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Home My WebLink About330 18TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 C .1obAddress: 330 E 18TH ST Suite No Vicinity: FRONT YARD AREA Parcel Nunmber: 11725717 CITY OF COSTA MESA ' BUILD/NG DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT npp�icant: BELOUS, GREGORY P Address: PO BOX 1264 � NEWpORT BEACH, CA � Owneis ' BELOUS,�GREGORY P� r Address P4 BOX 1264 �" ' - NEWpORT BEACH, CA PLUMBING PERMIT Phone: (949)645-6855 � Zip: 92659 Phone: Zip: 92659 Contractor: OWNER-BUILDER ' - Address: � , /� , � . � - r . -� . . _ . . ' , i' . , . Phone:_ Zip: - , , �`� - License: 0 -Arch / Eng : , - _ ' � - � Address: � - - � � = PERMIT NUMBER P00-00044 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: � Phone: ZiP: .r;,,,, ,'i, . � . ' � � �.License:.- � _ r i. � . , _ , 1 . . , � _ .. . . , f" '. " . � j"' /- � ; ' REpLACE 18 LF OF GAS PIPING SUBJECT TO FILED INSPECTION. ISSUE FEE BackFlow irrigation � BackFlow Preventer Bathtub � Clarifier System � � Connecl Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (i-4 oatlets) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Qrv Laundry Tub / Washer $0.00 . 0 �.' Landscape Irrigation $0.00 - 0 . P-Trap . �.$0.00 0 Pressure Regulator � � $0.00 0 � �� Process Piping (per 10 ft) � $0.00 0 �� Receptors $0.00 0 SepticTank - $0.00 0 . Sewer Cap for Demo $0.00 0 � Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 '.. Sink, bar � � $0.00 0 , Sink, commercial $0.00 - - 0 Sink, Floor � ' $0.00 0 Sink, kitchen $0.00 0 Status: ISSUED Applied: 01/24/2000 Issued: 01/24/2000 AMT Sump Pump $0.00 Swimming Pool $0.00 Trap Primer � $0.00 Urinal $0.00 Vacuum Brkr Bkflow(1-4) $0.00 Vacuum Brkr Bkflow(5+) $0.00 Wash Basin $0.00 Wash Basin Set $0.00 Waste"and Vent System $0.00 Water Closet (Toilet) $0.00 Water Heater / vent $0.00 Water Piping (Inst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 WaterSoftener � $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N0710E: The work authprized by this permit shall comply with al! applicable handicap access �equirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permii shall automatically expire and become void if work is not commenced within /80 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CAL�: (714) 7545626 � WORKERS'COMPENSAnON DECLARAnON: . I hareby attirm un0er penalry of perjury one of the following dadarations: � ❑ I have antl will meintain a certificate ot consent to self-Insure for workers' compensa�ion, es provided tor by sec�ion 3700 of the Labor Cotle, for �he performanca of ihe work for which ihis permit is issuetl. � ❑ I have and will meinlain workers' compensation insurance, as required by section 3700 ot the Lebor Code, tor the pedormance of the work for which this permit is issued. My workers' compensation Insurance carrier end policy number are: i Cernef: Policy Number: (This section need no( be mmpleted il tbe pennit is velued at one hundred dollars ($700) or /essJ ❑ I certiy that in Ihe pertormance ot the work tor which this permit is issued I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, and agree that if I should become suDject to tha workers' compensation provisions of Section 3700 ot the Labor Cotle, I shall fonhwith comply with these provisions. Applicant Signature: Date: WARNING FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,OD0). IN ADDRION TO THE COST OF fAMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTION 3]O60F THE LABOR fADE, IMEREST, AND AiTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under provisions ot Chapter 9(commencing wit� Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full force and effect. Lic. N Class u Comractor's Signeture: Date: CONSTRUCTION LENDING AGENCV: I ❑ I hereDy aHirtn that there is a construction lentling agency for the peAormance of tha work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: � Lentlefs Atldress: Signature: � Date: OWNER-BUILDER DECLARAT10N5: I hereby attirm ihat under penelty of peQury �hat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor ihe tollowing reason (SecJ031.5, Business antl Professions Code: Any ciry or counry which requires a permit to constmct, al�er, improve, demolish, or repair any strucwre, prior to ils issuance, also requires the applicant for such permit to tile a signetl statemen� thatlhe or she is licansed pursuant to ihe provislons of Ihe Contradors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code) or that he or she is ezempt iherefrom and the basis for ihe alleged eaemption. Any vlolation of Section 7031.5 by eny epplicant tor a permit su �ecis ihe applicent to a civil penalry of not more ihan five hundretl dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the structure is noi intendetl or oHered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner ot property who builds or improves thereon, antl who tloes such work himself or hersetl or through his or her own employees, provided thet such improvemenis ere not intended or oHered for sale. It, however, iha building or improvement is soltl within one year of wmpletion, the owner-builder will have ihe butden of proving ihat he or she did not builtl or improve tor puryase ot sale.). ❑ I, as owner of the property, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Protessions Code: The c ractors License Law tloes not apply to an owner of property who 6uiltls or improves thereon, and who contrac�s for such project with a coniractor(s) license pu nt to iha Contrecior License Laws.). ❑ I am ez untler sec., Business and Protessions Code for this reason: Siqnature: Data: �2 -�� Owner ID ve � tl �y nve icense. ❑ Yes ❑ No Drivers License No. �� '� Expires: Ventication f Owne hip by (rype of document, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to tlescend, wi�l be made in connection with work authorized by this permit, antl ihat no builCing siructure, scaRolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, California Administrative Code). i ❑ As owner-builder, I will not employ anyone to do work which would require a pertnit from �he Division of Industnal Safety, as nored above, unless such person has a permit to da such wark from ihe division. I Signature: Date: Division of Intlustrial Safety Permit Num6er: 7 Will ihe aDPlicant or present or future building occupant need to file antl certiry a Business Plan for emergency response to release or ihreatenetl release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of ihe Calitornia Healih and Satety Code requires, with some e:ceptions, that a Business Plan be filed with ihe Costa Mesa Fire Deparimeni by every business which has at any one time tluring a reported year a quentity oi hazardous matenals equal to or greater than a weighi of 500 pounds, or a volume of 55 gellons, , or 200 cubic leet of compressed gas at stantlartl temperawre and pressure). .... . . .... . ..__...._. ._._—._._ . . _.._ _____. .......... _.__.___ .._... ..... .. __._.. 2 Does or will the applicant or present or future bmlding occupant need to file a regisiration form �or acutety hazardous metenals7 ❑ Ves ❑ No (Section 25533 of the California Healih antl Sefery Code, wiih some ezceptions, requires regisiretion with Ihe Costa Mesa Fire Depariment by each business which at any one time has on hand a quantiry ot acutely �azartlous materlals equal to or greater than a welght ot 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas et standartl temperature end pressure). 3 Does or will the applicant or present or imura builtling occupant need to prepare an RMPP (Risk Managemen� and Prevention Program for acutety hazardous materials)? ❑ Ves ❑ No (Saction 25534 oi ihe California Healih antl Safery Cotle providas that ihe Costa Masa Fire Depariment may require the preparation, certification and filing with the Fire Depariment of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Depariment. 4 It an RMPP is presently required, has Seclion 25534 of the Calibmia Health and Safety Cotle been fulty complied with7 ❑ Yes ❑ N 5 Does or will iha epplican( or present or fuWre building occupan� require tor t�e work which is �he subjec� of ihis a pliCation a permit tor su[ from ihe South Coast Air �ualiry Management District or from any other air pollution control district or agency? � Yes u No (Section 658502 oi the Calitomia Govemment Code requires that the requested information be furnished on applications for nomresidentiel 6 Will any part ot the faciliry to be constructed under ihis permit be within 7000 feet from Ihe outer boundanes oi e school? ❑ Ves ❑ P (Ii'yes", the faciliry must meet the requirement of Sections 25534 and 42303 of Ihe Califomia Healih and Safery Code). or parmits). 7 tl a permit from the South Coast Air Oualiry Management Disind or other air pollu�ion conirol disinct or agency is reqmred for �he work which is the subject ot this application, have all of Ihe disdosures prescribetl by Califomia Healih and Safery Cotle Section 42303 been made? ❑ Yes ❑ No e Qf yes", a¢ach certificate of compliance from ihe appropnate air pollution control oflicer). CERTIFICATE OF COMPLIANCE: I certiy Ihat under penalty oi perlury ihe information given above is correct. I agree to comply with all state laws and ciry ordinances regarding Hazartlous Meterials and Emissions. Signawre: _ . . Date: CER7IPICATE OF �OMPLIANCE AND AUTMORVA710N OF ENTAV: I certify under penalty of perjury ihat I have read Ihis application antl state fhat the information given is wrrect. I aqre o�comply with all state laws a d ciry ordinances relating to builtling construction, and authonze representatives of ihe Ciry of Costa Mesa to enter upon ihe above-descr' ed property for in�ctior purp es. I pr¢e not to occupy or allow occupancy of any Duilding authorizetl by this p rmit until final inspection. /'� �� /�P 'J � . 2�-�'L7 j/Sign u��f Legal Owner(s) Date COOE t. INSiECTIONTYPE � 1616 Fixed System Final Fire Prevention 7266 Pool Spa Final ' 200 Final Re-Root �, 201 Final Block/Retaining Wall 202 Final Factory Fire Plece I 203 FinalSign 204 Final Demolition 26d6d6 �ATE NLSLA� 44P�! LNSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Final Fire Prevention � 220 Final Planning Approval 222 Final Si�e 250 Final BuiltlincyOccupency Date pAjE INTRIALS =e„ a� F CITY OF COSTA MESA ' � F '_ � � BUILDING DIVISION �.. 4 DEVELOPMENT SERVICES DEPARTMENT � � � PERMIT PERMIT NUMBER 89&02310 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 330 E 18TH ST Suite: Viciniry: Parcel Nunmber: 11725117 AppiiCant: BELOUS, GREGORY Address: Owner: BELOUS, GREGORY P Address PO BOX 7264 contraaor: Address: Zip: Arch : Address: Zip; NEWPORT BEACH,CA BUILDING PERMIT Zoning: Phone: ' � Zip: Phone: Zip: 92659 Phone: license: Phone: License: Eng: Address: Status: ISSUED � Applied: 12/28/1998 Issued: 12128/1998 Phone: License: SCOPE OF PERMIT CONSTRUCT A 6' HIGH BRICK PILASTER/WROUGHT IRON COMBINATION FENCE AT 5' SETBACK FROM fRONT PROPERTY LINE. APPROX. 