HomeMy WebLinkAbout234 FISCHER AVE - Building Permits •
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N° 2533 C
P. 0. Box 311
Costa Mesa, California
The Building located at 234 lithcbar Qvevr
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Occupancy.
Use of Building Th&1.0t1d0Bmt Ring
Legal Description Tract5935Cc Lot 3
•
p�
(See reverse side for Metes and Bounds)
Building Permit No. -28559 Electrical Permit No. 286I16 Plumbing Permit No. 52263
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments and/or guest rooms
ISSUED TO: Building Official /J/`�
NED WA .by//(rI ®//�� '/f fen
Date Septetbar 27, 1968
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except.by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form 13U34—IM-11.63—s-13 P
WNER FJ.T.TS, FRED DATE 5-15-78
-\JOB ADDRESS 234 Fischer Avenue BUILDING PERMIT NO. 4601ft
GENERAL CONTRACTOR Viking Fire Protection DESCRIPTION of WORK Fire Sprinklers
. 427-032-03 LOT TRACT FIRE ZONE VALUES 27,000•
�x
I CTIONS SI• Dote TYPE V -1 GROUP F-2 ZONE MP
SOIL SUBCONTRACTOR PERMITS ISSUED
AS Date I Number I Signature
ATER .17b IL -24.7V Plumbing •
ROUGH PLUMBING 4449
PROP. SWR. LINE 0 HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS%t Lit G OUP 70
ROUGH HEATING AND AIR CO ITIONING
TEMPORARY SERVICE OR POLE '
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES U FORMS U STEEL REINF. t I
FLOOR SYSTEM �- I
r�
BOND BEAM n STEEL REINFORCE ` , I1 / �I) / J {I
SHEATHING I U I, 'I . tl
FRAME AND FLASHING I \\ k II \ .1 to 1
LATHING — IN Fl OUT 11 • a
PLASTER, BROWN COAT I �� ^ •
'
1�!`�`. r
+ 4 j
Sir 'RAL, FINAL I `V ' ert e
HEA,._.,, VENT.. REFRIG. AND A.C., FINAL I flATF AP=---
c _ 4,
PLUMBING, FINAL AND GAS TEST ri Lam...-� - �
• ELECTRIC, FINAL
BUILDING, FINAL S. 7-4-74p
OWNER FfTT4 • DATE 10/21/80
JOB ADDRESS x234 Fischer Avenue BUILDING PERMIT NO. 50872
GENERAL CONTRACTOR Jeff F: Pfcf DESCRIPTION of WORK Renodel Office Building
VALUES
A I. 427-032-03 LOT 3 TRACT 5769 FIRE ZONE 18.000.00
IN-.. ECTIONS Signature Date TYPE V-N GROUP p-2 ZONE MP
SOIL SUBCONTRACTOR I PERMITS ISSUED
GAS Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE [Ti HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER 0 �j
ROUGH WIRING /LL �BZN-c0 Heating and Vent.
TRENCHES ❑ FORMS 0 STEEL REINF. ❑
FLOOR SYSTEM EXPIRED •
BOND BEAM n STEEL REINFORCE n IRDamplete Imcp rtinns
IHSHEATHING Cancel
FRAME AND FLASHING �G �/ �O1•2t Date P-7-6.8, Ag '� -
>LATHING – IN n OUT n
PLAC"R. BROWN COAT
S_I RAL FINAL 414°
' ten)
In HEATING, VENT.. REFRIG. AND A.C., FINAL Ly_e.Yl/'f h'`,Dj�j�.r^�,f 1 ie-Milt �2 jlj
PLUMBING. FINAL AND GAS TEST n V V"'YF"-
aELECTRIC. FINAL !�G 114-1t'
BUILDING FINAL
4,0
-2 cr-J
• • CITY OF COSTA MESA
,4q� �►, BUILDING DIVISION
3/4-, -'" "' ' DEVELOPMENT SERVICES DEPARTMENT 'PERMIT NUMBER
� ; PERMIT
M99-00402
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• MECHANICAL PERMIT
Job Address: 234 FISCHER AV Status: ISSUED
Suite No Applied: 08/26/1999
Issued: 08/26/1999
Vicinity: ROOF
Parcel Number: 42703203
ISSUED BY:
Applicant: HOPTON, JOHN
Address: 22971 TRITON WAY---.4,,,,C„ . / -•
UNIT G /f/i C \Phone: (949)454-6911 .-C
LAGUN/A HILLS,CA'-� 11 Zip: 92653 ^ 1 /�\�`\
Owner MATTHEWS TRUST / /�� / -\ '
N
;air
V\ \ ' �,.
Address: 22971/TRITON WAY V ., % /-"
/cc,
-• \ ,;
UNIT/vG Phone:, (949)454-6911. \'‘,\\`'‘
iA'
LAGUNA HILLS,CA ZIp:?,92653 ` '---- v vv
•
\ �
/- -\ //>i=
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Er-I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier 5 r(_f'r W 0 Policy Number Co 7 -y1 - OlYir a uuc•J "J7
(This section need not be completed if he permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for 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 alifo7lia,and agre t t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr i ion? A��
Applicant Signature: AM- /4.. Date: •, — Z C -ss
WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNIAW FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100, ),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.0 S 9 Z Sl Class# r —LJ
Contractor's Signature: Date: - 'c-C- f c
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: -� Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement thitt he or she.is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my,employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: _. _ Date:
Owner ID verified by drivers license. ❑Yes ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 II an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S'g ature f Le wner(s) Date
q - 2c - sT
An Authorized Applicant Date
CODE 4 INSPECTIONTYPE PAg INTRIALS CODF0 INSPECTION TYP{ PAIL INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical 51"/W1-1- /3N
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2448.46
ri .
'tr, r CITY OF COSTA MESA
• ,p At BUILDING DIVISION
%-.1 •••• ';" ` DEVELOPMENT SERVICES DEPARTMENT
o. �.� PERMIT PERMIT N 1 c�3'
'4aeze B98-0 285
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 234 FISCHER AV Status: ISSUED
Suite: Applied: 07/16/1998
Vicinity: Issued: 07/16/1998
Parcel Nunmber: 42703203 Zoning:
Applicant: SANFORD, KEN •
Address:
f - Phone "'94914650-0505-
�� 2, Zip i I 1 .-` i .
Owner: ELLIS,-F,RED V N TR ( I i / ;A //�-,
\ /
Address 18571RVINE'AVE� �� `� 2.:_ _i_ __ __ `�/�J , ti ��N_
�EWPORT BEACH,CA�% Zip: 92660' ;::: �� \ \��
Contractor. / '�;V e v>
Address: ,i---
� �U �/ \`\\
�Y� Zip. I c\ .�` �:'.
l
License \\V\\\
A� �\
/Arch�Eng: , _ ) I i - ` ��
-/Address: JJJJ�/- .tea Pe !--D.-fr.." 1' ti \
/Ir/ L7, � � Ptione i' y ,
h `'
. fp/ t r.e A. ,^✓ \ l
I,r / j ( �.? License:
l v/ yly - j/' j SCOPE OF PERMIT_ A v ._�
Hf / Ii/LEGALIZE PARTITIONS I;OR OFFICE,SEE DESCRIPiTION REF,EXPIED,PERMIT BE5387 AND 50872.
• \I / /VICTOR CLIFT WAS ON SITE AND TOLD.OWNERTO_COME:IN AND APPLY FOR NEW PERMIT TO �
�;� LEGALIZE. 1- '✓ -- _ — - ,:_::"L: __ /
i 1 11 t f,'� Y
1101 \ r ' V'V.)rh--/ —4i
- ' x FEE'SUMMARY/141: -
. 1,.t
\Plan'Check \\\ i$0.00 I' —'S------ - >
__C-:2-_ talc Valuation moo
\��� Pe�md ���y�$0.00 Claim Valuation j''so.00
SMIP Res. \$0.00 �`
SMIP Com::� $0.50 _ j��'; %-
\\Oiher.�/ $q.00 \ �— ' ,
y i l
Inspection:' $0.00 /
4 /M >�-QA, ���� A l
Total <-/ $0.50`.\\V` _ cli �"� � f� ;<!= /
:\ ` �, � 'eK PLANNING78 ZONINGi'' <:',/ % ' � .
-V � �\A- A
SETBACKS ;
\; / ,--_, -
MAIN STRUCTURE Fron\-.-S-.0-.0 �-. Rear0-0 Left_ 0 0 , Right 9-::6
ACCESSORY Front 0-0.5c> Rear 0-0 � 1 Left . 0-0 :S•>'` ;Right-T. 0-0
PARKING Existing: 0 Required: -0 " _ '"Proposed:, -'0':-
NOTES:
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.
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 Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 - 1
DECLARATIONS • , I
I 1 o
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have nd will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
or which this permit Is Issued.
I have and will maintain workers'compo •=tion insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'compense. Ins erre -. er endp011eynu�7� 99&Z 3 CCfr 1(9 '
Cartier. � . �ffPolicy Number. l(/(�� ll``�-
(This section need not be•• %sted if :permit is valued: e hundred dollars($100)orless.)
