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,
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PLOT PLAN -
Show location and distances from ..
property line and between buildings r,
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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'�
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t
-
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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.............................. STATE ................................
Paid to SHEET NO ...... ..:F�............. CORRECTIONS ENGINEER
--------------
Date -_------------- -------- �� :. d 7 - - - VERIFIED-_..................... CAL
Date
v I 1NSP__C7OR I
DATE--..-....- -�-------'--�--•--•----_.....-- ........................ ........ ......... ..........� ..------
=n ,
an --,-,a _..J
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