HomeMy WebLinkAbout902 18TH ST - Building Permits� � i .
` CIT STA MESA � , � _,. , � -
t ��pMF'r9 BUILDING DIVIS/ON . . - .. . . ;-. ,-,.;
o. �
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Pax p14) 754-4656 • www.ci.costa-mesa.ca.us` ... _._ _._ ... �
�• FOR INSPECTIONS CALL: (714) 754-5626
�°"°°°"°fi PERMIT NUMBER: 611-00223
PERMIT TYPE B_ROOF2
APN: 42434103
-*� _
JOB ADDRESS. 903 W 1'8� TH�S�Ti�CM
vicinity: —�"'�'�
Squares: 0
STATUS:
DATE ISSUED:
ISSUED BY:
S u ite/U n it:
Valuation:
ISSUED
0810112011
CAC
$15,500.00
�
SCOPE OF WORK: TEAR OFF PART OF THE ROOD. REROOF OVER OPEN NON CONDITIONED AREA. INSTALL BASE SHEET 3 PLIES
AND CAP SHEET � ' '
NOTE:RESIDENTIqL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided�for �'�� ���� �
verification of the installation of smoke and carbon monoxide alarms by the Ciry Inspectoc See Attachment w/Inspection Card ,. -'
OWNER: CAMP6ELL, ALLEN T TR Address: PO BOX 44-B Unit:
PHONE: Ciry/State/Zip: NEWPORT BEACH, CA
APPLICANT: BARNETT,CHRIS
C103
PHONE: 714-724•'1938
CONTRACTOR: BARNETT ROOFING
Address: 126 E 18TH STUnit:
City/State/Zip: COSTq MESA, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Address: 126 E 18TH ST
City/Slate/Zip: COSTA MESA, CA
UNIT C103
License No.
License No.
License No. 661981
PHONE: 714•724-�938
CELL:
PHONE:
PHONE:
. y��.'1 �
Unit: ":UNIT
. .F ; 9 ^! : _._
Reroof Plan Check: $0.00 =� ' °j' � '
;�r,r �::��,i
Reroof Permit Fee: $265.25 � •
Reinspection Fee: $0.00 _ _ '
Bldg Std Admin Funtl $1.00 �
TOTAL FEES $266.25 �,';,•;;;
HOURS FOR CONSTRUCTION ACTIVII'Y; EFFECTIVE 3118/2010 - PER CMMC Sec. 73-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays
z
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and �related
regulations. (Ord. No. 92-28, § 1. 12-21-92) _ .
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In orqer for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections end tinal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOE %. INSPECTON TVPE ORTE INPTIALS OOE � INSPECTION ME 0� ��- �' ��' IHPIIRLS
1816 Fixed System Final Fire Prevention 208 Final Mechanical
7266 Pool Spa Final ZOB Final Plumbing � �
'� .j..
200 Final Re-Roof � 1� �) 1� 270 Final Elecirical
201 Final BIocWReWining Wall 212 Pinal Fire Prevention '
202 Final Factory Fire place 220 Final Planning Approval
203 Final Sign 222 Final Site ..-
204 Final Demolition 250 Finai Building�Occupancy '
., . ..:.fr����.m _�:,�
�
WORKERS' COMPENSATION DECLARATION:
1 hereby affirm under penalty of perjury one of the follovring declarations: �
❑ I have and will maintain a Certificate of consent to self-Insure for workers'�
compensation, as provided for by section 3700 of the Labor Code, for the
eAormance o( the vrork for whiCh this permit is issued.
I have and will maintain wUrkers' compensa�ion insurance, as required by
s tbn 3700 of lhe Labor Code, (or the DeAortnance of the wnrk for which this
pe is issued. My workers' compensation Insurance carrier and policy
mh r ` ��� i�I U �/
(Tlu ' neetlieV�e[rvndefetleNepemvisvaWedatwrenundreddouars(St00)orless)
P icv umber' � ��y`�l% l''1
i y lhat in the pedormance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I shoultl
become subject b the workers' compensalion provisions of Section 3700 of
the Lab od �s _ orthwith co�m I�[h these provisions.'
�� licanl s si '� / � �Dale y �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS
PROVIDED FOR IN SEC7lON 37p6 OF 7HE LABOR CODE, INTEREST, AND
AiTORNEY'S FEES.
LICENSED CONTRAC70RS DECLO.RATION:
I hereby aHirm Ihat I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0� the Business and Professions Code, antl
my license is in full force and eflect.
���-n � I ��e� �� .�`�
/ o racmr' B^��ure � � Oate
CONSTRUCTION LENDING AGENCY:
❑ I hereby affvm lhat lhery is a consWction lending agency !or Ihe
peAortnance of the v.ork far wfiich tNs permit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Adtlress:
SiBnamre Daie
OWNER•BUILDER DECLARA710NS:
I hereby aKrm Ihat under penally of perjury lhat I am EXEMPT FROM THE
CONTRACTORS LICENSE LA,W lor the following reason (Sec. 7031.5,
Business and Protessions Code; Any cily or county which requires a permit to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicant tor such permit to file a signed statement
thal he or she is licensed pursuant to the provisions o! the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Cotle) or thal he or she is exempt lherefrom and
the basis tor the alleged exemption. Any violation of Section 7037.5 by any
applicant (or a permit subjecls Ihe applicant to a civil penalry of not more than
fve hundred tlollars ($500�.�:
❑ I, as owner of the property, or my employees with wages as t�eir sole
compensalion, WILL DO THE WORK, and the structure is not intended or
offered tor sale (Sec. 7044, BuSiness an0 Professions Code: The Contracrors
License Law does not apply to an ovmer of properry vfio builds or improves
Ihereon, and who does such wprk himself or herself or through his or her own
employees, pmvidetl that such impmvements are nol intended or ot(ered (or
sale. If, however, the buildinq or improvement is sold within one year of
completion, the ownervbuiltler will have the burden of proving that he or she
tlid not build or improve for purpose ot sale.�.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to wnstruct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an ovmer of
property who huilds or improves thereon, and who contracts for such project with
a cont2ctor(s) license pursuam to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
S�gnawre
309-46 (3/0])
,
IDverifedbydriver liCense.
DnverslicenseNa __
❑ Yes ❑ No
Ezpires:
Venfication o( Ownership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
� I hereby cenify Ihat no excavation frve (5) or more feet in depth into wfiich a
person is require0 lo descend, vnll be made in connection with vrork authorized
by Ihis pertnit, and that no building strucWre, scaffdding, false�wrk, a demolition
or dismaNling thereof, will be more than lhirty-six (36) feet high. (Chap. 32, Grp
2. Art 2, Sec. 341. Titfe 8, Cali(omia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Satery, as noted above. unless
such person has a permit to do such work trom the division.
ApPliwnl's SignaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or /uNre building occupant need to fle and
certify a Business Plan for emergency response to release or Ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of �he California Health antl Sa(ety Code requires, with some
exceptions, that a Business Plan be file0 with the Costa Mesa Fire
Department by every business which has at any one time Ovnng a reported
year a quantity of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cuGic teei of compressetl gas
at standartl temperature antl pressure).
2. Does or will the applicant or present or future building occupant neetl to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 0! the Calilornia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hand a quantity of acutely
hazartlous materials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature antl pressure).
3. Does or vnll the applicant or present or fuWre builtling occupaN need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous ma[erials)? 0 Yes � No
(Sec[ion 25534 of the Califomia Health antl Safety Cotle provides that [he
Costa Mesa Fire Department may require the preparation, certification and
filing wilh the Fire Departmenl of an RMPP by businesses which are required
Io register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 0! Ihe Califomia
Heallh and Safety Code been fully complied with? ❑ Yes � No
5. Does or will Ihe applicant or presenl or future building occupaM require tor
the vrork which is the subject of this applicalion a permit lor such conSWction
or modification trom the Soulh Coast Air Qualiry Management District or from
any mher air polWtion control tlistrict or agency? ❑ Yes ❑ No
(Seclbn 658502 0! the California Govemment Code requires that the requestetl
infortnation he fumished on applications for nornresidential DuiWing permits�.
6. Will any part of the facility to be constructed under this pertnit be within
7000 feel from the outer bountlaries of a school? ❑ Yes ❑ No
Qt yes", ihe facility must meet the requirement of Sections 25534 and 42303
oF the California Health and Safety Code).
7. I! a pertnit from the South Coast Air Quality Management Districl or other
air polWtion control district or agency is required for the vrork which is the
suDject of this application, have all of the disclosures prescribed by Cali(omia
Health antl Safety Cotle Section 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate ot compliance from the appropria[e air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ormation given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SiB�aWre Dale
CERTIFICATE OF COMPLIqNCE AND AUTHORIZATION OF ENTRY: I
cenity under penalry o! perjury lhat I have read this appliration antl state that
the information given is correcL I agree eo comply with all state laws antl ciry
ordinances relating ro building construction. antl authonze representatives of
ihe City o( Costa Mesa to enter upon the aboveEescnbed pmpeAy for
inspection purposes. I agree not to occupy or allow occupancy o! any builtling
authorized by Ihis permit until final inspec�ion.
5� aW� q( Ovmeqs) Date
� � -�\
nd/o nonze Ap01¢ant
woxess oF ew�axc: y V L i%1 1 u TH $ T'
OWNERSNAYEIFR�O'M!: Lp1„��.jit,LL, ALLEIv T TR
wopEss 5 s"v V 1A L ILu NURL
N�.WPirRi bEACH,CA �JLbb3
J48%17L
�vv�.�uiuxc �oonEsx
ANCXRECT ON ENtlNFEN:
uu xo.:
UNT: b \ \
1NLX.OP F.N(i.'S10011E53: UM:
���5� ENGINEEREU liEVELt7PMENI' ( 714 ) 650-8200
eor+rn�croxs�uiwo 11"17 RIVERSZLE
,wo�ss N,H. CA ��� 3b8793
. 9Lb�5 urn:
LICENSED CONfNACTON3 DECL1flATI0N: 1 hereby ell�im under pa� ury ihet I em Icenaed uMer povidone d Chepler 9
(commemirq vrith Section 1000) M Divison 3 d Ihe Buaineee vM P aio e, erd my licenaa u in hll /arca eM eMed.
cmuc.No.: � uacuss: C-I o�b875.3 F.xP:
o�a: � - �«
OW NER BUIL�ER DECIANATON: I hxeby eifi�m uMer pa y d rFN'Y �� �� aTa^W �^ �� ��� �'°a lew la Ihe
Idbwip �eaeon (Sedion �W 1 S Bueibss arM Prdesebns C : y cry a aounry whidi nyuiree a parm's m mmbucl, Mx. impwa.
�; moleh.orrcparerryNrucNre.pbrloca'asueMe.ebo ' r1YyApp���laawhpsmittb5baegrwEalmemenitlutMashe
'i„?Y�Ilcenaed W9uan� ta 1M Mowpn9 d �hB Conlredore LicoNe leW �CheMx 9(cammenp�0 �th $ed'nn 1000) d Dxwbn 3 d �M
� yYj�a��y �y pralessbna Cadej or ihm he or sM ia uemq Iharaimryi aM �he bmie Iw Ihs ellepad memqion. My violelion d Sadion
��']031.5 by eny epplicent Iw e parmn aubja�e the epplicenl lo e wil p��y d �at more Ihen liva huMrad dollen �f500�).
� I,esovrtwrd�hepropa�yormyempbyemw'vhwepevolheiqWemmpenaetion,willdolhaxork,eMtheNrucNnerot'unendeA
«Mered br aeb (Seewn ]oa4. B�ness eM Prolmdma Catle: Tha Canlredae Lieanaa lew Ema �wt npply�o en owner d propeery
WIIO b11�9 M�IIMw� I�1l1lM1.11� Yl�p dOBe bIM�1 YKK�. �1ITfp� M �1BRB� Cf 1�RWQh hO IX �1tt ONTlT�. pIP/1�4 ��MI flC�l
ITWw�BM9 BIB Ild II1�BIIdBd O! CiMBd �IX eB�B. tl. �IOWA4f. ��18 b111b1119 O! TG��MX 9 8� WI1�1YI IXN i� C� COTpB1M. aIB
ow�a��m �;n n,re ma wm� a a��e na «.na db m wue «�mv� �« m. ww�e a�).