❑ I certify that in the •. • r-. : of the work for •hich is permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws • •-r•m end agr .• at I shou•• become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I a1�aIt forthwith
with ase p:;441.ns. / / 7—/c,
_/L /" zC')
••plican ignature AM /. ll Ar r�� Date: / i —
W :• •- i •• TO SE.• 'E OmKERS•PI- SARON•• „ •a MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1.•,•••),I ADD • • E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTO•: D ^LARATI• ':
I hereby affirm that I am license. u•-e '' lo • •f • pier • mencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
torte a -tlp•s / /1 / / Class* /�/�,r
rector's eture: , • f Date: J ! Co.-'9
CONSTRUCTION LENDIN AGENCY: �^
❑ I hereby affirm that th re i a constructio nding agency for the performance of the work for which this permit is Issued.(Sec.3097,Clvll Code).
Lender's Name: Ct Lenders Address: _
Signature: r� Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
/61self or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
ld within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
as owner of the propery,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
ode:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
�y❑ I am exempt under sec. Business and Professions Code for this reason:
JG Signature: Date: "7 7 17�
T( Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.•property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation fNe(5)br more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure.scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code),
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: - Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing 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 presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes p No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to De constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes•,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comely with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described •lip for L pection purposes.I agree upy or allow occupancy of any building authorized by This permit until final ins act' n.
AP
�S gin: u : I Owner. Date!
L
l r. ries.. � Date
11
-
OOOEJ. "-ii • •T7 / � •,.0 EIMALS P00E I INSPECDON TYPF DAM IIRmALS
•
1618 ixed Syste Final Fire Pre irri 206 Final Mechanical _
1288 P•: .: -nal 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical _
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Be , ,L
204 Final Demolition 250 Final Building/Occupancy VC
2446-46
•
'+w CITY OF COSTA MESA
f. q�
' .. � BUILDING DIVISION •
F ._.::
� DEVELOPMENT SERVICES DEPARTMENT B98-01193
PERMIT PERMIT NUMBER
%Pommy dr
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 234 FISCHER AV Status: ISSUED C
Suite: Applied: 07/06/1998
Vicinity: Issued: 07/06/1998
Parcel Nunmber: 42703203 Zoning:
Applicant: GREENE, JOE
Address:
Phone: 949-642-9204
Zip: -
•
Owner: ELLIS, FRED V-N ' TR - -
Address 1857 IRVINE AVE-" - ' i
Phone: 2
NEWPORT BEACH,CA Zip: 92660
Contractor: G AND S CONSTRUCTION
Address: 00999 OAK ST
Phone:
COSTA MESA CA Zip: 92627
\‘:t,
Licenser 369762 ��; - '�',
Arch/Eng: �
Address: - I
' Phone:
' Zip.
' ' -License:-
SCOPE OF PERMIT •
REROOF EXIST SLOPED ROOFS ASPHALT SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,000.00
Permit: $137.25 • _ - ' '- Claimed Valuation: $8,000.00
SMIP Res: $0.80
SMIP Com: $0.00 ' /
•
Other: $0.00 '
• Inspection: $0.00 - ,
Total: $138.05
PLANNING &ZONING •
SETBACKS
MAIN STRUCTURE Front 0-0 Rear, -0-6- /\ Left 0-0 - Right 0-0
ACCESSORY Front 0-0 Rear 0-0 - Left 0.0 Right. 0-0
PARKING Existing: 0 Required: 0 /Proposed: 0
NOTES:
•
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.
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 Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
1)
DcCLAPATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My wo penSatiorance7ter and policy number are: . "'y �i� I
Carder: iv✓ Policy Number. ( � V 07,4 66t3.5-62 C
(This section need not be completed lithe permit is valued at one hundred dollars($100)or less.)
O I certify that in the rforma : of the wo for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation law- of Califon:,and ear:. at if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shag forthwith
.r
comply with these •rovisio -7"G—FCC--7--Applicant Signature: An Date:
I WARNING:FAILURE TO SECU- ERS'•• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($103.48 •••RION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES.
UCENSED CONTRA S DECLARATION:
I hereby affirm that I am Ii. r proviso•r. of Chapter 9(commencing with Section 7000)of DMsion 3 of the Busin and Professions Code,and my license is in full
force and effect.Uc.4 , , Ter/1� Class N
yContractors Signature: /!Myr Date: .7"--CI
CONSTRUCTION LEND NCY: .r
O I hereby affirm th, is a construction lendingi agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code).
?t4
Candela Name: Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS: ')
I hereby affirm that under penalty of perjury that ram EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or;she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not mere than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement Is
sold within one year b1 completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,Le.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMITCERTIFICATION:
❑ I hereby cerWy that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,An 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
permit to do such work from the division.
Signature: Date: __
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing 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 presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Nucleation appennit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 85850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date: _ -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
ebo ascribed prope or inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal• ner(s)
4-7---(0°
_ , ^ fir Date
//r.
And/Or Authorized Applicant Date
m•:, INSPECTION TYPP DAIS unnail CODE/ IISPECTIONTYPE DATE QIIIBALS
6 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final . 208 Final Plumbing _
200 Final Re-Roof r lJ_?t 2f0 Final Electrical
•
201 Final Block/Retalning Wall 212 Anal Fire Prevention
202 Final Factory Are Place 220 Anal Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Bullding/Occupancy
2448-46
y ___—
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. 0. BOX 1200411667 '10%23 % "I .15 TL,
Costa Mesa, California 4
ELECTRICAL PERMIT APPIICATEN TRACT NO
PERMIT NO.
ELECTRICIAN � i / e !t' .. LOT NO
` G i DATE ISSUED CZ
.
ADDRESS ,����� BUILDING USE \ (�`�� a
_ .
CITY t rF a irlW w. TEL. NO. ; .'y/ /0 093-co co
STATE LICENSE O. CLASS. 2-5-/' L
CITY LICENSE NO. 'BUILDINGES7�4,(s r 'fi�ee,',.�
NO. ITIM RACH IIEI /COSTA MESA, CALIFORNIA _,c W
Dwelling, Sq. Ft. S NEAREST CROSS ST. �`i Ala --R C)\"
W Geroge, Sq. Ft. OWNER / - ��( .1/� '�1%, ._/!
0 /5 First 20 Outlets, each aS 3 7� rt/DRESS •\\�/
Jr
4 Outleu, Additional , CITY ��`>� TEL. NO.
/f/ First 20 Fixtures, each 0/,/,1 ACKNOWLEDGE THAT I HAVE READ THIS APPLI-
} (f` -• CATION AND •STATE THAT THE ABOVE IS CORRECT AND AGREE
J Fixtures, Additional TOT-COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REG.
CC LAVING ELECTRICAL WIRING. 1
W Dryer �I CERTIFY THAT I POSSESS THE ABOVE VALID STATE OF
0C. .-N4 CALIFORNIA CLASSIFICATION OR I AM THE LEGAL OWNER OP
Cr Fon 4 t ty' THE SINGLE F/AM�ILY RESIDENTSIL PROPPEERRRTT(Y//'DESCRIBL/A /YEE.
2 Heater i % ' �✓ Signature of V ' / .'�,/�"_' /:/� j�
W b. L PERMITTEE _�(\ !/�//CC YY
Oven, Domestic I 4 C)Y NO] ITEM/ I EACH IIIf
Pe
I- Pole,Construction
Sign 61 Trans. 2.00
>~
E Range, DornaitiTransformers KW
W
a MSN.)
CC 3 _
0 -
Generators KW
U)
Motors /See Schedule)
(A
N.' r= HP
HP Sub-Total Fees
,
HP
APPROVALS
INSPECTOR 1— DATE
Meters, eo. TEMP. POLE
DOUGH CVD ql!{T I I
I I
Permit Fee 3 00 ROUGH �•./..L•-/
Sub-Tocol Fees FIXTURESOWEI _ rCC71
POWER I /, Y�1)
Total Fees / S UTILITY CO. NOTIFIED I V
CMF 0313-46, rev. 7/75 For items not listed refer to Fee Schedule BLDG. PERMIT NO. 4949.7
`JI "'D
28559 NAY -9.68asn00 507* ***251.25
COM MESA BUILDING-SAFETY DEPARTMENT
• 4 P.O. BOX 1200 • COSTA MESA, CALIFORNIA 92620 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
SUILDINGe34: For Office Use Only
ADDRESS r 1S,C—r}{.•�.�. /•d✓fz
RECEIPT NO. 5 5
COSTA MESA. CALIFORNIA a��/T�.
I� RECEI Y TE RECEIVS TTE IySSUEED
OWNER FR e.o EL-L•I� /- 611• mil (/1�
MAIL 3 � I.3 iMkt ) 1 ADDRSN0 /J J`/ /�//N/�
ADDRESS Z =�OEJ N fes+ Y CL ADDRIWA e/T , J. st.„ /C((,Q•
�7 •�]���. FIRE 3 / y
CITY CnsT+a JI11'-1•�F} NO..J'6.5.52 ZONE R OKOUp �1
APPROVED ( :1 `S )*"4.
nR ENGINE t1 F rr . Nobe 305c0 Br l I / DATE �/ rrJl
DRESS ISSoi6ATs l le.'Oa. it C • SING
ZON 1 No.OP� USE OF him**,f�'•Yl i
CONTRAOTOR 9D W.L'�.wCAN,.LCI(sit U i 1. c, I/PU.KyE I SUIILDINN-o� �,
ADDRES* 22,1� k\ YJLk1 Q.J DESCRIPTIO[N[^Ur// �" . j
0.0 C-‘1,4- WIGS A.P.NO. 1` Z ` — 032 — 03
CITY /� / / [� / NO EAVE .
