HomeMy WebLinkAbout934 17TH ST - Building Permits0
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3�9b9 -,3-19-G5 _ _ _ ::c � _ . _ _._—_�r.,)
-24214 - 4-0-65 '
23730 - 9-1'+-�5 _ � ____ --.. � 500.
25z91 - L-19-o"7 :'ec` i:C -.^ . -
25384 - 4-4-00 __._. _:;; ,r_oc�rsj . , .,, . � . � � .
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32502 - 1-14-71 __._ ---.'--- 500. . ..
��35734 - 5-15-73 ?lec. tiC (� �o.urs) ' � �� �
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', — F67734 �II�S'-1 1 — " � ' . � x . -. .
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_ B65882 3I?JIl�:-4- _ , ..... � " - .
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OWNER COASTAL Recreation� Inc.
JOBADDRESS 93 W• 17th Street
GENERAL CONTRACTOR Owner-Bldr.
AP No. 11 -230-28 LOT TRAC'
II CTIONS Si nat
so��
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOl15
ROUGH HEATING AND AIR CONDITIONING
TEMPORAFY SERVILE OR POLE
UNDERGROUN� � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEI REINF. �
FLOOR SVSTEM
BON� BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHIN� - IN OUT
P�ASTER. BROWN WAT
STP"'TURA
HE ;, V
F INAL
REFRIG. ANO
DATE
DESCRIPTION of WORK
EZONE VALUE
ROUP F-? TYPE
SUBCONTRACTOR
\�I{�'��Y v
Y/
GENERAL CONTRACTOR
nP xo. 11 -230-27 :
IT'��'`ECTIONS
S
Z Gas
� Water
Rough Com. Refrig. p
�. Rough Heating
Final
DATE
DATE
VALUE $ Qi
'LONE UBSCRLPTION
IOUP FZ�F2 TYPE IIr�,
SUBCONTftACTOR f
��i��Z7
�zo
Y•
OWNER
GENERAL Ci6]
AP No. 116-
IN�PECTIONS
:
UNIT A ' � - "
_ DATE 5-30-�
!►`C��
K A. NVI'OOs "" VALUE $ b�8D0.00
LOT TRACT F1AE ZONr ll�SCRiPTION OF WORKInd.bldg.
�Signature DAT� GftOUP F_2 TYPE III 7.ONE M_
L,; ' ./ :�./� P�RMITS ISSUI'
��� a n�. �,. SUi3CONTRACTOR n�.r,z.Trr�r�,���
r
VIA:VYA1Vl:Y \
FORM fl116.5M � )�61 _
AP No. � LOT
IN�PECTIONS
c
Gas
k.
urrzT B
DATE S-
�s VALUE $
TRACT RIRP 7.ONE DESCRIPTION OR WORK
Signatur DATE CROUP TYPE 7.ONE
�`�.. e,- ., - suBcorrT�tacTox n m� na.
GENERAL CONTRACTOR
AP No. R' LOT
INGPIiC'170NS
c
Gas
e
UNIT C
DATE 8—
iT
VALUE $
TRACT PIR� 7,ONE DPSCRIPI'ION OF WORK
Signaturc DATP GROUP TYP� 7.ONE
i, i .. �, � t SUBCONTRACTOR ,—, vLt
',6 `
PPOJECT ADOflF55: 9 3 q w 1�] TFi $ T
owHEs•snamc: MORHART, JOHN
nooxess: SAME
APLX/ENCINEEfl:
ADOflE55:
flEG.NO.:
uxrt:
PEflMITTEE: FIRE STOP ( 714 ) 631-3811
aouwess: 2082 S BRISTOL ST
SANTA ANA CA 92707
UCENSEO CONTflRCTOB OECLAflATION: 1 hereby atlirm ��at I am licensea under Omdsions o� C�aO�er 9(commencinA wi�� Section
7000� ol Drvisian 3 0l t�e Busine55 an0 Prolessions Cotle. an0 my license i5 in lulllorce antl eilett.
cirr .: 0 4 2116 sTare uc.: S 01419 cuss: C-16p EX.�/ �: 9 4
�¢; _`p� Signa�ure: � /— �/
WOHNEflS' COMPENSPTION OECIAflATION: I here�y affirm ihat I have a certificate ol consent m sel4insure or a cenificate oI Warkers'
Comoensa6on rl .is� pcz of 2cevrt�je; r�p� mereo� (secnon 3800, Lao. C�1.5 / 1 S/ 9 S
voucv xo.: GOLD EN EAGL E E%P. OFTE:
COMP Y: ,s�
erliiietl copy is hereby Iumi5�e0. U CertifieA copy is tiled wit� the ciry BuildinA Divisi
Date: �-/ �� AODlican�: � ���L-.�
E%EMPTION FPOM WOflIIEflS' COMPFNSRTION OECUMTION: �Th¢ secnon need no1 Ue completW ii NC pemtil is for one �uMrM (f100) a kss�.
I ceriily inal in I�e pedormance of ihe Mrork lor w�ic� t�is permit is issueA. I shall not employ any Derson in any manner so as to 6ecome
SUG�eci la Ihe Woder3' CAmpenSaiion law5 01 Calilornia.
'� Oare: Signature:
m n uan mvisbns of t�e Labor
NOTICE: II, alier making I�iS detlaraiion. you ShaUltl become SUbjetl Io IAe Workefs Co pe Sa D
CoEe. you musl lort�wil� camply wit� such pmvisions or �his p¢rmii 5hdll �e Aeemetl revOkeG.
LONSTPUCTION LENOINC RGENCY: I here0y allirm I�at there is a canslruction lenainp aAency for I�e peAormance ol l�e work lor
wnich Ihis permilis issuetl �Seciion 3097. Civ. C).
LENUEN:
aooness:
OWNEB BUIIDEB DECIAflRT10N: I hereby allirm Iha� I am exem0� �mm l�e Comrattors' S�a�e LicenSe Law for �he lollowinp r¢amn
(Section 70.31.5 Business an0 Professional Cotle: Any city of caunty which requires a oermil to canstNc6 alier, imD�ove, tlemolish, or
r¢Oair any slmtiure, priar IO ils issUante, alio reQuireS ��e applican� for Suth permii lo lile a 5igneE Slaiemenl Ihai �Us�e i5 licensea
pwsuam Io the pmvisions ol tne Camracmrs' Siate License Law (Chapter 9(commencinp witn Section 7000� of Division 3 of the 8usiness
antl Prolessions Code) or Ihal �e/s�e is exempl ��ere�mm anA Ihe Dasis lor the allepe0 exem0�ion. Any viola�ion ol Seciion 7031.5 by
any apPlicanl br a Dermil suble��s ttle aDPlicant to a civil penalry oi not more ihan five hunCreG aollars �5500).
I, as owner ol Ihe pmpetly or my emDloyees with wages as Ihei� sole wmpen5aiion, will tlo ihe wOrk, an0 Ihe
I ❑ SINCIUfCISfI0Il01Ef10Ctl �IO�ICf2� IOfSdIE (SCCIIOf17044. 6115111055 20O Pf01C551pfIdICOUC: TAQ COIIVdC�Of3 $IdiO LICEOSC LdW
aoes nol appry to an owner ol a pmpeny who builtls or imD�oves tnereon, ana who Ooes such work himselVAersell or througA
�is or her own emploVees, pmvitlea Ihal such impmvemeNs are not in�entled ar oileretl for sale. I�, however t�e Uuilding or
impmvemenl is 5old wit�in one year ol campletioq the owner will have tne burden oi proving �e/she OiA no� Uuild or impwve
lor �he Durpose ol saie).
I, as owner ol the Omp¢ny, am eaclusively coniracting wilh licensed contractors to consimct tAe prole�� (Section 7044, Business
❑ antl Pmlessions CoOe: The Comractors' S�ate License Law tloes not aDPly to an owner ol pmcerry wta Umltls or impmves therron
an� w�o coniracis lor such prOjetis wilA a canirac�oq5�license pur5uani to IAe Contrac�ors' Sta[e L¢ense Law�. I am aware
Ihai proof o� Ih¢ir Warker'S Compen5aiion insurance shoul0 De pronEeO lo me.
