HomeMy WebLinkAbout912 18TH ST - Building Permits�I • �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa�l:TKIGAL PERMI I
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
812 W 18TH ST
SIDE OF FRONT UNIT B
42434104
npp�icant: PINA,MARIA E
Address: P O BOX 17452
-- " Phone>�744-425•7854-� .
ANAHEIM,CA , ��;%���� Zip- 92817 - - __
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Owner: PINA;MARIA E \- 7 f� � �
Address P O BOX 17452 ��� �'"� � t-=� _ -- �. � � �
/„�-� � ��� �� �_ �"Phone: 714-4257854 �
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� . ' ANAHEIM, CA.� /� j � - � Zip: 92817 - �
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Co'ntractor OWNER:-BUILDER
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Phone:
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ISSUED BY
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Status: ISSUED
Applied: Ot/30/2007
Issued: 01/30Y2007
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SCOPE OFPERMIT � -_ ,
TO 100A, SAME LOCATION (SIDE OF HOUSE),FOR�FRONT UNIT 8
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� � � > � �, � �. '__ _ . __ _ FEE SUMMARY \ ;
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� . , ' � QuanUty� ,l r� � �i"'_- � � � -. -�` �� Quantlty .,
� ISSUE FEE � $23.50 �= -�: . t,% '' .4 Temp Di'sl System /,Lighting \ $0.00 0 �
��, Teinpservicetest $0.00 , _ --- - -�-` - _ '-Busway/100fl - �= -� $0.00 0 '" .� ,
. Res. a/c package . $0.00 �� Standing Sedion � $0.00 0 .
NewRes(1-2.units) � $O.W � 0,�,:�M MiscElectrical,Equipment $0.00 0 '
New Res (3+units) � '^ �, $0.00 ,-10� � - -c?["S� _ �; Siansfonners up to 1 kva/kw �. $0.00 0 - �
Pool / Spa $0.00 , -�0- ='= ---� - -" --- - .. .C.,up l0 10 kva/kw ' - � $0.00 0 _ �
� .. , - , ........ . : .
---- --_ �. . .
LightingFi�s- 1 ��'1�" $0.00 �"'0 - '-' - ;..1:.......::.up'to50k'valkw ' $0.00 0 i �� � . �
Recept Outlets� -' �t�,,�,� $0.00 � 0 ......... ...,:up to�700 kva/kw , $0.00 0,="� � ,, - -
Swilches '' �, c. �. $0.00 ,� 0 ...........::..:..over' 100 kva/kw . $0.00 0�' �� � � -`
Non Res Appl , � � ; � $0.00 �, 0 Low Voltaye Equipment $0.00 0 - , �,
Res Appb ', �� $0.00 0 Low Volt Wiring System / Ckt $0.00 �� 0" �
Service to 200a � � ' , , $0.00 0 -i+� l� -Misc, Conduit $0 00 ; ;0 - � ' '
Service to 1000a i �\ � .�50.00 0 _,,.� N� ' � Misa Condudor �$0.00 " . -0 . ' '
Service over;1000a � , �� $0.00 0 ,i -, - Circus ( gen or_ride) $0.00 �� � 0 , , ,
Motors to 1hp� -�$0.00 0, � - � Circus (mech ritle�or lights)..-. �$0.00 '� 0
Motors to tOfip,�.\ - $0.00:� ; l� S.�' 0�' � - - ' -Chnslmas Tree Stand �"" � 50.00 0
Motors to SOhp _ • � �-80.00 ��� 0 - � , - Fireworks Stand ,50.00 0
Molors to 100tip � ! � $0.00� ` � -� 0 . � , ,-Other Eledrical Fee " � $0.00 � � ,
Motors over 100hp �� �/i $0,00 �' V0 _,�- , , � v � � . ` "- � - , � L�i, / �- ,
Communiwtiondrops��� �$0;00� 0�,�� .� _ " ��I,nvesLgahon:6ee� - � �� $000; � � �; � '
Sub panel to 200a � �� , 590.50 �.,A 1 � -� = ��-- cplan Check Fee", ( ; $0 00,` �, ' �
Pole Light Pkg -� � $0:00� ( ,��� 0� - - � Reinspedion Fee � `� , $0 00 % �/�
SignCircuits ' ��30.00 �;' i 0� � _ � ��
Temp Pwr Pole �, $0.00� �-� 0 . ��' �:,r I i^ � ; - `TOTAL CALCULATED FEES ESd.00"� "
IntermedPole $0.00-�`;��0���.� � ,.. , . .. ;�"�
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�'� �COMMENTS I SPECIAL CONDITIONS
NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
tor a period ot 180 days: '
INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and Iinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
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WORKERS' COMPENSAnON DECLARATION:
I hereby aNirm under penalry oi perjury one of the following declarations: ,
❑ I have antl will mei��ain e cenilicate of consanl Io self-Insure for workers' compensetion, as provitled lor by section 3700 0l the Labor Cotla, for Iha peAortnence of the
work tor which this pertnit is iuuetl.
❑ I have antl will main�ain workers' compensation insurance, as requiretl Dy section 3700 of the Labor Code, for the peAortnance ot Ihe work lor which Ihis pertnit is issued.