S.IC.NO. in(a 6 A N2 O4 gi S i 30"TO BIDE S REAR PHALNG SHALL BE LESS THAN
SIZE OF LOT EAVES
x.01(/S X bs •8-I,NOW V ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OP MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
-- - IFROM C/LSTREET))1 evlN'v
Scent
een K LINE FROM &-X,
„, Y REAR YM i )4 FRONT 87 rr, L 5.1 Wil'C� 4F FT.
CEER OP STREET LLL!/ 1 /9�
BIDE YARD1 LEFT I b RIGHT -r _ N.SIDR C��FT. RT.
DESCRIPTION OF WORK L.01m; ./' PT. — FT.
r79 —
ALTERATION ADDITION 1 REAR / l PT' PT.
DISTANCE BET. BET.MAIN&
RGrAIR _MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS.
BUILDING NO.OR 1 VAR.# DATE
SIZE 000 X 1i 0 ROOMS •” STORIES C.V.p.# APPROVED
EXTERIOR WALLfl STOOP APt1/4196,4
���� DATE S a - 68
COVERING ` .{9111(„ COVERING (.JQ UITV ItPROVED
USE OF BUILDING AND WORK TO BE PERFORMED HOLD FOR SPECIAL w
�>.u-,�te., LA- PSL_o a. eR) our r Q �,M�,�i w
I h1Y u•a'tR.1aL.. tit t• u ,9 t.. Lci1 i 3572ccrKvkq steers _4a..c/J"CC(.,y
_too Q.PT. /So - ° 1
I HEEEEY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE o
AND STATE THAT THE ABOVE.111 CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND An LAWS REGULATING VALUATION /6 7,6-4 117--62
17 62 cl
BUILDING OONSTRV SR/ Y 1(pti.�
PERMIT FEE 5
PERMITURH OF "6/7251.....5“..t-- �� ��
SIGN TUR1t Y3.7�
r' a PL.V.1 CHP.IR A
AUTHORIZED AGENT / �(j7 00 eZ./!,.2.5 Of L},J�
_ . .. . . ^.➢ e G7J.35 TOTAL.FEE l QUO
•
• t ., 38434 0110.- ,Y „-7L�P"T�oo 3 i9:> ***::77M3i_ J
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP I TION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RE E E V DATE RECEIVED DATE ISSUED
BAUILDING 2 � -pc,� J/ ' t �1 e �/s/�21-7(! / ._ '7 !/
OWNERSS rf/flG!{ (ir// /"1'!Y/ A.P.NO.'js�/ �03 - 03 r0 OCT
,J /� /�'/ �/ /� �ER�IT NO. L
MAIL '2 4 ,,:s i,/tC AVs BUILDING
ADDRESS �� FSC E�SlY((fR AVG
ADDRESS
allj TE
U CITY Ca76 A7. s4 N0 4nff TRACTS-2154 LOT 3BLOCK
1- < CONSTRUCTION NEW I ADD ALTER REPAIR MOVING nFMnl LSH
0-m LENDER \/
J
J N O BRANCH ,J�• //'�
OWNER FRED 1.1.4 5
S W ADDRESS /� �'' /� {1 A/��//sg�
1 m ARCHITEC / j r/x /S TEL a57_15-3.8 USE ADD 7 /41T AL $ /VVr —”
'I Q OR ENGINEER �-�f.��rr55 `H/zt / /./�
O.
FIRE
WCC ADDRESS /7(2 1//v t /��/�� ZONE TYPE GROUP F.L
D. W JJJ- Mi/' N /� APPROVED
J O CONTflACTO !d/V BY DATE
CO ZJ74/ TZtyiJoes
J ADDRESS
W W ZONE /-1 NO.OF �t USE OF NEW ` r�
z CITY /2U/NF NO(i'7_7St' m rPLANS02 BUILDINGA pnT Sour 17 Lr
W O STATE t�/JJ /� �J CITY YARDS APPROVED YARDS APPROVED
In¢ LIC. NO.f�/� i(Q(� f�`/ LIC.NO. MAIN BUILQQQ tttfff��I G fACCES RY BUILDING
OO / (F ROM C/L ST7�ET)
SIZE NO.OF BLOT J1'�r
OF LOT NOW ON LOT FRONT /r. 1 FT
ti
USE OF ��JJ�� /� 6 � R.SIT,�(�(IYI EXISTING BLDG / G//�G t)t SIZE OF '26 /,r//1NO.OF `I
Z NEW BLDG. "6 /l/ ROOMS f STORIES L.SIDE A F C�` flY:::
EXTERIOR WALJ_. / ROOF0 COVERING (59/1[i COVERING REAR-I US5E F BUILDING AND WORKTO'p�E/PP�ARFOR.PEDD/ rsDISTANCE BET. BET.MAIN&
S 5 /440€/i/ //VrerKN" .G/e. 2zZ MAIN BLDGS. ACCESS.BLOCS.
• O 4 g 'L- N° /-L . DFP/CA� C U.P# DATE
APPROVED
I-y �/�.S/ ,aaS /^/TIt-// 4/V0P ROVEWJ4) PG -D. .a' _ 4 -7/
Z Camm�c.>4 5s7�aS gi
0
U I hereby acknowledge that I have read this application and state 43
that the above information is correct and agree to comply with Qv
CCall laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
N the State of California. m
ZI hereby certify that I am properly licensed as a contractor under SD. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and the such licen%es are In full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 2
am exempt fro th. provl of the S to of California Business VALUATION
and Profession6 r iv' I Chap r CO
/ PERMIT FEE $
S lgnatul /46L m
Permltt: / $and PLAN CHECK $ 74 E
0
Authorized Agent u.
TOTAL FEE $
'
A.
gQ �J�1 Pn1u �; \\
(JGf nl;i 7.4-71:--•.Q077Q9 v.r * 1
. • • COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1208 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Apppplicant to Fill in Completely RECEIVED BY DATE RECEIVED DATE ISSUED
ADIDRESS t- J �ISr�E2
ez dLLlf A.P.NO. PERMIT NO.
OWNER
MAIL BUILDING
Z ADDRESS ADDRESS
W W TEL.
0.0 CITY NO. TRACT I LOT BLOCK
2
CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH
d m LENDER
J D BRANCH
—I N OWNER
CO —J ADDRESS VALUE
-CO ARCHITECT TEL. _USE $
Q OR ENGINEER NO.
U In FIRE
W rC ADDRESS ZONE TYPE GROUP
0. tI
APPROVED
-J Q CONTRACTOR BY DATE
032
:-.71 cc ADDRESS
W UITEL. ZONE NO.OF USE OF NEW
0 r CITY NO. PLANS BUILDING
I—
r 0 STATE CITY YARDS APPROVED YARDS APPROVED
NCC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D SIZE NO.OF BLOCS. (FROM C/L STREET)
OF LOT ,NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. R.SIDE PT. FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES LSIDE FT. FT.
VEXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
a MAIN BLDGS. ACCESS. BLOCS.
Q VAR.# DATE
O C.U.P.#s APPROVED
~ APPROVED
Z .—ELY DATE -
0
U I hereby acknowledge information
tithon I have read this gree t tion and state / Tx-
1._
that the above information is correct and agree to comply with {''/yy/v1/j/ �Y/ `t
LC all laws regulating building construction, end I shall not employ 0 j�
F any person in violation of the workman's compensation laws of //�
(n the State of California. to
Z I hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR - •
Chapter 9, and that such licenses are in full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: S
am exempt from the provisions of the Stets of California Business VALUATIONA�00
and Professions Code, Division 3,Chapter 9. (� �_ N
PERMIT FEE $ D
Signature of �_ m /41
Permittee $ PLAN CHECK $ E
Authorized Agent Q//// OO a
TOTAL FEE $ /Tf
Pr
r X.-tom PAIS
440611 94Y 7Ll-77cIi,,;OO1161* *** 1 71.St
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill
rrillnt�((Completely— Use InkOnly RECEIVE BY DATE RECEIVE D/�TE ISSUED
BUILDING ^ /� 4,,Fri CL �I - �J/� I a 7/ �'�YJ
ADDRESS -���Grrr���7 u ,,// .} PPEERMI(T�NO.�4
OWNER rr� 2 I....LA S A.P.NO.'V —43„?-
BUILDING
MAIL ` F'` ADDRESS p 3� �r�f2'�' l .
ADDRESS �3 c' ` t /�
1 TEL. TRACT 54 LOT J BLOCK
CITY CCS. -C.irLA4 So— NO./
CONSTRUCTION 7 APO ALTER REPAIR (MOVING OFMOI ISH
LENDER
BRANCH
OWNER eel. -LLtADDRESS •
ARCHITECT q� i. I _, _ _ K A' .4. _!L� ✓s V a I`,/VALU$ ei am
OR ENGINEER 6`.(t,N L-eV�� NO. FIRE
tJ. .{�'tr
t ZONE ���tt1�'P� t/ ijB GROUP F-1—
ADDRESS //, n_y// �r r'
D /b_ 1SLZ'.9V% /[, APPROVED ✓r '�J.14
//��/,t'
CONTRACTOR �/(j���C U BV DATE., �i(t) L V
ADDRESS �pf� /� NO.OF USE OF NEW
TEL. ///q/ pLgryS� BUILDIN�t '
CITY NO.
f 2 fl'
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
pa SIZE 'w .[ NO.OF SLOGS. (FROM C/L STREET)�r
0. OF LOT .0 3 r` 33 n0 NOW ON LOT FRONT FT.,, 95' FT.
•re USE OF
1 EXISTING BLDG. to LUI=PRiIL't INlr
R.SIOF LO FT. FT. _
rn
•
Separate permits are required for L.SIDE -fig FT.13 2 ` FT.
electric,plumbing and heating work.