41 LF OF WALL � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $20.80 $32.00 $0.50 $0.00 $0.00 $0.00 $53.30 SETBACKS MAIN S7RUCTURE Front 0. 0 ACCESSORY Front S 0 PARKING F�cistin : o NOTE3: Rear 0. 0 Rear 0. 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0. 0 Left 0. 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0. 0 Right 0. 0 sezo.00 So.00 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlone end flnal epproval must be obtained. Failure to obtain inspec�ions and tinal approval wlll result In lhe expira�ion of lhis permit. FOR INSP�CTIONS CALL: (714) 754-5626 WORKERS' COMPENSATION DECLARATIbN: �� I hereby eXirm under penelry of par�ury one of the tollowing declerelions: • ❑ I heve end wlll malntein e cetllficate of consem to sell-Insure for workers' compansation, es pmvided tor by section 3700 ot the LeDor Cotle, tor the pertortnence ol Ihe work �or whiCh lhle permll 19lssuetl. ❑ I heve e� will mainteln workers' cwnpensation insurence, es requiretl by seclion 3700 ot the Lebor Cotle, for Uio peAortnence ot Ihe vrork br w�IC� t�is pertnit Is Issued. My workers' compensatlon Insurflnce cartier end poliq number ere: Certlar. Pdiq Number. (ID!s secNon neetl nat be comp/eted il !he peimiNs ve/ued ef one huntlred tlollers (S 100) or IessJ ❑ I certiy thet in the poAortnenca of the work tor whlch this permit is issue4 I shall noi employ eny pereon in any menner sa as to bocome sub�ect to the workera' compensetion lews oi Celifomia, entl agree ihet If I should become sub�ect lo t�e workers' compensetlon proWsions of Section 3700 at the Lebor CoQe, I shall lonhwlih compty with these provislons. Applicant Signeture: Date: WARNING: FAILURE TO SEWRE WORKERS' COMpEN$ATION CUVEMGE IS UNLAWFUL M1D SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FINES UP TO ONE MUNDRED TlIOUSAND DOLIARE (5100.000). IN ADDfTION TO1}{E CQST OF COMPENSATION, DM4IGES AS PRWIDED FOR IN SECr10N 9108 OF TME UBOR CODE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTAACTORS DECLARATON: I hereby eFtirm that I em Ilcensed under provisions of Chapter 9(commencing wlth Section 7000) ot Division 3 of t�e Business end Professiors Cotlo, entl my license is In full Iwce end aflect. Lic. a Class M Contractofs SignaNre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm Uat there is e constructinn lending egency for tha peAormance oi the wark tor w�ich ihis pertnit Is issued. (Sec. 3097, CMI Code). l.endefs Name: Lentler's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eKrtn �het untler penelry at perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe tollowing reesan (Sec. 7031.5, Business entl Protessions COOa: Any ciry or counry w�ic� requires a pe�it to construct, elter, Impmve, demollsh, or repair any structura, pdor to 145 Issuance, elso requires the epplicant for such portnit to file e signed statemem the� he or she is licensed pursuant to the provisions of the Contrectors LJcense Lew (Chepter 9(commencing with Secclon 7000) ol Division 3 0l �he Bustn�ss antl Protessions Cotle) or thet he or she Is ezempt Iherefrom and ihe basis lor Ne alleged exemptlon. My violatlon ot Section 7031.5 Dy eny apD�icant for e permlt subjects the epD��ent �o e dv�l panalry of not more ihen five hundred dollars ($500).): ��1, as owner oi the properry, or my employees with weges as thair sole comDenseUon, WILL DO TME WORK, entl the swcture Is not IntenOetl or ottered tor sale (Sec. 7044, Business and Pmtessions Code: The Contrectars License Law tloes not eppty to en owner of properry who builds or improves thereon, end who tloes such work I himsetl or herseli or ihrough his or her Own employees, proNdetl that such improvemenis ere not IntenOed or oXeretl for sale. If, however, the builtling or improvement is sold vrithln one year of complelion, the pwner-builder will have t�e Gurtlen at proving Uet he or she tliA not �uild or imprwe for putpose oi sele.). 0 I, es owner of the property am E7(CLUSIVELV CONTRACTING WfTH LICENSED CONTFiACTORS to consWd the projecl (Sec. 7044, Business end Pmfessions � Cotle: Tha � ntrectors Licensa Lew tl0es not epply to en owner ol properry w�o builtls or improves thereon, entl who contrects for such pro�ect with a coniractor(s) license p ant to the Contreclors Li nse Lews.). i ❑� I am ex � under sec Business and Professions Code tor Ihis reason: SignaNre:� �� Data:l �-� � v � Owner ID ve � ed by dnv license. ❑ Yes ❑ No Drivor's License No. ExD�res: Dy (type of documenL I.e. - Oroperty tes bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby ceNfy Ihat no excevation tive (5) or more teet In tlepth Into whlch e Derson Is requiretl to descend, will De matle in cannection with work euthodzetl by Ihis pertnit, and thet no huiltling structura, s�Xoltling, felsework, or tlemolitlon or di5manlling thereoi, will be more ihan t�irry-siz (36) feet high. (Chap. 32, Grp 2, Arl 2, Sec. 341, 71t1e B, Celiiomla Atlministrative Code). ❑ As owner-bullder, I wlll not employ enypna to do work whic� would requlre e pertnit Irom ihe Dlvisian ol IndusMel Selery, es noted ebove, unless such person hes e pertnit to Co such work from the divisiory. Signature: Date: DiNslon oi Indusirial Sefery Permit Number: fAUE �. INSVECTONTYPE 1616 FIxeC Sysiem Finfll Fire Prevenuon 1266 200 �1 202 2Q3 Pool Spe Finel Final Re-Roof Final BIacWRetalning Wall Finel Fectory Fire Plece Final Sign ' 20d Final �emolitlon c.co-•o �dg �� ',Z - � �,�, COUEt MSPECTMNTYVE 206 Flnal Mechanicel 200 Flnal Plumbinp 210 Final Elecirical 212 Final Fire PrevenGon 220 Final Plenning Approvel 222 Final Site 250 FinalBuilEing/Occupancy OAIE VI�ELS G, �nonFssatemiuwo: 330 E 18TH ST OM23�9NAYEIFRlOMM: BELOUS, GREGORY 'P `f" �ss: PO HOX 1264 NEWPORT BEACH,CA 92659 642-3330 �vx.. Yuiwa �oouFn. YICNRECT Ofl FN:d1ffA: MCII OH ENO.'S AWIiE53: caxrnacrarsw�: COM111CTORS YNl1N0 I0011ESY uHr: ucw.: UNf: UG N0.: uxr: 11CQlSEU COMR1CfORS UECLAfl�T10N: I Mnby eR�m ivMs psWy d ps�vy Ntl I am 4wnad uka pwbb�e d Cheplr 9 (wmmuxsn0 wuh 6action IOW) d Di.'sun J d iM &uNev end PMa��iau COEs. uM mY 0orw u in IW bm ad MIW. cmuc.No.: uc.cuss: uc.r+o.: EXP: • or.: cw�e«: � OWNER BUILOFA OECIAN�TON: I Iwetr/ elfirtn uMs penelY d qrjivy IAeI l em uxnp han ilr Cmuerlm tioru� Lew tar IM b0owiq eeeam (Sedian 1W �.5 &snns nd Prdaqia�+ CaAe: MYW n advnY Mtid� nPnm e G�� b awvbup. Ws. Yn>on. lsmdvh. a reper my niuctun. p'v b u uuum. ebo �apium iM eppiwtl la ach pami b 9s e tlpnM uv�nw� OW M a Me e�..e w�ww m m. ww:w,e a u. cowm. uo.�w �... �cn.a« s(�«dro .a, s.au� �aaa� a avw� a a �ro Bueinen ud Rahe'vm CoMI a�� M a Ya o uamq �Aadmn snd IM Mrim fa IM �Mp�J uwrylun. My vbWun d 8wion IOJ�.S W mry eov`mn la e permi a� IM eppGcen w e mJ peiWly d nol mon �lun fx� Iwd�W ddlan �SSOOp. 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Bu�Yw� eiW a o�o«�r �o am. a Impw.. m«�m .oe wno WONKER'S COYPEN4�ilON DECWi�T10N: 1 hwab� N�m wdr prWy d prpry w d Yr bbx'vp Eadutl'vs: � IMneMMlmeinlanacMlcm�dmmaYtowtlLmv�Oorwakr+'w�qwe�bn.mpwidMlabyBWion]]OOdlMlibor Cods. la tM paloemerca d IN wak tar wNU Nu OsimE b buM. ❑ � nn..�d wa mdman wanw�.' mnw�un Mw,nw. n�.yubed M s.alo, nao d m. labn Coe.. mr u. o�m.K. a ��r wqk la Mii1� N's P� e muad. MY waken' mmpnWion imvanc� ort'w aM D�Y �unMr aa: c.m« Pd'cyNumba: (rm,..aimn..enwe.rondwbiwo.�eawon.nm�mweNwrs lu,w..) ��] I mNY tlW in tlr GMmiwww d Ihe wak br �MiW Ihb O�M e b �d� I YUY nd enWM �Y oa� in �m' mwvr w m w Mmiw au jetl i tM xMrY mmpenWion Isw� N CdGanle, d�epiw tlW7Y I tlyId�C to IM r.wbn' . compe�uni n pa��iom d Sedion blUO d IM LeEar CaM. I Mell o(r.'v� mm �1✓1wi U(w� -��me. �� i ncp;�,n, "G�aa Wemlig: F�a ro�ewr woA'�n' conpnuetlon rowrp� l� un mG I�u�/sr �n �mplo�w� ro cMJMpwvMw xd cMl Ilna �p ro arH �,ntlrod thouwiJ AWhn (tiPq000A M� n ro tln ( o! rompw�wUOR G�np+i � prvvlML br M 9�etlon J106 0l tla LiDor Cob, IMra4 �d �ttorMY�� Iw�. corurnucnoN �v�arw �oerxr: i n..M .�,� w. o.�v a o«'wr �nr m«. o. mmnwim w�sno w�v m. u. p..�wm.M. a �n..un� w rn'rA �la v�� u e.wa (swvn b9'!. civ. cl. LENDEP'S NAYE ICMilythetlhew ihkeppl�tionWawtMttlrabowWamtlionbcarrW.lpiwlooampF/wphaptllyendeowqyorN�u�qe� enEMtslmn ' toWik�qmuvvCianWherabyeWnhanpewvetira�dlhhtlrybWrupontMebo.a�mWuneEp'apa�ry ��"°°°'�"' i GREGORY P BELLQWS , oma: /�/ � wnne-e„aa:c a sarur: o�-Fb: o��r-�oo�m: wok-a.��,.: c�ou.�roane.e..a. CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 079789 PERMIT NO: H 079789 PLAN CHECK NO: 04064-96 L GOVT; N SUPP; N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION : 108 SQ FT PATIO COVER /OVER EXIST DECK SQ FT: 108 CLAIM VALUE: 500,00 CALC—VALUE: 1,682.64 GROUP OCC: 0-1 / COMMENTS: REFER TO B-78119 FOR DECK �F 1k 1E iF iF 1f 1E 1E �f iE 1E 1E 1E IF 1E �f N iE 1E if iF 1E'lE fE IE 1E 1E 1E'IE 1E fE 1f 1f 1f 1F if iE if iE iE iE if� iE iF iE iE Ik IF 1k iE ih iE iE iE 1f iE 1E IE i8'lE aE �IE 1E 1E 1k 1f 1k ik IE ft 1E if iE i(' if if if iE iF 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 BUILDING ---------- --------- ACCESSOAY HUILDING --------- FRNT: FT IN REAR: 65 FT IN FRNT: FT IN REAR: FT IN LEFT: 5 FT IN RGHT: 52 FT IN LEFT: FT IN RGHT: FT IN PARKING AEQ: PROV: PARCEL: 11725117 ZNE: R1 REF NO: PLANNING NOTES> 8.5' HIGH PATIO COVER ATTACHED TO REAR OF HOUSE AT LEFT SIDE > , IE 1E 1E iE iE 1E fE i(� M 1E fE iE iE 1E if ff ff 1f iE ff if if-fF iF it 1E iE 1f iF iF 1E iE ik It M 41E iE 1E 1E 1E iE k iE 1E 1F i! 1F if 1[� 1E iE iE if 1E 1E 1E ik if 1E iE 1f IE iE 1E 1k 7f iE 1E iE fE iE iE 1E iE ik 1F 1! 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 HY (� G P DATE: I'� ''� BUILDING APPROVED BY � W J DATE: �— 3' 9� APPLICATION ISSUED HY: DATE: I�'�3' �-� **��t�**�**�t****+�*****� * � * LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMHING ELECTRIC MECHANIC PERMIT 54.00 FIRE STRUCTUAAL SEGMENT:Y SMIP/RES GRADING .50 SMIP/NON—RES PLAN 35.10 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 54.50 0.00 35,10 89,60 89.60 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 89.60 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54,00 ,50 35,10 1E 1E 7t 1E 7E 1k iE ik if ik if 7f 1k If 1f 1E iE ik it iE 1E 1k 1k 1t 1E ik iklk if 1E iF 1E 1E iElE ft iE iE iE 1E 1ElE IE iElE 1! 1E i! k iF if if iF iF iE 1E 1k 1f it 1F 1k if 1f 1f 1k iE 1E 1E if iF 1f M ft IE ff if iE f! 1E I N D I V I D U A L F E E B R E A K D O W N TYPE SFR QTY 108 f�7��ii�l��i7i RES—PATIO COVER—POST 6 TRELLIS END OF FEES UNIT COST TOTAL COST 15.58 1,682.64 01 00216352—OD2163S4 TO T 59.60 DATE: 10/03/9` TIIIE: 13:58 �� CONSTflUC710N AND PLANNIN� �� &'��A .... �' APPROVALS Permit # �Date � Inspector qppROVALS Permit # Oate Inspector 1. Temporary Eiectrical $ervice or Pole 52. Pool & Equipment Location � " 2. Soil Pipe�Undrgrnd. � 53. Steel Reinforcement 3. Electrical Conduit Utiliry-Undrgrnd. � � 54. Forms �. 