HomeMy WebLinkAbout323 18TH ST - Building Permits� . �
CITY OF COSTA MESA � ' .
BI/ILpIN6 pIVIS10N•
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.c ta•mesa.ca.
FOR INSPECTIONS CALL: (714) 754-5626 �
PERMIT NUMBER. B08-00163
PERMIT TYPE B_ROOF2
APN: 42501416
STATUS: ISSUED
DATE ISSUED: 05127I2008
- ISSUED BY:
, , __
JOB ADDRESS: 323 ABCD E-18TH ST CM Suife/Unit:' �.ABCD
vicinity: � -' - .
Squares: 0 � . , , - Valuation: ; ; $9,000.00
SCOPE OF WORK: T/OFF, SHEATH AND REROOF WlCOMP SHINGLES �
4UNIT APARTMENT (UNITS A,B,C,D)� , � ' � � � . �
. .
OWNER: SANDBERG, ROBERT W TR .. .- Address: 18832 WINNWOOD�LN �
PHONE: , � ; �. , �
APPLICANT: GLEN HOVEY � ,
PHONE: 909-798-0807 .
CONTRACTOR: HOVEY ROOFING -
Address: 11444 TERRACINAUnit: .
Ciry/SWte/Zip: REDLANDS, CA ', 92373
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspectian Fee:
TOTALFEES
$o.00
$16725
$0.00 �.
5167.25
Unit:
. ... City/State/Zip. SANTA ANA, CA , . .
���� .
- � Address: � -. � � . Unit: :
City/State/Zip: �
� • - - � . — - � ' License No. ' S38667
' ' - PHONE: � � 909-798-0807
' � ' CELL: ' -
License No. � � . ' ' PHONE:
License No. - � � - ' PHONE'
NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under Calitornia slatutes and related
regulatlons. (Ord. No. 92-28, § 1, 12-21-92) �.
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.'
INSPECTIONS: In order (or the work authorized under this permit to be considered legal, such work must comply with all aDPlicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit.
4oUE�• INSYECTONTYPE �T� IN �L LOUE/ INSiEC1I0NTYVE 1�4� INTRIRI
1818 Fized System Final Fire Prevemion 208 " Final Mechanical
1288 Pool Spa Final ' �— �% 208 Final Plumbing
200 Final Re-Roof `� �- " 21p Final EleCtncal
201 Final Block/Retaininq Wall 212 Final Fire Preventlon
202 Final Fadory Fire Place 220 Final Planning Approval
203 Final Sign 222 Fina1 Sita
20a Final Demolilion 250 Final Buildinq/Oaupanq
WORKERS' COMPENSAT!ON DECLARATIO�
I hereby amrm untier penalty o( perjury one of the o vnng declarations:
❑ I have antl will mainlain a certifcate o� consent to selbinsure Ia vrorkers'
compensation, as provitletl (or by section 3700 of the Labor Code, for Ihe
peAormance of the work tor which Nis pertnit is issue0. . �
❑ I have and will maintain workers' wmpensalbn insurance, as requiretl by
sectbn 3700 of the Labor Code, fw the peRormance of the work fw wfiich lhis
pertnit is issued. My wvrkers' compensation Insurance cartier and policy
number are:
!
i'
Owner ID veri(ed by dri se. ❑ Yes ❑ No � !
Driver's License No. Expires:
Verification ot Ownership by pype of document, i.e. - property Wx bill or deetl�:
DNISION OF�INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby certify lha[ no axcavalion frve (5) or more leet in depth into v.hich a
person is required lo descend, vrill be matle in connection vrilh Hwk auttqrized
�T� �� �v hj (� �y this pertnit, and lhat no Duiltling strucN2, scaffddirg, falsexark, a tlemolition
� Carrier. 7� or dismanlling ihereof, will be more than Ihirty-s& (36) feet high. (Chap. 32, Grp
(ma seu�'an rieedna ee amipletedlrneprmv rs.a�Lca af ax mntlroa mears (Stool a kss 1 2. AA 2. SeC. 341. TUe 8, Cali(omia Admini5t2Uve CodO).
�Da ZS � i 1� 'l S
Pohcy Number. r
❑ I certify that in Ihe peAormance of the v.ork for which lhis permit is
issued, I shall not employ any person in any manner so as lo Decoma subjeci
to Ihe vrorker ' ompensation laws o( Califomia, antl agree t�at if I shoulc
become suby' o the workers' wmpensation provisions of Seclion 3700 ot
the Labor Cd I shall forthwith wmply with lhesa provisions.
✓
Appliw 'sSigwWre Da�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMI
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR
($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AN
ATTORNEY'S FEES.
❑ As ovmer-builder, I will nol employ anyone to do work which vrould
require a permil (rom the Division of Intlustrial Safety, as noted above, unless
such person has a permit lo do suth work from the division.
noPiicanrs Signawre Da�e
� Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
E t. Will the applicant or present or future building occupant neetl to file and
� certify a Businass Plan for emergancy response to release or I�realened
S release ol a hazardous material7 ❑ Yes ❑ No
AS (Section 25505 of Ihe Calilornia Heallh and Safety Code requires. with some
D exceptions, that a Business Plan be filed wilh the CosW Mesa Fire
Department by every �usiness which has at any one time during a reportetl
year a quantiry of hazardous materials equal to or greater than a weigM of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet ol wmpressed gas
I hereby affirtn that I am licensed under provisions of Chapter 9(wmmencing at standard temperature and pressure).
wilh Section 7000) of Division 3 of Ne Business antl Professions Code. antl Z, Dces or will the applicant or present or future builEing occupant need to file
my licensee� is in f/ull force and eNect. /'� �i �registration fortn for acutely �azardous materials? � Yes ❑ No
—� Lic. # �1 -3 B 6 lass # (�� l (Seclion 25533 of the Califomia Health antl Safety Code, v+iN some
eaceptions. requires registration with the Costa Mesa Fire Department by
�519-`) / n b � each business which at any one time has on hand a quantity of awtely
or's5ignature oa hazartlous materials equal to or greater than a v.eight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet ot compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature antl pressure).
� I hereby a(fcm that there is a constmction lending agency for the
peAwmance o1 [he v.ork fa which tNs permit is issued. (Sec. 3097, Civil Code).
Lender'S Name:
Lentler's Atltlress:
&gw�we Dx�e
OWNER•BUILDER DECLARATIONS:
I hereby aHirm that untler penalty of perjury l�at I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7037.5,
Business and Professions Cotle: Any city or counly which requires a permit to
construct, alter, improve, Cemolish, or repair any slrucWre, pnor to its
issuance, also requires me applicant for suc� pertnit to file a signed statement
t�at ha or she is licensed pursuanl lo the provisions ol the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 0l the
Business antl Professions CoCe) or that he or she is exempt lherefrom antl
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permit suDjects the apDlicant ro a civil penalry of not more than
five hundred Aollars ($500).):
❑ I, as ovmer o( the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and lhe structure is no� intendetl Or
offered lor sale (Sec. 7044, Business and Professions Code: The Cont2ctors
License Law dces not apply to an owner of property who builds or improves
thereon, and who dces such work himself or hersell or through his or her own
employeesrprovitled that'such improvements are nol intendetl or oHered for
sale. If, however, the building or improvement is sold within one year of
complelion, the ovmer-builder will have tha burden of proving Nal he or she
ditl not build or improve for purpose of sale.). � ��
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces nol apply to an owner of
property who builds or improves thereon, and wtio contracts for such project with
a contractor(s) license pursuant to the Contractors Litense Laws J.
❑ I am eaempt under sec.
Business and Pro(essions Cotle lor this reason:
SignaWre Da�e
3057�a6 (3/O]) —�
3. DoeS or will the applicant or present or fu[ure builtling occupant need lo
prepare an RMPP (Risk Management and Prevenlion Prog2m for awtey
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the Califomia Heallh and Safety CoCe provides that the
Costa Mesa Fire Depariment may require the preparation, certification and
filing with ihe Fire Department of an RMPP by businesses which are required
to register aculely hazardous materials vrith the Fire DepaNnent.