� I am eeemp� unCer 5¢ttion: B. 8 P. C.
fot i�is reazon:
oa�e: v"'ner
I Eo nere�y cenily �nai I am aware ol an0 untlerstanOlhe requirements ol Caiifomia Health and Safety CoEe Sections 25505, 25533, antl
25534 anU IOaI 10� any fulure �uilaing occupanl will/witl nol (chcle one) nee0 to camply vnlh said slate co0es antl Ihe reduiremenis for a
Oermit lor cansimclion ar mo0ilicalion Iwm Ihe Air Oua6ry Management Disiricl. flesitlential constNciion aDPlicaiions are eKempi �mm
Ihese provisions.
DaI¢: Applitani:
I nereby cetlily I�al I have rea0lAis apPlicalion an0 state ihat ihe a6ove inlormalion is correct. I agree ta comD�Y ��� all cily and counry
ortlinances antl stalelav+srelalinglo Dmlding tonsimction ana herebyautharizere0�esen�alives ollhis ciryto enter uponihe ahOve�mentione0
property lor insp¢Ciion putposes. / �
�)a�e: � �� Signamre: ( � ��
Dri�ers �icense or Sociai Secudiy a:
i64i-46 While—Builtlmg', Green—Cotle Enlorcement; Canary—ApplmanC Pmk—Revenue; GalEenroO—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: F 067734 PliAN CHECK NO: 01468-94 L
CONSTRUCTION TYPE; PERMIT TYPE: FIR
JOB DESCRIPTION ; BACKFLOW UPGRADE
PERM NO: F 067734
GOVT: N SUPP: Y
SQ FT:
PURPOSE: OTH
CLAIM VALUE; 9,200,00 CALC—VALUE: GRCIUP OCC; B-2 /
COMMENTS: "MOTOR HOME REPAIR" BACKFLOW UPGRADE
***+r�rit*�**********+r*****�-x-*�***��c*+r�r*�t*�*+�+��?�***�+�+�+�*�t***�**+�**�*+�**x�#i�***+�#*x-#
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCES50P,Y HUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: ET IN REAR; FT IN
LEFT; FT IN RCHT; FT IN LEFT; FT IT] RGHT: FT IN
PARKING REQ: PROV; PARCEL; 42435106 ZNE: REF NO:
PLANNING NOTES>
>
if �lE # iE jE 1E iE if iE iE if i(� k�lk iE if iE iE iE if if if # iE iE if iE?F ik iE iF jE iE iE iE if fE iE iE iE ik iE % if if iF iE iE k iF iE M it if iE iE % iE �1f if iF iE iF if if i! if if iE �)f 1E df i'r i: iE iF 1E iF ik
D E V E L O P M E N T S E R V I C E S R E Q U Z R E M E N T 5
ZONING APPROC'ED BY .
�
BUILDING AFPROLED BY •
APFLICATION ISSUED BY:
�+�x***�ririe*�r*itx�*x�**u��r+r*'iF��� �3'r�F+�x*�e�r,r+r+r�.�iF
iEifiEihiEiEiFitiFitikitifiFifiEfEiFiEitiEiEiEifiFifiEiEtf. iEiF�F4iElEfhiE fifiEiEitifiEif#iciFif
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 72,00 0,00 46.80
REVENUE DIVISION TOTALS--> COLLECTED:
HLDG PMT PLUMBING ELECTRIC MECHANIC
DATE;
DATE: �
n —() - -Z Q
ATE• r
?F'��ir+�****+t**x��"3'"r> � �iF"xi �*,F �-
�
�t�r*�+�*i�**x�at+�*******i **�t*x+tx
STRUCTURAL S�.GMENT:N
FIRE SMIP/RES GRADING
72,00
65� SMIP/NON—RES
46.80
TOTAL PAID DUE
118.80 118.60 .00
72.00 OVER;SHORT; 00
FIRE SMIP/TOT GRADING PLAN—CHECK
%2.��
if if -lE��-k iF iE iE ih if� ik 9f if -k� if iE iF i! jf if k�k�-k i! k if aE if- iE �` # 9E iE�%� :E �1E �lf if if 9E it it 4 iF if # iF ik Y it M# iF# iE it iE iE-1E+t if i4 it # ih if it #�7F i� # Jf if df iF iE 1f iF Y.
I N D I V I D U A L F E E B R E A K D O W N
TYPE
FIR
QTY D E S C R I P T 2 O N UNIT C05T TOTAL COST
72 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 72,00
END OF FEES
�1 �0:62854-0016Z3`4 T C�T 72.�0
GAFE= t3b/24/94 TIME: 10�34
1
CONSTRUCTION AND PLANNING POO� ,PA '
APPROVALS Permit #'� � �ate I�spector APpROVALS Permit # Date Inspector i
�..
1. Temporary Elecirical Service or Pole ,� 52. Pool & Equipment Locacion i
2. Soil Pipe�Und�grnd. .;I y� 53. Steel Reinforcement
��
3. Elecirical Conduit Utility-Undrgrnd. 54. Forms
4. Electricai Conduit-Undrgrnd. 55. Electricai Bonding
5. Steel Reinforcement 56. Rou9h Plumhing & Pressure Tzst �
6. Electrical UFER Gmd. 57. APPROVAL TO CO�'ER-GUNITE
7. Footings � 58. Electrical ConduiT�Ucdrgrod. i
8. Foundation � 59. Gas Pipe, O Uricirymd., Test '
9. Water Pipe-Undrgrnd. },- � l 60. Backwash Lines, P�Trap, : J Undrymd. �'� '
- , � �
10. Structural Floor SYstem � � 67. APPROVAL TO DECK � j
7 t. Property Sewer Line & House Connection �� 62. Backwash & Recepmr�Pinal �
12. Setver Cap �
. /- 63. Heater & Vent-Fina1 j' �
73. Roof Drains �� ���; 64. Plumbing System - Final �
14. flough Plumbing .-��j � � 65. Electrical-Final "'
15. Rough Electrical-Conduit l�� 66. Solar SYstem-Final , �
16. Rough Electric Wiring 'i
67. Fencing & Access Approvai
17. Rou9h Wiring Sign 68. APPROVED FOR P�ASTEFING �
18. Rough Electricai•T Bar Ceiling 69. POOUSPA SYSTE^�7S FINAL �
19. flough Heating & Air Conditionin9 FIRE OEPT. REQUIREMENT '
20. Rouqh Factory Fireplace APPROVAIS Permit # I
21. Ducts, in Structure 70. Underground Hyclro �
22. Dvcts, Ventiieting 71. Product Piping O Gas ❑ Oil
23. Gas P�pe�Rough & Test 72. Underground Fiush
24. Roof Praming 73. Undergmd.StorageTank GiGas �Oil �
25. Roof Sheathing 74. Overhead :��^ru
�-1 s �v..y� . �
26. T-Bar Ce�ling (Structuraq & Monocoa: 75. Dry Chemical `
27. Frame and Fldshing 76. Dry Standpipe �
28. Lathing & Sid�ng 77. FIXED SYSTEM FIPJAL (
29. Insulation 7$, FIRE PREV. FINAL �.�cj1i� /�,y.'1
30. Drywall Naitiqg HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat _ � 79. FINAL INSPECTION � �
32. Electrical Power MeterFinal � 80. FOOD CERTIFlCATE ISSUED i
�
33. Final Electric � Notes: �
34. Final Heating & Air Conditioning ' j
35. Pinal Gas PipR�Test -
36. Hood or CanoPY �
37. Final Factory Fireplace � �
38. Final Piumbing •
39. Water Service-Final
40. Gas Servfce-Final
41. Sotar �omesticFinal
42, Backflow Preventer � �
43. Backflow Irrigation I
44. Landscape Irriqation System '
45. Sound Attenuation
�
46. Handicap Regulations �
4L F�NAL STRUCTURE & BUILDING ,
46, FINAL PLANNING :_. .