4.'Electrical Conduit•Undrgrnd. 56. Electrical Bonding 5.'Steel Reinforcement 56. Ro�gh Plumbing & Pressure Test . 6. -Elecvical UFER Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 U�drgrnd., Test � 9. _Water Pipe•Undrgrnd. �, i 60. Backwash Llnes, P�Trap, � Undrgrnd. 10. Structurai Floor Svstem 64. APPROVAL TO DECK � 1 t. Property Sewer Line & House Connection 62. Backwash & Receptor�Final ;- 12. Sewer Cap 63. Heater & Vent-final 13. Roof Drains ' 64. Plumbing System - Final 74. tiough Plumbing 65. Electrical�Fina� . 15. Rough Electrical-Conduit . 66. Solar System�Final . 16. Rough Electric Wiring 67. Fencing & Access Approvaf 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING , 18. Rough Electrical•T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMEN7 20. Rough Factory Fireplace APPROVALS Permit #� 21. Ducts, in Structure , ;� 70. Underground Mydro 22. Oucts, Ventilating . . 71. Product Piping O�Gas ❑ Oil 23. Gas Pipe-Rou.gh & Tesc . 72. Underground Flush 24. Roof Framing _ � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing , ' ' 74. Overhead Hydro , 26. T-Bar Ceilin9 IStructura�) & Monocoat - 75. Dry Chemical - 27. frame and Flashing - _ _, 76. DryStandpipe •. 28.'Lathing&Siding - _ . . 77. FIXEDSYSTEA2FINAL 29. Insulation ' ' ` � � � � 78. PIRE PflEV. FINA� - 30. Drywall Nailing � --� HEALTH DEPT, REQUIREMENT 31. Plascer Brown Coei � " ' 79. FINAL INSPECT.ION 32. ElectricaLPower Me}er-Final � - � 80. FOOD CERTIFICFlTE ISSUED 33. Final Electric � ' Notes: ` 34. Final HCating..& Air'COnditioning , ; ' _ � - _ � 35. Pinat Gas Pipe•7est � - ' 36. Hood or Canopv , - _ . , 37. Final Fa[tory Fireplace - ' � 38. Final Plumbing � � - 39. Water Service-Final . � � � 40. Gas Service-Final . . - - ' 41. Solar pomestio-Ftnal _ • - - 42. Backflow Preventer� - y � - . ' ~ ^ 43. Backflow Irrigation . ' _ "- - � ` - ' 44. Landscape Irri9ation SYstem � . , - - � , 45. Sound Attenuation _ " � 46. Handicap.Reguiations �� - � 47. FINA� STRUCTURE & BUILDING /Z-e,t.G� �� • ' 48. FINAL PLANNING � . 49. Electric Release to Edison � • 50. Gas Release to Southem Ca�ifornia Gas Co � 51. CERTIFICATE OP OCCUPANCY No Date � 3'1) � Applicant to /III In all spaces except thosa w(thin �eavy Oortler Iines an0 si9n all a0Vro0/iate Gaclarations. PERMIT NO. T T N OT O UNIT NO. A P�y 'i7'! oF COSTA MESA CON�ST1RUCTION PERMIT P oject Address ��. ��'n ��• � ��(IS �A'�fo'-,.� , �T APPIi �ni's Mailing AtiCrexi � �A��' � �_lc.��l Ownei s Name 1�w Ciil�d2ti �7�l.EJtw Gi Phone �1''�� AdUFess '?7=,YJ �. 1� 9'i�, [_('s�i� Wt�i✓�' Arch/Eng. Licenu No. Address i Contracmr's Nam Phone Address (mailing) Ciry License No. ' LICENSE� CONTRACTOR DECLARATION I nareDy alfirm I�al I am licensetl untlar prOvlslon5 01 ChartO� 9(commen<in9 wi[n se<tion 7000� of Division 3 oi the Buslnass antl ProteSsions CoOe, anC y license is In full force antl eftect. ' cense Class Licensa No. ate - Si9�aWre ORKERS' COMPENSATION OECLAqAT10N h¢r¢Dy aifirm tbat I Itave a Certificale o} ConStnt t0 SelNnsure or a Certlficate ot Work¢rs' Compensation Insurance, Or a certifletl <opy thereof (Sec[ion 3800, Lab.-C.) _ - Poli[y No. Co/npany BCertifietl copY �5 hereby fumi5h<tl. Certifietl copy B(iletl with roe city BUiltling �ivision. Date ApDi��ant E%EMPTION FROM WORKERS' COMPENS ON DECLARATION (This seclion neetl not be completetl it lhe per iit'Is for one hunOretl (5100) or less). I certify'tha in Ine performanGe of tne " c pr which IS rm' is issuetl snall no[ e pl y any Oerson in any n e so as lo c e bject e Workers' �n on� Laws of Cali Date ��—Si9natur comply with sucb provlslons or m � permn snau oe aeemea revoKea. CONSTRUCTION LENDING AGE V I hereDy afllrm that there is a constr ttion lentling a9ency for lha Derformance of tho work iar which thi5 p<rTil Is iSSuetl (Section 3097 Civ. CJ LenAcr's Name �enaer's atltlress � OWNER 9UILDEfiDECLARATION i nn.env alflrm lhal I am exempt from tha ConVactor's Ucense Law /or the tne to ofrom antl llle ba5is tar tne alle9ea exBmpLon. Any vio�anon o� oucuon 1.5 by dny aOP��ant fo� d Pe�rt�it Sub7aCt5 Ihe aDP��ant to a Civlt alty of not moro t�an (ive nundretl tlollars (5500). I, as owner ot tne property or my employoas with wages as their sole ipensation, will Go the work, anC t4e s[ructum I5 not in[entletl or.ofteretl sale (Saction 7044, Business and Professional Cotle: The Conlractor's :nse Law tloes nol apply [o an ownev oi a proparty wno bullAs or improves �con, and who tloe5 Such wo�k himself/horsoll or Ihrough h15 0� her Own �loyoos, proviGea that sucn ImOrovements are not Intentlea or oiteretl for ' If, however, tne builtlin9 or improyament I5 soltl within ona year ot com- �loJ� tha owner will nave the burtlen ot proving he/she tlitl not builtl or im- ye.Por ihn purpose oi sale). I, a5 OwnO/ ol tha property, am ezclusivaly contractin9 with Ilcensetl con- `.tors to construct tha pro7ect (SetUoq 7044, Business antl Professions Cotle: I COntractor'S LIce115e ldw tlOes nq( ap ly t0 an own¢t of prOpefly wh0 las or Imoroves theraon. antl who Gont ts �or such oroiects with a con-. :tor(51 hcensa PURuant [o me ConVac Y UcenSe Law). I am awar0 t�a[ oi of thNr Worker's Compensation s ranca shoultl be V�ovitlea to me. I am exefnqt unGer Section B;q6 P�C. lhls re on have to eMG/ NDOX [he Signature � 'v' / -/��_�"^ Drivers' Lice➢ e or 5� _ 0865-46, rev. 5/88 � Wh�te - Builtling; a 3 SS�I S -�O� �(,� � Le 7 TYPE OFCONSTRUCTION NEW DD ALTERATION RE�AIR ❑ CONVERSION ❑ DEMOLISH OT E DESCRIPTIONO�ORKNSEOFBLDG.�� A�'r�— � �—�'�2�� TVPEOFPER T GRADING FOVNDATION STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION Sq. FT. oCCUPAN/Cnv CONSTRUCTIONTVPE � VALUATIONS��O�� ZONE GRADINGCU.VDS. ACRES Remarka: (J� e, E� p G � 4� — 8ar Sink Backflow Preventer Backflow Irrigation athtubs Clarifiers Dishwasher Drinking FOuntains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink ' 3 lavetories P—Trap Roof Dreins Reinspection Fee � $15 Boiler Duct - Under Grountl Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BI�. ICBO dk �I�Hegt�ng System & Ducting �0.100,000 BTU 0100,000 peinspection Fee AP�Ilcant; Pink - Accounting: Goltlanrotl - Assessor $15, L 4/ 1 l �$ i{ �8v�5 Pfc, out�C i Showers Service Sink Sewer Cap Sewer COnnection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heacer Water Servite Auto-Wesh Laundry Treys laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System � 00.100,000 BTU ❑100,000 BTU System Repair/Alteratian - Fire Dampers Registers - laue Fae g nn.:,,— E T Front B Reer • A C Right S . �eft � Ping. Ret. �W A FEES �+utomatic Washer Construction Pole Sub. CAoking Unit Dishwasher � . Dryers ❑Gas • Eleci Fan I F.A.U. � Fixtures Device Boxes ' Outlets o� Switches � Gartiage Dispoul � � Generator �0.5;KW C 3 5 r Fee Zonin9 APProved�BV _ Buitdin�ppprowd By : APPIic'ation Issued Bv— � P+ \ - 1 I zona Parking ELECTRICAL Transformer � 15-50KW ❑ 50+KW Merer Dup to 100 amps Meter ❑over t00amps Sub Panel � - � Motors � 0.1 HP � 1 i5 - 8 Inc.�Sotar Og-75 HP �16-15+ Microwave Pole Light . � Range <W Trosh $15,. laue Feo ESqE�UIREMENTS: , N I N G R E � M T S. FEES � Date �^ I � � < SU MARV OF FEES �, �N, ,�(, BUILDING PERMIT $ ��8. s2% SMIP , $ � 3 7 �PLAN CHECK ' $ ' PERMIT �+� . 'PLUMBING _ $ � �_di ��UANCE�1 $ PLAN CHECK 25% $ —" ENERGY P.C. $ � r:� ELECTRICAL $ S9 . ZS GRADING $ / PLANCHECK 50% $ MICROFILM $ ' + i MECHANICAL $ 7'Y'�D TOTALFEE S , .PLAN CHECK . z5% $ - — �'f S �Z ,� n �. oi booisasa-CGR16357 T�iT U„5E: 10/Oolo� ;i�E: �1E:55 `�92.GS ��CONSTRLCTION AND PLANNI G . L& SPA ., ,- � �APPR�VALS Permit # Date Inspector AppROVALS Permit # Date Inspector : 1. fiemporary Electrical Service or Pole 52. Pool & Equipment Location �Ku�il�% (/ fri� , 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � -;, ' 3. EJectrical 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 S(�� qZ? 59. Gas Pipe, O Undrgrnd., Test � ' 9.�Water Plpe-Undrgrnd. �.�.� �� 60. Backwash Lines, P-Trap, � Undrgrnd. � �' 10.•Structurel Floor System 61. APPROVAL TO DECK � 11 .. Property Sewer Line & House Connection ��y1 62. Backwash & Receptor-Final 72. Se{,ver Cap � 63. Heater & Vent-Final • � ; � 13. Roof�Drains 64. Plumbing System - Final , ' 14. Rough Plumbing 65. Elec[rical-final ' 15. Rough Electrical-Conduit � 66. Solar System-Final '1��. Rough Electric Wiring _ 7�c�� . 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 yeating & Air CAnditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ��- ' APPROVALS Permit# 21. Ducts, in Structure -'_.- 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil � 23. Gas Pipe-Rough & Test '� ' �� Z2._Underground Flush � 24. Foof Framing �. "'; � 73. Undergrnd. Storage Tank � Gas ❑ Oil 25/ Roof Sheathing -" 74. Overhead Hydro � 26. T-Bar�Ceiling (Str.ucturaq & Monocoat 75. Dry Chemical � 2Z. FrameandFlashing ��,i, 76. DryStandpipe � 28. �athir�g & Siding � r� 77. FIXED SYSTEM FINAL , ,29. Insulation � • . 78. FIRE PREV. FINAL 30.� Drywall Nailing � ti � HEAL7H DEPT. REQUIREMENT 31. Plaster Brown Coat L 79. FINAL INSPECTION 32. Electrjcal Power�Meter-Final 80. FOOD CERTIFICATE ISSUED J , !� .. .., , a. ,-.. 33. Final Electric �� . j �7 �i ` ��r- Notes: _� � ,� � �`� �,�•- 34. Final Heating & Air Conditioning � J 0 9/ !% -Iu •-y - [ C.O T 35.SFinal Gas Pipe-Tes[ y �, ' �-'- 36.'Hood ot CanoPY LS 87 �CR-�o,yG Ore l_ tc p1�•.+S AQ"d��c-e 37 E Final�Facioiy.Fireplace � �� . 38: FinaY�Plumbing ;7 {�f�(OpL :�39.�Vtreter Service=Final qq� p Q� p� - � i � 40. �Gas Service-Final 41. $olar pomestic-Final 42. Backflow Preventer � � � , ,r ( �• y. � , � 43. Backflow Irri9ation n• : °• �� 44. � Landscape Irripation System - v � 4�.�Sound'Attenuation ' �•r� � �46.�HandicapFe'gulations � ;.:'f/((e.jq�` � •��, Y 47. FINALSTRUCTURE&BUILDING � �� `� :p. �.c. a��s; ol ci_8� c�.�c.p,�a ,, 46. Soeaal'RequirementsCompleted - ni 49. Electric Release to Edison . ' �� `.:'� . . ^ �, � 5b. Gas Release to Southem Califomia Gas Co ,,� ^ . !� �� 51:' CERTIFICATE OF OCCUPANCY � � " �d '� ,�, ' � •� " -�' !