D REAR IS FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
/1 L- G L MAIN BLfD�GtS/.J �/ ` ACCESS.SLOGS.
•
rt
Q t�pIA.l Ya•G�Ivs O( F(GG+ �,, CU.P.40/2..L(P—J4
APPROVED/6-21.1C
v APPROVE /I G''�' 9
j" W,/�� DATE L•} —. iG --Ick
� a HOLD FOR SPECIAL REQUIREMENTS
ua
/ Q I hereby acknowledge that I have read this application and state n
g that the above Information is correct and agree to comply with m
c. all laws regulating building construction, and I shall not employ i
't Z any person In violation of the workman's compensation laws of o
I W the State of California. !C
X55+ I hereby certify that I am properly licensed as a contractor under SO.FT. �VOO n
Wthe State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR mChapter 9, and that such licenses are In full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business y
VALUATION PERMIT FEE $ H CZV
and Professions Code,Division 3,Chapter 9. M
S. PLAN CHECK E /4,5-44-.Err
o(\
Signature of tut u .[ sy!�{/��s�\ 8 1`
Permittee 7�`� `�KNQ Zi r b �17f v TAX $
X.
Authorized Agent ` vtAJ tl TOTAL PAID y , 4 `�('
N / /
r
COSTA MESA BUILDING-SAFETY DEPARTMENT 7587 :i/ I 6/72 2:15022 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7507 3/16/78
2._5I ACCi(TO
For Applicant toFillin Completely— Use Ink Only /// APPLICATION FOR(STRU,CTURAC:PERMIT 1 A
BUILDING 9234 L/– – , n �F i � —RECEIVED BY DATE RECEIVEDDATE 155=E
ADDRESS /JTrytj ` �C..ffE/G `/G
F,Cc/' £Lu, PERMIT NO.
–
OWNER A.P.NO. //A c -cf,c€�, J
MAIL AD DR ESt/5Y C
ADDRESS
TEL.–
CITY NO. TRACT I LOT BLOCK
–CONSTRUCTION NEW ADD AI TER REPAIRJnFMOI(MOVING CH
LENDER 1111 ll
BRANCH MEP OWNER MEP eLGG5
ADDRESS VALUE
ARCHITECT TEL. USE $
—OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
–
TEL. ZONE NO.OF USE OF NEW
CITY NO. PLANS BUILDING
p.1., STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
LLI SIZE NO.OF BLDG (FROM C/L STREET)
.
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
Ca EXISTING BLDG. R.SIDE FT. FT.
CACA
F Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
G REAR FT. FT.
V "USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLOCS.
"'3 - VAR.# DATE
Q _
C.U.P. APPROVED
7 APPROVED
} r„ ,9Y DATE
..i
a
w
O. I hereby acknowledge that I have reed this application and state c.
m
athat the above information is correct and agree to comply with m
L all laws regulating building construction, and I shall not employ
i
Z any person In violation of the workman's compensation laws of E
Mt the State of California. -
.+3 I hereby certify that I am properly licensed as a contractor under SQ.FT. ci
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are M lull torte and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY:
em exempt from the provisions of the State of California Business a
VALUATION PERMIT FEE E
and Professions Code,Division 3,Chapter 9. n
PLAN CHECK $ 'n
0
Signature of e.
Permittee $ TAX S f
��tt ^ weer U
Authorized Agent TOTAL PAID E 4 el
.. . e1�.i
44062 nab?q-7700l 160* ***2 13.41
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant ttoo Fill in Completely —Use Ink Only
BUILDING ADDRENS 2 7 1.47- .. Came �� REC E}�'E V DAT�_ CEI D1 DAT/t ED Y
rn r� ���/-O'j -.SiERMI(I PERMIT NO.-Ye-
ADDRESS
OWNER 1 RCp EL-LI S A.P. NO. /f
ADDRESS #2..;4 t ICH a2 BUILDINGDRS ry�i{'/ /L� �
cosc ADDRESS 07
Niaxe
CITY
. I A4 CS � NO. TRACT TRACT I LOT BLOCK
CONSTRUCTIONNEW IA D ALTER REPAIR MOVING OFMOLISH
LENDER 111
BRANCH I
OWNER _
ADDRESS ///��I I VALUE /14. `
ARCHITECT II ' 1? iwL(/ TEL. (a'730- 0 USE / ' s $ ! /)�
mos-
ARCHITECT
VV 1�11Gnn/- F � '�fJ O. (�
/� , t r., FIRE ./n
ADDRESS oo /v QWIOO//Or RAUct—N�tl(�1\ _ ZONE (GEIIU 0 GROUPCONTRACTOR Scaer. - LA—t- on-' ` BYPROVED DATE 3�/kt^1(y
ADDRESS—
r TEL. Z/`/ pNLOA.NO5F ea., BBUSIELONF GNE�W/ed.adeej
CITV •
NO.
F" STATE CITY YARDS APPROVED YARDS APPROVED
gLIC.NO. • LIC. NO. MAIN BUILD N ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM C/ ST )
00.. OF LOT 203 )4 S 30 NOW ON LOT I FRONT T. I FT.
Q USE OF (�
� EXISTING BLDG. 13t-U t: 1 rl t4 '1 C",-I_ R.SIDF /*FL FT,
Ca
F Separate permits are required for L.SIDE 4 FT. FT.
electric,plumbing and heating work. ///�
W - PEAR P FT. FT.
(.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.21. 4- BET.MAIN&
Q MAIN BLOCS. ACCESS. BLDGS.
0 `, SLATE.? R.1 N 1 I N G VAR.# NA n DATE
Q C.U.P.# (Ur /b•/ _I'APPROVED 7CJ"
n�--A� -- 7 Ar1-a rG APPROVED/"../� ,/r R" ��- 761
'›. Ite'r —AT A1}� DATE
w HOLD FOR SPECIAL REOUIRFMFNT
O I hereby acknowledge that I have read this application and state in
X that the above Information is correct and agree to comply with m1=
0. all laws regulating building construction, and I shall not employ Vl
Z any person In violation of the workman's compensation laws of
eiki
W the State of California.
3 I hereby certify that I em properly licensed as a contractor under SQ.FT. �c""" n
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR re "'
Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business e
VALUATION PERMIT FEE S
and Professions Code,Division 3,Chapter 9. m M
�/fff,//D, J�J�� //J-�/,/�I //�J /� PLAN CHECK $ eVD oki C V
Signature of `�/VLLI�wN Y✓�"G"`/104 --Jur g /9 �1 U.
Permittee / I TAX b 33 2
( 3 U
Authorized Agent \ TOTAL PAID 57/I .7/ ,
' 44o&z X7585 3/16/78 315x50 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT
'P.O.BOX 120,0 COSTA MESA,CALIFORNIA 92626 V
For Applicant to Fill incompletely—Use Ink Only APPLICATION FOR STRUCTURAL PERMIT
BUILDING l7 ] /5C/ �/ r�l RECEIVED BY DATE RECEIVED TEE IS$}
a-ADDRESS jJ N//!V �' /r Ale
Giza [ PERMIT NO.
OWNER A.P.NO.
MAIL BUILDING
ADDRESS f�S idi'/� �
ADDRESS
• TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH
LENDER
BRANCH •
• OWNER
1260 atj 7
" ADDRESS VALUE
ARCHITECT TEL. USE $
OR ENGINEER NO
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
tel SIZE NO.OF BLDGS. (FROM C/L STREET)
13, OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
.y„ EXISTING BLDG. _B.$IDE FT. FT.
VI
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. REAR FT. FT.
EL)
y USE OF BUILDING AND WORK TO BE PERFORMED DGTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS BLDGS.
Q
VAR.* DATE
- C.U.P.tW APPROVED -
APPROVED
>n $Y - DATE
wla
IQ
0 I hereby acknowledge that I have read this application and state N
In
IX that the above information is correct and agree to comply with
m
O. all laws regulating building construction, and I shall not employ
Z any person in violation of Me workman's compensation laws of
SI
the State of California.
I hereby certify that I am properly licensed as a contractor under SQ.FT. H
the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
to
am exempt from the provisions of theState of California Business VALUATION PERMIT FEE ��5i a
and Professions Code, Division 3,Chapter 9. $ m
PLAN CHECK $ - ^�0
Signature of LL
Permittee $ TAX E f
U
Authorized Agent TOTAL PAID $ 3/c s�
r
0975 5/15/78i°,659r TL
• t46O18 21
- COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE (SSU D�//f
BUILDING ,34
J 14 1 AVE �L7jc7
ADDRESS !