� I. n ovmar d tha pWeM. em utlwne7 mmred'n0 wilh lioabed conoacton ro cmetrup Me>qeri (Saeun ]ON. Bus'vra eM
r�a.s,�a c�: nb c«n.mo� �,.e �w me. �a eac�r a� ow�,� a a�w�r wno naa. « ��wo+� �n..o� .m wno
conVects lor such prqetle vmh e mMreda(s) IiceneeA W��� to �M Cont�eqae lioenae Lew).
� I em azemp unEer Section: B. b P.G., br Nia reeson:
Dele: Ow^^��
II da �ereby cenily II� 1 em eware d ud uMenteM iM rpuiremeMy d Cdiomie HaMh enA Salery Cotla Seqioro?5505. Y5533. eN
T55�0. eM ihat I a e�ry Mwa buikinp omipen�. will / will m� (arcb ay) � b camply wih eeN elela mdee eM iM iepuiramwNs br
eParmillamnsl�iondmodificmionhamlM1eAr�ueC�.y enW^^�m0irtrid.Rdsnieloonet�uMunePG�iduanexemqlmmtlwa
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WOqKEP'S COMPENS�TION OECL�NITON: I Mreby dflrm uM�r peraliy d parjury ms d Ma Idbxinp Esderetbm:
� I hava erd wil manten e ceiNlicele d mneam �o eell�ineuro fur ��y �penW bn, m pwidad fa by Secion 3)00 al iM lebor
Coda, lor iM pa�lormelwe d �he xnrk for which ihie permA ie i���.
� I Mve vM wil mdmen Mwka�a' mmpenselion inauruae, m reQui�ed by Sepkn �]00 d t!n Leba Coda. M �M pe�ameMe d �M
wak la xhidi Ihia pamin u evued. MY worke�e' oompnatbn inaurar�ce farrier end pdiry number are:
c�«: ('AT, i'i�MP EXPIRES
Pd'ryNumEm a47���n�s5 07I01/98
.(rhiseeaionneednanecanWstedrrnew�.wro.msnuM�sdedbra/sr law..)
� I ceMA' �d in IM pMameze d the wwk br whc� �hie psrt�n}' E 1 hell no1 ampby e�ry panon in eiry menirr m m to
became wbpQ 10 �he xoM2 compen5e�ion lewe d Cel Ifi' tl pr IM ! I eAouk be�vme euCjW to IM xo'Im�c'
compan—,=ian p=unn o/ Seeion 3)OD of the Lebor C . I 1� t mp�y xilh ihoes pmieiom.
mvie
r
oa�e: � c'� � 1. i��� A
Weminp: Felluro ro ucun wortai romperustlon ro la l��l, entl LWI �ub/�cf an �mployn ro cNMn�l pwWtle enE
elv/l nroi up ro ms huWred fhoua�nJ tlo1Nn (SfOq000 edtl/tlon ro tln cwt ol rompawWn, A�mepu u povlWtl ror In
Sxtlm 9l(16 0l fM LeDo� Cotls. lnfw4 ene ettom�Y'� Isu.
CONSTi1UCilON LENDINO AOENCY: I heraby elfum uMm peryryy d parjary Ihet ihse o e wnneuiian bnd�p epeM.Y br tle
peApmarca d tM v.wk la whiW Ihi pnmY o bauad (�� �I. CM. C).
LENDEP'S NM1E:
LENOEN'4 ADORE55:
I cenity ihm I heve reed ihis epplkeu d mme ihm ihe ebove iMa��ion is mmea. I epiae �o canvN �h ell dry eM caumy oNinencm
endstetalawsrelalinglobuildi o ^ tlioneMharabyeWlwrae�9p�¢a����WihiealytoenterupontMebova�mentionadqopeM
lorirepedion purpmee.
Dme: V , �'
(5151�IB.WP) While-Buildvq 8 Selety; Oreeo-Fle; Ceney-App!icent; Pink-Revenue; (3ddenrobbeeeaor
CITY Gr CGSIA MESA - FciJILL" INi; FE:RMII
PERMIT NV: t 08�393 PLAN CHtCK NG; N
CUNSTRUi.2'IGN TYYE: PEkMIr TYFE: r,LE
JGB LESCRZPTIUN ; SEPARATE SERVICE, MISC £'LC2 WORri
CLAIM tiALiIE: CALi:-tiALUfi:
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FEkM NU: t G85s9
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GRGIIF� OCC: ti i
CGMMENTS; "OCEAN MOLDING" MISC ELECT WGRK, Nv.bUILLIN� PtRM2I GN r'ILE
if ie ii �le iE ie i?'st iF it iF iF iF iF 3F iF iF ii iF ie iF i? i! iE iE it'sE iFiP ii ie ie iE i'r it iP ii'vi ie �f iF �eiF if if # it ii if ie iF iF�1F iF iF ieii iE 3F iF ie ie ie ii� �eid iF it ie i'r �EiE iE i7 iF iE i'r ie #
� G N I N GS �R1E�QAi7`ZriRSE M E N T 5
------------ MAIN bUILLING ---------- --------- ACCfi55uRii bi.iiLi�IN� ----------
FRN7: FT IN AEAR: Ft �IN FkNT: Fi IN kEtl�c; Fi IN
LEFr: tT IN AGHl': FT IN� LEFT: Fr ZN AGiiT: FT ilv
Pe1RRING REt�• PROV: PARCEL:�i�434iu3 ZNE: kE"r Nv:
PLANNING Nv'TES�
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iFiF ii if if i'tiF i2 iF'k iE ii if iF iF ie iF sF iF ie if iF ie iE ii*'Ir if i't iF it ie if iF iFiF ie 9E'If i'v if sF iF ie'sP iF R ii's't iE'w iF iFiF ii iF i't d't iF iF iF iF iFlf ir if if iF ie iF # iE �e')F iF iF 7i i't iF i't
D E V E L O P M E N T S E R V I C E S R E�{ U.I R E M E N T 5
Zt�NING APPROVED bit UATfi:
BUILDING APPROVEL bY : UAIE;
APFLICATIVN ISSUEU BY: uATE; �� 2-(�ppp
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bLLG PMT PLUMbINi� ELECTRZC Mk:i.HANIC FZRE 5MIP/Rt;S i;RAuING
PERMIT 110.75
SOi SMIPiNON-Rfi5
PLAN
ISSUE FEE 22.OG
bUILDING-DIV-> PERMIT YSSUE FLAN-CHECA TVTAL YAIL LUE
TOTALS----> 110.75 22.00 0.00 132.75 132.75 .00
REVENUE DIVISIUN TGTALS--> COLLECTEL: 1:f2.75 GVfik/SHGR'I: .��
HLDG PMT PLUMBING ELECIRIC MECHANIC rIRE SMIPiTGT GkAUIN� PLAN-CHECK
132,75
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I N L I V Z U U A L r E E B R E A K U G W N
TYPE QTY u E 5 C R I P i I G N i7Nli CUs7 fUTAi CGSI
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ELE
ELG
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1 SERVZCES bELVW bv� 'v ti 2"vl- 1"v�� AMr »,SG
1 SUb-PANfiL 1b,L7
3 MUTORlP�Wk APPARA?iJ5 1.1 -'10.0 HP 11,v0
fiNL GF FEES
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18-21-1997/12:47 PM/f132.75
RfATY:Bl-B814193
PERMIT:085343
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CQNSTRUCTION AND PLANNING � - - P00. �PA .
APPROVALS Permit # � -� Date I�specto� APPROVALS Permit # Date Inspector
1, Temporary Electrical Service or Pole �-. � � 52. Pool & Equipment Location % � -
2. Soil Pipe•Undrgrnd. 53: Steel Reinforcement ; .
�w3: ,Elettrical Conduyt-U2ilitV-Undrgrnd. . 54. Forms - � � - •
: �' J4 �EI'eetrical Condu,�t�Undrgmd. - . . , 55. Electrical Bonding . _ � �
.n _� �.�� ,_, .
;.;S�;�Steef Reinforcer[�;e�t � 56. Rough Piumbing & Pressure Test '
^�6."'�Electrical UPER,Gind. . 57. APPROVAL TO COVER�GUNITE - ^
� ,� :i . -n
���7y� Footings 7.v i' ' 58. Electricai Condryit,Undrgmd_ '
- �.rg; Foundation � C _� o � � 59. Gas Pipe, Q Undrgrnd., Test •
-, r �.�
c9� �Vater Pipe-Undrgmd.'� ' . 60. Backwash Line���P-Trap, O Undrgmd. � �
td. Struc.ucat FlooriSystem . - , 6t. APPROVALTO DECK ,
i t. Py operty Sewer Tine & Hous �Connection . � 62. Backwash & Receptor•Final
12. Sewer Cap '' ;L ; 63. Heater & Vent-Finai ,
13. Roof Drains . 64. Plumbing System = Final '
14. Rough Plumbing, � � 7 :65. Electr.icabFinat . , - � � .
15. Rough Electrica�Conduit-- �� . -� 66. Solar SYstem-Fina� � � , i
16. Rough Electric WiriT ";' . " � g7�, Fencing & Accej;.ApProval - �
17. Rough Wiring Sign �� � .: 68. APPROVED FOR�PLASTER�NG �
1$, RoughElectricaKSTflarCeiting , - ' �� � � -69. POOLISPASYS11'.JEMS�FINAL
� 19. Rough Heating & Air Conditioning -' '� ' ' FIRE OEPT. REQUIREMENT
- .� - ,�.i rr _ rf pty ^ :i :j'•' q
20.'Roug� F;a�'��ctor� Fir��lace =!'? ^ � k � y 'r,,r, i �APPEFbVA,L'�=� � P��Fhiit #�- •,�
;.
21..aucis,in�truyture`�,q �..'�. -S e 5 7'-+k- 70.'f'Jndergiountll-,�dro �'
J � ,L�'
22. $uc(5, Ventilating" { � '�.S .R � a �%� 71. Produ� i�in C� as u Oil
, ,, :��: r.•� s �� ,�. s*S3n � �
��t h -: � - � : � i � .�
23. �Gas P.ipe,'f�oygfl & Test . �r. ; � ��y T 2 O K�- 72. UndergrclUnA Flus"h �' ��
24. •Roof=Framing• ,J F ' �-" ' ^ �� r :> > � t `- 73; Undergrn8. Stor'�r�e TanI��O Gas ❑ OT "�
25. Roof�.Shee�thing y F� � �v v¢ O > �v 6� 7�+ Overhead Hydrn�^ ?
26. •T-BaACeiiing (5truc4ural) & tRona oat � ,� �� �� �J fi 75;� Dry Che�icpl , : �' � ';:,�-'�,�
27, rameand Flashin "" �'''z' �'' � �
,� $ � � x � i -T . ,z+c 76. Dry Stanc�PiPe �-+�b �
��
•+ 28. Lathing & Siding .-� � �� ; Q�z �% � = ' 77� FIXED� T�.�,r'`-=fINA1 _ • ^ .'.
' �I' �-� �. ..f ..' .. k � I-� [J�' d k .-� � � _
''1 ;: Q �-1 .. .. r ��� � � , a �'. Y
�" 29. Insulatio�a ;�: ,S .. �: � r 78: FIRE PREV. FIM,AL x;:� •-. .� '- ,3
:, 30. Drywall Nailing E' .� :. .t i �. .� �1EALT��'DEPT.�qEQUif���IENT
1 U ,� c,-� 4�� � I r •r , � r. a.
U t I 'K � 1' y �� - � �-' J
� 31. Plaster Br,owmCoat-,�K ,� , r:. K G� � 79. FiNAL �}ySPECLION
• 32. £�ectrica4�Power M�t'er��rinai ' K^� I � �t 80�� FOOD CERT CAfi%E I�SUED �'s
�. �� t � �r K r ,: , •r � : z r• _
33. �Fina,!',Ele�ric,. ,� � m i � �� Notes: n : � �.� � 7 � -
�� 34. �Rina�Heating�$i Air Gond'+tioning � ' � �� ' � r �K ��.4� � - �; "' `' .� -
1 ^I K Tt �Y. Y.'l J�.�.i �i � F -� !!