� �" i No. Date : �� . , �, '�� ' ,� I 7 woxEssoveuiown 330 E 18TH ST OWNERSry,�yEIFRqMN: $ELOUS, GREGORY P moness: Pp BOX 1264 NEWPORT HEACH,CA �vv�. �wwa �ooness: �IICNR�CT OF FlY�NNEEN: COM111ACTd1'BNAYE: caMq�croas �uiaa �oox¢ss UNT: 92659 uc.xo: UNT: ua no, UNT: LICENSED COMN�CTON9 OECLAN�TION: I Mnby �S'rm uMv p�iuly af prjury IM I am fcwustl undw prwinw d CMpbr Y (comme�nY wllh 8ection )OW) d OivbM e d iM Bwinm end P�daNmf CaEa. eM mY Ibenr u in lull Mu W efled. cm uc. No.: uc. cuss: ue. wo.: E X P: Oma: Camria: OWNpp BUILDER DECUP�TON: I hxeby dfum uMa p�rWy d pojW Ihei I un �umq Irom tM CorttMm lloe� law la iM Idbw�p rwwn l9wbn'/a11 d&niwu end Prdmbu CoM: MY ciY n munN whid� nVuUu � oamX w muwcl. Nr. lmpow� d�mqeh, w npu ury s4uc1un, pnar to Ee awenu. ebo roVuiroe IM �ppllunl lu p�cli qrmM tolJe a tlpn�E �W�msM tlW M or �he � Ibe� punwnt �o tM prw'viom d IM Gau�etla� liorw l�w ICheqr 9(oqvnwidnp wCh Saqun 10W) a�� J d IM �u'abn entl Rdwiom Codsl a ihet M a ds o a�emp �Mrdwn W �M Enu b N� eMpeA axunqun. Mn videtion d Saaion z++.s M em �u �a a o� � ur mv«� �o e uw or�r a1 na maa �nen rv wiWrw dooeu Is500ll. �] I. m owner d the ww�Y «rtry anDbYea xin wepe+n Ihs sole mm0�. �NI do tM'�M. end tlw �vur�un b na iMeMeA or ofleraE lor eeb (Seetian IOM. Buvrca uM Pro/mamv COEe: The Coniradas lioanae lewdaes eqt applyto en ownard propeity who EuiEs u impiwea ihereon. ud who tlom suN Mvk himadf a henef ar Mraph he a hx own mmploysee, qwkeE Ihel euch impovamaes ere no1 imaded a Wsed la ub. tl. Mwewr. IM EuJdinp a inpv.anenl u wtl wu�in pr Yaer tl wmpbton. Ne owmr-0uiker xJl heva IM Eu�den d prowp M a eha ditl roi WJC a impws la tM qupa�a d ub). ❑ �.,, o.ai.. n m. ww.n..m ��b ��•�:c •an rcmn.a wno-.r�a, m canmw m. p,pa (swo� rou. ai,nm. w Proleuima CaEe: The Cwurtlm L.iene lew dma nd MV�Y b �owew d P�W�Y xM buiW a inpw'a iherean aM Ma conbena la � p�qetla xeh e mNreqa(�) limsed Wnuw �M CoNMo lioe e le� ❑ I em axemp Mer ec�bn: B. 8 P C.. Ior N amn: Dete: V �'� R Oww: i ao h�nr wna w� i.m �. a w w..ww u,e �.a�a� w cw ' H..m�.�e sm.n cae s.am, rsos. usa�. �e ]SS�a. end tlut 1 a enY M1Yw duM^0 � xi0 / wA nu (� ans) m mnply v.ih ud eels ooM� end tM rpivams�b la eGaM1NI«mutrvciionamoEJmionhomlMlv Y Dipritl.RwkWWoonurutlbneGViwionenezemqlran�hme v�%+ama. DNe; ApplirsN: W OqKER'S COYPENS�TON DKI�RATION: I M1rtly elfvm ivWr prutly al psjry ar d tM b0owinp EdW'vu: ❑ 1 heva enE xil meiMen e eendiuts d odwK lo utluwm br rwkai mnpe�uuion. n prwided ta Ey Satlion 3)00 d iM leboe CaM, ta IM pMmiwit� d IM wvk Ia WicA Evt peimE'u iwusd. ❑ i nw. �e w�� m.:,.a�.�.• �oe�mo� ��.�... �.d M s.aa� o�oo a m. i.no, coe.. n' ine o�a� a m. wpk Iw w1�iM Nia pnmiK b ivued. My wvMen' ampanmiion'vuurance wtier and poUry numper ms: c�.�: Pd'ry NumDsr: tia Hr.tion mW rot be mnplwM I W prml 'o b ar �uMrsd CaAers �5�001 n Im ) J I emlry thet in IM peelamene� d �M wak Ip xfi'rh ihh pmw 6 muW. I tlW nol rnpby eiry pwson in vry memr p n �o becwne �ubl� lo tM xvrken' comperimlion ler.i d cwm�d.. w aoro. u�n a i.nand e. wne wqw �o ins won�en cpnpenWion ➢�iom d Seaion T00 W iM leEv GoEa. I Ne0lon�wn� aomVl xn� �Mn Mm+don�. oma: �ud�m: w.m�na: c•uun ro..cw rort.n• �wro.wdon �o...+a. �s �na.M .ne.iwi s�elK�.n.mp�or« ro emNw p.lwan.�e e/Hl fln�s iq b om hvrArW IMULM tlo1Nn (StpqOWA bi WEltlon ro IM cm� ol romvww(bM1 C�m�ps u pvvlCM br In sxuon sns or m. l.imo, coe., rM..,t .�e.m,m.r. r.... COrySTRUCTON IENUINO ROENCY: 1 MMy dfiem uMar panMy d perjury �hm ihsn o e mMruqion bM4p epriey br IM perloimence d �ha xuA br whiM the pe�m� a ceusd (Seuion 309), Civ. C�. LENUEP'S N�NE: LENOEq'S �UUFESS: I cmy�y 1Ml l heva m. Nu eppliutian ud uale t!W the ebo.•a'udametion u mnC. l aprse �o oomqy x9h eG �Yy erd mwry ad'vwKm enEeiatelew�roltl pfoWiMvpcannrWionWhmebyaNhor'¢e�epevanietiwdihudtyioenier�pontMeLwe�memionaEqopeM �°`�"'°""°"v"`� ° GREG BBLOUS 'W � /� �- '" Dme: � 1 �' ' / � pnelun d Owred/penUAppfuMlCaY�atla (5151d6.WP) WhurBudE�q 8 Se/ey: ��semFb: �araM-�GDk'eN: Pink-Pe.enw: Gdden�o�Mwnr CITY OF COSTA MESA — HUILDING PERMIT PERM NO: H 078119 PERMIT NO; B 078119 PLAN CHECK NO: 02354-96 S GOVT: N SUPP; N CONSTRUCTION TYPE; PERMIT TYPE: STR pURPOSE: OTH JOB DESCRIPTION : BRICK PILASTERS W/WROUGHT IRON IN BETWEE SQ FT: 1,045 CLAIM VALUE: 1,500.00 CALC—VALUE: 1,450.00 GROUP OCC: R-3 / COMMENTS: 256SF UNCOVERED REDWOOD DECK �ritit+�+r��rx*�r�*�*+r+r+�at�t�r�rft*�r+�+r+��r�x*+�er�rat�tit*itit*x�t�+��*eEftit*at*iE*ie+�+t�+r+�+�at�r�rt��ratx��xiE�xit�*it Z O N I N G R E Q U I R E M E N T S I S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: 5 FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN IPARKZNG REO• PROV: PARCEL: 11725117 ZNE: R1 REF NO; PLANNING NtSTES> CONS•TRUCT 6' HIGH PILLAR/W.I. FENCE COMBO 5' FROM FT. P.L. 6 > 6" HIGH DECK TO TAE REAR OF AN EXISTING SFD. . 1E 1f fE ik IE 1E 1E iE iklE 1E 1E 1FlE IE 1E 1E fE fE fE 1E 1E K 1E iF 1f !E �ElE 1E 1E �E iE iF if if 1E iF fE iE 1E fE iE iE if 1f 1f k iE ik �E aElE 1f 3E fE iE 1E iE iE 3E 1E 1E iElF iE jE 1E * iE iF iE if if if ik ik iElE 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 I ZONING APPROVED BY �'� : iA� � DATE: I2 BUILDING APPROVED BY ; DATE: APPLICATION ISSUED "B�Y: DATE: i�p 12��( ifiEiEiF1EiE1EiEtflEiEiEiEiE1E1E1f1flEifiE1E 1E�E3('fE1F1E1hififlE �k�E 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 48.50 ' .50 PLAN 31.53 - SMIP/NON—AES ISSUE FEE BUILDING—DIV—> PEAMIT ISSUE PLAN=CAECK TOTAL PAID DUE TOTALS----> 49.00 0.00 � 31.53 80.53 80.53 ,00 .. � AEVENUE DIVISION TOTALS--> COLLECTED; 80.53 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 48,50 � . .50 31,53 � �-� iE iF �F if �f 1ElF i61f iF iE 1E 1E 3E iE ik i6 iE if iE 1E iF if K If 1f iF IE k 1E if fE fElf 1E 1E iE iE iE if 1E iE iE if iE 1E 1f 1f iF 1E iE iF 1E %�E iF 1f iF 1F 1f iF 1f iE 1F �E iE iE iE IE iE iE iF aF iF if iE �k iF ik 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 �' SFR 45 RES—PILAST£R WITH WOOD,ETC BET/ FT. 10,00 450.00 SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 1,000.00 END �OF FEES .� �i ' EXPI�.ED ;� DA'fE , ✓ �f �I �� i�'_ltl". '(7^?6: `.e.:. ,itj�� :� -- r � . ._''� �.. CONSTRUCTION ANDPLANNING APPROVALS Permit # t. Temporary Electrical Service or Pole 2. Soil Pipe•Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. A. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6, Electrical UFER Grnd. 7. Footin9s 8. Foundation 9. Water Pipe�Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 73. Roof Drains 1q. Rough Plumbing 15. flough Electrical-Conduit � 16. Rough EleMric�Viring . 17. Rough Wiring Sign 18. Rough Electrical•T Bar CeiVing �g. Rou9h Heating & Air Conditioning 20. Rough Factosy Fireplace . 21. Ducts, in Structure 22. Ducts, Ventilating - 23. Gas Pipe•Rough & Test � 24. Roof Framing 25. Roof Sheathing 26. T•Bar Ceiling (Structurall & Monocaat 27. Frame and F�ashing /Z ( 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. P�aster Brown Coat 32. Electrical Power Meter�Fina! 33. F,inal Electric 34, Final Heating & Air Conditioning 35, Final Gas Pipe�Test 36, Hood or Canopy � 37, Final Factory Firepiace 38. finai Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irrigation SYstem � � A5. Sound Attenuation 46. Handicap Regulations 47. F4NAl STRUCTURE & BUILDING 48. FINAL PLANNING 4g, Eleccric Release ta Edison 50. Gas Release to Southern California Gat Q Date Date POOL 1 > Inspector AppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrica� Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P•Trap, O Undrgrnd. 61. APPROVALTODECK 62. Backwash & Receptor-Final 63, Heater & Vent•Final 64. Plumbinq System � Final 65. Electrical•Final 66. Solar SYstem�Final 67. Fencing & Access Approvai 66. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE �EPT. REQUIREMENT APPROVALS . Permic # 70. Underground Hydro 71. Product Piping aGas ❑Oit 72. Underground Flush 73. Urtdergrnd. Stocage Tank � Gas ❑ �il 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL. 78, FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION B�. FOOD CERTIFICATE ISSUED Notes ��.l.' � / G ' ��L�S �; Date � Inspector I � � � PflOJEC7 pUUflESS: 3 3 O t. � 8 ii� ST OWNEfl'S NRME: $ELOUS GREGORY P nooeess:330 E '18TH ST COSTA M.ESA, CA 642-3330 AflCHIENGINEEfl: ADOHESS: UNIT: 42627 flEG.NO.: UNR: PEfiM1TTEE:GREG BF.LOCS (714)642-3330 aooness: 330 E 18TH ST C.M, CA 92627 LICENSEO LONTBRCTOfl OECIABATION: I hereby aifirm t�al I am lic¢nsed untler pmvi5ion5 0l CtuO�er 9 �commencing wi�A Seclion 7000� ol Oivision 3 oi the Business ana Pmlessions Code, anE my license is in lull for[e an0 e�fecl. CITY LIC.: STPTE LIC.: ClA$S: Daie: Signawre: WOPHQpS' COMPENSpTION DECLl�BRTION: I hereby aifirm t�al I �ave a cetlificate oi consent m sell�insure or a certificate ol Workers' Compensation Insurance. or a cenified copY �hereof (Secnon 3800. Lab. C�. POLICY NO.: E%P. UATE: LOMPpNY: ] C@rtihetl coOY �s he�e6y lurnishetl. ❑ Cennie0 cavY �s iile0 wi�� tne city Buildng Division. Oa�e: Applican�: EXEMP7�ON FBOM WOflNEP3' COMPENSRTION DECIABATION: (T�is stt' n¢e0 noi be COmpl¢Ie0 il IOe permil is �or One hUnOreU (5700) ar 1¢55�. I cenify �hai in ��e edo ante of Ihe work for which Ihis permil is uetl, I shall not em�y an pers in any so as to 6ecome sublem �o ��e Wo �eK Compensa�ion Laws ot Calilomia. � �' Oate� � � Signalure: NOTICE: If. iter aking Ihis tleclaration, you shoultl beco blect o the ork¢ s' ComDensation provisions of;thi Labor Cotle. you ust fonnwi�h comply with such pmvisions or is oermi shall be tleeme� revoke0. CONSTpUC710N LENOINC pGENCY: I AereOy aflirm t�at 1 re is a consimction IenOing agenry for t�e pedormaoce o�f t�e vrork lor w�ic� �his Oermii is issued (Section 3097. Civ. C). 9 d �- LENDEB: F� AOUflESS: � OWNEp BUILUEB OECLAHpTION: I �ereby affirm t�at I am exempt irom ihe Coniractors' Sta�e License Law for ihe followinp reason (Setlipn 703i5 BuSinesS 2n0 PwIe5Si0nal Cotl¢: Any Ci�y ol county whit� repuires a Dermit Io ConSirUtf, alleL impmv¢, tlemolish, Or repair any sVutlure. Orior �o i15 issuance. also requires �he aDDlitan� lor 5uch De�mit Io �ile a signea Slaiemen� �hat he/she is Iicen5e0 pursuam to 1�e O�ovisions oi Ihe Cantraciars' Stare License Law (CAaD�e� 9 kommencing with Section 7000) ol Division 3 ol the Business and Prolessions Code) or Ihai helshe is exemp� t�ere�mm antl ��e Easis lor ��e allegetl exemp�ion. Any violation o� Seclion 7Q91.5 hy any applicant lor a De�mit suhle��s t�e apDliwnt Io a civil penalty of na� more �han liv¢ �unGreA Aollars (E500�. I, as awner of IAe Dmpeny or rtry employees wil� wages as t�eir sole wmpensalion, vnll Eo the work. anA t�e I❑ slmcwre is not inknae0 or ollerea far sale (Section 704a. 9usiness anG Pmtessional Cotle: The Comracmrs' State License Law does nol apPly to an owner of a pmpefly who Gmlds or improves I�ereon, and who tloes suth work �imself/hersell or ihmugh his or �er own em0loyee5. O�a��tlea �hal Suth impmvemen�s are na� intended or oHereO lor 5al¢. II, however lhe bUiltlinp or imD�avement is sol0 vnihin one year oi complelian, ihe awner vnll have ine ouraen o1 pwvinp ne/she OiA not hui10 ar imo�ove �or �he purpose a! sale�. I, as owner of ��e O�oDerry, am eKclusively camracting wil� licensed conVacmrs lo cons�mm Ihe Drolecl (Section 7044, Business .