P' : •,e
OWNER I i _lr. s._. A.P.NO. lG -19 .• % . - •
--_� BUILDING3 • A
ADDRESS MAIL ADDRESS I /'
TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR (MOVING DFMOLISH
LENDER
•
BRANCH
OWNER , ' / geli �/
%- ADDRESS // f % UE�/ (.V �s,�—
ACT TEL. USE E I
OR ENGINEER NO. /
FIRE
ADDRESS ZONE //�1 TYPE ^A/ GROUP w 2
c� APPROVED(/ Jt n 5-/6--7C
CONTRACTOR vnJKtNG gF,Fs/`kyF 1�ROT, BY eIII/W DATE a
ADDRESS 1539 yet. 171VY/kc.' o00TEZON , NO.OF USE OF NE /
CITY NOL /, PLAN /A BUILDING �,�/1 �t'�
DRANc e- CA a 9r?-B6
F STATE CITY YARDS APPROVED YARDS •PROVED
Say LIC.NO. C)C. 18919 3 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE I NO.OF SLOGS. (FROM C/L STREET)
C. OF LOT NOW ON LOT FRONT FT. FT.
yUSE OF
EXISTING BLDG. R 5 FL FT.
U,
FSeparate permits are required for L.SIDE FT. FT.
G electric,plumbing and heating work. REAR F-�� T.
H USE OF BUILDING AND WORK TO BE PERFORMED
CBSTANCE BET. BET.MAIN&
(���� � MAIN BLDGS. ACCESS.BLOCS.
`, I ►.�STAL-i— Fin S C6'.iNY ! CfY VAR..' A
t C.U.P.# APPROVEDATE
a
7 APPROVED
)-' __BV DATE
EX
w -
0 I hereby acknowledge that I have read this application and state n
N
CC that the above information Is correct and agree to comply with m
1:6' all laws regulating building construction, and I shall not employ si
Z any person in violation of the workmen's compensation laws of
W the State of California.
3 I hereby certify that I am properly licensed as a contractor under SO. FT. a
The State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business to
VALUATION PERMIT FEE Eto
and Professions Code,Division 3,Chapter 9. he.`-t> n
Signature off ///s �{///// 29 PLAN CHECK $ �! '�O o
Permittee 1 `. `(r'• " ` $ 000 TAX E sOJ�89 IL
Q 1 U
Authorized Agent TOTAL PAID $ 1 / 6 44
Z38 ,god-
•
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION F9R;STRUCQLR) LPERMIT 65e30 TL
• p,O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• RECEIVED PERMIT N" - 49497
For Applicant to Fill in Completely — Use Ink Only
BUILDING !• -0 3 Z �O
A.P.NO.
ADDRESS ,._, � i . - — �/ I
BUILDING A-
OWNER OR ••� ADDRESS • Y�1 S d A >✓-r 1
TENANT s�`1 t: I I—t 5 (�
MAILINGF.-1 , 6a,
UNIT OR
ADDRESS z -5 4, 1 S h ey SPACE NO.
Cos
( I� ,t , TR.NO. LOT `BLK.
CITY
l_L.1-.4A 6..4, Q NO.
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION Q 6�,�
LENDER .1 X.
BRANCH OWNER ( red e--•‘. C /5
ADDRESS VALUEVA
ARCHITECT TEL. USE 0i c, cc, O
OR ENGINEER NO. r in
ADDRESS ZONE Ml t ITVPE GROUP L
CONTRACTOR n/frfA'S W , ,QAJ 111e� `9
APPROVED � DATE l,�/p-�
ADDRESS..//-- C )-bn Arm A.5 N�'_^�'`s�
CITY iY•�y 11'1 Pi NO. I.�Z
F STATE / CITY APPROVED SETBACKS
LIC.NO. j�b 1r¢ a LIC.NO.
IP
lC SIZE NO.OFBLDGS (FROM CVJLvSTA.
YEEf.7�,l b
0. OF LOT NOW ON LOT Ff��/u
et USE OF +1�
,N„ EXISTING BLDG.• 0 F-4i/ Cl-. R, F Orr
Ea
H Separate permits are required for L.SIDE T.
G electric,plumbing and heating work: REAR FT,
IQ
ityrii
k USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
et
CI 4 / r
r9 S//let. 'MO'P/0 AA' u/a IIS V DATE hp/
•
i
II •
APPROVED
APPROV to A ' p
Y. _BY KA/K DATE i " i6-- Ov
C
W
0 I hereby acknowledge that I have read this application and state °i
(y, that the above information Is correct and agree to comply with C
tL all lows regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of
W the State of California.isi 4 (J -:
I hereby certify that I am properly licensed as a contractor under SQ. FT. i A a O• r w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ON
Chapter 9, and that such licenses are In full force and effect,or I ' THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt om the provisions of the State of California Business
VALUATION PERMIT FEE S 64,
and Professlo Code, Division 3,Chapter
PLAN CHECK S /� p 0
Signature of COAD _ „ C t $ Oc 0.00 0
Permittee "'• � ''V 5
,, 96or 0"'"' TAX s eEQn2� a.
a.
ssizir
or
Authorized Agen Date /6 Jia,.00 Ic TOTAL PAID S Q ,3 0 U
\ .. V J
i -r
4
it
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
_.I. P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RE I E PERMITf. ,p�J
For Applicant to Fill in Completely -Use Ink Only i 4n .. L 2- 19 Z_6 ?_L! `
// -
BUILDING L{ �p p
ADDRESS Z3 l s Fischeit te 0 Cr A.P.NO. �� " -� CD
OWNER OR�pe y s''LL
j ! )< BUILDING 2.3t/
f 7[ j _ D .
TENANT CC d (�L..LI�.7 ADDRESS . T /�Qr
UNIT OR
MAILING ‘-/ dd '' , SPACE NO.
ADDRESS J FISCh QIR- `Ne
-{/, fir, �I �T�O. / LOT IBLK.
CITY C 0.51/4. //JC-$64. NO.
NEW ADO ALTS' 'EPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH S SIJ
OWNER . (, zf!
ADDRESS VALUE Q
ARCHITECT TEL.Ago --CV
USE •' • . $/Q Ago
OR EN INEE FWr%t'�. L . • e1•$o I� Y A� SAS
�/•
ADDRESS 70/ Cow.t. S"Art2a7 pJ R ZONE Mr • TYPE tr 4%) GROUP Z
..( APPROVED r /
CONTRACTOR V f/C5.51 BY q DATE 4$ ZIPS
ADDRESS J..5 , y��r//u1-1 P CA).
TEL, !�/76-?/SC /!
CITY Cos-/4 )14(gc#1 N0. /(D-//SC
gUC.NO, V-7i 7 LIC.NO.CITY APPROVED SETBAKGKS* t\
A. OF LOTDO' .743/tr.) SIZE x Jr )Q ),/INO.OF BLOCS.NOW/OyN�L,(O q 7 •NT CSL STREET/
7 . , .
�,
et USE OF
„N1 EXISTING BLDG. K/ prbit / # fC-/'vr�l7tFJ t RADE_ FT.
4
FSeparate permits are required for L.SIDE FT.
C electric,plumbing and heating work: REAR FT.
EW., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
'C
G
DATE
A.
n�M, 1ILAPPROVED
P
t fiat' L � 7- ` f ��- BWy1D DATEE-msi�l
P
�
C
W
0 I hereby acknowledge that I have read this application and state N
(k that the above information is correct and agree to comply with
0. all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of ;;
Ca the State of California.
I xSO. FT. N
II �r I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9,and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT/FEE ONLY: .,p-�'
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E / Aft.
va
and Professions Code,Division 3,Chapter 9.
Signature of /X't PLAN CHECK $ *gat
��• y �V / o
Permittee ..-+/A S TAX $ Z 4
or u
Authorized �i ' _
ta��a TOTAL PAID $ �"'�'�
!69.ze.
„.� Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
3sYA'MESA PERMIT NO. •
98 JG I'hlI2T3/,:P
F C - TRACT NO. LOT NO. BLDG.NO. - ' - 192.42 -TL
•
' ON RUCTIONPERMI:T ��• ,S13S7 593 h-2
Project Address '�53�f�/ Sal P - �-} —2, • TYPE OF CONSTRUCTION —Lis
NEW ❑ ADD ❑-ALTERATION /�/'p �
AddreA 3G '7/SCA'PK - ' ❑ REPAIR ❑ CONVERSION ❑DEMOLISI-t ZONING REGULATIONS
Arch/Eng. • - License No: ' 0 OTHER' }
DESCRIPTION OF WORK Leon,// ...,.... p//1•7047,1,04. L A.P'* 29 - 0•��• —. 0r 3 , + - _
Address '-' VZONE - PLNG. REF. *
'Contractor -O4)n.te Phonep.. -'a?>' TYPE OF PERMIT• a • - • BUILDING - -rp BUILDING �—
SETBACKC/t,ST- PROPERTY INE
_Address - -' 0 GRADING 0 FOUNDATION' 0 STRUCTURAL $IE1 E YARD - - - n )�D .