N 35. �inar'Gas`�Pip�??Test . ,� � � t� r+ � i � : ,�, „, �,� .�,� � _ � _;_ . . C
r�_�
�,,. -� .• . - �
36. Flood+or CanoPY -s � _•'� * '� 1 1 44 � � -. " _' '•r � F
'� a � 1 k Y ��7 K?1 �+�'
. c' �. � � Y, - s `� i. (. , �] � � �s ` �4 1 � f
y 37. �ina�; FacYory Fireplace �, _ ti � .Y � � r• Y -. �. .�
- 38. Final�Plumbing x+R �^� i � � : � I .!5 5 - v " � = "'� ---
'� / Y .-1 ti
ti y
>39.Water-Serice�FinaSk.� i •' �,^ , � ��•. ' _. f r�z. �� J
� 40. Gas Service�Final �y i.:, �^*' S f'. iTl � i4 � � r- f ^�� �
' 41 . Solar pomestioFinai" = � " � '�1 I �` � ' �_ �
k T? 1 f� r 'l�.. r.[
,- r F �.. , � 1 -
' 42. Backfiow Preve�ter� g ..� K � � � la � - x '7 -�
. ;'1 '�1 .-1 1
- 43. 6ackfiow IrrigatiorS��k �.� 5 K �, �� _ �. -; .:,,� D.0
I '� i+.Y. ' ' ' �
��q. 6andscaPe Iry9atiorxSYstem ��a] � '�� ;: .7 7 V -� z �. V �:; � •';'J � - _ .�.�
, .« .,� < ,� z�
, " ._' � � y'x' .y � { � I.w _ � X ' -1 '1 +�'• 1 ��'y K
45. Sound Attenuatiom' _•, n ,. 5
, r: r 7;r; i� * r �; •
' , �-�: l - � „ •• - - � � - '''
'46. Nandicap.Regulatians �a i x.i S : v �
i i.. e
47, �INAL STRUCTUfiE & BUIGDING * � ,� � � �`� S ` , ��
�.�' K - 1 I �F
48� F,INAL PLANNWG�F ��-� � K•�: i �` �.` .� v = - c, f�
G9'. 'Electcic Release to Etlison � � �x ': .F � ' � "' -�?
n� � R .R �7 'L � - -
.. .. k f ` J - ' _ � . '.
5.0�. G�as Release�to 5outhern Califoriaia.,riasCo I �K � � �� 7 � •���7 '� • � _ ,�
4 r - � e '. �.J..
5�,1�,. CERTIFICATE OF OCCUPANCY z k .:' � * � . � -' ' �' % ,
No. Date
:
PflOJECT ROOflESS: 9 Q z W 1 8 TH Cj T
owNeRseanie: CAMPBEL'L ALLEN T T=
aoosess: 530 VIA LIDO NOr�D � '
NEWPORT BEACH,CA .92663
5487132
AHCHIENGINEEN: flEG.NO.:
AOUHESS:
UNIT:
I1NIT:
PEHMITTEE: AQUA PLUMBING SERVICE ( 714 ) 964-2033
nooness: 19752 KINGSWOOD LN
HH CA 92646
UCENSEO CONTNFCTON OECIAflpTION: I hereby aflirm ��a� I am licensetl unGer pmvisions ol Chapter 9(eommencing wil� Section
7000) ol �ivision 3 ai Ihe Business antl Pmle55ion5 Cotle. antl my litense is in fuil btce and ellect.
ciTr uc.: �0��21/��y" Z/� STATE UC.: S S 4% Z 2 cusa
Date: _��'__/__/_�7 / Signalure�. � �
OBKEBS' C6MPEN�ATIQN �ECaRpTION: I h¢re0y a�hrm a( I have a cetli a�e ot c Sen� �o Selbin5ure or a tetli�iCale 0� Workers'
ampensation Insurance, or a cenilie0 coDY ��ereol (Sectio � 00, Lab. CI.
POLICY NO.: E%P. URTE:
COMPANY:
� Cenilie0 coOY �s here�y fum¢heG. ❑ CenilieG copy i5 lileE xil� IAe ciry BuilUing Division.
Oale: Fp0licant:
EXEMPTION fPOM WOFNEflS' LOMPENSATION OECNPATIOR (This sedion neeA noi �e campleteG ii the p¢rmi� is br one Aundretl (5100� or less�.
I cehity that in tTe pedo�mance ot lhe work br w�ich this permil is � 4 1 shall nol gmpl an er on in any manner so as lo hecome
subjec� �o I7he W� Gkeri� C/o/��OenSation Laws o� Cali�omia
Date: __�i J1�� Sipnature: � ' .
NOTICE: �I, atier rt�aking �hi5 Ceclaraiion, you 5hou10 be 0 sublecl m they orkers'p mpensation provisions ol tAe Labor
COtle. you muSl Iatlhwilh tOmpty wi�� Suth pmN5ion5 a IhiS permi� 5hall h€`eemeAr¢vOkeO.
CONSTNUC710N LENOING RGENCY: 1 nere�y aifirm ihzt there is a consimction lentling aAency 1or the peAormance of Ne work for
which Ihis permi�is i55ueA (Seclion 3097, Civ. C�.
LENOEN:
AODflESS:
OWNEB BUILOEfl DECUNRTION: � �ereby ailirm tlu� I am exempl �rom Ihe Goniracmrs' State Licenu Law for the lollovnng reason
�Section 7Q31.5 Business antl Pro�essional Coae: Pny city of County whic0 rtquires a permil to consiNCl, alteL impmve. Aemol4�, or
re0air any Slmclure, prior lo iis i55uance. also requires ihe appli[ant br Suc� permit to �ile a Signea Slatement e�ai A¢/She is licensetl
pursuam�a��e provisions olthe Lanlraclo�5' SW�e License Law(Chapler9�cammencing wi�h Sec�ion 7000�01 Division 3 oll�e Business
antl Pmfessions Code) or �ha� �e'she is exempt �hereimm an0 ihe basis for the alleged�eKemption. Any violalion ol Sectiun 7031.5 Uy
3ny applicant br a permit sublec�s the applicam to a civil penalty ol not more than tive hunUretl Aollars (5500�.
I, as owner ol ibe prOPeny or my employees witA waAes as their sole comDensation, will Ao ihe work, and ihe
❑ strucNre is n0i iniwCed o� o�fere0 �or Sale (S¢ction 70aa. Busmess and Pmteuional Catle: The Cantracmrs' Staie License Law
Ooes no� apply to an owner at a pwperly who builGS Or imprOv¢5 1�¢re0n, and who Eoes such wark hims¢IO�erSell or t�mugh
his ar her own employees. pwn4e0 I�ai such improvemenis are not intentleE or ofl¢reG br Sale. I�, �owever I�e building or
impmvemeni i5 5a10 wi�h�n one year ol cample�ion. �he owner will have �he Gurden of pmving he/S�e Eitl not 6uiltl ar impmve
for ihe purpose ol sale�. -
I. as owner ol Ihe D�openY. am ezclusively contractinp with IicenseA contracto¢ to conslNct Ihe oroie�� (Section 700d, Business
❑ and Pmlesvons COAe: The Comractors' S�ate License Law Qoes nat apDly to an owner of pmDeny who bml0.s or imDmves ihereon
and wAa wmrac�s for suc� pmjecis wii� a coniracloqs) license pursuant m the Contracrors State License Law�. 1 am aware
�hat pmal o� I�eir Worke� s Compen5aiion insurance S�aNU Ue Owvitlea to me. �
� I am exempl under Sepion: B. 8 P. C.
lor �his reason:
Oate'. Owner:
I tlo hereby cenify Ihat I am aware ol anU un0erstand I�e requirements ol Calilomia Healt� an0 Safety CoOe Sections 25505, 25533, and
2559a and ��at I or any Iuiure Uuilding occupan� will/will noi (cirtle one) nee0 io compty with saitl sta�e co�es antl the reQuiremen�s (or a
permii lor tonsimtlion o� modili4a�ian Iwm I�e Air Ouah�y Manapemenl DiSidt�. Resitlenlial con5imttion aOD���aiion5 are exeropt �mm
�hese pmvisions.
Date: AOD�icam:
I nere6y cer���y I�al I �averead�nis application an0 sta�e�hai Ihe a�ove informa�ion is corr ct. lagreeto comply with all ciiy an0 coun�y
ortlinancesantlslatelawsielalinglo�uiltlingcons�ruclionan4herebyaulhorirereD�esen�a- ol�hisci�y�oenleruponlhea6ove�mentione0
pm0er�y �ar inspec1 ion pur�^(sies. '
Dale: �/ /�`�! /_L� Sipnaiure: � _
oriver's License,ai Sociai Securitv a:
�641-46 While—DuilOing; GreB�—Cotle EnlorcemenL Canary—Applicanl: Plnk—Revenual Goltlenmtl—Assessor
C� TY OF COSTA MESA - BUILDING PERMIT PERM NO: P 05090
PERMIT NO: P 050906 PLAN CHECK NO: 00483-91 S GOVT: N SUPP; N.
CONSTRUCTION TYPE; PERMIT TYPE: PLU , PURPOSE: OTH
JOB DESCRIPTION : INSTALL HIING HEATER SQ FT: -
CLAZM VALUE: CALC-VALUE: GROUP OCC: B-2 /
COMMENTS; ELECTRIC PERMIT REQ�UIRED PRIOR TO FINAL
*�t��x��c�x��x*�**********�r�r+��er *�********���*�t***x�*�r****�******�r*�*x***�r��*�r�****
Z O N I N GS ERTEB4AUCIKRSE M E N T S.
------------ MAIN BUILDZNG ---------- --------- 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 REO• PROV; PARCEL: 92434103 ZNE: REF NO;
PLANNING NOTES>
�
�f iElE iE iF iE iF iE iF iF iE if 3f if if 3f if IF if iE if if if iE iF iF if iE if iE iE iE �f it 1E 1E iE if if if iE iE 3f iE if 3F iF iE if if if iE �F IE fE 3f iE iF if iE iF fF iE iE iE !F if if iE iF � 3E iF iE IFlE iE iE 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 APPRO��ED BY • DATE:
APPLICATION ISSUED • DATE; �.
+r�t*�r**x�**x**x�r�rx�x�*�r** �****�**�x �+�
ifiFlfif9E�E1EiElEifiEiEiFiE1EiliEifiFiEiE1E3EiEiEiE�E�E�flFiEifiEififif �EifiEififiEiFiEiEiEiEifiEfE!lfEiEjE3EiFaEiEififiElFiEifiFiElEifiEiE3EiEiEiEjf�fiflE
LEGALIZATION:N F E� S U M M A R Y " STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUMBZOO E ECTRIC MECHANIC FIRE SMIP/RES GRADING
PLAN �50 • SMIP�/NON-RES
ISSUE EEE � 3,00 '
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL � PAID DUE
TOTALS----> 2,00 3.00 0,50 5.50 5.50 ,00
REVENUE DIVISION T'OTALS--> COLLECTED: 5.50 OVER/SHORT; 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHE50
5.��
iF if iE if if iE iF iE if iE iE iF iE iE iE 1E if iE 1E iE ik if 1E iE 3E iE iE iE 1F iE iE if iE if ik i! iE if !f iE iElE iE if if * iE iE iF if ff if-ik iE 1E�F 3E iE if iE iE ff i! if if 1E 1E iE iF iElE IE iF if it lE i! if !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 TO'PAL COST
PLU 1 GAS PIPING SYS OF i TO 4 OUTLETS ,2,OQ 2.00
END OF FEES
#DUP'LICFST� REC=�.i:F'�P�:
01 40079S2?-0�074?28 � �a � �.Si}
DAT'c: �zios��i �tr,e; a�:5a
Ol Q�t�79427-�LD79923 i '-
pRTE: t73/O5/9! YbFf�n �,;.
I� � �
CONSTRUCTION ANp pLANM,.,i �OL & SPA
APPROVALS Permit # Date Inspector pppROVAIS Permit # Date Inspector
,
' 1. Temporary Electrical $ervice or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. � � 53. Steel Reinforcement
3: E.lectrical Conduit Utility-Undrgrnd. � 54. Forms �
4. Electrical Conduit�Und�gmd. 55. Elecirical Bonding "
5. Steel �Reinforcement 56. Rough Plumbing & Pressure Test .
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7; Footings - 58. Electrical Conduit�Undrgrnd.
� 8. Foundation • �. • 59. Gas Pipe, O Undrgrnd., Test ,
.
9! Water Pipe�Undrgrnd. � ' 60. Backwash Lines, P-Trap, O Undrgmd.
1�.1Structural Floor System , . �� ' 61. APPROVAL TO DECK •
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12:. Sewer Cap , ` " .- _ 63. Heater & Vent-Finai
13. Roof Drains `� .� 64. Plumbing System - Final �
1.