� an0 Prolessions CoOe: T�e Coniracmrs' Slate License Law Goes nol aDDly m an uwner of O�operty who builas or improves thereon an0 wh0 COntratl5 tor SUCh proleCis wilh a Wntraclor(5) IicenSe Dursuanl � he COntratlOrS' Sidle LitenSe Law�. I dm awarE thal D�aof o� �heir Worker'S Compensalion insurance 5�ou10 �e pmvitle o me. � I am eKemO� un6^ Seclion'. B. 8 P. G � tor tMs �ea n: � � 5 Dale: � Owner I tlo heieby cenify �a� I m aware ol ana un0erstantl ihe requiremems ol i mia ealin nd Sa ely Caee Sections 25505, 25533, anU 25534 an0ihallo anyfuture Ouiltlmg occupan�vnll/will not�circle one) n tllo comply wilh saia Slaie catles anEthe repuirem¢nIs bra permii �or consl5uction or moUdicalion Imm ihe Air Ouality Managemem DisVict. flesitlemiai conslruction apD�icalions are eeemD� ��om Ihese pmvisions. Dale: AOPlicanl I �erepy teni�ylhal I �ave reatl I�iS appliCation and S�aiethal��e ve inlormalion i5 torer¢tl I agre¢ 10 tOmply vn�h allCiry and counly ortlmynceSanOs�a law5 eWlinglobuil0ingconsimctionantlhere aNhorite�epre5enlai 5ofihiscity oenl Oe�eabove-mentioned n�ooen� ior ��soe uon o �pp5C5. � � � Oate: � Slgnamre: _ J oriver's ucense o� socia� securitv w: �6<L46 Whne—Builtlmg; Green—Cotlo EnlorcemenL Canery—Applicant: Pink�q¢yenue; GolOenroO—Assessor � �ITY OF COSTA MESA — BUILUING PERNIT PnRM NO: E 062034 PERM.IT NO; 'c 062039 PLAAi CHECK NO: U GOVT: ti 5JPP; � CONSTRUCTION TYPE: PERMIT TYPE: £LE PGRPOSE; ADD JO$ DESCRiPTION : N.ISC RESIDENTIAL ZMPROV „ RE;#B62033 SQ FT: CLAIM Vr1LUE: CALC—C�ALUE: GROUP OCC; R-3 / *�**+�*+��**R�*��#*�**u�##��*##��*�*****�*�**R�G�#�*�*�*#R�##��#��x#uu�st�#�:u#�±�±� ' Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAIN BUILPING ---------- ------ ACCESSORY BUIiDTNG FRNT: FT ZN REAR; FT IN FRNT; FT IN REAR; FT TN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REo • PROV: PARCEL: 11725117 ZNE: REF NO: I PLAI3NING NL7TES> > iEiF9F#3f��1EiF3Flf�7E�lEifiFiE#iE#ifKiEik�fbif#�f#1'tiE3E#iEiEiC�i�#iEffifiE�IfiFifiElf7E######iE####iE�IEiF####-1c#i£#if3t�######-0(�#iE D E V E L O P M$ N T S E�R V I C E S R E Q U I R E M E N T S ZUNING APPROVED BY DATE; BUILDING APPROVED BY : D'ATE: —"- APPi,ZCATION ISSUzD BY; I DATE:�� /�1 ifif�E?E'l.��i±Eif3EiFiE3f3F?E�k##iE##iF7E�r��'iFibiF��iFxiei�,riE��xiFo�x x fr xxxsr��Fx1FYe#af�IF###if#�K ieR�{f9f iEiE3EiEiFiEifiEiEiEiE�ljEiEiFiEiEif�lE##3FiE#ikiEiEiE#iFit�E-7E9E;K+iEitiEitiEii�iE#iE�KiE##itiE#iEiE##iE#iE##iE#iE3E#####iEH•##iE#iEitifif i,EGAiIZAiION:N F E,£ S U M M A R Y STRUCTURAL SEGN'.EUT;h BLDG P�1T PLUMBING ELECTRIC MECHANIC FIRE SM,IP/RES GRADING PERMiT 38 40 �08 SMIP/NON—RES ISSUE FEE 15,00 BUIiDING—DIV—> PERMIT ISSUE PLAN—CHECI{ iOTAL PAID DUc TOTALS----> 38.40 15.00 0.00 53,90 53,40 ,00 REVENJE DIVISIO� TOTALS--> COLLECTED: 53.40 OVER/SHORT: .00 BLDG PMT PL'JMBING ELEC3RiC MECHANIC FIRE SNZP/TOT GRADING Pi,AN—CHECK 53.90 ifiElfifififiElElfifif?EiE?EififiEif#if�F3f)('if1F'lf#iE##�1f#iEiFif##ieiFif###iL'#if#1Eji'iE####ifiEi("%#df#iilF#'7E')f#######i, ��#if#?! 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 CO5T ELE 12 FIXTURES LIGHTING 1 ST 20 EA. ,75 9,OU ELE 20 RECEPT/O'UTi,ET 1 ST 20 EA, ,75 15.00 ELE 2 RECEPT/OUTLET ADDITIONAL EA. ,95 ,9d ELE 14 RECEPT/5WZTCH 1 ST 20 EA. 75 10,50 ELE 1 NON—RES APPLIA,UCE NOT OVER 1,0 HP 3,00 3.00 END t�F FEES �1 �D1385;6-00133546 T GT `3.4(1 �ATE� OS/OS/93 iIt1E: OE�37 COi�STRUCTIOIV AND PLANNING APPROVALS Permit;,- i 7, T¢mporery Electncai S�rvice or Poie i � 2. SO�I Pipe-Undrgrnd. � � 3. Eieetr-GI Cnnduit Ut:lity�U�drgrrxl. � 4. Eldctrical Conduit-Undrgmd. I 5. Steel RdmfprCemen[ 6. E1eCUital U"r.R Grnd. F L 7 Faot�ngs 8. FoundaUon I9. VJatef Pspe�Undrgmd. � 10. Struetur;i Fbor System 11. Prope�ty Sevder Line & House Connection 12. S�+•+er Cap '3. "d�f ��a�ns �-- �14. Noug�h Plumbing Ra��an Electr!cai�Condw2 - ��Rduyh Elec:ric Wiring i ; 17. Rocgh �"' nng 5-.gn i ` 18. Rou3h Electric2l�T Bar Ceil.rq 19. Rcugh Heacinq & Alr Co�.dit,oning 2C. qo..5h Faaory Fi�ep'�ace 2L Ducts, in StruttUre 72. D_as. Vent��aLnq � 23. G� s?�pe� Rouah � Test 24. AooF Fram�ng .25. Ruor 5�^ra[hing 26. 'i �8ar Ce.i�r,g IStructurail & ivionocoat , 27. f-r,:"�: �-.d F�.eshing j 2& La:h�ng'd� Sld'ng I-- � � 2£, in5u�at�cn 30. 0•vV:all N.a�linc � 31. ?laster Bro•.vn Cott i-_ 32 E cctnc.l Po•:.e� .',:eter F r.ai �33. F�r�' Elcctric _ 34. riaal I�eai:ng �i Air Conort�Onfng 35. Final Gas Pipe�Test 36. Hood or Canopy `--- -- � 3Z °.rci Farorv F�reo�ace 38. f-�nal P�umbing 39. C.'ater Servic2-Final 40. Gas Service-Final 41. Sclar ComesticFinal 42. Badcflo�N Prevanter 43 f3�dcflo�v Irrigation 4�i. LzndscaRa Irriqation System 45. Sound Attenuation 46. Handicap Regu;;Lons 47. FIRAL STRUCTURE L: BUILOING Sb. FINAL PLANNING 46. Elrctric Retease to Edison 50. Gas Release to Southern California Gas 51. CERTIFICATE OF OCCUPANCY Date � DaLe � Inspector I PO(._ a SPA - - - � APPROVA�LS Permit #"r Date intpector 52. Pool & Equ�pmant Location 53. Steel Reinforr,ement 54. Forms 55. Electrical Bonding - 56. Rough Pl�mbing & Pressure Test 57. RPPPOVAI. TO COVER�GUiVITE 58. Electrical Condult�Undrgmd. , 59. Gas P,Ge, u Untlrgrnd., 7est ' 60. 8aclavasfi i.ines, P�Trap, O Undrgrrd. � 61. APPROVAL TD DECK � 62. 6ackwash � Receptor-Final 83. Heater & VenbPinai ' 64. Plum6ing SYs!cm � P;na: � 65. Electrical-Final -1-�-_--� 66. Satar System�Fina� i / 67. Fencing & Access Anproval � 68. APPROVED FOR PLASTERING 69. POOLlSPA SYSTE; ;5 FI�AI � FIRE DEPT. REQUIREN�ENT I � APPROVALS Permit;r� 70. Undergrouad Nydro 71. Prcduci P:p;ny :7 Gu � Oil i 72. Ur.deroroun�l F!�Sh � __-T �--� 73. Uadergrnd.5toregc Tank C Gas : � pi� '� � 74. Overheatl Hvciro I _I ___L__ � 75. Dry Chemica� i - - -i 76. Dry Star.dn;oe � -{' -- - --i I 77. FIXE�S�STE�" �'�'qL � I , j ---' 78. FIRE PREV. FINN� __ � 1-_�; I-IEALTH DEPT. REQUIFEi.iE�dT � 79. F7NAl IP'SPECTION -- i ------� - i---- fi0. FOOU CE.3'.��CA�E ISSI,E�f �_ I �__'_�,' ---- -�- - �-- --I �Notes: ---- �---- - ----- --- ---� �- I --- ---- --� --- -------- --' �; ' �� I ---� '^' '� I --- --^ ' I _ �a `� n � �I � PflOJECT ADDPESS: 3 3 O E 18 i x ST OWNEN'S NpME: BELOUS GREGORY P aooness: 330 E f 8TH ST COSTA MESA,CA 642-3330 APCHIENGINEEP: aooqess: UNIT: 92627 flEG.NO.: uxrt: PEflMInEE: GREG BELOUS t 714 ) 642-3330 aooxess: 330 E 18TH ST C.M. CA 92627 LICENSED CONTpALTOfl DEQAflAT10N: I hereby allirm ��a� I am IicenseA under provisions ol C�ap�er 9(commencing wi�� Seclion 7000� ol Divisia� 3 of t�e Business antl Pmlessions CoOe, and my license is in full force and eflect. CITY LIC.: STRTE LIC.: CU55: Date: Signature: WOHNEBS' COMPENSATION OECLAHATION: I hereCy atfirm t�ai I Oave a renilicate ot consent Io self-insure or a cetlilicate of Workers' Compensa�ion i�swance. m a cen�tie0 copy tnereol �Section 3800. La�. C). POLICY NO.: E%P. ORTE: COMPFNY: �] Cetlilietl topy is �ereby tumi5�ea. ❑ Cehi�ieU copy is �ilea wit� �he ciry Builtling Division. Oa�e: ApO�icant: E%EMPIION iPOM WOflKEflS' fAMPENSRTION DELLANATION: (fii55 ion n¢tH nol be cOmpleleU i� I�e p¢J mil i5 �or one �untlred (5100) or less). I cetlity Ihal in Ihe etlor nce ol �he work for which ��is Dermil' issuetl. I SAall not ploy ny pg/son in ayynfepn¢r 50 as lo become su�le[I to �he Wo ers' C mp.eSns.aiion Laws oi Cabbmia. � / / —� Dale: _ r �/ Signature: ' W �� NOTICE: IL a er making Ihis declaration. you 5hou10 �eco suDle 1 to tl Wor ers ComDentaGon provisiont o11Ae Lahor Cotle. you must lotlhwil� comply wi�h 5uch pmvisions o Ihis Oe� i[ S�all �e �eemed revokeU. '}� CONSTNUCTION LENOING AGENCY: I hereby a��irm I�a� 1 re is a constmction IentlinA aAency lor Ihe�perlormance o� ��e work �or whicn this oeimit is issuetl (Seclion 3097. Civ. C6 �' LENOEfl: AODHESS: OWNEB BWL�ER DECLABF710N: I �ereby affirm t�at I am exempt imm ihe Caniractors' State License Law for t�e tollowing reason (SetliOn 703L5 Busines5 anG PmtesSional fqGe: Any cily 0� cnunry w�ic� requiBs a Oermil �o cons�mc�, alter, imprw¢. Jemolish, Or reoair any siruc�ure. o�ior to its issuance, also reaui�es ihe apD�icanl lor such permii to lile a sipnea statement tlut ne/sne is IicenseU pursuant Io ��e Pmvisions al ��e Contractors' Sta�e Litense Law (Chapler 9(commencing wilh Sec�ion 7000) oi Oivision 3 0� the Bu5ine55 an0 Prolessions Code) or thal he/she is exempt I�erefrom and I�e basis tor I�e aliegea exemption. Any violation of Section 7031,5 by any aoPlicant 1or a permit subiects ihe apPlicant to a civil penally of nat more t�an five nundreA dollars (�`�). I, as 0�'ne� ol Ihe pmDe�Y ar my employees with wages as their 5ole tOmpensalion, vnll eo ihe work, an0 ine ❑ s�mcmre is not inlenAed or o11ere0 for sale (Secimn 70a4. Buvneu and Pmfessional CaEe: T�e Coniractors' Staie License Law Ooes no� apDly to an owner ol a D�oOeny who huilds or improves t�ereon, antl who does such work �imseltl�ersel� or ttlmupA his or ber own employees. OmviOea ihat such improvemenis are nol intentleE or olleretl far sale. If, however Ihe buil�ing or impmvemenl is 5oltl wi�hin one year oi comple�ion. Ihe owner will have �he Eurtlen of pmvinp he/she tli0 nol bWltl ar impmve for ihe purpose of sale�. I, as ow�ero�ihe propetly.am eeclusivety conVac�ing vnt�licensetl .� anE Prolesvons CoCe: T�e ConVaciors' Siate License Law Uoes nat antl w�J tonVat�s br SUth prole��s with a Conirat�Or(5)liten5e p� Inat prool ol ineir worker's Compensation insurance shoulU �e pn � I am ezempi unaer Seciion: 8. 8 P. C. �or IOis �ea n' Dale: � y � Owner: I tlo �ere�y certi�y hal I am aware oi anA un0ers�antl ihe repuiremen�s ol C 25534 an01�a1 I or any lulure builtling occuDan� wilVwill nol �circle one) nee permi� br construc�ion oi moUilicalion Imm t�e Frt u� Management Oi I�ese D�ovi5ion5� �ate: Applicam: _ Inere�y certiiyihailhave�eatl this applicalion and stalei�ai orainances an0 S�a e la relaimg lo builtling con5lmciion anE A pm0eny lar ms�1c�io purpases �ate: ✓� ' � SignaWrc: _ Orivei's Licenss�or ociai Secud�y a: i6<ba6 Wbite—BuilOing;Green—CoOeEnforCemem; ors to cansimct �he pmlect �Section 7044, Busineu an owner oi Droperty who �uilds ar im0«5 ihereon o We Coniracmrs' Sia�e License Lawl. I am aware a Salety Coae Sections 2550.5, 25533,ana faitl state cotles anE �he�eQUireme0I510! d tanSlNciion aDPlitaiion5 arE exempl �mm all c�ty and couMy e aEove-menlionetl Pink—Revenue: Goldenroa—Assessor CITY OF COSTA M.ESA — BUILDING PERM:T PER:� NO: P 062036 PE't2MIT NO; t� 062036 PLAN CHECR NO; N GOV:; ti SJP?: N CONSTRUCTION ;YPE: PER:•l2T TYPE; PLU PUR?OSP; t1DD SGB DESCRIPTZON : MISC RESIDENTIAL IMPRO��., RE:?FB67.033 SQ F:': C�AIf✓i VAiUE: CALC—VALUE: GROUP OCC: R-3 / CUMMENTS• REROOF H�DSE 40 PATIO COVER AT ENTRY MISC INPRO +�<**+�**��t**+�**�ttu**##x�k+�#*#x•�tt#*�**��**�#*�t*�##��u##�t###*��##tr##*��#u#�#�c�::��xs<* Z O N I N G R E Q U 2 R E M E N T S S E T B A C K S ------------ MAIN BUsLDING ---------- --------- ACCESSORY BUIi,DING --------- FRNT: FT IN R.,At�: FT IN FRNT: FT IN REAR; FT IN LEFT: FT ZN RGHT; FT IN LEFT: FT iN RGHT: FT IN PARKING REU• PROC�: PARCEL; 11725117 ZNE: REF NO: PLANNI,iG NGTES> > iEifjFjE!!