49. Electric Release to Edison '
50. Gas Release to Southern Califomia Gas Co __
51. CERTIFICATE OP OCCUPANCY I•
No, Date
PXOJECTAODNESS: (j34 W 17TH $T
OWNEfl'S NAME: SOHN MOREHART
�noxess: 126 W 16TH ST
COSTA MESA 92626
714) 548-8531
AflCHIENGINEEP:
RODNESS:
flEC.NO.:
UNIT:
UNIT:
PENMITTfF: ROOFING CONCEPTS ( 714 ) 645-7518
aooRess: 6 5 7 B EACH ST
C.M. CA 92627
tICENSEo CONTPRCTOP oECUNaTION: 1 nereey aBirm tha� I am ficenseC unEer prov5ions ol Chao�er B(�ommencinp witn Section
7000) ol �ivision 7 at t�e Business aM Pmi¢5sions Code, antl my licen5e is fn IW force ana efittl.
c c.: 0 5 7 9 6 srnre uc.: 4 412 71�ws�3��—
oaie� —/'-3 �� 5iqnamre: —
NKENS' COMPENSATION OELLANATION: I �er¢Gy a��irm I �ave a cenilicate ot consent �o setf-insure or a cetlilicate ol Workers'
Comoensa�ion Insurance. or a cenilietl cooY ��ereof (Section 3800. La�. q.
roucr xo.: 12 B 2 2 5 4— 9 3 E%P. �RTE: 1 O/ O S� 9 4
comeauv: STATE FUND
❑ Cerlilietl copY is M1ereGy fumishetl. � Ce�ilied capY is liled vnih Ihe ciry BuilOing Divi5i0n.
,y� , � ` 3 �� / f qpplicani: ���
%EMPTION FPOM WOPRENS' fAMPENSRTION OECUflATION: (ihis secuon nee0 noi be mmpk�eG i� tAe permi� is lor One hunOreO (4100) or 1¢ss�.
I Certily Ihal in I�e petlormanCe 01 ��e xrork lar wAiC� this permil i5 a5ue0. I S�all not employ any p¢rwn in any mann¢r 5o as t0 beCOme
su0ject to Ine workers' CAmDensalion laws al Calilarnia.
Date: Siqnature:
NOTICE: II. atter making t�is Ueclaratian. yau s�oulE Cecome subl�� �o �he WaM1ers' Compensation provisions of ihe Labar
Coae. you musl IanMni� comply vnlA sut� pro`risor5 or tMs permit sflaA 6e OeemeG rewke0.
CONSTRUC710N LENOING FGENCY: I �ert0y affirm ihai �h¢re a a wnstruction lenaing a0enq lor �he Detlarmance ol tAe work lor
wnicn �nis oermit is issuea (Section 3W7. Civ. CI.
LENUEN:
AO�flESS:
OWNEP BWL�EB DECIAMTION: 1 here�y affirm tl�at I am exemD� ��om t�e Contractori State License Law tor t�e IOAawinp reawn
�Seciion 7031.5 Business anE Professronal CoUe: Any aty al county wNc� repuires a perrttit to consirucl. alttr, imDmve, Oemolish, or
repair any simcWre. Odor to its issuance. a150 RGuires Ne apDticant lor suc� permil to lile a sipnetl statement ttut h¢ls�e is licensetl
Oursuant lo Ine O�avision5 0l I�e fqmranors' State Lipenu Law �Gupier 9(wmmendnp vnt� Seciian 7000) ol Division 3 0l I�e Business
an0 Pmlession5 Code) or Itwi he/s�e R exempi Iherelrom anOl�e OavS IOr lhe all¢qe0 ¢rempiian. Any violaiion 01 SECiion 7031.5 by
i any aoolicant for a permit suejetls Ine aoGlicant to a tivil penalty ol not moa inan liv¢ nundreA Oollars 13�).
I, as awnet ol t�e proDeny ar rtry employees vfi� wdges az t�eir Sole fAmp¢ludtion, vnll Eo the vrofk, antl I�e
❑ slmcWre is nol intenOeE o� oilere0lor sate (Section 70<4. Business anE Protessional COGe: T�e Contractors' SUte Licensa Law
aoes not apply lo an owner ol a pm0eny wlW euilas or impraves inereon, dnA who tloes sucn vrork Mmsell/hersell or ihmu0h
�is or her own employees, proviEeG ina� suc� impmvements are not intendea or allere0 lor sale. II, �oweve� Iha EuilAinp or
improvemem is soie wiihin one year ol completion, ine wmer will have tne ouraen oi O��np hUSAe EiA nat UuilO or impmve
lar Ine ourv�e ol sale�.
I, as ownei ol ihe pmpeny, am evclusively conlraciinp vnth IicenseJ canlraciors Io consimcl I�e pwlec� (Section 7U4A, Business
❑ ana Pmlessions CoOe: TAe Comractors' Slaie License Law Uoes not aDPN �o an ovmer ol pmDerry who bml0s or impmves Ihareon
antl who camraas �or sut� O�alens vrii� a caniractoq5�license pursuani lo Ihe ConVaclors' State License Lawl. I am aware
�IIdI pf001 01 II12if WOlkCf'S CAfIIDtO5dl10f1 IOSUfdllt! SA0014 UC DfONECd IO IIIE.
� I am edempt unJer Seclion; B. A P. C.
lor mis reason:
�ale: Owner:
I Oo �ereGy ceriity �Aa� 1 am aware ol antl unGerstanU ��e r¢Quiremenis ol Calilornu HeallO an0 Sa�e�y Cotle Sec�ions 25505, 25533, an0
25534 antl I�at I or any IWu�e Uuiltling occupan� wilUwill nol (circle one) need Ia comply vnih SaiG sla[e coAes and Ihe reQuiremen�s for a
permil for consimction or moailication Irom I�e Air Ouality Management Oisirict. FesiOeniial conslmction apDtications ara eKempt Imm
Inese pmvisians.
Date: ApO��cam:
I �er¢by tt�lily �Iwl I hau¢ r¢a0 i�i5 aOGlicali0n antl 5ta�¢ Itul Ihe abov¢ infotmation is correti. I agree Ia tOmply wi�h ail tiry an0 toUnly
oraindncM antl state laws �eWting io OuAOitp cWstmcli0n azW �ere0y auitqr¢e reD��niativ¢s ol thi5 aty lo enier upOn Ihe ahOve�mentioneE
proPe��Y �or inspeclion Ourpo5e5. � / �
�3f -%�/ ,--�� ,� ��.�,�<
�e� / Signaiure: � K
�er's License or $oCul SeCmily �:
—AO�IicanL Pink—Revenue; GdCanrotl—Asseswr
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: B 06588:
PERMIT NO: B 065882 PLAN CHECK NO: N GOC�T: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF, REPAIR SOME SETH 6 REAROF W/HUR SQ FT: 8,500
CLAIM VALUE: 8,500.00 CALC—VALUE: 8,500.00 GROUP OCC; B-2 /
COMMENTS: TEAR OFF 6 RESTHEATH PART S RE—ROOF W/ BUR
�rx*ir*�r�r**�r**x*�r+r�r��ri�x�rx�r*r**xxxx�*�r+*x��r�*�r�r*i�*�***+r�r+t***x��rr**�r*******x��r*+�+�+�***�r*
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BOILDING ---------- --------- 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; 92218109 ZNE: REF NO:
PLANNING N TES> ,
� .