My workers' compBnsation Insurance carner and policy number are:
Cerrier: POliry Number:
(7his section need nof b� �P�eted i! fhe permit is ve/uetl at one huntlred tlollars ($100) or /ess.J
�j ^I cartiy ihat in the peAormance of tha work for which this permit is Issued, I shell not employ any person in eny manner so as to become subject to iha workers'
� crompansatio lews oi Califomia, entl egree t�et if I should become5 bject to t�e workers' compensation provisions ot Secti n 3700 0l iha Labor Cotla, I shall forthwith
�^—comply with t ese p� �sw . � /9 �j
Applltent�5igneture ` �� '="`a Date: � { ��/� /
}�`, s _
WARNING FAIWRE TO SEGU E W RKERS' COMPENSAiION COVEiiAGE IS UNLAWFUL AND SHALL SU&IECT AN EM OYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO dJE HUNDRED
hKK15AND DOl1AHE (5100,0001. IN ADDRIIXJ TO TME COST OF fAMPENSATION, DMl4GES PS PROVIOED FOR IN SECTION 31060F THE IABOR CODE.IMEREST, AND ATiORNE1^5 FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby eHirtn that I am licensetl under proNsions of Chapter 9(commenGng with Section 7000J of DiWsion 3 at the Busineu and Professions CaAa, entl my license is in full
force end eHecL Lic. M Cless N
Comractofs Signawre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby eNirtn thai �here is e consiruction lendinq agency lor iha peAormence of the work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Neme: Lender's AOdress:
SigneWra: Date:
OWNER-BUILDER DEC4ANATONS:
I hereby eMirtn Ihat under panalry of perjury Ihet I flm EXEMPT FROM TME CONTRACTORS LICENSE LAW lor t�e following reason (Sec. 7031.5, Business ena Profession5
Cade: Any ciry or counry which requires e permit to consiruct, elter, improve, tlemolish, or repair any sWctura, pnor to its issuance, also requires Ihe applicant for such permit
ro lile e signed statemem that he ar she is Ilcensed pursuam to the pmWsians at t�e Contractors License Law (Chepter 9(commencing with Section 7000) of Division 3 0l the
Business and Profeuions Code) or that he or she is eaempt therefrom and Ihe basis for the elleged exemption. Any violation of Section 7031.5 by eny epplicant for a permlt
s�bjecis ihe applicaM to 8 ��il penelty ot not mwe than five hu�dred dWlars ($500).)�.
i�k as owner of ihe p�operry, or my employees with wages as their sole compensation, WILL DO TME WORK, antl the strucWre is not intentla0 or ofleretl lor sale (Sec.
'' 7044, Business end Professions Cotle: The Coniractors License Law does not apply to an owner of propetly who builds or improve5 ihereon, and who tloes such work
himself or herself oY through his or her own employees, provitled ihat such improvements are not Intended or ottered for sale. If, however, Ihe buildinq or improvement is
sold within one yea! of comple�ion, ihe owne�-builder will have �he burden of proving �hat he or she did not builtl or improve for purposa of sale.).
� I, as owner ot the p�aGeriy. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to canstruct ihe prqect (Sec. 70d4, Business end Professions
Cotle: iTe contract0�s License Ww does not epply to en owner ol propetly who 6uild5 or improves thereon, antl w�o coniracts for such project wlih e contractor(s)
license pursuant to /he Contrectors License Lews.).
❑� I.a un r sac. Business and Profeu/io,ns Codejor this reason:
9ipnetu ������� 0�,� G. � 6' , /% � ate_ ' ' - �
�
Owner ID venfietl by tlnvers license. ❑ Ves ❑ No Dnver's License No� � b oi °s . �
Verilicatian af Ownership by (rype of tlacument, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavetion five (5) or more feat in depih into which e person is requirea to descend, will be matle in connection with work authonzea by ihis
permit, end that no duilding stmcture, scaHoltlinq, falsework, or demolition or tlismantling ihereof, will be more Ihan ihiny-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sac.
341, Tltle B, CalitOmia Adminislrative Code).
❑ A5 ov.•ner-builtler, I wl�l not employ enyone to do work whic� woultl require e pertnit from the Division of Intlustnal Sefety, as noted above, unless such person has e
pertnit ta tlo such work tmm tha division.
Signature: Date:
Division oi Indusinal Safery Permi� Number:
CERTIFlCATE OF COMVI.�ANCE AN� AUTHORIZA710N OF EMRY: I cenity under penalty oi perjury that I have read this application and stata that ihe infortnation given is
correct. I agree to comply wilh ell sta�e lay{s and city ordinances rela�ing to Ouiltling cons�ruc�ion, antl eNhorize representa�rves 1 ihe Giry ot Costa Mesa to enter upon t�e
ebo pmperty i ction oiilooses. I egree not to occupy or ellow occupancy of any building euthonzed by Ihi per it unlil f' al insDedion.
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SignatureOTCegefOwnei(s)'�--� � ��ete��.