�fFiEiEiE�iFif3f�iE######1E�lf#iFiFiEiEiEiEff�lFfEiE3EiFi(��FiEiE )E#####3E�IEit####if#iE######SF�E######iF######fEiE 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 : ,. DAiE; APPLICATION ISSUED BY; —��/ DATE;' �� 3F3fiEif�E?f�ifif+flEiF?EiEiEffif?fiEiFiEjE�x3riF�xxsr�x��fetrir�k7e�x� eriF�'r��r�esr�+�Tr�iF�r�lE#K�iF#####::x srx+:xzxrt#iE �KiEifiEifdF?EiFiE7fiE�fiEiEiE##if�}EiFiE?EiF#�Y:1f�E14iE#iFififlf?FiFiE�lfifiElEiEiE##iF###1f########3b######!E`.FG#1f#i K##3ffE;i�3E LEGAiIZA3ION;N F E E S U M M A R Y STRUCTURAL SEGN,ENT;N ._ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT ?9.00 25�c � �' SN.IP/NON—RES PLAN , ISSUE FEE 20.00 �r BJZLDING—DiV—> PERMIT ISSUE PLAN-CHECK TOTAL PAZD DUE TOTALS----> 14.00 20.00 � 0.00 39.00 39.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 39.00 OVER/SHORT; 00 BLUG PMT PLUMBING ELECTRIC MECH�3IC FIRE SMIP/TOT GRADING PLAN—CHECR 34.00 ,� ififiEiE�leiEifififif�lFiEiEiE#iEiE3f###iFifiElEiEif#i6iEiE#ifiEiE±f3Eiri'r}��{(.*{f#iEiP#IE#it####1E#####!E!EiE#�N�####iE#####iEiEie I N D I V I D U A L F,E E B R E A R D O W I3 TYPE QTY D E S C R I P T I O N�/ � UNIT COST TOTA;, COS: PiU 1 DISHWASHER ��n 7,00 7,00 PLU 1 SINK, KITCHEN �� 7,00 7,00 EN�OF� FEES �� /f�l y 1'� al OD133543-001385<3 T O T 34.00 QqTE� OB/OS/93 TLME: 08036 � I CONSTRUCTION AN1YP�.ANNING i AP?ROVALS Permit # � ' 1. TemDorary Ele[trual Service or Pole j 2. Sod Pipe-Undrgrnd. '�., 3. Electrical Conduit Utility�Undr9rnd. � 4. Eiectncal COndu�t-Undryrnd. 5. St e� Relnto�c=ment 6. E!ectr,cai UfER Grnd. � _ �_�i 7. Foonngs I, 8. Fountlatm� �� 9. L"atcr Plpe-Undrgmd. L 10. Structurai Floor System � 11. Prope�ty Sewer Line & Nquse Connection , 1r 2. S:�i'ver Cap f---- '3. �'o.:f 7ra�rs I, �;4. Go�onPlumomg ' �i5 Ro,:gn Electrical-Condu�t � � 1� gh Electric Wirinq '� � i� i' No�gh lNlnng Sign . 18. Rough Elect�ical-T Bar Ceiling . 19 Rough Heati��g & Air Conditioning 20. r',oi�9t Factory Ffrepiace 21 Q�cts, ;n S:rucwrc � 22. D��L, \'ent cnnr• � 23.3rs'Ipa�Rou�h&Test �� 4. Floof Framing �� 25. Rout Shaathing � 26. T-B�+ G.ng l5tructu�ail r;; anvcoat . 1 � 27. �rmc ard Fldshing - � 28. �7Sh�f1�] �! Slf:lfl'� � ��suiat,on 30. 'J��,n.al: dla hng -- 37. P'*ster Qro•:rn Cozt � 32 Eleancal Power Meter-F�nai �--------- - 33. Fin�i Eiertr.0 3G. Fi��„I Heat�ny $�, A�r Co�-d�ti0n�^g 35. � i�al Grs Pipe�Test 36. Hood or Canopy 37. Finai "ractorY firepiace 38. F,nal P�cm6,ng 39. tYater Se�vice-Final 40. Gas Servme�Final 41. Solar pomesiio-Final 32. Backfio1�� P�eventer �3. Backflow Irr.gation 44. landscane �rnqation System 45. Sound Attenuation 40. H�r.dicap Regulaticns 47. FI^,'AL STRUCTURE & BUILDING 48. FINALPLANNING 49. Electric Release to Edison 50. Ges Release to Southern �ylifornia Gas 51. CERTIPICATEOFOCCUPANCY no Date Date POO� a SPA Inspector qppROVALS Permit � 52. Pool & Equ�pment Locai on 53. Steel Re�nforcement 54. Forms 55. Electrica� Bond�ng 56. RouSh Plumbing & Prassure Test 57. AP'ROI�AI. Tp COVER�GUNITE 58. Electrical Cardurt�Undrgrnd. 59. Gas P�pe, � Untlrgrnd., Test I 60. Backerash Unas, P�Trcp, � Ur.drgrrd 61. APPROVALTODECK 62. BaCkwesh & Rec�ptor�Finsl 63. Heater & Vent�Final �-/ 64. Plumbmg S✓s:em � Final 65. Elecirieal�Finai 66. SoWr SYstem�Pinal � 67. Fenang & Access Approval 68. APPROVED FOR PLASTERI��G 69. POOL/SPH SYS`E�: S f i�!qL FIRE DEPT. REQUIREMENT APPROVA!_5 Permit;: 70. Undcrg.o�no H��d�o � 71. Prcduct P�p�:.y :; G�, :- Od � 72. UndCrground Flush � -- ' 73. Undergmd. S;orayc Tanlc `.7 Gas -.-, 0�:� 74. O��rhead HV:Iro I 75 �ry C�-�.�r cd' - ---.. i 76. Dry Stanop�oe 77. FIXF.D SYSTEA' f iNAL Date �Inspector n � _J 0 _J 78. FIRE PRtI�. FINH'�-- � �-- -- y --`-- ItENLTHDEPT REQUIRE�s1E�.�T 79. FINt�i.l\'SrECTI�N � I �� 80. FOOD CERT�FICA?E ISSUED � � � -� VVotes: - _-_ -'-.__ __' _. �__ _ __�' _ -'. � 4s-26 _�4 2ovzor D� -- �t=� - r� -�i�G�_(�?��---J _ , i - --- ----- - I � s --- ---- 7 �I / � PqOJECTA00flES5: 33O E I8Tfi J`�T OWNEP'$ NFME: BELOUS G�7EGURY P aooeess:330 E `8_H ST COSTA MESA,CA 642-3330 AflCH/ENGINEEfl: ADUflESS: UNIT: 92627 flEG.NO.: UNIT: PEflMITTEE: GAEG HELOUS ( 714 ) 642-3330 nooxess: 330 E 18TH ST C.M. CA 92627 LICENSEO CONTBACTOB OECIAFATION: I �ereGy allirm ��at I am Iicen5e0 unUer provisions of C�apler 9(commencing wilh Seclion 7000� ol �ivision 3 0l the Business antl Professions Cotle, antl my license is in �ull Porce an0 etlec�. CITV IIC.: STATE LIC.: LN55: �ate: Signature: WONNEBS' COMPENSA710N oECLAflATIOx: I hereby affirm inat 1 nave a certifiWte af consenl to sell-insure or a certifitate ol worker5' Compensalion Insurance. or a ceni�ied copY Ihereof (Sec�ion 3800, LaO. C). POLICV NO.: E%P. OAiE: �CIOMPANY: J C2tlifIE4 COpY IS AC�Cby �IIf015110E. ❑ Ce�iheE copy i5 file0 with ��e ciry BuiltlinA Oivision. Oate: ADP��cam: EXEMPTION FflOM WOPKEPS' fAMPEN5pTI0N OECIAilATION: (TAis 1 I ceNty t�at i I�e q rlormance ol l�e work 1or whic� IAiS permi s is Subletl ro Ih WOtl� rs' Compen5aiion laws ol Califomia. Date: S SignaWre: NOTICE: If. af r making I�is tleclaration, you s�ou10 bec si Coee. you musl fotlhwi�� comply wi�h suc� pmvisions t�is { CONSTNUCTION LENOING RGENLY: I her¢Oy aflum IIIai ere is a whic� ihis permil is �55ue0 �Section 3097. Civ. C�. LENOEfl: aooness: il�he permiiislorone hunOre0�5100�orIe55�. any personlotn9'ma�ner so as �o become Nurkers' Compen5aiion provi5ion5 ollhe LaDor �. Ueemetl revoked. lending agenty for ihe pedormance ol t�e vrork for � OWNEfl BWLOEB OECLAflFTION: I �ereby allirm Ihal I am exempl Imm Ihe Coniraclors' S�ate License Law lor �he lollowing reason �Section 7Q97.5 Business anC Pmlessional CoOe: Fny ciry al tounly w�ic� repuires a Oermit �a canstmct, alter, im0��e. tlemolis�. or repair any S�mcWre, prior Io ils issuance, alm repuires Ihe applicanl for such permii to lile a signed s�a�ement t�ai �els�e is IicenseA 9 ' h$e Y 7000 1 D� i' n 3 f Ih Bu n s CITY OF COSTA N.ESA — BC=LU:NG PERM,ZT PERMIT NO: M 062035 PLAN CHECK NO: N CONSTRUCTION TYPE; PERMIT TYPE: M.EC JOB DESCRIPTION CLAIM VALUE: M.ISC RESIDENTIAL IMPROV., RE:NH62033 CALC—VALUE; PER� NO: v U620�� GOVT: U SUPP: N PURPOSE: AJD SQ FT: GROO? OCC: R-3 / *O*�**#S**R*'*00***O**#�tn#��####�*#�#***#�###�##�*###*#�#*��trer�#�##�#�•u��#�±��sr#* Z O N i N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILD'.NG --------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT Ih PARKING REO• PROV: PARCEL: 11725117 ZNE; REF NO: PLANNING N(5T'ES> 1 .�' if �;i' i! ji' jf']�,�i%i�' �*�' {f i�' i�' i{' if �' �' # if it' if if if if if if �.' # i�' i�' jf'�f if'K' it"�' �f'X•'K' if *�f'� if x• � if iZ' i�' i%if i�' i�' �("n i�' i�' X' i�' # if it' {} X' if i�' ��' if i�i # if i�' if �%if ' D E V E L O P M E N T S E R'V I C E.,S R E Q U I R E N,' E N T S . � u • ZONING APPROVED BY DATE: 7 " l. . BUILDING APPROVED BY : _ DATE; ' i :�"� Yl r1.� c' �AP�LICA;,,ION ISSUED BY• - DATE: �, �iEifL:jEiF1F3l"ffifiEifiEihj('1Fi�'###ifi%1�'1t�t�t3tlt'RltieiF�hlF�elt�P��til•HA'R\' 'x'RStieR'R'it'R F'lE�fif#if#iEiE###1tYth`fYRik.hia'H�.'lf iEiEi�iFiEif�fiE3EifiEiFif1E#iliEaE#ifififiEikiFifif##jfififiE?Eif}**.)(�***�p.7(.a�.�.*.�(.*�.�*##i(�#�f#######!E#####3t###lf#!E#iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGi;ENT;N C. � � BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING PERMIT �, - 13.00 pursuan� to I�e pwvisians ai lhe Coniraclors S�a�e Lcense Law (Chapter Icommencing wit t ion � o rv sio o e s� es P LAN '" � z S R SM I P/NON—RES and Pwlesvans Cotle) ar ihat �e/s�e is e�emD� �here�mm and Ihe Uasis lor ��e allegea exemD�ion. Fny violalion of Seciion 7031.5 Oy - any applicam for a permi� subjetls iM1e applicanl �o a civil penaliy ol not more I�an five hunOr¢d tlallars (E500�. I S S lIE t Et �' - � 1 5, Q Q �, as owner ot �Ae pmpeny or my emp�oyees wi�h wages as �neir so�e compensatian, will Ao �he work, ane �Ae ��Zi.,DSNG—DFV—> PERhiIT ZS$VE PLAN.�-CHECK TOTAI� PAID 1�Ut. ❑ nmcmre is noi imenaea or offeretl for sale (Section 70a4. Business and Pmlessional Coae: TAe Camractars' Siate �icense iaw YOTAL S— -- —> 1 3. 0 � 1 S. 00 0, 0 0 2$. 00 2$, 00 , 0 0 daes noi appry l0 an owner ot a O�aperty w�o builtls or impmve5 I�ereon, and w�o tl0e5 Suth work Aimsell/�¢rsell Or thmupA Ais or her own em lo ees. Drovided Iha� sucn im rovements are nai inlen0etl or offered far 5ale. II, Irowev¢r the Guiltlin or � im0�ovement is som witnin one year ol cam0leiiari. Ihe owner will have t�e burden ol pmving he/she aid nol builU or imOrove R EVENUE D Z V I S 1 ON TOTAL S— —> COLL ECTED ; 2$, 0 0 OVER /SHORT : , 0 0 lor the Dutpose o� sale). I, as owner oi Ihe propetly. am exclusiv¢Iy conirac�ing wi�h Iicense0 coniracmrs �o consimct IAe pmjec� �Seclion 704d, Business .E� anE Pmlessiws LoEe: T�e Coniracmrs' Slate License Law aces not aoP�Y to an ovmer ot OmpeM � �wWs anmprwes itrereon antl who cantratls �Or SUth prolects wilh a tonlratbr�5) license pufsuan� lo�Ne Coniratlors' Slate LiCense Law�. l am aware t�at pwol oi Iheir Worker'S Compen5aiion insurance shoultl Oe pmvideA I o1e. � I am e.empt un0er Seaion: B. 8 7. C. � ^ lor Ihis aso / J oate: � q� Owner: � � I Oa �ere�y ceN y �� 1 am aware oi antl un0erstanG �he reduir¢men�s ol Cal mia He 1� a A Salety CoGe Seaions 25505, 25533, anE 25534 ana ihal l or any lulure Duiltling occupanl will/will nal (circle one) nee to compl vn�h saiG Slaie cotles and �he �equiremenis lor a p¢�mi� far conslmction or mo0ilica�ion imm I�e Air Oualiiy Managemeni Dislriq. fleSiUential con5iructian aD�lica�ions are e�empt Imm Ihese pmvisions. Da�e: AOPlicanl: _ I �¢�¢by cCtlity thdi I hdv¢ rPdd IhiS a001i[aiian dnd Slaie �h arOmances ana tate Id�'�s relating lo OUNtling constmtlion an0 pmpetly for in, ecu n purposes. Oale: ✓ � Signalure: _ Omei s Litense ar Sotial Seturi�y >: I agr¢e Io campty vnih all ciry an0 county IN5 ddlo en�rOEOq Ihe above-men�ioneG 16aba6 White—BuilEing; Green—Code Eniorcemem: Canary—Applicanl: Pink—Revenuo: GOIQenroE—Assesmr HLDG PMT PLUMBING ELECTRZC MECHANZC FIRE SN,IP/TOT GRADING PLAN—ChPCK 28.0� iEjElEifiEifiEi�EiElEiEifiEiE#�#iEiElEifiEitiF1E#3F##3fjEiEiE1f#E#iEaf1ElFiE�FiEiFiE#iE-IfiE3E##1Eif#!f###ifiE�E##iE#############?f I N D I V I D U A L �r 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 TOTAI, COST MEC 1 FACTORY FIREPLACE '`� 6.50 6,50 MEC 1 I�ST HOOD W/DUCTS FED'BY. MEC EXHAUST 6,50 6.50 END OF FEES U1 00138542—U0138`42 T GT 23,OD DATE: OS/OS/93 TIHE: 08:36 CONSTRUCTION AND PIANNING APP�iOVALS Permii x 1, Tempa�ary Electncal Serwce or Pole 2. $od Pipe-Undrgmd. 3. Electrical Conduit Utdrty-Undrgrnd. 4. ElectriGal Condurt�Undrgrnd. 5. Steel Reinforcement 6. Eiectricai UFER Gmd 7. FODtings 8. FoundBtion 9. Water Pipe-Ur.drgmd. 