14. Rough Plumbing ' 65. �Electrical�Final
15. Rough Electriwl-Conquit 66. Solar System-Final � ',
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPFOVED FOR PLASTERING
78. Rough Electripl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air �pnditioning FIRE DEPT. REQUIREMENT
� � ,
20. �Rough Factory Fireplace ; ' � � APPROVAL'S Permit # , - -
21.�Ducts, in.Structure: , �.. . � � , � , . �J7p, Underground Hydro • �
22. Ducts, Venti�ating � � � _� � �77, product Piping O Gas QOiI
23.:Gas Pipe-Rough & Test . ' , � '- ` � �72. Underground Flush' �
24. Roof Framing � � � - � � 73. �Undergmd�: Srorage?ank 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 ' � ' _�� -� ,� i I 78'. FIRE PREV. FINAL .
30. Drywall Nailing . ! ; I � � �! � . • •HEALTH DEPT. REQUIREMENT
��
31. Plaster Brown Coat, ' I F,� E� ;, 79: PINAL INSPECT�ON ,� ..
� �' ': i 80. FOOD CERTIFICATE ISSUED
� 32. Electrical Power Meter-Final� I. �I�� �.
�,: . ,
33. Final Electric , ' I � �sa � 'j'' ; �No4es: , �
34. Final Heating & Air Conditioning � , � ; � � � . � . � -�
�� �' �.i�
35. Firial Gas Pipe�Test' ! i� �(i�p " � ' � � '
� !
36. Hood or Canopy •. � �I I�� ��: '
37: Final Fattory Fireplace �� � ' -
I i I ��
� 38. Final Plumbing � � . � �i ���� � .
.39. Water Service-Final � � � ' ' .-
' 40. Gas Service-Final . + 'i ! �, • _ . �
�I
41. Solar pomestic•Final � ' ' i I I� � '
� 42. Backflow Prevenier � � � I ��
43. Backflow Irrigation � , .
44. Landscape Irripation Sysrem ' - � . .
45: Sound Attenuation . � • � '� � � � �
��
46. Handicap Regulations , � � . -
47�. FIRlAL STRUCTURE & BUILDING ' j�' �
1 -�`
48. FINAL PLANNING . � ( � �'
I -;.
49. Electric Release to Etlison i .;�%i
50. Gas Release to Southern California Gas Co �: ,� , � . � -
' 51. CERTIFICATEOF;OCCUPANCY
No. Date
�
�
�ooncssaem�owa: g02 W 18TH ST
owneaswweivoawN:CAMPBELL, ALLEN T TR
` ���530 VIA LIDO NORD
_„',,;,� Sq8P03z BEACH,CA 92663
�cv� � mmwo �ooaess:
MCNRECT OP FIYdlfEP:
NCII OR EN6'S MDPESS:
uu xo.:
uxr: g
utn:
wNm�marsxu�L S W ELECTRIC ( 714 ) 830-7510
CONfFAttOPYY4Nl023%IZ VIA CHIKIPA
�oonEss:MISSION VIEJO CA uc.rro.: 353532
92691 u�r:
UCENSED CONTRRCTOPS DECL�RATION: I Mreby etl'rm uMx pe�1y M perjury Ihel I em IcenseE uMm prwiebna W Clapx e
(oommendnp wi�h Seclion ]000) d Oiviebn 9 d Ihe Bueinese arM PrWeedom Cods, aM my limnee ia in lull face eM eHed.
cmuc.r+o.pqgq92 'utc./c'uss:C-10 uc. .:353532 EXP: 00/00
Dele: �1 � � i� 1 �O CanrerJa: .Ti�� .
OWNER BUILUEP DECLANITON: I henb/ elfi�m urMer peiWy d j�ry �� ����q m �M Cau tas liro�va lew la tM
4ow*q �adon (SW ian )03f.5 Buarose end Prdevaio�u Cade: Aoy ry a muiuy xldeh g u'use e D�n �o meuwel. edx. imVrm+.
xna'o�, a ropai enY s��unwe. p'v b Ya ewerice. ebo repuims epp�'�yy Iw ux� psmut lo fYe e aproE slalemenl tlW M asM
.� IicenaM W�+�I to Iha Wovieiona d the Contreqore Lioenae w ICheptar 8(�ma�uirp Milh SeUion lWU) d Oivwion J d �M
6ueina..nd Prd.secn+ COEeI «�mm �. «.he u memq inselm�, y�e �n. bui. �a u» albpod ssanq'vn. Yn+idmion a s.aon
1W1.5 by e�ry epp4teN la a psrmn mdpCa tM appfr,enllo e ci pyupy d M mon Ihen (Ha �unEteE AoOen �55001).
� I. m owmr d ihe VOPaM a mY emVbY� wYh wWes m Ihei 9de comVenmlian. xiA do iM wM. enE Ne at'uclu�e'o M in�eMed
«en,�a ro�.�e tsaa� �aa. e�� dw rwe..:�.cma: ma can�ea. u�«,.a �. ao� �a ew�r�o N�. a wowm
�.no e�aea «mwa« mereo�..�a.n,o eoes wm .w �.ee «naw «m�cwh na «ne, o.�, «nporea•. ap+bea mm wcn
imwmemmm v. �a weMea «on.ee �« x�e. n. ro.�en.. �no ewatry « mwwa�w a.w .mnin on. v� a mmWrm. ub
owmr-0uildar vriA Mve tM buken d pwieq M or she Eid na piuy a impws la �M WNae d aebl.
� I. u oMner A tM peopeM. d^ esdmvely oonireGiq xiN limng� �vectwe io eanarue tM pqed (`�� ]ON. Buvi�wse arM
. r�w...�. coae: rna com�.aa. u�e� �. eoe, �a � m.� o�,,., d cmw�r •,�,o nnw « Mo�� �n«� ,�a .no
mnlreM la wA pqeqe wiN e cW rmor(s) IcereeE punwril to iM CoMreGas License lew�.
� I em oxampt uMar Seniore, B. 8 P.C.,1« thie reeeon:
Dme: ��
I tla hareby cerliy ihei l em aware W enA unJarsieM the requiremeMa d CelAomie HeeM1h eM Selety COJa Saclione 25505. 25533, eM
Y55�a, eM ihel I or eny M1nure builEiiq orcupent will I w11 nM (urcb qb� rwod b comply wih eeid eteta wdea end tM requiremenb M
apermulamuwnionamoddiraunhaniMA'r ue�ty ariepemm�t0ietntl.RmiAemieloonst�udioneppiWiomueezamqlvnlMsa
praririona.
De�e: ADd�I: _
W OHKEH'S CONPEN4ATON DECL�N�TON: I hereEy effum untlq pyyryy a papry dy q pro Idbr.i�q dadvmioro:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: E 077817 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE
JOB DESCRIPTION : UPGRADE ELECTRIC SERVICE TO 400AMP
PERM NO: E 077817
GOVT: N SUPP; N
SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B /
*�+Mr**�*****���*****��*+Kr�***����*�D*B��*******��**%**��*�**���D�**+r+�+sr*�*�****��*
Z O N I N G R E(] U I R E M E N T S
S E T H A C K 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: 92934103 ZNE: REF NO:
PLANNING NOTES>
i
1k 1f 1E 1E ik 1E IE iE 1E if i! 1Elk 1k 1t iE 1E 1E 1E 1F 7E if if iF 1E if 1E 1E 1(' iE 1E iE i(� 1E iE iE 3E �f 4 iE IE IE 1E iE f41E 1! �E iE 1E ff 1E k 1E 1E 1E 1E'IE fE �E k iF 1F 1E iF iE iE 1k iE fE 1ElE fElE'I!� 1E iE 1E 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:
HUILDING APPROVED HY : DATE:
APPLICATION ISSUED BY: DATE: � 2 ��'6
1FiE1E1Fif1E1E1E�1(�IEiEfElEiEiEiE141FfE1kikiF��if�7fi�iiiF�if�fiFiFiF3�{FiF{Fi�TfiF � TE��F�f�f3f�f�lflflflfiElEif�iEiEfE 3E1E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 37.50
508 SMIP/NON—RES
PLAN
ISSUE FEE 15.00
� IliewuMwilmeinlenecenMiraleWcmxmmeeMimumlaW�ere'mmpenWion,mpoMed/wbySMionJ100diMlebor HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
ca..i«in.o.n�.a��ia�n�w�na�ss,,,e. TOTALS----> 37.50 15.00 0.00 52.50 52.50 .00
❑ ina..�e,.u�w.:�.m�a.•a„�o���„�...�q,,;,.enisw�a�aoam.�m«coas.b.�rowns�wm.
worF la x1�icM1 tM pamG u iaued. MY ��n' �^G^^��^^ im�rerce urnx eM pofiry mimber ere:
c.m..: REVENUE DIVISION TOTALS--> COLLECTED: 52.50 OVER/SHORT: .00
Par�.r+�mna.: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(rnuseaiw,rm.enwm rmd.�.�eu.v�xzm�wenu�mwaab..Rroola'w..) 52.50
� I cMM ��� ��e pMmreMe d the wak br v.hch ihie psm�� u iesueA, I ehell � amploy eiry penm m any menrwr o m lo
becane w4a �o iM xorkae' canG��ion lexs d GalEwnu. tl eYres ilu� J I Jauld b oma w4� m �M Men' 1EihlEifiElEfEiEik�Eif�iEifiF�FiFiF1E1E1E1fififiEiElEiE1E1EiflfiElE�E1E1ElElEfE�El(�iE1EiEiEiEfE1E1E1E1EiEiEiEiElEjEiElElEiElEiFiflFiFiElFifiElEiEiFiflEiEififik
�c«�,.Ji�� wo.m`�'aIseaQ� nao w me �m. coee. i a�,n i mwnn �or+. ��ro.. n. �.. i N D I V I D U A L F E E B R E A K D O W N
De�e: ""1 � !'� Y _ f � APW'rant: '
Wem/ny:F�INnro�xuroworMri�o�«wnoo�wa+n��iwi� N(nWLr11�L/�cfen mploysrroetlMrolppultluanJ TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
elvll flM� ip N om huntlrsd thouurM GWI�n (S10J,000), M edy � p ryie to�f ol rompe tbn, Cemsq� e� pov/0M br In
sxno�sroeo�ms�worcow,mt«e�t.a�datromsv���+. ELE 1 SERVICES BELOW 600 V& 201— 1��� AMP 37, S� 37. SD
CONSTHUCl10N LENDIN� AOENCY: I he�eby elfirtn uMer penyy d perN'Y �� �� m e mnaiuubn bnNnp eperiry b iM
peno��ce a me .wn im ..nia� me roma re swae Isaao�, aw>, c«. cl.
LEN�EP'S N4ME:
LENOEP'S MDNE55:
I caniN �� I have reeE Inu epplice�ian eiM dYe thet Na ebwe inlame�p� ia cortw. I epiea to campy Mnh ell iy eM cwmy adinencee
end stale lewe mkinp io Wibvq conswaion eM Mreby eNMrixe mqeaen�elivee d Iho dty b onter upon iM ebova�mentioneE popmry
i«�v«a�+w�a�..JAMES LINVILLE
PURPOSE: OTH
(5151d8.WP)
om. 5-��-�-�
�+�W-Appirant: Fnk-Revervr:OOWm�ob-Assmwr
END OF FEES
� . i. ��1�
/ ,�/ / /� Q � � � u�n r��` �_ - . _ � .
L � V � � Ji^ •''� S
.�v� � yl�rl+�;
CC*VSTRUCTION ANP PLANNING PO� � SPA
�APPFiOVALS Permit# Date Inspector pppROVAIS Permit# Date Inspector
1, l:mporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe•Undigrnd. . ' - � 53. Steel Reinforcement
:-3:- �!e`ctl�cal Conduit Ut7ity-Undrgrnd. 54. Forms -
�.4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
��" 5ieel Reinforcement' , 56. Rough Plumbing & Pressure Test
6_,Electr�cal UFER�Grnd. 57. APPROVAL 70 COVER�GUNITE
� '7. FQotings , �- - 58. Electrical Co�duit�Undrgrnd.