LICENSED CONTRACTOR DECLARATION 0 TENANT-0-ELECTRICAL OPLUMBING ❑MECHANICAL LSIDEARD - I -
I hereby affirm thr.t I am licensed under provisions of Charter 9(com- RIGHT
,
mencing with section 7000) of Division 3' of the Business and ❑OTHER - - - -- - t����� -
±. Professions Code, and my license Is in full force and effect. • REAR YARD(TO P/L) `s')1 C
' PROJECT DESCRIPTION •
License Class _ - License No. /0 SO
- . 'PKG.SPACE REQ. ,/1.L.PROV IDED;
1
Date Signature '- SQ. FT. 8 N SP.PN,t' STREET WIDTH I J PARK FEE $ I --
1 WORKERS'COMPENSATION.DECLARATION OCCUPANCY B-2-CONSTRUCTION TYPE ` ^'! '
:1-hereby affirm that I have a certificate of consent to self-insure or a aeyO ' ZONING APPROVED-BY (' L .� i DATEg'/// /$'Z
certificate of Workers' Compensation Insurance, or a certified copy VALUATION' aY- - ZONE OW/4w
thereof(Section 3800, Lab.C.). • ,SPECIAL CONDITIONS:
GRADING CU. YDS. ACRES - •
Policy No, e• Company__ - - - .. ._ - . _ -
Certified.copy Is hereby furnished.. REMARKS: - .. - ' - '
Certified copy Is filed with the city Building Division. -
_dEMPTION FROM WORKERS' COMPENSATION DECLARATION -- - ” - - " ' - - -- ".. - -
(This section need not be completed if-the permit is for one hundred _ _ _ _ •
($100) or less). - - . . .. - . ..
Certify that in the performance of the wor for which this permit is
issued, I shall not employ any person in a manner so as to bec e PLUMBING -- _PLAN CHECK '- ,ELECTRICAL PLAN-CHECK ,
subject to t a WOr ers•Compensation of feta. • DWELLING - - -
DIIn/l BATHTUBS - SHOWERS
XDate Signature Q(A ia-Gt,4 �3' / :SO FT SO FT •- "'
NOTICE: If ai r making this declira Ion, you should become subject TOILETS • •f• URINALS - - GENERATOR ' -"0�1 KW_1-30 KW
to the W rkers Compensation provisions of the Labor Code,you must 'TRANSFORMER - f
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE CAVS- - " 'APPLIANCE 30:50'KW_50+ KW . • '
revoked. _ _ __
CONSTRUCTION LENDING AGENCY KIT:SINKS ` DISHWASHERS-' ' - ' - ' ' MOTORS - 0-1 HP 14HP, '- ' • '- - •
I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS - 'f• SUMPS" - ' t(INC.SOLAR) 10-50 HP_-50+HP - - • - -
formance of the.work for which this permit is issued (Section 3097 - - -
CivrC.). FLOOR SINKS . . -FLOOR DRAINS ' . -.FIXTURES 7- -OUTLETS 1y SWITCHES c' io
Lender's Name - - �- _
Lender's Address
.,
_ DRINKING FOUNTAINS' ' - -- " '- ' j - - -.GAS TUBE SIGNS- -
OWNER BUILDER DECLARATION' ' ' - ' '36 "-' •' - `PO LE'L'IGHT$ "'- "" _ •
I hereby affirm that 1 am exempt from the Contractor's License Law far
far INTERCEPTORS CLARIFIERS - -
the following reason (Section-7031.5 Business and Professions Code: SWIMMING POOL- - P TRAP ' • - - -,LUNO I RUL I UN. - - - �-
Any city or county .which requires a permit to construct, alter, - .POLES METERED SUB.
improve, demolish or repair any structure, prior to its Issuance,also re- WATER SERVICE-- - ALTERATION -a ' - - - - .PANELS ' MAIN' "SUB ' '
quires the ap,.licant for.such permit to file a signed statement that he - - - ---. i
is licensed pursuant to the provisions of the Contractor's License-Lava ; --' - ;SERVICE _ "' --- - ,"AMP- -
•
(Chapter 9 (commencing with;Section 7000) of Division 3 of.the' GAS SERVICE '• OUTLETS _ •
Business-and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT- - a `•- ' ' -EXP I R E D - -
basis for the alleged exemption. Any violation of Section 7031-.5 by - - ' - , ,
a•'• applicant for a permit subjects the applicant to a civil penalty - SEWER CONNECTIONS ' . ' -'
'I more than five hundred dollars ($500)., - - Incomplete Inspections
as owner of the property, or my employees with'.wages as their ' SOLAR TANK =:';-' COLLECTORS' -'"
sue compensation, will do the-work, and the structure is not intended __ ' _ _ _ _ �/ -�(£� "
or-of fered.for.sale. (Sectionj044, BusinessAnd Professions Code: The SOLAR PIPING SYS. - - - - ISS1 $E' •T IR8' Sig -,. 3 co
Contractor's License Law-does-not apwho d<an owner of a property -- _ - • "'APPLICATION APPROVED BY! ' DATE
who builds or improves thereon, and who does such work himself pr ISSUE FEE. �'
through his own employees,-provided that such-improvements are not _
intended or offered for sale. If, however, the building or Improvement •MECHANICAL, PLAN CHECK • SUMMARY OF FEES f
is sold within one year of completion, the owner'will have-the burden; - - _
of proving he did not build or improve for the purpose of sale). BUILDING - '- .
❑ I, as owner of the property, am exclusively contracting with HEATING SYSTEM 0-100,000 BTU PERMIT -$_•��''t�� SMIP - $ ' ' ��
licensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000 +BTU 'fl
as
CHECK $ !, .PERMIT.
and Prwn r of property.The C odds or is proves¢ hew doeanot apply to - -- -- i55V ANCE $ - _
to oro of h. oj who builds improves thereon, and whoa con- REFRIGERATION RATION 0-100,000 BTU PLUMBING $
tractsC from such.projects with a contractor(s) IiGesnetl pursuant to SYSTEM -- GRADING $_
the Contractor's License Law). 100,000 +BTU PLAN CHECK $ p� /-
❑ I am exempt antler Section O�N -'B.& P.C.for this BOILERS BTU 3r`'0 - $
�/..GI N�� _ ,/ / ELECTRICAL $
reason vIL(� - _ . MICROFILM $'
��•• 20 SYSTEM REPAIR,ALTERATION + HECK $ ' O.1 3Z
Date Owner i i• .1.4 // :TOTAL FEE$I /�
I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $
information is correct.-I agree to comply with all city and countyPLAN CHECK $ ' - LESS AD- - -
9 PY VANCE PC�$_
ordinances and state law elating to construction,and hereby authorize
representatives of city enter upon Ale above m ntionetl - 2, •
property for insp on pur es-• ///1h 'l ��✓1 �-'
X Signature j�f� �02e-r' Date �y /C FINAL FEE $ ��'
Drivers'License or SS* '< • ( ISSUE FEE -- - - - - • •
-
CMF 0865-46 White-Building;Cana,jy-Applicant; Pink-Accounting;Goldenrod-Assessor
• . . . ... . - ...„All
CONSTRUCTION AND PLANNING POOL&SPA -
APPROVALS .Permit# Date Inspector APPROVALS. - Permit#_ Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - . . . . . .. - - '
2. Soil Pipe-Undrgrn - __ _ 44. Steel Reinforcement . .. . - ••
3. Electrical Conduit Utility_Undrgrn - . •
_- -_- -- • _--_ 45. Forms , - - -
4. Electrical Conduit-Undrgrn _ - .. 46. Electrical Bonding - - - -
5. Steel Reinforce - 47. Rough'Plumbing& Pressure Test - - - - - -
6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE - -
7. Footings _ _ _ 49. Electrical Conduit-Undrgrn -
8. Foundation . . ... . . . 50. Gas Pipe, El Undrgrn,Test -
9. Water Pipe-Undrgrn _- - - 51. Backwash Lines.P-Trap. ❑Undrorn •
-
. 10. _ Structural Floor System, , t . . 52. APPROVAL TO DECK - . . - ' ,
11. Property Sewer Line & House Connection 53.. Backwash& Receptor-Final i - -
12. Street Sewer Connection - -54. Heater &Vent-Finat
13. Rough Plumbing 55 Plumbina Svsfem - Final . -
14. Rough Electric-Conduit - • - - - -56. Electrical-Final •
15. Rough Electric-Wiring • . -- • -- - - 57. Solar System-Final - -
16. Rough Heating& Air Conditioning - .- - - - 4.q. Fencing&Access Approval
17. Ducts, in Structure _ - .159. APPROVED FOR PLASTERING
18. Ducts,Ventilating . . . . , _ _ . _ . _ ______ _. . _ .... _ _• . .
19: Gas Pipe-Rough &Test - . 60. POOL/SPA SYSTEMS FINAL -
. 20, Roof Framing - . --_ . . _ - '
21. Roof Sheathing -' _ • - - - - -- _ • •' -
22- Frame and Flashing _ _- . .- /!/%/$-'4 WF L NOTES: //,/_ fta .R . F.r w;ap A/OrstitRtoray.
23. Insulation .. SI . it - L9...a. sQs,e . .
24. Lathing& Siding - -- -. LpMseta at iT?QA4m.._ do-m-sa •
25. Drywall Nailing - - . - _ SAA. o s i.e'Ka ie B (/.•__ _ '
26. Plaster Brown Coat - • - - - - H- _ 2 As e iteO Lc
27: . Electrical PoweriMeter-Final . - . . - ,_ /i- 7/ €.2._ S4.in i.w..r -3fifagst/ea( /4-n/ Do
28: -Final Electric - - . - . -- •' - - 11^4(-%2- -,__ 'L_C-, -. ' /P•/. /`2NS
AC'4, x IJ- d.0att. '-
29. Final Heating &,Air'Cdntlifioning . _ . ,, _ - Qin /,e .- Ile,,,i.'C-c/ •" 141,4"demos -
30. Final Gas Pipe-Test' '" t •<U rp ni .
31.. Final Plumbing - - - - - - 47`1-s0 4icec v-p- 0 24, c..• Q
32. Water Service-Final3'.----- • ___._ . 9r€,C.. . - eoo nea a,.e S DIV �.d� 2_'
-- !-•33. • Gas Service-Final. -- . -. .3-/f'•> 3 S c# 1 RY�� [¢��y,�},�se av r dip '.