iE if iE 1f !E iE 1E iE 1E ff 1E if 1E if * iE if f! 1E �t �F 1F 1! it 1E ff it ik 1E if 1E if if jE 1E * iF 1E if fE aE iE 1f %iF �E iE iF i4 if iF iE fE fF iE i! if if !f jE 9F fE if iFlf iE iE if iE.iE if iE iE iE iE iE aE iF jE
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 HY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: �� DATE: ��F��
ififitiEitifil�itiEififikiEtlififififklFifif��"iF"i�ii�F�iE�F7F iF3F���C�F'�F"�Pr'iFif7�iFiFi:iE�fifkiEifiFMiE iEif
if if �f 1klf fE fE iE K iF K 1f iF 1f if iE i! fE 1E iF iF f� if if fF iE fE iE i4 aE 1E 1f iE %iE if if ik if ik iP 1E �E �1F ik 1f iE If 1f ff �f iF 1f if if 1t 7t 1f K 1E if if iE fElE if iF if if ik iE iF iE iE if i! it iF dE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 108.00
PLAN SMIPiN09—RES
ZSSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 109.79 0.00 0,00 109.79 109.79 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 109.79 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FZRE SMIP/TOT GRADING PLAN—CHECK
108.00 1.79
1! iE t! if !E iE it k iE i! itlf if ff ff i! 1f 1k 7t 1k k if 1F jf if if M it if if k k 7E ih iF if if 1E if it 1E iE iE 1f it iE iE tE M iE 1f if if 1F 1E it it k it iE iE it it iE 1E if iE 1f it 4 iE iF 1E IE if iE iE iE if
I N D I V I D U A L F E E B R E A K D O W N
TYPE
SFC
QTY D E S C R I P T I O N UNIT COST TOTAL COST
8500 REROOF HY VALUE COMMERCIAL NOZONE 1.00 8,500,00
END OF FEES
�'` N� F7/fA � To ,� I SS a e r� G,5�7i LC /� s�,61�cA 7E �-��n, �-r
1� �ss� �� s f��'��o✓En !3`t �3u,cr��r�Q ����s,�
Zj �,,�%c ��l�iN/� �C
01 00354623—OO1S4624 TU T
DATF: p�/01/9S 1Ih1E: 15:41
109.79
.
CONSTRUCTION AND PLANNING POOL �'A
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms
4. Elecvical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinfo�cement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electncal Cqnd�it•Undrgrnd.
8. Foundation � 59. Gas Pipe, � Undrgrnd., Test I
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor SYstem 61. APPROVAL TO DECK
11, Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63, Heater & Vent�Final
73. Foof Dra�ns 64. Plumbiny System - Final
14. Rough Pfumbing ' 65. EfectricabFinaf
15. Rough Electrical-Conduit 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Access ApUroval
il. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Bar Ceiling 69. POOL/SPASYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. flough Factory Fireplace APPROVALS Permit #
27. Duccs, in Structure 70. Underground Hyclro �
22. Ducts. Ventilating 77. Product Piping C7 Gas ❑ Oil
23. Gas Pipe�Rough & Test �72. Underground Flush
24. Roof Fram�ng 73. Undergrnd.Stora9eTank OGas ❑Oil
25. Roof She2thing 2,..�-�Gr e�yb[ 74. Overhead Flydro
26. T�Bar Cefling (Structural� & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYS7EM F�NAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. RE�UIREMENT
31. Plasrer Brown Coat 79. PINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric. Notes:
34. Final Heating & Air Conditioning ,
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbin9
39. Water Service�Final
40. Gas Servite�Pinal
41. Solar pomes[ic-Final
42, Backflow Preventer •
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuaiion
_i
46. Handicap Regulations
47. FINAL S7RUCTURE & BUILDING /�� �
!
48. FIfJAL PLANNING ' ,
49. Electric Release to Edison �
50. Gas Release to Southern Caiifornia Gas Co .
51. CERTIFICATE OF OCCUPANCY
No, Da[e
�
$UII.DING SAFE7F '1EPA$TMENT
P. O. Bos No. 317
Costa Mesa, California -a
_� ' 1550 �
Date �TAAI iZ7 I ���..
CTIY OF COSTA MESA
CERTIFICATE OF OCCUPANCY
Building permit No�� Electrical Permit No Plumbiug Permit No
Use of Building � a%Z1 ��-?�.T, � iq ��'F A,_.�
The bvildin8 Iceated at %3N �A/,� �{ � r! I.i. r 7 TH 5%"
Legal DeSCripdo�
(See reverse side for MMes and Bounds)
has been inspected aad found to comply with the provisioas of all City of Costa Mesa Orclin-
_.--
ances applicable thereto for a Group %' Occupancy. �
ISSUED T0: �1 ) �^ � �t�ilding Offictaln
RI�/CY� Ka/<rk ! nlZ� � �/ •.yn
- (Owner of Buil ' ) B � a�V�T � .�
CC: ❑ Ot'iBinal�wner ❑]st copy—Gas Co. ❑ 2ndv py—Edison Co. O�3id copy—File
Form 206 SB P 1M 1-60 , V
a� �,�„ � ait�
9� 93� �.5�_6�
OSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX Sf7 COffiA MEBA. CALIFORNIA
For pplieani fo Fill In Complefely
TYPE OR PRINT
BUILDING (,V� / "J * �
ADORESS —
COSTA MESA. CALIFORNIA
OWNER � IC I S 1 O� L( � A I�f= 1�- OM1-
MAIL /�l{� <�'
ADDRESS v
�,T„ nnS%Q nRFSia • NEo�.I ���/l
L,. L� �E/�/ /� NEo'
FIRE
y i2 Oo
��� ��V���UN�i.,-'�
' � AUG 211961
FlIdANC� OEPT.
CIIY OF COSTA MESA
APPIICATION FOR PERMIT � ' �"
BUILDING
For Office Use Only
i .�i ri. iu-
9� w .17 � st.
COSTA MESA. CALIFORNIA
0�61� .
ADDRE55 I-1 �• b✓ D�C �J a� ZONING �
•V L w 21' �GA��� C�ALiF_ ZONE _/ I NO.OP � I U9E OF NEW�
Q�'ry PUNB BUILp�NG
LIC.TNO. I�� �� NO. K I I � O I �Eaw� !/ �`�- OO �'.�� �� //f .
O68CpIPT10N �ai
61ZE NO. OF BLDG�/ / � [�
OF LOT � O O Now ON LOT lV � p, p, NO. 6 2 3� —��
USE OF YARDS EVES
EXISTING BLDG APPROVED ALLOWED
BeTBACN LINE FROM TO J ���/ (CENTeR LINB BT.)�
CeNieR OF 9TREET �� REAR YARD �� FRONi �� O FT. IN.
SIOE YARD I�EFi O IRIGHT O R.SIDE �� FT. IN.
DESCRIPTION OF WORK o
L.SIDE
I IALTERATION IIADDI710N I REAR v�
BUILDING
512E
EXTERIOR WALL
GOVERING
USE OF BUILDING
S� 2 A-C'sz!
/�� � .
I HEREBY ACKNOWLEDpB
AND 9TATE THAT TXE AF
PLY WITH ALl CITY Oq{j
BUILDINO CONBiRU � SN
81GNATURE OF � �
IAUTHORIZED AGENT
n�. ut yOLD FOR
ROOMS STORIES
IROOF
COVHRING Pc�h.ri�*c� �
WORK TO BE PERFORMEO � r—
FT. � , IN.
onre ��30�6 /
AL R�QUIREMENI'S"
���. `1F /-�Phh.hc
1 HAV6 RH�O THIB APPLICATION �THB AMOOIp 9�WN UN�ER
' CORRECT AND A6RE6 TO COM- pURP09E OP T�BLI6HIN0
�%D 8}ATE LAWe R60UlI.TING
�• VALUATION
� �� PERMI
S�/ G,(/�� PLAN
�. � �%��
19 POR TH¢
FEE ONLY.