-8. Foundation �. -� 59. Gas Pipe, O Undrgrnd., Test
-9-Water Pipe�Undrgrnd. � - 60. Backwash Lines, P�Trap, � Undrg.nd. '
J0. Strucwral Floor System 61. APPROVAL TO DECK '
11 . C'roperty Sewer Line & House-Connection 62. Backwash & Receptor-Finai
12 Sewer Cap '' 63. Heater & Vent•Pinal -
13. Roof Drains - � 64. Plumbin� SYSrem � Final
14. Rough Plumbing' � , - 65. Elearical�Fina� �
15. flough Electrical•Corlduit �.. � 66. Solar SYstem-Pinal '
16. Rough Electric Wiring _ 67. Fencing & Access Approval
77. flough Wiring Sign � 68. APPROVED FOR PLASTERING
78. Rough Eiectricai-T Bar Ceiling � �69. POOUSPA SYSTEMS FINAL
19. RoughHeating&AicCondiiioning • , � � �- FI.R��E�EPT.REQUIREMEMT �
20. Rough factory Fireplace ' ' - �_ RPPROVALS' Permit #
1 F �-',- �
21. pucts, in;5tructur_�v , - • � - ��� 70. -Underground Hydro
22. Ducts; Ventilafing' ' ` � "� ` 77, ProductPiping O�Gas ❑Oii
23. Gas PiPe�Rough & Test �- i,. �- T � - �'- �, 7z, 1}ndergrounU Ftush
24. �Roof Framing � �„_ r`� - 73: Undergmd.StorageTankdGas ❑Oil
25. Roof.Sheathing .� ' . - ;; .- � 74. Overhead Hydro ^ • �
26. T•Bar Cei4ing (Strutmrai) & MpnQ'coat � - 75. Dry Chemical ' . �
27. Frame and Flashinqa ._ - `,. � ; � � _ . • --
76. Dry Sta�dpipe
28. LathiPg & Siding r'r _ � � .� � 7T. FIXED SYSTEM FINA� `'
- 29. Insulation `-,,. ;� ' ;� �. 7� FIiiE PREV. FINAL r
C
30. Dryw2�l Nailing ='^ r � ' ;HEALTH DEPT. REQUIREMENT
� 31. Plaster B�owr� Coat: •_ " F ' '� 79. FINAL IM$PEC710N � _ �-
- . � �,. -
- 32. Electrical�Power MeterFinal • ' 80�.. FOOD CERTIFICATE ISSUED �
- �
_� 33. Fina3: �lectric . � '- _ � ; J, . x Notes. .. .. � . . , .
� 34. �final Heatjng$� Air Conditionirig` � .. - � ' _ ^ - - . -
u ^
' 35. Final Gas_Pipe-Test „ ' , � , . � , _ .
36. HooB�orCanopy - � �? ' . �
37. Final�Facfory Fireplace, � , - „ ' -
- 38. Final-Plumbing � � r �� � - - � ��' " ,.. �
39. Water Service�final � - ' � " �
! , _
'.40. Gas Service-Final ; , � . - � - . . -
� ,.
-�41. SolarpomesticFirial' � ' :'� � ,
,a
42. Backflow Preventer � � -, _ � � �-� -.
43. Backflow Irriyation__ � - z,_` , . , , -
44. landscape.lrr`gation SYstem - ; `T, �;; '� � 1 �r'.. i .. '
45. $ound Attenuati0ii . _ , .. , , -� ", � - '� . -
. r, •
, 46. Handicap�Regulatioqs � . . ,S �
47. F�INAL STRUCTURE & BUILDING � ' � � _ . ` '
, r.
48. FINAL PLANNING �: ' �
49. Electric Release to Edfson ;�-
50. Gas Release to Soutfiern California_Gas Co n
51. CERTIFICATE OF OCCUPANCY
No. Date
��
City of Coste Mese �
Buildinp Safaty Dpartment C E R T 1 F I C A T E D F O C C U P A N C Y • , ,
, P.O. Box 1200 . ' ��,�,�'�j
Costa Meaa, Califomia
The Building located at 902 Ginat tAth SCr�eC
has bean inspected and found to comply with'the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group F2 Occupancy. Yi
M
Use of Building Industrinl Buildine
Legal Description I16�12D-QG u
(See re�rerse side for Metes end Bounde)
Building Permit�No_ f��+�lt� Electrical PermifNo. "�953Zt.'34535� plumbing Permit No. G�nt�?
`.
Number of apartments ' and/or guest �iooms
iSSUEDTO: BuildingOffio�ial �
;
ny " i''��-r``�r� _<✓..'`�1�-
r�IL�N CAi1PBELL
v
Dace April 9. 1976
This Certificate of Oecupancy SHALL�BE posted in a conspieuous place on the premises and SHALL NOT BE remrned except by.the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. '�;,
Form BU 34 Rev. 11/70
`�.
ii
City of Coste Mese
Buildinp Sefety Departmmt
, P.O. Box 1200
Corta Mese, California
�
�
' �
. � ." ` , �Y . .
CERTIFICATE OF OCCUPANCY
ll .
� i�.
•. ,
The Building located at 902 W[ � �
2950
has been inspected and found-to comply with the provisions of all City of Costa Mesa Ordinances applicable.thereto I
for a Group � PZ Occupancy � . �P������� � - i, � � . �i
. � • -i,� �
Use of euilding Industrial Buildina �
y -
Legal Description ' T16-120-OB � � ' ` ''� 'i
.'' � . (See reverse cide foi Metes and Boundsl ' —
� . �� ' r� . .. . . I� ' . 5 . �4 ^.
•�4 , ,
Building Permit No 6�g3fl ' Electrical Permit No. 395�4_39.535 plumbing Permit No. - 4nnna �
,; , �
Number of ---'--'- ' � " —"-- ----- --- - ' " �
ISSUED TO:
�_...
ALLEN CAMPBELL ;�
Bui
e
.`�....: ...� -"'.,,�
�.
, -
This Cettificate of Occupancy SHALL BE posted in a conspicuous place on the premise� and SHALL. NOT BE removed excapt by tho
Building Official of the City of Costa Mesa under Sed 306 (e) U�B.C. �
Form BU 34 Rav. 11/70 ' �� I�I
� � � � �
� �..__� . ':y . '� _����' .
City ot Costa Meu
Development Services Department
Building Safety Division
P. O. Box 7200
Costa Mesa, Ca�ifomia
CERTIFICATE OF OCCUPANCY No. OOZ7�6
The Building located at 9p2 W_ 18th Street
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group H-4 Occupancy.
Use of Build
Legal Description_.. 424-341-03 .
(See reverse side for Metes and Bounds)
Building Permit No. B 35513 Electrical Permit No.� 35514 Plumbing Permii No._
Mechanical Permit No. M 35812 Number of apartments and/or guest rooms
ISSUED TO:
Barlen Enterprises
. � • . . - u . . . •
� � . i i %
Date Novamhar 1 R. 1 9AR
This Certificate of Occupancy SHALL BE posted i� a conspicuous place on the premises and SHALL NOT BE removed except by the
BUilding Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CrnF io15-a6 rev. i/83 White -Owner; C- �- Numerical File; Pink - Bldg. Permit File �
!
C�
\
Applleant to flll in all spaees except thosa wit�in heavy Eortler Iinas antl sign all aD0�o0riata tleclantions.
aTr'�OSTA MEGSA CONSTRU�CTION PERMIT
Pro�ect / d�ess —_ /0 Z- G-J• li� S% COS1A .✓/CfFJ
Applir�nt's Mai�li7ng� Ad�dress /
Ow�er's Name �.Cp�.4 �• CLS�I' Phone$,$:'Z�-(
PQdtess p
Arch/Eng. /-�/4�'7e'� /��RIo icense No.
Address �� C
Contractor's Nam hone G C�0 '%��
Address Imailing) � ,
/ l` i TO ^/
Ciry License No. �'—�-9��^
LIC NSED CONTRACTOR DECLARATION
I hereby a I am licensetl untler provi5ion5 ot ChartOt 9(ComTGncing
with ieCtion 7000) 0 3 0� tha Bu5ine55 antl Plof¢SSIOnS Cotle, dntl
my Iliense is In tull force antl effec .
License Clazs License No.
Date Slgnature
WORKERS' COMPENSATION DECLARATION
I nereby atfirm Ihat I have a cerNficate of consent to self-Insure or a certlficate
f Workers' Compensalion Insurance, or a certifietl mpy Ihereoi (Se<tlon
800, Lab. CJ ' �
Poiicy No. Company �
Certltletl coOY is hereby turni5hetl.
Certifietl copy is filed with the city Builtling Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis section neeG no[ be completetl if Ihe permit i5 (or One huntlretl (5300) Or
Icss).
I<erllfy that in the pertormance of the work for which this Oer 't is issuetl I
shall not employ any person in any ma ne so 5 betort�e�bjett to t�e
worker o sat �1� ws of Calitor
Date � ��� �° Si9nature � /t�"✓��
NOTICE: If, after making this tleclaration, you shoultl become sub�ect to the
Workers' Compensation Provisians of lhe LaDor Cotle, you must fortbwlth
complY '�'��h such O�ovi5ion5 or this p¢�Tit shall be tleemetl �evoketl.
CONSTPUCTION LENDING AGENCY -
I he�eby aftirT that t�ere i5 a constru<tion lentling agency fa� the perto�mance
of tne work for whith this permit is issuetl (Section 3097 Clv. C.)
l.Cntler's Name
Lentler's Atldress
OWNER BUILDER DECLARATION
I heroby aHirT Ihal 1 am exempt (rOT [he ConlydCtOr's Llcensa L.aw !Or Itle
lollowing reason (Saction 7031.5 BuSinass antl Profeislonal Cotle: Any clty or
cou0ly whlGh fequiro5 a pefmit t0 cOnstfutt, dltlr, ITPfova, tlem011sll of f8pdir
any structuro, prlor to Its issuance, also requires the ao�litant lor such Oermit
l0 file a Signetl Sldtement lhdt he/she IS IicenS¢tl puf5udnt t0 [ho plOviilO�s O/
the Contractor's Licensa Law (ChaD�er 9(cammentin9 witn Sectlo� 7000) of
Dlvlslon 3 ot lhc' Buslna55 antl Prot¢Ssions Cotle) Or Ihal he/she IS Ox¢Tpt
-herelrom antl the basis tor tne a11e9etl exemptlon. Any violatlon of Sectlon
031.5 .by any apPlicant !or a permit subjects the ap0��canl lo a civil
enilry o1 not more lhan tiva hunAretl tlollarc (5500).
� 1, as own¢r O� �ne pro0erty or my emPloYoas with wages ai thBlr sole
Com0en5aliofl, wlll tlo th¢ work, antl lh8 Stfuctut¢ IS nOt Int¢nCeA Or O/fBfOtl
tor salo �Section J044, Business anC Prolesslonal Cotle: The Contractor'S
License Law tloes not apply lo an owner ot a property who Duiltls or improvas
the�eon, antl who tlols such wo�k him5¢It/heri¢If o� tn�ouglf Ifis or h0/ own'
� employees, provitletl that such improvements are not Intentletl or offeretl tor
I�le. If, howaver, tba bullding or improvament I5 soltl wlMin ona year of com-
pletlon, tne owner will bave thn burtlen of Provin9 he/she tlIG not bui10 or Im-
r ve for the purpose of sale).
I, a5 owner of the property, am ezclusively contraclin9 wit� Iicensetl con-
ractors to constru<t tne project (Section ]044, Business antl Prof¢szlons Cotla:
The ConVactor'S �Icenie Law dOei nOt appty [O an owner ot propGrtY who
bulltls or improves theraon. antl who contracts for such oroiects wltn a con-
tractor(51 hcanse pursuan[ to tne Contrac[or•s Licanu Law). I am aware that
rool o/ thelr Worker'S Compen ��q�nqn��s�ur�ap ce shoultl ba provitletl to me.
�I am exempt untler Set[lon—��--�[-�- B. & P. C. tor tnis reason
Dat o -P ^
I nereby certify that 1 have reaa tnis applicatlon antl state that tne above
Intormation Is wrrect. I agree to comply with all clty antl county orGlnances
antl Stat¢ laws reldtlng to builtling con5 <tiOn, antl h!r¢by dutnoNze repre-
5antatives of this city���ttt o enter e above-mentionetl Droperty for
InSpection purposey �� � p�
Signzture /A i? �! O 2. -- Da[e �� Z F�0
Drivers' License or 55 3° ! � ._
+�� C
TYPE OF CONSTRUCTION LI NEW U ADD L�I ALTERATION .LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER �
DESCRIPTION OF WORK/USE OF BLDG. �!{ 'T � � ��d
TVPE OF PERMIT GRADING FOUNDATION TRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PRWECT DESCRIVTION 5p. Fr. J oCcuanrvcv
CONSTRUCTIONTVPF�1�� VALUATION$�
ZONE GRA�INGCU.VDS. ACRES
Remarks:
3er Sink
3ackflow Prevenfer
3ackflow Irrigation
3athtubs
�larifiers
Jishwasher '
�rinking Fountains
Floor Dreins .