. 34. •Solar Domestic-Final . • - • /}s'' 4040 the Ca'- G;/y.ev
35. - Landscape Sprinkling System. - - - - _ ' - - - -
36. Sound Attenuation -- . . _ - , - _ - - • - - • '
•
37. Handicap Regulations -
38. FINAL STRUCTURE&BUILDING - - -
' 39. Special Requirements Completed- - --
, 40. Electric Release to Edison - - ' _ - - .
41. Gas Release to Southern California Gas CO.' ' . • • - _
42. CERTIFICATE OF OCCUPANCY -- - _ - ,
IC ' •
1 .No Date - -'---- • --•- _____ -- - --- - -
PROJECT ADDRESS: 234 FISCHER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT &CAWS Nu; r 0013_,.,
OWNERS NAME: ELLIS FRED V N TR
ADDRESS: 1857 ±RVINENEWPORT AVERAE 92660 PERMIT NO: F 061355 PLAN CHECK NO; 00597-93 L uuvi ; N °uNrr ;
CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE; OTH
ARCHIENCINEER: REG.NO.: JOB DESCRIPTION : BACKFLOW RETROFIT SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: 3, 600 . 00 CALC—VALUE: GROUP OCC: 8-2 /
PERMmEE:THE BAKER COMPANY ( 714 )835-8572
ADDRESS:S1202 HUNTER A CA 92705 COMMENTS: "MASTER BLUEPRINT"
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LtC.:0 47439 STATE LfC:5 5 4 9 6 CLASS:C—16
/'� r1"5 signet MAIN BUILDING ACCESSORY BUILDING
Dale:/ _ GUS• FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: (hereby um ihallhave acenilitate of consent to or a cenilicate of Workers LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
Compensatio% tane,.hrl ff fl ird4oT tl64eof cctfon 3800,Lab6ly/01 /9 3
POLICY NO.;W N 11 7 EXP.DATE:
COMPANY; INS COyy,, PARKING REQ: PROV; PARCEL: 42703203 ZNE; REF NO:
❑ certified copy is hereby furnished. 6 Certified copy`' the city Build g Division, PLANNING NOTES>
�/1� rT 3 Applicant. .vis 7 * le
CEN ` ***** ****#****#**####**###***#**************##***#*#***it#****#*#*#*#**###***#
Dd1e / DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATI . (This section need not be completed it the permit is foe one honored(3100)or less).
I certify that in the performance of the work for which th s permit is issued.I shall not employ any person in any manner so as to become ZONING APPROVED B Y DATE:
subject to the Workers'Compensation Laws of California.
Date: Signature: r
NOTICE:It.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED H Y / DATE: I
Code.you must
DINGwAGNCY: Ihecth suchfirmtiats or tethisaconsrctine lndingarencyfo. APPLICATION ISSUED BY: bpi.— ! DATE• 3) IZ,J �(A
CONSTRUCTION LENDING AGENCY: (hereby affirm that there isaconstructron lending agency for the performance of the work for ***************K***********#**********- *** 3(— ******************** **+t***f1F**
whim This permit i5 issued(Section 3091,Civ.C).
LENDER: ***-***-lE***#*#**#*********#*iP*********it***********'.E***************#*************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: t hereby affirm that l am exempt rom the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,after,improve,demolish,or PERMIT 63, 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that babe is licensed 65* SMIP/NON—RES I
pursuant to One mansions of the Contractors'State License Law(Chapter 9{Commencing v4th Section 7000)of Division 3 of the Business PLAN 40. 95
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to/acivil Penalty of net more than five hundred dollars l55O0L BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
1, as owner of the properly or my employees with wages as their sae compensation, will do the work, and the TOTALS----> 63 . 00 0 . 00 40 . 95 103 . 95 103 . 95 . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves/hereon,and who does such work himselNherselt or through
his or he;own employees.provided that such improvements are not intended oroffetedfor sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED. 63. 00 OVER/SHORT; 00
Will have the burden of proving he/she did not ho
improvement is sold within one year of completion.the ownerhood or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale). 63. 00
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does notappfyto an owneraf property who builds or improves thereon *,****,***,*_******.**.*,***,*********#**,**%,.*,*.,**#,*,*,**.**,*.*****#*#*******#*****9E***3h,*****
and who contracts lot such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
{ , ❑ 1 am exempt under Section: B.&P.C.
10iNsreason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Cate: Owner: FIR 63 FIRE EQUIP FEE ( FROM BLDG VAL TABLE) 1 .00 63. 00 ..
I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES
25534 and that I or any future building occupant will/wig not(circle one)need to comply with said state codes and the requirements IV a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt Iron a, —:w
these provisions.
'.A.
.n r'
Date: Applicant':
S
1 hereby certify that I have read this application and state that the above information is correct,I agree to comply with all city and county ,
•
ordinances and state laws relating to building construction and he hot represent Ives 01 this city to enter upon the above-mentioned '
properly for insp coon purposes. s,(
Date: 5 z/0 Signature: -y (,d/� =! s. 5.y - _ -
.Drivers License or Social Security a: V;r l�[ t;: 1
1645.46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING P00. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
{ 1. Temporary Electrical Servica`n'r Pole 52. Pool & Equipment Location
{{{ 2. Soil Pipe-Undrgrnd. /ei 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. ' ' 54, Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings /` i' 58. Electrical Conduit-Undrgrnd.
i /
8. Foundation 59. Gas Pipe, C Undrgrnd.,Test
,7
9. Water Pipe-Undrgrnd. , "i 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & Houss`Connection - / 62, Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final i
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68, APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 000
23. Gas Pipe-Rough& Test • 72. Underground Flush
4-2)-13 Wim.
24. Roof Framing 73. Undergrnd,Storage Tank a Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
26. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation I 178. FIRE PREY. FINAL
-243_W\P
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I 79. FINAL INSPECTION
32. Electrical Power Meter-Final ( 80. FOOD CERTIFICATE ISSUED
33. Final Electric ` Notes:
34. Final Heating& Air Conditioning ( j `
• 35. Final Gas Pipe-Test
36. Hood or Canopy ( !
37, Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final ( }
40. Gas Service-Final I
I
41. Solar Domestic-Final
42. Backflow Preventer I
43. Backflow Irrigation .�
44. Landscape Irrigation System
45, Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING , I
48. FINAL PLANNING
49, Electric Release to Edison
50. Gas Release to Southern California Gas Co
51, CERTIFICATE OF OCCUPANCY
No. Date
,I
ADDRESS OF BUSSING234 FISCHER AV ohm CITY OF COSTA MESA - BUILDING PERMIT /'eil- OOd/q
OWNERSN"MEIF IOtaw11: ELLIS, FRED V N TR FLOOD : AE-46 PERM NO: B 086898
Ammus: 1857 IRVINE AVE
NEWPORT BEACH,CA 92660 PERMIT NO: B 086898 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.IMMO ADORES& CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OREN3INEER: LIC.NO.: JOB DESCRIPTION : T/O SHEATH & REROOF SQ FT: 22, 570
ARCH.OR ENS'S ADDRESS: WIT:
CLAIM VALUE: 22 , 570 . 00 CALC-VALUE: 22, 570 . 00 GROUP OCC : R-3 /
c«GRACTOTrSNAlC: PETRONELLA ROOFING ( 714 ) 548-1645
gdn.OTowsulum 2626 NEWPORT COMMENTS : T/0 & INSTALL 1 BASE 2 PLY 1 CAP B . U . R.
ADDRESs& COSTA MESA CA =HO: 00460707 ***'+exit**4** Nie****** *** **�tiEieit�E+E +t******gat+tkE * ista**** *****prat**********SEN***
92627 WIT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby slim under penalty of perjury Nat I am licensed under provision of Chapter S SETBACKS
(commencing with Section 7000)or Division 3 of the Business and Professions Code,and my icense is in fu0 force and effect.
arc UC.No.:03 605 LIC.CLASS: C 39 UC.NO.: 46070 EXP : 07/98 MAIN BUILDING ACCESSORY BUILDING
�i FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
�� //" LEFT: FT IN RGHT: FT IN LEFT: FT ZN RGHT: FT IN
ne
OWNER BUILDER DECLARATION:I hereby affirm under peby d perjury y that I eexempt from t Contractors License Law for the
followingMAIM
ornepa any°11 Mixtura pion ts and aboyto rogCoda:
'Sthe emimd to wl�ermto fie a signed satement tat he orsitu PARKING REQ: PROV: PARCEL : 13953113 INE: REF NO:
s licensed pursuant to the proderms of the Contractors lienee Law(Chapter 9(commencing with Section 7000)of Dseion Oct the PLANNING NOTES>
Business and Professions Cade)or that he or she is examp therefrom and the bens tor the alleged exemption.My videlion of Section >
7031.5 by arty appkced lore permit subjects TM WpOunt to a dvi penally of not more than Ewe hundred an[5.503D. *****************************************************************************
❑ as edthe( dF wages as CKM rsed"� d the to'a � DEVELOPMENTended SERVICES R E Q U I R E M E N T Sorofefw (Section anCode:ThecontdLcensLw „tapplytoowure nedpropety
who Grids or improves thereon,and who does such wok himself or hetet or through his«Mr own employees,provided that such '• •
knprwemrNaneM intended«Cared IC.Bale.t,Mwever,the btnidmp«inprwoned is wtlwithn sae Yew dcompletion,IM ZONING APPROVED BYDATE:
owner-0sler wi0 have the dues d or d
dproving hee dor i
d not boldint prom 1«the pumas*pupae* tale).