':. 21776
�SA BUILDING-SAFETY DEPARTMENT
BOI 91] 409TA MEBA�CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
� ,��/ �? ' /
COSTA MESq, CALIFORNIA
BUILOINO
AO�R65
FIRH �
FEE RECEIVED
�yp 2 0 1964
FINANCE DEPT:
CITY OF COSTA MESA
APPIICATION FOR PERMR
BUILDIN6
Por Offtca Use Only
_... .--� - -- A • y,� � 65
ARCHITEGT � TEL. _� B ATH
OP �NGINEER NO.
` � NIN(i
A� .E53 ���
O NO.O� Ue80PN6W -
� PLAN! D GUILOINO
CONTRAGTOR
L60AL
OHBCPITON D O
ADDRE88 /
A. P. NO. �/ � � U—�
CITY
NOTE: NOEAVHOVERHAN08HALLBHLE88THAN
STATB �— T8L • T081DH REAR p. L
LIC. NO. N .
8AVE8
SIZE �� I No.oPBLDa�� ALLOWED (U.B.C.REOI11R8MENT7
OF LOT NOW oN LOT
YARDSAPPROVED YAROSAPPROVHD
USEOF �MAINBWLDINO ACGfiS50RYBWLDINO
EXISTINQ BLDO.
. , (FROM C/L6TR6ET) '
68TBACK LINE PROM .� r� PRONT FT.. � FT.
CENTEP OP BiHBGT (3HAR YARO
SIDE YAROI LEFT r_ RIGHT �� R. 810 FT. FT.
DESCRIPTIpN OF WORK �. aioe Rr. �.
N� ALTERATION �ADDITION REAR FT. Ff.
DI6TANCE BHT. BET. MAIN Q
REPAIR MOVINO DEMOLIBH MAIN BLOG9. AGCES9.BLD68.
BUILDINO NO.OP � VAR•# DATE
61ZE D X �� ROOM9 8T RI88 C. U. P. APPROVBD
EXTERIOR WALL ROOP ��O AYPR D �� DATB �C/ �
COVERIN6 COVERINO
U86 OF BUILDINC AND WORK TO BH P6RFORMHD
�� � � � / �`[�N
� � /'� � � SG. PT.
1 HEREBY �CKNO L T AT I XAV6 pHAO TN18 APPLICATION TN8 AMOUNT eXOWN YNOCR VALU�TION IB POR Try8
�NO 6TATE THAT BOVE �g COHRlCT AND AOqEB TO COM• PURPOSe OP 88TABL18NIN0 A PBRMIT F8B ONLY.
PLY WITH ALL CI ORDINANC68 AN TATB LAWe RLOUV.TIMO yqLUATION
BWLOINGCONSTHUCT( N.
SIGNATURE OF� PERMIT FE8
PERMITTE �a �'V c
AUTHORIZED AGENT , $� � �
TOTAL FE8
r . 237J0 {�p p
�COSTA MESA 9UILDINGSAFEfY DEPARTMEM ��TY �r" C�tSifl 111iSA
P.O. BOI917 COSTA MHBA, CALIFORNIA MAR 15 19656""
For Appllcdnf �o Fill In Completely APPLICATION FOR PERM
TYPE OR PRINT. � �`��Onh
eui�oiNa � � � —�
ADDRESS R[CtIIT NO. P[RM��
COSTA MESA. CALIFORNIA
J q6C 6�Y D� Rl 6D DA �ey O
OWNER `1 � /�
ADDRE88 �y � � �j � ADDRBiB L � � � � ' T_
CITY � fjc, �j „ TEL. ' 2,Q ZON6 T'1'PE OROUP ��^�
b NO. Ju
APPROVHD �
ARCHITEGT TEL BY DATE
O^ �NaINEER "� —i7D:'—�
{O INC;
A__AE88
ZO NO.O� UB80PN8W
\ PLAN9 y BUILGINO
CONTRAGTOR CUN�'` �.J/�' /
L80AL / !i U
D88CPIRION L V
A�DR888
A. P. NO. U
cin �
NOTE: NO EAVE OVERHANO BHALL BE L858 THAN
6TAT8 90' TO SIDE @ RPJ1R P. L
LIC. NO. NO.
61ZE ! I EAVES
OFLOT D� No,oPelCoe. ' ALLOWED fU.B.C.RHQUIREMENTI
NOW ON LAT
YARDBAPPROVEO YARDSAPPROVED
USEOF MAIN BUILDIN6 ACCESSORYBUILDINO
EXISTING BL�6. i
(FROM GLBTREETI
9ETBACK LINE FPOM � PRONT FT.
C6M8fl Op BTRHfiT NEAR YARD
SIDEYARDI LEFf RIGHT R.81�8 FT•
DESCRIpTION OF WORK L. HIOB '/ �•
N' ALTHRATION ADDITION REAR F'1'•
. DIS7AN B BEf. MAIN Q
REPAIR MOVINO� DEMOLIHH MAIN BLD63. AGCESS. BLD08.
BUILDINO NO OF VAR.iC DATE
SIZE I Q � ROOMH STORIES / C.U.P. APPROVED r
EXTERIORWALL��� ROOP ���`��'��si'C MP110ViD � ` �%
GOVERING Ii�12L COVERINO gT9L_ BY v 10
U9E 0 UILDING At�D WORKTO B8 PERFO ED
�' ' O
'� i3 � C t F
F'� rz l�L /��O �
so. �. �
1 NBp88Y �CKNOWLBOpg TMAT 1 HAVB PHAD THIe �PPLIGTION TMH �MOUNT 6XOWN UNOBq VALU�TION IB POR TH8 y
AND BTIITE THAT TNH ABOVB �8 COHPCR ANO ApqEB TO COM• PUPP098 OP 88TABLI6HIN0 A PERMIT P8H ONLY. p
PLY WITN ALL CITY OqO� • ANO BTATB 80ULATING ypLUAT ON
BUILOINOCONeTRUCTIp � �� m
N
SIGNATURE OF PERMIT FEE j
PERMITTE �
%i Ml C C ¢
AUTHORIZED A6ENT $ � � p,� �`
TOTALFEE ��
/
;
`' '�?602
. oEc3i-�o�K5A00 i3s ���x�*�5.06
COSTq MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to FiII in Compleiely qECEI v on e aEcerveo
BUILDING ''/ yy, , l� 3 oaj�iss3� 7
ADOFESS 9�Y- E5�' �7 - �f. p �[�S�
OWNER �' .5�'QQ eG�Y�,J `OK �RC� • A.P. NO. I - �O - ZO ��J T
MAIL �j (� �`� BUILDING r�
ADDRES$ /�O � •/- �. />DDRESS ,
W W TEL. �e�rTRACT �d �OT�OOB BLOCK
�. U CITY • e �iL NO. ���Z-OSYZ
f- Z
Z Q CON5TRU�{ION �
O N LENDER V
a m ��
J � BRANCH
.J N OWNER L
� ADDRE55 VALUE
� ARCHITECT /,{^- TEL. � S g
J a OR ENGI EER �"
V Q FIFE ' 7
W� ADDRES5 �� ZONE TVPE GROUP �••'
d w APPROVEO /� �� � O
J O CONTRACTOR Q BV QO OATE
m z
J � ADORESS
W w ,-- TEL. ZONE NO.OF USE OF NEW �XIST�HiC9
ZF CITV �' NO. — 'I P�� � BUILDING
w � STATE `— CITY ,_ VP.FlOS APPROVED VARDS APPROVED
�� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
�� SI2E / ' NO.OFBlOGS. (FROMC/LSTREET)
OF lOT f�O , X 3� O NOW ON LOT � FRONT FT. FT.
USE OF �,� '�
EXISTINGgLDG. (�QCQ�t�� F �' FT.
F" 512E OF ! v /� i NO.OF ` �
Z NEWBLDr. �D A'!O ROOMS STOFIES L.SIDE FT. FT.
U EXTERIOq WALL ROOF ..
COVERING COVERING REAR FT. FT.
� USE OF �UIIDING AND WOFK O BE PERFORMED DISTANCE BET. BET. MAIN &
�p MAIN BLOGS. ACCE$5. 8LOG5.