Aulhonzed Applicant Date
CQOE �. INSPECTIONTYPE D� INIILELS
1616 Fixad System Final Fire Prevention
1266
200
207
202
203
20a
Pool Spa Final
Final Re-Ro01
Final Block/Retaining Well
Final Factory Fire Place
Final Sign
Final Demoiition
COUE� INSPECTIONTYPE
206 Final MBChanical
208 Final P)umhfig
210 Final Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel Builtling/Occupancy,
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INIl1UL3
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monFss a eu�oun: 912 W 18 TH S T
a.*+Eas"u'{��F�wr�Q UACH, HUNG THE
,' ' .00�+Eu: NGUXEN TAM—MINH T
� 20 COP�S HILL ST
� LAGUNA NIGUEL,CA 92677
�VPI.WJlII10 AOOHE53:
IJMXRECT OR Q!@IFFA:
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�M � CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: H 072900
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110ENSED CONTP�CTONS DEC�ARATION: I MroW eflim uMs W�Y d pujury tIW I am licsaed wds proviebru d CMqm 9
(oomme�arp rmA SMian'l�a0) q Orvisun 9 d Ne Busnen eM Pmixeom CoOe. end mY ��^*a u in Iu0lace md N1aa.
crtr uc. No.: uc. cuss: uc. No.: EXP :
Dets: Conl�ador.
OWNEP BNLDER DECLAN�TION: I lweby dfirm u�Mer pmNY d parjury Ihtl I am axemp hom iM Can'etlan Lican�� law �a Ihe
topowip �aawn (Seeun lW t.5 &niroaa enE Pmlmsioeu Code: AnYW a caumY w�'rli nGtive, e W�E lo amstrutl. eEr.'vnpo.e.
Mmd'e�, a repar eiry eVucuva; par b o eauarca, ebo ieVa� tM eppliaM la ach pemw to Rs a rypad ue�ainenl tlW M a sM
b IironeaE Wmani to IM A�bns d tlr CaXreaon �icenae Law ICheNr B(canmencnY rrith Satlian )OOU) d Oilvion 3 af �he
3ueiMae and GeWeuvn Codel a tMl hs a eM b memp therNvn uM �M baw ta tM elbpsd sasmqion. MY vbW ion d SW ion
)W 1.5 by vry apWirsni Iw e per� wbjw� IM applirsm to e ari pmdry d nol maa ihen (xe hundnE Ed�en IiSWU.
.Cl I. ee ownar M IM pmpenY or my ynpbyeae wYh weB� %+IM1ei ede ownpsneetbn. xill do �ha waA. end �M ewclun e nd inlendad
K" aoflerediarxle(Section]pN.BudnonenEPrdmeiaruCaEs:TheCoMraqonlbnaeLewdose�ateppytoenow�wMpropeM
wM Wtltle ar'unpmvn Ihereo�, vd x1w tloae euch work MmceH or heneX w ihrouph hi a her own mmdW�s. P�+� �� auch
imqovementa ero mt inland� rc d1enE fa vala. q. however. the Eultli'p a inqwemem u wN wilhin wrYm at compblion. Na
ownrLuitlx wJl hevs IM 4uNen d pov'uq M a ehe Ak M WiN a impwa lor IM puryme d eeb).
� I. m ox+rr d IM pWMY. em ssddreN wruretlnY x'vh 4oenwE canVecbn b cmmue Ns V��1(5wion'lON. &ei�w� ud
PMemaie Code: TM Ca4recm Licaw lew Jw m eOWY m en owner d pW�Y Mn Gn'Ids a imP�'w �lrcn eM wtn
conueeb far uxli pqWa wYh a mnreea(s) GcarceE pursuam to tM Caueraps Liwve law).
� I em e�emq urdr 5 qion: B. d P.C.. br Nb� fie,u��on�: � ^� /� ���/a �
Deu�. I Ov.TMr "fl w� �✓I / l// vu+a-✓' �
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I tlo MreEy cenity Met I am ewer0 d vd uMentuM iM rWuiremema d CellanMleellh and Selely Code Seeiau �5505, R55�3, ud
25S1a, uM IMt I w eny lulure Wikup ocapeni will I wil na (cvcb om) naed to comply wi� veid mme mdee eM iM mpuiromenb /a
eparmFtacwniruGionamotli0cqi�hantM�i�y vapemen10iet�Id.Raudentilmnatrudionwp�ioroaneRemqlmmiMee
povievu. ^ ,�, ///�
Data: /!l /2�f�� �UW���
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W OPKEF'S COYPENS�TON U[{UN�TION: I huaby elfiem wda pmeEy d �wjury pr d IM Idbw'vq Aedv�cm:
� 1 hew enE xil meinlan a eeM'�qe ol mruanl �o eMimwe br Moekars' oompe�tian. n pwided la Ey Sw�im 9]00 d tM lebor
cee.. �a �ne v��• a u,a nan t« w:cn �nn o�a e iowa.
❑ in.rod,e.;e�me'.�.�w,e,.�mmv.��,��.%,�wo.eWsea�sroodub�mc.caee.�«meo«ivma�mdm.
wM fa whiM Mu pamil p iesued. MY waken' comDe�+mion imurerca cvrier aM pdiry mimbm ms:
c�..:
Pdey NUmber:
Ihie eMiar med irot 6e mnW4eJ / tM pennl 'a M me hunMetl Cdlere /Si00� w/ev.)