FIOOt Sinks
uasService �Oudets'
In[erceptors
Kitchen Sink
Levatories •
P-Trap
Roof Drains
Reinspaction Fee $15
eoiier
Duct - Under Ground
Duct - Slructurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact BIL ICBO �h �
Heating System & Ducting
❑0�100,000 BTU 0100;000
Reinspection Fee � S15
-� 0865-46, rev. 5/88 White - Builtlin9: Canary - APplicanQ Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink — �� -
Sewer Cap �
Sewer Connxtion
Solar Collectors
Solar Piping ^
Solar Tank , �
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
Auto-Wash �
laue Fee
Hoad or Typel ❑
Canopy Type II ❑
Refrigeration Sysiem
�laioo,000aru Oioo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
A.P. 4^ � � — � V �
S Main Building: Accessory
E
T Front
A Rear
C Right
g Lef �
Ping. Ref. qIE Parking Ri
Plonnin9 Notes:
G�J �Y
�i� No _ . n�. T� ,
_ 6 � � ELECTRICAL
O
FEES 'lutomatic Washer � Transtormer ❑ 75-50 KW
Construction Pole Suh. ❑ 50 + KW
$ 3
FEES
$ 3
Dishwasher
Dryers ❑Gas ❑EI
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Gerbage Disposal
Generator �65 KW
5�15 KW
� Reinspection Fee � $15
DEVELOPMENTSERVICESRE�1
ZoninB APProved By
Building APP�a�d By �
APPliqtion laued BY
Meter LJup to 100 amps
Meter ❑over100ampz
Sub Panel . � �
Motors, � 0.1 HP � i'f, - 8
c. Solar �9-15 HP �1G15+
Microwave .
Pole Light .
Range,
Standing Settions
Trash Compactor
Ittue Fea
SUMMARVOF
BUILDING PERMIT $ ���j • Q7
PLAN CHECK $ �.G •��
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN.CHECK 25% $
$ 3
`�
SMIP § �' ✓ 0
PERMIT
ISSUANCE $
ENERGV P.C. S
GRADING $
MICROFILM $ $� /�,
TOTAL FEE $ / `� � "*'
01 OQDi�J82S'�D�i58�� TU-i
DATE: 09/30/88 TIiE: 06:33
?7 s.Lb�-
_' ' �
CONSTRUCTION AND PLANNING P001 ;PA
- APPROVALS Permit #� Date Inspector qppROVALS Permit # 1 Date Inspector
. Temporary Electrical Service or Pole '". 52. Pool & Equipment Location �
.
2. Soi�;Pipe-Und�rnd. � 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms `
.
4.' Elecaical Conduit�Undrgrnd. 55. Electrical Bonding
v� �. . �
5.� Steel.Reinforcement � � 56. Rough Plumbing & Pressure Test �
6. ElecTticaI,UFERrGrnd � ' 57. APPROVAL TO COVER-GUNITE - �� �
��7:�Footin�s,� ; !�1 �, 58. ElectricalConduit-Undrgrnd. ��� ,
�
8. �Founylatior,i �� � i- " 59. Gas Pipe, O Undrgrnd., Test �,,
9: Water Pipe�Undrg,nd. • 60. Backwash Lines, P-Trap, O Undrgrnd. ' -
10. Structural Floo� System ' 61. APPROVAL TO DECK
1 t. ;Prdperty Sewer Line.& House Connec[ion ' 62. Backwash & ReceptorFinal ��
i
12. �Seuven�Cap � . �I ' 63. Heater & Vent-Final �
13. �Roof�Orains , 64. Plumbing System - Final I
74,� Rtiug� Plumbing .,� � 65. Electrical�Final .
15. Rougfi Electrical-Conduit 66. Solar System-Final .
16� Rough Electric Wiring 67. Fencing & Access Approval
17 � Rough Wiring Sign 68. APPROVED FOR PLASTERING
1$. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79._ Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20: Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure �`� 70. Undergraund Hydro
22. Ducts, Ventilating ( 71. Product Piping O Gas ❑ Oil .�
23. Gas�Pipe-Rough & l'r2"st 72. Underground Flush "
�
24. Roof Framing • 73. Undergrnd. Storage Tank O Gas ❑ Oil
251 Roof Sheathing ;; -� 74. Overhead Hydro
26.• T-Bar�Eeiling (Structural) & Monocoa[ �O 4-1 � 0� 75. Dry Chemical
27. Frame�and Flashing , ` s��' 76. Dry Standpipe
28. Lathirig &•Siding 77. FIXED SYSTEM FINAL
i
29. Insula"tion - � 78. FIRE PREV. FINAL
30.�Drywall Nailing 7 � HEALTH DEPT. REQUIREMENT
31. Plas[e`r,Brown Coas. ,; 79. FINAL INSPECTION
32. Electrical Power'Nletet-Final 80. FOOD CERTIF�CATE ISSUED
. -
33. Final Electric �• Notes: Q�
34. Final Heating & Air Conditioning ,
35. Final Gas Pipe-Test �
' 36. Hood or Canopy
37. Final Factory Fireplace
38. Final PlLmbing
3�. Water Service-Final •
40. Gas Service-Final �
. .�4 ,
41. $olar pomestic-Final� .
i
42. Backflow Preventer . � ��� � ' �'"
v�
43. Backflow Irriga[ion • ' '- '
44. Landscape Irrigation System .,� •
45. Sound Attenuation • �� , i� 7 .
46. Handicap Regulations � : ,r
47. FINAL STRUCTURE & BUILDING O,3/
4R. Snr.�al Requirements Complered
49. Electric Release to Edison � l
i
ir � _
50. Gas Release to Southem Califomia Gas Co y.,. •
51.'CERTIFICATE OF OCCUPANCY .� ,�t : '
No. ' Date • �, " ' . . '
�•.
AVV���ant to fill in ali sDaces except those within heavy boraer Ilnes anE sign all aDo/ov��ate tleclarationz.
CITY OF COSTA MESA CONSTRUCTION PERMIT P�9�^^�3S f7 ^ TRACT NO. LOT NO. UNIT NO.
Prol�ct Address
902 W. 18th St. Costa Mesa, CA. ���� 6 "
Applicant's Mailing Address 1150 Main St. Irvine, CA. TVPE OF CONSTRUCTION r�Ew ADo ALTERATION REaAIR
Nie�son CORGtTU(`t10II Phone 660-9515 �CONVERSION'❑DEMOLISH ❑OTHE q,p,#
Owner's Name ' DESCRIPTION OF WORK/USE OF BLDG. �YST��
Address 1�SO MaiT1 S2'_ TYVinP� A S MainBuildi
E
Arch/Eng. License No. TVPE OF PERMIT GRADING ❑ FOUNDATIO�Np STRUCTURAL T Front
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING LfAMECHANICAL A Reef
Contractor's Name D. W. PaVne Phone 54S—S54i � �THER
PROJECT DESCRIPTION 54. FT. oCCUCArvcV C Ri9ht '
Addreulmailing) ��n5 S_ H."�l 1r7� SFlnta An,��_�_ K
City License No. OOE>3.�LS CONSTRVCTION TVPE ' VAI.UATION 5 g Left
ZONE GRADINGCV.VDS. ACRES PIng.Ref.#
LICENSED CONTRACTOR DECIARATION
I hereby attirm that 1 am licensetl untle� prOvi5iOn5 ot Charte� 9(comm¢ncinq Rema�ks: 6 '35`��'S Planning Notes:
witn section ]000) ot �ivision 3 of [he Business antl Professions Cotle, antl
mv license is in tuu torte ana ettecL z$�319
License Class � C—ZO License No.
oaEe lU Signature £or D. W. Pavne
WORKERS' COMPENSATION DECLARATION
�ereby atiirm that I nave a certilicate ot consent to self-insure or a certificate
Workers' Compensation Insurance, or a certifj;{l�opy thereof (Sect�/r��
s00, Lab. C. IN r�u�y�� j�
Pnoi;�Y No. R�8614869 Company �raltice-Sc afnitz
LYlCerlif�{ie�tl c�jopY iz hletlbw�thrthehCitl'�,+�-�p�;�il ' 9 Divlsi n.
Date�+� APPlican�'+'� � ^^^l• O w payne
EXEMPTION F0.0M WORKERS' COMPENSATION DECLARATION
(This seclion neetl not be completetl it the permit I5 fo� one huntl�ed ($300) o�
lesz).
I certNy that in [he performance ot [Ite woYk fOr whlcM1 thls pe�m�t i5 Iszuetl, I
shall npl employ any person in any manne� so as to become subjecl to the
Workers' Compensation Laws ot Califomia,
Date Signature
NOTICE: If, af[¢r making this tleclaration, you shoultl become 5ubject to [he
Warkets' Compensation pravisions of the �bo� Cotle, you must fo�thwitM1
comply with SUCh p�ovisions or thi5 PE�mit shall b¢ tleemeG revoketl.
CONSTRVCTION LEN�ING AGENCV -
I hereby affirm that there is a construction I¢ntling agency tor the pertormance
ot [hn work for which Ihis permit is Issuetl (Section 3097 Clv. C.)
L.entler's Name
�en0er's Atltlress -
OWNER BUIL�ER DECLARATION
I he�eby affl�m that I am exempt from thp Contrac[o�'s Llcense Law for Ihe
followinq reason (Sec(ion ]031.5 Business antl Professional Code: Any city or
wunty which reqwres a permit to consVuct, alter, improve, tlemolish or repair
any 5[�utture, prio� to it5 i55uance, a150 redui�es [he applicant (o� such permit
to tile a signea statement that ne/she is lic¢nsetl pursuant to the provisions of
the ConVactor's License Law (Chapter 9.(commencin9 wlth Secfion 7000) of
i[y^ivision 3 of Ihe Business antl Profes5iOq5 Cotle) o� tM1at h¢/She is ezempt
'e�etrom antl [he ba5is fOr the allegetl eXemption. Any viOlatlon o( Section
-�{��J31.5 by any applicant for a Petmit subject5 the applicant [o a civil
"`�enalty of,not more than (ive huntlretl tloll8rs (E500�.
❑ I, as owne� ot lhe prOperty o� my emplOyees with wag¢5 as [heir sole
compen5a[ion, will tlo the work, antl the s[ructure i5 no[ in[entleG or otferetl
for sale (Sec[ion 7044, Business antl PrOfessional Cotle: The Contractor's
I License l.aw tloes not apply to an owner ot a properry who bulltls or improves
thereon, antl who tloes such work nimseli/nerself or through his or her awn
employees, provitletl that such improvemeMs are not intentletl o� offere0 for
sale. If, howeveq the builtling or improverryenl iz soltl within one yea� ot mm-
ple[ion, [he owner will have [he burtlen of proving h¢/she tlld not builtl o� im-
prova Por the purpose of sale).
❑ I, as owne� ot [he proper[y, am exclusively wntracting wifh IicenS¢tl con-
t�actoRto construct Ihe project (Sec[ion ]D44, Business antl Protessions Cotle:
TM1e Contractor's LicenSe Law does not apply to an owner of praperb wlto
builtls o� improves [hereon, antl who cont�acis tor such pro)ects wlth a mn-
tract0/(51 licenze pu�suant [o the Contraclor'S Licanse Law). I am aware tnat
proof o( Iheir Worker's Compensation inw�ance shoultl b¢ provitletl [o me.
❑ I am exempt untler Section B. & P. C. for this reason
Date —
� I herGby ce
'nformation
-�tl state la
`ative5 c
Owner
I have reatl Ihis app���ation antl State Ihat [he above
I a9ree to comply w{�n all clty antl county orCinances
to builtlin9 constr4ction, antl hereby authorize re0re-
� to e/nt/% r upo the above�mentione�l' praperty for
r�.[J[A• � Data 1��19�g8
or55�
Bar Sink
Backflow Preventer
Backflow Irriga[ion
Bathtubs
Clarifiers
�rinking Fountains
°loor Drains
Floor Sinks �
3asService Outlets
Interceptors
Kitchen Sink
Lavatories
f—Trap
9oof Drains
Reinsp0c[ion Fee $15
Boiler
Dutt - Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ Multiple❑
Firepl/Fact. Blt. ICBO �h
Heating System & Ducting
❑ 0.100,000 BTU � 100,000 BT
Reinspection Fee � $15
rev. 30/84 White - BUlltling; Canary - Applicant; Pink - AGcounting: GoltlenrOtl - qssesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
U�inal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Re(rigeration System
❑o-ioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
u
FEES
$ 3
FEES
Automatic Washer
Construction Pole Si
Cooking Unit
Dishwasher
Dryers ❑Gas ❑EI
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW
��
Zone
Accessory Building:
2
O
� N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ic
I Reinspeetion Fee
DEVELOPMENT SERVICES
2aning Approved By �
Building Approved By _
ELECTRICAL .