� �J ` � �Q . (A/Cl�� C U�P. qW � APPROVED
O . _
APPFOVED �^
y Qi a 1. � r�i ps< � h- 6Pf• � Z-- —
z Or�
O
VI hereby acknOwletlpe [�et I hava read Ihis epplicetiOn entl Stete
� that cho ebove information is correct antl apree to comply wIN
� ell taws regulating builtling conatruction, entl 1 zhall not employ
F any peraqn in vlolatlon of th¢ workman's compansatlon lowa of
the Sta[e of Celitornia. m
N �
z I hereb certif t�n[ I am y SQ. FT. O
V y pro0erl Iican tl es a contrncror under
the S[ate ot Californte Business antl Prof ss ns Cotle, Divislcn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, antl thet such licen s ar n ull torce antl etfett, or I THE PURPOSE OF ESiABLSMINo A PERMIT FEE ONLV: m
¢
am eKambt lrom tha provisio o the St te ot Calilornia Busine�s V AI.UATION � E�� m
antl Professions Cotla, Division 3, hapta 9. ��
PERMIT FEE $ �
SiBnature of % / I / ]
Parmi<tae OQ /� I _ FIOA �(�� g L� O/� PLAN CHECK $ E �
� �� `o
Authorizetl ABant � � � �'�' .� LL
TOTAL FEE $ .
AI
�Ir' oF COS7A nnESA C N%� TRUCTIO P MIT •
,� ' Proj�Address ���/ � � ���s�
� 'Applitant's Mailing Addr /^'�
Owner's Name ' � � `'Phor: �� 6���
9.3 � / �.� '
Adtlreu — -
Arch/Eng. License No. '
Addreu
Contractor's Nam W�` Phone �
Address (mailing)
City License No. 1
LICENSED CONTRACT00. DEGLARATION '
1 hereby alflrm that I am Ilcensetl untle� provi5ion5 of Charte� 9(commenCin9
with sectlon 7000) o� Division 3 of the Business antl Protessions Cotle, and
my Iicense is in full force antl ettect.
Litense Class License No.
Date Si9nature .
WORKERS' COMVENSATION DECLARATION '
J hereby afllrm tnat I have a certiticate ot mnsent to sali-insure or a certlflcate
• Workerz' Compenzatlon Insurance, or a certl(letl coDY tnareot (Sectlon
100, Lab. CJ .
Policy No. Company
BCertlfietl <opy is nereby fumisnetl.
Cmtlfietl copy is flletl with the city Builtling Divislon.
Date Applicant '
EXEMPTION FROM WORKERS' COMPENSATION DECIARATION
(Tnis SeGtiOn ne¢tl not be COmplete0 if the permit is far one huntlretl (S100) or
lesz).
I certify lhat In lhe p¢rformance of the work To� wnlch tnis pe�m�t i5 issuetl, I
shall not employ any parson in any manner so as lo become zubject to the
Workers' Compensation Lawz of Califomia. ,
Date Si9nature
NOTICE: It, after. makin9 this tleclaration, you shoultl become subject to tha .
Wo�ke�s' Compensation provisions ot the Labot Cotle, you mu5t to�t�witn
comply wltM1 such 'provlsions or [itiz permit shall be tleemed revoketl.
CONSTRUCTION LENDING AGENCV .
I ne�eby affl�m that the�e is a construction lentling a9enCy to� the pe�formanc¢
of �he work for whicb thls permit'is i55uetl (Sectlon, 309� Civ. C.)
LenCer's Name ,
� Lontler's AtlGress
OWNER BUILOEH DECIARATION
I her¢by dHbm that I am exampt from the Cont�actor'S License Law to� th¢
following reason (Section 7031.5 Business antl Prot¢ssional Cotle: Any city or
county which requires a permil to construct, alter, improve, tlemolish or repair
any structure, p�io� to Ils i55udnGe, also requires the applitant fo� Su<h pe�mit
to tile a SigneE Statement thdt Ile/she is licensetl pUrSudnt to [ha prOvi5ion5 of
the Con[ractor'S License Law (Chapter 9(commencing with Seclion 7000) of
Division 3 of the Business antl'Protess�ons Cotle)�or that he/she is exempt
';-?erefrom antl the basis tor the alleqetl exemption. Any violatlon of Section
�-'i�31.5 by any applicanl fOr a pe�mit zubjects the applicant to a civil
ii�lty of not more [han five hunOretl tlollars�(5500).
I, as owner of the property or my employees with wages as Iheir sole
compCnsation, will tlo the work, antl the structure is n0l IntCntletl o� ofteretl
for sale (Section 7044, Bu5ine55 antl ProtesSional Cotle: The Contrac[Or's
LicenSe Law tloes not dPPIY to an owner of a property wno builtls o� im0�ove5
thereon, antl who tloes such work nimzelf/herzelt or through his or her own
¢mployBCS, PtOvitl¢tl thdt SllGh IfflplOv¢TCntS dfC nOf IOL¢fltlBtl OI O((¢f¢4 10f
sale. If, hOwevlr, [he bui�0in9'or imP/ovement is Soltl wi[hin One Year of com-
o�etion; the owner wlll have the burden of proving he/she tlltl not bulitl or Im-
� rove 10� the purposa o1 Sale).
� I, a5 owne� of [he prOperty, am ezclusively contraCting with Iicensetl COn-
f�actor5 to cons[ruct th¢ Proj¢c[ ($ection 7044, Buziness and PrO�es5ion5 Cotle:
Tha Contractor's License law tloes not apply to an owner of property who
bWltls or Improves thereon, antl who contracts for such projects with a con-
tractor(51 license pursuant to the Contractor's License Law). I am aware that
proot of thel� Worker's Compen5atlon insurance shoultl Jbe provltletl to me.
� L� I am_exempt untler Section—,--�—.8!&/. C. for [his reason
� // I/ /
D t � ,' O
I hereby <ertify that I hava reatl this applicatlon antl state that the above
�ntnrmation is rorrect. I aaree l0 2omolv with all dtr antl county ortlinantes
the
$I9nature �q�
Drivars' Llcen�se or 55 �
to fill in all spaces
tnose witnin
Eortler lines antl si9n all appro0/�ate tleclarations.
LOT NO.' UNIT N0. (��Qyi, �
�� /
� �Fl; �, �e.%' r+�t C�?'/'
ALTERATION REPAIR
TVPE OFCONSTRUCTION �LIrvEw �M nDD
❑ GONVERSION ❑ DEMOLISH ❑ OTHER
' DESCRIPTION OF WORK/USE OF BLDG. —
TVPE OF PERMIT� GRADING LJ FOUNDHTION IJ STRUCTV RAL
❑ TENANT ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER �
PROJECTDESCRIPTION S�.FT. OCCUPANCV—
CONSTRUCTIONTVPE 'VALUATION$
:ZONE GRADINGCU.VDS. ACRE�S_
Remarks: � � , . ; �
Bar Sink
Backflow Preventer ' .
Backflow Irrigation
Bathtubs
Clarifiers
Dishvrasher
ri kin Fountains
D n 9
Floor Drains
Floor Sinks
GasService Outlets
Interceptors• �� ' �
Kitchen Sinli
Lavatories ' . �
P-Trap
Roof Drains.
Reinspection Fee � $15
Duct - Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple ��
Firepl/Fact. Blt. ICBO #
Heating System & Ducting �
❑ ai ao,000 sTu � i oo,000 en
Reinspection Fee � S15
CMF OB65-46, rev. 10/84 White - Builtlinq; Canary - Appllwnl; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap , " � ,
Sewer Connection
Solar Collectors
Solar Piping .-
�Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet '
Water Heater , �
Water Service �
Auto�Wash �
laue Fea'
Hood or Typel ❑
Canopy Typell ❑
A.P. # _ .