�] I ceN/y Mm in �ha pe�lamonce W tM work br whkh ihre pem+n is iaweE, I ehell iw1 employ e�ry pe�mn in eny menner o d �o
become wbpd b �M wa�ken' canpeneelion lewa d CalHanie, erM oprea thm G I ahouM became euEjetl to iM worken'
�omw��� w��• a seao�, a�oo w m. �mo. cm.. i.ndi �onnwnn oomoN ,Mn mob p�.�...
ome: �wa�:
w.mr�a:c.aw.ro,.���.ort.�: �o�ro«�•m�eo.�..+w�,w�wna.�w.rWr«eN�*,�«ro�oyrrownwwwtl«.ne
nvu Mu w ro ar. mner.a wuaw edl+r. (tto4aroA b��n ro m. oo.r or co�nurwn wn.u.i u o.ova�C ro. �n
S�ctlm �1P6 oI �hs LeOo� Caes, lirtasst N4 ��msy'a tsu.
, CONSTNlICl10N LENUINO �QENCY: I hereW ��m under per�eM1y d perpiry OW Ihera o e canpiudion bdirp epercy b IM
perlormenm d the work Iw whiqi t�w permM n ea�ed (`�bn 309]. Civ. CI,
LENOER'S N11NE:
LRIDEN'S ADOpESS:
I cen'dy thm I hew reeE Me eppliyp� dq qme IMt IM ebova Wmnelnn a consq. I epna Io camWy vmh ell ary eM munry ad'uw�oea
uW slela lexs �NYM W MNd^Y m�mWion ud hreby eulhorae rtp�ewn�tliw� d IM Ny b eMx u0� IM abwsmanlionad popMy
Iw iiupeaion Wrpv»s.
HUNG QUACH
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(5151J6.WP)
Dete: O %% �,�
1M'ns-6uild�q 8 Se�e�Y: oreeMFib: CeneiY-�CP��: Fnk-Pmanue: GddenroE-Memaor
PERMIT NO: B 072900 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: DEM
JOH DESCRIPTION : DEMOLISH ILLEGAL WORK /kS �f71 ISO(�C! foti0tl�— SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: DEMOLISH ILLEGALY CONVERTED BEDROOM BACK TO ORIGINAL AS A GARAGE
it*ie+tit+tit****�rit*�itatititie�rie*itat�it*�x�etie**at�atit*�it�t����*et*itrtiE**�x �**�r*it*itit�r�rit+Eititatatrtitx�atit+�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
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 RE(,�: PROV: PARCEL: 42434104 ZNE: REF NO:
PLANNING NOTES>
i
1E 3E IE'Ih 1F 1E if if if if 1f 1E iE iE iE 1E IE i! if 1k if 1E iE iE iE iE 1E iE iE ih 1E 1E �E it if ff if ik if iE if 1E ik if iE iF if iE if iE iE 1ElE iE 1k 1f 1f iE 1E if 1F iE 1E i(� 1E if iE iE i(� iE 1f'1F 1E iE'IE 1E 1E 1f iE
D E V E L O P M E N T S E R V I C E S A E Q U I R E M E N T S
ZONING APPROVED BY .
BUILDING APPROVED HY :
APPLICATION ISSUED HY:
if 1E iE ii 1E 1E IE if iE iF Ib iF 1f iF 1E iE 1ElE fE iE if M
LEGALIZATION:Y
F E E S U M M A R Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
PERMIT 50.00
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 50.50 0.00 0.00
REVENUE DIVISION TOTALS--> COLL£CTED•
BLDG PMT PLUMHING ELECTRIC MECHANIC
5�.��
DATE:
DATE:
DATE: �? ZI �r1
iFifiE1E1E1E1FiE 1Eik
STRUCTURAL SEGMENT:Y
SMIP/RES GRADING
SMIP/NON—RES
.5�
TOTAL PAID DUE
50.50 50.50 .00
50.50 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
.SO
iE iE 1F ik if 1k IE iF 1E iE 1E 1F 1(� iE if iE ik iF if 1E'lE iE if 1E 1E 1E iE iF ik f41ElE'IF iF iE �F iF 1E 1E i(' 1E 1E 1F'lE'!h 1f iE'lE 1E 1E iE iE iE 1E 1E iE 1E 1E fElE fE 3E fE iE iE 1E 14 if IE 1E 1E if 7E if 1f 1! iE 1E iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMIT
EXPIRED
DATE ��" 1�' L`' `
0?. Opir,::,<.z;—u?11F�63C � o�'.` ,
DA�E: Ua;2':9=. iIii;. _':';
�� - �
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�'QNSTRUCTION AND PLANNING pJOL PA
r Date Inspector � Date inspector
APPROVA•LS Perinit # APPROVALS Permit #
�1. Tbmporery-Elecvicat Service or Pole ,� 52. Ponl & Equipment Location
:.2J r�ai4 Pipe�Undrgmd. �� 53. Sceet Reinfo�cement . .