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps �
Sub Panel
Motors �0-i HP �1'h - 8 �
Inc.Solar �9�15 HP �16-15+
Microwave
Pole Light
Range
Standing Section
15 KW Trash Compacror
$15 Issue Fee
REQUIREMENTS:
�
�
FEES
$ 3
SUMMARV OF FEES
BUILDING PEqM1T $ SMIP $
PLAN CHECK $ PERMIT
P�UMBING $ � ISSUANCE $ ��
PLAN CHECK Z5% $ � ENERGY P.C. S
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ O� MICROFILM $
MECHANICAL '�' TOTAL FEE � $ ���
PLAN CHECK 25% $ ' � �-q L},p� �7J
: ioii9is8 TII1'e:
CONSTRUCTION ANDPLANNING
APPROVALS Permit #
,1.�Temporary Electrical Service or Pole
�2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement ,
6. Electrical UFER Grnd.
7. Footings
8.,Foundation .
9. Water Pipe-Undrgrnd,
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Elect�ical-Corlduit
16. Rough Electric Wiring
77. Rough Wiring Sign
'18. Rough Electrical-T Bar Ceiling
�
79: Rough Heating-& Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing .
26. T-Bar Ceiling (Siructuraii & PAonocoai
27. Frame and Flashing
28. Lathing & Siding �
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Faaory Fireplace - �
38. Final Plumbing
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. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Etlison
�50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF QCCUPANCY
�o. Date
POOL & SPA
Date Inspector AppROVALS Permit# '
52. Pool & Equipment Location
53. Steel Reinforcement ,
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE .
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P�Trap, � Undrgrnd.
61. APPROVALTODECK
62. Backwash & ReceptorFinal�
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping � Gas ❑ Oil
72. Underground Flush �
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL '�
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION •
80. FOOD CERTIFICATE ISSUED
Notes:
0
Date .�Inspector
Applicant to /ill in all spaces excapt thosa wit�in heavY Dortler Iinas anE sign al1 avcrovriate aeclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT .
Project Addrass C(� Z 1k/ � g TH $%:
AppYcant'sMailingAddress �73-3 MO�t/,�DV/� U.v/T L
Owner's tvame � R+�'NGE T2�OL Gc7 vho�e �+4-�'76/(
Address 402 ��! . � F TH .$T �. M. 92627
ArchlEng. �' License No.
Address
Contractor'sName ZZ�NG ELEGTR/Cphone 637-30iZ
Addresslmailing) S�� S• i-i��E $ Sj• n�N�^'E
� City License No. 4'I 4'Q �
IICENSED CONTRACTOR DECLARATION
I nereby af(irm that I am licensetl untle� p�ovitlon5 Of ChdrtGr 9(Commencing
with sec[lon 7000) ot Division 3 of [he BuSiness antl Professions Cotle, anC
my license is in tull (orce antl et e . /� i.. C ry
License Class G" . License No. �r7 J��_�
�. y'Z��cie w�iLLLviW.� �
Date
WORKERS' COMPENSATION D LARATION
' hereDy affi�m that I �ave a certiticate o( con5ent to 5¢If-ipSurG Or d Certifitat¢
i Workers' Compen.ution_ Iryurance, or a certifietl �op�th N;Sac on
,00. Lab. Git i�h�'}�b�.�� COM�M� f���, ,�
Policy No. mpany
�Gertifietl cooY �s hereby turMshea.
Certi(iea co is (ile ith the cit Buil in Divislon.
!�� °��x-�i " � o
Date � -/_ — Hpo�icant
EXEMPTION FROM WORKERS' CO ENSATION DECLARATI
(This seclion need not ba completetl i! Ihe permit is for one huntlreE (E300) or
less).
� I tertify Ihat in the perfo�mance o� tM1e wo�k for whlch fhis p¢�mR is I55Uetl 1
shall not employ any person in any manner so az to become subject to t�e
Workers' Compensation Laws of California.
Date Si9nature
NOTICE: If, after making t�is tleclaration, you ihoultl become sub7ect to the
Worketz' COmpensation provision5 O( thG Ldbor Cotle, you must �orlhwith
comply with sucti orovisionz or this permlt' shall be tleemetl revokea.
•CONSTRUCTION LENOING AGENCV
I hereby atiirm that there is a construtlion lentlin9 a9ency for Ihe performance
ot the work 1or which this p¢rTi[ is issuetl (SectiOn 3097 Civ. CJ
I,Entler•z Name
Lentler's Atltlress �
OWNER BVILDER DECLARATION
' I hereby affirm lhat 1 am ezempt from the Confrac[or's Lltenze Law for the
� following reazon (Sectbn 7031.5 Business antl Professlonal Cotle: Any tity or
county whith require5 a permit [o cOnstrutt, alter, Improve, tlemolish or r¢palr
any structure, prior to ils issuance, also requires the applicant for such permit
to file a 5i9neU sta[emenl that he/sha is licensetl pursuant to the provisioni of
tne Contractor'S License law (Chapter 9(commencing with Section 7000) of
�ivizion 3 of the Business antl Protessions Cotle) or that he/she is exam0�
eretrom antl the basis tor the allegetl exemption. Any violatlon of 5¢cUon �
131.5 by any applican[ tor a permit subjects lhe applicant to a civil
� enalty ot not more than five huntlreC tlollars (E500�.
� I, as 'owner of the properly or my employees wllh wages as tM1eir sole
'<ompensation; will tlo the work, antl the structure is not intentletl or.offeretl
tor sale (Section 7044, Business an❑ 7�ofessional Cotle: The Contrattor's
' License Law tloes not appry to an owner ot a property who builtls ar improves
thereon, antl who tloes such work himseif/nerself or through his or her own
employee5, provitl¢tl that such Improvements a�e not int¢ntletl o� offe�etl (O/
. sale. It, however, the builtlin9 or improvemen[ is soltl within one year oT com-
ple[ion, tne owner will have the burtlen of provin9 he/she tlitl not bulltl or Im-
prova for the purpose of sale).
� � 1, as owner of the property, am exclusivaly conlra<ting with Ilcensetl <on-
tractors to construct the pro�ect ISection 7044, Buziness antl Rofessions Coae:
The Contractor's License law does nOt apply to an own¢r of prop¢rty who
. builtls or improves thereon. antl who wntracts for such oroiects wi[h a con-
tractor(s) hcense pursuanc ro[ne Con[ractor•5 License Law). 1 am aware [Itac
proof of [hei� Worker'S Compensation inm�ance zhoultl be provltletl to m¢.
❑ 1 am ex¢mp[ untlec Section 8. S P. C. (or this red5on
Date Owner
�I hereby c<rtity lhat I have rea�
information is correct. I a ree
antl state laws relatin to bu'
sentatives ot Ihiz
inspectlon ourpose
519nature
Orlvers' �icense r 55 �
0865-46, rev. 5/88
f state that the above
antl county ortlinan<es
e�eby auth0/iie rep�e-
onetl O�operty 1or
_� q-u-��
. _....... .._. ... . __ . .,,... �..,.
S � � �D� I �— — A.P. #� — �
TVPE OF CONSTRUCTION NEW D ALTERATION REPAIR S Main Building:
E
❑ CONVERSION ❑ DEMOLISH OTHER T Ffont
DESCRIPTION OF WORK/USE OF BLDG. I�% � ' A Rear
TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL IC Right
y� � K Left
❑ TENANT Lp`EIECTRICAL ❑ GLUMBING ❑ MECHANICAL $'
❑ �OTHER �' Ping. Ref. # �
PROJECT DESCRIPTION 5�. F 7� oCCUPANCY � Planning Notes:
CONSTRUCTION TVPE � -VALUATION $ 1 O� ,S�iYJ�
ZONE GRADINGCU.VDS. ACRES � DYLC^
Remarks: P� l� 2
R�•
Bar Sink
Backflow Preventer
Dishnvasher
Drinking Fountains
Floor Orains
Gas Service
Interceptars
Kitchen Sink
Lavatories
P—Trep
Roof Drains
Reinspeaion Fee
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Outlets 5ter Closet
� Water Heater
Water�Service
Auto�Wash
$15
Duct-UnderGround
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iC80 �
Heating System & Ducting •
❑Q700,000 BTU 0700,000
Reinspection Fee � $15
White - Building; Canary - APPi���t: Pink - ACcounting; Gottlenrotl - Assessor
laue fee
Hood or' Typel ❑
Canopy Typell ❑
�rigeration Syttem
7aioo,000eru Oioo,000
System Repair�Alteration
F ire Da mpers
Registers
FEES
Auromatic Washei
Construction Pole
Caoking Unit
Dishwasher
Dryers ❑Gas C
Fan
F.A.U.
Fixtures
OCVICf BO%CS �
Outl¢t5
Garbage Dispoul
Generator �65
5KW
Accessory
Parking Req./Provided
ELECTRICAL
Transformer
Meter ❑up
Meter ❑ov
� Sub Panel
3 Mocurs' o-
�{- Inc.Solar
Microwave
Pole Light
Range
'I Heinspection Fee � $15 I
DEVELOPMENT SERVICES REQUIR
Zoning APProved By
Building Approved By
Appflcation Issuad By
� fi
Issue Fee $ 3 ' i l� '
C�
. FEES
❑ 15-50 KW
❑ 50+KW
to 100 amps
er 100 amps
LDo �}MP
1 HP X-fl,
9-15HP�16d5+ /iYJ
Standing Sectionz
Trash Compattor �
luue Fee
�
I
N
G
R
E
U
M
T
S.
SUMMARV OF FEES�
BUILDING PERMIT $ � SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ��-- . �� ENERGV P.C. $
ELECTRICAL $ '"�v • LV GRADING $ �
PLAN CHECK 50% $ ��ICROFILM $
MECHANICAL $ TOTAL FEE $ ��
PLAN CHECK 25% $ _ _
O1 00015823-OQ015E24 TGT 243.25 `
DATE� �9/30/8$ TIPiE: C8:32 �
rF � � :
�. . \
CONSTRUCTION ANDPLANNING - � POG .SPA � �
APPROVAL5 Permit # Date Inspector AppROVALS Permit # Date Inspector
i. `Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil,Pipe-Undrgrnd. � , }, " 53. Steel Rein4orcement
3. Electrical CUnduit �Utility-Undrgrnd. � 54. Forms , ,�
4.� Electrical COnduit-Undrgrnd. � 55. Electrical Bonding .�.
5. Steel Reinforcemen[ � 56. Rough Plumbing & Pressure Test -'
i
� 6: Electrical UFEFt Grnd. i 57. APPROVAL TO COVER-GUNITE
,. 7. Footings � , ' 58. Electrical Conduit-Undrgrnd.
8. • Foundation �, � 59. Gas Pipe, O Undrgrnd., Test /� �'
�
9. YVater Pipe-Undrgrnd. � - � 60. Backwash Lines, P-Trap, 0 Undrgrnd. .,
10.'Structural Floor SYstem , . 61. APPROVAL TO DECK '
71. Property Sewer Linei & House Connection` . 62. Backwash & Receptor-Final
� i.
12� ��^'?C �P � 63. Heater & Vent-Final �
13. Roof Drains , � � ' ' 64. Plumbing System - Final _ ,
74. Rough Plumbing; 65. Electrical-Final �
15. Rough Electrical-Conduit ' Solar System-Final
;16� Rough Electric Wiring - . Fencing & Access Approval
17! Rough Wiring Sign �8. APPROVED FOR PLASTERING
�v
18i Rough Electtical-T Bar Ceiling (g 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditiioning FIRE DEPT. REQUIREMENT
20: Rou h Facto� Fire lace `
�, g Y P d(il � APPROVALS Permit #
21. Ducts, in Structure �" �� 70. Underground Hydro
�22. Ducts, Ventilating �`,� ���Vy 71. Product Piping OGas ❑Oil
23; Gas Pipe-Rou9h &�Test 4,. � 72.�Underground Flush ��'
24.' iRoof Framing .��' �� 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof heathing '! �� 74, Overhead Hydro
26. T-Ba �eiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Ory Standpipe
.K.
28. LatHi7g & Siding 77. FIXED SYSTEM FINAL
r.
�• .
