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HomeMy WebLinkAbout2687 ELDEN AVE - Building PermitsCosta Mesa Building Department APPLICATION FOR PERMIT .� 111 EAST 20th STREET 634 BUILDING COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. �[, / Building , Address Costa Mesa, Cialiforma Received by Date Recd. Date Issued Nearest Cross St. / /(4/ Building Address Owne �i Costa Mesa, California Mai AI Address �L�I Nearest Cross St. Zone�//I Plans I Type ✓ I Grou 7`' ��//�� � L � Tel. p B city(�Q�C� � No.�O '��Q Architect or Lic. Engineer No. Approved by Date 'ess City Lie. Contractor No. CORRECTIONS AddressLe ILot Descrgption �1 I No. I Block / I Tract3 - (Attach Metes and Bounds)N of/� Bldg�3 Size of Lot �, x /* d I Now, t�' ' 0-)(' 1 1954 Use ofNo. of / No. of Existing Bldg- 'F Families / I Rooms 9 0 2 y Setback Line from 0 Rear Yard YL Center of Street Side YardMy DESCRIPTION OF WORK ' , , New I I Alteration I Addition Repair I I Moving Demolish Building No. of -le O -'K-17 Rooms l Stories erior Wall•..f I Roof _.vering Qom{ / Covering APPROVALS Use of New Building ( Foundation Forms, Materials, Under -Pinning Inspector Date Frame: Fire Stops, Bracing, Bolts Lath. Int. Lath. Ext. Plaster, Int. I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building constru oon.. Signature ofiA Permittee Authorized Agt. Plaster, Ext. = Masonry Reinforced Bond Beam Valuation -1Cf $ J Permit Fee $ Plan :he $ S`y Total Fee $ ���' FINAL � � 17 33 PLOT PLAN - Show location and distances from .. property line and between buildings r, -:j .. 1 d J � 6 J.. o n a Street PLOT PLAN - Show location and distances from .. property line and between buildings r, -:j .. 1 ,r 6526 COSTA MESA BUILDING DEPARTMENT P.O. BOX 312 COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN BULDIBUILDING BUNG SS 2687 Elden Avenue IQR Z4'S6PDNESAA9� 9a Afiit{r'� Q.pjQ,P APPLICATION FOR PERMIT BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. P R%A NO. OWNER Thomas T. & Georgia M. Thomps n 5 Z.G MAIL 268 Elden Avenue RECEIVE. BY DATE RECEIVED OA 3 I65U ADDRESS 3-a 27 TEL Mesa Li 86 8 BUILDING CITY Costa NO. - ApORESS ARC .T LIC. OR L JEER NO. COSTA MESA, CALIFORNIA FIRE 3 ADDRESS ZONE ( L C .ONE_ pO;O. TYPE GROUP CONTRACTOR TEL. APPROV ADDRESS NO. BY ( DATE `EGA` No?Por 17 6 CORRECTIONS LEGCRIPT1oN BLOCK TRACT A.P. NO. 119-040-19 SIZENO. OF BLOG6 521 x 140 1 2. �� rI OF LOT nIOW Ory LOT Ip��p Y� USE of EXISTING BLDG. Dwellingand Garage CITY Ur ( 'TA MESA SETBACK LINE FROM !1 CENTER OF STREET 01 REAR YARD SIDE YARD RIGHT. FT DESCRIPTION OF WORK BY DAT - N. ALTERATION ADDITION S REPAIR MOVING DEMOLISH BUILDING11 /1 NO OF 1 512E ROOMS 3 STORIES 201 EXTERIOR WAl_ttIAu(�.CO ROO le _COVERING COV EFRINGWOOd Shin USE OF NEW BUILDING Bedroom Bath & Service Porch m� N y 3 Ste - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND - 'TATE THAT THE ABOVE IS CORRECT AN. AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION SIGNATURE OF PERMIT FEE S PERMITTEE 3/// PLAN CHECK S Ae AGENT SAUTHORIZED TOTAL FEE S UiF J`l -_ _._ _---.__V. __ � I �.j ••ill �f�l'� It t - 131 .�:r.F-+.' 1)?-.. .. r.. ��••. !'�.i. _ .. . Pf Z . w U F- Z Z_ F O to am Q M J J 00 a U N Za W Ly aW W Z J O 03 J M WW O= ZI.- W0 N M DO COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PA10 .1. Yr**,.;r* "11V P2-7IIC;,S.OQ �6�• 7.50 1744 4 / /'4 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE VE By DATE RECEIVE /,.