3. Electrical Conduit Utility�Undrgrnd. � 54. Forms �
��.4. Elactrical Cond�it�Undrgmd. 55. Electrical 8onding `�
5. Steel fleinforcement 56. Rough Ptumtring & Pressure Test �_
' 6. Electrical UFEfl Grnd. 57. APPROVAL TO COVER�GUNI7E i
7. Footings 58. Electrical Cqnduit-Undrgrnd. �
�
� 6. Foundation 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 1- 60. Backwash �ines, P-Ttap, O Undrgrnd.
50. Strucmral Fioor System ,' 65. APPAOVAL SO DECK
i t, Property Sewer line & House Connection �' � 62. Backwash & Receptor-Final
72. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains '�� 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical�Conduit � 66. Solar SYstem-Final .'
16. Rouqh ElectriclViring 67. Fencing & Access Approval
77, Rough Wiring Sign , 68. APPROVED FOR PLASTERING
18. Rough Electricai�T Bar Ceiiing 69. POOLlSPA SYSTEMS FINAL I
19. Rough Heatinq & Air Conditioning . FIRE DEPT.REQUIREMENT
20. Rough Factocy fireplace � r �. APPROVALS_ Permit # �
21, Ducts, in Structure �' . � 70. Underground Hydro
22. Duct5, Ventilating`, ' .�• - �� i. 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test ' • �' 72. Undergr'ound Ftush' •
24, Roof Frarpin9�� . ' - , - .� 73. Underqmd.StorageTank.OGas ❑Oil
25. Roof Sheathing - � - � - ' � � 74. �Overhead Hydro .
26. T-Ba� Ceilin9 (StructLral) & Manocoat - ,� 75. _Dry Chemical �
27. Frame and Flashing : •� � . .. 76. Dry Standpipe
28. Lathing & Siding . ' -' `.� , - " " 77. FIXED SYSTEM FINAL -
29. Insulation � •� 7$. FIRE PREV. FINAL �' � ?---� ^�
30. Drywall Nailing ' � HEALTH OEPT. REQUIREMENT �^^�4 i
�,.A
31. Piaster Brown,Coat � , . ' . 79. FINAL iNSPECTION '. ,�"� {
' 32. Electrical Power MeterFinal � • 80�. FOOD CERTIFICATE ISSUED � !
. � � ,
33. Final Elec'tric � . ' � Noter. � '
34. Fina! Heating"& Air Conditioning" � " � - ` .
35. FinaFl�Gas Pipe-Test . � �_
36. Hood or.Canopv ' _ .
n
37. Final. Factory Fireplace . � - ~ - � - � � �
38. Final Plumbing " � � ' . . �
39. Water Service-Final ; � ` , . : � �
40. Gas Service-Finai � ^ ' . � ' ' • � ,
41, Solar pomestioFinal , , - . �
42, Backflow Preventer � � ' �
- �
43. Backflow; Irrigation ' � ' : - �
44, Landscape Irrigation System _ ' � . �� . .
45. Sound A[tenuation ,. " � � ' - - �
,
46. Handicap Regulations � ' - -
47. FINAL STRUCTURE & BUILDING
48. PINALPIANNING . � � t• . - ' ''
i
4g, Electric Release to Edison '
50. Gas Release to Southem California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No Date
I
�
\
`\
AOP���ant ta /III In all ipaces exce0� lhose wl�hin heavY �or0er lines anG si9n all apD�oD�iate Ceclantions.
CITY OF COSTA M/ESA CONST �ION P.E]R` MIT
Project Address `� �� � � S / �
Applicant's Mailingµg ddress/� � `r/��'��"L'
Owner's Name ..,/�—:�� �� Phone
Address ��� =��1 �� S�r
Arch/Eng. Licenu No.
Address
Contractor's Nam � L� ' PhonQ��eL�a+---
Addresslmaiiingl o y�'/ j- ��l��'Sl(i�V-.�[]� '% � '«.s
Ciry License No.
LICENSED CONTRACTOR OECLARATION
I hereby aftirm [hat I am Ilcensetl untler provi5ions o1 Charte� 9(commenCln9
with sectlon 7000) of Division 3 ot [he Bu5ine55 antl Prot¢sslons Cotla, anC `
my Iicense is'in (ull fp rce an�l et ect ' � ^// /�/, //j�
License Class �1f4 � � � _ 'rance w f(/ "f 7
�ate �'�Z' jS Si9nature � �
WORKERS'COMPENSATION DECLARATION
1 h<reDy atfl�m thdt I have a certificate ot mnsent to selMnm�e o� a Ce�tltiCdtG
of workers' Compensation Insurance, or a certifietl copy thereof (Sectlon
�eoo. �b. �., ,�-%a 1033 $ �
Policy No. yCompany
Certitletl cooY �z hereby turnisheE.