29. Insulation 78. FIRE PREV. FINAL
,�
30. Dryod311 Nailing ? HEALTH DEPT. REQUIREMENT
31. Plas4er Brown CoaYj� 79. fINAL INSPECTION
32. Electrical Power NIeL'er-Final 8. FOOD CERTIFICATE ISSUED
33. Final Electric i�; ' otes: - rO
34. Final Heating & Air Conditioning ' ' �
� � fa
35. Firial Gas Pipe-Test -_
�36. Hood or Canopy
37. Final Factory Fireplace
�38. Final Plumbing `� '
'39. Water Service-Final �� ._ �,� '
40. Gas Service-Final � ', � ; �T
�41. Solar pomestic-Final� ',' • ��
� i ,1�' tt
42. Backflow Preventer-� ' - • 1��� �? �'"�
<
43. Backflow Irrigation. • �{ � ��� " ' '
i
, '; �
44. Landscape Irrigation;System . ' ,,. '
,
45. Sound Attenuation� � �' ��
� i� ,
46. Handicap Re9ulations � � ' �
47. FINAL STRUCTURE & BUILDING � - .
�
48. Special Requirements��Completed _
_49� Electric Release to �Edison - ' ' �
J I
50.�Gas Releare to Southern Califomia Gas Co _ c• i� �' �"�
i� -,
51. CERTIFICA7E OF OCCUPANCY -" ' • r ;" �' � , t .:, �
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No. ' Date � - '� � , • �' r.
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P• O. BOX 917 COHTA M68A. CALIFORNIA
For Applleanf fo Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRE88
COSTA MESA. CALIFORNIA
OWNER %y� ��i�nclL X
� T rj �/ TEL.
/Yutyc� rao.� A.i
TEL.
NO. —�
cirr
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BTATE TEI. r---- �eoAL
LIC. NO. NO. op�a�p'
81pZE^TI � ./ /✓ Y I NO,•OF,BLD69. � _ _ __"
� 88TBACK LIN6 PPOM
DESCR(PTfON =0F WORK
WALL IROOF
COVEI
I�LDING AND WORK TO I
FEE RECEIVED
SEP221961 �(,�/�-
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use O:nlv.,:�,�
er
�.
7� L� L.�J _ 1 O"'-
COSTA MESA. CALIFORNIA
ZONING
NO.OP IIBE OP NEW '
Pl.AN9 � BUILDING�(��
4-�' /oo �/ /�"ici /V��
'6-iz� - 6�
YARDS EVES
APPROVED
(CeNTBR LINe 6T.1
APPROVED
G
L
) H8A6BY AG%NOWLHO09 THAT 1 HAYB READ THIB MPLIWSION THH AMOUNT 6HOWN UNOHR VALUATION I6 FOR TH¢
ANO BTA1E TNAT TX8 �BOV¢ 18 GOHREGT ANO AGkeB M COM• pURP098 OP E9TABLIBHINO A PERMIT P¢E ONLY.
PLY WITry ��,� CITY Oq�INANCE6 AND BTATE I.AWe rtHGULATNO
9u1tnlNo CONBTnuciloN. VALUATION � O�
81GNATURE OP � �0 • PERMIT FEE $ �.+.
PERMITfq n ..�
S J� O. ALAN CHECK $
AUTNORIYED AGENT ���
TOTAL FEE
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
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OWNER
MAIL
CITV
LENDER � �
BfiANCH �—
ADDRESS --
ARCHITECT ^_ TEL.
CONTRACTpR
ADDRESS
TEL.
CITY NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE / NO.OF BLDGS.
OF lOT // 0 x I,?� NOW ON LOT
USE OF i/�
EXI5TING BIpG, ��
SIZE OF NO. OF
NEW BLDG. ROOMS STORIE:
EMERIOR WALI ROOF
COVERING COVERING
USE OF BUILOING AND WORK TO BE PERFOfiMED
I horoby acknowletlpe Mat I have reatl Nis eppllcotion antl state
tho[ the ebpve Informe[ion is corrett entl a0ree ro comply wit�
ell lews reg�lating buildinp construction, entl I sholl not amploy
eny perwn �n violaiion of xhe workmen's compensatian laws of
tha State of Celitornie.
I hereby cor�ify the[ I em praperly IiConsetl as a eonttactor untler
tha Steta of California B�sineu antl Proteuions Cotla. Divizicn 3,
Chapter 9, antl that such licenses ere in full forca and etieei, or I
am axempt irom Me prov(sions of the State of Californla Business
entl Profezsibne Cotla, Division 3, Chaptar 9.
$ipnature of T�l�
Permlttae i � •�����
AutnoNzea Ape�i
FIR
rcf. —7-71����,.00 427 na•'�; t. ���
APPLICATION FOR BUILDING PERMIT
EIV BV DAT RECEIVED DATE ISSUJ
� % /�-7-7 ��—,
ED
N _/NO.OF L USE OF NE
PLANS "V I DIN
VARDSAPPROVED YAqDS
BET. MAIN &
VAR. #`
C.U.P.#s
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THE AMOUNTSHOWN UNDER VALUATION IS FOR �
THE PURPOSE OF ESTAgLISHING A PERMIT FEE ONLY: Q
VALUATION ` /, m
�jZ/� PERMIT FEE S �/ �— j
m
$ /D PLAN CHECK $ � E
LL
TOTAL FEE $
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' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fil7 in
BUILDING C DZ w•`�� 1
ADDRE55
OWNER �e'/{�j �Y,�, y�
MAIL �
Z ADDRESS'
a cW.� ciTv � �
CANSTRUCTION
O H LENDER � �
am
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m ARCHITECT
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a w -IJO CONTFiACTOR�/.J
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Z� CITV /(�(�J'�� ua.
W O STATE I � � �I
y � LIC. NO.
�O ,J_
OF LOT / / /�J K � ��-� � �
�—
USE OF Q
EXISTING BLDG. "� �
♦
TEL.
NO.
P�U�
TEL.
NO.;S,7
CITV
UC. NO.
NO. OF BLOGS.
NOW ON LOT
'aAY 26-7,G�Pt.IOoC 846� *`* 17�.13
cr;; ^
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APPLICATION FOR BUILDING PERMIT \
REC�Iy�O BV D=TE R=CEIVED DATE ISSUED�7 �� �
G� P� �j �ZS� /
PE IT N . �
A.P. NO 0
BUILDING O� �
ADDRESS' ,- .
EcaPo.�T /Z (�
7RACT LO, BLOCK
0
FIRE
ZONE
APPROVED
ZONE_ NO.
rn P�
VARDS APPRC
' V UE _
$ s
GROUP C
DATE � �
' I
USE OF NEW `�,
BUILDING D \`�
\Y�
VARDSAPPROVED (�_
ACCESSORV BVILDING \'�
i_ �
FT. �'
n_ _ __ . _ /) ...,
V� SRE OF p NO.OF /J
z NEWB�DG. O 3 ROOMS STOFIES L,SIDE FT. FT.
a EXTEFIOF WAL ROOF R��
V COVERING '�VC COVERING �'�"��� �% REAF FT, FT.
J � E OF BVILDIN AND WORKTO BE PE%7FORMEO T� DI5TANCE BET. BET. MAIN &
a �LiN ' 'U t 1`'� � �� �� r'+'� MAIN BLDGS. ACCEa. BLDGS.
Q �f, Q �( �' VAR. # DATE
O 'd CJ�`'D i C.U.P.#� qPPROVED
� APPROVE
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UI haraby acknowledpe that I he�e reatl this application and stata
= that the ebove into�mation is cOrract and aprea to comply with �
� atl laws ragulatfng builtlin8 �onsvoction, entl 1 shall not employ .
F any person in violaiion of the workman's compensailon laws of
y the State of Celitornia.
ZI hereby certity that I am properly licensetl as a contractor untler SQ. FT.
tha Stete of Celifornia Business antl Professions Cotle, Olvisicn 3, THE AMOUNT SHOWN UNDER VA�UATION
Cheptar 9, antl that Such licenses ere in full force antl 0ffect, or I� THE PURPOSE OF ESTABLISHING A PERMIT FEE
am exampt from the provisions of the State of California Business VALUAYION
antl Professions Code, Division 3, Chap r 9.
� PERMIT FEE $
Signeture of /
Parmlttee C $ i� PLAN CHECK $ f �
a� V%
Authoiizetl ABent TOTAL FEE $
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0
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7
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� COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
P IC I�
For Applicant to Fill in Completely — Use Ink Only R � Y
gUIIDING � / �
ADDRESS W
PWNER A.P. NO.
M/>IL BUILDING . 11
ADORESS �+DORESS V
TEL. TRACT
CITV NO.
�'AN5fRUCTION
�EN�ER
gFANCH
ADDflE55
ARCHITECT TEL.
OFl ENGINEER NO
ADORESS
CONTRACTOR
ADDRESS
TEL.
C17Y NO.
STATE ' CITV
L�C. NO. LIC. NO.
SIZE NO.OF BLDGS.
dF LOT NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
OF BUILDING AND WORK YO BE PERFORMED
� 75-7�cr5��0 097 0�**328.70
.,,�
FOR STRUCTURAL PERMIT
DATE RECEIVED �o,TF �tcucr
FIRE
ZONE T
APPROVED
BY
ZONE NO.OF
PLANS
VARDSAPPROVED
DISTANCE BET
APPROVED
VALUE
c ��
DATE
USE OF NEW
BUILDING
VARDS AI
BEf. MAIN &
ACCESS. BLd
DATE
� herebY acknowlaCge t�at 1 have read chls epplication antl stete
inet She ebove Informetlon is cortect antl aprea to comply wlth
¢II lows raBulating bulltling construction, antl I shall nat employ
anV person in violation of ihe workmen'a comp¢nsation lawa of
tna Scate of Californle.
� hereby cartify that I am properly Iicansatl as a contrecior under SQ. FT.
tne Stata of Califarnia Business and Professions Code, Olvlsion 3, THE AMOUNT SHOWN UNDER VALU
Chepter 9, antl thet sueh Iicensas ara in full for<e end effeci, or 1 THE PURPOSE aF ESTABIISHWG A PERI
am exompi from the provlsions of Ne State o7 Callfornia Business VALVATION PERMI7 FEE $
entl Protossions Code, DIvlslon 3, Chaptar 9.
LAN CHECK §
Signatura of
Permittea 5 TAX E
A�ihorizatl Agent TOTAL PAID E
V `
n
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IS FOR m
ONIY: �
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Comple[ely — Use Ink Only
BUILDING .. _ _ , i , ilY-. _ wCy
OWNER
TEL.
GTV NO.
CONSTRUCiION
BRANCH
ADDRESS
0
ADOFESS
ADDRE55�76 / Re/Yo,[DS
r
o TEL.
CITV �/` �%I/��y NO.S'�'%
STATE �G6G� �_/ CITV
LIC. NO. LIG. NO.
SIZE /2�,1�s �'�7'p.0� INOWONLO/
OF LOT J
USE OF
EXISTING BLDG.
Separa[e permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
PAfO
SEP-�i-75r.ns;.�d 18�:r �aa�•��,.5�
FORSTRUCTURALPERMIT
DATE RECEIVED nerc �ewm�
A.P.NO.I��� I
OUILDING
ADDRESS �
OWNER
FIRE
ZONI
APPF
.vrvF. I IPLANS 2
N1
V ARDS APPRO V ED
MAIN BUILDING
FROM C/L STREET)
VAR. 9W
C.U.P.yW
i heraby acknowladpe thot t heve reetl this appllcation and stote
thet the ebova Informetian Is corract antl aprae to eomply with
ell lawc raBulating bulltlinp construction, and I shall not amploy
any parson in vlototion of the workman's companzation lows oi
Me Stata of Calitornfa.
I haraby canify thet 1 om proparly Iicansetl as a contractor undar Sn'
the State oi Callfornie eusineu antl Proteuions Cotla, Dlvlsion 3, THE AMOUN'
C�epter 9, entl Nat such Ileenms ara in f�ll force antl effect, or I h1E PVRPOSE
am exempt from tho provlsians of the Stata of California Business VA�UATION
entl Professions Cotle, Dlvision 3, Chepter 9.
5,a�e���, ��e, �.�� ia ��
Permlttee l $
Auihorized Agent
� -r—
IJ
VARDSAPPROVED
FT. '
BET. MAIN &
ACCE55. BLDGS.
DATE
APPROVED
��r�4_'�- iS
N
�
m
i
m
m
N
VN UNDER VALUATION IS FOR m
'ABLISHING A PERMR FEE ONLY: �
PERMIT FEE S P
N
m
PLAN CHECK $ �— o
TAX S SD LL
f
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TOTALPAID S