4. If an RMPP is presently required, has Section 25534 of the Calitomia
Heallh anC Salety Cotle been fully complietl with? ❑ Ves ❑ No
5. Does or will the applicant or present or fuwra building occupant reQuire tor
the work which is ihe subjact of Ihis application a pertnit for such consiruction
or modification from the South Coast Air Quality Management DisMct or (mm
any olher air pollulion control dislnct or agency2 ❑ Yes ❑ No
(Sectbn 658502 of Ihe Califomia Govemment Code requiras Ihat Ihe requestetl
infortnation be fumished on applications fa ran-residential building pertnits�.
6, Will any part of the taciliry to De constructed under this permit be within
7000 leet from Ihe outer boundaries of a schooll ❑ Yes ❑ No
(If'yes". Ihe facility musl meet the requirement of Seclions 25534 and 42303
ol the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Qualiry Managament District or olher
air pollulion control distnct or agency is requiretl for the v+ork which is the
su6jecl ot this application, have all of the disclosures prescribed by Calilomia
Health and Safety Code Section 42303 been made7 ❑ Yes ❑ No.
8. (II yes", atWch cenifiwte of compliance trom the appropriate air polluGon
wntrol oKcer). . �
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances reqartling Hazardous Materials antl Emissions. � �
� SignaNre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I�
certify untler penalty of perjury that 1 have read this application and state that
lhe in(ormation given is cortect I agree to comply vrith all state laws and ciry
ordinances relating to building conswction, antl authorize representatives o(
lhe City of Costa Mesa to enter upon the aboveEescnbed property for
inspection purp�es. I agree not to occupy or allow occupancy of any builtling
authonzed by�{ ' pertnil until final inspection.
.`� � � �'.
;;, : . , , CITY OF COSTA MESA
BUILDING DIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w.vw.ci.costa-mesa.ca.us
�.�p*. FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER B08-00164
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 42501416 - DATE ISSUED: . 05127/2008
' i ` : � - ` " ISSUED BY:
, - ,::. ,
JOB ADDRESS: 323 EF E 18TH ST CM !�`, ,' �'' Suite/Unit:'.�,;",EF
vicinity: � . ��, ..- � �. '
Squares: 0 �.;, Valuahon �° „ 53,000.00
. . :..r�� _ . i. ,`,
SCOPE OF WORK: T/OFF, SHEATH AND REROOF W/COMP SHINGLES ��������' ,
4UNITAPARTMENT(UNITSA.B,C,D),��� ,1�,�� . , '�,�y'�� .
r' . . ,
OWNER: SANDBERG;,ROBERT�W,�TR�..- . � Address: � 18832,WINNWOOD'LN, ,�� �, . �
PHONE: � � �. -' -:City/StatelZip: SANTA ANA, CA ,� , � . . ,
, ' .. . r'. ' , ._.. . .. . " ' , , , � .
APPLICANT: GLEN HOVEY � � � �� � . Address: "' .- , . � ,
PHONE: 909-798-0807 ' . ' . ... - City/Slate/Zip: . , � , . ' ' : ..
. . .. . _ .. _...._ . _ ., . . . �- .i
CONTRACTOR: HOVEY ROOFING _ � -- � . - �- - � ��.. �License.No. � 538667
Address: 11444 TERRAEINAUnit: � � �. -. .. .- - - -' PHONE:�' _ � I 909-798-0807 ' � .
City/State/Zip: REDLANDS,_CA _ �� 92373 , � "CELL: " . , �-
, � ' :, ' . - .,-.;-,— , -,_ .. - ,,. . . , . .
ARCHITEC7: . _ - -�'- License�No: - � �� - `� PHONE: ;
,t ' _
ENGINEER: ' License�No. -- - � �,PHONE>'
.. �t.�-.' ..i . . . � ... .
. ; . i�� ;t..: � � .
FEE SUMMARY k-., �
F .,
Reroof � Plan Check: '" � �. $0 00..�,:.. � � . , � � a . ,. •
Reroof Permit Fee: �$8325�,' . �; � , . . t .. _ � � � , - , � � �„ ��r�'
ReinspectionFee: $000, , � �, � - ,,.'�, ,;� �i ;�_�' �
TOTAL FEES $83 25 � � . � ' .- . � , � `f;'"::%� �
Unit:
Unit: :
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia sWtutes 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 order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes, and all
required inspections and Tinal approval must be obtained. Failure to obtain inspections and f nal approval will result in the expiration of Ihis pennit.
oc oe�. ixsvecnoxrvve
1616 � Fized System Final Fire Prevention
1266 P001 SDa Final �
200 Final Re-Roof
201 Final BIotWRe�aining Wall
202 Finel Facrory Fire Place
203
204
Final Sign
Final Dertrolition
p� ix n
�� �
COOE / INSPEC710N TYPE
208 Final Mechanical
208 Final Plumbing
210 Final Electrital
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�AT�F INiRIRI
WORKE ENSATION DECLARATIO�
I hereby affrm untler penalry of perjury one of the o owing declarations:
❑ I have antl vAll maintain a certificate of consent to self-Insure for workers'
compensatian, as provided for by section 3700 of Ihe Labor Code, (or lhe
pertortnance of the vmrk tor which thirpermit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, ta the peAortnance of Ihe �+ork fa J+hich this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
�, .
-�\
Owner ID venfed by dr se. O �es ❑ No
Driver s license No. Expires' � � G
Venfica[ion of Ownerehip by (rype o( document. i.e. - pmperry lax bill or deed):
�DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or mo2 feet h depth into vfiich a
erson is required to descend, will be made in connection with work auttpr¢ed
� Carrier. STAT L � U �l (� �y this pertnit, and that no building struclure. scaffdding, talse�wrk, v demolition
or dismantling thereof, vrill be more than thirty-six (36) feel high. (Chap. 32, Grp
(Tnksatianneednoreemmpeteedlnepnmaureh�MelaronunmMaalars(5�oo)aieu) 2 Mz SeC.341,T�1e8,CalifOmiaAdmini5lrativeCode).
Policy Number. �Z B� �� 1\�
�❑ As ovmer•builder, I will not employ anyone to do work whic� would
❑ I certi(y ihat in lhe peAortnance of the work for which this permit is requira a permit from the Division of Industnal Safaty, as noted above, unless
issued, I shall not employ any person in any manner so as to bewme subject such person has a permit to tlo such vrork from the division.
to the workers' cqmpensation laws of Calilomia, and agree that if I should
become subject td Ne workers' wmpenution provisions of Section 3700 af
the Labor Co I all forthvnlh wmply with lhBSe provi5i0n5. /o0iinm's Signawre oa�e
� f Division of Industrial Safety Pertnit Number.
li I's&gnawre � �« HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE �� �^lill the applicant or presenl or (uture building occupant need to fla and
IS UNLAWFUL AND SFLILL SUBJEC7 AN EMPLOYER TO CRIMINAL certify a Business Plan for emerqency response lo release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND DOlLARS release of a hazardous material? ❑ Yes ❑ No
($700,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of Ihe Califomia Heallh antl Safety Code requires. with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Depariment by every business which has at any one lime during a reportad
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn Ihat I am IicenseA untler pravisions ot Chapter 9(commencing
with Section 7000) ot Division 3 of the Business anC Professions Code, anC
my license is in full force and eflect. �7
� Lic. # �� g �� � Class # �^ `� �
S�
Ca 1 Sgnamre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a consWction lending agency tw the
peAormance o( the work for v.fiich this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's A�dress:
SignaWre Date
year a Quantiry ot hazardous materials equal to or greater than a weight o!
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
al standarG IemperaWre and pressure).
2. Does or will Ihe applicant or present or future building occupant need to file
/a registration form for acutely hazartlous materials? ❑ Yes ❑ No
�(SeCtion 25533 of the Califomia Heallh anG Safely COde, wiN SOme
exceptions, requires regislration with the Costa Mesa Fire Deparlment Dy
eaCh bu5ine55 whiCh al any one lime ha5 On hanC a quanfity of aGu[ely
hazartlous matenals equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at stantlarcl
lemperature antl pressure). �
OW NER-BUILDER DECLARATIONS:
I hereby aKrm ihat under penalty of perjury Nat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7031.5.