Cer[ifle� co y is filetl with the ci[y,�uiltl� �si A '� �
Date �� ��� APP��cant ��— ��`s�
EXEMPTION FROM WORKERS' COMPENSATION �ECL RATION
(This section neetl no[ be completetl if the permit is for one �untlretl (E100) or
less). '
I certify that in the oerformance oi Ihe work for wnlch tnis oerm�t Is Issuetl I
Shall not employ any person in any manne� so as to become Subje<t to t�te
Workers' CompensaHon Laws of California. �
. Da[e Signature
`NOTICE: It, atter making this aeclaration, you shoultl become sub�ect l0 thC
Workers' Compen5ation O�a��sions Ot Ihe Labo� Cotle, you mu5l tOrlhwilh
Comply with zuc� D�oviSiOns o� [his Oermlt shall be Oeemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aHirm that there is a consVuction lentling agency tar tna oerformance
oi lhe work (or wbich this permi[ is issuetl (SeCtion 3097 Civ. CJ
Lender's Name
Lender's AEtlress - �
OWNER BUILDER DECLARATION ' �
I nereby afilrm that I am exempt irom the CanVactor's License law tor tna
tollowing reasori (Section 7031.5 Buzlness antl Prolessional Cotlo: AnY citY or
county which requirez a pe�mil IO con5lrutl, alte�, Improve, Oemolish Or repal�
any sVUGture, O�iOr to it5�lssuance, alio.requlrEs IhG applicant for Such parmit
t0 flle a signetl Statemen[ tllat he/She IS IIC8n50tl pufsudnt to th0 PIovI5iOn5 0�
the Conlractor'S License Law (Cnao�er 9(commancing with Section 7000) ol
plviSiOn 3 0( [he BvSineiS anG ProfCisions Cotle) o� tha� he/shB is exempt
therefrom antl [h¢ �asi5 fOr lhe allegetl exomplion. Any vlolallOn o/ $ection
'033.5 by any applicant 10� a pe�mit sub�ecls lha applltant t0 d clvil
�enalty oi not more than five hundretl tlollars (E500).
❑ I, as owner of the property or my employees witn wages as their solo
compensation, will Oo tha wark, antl the structure Is not IntenOeC or oHoroa
lor ule (Section 7044, Business antl Profesiional Code: The Contractor's
License Law tloes mt apply lo an ownar Ot a p�op¢rty who,builtls or ienproves
thereon, antl who tloes such work himzetl/nersall or.throu9h his or'her own
employee5, provitled lnat zuch Improvementz are nol intantleC O/ olleretl 10r
Sate. If, however, the bulitling or ImD�ovement is soltl within one year ot com-
pl¢(lon, the owner wlll have the burtlen o1 prOving he/sne Cltl not �uild or im-
prove for Ihe pur0ose o1 sale).
❑ I, as owner of the pro0erty, am exclusively contra<tlng with Iicensatl con-
tractors to construct tne oroject ISection 7044, Business ana Prolezsions Cotla:
Tbe ConVactor's License Law does not ap01y to dn owner of property wlto
I builtls or Imp�ovez tM1ereon, antl who contrac[s �o� such projacts wIN a con-
Vac[or(s1 license pursuant�to tne Con[raHor's License Law). I am awar¢ that
proot o( [M1eir Wo�ker's Compen5ation in5urance shoultl be provitlotl to•ma.�
❑ I am exempt untler Section B. & P. C. lor thls reason
• lp [ l r
TVPE OFCONSTRUCTION NEW AOD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p *,
DESCRIPTION OF WORK/USE OF BLDG.
' S Main Buildi
TVPE OF PERMIT GRAOING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B R¢at
❑ OTHER ' � ' " A
PROJECT DESCRIPTION 5c1. FT. oCCUPANCv C Right
K Left
CONSTRUCTION TVPE VALUATION $ $
20NE GRADING CU. VDS. ACRES p�ng. Rei. #.
Remarks: Planniny NOf¢S:
$ink
Preventer -
Irrigation
ing Fountains
Floor Drains
Floor Sinks
Gas Service �
I nterceptors
Kitchen Sink
Lavamries
P—Trap �
Roof Drains
Reinspection Fee
JOUt12L5
S15
Boiler
Ducl-UnderGround
Duct - Structural
Duct - Ventilating
Exhoust System ❑ Multiple ❑
F irepl/Fact. Blt. 1 CBO #
Date Owner Heating System & Ducting
I hereby �certify that 1 have reaa this applicatlon antl state that-the above • ❑4100,0� BTU �t00,0�BT
iniormation is m�recl. t agree to coTply with all city antl County ortllnanc05
antl state laws relating to builtling consVuctlon, ana hereby authorize repre- , •
sentatives o1 [nis�City. o e uppp Ihe above-mentlonetl OJoVertY,f�
inspection pucpbs . /
Signature �ate i-a-�: �
Drivers' License or�55 � � Rainspec[ian Fee $15
1F 0865-46, rev. 30/84 White - Builtling; Canary - APPliwnt; Plnk - Accountin9: GOICenrotl • Assessor
$hoWers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Wa[er Closet
Water Heater . -.
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
00.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
§ 3
S 3
Automatic Waiher �
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A,U.