10. Structu�ai Fioor System 17. Property Sewer Line Rr House Connection 72. Sevver Cap 13. Roof Orains 14. Ro�ugh Piumbir.g 15. Rough Electrical-Cond�rt 16. Rocgh EleMric iNiring 77. Rough 4Viring Sign 19 Rough Elect�ical-T Bar Ceil�ng 19. Rough Heating & Air Co�dit�or�ng 20. Ro�gh Facmry Firr.p�ace 21. Oucts, �n Structure 22. Ducts, Ventilating 23. Gas Pipe•Rougl. & Test 24 Rouf F�aming � 25. Rocf Sheathing , 26. T-Bar Ceiling (Structurall � �vionocoat 27. Frame ard Flashin� � 28. Lathing & S�d ng 29. Insuiauor. 30 Dry�,yal� �ailing 31. Plaster Bro�vn Coat 32. ElectriCal Poive�'.Sate'�Finai - 33. F�ral E'ectnC 34. Fir.al Heatmg & A�r Conditlo^!nn 35. Final Gas Pip��Test 3G. Hood or Canopy 37. Final Factory Firepiacc 38. Finai P4�mbing 39. �'Jater 5ervice�Final 40. Gas Service-Final 41. Solar pomesuoFinal 42. Backflove Preventer 43. Backflow Irrigetion 4�. Landscape Irnqauu� System 45. Sound Attenuation 46. HardicaP RegulaTons 47. PINAL STRUCTURE t5 BUIIDING 48. F;NAL PLANNING 49. Electrit Release to Edison 5Q. Gas Release to Southem CaGfomia Gas 51. CERT;FICATE OF OCCUPANCY POU, d SPA Date Inspector APPROVALS Permit,$ 52. Pool & EquiAment Locat�on 53. Steel Reinforcement 54. Forrti, 55. Elecirical Bonding 56. Rough Plumbmg & Pressure Test 57. APPROVAI TO COVER�Gu'!iTE 58. Electncal Cqnduit�Undrgrno. 59. Gas P�pe, U Undrgrnd., Test 60. Backwash Linus, RTrap, i-1 Undrprnd. 67. APPR0I�AL TO DECK � 62. 8ackc:ash & Reeeptor-Fi�=! �_ 63. Heater & Vent-Pinal _ 64. Plumbin9 SYstem - P'�al 65. Electric2hFinal � � 66. Solar System-(ira: 67. Fencin�7 & Access APpruvsi 68. APPROVED FOR PLASTERING 69. POOLiSPASYSTEP.15PiNAL .� �.1�_ fIRE UEPT. RE�UIRE�41E1\T 'S" -�/_ � APPROVALS Pr:mit# wp 70. Undergra.�nd HyGro _ ,��1 Date � lnspector 71. Product F�pin9 ^Gas �,_�Oa I � -t-- - -'+'---;� 72. Unde�g�oun� Flus^ I , ---- J -t------1--- - 73. Undcrgm�.!. Sto•as., ; �r,!a ;'� Gas . ' 74. Overt,aad Nvare ------� -----+- --_. - ---�---�--- 75. Ory ChemiC2l 76. Dry StancpiFe 77. FIXED SYSTE'S F111AL 7B. FIRE PREb. FI:;A.L NEALTH DEPT. REQUIRE7eiERT � �� 7Q. FINAL IP!�PECTION � � 80. FDUD CFRTIFIC,4-E t55UEC � � � _____-__-___ --_____- _ 1____ _ Notes: --- --�----------��------ ' _Zb=t`{�- _iLO�U_cM_ 26's��_ �-l�-G�-- Date I ' I : y� / �� PPOJECT ADOBESS: 3 a O E 2 R TH S T OWNEfl'S NAME: j'�Ei+OUS GREGORY� P aooness:330 E �8TH ST COSTA MESA,CA 92627 642-3330 qNCH/ENGINEEfl: AUGHESS: flEG.NO.: UNIT: UNIT: PEFlMITTEE:GREG BF.:,OUS (714)642-3330 NODflE55: 3� � E 1({ 1 H S 1 C.M. CA 92627 UCENSEO CONiflACTOP OECIAFATION: I hereDy aifirm ��ai I am Ilcensetl wder pmvisions of C�apier 9(commencing wiih Section 1000) of Drvision 3 oi the Business antl Pmfessions Cotle, an0 my license is in full force and ellect. CITY LIC.: STATE IIC.: ClAS$: Date: Signature: WOflKEflS' COMPENSA�ION OECIAPATION: I hereby affirm �ha� I have a terti�ita�e ol consent IO Self-insure or a certitiCale of Warkers' Compensation Insurance, or a cer�ilietl capy �hereol (Seciion 3600. Lab, C). POLICY NO.: E%P. DATE: COMPANY: ❑ Certified copY is hereby lumishetl. ❑ Cerlilie0 coDY is filed with Ihe ci�y Builtling Division. pa�e: ApplicanC E%EMPTION FflOM WOPREflS' COMPENSATION OEClA8ATI0N: (ihis spd�on neetl no� be comDleletl il lhe Dermit is �or one AunOree ($100) ar less�. I certity (hat in 1 pe rmance ot 1he work tor which �his permit' � ued. I shall no� ¢�pl y any erson i y manner so as �o become su�jeq to ihe orker ' Compensa�ion Laws ol Califomia. Daie: S Signamre: � NOTICE: If afie making �his declaration, you should bec e suhl d �o tl rkers' Compensa�ion pmvisions a� Ihe Labor Cotle. you musl �orlhwilh comDly with such Omvisions �hi5 per i� shall be tleemed revoke0. LONSTBUCTION LENOINC PGENCV: I �ereby a��irm Ihai ere is a con5lmclion lending agency for lhe petlormance ol Ihe work for wnich this permn is i=_sue0 �Secnon 3097. Civ. C�. LENOER: FDDNESS: OWNEfl BUIIOEB OECLPPATION: I hereby aifirm tha� I am exemDt imm �he ConVac�ors' Sta�e license Law for the Following reason (Seciion 7031.5 Business and Professional Cotle: Any city ol counry which reQuires a permit �o cons�mc�, al�er, impmve, Jemolish, or �e0air any slmclure. prior to i�s issuance. also reQuires ��e ap0licant lor such permil �o file a signetl staiement ��at he/she is licensetl pursuantto�he pmvisians olthe Coniractors' Siale License Law�Chapier9�commencing wilh Sec�ion 7000) o�0ivision 3 oilhe Business antl Pm�essions CODe) ar Ihal he/she is exemp� �herelrom and Ihe 6asis br the allegetl e�emp�ion. Nny viola�ion af Sec�ion 7031 5 by any applican�for a permil sublects Ihe applican�lo a civil penal�y of not more than live hunOreA tlNlars (E500). I, as owner oi I�e pwpetly or my employees wilh wages as ��eir 5ole compensa�ion, will Oo lhe work, and Iha ❑ simcture is noi inieneetl or offered far sale (Sec[ion 704a, Business antl Protessional Cotle: The ContracmrS State License Law tloes nol apply lo an owner oi a pmpeny who builtls or impmves ��erean, antl wha does such work himseltlhersell o� �hrouAh his or �er own employees. D�ouidea �ha� suc� impwvemen�s are no� intentletl or o��ere0 for sale. I�, however the building or impmvement is sold wi�hin one year of compleiion, Ihe owner will have the Duraen ot pmving he/she tlitl not Cuild or impmve �or ihe purpose of sale�. I, as owner of the properly, am eeclusively conVac�ing wiih Iicen5e0 contrac�ors lo cons�mcl [he pmlect (Sec�ian 7044, Business •� ana Prolessian5 COUe: The Conirac�ors' State License Law �oes no� aOPly �o an owner of DwOehy who EuAds or impioves thereon and w�o conlratls lor suc� prolects with a contracloqs) license Oursuan� lo e Contrac�ors' State License Law). I am aware t�at prool o� their Worker'S Compensa�ion insurance s�ould be Drovitled me. � I am e�em untler Seciion: B. 8 P. C. for Ihis re sort j , /� �ate: � Owner: / ly I ao hereby cetld I�a� I am aware of and unders�antl �he requiremen�s o� C il nia He �h and Salei Code Sections 25505, 25533, an� 25534 an0l�al I or any IuWre builtlmg oaupanl wilVwill not �circle one) neetl �o comDly with saiG Slaie co0e5 antl ��e reduiremen�s lor a permil tor cons�mc�ion ar mo0ificaiion Imm the Air Oualrty Managemen� �iSVici. FeSiAential cons�mc�ion apDlicalions are exempt �mm Ihese pmvisions. Oa�e: ApplicanL _ I here�y cetlily ��a� I have read �his applica�ion ana slale that ortlinances antl s Iela 'Srelaiing�o builtling conslmciion antl � p10pEf�y �Q! �It15 CC�10 plllPOSCS. � � �aie'. 9 Signamre: _ oriver's �icen e ar Socia� Securiiy x: is correcC I agree to comply with all cily antl t646a6 Whi�e—Builtling: Green—Cotle Eniorcemem: Canary—ApP�icant: Pink—Revenoe; Goltlenrotl—Asseswr C:TY OF COSTA MESA — HUILDING PERNIT t�?RMIT NU: B 062033 PLAN CHECK NO: 04773-92 � CONSTRUCTIOV TYPF: PERMIT TYPE: STR JOB DESCftZPTION : MT_SC RESIUEtiTIAL IMPROV£MENTS PERM NO: B U62033 GOCIT; N SJPP: � PIIRPOSE: ADD SQ FT: 3,020 C�AZM VALUE: 80,000.00 CALC—VALUE: 15,592.00 GROUP OCC: R-3 / c�,�N�*}�**;=�R*ROO**�OD�*�#*��*#��#*�**R��*�*#*##*##ceu��R�##*#a�x�st�##x##u�ce�rce�r Z O N I N GS �RTE�QAUCIKRSE M. E N T S ------------ MAIN BUZLDI�G ---------- ---_----- ACCESSORY BCFILDING --------- FRNT; 21 FT 6_N REAR: 61 FT IN FRNT: FT iN REAR: FT IN LEPT; 5 FT ZN RGHT: 6 FT 2 IN i,EFT: FT IN RGHT: FT SN PARKING REp • PROV• PARCEL: 1172�117 ZNE: R1 REF NO: PLANNING NLSTES>�REROOF FiEMOVE INTERIOR WALLS; VARIOUS INiERIOR >� MourF�tAa�r�Ns. ,s 3EiE�E�lifiE?f3E!6iEif?f�)ffC•ifdEiEiEiEiFafiE#if2F�lEjfif#Ifif1E�lEiEiE###�3E1EiEiE3EiEiF#3E###1E####ifif#######iE####�#GH�Ya#�iEiEif DEVE'I,O•PM.E,1T SERVICES �EQQIREMEh�S � ; � ZONZNG APPROE'£D BY '- C� � L' < DA3E; S: '�� BUIiDING APPROVED BY�: - DATE: -. APPLICA�TION T_SSUED BY: ��- I S-k� DATE; �%� 5� iEiEAf�lf3Fff±E!iiEifiEk?fi(-ii.#?FiElE�iFiE. frRltRae . ft �YiT�iFYtitie£iF'1F�%Tzi"t�glfif#iE###1E## ,nR-1F�'e�A�R if# :4 �!F if dE 3't ie aE x?E !E jf iE iF fE �lf #'!F ##�IE �1E iE �! if if�?E iE �!E iE fh if 3F 3E iE if iE bF k� #�)f #�7f if iE 1EiQ• #iE #%#!F �%# 3f i't!f 4(�-0E iE iE if iF iE �#� # i(��u'i� ## iE #!f �IE?E iE'1F i,EGALIZAiION:N ,� F:E E S U M M A R Y STRUCTURAL SEGM�NT:Y BLDG PMT 'F?LOMBING ELECTi2�C MECHANIC FIRE SMIP/RES GRADING PERMIT 17?.00 � 1,56 PLAN 111.15 SMIP/NON—RES ISSCiE FEE r%- BUILDING—DIV—> �PERMIT . ZSSliE' PLAN;GfiECK TOTAL PAID DUE TOTALS----> !172.56 � O.OU.. "`1Z1''1� 283.71 518,04 —234.33 RE��ENUE DIVISION:TOTALS--> COLLECTED: 172,56 OVER/SHORT; .00 B�DG PMT P:.UMBING ELECTRZC ,�,ECK�NIC FIRE SMIP/TOT GRADING PLAN—CHECK ?71;00 ; � C' / 1,56 *��****x**?��***x�*��*�*�x**#�*;�*+r*�** � +�'��*�x*##*�r*x*z��*��r*st�-�c*�*##*�*�r**�#***�t i S N D I V I D U A i P"£ E B R E A K D O W N � �� TYPfi �TY D E S C.R I P T I;O �\� �� UNST COST TOTAi COST SFR 90 R£S—PATIt] COVER'—POST � TRELLIS 19,80 592.00 SFR 15000 ALTER BY VALIIE R�51D NT•IAL NOZONE 1,00 I5,000.00 END,fO�F" r�ES r, � � 1 t� f �J � F f� OS OD13S544-00138545 T O T 172,;b � DA7E+ OS/OB/93 TIttE= 08:37 l CGi�"RUC7ION ANO PLANNING APPROVALS Permi4 � 1. Temporary Electncal Service or Pole 2. Soil Pipe•Undryrncj. 3. Electricai Conduit Utdity�Undrgmd. 4. Electrical Conduit�Undrgrnd. 5. Steel Reinforcement 6. E;ecirical UFEfi Grnd 7. Footings 8. Foundauon 9. Water Pipe-Undrgrnd. 10. Structural Floor SYstem 11. Property Sewer Line & House Connection 12. Sewer Cap i3. Roof Orains 14. Raugh Plumbing 15. Rough E;ecuicabContlu�t 76. Rough ElectY�c!4�iring 77. Rouyh'.V:nr.6 S�gn 18 Rough Etectricat•T Bar Ceitmg 79, Rough HEati�9 & Ait Cond�iioning 20. Rough Factory Fireplace 21. Ducts, in Structure . 22. D�cts, Vent�lanrg 23. Gzs Pipa�RoJ9h & Test 24. Pcaf Fram:ng 25. Roc' Shcathing '� , 26. T•6ar Ce�hng (St�ucturall & tironoeoat 27. Frame �nd Flash'ng 28. Lathing & Sid�ng 29. Insulat�on 3�. D�y�eah iVadin9 37. P:ast�r 3ro�vr• Coat_ 32 E�ecv�� P�::e� ': eter�F ai 33. Fir¢I EeetnG 34. Fir.;,l I-fc�tiny 3 f. � Co: ditior.np 35. Final Gas P�C"�Te.t 36. Hood or Canopy 37. F,�al Fcctory F��eplace 38. Finai Plumbing 39. 1'dater ScrvicE-Final 40. Gas Service�F�nal 4'. Solar pomesdc�=�ra� 42. Backflow Prsven2er 43. Backflow irngation 44. Lnndsc:.pe irriqaUon Systerr. __ .. _._-.____ 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release io $outhern California Gas 51. CERTIFICATE OF OCCUPA�CY Oate Date � POOL d SPA ��SP��Of APPROVALS Permit � 52. Pool 6e Equipment Locat�on 53. Steel Reinforcemeat 54. Forms 55. Electrical Bonding � 56. Rough Piumbing & Pressurc Test 57. APPROVP L TO COVER�GU"iTE 58. Elec[ncal Condwt�Undrgmn. 59. Gas P�pe, �7 UnC�n�nd., Te;; _ 60. 8ack�aash Lines, P�Trap, CI Ur,drgmd. 61. APPROVAL TO UECK 62. Backsvash i� Receptc� Fina� 63. Meater & Venl�Final G4. Plumbir.g System � F��al 65. ElectticabF�nal 66. Solar Sysi�-m�Find�. 