Business and Pro(essions Code: Any city or county which requires a permit to
conswct, alter, improve, tlemolish, or repair any sWCNre, pnor to its
issuance. also requlres t�e applicant for such pertnit to file a signed statement
that ha or she is IicenseE pursuant to the provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business antl Pro(essions Cotle) or Ihal he or s�e is exemDt lherefrom and
me basis lor Ihe alleged exemption. Any violalion ol Section 7031.5 by any
applicanl for a permit subjecis the applicaN to a civil penalty of not more ihan
fve hundred tlollars ($500).):
❑ I, as ovmer ol t�e property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and t�e structure is not intenCetl or
offered for sale (Sec. 7044. Business and Professions Code: 7he Contrectors
License Law does not apply to an owner ol property who builds or improves
thereon, and who does such work �imself or herself or through his or her own
employees, pmvided that such improvemenis are not intended or oHered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have tha burden of proving that he or s�e,
did not build or improve for purpose ot sale.).
❑ I, as owner of the property, am EXCWSIVELV CONTRACTING,WITH
LICENSED CONTRAC70RS lo conslruct the project (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not apply to an ovmer of
property who builds or improves thereon, antl who contracts tocsuch project vrith
a contracta�s) license pursuant tothe Conlractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3. Does or vnll the applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazartlous malenals)? ❑ Yes ❑ No
(Section 25534 of [he California Heallh and Safety Code provides thal the
Costa Mesa Fire Department may require the preparacion, certifica6on antl
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presentty required, has Section 25534 of Ne Califomia
Health antl Safety Code been fully complied wilh7 ❑ Yes ❑ No
5. Does or will the applicant or present or luture builtling occupant require tor
the work which is the subject of this application a pertnit for 5uth conSWttion
or modifiwtion Irom the South Coast Air Quality Management DisVict or from
any at�er air polWtion wntrol district or agency7 ❑ Yes ❑ No
(Seclion 658502 0l the Cali(omia Govemment Code raquiras Ihat the requested
inlormation ba (umished on applications lor non-residential Duilding pertnits).
6. Will any part of the (aciliry to be constructed under this pertnit be within
1000 feet from the outer boundanes o! a school't ❑ Ves ❑ No
(II'Yes", Ihe Iacilily must meet ihe requirement of Seclions 25534 and 42303
of the Calilornia Health antl Safely Cotle�.
7. If a pertnit from lhe South Coasl Air Quality Management Dislrict or olher
air polWtion control district or a9ency is requiretl for the work which is the
subjecl of this application, have all of Ihe disclosures prescri�etl by Caiifomia
Health and Safe�y Code Section 42303 been made7 ❑ Yes ❑ No.
8. (If'yes", attach certifiwte of compliance from lhe appropriate air polWtion
conirol oHicer). .
CERTIFICATE OF COMPLIANCE: I certity that under penalry of perjury the
information given above is cortect. I agree to comply with all state laws and
city ordinances regartling Hazardous Malenals antl Emissions.
$iB�aWre Dale ,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have reatl this application and state thal
the information given is correct. I agree to comply with all state laws and ciry
ortlinances relating lo building consWction, antl authorize represenWtives of
the City of Costa Mesa to enter upon lhe above-described property tor
inspectio purposes. I agree not to occupy or allow occupanq of any building
authonze� by this permit until fnal inspection. _ .
. SignaWrealLegalOwner(s) Date
SignaWre , Dale � \ Z� O �
305]<61��) �-7 AnE/or AulM1onzetl AOPliwnt ate
(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 323 E 18TH ST
Suite No B
Status: ISSUED
Applied: 02/Ot/2002
Issued: 02IO1I2002
Vicinity: . �
Parcel Nunmber: 42501416 _ - � - - --� --_ _ ISSUEDBY: �/.�
- � ii�/��� .�- � "_ � �.
� _
Applicant JAMESBRADFORD/'' �� " `�`
' i
Address: .: �%�- i ' �. � . / � � ��
/ � � �-- � � ' � ' � Phone . 714-847 3664 � �/ � �-� � \ c �
/, ' � -'� �� � - , ��
� - Zip. / ��� / �\ �� �
i ' ���
� - _
� . - - - - /\\�-
� �j � �� '� . �� _ � =- - . : A � � ���
� �� ` �' / \��
Owner:- SANDBERG; ROBERT W TR ���;���` '�� i";�\�` `
� ; : �� i `� � � _i . ��V��
Address ��18832 WINNWOOD LN ��������� %� � �,��, A
' � % ;, � ��; j � Phone: \`���� � �`��::�
� �` - " SANTA ANA, CA Zip 92705 �� � �� �� � �,
� �_ ,
i l ��� .,� . ; < / i � .�1 _ - �,, ,, �\ � ` `(� \ \ \
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� �'Coniractor �THE3EEBEE'S �� ��' -�� " �� -• � � �� �
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, �-y'/i _ �., ` , . � _� ,
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� ' Address � , 7436 TALBERT AV i �: � '
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� \ , / `�� , . - � Phone: 774-8473664 � � �"� \ -� : /���• �<,tl .
" i �:. , '- "% i'� \n
�� � ; HUNT�NGTON BEACH,CA Zip: 92648 �/ � �- �
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� ��, � �
, � License: 735383 . .
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� �'' / �/ 7/r'`�,� � �/l � '� r'1�.; Y ��A ,.
� Arch/Eng:-. . ..,/ � . ': � . �.�.� ��' ; � .
� Address:
-- '. . ' .- .-. _'_' ' . ) : '� , .
i �� � � .
� " Phone: -� � -
i, , '�/ .�\_,: Lp.,i-,A � �� � �
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, . -- � License: - , �� I - -
WATER REPIPE AND REPLACE 1
v
� i �- , �
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,- ;
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F-PERMIT � , .- � � /', � (� '
2 HEATER IN UPSTAIRS UNIT. ��;; ��� , '
� ,
i -,
;�.FEESUMMARY.. ;�%� � . '
, � AMT� QTY � � � " � �AMT�'��,QTY �i�� � � " AMT
ISSUE FEE ��- � � �' $23 50 '= ��,. i := Laundry Tub I Washer . - $0.00 '; 0.:' : +;x'�'. Sump�Pump �- $0.00
i.
BackFlowirrigation $000 �.��0� '" Landacapelrrigation„ �$0.00 0� � -SwimmingPool � /- ,�$0.00
BackflowPrevente��� �$0.00 , ��0 �A�� -P-Trep � _ ��� �o $0.00 0 "�TrapPriiner � ���� " $0.00
Bathlub `-��� �,$000�,_,0 `>` c>Pressure-Regulator�" � $0.00 �0 �- Urinal� �.�;: �� � $0.00
Clarifier System �` �� �$0 00 �. �0„ � � Process Piping (per 10 ft)� $0.00 _ . 0 - �� Vacuum B'rkr Bkflow(1!4) $0.00
Connect pce,Soda etc) `� ; $0 00� � 0' �� �' Receptors = �-� � - $0.00 �0 �"� � ( .Vacuurri�Brkr Bkflow(5+) $0.00
DentalUnits ���$000���>,Oi - !''��SepticTank�� - � "�_�$0.00��0 ���� Waeh'Basiri'�i $0.00
Dishwasher `$0:00 �, 0:, �; ;%, ���- Sewer Cap for Demo 50.00 }(0-��� AA N/ash.Basin�Set 50.00
Drain, Floor $0.00� ' 0 _ ' , -�Sewer,Conneot � � � ' ' �� $0.00 ��0�� �� Waste�and Vent System $0.00
Drain, Rainwater $0.00�� � '0 � � �'� Sewer Private Line . . $0.00 '-0 - ' - ; Water Closet (Toilet) 80.00
Drain, Roof $0.00 `0� � ��Shower - �, , � , . ; $0.00 0 . " �i�.WaterHeater/vent $12.30
Drinking Fountain $0.00 0 ��Sink, bar $0.00 ,0- '�' ��%� Water Piping Qnst or Rep.) 50.00
ExpansionTank $0.00 0 ``5ink,-commercial- ��.. �%-a0.00�� D-`"� WaterRe-pipe $9.80
Gas Earthquake Valve $0.00 0 Sink, Floor- -- -- ---$0�.00 0 Water Service $0.00
Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Sokener E0.00
Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER 50.00
Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION 50.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK 50.00
Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00
Intetceptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: E45.60
COMMENTS / SPECIAL CONDITIONS
QTY
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) '
EXPIRATION: This permit shall automatically ezpire and become void it work is not commenced within 180 days, or if work is suspended or ebandoned
for e period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetiona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmit.