� DATE ISSUED BUILDING 2687 Elden Avenue ADDRESS `� o' Thos. Thompson Sr �p A.P. NO. �}(] J 1 —Opti �2 OWNER .T. • MAIL 2687 Elden Avenue BUILDING ADDRESS ADDRESS r o p CITY Costa Mesa NO`548-648 // TRACT t0 rp.or. LOT BLOCK. CONSTRUCTION None W A LENDER BRANCH OWNER . ADDRESS VALUE IF /O $ to AQ ARCHITECT None TEL. OR ENGINEER _ FIRE ADDRESS ZONE PE' ROUP tr APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZO IJ NO. OF PLANS USE OF NEW CITY NO. („r �. BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE 1 NO. OF BLDGS. (FROM C/L STREET) ,r• OF LOT 521 x 140 NOW ON LOT ERONT FT. TJ FT. USE OF EXISTING BLDG. F SIZE OF NO. OF wall NEWSLOG. ROOMS STORIES L SIDE FT. FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & Construction of slum13 block MAIN BLDGS. ACCESS. BLDGS. wall along front of cu.P.1w DATE property. APPROVED APPROVED O • _STATE All 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of the workman's compensation laws of s the State of California. pTs:Gi�ei%$.$oitT.aBtgr r SO. FT. THE SHOWN UNDER VALUATION IS FOR �W�9s5r3Priif19f9sWaP�(ISIQPK IP 4rts'SS�a'r�iS'1'uYl��r e a e acT,'o71 PURPOSE THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: TA VALUATION PERMIT FEE $ Signature of '•1f _ s -y �y per, Permittee diLOY�La/d d dMevN ' $ ��(O / PIAN CHECK$ Authorized Agent TOTAL FEE $ 1744 4 / /'4 r•71 42229 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 i PP Cr ON FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R I V DA RECE ED D IM " D 2687 Elden Avenue A ADDDRESSRESS _ 39 ��� PE MIT NO. owNERThomas & Georgia Thompson A.P,NO. 1 MAIL BUILDING A. I,/ ADDRESS 2687 Elden Avenue ADDRESS TEL - p TRACT ty LOT `l BLOCK CITY Costa ijesa NO. 8-6 8 8 NEW 1AqD1A 1149PAIR CONSTRUCTION LENDER BRANCH OWNER ADDRESS VALUE S S ARCHITECT TEL.USE OR ENGINEER FIRE ADDRESS ZONE TYPEC'V--GROUP APPRO CONTRACTOR Owner BY AAA DATE ADDRESS TEL. Zpy '/ NO. OF �/ PLAN USE OF NEW BVILOI CITY NO. s� t.-. G._ STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF LOGS. (FRO C/L S'REET) OF LOT 21 }� 1 O 1 NOW ON LOT ONT FT. FT. USE OF EXISTING BLDG. House, Garage, Storage B. Sf T. - FT. Separate permits are required for e'er L. SIPE J .FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. VAR.+ DATE Sunshade C.D.P. w. APPROVED APPIeRYDATE % _ In Fod CI L REQUIREMENT I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of /� 12gos O. FT. the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Coda, Division 3, 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 VALUATION PERMIT FEE § and Professions Code, Division 3, Chapter 9. Signature of s'S �'S � PLAN CHECK § TAX § . Permittee J J y S {/(� {/ TOTAL PAID § Authorized Agent i ADORESSOi BUILDNO: Zbtl / ELUEN AV OWNERS NAME IF KNOWN: THOMPSON THOMAS T Attroa : 2687 ELDtN AVE COSTA MESA,CA 92627 548-6483 APDL. MMI0I(I OGRESS. ARCIIRECTOREAGPIEER: MNG: UNIT: ,ICK OR M'S ADDRESS: UNIT. CONTRACTORS NAME LEE ROOFING OF COSTA MESA (714)642-7223 CONTRACTORS MAJUNG 1653 SUPERIOR ADDRESS: COSTA MESA CA uaNO.: 349686 92627 UNT: LICENSED CONTRACTORS DECLARATION: I hereby aHcm orals, pereky of perjury thel I an ficemed under povidone of Chapter 9 (commandeg vmh Seclbn 7000) of Division 3 of the Bovines and Prdaaeione Doris. end my license is in full tome and sheet. CdYUC.NO.:028751 uc.cuss: C-39 L1cNo.:_34M6 _EXP: 03/97 OWNER BVLDER DECLARATION: I hereby affirm under peruly of that I we exempt from the Contractors License Law for the followW s, manard ISion 7Wl S Bummed, and Pmfeaeiom Code: Arty a coudy whidh requires a pereft tconstruct.ee, after. improve, 'wnd'ah. a ropes any ewcture, pW to is ueusom, sloe require t applicant for such par eft to fib a w clavi ousemW dust he and e licensed pureuam to the provisions of the Contractors License Law (Chapter 9lcommencinp wih Sedan 1000) of Division 3 of the mess mal PMeeslons Code] or that ha a she a exempt therefrom and the beau for the alleged exemption. Any violation of Section 1031.5 by and applicant for a permk u bpda the applicant to a dW penally of not more than We hundred co8ars r5OOD. ❑ I. as owner of the property or my employees wish wages m their We oompessation, will b the work. end the Measure