Fixtures ' '
Device Bozes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW
Fee
4820 I/02/85 � ;,.;�p :T�
� I
� Zone
�ry Building: �
Parking Req./Provided
i
I J
Z
" O
N
I
r: N
, G
R
- E
_ �
` M
,n T
S
ELECTRICAL ' � IFEES
Transfoime� � 15-50 KW �
� � O$O+KW � �
Meter ❑up to 100 amps
Meter �over 100 amps i � __1 _,
Sub Panel
Motors�61 HP�iX-8 � -
InaSolar��9-15 HP 076�15+ . �
Microwave —� - " — - '--- } '
Pole Light ' �
Range ' �
Sign
; Standing Sections �
15 KW Trash Compattor ',
$15 laue Fee � � , $ 3
DEVEIOPMENT SERVICES RE�UIREMENTS:
ZoninB Approved By
Building Approvad By �
' SUMMARV OF FEES i � �
BUILDING PERMIT $ SMIP � , g �
PLAN CHECK $ PERMIT �
PLUMBING $ -� •5��. ISSUANCE $ �
PLAN CHECK 25% $ ENERGV P.C. ,$ �
ELECTRICAL $ ' GRADING ,$ � �
PLANCHECK 50°,6 $ ' MICFiOFILM $ � � '
1
MECHANICAL $ TOTALFEE $ - S-�Ci
PLAN CHECK 25% $ � � ' � , j . � ,
�,.._ -
� CONSTRUCTIONANDPLANNING � POOL._..PA � _
' APPROVALS � Permit # Date Inspector - AppROVALS Permit # Date Insper.mr
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location ' �
,
2. �Soil Pipe-Undrgind. � 53. S[eel Reintorcement � _ �
-�3� Electrical Conduit Utility-Undrgrnd. 54. Forms
. 4:" Electrical Conduit�-Undrgrnd. � 55. Electrical Bonding �.
5. Steel �Rei�nforcement � 56. Rough Plum6ing & Pressure Test '
'6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
�7.,Footings - 58. Electrical Conduif-Undrgmd. .
8: Foundation � , 59. Gas Pipe, O Undrgrnd., Tett
,
9. Water,Pipe-Undrgrnd. . 60. Backwash Lines, P•Trap, ❑ lhidrpmd. •
10. Structural Floor System , 61. APPROVAL TO DECK
.11' Property Sewer Line & House Connection . 62. Backwash & Recepta•Fina�
• 12. Sewer'Cap 63. Heater � Vent-Final �
,,-�
13. Roof Drains � • 64. Plumbing System - Final
14. Rough Plumbing �' 65. Electrical-Fina1
15. Rough Electrical-Conduit 66: Solar SystenrFinal . �
16. Rough Electric Wiring _ � '67. Fencing & Actess App►orel - �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit# .
" 21. Ducts, in Structure 70. Underground Hydro
�22. Ducts, Ventilating 79.' Product Piping O Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrnd. �torage Tank O Gas ❑ Oil. .
25.'Roof Sheathing � - 74. Overhead Hydro � - -.
26. r-Bar Ceiling�(Structural) & Monacoat 75. bry Chemical
27. Frame and Flashing � _ 76. Dry Standpipe .
28. Lathing & Siding � - 77. � FIXED SYSTEM FINAL
29.•Insulation � - 78. FIRE�PREV.FINAL .� .
. 30. Drywall Nailing � , HEALT.H DEPT. REQUIREMENT
31.-P.laster Brown Coat 79. FINAL INSPECTION .
, 32. Electrical Power I�Aeter-Finai ' 8Q.• FOOD CERTIFICATE�ISSUEQ
33. Final Electric Notgs: . ' " � _
34. Final Heating & Air Copditioning
. 35.�Final Gas Pipe=Test /��� � , ' � � , _
.36. Hood or Canopy � � � -' - . � . ' -
37. Final Factory Fireplace � � - � � �. -
38. Final Plumbing . � - . - -
39. Water Service-Final , � � " �
40. Gas Service-Final - � . "
41. Solar pomestio-Final _ � � � � - - � � .
42. Backflow Preventer � . � � . " , � � .
43. Backflow Irrigation �. - � -
44. landscape Irrigation System
45. Sound Attenuation . � � ' � � . �
46. Handicap Regulations ' _ . • � �
47. FINALSTRUCTURE&BUILDING � ' ' '
48. Special Requirements Completed
49. Electric Release to Edison ' , - � �
�.50. Gas Release to Southern California Gas Co � � ,�_
51. CERTIFICATE OF OCCUPANCY _ , � . . . �
No. � Date � , � . �
. ! � 1.2223
CCSSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX s17 G06iA MEBA. CAI.�FORNIA
For Applieant fo Fill In Compleiely
TYPE OR PRINT
BUILDING / TNST Q
ADDRE65 R�A Q / �
COSTA MESA CALIFORNIA
OWNER � UL' L S L'�
MAIL Q � � W / TN �
ADDRE65 /
��r.
C o 5 rA /it si� No: .Gv.�r
ARCNITECf TEL.