FOR INSPECTIONS CALL: (714) 754-5626
zaae-ae�eiao�
WORKERS' COMPENSATION DECLARATION: . -
I hereby attirm under penalry ot pe�ury one oi ihe lollowing tleclarations: �
� I have flnd will maintein a cenifiwte ol consent to sefl-Insure for workers' compensation, es provided for by section 370D of �ha Lebor Cotle, for Ihe pertormence of the
work for w�Ic� �hi5 pertnii is is5uetl. .
❑ I have antl will meimain work2rs' compensatlon insurence, as requirea by section 3700 of the Labor Code, tor ihe perfortnance of Iha work For which Ihis pertnil is issuetl.
My workers' compens tion Insurence c er a policy num6er ere: p
Cartier: 'f�H�r iA.�� � PoliryNumber: ZZ /—O Z ��
(7itls section need nof e cromp/eted il fhe permil is velued ef one hundred dollers ($1 OJ ar less.)
❑ I certity that In ihe pertormance of the work for whic his permit is issuetl, I shell not amploy any person In eny manner so as to become subjact to ihe workers'
compensatlon laws ol Celifom�a, and a ree the oultl e me subject ro the wo ers' compensation provisions of Sectlon 3700 at the Labor Cotle, I shall torthwith
compty with Ihese provi ions.
Applicant Signature: � Dete: Z/ r/0 �" �
WARNING: FAILUPE TO SEC R WOpKERS' COMPENSATION COVE OE IS UNUWFUL ANO SHALL SUBIECT AN EMPLOYER TO CRIMIWIL PE TIES /WD GVIL FlNES UP TOONE HUNDRED
THOUSANDDOILARE(E100, INAODITIdJTOTHECOSTOFCOMPENSATION,�AIMGESASPiiOVIDEDf-0RINSECTION3�p50FTHELABORCODE,IMEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that 1 em licensetl u�tler provisions of Chapter 9
torce end eftect. uc. a_�- u 3
� Conirectafs SigneWre:
with Section 00) af Division 3 of Ihe Business antl Professions Cotle, and my license is in tull
cia�a l;-3�a
/ oe�e: '/ 0 3 i o 3
CONSTRUC710N LENDIN(T. AGENCY:
❑ I hereby eNirm ihat Ihere is a construction lending agency for the pertormance ol Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Name: Lender's Atldress:
Siqnature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirtn �hat under penelry o� per�ury Ihat I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7037.5, Buslness antl Professions
Code: Any ciry or counry which requires a pertnit to consWct, elter, improve, tlemolish, or repair any structure, pnor to its issuance, elso requires the applicant tor such pertnit
b lile a signetl statement ihet he or she Is Iicensed pursuent to Ihe provisions oi the Contractore Licensa Law (Chepter 9(commencing wlth Section 7000) 01 Divislon 3 of Ihe
Business and Protessions Cotle) or ihet ha or she is eaempt Iherefrom end ihe besis lor Ihe elleged exemption. Any violation of Sectlon 7037.5 by eny epplicent for a permit
subjects the applicent to e civil penalry of not more then five hundred tlollars ($500).):
❑ I, as owner of Ne proDerry, of my employees with wages es their sole compensation, WILL DO THE WORK, end the struciure is not intended or oHered lar sale (Sec.
7044, Business antl Professions Cotle: The Contractors License Ww does not aDPly to en owner ot properry who builds or imD�oves thereon, antl who does such work
himself or herself ar thraugh his or her own employees, provltlad Ihat such improvemenls ara not Intended or ottered for sale. If, however, Ihe building or improvement is
sold wit�in one year oi completion, ihe owner-builtler will heve Ihe burden oi proving that he or she did not build or improve lor purpose of sale.).
❑ I, es owner ol ihe property, am EXCLUSIVELY CONTRACTiNG WI7H LICENSED CON7RACTORS to construct the project (SecJ044, Business and Prolessions
Cotle: The conirectors License Lew tloes nol apply m an owner ol property who bullds or improves thereon, antl who contrects for such project with e comracror(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Protessions Code tor this reason:
Signature: Date:
Owner ID venfied by tlnvers license. ❑ Yes ❑ No Drivefs License No. Enpires:
Venlication oi Ownership by (rype a� tlxument, i.e. - proparty ta: Gill or deetl�:
DIVISION OF INDUSTRIAL SAFEY�' �ERMIT CER7IFICA710N:
❑ I hereby certify �hat no excava�ion five (5) or more feet in depth into which e person Is requiretl to descentl, will be made in connectlon with work euthorized by Ihis
pertnit, and ihat no building slNcture, scaHolding, falsework, or demolition or dismentling ihereot, will be more than thirty-sis (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Celitomia ACminlStretive Coda).
❑ As owner-�ullder, I will not emp�ay enyone to do work which would require a pertnit irom the Division ol Industrial Sefery, as noted ebove, unless such person has e
permit lo da such work trom ide division.
Signeture: Date:
Division ot Indusinal Sefery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I certify under penalty ot pery'ury ihat I have reatl this epDlicalion and state thet ihe information given is
cortect I agree to comply with all sete lews end ciry ordinances releting to building consWction, antl euthodze representatives oi the Ciry of Coste Mesa to enter upon the
above-descnbed pmperry for inspeciian purposes. I egree not to acupy or allow occupancy ot any building euthorized by this pertnit until tinal inspectlon.
��
CODE I.
1616
1266
Fixetl System Final Fira Preventlon
Pool Spe Final
200 Finel Re-Rooi
201 Final 81aN/Retaining Wall
202
203
Final Fectory Fire Place
Final Sign
204 Final Demoliiion ,
Qaif. �mn�$
CODE� INSPECTONTYVE
2oe Final Mechaniwl
208 Final Plumbing
210 Final Electdcal
212 Final Fire Prevention
22o Final Plenning Approval
222 Finel Sita
250 Final BuiltlingiOccupancy
Pate
OZ/�� Oz_
o a —�
GAIE 11�
(714) 754-5273 • Fe1c (714) 754-0856 // r�ain univc, �.va i n moan, �.r� ncom
.lob Address: 323 E 1 STH ST
Suite:
Vicinity: GARAGE ONLY
Parcel Nunmber: 42501416
Applicant: HOVEY, GLEN
Address: 11444 TERRACINA
REDLANDS,CA
Owner: SANDBERG, ROBERT W TR
Address 18832 WINNWOOD LN
SANTA ANA, CA
Contractor: HOVEY ROOFING
Address: 11444 TERRACINA
REDLANDS,CA
Zip: 92373
Arch :
Address:
BUILDING PERMIT
Zoning:
Phone: 909-798-0807
Zip: 92373
Phone:
Zip: 92705
Phona: 909-798-0807
License: 538667
Eng:
Address:
Phone:
Zip License: Zip:
SCOPE OF PERMIT
REMOVE EXIST. BUR AND INSTALL BUR WITH GR4VEL ONLY TO THE GARAGE AREA..
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total;
$0.00
$74.75
$0.50
$0.00
$0.00
$0.00
$75.25
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Fmnt 0-0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Reouired: ' 0
FEE SUMMARY
PLANNING 8 ZONING
LeR 0- 0
Left 0- 0
Proposed: 0
Status: ISSUED
Applied: 0411 6/1 9 9 9
Issued: 04/1611999
ISSUED BY: C F� �
Calc Valuation:
Ciaim Valuation
Right 0-0
Righl 0- 0
Phone:
License:
sz,zoo.00
52,200.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia slatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. '
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectio�e end finel approvel must be ob�ained. Feilura to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTION9 CALL: (774) 7545626
WORKERS'COMPENSAnON OECLARAnON: � ,
I hereby eftirtn under penelry ot perJury one of Iha tollowing declarations: '
❑ I heve end will meintaln e certificate of consent ta selt-Insure tor workers' compensation, es D�ded far Cy seclion 3700 of Ihe Lebor Cotle, for the pertortnance of Ihe
,- work for which this pertnit is issuetl.