a W intended or offered for We (Section 7044. Buaireva and Professions Cale: The Contractors Licamm Law dose W apply to an oyster of prop" wW Willa or improves thereon. end who does such work Nmeelf no himself or thragh No or her own employees. provided that wont improvements we W intendnd or dlered for sob. d, however, the Wikieg a impressment to; sold within was year of compasses, the ownerbuikbr will have the human of Provo, he a she flat W Wik or improve for the purpose of We). ❑ I. u owner of the prop". we exclusively cmirW iry with licensed contractors to construe tht project (Section 1014. Businesses nal Prof. Cob: The Coronas. Liranes Law daas W ply apto an owmr of property who budder a imawes thereonnd awsn cos forwW projects yeah a mmreda(s) liceneed pursued to the Cmtrasas License Lew). ❑ I mon exempt under Semon: B. A P.C., M this reumn: Dale: Ow .. I b hereby codify IW I ern mea, of and understand the requirements of California Nedth end Solely Code Sections 25505, 25533, end ?5.534, and that I or My future Wikieg aoa,anl will / wil W Iamb one) need W comply with sok were codes end the regdremeW for a pamd faconamasionamndifiutionfrom the As am9ement DimW.PesidxeW carWrWion appirtlbmenaxernpt hen uses wo cions. Dae: Applcarm WORKER'S COMPENSATION DECLARATION: 1 hereby affirm under penalty of pwhs, arra of the fo0ovm, btlarmloro: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 076653 PERMIT NO: B 078653 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: SIR PURPOSE: OTH JOB DESCRIPTION REROOF 1400SF PART OF RESIDENCE W/COMP SQ FT: 2,409 CLAIM VALUE: 2,409.00 CALC-VALUE: 2,409.00 GROUP OCC: R-3 /U-1 COMMENTS: REROOF 1400SF W/COMP SHINGLES Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING-------- FRNT: FT n IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT -' IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 43908122 ZNE: REF NO: PLANNING N TES> TOTAL PAID DUE cad..fatnepenammedtnewakawmhn.amaaMened. db*dE*!F*dE*iE*dE ib iE�k*dE***k*ie side*1E iE***ill dE*iE*dE*alt**iE iE iE if*d6*dEif lE if de d6 db db ill iE**dF dF iE dE dE*dF iE iE iE iFie alt**iF iE db*dE D E V E =L O P M E N T S E R V I C E S REQU I REM EN._,, S ZONING APPROVED".BY DATE: BUILDING APPROVED BY soak la whits this pamX is iesued. My workers' mm oration insurance cams, end policy number are: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> DATE: 75.25 OVER/SHORT: Camay: Policy Numlur. - 06/30/97 APPLICATION ISSUED BY: PLUMBING ELECTRIC DATE: dF dF iE dF iE**1E 1EkiE dE iE iF*1F dE SF 1E 1E 1E if .00 PLAN -CHECK ,.his season coed W ea compatm i me pemhi is for one hummed dollen/$tool or lass.) IE dE dE SE**iE*alk dE dE* LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 74,75 .50 became subject to the waken• pornPensollon laws a Ca4lornurras . and athat ehwk bowers abject to the vvorers. *k1E*iEiF1E**dkdEdEkiEdF**iE1ElEdbdb*ill*dEib de drill*ihdtdf*kikiFiEiE1E*dbdEiF*rtiEitiEiEdE*dEiFdedrRtdtiFih*dEdE*lEiEitiidEdedtdedt**de SMIP/NON-RES PLAN ISSUE FEE ❑ Ihave and 41maintain acadiiceteofconsent toseB-imurefor workers compsmetion,aspro+idedfor bySection 37Wofthe Lebar BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE cad..fatnepenammedtnewakawmhn.amaaMened. TOTALS ---- > 75,25 0.00 0.00 75.25 75.25 ❑ I hew end ail mainun waken• oompermalipn imurarae, es reguired by SW ion 3100 a the labor Code. brill Pedamence d the .00 soak la whits this pamX is iesued. My workers' mm oration insurance cams, end policy number are: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 75.25 OVER/SHORT: Camay: Policy Numlur. - 06/30/97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING .00 PLAN -CHECK ,.his season coed W ea compatm i me pemhi is for one hummed dollen/$tool or lass.) 74.75 \ .50 ❑ 1 pertly that in the pedomherae of the