S Main Building:
E
T Fron[ •
B Rear
A
C� Right
K
S Left
PIn9. Ref. # ' �
PlanningNotes:� : �
Automatic Washer
Construction Pole Sub.
Cooking Unit,
Dishwasher� .
F.A.U.
FixWres
Device Boxes
•�.9533 7/16786
r -- •- �
2one
Accessory Building:
Parking Req./Provided I
ELECTRICAL
Transformer ❑ 15�50 KW ;
O 50+ KW
Meter �p to 100 amps �
Meter ❑over 100 amps :
Sub Panel
Motors �
Inc. Solar I
Microwave
Pole Light
Range
iHP�iX-8 ^
9-15 HP �16-15+ '
�
� Switches Si9n . ' '
Garbage Disposal Standing Sections
Generator �0.5 KW �5-15 KW Trash Compactor
$ 3 �
Reinspection Fee $15 luue Fee
FEES �
DEVELOPMENTSERVICESREQUIREMENTS:
� 2oning APProved 6Y .
� Building Approved 6y
Refrigeration System
❑o=ioo,000aru ❑ioo,000aru
System Repair/Alteration
Fire Dampers .
Registers � .
I�sue Fee � � $ 3
6.00 ;TI.
FEES
u
9
$ 3
Z
O
N
I
N
G
R
E
�
M
T
S
� ' � SUMMARV,OF FEES � � .
BUILDING PERMIT $ . �SMIP . $ _
, PLAN CHECK $ PERMIT • , � , �
�.+ , PLUMBING $ �SSUANCE � $ .
� PLANCHECK 25% $. ENERGV�P.C. $
- ELECTRICAL $ � GRADING $ ' �
PLAN CHECK 50% $ MICROFILM - $
MECHANICAL $ TOTAL FEE , $ �
� , PLAN CHECK 25% $ . ' � •
CONSTRUCTION AND PLANNING POOL & SPA ., �
APPROVALS Permit # Date Inspector AppROVALS Permit # Date- Insp ector
� t � Temporary Electrical' Service or Pole ' 52. Pool & Equipment Location �
� 2. Soil Pipe-Undrgrnd.� 53. Steel Reinforcement �. , �
3. Electrical Conduit Utility-Undrgrnd� � 54. Forms '
4. Electrical Conduit-Undrgmd. 55. Electrical 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-Gndrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System 61. APPROVAL TO DECK � � �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �.
12. Sewer Cap 63. Heater & Vent-Final '
13. Roof Drains 64. Plumbing System - Final ��
14. Rough Plumbing 65. Electrical-Final .
15. �Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring � 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts; Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
' 25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical
27. Frame and Flashing • � 76. Dry Standpipe �
28. Lathing & Siding ' 77. FIXED SYSTEM FINAL '
�
29: Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final �t �� ��%i 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes: - -
34. Final Heating & Air�Conditioning �G''� s��
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 pomestic-Final � � `
42. Backflow Preventer
43. Backflow Irrigation
'44. LandscapelrrigationSystem
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
�_ i
No. Date . - � , j
� ♦
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O
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n �� �Z'
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� ��11<Cc�aF ��� �q. .fiOE
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YY��c �`rX��� , �
CI OF O. Il �A
PLAN\iNG Dr??.
SU81E 70 BlOG. DEPG CCG.
:t.. L
BY. _ . .. . ATE:IZF..".L/.L.:.�..0,.
�IREROR OP PLANNING
������ ��
�
i11 �I �'�i R1� I �i 1 � S
`� S h i�� � �.. �:
City of Costa M�]esa Building De t.
BY�U-uLJ--.l�"`i .._._DATE.�.l.=1..19%(�
THESE PLANS M.USi BE ON J03 AT .ALL TIMES
MAKE NO CHANGES WiTHOUT PRIOR iXPPROVAL
OF OEPi.
THE ISSUA�7CE OR GRAilTIiJG OF A PER111T OR RPPROVAL
OF PIh;;S HGO S°E(:1Fl�i1L".S SH'lL FlCT 6E WM13TRUED
TO BE A PEft,';JT iOR. G:; f.:7 6PF; C..:L CF, :;:Y `110LFTION
OF AN'f OF THE PnO:!3!0..5 OF iY.!a LD�c. :10 PERi.11T VRE�
SUthIi:G TO GIVE AUP:0.�iTf TO 410Lt1TE OP, CAiICEL THE
PROVISIONS OF THIS COC: $ir.lLL BE VALI6. EXC.PT Ifl SO
FAR AS TNE WORK OR USE tlniCH Il HUTHOdIZES IS LA'7lFUL.
THE ISSUANC� OF-A PE3HIT 6ASED UPOH PLANS A!!D
SPECIFICATIO':S SHALL ROT FBt;'E�:T T1(E OJILDING OFFICIAL
FROA1 THEREAFTER REQ'JIRING THE CORRECTION OF ERRORS
IN SAIO PLIIIS RND SPEGFICATI011S OR FRO1A PREVENTING
BUILDIilG OPEfL1TI0NS BEING CAFRIED ON THERNNDER 4lHEN
IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE
Of THE CITY. � � '
�
�
�
APPROVAL OF THESE
STRUCTURAL PLANS DOES
NOT CONSTITUTE�^APPROUAL
OF PLUMBING, ELECTRiCAI OR
CONTINGENT INSTALLATIOYS.
Per��t #�3._�.:_6�D_�
_ ..... ... _............
� TFIIS fdUib�?�^ �;iUST ACCDDr1°�INY
ALL IfJS"ECT�OIV R�Q;.iESTS
fOR BUILUdJ�S l'1�lL2E p�RgpvS �u;E TO
DE EA1PL0(ED, l'�c SU:;eSI TN,;i iHE
SI'ATE 0: CP,LliO„Pliq Oit'IS;O;! OF
INDUSTP,IA! S:iFEiY 6c �OhlSUUED FOR
ADDfilOidAL i�_�Jl�:cf9_iliS.
Aco�icant to fill in all spaces except enose witnin neavy Dortler Ilnes anC si9n all a00ro0riate
CITY OF COSTA MESAL /CONST,RU�TJQN PkRMIT
.IPralect�ddress �'� { /� � ���_
• Applicant's Mailing A�d/�jress ""� � �
Owner's Name —�1Q�+ �'�- ---Phone � �z�
Address
Arch�Eng. License No.
Address
Con�ractor's Nam "t `' Ph e �GS3
Address Im="�"�;� � ��/ �"-� � � ��-
Ciry License No. ������ � �
LICENSED CONTRACTOR DECLARA710N
.t ne�eby a(firm t�al 1 am licensetl untler O�ovislons of Charter 9(<ommencin9
wi[n section 7000) ot Division 3 ot the Business antl Professlons Cotle, antl
my license is in f for and etfect. � �lJZ�.7D
� LicBnre Clas nze . 4
DatC�,7—�� S�S Si9nature
WORKERS' COMPENSATION DECLARATION '
1 h¢�eby atfirm that I have a certiflcat¢ of mn5ent to selftinsure o� a CertifiCdtG
� • Workers'� Compensatlon Insurance, or a certlfletl copy_ thereot. (Settlon
� 00. I..aD. C.)
. �i�cy No. Company �
BCertifietl copy is hereby fumishotl.
�ertifietl ropY is flletl with the dty Bu�ltling Divislon. '
Date ApP��cant
EXEMPTION FROM WORKERS' COMPENSATION OECLARATION
(Tnis section ne¢tl nol be coMPletee if th¢ Permit Is fOr one huntlretl (§100) or
less).