�' 1 �ave antl will maintaln workers' cwnpensatlon insurance, es required by section 3700 of ifre Lebor Coda, tw Ne pertortnence of Ne work tw which Nis pertnit Is issued.
My warkars' compensetion Insurance cerrier and policy number are:
Cemec STATL ���r+l �� PolicyNumber.,US%la�B
(TM1Is sectlon neetl not be cromp/eted i/ the permit Is veluetl et one hundred dollars (5100) ar /ess.)
❑ I certify that in the pe rmence of Ihe work for which this permit is Issueq I shell not employ eny persan In eny menner sa es to become sub�ect to ihe workers'
compensalion laws i la end a r t If I shoultl Oecome sub�ect lo Ihe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these s. �/
ApplicaniSignature: Date: `i—f �� ��
WARNING: FNLURE TO SECSIRE WORKERS' Q7AIPENSATIIXJ COVERAGc IS UNLAWFUL AND $FULL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED
T/qU$AND OOLLARE (5100,000). IN AODfiION TO THE CQST OF COAIPENSATION, DAMAGES 0.S PROVIDED FOR IN SECTION 31060F THE LABOR COOE. IMEREST, ANO ATTOqNE1"S PEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aftirm ihat I am
force antl ettect Lia k_
Conirector's Signeture:
ot C�epter 8(commencing wlih Sectlon 7000) ol Divlsion 3 of the Business entl Professions Coda, antl my Ilcense Is in tull
Cleu x G— 7 `'�
Date: —1 ��`�"1
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm thel there is a construction lending epency for Ihe pertormence of ihe work for which Ihis permit Is issued. (Sec. 3097, Clvil Coda).
Lendefs Name: Lendels Adtlress:
Signeture: Date:
OWNER•BUILOER DECLARATIONS:
I hereby aKrm ihat under penalry of perjury that I em EXEMPT FHOM TNE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness end Professions
Code: Any ciry or county which requires a pertnit to construct, elter, improve, demollsh, or repair any strucWre, pnor to its issuence, elso requlres the applicant 1or such partnit
b tile e signed statemeN Ihat �e or she is licensed pursuent lo the provlslons of the Contractors License Lew (Chepter 9(commendng wIN Section 7000) of Dlvlsion 3 of the
Busineu and Profeuions Code) o� that he or she Is exempt ��ereirom entl the basis for the allegetl exemptlon. Any violetion ai Sectlon 7031.5 by any epplicent for e permit
subJecis ihe epplicant ta e ciWl penalry of no� more then Ilve huntlretl tlollars ($500).):
❑ I, es owner of the property, or my employees with wages as their sole compensatlon, WILL DO 7HE WORK, end the structure is not intendetl or oXered for sale (Sec.
7044, Busineu entl Professlons Code: The Contrectors License Lew does not apply to an awner at properry who builds or impraves Ihereon, and who tloes such wark
himself or harself or ihrough his o� her own employees, providetl ihet such Improvements are not Inlended or aHeretl for sale. If, however, Ihe Duilding or Improvement is
sold wlthin one year ot completion, the owner-bulltler wlll have the 6urOen of provinq ihet he or she did not huild or improve for purpose of sale.).
❑ I, es owner ol the property, am E%CLUSIVELY CONTRACTING WI7H IICENSED CONTRACTORS ta construct Ne pro�ect (Sec. 7044, Business end Professions
Cotle: 7Te contracrors License Lew tloes not appry ro an owner oi praperty who �uiltls or impmves ihereon, and who wntrects for such project with e contractor(s)
Ilcense pursuant to the Contractors License Lews.).
❑ I am exempt under sec. Business end Professions Code tor this reeson:
Signature: Date:
Owner ID verified by drivers license. ❑ Ves ❑ No Drivers License No.
Venficetlon of Ownership by (type of daumenL i.e. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ I hereby certlry thet no excavatlon five (5) or more feet In tlepth into which e person is requlreC to Oescen4 will be mede In connection with work euthorized by this
pertnit, end that no builtling sWclure, scaHolding,lelsework, or tlemolitlon or dismentling Ihereof, will be more then thirty-siz (36) teet NgR (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calilamia Adminisiretive Cotle).
❑ As owner-bulldar, I will not employ enyone to do work which would require e permlt Irom the DlNsion ol IndusMel Safery, as noted flbove, unless such person has a
pertnit to do such work Irom Ihe division.
Slgnamre: Date:
Division of Industrial Sefery Permil Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOROJITION OF ENTAY: I certily under panfllty ot perjury Ihel I heve read ihis epplication entl state �hat t�e infortnation given is
correct. I agree to comply with all state laws and ciry ordinances relating to building consiruction, end authodze representatives ot ihe City of Costa Mesa to enter upon Ihe
ebove-describetl properry tor Inspection purposes. I agree not to occupy or allow occupancy of any builCing authorizetl by this pertnit until Ilnfll Inspecllon.
COOE�. INSVEC7IONTYPE , Qsjf, IIiI�ELS
1676 Fixed System Finel Fire Prevention
1266 Pool Spe Finel
200 Final Re-Roof
201 FIneI B1acWRetelning Well
202 Finel Fedory Fire Place
203 Final Sign
204 Final Demolition .
2uE48
�
4— i �_�� �a�a
Date
CQDE I IN57ECTION TYPE
� 206 Finel Mechanical
20B Finel Plumbing
210 Finel Electricel
272 Finel Flre Preventlon
220 Flnel Plenning Appravel
222 Final Site
, 250 Finel Builtling/Occupancy,
Q� INiII7pL5
PXOJECI�ROOflESS: 3 2 3 E 1 8 TH ST
OWNEN'$NFME: MURY�A , FRANCIS J TR
nooaess: q306 1`/OTH ST
LAWNDALE,CA 90260
RPCHIENGMEEP:
ROONESS:
flEG.NO.:
UNIT:
UNR:
renminee: MACFARLANE ELECTAIC ( 714 ) 543-9265
nooness: y115 N. MAIN ST
SANTA ANA CA 92706
UCENSEU CONTflRCTON �ECLAXATION: I �¢reDy aifirm Ihat I am Iicense0 unaer D�ovisions of Chdpter 9 �tammencing wit� Section
7000) ol Division 3 0l ��e Business antl Prolessions Catle. anC my lirense is in lull lorce an0 effecl.
��n��� 006246 sTnreuc.:13165 cus��-�p
oaie: 12J3�qz Signawre: —
-�--i' �
IWOBNENS' COMPENSpTiON OECNNl1T10N: I �ereby aifirm ihat l �ave a cenificate al consenna sell-insure or a certilicate o1 Warkers'
ICompensa�ion InSurance, or a certilietl cop Ihereof (Secnan 38W. LaE. C).
voucv xo.: WP 8 0 S 8181 � E%P. ORTE: 1 O I O S I 9 3
coMraxr: FIR$MAN'S FUND
'� Cenitied copY �s Aereby lumis�ed. � CertilieA copy i' etl wRh �he city BuilAing ivison.
�aie: �/ti/�J' Applicanl: ��'"'�/�' /v�
EXEMPTION FBOM WOPNEq$• �pMPEN5NT10N OELUMT10N: Qhis seclion neetl iro1 De comple�e0 il Ihe perimt is ior one AunOreO (510D) ar le5s�.
I C¢riity I�ai in I�e Oedarman[e at th¢ xroB br whiCh I�is permli i5 i55UeG, I Shall no� ¢mpl0y any Delson in any mannef 5o as lo betome
suDjecl to ine Wo�kers Comoensation LawS of Califomia.
Daie: SignaWm:
NO710E: II, alter maWng t�is declaration. you s�ould become suElen to ihe Workers' Campen5a(ion prm�itions ot ihe LabOr
Coee. you must foqhwitn compty witA sucn pmvisions or tnis permit shall be EeemeO revoke0.