work for which this pemrk is issued, 1 shell W employ aoy Person in any manner W m to became subject to the waken• pornPensollon laws a Ca4lornurras . and athat ehwk bowers abject to the vvorers. *k1E*iEiF1E**dkdEdEkiEdF**iE1ElEdbdb*ill*dEib de drill*ihdtdf*kikiFiEiE1E*dbdEiF*rtiEitiEiEdE*dEiFdedrRtdtiFih*dEdE*lEiEitiidEdedtdedt**de ie de canpeymati h previ area d Sermon 3700 d the laW Cade, anh ' ons oath pmviebm. I N D I V I D U A L F E E B R E A K D O W N Dere / Applicant: wamep:F Ivnt aspvro workers• compensation coverers b un1 andwun resect an wilwaysr to alrNrWpsrWtlu amf TYPE QTY I D E S C R I P T I 0 N UNIT COST TOTAL COST dv/l flora rpt b 1s hurtlrotl fMvsam do/sn /$100.000), M stltlltlo b tlrs cost of rompsrsaabrt brrrepsa u pmv/tlstl br In Swollen 3laofMeL or cob, Interval, and aromoys16a. SFR 2409 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,409.00 CONSTRIICNON LENDING AGENCY: 1 hereby affirm under penalty of Peggy that there is a construction lending a9eney b the END OF FEES porlwon a of lha work for which the permit ie awed (Section 3087. Civ. C). LENDER'S NAME: LENDER'S ADDRESS: 1 candy Ihet I have reed this application and den that the above information is correct. I spree to campy with ell city and omunty ce irunoss and mere leve nasi, to Wilding construction end hereby eun,rbs representatives d this city to enter upon the above-mMIkmwI property for inspWm purposes. MIKE BURKE cjv i Dole: Wme�uikig & Soley; Gr Rls; Camry-Appkcanl: Hnk-Roads; 7 - ---.-�' CONSTRUCTION AND PLANNING POO" SPA ' APPROVALS Permit #' Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Po4e_- 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • '53. Steel Reinforcement '- 3::E1ectrical Conduit Utility -Ur drgrr d.., - 54. Forms, ;c.4 -Electrical Condu4-VU drgrndu 55. Electrical Bonding , 1'5�teel Reinforceinen 56. Rough Plumbing & Pressure Test _ 6.:'Electrical UFER•Grnd. 57. APPROVAL TO COVER•GUNITE ' 77, Footings 58. Electrical Conduit-Undrgrnd. ' '8.`Foundation r•n 59. Gas Pipe, O Undrgrnd., Test :9. Water Pipe.Undrgrnd. 60, Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural FlooLSYsteFn !' 61. APPROVAL TO DECK a ' 11. Property Sewer -Line &House Connection 62. Backwash & Receptor -F incl .I 12. "Sewer Cap 7 '4 .i 63. Heater & Vent -Final 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbirig r- 65. Electrical -Final 15. Rough Electricf!'-Ccrhduit _. 66. Solar System -Final 16. Rough Electric-FViririg 67. Fencing & Ace'ess-Approval ✓• O-1 17. Rough Wiring Sign `" "' 68. APPROVED FO8 PLASTERING ) 18. Rough Electrical•T Bar Ceiling -69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT - APPROVALS- Permit# _ , 20. Rough Factory Fireplace cz. 7 `-f Zt.�DuCi§, in.StrGcture • - �, _ -' r 70.; Underground Hydro • -: n - 22. Duels, ventilating`--, ;� _ _ -:> •- r c.. r 71• Prod ut_l:?i ping-gGas ❑Oil 23. Gas PiP?"Rou`gh 8( Test c 72• Underground Flush - r -� w' » _ 24. ;Roof, Framing. 73. Undergrhd. Storag-e Tank 0 Gas O Oil 25. Roof Sltiathing .�� `G ���I� M -`Y -`- 74. Overhead Hydro ..'r}I/.r�' 26.'T -Bar Ceiling (Structural) & Monocoat =f t�- ?;r l"76: 75. Dry Chemical - 27.'Frameand FLla.shi i- ix 0N DrYStard i e,- _- ` 28.-Lathin _ Siding 7dt FIXEDSYSTEM'FINA'L ' 29. Insulation - •• a a; 1 78. FIRE PREV. FINAL L - 30. Drywall -Nailing,^.: -• -� !: v 1 , I .Y _- -HEALTH DEBT- REQUIREMENT 31. Plaster Brown Cosi' _ _ f w * 79'. FINAL'. SPECTIQN . 32. ElectricaFPower Meter -Final r •; 1 F• 89: FOOD CERTIFICATE ISSUED 33. _Final; Electric r -'y. �" ,• Notes: rn 34. -FinaP H sting & Aii.",Condition eg_ t 1 ~ ' p ' •'j. C`',• - _, r --i Y_t 35.