C(<%A i /,
L14�N0. UiJ � No:/ .6-sosr
ncZE nr I�U �/ /� f I.�,�;.,��.,B�oae. �
B6TBA<K LINE FROM
CeNTER oF BTetEGT `� � REAR YARI
SIDE YARD I LEFT J I RIGHT
DESCRIPTION OF WORK
�
� USE OF BUILDING.�+ND WORK
FEE RECEIVED �
�..-$, � - i�- ��
FINANCE DEPT. b
CITY OF COSTA MESA �
APPLICATION FOR PERMIT �
BUILDING �
�-'o
For Office Use Only
RBCEIM NO. I PlRMIT NO. , `
1 '
\ 1
rsecerveo er n�re necerveo o e i ueo
i--i _
�-�.� 6-��o - 6 o �G �yr G��.�
BUILDING / . .. /_i i f, ..✓ /'. � / A� .I
� I NO. OI
� rune
YARDS
APPROVED
5 (^8^T=R LIN[ BT.)
�
1 HEREBY ACKNOWLEDOH THAT 1 HAV& RBAD THI9 APPLIGTION
AND BTAT6 THAT THE A90VE IB CORRECT ANO AGRBH TO COM-
PLY WITH ALL CIYY OpDINANLE6 A BiATE UW6 ReGUL/.TIN6
Bl11LDIN0 CON9TR�ICTQJt1 " ��//����^
/ 1 /i'/
8^GNAT. U'R8 OF �� r � �
AUTHORIZED
APPROVED
MESA. CALIFORNIA
TVPE 6ROUP
ATE � � G
ING
USE OP NEW�L
YBUILDING C%
� �-U'� i0 U ' ��
6 - ��a -0 �J
EVES
ALLOWED
V FT. M
I O FT. �_
c ° ,Q U '
a��o _
TX8 AMOUNT 9HOWN UNOeP VALUATION IB POR TXE
PUIiPOBH OR 86TABL16HIN0 A PEqMIT pEE ONLY.
VALUATION B,
PERMIT FEE $ ��
� 9� �/ 9 � PLAN CHECK $ �'�` ` �
�
'�� 9�`�G� �-,� �5�,�:�,. � . �- �
� � I'J .� ! '7 --� !,l ty�
COSTA MESA BUILDING-SAFETY DEPARTMENT FINAf10E DEPT.
P.O. BOX 377 COSTA MESA. CALIFORNIA
CITY OF �QST" �9FS�;
fOR APPL/CANT 70 f/LL /N COMP[ETE[Y APPLICATION �FOR PERMIT (�
TYPE OR PRINT BUILDING V\
BUILDING � 7. t � 1 ^
woopess COSTA MESA, CALIFORNIA ��� 1/ )
FOR Off/CE USE ONLY,,,, �
I RECEIPT NO. I . `
OWNER �
MAIL `) ' ` ' REL BY E R IV A ISSUEO �
ADDRE55 V -/ 7'�"�VII—i�._-C_.n/ I � I �
TEL. BUIL ING
GITV � / .J i�n NO. ADDRE55
qect+rrecT � ��c. . COSTA MESA. CALIFORNIA �
OR .INEER NO. 1
ADDnE55 FIRE I � 1
ZONE TYPE 4/ GROUP.� % �
' � STATE 7
CONTRACTOR LIC. NO. ��- BYPR�VE� I DATE " ��
\� � / NING
ADDlRESS O / l � hJ
LE6hF LOT � �"Q �'dN ZONE NO.OF USE OF NEW
OE6CflIPTI O. BLOCK ITRACi �"Y� IPLANB� IBUILDINO
A.P. NO. I L7 ' � �i � BVPROV6 DATE /"I � �`'
SIZE NO.oFeLoas. ypRDS EVES
OF LOT J � O / SO I Now orv �or REOUIRED ALLOWED '
USE OF ^� (CENTER LINE ST.1
EXISTING BLDG. 'v�Y FRONT �� FT. IN.
SETB�CN LiNE FROM ' � � t�
ceNien of' sirseei REAR YARD R. SIOE
y� .�/ Ff. IN.
SIDE YARD ILEFT (.' IRIGHT / 6 f ['
L.SIDE J FT. IN.
DESCRIPTION OF WORK .( �
REAR �J FT. IN. �
NE` I ALTERATION I II ADDITION I -
REPAIR I II MOVING I I DEMOLISH I
SIZIE DING•� S'i �(� RO MS STORIES �
oc
EXTERIOR WALL IROOF / ,
COVERING COVERING ���(r �/q•
USE OF BUILDING AND WORK TO.BE PERFORMED
�1 J
- � _� � r---- c, r. �� ,
r
1 HEPEBY ACKNOWLHD('.E THAT 1 HAVE READ THIS APPLICATION THE AMOUNT 6HOWN UNOER VALUATION IS FOR THE
ANO 6TATE THAT THE ABOVE IS CORqECT ANO AGftEE TO COM-
PLY WITX ALL CITY ORDINANCES RNO HTATE LAWS NEGULATING PURPOHE OF ESTABLI6HIN0 R PEPMIT FEE ONLY.
BUILDING GONST TION.
/J VALUATION gq
SIGNATURE O S�YB 1 /��� �%% �,�` � PERMIT FEE S J/ �
PERMITTEE /� L./✓�� d
L, �o
//p(� //j��� S • C) U, OC PLAN CHECK $ /�/
AUTHORIZED AGENTQ(i� /� J 1 ,1�� l,�(s'�i � .h
t''V ,Z-� 2 TOTAL FEE 5
i ,