LONSTHUCTION LENOIryG FGENCY: I �ere�y altirm ttwt IAere is a cansimctian lentling apency far t�e pedormance ol the work lor
whkn Ihis pe�mit is issue0 ISettbn 9W7. Gv. C).
LENOEN:
R�ONESS:
OWNEB BWLOEB OEC4NR7ION: I nereoy affirm Inat I am exempi imm tAe Caniractors' State License Law for t�e followinp reason
(Seclion 7031.5 BusinesS anG Pmtessional Cotle: Any city ol county whic� repuires a permit Io consiruct, alter, improve, Oemolish, or
rtDair any simcture. prior ta its issuance. also repuias the aODlicant lor such permil to file a signetl sta�ement tAat hpJshe is IicenSeA
purzuam io Ine pmvisions af tne Contracmri Siate License Law (Chapter 9(commencinp witA Section 7000) ol DHisian 3 of tAe Buvness
ana Prolessions Cotle) or that nelshe is eeempt t�erefmm and ihe basis far the alleAetl exemption. My violation of Section 7031.5 ey
any aoDliWnt tar a oermit suhie��s ine appliWnt to a civil penalry of not more Olan live nunErM dollars (E500).
I, as owner oi ihe D�opetly or my employees with waAes as iheir sole compensation, will Oo tAe work, anU I�e
❑ slmc�ure is not intentle0 ar ollere0 for sale (Sec�ion 70aa, Business antl Pmlessional Code: T�e ConVactors' S�a�e License Law
Uoes not apply ip an owner of a DmOetlY wM buil�s or impmves ihereon, anA w�o tlaes such work himsetl/�erse�f or Nrouph
Ais or �cr own employces, pmvideE I�al such impiovements are not inlen0ee or ollered tor sale. It, �owever Ihe Duilding or
im0�ovemenl is soltl wi��in one year of compleiion, �h¢ owner will have �he burtlen o� D�oving he/she did not 6ui10 or impmve
lor t�e Durpose oi sale).
I, as owner oi t�e pmpeny. am exclusivel9 contractinp with licensetl coniracmrs to constmct Ihe O�olecl (Section 70aa, Business
❑ anG Pmlessims �p¢: T�e Cantractors' State License Law tloes not apply �o an ovmer ol pmperty wtp hml0s or improves thereon
an0 w�a coniratis lai sucM1 prolecis wil� a comracmqs) license Oursuant to ��e Contracmrs State Laense Law). I am aware
Iha� proo� 01 t�pir Worker'S Comp¢n5alian insurance ShoU10 be pwviJeO Io me.
� I am eKempt under Section: B. 8 P. C.
lor ��is reason:
Da�e�, Qwner
I tla nereby certily that I am aware of antl untlerstand the reQuirements o� Calitomia Health ard Sa�ety Code Sectbns 25505, 25533, arrd
255�4 antl inat I or any tuture builtling occupanl will/_II not �circle one) need lo comply wilh saiU staie codes and ihe reQuiremenis br a
permi� lor cons�mction or mo�ilicalion Imm �he Nir Oualiry Managemen� DiSiricl. Fesitlen�ial con5lNction applicafions are eKemp� �mm
Ihese O�Ovision5.
Date: Applicant:
I �ereDy cerlityt�atl �averead t�is application an0 statet�att�e above information is mrrect. I agre¢ta compry w�t� allciry antl cwniy
ortlinance5antl51a�elaw5relalingtoOviltlingcon5lmclianantlhEr amnonzere0�esentatives l�iscirytoenie�upan��eabove�m¢ntianetl
pmDerN �orins0eciion purposes.
Daie: ��q�% 1 Signaiure: � `_ '
Oriver's License or Social Securi�y a: ]
16ALa6 Wh�le-8uilqing: Green—CoCa Enlorcament: Canary—AOP���ant: P�ink—Revenue; GalEenrotl—Assessar
� ^ CITY OF COSTA MESA — BUILDING PEAMIT PERM NO; E 060264
PERMIT NO: E 060264 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION : ELECTRICAL SERVICE CHANGE—OUT SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /
COMMENTS: SERVICE CHANGE—OUT ONLY. NO 'BUILDING' PERMIT INVOLVED.
�t�t�t�e��e*�t�t�t+�x�r�r�t�t***�t*��ex�e��r�t�t�t�r*+t�t���r�t�t�e+t�r*�t**�r*+t*�r�rir+r�t�r�r�e�r�t**�t�r�r�*�r�t*�t�r�t��tx�*�t�r
Z O N I N G R E Q U I R E M E N T S
sETSAcxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT ZN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REp • PROV; PARCEL: 42501416 ZNE; REF 1J0;
PLANNING N(31'ES>
�
if iFiF iE iE k if If if iF k!f iE iF�f it iE k±f if k if if ik If if if 1f 1f ik �f iF if if�if if iF iflf 1f �E if if * iF M if if iF if iF 1f if 4 iF k iFif 1f 3f If k iF 1E iF 1f iF �E 1E iF iF 1E �f i!!F 1F if 1k 1f
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 i DATE;
BUILDING APPROVED HY : - DATE;
APPLICATION ISSUED HY: DATE• �'2 �
iFiFlF�fMlFiFiflfit�f!!lffFlflF�fitiFiF�f1F if�FlFlFifiFif�klklf **
ititifif�Flk�flfit�fiflf�E�F�f�f�fififlF�fit�fiF�Flt�f�l�f�fiFifdFifififitit�F�l3f�fklt�f itiFiFifiFifiFifiFifiFitififiFifikltlFil�filiFiF�fitiEif4iklk�F�F
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 1850t
PLAN —
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 18.50 15.00 0,00
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMHING ELECTRIC MECHANTC
33.50
SMIP/NON—RES
TOTAL PAID DUE
33.50 33.50 ,00
33.50 OVER/SHORT: ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
k�l�klfiFMiFiFMkitlfMlElFiFif!litMlfMiFMlFifiFiFiklf iFiFiFMlfillfMMiFiE�tiF�Fik�EiEkMiEMkklEk�FlklkiFififiFifikitiFlEiflkifftilikififikif iFik
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 1 SERVICES BELOW 600 V 5 BELOW 201 AMP 18.50 18,50
END OF FEES
, _ CONSTRUCTION AND PLANNING- POOL 'A �
APPROVALS Permit # Date Inspector AFPAOVRLS Permit # Date Inspector
� •
- 1. Temporary Electrical Service or Pole�� _ 52. Pool & Equipment Location -
2, Soil Pipe•Undrgrnd_ Q.� � 53. Steel Reinforcement
.. ;. Electrical Condei}1T�ility-Uhdrgrnd,,;; 54. Forms
`�: Electrical Condse•USdrgrnd. �- 55. Electrical Bonding
���; Steel Reinforcem�L= �� 56. Rough Plumbing & Pressure Test '-'�
�.6, glectrical UFER Grnd. A 57. APPflOVAL TO COVER-GUNITE .=
��'7,;:Fpotings r�' � 58. ElectricalCpnduit•Undrgrnd. �'
;_ 8. Fpundation � - � 59. Gas Pipe, O Undrgmd., Test ,
9. Water Pipe�Un�gmd. ' � 60. Backwash Lines, P�Trap, � Undrgmd. �
_ ,
10. Structural Floor System _ - 61. APPROVAL TO DECK �
tl. PrApertV Sewer linef& Hoilse Co�n€ction . 62. 8ackwash & AeceptorFinaV
12. Sawer Cap _: " �l 63. Heater & Vent-Final "��
13. Roof Drains y • � 64. Plumbing System - Final '
14. Rough Plumbi7B � - 65. Electricai�Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. ROugh ElettricNJirin9 67. Fencing & Access ApProval
17. Rough Wiring $ign 68. APPROVED FOR PLASTERING
18. Rpugh Electriql,-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI
19. Rough Heating & Air Conditioning `� FIRE DEPT. REdUiREMENT
_ . _ _ i tT C7'N�.Dr• .K e. R}
20. Ro�gh Ractory Ftreplace � =��T� a' = O � crx :� ppR6VlfL'9����Per "iit # - �' "�
- t-.[ �,. i�,�r �.�5 � 7'; Y h �`!1Ji�� � � ��:.