-,Finai Ga"s Pipe•-Te'si' - - 36. Hood ort -,Canopy ' 37. Fi naT-Faclory Fireplace �. - 38. Final Plurnbing •• :: •�" ' c �; _ ---' 39. Water Service -final= -• rr _ c o. - 40. Gas Service -Final 41. Solar Domestic -Final - .' -• -� y s Y t _ _ -' 42. -Backflow Preventers 43. Backflow Irrigations'" r -. y~• 44. Landscape Itr.igation System, rj'=�- 45. Sound Atteduation = [ �• r 46. liandica ;Regplatiops STRUCTURE & BUFCDING -47.+INAL 48.:FINALPLANNING' A9.'Electric Release to Edison ,- °50.Gas Release to Southern Califot_nia Gas Co - 51. CERTIFICATEOF.000UPANCY' -, No. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 2687 - ELDEN AV Status: ISSUED Suite No Applied: 04/16/2002 Issued: 04/16/2002 Vicinity: , . ----- - -. Parcel Nunmber. 43908722ISSUED BY: ----�--`- "�--- Applicant: STARK, C Address: 7229 VARW XI, Cwner THOB Address 2687 E COST/ ff(y `Contractor IALAP r Address ' 7229,V , vn 1 NORTI 'Arch / Eng d Adress r . y _ t „ � �t r' �l IS 5 Ir Phone 818-407-1247 CA Zip _91605-­ 7-- THOMAS 1605 THOMAS T s El Phone: :/ . a'1 ,I \\A r l ; l ESA, CA Zip: q, 92627 r, _ 1$0.00 0 - - - " $0.00 0 - t ' $0.00= '0 tr- $0.00 ,-..0.%i' ;SOCIATES GP °$0:00--:_`0= "� <�• r'` -„ t $0.00 �i0-" ' r��t�\� •t `r'� ^6 Phone: (800) 444-8865 �) r =� -x$0:00_`_-0_ .., Or1�� nmercial�]"-_'` )LLYWOOD, CA Zip: 91605 -, �`� � License: 771905 ( ,'{', _-V jr i rt 1'>P t -' Iri '7r iTjr�rr f )t'D •^+"cry _t� �r) _- 4 l' Phone C' - r Zip I - /,.G, :- Licenseer_ T ., `% - - �. '/, / )r ,r SCOPE OF PERMIT''; r WATER,HEATER CHANGE OUT. AMT V• QTY -- ISSUE FEE '-` - `-' $23.50 , tom. -x.r l-aundfl Backflow irrigation� Backflow Preventar\ Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) $0:00 x$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 1\�U LandsG `P Trap ,0``.� �:h Presses ^Oz �ti'�.P`roces: 0 r�A Recep6 '-� Off _:�7 Septic- 0�... 0 0 0 0 0 0 0 0 0 Sink, Floor - -__.. Sink, kitchen Sink, service/mop Spa (private) Spa (public) $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 COMMENTS / SPECIAL CONDITIONS ump Pump i wimming Pool -ap Primer rinal,,� <... Wasteland Vent System -Water Closet (Toilet) rWater Heater / vent Water Piping (Inst or Rep.) Water Re -pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION J $0.00 /$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $35.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 U NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92728, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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 AMT XQTY Tub/Washer, -�� . $0 00� Ir0 : p0mgation,,) _ 1$0.00 0 - - - " $0.00 0 - iRegulator 'Regulator ' $0.00= '0 Piping (per'10 ft)° $0.00 ,-..0.%i' - ".� --_ °$0:00--:_`0= "� <�• ink-` _ `'-$0:00 0, 1..-� ap-for Demo $0.00 �i0-" onnecU -- `�,- 1-$0.00, O\ rivate-Une`-' {�- $0.00, 0---`� --' -x$0:00_`_-0_ .., Or1�� nmercial�]"-_'` =i$0:00". 0'f Sink, Floor - -__.. Sink, kitchen Sink, service/mop Spa (private) Spa (public) $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 COMMENTS / SPECIAL CONDITIONS ump Pump i wimming Pool -ap Primer rinal,,� <... Wasteland Vent System -Water Closet (Toilet) rWater Heater / vent Water Piping (Inst or Rep.) Water Re -pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION J $0.00 /$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $35.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 U NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92728, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the w k for which this permit is issued. have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' cos�liay�elstuanca carder and policy number are: / (�/� / -�-7 Carrier: I Policy Number: 2,Q vi l(7 (This section need not be completedepe uedat one hundred dollars ($f00) or less.) ❑ I certity that in the performance this permit is issuetl, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califf I should become subject to the workers' compensation provisions of Section 31100 of the Labor Cade, I shall forthwith comply with these Pro visi P � Applicant Signature: Date: 0 L.