I ceft��Y thaf in the perto�mdnCe of th¢ work fo pppfch p t I5 is5u¢tl, I
shall not employ any person in any manner /f5 c subject [o [he
wnrkers' Comoensa4on Laws ot Calitornia /
�I
'NOYICE: If, after making this tleclaratlon, You snould become subject to the
Worker5' CompCnsation provislons O( tlte Labor Code, You mu5t forthwith
WmP�Y with such orovisio�s or this permit sha11 be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV . '
I heleby atfi�m [hat thGr¢ i5 a wn5t�uctlo0 lentling age�cY tor tha per}o�mance
of the wo�k, for which [his permit is issuetl (Section 3097 Civ. CJ
LentleYs Name
Lender's Aatlress' '
pyyNER BUILDEI2 DECLAHATION
I nF�eby aftirm that I am exempt lrom the Contractor's Licensa.law for the
follo�+��9 reason (Section 7031.5 BuSiness antl Pro(esslonal Cotle: Any city or
cou�ty which requires a perYnit fo�conStNct. alte�, imP/ove, tl¢mO��Sh.or repai�
y�y sGucture, prior to its issuance, also requires the applicant for such permit
to f�ie a signed slatement that he/sne is licensetl pursuant to the provi5ions of
tne Contractor•s License Law (Chapter 9(commencing with Sectlon ]000) of
Division 3 Ot the Bu5ine55 antl� Pro(essionz Cotle) o/ that h¢/Sh¢ i5 exem0�
•h¢lef�om antl tne DaSis fOr th! a118ged ezempUon. Any violation of SecHon
31.5 by any applicant to� a' p¢rmit zubjG<IS tbe appllcant to a civil
ialty of not more than tive huntlred tlollars (y500).
,J I, as �owner ot the property o� my employees with wd985 es their Sole
corr�Pensation, will tlo the work, antl'the structure is not intentletl or offeretl
for sale (Section ]044, Business anG Pro(essional Cotle: Tha Contractor'S
LlcCnse Law tloes not apply to an owner ot a property who builtls or improves
the�eon, antl wno does sucb work hlmielfJheriflR or through hii or har own
em0�oyee5, proNtl¢tl that such Improvert�e�t5 ara not Intentletl of Offere� tOr
sal¢. It, however, [he buil0in9 0� improvement Is soltl within one yea� ot com-
plet�on, the owner wlll have the bu�tlen of proving he/she tliG not Duiltl or Im-
prove for tne pWpose oi sale).
❑ I, as owner oi the property, am exclusively contracting wlth Ilcensetl con-
traEtoR to conStNct the ploject ($ectlon 7044, Buslne55 antl Profe551on5 Cotle:
The Contractor'S U<ense Ld`�' dOes not apply to an owne� of pfo0erty who
builas or improves thereon, antl who wptracts for such prOj¢ct5 �+'��h a con-
trador(s) Ocense purzuant to tha Contractor'z Litense Law). I am aware [haf
proof o( their Worker's COTpensatlon inzurance ihOultl be providetl t0 m¢.
❑ i am exempt untler Section B. & P. C. tor this reason
Data . owner
this
� .../ �5�,� .I I ;
TYPE OF CONSTRUCTION NEW nDD
" ❑ CONVERSION ❑ DEMOLISH ❑ pTHER
DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATION LJ REPAIR
T�YPE OF PERMIT U GRH�ING Ll FOUNDqT10N LI STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa.FT. OCCuvnrvCV_
CONSTRUCTION TYPE VALUATION S
ZONE ' GRADING CV. VDS. ACRES_
Remarks: i
Sink
Preven�er - -
Irrigation
Drinking Founta�ns
FloOr Drains •
Floor Sinks
Gas Service Outlets
Interceptors �
Kitchen Sink'
Lavatories • -
P-Trap
Roof Drains
Reinspec[ion Fee� ' $15
Boiler
Duct - Under Ground
Duct-Structural � '
Ouct-Ven{ilating _ _ _
Exhaust System � Multiple �
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
' ❑0.700;000 BTU 0100,0008T
Signature � uace�i� -
i orivvs' ticense or 55 � _ ' Reinspee[ion Fee
CMF 0865-46, rev. ]0/84 White - Bulltling; Canary - qpplicant; Pink - Accountin9; GOltlenroG - Assessor
$15
Showers
Service'Sink
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinel -
�%'idL2f C�OSEL �
Water Heater
Water Service
Auto-Wash �
Isue fee
Hood or Typei ❑
Canopy Type II ❑ -
iefrigeretion System ' �
�o-iao,000�ru ❑ioo,000eT
Sysrem Repa�Alterat�nX;P �
Fire Dampers Iticomplete I
Regirters � � �
Fee
FEES
A.P. qW
S Main Buildi
E
j Front
A Rear •
C Right
SLeft
Ping. Rei. #
Planning Notes:
AptOflld[IC wBShF
Construction Pol
Cooking Unit
Dishwasher
Dryers OGas L
Fan
F.A,U.
Fixtures
Device Boxes
OuUets
Switches
Garbage Disposal
Generator 065
,--• 6864 ,.7/19/95
.. � - r �
Zone
� Accessory Building:
Pxrking Req./Provided
ELECTRICAL '
-Transformer ❑ 15-50 KW'
� ❑ 50+KW
�/ Meter ❑up to 100 amps
Meter ❑over 1008mps
ric � Sub Panel
• Motors O67 HP �1 �- 8
Inc: Solar 09-15 HP �16-15+
' ��� � Microwave. �
� Pole Lighti: �
Range
Sign, •i-- .. " .
i c...:.w:..., c..:..:,._'
KW L15-15
$ 3 ' _ •—
Reinspection Fea � $15 Iuue:Fee �''
FEES
DEVELOPMENTSEHVICESREQUIREMENTS:-.; t'.'
� Zoning APProved By .
Building APProvad By
AppliCation 15sued Bv � �
$ 3
0
FEES
0
$ 3
, . 'T� ' � SUMMARY OF FEES -
98UILDINGPERMIT, $ 'SMIP $,
• PLAN CHECK $ ' PERMIT ,
PLUMBING $ , ��UANCE $
PLAN CHECK 25% $ ENERGV P.C: $,
,� ELECTRICAL $ • D O GRADING $��
PLAN CHECK 50% $ ' MICROFILM $ �
� '�EC ANICAL $' � �TOTALFEE $ � O D
LAN�CHECK 25% $ � � '
2
O
N
I
N
G
R
E
Q
M
T
S
pONSTRUCTION AND PLANNING POOL 'A
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1:rTemporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ,' 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
.,4. Electrical Conduit=Undrgrnd. ' 55. Electrical 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, � Undrgrrid., Test :, '
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, � Undrgrnd. •
i
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer� Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final � .
13. Roof Drains ' 64. Plumbing System - Final ' � �
�
14. Rough,Plumbing. 65. Electrical-Final -
15. Rough Electrica.l-Conduit . , 66. Solar.System-Final .._
16. Rough Electric Wiring � 67. Fencing & Access Approval . .
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � � 69. POOL/SPA SYSTEMS F.INAL . � .
19. Rough Heating &,Air Conditioning ' � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . APPROVALS Permit #
21. Ducts, in Structure . 70.� Underground Hydro �
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test _ 72. Underground Flush - -
24. Roof Framing � 73. Undergrnd. Storage Tank � 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. �nsulation . � . 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT ��•
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � � -
34. Final Heating & Air Conditioning �. , � � -
35. Final Gas�Pipe-Test � � - � � ' ' - �
36. Hood or Canopy � - �
37. Final Factory Fireplace .
38. Final Plumbing � , � � �
39. Water Service-Final' � � -
40. Gas Service-Final �
41. Solar pomestic-Final
42. Backflow Preventer � � � � �
43. Backflow Irrigation' � E X P � R E � -
44. ,Landscape Irrigation SYstem � � ete Inspections .
_ ,
45. Sound Attenuation ' � I�aiB •Z, � .
46. Handicap Regulations . , _ ' �
47. FINALSTRUCTURE&SUILDING
48. Special Requirements Completed,
49. Electrie Release to Edison _ _ _ � . _ . . � . i
50. Gas Release to Southern California Gas Co �,
51. CERTIFICATE OF OCCUPANCY �
No Date � . .' � . � �
. �