❑ i.es ay"'d the property,am"aka**
t dvely codredng•vh loomed mteacbrs to«red n the
prised(Seam 7044,Business and
Professions Cala:The Codredm L+aree Law does neteppyb en armee property wb buds o flames thereon and who BUILDING APPROVED BY DATE:
contracts for such projects with a o naso ls)Foamed pursues Io the Coramms License law).
o Ism exempt dr Section: B.AP.C.,for des nason: APPLICATION ISSUED BY: VI.. DATE: 2).1° ' q6
Date: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby cantly the I em aware of and understand the raldremab el CWonv Heath and Salley Code Sections 25505,25533.and n /
25531.and Nat I or any Mute Wilding comment we I war not(tide one)need to comply will said nate colas and the nstuemelt b 1
aprmdf«construction«modification from the AiWty.ansh
agerrs Din .ReegwYSl construction applications sus ammo.from these BLDG PMT PLUMBING ELECTRfC'. ME'HANIC FIRE SMIP/RES GRADING
provisions PERMIT 324 . 75 0 • i,' 2 . 26
Date: Apprvd: 4SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby dlim under penalty py perjury they one following declaims: PLAN `'
ISSUE FEE
❑ IMVO dwmaintain•centime COMMIL 10 sued. c«npareeInn,nproddedfoe bySedion37006IMLWm BUILDING—DIV—> PERMIT ISSUE PL/ANleHECK / TOTAL PAID DUE
cola.I«N.p.npmamC.aN..«kf«wHdd:ap.m.em.d. TOTALS----> 327 . 01 0 . 00 0:.00 , . 3.27 .01 327 . 01 . 00
o I have and MI maintain wallsm
' npenesInsurance,es
tion nestled by Section 3700 d Ne Labor la
Co ,for r the performance the •
work for which IM prone S issued. compensation My workers' insurance d b
ance npolicy numere:
Canis; ARGONAUT EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: r ' '327 .01 OVER/SHORT: . 00
Poky Number: j0-0441P)4444 02/17/98 BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not M competed i the prone s b one hundred dollen(SfmP«lag) 324 . 75 2 . 26
❑ 1 certify that in Ihe performance of Ow wait IF.which I:s permit Is sailed.1 chat tae employ any person M any ma=o as to ,•
become b the workers'm., .1nswdCadads./�,ar,,ed ilabtid sklaw lo tMwodwa' *******************************************************************************
COM "q� tabor ° .tp/57, IND I V IDUAZ FEE� E R E A K D O W N
site: L x /arta I�r �(�tleeta�\
w.mng:Falvnrosecure wolkers'rorryansstlen awing*is ca iawM,and WNWstaNd an smell ydynt%ssamnw penalties and TYPE QTY DESCRIPTION . ,. UNIT COST TOTAL COST
civil(Inas up to one hundred thousand dollars($1D1000A In addltlon to me cost of compensation as provided for In
Secton3706ofOwLaborCodaIntresLwafrorW'SIOW SFR 22570 REROOF BY VALUE RESIDEIJTt•ALA NOZONE 1 . 00 22 , 570 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under panty of perjny the there is a permntdlon lending Mercy foe the ESD 1:0 Pe FEES /
performance of the work far which the prime is issued(Section 3097,Cs.C), , I
LENDER'S NAME ' '
LENDER'S ADDRESS: .�
r . i c
Ind state taws
srel hp to thisapplicationconned eathatlideMhorizeve repbesme,of Ipree ti mit uponth0 aye menton dirm•w�` ,�®Km.. ®ETECT®F
dstpe sac retatkq nbunloic caretrttdiomdbeby etlNor¢are«eamtatMldu,ts erybamr the above-mentioned' propertyes
a 3` V E
for inspection pit - IRGINIA MOCK „
82 18-1998/82:30 PM/$327 81
y / NI.
REQUIRE[) RCPTB:o1-8819472
�/, � /Data: i I PERMZT:986898
natpre downs+K�OY••!e-'>tr ..«
\.., •
1 (5151-46.WP) White-Building&Safety;Green-Rte;Canary-Appium;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL .. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank CI Gas 0 Oil
25. Roof Sheathing • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:34/a �7 /14.c.1)
�,/ay ,f4 4ti arra/
34. Final Heating & Air Conditioning Vies 8 9�.
Sod f� pfe
35. Final Gas Pipe-Test 'Attlee $u�9/✓ ➢th7
36. Hood or Canopy 3/9491, �-/_w y( de� ,e .✓ re.
�" src r� f � G a
37. Final Factory Fireplace ��JJ // ./
fir Xaittl v/ diNyt,.. Sar e_
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation _r
46. Handicap Regulations _ 7 :c
47. FINAL STRUCTURE & BUILDING 1 trig 4/L n
r4/".
. 48. FINAL PLANNING •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY '-n
No. Date
.PPLICATION FOR A BUILDING PE. .IT
BUILDING PERMIT NO. Electrical CO
Tract Block Lot Permit No. C
/� r� ��� Plumbing
c
Building dl\ •� U€ CO 87
�J Permitlub No. rp
Address Q (-
Cross , Mechanical G
Area 6067%. 5� Street Q••A r' I I L Permit No.
1 t co
M
Owner " Pe. Li S Type of Project: ❑ New ❑ Alter ❑ Addition
Address % *y' /�I SiLye_ Bi-v() ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt.
City ✓ e .)fasav1l&.tLjp Phone A.P. Sup.Dist./
net, (I s'Ic Insp.Area
ArchitecDesigner t/�'"I U (Hon License No._- ,_l�vyt� sp Zone Spl.Pmt.No.
•
Address 70/ Ll3uf_ 57 `105 Setbacks P/L Front C/L St. Street Width
,�1 �'-C/ Yards Left ' Right Rear
City /Ir 6 Zip Phone
Eave Proj. Left - Right h.P.
it Engineer License No.
a Parking Spaces Required ' Provide ' Coveted
N6 Address
m CityZip Phone Strutt No.of No.of
Height Stories Family
a LICENSED CONTRACTOR'S DECLARATION Park Fees 'syI Yes Fee
as
m I hereby affirm that I am licensed under provisions of Chapter 9 Required LJ No CT Receipt
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved BY: Date
Professions Code and mylicense is in full force and a ec 5
License C'asz�f License Number _C� �J
/ Misc. •
_> Date n 1/ 8n Contractor
E Address 1 Ci 7;JL iP AGe
`, Proposed Use
y City and zip c 44 731A1) Phone 61/6 9icti of Structure
LL
vi CONSTRUCTION LENDING AGENCY
la
E I hereby affirm that there is a construction lending agency for the
1 performance of the work for which this permit is issued (Sec. 3097, CCons Code
' Civ.C.). Class Const. Year
C
Lender's Name USE/OCCUPANCY SIZE SQ.FT.
Lender's Address
.:I OWNER-BUILDER DECLARATION
•
Y I hereby affirm that I am exempt from the Contractor's License Law 1.
17 for the following reason:
❑ I, as owner of the property, or myemployeeswith wages es their 2.
C
solo compensation, will do the work, and the structure Is not
...5 intended or offered tor sale. 3.
❑ I, as owner of the property, am exclusively contracting with -
licensed contractors to construct the project.
sa', 0 I am exempt under Sec. - , B&PC for this reason 4.
N
EL Date Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
I hereby affirm that I have a certificate of consent to self-insure, ElNo
or a certificate of Workers' Compensation Insurance, or a certified
Encroachment Permit Required ❑ Yes
C copy thereof. Grading Pmt. Grading
8 Policy No Company Required ❑Yes ❑No Pmt.No.
.a 0 Certified copy is hereby furnished. Rough Grading 'U
0. ❑ Certified copy is filed with Orange County,EMA. Approved by: Date
m
Q Date Applicant 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less). C
I certify that in the performance of the work for which this permit is P
Issued, I shall not employ any person in any manner so as to become m
subject to he orkers'Cornpensati La s Bali niaii_ PERMIT FEES
Dat Applicant
NOTIC T APPLICANT: If a making this Certificate of Structural s Plan Check $
Exemption, you should becom su le to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchSpecial
Electrical $ Invest. $
provisions or this permit shall be deemed revoked.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade
POSE . �t /-) " 0/ea Inepecaion $
Y 6.caVnt or Agent
Pre-Grade Permit
Si:.'a Applicant or Agent Da $ $
� Rec.No. Issue
Ix ge ibS 7 c 87Z SC3
Print Applicant's/Agent's Name fl-'f- 8&' rT 4'3
ce
All spaces within this box must be completed to process PlanhApproved:P P _ Check By: Approved:
CMF 033546(BU-28)rev. 6/80 -