� I V WARNING: FAILURE TO SECURE W COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR W SECTION 37W OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions mencing with Section 7000) of Division 3 of the Business ,4nZl PSI a ons Code, and my license is in full force and effect. Lic. ft Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lender's Name: Lender's 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 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).): ❑ 1, 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.). , . ❑ 1, 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's 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: ❑ 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 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: 1 Will the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous materiel? ❑ Yes ❑ 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). .......................................................li'c".......................................................ildi................................ 9"d,..........................ist'r..............................................................................ta-d.als"................................................................................................. 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). ............................................................................................................................................................................................................................................................................................................................................................... w 3 Does or ill 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 ❑ No ..................................................................................................................... ildi..............................................................................................................................................................................................................................................ific............. 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication a8 No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ 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? ❑ Yes ❑ 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? ❑ 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 O'E Y. 1 certity 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 ordinatece relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I of occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of `� ate `Y z /Le /('1 And/Or AUJh&ffecl A Date CODE E. INSPECTION TYPE 2A¢. INTMA e4 CODE# INSPEC110NTYPE 1firrinALS 1616 Fixed System Final Fire Prevention 2G6 Final Mechanical - 1266 Pool Spa Final 208 Final Plumbing .. �•'�a 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 COUNTY OF ORANGE - Application for, Building Permit - BUILDING DEPT. Permit No... -,Y. 636 No. Broadway AND FORA .a...:5.-• Santa Ana, California Certificate of Use and Occupancy Phone: KI 26211 p i Date.... ............................ .................. ....... .......... i. OWNER'S NAME.... .............------------------- MAILING ADDRESS PHONE: .......--/......... ......CITY.. .. ..11 Name.................. ................................._...................... -- Name � /..£!J ... (Architect or Engineer) (Cont to Address .............. -- ........ ..::. - ------ Address . � �. _ mss , City... .......................... ..-----..._....-------._.....------ ................................................... City ._...--...'":.lF..-=--.�...:-----------............