67. Fencing & Acc�ss Anpro•�al 68. APPROVED FOR PLASTEFING 69. POOI'SP,O SYSTEF'S PI�AL FIRE DEPT. RE�UIflEMENT APPROVALS Permit � _ 70. Underground Hydro 71. ProduCt P Piny �7 �a: �' 0�1 72. Unde�gro,.n� F4,�s'� 73. Undcrgrnd Storg. �.:nk �'Gas ... L i �(�✓C�L I 74. O�cri,ead Hv��c . i " �i Date Inspecm- i 75. Dry Chemicai 76. Dry StanuP.i�= -- ------ -- - -� - - - 77. FIXEDSYS?E14FINAL 76. F�RE PREV. FIVHL NEALTH DEPT. REQUIREP:�E��T 79. FINAL IiVSFECTiO\ - - - - - -�-- � - ---- --- ---- - - - _ 1_ - - -- - - 90. FOOU CENI'�:�=�.'E ISSUED � � --- ---�---- 1-- - -- Notes: Q�_ -(. B S. � f Y� �oSv� �aS.e.s - � �ol�.s-� . D!� �_�-� _ �---------' i --- ----- � � �-_ __- i t _ � A Applicant to fill in all spaces ezeept 'EIT'OFCOSTAMESA CONS�RI��ONP �MIT Pro�ect Address y�� • 1 y /r%'C.�°' � G. �- Applicant'sMaili/ngJ�ld�d�re�ss� ��•O.?�jo��c IZtd�- —y� ^7oR�/' �� Owner's Nj�mp -L_tJ'3ffiaCZri w C' Phone � �.W. � Address �7%1� �. • i��'� %'�^i(p' lt� A�i.�' ArchlEng. Licenx No. Address Coniractor's Name G hone Address (m 'I' g) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm [hat I am Ilcensetl untler prOvi51on5 of Charter 9(commOnCing with section 7000) of Division 3 of the Business antl Profezsfons Cotle, antl my licenm is In (uIl (orce antl eftect. Licunso Class � littnse No. Date Si9nature W00.KER5'COMPENSATION DECLARATION i hereby affirm that I have a certitica[e of consent to selNnsure or a cartlflcate �f Wo�kers' Compen5ation Insu�ance, or d certifietl copy the�eot (58Ction 3800; lab. C.) Policy No. Company eCertified toDY �s hereby tumishetl. ' Certlfietl capy iz tilea with Ihe city Builtling Oivision. Date Appliwnt EXERIPTION FROM WORKERS' COMPENSATION DECLA0.ATION (Thi55ecliOn neetl nol be COmD�etetl if the 0¢rmlf is fo� on¢ hpntlretl (E300) Or Ioss). 1 certiry that in the pertormance of the wor or which t is perm�tjs issuetl I 5M1a11 m[ e plo any penon In any Tan so as to orr� SV6ject [o t�e Wqrkers' C m c lon Laws ot Callforn' t f/ ` Dale � SignaWre � � — NOTICE: I a(t making this tleclarati , you ha Itl become suo7ect to the Workers' Compenzation provisions o the La r otl¢, you must torthwith [omp1Y �+'��h suCh provisbn5 0� IS p¢rmlt ihal� be tlaematl rnvOketl. CONSTRUCTION LENOING AGENCV 1 hereby alflrm Nat them Is a consVuctlon tenain9 agency tor tha performance ot tha work for which thi5 pCrmit"is issueG�(Section 3097 Civ. CJ l.entler•s Name Lantler's Atltlreis OWNER BUILDEN UECLARATION I horeby a/lirm that I am oxompt Irom the Contractor's Licensa l.aw tor tne lollowing reason (Secllon 7031.5 Businass antl ProfeSsional Cotle: Any city or I county wnich requlres a parmlt lo construcq alter, imorove, tlemollsh or repair 'I any strutture, prbr to Its issuance, also requires the applicant for such permit t0 fllo a Sl9netl StdtOmont thdt h�/ihe IS IlcCnsetl purSuant lo [he prOvlsiOns of [ne Con[ractor's Licanw l. w(Chapler 9(commencing with Sectlon 7000) of D�vi5lon' 3 of tha Business antl Protesilons Cotle) or that he/iho' is exempt inarefrom antl tne basis for the alle9etl exemption. Any violation of Sactlon , 7031.5 by any applicant for a permit subjects lha applicant to a civll e aIW of not more than flvo huntlretl tlollars (E500j. I, a5 owner of the propc�ly wlll tlo th0 wo�k, antl the st�uttur¢ Is not IntCnOetl o� olfErOtl : for sale (Sectlon 7044, BuSinoss antl Protessional Cotle: The Contractor's License law tloes not apply ro an owner ot a properry w�o builCs or ImOroves thcreon, antl wno tloes such work himseN/herself or Nmugh his or her own employoas, O�oNtletl tM1a[ suclt improvements are not Inlen0e0 0� ofl¢rOtl 10� zale. If, howevOr, the bulltlln9%o� ImO�Ov¢Tent Is 5014 within Ono y0ar ot com- pletion, tha ownor wlll have th¢ burtlen ot proving he/s�e tl10 not builtl or im- �rOva for Ih0 pulOo500t sal¢). 1, a5 owner ot tha OrOOerty, am axcluSivety contractin9 with IiGensetl con- tfactor5 f0 conSV uCt [he ploje<[ (Section 7044, Bu5ine55 antl AOtesslon5 COtlO: The GonVa<tor'z LlcenR Law tloes not apply to an owner of property who bulltls or ImOroves thereon, antl who contracts ior sucn projecls wlth a con- VactOr(Sl I�cense pursuant [O the CoM�acto�'S LlcenSG Law). I am awara tnat ' o�oo+ of th¢ir WO�ke�'S Compensalfon InSuranca Shoultl be provitloU to Te. ❑ I am exempt untlor Settion B. & P. C. for Ihis reason Date '� Owner I hereby erti y that1l have r¢a� IntolmatiOn IT COrtC.C� I agr¢e [O ana state laws reW(VA9 to builtlir � 5¢fltdtlVCS OI [III LI inspettiOn pu� � � Signature Driver5' Liten or 5° CMF 0865-46, �ev. ]0/84 abova IdOC¢S rep�e- v for witnin naavY eorGer Ilnas ana sign all aovroorlate Ceclarations. iACT NO. LOT NO. UNIT NO.. .J C S� �.- � . P7YPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR y� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER '� DESCRIPTIONOF�WORKNSEOFBLDG. i ' �TVPEOFPERMIT GRADiNG FOUNDATION STRUCTURAL � ❑ TENANT �EIECTRICAL ❑ PLUMBING ❑ MECHANICAL � ❑ OTHER �PROJECT DESCRIPTION �Sa.FT. CON STRUCTION TVPE V ALUATION §_ GRADINGCU.YDS. AGR Sink Preventer � - Irrigation Drinking Fountains Floor �rains Floor Sinks . Gas Service OuUets IntercePrors Kimhen Sink Lavaiories P—Trap Roof Druins ' Roinspaction Fee $15 Boiler Duct- UnderGround DUCi' $I(UCLUfeI Duct � Ventilating Exhaust System � Multiple FireptlFact. Blt. ICBO # Heating System & Ducting � ❑6100,000 BTU 0100,000 Rainspection Fee � $15 �— White - Bulltling; Cana�y - AOO��nt; Pink - A<counting: GOIO<nrOtl - ASsesso� Showers ' Service Sink - Sewer Cap Sewer Connection Solar Collec[ors - Solar P.iping Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater Wacer Service - Auto�Wesh Iuue Fee Hood or Typet ❑ Canopy Type I I ❑ Fiefrigeration System ❑a,00,000eTu o,00,000sr System Repair/Alteratian Fire Dampers Registers laue Fea FEES S 3 $ 3 0 A.P. qW S Main Building: E T Front A Rear C Right g Left Ping. Ref. # Planninq Notes: � Aummatic Washei Construction Pole Si Cooking Uni[ �ishwasher Dryers �Gas ❑EI Fan � � F.A.U. Fixtures Device Boxes Outlecs Switches Garbage Disposal Generator �0•5 KW 0 0 5038 10/13/BF �— -p,5�, Zone Accessory Building: ELECTRICAL . Transformer ❑ 15-50 KW ❑ 50+KW 15 KW Meter � ❑up to 100 amps � Meter over 100 amps Sub Panel i Motors � 67 HP � 1'h - 8 Inc.Solar �9-15 HP �16-75+ Microwave ' Pole Light Range Sign Standing Sections Trash Compactor . , � ReinsPection Fae �$15 � - � luuo Fea DEVEIOPMENTSERVICESREOUIREMENTS: ' Zoning Approved By Building Approvad By Appliption Issued By n FEES $ 3 Z O N 1 N G R E Q M T $ SUMMARV OF FEES � BUILDING PERMIT $ �SMIP § PLAN CHECK 5 PERMIT PLUMBING $ ISSUANCE 5 PLAN'CNECK 25% $ ENERGV P.C. S ELECTRICAL § �S� GRADING S PLAN CHECK 50% $ MICROFILM S. MECHANICA'L 3 TOTALFEE $ �� PLAN CHECK 25% $ - � CONSTRUCTION AND PLANNING POOL & SPA -�� 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 Utiliry�Undrgrnd. 54. FormS I 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, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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. Electrica�-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 77. Rough Wiring Si9� 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 O Gas OOiI 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. Drywail Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: �.- '? Ce��r-r�-� 34. Final Heating & Air Conditioning C , 35. FinalGasPipe�Test �3�^8 � C • 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomesticFinal - � 42. Backflow Preventer 43. Backflow Irrigation . 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed , ' 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co ' "s_ 57. CERTIFICATE OF OCCUPANCY . , No. Date ' �� i , i . � ��.� 62�6 COSTA MESA BUILDING DEPARTMENT P.O.BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING�� ^ � �- �% n�G nooRess c.i � � r COSTA MESA. CALIFORNIA OWNER � MAIL � �t ADDRE55 CITV �0�//7 ARCHITECT OR ENGINEER ADDRE55 '� .Y.f� e� ii� o c �� ' T.� S Yr� ' / C'SA ^' TEL. NO. LIC. �– NO. -- CITV LIC � ;r� �5'�ss �o: �f"� � 3 oescnivnoN INO. � IBLOCK ITRACT� A.P. NO. � — SIZE �J rvo.or e�ocs. OF LOT ��_�� „} I NOW ON �oi � USE OF � E%ISTING BLDG. _�_�.!/� �� q SETBICK LINE FflOM / � CENTER OF STREET 3 3 `� R YARD SI�E YARO RIGHT ��, LEFT � / � DESCRIPTION OF WORK NEW ALTERATION qDDITION REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES E%TERIOR WALL �� ROOF /� j�_� COVERING COVERING �f USE OF NEW S/ V�Y/S�G� /'� BUILOING — /'��%V 4 .w . COSTA � �nn io-sePD�.�. i�na ***A*U nn APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY FECEIpT NO. ERMIT NO. �Z7G RECEWfO BY =RTEORECEIVEp /O oE I5, � G1 BUILDING � /�f , AOORE55 d COSTA MESA. CALIFORNIA FIRE ZONE 20NE NO.OF TYPE GROUP PLRNS 2� APPROVE � � /' \ BY QH[ IC DATE �0 l� CORRECTIONS I 7 - �� CITY OF TA MCJA � �•��a • SU6JEC1' TO , )G. DEPT. RECi. BY • . �. � .... /NA — STwTE TH�T THE ABOVE IS CORRECT 4NO �GflEE TO COMPLY WITX �Ll CRY ORO�NiNCES wND ST/.TE L�WS REGVL�i1NG OING CONSTRUC- T�o�. VALUATION SIGNATURE OF /� � PERMIT FEE $ PERMITTEE �� V %/ / K•�� PLANCHECK $ g � AUTHORIZED AGENT TOTAL FEE 5 f�.�T' �� COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING ,.9.� Q r /� ".1!` AOf]RESS S Li Z . ww aV Z Za O v~i n. m J � J N Q W (t1 J • 00 J Q U Q Z� aw W Z J Q m Z J � W w O= Z F W � �O F Z Q U J a a Q 0 F N Z O H U � � H � z t OWNER MAIL CITY C .7"L��, CANS�RUCTION LENDER /y BRANCH ADDFESS ARCHITECT OR ENGINEER ADDRESS CONTRACTOR �D �3, ADDRESS .2 O 3% y cirv ��e7/Y/fl .S STATE LIC. NO. 2 L p�} 1i SIZE / OF lOT l ..�Tv / o� EXISTING BLDG. SIZE OF NEW BLDG. EXTERIOR WALL COVERING VSE OF BUILDING AND �n i�i_�i FInY zS'7jPp10OO 997 0*****5,i.'� CMSi APPLICATION FOR BUILDING PERMIT �EX�� °�'=as=�i °�=�� .. A.P. NO. BUILDING ADDRESS i TEL. TRAC NO. W AD ✓ OWNER TE�. S NO. FIRE 20NE e � APPFOVED V � B� �Q L'. �- TEL. JP/� NO. .'?/ 7 CITV LIC.NO. �� NO. OF BLDGS. NOW ON LOT S / ci.C`C iVr F NO.OF ROOMS STOF ROOF COVERING K TO BE PERFORMED � 20 � NO.OF PlAl�S .• VAROSAPPROVED DISTANCE MAIN BLD VAF. vW C.U.P.qW DA USE OF NEW BUILDING VARDSAPPROVED ACCESSORV BUILDII T� FT BET. MAIN & ^' A� � I hereby acknowletlge ihat I hava reatl this application and state that the above intormation is correct end aB�ea to comply wiih all laws re0ulatin8 builtling construclion, entl I shall not employ any person in violation ot the wOrkmen's compensation laws ot t�e $ta[e of Calitornie. m b I hereby certify [hat I am proparly licans¢tl as a cantractor untler SQ. FT. o the Stata of California gusiness antl Professions Cotle, �ivisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, antl chat such licanses are in full (orce an0 effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m am exempt irom the prov(sions of the State of California Businass Q and Professions Cotle, Division 3, Chapter 9. VALUATION l r_ y ///_� , / �DY� PERMIT FEE $ J � Sipnature of ��,y— Z/' y . L/ %' �f�/}/ �— E Permittee LJ /�� F � 'fN [ %� $ � `� PLAN CHECK $ o` Autho�ixetl Agent � � LL TOTAI. FEE S