' i < . - ? X :-� X a J :•S . .. rp�
21; Duct's, inrStructur.e.r �.. .. '� S r, � - H.•. �c � 0. WRderg[ouAchHKelro .
22. Ducts, VentiTatin9" ; ����; �'r. b y �,� y�71. Produc�` i�ing Q�G�js ❑Oil
23. �Gas Pipe�tough &�st ; �� '` " '""''•` r � � r. -
:T;S ;� a: 7 d G+< �+72• Undergrobr� FIwt,F� .. �"�
24. Roaf Framing � FF yF ", � � t' �� s s/3�Undergmd.'Stordg�'iank �] Gas ❑ Otl
�� rn x :. S „1: r: �
.� . � x S' ri M . '.T� lJ� x • � V �-'.. >
�� 25. Roof SAeathing . ,y x c� ;> `�74,^Overhead Hydro� �
26.��T�Ber Ceiling (StcucauraU &'fel�nrocoat �- � " ^7t r 75.�Dry Chemical ` ' - N
r
27: Frame and Flashrolj� �S,K � 7 y yr ; 76: Dry StandRipe �,i x S " j
t-�i8. Ldthing.& $iding5x t. ='C-:: S x. i ^�'t 77?FIXED S�''$TENF NAL� �� , n
' "29. Insulation `` °: �' " .. •• '' '' n •. '� � ' �' � ^�
� � ; * . ,� 78„FIRE PREV. FI(VP.t �: > �
� 30. Drywall �Nailing �' � � � ~� HEALTH DEPT: RfQUIRE�MENT
.. cf c x
�
r37. Plester Brown�Co�aty, � � :, , � . _J9.`�'FINAL IN56ECTION', : C ' 3
.
32.,Electrical Power tvletet;Final; �� .� •:=80.:FOOD CERTIFICATE ISSUED �
r
.33.,�inaf Electri� '* r � � �j� ` �Noie�:, ,. � '�' ; _ .. '' r
� c - � :... - ,_.�
;�34. Final Heating & AirConditioning-; r' �r + C�� S C
� , �.-; , i -
35. Fin'alGas;Pipe�Te5 � • � ^ _ ` `- - `-�' _ ' ;
,[{>. r�i� r. , .'Z-" .x �
� �. _). � r� �. �n J . J't~ +. � � _�•
36. �Hood or Canopy .- > �_r�- n n : � F. �' J -�
_ r
37. Final Factory fireplacA_. � `'`� " �`� ; " r' ` � ��
- n Y �° �
38. Final Plu`lnbing '� < � � � n Y ' g . � � -
39. Water Service-Pinaf: .-: ' � . � � • T• ^
-x �' F K?
z40. Gas Service-Finalr . .*� -t �-,� � x •. Y >� � x �
�47, $olar pomestio-Fimal S i�� - ^ " � � t - '
.0 .. r -
:F : : K a H � � � „ .
� 42: �Backflow Prevent@r� � � ;t ' ,. .� s, - -� _
43. Backflow Irrigatioli' �V s'+•� x ' `�' - - ��
ti y. �
�44. Landscage IrFigatCpn SYstemr n� F .q - - �> �< � :•1 :� :(' . � J -�
45. Sound Attenuation� -.+.: : F .. : ` {; =.. �, t� � ,r �. .i.� x �
.- . t , - :: -:, .
-06. Handicap,Regulations : ` K'" � � A �" x g �� ' g .
47. FINraLSTRUCTURE&BUI�LDING � F'F � L :; �
x: i -
.•48.'FINALPLANNING� ' `'� �:,; � r , -
�A9. -Eleciric Release to Edison � ' L T . � �
r '
'S0. �GasAelease to SouGhem Cafifor�ia Gas Co ;� ; � �: �. - L - r " .
�51. CERTIFICATEOF�OCCUPANC i v r.'s .' `' � < � " �-
No. Date
City of Costa Masa
Buildinp Sefaty Depertrnent
P.O. Box 1200
Costa Mese, Celifornia
CERTIFICATE OF OCCUPANCY
The Building located at
has been inspected and found to comply with the provisions of ell City of Costa Mesa Ordinances applicable thereto
for a Group Occupancy.
Use of Building
Legal Description
(See raverse cide for Metes end Bounds)
Building Permit N
ISSUED TO:
lectrical Permit No. Plumbing Permit No.
Number of apartments and/or guest rooms
Building Official
by
Date
This Certificate of Occupancy SHALL BE posted in a eonspicuous plaee on the premisea and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C.
Form BU 36 Rev. 11/70
• .. C �' : •
��' ` '7308 �'�� .��� (�ECE��:;�
' ic� ' � S - �-/- s Fl
COSTA MESA BUILDING DEPARTMENT FIN",NCE DEPT.
P.O. BOX 31]
COSTA MESA. CALIFORNIA Clly �F f,OSTP MESA
FOR APPLICANT TO FILL IN
� s.. . i o � i �
COSTA MESA. CALIFORNIA
MAIL
ADDRES�
CITV
ARCHtTECT
OR ENGINEER
ADDRE55
�ccn� ILOT �
DESCRIPTION NO. L
A.P. N�/ � �
SIZE � y X ��
OF LOT J
��-
USE OF
EXISTING BLDG. ��
SETO�CH LINE FROM' �
CErviER OG SiREEi
NEW
REPAIR
BWLDING
SIZE
E%TERIOR W.
COVERING
USE OF NEW
TEL.
NO.
LIC.
NO.
TEL.
NO.
TR�
�� O �
NO.OF BLDGS.
Now oN Loi
RIGMT '�� LEFT �i
DESCRIPTION OF WORK
ALTERATION qpDITION
MOVING � DEMOLISFI
� NO.OF
)Y'aA ROOMS .',� 5'1'ORIES
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. h�Pa�RM�T
/ �l
1
FECEIVCp BY pnTE RECEIVEO pqTE ISSUE
O ' —
��
ILDING
GOSTA MESA. CALIFORNIA
iV � �/ OHTE
ORRECTIONS
ry� i
y i.� �
CITY OF STA RtESA
SUBJECT TO DG. DEPT. REG.
�
$TATE TMAT THE LBOVE IS COFPECT RNO 4GREE TO COMPLV WITX iLL
CITV ORDINRNCE$ f�NO $TRTE 5 NEGUL/�TIN UILOING CONSTRVC-
noN. VALUATION .'
PERMiT FEE $ /
SIGNATURE OF u`
PERMITTEE � I� i �JL�� � pLAN CHECK S ,. /
� v ' - � -.�'
AUTHORIZED AGENT ' TOTAL FEE S � u�
.�
�`+' � . }� � ,79'i'O
COSTA MESA BUILDING DEPARTMENT
P.O. BO% 31�
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
.a000RE�s"s �' "Y_� /. /� 9i
COSTA MESA. CALIFORNIA
MAIL
ADDRE55 5
CITV
AftCHITECT
OR ENGINEER
ADDRE55
LEGRL LOT �
OESCRIPTION NO.
A.P. NO, �/� � � y
SIZE ` ! �
OF LOT( .�
USE OF
E%ISTING BLDG.
��� ��������
f I 3 I�S����_
��fyitlAtM ��►PT.
M�1 QF F�,� �
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
-�-.�. i-� / - -��" !/
TNO.(//�'3 LS/J� ADDRE55 `/ Z�/ L� Ji �
LIC.
No. COSTA MESA. CALIFORNIA
CITV LIC.
NO.
TEL.
NO.
DCK�Y TRAC
S
• No.oe e�ocs.