-------------------...----... State State Lic. No .................. ................ ... Phone ................................. Lic. No... -----....--...--....... Phone.. ---- -......------- PROPOSED USE:..... .... . 2. JOB LOCATION ........... (��%. _ . w - ` (; (House (Name eet) NAME OF AND DIRECTION FROM NEAREST CROSS STREET ............... 3. LEGAL DESCRIPTION: Lot.. .........../--... -. - . - -•---•-•---•---.Block ...................... (Metes and Bounds Description—Use reverse side f form) 4. CORNER LOT ( ` ) INTERIOR LOT ( ) THROUGH LOT or Tract.._3-7. ...p- ----------- SLOPE OF LOT ( ) i. SIZE OF BLDG.:.. --... J..4 I�.....I.j. .SIZE OF LOT:....... 4k6?rL./_.U_....AREA:.................. I ....... HEIGHT OF BLDG.:. ............�..Z^.............CEILINGGHT:......_..�---`.------.._.NO. OF STORIES_... ................_..... 7. NO. FAMILIES.......................................Size of S lest Bedroom:........ Size of Kitchen.................................... S. EXTERIOR WALL CONSTRUCTION:..._ ........ I TERIORWALLCOVERING_..... (frame, Stucco, Etc.)../ , .....� (Plaster•Drywall, Etc.) ROOFING COVERING -------.._..._-;55... ...._...._...._._._......._.. ..... -- -- --- ................................ 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH_ ------------- .................. ............. ------------------ -----.._..... - ....... .. .. ..... ...... - ..._.......--------I................. - -- ....----------I.............. ----------- _.................. .............. .......__................... 10. SETBACKS: Front Yard From Center Line of Street ...... ....... ��.� l II 12. 13. 14. Nearest Side Yard ��--------Rear Yazd. -?.+... Distance in Feet Between Bldgs. on Same Lot. ......... (Property Line) (Property Line) v 1711 A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. -........._._.De Depth in Ground. --.l......._ (a) Footing: Width--'------.�..---- p �'.-:....... Width of Wall ......... ....................... y / (b) Size of Studs:..._.` b ; ......Spacing.......-.-.-.ys._....._"CC Material of Floor_ ..................................... (c) Size of Floor Joists'•xX�................ ...... Spacing ......... /.�........ __.......... -'CC (d) Size ofRafcers ..�... ......... ---- Spacing ..CC VALUATION OF P%POD7�WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $..........{{//..!c..D---------- - I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND. BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STA' Plans (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY �,, GG �-- GROUP_ -1:;.. ....._S.._... APPLICATION..... HEALTH Bldg. Permit Plan Check $---�.-vi,.... ........ - ........... "-'--- ' TYPE.-----. ........... ............................ ZONING---- Y~ FIRE Total . $ �� G............ s DIST. L -- - MARSHAL ....-------- --...... PLANS AND Receipt No. p --ld-��.•�-------- MAP -- - .................... - t/ ;... STATE ....... ---•---._..._..._----- SPEC'5....------ Paid to -•-• -•--• ..---- SHEET NO........ ................. CORRECTIONS ENGINEER Date ..........- ----..... -1 �_�3.7..... S� ...... --- ............................. VERIFIED.... CAL. ..._....... - PERMIT I COUNT► @t,ftCDfPKi O r' n 1/ �� r ` DATE......V..........------•--------------------- ------------------- •-- ......... 5000--7-52 ,f COUNTY OF ORANGE +Application for building Pernr-_ - BUrLDING DEPT. nn r 636 No. Broadway AND FOR A = Permit No.-d.J.- --- Santa Ana, California Phone: Kl 2-6211 Certificate of Use and Occupancy f.. OWNER'S MAILING Name ...................... Address ------------------ City........................ State Lic. No .................... PROPOSED USE PHONE:--------------- -------------- ......-..................................................... Name................ (Architect or Engineer) (Contractor) .....