPAIR/ALTER DRAINAGE/VENT�PIPII� �'7�' `7�0 7.00
PLU 1 WATER RE-PIPE '' _. �y^,'�-; �`,7.0� 7.00
-�ND%�OF F�S i 7 � � �)
! , � i � � '-_/
� � �J :
� � l y � j I �
�' � I'X l %�
f= 4�� '"' � O1 0019�3`:-�915235: i� T
; �� � " �J i PA7E: iD.--'v: 'IP�s ?4::7
'� 1 w.
/
Yu.Uo
r
- - .i
l CONSTRUCTION AND PIANNING � POO SPA
.APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
'' t. Temporary Electriwl Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrica� Conduit-Undrgrnd. 55.' Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test `
6. ElectricalUFERGrnd. 57. APPROVALTOCOVER�GUNITE
7. Footings 58. Elettrical 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 �, �
' 11. Property Sewer Line & House Connection 62. Backwash & Receptor•Final
12. Sewer Cap 63. Heater & Vent-Final
• 13. Roof Drains 64. Plumbina System • Final
14. Rough Pfumbing 65. Electrical-Final
15. Rough Electriwl-Conduit 66. Solar SYstem-Final •
i6. Rough &lectric Wiring . 67. Fencing & Access Approvai .
17. Rough Wiring Si9n 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Neating & Air Conditioning FIRE OEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS ' Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Oucts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Freming 73. Undergrnd. Storaye Tank � Gas ❑ Oi�
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Cei�ing (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77, FIXED SYSTEM FINAL
29. Insulation 7$, fIRE PREV. FINA�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. F000 CERTIFICATE ISSUED
33. Finai EI¢ctric Notes: Z_c�' C}�- _/���� � ���T
a 4 �
34. Final Heating & Air Conditioning
/�GD_T GE' 3rCYtI12lyts0 Lfiivctr�
35. Final Gas Pipe•Test
- -/�_�1e�YsSr--,-�t���2�� �Q-�cc
36. Hood or CanoPY ' '
'� L2� /G/_z/.c�'/_ �7 r�_ _S_73t.�-�,' �'j�yj
37. Final Factory Firepiace ',
� ✓!_�c-� !-<L��zrz-Y_.
38. Final PlUmbing Z�
� - / S� ��-,�-- - �-_�'G�tz��
39. Water Service-Final
cLG/%h��_�O�T�fiv-�iY
40. Gas Service-Final n
_�v=�%2_��4`- �!. �c.
41. Solar pomestic-final � - _ /
42. Backflow Preventer
/Z- � �s ,�Ld7J��1 � 2_'�2L7
43. Backflow Irrigation �
- -� f��j�LT
44. Landscape IrriOation System
2`L��_5-� �� �� _
45. Sound Attenuation
46. Ha�dicap Regulatians
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING ��
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OP OCCUPANCY
NO Date
City of Costa Mesa
Building Safety Deporlment
P. O. Box 317
Ca��a Ma�a, Califomia
CERTIFICATE OF OCCUPANCY N� 2658 C
The Building located at 7� ��' �� ��+
has been inspeded and fo�nd to comply with the provisions of all City of Costa Mesa Ordinances applicabie thereto
for a Group 8� J Occupancy.
Use of Building $iL1af�Y �� 8'ii.4+'�-'M"4 �N_Ae
Legal Description 3�"���
($ee reverw iide for Mefea and Bound�)
Building Permit No. �� Electrical Permit No. �9 Plumbing Permit No._ �Q
Floor Load Signs have been installed as Room Capacity $igns have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. .
17050. CERTIFICATE OF OCCUPANCY. (a) No apanment house, hotel, or lodging ho�se shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occ�pancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under $ec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article S.
Number of apartments 3 and/or guest rooms
ISSUED TO:
'L:I�u'7��Y < c : `F,7dP.7+it
•
ll �' � • �A � r
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This Certificate of Occupancy $HALL BE posted in a conspicuous place on the premisus and SHAIL NOT BE removed
except by the Building Official of the City of Costa Mesa under See. 306 (e) U.B.C. Fm,,, aua��ni—ii-sa_s-s r
� � 31029
Fo� Applicant to Fill in Completely
ADIDRESS � � � W /� �y J�
OWNER /yOI��4 lT•/_ H/TLLA
MAIL /� I�+ (J�7 LO IL ��
GhIlRF55
CITV
BRANCH
ADDRESS
CONTRACTOR ��
ADDRESS �r ��-- A-��- �--
CITV��h/�Q/ r(J�A�C��'7
STATE
LIC. NO.
SIZE ��� �D
OF LOT
USE OF
EXISTING BLDG.
SIZE OF ��oa NO. OF �
NEW BIDG. ROOMS
EMERIOF WAIL ROOF' C
COVERING � �ULLp COVERIN
USE OF BVILDING AND WORK TO BE PE
r` i PG � �' ��
L.
CITV
UC. NO.
INO. OF BIDGS.
NOW ON LOT O
6+ STOFIES 2
ompo311�e.1 (p�
G
RF RMED
n pAicOO 961+� **�234.00
CT 23-G9cns:.
APPLICATION FOR BUILDING PERMIT
RECEI ED BV DATE RECEIVED DATE ISSUI
3-6y /I �I-�
_ /� _ �. P RMO�T N�
A.P. NO. (%
BUILDING � S � �U � �)
ADDRESS i d ^
OWNER
FIRE �
NE NO.OF
PLANS �
YARDSAPPROVED
MAIN BUI�DING
iOM C/� STREET)/ ��
� F
DI5TANCE BET
MAIN BLDGS.
VAR. #
C.V.P. �'+
I hereby acknowledBe that I have raatl this apPlication antl stete
that the abova information is correct antl eB�ea to comply wlih
all laws reBulaNng builtling construcNon, end 1 shall not employ
any perwn in violetion ot the workman'a companution lews ot
the Stace of Celifomia. . �
I hereby certity that I em properly IicenseC es a contractor untlor SQ. FT.
the Stata of Califomia Business entl Protassions Cotle, Dlvislcn 3, THE AMOUNT SI
Chapter 9, and that such licanses are in full force entl eftect, or I THE PURPOSE OF
em exampt from tha Orovisions of Na Stete of California Businnss VALVATION
antl Protesslons Cotle, Divislon 3, Cheptor 9.
K
SiB^atura of �j�
Permittea ���� � $ ��j �
Authorized ABent
� {r! F.
VAWE �
0
VSE OF NE �� QW/ �
BUI N� ', t(v
� YAROSAPPROVED
ACCESSORV BUILDING
BET. MAIN &
ACCESS. BlD
OATE
APPROVED
m
D o
N UNDER VALUATION IS FOR �
46LISHING A PERMIT FEE ONLV: m
¢
m
PERMIT FEE $/✓ � p U j
� m
>LAN CHECK $ �� d E
0
�3y LL
iOTAL FEE $ � � `n