NOW ON LOT
SETBACK LINE FROM � /� I Y y ( ��
CENTER OF STREET rV � �O REAR YARD �/ G
.i 1 �
SIDE VARD RIGHT ,� LEFT
DESCRIPTION OF WORK
NEW ALTERATION ADOITION �
REPAIR MOVING DEMOLISH
5 ZIE DING �6t x� L� ROOMS � STORIES �i�
EXTERIOR WALL ROOF �
COVERING COVERING
L15E OF NEW ay�
BUIIDING /•�Yrt
� i . /�
BY
'/�.« DATE /�
CORRECTIONS
CITY OF CUSTA A.�+ESA
II MEREBV ACKNOWLEDGE TMAT I MRVE FEi� TMIS FYVLIC4TION 4N0
STATE TMAT THE ABOVE IS C FRECT PND 4GflEE TO COMP�Y WITH 4LL
CITV OfiOINRNCES 4ND $ LnWS REGl1L�TING BVILO NG CONS=RUC�
TION. � VALUATION
SIGNATURE OF �M ,�
I PERMITTEE �
s �U
�
AUTHORIZED AGENT '
I
�.
:�
PERMIT FEE $ / -
PLAN CHECK $ � �
TOTAL FEE $ pC� —" �°'"F
. _-� . 332.5 PAID � -�i.i 'ri.�•; ��
iti� �3-71�...:p0 9 � <�
COSTA MESA BUI'LDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
ForApplicant t�� ill in Completely . RE�veo ev D TE REC�VED �a^
D T ISSUED
BUILDING �+ �
ADDRE55 � t I SLYter C. M
, N a R re� % v z r ' '-� -� 3' P r.
OWNER �N% C/I rH/(IjF_ A.P.NO. � � O S
MAI L /] ^ BUILDING
� �S �/YOS /Y/YL C' . ADORESS
Z ADDRESS �j - C•
aU COS� �s�i • TEL. TRACT �/�` LOTOJ BLOCK
CITV a NO. S yf���j)%
FZ
Z Q CONSTRUCTION � " W p'� A P
O� LENDER H�E%%J�L SAV�NC> ��
am r
J� BRANCH /J�EIY� B�/ t C�H '. � ��t
J N OWNER
m J ADDPE55 - 1 4','. VA�UE
J a OR ENGIN ER O � /7I�JINS nT,E`'�� f'3i'f 5 g
V � /� ,�/n �/ FIRE , T ��}). -/ %1
w � ADDRESS �y //q��(C y � , /-/� ZONE TYPE Y GFOUP !'/ � '/ / �
APPROVED `/ /�y/..
JO CONTFACTOR DWNE BY Z` / DATE '�G�-"' ^
m Z
J� ADDRESS �� �'%OS�L' �:iH�C �
W W ZONE NO.OF USE OF NE �
�_ �' L/�1lS�t rE S�Y83y•%i �Z P�'"5 BUILDIN �
Z r cirv o No. � � �r e
-� STATE CITY YARDSAPPqpVED V S P R V
N K LIC. NO. LIG. NO. MAIN BUILDING S �
_� 512E NO.OF BLDGS. •' (FROM C/l $TR ET)
OF lOT NOW ON 40T G y� FROfYT FT. FT.
USE OF 9 r J� . Il
EXISTING BLDG. / - / �J FT
F SIZE OF p NO. OF !1 _ L ��
Z NEW BLDG.3G l OO, G ROOMS uC�tl STORIES L. SIDE l FT. FT. `
U E%TERIOP WAL ROOF ` ` 1
COVEFING �r�ILCO COVEHING J�O IS .FEAF FT. FT. `�`�
J USE OF BUILDING AND WORK TO BE PERFOFMED OISfANCE BET. gET, MAIN & VVV\
a MAIN BLDGS. ACCESS. BLDGS. (�
a I',' ��
O [�/►L C.U.P.qW �E '1 -�� qP ROVED 5-3 � j
� � APPR A �7 �
- _ � '� �'t - l �
p t10LD FOR SPE ' REQUIRENiENi� ��
VI �areby acknowlatlge that I have reetl this applicaeion and state �
� thet the abova Information is correct antl eprea to comply with ✓
� ell laws reguletinp builtling construttion, and 1 shall not empioy
r any person in viola[lon ot xhe workman's compenaation laws of
z[he Sta[e of Calitamia. � f O 'A � �
� I hereby cerHfy t�at I am prop¢rly licensatl as e contractor untler
47 SQ. FT. U o
the State of Celitornia Businass antl Professions Cotle, Divisicn 3, THE AMOVNT SHOWN VNDER VqLUAT10N IS FOR �
Chapier 9, and [het sach licanses are in tull forca antl e£fxt, ar 1 . 7HE PVRPOSE OF ESTqgLISHlMG A PERM17 FEE ONLV: �
am exempt f�om the provisions of the Stace ol Celifor�ie 8usinoss - Q
entl ProlessionsCoda, Division 3, Chaptar 9. VALVATION m
PERMIT FEE $ \. �
/ J
Sipnature of / /7( = m
Permittee / �l/i� �� 5 \� PLAN CHECK $ �/ / E
. 5 �ISDv \ °
Authorizetl Apent � LL
TOTAL FEE $
' � " :��-77�-«"001283�* **�**5.04
� � �.
- COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICA710N FOR BUILDING PERMIT
For Applicant to Fill in Campletely
�j y RECE D D:g,�{ /E q�) C VED ppTF �P��
4DORESS �7�� � /J�� ��YG GG ✓ f�`�% � n
C�I� �G I�d NS L</ A.P.NO. .�.� 3�(j PERMIYiVc'i 0
OWNEF J''t
MAIL /� BUILDING �..C.
ADDRESS ({�jOS'C �AL/'C �+DORESS
Z . ,(/ �
a U CITV CO �C/ //!� NOL'J�''SS�Ti TRACT � LOT S BLOCK
� Z
Z Q CONSfRUCTION y W A
ON LENDER .1 r ' ✓- �
am �J � BFANCH O ✓�•CHQ .— '
JN OWNER
m J ADDRESS � � %
m i /i�� VALUE �DD-�
ARCHITECT TEI. $ �/�� S
J N OR ENGINEER IV4 �� � N
V Q FIFE �
W Q ADDRESS ZONE TVPE GROVP
dW ^
/�j APPROVED
J O CONTRACTOR (r/ k/ LI <✓ BY DATE ��
°' z D
J ¢ ADDRESS M
w W TEL. ZO NO.OF USE OF NEW
Z� GITV NO. �� P�� BUILDING
—� STATE CITV YAROSAPPRpVED VARDSAPPqOVED
y K LIC. NO. LIC. NO. MAIN BUIIDING ACCESSORV BUILDING
7 O (FfiOM C/L STqEET) � ( �
512E NO.OF BLDGS.
OF LOT NOW ON LOT OM �
USE OF
EXISTING BLDG. FT
r SI2E OF NO.OF
QNEWBLDG. ROOMS STORIES I.SIDE T. T.
� EXTERIOR WALL ROOF l
COVEflING COVERING REAR FT. FT. .
aUSE OF BUILDING AND WORK TO BE P�flFORMEO DISfANCE BEf. BET. MAIN &
a MAIN BLOGS. 4CCE55. 9LOG5.
Q S_/ f��L� ��/ VAR.qW DATE
O C,U.P.�W I / APPROVED
� / � APPROVED 11 A v
N (O v.� l.
Z
O
VI heraby acknowlatlpe Ihel I heve reetl thig application antl stom rAje
� Net the abova information is correct entl oprea to comply wIM �
� all laws reBulatinp buildin8 cOnsvuttion, antl I sholl not amploy
� any Derson in violatlon ot the workmen's tom0ensation lawa ot
(n the State of Celifornia. � m
b
zI hereby certlfy 2hat I am properly licensetl ez a cont�actor untlar SQ. o
the Stete of Calitornia Business antl Protessions Code, Divisicn 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR �
Chapter 9, antl that such licenses are in full farca antl affoet, or I THE PVRPOSE OF ESTABL�SHING A PEIiMIT FEE ONLV: m
em exampi from the Orovisions ot tha State of Callfornia Businass �
untl Profossions Cotla, Oivislon 3, Chapter 9. VALVATION /pj) m
(/� PEFMIT FEE $ �� �
�.�� ��-�-� .�DD '
Sig^etura of m
Permittee PLAN CHECK $ ' E
0
� LL
Authorizetl Aqant TOTAL FEE S �