-...--•........................................... Addrev d!p....................... - ........., ...................................................... City ........................................ ------.... -----...-...-..............-..----.-...--- State ............ Phone... ................................... Lic. No...... -- --------- ....................... Phone ...................................... a 2. JOB LOCATION ................ ...- 4 ....... - - ...,...._..........- ----- - - (House N0. ame of reef) (Town or School District NAME OF AND DIRECTION FROM NEAREST CROSS STREET................................................................................................ 3. LEGAL DESCRIPTION: Lot ... _..... ---... --.Block .................................................. Tract..-.-r�--- � 1 ---- --------------- (Meta and Bounds Description—Use reverse side /or 4. CORNER LOT ( ) - INTERIOR LOT( ) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG. / )AREA: - ..--SIZE OF LOT: ........................... . ....... AREA: --- - --- -------- --............... 6. HEIGHT OF BLDG -------------------------------------------CEILING HEIGHT: .................................. NO. OF STORIES ................................ 7. NO. FAMILIES ..... __ ...............................Size of Smallest Bedroom:..--....-.-.-.....--.....-.......-...... Size of Kitchen .................................... U L G P� INTERIOR WALL COVERING ............................................ 8. EXTERIOR WALL CONSTRUCTION:..._-✓-�-----------------_-,--.... (Frame, Stucco, Etc.) (Plaster•Drywall, Etc.) ROOFINGCOVERING ............... �........................................................................................................... .---------------------------------------- 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH.................................................................... t.. ..............................................•............................................................ . ... /......�............ .... 10. SETBACKS: Front Yard From Center Line of Street.........................L/..-...-.........-..........--_.......5........-.........................................-- Nearest Side Yard ... _-- -.Rear Yard ....... _�.....--Distance in Feet Between Bldgs. on Same LOL........................................... (Property Line) (Property Line) 11. A COMPLETE PLOT PLAN IS REQUIRED SHOWING ALL STRUCTURES AND USE OF EACH. 12. (a) Footing: Width ........... �``-/��................Depth in Ground ----.../�.-A.—... _Width of Wall .................. .............. b Size of Studs:-...,. ........ Spacing f "CC Material of Floor-. -Q? ! -_L :.................... (c) Size of Floor Joists:-- ...... . ........................Spacing. -...--...---_ ---:--.....--...:"CC (d) Size of Rafcers:....... y._?`...Y........ - .....--..Spacing - de-- : ............................. CC 13. VALUATION OF PRO K: Including all labor, plumbing, electrical wiring, hearing, fire sprinklers, painting and sewage disposal $----...---.......... 14. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNI, APPLICABLE THERETO. Plans Piled------------------- - --.......---........ --..._...------- e ` - .............. (Owner) (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: —� ��CHyyE,,CC�KING BY Bldg. Permit $....-. ._� GROUP....--, V---------------------- APPLICATION --1561- . HEALTH ............................ oC----------•- Plan Check $----..-' _aG -------------- TYPE ............ -----�----------- ZONING ............... FIRE Total $.------;+-------------- DIST. MARSHAL---...------............. MAP..-...._.�-R.................. PLANS AND Receipt No. f. SPEC'5.............................. 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